Between 1870 and 1920 Spanish doctors’ perspectives on alcoholism were directly influenced by French and to a lesser extent British, German and Italian scientific research.¹ In general, Spanish medical studies dedicated to alcoholism did not demonstrate doctrinal originality, nor did they have an original empirical basis, as evidenced in the use and systematic analysis of statistics from other countries to support their claims. This doctrinal dependence on foreign research affected the nature of the work focusing on alcoholism, which consequently had an evident propagandistic and informative tone, making it difficult to distinguish from the writings and lectures of non-medical, anti-alcohol propagandists.²

In general, medical studies focused on warning the population of the dangers of excessive consumption of alcohol regarding health, morals, social order and race. This created a dual perspective of alcoholism within the medical-social field: as a vice and a disease.³ Alcoholism was associated with a lack of morality, deviant behaviour – such as crime, sexual promiscuity, prostitution and vagrancy – and misery. Since alcoholism was also seen to be a social plague, a connection began to be established between alcohol and other diseases such as syphilis, tuberculosis and madness.

In this regard, studies on alcoholism and anti-alcohol attitudes differed little from the international publications of the time, and the appearance of alcoholism in degeneration theory strengthened the view of drunkenness and alcoholism as vice and disease. This trend began to crystallise in Spain in the 1890s, coinciding with a period of significant social and economic change and the loss of its last colonies in 1898, and after a brief war with the USA plunged the country into a crisis that was interpreted by elites as a symptom of deep decline.⁴ The biological determinism of degenerationism – the idea that it was based on heredity – had a substantial influence on anti-alcohol discourse in such a context, reinforcing the association of alcohol with vice and disease: alcoholism appeared to be the cause and product of degeneration. Additionally, the importance given to the idea that alcoholism was hereditary created a nihilistic attitude towards the issue, which in turn led the anti-alcohol struggle to propose the implementation of preventive measures, essentially suggesting that treating hereditary alcoholism would be unsuccessful. Nevertheless, Spanish psychiatrists played a secondary role in the development of this anti-alcohol corpus, which was led by doctors and hygienists with no psychiatric training. This fact is striking, and the possible causes of their reticence should be analysed.

The purpose of this chapter is to analyse psychiatrists’ positions on alcoholism at this time and explain why they did not play a leading role in the fight against alcoholism together with hygienists and social doctors. An explanation given by some authors is that alcoholism is a difficult disease to catalogue and cure, a fact which may have led many psychiatrists to pay little attention to it.⁵ However, from the many sources that I have studied I have inferred that there are deeper issues relating to the clinical approach to alcoholism and psychiatrists’ professional priorities, ingrained in the social weakness of the discipline of psychiatry at that time.⁶ I will work from the hypothesis that psychiatry during this period was still constructing itself as a profession and was focusing on other priorities that would legitimise it publicly as a field in itself, such as psychiatric expertise in major criminal cases. Psychiatrists’ interest in alcoholism was reduced to psychiatric clinical symptoms, in that alcoholism was considered a cause of ‘alcohol madness’: alcoholism was not, at this point, considered from a social perspective by psychiatrists.

On this basis, this chapter analyses alcoholism in psychiatric publications and the clinical perspective of the disease, within the context of hereditary alcoholism advocated by degenerationism, as well as changes that occurred after 1900. The period of analysis of this work begins in 1870, when the term ‘alcoholism’ was used for the first time in Spanish medical literature. It concludes in 1920, when the journal Archivos de Neurobiología (Archives of Neurobiology) was founded and the movement of mental hygiene began. In the new context of mental hygiene that developed during the 1920s and 1930s, psychiatric discourses and practices began to focus on the prevention of mental illness.

Medicine and alcoholism: the discreet role of psychiatrists

From the mid-nineteenth century, Spanish medicine described immoderate consumption of alcohol as a social and health problem associated with profound changes emerging from industrialisation. The first hygienist doctors noted the significant consequences that these transformations had on the life of the popular classes, and especially among the emerging working class. In this new context, traditional patterns of consumption and production of alcoholic beverages changed, and alcohol began to be perceived not only as a vice and a danger to the social order, but also as a social disease closely linked to the working class and their miserable living and working conditions. In the mid-nineteenth century, Spanish doctors believed that alcoholism was mainly sociological and moral and could thus not be treated clinically. An important addition to Spanish scientific data was the late and incomplete incorporation of Alcoholismus chronicus by Magnus Huss (1807–1890), published in Swedish in 1849 and translated into German in 1852.⁷

In this sense, the delay in the use of the term ‘alcoholism’ in Spanish studies is striking.⁸ Coined by the Swedish doctor to define a new disease, used by French alienism since the 1850s,⁹ and incorporated and reinterpreted by Benedict Augustin Morel (1809–1873) in his formulation of degeneration theory in 1857,¹⁰ the term was not used in Spain until the 1870s. One of the first authors to do so was Pedro Felipe Monlau (1808–1871) in the third edition of his work Elementos de higiene pública (Elements of Public Hygiene), published in 1871. Unlike the two previous editions of that book (1847 and 1862), the third edition included the terms ‘alcoholism’ and ‘alcoholic’ to refer to both the excessive consumption of alcohol and its effects on health and the intoxicated subject.¹¹ Despite the modern terminology, medicine continued to incorporate social prejudices towards drinkers, which in turn influenced new scientific parameters, meaning that an alcoholic came to be defined as a medicalised drunk, and alcoholism as a vice and social plague rather than as a disease. In this sense, the substitution was never complete, and the old and new terminologies were interchangeable for decades, as is evidenced by the 1914 publication of a book entitled Borrachos (Drunkards) that attempted to clarify and define the use of those terms.¹²

The late use of the term ‘alcoholism’ points to Spanish doctors’ unawareness – until the last quarter of the nineteenth century – of the innovative work on alcoholism being published abroad. It also shows that until then there was no clear appreciation that the consumption of alcoholic beverages could be a disease in itself. A greater understanding and knowledge of alcoholism from works published abroad, especially in France, and a reception of degenerationism contributed to the terminological change and, to a lesser extent, a conceptual change; despite the biological determinism that permeated degeneration theory, the nature of alcoholism as a social plague began to be emphasised, paradoxically, as it was now believed to be hereditary.

Degenerationism was very well received by social doctors and hygienists as a medical-sociological theory to explain the collective evils of society.¹³ Their support for an interventionist approach to the population’s physical and moral environment, especially in the case of the working class, fitted well with the ideas of degenerationism and the interpretation of alcoholism based on that theory. Familiar with social problems and committed to their solution, doctors and social hygienists interpreted degeneration and alcoholism as a collective issue, and the clinical and individual aspects of degeneration were quietly ignored. They gave vital importance to the consequences of alcoholism for the human species and the necessity of imposing a moral intervention on the population.

In this context, psychiatrists’ minimal role in the anti-alcohol struggle is striking. Despite their familiarity with alcohol-dependent patients admitted to psychiatric institutions, their writings on the subject were scarce and focused on the clinical symptoms related to the mental health of the alcohol-dependent patient, avoiding social-medical discourse that emphasised the nature of alcoholism as a social plague. In their publications, psychiatrists of the time tried to define alcoholism, as well as its clinical evolution and its different phases, using both the literature and theories of the time and their daily practice in asylums. The resulting scientific production, however, was unoriginal, borrowing heavily from foreign literature, especially French publications.

There was, in my view, a contradiction between theory and conceptualisation on the one hand and practical application on the other. The former was characterised by unoriginality (although psychiatric theories did raise some interesting points such as rejecting – or questioning the importance of – degeneration theory and the role of hereditary alcoholism). In regard to the latter, cases of alcoholism were presented in medical journals to illustrate and construct a scientific discourse based on clinical observation. But beyond these published case studies, research into clinical cases from asylum settings showed a fissure between theoretical and practical facets, as is evidenced by the low percentage of admissions due to alcoholism in psychiatric institutions and the absence of therapy reflected in the medical records.¹⁴

For example, between 1857 and 1928, from 2,314 medical records, the Santa Isabel National Asylum diagnosed a total of seventy-eight cases of alcoholism, thirty-three of them as first diagnoses, forty-three as second and two as third.¹⁵ Between 1900 and 1931, there were thirty-four cases of alcoholism, ten as second diagnoses: 3.2 per cent of the total number of patients.¹⁶ In the case of the Sant Boi de Llobregat Asylum (Barcelona), the figures were higher, reaching 6.7 per cent of the patients admitted between 1885 and 1939.¹⁷ In 1917 Salvador Vives, director of the Salt Asylum (Girona), said that of the 525 patients admitted, twenty were alcoholics (3.8 per cent), excluding those who consumed excessive amounts of alcohol because of the mental illness they suffered.¹⁸

Why did psychiatrists remain in the shadows? What motivated their seeming disinterest in the theory of degeneration, despite it being well received by their medical colleagues? If doctors and hygienists openly interpreted alcoholism as a collective issue associated with degeneration, why did psychiatrists focus on the clinical aspects of alcoholism and prioritise them over an approach that focused on population issues?

Some authors have suggested that the disinterest of psychiatry towards alcoholism was rooted in the resistance of the disease to therapeutic advances.¹⁹ The moral considerations involved – namely that alcohol consumption was considered a vice – may have been responsible for psychiatrists’ lack of attention to alcoholism, and the prioritisation of less socially pejorative pathologies.²⁰ Although this idea is partially true, both psychiatrists’ relative disinterest towards alcoholism and the contradictions noted above directly relate not only to clinical factors, but also to the institutionalisation of psychiatry as a medical speciality – a slow and hesitant movement in Spain during the nineteenth century. As will be shown below, Spanish psychiatrists were not interested in the theory of degeneration until the 1890s. Therefore, up to that point, their interpretation of alcoholism was not degenerationist and was limited to a clinical and individual focus. From the 1890s, and especially after the trauma of the 1898 war against the USA, they began to pay more attention to degenerationism and included it in their explanations of alcoholism.

Psychiatry and degeneration: an ambiguous relationship

In 1876 Juan Giné y Partagás (1836–1903), director of the Nueva Belén Asylum (Barcelona), published his Tratado teórico-práctico de freno-patología o Estudio de las enfermedades mentales (Theoretical-Practical Treatise on Phreno-Pathology or The Study of Mental Illnesses),²¹ which is considered the first Spanish book on the subject of psychiatry. It recognised the role of biological heredity as an individual predisposing cause to mental illness, including alcoholism. Closely following the ideas of Auguste Voisin (1829–1898), Giné noted that ‘the alcoholic habits of parents’ produced a predisposition to mental disorders in their children, especially if those parents ‘were under the influence of alcohol at the time of intercourse’.²² However, despite declaring himself a somaticist and positivist, Giné was reluctant to recognise the influence of heredity within the framework of degeneration theory as formulated by Morel in 1857, as he considered it to be ‘inapplicable as a diagnostic guide’.²³ He distanced himself from degenerationism because of clinical reasons, but also because of the theoretical influence of Joseph Guislain (1792–1860) and others related to the hesitant development of psychiatry as an institution in Spain.²⁴

Giné was not the only psychiatrist who distanced himself from degeneration theory. His disciple Arturo Galcerán y Granés (1850–1919) paid scant attention to it until the twentieth century. Neither Galcerán’s articles in the Revista Frenopática Barcelonesa (Barcelona Phrenopathy Journal) published during the 1880s, nor his book Neuropatología y psiquiatría generales (General Neuropathology and Psychiatry) published in 1895, addressed the issue.²⁵ This omission is most surprising in the case of the latter: the theory of degenerationism had been updated by Valentin Magnan (1835–1916) and Paul Maurice Legrain (1860–1939) in the years preceding the publication of Galcerán’s book, and that same year Magnan’s Les degenerés was published.²⁶ Further to this, José María Esquerdo (1842–1912), director and owner of the Carabanchel Asylum (Madrid) and promoter of a large group of psychiatrists in Madrid, did not use degenerationism in his clinical practice either.

Despite this, these authors and their disciples openly supported degenerationism when they intervened as experts in the courts of justice. Their expert psychiatric reports on criminals on trial meticulously described family trees showing the apparent importance of biological heredity in the spread of madness and of ‘degenerative’ symptoms throughout the family.²⁷ They also meticulously referred to the physical and mental symptoms of the accused in order to show that their criminal act was determined by the mental illness they suffered and provoked by being born into a ‘degenerate’ family. Why were psychiatrists so inconsistent in their use of degenerationism? Why was it left out in clinical practice but used in psychiatric expertise? Included among the clinical reasons that psychiatrists themselves gave, flexibility towards degenerationism served a political and social strategy to support the legitimisation of psychiatry.

During the first half of the nineteenthth century, healthcare in Spain was marked by the attempt to replace the private charity system of the Ancien Régime with one in line with liberalism that recognised charity as an obligation of the state. The process was complicated on account of the political instability of the country (French invasion, independence of the American colonies, civil war between absolutists and liberals) and the economic bankruptcy of the state. From 1843 onwards, a period of political stability began that allowed the liberal reforms and the debate on the care of the mentally ill to be tackled. In order to solve the economic crisis of the charitable institutions, organise healthcare and solve the problem of begging, the Law of Beneficence was passed in 1849. For the care of the insane, the creation of a network of six model asylums was envisaged, although economic difficulties did not allow it to be developed, and it was limited to the creation of the National Asylum of Santa Isabel in Leganés. Although the state assumed its obligations with regard to care, the law enshrined the principle of the subsidiary nature of public care, assuming a mixed management formula that allowed the development of a private network of lunatic asylums.

The 1849 Law of Beneficence consecrated a double welfare model of madness. On the one hand, it created a public healthcare model that was more social than medical, and did not receive sufficient funding for the number of people in need of help. On the other, it also set up a private healthcare network, located mainly in Catalonia and Madrid, which played a fundamental role in the development of psychiatry as a scientific discipline.²⁸

The purpose of private centres was to attract clients with solid purchasing power. Thus medical directors’ discourse, regardless of their beliefs on mental illness, emphasised the scientific nature of psychiatry, the curability of mental illness, the therapeutic virtues of their establishments and these establishments’ high success rates.²⁹ Although they defended the somatic origins of mental illness and the importance of biological heredity in its genesis, an acceptance of degenerationism – associated with incurability – in the clinical setting would conflict with the economic and scientific interests of private institutions. However, the objectives of psychiatrists in a legal context differed. The necessity for their expert opinions had opened an important opportunity for the public and official legitimisation of their profession: they were the only experts able to define whether defendants were truly ‘mad’ or not. In judicial courts, psychiatrists were not asked to ascertain whether madness was curable or not, but to defend and consolidate the figure of the alienist as an ally of public order.

Therefore the rejection of or indifference to degenerationism as an explanatory model of mental illness and in turn alcoholism had, in those years, a combination of clinical and socio-professional motivations. However, from the 1890s Spanish psychiatry did eventually begin to assimilate degenerationism, albeit with certain peculiarities, which affected the interpretation of alcoholism as a fundamentally clinical and individual phenomenon.

The psychiatric clinic and hereditary alcoholism

In his 1876 treatise, Giné addressed alcoholism from a triple perspective: as a cause of madness, as a madness and as a vice. A concern that the effects of alcoholism could be confused with symptoms of other mental pathologies was central to his work. He thus wrote that the injuries typical of ‘confirmed alcoholism’ included alcohol insanity, alcoholic epilepsy and chronic alcoholism. The latter included general paralysis, dementia and alcoholic pseudo-pellagra. He went on to describe the symptoms that accompanied each of the injuries, comparing them with other mental pathologies in an attempt to clarify differences and establish a correct diagnosis. Giné was also very aware of the existence of drinkers who had previously suffered from mental illness – as a consequence of either biological heredity or what seemed to be an alcohol-related monomania or dipsomania³⁰ – who should not be confused with those inclined, voluntarily or by habit, to drink.

Despite these detailed descriptions of clinical symptoms and comparisons with other pathologies, moral and social considerations were also present in his arguments. Consequently, he thus associated drunkenness with a licentious life and considered it a degrading vice that caused disorder, abandonment of obligations and laziness,³¹ which especially affected the working classes, ‘who could not resist’ the influence of alcohol ‘as a restorative diet’.³²

Despite this, alcoholism was not one of psychiatry’s central concerns during the next two decades. José María Esquerdo’s most well-known work concerned certain psychiatric reports and documents related to crime. Alcoholism had a notable presence only in psychiatric reports on the defendants’ family backgrounds and in work on criminality. In this context, it was always presented as the cause of hereditary madness and degeneration. The 1881 psychiatric report that Esquerdo wrote on José Garayo, known as ‘El Sacamantecas’, accused the latter of murdering, raping and disembowelling several women, and diagnosed him as an imbecile and as suffering from moral insanity.³³ A reconstruction of Garayo’s family tree was used as evidence to suggest that alcoholism was predominant in the family as a cause of madness and degeneration: Garayo was the son of an alcoholic, the brother of two alcoholic women and the father of an alcoholic child. Moreover, in 1894 Giné published a report, endorsed by fourteen other doctors, stating that alcoholism was prevalent in the genealogical background of Samuel Willie, an English businessman based in Barcelona who murdered his associates and was diagnosed as a degenerate by heredity. Willie’s maternal grandfather had habitually abused alcohol, it was suggested, because he suffered from some kind of madness that impelled him to drink.³⁴

In 1888 Victoriano Garrido, a disciple of Esquerdo, published his book La cárcel o el manicomio (Prison or Asylum), in which he used openly degenerationist and Lombrosoesque positions in order to defend the idea that insanity and crime were linked.³⁵ He included alcoholism in his chapter on impulsive madness, warning of the devastating effects the hereditary degenerateness of alcoholics could have on the human race: ‘From drunken parents come epileptic children, neuropaths, unstable beings, of little moral sense, with early tendencies for vice and crime’; he added that alcoholics were ‘monstrous excrescences of a sick society, disgusting dross born in the rot of vice’.³⁶ Following Morel, Garrido further argued that ‘deviation from the normal type of the human species’ is born ‘from causes that threaten the natural growth of organisms, and in particular the intemperance or abuse of beverages’.³⁷ Nonetheless, Garrido’s perspective was exceptional, and his frightening messages about the effects of alcoholism on the human race did not correspond to the rather moderate and distant tone of most psychiatrists.

In 1893 Vicente Ots (1863?–1906) strongly criticised Spanish psychiatry’s lack of knowledge regarding alcoholism. He noted that, unlike those in other countries, Spanish asylums almost never diagnosed alcohol insanity even though ‘many of the mentally ill’ had symptoms that suggested they were suffering from it. According to Ots, this was because of the ‘scarce classification of diseases’ available for diagnosis, limited to the paralytic, epileptic, hysterical madness and imbecility, such that many mental dispositions were left out, among them alcohol insanity. To address this, Ots suggested studying the types of alcohol insanity more closely, which, in his opinion, had increased exorbitantly as a consequence ‘of dominant mercantilism’.³⁸

Ots also noted that alcoholism was difficult to diagnose because it shared symptoms with other forms of mental illness. In his opinion, ‘degenerative syndromes and stigmas of alcoholism as defined by Magnan’ were difficult to distinguish from each other and tended to be ‘be identified as the same kind of illness’, and that it would require detailed observational clinical study to tell them apart.³⁹ Ots’s article presented several clinical cases with different varieties of alcohol insanity: dipsomania, alcoholic maniacal excitement, alcoholic mania, alcoholic epileptic madness, alcoholic pseudo-paralysis and a final form that, according to Ots, produced symptoms that could be related ‘to both alcoholism and degeneration’ and which presented in difficult-to-diagnose degenerated individuals. Ots noted that if the individual was observed during periods of calm, their ‘somatic and psychological analysis’ was used to deduce that they were degenerates. However, the diagnosis could change if they were examined in a state of alcoholic intoxication. Here, they would be likely to be diagnosed with toxic insanity⁴⁰

Ots had absolute belief in degenerationism and thus analysed alcoholism through that perspective. Within this standpoint, however, he was limited to the individual and a clinical setting and so was unable to associate alcoholism with the degeneration of the human race as a whole, as the social-medical field had done. This perspective was evident in other works by Ots, such as his book Neurosis y degeneración (Neurosis and Degeneration, 1897), where he advocated a clinical approach to the issue in order to create

Speculation on the social aspects of degeneration fell outside his interpretations and would form part of what he called ‘legal degeneration that included ‘criminals, vagabonds and prostitutes’.⁴² The moderation in the language used here contrasted with the tone used in a conference on alcoholism he gave to socialist workers, where he used all the clichés associated with degenerationism: ‘Children conceived during the drunkenness of either a man or a woman are born idiots, imbeciles, deaf-dumb, crazy, stunted, sickly, epileptic or unable to live properly.’⁴³

In general, psychiatrists were very cautious with therapy because, despite using certain treatments to facilitate patients’ abstinence, they used to rely exclusively on patients’ complete isolation. But there were also psychiatrists, such as Timoteo Sanz, who were optimistic about the possibility of treating alcoholics,⁴⁴ and in Sanz’s case this was despite being a supporter of the theories of heredity and degeneration. Sanz thought that the negative regression of the human race was not unavoidable, as was argued by Morel and other psychiatrists, because there were regenerative elements present in the environment that cushioned and corrected the ‘pathological energies’ contracted through heredity.⁴⁵ Thus he distanced himself from the nihilistic idea that the implacable laws of heredity would lead to the total degradation of the human species. This therapeutic optimism was reflected in the articles he published in 1895, where the cases of alcoholism he presented, including those with a hereditary background of the disease, were cured.⁴⁶

In the social-medical field, theoretical links between alcoholism and degeneration grew rapidly during the second half of the 1890s. In addition to scientific justifications for degenerationism, the political and cultural climate of the country was characterised by what was perceived as a generalised decadence – the consequence of a significant political crisis, a military defeat against the USA in 1898 and the subsequent loss of Cuba, Puerto Rico and the Philippines – which was fundamental to the growth in popularity of degeneration theory. From this crisis emerged a ‘Regenerationist’ movement which penetrated the entire ideological spectrum.⁴⁷ The presuppositions of degeneration theory, in both its scientific and its cultural interpretations, offered a social-biological explanation for the ills that the country was suffering, and warned of national decadence. In such a context, at the end of the century, anti-alcohol medical discourse became radicalised and unashamedly adopted degenerationism and the idea that alcoholism was hereditary. Warnings about the dangers that alcoholism entailed for ‘the race’ multiplied and were central to medical-social discourse and to anti-alcohol, non-medical propaganda.⁴⁸

Psychiatrists also began to show greater interest in degeneration and the effects of alcoholism on the population, although in a more careful manner. José María Escuder (1852–1923) stated in 1895 that ‘a town full of drunks paves the way for a generation of imbeciles, fools or evildoers’.⁴⁹ In his text, alcoholism was not exclusively an individual problem but took on a social dimension that affected society as a whole and the future of the race. Shortly afterwards, Mateo Bonafonte (1862–1940), a psychiatrist at the Zaragoza asylum, defended the link between ‘the development of alcoholism and mental derangement’, pointing to the increase of ‘degenerative insanity’, to the detriment of ‘pure’ psychoses, and as a result of ‘habits and customs inherent to modern civilisation and widely developed vices and diseases’.⁵⁰ For Bonafonte, alcoholism was a symptom of degeneration that had a strong hereditary nature.

To illustrate this point, Bonafonte used the case study of Ada Jurke, an alcoholic vagabond whose offspring over time had produced 106 illegitimate children, 142 beggars, 64 vagrants living in homeless shelters, 81 prostitutes and 76 convicted criminals, all of them, according to Bonafonte, degenerate.⁵¹ He also used Legrain’s research, especially Dégénérescence sociale et alcoolisme (Social Degenerationism and Alcoholism) to demonstrate the devastating effect that alcoholism had had on hereditary alcoholics. Bonafonte’s conclusion from analysing this data was that alcohol was a toxin, producing ‘degenerative states’ that were transmitted by heredity.⁵² The social dimension of the problem was thus outlined by Bonafonte, who proposed preventative action with regard to the popular classes, who he considered to be ravaged by hereditary alcoholism and degeneration, and educating them. In his work, he attributed the triumph of Germany over France in 1870 and of the USA over Spain in 1898 to racial and cultural superiority. However, that same year another psychiatrist, Joaquín Martínez Valverde (1862–1902), addressed alcoholism in strictly clinical terms, describing its phases and insisting on the difficulties of differential diagnosis, without referring to hereditary alcoholism or degenerationism.⁵³ The tension between the two approaches was thus still in existence at the beginning of the twentieth century.

Nonetheless, the importance given to hereditary factors in an explanatory model of alcoholism was similar in extent to the acceptance of degenerationism by Spanish psychiatry. In 1905 Luis Martín Isturiz (1863–1944), director of the asylums in Palencia, published his doctoral thesis, in which, from a strictly clinical perspective, he analysed the causes and forms of nervous and mental illnesses produced by alcohol intoxication. In this thesis he also argued that alcoholism was the main cause of degeneration, weakening the human body and ‘transmitting morphological anomalies to the embryo that are then translated into offspring in neurotic or degenerative manifestations’.⁵⁴ Although his work focused on clinical aspects, he also showed a concern about the effects of alcoholism on the population by indicating its influence on the degeneration of the race. In this sense, the Revista Frenopática Española (Spanish Phrenopathy Journal) published articles that were in line with degenerationism and went beyond the clinical framework.

Thus Francisco Ferrer wrote in the journal in 1908 that alcoholism was ‘an important factor in the individual decline of the race and one of the immediate causes of crime’,⁵⁵ Ramón Álvarez Gómez (1870–?), studied a case of a dipsomaniac who had ‘symptoms of physical and psychological degeneration’,⁵⁶ and A. F. Victorio attributed a fundamental role to hereditary alcoholism in the aetiology of ‘many nervous and mental conditions’.⁵⁷ Other articles were published, usually by foreign publicists, which had a similar tone and a view of alcoholism that was similar to that of a social plague.⁵⁸

The journal also published psychiatric and expert reports on individuals who were considered degenerate and whose family history contained alcoholics.⁵⁹ There was the case of a patient accused of terrorist attacks who was diagnosed as degenerate, whose father was a drinker and whose grandfather was known as the Rey del alcohol’ (King of Alcohol).⁶⁰ The link between revolution, terrorism, degeneration and alcoholism had been popular in the degenerationist and anti-alcohol literature since the Paris Commune in 1871.⁶¹ In his 1920 book Los degenerados en sociedad (The Degenerates in Society), the director of the Santa Isabel National Asylum, José Salas y Vaca (1877–1933), argued that in the most advanced political organisations ‘there are always fools’ who are clearly degenerate, and alcoholics who lead the masses to commit seditious and criminal acts.⁶²

However, in 1919 the director of the asylum in Salt (Girona), Salvador Vives (1886–1965), questioned the commonly accepted knowledge of hereditary alcoholism. From the responses of fifty-nine doctors to a survey sent to the 247 doctors practising in the province of Girona, the purpose of which was to gather data to investigate whether there was a direct relationship between alcoholism and defective procreation, Vives concluded that it was not

Vives was therefore of the opinion that the effects of alcoholism on offspring were far from known and required more in-depth studies, and he accused anti-alcohol publicists of simplifying the question:

The use of the concepts of degenerationism and hereditary alcoholism is very evident among psychiatrists from 1898 onwards, when the explanation of the loss of the last colonies in the wake of the Spanish defeat during the war against the USA in terms of biological and cultural decadence favoured the spread of degenerationism. However, the clear link between alcoholism, degeneration and racial decadence was established by hygienists, who were more accustomed than psychiatrists to thinking in terms of ‘collective health’. Psychiatrists were more cautious and focused on the clinical aspects of hereditary alcoholism and degeneration. From 1910 onwards, however, there was greater interest in the social dimension of alcoholism. In 1911 Arturo Galcerán y Granés gave a speech in which he stressed the importance of psychiatry in the fight against social diseases and vices.⁶⁵ Salas y Vaca was also concerned about the social consequences of racial degeneration and decadence, proposing educational and social measures to help prevent it. From the 1920s onwards, within the framework of the mental hygiene movement and with a new generation of psychiatrists as protagonists, concern for the consequences of mental illness on the population as a whole became part of their priorities. In this new context, which is beyond the scope of my analysis, the discourse about the prevention of mental illness and eugenic reflections became central.

Alcoholism, a voluntary disease

When the psychiatric texts on alcoholism being published during this period are analysed, an important tension regarding its aetiology emerges. The individual is essential in this categorisation, because alcoholism was declared to be either a disease or a vice depending on the individual’s involuntary or voluntary intentions. Despite both origins coexisting in permanent dialogue in the psychiatric discourse of the time, the involuntary type seems to have been given more weight. The two main forms of involuntary alcoholism described by psychiatrists were dipsomania and heredity alcoholism, which were both part of general alcohol insanity.

Dipsomania was a recurring theme. Classified among mental dispositions, it was said to be characterised by fits of insanity that pushed the individual to consume uncontrollable amounts of alcohol.⁶⁶ It was thought at that time that its main difference from alcoholism, understood to be a vice, was that the dipsomaniac patient lacked will while the alcoholic, unless having acquired the disease hereditarily, drank for pleasure and vice. Giné included dipsomania alongside impulsive monomanias, in the same list as homicidal and incendiary monomanias and kleptomania. For him, dipsomania was characterised by ‘a morbid impulse that creates an irresistible urge to abuse alcohol’, not to be confused ‘with a fondness for drinking that is frequently seen at the beginning of mania and general paralysis: in the former, fondness for alcohol is a mere symptom, whereas in the latter, it constitutes the whole disease.’⁶⁷ He warned that neither should it be confused with alcohol insanity, which was ‘a mental disorder symptomatic of alcoholism’.⁶⁸ Dipsomania was also distinguished from drunkenness in that the latter was ‘a degrading vice’ and the former ‘a true mental affliction’.⁶⁹

The idea that dipsomania marked the limits between illness and vice was maintained during the period. Ots commented that the ‘dipsomaniac patient differs completely from the depraved drinker’ because, according to him, the former only got drunk when ‘compelled by obsessive urges’, while the drunk imbibed alcohol ‘at any opportunity’.⁷⁰ Thus, noted another author, the dipsomaniac patient is ‘a madman who drinks because he is mentally ill, while the alcoholic is a degraded being who is responsible for his own madness’.⁷¹ Another characteristic attributed to the dipsomaniac patient by such authors was that after consuming alcohol they felt shame and remorse for their behaviour.

But this apparent consensus on dipsomania was not in fact a consensus at all. Although most authors noted that alcoholism was a mental affliction, in cases where there was a hereditary background to the disease, there were nuances in the arguments put forward. In 1920 José Salas y Vaca considered that dipsomania was a closed circle, because the ‘alcoholic ended up being dipsomaniac’ and ‘dipsomania leads to intoxication’.⁷² From this reasoning, this author differentiated between the patient who was dipsomaniac by habit and the patient who was constitutionally so. The first was a ‘normal individual’ who became a dipsomaniac ‘because they began being an alcoholic’, while the latter was a degenerate and felt irresistible impulses towards drinking.⁷³ For Vaca, the latter had no possible cure while the former was ‘susceptible to returning to reason’ if they were isolated and abstained from drinking.⁷⁴

The underlying issue was whether alcoholism was a disease of will or one of intoxication. According to Abdón Sanchez-Herrero (1875–1934), the differences between the alcoholic and the dipsomaniac patient were negligible because ‘the will of both is weak, their capacity to resist evil, minimal’.⁷⁵ Gimeno Riera (1877–1945), director of the Zaragoza asylum, linked dipsomania ‘to neuropathic heredity’ that weakened the will and led the subject to commit immoral acts, such as the ‘immoderate and constant use’ of alcohol.⁷⁶

Along with the idea that alcoholism and dipsomania were the result of previous, usually inherited, mental illness, psychiatrists also focused on acquired or voluntary alcoholism. They concurred in defining alcoholism as a process of voluntary intoxication caused by the habitual consumption of alcohol. This perception opened the door to the consideration of alcoholism, especially in its acute phase, as a degrading vice. In this interpretation, acute alcoholism was not strictly thought of as a disease but as a fleeting alcoholic intoxication, the effects of which disappeared with the elimination of alcohol from the body, just like some temporary mental illnesses might. Chronic alcoholism, on the other hand, was defined as permanent intoxication arising from habit and ‘an acquired need’, and as sharing symptoms with other mental illnesses.⁷⁷

Another aspect of the relationship between mental illness and alcoholism that concerned doctors was moral insanity. Defined by J.C. Prichard, moral insanity was characterised by the loss of moral feelings without the faculties of intelligence being affected.⁷⁸ Alarm over the high number of crimes committed under the influence of drunkenness was widespread among psychiatrists and many diverse anti-alcohol propagandists. Moral insanity was seen as an important link between alcoholism, mental illness and criminality. Martínez Valverde considered that it was transmissible by heredity and typical of degenerates.⁷⁹ At the end of the 1880s, Victoriano Garrido warned that alcoholism ‘disturbs and disorders’ the moral element of humankind, and gives rise to offspring ‘of little moral sense, with early tendencies to vice and crime’.⁸⁰

In addition, one of the characteristics of chronic alcoholism was said to be ‘general mental weakness involving stultification and anaesthesia of the moral sense, and racing thoughts, with rapid enactment of these thoughts in action, which often makes the patients frightening’.⁸¹ This moral anaesthesia was also described from a perspective that was not necessarily degenerationist, an example of which is the work published by Prosper Despine (1812–1892) in 1871.⁸² From the field of criminal anthropology, Rafael Salillas (1854–1923) addressed the issue in a session of the Criminology Laboratory group; he carried out an in-depth analysis of a case of alcoholism and moral insanity exposed by Morel in his Traité des dégénérescences (Treatise of Degeneration).⁸³

Conclusions

As noted at the beginning of this chapter, the purpose of this study was to analyse Spanish psychiatry’s position towards alcoholism. Unlike psychiatry in other countries, psychiatry in Spain did not seem to be particularly interested in alcoholism during the last quarter of the nineteenth century, which seems paradoxical given the enormous influence that degeneration theory was having on the construction of anti-alcohol discourse. Clinical and theoretical reasons formed the basis of the rejection or indifference towards degenerationism, as the psychiatrists themselves acknowledged. But there were also professional reasons for this which were related to the development of psychiatric care. The existence of private institutions had a significant influence on the hesitant use of degeneration theory: in establishments designed for a paying clientele, it was deemed important that clients heard only optimistic messages regarding the successful treatment of mental illness. In the courts of justice, however, the discourse was different, and degenerationism was readily used in psychiatric expert reports. This dual approach was in response to different strategies of professionalising the psychiatric field, and psychiatrists did not hesitate to adapt their discourse to different contexts as needed.

In contrast to the way that other medical sectors interacted with the anti-alcohol struggle, the field of psychiatry did not fully exploit degenerationism in the study of alcoholism. It was only from the 1890s, in the context of political and social crisis enveloping Spain – interpreted by many in the country as a crisis caused by utter decadence – that psychiatrists began to accept degeneration theory to a greater extent and to implement it in their clinical practice regarding alcoholism. But their interpretation of degenerationism never had the social and racial tone used by their medical colleagues. Far from the apocalyptic hysteria that biological heredity determinism evoked, with the associated dangers that alcoholism and degeneration brought to the country as a whole, psychiatrists focused on the individual and family consequences of hereditary alcoholism, causing more flexible positions to be adopted. Interestingly, psychiatrists addressed alcoholism as both the cause and the consequence of madness. Reflections on dipsomania, alcohol insanity and moral insanity emphasised the different clinical symptoms of each, but above all they testify to the dual conceptual categorisation of alcoholism as both vice and disease.

This chapter has provided a chronological account that ends shortly before the emergence of the mental hygiene movement that reached its highest peak in the 1920s and 1930s. The impact this movement had on the development of psychiatry in that particular social context was extensive, to the point that reforms in psychiatric care undertaken during the Second Republic (1931–39) were conducted by practising psychiatrists themselves, who became part of the apparatus of the state. Principles advocating prevention and prophylaxis of mental illness were fundamental to the thinking behind these reforms. This new context had direct consequences with regard to psychiatric perspectives on alcoholism, a topic I hope to investigate in a future study.