"An Argument That Goes Back To The Womb": The Demedicalization Of Fetal Alcohol Syndrome, 1973-1992

Journal of Social History, Winter, 1999 by Janet Golden

On May 31, 1977 Americans met Melissa--the first child with FAS (fetal alcohol syndrome) to appear on network television news, in this case, the NBC Evening News with David Brinkley. Named in 1973, FAS is a pattern of birth defects that occurs in approximately 3 per 1000 to 1 per 2000 live births in the United States as the result of heavy maternal alcohol use during pregnancy. [1] Clinically, it is defined by pre and postnatal growth retardation, head and facial abnormalities, and central nervous system disorders; organ system problems are also frequent. Many experts believe that alcohol is "probably the most common cause of mental retardation in the United States and may be responsible for up to 5% of all congenital abnormalities." [2] A conservative estimate of the cost of FAS in the United States is $250 million per year, with lifetime institutional care for those with mental retardation accounting for the bulk of the expense. [3]

Melissa was not only mentally retarded, she also exhibited all the other features of those with FAS. Dr. Kenneth Lyons Jones, co-author of one of the first studies of FAS and one of the leading researchers in the field, described Melissa to the television audience:

She's very, very small, her head is small, she has microcephaly which means that her head is very small. She also has short palperable fissures or small eye slits, and she is mentally deficient. [4]

In this recitation, during which the camera closed in on Melissa, Americans not only received a brief lesson in the clinical diagnosis of FAS, many saw for the first time what an FAS child "looked like." The day after this segment aired, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Council on Alcoholism (NCA) made a public announcement. Women who had more than two drinks a day during pregnancy, they advised, risked giving birth to deformed and/or retarded babies. Both the ABC and CBS evening news broadcasts reported this announcement. [5]

Kenneth Lyons Jones, the medical expert who described Melissa, continued to publically discuss FAS, appearing in 1992 on "Nightline" with Ted Koppel. The show opened with a teaser about "an argument that goes back to the womb," promising that the evening would offer the portrait of a killer who was "brain damaged as a fetus, abused as a child." This was followed by the film clip of Jones taken from part of a clemency video sent to California Governor Pete Wilson on behalf of convicted double-murderer Robert Alton Harris. Jones, who recommended that the death penalty not be imposed, is heard to say "his mother was a chronic alcoholic." [6]

The medical experts in the video failed to convince Wilson to halt the execution. Wilson responded with a lengthy statement deploring prenatal alcohol abuse as "nothing less than child abuse through the umbilical cord" and detailed his own efforts to combat and prevent substance abuse by pregnant women. Yet, he concluded, "As great as is my compassion for Robert Harris the child, I cannot excuse or forgive the choice made by Robert Harris the man." The clemency appeal foundered on Wilson's belief that

we must insist on the exercise of personal responsibility and restraint by those capable of exercising it. If we excuse those whose traumatic life experiences have injured them--but not deprived them of the capacity to exercise responsibility and restraint--we leave society dangerously at risk. [7]

FAS, Wilson seemed to say, did not diminish Harris' capacity to understand the consequences of his actions--a determination clearly at odds with that of the medical experts. Robert Alton Harris died in the gas chamber at San Quenrin on the morning of April 21, 1992, becoming the first individual executed in California since 1967.

Between its naming in 1973 and the 1990s, when it began to be cited in appeals from death-row inmates, FAS was demedicalized. That is, physicians gradually lost the cultural authority to frame its public meaning. Under the leadership of government officials and legal professionals, and in response to growing public mistrust of the medicalization of deviance, FAS came to be understood not as a cluster of precisely delineated symptoms, but as a social deformity that expressed the moral failings of mothers and marked their children as politically marginal and potentially dangerous. Critical to this refraining of FAS was its identification with a racial minority--Native Americans, its interpretation as an expression of maternal/fetal conflict, and its economic and social costs. Yet, the history of FAS in the late twentieth century is nor so much about race, gender, or fetal politics per se as it is about how these issues contributed to its demedicalization. In charting this demedicalization I will explore the po pular portrayals of FAS as well as the competition among professional groups to shape its meaning. I begin by defining medicalization and demedicalization and then turn to a chronological account of the framing of FAS. [8]