Pp. 33-45 in: Nick Heather,
Timothy J. Peters, Timothy Stockwell, eds. Handbook of Alcohol Dependence
and Alcohol-Related Problems. Chichester, UK, etc: John Wiley & Sons,
2001.
GOVERNING IMAGES IN
PUBLIC DISCOURSE ABOUT PROBLEMATIC DRINKING
Robin Room
Centre for Social
Research on Alcohol and Drugs
Stockholm
University
Sveaplan
S-106 91 Stockholm,
Sweden
SYNOPSIS
The chapter reviews
studies of governing images or “discursive formations” of problematic
drinking. Analyses in the late 1960s
first systematically contrasted different “models of alcoholism” and
conceptualizations of the “deviant drinker”.
These initiated a sociological
tradition of “constructivist” analysis of the “medicalization of
deviance”, primarily focused on the rise
of the disease concept of alcoholism in the modern era. Starting in the late 1970s, historical
analyses argued that the initiation of “addiction” concepts came much earlier,
and were popularized as part of 19th-century temperance movement
thinking. Recent analyses in the
cultural studies tradition have placed the alcohol discourse in a broader frame
of discourse in English-speaking societies about “diseases of the will”.
Meanwhile, research on
discursive formations has expanded to take into account ideologies of alcohol
control, including the “new public health approach”, and a loosely-linked
“alcohol problems” approach. Particularly in Nordic countries, attention has
been given to the competing discourses of neoliberalism and of the welfare
state, which have been the dominant discourses in the debate over Nordic
alcohol control measures.
In their timing and
location, the appearance of analyses of a particular governing image are
themselves a signal and symptom that that conceptualization is coming under
critical scrutiny. More attention is
needed in future work on discursive formations to who uses a discourse, and how
it is received; to the boundaries of application of a discourse, and to breaks
and imperfections in its application; and to the relation between governing
images and the images, attitudes and arguments at the level of everyday communications.
____________________________________________________________________
The potential problems
from drinking of alcoholic beverages have been the subject of public discourse
for all of recorded history. An ancient
Egyptian text, for instance, offers the injunction:
Make not thyself
helpless in drinking in the beer shop. For will not the words of thy report
repeated slip out from thy mouth without thou knowing that thou has uttered
them? Falling down thy limbs will be broken, and no one will give thee a hand
to help thee up. As for thy companions
in the swilling of beer, they will get up and say, “Outside with this
drunkard”. (Budge, 1972)
The text illustrates that there are at least two levels of understanding
operating in any communication. In the
first place, the text is an argument about drinking and its potential adverse
consequences that is intended to inform or persuade. We can thus analyze the text in terms of its
subject-matter and message.
In the second place,
the text includes within it a whole way of thinking about alcohol. We notice that the message assumes a concept
of a “drunkard” as a moralized social category, carrying a negative
stigma. The text is thus giving us a
scrap of evidence about a way of thinking about drinking assumed by the writer
to be both understood and shared by the readers.
Nowadays, the term
“discourse” is used for both these aspects of communication. The meaning which concerns us here is the
second, referring to a system of thinking about a particular topic, and
relating back to Foucault’s concept (1972) of a “discursive formation”. Thus
Sutton (1998), for instance, distinguishes between several major formulations
of the nature of alcohol problems in Swedish history. In this sense, “a discourse may be understood
as a bounded body of knowledge and associated practices, a particular identifiable
way of giving meaning to reality via words or images” (Lupton, 1999:15). Earlier analyses in the field had used other
terms roughly in place of this sense of “discourse”, talking in terms of
“models of alcoholism”, for instance (Siegler, Osmond and Newell, 1968; Bruun,
1971), of “conceptions” (Levine, 1978),
or of “governing images” (Room, 1974, 1978; Moore and Gerstein, 1981).
The reader is thus
referred elsewhere for material on discourse at the level of elements of
meaning and their relationship, often discussed in the alcohol literature in
terms of “representations” (e.g., Paakanen and Sulkunen, 1987), “images” (e.g.,
Sulkunen, 1998), or “portrayals” (e.g., Grube, 1993), and for reviews of the
substantial literatures on the content of communications about alcohol and
their persuasive value (Casswell, 1995; Martin and Mail, 1995; Baillie, 1996),
and on representations of alcohol in fiction and other literary works (Forseth,
1999).
Moral vs. medical models
That drinking or
alcohol problems can be conceptualized and discussed in very different terms
has been self-evident in societies such as the United States, where the
conceptualizations have been openly contested during the last two
centuries. In such circumstances, it has
not required scholarship to perceive that alcoholic beverages could be defined
alternatively as “the good creature of God” or the “demon rum” (Levine, 1983),
and that problematic drinkers could be defined alternatively as “drunkards” or
as “alcoholics”.
Systematic efforts to
describe and contrast different discourses or conceptualizations of problematic
drinking may be dated from Gusfield’s paper (1967) on “moral passage” and
Siegler, Osmond and Newell’s paper (1968) on “models of alcoholism” (see also
Bruun, 1971). Siegler et al. laid out a
number of alternative conceptualizations of the problematic drinker, and sought
to systematically fill in the blanks for each model in terms of its definition
of the drinker and the implications for the drinker’s social handling. While “moral” and “medical” models are
distinguished in the classification, the authors further distinguish within
these general rubrics between different “moral” and different “medical” models.
The ideas that there are multiple medical models, and that medical and moral
models were not necessarily mutually exclusive, have received some further
attention (Room, 1974; 1978), but are still overlooked in much analysis.
While Siegler et al.
had not focused on the historical succession of conceptualizations, this issue
was at the heart of Gusfield’s analysis (1967), which traced the succession of
three different dominant conceptions of the “deviant drinker” in the United
States in the preceding century and a half.
In the first period of temperance ferment, oriented to “moral suasion”,
the dominant image, Gusfield proposed, was the “repentant drinker”. In the latter part of the 19th century, as
the temperance movement moved towards legislating sobriety, the image shifted
to the “enemy drinker”. In the 1940s, after the collapse of the temperance
cause and the Repeal of Prohibition, the image shifted again to the “sick
drinker”. Gusfield emphasizes the
symbolic functions of laws and official acts expressing such conceptions, whereby
the “worth of one set of norms” over others is publicly affirmed, and the role
of social “movements to redefine behavior” in catalyzing the “transition of the
behavior from one moral status to another”.
The shift towards the
“disease concept of alcoholism” in the 1930s and after has drawn considerable
further attention by sociologists.
Building on a perspective which Gusfield’s 1967 analysis pioneered,
Schneider (1978) and Conrad and Schneider (1980) adopted a self-conscious
framing as “historical social constructionists” (now often termed “constructivists”),
emphasizing the social processes by which concepts are created and take on
social authority. Conrad and Schneider
fit the alcoholism story into an analysis of the “medicalization of deviance”
as a general historical shift. On the
other hand, focusing specifically on alcohol, Roizen (1991) analyzed the
repeated efforts to find a discourse about alcohol problems which the American
public could accept in the 1930s and 1940s, after the debacle of Prohibition. While these analyses have focused primarily
on the role of ideological entrepreneurs, and their interaction with and
effects on public discourse, other analyses have shown how the shift in
discourse had effects, too, on the mainstream of scientific and biomedical
knowledge (Herd, 1992; Katcher, 1993).
The rise of the addiction concept
In his landmark paper
on “the discovery of addiction”, Levine (1978) shifted the focus of attention
to the early 19th century, more than a century earlier than the period which
was the focus of discussions of the rise of the modern “disease concept of
alcoholism”. Paralleling analyses by
Foucault and Rothman of the shift in perspective and discourse that brought
into being the 19th century mental asylum, Levine argued that the addiction
concept was first developed for alcohol, and that it arose in connection with
early temperance thinking, in a social context of a heightened concern for
self-control in Jacksonian America.
Porter (1985) and
Warner (1994) have since argued that the inception of the addiction concept
must be pushed back from Levine’s dating, with Porter finding an addiction
concept in 18th-century British medical writers, and Warner (1994) in 17th and
18th-century sermons. It is unclear,
however, how widely such concepts were accepted then. Acknowledging Porter’s and Warner’s evidence,
it can still be argued that Levine’s dating of the rise of addiction concepts
is right, in terms of broad-based popular discourse about drinking. Supportive evidence can be found in
McCormick’s pioneering study (1969) of conceptions of problematic drinking in
English literature. “When we look at fiction about
1830, when the industrial revolution was in full swing”, McCormick concluded,
“we find that the same drinking may be described as existed 80 years before but
that a new and more desperate kind of solitary, tragic and inexplicable
drinking has come into existence beside it.”
These discussions of the advent of
the addiction concept in the 19th century have been primarily
limited to material from Britain and the United States. Although it is clear that addiction concepts
also became rooted in other European societies in the course of the 19th
century (e.g., Baumohl and Room, 1987), relatively little historical work has
appeared, in English at least, focusing on the shift in discourse associated
with the advent of the addiction concept (but see Mitchell, 1986; Sournia,
1990).
There has, however, been some
research and analysis on the applicability of alcoholism or addiction concepts
in a broader frame cross-culturally. The
present author argued that alcoholism could be regarded as a “culture-bound
syndrome” (Room, 1985), given the ethnographic evidence that interpretations of
problematic drinking in terms of loss of control were culturally specific,
depending among other things on a cultural expectation of personal
self-control. As Lemert (1951:356) had
earlier noted, the theme of lack of self-control at the heart of American
attitudes to the alcoholic “is one of the most vivid and isolating distinctions
which can be made in a culture which attributes morality, success, and
respectability to the power of a disciplined will." In a given society, Lemert proposed,
in order for chronic alcohol addiction or compulsive
drinking to develop, there must be strong disapproval of the consequences of
drinking or of drinking itself beyond a certain point of intoxication, so that
the culture induces guilt and depression over drinking and extreme drunkenness per
se. (Lemert, 1951: 348-349)
Along
the same line, qualitative research on a World Health Organization project has
raised further questions about the cross-cultural applicability of current
diagnostic concepts of dependence (Room et al., 1996; Schmidt and Room, 1999),
although other studies, using quantitative factor-analytic methods, have argued
for the cross-cultural applicability of the alcohol dependence syndrome (e.g.,
Hall et al., 1993).
Recently, the burgeoning field of
cultural studies has begun to take an interest in the issue of self-control and
the will as a focal conceptualization and concern in English-speaking
cultures. The discourse around alcohol
is brought into analyses like Sedgewick’s essay (1992) on “epidemics of the
will” and Keane’s work (1998), in the context of a broader discussion of the
cultural position of concepts of willpower and addiction. Peele (1995) offers a more partisan critique
of addiction concepts as fueling the growth of an anti-addiction industry in
the U.S. Valverde’s recent volume on Diseases
of the Will (1998) returns problematic drinking to a central place in the
discussion, analyzing it as an object both of self-control and of state
control.
The
impact of the temperance movement: reactions and continuities
The historical analyses we have been
discussing can be seen as driven by the central feature in the landscape of
discourse on problematic drinking in English-speaking societies in the last two
centuries: the rise of the temperance movement, and its aftermath (including
the movement’s political decline). In
this context, the main object of research attention has been the governing
image of addiction, as a way of problematizing and understanding some or all
drinking. While the “medicalization of
deviance” tradition has emphasized the transition between different governing
images in the 20th century, analyses like Levine’s have emphasized
the transition to temperance from conceptions of earlier times, and have
focused on the continuities in conceptions and discourse between the temperance
era and more recent decades.
Temperance movement thinking about
alcohol extended well beyond the domain of addiction concepts (e.g., Levine, 1983b). And temperance movements of
the 19th and early 20th centuries were heavily intertwined
with the major “progressive” movements of the day -- abolition of slavery,
women’s rights, socialism, and in many places nationalism and
nation-building. The extensive
historical literature on these movements, and on those who opposed them, often
considers or touches on the ways of thinking and discourse of those involved,
but is beyond the scope of this essay.
For relevant historical studies, the reader is referred to bibliographic
essays by Verhey (1991) and in the pages of the Social History of Alcohol
Review.
“Alcohol
problems” and alcohol control
Research on frames for problematic
drinking and for social responses to it has expanded in recent years to take
into account ideologies of state control of the alcohol market. As Levine (1983a) notes, the idea of state
alcohol control developed explicitly as an alternative to prohibition, and thus
was bitterly opposed by the mainstream of the temperance movement. The idea, which often included the idea of
the state monopolizing all or part of the industry, remained an elite rather than popular
discourse nearly everywhere until and unless it was actually put into
practice. As government monopolies were
implemented, in Sweden incrementally after 1850 (Frånberg, 1987), in Russia
around 1900 (McKee, 1997), in Canada in the 1920s (Smart and Ogborne, 1996) and
in 18 states in the U.S. in 1934 (Room, 1987), they often set the frame for
continuing debates in these societies about government versus individual
responsibilities for controlling problematic drinking. Thus this framing of discourse about alcohol
has figured prominently in current analyses based on Swedish (Sutton, 1998) and
Canadian (Valverde, 1998) experience.
Analyses have begun to appear of a
relatively recent formulation of the argument for state intervention in the
alcohol market, variously called the “total consumption approach” or the “new
public health approach”. This framing is
at centre stage in Sutton’s analysis (1998) of Swedish alcohol discourses; only
in the Nordic countries, and particularly in Sweden, could this framing be
considered to have entered popular discourse, rather than remaining an elite
discussion. The discourse also plays a
part in the story in the growing field of studies of the formation of
government alcohol policies, both in the Nordic countries (e.g., Holder et al.,
1998) and elsewhere (e.g., Baggott, 1990).
Loosely linked with the “new public
health approach” has been a conceptualization of the focus of discussion in
terms of “alcohol-related problems” or “drinking problems”. Whereas the classic alcoholism concept had
tended to regard all specific health and social problems as symptoms of a
unitary alcoholism, the “alcohol problems” approach disaggregated the field
into wide diversity of health, casualty, interactional and social problems
related to alcohol consumption or drinking comportment. Though some formulations in the “alcohol
problems” tradition subsume alcoholism or alcohol dependence as one more among
the problems (e.g., Edwards et al., 1977), the approach tended to be
counterposed to an approach in terms of “alcoholism” (Room, 1984). For instance, one early formulation argued,
after listing “the most important kinds of damage caused by alcohol, alcoholism
is excluded from the classification because the damage caused by alcoholics
already appears in the above classes” (Bruun, 1973). This tradition, too, has received some
constructivist scrutiny (Levine, 1984).
The
dialectic of control: consumer sovereignty and external governance
In an era in which the tide has
flowed strongly in favour of privatization and of the doctrine of consumer
sovereignty, a framing of alcohol issues in terms of “alcohol control” or
“alcohol policy” -- relatively recent terms in the alcohol literature (Room,
1999) -- is now seen by many as an assertion of state power at the expense of
individual autonomy. As Tigerstedt
(forthcoming) points out, there is some irony in this, as the framing, with its
emphasis on patterns and problems at the level of the population as whole, was
originally put forward as a justification for dismantling individual-level
social controls on drinking in Nordic countries.
A number of recent studies in Nordic
and neighboring countries have paid detailed attention to the competing
discourses concerning drinking and conceptualizations of drinking and alcohol
problems, often in the context of general discourses about social problems
(e.g., Simpura and Tigerstedt, 1992; Lagerspetz, 1994; Hanhinen and Törrönen,
1998). Contrasting the framing of newspaper
discussions by public health advocates and by advocates of looser Swedish
alcohol controls, Olsson (1990) noted that the public health discourse tended
to use statistical and impersonal arguments, while opposing arguments were
pitched at the personal and anecdotal level.
Those opposed to the current controls offered an alternative “dream of a
better order”, in which
the central role of alcohol still remains, but ... it
is less dramatic and ... the negative consequences of alcohol are believed to
be minimized. The continental drinking
culture is the theme of this dream, nourished by the shame felt about what is
felt to be the dominating drinking culture,... the Scandinavian way of
drinking, which is characterized by heavy drinking, drunkenness, and violence.
(Olsson, 1990)
In a
participant-observation study of the ways of thinking and speaking of
middle-class regular drinkers in Helsinki, Sulkunen (1992) found among their
generally relaxed views on moral questions one strand of “militantism”: an “antipathy
of external control and patronizing over individuals, particularly over
drinking in public” (p. 114). “Their rally against the moral barrier [between
alcohol and everyday life] finds an easy target in the public alcohol control
system” (p. 117). Likewise, focus groups with local influentials in a Finnish
community study (Holmila, 1997) found a strong contingent of “neoliberals”, who
saw decisions about drinking as a matter for individual decision and autonomy,
in contrast to those whose thinking ran in older liberal terms, with authority
resting with the family, or the supporters of welfare state thinking, who
assigned the state a substantial role in preventing problems from drinking.
Some
conclusions and suggestions
A constructivist perspective on
constructivist analyses. The timing
and orientation of the studies we have been considering suggests that analyses
of the discourse of a particular conceptualization in the alcohol field are
themselves a signal and symptom of the fact that that conceptualization is
under critical scrutiny, and often under attack. Already in the late 1960s and early 1970s,
the disease concept of alcoholism was under critical scrutiny by sociologists
(Room, 1983). By treating it as just one
more “model” to be ranged alongside others, analyses such as those by Siegler
et al. (1968) and Bruun (1971) were implicitly putting in question the model’s
claim to be the “new scientific approach” which transcended all others. Likewise, Levine’s analysis (1978) in terms
of a continuity between temperance
thinking and the alcoholism concept undercut arguments by the alcoholism
movement that their conceptualization was a “new scientific” replacement for
temperance models.
In a similar fashion, the new
cultural studies of “epidemics of the will” (Sedgewick, 1992) and historical
analyses of the idea of “diseases of the will” (Valverde, 1998) come in the
wake of a new North American efflorescence of concerns about self-control,
expressed among other ways in a fanning-out into other preoccupations, from its
origin in Alcoholics Anonymous, of 12-step ideology (Room, 1992; Rice,
1996). Along with the new cultural
studies have come more polemical critiques of these trends (e.g., Kaminer,
1992; Rapping, 1996).
Even more obviously, analyses of the
discourse of alcohol control and of the “public health approach” have primarily
emanated from societies (Canada and the Nordic countries) and a time when
alcohol controls have been being weakened or dismantled (Holder et al., 1998;
Her et al., 1999), and public discourse about a “total consumption model” has
been losing ground (Sutton, 1998). These
changes also provide a context for the recent Nordic studies of the competing
neoliberal discourse in terms of individual consumer autonomy.
The dating and shape of the current
literature suggests a slightly facetious conclusion: when an eager young
scholar comes to you offering a label for the conceptual framing you have been
struggling toward or working within, and proposing to study it as a discourse,
then you know you are history.
That the analyses are to some extent
creatures of their own time and place does not, of course, in any way
invalidate them. The work we have been
considering includes solid research and some brilliant thinking, and makes contributions
which will last beyond its own historical moment. But the record so far does leave a
question: Is there some way in which
such work can be stimulated in other times and places, where there is no
alternative conceptualization to lean on, and before scholars are growing
uneasy with the old dispensation?
Who uses a discourse, and how is
it received? In recent decades, a
revolution in historiography has broadened the attention of historians from the
narrow focus of diplomatic and intellectual history to the broader spheres of
social and cultural history.
Imperfectly, and as yet only partially, a version of this expansion of
attention is under way in analyses of public discourse on alcohol. Studies still appear which are primarily
grounded on policy documents and medical, professional or research literatures,
but the questions of who shares a discourse in common and of how communications
within a particular discourse are received by various audiences are coming more
to the fore. The use of focus groups and
participant observation methods, as in the recent Nordic studies, open up the
possibility of understanding how discursive formations are actually put to use
in everyday reasoning and conversation, of studying who adheres to a discourse
and interpersonal variations in its expression, and of testing how those
holding to one discourse respond when challenged from another.
Quantitative methods such as sample
surveys may also play a part in helping us understand the cultural complexes
which we have been calling governing images or discursive formations. In the context of such surveys, approaches
such as offering respondents vignettes to think their way through, and
recording and analyzing their open-ended responses, offer the promise of
capturing the reasoning and associations that tie the discursive formation
together.
The
reach of a governing image, and its imperfect hegemony. A governing image
or discursive formation gathers together a broad field in terms of a single
frame of understanding, often summarized in a few shorthand phrases. It is thus always an imperfect fit to the
reality it seeks to cover (Room, 1978); adherents will tend to downplay the
discrepancies, while opponents, if any, will tend to focus on them. The conceptual terrain which a governing
image seeks to cover many expand or contract over time. Thus, for instance, the extent to which
drinking-driving is to be understood in terms of alcoholism has varied in the
last 30 years in North America. For
another example, alcoholism concepts are surprisingly absent from North
American public discourse about the role of intoxication in sexual and other
violent crimes (Room, 1996). More
attention to the boundaries of application of governing images will give us a
better understanding of their core of meaning and their social significance.
In fact, it is quite common for
people, even when quite committed to a particular discursive frame, to shift
into and out of it in different contexts.
Someone strongly committed to talking about and understanding the world
in terms of scientific rationality may nevertheless read and half believe the
newspaper’s horoscope column. It even
seems possible and fairly common to work within supposedly antagonistic conceptual
frames for the same material. Thus Kaskutas (1992) reports that 29% of the
members of Women for Sobriety also concurrently attend Alcoholics Anonymous,
and Connors and Dermen (1996) report 35% concurrently attending AA for members
of Secular Organizations for Sobriety (SOS) -- though both WFS and SOS were
founded around critiques of some of AA’s central ideas. In the words of an AA slogan, it is not
unusual, with respect to discursive formations, for people to “take what you
can can use and leave the rest”.
In the context of linguistic
studies, attention is now given to these “breaks” and discontinuities in the
framing and logic of speech, as especially informative about the structure of
thinking and discourse (e.g., Arminen, 1998).
Analyses like this at the level of
conceptualizations and discursive formations would give us a much better
understanding of the collective thinking and social processes surrounding
governing images of problematic drinking.
Discursive formations and the analysis of everyday
discourse. At
the level of empirical work, the boundary between studying a governing image or
discursive formation and studying discourse in its other meaning -- the
imagery, associations, and structure of argument of speech or other
communications -- is often unclear. We
have excluded from consideration here the wide range of survey and experimental
studies of attitudes and expectancies about drinking, and survey studies of
reasons for drinking and of attitudes towards public policies on alcohol and on
community responses to alcohol problems.
For purposes of studying discursive formations, off-the-cuff responses
to the precoded questions in such studies tend to offer only fragments of the
picture. Along with content analysis of texts and other prepared
communications, however, they do provide the material for analyses of images,
attitudes and arguments in everyday life.
We need some clear thinking about analyses of the relation between the two levels, that of
discursive formations and that of everyday discussion, as a prelude to actual
analyses of the interrelations.
The dynamics of competition
between discourses. The alcohol experience suggests that old discourses
rarely die; they go out of fashion, or they go underground as being
“politically incorrect”, but there are still elements of them extant in the
culture in which they once flourished.
Though Gusfield’s early formulation (1967) was in terms of shifting
designations of the deviant drinker over time, his later work fully recognizes
that American social thought on problematic drinking is a matter of continually
“contested meanings” (Gusfield, 1996).
While the focus of the sociological constructivist tradition has often
been on the ideological entrepreneurs who push forward a new conceptualization,
attention is needed to do to the responses of various audiences to the
ideological contests.
In this regard, new attention is
needed to the various “moral models” of
problematic drinking. Long after the
demise of the north American temperance movement, it is clear that “moral models”
of drinking are alive and well, and indeed riding in triumph in the context of
criminal law (e.g., Keiter, 1997). New
moral-accountability discourses can be found also in such contexts as cognitive
behavioural psychology and economic theories of “rational addiction” (Elster
and Skog, 1999). As Valverde (1998:203)
suggests, after documenting discontinuities between the Canadian medical-social
and criminal-justice discourses, “uncovering historical connections would be
helpful in breaking through vicious circles and avoiding unknowing, forgetful
repetitions”.
More sustained attention is also
needed to the relation between discourses of normalized drinking -- drinking as
a pleasure and a social activity -- and the discourses of problematic drinking
which have been our focus here. For that
matter, the somewhat more hidden discourses in praise of intoxication need also
to be taken into account. The theme of
needing to understand the “pathological” in the context of the “normal” is an
old one in alcohol studies; as Gusfield (1996:40) found in making the point,
Selden Bacon, the founder of modern alcohol sociology, had made it forcefully
and repeatedly over a period of 30 years and more.
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