Book Review of Courtwright’s “Dark Paradise” – Johns Hopkins

[johnkarls]

.
https://muse.jhu.edu/article/39760

Johns Hopkins Univ Press – Bulletin of the History of Medicine, Vol. 77, No. 1, Spring 2003

Book Review - David T. Courtwright. Dark Paradise: A History of Opiate Addiction in America. Enlarged edition of Dark Paradise: A History of Opiate Addiction in America before 1940 (1982)
Review by Prof. Nancy D. Campbell - Rensselaer Polytechnic Institute - As of 6/12/2020, she is Head of RPI’s Department of Science and Technology Studies


The ambivalence of our agonistic romance with these chemical compounds is captured in the very title of this foundational text in the field of drug policy history. David Courtwright has marshaled a wealth of knowledge, demographic evidence, and extensive archival research for the present enlarged edition, which contains a preface and two post-1940 chapters that narrate the decentering of opiate addiction as the main driver of U.S. drug policy. Enriched by ethnographic work accomplished since the original publication, as well as by Courtwright's familiarity with the new generation of drug policy historians, the book maps out the current conceptual and political terrain on which the theoretical and empirical contentions of drug policy history abound. Himself a founding figure of the field, Courtwright examines the nagging question of why neither conservative nor liberal reform proposals have really taken hold despite widespread agreement that the policy is a "failure." The meaning of the political appellations of Left and Right has changed rapidly in the world of drug policy, and drug policy historians would do well to dispense with such problematic labels rather than inhabit them once they are evacuated of sense.

Although Dark Paradise is by no means polemic, it is difficult if not impossible to contribute to drug policy history without staking a political position on current policy, which is no longer as tethered to the criminalization-medicalization continuum nor as stably centered around opiate (heroin) addiction as it was throughout the early to mid-twentieth century. To Courtwright's credit he provides a clear account of his own position as a deconstructive critic of both "liberal" and "conservative" camps, stating his support of legal maintenance for confirmed addicts without playing into legalization rhetoric. As a social historian he grants more credence to changes in clinical practice and demographic shifts in the addicted population than would diplomatic or legal historians. The central mystery of why a policy widely considered a fiscal and political failure would be so difficult to shift pragmatically and would acquire such a "reactionary tone" (p. 179) by the end of the twentieth century remains a touchstone throughout the book.

History is always about the present. This well-argued analytic history synthesizes two significant lessons, both of which have their value as heuristics as well as their pitfalls. The first argument can be summarized as "epidemiology recapitulates etiology": the idea that geographic availability, cultural contexts that encourage use, and sheer exposure to opiates are the best predictors of opiate addiction (p. 6). Courtwright backs up this claim with historical demography of the highest order, supplemented by ample qualitative data. Yet his reduction of etiology to epidemiology can also bear critical scrutiny. While the struggle to render epidemiology scientific has succeeded since its mid-century deployment as a more speculative science, historians of science and medicine should not forget that "epidemic" narratives function as models or metaphors designed to make sense of large-scale patterns of statistical risk and occurrence. Population-based themes echo throughout much of Courtwright's work, including Violent Land: Single Men and Social Disorder from the Frontier to the Inner City (1996). Sex ratios are complex—they are produced by, as well as productive of, the complex behaviors and attitudes that undergird the "propensities" toward violence exhibited among American men. As a social historian, Courtwright deftly captures that fine-grained complexity in his narrative, and the archival and qualitative sources drive him toward it. Yet his wholesale adoption of the epidemic metaphor binds his analysis to its historical moment in somewhat limiting ways.

The second major contribution underlines Courtwright's well-known and elegantly argued thesis that the transformation of the modal American addict from upper- and middle-class white women maintained by physicians to under-class urban males was not due to the antimaintenance interpretation of the Harrison Act, as historians assumed until his groundbreaking work; rather, he argues that the social and cultural transformation was under way well before the enactment of this set piece of Progressive legislation. Drug policy historians debate how responsive drug policy was to antimaintenance attitudes, and how closely such beliefs follow Courtwright's dictum, "what we think about addiction very much depends on who is addicted" (p. 3). Whether the public considers incarceration effective policy, and how the public thinks about treatment—what we define as therapeutic, what we consider effective, and what we will fund—very much depends on whom we perceive as the primary addict population and their "drug of choice." Dark Paradise remains one of our most thoughtful yet provocative reflections of the changing historical convergences between perceptions of crisis, risk, and reality in the arena of drug policy.