Die heimliche Krankheit: Eine Geschichte des Suchtbegriffs (review)

Claudia Wiesemann. Die heimliche Krankheit: Eine Geschichte des Suchtbegriffs. Medizin und Philosophie, no. 4. Stuttgart-Bad Cannstatt: Frommann-Holzboog, 2000. 218 pp. DM 58.00 (paperbound, 3-7728-2000-X).

The "secret disease" to which the title of this book refers is drug addiction. In eighteenth-century Germany, indeed, chronic drug users were not automatically seen as suffering from an illness, as the example of the physiologist Albrecht von Haller (1708-77) shows. Haller treated himself with opium in the 1770s when he suffered from a painful urinary tract condition. While experiencing signs of dependency, he worried only about the effects of acute intoxication. This was no matter of self-deception, Claudia Wiesemann argues: "Addiction in the eighteenth century was not seen as a side effect, it was [as a concept] nonexistent" (p. 139). She sets out to identify the historical origins of perceiving a dependency like Haller's in itself as a disease, and she finds these origins in the intense debates among German and British physicians over the teachings of the Scotsman John Brown (1735?-1788).

The reception of Brown's writings in the German-speaking countries coincided with the rise of romanticism and Naturphilosophie: between 1795 and ca. 1820, Brunonian ideas found influential followers in German medical schools. The modern concept of addiction, as Wiesemann argues, was a product of the controversies between Brunonians and their opponents over the (ab)use of drugs. The physician Christoph Wilhelm Hufeland (1762-1836), for example, attacked the Brunonians for performing "the largest . . . experiment with opium that has ever been performed on humankind" (p. 140).

In these debates, according to Wiesemann, while rejecting Brunonianism as such, the opponents adopted some of its fundamental assumptions. With different intentions, both parties referred to the "relative health" of chronic drug users. The term had been coined by Andreas Röschlaub (1768-1835), one of the most prominent Brunonians in the German-speaking countries. Up to the end of the eighteenth century, as Haller's example demonstrates, the main marker of health had been well-being; dependency could be judged only on moral grounds, not medically. The concept of "relative health," as Wiesemann argues, provided a new theoretical foundation for the medicalization of chronic alcohol and opium consumption and the social disciplining of "sober drunkards" and apparently healthy opium eaters. In the past, only the excessive abuse of these drugs had called for medical intervention; now, even seemingly modest but frequent consumption could be considered pathological. According to Hufeland, the "greatest danger" of opium was to be seen no longer in "its deadly, but its deceptive effects" (p. 147).

Wiesemann appears to challenge one of the central paradigms of the social history of medicine, according to which (to put it simplistically) the social determines the medical. While she acknowledges the central role that changing attitudes toward deviance played in the rise of the new concept of addiction, she argues that such "long-term social change under certain circumstances, for example the emergence of a new medical concept, can be subject to a sudden acceleration" (p. 124). The changes she refers to are the emergence of new perceptions of the body and new roles for the medical profession. The assumption that these changes were connected and that the debate over Brunonianism triggered them is plausible, but while Wiesemann convincingly links concepts of addiction to the reception of Brown's theories in medical writings, this reviewer would have liked to read more about the social side of the story.

I can hardly hold this against the author, though, since the book appears in a series titled "Medizin und Philosophie" and--while citing and drawing on the relevant social-historical literature--it is primarily a history of medical ideas. Wiesemann not only seeks to explain the emergence of addiction, she also uses Brunonianism as a striking example of a consistent theory of nonspecific disease causation, comparing it to the stress theory of the...