Edward Wren is an MA History student at the University of Bristol. He recently had the chance to ask Dr James Nicholls about his overlapping interests in philosophy and alcohol research. As Director of Policy and Research at Alcohol Research UK and an Honorary Senior Lecturer at the London School of Hygiene and Tropical Medicine, Dr Nicholls is well placed to answer such questions. Though he has engaged alcohol and addiction through several critical lenses, Ed wanted to ask about the specifically philosophical dimension of his academic and professional work.
Through much of your published work you have shown how drinking and alcohol have engaged historic philosophical questions. Could you explain, for example, the problem posed by alcohol (particularly drunkenness) for the early modern debate on mind-body relationships?
One of the more obvious touchstones for thinking about early modern philosophy is the Cartesian mind-body dualism. When I was first looking at this area it jumped out at me because alcohol and intoxicating substances posed a problem for a simplistic dualistic model. Put obviously, you take a material substance into your body and it appears to have a demonstrable impact on your cognition. In the UK there was an empiricist reaction to the simple Cartesian dualism amongst some of the British philosophical schools, and things like intoxication were particularly interesting because rather than separating mind from body they seemed just to drag them closer together so that it became impossible to disentangle them. 18th-century medical writers like George Cheyne and David Hartley had a fascination with the nature of the relationship between mind and body, and the problem was picked up in ideas like Associationism which sat on the border between philosophy and medicine.
Quite a number of those writers wrote about drinking in particular, I think specifically because it posed this particular set of problems about how to explain such a tangible relationship between body and mind. There aren’t many other examples to hand that are so tangible in that respect, which seemed to problematize a simple dualistic model of that relationship. It was partly a medical problem, partly a philosophical problem, and partly a problem of early psychology. And alcohol is like that: in the West, it has sat at the heart of a lot of social and cultural practice and imagination.
Another classic example you have discussed concerns individual sovereignty, particularly in the 19th century. What do you think was the philosophical significance of John Stuart Mill and Thomas Hill Green’s wranglings over the prohibition movement?
That’s one of my favourite parts of the political and philosophical history of intoxication. In the 19th century there was the rise of the temperance movement which metamorphosed from a voluntarist, collective set of small organisations and communities who opted to reduce their alcohol consumption, and over the century moved to a radical teetotal movement which was all about self-transformation and overcoming, and also political transformation: this very millenarian sense that society could be transformed if it became sober. And then late in the mid-19th century there was the prohibition movement, which instead of arguing that it was about personal overcoming, said that the state had a responsibility to protect people from alcohol because it was one of those influences that undermined their capacity to be free liberal subjects. By the late 19th century in the UK this was a very pressing, concrete political question. The temperance and prohibition movements were very powerful at the time liberalism was establishing itself both economically and politically.
John Stuart Mill, in defining his brand of liberalism, argued that the state could only intervene on your individual freedom at the point at which you threatened the freedom of somebody else. As far as alcohol was concerned, as long as you didn’t behave badly when drunk, as long as you didn’t punch someone or run someone over, then it was entirely within your right to become as drunk as you liked. But people like Thomas Hill Green, who came from a much more interventionist liberal position, took the view that in order for society to progress and improve, the state had the responsibility to create the conditions in which we could realise ourselves as humans. To realise yourself as a human you had to be partly protected from influences that could constrain that process of self-realisation. So Green was a prohibitionist and strongly felt that it was the responsibility of the state to remove the dangerous influence of alcohol from society.
One further historic thinker with an important contribution to alcohol debates is Nietzsche. What was his take on the question of intoxication?
Intoxication was really important to Nietzsche in some respects. There is a translation issue, and as I understand it the German term ‘Rausch’ translates more as ‘rush’. The idea of a drug rush was slightly closer to the language that Nietzsche was using, but it is generally translated as ‘intoxication’ in his work. He talks about intoxication as the necessary precondition for art and in his early work such as The Birth of Tragedy where he talks about the Dionysian and the Apollonian, he was caught up with the Romantic idea of Dionysian art as welling up in that intoxicated, transgressive way. But as with a lot of things with Nietzsche, it was very abstracted and metaphorical. He didn’t like the idea of people being drunk: he thought it was bestial and dehumanising. That was the herd-like version of intoxication rather than the grand, Ubermensch standing at the top of a mountain being overwhelmed by the sublimity of the landscape.
In Nietzsche’s idea of intoxication he takes what is a tangible, everyday reality and sublimates it into this grand, metaphorical idea into which he pours all his Romantic notions of the Dionysian. But intoxication is earth-bound, it’s about people tripping over, stumbling around. Usually it doesn’t look transcendent or spiritual! Intoxication creates its own mythology, its own transcendent narrative, but it’s also always physical, corporeal and daft – all those very un-Nietzschean things. There’s a lot of interesting stuff about his idea of intoxication, but for me what’s interesting is how he almost wilfully sublimates it.
There has been more recent philosophical commentary on drinking and alcohol as well. What did you make of Steven D. Hales’ and Fritz Allhoff’s edited collections of philosophy essays on beer and wine?
What interested me in those books was that cultural capital overlaid the entire thing. It was amazing how many of the papers on wine were about aesthetics in one form or another, and how the papers about beer, if they approached that territory, became jokey and self-referential. Very few of the wine essays considered that making aesthetic judgements is always an expression of cultural capital. They assumed that there were aesthetic judgements about wine to be made, and asked how they were to be applied and how we were to test their accuracy and value. But there was no question about why they were assuming this in the first place. Whereas in the beer book these grandiose philosophical questions were taken less seriously.
Though in your 2011 review you are non-committal, are you instinctively a beer realist or a beer relativist?
I think I’m a beer relativist. Only a community of beer drinkers would care about whether it was one type of hops or another. You become a beer aficionado and suddenly it matters whether you have Cascade hops or whatever. It reminds me of Rorty talking about Derrida: if you’re playing the game then it really matters, but if you’re not it doesn’t matter at all. You either like the beer or you don’t.
But that said, you can’t say that the game doesn’t make any difference to the real world. That’s demonstrably not the case. The craft beer revolution has transformed the market, driven by a community of experts engaged by this language of taste which ‘normal beer drinkers’ think is absurd and laughable. But it’s dragged up the quality of beer and has changed the market so that people expect a level of quality and choice that wasn’t there before.
What public benefits might be attached to philosophical analysis of drinking and alcohol?
I think that a lot of the debates around alcohol and drugs are questions of political philosophy in another form, even if not always explicitly. Almost invariably underpinning them are questions about what it is to be human, the relationship between individual freedom and state intervention, about the points at which our experience of the world is reliable/unreliable, and whether that matters, and what our responsibilities should be in those different situations.
So to make those latent ideas explicit – there is a public good to come from that. We are completely inconsistent in our thinking on alcohol and drugs. In reality TV like Big Brother you can have a group of contestants whom you get as drunk as you like to make a funny show, but if a contestant is found with a banned substance it’s a scandal all over the tabloids which would have them in court and, quite possibly, in prison. That’s a deeply problematic situation. We can’t get our heads around how to manage different means of intoxication.
This isn’t a simple anti-prohibitionist line, and certainly not a prohibitionist line, but I think that these are really important questions, especially looking at the incarceration rates around drug use and the damage done through the illicit nature of the drug trade. You look at the damage done to people’s lives, when through an attachment to one particular substance they may enter social circles where they are exposed to other illicit, more dangerous substances, and the level of costs to society that accrue from that. The more thoughtful and complex debate we can have the better.
Let’s move now to discuss current public health debates on alcohol policy. In your 2009 book ‘The Politics of Alcohol: The History of the Drink Question in England’ you describe the current phase of public health campaigning as targeted at the population level by advocating tax measures and licensing controls, with both industry and consumers as key players. Seven years later, does this basic characterisation still hold?
Very much so. In the politics around alcohol policy there are two sides to the argument. On the one hand there is what I’ve described elsewhere as a ‘continuous’ model of alcohol harm with no clear ontological distinction between addiction, harmful drinking and moderate drinking: they exist on a sliding scale. On the other there is a ‘dichotomous’ model of alcohol harms with harmful and moderate drinkers as distinct groups. This analytical problem has become overlaid with politics because the drinks industry is very keen to frame alcohol issues in a dichotomous way. It makes sense for them to say that harmful drinkers are just irresponsible individuals or suffer from an addiction which is not really caused by the substance, and that it isn’t the responsibility of the suppliers but just an unfortunate reality.
On the other side, the development of public health analysis of alcohol harms in the late 1960s and early 1970s was partly in response to/a critique of this simple dichotomous model that had become dominant from about the 1920s/30s onwards, which seemed both to stigmatise drinkers and to let suppliers off the hook, letting AA deal with the few alcoholics with a real problem. The public health perspective came out of a sociological reading of alcohol harms and new epidemiology identifying how harms were spread across society, and was also a political critique of those not holding the alcohol industry to account.
You conclude your book by alluding to the positive aspect of intoxication that largely escaped the temperance movement’s notice in the 19th century, which meant campaigners and the public were at cross-purposes on questions of health and leisure. Could a mutual acknowledgement of the positive aspect of intoxication serve as a new talking point in current public health debates?
Very often in alcohol debates the great unmentionable is intoxication. We talk about health, we talk about very extreme drunkenness and bad behaviour, but what very few people talk about is intoxication as something which for many people has a positive value. I think that we still find it extremely difficult in our political culture and more generally in society to talk rationally about intoxication.
Either tacitly or explicitly we talk positively in our social worlds about intoxication to the effect of ‘I had a few too many last night but it was right laugh’. In everyday talk, it is not an uncommon thing to talk about intoxication positively. But as soon as you get to the level of public debate, whether it’s on policy or health or regulation or whatever, suddenly it becomes this unspoken thing. No one admits to enjoying intoxication. We’re still really uncomfortable talking about intoxication in ways that address its ambivalence, its pleasures as well as its problems. Intoxication remains absolutely locked in our everyday speech. It doesn’t ever make it to the public level of discourse; who the hell would mention in it in positive terms in a parliamentary question, or a philosophical treatise, or a health advice pamphlet?
Turning to your work at Alcohol Research UK, could you summarise your work as Director of Policy and Research?
My role is to oversee our research function, the core of what we do. We fund research into alcohol with the particular goal of reducing alcohol-related harms, but we also see that in order to reduce alcohol-related harms we have to have a broad social understanding of alcohol use. So in addition to funding work on things like treatment, interventions into obviously harmful consumption patterns, we do also fund work on studies that aid our understanding of drinking cultures, behaviours and marketing. Because harms pop up in all sorts of different places, some more obvious than others, and because stuff like public disorder around drunkenness can occur in quite unpredictable ways, you have to take a holistic approach and come at it from lots of different angles.
How does the organisation’s ethos of alcohol-related risk and harm prevention interact with other efforts in the field? Is it typical or different in this regard?
I don’t think there is a typical approach. There are so many different disciplinary approaches to alcohol harm. In order to understand where harms occur, you can come at it from an epidemiological perspective, an economic perspective, a perspective on treatment drawing from psychology and psychiatry and lots of social research. The field of alcohol-harm prevention is a very broad field, itself part of an even broader field of alcohol studies incorporating all sorts of different projects. We’re limited in the amount we can do with the funds that we have, and because our charity is specifically about alcohol-related harms our work is geared towards that. But we tend to look at the concerns and issues that a lot of the other funders are interested in: how do you regulate alcohol? How do you address issues around individual problematic drinking? How do you understand patterns of consumption across society? How do you understand why behaviours change? How do you understand the role of external drivers like marketing and pricing in shaping consumption?
The charity’s recent annual review demonstrates its support for a wide number of research projects. Could you say a little about the recent ‘harm paradox’ study it supported?
The harm paradox study was a really important one for us, an extraordinary phenomenon whereby you have massively higher levels of alcohol-related hospital admissions and mortality in the most deprived areas despite the fact that apparently average consumption is lower than in more affluent areas. There are lots of obvious reasons for that: poverty is bad for health, to do with things like housing, stress, diet, all the things that are to do with health inequalities more generally. But if there is something particular around alcohol then it’s really important to understand it. I think we are getting closer: within very deprived communities you’ve got more people that don’t drink but you may also have a disproportionate number of people that drink in a problematic way.
Survey work on alcohol consumption very often misses the people most at risk. Surveys tend to be responded to by people who are in fairly stable environments with time to complete surveys and without anxiety about what they tell a complete stranger. So we’re working with very imperfect data trying to create models that explain patterns of consumption and interventions that will change those patterns. Things like the harm paradox can emerge under the radar because very often we’re missing that granularity and the reach that you really need to understand what’s behind those phenomena.
Looking to the future I note that you co-authored a forthcoming book on public health and alcohol policy in Europe. What can we expect?
That book is interested in the tension between public health advocacy, political reality and public framing of alcohol problems. It takes historical and comparative perspectives looking at different countries. With alcohol-related harms we are looking at an area which involves a set of very complex, widespread and emotionally attached behaviours. What are the challenges that are faced there? How do advocacy movements organise in ways that maximise their political influence? What is the role of evidence gathering, policy framing and advocacy action?
We use ‘multiple streams analysis’ which makes the obvious but important point that policy is never really made on the basis of a rational analysis of evidence from which flows a policy solution. It’s based on a whole load of chance, a whole load of lobbying/advocacy/campaigning effort, based on perceptions of public opinion, news cycles and the individual opinions of ministers. When those things come together very occasionally what’s called a policy window will open and you either go through it or you don’t.
I remember speaking to an ex-Minister for Public Health under Labour who played a large part in the late 2000s public interest in alcohol harms. She had commissioned a units awareness campaign which was quite high-profile. She told me that it was provoked by a Daily Mail front-page article she had read reporting on how 30% of British people drink hazardously. Right there you’ve got how policy works: an individual with their own hunches and presuppositions, reading the Daily Mail which is running with a story that had just happened to make the front pages (but which was, in this case, based on a piece of academic research), holding a particular ministerial position. And the train gets set in motion. Had she not been reading the Daily Mail that night, had the Daily Mail not picked up on that story using something else that day… there’s so much contingency involved.
Thanks very much for your time.
To see Dr Nicholls discuss his work further, visit: http://www.fead.org.uk/contributor/james-nicholls/