Alcoholism in America: From Reconstruction to Prohibition

Alcoholism in America: From Reconstruction to Prohibition is not exactly a history of alcoholism in the Gilded and Progressive Eras, as the title might seem to imply. It does, however, provide its readers with an excellent analysis of the ideas about and various methods for treatment of alcoholism as a disease. The author, Sarah W. Tracy, begins by examining the development of various concepts of alcoholism (often called intemperance, dipsomania, or inebriety) as a disease. She then dissects the various ways in which the disease concept was “framed” or imagined in the broader cultural sense; how it interacted with and was influenced by other ideas and trends of the time; and how the view of habitual drunkenness as a vice continued to inform and complicate thinking about the causes and cures of alcoholism. The remainder of the text investigates the period's efforts to treat alcoholism in an institutional setting through a variety of mixes of medicine, moral, and spiritual programs. The author discusses the early private inebriate “homes,” including the famous Keeley Institutes, but places special emphasis on the establishment of public asylums and hospitals for those with alcohol abuse problems, which admitted both voluntary and involuntary patients. Two chapters provide detailed examinations of the experiences of the inebriate hospitals established by the states of Massachusetts and Iowa.

The time frame of the book neatly coincides with the rise and demise of the vogue for institutional treatments of alcoholism, whether in specially constructed inebriate asylums or in mental hospitals. After the founding of the American Association for the Cure of Inebriates (AACI) in 1870, institutional approaches to the treatment of alcoholism found increasing favor in the decades following the Civil War, due to such developments of the time as large-scale immigration, rapid and often chaotic urbanization, and the obvious failure of penal approaches to the problem. Although many individuals with alcohol abuse problems ended up in the new state mental hospitals, superintendents objected to their presence as disruptive and ineffective unless their alcoholic excesses had produced psychoses.

As a result of the advocacy of the AACI and mental hospital superintendents, aided by many legislative, judicial, and penal officials, several states and cities created inebriate asylums or farm colonies between the 1870s and World War I. Others established separate departments for the treatment of alcoholism in state mental hospitals. But these institutional solutions were dealt a heavy blow in 1920 by national Prohibition, which sought to solve the alcohol problem by removing the drink instead of the drinker from society. Although Prohibition was abandoned as a failure in 1933, inebriate institutions never quite recovered from its effects on their mission. Many of the ideas of their promoters persisted and were revived in somewhat different forms after the end of Prohibition.

In her investigation of the institutional approach to alcoholism, Tracy focuses on 2 broad questions: “First, how do diseases reflect social values, economic imperatives, as well as political and professional priorities? And second, what consequences do new diagnostic categories have on social institutions, public opinion, and ultimately on the lives of ordinary individuals?” (p xi). She merges theory with practice, aims and outcomes, bureaucratic detail, and human reactions. She is less concerned with gauging the effectiveness of the treatments than with their nature and with the perceptions of those who received them; that is, what did the institutions do to cure alcoholism and how did the recipients assess the treatments' effects on their lives? Not surprisingly, treatment regimens and reactions to them varied, with some patients praising and others condemning their institutional experiences. Many accepted the disease concept without difficulty, although they often merged it with older views of their condition as a sin or personal weakness.

The most significant conclusion of Tracy's research is the striking continuity it reveals between current ideas about alcoholism and its treatment and those of the turn of the century; in other words, how little has changed in a broad theoretical sense, although the public institutions and many of the therapies of that time are no longer in favor. In both periods, alcoholism has never developed into a fully medicalized concept. Its acceptance as a “disease” has been compromised by a widespread tendency to see it as a “vice,” to find the patient at least partly responsible for his or her condition. Now as then, those involved in treatment invoke social, cultural, and spiritual, as well as medical, aids in the quest for a cure—witness the Twelve Steps of Alcoholics Anonymous. Today, as in that time, agreement on the etiology of alcoholism is lacking, and experts often cite a similar range of environmental and biological factors in its genesis. These similarities are not necessarily a bad thing, but they are important for those involved in the treatment of alcoholism today to be aware of, as is the oft-forgotten fact that the disease concept of alcoholism itself is not some recent “enlightenment” but rather the result of building on ideas rooted in the 18th-century Enlightenment; also, that the term “alcoholism” itself was coined in 1849 by Swedish physician Magnus Huss. Perhaps the most important fact about the disease concept of alcoholism, as Tracy argues, is not its theoretical consistency but its practical effect: providing those with alcohol abuse problems a sympathetic and optimistic framework to aid them in their efforts to recover and remove their alcoholic chains. Her fine book illuminates a neglected and often misunderstood chapter in the history of alcohol and alcoholism.