David A. Rochefort

Nationalism Versus Ethnic Identity in Sub-Saharan Africa

Part and parcel of the conventional wisdom about rural publics in Africa is that populations on the periphery will accord ethnic solidarity greater significance than national consciousness. A survey of neighboring Hausa villages on different sides of the Niger-Nigeria boundary counters this myth. Probing issues of self-identity and ethnic affinity, we found that most Hausa villagers on the frontier did not place their Hausan ethnic identity above their national one as citizens of Nigeria or Niger and expressed greater affinity for non-Hausa cocitizens than for foreign Hausas. However, expressed attachments to ethnic, national, and other social identifications (such as religion) varied according to village : citizenship does make a difference in the political consciousness of villagers on the geographic margins of the state. More survey research in other transborder regions should shed further light on processes of state penetration and national integration in developing countries

The Lessons of "Lesson Drawing": How the Obama Administration Attempted to Learn from Failure of the Clinton Health Plan

In late 2010, as President Obama was bracing himself for the electoral backlash that loomed like a gathering storm among Americans unhappy with the passage of health-care reform and otherwise discomfited by the state of national aff airs, one source of consolation could be found in the thoughts of Tom Daschle, former Senate Majority Leader from South Dakota. In his book detailing the events leading up to the Democrats’ legislative breakthrough, Daschle recounted that as Lyndon Johnson signed the Civil Rights Act of 1964, he reportedly stated: “We have lost the South for a generation.” 1 With a little historical perspective, then, the Obama administration’s current plight seemed neither unique nor necessarily calamitous over the long term. Daschle’s observation was not only perspicacious but also extremely apt in that a sense of historical awareness had suff used the administration’s health-reform effort from the outset. Throughout the months when the Obama team had developed an overhaul proposal and then fought for its adoption, avoiding damaging mistakes of the past approached the level of obsession. Th e push for health-care reform at times resembled nothing so much as an advanced policy seminar in which a bevy of experts, reform advocates, and other political commentators—from inside and outside

Reimagining the Cuckoo’s Nest

One Flew Over the Cuckoos Nest (1962) by Ken Kesey and The Devil in Silver (2012) by Victor LaValle are two novels that focus on mental hospitalization as a medical and social practice. Published fifty years apart, however, the books possess important differences in setting, method, and message reflecting the times that spawned them. The purpose of this paper is to examine the changing documentary and metaphorical uses of the asylum novel by comparing an iconic work in the genre with a respectful, but divergent, successor. What emerges from this comparison is an appreciation of the literary conventions shared by Kesey and LaValle but also the ingredients that separate their work. Whereas Kesey produced an enduring tribute to the virtue of nonconformity, LaValles social criticism expresses itself as a disturbing portrayal of class-based disparities and administrative dysfunction inside the contemporary American mental health system.

The Affordable Care Act and the Faltering Revolution in Behavioral Health Care

Often described in such terms as a “revolution” and a “game-changer” for the behavioral health sector in the United States, the Affordable Care Act has helped to enhance coverage for mental health and substance use disorders while encouraging service system innovations at the organizational level. However, tens of millions of Americans still lack health insurance, insurance companies are resisting the implementation of parity coverage rules, and inequalities in the financing and organization of care continue to worsen in key respects. This article examines these difficulties and their political-economic nature, highlighting the need for a single-payer framework if the task of reform is to be fulfilled.

Book ReviewsComparative Mental Health Policy: From Institutional to Community Care. By Simon Goodwin. London: Sage Publications, 1997. Pp. 183.

The timing of this book’s publication was excellent—it appeared during a major reform in the operation and aims of public assistance, including substantial changes in the levels of benefits and work requirements for food stamps, which is our major program for ameliorating hunger. That reform also reflects much of the underlying political discourse that has shaped the food stamp program, other nutritional assistance programs, and the nature of major nongovernmental antihunger efforts and advocacy movements. The author provides the most comprehensive treatment of evolving governmental and nongovernmental food assistance programs to date. The politics of that evolution and its implementation’s twists and turns result from the same types of social trends, recession cycle, and federal budgetary conflicts that led to the current welfare reform. Thus, Eisinger has provided an essential source for developing a deep understanding of the history and nature of the U.S. debate and policy-making outcomes that shape our current public assistance programs and their long-term goals. His book will serve as a superb text for upper-level courses in appropriate fields, and as an outstanding example of effective policy analysis for training graduate students. It also demands reading from leaders in government and private charitable organizations, so they can develop improved food assistance strategies. Like most Brookings publications, the tale here is told from the perspective of those who believe that government must make a large contribution to the essential economic support of the disadvantaged, subject to the very real budgetary constraints of political feasibility and the need to avoid creating undesirable behavioral patterns among recipients. Its analysis explains how we came to strike a certain balance in various kinds of efforts to end hunger without abrogating personal responsibility too much. The book’s historical segments emphasize both the importance of a few key political leaders who are now justly famous for their persistence and accomplishments and the less well-known but critical efforts of a handful of cooperating advocacy groups that developed an effective division of labor (or, as the author says, a ‘‘niche strategy’’). The scope of the book exceeds any prior effort with respect to the analysis and history of the entire range of food assistance programs, both public and private. And the relish with which the author approaches this material clearly demonstrates that he sees this effort as one that is needed and sorely lacking. He relies heavily on extensive materials from all kinds of sources and lavishly uses the works

69.95 (cloth);

I was a few days late completing this review, as the book editor can attest. Yet I did not labor under an unreasonable deadline. Nor did the book languish upon myshelf unopened until a last minute sense of professional obligation stirred. The difficulty, rather, was that I had a hard time keeping the book in my hands long enough to read it through.