Updated: Aug 29
Editor’s Note: This post is from Contributing Editor Michelle McClellan.
I’ll begin with two anecdotes, the first of which is probably familiar to most Points readers. In 1935, a stockbroker named Bill Wilson found himself in Akron, Ohio for a business deal. When it fell through and Wilson felt the urge to drink again after a period of sobriety, he reached out through area ministers and was put in touch with a woman who arranged a conversation between him and Dr. Robert Smith, a local physician who also struggled with his drinking. Their conversation is now recognized as the genesis moment of Alcoholics Anonymous (AA).
The second may be less familiar. In the summer of 1956, two mothers nursing their babies at a picnic outside Chicago attracted attention from other women. These two mothers joined with like-minded friends to form La Leche League (LLL), a voluntary organization of women that encourages and assists mothers in breastfeeding their babies. (1)
Both Alcoholics Anonymous and La Leche League grew rapidly: today, both have a global reach (in fact, LLL is known as La Leche League International). Although both organizations were established during what might be termed the “golden age” of American medicine, each challenged medical authority by substituting experience for formal training or expertise. Each also offered an ideology, even a way of life, that is difficult to categorize through conventional cultural labels. As the economics and politics of American medicine undergo drastic changes in the first decades of the twenty-first century, these two lay health movements offer intriguing insights into the complicated connections among morality, authority, and health that continue to characterize American society.
The two groups have many parallels. In both cases, founding members connected through their involvement in other organizations: the Oxford Group in the case of AA, and the Christian Family Movement for LLL. Both emphasized the importance of face-to-face support while also creating a written resource that became central to the organization: the Big Book for AA, and The Womanly Art of Breastfeeding for LLL. Each decided that while its cause intersected with other goals, clarity and focus were critical to success and each restricted its mission accordingly.
Traditional ideas about gender also shaped both groups. During the early years of AA, most members were alcoholic men, while their non-alcoholic wives played critical supporting roles. Although that situation has changed in recent decades as hundreds of thousands of women, as well as men, have found sobriety through the fellowship, the resonance of that initial template with both the temperance movement and current statistics about alcoholism rates has amplified its cultural significance. Meanwhile, the philosophy of LLL reflected a biological reality: although fathers play an important role in family structure and parenting strategies propounded by the group, the “nursing couple” is the mother and baby.
The “nursing couple” needs no adult men, at least not according to La Leche League
At the same time, both groups advocated a way of life that cannot easily be labeled conservative. Their worldviews valued human relationships over things and featured a rejection of the individualized, achievement-focused orientation of modern American society. The mothering philosophy advocated by LLL required that a woman be available to her infant in ways that seemed to preclude a career—or even an uninterrupted night’s sleep. But the families that adopted this model insisted that the mother was far more valuable at home than earning a wage. A woman’s unique contribution—indeed, only she could care for children in this way—was recognized, even celebrated. While this approach to family organization might seem restrictive to some Americans today, many women involved in LLL have found it to be profoundly satisfying. And by stepping outside the materialism and conformity of post-World War II American life, the founders were indeed doing something radical.
But just as the gender politics of AA and LLL are more complicated than they appear at first glance, so too the relationship of each group to organized medicine has been complex. AA developed in large part as a response to the failure of medical professionals to deal effectively with problem drinking. LLL represented a kind of de-medicalization as it sought to move childbirth and infant feeding away from the purview of physicians who advocated drugs during delivery and strict schedules and formula for babies. Again, authority came from shared experience rather than expertise. Wilson claimed that he knew “instinctively” that he had to talk with another alcoholic when he was in Akron. To become a La Leche League leader, a woman must have nursed a baby for at least nine months, in addition to other qualifications. Yet both organizations positioned themselves carefully relative to organized medicine, seeking alliances when possible and medical endorsement for purposes of credibility.
Today, both groups remain non-professional and free of charge, yet each parallels — and may exist in tension with — professionalized forms of the same service they provide. Many addiction counselors may themselves have gained sobriety through Twelve-Step fellowships, while AA, Narcotics Anonymous and other programs are “prescribed” by medical professionals through in-patient treatment or even mandated through the courts. Similarly, Weiner (see footnote 1, below) argues that the LLL replaced the U.S. Children’s Bureau as the “primary source of expertise on motherhood” (p. 1357), and by the mid-1980s, the LLL had gained a place on the International Board of Lactation Examiners, thereby helping to create “lactation consultant” as a recognized specialty. On a personal note, I remember being surprised when the lactation consultant at the hospital where I gave birth to my son deferred to a local LLL leader with whom I had also conferred. As an historian of medicine, I was surprised at what I perceived then to be a reversal of medical hierarchy. And today, the American Academy of Pediatrics recommends breastfeeding exclusively until the infant is six months of age, to be continued for one year or longer “as mutually desired by mother and infant” as complementary foods are introduced.
Despite these similarities, one major difference between the two groups is that AA, consistent with post-Repeal ideas about alcoholism, concerns itself only with those whose drinking problems are severe and sidesteps the issue of wider social drinking practices. The LLL, on the other hand, advocates breastfeeding for all babies — and thus for all mothers. Even with this difference, however, both groups have been charged with exclusivity and even zealotry. Still, I find their presence encouraging, especially in our age of ever-increasing professionalization and standardization.
In putting together this post, I tried to think of other models where lay health movements have influenced medical ideas and protocols and public heath guidelines. Fitness is another possible domain, as seen in Emily Dufton’s recent post. I invite readers to offer other suggestions, all of which can help us understand the role of medicalization in substance use and other aspects of modern American life.
(1) This account of the founding and much of my discussion of LLL is drawn from Lynn Y. Weiner’s informative and insightful article, “Reconstructing Motherhood: The La Leche League in Postwar America” which appeared in the Journal of American History in 1994 [Vol. 80, No. 4 (March 1994): 1357-81].