Again, for the theoretically minded ATHG subscribers.

------- Forwarded Message Follows -------
Date:          Fri, 21 May 1999 17:18:31 +0200
Reply-to:      Kettil Bruun Society <[log in to unmask]>
From:          Robin Room <[log in to unmask]>
Subject:       Re: all knowledge in field disproven
To:            [log in to unmask]

Ron -- no, I'm not arguing all labelling is bad, I'm arguing that a generation or
more of sociologists have been skeptical of it -- skeptical, that is, of the processes
described as labelling -- at
 time when sociology was spending considerable
energy pointing out the effects ("secondary deviance") the labelling itself can have.
We discussed long ago, as I remember, how curiously small a connection there
was between alcohol sociology and the formal American sociological labelling
literature -- a couple of pieces by Tric
 and Roman are the main citations
specifically focussed on it, I think.   But I still would argue that a disvaluing of
labelling is in the background of Bruun et al., 1975 (the purple book) and is
e
plicitly expressed in Maekelae et al., Alcohol, Society, and the State, 1981.
I think it's an underlying factor, too, in the ambiguity about the alcoholism
concept in such sociological discussions as
Seeley, 1962.
 I got Valverde's book, Diseases of the Will: Alcohol and the Dilemmas of
Freedom (Cambridge University Press, 1998) out of hock today -- Swedish
 customs punished me for ordering it by internet f
om Barnes and Noble by
making me pay customs at a far-away post-office.  Valverde makes an ambitious
effort to tie it all together -- the history of inebriety, AA and "the power of
powerlessness", t
e postwar history of alcohol studies, alcohol control systems
and ideology, legal concepts about intoxication as an excuse, controlled or
moderate drinking -- with a focus on the cultural nexus betw
en drinking and
willpower.  Sociologists, psychological moderationists, judicial theorists, and
psychiatrists are all subjected to the somewhat harsh light of this critical gaze.
I look forward to
eading it.  I think it will be viewed as a
landmark, whether we regard us "insiders" regard it as so or not.
    Just as the "sociology" section in the bookstores has more or less dissolved
 into other things, what I think of as critical sociological perspectives today
 operate under other labels.  Valverde
s a criminologist.  A wonderfu
 dissertation in this same Foucauldian area of ideologies of self-control by an
Australian, Helen Keane, now being turned into a book, came under the heading
"cultural
studies".
  Robin

-----Original Message-----
From: Ron Roizen <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: den 21 maj 1999 18:19
Subject: Re: all knowledge in field disproven


>APPLETON and VALVERDE?  My God, Robin, these are pretty damn
 marginal folk
>on whom to
>vouchsafe the general vigor and salutary condition of "on the side"
>sociology since Gusfield!  I haven't
>even gotten Valverde's recent book yet and Appleton did one paper
and then>seems to have disappeared from the scene.
>
>Moreover, the great sociological critics of psychiatric labeling--starting
>with the great Lemert's book, Social Pathology (1950?)--eschewed dissing
>the alcoholism label, probably because they regarded it as an exercise in
>status rescue pushed forward largely by the labelees themselves and NOT the
>exercise of arrogance by a powerful foe (institutional psychiatrists) as in
>other mental illness labels.  You've written persuasively on the
>status-rescue aspects of the disease-concept movement yourself.  Are we now
>to infer that all labeling is bad, period, because it fails some sort of
>small "d" democracy test?
>
>Ron
>
>----------
>> From: Robin Room <[log in to unmask]>
>> To: [log in to unmask]
>> Subject: Re: all knowledge in field disproven
>> Date: Friday, May 21, 1999 7:03 AM
>>
>> Laura --
>>     The context for my answer was Stanton's attribution of the cooptation
>of sociology to involvement in large-scale epidemiology.
>>     I certainly agree that sociology's role has been pretty equivocal --
>in part, of course, reflecting that sociologists are not of one mind about
>the disease concept.  And you're right that there was an effort at a
>truce, stage-managed by Griffith Edwards, between psychiatric and
>sociological perspectives in a WHO meeting in 1976, recorded in G. Edwards
>et al., Alcohol-Related Disabilities, Offset Publication No. 32, Geneva:
>WHO, 1977.  (And yes, I am implicated in this document.)  The formulation
>of the truce was that there are many alcohol-related disabilities
>(=problems; WHO was on a big disability kick at the time), and that the
>alcohol dependence syndrome is one of them.
>>     All in all, I think the "on the side" critical perspective has not
>suffered much from any cooptation.  Gusfield and after him Conrad and
>Schneider and after them Appleton and Valverde have done quite OK in
>mainline sociology; I don't think anyone would see any of them as coopted.
>For those of us working in the grants economy, "on the side" critical
>pieces have not directly earned us our living (although mine probably
>helped me get my job in Sweden), but I don't think our participation in the
>grants economy coopted us away from them (whereas I would see that as
>having happened to some in the drugs literature).  But maybe I'm too far
>inside to see out on this.
>>     What you call the "public health paradigm" is something else again
>from the disease concept -- in fact, the models have often been viewed as
>antithetical.  In this, yes, sociologists did play an important role.
>Christoffer Tigerstedt has a paper at the Montreal KBS reexamining Kettil
>Bruun's role -- ask someone who is going there for it; they have the
>password to print it off the website.  A couple of British psychiatrists --
>notably Edwards -- were important in this history, but you would have to
>search a long way to find any American psychiatric influence on the "public
>health paradigm" in the alcohol field.
>>     One thing that occurred to me reading Caroline Sutton's dissertation
>on the Swedish alcohol discourse, and which is there in Tigerstedt's paper,
>too: the sociologicalness of the paradigm lies in its emphasis on measures
>that apply to aggregates rather than individuals.  At the heart of the
>sociological connection, then, is an animus against labelling, whether
>therapeutic or punitive.  Keep in mind the Scandinavian context in which
>the paradigm developed: a history of extensive individual control and
>labelling -- the "buyer surveillance" system in Finland;
>individually-assigned ration-amounts in Sweden, according to the
>ration-holder's worthiness; local committees of neighbors (temperance
>boards) keeping watch over your drinking behaviour  in Finland, Norway and
>Sweden.  What is now called the public health model offered a rationale
>which justified sweeping all this away: that rates of alcohol problems in a
>population could be kept in check instead by measures like taxes and
>opening hours which did not sitoo keen on disease concepts, I acknowledge.)
>  Faced with this value choice, sociologists have often leaned the other
>way.      Robin
>>
>> -----Original Message-----
>> From: Laura Schmidt <[log in to unmask]>
>> To: [log in to unmask] <[log in to unmask]>
>> Date: den 21 maj 1999 05:24
>> Subject: Re: all knowledge in field disproven
>>
>>
>> Robin, maybe you are being a little too generous to the sociologists in
>> addiction research.  The heavy influence of the medical-epidemiologic
>paradigm
>> on the way that sociologists do work in this field can't be ignored.
>What has
>> suffered is the distinctively "on the side" critical perspective that
>> characterizes some sociology.  What has done better under this influence
>is
>> micro-sociology and survey methods.  The same is true of the sociology of
>> deviance and medicine.  Just take a look at the ASA's health journal, the
>> Journal of Health and Social Behavior.  What you see is primarily
>social-psych
>> and psych-epi studies with long theory sections.
>>     But at the same time, I really can't agree to a simplistic
>explanation of
>> this as a case of sociologists being coopted.  Or if so, then
>sociologists
>> played an active role in their cooptation.  Sociologists, after all, had
>a lot to do
>> with getting us where we are today: to an addiction field oriented around
>the
>> public health paradigm -- that strange blend of sociology,
>medical-epidemiology and
>> health moralism.  The interesting questions for "on the side" sociology
>today
>> are where did this paradigm come from and what does it do for us?
>Certainly
>> one thing that it does for us is to allow social scientists and
>psychiatrists
>> to peacefully coexist in the same field.  In other words, it allowed for
>an
>> uneasy resolution of the debates over the disease concept in the 60s and
>70s.
>> During the 1970s (particularly in discussions at the WHO around framing
>the
>> ICD criteria), social scientists and psychiatrists came into agreement
>that there
>> were actually two phenomena that should be studied and intervened on:
>> "dependence" and "alcohol-related problems."  Since then, there's been
>room at
>> the table for everybody.  And for better or worse, we can call ourselves
>a
>> truly "interdisciplinary" field.
>>
>> Laura Schmidt
>> Alcohol Research Group, Berkeley
>>
>> At 05:17 PM 5/20/99 +0200, you wrote:
>> >
>> > Stanton -- no implication about you, don't be touchy. I was just
>interested
>> > where you stand on this.
>> > Whether it's red wine or ethanol has rather different implications. I
>> > actually think it's ethanol, and the red winemakers (and their allies
>in the
>> > research and professional literature) have put one over on the great
>> public.
>> > There is no single claim on alcohol and health, good or bad, that has
>had a
>> > great a measurable effect on people's consumption choices as the red
>wine
>> > theory.
>> > If it's really red wine/resveratrol, then grape juice or raisins or
>> > whatever would do just as well as the red wine, usually for cheaper,
>and
>> > without the "side-effects", as the medication literature would say.
>> >
>> > The "we're both sociologists" referred to Laura -- it would never have
>> > occurred to me to accuse you of sociologism.
>> > When the directorate of NIAAA was disowning any controlled-drinking
>> > implications of the RAND followup, they tended not make much of the
>fact
>> that
>> > if your criterion was abstinence for the whole 4.5 years of follow-up,
>the
>> > success rate would be 7.5%. It has been a long time since the treatment
>> > evaluation literature tried to hew to the abstinence standard as its
>> > criterion for success -- the results look too gloomy. It is surprising,
>> > actually, that more people don't notice the discrepancy between the
>outcome
>> > criteria and the official treatment goals.
>> > On sociologists being tamed by "the advent of large-scale
>> > epidemiological research": I would say the history here has been at
>worst
>> > mixed and often better than that. Conrad and Schneider, in the first
>> edition
>> > of From Badness to Sickness (not sure about the 2nd), had a curious
>footnote
>> > where they made much the same charge about the Berkeley group I used to
>be
>> > part of -- since we were funded by the feds, it puzzled them that some
>of us
>> > nevertheless wrote critically about the disease concept, and they kind
>of
>> > predicted that we would eventually be coopted. But the Schmidt and Room
>> > paper, I would contend, is evidence that this hasn't yet happened
>(Laura is
>> > at ARG) -- the findings of the study are pretty subversive of a simple
>> > US-centred disease concept.
>> > My take on it would be that in my professional lifetime sociologists
>> have
>> > been privileged in alcohol studies (unlike drugs or tobacco research)
>to be
>> > allowed to nip the hands that feed us, without suffering much reprisal.
>I
>> > know psychologists have the scars to prove that this hasn't always been
>true
>> > for them. Perhaps sociologists matter less, since most of us can't
>actually
>> > corrupt clients. Maybe we fare better because we tend to be critical of
>ALL
>> > governing images, rather than propose a competing one, as psychologists
>tend
>> > to do.
>> > This doesn't mean that all of us spend all our time nipping the hands.
>> > Ron Roizen, I know, has been perplexed at and critical of my
>> > ability/tendency/willingness to both do work within a paradigm and also
>> stand
>> > outside it critically. (If you would put it differently, Ron, it's up
>to you
>> > to jump in.)
>> > I agree that large-scale epidemiological research threatens to weaken
>> the
>> > position of sociologists, but it is because others have been moving in
>on
>> and
>> > perhaps taking over the territory, not so much that the sociologists
>have
>> > been coopted. The psychiatric epidemiological tradition, in particular,
>has
>> > a hard time taking a critical stance to what it is studying, since its
>> > paradigm is that the psychiatrists get to define what it is that is
>being
>> > measured, and the epidemiologist's job is just to apply this
>definition.
>> > Please don't get me wrong, I am certainly not inclined to be
>> > congratulatory about alcohol sociology. We have a long way to go. Robin
>> >
>> > -----Original Message-----
>> > From: Stanton Peele <<mailto:[log in to unmask]>[log in to unmask]>
>> > To: <mailto:[log in to unmask]>[log in to unmask]
>> > <<mailto:[log in to unmask]>[log in to unmask]>
>> > Date: den 20 maj 1999 16:53
>> > Subject: Re: all knowledge in field disproven
>> > Robin:
>> >
>> > Are you implying something about me -- where have I said in any mail or
>> > elsewhere that the beneficial effects of alcohol are limited to wine? I
>> > didn't say it in the mail you reponded to. And, who aside from you, has
>> > mentioned the idea that resveratrol accounts for alcohol mortality
>> findings?
>> > I am bewildered by your insinuatons here. Are you striking out blindly?
>
>> >
>> > I think you short shrift your positions (or the reality) in each of
>your
>> (and
>> > my) points -- your expressed regret about the benefits of alcohol in
>your
>> > former exchange, the impact of the variability of physical dependence
>> > symptoms in terms of your assumptions and those made in the field, and
>the
>> > overall impact of MATCH (they didn't require 15 commentaries in
>Addiction to
>> > agree that all therapy is =) -- for example, no one has yet addressed
>the
>> > reliance on reduced drinking as the sine qua non of the overall success
>of
>> > treatment claimed for MATCH (by Gordis, among others), and the
>consternation
>> > this would sow in NIAAA were it to be acknowledged.
>> >
>> > Since this list is not specifically clinically oriented, the lack of
>> > discussion of this finding seems to me to indicate how strongly in lock
>step
>> > the field has become -- it is no longer necesary for the directorship
>of the
>> > NIAAA to shoot down the Rand researchers (whose study it funded) over
>> > controlled drinking findings, and for battle lines to be drawn and
>fought
>> > over it. Whereas you are inclined to congratulate sociology for its
>> critical
>> > role (Robin, when you say "we're both sociologists" did you mean
>Schmidt or
>> > me along with you? -- I'm a psychologist), the advent of large scale
>> > epidemiological research has largely reversed that role. The "best"
>> > sociologists are now funded to support the same growing ball of string
>that
>> > not only clinical researchers, but biological, are accreting. Everyone
>toes
>> > the same lines now.
>> > (Robin: find something in this last paragraph that you will agree has
>some
>> > semblance or appearance or note of truth, and cop to it and discuss it
>--
>> > just as an intellectual exercise, just to give some credence to the
>idea
>> that
>> > sociologists are able to step back from the globe and discuss their
>role in
>> > it.)
>> >
>> > Stanton
>> >
>> > Robin Room wrote:
>> >>
>> >> Oh, Stanton.... If only the pastures were so green for sociologists,
>> who
>> >> are never so happy as when disproving conventional wisdom. 1.
>Actually,
>> >> Nancy Day and I somewhat beat the rush on the general-mortality
>findings,
>> >> though our study was not published in a journal and thus does not
>usually
>> >> get noticed (see pp. 79-92 in Alcohol and Health: New Knowledge, 2nd
>> special
>> >> report to Congress, final edition, June 1974). We were using better
>> >> measures of drinking than the usual epidemiological study, since we
>were
>> >> analyzing mortality in longitudinal drinking surveys. But of course
>the
>> true
>> >> godfather of this line of findings is Raymond Pearl in 1926. It's a
>little
>> >> hard to argue, after you read Pearl, that this is a new finding. Nor
>> do I
>> >> agree that it "strikes at the foundation of modern public health
>analysis
>> >> and policy", since you apparently can get most of the heart-protective
>> >> effect from alcohol with a drink every second day. (Incidentally,
>Stanton,
>> >> shouldn't you be leading a campaign to say it's not the red wine or
>> >> resveratrol, stupid, it's the ethanol? Or where do you stand on
>> this?) To
>> >> the best of my memory, the "unfortunately" was ironic. A couple of bad
>> >> experences in grad. school should have taught me that irony is usually
>a
>> >> mistake -- it only works within a shared frame of reference. 2. I
>don't
>> >> think you should blame the rest of the cadre for this minor point in
>> Schmidt
>> >> and Room. In what you have picked on, we may have been reaching a
>> little in
>> >> our write-up, setting up a paper tiger we could then crush (or
>whatever Mao
>> >> did with paper tigers). We're both sociologists, after all. As for
>> >> Project Match, the finding that nearly all treatment modalities make
>about
>> >> the same amount of difference has been there in the literature for
>quite a
>> >> while (although it profoundly threatens the claims of CBT and other
>> >> "evidence-based" clinical traditions). The sociologist's best hope for
>a
>> >> disciplinary future, in fact, is that disproofs of cherished positions
>> often
>> >> make very little difference in practice, so after a while we get to do
>the
>> >> disproving all over again. Robin
>> >
>

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