- Email: [email protected]
Ethnic drinking subcultures
346
Book reviews
anywhere in the text. Trager has something worthwhile to say, which makes the writing style doubly unfortunate. The best part of her book is Trager’s assessment of the current federal programs, which are an undeniable mess. I agree with her perception of the problems of home services and with her proposed remedies, but would build a stronger data base before any major policy shifts. Although unlikely to attract a broad readership, this book will be useful to health planners and to those concerned with home health policy. Department of Medicine Massachusetts General Hospital Chelsea Health Centre Boston, MA, U.S.A.
FRED H. RLJBIN
Masochism and the Emergent Ego: Selected Papers of Esther Menaker, edited by LEILA LERNER.Human Sciences,
New York, 1979. 384 pp. $19.95 This book consists of twenty-two selected papers of Esther Menaker and covers a period of over forty years. The material is divided into five parts: 1. Prologue: Psychoanalysis in Perspective; 2. Aspects of Masochism; 3. Identification and the Social Process; 4. Creativity: and 5. Epilogue, Indications for the Future. The editor’s introductions to Aspects of Masochism, Identification, the Social Process and Creativity highlights the history and development of each topic. Of the six papers on the Aspects of Masochism, the first cites the masochistic aspects of submission in Thomas Mann’s story of “Mario and the Magician”, when the submission of hypnosis is broken, agression takes over and the magician is killed. Dr Menaker thereafter clarifies the elements of masochism in papers that deal with separation from the mother, the evolution of masochism as a self concept of the ego in an early phase of the mother/child interaction, and the sense of child’s weakness as an imprint of the mother’s image of the child. Masochism becomes a way of relating and avoiding separation. The passive role in the analytic process may hide the patient’s devalued sense of self in relationship to the analyst, a reaction that is counter-therapeutic. The analyst’s behavior in displaying a friendly interest toward the patient is deemed important; in this way, the patient’s ego is liberated so that the patient is able to relate to the analyst as a person rather than an authoritarian parent. From the work of ethologists on animal behavior, Menaker reports masochistic behavior of animals similar to the human pattern, e.g. the young timber wolfs submissive reaction to a more powerful wolf. By baring his jugular vein and placing himself in a submissive position, he placates the more powerful wolf and survives. Masochism is part of the evolutionary process of survival in both animal and man. For treatment, Menaker strongly emphasizes the concept of will as a function of the ego in contrast to Freudian analysts who view will as a definition of ego strength or weakness. In borderline states, character disorders and masochistic patients, insight as a therapeutic tool fails. Consequently, Dr Menaker supports the ego as will the ability to actualize goals and choices. This capacity of will depends on the ego development in the mother/child relationship and on the inherited abilities of the individual. Dr Menaker suggests that the early masochistic reaction prevents independent action or will, so that one must undo and redo the experiences of childhood. This reconstruction can only be accomplished in actual relationship with the therapist. In that relationship, the Patient can exercise his will and rupture the masochistic
bond to mother with its attendant anxiety. This process could be designated as a new identification. In her paper. The Issues of Symbiosis and Ego: Autonomy in the Treatment ofMasochism, Menaker again advises the therapist to
minimize the transference neurosis by behaving as a helping person rather than a distant, neutral professional, and by analyzing the patient’s reality distortions in relationships with others. a process which allows the patient to establish new identifications. Identification with the analyst is primary, establishing a basis for new identifications with still others. The second section, Identification and the Social Process. is a series of eight papers, dealing with social processes as the basis of analogy of the genetic code as transmitter of biological evolution; identification, similarly, is the transmitter of social evolution. Basic to this concept is the mother/child bonding which leads to the separation/individuation process. In the paper, Possible Forerunners of the Indentijication Process in the Animal World, Menaker writes of Elsa, the baby lioness raised from her first few days by Joy Adamson, so that Adamson became the mother through imprinting or bonding. On the other hand, Elsa’s cubs were six weeks old before they met Adamson so that their reaction was one of distrust and caution. In the paper on The Injkence ofChangingVa/alues,Menaker stresses that because of massive social changes, value systems may be disrupted for succeeding generations due to the lack of solid identifications, increased narcissism and lack of genuine ego autonomy. The last section is devoted to the concepts of creativity, concepts derived from Otto Rank, which are compatible with Menaker’s view of differentiation and individuation. Creativity is a form of individuation based on unconscious functions-on the ego-ideal, the sense of self and the relationship to contemporary life. I would highly recommend the book and its exceptional combination of excellent case material, understanding of personality, and concepts of treatment. Department of Psychiatry Massachusetts General Hospital Boston. MA, U.S.A.
JEROMEL. WEINBERGER
ANDREW M. GREELEY, WILLIAM C. MCCREADY, and GARY THEISEN.Praeger, New
Ethnic Drinking Subcultures, by York, 1980. 138 pp. IE15.95
This thin volume reports the findings of an investigation into differences in drinking problems and their genesis among five American national-descent groups (English, Irish, Italian, Jewish, and Swedish) sampled in four cities (Boston, Chicago, Minneapolis, and New York) during 1978. Data were collected by means of self-administered questionnaires filled out by one parent and one adolescent child in each of the 980 families studied. The study was designed to test a general multivariate model, derived for the most part from previous research by the senior author into the socialization of political values among ethnic groups. Essentially, the model postulates that drinking behavior (with particular emphasis on drinking problems) is determined by cultural norms (defined as parental approval+iisapproval of drinking), parental drinking behavior, relationship between parents, family drinking customs, family structure (i.e. power, or the locus of parental decision making, and support, or perceived closeness to parents), and personality factors (i.e. efficacy, or sense of competency; attitude towards authority; and achievement orientation). The model was tested by path analysis. With regard to findings. the investigators expected and
Book reviews found distinctive drinking subcultures among the five groups studied. Further, these subcultures proved to be extremely hardy, showing little tendency to erode over time, a finding also observed by others. The general model guiding the study accounted for a considerable proportion of problem drinking regardless of generation, sex, and ethnicity, but variations in detail were also found within each national-descent group. Not surprisingly, the authors report that problem drinking was more consistently related to drinking among one’s friends than to any other single variable. Considerably more surprising is the finding that mother’s drinking was related to problem drinking in several of the ethnic-sex subgroupings. This result requires replication and merits further exploration. This summary of the study and its findings fails to convey the tone of glib certitude with which it is reported, a tone that would be irritating even if the investigation were flawless. Unfortunately, it is not. Despite an elegant and carefully documented sampling design, worthy of the authors’ association with NORC, and sophisticated statistical analysis, the study as presented is marred in several crucial respects. The introductory literature review on drinking is badly out of date, covering classic tiorks from the fifties and sixties (only two citations to the alcohol literature are more recent than 1974). and is completely uninformed by recent theory and research on socialization of alcohol and drug use as reflected in the work of Jessor, Johnston, Kandel, Zucker, and others. Although well-written, the text is hard to follow, with little continuity from one chapter to the next and many confusing shifts in terminology and conceptualization. The tests of the model exclude some variables and introduce others with no explanation. For example, quality of family relationships, a key variable in the model, appears in none of the analyses, while drinking environments (companions), unmentioned in the model, is a key variable in the analysis: in fact, it is the single most powerful predictor of drinking behavior. Rudimentary, but essential, information about the study is often difficult to find or not available at all. Sample size, for instance, is to be found only in an appendix. Tables and figures are poorly labelled and awkwardly placed. Many of the variables are not defined, and all have unknown (or at least undescribed) reliability and validity. Measures that are defined appear weak and unconvincing. Power, one of two components of family structure, was assessed by responses to two questions concerning parental decisionmaking; the other component, support, was measured by responses to two questions regarding closeness to parents. Finally, scoring procedures are not described in detail sufficient to permit replication. These problems are further complicated by variations in level of discourse. At some points, the report is highly technical, as if addressed to a sophisticated scientific audience (e.g. the discussion of saturated models on p. 71). fn other places. the intended audience seems to be the interested layperson; here, the authors omit technical details important to the scientifically oriented reader (e.g. in the description of the quantity-frequency index on p. 125). In general, then, the book reads as an early draft that requires more thought, more coordination among the authors, and more attention to communicating with a specified audience. The final result is disappointing and frustrating. One welcomes good research in an important area; one can even grapple with flawed research that is well-reported. But there is no such resolution here: this could be either a hastily contrived report of a well-conducted investigation or simply a poorly conducted piece of research. School of Education Unioersity of Pittsburgh Pirtsburgh, PA. U.S.A.
HOWARD T. BLANE
341
Ethics, Humanism, and Medicine: Progress in Clinical ad Biological Research, Vol. 38, edited by MARC D. BASSON. Alan R. Liss, New York, 1980. 321 pp. $22.f~0 The Committee on Ethics, Humanism and Medicine, of which Marc Basson was Director at the time this book was prepared for publication, was founded by medical students at the University of Michigan Medical School in response to a felt need for a genuinely interdisciplinary and interprofessional dialogue on problems of ethics and law in medicine. Aware of the rigorous examination of questions in biomedical ethics in progress in the philosophical journals, and the enthusiastic grass roots movement for the discussion of ethical problems among health professionals and concerned others, and equally aware of the grave difficulties in communication between the philosophers on the one hand and the health professionals on the other, the students set out to bridge the communication gap in a series of conferences. Each conference took on a group of current problems, ethical in content and of interest to the health care professions (not necessarily unique to health care contexts), the discussion of each problem carefully set up to include and criticize the views of professional philosophers and those of practicing clinicians; most problem sessions had a case presentation at the outset to focus the commentary and an extended discussion period at the end. This volume consists of presentations, excerpts and summaries of the discussions, from three of those conferences, The range of topics covered is wide, including, among others, such standard problems as euthanasia, amniocentesis and abortion for sex choice, sale of organs for transplant, allocation of scarce medical resources, confidentiality, disclosure and informed consent, and the ethics of placebo usage in clinical trials of lifesaving drugs; also included are problems less well worked and perhaps of more immediate interest to health care professionals and those in preparation to be such: dealing with ethical and value differences between doctor and patient, medical whistle blowing, Good Samaritan laws, the physician’s right to strike, and the reform of medical education to include a more humanistic orientation. A list of participants in the conferences, conveniently gathered at the front of the volume, includes some familiar names in ethics and its biomedical subspeciality-Richard Brandt, Carl Cohen, George Mavrodes, and Holly Goldman, all of whom are now at the University of Michigan or thereabouts; most of the others are local medical, legal and academic talent, recruited for the purpose by the student committee. The worth of such conferences for the participants therein is certainly beyond doubt; I was delighted at the enterprise shown by the students in organizing the Committee on Ethics, Humanism and Medicine, and in putting together the conferences. The worth of gathering the Proceedings of such local conferences in permanent formhardbound and probably expensive, despite that economical typesetting method that leaves right margins uneven -is open, I think, to debate. In the very nature of the enterprise the treatment of each topic must be partial, unsystematic, far less enlightening to read than the works that the participants cite and comment upon, works that were written to be read. In the nature of the gathering, the contributions must be of uneven quality, and so these are, ranging from pedantic presentations of academic categories of dubious relevance to the current debate: (e.g. Margaret Dewey’s mercifully short piece on Lonergan’s theory of decision making and selected theological criteria on the same) to admirably clear, and illuminating, readable analyses of the case presented and related issues (e.g. George Mavrodes’ piece on the sale of organs for transplant). In the nature of the assignment given them, the philosophers were restricted to teaching basic distinctions and elementary ethical theory, too briefly to serve as a basic
Book reviews
anywhere in the text. Trager has something worthwhile to say, which makes the writing style doubly unfortunate. The best part of her book is Trager’s assessment of the current federal programs, which are an undeniable mess. I agree with her perception of the problems of home services and with her proposed remedies, but would build a stronger data base before any major policy shifts. Although unlikely to attract a broad readership, this book will be useful to health planners and to those concerned with home health policy. Department of Medicine Massachusetts General Hospital Chelsea Health Centre Boston, MA, U.S.A.
FRED H. RLJBIN
Masochism and the Emergent Ego: Selected Papers of Esther Menaker, edited by LEILA LERNER.Human Sciences,
New York, 1979. 384 pp. $19.95 This book consists of twenty-two selected papers of Esther Menaker and covers a period of over forty years. The material is divided into five parts: 1. Prologue: Psychoanalysis in Perspective; 2. Aspects of Masochism; 3. Identification and the Social Process; 4. Creativity: and 5. Epilogue, Indications for the Future. The editor’s introductions to Aspects of Masochism, Identification, the Social Process and Creativity highlights the history and development of each topic. Of the six papers on the Aspects of Masochism, the first cites the masochistic aspects of submission in Thomas Mann’s story of “Mario and the Magician”, when the submission of hypnosis is broken, agression takes over and the magician is killed. Dr Menaker thereafter clarifies the elements of masochism in papers that deal with separation from the mother, the evolution of masochism as a self concept of the ego in an early phase of the mother/child interaction, and the sense of child’s weakness as an imprint of the mother’s image of the child. Masochism becomes a way of relating and avoiding separation. The passive role in the analytic process may hide the patient’s devalued sense of self in relationship to the analyst, a reaction that is counter-therapeutic. The analyst’s behavior in displaying a friendly interest toward the patient is deemed important; in this way, the patient’s ego is liberated so that the patient is able to relate to the analyst as a person rather than an authoritarian parent. From the work of ethologists on animal behavior, Menaker reports masochistic behavior of animals similar to the human pattern, e.g. the young timber wolfs submissive reaction to a more powerful wolf. By baring his jugular vein and placing himself in a submissive position, he placates the more powerful wolf and survives. Masochism is part of the evolutionary process of survival in both animal and man. For treatment, Menaker strongly emphasizes the concept of will as a function of the ego in contrast to Freudian analysts who view will as a definition of ego strength or weakness. In borderline states, character disorders and masochistic patients, insight as a therapeutic tool fails. Consequently, Dr Menaker supports the ego as will the ability to actualize goals and choices. This capacity of will depends on the ego development in the mother/child relationship and on the inherited abilities of the individual. Dr Menaker suggests that the early masochistic reaction prevents independent action or will, so that one must undo and redo the experiences of childhood. This reconstruction can only be accomplished in actual relationship with the therapist. In that relationship, the Patient can exercise his will and rupture the masochistic
bond to mother with its attendant anxiety. This process could be designated as a new identification. In her paper. The Issues of Symbiosis and Ego: Autonomy in the Treatment ofMasochism, Menaker again advises the therapist to
minimize the transference neurosis by behaving as a helping person rather than a distant, neutral professional, and by analyzing the patient’s reality distortions in relationships with others. a process which allows the patient to establish new identifications. Identification with the analyst is primary, establishing a basis for new identifications with still others. The second section, Identification and the Social Process. is a series of eight papers, dealing with social processes as the basis of analogy of the genetic code as transmitter of biological evolution; identification, similarly, is the transmitter of social evolution. Basic to this concept is the mother/child bonding which leads to the separation/individuation process. In the paper, Possible Forerunners of the Indentijication Process in the Animal World, Menaker writes of Elsa, the baby lioness raised from her first few days by Joy Adamson, so that Adamson became the mother through imprinting or bonding. On the other hand, Elsa’s cubs were six weeks old before they met Adamson so that their reaction was one of distrust and caution. In the paper on The Injkence ofChangingVa/alues,Menaker stresses that because of massive social changes, value systems may be disrupted for succeeding generations due to the lack of solid identifications, increased narcissism and lack of genuine ego autonomy. The last section is devoted to the concepts of creativity, concepts derived from Otto Rank, which are compatible with Menaker’s view of differentiation and individuation. Creativity is a form of individuation based on unconscious functions-on the ego-ideal, the sense of self and the relationship to contemporary life. I would highly recommend the book and its exceptional combination of excellent case material, understanding of personality, and concepts of treatment. Department of Psychiatry Massachusetts General Hospital Boston. MA, U.S.A.
JEROMEL. WEINBERGER
ANDREW M. GREELEY, WILLIAM C. MCCREADY, and GARY THEISEN.Praeger, New
Ethnic Drinking Subcultures, by York, 1980. 138 pp. IE15.95
This thin volume reports the findings of an investigation into differences in drinking problems and their genesis among five American national-descent groups (English, Irish, Italian, Jewish, and Swedish) sampled in four cities (Boston, Chicago, Minneapolis, and New York) during 1978. Data were collected by means of self-administered questionnaires filled out by one parent and one adolescent child in each of the 980 families studied. The study was designed to test a general multivariate model, derived for the most part from previous research by the senior author into the socialization of political values among ethnic groups. Essentially, the model postulates that drinking behavior (with particular emphasis on drinking problems) is determined by cultural norms (defined as parental approval+iisapproval of drinking), parental drinking behavior, relationship between parents, family drinking customs, family structure (i.e. power, or the locus of parental decision making, and support, or perceived closeness to parents), and personality factors (i.e. efficacy, or sense of competency; attitude towards authority; and achievement orientation). The model was tested by path analysis. With regard to findings. the investigators expected and
Book reviews found distinctive drinking subcultures among the five groups studied. Further, these subcultures proved to be extremely hardy, showing little tendency to erode over time, a finding also observed by others. The general model guiding the study accounted for a considerable proportion of problem drinking regardless of generation, sex, and ethnicity, but variations in detail were also found within each national-descent group. Not surprisingly, the authors report that problem drinking was more consistently related to drinking among one’s friends than to any other single variable. Considerably more surprising is the finding that mother’s drinking was related to problem drinking in several of the ethnic-sex subgroupings. This result requires replication and merits further exploration. This summary of the study and its findings fails to convey the tone of glib certitude with which it is reported, a tone that would be irritating even if the investigation were flawless. Unfortunately, it is not. Despite an elegant and carefully documented sampling design, worthy of the authors’ association with NORC, and sophisticated statistical analysis, the study as presented is marred in several crucial respects. The introductory literature review on drinking is badly out of date, covering classic tiorks from the fifties and sixties (only two citations to the alcohol literature are more recent than 1974). and is completely uninformed by recent theory and research on socialization of alcohol and drug use as reflected in the work of Jessor, Johnston, Kandel, Zucker, and others. Although well-written, the text is hard to follow, with little continuity from one chapter to the next and many confusing shifts in terminology and conceptualization. The tests of the model exclude some variables and introduce others with no explanation. For example, quality of family relationships, a key variable in the model, appears in none of the analyses, while drinking environments (companions), unmentioned in the model, is a key variable in the analysis: in fact, it is the single most powerful predictor of drinking behavior. Rudimentary, but essential, information about the study is often difficult to find or not available at all. Sample size, for instance, is to be found only in an appendix. Tables and figures are poorly labelled and awkwardly placed. Many of the variables are not defined, and all have unknown (or at least undescribed) reliability and validity. Measures that are defined appear weak and unconvincing. Power, one of two components of family structure, was assessed by responses to two questions concerning parental decisionmaking; the other component, support, was measured by responses to two questions regarding closeness to parents. Finally, scoring procedures are not described in detail sufficient to permit replication. These problems are further complicated by variations in level of discourse. At some points, the report is highly technical, as if addressed to a sophisticated scientific audience (e.g. the discussion of saturated models on p. 71). fn other places. the intended audience seems to be the interested layperson; here, the authors omit technical details important to the scientifically oriented reader (e.g. in the description of the quantity-frequency index on p. 125). In general, then, the book reads as an early draft that requires more thought, more coordination among the authors, and more attention to communicating with a specified audience. The final result is disappointing and frustrating. One welcomes good research in an important area; one can even grapple with flawed research that is well-reported. But there is no such resolution here: this could be either a hastily contrived report of a well-conducted investigation or simply a poorly conducted piece of research. School of Education Unioersity of Pittsburgh Pirtsburgh, PA. U.S.A.
HOWARD T. BLANE
341
Ethics, Humanism, and Medicine: Progress in Clinical ad Biological Research, Vol. 38, edited by MARC D. BASSON. Alan R. Liss, New York, 1980. 321 pp. $22.f~0 The Committee on Ethics, Humanism and Medicine, of which Marc Basson was Director at the time this book was prepared for publication, was founded by medical students at the University of Michigan Medical School in response to a felt need for a genuinely interdisciplinary and interprofessional dialogue on problems of ethics and law in medicine. Aware of the rigorous examination of questions in biomedical ethics in progress in the philosophical journals, and the enthusiastic grass roots movement for the discussion of ethical problems among health professionals and concerned others, and equally aware of the grave difficulties in communication between the philosophers on the one hand and the health professionals on the other, the students set out to bridge the communication gap in a series of conferences. Each conference took on a group of current problems, ethical in content and of interest to the health care professions (not necessarily unique to health care contexts), the discussion of each problem carefully set up to include and criticize the views of professional philosophers and those of practicing clinicians; most problem sessions had a case presentation at the outset to focus the commentary and an extended discussion period at the end. This volume consists of presentations, excerpts and summaries of the discussions, from three of those conferences, The range of topics covered is wide, including, among others, such standard problems as euthanasia, amniocentesis and abortion for sex choice, sale of organs for transplant, allocation of scarce medical resources, confidentiality, disclosure and informed consent, and the ethics of placebo usage in clinical trials of lifesaving drugs; also included are problems less well worked and perhaps of more immediate interest to health care professionals and those in preparation to be such: dealing with ethical and value differences between doctor and patient, medical whistle blowing, Good Samaritan laws, the physician’s right to strike, and the reform of medical education to include a more humanistic orientation. A list of participants in the conferences, conveniently gathered at the front of the volume, includes some familiar names in ethics and its biomedical subspeciality-Richard Brandt, Carl Cohen, George Mavrodes, and Holly Goldman, all of whom are now at the University of Michigan or thereabouts; most of the others are local medical, legal and academic talent, recruited for the purpose by the student committee. The worth of such conferences for the participants therein is certainly beyond doubt; I was delighted at the enterprise shown by the students in organizing the Committee on Ethics, Humanism and Medicine, and in putting together the conferences. The worth of gathering the Proceedings of such local conferences in permanent formhardbound and probably expensive, despite that economical typesetting method that leaves right margins uneven -is open, I think, to debate. In the very nature of the enterprise the treatment of each topic must be partial, unsystematic, far less enlightening to read than the works that the participants cite and comment upon, works that were written to be read. In the nature of the gathering, the contributions must be of uneven quality, and so these are, ranging from pedantic presentations of academic categories of dubious relevance to the current debate: (e.g. Margaret Dewey’s mercifully short piece on Lonergan’s theory of decision making and selected theological criteria on the same) to admirably clear, and illuminating, readable analyses of the case presented and related issues (e.g. George Mavrodes’ piece on the sale of organs for transplant). In the nature of the assignment given them, the philosophers were restricted to teaching basic distinctions and elementary ethical theory, too briefly to serve as a basic