- Email: [email protected]
The sociology of mental disorders: Analyses and readings in psychiatric sociology
Book REVIEWS
3-N
on 157 published studies. He stresses the need to regard childbirth against a knowledge of the woman’s life experience and the patterns of her social group. There is further documentation of failings in research methodology: for example, retrospective assessments after the emergence of the complication being studied, or confusion of dependent and independent variables. He urges an emphasis on “process” rather than “factors”, and he reminds us of the long-term nature of action research. The paper by Margaret Mead and Niles Newton is a compendium of cross-cultural information regarding the beliefs and practices associated with pregnancy, childbirth, and child care. Besides being inherently fascinating, such a. review of culture patterns raises important research questions. One of these is the consideration of how we modify behavior patterns “without unduly disturbing other meaningful aspects of the culture. The majority of the problems in the area of reproduction in the United States today probably stems not from lack of abstract knowledge but from lack of understanding how to apply what is known.” In the final paper, Jay S. Rosenblatt reports animal studies which show the influence of social and environmental factors on reproduction and on development of the offspring. Obviously, there is an advantage in the ability to control and manipulate more factors in animal than in human studies. In spite of differences among species and the inability to apply all findings from lower mammals to humans, such research certainly stimulates new thinking about maternal behavior. The editors’ stated aim is to “foster long-term collaboration among investigators”. By bringing together such a broad range of material and making the need for collaboration evident, they may succeed. However, they may simultaneously discourage the clinician in his more modest, if less rigorous, research. The overall impact of the book is that a massive national effort is necessary, and it is fortunate that the National Institute of Neurological Diseases and Blindness has undertaken such a project involving the collaboration of 14 medical schools. We are indebted to them for conducting these longitudinal studies of children and to the Perinatal Research Committee which commissioned these five comprehensive reviews. The editors have provided valuable research background and information in an area which clearly links social science and medicine. EDWARDA. MASON,M.D. Laboratory of Community Psychiatry, Harvard Medical School, Boston, Mass.
THE SOCIOLOGY OF MENTAL DISORDERS: ANALYSES AND READINGS IN PSYCHIATRIC SOCIOLOGY. Edited by S. KIRSON WEINBERG. Aldine Publishing Company, Chicago, 1967. 367 pp. Price $12.50. DR. WEINBERGis a sociologist and social psychologist who has published extensively in the field of social psychiatry, his work including studies of patients in hospitals and earlier work on the general fieldofmentaldisorders. This volume, as he states in the preface, attempts to deal with the topic as a branch of general sociology including epidemiological and class studies, the social aspects of disordered behavior and also the social effects of new approaches including community and transcultural psychiatry. The book begins with three essays by WEINBERGhimself, followed by a collection of reprints from various classical studies
380
BOOK REVIEXVS
such as Dunham’s, our own Midtown Studies, Hollingshead et al. in New Haven and the Kleiner-Parker position on aspirations and social status in regard to mental illness. The last is rounded out by William Scott’s summary of social psychological correlates. This completes the theoretical orientation and epidemiological sections. Part III and Part IV are also indebted to Weinberg’s writings rounded out by Kohn and Clausen on social isolation and Lowenthal on the isolation of old age with such additions as the “myth of mental illness” pronouncements of Szasz. Part V on the mental hospital includes Goffman, Pine and Levenson on the patienthood status, Schwartz on “patient demands”. Part VI begins with the well-known family studies of mental patients following hospitalization, done by Simmons and Freeman. Parts VII and VIII shift the focus to outpatient treatment with VIII emphasizing community psychiatry and beginning in the novel manner of a Message of John F. Kennedy in 1963 which outlined the interest of his government in the modernization of prevention and treatment. The final Part IX (only 35 pages) is called “cross-cultural” aspects and because of brevity focuses only upon the institutional framework of Russian psychiatry, Weinberg’s essay on healing and social change in West Africa, preceded by the Wittkower and Fried paper in the International Journal of Social Psychiatry (i958) and the now totally out-of-date Benedict and Jacks paper, reprinted from Psychiatry (1954). Since so many of these contributions as listed above have existed in the public domain for some time and are so well known the present book is largely a collection of reprints, although Professor Weinberg has added some brief introductory sections or chapters especially at the beginning of the volume. Because the book is approximately 350 pages and covers such a broad terrain largely through reprints, it perhaps would serve best as a kind of course supplementary text, or book of readings which somehow merge the recent history of medical sociology with other readings illustrating studies which have been “good, bad and indifferent”. Therefore this cannot be recommended as an introductory text but would require the scholarly scrutiny of a seminar and discussion approach in order to separate the wheat from the chaff amid so much uneven material. Such readings save the young scholar who can afford the book a lot of time from the onerous job of taking notes on journal articles in the college library. Let me illustrate this point by quoting from the brief and erroneous conclusions of the Benedict and Jacks article of 1954 mentioned above. These authors state that they “feel” that the mental disorders known “to Western psychiatry do occur among primitive peoples throughout the world . . .” They go on to say that: “This universality of occurrence does not per se point to any particular etiological hypothesis, constitutional or cultural”. These authors make such astoundingly erroneous statements after stating that anthropologically oriented writers have led the unwary public into a false belief in the cultural variability of mental disorders. What they meant in 1954 by constitutional factors at work in ethnic groups could only point to either a racist conception of the well-documented variations from all parts of the world or, to be more charitable, a mystical notion of constitutional factors working among certain groups of mankind. They pitched their appeal for this resurrection of German organicism and one-way causality on a careless survey which minimized the variations in types of psychoses and thereby left room for the magical belief in some undefined “constitutional factor in personality formation”. As a matter of fact. the present reviewer went to some pains in 1956 in the book, Culture, Psychiatry and Human Values, to reassess all of these materials plus many more modern studies and in the same year published with psychologists on cultural variations in the schizophrenias among
BOOK REVIEWS
381
such groups as Irish-Americans, Italian-Americans and a variety of primitive peoples who did not have schizophrenias of the modern type with paranoid reaction, but instead had much more transient dissociations from reality open to primitive cures or to spontaneous remissions. in his own essay on “mental healing” in Ghana, a subject upon which this reviewer has also published, Weinberg himself comes closer to the fact of cultural variation, but tends to miss the differences among people in Ghana as to the amount and type of the disorders native practitioners deal with and the enormous community-based supports and ideologies which are put at the service of their patients in their own therapeutic efforts. More is involved here than “faith healing” as it is called since Chanaian cult practices already enjoy the distinction of using in vivid fashion much of what we are painfully trying to develop in Western psychiatry (such as group therapy, more esthetic techniques, increases in ideological communication, after-care programs, family involvement in therapy, work and rehabilitative techniques, and so forth). Of course, Weinberg has attempted to deal more thoroughly with modern epidemiological studies such as the Midtown Study, the New Haven Study, Dunham’s more recent work and the work of Pasamanick on those ill in the community. He also adds brief discussions of such things as the Horney and Sullivan movements in psychoanalysis. Also, some of the essays mentioned above are indeed classics such as that of Kohn and Clausen on the social isolation hypothesis in relation to schizophrenias. But again some of the older classics are not properly corrected. The Faris and Dunham work on the mental disorders of the Chicago urban area is again something which the modern seminar would have to correct to bring up to date. For instance, the notion that depressive state disorders in their psychotic dimensions are more characteristic of the upper classes is approvingly stated by Weinberg himself on p. 24 along with the view in the 1940’s that upward mobility characterized manic patients. However, both the New Haven Study of Hollingshead and Redlich found psychotic depressions more than twice the amount in the lower class than in the upper; and the Midtown Manhattan Study which added random community samples to a treated prevalence rate found three times as many depressions in lower class than in upper. All this tends to correct the earlier Faris and Dunham assertion that depressive states are associated with high status. A list of the minor errata in this book would make far too long a review. The main fact is that Dr. Weinberg has done the student a service by bringing together in one volume many of the interesting essays scattered through the journal literature and some culled from books as well. While some of the materials on transcultural psychiatry and epidemiology are weak, the sections on the mental hospital, posthospital adjustment and outpatient treatment are very strong. Likewise, his cautions on community psychiatry which follow President Kennedy’s invocation are well taken. There is, today, both a bogus kind of “community psychiatry” and cross-cultural or social psychiatry to which some persons only pay lip service by tossing these terms around. Weinberg’s work is certainly intended to be more serious than that. MARVIN K. OPLER, Ph.D.
Depts. of Psychiatry, Sociology and Anthropology, State University of New York at Buffalo, Buffalo, New York.
3-N
on 157 published studies. He stresses the need to regard childbirth against a knowledge of the woman’s life experience and the patterns of her social group. There is further documentation of failings in research methodology: for example, retrospective assessments after the emergence of the complication being studied, or confusion of dependent and independent variables. He urges an emphasis on “process” rather than “factors”, and he reminds us of the long-term nature of action research. The paper by Margaret Mead and Niles Newton is a compendium of cross-cultural information regarding the beliefs and practices associated with pregnancy, childbirth, and child care. Besides being inherently fascinating, such a. review of culture patterns raises important research questions. One of these is the consideration of how we modify behavior patterns “without unduly disturbing other meaningful aspects of the culture. The majority of the problems in the area of reproduction in the United States today probably stems not from lack of abstract knowledge but from lack of understanding how to apply what is known.” In the final paper, Jay S. Rosenblatt reports animal studies which show the influence of social and environmental factors on reproduction and on development of the offspring. Obviously, there is an advantage in the ability to control and manipulate more factors in animal than in human studies. In spite of differences among species and the inability to apply all findings from lower mammals to humans, such research certainly stimulates new thinking about maternal behavior. The editors’ stated aim is to “foster long-term collaboration among investigators”. By bringing together such a broad range of material and making the need for collaboration evident, they may succeed. However, they may simultaneously discourage the clinician in his more modest, if less rigorous, research. The overall impact of the book is that a massive national effort is necessary, and it is fortunate that the National Institute of Neurological Diseases and Blindness has undertaken such a project involving the collaboration of 14 medical schools. We are indebted to them for conducting these longitudinal studies of children and to the Perinatal Research Committee which commissioned these five comprehensive reviews. The editors have provided valuable research background and information in an area which clearly links social science and medicine. EDWARDA. MASON,M.D. Laboratory of Community Psychiatry, Harvard Medical School, Boston, Mass.
THE SOCIOLOGY OF MENTAL DISORDERS: ANALYSES AND READINGS IN PSYCHIATRIC SOCIOLOGY. Edited by S. KIRSON WEINBERG. Aldine Publishing Company, Chicago, 1967. 367 pp. Price $12.50. DR. WEINBERGis a sociologist and social psychologist who has published extensively in the field of social psychiatry, his work including studies of patients in hospitals and earlier work on the general fieldofmentaldisorders. This volume, as he states in the preface, attempts to deal with the topic as a branch of general sociology including epidemiological and class studies, the social aspects of disordered behavior and also the social effects of new approaches including community and transcultural psychiatry. The book begins with three essays by WEINBERGhimself, followed by a collection of reprints from various classical studies
380
BOOK REVIEXVS
such as Dunham’s, our own Midtown Studies, Hollingshead et al. in New Haven and the Kleiner-Parker position on aspirations and social status in regard to mental illness. The last is rounded out by William Scott’s summary of social psychological correlates. This completes the theoretical orientation and epidemiological sections. Part III and Part IV are also indebted to Weinberg’s writings rounded out by Kohn and Clausen on social isolation and Lowenthal on the isolation of old age with such additions as the “myth of mental illness” pronouncements of Szasz. Part V on the mental hospital includes Goffman, Pine and Levenson on the patienthood status, Schwartz on “patient demands”. Part VI begins with the well-known family studies of mental patients following hospitalization, done by Simmons and Freeman. Parts VII and VIII shift the focus to outpatient treatment with VIII emphasizing community psychiatry and beginning in the novel manner of a Message of John F. Kennedy in 1963 which outlined the interest of his government in the modernization of prevention and treatment. The final Part IX (only 35 pages) is called “cross-cultural” aspects and because of brevity focuses only upon the institutional framework of Russian psychiatry, Weinberg’s essay on healing and social change in West Africa, preceded by the Wittkower and Fried paper in the International Journal of Social Psychiatry (i958) and the now totally out-of-date Benedict and Jacks paper, reprinted from Psychiatry (1954). Since so many of these contributions as listed above have existed in the public domain for some time and are so well known the present book is largely a collection of reprints, although Professor Weinberg has added some brief introductory sections or chapters especially at the beginning of the volume. Because the book is approximately 350 pages and covers such a broad terrain largely through reprints, it perhaps would serve best as a kind of course supplementary text, or book of readings which somehow merge the recent history of medical sociology with other readings illustrating studies which have been “good, bad and indifferent”. Therefore this cannot be recommended as an introductory text but would require the scholarly scrutiny of a seminar and discussion approach in order to separate the wheat from the chaff amid so much uneven material. Such readings save the young scholar who can afford the book a lot of time from the onerous job of taking notes on journal articles in the college library. Let me illustrate this point by quoting from the brief and erroneous conclusions of the Benedict and Jacks article of 1954 mentioned above. These authors state that they “feel” that the mental disorders known “to Western psychiatry do occur among primitive peoples throughout the world . . .” They go on to say that: “This universality of occurrence does not per se point to any particular etiological hypothesis, constitutional or cultural”. These authors make such astoundingly erroneous statements after stating that anthropologically oriented writers have led the unwary public into a false belief in the cultural variability of mental disorders. What they meant in 1954 by constitutional factors at work in ethnic groups could only point to either a racist conception of the well-documented variations from all parts of the world or, to be more charitable, a mystical notion of constitutional factors working among certain groups of mankind. They pitched their appeal for this resurrection of German organicism and one-way causality on a careless survey which minimized the variations in types of psychoses and thereby left room for the magical belief in some undefined “constitutional factor in personality formation”. As a matter of fact. the present reviewer went to some pains in 1956 in the book, Culture, Psychiatry and Human Values, to reassess all of these materials plus many more modern studies and in the same year published with psychologists on cultural variations in the schizophrenias among
BOOK REVIEWS
381
such groups as Irish-Americans, Italian-Americans and a variety of primitive peoples who did not have schizophrenias of the modern type with paranoid reaction, but instead had much more transient dissociations from reality open to primitive cures or to spontaneous remissions. in his own essay on “mental healing” in Ghana, a subject upon which this reviewer has also published, Weinberg himself comes closer to the fact of cultural variation, but tends to miss the differences among people in Ghana as to the amount and type of the disorders native practitioners deal with and the enormous community-based supports and ideologies which are put at the service of their patients in their own therapeutic efforts. More is involved here than “faith healing” as it is called since Chanaian cult practices already enjoy the distinction of using in vivid fashion much of what we are painfully trying to develop in Western psychiatry (such as group therapy, more esthetic techniques, increases in ideological communication, after-care programs, family involvement in therapy, work and rehabilitative techniques, and so forth). Of course, Weinberg has attempted to deal more thoroughly with modern epidemiological studies such as the Midtown Study, the New Haven Study, Dunham’s more recent work and the work of Pasamanick on those ill in the community. He also adds brief discussions of such things as the Horney and Sullivan movements in psychoanalysis. Also, some of the essays mentioned above are indeed classics such as that of Kohn and Clausen on the social isolation hypothesis in relation to schizophrenias. But again some of the older classics are not properly corrected. The Faris and Dunham work on the mental disorders of the Chicago urban area is again something which the modern seminar would have to correct to bring up to date. For instance, the notion that depressive state disorders in their psychotic dimensions are more characteristic of the upper classes is approvingly stated by Weinberg himself on p. 24 along with the view in the 1940’s that upward mobility characterized manic patients. However, both the New Haven Study of Hollingshead and Redlich found psychotic depressions more than twice the amount in the lower class than in the upper; and the Midtown Manhattan Study which added random community samples to a treated prevalence rate found three times as many depressions in lower class than in upper. All this tends to correct the earlier Faris and Dunham assertion that depressive states are associated with high status. A list of the minor errata in this book would make far too long a review. The main fact is that Dr. Weinberg has done the student a service by bringing together in one volume many of the interesting essays scattered through the journal literature and some culled from books as well. While some of the materials on transcultural psychiatry and epidemiology are weak, the sections on the mental hospital, posthospital adjustment and outpatient treatment are very strong. Likewise, his cautions on community psychiatry which follow President Kennedy’s invocation are well taken. There is, today, both a bogus kind of “community psychiatry” and cross-cultural or social psychiatry to which some persons only pay lip service by tossing these terms around. Weinberg’s work is certainly intended to be more serious than that. MARVIN K. OPLER, Ph.D.
Depts. of Psychiatry, Sociology and Anthropology, State University of New York at Buffalo, Buffalo, New York.