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Selected Papers of William L. White

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Selected Papers of William L. White Selected Papers of William L. White www.williamwhitepapers.com Collected papers, interviews, video presentations, photos, and archival documents on the history of addiction treatment and recovery in America. Citation: Baumohl, J. and White, W. (2003). Treatment Institutions. In Blocker, J. and Tyrell, I., Eds., Alcohol and Temperance in Modern History. Santa Barbara, CA: ABC-CLIO, pp. 619-624. Posted at www.williamwhitepapers.com Treatment Institutions Jim Baumohl and William L. White This article reviews the history of shortly before and after the Civil War. institutions established to “redeem,” Although the temperance movement would “reform,” “rehabilitate” or “treat” individuals become increasingly associated with the who experience problems in their goal of alcohol prohibition, groups like the relationship with alcohol and/or other drugs. Women’s Christian Temperance Union, Historically, the combined use of alcohol and founded in 1874, typically supported efforts other drugs has been very common, and to sober and rehabilitate obsessive drinkers. institutions established to treat obsessive Most temperance leaders believed that while drinkers rapidly found themselves dealing prohibition would prevent the creation of with habitués of opium, morphine, heroin, drunkards and make treatment measures cocaine, and in later years, a variety of more unnecessary at some point, in the meantime, exotic substances. treatment was an important element in the battle against Demon Rum. Therapeutic Temperance The temperance movement’s most important contribution to the history of Pleas from physicians and social treatment was a fellowship-based approach, reformers for the creation of specialized drawn from Protestant religious practices institutions for the care and control of (most notably early Methodism). Put simply, habitual drunkards came on the heels of a “therapeutic temperance” as practiced by the tripling of annual per capita alcohol Washingtonians, fraternal temperance consumption in the decades following societies and reform clubs, relied on American independence. It was in this collective measures to exhort drunkards to context of widespread heavy drinking and pledge their abstinence and keep their related problems that medical leaders like pledges. Sobriety was to be achieved within Dr. Benjamin Rush and Dr. Samuel a network of likeminded others who provided Woodward conceptualized chronic support and maintained surveillance. drunkenness as a disease and called for its Usually, this process was undertaken treatment. without the use of any segregation in a The first such institutions were formal treatment facility. The affected established by temperance organizations individuals, typically men, attended williamwhitepapers.com 1 temperance meetings and other “elevating” Nineteenth-Century Inebriate Asylums activities held in local temperance halls and tried to limit their social partners to others In some part, the conflict between the pledged to abstinence. Visiting committees supporters and critics of inebriate homes looked in on recovering people and their was about understandings of human nature. families. However, some temperance While many supporters of inebriate homes groups established formal residences for were physicians, and while most used the recovering people. Often, these were called language of disease to characterize habitual “homes” to convey their simultaneously drunkenness, they emphatically denied that supportive and controlling character. inebriety could be reduced to an involuntary The first “inebriate homes” based on state created by changes in the brain or these principles were established in Boston nervous system. Their logic was religious: (1857), San Francisco (1859), and Chicago Human beings had immortal souls that (1863), with many others following their lead. represented the spirit of God; thus, habitual These homes shared several important drunkards had a residual self-control that characteristics: Their residents were present could never be entirely extinguished. While on a legally voluntary basis rather than treating the physiological symptoms of treated by force of law; they were private inebriety, the homes’ methods spoke to organizations (although some received matters of human purpose and community in public funds); they employed recovering ways that were often frankly spiritual. people as staff; they were relatively small, Their critics tended to be younger, housing fewer than fifty residents at a time; trained more rigorously in scientific and they were located in cities so that family, medicine, and enormously influenced by the friends, and the members of temperance neurological research emerging from fellowships would be available to each Europe. They took a decidedly material resident. Finally, they relied on a very short approach to inebriety: It was a disease of the term of residence, usually just long enough brain and nervous system, often incurable, for residents to get through withdrawal and always requiring lengthy treatment in symptoms and be restored to reasonable settings distinctly segregated from health. The real work of achieving sobriety insalubrious influences, including those of was to be accomplished in fellowship outside friends and family. Asylum enthusiasts had of the institution. little regard for the methods of therapeutic It is impossible to know how temperance, and to achieve treatment of the effectively such institutions and their related sort they admired, they turned to the model fellowships restored alcoholics to sobriety. of the insane asylum. For every testimonial to their success there Important reasons quite apart from is a condemnation of their methods. The therapeutic ideology inclined these men to homes’ critics focused mainly on the admire the asylum. In the late 19th century, voluntary nature of the treatment and its public insane asylums – or mental hospitals short duration. They developed an alternate as they would begin to be called early in the view of treatment derived from institutions for 20th century – represented the single largest the treatment of people with mental illness. annual expenditure of American states. They In time, the asylum model prevailed, but were grand, castellated affairs and their inebriate homes never disappeared entirely. superintendents were men of great Though transformed in significant ways, the professional and political power. The philosophy of therapeutic temperance Association of Medical Superintendents of remains influential, as we discuss further on American Institutions for the Insane in this entry. (AMSAII), the forerunner of the American Psychiatric Association, was the model for any professional group seeking power and influence. The promoters of inebriate williamwhitepapers.com 2 asylums were attempting to create a new its therapeutic approach. While the methods medical specialty and the AMSAII’s success of therapeutic temperance were derided as was not lost on them. A specialty needed an sentimental and unscientific in an era institutional base. The American Association increasingly enamored of hard-headedness, for the Cure of Inebriates (AACI) was formed therapeutic temperance at least had in 1870 to do for medical specialists in methods appropriate to its philosophy. The inebriety what AMSAII had done for asylum approach, on the other hand, had no “alienists,” physicians now known as therapeutic methods consistent with its psychiatrists. claims about the nature of inebriety. Simple In addition to the prestige and power custody, healthy diet, exercise, the routine of associated with the control of public institutional work – these were not medical institutions, the inebriety doctors sought interventions. Moreover, such methods were financial stability. The cyclical depressions the stock in trade of a variety of institutions that followed the Civil War caused many that managed inebriates at far less cost. In inebriate homes to fold, especially those that the end, the inebriate asylum was perceived depended on payments from patients. Early in most jurisdictions as a costly and in its career, the AACI took up the cause of redundant enterprise. In Toronto, Ontario, creating public inebriate asylums on the only North American jurisdiction in which substantially the same political and financial public support for an inebriate asylum was footing as asylums for the insane. put to a vote (in 1889), it failed in every ward, The asylum model offered another usually by a wide margin. advantage that was both therapeutic and Other responses to the treatment of political: The force of legal commitment inebriety in the nineteenth century included could be brought to bear most easily on the private, for profit addiction cure institutes, patients of public institutions designed to bottled home cures offered by the same provide some measure of secure custody. patent medicine industry that was Legal commitment would permit the lengthy distributing alcohol-, morphine- and cocaine- detention of patients, thus allowing the AACI laced patent medicines, and religiously- to portray the inebriate asylum as a potential oriented urban rescue missions and rural solution to the endemic homelessness of the inebriate colonies. The most culturally visible late 19th and early 20th centuries. Just as the and controversial of the nineteenth-century insane asylum had to some extent allowed treatments promised brief, low-cost local poorhouses to transfer the care of the treatment usually involving some medicinal insane to state institutions,
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