Introduction
THE IMPACT of social and cultural environment upon the development of personalities is the central concern of social psychiatry. While this environment is in no sense a fixed form or pattern into which personality falls and is moulded, neither is it simply a mere extraneous influence added to inevitable results determined by the child-rearing practices of a culture. The attempts to exaggerate the socio-cultural setting to a global and inclusive mould effect are daily belied by the variations in personalities encountered by observers, scientific or otherwise, in any given setting. On the other hand, even the most cursory acquaintance with psychiatric case histories individually considered indicates the crudity of beginning with the Freudian basic disciplines and inferring therefrom the total contours of adult personality configurations. Both methods, the grossly cultural and the rigidly psychogenetic, are only partly useful as formulae and only partly true to individual and cultural realities.
These theoretical opposites fail in that they do not assess, beyond the one-way causal scheme either for psychiatry or anthropology, the exact relationship that environmental experiences bear throughout the life history to individual adjustment. As Edward Sapir once said, “The worlds in which different societies live are distinct worlds, not merely the same world with different labels attached.” In connection with Princeton’s Perception Demonstration Center, Hadley Cantril has shown how the nature of the individua’s experience in life, even upon the perceptual level, depends on his prior assumptions, how these in turn are built from past experiences; and how attitudes, opinions and percepts change only when the individual is blocked and feels frustration. No doubt, turning to psychiatry, a building up of cognitive, attitudinal and perceptual patterns has also an organic, metabolic and hormonal basis since the organism, as such, is the reactive mechanism; however, personality is more than mechanism, and the individual is more than an autonomic system, self-propelled and self-motivated.
Ordinarily, a person’s experiences are in the normal course interpreted along lines laid down by his culture, even though the channels cut by culture thread through such more familiar terrain as family structure and functioning, a system of values and beliefs, a range of social and economic statuses, certain practices and taboos, attitudes towards health and illness, and such features as the characteristic styles of interpersonal relationships. All of these features are the coin of the realm of personality formation, affecting marital, parent-child, sibling, peer, and other group relations. They vary with culture, and with degree and pace of acculturation or culture change. Among the basic orientations provided by culture, A. I. Hallowell has recently listed self- and object-orientation, spatio-temporal orientation, a motivational orientation, and a sense of normative standards and values.1 The kinds of relationships set up within a culture and defining its age-groups, its sex behavior and attitudes, its statements of the individual position in the family and in the social group are no doubt ramifications of these basic categories. They may be seen also in what Ruth Benedict once called the continuities and discontinuities of the life history pattern.
This life span, or life cycle, is lived in a constant homeostatic relationship with this total environment, parts of which become internalized and implicit in an individual’s responses and reactions as well as external and explicit. On the individual level of responses in actions and symbols, unique though these are, no life is lived alone and apart from interpersonal patterns of communication and interaction. All personality formation, or the psychodynamics of well or ill alike, rely in the last analysis upon symbolic forms of communication and self-expression in which what is human and cultural is shared, while that which is bizarre and autistic is closer to raw impulse or guarded illusion. A psychiatry, or a behavioral science, which credits a human being with a dynamic life biography and with conditions of existence in communicated and felt socio-cultural settings, but which ends by denying reality of the social and cultural groups, cannot move from case A to case B, or indeed fully assess the impact of other people on either A or B.2
In his recent posthumous work, The Interpersonal Theory of Psychiatry, Harry Stack Sullivan has stated that progress toward a “psychiatry of peoples” can emerge only from improved understanding of significant patterns of living in the modern world coupled with the discovery of important details in personality development by which persons of different socio-cultural background “come to manifest more or less adequate behavior in their given social settings.” Each of these lines of inquiry, the first in anthropology and the second in social psychiatry, he regarded as a “necessary supplement to the other.” Seen from this vantage point, not merely the often unrecallable earlier stages of childhood confusion, but any appropriate and less dereistic or painful points in the life cycle are equally important in their own right “in the unfolding of possibilities for interpersonal relations in the progression . . . toward mature competence for life in a fully human world.” The importance of families, communities, socio-political entities, group cultures and sub-cultures as the settings for these progressive efforts of the individual are all alluded to by Sullivan. He also stresses the special skills in the study of interpersonal relationships, participant observation and interviewing techniques using the operational approach and field theory concepts of psychiatric and anthropological science. Finally, we learn that, ideally, the psychiatrist as “participant observer” uses concepts derived from the anthropologist’s analyses of other cultures.3
This concordance of interests in the fields of psychiatry and anthropology in three areas, the individual personality, the cultural background, and family or social group participation is a convergence in broadly integrative behavioral science. That it should appear in the consolidating and synthesizing phases of each discipline in the Twentieth Century is not surprising. If, as has been known for some time, there are intimate connections between the organization of personality and its socio-cultural background, then the study of either is revealing of outlines, demarcations and significances of conduct in the individual.
The increasing use of projective test methodologies in the study of cultures is instructive at this juncture, since it was Rorschach himself who first studied psychotic patients from two different Swiss cantons and who reported that the results obtained seemed to indicate variation in the actual form of psychoses which could be attributed to distinct cultural backgrounds. The ease with which the Rorschach, and other projective techniques, could be administered even to nonliterate peoples, and the objective criterion of “blind analyses” by psychologists who did not know the informant, opened the way for on-the-spot ethnologists to gather reasonably unbiased personality data. It is no wonder that psychologists, interpreting such materials with scoring systems which were not even well-established in our culture, found these to fall short of adequate quantitative establishment of norms elsewhere and were consequently guided by intelligent use of the raw materials and by general principles governing the use of the total instrument.
The underlying Rorschach principles, or assumptions, that the individual had no way of knowing what was expected in terms of performance and therefore characteristically responded in the way in which he handled every life situation seemed true enough if one further assumed inherent grouping principles in the perception of form, as promulgated by Gestalt psychology, and secondly, recognized the possibility of cross-cultural differences and comparisons. Indeed, Hallowell showed that certain responses were popularly given despite strongly divergent cultural backgrounds.4 On the other hand, Laura Thompson, in a study of three different Hopi communities with variance in economic security and social organization, demonstrated through projective material the importance of cultural background and varying social organization in the personalities of members of each group.5 Hallowell, even earlier, found significant Rorschach differences among acculturated and unacculturated Salteaux.6
The techniques of separate or blind analyses, initiated by the anthropologist, Cora DuBois, and Oberholzer in DuBois’ The People of Alor, were continued with inclusion of the Thematic Apperception Test by the anthropologist Thomas Gladwin and the clinical psychologist, Seymour B. Sarason, in their joint work, Truk; Man in Paradise.7 In such blind interpretations, there is remarkable similarity in interpretations given by ethnologists and clinicians, as where, in the last example, Sarason was able to draw conclusions, similar to Gladwin, about the concentration of Trukese on rigid suppression of feelings and impulses, and on the development of conformance and concreteness of thinking in these subjects. Actually, the anthropological data on the all-important lineage relationships proved to be of crucial significance in explaining the development of conforming, inhibited, suppressing personalities. On the other hand, the psychological data revealed a dominance of women and forced an ethnological re-examination of the material wherein, though seemingly more submissive, they did indeed occupy the truly pivotal position in social organization because of their primary role in the handling of food allocations. With these basic orientations in mind, purely descriptive data including male and female sexual conduct, family organization and even child-rearing practices fall in line. Equally, records examined by Oberholzer, and revealing kinds of reaction typical of patients suffering brain injury in our culture, were adequately understandable only when cultural themes and organization were explicit. In the Trukese study, an important sexual problem of women was missed in Rorschach interpretations of the psychologist by merely not knowing the female sexual symbol.
Jules Henry has pointed out that the use of rare detail in Rorschachs of a jungle people of South America is a function of their need to observe their surroundings in order to survive. Similarly, Cook’s finding of “overuse” of space-responses in Samoa reflected simply the special cultural value attached to the color white. The point is clear that in two sciences related to social psychiatry, in cultural anthropology and clinical psychology, there is increasing awareness that in order to understand both culture and personality adequately, one must ascertain how the personality of the members of a given society finds expression within a social and cultural framework. Three-dimensional social psychiatry, involving the techniques of social science and psychology, would likewise require as a necessary parameter of scientific observation the notion of a sociocultural frame of reference for normative and aberrant; for gauging the intensities of affect; the types and degrees of human expressivity in different cultures; the choice of cultural symbols used in human communication; or in short, the varying cognitive, perceptual and attitudinal interpretations of any cultural human being.
Awareness of these generalized, or cultural, symbolic functions in individual psychodynamics is not limited to psychology. The fact that human communication and expression is based on symbols to which meanings are assigned was discovered, so to speak, independently in psychiatry once the notion of an inevitable course of illness and rigid diagnostic categories, as in the classical descriptive work of Kraepelin, gave way to a more dynamic view of variables in typology, illness progression, and environmental influences as in the work of Adolf Meyer. With the gradual death of the notion of a “unit psychosis,” the ideological importance of longitudinal case history grew, relying at first on relating the organic and metabolic functioning to unique symbolic functioning of personality. Gradually, the hospital as a therapeutic milieu, “push therapy,” the phenomena of transference and countertransference, and explorations into symbolic content and dynamics came into purview. The movement was from hospitalized to ambulatory treatment where possible; from custodial care and descriptive analysis to devices aimed at gradual socialization and improved environment; from cross-sectional symptomatology to assessment of the longitudinal course of illness; and from random exploration and probing to carefully guided support and re-education.
Increasingly the psychosocial position required a knowledge of the cultural setting and background of each patient to the end that his world of meanings and experiences be assessed in therapy, and his organic and symbolic functioning understood in terms of the contexts or milieus of family, community, social and sub-cultural groups in which he had played a role. Independently, in the social sciences, the areas of social action and interactive process were explored in social systems and social roles. The social statuses and their functions in the social structure, and the manner in which that structure was systematized were all important ingredients in defining an individual’s relationships to his fellows, and his activities, to be sure, in relation to theirs. Nevertheless, the anatomy and physiology of a social system and its functioning related ultimately to a further system of meanings, at once cultural and personal in essence. This was to say that roles were, by and large, culturally defined; that social structures varied with cultural backgrounds and identities, and that whole social systems were built on foundations supplied by what Kluckhohn called implicit (Sapir’s “unconsciously patterned”) and explicit (consciously followed) cultural symbols.
In the work of Adolf Meyer, the challenge to an oversimplified and rigid typology and labeling process was to construct new typologies having greater range and also greater reference to the variability of process in the adaptation, or maladaptation, to environment. In therapy, too, one of his contributions was to point to possibilities of adaptation to a milieu, or to point up positive relationships which a patient was in a position to utilize. In the same intellectual period, John Dewey in philosophy was noting that a social existence was a necessary condition for the development of normative mentation processes in any individual. Physical anthropologists like Boas were pointing out the mutational plasticity of humans under environmental changes ; social biologists like Hogben were documenting environmental effects in the statistical incidence of mental deficiency; and H. S. Jennings was initiating the studies of human behavior and genetics which have led ultimately to our present knowledge that of the more than five hundred single gene substitutions for which there is good evidence, only a minor few determine behavioral resultants. The psychoanalytic movement, least “organicist” of all, was at the same time enjoying a growth of popularity in the United States while giving rise to sharply varying systems like those of Horney, of Roheim, of Rado, Kardiner and Ferenczi, which like Sullivan’s were directly influenced by anthropologists such as Sapir and Linton, Kluckhohn, Benedict and Mead.
In none of this transfer of interest to total life span, to situational context or milieu, to relationships within a social system, and to cultural background, were the sacred precincts of any one science inviolable. Multidisciplinary research recognized that the pathology of a society reflects its general conditions, and conversely offered important clues to an understanding of the culture. Galen’s ancient phrase, “Man is a whole with his environment,” found epidemiological confirmation not in the least from carefully designed public health inquiries in which the epidemiology (how much illness in time periods of incidence) soon came to mean how much illness emerged in relation to age, sex, and finally social and cultural strata. Why these problems of incidence and prevalence mean very little for certain kinds of illness such as mental disorder, unless at the same time etiological problems of the same illness groups are attacked, is a matter which will be discussed below. Suffice it to say the scenes were set for interest in the how and why of mental illness by a study of the incidence or occurrences of different psychopathological states in persons of specific socio-cultural background.
Psychiatry, par excellence, is a science which specializes in a knowledge of the way human experience is utilized in the total economy of personality; psychiatrists soon realized that as a generalizing behavioral science it must press beyond individual case formulations to psychosocial typologies. Indeed, J. L. Halliday in his Psychosocial Medicine8 defines illness in general as “a reaction, or mode of behavior, or vital expression of a living unit in response to those forces which he encounters as he moves and grows in time.” Etiology of mental illness is studied in terms of dual, relational causes which lie both in the nature of the individual and in the nature of his environment, but in both at the same time. While a culture is, at any point in time, more massive and imposing than any individual participant and must be distinguished from the individual, the great danger in multidisciplinary research involving relational causal systems, is to so abstract the individual from his meaningful cultural background that he ceases to be a responsive or live subject for diagnosis, case formulation or psychotherapy. There are are simply no individuals apart from specific socio-cultural background.
By culture we then mean an imposing and conditioning variable which always becomes internalized, in one way or another, in the psychic systems of human beings. Far from being a mere matter of the artifacts and social organization of a people, culture also contains their range of expressive symbolism, whether in art, language, dance or song, or in the non-verbal communication patterns involved in gestures, interpersonal emotional contacts, and the rules governing relationships of age groups and of sexes. It:9
“consists of patterns, explicit and implicit, of and for behavior acquired and transmitted by symbols, constituting the distinctive achievement of human groups, including their embodiments in artifacts; the essential core of culture consists of traditional (i.e., historically derived and selected) ideas and especially their attached values; culture systems may, on the one hand, be considered as products of action, on the other as conditioning elements of further action.”
More specifically, it includes the patterned family and social influences, the means of symbolic communication forged into a way of life, affirmed and reaffirmed in the common currency of custom, and most importantly, always having a significant discernible meaning and value for the individual.
That these traditional ideas, or themes of culture influencing patterns of behavior; the prevailing ethics, the child-rearing practices, the notions of social integration, the taboos, religious values, and attitudes toward health and illness; that these leitmotifs of a culture were precipitates of history or could influence history was probably not the main fact about them. Surely the dynamic interplay of factors within culture influenced history. But equally important, at least for behavioral science, was the manner in which these elements in a way of life became incorporated in individual functioning, how much or to what extent ego involvements became dependent on them, and why they had much to do, positively or negatively, with superego functioning.
The tendency, in the Freudian view, to equate culture and super-ego, as in Totem and Taboo, was a need...
