A selection from Stockholm University publication database
A medical challenge
2019. Johan Edman. Social history of medicineArticle
The aim of this article is to analyse how alcohol misuse was constructed as a disease inSweden from 1946 to 1955. During these years, alcohol misuse was intensely medicalised on a conceptuallevel, albeit not so much within the treatment sector or at the institutional level. Post-warhumanism, a search for a solid ground for reformation of an unpopular system, and strong US influencewere some of causes for this development. However, a medical framing without a medicalcure did not manage to establish itself and the dominant problem description remained mostly socialfor the better part of the 20th century.
A thickening plot
2019. Johan Edman, Josefine Berndt. DrugsArticle
Swedish state regulation of tobacco use came much later than the regulation of alcohol and drugs.Only in 1993 did the first more comprehensive regulatory act – the Swedish Tobacco Act – come intoforce. By examining the political prehistory of the act in 1957–1993, this article analyses the increasinglycomplex problem description that made the new legislation possible. The article shows that differentparts of the problem description – harms to others, a connection to the public health discourse,and an increasing medicalisation – came to reinforce each other, but also that all essential componentswere in place from the outset and that research confirmed established descriptions rather than drovethe development.
2019. Johan Edman. Det nya SverigeChapter
The war on good research
2019. Johan Edman. Nordic Studies on Alcohol and DrugsArticle
A weak scientific basis for gaming disorder
2018. Antonius J. Van Rooij (et al.). Journal of Behavioral Addictions 7 (1), 1-9Article
We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.
Alcohol consumption as a public health problem 1885–1992
2018. Johan Edman. Conceptualising Public Health, 135-155Chapter
Conceptualising public health
2018. Sophy Bergenheim (et al.). Conceptualising Public Health, 1-17Chapter
Den samhällsfarliga fattigdomen och mellankrigstidens lösdrivarlag
2018. Johan Edman. Bedöma och åtgärda fattigdom, 163-178Chapter
2018. Lena Eriksson, Johan Edman. Nordic Studies on Alcohol and Drugs 35 (4), 257-274Article
Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.
2018. Johan Edman, Josefine Berndt. Addiction Research and Theory 26 (6), 431-438Article
The aim of this article is to examine the framing of excessive consumption as a disease-like condition in the Swedish press during the years 1992-2012. Against a theoretical background discussing medicalisation, we have analysed the characteristics of problematic consumption framed as a disease, as well as the presumed causes of and responses to this problem. Alongside and intertwined with a structural and a rationalisation perspective, we find discussions and explanations of problematic consumption as a disease all through the investigated period. Class and gender are noticeable components of the core problem description, but the reductionist assumption of addiction as a brain disease seems to point to a problem beyond historical and social context. The disease conceptualisation of problematic consumption can be seen as a compensatory perspective in an individualising and consumption affirming society. However, this perspective is ultimately decided by politics and not by research. Despite being a frequently occurring perspective on a conceptual level in Sweden, it is not a legitimate description in legislation or as a cause for public treatment interventions.
Un siècle de restrictions sur l’alcool
2018. Johan Edman. Prohibition(s)Chapter
A qualitative analysis of Pål Kraft
2017. Johan Edman. Nordic Studies on Alcohol and Drugs 34 (3), 196-197Article
Behavioural Addiction Open Definition 2.0—using the Open Science Framework for collaborative and transparent theoretical development
2017. Joël Billieux (et al.). Addiction 112 (10), 1723-1724Article
How can we conceptualize behavioural addiction without pathologizing common behaviours?
2017. Daniel Kardefelt-Winther (et al.). Addiction 112 (10), 1709-1715Article
Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.
Knowledge, Values, and Needle Exchange Programs in Sweden
2017. Lena Eriksson, Johan Edman. Contemporary Drug Problems 44 (2), 105-124Article
Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such as needle exchange programs (NEPs), while another strand of research testifies that policy makers often neglect to take the research evidence into account and hence fail to introduce these programs. This article studies the interplay between research-based knowledge, values, and policy making during 16 years of intense parliamentary debate in Sweden on the needle exchange issue. In 2000, the future of the two existing experimental NEPs was uncertain; in 2006, the regulations were reformed; and in 2015, they underwent a government inquiry. Both the reform and the inquiry aimed at regulating and expanding the programs. The analysis is guided by work done within the tradition of science-policy nexus, where the increased emphasis on evidence-based political measures is problematized. As drug policy arouses normative and ethical concerns, the analysis also explores values. The study illustrates the central role that values play in a policy field which is repeatedly declared to be science based. Within the overall framework of the Swedish drug policy ideology of a drug-free society, the advocates of NEPs framed drug misuse as a consequence of either an unjust society or a disease, arguing that because misuse is a condition beyond the control of the individual, the Swedish welfare state has an obligation to take care of those affected. For their part, the opponents framed drug misuse as a result of misguided attitudes, which would only be corrected by restrictions and prohibition. In their view, NEPs are a tool for drug policy liberalization. In the debate between the two positions, research evidence played only a minor role.
Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal
2017. Espen Aarseth (et al.). Journal of Behavioral Addictions 6 (3), 267-270Article
Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.
Swedish drug policy
2017. Johan Edman. European Drug PoliciesChapter
Alkoholen som katalysator
2016. Johan Edman. Ikaros 13 (1-2), 17-19Article
Concepts and policies directed at drug use i Denmark, Finland and Sweden
2016. Bagga Bjerge (et al.). Concepts of Addictive Behaviours across Time and PlaceChapter
The Nordic countries are often thought of in terms of social democratic welfare regimes with numerous shared cultural aspects. Based on research from Denmark, Finland, and Sweden, this chapter explores how historical developments, specific ways of constructing policies, and welfare institutions articulate specific conceptions of what drug-related issues are and how they should be managed in three seemingly very similar welfare states. The Nordic welfare states are often described as quite alike and fairly open and inclusive in their approach to welfare policies and concerns, but the chapter demonstrates that similar political systems adopt different policy responses to similar conditions. To explore the similarities and differences, we are inspired by the analytical concepts of policy space and political rationalities; we use this approach to provide an overview of drug policy history in the three countries and present a closer examination of the topics of sanctions against drug users, coercive treatment, and substitution treatment nationally as well as cross-nationally.
Depoliticising the political
2016. Johan Edman. International journal on drug policy 32, 93-99Article
Background: This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. Methods: The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. Results: The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. Conclusion: The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means.
From boredom to dependence
2016. Johan Edman, Josefine Berndt. Nordic Studies on Alcohol and Drugs 33 (1), 81-110Article
AIMS - The aim of this study is to investigate the medicalising of gambling problems by comparing the political discussions on gambling in the Swedish Parliament in the early 1970s and the early 2010s. DESIGN - Against a theoretical background on medicalising processes in general, and medicalisation of gambling problems in particular, we have analysed discussion protocols and parliamentary bills in the Swedish Parliament from the years 1970-1975 and 2012-2013. RESULTS - The problem descriptions of the 1970s and 2010s are, in certain respects, strikingly similar, identifying proactive operators such as the gambling companies and highlighting an inadequate legal framework. But where the MPs of the 1970s put some effort into describing the drab society which fed the need for gambling, the elected representatives of the 2010s shortcut to individual dependence. CONCLUSIONS - EU membership and the development of the Internet have made effective control and regulation impossible in the early 2010s and the political handling of the Swedish gambling problem is therefore a clear example of how market liberalisation can pave the way for individualisation, medicalisation and depoliticisation of social problems.
Harm to others – rediscovered or eternal?
2016. Johan Edman. Nordic Studies on Alcohol and Drugs 33 (5-6), 479-482Article
Researchers should avoid conceptual banalization
2016. Johan Edman. Nordic Studies on Alcohol and Drugs 33 (2), 119-122Article
Transnational Nationalism and Idealistic Science
2016. Johan Edman. Social history of medicine 29 (3), 590-610Article
This article studies the interwar international conferences on the alcohol problem. How did they view the alcohol problem and its causes; what were the consequences for the individual and the society as a whole; and which solutions merited discussion? The first post-war conferences enjoyed an optimistic and internationalistic atmosphere, added to by American prohibition, which had given the temperance movement plenty to be hopeful about. But when the 1920s turned to the 1930s, the conferences were transformed into arenas for national solutions and into outright propaganda pieces. The responses to the alcohol problem debated in the interwar conferences built on a combination of scientifically masked ideological conviction and ideologically inspired passion for science. The apparently neutral ethics of such thinking was manifested in various radical measures to combat alcohol abuse.
From self-control to medicalization.
2015. Johan Edman. Addiction through the ages.Chapter
The aim of this sub-project was to analyse the alcohol question and its responses through a series of international anti-alcohol conferences from 1885 onwards. How did they view the alcohol problem and its causes; what were the consequences for the individual and the society as a whole; and which solutions merited discussion?
The conferences before the First World War can be seen as an arrangement for the modern state where the temperance movement placed itself in the service of the state and at the same time demanded that it be given some responsibility for the future development of society. These were years when the nation acted as a point of reference in several questions that were chafing within the modern project: population qualities and the condition of future generations, the notion of citizenship, industrial strength and competitiveness, the role and the strength of the state.
The first inter-war conferences enjoyed an optimistic and internationalist atmosphere, added to by American prohibition, which had given the temperance movement plenty to be hopeful about. But when the 1920s turned to the 1930s, the conferences were transformed into arenas for national solutions and into outright propaganda pieces. The responses to the alcohol problem debated in the inter-war conferences built on a combination of scientifically masked ideological conviction and ideologically inspired passion for science.
Several themes from the early part of the twentieth century also dominated the post-war conferences: much of the presented research could easily fall into categories such as control, treatment and prevention; women and youth (who still hold positions as extraordinary but frequently discussed problem groups); and traffic and working life. All these themes are recurrent arenas for the formulation of alcohol and drug problems. But sociological and psychological perspectives are more common now, epidemiological research has grown steadily, the drug problem is ever present and a comprehensive addiction concept has opened up for topics beyond substance misuse.
Temperance and Modernity
2015. Johan Edman. Journal of social history 49 (1), 20-52Article
My aim is to analyse how the alcohol question and its responses were framed in the formative period in 1885-1913, when the international anti-alcohol conferences were taking shape. How was the alcohol problem framed in terms of current discussions on general themes such as the individual's role in society, the challenges of modernity and the contribution of science in solving a problem that was traditionally seen as a moral issue? The anti-alcohol conferences of 1885-1913 can be seen as an arrangement for the modern state where the temperance movement placed itself in the service of the state and at the same time demanded that it be given some responsibility for the future development. These were years when the nation acted as a point of reference in several questions that were chafing within the modern project: population qualities and the condition of future generations, the notion of citizenship, industrial strength and competitiveness, the role and the strength of the state. That nation which desired industrial competitiveness, an efficient infrastructure and a strong military institution also did well to ally itself with those temperance advocates who met at the transnational anti-alcohol conferences. The nation which had such objectives and wanted to see sober and strong citizens was encouraged also by the progressive forces in the temperance movement to take up a whole host of issues from women's political status to an individual's sex life.
The Swedish drug problem and the political use of common ground.
2015. Johan Edman. Drugs - what is the problem and how do we perceive it?Conference
The project has examined drug consumption as a political problem and its ideological undertones. It is shown how drugs and drug consumption often have been subordinate in problem descriptions that have fulfilled other political purposes. Worries about politically radical youth, foreign religions or incomprehensible music have been understood as a drug problem. In the Swedish parliament the drug problem has been described in terms of capitalist class oppression, Americanism or cultural superficiality. Modernity, urbanization and industrialization have also been criticized in the name of the drug problem. In the treatment centres and within the ruling bureaucracy it was also elucidated that the drug problem was an ideological problem. The effective treatment method has been elusive, but the effective method has also played second fiddle in the choice of treatment solutions. Other values have been awarded, such as rural romanticism, Swedishness, solidarity and diligence. Individualism, Americanism and profit making have also been opposed within the ideological treatment sector. At the end of the research period such assessments however became subordinate to an overarching ideological quest to make substance abuse treatment a market among others.
2014. Derek Heim (et al.). Nature 507, 40-40Article
Conceptual carpentry as problem handling
2014. Johan Edman, Kerstin Stenius. International journal on drug policy 25 (2), 320-328Article
Background: The drug and alcohol fields are characterised by continuous contestations of key concepts and the competing uses of concepts by various actors, in different geographies and over time. This study investigates the political processes leading to legislation enabling coercive treatment of (non-psychotic) drug users in Finland and Sweden from the 1950s until the early 1980s. The drug treatment policies are analysed through conceptual changes and innovations. Methods: The article analyses conceptual discussions in public reports in Finland and Sweden, focusing on the work preceding the first legislations where both alcohol and drug treatment were included (in Finland 1961, in Sweden 1982). Theories from conceptual history are applied. Results: The Finnish and Swedish discussions carry arguments from two periods of the Nordic welfare state: in an early development stage and a fragile situation in Finland, and in a more mature and affluent time in Sweden. The paternalistic arguments vary over time and between countries. Still, in both countries and time periods, the view of the drug problem as a youth issue, as particularly enslaving and on society's obligation to protect drug using individuals from damaging their future give enough motivation for coercive treatment. The conceptual work included avoidance of certain terms but in other cases, a broadening of their meaning, to adopt them to the political goals. Conclusion: Close analyses of conceptual history can reveal new features of drug policy struggles and show how central concepts in drugs and alcohol field are continuously contested.
The Swedish drug problem
2014. Johan Edman, Börje Olsson. Nordic Studies on Alcohol and Drugs 31 (5-6), 503-526Article
AIM – To analyse the Swedish drug question by examining dominant concepts used to portray theproblem in the years 1839–2011. Theoretically, we understand these concepts as ideological toolsthat shape the political initiatives and administrative efforts to deal with the problem. The studyis based on two kinds of source material: articles in medical journals from the years 1839–1964and public reports on vagrancy, the alcohol problem, mental health and the drug problem fromthe years 1882–2011.
FINDINGS – During the nineteenth century and the first part of the twentieth century the drugproblem remained an individual problem handled by doctors. When the Swedish drug problemwas established as a political question from the 1960s on, it also came to disengage itself from themedical frame of understanding. Medically oriented descriptions of “dependence” and “addiction”have appeared adequate or attractive when, for example, the socially motivated coercive treatmentsolution has been discredited (as in the 1970s), when there has been a desire to connect with aninternationally accepted terminology (as in the 1990s) or when a new organisational model with astronger professional support has been on the agenda (as in the 2010s). But otherwise the socialproblem description has called for concepts that have more or less explicitly dissociated themselvesfrom speculations in physiological or psychological predispositions for substance abuse.
An all-embracing problem description
2013. Johan Edman. International journal on drug policy 24 (6), 558-565Article
Background: This article examines the political formulation and ideological solution of the Swedish drugproblem in 1982–2000. How was the drug problem described in the Swedish parliament at the time? Howserious was the problem and what solutions were proposed? What were the ideological implications ofthe problem description, and how was the general political and ideological solution formulated?
Methods: The empirical basis for the textual analysis consists of parliamentary bills, government bills andparliamentary records discussing the drug issue during the years 1982–2000.
Results: In the prevailing spirit of consensus in the Swedish parliament at the time, both left-wing andright-wing parties portrayed drugs as a threat to the nation, people and the welfare state. Still, as theideological dimension kept growing stronger, the drug question functioned even better as an arena forpolitical discussions and ideological positions than in the 1970s.
Conclusion: Compared to previous decades, the problem description broadened during the 1980s and1990s, and the drug problem could be used to support arguments on almost any topic. The drug problembecame a highly politicized issue about whom or what to change when the individual and the societyclashed, but also about what the individual and/or society should be changed into.
An ambiguous monolith - The Swedish drug issue as a political battleground 1965-1981
2013. Johan Edman. International journal on drug policy 24 (5), 464-470Article
Background: The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965-1981. Methods: The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. Results: The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. Conclusion: The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight one's own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problem's severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues.
Red Cottages and Swedish Virtues
2013. Johan Edman. Social history of medicine 26 (3), 510-531Article
This article investigates Swedish drug treatment as an ideological project, from the establishment of the first treatment centres in the late 1960s up until the change in legislation and management in the early 1980s. The empirical basis for the analysis consists mainly of archival materials produced in the application process of aspiring treatment homes. The article compares treatment programmes that were supported by the state in 1968-81 to those which were opposed during the same years. The choice of caregivers tells us a great deal about the underlying ideological positions. The analysis suggests that the endorsed treatment programmes embraced the virtues of a rural romantic setting, democracy and socialism, whereas the opposed treatment programmes were branded as un-Swedish in several ways: shallow, individualistic and profit-seeking.
The ideological drug problem
2013. Johan Edman. Drugs and Alcohol Today 13 (1), 9-19Article
Purpose - This article investigates the ideological visions embedded in the political formulation of the Swedish drug problem and in the bureaucratic management of the Swedish drug treatment services during the years 1960–2000.
Design/methodology/approach - The empirical basis for the analysis consists mainly of parliamentary material from the Swedish Parliament (403 parliamentary bills, 66 government bills, 198 parliamentary records, 14 government letters and 159 standing committee statements) as well as archival materials produced in the application process of 73 aspiring treatment homes from the years 1960–2001. The empirical material is partly analyzed from a theoretical understanding of political consensus as a doxa (Bourdieu, 1977) and political debate as permeated by naturalizing ideologies (Freeden, 2003; Eagleton, 2007).
Findings - The article examines drug consumption as a political problem and its ideological undertones. I show how drugs and drug consumption often have been subordinate in problem descriptions that have fulfilled other political purposes. Worries about politically radical youth, foreign religions or incomprehensible music have been understood as a drug problem. In the Swedish parliament the drug problem have been described in terms of capitalist class oppression, Americanism or cultural superficiality. Modernity, urbanization and industrialization have also been criticized in the name of the drug problem. In the treatment centres and within the ruling bureaucracy it was also elucidated that the drug problem was an ideological problem. The effective treatment method has been elusive, but the effective method has also played second fiddle in the choice of treatment solutions. Other values have been awarded, such as rural romanticism, Swedishness, solidarity and diligence. Individualism, Americanism and profit making have also been opposed within the ideological treatment sector. At the end of the research period such assessments however became subordinate to an overarching ideological quest to make substance abuse treatment a market among others.
Originality/value - The analyzing of naturalized and apparently self-evident ideology as part of the rational argument rather than it’s very opposite would be useful both for further research on the topic as well as for deepening the democratic discussions on, for instance, evidence-based methods within the drug treatment services.
Swedish Drug Treatment and the Political Use of Conceptual Innovation 1882–1982
2012. Johan Edman. Contemporary Drug Problems 39 (3), 429-460Article
This article investigates the concepts applied to drug use and drug users in Sweden during the years 1882–1982. As a theoretical point of departure, concepts are treated as political tools and conceptual descriptions as political work. From an analysis of 43 public reports, three distinct periods stand out. In the first period, 1882–1962, there was no specific political need for conceptualclarity. During the second period, 1964–1969, the political need for certain (medicalized) concepts is more evident. Drug users were understood as sick and as potential objects for compulsory treatment. In the third period, during the mid-1970s and early 1980s, the process was reversed: specific concepts of sick drugusers gave way to creating the political means for bringing alcohol and other drug users under joint treatment legislation.
Vård och ideologi
2012. Johan Edman.Book
Sedan mitten av 1960-talet har narkotikaproblemet varit ständigt närvarande i politiken. Utredning har följt på utredning, lagar har stiftats, straff har höjts, informationskampanjer sjösatts och nya vårdmetoder har lanserats. I boken Vård och ideologi undersöker historikern Johan Edman den svenska narkomanvårdens historia. Han visar hur narkomanvården varit en fråga som använts för vitt skilda politiska syften, där allt ifrån oro för politiskt radikal ungdom, främmande religioner eller obegriplig musik tolkats som problem med koppling till narkotika. Narkotikabruket har beskrivits som kapitalistiskt klassförtryck, amerikanism och kulturell förflackning samtidigt som svenskhet, solidaritet och arbetsamhet varit värden som präglat behandlingshemmens arbete.
I boken studeras den svenska narkomanvården under åren 1960–2000. Den handlar om statens försök att få till stånd en verksam narkomanvård, om de politiska diskussionerna och den byråkratiska organiseringen av ett problem som visat sig vara svårt att lösa. Jakten på den verksamma vårdmetoden tycks vara ett evighetsprojekt: från det tidiga 1900-talets aversionskurer, vitamin- och insulinbehandlingar, via Antabus och psykoterapi, till fostransmodeller, tolvstegsmetoder och substitutionsbehandlingar. Trots 100 år av missbrukarvård efterfrågas fortfarande en verksam kunskap. I den här boken undersöks varför denna jakt tagit sig dessa uttryck, varför den ständiga ambitionen att nå säker kunskap ter sig som ökenvandringar mot en hägring.
Narkotikaproblemet visar sig vara både politiskt och terapeutiskt, och debatten om narkotikakonsumtionen har ofta haft vitt skilda politiska syften. Oron för politiskt radikal ungdom, främmande religioner eller obegriplig musik har kunnat begripliggöras som narkotikaproblem. Från annat håll har narkotikaproblemet beskrivits som kapitalistiskt klassförtryck, amerikanism och kulturell förflackning. Modernitet, urbanisering och industrialisering har också kritiserats i narkotikaproblemets namn. Högern har ropat på förstärkt polis medan vänstern har önskat krossa det kapitalistiska klassamhället; kristen kärlek och skattesänkningar har på olika sätt motiverats som medel i kampen mot narkotikan.
De politiska problembeskrivningarna och kampen om de ideologiska lösningarna har också varit intensiv utanför de folkvaldas kammare. På behandlingshemmen och inom den styrande byråkratin har det tydliggjorts att narkotikaproblemet är ett ideologiskt problem. Den verksamma behandlingsmetoden och den attraktiva ideologin har konkurrerat om utrymmet — många gånger har de betraktats som samma sak. Behandlingshem har motarbetats från byråkratiskt håll när de intagit ideologiskt tveksamma positioner. Värden som landsbygdsromantik, svenskhet, solidaritet och arbetsamhet har premierats.
Däremot kom individualism, amerikanism och profitintresse länge att motarbetas inom den ideologiska narkomanvården. I slutet av undersökningsperioden blev sådana bedömningar dock underordnade en övergripande ideologisk strävan att göra missbrukarvården till en marknad bland andra.
Författaren visar sammanfattningsvis att narkotikaproblemet i grunden är ett ideologiskt problem. Frågan om vad som är problematiskt med narkotikakonsumtion kan varken ställas eller besvaras utan att man samtidigt berör frågan om den goda medborgarens eller det goda samhällets kvaliteter. Denna ideologiska grundton är uppenbar när man studerar narkotikaproblemets formulering på politisk eller byråkratisk nivå och även på behandlingshemmen. Detta ideologiska perspektiv är nödvändigt om man vill förstå narkotikaproblemets komplexa natur och varför det inte låter sig lösas med aldrig så kunskapsbaserad metodutveckling.
2011. Johan Edman. Narkotika, 139-159Chapter
Jakten på den verksamma vården
2011. Johan Edman, Jan Blomqvist. Narkotika. Om problem och politik, 101-137Chapter
Why do we care? Notes from a periphery
2011. Kerstin Stenius, Johan Edman. Addiction 106 (5), 889-891Article
Vård till varje pris
2009. Johan Edman.Report
What's in a name?
2009. Johan Edman. Nordic Studies on Alcohol and Drugs 26 (4), 339-353Article
The aim of this article is to investigate the use of a rather vague medical conceptual framework within the compulsory treatment of alcohol and drug users in Sweden during the 20th century. Focus lies on exploring how a phenomenon come to be described as pathological, what the causes are for certain actions all of a sudden being interpreted in medical terms, and what consequences that might lead to.
Supported by theoretical speculations on medicalization processes and conceptual history, two empirical cases (the compulsory care of alcohol abusers in the 1950’s and the legislative process leading to psychiatric compulsory care of drug users in the late 1960’s) are investigated. The first case draws mainly upon official reports and archive material from alcohol treatment institutions, whilst the second case is built from reading official reports and parliamentary material. The research task for the two empirical cases has not quite been the same: whereas the first case is illustrated by the discrepancies between the labelling of treatment activities and the treatment actually carried out, the second case rather draws upon the enlargement of the field of signification of the disease concept to cover most aspects of drug use.
A medicalization process on different levels is traced both in the post-war compulsory treatment of alcohol abusers as well as being a part of the launching of compulsory psychiatric care of drug abusers from the late 1960’s onwards.
The investigated cases shows how the medicalization processes gained from a conceptual vagueness, a widening of the conceptual dimensions of both the treatment and disease concepts. In this, the medicalization of alcohol abuse in the 1950’s and drug abuse in the 1960’s made way for a paternalistic justification of compulsory care measures that might otherwise have become politically troublesome.
Örfilar och förnimmelser
2009. Johan Edman. Missbruk och behandling, 43-53Chapter
Lösdrivarlagen och den samhällsfarliga lättjan
2008. Johan Edman. Villkorandets politik, 131-143Chapter
A crutch for cripples or a shield for the endangered?
2007. Johan Edman. On the marginsChapter
2007. Kerstin Stenius, Johan Edman. On the margins, 5-23Chapter
Brukarorganisering och narkotikafrågans nya formulering
2007. Johan Edman. Nordisk alkohol- och narkotikatidskrift 24 (1), 66-70Article
From hard labour to unemployment
2007. Johan Edman, Olav Hamran. On the margins, 185-210Chapter
From sanatoriums to public injection rooms.
2007. Johan Edman, Kerstin Stenius. On the margins, 339-361Chapter
On the margins
2007. Johan Edman, Kerstin Stenius.Book (ed)
När toppen stack ned
2005. Johan Edman. Nordisk alkohol- & narkotikatidskrift 22 (2), 181-185Article
Treatment of what?
2005. Johan Edman. Nordic Studies on Alcohol and Drugs 22, 45-61Article
The aim of this article is to investigate the problem formulations – the preconceptions about causes and effects and the possible solutions to the problems of alcohol abuse – that characterized the compulsory institutional care of alcohol abusers in Sweden in the 20th century. The article focuses on problem formulations that – beyond institutional and a discursive levels – actually were practised in the institutions.
Methods & Data
The main source material is to be found in the archives of four institutionalized care establishments and consists of official reports, correspondence, supply estimates, circulars for consideration and – above all – patient records. From this material you can learn about the institutions’ struggle for autonomy, expansion and legitimacy, and also about the clients’ characteristics and how the clients were viewed. The study of the archives allows you to form a picture of the problem formulations that affected the activities in the institutions directly, a picture that goes beyond the more abstract expectations preferred by official reports and legislation.
Within the compulsory institutional care actually carried out, the problem formulations that were stipulated in the sex-neutral legislation and vague regulations became sex-specific and precise. Here it was made clear that the treatment of alcohol abusers was a class and sex related project, aiming not only at encouraging male diligence and the fulfilling of a man’s maintenance obligation but also at female virtuousness and concern for the family.
The historical development of care services for alcohol abusers shows that the abuse need not necessarily, or even primarily, be seen as a problem to do with the individual’s relationship with alcohol. Alcohol itself has been a secondary factor in problem definitions which have let themselves be attached – via perceived links with either cause or effect – to more overarching social issues in Sweden. The concerns of emergent family policy in the 1940s, the developmental optimism and scientistic passions of the 1950s, and the systemically critical protest movements of the 1970s are all clearly reflected in trends within social care services for alcohol abusers – albeit much more often at the level of discourse than of praxis.
Work as care?
2005. Johan Edman, Lena Eriksson. Wefare Politics Cross-ExaminedChapter
Arbetsfostran och samhällsförändring
2004. Johan Edman. Spiritus 6, 79-95Article
2004. Johan Edman.Thesis (Doc)
This dissertation investigates compulsory care of alcohol abusers in Sweden during the years 1940 to 1981. The purposes of the dissertation are twofold: in part to determine the concrete forms which care services for alcohol abusers took during the years focused on, in part to analyze what connections existed between the development of services and conceptions of the reasons for, consequences of and possible solutions to alcohol abuse. One point of departure is that the problem was defined with respect to the interests of influential social actors, and with respect to a very particular view of what a respectable life (free of social problems) was. Among the most influential actors involved in these social services, I argue for a focus not least on so-called “street-level bureaucrats”, with direct influence on the goals and methods of institutional care. The study is thus oriented towards mapping the development of problem definitions and formulation within the praxis of compulsory care in four institutionalized care establishments for alcohol abusers. This development is contrasted to broader trends of institutional and discursive development in the definition of alcohol abuse as a social problem.
The legislation regulating compulsory care has constantly been founded upon assumptions of the social damage caused by alcohol abuse. At the level of concepts or discourse the consequences of causes for and solutions to alcohol abuse were initially defined in terms of individual morality, with definitions subsequently developing so as to depart from more medicalized terminology. Towards the end of the period the problem descriptions became focused on societal dysfunctions and reforms as the respective causes of and solutions to societally problematic alcohol abuse. At the level of treatment focused upon in the dissertation, societal explanations of alcohol problems departing from societal dysfunctions as causes thereof, and societal reforms as solutions, have never been fully integrated in care services praxis. This was not the case for the simple reason that these care activities, as such, were developed to deal with individuals rather than with society. Neither did a medicalized perspective come to dominate institutionalized care during the period studied – something which can be explained not least with the fact that the perspective’s expansion was not attended by development of medical treatment methods which were convincing with respect to results of use. On one hand, concretely practiced compulsory care thus long remained dominated by problem definitions departing from inmates’ gender-specific moral qualities. On the other hand, certain elements of a more resource-oriented and societal-reformist perspective can certainly be distinguished in the development of care services, albeit on the special terms associated with service implementation in the field.
In conclusion, the historical development of care services for alcohol abusers shows that alcohol abuse need not necessarily, or primarily, be seen as a problem having to do with individuals’ relationship with alcohol. Other definitions of the problem have focused upon individuals’ relationship also to working life, the family, sexual morals, the gender order, or capitalist oppression. The problem has been seen as a workers’ and poverty problem, a problem of families and violence, a medical problem, or a symptom of societal problems. Causes have been sought in the character of individuals, the ways in which they have been raised or not raised, their spiritual life, their metabolism, their genetic material, their socioeconomic environment, gender and family situation. The proposed solutions have included everything from work, organized coffee breaks, medicines, psychotherapy and democracy to piece-rate wages, no wages, collective care, or solitary confinement. Alcohol itself has been a secondary factor in the problem definitions which have let themselves be attached – either via perceived links of cause or of effect – to more overarching social issues.
Familjen på anstalt
2002. Johan Edman. Familjeangelägenheter, 202-235Chapter
"På grund av sitt alkoholmissbruk och omoraliska leverne..."
2000. Johan Edman. Arkiv för studier i arbetarrörelsens historia 79, 56-86Article
This article deals with the close connection between the care of vagrants and the care of inebriates in Sweden. With examples taken from the institutional care of female inebriates during the 1940’s and 1950’s, the author argues that the care of inebriates “inherited” a system of norms from the care of vagrants. This system of norms emanated from a familistic conception of female morality and it came to influence the female clients’ possibilities to assert themselves within the institutional care.