Jump to the text Jump to the menu.

| About Stanton Peele | On-line Library | Ask Stanton | Coaching | Lectures | Bookstore | Home | Back

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 responsibly—these 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 others—perhaps not fully acceptable even to the drinker—but 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 offer—that 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 true—and the drinker knows it. Is it possible that Herb might not have fully recognized the kind of response that writing an iconoclastic—if 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 proposed—since studies of public alcoholism facilities consistently find that fewer than 10% of graduates abstain for any period following treatment—that 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 approach—one 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 found—among alcoholic survivors of hospital treatment—that 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 space—half of his response—on 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 Sobell—a 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 number—but 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 tragic—but 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, which—according to Madsen—means 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 help—which 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 anything—and 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 survey—who had investigated every single comparative study of alcoholism treatment ever published in English—noted 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 Madsen—through 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 agrees—actually 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 answer—denial. 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 book—which 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 recovery—the 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 home—even those who don't behave this way themselves—accept 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 this—and 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 competence—may 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 results—sociologist 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.

Search the web Search peele.net
### Workshops Stanton Peele presents workshops on the nature and treatment of substance abuse and other addictions. He covers cultural and social determinants of addiction, a general model of addiction, natural recovery in addiction, harm reduction treatment, motivational interviewing, brief interventions, skills training, returning clients to the community, and related topics. Contact Stanton | See schedule

© Copyright 1996-2004 Stanton Peele. All rights reserved. No data on this website may be reproduced, stored in another retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilm or otherwise, without the prior written permission of Stanton Peele. The opinions contained on this website are Stanton Peele's and in no way reflect those of the financial supporters of the website. All material provided on the Stanton Peele Addiction Website is provided for informational or educational purposes only. Stanton Peele cannot provide individual clinical or therapy recommendations for persons consulting this site unless they have specifically retained Stanton for this purpose and he addresses them individually. Consult a licensed therapist or physician regarding the applicability of any opinions or recommendations with respect to your problems or medical condition. Webmaster: Arjan Sas. Last updated February 24, 2004 .