Thursday, January 1, 2009

Review: Jean-Charles Sournia, A History of Alcoholism, Oxford, Basil Blackwell, 1990, 8vo, pp. xix, 232, illus., L 25,00.

Jean-Charles Sournia is both an eminent French historian and Vice President of the French Government's Commission on Alcohol. A history of alcoholism is the English translation of his ambitious attempt to chronicle how attitudes toward the excessive consumption of alcohol have changed through time. Both the structure of this book and its point of view reflect the author's dual perspective. While the first two sections of the book present a more or less narrative account of the history of the subject up to 1950, the third section largely an explication of enlightened late twentieth century views. Sournia is well aware of the limitations of these views. Nonetheless he writes both as an historian and as an advocate of what he regards as humane non-judgmental contemporary approaches to the problems of excessive drinking.
A history of alcoholism is inevitably a history of the shifting boundary between moral and medical or scientific attitudes toward excessive drinking. As Roy Porter comments in his introduction to Sournia's book, many recent historians have adopted a skeptical and even hostile stance toward the motives behind efforts at "medicalization." Sournia does not engage in this kind of analysis. His book is not, however, an argument for the power of medicine either.While Sournia accepts the idea that alcoholism is a disease, he insists that it is not a "disease like any other." Had it been, he argues, Western society might have come to terms with it. Sournia does accept the popular contemporary view of alcoholism as complex bio-psycho-social problem. This vantage point has the virtue of allowing him to see medical history against the background of the social, economic and political factors involved in controlling the production and consumption of alcohol.
The first section of the book covers the nineteen centuries before 1850. While necessarily sketchy, it is broad in scope. Among many other things, Sournia briefly mentions a number of drink-related incidents in the Bible, pauses to speculate on the role of alcohol in the death of Alexander the Great, sketches the spread of distilled drinks through Europe, and indicates the views of early medical writers such as Rush and Trotter. If a theme ties this overview together it is Sournia's observation of the limited role medical thought played in early approaches to excessive drinking.
In his second section Sournia looks much more closely at the period from 1850 to 1950. He begins with a chapter on Magnus Huss, who coined the word alcoholism in 1849 and whose work ushered in the era of intensive medical scrutiny of excessive drinking. Following this he wisely chooses to treat the complex ideas and events of the period both thematically and chronologically with separate chapters on drinking habits, medical ideas, temperance efforts and the interaction between late nineteenth century medical thought and the tremendous anxiety that was felt over the role of alcohol in corrupting Western society.
The final section of his book is devoted to recent efforts to acheive an adequate understanding of and treatment for alcoholism. Here his book reads, at times, less like history and more like a review of the literature on enlightened approaches to the many problems created by alcohol. His review of late twentieth century views is judicious and balanced though some doctors might take issue with him on certain points. American readers might also feel that he doesn't give sufficient credit to the tremendous impact of self help groups such as Alcoholics Anonymous.
Sournia's ability to cover a great span of time coherently and lucidly, as well as to consider variations between different countries and religions is truly remarkable. Because of its comprehensive scope and attention to detail this book will serve as a useful orienting reference for those planning to make more detailed studies in the history of alcoholism. As a French historian he understandably pays more attention to his own country than to others, but this should be a benefit to readers of this English translation. While his identification with the currently popular bio-psycho-social point of view leads him to make a number of unhistorical judgments as, for example, when he dismisses nineteenth century biological theories as "simplistic," it also allows him to insist on the complexity of the unsolved problem of excessive drinking. Overall the combination of Sournia's commitment to humane, non-judgmental approaches to alcohol related problems with his scholarly, lucid, and well translated, prose make this a book well worth reading.
Edward M. Brown
Brown University, Providence R.I.

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