The American prison business

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Book reviews hood and 1 assume that Laing is as indifferent to Szasz’s bitter attack as he has profited by what is otherwise clearsighted and wise in the man. These are small issues when seen by these writers’ perspectives on what psychiatry has done in the name of schizophrenia. It is, after all, a relatively recent artifact of the imposition of the medical model on human behavior. Since its invention, there has been an inflexible assumption that someday the “lesion” will be identified to justify calling it a disease. Today, legions of biochemical crusaders are searching for it like the true cross, and, like the true cross, many have found it. Of course, schizophrenia (whatever it is) is biochemically caused. Ultimately all behavior is. But it may be as reasonable to ask about the biochemical differences between liberals and conservatives as between “schizophrenics” and “normals”. Indeed there is more coherence and predictability in political attitudes than there is in the collection of “symptoms” said to be diagnostic of schizophrenia. Psychiatric diagnosis has an almost legendary unreliability. There is now impressive documentation that the labeling process is as capricious as it is sticky. In the final analysis, the major characteristic of schizophrenics is that they are socially obnoxious, which is why political dissidents in the Soviet Union and impoverished minorities in the United States tend to disproportionately carry the label and its awesome burdens. Much of the Szasz and Torrey books is a litany of the civil libertarian monstrosities borne by institutional psychiatry. Seeing them so relentlessly compiled might cause some of us to ask forgiveness. Every society has had its witches to burn. But never before has the burning been so smug, so specialized, so rationalized, in short, so professionalized as it has become in our hands. Despite the nebulous and arbitrary way we define schizophrenics we incarcerate them for lifetimes, saturate them with drugs, shock them with electricity and cut through their brains. It is a spectacle which ceases to be awesome only when seen very close. I do not know where this will lead us. Szasz clings to a libertarian model of psychiatric therapy and Torrey chooses to change the grammar of the whole enterprise to an educational one, so that what he likes about his training can be preserved. Neither of them pursues the trail of social misery beyond the parameters of psychiatry so we are left, as in the old Mutt and Jeff cartoon, looking for a coin where the light is, rather than where we dropped it. But now the light is out. It may be that only an impeccably just society has the right even to address its deviants. MATTHEWP. DUMONT Chelsea. Ma.. U.S. A.

The Economics

while data comparing U.S. morbidity, mortality, and per cent of GNP expended on health care with data from other developed nations are also presented. A general conclusion of this section is that the U.S. health care sector is not cost-effective in terms of its impact on health status. This is an important observation, but unfortunately, no new techniques are suggested for applying that logic to other aspects of health economics discussed in the book. Other sections are descriptive, rather than analytic, and not timely with respect to presented data, or theoretical development. For example, Section II, which might be expected to be of major concern to readers of this journal, deals with Productivity and Medical Personnel. Instead of providing interesting insights into this vital area, the section describes problems in measuring health sector productivity, and then goes on to describe trends in physician and non-physician manpower supply. This description is based on published sources, such as the Social Security Bulletin and the HEW Health Manpower Sourcebook which are available to any interested party. No new data are introduced. Current thinking in the area of productivity analysis centers on adjustment of workload by case severity, while manpower planning efforts are attempting to utilize indexes of medical which require underservice to determine locations additional resources. Neither of these techniques are discussed. Most other areas in the book suffer from deficiencies in current data, or innovative thinking. The section on Utilization and Quality Control describes early experience with utilization review under Medicare and Medicaid, but merely introduces the Professional Standards Review Program. This is a serious shortcoming because the program has been criticized both for its inability to truly exercise quality control and for its inability to control costs, as revealed by research findings which could not document significant impact. Finally, the areas of greatest current concern to health economists and experts in health finance are cost-finding and reimbursement rate-setting methodologies. They receive no real attention at ail in this volume. A reader could benefit much more from a discussion of the need for uniform hospital accounting practices, or a presentation of the evolving theory of rate-setting than the historical review of national health insurance proposals, which is treated more thoroughly elsewhere. The book is no doubt intended as an introductory overview of health economics, but a prospective reader will be better informed if he/she reviews current primary sources of basic data, and current journal articles. Department of Health Care Administration City University of New York, U.S.A.

HARRY M. ROSEN

of Health Care: Finance and Delivery,

SEYMOURE. HARRIS. McCutchan.

by Calif. 1975. 488 pp.

s15.00.

This book provides a review of a wide range of material concerning health sector economics. It is comprised of eighteen chapters which are organized into five sections as follows; I. Issues, Costs and Expenditures, II. Productivity and Medical Personnel. III. Inflation and Medical Markets. IV. Insurance. and V. Delivery. It is a thorough review. but the data actually presented are quite dated. with most series of figures ending in 1969. The value of the late Professor Harris’ text is its historical perspective on cost. manpower. and insurance trends and his interesting discussion of indirect health costs in Chapter 2. Results of research directed at determining the cost to society of morbidity and mortality are reviewed:

The American

Prison Business,

guin Books, Harmondsworth, 329 pp. 52.95, f1.00.

by JEZXA MITFORD.PenMiddlesex, England, 1977.

If the pathway to ultimate, rational change in the way we deal with criminals begins by a careful understanding and analysis of the current complexity surrounding such projected change, then Jessica Mitford has written a most important book. Her style is unusually direct, precise, and, while not marked by indifference, certainly is dispassionate-presenting multiple questions and multiple answers all subject to most careful scrutiny and fairness. Substantially, the major evidence points to mounting conviction that no help for society or the offender of that society can take place behind prison walls. Mitford points out how powerful members of society that gain direct benefit from the

674

Book reviews

prison system, including drug industries and architecturalconstruction firms, function as gross impediments to change in the institutionalizing of the criminal offender. Added to that, of course, she presents in considerable detail the position of a potent, entrenched, tradition-bound bureaucracy. The opposition to change is formidable indeed! Further, any rehabilitative efforts must, of necessity, collapse in the face of this opposition. Nevertheless, taking into full consideration the immensity of the problem, this book slices the opposition by its solid reasoning and thorough presentation of the facts. There is no turning back. The direction is toward treating persons who have committed criminal acts on a meaningful, individual basis (not simply from the 19th century individualistic philosophy point of view-where each man was seen as a fragment of God), i.e. recognizing that each person constitutes a unique part of his society. This book is very rich in source material, provocative ideas, offering the definite possibility of humanistic and practical change.

terium ris-&is the responsibility: and the Church’s teaching on human rights. Since the encyclical letter. Hmar~ar Vitae was the source of much of the discussion. it is quoted frequently. There are some references to other Church documents. notably those of Vatican II and statements of Conferences of Bishops. There is. finally. an interesting paper, “Protestant aggiornamento on population-parenthood problems”. The papers by the non-theologians were very technical. at times hard to read. It was difficult for this layman reading them to appreciate the impact of some of the important issues raised. A prerequisite skill of interpreting statistics. trends and tables clouded the clarity of some authors’ presentations. For the inverse reason, I was disappointed by the papers presented by the theologians. I wondered at times how much preparation had been done for the papers. Their statements were shallow, of poor theological quality. There were few footnotes or references offered by the theologians. Besides being support for statements by an author, references assist the reader in broadening research and underThe Hacker Clinic MALWN BRAVERMAN standing of a matter. . Psychiatry I was concerned by the ecclesiology used by some of Beverly Hills, Cal., U.S.A. the authors. I felt it did not reflect contemporary teaching. “Church” was understood by them to mean hierarchy or Population Problems and Catholic Responsibility, edited by authority figures. True, the bishops and others with special authority do have special responsibility concerning populaL. H. JAN~~ENS.J., Tilburg University Press, The Nethertion problems. However, the whole Church-very person lands, 1975. 196 pp. therein-has a real responsibility concerning them, too. There wasn’t much discussion of the Catholic responsiThis book is Volume II of the Tilburg Studies on Development Research. The Studies are edited by the Institute of bility of the Church in this area. Strong feelings of some authors frequently surfaced in Development Research of the School of Economics, Social their presentations. It would not seem unreasonable to Science and Law at Tilburg University in The Netherlands. conclude that there was some tension among the particiThe book consists of the Proceedings of a Symposium pants. Negative feelings, defensiveness bordering on anger organized by the Institute to discuss Catholic participation and belligerence, were not unusual. Such demonstrations in the development of population policy. It is a multialso cloud the clarity of the points to a reader. How helpful disciplinary compilation, with contributions from demois such negativity and hostility to the accomplishment of graphers, sociologists, public administrators, public health the aims of the Symposium? experts and theologians. For many reasons I felt the editor did not do a good Though the Table of Contents divides the material into job. At the end of the Introduction he abjures the matter seven sections, there are actually four main divisions. There of translation, claiming financial cost as a prohibitive facis an Introduction and the Opening Addresses; there are tor. However, even were one to grant that, his sloth in the presentations of the scientists other than theologians; other matters makes the book hard to read from a structhe theological reflections follow; the Report of the Meettural point of view. There are mistakes in spelling and ing concludes the book. basic grammar. There was apparently no form for the The introduction to the Report of the Meeting proposes written presentations. The non-theological papers present three aims of the Symposium (p. 175). First was to focus regular footnotes and references. The references of the attention on the problems created by current unprecetheologians are included in the text, making reading more dented population growth. Secondly, there was emphasis cumbersome. on the necessity of an integral development effort. ProbFor whom is this book intended? To whom is it lems created by accelerated population growth are so serious that population policy must be an integral part of addressed? It would probably be helpful, as a written record, to the participants in the Symposium. Perhaps development policy. It was in this context that Humanae some specialists in the social sciences would find the data Vitne. termed. “the main obstacle to full cooperation of informative. From my perspective its readership would be the Catholic community in the field of population policy” quite limited. (p. 175) was discussed. Finally the Symposium was looking The aims of the Symposium look forward to the more for possibilities of positive action by the Catholic comadequate participation of the Catholic Church in the develmunity with respect to population problems. opment of population policy. I find no names of bishops The papers in the second main division of the book as participants or presenters. Since bishops are sigmficant (according to my division; sections III-V according to the persons in the development of policy in the Catholic editors) deal with six general topics: (1) demography (inChurch, their absence would seem to be a significant lack. cluding many statistics [with tables] and trends; also family size, growth/decline of populations, migration and St. Luke’s Hospital The Rev. KEVIN F. TRIPP mortality); (2) public health (family planning, fertility, conNew Bedford, Mass.. U.S.A. traception, abortion, nutrition); (3) economics (cost of services and unemployment); (4) public policy; (5) attitudes (toward education, religion and politics): and (6) education Handicap and Family Crisis: A Study of the Siblings of (of children, adults, family units, etc.). Handicapped Children, by STEPHENKEW. Pitman. London. The theological papers (constituting section III accord1975. 194 pp. 24.50. ing to me, section VI according to the editor) discuss the Church’s responsibility in reference to moral guidance and The significance of Mr. Kew’s study does not lie in his inspiration: principles by which the Church’s responsibility approach or in a conclusion. but simply in the existence of the book. might be understood and exercised; the role of the magis-