OF TWO MINDS: The Growing Disorder in American Psychiatry
By T. M. Luhrmann. Knopf. 352 pp.$26.95
pose such grave challenges that they must be directly confronted. Respect for the free exercise of religion, for example, does not encompass human sacrifice.
In moving from the general to the particular, the difficulties with Macedo’s thesis emerge. To begin with, "liberal democracy" names a family of conceptions, not a single uncontested view. For example, Macedo regards participation in public life as an end in itself; other liberals disagree. So certain kinds of liberals could embrace schools that Macedo deems defective.
Second, liberals can agree on the ends of education while disagreeing on the means. Macedo describes the common school "ideal" as an institution that contains society’s diversity in a context of tolerance and mutual respect. Unfortunately, relatively few public schools qualify. In many urban areas, in fact, the Catholic schools are more "common" than the public schools. Macedo offers almost no evidence that students attending sectarian schools emerge less tolerant or as inferior citizens overall.
Third, it is possible for liberals to disagree about the priority that should be attached to different components of their creed. While Macedo regards the Religious Freedom Restoration Act of 1993 as a "disaster," for example, other liberals saw it as safeguarding the central place that religious freedom occupies in liberal morality and constitutionalism.
Finally, many liberals believe that liberalism’s public principles need not govern the totality of one’s private life. Despite his critique of civic totalism, Macedo’s brand of liberalism comes close to effacing the public-private distinction. He speaks repeatedly of civic liberalism’s "transformative aims," by which he means (among other things) reshaping civil associations and even religious institutions to be consonant with liberal public principles. At one point he says that "liberal citizens should be committed to honoring the public demands of liberal justice in all departments of their lives," from which it would seem to follow that American Catholics are obligated to apply public laws against gender discrimination to the recruitment of their priests.
When public norms and religious commitments come into conflict, which should prevail? Macedo’s brand of liberalism accords "supreme importance" to maintaining political institutions. Other, no less authentic understandings see freedom of religious expression as a liberal end to which liberal institutions are simply means. No verbal formula can dissolve the tension between basic liberties and the requirements of the institutions that protect them.
—William A. Galston
Science & Technology
OF TWO MINDS:
The Growing Disorder in
By T. M. Luhrmann. Knopf. 352 pp. $26.95
In Structural Anthropology (1963), Claude Levi-Strauss retells the story, collected by Franz Boas, of the sorcerer Quesalid, a Kwakiutl Indian of Vancouver, Canada. Quesalid is a skeptic who studies with shamans in order to expose their tricks. Their darkest secret involves a tuft of down which the shaman hides in his cheek and, at the crucial moment, spits out, covered with blood—false evidence of illness sucked from an afflicted body. But Quesalid finds himself trapped: As an apprentice shaman, he cures patients with such success that he cannot cast off his calling. His attitude changes. He comes to value conscientiousness and forget his initial doubts. The signs of the true shaman, he declares, are that "he does not allow those who are made well to pay him" and that he never laughs.
Each year, I assign this passage to beginning psychiatry trainees. It speaks not only to their cynicism, but to their growing sense of competence as they enter a fellowship whose methods are vulnerable to attack and yet demonstrably effective.
Of Two Minds examines how psychiatric residents become acculturated in this fellowship. Luhrmann, an anthropology professor at the University of California, San Diego, calls her method ethnography, but she writes like a journalist who has dived into psychiatric training. The result is a reasoned and reasonable
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report on the current state of psychiatry and its struggle with Cartesian dualism—mind and brain.
Luhrmann shares the viewpoint of her subjects: Mental illness exists, and it responds to both medication and the talking cure. Despite their contradictions, she finds, these two methods can be combined to good effect. She recognizes and appreciates wisdom and experience in senior clinicians. To her, psychiatry is a vital and fascinating field—"unquenchably compelling because it forever changes the way you understand human experience"—unjustly inhibited by excessive managed care. The book’s provocative subtitle notwithstanding, she mostly admires what she sees in American psychiatry.
Luhrmann is a good storyteller, convincing in her accounts of professors, students, and patients. She ignores, however, a substantial literature on the training of physicians. We never learn how becoming a psychiatrist here and now contrasts with entry into other professional cultures, or with entry into psychiatry in other countries or (except in passing) other eras.
But she gets the portrait right; at least I see the profession as she does: honorable, demanding, flawed in the manner of all human enterprises. And at a time when the profession is under siege, accuracy is virtue enough.
—Peter D. Kramer
—Peter D. Kramer
RAILWAYS AND THE VICTORIAN IMAGINATION.
By Michael Freeman. Yale Univ. Press. 264 pp. $39.95
In 1990, century-old paintings by the oncecelebrated English sporting artist George Earl reappeared on the market. Going North and Going South, showing wealthy Londoners thronging the King’s Cross and Perth railway stations at the beginning and the end of the season in Scotland, had followed the sad but common downward trajectory of Victorian society art: they were discovered in the disco lounge of a Liverpool pub.
In universities, railroads likewise have an equivocal reputation. For most academics outside the field of economic history, they are too important and too accessible to be theoretically interesting. Even economic historians have misgivings. In the 1960s, Robert Fogel argued that other transportation technologies, especially canals, could have promoted growth equally effectively. In cultural studies, one major book appears each decade or so, such as Wolfgang Schivelbusch’s The Railway Journey (1979) and Jeffrey Richards and John M. McKenzie’s The Railway Station (1986).
Freeman’s book is the best blend of solid scholarship and sumptuous production yet. An Oxford University geographer, he portrays the railroad as one of the most radical and rapidly introduced discontinuities in the everyday life of the United Kingdom. The very establishment of a line was socially disruptive. Each road needed its own act of Parliament authorizing the surveying and forced sale of private property to the new company—a minor social revolution that initially mobilized landowners and tenants against the invaders. Cartoonists depicted railroads as voracious monsters swallowing the countryside (in contrast to the modern view of the train as the environmentally preferable alternative to the automobile). Some early surveyors had to work surreptitiously, using darkened lanterns at night, and one company hired a prizefighter to carry its surveying instruments.
Trauma soon yielded to fascination as landscapes little changed since the Middle Ages were transformed. Artists and poets found that railroads could blight nature, but they could also accentuate the picturesque. Lines afforded panoramic views of monuments such as Durham Cathedral. Viaducts added graceful rhythmic punctuation to landscapes, while tunnels evoked the darker side of Romantic sublimity. As Freeman