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American Addict: the Historical Emergence and Wanderings of a Human Kind, 1860-1960

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American Addict: the Historical Emergence and Wanderings of a Human Kind, 1860-1960 American Addict: The Historical Emergence and Wanderings of a Human Kind, 1860-1960 Paul Eric Rosenstein Charlottesville, Virginia Master of Arts, Sociology, University of Virginia, 2012 Master of Social Service, Social Work, Bryn Mawr College, 2010 Bachelor of Arts, Religious Studies, Macalester College, 2002 A Dissertation presented to the Graduate Faculty of the University of Virginia in Candidacy for the Degree of Doctor of Philosophy Department of Sociology University of Virginia May, 2017 Contents Introduction 2 chapter one Human Kinds, Looping Effects, and Dynamic Nominalism 27 chapter two The Addict as Sociological Subject 54 chapter three Initial Conditions 86 chapter four The Historical Emergence of the Addict 124 chapter five Institutionalization 162 chapter six The “Psychopathic” Addict 201 chapter seven The Self-Ascriptive Turn 232 chapter eight Face-To-Face Encounter 279 Conclusion 313 Works Cited 334 1 Introduction The Holy Spirit will not visit, much less will He dwell with him who is under the polluting, debasing, effects of intoxicating drink. The state of heart and mind which this occasions is to Him loathsome and an utter abomination. —Anonymous (1836: 46) Addiction is not an abnormality in our society. It is not an aberration from the norm; it is itself the norm. —Stanton Peele and Archie Brodsky (1975: 26) From Sin to Sickness Most nineteenth-century temperance reformers regarded drunkenness and drug use as sins. Habitual intoxication was both pitiable and wicked, and the inebriate often evoked a complex mélange of compassion and condemnation. Abstinence was a moral imperative critical to both individual salvation and collective progress. On the eve of the Civil War, temperance leaders routinely drew parallels between habitual intoxication and the Southern institution of slavery. Both drunkenness and human bondage, these reformers argued, arrested individual autonomy and self-determination. Especially to the progressive Bourgeois temperance advocate, the despotic relationship between “King Alcohol” and the alcohol drinker, like that between the slave owner and the slave, seemed to inhibit human flourishing and undermine the liberal foundations of a vibrant and stable democratic regime. In this view, habitual intoxication, like slavery and absolutism, represented a sinful archaism whose abolition would advance the march toward absolute self-possession and political freedom. 2 By the last quarter of the twentieth century, addiction appeared to be so ubiquitous that observers like Peele and Brodsky (1975) described it as an unremarkable facet of modern American life. Individuals now claimed to be addicted not only to psychoactive substances like alcohol, opiates, and cocaine, but also to various behaviors like work, gambling, and love. Beyond its encroachment into new dimensions of human experience, addiction increasingly appeared to transcend the social and cultural boundaries that had been central to temperance- era arguments. A common refrain by the middle of the nineteenth century, reformers claimed that habitual intoxication was particularly common among German and Irish immigrants and the urban poor, and insisted that moral uplift and legal reform were critical to the preservation of dominant cultural values. By the late twentieth century, however, all Americans, regardless of social location, appeared vulnerable to a psychophysiological disorder governed by indifferent natural laws. The nineteenth-century sin of intemperance had given way to the twentieth-century sickness of addiction. As popular and academic interest shifted “from abusive substance to substance abuse” (Gusfield 1963: 199), concern for the rum drinker supplanted the temperance reformer’s preoccupation with “Demon Rum.” The habitual use of psychoactive substances no longer indicated social systemic disorder or the debasing consequences of a sinful institution like slavery. Rather, it was now symptomatic of an underlying psychosomatic disorder appropriate to empirical observation and scientific explanation. If the nineteenth-century reformer assumed that intemperance threatened the drunkard’s sovereignty from without, then the late twentieth-century expert held that addiction proceeded from within. Significantly, the twentieth-century addiction sciences did not strip habitual intoxication of its 3 moral connotations; the new empiricism refracted the old normativity through the austere language of clinical and statistical normality. In light of these new representations, the twentieth-century addict called for rehabilitation rather than reformation. Moral suasion was inappropriate for the individual who suffered a psychophysiological disorder. Now, only medical treatment, psychotherapy, personal introspection, or incarceration appeared viable. Rehabilitation, as opposed to reform, demanded a private, rather than a public, politics. The Wandering Addict The transition from the sin of intemperance to the sickness of addiction was neither immediate nor direct, but in fact proceeded through a complex series of underlying shifts— some incremental, others radical. Since the middle of the nineteenth century, the seat of addiction seems to have “wandered” from the sinful substance (e.g., Demon Rum) to the inebriate’s diseased body to the addict’s disordered mind, back to his body, and eventually to the abnormal neurological processes of the addicted brain. Simultaneously, epistemic authority regarding the behavior and the person meandered among religious authorities, physiologists and inebriate asylum directors, psychiatrists and legal authorities, addicts themselves, and neuroscientists. As addiction wandered among these etiological loci and epistemic authorities, addicts were shepherded between various therapeutic sites: churches and temperance meetings, turn-of-the-century inebriate asylums and sanitaria, massive mid-century Federal Narcotics “Farms,” and 12-step fellowship meetings, among others. This series of material and ideal shifts affected the ways that authorities treated addicts, how “normal” Americans related to addicts, and how addicts understood themselves, their pasts, and each other. In other words, between the temperance reformer’s vitriolic condemnation and Peele’s bland 4 resignation, the addict seemed to wander both objectively and phenomenologically. The present work concerns the meandering path that addiction cut across the United States specifically between 1860 and 1960. The Diseased Addict In the decade following the Civil War, a small cadre of inebriate asylum directors, physicians, and biomedical researchers elaborated a novel theory of habitual intoxication that represented inebriety as a symptom of physiological disease. Against temperance ideology, which disregarded alcohol and drug use as either the baffling vice of immoral individuals (particularly immigrants and otherwise abnormal Americans) or evidence of vaguely-defined sociocultural disorder, this first generation of addiction scientists regarded the inebriate as a discrete “kind” of person appropriate to empirical observation and deductive nomothetic explanation. The asylum directors and scholars associated with this movement assumed that the same natural laws which governed other physiological processes determined also the inebriate’s behavior. Drawing on proximal physiological discoveries and biomedical advances, they sought to provide naturalistic explanations for the addictive behaviors that they claimed temperance reformers had mistaken as evidence of immorality. Inebriety, they argued, constituted a physiological disease that was “curable in the same sense as other diseases” (PAACI 1870: 8). In short, the turn-of-the-century addiction scientists sought to medicalize the phenomenon and render the treatment field more humane, just as modern psychology had done for the insane during the nineteenth century. 5 In 1870, the asylum directors and scholars established a professional organization, The American Association for the Cure of Inebriety (AACI), and six years later, began publishing the organization’s main organ of communication in the form of a scholarly periodical, The Quarterly Journal of Inebriety (QJI). They organized professional and academic conferences devoted to addiction research, collected and published statistics regarding the demographic composition of the inebriate population in the United States, and elaborated increasingly sophisticated typologies of inebriates and their behavior. The new scientific classifications drove new therapeutic modalities. Medical directors of public sanitaria, private inebriate asylums, and proprietary facilities began to organize their patient populations and therapeutic regimens around the new scientific classifications. Rather than sermons and religious tracts, by the turn of the twentieth century, addicts were more likely to receive chemical detoxification and hydrotherapy. The Menacing Addict By the mid-1910s, the optimism that addiction represented a curable physiological disease began to wane. Relapse appeared to be far more common than the first generation of addiction scholars predicted. Simultaneously, authorities in the United States grew alarmed at the emergence of underground drug economies and addict subcultures, and increasingly associated addiction with criminality. If addiction was a disease, as the first generation of scholars insisted, then it now appeared to be incurable in many cases. Further, the specter of a menacing and nefarious underworld of drug use seemed to suggest that some
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