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.
