The call from the Western Health Board for fines to be imposed on those presenting to hospital Accident & Emergency Departments due to over-indulgence in alcohol is radical and interesting, but ultimately wrong-headed.
It fundamentally misunderstands the nature of alcohol abuse, both in the individual and collective dimensions of the problem.
The misapprehension is captured sublimely in Cllr Des Bruen's assertion: "People who are seriously ill are being kept on trolleys in A&E because of all the services being used by people who are under the influence, [which is\] self-inflicted." The misapprehension arises from the fact that the vast majority of those presenting for treatment at A&E Departments for injuries arising from the abuse of alcohol are, in fact, seriously ill. They suffer from the disease of alcoholism.
We tend to relate alcoholism only to the tramp guzzling cheap plonk in the gutter, but that is one of its many manifestations. Someone who drinks so much and in such a way that he or she ends up in an A&E Department is almost certainly an alcoholic. Non-alcoholics, people who can drink normally, do not find themselves in this situation.
Our cultural attitude to alcohol tends to oscillate between two diametrically removed points. On the one hand, we tend to be tolerant beyond prudence of those who over-indulge. In this part of our collective brain, we imagine that a tendency towards drunkenness is, if a flaw at all, a flaw to be indulged. But occasionally, when things get out of hand, we lurch off into total intolerance, demanding that those who appear to take our first response too literally be brought to account for their conduct. The two responses might be called half-full and half-empty manifestations of the same misunderstanding, which itself results from a misdiagnosis of the problem.
Either alcoholism is a disease or it is not.
More than six decades ago, William D. Silkworth, a medical doctor consulted by the embryonic Alcoholics Anonymous, defined two of the key symptoms of alcoholism as physical allergy and mental compulsion. This means that (a) the body of an alcoholic is not the same as the body of a non-alcoholic; and (b) those who drink abusively are drinking to overcome a craving beyond their mental control. The only hope of recovery, Dr Silkworth asserted, is "an entire psychic change".
If this is true - and six decades of experience tell us it is - then punitive methods against those suffering from alcoholism are, firstly, doomed to failure; secondly, liable to wrongly exculpate society in an unhelpful way; and, thirdly, short-circuit the learning process at both individual and collective levels.
If alcoholism is a disease besetting the individual, then it is reasonable to conclude that disproportionate consumption of alcohol in the collective dimension amounts to a national pathology. Already, in the belated responses to this well-established crisis, we observe our own desire to obfuscate and deny this possibility. The standard analysis is that alcohol consumption, even to considerable excess, is primarily for enjoyment, with a few debauched individuals contriving to spoil the party for everyone else. This viewpoint would seek, up to a very stretched point, to interpret the massively increased consumption levels of recent years as an unabashed celebration of national prosperity. But the statistics suggest that the relationship between the consumption of alcohol and increased wealth is not so straightforward. Over the past decade or so, more affluent households and individuals have consumed more alcohol than before, but the most significant increases in spending on alcohol have tended to be in the lower socioeconomic groupings, which spend relatively more on drink than the more comfortable classes. The sole exception to this pattern is among small farmers and agricultural workers, whose drinking patterns have not altered significantly.
A crude analysis of this might go as follows: that the increased consumption of alcohol in Irish society, and the epidemic of alcoholism which accompanies it, are the symptoms not so much of increased prosperity as of increased alienation from the society which prosperity has delivered. We need a new word for this, since "alienation" has been rendered meaningless by the dead-hand of Marx, and another alternative, "anomie" is too opaque and pretentious to be of any use in the project of collective enlightenment.
Identified by the French sociologist Emile Durkheim, "anomie" is a condition afflicting societies where the normative regulation of relationships by rules and values has collapsed, resulting in individual feelings of despair, isolation and meaninglessness which surface in the form of various social disorders such as now beset this Republic. There can be little doubt that the national alcohol problem is one such symptom. The physical and mental symptoms of the disease of alcoholism are, in the individual, the manifestation of the spiritual paraplegia which besets the collective to which he or she belongs. Durkheim called it "the malady of infinite aspiration", the condition of wanting more and more of what fails to answer your questions.
It is an unsettling irony that, even in seeking to address this malady's more acute symptoms, we think immediately in terms of money.