Five weeks ago I was doing very well. My recovery was progressing nicely. The promises were materializing. Emotional sobriety seemed within reach. Being happy, joyous, and free appeared like a real possibility. I had celebrated 38 years sober and published my second book about what I had learned.
And then, out of the blue, lightning struck. I found myself lying flat on the floor. I had no idea how I got there. I tried to get up, but I couldn’t. I wanted to raise my left hand and grab the back of my chair so I could pull myself up, but the hand wouldn’t budge. I reached over and squeezed it with my right hand as if to awaken it, but it remained unresponsive. I got inventive and tried a variety of ways to get back on my feet, but none of them worked. I could devise, but I couldn’t execute; had the will, but not the power.
After what I thought was an hour, (I’m told it was more like six or seven), I managed to reach my cell phone on top of my desk and called my daughter Tana. Getting no response, I dialed my son-in-law. Tommy picked up, and immediately realizing what was going on, proceeded to read me the riot act. He was going to call 911. I objected. I wanted no drama. No need to disturb the neighbors. Tommy wouldn’t relent. Soon I heard a knock on my door. I knew who it was. The guys from D Ambulance. I had seen them blare their way to my neighborhood many times. I knew one day they would come for me. This was the day. They picked me up, laid me on a stretcher, and off we went down 9W to K Hospital.
Last time I was there was to see my sponsee Ray, who had contracted sepsis during his long battle with cancer. I had felt very uncomfortable then, seeing him struggling to breathe when I, though much older than he, seemed to be in perfect health. Little did I know that just a few months after his death, I would enter into my own struggle. It all seemed so fortuitous. I had joined AA and stopped drinking 25 years earlier than he and thus had spared my body that many additional years of damage. But my time would come. And when it did, I would be just as powerless.
I would lose control over my mind and body. The simplest thing would become too difficult: To talk or walk, or bring a spoon to my mouth or a glass of water to my lips, even to swallow. My personality and temperament would be equally affected. Once alert and energetic, I would turn dull and lethargic. Always highly motivated, now I would have to force myself to do things. Formerly able to work 10 or 12 hours a day with relative ease, I would now grow weary after 3 or 4. Where I had always prized solitude, I would now feel lonely when alone. Where I had always treasured peace and quiet, silence would only accentuate the loneliness now.
In AA, we learn to look for a silver lining in any cloud, something that we can be grateful for and which can thus render a burden a little easier to bear. And so it was that I came to see the new experience of powerlessness I was going through from a different perspective: as something from which I could learn and grow. I was having to walk in other people’s shoes, to feel what they felt, and this raised questions worth pursuing. Was it possible that the way I felt now was the way some people felt all the time, that the powerlessness which was abnormal to me was normal to them, an ordinary part of their daily lives? Was it possible that some people are the way they are, not necessarily because they want to, but simply because they are and lack the power to change it? Was it possible that, by experiencing now the powerlessness they experience, I would be able to understand such people better, identify with them, be perhaps a tad more compassionate?
As I pondered these questions, I came to appreciate the value that AA attaches to experience. Some things are just beyond our ken unless we live them. I also came to see the wisdom of the ancient call to be grateful in (not necessarily for) all things. My daughter carried this message when she told me how, after suffering a stroke, the mother of one of her sponsees could no longer recognize her own daughter. My inability to tie my shoelaces amounted to a minor inconvenience by comparison. It’s a lesson we learn in the rooms early on. No matter how bad it may have been for us when we drank, it always could have been worse. So we have reason to be grateful. So it was with me now. A clot had lodged in my brain. The stroke could have killed or seriously disabled me. It hadn’t. Furthermore, all the signs seemed to indicate that I stood a good chance of making a full recovery. Much depended on the effort I put into the rehab program I would be entering.
This naturally led me to wonder whether the AA program could help me in this new journey through powerlessness. The more I researched and reflected, the more I realized that the two programs have some very important things in common. Like AA’s 12 Steps, stroke therapy revolves around a series of distinct exercises designed to foster the same process of recovery in the brain. Termed neuroplasticity by William James, this is the process whereby the brain is able to rewire itself in response to new experience. Key to this is the creation of new neural pathways and networks. In the case of AA, the goal is to displace networks of defective traits and emotions and replace them with their virtuous counterparts (cf. PTP123, pp. 42, 43; PTP4, p. 322), in the case of stroke therapy, to displace non-functional networks of damaged or dead cells and replace them with new networks developed to take over their functions. In both cases, the process is driven by practice and repetition. That's what sets in motion the electrochemical mechanisms whose end bring about the functional facility typical of habituation, a connection noted by James.
That’s the mechanical part of the process. From a spiritual and not just a purely medical perspective, however, the question is whether stroke recovery can involve more than the ability to regain functionality and if so, the extent to which the practice of 12 -step principles can contribute to it.
In my case, I’ve become acutely aware of the need to practice acceptance, for instance. I was not a likely candidate for a stroke. I exercised 7 days a week for at least an hour. From Spring to Fall, this included strenuous biking on steep country roads. Before this, (until I damaged my knees), I had been a runner and would log in a few miles most days. I had run the Boston Marathon twice. Moreover, I had an excellent, personally designed Mediterranean diet, with breakfast consisting of steamed vegetables and fruit. Dinner was fish and a variety of fruits and nuts. Extra-virgin olive oil was part of almost every dish. I avoided processed food and consumed no soft drinks. My blood pressure was optimal; my bad cholesterol was more than compensated for by my good cholesterol. I had quit smoking in 1976, ( after seeing my mother die of lung cancer), and drinking in 1984, after which I also gave up caffeine. Though like most of us I had neglected my health as an active alcoholic, since joining AA 38 years earlier I had taken good care of myself. At my annual checkup a month before the stroke, my doctor had congratulated me on reaching a new age milestone in good health.
In short, there was nothing I could have done to prevent the stroke. I was powerless over it. I have to accept that. Together with gratitude that it wasn’t as bad as it could have been, acceptance can help me avoid the pitfalls of self-pity, despair, and depression, which will undermine any attempt at recovery. Acceptance is the foundation of patience and perseverance, another two necessary virtues, as the road to recovery is long and difficult. The practice of these principles can help me to keep frustration and discouragement from causing me to give up.
Repeated practice is as central to stroke therapy (which refers to it as “mass practice”) as it is to alcoholic recovery. Though rest is needed for healing, inactivity and passivity will only allow the "use it or lose it" principle to become operative and the effects of the stroke to become permanent. If I am to walk normally gain, I will simply have to practice walking. Even if I don’t feel like it, I have to keep putting one foot in from of the other and walk. If my speech is going to improve, I need to practice speaking. In the rooms, this includes agreeing to read “How It Works” or “The Promises” when asked to at meetings—and sharing when my turn comes, as hard as it may be to enunciate and project enough to be heard. There are other ways the AA program can be integrated into a stroke rehab program. For instance, I've started practicing prayer during my daily walks, reciting out loud The Lord’s, the Serenity, the 3rd and the7th Step prayers, adding to my physical and speech therapy a spiritual dimension that fosters hope and augments motivation.
At a recent AA meeting focused on Living Sober, the discussion revolved around the topic of First Things First. Like other 12-Step principles, this one too extends beyond early sobriety and our drinking problem. Practicing it is of the essence in my current situation. Recovering from the stroke is my main job right now. This means concentrating all my attention on my stroke rehabilitation therapy. I cannot afford to become distracted by the demands of everyday life and allow other things to come before that. I have a window of six months during which to do all I can to recover fully. Progress slows down after that and what is not recovered by then is less likely to be recovered.
From a 12-step perspective, my concern is not only to recover fully, but to recover well. As already suggested, this is not only to regain functionality, but, to whatever extent possible, to learn from the experience and grow as I go through it. Besides gaining a more understanding view of other people’s experience of powerlessness, I would like to do what I can to minimize the amount of collateral damage that my condition may inflict on those on whom I become dependent, to lighten the burden of those who will do for me what I cannot do for myself.
We sometimes hear people say at meetings that, were it not for AA, they would have been dead a long time. This is no exaggeration. The fact is that, thanks to AA, many of us are living longer than we would have if we had not gotten sober. As we age, however, we will find that one of our biggest concerns is not becoming too much of a burden on our loved ones. This concern can be allayed if we have a proper view of what “all” means in “to practice these principles in all our affairs.” It means in all those situations where we have moral agency and can choose right over wrong, the good over the bad. This may not be feasible in some situations (e.g., the advanced stages of Alzheimer’s), but where it is, it can make a substantial difference in our relations with our caretakers. Practicing our program’s spiritual principles to the extent possible in our condition can lessen the attitudinal deficiencies that our dependence can aggravate and which can make taking care of us a bigger burden than it needs to be. As in everything else, acceptance, gratitude, and humility are pivotal. Our concern can also be allayed if we avoid taking a one-sided view of the question of being a burden. People like to help. In fact, people need to help. As human beings, we have a need to feel needed, to feel that we can be useful, that we can make a contribution. That's why the discipline of service is one of the key spiritual principles in Step 12.
By practicing our program’s spiritual principles in our dependence, we can bear witness that, no matter how far down the scale we have gone regarding our health, there is still hope for us. We can carry the message that such experiences need not destroy us, that in some cases they can even help make us better people, more understanding and helpful individuals. Through our practice we can we try, to the best of our ability and by the grace of god, to do what we always do in AA: to turn a bad thing into a good thing. That’s the ideal and the aspiration expressed in the 3rd Step Prayer (Big Book p. 63):
“God, I offer myself to thee, to build with me and to do with me as Thou will. Relieve me of the bondage of self, that I may better do thy will. Take away my difficulties, that victory over them may bear witness to those I would help of Thy Power, Thy Love, and Thy Way of life. May I do Thy will always.”
And so on this prayerful note I conclude this little reflection, my first attempt at writing since the stroke. My mind is still foggy and there’s neither flow nor inspiration. Nor do my fingers always happen upon the intended keys on my computer’s keyboard. But this too shall pass, and my hope is that, when it does, I will be able to resume my work on Step 5 and go on to write on as many of the remaining Steps as possible. Yet, thy will, not mine, be done.
[Posted 12/18/22. Image: An elderly Bill W. Like his sponsor Ebby T., Bill remained a heavy smoker in sobriety and eventually developed emphysema. He died of pneumonia on January 24, 1971 at Miami Heart Institute, three days after rising from his wheelchair to address the 35th International AA Convention in Miami Beach. He was 75.]