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.
Book Reviews 109
The book also fails to address an array of Third World problems such as
superstition, the absolute or relative absence of mental health facilities, poverty, malnutrition,
unemployment and low levels of living generally. These aspects have a direct bearing on
the causative factors, diagnosis and prognosis, and the preventive and rehabilitative aspects
of psychiatric disability. As such, the book has limited relevance to African and Third World
conditions.
In addition to these general limitations the bookhas specific areas of weakness. The first
two sections on epidemiology and clinical pathology (Overview and Clinical Issues) not
only adopt a medical model but use confusing and complicated medical terminology which
makes the book relevant and useful only to medically qualified practitioners. Open
psychological terms would benefit all levels of personnel involved with psychiatric
disability.
As indicated above, Chapter 2 refers to purely American definitions, statistics, and
prevalence rates, and makes specific and limited conclusions. These conclusions cannot be
generalised. Chapter 3 is misleading and is a major let down. The title is "The Basis of
Psychiatric Disability", but only two conditions are discussed. Schizophrenic and alcoholic
dementia, though major conditions, are not the only conditions in psychiatry. The
conclusions drawn from these two conditions can not be generalised across all the other
conditions. This is the only chapter in the book tasked to explore the basis of psychiatric
disability, yet it frustrates the expectations raised by the chapter heading. However, the two
conditions are discussed in a very comprehensive and detailed manner, and extensive
references are given.
Chapter 4 is completely divorced from psychiatric disability. Disability is discussed in
a completely different and non-psychiatric context. It is a general sociological discussion
Which analyses the relationship between work and physical disability. This chapter is not
very useful and was possibly included to expand the book and give it respectability. The
chapter actually breaks the flow of the content, as a sociological issue is thrown into the
middle of medical issues.
Chapter 5 contradicts Chapter 3 in terms of the definitions of schizophrenia adopted. It
adopts a broad and inclusive definition covering the whole spectrum from Bleuler to the
DSMII. The authors could have agreed on a specific operational definition. The chapter
also fails to be comprehensive in discussing the disabling social and interactional aspects
of schizophrenia. Chronicity is not emphasised and the need for a long term management
plan is not highlighted.
Chapter 6 is not linked to Chapter 3 which discussed the basics of disability. However,
the chapter tries to quantify the problem and gives useful statistics but fails to utilise relevant
research findings, particularly Seligmans' (1973) learned helplessness as a key disabling
factor. The chapter is also bankrupt in terms of treatment and rehabilitation. It offers only
traditional (AA) methods and vocational rehabilitation.
The third section of the book on psychiatric rehabilitation is very useful and relevant.
Though addressed to and intended for the American environment the section has wider
relevance, and the theories and information given can be applied to African and Third World
conditions. Chapters 11 and 12 are very useful and can be applied generally with minor
modifications.
The last two sections on administrative and legal issues are specific and only relevanl
in the American context. These sections cover the interpretation of the American legal
system as it affects and applies to the administration of American mental health institutions
and rehabilitative programmes. For somebody outside the American system it is difficult
to understand the implications and dynamics involved, and to later on adopt and implement
some of the recommendations made.
Overall, the book needs to be used with caution and discretion. For teaching and research
purposes the book offers some useful but limited chapters and sections. Chapters 11 and12
are highly recommended and the whole section on rehabilitation is useful. The frrst two
sections on epidemiology and clinical pathology may be used for the general understanding
of mental health and disability issues, together with other well established and proven
references. The book is rich in bibliographic references which could be used for fruitful
research.
Reviewed by A Madhaka, School of Social Work, Harare.
References
Seligman M E P (1974) "Depression and Learned Helplessness" in R J Friedman andM
M Katz (eds) The Psychology of Depression: Contemporary Theory and Research,
Winston-Wiley, Washington IX.
Seligman M E P (1973) "Fall into Helplessness" in Psychology Today, June, 17,43-48.
Magomero. Portrait of an African VlIIage, Landeg White, John McCracken, Cambridge
University Press, Cambridge, 1987 (271pp, US$14,95).
This book is a compelling historical portrait of an African village in the southern region of
one of Africa's poorest countries, Malawi. The author takes the reader through 126 years
of startling events in the lives of a few hundred men and women who are made powerless
by events obeyond their control and the poverty they live in. The book has two major
aspects. the frrst is Magomero, as a place in which historians in recent years have focused
on the slave trade, Christian missions and their impact, colonialism and ethnicity, land
alienation in a plantation economy, resistance and the rise of nationalism, peasant cash
cropping and the mobilisation oflabour, the struggle forresources between men and women,
and the perpetuation of poverty in the period after Independence. The second aspect, as
stated in the Preface, is an attempt by the author to record the changes that have occurred
in the economy, in custom, in political and personal relationships, and the village's
changing relationships witll the broader Malawian and Southern Mrican context since 1859.
The village story also shows the contradictions between Livingstone's Christian doctrine as
a way of establishing legitimate trade and commerce in the region, and the African
perception of Christianity as a way to attain self dignity, as seen through the person of John
Chilembwe.
The frrstpartofthebook covers the period between 1859to 1863. In this part the author
provides a clear but lengthy description of the area, even distances from one important pllk:e
to another are given, and the origin and meaning of village names made clear. The problem
with this part of the book tends to be in this description. Too many names of geophysical
features, tribes and individuals are given, making it difficult to master them - particularly
as this may not be of value to a non-historian. In this chapter the author shows tliat the