Am
J Psychiatry The
136:3,
conclusion
March
that
1979
the authors
LETTERS
have
reviewed
stand
prominent
concepts and findings is an understatement. They did not mention Jaspers’ General Psychopathology (6), which contains a section on ‘ ‘The Abnormal Psyche in Society and History.” This section provides a glimpse ofthe relevant literature as well as indicating ways of making it important to
the clinical
psychiatrist.
The
strangest
feature
of their
over-
view is that only the English literature-actually, only the American one-was quoted and even this was done onesidedly. Could the authors not open their (and our) horizon a bit wider?
by
our
assertion
that
the
TO
study
THE
EDITOR
of culture,
in com-
parison with the study of psychology or of the neurosciences, has not been fully established as a cornerstone of psychiatry. Dr. Pivnicki states that he learned little from our article. He is certainly to be congratulated heartily on his fund ofcultural knowledge. We wish that allfournal readers were as well-read as he because it certainly would advance the sophistication of work in cultural psychiatry.
R.
ARMANDO
M.D.,
FAVAZZA, MARY
M.P.H.
M.A.
OMAN,
Columbia,
Mo.
REFERENCES
I. Lewis A: The State ofPsychiatry. London, Routledge & Kegan Paul, 1967 2. Williams R: Keywords, a Vocabulary of Culture and Society. New York, Oxford University Press, 1976 3. Kraepelin E: Comparative psychiatry (1904), in Themes and Variations in European Psychiatry. Charlottesville, Va, University
of Virginia,
Press
1974
4. Freud 5: Totem and taboo (1913), in Complete Psychological Works, vol 13. Translated and edited by Strachey J. London, Hogarth Press, 1957 5. Jung CG: Symbols of transformation, in Collected Works, 2nd ed, vol 5. Bollingen Series 20. Princeton, NJ, Princeton University Press, 1967 6. Jaspers K: General Psychopathology. Translated by Hoenig J, Hamilton MW. Chicago, University of Chicago Press, 1963
The Military SIR: Certainly
small
Family:
Who
Nietzsche noted that a published study
undefined
military
PIvNICKI,
Montreal,
Que.,
Canada
to any
particular
The
Dr. Favazza and Ms. Oman SIR:
Reply
one
In our
because
for an overview
article.
We did not discuss
ily and social
networks,
sex roles
and behavior,
alcohol
use,
Dr.
Pivnicki
frain
from
psychologists,
plicated. ogists
have
us further
have
developed
sociologists, useful
to reject this by psychiatrists.
reviewing
with
the continuity
of psy-
not reach out to anthropology or socioloof reasoning psychiatrists should also relearning from biochemists , neurophysiologists, etc. The study ofculture is complex and corn-
If anthropologists,
seems unwise not produced After books
would and line
over
anthropological
methods
knowledge
3,600
mental
or
and social for studying
just health
cross-cultural
psycholculture,
because articles
themes,
it
it was and
we
in the midwest
the author
to the to-
families
that the individual
person-
by the group as a whole, of all the characteristics
of a syndrome
as a ‘ ‘ set attempted.
and no imputed
of symptoms There is an
as in some
way
in its simplest which attempt
operational
occur together’ ‘ is to impugn all mili-
pathological
by
designating
them as a syndrome. The idea that military psychotherapists should not treat disturbed military families and their children because they themselves are in the military is absurd and speaks to a peculiar belief system and environmentalism which holds that people in the military are less human than others.
Relevant
communication, and therapy are not basic psychiatric concepts because they do not fit in with his definition of psychiatry. Of course, we are all entitled to define psychiatry as we see fit, but our critic’s definition would appear to be exceptionally narrow. chiatric work gy. With this
tary
Kraepelin’s
Javanese data because we were not writing a historical artide. As for the charge that we built a petio principii into the article, we can only deny it. Res ipsa loquitor. We stated in our paper that we would deal with ‘ ‘ concepts basic to psychiatry. “ Dr. Pivnicki seems to feel that our choice ofchild rearing and basic personality, cognition, fam-
a bias. from a
group?
delineation
definition not even
article, we included only English language refJournal editorial policy limits the number of references that may be cited. We chose what we felt to be salient references which would be available to most Journal readers. A number of our references are to books and artides that do provide an entr#{233}einto the foreign language literature. We think our approach in this matter was the proper
erences
Scapegoated?
every word represents of opinion generalized
population
ality is never determined individual is representative
M.D.
Been
tal military community, done without serious consideration of statistical tests of validity, reliability , and standardization, represents a subjective bias. My own experience and the relevant literature on the military family (1-3) fail to confirm the ideas presented by Don M. LaGrone, M.D. , in ‘ ‘The Militaly Family Syndrome’ ‘ (September 1978 issue). Such caricaturization represents the error of extreme views. The author stresses the inadequacy of intrapsychic models and professes an environmentalism that is startling in its simplicity.
Do we need to remind DIMITRIJE
Has
stands
published
in contrast
research to the
on
author’s
the views
military was
family ignored
that (1,
2).
There is some indication that psychopathology in the military child tends 1) to run more toward ego restrictiveness and inhibitions than impulse-ridden behavior and 2) to be less frequent than that in civilian children (2, 3). The author states times
that the incidence the national rate.
of child abuse in the military is five This might be interpreted as a testi-
monial
to good
case
finding,
cedures
rather
than
a negative
Ft. Lewis,
Wash.
and San Antonio, (4, 5). The San Antonio was 20% of the area’s
his data families
author
did
not
abuse
consider
by the high incidence in his sample. What
care,
and reporting
indicator.
,
site finding the military for only 1 1% of all child
The
medical
Recent suggest
pro-
studies
at
Tex. the oppostudy found that while population, it accounted ,
cases
(4,
the
possible
5).
confounding
of noncommissioned he designated as the
of
officers’ child-rear-
ing techniques of the military family are probably a function more of socioeconomic level than of the specific nature of the military milieu, ifwe regard it in the light ofKohn’s classic
study
(6).
There is little substantiating evidence that scapegoating is more common in military families. The vague notion of a coalition between fathers and the military, with dependents 351
LETTERS
TO
THE
Am
EDITOR
excluded as the third part of the triangle, runs counter to all we know of family relations. Certainly, the lower divorce rate in the military community would point to greater family stability. The military commitment to child care is represented in AR 600-48, which requires that every military installation of more than 2,000 dependents establish a child advocacy program all programs this. In that
has
for the purpose and services for sense, the military
attempted
1970
to implement
report
of the
Children.
Joint
and
the
the
inherent
Commission
philosophy
military
on the
of the
Health of is an issue in this paper, it is the family that have been scapegoated.
If scapegoating
military
of monitoring and coordinating children: Dr. LaGrone ignored is the only community which Mental
into
practice
tests
and
how
of validity,
effective
reliability,
5, Robinson
JA,
Fiman
BC:
Drug
use:
in the Mili1976 J Am Acad
JON
demography
and
A.
SHAW,
Washington,
DON
Psychotherapy
M.D. D.C.
penienced their
by
Replies
and
work
rience
that
crises. SIR:
Dr.
Shaw
refers
to Nietzsche’s
thoughts
on
then betrays his own. His long list of complaints objection not just to what was said but to the fact said at all. simplistic.
He seems I would
least as restrictive ther-or stand with I simply suggested therapist
in his
There
was
The
understanding
idea
itary families is not absurd,
would Dr. him
I was tary
the
an interactional an intrapsychic
of military
to assign
feel
that
there
pathologic that military
because
they
and
reveals an that it was model model
is too is at
and I believe
military
still
in the military, Syndrome.
are
to all military
conditions
members
of the
the literature ‘ ‘
definition
Family
families.
pathology
relevant’ of the
‘
mili-
After
eight
same
on family
process
‘
attempts
‘ ‘
to
have
it
cleared through “channels,’ I was finally told that it would not be cleared because it would hurt the recruiting program. It was only after I left the military that I was able to send it to the Journal. Just how valid is military research ‘
‘ ‘
when
352
or Failure:
many the
and family
obligations.
more
more
and
yet,
their
or to ascertain
immature
work.
and
In the case
represses
as
are
the To to
that have
Consid-
make
women,
been
and ex-
career in
my expe-
career-related
source
be sure, help some
some
,
conflicts
involvement
facing
best
Tex.
M.D.
they
of help
for
a short series of of them regain
are actually
unrealistic
of married
psycho-
expectations
spouses
of
should
also
participate in the consultation. Prescribing psychotherapy carries the implication that a person is sick or has failed in some way because of her own conflicts. Actually, many ofthese women’s problems are the result of their attempts to cope with adverse circumstances in a culture that is still highly ambivalent about women’s success.
Many
women
have
not internalized
we realize. political ing the
More
women’s Like
who
research
biases, mistakes
cultural
values
that
as-
in this area,
“unofficial”
from
cultural
and
roles. the
are one
authors,
torn may
I see
between need
many
part of a committed and the realization to their
single
pursuing not
they do not marry and choice between satisfying
handicap
free
is urgently needed if we are to avoid repeatof the recent past in terms of men’s and
it is derived
that
M.D. ,
Conflicts?
It has also
that
is psychotherapy. may be needed
balance
LAGRONE, Beaumont
a serious
women
however,
these women consultations logically
today
between
which
a system
‘statistical
Better
Psychotherapeutic
women
choice
I doubt,
M.
in Conflict” Carol Nadelson, 1978 issue) discussed the
and having a family. My view are no longer concerned about
from
‘ ‘ ‘
for Women’s
‘ ‘
of view? Dr. Shaw implies that because there is a regulation (AR 600-48) for a commitment to child advocacy, this cornmitment actually exists. There is a difference. Perhaps Dr. Shaw would like to outline for us what actually has been put points
using
sume that they, too, must achieve in the work world to realize their potential. This is further complicated by the fact that we know much less about female-male differences than
system
literature. I would ask ‘relevant. While to publish “The Mili-
word
I attempted ‘ ‘
in the
relationships might naturally therapists should not treat milare
support my point. Shaw refers to the
for
that that
bias
and simplistic. I did not advocate an eithe use of theoretical models in my paper; that a systems model might assist the
no attempt
families, but I do tary from which
evolve.
to feel suggest
or Consultation
SIR: In ‘ ‘Success erations for Women associates (September choices
LaGrone
been,
and standardization.
1979
I. Bloom W: The Chap Clinic revisited. Presented at the 16th Annual Conference of Air Force Behavioral Scientists. Brook’s Air Force Base, Tex, January 1969 2. White JH: Analysis of first year referrals to military child psychiatry clinic. US Navy Med 67: 18-2 1 , 1976
attitudes in a junior and senior high school population. Journal of Drug Education 4:179-185, 1974 4. Schnall S: Child abuse and neglect in the military community. Presented at the Military Family Research Conference, San Diego, Calif. Sept 1-3, 1977 5. Lanier D: A new look at child abuse and neglect in the military family. Ibid 6. Kohn M: Social class and parent-child relationships: an interpretation. American Journal of Sociology 68:471-480, 1963
Dr.
it has
March
REFERENCES
1. McCubbin HS, DahI BB, Hunter EJ (eds): Families tary System. Beverly Hills, Calif. Sage Publications, 2. Kenny JA: The child in the military community. Child Psychiatry 6:51-63, 1967 Frenkel
136:3,
perhaps the military would do well to allow a neutral body of investigators to look at its mental health problems and to publish its report without repression. Finally, there have been other studies that have reached conclusions similar to mine. Bloom’s study was mentioned in my paper (I). Incidentally, his population was similar to the one in San Antonio that Dr. Shaw mentioned. White (2) studied a military population in Portsmouth, Va. , and found that 59% ofhis patients were diagnosed as having a behavior disorder. The family dynamics he described were similar to those in my sample.
REFERENCES
3.
J Psychiatry
only
women
time
but
is that feeling
advancement.
30
career-for
geographic
mobility-
most of these women deviant or different if
have a family. Rather, their deep emotional
marital relationship that family obligations career
approaching
a successful
they needs
face a to be
and to have children may pose a serious This
dilemma
was
il-
J Psychiatry The
136:3,
conclusion
March
that
1979
the authors
LETTERS
have
reviewed
stand
prominent
concepts and findings is an understatement. They did not mention Jaspers’ General Psychopathology (6), which contains a section on ‘ ‘The Abnormal Psyche in Society and History.” This section provides a glimpse ofthe relevant literature as well as indicating ways of making it important to
the clinical
psychiatrist.
The
strangest
feature
of their
over-
view is that only the English literature-actually, only the American one-was quoted and even this was done onesidedly. Could the authors not open their (and our) horizon a bit wider?
by
our
assertion
that
the
TO
study
THE
EDITOR
of culture,
in com-
parison with the study of psychology or of the neurosciences, has not been fully established as a cornerstone of psychiatry. Dr. Pivnicki states that he learned little from our article. He is certainly to be congratulated heartily on his fund ofcultural knowledge. We wish that allfournal readers were as well-read as he because it certainly would advance the sophistication of work in cultural psychiatry.
R.
ARMANDO
M.D.,
FAVAZZA, MARY
M.P.H.
M.A.
OMAN,
Columbia,
Mo.
REFERENCES
I. Lewis A: The State ofPsychiatry. London, Routledge & Kegan Paul, 1967 2. Williams R: Keywords, a Vocabulary of Culture and Society. New York, Oxford University Press, 1976 3. Kraepelin E: Comparative psychiatry (1904), in Themes and Variations in European Psychiatry. Charlottesville, Va, University
of Virginia,
Press
1974
4. Freud 5: Totem and taboo (1913), in Complete Psychological Works, vol 13. Translated and edited by Strachey J. London, Hogarth Press, 1957 5. Jung CG: Symbols of transformation, in Collected Works, 2nd ed, vol 5. Bollingen Series 20. Princeton, NJ, Princeton University Press, 1967 6. Jaspers K: General Psychopathology. Translated by Hoenig J, Hamilton MW. Chicago, University of Chicago Press, 1963
The Military SIR: Certainly
small
Family:
Who
Nietzsche noted that a published study
undefined
military
PIvNICKI,
Montreal,
Que.,
Canada
to any
particular
The
Dr. Favazza and Ms. Oman SIR:
Reply
one
In our
because
for an overview
article.
We did not discuss
ily and social
networks,
sex roles
and behavior,
alcohol
use,
Dr.
Pivnicki
frain
from
psychologists,
plicated. ogists
have
us further
have
developed
sociologists, useful
to reject this by psychiatrists.
reviewing
with
the continuity
of psy-
not reach out to anthropology or socioloof reasoning psychiatrists should also relearning from biochemists , neurophysiologists, etc. The study ofculture is complex and corn-
If anthropologists,
seems unwise not produced After books
would and line
over
anthropological
methods
knowledge
3,600
mental
or
and social for studying
just health
cross-cultural
psycholculture,
because articles
themes,
it
it was and
we
in the midwest
the author
to the to-
families
that the individual
person-
by the group as a whole, of all the characteristics
of a syndrome
as a ‘ ‘ set attempted.
and no imputed
of symptoms There is an
as in some
way
in its simplest which attempt
operational
occur together’ ‘ is to impugn all mili-
pathological
by
designating
them as a syndrome. The idea that military psychotherapists should not treat disturbed military families and their children because they themselves are in the military is absurd and speaks to a peculiar belief system and environmentalism which holds that people in the military are less human than others.
Relevant
communication, and therapy are not basic psychiatric concepts because they do not fit in with his definition of psychiatry. Of course, we are all entitled to define psychiatry as we see fit, but our critic’s definition would appear to be exceptionally narrow. chiatric work gy. With this
tary
Kraepelin’s
Javanese data because we were not writing a historical artide. As for the charge that we built a petio principii into the article, we can only deny it. Res ipsa loquitor. We stated in our paper that we would deal with ‘ ‘ concepts basic to psychiatry. “ Dr. Pivnicki seems to feel that our choice ofchild rearing and basic personality, cognition, fam-
a bias. from a
group?
delineation
definition not even
article, we included only English language refJournal editorial policy limits the number of references that may be cited. We chose what we felt to be salient references which would be available to most Journal readers. A number of our references are to books and artides that do provide an entr#{233}einto the foreign language literature. We think our approach in this matter was the proper
erences
Scapegoated?
every word represents of opinion generalized
population
ality is never determined individual is representative
M.D.
Been
tal military community, done without serious consideration of statistical tests of validity, reliability , and standardization, represents a subjective bias. My own experience and the relevant literature on the military family (1-3) fail to confirm the ideas presented by Don M. LaGrone, M.D. , in ‘ ‘The Militaly Family Syndrome’ ‘ (September 1978 issue). Such caricaturization represents the error of extreme views. The author stresses the inadequacy of intrapsychic models and professes an environmentalism that is startling in its simplicity.
Do we need to remind DIMITRIJE
Has
stands
published
in contrast
research to the
on
author’s
the views
military was
family ignored
that (1,
2).
There is some indication that psychopathology in the military child tends 1) to run more toward ego restrictiveness and inhibitions than impulse-ridden behavior and 2) to be less frequent than that in civilian children (2, 3). The author states times
that the incidence the national rate.
of child abuse in the military is five This might be interpreted as a testi-
monial
to good
case
finding,
cedures
rather
than
a negative
Ft. Lewis,
Wash.
and San Antonio, (4, 5). The San Antonio was 20% of the area’s
his data families
author
did
not
abuse
consider
by the high incidence in his sample. What
care,
and reporting
indicator.
,
site finding the military for only 1 1% of all child
The
medical
Recent suggest
pro-
studies
at
Tex. the oppostudy found that while population, it accounted ,
cases
(4,
the
possible
5).
confounding
of noncommissioned he designated as the
of
officers’ child-rear-
ing techniques of the military family are probably a function more of socioeconomic level than of the specific nature of the military milieu, ifwe regard it in the light ofKohn’s classic
study
(6).
There is little substantiating evidence that scapegoating is more common in military families. The vague notion of a coalition between fathers and the military, with dependents 351
LETTERS
TO
THE
Am
EDITOR
excluded as the third part of the triangle, runs counter to all we know of family relations. Certainly, the lower divorce rate in the military community would point to greater family stability. The military commitment to child care is represented in AR 600-48, which requires that every military installation of more than 2,000 dependents establish a child advocacy program all programs this. In that
has
for the purpose and services for sense, the military
attempted
1970
to implement
report
of the
Children.
Joint
and
the
the
inherent
Commission
philosophy
military
on the
of the
Health of is an issue in this paper, it is the family that have been scapegoated.
If scapegoating
military
of monitoring and coordinating children: Dr. LaGrone ignored is the only community which Mental
into
practice
tests
and
how
of validity,
effective
reliability,
5, Robinson
JA,
Fiman
BC:
Drug
use:
in the Mili1976 J Am Acad
JON
demography
and
A.
SHAW,
Washington,
DON
Psychotherapy
M.D. D.C.
penienced their
by
Replies
and
work
rience
that
crises. SIR:
Dr.
Shaw
refers
to Nietzsche’s
thoughts
on
then betrays his own. His long list of complaints objection not just to what was said but to the fact said at all. simplistic.
He seems I would
least as restrictive ther-or stand with I simply suggested therapist
in his
There
was
The
understanding
idea
itary families is not absurd,
would Dr. him
I was tary
the
an interactional an intrapsychic
of military
to assign
feel
that
there
pathologic that military
because
they
and
reveals an that it was model model
is too is at
and I believe
military
still
in the military, Syndrome.
are
to all military
conditions
members
of the
the literature ‘ ‘
definition
Family
families.
pathology
relevant’ of the
‘
mili-
After
eight
same
on family
process
‘
attempts
‘ ‘
to
have
it
cleared through “channels,’ I was finally told that it would not be cleared because it would hurt the recruiting program. It was only after I left the military that I was able to send it to the Journal. Just how valid is military research ‘
‘ ‘
when
352
or Failure:
many the
and family
obligations.
more
more
and
yet,
their
or to ascertain
immature
work.
and
In the case
represses
as
are
the To to
that have
Consid-
make
women,
been
and ex-
career in
my expe-
career-related
source
be sure, help some
some
,
conflicts
involvement
facing
best
Tex.
M.D.
they
of help
for
a short series of of them regain
are actually
unrealistic
of married
psycho-
expectations
spouses
of
should
also
participate in the consultation. Prescribing psychotherapy carries the implication that a person is sick or has failed in some way because of her own conflicts. Actually, many ofthese women’s problems are the result of their attempts to cope with adverse circumstances in a culture that is still highly ambivalent about women’s success.
Many
women
have
not internalized
we realize. political ing the
More
women’s Like
who
research
biases, mistakes
cultural
values
that
as-
in this area,
“unofficial”
from
cultural
and
roles. the
are one
authors,
torn may
I see
between need
many
part of a committed and the realization to their
single
pursuing not
they do not marry and choice between satisfying
handicap
free
is urgently needed if we are to avoid repeatof the recent past in terms of men’s and
it is derived
that
M.D. ,
Conflicts?
It has also
that
is psychotherapy. may be needed
balance
LAGRONE, Beaumont
a serious
women
however,
these women consultations logically
today
between
which
a system
‘statistical
Better
Psychotherapeutic
women
choice
I doubt,
M.
in Conflict” Carol Nadelson, 1978 issue) discussed the
and having a family. My view are no longer concerned about
from
‘ ‘ ‘
for Women’s
‘ ‘
of view? Dr. Shaw implies that because there is a regulation (AR 600-48) for a commitment to child advocacy, this cornmitment actually exists. There is a difference. Perhaps Dr. Shaw would like to outline for us what actually has been put points
using
sume that they, too, must achieve in the work world to realize their potential. This is further complicated by the fact that we know much less about female-male differences than
system
literature. I would ask ‘relevant. While to publish “The Mili-
word
I attempted ‘ ‘
in the
relationships might naturally therapists should not treat milare
support my point. Shaw refers to the
for
that that
bias
and simplistic. I did not advocate an eithe use of theoretical models in my paper; that a systems model might assist the
no attempt
families, but I do tary from which
evolve.
to feel suggest
or Consultation
SIR: In ‘ ‘Success erations for Women associates (September choices
LaGrone
been,
and standardization.
1979
I. Bloom W: The Chap Clinic revisited. Presented at the 16th Annual Conference of Air Force Behavioral Scientists. Brook’s Air Force Base, Tex, January 1969 2. White JH: Analysis of first year referrals to military child psychiatry clinic. US Navy Med 67: 18-2 1 , 1976
attitudes in a junior and senior high school population. Journal of Drug Education 4:179-185, 1974 4. Schnall S: Child abuse and neglect in the military community. Presented at the Military Family Research Conference, San Diego, Calif. Sept 1-3, 1977 5. Lanier D: A new look at child abuse and neglect in the military family. Ibid 6. Kohn M: Social class and parent-child relationships: an interpretation. American Journal of Sociology 68:471-480, 1963
Dr.
it has
March
REFERENCES
1. McCubbin HS, DahI BB, Hunter EJ (eds): Families tary System. Beverly Hills, Calif. Sage Publications, 2. Kenny JA: The child in the military community. Child Psychiatry 6:51-63, 1967 Frenkel
136:3,
perhaps the military would do well to allow a neutral body of investigators to look at its mental health problems and to publish its report without repression. Finally, there have been other studies that have reached conclusions similar to mine. Bloom’s study was mentioned in my paper (I). Incidentally, his population was similar to the one in San Antonio that Dr. Shaw mentioned. White (2) studied a military population in Portsmouth, Va. , and found that 59% ofhis patients were diagnosed as having a behavior disorder. The family dynamics he described were similar to those in my sample.
REFERENCES
3.
J Psychiatry
only
women
time
but
is that feeling
advancement.
30
career-for
geographic
mobility-
most of these women deviant or different if
have a family. Rather, their deep emotional
marital relationship that family obligations career
approaching
a successful
they needs
face a to be
and to have children may pose a serious This
dilemma
was
il-
