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Review: The Question of NeedsAuthor(s): Kathleen M. BleeSource: Contemporary Sociology, Vol. 15, No. 6 (Nov., 1986), pp. 823-826Published by: American Sociological AssociationStable URL: http://www.jstor.org/stable/2071109 .

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REVIEWESSAYS 823professors' side, their own careers and/or familydemandsstructure dditionalobstacles to importantmentoringrelationships.Not surprisingly, relationships with men con-tinue to pose problemsin this historical period oftortuously changing gender roles. The feministideal of heterosexualegalitarianism reates confu-sion amida palpable struggle to establish mutuallysatisfying relationships. Behavior between maleandfemale friends s more likely to be markedby adeliberateegalitarianismn financialarrangements,initiation of interaction,and self-disclosure. Thisstands in marked contrastto the initial stages ofdating, where sharing financial responsibility,particularly, conveys the "wrong" signals. Theearly dating phase is fraught with ambiguity,confusion, and strain stemming largely fromrapidly volving gender-role xpectations.Komarov-sky describes both interpersonaland intrapsychicconflicts arising from the "clash between someidiosyncratic psychic wish . . . and an internal-ized value" (228). She notes that, in the process,"each sex may reach out for the double dose ofprivileges . . . laying the burdenof all obligationsupon theirpartners"(228).Thus, the earlier and simplerfemale conflict ofthinkingsmartandactingdumb s replacedby a farmore complex picture. The rope burns of braidednew and traditionalexpectationsleave their markon the minds and spirits of some. Almostmiraculously,otheremerge unscarred, onveyinga

surprisinglyclear sense of purpose and direction.Komarovsky killfully exploreswhy and how somestudents manage to deal successfully with aca-demic traumata ndsociopsychologicaltransitions,while others fall victim to the special demandsofan elite academicinstitution.Reliance on in-depth interviews is simulta-neously the obvious weakness and the uniquestrengthof the study. The method bears the usualstatistical burdensof a relativelysmall sample, aswell as a host of other methodologicalshortcom-ings to which qualitativedata are heir. In addition,the capacity to generalize from this very specialelite academic context to a wider world isobviously problematical.Nonetheless, in the handsof this sensitive and skillful investigator, theseinterview data offer a window on the collegeexperience of bright women students strugglingwith the challengesof a world in transition.Astute educationalpolicy makers and adminis-trators will find various cues for developingpolicies, practices, and institutionalarrangementsthat might enhancethe college experience.Parents,too, might gain a penetrating glimpse into theanguish their expectations can impose on theirchildren. Other, more methodologically sophisti-cated researchers might gather the seeds togeneratemore quantitativemodels. To answer ourinitialquestion, "No, we don't reallyneed anotherstudy of college students, but it certainly wouldhave been a shame to miss this one." f

The Question of NeedsCapitalism, Consumption,and Needs, by EDMOND PRETECEILLEAND JEAN-PIERRE TERRAIL. New York:Basil Blackwell, 1985. 220 pp. $34.95 cloth.KATHLEEN M. BLEEUniversityof Kentucky

The applicability of Marxist theory to theanalysis of advancedcapitalist societies often hasbeen questioned. Recently, the rise of consumermovementsin WesternEurope and North Americahas shed doubt upon the traditional entralityof theworkplacein Marxist analyses of political move-ments. Social movements have proliferated inareas seemingly distant from the relations andprocesses of production. Workplace and laborunion organizinghave declined, even as organiza-tions for social change and societal transformationhave flourishedin neighborhoodsand municipali-ties. Moreover, the issues that provoke mobiliza-tion among the middle and working classes havenot been restricted o production-basedssues butinclude struggles over the nature of life outside

waged work. Gender and family relations, thequality of the environment and consumer goods,and the level of state services all have served aspivotal issues for importantsocial movements inadvancedcapitalist societies.Traditionalcategories of Marxist analysis arechallenged also from a different direction. Re-searchon twentieth-centuryworking-classpoliticalquiescence locates its source in a matrix of powerand domination shaped by commodified massculture. Oppositionalmovementsby an organizedworking class are seen to be less likely and lessviable as class domination becomes systematizedinto a patternof manipulateddesires and artificialneeds. Capitalismpenetrates work and nonworklife alike, channeling discontent into desires that

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824 REVIEW ESSAYScan be commodified and satisfied within theexisting social logic. A productionprocess basedon alienated labor redirects workers' resultantdissatisfaction nto a desire for nonworktime-aleisurethat can be packagedby capital and sold tothe working class at a profit.PreteceilleandTerrail, n a series of fourrelatedessays, developa comprehensiveMarxist heory ofneeds that addresses these political and culturaldimensions of advanced capitalist society. Theyexaminethe issues of consumption,consumerism,and the creationof needs thathave been central tosocial movements and mass culture in latetwentieth-centuryWesterncapitalism. In contrastto works that simply criticize the nature of"consumer societies," Capitalism, Consumption,and Needs probes the patternsof individual andcollective consumption that exist behind anappearanceof mass consumption and advanceshow we understand he creation of needs amongdominatedclasses. While not minimizing ideologyanddaily life practicesoutside the workplace,theyavoid overinterpreting ymbolic relationsof statusat the expense of materialrelationsof social class.As such, they make an importantcontribution othe developmentof a Marxist theory of politics,culture,and daily life.In Capitalism, Consumption, and Needs,Preteceilleand Terraildevelop a Marxistapproachto the questionof needs thatis sharplyat odds withthe analysis of consumption in non-Marxisteconomicsandsociology. NeoclassicalandKeynes-ian economics have situated consumption as adeterminant f production,sparkinga vast researchliterature on consumer behavior and demand inwhich class relations and the interrelation ofproduction, consumption, and needs largely re-main unanalyzed. In contrast, the materialistanalysis proposed by Preteceille and Terrailsituatesconsumptionwithin the logic of capitalistproduction.The contradictionsof unevendevelop-ment, overproduction f commodities,andscarcityof essential needs in affluentsocieties areanalyzedwithin a logic of capitalist production andreproduction.Preteceille and Terrail are critical of thesociological studies of consumptionexemplifiedinwhat they refer to as the "differentialist" move-mentof BourdieuandBaudrillard,whereconsump-tion is seen as the productionof differentiation.Veblen's (1912) indictment of the consumptionpractices of the leisure class and Halbwachs'(1958) studies of how class membership hapesthetranslationof income into consumption practicesare echoed in contemporary studies of theorganizationof class in, andthrough,consumptionactivities.Although"differentialists"ike Bourdieumay arguethe primacyof relationsof productionover symbolic distinctions,Preteceille and Terrail

insist that this theory ultimately subordinates lassrelations to ideological relations. Such analyses ofthe consumptionof signs of difference and of thepenetrationof the commodityform into all aspectsof daily life, they conclude, tend to minimize thetransformativepotential of working-class move-ments. The differentialistapproach positions thecreation of desire and needs outside the relation-ship of consumption o productionso thatdomina-tion ceases to be amenable to revolutionaryrestructuring f productionrelations.Preteceilleand Terrail efuteboth the economisticand the differentialist conceptions of needs.Instead, they pose an analysis of social needs asthe product of the reproduction of a particularmode of production.Needs are both an outcomeof, anda contradictorynfluenceupon, the logic ofcapitalistproduction.For example, PreteceilleandTerrail argue that needs for improved working-class education (an outcome both of increasedrequirements or the reproductionof labor powerand of class struggle) tend to increase both thevalue of labor power and the political resources ofthe working class. This analysis is a welcomecorrectiveto theories of state services that eitherstress the manipulative,cooptive natureof servicesto dominated classes or view services as thevictorious outcomes of working-class struggles.Preteceilleand Terraildrawuponthe differential-ist understandingof the expansion of capitalistrelations as a total way of life in state-monopolycapitalist society. Yet, they situate this within ananalysis of social relations and materialpracticesas these are mediatedby work and the relations ofproduction. Preteceille and Terrail thus avoid asociology of despair n whichassertionof desirebythe workingclass serves to strengthen he matrixofclass power and domination. Instead, they poseclass struggleas the meansby which the emergingneeds of the working class to escape capitalistrelations of production and reproduction-needsthat can never be satisfied within a logic ofcapitalism-can be realized.Preteceille and Terrail apply this theory ofconsumption and needs to currentconditions instate monopoly capitalism. Needs, they argue,arise not from capital's manipulationof insatiableconsumerappetites,but fromclass struggleand thechanging conditions for the reproductionof laborpower. They note, for example, the increasingamount of hidden labor time and consumergoodsinvolvedin householdconsumption.The shift fromcornermarketsand delivery services to supermar-kets and shopping malls (requiringautomobilesand time to travel) representsa transfer of workfrom capitalto consumers, and thus an erosion ofnonworktime for the working class as a whole.Shortening the work day, therefore, does not

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REVIEWESSAYS 825increase uncommitted time if household andconsumerwork is expanding.Conditions of collective consumption are ana-lyzed also as the result of contradictory endenciesof class struggleand pressures or reproduction flabor power and the political integrationof theworkingclass. Preteceilleand Terrail ee consumermovementsas neither futile nor revolutionary,butas having the possibility of challenging capitalistproductionrelations.Although consumerneeds donot necessarilycontradictexisting arrangements fproduction and class, they may raise morefundamental ssues. The desire for higher qualityconsumergoods or for socializedconsumption,forexample, may shape needs for a logic ofproductiondifferent from that of profitability.The same contradictory dynamics of classstruggle infuse relations of production in state-monopoly capitalism. Preteceille and Terrail dis-cuss how the introductionof smaller work groupsby capitalist management n searchof stable laborrelationsand higher productivitymay create needsfor nonalienated work-needs that cannot besatisfied within a capitalist mode of production.Similarly, local movements against plant closureare defensive struggles, but may also challengecapital'sdrive for profitand affirm workers' needsfor identityas productive aborers.Preteceilleand Terrailconclude by proposingabroadpolitical agenda n which needs are acknowl-edged across the rangeof daily life concerns,fromwork to health, the environment, and livingconditions. They stress the importance of aclass-based politics, but see a tendency towardinterclassalliancesas heightenedcapitalistproduc-tivity increases the objective benefits of socialismin work and nonwork life for the middle andworking classes. As the traditional separationbetween the politics of productionand the politicsof consumption and daily life is eroded by thecontradictions nd crises of state-monopoly apital-ism, social movementsbasedon productionand onconsumption, they suggest, may converge inideology andpractice.Capitalism, Consumption, and Needs is animportantcontribution o developing a genuinelyMarxist theory of needs, consumption, and thepoliticsof daily life. It presentsa thoroughcritiquefrom a materialist perspective of the issues ofcommodificationof leisure and the dominationofdesire. The insistence on consumptionand needsas crucial in an analysis of advanced capitalistsociety is not new to Preteceille and Terrail, yetotherwork, as Kellner (1983: 69-75) argues, hastended to downplay class conflict and poseideological/culturaldomination as impervious tosignificant challenges from dominated groups.Preteceilleand Terrail, by linking issues of needsandconsumption o the logic of capitalist produc-

tion, rather han to the sphere of circulation, makeclass conflict central to theiranalysis.Preteceille and Terrail acknowledge the greaterburden of household and consumption work onwomen relative to men, but their analysis wouldbenefit from greater attentionto issues of gender.Two aspects in particularare problematic. First,Preteceille and Terrail situate their analysis ofconsumption practices at the social unit of thehousehold. This encompassesthe widest variety ofliving/consumption arrangements,but at the ex-pense of a sharpanalysis of genderrelations. Sincefamily and gender relationships structure mosthouseholds in twentieth-century dvanced capital-ist societies, a focus on household rather thanfamily mutes the analysis of gender. Closerattention to feminist research and theory wouldstrengthen Preteceille and Terrail's argument.Feministresearchnot only affirms the inseparabil-ity of production and consumption/reproduction(which Preteceille and Terrailalso argue, from amaterialist perspective) but also clarifies thedifferential effect of relations of productionandconsumption on women and men (Hartmann,1981; Kelly, 1983). Indeed, gender relations arecentral to the analysis of individualand collectiveconsumption in advanced capitalist society. Amore comprehensive exploration of the genderbasis of consumption work also would enrichPreteceilleandTerrail'sdiscussionof consumption-based politics and the possibilities for interclassgender-basedpolitical alliances.Second, by not confrontingcontemporaryemi-nist researchdirectly,Preteceilleand Terrail ail toelaborate on the gender consequences of classissues. Forexample, they see the increasein laborforce participationby married women as supple-mental to the wage of (male) workers and asrepresentinga decline in the qualityof life for theworking class. This analysis addresses the aggre-gate quantityof uncommittedime among working-class households withoutsufficiently exploringthecomplicatedissues of gender relations and finan-cial dependency that underlie women's positionwithin productionand reproduction. Although amaterialistanalysis of consumptionhighlights thenexus of class and productionrelations that shapegender relations, it runsthe riskof minimizingthedynamicsof family andgenderthatshapethe workof consumption and reproduction. Research ongender in advancedcapitalistsociety confirms theimpact of gender ideology and the materialpractices of family life on the structure ofconsumptionandthe creation of social needs.Futuredevelopment of a materialisttheory ofconsumptionand needs must address these issuesof gender and family relations. Nevertheless,Capitalism, Consumption,and Needs is a majoradvance in Marxist understandingof advanced

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826 REVIEW ESSAYScapitalistsocieties. Preteceilleand Terrailprovidea careful, systematic overview of the issues ofconsumer culture and the production of socialneeds that are basic to the agendaof politics andtheory in twentieth-century apitalism. This is animportantbook for understandinghe complicatednature of consumption and politics in modemcapitalist ife. IOther Literature CitedHalbwachs, Maurice. 1958. The Psychology of SocialClass. London:Heinemann.

Hartmann,Heidi I. 1981. "The Family as the Locus ofGender,Class, and Political Struggle:The ExampleofHousework." Signs 6:366-94.

Kellner, Douglas. 1983. "CriticalTheory,Commodities,andConsumerSociety." Theory, Culture,and Society1:66-83.Kelly, Joan, 1983. "The Doubled Vision of FeministTheory." In Sex and Class in Women's History, ed.Judith L. Newton, Mary P. Ryan, and Judith R.Walkowitz.Boston: Routledge& Kegan Paul.

Veblen, Thorstein. 1912. The Theory of the LeisureClass. New York: Macmillan.

Are HealthSystemsBecomingMore Socialized?National Strategiesfor Health Care Organization:A World Overview, by MILTONI. ROEMER.AnnArbor,MI: HealthAdministrationPress, 1985. 426 pp. $27.00 cloth.RAY H. ELLINGUniversityof ConnecticutHealth Center

This book collects adaptedand revised versionsof twenty-five articles, chapters, addresses, andreportswritten since 1976, some of them previ-ously publishedandothers in the form of workingpapers, essays, or reports to internationalhealthagencies. The authoris the preeminentscholarofour time in the comparative study of nationalhealthsystems. He is a mentorof mine, andI am along-termadmirerof the author's work, but thisreview will present a balanced view. There arepoints to be criticized as well as many to beappreciated.The twenty-five chaptersare organized in fiveparts:-historical backgroundand overview of healthcare organization, ncluding rends,financing,and structure f systems;-developing countries,madeup of one chapteron overall health care organization andstructure,plus individual countries (Guate-mala, Barbados,Thailand, Kenya, Malaysia);-industrialized nations, including an overviewof health policies and strategies and theireffects in Europe, as well as chapters onNorway, the United Kingdom, and Canada;-socialist countries,includinganalysesof bothindustrializedand less economically devel-oped nations(USSR, Poland, Cuba, People'sRepublicof China);-an examinationof generalhealth care policyissues under different national strategies(ambulatorycare, regionalization of healthservices, coordinatingpersonneldevelopment

and services, health insurance, and planningmethodologies).This is rich fare for the studentof comparativehealth systems and international health. It isinformed by deep, wide, and long experience.From a sociological perspective, one of the mostvaluablecontributionss found in chapter3, "TheStructureand Types of HealthService Systems."Having recognized a set of forces, including thephysical and social environments, the biologicalstatus of a nation's population, and the healthservices as determinants of a "population'sphysical, mental, and social well-being" (theWHO definition of health), the author givesprimacy o politicaleconomicforces. From this, hederives a nine-cell typology of national healthsystems.Along one axis is level of resources (affluentorindustrialized, moderateor developing, and pooror underdeveloped);along the other are politicaleconomic forms(permissiveor laissez-faire, coop-erative or welfare, socialist or centrally planned).By way of examples, the United Statesof Americafits in the affluentpermissivebox, the UK in theaffluent cooperative, and the Soviet Union in theaffluentsocialist. At the moderate evel, the threepolitical economic types are exemplified by thePhilippines,Peru,andCuba, andat the poor level,Ghana,Tanzania,and China.There would be much to discuss about such atypology. Forexample, how dynamicor frozen arethe placements of countries? Ghana and thePhilippinestoday are in ferment and challengingtheir dependenceon the capitalistworld-system of