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By Lucian Cary

We’ve been told a hundred times that “Alcoholism is a disease.” We’ve acquiesced in the statement, though but vaguely understanding it, believing all the time probably that in this connection “disease” means moral weakness. Psychology, powerfully bolstering up medical science, now shows us the nature of this disease. It tells us why, in many cases of alcoholism, sons of the best families “go wrong”; why too frequently the recognised “cures” are futile. To all who would lessen the liquor evil we commend this article.—The Editors.

FOR ten thousand years the drunkard has been a mystery. Not that men have always realized that they did not understand drunkenness. Mostly they have supposed that they did. In careless, robust days, like those of Shakespeare, the sot was mostly a joke— although Shakespeare himself was too close an observer of life and too splendid a literary artist to make his Falstaff merely a butt of laughter. In earnest, improving days, like our own, the chronic alcoholic is mostly a social problem, to be solved by temperance reform. In all times the man who did not drink has mostly been quite certain that the trouble with the man who did was a lack of willpower. But there have always been a few who stopped to think before the spectacle of the habitual drunkard and saw that they did not know why he was so. And there have always been the family and friends of once fine men ruined by drink, who asked, “Why does be do it ?” and could not answer.

Of late science has been rapidly disposing of old views of alcoholism. Science has shown that if drunkenness is a joke, it is a most dangerous joke; that if it is a social problem, it is one which can be solved only by a study of the individual ; and that lack of will-power is an altogether negative explanation of a positive fact.

Dr. G. Archdall Reid, a British biologist, is one of those who reached this conclusion. In his book on “Alcoholism —A Study in Heredity” (London: T. Fisher Unwin), he distinguished three classes of drinkers. The first class consists of those who drink to satisfy the normal thirst of the body for liquid and who choose beer, ale, or light wines. The second class includes those who drink to satisfy a taste for the flavor of alcoholic liquids and who usually choose wine. The third class consists of those who drink to secure the stimulation of alcohol circulating in the blood and who are most apt to choose whiskey, gin, or brandy. The first two classes are not drunkards. Indeed, only a few of the third and largest class are habitual drunkards.

Dr. Reid generalizes thus: “As a rule, men drink in proportion to their desires, and, therefore, the deep drinker, generally speaking, is one so constituted mentally that deep indulgence is delightful to him, whereas the moderate drinker is one to whom moderate indulgence is more pleasant.

“We may go farther and say that the habitual deep drinker is always one to whom deep intoxication is pleasant; for it is inconceivable that any one would brave the many ill-effects of deep indulgence, the physical and mental evil, the social and material loss, unless intoxication were to him, in some way, a pleasure or a comfort.”

When he had made this point Dr. Reid proceeded to expend a good deal of irony on the notion that the difference between a teetotaller and a drunkard is a difference of will-power. The power of will is sometimes a factor. But the important difference between teetotallers and drunkards is a difference in temptation. Ninety-nine men out of a hundred in these United States have tasted alcohol in some form or other. Perhaps two out of the ninety-nine drink to manifest excess. Perhaps fifty out of the ninety-nine drink in what is called “moderation.” The remaining forty-seven are teetotallers, or virtually so. They are teetotallers not so much because they are men of great power to resist temptation, but rather because they do not care for alcohol.

Dr. Reid put it this way: “Most people with whom I am brought into social contact are temperate manifestly without effort. A little alcohol satisfies them, more would awaken sensations which, on the whole, are unpleasant. A certain section of moderate drinkers—who generally drink rather more—would doubtless enjoy deeper indulgence, but their craving is not so strong as to balance their dislike of the consequences. A remainder so delight in alcohol, are so driven to it, as by a force of a tempest, that, ignoring the remote consequences, they seek immediate satisfaction and are therefore intemperate.” That statement gives food for thought.

Dr. Reid and his colleagues by it slashed through much loose thinking about alcohol. He made clear that there is in a few men an irresistible taste for intoxication which is not shared by all men. He made clear that there is a congenital pre-disposition for intoxication.

He more than hinted that alcoholism in the individual is not only the cause of suffering in the individual but itself the result of suffering. But Dr. Reid went on to seek the hereditary origins of the alcohol diathesis rather than to investigate the diathesis, the individual demand for alcohol itself.

It remained for the psychologists of the Zurich school further to trace the secret of the taste for alcohol in excessive quantities. They may not have known it but when they developed certain simple but searching tests to use in the diagnosis of mental defects they were taking up the problem that Dr. Reid left with his cautious remark about the kind of man “who is so mentally constituted that deep indulgence is delightful to him.” That remark is evidence that Dr. Reid was close to the secret.

For as a result of the mental tests developed at Zurich in the Psychopathic Laboratory of the Municipal Court of Chicago under a student of the Zurich clinics, Dr. William J. Hickson, it was announced in June of the present year that the taste for drunkenness is almost invariably the result of some form of mental disease or weakness. The drunkard is driven to drink by a blind, unreasoning desire to make up a defect in his brain for which he is not in the least responsible, and of which he is not aware. Again and again it is the strongest motive, and from the human point of view, the best motive in him which sends him to alcohol—it is the most fundamental and overpowering instinct of self- preservation. He may know that alcohol is a poison and wish to avoid it. But the pressure of his psychopathological condition drives him to drink in spite of his intellectual decision against it.

Chief Justice Harry Olson makes this statement of the laboratory’s conclusions: “The laboratory has examined hundreds of chronic alcoholics and we have yet to find the first case of this kind where there is not at least a psychopathic constitution, epilepsy, dementia praecox, manic-depressive insanity, or feeblemindedness as the basis, with the exception of a few cases where there was a physical basis such as diabetes or tuberculosis, and the man was whipping up his flagging energy with alcoholic stimulants.

“The group with the mental defects at the bottom of the alcoholism practically all show a defective heredity beyond the average.

“We would therefore emphasize the point that chronic alcoholism is secondary to some underlying mental or physical defect which is primary and without which the chronic alcoholism would not exist.”

Perhaps the simplest and most illuminating of the tests which are made in diagnosing the specific weaknesses of alcoholics in the laboratory of the Chicago Municipal Court is a visual mem- ory test used in psychology laboratory work. The subject is prepared in advance so that he knows exactly what will be expected of him. A white card containing two geometrical figures outlined in heavy black is then placed before him for ten seconds. After ten seconds the card is hidden and he is asked to draw the figures with pen and ink. Persons of average intelligence and no serious mental defect are able to do this with ease. Defectives are not able to do it. Often they are unable to reproduce these figures with recognizable accuracy when they are given the chance to copy with the examples before them. The amazing thing is that the alcoholic, the dope fiend, and the victim of insanity reveal their particular defects in the manner of their failure accurately to reproduce the figures.

Thus the chronic alcoholic shows a characteristic tremor in the lines he draws. The person suffering from dementia praecox (one of the most common forms of insanity) invariably adds details to his drawing which are not found in the original. The attempt of the drug habitue is strikingly different from that of the drunkard.

“Here,” Dr. Hickson said in explaining the tests and the results of them, “is a typical alcoholic.”

Dr. Hickson removed the wire clip which bound half a dozen sheets of paper —the record of a man’s life.

“This man was sent in for examination by the Court of Domestic Relations. He is of German parentage, forty-five years old. He was trained as a cabinet-maker in the old country, but he is a metal polisher by trade. He is a man who passes among his acquaintances as of fair intelligence. He has worked in the same place for twenty-two years. In that period his wife has had him arrested six times for getting so drunk that he was dangerous to her and the children. He has beaten her and threatened her life repeatedly. Look at his visual memory test and see what it shows.”

The sheet which Dr. Hickson held out showed a drawing done in tremulous lines which bore little resemblance to the figure the man had tried to reproduce.

“You will notice,” the director continued, “that the drawing displays the tremor of the alcoholic. But the significant thing is the phantasy, the putting into the drawing things that aren’t in the original he was trying to reproduce. Phantasy of that sort means dementia praecox. That man’s wife thinks he is a little ‘queer’ but she doesn’t mind that. All she objects to is his drinking, and the things he does when he is drunk. Her complaint of him as a husband and father is simply that he periodically gets drunk. She doesn’t dream that actually he is insane, and that his debauches are merely one of the results of his insanity.

“The immediate problem of the court is to find some way of dealing with this man which won’t make things worse than they are now. If he is discharged and allowed to go back to his family, he will most certainly get drunk again and he may kill his wife when he does. If he is sent to the bridewell for six months, his family will be robbed of his support for that length of time and he will come out in worse shape than when he went in. He won’t be able to get a drink in the bridewell and that will be good for his body but the conditions of life there are most unfavorable to dementia praecox so that confinement will be bad for his mind —and it is his mind that is making the trouble. A six months’ sentence will see him less able to do without alcohol than he is now. No amount of physical care and no amount of will-power on his part will enable him to escape alcohol as long as his dementia praecox endures. What he needs is light work on a farm and the society of other men. His case is probably too far gone to be cured but social contact would do him good. Bleuler of Zurich used to say that he believed the reason psycho-analysis was effective in dealing with dementia praecox was due more to the fact that psycho-analysis re- quires frequent long conversations with a physician, which make the patient feel that somebody has an interest in him and that he has a place in the world, rather than to the special character of the psycho-analytic method—and yet Bleuler is a practitioner of psycho-analysis.

“But what are you going to do with a man in the condition of this dementia praecox case? He has no money and Illinois hasn’t yet provided a public institution that isn’t likely to do him more harm than good.

“Men of well to do families aren’t so much better off when they become chronic alcoholics. They are more likely to be sent to a private ‘cure’ than haled into court by their relatives. But splendidly managed as are the best private ‘cures’ they don’t cure. Occasionally they may do something of permanent advantage to a patient. Usually they can do nothing more than straighten him out physically and send him back to begin over again a fight he is bound to lose. Physical treatment and care will prolong the life of a chronic alcoholic, sometimes indefinitely. But all the physical treatment in the world won’t cure a psychic defect, and it is psychic defects that lie at the root of chronic alcoholism nine times out of ten, perhaps ninety-nine times out of a hundred. I have seen men who had taken well-known drink cures three times over and who were ready to take one again. What else can you expect?”

Chief Justice Olson says: “It is important that the underlying basis be recognized, for until that is re- moved there is no hope for curing the alcoholism which our daily experience carried on for years of failure in the treatment of these cases attests.”

The psychic tests are too new to have been extensively used, as yet, in determining how far moderate drinking and drunkenness are similar in their causes. It is altogether reasonable to suppose that Dr. Reid’s classification will stand. The man who drinks beer instead of water or buttermilk, when he is hot and dusty, may be a fool but he is not necessarily suffering from mental disease. The connoisseur of wines who rolls a minute quantity of a vintage on his tongue in order to get its full savor may be the victim of a perverted taste, which will injure both his health and his pocketbook, but he is not necessarily suffering from dementia praecox or manic-depressive insanity. Even the man who is able to enjoy a dinner party or a chance meeting with an old friend if his barriers of reserve are broken down with cocktails may be mentally normal. These varieties of drinking are unfortunate, so unfortunate in their effects, that mankind is gradually learning to do without them. But they are not such a red flag of danger as is the presence of the desire to get drunk.

The man who wants to get drunk, who feels that he is driven to drink, will do well to search out the nearest neurologist. The probability is that the desire is born of some hidden psychic defect. Normal men do not desire alcohol in excess. It is only the abnormal who are driven to drink.

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