James Nicholls / “The Study of Inebriety: Medicine and the Law” / The Politics of Alcohol / 2009Posted: June 5, 2012
1820-1918, intense debate about what we now call alcohol addiction. Late 19th century, disease-based model of alcohol addiction up. But, vice/sin based model emphasizing individual choice persisted. Disease model of addiction entered public domain in Britain with legislation creating quasi-penal institutions for “habitual drunkards.” This was the 1st treatment regime linked to institutional management of social order and of deviant population. 1st time of the idea that the State should create institutions specifically for housing “habitual drunkard,” 1850, Edinburgh-based physician Alexander Peddie. Saw as disease. There was “a deliberate injustice and inhumanity in … permitting a man to expose himself to the penalties of law, when it has long been apparent that he has not the power to govern his own will and reason.” 1879, Habitual Drunkards Act. Allowed local authorities to grant licenses to private organizations for retreats, voluntary, costs paid by patient, but once you commit you cannot leave til completion. Habitual drunk legally defined as “a person who by means of habitual intemperate drinking of intoxicating liquor is dangerous to himself, or herself, or to others, or incapable of managing himself or herself, and his or her affairs.” Failed, because required people who were 1) wealthy, 2) self-declared drunks, to 3) sign away liberty. 5 years after Habitual Drunkards Act, just 6 retreats and 45 patients. By 1891, 7 retreats, 62 inmates. 1893, Departmental Committee established to asses 1879 Habitual Drunkards Act. Report found voluntary wasn’t enough. 1898 Habitual Inebriates Act. Section 2: Anyone convicted of minor crimes involving drunkenness 4 times/1 year could be sent to local reformatory for up to 3 years. 2 types reformatory: 1) local, 2) state reformatory, for more serious offenders. Gender bias. More women convicted under Habitual Inebriates Act than men. Majority of women committed under section 2 were prostitutes. “The drunken woman is a reckless, depraved, dissolute being, with only half a mind and no conscience.” Turning point came with the suggestion that there were pre-existing conditions that could appear before 1st drink that made people incapable of drinking moderately, or refuse drugs generally. 1838, invention of dipsomania, mental disease causing excess drinking. Later term, “inebriety,” referred specifically to alcohol. Question of vice or disease went to the heart of liberal notions of selfhood and responsibility. Was the inebriate a rational criminal or insane? Incarceration not as therapy, but a eugenic control. “The treatment at least restrains for the time [the inebriate’s] tendency to procreate offspring that are likely to be parasitic or dangerous to the community.” W.C. Sullivan, “The Causes of Inebriety in the Female and the Effects of Alcoholism on Racial Degeneration,” British Journal for the Study of Inebriety, 1:2 (1903), 61-4, p.64. Benedict Morel, a father of degenerationist thought, believed excessive alcohol consumption was one driver of degeneracy. Emile Zola literary study of alcoholic degenerate, novel L’Assommoir. Continental medical writers Cesare Lombroso, anti-modernist Max Nordau. Nordau, Degeneration, called Paul Verlaine “a repulsive degenerate,” Walt Whitman “a reprobate rake,” Maeterlinck “a pitiable mental cripple,” Ibsen a “malignant, anti-social simpleton,” Nietzche “a madman,” Zola a “sexual psychopath.” In Britain, The Lancet debated not whether but how. 1895. Departmental Committee on Prisons, “Not unreasonable to acquiesce in the theory that criminality is a disease, and the result of physical imperfection.” Inebriety believed to be hereditary. Physiologists Horsley and Sturge pointed out that cress and geraniums withered when raised in alcoholic solutions. Inter-Departmental Committee on National Deterioration, 1904, “The abuse of alcoholic stimulants is a most potent and deadly agent of physical equipment,” but observed that historically many “drunken nations” did not degenerate. Why? Only their men drank. Therefore, “If the mother as well as the father is given to drink, the progeny will deteriorate in every way, and the future of the race is imperiled.” Counter argument to “curse of civilization” line of thought: British doctor George Archibald Reid criticized hereditary inebriety as based on bogus Lamarckian ideas of inheritance of acquired characteristics. Saw alcohol as disease that culled the genetically weak. “Drunkenness among ancestry is the cause of temperance among the descendants.” Deeply imperialistic. Intolerance was primitive. Idea caught on among anti-prohibitionists. 1910, 2 researchers at Galton Laboratory for National Eugenics at University College London found no difference in general health of children of alcoholics and “the physically strongest in the community have probably the greatest capacity and taste for alcohol.” So, conventional degenerationist idea that alcohol consumption led to reversal of evolutionary progress was trumped by eugenicist belief that non-problematic alcohol use was a sign of genetic strength. During WW1, Central Control Board reviewed drink question. 1917 report explicitly distanced study of habitual drinking from “ethics, administration, or national economy.” Pragmatic conclusion asserting harmlessness of moderate drinking, and broadly physiological explanation for alcoholism (continued use creates need). Hedged: nothing intrinsically good or bad about stimulant or narcotic. End WW1, shell shock studies found that trauma caused behaviors previously associated with degeneration, even in robust and respectable individuals. C. May, “Pathology, Identity, and the Social Construction of Alcohol Dependence,” Sociology 35:2 (2001), 385-401, p. 398. Shell shock studies reinforced growing trend of psychologizing problematic behaviors. Psych trauma of shell shock and Freudian ideas re-conceived inebriety as neurotic compulsion rather than disease “like gout.” Also, political failure of inebriate asylums. Combination of 1) political failure of inebriate asylums, 2) decline of social-medical idea of degeneration underpinning disease models, 3) psychological turn at the end of WW1, meant alcohol policy began to focus solely on issues of social order that were quantifiable, actionable, and therefore appropriately political. Shift from disease model to later public health.