Mrs. Marty Mann and the Early Medicalization of Alcoholism

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She didn't believe clinics could solve all of our problems, but Mann pushed for the acceptance of alcoholism as a treatable, curable disease.

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I'm a big fan of contradictions. Where they occur -- in social movements, in ideology, in programs of action -- they tend to highlight the underlying compositional character of human enterprises. Thus contradictions also provide occasions where the contributing strands of such enterprises may be more easily separated out for examination. (Comedians, of course, love contradictions too -- because they highlight our foolishness as a species.) Below, I examine an intriguing contradiction lodged in one of the deep assumptions of the modern alcoholism movement.

The alcoholism movement sought to popularize the notion that alcoholism was a disease or illness phenomenon. In that sense -- and understood at face value -- the movement also sought to medicalize alcoholism. Yet, Alcoholics Anonymous, whose emergence was arguably the deep underlying force in the development of the alcoholism movement, offered an essentially lay and spiritually oriented approach to alcoholism. Moreover, whereas a fully medicalized view of alcoholism might promote the appropriateness of alcoholism treatment as offered, say, by psychiatrists, other M.D.s, psychologists of various stripes, and hospitals and clinics, AA arguably emerged in response to the past failures of these medical efforts respecting alcoholism's treatment; AA offered an alternative to alcoholism's past medical handling. Hence, if AA was the institution that, deep down, drove the modern alcoholism movement and if the movement's ideological centerpiece, the disease concept of alcoholism, sought to medicalize alcoholism, then, and therefore, AA was fostering (albeit indirectly) an idea that ran counter to its own program and philosophy.

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Not the least interesting aspect of this suggested contradiction is how little attention it has garnered in the literature on alcoholism and the modern alcoholism movement over the years. Perhaps the notion that AA and the disease concept are happy complements to each other is just too familiar by now to raise eyebrows regarding this underlying dissonance. Yet, the contradiction did not go entirely unnoticed, either. In 1945, in Texas, soon after the launch of Mrs. Marty Mann's National Committee for Education on Alcoholism (NCEA), a local NCEA organizer named Julian Armstrong wrote Mann a letter objecting to the medicalizing aspect of her disease concept campaign. Conventional medical and psychiatric treatment programs, Armstrong suggested, didn't work. Moreover, Mann, as a member of AA, Armstrong added, knew they didn't work. So why, Armstrong asked, was Mann promoting the appropriateness of all kinds of treatment responses to alcoholism as part of her alcoholism-is-a-disease campaign?

Mann's reply to Armstrong was both fascinating and revealing. She agreed with Armstrong regarding the inefficacy of conventional medicine regarding alcoholism; she also vouchsafed her commitment to AA and its less-than-generous opinion of conventional treatment enterprises. "Not that I, as a dyed-in-the-wool AA," she wrote to Armstrong in reply,

believe that clinics, or any other medical or psychiatric means can straighten out very many "alkies" (although I know it can in some instances, here and there) but I do believe that the average individual will more readily go into a clinic to find out what to do for what ails them than they will investigate a layman's organization such as ours. And also I believe that the very presence of a clinic will emphasize and advertise to the uninitiated that alcoholism is a disease which is to be treated, not hidden or punished.

It bears noting that Mann's apparent support and promotion of various conventional medical and psychiatric approaches to alcoholism treatment was a theme she carried forward into both her Primer on Alcoholism (1950) and New Primer on Alcoholism (1958). In other words, this aspect of her promotional enterprise was by no means a passing or incidental element.

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Ron Roizen is an independent scholar and author of some of the earliest interdisciplinary studies of the alcoholism industry. He works in Kaye Fillmore’s research group at the Scientific Analysis Corporation in San Francisco and Alameda, California.

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