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The American Disease: Still Learning?

Updated: Aug 30, 2023

Editor’s Note: This week’s symposium marking the 40th anniversary of David F. Musto’s The American Disease continues today with a reflection by Joe Spillane, managing editor emeritus of Points and Associate Professor of History at the University of Florida. Joe’s discussion illuminates the breadth of a scholar’s engagement with a major work in his field, ranging from deep immersion in the footnotes to meditations on the structure of Musto’s argument in relation to dominant historical ideas of its day.

The first drug history book I owned was David Musto’s The American Disease.  I purchased the second edition (actually the first expanded edition) not long after it appeared in 1987. Musto’s footnotes were for me, as they had been for David Courtwright more than a decade earlier, loaded with clues as to how and where I might further mine the early history of drug control in the United States. I cannot express just how important those notes were–not only were they the only really comprehensive survey of historical source material, they offered comforting reassurance that I was not alone in my particular scholarly interest. Twenty-five years later, that expanded edition (paperback, of course) is still the one on my shelf to which I turn as a first reference; the majority of pages have at least some notation, and the folded corners, post-it notes, and margin comments serve as a record of my one-way conversation with David Musto over many years.

Scrutiny rewarded.

Scrutiny rewarded.

It took a long time for me to stop thinking about The American Disease solely as a reference volume, and come to grips instead with Musto’s argument. At the heart of the volume is a notion that American drug history is marked by series of cycles of tolerance and intolerance for drug use. Those cycles are partly learning cycles–or, more correctly, cycles of learning and forgetting. As I’ve noted before, I had always intended to ask David where his notion of cycles came from. To some extent, it seems drawn fairly directly from mid-century social learning theory. Here, the process of “learning” about the harms of particular drug use tend to fade away, which leads to a forgetting of what had been learned. This forgetting, in turn, produces a new round of consumption, the harms of which produce a new round of learning.

To this relatively straightforward (though highly disputable) social learning model, however, Musto added a layer focused on emotions and fear. In truth, this argument became clearer in the 1987 edition of the work–no doubt because of the remarkable social and political changes Musto observed in the years following the first edition’s appearance. In a 1991 Scientific American article, Musto concluded: “Americans seem to be the least likely of any people to accept the inevitability of historical cycles. Yet if we do not appreciate our history, we may again become captive to the powerful emotions [emphasis mine] that led to draconian penalties, exaggeration, or silence.” Emotions are the key. Musto was arguing that people respond to drug use with powerful emotions that come from equally powerful cultural dispositions, and that these emotions lead us from the objective response to the visceral, sometimes dangerously so, before the objective pulls us back again, and so on. As (again) I have written before, this argument sounds an awful lot like Richard Hofstadter’s mid-century emphasis on the non-rational aspects of populist and progressive movements, or perhaps John Higham’s portrait of the cycles of nativism in 1954’s Strangers in the Land, or even Andrew Sinclair’s 1962 account of Prohibition in America, Prohibition: The Era of Excess (to which Hofstadter contributed the Preface).

The cycles of emotional reaction argument.

The cycles of emotional reaction argument.

David Musto’s wonderful footnotes are less wonderful in helping us to discern the roots of his argument, but there is a clue or two. Footnote 27 of Chapter 6 references Robert K. Murray’s Red Scare: A Study of National Hysteria, 1919-1920 as “the standard study of the period,” and Murray’s work was certainly of a piece with that of Hofstadter, Arthur Schlesinger, Jr. (himself a well-known promoter of a cyclical approach to American political history), and other mid-century liberal critics of populist political culture. Musto also references William E. Leuchtenberg’s chapter on the Red Scare in 1958’s The Perils of Prosperity, which made a similar argument. Footnote 38 of Chapter 3 references Sinclair’s Prohibition as the standard account. So the argument about the tolerance/repression cycle may well owe its genesis to this branch of historical criticism.

Regardless of its connections to this literature–and of contemporary feelings about the merits of that work–Musto’s study continues to remind us that there are, in the American democratic tradition, deep and abiding strains of fear and hostility–fears that, when attached to drugs and drug users, are more than capable of propagating repressive control measures, punitive legal sanctions, and worrisome encroachments on freedom and liberty.


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