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Based on the ideas presented in the course readings, the points made during lecture, as well as material from “Brittany’s Story,” here are two questions for you to write about:1. How can people who are, by definition, chronically afflicted by a disease that is beyond their own personal control be empowered to master this disease through participation in a therapeutic community?2. In what ways does this documentary paint addiction as a chemical problem? In what ways does it paint addiction as a social problem too?Please draft a written response to either #1 or #2. Your choice.https://www.dailymotion.com/video/xjfi49
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Deviant Drinking as Disease: Alcoholism as a Social Accomplishment
Author(s): Joseph W. Schneider
Source: Social Problems, Vol. 25, No. 4 (Apr., 1978), pp. 361-372
Published by: Oxford University Press on behalf of the Society for the Study of Social
Problems
Stable URL: https://www.jstor.org/stable/800489
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DEVIANT DRINKING AS DISEASE:
ALCOHOLISM AS A SOCIAL ACCOMPLISHMENT*
JOSEPH W. SCHNEIDER
Drake University
This paper presents a brief social history of the claim that certain forms of deviant
drinking behavior should be defined as disease, and that their authors ought t
receive medical treatment rather than moral scorn and punishment. It provides a
case example of the medicalization of deviant behavior. The concern is then wit
the viability rather than the validity of this claim. The almost two hundred year history o
the medicalization of repeated and disruptive alcohol intoxication is reviewed. The
twentieth century “success” of the disease concept is linked to three development
the scientific Yale Center on alcohol Studies, Alcoholics Anonymous, and the Jelline
formulation. The symbolic endorsement by the American Medical Association is
seen as a product rather than a cause of these developments. I concluded that
rather than an achievement of medical science, the disease concept of alcoholism
is understood best as a social and political accomplishment.
This paper presents a brief social history of the idea that certain kinds of devia
behavior should be identified by the label “disease.” The historical location is the U
since roughly the end of the eighteenth century. I define the claim that such behavio
as a social and political construction, warranting study in its own right (Berger an
1966; MacAndrew, 1969; Mulford, 1969; Freidson, 1970; Spector and Kitsuse, 197
such drinking “really” is a disease and, as such, what its causes might be, are not
analysis will trace the connection between ideas and social structures which appear to
“own” them (Gusfield, 1975). This study is an investigation of the social bases of
about a drinking behavior. More generally, this discussion is a case example of the m
of deviance and social control (Pitts, 1968, Szasz, 1970; Freidson, 1970: 244-277; Ki
Zola, 1972; Conrad, 1976) wherein a form of non-normative behavior is labelled f
then a “crime,” and finally a “sickness.”‘
CLARIFICATION OF THE PROBLEM
To those who treat problems caused by alcohol, debates about the definition of
as a disease are tedious and academic. After all, if one is employed in a hospital cl
alcoholics, then alcoholism must be a disease. However, whether something is a di
on significant portions of the medical community accepting the definition or not
use by those in other fields. Because physicians represent the dominant healing
most industrialized societies, they have control over the use of the labels “sickne
and “disease,” even if they are sometimes unable to treat those conditions effect
son, 1970:251). As such, these designations become political rather than scientific
(Spector and Kitsuse, 1977). Zola (1972) captures the expansive quality of medical
clearly:
My contention is that if anything can be shown in some way to effect the inner workings of the
body and to a lesser extent the mind, then it can be labelled an “illness” or jurisdictionally a
“medical problem.”
* Revised version of a paper presented at meetings of the Midwest Sociological Society, Minneapolis,
Minnesota, 1977. The author thanks Peter Conrad, Malcolm Spector, Seldon Bacon, and Harry Levine
for their critical comments on an earlier draft.
‘ The medicalization of a variety of forms of deviance and social control is discussed in Conrad and
Schneider (Forthcoming), which contains a considerably expanded version of this paper.
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362
SCHNEIDER
This
becomes particularly likely w
than positive. The label “sick,” al
of “criminal,” nevertheless involv
“health, and a threat to the on-g
moral
trol
dimension
(the
church
Although
am
here
it
is
provides
and
clear
concerned
the
state)
that
with
foun
increasin
what
only
a
idea that a particular pattern
behavior should, of itself, be
issue
is
the
belief
that
some
is
sm
of r
con
prio
drinking which is seen as a “symp
am I concerned with medicine’s ju
logical
cerned
of
the
effects
with
the
on
the
body,
assertion
specification
of
that
any
alth
ther
conditio
COLONIAL FOUNDATIONS AND ORIGINS OF THE DISEASE CONCEPT
Drinking in seventeenth and eighteenth century America was normative and
approved, drunkenness was far from rare (Lender, 1978; Levine, 1978; Paredes,
1976). If anything was “bad” about drinking it was not drink itself, which eve
clergy called a “good creature of God.” Churches and drinking houses, as social c
community, were often close together. Concern about public drunkenness was
small few scholarly, aristocratic church leaders who warned against the sin of d
sometimes attributed to the work of the Devil. Punishment was initially a cleric
followed by the extreme sanction of suspension, and finally by excommunication as
although probably infrequently used, religious control. Civil authorities affirme
judgment and meted out various forms of public degradation: fines, ostracism, w
imprisonment (Lender, 1973).
The colonists, like their ancestors and descendents, distinguished between bei
habitual drunkenness. The latter not only made the drinker a public spectacle but h
effects on health, family, and the larger community. Historically, it is this
and apparently irrational-pattern of repeated, highly consequential drinking th
explanation (MacAndrew, 1969). The proposed solution reflects the interests and
the time as well as the “world views” of specialists charged with providing such ans
1968: 122-162). The religious heritage of the colonies defined such behavior as
drinker’s will, freely operating in terms of a rational, hedonistic calculus. This kin
if repeated was often taken as an indicator of moral degeneration. The “ownership”
lem of drunkenness during this period fell to leading clergy and civil authorities, joine
by prominant citizens concerned about the use of spiritous liquors among workers,
and other persons of lesser station.
The idea that extended drunkenness might be the joint result of the drink and q
drinker that might be beyond his control, was first synthesized by the highly respe
Benjamin Rush, in his An Inquiry of the Effects of Ardent Spirits Upon the Hu
Mind, published originally in 1784 (Levine, 1978; Wilkerson, 1966:42-50). Rush
bodily effects of various forms of alcoholic drink and provided what is prob
2 Seldon Bacon has pointed out to me that the recent controversy over alcohol use am
women attests to the political nature of even these “obvious” medical questions.
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Alcoholism
363
systematic, clinical picture of intoxi
was the connection between drinker
He believed the disease developed
a “loss of control” over drinking.
that
and
one’s
will
and
ultimately
desire
were
debilitated
by
indepen
excessiv
alcohol.
Although Rush did not specify the mechanisms by which this disease of the will developed,
his ideas provided an alternative to the traditional morality of the church. In trying to solve the
puzzle of habitual drunkenness, some physicians began to employ science as a framework in
which new solutions might be found. They avoided the traditional description of the drinker’s
“love” of drink and supplied new terms, such as “craving,” and “insatiable desire” to describe
the link between the individual and alcohol. Important for questions of individual responsibility,
this conceptualization implied that since such persons are not willful in their chronic drunkenness,
punishment is not an appropriate strategy of control. Treatment and therapy, allegedly
employed in the individual’s and the community’s interest, became the “reasonable” and human-
itarian solution. The historical trend whereby persons deemed incapable of willful criminal or
wrong intent have been subjected to “treatment” rather than punishment has been called the
“divestment” of the criminal justice system and the rise of the “therapeutic state” (Kittrie, 1971;
Szasz, 1970). Rush’s concept of alcohol addiction represents the beginning of this divestment
process for habitual deviant drinking behavior in America.
THE DISEASE CONCEPT AND THE AMERICAN TEMPERANCE MOVEMENT
Rush and his fellow “temperance physicians” provided two themes that became p
important in the nineteenth century temperance movement. First, they established
causes both deviant physiology and deviant behavior. Their descriptions became g
temperance mill. Facing arguments on both physical and social grounds, the “soc
found it more difficult to resist the temperance call. The second theme was the st
inebriety is a disease, which quickly became a slogan of the movement (Levine, 1978)
The plausibility of Rush’s interpretation depended on the decline of the philoso
will and the rise of the idea that one’s behavior could be determined by forces b
control; that one’s will and desire were distinct (Levine, 1978). Demonic possession
acceptable solution. The apparently irrational nature of repetitive drunkenness
puzzle. However, science slowly provided some solutions. Although crude by co
standards, medical explanations referred to natural laws in an “objective,” non-mysti
Loss of control was increasingly assumed to be the result of an unknown but nat
process, an idea that supplied at least the borders of the habitual drunkenness puzzle
Such a characterization allowed temperance leaders to draw on a cultural univer
however defined, is undesirable. It should be opposed, controlled, and if possible,
and by logical extension, so should all known or suspected causes of disease. Th
who called inebriety a disease provided the movement with an evil more pervasive th
Rush’s prescription of abstinence was also turned to use as “the” temperance solu
problem drinking. An important consequence of the use, politically, of the disease
that the idea was not examined as an intellectual or scientific claim during most of th
century. As a moral slogan it allowed advocates both to pity the sick inebriate w
treatment and to rail against “Demon Rum” and even moderate drinking as som
demanded control.
An intellectually noteworthy but politically inconsequential exception did occur toward the
end of the century. Trying to succeed where traditional institutions such as prisons and mental
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364
SCHNEIDER
asylums
had
failed,
to
provide
in
Binghamton,
had
begun
tions
both
the
as
a
the
hostile
New
in
small
York
about
the
because
caused
group
moral
1867
two
of
dec
Stat
moveme
the
physicians
by
care
in
United
temperance
superintendent
disease
a
and
operation
operating
by
more
physical
sinful
use
o
form
indulg
endorsement:
The Temperance press has always regarded drunkenness as a sin and a disease-a sin first,
then a disease; and we rejoice that the Inebriate Association are now substantially on the same
platform (Quoted in Levine, 1978.)
The physician-superintendents and a number of interested colleagues, mostly psychiatrists,
began to publish a journal devoted to the belief that inebriety is a disease. The Journal of
Inebriety was first published in 1876, and continued, on a precarious basis, until 1914. Its
approach was distinctly psychiatric. It reinforced the idea that inebriety was a special kind of
mental illness. Neither the Journal nor the association received the support of the psychiatric
community or medical profession. Although one explanation of this reception might be the poor
quality of research reported in the journal, it is more insightful to consider: the relatively low
status of psychiatry or alienism in American medicine; the moral stigma attached to working
with and in support of inebriates; the political controversy surrounding the inebriate hospitals
coupled with the weak position of the medical profession in the public consciousness. Regardless of the scientific quality of the disease-advocates’s work, these conditions would preclude
professional and popular support.
THE POST-PROHIBITION REDISCOVERY: THE YALE CENTER,
ALCOHOLICS ANONYMOUS, AND THE JELLINEK MODEL
As Gusfield (1975) has suggested, there was virtually no organized interest in the disease con-
cept from the end of the nineteenth century until after prohibition. There was considerable
interests, however, in science and the professionalization of scientific research in American
universities (Ben-David, 1971:139-168). As the moral crusade against alcohol waned, science and
scientific work became established. This trend had a great impact on the solutions Americans
would pose for a variety of problems. It was not likely that alcohol, popular and again legal after
1933, would be seen as the source of deviant drinking. Intoxication and drunkenness, when
requiring control, were problems assigned to civil authorities or the state. But with the rise and
achievements of science, the apparent irrationality of chronic drunkenness became a more intriguing and less tolerable mystery.
In this context even more than during Rush’s time, science and medicine seemed to hold promise.
Three developments, all beginning within a decade after repeal, provided the foundation on
which a “new” conceptualization of chronic deviant drinking was to rise in the twentieth century: The Yale research center; the self-help group, Alcoholics Anonymous; and a more careful,
largely non-psychiatric, specification of the claim “alcoholism is a disease,” referred to here as
the Jellinek model. These developments provided the moral and political foundation for the
subsequent rise of the more than two hundred million dollar federal bureaucracy, the National
Institute on Alcohol Abuse and Alcoholism (NIAAA), and an “alcoholism industry” (Trice
and Roman, 1972:11-12) of professional and other workers devoted to treating this disease.
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Alcoholism
365
The Yale Research Center
The major body coordinating support for scientific work in the mid-1930s was the Research
Council on Problems of Alcohol, organized shortly after repeal (Keller, 1976). This council was
composed disproportionately of physicians and natural scientists interested in finding the causes
of alcoholism. One member of the committee was Howard Haggard, the physician-director of
the Laboratory of Applied Physiology at Yale University. Although the Council was unsuccessful
in raising substantial monies for alcohol research, the prominence of its members gave the work
scientific respectability. One grant, however, was consequential. It was for a review of the litera-
ture on the biological effects of alcohol on humans. The Council called on E.M. Jellinek, who
had been doing research on neuroendocrine schizophrenia, to administer the project.
Haggard and his colleagues at the Yale Laboratory were involved in alcohol metabolism and
nutritional research, a study which was gaining attention through the journal he founded in
1940, The Quarterly Journal of Studies on Alcohol. As this work became more interdisciplinary
within the natural sciences, Haggard came to believe that adequate study required an even more
comprehensive approach. He invited E.M. Jellinek to Yale where he became the director of a
truly multidisciplinary Yale Center for Alcohol Studies. The Center, the Laboratory, and the
Journal became the core of American research on alcohol.4 One of the Center’s most significant
contributions to the idea that alcoholism is a disease was its Summer School program, begun
in 1943. These annual sessions were educational programs for concerned citizens from around
the country who were involved in policy formation in their local communities. A common con
cern was what to do about alcoholism and alcohol-related problems. Straus (1976) and Chafetz
and Demone (1962) suggest that the slogan “alcoholism is a disease” was introduced intentionally
by Center staff in an attempt to reorient local and state policy and thinking about “alcoholics.”
These summer sessions were a good opportunity to disseminate the idea and point out its mora
and political implications for treatment and cure. Although only a small segment of the summer
program was devoted to the disease question, it soon became a topic of interest among the lay
audience. Critics of this idea (Seeley, 1962; Pattison, 1969; Room, 1972; Robinson, 1976) suggest
that its appeal must be seen in historical perspective and should be understood in terms of its
practical, humanitarian, and administrative consequences rather than on the basis of scientific
merit.’
These sessions also provided an established organizational foundation for the rise of the
National Council on Alcoholism, the leading voluntary association in the United States devoted
to public education about the disease (Chafetz and Demone, 1962; Paredes, 1976). The National
Council, known initially as the National Committee for Education on Alcoholism, was established
in 1944 by three women: a former alcoholic, a journalist, and a psychiatrist. Mrs. Marty Mann
a one-time member of Alcoholics Anonymous, saw the National Committee as supplementing
the work of A.A. for public education against ignorance about alcoholism’s disease status. In
3 This journal, which in 1975 became The Journal of Studies on Alcohol and is issued monthly, is perhaps
the key international publication on alcohol research, its tenure of continuous publication being second only
to the British Journal ofAddiction, which began in 1892 as The British Journal of Inebriety.
” In 1962 the Yale Center was moved to Rutgers-the State University, where it remains one of the most
prestigious of the few such centers in the world. Straus (1976) provides some insight into the social and political history leading to this move. He suggests that the wide publicity the Yale Center received was an embarrassment to the University because of the substance of the Center’s work, and that its interdisciplinary
quality was perceived as inappropriate in the context of the traditional departmental structure of the
University.
I Trice and Roman (1968) suggest some unintended consequences of adopting the sick role that may serve to
perpetuate and perhaps reinforce the individual’s self-definition as one who cannot control his or her
drinking.
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366
the
SCHNEIDER
spring
“plan”
be
of
1944,
these
introduced
in
women
the
Yale
met

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