The Outbreak Narrative: What has changed this time around?

EDITOR’S NOTE: Points is delighted to welcome past guest contributor, Jessica Diller Kovler (check out her previous post here). Kovler is part of the History of Science program at Harvard University and currently teaches at John Jay College of Criminal Justice, the City University of New York. Her work has appeared in The New York Times, Forbes, and Discover magazines. 

Unless you’ve had your head buried in the sand for the past month, you’ve undoubtedly thought of the recent Ebola outbreak. Even if you have a background in public health, you would probably avoid the New York bowling alley visited by Dr. Craig Spencer (even though the City shut it down the day the news of his illness hit the papers). You’re probably using extra Purell, even though we’re relatively knowledgeable about the pathogen’s mode of transmission.

News reporters have scrambled to assemble our patient zero. Even our most liberal friends are arguing for shutting down the borders. We are blaming and looking for answers.

Bloomberg Buisnessweek, September 24, 2014
Bloomberg Buisnessweek, September 24, 2014

As my grandfather would ask at our Passover Seder: “Manishtana?” (What has changed?) As a social historian, I wonder what makes the societal response to Ebola any different than our collective response to the Black Death, typhoid, polio, and HIV? In the past few weeks, people have compared the response to Ebola to the first cholera pandemic of the early-19th century, the 1918 Spanish Flu epidemic, the polio epidemic of the first half of the 20th century, and AIDS in the early 1980s. Perhaps, as some have argued, there is a formulaic narrative in how we respond to outbreak of disease. But does this narrative also apply to epidemics involving alcohol abuse (or, in the case of the disease I’m about to describe, suspected alcohol abuse)?

From 1915 to 1927, a mysterious illness befell millions worldwide. Its symptoms were wide-ranging—no two patients presented exactly the same—and the illness left many of its survivors in a catatonic, semi-conscious state. Those who “awakened” were left with Parkinsonism, psychiatric sequelae, and severe behavior disturbance. Almost as quickly as Encephalitis Lethargica appeared in 1915, it seemingly vanished 12 years later. Thousands around the world, however, lived long past 1927, imprisoned—some for decades—in their own bodies. The lack of attention to this disorder beyond its peak, has, in recent years, earned the disease the moniker “The Forgotten Epidemic.” (Perhaps you’ve heard of the disease thanks to the 1990 Oscar-nominated film, Awakenings, starring Robin Williams and Robert DeNiro, based on the work of Oliver Sacks.)

Yet the history of Encephalitis Lethargica is more than the tale of a forgotten epidemic. It is an illness narrative evoking shifting socio-medical paradigms in the second half of the 20th century that is uniquely tied to the sociomedical response to alcoholism.

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A brief commentary on comments or, “we will figure this shit out”

DontFeedTheTrolls2
“we will figure this shit out” is from a commenter in the youtube debate I discuss in this article. Feel free to comment on this post if you, too, would like to join the figuring out.

youtube comment: “Addiction is such a vague term”
reply: “Disease is also a vague term…we can spend hours picking apart words and meanings”

It is a truth universally acknowledged, that an author who wants to remain in possession of her sanity must avoid reading the comments section of anything she writes. If the internet is a neighborhood into which one might enter to tell a truth about something personal, if I may borrow again from Jane Austen, an author must accept that her words are taken as the rightful property of some one or other of the many trolls lurking in the deep recesses of the intertubes. Here at Points, we screen comments in order to keep nasty, provocative, or derailing comments out of the mix (this post being the exception), but elsewhere, they flourish like kudzu.

Perhaps it was morbid fascination that drew me to explore some of these cesspools pockmarking our information superhighway, so I donned my emotional hazmat suit and clicked my way in to the comments sections.

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Brides and Booze: The Alcoholic Wife in Mid-Century Pulp Fiction

“How should he handle his alcoholic wife,” asks the lurid cover of the 1960 novel Alcoholic Wife by G.G. Revelle. “Beat her? Cater to her inflamed desires? Overlook her drunken intimacies with other men? Desert her for his seductive mistress?” With a retail price of 35 cents, the volume helpfully included a list of other Beacon Book titles that readers might enjoy, such as Footloose Fraulein and Trailer Tramp. Yet Alcoholic Wife was not just entertainment, but an examination of a growing social crisis, as the back cover promised: “This novel courageously tackles the problem of the drinking wife—today more common than ever before!”

Cover of novel Alcoholic Wife
Cover of novel Alcoholic Wife

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Complete Quarterly Journal of Inebriety (1876-1914) Now Available Online

Editor’s note: This is an exciting development for researchers in addiction history and a welcome contribution from Weiner and White.

After more than a decade of persistent searching and meticulous collecting, a team led by historian William L. White and Hazelden Library Manager Barbara Weiner has acquired and digitized all 141 issues of the Quarterly Journal of Inebriety, which, from 1876 to 1914, documented the earliest stages of addiction medicine in the United States.

QJI issue 2 masthead clean editedThe Quarterly Journal of Inebriety (QJI) was published by the American Association for the Study and Cure of Inebriety (AACI), a group of managers and doctors that formed in 1870 to normalize and improve practices at the residential treatment institutions that had been springing up since midcentury. Its sole editor for 38 years was T.D. Crothers, superintendent at the Walnut Hill Asylum in Hartford, Connecticut and a leading advocate of the medical treatment of inebriety until his death in 1918. The QJI‘s central principle was the disease concept of alcohol and opiate inebriety and although it announced the AACI’s position on various issues, its commitment was to medical knowledge over moral or legal polemic. It was received with some hostility by critics of the disease concept, as well as by temperance advocates and religious reformers refused publication by Crothers for their unscientific approaches. It folded, upon the collapse of the field it represented, when public and political attention to the issue shifted decisively from individual vulnerabilities to dangerous–soon to be illegal–substances (Weiner and White, 2007, see below).

“As the nation’s first scientific addiction journal, [QJI] remains an important resource for us today, in terms of setting contemporary issues in historical context,” said White, emeritus senior research consultant for Illinois-based treatment provider Chestnut Health Systems. “I’m proud that we’ve been able to make it readily and comprehensively available to the public.” White began collecting issues while doing the research for his monumental history of addiction treatment, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (1998). Weiner and her team at Hazelden took up the project in 2000. Read More »

Does “Public Health” Really Want To Own Addiction?

Editor’s Note: Guest blogger and medical anthropologist Kim Sue returned from a recent conference entitled “From Punishment to Wellness: A Public Health Approach to Women and the War on Drugs” with some questions about the coherence of the public health paradigm.

To celebrate the release of a joint report published by the New York Academy of Medicine (NYAM) and the Drug Policy Alliance (DPA) entitled a Blueprint for a Public Health and Safety Approach to Drug Policy, WORTH (Women on The Rise Telling Herstory) organized a conference focusing on women and the War on Drugs. The conference brought together formerly incarcerated women, direct service providers, researchers, policy analysts, and advocates and activists to discuss how to move from a criminalization model of drug use to a public health model. “The war on drugs is more than a failure,” the organizers announced. “It has swollen the prison system, left millions of people with criminal records and damaged communities.” The one-day event was aimed at exploring “practical examples of public health alternatives,” through discussions around four main themes: prevention, treatment, harm reduction, and safety.

Thinking through public health at the New York Academy of Medicine.
Thinking through public health at the New York Academy of Medicine.

What was interesting to me during the panel sessions and the break-out groups was the relative absence of public health professionals and clinicians in these discussions (one notable exception was Professor Lynn Roberts of Hunter College’s Department of Community Health). While “public health” was one of the buzzwords of the day, it seemed to stand in for other things that the conference attendees were actually more interested in talking about: structural violence, poverty, racism, patriarchy—often referred to as the “structural determinants of health.” One possibility is that “public health” was being used rhetorically as a means to talk publicly and politically about race, class, gender and various axes of social inequality under “public health’s” cloak of respectability.

There was some discussion of specific legislation and public-health oriented programming by several of the speakers—for example, Good Samaritan Acts, needle exchange programs, the decriminalization of sex work, and bills against the criminalization of HIV status—but the conference neglected how the massive apparatus of the War on Drugs endeavor will be “public health-ified” on a large scale. What will be the unintended consequences of doing so?

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The Authority of What Experience?

In most cases, people gain expertise through direct experience. This is not true when it comes to addiction, where legitimate expertise is derived from a lack of direct experience. There are many reasons for this, including cultural investment in educational prestige, faith in systems of authority, resentment of those who take their pleasure in what Derrida calls “an experience without truth,” and a distrust of addicts, who are “by class the most lying, scheming, dishonest group of patients.”

addiction medicine
That quote about lying drug addicts is from this new report, “Addiction Medicine: Closing the Gap between Science and Practice,” which was released by the National Center on Addiction and Substance Abuse at Columbia University.

So when it comes to talking about addiction with any sort of legitimate authority, we generally turn to those with letters after their name rather than those with addiction in their background. The field of expertise has changed over time, from moral to legal to medical but, with very few exceptions, addicts have not been included in the cohort of experts.

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Setting the Record Straight, Part 5: A Disease They Didn’t Have

Editor’s note: Today marks the final installment of guest blogger Marcus Chatfield’s eye-opening exploration of the role that peer-reviewed research played in facilitating the survival of Straight Inc. into the 1990s, as well as its ongoing legacy in coercive youth drug abuse treatment.

In the 1989 Journal of Substance Abuse Treatment article “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.”, Alfred S. Friedman, Richard Schwartz, and Arlene Utada state that 99 percent of Straight’s clients were white and that 30 percent of clients attended church regularly prior to intake. It is relevant to consider the type of teens that were recruited for “treatment,” as well as how they were recruited for treatment and why their parents placed them in Straight. Notably, several authors have reported that many clients at Straight were treated for a disease they didn’t have. This was due in large part to Straight’s assertion that even the experimental use of alcohol or marijuana was the symptom of a disease. And because this disease was the cause of even initial drug use, treatment was required whether teens had experimented with drugs or not. Many clients in Straight were “dry druggies” who had never used an illegal substance but were displaying “druggie behavior.”

Spot the druggies.
Spot the druggies.

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Setting the Record Straight, Part 2

Editor’s note: Today guest blogger Marcus Chatfield continues his series on Straight, Inc. and the research it used to burnish its reputation in the 1980s.

As part of my research I sent a questionnaire to 12 former clients of Straight, some of whom I was in treatment with. My purpose was to collect testimony that would help explain the findings of Friedman et al., and to help raise awareness about the abuses that went on in Straight. I asked participants to reflect on their experiences in Straight and compare their current perspective with their perspective immediately following treatment. Their reports also included descriptions of broken relationships with parents, intensified drug use in the first few years after graduation, and long-term trauma resulting from coerced participation in the program. All of the participants reported being “extremely dissatisfied” now but most reported high levels of satisfaction with their treatment during the time soon after their release. As one former staff member responded, “my answers to these questions are completely different than they would have been immediately after completing aftercare because I was still brainwashed by Straight’s doctrine well beyond my involvement with Straight.”

Large group therapy
“Large group therapy process” (Straight brochure)

The only peer-reviewed research specific to clients of Straight was conducted by Straight’s own Medical Director, Richard Schwartz. Looking at the history of the program, it appears that this research began during a financially critical time.Read More »

Confessions of an Historian of Secrecy, Science, and the Self

Editor’s note: We continue our celebration of the 40th anniversary of the publication of David F. Musto’s book with a contribution from cultural historian and American Studies scholar Timothy A. Hickman, whose first book, The Secret Leprosy of Modern Days, reconstructs (and deconstructs) the entrepreneurial therapeutics of the late 19th century historical world inhabited by Dr. Leslie Keeley, proponent of the famous “Gold Cure” for inebriety. Hickman recounts grappling with Musto’s capacious framework in the context of a post-Foucauldian intellectual moment.

Most historians of drugs and alcohol get used to the question, “So how did you get interested in THAT topic,” usually punctuated by a cocked eyebrow and an arch chuckle. My interest arose during the popular recovery movement of the late 1980s, when I read “As Sick as Our Secrets,” a Summer 1990 LA Weekly article by writer Helen Knode, who detailed her family’s troubles with substance dependence over the years. I was particularly taken by her claim that, if one were to multiply the number of “addicts” by the number of “co-dependents” asserted by recovery writers, the product would exceed the entire US population!

The fonts were just a symptom.
Bad fonts were a symptom.

What fundamental beliefs might underwrite the diagnosis of the entire American population as “dysfunctional”? Whose interests were met in defining a whole population as a target for therapy? What institutions benefited? What did this state of affairs suggest about American society, and why did millions of people ‘Just Say Yes’ to the recovery movement’s call?  Still more pressingly, what kind of a “disease” required confession as the first step to cure?

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‘The American Disease’ Turns Forty

Editor’s Note: This spring marks 40 years since the first publication of The American Disease: Origins of Narcotic Control, the groundbreaking book by David F. Musto (1936-2010). In honor of this anniversary, Nancy D. Campbell has organized an online symposium at Points this week on Musto’s book and its impact, featuring leading drug historians. The symposium begins today with a reflection by David T. Courtwright, Presidential Professor of History at the University of North Florida. Courtwright discusses the origins and publishing history of The American Disease, and the role it played in his own career as a drug historian, which has produced such similarly lauded works as Addicts Who Survived: An Oral History of Narcotic Use in America, Dark Paradise: A History of Opiate Addiction in America, and Forces of Habit: Drugs and the Making of the Modern World.

In 1968 Dr. Stanley Yolles, the Director of the National Institute of Mental Health, assigned a young physician named David Musto the task of investigating the history of the narcotic issue. Yolles was particularly interested in the narcotic clinics that briefly flourished in the early 1920s. Musto, then attached to the U.S. Public Health Service, dutifully began reading documents in the National Archives and the Library of Congress. He made two discoveries. The first was that almost no one before him had bothered to use archival sources. The second was that these sources did not line up with either the medical-reformist or police-enforcement versions of the past. “These ‘histories,’” Musto wrote, “appeared to be more in the nature of political party platforms than accurate descriptions of the process of narcotic control in the United States.”

This defect Musto corrected in The American Disease (1973), whose fortieth anniversary falls this year. What his book conveyed was the contingency and complexity of narcotic control. It untangled American drug policy’s serpentine roots, showing how narcotic abuse and addiction, diplomatic maneuvering, muckraking journalism, racial anxieties, pharmaceutical and medical lobbying, and moral entrepreneurship all affected early laws and treaties. Federalism further complicated the story. In the early twentieth century many Americans questioned whether and to what extent the federal government had jurisdiction over drug control. The matter ended up in the Supreme Court, which in 1919 narrowly upheld both the constitutionality of the Harrison Narcotic Act and federal prosecutions of individual physicians who wrote large numbers of prescriptions to maintain addicts’ habits.

Yale University Press ad for the 1973 edition of 'The American Disease'.
Yale University Press ad for the 1973 edition of ‘The American Disease’.

It was the constitutional questions that first led me to the book. In 1975 I was a Rice University graduate student in Harold Hyman’s legal history seminar. I was struggling to understand the ban on addict maintenance, which had only recently and grudgingly retreated before the methadone revolution. My first thought, as I thumbed through The American Disease, was one of disappointment. Someone had already published a big book—with Yale University Press, no less—on my intended subject.Read More »