Abstract
Through close reading of medical and cultural texts, this article demonstrates how the narrativisation of relational harm underpinned the emerging categorisation of ‘addiction’ in the 19th century: excessive consumption was conceived through its detrimental impact upon others, and more specifically, upon the family. The problem was portrayed as physiological, psychological, and social: ‘addiction’ could not be located securely within a single individual, nor was it conceived simply as a social vice. While other societal themes emerge in the medical writing of the period, such as the relationship between drinking and criminality, and the visibility of drinking in the working-classes, these are not presented as proto-diagnostic criteria in the same way as relational harm. In theorising addiction, medicine relied upon rhetorical devices and narrative modes, and authors and artists took an active role in defining the terms of the debate around drinking, drug use, and gambling. Charles Dickens and George Cruikshank represent childhood through the adult's compulsive behaviour, which the child witnesses, while the adult's behaviour itself is conceived as harm directed towards child. The article demonstrates how 21st-century attitudes, particularly located in the fields of psychiatric diagnosis and child protection social work, echo debates established by 19th-century narratives, arguing that that the disease model of addiction was closely associated with the medico-legal production of childhood. Nineteenth-century narratives of addiction therefore anticipate late 20th- and 21st-century attitudes regarding the impact of parental substance use upon children.
Introduction
Writing in 1804, Royal Navy surgeon Thomas Trotter maintained that physicians had a moral duty to give their attention to the problems caused by alcohol. In An Essay, Medical, Philosophical, and Chemical on Drunkenness, and its Effects on the Human Body, Trotter describes his compassionate proto-therapeutic intervention, through which the relationship between a drunken father and his infant child is centred, the baby celebrated for their therapeutic potential (Trotter, 1804: 188). By the mid-19th century, the ‘habitual drunkard’ and the ‘dipsomaniac’ were routinely associated with damage to the public and private spheres, economy and home: excessive consumption was conceived through its detrimental impact upon others, and more specifically, upon the family.
Through close reading of medical and cultural texts, I demonstrate how the narrativisation of relational harm underpinned the emerging categorisation of ‘addiction’ in the 19th century. The problem was portrayed as physiological, psychological, and social: ‘addiction’ could not be located securely within a single individual, nor was it conceived simply as a social vice. The texts I examine depict ‘addiction’ as dynamic and relational: guilt and shame are represented as driving the experience of compulsion and the practice of excessive consumption. Children occupy a privileged position in these narratives. I aim to show how literary analysis can complement and enrich the historicist understanding of addiction. For that reason, I do not attempt to engage with the entirety of the addiction studies field, but rather create a pathway to a narrative understanding of how 19th-century theories were formed.
I am interested in indicating how 21st-century attitudes, particularly located in the fields of psychiatric diagnosis and child protection social work, echo debates established by 19th-century narratives. The classification of addictive behaviours in the mid-to-late 19th century produced a conceptual problematic which necessarily persists: namely, at what point is a behaviour deemed harmful enough to be labelled as a pathology, and how do we understand this harm in relational terms? The relevance of this question both to an understanding of compulsive behaviours, and to the evolving demarcation of the category of addiction in the 19th century has been comparatively neglected in historical accounts. I do not wish to imply that ‘addiction’ is a transhistorical truth: as anthropologists Eugene Raikhel and William Garriott neatly put it, addiction ‘must be seen as a trajectory of experience that traverses the biological and the social, the medical and the legal, the cultural and the political’ (2013: 8).
My approach here is driven by a focus on the construction of psychosocial concepts through narrative practices. Following Stuart Hall, I work on the premise that representation is constitutive, rather than reflective, of meaning: however, as Hall writes, ‘events, relations, structures do have conditions of existence and real effects, outside the sphere of the discursive; but that it is only within the discursive, and subject to its specific conditions, limits and modalities, do they have or can they be constructed within meaning’ (Hall, 2008[1989]: 585). As Rachel Bowlby states in relation to literature, ‘realism can never be simply codeless in its claimed replication of reality’ (2007: xv). I suggest that medical and cultural discourses rely upon coded forms of representation or plots to give meaning to the experience of compulsion; however, this does not by extension negate the ‘experiential trajectories’ (Raikhel and Garriot, 2013) of addiction, as I consider further in my theoretical framework.
It is important to acknowledge here the diverse ways in which compulsion was labelled in the 19th century: in the newly emerging Victorian discipline of psychology, ‘addiction’ to a substance was not consistently distinguished from other forms of compulsive thinking. I use the term addiction, in addition to specific historical terms, to capture the representation of compulsive consumption in relation to alcohol use, drug use, and gambling. Throughout the 19th century, addicted was often used as a transitive verb and adjective to denote an excessive preoccupation with an activity or substance, with the noun addict first being used in America in 1899 (Oxford English Dictionary).
Darin Weinberg (2021) and James Nicholls (2009) emphasise earlier discursive histories, tracing the origins of contemporary debates to the early modern period. By focusing my own enquiry on the 19th century, I do not suggest that these genealogies are unimportant. However, although a disease model of excessive alcohol use had been produced earlier, the 19th-century taxonomies of mental illness entailed a significant shift in thinking (cf. Nicholls, 2009: 166). The 21st-century psychiatric view of ‘substance use disorder’ and ‘gambling disorder’ (DSM-5) as mental health pathologies remains covertly reliant on 19th-century prototypes, as I outline in my conclusion.
The idea that moral management could be used to treat or manage insanity was a 19th-century model promoted by John Conolly, and remained dominant throughout the period, notably in the creation of the 1879 Habitual Drunkards Act, which sought to provide a legal structure through which treatment was to be provided. 1 Harm was deemed to be a medico-legal matter; the Act targeted individuals ‘incapable of self-control’ who did not pay ‘proper attention to and care of his affairs and family’ (qtd. in Eastwood, 1871). In the 1860s and 1870s, prior to the 1879 Habitual Drunkards Act, writers in the British Medical Journal (BMJ) represent addiction as a tragic family plot, drawing upon the fervent style of the mid-Victorian press to agitate in favour of social intervention, presenting a call to action.
As Sally Shuttleworth et al. argue (Bonea et al., 2019, Dickson, Taylor-Brown, and Shuttleworth, 2020), Victorian representations of addiction can be understood as part of a broader process through which technological and industrial modernity were interpreted as creating new forms of disease and nervous debility. Further, I suggest that the disease model of addiction was related to the production of childhood, specifically, the growing conviction that children required legislative protection from harm caused by adults. This shift culminated in the first legal framework for child protection: the Prevention of Cruelty to, and Protection of, Children Act 1889. As I argue through close readings of Charles Dickens and George Cruikshank, the Victorian child inhabits a troubled position as both victim and witness. The 1889 Act endorsed this concern, presenting the conditions in which children could give evidence in court against adults who have mistreated them (s.8).
In the first part of this article, I consider some of the theoretical frameworks surrounding addiction, and their relevance to my own approach. In the second, I analyse the way in which the medical view of alcoholism as a disease was produced through a mid-Victorian family plot, using the BMJ as my primary source material. The BMJ demonstrates how medical perspectives were elaborated within a specific timeframe and context. I develop my interpretation of the relational dynamics of ‘addiction’ through readings of Trotter (1804) and James Cowles Prichard (1835). Despite their theoretical differences, both authors privilege the troubled/troubling presence of the drunkard's disordered speech, which requires translation by the physician: the positioning of the patient within the cure is a key focus. Finally, by charting the debate between Dickens and Cruikshank, I demonstrate how childhood is represented through the adult's compulsive behaviour, which the child witnesses, while the adult's behaviour itself is conceived as harm directed towards the child.
Theory
There is a tendency for research into addiction to become siloed: although the nature of the field necessitates interdisciplinarity, empirical sociological and medical discourses can feel disconnected from the humanities, specifically history (including the history of medicine) and literature. Weinberg's ethnographic work is an exception to this tendency (2011, 2015). In a recent article, Weinberg argues that a comparative historicist approach is necessary to bridge the unhelpful divide between ‘brain disease and choice theoretic literature’, placing his focus on early modern Puritanism and civic republican discourse (Weinberg, 2021). Robert Reinarman and Craig Granfield articulate the aim of critical addiction studies by stressing the ‘contextual causes of addiction’ (Reinarman and Granfield, 2015: 11). However, as I demonstrate through my textual readings, the classification of addictive behaviours in the mid-19th century was already orientated towards the relational and the social.
I work on a premise that medico-scientific phenomena are given meaning through cultural representation, while recognising that cultural production itself is constituted by temporal relationships between embodied selves, and structured by ideological frameworks. I engage with sociological and critical theory, notably that of Pierre Bourdieu and Michel Foucault. My focus on relationality resonates with recent interventions into the psychology of addiction; L. Graham Bufford and Sara Lappan (2024) make a strong case for adopting a systemic understanding of addiction and its treatment, providing a detailed overview of the clinical literature produced in this area. Again, what is perhaps missing from this is the awareness that the category of addiction, as it emerged in the 19th century, was relational.
The difficulty of mediating between the individual and social dimensions of addiction is acknowledged within sociological accounts. Alfred Lindesmith's important research rejected the then current psychiatric view that addicts were defective ‘psychopaths’, and instead proposed, Any satisfactory theory must attempt to account for the fact that the repeated administration of opiates sometimes is followed by addiction and sometimes is not. The factor which accounts for this differential effect appears to be the person's knowledge or belief, supplied him by his cultural milieu, concerning the nature of the distress that accompanies the sudden cessation of the opiate. (Lindesmith, 1938: 593)
Robert Merton's theory of addiction (1938: 677) as social deviancy has also been highly influential to the sociological field, Merton working on the premises that the addicted subject has intentionality and has rejected ‘culturally defined goals’. This formulation offers an interesting point of comparison to 19th-century narratives: while physicians undoubtedly interpreted habitual drunkenness (for instance) as being detrimental to individual, family, and society, this formulation, in narrative terms, is driven by an idea of relational harm, rather than social deviance, and intentionality is problematised. The 19th-century focus is affective and ideological. For Trotter (1804), excessive alcohol use is the great leveller, found within all classes of society. In The Old Curiosity Shop (1841), Dickens represents the compulsive gambler as speculator, an exemplar and symptom of capitalist modernity: rather than deviating from bourgeois normativity, Dickens suggests that the gambler, as proto-addict, over-conforms to it. Through this thematic, he reinforces a critique established in his journalism: financial speculation has become a ‘frenzy’ (Dickens, 1856: 385). Colin Wright argues that in the 19th century the typology of addiction was used to shore up both bourgeois and Marxist political discourses (Wright, 2015). Dickens produces a socio-economic critique through Nell's grandfather, whose consumption – as an extension of bourgeois speculation – poses an urgent threat to both the family economy and Nell's safety. The 19th-century formulation of ‘addiction’ relied upon ideological fantasies concerning the sanctity of home and the efficacy of the marketplace; however, this also led to growing interest in the physiological harm caused by alcohol use, and the impact of adversity upon the developing child.
Weinberg (2011) creates a detailed critique of sociological theories of addiction in order to situate his post-humanist approach. In contrast to some of the sociological perspectives he analyses, Weinberg, like Lindesmith, is interested in voice, the narratives offered by individuals experiencing addiction. He insists that these narratives can be ‘descriptively valid’ while acknowledging that narratives are produced through existing cultural beliefs, and bear functional purposes (ibid.: 306). As this example shows, sociologists debate how to respond to, manage, or control the addicted voice, a problem discussed in Trotter's Essay (1804), and at work in Prichard's Treatise on Insanity (1835). Weinberg conceives addiction as a disease, writing, ‘Following the lead of my research subjects, I conceptualize addictions as non-human agents residing in the bodies of those who are addicted’ (2011: 307). Reframing this proposition through an examination of 19th-century narratives, it would be possible to consider the way in which addiction as an experience could be located between embodied selves, driven by psychosocial and psychodynamic mechanisms such as shame and guilt. As the 19th-century texts suggest, harm is not simply located in the substance or individual: rather, it is the interaction of the substance or behaviour within a precise relational context that provides the foundation for ‘addiction’. To express it simply, there is ‘otherness’ in the addicted self, but otherness cannot be understood without an actual other: real, imagined, or internalised.
Michel Foucault's theorisation of power and discourse remains an important reference point in analysing the way in which medical categories were socially constructed in the 19th century (Foucault, 2001). Henry Levine's Foucauldian reading of the ‘habitual drunkard’ (2015[1978]) influenced the development of critical addiction studies (Reinarman and Granfield, 2015), with addiction regularly interpreted as a form of governmentality (see Palm, 2023). However, as Fredrik Palm has suggested, this form of approach ‘harbours its own risk and tendency to reinforce the fundamental impulse of liberalism to defend the market, and the desire released by capitalist society’ (ibid.: 503).
Bourdieu's work on the field of cultural production (1993) can facilitate interdisciplinary approaches seeking to bridge the divide between sociology and the humanities. For Bourdieu, a field is constituted by a set of boundaried relationships, where individuals act strategically in their own interests, and accumulate economic, social, or cultural capital: as David Swartz writes, ‘Fields mediate the relationship between social structure and cultural practice’ (1997: 9). This is a helpful lens through which to consider 19th-century narratives of addiction. As popular cultural commentators, whose works were exported to mass markets globally, Dickens and Cruikshank arguably possessed a far greater degree of cultural capital than the individual physicians writing in the BMJ: the use of a mid-Victorian family plot could therefore consolidate or shore up the professional medic, and indeed the journal itself. The mid-Victorian family plot became something like a ‘structuring structure’, a way of apprehending the world and generating practice: for medical writers, this plot allowed them to assume a medico-legal position and underpinned their analyses of physiological and societal harms.
I am concerned with how addiction was understood through the idea of relational harm, and in an openly narratological mode. I work on Bourdieu's premise that individual writers and artists act as agents within the field of cultural production; however, this theory of culture, taken in isolation, is insufficient to conceive the relationship between Victorian writers and their audiences. Writers and artists, including Dickens, took on an activist role, seeking to raise consciousness to produce new ways of thinking and feeling in their readership. As I show here, authors and artists including Dickens, Cruikshank, and George Augustus Sala took an active role in defining the terms of the debate around drinking, drug use, and gambling; literary authors deployed and developed medical categories such as monomania. 2
In theorising ‘addiction’, 19th-century medicine relied upon rhetorical devices and narrative modes. This article is therefore indebted to interdisciplinary research examining the reciprocal relationship between Victorian medical/scientific and literary discourses. In her seminal study, Darwin's Plots: Evolutionary Narrative in Darwin, George Eliot and Nineteenth-Century Fiction (1983), Gillian Beer analyses Charles Darwin's representational strategies in On the Origin of Species. Sally Shuttleworth's historicist research has consistently sought to elucidate the dialogue between the ‘open fields’ (Beer, 1999) of literature, science, and medicine (Shuttleworth, 1984, 1996, 2010). In the Diseases of Modern Life project, Shuttleworth et al. interpreted the category of addiction as taking shape in the context of Victorian preoccupations with the pressures of modernity (Bonea et al., 2019; Dickson, Taylor-Brown, and Shuttleworth, 2020).
Virginia Berridge's social histories are also important here, her research showing how 19th-century attitudes towards drugs and alcohol were shaped by socio-economic and cultural forces. In Demons: Our Changing Attitudes to Alcohol, Tobacco, and Drugs (2013), Berridge analyses 19th-century legacies in 20th- and 21st-century legislation and policy, examining the interaction between culture and regulation. Berridge investigates the reasons why specific substances became prohibited in the early 20th century, noting that in the 19th century, ‘the cultures of alcohol consumption, opium use, and tobacco smoking were not that different’ (ibid.: 12). This article traces points of continuity between the 19th century and today, arguing that the mid-19th-century preoccupation with relational harm produced a conceptual problematic that persists in 21st-century formulations of addiction, specifically in the fields of psychiatric diagnosis and child protection.
The medical categorisation of harm
In 1804, Royal Navy Surgeon Trotter proposed that ‘the habit of drunkenness is a disease of the mind’ (Trotter, 1804: 172). In An Essay, Medical, Philosophical, and Chemical, on Drunkenness, he insists upon the conceptual equivalence of alcohol, opium, and cannabis (‘bang’) use, justifying his exclusive focus on alcohol in relation to its social predominance (ibid.: 18). Robert MacNish's popular book The Anatomy of Drunkenness: An Inaugural Essay (1827) largely sidesteps the issue of whether the habit of drinking constitutes a disease with its own aetiology, although MacNish distinguishes between the drunkard who drinks from ‘choice’, loving the ‘riot and roar of drinking clubs’, and the more delicate character who drinks secretly from ‘necessity’ as a ‘consequence of misfortune’ (ibid.: 23–4).
In the German context, C. von Bruhl-Cramer identified alcoholism as a physical disease in the early 19th century. As Friedrich Wilhem Kielhorn clarifies, Bruhl-Cramer coined the term Trunksucht (now translated as ‘alcoholism’) in his 1819 text; C. W. Hufeland translated this as ‘dipsomania’ in his preface to the English edition (Kielhorn, 1996: 121). However, dipsomania and the corresponding term oinomania do not appear in the British medical context until the mid-19th century, when the seemingly illogical compulsion to drink was presented as a distinct mental illness.
Developing Jean-Étienne Esquirol's classification of insanity, Prichard differentiated moral insanity and monomania, placing excessive drinking within the context of moral insanity, and by extension, a perversion of ‘the natural feelings’ and ‘habits’ rather than the intellect (Prichard, 1835: 6). In contradistinction, Esquirol theorised alcohol abuse as a form of monomania (1845: 352); this nosology meant that it shared the same conceptual space as other forms of compulsive thinking, theoretically indistinct from the uncontrollable desire to drink. 3 The theoretical malleability of monomania proved an advantage to literary authors. Dickens uses the possibility of reading the gambler as a monomaniac with a ‘disease of the brain’ to disturbing effect in The Old Curiosity Shop (Dickens, 2000[1841]: 236), an idea that Sala develops in his article on ‘Gambling’ in Household Words (1855).
It was in the wake of the 1830 Sale of Beer Act (described by Nicholls as a ‘victory for free trade capitalism’ [2009: 80]), and the simultaneous expansion of the temperance movement in the 1830s and 1840s, that the move to identify drinking as a specific evil, with a precise narrative trajectory, became dominant in the British medical press, although by no means in a univocal fashion. Outliers include John Charles Bucknill, who in 1877 argued against the possible arbitrariness of ‘the classification of insanity’ and refuted the categorisation of oinomania (Bucknill, 1877: 254). In the BMJ from the 1850s through to the 1870s, a fraught distinction recurs, with an uneasy separation emerging between the habitual drunkard, who drinks because they like it, and the mentally ill dipsomaniac, who drinks without pleasure, either as a form of self-medication or due to periodic insanity. Middle-class female drinkers are often, although not always, positioned in the second category. As Amelia Bonea et al.'s work on tippling indicates, fears concerning secret female drinking became prevalent in the fin-de-siècle press (Bonea et al., 2019: 119–48). In the 1860s and 1870s, the difficulty of distinguishing between the drunkard and the dipsomaniac is at times conceded within the same medical texts that insist upon the distinction.
In the Victorian period, addictive behaviours were conceptualised through reference to a destructive outcome: the inability or unwillingness to reduce the harm caused to self and others. In The Use and Abuse of Alcoholic Liquors, his prize-winning essay of 1849, William Carpenter writes, It must be remarked, that in all these forms of the disease the patient is perfectly incapable of self-control; that he is impelled by an irresistible impulse to gratify his propensity; that while the paroxysm is on him, he is regardless of his health, his life, and all that can make life dear to him. (Carpenter, 1853: 47)
In the period, addictive behaviours were not only represented, but also understood as being produced through an interpersonal scheme. This relational dynamism helpfully unsettles the question of individual willpower, instead implying that relationships could shape the experience of addiction in social and psychological terms. The inevitable disruption of intimate bonds is embedded within medical, literary, and cultural representations. Articles in the BMJ throughout the 1860s and 1870s return to the unhappiness caused by the habitual drunkard. The earliest such reference in the BMJ is found in W. Allison's letter to the editor of the Provincial Medical and Surgical Journal in 1845: It would be well if the law would protect the property, as well as the person of habitual drunkards; it professes to discountenance vice and immorality, but unfortunately, in these cases it is not the vicious and immoral, but the well-conducted and innocent, who are the sufferers: instances are becoming too numerous of men of property, with large families, whilst in a continual state of aberration of mind, from excessive drinking, neglecting business, squandering their property more and more every year, distressing and harassing their wives and children, and undermining their health. (Allison, 1845: 593)
In his 1864 address to the Medical Society of Liverpool on ‘Dipsomania’, F. D. Fletcher appeals to his audience in rhetorical and fervent mode: Gentlemen, we all know that the cases to which I have referred are not few and far between – are not limited to any class of society. Which of us have not seen them blighting the families in which they occur, planting a sorrow more bitter than that of those who mourn for the dead in the hearts of those to whom the victim is dear? Which of us have not seen men, or still worse women, possessed by this impulse, descending swiftly, and only too surely, that easy slope which leads from one level of degradation after another lower and lower to the dark waters of a hopeless death. (Fletcher, 1864: 37–8)
It is important to note that the representations of relational harm found in the BMJ are not limited to articles on alcohol use. In 1860, James Russell presented a ‘Clinical Lecture on Opium: Its Use and Abuse’, representing the misery experienced by the family as an unavoidable corollary to this abuse: It is not easy to realise the misery of mind which often accompanies habits of intemperance; to imagine the repentance which follows indulgence; the struggle to resist temptation; the awful craving for the stimulus to which the stomach has been accustomed. Nor must we forget the pain with which the sufferer discovers his altered position in society, the disorder in his affairs, the sorrow of those nearest and dearest. (Russell, 1860: 314–15) But filth is too often a direct result of intemperance. The drunkard's wife is too often a spirit-broken creature, lacking food, enduring cruelty, obliged to nurse sickly children, or having to struggle to maintain them; who can wonder that she is slatternly or dirty in her home? (Martin, 1871: 198)
The drunkard or dipsomaniac's negative impact upon others is multifaceted: in the 1860s and 1870s, the male drinker, in particular, is represented as a danger to both public and private economies, neglecting his personal ‘affairs’, he also poses a threat to public health. As these articles imply, the category of ‘addiction’, by definition, involves others: the narrative trajectory is driven by relationships which shape, and are shaped by, the drunkard.
Reading the ‘addict’: Thomas Trotter and James Cowles Pritchard
The positioning of ‘addiction’ between selves was a social concern through which medical and cultural commentators conceived the relationship between author and reader and the production of shared social values. Trotter insists upon the need to locate and read the ‘addict’ in An Essay, Medical, Philosophical, and Chemical, on Drunkenness. Although the Essay predates the Victorian period, it remained influential: MacNish makes several references to Trotter's Essay in The Anatomy of Drunkenness (1827), as well as drawing liberally from the Essay at times when he does not. Dickens's library contained a copy of MacNish's book; it seems likely that Dickens would have been familiar with many of Trotter's ideas at second hand, even if he had not read the Essay itself. 4 Trotter and Pritchard are both, in different ways, concerned with the troubled/troubling speech of the drunkard, considering how the physician should contain, repress, or respond to it. This enquiry anticipates 20th- and 21st-century sociological debates.
Drawing upon literary authors such as Shakespeare as well as medical observation, Trotter represents the drinker's use of language as the problem: ‘Every human being, who was ever intoxicated, must have found, on reflection, that he had said and done things which he would have neither thought of or acted in a state of sobriety’ (Trotter, 1804: 92); consequently, the drunkard cannot be trusted to put their name to a legal document: ‘The acts of the drunkard, in this respect, ought not to be valid’ (ibid.: 93). The intoxicated voice, then, cannot be wholly authentic: it requires medico-legal and, as Trotter shows, therapeutic translation.
Moving between the medical, legal, physiological, and emotional dimensions of the problem, the Essay presents a serious analysis and an important therapeutic proposition. In the opening pages, Trotter represents his enterprise as remedying a tragic failure of attention: Most instances of casual or sudden death, and suspended animation, have obtained rules for recovery; while the drunkard, exposed in the street and highway, or stretched in the kennel, has been allowed to perish, without pity and without assistance; as if his crime was inexpiable, and his body infectious to touch. Our newspapers give us too frequent accounts of this kind. The habit of inebriation, so common in society, to be observed in all ranks and stations of life, and the source of inexpressible affliction to friends and relatives, has seldom been the object of medical admonition and practice. (Trotter, 1804: 3)
For Trotter, in contrast to some of his Victorian successors, problem drinking is the great leveller, ‘to be observed in all ranks and stations of life’ (Trotter, 1804: 3). Trotter argues that ‘the habit of drunkenness is a disease of the mind’ (ibid.: 172); the most effective cure is therefore a therapeutic collaboration rather than a physical palliative. In so doing, Trotter shifts his attention from the ‘infectious’ body to the psychological subject. Trotter's therapeutic strategy develops the idea of attention presented in the passage above. Rather than working against his patients, Trotter attempts to gather cohesive case histories: the doctor must obtain ‘the confidence of the sick man’ (ibid.: 172) and then ‘hold up a mirror’ to the patient's conduct so they can perceive their errors (ibid.: 174). Nicholls describes this as a form of ‘moral counselling’ (2009: 69).
This interpretation can be developed further. Through Trotter's process of gathering stories, the ‘drunkard’ becomes author and reader of their own history. Although the intervention has strategic intent, Trotter does not appear to judge the patient; instead, the physician creates a reflective space where the patient can perceive the profound disconnect between his meaning and his actions: it is Trotter's ‘duty to break’ a ‘chain of habit’ (Trotter, 1804: 188). In this context, Trotter identifies the drunkard's family as a potential source of therapeutic power: Much may frequently be done by rousing particular passions, such as a parent's love for his children, the jealousy attached to character, the desire of fame, the pride of reputation, family pride, &c. I have seen a lovely infant force tears from a drunken father, when nothing else could affect him, though he was afterwards reclaimed. (ibid.: 188)
Prichard's work on moral insanity and monomania likewise situates the drinker in a precise relational context, although A Treatise on Insanity lacks the therapeutic dimensions of Trotter's Essay. Discussing the progress of moral insanity, Prichard writes, A female modest and circumspect becomes violent and abrupt in her manner, loquacious, impetuous, talks loudly and abusively against her relations and guardians, before perfect strangers. Sometimes she uses indecent expressions, and betrays without reserve unbecoming feelings and trains of thought. Not unfrequently persons affected with this form of disease become drunkards; they have an incontrollable desire for intoxicating liquors, and a debauch is followed by a period of raving madness, during which it is absolutely necessary to keep them in confinement. (Prichard, 1835: 19)
Prichard situates the male drinker within the context of moral insanity and monomania; in contrast to the presentation of the female drinker, the tone is apologetic and sympathetic.
5
The ‘Gentleman’ had been ‘fond of literary pursuits, and had rendered himself an ornamental member of society’: An unfortunate excess to which he was seduced when his duties in London were fulfilled, laid the foundation for a complete subversion of his character. He became irregular in his habits, negligent of his person, careless of the society he fell into, addicted to drinking, suspicious of his friends, wantonly extravagant, perverse in disposition, irritable and overbearing. (Prichard, 1835: 57)
Early 19th-century medical discourse addressed the relational basis of compulsive behaviour by conceiving the forms of harm which could be produced within the spheres of work and home. Drinking, as a cultural practice of consumption, reveals the already unstable boundary between home and marketplace. The ‘drunkard's’ speech is represented as damaging, as well as offering the possibility of recovery.
The child as witness: Charles Dickens and George Cruikshank
Debates concerning alcohol use became more visible in the Victorian period, driven by the rise of the temperance movement in the 1830s. Meanwhile, the expansion of laissez-faire capitalism and the railway speculations of the 1840s provoked a plethora of literary representations of gambling by authors such as Dickens, Emily Brontë, William Makepeace Thackeray, and Edward Bulwer Lytton. For Trotter, his belief in the recuperative power of attention directly connects the newspaper readers, his fellow doctors, and the drunkard himself. The ‘lovely infant’ is both witness to their father's degradation, and the only possible source of his redemption. This little moment provides a medical prototype for mid-Victorian representations of childhood.
In the 1830s and 1840s, the association between childhood and drinking was reinforced by temperance literature, with the child often positioned as victim and moral arbiter. Pam Lock cites Lucius M. Sargent's short story ‘A Word in Season, or, the Sailor's Widow’ (1835) as ‘an inspirational story for both father's [sic] considering abstinence for the sake of their children, and children encouraged to promote temperance in their parents’ (Lock, 2022: 545). Sargent's short story ‘My Mother's Gold Ring’ (1833), narrated by the drinker's wife, likewise centres the children's suffering: ‘Till that moment, I did not believe, that my affection could have survived, under the pressure of that misery, which he had brought upon us all.… Our five little children followed, weeping bitterly’ (Sargent, 1833: 13).
Amanda Claybaugh argues that Dickens uses the temperance narrative in Sketches by Boz (1836) as part of an ‘apprenticeship in plotting’, through which he could develop his novelistic skill without making a case for social reform (Claybaugh, 2004: 46): Dickens's interest in temperance is represented as ‘formal rather than ideological’ (ibid.: 52). However, I propose in contrast that in ‘The Drunkard's Death’, Dickens creates an ironic distance between plot and style, which enables him to resist the temperance narrative and gesture towards reparative social action. Dickens's representation of childhood witnessing complicates the story and our understanding of the ‘addict’: the story anticipates his mid-period novels, which are driven by cross-generational trauma (Wood, 2020). Dickens's argument with Cruikshank, driven by the former's dislike of moralising teetotalism, later revealed the broader conflict between those, like Dickens, who perceived drinking as a social problem caused by poverty, and the temperance movement, which pushed for the legislative restriction of drink.
‘The Drunkard's Death’ opens in medias res with the narrator's account of men who have sunk into ‘destitution’ through drinking (Dickens, 1995[1836]: 554). Dickens underscores the fundamental humanity of his subject with his repetition of the word ‘man’, first used to designate the narrator and his readership, and then the ‘fallen and degraded man’ from whom ‘every one turns coldly away’ (ibid.: 554). The plot initially appears to endorse the narrator's argument that ‘by far the greater part [of drinkers] have wilfully, and with open eyes, plunged into the gulf from which the man who once enters it never rises more’ (ibid.: 555). However, Dickens creates an ironic play of meaning: the interpretive frame which the narrator imposes on the story is inadequate. While the latter states that drinking is the cause, rather than an effect, of social deprivation, the rich description of the crumbling streets belies this: ‘the only light which fell upon the broken and uneven pavement, was derived from the miserable candles which here and there twinkled in the rooms of such of the more fortunate residents as could afford to indulge in so expensive a luxury’ (ibid.: 558). Dickens's satiric use of the word ‘luxury’ to describe a ‘miserable’ necessity implies a wider social injustice.
Dickens's use of voice complicates and subverts the temperance plot. Dickens opens the piece with a strolling spectator, an observer, like himself, who ‘in the constant habit of walking’ (Dickens, 1995[1836]: 554) observes ‘abject and wretched’ men whose ‘utter destitution’ has been caused by drunkenness (ibid.: 554–5). Like Trotter, Dickens alerts us here to the importance of seeing, of paying attention. The narrator and the drunkard appear to mirror one another: it is someone the narrator would ‘know … by sight’ (ibid.: 554). Dickens's use of the free indirect style following the wife's death blurs the distressed, chaotic, thoughts of the protagonist, and the moralising voice of the narrator: His wife alone had clung to him in good and evil, in sickness and in poverty, and how had he rewarded her? He had reeled from tavern to her bed-side, in time to see her die. … His blood mounted, and his brain whirled round. Death! Every one must die, and why not she? She was too good for him; her relations had often told him so. Curses on them! Had they not deserted her, and left her to whine away the time at home? Well; she was dead, and happy perhaps. It was better as it was. (ibid.: 557)
Dickens represents Warden's children as witnesses: at the wife's deathbed, the father ‘gazed from child to child, but when a weeping eye met his, he quailed beneath its look’ (Dickens, 1995[1836]: 556), his ‘remorse, fear, shame’ driving him back to the tavern (ibid.: 557). The name Warden ironically implies his inability to protect and guard his children: a failure stated powerfully by his son, William: ‘My brother's blood and mine, is on your head: I never had kind look, or word, or care, from you, and alive or dead, I will never forgive you. Die when you will, or how, I will be with you. I speak as a dead man now, and I warn you, father, that as surely as you must one day stand before your Maker so surely shall your children be there, hand in hand, to cry for judgement against you.’ (ibid.: 562)
Dickens entered a public dialogue with Cruickshank (who had illustrated Sketches by Boz and Oliver Twist) when the latter turned his attention to the temperance cause in ‘The Bottle’ (1847). Responding to its sequel, ‘The Drunkard's Children’ (1848), Dickens praised the power of Cruickshank's polemic sequence. However, he opened his review with the following critique: ‘A sequel to ‘The Bottle’ seems to us to demand a few words by way of gentle protest’. Giving an account of the abject conditions in which the poor lived, Dickens argued that ‘drunkenness is a national horror, is the effect of many causes’ (Dickens, 1848: 436). Crucially, then, Dickens insisted that excessive drinking is a symptom, rather than the cause, of poverty. Drinking was a personal issue for Cruikshank; in 1811, his father had ‘won a drinking match and collapsed comatose. He never recovered’ (Patten, 2006). Cruickshank and his brother Robert had to support the family from this point on. Cruikshank's youth was defined by excess, and it was not until the Victorian period that he became a spokesperson for temperance. In his diary entry of 27 September 1846, he wrote feelingly, ‘The follies of youth punish us in our old age’ (ibid.). Cruikshank's abstinence began after he produced ‘The Bottle’, as if the artist felt duty-bound by the power of his own art (ibid.). His sequences of etchings, ‘The Bottle and ‘The Drunkard's Children’ present drinking as a childhood concern. In many ways, ‘The Bottle’ rehearses a similar narrative to Dickens's sketch, ‘The Drunkard's Death’, with the father bringing about the family's ruin; however, despite the inclusion of Charles Mackay's poem to accompany the etchings, this is temperance narrative rendered as a pure spectacle.
Cruikshank lifts the fourth wall of the family home at the very moment the father persuades his wife to partake of the bottle (1906[1847]: Plate I). The second plate shows the abrupt change in the father's appearance and the declining comfort of the home. The cat, now without her kitten, has moved from the cosy warmth of the hearthrug to roaming, starved, over the empty table, which has moved from the foreground to the background; the flowers over the picture, and in the vase, have wilted and drooped, giving the impression this change has happened in a single day. The shadow on the right-hand side of the picture is suggestive: in Plate I, it is the elder daughter's shadow on the wall; in Plate II, it is the shadow of the drunken father himself. Cruikshank creates a haunting visual prolepsis: the father and daughter are drawn into one narrative trajectory: in Gothic fashion, the sins of the fathers are visited upon the children. However, Cruikshank is also interested in domestic harm – the shocking immediacy of the infant's death, and the father's assault of the mother, which the children witness and attempt to prevent.
In Cruikshank's final plate for ‘The Drunkard's Children’, the generational impact of drinking is brought to the fore when the daughter kills herself by jumping into the Thames: the wasted life of the young woman functions as a metonym for (male) habitual drunkenness. Dickens was alive to the power of this plate. In The Examiner he writes, ‘The power of this closing scene is extraordinary. It haunts the remembrance like an awful reality. It is full of passion and terror, and we question whether any other hand could have so rendered it’ (Dickens, 1848: 468). The blurring of the boundary between viewer and image was reminiscent of Dickens's strategies in ‘The Drunkard's Death’; however, despite Dickens's acknowledgement of Cruikshank's skill, their conversation, played out around the semiotics of drunkenness, became increasingly derisive in the 1850s and 1860s. Dickens bemoaned what he perceived as the intemperance of temperance in Household Words and All the Year Round: Cruikshank was the target of some of his harshest criticism, represented as Mr Monomaniacal Patriarch in his article ‘The Great Baby’ (1855).
Dickens's mid-century novels again complicate the presentation of drunkenness or ‘addiction’ by representing its relational dynamism. The Old Curiosity Shop is his booziest novel: the charming Dick Swiveller is a relentless drinker, as is Mrs Jarley. Neither is vilified as a result, although the gin-soaked Dick must learn to enjoy tea drinking on his sickbed (Dickens, 2000[1841]: Chapter 66, 490), while his future wife, the Marchioness, is given ‘glasses of wine and choice bits of everything’ (ibid.: Chapter 66, 493). It is the grandfather's compulsive gambling that produces the novel's narrative energy, leading to the Trents’ final ruin, their subjection to the dwarf Quilp, the flight across the country, and Nell's death.
In his 1855 article on ‘Gambling’, Sala writes, ‘Addiction to play not only has the power of making the heart hard as the nether millstone, but it will confer insensibility to pain, and indifference to privation’ (Sala, 1855: 285): Nell's ‘monstrous’ grandfather anticipates Sala's description (Dickens, 2000[1841]: Chapter 31, 286). As his article ‘Railway Dreaming’ demonstrates, Dickens interpreted speculative capitalism as a form of gambling: a ‘frenzy’ and social contagion (Dickens, 1856: 385). (He returned to this theme in Little Dorrit [1982(1857)] through the financial collapse and suicide of the banker, Merdle.) In The Old Curiosity Shop, the grandfather's gaming is a financial venture, through which he attempts to make reparation for the familial and economic losses caused by Nell's father and brother. However, in so doing, the old man symbolically becomes father and brother: Nell considers the gambler as a ‘monstrous distortion of [the grandfather's] image’, a ‘shadow’ (Dickens, 2000[1841]: Chapter 31, 236). Dickens's representation of the monomaniac as capitalist implies a shared social disease, of which the old man is victim.
Dickens's library contained two medical texts contemporary with the novel: John Abercrombie's Inquiries Concerning the Intellectual Powers, and the Investigation of Truth (1841) and John Elliotson's Human Physiology (1835). 6 Elliotson's insistence that the brain was the foundation for ‘mind’ appears influential; Dickens's description of the grandfather resonates with the age-related deterioration identified in Human Physiology: the mind ‘of the old man weak and dull, exactly like the body’ (Elliotson, 1835: 35). In contrast to Elliotson's emphasis on the physical body, Abercrombie's work draws together philosophy and medicine to reassert moral being. However, he also addresses the impact ‘bodily disease’ has upon attention and memory, including in ‘persons broken down by intemperance, and the first approaches of old age’ (Abercrombie, 1841: 109), and ‘other habits of dissipation’ (ibid.: 108). Although these contemporary discourses probably influenced Dickens, he handles these themes with more nuance than either Elliotson or Abercrombie, focusing upon an urgent ethical situation between adult and child, where the adult's habit is represented as obsession and child neglect.
Dickens represents the grandfather's compulsion to gamble as a form of madness– a ‘disease of the brain’ (Dickens, 2000[1841]: Chapter 31, 236). In a key scene, Nell lies in bed imagining the dangers besetting them: falling asleep, she is ‘troubled by dreams’ and wakes up in ‘great terror’ (ibid.: Chapter 30, 234) to see an ominous figure entering the room: its ‘wandering hands’ drifting near her, ‘creeping’ ‘silent’, and ‘stealthy’. This intrusion into Nell's bedroom invokes the sinister sexual threat posed by Quilp earlier in the novel. Rushing to her grandfather for protection, she then sees him, the only living creature there, his white face and pinched and sharpened by the greediness which made his eyes unnaturally bright, counting the money of which his hands had robbed her. (ibid.: Chapter 30, 235)
Both Nell and the unnamed daughter in ‘The Drunkard's Children’ are driven to death by the weight of their paternal legacies. Nell, however, remains angelic in the face of her grandfather's obsession: her moral value is enhanced rather than compromised by his decline, while her presence as witness mediates her grandfather's psychological state for the reader. Dickens makes this visible through her nightly watching at the window: in Chapter 9, he develops this, eloquently moving from the ‘sadness and sorrow’ of Nell's thoughts to represent their cause: To see the old man struck down beneath the pressure some hidden grief, to mark his wavering and unsettled state, to be agitated at times with a dreadful fear that his mind was wandering, and to trace in his words and looks the dawning of despondent madness; to watch and wait and listen for confirmation of these things day after day, and to feel and know that, come what might, they were alone in the world with no one to help or advise or care about them – these were causes of depression. (Dickens, 2000[1841]: Chapter 9, 76)
In Our Mutual Friend (1865), Dickens explores the interpersonal dynamic of ‘addiction’ through Jenny Wren, and her drunken father, named Mr Dolls by Eugene Wrayburn. To construct this relationship, Dickens turned back to Nell and her gambling monomaniac grandfather for inspiration: the angelic Nell metamorphoses into the disabled child-woman, Jenny Wren, who is ‘Twelve, or at the most thirteen’ (Dickens, 1997[1865]: II.1, 224). Mr Dolls is a ‘weak, wretched, trembling creature, falling to pieces, never sober’ (ibid.: II.1, 227). Dickens's representation of the drunkard resonates strongly with physiological accounts such as MacNish's; however, Dickens creates something far more psychologically detailed.
Jenny is represented with the full force of Dickens's grotesquery: a ‘child – a dwarf – a girl – a something’ (Dickens, 1997[1865]: II.1, 222). She is a child masquerading as an adult as a result of her father's failure. Mr Dolls is a function of his daughter's identity, while simultaneously leaching her of money and endangering her home. Dickens shows us the intimate consequences of Mr Dolls's alcoholism: he is rendered thing-like, a marionette who needs winding up with rum before he can speak (ibid.: III.10, 527). His daughter assumes the premature status of ‘the person of the house’ (ibid.: II.1, 222). Jenny's physical disability symbolises the damage her father has caused, as well as being the literal outcome of her deprived childhood: ‘chilled, anxious, ragged, or beaten’ (ibid.: II.2, 238).
Mr Dolls is both victim and perpetrator: Jenny describes his drinking as ‘play’ (Dickens, 1997[1865]: IV.9, 713) and represents herself as the mother to this ‘bad child’: ‘My bad child is always dangerous, more or less’ (ibid.: III.2, 429); ‘And he never did well in the streets, he never did well out of sight. How often it happens with children!’ (ibid.: IV.9, 712); ‘I couldn’t play. But my poor unfortunate child could play, and it turned out the worse for him’ (ibid.: IV.9, 713). Mr Riah stands in for the reader when he wonders after Mr Dolls's death whether Jenny ‘really did realize that the deceased had been her father’ (ibid.: IV.9, 712). Jenny's own creative play – her insistence that she is the harsh parent, and her father the errant child – both consolidates and resists the damage Mr Dolls's drinking has done both of them. It is a creative defence which ensures her social and psychological survival. Further, it is inextricable from her poetic vision, ‘inspired and beautiful’ (ibid.: II.2, 238).
Throughout the novel, Mr Dolls is denied name, position, and character: despite this, he is granted immense narrative importance. His betrayal of his daughter, selling Lizzie Hexham's address to Eugene for ‘sixty threepennyworth's of rum’ (Dickens, 1997[1865]: III.10, 530), leads directly to Eugene's pursuit of Lizzie, his contemplated seduction, and Bradley Headstone's assault. This, in turn, leads to Eugene and Lizzie's marriage and the healing of the novel, if not of Society itself. Through Mr Dolls and Jenny Wren, Dickens explores the possibilities and limitations of reparation; their relationship operates as a refractive prism for the novel's wider concerns. Mr Dolls's betrayal of Jenny haunts him, and this plays into his continuing desire to drink; for ‘it was always on the conscience of the paralytic scarecrow that he had betrayed his sharp parent for sixty threepennyworths of rum’ (ibid.: IV.8, 696). Mr Dolls's remorse contrasts with Bradley Headstone's morbid reiteration of his brutal crime against Eugene. By comparing the crimes of the tortured monomaniac and the betrayals of the habitual drunkard, Dickens undermines the nosological distinction between them, creating a bridge between the psychological subject – Bradley – and the thing – Mr Dolls. Dickens draws upon and plays with the idea of the ‘type’ so cherished by Victorian medical thinking, refusing to cast Nell's grandfather simply as an abject monomaniac or Mr Dolls as a vicious habitual drunkard. This troubling of categories develops the uncertainties found in the medical writing. However, it is through children that Dickens's reworking becomes manifest, his textual strategies showing the need to read and reread each individual case. In a comparable way to Trotter in his Essay, Dickens narrators perform a therapeutic function by negotiating the experience of compulsion and by refocusing the reader's gaze: the child's vision is used to mediate our own. Both Dickens and Cruikshank represent the damage caused to children through ‘addiction’; however, for Dickens, the production of harm is never straightforward. In The Old Curiosity Shop and Our Mutual Friend, the child is represented as visionary and victim. The Dickensian child holds a potentially therapeutic mirror to the ‘addict’: however, this is also a traumatic encounter exposing the unequal relationship between adult and child.
Conclusion
While other key themes emerge in the medical writing of the mid-Victorian period, such as the relationship between drinking and criminality, and the visibility of drinking in the working-classes, these are not presented as proto-diagnostic criteria in the same way as we see in the case of relational harm. 7 The identification of harm remains at work within contemporary psychiatric models, despite the increasing dominance of the neurobiological model of ‘addiction’. 8 In the DSM-5 and ICD-11 psychiatric manuals, ‘Substance-Related and Addictive Disorders’ (DSM-5) and ‘Disorders Due to Substance Use’ and ‘Addictive Behaviours’ (ICD-11; World Health Organization, 2019) are defined through reference to a damaging outcome: the inability, unwillingness or impossibility of reducing the harm caused to self and others. In her reading of the DSM-IV's entry on Substance Abuse, Mariana Valverde distinguishes between the criteria relating to ‘feelings’ and those relating to ‘harm’, reading the latter as making a failed (even ludicrous) claim to medical objectivity (1998: 27–8). However, Valverde's argument does not take account of the historical narratives that established these ideas, nor the productive potentiality in the latter for a relational, contextual, and socio-economic understanding of mental health. The neurobiological model of addiction, focused on the way in which drugs could negatively impact the brain's reward system, arguably closes down such possibilities. Nineteenth-century accounts repeatedly centre the relational dynamics at work within the diagnostic category, and the trajectory of subjective and intersubjective experience that the diagnosis sought to represent.
I have presented an original historical account concerning the centrality of relational harm and the positioning of the child within 19th-narratives of addiction, suggesting that the theorisation of addictive behaviours was concurrent with, and enmeshed within, discourses of childhood: the emergence of the disease model in Victorian medicine and psychology was coextensive with a family plot, the (often tragic) ‘addict’ posing a threat to home and marketplace: private and public economies. The debate ranged across many areas, with the medical profession interrogating essential subjects such as the use of alcohol as a palliative, the physiological operation of delirium tremens, and the impact of drinking on pregnant women and their unborn children, to name only three. (The latter pointing towards the later identification of foetal alcohol syndrome.) But it was the idea that ‘addiction’, by definition, negatively impacts others which predicated this discourse. For Trotter, writing earlier in the century, this was an ethical concern; he exhorts his fellow doctors to pay attention and take the subject seriously: in his proto-therapeutic work he gathered case histories in order to create a space where the ‘drunkard’ could break his destructive chain of habit, with the child taking on a privileged role as witness and victim.
The centring of the child in the scene of addiction anticipates and influences later attitudes towards child protection. The narratives I have examined here establish a particular concept of harm that remains central to 20th- and 21st-century social work perspectives regarding the negative impact of parental substance use upon children. 9 Understanding the forms of harm caused to children through parental substance misuse comprises part of the Knowledge and Skills Statement for newly qualified social workers in England and Wales (Department for Education, 2018). However, I would suggest that the current child protection system in England and Wales still tacitly relies upon a hope that parents can create change when the impact of substance use upon their child has been clearly stated and explained by professionals; the progression of some high-risk cases into the Family Court and the common use of hair strand testing in court proceedings demonstrate the inadequacy of this. Neo-Victorian ideas of moral management remain implicit in our post-Thatcherite legislation and policy, and arguably in some strands of sociological theory, such as Merton's (1938) influential work on deviancy. Weinberg's (2011) insistence that the addicted individual lacks control seeks to readdress the difficulties produced by some other sociological models, Weinberg permitting first-person narratives to be heard.
As I have shown here, in 19th-century accounts, ‘addiction’ by conceptual definition draws in others: the narrative trajectory is driven by relationships which shape and are shaped by the ‘addict’. Addictive behaviours are not only depicted, but are also understood as being produced through an interpersonal scheme: the question of willpower is helpfully unsettled, complicating the binary of willpower versus enslavement. Significantly, in ‘The Drunkard's Death’ and Our Mutual Friend, Dickens implies that drinking can be driven by shame, compulsive awareness of an alienating social gaze. The history of addiction cannot be divorced from consideration of the function of representational practices and narrativisation. This article has demonstrated how literary analysis can provide a new perspective on the historical categorisation of addiction, further shedding light on how the psychosocial experience of compulsion was understood, and pointing towards its legacies in contemporary systems.
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
