| Reviews / Comptes Rendus | Labour/Le Travail, 56

Reviews / Comptes Rendus

Janet Golden, Message in a Bottle: The Making of Fetal Alcohol Syndrome (London: Harvard University Press 2005)

THE SUB-TITLE of this book reveals at once its greatest strength and its unforgiveable weakness: it treats Fetal Alcohol Syndrome [FAS] almost exclusively as a social construct. This is a strength because it helps explain why FAS as a concept did not exist before 1973, and allows us to understand that the causes, symptoms, and prognosis for FAS are subject to at least some debate even if a degree of consensus is emerging around many of the issues surrounding FAS. It is a weakness however because, despite Golden's concession early on that FAS does describe a real phenomenon rather than just a social construct, she is never able to get beyond the relativizing and socially demobilizing language that characterizes so much of the linguistic turn. For the rest of this review, I will refer to FASD — Fetal Alcohol Spectrum Disorder —rather than FAS because the former term is more all-encompassing, FAS referring to people with alcohol-related birth defects for which there are characteristic physical signs and FASD including those who have such defects but look "normal." I am the father of a marvelous young man with FASD, and so there's nothing very objective about this review.

Janet Golden, it should be said from the outset, makes a valuable contribution simply by producing the first monograph on the emergence of FASD as a recognized medical problem. For those unacquainted with fetal alcoholism, it refers to the brain injuries and physical problems that some babies are born with as a result of the transfer of alcohol from a pregnant mother's bloodstream into a fetus. As far as science has been able to determine, women risk their babies being born with FASD only if they drink during the pregnancy; it is not a case of an ovum or a sperm being damaged as a result of alcoholism on the part of its originator but of alcohol ingested during pregnancy causing damage to the brain of a fetus. People born with FASD have a continuum of problems, but common to most of them is brain injury that results in impaired judgment and limited self-control. Their memories are porous and they usually have some motor difficulties. None of the rules of behavioural psychology, themselves contentious in any case, apply to people living with FASD because the parts of their brain that control behaviour have been damaged to one degree or other. While some have normal IQs, mental retardation is common. Even those with normal or above-average intelligence often fail to thrive because their impulsiveness, short fuses, and inability (though not generally unwillingness) to follow too many orders makes it difficult for them to fit in.

Now, there is a strong liberal pseudo-anarchist thrust in the Foucauldian literature that would be immediately suspicious of any "label" such as FASD that normalizes particular notions of what constitute rational judgement, reasoned response to frustration, and acceptable responses to socially constructed authority. The term, "moral panic," is quickly erected as a barrier to discussion about whether particular regimes of punishment and deterrent have any validity. They are all invalid, in all respects, by definition, it sometimes seems. Janet Golden certainly uses the term, "moral panic," to apply to FASD, though she is careful to also indicate that it is applied to a social issue that she thinks has validity. She is not so much a Foucauldian as a typical historian of our age who has been shaped by the now omnipresent notion that discourse equals reality. This is not meant to be dismissive to the discourse missionaries who have, in fact, rescued scholarship in the social sciences and humanities from overly-schematic materialist dyads and from economic determinism. It is to say that a new pseudo-religion has been unveiled, which it is important to unmask at every (linguistic) turn.

If one wished to place Janet Golden on a continuum among practitioners of the new religion, she would be on the United Church end of it rather than a born-again. She wants to cling to the core beliefs of the dogma, but not to reject consideration of those who might be outside its parameters. So, for example, she believes that it is acceptable to ignore actual people with FASD — "It is not my intention to examine the lives of individuals, families, and communities affected by alcohol exposure in utero" (15) — while still using "the diagnosis of FAS as a window through which to view and interpret American culture and institutions." (15)

So what's wrong with seeing FASD as a social construct, and no more? Golden's evidence, though not her commentary, demonstrates the problem with trying to keep a healthy distance from the lives of people with FASD and their mothers while focusing on the impact of FASD on social debates that go beyond FASD. In one chapter, she deals with the American campaign for and against warning labels on liquor bottles regarding the dangers of drinking while pregnant. She presents the arguments of feminists on both sides of the divide. Opponents of warnings about liquor use that singled out pregnant mothers, she notes sympathetically, believed that it was all a plot of abortion anti-choicers "to establish a vocabulary of fetal rights in excess of the rights of the women in whose bodies these fetuses rest." (88) The effort to make people living with FASD collateral damage in the battle against anti-abortionists conflates fetuses that are to be aborted with fetuses that are to become human beings. Their opinions, mainly reflecting those of feminists in the US who are, on most issues, well within the confines of American bourgeois individualism, are only balanced by the views of feminists in the public health movement. But what about the mothers who give birth to fetal alcohol babies and the mothers, including birthmothers, adoptive mothers, foster mothers, and operators of institutions who raise these babies? Some historical searching on Golden's part would reveal what "choices" many of these women had, both about drinking during pregnancy and then raising the children afterwards. Many of the birthmothers are themselves sufferers of FASD and have little ability to resist drinking during pregnancy, even when they have the desire; others are simply alcoholics living in poverty and despair. Once the baby is born, most of these mothers, if they try to raise the child, fail, even if they have shed their alcoholism: raising these children requires many times the effort and many times the funds than average children. In short, drinking during pregnancy usually leads to a mother losing the right to choose whether or not to raise her own child. So much for liberal shibboleths with no context of social class or social circumstances.

After Golden leaves the debate about pregnant mothers' responsibility for their children — which, unfortunately is limited to the rather unedifying debate about warning labels — she wades into the difficult waters of how courts have treated FASD-affected individuals. Here there is little question of her sympathies. She doesn't have the time of day for the hang-'em-high crowd who want to hold all individuals responsible for their actions and to write off brain injury as a rationalization rather than an explanation for why some people cannot be held accountable in the same way as others. I don't either, but there is a terrible contradiction among the liberally minded if, at one and the same time, we recognize that some people are born ticking time bombs to commit crimes and otherwise to lead unhappy lives, and yet reject all efforts to prevent their being born that way.

Of course, what efforts can be made to prevent their being born that way is the issue that stymies everyone. As Golden notes, efforts to institutionalize pregnant women at risk of bearing FASD babies are fraught not only with complicated civil rights implications but with the simple pragmatic fact that they cause alcohol-addicted women to hide their pregnancies from doctors and others and perhaps make matters go even worse for the fetus. But it is likely that a Cadillac service that turned pregnancy into a queen-for-nine-months experience would voluntarily attract many otherwise destitute women to agencies that rewarded temporary sobriety with treatment as a real citizen.

The dirty secret behind FASD, as with so much else, is class and race discrimination, usually the two combined. In the US, as Golden indicates, Native women are 33 times as likely as the general population to bear babies with FASD. For African American women, the figure is six times that of the general population. While any woman who drinks during pregnancy, particularly if she goes on periodic binges or always drinks to excess, might bear a child with some alcohol-related damages, the women whose drinking patterns are most likely to produce a child with brain damage are marginalized women. An end to internal racial colonialism within North America, to super-exploitation of certain groups of women, and to patriarchy (and perhaps to capitalism which has created a liquor industry that has managed to turn a dangerous product into something glamorous and supposedly healthy, even fooling most labour historians) would all contribute immensely to ending FASD. But since none of this will occur in one fell swoop, a reformist campaign that focused on pregnant women who choose to continue their pregnancies seems quite defensible. The alternative, frankly, for Native people in both Canada and the US seems to be genocide, since the liberal defence of a woman's right to choose whether she drinks during pregnancy has, by now, become incompatible with Aboriginal peoples' demands for control of their communities and restorations of their former traditions (in communities where everyone has FASD, and Aboriginal peoples active in work dealing with the problems of people living with FASD insist that there are already such communities, colonialism will have succeeded in its goal of infantilizing the subject population).

Radical social intervention is needed not only to reduce and eventually wipe out FASD but also to deal with the damaged lives of the people who currently suffer from FASD, and their families, both by birth and adoption. Most people do not have the fancy salary and book royalties of the author of this review, and have neither the time, money, nor social influence to deal with the maze of difficulties that children and adults with FASD face in the schools, courts, workplaces, and communities. FASD adults living in poverty are a living demonstration of the fallacy of the Poor Law legacy of "less eligibility" and its comforting notions that those left at the bottom of the pile without help from the state will pull themselves up by their own bootstraps.

Janice Golden offers an historical account of why it took until the 1970s for researchers to recognize the impact of alcohol on a fetus, and the ways in which that knowledge was used, abused, or ignored in a variety of settings. But her book would be so much better if she had recognized that the lives of those with FASD and their families, as opposed to myriad social constructions, are the centre of the story of FASD. She ends with a beautifully written set of scenarios (170-71) that capture the complexities of FASD. But few of them appeared within the main body of the book. On a single day during the week when I am writing this review, a young man in Winnipeg with FASD, whose parents had complained that he lacked the 24-hour services required, was murdered, while another, in Lethbridge, was on trial for a brutal murder. It is likely that a large proportion of the people who are doing serious time in our prisons, perhaps a majority, suffer from FASD. One can over-determine the roots of FASD in colonialism and capitalism, as I tend to do, or try to locate the phenomenon mainly in discourse theory, as Janice Golden does. But there is little doubt that the costs to individuals and to society as a whole of the alienated lives and alcoholic bodies that produce FASD, and then of FASD itself, are incalculable.


Alvin Finkel Athabasca University

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