Alcoholism in America: From Reconstruction to Prohibition
http://www.100md.com
《新英格兰医药杂志》
Is alcohol dependence, as alcoholism has come to be known, one disease? Is it many? Is it a disease at all, or just a moral failing? For how much of their behavior should alcoholics be held accountable? What is the best treatment, and who should be responsible for it?
The urgency of these questions is not diminished by their longevity, which the reader of this book will discover has encompassed a rollicking two centuries. Sarah Tracy, a historian of medicine, has written an engaging and readable but scholarly examination of the many forces in the United States that have shaped and continue to shape the answers to these questions.
Tracy illustrates how socioeconomic forces — for instance, the rise of professionalism, industrialization, and urbanization, or waves of immigration — have intersected over the years to yield one or another predominant view of alcoholism. The process of defining alcoholism is iterative and constantly changing. The dominant thinking about the cause of the condition will call for one treatment or another, which in turn will influence policy, programs, and professions. Tracy ably describes how medical ideas, professional authority, values, and policy all came together in the 19th and 20th centuries to affect the concept and management of alcoholism. The book includes detailed chapters on the history of public asylums for inebriates established in Massachusetts, Iowa, Minnesota, Connecticut, and New York City.
No less a figure than Benjamin Rush, in 1784, first considered intemperance a disease. As a result, the medical profession's purview expanded, and with it, the status of that profession in society. It is interesting to note that, in the 19th century, dipsomania was often considered a disease of the sensitive wealthy (who could pay for private treatment), whereas the coarse laborer seemed to be resistant to the condition. On the other hand, inebriety was viewed as a moral failing, and assertive temperance leagues moved to the fore. The power and role of the Woman's Christian Temperance Union in the 19th century is an interesting tale: imagine prayer vigils around the local saloon, the site of many vices. Such was the power of the temperance movement that "scientific temperance instruction" was federally mandated as a topic in high-school physiology textbooks.
In addition to these debates about the cause of alcoholism, the motive of profit occasionally entered the arena. One of the most colorful characters in the book is the salesman of patent medicine in the mid-19th century whose marketing savvy led to the successful franchising of his "Bi-Chloride of Gold Cure" for alcoholism and his treatment centers. Although his oversimplification of the disease and its treatment drew criticism from the more academic members of the medical profession, his success in promoting the concept of alcoholism as a disease was embraced, even by many of his detractors.
(Figure)
The Prohibition Movement — The Drug Store of the Future.
Lithograph by F. Graetz, published by Mayer, Merkel & Ottmann, New York, 1882.
National Library of Medicine.
With prohibition came the criminalization of drinking, which stifled proponents of the disease concept. The more modern view of the late 20th century, after prohibition was repealed, is described with disappointing brevity in the last chapter. This pragmatic stance is one of synthesis, stating that the syndrome of alcohol dependence is a manifestation of biology, learning, society, and economics. Many treatments that are still recommended have their roots in 19th-century debates, however, and today's acceptance of multiple causes of alcoholism and many types of alcohol-related problems permits the old approaches to persist. Because so much of the environment in which all clinicians now work is conditioned by the past, if not by ancient prejudice, examining those roots is valuable and enlightening.
I liked this book. I'm no historian, so I can vouch for neither its accuracy nor its sources. I confess that I found some of the text dry or repetitious. But, as a practicing clinician in drug and alcohol dependence, I found this book fascinating.
The cry for scientific understanding of the physiology of addiction is not new. Neither are the claims of pharmaceutical companies of the efficacy of the latest magic bullet, echoing claims of snake-oil salesmen of yore, nor the need for compassionate care in the face of uncertainty. Indeed, many voices of reason, now long gone, might have been heard amid the cacophony of proud zealots. Tracy's narratives of different approaches to the treatment of alcoholism and of patients' experiences lend an attractive clinical depth to the book. It is a history of the interplay of values, knowledge, and politics in the definition of disease. Anchored by the suffering of those with alcohol dependence, Tracy's book tells a compelling and revelatory story.
Michael F. Bierer, M.D., M.P.H.
Harvard Medical School
Boston, MA 02115(By Sarah W. Tracy. 357 pp)
The urgency of these questions is not diminished by their longevity, which the reader of this book will discover has encompassed a rollicking two centuries. Sarah Tracy, a historian of medicine, has written an engaging and readable but scholarly examination of the many forces in the United States that have shaped and continue to shape the answers to these questions.
Tracy illustrates how socioeconomic forces — for instance, the rise of professionalism, industrialization, and urbanization, or waves of immigration — have intersected over the years to yield one or another predominant view of alcoholism. The process of defining alcoholism is iterative and constantly changing. The dominant thinking about the cause of the condition will call for one treatment or another, which in turn will influence policy, programs, and professions. Tracy ably describes how medical ideas, professional authority, values, and policy all came together in the 19th and 20th centuries to affect the concept and management of alcoholism. The book includes detailed chapters on the history of public asylums for inebriates established in Massachusetts, Iowa, Minnesota, Connecticut, and New York City.
No less a figure than Benjamin Rush, in 1784, first considered intemperance a disease. As a result, the medical profession's purview expanded, and with it, the status of that profession in society. It is interesting to note that, in the 19th century, dipsomania was often considered a disease of the sensitive wealthy (who could pay for private treatment), whereas the coarse laborer seemed to be resistant to the condition. On the other hand, inebriety was viewed as a moral failing, and assertive temperance leagues moved to the fore. The power and role of the Woman's Christian Temperance Union in the 19th century is an interesting tale: imagine prayer vigils around the local saloon, the site of many vices. Such was the power of the temperance movement that "scientific temperance instruction" was federally mandated as a topic in high-school physiology textbooks.
In addition to these debates about the cause of alcoholism, the motive of profit occasionally entered the arena. One of the most colorful characters in the book is the salesman of patent medicine in the mid-19th century whose marketing savvy led to the successful franchising of his "Bi-Chloride of Gold Cure" for alcoholism and his treatment centers. Although his oversimplification of the disease and its treatment drew criticism from the more academic members of the medical profession, his success in promoting the concept of alcoholism as a disease was embraced, even by many of his detractors.
(Figure)
The Prohibition Movement — The Drug Store of the Future.
Lithograph by F. Graetz, published by Mayer, Merkel & Ottmann, New York, 1882.
National Library of Medicine.
With prohibition came the criminalization of drinking, which stifled proponents of the disease concept. The more modern view of the late 20th century, after prohibition was repealed, is described with disappointing brevity in the last chapter. This pragmatic stance is one of synthesis, stating that the syndrome of alcohol dependence is a manifestation of biology, learning, society, and economics. Many treatments that are still recommended have their roots in 19th-century debates, however, and today's acceptance of multiple causes of alcoholism and many types of alcohol-related problems permits the old approaches to persist. Because so much of the environment in which all clinicians now work is conditioned by the past, if not by ancient prejudice, examining those roots is valuable and enlightening.
I liked this book. I'm no historian, so I can vouch for neither its accuracy nor its sources. I confess that I found some of the text dry or repetitious. But, as a practicing clinician in drug and alcohol dependence, I found this book fascinating.
The cry for scientific understanding of the physiology of addiction is not new. Neither are the claims of pharmaceutical companies of the efficacy of the latest magic bullet, echoing claims of snake-oil salesmen of yore, nor the need for compassionate care in the face of uncertainty. Indeed, many voices of reason, now long gone, might have been heard amid the cacophony of proud zealots. Tracy's narratives of different approaches to the treatment of alcoholism and of patients' experiences lend an attractive clinical depth to the book. It is a history of the interplay of values, knowledge, and politics in the definition of disease. Anchored by the suffering of those with alcohol dependence, Tracy's book tells a compelling and revelatory story.
Michael F. Bierer, M.D., M.P.H.
Harvard Medical School
Boston, MA 02115(By Sarah W. Tracy. 357 pp)