Cultural Illness and Health jq085n503

Table of contents :
Title Page
Copyright Page
Table of Contents
Dedication
Preface
Introduction: The Culture of Health
PART I: ETHNOGRAPHY IN THE AMERICAN SCENE
Anthropology and Mental Retardation
The Ethnography of Crime in American Society
Ethnography and the Addict
Before Divorce: Some Comments About Alienation in Marriage
PART II: LIFE CYCLE COMPARISON
Altruistic and Egoistic Behavior in Six Cultures
Psychiatry and Anthropology: The Individual and His Nexus
Contributions of Cultural Anthropology to the Study of the Aged
Tranquility for the Decision-Maker
PART III: SOME THEORETICAL CONSIDERATIONS
Mental Health Research and Out-of-Awareness Cultural Systems
Sociolinguistic Approach to the Relations Between Language, Society, and the Individual
Cultural Constructions of Reality
Primate Field Studies and Scoail Science
Epilogue
Contributors
Index

Citation preview

ANTHROPOLOGICAL STUDIES \ DAVID H. MAYBURY-LEWIS, Editor

Number 9

Cultural Illness

and Health

essays in human adaptation

edited by LAURA NADER and THOMAS W. MARETZKI

Published by the | | AMERICAN ANTHROPOLOGICAL ASSOCIATION 1703 New Hampshire Avenue, N.W. Washington, D.C. 20009

| Library of Congress Catalog Card Number: 73-8513 Copyright © 1973 by the American Anthropological Association. All rights reserved. Contents may not be reproduced in any form or by any means without prior written permission from the publisher. Printed in USA.

Contents Preface 2... ee ee eee eee eee eee ececes Lhomas W. Maretzki vii Introduction: The Culture of Health ............................. Laura Nader 1 PART I ETHNOGRAPHY IN THE AMERICAN SCENE

Anthropology and Mental Retardation .................. Robert B. Edgerton 11 The Ethnography of Crime in American Society ............ James P. Spradley 23

Ethnography and the Addict ............................... Michael Agar - 35 Before Divorce: Some Comments About Alienation in Marriage .. Paul Bohannan 43

PART II LIFE CYCLE COMPARISONS . Altruistic and Egoistic Behavior in Six Cultures .............. 0.0... .. 000 eee Lace eee eee eee eeeeee es... JOhn W. M. Whiting and Beatrice Blyth Whiting 56 Psychiatry and Anthropology: The Individual and His Nexus .... William Caudill 67 Contributions of Cultural Anthropology to the Study of the Aged . Margaret Clark 78

Tranquility for the Decision-Maker .....................2....+... Colson 89 PART III SOME THEORETICAL CONSIDERATIONS

Mental Health Research and Out-of-Awareness Cultural Systems ......£. T. Hall 97 A Sociolinguistic Approach to the Relations Between Language, Society, and Cultural Systems ............. Claudia Mitchell-Kernan and Keith T. Kernan 104

Cultural Constructions of Reality ...................... Roy G. D’Andrade 115 Primate Field Studies and Social Science .................... 8S. L. Washburn 128

Epilogue .. 0... . ee eee eee ee ee eee eeee eee. Lhomas W. Mareizki 135

Contributors 2.0... ee ee ee nee eee eee eee e nes 138

Index 2... ee ee ee ee eee ete eee eee ees 141

To Margaret Mead and the memory of Clyde M, Kluckhohn, for their view of anthropology as a study meant to benefit the public interest

Preface : WHAT DIFFERENCE does anthropological knowledge make to mental health? A group of

anthropologists sought to answer this question at a conference on Anthropology and Mental , Health at the Center for Behavioral Studies at Stanford in October 1971. The participants— anthropologists, psychiatrists, and mental health administration officials—met for discussions and reflections stimulated by the papers printed in this volume.

As conveners of the conference we feel that an answer to this question is of considerable importance to a broad public. It is of special importance to consumers who draw on mental health services. We assume that they would like to be assured that basic knowledge produced is applied to

the solution of life problems. Answers are of equal importance to those who generate such knowledge—the anthropologists in this case—unless we assume that anthropologists have no purpose in carrying out their research but to satisfy in a very personal and narrowly professional sense their curiosity about human beings and their search for better theoretical constructs to explain behavior. Unlike fields closely related to anthropology such as sociology and psychology, in anthropology there is no true clinical branch. It may be just this lack of clinical involvement which brings into question the value of anthropology in the concerns of politically influenced and

bureaucratically administered mental health programs. So the question is not only whether anthropological Knowledge makes a difference, but of what use can an anthropologist as a professional be in mental health concerns? The objective of the conference was to present some products of anthropological thinking and research which illustrate contributions anthropologists can make to concerns with mental health. At the same time, the conference offered an opportunity to solicit responses from mental health administrators about their receptivity to such ideas applicable to policy issues and administrative

concerns. |

Anthropologists and psychiatrists have maintained a long-standing relationship based on their common interest in human beings and their behavioral varieties. Malinowski’s testing of Freud’s generalizations, Kroeber’s arguments with Freudian assumptions, Sapir’s references to the need for

anthropology to work with psychiatric knowledge and, later, Caudill’s study of a psychiatric hospital, and other explorations of this relationship, are well known. A recent publication has addressed itself directly to The Interface between Psychiatry and Anthropology (1. Galdston,

1971). A good deal has been said by anthropologists and to anthropologists about the . contributions of psychiatric theory and knowledge to anthropological thinking. Much less has been

communicated to psychiatrists about the potential contributions by anthropologists to their medical field. When the National Institute of Mental Health was established, anthropology was one of the Behavioral Science disciplines for which a research training program was established. This program has had a major practical and positive impact on the anthropological profession, and some of the products of this program are represented in the papers in this volume.

Anthropology is a discipline which produces knowledge about human beings in the form of descriptive data and theoretical explorations. Most of its practitioners are basic researchers and teachers. Anthropological products are essentially addressed to those within the discipline, or to

those outside who are interested and prepared to digest the products of the discipline. The presentation of anthropological materials is usually made in a format appropriate to disciplinary needs and traditions of the field. Psychiatry, on the other hand, is a medical field concerned vii

primarily with the prevention and treatment of mental disorders and, by implication, with any basic knowledge which helps to meet these practical, medical, and therapeutic goals. Psychiatry produces its own basic research but leans heavily on results provided by other specialty fields. While there are many different ties linking anthropology and psychiatry, the shift in psychiatry,

from predominant concern with the individual patient to the patient as a member of the __.. community and the role of the community in response to psychiatric problems, has opened a - broad area of natural overlap. To a considerable extent the papers presented in this volume relate to issues pertinent for community psychiatry. Anthropologists use an approach to understanding human behavior which needs reiteration: they are aware that even as anthropologists they enter the community with notions, concepts, or categories which are taken from their own community, both in a professional and personal sense. Although not native born or permanent immigrants to the community or social grouping they study, anthropologists try to learn about the group as would any member born and reared in it or who joined it as a permanent resident. This gives the anthropological approach a uniqueness which results in giving a special place to understanding from inside the community. Anthropologists share with ethnologists observational techniques which require extended participant observation and participation. They differ from the students of animal behavior in that all kinds of factors stemming from the special nature of humans, including the fieldworkers’ personality and the reactive potential of those studied, must be taken into

consideration.

As a result of this knowledge gained by acting as a member of the community who has been socialized into the ways of the community, anthropologists have learned that their knowledge ofa culture may as yet be limited, or always remain limited, but minimally they have learned to. ask better kinds of questions. So people can answer in terms meaningful to them. To illustrate this point during the conference discussions Agar quoted Frake in an exchange with a psychologist: “When you ask a question and people laugh you are likely to say: ‘Why do you laugh, this is serious business?’ When I ask a question and people laugh, I am likely to say: ‘Is something wrong with the question?’ But anthropological learning about the community and abstraction of what is learned goes beyond the knowledge of the indigenous or immigrant resident. Anthropologists abstract “‘rules’’ by which people operate. While it is still a much debated problem within the discipline—to what extent do anthropologists “‘get inside the heads’ of community residents, where they can actually tap cognitive processes by which people operate—it must be understood as © a basic commitment of contemporary social anthropologists that they attempt to recognize or delineate the principles according to which persons operate as members of a group. The analogy with providing a “‘map”’ of the culture has been used, as well as many others. It is probably in this area of anthropological endeavors that communication with psychiatrists is of greatest importance. There may be a lag in understanding of what anthropologists—especially: those with a psychological ; Orientation—can offer to psychiatric concerns. While the culture and personality approach which is most widely known among psychiatrists continues to hold an important place in anthropology, the ‘cognitive approach has profound significance for mental health. Culture is viewed as, and equated _ with, shared cognitive processes, and the determination of reality or the structuring of reality is

filtered through cultural lenses. ,

The papers presented in this volume illustrate anthropological approaches and their products. These products do not always satisfy specialists in the clinical professions, at times because they imply so much relativism that the road to practical applications seems obscure. But psychiatrists, especially, will appreciate the importance of an approach which presents a reality as people experience it, and so it may not be considered too ambitious if anthropologists claim that their

primary contribution to the field of mental health may well be reality construction and the development of special methods which aid in the construction of reality.

. Above and beyond this, the communications emphasis in anthropology is of relevance to . mental health problems. Anthropologists and psychiatrists have studied singly and in cooperation with each other the out-of-awareness behavior systems such as the use of space, or more generally the handling of time/space relationships. These culturally influenced dimensions are of basic + significance in the physical and social environment of “‘healing’’ efforts in mental health, and as viii

well in establishing better communications across cultural groups, or, as Claudia Mitchell-Kernan put it in discussion, in permitting better personal adaptation across the symbolic gap. The use and application of testing and the consequent labeling of people is also of concern to

anthropologists. People construct reality in terms of cognitive processes characteristic of their community, and this may include communities not usually thought of in such terms, such as the community of drug users, people who are tied together by the common use of alcohol, and other | groups characterized by special behavior or symbolic sharing. The way people construct reality often affects performance” on psychological tests. Anthropologists are not alone in decrying the overgeneralizations of IQ tests, and the serious abuse to which they have been put—often with the best of intentions—and psychiatrists are also aware of the pitfalls. But we are in need of some diagnostic devices by which symptoms can be abstracted and brought into a common frame of reference. Only now do we begin to see some serious and systematic work in cross-cultural

cognitive development and cognitive abilities. It needs to be stated that anthropologists do not deal only with people at the level of

~~ “understanding” their culture. They share with psychiatrists and other professionals working directly

with people the awareness of primary human interaction processes. They realize that their work depends on the quality of relationships with members of the community in which they study, and their ability to communicate with other individuals who are members of that community. While this is quite basic, it nevertheless has important implications which ramify widely. Anthropological research entails consideration of an ethical nature: the relationship of researcher and “‘informant”’ or research subject is so intricate that its full significance at this time is hardly fully recognized by all anthropologists. What is it anthropologists learn about events which may have detrimental implications, moral or legal involvement of a nature which concerns other individuals? Several papers in this volume, although not directed toward these ethical questions, give an idea of such situations. The drug scene is illustrative of the ethical problems at the present.

But, unlike priests and psychiatrists, anthropologists do not have the legal protection, nor do they | have clearly delineated ethical rules which govern their profession at the present time. These and other issues are directly or indirectly reflected in the papers presented in this volume. | As the conference participants explored potential contributions of anthropology for mental health concerns, ‘there was general consensus that_the most important and appropriate contribution would-be-basie-researeh: Where anthropologists play roles as teachers in medical settings, or even as consultants to the medical and mental health professions, their roles become more vague, both in

the eyes of health professionals and in their own estimation. There is a need for a continued dialogue between psychiatrists and other mental health professionals about anthropological participation in teaching and services, but this conference did not pursue this topic. These papers,

we hope, will open further communication channels between anthropology and mental

health-related specialties. 7 All the papers in this volume were presented at the conference. In addition, a number of psychiatrists, anthropologists, and psychologists attended, and their direct participation served to make the experience varied and stimulating: Herman Bleibtreu, William Davenport, George Foster,

Robert Levine, Anthony. F. C. Wallace, and Irving Zaretsky from anthropology; Herant _ Katchadourian and Ronald M. Wintrob from psychiatry; and Paul Ekman from psychology. We thank the many others who attended the conference; in particular we express our appreciation to the National Institute of Mental Health for its generous support of the conference, to the American Anthropological Association for administrative support, and to the Center for Advanced Study for

their warm hospitality. Our special appreciation goes to the many members of the Cultural Anthropology Review Committee and to Bela Maday and Kenneth Lutterman of NIMH who contributed in numerous ways to this conference and to the solution of problems that extend beyond the conference. In addition, we thank Mrs. Anne Brower for editing the manuscript, and Ms. Gay Englezos and Judy Gunton for care in typing of the work. All in all, the experience has served to remind us all of the value of stopping more regularly to assess progress in our field, and to communicate what we have been doing for the benefit of the general public. Thomas W. Maretzki ix

Introduction: The Culture of Health’ LAURA NADER UNIVERSITY OF CALIFORNIA, BERKELEY

WHY WOULD ANYONE write a book entitled The End of Medicine? Yet, someone has.” Quite

often of late in newspapers, we find talk of the patient’s rights, the doctor’s accountability, mothers wishing to have their babies at home, lawyers’ groups bringing lawsuits on behalf of mental patients, and even an experiment to “prove’’ what apparently is well known among psychiatrists: judging who’s crazy and who’s sane is far from being a clear cut business. Among the general public there is talk of community medicine and folk herbal cures. People are beginning to question _ whether science should have a monopoly on answers to health questions. Acupuncture in China and psychotherapy among African tribes are only additionally unsettling that which has been considered for the past few decades as the health field.

Perhaps the major contribution of the social sciences, and particularly we would argue of anthropology, is a broadening of our conception of what the health field comprises. If an Indian takes his problem to a village judge, does he have a legal problem, a mental health problem, a medical problem, or does it matter? Doctors in the US are faced with thousands of middle-aged women in menopause; are they dealing with a health problem or a social problem? Do consumers,

powerless to be heard, have mental health problems or economic problems, or both? Our problem-solving expertise has become so specialized in this country that the result is at best confusion. Drunks (that is, those that cannot pay bail) are “treated” by jailers. Judges are supposed to decide who is mentally retarded. Doctors try to solve a woman’s social role problems

at menopause with hormones and tranquilizers. Lawyers act as mental therapists. Companies deal ) with consumer problems by means of advertising gimmicks. The outcome is all too often incompetent diagnosis and treatment or well intentioned bungling. It is simply true that we have no clear way to evaluate whether a professional is successful or unsuccessful because of, or in spite

of, his expertise. so

The consequences of inadequate treatment are recidivism, as with drunks and others jailed on criminal charges; loss of self-reliance, as with women who learn to depend on tranquilizing drugs; loss of income, as with consumers whose problems are handled cosmetically. Or, on the other hand, people under stress become creative problem solvers, as do mentally retarded individuals who are caught in the system. In some cases, the creative problem solvers are the professionals who -study the victims of “‘the system.”’ Such is the subject matter of this volume.

| THE EXPERT DILEMMA ] Anthropologists at work try to get as close as possible to the people they are studying. This usually means that we often live with and observe and participate in the life of the people we

study. Leaving to one side how successful we are, the aim of such closeness is to gain an understanding of a people. For anthropologists, the people being studied are the specialists in what we, as students, are attempting to learn. Such a perspective is particularly crucial in this age of professionalization: the view of the system from the bottom up, from the inside out, so to speak, is often not understood by the professional by virtue of professionalism which usually confines the expert to a narrow sphere. This is the expert’s dilemma today; this is the dilemma of modern day 1

2 CULTURAL ILLNESS AND HEALTH [AS9 [organizations and one that is being “faced” in a variety of mini experiments in this country. In China the problem evoked governmental policy which brought leaders in regular and participatory contact with the grass roots workers in order to arrive at better solutions. The experiments being conducted in the United States are few and usually described in anecdotal form: Pan Am has its

executives behind the desk for two weeks every year; Procter and Gamble is trying its hand; education at the National College of State Trial Judges in Reno is getting the judges into the jails. At the Reno gathering a half-dozen judges were “‘busted”’ on trumped up charges in order to expose them to realities of jail—often for the first time. The judges were arrested and jailed. Since

this ‘“‘busting” experience was videotaped, we could follow the reactions of the judges from their protestations: “Do you know who we are?” “Why, we'll have your jobs.”’ And the first judge who entered the “‘drunk tank”’ shouted at the top of his voice, ‘“Where’s a chair, where’s a goddamned chair?’ When this judge was asked what else he had learned, he noted: ‘““Those fellows kept coming up to us and saying, ‘What are you guys doing in here, you got money.’ ”’ After twenty years on the bench, this judge and others like him were unaware that there were no chairs in jail and that the only people who end up in the drunk tank are usually those who don’t have twenty dollars or so for bail. It may be inferred generally that judges are totally unacquainted with the system into

which they routinely thrust people. At least judges have not had enough experience to equip themselves with the empathy and knowledge necessary for understanding and evaluating the

. / consequences and effectiveness of their actions. Ethnography may be one way to inform ~~ | “4 professionals of the range within which they are functioning so as to allow them to take \ responsibilities for the consequences of their professional actions. Another aspect of the expert dilemma is the belief of the expert and often of his or her client that only the expert has the answer. The expert is not perceived amidst a plethora of alternatives. Not long ago a Mexican girl working in the United States began to exhibit symptoms of severe

depression and paranoic delusions. The family for which she worked consulted an American psychiatrist who recommended that she immediately be returned home. She was from a low income family, but with outside help she was taken to a Mexican psychiatrist with whom she did not continue long due to eventual financial strain. She was then committed to an institution for a short period, only to return home simply to exist around the house; by then she was in a rather impaired state of health. Her mother continually sought help from people whose services she could afford: curers or witches. Three years later, this girl was healthy and again a functioning member of society. As her story unraveled, one had the uncomfortable feeling that if this girl had been committed to an institution in the United States she might still be there. As it was her family simply said, ““She was sick, and now she is well.”’ Her sickness was viewed as temporary; the stigma

-was not permanent. One may well ponder about the value for society of alternatives which range : from psychiatrists to witches; we may also wonder about this girl’s constant associations with ‘“‘normals,”’ and about her family’s underlying assumption of mental illness as a passing temporary = | phenomenon. ETHNOGRAPHY IN THE AMERICAN SCENE

This volume, which basically is challenging assumptions underlying concepts of health for individuals and for society, opens with a series of essays on Ethnography in the American Scene. All of these papers deal with topics which on the American scene are viewed as “‘social problems”

or crimes: mental retardation; drug addiction, including alcoholism and heroin; and divorce. Despite the fact that research on these very same social problems has been carried on for decades

and about which there is a massive literature, each anthropologist has made a singular contribution. For those who know very little about mental retardation, Robert Edgerton’s contribution is a ) fascinating introduction because he is so skillful in recognizing and dispelling the false impressions that most of us who know little about mentally retarded people—and some of us who know a great deal about them—usually harbor. Of particular interest is the information regarding the degree of diversity in mental acuity in those lumped into the category “mentally retarded,” and the ability

Nader ] INTRODUCTION 3 of people who are supposed to be ‘“‘retarded.” People who are not supposed to have a very clear-cut sense of time and place have a very impressive ability to get to the right place at the right time when they are highly motivated. It is impressive that Edgerton carried his study of hospitals for the mentally retarded and the details of institutional life into the post-hospital phase. It is rare that such studies are made; medics in general, and lawyers as well, rarely concern themselves with that ‘“‘post period.”’ (Lawyers, for example, will do a tremendous amount of research prior to

advocating legislation, but once the legislation has passed they appear to be uninterested in following up on the consequences of what they have done.) Edgerton’s hospital study is very important in raising questions as to how these people adjust. His post-hospital study makes an interesting comparison between people who are indeed stigmatized by society as Edgerton points out, and criminals who are also stigmatized. The mentally retarded were able to make it in society

very often by virtue of what Edgerton calls their benefactors, people who help them out; the ex-con in our society is less likely than the ex-mental patient to have the same kind of benefactors. Edgerton’s work raises further questions having to do with the use of intelligence testing, and the ; -understanding of intelligence in its cross-cultural perspective. The problem of testing in general, | from the IQ to the Princeton testing service, and the effect that psychological concepts of testing

have had on developing or inhibiting the potentialities of peoples, is one which for this anthropologist takes us from the peripheries—the primitive society and the world of mentally retarded—to the center. Neither Edgerton nor Spradley were studying communities in the traditional sense, but what they have done is nonetheless anthropological. They were applying the ~ kind of wholeness and contextual perspectives that anthropologists bring to their subject matter, a perspective that we learned first by studying small communities. ) James Spradley set out to study public drunkenness. People have worried about the problems of drunks for a long time in the United States. The amount of police time spent on enforcement of , drunk laws is extraordinarily high in some communities. For example, in Spradley’s Seattle, some 70% of police man hours were spent on processing drunks. Spradley wanted to study the problem

, of drunkenness from the point of view of the drunk. So he sat and watched the process of arraignment and sentencing at the municipal court; he spent time at the alcoholics treatment center; he messed around skid row. He learned their language, how they differentiate themselves first, then how they differentiate themselves from other people. How, he asked, did the language reflect what was happening to these men? How was what was happening to them affecting what happened to them in the future? The process which was supposed to be curative or preventive was, when seen from an insider’s point of view, so bad an experience that when you leave the jail you feel like you owe yourself a drink, and then of course, very shortly afterwards you are back in the circle again. He speaks about the mobility which is a consequence of the system of sentencing and the treatment of alcoholics at the treatment centers. Various factors keep these tramps moving, and

moving only serves to reinforce the drinking patterns. Spradley explores the cognition of the people that are being processed through “the system.” He focuses on how their thought structure works and how that affects what is happening to them. When Spradley made public his findings in a Seattle newspaper, the city council was led to repeal the laws for public drunkenness. A strictly scientific investigation in this case had immediate action consquences. Michael Agar deals with the heroin addict, and his work is a good example of the need for ' describing behavior from within the framework of the subject. The ethnographer enters into the -addict’s environs rather than attempting to understand addicts as intruders into the professional’s

world, as happens when we study addicts primarily from a series of office interviews. Agar elaborates two contradictory pictures of the addict. First, he is seen as a social psychological failure, and secondly, as a social success—a functioning member of the addicts’ subculture. As part of his study of addicts, Agar, like Edgerton and Spradley, looks through the eyes of his informants _

at the program designed to handle this particular social problem. The patient’s perception of the | effectiveness of the staff and program is clearly important information that needs to enter into the awareness of the professionals involved. And if professionals use such perceptions to improve their * work, they must not be defensive about them. Agar tells us, for example, that the addict perceives his interaction with the therapist as a confidence game. One may well wonder to what degree such

4 CULTURAL ILLNESS AND HEALTH [AS9 game playing is bound to occur when different value systems and class conflicts are characteristic components in the relation between professional and patient. What are the patterns of recruitment in and out of this subculture? What are the effects on drug abuse of the drug abuse centers that continue to spread throughout this country? Although this is an extremely important population, we only know about the few addicts who come to our attention through the traditional agencies. Our point is clear: the cross-cultural information on hard drug addiction and mental retardation is

nowhere as plentiful as materials on divorce. |

When Paul Bohannan began his work on American divorce in the early sixties, there was a very

large social science literature on the topic. However, at that time no social scientists had concerned . themselves with the aftermath of divorce in this country. Bohannan came to his study with a wide experience in divorce studies in Africa where divorce had been analyzed as to its processual nature.

, It was quite natural for him to ask then, “‘What happens after somebody gets a divorce?” He \ studied institutions like Parents Without Partners, and became interested in challenging the idea that divorce was necessarily dysfunctional. Although this idea was so predominant in the American literature, from the African data it was clear that divorce in specific structural contexts, such as | matrilineality, was not as devastating as divorce in an American nuclear family. Bohannan began to

' plot divorce networks and noticed that there was such a thing as the extended family based on

divorce. His life history materials also pointed out that people who marry for neurotic reasons may solve their neuroses and see no necessity for continuing the marriage. So he concluded that there’.

may be good reasons for divorce. The present paper deals with the Before Divorce scene in . American middle-class marriage. In a sense, Bohannan is trying to get at the alternatives that Agar was only able to allude to—what is responsible for certain kinds of alienation in marriage either leading to divorce or not leading to divorce. He is concerned with the process of divorcing or not divorcing. He is quite right in noting that American middle-class marriage is particularly subject to crises between spouses since they interact with one another at close range with a high degree of isolation from others. The fact of breadth of choice is a further complication. Bohannan argues

that, in a middle-class society where choice is ever-present, marriage must constantly be ‘“‘renegotiated.’’ His description of how crisis points build into major crises serves to remind us that the ability to adjust to the differing requirements of the life cycle is crucial to healthful living. This theme is constantly reiterated in the second part of this volume, which deals with the life cycle.

LIFE CYCLE COMPARISONS The four papers on life cycle deal with behavioral styles and generally with human adaptation. The first two papers by John and Beatrice Whiting and by William Caudill are the result of careful

recordings of behavioral interactions. The Ulark and Colson papers deal with developmental aspects of what Margaret Clark calls an ethnography of adult life; the focus is on human creativity and adaptation. The Whitings’ paper focuses on two types of behavior: altruistic as compared with egoistic behavior. They report on child interaction in six cultures for children three to six years old and for children aged seven to eleven. Altruistic behavior as they use the term refers to situations where

the “‘intended primary beneficiary of the action is some other person or persons.’ Egoistic behavior, by contrast, involves ego or the actor “himself primarily benefitting from specific types of behavior.” Girls are found to score higher on altruistic behavior in all six cultures; nuclear families are found to value independent (egoistic) behavior more than extended families; and cultures with extended rather than nuclear family structure produce children who score higher on measures of altruism than children from nuclear family structures. Furthermore, children who, compared with their peers, perform more domestic chores, are also found to help more with economic tasks and

spend more time caring for infant siblings, and these children score higher on altruism. The Whitings also found that increased cultural complexity with increased job specialization leads to decreased altruistic behavior and increased egoistic behavior. They consider that a culturally determined defense in complex societies against too great emphasis on egoistic behavior might be called “‘displaced altruism’’: missionaries have always been a part of Western society.

Nader ] INTRODUCTION 5 The Whitings point to the role of the school with its emphasis on individual achievement as a training ground for egoism and, secondly, point to the fact that modern industrial societies hinder children from contributing to the welfare of the family: they are not caretakers of infants, and, since the development of child labor laws, can no longer contribute to the financial well-being of the family. If the Whitings are right that we in America at least have failed to provide an arena for learning altruistic behavior, then maybe we have unwittingly set ourselves on a course that is from an evolutionary viewpoint mal-adaptive. In a world which is interdependent and shrinking by the day, surely altruism will need to be viewed as the ultimate form of egoism. While it is not clear how we decide whether a given item of behavior is altruistic or egoistic, the Whitings have raised

for us a most interesting problem that is central to success in preventive aspects of health services. If, indeed, girls are more altruistic and grow into more altruistic adults than boys, this is yet another argument for increasing the number of women in helping professions such as medicine. It argues as well for the importance of preserving altruistic training patterns among ghetto dwellers | at the same time as the ghetto is being brought “‘into the middle class.”’ _ - While the Whitings’ observations were focused on interactions between children, William Caudill

reported on his long-term study of maternal-child interaction in Japanese and American middle-class families. Again we have a very careful methodology which lends itself to replication. Caudill documents the crucially important observation that cultural patterning of behavior can be observed reliably in a three- to four-month-old infant. He has observed that American infants at three to four months of age display more happy vocalizations than Japanese infants of a similar

age and social class. Furthermore, American mothers demonstrate increased verbal and play interaction with their infants as compared with the more restrained Japanese mothers, and . American infants are encouraged to earlier individualization and increased assertiveness compared with Japanese infants. At age two and one-half, American children and their caretakers are more aggressive and express more hostile affect than Japanese children of the same age, and Japanese children of that age show more unhappy emotionality than their American peers. Dr. Wintrob was

quite correct in asking, ‘““‘What are the implications for adult personality suggested by the differences in childrearing Caudill has observed among middle-class Japanese and American families?”’ The process of studying childrearing is so intricate that professionals have specialized in different ages, with few interested scholars following the process right through. Certainly a theory

of personality development must be based on careful studies of all ages, but personality development is surely a phenomenon that continues on into adulthood. Caudill calls our attention to the fact that the time spent in caretaking and the time that children spend sleeping is the same in both cultures, but that the patterning and rhythm of both activities is quite different in Japan and America. His observations that in Japan the mother views the baby as an extension of herself, and that in the US mothers from the beginning view the baby as a separate and autonomous being, are central to understanding patterns of responsibility for others, and in particular for children in both cultures. Caudill’s observation reminded us of the story of the American mother who was rebuked by a friend for buying hotdogs; the mother replied, ‘“‘But I don’t eat the stuff.” ‘““Who does then?’ queried the friend. ‘“‘“My ten year old,” replied the mother. The papers by Drs. Clark and Colson are, as we mentioned, concerned with adulthood. Dr. Clark begins her paper by reminding us that there are now twenty million persons over 65 years of age in the United States. The aging problem, which has suddenly appeared from out of nowhere to

overwhelm us as a “social problem,” stems from the fact that the very society which made it possible for over a million Americans over 85 to be living today has also isolated these people from

any meaningful participation in the ongoing creative processes of life in twentieth century America. In the process of becoming an ever more age-graded society, we have segregated the old out of the living social system. Dr. Clark studies aging as a developmental phenomenon; at the same time she reminds us of the prevalent cultural concepts of aging, as dying, as decrement and

disengagement, as disease, as dependency and regression, as minority group. Dr. Clark’s observations are compelling: unlike societies where children are more often ill than older adults, in urban American society sickness is more frequent among the old than the young. Furthermore, in most of the industrialized world the elderly are the poor. In answer to her question, “‘Does aging have a future?’’ Dr. Clark focuses on ‘“‘healthy adaptations to old age” and cites case studies of

6 CULTURAL ILLNESS AND HEALTH [AS9 failure to adjust; e.g., “it is painful to think of life without work” or “I keep wishing I could do some good—be useful. But I know the answer: it’s the end of the road.” It is astonishing that we have eschewed the resources of the aging at a time when the needs for “‘helping’’ have been made

manifest in a variety of contexts, particularly the need for helping young children. Yet, in pushing the elderly out of the ongoing system, we have created the seeds for failure at attempts to healthy adaptation. Perhaps we need to find and analyze the success stories—the men and women who refused to be labeled as “‘useless appendages”’ in a society that also refuses to let them die.

That responsibility is often accompanied by stress does not come as a surprise to many Americans, particularly those for whom such stress was immediate precursor to problems in individual health. Dr. Colson, in her essay, is concerned with the question of the ‘“‘defenses that

people develop to allow them to live with responsibility.”’ Particularly she is interested in documenting how individuals cope with the consequences of having to make decisions involving the unknown future where risks cannot be calculated. She describes how the Gwembe Tonga of

Zambia learned to cope with the difficult and immediate decision that their land was to be flooded; that over 60,000 of them were to be uprooted and settled in new localities. Essentially she observes that in the face of increased uncertainty following relocation there was an increase in the appeal to traditional diviners. Faced with a situation of anxiety-provoking rapid social change,

the Gwembe attempted to deal with that increased anxiety by strengthening adherence to their traditional religious system. Dr. Colson contrasts the irritability of the Gwembe when faced by _ - ; uncertainty and drought with the way in which they learned to cope with this difficult experience and the euphoria with which they greeted the disastrous Zambezi flood of 1957. Colson points out that the emotional consequences for those who have to make decisions for an unknown future varies: “It is when people cannot agree on what is the right choice or when they cannot agree on what are the appropriate procedures for legitimating choice that decision-making becomes charged with emotion.”’ Systems of divination, such as characterized by her example of the British Coal Board consultation with statisticians and the Gwembe culture of the shades, function to give peace

of mind when people are faced with accounting for their decisions. Divining allows one to legitimate direction of choice. The role of tension and anxiety-provoking patterns certainly affects the procedures and qualities of the decisions themselves; this fact needs to be met head on by those who would wish to improve decision-making. Colson’s experience is also an elaboration on the explanation of modern day tension as a result of slow physical evolution accompanied by rapid

social and cultural change. :

Part III of this volume raises theoretical questions that are not specifically discussed in the previous papers. Space, language, methods and cultural constructs, and evolution are the central topics. EK. T. Hall, who has led the way in elaborating the importance of the cultural paradigm for the layman and interested professionals, notes the slowness on the part of physicians and others to © recognize the relevance of spatial arrangements in health care. He takes a basic cultural system—the _

spatial one—and illustrates the relevance of space to mental health, particularly as used in institutional settings. One of the examples he uses is a large mental hospital outside Paris where ‘“‘milieu therapy’’ is practiced. This involves introducing patients over a six-month period to a variety of settings ranging from a very simple social setting to a more complex “‘village’’ with its attending complexities. He argues that the altering of space, time, and social relations is crucial in the treatment process, since patients are labeled psychotic on the basis of perceptual aberrations. Hall tells of the psychiatrist who treats patients who cannot distinguish their own boundaries from those of the rooms they are in by putting them in larger and larger rooms until the patient can no longer “fill” the room. He speaks of the rearrangement of furniture in a Saskatchewan geriatrics

hospital as a way to decrease the deterioration rate of the patients, and the meaning of territoriality for people living in institutions. The importance of time, space, and social systems in organizing human life is complicated by the fact that our paradigms of these topics are drawn from non-verbal and out-of-conscious awareness. Only by observing and analyzing microcultural events can we understand communication processes in the broadest sense. This is the kind of information which the informant could not confirm because it is out-of-awareness and not retrievable; as Paul Ekman points out, it is not known by the informant on any level that can be symbolized.

Nader ] ~ INTRODUCTION 7 Recent developments in linguistics emphasize speech behavior and language use, rather than linguistic structure. Claudia and Keith Kernan see language behavior as an important resource. From a reading of Hall and D’Andrade, one could question the Kernans’ total focus on verbal

communication; they do point out, however, that while language has to do with meaning, meaning does not derive from linguistic structure alone. The parts of the paper directly important

to mental health questions have to do with the way that semantic misinterpretation can occur through the misapplication of rules of speech. The Kernans suggest that the great number of speech communities of different sizes and degrees of integration that exist in our culture is in part related to misinterpretations. In order to avoid misunderstanding between members of different speech communities, perhaps people need to develop a greater understanding of verbal repertoires and sociolinguistic rules of various speech communities. This is an open question; it is obvious that we need to notice or recognize that there are differences in language within the United States. In

the Middle East, for example, people are attuned to dialect diversity. Without knowing verbal repertoires, they at least recognize that there are differences. In the United States we often assume that there is one dialect—whatever it is that we are speaking. Thus, we present the example of the defendant who was asked, ‘“‘Have you ever been in a penitentiary?’ and answered, “‘No sir, but I worked on a boat once’’; only to have the district attorney pursue by, “‘But it says here you’ve been to San Quentin.” “Yes sir, I’ve been to San Quentin.’’ The jury was full of speculations as to the incomprehensible response to questioning; he was lying, he was an idiot, he was trying to confuse

matters. Only the bailiff-anthropologist realized that to some degree the dialects used in the courtroom were mutually unintelligible.

All of the papers in this volume clearly point to the need for careful observation of human -behavior. Roy D’Andrade is chiefly interested here in the methodological problems of exactly how

one observes it. Specifically, he discusses the ways in which cultural tradition affects the construction of reality, and illustrates how this makes for ethnocentricity in the social sciences, particularly with respect to the testing of ‘‘intelligence.’’ Hausa children perform “‘poorly” on the

_ Kohs block design test; is it because they are genetically inferior or is it due to the waysin which these children construct reality? The story that D’Andrade tells is enormously important for all disciplines interested in behavior. When he describes for us the difficulty of reporting behavior, he is not just presenting something that is a problem for ethnography, but rather something which has implications for many disciplines. Is there a method of description that is free from the particular selective bias of how one constructs reality? D’Andrade’s suggestion is not that memory error occurs when people rate or rank other people’s behavior; the error he suggests is systematic and non-random. He is, by examples, calling into question a large number of social science studies in which, for example, correlations are based on questionnaires in which the respondent answers on the basis of his recollections. In using recorded law cases as ethnographic data, for example, we face the problem D’Andrade speaks about; in order to understand exactly what we are getting we need to know about the specific patterning of error which he mentions.

S. L. Washburn’s contribution serves to remind us of our biological heritage. He uses his knowledge of nonhuman primates to inspire new insights and emphasis in the observations of, experiments on, and interpretation of human behavior. For example, he points to the fact that sleep and play are time consuming behaviors among nonhuman primates, which must therefore have important adaptive functions which could only by observation and experiment be understood as to their biological and social consequences. In the area of language research, Washburn again points out that observation has to be complemented by experiment. Description alone was not able to demonstrate the fundamental differences in the biological bases of language between human and nonhuman primates: nonhuman primates communicate primarily emotional states; human primates communicate information of a non-emotional nature as well, and are, in addition, able to use symbols. As Washburn notes, major problems of primate communication can only be solved by understanding the interrelations of linguistic behaviors and their biological base. While the Kernans and E. T. Hall have stressed the importance of social setting and environmental settings for understanding communication, Washburn makes it obvious that biology cannot be ignored.

8 CULTURAL ILLNESS AND HEALTH [AS9 Play, in contrast to language, is a type of behavior that has received little attention, yet it has an important function as preparation for adult life, and its absence leads to serious consequences. Young primates see play as pleasurable learning. Washburn sees the lessons of primate research as thought provoking, particularly when contrasting the nature of play among nonhuman primates to those human institutions called schools. Washburn asks us to remember that humans are primate

animals with some of the same needs, and suggests that our schools are based on a misunderstanding of the nature of primate biology.

| FROM UNDERSTANDING TO NEGLECT

a shock:

If there is any single theme that runs deep throughout this volume, it is the idea that health is not simply the result of an individual’s state of being. Rather, the point is made over and over again that health is intimately connected with the way in which people construct reality; with the way in which communities, including administratively created communities, function; with the way in which health expertise works in the context of the nation. As both psychiatrists Wintrob and Katchadourian pointed out in their discussions, this observation came to psychiatrists rather as

As psychiatrists tumbled out of their offices into the community, these mental health : professionals found themselves blinking uncomfortably in the harsh and unaccustomed sunlight, unsure of their skills, not knowing which way to turn or how to contribute to the effort of solving those problems the community defines as related to mental health (such as

inadequate jobs, housing, education, and safety in the streets and corridors). |

Wintrob, continuing, pointed out that issues tied to change in the macro-society—whether defined racially, ethnically, medically, or legally—constitute the center ground in terms of community health. Anthropologists have long been concerned with the use and application of diagnostic testing and the consequent labeling of people. From their basic premises that people construct reality in terms of cognitive patterns characteristic of their community, it follows that anthropologists are

aware of the nature of problems as being traceable to the use of different concepts, including different styles of communication which result in mis-communication. They are also aware that —

different cognitive patterns often camouflage power differences. | :

It was the psychiatrists at the conference who pointed to this second and related theme that is the problem of psychiatric diagnosis. Katchadourian underscored a need when he said:

The circular definition whereby he who sees a psychiatrist becomes a psychiatric case is hopelessly inadequate. The vexing problem is how to distinguish mental illness from other

forms of deviance. Since we are likely to consider deviant anything that is rare, sick, immoral, and illegal, so many people get caught in one or another of these nets that further distinctions become meaningless.

It is a general perspective that we wish to underline in this volume: few problems involving humans can be defined and solved within the confines of any narrow analysis. Katchadourian thought that an evolutionary approach such as that used by Washburn would provide psychiatry with the beginnings of a conceptual framework within which behavior could be understood over its entire adaptive-maladaptive range. In addition to the evolutionary perspective, there is the

cross-cultural perspective which attempts to illustrate what anthropologists can do on the American scene. It is not overly represented here but underlies much of what was said. To take a mental health problem such as described by Margaret Clark among aged Americans and view this in cross-cultural perspective informs us about the degree to which our health problems are culturally defined; to take another problem, Zapotec Indian women, for example, did not know about ill health resulting from menopause, which for them was a time when one could enjoy sex without worrying about children; a time when their status and rank was rising rather than declining as among the majority of American women.

Nader] INTRODUCTION 9 Clearly, however, this volume does not cover the waterfront. There are other interests among

anthropologists who study health. We have spoken about the people who fill our mental institutions, our jails, and our addiction stations, but we have not spoken about people in our ordinary hospitals and the administration of those hospitals. We have spoken about people outside

of administratively created communities—mothers and their children in homes, couples in controversy, schools in trouble. We have not spoken about the predominant attitudes that Americans have vis-a-vis health.

As one example of a macro pattern in American health concepts, we might explore the place of preventive medicine, which is perceived in American medicine as part of Public Health and not as part of what goes on in private practice. If we look to the preventive side of health in the United States and ask what areas need adjustment so that health states would improve, we would haveto — understand the cognitive categories of professionals much in the way Spradley studies drunks.

What have been the consequences of ingrained medical cognitive patterns such as the one mentioned above? A discussion of prevention would lead us to talk about nutrition and environment and drug intake, about which there is no mention in this volume. No one is in a better position than the anthropologist to underscore what is perhaps the most important fact about the American diet and total intake today, namely, that no society in world history has ever eaten and been exposed to anything like it; it is an intake.untested by time, unknown in its long-term effects. Is the disinterest in prevention in private practice related to the fact that, in spite of being the richest country in the world, the United States has serious problems of hunger

and malnutrition and total intake? There are other facets of culture not represented in this volume. We need to explore further the

patterns of work and retirement that have been linked with specific mental and physical illness. There is the whole value system that ranks people as to their economic productivity and thus downgrades any sense of worth among the elderly. Evaluation studies are missing. We need to evaluate what it is that medical doctors are good at and where they are not so good: it has been _ observed that some people would be better off for not having seen a medical doctor, and doctors would have time for other patients if they did not see these people. We could look to the side effects of drugs and examine the system of testing and the cultural underpinnings of the system of inventing, testing, distributing, and producing a demand for drugs, which would allow us to look at the drug problem in broad aspects. We could study the relationship between patient and doctor

and understand what it would take to enable a patient to advocate for himself, which would

enable a doctor to know when his prescriptions are being followed. In such work the anthropologist would, of course, realize that the resolution and prevention of illness are everybody’s business in most societies, and would ponder how it came about that the patient has accepted a passive role vis-a-vis his own health state in the United States.

Urgency and outright advocacy are not apparent in the papers for the most part. The anthropologist, it has been pointed out, does not have a clinical base. He does not produce knowledge for his own immediate use as the clinical professions do. The anthropologist produces information, knowledge, and understanding, for the most part so that others may use this “gift.” The “gift,” however, is not always accepted, as was illustrated in many of the papers but most directly in Agar’s contribution. And this is where neglect and the double bind enter. We produce findings which may be used or not used by the managers or consumers in society. It always costs something to use social science findings. It cost the city of Seattle 500,000 dollars to replace the drunks with trusties in the jail system. It cost Agar’s addiction program loss of face. Edgerton’s findings undermine the very pattern of recruitment into hospitals for the mentally retarded. Washburn’s notion that schools run contrary to primate biology would have devastating effects on the administrators of schools, and on assigning budgetary priorities. We are not saying that all anthropological findings should be used. We are saying that findings should be verified and, if proven contributory in improving the standards of health in this country, the question should be put “why is our knowledge not being verified and used?” Anthropology was found to be of great importance during World War II. Madison Avenue has built a billion dollar industry on social

science findings. Therein lies neglect and the double bind. |

10 CULTURAL ILLNESS AND HEALTH [AS9 NOTES

‘In writing this chapter use has been made of the conference discussions by L. Nader, R. Wintrob, H. Katchadourian, and P. Ekman.

* Rick Carlson, lawyer, and fellow at the Center for the Study of Democratic Institutions at

Santa Barbara is the author of The End of Medicine.

PART | ETHNOGRAPHY IN THE AMERICAN SCENE

Anthropology and Mental Retardation' ROBERT B, EDGERTON THE NEUROPSYCHIATRIC INSTITUTE, LOS ANGELES

FROM ITS ‘‘CULTURE AND PERSONALITY” INTERESTS of the 1930s to the present day, anthropology has maintained an active and well-publicized interest in psychiatry and general issues of health. My own interests have often paralleled this course, touching upon general psychiatric concerns (Edgerton 1969, 1971a), specific examples of psychiatric symptomatology (1966), and psychiatric treatment in East Africa (1971b), as well as an assortment of similar concerns among Mexican-Americans (Karno. and Edgerton 1969; Edgerton et al. 1970; Edgerton and Karno 1971). I have also commented upon some more general health matters (1964, 1969). But these kinds of interests in anthropology are already amply demonstrated, as witness the presence within the discipline of both medical and psychiatric anthropology societies. Discussing my interests in these areas would add little, I fear, to what is already known of anthropology’s sizable contributions to the health sciences. Instead, I shall discuss mental retardation, a far less well studied health

problem. I shall do so not merely to report my own interest in this problem, but in order to illustrate the ways in which anthropological research in this seemingly medical problem can be of

benefit to the health sciences, and how such research may both utilize and stimulate basic

anthropological concepts and theory. | | MENTAL RETARDATION

The concept of mental retardation would have delighted Lewis Carroll, for under the rubric of inadequate intelligence it piles together a multiplicity of phenomena.and an unknown complexity of causes. Binet undertook to develop an IQ test shortly after the turn of the century in order to place the ‘‘mentally retarded’? on a continuum of relationship to the non-retarded population. Since that time, the IQ criterion has usually served in the US as the legal and medical criterion of mental retardation and it, almost alone, has unified the field. Basing their understandings upon Gaussian assumptions of the “‘normal”’ distribution of intelligence, it is estimated that some three percent of the population is retarded. The upper limit for a retarded IQ varies from place to place and situation to situation, but with rare exceptions it falls between 70 to 80, with 70 being the

most common. Recently, especially with the impetus of the 1961 definition by the American Association on Mental Deficiency, recognition has been given to the need for an additional criterion—impaired adaptive behavior. While scales of adaptive behavior are under development,

they are not yet fully standardized or widely used. .

In 1959, when my own research in mental retardation began, the history of the field had progressed from early abuse and eugenic frenzy, through a long and dreary period of benevolent custodial confinement, to a newly won concern with therapeutic intervention (Doll 1962). Study of the problem was undertaken almost entirely by psychologists, educators, medical men, and ancillary professionals such as social workers. Social scientists, who were devoting so much effort to the study of mental illness, regarded mental retardation as a dismal and irremediable medical problem, and consequently ignored it. Thus, when I entered the field there was little or nothing of

a sociological or anthropological sort available (Farber 1968). | My first and most vivid impression of the population designated by the label ‘‘mental 11

12 CULTURAL ILLNESS AND HEALTH [AS9 retardation’ was extreme diversity. Even the etiology of their impaired intellectual performance and adaptive behavior seemed to represent the full range of social, cultural, psychological, and biological phenomena. To illustrate this diversity and complexity, I shall take examples from my research with severely, moderately, and mildly retarded persons.

| THE SEVERELY RETARDED The severely retarded—or “idiots” in an earlier, more pejorative nomenclature—probably number over 100,000 in: the United States. Such persons have IQs that measure below 20; they

possess only rudimentary speech, require constant care, and are characteristically physically , handicapped. They are the most profoundly damaged of mental incompetents, and most of them, now as in the past, live out their lives in large institutions. Yet, the scientific literature contains virtually nothing about the daily lives of such persons. A psychologist, Craig MacAndrew, and I collaborated in examining the lives of such persons in a large state institution (1964). What we found was shocking: a ward filled with nearly 100 men, most of whom were partially naked, some entirely so. The appearance of many was bizarre, even grotesque, with heads too large or too small,

faces that were asymmetrical or contorted, and bodies that represented every conceivable malproportion and malfunction. These bodies moved about in an atmosphere that smelled overpoweringly of kitchen cleansers, soap, disinfectant, feces, urine, sweat, and too many human -

bodies closely confined. The world of sound was equally strange. Mouths opened and sounds . issued, yet few were understandable. Instead, there were screams, groans, howls, and cries, which

united with the raucous music of the loud-speaker system to produce true cacophony. Some individuals stared glazedly while they rocked back and forth; other moved about in great animation, flapping their arms, twirling rags, uttering unintelligible sounds, and occasionally masturbating. Others lay on benches or on the floor, sleeping or staring fixedly at nothing. To

encounter these people and then to think of them living out their lives in this apparently meaningless manner was frankly appalling; especially so, when the cost of such institutional care was considered, and when it was realized that the patients we described were ambulatory and thus far more competent than a great percentage of fellow “‘idiots’” who are completely infirm and must endure their lives in a hospital crib or wheelchair. More appalling still is the realization that at

mentally retarded. .

least one child out of every 1000 born in the United States will be, just like these, severely Dismal, indeed, is this picture of mental retardation. But even at this, the most extreme level of human incompetence, there is another side. For example, we learned that the staff who daily cared for these patients did not regard them as subhuman or contemptible. Instead, they had sincere respect for the humanness of their charges and, what is more important, they demonstrated that they related to them by attributing to them such incontestably “human” qualities as knowledge of _ -

the future, awareness of the consequences of their actions, a strong sense of self, responsibility, | and knowledge of right and wrong (MacAndrew and Edgerton 1964a). What is more, our own observations on the ward soon confirmed the correctness of these views. These patients were far more ‘Shuman’ than they seemed. Despite their many afflictions and their severe intellectual

deficit, they were undeniably human in their perceptions, their emotions, and their moral character. Yet they were also largely acultural. They communicated little, used language only minimally, and seldom interacted with one another. They remain paradoxical. For medicine they

will continue to provide a difficult problem in long-term residential care and treatment. For anthropology, they could provide an instructive example of organisms occupying the threshold between man and not-man. THE MODERATELY RETARDED

In the general category of ““moderately retarded’’ are placed persons whose IQs fall between 20

and 50. They have constituted the bulk of the patient population in most large residential institutions, as they do today. In recent years, they have also been exposed to a variety of alternative residential settings in the community. They are sometimes stereotyped as a

Edgerton ] MENTAL RETARDATION 13 homogeneous population that requires continuing benevolent care but presents few difficult social or psychological problems, The Down’s Syndrome (‘“Mongol”) patient is sometimes offered in evidence as a pleasant, trouble-free person of this sort. In fact, however, the moderately retarded manifest diverse physical, intellectual, and social disabilities. What is more, even in large institutions their lives are greatly variegated. At one such institution, for example, the moderately retarded work in many roles, including some such as car washing (Edgerton, Tarjan, and Dingman 1961) that represent entrepreneurial free enterprise. They engage in many recreational activities, from dances and parties to organized sports and field

trips. And they date one another, sometimes developing enduring relationships that become informally solemnized as fictive marriages. They live in neat, tidy wards with comfortable and attractive accommodations that include many personal possessions. Many converse amiably or

watch television in the dayroom in an atmosphere like that of a quiet boarding home. Nevertheless, each of these persons is seriously disabled intellectually, and most are unable to | adapt to the demands of anything but a fully sheltered environment. Although there is no doubt that most persons whose IQs (without cultural contamination) are below 50 have severely limited ability to adapt to their environments, it is nonetheless true that such persons are capable of surprisingly complex human interactions. It is well known that an occasional Down’s Syndrome patient will develop intellectual abilities far beyond those thought possible for him. For example, one man who was reliably diagnosed as trisomy-23 has actually written a book (Hunt 1967). But it may be less well known that persons with low IQs are able to establish and maintain complex human relationships. MacAndrew and Edgerton (1966) wrote about a pair of men whose friendship is an example of what I have in mind. One man, who was 28, had an IQ of 31; the other, aged 33, was blind and his IQ varied between 34 and 40. When we

studied them, these two men had been inseparable for a number of years, and although their relationship had nothing sexual about it, it did contain just about every other human concern. They lived for and through one another, and despite occasional mild quarrels, they created a _ joyous and stimulating world for one another. That a relationship of such intensity, complexity, and long duration could exist between two men of such reduced intellect, suggests that even at this level of retardation we have much to learn about human abilities. MILD MENTAL RETARDATION

Mild mental retardation, usually defined by IQs between 50 and 70, provides a full measure of complexity. It is a disorder based upon a criterion—the IQ—that is acceptable to very few and is

admittedly inaccurate when applied to a large portion of the population. The etiology of this category of retardation is unknown, and no treatment has yet been successful. I hope to illustrate these issues, beginning with the least complex. Hospital Studies

As recently as the mid-1960s, many of the large state residential institutions for the mentally retarded in the US were still housing large numbers of mildly retarded patients. These persons

typically speak and behave in virtually a normal manner and are often unexceptional in appearance. It should be noted that the lower socioeconomic statuses and ethnic minorities are usually substantially overrepresented in any assemblage of mildly retarded patients. So it was at a large state institution studied in the early 1960s. There, many patients initially reacted to the hospital with horror, complaining bitterly that they had been falsely diagnosed and wrongly hospitalized (Edgerton and Sabagh 1962), and that quite literally anything was better than their current status. At this point, the patients’ self-esteem was reduced to such a nadir that we can properly refer to mortification as the result. Evidence for this assertion was plentiful, as in the anguished lament of a teen-age boy who said, “why do I got to be in here with these people? I’d rather be dead than here.” However, these same mortified patients soon found opportunity for self-aggrandizement. For example, (1) compared to the majority of more severely retarded patients, they were obviously

14 CULTURAL ILLNESS AND HEALTH [AS9 and gloatingly superior; (2) with the aid of other mildly retarded patients, they were able to establish more rewarding peer-group relationships than had been possible in the prehospital environments; (3) they became the indulged favorites of ward employees, who valued their intelligence to relieve boredom, to help with ward jobs, and to control other patients; (4) failing all

else, they were able to engage in grandiose self-aggrandizement (e.g., fantastic tales of past achievement and present skills) that were accepted, or encouraged, by other patients and even by staff. This pattern was both paradoxical and significant, for it suggested that patients might resist leaving the hospital (as they did), but that if they accepted release they would be better able to cope with community living because they would be better able to convince themselves and others that they had never belonged in the hospital in the first place. Those who remained in the hospital constituted an elite, and a counter-cultural one, whose practices within the hospital were often opposed to hospital authority (Edgerton 1963). There were some 50 members of this elite group, almost 70% of whom were Negro or Mexican-American. This handful of patients—50 among 3000—became a visible and significant collectivity. in the hospital, being able to manipulate large numbers of patients and not a few staff members. Part of their mystique was their claim to being “tough,” and hence heroic and dangerous. Members of the elite claimed prehospital membership in delinquent gangs. Although these claims were typically fraudulent, it was true that the elite constituted a delinquent gang within the hospital. They made. fighting prowess a prerequisite to elite acceptance and were not averse to using their prowess—or-. __ at least threatening to do so—against non-elite patients. Compared to other patients, the elite were also ‘‘sharp,”’ in the idiom of that time. They focused their attention upon automobiles, music, the latest dance steps, and the most fashionable clothing. They also used a distinctive language, an

argot that appeared to be a combination of Pachuco and the latest teen-age vocabulary. | Members of the elite looked upon their lives in the hospital as a game of “cops-and-robbers.”’ They opposed themselves to the authority of the institution by their fights, thefts, and episodes of vandalism such as destroying hospital property, hijacking coke machines, or throwing trash in the swimming pool. They also defied certain staff members whom they were able to intimidate. Yet

their behavior was anything but capricious or impulsive. Their actions were calculated to demonstrate to one and all—to non-elite patients, to staff, and to themselves—that they did not

belong in the hospital and that they were vastly superior to all other patients. Instead of identifying with the patients, they identified themselves with the ward employees, many of whom, for various reasons, were willing to give respect and even prestige to elite members. The presence

of such a delinquent clique in a large state hospital for the mentally retarded raises many questions. For example, does such a group serve as a reference group for many non-elite patients? Does the imperious exclusiveness and superiority of the elite group drive non-members into greater

acceptance of hospital authority and programs? Does membership in such a clique provide a therapeutic haven for ethnic minority patients, or does it merely reinforce their deviancy and © . preadapt them for failure after release from the hospital? These questions remain unanswered ten years later. In the area of sexual behavior, however, it was possible to reach a more confident conclusion. Consistent with the growth of milieu therapy, hospitals for the retarded have tended increasingly

to program and supervise the activities of resident patients. For obvious reasons of moral — propriety, as well as for therapeutic considerations, interaction between male and female patients has traditionally fallen under close supervision and careful planning. In the large state hospital I have been discussing, moderately and mildly retarded patients were given considerable freedom to spend their time as they saw fit and with whom they chose (Edgerton and Dingman 1964). Many patients, and not just the elite, saw fit to spend their time with the opposite sex, and not always in places designated for that purpose, such as the canteen, the recreation rooms, or the swimming pool. Instead, they often frequented places that were officially off-limits—secluded bushes and trees, hallways and empty rooms, various basements and shops not supervised by the staff. On any given afternoon, therefore, several hundred patients, approximately half of whom were male and half female, were interacting with one another over a very large area in which there was no consistent supervision. It may come as no surprise to learn that many of these patients chose to engage in one or another kind of sexual behavior. If this had become known to them, it would

Edgerton | MENTAL RETARDATION 15 surely have called forth the most outraged protests from those such as parents, hospital staff, and public officials who felt obliged to maintain puritanical standards of rectitude among patients. And, indeed, such protests were aroused when I published an article about this sexual behavior (Edgerton and Dingman 1964). The article concluded, and I still maintain, that this quite illicit sexual conduct was among the most therapeutic activities available to patients in that institution. The most clearly recognizable benefits were these: (1) control of time and space; (2) utilization of subtle communication; (3) understanding of rules for acceptable interpersonal conduct; and (4) control of sexual impulses. I

shall discuss each in turn. -

Patients live in a world in which time and space are regulated, with staff directing them here and there according to a schedule. When patients meet in unsupervised free time, their male-female relationships begin not with sexual encounters but with formal and rather old-fashioned “‘dating.”’

This means that a boyfriend must arrange to meet his girlfriend at a scheduled time in a scheduled . place, and since schedules often change, private places to meet must be changed each day; the ‘date’? will often take place at a different time and different place each day. What is more, both partners to the date must be aware of a variety of contingencies that might interfere with the successful meeting. When one considers that these patients are almost without exception regarded as being incapable of conducting themselves appropriately in spatial-temporal orientations, it is remarkable to see the ease with which a mute boy, IQ 42, can arrange to meet a brain-damaged girl, IQ 47, at approximately 2:00 pm on a bench under a particular tree. This ability is especially impressive when it is realized that neither patient is ordinarily credited with the ability to tell time.

In no other context of their lives are these patients regularly required to control their world of time and space without some sort of direct supervision. Only in the world of “‘dating”’ are patients

challenged to demonstrate their ability to locate themselves in time and space. They meet this challenge with singular enthusiasm and no little skill.

So, too, they show surprising skill in their communication. The making and maintaining of a dating relationship in the hospital demands many subtle techniques of communication. Messages from partner to partner must discriminate between degrees of affection—interest, like, and love—as

well as among a rich selection of directives regarding not only simple everyday matters, but complicated and intimate emotional matters as well. Indeed, the subtlety involved in making a date is quite impressive, seeming to be of the same order of complexity that one would find outside the hospital among normal persons of the same age. As a result, a patient who is interested in another must acquire substantial interpersonal skills even to begin a relationship. Consider for a moment how difficult it must be for girls whose IQs are well under 70, and who have been denied

any contact with boys before being admitted to the hospital, to learn to discriminate between what is merely ‘‘friendly’’ and what is “‘flirting.” It is important for a girl to learn this distinction, for “flirting” is subject to strong disapproval. When one considers that to define “flirting,” “‘silly,”’ “easy,” and “‘dirty”’ is no simple matter for “‘normal’’ people to agree upon, the achievement of

these ‘‘retarded’’ people is placed in proper perspective. It is noteworthy that the kinds of tactlessly direct and inappropriately blundering questions that the mentally retarded so often ask are not typically in evidence in making a date. Patients must be reasonably indirect and subtle or

_ they are rejected; and, as in their orientation to time and space, patients who ordinarily are incompetent in communication (verbal or nonverbal) can be surprisingly adept in such matters where affairs of the heart are concerned. One can only infer that when the system is of their own making and the rewards are great, low IQ patients can call upon otherwise hidden reserves of interpersonal ability.

The freedom of unsupervised dating encourages commitment to various rules of proper conduct. Patients learned to accept the rules of others (typically, of other patients) and to respond

intrapunitively to breaches of such rules. The rules that they developed and valued defined a decidedly puritanical sexual life, even for the early 1960s. The patients generally regarded any mention of sexuality as obscene, and they employed euphemisms for even the most benign sexual terms. Kissing and petting were acceptable, but intercourse was usually considered to be wrong, and virginity was prized in females. Homosexuality seldom occurred and was strongly disapproved

16 CULTURAL ILLNESS AND HEALTH . [AS9 when it did. Masturbation occurred among both sexes, but it was regarded as “‘dirty’’ and was not discussed. Practices such as fellatio or cunnilingus were thought to be perversions. In short, the

patients had adopted for themselves rules of sexual propriety that were more delicate than those _ generally in effect outside the hospital. Of course, these dating relationships did develop a sexual dimension. Despite rather stringent hospital sanctions against such behavior, patients consistently engaged in prolonged and sometimes heated “‘petting.”’ Although marked excitement was sometimes evident, this ‘‘necking’’ rarely went beyond fully clothed petting and frottage. This restraint cannot be explained solely by a fear of

discovery. Thanks to excellent concealment and a system of lookouts, detection was highly unlikely. The self-control that was displayed was internal. Patients were able to stop petting at a moment’s notice, and they regularly restrained any impulse to experience more complete sexual gratification. This degree of control was the more remarkable in view of the fact that most of these patients were thought—by their parents and by hospital staff—to be totally lacking in such control. In fact, their prehospital biographies repeatedly recorded sexual acting-out behavior, most of which was highly uncontrolled and some of which was monumentally dangerous to themselves or others. But the fact remains that such people exercised full control of their sexual impulses in the hospital, and they did so primarily because of internal, not external, sanctions. It was findings such as these that led to the conclusion that unsupervised dating provided, as did

no other experience in the hospital, a sense of the complexity of social action demanded of. | competent members of society. Where rehabilitative release is the goal of an institution, patients must be provided with a set of experiences that lead to increased interpersonal competence and responsibility. Competence, and especially responsibility, are not learned easily under supervision.

But such learning can occur when patients supervise themselves. | , Posthospital Studies —

We continue to know very little concerning the lives of former patients who have been released from hospitals, even though we possessed a sizable corpus of studies on just this question. Unfortunately, these studies have produced results that provide every conceivable answer, from the most positive to the most negative. This is probably so because the life circumstances of the mentally retarded—and the “mentally retarded’’ themselves—are highly diverse, but it may also be so because all of these studies chose to view these persons either demographically or through the

eyes of others. None of these studies, that is, employed anthropological methods. In 1960, I designed research that would use such methods (Edgerton 1967). I took as my sample all the patients from the same large state institution who had graduated from vocational training and had been released to live independently in the community during the prior decade. These 110 persons were the most capable former patients of the hospital in terms of their predicted ability to live in the community, even though the mean IQ of the cohort was only

64. Approximately half of these former patients were located within a 50-mile radius of the hospital, and all but two of them cooperated fully with the research. In addition to the procedures employed by earlier follow-up studies (examining records of pre- and posthospital performance, and interviewing social workers, employers, and relatives), we devoted many hours with each former patient to informal interviewing and participant-observation. Over the course of a year, we came to know these people well and to have confidence that their lives were completely open to

us. :

We found them all over southern California, in trailers, stum shacks, modern apartments, and middle-class houses. Their household furnishings were characteristically few, old, and worn, and their dwellings typically more rundown than others in their neighborhood, but the cleanliness of these dwellings was remarkable. Only six persons were unemployed; the rest were occupied in a

: variety of jobs, the most common being housewives, sanitarium workers, and kitchen helpers in restaurants. With very few exceptions, their income and their security were marginal; most were in debt, and few had marketable skills. Simply making a living was a constant challenge, but this was as we expected.

Edgerton | MENTAL RETARDATION 17 It was not expected that they would have so few problems in their personal lives. Sexual problems had led to the original hospitalization of many in the cohort, and all but a few were surgically sterilized before they were released. After release, only a handful had any sexually related problems in community living and these were seldom major. At the time of the study, 14 were single and 4 were divorced or separated, but 30 were married—12 to other former patients and 18 to “normals.” It was difficult for the men to find and support normal spouses, but many of the women made successful marriages to older normal men who were able to support them and who typically treated them well. While some of the single men appreciated being sterilized, many of the men and almost all the women were grieved and stigmatized by the sterilization, feeling that it was a visible and invidious sign of their subnormality, and one that had been wrongly imposed upon them. Many wanted children and felt that the joys of parenthood had been unjustly denied them.

Without children, and with the additional limitations of illiteracy, limited transportation, and very low income, these former patients were confined to a few leisure activities. For the most part, leisure time was spent in conversation—with whomever could be found for that purpose—or in front of the television set. But if their leisure lives were narrowly circumscribed (and they may have been no more narrowly defined than the lives of normal persons with comparably low income and little education), then neither were they in any way troublesome. The former patients made little trouble for friends and neighbors. For example, they rarely were given to the use of alcohol or narcotics. Their contacts with the police were limited to misdemeanors, and there were very few of these. On the other hand, their community participation was strictly limited as well. None attended church, none participated in community organizations, and none had ever voted in an election at any level. They lived, unobtrusively, in atomistic family groupings. In many ways, then, the everyday lives of these ex-patients were more successful than we might have imagined. Unfortunately, their lives were dominated by another and even more fundamental problem—that of seeming to be normal. Whereas we may flippantly enough refer to one another’s stupidity, and joke about our own incompetence, we usually mean little by these remarks, and the victims of our speculation or accusations seldom suffer very much as a result. For the ex-patient, intelligence is a matter of deadly seriousness. He has, above all, been accused and convicted, as it were, of being so stupid that he was confined to an institution for the mentally incompetent. The stigma of this verdict is one that these former patients rejected as being completely unacceptable. As a result, their lives were devoted to a single-minded effort to present themselves to others as “normal,” while convincing themselves that this was in fact so. The label “‘mentally retarded” is a humiliating and discrediting one in our society; these ex-patients fervently believed that the life of

a person so labeled is. scarcely worth living. Thus, their energies were directed toward the seemingly unending task of “‘passing”’ as normal—hardly a simple matter for persons who have but minimal abilities to read, write, or tell time—and their deceptions in this regard are as ingenious as

they are poignant. Similarly, they must deny to themselves that the original label was correctly applied.

No portrait of these former patients is complete without mention of the critical role played by , ‘‘benefactors’—normal persons who helped them with their many problems. These benefactors aided with the practical problems of coping with the everyday demands of a complex’ urban world, as well as with the sensitive problem of passing and even the delicate need for denial. So essential was the assistance of these benefactors that scarcely a handful of former patients—perhaps only three—could have maintained themselves in the community without their help. It would not be an exaggeration to conclude that they succeeded in their efforts to live in the community only as well as they succeeded in locating a reliable benefactor. These benefactors were usually altruistic, and their role was quite secretive and protective. In that sense, it was a conspiracy, but a benevolent one indeed. In assessing the success of these former patients in the community, it was impossible

to determine to what extent their life circumstances and their competence was a product of labeling and hospital deprivation versus actual intellectual incapacity. It was clear, however, that their competence required the intervention of normal benefactors and that their lives centered around a kind of masquerade made possible only by the connivance of normal persons, who saw

18 CULTURAL ILLNESS AND HEALTH [AS9 them as incompetent persons but treated them with great sympathy. It seemed correct to conclude that the ex-patients

strive to cover themselves with a protective cloak of competence. To their own satisfaction they manage to locate such coverings, but the cloaks that they think protect them are in reality such tattered and transparent garments that they reveal their wearers in all their naked incompetence. In a sense, these retarded persons are like the emperor in the fairy tale who thought he was wearing the most elegant garments but, in fact, was wearing nothing at all [Edgerton 1967:218 ]. This single study cannot answer our crucial questions about the lives of the mentally retarded , after they have been returned to the community, but it can point to the inadequacies of earlier

School Studies research and suggest the directions that future research must take.

Probably the most acute problem in mental retardation today is what has come to be known as the phenomenon of the six-hour retarded child: “retarded from 9 to 3, five days a week, solely on the basis of an IQ score, without regard to his adaptive behavior, which may be exceptionally

Retardation 1969). ,

adaptive to the situation and community in which he lives’ (President’s Commission on Mental

In the past few years, we have discovered—to the apparent amazement of many in our school systems—that our ethnic minorities will utilize litigation to end IQ testing and MR labeling in our schools. In the past, disproportionately large numbers of ethnic minority children have produced low IQ testing scores and have, as a consequence, been labeled EMR and placed in special classes.

The MR label has an enormous impact, typically leading to lowered academic achievement, reduced economic prospects, and impaired self-esteem. The IQ criterion has not been solely responsible for labeling minority children mentally retarded, but it has been largely responsible. We are told that the predictive validity of the IQ test for schoo] performance has justified its use, yet we also find many exceptions to this rule, both at the higher and the lower IQ levels. Where

the children being tested come from ethnic minorities, there is little doubt that cultural differences—in language, in knowledge of the world, in cognitive structure, and in motivation— | serve to lower IQ scores, making ethnic children far more vulnerable to labeling as MR. We also know, to complete the tragic cycle, that labeling such children MR and placing them in special classes has done nothing to enhance their learning ability or to make them better able to cope with their non-school environments (see Edgerton and Edgerton n.d.). Our work in Hawaii supports the earlier work of various sociologists and psychologists with regard to these questions. Our research was centered in a modern school serving a semi-rural — Hawaiian community. Twenty-four of the school’s 700 students were considered to be mentally retarded. These children had low IQs, but they also did very badly in class, failing to progress beyond minimal kindergarten skills. After MR labeling, some of these children were placed in segregated special classes in another school, and these children either made no academic progress _ or they retrogressed. However, when these same children (and others never placed in segregated classes) were returned to their own school and placed in regular classes except for brief periods of individualized special instruction based upon careful testings and evaluation of each child, quite impressive academic progress was made. Indeed, some children achieved so well and so rapidly that they are now, or soon will be, ‘“‘normal”’ students (Edgerton and Edgerton n.d.). Our research indicated a truly remarkable diversity among these 24 ‘‘mentally retarded”’

children. They differed markedly in such a variety of ways having to do with their styles of learning and behaving, that any effort to conceive of them—or treat them—as a homogeneous , category of children would be absurd. And yet such mentally retarded children are often thought of, and treated, as just such a homogeneous population. Do we not routinely hear and speak of the mentally retarded, or the mildly retarded, as if that term represented some underlying unity of performance or etiology? We do; and that fact leads directly to the question of intelligence itself.

Edgerton ] MENTAL RETARDATION 19 Studies of Intelligence

Just what is the quality “intelligence” that we so confidently measure and find the “mentally retarded” to lack? As so many have noted, the concept is new, even in the West, and the IQ test is newer still. Unfortunately, even today, the concept of intelligence lacks consensual definition, and this lack leads to operational definitions such as ‘‘that which IQ tests measure.”’ Within academic psychology, there is lively debate not only over the value of IQ, but also over the nature of the concept itself. From what behavior should it be abstracted? To what extent can it be reduced to

those brain structures or biochemical substances that permit efficient perception, learning, decision making, and the like? These questions remain unanswered. There is not even any agreement as to whether “intelligence” should be thought of as a single unitary trait or a multidimensional structure of discrete abilities.

Cross-cultural psychologists are just beginning to unravel the many threads of this argument. A | fundamental task for anthropologists continues to be epistemological: Do men in different societies have concepts that discriminate between human abilities? If so, what is the nature of these concepts and how did they evolve? How do they differ from society to society? And what of the men who are seen to be deficient in one or another important ability? Although an anthropologist, Thomas Gladwin (Masland, Sarason, and Gladwin 1958), made an

early contribution to the task, when I undertook a review of what was known of “mental retardation’? in the world’s non-Western, non-industrial societies, I was virtually starting from scratch (Edgerton 1970). Despite the conspicuous lack of data upon which to base conclusions,

there were a number of widespread assumptions about mental retardation that needed to be examined. The first of these conventional assumptions was that, in such societies, the severely retarded would be dispatched or exposed to die as soon as their disability became apparent. In many societies, this assumption is warranted; in some, a particularly horrible death is inflicted. In several parts of the world, however, the severely retarded are tolerated; and in others they are given affectionate, even preferential treatment. The second, and more complex assumption, is that persons whom we would consider mildly retarded would be seen as nothing out of the ordinary in the simpler societies of the world. This assumption appears to be false. Although it may hold in some non-Western societies, in the world’s smallest and least complex societies, fine distinctions in what we would call intelligence are made. Until we know more about the epistemologies of such societies, and until we can better compare their notions with ours; we cannot confirm these impressions. However, there is far less doubt

about the third assumption, that in most societies the retarded are not the victims of overt discrimination. This assumption is borne out in Southeast Asia, in much of the Himalayan area, in Siberia, and in parts of India, Central Asia, and peasant Russia; and among Middle Eastern Muslims the retarded are called “‘saint” and. afforded benevolent, protective treatment. In the majority of

the world’s non-Western societies, however, even the mildly retarded are the victims of overt discrimination, often of a most humiliating and heartless kind.

The fourth assumption has it that the mildly retarded are not a social problem. By now it comes as no surprise that the problem generating potential of such persons varies, but it seems correct to say that more often than not they pose a problem for someone, be it their nuclear

family, clan, or village. In societies where members of a lineage or clan share corporate

restraint. :

responsibility for any wrongdoing by one of their members, the retarded pose a problem for all members of this corporate group and are, consequently, subjected to close surveillance and By focusing upon these general assumptions, it was, I thought, possible to begin sorting out the diversity so characteristic of our non-Western world. This review was unable to lead to a definition

of intelligence, nor did it do anything to clarify the epistemologies involved, but it did help to emphasize the preeminent fact that non-Western peoples, as well as Western, require not only

subsistence skills but also interpersonal ones involving great verbal adroitness, subtlety, self-control, tact, deceit, innuendo, and the like. All societies also require their members to master their intellectual demands for a command of time, space, and number. Economic duties are seldom

| 20 CULTURAL ILLNESS AND HEALTH [AS9 as simple as they seem to Western eyes, and the world of supernaturalism in which such persons must live can be as bewildering as it is dangerous. Unfortunately, we cannot yet say whether one society’s demands for competence are greater than those of another society. We can only say that it is premature to assume, as so many do, that technologically advanced Western societies require greater competence from the majority of their members than “‘simple,” tribal societies do. As I wrote at that time (Edgerton 1970), the history of science leaves no doubt that scientific advance depends upon the worth of the questions we ask. In this field we have yet to formulate the right questions about how men learn to learn and to think, about how they come to judge » their own competence and that of their fellows, and about the complementarity of physical and intellectual abilities. But it is clear that we shall see no progress until we look at incompetent men not as persons with certain defects, but as men who live with other men in a social and cultural order. The Evolution of Intelligence

As Gregory Bateson has so often reminded us, life is a process of acquiring knowledge, and evolution occurs in an ecology of knowledge. Man has evolved by learning to make better use of knowledge—or information, if you prefer—about his environment. My current research attempts to

relate this basic understanding to the nature of human intelligence (Edgerton n.d.). If the’ common speculation is correct that 99% of man’s evolutionary history was spent as a hunter (Washburn and Lancaster 1968), then his intelligence should be shaped by the demands of that mode of adaptation. What is more, men and women may differ notably in their intellectual abilities because men’s and women’s imperatives for survival in a hunting society may have differed markedly, with men banding together to hunt large animals while women, who were encumbered by children or pregnancy, remained in the safety of the camp gathering food and caring for the young (Tiger 1969). Given such environmental conditions, men might well have developed their abilities of spatial and temporal orientation (abilities that modern men do in fact display on IQ tests), just as modern women might be expected to become more verbal (to reduce the boredom of

their economic tasks) and to avoid risks (to protect themselves and their children). Western women manifest just such attributes on IQ tests. Since the serious study of the evolution of human intelligence has scarcely begun, and cross-cultural intelligence testing has yet to achieve much beyond a series of horrendous errors, verification of such hypotheses is not yet possible.

CONCLUSION : Mental retardation is a field far removed from the traditional concerns of anthropology, and yet it is assuredly a problem that can profitably be studied by the application of anthropological methods and concepts. Study of the problem also serves to illuminate a number of conceptual and theoretical issues in‘anthropology such as labeling, passing, deviance, competence, and adaptation.

It also points to areas of inquiry such as the nature and evolution of intelligence that anthropologists have too long scanted. On another level, mental retardation remains a poignant practical problem that anthropologi-

cal research can help to ameliorate. For example, even my own preliminary work has had an impact upon those who plan and provide care for the retarded, or who attempt to deal with the problems faced by ethnic minority children in our school system.

Mental retardation is one of my interests, but it is certainly not the only one. For close to a decade, however, it was the only one of my interests in which my students had no interest. In the past few years, this has changed, and several of my anthropology graduate students have chosen to

specialize in mental retardation (as have students with whom I have corresponded in other universities). Their numbers are still small, but their research is promise of a better understanding of that epistemological enigma ‘“‘intelligence”’ that has blighted the lives of so many who are said to lack it; that has served poorly enough _ those who are said to possess it.

Edgerton ] MENTAL RETARDATION 21

NOTE

1This research was supported by the California State Department of Mental Hygiene, and the Mental Retardation Center, NPI, UCLA. My deepest appreciation is due the late Dr. Harvey F. Dingman, of Pacific State Hospital, and Dr. George Tarjan, formerly Medical Director, Pacific State Hospital, and now Program Director, Mental Retardation Center, NPI, UCLA.

” BIBLIOGRAPHY Doll, E, E.

1962 A Historical Survey of Research and Management of Mental Retardation in the United

States. In Readings on the Exceptional Child. Research and Theory. E. Trapp and P.

Edgerton, R. B. of Mental Deficiencies 68:372-385. Himelstein, Eds. New York: Appleton-Century-Crofts. pp. 21-68.

1963 A Patient Elite: Ethnography in Hospital for the Mentally Retarded. American Journal 1964 Pokot Intersexuality: An East African Example of the Resolution of Sexual Incongruity. ~ American Anthropologist 66:1288-1299.

~ 1966 Conceptions of Psychosis in Four East African Societies. American Anthropologist 68 :408-425. 1967 The Cloak of Competence. Berkeley and Los Angeles: University of California Press. 1969 The Recognition of Mental Illness in Non-Western Societies. In Changing Perspectives in Mental Illness. S. Plog and R. B. Edgerton, Eds. New York: Holt, Rinehart and Winston. pp. 49-72.

1970 Mental Retardation in Non-Western Societies: Toward a Cross-Cultural Perspective on } Incompetence. In Social-Cultural Aspects of Mental Retardation, H. C. Haywood, Ed. New

York: Appleton-Century-Crofts. pp. 523-559,

1971a The Individual in Cultural Adaptation: A Study of Four East African Societies. Los

Angeles: University of California Press.

1971b A Traditional African Psychiatrist. Southwestern Journal of Anthropology 27(3):259278.

n.d. Human Intelligence: Some Anthropological Comments. Jn Human Intelligence. H. Jerison, Ed. In press. _ Edgerton, R. B., and H. F. Dingman 1964 Good Reasons for Bad Supervision: ‘‘Dating’”’ in a Hospital for the Mentally Retarded. Psychiatric Quarterly Supplement 38 :221-233. Edgerton, R. B., and C. M. Edgerton n.d. Becoming Mentally Retarded in a Hawaiian School. In Readings in Mental Retardation. R. Eyman and E. Meyers, Eds. In press. Edgerton, R. B., and G. Sabagh 1962 From.Mortification to Aggrandizement: Changing Self-Concepts in the Careers of the Mentally Retarded. Psychiatry 25:263-272.

Edgerton, R. B.,M. Darno, andI. Fernandez — |

1970 Curanderismo in the Metropolis: The Diminished Role of Folk Psychiatry Among the

Los Angeles Mexican-Americans. American Journal of Psychotherapy 24:124-134. Edgerton, R. B., G. Tarjan, and H. F. Dingman 1961 Free Enterprise in a Captive Society. American Journal of Mental Deficiencies 66:35-41. Farber, Bernard

1968 Mental Retardation. Its Social Context and Social Consequences. Boston: Houghton Mifflin. -

Karno, M., and R. B. Edgerton

1969 The Perception of Mental Illness in a Mexican-American Community. Archives of | General Psychiatry 20:233-238.

MacAndrew, C., and R. B. Edgerton | 1964a IQ and the Social Competence of the Profoundly Retarded. American Journal of

Mental Deficiencies 69:385-390. 1964b The Everyday Life of Institutionalized ‘‘Idiots.”” Human Organization 23:312-318. 1966 On the Possibility of Friendship. American Journal of Mental Deficiencies 70:612-621. Masland, R., S. Sarason, and T. Gladwin 1958 Mental Subnormality. New York: Basic Books. Six-Hour Retarded Child, The

1969 A Report on a Conference on Problems of Education of Children in the Inner City. August 10-12, 1969, Airlie House, Warrenton, Va. The President’s Committee on Mental Retardation and Bureau of Education for the Handicapped, Office of Education. US

Department of Health, Education and Welfare. :

22 CULTURAL ILLNESS AND HEALTH [AS9 Tiger, L.

1969 Men in Groups. New York: Random House. Washburn, S. L., and C. S. Lancaster

1968 The Evolution of Hunting. Jn Man the Hunter. R. B. Lee and I. DeVore, Eds. Chicago: Aldine. pp. 293-303.

The Ethnography of Crime in American Society JAMES P, SPRADLEY MACALESTER COLLEGE

CRIME IS AN AMERICAN CUSTOM. If it were to disappear, it would leave a gaping hole in the

social order. Newspapers would have much less to print. Most television serials would lose their appeal. Local and national elections would suffer from lack of issues. Taxes could be reduced. Hundreds of institutions would close their doors. Millions of people would be out of work. Entire professions would cease to be needed. Crime is such an integral part of the

American scene that, if it were removed, nearly every institution and individual in our country would be affected. Because crime is intimately related to illness, the health professions would be the first to feel the effect. In fact, it is impossible to consider crime in our society without including sexual offenders, the mentally ill, prostitutes, chronic alcoholics, drug addicts, abortionists, pharmaceutical companies, and diseases of all kinds. __

The complexity of crime and the way in which it is intertwined with health and disease in our society is a striking fact to the scientific investigator. Yet the more impressive fact about crime in America is our woeful ignorance about its nature, cause, and prevention. Few would dispute the premise that basic research on criminal behavior is a high priority. We need reliable knowledge with which to diagnose the causes of crime and prescribe ways to

control and prevent it. In this paper I shall discuss one significant contribution that

anthropology is making in this direction. — 7

Anthropologists have made important contributions to the scientific study of crime in a number of ways. (1) Ethnographic descriptions of non-Western cultures have broadened our understanding of crime as a human problem.’ (2) These descriptions have been the basis for cross-cultural comparisons of such things as social control, suicide, homicide, alcoholism, and mental illness.” (3) Anthropologists have developed theories of human behavior which have guided both cross-cultural and ethnographic studies.’ (4) Finally, anthropologists have studied a variety of crime-related phenomena in our own society using methods common to the social sciences; these include studies of poverty, mental illness, juvenile delinquency, and

drinking behavior.* |

This paper is not a survey of anthropological studies of crime and related phenomena, but

behavior. .

instead, I wish to examine what I believe to be the most important anthropological contribution. By training and experience, anthropologists acquire a cross-cultural perspective and they are the best equipped among scholars to study the cultural dimension of criminal

Crime is only one form of social behavior, and it is intimately linked to many other forms. A fundamental premise of anthropology is that social behavior is culturally constituted. When an individual commits a crime, he does so in terms of the cultural meanings he has acquired. When a policeman arrests a suspect, he acts on the basis of a somewhat different set of cultural rules that he has learned. When a judge sentences a person found guilty of a misdemeanor, he makes his decision in terms of implicit definitions of the

| 23 |

situation. When a prison guard places an inmate in solitary confinement, he acts in terms of the cultural milieu in which he works. Nearly everything in human experience is imbued with cultural meaning. We locate ourselves in time and space by learning the appropriate way to

24 CULTURAL ILLNESS AND HEALTH [AS9 organize these dimensions and recognize their significance. We are taught to identify features

of the physical environment. The identity of persons in our social environment and what they are doing at any moment are culturally defined. As an individual acquires his culture, he learns to anticipate events and to behave in ways which he considers appropriate and often desirable.

Culture, as used in this paper, is the learned and shared knowledge which people use to generate and interpret social behavior.’ If we are to understand crime, or any other form of social behavior, we must begin with a cultural description. Those who commit crimes and those who are involved in the law enforcement process organize their behavior by means of , their distinct cultures. Any attempts to reduce or eliminate criminal behavior, change police

attitudes, or modify the court system, must be based on a knowledge of this cultural dimension.

The work of describing a culture is called ethnography.® This task is the foundation of all

anthropological research. The comparative and theoretical work of cultural anthropology depends upon adequate ethnographic descriptions of the world’s many cultures. While most behavioral scientists readily admit that ethnography is important in the study of non-Western societies, they often assume that cultural descriptions are unnecessary in our own society. In the study of crime, two factors have obscured the importance of the cultural dimensions: (1)

the failure to appreciate fully the multicultural nature of our society, and (2) the use of -

culture-bound research methods. Let us examine each of these briefly. . No one disputes the fact that we live in a pluralistic society. But the extent to which

cultural diversity permeates American Life is often overlooked. The emphasis upon assimilation of all groups into the mainstream. has obscured the multicultural nature of our society. In their quest for generalizations, investigators have created analytic categories such as middle class, lower class, and subculture, which have been substituted for empirical reality. Once a

population is known to reflect the characteristics of one or another social class or subculture, the investigator assumes he knows what their cultural knowledge is like. But our. society is much more complex than that. Urban America, in particular, is made up of hundreds and thousands of distinct cultural scenes. Individuals who are otherwise perfectly middle class may operate with a very different set of rules in one area of their lives. Student drug users, members of the Satanist church, car thieves, judges, nurses, sex offenders, and parole officers all have acquired a segment of cultural Knowledge which is distinct from what

members of the other groups know. The concepts of crime, disease, law, justice, and rehabilitation have different meanings for each of these groups. Information about social characteristics is not to be confused with a cultural description. The knowledge that each of

three students, for example, grew up in a middle-class home, have similar scores on intelligence tests, and have attained the same educational level, does not explain why one is — a homosexual, another steals cars, and the third uses narcotics illegally. A description of the

cultural knowledge that each employs in these distinct cultural scenes is a first step in understanding their behavior. Prisons, jails, hospitals, churches, police departments, courts, and universities all involve different cultural scenes. Unless such cultures are described, we

shall not be able to account adequately for the social behavior which occurs in these

institutions. -| A culture bound research method is one constructed out of the meanings of a limited

cultural scene. Any method, test, or technique which is culture bound is efficient with a particular group of people, but once it is used outside that group it obscures the cultural | dimension. Methods of treatment and rehabilitation may also be culture bound, a point to which we shall return later. Research instruments which have built-in cultural limitations may still yield a great deal of information about a population with a very different culture. It is

} possible, for example, to gather a great deal of data on chronic alcoholics, sex offenders, prostitutes, and drug addicts without studying their culture. It is all too easy for an investigator to assume that he knows the meaning of events and objects which make up the experience of those he studies. He may observe their behavior and then interpret it from an

Spradley ] CRIME IN AMERICAN SOCIETY 25 outsider’s perspective. He may formulate questions based on his own cultural knowledge, and

then interpret the responses of another cultural group in terms of his own system of meaning. He may employ psychological tests which have inherent biases that prevent them

from revealing the world as perceived by the subject. Scholars often construct and test theories, carry out surveys, and compare different groups, while ignoring and distorting the cultural dimensions of those studied. This is not to say that non-cultural information is unimportant. Social behavior is not only a result of cultural knowledge. There are biological, psychological, social, and ecological constraints on behavior which are outside the culture of the actor. Studies of the characteristics, behavior, and environment of human populations are necessary for the advancement of scientific knowledge, but they must not be a substitute for investigating the cultures of these same populations. Because the ethnographer seeks to discover the meaning which people

attach to their experience, he must take great care not to pre-define the population he studies, As he learns from informants the ways in which they construe their own experience,

- mew understandings begin to emerge. In order to make clear the importance of studying , cultures related to crime in our own society, and the nature of such ethnographic enterprises, I shall present data from my own research on one of the most widespread criminal activities in our society—public intoxication. ETHNOGRAPHY OF PUBLIC INTOXICATION’

In 1967 I began an investigation of the cultural dimension of the police case inebriate and his experience with law enforcement agencies in Seattle, Washington. Public intoxication

is viewed as a crime in almost every state and city of this nation. It accounts for more criminal arrests than any other crime. While some cities have redefined it as a health problem, it still is one of the major criminal problems in our society. Pitman, writing for the Task Force Report: Drunkenness, The President’s Commission on Law Enforcement and the Administration of Justice, states: For the public intoxication offender, the enforcement is indeed intense. In 1964 the FBI reported 1,458,821 arrests for public drunkenness... This figure accounted for over 31 percent of the total arrests for alloffenses and is almost twice the number of arrests for index crime offenses. If alcohol related offenses (driving under the influence of alcohol, disorderly conduct, and vagrancy) were added to this percentage, it would constitute from 40 to 49 percent of all reported arrests in 1964 [Pittman 1967:8]. In Seattle, Washington, at the time this study was carried out, more than half of all arrests

were for the crime of public drunkenness. In 1967, 65% of all cases processed in the municipal criminal court were for this charge. Many of those who appear in this court are chronic alcoholics in need of medical treatment. The data for this study were gathered by means of participant observation and interviews

in a variety of places inhabited by men arrested for public drunkenness. The first few months were spent observing the arraignment and sentencing process in a municipal criminal court. Then I began to participate in the daily life of an alcoholic treatment center for men found guilty of repeated drunkenness. I listened to informal conversations, observed behavior, and established my role as an investigator from the University of Washington Medical School.

From time to time, I visited the Skid Road district and the city jail where I observed and talked to more individuals. After several months of informal interaction with men at the treatment center, I began to acquire a working knowledge of their language. At that point I began intensive ethnographic interviews aimed at discovering the cultural meaning of the concepts employed by these men. Finally, after many months of fieldwork, I constructed a lengthy questionnaire in the idiom familiar to them and administered it to a group of one hundred men. Communication with other social scientists, physicians, policemen, court officials, and local

politicians made me aware that nearly everything about the public intoxicant could be

26 CULTURAL ILLNESS AND HEALTH [AS9 defined from more than one perspective. The professional literature of law, science, and medicine contained many descriptive references to this population, but almost always from the viewpoint of someone outside their experience. One of the major pitfalls of ethnographic research is to treat such perspectives as equivalent to the culture being studied. In this case, the outsider’s definition of the situation did not reflect the cultural knowledge which these men employed to organize their behavior. Indeed, most outside accounts distorted this culture. Instead of being arrested for public drunkenness, informants saw themselves making

the bucket as marked men or because the “bulls needed some good trusties.” Instead of being arraigned in court for their crime, they saw themselves as employing one or more of nearly a dozen ways to beat the drunk charge when in court. Instead of being destitute or down-and-out, they perceived themselves as having a large repertoire of survival strategies, ways of making it. Instead of begging on the street, they recognized fine distinctions among panhandling, stemming, bumming, and throwing a Frisco circle. Instead of serving sentences in jail for their crime, they were learning the lifestyle of their peer group by hustling. in the bucket. This dual perspective, one from outside and the other from within, is possible for

every characteristic and action of these men. Furthermore, it was not simply a case of different terms to refer to the same situation. The meaning which the outsider reads into the experiences of these men was not equivalent to their own understanding. An ethnographic

_ description required that I learn their language and the meaning of the concepts of their cultural knowledge. Nowhere was this more apparent than in the study of who these men

Cultural Identity | were.

Outsiders have a variety of definitions for this group of men. They are called down-andouters, public intoxicants, bums, and winoes. In the court, they were considered common

drunkards. The police viewed them as drunks or vagrants. Physicians and public health officials defined them as chronic alcoholics. The most common designation among social scientists has been the homeless man. As an outsider I began my research with a tentative definition of the population as public intoxicants and chronic alcoholics. But it soon became

clear that none of these labels was salient for the men in question. They referred to themselves and others by terms which were strange to me. Instead of alcoholics, they were dings, bindle stiffs, airedales, Georgetown men, rubber tramps, and mission stiffs. Instead of chronic alcoholics, they had acquired cultural identities labeled trusty, nose diver, fruit

tramp, box car tramp, and inmate. . . Cultural classification systems are more than lists of linguistic labels. Concepts are

organized into systematic relationships which must be discovered rather than imposed from - — the outside. One relationship which appears to be a universal feature of human cultures is class inclusion. This occurs when a general concept includes more specific ones.®- Research showed that the long’ list of concepts for cultural identity were organized into two major sets: tramps and inmates. For instance, a Georgetown man and a trusty were both kinds of inmates. A bindle stiff and a box car tramp were both kinds of tramps. A number of sorting tasks and eliciting techniques were developed in order to establish these relationships.’ (Table I shows the primary terms included in these two classes.) Cultural meaning is also revealed by another type of organization called contrast. The

terms included in the category tramp are all in contrast: Their collective and individual meaning emerged from interviews with informants about the ways in which the various kinds

of tramps are alike or different. The single most important value which constituted the meaning of this identity was mobility. These men did not distinguish their cultural identities on the basis of drinking, income, age, or some “demographic criterion.” The different types

of tramps were distinguished in terms of: (1) their degree of mobility, (2) their mode of travel, (3) the type of home base they had when traveling, and (4) the survival strategies employed when on the road. For example, while all tramps are mobile, the home guard

Spradley ] CRIME IN AMERICAN SOCIETY 27 7 TABLE I. CULTURAL IDENTITIES

TRAMP INMATE 1. Working stiff _ 1. Drunk a. Construction tramp 2. Lockup b. Sea trap

c. Tramp miner | 3. Rabbit

e. Fruit tramp 4, Kickout 2. Mission stiff 5. Trusty d, Harvest tramp -

a. Nose diver | a. Clerk b. Professional nose diver b. Bull cook

a |3.c.Bindle Court usher stiff d. Hospital orderly 4. Airedale | f, Kitchen man : g. Runner 5. Rubber tramp h. Barber

e. Blue room man

| i. Ranger

6. Home guard tramp j. Odlin’s man k. Georgetown man

7.| Box tramp 1], City hall man : m.carHarbor patrol man

. 8. Ding . - n. Wallingford man o. Floor man

tramp travels less frequently and for shorter distances than the others. Box car tramps customarily travel by freight trains in large continental circuits which cover most of the United States or a portion of it. Rubber tramps, on the other hand, travel in their own cars, while mission stiffs tend to use commercial vehicles. To assume the outside perspective which defines this population as homeless men would have ignored their definition of themselves. When traveling, they. have different types of “‘homes.”’ The airedale and bindle stiff both carry a pack and bedroll, which enables them to make a home anywhere. Rubber tramps live

in their cars, mission stiffs stay at the missions, while both dings and box car tramps are without a well-defined home base. Moreover, tramps have learned a large number of places to sleep and eat which are not part of the cultural knowledge of most outsiders. _ What it means to be an inmate is also culturally defined. The criteria used to distinguish the identities included in this concept also proved to be related to the value of mobility. As

I have written elsewhere:

Incarceration may appear to be-a similar experience for all inmates, but informants perceived radical differences depending on one’s identity. The men in the drunk tank have

- jittle freedom to move around and their resources are extremely limited. If a man

becomes a lockup he continues to feel restricted, he must “lay it out on the steel.” Each day he will be allowed to leave the cell to pick up his meals and he may have a brief ‘“‘walk time’’ in the late afternoon. Otherwise he remains confined to a cell with other men, The mobility of all trusties is much less restricted than other inmates. A man might

work many hours each day as a trusty, but he will be free to move about and that is worth a great deal. At the same time restrictions on mobility vary among the various kinds of trusties [Spradley 1972b].

There are an infinite number of distinctions that could be made among the different kinds

of tramps and inmates; these men learned to make those that were significant in their cultural world. Mobility is not merely traveling from place to place. It is not simply living

28 CULTURAL ILLNESS AND HEALTH [AS9 without a permanent place of residence. More importantly, it is a value that has been internalized. It is part of the tramp’s cultural identity.

Consequences of Mobility : . The discovery that mobility, rather than drinking or public intoxication, structured the

primary identities of these men, led to an examination of the effect it had on other behavior patterns of tramps. To my surprise, one of the most important consequences of a mobile life style was its effect on their drinking behavior. I was talking to a man who had been at the alcoholism treatment center for several months. He had “dried out,” participated in a variety of therapy experiences, and was anxious to maintain his sobriety. As we talked, he expressed his fear that he might go back on the bottle when released. Then he said, “My biggest problem when I get out next week is traveling.’’ He believed that if he could get established in a permanent locale he could more easily control his drinking behavior. This concern was not because the desire for alcohol increases with traveling. In fact, drinking while traveling to a destination was not considered nearly the problem as drinking when you arrived. He summarized the experiences of many men when he said, ‘‘When I get in a strange vicinity, | head for a bar. If I want work, I go to a bar; that’s where they come to hire a man.’”’ The most important consequence of mobility is to produce strong motivations in the tramp to head for skid row bars and other places where social drinking offers a sense _

of belonging. |

There is an intimate relationship between mobility and other features of their life style which involve drinking: alcoholic beverages function as a social lubricant at all levels. of American society, but they fulfill this need in a special way for urban nomads. Nomadism creates a unique kind of loneliness and sense of isolation in an individual, and when he arrives alone in a new town he seeks to find others of his own kind to reduce such anxieties. Almost the only place where he can find acceptance, friendship and sociability is on skid row and in the bars located there. Bars are categorized among tramps in a

variety of ways, but especially in terms of what one may find there in the way of

friends, female companionship and work opportunities. For urban nomads, bars function as churches and clubs, employment agencies and dating centers, begging places, drinking and eating places and flops. Most of all, they are a place to find friendship, even if it is only of a fleeting nature. In a skid row bar one is not restricted in his behavior; he can perform in ways appropriate to this subculture and know he will be accepted; he can find out important information about jail and court and employment which other tramps will freely give him [Spradley 1970a:25-26 ].

But the life style that revolves around mobility does more than place a man in social situations that induce drinking behavior. It also creates a shifting social landscape which makes more permanent relationships all but impossible. The continuous social sanctions that . | would come from employers, friends, family, and neighbors are not there to assist him in the control of his drinking behavior. The needs that are met by a sense of belonging,

acceptance, and meaningful social interaction are not fully met for the man who is

life of travel. . |

constantly on the road. Drinking and drunkenness. become a way to reduce the frustrations that arise from these unmet needs. Reduced behavioral control is thus linked to the tramp’s Finally, mobility works to prevent effective treatment of the chronic alcoholic. Men who _ volunteered to go to the alcoholism treatment center were sentenced for a six-month period with the promise of an early release by the judge for improvement in their condition. During the early days of operation, the staff at the center was constantly bombarded with requests for early release. This became such a major issue and interfered with the treatment programs

to such an extent that the time period was reduced to four months. Many men still badgered the staff for early releases, not because they were confident of recovery, but because they found an immobile situation intolerable. The staff at the treatment center realized that recovery of a chronic alcoholic required intensive follow-up programs after treatment in a residential setting. They urged their patients to stay in the vicinity, return for

Spradley ] CRIME IN AMERICAN SOCIETY 29 Alcoholics Anonymous meetings, drop in for counseling, and take up residence in one or another half-way house. In rare cases, there was opportunity for follow-up treatment, but more often, when released from the treatment center, the tramp moved on to some other city. There he is lost in the anonymity of his nomadic life style. Learning To Be Mobile

The outsider who observes the way tramps continuously travel from one place to another , may interpret this behavior as an attempt to escape from problems of anxiety and drinking. While this may be partially true, it overlooks certain experiences that induce a man to move on. The fact that mobility has become part of their self-definition may in itself account for much of their nomadic lives. At the same time, other forces are at work to reinforce this value and make traveling a priority of the first order (see Figure 1).

eSoNal

- (a) Sentences of

. Induces Drinking

Sentences N a Policies _ ,

(c) Becoming a

Control

Treatment

Philosophy

- Figure 1. Mobility and drinking. (a) The first: factor is based on the sentencing practices in the court. Tramps keep a running tab on the number of days they have “hanging.” When a man is arrested for public intoxication, he may post twenty dollars bail and go free; he is allowed to pay for his crime at this rate no matter how many times he is arrested each year. But tramps have little cash on hand, and are often guilty and sentenced to “‘do time’ in jail. But their sentences are not all the same—the rate increases in magnitude with each succeeding arrest. Sentences begin

with a few: days but may become as long as six months. The length of a sentence is | determined by the frequency of a man’s past arrests. If a man can stay out of court for at least six months, he starts again with minimal sentences.. The number of days that he calculates the judge will give him on his next appearance in court is the number of ‘‘days hanging.’”?’ When he anticipates more than thirty to sixty days for his next arrest, he has but one reasonable alternative: leave town. But since this practice of sentencing is widespread, he will soon be moving on to still another town until his six months are up and he can return to where he started. (b) Suspended sentences are sometimes given to a man who pleads his case and/or has recently served a long sentence on a drunk charge. This means that he may receive both the suspended and the new penalty the next time he is arrested. Because he is poor and knows

the possibility to bail out is unlikely, he again selects the only wise choice after he is released with a suspended sentence: leave town.

30 CULTURAL ILLNESS AND HEALTH [AS9 (c) Tramps realize they are arrested because of their visibility to the police. They also believe that one can become a marked man if the policemen get to know him. Then they believe that repeated arrests will occur even if they are not drunk. One man expressed this in the following manner:

I’ve got so bad that way I finally had to leave town. That’s when my mother was living

here; and that judge—I finally had him convinced. Sometimes I would get out of

jail—someone had come and bailed me out—I wouldn’t get a half-a-block and that same son-of-a-bitch would come and say, ‘‘Let’s go.”

Because the Seattle City Jail used more than 125 men each day to work as trusties in a variety of janitorial jobs, and because most of these were men who had been sentenced for public drunkenness, many tramps believed they became marked men in order to provide the police department with cheap labor. The important point here is not the actual incidence of arrests resulting from the status of a marked man, but the cultural beliefs about it which

work as a powerful motivation for tramps to become nomadic.

(d) Even the missions have policies that influence tramps to travel. A mission stiff may ‘“‘get on the program’? at one or another mission, and then someone discovers he is drinking,

and he must move on to another mission. As his failure to stay off the bottle becomes known among mission personnel in one city, he must move on to a new town. In addition, — some missions give preferential treatment to men who have recently arrived from out of | town. The newcomer is allowed first choice on the available beds, thus reminding others of

the fundamental rule for tramps: leave town.

(e) Finally, commitment to the alcoholic treatment center also influences a man to travel when his stay is completed. This works in two ways. First, a man at the center must still calculate the ‘“‘days hanging’ he has accrued. For example, most men accepted for treatment

had a long record. If they stayed at the center for four months and then were arrested for drunkenness, it would mean a very long sentence for most. Because of this, many men planned to leave town as soon as they were released. Undergoing treatment did not alter the way sentences were dispensed, which made it difficult to follow them up with post-release treatment programs. One man explained to me why he had come to the treatment center in the first place:

If I'd done my time in there [the city jail] I might have been back in there doing time now. I think I’m ahead coming out here [the treatment center] because I had sixty days

hanging and might have gotten another sixty days. He planned to leave town for a couple of months after his four-month stay at the treatment center. Then, when he returned to Seattle, if he was arrested, his sentence would begin with _

only a few days. / _ The second way in which the alcoholism treatment center induced a man to travel

involved their philosophy of treatment. Although they defined alcoholism as a disease, and although tramps were taught they were not responsible for this illness, there was one thing under a man’s control: taking the first drink. Thus, even though drunkenness itself was not considered a moral failure, taking the first drink was. From the moment the judge questioned a man in court about his willingness to help himself and undergo treatment until he was released from several months of intensive therapy, he would be reminded that he had to © “help himself’? and ‘‘want to recover’’ in order to gain sobriety. Since counselors from the

treatment center went to court each morning to help select new candidates, news of graduates who had failed quickly spread through the ranks of the tramps back at the center.

The pain and embarrassment of failure after months of residential treatment was not a pleasant anticipation. The solution for many men was to leave town. In addition, some felt

. that the judge might increase their next sentence if they were arrested after undergoing treatment. After all, a subsequent arrest was proof that they did not ‘‘mean business” and had elected to go to the treatment center in order to do “easy time.” - ‘These are not the only factors that increase the mobility of tramps, nor is continuous travel the only thing that influences them to drink excessively. The entire process of arrest,

Spradley ] CRIME IN AMERICAN SOCIETY 31 arraignment, and incarceration works to change the identity of men who are on the edge of the tramp world. In jail they learn the strategies for survival as urban nomads. Jail becomes a rite de passage for many men into the world of tramps where public drunkenness is seen

as a custom, not as a crime.

. ETHNOGRAPHY AND APPLIED ANTHROPOLOGY The systematic description of cultural knowledge employed by people who commit crimes, enforce laws, or rehabilitate criminals is necessary for the advancement of scientific knowledge. At the same time, ethnography provides the kind of information needed for applied anthropology. It should be evident from the preceding discussion that changes in sentencing procedures, in the alcoholism treatment center philosophy and in the use of drunks as a labor

force within the jail, all could have important consequences on the mobility of tramps. The single most important conclusion that came from this study was the necessity to eliminate -the widespread practice of jailing the chronic alcoholic on charges of public intoxication. This is not a new idea, but most arguments in support of this position have been based on humanitarian grounds. At the time of the study described here, I was appointed to a committee of the Seattle City Council to consider alternative ways to handle the public intoxicant. The humanitarian argument for establishing a detoxification center was presented | by various members of the committee, but others countered that jail was actually beneficial to the drunk. One of the reasons for the establishment of the committee was the knowledge that the Supreme Court was soon to rule on the case of Powell us. Texas, and officials in Seattle anticipated that this forthcoming decision would no longer allow them to jail public drunks.

On June 17, 1968, the Supreme Court ruled in this case to uphold the laws that make public drunkenness an offense in every state. One of the majority opinions stated the following reasons for this decision: Jailing of chronic alcoholics is definitely defended as therapeutic, and the claims of

therapeutic value are not insubstantial. As appellees note, the alcoholics are removed from the streets, where in their intoxicated state they may be in physical danger, and are given food, clothing, and shelter until they ‘‘sober up” and thus at least regain their ability to

keep from being run over by automobiles in the street. |

Apart from the value of jail as a form of treatment, jail serves other traditional functions of criminal law. For one thing, it gets the alcoholics off the street, where they may cause

harm in a number of ways to a number of people, and isolation of the dangerous has always been considered an important function of the criminal law. In addition, punishment of chronic alcoholics can serve several deterrent functions—it can give potential alcoholics an additional incentive to control their drinking, and it may, even in the case of the chronic alcoholic strengthen his incentive to control the frequency and location of his drinking experiences [Powell vs, Texas 1968:2-3]. This point of view, of course, is largely based upon the perspective of outsiders, When a

tramp is released from jail, he feels that “‘you owe yourself a drunk’’ because of the restrictions of incarceration. Ethnographic description of their culture, both inside and outside of jail, provides empirical evidence of the impact of incarceration on these men. The claims that this practice is therapeutic for tramps are not substantiated. The decision made by the Supreme Court in the Powell vs. Texas case had an immediate and powerful influence on the local committee in Seattle. Members who did not accept the humanitarian argument or who did not understand the culture of tramps immediately moved to retain the traditional legal system which could continue jailing these men. One police official suggested a small detoxification center for those who had not progressed as far in their inability to control] their drinking, but believed that the jail should continue to be used for the chronic offender. He stated:

We don’t have too different a system now. The election to charge them is purely a

matter of election. There are going to be cases where a person is intoxicated and violates some minor city ordinance. He urinates. So why charge him and clog the courts? If you

32 CULTURAL ILLNESS AND HEALTH [AS9 stick strictly to the law, the language of the law, you aren’t going to have good law

enforcement and you will have some injustices. If three persons are drunk and drinking in public, two may go to the detoxification center and one to court, depends on his record. Several physicians who were members of the committee found it difficult to believe that a detoxification center would be any better for the public intoxicant than the jail. This was not because they expected a poorly operated detoxification center to be established but because they believed that jail was beneficial for these men. One stated: All things now are provided in the jail—emergency medical treatment and interruption of drinking. I find it hard put to think that any other facility is going to be able to offer better care other than the bar bit, than the jail. Another expressed his view this way: “The only difference in treatment at a detoxification center is they are not behind bars.” Now, one should not be surprised at these expressions. They are consistent with the views

held by most people without knowledge of the tramp culture. At this point, I made a decision to publish in the local newspaper an extensive account of the way in which tramps perceived their experience in the Seattle City Jail. The use of trusties, their experiences of

arrest and incarceration whether drunk or not, their feelings about needing to travel to escape long incarceration—these and other things were made public knowledge. The issue was

dramatized by the local press and this was one of the things that led to a final decision by © the City Council to repeal the laws on public drunkenness and to develop a detoxification

center for offering treatment to the tramp in Seattle. ) CONCLUSION

My own ethnographic research hardly scratches the cultural surface of this one crime and health problem. The incidence of arrests for public intoxication is higher than for any other crime, and underlying most cases of public drunkenness lies the problem of alcoholism. Although a great deal of information has been assembled on both the crime and the illness,

very little of the research has yielded data on the cultural dimension. Considering the enormity of these problems, the paucity of ethnographic data on them is alarming. If we are to understand and effectively deal with these and other problems of crime and _ illness, ethnographic research should be of the highest priority. In conclusion, let me suggest several areas where studies are needed. (1) Minority populations. Official statistics often report that Black Americans, Mexican Americans, and Indian Americans have a higher’ incidence of crime and illness than the population at large. But the meaning of such statistics requires a knowledge of the culture of _

these groups. What Baratz has said about Black Americans is also true for the other minorities: ‘‘We have not seen Afro-American culture as a distinct culture. We have treated it as a disturbed form of Western culture’ (1970:60). As he points out, we do not need more

studies based on ethnocentric concepts. Rather, ethnographic studies must be done that reveal the culture of these groups as defined by themselves. Recent research of this nature (Hannerz 1969; Liebow 1967; Valentine and Valentine 1970) makes it increasingly clear that our institutions of justice and medicine need to be restructured to serve a society that is

multicultural. |

(2) The cultural nature of criminal identities. Criminals are made, not born. They learn new identities as they are labeled by others. We must realize once and for all that crimes are not merely violations of legal statutes, and criminals are not simply those who break the law. Rather, in our society some illegal acts and some individuals become defined as crimes

. and criminals. An ethnography of crime would examine how these definitions come -to be applied, why many illegal acts and violators are not so defined, and the process involved in changing these cultural definitions. (3) Rehabilitation and identity change. From a cultural perspective, rehabilitation involves changing a person’s identity as a criminal to one accepted by our society. Anthropologists

Spradley ] CRIME IN AMERICAN SOCIETY 33 have long studied rites of passage and identity change in non-Western societies (Goodenough 1963). Our institutions that attempt to rehabilitate criminals are performing rites of passage

intended to move men back into the larger society. The fact that most institutions fail in these attempts should alert us to the possibility that their treatment methods are culture bound. We need to examine prisons, treatment centers, and hospitals as institutions that are attempting to change cultural identities. This will require that we describe both the inmate and the staff cultures employed to organize behavior. Such studies may then set the stage of restructuring these institutions so that they effectively change identities. (4) The management of danger. An important component of crime in our society is fear. Life in American cities is often characterized by people’s fear of one another. We are all aware that we must manage the potential dangers of our experience. As Ulf Hannerz (1970)

has suggested, we must study ethnographically the strategies and plans people employ to : manage danger.

_. (5) The meaning of guns. Anthropologists know a great deal about the weapons used in many small societies, but there has been: no comparable research in American society. There

is a widespread realization that guns and their use are a significant aspect of the crime problem. Efforts at legal control of guns meet continued resistance and failure. What we need is a full-scale cultural study of the meaning of guns among sportsmen, gun collectors, suburban women, the police, and others. Guns will not be controlled until we realize they _ are not merely metal objects used to harm people. The meaning of guns is culturally defined

and must be ethnographically studied. | NOTES

‘The study of non-Western law, social control, crime, and related subjects is too extensive

to review here. The interested reader may examine the following: Nader (1969), Gillin (1934), Hoebel (1954), Gluckman (1965), Bohannan (1960). 2The following cross-cultural studies illustrate this type of research: Naroll (1959), Wash-

(1965), Opler (1959). | 3 See, for example, Jessor et al. (1968), MacAndrew and Edgerton (1969), Leighton etal.

burne (1961), Horton (1943), MacAndrew and Edgerton (1969), Murphy and Leighton (1960).

. * Anthropologists have worked with other social scientists on interdisciplinary research projects in these areas. Often these projects take a general social and behavioral approach rather than one which is ethnographic.

>The concept of culture has been used in a wide variety of ways in anthropology. The definition used in my own research and for this paper is based on a cognitive approach and is discussed at length in ““The Foundation of Cultural Knowledge” (Spradley 1972a, Ch. 1). 6In this paper, anthropology is used to refer to cultural anthropology. For a discussion of ethnographic field methods see Spradley (1972a). "Much of the data from this study have been published in Spradley (1970b). The discussion

here draws on that as well as some unpublished data, especially the discussion of the

alcoholism treatment center.

5 This point has been discussed at some length by Willard Walker in his article ‘“Taxonomic Structure and the Pursuit of Meaning” (1965). ?For a discussion of eliciting methods and sorting techniques used in this research, see my article, ““Adaptive Strategies of Urban Nomads,” in Spradley (1972a),.

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1959 A Tentative Index of Culture-Stress. International Journal of Social Psychiatry |

Opler, Marvin K.

1959 Culture and Mental Health. New York: Macmillan. |

Pittman, D. J. .

1967 Intoxication and the Alcoholic Offender in American Society. Task Foree on Drunkenness, The President’s Commission on Law Enforcement and Administration of Justice. Appendix A:7-28.

Powell us. Texas

1968 Supreme Court of the United States, No. 405, October term, 1967, June 17, 1968.

Spradley, James P. 1970a The Moral Career of the Bum. Transaction, May.

1970b You Owe Yourself a Drunk: An Ethnography of Urban Nomads.-Boston: Little, Brown.

1972a Rules, Maps and Plans: Readings in Culture and Cognition. San Francisco: Chandler.

Brown. pp. 94-105. So

1972b The Ethnographic Study of Complex Organizations. In Complex Organizations and

Their Environments. Merlin Brinkerhoff and Phillip Kunz, Eds. Dubuque: Wm. C.

Valentine, Charles A., and Betty Lou Valentine 1964 Making the Scene,- Digging the Action and Telling It Like It Is: Anthropologists at Work in a Dark Ghetto. In Afro-American Anthropology. Norman E. Whitten and John F.

Szwed, Eds. New York: The Free Press. pp. 403-418. Walker, Willard . pology 21:265-275. _ .

Washburne, C. | | 1965 Taxonomic Structure and the Pursuit of Meaning. Southwestern Journal of Anthro-

1961 Primitive Drinking: A Study of the Uses and Functions of Alcohol in Preliterate Societies. New York: College and University Press.

Ethnography and the Addict’

CAGE

MICHAEL AGAR

UNIVERSITY OF CALIFORNIA, BERKELEY _. IN A RECENT PUBLIC SPEECH, Governor Rockefeller of New York stated that attempts to treat heroin addicts and other drug abusers have generally failed. Drug abuse continues to spread through all segments of American society. Perhaps the most important result of this i. failure is an awareness of ignorance. Discussions of ‘“‘the. problem” usually show that no one _

is sure what the problem is. Although no one person or profession will provide all the answers, some questions about addicts might profitably be approached using an ethnographic perspective. In the past, ethnographers studied the ways of life of different kinds of groups, usually tribes or villages in isolated places with comparatively primitive technology. Recently,

some have become interested in urban groups, and a few have looked at American urban groups. In the case of heroin addicts in American cities, there are compelling reasons why this should be done.

First of all, most professional studies of addicts draw on data obtained in formal settings, . where a specific, short-term relationship exists. One example of this would be an interview

for an hour or so in a professional’s office. The addict is asked to fit his behavior to the needs of the situation for a short period of time. In contrast, the ethnographer’s primary data source is his fieldwork. Here the situation is reversed—the professional enters into the addict’s environs, hoping to fit his behavior to the addict’s world. He enters into long-term, nonspecific relationships with addicts in order to become an accepted part of the social environment.

Consider another example. Most professionals interpret what an addict says or does in terms of some substantive theory. Many sociologists begin with a body of theory, and from this they deduce relationships between items that should hold true if the theory is valid; thus the sociologist must define the correspondences between the items and instances of empirical addict behavior so that he can test the relationships. For the psychologist or psychiatrist, addict behavior is similarly interpreted into a set of psychological categories. In contrast, the ethnographer observes addict behavior and then tries to ascertain how the behavior is interpreted by the addict; that is, how it relates to the addict’s categories and

their interrelationships. When a professional talks to addicts or otherwise observes their behavior, it is usually in situations where they are intruders into the professional’s world. Behavior is interpreted in terms of definitions and measured against the environment that the professional is most

familiar with. Although this viewpoint is necessary for certain purposes, it presents a one-sided view of the addict. There is another side that calls into play an alternative cultural system that has its own goals, its own values, and its own rules of appropriate behavior. Only in the last few years has published research offered a significant ethnographic view of the addict. Although some behavioral scientists previously suggested the existence of an addict culture or subculture, none had done an ethnographic study. Let me describe three

recent efforts in order to show the kind of perspective on addiction that emerges from them. The first, by Alan Sutter, is part of a coordinated effort to examine drug abuse in a

West Coast city. :

Sutter reviews and criticizes some of the research and popular stereotypes related to the 35

36 CULTURAL ILLNESS AND HEALTH [AS9 addict, noting that “for the most part little is known about the content of the addict subculture” (1966:181). He describes certain behaviors of an addict, such as fixing (administering heroin), nodding (unconscious state induced by heroin), and kicking (withdrawing). He

goes on to describe types of drug abusers and hustlers (those who obtain money/goods illegally) with reference to prestige, and describes various others on the set, such as the snitch (informer) and the narco (narcotics agent). Sutter often alludes to rules of appropriate behavior in his article. For example, he writes: He lies, tricks, steals, and deals to make money for ‘“‘stuff,” although the way he handles

himself on the hustling scene becomes as important as the goal he is after [1966:198]. |

As another example, he describes the appropriate way to treat a stranger.

A working rule asserts that everybody is either a ‘“‘narco or a snitch’? unless he has established his reliability on the “‘set’’ [1966:216 ].

some rules of addict culture.

Again, in his overview of the “righteous dope fiend,’ Sutter provides an introduction to A second recent work on addiction is that of Seymour Fiddle, who is associated with a

treatment program in New York City. In his discussion of addicts, Fiddle combines description and biographical narratives with a philosophical perspective. He views the addict

as ‘“‘existential man” (1967:43), for whom addiction is a method of assigning meaning to life.

Heroin gives symbolical significance, a meaning to life. Events, persons, objects, places—all —

can be characterized in the light of the need for heroin [1967:65].

In addition to offering such philosophical insights, Fiddle engages in some ethnographic description. For example, he mentions some common topics of conversation. these men will talk unavoidably about who has the “‘stuff,’”’ how ‘“‘stuff’? was in the past,

the pressure of the police, events having to do with the comings and goings of men in jails or hospitals, and finally, deaths due to various causes, and speculations on those causes [1967:77]. Fiddle discusses other aspects of the culture, such as the folk theory that the addict is a

member of an elite culture, since he can survive in the concrete jungle while the square (nonaddict) cannot (1967:81). Like Sutter, Fiddle offers some fundamental insights into the addict culture.

Edward Preble, an anthropologist who has spent years working in the New York City area, and John J. Casey, Jr., are the authors of a third study of addiction. This study, like Fiddle’s, is concerned with the meaning of the life for the addict. the quest for heroin is the quest for a meaningful life, not an escape from life. And the — meaning does not lie, primarily, in the effects of the drug on their minds and bodies; it lies in the gratification of accomplishing a series of challenging, exciting tasks, every day

of the week [Preble and Casey 1969:3]. |

Preble and Casey discuss the life as an economic career, giving relevant ethnographic and historical data to demonstrate the meaning for the participant. For instance, they quote an

informant: . When I’m on the way home with the bag safely in my pocket, and I haven’t been caught

stealing all day, and I didn’t get beat and the cops didn’t get me—I feel like a working man coming home; he’s worked hard, but he knows he done something, even though I know it’s not true [1969:21]. These three publications are samples of the few ethnographic studies attempted in the last few years. All, with the exception of Fiddle’s, are in article form, and consequently none is - a full-scale ethnography. They vary in quality as systematic ethnographic discussions. Preble’s and Casey’s economic descriptions and Sutter’s presentation of role-types and behaviors on

the set are, in my opinion, the best of the lot. The ethnographies suggest that heroin addiction is more than a psychological escape through a chemical addiction. They show the addict actively engaged in purposive behavior,

Agar | THE ADDICT 37 following shared rules, and behaving in a manner valued by others on the street scene. How, then, do we reconcile these descriptions with the image of the addict as a social failure, a miserable creature captured by his physical addiction as he escapes from his psychopathologies? Which portrait depicts the “real” addict? Using some of my own work (Agar 1971), I hope to show that both are different aspects of the same person. During informal discussions with addict-patients at the National Institute of Mental Health

Clinical Research Center in Lexington, I noticed some interesting behavioral shifts. Such shifts were marked most noticeably by a change in.attitude toward street behavior and a related linguistic alternation between Standard American English and lexical items from the addict argot. For example, an addict might initially characterize himself as sick, and his street behavior as disgusting. A short time later, he might describe himself as a slick hustler

and the street life as hipper than anything the squares experienced. , While wondering about the disparity in self-image reflected both in the ethnographic work

and in my anecdotal observations, I discovered two ‘“‘toasts’ among Lexington patients. These toasts, or rhyming verbal narratives (see Abrahams 1964, 1969), were far and away the best Known at Lexington. According to patients, toasts originate and are usually recited in prison settings or treatment centers. Of unknown authorship, they are primarily valued for entertainment during confinement. The toasts codify the two different self-images reflected in the literature and in my observations. On the one hand, consider the toast entitled ‘“‘King Heroin,’ which is expressed in Standard American English with no argot terms. The primary theme is the negative consequences of heroin addiction. One set of statements in this toast refers to social consequences, for example: I’ve captured men’s wills, destroyed their minds.

Caused men to commit brutal crimes.

Now I can make a mere schoolboy forget his books; Make a world-famous beauty neglect her looks; Make a good husband forsake his wife.

A second set emphasizes physiological consequences; for example, Those greedy few who use the most Pll kill off quick with my overdose.

And later there is a description of the withdrawal syndrome: Awake in the morning so hungry and weak, With your tongue so swollen you can hardly speak. Vomit your guts out with a hacking cough. Six days of this madness and you might throw me off.

The tone of this toast should be fairly clear by now. The addict is pictured as a social failure who suffers physically from his addiction. He is held captive by his overwhelming

need for the chemical. :

In the toast “‘Honky Tonk Bud,” on the other hand, a quite different picture of the addict emerges. First of all, the text draws heavily on lexical items from the addict argot. So extensive is the use of the argot that several professionals who work with addicts could not understand major portions. Bud is a heroin addict, but he is also a high-status member of the street scene, for example: I’m Honky Tonk Bud, the hip cat stud, known up and down Eighth Avenue. Elsewhere, the toast describes Bud’s fashionable appearance:

He was choked up tight with a white-on-white (kind of shirt), had on a cocoa front

(jacket) that was down (stylish).

Sported a hand-painted tie that hung down to his fly, and he had on a gold dust crown (hat).

Another passage shows Bud’s high status by indicating his popularity. Abrahams (1969) suggests that such passages demonstrate “‘security in the friendship network.”

38 CULTURAL ILLNESS AND HEALTH [AS9 There was Sweet Drawers Lucy, looking real juicy, Half-Head and Stumbling Blue, Humphrey the Grinder, a stone mainliner, Stick-Pin and Tough Tit Sue, There was Creepy McFaror, the whorehouse terror, Rum Dum and Cabbage Head Nick, Fo-fo the Rabbit, who just kicked his habit, Fast Eddy and Speakeasy Vic.

as a train.

Bud is obviously quite a different type of addict from that described in “King Heroin.” In “King Heroin,” criminal behavior is defined negatively; the addict is forced into it to support his habit. Bud’s criminal behavior is described as a positive attribute: He wears a 200 dollar vine (suit). He has an adding machine mind, drives a Cadillac long

Talks like a squirrel, and he’s backing ten girls, and he’s a master of the confidence game. Bud is also a stand-up cat (Feldman 1968), an individual who refuses to be cowed by the authority system’s representatives—police, judges, and so on. The toast describes how the

for using heroin

narcotics agent lied to get Bud’s conviction, and Bud points out that he gets twenty years

while some drunken villain runs over your children, pays a small fine and goes free. _Finally, even though the system wins, Bud refuses to accept defeat. The last defiant line is:

And I want to note, and reporters can quote, that I lost this case with a grin. - | And there’s many who know, who will tell you so, that it’s the same grin I wear when I — win.

Bud exemplifies the attributes of a social success, whereas ‘‘King Heroin’? describes the attributes of a social failure. In formulating an explanation of these different viewpoints, our first clue comes from the linguistic style. A review of sociolinguistics by Gumperz (1972) suggests that alternating speech styles often signal something about social category membership. As noted earlier, “King Heroin’ is entirely in Standard American English, whereas

‘Honky Tonk Bud” draws heavily on the addict argot.

The two toasts appear to represent different self-images based on different social-category identifications. On the one hand, the addict is a member of an addict subculture with the values, goals, and rules of appropriate behavior exemplified by Bud. On the other hand, he is a member of the mainstream American subculture, which defines him as criminally deviant.

As described in “King Heroin,’ he lacks the proper set of values, goals, and rules of appropriate behavior.

This seems like a plausible explanation to account for the differences in the toasts as well

as the anecdotal data I mentioned earlier. But how did the two different professional viewpoints develop? Again, let me offer a possible explanation. Symbolic interactionists (Goffman, for example) have shown that humans have differing self-images in response todifferent significant others in their social milieu. If we assume that research and treatment personnel are defined as representative of mainstream subculture, then we could expect the addict to behave with reference to the self-image appropriate to that culture—namely, that of

“King Heroin.” Such- interaction would produce a portrait of the addict as a socialpsychological failure, and this has, in fact, been the case in most professional studies. On the other hand, in the relatively few ethnographic efforts where the addict is studied

on a long-term basis in his natural habitat and on his own terms, a description of the addict that more closely approximates ““Honky Tonk Bud” is emerging. Under these conditions, the addict is observed as a functioning member of the addict subculture, where the appropriate self-image would be that of ‘‘Honky Tonk Bud.” Of course, you don’t find ‘“‘“Honky Tonk Bud” only in the streets. Earlier, I noted that

the same individual might shift during the same segment of interaction. This alternation . between communicative styles—called “code switching” (Gumperz 1972)—can be elicited by anthropologists, by therapists, or by other addicts. It turns out, though, that therapists almost always use a style that communicates the message “the addict is a social failure.” Peers on the street, however, usually use a style with the message “the addict as social success.”’ Hence the relationship between institutional studies and the “King Heroin” selfimage, and between street studies and the “Honky Tonk Bud”’ self-image. There is no reason,

Agar ] THE ADDICT 39 however, that a professional who is aware of the alternate codes cannot elicit switching behavior.

The “Honky Tonk Bud” side of the addict is not so well understood as the ‘King Heroin” side. Earlier, I mentioned a few studies that indicate that the Bud side is associated with an organized cultural system. Drawing on some examples from my own work, I would

like to show how ethnographic studies of the system can yield knowledge important to treatment personnel. First, consider an example from a study within the institutional setting. In 1968, when I first began working at the NIMH Clinical Research Center in Lexington, Kentucky, the staff viewed the addict patients as in- “‘King Heroin,” reflecting the larger social definition of the heroin addict as a pathological, maladapted social failure. Following

my ethnographic training, I began exploring areas of the institution where the addicts functioned on a day-to-day basis—residential areas, the gym, the dining hall, etc. Over a period of three months, I developed several friendships and high rapport with patients. ‘The addict as I began to understand him was quite different from the addict as the psychiatrist understood him. One important difference is related to patient perceptions of the

Center. Usually, the staff dismissed statements by the patients that were critical of the institution, attributing them to pathological flaws in the addict personality. From my perspective, such statements were, to some extent, accurate observations of both the treatment staff and the program as it was then structured. I began a research project designed to study the patient’s perception of the staff and the

program. After about two months of informal discussions on the topic, several patients invited me to check in as a patient to experience the institution on a day-to-day basis. I did so for a period of two weeks. Finally, I prepared an informal, in-house report for treatment staff, describing the patient point of view with no attempts to diagnose possible psychogenic

On the program: , .

causes. Let me give a few examples of the report’s content: |

therapy. |

, (1) Patients defined the institution as hypocritical when it assigned them to menial service roles in kitchen, laundry, or maintenance under the name of “‘vocational’’ or ‘“‘occupational”

(2) Patients defined group therapy sessions as ineffective, claiming that group composition ‘ignored several street dimensions of social variation that inhibited effective communication.

(3) Patients sometimes defined therapeutic interaction as a hustle, more specifically, a confidence game. The therapist is the mark or target of the hustle. The therapy game, as many patients call it, proceeds as follows: the patient acts uncooperative or withdrawn or hostile initially; gradually he opens up; just before he wants something from the therapist, he produces some kind of ‘“‘insight” into his problem. This gratifies the professional ego and disposes the therapist to grant requests.

On the staff: ;

(1) Patients described staff as mostly young, inexperienced medical personnel who had moved from one sheltered, middle- or upper-class environment to another. Consequently,

patients felt that treatment staff could not adequately understand life in urban slum or ghetto areas, and that they (the patients) were superior in the sense of being able to survive by their wits in the streets where the staff could not. (See Fiddle’s discussion, cited earlier in this paper.) (2) Patients stated that staff came to Lexington primarily to avoid military service, rather

than from concern or interest in the problems of addiction. (This was an accurate observation about most of the medical staff, not to mention the ethnographer. Two years in the Commissioned Corps of the US Public Health Service fulfills selective service obligations.)

The report attempted, in short, to describe the patients’ perceptions as one viewpoint on conditions in the institution, on the assumption that this information would be useful to

staff in planning. ,

After being read by close friends among both medical staff and patients, the report was

40 CULTURAL ILLNESS AND HEALTH [AS9 released to the chief of the research sections and the medical officer in charge at the hospital. The chief of the research sections commented favorably on the report, but the medical officer in charge felt that it reflected unfavorably on the institution and took the matter to the chief of the male treatment unit. The chief of the treatment unit reacted by writing a memo critical of the report, calling for a meeting of a research committee to assess its ‘‘scientific validity.”

The research committee (a mix of research, treatment, and administrative personnel) met and discussed the report. The minutes of that meeting list a few criticisms related to matters of style, mention areas not covered, and conclude that the report should be ‘‘destroyed in its present form.” Between the project’s inception, when the proposal for the report was favorably received by the research committee, and the presentation of the actual report,

which was condemned, something clearly went wrong. )

I eventually learned that much of the reaction was caused by my ignorance of bureaucratic protocol. When I sent a copy of the report to the medical officer in charge, bypassing

the director of the treatment unit, I committed a gross administrative discourtesy. The reaction had less to do with the content of the report than with the nature of the insulting manner of the presentation. As a graduate student, I had learned to do ethnography but not

to communicate the results of that ethnography in an institutional setting to nonanthropologists. The ethnographic report, which highlighted some of the problem areas in the institution as seen by the patients, was almost canceled out by my administrative ignorance. Eventually, the report did play a role in the design of new treatment units. Four months | later, a new medical officer in charge formed committees to study alternative treatment

approaches, requesting copies of the report to use as a resource. Partly because of the report, some of the new treatment units incorporated experiments in patient and staff roles and in program structure. In the end, the report was used for its intended purpose. If we expand our view beyond the institution, other ethnographic findings relevant to treatment personnel become apparent. For example, cultural differences between therapist and addict can be systematically analyzed. One difference lies in the cognized attributes of the square. The therapist usually thinks of the square as a person who works in a legitimate occupation and has a normal household role as parent or spouse. Consider, in contrast, the attributes of the square as the street junkie usually encounters him. First, the street junkie

often sees the square in those areas of the city where he comes to find such goods and services as prostitution or pornography, which squares overtly condemn. Second, the junkie

depends on “the larceny in men’s hearts’ for the success of many of his hustles; most confidence games, for example, depend on the square’s desire to make quick money using

questionable methods, and, further, the square world provides a market for the goods _ the junkie steals. Third, the junkie considers himself superior to the square in the sense that _ the square is not capable of living by his wits and foregoing an existence in the streets. Clearly, the meaning of square may be interpreted in two quite different ways.

It should be noted in the discussion of therapeutic interaction that there can also be | problems in the interpretation of addict street behavior. For example, the implicit social environment against which behavior is measured as ‘‘adaptive’’ or ‘‘maladaptive” is often that of the psychiatrist—usually white, upper-middle-class. Further, the categories into which the

observations are encoded are derived from an a priori model of human behavior; the psychiatrist is not so concerned with the meaning of ongoing behavior to an addict in the streets as he is with its meaning in terms of psychiatric theory. This is justifiable for certain purposes, but it sometimes leads to misunderstandings. For example, one factor recurrently involved in decision-making in the streets is how well the junkie ‘‘knows’” some other person. Now consider the kind of social environment in which - the addict produces these decisions. First, he is under constant threat of arrest from law enforcement personnel, who do not always use the most scrupulous methods; this contrasts with the relationship betwen an upper-middle-class white and the police. Second, the professional’s implicit assumption that police are available to intervene when interpersonal

Agar | THE ADDICT Al relationships break down does not apply to the addict; if someone steals from him or cheats

him in business transactions, he must correct the situation alone, or at most with one or two trusted others. Given his categories and his social environment, then, it is quite adaptive for the addict to

examine how well he “knows” another. In fact, if a junkie did not raise this question, he would soon learn to do so; an error of judgment in this regard could cost him money, heroin, several months in jails, or perhaps his life. Yet my observations of treatment staff indicate that the usual practice was to label such cautious interpersonal behavior as indicative of ‘‘paranoid tendencies” or “alienation.” Such labeling is understandable. The frequent use

of the “Show well do I know him” question makes little sense in the kind of social environment the psychiatrist assumes, and, as measured by that yardstick, the behavior is maladaptive. The only question remaining for the therapist is how to classify the pathology, | and in the repertoire of psychiatric theory such concepts as “paranoid” and ‘“‘alienated” | provide the best labels of those available.

Erroneous assumptions regarding the addicts’ social environment, which are the more influential for being held tacitly, allow the psychiatrist to diagnose the addict as psychologically maladapted. However, an examination of the addict’s actual environment, by way of his cognitive representation of it, reveals no systematic personal distortion. The distrust and

fearfulness that a psychiatrist may count as pathological responses to a (tacitly assumed) benign and predictable environment are adaptive responses to an accurately perceived and cognized environment of unpredictability and danger. Of course, this is not to say that addicts do not sometimes want help or need to change their behavior, but only that those who want to help should be cautious in interpreting addicts’ behavior. Interpretations in terms of theories embracing tacit assumptions regarding the sociocultural matrix may be misleading, with unfortunate implications for treatment. This discussion has only hinted at some of the questions needing attention. For example,

: there is much current discussion of methadone maintenance programs. The perspective outlined here suggests that the program is not the best approach for all junkies. To the extent that an addict is involved in and rewarded by the life style aspects of addiction, the substitution of one chemical for another does not necessarily alter the rest of his behavior.

Further, the therapy game suggests that close attention must be paid to the criteria by which professionals judge a methadone patient to be cured.

Another question is posed by the different types of narcotics and other drug abusers. Does an addict who arrived via a suburban hip subculture differ from one who arrives via the slum? How do these types relate to the soldier who is addicted in Vietnam? Perhaps for some, narcotics use is solely a chemical escape, whereas for others it is a life style. What kind of overlap might there be between street junkies and other American subcultures? For example, Spradley’s (1970) discussion of urban nomads in Seattle suggests areas of overlap with the street junkie in such areas as hustles and courtroom strategies. Finally, what about cultural differences in therapist-patient interaction? Some implications of these differences have been discussed in this paper, but what does this suggest about the use of professional therapists and ex-addict therapists in treatment programs? A final important question has to do with the relation between the street junkie culture and the individual who chooses to acquire it (Feldman 1968). Perhaps it is here that the King Heroin and Honky Tonk Bud aspects interlock. Even to approach this question, we need more information on those who sample street junkie life and leave it. Who are they and what do they become instead? Unfortunately, all our ethnographic data come from the study of those who became visible street junkies. NOTE

‘Research in support of this paper was conducted while the author was a commissioned

officer in the US Public Health Service, NIMH Clinical Research Center, Lexington,

42 CULTURAL ILLNESS AND HEALTH [AS9 Kentucky. The support of the Center staff, particularly my colleagues in the Social Science

Section, is gratefully acknowledged. I am also grateful to the University of Hawaii for

providing writing time, and particularly to R. Lieban, T. Maretzki, and L. Nader for reading earlier versions. Social Science Research Institute in Hawaii and Language-Behavior Research

Laboratory in Berkeley provided typing services. Parts of this paper are taken from Agar (1971, 1978).

BIBLIOGRAPHY

Abrahams, Robert D. 1964 Deep Down in the Jungle. Philadelphia: Hatboro. 1969 Positively Black. Englewood Cliffs: Prentice-Hall. Agar, Michael H.

1971 Folklore of the Heroin Addict: Two Examples. Journal of American Folklore 331. pp. 175-185.

1973 Ripping and Running. New York: Seminar Press. In press. Feldman, Harvey

1968 Ideological Supports to Becoming and Remaining a Heroin Addict. Journal of

Health and Social Behavior 9:131-139. Fiddle, Seymour 1967 Portraits from a Shooting Gallery. New York: Harper and Row. Goffman, Erving 1959 The Presentation of Self in Everyday Life. New York: Doubleday. Gumperz, John J.

1972 Introduction. In Directions in Sociolinguistics. John J. Gumperz and Dell Hymes, Eds. New York: Holt, Rinehart and Winston. pp. 1-25.

Hannerz, Ulf 1968 Soulside. New York: Columbia University Press. Preble, Edward, and John J, Casey, Jr. 1969 Taking Care of Business—The Heroin User’s Life in the Street. International Journal of the Addictions 4:1-24. Spradley, James P,

1970 You Owe Yourself a Drunk. Boston: Little, Brown.

Sutter, Allan C.

1966 The World of the Righteous Dope Fiend. Issues in Criminology 2:177-222.

Before Divorce: 7

Some Comments About Alienation in Marriage’

| PAUL BOHANNAN

. NORTHWESTERN UNIVERSITY

AN OLD SAW goes the rounds among lawyers about the young client who came in and asked the experienced family lawyer for information—he wanted a divorce, but was not sure he had grounds. The laconic reply was, ‘““Are you married?”’ = There is, the story is telling us, always a reason for getting divorced. There are also always reasons for not getting divorced. No matter how rough things are, there are reasons for not doing it; no matter how good things are, there are reasons for doing it. Therefore, we want to examine the kind of situations of alienation in marriage that sometimes

lead to divorce and sometimes do not.

Karl Menninger, some years ago in Man Against Himself (1938), pointed out that if you want to commit suicide successfully there are at least three things you have to want. You have to want to kill somebody. You have to want to be killed. And you have to want to die. If any one of these needs is lacking, either you won’t try or you will botch the job.

Because there are continuing relationships, it would seem to be more complicated to get divorced than it is to commit suicide. You have to want at least three things. You have to want to reject your spouse. You have to want to be rejected by your spouse. And you have to want to be single. The third is not difficult—surely almost anyone can want that, at least from time to time. Rejecting and being rejected are the great difficulties. In order to think about divorce, we must talk about alienation in marriage—how a person gets to the place that he is willing to reject and be rejected by the person he formerly selected and was selected by. In a study of divorce and its aftermath among the American middle class (Bohannan 1970), I found, in my case histories, that I could not gather information about the process and aftermath of divorce without being told what led up to divorce. Although the ‘‘causes” of divorce are as many as there are divorcees, I want here to discuss three points that seem to be represented in the cases of all the divorced persons I interviewed. | The first point has to do with the unconscious aspects of the marriage contract. The second deals with -a reluctance or inability to draw boundaries. The third is a model of the series of mounting crises within endangered marriages. When there is a crisis in the family or the marriage that is not resolved to the satisfaction of the parties concerned, there is a residue of discontent and perhaps distrust—wariness at very least. But most people of good will smooth things over and go on. They get to the next crisis—the next rough spot. If that second one is not resolved, they again

smooth things over and go on. But at the time of the third crisis, or the fourth, there is a regression-like phenomenon in which everything that ever happened in the marriage emerges, stacks up. And the easiest solution—by then, the only solution—may be to break the marriage, no matter how difficult that may be. CONTRACTURAL RELATIONS IN MARRIAGE

The greater the individual responsibility every person has for his own marriage—whether it be freedom to choose a partner, or freedom to let the relationship develop idiosyncratically—the 43

44 CULTURAL ILLNESS AND HEALTH [AS9 more substance is to be found in the fact that marriage, like any other relationship, is the result of

- interaction. American middle-class marriage is particularly subject to the vicissitudes of misunderstanding between spouses—they interact with one another at close range, with a fair degree of isolation from any audience or referee, and they have great breadth of choice. In interaction, each party has a set of motives and goals, some of them unconscious. Nowhere else, perhaps, in all of American culture, is the irony that accompanies freedom so -

heavy as in middle-class marriage. If the maturation of the individuals—and hence of the relationship—is to occur, the two perceptions unavoidably get out of phase. Communication can never be so perfect that the two perceptions are always in phase. It is like growing up: without getting out of phase as one proceeds from one stage to the next, it seems unlikely that one is able

in fact to proceed. The same in a marriage: if the maturation of the individuals and of the relationship is to occur, the two will get out of phase, and those out-of-phase perceptions of the

| situation must be brought back into phase. The alternative is that the marriage must be ended—either actively and more or less creatively by divorce, or else passively by erosion, with its —

accompanying psychic pain and ultimate numbness and stagnation. | |

The problem for every married couple of the American middle class—and for their marriage counsellors as well—is to find techniques for determining when the two perceptions are in fact out

of phase, and for bringing them back into phase. ;

The American middle class (like many other twentieth century peoples) take it as one of their inalienable rights not just to marry, but to marry whomever they choose. The more overt the civil rights an individual claims to contract his own marriage, the more extreme, even eccentric, his

demands and choice may become. . : In a cultural tradition in which romantic love has been so deeply institutionalized and mythologized as in our own, it is difficult to understand that the two principals to a marriage contract may not be the best qualified persons to choose the contracting partners. In other societies, in which the relationship of the spouses is more carefully spelled out and the rights and obligations of each are known to the entire community, the demands on the individuality of the spouse are not so great. In those situations, marriages are less intense because they are not

expected to fulfill as wide a spectrum of the individual’s needs. When people select their own spouses—when they make their own marriage contracts—they do so on two levels. They pick out a person with the “‘right” qualifications, peculiarly “‘right’’ for them no matter what the community may say. Indeed, defiance of the community may become a major factor in the choice. This part of the choosing is done at a conscious level. But people select spouses not merely for their conscious needs and with their conscious minds. The unconscious part of the mind—most of it below the surface of a repression barrier—is given _

full play to make its demands and take its part in decision making. And, through such dogmas as a ‘love,’ American middle-class people sometimes allow their unconscious decisions to have practically full control of the process. This social convention leads to very different problems from |

those engendered by a situation in which a matchmaker looks for entirely overt symbols of |

suitability and in which there is little or no unconscious contract. |

The Conscious Contraet . |

Social scientists have shown that people marry people like themselves—the mean geographical distance, even in our mobile world, between the homes in which American husbands and wives grew up, is only a few blocks (Winch 1963:322-324). People marry within their own interest groups, economic categories, and social classes.

Therefore, in middle-class American society, the conscious contract is most often made between a man and a woman of approximately equal social “‘standing.”’ Americans pay lip service ' to this idea in largely negative terms: they say on all relevant occasions that major discrepancies in age between spouses leads to “unnecessary” difficulties, that interfaith or interracial marriages are more difficult than those that are ““chomogeneous,”’ and that marriages between spouses from

different parts of the country may have some problems not found in those in which there are fewer cultural differences in the backgrounds of the spouses.

Bohannan } ALIENATION IN MARRIAGE AB However, if we hold religion, race, age, and socioeconomic status constant, then Americans can ‘“‘marry anybody,” except where the law intervenes—all states have incest prohibitions, all have minimum age requirements, and a few still have “‘miscegenation’’ laws. But it can be argued that

we do not need laws. We, and all the rest of the peoples of the world, find ourselves most comfortable (in an ovérwhelming proportion of cases) with people whose cultural backgrounds are similar to our own. And it is from among such people that we choose spouses. The exceptions can be explained—and sometimes it is felt that they ‘“‘should”’ be explained. The basic division of labor and responsibility between a married pair is ‘““known to all,” in

middle-class American society, in spite of the fact that there are now (and always have been) people who try, more or less successfully, to change it. Of course, this division of labor varies with ethnicity, education, and other factors, but the general culture pattern is known even when one’s self manages successfully to follow another. Similarly, the tasks of parenthood are known in the

society (for all that the capacities or inclinations to be a parent are usually not known in any specific person on first marriage).

Obviously, then, the overt part of the contract involves finding someone who agrees to do all these things for you, in some subcultural version or another, in return for your doing all these things in return. This is a form of what ethologists call “bonding.”

The Unconscious Contract , : Some instinctual animal behavior can be carried out by an animal alone—feeding, elimination, shelter-seeking, exploring. But other instinctual behavior demands conspecifics: sexuality, reproduction, parenting, fighting, teaching. a

When American middle-class persons (and probably almost everybody else) select somebody - with whom to bond over a long period of time, they have goals, both conscious and unconscious. The unconscious goals are all related to rewards and frustrations that have been suffered in their past lives—the human mind either repeats or else tries specifically to avoid the affect and activities associated with past experience. So, when one marries, one makes not merely a contract with the ‘right person” in order to be more fully a “man’’ or ‘“‘woman,”’ He makes a specific, and largely unconscious, contract with a specific person in order that he can be more fully himself. In American society, becoming more “‘one’s self”’ is a vastly important value; and a large part of one’s identification is tied up in marriage. In many other societies, identification is much more dependent on other relationships and kinship groups than it is on marriage. Therefore, Americans of the middle class do not marry only to form a bond to allow them to enhance the self—to express their sexual and parenting instincts, their domestic and cooperative

propensities. They also marry in order to enhance the ego (which is only a part of the self). Therefore, a person’s attitude toward his “‘self’’ takes on an importance that is, I think, much more decisive than it is in the situation in which spouses are selected for him. In arranged marriages of

the sort I investigated among the Tiv of Nigeria, the attitude of a spouse toward himself was, although not totally unimportant, not central to his marriage as it is in our society. The conscious contract, known to all, was the important part. One’s sense of self was, especially for the men,

derived from the lineage and kinship groups. For women, virilocality created some psychic problems, but not those concerning the view of the self found among the self-selecting, neolocal

middle-class Americans. )

It is just here—in the selection of the spouse in order to enhance the ego as well as the self, no matter what the unconscious view of one’s self may be—that the unconscious contract lies. It would seeem that in middle-class American society every person, before he marries, has some

more or less overt and many covert ideas of what the other person is going to be and what that person will symbolize. Indeed, even after marriage, most people (I have asked a number of divorced and also long-married people about this) create fantasy dialogues about what one will one’s self say, and then what the spouse will reply, and how one will reply to that. This is of any - moment only to those persons whose contact with “reality” (as the psychoanalysts call it) is tenuous enough that they cannot tell if the spouse makes quite a different response to the opening

46 CULTURAL ILLNESS AND HEALTH [AS9 line. Obviously, good reality testing must go into any marriage, but particularly one with a large unconscious component. In other words, the question is: Is my view of my spouse in any degree concordant with the spouse’s view of himself? And is my view of myself in any way the same as my spouse’s view of me? Is it reasonable for me to expect what I expect? Am I being cast in a character drama in which there is dissonance between what that person expects of me (his view of my self) and my own view of my self? And—to invert the question—am I casting my spouse into roles that I need to populate my psychic world, but which nevertheless do not accord with the spouse’s view of himself or his

view of the world? . It is difficult to distinguish the boundary between the conscious and the unconscious contract—although not difficult to distinguish the heartland of each. The more we come to know about our spouses, the more of the contract becomes conscious. Many divorcees have told me that they ‘‘knew”’ before marriage about those traits in the spouse that led eventually to divorce. I am not sure how much they consciously “knew” and how much they became conscious of after marriage. Here is an example: ‘‘We dated off and on for over a year—it was friendly, fun. He always had planned what we would do, and I liked this. I was fond of him as a companion—he was stimulating, not brilliant but educated and intellectual.” He asked her to marry him, by mail—she asked for a week to think it over. The letter in which she accepted

crossed in the mail with one in which he told her to forget it.

“Strangely enough, part of my reticence was the ten year difference in age—another was that I wasn’t in love with him, but figured that he’d be a good catch. Then, I had a fight with my father and he told me if I didn’t like it to get out—I had two years to go on my training, so I left and got a job as a housekeeper—during this time I wrote to this man. Some months before, I had borrowed $100 from him, and now I didn’t have the money to pay him back. In some ways I married him to repay that $100. But I said to myself that I would make him a good wife. I didn’t love him, but I was fond of him and I didn’t love anyone else. I thought it was a will for success that made good marriages—and I thought he had it too.

“Then, right after we were married, he became very concerned about whether he was impotent—I had suspected that prior to marriage.” A little later in the interview she said, ‘““To him

sex was not something that went along with affection—to him it was an end in itself. I had no objection to that—I like sex.” She also claimed that she had a good sex education, but he had not (he was over 35 when she married him), so she decided she would have to teach him and to ‘‘make up to him all the things he lacked in childhood.”

This woman obviously was sloppy even about the conscious component of the marriage contract and, even at the late date when I interviewed her, was unaware that there was a large unconscious—and destructive—element that had led her to make her choice. Many people make —_—© wrong choices and, like this woman, many of them project backwards in memory to before the marriage what they in fact learned in the course of the marriage. Nevertheless, our culture does provide a freedom to cater for the unconscious demands of the psyche. This case history illustrates something important: most divorcees think that they “knew” before their marriages about those aspects of the spouse’s character that eventually became unbearable. However, their unconscious needs made it impossible for them to utilize common caution. The exceptions are those people whose courtship was totally inadequate for learning, and those who use massive defenses to keep from seeing the truth about anything. As a result of several dozen case histories like the one excerpted above, I am convinced that a viable and long-term marriage is, among the American middle class at least, based on a successful unconscious contract. Many unconscious contracts lead to destructive, neurotic relationships—and are still successful, no matter how much friends, psychiatrists, or the children of the union deplore _. the result. There is little doubt that the more neurotic individuals are more likely to make a “bad choice’ at the covert level than are the less neurotic individuals. But a ‘‘neurotic” contract for mutual misery can, at the level of merely enduring, be just as firmly binding as a healthy contract for mutual support, esteem, and love.

Bohannan J ALIENATION IN MARRIAGE AT BOUNDARIES

The intimacy in a relationship ideally continues to grow after marriage. (It is not always so, as the student of American divorcees soon discovers.) However, there is, associated with this very growth, a trap in which many marriages come to ruin. Boundaries must be created between the self

and the relationship in order to keep the personality from being swamped. The greater the out-of-phase quality in the unconscious contract, the more difficult it becomes to draw adequate boundaries. Many—indeed most—of the divorcees with whom I worked had boundary trouble. Bruno Bettelheim (1967:81) has written eloquently: A self, if it is not to wither away, must forever be testing itself against the non-self in a process of active assertion. By self-assertion is not meant a rugged individualism nor an egocentric having one’s way... Testing implies both respect and consideration for what we test. ourselves against. Otherwise it becomes not a test of self, but of something entirely different, perhaps of brute force.

Thus, as one tests one’s partner, boundaries must be discovered. The parties to a marriage have to find a key to maintaining intimacy in the face not merely of constant boundary searching and testing, but also of boundary discovery. Discovering that one is not infinitely loved or loving comes as a deep narcissistic blow to some people, especially those who have never questioned the stated American middle-class norm that unlimited love and loving is the only “‘correct’’ way. For some people to admit that a boundary

exists is tantamount to admitting failure. One divorced man told me, “Each time | would even

raise my voice, she was convinced that she had failed. You cannot deal with this infinite goodness.’ His thinking of this quality as “‘infinite goodness’ was almost as damaging, I think, as her original attitude. The Nos

Thus, not only must every marriage have two heads and two selves, but it must also have a common culture and an area of interaction in which true mutuality does exist. In analogy to the ego, I put forward the idea of the nos. Nos is the first-person plural pronoun

in Latin, just as ego is the first-person singular pronoun in Latin. ) There is one difficulty in understanding the concept of nos: psychiatrists will think of it in intrapsychic terms, whereas social scientists will think of it in social terms. I mean it to be both, and to include a long-term transaction that is a distillate of many smaller transactions. It “exists” only in the psyches of two people, but each is such a clearly known object to the other that a mutuality can develop. One nos is a part of two psychic structures; it is, through language, gesture,

empathy, and introspection, an interlinking of two psychic structures. Because, through identification, each is not just an object but is a part of the self, the nos exists in two places at once. It can be studied as a single entity—the American language even has a word for it: a

‘“‘marriage.”’

The idea of the nos has its roots in the idea of ethological bonding. Each of the spouses

developed in a family-household apart, and each developed in accordance with—one a masculine, one a feminine—experience of the world. The greater the complementarity of these experiences—

, each being different in such a way that the two parts create a whole—the more likely the two people are to be able to create nos to bind the marriage without damage to the self of either partner. A lot of popular lore says that the best marriages are created by “‘opposites’”—which means that the experience and the needs are indeed complementary. The idea is to be taken literally—each completes the other, in the ethological sense that a bond is created that allows each to be securely and fully himself, whatever that self may be. On the other hand, there is a lot of popular lore that the best marriages are created by people who are “alike’”—who share common interests. That idea

is also true. In fact, the two points—marrying somebody who is complementary to you, the

48 CULTURAL ILLNESS AND HEALTH [AS9 ‘opposite’? from yourself, and marrying somebody with whom you share a lot of common

interests and experiences—are not contradictory. |

| The solution, then, for the problem created by the great part played in American middle-class marriage by the importance of the unconscious contract, is the creation of a more effective and more wide-ranging nos. It is, in my opinion, one of the weaknesses in American middle-class culture that so little outside assistance is given in the process. Restated in these terms, the myth of marriage among the American middle class is that, in the best marriages, both selves are expanded at the same time and that the nos can alter the direction of expansion. The myth is reality in just enough marriages to nourish it. But the problem in the nos is always the boundaries between the two selves and those between the nos and each self. A case history is of value here. Toby was a woman of 33 who had left her second husband a few months before her interview

with me. She had had a son by each husband; the boys were now 4 and 9. Each husband was a small-business man at the time she married him. Toby soon systematically began two concurrent processes: she moved into the business to ‘“‘help”’ her husband, and she refused to give him guidance

(either at home or in the office) about what she wanted and did not want. In the first instance, it was a small appliance business. She began coming in to keep books and send out the monthly statements, to do the ordering, and keep the inventory. She did it efficiently and well in about two hours each day, with a few longer days toward the end of each calendar month. She enjoyed being ~ in the store; she began to talk with and then assist the customers, and soon spent all her days there. She was verbal, pleasant, easy to get along with. Her husband was, at first, delighted—or so she said. But he became increasingly less so as she moved farther in on him, leaving him fewer and fewer tasks. Although obviously it is impossible to tell, without talking to him, what his view of the matter was, he seems to have thought he had no grounds for complaint, because she was doing the job well and the business was prospering. I surmise, however, that he began to feel the distress

of being dispensable.

At any rate, he grew irritable. At home he often flew into a rage and yelled at her for “‘little things” or for “‘nothing.’’ I interpret this as his displaced rage, because he was threatened by her success in the store which he saw, perhaps unconsciously, as leaving no room for himself to be the achiever. However, when the tantrums occurred, she meekly said nothing, did nothing. Obviously, when she did not respond, the outbursts grew worse. And still she did not respond.

Years later, Toby told me, “I was afraid that if I tried to stop him, I would ruin my marriage—when he was like that, nothing could stop him. If I tried, he would have beaten me up or thrown me out or both.” His outbursts became more and more uncontrollable. ““So who wants to live with that kind of man? I finally just left him, it got so bad. I just left him.” My own sympathies are with the husband in this case (indeed, my sympathies were often with __

the spouse I did not interview). He was trying to establish some sort of boundaries on his ill temper, on his rage, and perhaps on his fear that she would dominate him and make him useless in his own business endeavors. There was, obviously, also an inability on his part to draw boundaries against her incursions in his business. When he could not rationally object to what she was doing,

he turned to rage. When she did not establish boundaries on his behavior, at the same time expressing her own demand for rational and adequate relationships—he got worse. In what appears

from her description to have been an absolutely frantic search for boundaries, he became unbearable to her—and probably to himself as well. In her refusal to establish boundaries, she became more and more the sufferer from irrational behavior until she had no self-respect left.

Toby saw her acts—or her inaction—as an attempt to save her marriage with what she concomitantly came to regard as a more and more unreasonable and destructive man. Her own view of the matter was, “‘I thought if I just tried hard to love him more, he would see how much I

. loved him and would stop being so nasty.” About a year and a half after her divorce, she remarried—this time to a tax accountant. She was a good typist, and began to spend a few hours each day in his office. Soon, she was running the office. She squeezed him systematically into the back room, while she did all the public relations, displaying great efficiency and skill. The business prospered.

Bohannan J ALIENATION IN MARRIAGE AQ Apparently the second husband, like the first, felt he had no rational basis for complaining—she was doing the job well. Because she so much enjoyed it, or for whatever reason he found, he did not ask her to stay home, or to get a job elsewhere (which, in my opinion, any sensible man with his particular sensibilities might profitably have done). Rather, he allowed himself to be pushed into the back room (obviously, of course, he had been picked to do this—part of the unconscious contract led her to select men who would react in this way to her efficiency). The second marriage ended like the first, except that the second man turned to other women instead of to rage. She did nothing to try to stop him, “for fear I would ruin my marriage.” She insisted, ‘‘If I had done anything, he would have left me for one of those blonde bitches. Just. like that. I did it to keep him. I put up with a lot from him!” But she left him—‘‘just like that.” After the second divorce, Toby decided that she did not want to be married to anyone. “I’ve got two good kids. Why should I put up with a husband? Oh, I don’t mean I’m about to give up men—I like men—but no more husbands.”’ By her report, the children were doing well in school, she had established a secretarial service that was thriving, and she had four divorcees typing for her cheap, because she was willing to adjust hours to their needs. This is a classical case of spouses who will not or cannot establish boundaries. Therefore, neither spouse knows for certain what behavior is required or what behavior is disapproved or disliked. Even if one of them were to want to change to please the.other, it is impossible to do so in such a situation. In this particular case, Toby may have been right that the husbands would have left her had she established boundaries and made the demands. But she seems not to have recognized the fact that she left both of them because of their reactions when she did not make demands. Either or both spouses may be guilty of putting up with so much that the marriage collapses. Success in marriage is not possible if, instead of creating a nos, one self is allowed to swamp the other, or if one so dominates the nos that it is lopsided, or if the selves are never sufficiently involved.

THE PSYCHOSOCIAL STAGES OF MARRIAGE

The marriage contract is not unalterable. Certainly the unconscious dimension is most unstable. The boundaries drawn by a couple in their twenties will probably not serve the same couple in their thirties, forties or fifties. The nos is an evanescent, ever-changing structure. The changes, however, are not haphazard. They follow what can be called an event structure, which correlates very closely with the stages of psychic development of the spouses. Although my interviews with divorced persons were focused primarily on the mechanics of divorce and what happens during and after it, not before it, they nevertheless contain sufficient material that a clear event structure emerges. An “‘event structure” is a series of type events that always follow one another in the style of a Gutmann scale. They can be diagrammed in this way:

pa | > > >{ |

It should be read that event D is preceded by events of the types A, B, C; event C is preceded by A and B; event B is preceded by A. The process is not like the familiar hydraulic model in that the occurrence of A does not trip the entire sequence; the sequence can stop at any point. The gross form of the event structure of middle-class marriage is this:

or > Wedding > Marriage > Divorce

Arrangement

The idea of event structure in family and marriage is at least as old as Adolph Meyer, and a version of it has recently been given, briefly and rather off-handedly, by Theodore Lidz (1968). It

50 CULTURAL ILLNESS AND HEALTH [AS9 is found in the sociological literature of some decades ago (Loomis 1945; Glick 1957); in anthropological literature it was investigated by Meyer Fortes (1958, based on ideas that were published earlier), by Goody (1958), by Gray and Gulliver (1964), and most recently by Otterbein (1970).

°””

The box marked ‘marriage’ in the preceding sequence can itself be viewed as an event structure. A husband-wife relationship goes through certain phases. Therese Benedek, the psychoanalyst, has suggested names for these stages or phases (1959):

cation Substitution Autonomy]

Love: The First Phase

Love, late twentieth century Western style, is a combination of the bonding of friendship and the bonding of sexuality. In psychoanalytic terms, it involves an ‘exchange’ of ego ideals; that is, in the nature of the mammalian world, there are two sexes—and each of us has to settle with better or worse grace for being either male or female. Every individual learns the social roles and cultural —

activities of both sexes but must forego (no matter how gladly he thinks he does it) the opportunity to exercise his talents at the roles of the other sex. We all learn to be parents while we are children—and we all learn to be both fathers and mothers, for all that no one can actually be both. The cultural tradition divides social experience into male and female, along different lines from the experiences of individuals as children.

Thus it becomes necessary, when one is growing up, to suppress those of our talents and inclinations that we are socialized to believe belong to the other sex. Still, there are qualities in us, which form part of our ego ideals, that we like—but which belong socially to the other sex, and are

therefore repressed. If may even be necessary to convince ourselves that we do not like these qualities. But it is easier and leads to less strain if we simply recognize that they are unsuitable for our selves and that we can find those very qualities in a person of the other sex. Then we finally come to love the qualities themselves—but in the “‘other’”’ and not directly in the self. When two people each find some of the suppressed aspects of their own ego ideals in the other, then they are taught by our culture to interpret this state as being in love with each other. When this love is also fired by the drives of sexuality, then a highly-charged emotional bonding has occurred between the two ‘‘partners,”’ as Americans have come to call them. This very state of affairs, in itself, produces character alterations in both partners. Each is not

only taking great pleasure in loving, but is strengthened and nurtured by being loved. This _ strengthening makes each partner increasingly independent of the demands and rewards of the other. One outcome of these subtle changes is likely to be that each envies the other; that is, feels “T’m giving more love than I am receiving’ (which means, “I give more than I now seem to need, since I have been strengthened by that very receiving’). And this notion—usually it remains unconscious, but unconscious only in the sense that we never put it into words, not in the sense that we have repressed it—grows into envy and ultimately erupts into hostility. It is just here that “the fight starts.” Mere romantic love and the exchange of ego ideals is no longer enough. , Identification: The Second Phase

Often before the wedding, and always by the first few months after it, with successful middle-class marriages, another psychic state begins to develop. It is a process of identification.

. Each partner identifies himself with the other. Identification is not Just the sympathy of “I know how you feel.’’ Rather, it includes taking the other into the self in such a way that the other becomes part of the self—in the process of building a nos, the boundary between self and beloved is likely to become hazy. What happens to my spouse creates reverberations in me. There are a number of difficulties inherent in such identification, one of the most notable of

Bohannan ] ALIENATION IN MARRIAGE 51

determination.

which is that I will try to control my spouse by the same methods and for the same reasons that I try to control myself. Because of the intensity of identification, combined with a fear of some of.

the forces within myself, I may not dare leave the spouse any autonomy, any area of self If the identification proceeds well, it means that the two people “share the same reality,” as Benedek puts it. The psychic identification of the two occurs within the mind of each; but, in order to work, it is necessary that it occur without each trying to diminish the autonomy of the other. The identification is reinforced from outside—the couple are identified by others as a single

unit. The social unit for many activities in American life is the couple, and Americans have a phrase (‘‘fifth wheel’’) for the individual in a group that is made up, otherwise, of couples.

As an individual personal experience, the identification may emerge as each member of the couple becomes acutely aware that outsiders may judge them in terms of the other member. But, they also experience many things as a couple: ““When we were pregnant,” or ‘“‘our career plans.” Common ambitions and shared experiences cement the experience of unity. Yet, during this phase, the identification may also backfire: when each becomes aware of being

publicly judged in terms of the other, he may be aghast. He may regard the spouse as “too revealing.” As the growth of the self continues, and is joined by the growth of the “couple,” it may become ‘“‘a dead giveaway.’ You may suddenly see the spouse—and it may become conscious very suddenly indeed, whatever you have ‘“‘known’’ at some deeper level—as the embodiment of _ your own self.. The two spouses have been locked in this intimate relationship for some years now. They have, as the world knows, chosen each other, and they have contributed, . each to the other, many of the experiences that have gone toward sharpening the characteristics that now become evident. ~

When this happens, some people look at their spouses and fairly shout, ‘‘I refuse to be judged

by that!’ Almost always, it would seem, this is a horror of being what one really is, as it is reflected in the spouse one chose and has stayed with. Often what one sees there is projected from the self into the spouse so as to avoid seeing it in the self. One then assumes (often wrongly) that the rest of the world can also see it there. Whatever the device, the spouse is experienced as “‘too revealing.”” The implication is “I helped to create that!”’ or even “‘The world knows X about me because I presumably love that!”’ A severe identity crisis may occur. The marriage may be the easiest thing to break. If, on the other hand, such identification is not considered too revealing or distasteful—or is even gratifying—then the marriage is firmer than ever: “What a lovely wife I have, and how proud I am for people to know that I am married to this wonderful woman, whose real quality becomes every day more apparent.” This phase (like every other, but it is more obvious here) is composed of two dimensions—one inside the nos, which involves the identification of the partners with one another, and one in the outside world—in which each member of the couple takes the other to be the yardstick by which the world examines him. The latter is a phenomenon of the individual psyche; the former is a phenomenon of the nos—two psyches bonded together. Parent Substitution: The Third Phase

Besides the many practical changes that parenthood creates in the day-to-day lives of the parents, parenthood must also necessarily be considered one of the stages of psychic and social maturation. Whereas the couple is composed of two people, the child creates a triangle—indeed, the eternal triangle—which disturbs the nos. Now, instead of identifying merely with the spouse, each spouse also identifies with the child. Loving the child, knowing that you gave it life—that half its genes are your genes—creates a different kind of identification. The child seems almost to be an extension of the self—and the parent identifies with the child. As the child gets older, the parent must learn increasingly to see the child as an individual with whom one interacts closely instead of as an extension of the self.

52 CULTURAL ILLNESS AND HEALTH [AS9 The subtle connotations for the couple, however, are vast. When you identify with your child, that child’s other parent—at one level or another, in or out of conscious awareness—is identified with your own parent. Thus, when you, a male, identify with the child, the child’s mother is (to one degree or another) assimilated in your psyche with your own mother. You are, ipso facto, driven to be more like father. Benedek puts it elegantly: “The marital partners (as if they were parents for each other) become, as once the parents did, a critical forum, a measure of each other’s

personality” (1959:362). . The difficulties are obvious: the unsettled differences and the unadmitted pain and anger of the

relationship with your own parents may be turned on the spouse, in some disguised form or other. __ If all works well, the hidden forces of conscience that appear as guilt reinforce the identification and the compounded ego ideals. Identification with the child or children (and the sex of the child may make all the difference in the way a parent readjusts to his spouse) means that the parent goes through the entire process of growing up again—this time vicariously, but none the less intensely. Whereas the first time around being the parent is vicarious, the second time around being the child is vicarious. In identification | with one’s child and playing the other social role—that of parent—you have to do again the same thing all over. It is a chance to do it better, and many parents see it and feel it in that light. But, ; obviously, it is also a chance to fail again. The problems of their oedipal child stir the parents’ oedipal problems; the problems of an. adolescent child stir the parents’ memories of adolescent agonies. If those difficulties were satisfactorily resolved, the stirring is helpful in the parent role. If they were not, it may make

parenting an adolescent a trying or even an impossible task.

Dyadic Autonomy: The Fourth Phase | When children grow up and leave ‘“‘to live their own lives,” or “‘start their own homes,”’ the couple becomes a couple in a new sense. The role of parent of adult children is not an easy one in contemporary America. The parent may still identify with the children, and indeed the successes of the children may still be one of the major sources of pleasure or even of identity for the parent. Yet, however much one depends on the children, they are not there—and the spouse is: you have what Americans call the ‘“‘empty nest” syndrome. Obviously, being part of a couple with an exciting glowing young woman is very different from being part of a couple with a menopausal little old lady. Just as obviously, identification with a

Greek god is different from identification with a middle-aged wheezer who has more or less strenuously to diet and do calisthenics to keep his paunch within the bounds required by good health and decency. Whereas coupleness for the young is based primarily on an exchange of ego ideals with some identification, coupleness for the middle-aged and the aging is built on. identification, some transference from the parents, a firm realization of one’s age and experience, and a good view of the ‘‘real world.” At this stage of the process, autonomy takes on a new importance—an even greater importance than it had all along. Autonomy is that state in which people have no “‘dependency needs,” but

rather choose to be dependent and depended upon for the mutual benefit of the parties concerned. The dependency is of a type that can, with proper psychic work, be overcome and

altered. One can become independent, but one chooses not to be and opts rather for a combination of dependence and dependability. If this step can be achieved, then the concatenated ego ideals, the identifications, the transferences, and the grasp on reality all come together finally to cement the nos.

I have called this a state of “dyadic autonomy” because it must be done by each person, and demands a considerable degree of agreement, usually carried on by discussion—at least com-

munication at some level or another must be pretty good. If a state of dyadic autonomy is achieved, it is usually pretty solid—although, of course, the severe illness (or perhaps many other factors) of one party may disrupt it, leading to regression in the couple-relationship as well as in the individual psyches. And there is no “‘regression in the service of the nos.”

Bohannan | ALIENATION IN MARRIAGE 53 THE CRISIS STRUCTURE OF A MARRIAGE

The task within marriage, then, is to build an adequate nos to pass through the phases of marriage and at the same time adapt the contract, conscious and unconscious, to reality in the new phases. The marriage proceeds, I think necessarily, from crisis to crisis. But the crises are not random. Indeed, looked at from the outside, the matter is very simple. One of the points on my interview schedule—and it was almost always asked in this precise form—was “‘Tell me as much as you like about what happened between your marriage and your divorce.” One insightful and terse young woman said, ‘‘We got to know each other.” All the others talked from thirty minutes to three hours, with my tape recorder. going—and then often added intimate details after the recorder was turned off. What they all said, however, was “‘We got to know each other.”’ In going over these interviews, I find that American middle-class divorces occur in a situation of ‘“‘multiple crisis’—either at the first such crisis or after a third unresolved crisis. If one projects along a time scale the medical histories and job histories of both spouses, the changes of residence or community or both (the two do not always coincide), the child-bearing history of both partners (including, of course, abortions, miscarriages, and children of other unions), and the stages of psychosexual development for each child, then one has a “‘field” onto which to mark crisis points. I discovered that among divorcees at least (and probably in all marriages, but the point remains to

be investigated), the crisis points ‘“‘stack up’? into major crises. Things do not happen one ata time—several crisis points arrive at once. This puts the partners to the marriage under very considerable strain—and each must adjust to the new situation and to the strain.

At the time of a major crisis, the marriage “‘contract’’ must be reviewed, altered, and renewed—and that goes for the unconscious contract as well as for the overt one. Boundaries must be explored, some relaxed, some changed, new ones drawn. The investigator must then look at the profile of major crises of a marriage in terms first of the psychic histories and characters of each of the spouses, and second, the stages of the psychosocial

developmental sequence of the marriage. ,

With each major crisis, with each developmental move, obviously there is a whole concatenation of role changes and alterations in basic expectations. Jf the adjustments and the roles changed,and if the new expectations are either empathized by the spouses, or made overt, or both, then the

matriage. |

multiple crisis will probably be looked back upon by the couple as a “growing point’ in the

However, if the changes of roles and of expectations (and the psychic growth that accompanies them) are not encompassed, then a crisis point becomes a point of arrest in the development of the marriage. As with points of arrest in personality development, the couple either cannot proceed from there, or else they can do so only by encapsulating that aspect of their lives and going on with a serious “hole” in their perceived experience. However, at the time of the next crisis, there is likely to be something resembling a regression back to the point of arrest. That means that the second crisis cannot be dealt with in terms of itself, but must bear the overload of the inadequate solution of the first crisis—which is what caused (or was) the point of arrest. The weight of the first crisis is superadded to the second. If it could not be done the first time, it is even less likely to be successful the second—and at the third major crisis point without growth, it may be that the

marriage is the easiest thing to break. |

Obviously the psychic histories of the partners, particularly their infantile and child

development, are crucial to such matters—many people suddenly, at the time of crisis, undergo

regressions to traumata in their own earlier development, well before the marriage, which obviously cannot be solved or even shared by the spouse. Such people may be unable, without therapeutic assistance, to encompass the next step in the development of the marriage (and, with it, of course, their own personalities). This idea, obviously, underscores the notion of the points of arrest and of regression.

All this means that a marriage must constantly, throughout its existence, be “‘renegotiated.” Alienation is a natural state of the nos—the nos is built only by overcoming alienation. If the

54 CULTURAL ILLNESS AND HEALTH [AS9 renegotiation fails, or if it is ineffective, the alienation in the relationship reaches crisis proportions. Without the constant process of renegotiation—new contracts, new boundaries, new degrees of autonomy and interdependence, new roles that are recognized—the growing alienation cannot be checked. People who renegotiate their marriages successfully seldom know that they are doing it: they are people who have minimal specific requirements in the unconscious contract. They are able to draw boundaries—and, later, to reconsider them and alter them, making them more stringent or less stringent. They must be able to talk, or otherwise communicate, what their view of the new

situation is, and what they have to do to master it. ; |

Renegotiation is difficult, in part because it is difficult to know what one wants. Spouses constantly grow out of phase and must struggle with the implications. I know a couple who are, just now, out of phase. He has worked very hard, and has been thoroughly successful. She has worked very hard and has raised three magnificent children and kept a beautiful house and garden. They are rich. They are in their early fifties. When he was offered the presidency of his company, he resigned and made an arrangement to work a few weeks a year as a consultant. He is

going to the beautiful small house that they had built in an isolated corner of the world for a week-end retreat. And he is going to paint. He has his inner resources built and intact. But she is getting back into the world—‘‘finding herself,” in the jargon of the new woman. She has finished a | year’s college for the degree she willingly gave up when she married. She wants to become a stock . broker—her major was in economics and she has long followed the market and occasionally made money on her investments. And he wants to go to the woods! These are sensitive, solid people who can talk to each other. They can work out something. Why shouldn’t she stay in the city? Have a career? Why shouldn’t he go to the woods? Why shouldn’t they meet for idyllic week-ends? Why shouldn’t they completely alter their life-style? They are creative enough that I think they will find a non-traditional solution. But the culture offers them no patterns. They are on their own. And far too many couples, faced with this situation, would pull and tug and hurt and cuss until the marriage collapsed—which neither of them wants.

NOTE

The interviews on which this paper is based were carried out under Grant No. MH 11544-01, Ethnography of Middle Class Divorce, from the National Institute of Mental Health. BIBLIOGRAPHY

Benedek, Therese

1949 The Emotional Structure of the Family. Jn The Family: Its Function and Destiny. Ruth

Nanda Anshen, Ed. New York: Harper and Row. pp. 202-225. 7

Bettelheim, Bruno 1967 The Empty Fortress. New York: The Free Press.

Bohannan, Paul, Ed. and Contr. |

Fortes, Meyer

1970 Divorce and After. New York: Doubleday.

1958 Introduction to The Developmental Cycle in Domestic Groups. Jack Goody, Ed.

Cambridge Papers in Social Anthropology, Vol. 1. Cambridge: Cambridge University Press. Glick, Paul 1957 American Families. New York: John Wiley and Sons. Goody, Jack, Ed. ©

1958 The Developmental Cycle in Domestic Groups. Cambridge Papers in Social Anthro-

pology, Vol. 1. Cambridge: Cambridge University Press. Gray, Robert F., and P. H. Gulliver 1964 The Family Estate in Africa. Boston: Boston University Press.

Loomis, Charles ,

. Lidz,1968Theodore The Person: His Development Throughout the Life Cycle. New York: Basic Books.

1945 The Cross-Section vs. the Historical Method in Family Life Cycle Analysis. In Studies of Rural Social Organization in the United States, Latin America and Germany. East Lansing,

MI: State College Book Store. |

Bohannan ] ALIENATION IN MARRIAGE 55 Menninger, Karl 1938 Man Against Himself. New York: Harcourt Brace. Otterbein, Keith F.

1970 The Developmental Cycle of the Andros Household: A Diachronic Analysis. American Anthropologist 72:1412-1419. Winch, Robert F. 1963 The Modern Family. Revised ed. New York: Holt, Rinehart and Winston.

PART Il LIFE CYCLE COMPARISONS

Altruistic and Egoistic Behavior in Six Cultures JOHN W. M. WHITING BEATRICE BLYTH WHITING

HARVARD UNIVERSITY .

MOST SYSTEMATIC OBSERVATION of children’s social behavior has been done on American and British children. Our Knowledge of the behavior of children in other cultures is based largely upon ethnographic reports in which general statements are made describing the customary or typical behavior of the children of the society being studied. Although these reports have been very useful in broadening our culture-bound perspective, it became evident that more detailed and systematic observations were needed to determine which of the findings reported in the child development research literature were unique to modern Western industrial societies, and which were transculturally valid. William Lambert, Irvin Child, and the present authors in the early 1950s undertook to

make a start on this task.! A corpus of detailed materials were collected on the social behavior of a sample of children in six communities, each representing a different culture. The field teams who collected these data were: Robert and Barbara Levine, Nyansongo, a Gusii community in Kenya; Kimball and Romaine Romney, Juxtlahuaca, a Mixtecan barrio in Mexico; William and Corrine Nydegger, Tarong, a hamlet in northern Luzon, Philippines; Thomas and Hatsumi Maretzki, Taira, a Ryukyuan village in Olinawa; Leigh Minturn and John. Hitchcock, Khalapur, a local segment of a Rajput caste group in Uttar Pradesh, India; John and Anne Fischer, Orchard Town, a subcommunity of Yankees in a New England town, USA.

In addition to collecting materials on the culture of each community, the field teams, assisted by a bilingual member of each society, collected descriptive protocols on the social interaction of children in natural settings. The samples of children from each community were matched by sex and age groups. In Tarong, Taira, Khalapur, and Orchard Town, there were six children in each of the following groups: young (38-6) boys, old (7-11) boys, young (3-6) girls and old (7-11) girls. In Juxtlahuaca, there were only five children in the older age. groups; and in Nyansongo, four children in each sex-age group. (Total sample: 134 children). METHOD

Kach child was observed for a period of at least five minutes per session. No more than one observation was made in a day, and observations were spaced over a period of several

months to a year. An average of 17 separate observations was made on each child, distributed over the settings that children frequented during the course of the day and under

a variety of conditions—in the courtyards near the houses, in the fields, in school playgrounds; with adults present or absent; with many people or few people present; when the group activity was play, work, or casual social interaction. Since the focus of the study was upon social interaction, the children were not observed when they were alone. Each protocol was divided into interacts that consisted of an instigating act by an alter (if any), a central act by ego, and an effect act by an alter. These acts were then coded into discrete categories of behavior, twelve of which will be the subject of this paper.* Table I lists these categories of behavior with the frequency of their occurrence. 56

Whiting and Whiting] ALTRUISTIC AND EGOISTIC BEHAVIOR 57 TABLE I. SHOWING THE FREQUENCY OF THE TWELVE ACTS BY CULTURE FOR THE POOLED SAMPLE*

Acts sociably 2795 Seeks attention 603 Shows symbolic aggression 1148 Seeks help 556 | Offers help 827 Suggests responsibly 529 Reprimands 752 Assaults sociably 286 Offers support 610 _ Contacts physically 286

Seeks dominance 609 Assaults 263 TOTAL 9264 - *arranged in order of frequency

The characteristics of the setting—time, place, sex, age, and relationship to the ego of the personnel present, and of the interactors, i.e., instigators, and targets of the central act—were also coded for each interact. These data, consisting of approximately 9500 interacts, formed the basis for determining

the structure and concomitants of the social interaction of children. That the children represent six cultures permits the discovery of those relationships between variables that hold true in all six cultures and are presumably transculturally valid, as distinguished from those

that are unique to one culture. It also permits an inquiry into the degree to which differences within cultures are predictive of the social behavior of children. Finally, it permits the discovery of new variables that have been taken for granted and hence have not been recognized by those investigators who have limited their study to a single culture. THE STRUCTURE OF SOCIAL BEHAVIOR

To discover the underlying structure of the social behavior of the children of our sample, a multidimensional scaling procedure was carried out on the data (Kruskal 1964). To rule out differences in the activity level, scores for each child on each of the twelve behavior types were converted to proportions or percentages such that the sum of the scores for the twelve behavior types for each child would be 100. A rank order correlation matrix of these scores over the 134 children of the sample formed the basis of the scaling procedure. The results, presented in Table II, yielded three interpretable dimensions. Since this is a brief paper, dimension two (intimate vs. aggressive behavior) and dimension three (peer vs. adult oriented behavior) will be dropped from further consideration. Dimension one contrasts the primary beneficiary of social interactions and has been labeled altruistic vs. egoistic. On the altruistic end of the dimension, the primary beneficiary is the alter, the two types of behaviors with the highest positive loading being offers help (+.99) and offers support (+.91). By contrast, the ego or the actor himself primarily benefits from the following types of behaviors: seeks dominance (—.87), seeks attention (—.78), and seeks help (—.68), the egoistic pole of the dimension. Since suggests responsibly (+.71) refers

to behavior concerned with implementing or enforcing the rules of the household or community, the group of which the child actor is a member can be considered the beneficiary. Thus, dimension one structures social behavior along a dimension of altruistic to

egoistic social behavior. It should be noted that the technical sociological definition of altruism, which involves the risk of self-sacrifice, is not implied in the dimension. Altruistic behavior in this instance simply means that the intended primary beneficiary of the action is some other person or persons.° As has been stated above, the scale was based upon the pooled scores of children from all six cultures; thus the basis of a child’s score on the altruism vs. egoism dimension may result

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Whiting and Whiting ] ALTRUISTIC AND EGOISTIC BEHAVIOR 59 either from his membership in a particular culture or from some features of his individual personality, or both. If the former is the case, all the children of at least one of the cultures should score high on the altruism vs. egoism dimension; and, in contrast, all the children of at least one other culture should score low on this dimension; furthermore, the scores of the children in any one culture should be very similar to one another. On the other hand, if the basis of this pattern is at the level of individual personality, approximately half the children of each culture should score high and the other half low; in other words, the average of the scores Of all the children in any one culture should be the same as the average for any

other. ) i.

It is not surprising that the truth apparently lies between these two extremes and that

both culture and personality have an influence on children’s behavior. Most of the children

in three of the cultures are above the median of the whole sample on the altruistic vs. egoistic dimensions:* the Nyansongo of Kenya, 100%; the Juxtlahuaca of Mexico, 73%; and the Tarong of the Philippines, 63%. Less than half of the children in the other three - eultures are above the median: the Taira of Okinawa, 29%; the Khalapur of India, 25%; and , the sample from Orchard Town, USA, 8%. The means of the scores of the children of each

cultures (P< .001). -

of the first three cultures are significantly different from the means of the second three | In the first group, Nyansongo children score significantly higher on the altruistic vs. egoistic dimension than the children of Juxtlahuaca (P< .05) and Tarong (P< .01), but the scores of the children of the latter two cultures do not differ significantly from one another. .

This is also true of all three of the second group of cultures. The children of Taira, Khalapur, and Orchard Town might have been drawn from the same population as far as their altruistic vs. egoistic behavior is concerned. -

| INDIVIDUAL DIFFERENCES WITHIN CULTURE It is true that a child’s score on the altruistic vs. egoistic dimension is appreciably affected by the type of culture in which he is being brought up. The reasons for this will be explored later. It is also clear that culture does not entirely account for a child’s score on this dimension, since the scores of the children in each of the six subsamples cover a wide - range, indicating appreciable individual differences not accounted for by cultural membership.

A number of features that vary within each culture may account for the range of

individual differences among the children of each culture. Girls may differ from boys, and older children from younger children. A child’s position in the sibling order, the type of

family in which he was brought-up, and the nature of the tasks and chores that he is expected to perform, may influence his score on the altruistic vs. egoistic dimension of social behavior.

Measurement Stability | Before proceeding with this investigation, however, the possibility that the variation (within cultures) of the scores of the children is due entirely to measurement error should be ruled out. To test for the stability of our estimate of the propensity of a child to behave either altruistically or egoistically, the scores for each child were divided in two, depending on whether they were taken from odd or even protocols. The difference between the means for

the odd vs. the even protocols over the whole sample was negligible (0.5%), and the correlation between the two sets of scores was +.42 (P< .001). This indicates that a search for variables that occur within each culture that influence the altruistic vs. egoistic behavior at the level of individual personality on these data is worthwhile. -

60 CULTURAL ILLNESS AND HEALTH [AS9 Sex Differences

In a cross-cultural study, Bacon, Barry, and Child found that in many societies there was more pressure put on girls than upon boys to be nurturant and responsible. Boys, on the other hand, were expected to be more self-reliant and achievement-oriented than girls. This suggests that at the cultural level females are more likely to be altruistic and males to be egoistic. Our data show that this is true for each of our six cultures. The difference is particularly strong in Juxtlahuaca where the distribution of the scores for boys and girls scarcely overlap on the altruistic vs. egoistic dimension. The component behavioral types that contribute most strikingly to this difference are offers help and offers support. Girls score ©

higher than boys on these two types of behavior in each of the six societies, and the difference when the scores are pooled is statistically significant: P< .05 and P< .01 respectively. Boys seek dominance more than girls in five of the six cultures—there is a slight reversal in Juxtlahuaca—and the difference for the standardized pooled scores” is significant

at the 5% level. Similarly, boys seek attention more than girls in all the cultures except Orchard Town, where there is a slight reversal, but the difference for the standardized pooled scores just fails to reach statistical significance. There is no consistency across cultures, nor a significance in the pooled scores for seeks help or suggests responsibly, the

dimension.° | Age Differences |

two remaining behavior types that have high loadings on the altruistic vs. egoistic

Although there is a positive correlation between age and altruism, this tendency is neither so strong nor so consistent as the effect of sex upon this dimension. Older children behave more altruistically than younger children in Khalapur and Orchard Town, the reverse is true in Nyansongo, and there is virtually no difference in the remaining three cultures. There are, however, some shifts in the altruistic components of the dimension. Suggests responsibly is the single component behavior type that most significantly (P< .01) and consistently (in all six cultures) increases with age. Offers help and offers support shows a similar but less striking trend (P< .05 for the pooled score and positive in five of the six cultures). On the egoistic pole of the scale, seeks help shows a slight decrease with age, but seeks attention and seeks dominance increase slightly. These trends are very small and not consistent across

the six cultures. ; Sibling Order

A Kikuyu saying, ““The youngest child is the spoiled child,’ suggests that a child’s score on the altruistic vs. egoistic dimension may be related to his position in the sibling order. Kikuyu informants go on to explain this aphorism. “Since the youngest sibling has no younger brother or sister to care for, how can he learn to be responsible and nurturant? He will obviously end up selfish.”’ This bit of folk wisdom turns out to have some transcultural validity. The standardized pooled scores for children who had no younger siblings (only and youngest) was significantly (P< .05) and consistently (in all six cultures) higher on seeks help than for children with younger siblings (oldest and middle). Furthermore, youngest and only children scored lower on both suggests responsibly and offers help in five of the six cultures, but in neither case was the difference statistically significant for the standardized pooled scores. The other three components of the altruistic vs. egoistic dimension showed no strong or consistent relationship to sibling order. However, there is a tendency, expressed in seeks help, suggests responsibly, and offers help, for the children with no younger siblings on

| whom to practice to be low on altruism and high on egoism. | - Cross-cultural studies have shown that societies with an ideal of the independent nuclear family customarily train their children to be independent at an earlier age and more severely (Whiting et al. 1966) than societies with the extended family as an ideal. These findings

Whiting and Whiting | ALTRUISTIC AND EGOISTIC BEHAVIOR 61 were interpreted to indicate that the independent nuclear family isolated from the relatives of either the husband or the wife expressed a strong positive value on the independence of the individual, a value inculcated at an early age and with strong pressure. Such a value, if it is held differently by parents living in different types of households within a society, should affect the behavior of their children on the altruistic vs. egoistic dimension. Children brought up in independent nuclear families should score lower on this dimension than those brought

up in extended families. A test of this hypothesis could only be made in five of the cultures, where both extended and independent nuclear families occurred. Although there were three families in Orchard Town in which grandparents lived in the household, they did

so as dependents of their son or daughter rather than as head of the household, and thus did not meet the standard definition of the extended family. Excluding Orchard Town, children brought up in independent nuclear families scored higher on seeks attention than their peers in the same culture who were brought up in families where grandparents and/or } married aunts and uncles lived in the same household or courtyard with their parents. The difference was both statistically significant (P< .01) and consistent (in all six cultures). There was a slight and statistically nonsignificant score in the same direction for seeks dominance and in the reverse direction for seeks help. The altruistic components of the dimension were slightly higher for children brought up in extended family households, but the differences were also small and inconsistent. These findings throw light on an interesting and apparent

contradiction. If seeks attention is taken as a form of dependent behavior, why should children who are punished early and severely for being dependent score higher on it? If the facts are correct that independent nuclear families do indeed punish dependent behavior in their children, seeking attention may be a response to conflict about dependency, and as such condoned. -

Task Assignment

The mother of each child was asked in an interview, ‘What chores do you expect your child to do? How often does he have to do this? Is it regularly?’ It was also noted in the behavioral observation protocols whether or not the subject being observed was engaged in some task or chore. There were considerable differences among the children of each culture in how much he or she was reported and/or observed to help out with the domestic chores and economic tasks of the household. Since the primary beneficiary of such work is the family rather than the child himself, the children in each culture who were assigned more tasks than their peers should score higher on the altruistic vs. egoistic dimension, and this was indeed the case. When the children of each of the sex-age groups in each culture, on the basis of their mothers’ reports or of observed behavior, were divided into those who worked more and those who worked less than their peers, the former scored higher on the altruistic

components of the dimension. Suggests responsibly, as might be expected, showed the strongest and most consistent effect. The difference for the standardized pooled score was statistically significant (P< .05), and the harder workers were more responsible in all six cultures. Offers help also shows some tendency to positively relate to task assignment, but there is a reversal in Nyansongo and no relation in Orchard Town. As a consequence, the

pooled score is not statistically significant. Both seeks help and seeks dominance are negatively related to the assignment of economic tasks in five of the six cultures, but there is a strong and statistically significant (P< .05) positive relationship in Taira for seeks help, and in Tarong for seeks dominance. The pooled scores are not statistically significant for

either behavior type. Neither seeks attention nor offers support shows any strong or consistent relationship to task assignment.

Baby tending is another task that should favor learning to be altruistic. Here, again, the primary beneficiary of social interaction is the alter rather than the ego. In general, the altruistic types of social behavior were positively related to the amount of babysitting. The strongest relationship was for suggests responsibly, which was positive in Tarong (P< .05),

62 CULTURAL ILLNESS AND HEALTH [AS9 Khalapur (P< .05), Juxtlahuaca, and Taira. It was, however, slightly negative for Nyansongo, and no test could be made in Orchard Town. There was no consistent relation for the three

types of egoistic behavior. :

Summary of Individual Difference

Thus, sex, age, sibling order, family structure, and task assignment all affect the scores of individual children on various components of the altruistic vs. egoistic dimension of social behavior, and most of these effects are both consistent across the six cultures and statistical- _ ly significant when the scores of all the children are standardized by culture and pooled. Of the component behavior types of the dimension, both offers help and offers support are higher for girls than boys and for older children rather than younger children. Seeking help is more characteristic of youngest and only children than of children in other positions in the sibling order. Children brought up in independent nuclear families seek attention more than those brought up in extended families, and boys seek dominance more than girls. _ , CULTURAL DIFFERENCES

The foregoing analysis at the individual level suggests what the features of a culture might ©

be that would lead to placing a high value on altruistic behavior, in contrast to one that

would value such behavior less highly. | Role of Mother

Taking their contribution to the subsistence economy as an index of the importance of the female role, the women in the two societies in which the children score lower on the altruistic vs. egoistic dimension—Orchard Town and Khalapur—do much less than those of the other four societies toward contributing to the food supply of the family. Although a few of

the mothers in the Orchard Town sample were part-time wage-earners, most of them occupied themselves with marketing, cooking, housekeeping, and civic affairs. Most of the Khalapur women were in purdah and could not leave the confines of the courtyard, where they devoted themselves to housekeeping and were not involved in either agriculture or marketing. Women played a major role in food production in the other four societies. In Nyansongo (where children scored highest in the altruism vs. egoism dimension) the women rather than the men were primarily responsible for gardening. In the other two societies scoring high on the dimension, women were also important. In Tarong, they spent many hours a day weeding and tending the crops; and in Juxtlahuaca, although the women helped ~ only seasonally in gardening, they were involved in processing food and other goods for sale in the market. The women of Taira also played an important role in the economy, helping with the gardening and with cutting firewood for sale to residents in the deforested southern part of the island. If it is true that the contribution of women to the economy increases the positive value of altruistic behavior, we might expect Tairan children to be more altruistic than they were observed to be. However, since in the remaining five societies the cultural. evaluation of altruistic vs. egoistic behavior is consistent with the importance of the contribution of women to the subsistence economy, the hypothesis receives some support from the data.

Size of Families

| The individual level finding with respect to sibling order should generalize to the cultural level if cultures differed in the proportion of youngest and only children as compared to middle and oldest. This would, of course, be the case if among cultures the number of children in the family differed markedly. In Nyansongo, with a median of 5 children per

Whiting and Whiting] ALTRUISTIC AND EGOISTIC BEHAVIOR 63 family, only 25% of the sample were in the only and youngest position in the sibling order, whereas in Orchard Town, where the median number of children per family was 2.5, more than half the children were youngest or only children. Those two cultures represent opposite extremes on the altruistic vs. egoistic dimension in the direction predicted by the hypothesis.

The other four societies, however, do not support the assumption. All of them have relatively large families and in only one of them do the only and youngest position represent more than 25% of the sample. A preponderance of youngest and only children in a society therefore apparently does not contribute in any marked degree to the cultural evaluation of altruistic vs. egoistic behavior. .

Family Structure If the individual level finding that children brought up in localized, extended families | score higher on altruism than those from independent nuclear families generalizes to the level

of cultural values, it would be expected that the ideal family type should be extended for the altruistic cultures and independent nuclear for the egoistic culture. Only Orchard Town, however, has the isolated nuclear family as an ideal, and its children, as would be predicted, | are low on the altruistic vs. egoistic dimension. However, neither Khalapur, which is second lowest, or Taira, which is third, accepts the independent nuclear family as an ideal. The extended family co-residing in a courtyard and stem-family households are the respective | ideals of these two cultures. The remaining three cultures, whose children have high scores on the dimension, all have some form of extended family. Thus there is only partial support for the hypothesis if the ideal family type is taken as the independent variable. However, the actual frequency of independent nuclear families among the six cultures is as follows: Tarong, 8%; Juxtlahuaca, 138%; Nyansongo, 12%; Khalapur, 37%; Taira, 42%; and Orchard

Town, 100%.’ This order roughly corresponds to that for the children’s score on the altruism vs. egoism dimension for their respective cultures. This lends some support to the hypothesis that a culture in which the members of an extended family ideally, and in fact usually, co-reside, tends to place a high value on altruism, and also that egoism is permitted in societies where the independent nuclear family is frequent and ideal.® Task Assignment

The final hypothesis suggested by our culture analysis—that children who, as compared to their peers, perform more domestic chores, help.more with economic tasks, and spend more

time caring for their infant brothers, sisters, and cousins, score high on the altruistic vs. egoistic dimension—is more strongly supported at the cultural level than any of the other hypotheses discussed above. As indicated above, the mothers of each of the children were asked what chores and tasks they were expected to perform. Furthermore, many of the children were performing tasks during the time they were observed. When the percentage was computed of children in each culture reported by their mothers and/or observed by the field teams to perform household chores or economic tasks, this percentage score was compared

to the mean score on the egoism vs. altruism dimension. The rank-order correlation was

almost perfect (+.94, PTo remove the direct effects of culture, the scores for the children of each culture were converted to Z scores. This resulted in each of the six sub-samples having the same mean and standard deviation, permitting the scores of the six samples to be pooled and a single test run on them.

For a full report on sex differences, see Whiting and Edwards (forthcoming in Journal of Social Psychology).

This figure is 83% if the households with dependent grandparents are considered to be

extended. 8 Family structure is more strongly related to dimension two. BIBLIOGRAPHY

Barry, H. H., M. K. Bacon, and I. L. Child 1957 qo NN LOO a O Y "OOOO | nea | 8 seer Be ASRAWO c9 09 BY03EY q m~ AONNNG I~ ~H dixis 1900 05rs} et

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rm CS ‘a 3.4 N sn ’ E a2n0008 Ye) was | Ss o Ml £ NO : Sse Ga NN we 1D | ON apo ON ~*, Fee ¢ m wm ~~ Ona! Ad 4+ > ‘ . . e ° ~~

>ore Be fe S&S mA oO) dH 10 cmd HNO H10 %q9 O >> |S 8 1~HCO ogg SSe ASHea} > to Y NICO HS » >» 2eeks

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Omm 0 | > Bam |»o &9) 1% 4 383) £3 =) |Q .: $rs ee) oa — Bo O ay l(c '>|3 oat: oS uw + ie)qe S:

or S 93 22 é 23 Be fo oe {5 Oa 2) > as S OD +0 ae) -2 “8 yO x oO . Bd 3 pO gS < . 52|a2a7|#2288 oo EB a3 |to2Pa >2

ae) G28 8 § gee es) vie | ~ 7 o SH Wer o yD SH Bes ; $4 ° > ge me os & 22 og g g ll ae wo 3 8. G mp9 sR 3.4 9 Pp bs Td SON OT mnogo a 9 do - sa LO x ro) N Ose S . MAO 19 co > as - hoot

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D’ Andrade] CULTURAL CONSTRUCTIONS OF REALITY 123 (5) The semantic-similarity rankings of the Bales-Mann categories are fairly similar to the

correlations for the subjects’ ratings (r, = .50). .

(6) The semantic-similarity rankings of the Bales-Mann categories are strongly similar to the

correlations for the observer’s ratings (r, = .64). |

(7) The semantic-similarity rankings of the Bales-Mann categories are not similar to the correlation for immediately recorded observations (r, = —.05).

The overall pattern of results shows a consistent congruence between the semantic-similarity ranking and the correlation matrices for ratings made on the basis of long-term memory, whether the ratings were made by the subjects or the observer. In contrast, the correlation matrices for the immediately recorded observations are not similar to those for either of the kinds of ratings made

on the basis of long-term memory. (A more extensive analysis of these data and related studies is given in D’Andrade 1970). My argument here is not just that there is memory error when people make ratings or rankings of other people’s behavior, but that the error is systematic, nonrandom, and in the direction of the rater’s conception of “‘what goes with what’’; that is, in the direction of his construction of reality.

Because of thisbased type of error, in research on theinorganization humanreflect behavior, reliance | y); on judgments onmemory long-term memory will result conclusionsofwhich primarily the,

-subject’s constructions of reality, not the world as it is. : After completing the analysis just reported, I discovered a reference to a study done by

Newcomb (1931) which clearly states the hypothesis presented here and supports it by differences in correlations found between observer ratings based on long-term memory and the correlations found between immediately recorded behavior frequencies. The subjects were thirty ‘“‘problem” boys sent to a summer camp for five weeks. The boys were under the constant observation of a psychiatrist and six or more trained counselors. A daily record was kept for each boy by his own counselor of specific incidents involving twenty-six categories of behavior. Some 8500 incidents involving these categories were also recorded by the experimenter. At the close of the camp,

ratings were obtained from each of the seven observers on the frequency of each of these categories of behavior for every boy. A mean correlation of .41 was found for the relation between daily record scores for particular categories and the ratings for these categories. On the basis of this evidence, it appears that there was a fair degree of validity for the specific behavior category ratings. However, the correlations between behavior categories showed a considerable degree of distortion when the results from the two different methods were compared. Intercorrelation of the categories thought to make up nine general traits (a total of 112 correlations) yields a mean correlation of .49 for the ratings, but only .14 for the daily records of the children’s behavior. Newcomb states: The conclusions may therefore be drawn that the halo effect, inevitable in the ratings, worked

in such a way as to cause the rater to rate similarly logically related behaviors ... The close relation between the intra-trait behaviors which is evident in the ratings may, therefore, be presumed to spring from logical presuppositions in the minds of the raters, rather than from — actual behaviors [1931:288; my italics]. If the argument presented here is correct, then a large number of social science studies are brought into question. Studies based on correlations from memory-based check-lists, ratings, or interviews are obviously placed in the category of dubious findings. Studies in which the correlations are based on questionnaires in which the respondent answers on the basis of his recollections also are placed in doubt. A growing body of evidence indicates that the results of many different kinds of memory-based

studies may be artifacts of the common cognitive structures held by the respondents. Factor-analytic studies of personality ratings can be reproduced relatively accurately with nothing but semantic-similarity judgments (D’Andrade 1965). Dimensions of small-group structure found by several studies using memory-based ratings have also been reproduced using only similarity judgments (Shweder 1972). The failure to replicate even very well conducted research which used memory-based interview material from mothers about their techniques of child rearing would seem to indicate that this type of data is suspect even when taken from well-informed sources (Yarrow,

124 CULTURAL ILLNESS AND HEALTH [AS9 Campbell, and Burton 1968). These memory-based studies may turn out to have an unexpected value in showing how Americans construe reality. In any case, it is remarkable that so many social scientists collect data as if humans were videotape-like creatures with near-perfect retrieval systems. In the examples presented so far, the major research difficulty has been uncovering nonverbal

aspects of reality construction. The investigation of well-verbalized aspects of reality construction, however, also presents certain difficulties. Often, such a large amount of verbal material is

collected that the primary problem becomes one of trying to determine which of the many statements are really important to the individuals who made them. This type of problem, which occurs frequently in research on belief systems, perhaps can be illustrated by one of the research projects carried out by the Stanford Anthropology Research Laboratory (1958 to 1966) under the direction of A. Kimball Romney. The major focus of this project was to determine the salient categories of illness in American and Mexican cultures. In the initial phases of the investigation, an attempt was made to elicit taxonomic structures for disease terms and to construct componential analyses of these terms. Unfortunately, these techniques led to non-replicable and idiosyncratic results for both American and Mexican informants. Other studies at the Laboratory at this time (Frake 1962; Metzger and Williams 1966) indicated that more reliable and accurate results might be obtained by using a | sentence-frame technique. From informal interviews with informants, various statements made - about illness were collected. These statements were put in sentence-frame form by replacing the name of the particular illness with a blank (e.g., “it is safer to have__._ = —~—S= ——O as a child and get

it over with’), Next, on the basis of informant and interviewer judgments, the most general, unambiguous, and semantically independent sentence-frames were selected. A list of “disease” terms were also collected during these interviews and a similar procedure used to select the least ambiguous and best-understood terms. Sentence-frames and disease terms were obtained first for the American-English sample. The Mexican-Spanish items were obtained both from translations of

American-English items (to ensure some degree of comparability) and from free interview

statements made by the Mexican respondents. .

- From this collection of sentence-frames and disease terms, a test was constructed in which each informant was asked, for every sentence-frame, whether the insertion of each disease term into the frame would make the sentence true or false. Thus, an informant taking the American-English test

would be asked for the sentence-frame “‘you can catch from other people’? whether it was true for (1) “appendicitis,” (2) “arthritis,” (3) ‘asthma,’ etc. To the Mexican-Spanish speaking informants, the test was given orally, while a dittoed form was filled out by the American-English informants. The pretest indicated that the American-English informants — preferred to answer on a scale, rather than give simple “yes-no’”’ answers. A five-point scale was developed for the final American-English test form. The Mexican-Spanish speaking informants, on . the other hand, did not seem willing to accept this type of continuous scale, preferring just three alternatives: “‘yes,”’ ““sometimes,” and “‘no.”’

The American sample consisted of ten Stanford undergraduates judged to be of standard American middle-class background. The Mexican sample consisted of eighteen Mexican-Spanish-

speakers from Villa de las Rosas, a rural village in the highlands of the state of Chiapas. | From the test records, the data from each informant were placed in a matrix form, with each row of the matrix containing the scores for a particular disease term and each column containing the scores for a particular sentence-frame. The next step was to assess the degree of similarity between disease terms. Two matrices of product-moment correlation coefficients were computed, the first containing the correlations for each pair of disease terms calculated from the mean scores across sentence-frames, the second containing the correlations for each pair of sentence-frames calculated from the mean scores across disease terms. Correlation matrices were computed separately for the American and the Mexican groups. Kruskal’s (1964) multidimensional scaling technique, a hierarchical clustering technique similar to the technique developed by Johnson (1967), and factor-analytic techniques were used in the analysis of the data. The three techniques gave convergent results, indicating that the structures obtained were not technique-specific. The results from the American sample display a structure in which the two major dimensions or

D’ Andrade] CULTURAL CONSTRUCTIONS OF REALITY 125 clusters are formed around the concept of contagion and the concept of seriousness. Related to the contagion concept are subclusters involving children’s contagious diseases and weather-induced colds. A third cluster combines both serious and contagious diseases, such as syphilis, polio, and tuberculosis. The noncontagious illnesses appear to be subdivided into two subclusters, one of the serious and often crippling or fatal internal diseases such as cancer and heart attack, and the other

psychosis, ulcers, etc.

of the inheritable, old age or emotionally affected illnesses such as rheumatism, arthritis,

The Mexican informants appear to organize their beliefs about disease in a different manner than the US Americans. One major concept appears to be the hot-cold dimension of illness and medicine. Other clusters center around ideas concerning epidemic illnesses affecting children (measles, smallpox) in contrast to diseases more likely to affect older people, including witchcraft ; and certain intestinal disorders. One striking finding is that the range of disease considered contagious is very much more limited among the Mexican respondents, with dysenteries and respiratory infections apparently not considered to be especially contagious. These analyses throw some light on why our first attempts to develop classifications of illness yielded unreliable and idiosyncratic results. It had been our assumption that the distinctive features of illness (i.e., features which are used to identify and define particular illnesses) also were most

likely to be the salient feature. But the characteristics that our informants discussed in the informal interviews and that form the core of the different belief clusters appear to be consequences and preconditions of the illnesses rather than the features which are used to define them. This seems to be true of both American and Mexican sample data (D’Andrade, Quinn,

Nerlove, and Romney 1972). , |

While these results fit general ethnographic impressions about the important categories of illness

in each culture relatively well, it should be pointed out that the techniques of cluster analysis, factor analysis, and multidimensional scaling do not, by themselves, give a solution to the problem of selecting salient attributes. These techniques are excellent ways of grouping together sets of

associated characteristics. They can be used to determine which characteristics are salient, however, only on the basis of the assumption, that important characteristics tend to have many associated characteristics, and thus to be located in the center of large swarms of variables. This assumption may prove to be sound, but needs to be tested directly. The examples given so far have concerned the way in which cultural traditions affect the individual’s construction of reality. The examples have covered a variety of phenomena, ranging from problems of diagrammatic representation to methods of determining salient features in classification. In finding out how individuals are affected by their cultural traditions, anthropology is also taking part in the general goal of the social sciences, which is to construct more accurate representations of human nature, society, and culture. Lately there has been considerable criticism of the social sciences. The major criticisms appear to be that the social sciences have failed to communicate effectively with the public and the government; that they have failed to discover

anything of scientific value; and that what they have found out has failed to be relevant to _

important social problems. | |

While it is true that the social sciences have a long way to go before they become as effective as the physical sciences, nevertheless it seems, from the kind of viewpoint expressed in this paper, that the source of much present-day criticism is not lack of accomplishment. In my opinion the source of much of the criticism comes about because of the mismatch between the constructions of reality being presented by the social sciences and the constructions of reality embedded in both public and governmental domains. These mismatches have become salient primarily because of conflicts over administrative policy. Social scientists in most fields are not knowledgeable enough to draw up plans which, if put into effect, would effectively solve pressing social issues. However, the social scientists are generally knowledgeable enough to be able to evaluate the effectiveness of plans once they are in operation. Unfortunately, reverse oracles are not popular. Often the conclusions of effectiveness evaluation are negative and come into conflict with the agencies which have been created to administer these plans. Even Rand and the CIA could not convince the Joint Chiefs of Staff that

126 CULTURAL ILLNESS AND HEALTH [AS9 the bombing of North Vietnam was ineffective. (See the Pentagon Papers, especially McCone Memo #97 and Document #117.) It apparently is common sense that bombing hurts the enemy more than it hurts the bomber. In the face of that particular construction of reality, evidence to

the contrary appears to have had little effect.

When the CIA cannot convince the Joint Chiefs of Staff about military matters, consider the problem of social scientists attempting to convince any city, county, state, or federal agency that its procedures are failing to accomplish their manifest goal. I do not mean that it is impossible to accomplish such a task—only that it is a difficult and unpopular role to try and do so. Perhaps itis _ not surprising that the more important and significant the social policy under consideration, the less likely it is that any social or behavioral science expertise will be utilized. The major exception to this generalization is in the field of economic policy, wherelI suspect that the indices compiled by the government have become so numerous and complex that experts have to be called in to

determine whether things are getting better or getting worse. Perhaps the other social and behavioral sciences will follow a similar route to involvement with policy making. os As a final point, it should be noted that the part that social science will play in helping to construct more humane and beneficial cultural institutions is still in the process of development. Even in their present relatively primitive stage of intellectual development, the social sciences have a great deal to give those who are concerned with the future of our society. I believe that a major

problem of the next decade will be to work out ways in which the social sciences can take a positive role in the policy making process. BIBLIOGRAPHY

Campbell, D., and D. Fiske

1959 Convergent and Discriminant Validation by the Multitrait-Multimethod Matrix, Psy-

chological Bulletin 56:81-105. D’Andrade, R. G.

1965 Trait Psychology and Componential Analysis. American Anthropologist 67(5, pt.

2):215-228. 1970 Cognitive Structures and Judgment. Manuscript presented at NRC Committee on Basic

in Education. Huntington Beach, California. | D’Research Andrade, R. G., et al. -

1972 Categories of Disease in American-English and Mexican-Spanish. Jn Multidimensional ' Sealing: Theory and Applications in the Behavioral Sciences. Vol. 2, Applications. A. K.

«-Frake, C. O.

Romney, R. N. Shepard, and S. Nerlove, Eds. New York: Seminar Press. pp. 9-54.

1962 The Ethnographic Study of Cognitive Systems. In Anthropology and Human Behavior. T. Gladwin and W. C, Sturtevant, Eds. Washington: Anthropological Society of Washington. .

Mann, R. D. pp. 72-85,

Kruskal, J. B. |

Johnson, C. O.

1967 Hierarchical Clustering Schemes. Psychometrika 32:241-258. : 1964 Non-metric Multidimensional Scaling. Psychometrika 29:1-27, 115-129.

1959 The Relation Between Personality Characteristics and Individual Performance in Small

Groups. Ph.D. dissertation, University of Michigan, .

Metzger, D., and G. Williams

1966 Procedures and Results in the Study of Native Cognitive Systems: Tzeltal Firewood.

- American Anthropologist 68 :389-407. Newcomb, T.

1931 An Experiment Designed to Test the Validity of a Rating Technique. Journal of Educational Psychology 22:279-289.

Price-Williams,D.R. __

1969 Cross-Cultural Studies. Middlesex: Penguin Books. Shweder, R. A.

Tenzel, James | |

1972 Semantic Structures and Personality Assessment. Ph.D. dissertation, Department of ‘Social Relations, Harvard University.

1970 Shamanism and Concepts of Disease in a Mayan Community. Psychiatry 33:372-380.

D’ Andrade ] CULTURAL CONSTRUCTIONS OF REALITY 127 Wickert, F. R., Ed. 1967 Readings in African Psychology from French Language Sources. African Studies Center, Michigan State University. Yarrow, M., J. L. Campbell, and R. V. Burton 1968 Child Rearing: An Inquiry into Research and Methods. San Francisco: Jossey-Bass.

Primate Field Studies and Social Science S. L. WASHBURN

UNIVERSITY OF CALIFORNIA, BERKELEY

OVER THE LAST FEW YEARS there has been an enormous increase in knowledge about. the behavior of the nonhuman primates. The purpose of this paper is to call these data to the attention

of social scientists and to suggest that they offer a way of approaching the study of human behavior. In order to make the issues clear, I will state briefly what the fieldworker does, and present a model for the research. This model will then be applied to the interpretation of human — behavior, hopefully showing that the insights and emphases are quite different from those of

traditional social science. , oe

The fieldworker observes the behavior of animals. If the kinds of behavior are listed according to the amount of time they consume, the usual order would be as follows: sleeping, looking for food, eating, playing (primarily by the young), resting, and being social (sitting close, grooming, etc.). Less frequent and varying greatly by the species would be: mating, agonistic behaviors, drinking, exploration, and flight. Two contrasts with social science are already apparent. Sleep and play are major categories of behavior, and the student of primate behavior must try to understand them. According to the theory of natural selection (recently summarized by Mayr 1970), such time- and energy-consuming behaviors must have important adaptive functions, and it is the task

of the student of primate behavior to try to understand them.

The method of understanding is by observation, interpretation, and experiment, and this

paradigm may be illustrated by considering the problems and functions of sleeping. The great apes

sleep in nests, and Old World monkeys sleep sitting. The nest-building is apparently a recent evolutionary development, because gibbons sleep sitting and the great apes show traces of the anatomy that makes sleeping sitting possible. There are pronounced differences in the sleeping behaviors among the Old World monkeys. For example, geladas sleep in great concentrations on cliffs (Crook 1970). Patas monkeys sleep in bushes, separated from each other (Hall 1965), and — the majority of the monkeys sleep high in big trees. The details of the behavior cannot be reviewed here, but it is clear that sleeping locations are chosen to minimize danger at night. One function of sleep at night and activity by day is to avoid predation. But sleep is no simple matter, and the adaptive patterns of sleeping have evolved (Snyder 1966). At one extreme are ungulates, which may sleep only a few minutes in a rapidly alternating pattern of sleep-wake, and at the opposite are lions, which may sleep and doze up to 19 hours. The sleep itself is divided into deep sleep and REM sleep, and the understanding of these states is based on a very large number of experiments over the last 20 years. Among the monkeys and apes, sleep serves three quite different functions: rest (deep sleep), mental activity (REM), and protection of the species. If this model is applied to man, it is at once apparent that sleep no longer has the function of protection. And yet a child easily learns to be afraid of the dark, especially when alone. As Hamburg (1963) has put the matter, animals easily learn those patterns of behavior which have been important in the evolution of the species. Fears in particular must be quickly learned, if the animals are to survive. Since the learning of fear has this peculiar quality (rapid, emotional), it is easy for an animal or man to learn an irrational fear, and such fears will be hard to extinguish. The evolutionary approach not only shows why children easily learn to be afraid of the dark, but it also suggests a way of looking at learning to fear. To 128

Washburn ] PRIMATE FIELD STUDIES 129

hard to extinguish.

play their role in the evolution of the species, fears must be easy to learn quickly, and must be The study of REM sleep shows that man dreams far more than anyone suspected even a few years ago. The dreams that are recalled are only a small fraction of those that actually occurred, and they have been modified to an unknown extent by repression and unconscious selection. An efficient way to collect dreams would be to wake the subjects at the end of REM periods. This should enable the collection of less distorted data and the comparison of the dreams collected at

the end of REM with those recalled hours later.

Since the evolution of sleep was for rest, REM, and protection, there never was selection for rest and REM alone. This is one of the reasons that the need for sleep varies so much among

different individuals; there never was evolution for an amount fixed in narrow limits by selection. The illustration of sleep has been used to show the way the model (observation, experiment, interpretation) may be applied to human behavior. Without fieldwork, the protective function and the problems of sleeping under natural conditions could not be discovered. Without experiment, deep sleep and REM could not be differentiated. The example leads to speculations on the learning of fears and to a new view of dreams and how they should be collected. The adaptive functions of sleep are patterned quite differently in various mammals, and this model does not reduce human behavior or minimize the differences between man and other primates. The evolutionary approach is used to guide our speculations, not to fit behavior into any predetermined stages. The purpose of the model is to provide rules for looking at behaviors. They must be observed, interpreted, and analyzed in both their biological bases and social consequences. The importance of including the biological bases in the analysis of behavior may be illustrated

in the case of language. It is obvious that humans can communicate far more than any other mammal, but the reasons for the difference and the nature of the difference are by no means obvious, and have been the subject of extended controversies (Sebeok 1967; Lenneberg 1967). At first sight, it would seem easy to describe the sound communications of monkeys and apes and compare them to human language, discovering both similarities and differences. However, this proves not to be a simple matter at all. Most of the design features of human language occur in the communication systems of the nonhuman primates (Altmann 1967; Hockett and Altmann 1968),

and two views of the origin of language persist. One is that language is simply more of a communication system than is present in the nonhuman primates and the other is that language is

something new. The points of view are clearly contrasted by Bronowski (1967), and were discussed at length in a Neuro-sciences Research Program session (Ploog and Melnechuk 1969). In

my opinion, the matter has been settled by a series of experiments by Robinson (1967) and a series of comparable experiments, summarized by Ploog (1970). In both New and Old World monkeys, all the normal vocalizations can be elicited by electrodes implanted in the limbic system, the deep midial part of the forebrain. The vocalizations were elicited from ‘“‘the same limbic areas that generate feeling states that support feeding, sexual behavior, alerting, and other behavioral manifestations of the primitive drives’ (Robinson, in Ploog and Melnechuk 1969:454). These — experiments support the view clearly stated by Lancaster (1968) that what is communicated by the nonhuman primates is primarily the emotional states of the animals.

In contrast to the limbic-emotional system of monkeys, the human language system is dependent on the cortex of the dominant hemisphere (Geschwind 1970; Sperry 1968). The reason that chimpanzees cannot learn to speak (Kellogg 1968) is that they do not have the necessary neurological base to learn. The reason that humans can learn to talk so easily is that an extensive biological base has evolved which makes this learning so easy that it is almost inevitable. The experimental demonstration of the fundamental difference in the biological base of language and

of the sounds of the nonhuman primates clarifies the differences in the two systems of communication, something that description alone was quite unable to do.

The application of the model (observation, interpretation, experiment) to the problem of communication in the primates brings out some other important points. First, man still uses the primitive emotional system. As in so many other functions of the brain, the new cortical system is

added to the older structures, which not only remain but increase in size. Man continues to

130 CULTURAL ILLNESS AND HEALTH [AS9 communicate emotion. What is new is the ability to communicate information of a specific nonemotional nature. Second, nonhuman primates are able to use symbols and do so all the time.

The experiments by the Gardners (1969, 1971) and Premack (1971) demonstrate that chimpanzees can easily learn complicated tasks that have the form: visual input, hand/motor output. In a sense, the brain is a symbolic machine. An animal can only act on the basis of information that has been processed by the brain. Monkeys and apes can easily learn to associate meanings with visual inputs or with sounds. Symbolic behavior in general has nothing to do with language, but is a normal function of the mammalian brain. Third, the phonetic code upon which __ human languages are based is unique to man; makes human languages possible, and has caused the evolution of the speech apparatus (Washburn and Strum n.d.). It is specifically the sound code that allows the generation of a particular kind of symbol, and makes language an open system. Fourth,

the confusion of language and thought persists to the present day (Slobin 1971:98), but nonlinguistic primates clearly think, and Premack’s experiments show that the patterns of chimpanzee thinking are much closer to those of man than many might have guessed. It is the brain that thinks, and some small part of thought may be labeled by the code of language. But it is the brain that makes speech and language possible, that creates the universals of language; and language cannot be fully understood until scientists have elucidated the functions of the brain. | Clearly, more must be known about the brain and about the way it functions before the nature. of primate communication can be fully understood. The problem is discussed here only to show that there are major problems whose solution depends on understanding the interrelations of linguistic behaviors and their biological base. Linguistics as traditionally defined cannot solve the problems of the origin of language, language and thought, universals of language, or the relation of language to nonlinguistic communication. Communication itself can only be understood in a social

setting, and so, even at the level of communication in monkey societies, the paradigm (observation, interpretation, experiment) involves both biological and social factors. The student of primate communication cannot study communication without regard to meaning, social setting, and biology. In contrast to communication, a subject that has received a great deal of attention in nonhuman primate studies, play is a category of behavior that has received very little attention (Dolhinow and Bishop 1970). Our culture does not consider play important, but it is a major, time-consuming activity and, according to evolutionary theory, it must have important adaptive functions. Play is important in the development of all mammals, but it appears to be particularly important in the slow-maturing monkeys and apes. Juvenile monkeys play for years, and this is an investment of thousands of hours of time, energy, and emotion. The adaptive function of the play appears to be preparation for adult life, and, bearing out this theory, adult monkeys and apes rarely play. Play behaviors have several characteristics which allow them to be easily defined. They are the activities. of infant and juvenile animals and occur while adults are doing something else, such as feeding or resting. The play behaviors are their own reward; play does not lead to the attainment of some other goal, such as food. The young monkeys make great efforts to play—the animals are seen to go to others, to solicit play, and to make great efforts to engage in these activities. Play sequences use the same kinds of behaviors as are used in adult activities, but often in odd combinations. Play fighting, for example, may be aggressive, but can contain actions that would be suicidal in serious encounters. The young primates see all phases of adult life and the behaviors are mastered by thousands of repetitions. Play is the best example of the importance of the concept of “ease of learning” (Hamburg 1963). Judged by their behaviors, play is pleasurable to the young primate, and the joy of almost countless repetitions leads to the attainment of adult skills. A very large body of experimental evidence (reviewed by Mitchell 1970) shows that isolation and the inability to play leads to disastrous consequences for the developing monkey. Even the elements of mating

: behaviors require practice in play for normal performance. And it must be remembered that “normal” in the laboratory only means adequacy in a very restricted and protected situation, not highly skilled behavior adequate for competition and survival under natural conditions. The evolutionary prolongation of the juvenile period gives some measure of the importance of years of protected play. According to Schultz (1969), the juvenile period lasts some two years in

Washburn ] PRIMATE FIELD STUDIES 131 lemurs, four years in macaques, eight years in chimpanzees, and 16 years in man. Such figures can only be approximate, and there is a great deal of variation, both among species and individuals. Nevertheless, evolution has been for delayed maturation, especially in apes and man. Since the chances of the young falling victim to disease, accidents, or predation increase with time, there must have been very strong selection for the delay. The explanation appears to lie in the increasing importance of learning, and especially visual learning combined with motor skills. For example, if

fighting is compared in cats and macaques, the monkeys employ a far greater variety of skills. Chimpanzees appear to use more variety than monkeys in fighting and certainly in both aggressive

threats and appeasement gestures (van Lawick-Goodall 1971). I believe that the study of the aggressive behaviors of primates under natural conditions using motion pictures would substantiate that there have been major changes in the variety of aggressive behaviors. In the case of man, there

is no doubt that a high level of skill in the use of weapons takes years of practice and that such practice normally takes place in play with the young eagerly making the almost countless repetitions that are necessary for high levels of performance. Summarizing the characteristics of learning for the nonhuman primates, the animals learn, by observation and repetition, the behaviors for which they are adapted. The desire for learning (play) comes from within, and all the behaviors of adult life are practiced for years before they must be undertaken under serious circumstances. Human beings appear to be extreme in: slow maturation, quantity and variety of patterns of play, play with objects, and social play. But the motivations for

play seem no different from those of the nonhuman primates. Through play (emotional, repetitious, from within) children prepare for the adult life of their culture. The separation of education from life in the tradition of our schools is new in the history of the primates. In the American school, there is no view of adult life, and all the identification, emotional learning, and repetition that comes from observational learning is lost. In the schools, discipline is substituted

for the internal drive to learn, to try, to explore, to be a part of culture. Through a profound misunderstanding of the nature of primate biology, the schools reduce the most intelligent primate to a bored and alienated creature,

A view of traditional European educational practices from the vantage point of the primatologist suggests that the school system is based on a series of traditional mistakes. Primate studies suggest that the early years are the most important for learning, and thus that schooling starts too late. They stress the importance of all the actual behaviors of the young for learning, and not just those in the school. They suggest the importance of emotion, repetition, identification, and clear picture of purpose, of the relation of the school experience to adult life. To the student of monkey behavior, schools seem grounded in ignorance of the kind of being they are trying to teach. The view of the human being as a particular kind of primate makes the schools seem strange and leads to the conclusion that human customs are not necessarily efficient, necessary, or useful

in the way they are supposed to be. Educational institutions cannot be designed effectively - without regard for the biology of human beings. For example, both field and laboratory studies show that primates learn from peers. Juveniles learn behaviors from slightly older animals. The. notion embedded in our culture that teachers must be adults, usually elderly, is contrary to what is known about how primates learn. We have found that college seniors are particularly effective in

teaching freshmen, and there is no reason that the professional teachers should not be supplemented by those who are learning through teaching. The influence of older peers could be a powerful educational force, helping both student and teacher.

The problems of the traditional educational system may be illustrated by considering the environment and rewards. The environment with which an animal interacts is not something in general but is composed of specific realities that have very different meanings for the organism. For example, for a few years baboons were described as living in the forest or the savanna. But it soon became apparent that this classification is almost useless. The actual influences on the

animal’s behavior are: trees and their distribution, food and its abundance, water, etc. The behavior of the same troop may be “forest” in one part of the day and ‘“‘savanna” in another. But in the consideration of educational problems, and particularly problems of intelligence, humans have been divided into social classes, occupational groups, or races. But, if one is concerned with

132 CULTURAL ILLNESS AND HEALTH , [AS9 reading, for example, such gross classifications do not define the relevant variables. More importantly, questions are rooted in the actual behaviors of the parents. Do they read to the child?

Does the child see parents reading? Are books present and prized? Is reading used and discussed? Just as a mother-infant relationship is an ongoing set of behavioral activities, so learning to speak or learning to read is an activity in a behavioral situation, and there

is both a biological and a social reality. General environmental categories are useless for the understanding of how the child learns at home or in school. For example, many authorities have recently urged that since the school situation is ridiculous, children should be allowed to do much as they please. But “‘please’’ has both a biological and a social root. The human child cannot learn a culture that cannot be perceived, nor identify with people who are not there. City rhesus learn differently from their country cousins, and even as simple a social system as that of such monkeys

is a product of both biology and learning the local environmental reality. The fallacy of considering general categories of environment as comparable is shown in the study of the intelligence of identical twins. Twins brought up apart are not necessarily in different environments, any more than people in different houses are necessarily on different diets. The relative role of environment and heredity in determining performance in school requires that the relevant parts of the environment be specified and their effect on performance be assessed. Just as environment is much too general a concept to help in understanding monkey behavior, |

so reward is a complex idea, and the nature of rewards changes with age and with species. Watching a monkey develop over the years, one sees a slowly changing set of situations which prove rewarding, which the monkey repeatedly seeks, which guide the behaviors. To the infant, the mother is a complex reward system toward which the behaviors are directed. Later, relations with peers will guide many activities. But the activities will be very different for macaques, gibbons, and human beings. What is rewarding is determined by the species and by the experiences of the individual. Pigs and monkeys do not seek the same rewards, and it is no accident that behavioral science stressing a simplistic reward system finds the pigeon a useful subject. Birds mature in approximately 1% of lifetime, and they have evolved so that adult behaviors have the lightest possible biological bases. In behavior, this is achieved by stereotyped behaviors which can be mediated by a very small nervous system. Man is at the opposite extreme of living vertebrates, in which learning is prolonged, its biological base is large and complex, and rewards are biosocial relations, which may take years to establish. Human rewards in sports, arts, music, politics, in our complex social life, cannot be understood or reduced by speaking of “‘rewards’’ as if this were something simple. To try to educate humans with rules derived from the behavior of pigeons is to

miss the entire implication of human evolution. ,

In considering play, environment, or rewards, the fieldworker soon finds that the general problems of categories of behavior are dependent both on the kind of animal under consideration - . and on specific features of the environment. Gibbons learn to be gibbons, while in the same forests macaques learn to be macaques, and men learn to be men. As discussed earlier, the biology of the . species predisposes it to learn certain behaviors. Critical in this learning is the brain, and the fieldworker sees the brain as an organ of adaptation, not as an organ of truth or of reasoning or

thinking in any other sense. Evolution, through selection over millions of years, resulted in patterns of behavior, mediated by the brain, that permitted the primate to adapt to those features of the environment that are important for it. Environment, brain, and behaviors are linked in adaptive patterns, but these are not necessarily efficient, desirable, or necessary in any other sense. If the human brain is viewed in a similar way, as an organ of adaptation that evolved under the

conditions of the pre-scientific world, some of the peculiarities of human behavior may be understood. During most of his history, man (more than 99%, if by man we mean Homo erectus and later forms) lived in small groups and his thoughts were limited by the experiences of a very , small world. Under such conditions the human brain interprets this limited world as all reality, as flat, static. It is a place where objects fall, unless held up. The differences between life and nonlife are obscure, and virgin birth is normal. Causes, forces, and origins are personalized, and there are spirits, ghosts and gods (Washburn and Strum n.d.). The elements of the prescientific thinking may be institutionalized in many different ways, but the fundamental ways in which the human brain manages the relations between man and his environment is the same for all prescientific cultures.

Washburn ] PRIMATE FIELD STUDIES | 133 With agriculture, the reality of the small flat world began to change, but it was thousands of years before the physical sciences began to develop methods that corrected the fundamental errors of human thought. Progress in biology came much later, and the theory of spontaneous generation was finally abandoned by scientists less than one hundred years ago. The relation of man to nature may no longer be stated in terms of gods, spirits, and personal power. Disease is a problem for biology, no longer for religion. But the primitive world view pervaded all aspects of human thinking. The problems stemming from the way the brain processes the human experience pervade all aspects of human behavior and are still with us, deeply embedded in our culture. If we regard human behaviors as adaptations to the problems of life as perceived by human beings, then human institutions are simply the way human behaviors were ordered in times past, and institutions may not be any more necessary,

useful, or efficient than are the oaths that are still used as means to guarantee the truth in our © | courts of law. Social science is still divided according to the prescientific categories of the primitive -world. In part, these categories may be necessary if the goal is to understand the past, but to help in the understanding of the future it is not clear that a course on religion has any more utility than |

a course on spontaneous generation. ] 7

SUMMARY |

In this paper I have tried to indicate a few of the ways in which the study of the behaviors of

the nonhuman primates may be useful in the study of man. A model was first presented (observation, interpretation, experiment), and it was concluded that, even in monkey society, behavior is too complex to be understood without biological experimentation. This point was illustrated by the example of sleep. It was suggested that the problems of origin of language, nature of language, and language and thought, cannot be settled without an understanding of the biological base for these behaviors. The nature of play in the nonhuman primates was contrasted to the peculiar institutions we call schools, and it was suggested that the basic premises upon which the schools are built are wrong. The nature of environment and rewards were briefly considered, and it was argued that these are complex notions and that they are not independent of the kind of animal under consideration. Finally, attention was called to the limitations of the brain, how these have been circumvented in the physical sciences, and how they continue in the social sciences.

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Epilogue | IF HEALTH AND MENTAL ILLNESS were conditions that could easily and reliably be verified, we could study and describe them in terms which have some universal meaning. After reading the preceding papers it is evident that whatever the label health denotes, it is as much a condition of the community and the social system as it is of an individual who is part of it. That this is so hardly requires the presentation of anthropological studies, for this fact is widely known.

We are in a crisis, yet our responses are totally inadequate. From the perspective of the anthropologist, as a society we persist in devoting our resources in areas which are likely to generate more imbalances, instead of concentrating our knowledge and resources where they are most needed. A simple review of government funding priorities would reveal where we seek solutions either because our values favor these fields, or because political skills are more developed in some if compared to others. In preparing space explorations, we employ systems analysts who plan and prepare down to the smallest detail. In dealing with social problems such as the ones reflected in this volume, we do not even resort to the systems analysts who could best reflect what happens. We propose that in the areas of health, society, and the individual, anthropologists are the equivalents to systems analysts in complex engineering problems. Any future approaches to dealing with issues involving the health and adaptations of individuals and groups in the social systems need the knowledge and skills of anthropologists. As teachers we have learned that the

anthropological perspective offers an objectivity about human differences which leads to attitudinal changes and to behavioral modifications of those who have studied cultures. This objectivity is also needed in the efforts to deal with problems of health.

Anyone close to the clinical efforts of the health professions and the attempts to provide preventive and interventive services in the community, realizes that there are differences of perspectives and understandings between “‘patients” and “‘healers,’’ professionals and laymen, medical specialists and non-medical specialists which involve all the misunderstandings found in

cross-cultural situations. The most exposed and vulnerable specialist in this situation is the psychiatrist. The psychiatrist is a part of a profession which is imbued by society or by patients with tremendous power. The myth of the absolute validity of scientific solutions in our society has given the medical profession a place which is matched only by engineers and technicians whose

creations and skills we blindly trust. At the same time within the medical profession the — psychiatrist is marginal since he does not deal with organic diseases as much as he deals with the less accessible conditions of the mind and social environment. To maintain himself as a marginal professional in his own profession, to keep sharing the gratifying position of omnipotence, the

psychiatrist lives and acts in too narrow a conceptual and practical world. To begin with, the psychiatrist uses a medical model which turns a person in need of help into a “‘patient.’’ This implies the special status of a “‘sick’’ person, Even the most enlightened practitioner who realizes that the categories of “‘well’’ and “‘sick”’ are relative, ultimately acts as though they are based on a concrete reality which lies outside the process of seeking the advice of a physician. As a medical specialist, the psychiatrist needs a diagnosis to treat a person. But the diagnosis implies a “‘label”

135 )

which, once established, attaches to the person and changes drastically his status in society. Consider the conflicts for the psychiatrist who sees an individual as temporarily disturbed, and who needs to “‘diagnose’’ a patient in order to treat him for a temporary condition, knowing full . well that a diagnostic label may remain with him throughout the future when the temporary

condition has long subsided. :

136 CULTURAL ILLNESS AND HEALTH [AS9 Apart from taking responsibility for an individual in need, or seen to be in need of psychiatric care (or psychological relief), in the American system the psychiatrist is the only person charged with the responsibility to determine for legal purposes whether a person is mentally ill. On the basis of his professional judgment, an individual will be declared legally insane by the courts. Anyone who has read accounts or records of cases before the court in which psychiatrists are

required to testify with regard to the mental condition of a defendant or a person subject to judgment by the court, will remember contradictory testimony by different members of the same profession. And this should not come as a surprise, for any close contact with the psychiatric profession would reveal considerable variation in diagnostic as well as therapeutic approaches for the same case or for different individuals with seemingly similar complaints. All this may not need further documentation here, but it does become a reality for the many individuals for whom decisions by established authorities, as well as the community as a whole, depend on just those findings which members of this powerful profession issue. Now let us take as an example of vulnerability the psychiatrist who finds himself out on the limb of his profession in a situation where he is expected to recommend to a Department of Social Services whether or not an individual who was referred to the clinic for an evaluation which will determine his eligibility for social welfare support is capable of working. Does the psychiatrist serve the individual, the community, or the system which distributes welfare checks? Or to make the situation worse, although not less realistic, assume that the psychiatrist in a community mental health clinic can maintain a patient on welfare who is in need of chemotherapy only if he is willing to give him a diagnostic label implying a condition more serious than is actually the case. Does not

the psychiatrist respond to the system’s demands in order to provide a patient with needed support, rather than to the patient’s actual condition? Yet this is what happens constantly with all

that it implies for the doctor, the individual, the system, and even the future doctor who at a much later time may come across the individual’s medical records which list a condition reflecting the system’s needs rather than the patient’s actual condition. Psychiatrists are caught between the professional fiction developed when with the best of all intentions they extended their range of concern from the individual patient to the community. The community, in turn, questions the overextended professional range of psychiatry, and the

special remunerative expectations which stem from a professional base in medicine. Quite obviously, whatever the individual’s condition in the first place, the complexities of the systems in which he is enmeshed, those which include his past, his present, the community, agencies, and specialists, determine his condition of health or illness, and the various judgments of realities in each determine responses. We suggest that there should be a clear distinction between problems which have shown to have as a basis of complaint organic malfunctioning, and those which are entirely psycho-social. The latter, we submit, should not be left as the responsibility of the medical profession, but involve all kinds of clinical professions, including the applied social sciences. But even where there are organic

components in a person who has problems of adapting to the expectations of social groups or otherwise does not function adequately in society, would it not be much more realistic to think that physicians (psychiatrists) here work together with others in the community who have experience and: capability of mature judgment to handle the cases which now seem to become the

ultimate responsibility of that one specialty in the medical profession? This, of course, corresponds much more to what we as anthropologists see happen in many different societies which have integrated systems of healing involving family, community, and supernatural responses to mental suffering as well as physical suffering. As anthropologists we do not profess to have all the answers—we doubt that there are simple solutions at this time to the complexities raised in this volume. Our contributions are based on our basic assumptions which ascribe reality to cultural differences, and our methods which result in

objective description and analysis of interrelated social and behavioral phenomena, Out of our basic theoretical stances, and with the aid of our special methods, we have created a body of knowledge which is directly relevant to the situations which our society, and other societies throughout the world, face today in relation to health and psychological integration. And yet, we

Maretzki] EPILOGUE 137 sometimes feel as though the knowledge developed out of an anthropological perspective has to be rediscovered and verified by mental health professionals before it becomes a reality to be tested in

the market of practical decisions. The community health program in the United States is one example of a development which did not sufficiently utilize the knowledge available from many : studies of the community, nor the role of individuals within it. Mental retardation programs, alcoholism programs, drug treatment and prevention programs, all seem developed without an understanding of the realities according to which the “‘target” populations of these programs behave. The papers in this volume document this view. The anthropologist in the health and mental health programs can assume the role of objective observer, recorder, and perhaps of a kind of ombudsman who helps to lay out all the facts as they

can be gathered, and relates these facts to decisions and practices in health care and preventive programs. To be able to do so, anthropologists need recognition as specialists who have valued knowledge. Anthropologists have a specialization which contributes more than knowledge for museums and libraries. Sometimes the information which anthropology provides runs counter to the interpretations of other specialists; sometimes it seems nothing more than what is already widely known and accepted. If there is a real hazard in looking for cultural realities it is the shortcut route, the attempt to bypass the careful work of anthropologists by generating quick and rash and mostly intuitive insights.

What is going to happen if the present amorphous situation is left to run its course, if health | professionals feel that while their efforts do not produce perfect results, they accomplish as much as can be expected? As anthropologists, we do not believe that the lack of adequate solutions to

existing social problems should serve as a continuous base for the kind of entrepreneurial experimentation which characterizes our established approaches to so many problems in the United States. Probe, act, and hope for results is not going to be acceptable as a problem-solving

strategy in years to come. Instead, to assess as objectively as possible taking a variety of conceptualizations into account, to analyze, and then to develop logical, not quasi-political,

approaches is the only possible basis for effective responses in the future. |

The issues we have raised are the concern of all of us. They relate directly to important social changes in the macrosociety no less than among particular minority populations defined racially, ethnically, medically, or legally. They link psychiatry and other health professions, volunteers in the health fields, patients, and ultimately all other members of society, in a common concern of finding better ways of coping with stresses, and more appropriate ways of defining conditions of individuals, groups, and ultimately the society as a whole. All this we had better consider before our health systems have been broadened and bureaucratized as they are bound to be in the United States within the next few years.

In conclusion, we propose that the entire handling of health related problems needs to be revolutionized in our society and in all those which have borrowed our model. Nothing short of a complete overhaul of the present established way of responding is likely to make much difference. Anthropologists have pleaded with the National Institute. of Mental Health to gain permission for

studies of decision making in that institution which for years has set the patterns for national mental health programs. Without such a study, how can we expect others in the country to accept us in the role we see for ourselves? We would like to do the same in hospitals, in clinics, in community mental health centers, and would even in the sanctums of private practitioners who need interpret our request no differently than the many respondents throughout the world who have contributed so much to our anthropological knowledge of other cultures.

| Thomas W. Maretzki

Contributors : PAUL BOHANNAN is the Stanley G. Harris Professor of Social Science at Northwestern University. Since his degree from Oxford University he has written Justice and Judgement Among the Tiv, Tiv Economy, Africa and Africans, Social Anthropology, and many articles on religion, divorce, sex and morality, and on problems in the general area of social control. He has done field research among the Tiv of Nigeria, the Wanga of Kenya, and divorcees in San Francisco.

York. .

MICHAEL AGAR received his PhD from the University of California at Berkeley in 1971. His major work is a book entitled Ripping and Running: A Formal Ethnography of Urban Heroin — Addicts. He has been an Assistant Professor in the Department of Anthropology at the University of Hawaii since 1971. He is continuing research on the ethnography of the heroin addict in New

WILLIAM CAUDILL instructed in social anthropology at Yale and Harvard University. At the time of his death in 1972 he was Chief of the Section on Personality and Environment, Laboratory of Socio-environmental Studies, National Institute of Mental Health. He published The Psychiatric Hospital as a Small Society, and Mental Health Research in Asia and the Pacific (with Tsung-yi Lin), and authored numerous articles on studies of culture, personality, and social institutions in Japan and the United States. He was especially concerned with cross-cultural aspects of psychiatric

issues. Dr. Caudill received his PhD degree from the University of Chicago. 7 . MARGARET CLARK is Professor of Anthropology in residence at the University of California, San Francisco. Professor Clark has authored a number of books on health and on aging: Sickness and Health in Sal Si Puedes—Mexican Americans in a California Community, Health in the Mexican

American Culture, and Culture and Aging—an anthropological study of older Americans (with Barbara Anderson). She continues her interest in health, ethnicity, and the elderly as Project —

Director of Ethnic Identity and Adult Development. Dr. Clark received her PhD from the University of California at Berkeley. ELIZABETH COLSON is Professor of Anthropology at the University of California, Berkeley. She is the author of numerous articles and books: The Makah Indians, Marriage and the Family among the Plateau Tonga of Northern Rhodesia, Social Organization of the Gwembe Tonga, ThePlateau Tonga of Northern Rhodesia: Social and Religious Studies, and her most recent book, The Social

Consequences of Resettlement, which are but a few examples of her work. Professor Colson received her PhD from Harvard University.

ROY D’ANDRADE is Professor of Anthropology at the University of California at San Diego. He

‘received his PhD from Harvard University and has authored numerous articles in the field of cognition, such as “Transcultural Studies in Cognition” (with A. K. Romney), and “Cognitive Aspects of English Kin Terms” (with A. K. Romney). Recent articles include ‘‘Categories of Disease in American English and Mexican Spanish” (with N. Quinn, S. Nerlove and A. K. . Romney), ‘‘The Colors of Emotion” (with M. Egan), and “A Cross-Cultural Study of Residence from Infancy Through Marriage” (with J. Whiting). 138

CONTRIBUTORS 139 ROBERT B. EDGERTON received his PhD from University of California at Los Angeles. He has had field experience in Kenya and in the United States. He is the author of Drunken Comportment and the Cloak of Competence. His numerous articles include ‘“‘Violence in East African Tribal

Societies,” ‘Mexican-American Bilingualism and the Perception of Mental Illness” (with M. Karno), “A Traditional African Psychiatrist,” and “Community Attitudes Towards the Hospitalization of the Mentally Retarded” (with M. Karno). He has in addition written “‘An Evaluation of the Behavior of ARL Colony Chimpanzees” (with E. J. Kollar and W. C. Beckwith).

EDWARD T. HALL is Professor of Anthropology at Northwestern University and the author of The Silent Language and The Hidden Dimension. Dr. Hall recieved his PhD from Columbia University, and after Army service in World War II did fieldwork in Micronesia. For five years he was

Director of the State Department Point Four Training Program, preparing Americans for service overseas. He has taught at a number of universities and is best known for his work in intercultural communications. His next book will be about man and contemporary culture. CLAUDIA MITCHELL-KERNAN is an Assistant Professor at Harvard University. She received her PhD from the University of California at Berkeley in 1969. Dr. Kernan has authored a monograph

on Language Behavior in a Black Urban Community and a number of articles including “Signifying , and Marking: Two Afro-American Speech Acts,’ and “On the Status of Black English for Native Speakers.”’ Dr. Kernan is presently on leave working on a sociolinguistic study of speech patterns

and styles in Oakland, California. ,

KEITH KERNAN received his PhD from the University of California at Berkeley in 1969. He has been an Assistant Professor at Harvard University since 1970. He has authored ‘“‘Language’”’ for the

Biennial Review of Anthropology, ‘Semantic Relationships and the Child’s Acquisition of Language,” and “Speech and Social Prestige in the Belizian Speech Community” (with C. Kernan, J. Sodergren, and R. French). Dr. Kernan has had field experience in Samoa and the United States and has current research interests in developmental sociolinguistics.

THOMAS W. MARETZKI is Professor of Anthropology and Psychiatry at the University of Hawaii. He received his PhD from Yale University, and is presently researching culture and mental health issues in Hawaii and Indonesia. Dr. Maretzki participated in the Six Culture Study of child

socialization patterns directed by John and Beatrice Whiting. He is the author of Taira: An Okinawan Village (with Hatsumi Maretzki), and has published on the Peace Corps impact in the Philippines and on other topics in psychological anthropology. LAURA NADER is Professor of Anthropology at the University of California at Berkeley. She holds a PhD from Harvard University and has done fieldwork in Mexico, Lebanon, and the United States. Dr. Nader has both edited and contributed to The Ethnography of Law and Law in Culture _ and Society, She has written on problems relating to conflict, social control, and fieldwork. In addition, she is the author of Talea and Juquila: A Comparison of Zapotec Social Organization, and has produced a film on Zapotec court procedure: To Make the Balance. She is currently conducting a study of complaint management in the United States. JAMES P, SPRADLEY, Associate Professor of Anthropology at Macalester College, received his PhD from the University of Washington. In 1969 he received the American Anthropological Association’s Stirling Award in Culture and Personality Studies for his paper entitled “Adaptive Strategies of Urban Nomads: The Ethnoscience of Tramp Culture.” Dr. Spradley is the author of You Owe Yourself a Drunk and has edited and contributed to Culture and Cognition: Rules, Maps, and Plans, and The Cultural Experience (with D. W. McCurdy). He is presently involved in several research projects on American culture. SHERWOOD WASHBURN received his PhD from Harvard University and is presently Professor of . Anthropology at the University of California at Berkeley. He is a Fellow of the National Academy

140 CULTURAL ILLNESS AND HEALTH [AS9 of Sciences. Professor Washburn’s early publications were concerned with anatomy and structure; his more recent publications deal with various aspects of race, primate behavior, and conflict in society. He has edited Classification and Human Evolution, and Perspectives on Human Evolution (with P. C: Jay), and authored The Study of Human Evolution. He is a recipient of the Viking Fund Medal and Award, the Ciba Foundation Annual Lecture Medal, and in 1967 was the Huxley Medalist.

BEATRICE BLYTH WHITING, who received her PhD from Yale University, is Lecturer in Educational Anthropology at the Harvard School of Education. She is the author of Peyote Sorcery and Child Rearing in Six Cultures. For the past several years she has been involved in research on families in Kenya. JOHN W. M. WHITING, Professor of Anthropology at Harvard University, received his PhD from Yale University. He is the author of Becoming a Kwoma and (with I. Child) Child Training and

Personality: A Cross-Cultural Study. :

Index ,

Abrahams, Robert D., 37 architecture: as a channel of communication,

adaptive behavior: of the aged, 5, 83-86; the 100; psychiatric, social, and cultural signibrain as an organ of, 132-1338; of the drug ficance of, 98

addict, 40-41; of nonhuman primates, argots: of the alcoholic, 26, 27; of the drug _ 128-131; play as, 7, 130-131; of the “‘six- addict, 36, 37, 40; of the elite mentally re-

hour. retarded child,’? 18; sleep as, 7, tarded, 14

128-129Michael, Azande, oracles Agar, 3-4,among, 9 a ,93 age: definition of old, 80-83; as factor in al- Bacon, M. K., 60

truistic-egoistic behavior, 60 Baker, A., 98

the aged: adaptive tasks of, 83-86; capabilities Baratz, Stephen S., 32

of, vs. cultural definition of, 81; cultural Barry, H. H., 60 |

concepts regarding, 5, 80-83; dearth of data Bateson, Gregory, 20

on, 78; increase in numbers of, 78; as a Benedek, Therese, 50, 51, 52 minority group, 82; poverty of, 82; as a Bettelheim, Bruno, 47

social problem, 79, 82 , bilinguals, 112

aging: adaptive behavior required in, 83-86; as biology and human behavior, 7, 69, 71, 97, 129 decrement and disengagement, 81; as de- birth order. See sibling order

pendency, 82; as development, 82; as ‘Black English,” 111, 112 disease, 81; as dying, 80-81; as social devi- Bohannan, Paul, 4

ancy, 82-838; studies of, 78-80, 86

Albert, Ethel, 107 Calhoun, John, 98 alcoholics: alternates to present treatment of, Carlson, Rick, 10

31; argot of, 26, 27; cultural identity of, Casey, John J., Jr., 36 26-28; definitions of, 26; detoxification Caudill, William, 4, 5 center for, 31, 32; jailing of, 29, 31; and Chateau de la Verriére, 98-99 mobility, 26-31, 32; self-perception of, 26; Child, Irvin L., 56, 60 use of, as trusties, 30, 31, 32. See also child-rearing: in Japanese and American middle

drunkenness | _ class, 5, 73; in six cultures, 56-64. See also

altruism, displaced, 65 altruistic (nurturant) vs. egoistic behavior,

altruistic (nurturant) vs. egoistic behavior: fac- factors in development of; maternal-child tors in development of, 4-5; age, 60; culture, interaction; maternal-infant interaction 59, 68, 64; family size and structure, 60-63; children, cultural differences of: in physical mother’s role, 62; personality, 59; sex, 59, activity, 75; in verbal behavior, 74-75

60; sibling order, 59, 60; task assignment, Christian, John, 98 |

61-62 . Clark, Margaret, 4, 5-6, 8

American: concepts of age, 5, 80-83; cultural class: conflicts of, in doctor-patient relations, 4; diversity, 24; divorce, 4, 58; health concepts, as a factor in maternal-infant behavior, 70 9; language differences, 7; marriage, 44-46; Colson, Elizabeth, 4, 6 maternal-child interaction, 73-76; maternal- communication: contrast in, between human

infant interaction, 70-73 and nonhuman primates, 129-130; as cul-

anthropology: contributions of, to concept of ture, 97; failure of, 107-109, 110-111; be-

health, 1, 8, 67; contributions of, to tween mother and infant, 69-72; nonverbal,

studies—of aging, 78-80, 83, 86; of crime, 23; in psychotic patients, 101; in marriage, 44; of drug addiction, 40-41; of mental retarda- role of microcultural events in, 6; skill of tion, 2-3, 21; changing view of decision- mentally retarded in, 15; vocabulary as bar-

making in, 89; and diagnostic testing, 8;. rier to, 105

findings of, not used, 9, 187; and language communicative competence, 106, 113 studies, 104-105; objectivity in perspective community health, 8 of, 135, 137; public role of, 125-126, 137; Cowgill, Donald O., 80 relation of, to psychiatry, 67, 68, 97-98, crime: cultural matrix of, 23, 32; relation of, to 102, 136; as systems analysis, 135. See also health and disease, 23 cross-cultural perspectives; ethnography cross-cultural perspectives, 8; on aging, 81, 82; 141

142 CULTURAL ILLNESS AND HEALTH [AS9 on children’s social behavior, 60-61, 64; on cation of, 65; overemphasis upon, 64-65; crime, 23-25; on divorce, 4, 45; on drug ad- and the schools, 5, 65 diction, 35-36, 40, 41; on intelligence test- Ekman, Paul, 6, 10 ing, 3, 18, 19-20; on maternal-child be- environment, as composed of specific realities, havior, 73-76; on maternal-infant behavior, 131-132 68-73; on problem solving, 8; on the re- Ervin-Tripp, Susan M., 107

tarded, 3,18 Esser, Aristide H., 101

culture: as communication, 97; and construc- ethnography: of adult life, 86; in the American tion of reality, 7, 104, 115-126; definition scene, 2-4; and applied anthropology, 31-32;

of, 24; and decision-making, 90, 96; and in the study of crime, 24-25, 31, 32-33; in definition of body boundaries, 99; effect of, the study of public intoxication, 25, 31. See on altruistic vs. egoistic behavior, 59, 63, 64; also anthropology; cross-cultural perspecas extension of biological processes, 97; rela- tives tion of—to adult behavior, 24-25, 67-68; to _ evaluation studies, need for, 9 children’s behavior, 74-76; to crime, 24-25; Evans-Pritchard, E. E., 93

to drug addiction, 9; to infant behavior, evolutionary perspective, 7-8, 128-133 —

69-73; to marriage, 44, 45, 50, 51, 54 ~ experts. See professionals .

culture and personality, 73, 76; as conceptual

: | ischer, Anne, -

approach to study of aging, 83; relation of, .

to altruistic-egoistic behavior, 59, 63; studies fear, ease of learning, 128

of, 67-68 . pede, seymour, 38

Cumming, E., 81 Fischer, John, 56 Fortes, Meyer, 50 D’ Andrade, Roy G., 7 The Fox in the Attic, 100 | danger, the management of, 33 Fromm-Reichmann, Frieda, 99 :

Davies, R. Llewelyn, Davis, David E., 98 99 decision-making: anxiety associated with, 6,92; Ga (Ghana) children, testing of, 119

appearance of responsibility in, 94-95; cul- gerontology, 78 tural differences in effects of, 90, 96;divina- Gibson, Eleanor, 98 .

tion as procedure for, 93-96; procedures for Gibson, James, 98 legitimating of, 96; universal requirement Gladwin, Thomas, 19

for, 89 Goody, Jack, 50

dependency: cultural attitudes toward, and Grace, M., 100

. aging, 82; Japanese vs. American attitudes Gray, Robert F., 50 a.

regarding, 69, 72 Gulliver, P. H., 50 Devons, Eli, 93-94 Gumperz, John J., 38 diet, present-day American, 9 guns, the meaning of, 33 —

Dingman, Harvey F., 21 the Gwembe Tonga (Zambia): characteristics

divination. 6. 93-96 of, 90; Christianity invoked by youth of, divorce. 4. 45. 53. See also marriage 95-96; divination as modification of risk-

doctor-patient relations, 69 taking by, 93, 94, 95; effects of dam on, dreams and REM sleep, 129 90-91; limitations of prophets among, 99; oo drug abuse. See drug addiction mental illness among, 91; personal responsi-

drug addiction: cultural contribution to, 9; bility of, 92-93; resettlement of, 91; re-

ethnographic studies of, 39-41; as purposive sponse of, to political and social change, 91;

behavior, 36, 37-39; treatment of, 39-41 response of, to certainty and uncertainty, 6, drug addicts: behavior shifts in, 37, 38-39; 91-92; role of elders among, 91; violence professional view of, 35, 39, 40, 41; self- among, 91

ceived by, 3, 39; varieties in types of, 41

image of, 36, 37-38;-40; treatment as per- the Gwembe Valley, 90

the Paar subculture, 3-4, 35-41 Hall, E. T., 6 :

amer, John H., 79

drunkenness: acquisition of data on, 25-26; as a Hamburg, im avid A., 128

criminal problem, 25; ethnography of, Hannerz Ulf. 33

25-31; and mobility, 26- 27, viewed from Hausa children, testing of, 115-119

within, 3.S ce also alcoholics health: definition of, 1, 8; problems of, 137

Dutch mother-infant relations, 70 Henry, Jules, 81 | heroin, symbolic significance of, 36. See also Edgerton, Robert, 2-3, 9 drug addiction; drug addicts education, problems of environment and re- Hitchcock, John, 56

wards in, 131-132. See also schools Holmes, Lowell D., 80

Edwards, C., 66 “Honky Tonk Bud,” 37-38, 39

- egoistic behavior: consequences of, 64; modifi- Hughes, Richard, 100

INDEX 143 hunger in the United States, 9 Maretzki, Hatsumi, 56

Hymes, Dell, 106(linguistic), Maretzki, T., 42, 56 112 | markers 111,

ilIness: frequency of among the old, 5, 81; ™é@rtlase: alienation in, 4, 43, 46; role of study of American and Mexican categories poun caries ddl she 4 fhatactenisties ' or

of, 124-125 merican ml e€-ciass, > > concept oO

indicators (linguistic), 111 the nos in, 47-48, 49, 51, 52, 53; the con-

industrial socety me emphasis on egoism, 65 scious contract in, 44-45, 53; cultural tradi-

infants: cultural differences in motor activity, tion and, 44, 45, 50, 51, 54; effects of sleep, and vocalization of, 69-72; gradual dif- “multiple crisis On, | 03; psychosocial stages ferentiation of body boundaries in, 99; onset in, 50-52; “renegotiation” of, 53-54; self-

een : contract in, 45-46, 48,

of culturally patterned behavior in, 69, 73; identineation 5 rea 46; unconscious 72: os autonomous Dy ot esi be Japanese maternal-child interaction: American, 73-76;

mothers, 72-73; similarity of biologically change in direction of, 75-76; emotional

rooted behavior of, 69-71 content of, 74; Japanese, 73-76; method of

and, 7; studies of, 19-20 TAO ; ;

intelligence: evolution of, 20; reality constructs coe data on, 74; vocal activity in, intelligence testing: in cross-cultural perspec- maternal-infant interaction: American, 70-73; tive, 3, 7, 18, 19-20, 115-120; effect of, on cultural differences in pace of, 71; Dutch, achievement, 18; effect of cultural tradition 70; Japanese, (0-795 Japanese A mencan, 70; on, 7; and the retarded, 3, 18-20; value of, metnods Of observing, OY; In middle Class VS. in, 71, 72-73; with respect to sleeping, 71, Japanese: doctors’ behavior, 69; family sleep 72; vocal communication in, 70-71 patterns, 72, 73; maternal-child interaction memory-based studies, accuracy of, 123-124

19 -working class, 70; role of physical contact

sleep disturbances, 72 Se? «ay Japanese-American maternal-infant relations, rene tally retarded: enone the 73-76; maternal-infant interaction, 70-73: menace man as

g, Carl G., 78 "*

Jun 0 mental retardation: anthropological approach | juvenile period, prolongation of, 190-181 to problem of, 2; characteristics of severe Juxtlahuaca (Mexico), 56, 59, 60, 62, 63, 64 garding, 2-3, 19; freedom from regulation as _~

. therapy for, 15, 16; range of ability in

Kariba Gorge, effects of dam at, 90 moderate, 12-13; stigma of, 3, 17 Katchadourian, Herant, 8, 10 the mentally retarded: ‘“‘benefactors’’ of, 3, 17;

Kernan, Claudia, 7 capacity for complex relationships of, 13; Kernan, Keith, 7 | communication among, 15; diversity in,

Kahlapur (India), 56, 59, 60, 62, 63, 64 12-13, 18; elite among, 14; follow-up studies

King Heroin,” 37, 38, 39 on, 3, 16-18; “‘intelligence” of, 19-20; in Kleemeier, Robert W., 79 non-Western societies, 19-20; rules of conKluckhohn, Florence R., 68 duct held by, 15-16; sexual behavior of, Kohn, Melvin L., 68 - 14-16; school studies of, 18 Kohs Block Test, 115-119 methadone maintenance program, 41

methodological problems, 17 ‘la langue,’’? 104, 105 Meyer,6,Adolph, 49| | “la parole,” 105 “milieu therapy,” 14, 98-99

Labov, William, 111 minority group(s): the aged as a, 82; election of Lambert, W., 111 - life styles of, 76; make up majority of reLambert, William, 56, 65 tarded elite, 14; overrepresented among relanguage: as basis for interpreting social identi- - tarded, 13; statistics regarding, 32 ty, 111; biological bases of, 7, 129; differ- Minturn, Leigh, 56, 65 ences in, in U.S., 7; relation of, to brain mobility, relation of to alcoholics, 26-31 functions, 130; as reservoir of data, 104; two views of origin of, 129

Levine, Barbara, 56 Nadel, S. F., 79 Levine, Robert A., 56, 79 Nader, Laura, 10, 42

Lidz, 49 Nader, 82 | Lieban,Theodore, R., 42 Newcomb, T., Ralph, 123

The Non-Human Environment, 101-102

MacAndrew, Craig, 12 nonhuman primate behavior, 7, 128-131

9 the nos, 47-48, 49, 51, 52, 53

malnutrition as a problem in the United States, Norbeck, Edward, 79

Mann, R. D., 120-121 Notsuki, Seiko, 69

144 CULTURAL ILLNESS AND HEALTH [AS9 Nyansongo (Kenya), 56, 59, 60, 61, 62, 63, 64 8, 1381-132; IQ testing in, 18; as training

Nydegger, Corrine, 56 ground for egoism, 5, 65 Nydegger, William, 56 Schultz, A. H., 130 Scudder, Thayer, 90

GA semanie nero soo eusie factors Ol, ° > ’ ’ Osmond, Hump hry, 100 semantic-similarity judgments, 121-123 Orchard Town (U.S.), 56, 59, 60, 61, 62, 63, Searles, Harold, 99,100,101)

Ottermen, Keith Bos BO 97. 102 sex differences: in altruistic and egoistic be-

OULOTAWAFENESS SYSUETNS, hs * havior, 4, 59, 60; in vocalization, 74

} ; sexual behavior of the mentally retarded, 14-16 perceptual aberrations, 98-100 behavior, 59, 60 Piaget, Leo W., 79 Pittman,Jean, D. J.,99 25Simmons, Sivadon, Paul, 98, 99 Park, G., 93 sibling order as factor in altruistic and egoistic play, 8, 69-70, 130, 131. sleep: disturbances of among the Japanese, 72; poverty: and the aged, 82; and crime, 23 family patterns of, in Japan, 72, 73; func-

Powell vs. Texas, 31 tion of, in nonhuman primates, 128; in Preble, Edward, 36 humans, 129; maternal interruption of, 71,

Premack, David, 130 72; REM, 128, 129 preventive medicine, 9 social-behavior rating studies, 120-123

problem solving: alternate methods for, 2; ef- social interaction of children: analysis of, | fect of specialization on, 1-2; entrepreneurial 57-59; methods of observing, 56-57

experimental approach to, 137 sociolinguistic rules: affect semantic interpreta-

professionals: alternates to, 2; importance of tion, 112; effect of, on modes of reasoning, protocol to, 40; lack of acquaintance of, = 110-111; effect of setting upon, 109, 110; with system, 2; limitations of, in dealing govern choice of topics, 112; misunderstandwith addicts, 35, 41; as viewed by patient- ing of, and mental health, 7; three basic

addict, 39 types of, 107; violation of, and communica-

pronunciation, situational shifts in, 106 tion, 107-109 :

psychiatric diagnosis, problems of, 8, 135 Sommer, Robert, 100

psychiatrists: assistance to, of other disciplines, space: defined as a basic cultural system, 98;

136; responsibility to the community of, and hierarchy among psychotics, 101; rele136; and the social aspects of mental health, vance of, to mental health, 6, 98-102

8; vulnerability of, 1385, 136 speech acts, functions of, 106-107

psychiatry: and the drug addict, 35, 39, 40,41; speech behavior: emotion accompanying shifts interrelation of, with anthropology, 67, 68, in, 112; hypercorrection of, 111; situational

97-98, 102; variation of, in approaches to shifts in, 37, 38-39, 106, 111

problem solving, 136 speech communities: definition of, 105; multi-

ness 107; verbal repertoires of, 7111 | speech, Radcliff, K, B., dr., 100 Spencer, P., 79 , reality: concept of, and health, 8; concept of Spradley, James, 3, 41

the public intoxicant. See alcoholics; drunken- plicity of, 113; sociolinguistic rules of, 7,

: . ? >? > stereotypes: of the aged, 83; of the drug addict,

and marriage, 45-46; construction of, and 25 37 38 39. AO: linguistic. 111 conduct of Vietnam war, 125-126; construc- St 991, 0, 08, BY) UNBUIShIC, tion of,?modifies recollection, 120-121, 123; rodtbeck, Fred L., 68 vs ? » 7? ~—s suicide, 43, 91 effect of cultural tradition on construction Sulli ° us Stack. 97. 99 of, 7, 104, 115-126; and mental illness, Sutter. Alan C.. 35-36

; . ullivan, Harry Stack, 97,

98-100; multiple influences on construction , ° |

of,124 115; nonverbal aspects of construction of, Taira (Okinawa), 56, 59, 62, 63, 64 Rebelsky, Freda Gould, 70 Tarjan, George, 21 rehabilitation: and identity change, 32-33; of Tarong (Philippines), 56, 59, 61, 62, 63, 64

the mentally retarded, 16-18 Tenzel, James, 115 responsibility, problems of, 6, 89 territoriality among psychotics, 101 rewards, complexity and variability of, 132 Therapeutic nihilism, 81, 83 Romney, A. Kimball, 56, 124 Tinbergen, Niko, 98

. Romney, Romaine, 56 _ the Tiv (Nigeria), attitudes toward marriage

Ross, H., 100 among, 45

Tulkin, Steven R., 73

Sapir, Edward, 67, 68, 71

schizophrenia, disorientation in, 98-100 value systems: in relation to aging, 9, 81, 86; | schools: based on misunderstanding of biology, effects of differences in, on doctor-patient

|

INDEX 145 relation, 4; in sociolinguistics, 111-112 Warner, W. Lloyd, 79

verbal repertoire, 7, 106 Washburn, S. L., 7-8, 9 vocabulary: as barrier to communication, 105; Weinstein, Helen, 69

situational shifts in, 37, 38-39 _ Whiting, Beatrice, 4-5, 56, 65, 66

vocalization in infants: in American vs. Japan- Whiting, John, 4-5, 56, 65, 66 ese children, 74-75; differential maternal Wintrob, Ronald M., 5, 8, 10

responses to, 70-72 Wittreich, Warren J., 100 von-Mering, Otto, 81 Woodbury, Michael, 101

DOMINANCE AND DEFIANCE a study of marital instability in an Islamic African society

by Ronald Cohen $6.50 cloth $4.00 paper Kanuri marital instability is a common, well-established feature of their society. They are not concerned or

aware of it as a problem in much the same way that we in the West were not concerned until recently about the

air we breathe. Yet to an outsider from the West the instability is a striking feature of their society. This can indeed shed light on a universal problem, that of marriage and the family.

STUDIES IN ECONOMIC ANTHROPOLOGY

edited by George Dalton | $7.00 cloth $4.50 paper with essays by Karl Polanyi, Walter C Neale, Marshall Sahlins, Maurice Godelier, Philip Grierson, Shirley Birch, Larissa Lomnitz, Nelson H H Graburn, Hugh and Christina Gladwin, Allen W Johnson, Clifton R Wharton Jr, Irma Adelman and George Dalton

The essays in this volume show that economic anthropology is not a single topic but rather a wide subject containing very different fields of interest, some of which are shared by historians, economists, and other social scientists, and some of which are studied by anthropologists alone. Three things are clear: Those interested in economic anthropology can learn much that is important from neighboring subjects as well as from the use of Statistical techniques. Writings on acculturation, applied anthropology, and (post-colonial) micro-development

analyze change under markedly different historical and therefore economic and social conditions. The “substantivist-formalist’” controversy is not capable of clear-cut resolution because more than one theoretical

framework is required to analyze and measure the very different fields of interest studied in economic anthropology.

RACE AND INTELLIGENCE . edited by C Loring Brace, George R Gamble and James T Bond $5.50 cloth $3.00 paper — with essays by Arthur R Jensen, Alexander Alland Jr, Vera John, Rosalie Cohen, Thomas G Gregg and Peggy R Sanday, C Loring Brace and Frank B Livingstone

In spite of the application of multivariate statistics, “matrix algebra, and a bewildering array of other computer-assisted techniques, questions concerning the utility of intelligence tests and what it is they measure are still unresolved. The process of enculturation, and the sequence of individual experiences that occurs while this takes place, plays such an overwhelming role in shaping human behavior that it has become a major challenge to psychologists to discover whether any aspects of human behavior are inherited. If it has been difficult to find the very existence of such dimensions, it has proven even more difficult to compare the extent of their development from one individual to another, and next to impossible when the comparison pits one population against another,

CULTURAL ILLNESS AND HEALTH essays in human adaptation

edited by Laura Nader and Thomas W Maretzki $6.00 cloth $3.00 paper with essays by Robert B Edgerton, James P Spradley, Michael Agar, Paul Bohannan, John W M Whiting and Beatrice Blyth Whiting, William Caudill, Margaret Clark, E Colson, E T Hall, Claudia Mitchell-Kernan and Keith T Kernan, Roy G D’Andrade, § L Washburn

Health is intimately connected with the way in which people construct reality; with the way in which ‘communities function; with the way in which health expertise works in the context of the nation. This volume,

which consists of papers presented at a recent conference on anthropology and mental health, challenges assumptions underlying concepts of health for individuals and for society and clearly points to the need for careful observation of human behavior. Part | deals with topics which on the American scene are viewed as “social problems” or crimes—mental retardation, drug addiction and divorce. Behavioral styles, including development and interaction, and human creativity and adaptation are covered in the life cycle section. Part II] deals with theoretical questions pertaining to space, language, methods and cultural constructs, and evolution.

Coming Soon... THE ARCTIC HYSTERIAS of the North Alaskan Eskimo by Edward F Foulks

The Arctic Hysterias comprise a group of mental disorders which have occurred with some frequency among circumpolar peoples from pre-contact periods to the present time. The subject may surprise those who consider

mental disorders a product of the complexities of modern, overpopulated, socially stratified urban society. However, it is apparent that even in the pristine purity of primitive peoples problems arise that result in mental disorders. This volume is an attempt to establish the historical-traditonal relationships of this behavior among peoples of the North in general; an exploration in detail of its role in the history and culture of the Innuit Eskimo, a people in whom episodes of the Arctic Hysterias have been amply documented since the earliest contact times; and finally, an analysis of the present day patterns of occurrence.

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