Book Reviews 105
foreign exchange earnings of the producer price taxes, fertiliser subsidy and exchange rate
policies on maize imports and tobacco exports was an average of $70 million per annum of
8% of merchandise exports.
Excluding inefficiency costs, the budgetary effects of price policy were estimated to be
some K74 million per annum from 1970-84 (almost 10% of the government budget). These
subsidy situations often constitute a large proportion of the budgetary allocation for
'agriculture'. Despite repeated determination to channel resources to agriculture and to
diversify exports away from copper, only 6% of the budget is actually allocated to
agriculture. Jansen points out that another problem is that whilst capital appropriations may
have increased the recurrent budget has declined with per capita allocations decreasing
significantly. She estimates that mere has been a net transfer of resources out of agriculture
of some 7% of GNP per annum. The study shows a deterioration in both rural and urban
incomes despite the food subsidies for urban households. The average rural household
avoided the negative impact of government pricing policy by reverting to subsistence
production.
The study includes a comprehensive history of agricultural pricing policy and a
normative assessment of the impact of administrative controls. As a study contributing to
the literature onZambian agriculture, this publication is essential reading. As a text to assist
other countries utilising similar methodologies it would have to be used in conjunction with
a policy analysis text (eg Monke and Pearson, 1989; or Timmer, Falcon and Pearson, 1983).
It provides students and analysts with an excellent example of how to make the best use of
available data to provide rough approximations where precise estimates are not feasible. As
with all quantitative studies throughout the world, but especially in developing countries,
the results are only as strong as the underlying assumptions. Jansen has a good knowledge
and understanding of the basic relationships in the Zambian economy and has provided a
useful analysis.
Reviewed by Kay Muir Leresche, Mutare, Zimbabwe
References
JansenDoris (Dodge) (1977) Agricultural Policy and Performance in Zambia, University
of California, Berkeley.
Monk Eric and Pearson Scott R (1989) The Policy Analysis Matrix for Agricultural
Development, Cornell University Press, Ithaca.
Timmer C Peter, Falcon Walter P and Pearson Scott R (1983) Food Policy Analysis, John
Hopkins University Press, Washington.
Prisoners of Ritual An Odyssey into Female Genital Circumcision in Africa, Hanny
Lightfoot-Klein, Harrington Park Press, New York, 1989 (306pp, US$14,95)
The very title of this publication indicates the author's view of its subject, female
circumcision, and it would indeed be difficult for anyone outside the cultures where it is
practised to hold a supportive view of this custom. Nonetheless, Lighfoot-Klein manages
to give a balanced, objective, sensitive and perceptive portrayal of this highly emotive issue.
106 Book Revie~
The main focus of the book is on the Sudan, although there is a little coverage of East
African natiOIll (notably Kenya), a brief history and geographical overview, and a short
discussion of both female and male circumcision in the West. Nevertheless to subtitle the
book an odyssey 'in Africa', when the reality is an indepth study of the Sudan alone, is
slightly misleading. Literature on other countries in Africa is reviewed, and an extensive
bibliography included. but of the twenty eight to thirty countries mapped out as practising
circumcision of one sort or another, only Sudan has in depth and first hand coverage.
In writing about the Sudan the author varies her approach from informal diarising and
recounting of conversations and events, to extensive personal experiences of women and
some men recounted in direct speech, and formal analysis of the issue of circumcision. The
author travelled widely in the C01.Dltry,and spent considerable time in hospitals in the
obstetric and gynaecological departments, both witnessing the traumas there and talking
with medical staff and women patients and mothers. A large number of brief case studies
are included as appendices and within the main chapters, indicating a wide range of views
and personal experience. 1be author also discussed with local psychiatrists the psychological
impact of circumcision on Y01.Dlggirls and women in later life.
The second, shorter, part of the book contains photographs of women and a series of
vignettes of the author's experience of Sudanese culture in general as she travelled through
the country, thus providing a wider context for the earlier discussion.
Regarding the practice of female circumcision itself, the book is a mine of information.
It describes the various degrees of genital mutilation that may be performed, concentrating
on the severest form which is also the most widely practiced in Sudan. This is pharaonic
circumcision, involving excision of the entire genital area, clitoris, labia minora and majora,
and scraping the flesh away down to the bone before suturing until only a tiny pinhole
opening is left. The mutilation is so extensive that even urination becomes difficult,
normally taking ten to fifteen minutes as each drop of liquid is forced out. For some women
urination is reported to take half an hour or more, and for some unforl1.D1ategirls after
circumcision it becomes impossible, and they have to be cut open again in order to pass
water.
Menstruation becomes equally difficult and extremely painful, as blood clots build up
behind the circumcision scar. The next ordeal for women is the forcing open of the scar
tissue after marriage, a process achieved by repeated penile assault or by resort to a knife
if the former fails. 1be open, bleeding wound created by penis or knife is used for sexual
intercourse repeatedly in order to keep it open until it can heal with fresh scar tissue.
Childbirth, as could be anticipated, is fraught, and involves massive cutting to enable the
baby to emerge. The final assault is the resuturing of the women after childbirth to pinhole
size again, so that the agonising process of repenetration can begin again. This latter
refmernent is reported to be fairly new.
Inevitably, a number of young girls, who are usually circumcised between the ages of
five and nine, do not survive the ordeal. They may bleed to death, or die of sepsis or urinary
complications. Such a death is accepted as 'the will of Allah', and the cause concealed
because pharaonic circumcision, despite its very wide practice, is infact illegal.
Book Reviews 107
One's gut reaction. coming from a different culture, cannot be anything but utter disgust
mloutrage that literally millions of young girls are routinely subjected to such a procedure,
usuallywith no anesthetic whatsoever (except the reputed numbing effects of acacia thorns
used IS sutures), and that women's lives consequently become a perpetual round of
agonisingpain surrounding menstruation. sex and childbirth. Yet outrage is not enough.
Onemust try to understand the cultural values and expectations that lead so many men and
womento support the practice. Lighfoot-Klein helps us to do this, whilst at no time
eOOorsingit. On the contrary, her aim in writing the book is clearly to assist movements
againstfemale circumcision by alerting them to the sensitivity with which the subject must
be faced. Western and even African outrage from outside the region may entrench the
practicerather than facilitating change.
Thedescriptions women give of their memories of circumcision itself and of sex are so
variedit is difficult to believe they are describing the same situation. Two examples will
illustrate this. One woman, who has lived in the USA and has an extreme pharaonic
circumcision, reports, "I came from a bad village in the west, where they scrape off
everything.1bere is not even skin left to sew up and they tieyour legs together for forty days,
until a scar fonns. There is nothing left with which to feel. When your husband comes to
you,it is the same as ifhe came with a stick to a piece of leather". Yet another woman says
thatthepharaonic is a good thing, and once the pain of penetration or repenetration is over,
sex forher is highly enjoyable and orgasmic. She, and many others, rationalise the pain as
thewayto give the man most pleasure, although several men interviewed spoke of guilt and
physcialpain themselves because of the process of penetration.
The value attached to the pharaonic is that it is thought to prevent girls from becoming
sexuallywild, it keeps them pure and virginal for their husbands, and it removes what are
seen as ugly, dirty, odorous and evil parts of the anatomy. It is widely and erroneously
believed that Islam demands pharaonic circumcision, so failure to perform it would be
sacrilege.Not to circumcise a girl would go against very deepseated customs, and leave the
uncircmncised girl totally ostracised. 'The point is also made that if every woman is
circumcised,there is no possible comparison with non-circwncised women., so the extent
to which subsequent infections and pain in sex and parturition are direct concequences of
the pharaonic is not clearly understood. Women know their lot in life, and KCept it with
very few exceptions. Some men rationalise it by saying women have a very high pain
threshold.Both sexes support thecustorn. and the midwives who carry out circumcision are
highlyrevered.
Highly educated Sudanese are depicted as showing ambivalence towards the practice,
particularlywhen they have been exposed to other, non-circumcising cultures. A few report
thattheytotallyrejectit, particularly those doctors who see the medical risks and IrlUllla that
thepracticecauses. Nevertheless, it is not clear to what extent they have actually spm:d their
own daughters from being cut. Grandmothers in favour of the pharllOJlic have great
influence,and the subject is strongly felt to be a women's issue. Some report that they only
carryout a 'surma' or clitoral cutting, rather than infibulation.
108 BOO«Rev~ws
For myone concerned about women's issues, and the ways that culture and custom can
dictate the most severe mutilation and assault on women, this book is valuable reading. lit
is also deeply disturbing. Yet in all this, the warmth of the cultures shines though, and the
point is made that in a society where daily life for the vast majority is very hard, the agonies
of pharaonic circirncision may seem rather irrelevant. For most people, changing the
practice is just not a priority issue. For the educated few it can become more central,
however, and hopefully their influence over time may increase the prestige and hence
acceptability of leaving girt~ intact.
Reviewed by Helen Jackson, School of Social Work, Harare.
Psychiatric Disability. Clinical, Legal and Administrative Dimensions, Arthur T
Meyerson and Theodora Fine (008), American Psychiatric Press, Washington OC, 1987
(461pp, £30 hbk).
This is a very welcome textbook which attempts to provide a comprehensive, detailed and
multi-dimensional approach to the study and understanding of psychiatric disability. The
book offers extensive information and bibliographic material on the identified clinical, legal
and administrative aspects of psychiatric disability. It is a rich source book which provides
a wide range of comprehensive references. However, despite this broad and detailed
perspective the book fails to honour its intention and the objective of being cross-cultural.
The book is grossly 'disabled' by its 'pathological' and limited American bias.
The book draws from major American sources and references. It is focused on and
intended for American practitioners, and specifically tries to address problems arising from
or connected to the Social Security Administration Programme of the USA. The only
attempt the book makes to give a cross-cultural perspective is the citing of two studies. The
first study looks at the long term prognosis of schizophrenia and was undertaken in
Switzerland. The second looks at the prevalence of psychiatric disability among the aged,
and was undertaken by the WHO in West Germany . Even bythemostnarrow andrestrictive
defmition this can not be classified as a cross-cultural perspective. Comparing American
and European conditions does not give the book a broad cross-cultural base.
The book's major bias is shown in its analysis of the legal and administrative issues of
psychiatric disability. These are given in precise American terms and interpretations. The
American community is preoccupied with individual rights and freedom. The book goes
to extremes to portray, emphasise and safeguard this 'sacred' American attitude. As such,
the book is not very useful to people practising in a system which is politically, legally and
administratively different from the American system. The aim of the book is to prepare
American practitioners for the American environment and conditions under which they will
have to practice.
The book fails to address, and is insensitive to, African and Third World countries where
cultural values and beliefs in witchcraft and ancestral spirits have a causal effect, and where
the traditional healer has both a therapeutic and rehabilitative function. Lack of facilities
in most Third WorId countries make itvery difficult to spend time and money on issues like
individual rights and freedom.