OPEN
3
Men, Alcohol and Coping
Introduction
Lord Stephen Taylor of Harlow, speaking in the House of Lords in 1965,
recalled that he once knew a French GP who was ‘much mystified
by the English disease of the “nervous breakdown”’. The friend had
observed: ‘We do not have this in France. En France c’est l’alcoholisme
(In France it is alcoholism)’.1 By the mid 1960s, concerns about alcohol
abuse among industrial workers emerged in a number of international
studies about psychological illness, driven largely, as the previous
chapter has illustrated, by concerns about sickness absence in industry.
A study of Australian male telegraphists, for example, drew explicit
attention to the inter-relationship between sickness absence, drinking,
gastritis and peptic ulcer. Drawing a direct association between drinking
and neurosis, the author argued that the subsequent ‘physical consequences of drinking to excess no doubt contributed to the liability of
the drinker to be absent repeatedly’.2 As with much of the research on
this topic, nonetheless, there was no clear consensus when it came to
deciding whether the alcohol abuse was caused initially by the worker’s
constitution, or by the pressures of any personal or professional problems he might be experiencing. Research papers from the Netherlands
articulated similar difficulties. A follow-up study of male alcoholics
undertaken by clinicians at a treatment centre in Groningen proposed
that troubles and conflicts in the marital and family sphere were usually
present in patients; however, these conflicts were ‘dependent on the
pathological drinking – either being caused by it or, if present before,
being intensified by it’.3 In Britain, even less was known about the antecedents of drinking behaviours, and debates about alcohol took much
longer to develop. Despite clear evidence that men were more likely to
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© Ali Haggett 2015
Men, Alcohol and Coping 83
present (and take time off work sick) with somatic symptoms, such as
gastritis and peptic ulcer, often exacerbated by the use of alcohol, few
investigators sought to explore the extent to which men self-medicated
with alcohol for the relief of depression and emotional release. This
chapter examines the complex clinical, social and cultural forces that
influenced debates about alcohol abuse in Britain from the 1950s and
it suggests that historically, the failure to examine drinking as a ‘coping
mechanism’ in men has had important implications for the broader
interpretation of patterns of psychological illness.
Reflections on alcoholism
The disease concept of alcoholism that became dominant during the
post-war period had its roots much earlier in the late eighteenth- and
nineteenth-century theories put forward simultaneously by America’s
Benjamin Rush (1746–1813) and Britain’s Thomas Trotter (1760–1832).
Their theories are now well known and broadly describe the central
characteristics of alcoholism that are still familiar to us today: namely,
‘powerlessness’ over the substance and the ‘progressive’ nature of the
illness. By the turn of the twentieth century, the ‘disease’ of inebriety
had begun to find its way into medical textbooks and academic psychiatry.4 In Britain, the Society for the Study of Addiction to Alcohol
and other Drugs (formed originally in 1884 as the Society for the Study
and Cure of Inebriety), emphasised a medical, materialist conception of
disease, despite its original aim to pursue a social medicine and public
health approach. As Berridge notes, initial developments were a product of the particular state of the medical profession during a period
in which physicians were, for the first time, treating ‘specific’ diseases
with ‘specific’ treatments with some success. It seemed, therefore, ‘only
natural to extend this disease formulation to other conditions’, such as
homosexuality, insanity, alcoholism and drug addiction.5 The central
theme of the society was ‘the crusading advocacy of a disease theory of
inebriety to what was seen as an outmoded, moralistic approach’ and
its membership ‘lay firmly in the medical sphere’.6 In promoting alcoholism as a disease as opposed to a vice, the society lobbied to secure
state legislation and a medical treatment structure.7 A brief change
of focus followed during the First World War, when concerns about
efficiency during wartime prompted discussions about the control of
alcohol more broadly. Pre-war discussions had been notable for not
focussing on licensing laws and other ‘non-medical legislative aspects
of the drink question’.8 During the inter-war period, nonetheless, these
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concerns receded and debates refocused on alcoholism as a racial and
eugenic concern – although following the developments in psychiatry related to war neurosis in soldiers, there was limited and cautious
acceptance in some circles of a psychological aspect to addiction.9 For
a number of reasons, a major shift took place in the mid-twentieth
century towards a disease model of alcohol addiction, requiring medical treatment.10 Berridge has shown that a strong biomedical emphasis
developed and flourished in the post-Second World War period due to
a new scientific optimism and faith in technology, which bolstered the
belief in the power of clinical medicine. Simultaneously, the efficacy of
psychological methods had been questioned as the process was increasingly viewed as ‘tedious and long-drawn out’.11 During the 1950s, those
working within the field argued that the state should play a greater role
in the provision of hospital-based treatment for alcoholism; however,
there was very little funding available for alcoholism research.12 By the
1960s, as this chapter will illustrate, concerns had prompted the development of a number of competing organisations, such as the National
Council on Alcoholism, which was established in 1962, and the Medical
Council of Alcoholism, which was formed in 1967.13
The American biostatistician and physician, Elvin Morton Jellinek
(1890–1963), published his seminal piece ‘Phases of Alcohol Addiction’
in 1952 in which he highlighted the notion of ‘loss of control’ which
progressed through a set of stages towards ‘rock bottom’.14 These principles were further developed by the German-born neurologist, Max Glatt
(1912–2002), into a ‘U shaped’ chart depicting a ‘slippery slope’ with an
upward path to recovery.15 In the 1970s, the British psychiatrist, Griffith
Edwards (1928–2012), who became an internationally renowned expert
on addiction, coined the term ‘alcohol dependence syndrome’, which
was incorporated in the World Health Organization’s International
Classification of Diseases (ICD) in 1979. Griffith outlined the dependence syndrome in an article published in the British Medical Journal
in 1976, co-written with American psychiatrist Milton M. Gross.16
Edward’s influence on addiction studies was manifest in a prolific range
of publications directed at both academic and popular readerships.17
The model of alcoholism eventually adopted by the NHS, and influential during the period under study, was that based on the work of Max
Glatt at his therapeutic treatment unit at Warlingham Park, Middlesex
during the 1950s.18 Although there was increasing acceptance of the
notion of alcoholism as a ‘disease’, developments in policy and treatment
in Britain were nonetheless fragmented and piecemeal. While some articulated increasing concern about alcohol abuse, there was still widespread
Men, Alcohol and Coping 85
denial of the problem. The first branch of Alcoholics Anonymous (AA)
was founded in London in 1948 but aroused little interest among those
in the medical profession.19 It is testimony to the disregard of the medical profession that three years later, in 1951, a consultant psychiatrist
applied for funds to attend a World Health Organization conference on
alcoholism to find that his application was rejected, on the grounds that
‘there was no alcoholism in England and Wales’.20 Glatt, who first came
across alcoholics when working as a psychiatrist at Warlingham Park
hospital, recalled that when he became interested in alcoholism during
the early 1950s, he knew ‘not a thing about it’ and that ‘nothing much
was written’ about it in Britain.21 His treatment unit became a model for
others that were eventually opened under the NHS and he often received
foreign clinicians to his unit who came to learn about his treatment
methods. Despite increasing concern about alcoholism in specialist circles, the Ministry of Health continued to deny outright that alcohol was
a problem at all in England and Wales.22
In the scant statistical evidence that emerged in figures from
in-patient units and general practice, men were significantly overrepresented. However, prior to the 1970s there was no organised discussion about gender in British debates about alcoholism; it was simply
noted to be less common in women. Efforts instead focused upon
establishing an accurate national estimate of alcoholics and discussion
centred otherwise on how best to treat the condition once diagnosed.
The Rowntree Steering Group on Alcoholism, set up in 1956 under the
chairmanship of W. B. Morrell from the Rowntree Trust, was particularly
concerned with finding a true estimate of numbers affected by alcohol
abuse, since numbers varied greatly in existing studies. Jellinek had
developed a formula for estimating the percentage of alcoholics in the
general population based broadly on the number of deaths from liver
cirrhosis in a given year. However, Denis Parr, then a Research Fellow
at the Department of Psychiatry, St. George’s Hospital in London, put
forward a much lower estimate based on numbers presenting in general
practice.23 Glatt was critical of Parr’s research, arguing that GPs were
not always likely to detect the early stages of alcoholism and he raised
concerns that this lower estimate would increase the general apathy
about alcohol abuse.24 The steering group called upon the assistance of
social agencies, such as health visitors and probation officers, eventually
confirming that much hidden alcoholism existed in the community,
thus calling into question Parr’s figures.25
Other initiatives developed along similar lines. Griffith Edwards,
inspired by alcoholism programmes he had seen in America, began
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discussions during the early 1960s with a group of interested individuals in the Camberwell area of London – a move that developed into
the Camberwell Council on Alcoholism (CCA). This group consisted of
members drawn from medicine and psychiatry, the clergy, the police,
social services and the Chamber of Commerce and it worked to educate doctors and other interested parties. While Glatt’s treatment unit
tended to treat middle-class drinkers, the CCA was particularly concerned about the plight of ‘skid row’ alcoholics and habitual drunken
offenders.26 It went on to become nationally influential, in part because
of the lack of other strong policy-relevant interest groups in the alcohol
arena.27 Although their objective was ‘to gauge the extent of the problem and to investigate personal, social and economic factors concerned
in the causes of alcoholism’, discussion tended to be dominated instead
by its ‘impact upon the life of the nation’, in particular the deleterious social consequences of alcoholism: crime, social disturbance and
family breakdown.28 Alcohol abuse clearly appeared to affect men in
much larger numbers than women, but nonetheless, discussions rarely
mentioned why this might be. Rare individual accounts from alcoholics
themselves demonstrate widespread denial and reluctance to confront
the problem. One former alcoholic whose contribution was published
in the Journal of Alcoholism, for example, recalled that none of his
friends, work colleagues or his employer ever took him aside and spoke
seriously to him. Instead, he noted that they ‘all connived in covering
up . . . what now appears to be serious drinking bouts and their attendant hangovers’.29 This man declared that the situation within which
he found himself was simply ‘part of the rich pageant of life as [he
knew] it’, and he concluded that, where alcohol was concerned, he was
just ‘slightly more blind in a whole kingdom of the partially sighted’.30
General medicine
Although researchers eventually acknowledged that much problem
drinking remained unreported in the community, the official figures
that existed by 1950 suggested that alcohol consumption in Britain
was comparatively low.31 This contributed to the official view from the
Ministry of Health that alcohol abuse was ‘not a problem’. However,
as Thom has shown, a number of other factors framed the discourse
on alcohol abuse. Firstly, the power of the temperance movement had
waned considerably and thus policy action, when it came, focused on
the medical aspects of alcoholism and not on preventative measures.
Secondly, the general disarray of mental health services following the
Men, Alcohol and Coping 87
introduction of the NHS resulted in a lack of resources for alcohol
treatment. Thirdly, and perhaps most importantly, the disease model
of alcoholism legitimised medicine’s role in treating the condition,
viewing it as a ‘disease of the unfortunate minority’.32 As such, debates
did not focus in any serious way on the social factors and life stressors
that might have contributed to individual drinking habits, nor did they
address the strong cultural forces that prevented men from discussing
their problems and seeking help. Indeed, the Ministry of Health was
explicitly concerned about limiting their enquiries strictly to treatment
issues, since prevention would open ‘very wide vistas’, which were
thought to be quite outside the scope of the department’.33
Accounts from those working in medicine certainly reflected this
approach. Casualty doctors noted that cases of alcoholism usually
presented at the ‘emergency end of the disease’, and, because patients
were admitted to general hospitals, not psychiatric wards, as soon as
they were ‘physically well’ they were discharged.34 The emphasis on the
physical nature of the condition was widely evident in accounts from
hospital doctors who contributed to a series of seminars on the topic
held by the CCA in 1967. One remarked, for example, that alcoholics
rarely presented in ‘such a mental state’ that it would justify compulsory detention under Section 25 of the Mental Health Act.35 During
a subsequent seminar in 1970, the Registrar in charge of Casualty at
King’s College Hospital similarly described his experience of treating
intoxicated patients:
Should someone present himself as very depressed, we try and find a
physical reason to account for this . . . such as an overdose of drugs . . .
or some overwhelming disease – I wouldn’t spend too long on it.
If it’s an acute problem, we treat them, but if it’s not, then they have to
go. Overdose is seen as a psychiatric emergency – alcoholics are not.36
The remaining seminar discussion focused on the physical treatments
that were available such as stomach irrigation for alcohol poisoning
and the use of vitamin injections. ‘True’ psychiatric cases, one doctor
pointed out, were assured a consultation at the Maudsley Hospital;
however, he cautioned that the broad remit was ‘to find out what
is the matter with him, to assess whether he should be chucked out
or kept in’.37 This approach was in many ways at odds with the official approach of the psychiatric profession and the classification of
‘alcoholism’, which was placed firmly under the heading ‘Neurosis,
personality disorders and other non-psychotic mental disorders’, in
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the International Classification of Diseases.38 While psychiatrists were
more likely to consider that alcohol problems might be related to
personality disorders and neurosis, clinicians working within general
medicine, often dealing with late-stage alcohol problems as emergencies, highlighted its organic and physical effects.39 This approach was
also in marked contrast to the attitudes of alcohol experts such as Glatt
who, although not underestimating the importance of personality,
emphasised the ‘great influence of social problems on the causation
and development of alcoholism’.40 His position was that alcoholism was
both a ‘symptom’ and a ‘disease’; ‘family strife may have been caused
by the drinking but [was] in itself later a cause for further drinking’.41
Indeed, one of his methods of treatment involved patients telling their
life-stories – a technique he had developed previously when working
with neurosis patients.42 Glatt also worked closely with AA and claimed
his methods complemented those employed by the organisation.43
However, despite his notable influence, the eventual development of
alcohol treatment units between the early 1960s and the 1980s was
slow and patchy and treatment methods were diverse.44 Glatt noted
that he faced considerable inertia and that ‘many doctors and professionals [were] only too keen to avoid involvement with alcoholic
patients’.45 Although some provision was made for women, those who
were referred to treatment units were predominantly male, likely to be
in their forties and from the higher social classes. ‘Skid row’ drinkers
were less likely to call upon services provided, and consultants were less
likely to admit them to in-patient wards. Thom notes that this demographic remained stable until the 1980s.46
During the early 1970s, a small group within the CCA put forward
a proposal to investigate women alcoholics. Although numbers of
women were thought to be very small at a ratio with men of one to
four, a review of the literature suggested that there were some specific
concerns – among them the fact that within the family unit, women
were usually the primary carers of children, and the fact that ‘drinking at
home’ featured much more regularly, making it harder to detect.47 The
nature of this investigation is particularly illuminating. In many ways
concerns clearly reflected long-established moralistic overtones about
women and alcohol. As others have shown, in the alcohol arena the
focus has historically been ‘not so much on women as women, but on
women as mothers, and on the notion of maternal neglect’.48 However,
the approach employed for this research on women says much about
contemporary attitudes towards gender, ‘ways of coping’ and psychological illness. The investigative framework was notably different to that
Men, Alcohol and Coping 89
applied to the seminars, symposia and enquiries into drinking problems
in men. To begin with, the group of professionals invited to contribute
to discussions included sociologists and marriage guidance counsellors
in addition to clinicians and members of the criminal justice system.49
Subsequently, specific areas for research included: the role of femininity; recent changes in women’s social role; the relationship between
drinking and marriage; and how conditioning, upbringing and consequent life expectations might influence drinking. In many discussions,
the onset of drinking was noted to be triggered by marital breakdown,
in contrast to the assumption that alcoholism in men was likely to lead
to divorce. Research questionnaires distributed via staff to patients at
treatment centres included explicit questions such as: Why did your
drinking become a problem? Do you think that being a woman makes
a difference to your drinking problem? Was depression a factor in your
drinking?50 Staff working at treatment centres were asked specifically
about factors that might be unique to women in patient case histories,
referral patterns and treatment methods.
Contributors to the CCA’s project observed that women were more
likely to be labelled as ‘depressive’, with the alcoholism treated as a
secondary disease, if it was diagnosed at all.51 Hospital doctors and GPs
were more likely to diagnose psychoneurosis to shield a woman from
the stigma of alcoholism. Because of this propensity to be diagnosed as
‘depressed’ and not ‘alcoholic’, women were subsequently more likely
to appear in statistics for psychiatric referral and for treatment with psychotropic drugs. The effects of menstruation, menopause and hysterectomy were explicitly noted to be factors that could influence the onset
of drinking, and attention was also paid to possible problems associated
with homosexuality, sexual identity and loneliness. These points of
reference were in stark contrast to those that emerged in debates about
male alcoholics, none of which explored what might be unique about
being a ‘man’ in relation to drinking. Conclusions from this research
indeed suggested that women reported drinking when life ‘got them
down’ or when they were ‘restless and tense’, because it helped them
‘forget their worries’.52 In psychiatric settings, ‘marital discord and
domestic stress’ were specifically observed as ‘precipitating factors for
hospitalisation in women’, whereas alcoholism was less likely to result
in a man being referred for psychiatric assessment at all.53
These findings were mirrored in a research paper written by a Scottish
psychiatrist, A. B. Sclare, who observed that alcohol problems in women
could be correlated specifically to environmental factors related to
employment or domestic stress.54 Personal testimonies from men, in
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contrast, suggest that they were not comfortable with reflective analysis
of their feelings or their situation. One recovering male alcoholic for
example recalled: ‘The question I am often asked is “do you know what
caused your drinking?”’ to which he added, ‘I am not able to isolate any
particular cause or causes in myself . . . I am drawn to the conclusion that
the most likely hypothesis is that I was conceived on the back of a brewer’s
dray.’55 The CCA’s enquiry into female alcoholics thus focused not only
on dealing with the social consequences of alcohol abuse, but instead
included a set of research questions that were much more likely to identify
social, cultural and economic factors that prompted problem drinking.
General practice
Inevitably, some patients with alcohol problems presented in primary
care. However, GPs were primarily concerned with how to diagnose
the problem and deal with sickness certification and focused less upon
finding out why their patients might drink in the first place.56 Many
felt that there was so much stigma surrounding alcoholism they were
justified in falsifying certificates when a true diagnosis might result
in patients losing their job. Glatt conceded that hospital doctors were
inclined to do the same thing.57 Correspondence from the Rowntree
Trust Steering Group on Alcohol also suggests that GPs felt ‘services
on the NHS were so inadequate that many h[ad] decided not to waste
their own time or that of their patients by attempting further use of
them’.58 GPs, reflecting on their time in practice, confirmed the general
picture that alcoholic patients were usually male and that they would
usually present with some kind of somatic disorder that would indicate
an alcohol habit. Alternatively, their wives would make a visit to the
family doctor to report the problem.59 Griffith Edward warned GPs
that the alcoholic often came into the surgery asking for something for
‘bad nerves’ or something for ‘his stomach’, concluding that abnormal
drinking may in fact cause, precipitate, imitate or be secondary to every
known psychiatric syndrome.60
There were important regional differences in the incidence of alcohol
abuse, and the characteristics of presentation also varied depending on
social class. Although it was eventually determined that Parr’s estimate of
the numbers of alcoholics nationally was much too low, his study of alcoholism in general practice nonetheless highlighted some distinct regional
trends in male drinking. Overall estimates for the south west of England,
for example, were relatively low. However, numbers of male alcoholics in
the region were particularly high, followed closely by high numbers of
Men, Alcohol and Coping 91
male alcoholics in the north of England and the Midlands.61 Cider drinking among west-country farm labourers resulted in significant alcohol
problems that were reflected in Parr’s statistics. Personal accounts from
GPs who responded to his research questionnaires provided evidence
that farm workers regularly drank ‘a gallon a day’ and this habit would
often continue for the duration of their employment. Similar problems
were described in the oral histories of retired physicians who had spent
their careers in general practice working in Devon and Somerset. One
doctor from east Devon, whose practice list consisted largely of farmers
and their families, recalled that cider drinking was a ‘significant problem’,
particularly during harvest time. He felt that it was also often related to
depression but that it was very difficult to decipher which came first: the
depression or the drinking.62 Professional journals that focused specifically on alcoholism were able to identify a number of other occupations
in which individuals might be vulnerable to over-drinking. Concern
was directed in particular towards executive workers who drank alcohol
socially as part of their role and those with jobs in the hospitality trade
where alcohol was widely available. Other types of employment that
allowed abuse to go undetected were also noted. Sickness absence among
casual labourers, for example, might go undetected where workers could
simply resume work when they had recovered from a drinking bout.63
The incidence of alcohol abuse among fishermen had also been a longstanding concern. A retrospective study of alcoholism among Scottish
fishermen between 1966 and 1970 suggested that men working in this
trade were ‘about six times as likely as other men to die of cirrhosis of the
liver and were also more prone to peptic ulceration’.64 It was once again
not clear from reports whether or not fishermen drank due to the unique
strains of a life at sea, or whether the job attracted ‘unusual men’ who
already had an increased risk of alcoholism.65
For GPs dealing with alcoholism in their community, there was a clear
distinction between working-class and executive ‘habits’. A common
theme among interviews was the working-class culture in which men were
paid on a Friday, gave their wives ‘housekeeping’ money, but then spent
the rest of their wages on alcohol over the weekend – a practice described
pertinently by one GP as ‘brickies on blinders’.66 This culture may account
for high numbers of men affected by alcohol abuse in the Midlands and
the north of England where manufacturing industry, building and mining
predominated. As another doctor recalled:
The culture of the working-class man was, he came, he did a heavy
job, which was physically demanding, he sweated a lot, lost a lot of
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fluid, and the culture was, he came home, his wife put the meal on
the table, and then off he went to the pub, night after night, to put
in lots of beer . . . and working men, if you look at the beer consumption, it was absolutely enormous, and it was mostly male. And the
pubs were male in those days.67
One female GP whose patient list included men who worked for
Smithfield and Billingsgate markets in the City of London, recalled
that it was difficult to challenge patients about how much they were
drinking because ‘the norm was very high’. White men in the East End,
she recalled, were ‘doing it day in, day out’. But in many cases ‘they
held a job, for a lot of them they managed their life perfectly well,
but boy, were they drinking heavily, and were they damaging their
health’.68 Others pointed out that age was a significant factor for men
in socially deprived areas; many older men had serious health problems;
co-morbidity and alcoholism was ‘a big, big thing in east London’.69
Alcoholism, according to one doctor, was very much associated with
depressive illness and other psychiatric conditions, complicated further
by the fact that older, alcoholic white men with other health conditions
tended also to be non-compliant with their medication.70
The general consensus among doctors was that alcohol abuse among
professional men was perhaps no less common, but that they ‘hid it
very well’ until the problem deteriorated beyond a certain point.71
Professionals and semi-professionals were more acutely concerned
that their employers did not find out about their alcoholism for fear
that they would ultimately lose their jobs. This presented GPs with a
dilemma when faced with what diagnosis they should place on the sickness certificate. One doctor remarked:
They would actually say ‘Can you put something else down?’ So
I, I’d say, ‘Well how about stress-related?’ And they were happy to
accept that. Even though if they hadn’t been alcoholic they wouldn’t
have, they were quite happy to, I used to agree with them . . . ‘make
it stress-related, but you and I know that it’s an alcohol problem’.72
David Palmer, when interviewed, agreed that the problem went ‘right
the way up’ the social scale, but that ‘the drink [was] different. They
drank scotches and gins and things’. Ultimately, he added, whether
the men were white- or blue-collar workers, they all drank for ‘escapism’.73 Alcoholism did not respect class, profession or lifestyle, as one
other family doctor pointed out: a church-warden patient of his was
Men, Alcohol and Coping 93
once found to be behaving strangely, falling asleep in his car and at
parish council meetings. They discovered he was stealing the communion wine at about the same time that his wife discovered ‘a bottle
of whisky in a wellington boot in the garage’. Once again, this doctor
felt that the patient’s alcoholism had ‘probably concealed a degree of
depression’.74
There was little doubt among GPs reflecting on their time in general
practice, that the over-use of alcohol was commonly used among men
as a coping mechanism.75 As was evident in Chapter 2, there was also
a general consensus among them that men tended to present with
psychosomatic symptoms that were more ‘acceptable’ and less stigmatising. Sarah Hall, who had a particular interest in the psychological
dimension of disease, noted that in her London practice alcohol presented in many ways, but that dyspepsia was one of the most common:
So, with the dyspepsia, you know, probably, the first thing you
thought of is alcohol. And, if you had really ruled that out, you
know, then you began to wonder about, whether there was also a
psychological element to it. But simply, the person who was always
taking Monday and Tuesday off, and so wanting certification. And
of course, often they would also come and say they’d got back pain.
And, so, some of the back pains were actually problems with alcohol, but they didn’t want to admit that, so they just turned it into
back pain.76
Indeed, employers were warned by alcohol experts to be suspicious of
repeated sickness certificates for gastritis, signs of irritability, decreased
performance and poor time-keeping.77 They were also advised to be
alert to absences on Monday mornings, particularly ‘if a wife phoned
in’, since this might indicate a weekend of heavy drinking.78 Such
concerns did not go entirely unnoticed by the media, as occasional
articles were released in the press highlighting the issue of sickness
absence due to alcohol. One headline in 1970 warned that ‘Monday
is hangover day for British industry’, and claimed that ‘a quarter of a
million men in Britain will be off sick today, when all they have is
a bad hangover’.79 Another news item in the Daily Express described
the problem as ‘a secret illness’ and as ‘the complaint that nobody
wants to talk about’.80
Not all GPs were as perceptive as Hall when it came to recognising somatic symptoms caused by alcohol abuse. As Glatt pointed out
in 1960, doctors were ‘not well-trained to suspect or diagnose the
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condition in its early phases’ and in many cases ‘doctors and alcoholics
[did] not care a great deal for crossing each other’s path’.81 The personality of individual doctors certainly influenced their patterns of diagnosis.
In a lengthy article on this topic that covered numerous research studies, H. J. Walton, a psychiatrist from the University of Edinburgh, found
that a substantial proportion of both medical students and experienced
GPs reacted unfavourably to patients presenting with psychosomatic
disorders without serious organic disease.82 Although most doctors
fully accepted a responsibility towards such patients, those whom
Walton described as ‘physically-minded’ as opposed to ‘psychologicallyminded’ found alcoholic patients to be ‘not acceptable’ and described
them as a ‘clinical burden’.83 An enquiry into GP’s opinions about
alcoholism also found that although an increasing number of doctors
viewed the condition as an illness, ‘a disturbing minority still [thought]
of it in terms of moral weakness or weakness of willpower, or sin and
vice’.84 This, the author observed, was worth noting precisely because
such opinions were likely to be reflected in attitudes towards, and
management of alcoholic patients.85 Concerns about the difficulties
associated with understanding alcoholism and alcohol-related behaviour prompted a sociologist from the Addiction Research Unit at the
Institute of Psychiatry to remind the medical profession that, although
the over-use of alcohol resulted in, on the one hand a ‘biochemical
and physiological state’, on the other hand, the function of ‘noticing,
recognising, responding to and treating’ it should be seen within the
context of both personal and societal ‘beliefs’ about the condition – and
wider culturally held values about such issues as personal responsibility
and ‘appropriate’ behaviour. Thus, whatever the medical basis of the
condition, much of the decision-making process about diagnosis and
treatment depended upon ‘explicitly social considerations’.86 Given
doctors’ paucity of training in psychological medicine, the lack of postgraduate training for general practice, and the broader stigma and indifference towards alcoholism, it is perhaps not surprising that men who
self-medicated for emotional problems were reluctant to seek help from
family doctors and were often diagnosed incorrectly when they did so.
Reflections
In an article published in the British Journal of Addiction in 1963, Herbert
Berger, an American physician, lamented existing approaches towards
alcohol abuse.87 He had deliberately changed the title of his paper
from ‘The treatment of alcoholism’ to ‘The prevention of alcoholism’,
Men, Alcohol and Coping 95
arguing that the word ‘treatment’ should be ‘dropped’ from its prominent place in discussions.88 Berger recommended instead, a ‘philosophy of alcoholism’ in which ‘causative factors’ should be central to
investigations.89 His core argument was that alcohol was a ‘secondary
aetiology’ – the prime cause being ‘some difficulty’ making it ‘impossible for the patient to cope with the vicissitudes of his environment’.90
Berger reminded the medical profession that the need for ‘escape’ was
a normal human attribute and that humans in every culture had practised emotional release from daily frustrations. In this time and place,
he noted, ‘making the environment more tolerable’ included drinking
alcohol as medication for the relief of depression and ‘as a lubricant
to forget one’s troubles . . . to blur one’s accurate observation of stark
reality’. Failing to focus on the environmental causes of alcoholism, he
warned, would result simply in ‘shifting addictions from one material
to another’.91 In his paper, Berger also criticised AA for its practice of
leaving alcoholics to ‘hit rock bottom’, arguing that in no other speciality of medicine did physicians ‘wait until the patient has practically
succumbed to a disease before attempting to effect a cure’.92 Berger thus
broadly urged both the medical profession and AA to do more in terms
of preventative medicine, concluding that ‘no man is an island’ and the
entire community was needed to attend to the problem.93
Berger’s comments were expressly relevant to those working in the
alcohol arena in Britain. Speaking in 1963 at the annual dinner of the
Society for Study of Addiction, Kenneth Robinson MP, acknowledged
that there was less than good provision on all fronts in Britain compared with America and some other countries.94 Commentators noted
with regularity that approaches to alcoholism in other countries such
as America, Norway and Sweden more readily provided initiatives to
help alcoholics that included the use of psychiatrists, psychologists and
social workers to explore the social and cultural aspects of the disease.95
Countries where the temperance movement had previously asserted
more influence, despite the divisions this caused, spoke more candidly
about alcohol abuse and its problems and were more open to exploring
alternative dimensions of the disease. As Selden Bacon, the Director
of Alcohol Studies at Rutgers University noted, by the 1960s, the rigid
structures of the temperance camp, the anti-temperance camp and the
‘avoiders’ (who were more opposed to the conflict than to alcohol itself)
had begun to lose their power. The resulting interchange of ideas emphasised tested knowledge and an evidence-based approach. Furthermore,
as Lord Soper pointed out in the House of Lords debate in 1965,
Canada, Australia, New Zealand and Australia received ‘a great deal of
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A History of Male Psychological Disorders in Britain
government assistance’ for alcohol research, and in Scandinavian countries, where there was a state monopoly of the manufacture and sale of
alcohol, a proportion of the profits were ploughed back into research
and education.96 Consequently, as the previous chapter demonstrated,
industrial employers were more likely to provide programmes providing
assistance to alcoholic workers. The contrast in Britain was stark: there
was widespread denial among industry leaders and within the Ministry
of Health, while the state benefited from large revenues from the duty
on alcoholic beverages. It is notable that, in Britain during the 1970s,
when concern was eventually raised about female alcoholism, research
questions were constructed around a more productive framework, less
focused on aspects of treatment and diagnosis, and more upon what
it might be about the female role that caused women to abuse alcohol. Betsy Thom has argued that the feminist movement of the 1960s
was instrumental in this respect, since it had begun to frame women’s
health issues in political, social and economic terms. It thus provided
the ideological motivation for explanations of women’s use and misuse
of alcohol, emphasising the social and psychological context of drinking.97 As this book has illustrated, the men’s movement in Britain was
less influential and there were no prominent initiatives actively questioning the male role and its impact on men’s wellbeing.
The problem was exacerbated further by the fact that manufacturers
of alcoholic beverages directly targeted men in their advertising campaigns, which promoted drinking as not only a pleasurable pastime,
but also increasingly as a way to relieve stress. During the 1950s, these
advertisements appeared widely in daily newspapers and also in publications directed exclusively at men, such as Lilliput and Men Only. Whisky
adverts even claimed that alcohol had ‘health-giving’ properties: ‘a
White Horse toddy at bedtime’, for example was supposed to ‘promote
warmth and glow of wellbeing’ while ‘disarming the threat of colds or
influenza’.98 The manufacturers of the fortified wine, Dubonnet, stated
that their drink was an effective ‘tranquilliser’ and that ‘at no time
does it affect the liver’, despite its alcohol by volume (ABV) content of
over 14 per cent.99 During the mid-1960s, alcohol often featured in the
advertising matter in the Journal of the College of General Practitioners.
Guinness in particular was promoted with regularity for consumption
both by patients and doctors. One advert featured a cartoon of a man
in sports vest and shorts, jogging – while at the same time drinking a
pint of Guinness. The caption read: ‘Dear Doctor, I have taken Guinness
for seven days running and how much better I feel.’100 Another, aiming
directly to entice medical professionals, and picturing a cartoon of an
Men, Alcohol and Coping 97
exhausted-looking doctor, suggested that ‘When you’ve been worked
off your feet . . . Relax with a Guinness.’101 Concerns about trends in
advertising developed from the 1960s as manufacturers increasingly
drew upon sexualised images to promote their products. Lord Soper
condemned the alcohol adverts as ‘unscrupulous’, arguing that they
invited young people – if they wanted to be virile – to be constantly
taking in alcohol.102 An article in The Times in 1979, urged the alcohol
industry to be more responsible, since it had caused trouble confusing
‘good’ things like holidays and sport with drinking, while being mendacious about the true merits of alcohol.103 Lemle and Mishkind noted in
research published in 1989, that through the second half of the twentieth century social drinking increasingly became a primary cultural
symbol of ‘manliness’.104 Heavy drinking symbolised greater masculinity than lighter drinking, and the more a man tolerated his alcohol, the
more manly he was deemed.105
Accounts from a Mass Observation investigation into public houses
and drinking confirm indeed that working-class men were inclined
to drink to appear ‘tough’ and to fit in with their peers. The cultural
association between alcohol consumption and masculinity was clearly
evident in the words of one respondent who claimed: ‘My reason for
drinking beer is to appear tough. I heartily detest the stuff, but what
would my pals think if I refused? They would call me a cissy.’106 Another
declared that he only went into the pub with his friends ‘for the sake of
their company’.107 Many noted the apparent health-giving properties of
alcohol, listing its ‘good effect on appetite’, and its ‘laxative and sleepinducing effects’ as reasons for drinking. These reactions, the authors
of the study noted, indeed reflected the themes promoted heavily in
brewers’ advertising.108 Beer-drinking was also widely associated with
increased sexual performance. One pub-drinker declared that ‘if [he got]
three pints down [him]’, he ‘was able to have sexual intercourse with
the maximum of efficiency and when he woke up in the morning he
was able to repeat the process with the utmost satisfaction’.109 This Mass
Observation study was primarily of working-class beer drinkers; however, the publicans who were interviewed observed that spirit drinkers
tended to be businessmen, who were ‘hard-pressed by work or financial
matters, fall[ing] to spirits as a quick consolation to forget matters’.110
The authors also concluded that a large amount of wine and spirits was
being consumed at home by the middle class.111
From the accounts of physicians, the growing concerns of those
working in the alcohol arena and in industry, it is clear that for men,
drinking alcohol was a common means of escapism. In the workplace
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A History of Male Psychological Disorders in Britain
and during leisure activities, ideas about the degree to which it was seen
as appropriate to admit to emotional difficulties discouraged men from
seeking help for problems both at work and at home. On a rudimentary
level, men appeared unable or unwilling to look introspectively at the
cause of their problems. These issues were compounded further by the
dominance of the disease theory during the 1950s and 1960s, which
assumed the alcoholic to be in the minority, diverting attention away
from broader consumption levels and social factors in causation.112
During the post-war period, GPs and hospital physicians were also
poorly trained in psychological medicine and, until the late 1970s,
were usually male and therefore affected by the same difficulties when
challenged to be reflective or emotionally expressive. Many unwittingly
colluded with stereotypical views about femininity and masculinity,
providing psychiatric diagnoses for women and somatic diagnoses for
men. Quite often, both the male patient and the doctor were satisfied
with a somatic diagnosis and looked no further.
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