The History Of Rehab, From Aristotle To AA
When news broke this week that Selena Gomez has entered rehab in Tennessee, the gossip world performed a collective shrug. Rehab visits for today's American elite are fairly normal; regular readers of tabloid news will even be familiar with the most expensive (Cirque Lodge, Passages, the Betty Ford Center). But beyond the exclusive stays and the perils of modern pop stardom, there's a much stranger history to the phenomenon of addiction rehabilitation, stretching back thousands of years.
Humans have been dosing themselves on interesting substances for an extremely long time; Otzi, the Bronze Age corpse found in the ice of Italy, carried an intriguing fungus in his bag, beer played a huge role in ancient civilizations like Egypt, and accompanying problems surely followed. It's only in relatively recent years, thought, that modern rehab as we know it has emerged. There were possibly as many bizarre cures for drug addiction in history as there were addictions; Medical Daily found evidence of everything from horse blood to injections of gold.
But the notion of rehab centers themselves, places where addicts could go to recover and find treatment, is only a little less bizarre. People in need of treatment across the centuries could face everything from having their teeth pulled out, being thrown in jail and swallowing belladonna to having Freud feed them cocaine. And that's before official rehab centers started serving LSD. It's been a very weird ride. Gomez is at the quiet end of a riotous history.
Ancient World: Aristotle Blames The Addict
The first discussion about potential addiction in history likely belongs to the philosopher Aristotle, but he didn't exactly place the blame in a way modern thinkers would advocate. Artistotle believed that alcoholism, an excessive dependence on a substance, was the fault not of the substance itself, but of the will of the addicted person. He called the problem "akrasia," or "incontinence of will": people who were akratic couldn't control themselves enough to be able to stop imbibing. One can assume, from that, that the treatment of addicts in ancient Greece was likely not entirely sympathetic, or at least focused on building up internal qualities of "strength."
14th-16th Centuries: Discouraging Use Through Teeth-Pulling
The criminalization of addictive substances rather than the treatment of addicts may have had its most famous historical moment in history with Prohibition, but numerous societies had slightly more brutal ways of dealing with things deemed to be "dangerous." Marc-Antoine Crocq, writing on the history of humanity's relationship with addictive substances, has picked out three legal examples from history: in the 1600s, smoking was punishable by beheading in the Ottoman Empire and by lip-cutting in Russia, while anybody smoking hashish in 14th-century Egypt would face the much more benign strategy of having their teeth pulled out. Legal measures to control consumption of alcohol occurred in the New World, too: the governor of Massachusetts attempted to outlaw all alcoholic beverages in the state in 1630, and the state made serving drunk people or letting anybody drink for more than half an hour a criminal offense in 1645.
19th Century: The Rise Of Insane Asylums & Cocaine
Across Europe and the Americas, drug and alcohol addictions became more pressing issues in society, and various solutions were posed to "contain" them. How you were treated, though, depended very heavily on whether you were socially well-connected or relatively poor. The wealthy could get away with confinement at home and private treatment, much of which was slightly ludicrous: aside from the misguided marketing of morphine as a treatment for alcohol addiction, there are also records of private patients inhaling amyl nitrate or, in the case of a friend and patient of Sigmund Freud's, cocaine. Chronic addicts of lower social status, though, were prone to being shut up; and the options were rarely salubrious. Jails, almshouses for the poor, hospitals, and insane asylums all received their share of addicts, though private hospitals often refused to house "inebriates" because it was seen as a waste of resources.
When institutions did start to form in the U.S. in the late 1870s, called things like "homes for the fallen" and "inebriate asylums," their treatment regimes were, well, interesting. The usual treatments in an institution involved isolation and "detoxification," a bewildering and slightly dangerous process involving the administering of everything from poisonous belladonna to the hypnotic drug chloral hydrate. One, in 1867 in Chicago, specialized exclusively in the treatment of female alcoholics.
Early 1900s: Temperance Leagues & "Sober Houses"
One of the big moments in the history of America's attitude towards alcohol addiction happened in 1808, with the publication of physician Benjamin Rush's The Effects of Ardent Spirits Upon Man. Rush's basic idea? Alcohol was dangerous and should be stamped out immediately, with the use of "sober houses" to treat those who were addicted to it (often using methods like forcible vomiting and compulsory attendance at religious services).
The notion of "temperance," the idea that people should abstain from all substances altogether, spread rapidly throughout the U.S. and worldwide in the 19th century (including anti-slavery campaigner Frederick Douglass, who signed "the pledge" of abstinence in 1845 and thought going teetotal was critical for the emancipation of African-Americans). Temperance movements did everything from installing drinking fountains in public places to putting on plays, but their biggest victory was, of course, Prohibition's 18th Amendment, which held sway across the U.S. from 1920 to 1933 and utterly prohibited alcohol of any kind.
1930s: AA & Narcotic Farm
When one thinks of addict support in the modern world, the first thing to come to mind is Alcoholics Anonymous, but it's actually not as old as it seems; it only formed in 1935. AA, as it's now called, was the brainchild of two men who'd had previous failures in other support groups, and began to form a collective at Akron's City Hospital. It's since become the dominant method through which addicts around the world fight addictions via the famous 12-step program.
The other (mostly) positive development in the 1930s was the introduction of the now-famous Narcotic Farm, the first national drug treatment facility. It was famous at the time for its huge grounds and emphasis on good food and hard work, and for the amount of addicted jazz musicians who came through the program. Unfortunately, as NPR covered in 2008, the Farm earned a reputation for experimenting with addicts, allowing them to "bank" morphine through good behavior and testing their reactions to other drugs. It was shut down when Congress discovered that the inmates had been used as test subjects for experiments on the effects of LSD.
Post World War II: The Growth Of Twelfth Step Houses & Professional Rehabs
After the Second World War, Alcoholics Anonymous only got more popular, and "twelfth step houses," often in residential areas, grew rapidly across America. They emphasized a totally sober environment and held regular AA meetings for inhabitants and outsiders, a practice that still continues. The 1950s brought the introduction of the Minnesota Model, an addiction treatment system that's still used today: it involves a 28-day inpatient stay, individual treatment plan, family involvement, and education about addiction.
These days, rehabs operate on a variety of bases: they can be devoted to one particular addiction or to many, focus on outpatient programs, inpatient ones or both, provide methadone, and give many different kinds of therapy (and varying levels of luxury: the Cirque Lodge, one of the most high-profile in America, has Jacuzzis). But they've come a long way from asylums, vomiting, and medicinal cocaine.