Download A deconstruction of the Swedish alcohol discourse

A deconstruction of the
Swedish alcohol discourse
--------------------------------------------Caroline Sutlon: Swedish Alcohol Discourse. Constructions of a Social
Problem. Uppsala: Acta Universitatis Upsaliensia 45, Uppsala University
Library 1998, 184 pp.
This dissertation is not concerned with the rates of alcohol problems in Sweden, nor
with the nature of alcohol
problems in Sweden, but
rather with how public discussion in Sweden has
thought about alcohol problems, and how these conceptions and governing images of
alcohol
problems
have
changed through time. Three
alternative formulations of
the alcohol problem in Swedish history are considered fairly briefly. One is the temperance or prohibitionist formation of alcohol as a poison.
The second is the earlier
medical discourse on alcohol,
from Magnus Huss through
Ivan Bratt to the 1940s,
where the main burden of alcohol problems was "an expression of bad or crude habits or customs", as a 1912 report put it. The third is a conceptualization of alcoholism
as a symptom of poor social
integration, a disorder of the
social system - a view which
found some popularity in the
1960s and 1970s.
138
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The primary emphasis in
the dissertation, however, is
on three central formulations
of the alcohol problem in the
period from the 1950s to the
present day. The first of these
is of alcoholism as a disease,
centred around loss of control
and an 'uncontrollable need
for alcohol'. In the Swedish
version of this U.S.-derived
formulation, any medical intervention should be in partnership with other institutions in the alcohol policy
arena - the police, temperance boards, and other welfare authorities.
The second formulation is
the public health or 'total
consumption'
discourse,
which the dissertation dates
as having come to Sweden in
about 1975. Sutton notes
that this formulation reflected particularly the influence
of sociology and social welfare
thinking in Swedish society,
and only really became prominent in medical thinking
with a repon published in
1982, Lakare om alkohol
('doctors on alcohol'). The
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VOL . 16. 1999 ( I )
formulation emphasizes the
connection between rates of
alcohol problems and the rise
and fall of the overall level of
consumption of alcohol, and
thus points to measures
which will have the effect of
limiting the overall level of
consumption. Sutton shows
that this formulation has
been dominant in official and
medical discourse on alcohol
problems in Sweden since the
mid-1980s. (Sweden indeed
seems to be unique internationally in the extent to which
this discourse became dominant. Certainly there is no
English-speaking country in
which a front-line social
worker or doctor would be
likely to know what was
meant by the 'total consumption model'.)
The third major formulation in the dissertation
emerged in the context of
Sweden's entry into the European Union. In this discourse,
free trade ideology plays a
central role, and formulations
of alcohol problems are subordinated to this ideology.
While the impetus for the
ideology may have come from
outside Sweden,
Sutton
shows that the entry into the
EU opened up a discourse
also among Swedes.
In an imporrant coda to the
dissertation, it is noted that,
beneath the transformations
in the dominant Swedish discourse which it documents,
there are three important un-
derlying continuities. One is
that alcohol problems are
viewed as a social problem,
not (as often elsewhere) purelya matter of private anguish,
and that state intervention
with respect to problematic
drinking is seen as necessary
throughout the period studied. The second is a heavy reliance on expert knowledge,
rather than policy decisions
being simply made by the
state apparatus or in the interplay of political interest
groups. The third is that
Swedish policy-making in the
field is characterized more by
consensus-seeking and compromise than by open conflict.
The dissertation places itself squarely in a sociological
tradition of analysis of the social construction of social
problems, a tradition which
has been particularly strong
in the United States. Constructivist analyses of the U.S.
experience with alcohol problems have often been historical, focussing on the changes
with the advent and during
the course of the historic temperance movement, or on formulations in terms of alcoholism as a disease. More
sparingly, the constructivist
gaze has also been turned on
the contemporary scene, as in
Joseph Gusfield's (1981) and
other analyses of conceptions
of drinking-driving as a problem.
SUllun's analysis breaks
ground in two ways. First, she
applies sustained constructivist analysis of alcohol issues,
in the American style, to material from outside North
America. Applying such a
framing to Nordic data is not
entirely new; as in so many
territories, Kettil Bruun had
already paid a visit (Bruun
1971). But Sutton's analysis
does demonstrate that a fuH
constructivist analysis can be
fruitful and informative outside its native terrain of U.S.
material. In so doing, her
analysis tells us something
about the limitations of a tradition of analyses based only
on U.S. experience. For she
shows that, although Swedish
doctors played a pivotal role
in Swedish policy discussions
throughout the century, pure
and simple medicalization, in
the North American sense,
was never an option in the
Swedish discourse. An American physician on a study tour
in the 1930s noted this, contrasting the framing of alcohol problems as a medical
matter by Swiss physicians
with the insistence by Swedish physicians that alcohol
problems were more a social
than a medical problem
(Fleming 1937).
Second, Sutton applies a
constructivist analysis to material where it is sociologists
thems elves who are part of
the object of study. Previous
constructivist analyses have
been of material and formula-
tions abour which sociological perspectives tended to be
critical or at least distanced.
In the alcohol field, Gusfield
and Levine wrote about temperance thinking from a position of temporal and conceptual distance, and the implicitly critical stance is there too
in Gusfield's writing about
the rhetoric of science in
drinking-driving policy.
But sociologists were at the
heart of the formulation
which is at the centre of Sutton's dissertation, the 'total
consumption'
discourse.
Among the 11 authors of
Bruun et al. (1975), one
could count 5 sociologists
and an anthropologist - and
only one physician. And
there are elements undergirding the discourse which
reveal a sociological sensibility: the emphasis on phenomena at a social level and in the
population as a whole; the
recognition that drinking is
social behaviour, with drinkers influencing each other's
drinking; and a preference
for impersonal social control
over individualized labelling
and punishment or treatment.
It could be argued that it
was actually these underlying
elements which made the
discourse so attractive in the
Swedish situation, and particularly to Swedish doctors,
in the 1970s and 19805. The
old 'Bratt system' of alcohol
con tro Is had included not
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1 139
only the impersonal controls
on availability by price, time
and place, but also a farreaching set of individualIevel social controls: community temperance boards to
advise, admonish, and if necessary compel the problematic drinker; individualized
alcohol ration-books, with
overt social discrimination
built into the system; and active surveillance of purchasers, with 'blacklists' of those
forbidden to purchase (Frånberg 1987). These measures
had come to be seen as too
intrusive on private life and
individual rights, but on the
other hand alcohol problems
were still seen as being a collective and not just an indivi dual private matter. The
'total consumption' model,
with its emphasis on control
meas ures that did not label
and did not intrude on private life, was made to order
as a solution to this dilemma.
Though the parentage of
the
'total consumption'
model was sociological, it
was not Swedish. And sociologists are not prominent,
either, in the Swedish materi-
140
I
al Sutton examines, partly
because she puts special emphasis on the discourse
among doctors. These factors may have helped in giving some distance for her
analysis. As her preface
notes, coming to the Swedish
alcohol discourse from a
California upbringing also
helped. Lastly, she has the
advantage of being a generation apart from the authors
of what she is analyzing.
There is, indeed, every reason for sociology to be included within the constructivist's gaze - for sociological
contributions to be problematized along with everyone
else's. With the unusual importance sociology has had
in Nordic societies, Sweden
provided a particularly apt
locale for this innovation in
analysis. However, those af
us whose work lies somewhere near the direction of
the gaze may experience for
ourselves what our own subjects have long known - that
the gaze may be flattering,
but it is also a litde disconcerting.
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REFERENCES
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Alcohol Control Polieies in
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Alcohol Studies
Fleming, Robert (1937): The
management of chronic alcoholism in England, Scandinavia
and Central Europe. New England Journal of Medicine 216:
279-289
Frånberg, Per (1987): 'The
Swedish Snaps: A History of
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Drug Problems 14: 557-611
Gusfield, Joseph R. (1981):
The Culture of Public Problems: Drinking-Driving and the
Symbolic Order. Chicago: University of Chicago Press.