Drunkard's Refuge: The Lessons of the New York State Inebriate Asylum (review)

The New York State Inebriate Asylum in Binghamton was a pioneering institution: chartered in 1854 and opened to patients a decade later, it was the first large-scale American facility devoted to the medical treatment and rehabilitation of inebriates. In outline, however, its history was a brief, sad chronicle of failure. Even before it opened its doors in 1864, its visionary founder, Dr. J. Edward Turner, had become enmeshed in disputes with state and local authorities over control of the facility. The operation of the Asylum was further hampered by a series of fires; by objections to the expense and elegance of Turner's building plans; and by a disabling personal and professional rivalry between Turner and Dr. Willard Parker, the chair of the institution's board of directors. Turner's difficult and inflexible manner worsened each of these crises until he was forced out as director in 1866. A second director, Dr. Albert Day, enjoyed brief success until he, too, was shoved aside in 1870. The Asylum then fell under the influence of graft-seeking politicians until it was sold to the state of New York in 1879. Two years later, the facility was reopened as an insane asylum with no attention to the treatment and rehabilitation of alcoholics.

John W. Crowley and William L. White sketch the basic features of this institutional history, but their interest is in another aspect of the New York State Inebriate Asylum. Specifically writing for an audience of "individuals working within or living within the worlds of addiction treatment and recovery" (p. vii), Crowley and White explore Turner's contribution to the developing disease concept of alcoholism, and the implications for contemporary treatment and recovery programs of his struggle to establish an institution devoted to the medical treatment of inebriates. They see Turner as an important figure in advancing a medical understanding of inebriety (building on the ideas of Benjamin Rush and others) against the dominant nineteenth-century moral construct that condemned the drunkard as a victim of weak will and base appetite. Crowley and White, working through thin and sometimes idiosyncratic sources, place Turner in an ambiguous position between the moral framework of temperance reform and the professional outlook of medicine. On the one hand, he never became involved in temperance work, even though he was raised in Maine, a nineteenth-century hotbed of dry activism; rather, he pursued a medical approach to inebriety, studying the issue with European authorities and firsthand through the dissection of more than 350 dead drunkards. On the other hand, Turner's medical education was somewhat informal (studying with a neighboring doctor and attending lectures in Philadelphia), his critics frequently challenged his medical credentials, and the authors claim that his commitment to founding an institution to treat inebriates was inspired by the Washingtonian movement (a self-reforming body of former drunkards) and that he carried on with the same fanatical zeal as the dry crusader Neal Dow.

The influence of Washingtonian reform is central to Crowley and White's argument, but also problematic. The Washingtonian project of reclaiming drunkards and making them into sober men, they argue, hardened Turner's belief that inebriety was a treatable condition—yet the Washingtonian emphasis on self-improvement in a supportive peer community clashed with Turner's autocratic methods. Turner believed that isolation and a completely controlled environment were essential to treatment. In contrast, both his rival, Parker, and his successor, Day, endorsed greater freedom for patients, trust within a community of recovering inebriates, and an emphasis on the will that borrowed from the moral tradition of reform. Indeed, Crowley and White demonstrate that the moral and medical paradigms for understanding and treating alcoholism intermingled in the nineteenth century and endured in drug and alcohol treatment in the twentieth century.