Review

Author(s): Barbara W. Lex

Review by: Barbara W. Lex
Source: Medical Anthropology Newsletter, Vol. 12, No. 3 (May, 1981), pp. 16-17
Published by: American Anthropological Association
Stable URL: http://www.jstor.org/stable/647752
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can best be described by a Chinese saying: "Good medicine
tastes bitter" (liang yao ku ko).
I am aware of only three typographical or editorial errors.
Since the author appears to be well versed in all verifiable
Chinese medical literature, careful readers should have con-
fidence in the originality and authenticity of this book, an
open sesame to the treasure trove for those who work in the
topics of Chinese medicine, ethnomedicine, medical history,
comparative medical systems, and medical ethics. Many
thought-provoking original materials have the potential to
be expanded into good papers with fresh issues, such as
"The Chinese Reception of Indian Medicine in the First
Millenium A.D.," or "Comparative Systems of Health
Care." Finally, this book can be popular and give epicurean
taste to the general readers in China, Taiwan, Hong Kong,
or the Chinese communities in America, if retitled and
rewritten into Chinese by an able editor/writer.
After Plastic Surgery. Frances M. Cooke Macgregor. New
York: Praeger, 1979. Pp. xii + 136. $16.95 (cloth).
Reviewed by Vera Rubin, PhD
Director, Research Institute for the Study of Man
New York City
When Frances Macgregor began a study of preoperative
and postoperative reconstructive surgery patients in 1946,
she carved out an unusual career in medical sociology. For
the past 25 years she has been a research scientist at the New
York University Medical Center, Institute of Reconstructive
Plastic Surgery, working with an interdisciplinary team on
the social and psychological implications of facial disfigure-
ment and plastic surgery.
After Plastic Surgery, the third in the series of her major
publications on this subject, provides a unique in-depth
study of cultural, psychological, and sociological aspects of
the long-term adjustment of patients with severe facial
disfigurement whose progress Mcgregor has followed over
the past two decades.
For this volume, Macgregor has selected six representative
cases of 44 patients in the study, whose disfigurement was
classified as marked or gross. They represent the variables of
age, sex, genesis, severity, and type of disfigurement, as well
as the range of problems, coping strategies and modes of ad-
justment of patients originally studied by the interdisciplin-
ary team. Macgregor's follow-up study, 20 years later, is
based on intensive life histories, including childhood ex-
periences and parental attitudes; family and social back-
ground; psychiatric evaluations of preinjury personality and
postsurgical adjustments; the values of the sociocultural
milieu in which the patients have lived; and their efforts to
cope with the stigmata of facial disfigurement.
Macgregor observes that the problems of social and psy-
chological adjustment of the facially disfigured are especial-
ly severe, given the cultural values placed on external ap-
pearance and physical attractiveness in our society. Further,
the high visibility of victims of severe congenital deformity
or disease-engendered facial disfigurement is correlated
with the societal denial of normative opportunities to select
friends, careers, mates, and life-styles.
Macgregor highlights zeitgeist factors in cultural at-
titudes, pointing out that during the Second World War
16
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there was a climate of greater tolerance for the mutilated
and disfigured than in subsequent periods. Two of the cases,
one male and one female, both severely injured during
World War II, are salient illustrations. The woman, par-
ticularly, a member of the Polish underground, was con-
sidered a heroine in her circles, but felt "like a creature from
another planet" when she migrated to the U.S. Another pa-
tient, severely disfigured by a noma lesion in early child-
hood, had had 60 operations by the time she was 15 years
old and was first interviewed by Macgregor. The physical
trauma of multiple operations for the severely disfigured is
psychologically compounded by the ultimate realization
that their disfigurements are never fully remediable. Partly
motivated to undertake traumatic multiple operations by
the cultural value to do something to eliminate or minimize
the social stigma of disfigurement, partly spurred on by the
expectation of parents that plastic surgery "can perform
miracles," the subjects have had to cope with severe frustra-
tions, as well as economic problems entailed by extensive
medical costs, inability to achieve gainful occupations, and
intensified family strains.
Nevertheless, Macgregor reports that the patients have
made surprisingly good adjustments 20 years after surgery,
despite gloomy psychiatric forecasts about their capacity to
cope. She hypothesizesthat the psychotherapistswho tended
to view emotional disturbances as a basic "neurosis"were
projecting their own discomfort with severe disfigurement,
tended to overestimate the subjects' weaknesses and under-
estimate their potential strengths, and, using the then avail-
able personality protocols, failed adequately to measure pa-
tients' courage and resiliency. She points out that the social
scientists focused on the patients' interpersonal relations,
social functioning and efforts to cope with their situation in
a rejecting milieu, rather than on the concerns with classifi-
cation of neurosis.
After Plastic Surgery vividly conveys the internal and ex-
ternal worlds of the facially disfigured and depicts their
perceptions of the situation in their own words. Macgregor,
who notes that adequate long-term studies have been the
weakest area of rehabilitative research, has made a signifi-
cant stride in this direction. Exceptionally well written and
free of technical phraseology, After Plastic Surgeryprovides
an elegant model for holistic analysis of the lives and
adaptations of severely handicapped individuals in our
society, and a classification of coping mechanisms.
Macgregor's study also offers a framework for sensitizing
professionals to the full range of their patients' problems,
with implications for the field of rehabilitation generally.
The volume is a valuable resource for researchers and
specialists in the field and a contribution to medical social
science.
Catharsis in Healing, Ritual, and Drama. T. J. Scheff.
Berkeley: University of California Press, 1979. Pp. xvi +
246. $12.95 (cloth), $3.95 (paper).
Reviewed by Barbara W. Lex, PhD
Alcohol and Drug Abuse Center, McLean Hospital,
and Psychiatry, Harvard Medical School
Scheff's book brings a new perspective to the study of the
role of emotions in social behavior. It will interest patients
and practitioners, students of the theater, and students of
religion, as well as medical anthropologists and medical ers in mental health. Both the title and the authors' stated
sociologists. By addressing the need to define catharsis, purpose that "therapy systems applied in publicly funded in-
Scheff has taken an important step toward clarifying the stitutions such as state mental hospitals or community men-
process through which emotional tensions are discharged. tal health centers exist, not on the basis of their effectiveness
The author assumes that catharsis is a necessary condition to treat but on their allegiance to dominant cultural
for therapeutic change (p. 13). In his view, an accumulation ideas" (p. ix), suggest that the volume is an anthropological
of inhibited emotional distress generates patterns of work. It is not.
behavior designated as "rigid" or "neurotic." A distressed The major deficit of this volume is the theoretical frame-
individual relives and reacts to past emotional distress as if it work upon which the authors attempt to build their thesis. A
were occurring in the ongoing present. Catharsis dissipates framework based upon a philosophy of the environment and
old patterns (p. 14). But, catharsis can only occur if one at- human nature and a quote from Albert Schweitzer's (1933)
tains an appropriate degree of separation from the distress autobiography does not provide the theoretical base needed
of past emotions. Catharsis is achieved via "distancing." to attain the authors' stated purpose. The authors refer to
Scheff borrows the notion of distancing from the study of this conglomeration as "the cultural thought world." After
aesthetics. Accordingly, one's experience may be located at using this concept to examine 199 years of American history
some point along a continuum between intense participa- (in 50 pages), the authors conclude that "our premise of
tion that is "underdistanced" and complete detachment that cultural determination seems well founded. . ." (p. 69).
is "overdistanced." For catharsis to occur, a balance must be Neither 50 pages of grossly generalized and oversimplified
struck: the individual is said to become a "participant history nor their mechanism of "the cultural thought world"
observer," experiencing repressed feeling concomitant with support their conclusion.
its discharge. Chapters 4 and 5 are devoted to a review and evaluation
Anthropologists may be most curious about the chapter of milieu therapy and behavior modification. In these
devoted to "Emotion in Ritual and Mass Entertainment." chapters the authors appear to be dealing with more
Scheff defines ritual as "the potentially distanced reenact- familiar material. Both are interesting and raise provocative
ment of situations of emotional distress that are virtually questions regarding research design. In chapter 6, the first
universal in a given culture" (p. 118). It follows that ritual is chapter that presumably deals with the mental health in-
the institutionalized means for collectively discharging emo- dustry, the authors abandon their notion of "the cultural
tional distress. Scheff's perspective departs from that of thought world" and decide that the mental health establish-
Chapple (in The Biological Foundations of Individuality ment has to be placed within society (p. 164). This chapter is
and Culture, Krieger, 1979), who sees ritual as a vehicle that replete with undocumented conclusions and dated refer-
promotes emotional synchrony-and thereby reestablishes ences in order to support the idea that the real aim of men-
homeostasis-among participants. In all likelihood the tal health professionals is social control.
disparity results from the backgrounds of the two authors, In the final two chapters the authors present two treat-
for Scheff is stlongly influenced by personal experience in ment models for the mentally ill. Chapter 7, entitled "Treat-
"Reevaluation Counseling," and Chapple by systematic ing Cultural Man," is a poorly documented argument that
research in behavioral biology. suggests that the mentally ill should be treated in milieu and
The book is written clearly but there are several flaws. behavioral modification programs that are socioeconomic
One very serious omission is the lack of any cognizance of the class structured. In effect, the goals of middle-class treat-
work of Van Gennep on rites de passage. Also absent is the ment programs should be different from those of the lower
important distinction of rites of passage from rites of inten- class. The second model, an "economic model," suggests
sification (see Chapple and Coon, Principles of Anthropol- that practitioners should get economic rewards according to
ogy, Henry Holt, 1942), and there is no mention of work by outcome, and clients should be able to stipulate their choice
Ernst Gellhorn and his colleagues that was published after of treatment.
rea men Ne Neither
her mode
model iss curren
currentlyy be ng tested
being es ed by thehe
1963. authors.
au hors
Nevertheless, because investigations of the role of emo- IIt iss ddifficult
cu too es
establish
ab sh the he va
value
ue oof this
h s book
book. The
tions in human behavior may benefit from incorporation of hors aall psycho
authors,
au og s s have aattempted
psychologists, emp ed too wr writee a book
the concept of distancing, even this level of analysis has its that
ha by itss titlee wou
would d seem too appea
appeal too an hropo og s s and
anthropologists
uses. One would hope that Scheff might refine his ideas and oothers
hers interested
n eres ed in n thehe cucultural
ura componen
componentss oof men mentala
engage in futher study of this concept, despite the possibility health.
hea h Bu But this
h s vo
volume
ume lacks
acks concep
conceptual gor iss rep
ua rrigor, replete
ee
that ritualized catharses may be manifestations of culture- with
w h da dated
ed re references,
erences and con contains
a ns too oo many un un-
specific elaborations on the neurobiological substrates of documented
documen ed genera
generalizations
za ons and oversimplifications
overs mp ca ons to
o be
human behavior. useful
use u too eeither
her a ser
serious
ous prac oner or sstudents
practitioner uden s interested
n eres ed
inn men
mental a hea
health.
h
The Mental Health Industry: A Cultural Phenomenon. In their
he r rev
review
ew oof thehe research on token oken economy pro pro-
Peter A. Magaro, Robert Gupp, and DavidJ. McDowell. grams, the
grams he auauthors
hors cr
criticize
c ze thehe token
oken economy researchers
New York: John Wiley, 1978. Pp. vii + 272; index. $18.95 because they hey do no not take
ake into
n o accoun
account " "the
he comp ex inter-
complex n er
(cloth). actions
ac ons occurr
occurringng in n an institutional
ns u ona se ng . . ."
setting " (p.
p 138
138).
The same cr criticism
c sm can be made oof this h s vo ume In eeffect,
volume. ec
Reviewed by Evelyn L. Barbee, PhD the
he auauthors
hors have no not taken
aken into
n o accoun
account thehe comp
complexex inter-
n er
Psychosocial Nursing, University of Washington actions
ac ons thatha occur in n a soc e y among itss soc
society sociocultural,
ocu ura
This volume, one in the extensive Wiley series on Per- political,
po ca economic,
econom c and ega sys
legal ems that
systems ha serve too crea
createe
sonality Process, is intended for practitioners and research- and ma n a n he men a hea h ndus ry n h s coun ry

17

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