A fascinating – if abstemious – two days of discussion concerning the relationship between alcohol, psychiatry and society revealed how cultural, political and social factors underpin both medical and public attitudes regarding alcohol, and how these attitudes changed over time. Speakers from eleven different countries demonstrated that definitions of excessive drinking, drunkenness, alcoholism and addiction varied across national contexts. What was an acceptable – or even desirable – level of drinking in one culture was considered problematic in another. It became clear that alcohol consumption was not universally condemned; in fact, it could be a sign of civilisation or individual status. Alcohol might be used as medical treatment in certain contexts and as a source of tax revenue in others. Certain types of alcohol might be considered “good” while others were “bad”.
The perception of alcohol as a social problem and the understanding of alcoholism as a medical disease emerged at different times in different national contexts. DAVID KOROSTYSHEVSKY (University of Minnesota) argued that before the emergence of psychiatry as a distinct medical specialty and the paradigm of alcoholism, the idea that the alcohol in distilled beverages was a poison that could debilitate both body and mind was first popularized by physicians, clergymen and social critics early in the eighteenth century. Korostyshevsky presented a revisionist history, noting that distinctly medical aspects of drinking can be traced to a period before concepts of alcoholism and addiction appeared. In Greece, as KONSTANTINOS GKOTSINAS (University of Crete) revealed, physicians turned their attention to the problem of “alcohol-induced diseases” at the turn of the twentieth century, despite the economic benefits of alcohol to Greek society in terms of trade and tax revenue. Gkotsinas highlighted the importance of transnational networks for treatment at the Athens Lunatic Asylum which was heavily influenced by French and German approaches.
Fin-de-siècle France was so awash with alcohol that even domestic animals were intoxicated, as AUDE FAUVEL (University of Lausanne) observed. The problem of drunken beasts was emphasised by French psychiatrists in their attempts to curb over-consumption in humans. Fauvel highlighted the work of French psychiatrist Valentin Magnan, who believed that alcoholism was the cause of one quarter of cases of insanity; in 1889 ten per cent of French asylum patients were diagnosed with alcoholic insanity. IAIN SMITH (University of Glasgow) asserted that Scottish psychiatrists drew parallels between “lunacy” and “inebriety” in the late nineteenth century, claiming that heavy drinking could lead to brain disease. As THOMAS MUELLER (University of Ulm / Centre for Psychiatry Südwürttemberg Ravensburg) noted, although the Swedish physician Magnus Huss had defined alcoholism as a medical problem in 1849, its disease status was not officially acknowledged by German Health Insurance Authorities until 1968. While excessive drinking was considered a serious problem in nineteenth-century New Jersey, USA, the link between alcohol and mental health was less well established, as JAMES MORAN (University of Prince Edward Island) explained. Physicians disagreed on whether alcoholism was a cause of insanity or a form of insanity, whether the mental disorder caused by drinking was permanent and how it should be treated. Lunacy trials sought to establish whether a drunk individual who had committed a crime was in fact insane.
Anxiety concerning mental and physical degeneration fuelled late nineteenth- and early twentieth-century concerns about alcoholism. As Fauvel noted, the belief that alcoholism was inheritable and would ultimately lead to the degeneration of society was propagated by influential French psychiatrists, such as Valentin Magnan. JASMIN BRÖTZ (University of Koblenz-Landau) explained that in Germany by the late nineteenth century even moderate drinking was frowned upon by both medical experts and the general public, as this was believed to be the route to excessive drinking. While drinking was perceived as a problem for individuals in the early nineteenth century, by the 1880s alcoholism was regarded as a problem for the whole of German society, threatening the economy and compromising Germany’s competitiveness. Brötz highlighted early twentieth-century concerns about the detrimental effects of modernity on individuals, regarded as a cause of the preponderance of alcoholism in society. In response to such concerns, the concept of the “new man” emerged. This idealised version of a human being entailed that the individual was in total control of his/her desires, committed to a healthy lifestyle, and possessed the strength of character to eschew alcohol. In post-war Czechoslovakia, as ADÉLA GJURICOVA (Czech Academy of Science) explained, drunkenness and alcoholism were believed to compromise a citizen’s ability to work for the communist state. The Czechoslovakian state supported a medical approach to treating alcoholics. As Gjuricova explained, patients were subjected to a variety of invasive procedures, including experimentation with drugs such as LSD. An alternative to the state-approved methodology was offered by pioneering psychiatrist, Jaroslav Skala, who advocated a non-invasive daily regime comprising psychotherapy, work therapy, lectures, creative activities and walks in the countryside. Skala’s training courses, which challenged state approaches to treatment, had to be delivered to some 2,000 students clandestinely. Skala’s methods were ahead of his time; psychotherapy was not widely used as a treatment for alcoholism in the immediate post-war period anywhere in the world, and was not recognised in Czechoslovakia until the 1980s. In the USSR, as CHRISTIAN WERKMEISTER (Martin Luther University Halle-Wittenberg) observed, alcohol was perceived as a threat to productivity and to society as a whole. During the 1970s and 1980s alcoholics were diagnosed as schizophrenics; individuals were hospitalised at the first signs of drunken or disorderly behaviour and forced to undergo treatment. Between 1965 and 1978, the population of Soviet mental hospitals tripled. The regime was punitive, reflecting the link perceived by the state between alcoholism and crime. Work therapy in these institutions was exploitative and provided a source of cheap labour rather than a successful method of re-integration into society and employment.
Alcohol was itself a treatment in certain situations. OONAGH WALSH (Glasgow Caledonian University) highlighted its use in Irish mental hospitals to treat women suffering from puerperal insanity during the nineteenth century. Wine and beer were prescribed to build up the women’s mental and physical strength. In Germany, as Mueller acknowledged, patients were given alcohol daily as a “somatic” treatment during the mid- and late-nineteenth century. Some early twentieth-century Greek neurologists also referred to alcohol’s nutritional value, rather than to its ability to poison, as Gkotsinas noted. MAURICIO BECERRA REBOLLEDO (Universitat Autonoma de Barcelona) highlighted South American psychiatrists’ understanding of alcohol as a therapeutic agent or “nervous food” prior to 1870, after which it became regarded as a cause of mental illness. Rebolledo compared the approaches of Brazil and Chile to diagnosing and treating alcoholism between 1870 and 1920, highlighting the influence of French and German psychiatrists.
Alcohol was so culturally embedded in certain societies that its use within the asylum, by both patients and staff, was widespread. In Ireland, as Walsh pointed out, social and familial occasions – from Christenings to funerals – were marked with copious amounts of alcohol. Irish asylum nurses were heavy users of alcohol, perhaps because of the stressful nature of their work and the stigma attached to the institutions. While fines and dismissals were occasionally meted out, the nurses’ drinking was generally tolerated. In Czechoslovakia, however, where alcohol was also an integral part of local culture, total abstinence was observed by both staff and patients of Skala’s clinics in the post-war period.
Attitudes towards alcohol were further complicated by colonialism. In Algeria, the consumption of alcohol by the indigenous population became associated with a relinquishing of “primitivism” and the adoption of French culture. It was a sign that the French mission civilisatrice had been accomplished, at a price. As NINA SALOUÂ STUDER (University of Bern) highlighted, French colonial psychiatrists were concerned that alcohol consumption was creating medical and mental problems amongst indigenous Algerians. Indigenous populations were assumed to be virgins with regard to alcohol consumption, and less able to either moderate their drinking or cope with its effects than Europeans. This, as Studer remarked, was inaccurate with regard to the indigenous Algerians, who brewed their own alcohol and were therefore used to its effects. This was also the case in Nigeria, where alcohol in the form of palm wine and grain beer was produced and consumed by the indigenous population of the south. Here, as SIMON HEAP (Oxford Brookes University) showed, debates raged locally over the potentially noxious effects of the much stronger European spirits on the indigenous population. Some argued that the Nigerian constitution was more robust than that of the European and that spirits would not pose a health risk to existing drinkers, while others believed that Africans were more susceptible to the effects of spirits. The variability in the ability of different racial types to tolerate alcohol was addressed by AKIRA HASHIMOTO (Aichi Prefectural University) who explained that the Japanese lack the enzyme required to metabolise ethanol; as a result, alcohol induces feelings of nausea. Despite the tendency of alcohol to make Japanese consumers feel unwell, alcohol consumption increased dramatically after World War II. Alcohol became a symbol of social status and wealth, factors which appeared to take precedence over its nauseous effects. The Japanese government established the first national hospital for the psychiatric treatment of alcoholism in 1963. In what became known as the Kurihama method, patients participated in a three-month rehabilitation programme based on group therapy. Support for alcoholics outside hospital was available through Danshukai self-help groups, a support network modelled on Alcoholics Anonymous, established in the USA in the 1930s, which was then adapted to be more accessible to Japanese patients and their families.
The papers presented during the symposium highlighted the transnational nature of excessive alcohol consumption, its associated social problems and its detrimental effect on the mental health of individuals and nations. Responses to these issues were influenced by contemporary psychiatric practice, the political and social context, economic factors and the extent to which alcohol was embedded in the local culture. Whether one believes Thomas Jefferson, who claimed that "Beer, if drank with moderation, softens the temper, cheers the spirit, and promotes health" or Robert South for whom “Abstinence is the great strengthener and clearer of reason”, there appeared to be a consensus that excessive drinking was – and is – a scourge of society and a cause of ill-health, even if such a consensus was not reached simultaneously across the globe.1
Conference Overview:
Panel 1
David Korostyshevsky, History of Medicine, University of Minnesota, USA
“From Aqua Vitae to Poison: The early-modern transformation of alcohol in the Anglo-phone world”
Aude Fauvel, History of Psychiatry, Institut universitaire d’histoire de la médecine et de la santé publique, University of Lausanne, Switzerland
“Alcoholic Beasts: Alienists and the Problem of Animal Drunkenness in Nineteenth-century France”
James E. Moran, History, University of Prince Edward Island, Charlottetown, Canada
“Alcohol and Alienation in New Jersey, c. 1810 to 1890”
Oonagh Walsh, Gender Studies, Glasgow Caledonian University, UK
"Alcohol and Psychiatry in Nineteenth-century Ireland"
Mauricio Becerra Rebolledo, History of Science, CEHIC, Universitat Autónoma de Barcelona, Spain
“From nervous food to powerful agent of degeneration: Alcoholism and alcoholic psychosis in Rio de Janeiro and Santiago de Chile (1870-1920)
Panel 2
Jasmin Brötz, History, University of Koblenz-Landau, Germany
“Healing the Nation’s Mind. The fight against alcoholism in the public discourse on rationalisation in late nineteenth and early twentieth-century Germany”
Simon Heap, History, Oxford Brookes University, UK
“‘In the Hot and Trying Climate of Nigeria the European has a Much Stronger Temptation to Indulge in Alcohol than the Native’: Alcoholism in Nigeria, c. 1880 to 1940”
Iain D. Smith, Consultant Addiction Psychiatrist, NHS GGC and Researcher, Centre for History of Medicine, University of Glasgow, UK
“ ‘Finish’ Drinking and ‘Secret Cures’: A Snapshot of Alcohol, Psychiatry and Society in Scotland in 1895”
Konstantinos Gkotsinas, History, University of Crete, Rethymnon, Greece
“ ‘Disciples of Asclepius ‘or ‘Advocates of Hermes’? Greek psychiatrists and alcohol at the turn of the twentieth century”
Panel 3
Adéla Gjuričová, History, Institute of Contemporary History, Czech Academy of Science, Prague, Czech Republic
“A Cradle of Psychotherapy: Alcohol addiction and treatment in Socialist Czechoslovakia, 1948-1989”
Christian Werkmeister, History, Martin Luther University, Halle-Wittenberg, Germany
“ ‘Doctor, now from face to face, answer quick: Will there be a diagnosis, or rather a verdict?’ Medical, moral, and political treatment of alcoholics in late Soviet psychiatry, 1970-1991”
Nina Salouâ Studer, History, University of Bern, Switzerland
“Assimilation by Alcohol: The role of France’s Mission Civilisatrice in the spread of alcoholism in twentieth-century Algeria”
Akira Hashimoto, History of Psychiatry, Aichi Prefectural University, Japan
“Medical and Social Approaches to Alcoholism in Post-WWII Japan”
Thomas Mueller, History of Psychiatry, Ulm/Ravensburg, Germany
“Alcohol, Psychiatry and Society in Germany”
Panel 4
Discussion opened by Len Smith’s, Thomas Mueller’s and Waltraud Ernst’s comments on main themes
Note:
1 If you wish to access a podcast of this symposium, you will be able to listen to most of the presentations at http://www.pulse-project.org/ (07/08/2017).