Alcoholism in America: From Reconstruction to Prohibition

Preface

Preface There is a personal story behind my choosing to study the history of alcoholism , but it does not involve alcohol. At times I have wished that I had a more direct connection, rationalizing that I might have finished the book earlier had I been propelled by the immediacy of the problem in my own life. But the truth is that the more I have learned about the history of alcoholism—and its present state—the more grateful I am that my life has not been directly affected by it. Addiction to alcohol is a complex and devastating phenomenon: medically, personally, and socially. My work on this book over the past decade has given me the chance to meet dozens of people who have had problems with alcohol. I have benefited from their willingness to share their experiences and insights, and from their enthusiasm for the project. Although I have developed a profound respect for individuals who contend with addiction on a daily basis, as a historian my primary interest is in the past. This book is an attempt to understand how and why many physicians , social reformers, and heavy drinkers in an earlier day came to regard habitual drunkenness as a disease, and what they chose to do about it. I hope, however, that my historical study will engage those with interests in contemporary addiction as well as historians of medicine, alcohol, and social welfare policy in America. I was drawn to the study of alcoholism while studying for my comprehensive examinations in graduate school. Having defined the history of American medicine, American social history, and the sociology of knowledge as my three areas of interest, I made the commitment to finding a topic that would link these different subjects. Ever patient as I searched for a topic, Charles Rosenberg, my advisor at the University of Pennsylvania, dispatched me to the Historical Collections of the College of Physicians for inspiration. There, on a wintry Philadelphia day, I discovered that many late-nineteenth-century physicians believed that “inebriety” and “dipsomania” were constitutional diseases in which heredity played a heavy hand. My research antennae began to twitch. Here was a topic that allowed me to probe the connections among reform movements, social welfare policy, the professionalization and specialization of medicine, and the social construction of disease. When I learned how little attention historians had paid this episode in the history of disease, my commitment grew more resolute. Writing a dissertation is a humbling experience. When I selected “the medicalization of alcoholism” as my topic, I imagined that I would produce what one of my professors, Henrika Kuklick, dubbed “The Great American Monograph ,” titled, in my case, “From Vice to Disease: the History of Alcoholism in America from Benjamin Rush to Bill Wilson.” While both Kuklick and Rosenberg will attest to the fact that I may have collected enough archival data to fulfill my ambition, the practical task of completing the dissertation meant that I narrowed my scope considerably. I wrote my thesis on the efforts of the Commonwealth of Massachusetts to build a state system for the medical management of inebriates between 1833 and 1919.1 It was an interesting and important story, for the rest of the nation watched what went on in the Bay State, anticipating that success in Massachusetts might be incorporated into their own states’ public health and social welfare programs. Early in the dissertation writing process, however, I realized that the narrative I was telling concerned contested or incomplete medicalization.2 I had defined medicalization quite simply as the process by which society comes to regard specific conditions and particular forms of social deviance (e.g., pregnancy , homosexuality, opiate addiction) as diseases. In the case of Massachusetts , it was clear that nineteenth-century social reformers, physicians, and politicians were promoting new medical understandings of a resilient social problem: habitual drunkenness. They were also putting a new disease framework into practice through the creation of specialized state and private institutions and the revision of laws concerning public drunkenness. Still, there remained resistance at a number of levels, and ultimately Prohibition appeared to bring an end to these remedial efforts. I had not anticipated the complex dynamics of inebriate reform in the Bay State: a dynamics that linked medical experts, social reformers, state institution builders, politicians, the general public, and the inebriates themselves. This was no simple case of “From Vice to Disease,” and hardly a case of medical “imperialism.” Did a similar...