 In Mary I. Bockover (Ed.), Rules, Rituals and
Responsibility: Essays Dedicated to Herbert Fingarette, (La Salle,
IL: Open Court) pp. 37-53, 1991
Herbert Fingarette, Radical Revisionist
Why Are People So Upset With This Retiring Philosopher?
Stanton Peele
Morristown, New Jersey
One
would not think of Herb Fingarette as a radical revisionist. A gentlemanly,
soft-spoken man, he has spent his years in philosophy contemplating questions
of behavior and responsibility, writing for legal and behavioral journals,
and participating in learned councils that deliberate on these issues.
This was how he became engaged in the most contentious topic in modern
social science (excluding, perhaps, racial differences in intelligence):
the debate over whether alcoholism is best regarded as a disease.
As a legal/moral philosopher, Herb had long been concerned with issues
of criminal responsibility. In his book, Self-Deception, Herb argued
that explicit consciousness required a person to spell out the motivations
and consequences of his or her actions: the refusal to do so comprised
a particular variety of self-deception.1
One noteworthy consequence of the compromised personal agency brought
on by a person's ignoring, and thereby disavowing, personal engagement
in his or her actions is to undermine moral and criminal responsibility.
If a person is unconscious of how his or her actions lead to harm of others
or what brings on this misconduct, then may he or she not be excused for
these actions?
An opportunity to explore this model was presented for Herb when the
Supreme Court considered the issue of whether alcoholism is a disease
and whether being alcoholic excuses one from criminal responsibility.2
Although, when entering this fray, Herb's sense was that alcoholism had
been established to be a disease, his examination of the issues thoroughly
convinced him otherwise. There was no genetic or other biological explanation
for why a person drinks too much either on a particular occasion or habitually,
why a person commits violent or criminal acts when drunk, why a person
decides that he or she is an alcoholic and that drinking is an excuse
for misbehavior. Instead, Herb saw, drinking was an all-purpose excuse,
a special case of self-deception anointed by science but actually steeped
in the lore of magical "loss of control""I couldn't
help myself"as though this description of irresponsibility
was somehow an explanation and an excuse for it.
Herb's position achieved its greatest notoriety when his work was cited
by the Supreme Court in denying two alcoholic veterans VA educational
benefits they were unable to use within the period established by VA regulations
because, they claimed, they were alcoholics. In other words, they spent
so much of this time drinking that they didn't feel like going to school,
a situation they claim was brought on by the disease of alcoholism from
which they suffered. One irony in this case was that, although the VA's
position was that these men engaged in willful misconduct rather than
manifesting a disease, the VA treatment creed is very much one based on
the disease model. The VA expressed a different, sensible position in
this case because to do otherwise would simply overwhelm the federal government
with unimaginable claims it owed people who were too drunk to demand them
at some time in the past.
As a psychologist, I am interested primarily in the psychological implications
of disease views of human behavior, and of the excuse-making and lack
of self-awareness they signify. Herb Fingarette has addressed these issues
as a philosopher. In his book Heavy
Drinking: The Myth of Alcoholism as a Disease, Herb makes clear
that it is both more accurate and more useful to think of heavy drinking
as a "way of life" than as a disease. Herb's great achievement
was, with the dispassion of a professional philosopher and the compassion
of a concerned human being, to dispose of the fallacy that the only alternative
to treating alcoholism medically as a disease is to treat it punitively
as a sin or a crime:
There is no reason to see heavy drinking as a symptom of illness, a
sign of persistent evil, or the mark of a conscienceless will. Rarely
do people choose a destructive or self-destructive way of life. On the
contrary, we shape our lives day to day, crisis by crisis.... We each
share the propensity to choose opportunistically when under stress.
So, on a series of occasions, a drinker chooses what seems the lesser
evil, the temporarily easier compromise, without a clear appreciation
of the long-run implications.
If our righteous condemnation is not in order, neither is our cooperation
in excusing heavy drinkers or helping them evade responsibility for
change. Compassion, constructive aid, and the respect manifest in expecting
a person to act responsiblythese are usually the reasonable basic
attitudes to take when confronting a particular heavy drinker who is
in trouble . . . . 3
Herb makes clear that the disease model, by dismissing the heavy drinker's
responsibility for his or her excesses, also denies the drinker's responsibility
to change his or her way of life in ways that matter:
Instead of encouraging those concerned to see the drinking in the context
of the person's way of life, and thus to discern what role or roles
it may play for that person in coping with life, the logic of the disease
concept does the contrary. It leads all concerned, including the drinker,
to deny, to ignore, to discount what meaning that way of life may have.
Seen as an involuntary symptom of a disease, the drinking is isolated
from the rest of life, and viewed as the meaningless but destructive
effect of a noxious condition, a "disease."4
He then asks a key question:
But what if this is totally wrong? What if that life reflects,
perhaps unwisely and obscurely, the drinker's attempts to cope with
feelings, emotions, attitudes, relationships that are not acceptable
to othersperhaps not fully acceptable even to the drinkerbut
that are, for better or worse, those that surge up in the drinker's
soul?5
In other words, what if you accept the disease theory's seductive offerthat
of viewing your desire to drink and your difficulty in controlling your
drinking as alien to you, as having some mysterious biological, perhaps
genetic cause? With great relief, you find yourself "off the hook."
Meanwhile, though, you still can't talk to your spouse, or you still feel
inadequate at your job. What have you accomplished? You haven't dealt
with your drinking or your life. This, according to Fingarette, is the
self-deception engendered by the disease notion of alcoholism,
which only adds to the confusion and paralysis experienced by the heavy
drinker. This self-deception is expressed, for example, in the claim that
the alcoholic who is completely incapable of control after taking one
sip can nonetheless be held rigidly responsible for controlling the urge
to take that sip. As a description of human motivation and behavior, this
quick shift from complete control to loss of control doesn't ring trueand
the drinker knows it.
Is it possible that Herb might not have fully recognized the kind of
response that writing an iconoclasticif truthful book on alcoholism
would elicit? For the reaction his book aroused was immediate and brutal.
In the same year Heavy Drinking was published, a member of his
own faculty at the University of California at Santa Barbara (William
Madsen, Department of Anthropology) published an entire pamphlet whose
sole purpose was attacking Herb and his book.6
It was as though, out of the imminent danger that some unsuspecting lamb
would be led astray by Herb, it was necessary to produce a concordance
which any reader of Heavy Drinking must keep by his or her side
for instant refutation of Herb's heresies, even though thousands of popular
works already exist to promote the disease position Herb refuted.
There are many intriguing aspects to Madsen's broadside. I select one,
based on Herb's mild-mannered proposition (or at least what would appear
to be such in any other than the alcoholism field) that we "view
alcoholism pluralistically" and try a variety of approaches to treating
alcoholism. In particular, Herb proposedsince studies of public
alcoholism facilities consistently find that fewer than 10% of graduates
abstain for any period following treatmentthat some goal of moderated
drinking be included in the panoply of therapies for and accepted outcomes
of alcoholism treatment.
Madsen, typical of representatives of the alcoholism field who find
this an intolerable heresy, responded to Fingarette's summary of information
indicating that moderation training and treatment goals can be useful
by referring to the "most impressive and precise study" ever
conducted on the subject of moderate-drinking. This penultimate study,
Madsen claimed, can once and forever lay to rest the dangerous idea that
some alcoholics reduce their drinking problems without abstaining. The
study, which appeared in the New England Journal of Medicine and
was authored by John Helzer and his colleagues at Washington University's
School of Medicine, dealt with outcomes among a highly alcoholic hospital
population.7 Madsen summarized the study
as proving that, since only 1.6% of hospitalized alcoholics resumed moderate
drinking, that "to urge alcoholics to try for a goal with a demonstrated
failure rate of 98.4% is madness."
Philosophically minded readers may recognize in this statement the logical
fallacy of the excluded middle, where, since the researchers defined 1.6%
of patients as moderate drinkers, Madsen concluded everyone else failed
at this goal. One might deduce from Madsen's description of a 98.4% failure
rate for moderate drinking that the hospitals in this study pushed controlled-drinking
therapy. In fact, these hospitals in all likelihood recommended total
abstinence to alcoholic patients. Actually, not all of the hospital units
where alcoholics were treated offered specific therapies for alcoholism;
only one of the four was an inpatient alcoholism ward. And the alcoholism
unit had the worst outcomes of any of those studied, showing one
half the remission rate (among survivors) of a medical/surgical ward.
Indeed, from five to seven years after treatment, only 7% of those in
this inner-city alcoholism ward survived and were in remission!
Based on these data, one would think humility was called for in discussing
current hospital treatments for alcoholism, rather than the cocksure rejection
by Helzer et at. and Madsen of an alternative approachone that was
not actually tried in the study under consideration. Could not someone
say that this study demonstrated primarily the failures of standard therapy
and the need to consider alternative approaches? In another piece of research
on hospital treatment of alcoholism, Edward Gottheil of Jefferson Medical
College reported that from 33% to 59% of patients engaged in some moderate
drinking during a two-year follow-up of alcoholics treated at a VA hospital;
only 8% of this hospitalized group abstained throughout the two years.
Gottheil commented:
If the definition of successful remission is restricted to abstinence,
these treatment centers cannot be considered especially effective and
would be difficult to justify from cost-benefit analyses. If the remission
criteria are relaxed to include . . . moderate levels of drinking, success
rates increase to a more respectable range . . . . [Moreover] when the
moderate drinking groups were included in the remission category, remitters
did significantly and consistently better than nonrermitters at subsequent
follow-up assessments.8
What actually did occur for the remaining 98.4% of the surviving Helzer
et al. subjects (a question that the actual research answers in some detail,
although the authors of the New England Journal article do not
emphasize these results)? Fifteen percent of them were abstaining at the
point when they were assessed from five to seven years later. We don't
know to what extent they did or did not try moderate drinking previously.
Another group, consisting of 4.6% of treated patients, did drink exclusively
in a moderate manner, but in fewer than thirty months during the three-year
assessment period. While Helzer et al. did not define these as moderate
drinkers, many would say they were. They certainly were not failures at
attempts at moderate drinking. Finally, another 12% of these patients
admitted that they had more than six drinks on three occasions during
at least one month in the previous three years, but claimed they had had
no drinking problems over these three years.
These patients, Helzer et al. believed, were denying their continued
alcoholism. And to prove it, the researchers checked with relatives of
these patients and hospital and other records to see if they could find
proof of continued alcoholic problems. The investigation turned up none,
so that Helzer et al's decision to say these patients were "in denial"
was based on an a priori conclusion about the nature of alcoholic patients,
i.e., that they can't drink again without problems. Overall, then, the
Helzer study foundamong alcoholic survivors of hospital treatmentthat
6% had been drinking moderately or lightly for three years and that 12%
had had at least one intermittently heavy drinking period (lasting for
as little as a month) over three years but said they had no more drinking
problems, while no evidence or collateral reports could be found to gainsay
them. It might seem that Madsen's statement that Helzer et al. "demonstrated
[a] failure rate of 98.4%" for controlled drinking clearly misstates
the actual situation.
Madsen himself claims not to be against controlled-drinking therapy,
and he doesn't even think it is that hard to practice successfully. "Any
third-rate counselor should be able to help a non-addicted drinker moderate
his or her drinking," he wrote in his pamphlet (p. 25). The trick,
then, according to Madsen, is to decide who is the non-addicted alcohol
abuser and who is the addicted one. In alcoholism treatment in the United
States, no one takes the trouble to differentiate between the two. For
example, Kitty Dukakis, who began getting drunk following her husband's
1988 presidential election loss, after a lifetime of social drinking,
was taught at the Edgehill Newport Hospital that she was a lifelong alcoholic
who must abstain forever. We might ask whether any alcohol abusers screened
at Edgehill Newport are referred to appropriate outpatient or controlled-drinking
counseling based on their being, in Madsen's words, "non-addicted."
As for real alcoholics, Madsen declares, "Not a single validated
case of a competently diagnosed alcoholic returning to normal drinking
has ever been demonstrated." What, then, about the 1.6% of alcoholics
who returned to moderate drinking (and the additional 4.6% who drank moderately
but too occasionally for Helzer et al. to accept them as genuine moderate
drinkers) in the Helzer et al. study that Madsen cites so enthusiastically?
Was this research incompetently administered, and do we need therefore
to ignore it? If the Helzer et al. study provides the bottom figure for
alcoholics' resuming moderate drinking, the upper figure might be from
a study published in 1987 in the Journal of Studies on Alcohol
by two Swedish physicians who followed socially stable alcoholics two
decades after their hospitalization for alcoholism. "Social drinking
was twice as common as abstinence among the former alcohol-dependent [addicted]
subjects" in this group. This research would represent a considerable
failure at diagnosis and accurate follow-up, according to Madsen, and
one can only marvel that it was accepted for publication at this late
date in the most prestigious American journal devoted to alcohol studies.9
When Herb summarized the material in Heavy Drinking in an article
in the journal Public Interest,10
Madsen once again attacked Herb, in a response published in the same journal.11
Again, Madsen spent quite a bit of spacehalf of his responseon
the issue of controlled drinking, about which Herb had relatively little
to say in his book or article, beyond that it be considered in the context
of the failures of standard treatments, such as that which produced a
remission rate like the 7% Helzer et al. found for inpatient alcoholism
treatment. Meanwhile, private treatment centers charge exorbitant rates
for group therapy and individual counseling that consist primarily of
exhortations to alcoholics to quit drinking, and that have been shown
to have no greater effect than receiving a lecture about the dangers of
alcohol, being prosecuted for a drunk driving arrest, or the simple passage
of time.12
Madsen's Public Interest response contained a prolonged discussion
of the case of Mark and Linda Sobella husband-and-wife research
team who taught alcoholics moderate-drinking techniques before it became
essentially verboten in the U.S. to do so and who subsequently were attacked
in a 1982 article in Science which claimed that few if any of these
treated alcoholics achieved moderation.13
Actually, the Science investigators noted, at least one alcoholic
did become a moderate drinker, but (in Madsen's paraphrase) "this
person may not have been a genuine gamma alcoholic." (Gamma alcoholics
are the same genuinely addicted alcoholics not one of whom Madsen has
said has ever been found to return to moderate drinking.) Madsen attacked
Fingarette in the pages of Public Interest for "lacking all
scientific credentials." He then proceeded to review the Sobell controversy
by referring to the television program 60 Minutes, which ran a
segment on the Sobells' experiment.
Sixty Minutes interviewed a numberbut not allof the surviving
controlled-drinking subjects in the Sobells' study. It did not interview
any of the subjects in a hospital abstinence group that the original experiment
compared with the controlled-drinking subjects. Thus, 60 Minutes
filmed Harry Reasoner walking near the grave of a subject in the controlled-drinking
group in the Sobells' experiment (the first such death occurred eight
years after treatment). However, Reasoner could also have walked near
the graves of many of the hospital abstinence group as well-since more
of them died in the period the Science article studied (and since)
than did those in the controlled-drinking group.
The discovery of the deaths of patients who received standard hospital
abstinence treatment appeared as a result of an investigation of the Sobells'
experiment conducted by a committee appointed by the Toronto Addiction
Research Foundation brought on by allegations of fraud against the Sobells
by one of the authors of the Science article, Irving Maltzman.
This blue-ribbon committee published an exhaustive document, in which
it noted:
The charges made and implied with respect to the Sobells involve the
most serious kinds of allegations it is possible to make against . .
scientist(s). . . . By choosing not to compare the [controlled-drinking]
subjects' outcome with data from an appropriate control group, Pendery
et al. implied that the long-term prognosis of the subjects was worse
than would have occurred with routine treatment. No form of treatment
of alcoholism known to the Committee is clearly perfect for any group;
hence comparisons must be made of treatment groups in order to evaluate
any particular treatment . . . . Science, the activity, would
have demanded such a comparison, even though Science, the magazine,
did not. Ultimately, the goal of the scientific study of alcoholism
is not well served by disputes such as this one.14
Other investigations have been conducted of this research, including
one by the United States Alcohol, Drug Abuse, and Mental Health Administration
(ADAMHA). After taking testimony from all concerned patients and the authors
of the Science article and examining the Sobells' data without restrictions
on two occasions, the ADAMHA committee declared it "did not find
evidence to demonstrate fabrication or falsification of data reported
by the Sobells."15 That Madsen repeated
in a national magazine Maltzman's claims of fraud without citing the Addiction
Research Foundation and other investigations that have exonerated the
Sobells is character assassination and it is reprehensible.
A television crew could also walk near the graves of the subjects in
the Helzer et al. study who were taught to abstain in the hospital but
who died. That many alcoholics whom people try to help don't stop drinking
alcoholically and may eventually die of alcohol-related causes is indeed
tragicbut who should be blamed for this? And who should be praised
for their great success in treating alcoholics? Madsen knows"Treatment
programs based on AA principles, such as the Betty Ford Center, the Navy
Alcohol Program, and the Employment Assistance Programs, have recovery
rates up to 85 percent."16 Indeed,
since nearly every program in the United States is based on AA principles,
America must have one of the most effective treatment systems for this
disorder ever conceived. For the 85% figure to be accurate, almost nine
of ten people who enter treatment must stop drinking alcoholically, whichaccording
to Madsenmeans they stop drinking altogether.
Surely, these are tremendous claims. And one can wonder how Madsen makes
them so confidently, since he referred to no published treatment outcome
research either in his article in The Public Interest or in his
pamphlet. If Madsen has evidence of such sure-fire treatment for alcoholism,
he should perhaps take some greater trouble to make these facts clearer
to others in the alcoholism field. For example, in an editorial in the
Journal of the American Medical Association, Forest Tennant, a
medical researcher, remarked:
The serious problem of alcoholism has been lost in the competitive
hype among alcoholism treatment centers. Any sophisticated critic using
statistical analysis to measure treatment effectiveness is appalled
by the display of a media or sports star claiming cure thanks to a specific
treatment center's helpwhich proclaims 80% to 90% cure rates.17
Another poorly informed person Madsen will clearly want to educate is
the current Director of the National Institute on Alcohol Abuse and Alcoholism,
Enoch Gordis, an alcoholism researcher, who believes:
In the case of alcoholism, our whole treatment system, with its innumerable
therapies, armies of therapists, large and expensive programs, endless
conferences . . . and public relations activities is founded on hunch,
not evidence, and not on science . . . . Yet the history of medicine
demonstrates repeatedly that unevaluated treatment, no matter how compassionately
administered, is frequently useless and wasteful and sometimes dangerous
or harmful. The lesson we have learned is that what is plausible
may be false, and what is done sincerely may be useless or worse.18
One survey of therapies that have been tested in comparison with alternative
treatment in controlled research studies found a number of therapies that
had been shown to work better than not doing anythingand better
than standard treatments that attempt to educate alcoholics by explaining
to them they can't drink normally because they have a disease. These useful
therapies are stress management, aversion therapies, social skills training,
family therapy, a comprehensive job and family-oriented treatment called
the community reinforcement approach, and controlled drinking treatments.
The authors of this surveywho had investigated every single comparative
study of alcoholism treatment ever published in Englishnoted one
strange thing about alcoholism treatment in the United States:
As we constructed a list of treatment approaches most clearly supported
as effective, based on current research, it was apparent they all had
one thing in common: . . . they were very rarely used in American treatment
programs. The list of elements that are typically included in alcoholism
treatment in the United States likewise evidenced a commonality: virtually
all of them lacked adequate scientific evidence of effectiveness.19
Madsenthrough his abstinence monomania; through his self-certain
claims that he knows which treatments work and which don't (while failing
to support his personal knowledge with concrete evidence); through his
cut-and-burn attacks on any alternatives to standard American disease
concepts and medical practices in the alcoholism field; through his totemic
reference to science when he means only to air his own prejudices and
those of the people with whom he agreesactually makes the strongest
case possible for Herb's claim that alcoholism treatment in the United
States is controlled by a group of individuals who, for emotional and
economic reasons, have made what should be a scientific field into a personal
preserve of pride and prejudice.
If (as many people like Madsen believe) conventional treatments for
alcoholism work so well, we might wonder why so many people refuse to
go to them and why there continue to be so many active alcoholics. The
true believers have an answerdenial. These alcoholics deny that
they are alcoholics or that they need the help of AA and similar treatments.
And Fingarette's worst crime, shared by others of his ilk who won't jump
on the disease bandwagon, is in facilitating this denial. Madsen and others,
on the other hand, know through personal experience and/or revealed knowledge
what is true, what is right, and what people must accept for themselves
before they can be cured (or saved). What Herb had run up against is a
religious zealotry and bigotry, and the attacks on him resemble nothing
so much as a modern Inquisition. Madsen wrote:
Fingarette has no trouble demanding responsibility of others, alcoholic
or non-alcoholic . . . . Do crusades like his which urge the alcoholic
to drink and even accept drunkenness show any responsibility at all?
Does he not also have moral and legal responsibilities? He states that
it is too bad statistics don't show the actual blood, suffering and
cadavers produced by alcohol. Yet, I am convinced his crusade will increase
this carnage.
I worry about the responsibility of a reputable academic press Publishing
the Fingarette bookwhich would seem to authenticate its contents
to the public. When others worry about the state of the nation, I, in
particular, worry about how the Supreme Court could soberly consider
Fingarette's "research" as possibly valid.20
People need to be protected from Herb's ideas; publishers need to be
warned of their complicity in publishing what Herb writes; the Supreme
Court has to be persuaded that what Herb says is dangerous (although presumably
able lawyers on the other side did their best to make this clear to the
justices).
Madsen calls, simply and straightforwardly, for suppressing Herb's point
of view, one which Madsen rightly indicates runs counter to orthodox thought
in the United States. The whole debate is one Madsen clearly feels should
never have taken place. Even to publish a book questioning the disease
theory is so dangerous a proposition, one that leads to more deaths of
alcoholics, as to be reprehensible and possibly to create a legal liability
for the writer and publisher. Here, on the other hand, is the writing
of a distinguished disease theorist of alcoholism, psychiatrist George
Vaillant, in his 1983 book, The Natural History of Alcoholism:
It seemed perfectly clear that . . . by inexorably moving patients
from dependence upon the general hospital into the treatment system
of AA, I was working for the most exciting alcohol program in the world.
But then came the rub. Fueled by our enthusiasm, I and the director
. . . tried to prove our efficacy. Our clinic followed up our first
100 detoxification patients. . . . [and found] compelling evidence that
the results of our treatment were no better than the natural history
of the disease.21
Should Vaillant be penalized for not using the correct treatments that
Madsen knows to be successful in treating alcoholism, since Vaillant's
patients did no better than alcoholics who received no treatment? Or should
Vaillant (and Harvard University) be punished for publishing the finding
that the results of standard hospital and AA treatment "were no better
than the natural history of the disease"? Actually, Vaillant escapes
the wrath of Madsen and people like him by simply affirming the verities
of the field which say that alcoholism is a disease and AA is the treatment
of choice, no matter how futile Vaillant's own data indicate this approach
to be. In this environment of intimidation and double-talk, we must be
thankful that someone like Herb Fingarette, a calm and dignified figure
who values dispassionate reasoning and evidence, has the courage to put
the brake to this runaway train of disease imagery and treatment for alcoholism.
Consider that compulsive gamblers now have their own national organizations
and support groups to argue that gambling is an uncontrollable disease
and that the former scientific director of the National Council on Alcoholism,
Dr. Sheila Blume, calls for treatment of gamblers in hospital wards; that
there are similar groups and treatments for sexaholics, compulsive shoppers
and spenders; that the standard defense when mothers kill their infant
children is postpartum depression; or that jurors refused to convict Joel
Steinberg of murder because they felt his judgment was impaired by cocaine,
while many people feel his partner Hedda Nussbaum was suffering from "battered-wife
syndrome," so that nobody was fully responsible in this case as a
little girl's life ebbed away on the bathroom floor while two adults smoked
cocaine nearby. We need people like Herb Fingarette to question this madness.
This volume marks the end of Herb's struggle with the alcoholism establishment,
unless he plans any post-retirement work in the field. He might be forgiven
if he decided after his exposure to Madsen and others that he deserves
a rest from ill treatment and irrationality and from the attacks of people
whose methods contrast so starkly with the reasoned exchanges of the philosophical
discourse Herb Fingarette embodies. It is the shame of the alcoholism
field that sooner or later this is the fate of most good, intelligent
souls who contemplate our alcoholism mess. To research a question only
to be accused of being an unscientific parvenu or, worse, of being a dissembler
and murderer is really too much.
One of Madsen's central criticisms of Herb's work is that Herb is not
an alcoholism researcher or scientist, only a philosopher. But those who
actually work in the alcoholism field let themselves in for far more serious
attacks (if that can be believed) than Madsen's on Fingarette. Consider
the following, very ominous warning issued by John Wallace (clinical director
of the Edgehill Newport Hospital that treated Kitty Dukakis) for psychologists
who consider controlled drinking a possible outcome of alcoholism treatment:
With regard to the controlled drinking issue, I feel that the alcoholism
field has too long suffered these outrageous attacks by certain members
of the "Anti-Traditionalist" crowd. In the interests of our
patients and their families, and in the interests of alcoholics who
still suffer, we must begin to scrutinize more closely the activities
of this group and to take steps to ensure they do no harm . . . . When
thousands of lives and so much human tragedy is [sic] at stake, as they
are in alcoholism and chemical dependence, then we must demand that
the right to freely express our opinions be tempered by reasonable caution,
healthy skepticism, fairness, and attention to scientific method and
data. We must not forget that it is the duty of members of the various
professions to defend the public against quackery.22
This article was entitled "Waging the War for Wellness:II. The Attack
upon the Disease Model." Note the war imagery; this imagery is maintained
in an editorial by the managing editor of the journal in which the Wallace
article appeared. This editor entered the field as an alcohol/drug counselor
and program administrator soon after embarking on his own recovery:
I would find a way to take up the banner against the forces of wealth
and cunning who promote behavioral retraining as a means to avoid the
"penalty" of abstinence borne by those of us who have chosen
the "traditionalist" route to recoverythe only known
route, by the way . . . . The most effective means of spreading truth
and enlisting soldiers to fight the wars against incompetence and deception
is the mass media.23
Incidentally, the author of this call-to-arms received a degree in alcohol/drug
studies and counseling skills from the University of California at Los
Angeles. He will, in turn, teach others in university programs. What kind
of reasoned consideration of the issues can we expect to find in the many
programs run by people like this man in major universities around the
country?
In the long run, unless more of those outside the alcoholism field become
involved in this debate, Madsen and his ilk will prevail with their slanders
and assaults, their crusades against apostasy. The alcoholism field actually
resembles a dysfunctional home dominated by alcoholic parents where irrationality
becomes the norm, where those inside the homeeven those who don't
behave this way themselvesaccept the crazy way things are done as
normal, and where those who blunder in from outside get out as quickly
as they can. Those who step outside the home, as by traveling to another
country, confront another reality:
The ten men and women who live at the Thornybauk recovery home in Edinburgh
have all had trouble with alcohol, but don't call them alcoholics or
suggest that they have a disease. They're problem drinkers. They developed
a dependence on alcohol. They aren't being treated for alcoholism but
are trying to learn to deal with personal problems in a way that avoids
getting drunk. If they want to try to drink again and control it, their
counselors at Thornybauk wouldn't object.
Thornybauk would be considered a novel, if not dangerous, course of
treatment for alcoholism in the United States, where the traditional
disease concept of alcoholism makes total abstinence the widely accepted
goal of treatment. In England and Scotland, and much of the rest of
the world, it's the other way around. The majority of medical and psychiatric
practitioners frown on the idea that persons who have once lost control
of their drinking must, above all, avoid a "first drink" if
they expect to sustain their recovery. In the eyes of these doctors,
it is insisting on abstinence that may jeopardize alcoholic recovery.
They prefer to work with a concept of alcohol dependence which has varying
degrees of severity and may leave the door open for a return to social
drinking by some patients.24
Of course, it is hard to escape your culture to "put on" the
perspective of another nation or, for that matter, of the rest of the
civilized world. It is particularly interesting that Madsen, a cultural
anthropologist, should show the prejudice and narrow-mindedness that provoked
George Bernard Shaw to define a barbarian as one who "thinks that
the customs of his tribe and island are the laws of nature." On the
other hand, it is an act of courage and defiance to shed one's cultural
blinders through the sheer power of one's own thought. That Herb has accomplished
thisand at the same time exposed the peculiarity of the American
system to a broad readership at the cost of attacks on his person and
his professional competencemay be the most commendable of the many
good things he has accomplished in his long and distinguished career.
Afterword
Among other of his character assassinations, Madsen
took Fingarette into the wood shed for mischaracterizing Jellinek's academic
specialty (both in Heavy Drinking and in an earlier piece in The
Center Magazine).
Fingarette, as I have said, has a terrible time with facts. I was asked
to reply to [the Center article]. . . . Among other errors, I pointed
out that E.M. Jellinek was not a "distinguished sociologist."
In his new book, therefore, Fingarette changed this and identifies Jellinek
as a "distinguished biostatistician." He was not a biostatistician.
I DO NOT INTEND TO IDENTIFY JELLINEK'S ACADEMIC AND SCIENTIFIC CREDENTIALS
FOR FINGARETTE. I am sure that with his vast experience in library research
[this is a put-down of Fingarette's lack of experience with actual alcoholics]
he may in time discover the reality for himself. (Madsen, 1988, p. 16)
In general, Madsen's point is that a long line of distinguished scientists
have found the biological/genetic basis for alcoholism, beginning with
Jellinek, who is thus important for establishing the scientific pedigree
for this idea: "Although others had postulated a biological basis
for alcoholism long before Jellinek, he gave this hypothesis strong support
by those who interpreted his 'X' factor as being physiological."
Madsen's cocksure challenge to Fingarette to locate Jellinek's credentials
was actually taken up by another researcher with stunning resultssociologist
Ron Roizen discovered
that Jellinek manufactured his education and degrees! Although Jellinek
was born in America (in Brooklyn), he claimed that his university degrees
were acquired overseas. In the prestigious journal Addiction, head
Rutgers Alcohol Center librarian Penny Page reported that Jellinek "studied
in Germany and France, receiving a master's degree in education and later
an honorary Sc.D. (Doctor of Science) from the University of Leipzig."
Meanwhile, Jellinek's own CV listed attendance at the University of Leipzig
from 1911-1914, accompanied by the notations "M.Ed., 1913" and
"Sc.D., 1936."
Roizen noted that Jellinek, who was Jewish by birth, claimed to have
received a Ph.D. from a German University after the Nazis had solidified
power (which seems highly unlikely). In addition, Jellinek claimed in
his CV to have been director of the Biometric Laboratory at the Memorial
Foundation for Neuro-endocrine Research at Worcester, Massachusetts from
1931-1939.
Roizen wrote to Leipzig and obtained Jellinek's transcript, which showed
that Elvin Morton Jellinek had studied philosophy at Leipzig from November
1911 to July 1913 and from November 1913 to December 1914. Jellinek, however,
received no degrees at Leipzig. Moreover, "Jellinek appears to have
been dropped from the University's rolls in both 1913 and 1914, for failure
to attend lectures or take classes." E.M. Jellinek, Madsen's (and
many other disease theory adherents') hero, after whom the most prestigious
international award for alcoholism research is named, is a liar and a
fraud!
References
- H. Fingarette, Self-Deception (Atlantic
Highlands, NJ.: Humanities Press, 1969).
- H. Fingarette, "The Perils of Powell: In
Search of a Factual Foundation for the 'Disease Concept of Alcoholism,'"
Harvard Law Review 83 (1970): 793-812; H. Fingarette and A. F.
Hasse, Mental Disabilities and Criminal Responsibility (Berkeley:
University of California Press, 1979).
- H. Fingarette, Heavy
Drinking: The Myth of Alcoholism as a Disease (Berkeley: University
of California Press, 1988), pp. 111-12.
- H. Fingarette, "Alcoholism and Self-Deception,"
in Self-Deception and Self-Understanding: New Essays in Philosophy
and Psychology, ed. M. W. Martin (Lawrence, Kans.: University Press
of Kansas, 1985), pp. 60-61.
- Fingarette, "Alcoholism and Self Deception,"
p. 61.
- W. Madsen, Defending the Disease: From Facts
to Fingarette (Akron, Oh.: Wilson, Brown & Co., 1988).
- J. E. Helzer, L. N. Robins, J. R. Taylor, et al.
"The Extent of Long-Term Moderate Drinking among Alcoholics Discharged
from Medical and Psychiatric Treatment Facilities," New England
Journal of Medicine 312 (1985): 1678-82.
- E. Gottheil, C. C. Thornton, T. E. Skoloda, and
A. L. Alterman, "Follow-Up of Abstinent and Nonabstinent Alcoholics,"
American Journal of Psychiatry 139 (1982): 564.
- G. Nordström and M. Berglund, "A Prospective
Study of Successful Long-Term Adjustment in Alcohol Dependence: Social
Drinking versus Abstinence," Journal of Studies on Alcohol
48 (1987): 95-103.
- H. Fingarette, "Alcoholism: The Mythical
Disease," The Public Interest (Spring 1988): 3-22.
- W. Madsen, "Thin Thinking about Heavy Drinking,"
The Public Interest (Spring 1989): 112-18.
- S. Peele, Diseasing
of America: Addiction Treatment Out of Control (Lexington, Mass.:
Lexington Books, 1989).
- M. Pendery, 1. M. Maltzman, and L. J. West, "Controlled
Drinking by Alcoholics? New Findings and a Reevaluation of a Major Affirmative
Study," Science 17 (1982): 169-75.
- B. M. Dickens et al., Report of the Committee
of Enquiry into Allegations Concerning Drs. Linda and Mark Sobell
(Addiction Research Foundation of Toronto, 1982), pp. 14-16.
- R. L. Trachtenberg, Report of the Steering
Group to the Administrator Of the Alcohol, Drug Abuse, and Mental Health
Administration Regarding Its Attempts to investigate Allegations of
Scientific Misconduct Concerning Drs. Mark and Linda Sobell (Alcohol,
Drug Abuse, and Mental Health Administration, 1984).
- Madsen, Thin Thinking about Heavy Drinking,
p. 117.
- F. S. Tennant, "Disulfiram Will Reduce Medical
Complications but Not Cure Alcoholism," Journal of the American
Medical Association 256 (1986): 1489.
- E. Gordis, "Accessible and Affordable Health
Care for Alcoholism and Related Problems: Strategy for Cost Containment,"
Journal of Studies on Alcohol 48 (1987): 579-85.
- W. R. Miller and R. K. Hester, "The Effectiveness
of Alcoholism Treatment: What Research Reveals," in Treating
Addictive Behaviors: Processes of Change, ed. W. R. Miller and N.
K. Heather (New York: Plenum, 1986), p. 123.
- Madsen, "Defending the Disease," p.
32-33.
- G. E. Vaillant, The
Natural History Of Alcoholism, Harvard University Press, 1983,
pp. 283-84.
- J. Wallace, "Waging the War for Wellness:II.
The Attack upon the Disease Model," Professional Counselor,
March/April 1987, pp. 25-26.
- C. Creager, "Calling All Counselors: Special
People, Special Causes," Professional Counselor, January/February
1987, p. 4.
- R. Zimmerman, "Britons Balk at U.S. Treatment
Methods," U.S. Journal of Drug and Alcohol Dependence, January
1988, pp. 7, 18.
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