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Is alcoholism hereditary?
2’0
Book reviews
on the roles and expectations of the funeral director. the physician, the nurse. the clergyman and the mental health specialist. In Part II. the chapter on suicide is more specific and digs into the content more systematically. This is in contrast to the following chapter on murder which is wideranging, has an interesting array of statistics but tends to suffer from philosophico-cultural opinion, e.g. “Malnutrition and tuberculosis are far from uncommon on the reservations at a time when the average white American is healthier and wealthier than ever before. In short. we are still killing the Indians.” (p. 283). In this same vein the authors appear to “grind axes” or “take shots” at a most unusual variety of targets, e.g. highway accidents, obesity, hexing, greed, suntanning, dieting and “administrative murder” to mention a few. One is not sure whether these topics are brought up because of a basic “liberal” stance of the authors or merely as a Socratic stinger to the reader’s conscience. Although this is not in the Anglo-American scientific tradition, it does serve well the purpose of broadening one’s reflection. The authors have concisely dealt with the Freudian death instinct and constructively criticize it as an hypothetical construct. One of the most intriguing concepts in the book is that of the representation of Death .as The Automaton. The authors suggest that in our changing world it is no longer adequate to identify with angels or devils, sinners or heroes and in representing Death as The Automaton we are beginning the long psychic task of identifying with the computerized robot-world that is taking shape around us. This book, besides being well-written, is a global view of death with its multifaceted insertions into contemporary culture. Complaints of tangentiality and non-scientific may be voiced, but in the main, the book is a pleasant, knowledge-giving reading experience about a subject that is often anxiety-provoking. Department ofPsychiatry Harvard Medical School Massachusetts General Hospital Boston, Mass., U.S.A.
GEORGE B. MURRAY
a sample of public and official attitudes towards drug taking. The book ends with an inventory of treatment and control agencies in each country. The author rightly points out the hazards of international comparisons and adds that these ‘*might well reduce the reliabili!? of the findings to a level that would jeopardize their utlhty and their credibility”. Unfortunately. this fundamental criticism has not been overcome. The strategies adopted emanated from a conference in Italy in 1972 and each country has tried in very different ways to cope with these requirements. The result is a botch patch of brief surveys of a widely differing kind and reliability. and in one case a plan for an as yet uncompleted study which discusses pitfalls largely ignored by some of the other regional reports. It would be hard to regard a questionnaire given to 249 students of the State University of Milan who were members of a cultural association interested in concerts and films as representative of anything very much. It is impossible to relate this to a pilot study of an urban Mexican sample. The same difficulties arise in the surveys of public attitudes. The book mentions that the “sample was drawn from among the public-but not representative of the population of the federal district”. The author does not specify what the sample does represent. The author also states “the significance of these findings is greatly limited however. by the small size and unrepresentativeness of the sample, and so generalisations from them are not justified”. True, but if this is so then what is the purpose and value of this book? In purely scientific terms probably little but it has doubtless enhanced understanding between workers in different countries and helps the reader understand the complexities of international co-operation and research. The problems involved are great and this book attempts to describe the pitfalls and occasional triumphs which beset researches in this field. The book should be of interest to those who are actively engaged in social research into drug abuse particularly if they feel tempted to enter the field of cross-national comparisons. Edinburgh
Is Alcoholism Investigating
Drug
Abuse,
by JAMES J. MOORE. United Nations Social Defence Research Institute Publication No. 16, Rome, June 1976. This book reports a number of studies on the characteristics of drug abuse in Puerto Rico, Mexico and Italy. The projects were sponsored by the United Nations Social Defence Research Institute. It is claimed that the programme was based on two assumptions: “First, that if this phenomenon were to be successfully contained or checked through international efforts it would be necessary not only to attack production and supply sources, but also to become familiar with the characteristics and dynamics of drug abuse in individual countries; and secondly, that these characteristics could only be investigated, identified and validly interpreted by research teams indigenous to the countries affected by the phenomena”. Despite these worthy assumptions it is hard to believe that the data presented can have contributed much to fostering international control, but they do add something to an understanding of the presentation of and public concern about drug abuse in different countries. One of the most surprising findings must be that three quite different cultures perceive the phenomenon of youthful drug abuse in quite similar ways-further evidence that the world is shrinking fast and conventional attitudes toward drug abuse transcend cultural boundaries. The projects reported are concerned with the incidence and prevalence of drug abuse completed with
Hereditary? by University Press, 1976. f4.95
E. B.
DONALD
RITSON
GWDWIN. Oxford
Despite some initial resistance to a book for the lay reader with such a specific and provocative title. I was fairly quickly won over to become an enthusiastic and devoted reader. (I began to enjoy reading an account of alcoholic amnesia being discussed with a bartender called Joe and then finding a reference at the end of this section which took me to the notes and references section and finding there the question “Why are bartenders always called Joe?“.) The title is somewhat misleading. because while Dr. Goodwin’s own research on the inheritance of alcoholism forms the keystone of the work. it is in fact a general review of alcohol abuse and the problems it causes. There is a useful discussion in lucid terms of the effects of alcohol and its relationship to other drugs. I was pleased to read “that drug comparisons were senseless except in terms of amount”. How often do we see “shock reports” of children drinking alcohol or smoking cannabis without any attempt to quantify the amount. Half a glass of sherry sipped at Christmas by a 10 year old is liable to be presented as a serious problem of alcohol abuse raging in the primary schools. While skilfully ensuring that the account is easy to follow. Dr. Goodwin avoids the pitfall of over-dramatising the situation. The social and psychological aspects of alcohol abuse are discussed before entering the central thesis that alcoholism “is known to be a family disease”.
Book reviews He makes clear that the male and female relatives of alcoholics have rates of alcoholism at least fivefold what would be expected of the general population. Having accepted that it does run in families. he then carefully takes the reader over the well-worn nature-nurture argument, with particular reference to his own recent Danish studies which he describes in considerable detail. This is an important study that has recently checked the tide flowing strongly for the environmentalist case. Lest he be accused of bias there is an appendix giving a reasoned criticism of his own work by two other research workers. In the Danish study of individuals separated from their biological parents and raised by foster parents from infancy he contrasted those in whom the biological parent had suffered from alcoholism with a control group of children of parents some of whom were normal and others who had past psychiatric illness: “By their late 20s or earher. the offspring of alcoholics had nearly twice the number of alcohol problems and four times the rate of alcoholism as the children whose parents had no record of hospitalisation for alcoholism”. The two groups were in other respects similar in their life histories although those who had an alcoholic parent were three times more likely to be divorced, which is hardly surprising in view of the known association between alcohol problems and marital discord. They were also able to contrast the adopted sons with the non-adopted sons of alcoholic parents and found, surprisingly, that the sons of alcoholics were no more likely to become alcoholic if they were reared throughout by their alcoholic parent, than if they were separated from their alcoholic parent soon after birth and reared by nonrelatives. This was true despite the fact that as a group, the non-adopted sons were older than their adopted brothers and therefore further advanced in the age of risk for alcoholism. He comments: “It is interesting how little environment appeared to contribute to the development of alcoholism among the sons of alcoholics in this sample”. He then reviews the small number of twin studies that have been undertaken of alcoholics and admits that they have produced conflicting findings. Turning from the case for nature to the evidence for nurture he introduces a chapter in the form of an imaginary conversation between an hereditist and an environmentalist (perhaps over a drink). As he points out, any final explanation for alcoholism requires to account for the low rate amongst Jews and the high rate amongst the Irish, its rarity in the Orient. and the fact that it is commoner in urban than rural populations and in certain occupations It is also well known that alcoholism remains much more prevalent in men than in women. He also poses the interesting question: “If there is a specific in-born vulnerability. does it reside in a susceptiBility to a particular drug or a general vulnerability to addictiveness. with the substance to which he then becomes addicted being determined by availability and cultural sanction?” For instance. many clinicians have observed the phenomenon of poly drug abuse with tendency for drug takers to move from drugs to alcohol in later life. In A Lorig Dtrr’s Journe.~ Into Night. the mother says: “You brought him up to be a boozer. Since he first opened his eyes he saw you drinking. Always a bottle on the bureau in the cheap hotel rooms”. Many of us feel that leaming by familial example in this way is a potent cause of alcoholism running in families. He accepts this case with many references to Eugene O’Neill and other Irishmen, but returns convincingly to the evidence of the previous chapter. The booh concludes with a glimpse into the future and brief review of treatment methods. I found this latter the least satisfactory part of the book. but it contained an excellent quotation from Peter Medawar which probably gets near to the nub of most treatment methods, all of
221
which have devotees and critics mostly without objective evidence to contrast one against another. Talking of the non-specific aspects of all treatment. he says that is the “Assurance of a regular sympathetic hearing, feeling that somebody is taking his conditions seriously, the discovery that others are in the same predicament, the comfort of learning that his condition is explicable, which does not depend on the explanation being the right one”. These factors are common to most forms of psychological treatment, and the good they do cannot be credited to one treatment in particular. I found this a most satisfying book which should be widely read by all those interested in alcohol abuse and addiction. Edinburgh
E. B. RITS~N
The Honorable Elders: A Cross-Cultural Analysis of Aging in Japan.by ERDMAN PALMORE.Duke University Press, NC, 1975. 148 pp. $8.95, (paper) $3.75. This small book attempts to assess the position of the aged in Japan today in order to ascertain the extent to which once traditionally high status for the aged is maintained in modem Japan. At the same time their current status is placed in larger cross-cultural context by introducing data primarily from the United States, but peripherally from a number of other societies. Palmore addresses two central questions which are of continuing interest in gerontology. The major thesis concerns the impact of modernization on the status accorded the aged in society. He argues that while Japan becomes more like industrialized western societies in terms of its economic system, that their social and cultural systems are significantly different such that the aged will continue to have high status and be. well integrated-a pattern not followed in the West. The second major theoretical issue with which Palmore deals concerns the utility of disengagement theory versus activity theory for understanding “satisfaction” of the aged. While some interesting ideas are presented, this is perhaps the most disappointing aspect of the book. The discussion of the more appropriate theoretical framework seems at best perfunctory and superficial. For the reader unfamiliar with this debate, the discussion fails to explicate the assumptions of disengagement theory especially as they have been modified over the years. While he acknowledges that he poses the theory in an “unequivocal form”, it is not at all clear what purpose this serves. He concludes that activity rather than disengagement is modal among Japanese aged. Related to this and also of considerable interest, Palmore notes the continued activity of older people in both social and occupational spheres. Further, activity is associated with both higher satisfaction and better health. This is indeed an interesting contrast to the American pattern; unfortunately, comparable American data are not presented. Palmore draws on a wide variety of sources for data, utilizing census data and national surveys which he translated, small observational studies made by his students and his own personal experiences in Japan, he has put together a most interesting picture of the social world of Japanese aged. Based on a sabbatical year, an early childhood in Japan and a lifelong interest in Japanese culture. Palmore richly interprets the data he has gathered. In recent years there has been an increased awareness that there is a need. as the author clearly recognized. to broaden our understanding of aging in other cultures. While it is of intrinsic interest to do so. it also increases understanding of aging in our own society. Palmore’s comparative approach makes an important contribution to this growing body of research.
Book reviews
on the roles and expectations of the funeral director. the physician, the nurse. the clergyman and the mental health specialist. In Part II. the chapter on suicide is more specific and digs into the content more systematically. This is in contrast to the following chapter on murder which is wideranging, has an interesting array of statistics but tends to suffer from philosophico-cultural opinion, e.g. “Malnutrition and tuberculosis are far from uncommon on the reservations at a time when the average white American is healthier and wealthier than ever before. In short. we are still killing the Indians.” (p. 283). In this same vein the authors appear to “grind axes” or “take shots” at a most unusual variety of targets, e.g. highway accidents, obesity, hexing, greed, suntanning, dieting and “administrative murder” to mention a few. One is not sure whether these topics are brought up because of a basic “liberal” stance of the authors or merely as a Socratic stinger to the reader’s conscience. Although this is not in the Anglo-American scientific tradition, it does serve well the purpose of broadening one’s reflection. The authors have concisely dealt with the Freudian death instinct and constructively criticize it as an hypothetical construct. One of the most intriguing concepts in the book is that of the representation of Death .as The Automaton. The authors suggest that in our changing world it is no longer adequate to identify with angels or devils, sinners or heroes and in representing Death as The Automaton we are beginning the long psychic task of identifying with the computerized robot-world that is taking shape around us. This book, besides being well-written, is a global view of death with its multifaceted insertions into contemporary culture. Complaints of tangentiality and non-scientific may be voiced, but in the main, the book is a pleasant, knowledge-giving reading experience about a subject that is often anxiety-provoking. Department ofPsychiatry Harvard Medical School Massachusetts General Hospital Boston, Mass., U.S.A.
GEORGE B. MURRAY
a sample of public and official attitudes towards drug taking. The book ends with an inventory of treatment and control agencies in each country. The author rightly points out the hazards of international comparisons and adds that these ‘*might well reduce the reliabili!? of the findings to a level that would jeopardize their utlhty and their credibility”. Unfortunately. this fundamental criticism has not been overcome. The strategies adopted emanated from a conference in Italy in 1972 and each country has tried in very different ways to cope with these requirements. The result is a botch patch of brief surveys of a widely differing kind and reliability. and in one case a plan for an as yet uncompleted study which discusses pitfalls largely ignored by some of the other regional reports. It would be hard to regard a questionnaire given to 249 students of the State University of Milan who were members of a cultural association interested in concerts and films as representative of anything very much. It is impossible to relate this to a pilot study of an urban Mexican sample. The same difficulties arise in the surveys of public attitudes. The book mentions that the “sample was drawn from among the public-but not representative of the population of the federal district”. The author does not specify what the sample does represent. The author also states “the significance of these findings is greatly limited however. by the small size and unrepresentativeness of the sample, and so generalisations from them are not justified”. True, but if this is so then what is the purpose and value of this book? In purely scientific terms probably little but it has doubtless enhanced understanding between workers in different countries and helps the reader understand the complexities of international co-operation and research. The problems involved are great and this book attempts to describe the pitfalls and occasional triumphs which beset researches in this field. The book should be of interest to those who are actively engaged in social research into drug abuse particularly if they feel tempted to enter the field of cross-national comparisons. Edinburgh
Is Alcoholism Investigating
Drug
Abuse,
by JAMES J. MOORE. United Nations Social Defence Research Institute Publication No. 16, Rome, June 1976. This book reports a number of studies on the characteristics of drug abuse in Puerto Rico, Mexico and Italy. The projects were sponsored by the United Nations Social Defence Research Institute. It is claimed that the programme was based on two assumptions: “First, that if this phenomenon were to be successfully contained or checked through international efforts it would be necessary not only to attack production and supply sources, but also to become familiar with the characteristics and dynamics of drug abuse in individual countries; and secondly, that these characteristics could only be investigated, identified and validly interpreted by research teams indigenous to the countries affected by the phenomena”. Despite these worthy assumptions it is hard to believe that the data presented can have contributed much to fostering international control, but they do add something to an understanding of the presentation of and public concern about drug abuse in different countries. One of the most surprising findings must be that three quite different cultures perceive the phenomenon of youthful drug abuse in quite similar ways-further evidence that the world is shrinking fast and conventional attitudes toward drug abuse transcend cultural boundaries. The projects reported are concerned with the incidence and prevalence of drug abuse completed with
Hereditary? by University Press, 1976. f4.95
E. B.
DONALD
RITSON
GWDWIN. Oxford
Despite some initial resistance to a book for the lay reader with such a specific and provocative title. I was fairly quickly won over to become an enthusiastic and devoted reader. (I began to enjoy reading an account of alcoholic amnesia being discussed with a bartender called Joe and then finding a reference at the end of this section which took me to the notes and references section and finding there the question “Why are bartenders always called Joe?“.) The title is somewhat misleading. because while Dr. Goodwin’s own research on the inheritance of alcoholism forms the keystone of the work. it is in fact a general review of alcohol abuse and the problems it causes. There is a useful discussion in lucid terms of the effects of alcohol and its relationship to other drugs. I was pleased to read “that drug comparisons were senseless except in terms of amount”. How often do we see “shock reports” of children drinking alcohol or smoking cannabis without any attempt to quantify the amount. Half a glass of sherry sipped at Christmas by a 10 year old is liable to be presented as a serious problem of alcohol abuse raging in the primary schools. While skilfully ensuring that the account is easy to follow. Dr. Goodwin avoids the pitfall of over-dramatising the situation. The social and psychological aspects of alcohol abuse are discussed before entering the central thesis that alcoholism “is known to be a family disease”.
Book reviews He makes clear that the male and female relatives of alcoholics have rates of alcoholism at least fivefold what would be expected of the general population. Having accepted that it does run in families. he then carefully takes the reader over the well-worn nature-nurture argument, with particular reference to his own recent Danish studies which he describes in considerable detail. This is an important study that has recently checked the tide flowing strongly for the environmentalist case. Lest he be accused of bias there is an appendix giving a reasoned criticism of his own work by two other research workers. In the Danish study of individuals separated from their biological parents and raised by foster parents from infancy he contrasted those in whom the biological parent had suffered from alcoholism with a control group of children of parents some of whom were normal and others who had past psychiatric illness: “By their late 20s or earher. the offspring of alcoholics had nearly twice the number of alcohol problems and four times the rate of alcoholism as the children whose parents had no record of hospitalisation for alcoholism”. The two groups were in other respects similar in their life histories although those who had an alcoholic parent were three times more likely to be divorced, which is hardly surprising in view of the known association between alcohol problems and marital discord. They were also able to contrast the adopted sons with the non-adopted sons of alcoholic parents and found, surprisingly, that the sons of alcoholics were no more likely to become alcoholic if they were reared throughout by their alcoholic parent, than if they were separated from their alcoholic parent soon after birth and reared by nonrelatives. This was true despite the fact that as a group, the non-adopted sons were older than their adopted brothers and therefore further advanced in the age of risk for alcoholism. He comments: “It is interesting how little environment appeared to contribute to the development of alcoholism among the sons of alcoholics in this sample”. He then reviews the small number of twin studies that have been undertaken of alcoholics and admits that they have produced conflicting findings. Turning from the case for nature to the evidence for nurture he introduces a chapter in the form of an imaginary conversation between an hereditist and an environmentalist (perhaps over a drink). As he points out, any final explanation for alcoholism requires to account for the low rate amongst Jews and the high rate amongst the Irish, its rarity in the Orient. and the fact that it is commoner in urban than rural populations and in certain occupations It is also well known that alcoholism remains much more prevalent in men than in women. He also poses the interesting question: “If there is a specific in-born vulnerability. does it reside in a susceptiBility to a particular drug or a general vulnerability to addictiveness. with the substance to which he then becomes addicted being determined by availability and cultural sanction?” For instance. many clinicians have observed the phenomenon of poly drug abuse with tendency for drug takers to move from drugs to alcohol in later life. In A Lorig Dtrr’s Journe.~ Into Night. the mother says: “You brought him up to be a boozer. Since he first opened his eyes he saw you drinking. Always a bottle on the bureau in the cheap hotel rooms”. Many of us feel that leaming by familial example in this way is a potent cause of alcoholism running in families. He accepts this case with many references to Eugene O’Neill and other Irishmen, but returns convincingly to the evidence of the previous chapter. The booh concludes with a glimpse into the future and brief review of treatment methods. I found this latter the least satisfactory part of the book. but it contained an excellent quotation from Peter Medawar which probably gets near to the nub of most treatment methods, all of
221
which have devotees and critics mostly without objective evidence to contrast one against another. Talking of the non-specific aspects of all treatment. he says that is the “Assurance of a regular sympathetic hearing, feeling that somebody is taking his conditions seriously, the discovery that others are in the same predicament, the comfort of learning that his condition is explicable, which does not depend on the explanation being the right one”. These factors are common to most forms of psychological treatment, and the good they do cannot be credited to one treatment in particular. I found this a most satisfying book which should be widely read by all those interested in alcohol abuse and addiction. Edinburgh
E. B. RITS~N
The Honorable Elders: A Cross-Cultural Analysis of Aging in Japan.by ERDMAN PALMORE.Duke University Press, NC, 1975. 148 pp. $8.95, (paper) $3.75. This small book attempts to assess the position of the aged in Japan today in order to ascertain the extent to which once traditionally high status for the aged is maintained in modem Japan. At the same time their current status is placed in larger cross-cultural context by introducing data primarily from the United States, but peripherally from a number of other societies. Palmore addresses two central questions which are of continuing interest in gerontology. The major thesis concerns the impact of modernization on the status accorded the aged in society. He argues that while Japan becomes more like industrialized western societies in terms of its economic system, that their social and cultural systems are significantly different such that the aged will continue to have high status and be. well integrated-a pattern not followed in the West. The second major theoretical issue with which Palmore deals concerns the utility of disengagement theory versus activity theory for understanding “satisfaction” of the aged. While some interesting ideas are presented, this is perhaps the most disappointing aspect of the book. The discussion of the more appropriate theoretical framework seems at best perfunctory and superficial. For the reader unfamiliar with this debate, the discussion fails to explicate the assumptions of disengagement theory especially as they have been modified over the years. While he acknowledges that he poses the theory in an “unequivocal form”, it is not at all clear what purpose this serves. He concludes that activity rather than disengagement is modal among Japanese aged. Related to this and also of considerable interest, Palmore notes the continued activity of older people in both social and occupational spheres. Further, activity is associated with both higher satisfaction and better health. This is indeed an interesting contrast to the American pattern; unfortunately, comparable American data are not presented. Palmore draws on a wide variety of sources for data, utilizing census data and national surveys which he translated, small observational studies made by his students and his own personal experiences in Japan, he has put together a most interesting picture of the social world of Japanese aged. Based on a sabbatical year, an early childhood in Japan and a lifelong interest in Japanese culture. Palmore richly interprets the data he has gathered. In recent years there has been an increased awareness that there is a need. as the author clearly recognized. to broaden our understanding of aging in other cultures. While it is of intrinsic interest to do so. it also increases understanding of aging in our own society. Palmore’s comparative approach makes an important contribution to this growing body of research.