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The Mismanagement of Drunkards

  • George R. Wilson
Extract

“It is to be hoped and expected that with the spread of knowledge and education alcoholic intemperance may come to be regarded always and everywhere as vicious and reprehensible. It is a grievous matter that it should be lightly regarded in any quarter as a venial offence, and I should gladly support some more rigorous form of punishment for the vice of occasional intemperance than can now be meted out.

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We hope to publish a more detailed account of this process in a future number of this Journal.—Ed.

Read at the Annual Meeting of the Medico-Psychological Association, Edinburgh, 1898.

Misunderstandings and misquotation have made it desirable to enlarge upon some of the opinions expressed in the abstract of this paper which was read to the meeting in Edinburgh. There are many verbal changes as well as additions. The former are inevitable in so far as a written statement must differ from what is spoken, and the latter seem desirable because of the nature of the attention which these views have received. Most of the disagreement which has been expressed is from misunderstanding, due to the shortness of the statement which the conditions of a meeting, called together for discussion, imposed. Nothing which was said then, or which has appeared subsequently, has induced me to alter, in the slightest, the significance of what I said. On the contrary, much proof has been forthcoming that the paper expressed, however imperfectly, the opinion of a very large number of those who seriously study the problem of drunkenness.

Since the meeting Sir Dyce Duckworth has been good enough to remind me of his address on the subject, published in 1893, and a passage in it is so apposite that I substitute it for the greatly less authoritative quotation with which the paper opened.

The Relation of Alcoholism to Public Health, by Sir Dyce Duckworth, M.D. London, Eyre and Spottiswoode.

At this point it may be well to make clear that the physician's view of punishment must be dissociated from that of those who administer the law to ordinary persons. The latter punish as a penalty for offences committed. We must have nothing whatever to do with that view of punishment. We must put all idea of retribution far from our minds. Punishment must be used on our initiative only as corrective. If the question, for example, arises whether such an one should be flogged, we have not to ask whether the thing that he has done deserves flogging or not, we need not even ask whether he was fully aware of what he did and fully responsible for it. Our only question should be, is this person one who requires flogging, in the sense that nothing short of flogging will affect him, and it is likely that flogging will produce the desired improvement? I do not think we are justified in the use of such severe measures as a warning to others, for the physician has more regard to the individual and less to society than has the judge or the sheriff. But—to return to the point—there are some criminal drunkards who would be improved by flogging and by nothing short of it.

Many people seem to have some difficulty in understanding what we really mean by a crave for alcohol, and why it is not true that every one who wants a drink may be said to exemplify it. But there is no very great difficulty in the subject. In an act or choice, and in a habitual act or choice, there is, on the one hand, desire or impulse, and on the other direction or control. The act may become automatic and ungovernable, either because of excess in the desire or impulse (as in a man who has been for days at sea without water), or because of reductions in the functions of control. In nearly all drunkards it is the control which is at fault. That is what Hughlings Jackson calls the primary or negative lesion. It is in the nature of a want. The drunkard takes to drink immediately he feels wrong, not because he has an excessive susceptibility in the part of his brain which represents drink, but because he has closed the avenues of other lines of conduct; he has shut the door on his freedom of choice. The excess of sensation which constitutes a crave is of the nature of a hypertrophy or overgrowth in the organs of sensation, and it is extremely rare. An alcoholic crave proper is characterised by its exclusiveness; nothing but drink will satisfy it. It is generally periodic, coming on at stated intervals. It is due to a peculiar nervous constitution, and not to disorders of the bodily organs. It is generally idiopathic, and not induced (though it sometimes follows severe injuries); that is, it is usually a development of the man's original nature, like a taste for music or an extraordinary interest in colour. As a rule it manifests itself not later than the end of adolescence, and is of irresistible intensity whenever it has realised itself in the taste of alcoholic drink. So one need hardly add that all states of general restlessness and excitability are not a crave at all, but primarily due to impairments in the functions of control.

We hope to publish a more detailed account of this process in a future number of this Journal.—Ed.

Read at the Annual Meeting of the Medico-Psychological Association, Edinburgh, 1898.

Misunderstandings and misquotation have made it desirable to enlarge upon some of the opinions expressed in the abstract of this paper which was read to the meeting in Edinburgh. There are many verbal changes as well as additions. The former are inevitable in so far as a written statement must differ from what is spoken, and the latter seem desirable because of the nature of the attention which these views have received. Most of the disagreement which has been expressed is from misunderstanding, due to the shortness of the statement which the conditions of a meeting, called together for discussion, imposed. Nothing which was said then, or which has appeared subsequently, has induced me to alter, in the slightest, the significance of what I said. On the contrary, much proof has been forthcoming that the paper expressed, however imperfectly, the opinion of a very large number of those who seriously study the problem of drunkenness.

Since the meeting Sir Dyce Duckworth has been good enough to remind me of his address on the subject, published in 1893, and a passage in it is so apposite that I substitute it for the greatly less authoritative quotation with which the paper opened.

The Relation of Alcoholism to Public Health, by Sir Dyce Duckworth, M.D. London, Eyre and Spottiswoode.

At this point it may be well to make clear that the physician's view of punishment must be dissociated from that of those who administer the law to ordinary persons. The latter punish as a penalty for offences committed. We must have nothing whatever to do with that view of punishment. We must put all idea of retribution far from our minds. Punishment must be used on our initiative only as corrective. If the question, for example, arises whether such an one should be flogged, we have not to ask whether the thing that he has done deserves flogging or not, we need not even ask whether he was fully aware of what he did and fully responsible for it. Our only question should be, is this person one who requires flogging, in the sense that nothing short of flogging will affect him, and it is likely that flogging will produce the desired improvement? I do not think we are justified in the use of such severe measures as a warning to others, for the physician has more regard to the individual and less to society than has the judge or the sheriff. But—to return to the point—there are some criminal drunkards who would be improved by flogging and by nothing short of it.

Many people seem to have some difficulty in understanding what we really mean by a crave for alcohol, and why it is not true that every one who wants a drink may be said to exemplify it. But there is no very great difficulty in the subject. In an act or choice, and in a habitual act or choice, there is, on the one hand, desire or impulse, and on the other direction or control. The act may become automatic and ungovernable, either because of excess in the desire or impulse (as in a man who has been for days at sea without water), or because of reductions in the functions of control. In nearly all drunkards it is the control which is at fault. That is what Hughlings Jackson calls the primary or negative lesion. It is in the nature of a want. The drunkard takes to drink immediately he feels wrong, not because he has an excessive susceptibility in the part of his brain which represents drink, but because he has closed the avenues of other lines of conduct; he has shut the door on his freedom of choice. The excess of sensation which constitutes a crave is of the nature of a hypertrophy or overgrowth in the organs of sensation, and it is extremely rare. An alcoholic crave proper is characterised by its exclusiveness; nothing but drink will satisfy it. It is generally periodic, coming on at stated intervals. It is due to a peculiar nervous constitution, and not to disorders of the bodily organs. It is generally idiopathic, and not induced (though it sometimes follows severe injuries); that is, it is usually a development of the man's original nature, like a taste for music or an extraordinary interest in colour. As a rule it manifests itself not later than the end of adolescence, and is of irresistible intensity whenever it has realised itself in the taste of alcoholic drink. So one need hardly add that all states of general restlessness and excitability are not a crave at all, but primarily due to impairments in the functions of control.

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The British Journal of Psychiatry
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  • EISSN: 2514-9946
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The Mismanagement of Drunkards

  • George R. Wilson
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