Alcoholism in America: From Reconstruction to Prohibition (review)

This excellent volume reworks intellectual territory opened up in the 1970s and 1980s by members of the Alcohol Research Group, based in Berkeley, California. Sociologists and alcohol researchers such as Harry Gene Levine, Robin Room, Jim Baumohl, and Ron Roizen located the origins of the disease concept of alcoholism in the late eighteenth century and laid out the broad outlines of its further history into the second half of the twentieth century. Sarah F. Tracy, a historian of medicine, concentrates on the Gilded Age and Progressive periods, when disease categories of habitual drunkenness (inebriety or dipsomania) informed a concerted effort to establish institutions devoted to the care and treatment of habitual drunkards. Supporters of all the 200 or so American "inebriate" asylums, homes, and hospitals (most of them short-lived) conceived of them as much-needed alternatives to the fruitless moral exhortations of temperance reformers and to the legal-penal approach that punished or incarcerated common drunkards. A pure disease concept of habitual drunkenness held the drunkard to be a victim of physiological processes beyond his control. Tracy establishes that in practice, such a disease concept was always intertwined with moral interpretations that recognized the roots of the drunkard's condition in bad character or habits. Thus the inebriate who sought or was compelled into treatment was rarely absolved of responsibility for his or her condition. Nor were the disease categories of inebriety, dipsomania, or alcoholism controlled by the physicians who sought to popularize them most vigorously. Rather, doctors, judicial officers, temperance reformers, and drinkers and their families engaged in complex social negotiations that shaped their meaning and application. These negotiations determined who would be treated in inebriate institutions and what their treatment consisted of. The public watched and judged the institutions on the basis of how successful they were in making their patients into abstinent individuals.

Tracy's history draws upon intellectual, cultural, and institutional sources and sets a high historiographical standard for future studies. Chapter one explores the social and intellectual implications of various medical disease categories such as dipsomania and inebriety and places them in the context of inebriety physicians' quest for professional legitimacy. The second chapter establishes the broader cultural "frames," such as loss of manhood, nervousness, and domestic abuse, within which alcoholic deviancy was understood in America. Tracy's most original contribution arises from her immersion in the histories of the inebriety homes, asylums, and hospitals that were the testing ground for disease concepts of alcohol addiction, which occupy the remainder of the book. Attending to the politics surrounding the struggles to establish and sustain state-supported inebriety institutions, Tracy demonstrates the American public's ongoing doubts, even at the height of the Progressive Era's institution-building, about their effectiveness and necessity. Private or semiprivate institutions were a different matter.

After the turn of the twentieth century, sympathetic reporting in the popular press stimulated public support for the idea of the inebriate as a victim of a disease, if not for state-financed, therapeutic institutions. Yet Tracy's analysis of selected case records of patients treated at the Massachusetts Hospital for Dipsomaniacs and Inebriates reveals that patients continued to describe their drinking as bound up with personal moral and spiritual defects. According to their letters, successful treatment—staying sober—involved helping them fight their flaws rather than curing their disease in a medical sense. Was this attitude shaped primarily by the views of the treating physicians, who found it difficult to regard their patients as simple victims, or were patients and doctors operating within a cultural frame that made it difficult to maintain a pure disease concept? Tracy comments in passing that the women of the Woman's Christian Temperance Union who championed Prohibition as a home protection measure and as a means to diminish the incidence...