522 Commentaries

and de-medicalized. This trend, of course, paral-leled the development of moral outrage embod-ied in the Temperance movement that resultedin the institution of Prohibition, and had a simi-lar effect on alcohol use.

Then attitudes took a turn. Ultimately, theyallowed for the emergence of heavy use of intox-icants associated with the counter-culture of the1960s and 1970s, Much of this use would havebeen subsumed easily under current definitionsof psychoactive substance use disorder. Becausethis use was undertaken by many well-educated,thoughtful youths, however, psychiatrists at thetime would have found the application of dis-ease-related terms to be irrelevant. History canmake fools of us if we take our nomenclature atface value.

And so, what would have happened if the termalcoholism had not been invented? Another 10-letter word, or perhaps a 5- or 20-letter word,would have evolved to reflect the historicaltrends to which we are captive at a given time.

Should we presume to think that our inventionof a mere term determines the course of howillness is treated, or how social history unfolds? Iwould suggest that the constructs that we gener-ally take so seriously are simply the products ofhistoric trends. And it is these trends that deter-mine the choices we make in our use of lan-guage.

MARC GALANTERProfessor of Psychiatry,

Director, Division of Alcoholism and Drug Abuse,New York University School of Medicine,

550 First Avenue,New York,

NY 10016, USA.

A world that does not existEsa Osterberg

"Given that science knows what humans mighthave done with about the same uncertainty thatit knows what they will do, some speculation isin order." Predicting the fiature is difficult, andevery forecast concerning the future reactions ofpeople involves uncertainty. Because we do notreally know today what will happen tomorrowevery forecast has a real possibility of becomingtomorrow's reality; some forecasts, of course.

have a greater probability of being realized thansome others—but even the forecast with thelowest probability may still be tomorrow's re-ality.

When we try to turn back the clock and beginto think about what might have happened yester-day we are posing a different kind of dilemma.As with the forecasts for tomorrow, this time wealso know what might have happened yesterday.But now we even know what actually happenedyesterday. Therefore, we have to ask ourselvesthe following question: is it really possible towrite an alternative history beginning with achange in history which did not actually happen?Is it sensible to try to write an alternative history,and how one should proceed in doing so?

The use of counterfactual hypothesis is noth-ing new. For instance, the formulation of coim-terfactual questions and the employment oftheories to settle these questions are a long-standing practice in economic history. This prac-tice has also been much debated since the neweconomic history made both these statementsand theories explicit. In any case, the counterfac-tual patterns of American development, what-ever they may be, cannot obviously be observedand they are not recorded in historical docu-ments. Therefore—as Fogel (1973) has put it-—"in order to determine what would have hap-pened in the absence of a given institution, theeconomic historian needs a set of general state-ments that will allow him to deduce a counter-factual situation from institutions andrelationship that actually existed". Furthermore,economic historians are not trying to write animaginary history. Rather, the counterfactual hy-pothesis is used to show that the alternative that,in fact, was realized (the building of the railroadsystem) was the only or the most probable out-come given the prevailing economic circum-stances, or that given the prevailing economiccircumstances, something would not have hap-pened (slavery would not have died out) withoutsomething preceding it (without legal strictures).

In Mulford's essay it is speculated "on whatmight have been had alcoholism not been in-vented, and what might follow the invention'snatural passing". As said earlier, it is worthwhileto speculate on what might follow if alcoholismwould naturally pass (if that is a real possibilityin the near future). But—according to my view—it is not worthwhile to try to image a new alterna-tive history with certain specific outcomes for

Commentaries 523

several decades. Therefore, I do not have theslightest confidence in Mulford's conclusion thatwithout the invention of the idea of alcoholism"American alcohol consumption levels might stillbe trending upward" or that the invention of theidea of alcoholism "may help to explain theotherwise mysterious consumption uptrend re-versal in 1982". These statements are purespeculation without the slightest proof of causallinks.

The basic problem, however, is the assump-tion that instead of having been invented, alco-holism has not been invented. The idea ofalcoholism was invented, and the ideas peopleinvent do not come out of nowhere. The appear-ance of human ideas are by no means determin-istic in the sense that we can state beforehandwhen, where and in what form and content someidea will be invented. But after a certain idea hasbeen invented there is a good possibility of givinga very accurate explanation as to why that specialidea was invented, and in some cases it may evenbe possible to show that it would have been asurprise if the given idea had not been invented.

Regarding the idea of alcoholism, Mulfordhimself writes that there was "the public'shunger for a simple explanation of chronicdrunkenness, its yearning for simple solutions,its faith in science and technology to find a quickfix, and its awareness of medical science's dra-matic successes in conquering many diseases".According to the principles laid down in the neweconomic history, one cannot simply begin toimagine an alternative history of any relevance bystarting with the assumption "if nothing hadhappened", because this counterfactual situationis not deduced from actually existing institutionsand relationships.

Here, in fact, we are encountering the samebasic problem that we find in so many studiestrying to calculate the social cost of alcoholabuse or alcohol consumption. To assume animaginary society with no alcohol problems andto compare it with the actual society with itsalcohol problems, and to say that this differenceis the actual societal cost of alcohol is meaning-less, because the alternative society is not de-duced from the actual society. Even if thesestudies show that the imaginary society withoutany alcohol problems would be much better thanour actual society, these studies cannot show theway to a better problem-free society. And if thereare no means to achieve this better state of

affairs, this better alternative society does notreally exist and does not give any guidance to usin our actual attempts to build a better society.

ESA OSTERBERGResearcher,

Social Research Institute of Alcohol Studies,00100 Helsinki,

Finland.

ReferenceFoGEL, R. W. (1973) The Specification problem in

economic history, in: TEMIN, P. (Ed.), New EconomicHistory (Harmondsworth, Penguin Books Ltd.).

The currency and spread of Americanmythology about alcoholDwight B. Heath

Harold Mulford has done an interesting serviceby speculating about how different many thingsmight be if the idea of "alcoholism" were not aprevailing social construction of reality in theUnited States. He fiiUy understands that whatone person considers a myth may be history toanother, genealogy to a third, cosmology to an-other, or even "a scientific fact" to yet another—but he neglected to mention that aspect ofmythology for the benefit of some who may notalready recognize it. So "American mjrthology"concerns not only the invention of the idea ofalcoholism; it also includes views about drinks,drinking, the drinker, outcomes of drinking,problems and illnesses, modes of "treatment",and outcomes of those, all of which must beunderstood as being social inventions also.

The very drastic and sometimes rapid changesthat occurred in such patterns of belief andbehavior during the history of the USA may helpto convince readers who are sceptical about sucha social constructionist perspective. All that islacking in Mulford's amazingly brief but thor-ough sketch of such trends is discussion of na-tion-wide prohibition (1919-1933), one of thefew such restrictive experiments in world history.It proved to be counterproductive in manyrespects, as did most other prohibitions, andwas repealed by popular demand (as were most