Psychiatry and addictions in Europe in the 20th century
26-27 January 2023, Strasbourg, France.
Submission and deadline information
“The inebriate although appearing to be in possession of his mind, will always be found on the other side of that mysterious border-line of mental health[i].” This observation by physician Thomas Crothers in 1881 is indicative of the fact that alcoholism was never integrated without controversy into the field of psychiatry[ii] – and the same holds true for other types of addiction. Historians have shown how social attitudes to the use of addictive substances have evolved over time. They have highlighted the interconnectedness of the history of substances such as opiates, tobacco or alcohol, which were at times incorporated into the same frame of reference, or at other times considered and handled separately[iii].
The goal of this international colloquium is to explore psychiatry’s contribution to the troubled and non-linear[iv] history of the medicalization of addictions in Europe throughout the 20th century. This question should be explored through the lens of medical concepts, institutions of care and cure, as well as patients’ experiences. At the same time, our aim is to explore how psychiatric archives may renew the social history of drugs. Proposals can be made along the five lines of enquiry that we present below.
1. Psychiatry and the medicalization of alcoholism and drug consumption
Various works have charted the emergence of the “disease concept” of alcoholism or drug addiction[v]. But was this disease concept predominantly a psychiatric one? When were alcoholism or drug consumption encompassed in the domain of mental illness – and were they seen rather as a cause, a consequence or as types of mental trouble in themselves? How did psychiatry integrate the concepts of inebriety, toxicomania, etc., to conceive the interrelations between alcohol, tobacco and other drugs, and how were these concepts replaced by the notion of addiction? How did psychiatrists interact with other actors involved in the care and cure of alcoholics and drug addicts, such as self-help or users’ movements, other physicians, or actors from the penal system? Finally, does the recent rise of addictology and neurobiology lead to a ‘depsychiatrization’ of addiction[vi]?
2. Addicted patients and psychiatric institutions
Lunatic asylums have long remained the main locus of care for alcoholics. What about other types of drug users? When and how did specific institutions (public as well as private) for the care of alcoholics and drug users emerge? How did the 20th century shift to outpatient care[vii] transform the psychiatric care of addiction? Were psychiatrists able, through consultations, dispensaries, and day clinics, to reach new types of drug users?
3. Psychiatric practices of cure and care
The tension between cure and coercion – at the heart of all psychiatric cure – tends to be exacerbated in the case of addiction, since, on the one hand, the patient’s desire to heal is seen as essential to success, whereas, on the other hand, the will to impose abstinence may encourage the use of coercion[viii]. How have psychiatrists conceived the role of coercion and constraint in the cure of their addicted patients? When and how did a psychotherapeutic perspective on drug consumption emerge, and how were psychiatric interpretations transformed by the advent of psychoanalysis? How was psychiatric care articulated with social work, and how were the addicted patient’s families integrated into the picture throughout the 19th and 20th centuries? Finally, the changing role of medication in the cure of alcoholism and drug addiction can be explored. How did psychiatry’s use of psychoactive substances contribute to the shifting of the boundaries between legal and illegal substances, between use and abuse? When and how was the problem of iatrogenic toxicomania tackled by psychiatrists?
4. National paths and international circulations
Another important area of investigation concerns the diversity of national responses to drug consumption. Patricia Prestwich has described how, starting from the mid-19th century, alienists were able to achieve an almost absolute monopoly (conceptual as well as institutional) over the question of alcoholism in France[ix]. But the role of the psychiatric profession was much more limited in other countries. What explains these differences? What role did transnational circulations and international psychiatric congresses play in the evolution of conceptions regarding alcohol and drug consumption?
5. Psychiatric archives as new sources for a social history of addictions
Psychiatric archives – and especially admission registers and patient files – usually contain very rich biographical material, which can be used to write a social history of alcohol and drug consumption, bringing new perspectives on a topic that is usually studied from the lens of legislation and public policies, or from that of cultural representations[x]. What can we know of the social background and biographical trajectories of addicted patients in psychiatric institutions? Psychiatric archives can also be very instructive on the question of the gendered uses and practices surrounding drugs. Finally, taking up the perspective of the “patient’s view”[xi], can psychiatric patient files be a way to uncover the voice of drug users?
[i] Thomas D. Crothers, “What Shall We Do with the Inebriate?”, Alienist and Neurologist, No. 2, 1881, p. 175.
[ii] Waltraud Ernst and Thomas Müller (eds.), Alcohol, psychiatry and society. Comparative and transnational perspectives, c. 1700-1990s, Manchester, Manchester University Press, to be published, October 2022.
[iii] Virginia Berridge, Demons. Our changing attitudes to alcohol, tobacco, and drugs, Oxford, Oxford University Press, 2013; David Courtwright, Forces of Habit. Drugs and the Making of the Modern World, Cambridge, Harvard University Press, 2001; David Herzberg, “Boundaries in the History of Alcohol, Drugs, and Medicines”, Social History of Alcohol and Drugs, Vol. 26, 2012, pp. 117–121.
[iv] On this idea of the non-linearity of the process of medicalization, see Dominique Vuillaume, “Interdire l’alcool ou soigner l’alcoolisme ? Flux et reflux de la médicalisation de l’alcoolisme aux États-Unis (1860-1995)”, Sciences sociales et santé, Vol. 34, 2016/4, pp. 5–31.
[v] Nicolas Fortané, “La carrière des ‘addictions’. D’un concept médical à une catégorie d’action publique”, Genèses, No. 78, 2010/1, pp. 5–24; H. Levine, “The discovery of addiction. Changing conceptions of habitual drunkenness in America”, Journal of Studies on Alcohol, Vol. 39, No. 1, 1978, pp. 143–74; Terry M. Parssinen and Karen Kerner, “Development of the disease model of drug addiction in the UK, 1870-1926”, Medical History, No. 24, 1980, pp. 275-296; Roy Porter, “The Drinking Man’s Disease: The ‘Pre-History’ of Alcoholism in Georgian Britain”, British Journal of Addiction, No. 80, 1985, pp. 385–396.
[vi] Virginia Berridge, “Was addiction psychiatry an accident in history?”, The Lancet Psychiatry, Vol. 3, October 2016, pp. 927–928.
[vii] Despo Kritsotaki, Vicky Long et Matthew Smith (eds.), Deinstitutionalisation and After. Post-War Psychiatry in the Western World, London, Palgrave-Macmillan, 2016.
[viii] For an exploration of this tension between freedom and constraint in the ‘technologies of recovery’ from alcoholism, see Mariana Valverde, Diseases of the Will: Alcohol and the Dilemmas of Freedom, Cambridge, Cambridge University Press, 1998.
[ix] Patricia E. Prestwich, Drink and the politics of social reform: antialcoholism in France since 1870, Palo Alto, Society for the promotion of science and scholarship, 1988, 365 p.
[x] See, for example, the use of hospital records by Katariina Parhi to document drug use in Finland: Katariina Parhi, “No Coming Back to Sick Society: The Emergence of New Drug User Segment in the Järvenpää Social Hospital in Finland, 1965–1975”, Journal of the History of Medicine and Allied Sciences, Vol. 76, No. 4, pp. 417–439.
[xi] Alexandra Bacopolous-Viau and Aude Fauvel, “The Patient’s Turn. Roy Porter and Psychiatry’s Tales, Thirty Years on”, Medical History, Vol. 60, No. 1, 2016, pp. 1–18.
Virginia Berridge (London School of Hygiene and Tropical Medicine)
Volker Hess (Charité – Universitätsmedizin Berlin)
Anatole Le Bras (Université de Strasbourg)
Benoît Majerus (University of Luxemburg)
Alexandre Marchant (ENS Paris-Saclay)
Mathilde Rossigneux-Méheust (Université Lyon-II)
Marianna Scarfone (Université de Strasbourg)