From Temperance to Alcoholism in America

Sarah W. Tracy. Alcoholism in America: From Reconstruction to Prohibition. Baltimore: Johns Hopkins University Press, 2005. xix + 357 pp. Notes and index. $48.00.

Writing in 1939, Bill Wilson, a co-founder of Alcoholics Anonymous, noted the perplexing and seemingly inexplicable behavior exhibited by compulsive drunkards. The "absurd and incomprehensible" actions of the alcoholic, Wilson told readers of the "Big Book" Alcoholics Anonymous, could well be compared to an "individual with a passion, say, for jay-walking." Ignoring cautionary advice from friends, this individual gets a "thrill" from dodging speeding vehicles. Despite several minor injuries, he persists in this dangerous avocation. One would expect him, Wilson observed, "if he were normal, to cut it out." But he does not and sustains a fractured skull. Mere days after being released from the hospital, he is at it again and breaks an arm. At this point, he tells friends that he has decided to give up jaywalking "for good, but in a few weeks breaks both legs." For years, this conduct continues, "accompanied by his continual promises to be careful or keep off the streets altogether." At last, his repeated injuries render him unfit for work, convince his wife to divorce him, and expose him to ridicule. The unfortunate thrill-seeker "tries every known means to get the jay-walking idea out of his head," even committing himself to an asylum. The day of his release, he "races in front of a fire engine" and breaks his back. Such a man, Wilson asked his readers, "would be crazy, wouldn't he?" Yet, he added, substituting drinking for jaywalking would describe precisely the experience of many alcoholics. "However intelligent we may have been in other respects," Wilson concluded ruefully, "where alcohol has been involved, we have been strangely insane."¹

For more than two centuries, American society has struggled to mitigate the damage wrought to individuals, families, and society by the kind of behavior Wilson described: the excessive, persistent, and often incomprehensible drinking of those we now term alcoholics. A major aspect of the social challenge presented by alcoholism has been the difficulty of understanding and defining this intractable and baffling problem. Is chronic drunkenness a medical condition? A moral failing? A mental illness? And how best to help the unfathomable problem drinker? With moral and religious exhortation? Medical treatment? Social support? Institutionalization in hospitals, asylums, or jails? The diverse and changing solutions to these questions that Americans have ventured between the end of the Civil War and the beginning of Prohibition are the subject of Sarah W. Tracy's fine book, Alcoholism in America: From Reconstruction to Prohibition. Tracy seeks to understand how conceptions of alcohol changed during the latenineteenth century, a period of social upheaval, economic change, and medical professionalization that produced the "first widespread attempt to medicalize habitual drunkenness" (p. 7). In the process of seeking greater cultural authority through the development of the "new medical specialty of inebriety medicine," American physicians hoped to reduce the growing rates of crime, poverty, and mental illness (p. 14). Their efforts fed into Progressivism's crusade to employ scientific experts and expanded state authority in the cause of social betterment. Tracy portrays the emergence and growth during the late nineteenth century of inebriate asylums, the first major state-sponsored institutions to address the social problems posed by alcoholism as a classic instance of Progressive reform. Yet despite the infusion of medical expertise and governmental resources, efforts to define and ameliorate chronic drunkenness often flagged, hampered by the competing agendas of physicians, legislators, patients, and the relatives of inebriates, the social difficulties involved in treating as a disease what many Americans saw as a vice, and, by the earlytwentieth century, the belief that prohibition could solve society's alcohol problems.

One of the signal achievements of Alcoholism in America is its thorough historicization of modern understandings of alcohol abuse. Much of this story revolves around the evolution of the disease concept of alcoholism; that...