For the past decade and more, American psychiatry has been at sea on the adventurous if uncontrolled odyssey of community psychiatry. The voyage has often coursed through uncharted oceans, and for many the purpose and destination of the journey have been obscure. Even among those whose sights are clearer, there is growing concern that the ship will be becalmed by inadequate funding or run aground on the shoals of bureaucratic anarchy. For all of these voyagers this volume should come as a welcome compass. The authors' review of their subject is encyclopedic. They have not only traced the origins of modem concepts and studies back to their historical roots, but have drawn their material widely from the work of investigators throughout the world to illustrate current trends and prob lems. The novice will find their discussion of epidemiology a clearly written and useful introduction to one of the scientific foundations of social psychiatry, and novice and expert alike can profit from their thoughtful and critical assessment of basic terms and concepts, including illuminating chapters on stress, genetics, psychophysiologic disorders, and cultural psychiatry. The volume ends on a personal note as the authors present their views of the current state of social psychiatry and suggest ways in which its theoretical structure might be strengthened. Too often the plight of the individual is overlooked in the concern with impersonal numbers and surveys that preoccupy epidemiologists and social scientists.

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1 · The Social Psychiatric Setting.- The development of psychiatry as a specialty.- social psychiatry and social change.- reasons for fluctuating interest in the field.- renewed interest in social psychiatry since World War II.- current fears of increased mental illness.- the culture of violence..- 2 · Social Psychiatry: Definitions and Scope.- The recent development of social psychiatry.- definitions and distinguishing characteristics.- scope of social psychiatry: cause and treatment of mental illness, governmental programs, cultural influences, social control, the sicksociety?.- current status of social psychiatry.- psychiatry's identity crisis.- 3 · The Epidemiologic Background.- Definitions of epidemiology.- Hippocrates.- mental epidemics.- historical background.- host, agent, and environment.- medical ecology.- 4 · Epidemiologie Terms, Concepts, and Levels of Investigation.- Hypotheses.- problems with case finding.- Farr's studies of prisoners.- case, risk, and population at risk.- counting.- prevalence and incidence.- descriptive epidemiology.- investigative epidemiology.- analytic epidemiology.- experimental epidemiology.- 5 · Raw Materials and Tools Part 1 · Secondary Source Data.- Secondhand information.- Goldhamer and Marshall.- findings from rates-under-treatment studies.- trends in psychiatrie hospitalization.- data from death certificates.- suicide and homicide rates.- limitations and appropriate uses of secondary source data.- social indicator analyses.- key informant data.- 5 · Raw Materials and Tools Part 2 · Primary Source Data.- Firsthand information.- the survey approach.- sampling.- methodology for surveys.- methodology for cohort studies.- census investigations.- the social breakdown syndrome.- nationwide surveys.-scales.- sensitivity and specificity.- validity and reliability.- interviewer and response bias.- 6 · Associations and Causation.- Associations.- inferences about causation.- the concept of causation.- causation in psychiatry.- multiple causation.- ecologic concepts of causation.- 7 · Early History of Psychiatrie Epidemiology.- The sociology of knowledge.- the seventeenth and eighteenth century background.- extrusion of the mentally ill from society.- early nineteenth century studies.- Pinel.- Esquirol.- Burrows.- Griesinger.- Jarvis.- Daniel H. Tuke.- resumé.- 8 · The Problem: Concepts and Definitions of Mental Illness. ....- Definitions of health.- the myth of mental illness.- the medical model.- the social-statistical model.- the super-normal.- Sjöbring's pathologic and normal variations.- the normative and cultural models.- impairment.- some current trends.- 9 · The Quest for Prevalence: Twentieth-Century Studies19001950.- The neuropsychiatrie influence.- psychoanalytic and psychobiologic contributions.- early prevalence studies.- Williamson County, Tennessee study.- Norwegian coastal village study.- other studies in the 1940's.- summary.- 10 · Social Correlates and Questions of Etiology: Twentieth-Century StudiesSince 1940.- Faris and Dunham's Mental Disorders in UrbanAreas.- geographic distributions: Bristol and Hagerstown.- changing patterns.- social class and mental illness in New Haven.- the Midtown Manhattan study.- stress and strain.- stress and impairment.- low SES and high rates of mental disorder.- social causation and social selection.- drift.- social mobility.- labeling.- migration and mental illness.- Minnesota-Norway.- migration and social change.- 11 · The Community: Twentieth-Century Studies.- The Hutterites.- theStirling County study.- the integration-disintegration frame of reference.- Stirling County-The Road.- psychiatrie disorders among the Yoruba.- 12 · Later Twentieth-Century Studies.- Lundby, Sweden, Essen-Möller.- Lundby, Sweden, Hagnell.- the incidence of mental illness.- Lundby: predictive implications.- Stirling County and Lundby comparisons.- Iceland.- Midtown Manhattan re-study.- discussion and summary.- 13 · Assessing Hereditary and Sociocultural Factors: Genetics.- Background.- population genetics.- family and pedigree studies.- adoptee studies.- census studies.- longitudinal studies.- summary of findings: schizophrenia, manic-depressive illness, neurosis, alcoholism, intelligence.- 14 · Stress and Life Events.- The physiological background.- concepts of stress in psychiatry.- studies of healthy populations.- life events scales.- stress and mental illness.- 15 · Psychosomatic and Psychophysiologic Disorders.- Frequency and distribution: age, sex, race, and social class.- the concept of psychosomatic illness.- changing patterns.- coronary heart disease: Framingham and WCGS comparisons.- CHD and social psychologic factors.- social processes and psychosomatic illnesses.- 16 · Cultural Psychiatry.- Early psychiatric approaches.- early anthropologie approaches.- the convergence of interests.- ethnic psychoses.- culture and personality.- the concept of culture.- transcultural psychiatry.- culture and mental illness.- culture change.- cultural psychiatry in a complex society.- culture's pathogenic influence.- acculturation.- culture's therapeutic influences.- the cost of mental illness.- 17 · Findings and Issues.- Consistent findings.- is mental illness increasing?.- lower social status and high prevalence.- the problem of untreated mental illness.- the needfor theory.- 18 · Social Psychiatry: Concepts and Models.- Rabkin's metapsychological model.- role performance and role strain.- consciousness, personality and behavior.- community integration.- disintegration.- stress-strain.- social change and social psychiatry.- Author Index.