172 American Anthropologist [70, 19681

little caution, the speculations of a psychoanalyst, Margolin, that “the Utes [which band remains un- specified, and this one reference is incomplete], “that most unhappy of all peoples” (p. 298), now “suffer more frequently from neurosis than any other human group” because they are unable on the reservation to discharge the ‘Iextreme aggressive- ness” that was bred into them by “eztreme selection pressure . . . during the comparatively few centuries when the Prairie Indians led a wild life consisting al- most entirely of war and raids” (p. 244). If Margolin and Lorenz had looked a t neuroses in a variety of other modern Indians, including some from tradi- tionally more peaceful groups, and also a t the often shameful history of White contact, they might be less impressed by the biological factor in the Utes’ troubles.

Excesses like this in Lorenz are easy for an an- thropologist to pick at, but they do not necessarily invalidate his basic thesis about the instinctive na- ture of human aggression. If Lorenz, as I believe, is basically right, anthropologists must renounce the position of cultural relativity that “some cultures have aggression and others do not-or not much.” Our task then becomes rather to see how the aggres- sive instinct is channeled in the life cycle, even in outwardly peaceful societies. This view will not meet universal immediate acceptance, but Lorenz would probably cite the fury of his critics as further proof of the correctness of his thesis.

Socwlogie des maladies menlales. ROGER BASTIDE. (Nouvelle Bibliothkque Scientifique.) Paris: Flammarion, gditeur, 1965. 282 pp., 29 illustra- tions and tables. 20 I?. (paper).

Rm’ewed by ERIKA BOWGUIGNON, The Ohio Slate University

The aim of this book is stated most clearly by the author in the very last sentence of the volume: to prove “that insanity is essentially a social thing, that therefore it is as much the subject of socio- logical analysis as of psychiatric analysis” (p. 278). The author begins his work hy assessing the present state of the growing interdisciplinary field known as social psychiatry. He reviews its various definitions and finds them heterogeneous, diverse, and wanting. He then proceeds to distinguish (pp. 14-19, and passim) three fields of study: (1) social psychiatry, “the science of the morbid social behavior of indi- viduals suffering from mental disorders” (p. 14, where “psychiatrie spe‘ciale” apparently should read “psychiatrie sociale”) ; (2) sociology of mental ill- ness, “which is only interested in collectivities and groups” (p. 15); and (3) ethnology of mental illness or ethnopsychiatry (p. 16). The latter is a field of ethnology and not of ethnopsychology, or abnormal ethnopsychology, which, in its turn, is a field of social psychiatry, as defined above. Ethnopsychia- try, in the author’s view, deals with the relation be-

tween cultural factors and mental illness and with the native ideas concerning mental illness. Thus, the traditional concerns of culture-and-personality re- search (or, in Hsu’s phrase, of psychological anthro- pology) are redistributed in this scheme, some of them falling outside of it altogether. This is also seen in Bastide’s claim that each of these fields has its characteristic methods, statistics being the primary tool of sociology and the case history that of psy- chiatry, whereas anthropology is characterized by its concern with that which is “different” or “other” (a&ri16) (p. 60). Clearly, anthropologists have en- gaged in statistical work and in analyscs of life histories and not all their studies have concerned the “other” or exotic.

The body of Bastide’s book is a broad survey of a large number of specific studies in the sociology of mental illness. Most of these were carried out by sociologists in the United States. They cover such broad categories as ecology and rural urban differ- ences in regard to mental illness, ethnic and religious differences, and family structure and familial status. The review of this vast literature is compact, com- petent, and useful. However, as the author points out, the studies under review are highly specific and diverse, each with its own methodology and assurnp- tions. There are virtually no replications, and it is generally impossible to draw any conclusions from these microscopic investigations with reference to any larger macrocosm. While this approach charac- terizes American sociological research, it is not unique to it, and in addition to some British studies, some German and French studies under review show the same pattern.

Part of the difficulty of producing generalizations from this scattering of small studies (“une poussikre d’dtudes” the author calls it) resides in the divergent theoretical orientations of the researchers. Bastide turns to Ruth Benedict’s classic paper, “Continuities and Discontinuities in Cultural Conditioning,” to suggest a resolution of one argument among students of neurosis. He sees Benedict’s approach as permit- ting the development of a “true theory” which would reconcile the difference between the psychoanalysts who explain neurosis through infantile experience and those who see its sources in the structure of modern society. Benedict’s thesis, he tells us (p. 217), helps us to understand how the social effects are added to the earlier effects of the family on the indi- vidual. Thus i t is the discontinuities of modern society that bring about neurosis, whereas there are continuities in many primitive societies and con- sequently no neuroses. This sweeping assertion goes indeed beyond Benedict’s claim.

To escape from the microsociology of empirical, statistical studies, Bastide proposes a structuralist study of mental illness, which takes its point of de- parture with Durkheim (p. 229 ff.) and Mauss in the concept of the symbol and which finds its elaboration in the work of LCvi-Strauss. In the work of the latter

Book Reviews 173

he finds the suggestion for a study of the interrela- tionship between the normal and the pathologic within “organized wholes” (p. 232). This refers both to the symbolic activity involved in mental illness and to the place of the deviant within the social system. Thus the mentally ill may be considered as providing a synthesis, a middle term, between the contradictory elements of the system (p. 251); a middle term which is required by the dualism of structural analysis. “The role of the sociology of mental illness . . . consists in emphasizing this third term, that is, to relate the ‘madman’ and those who treat him to the total field which defines both the criteria of madness and those of recovery” (p. 256). Since collective consensus defines the madman and his recovery, this appears to be a strong statement of cultural and social relativity of the “normal” and the “abnormal,” yet elsewhere (pp. 78-79) Bastide sides with Devereux against Benedict on this issue.

In summary, modern science is seen as having made three contributions to the sociology of mental illness, two of which come from structuralism and one from both history and ethnology. Structuralism, in addition to viewing insanity and the insane as part of a social system, also provides a concern with formal qualities rather than an emphasis on content. Here, however, Bastide finds a difficulty in the manipulation of metalanguages by the insane and in the retreat by schizophrenics into silence and gesture language, which structuralism has not yet learned to treat. The contribution of history and ethnology is seen in the variability, which it reports, of illnesses in relation to myths and beliefs, so that delirium and delusion may be seen as integral parts of collective representations (p. 263).

The book is rich in allusions, suggestions, and leads, in addition to its extensive review of the litera- ture, and only an indication of this wealth of ma- terials has been possible here. A bibliography and an index, in addition to the large number of footnotes, would have been helpful.

Magic, Faith, and Healing: Studies in Prirnitiuc Psychiatry Today. ARI KIEV, ed. Foreword by Jerome D. Frank. New York: The Free Press of Glencoe (Macmillan), 1964. xvii, 475 pp., chapter notes, figures, index. $7.95.

Approaches lo Cross-Cultural Psychiatry. JANE M. MURPHY and ALEXANDER H. LEIGHTON, eds. Ithaca: Cornell University Press, 1965. xxvi, 406 pp., biographical notes on contributors, 2 charts, 5 figures, index, 8 tables. $9.75.

Reviewed by EDWARD STAINBROOK, University of Southern California

The collected diverse contributions in these two books attempt to apply Western psychiatric theory and epidemiologic methods to an assessment of psychiatric disorder and treatment in several differ- ent preindustrial societies. The theoretical and

methodological adequacy of the various studies ranges from the journalistic reports of, as Dr. Leigh- ton would have it, “itinerant psychiatrists” to the thoroughly reasoned and carefully validated work of full-time, field-studying scientists.

Murphy, Leighton, and their collaborators assume that there are universally occurring forms of devi- ance, especially the mentally deficient, those persons who indiscriminately kill others, those who behave with uncontrollable excitement, and those who evidence severe senile deterioration. The authors give a very clear and relatively unequivocal West- ern classification of the diagnostic clustering of symptoms that would seem to be usable in almost any culture.

For the evaluation of the more culturally deter- mined and situationally responsive psychoneurotic and psychophysiological reactions, a screening in- strument utilizing basic questions regarding health and subjective feelings and perceptions of body- functioning is used in some of the reported studies.

Edward Thomas, in his discussion on the use of physiologic indicators to detect psychiatric disorder, points out that emotions are symbolically organized physiologic reactions which respond frequently to stimuli from a psycho-social-cultural environment. Hence it should be possible, using certain inter- vening variables, to arrive at a correlation between the presence of such stimuli and the existence of what is conceptualized as individual psychiatric disorder. Thomas also offers a provocative sug- gestion for the use of blood serum pooling techniques to assess physiologically the emotional state of a social class or other definable group in a society.

One of the basic and significant themes of the Murphy and Leighton work is the correlation across cultures between psychiatric disorder and socio- cultural disintegration, rapid acculturation and low socioeconomic position. In general this correlation seems to hold particularly for those psychiatric problems diagnostically labelled as personality or character disturbance, psychoneurotic and psy- chosomatic reactions. But this is precisely the area where the orthodox disease model may have to be altered drastically by social decision, not only be- cause it may be an illogical and misleading con- ceptualization of deviance, but also because the effective “therapeutic response” to such deviance is not medical psychiatric treatment but intelligently informed social and political action.

In fact, my only quarrel with the scholarly thoroughness and comprehensive adequacy of Leighton’s work is the implicit and explicit ad- herence to a disease model of psychiatrically-defined deviance.

Ari Kiev’s compilation of studies on what he suggests is “folk psychiatry” is a widely-sampling report on psychiatric theory or practice in many societies. The confessional practice of American Indians, magic healing in Central India, psychiatric