Waltraud Ernst, Oxford Brookes University
Thomas Müller, Ulm University
This new book addresses one of the central debates in the history of alcohol and intoxication: the supposed ‘medicalisation’ of alcohol use from the nineteenth century onwards. The editors argue that many cultures understood the link between overconsumption of intoxicating beverages and the deterioration of physical and mental health. The idea that alcohol works as either medicine or poison for the body and the mind is therefore neither new nor specific to the modern period. The concept of medicalisation and responses to alcohol consumption therefore need to be more closely interrogated and situated within their varied historical, cultural and socio-economic contexts. In doing so, avoidance of a Euro- and North America-centric gaze is vital. The authors’ aim is to avoid undue generalisations over time and place.
Contributors to this book present tightly focused case studies from Algeria, Brazil, Chile, Czechoslovakia, Fiji, Germany, Greece, Japan, Nigeria, North America, the Soviet Union, Spain and Yugoslavia. These are rich in detail as well as firmly set within their wider, global developments in medical theories and practices, and locality-specific economic policies and political ideology. The chapters track the shift from the use of alcohol in clinical treatments, dietary regimens and as a work incentive to the emergence of ‘alcoholism’ as a disease category requiring medical intervention. Contributors demonstrate the complexities of medicalisation in practice: limited funding, state control of healthcare, ideological constraints and tensions between legislation and traditional cultural practices.
Despite the medical focus, the chapters illustrate that drinking is not merely a medical concern or an expression of individual preference for certain beverages but also dependant on the availability of products, as well as the wider social, political and religious settings within which it occurs. The historisation and contextualisation of alcohol and its consumption in relation to mental health is therefore at least as important as the identification of any similarities over time. The companion volume to the current book, Alcohol Flows Across Cultures. Drinking cultures in transnational and comparative perspective (published by Routledge in 2020) maps similarities and in particular the connected histories of different regions and populations across the globe regarding consumption patterns, government policies, economics and representations of alcohol and drinking. Readers will benefit from reading these two volumes alongside each other.
Both Alcohol Flows Across Cultures and Alcohol, Psychiatry and Society stress the importance of issues of power – political, economical/commercial, social and cultural – whilst the latter highlights in particular the ways in which modern psychiatry’s discourse on alcohol sat within and alongside, was fuelled by, and drove, other issues, such as those of empire, social class, religion, race, gender, population control, nationalism, oppression, medical power and politics. While doing so, authors challenge homogenising characterisations that are isolated from their historical context (such as “dry” versus “wet” cultures, “Mediterranean drinking”, “Muslim abstinence”) that do not admit for fluidity of behaviours and changes over time, and which have hitherto been prominent in some historical and sociological writing.
As is shown by the contributors to Alcohol, Psychiatry and Society, the impact of Western moral reformers’ initiatives and the flow of medical ideas and popular sentiments about alcohol and drinking from metropolitan centres to the colonial peripheries was substantial, leading to colonial interventions that aimed at the emulation of policy and medical measures taken in the colonial motherlands. Yet, at the same time, the starkly different socio-demographic, cultural and political circumstances prevalent in the colonies led to certain modifications of metropolitan blueprints. Such adaptations were rooted in the colonial prerequisite of racial exclusion as well as a multitude of essentialising tropes bound up with colonisers’ perceptions of indigenous communities’ assumed characteristics.
In fact, the prominence of modern medicine and the upsurge of racial science coincided with the nineteenth-century heydays of British and French colonial expansion and the Scramble for Africa, bestowing a key role on medicine and psychiatry also in the management of drinking in the metropoles and colonies. During this period, the discourses of civilisation, national decline and degeneration were fuelled by the twin concerns of diseases of civilisation and the degeneration or decline of the nation. Within this context, the long-lasting popularity of Cesare Lombroso’s theory of “criminal types” and of degenerationism, with its handmaiden eugenics, were arguably among the most disturbing scientific developments in which psychiatry became implicated. Medical ideas and popular views on “drunkards” and “alcoholics” became embedded in and entrenched within these theories.
As in any historical research on drinking and mental health, methodological problems restrict what can be gleaned from the available primary sources about people’s perceptions in contrast to their behaviours; about doctors’ theories versus their medical practices; and in regard to theories about alcohol consumption and its effects in contrast to what was actually happening and experienced at the time. Furthermore, pre-twentieth-century statistics are not always reliable, the reported incidence of drink-related mental health concerns does not equate with the actual frequency of these events, and the effects of moonshining and home brews in contrast to adverse health impacts resulting from “officially” produced alcohols are difficult to ascertain. While these issues have been raised in some of the chapters, hitherto well-covered themes have been omitted, such as the impact of the World Wars and the roles of the intemperance movement, prohibition and conceptions of alcohol as a public health issue in the wake of WHO interventions during the period after World War II.
Instead, authors focus on medical, philosophical, political and socio-cultural debates, conflicts and processes of negotiation about drunkenness and alcohol abuse in a variety of geographical and temporal spaces, ranging from the Anglophone and European world of the early modern and modern eras, to colonial Africa, South America, East Asia and the Pacific to the post/-Communist states of Eastern Europe towards the end of the twentieth century. The contributors to this volume concur that the quests for a definitive nosology of alcohol-related diseases, and for therapeutic strategies and public health measures that enable national governments to effectively deal with drunkenness and alcohol misuse, were characterised by heated debate, locality-specific decision making and plurality. There is no one, single story of the “birth of alcoholism as a disease”, nor one single history of how alcohol was represented as a medical, moral and political problem. Despite similarities around the globe, alcohol consumption in its varied guises and the medical responses to it are profoundly context sensitive and need to be closely historicised.
The book is aimed at students at postgraduate level, mental health service workers and academics in a variety of disciplines such as history (including history of medicine, history of science, and history of colonialism), social geography, medical anthropology, health studies, psychiatry and medicine.
About the Editors:
Waltraud Ernst is Professor Emerita in the History of Medicine at Oxford Brookes University.
Thomas Müller is Professor in the History and Ethics of Medicine at Ulm University.