Psychiatry, November 1 st, 1959, Vol. 22, No.4, pp. 307-320

Culture, Psychiatry, and the Written Wordt

J. C. Carothers *

ANUMBER OF OBSERVERS of diverse human groups have developed the thesis that many attributes of people are largely products of the cultural patterns of

the groups to which they belong. It would be helpful for ethnopsychiatry if one could discover which cultural factors have been most important in producing varying human attributes, both in mental health and illness. It is the theme of the present article that the existence or lack of literacy in a society is one, if not the major one, of these-in other words, that literacy in a society, or the lack of it, plays an im­portant part in shaping the minds of men and the patterns of their mental breakdown.

In earlier articles, I drew attention to a number of differences in the incidence and symptomatology of mental disturb­ance as between nonliterate African peo­ples and western Europeans.1 Later, in a monograph for the World Health Organi­zation, I collated these findings with those of other psychiatric writers on this sub­ject, and arrived at certain general con­clusions.2 Those findings and conclusions which are relevant to the present theme are briefly summarized below.

In regard to schizophrenia, delusional systematization in nonliterate Africans is relatively lacking, and, accordingly, the categories described as "paranoiac," "par­aphrenic," and "paranoid" are seldom seen. In general, the clinical picture in schizophrenic patients is marked by con­fusion, so that Tooth, for instance, was able to say, "Whereas in Europeans, the distinction between an affective state with schizophrenic features, and a depressive phase in a primarily schizophrenic psy-

1 Carothers, "A Study of Mental Derangement in Africans, and an Attempt to Explain its PeculIar­ities, More Especially In Relation to the African Attitude to Life," J. Mental Sci. (1947) 93:548-597. Carothers, "Frontal Lobe Function and the Afri­can," J. Mental Sci. (1951) 97:12-48.

2 Carothers, The African Mind in Health and Dis­ease; Geneva, World Health Organization Monograph Series, No. 17, 1953.

chosis, is a common stumbling block in differential diagnosis, in Africans, schizo­phrenia is more liable to be confused with one of the organic psychoses," a and Laub­scher, also in the context of schizophrenia in Africans, wrote, "The picture of mental confusion stands out clearly above any other syndrome." 4

Affective disorder is mainly seen in the form of mania. Classical depressive syn­dromes with retardation and ideas of guilt, unworthiness, or remorse are hardly to be found among the rural populations. It may be that some hypochondriacal pa­tients are fundamentally 'depressive,' but depression, in a mental sense, is rarely ad­mitted in these cases, and confusion, with perhaps vague persecutory ideas, takes its place. Examples of obsessional neurosis are also rarely encountered.

In contrast to the rarity of these condi­tions, so frequent in European psychiatric experience, it is common in Africa to see states of confusion with excitement, which tend to resolve spontaneously within a limited time, but may be marked during

• Geoffrey Tooth, Studies in Mental Illness in the Gold Coast; London, His Majesty's Stationery Office, 1950.

• B.J.F. Laubscher, Sex, Custom and Psychopathol­ogy: A Study of South African Pagan Natives; Lon­don, Rutledge, 1937.

• M.B., B.S. 28, Unlv. of London; D.P.M. 46, ConjOint Board; Medical Officer, East African Medical Service, Kenya Colony 29-38; Specialist Psychiatrist, East African Medical Service, Nairobi, Kenya Colony 38·50; Consultant Psychiatrist, World Health Organization, Geneva 52-53; Consultant Psychiatrist, St. James Hospital, Portsmouth, England 50-.

t I would like to thank Professor G. R. Hargreaves, Professor of Psychiatry, University of Leeds, Dr. C. Haffner, Consultant Psychiatrist, St. James Hospital, Portsmouth, and Miss A. M. SUver, Senior Clinical Psychologist, St. James Hospital, Portsmouth, for reading and helpfully commenting on this article, and my wIfe for much of the typing involved In Its preparation.

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this time by any degree of violence, ex­ternally directed as a rule. During these episodes, action is wholly dominated by emotion-the emotion being one of acute anxiety, followed by generalized hostility and fear, or even panic.

I suggested in the WHO monograph, in explanation of these phenomena, that they derive not from any genetic 'racial' dif­ferences between Africans and Europeans, but from cultural factors which are so markedly divergent in these two human groups that their 'normal' mental develop­ment occurs on very different lines. I con­tended that, by reason of the type of edu­cational influences which impinge upon Africans in infancy and childhood, and in­deed throughout their lives, a man comes to regard himself as a rather insignificant part of a much larger organism-the family and clan-and not as an independ­ent, self-reliant unit; personal initiative and ambition are permitted little outlet; and a meaningful integration of a man's experience on individual, personal lines is not achieved. By contrast to the constric­tion at the intellectual level, great freedom is allowed for at the temperamental level, and a man is expected to live very much in the 'here and now,' to be highlyextra­verted, and to give very free expression to his feelings.

Several interwoven cultural factors were believed to have operated to produce these effects. The most important of these factors, as it seemed to the present writer, are briefly summarized as follows. Behav­ior is minutely governed from childhood on in a host of particular, concrete situa­tions by meticulous rules and taboos, and not on the basis of a few broad principles which require personal decisions for their "application. These rules acquire much of their force from the fact that they are sanctified by tradition and reinforced by supernatural 'powers,' and so may not be questioned. Explanations of events are given to children on magical and animis­tic lines, which are far too facile and too final, and effectively frustrate childish curiosity and suppress the urge to specu­late. Whereas the Western child is early introduced to building blocks, keys in

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locks, water taps, and a multiplicity of items and events which constrain him to think in terms of spatiotemporal relations and mechanical causation, the African child receives instead an education which depends much more exclusively on the spoken word and which is relatively highly charged with drama and emotion. In general, the monograph maintained that rural Africans live largely in a world of sound-a world loaded with direct per­sonal significance for the hearer-whereas the western European lives much more in a visual world which is on the whole indifferent to him, and that this differ­ence is of fundamental importance for the development of thought. Finally, the monograph called attention to the impor­tance of the very recent introduction of the written word to Negro and Bantu­Negro Africa. The significance of this­and of perceptual worlds in general-for the development of thought will come in for more extended consideration in later sections of the present article.

These observations and conclusions were based on evidence from various parts ' of Africa-east, west, and south. It seems, however, at least as far as the psychiatric summary is concerned, that their truth is of much wider application than to Africa alone. This possibility was foreshadowed in the preface to the WHO monograph, and it would seem, indeed, that much that was written in that monograph and in the earlier articles which have been men­tioned may be no more true for nonliterate Africans than it is for many other 11on­literate societies the world over.

Opler, writing in his recent book on the much broader theme of culture, psychi­atry, and human values in general, says in a chapter on variations in culture and psychopathology: These data, from Asia, Oceania, Africa and the Americas uniformly mark a high inci· dence of states of confused excitement, with disorganizing amounts of anxiety, fear and hostility present, and frequently associated with either indiscriminate homicidal behavior or self-mutilation, or both, in a setting of catathymic outbursts of activity. The contrast to the West of these nonliterate peoples, Eski­mos, Ojibwa, Cree, Fuegians, and various cul­tures of Asia, Africa, northern Europe, and

CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 309

the Pacific, with their relatively low inci­dence of depressed and suicidal states suggests that in addition to their marked associative concreteness and high activity and motility orientations, these psychotics more typically direct hostility outward and express it with greater freedom and directness than in Euro­pean models. That they express it outside of tightly organized family or kinship scenes is also interesting. In European patients, not only will the confusion in sexual identifica­tion (homosexual or asexual) be masked by systematized rationalizations, but basic hos­tility and anxiety will themselves be disguised and internalized with less expressive outlet. In this light, it is entirely conceivable, as Carothers, Seligman, and others have docu­mented, that "brief, maniacal attacks," often self-terminating in natural course, are a result of lack of systematized fantasy or delusions acting as ego-<iefenses and in place of them action and motility functioning. In the West, there are superimposed layers of fantasy.5

Whether these generalizations by Opler carry truth for all nonliterate societies is beyond my knowledge. They do seem to be true, however, for many or even most of these; and, conversely, they are not applicable to most of the literate societies, and perhaps not to any of them. Viewing these matters broadly, therefore, one is led to ask whether literacy itself in a society, or the lack of it, may have played no in­considerable part in shaping the minds of men and the patterns of their mental breakdown. Perhaps the answer can best be found by turning aside for a moment to consider certain aspects of men's atti­tudes to words in general.

Some years ago my little son said, "Is there a word 'pirates,' Daddy?" When I replied in the affirmative, he asked, "Are there pirates?" I said, "No, not now; there used to be." He asked, "Is there a word 'pirates' now?" When I said, "Yes," he replied, "Then there must be pirates now." This conversation, which might have come straight from Parmenides' doctrine of twenty-four centuries earlier, is a re­minder that, for a child, a thing exists by virtue of its name; that the spoken or even the imagined word must connote something in the outer world. This atti-

S Marvin K. Opler, Culture, Psychiatry and Human Values; Springfield, m., Charles C Thomas, 1956; P.135.

tude toward words, which also appears among nonliterate societies in Africa and, I believe, elsewhere, applies not only . to substantives, as in the above example, but to verbal thought in general. Thus, such thoughts, especially when wishful, are often regarded as having effectiveness of a similar order to that of any physical activity.

Much magic, in Africa and elsewhere, incorporates this principle. Thus Ken­yatta, writing of love magic among the Kikuyu, says: It is very important to acquire the correct use of magical words and their proper intonations, for the progress in applying magic effectively depends on uttering these words in their ritual order .... In performing these acts of love magic the performer has to recite a magi­cal formula .... After this recitation he calls the name of the girl loudly and starts to ad­dress her as though she were listening.

Describing the tribal execution of a Ki­kuyu witch doctor, Kenyatta says of this man: He was asked to declare that he had not, and would not, at the time of his death, utter, silently or loudly, curses on anyone.o

It must be noted, moreover, that this attitude toward words has passive, as well as active, implications. Words can be vulnerable as well as powerful, and this applies especially to personal names. This is shown in the above quotation from Kenyatta, when he refers to the calling of the loved one's name. Indeed, with this in mind the people of some non literate societies give their children, in addition to their generally known names, secret and thus invulnerable names.

These are not new observations. Both in regard to children generally and to members of nonliterate societies at all ages, it is well known that thinking and behavior are partly governed by the sup­posed 'power' of the word. It is equally well known that, as children grow up in modern Western societies, they come to know that, insofar as words do have effects upon the outer world, those effects occur only by the action of those words on the

8 Jomo Kenyatta, Facinu Mount Kenya; London, Seeker and Warburg, 1938; pp. 287-289; p. 302. The ltaIlcs are my own.

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minds of those who hear (or see) them. I am not, therefore, concerned in this article with the further elaboration of this familiar theme as such. I am, how­ever, concerned with three questions which arise in connection with this change in attitude toward words: How might literacy in a society operate to effect this change? What, theoretically, are the im­plications of this change for sociocultural development? And how far are the theo­ries developed in answer to the first two questions supported by the facts of eth­nology and of history? The rest of this article is concerned with the attempt to answer these three questions.

How Might Literacy in a Society Operate to Destroy the Magic 'Power' of Words?

I suggest that it was only when the written, and still more the printed, word appeared upon the scene that the stage was set for words to lose their magic powers and vulnerabilities. Why so?

I developed the theme in an earlier article, and with reference to Africa,1 that the non literate rural population lives largely in a world of sound, in contrast to western Europeans who live largely in a world of vision. Sounds are in a sense dynamic things, or at least are always indicators of dynamic things-of move­ments, events, activities, for which man, ·when largely unprotected from the haz­ards of life in the bush or veldt, must be ever on the alert. Whatever form they take-thunder, the burble of running water, the snapping of twigs, the cries of animals, the beating of drums, the voice or music of man-they are usually of di­rect significance, and often even of peril, for the hearer. Sounds lose much of this significance in western Europe, where man often develops, and must develop, a remarkable ability to disregard them. Whereas for Europeans, in general, "see­ing is believing," for rural Africans reality seems to reside far more in what is heard and what is said. Thus Cloete, referring

1 "Frontal Lobe Function and the African"; see footnote 1.

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to the trials a few years ago of the Leap. ard Men of Nigeria, wrote: The witnesses-there were witnesses on some occasions-said they had never seen a man. They had seen a Leopard, or a thing on two legs and then had run away to call for help. Even if they knew the murderer they would not say so, not merely because of their fear of reprisals, but because, to the African, a man becomes the thing he says he is, even if he isn't, by an act of faith.8

And Nadel quotes a verse from a song cycle connected with the gunnu religious ritual of the Nupe, which runs as follows:

Do you know the gunnu? You do not know it. For can you hear it? g

Indeed, one is constrained to believe that the eye is regarded by many Africans less as a receiving organ than as an instru­ment of the will, the ear being the main receiving organ.

In the earlier article which I have men­tioned, I argued that, although at first sight it might not seem important whether mankind was introduced more inSistently to the world of sight or the world of sound, this is in fact of fundamental importance. For living effectively in the modern West­ern world, a well-developed sense of spa­tiotemporal relations and of causal rela­tionship on mechanistic lines is required, and this is highly dependent on a habit of visual, as opposed to auditory, synthesis. The world of magic governed by animistic 'powers' could, it was argued, pass away only when man's attention became focused more emphatically on the relatively objec­tive, continuing, and irrelevant visual world. While this argument, which I have only briefly summarized, referred to rural Africa, it has, I have little doubt, some application to all non literate, magic-rid­den peoples the world over.

The question was never raised in that argument as to what factors might have served to bring about the shift in percep­tual attention, nor was consideration given to the possible role of written words in this connection. And so here I would

8 Stuart Cloete, The African Giant; Boston, Hough· ton Mlffiin, 1955; p. 175. .

8 Siegfried Frederick Nadel, Nupe Religion; Lon­don, Routledge and Paul, 1954; p. 14. The italics are my own.

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like to turn to a consideration of the writ­ten word.

When words are written, they become, of ~ourse, a part of the visual world. Like most of the elements of the visual world, they become static things and lose, as such, the dynamism which is so character­istic of the auditory world in general, and of the spoken word in particular. They lose much of the personal element, in the sense that the heard word is most com­monly directed at oneself, whereas the seen word most commonly is not, and can be read or not as whim dictates. They lose those emotional overtones and em­phases which have been described, for in­stance, by Monrad-Krohn,to and which are such an integral part of vocal speech. They can much more easily be misunderstood; few people fail to communicate their mes­sages and much of themselves in speech, whereas writings, unless produced by one with literary gifts, carry little of the writer and are interpreted far more ac­cording to the reader's understanding or his prejudice. Thus, in general, words, by becoming visible, join a world of relative indifference to the viewer-a world from which the magic 'power' of the word has been abstracted.

These remarks need qualifying. The word does carry some of its initial dyna­mism over into the visual world. Apart from other considerations, one still, quite literally, 'listens' to the words one reads. The written word maintains a foot in both worlds. If it is characteristic of people of the modern West to live in a predomi­nantly visual world in which "seeing is believing," then the presence in that world of these strange things-written words which must be listened to when seen-carries its own dangers for those people's objectivity. These dangers have been much exploited, for artistry can re­store to the written word at least some of the 'power' which the spoken word had. Indeed, since the scientific approach to life did not emerge until shortly after the gen­eral diffusion of the written word through

10 G. H. Monrad-Krohn, "The Third Element of Speech: Prosody In the Neuro-psychiatric Cllnlc," J. Mental Science (1957) 103:326-331.

the discovery of printing, it is even pos­sible that mankind's major interest shifted, in general, to the static visual world only with the entry into that world of words-static things which yet retained their dynamism for the human viewer.

By and large, however, it is clearly far more easy for words, when written, to be seen for what they are-symbols, without existence in their own right. Equally clearly, it is only at this point that it be­comes easy to see that verbal thought is not of its nature behavioral and is sepa­rable from action.

What, Theoretically, Are the Implications oj This Change jor Sociocultural Development?

We pride ourselves in the Western world on belonging to communities in which, although freedom of action is not permitted, freedom of speech and of thought are permitted. We deceive our­selves, of course, for no existing society really allows free speech. All societies place well-defined limitations upon speech; and, although there are no ex­plicit limitations on thinking, there are, in fact, a host of constraints which act insidiously in each society to curtail the ideation of its members. Our pride, how­ever, is not based on nothing, for there lies behind it a concept which seems to have emerged quite late in the course of man's mental evolution-the concept that verbal thought is separable from action and is, or can be, ineffective and contained' within the man. Clearly a development such as this has important sociocultural implications, for it is only in societies which recognize that verbal thoughts can be so contained, and do not of their nature emerge on wings of power, that social con­straints can, in theory at least, afford to ignore ideation. This, however, is a rather special case, which I refer to here for pur­poses of illustration.

The general answer to the question posed above would seem to run as follows. All societies must achieve some measure of behavioral conformity in their mem­b'ers, but their manner of achieving this will vary and will fundamentally depend on their attitude in regard to the relation

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of thought and deed. In those societies­apparently comprising most, if not all, nonliterate societies-in which verbal thoughts are seen as having power in the real world in their own right, no clear dis­tinction can be made between thought and action, words are regarded as being of the same order of reality as the matters and events to which they refer, and thought is seen as being 'behavioral' in the same sense as any other type of action. In these circumstances it is implicit that behav­ioral constraints must include constraint of thought. Since all behavior in such societies is governed and conceived on highly social lines, and since directed thinking can hardly be other than per­sonal and unique for each individual, it is furthermore implicit in the attitude of these societies that the very possibility of such thinking is hardly to be recog­nized. Therefore, if and when such think­ing does occur, at other than strictly prac­tical and utilitarian levels, it is apt to be seen as deriving from the devil or from other external evil influences, and as something to be feared and shunned as much in oneself as in others. Thus, on these grounds alone and apart from other factors, a member of such a society tends to become highly extraverted, and to be­come incapable of creative, speculative thought on personal lines, confining him­self to daydreams. His uniqueness as an individual is encouraged to express itself only at the temperamental level. In these circumstances, systematization is likely to be slight, and remorse and guilt are hardly to be looked for, although fears and ideas of persecution are likely to abound and to be expressed in externally directed hostile action.

On the other hand, in those societies­which seem to comprise most, if not all, literate societies-where verbal thought is recognized as being in some sense sep­arable from action, where thought is seen as not of its own nature 'behavioral,' the modes by which conformity is achieved will vary greatly according to the prevail­ing attitude in each society as to the part that 'thought' and 'will' may play in gov­erning behavior. Thus such societies may

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or may not endeavor to constrain their members at the level of their thinking. But the main point is that man, the indio vidual, comes always to be regarded, and to regard himself, as capable of thinking for himself, of being potentially unique at the level of ideation and of will. The ap­proach of such societies to the problem of conformity is more sophisticated and does not fail to take account of this; and the in­dividual does not fail to see himself, in some degree, as responsible for his own thoughts, with all that this entails-in the way of rationalization, self-denigration, and so on-in mental health and illness.

How Far Are the Theories Developed in Answer to the First Two Questions Sup­

ported by the Facts of Ethnology and History?

A really comprehensive answer to this question would require a thick tome. Even if one used all available knowledge of past and present cultures, it would still be in­complete, since many existing societies have as yet been little studied, and the attitudes in many past societies must be forever unknown. The problem is further complicated by the fact that, whereas non­literacy in a society is a fairly straight­forward, meaningful phenomenon, liter­acy is not, for there are all degrees of it.

This part of my article, therefore, takes the form of a series of brief essays, with quotations from other sources, which may serve to illustrate the attitude to thought in various past and present societies in re­lation to their nonliterate or literate state.

The power of the word in ancient Greece.-Writing developed at first in cer­tain hierarchic societies-for example, the Egyptian, Sumerian, and Mayan-in the form of hieroglyphs, or, literally, priestly carvings, which were virtually the monop­oly of a few highly privileged, entrenched guardians of the traditional modes of thinking and behavior of their groups. In this setting, written symbols became, in the main, tools for the keeping of ac­counts, the recording of events, and the maintenance and elaboration of those tra­ditional modes.

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When writing was at last introduced to a society-the early Greeks-which was not already, to use Fisher's words, under "the paralysing control of an organised priestcraft," 11 it emancipated thought, but only up to a point and for a time. It has often occasioned surprise in modern times that the Greeks, with all their in­tense curiosity and energetic speculation, produced so little that could be called sci­entific, even though they paved the way for scientific development in later ages.

Bertrand Russell says of the Greeks:

Now almost all the hypotheses that have domi­nated modern philosophy were first thought of by the Greeks; their imaginative inventive­ness in abstract matters can hardly be too highly praised .. _ . they discovered mathe­matics and the art of deductive reasoning. Geometry, in particular, is a Greek invention, without which modern science would have been impossible. But in connection with mathematics the one-sidedness of the Greek genius appears: it reasoned deductively from what appeared self-evident, not inductively from what had been observed. Its amazing successes in the employment of this method misled not only the ancient world, but the greater part of the modern world also. It has only been very slowly that scientific method, which seeks to reach principles inductively from observation of particular facts, has re­placed the Hellenic belief in deduction from luminous axioms derived from the mind of the philosopher.12

In describing Plato's theories, Russell says:

We are told that the body is a hindrance in the acquisition of knowledge, and that sight and hearing are inaccurate witnesses: true existence, if revealed to the soul at all, is revealed in thought, not in sense. Let us consider, for a moment, the implications of this doctrine. It involves a complete rejec­tion of empirical knowledge, including all his­tory and geography. We cannot know that there was such a place as Athens, or such a man as Socrates; his death, and his courage in dying, belong to the world of appearance. It is only through sight and hearing that we know anything about all this, and the true philosopher ignores sight and hearing. What, then, is left to him? First, logic and mathe­matics; but these are hypothetical, and do not justify any categorical assertion about the real

U H.A.L. Fisher, A History of Europe; London, EdWard Arnold, 1936; p. 19.

12 Bertrand Russell, A History of Western Philos­ophy; New York, Simon and Schuster, 1945; pp. 38·39.

world. The next step-and this is the crucial one-depends upon the idea of the good. Hav­ing arrived at this idea, the philosopher is supposed to know that the good is the real, and thus to be able to infer that the world of ideas is the real world .... This point of view excludes scientific observation and ex­periment as methods for the attainment of knowledge .... The two kinds of mental ac­tivity that can be pursued by the method that Plato recommends are mathematics and mys­tic insight.u

Plato, of course, was not the only Greek philosopher. But it does seem that Greek genius, both in its transcendences and its deficiencies, achieved its most profound and characteristic expression through him.

Now, as it seems, the great emancipa­tion of thought which first occurred among the early Greek intelligentsia de­rived from the fact that this group was literate, and so had the benefit of knowing what other people thought, yet by a for­tunate circumstance was not entram­meled by a hierarchy backed by a priestly literature. Writing at last was at the dis­posal of folk without a vested interest in the traditional modes of thinking.

But, so far as Plato's thinking can be considered representative of the thinking of the Greeks, it is very clear that the word, whether thought or written, still retained, for them, and from our point of view, vast powers in the 'real' world. Al­though at last it was seen as nonbehav­ioral itself, it now came to be regarded as the fount and origin not only of behavior but of all discovery: it was the only key to knowledge, and thought alone-in words or figures-could unlock all doors for understanding the world. In a sense, in­deed, the power of words or other visual symbols became greater than before, for, whereas previously it is likely that hear­ing was believing, now verbal and mathe­matical thought became the only truth, and the whole sensory world came to be regarded as illusory, except insofar as thoughts were heard or seen.

Disappointment in the Greeks for their failure to reason inductively and to de­velop the scientific method has often been

U See footnote 12; pp. 130-137.

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expressed. If, however, it is true that the most 'real' aspect of the world for non­literate peoples is its auditory aspect, and especially the spoken word, it is only to be expected that the first people who were both literate and free to think as they chose should still regard thought ex­pressed in words or other visual symbols as being the chief reality. Even Greek genius could hardly be expected to skip over this essential step.

The achievement of conformity in an Eskimo society.-The Eskimos of Bylot and BaffiW Islands in northern Canada are essentially a nonliterate people still living in a Stone Age world and little touched by Western cultures. Scherman, who visited these far north people, says of their lan-guage: '

There are no abstract words and all verbs are verbs of action. The Eskimos, though extraor­dinarily quick and alert mentally, are not thinkers in our sense-and their language is a reflection of their life and their racial char­acter. It is a language of people whose lives are lived in their bodies and not in their minds.14

If this description is just, it would seem that here, among these northern people, so radically different in the circumstances of their lives from the indigenous inhabi- ' tants of tropical Africa, conformity is similarly achieved-by the encourage­ment of outward expression and of action, and by the abrogation of thought. As to the mode of its achievement, there may be many factors. However, one most reveal­ing clue is supplied by Scherman when she writes: All the Eskimos we saw talked a great deal. A rule of Eskimo life is that a man must not keep any thought to himself-for if he does so he will go mad.15

A better method for insuring that a man should not develop ideas which are un­orthodox within his culture could hardly be devised. Whatever other educational factors play a part in achieving Eskimo conformity, this one alone would be effec­tive.

14 KatharIne Scherman, Spring on an Arctic Island; Boston, Little, Brown, 1956.

15 See footnote 14.

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Riesman's description of "tradition-di_ rected" societies.-Riesman's stimulating book, The Lonely Crowd,16 calls for con­sideration in the context of the present article. His study of the modes by which conformity is achieved in various socie­ties, although not directly concerned with the subject of literacy, is in many ways very pertinent to my general theme.

Riesman classifies humanity into three broad groups on the basis of their type of population growth. Societies in an early stage of their development are said to be in a phase of "high growth potential" (with a high birth rate and an equally high death rate); at a later stage they are said to be in a phase of "transitional growth" (with a high birth rate and a de­creasing death rate); and finally they reach a phase of "incipient population decline" (with low birth and death rates).

Riesman equates the areas of high growth potential in the present-day world with India, Egypt, China, parts of Central and South America, most of central Africa, and, in fact, most areas of the world which have been relatively untouched by indus­trialization; he equates these also with the Europe of the Middle Ages. He sees all these societies as developing in their "typical members a social character whose conformity is insured by their tendency to follow tradition," 11 and terms these mem­bers "tradition-directed." He equates the areas of transitional growth with post­Renaissance Europe and sees these soci­eties as developing in their "typical mem­bers a social character whose conformity is insured by their tendency to acquire early in life an internalized set of goals," 18

and he terms these members "inner-di­rected." Finally, he locates the areas of incipient population decline most char­acteristically in urban North America, and sees such societies as developing in their "typical members a social character whose conformity is insured by their tendency to be sensitized to the expectations and pref-

18 DavId Rlesman, The Lonely Crowd; New Haven, Yale Unlv. Press, 1950. ', ' '; "

n See footnote 16; p. 9. ,.", .;~:.:: 18 See fooinote 16; p. 9.

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erences of others." 10 These people he terms "other-directed."

Now Riesman, as was said before, is not concerned with the question of literacy as such, and his observations are thus all the more significant for the present purpose. The areas which he describes as populated by tradition-directed people correspond quite closely to those areas occupied by societies which are nonliterate or in which the great majority of the population has been untouched by literacy; and the areas which he describes as populated by inner­and other-directed peoples correspond as closely with the areas occupied by socie­ties which have long been much in­fluenced by written words. It is therefore valuable to see what else Riesman has to say about the modes by which conformity has been achieved in these societies.

Referring to tradition-directed peoples, he says: Since the type of social order we have been discussing is relatively unchanging, the con­formity of the individual tends to be dictated to a very large degree by power relations among the various age and sex groups, the clans, castes, professions and so forth-rela­tions which have endured for centuries and are modified but slightly, if at all, by succes­sive generations. The culture controls be­havior minutely, and, while the rules are not so complicated that the young cannot learn them during the period of intensive socializa­tion, careful and rigid etiquette governs the fundamentally influential sphere of kin rela­tionships. Moreover, the culture, in addition to its economic tasks, or as part of them, pro­vides ritual, routine, . and religion to occupy and to orient everyone. Little energy is di­rected toward finding new solutions of the age-old problems, let us say, of agricultural" technique or "medicine," the problems to which people are acculturated.1O

A little later, in comparing tradition-di-. rected with inner-directed peoples, Ries­man says:

In societies' in which tradition-direction is the dominant mode of insuring conformity, atten­tion is focused on securing external behavioral conformity. While behavior is mimit«:~ly pre­scribed, individuality of character m!ed'not be highly developed to meet prescriptions that are objectified in ritual and' etiquettgthough to be sure, a social character 'capable':of);uch

,. See footnote 16; p. ~: ' , .. See footnote 16; p. 11. . .'

behavioral attention and obedience is requi­site. By contrast, societies in which inner­direction becomes important, though they also are concerned with behavioral conformity, cannot be satisfied with behavioral conformity alone. Too many novel situations are pre­sented, situations which a code cannot en­compass in advance. Consequently the prob­lem of personal choice, solved in the earlier period of high growth potential by channeling choice through rigid social organization, in the period of transitional growth is solved by channeling choice through a rigid though highly individualized character.21

Riesman's descriptions of tradition­directed peoples are in accord with my own experience of those non literate or near non literate peoples I have seen in Africa, as contrasted with the inner-di­rected, literate peoples of western Europe. I have quoted from his thought-provoking book at some length partly to emphasize this, and to emphasize the significance of the fact that, although Riesman does not relate his classification of social patterns of thinking and behavior to social literacy, it could equally well have been so corre­lated. I have also, however, quoted from his work with a view to dissenting from his generalization as to the mode in which conformity is achieved, although even here the disagreement is partly a semantic one.

In discussing the mode of achieving conformity in tradition-directed societies, Riesman suggests that attention is focused on securing external behavioral conform­ity. Now it is doubtless true that con­scious, deliberate attention is focused on securing -external behavioral conformity; for instance, to quote Westermann:

The gods and ancestors take but a slight in­terest in the ethical behaviour of their wor­shippers and are almost indifferent as to the inner attitude in which they are approached . What they demand is offerings and invoca­tions. ' ... Ethics, in the sense of civic vir­tues, are rooted in the traditional rulesregu­lating the behaviour in social groups.22 ,

But the point, as ,1 see it, 'is .thatin' niany if not all of these 'sodiitieift~1igh,t ani:l ;l/e~ haviorare ' riot ~seen:;,a,sseparate;'they ~are bbtli slJen,'~as':~ pehavioral: " Evi1~wi11in'g:1s, ~·;~;~~e: ~:~t:'~~':i~; ~;Xi~~ '· '<Y,~nL:;:P:O:;~:: '::'~;j.::';,:S;~::, .~· It DiedrIch ' We8terman~·; The .·:Afrfccin· TodaJ/: cind

. . TomOrrow;.· London; : Oxford ~.UnIv; Pr.essi 1939: :"':" ; ;,

316

after all, the most fearful type of 'behav­ior' known in many of these societies, and a dormant or awakening fear of it lies ever in the minds of all of their members. Thus, although the conscious attention of society is focused on the external aspect, the internal aspect is also and always taken care of. Control of the latter is achieved automatically by the traditional modes of education of the child-that is, by the stultification of curiosity and the inculcation of a fear of the strange and untraditional, including strange thoughts. This is done with little sophisticated ap­preciation of the mode of its achievement , but all the more effectively for that.

So effective, indeed, is this control of verbal thinking that it seems that when men in these societies, either as individ­uals or groups, first break away from their traditional ways and start to question those ways on independent lines, they feel that they are courting disaster and are even apt to see their thoughts as evil. After all, if a man turns his back on his traditional gods, he has to turn for help to other gods, who must be anathema to his original gods-even devils; for a man can­not see himself, at first, as really being a free agent in the field of thought.

In studying the psychology of Mau Mau,23 I saw much evidence of this in the oaths, rituals, and behavior that charac­terize that movement. Some of these oaths and rituals were obscene and shock­ing, both by western European standards and by the traditional standards of the Kikuyu people themselves. They de­pended, indeed, for their force on the shock they produced; and this shock was produced for the Kikuyu, whose faith in the traditional ways was not yet wholly lost, because they were in general line with those traditional ways, yet reversed them and made an obscene mockery of them. They shocked something deep in these people-so deep that many felt that they were forever outside the pale of their society on these grounds alone, for if they recanted they would die instantly from the 'power' of the oaths. Much of the suc-

23 Carothers, The Psychology of Mau Mau; Nairobi The Government Printer, 1954. '

J. C. CAROTHERS

cess of Mau Mau and much of the subse­quent difficulty in rehabilitating its ex­ponents-or its victims-has been due to this. Clearly, therefore, in this tradition­directed people-the Kikuyu and certain allied tribes-society does achieve con­formity by constraining thought as well as action. I have no reason to believe that in this regard, they are likely to be pecu~ liar among such societies.

Piaget's studies .of the development of thought.-Piaget, in his studies of Euro­pean children,24 . has, broadly speaking, recognized three major stages in the de­velopment of their modes of thinking.

In the first stage, which lasts to the age of two or three years, there is little self­consciousness, and the world in general is largely identified with oneself, without distinction of its subjective and objective aspects. In the second stage, which lasts until about seven or eight, the distinction between subjective and objective aspects of the world is made increasingly, al­though explanations are marked by a high degree of subjectivity. Events occur to help or to defeat oneself; they occur by reason of motives which are like one's own; superficial similarities between ob­jects are regarded as indicative of causal bonds, even though there is no contiguity in space or time; all manner of objects are imbued with a life or force of their own; all happenings are possible; and the world is governed, both in material and social matters, by personal 'wills.' The third stage, which lasts until about eleven or twelve, bridges the gap between childish and adult thinking. It is characterized by an increasing tendency to search for gen­erality of principle, to recognize the need for continuity and contact in causation, and to see the birth of new events as the outcome of a reassortment of parts or qualities, and by the gradual replacement of moral by logical necessity.

With regard to these findings of Piaget, I wrote in the WHO monograph: To return to the African child, it is clear that his mental development shows no striking

"See especIally Jean PIa get, The ChUd!s Concep­tion of Physical Causality; London, Kegan Paul, Trench, Trubner, 1930.

CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 317

difference from that in Europeans up to the age of seven or eight years, but that thereafter his thinking does not develop along European lines. Piaget's description of the second de· velopmental stage accords closely with the thought modes of even adult rural Africans, and not one of the developments observed in his third stage is characteristically seen in them. African thought in later childhood, adolescence, and adult life does not advance beyond that point except for some elaboration of detail."

This difference in development was ex­plained in the monograph in terms of en­vironmental factors and on the lines indi­cated in earlier pages of this article, and it is noteworthy that Dougall many years be­fore had made closely similar observations in regard to African psychology and in re­lation to Piaget's findings. 26

The question that arises here, however, is a rather different one. One has to ask at this point whether it is merely a coin­cidence that it is by about the age of seven or eight that children in western Europe have fully acquired the art of reading.

In the absence of comparisons of the mode of thought development among European children who have, and who have not, been taught to read, and in terms of Piaget's criteria, one cannot make too much of this. These children, after all, are learning many other things besides reading and writing, for the writ­ten word is only one facet of a cultural environment which differs in many others from that of African children. Neverthe­less, it would be surprising if the altered attitude toward words, toward thought, and toward the world in general which may derive from reading operated only in the case of human groups and found no parallel in individuals. The next illustra­tion, however, would seem to demonstrate, very much more definitely, that the acqui­sition of this skill does operate in a similar way for individuals.

The effects of U a very little education." -In July, 1945, a remarkable article ap­peared in the East African Standard (a

2S See footnote 2; p. 100. 2e James W. C. Dougall, "Characteristics of African

Thought," Africa (1932) 5:249-265.

Kenya daily newspaper) entitled, "How Civilisation Has Affected the African." Although the article was contributed anonymously, it is known that its author was a missionary doctor who had worked for many years among rural Africans in Kenya. He wrote:

The purpose of this article is to show that through a very little education a remarkably rapid and far·reaching change has taken place in African boys and girls, so much so that in a generation, human characteristics and reo actions have altered to a degree which one would have expected to have taken centuries.

The high qualities of the African untouched by missions or education impress nearly everyone. Those of this district are good workers, cheerful, uncomplaining, unaffected by monotony or discomforts, honest and usu· ally remarkably truthful. But it is not un· common to hear uncomplimentary compari. sons made between these Africans and those born of Christian parents or those who started school at an early age. A writer, however, who visited schools in Madagascar says that these untouched children are naturally Ie· thargic. They sit still too long; the impulse to play seems to be dormant. They are im· pervious to monotony and their mental leth· argy enables them to perform, for children, prodigious acts of endurance. These children naturally develop into the uneducated African, who is incapable of filling any skilled post. At the most he can be trained to carry out work that requires no reasoning. That is the pen· alty paid for his good qualities.

The African will remain in permanent servi· tude if only to ignorance unless there is will· ingness to risk the destruction of these quaU· ties in the changes educaUon brings and a desire to face building up his character again but with a- totally different mentality. This different mentality may show itself in a shirk· ing of work, trouble over food or in a desire to have his wife living with him however difficult for the employer. The reasons are clear; the African's whole capacity for inter·

. est, pleasure and pain are immensely In· creased through even a little education.

For the educated African (using this term for even the comparatively low standard achieved by the average African schoolboy) the sense of interest has been aroused through the new variety of life and monotony has be· come a trial to him as it is to the normal European. It takes greater will·power for him to be faithful in uninteresting work, and lack of interest brings fatigue.

The writer then described and illus­trated the enhancement of interest in the pleasures of taste and of sex, and the in-

318

crease in the sense of pain and in reason­able fears which he had observed to oc­cur in Africans when they received a lit­tle education on European lines. He con­cluded:

I suggest also that the nervous system of the untouched African is so lethargic that he needs little sleep. Many of our workmen walk some miles to their jobs, work well all day and t~e~ return home and spend most of the night slttmg up guarding their gardens against the depredations of wild pigs. For weeks on end they sleep only two or three hours a night.

The important moral inference from all this is that the African of the old generation with whom we h~ve nearly all worked, will never be seen agam. The new generation is com­pl~tely different, capable of rising to greater heIghts and of descending to greater depths. They deserve a more sympathetic knowledge of their difficulties and their far greater temp­tations. African parents need to be taught ~his before it is too late so that they may real­Ize that they are dealing with finer bits of mechanism than they themselves were.

The point is well made by this writer that it is through only "a very little edu­cation" on European lines that the Afri­can's whole attitude toward life is changed in the manner he describes. This education often comprises little more than some familiarity with written symbols­in reading, writing, and arithmetic-and it would seem that this alone can be effec­tive in accomplishing this change.

What is this change which the writer describes as the arousal of interest, of awareness, of zest for life? It could surely be seen as the reawakening of dormant intellectual curiosity and as a dawning recognition that it is man's prerogative to see the world with his own eyes. These faculties are stifled by cultures which con­fine their members within the bounds of Piaget's second stage.

The influence of the invention of p1'int­ing on thought.-Since printing can enor­mously increase the availability of written words, it is to be expected that its inven­tion would have important effects on thought. It i~ worth while, therefore, to consider very briefly the part that print­ing has played in history in this regard.

Printing was invented in China in about the seventh century and in Europe eight

J. C. CAROTHERS

centuries later. Prior to its invention only a privileged few could read, and fewer still could write.

In China, printing, though introduced so much earlier than in Europe, seems to have had little effect in emanCipating thought. Latourette says: The hypothetical visitor from Mars might well have expected the Industrial Revolution and the modern scientific approach to have made their first appearance in China rather than the Occident. The Chinese have directed so much of their energy toward attaining this. worldly ends, are so industrious, and have shown such ingenuity in invention and by empirical processes have forestalled the West in arriving at so much useful- agricultural and medical lore that they, rather than the nations of the West, might have been looked to as the forerunners and leaders in what is termed the scientific approach towards the understanding and mastery of man's natural environment. It is little short of amazing that a people who pioneered in the invention of paper, printing, gunpowder, and the compass -to speak only of some of their best known innovations-did not also take precedence in devising the power loom, the steam engine, and the other revolutionary machines . of the eighteenth and nineteenth centuries ....

The explanation may lie in the fact that Chinese writing-or printing-re­quires much erudition for its understand­ing. Latourette says: The greater part of the voluminous literature in Chinese has been written in the classical style. . . . The Chinese classical language presents difficulties. It is highly artificial. It is often replete with allusions and quota· tions and to appreciate and even to under· stand much of it the reader has to bring to it a vast store of knowledge of existing litera· ture. . .. . It is only by going through a pro­digious amount of literature and especially by memorizing quantities of it that the scholar obtains a kind of sixth sense which enables him to divine which of several readings is correct. Even the perusal of the classical language, therefore, requires long prepara­tion. Composition is still more of a task. Few Occidentals have achieved an acceptable style and many a modern Chinese · who is the fin­ished product of the present-day curriculum is far from adept.28

Chinese writing, even after the advent of printing, must thus have remained

%f Kenneth Scott Latourette, The Chinese, Their History and· Culture; New York, Macmillan, 1934; p.310.

:Ii See footnote 27; pp. 301·302. .

CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 319

very much in the hands of a scholarly mi­nority, and even those in this minority must have spent most of their lives in attempting to master the arts of reading and writing. The tool became in high degree the master and, in these circum­stances, could hardly do more than serve to reinforce the traditional modes of thought.

Far otherwise was the case in Europe. Printing was invented in Germany in the fifteenth century, spread rapidly through Europe, and, according to Fisher:

It has been calculated, but on an estimate which is probably too conservative, that by the close of the century some nine million printed books must have been in existence as against a few score thousand manuscripts which, up to that time, had contained the in­herited wisdom and poetry of the world. . .. In the sixteenth century the printed book acted as a powerful inducement to liberating and critical movements of thought: but the first consequences of typography were other­wise, and are to be found in an awakening of popular religion and in a diffused interest in the reading and discussion of religious books.l!9

/ Referring to the Protestant Reformation of the sixteenth century, Fisher says:

A great movement of intellectual emancipa: tion preceded its advent and accompanied its course. Thousands of separate little rills of doubt, criticism and protest which had been gathering volume for a generation suddenly flowed together into a brawling river of revolt. The public mind recoiled from the discipline of the past. Old limitations upon thought and learning fell away .... The enlightenment of the sixteenth century, though quite dis­tinct from the Protestant movement, was one of the causes which helped it to succeed. The new learning weakened the traditional senti" ment of reverence by which many of the be­liefs, traditions, and customs of the Roman Church had long been supported. The layman could now read for himself.80

The year 1494 A.D. is often regarded as constituting the boundary line between medieval and modern times in Europe. As far as anyone year can do so, it marks the passing of an age in which faith in and acceptance of the traditional ways were the rule among the common people and in which 'scholastic' deductive logic was the

.. See footnote 11; pp. 465-466. ao See footnote 11; pp. 498-499.

characteristic expression of the thinking of the highly educated, and the emergence of an age characterized by a spirit of revo­lutionary inquiry and by inductive sci­entific thinking. Above all, perhaps, it marks the emergence of the concept that man, the individual, is capable of thinking for himself about anything at all.

It seems not farfetched to attribute these developments in large measure to the general diffusion of the written word, through printing, which had occurred by just about that time.

In general, the differing genetic consti­tutions of large human groups, even when races are concerned, playa very uncertain part in governing the different modes of thinking and behavior which characterize these groups in relation to each other. It seems that this part is small, and, in any case, is so transcended by the manifest part played by environmental factors that, for the present at least, attempts to deci­pher it are not likely to be profitable. It is far more profitable to study the psychol­ogy and psychiatry of human groups in relation to their differing experience as groups.

There is no limit to the ways in which environmental factors might be chosen as a basis for such studies. It is, however, surely important, in these early days of ethnopsychiatry, to endeavor to discern the major factors. I have chosen social literacy in this article, because, as it seems to me, the broadest and deepest differ­ences between large human groups, both in regard to their psychology and their psychiatry, can be related to this factor.

From the psychiatric angle, there is a growing body of evidence that patterns of mental disturbance vary most conspicu­ously and fundamentally on this basis. I have endeavored, by considering some as­pects of the psychology of nonliterate and literate peoples, to show how this might come about. It is postulated that the rec­ognition of the impotence of verbal thought is the prerequisite for general directed thinking on personal lines, that this comes only with social literacy, and

320

that, without this recognition, man is afraid of thought itself.

I have not, in this paper, arrived at any firm conclusions. The theories are tenta­tive, but are here put forward in the be­lief that they are the most feasible and

J. C. CAROTHERS

simple explanation of a large array of eth. nopsychological and ethnopsychiatric facts.

ST. JAMES HOSPITAL PORTSMOUTH, HAMPSHIRE

ENGLAND