No one needs to tell us that the world is changing fast. We are living it. Low-cost and ubiquitous digital technology is irrevocably altering human behavior causing seismic social and economic shifts. As digital technology becomes deeply entrenched into our daily lives, the need to update our mindsets, strategies, and methodologies is becoming compulsory in order to keep our organizations and ourselves relevant. History shows that those that can ask themselves, “How does this shift alter what we have been doing?” and “How might we do things differently to capitalize on this shift?” have the opportunity to realize substantial new value in the midst of disruption.
Rev. Dr. Elwood Worcester was one of those people. Worcester, who had a PhD in Psychology and a divinity degree, served as the rector of Emmanuel Church in downtown Boston from 1904-29. This, too, was a time of intense social and economic upheaval. Industrialization had birthed new divisions of labor, specialization of work, and mechanization, which was changing the way most Americans lived and worked. New ways of manufacturing generated large quantities of goods at low prices, increased Americans’ standard of living, and inspired many people to relocate from rural areas and Europe to American cities.
This rapid urbanization had many unintended consequences, including numerous public health risks. Tuberculosis (TB) and other infectious diseases spread rapidly though overcrowded tenement housing in American cities. Indeed in 1900, 194 out of every 100,000 U.S. residents died from TB and the majority of its victims were residents of urban areas. Death rates in newly industrialized cities often exceeded birth rates—high rates of immigration kept cities like Boston growing.
Coughing, night sweats and chills, and the spread of the disease to other organs were common symptoms of TB, as was the general wasting away of the body and spirit, which is why the disease became known as consumption. Sanatorium cure was the dominant treatment for TB at the time; its salient features included rest, nutrition, and fresh air, delivered in environments like the Adirondacks or the Swiss Alps. While this treatment worked for many, it was accessible to only a few. If there were to be any hope of treating the rapidly growing number of urban poor, a different approach would be necessary.
Reimagining Treatment for Tuberculosis
Wanting to provide effective treatment for people infected with TB who were living in the poorest sections of Boston, Worcester collaborated with Dr. Joseph Pratt of Mass General Hospital to adapt the sanatorium treatment protocol for at-home convalescence. But they didn’t stop there. Convinced of the impact of psychosocial factors on physical and mental health, what was then an emergent field known as “medical psychotherapy,” Pratt and Worcester took a more holistic approach to treatment. They sought to understand the context surrounding patients’ lives—their stresses, economic situation, and work life—in order to accurately and effectively diagnose and treat them. Certain of the connection between mind, body, and spirit, their program also focused on positivity and building a supportive peer community.
Drawing on the success of sanatorium care, Pratt and Worcester instructed patients to rest, out-of-doors, until their symptoms abated, as fresh air and immobility for lungs were believed to be essential. “We placed white tents on the lofty roofs of the tenement houses and in backyards, or built little covered porticos outside the windows of bedrooms,” Worcester recalled. “Even during the cold of winter people would manage to be outside 23 of 24 hours.”
A visiting nurse—a prototype for today’s medical social worker— made regular house calls to patients in order to supervise treatment, assist families in making necessary arrangements, and “sustain [patient’s] courage.” To ensure that patients had adequate nutrition, they also provided milk and pure olive oil.
Patients’ involvement with their care was considered critical. As Worcester explained, “We can give little. What we can do is encourage them to help themselves.” As part of their treatment, patients were instructed to maintain a diary in which they would record their food, sleep, hours outside, temperature, and coughing intensity every three hours. Patients who were well enough were invited to attend a weekly meeting at Emmanuel Church where they would hear inspirational talks on wellness and healing from Pratt and have a chance to share success stories with others who were recovering from TB.
Their model worked. “Working in the slums and tenements of a great city…we consistently obtained as good results as the most favored sanatoria in the Adirondacks,” Worcester recalled. (Years later the health authorities of the Commonwealth assumed management of the program and discontinued its psychosocial dimensions. Without these features, the program failed. “It could not command the obedience of its patients, nor the faith and hope with which we inspired them,” Worcester explained.)
Adapting the Model to Treat Alcoholism and Anxiety
Inspired by the success in treating TB, Worcester and his colleagues, Dr. Samuel McComb and psychiatrist/neurologist Dr. Isador Coriat, set out to adapt the program to the treatment of anxiety. They soon discovered that most of their patients were also alcoholics and developed a unique treatment plan for them.
Diverging from the prevailing philosophy of the day, which considered alcoholism a problem of character or will, Worcester et al viewed alcoholism as a disease of the mind, body, and spirit. Reframing alcoholism in this way prompted a protocol that would focus on all three dimensions. It also improved patient’s view of themselves, “reducing their sense of inferiority” allowing them to glimpse their “higher and best selves.”
Convinced that for any treatment to be successful it had to be undertaken under a person’s free will, Worcester et al insisted that people come voluntarily, motivated by their own desire to stop drinking. They insisted on compete abstinence—“the attempt to covert a drunkard into a moderate drinker cannot be done once in a thousand times”—and for patients to pledge abstinence a week at a time. Exercise and adequate sleep were also deemed essential.
Observing that people were often “morbidly preoccupied with their ailments,” Worcester et al sought to redirect their patients’ attention. Recovering alcoholics were taught to live in reality, not in fear, in order to avoid unnecessary suffering. Patients were encouraged to shift the focus away from themselves, to focus on helping others, and to develop their spiritual lives, in order to improve their contact with something greater than themselves. Group meetings provided vital support, friendships, and the opportunity to focus on growth and progress—not ailments.
Social service visitors provided support, assistance in finding a job, and occasional financial support to patients. Lay therapists offered support for making change in one’s life, and a clinic, located at the church and staffed by medical doctors, provided limited traditional medical care.
Over a century later Worcester’s ability to think differently continues to have impact. This program became known as The Emmanuel Movement and was a success in its own right. It also provided a foundation for later programs—The Jacoby Club, Richard Peabody’s classic text, The Common Sense of Drinking, and eventually, albeit indirectly, Alcoholics Anonymous.
Take Away: How might Worcester’s story inspire us? In what ways can we employ the many changes ushered in by digital technology to better understand and serve our prospects and customers? Might we be able to better serve their needs by making our solution more readily accessible?