In 1903 the Second Pan-Hellenic Medical Conference, held in Athens, included a session on ‘alcohol-induced diseases in Greece’, with papers by two members of the then small community of Greek psychiatrists. While the speakers denounced the health damage caused by alcohol use, in the ensuing discussion a neurologist stated instead that alcohol ‘is not a poison, but a nutritional element useful to the normal functioning of the human organism’.¹ His intervention provoked an indignant reaction of a colleague: ‘We did not gather here as merchants, but as doctors with the one and only holy and great duty: to enlighten society as the disciples of Asclepius and not as the advocates of Hermes, the God of profit’. The debate evinces a dissonance within the psychiatric corps, divided between proponents of total abstinence and advocates of moderate use who made a distinction between fermented and distilled beverages.

What arguments were employed by each side, the ‘disciples of Asclepius’ and the ‘advocates of Hermes’? What were the reasons for the divergent attitudes of Greek psychiatrists towards alcohol? And were these attitudes a Greek particularity or did they correspond to a broader network of ideas on alcohol circulating across Europe at the beginning of the twentieth century? In order to answer these questions, one must analyse the discourses on, and the attitudes of Greek psychiatrists towards, alcohol and alcoholism within their broader political, economic, social, cultural and intellectual context. Thus far, the secondary bibliography on alcohol production and consumption in the Hellenic world or, in more recent times, within the Greek state has delved into a wide array of issues: the history of the vine plant, winemaking techniques or wine culture, from Antiquity, through the Byzantine period and the years of Venetian and Ottoman rule, to the twentieth century;² the perspective of the agrarian economy with special emphasis on the cultivation and exportation of currants in the nineteenth century;³ the development of the alcohol industry and the trade in alcoholic products in the eastern Mediterranean in the second half of the nineteenth century and the beginning of the twentieth;⁴ and, finally, the social and cultural implications of alcohol production and consumption, with the constructive contribution of anthropological studies to fruitful research fields, such as practices of commensality, gendered attitudes towards alcohol or representations and symbolic charges of a given alcoholic beverage, for example, whisky in contemporary Greece.⁵

Intriguingly, there has been not much interest in discourses against alcohol in the Greek case, although such discourses did exist. This omission was perhaps due to the fact that the denunciation of alcohol and its effects was not as vociferous as in other countries and, ultimately, did not gain momentum. Nonetheless, efforts to curb drinking were not doomed in advance, and their contextualised analysis illustrates the history of both alcohol in Greece and the groups that adopted an anti-alcohol rhetoric, such as the psychiatric body. The development of the latter has interested historians and psychiatrists alike in recent decades and inspired studies of institutions, actors and scientific trends. But, once more, the question of alcohol, albeit central to the works of some early psychiatrists and neurologists, remains to be investigated.

Before doing so, it would be useful to briefly address two issues: first, the patterns of alcohol production and consumption during the nineteenth century in Greece and, second, the development of the psychiatric discipline at the turn of the twentieth century. After setting the background, we can explore how the members of the nascent scientific discipline of psychiatry, who sought to put their expertise into practice and to assert their authority, increasingly perceived ‘immoderate’ alcohol consumption as a pathology. To this end, this chapter examines the introduction and ascendance of the term ‘alcoholism’ in Greek scientific and non-scientific vocabulary, the symptoms attributed by neurologists and psychiatrists to the ‘chronic intoxication from alcohol’, the therapies and the measures proposed to cure or prevent this ‘social malady’ and, finally, the crystallisation of two major positions towards alcohol within the ranks of anti-alcohol crusaders (total abstinence versus moderate use).

Alcohol in Greek society

For millennia, wine has constituted an essential calorie supplement and an important component of the everyday diet in the Mediterranean: according to an 1840 source, a wealthy merchant in Athens bought 3.2 kg of bread, 2.2 l of wine and 1.2 kg of meat for his family every day.⁶ But wine was also a central component of social life and religious ceremonies in the eastern Mediterranean, from the worship of Dionysus and Bacchus to the Eucharist. In the Greek case, this meant that alcohol consumption was sanctioned both by the heritage of ancient Greece, where modern Greeks sought cultural references and legitimisation of their present, and by the second pillar of modern Greek identity, so to speak, Christianity, whose holy texts contain many references to the grape product.⁷ Apart from wine, the production of distilled drinks (such as raki) is attested in the region from the late Byzantine period onwards, so that by the nineteenth century spirits had also joined daily practices and social rituals.

In other words, when the modern Greek state was created in 1830, it inherited a tradition of alcohol production, commerce and consumption. The Bavarian administration, appointed by the three Great Powers (France, Britain, Russia) that guaranteed the new state’s independence, did not fail to notice the economic prospects of alcohol. For this reason, a series of measures was adopted to encourage production (importation of vines, grants for scholars to study winemaking abroad, invitations to foreign oenologists and the creation of a model winery in Athens).⁸ In the same vein, private initiative resulted in the foundation of the first wineries, breweries and ouzo or tsipouro (the equivalents of arak) distilleries in the 1850s and 1860s. Some of these efforts ultimately failed, but others bore fruit, and in the following decades, Greek wineries and distilleries multiplied in symbiosis with the currant economy.

In fact, whereas Greek currants were exported mainly to Britain until the 1860s, their production increased rapidly after the 1870s phylloxera blight that destroyed French vineyards, in order to cover the needs of the French wine industry. However, when a few years later French vineyards recovered, excessive quantities of Greek currants remained unsold and rotted in warehouses. Wineries and distilleries constituted a means of channelling this surplus and of mitigating the consequences of an acute social issue, while the Greek state intervened with measures like the creation of the Wine & Spirits Company in 1906, in an attempt to absorb the surplus currant production. These trends determined the character of wine production (wine made from currants was preferred to that from grapes) and contributed to the creation of the Greek cognac industry.⁹

In this manner, by the end of the century, the three branches of the alcohol industry (winemaking, beer brewing and cognac distillation) were growing, and Greek industries supplied the coasts of the eastern Mediterranean. Those who believed that industrial development was a necessary condition for the financial recovery of the Greek state, especially after the bankruptcy of 1893, placed their hopes on the distilling and winemaking sector. In 1894 for instance, Othon Rousopoulos (1856–1922), the founder of the Industrial and Commercial Academy, imagined the country’s future in the following decade thus: ‘I see in every corner colossal wine depots, containing rows of wine bottles filled with exquisite wines and constituting a kind of bulwark against economic decay.’¹⁰

Beyond the dreams of a thriving Greek industry and economy, one must not forget that commodities like alcohol constitute a substantial source of state revenue. As early as 1834, the Greek state imposed a land tax on wine, and at the end of the century, successive governments imposed consumption taxes on alcohol; interestingly enough, a part of the revenues generated from these taxes was allocated to the National Defence Fund, created after the defeat against the Ottoman Empire in 1897 to finance the modernisation of the Greek army.¹¹ In this general context, it is not surprising that the authorities prioritised accommodating the viticulturists and the electorate of grape-producing constituencies, or the demands of brewers, distillers, winemakers or grocers, who, on more than one occasion, addressed petitions to the authorities to promote their interests and to seek favourable conditions for pursuing and expanding their activities.¹²

On the consumption end, according to the neurologist and psychiatrist Simonidis Vlavianos (1873–1946), ‘until 1870, even until 1880, the Greek, most of the Greeks, ignored what alcohol is, making almost exclusively pharmaceutical use of raki, which only a minority knew how to produce, and of cognac; what is more, our parents partook in wine moderately and scarcely sacrificed to Bacchus’.¹³ However, in the last quarter of the nineteenth century, per capita consumption of alcoholic beverages apparently rose, partly as a result of the growth of local production.¹⁴ Another factor that contributed to the spread of alcohol consumption was its medical uses in a society that hesitantly became more medicalised. Indeed, during the nineteenth century and later, alcohol was used as a raw material in tonic preparations, and various ‘medical’ wines (vins médicinaux) were prescribed for a vast array of illnesses and pathological conditions, ranging from fever to anorexia and weakness. A 1884 pharmacopoeia based on a French publication contained more than thirty preparations containing wine, while the cognac industry developed rapidly, purportedly after the drink was generously administered as medicine during the typhus epidemic of 1881–82 in the capital; an advertisement in a 1891 newspaper claimed that ‘many hospitals use [Metaxa cognac] as a medicine for the suffering and the recovering’.¹⁵ More generally, broader socio-cultural shifts concerning the management of leisure time, the emergence of new entertainment forms and the growing popularity of places of both consumption and socialisation, such as tavernas and coffee shops, contributed to the diffusion of alcohol; this was reflected in various cultural products, from popular songs to operetta and from literature to theatre, where the character of the ‘drunkard’ entered the scene. For instance, in a short story by Alexandros Papadiamantis (1851–1911), published on 1 January 1895, a carpenter and father of five spends his Sundays and half of his wage drinking, despite his family’s misery – a recurrent theme in anti-alcohol literature.¹⁶ At the same time, we encounter positive depictions of alcohol consumption, for example, in a revue staged from August 1894 to October 1895 involving a group of fashionable youngsters singing: ‘Golden, golden youth / drink, drink wine / and thus the early years merrily go by.’¹⁷

The development of psychiatry in Greece

These developments coincided with the first timid steps of psychiatry in Greece.¹⁸ When the Greek state became independent from the Ottoman Empire in 1830, it lacked not only resources and industrial infrastructure, but also health and educational institutions. It is no coincidence that the first psychiatric hospital in Greece was founded beyond the borders of the small state: in 1838 the British administration of the Ionian Islands created, in a suburb of Corfu’s capital, a psychiatric institution, which was inherited by the Greek state when the Ionian Islands were transferred to it in 1864.¹⁹ For two decades, it was Greece’s only psychiatric hospital, essentially a mental asylum, until in the mid-1880s a private donation led to the creation of the Dromokaition psychiatric hospital in Athens, built according to French plans and hosting initially eighty-five patients.²⁰ In other words, until the turn of the twentieth century the therapeutic options were extremely limited. This began to change at the beginning of the century with the creation in 1904 of the Aiginiteion, the psychiatric clinic of the University of Athens (again thanks to a private donation for want of public funds), the functioning of a few municipal and communal asylums in smaller cities and on islands (Thessaloniki, Syros, Kefalonia, Chios, Chania, Lesbos) and the founding of a dozen private clinics, as well as the establishment of Athens Public Psychiatric Hospital in the 1920s.²¹ Thus, without taking into account private clinics, the total bed capacity reached 4,000 on the eve of World War II.²²

Destined to train personnel for the state mechanism and institutions, the University of Athens was inaugurated in 1837 (it remained the country’s only university for a century), and one of its four initial faculties was a faculty of medicine. However, a chair of ‘Neurology and Phrenic [Mental] Maladies’ was created only at the end of the nineteenth century, in 1897, and entrusted to Professor Michail Katsaras (1860–1939), who held it until 1930. Even so, Greek students who were attracted by this emerging discipline had to pursue their studies abroad, which many of them did, by visiting mainly France and Germany, the two leading schools of thought in psychiatry at the time as well as the two major cultural references for Greek society. Beyond the Greek neurologists’ and psychiatrists’ curricula vitae, the impact of these foreign influences can be traced in the translations of foreign manuals (Heinrich Schüle’s Handbuch der Geisteskrankheiten (Handbook on Mental Disorders, 1878), Benjamin Ball’s Leçons sur les maladies mentales (Lessons on Mental Maladies, 1880–83) or Emmanuel Régis’s Manuel pratique de médecine mentale (Practical Manual of Mental Medicine, 1885),²³ in the names given to clinics, like Dr Simonidis Vlavianos’s Maison de Santé, or the references cited by Greek experts in their writings and lectures, which covered an extended bibliography and, as a rule, kept up with developments in the psychiatric field abroad, following the changing trends and shifting paradigms. To be sure, more often than not foreign models were grafted rather than assimilated, as Dimitris Ploumpidis points out, and the use of psychopathological and nosographic criteria lacked uniformity.²⁴ Thus terms and notions coined in Western and Central Europe were translated and used according to the particular foreign academic ties of the individual authors and without input from patient observation, since the latter was rare before the development of psychiatric institutions.

Be that as it may, neurologists and psychiatrists gradually took charge of mental health, which in the previous centuries had been entrusted to religious institutions, such as monasteries. Among other issues, like their counterparts in Europe, they took interest in the question of alcohol and its effects on the human body. The aforementioned Vlavianos (one of the prominent figures of Greek psychiatry, who had studied in Paris, had founded the first psychiatric and neurological journal in 1902 and was the director of a private clinic) gave a speech on alcoholism and its disastrous consequences in December 1907, in which he claimed, ‘we neurologists and psychiatrists of Greece, then all the other physicians, will be morally responsible if we do not halt the progressing and growing tide of evil with everything within our powers.’²⁵ The growing evil in question was precisely ‘alcoholism’, the subject of Vlavianos’s doctoral dissertation²⁶ and a concept that had found its way into Greek scientific writings and public discourse at the end of the nineteenth century.

The introduction and use of the ‘alcoholism’ concept

In 1819, the German-Russian physician Constantin von Brühl-Cramer (d. 1821) published a treatise on what he termed Trunksucht, which was translated as ‘dipsomania’, and suggested an approach to addiction as a disease rather as the result of immorality.²⁷ At the end of the nineteenth century, Tilemachos Mitaftsis, associate professor of nervous and mental maladies at the University of Athens, ranked ‘dipsomania’ among the impulses of ‘degenerates’ and went on to describe a difference between the ‘dipsomaniac’ and the ‘habitual wine drinker and alcoholic’ (‘καθ’ έξιν οινοπότην και αλκοολικόν’): the latter consumed alcohol on an everyday basis and preferred a specific alcoholic beverage, while the former had paroxysms and consumed enormous quantities of any liquid.²⁸ In fact, the difference between ‘dipsomania’ and ‘alcoholism’ was more profound, as Hasso Spode argues: Brühl-Cramer’s approach constituted a shift in scientific paradigms and an emancipation from moral considerations.²⁹

This does not necessarily apply to ‘alcoholism’, since according to Katsaras’s manual, which for decades served as a reference work, ‘In the case of wine drinking it is a question of a moral flaw, whereas in the case of dipsomania of a morbid conscious and unrestrained urge to drink.’³⁰ The term ‘alcoholism’ was coined in the mid-nineteenth century, by the Swedish doctor Magnus Huss (1807–1890), who, elaborating on previous theories, united the negative effects of alcohol on the human body in one nosographic category. The term proved successful and spread rapidly across Europe, being used also in Greece by the end of the nineteenth century. Although a 1892 Greek-English dictionary featured only entries like ‘drunkenness’, ‘inebriation’, ‘intoxication’ (μέθη) and ‘given to drinking, drunken’ (οινόφλυξ), two years later Mitaftsis’s Greek translation of Schüle’s manual included a chapter entitled ‘Alcoholism and alcoholic insanity’.³¹ And in a less scholarly context, a series of articles published in December 1897 by the daily newspaper Akropolis reported on ‘The great social plagues in Europe’, namely ‘Alcoholism, madness, suicides’, which the reporter significantly located away from Greece.³²

It is true that at the turn of the twentieth century, these formative years for Greek psychiatry, other terms and variants were also in use to describe this new pathology, for example, ‘oenopneumatism’ (οινοπνευματισμός), ‘oenopneumatosis’ (οινοπνευμάτωσις), ‘oenopneumatiasis’ (οινοπνευματίασις) or ‘absinthism’ {αψινθισμός) for the particular cases of absinthe or liqueur consumption.³³ Nonetheless, these fumbling terminological attempts, like ‘dipsomania’, did not prevail and by the 1910s the terms ‘alcoholism’ and ‘alcoholic’ were well established and used by specialists and non-specialists alike. As a professor of linguistics in the University of Athens wrote to Vlavianos asking him to endorse the use of ‘alcoholism’ and its derivatives, the term ‘has already become a possession not only of science, but of our common language as well’.³⁴ In other words, the vocabulary and conceptual framework were set for the study and description of ‘chronic intoxication from alcohol’.

Symptomatology of ‘chronic intoxication from alcohol’

The interest of neurologists and psychiatrists in the issue of alcohol was certainly stimulated by their training abroad, their participation in international conferences,³⁵ the study of foreign bibliography and later that of texts published in Greek; the first psychiatric periodical publication, the Ψυχιατρική και Νευρολογική Επιθεώρησις (Psychiatric and Neurological Review), hosted articles on alcoholism from its first issue in September 1902.³⁶ But their attention was aroused equally by the first hospitalisations for ‘alcoholic insanity’ in psychiatric institutions (thirty-four cases were recorded in the Dromokaition hospital from 1887 to 1892) and eventually by the publication of statistics concerning deaths attributed to chronic or acute alcohol intoxication.³⁷

Drawing on their experience from psychiatric hospitals, clinics and private practice, Greek psychiatrists started conducting their own observations.³⁸ But more often than not, they drew their examples and arguments from the rich foreign literature, as is proved by their quotes, references and citations of sources and statistics from France, Switzerland, Prussia (and later Germany), Scandinavia, Britain and the USA. Such references served both as a display of erudition and scientific competence and as an indisputable confirmation of the writers’ claims. In any case, in their texts and lectures they addressed the question of ‘alcoholism’ and described the various health issues associated with alcohol. These accounts regularly distinguished between, on the one hand, ‘drunkards’, who experienced ‘acute alcoholism’, and, on the other, ‘alcoholics’, who were subject to ‘chronic alcoholism’. This distinction is illustrated, for instance, by the questionnaire that the editor of the Psychiatric and Neurological Review, Vlavianos, addressed to its readers in the second issue of October 1902, in order to collect data concerning alcohol consumption and alcoholism in Greece.³⁹ The first two of the forty-seven questions enquired which alcoholic beverages were consumed and whether there were ‘drunkards’ (acute alcoholics) and chronic alcoholics in the readers’ respective localities.

The latter were of more interest to scholars, who enumerated the various physical and psychic alterations and lesions provoked by alcohol consumption.⁴⁰ According to their accounts, at the initial stages alcoholics experienced a decrease in memory and an increase in headaches, vertigo, insomnia, nightmares, delusions, hallucinations, irritability and mood swings. The escalation of consumption was presented as an unavoidable path that led to further trouble, including both organic disorders (for example, stomach ulcers, cirrhosis, heart hypertrophy, arteriosclerosis, vision problems, erectile dysfunction, etc.) and neurological or psychological disorders. More precisely, in the context of a predominantly neurological approach, emphasis was placed on alterations of the nervous centres and brain functions, affecting perception, mobility and the intellect (tremors, atony, anaesthesia, bouts of epilepsy, general progressive palsy, neuropathy). Another set of symptoms was closely linked to a psychiatric interpretation of alcoholism and included what specialists termed acute or chronic alcoholic phrenitis or insanity, delirium tremens, dementia, moral insanity, mental alienation, bouts of hysteria, etc. According to a more elaborate schema, chronic alcoholism would lead to acute psychosis (divided into subacute alcoholic phrenitis or oniric delirium, acute alcoholic phrenitis or acute alcoholic hallucinatory delirium, and ultra-acute alcoholic phrenitis or delirium tremens) or to chronic psychosis (in the form of Korsakoff syndrome or alcoholic dementia).⁴¹ Ultimately, alcoholics would meet their demise as a result of apoplexy or a weakened constitution that led to tuberculosis, pneumonia and other common pathologies.

But psychiatrists and neurologists did not limit themselves to recording the organic and psychic disorders caused by alcoholism. Ascribing to themselves the role of defenders of Greek society, they almost invariably detailed the broader consequences of alcohol on society, for they estimated that it was above all a ‘social poison’.⁴² In the first place, they stressed the economic repercussions of alcohol misuse, which were twofold: on the one hand, the cost of alcohol was blamed for diverting workers’ incomes and draining family budgets, leading to pauperisation (see Figure 7.1); on the other hand, and on a larger scale, they calculated the financial consequences of alcoholism for the state, in terms of lost labour days, of aid to paupers, of maintenance costs for prisons, reformatories, hospitals, clinics and asylums, or of higher mortality rates.⁴³

Figure 7.1 ‘Image 3. K.G.… Family man, before he became an alcoholic. Image 4. The same K.G.… having become an alcoholic.’

Another danger linked with pauperisation and stemming from the ill-effects attributed to alcohol was the rise of criminality, a menace for the lives and properties of Greek citizens. To back up this opinion, authors invoked penitential statistics that were principally foreign, given the lack of official Greek statistics. And, as if the impact of alcoholism on contemporaries was not enough, there lay a danger for future generations, since psychiatrists were, among other things, convinced of the catastrophic hereditary effects of alcohol consumption. This belief was associated with the widespread and popular theory of degeneration, which was based on the Lamarckian principle of the heredity of acquired characteristics. In fact, the terms ‘degenerate’ (εκπεφυλισμένος) and ‘degeneration’ (εκφυλισμός) are encountered in the decade following the publication of Morel’s Traité des dégénérescences physiques, intellectuelles et morales in 1857.⁴⁴ By the end of the nineteenth century the adjective ‘degenerative’ (εκφυλιστικός) was employed to qualify a delirium, a tendency or a frenzy, and the Greek neurologist Mitaftsis, as already mentioned, wrote his PhD on ‘the degenerates’. In this work, which was prefaced by Jean-Baptiste Charcot, son of the famous Salpêtrière neurologist, Mitaftsis listed ‘dipsomania’ among the psychic stigmas that were believed to constitute pathological psychic manifestations. In other words, Mitaftsis adopted the point of view of Morel, who began the list of the principal causes of degeneration with intoxicating agents like alcohol, hashish and opium.⁴⁵ Thus the link between alcohol and degeneration had been established since the second half of the nineteenth century and remained popular well into the following century.

Moreover, this association was developed within a broader intellectual climate of eugenic aspirations and racial ideas that were widespread in Europe at the time.⁴⁶ In this context, the threat of alcoholism cast its shadow over the ‘Greek nation’, which ‘at the first steps of its rebirth and national rehabilitation … ought to maintain its vital forces in good condition, in order to use them in due time to fulfil its truly great mission’.⁴⁷ Therefore alcoholism was perceived as a national danger, jeopardising national or even ‘racial’ survival and destiny, and all the more so because Greeks were believed to be particularly exposed to the psychic and psychological effects of alcohol, owing to the ‘nervous nature of the Greek race’.⁴⁸

Therapeutic responses

As therapists, psychiatrists and neurologists set forth a variety of therapeutic responses to address the physical and psychological effects of habitual drinking. These responses combined traditional approaches that can be traced back to Hippocratic practices (such as a diet devised to purify and fortify the patient’s organism, and hydrotherapy)⁴⁹ with the latest methods recommended by European colleagues, namely the administration of various substances expected to counter the action of alcohol (for example, strychnine injections, ‘anti-ethylene’, or antiserum therapy).⁵⁰ Certain therapists advocated also the recourse to hypnosis and hypnotic suggestion – during this transitional period many articles in the Psychiatric and Neurological Review were dedicated to the study of hypnotism, while psychoanalysis remained largely unknown to Greek scholars and the public.⁵¹

However, because alcoholism was considered an issue that extended beyond strictly medical grounds, the authorities on the matter wished to equally address its social consequences. As a part of a broader hygienist programme, they called for a series of measures. One set involved state intervention and legislation. Prohibition was considered as an option, and Greek authors referred to similar measures adopted in various US states even before the passage of the Volstead Act in 1919 – but even the more uncompromising among them conceded that strict prohibition was contrary to Greek habits, tastes and traditions.⁵² Other potential legislative measures included modifying the closing time of public houses, increasing the price of or limiting the permits to run such establishments and raising taxes on alcoholic beverages in general or distilled products in particular. In fact, in 1899 a bill was submitted to parliament proposing the re-enactment of taxation on alcohol, which had been suspended after the country’s bankruptcy in 1893.⁵³ One of the main arguments invoked to support the taxation of consumption rather than that of production was that such legislation would help combat alcoholism. However, as the parliamentary record shows, MPs’ main concern was how to generate state income and how not to incommode the alcohol industry and the viticulture sector.⁵⁴ For that reason, other suggestions like the creation of a state monopoly on alcohol never materialised, contrary to the treatment of other products like salt, matches or rolling paper. Similarly, while many recommended the creation of asylums for immoderate consumers who were diagnosed as alcoholics, the finances of the Greek state, as mentioned above, were meagre and hardly allowed the creation of a public psychiatric hospital even as late as the 1920s.

Finally, apart from measures destined to crack down on producers, sellers and consumers, another set of measures was prophylactic, that is, they aimed to prevent alcoholism through lectures, publications, special courses in schools on the dangers of alcohol, sports, the formation of temperance leagues, the creation of popular clubs and meeting places where no alcohol would be served, and overall the amelioration of living and eating conditions for the working classes, as poverty was considered not only a consequence of alcoholism, but also one of the principal causes for its spread.⁵⁵ Indeed, some actions were taken in the direction of prevention and propaganda. For example, the Athena-Health Fraternity, founded in 1907, included in its statute the ‘combating of meat eating, smoking, alcoholic drinks’.⁵⁶ And a decade later, in 1917, the Supreme Directorate of Public Education issued a circular encouraging the circulation among elementary and high schools across the country of the brochure The Disastrous Effects of Alcoholic Beverages and Tobacco in order to combat and eradicate ‘habits destined assuredly to sap the soul and body of youngsters and lead to imperil the existence of our race’.⁵⁷ Nevertheless, it is evident that these propositions required substantial means and a large consensus in order to produce concrete, durable results and, ultimately, have an impact.

Total abstinence versus moderate use

However, the anti-alcohol front that was formed in the early twentieth century was not uniform. According to the gynaecologist Moysis Moyseidis, writing in 1935, there were three camps in the battlefield over alcohol: the anti-alcohol extremists, who condemned alcohol in every form; the friends of wine and beer, who propagandised for their consumption; and, between them, the anti-alcohol moderates, who accepted the reasonable use of fermented, but not of distilled, drinks: one such example was the professor of food chemistry of the University of Athens, who believed that ‘drinking a glass of wine or beer in a pleasant meeting is not harmful; on the contrary, it offers a pleasant relief from life’s everyday struggles’.⁵⁸ For his part, Moyseidis considered that the moderates were closer to ‘scientific truth’ and that, at the same time, they respected the economic, social and psychological aspects of the matter – hinting thus at the importance of the specific socio-cultural context in Greece on scholarly discourses.⁵⁹

Overall, one would expect that among the detractors of alcohol, neurologists and psychiatrists would have been particularly eager to adopt a more intransigent point of view on the matter of drinking. Contrary to physicians, who could have recourse to alcoholic preparations in their medical practice, psychiatrists treated alcohol as the root of many mental and neurological conditions. Moreover, the crusade against alcohol offered neurologists and psychiatrists the grounds to assert their expertise and their scientific and professional autonomy to physicians as psychiatry made its first steps in Greece at the turn of the twentieth century.

However, things were more complex. Leaving aside eventual turf wars between members of the medical profession, opinions on the nature and the extent of the anti-alcohol fight diverged even within the limited circle of Greek psychiatrists. Opposed to the proponents of total abstinence, the advocates of moderate use often put forward a distinction between fermented and distilled beverages, arguing that the consumption of the former had either a recreational and social function or a nutritional value. Eventually wine or beer consumption could be presented as a bulwark against alcoholism in the strict sense of the term, which they believed was provoked by distilled beverages containing starch (based, for instance, on cereals, potatoes or beets). On the other hand, the proponents of total abstinence considered that the amount of ethanol contained in beverages was irrelevant, as the substance remained a poison. Therefore the drunkard and the chronic alcoholic simply represented different degrees of the same condition, and their harmful habit should be eradicated at all costs and by all means.

An episode that highlights the opposition between the advocates of the two approaches is the one cited in the beginning of this chapter and recorded in the proceedings of the Second Pan-Hellenic Medical Conference held in 1903.⁶⁰ The rising concern about alcoholism was reflected in the inclusion of a session on ‘alcohol-induced diseases in Greece’, with two papers presented by the assistant directors of the Dromokaition psychiatric hospital: Michail Katsaras and Michail Yianniris (1865–1956), a psychiatrist who had studied in Greece and France and who would later become director of the hospital. They both denounced the damage to health caused by alcohol use, although Katsaras was more pessimistic in his account, while Yianniris presented statistics that allowed him to consider that the numbers were not yet alarming in Greece, thanks mainly to the nature and quality of drinks consumed and of the living conditions in the country. However, in the discussion that followed, Georgios Karyofyllis, a neurologist who later founded his own private clinic, argued that alcohol ‘is not a poison, but a nutritional element’ which helps its consumers breath and digest better, and is indicated for the treatment of tuberculosis, typhus, post-partum septicaemia or cases of acute psychosis and post-partum mania. To back up his views, he also referred to foreign scientific expertise, quoting, among others, the sixth memoir of the American National Academy of Sciences, ‘An experimental inquiry regarding the nutritive value of alcohol’, published the previous year in Washington – a good illustration of the fact that Greek psychiatrists kept abreast with contemporary scientific publications, even from across the Atlantic.⁶¹

His intervention provoked an indignant reaction from Vlavianos, who was a fervent opponent of alcohol consumption, ranking himself among the ‘disciples of Asclepius’ who were on a mission to enlighten society. He admonished his colleague Karyofyllis for defending commercial interests linked with alcohol, stating that in many cases of neurasthenia, epilepsy or general palsy due to alcohol, practitioners tended to record the result instead of the cause. Finally, he proposed the creation of a pan-Hellenic anti-alcohol association. Other physicians objected equally to Karyofyllis’s medical argumentation.⁶²

Nonetheless, the matter was far from settled. A similar debate was repeated three decades later, this time by means of published texts. Spyridon Dontas (1878–1958), professor of physiology at the University of Athens, had already contributed in 1934 an article on ‘Le vin comme aliment’ (Wine as a nutrient) to the French journal Bulletin international du vin, the organ of the Office International du Vin.⁶³ On the occasion of his acceptance to the Academy of Athens in 1935, he gave a speech entitled ‘Wine against alcoholism’ (which was also published as a brochure by the Ministry of Agriculture with a foreword by its general secretary). In his speech, after enumerating the harmful effects of spirits, he praised the properties of wine, claiming that ‘the appropriate way to control, insofar as possible, alcoholism is the broader diffusion of the use of natural wine, to replace the harmful alcoholic drinks. The moderate use of natural wine, which is plentiful in Greece, and in particular of the healthy resinated wine, is beneficial to the organism, causing no harm. Especially for those who work and are insufficiently fed, wine is a necessary nutritional supplement.’⁶⁴

Such points of view were not specific to Greece. In other wine-producing countries, like France, temperance advocates promoted wine over distilled beverages as well.⁶⁵ But, as was the case elsewhere, such views triggered the ire of the inflexible part of the psychiatric profession. Thus Dontas’s publication led to a response from Konstantinos Katsaras (1886–1958), a neurologist who had studied in Germany, was the director of a private clinic situated near Piraeus, the Greek capital’s port, and was the son of Michail Katsaras. His own text, published in 1936, was eloquently entitled Wine and Alcoholism. In it, he refuted the nutritional benefits of wine and alcohol in general and asked his colleagues to cease ‘the extremely dangerous scientific propaganda’ in favour of wine consumption, proposing instead the consumption of grape juice (see Figure 7.2).⁶⁶ Contrary to the opinion expressed by Dontas in another article, where he compared wine to quinine and alcoholism to malaria, Katsaras argued that wanting to combat alcoholism with wine was similar ‘to wanting to put out the blaze with fire, or to throwing gunpowder or oil on an open fire!’⁶⁷

Figure 7.2 ‘THE NEW NUTRITION WITH WINE! … How brutes become stronger! …’

However, these turf wars and scientific debates were not irreconcilable. In 1938 the Supreme Hygienic Council constituted a committee to study how to encourage currant and wine consumption. Its conclusions were that there should be a campaign to promote the use of currants in industry and a systematic fight against alcoholism, based on the principles that the consumption of a small quantity of wine with every meal is useful for every healthy person, since wine excites the appetite, facilitates digestion, fortifies the organism and encourages a pleasant psychic disposition. What was more interesting than the committee’s conclusions was its composition. Apart from Spyridon Dontas, it consisted of the General Technical Advisor of Hygiene in the relevant ministry and the professors of therapeutics, of hygiene, and of neurology and psychiatry in the University of Athens, as well as a psychiatrist who for nearly forty years had denounced the dangers of alcohol and promoted the role of the ‘disciples of Asclepius’ in the fight against alcoholism: Dr Simonidis Vlavianos, by that time President of the Athens Medical Association.⁶⁸

Conclusion

How should we interpret the participation of Vlavianos in the committee and his endorsement of an indulgent approach towards wine drinking? Was it a sign of pragmatism, opportunism, or simple resignation? Already in 1910, he was professing: ‘Let our symbol be total abstinence [abstinence totale] and then moderate use [modération]. The latter succeeds, the former triumphs.’⁶⁹ In other terms, he did not rule out a less intransigent tactic in his fight against alcoholism. On the whole, the attitude of Vlavianos and of his colleagues in denouncing the consequences of alcoholic beverages was shaped by their studies and scientific training, by their professors and readings, by their personal observations as they practised and, as alcohol-related hospitalisations occurred, by their professional interests, as well as by their social and cultural ties. Therefore, their opinions expressed their desire to assert their scientific expertise and their anxiety about what they perceived as a menace to society at the same time.

However, they lived and worked in a society with the characteristics of what some anthropologists term a ‘wet culture’, that is, a society where production and consumption of alcohol was fully integrated in social and cultural practices. What is more, alcohol represented significant financial and fiscal benefits, which were even associated with national interests for the Greek state. As a result, and as in other European countries, the campaigners against alcohol, divided on the question of total abstinence or moderate use, failed to form a common front and influence public policies. And as psychiatrists and neurologists gradually attained recognition in the eyes of the medical profession and of public and state institutions (as demonstrated by the inclusion of two psychiatrists in the 1938 committee), they proved more willing to ‘water down their wine’ and to retreat from their more uncompromising stance.