Alcoholism in America: From Reconstruction to Prohibition

Conclusion

C O N C L U S I O N In 1945, a quarter of a century after the Norfolk State Hospital had closed its doors and a dozen years after the repeal of national Prohibition, the Special Commission to Investigate the Problem of Drunkenness in Massachusetts reported : “It may seem ironical that at the conclusion of this study our thoughts and recommendations finally have become crystallized along the same general trends which repeatedly have been called to the attention of the General Court during the past thirty-five years through the media of special messages or special reports. . . . We see no other alternative to curb drunkenness in its broadest aspects on a state-wide basis, except those measures that the State has tried and failed in.”1 Having concluded a two-year study of the habitual drunkenness problem in the Bay State, the commission observed that inebriety needed to be addressed as a “medico-social-penological problem.”2 The Special Commission dismissed the previous system-building and treatment efforts of the state hospital for inebriates as “failed” but recommended that they be tried again, for the holistic sociomedical approach Norfolk had put into practice appeared to offer the most promise for reforming the Commonwealth’s alcoholic population. The recommendation was eerily similar to that of the governor’s executive council , which had advised a wholesale reorganization of the Foxborough State Hospital in 1907 but had insisted that an institution like it should be continued . Over the ensuing years, Foxborough and Norfolk had succeeded in many ways, but Norfolk’s last years were plagued by dwindling census figures and rising per capita expenditures that hurt its image as a useful state institution. Ironically, as the Special Commission acknowledged, their views were similar to those voiced in the annual reports from Foxborough and Norfolk and the legislature’s investigative reports of 1909 and 1914. Under the leadership of Judge Joseph T. Zottoli (the report was known informally as the “Zottoli Report ”), the commission had divided the inebriates of Massachusetts into five categories: (1) acute alcoholics, or occasional drunks; (2) early and moderate alcoholics , or those who had not been confirmed alcoholics for more than five years; (3) chronic deteriorating alcoholics, or those who had been confirmed inebriates for many years; (4) alcoholics of various classes who have physical but not mental disabilities; and (5) alcoholics of various classes who, regardless of their physical state, are mentally ill.3 This classification system emphasized that persons with drinking problems came in many varieties, each of which required a distinctive brand of care aimed at physical, mental, and social rehabilitation. Indeed, this was a central tenet of the modern alcoholism movement, reiterated by Yale physiologists E. M. Jellinek and Howard Haggard in their 1942 Alcohol Explored: “In dealing with this problem [alcoholism], no order can be expected until it is generally recognized that it is not one of inebriety but of inebrieties. This distinction is not only of theoretical significance but of practical significance in the treatment and prevention of inebriety. The prevalent failure to make distinctions among the categories of inebrieties has obscured many phases of the research in this field, and, in tracing these researches, we shall point out this fact again and again even at the peril of repetition.”4 Haggard and Jellinek recognized that their concept of alcoholism as a pluralistic disease was out of step with the unitary and reductionistic notion of disease that had come to dominate modern medicine; it did not resemble the reigning “ontological” model that assumed that a disease and its mechanism were the same in each afflicted person.5 A pluralistic understanding of alcoholism demanded a broad therapeutic approach. Thus, the Special Commission—composed of businessmen, lawyers, educators, a physician, and a judge—advised a range of treatments to address 274 Alcoholism in America each variety of inebriety. State hospitals for the mentally ill were to care for the last group identified in the Zottoli Report; group four was to receive care along with other patients suffering from a variety of chronic diseases at the Tewksbury State Hospital until the state could fund alcoholism clinics and wards with their own staffs inside local general hospitals. The commission also advised that chronic deteriorating alcoholics be “sentenced” to long stays at the state farm, where they would be treated, if necessary, and made as self-sufficient as possible...