Book Reviews

BOOK REVIEWS

Robert E. Bartholomew (2000) Exotic Deviance: Medicalizing Cultural Idioms— From Strangeness to Illness . Colorado: University Press of Colorado. 280 pages. ISBN 9–63911– 699– 8.

Although the title screams for attention, it is the subtitle that is a more accurate re ection of Bartholomew’s book, Exotic Deviance: Medicalizing Cultural Idioms — From Strangeness to Illness. This is not as much a select study of bizarre cultural behaviour as it is of the Western medical and psychiatric interpretations of them. This book is a compilation of Bartholomew’s research conducted since the mid-1990s on various bizarre and deviant behaviour, but which united under a common theoretical thread in this book — the critique of the medicalisation of deviance. The line of critique follows the theoretical framework that Peter Conrad and Joseph Schneider (1992) have mapped out in their seminal study, Deviance and Medicalization: From Badness to Sickness , except that Bartholomew extends its scope to the medicalisation of more exotic deviant behaviour in non-Western contexts. The argument is simple but forceful — because of inadequate cultural understanding, certain strange behaviours are mis- takenly categorised as medical illnesses even though they are culturally rational and adaptive responses if only one understood their actual social meanings. Bartholomew utilises what he calls “an eclectic blend of inter- actionist, phenomenological, con ict and feminist models” (15) to examine the process of deviance creation and the social and cultural bases of deviance categorising. By looking at the social and cultural patterning of episodes, the political nature of deviance designations and gender aspects of those de ned as deviant, Bartholomew conceptualises medical “syndromes” as deviant social roles and worldviews. His approach, together with his dis- covery that many Western psychiatric studies on the phenomena lack consistent biological or clinical ndings of abnormality, demonstrates the insidious operation of categorical fallacies in medical and psychiatric approaches. He focuses on three di Verent types of medicalised deviant cultural practices. The rst is Latah, which according to contemporary psychiatric consensus, is a category of mental disorder characterised by the mimicry of body movements, actions and verbal articulations of another that is brought about by startling the subject. Bartholomew suggests instead that Latah is a multi-functional idiom utilised for achieving various social gains, and is therefore more adequately seen as a form of performance or fraud. This explains why it is utilised by the politically weak, in this case largely women and children, to perpetuate transgressions of their cultural conduct with impunity (Chapters 2 and 3).

The second disorder is koro, a delusion that involves the perception of genital shrinkage or retraction and its accompanying panic, common in parts of Asia. Psychiatry typi es koro as a hysterical variant of universal categories of human sexual dysfunction precipitated by culture-speci c folk beliefs and various pathologies, such as obsessive-compulsive disorder, sexual- con ict neurosis and psychosexual disorder. However, Bartholomew nds that koro is more adequately conceptualised as a case of social misperception, a non-pathological mass adherence to a false belief that is perpetuated because of the social construction of rumour (Chapter 4). Lastly, Bartholomew looks at variants of “mass psychogenic illnesses”: 1) medieval dancing manias; 2) epidemic conversion hysteria in schools. The medieval dancing manias examined include tarantism and Saint Vitus’ dance. The former is the mass reaction to perceived bites of the tarantula spider during the Middle Ages in southern Italy, where people would then dance publicly in great excitement as a means of temporary cure. The lat- ter is a dancing mania observed between the 13th and 17th century through- out Europe, where participants often ended their processions in the vicinity of shrines and chapels dedicated to this saint. These various behaviour are regarded by biomedicine and psychiatry as historically speci c mani- festations of “ epidemic hysteria” , a form of unitary mental disorder that had speci c features such as female susceptibility and abnormal personality correlates. On the contrary, Bartholomew argues that dance manias were simply rituals that happened during periods of social upheaval, such as during crop failures and famine, as such behaviour were a socially accept- able means of expressing deeply rooted emotional con icts (Chapter 5). In his analysis of mass hysteria in school settings, he claims that the extreme anxiety reactions or psychomotor activity are the result of wide- spread misperception that were perpetuated by participants who over-scru- tinised and rei ed tangible but ambiguous rumour-related objects from the environment (156). This is the mechanism that perpetuates beliefs in various beliefs in the paranormal, an area in which he does extensive research. But before we start assuming that Bartholomew is simply going to fol- low the trajectory of his argument — that what has been regarded as mental disorders are actually behavioural idioms that have been misinterpreted by scholars who did not have an intimate understanding of the regional context and meanings — he criticises the “antipsychiatrists” and radical feminists who take an extreme constructivist position by their assertion that such events are a structural result of female subjugation and that few, if any behaviour deserves the label of mental illness. He rejects the feminist discourse that views such events purely in terms of female protest and dis- tress and cautions against regarding nearly any unconventional behaviour given a disorder label as a social construction. Citing the uniformity of symptoms as consistent across cultures and time periods, he is convinced that mass psychogenic illness is a stress-induced medical syndrome. Bartho-