John G. Kennedy

A medical evaluation of the use of qat in North Yemen

The data presented in this paper examine the frequent statements that the regular use of the drug qat by the people of North Yemen is harmful to their health. The research strategy employed performance of blind physical examinations as well as extensive interviews with 335 females and 371 males in and around the cities of Sanaa, Taiz and Hodeida who had been selected using a quota sample. The sample was classified into heavy, light and non-chewers of the qat plant, and systematic comparisons were made. In general, few diseases or conditions occurred with enough frequency to permit detailed analysis and fewer yet were associated with qat-use. Where associations occurred, differences by sex were often strong. Conditions most strongly associated with use by both sexes were histories of gastritis and insomnia, and the general body system groupings of gastrointestinal disorders. In males the strongest associations were with the histories of anorexia, constipation, insomnia and headaches, as well as the general history of respiratory difficulties. In females strong associations were seen between qat-use and the diagnosis of acute gastritis, and histories of jaundice, bronchitis and hepatic diseases. When effects of age and residence were corrected for by Mantel-Haenszel odds ratios on these items, some of the associations were diminished even further. In general, remarkably few of the allegations regarding the direct effects of qat-use on health by Western visitors to Yemen were supported by this study.

Qat use in North Yemen and the problem of addiction: A study in medical anthropology

Travelers to North Yemen nearly invariably report that Yemeni people are universally addicted to the drug qat and that the problems of the country are related to this. On the other hand, the majority of Yemenis claim that qat is not only harmless, but that it has many virtues. After describing the chemistry of the drug and the customs of use, this paper addresses the question of the concept of addiction in terms of data gathered during an extensive field study of qat use. Questions of latency, tolerance and availability are discussed, while particular attention and data are devoted to an examination of the “analgesic hypothesis.” It is concluded that a more complex theory is needed to deal with drug “dependencies” and that social and cultural perspectives must be added to concepts of the physiological and psychological effects of drugs if progress is to be made toward understanding institutional drug use such as is found with regard to qat.

Psychosocial Dynamics of Witchcraft Sytsems

THE above statement from Evans-Pritchard’s famous work on the Azande expresses the relativistic tone of most of the interpretations of witchcraft done by modern anthropologists. They have taken delight in showing how customs deemed &dquo;savage&dquo; and immoral by enthnocentric missionaries and colonial administrators may be &dquo;functional&dquo; in terms of their native social contexts. The people themselves may view witch activities as terrifying and criminal, but the anthropologist continues to interpret them as elements of a &dquo;positive philosophy&dquo;, to quote a recent statement by Max Gluckman (1968: 26).

Book Reviews : RELIGION: AN ANTHROPOLOGICAL VIEW. By Anthony F. C. Wallace. New York : Random House, 1966. Pp. 300. Price

paid particular attention. Their response to training methods is subjected to close and experimental investigation. Although this book is if anything longer than the previous one, it concerns itself with much greater detail with a much narrower section of the total field. Considerable space in the book is devoted to criteria of mental deficiency, and to intelligence, and includes a very useful and critical examination of the available tests. The problems of education and rehabilitation are dealt with very thoroughly and indeed the &dquo;Changing Outlook&dquo; of the title refers as much to this aspect of the field as to any other. A very valuable feature of the book is the critical examination of literature and a very full bibliography, which is of particular importance to the serious

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nurse or graduate who wishes to gain further knowledge of present day psychodynamic frames of reference. Cartoon type illustrations occasionally lighten the strongly didactic approach. Unfortunately the oversimplification tends to lead to a kind of dogmatism which does not always do justice to the complexity of human behaviour. Perhaps this same tendency leads to the use of &dquo;speech&dquo; when disturbances in language or thought processes are being described in the chapter on symptoms and signs. The presentation of the clinical syndrome is often skimpy because of an effort to be all inclusive. The same problem presents itself when a profusion of different drugs are mentioned. For example, under anti-depressant drugs, a new class of drugs is described with strict warnings against the use of adrenalin and eating cheese without any explanation or mention that these drugs have in common the property of inhibiting the action of specific enzymes such as monoamine oxidase leading to the accumulation of certain substances within the central nervous system. The nurses’ relationship to the patient’s relatives and its importance in the future rehabilitation and maintenance of improvement is well described. A chapter is also devoted to the management of special psychiatric situations including suicidal, aggressive or markedly regressed patients. A desirable feature is an up

Book Reviews : APPROACHES TO CROSS-CULTURAL PSYCHIATRY. Edited by Jane M. Murphy and Alexander H. Leighton. Ithaca, New York: Cornell University Press, 1965. Pp. 406. Price,

The section on &dquo;Diagnostic Methods&dquo; investigates interviewing, personality inventories, I.Q. tests, projective tests, child diagnosis, test interpretation, organic problems, and classification. Notable is Molly Harrower’s consolidation of other therapists’ data on Rorschachs, T.A.T.s, M.M.P.I.s, and Wechslers. The &dquo;Clinical Patterns&dquo; unravelled are those in speech, physical disability, mental deficiency, psychosomatics (Franz Alexander and Glenn Flag do a thorough job and include an extensive bibliography), psychoneuroses, schizophrenia, depression, and psychopathic conditions. The section on &dquo;Treatment&dquo; begins with an overview of systems and techniques in psychotherapy-a service originating on the witch doctor and shaman level and now facilitated (in some cases) by Zen and drugs. Freudian, nonFreudian, client-centred, and children’s therapy are all duly examined. Henry Kalish, in his behaviour therapy chapter, reports some impressive results of this treatment and questions the necessity of many commonly accepted constructs of psychotherapy. In the closing chapter on the history and current status of &dquo;prevention&dquo;. Nevitt Sandford is critical of dogmatic Freudian answers and urges more attention to ameliorating stress ( i.e., bad housing) and to later relationships and conditions of a patient. Further, since psychoanalytic therapy is not feasible on a large scale, Nevitt Sanford appeals for better training of clinical psychologists in the future.