PREFACE

FROM PULPIT TO PULPIT (VIA COUCH)

There was never any doubt in my mind what I was going to be when I grew up. I was going to be a rabbi like my father.
My father was a Hasidic rabbi, with uncanny, innate psychological acumen and keen knowledge of the ways of the world that made him a much sought after counselor. In addition he was so successful as a mediator that judges would say, “Take this case to Twerski.” My father received a citation from the Milwaukee judiciary.
My father’s study was always humming, day and night, with people who sought his advice and guidance. I wanted to be just like him.
When I was ordained in 1951, I became his assistant. In the years following World War II, psychiatry and psychology had a meteoric rise. It was fashionable to be psychoanalyzed. It became obvious to me that in contrast to my father, people were not going to consult me for anything. It was not primarily because I was still wet behind the ears, but rather because the competence for counseling was felt to be with the professional psychotherapist rather than with the clergy. Pastoral psychology had not yet come into its own.
Nor did people seem to be interested in adult education. I would have loved to teach, but there were no students, except those coming for bar-mitzvah classes, and they all “graduated” at 13.
My function as a rabbi was to officiate at weddings, bar-mitzvahs, funerals, monument dedications and other rituals. I saw my life as being one of a performer of ceremonies rather than as teacher or counselor, and this was hardly to my liking. It was evident that if I wanted to function as the kind of rabbi my father was, I’d have to become a psychiatrist or psychologist. That led me to follow a medical career at Milwaukee’s Marquette University.
After a year’s internship in general medicine, I underwent three years of training in psychiatry at the University of Pittsburgh. I was the fair-haired boy of the Director of the Department of Psychiatry, who promised me a staff position after completing two years service at a state mental hospital.
When I returned, the director said, “Abe, I promised you a staff position, and you can have it. But I want you to consider the directorship of St. Francis Hospital’s psychiatric service. St. Francis has been the largest provider of community psychiatric services, and they have not been able to keep a director. The community owes St. Francis a debt, and I want you to consider the position. Try it for a year.”
Simply to satisfy the chief, I met with Sister Adele, St. Francis Hospital’s administrator. I gave her numerous reasons why I was not the person for the position, but Sister was adamant. Upon leaving, Sister escorted me all the way and said, “Dr. Twerski, I know you will come to us. The Holy Ghost sent you to us.”
I wanted to be in the chief’s good graces, so I took the job for a year after which I would go back to the university. That year extended itself to twenty years.
St. Francis had a large alcohol-detoxification service, because many hospitals rejected alcoholics as well as mentally ill patients as undesirables. As you will soon see, I had become interested in the 12-step program for alcoholism recovery. I realized that simply “drying-out” the alcoholic was not enough, and I prevailed upon Sister to develop a residential rehabilitation center. In 1972, Gateway Rehabilitation Center admitted its first patient. Today, it is a rehabilitation “system,” providing services to 1800 people on an average day.
A frequently asked question is, “Did the training and experience as a rabbi affect your practice of psychiatry?” Of course it did. Every experience one has impacts on one’s thinking and behavior. Certainly my religious training gave me insights into spirituality, although, as you shall see, it is possible to be spiritual even if one has no religious orientation.
The most profound effect of my earlier life in religion was greatly influenced by my father’s staunch conviction of the inherent good in man (albeit there are some exceptions). When someone referred to a person as being bad, my father would say, “He is not really bad, he is foolish. He does not understand that what he is doing is self-destructive. How can I bear a grudge against someone when I pity him for being a fool?” So, much of my success in treating alcoholics and drug addicts is due to my belief that they are inherently good people.
The struggle of the alcoholic and drug-addict to break free of their addiction is a model for everyone who wishes to improve one’s spiritual life. So, although no longer officiating as a rabbi, I feel myself very much to be a rabbi, with my patients as my congregants. “Rabbi” means “teacher,” and I have been blessed to be able to teach people about their self-worth. To do what he excelled at, my father became a rabbi, and I emulated him by becoming a psychiatrist.


INTRODUCTION

“Who is a wise person? One who learns from everyone”
(Talmud)

My formal education began at age five, when I was taught my first words of the Torah. My formal religious education continued until I was ordained at age twenty-one. During my ten years as a pulpit rabbi, I continued my studies on my own.
A new path in learning came with medical school, followed by three years of psychiatric training. The chief of our department wisely added major literary works to the curriculum. In addition to psychiatric texts, we had a weekly literature seminar featuring the works of Dostoevsky, Tolstoy, Thomas Mann, Melville and other great authors. Freud once said that Dostoevsky knew more about the workings of the unconscious mind than all of the psychoanalytic congress put together.
In this wide world, we can learn from everyone and everything. Rabbi Israel of Salant was once walking with several disciples when he saw a procession of three horse-drawn wagons loaded with hay. The middle horse was eating the hay from the wagon in front of him, and the third horse was eating from the middle wagon.
“What does that teach you?” Rabbi Israel asked his students. When there was no reply, he said, “The horse pulling the first wagon has nothing to eat, but he does benefit because his load becomes lighter as the horse behind him eats. The load of the third horse does not become any lighter, but he can eat from the middle wagon. The middle horse has the greatest benefit, because he can eat from the wagon in front of him and his load becomes lighter as the horse behind him eats from his wagon.
“This teaches you that the greatest benefit is accrued by one who takes a middle-of-the-road approach and avoids either extreme.”
If we keep an open mind, we can learn from things we see in the street, even from horses. I was fortunate in being exposed to people and things from whom I could learn, and this substantially supplemented what I received from formal training, both as a psychiatric physician and as a rabbi.
Psychologists and psychiatrists learn a great deal in their training. However, I recall the words of Paracelsus, a sixteenth century physician in Switzerland, who assembled his medical students around a huge bonfire and threw all the medical books into the fire. “If you want to learn medicine,” he said, “go study your patients.”
Fortunately, that is no longer true. Our modern textbooks contain a great deal of valuable information. Nevertheless, it is still true that we learn most from our patients. There is just no substitute for experience. Psychiatrists and psychologists are always educable, always alert to what they may learn from their patients, unless of course, they close their minds to anything new.
In psychiatry, as in other fields of medicine, we must learn new things as our science progresses. We must also be able to unlearn some things.
In addition to learning from my patients and from the masters of classic literature, I also found profound psychological insights in the cartoons of Charles Schulz, creator of Snoopy and Charlie Brown. This resulted in the publication of several books on Schulz’s insights. In fact, I was able to develop a system of “cartoon therapy.” I found that some patients who were resistive to my interpretations could accept them when they saw themselves in the cartoon characters.
I was also privileged to hear many stories from my patients from which I could derive valuable psychotherapeutic tools. There is much wisdom in folk tales and folklore.
Forty years of attending meetings of Alcoholics Anonymous provided a common sense approach to many of the problems of life. My teachers were people who, having discarded the futile attempt to escape from life’s problems by drinking or using drugs, had developed effective skills for coping with difficulties.
Long-term, quality recovery from alcoholism is impossible without development of spirituality. Working with people in recovery actually intensified my pursuit of spirituality that I had begun as a rabbi.
I take this opportunity to share with you some of the wisdom that was made available to me.