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

307-320
Culture, Psychiatry, and the Written Wordt
J. C. Carothers *
A
NUMBER 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 im-
portant 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 disturb-
ance as between nonliterate African peo-
ples and western Europeans.
1
Later, in a
monograph for the World Health Organi-
zation, I collated these findings with those
of other psychiatric writers on this sub-
ject, and arrived at certain general con-
clusions.
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," "par-
aphrenic," and "paranoid" are seldom
seen. In general, the clinical picture in
schizophrenic patients is marked by con-
fusion, 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 PeculIar-
ities, More Especially In Relation to the African
Attitude to Life," J. Mental Sci. (1947) 93:548-597.
Carothers, "Frontal Lobe Function and the Afri-
can," J. Mental Sci. (1951) 97:12-48.
2 Carothers, The African Mind in Health and Dis-
ease; Geneva, World Health Organization Monograph
Series, No. 17, 1953.
chosis, is a common stumbling block in
differential diagnosis, in Africans, schizo-
phrenia is more liable to be confused with
one of the organic psychoses," a and Laub-
scher, 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 syn-
dromes with retardation and ideas of
guilt, unworthiness, or remorse are hardly
to be found among the rural populations.
It may be that some hypochondriacal pa-
tients are fundamentally 'depressive,' but
depression, in a mental sense, is rarely ad-
mitted 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 condi-
tions, 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 Psychopathol-
ogy: A Study of South African Pagan Natives; Lon-
don, 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
3850; 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.
[307 ]
308
this time by any degree of violence, ex-
ternally 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' dif-
ferences between Africans and Europeans,
but from cultural factors which are so
markedly divergent in these two human
groups that their 'normal' mental develop-
ment occurs on very different lines. I con-
tended that, by reason of the type of edu-
cational influences which impinge upon
Africans in infancy and childhood, and in-
deed 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 independ-
ent, 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 constric-
tion 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 highlyextra-
verted, 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. Behav-
ior is minutely governed from childhood
on in a host of particular, concrete situa-
tions 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 animis-
tic lines, which are far too facile and too
final, and effectively frustrate childish
curiosity and suppress the urge to specu-
late. Whereas the Western child is early
introduced to building blocks, keys in
J. C. CAROTHERS
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 per-
sonal 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 differ-
ence is of fundamental importance for the
development of thought. Finally, the
monograph called attention to the impor-
tance of the very recent introduction of
the written word to Negro and Bantu-
Negro Africa. The significance of this-
and 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 men-
tioned may be no more true for nonliterate
Africans than it is for many other 11on-
literate societies the world over.
Opler, writing in his recent book on the
much broader theme of culture, psychi-
atry, 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, Eski-
mos, Ojibwa, Cree, Fuegians, and various cul-
tures of Asia, Africa, northern Europe, and
CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 309
the Pacific, with their relatively low inci-
dence 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 Euro-
pean 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 identifica-
tion (homosexual or asexual) be masked by
systematized rationalizations, but basic hos-
tility 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 docu-
mented, 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 in-
considerable 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 atti-
tudes 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 re-
minder 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 Ken-
yatta, 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 magi-
cal formula .... After this recitation he calls
the name of the girl loudly and starts to ad-
dress her as though she were listening.
Describing the tribal execution of a Ki-
kuyu 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 sup-
posed '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.
310
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, how-
ever, 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 im-
plications of this change for sociocultural
development? And how far are the theo-
ries developed in answer to the first two
questions supported by the facts of eth-
nology 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 move-
ments, events, activities, for which man,
when largely unprotected from the haz-
ards 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 di-
rect 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, "see-
ing 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.
J. C. CAROTHERS
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 instru-
ment of the will, the ear being the main
receiving organ.
In the earlier article which I have men-
tioned, 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 West-
ern world, a well-developed sense of spa-
tiotemporal relations and of causal rela-
tionship 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 objec-
tive, 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-rid-
den 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 percep-
tual 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; Lon-
don, Routledge and Paul, 1954; p. 14. The italics are
my own.
CULTURE, PSYCHIATRY, AND THE WRITTEN WORD
311
like to turn to a consideration of the writ-
ten word.
When words are written, they become,
of ~ o u r s e , 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 character-
istic 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 com-
monly 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 em-
phases which have been described, for in-
stance, 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 mes-
sages 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 ac-
cording 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 dyna-
mism 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 predomi-
nantly 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 re-
store 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 gen-
eral 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 pos-
sible 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 be-
comes easy to see that verbal thought is
not of its nature behavioral and is sepa-
rable 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 our-
selves, of course, for no existing society
really allows free speech. All societies
place well-defined limitations upon
speech; and, although there are no ex-
plicit 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, how-
ever, 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 con-
straints can, in theory at least, afford to
ignore ideation. This, however, is a rather
special case, which I refer to here for pur-
poses 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 mem-
b'ers, but their manner of achieving this
will vary and will fundamentally depend
on their attitude in regard to the relation
312
of thought and deed. In those societies-
apparently 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 dis-
tinction 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 behav-
ioral 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 per-
sonal 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 recog-
nized. Therefore, if and when such think-
ing does occur, at other than strictly prac-
tical 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 be-
come incapable of creative, speculative
thought on personal lines, confining him-
self 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 societies-
which seem to comprise most, if not all,
literate societies-where verbal thought
is recognized as being in some sense sep-
arable 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 prevail-
ing attitude in each society as to the part
that 'thought' and 'will' may play in gov-
erning behavior. Thus such societies may
J . C. CAROTHERS
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 ap-
proach of such societies to the problem of
conformity is more sophisticated and does
not fail to take account of this; and the in-
dividual 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 in-
complete, 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 non-
literacy in a society is a fairly straight-
forward, meaningful phenomenon, liter-
acy 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 re-
lation to their nonliterate or literate state.
The power of the word in ancient
Greece.-Writing developed at first in cer-
tain hierarchic societies-for example, the
Egyptian, Sumerian, and Mayan-in the
form of hieroglyphs, or, literally, priestly
carvings, which were virtually the monop-
oly 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 ac-
counts, the recording of events, and the
maintenance and elaboration of those tra-
ditional modes.
CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 313
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 in-
tense curiosity and energetic speculation,
produced so little that could be called sci-
entific, 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 domi-
nated modern philosophy were first thought
of by the Greeks; their imaginative inventive-
ness in abstract matters can hardly be too
highly praised .. _ . they discovered mathe-
matics 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 re-
placed 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 rejec-
tion of empirical knowledge, including all his-
tory 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 mathe-
matics; 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 Philos-
ophy; New York, Simon and Schuster, 1945; pp.
3839.
world. The next step-and this is the crucial
one-depends upon the idea of the good. Hav-
ing 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 ex-
periment as methods for the attainment of
knowledge .... The two kinds of mental ac-
tivity that can be pursued by the method that
Plato recommends are mathematics and mys-
tic 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 emancipa-
tion of thought which first occurred
among the early Greek intelligentsia de-
rived from the fact that this group was
literate, and so had the benefit of knowing
what other people thought, yet by a for-
tunate circumstance was not entram-
meled by a hierarchy backed by a priestly
literature. Writing at last was at the dis-
posal 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. Al-
though at last it was seen as nonbehav-
ioral 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, in-
deed, the power of words or other visual
symbols became greater than before, for,
whereas previously it is likely that hear-
ing was believing, now verbal and mathe-
matical 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 de-
velop the scientific method has often been
U See footnote 12; pp. 130-137.
314
expressed. If, however, it is true that
the most 'real' aspect of the world for non-
literate 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 ex-
pressed 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 extraor-
dinarily quick and alert mentally, are not
thinkers in our sense-and their language is
a reflection of their life and their racial char-
acter. 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 encourage-
ment 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 reveal-
ing 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 un-
orthodox within his culture could hardly
be devised. Whatever other educational
factors play a part in achieving Eskimo
conformity, this one alone would be effec-
tive.
14 KatharIne Scherman, Spring on an Arctic Island;
Boston, Little, Brown, 1956.
15 See footnote 14.
J. C. CAROTHERS
Riesman's description of "tradition-di_
rected" societies.-Riesman's stimulating
book, The Lonely Crowd,16 calls for con-
sideration in the context of the present
article. His study of the modes by which
conformity is achieved in various socie-
ties, 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 de-
creasing 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 indus-
trialization; 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 mem-
bers "tradition-directed." He equates the
areas of transitional growth with post-
Renaissance Europe and sees these soci-
eties as developing in their "typical mem-
bers 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-di-
rected." Finally, he locates the areas of
incipient population decline most char-
acteristically 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.
CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 315
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 inner-
and other-directed peoples correspond as
closely with the areas occupied by socie-
ties which have long been much in-
fluenced 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 con-
formity 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-rela-
tions which have endured for centuries and
are modified but slightly, if at all, by succes-
sive generations. The culture controls be-
havior minutely, and, while the rules are not
so complicated that the young cannot learn
them during the period of intensive socializa-
tion, careful and rigid etiquette governs the
fundamentally influential sphere of kin rela-
tionships. Moreover, the culture, in addition
to its economic tasks, or as part of them, pro-
vides ritual, routine, . and religion to occupy
and to orient everyone. Little energy is di-
rected 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, Ries-
man says:
In societies' in which tradition-direction is the
dominant mode of insuring conformity, atten-
tion is focused on securing external behavioral
conformity. While behavior is pre-
scribed, 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 requi-
site. By contrast, societies in which inner-
direction becomes important, though they also
are concerned with behavioral conformity,
cannot be satisfied with behavioral conformity
alone. Too many novel situations are pre-
sented, situations which a code cannot en-
compass in advance. Consequently the prob-
lem 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 tradition-
directed 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-di-
rected, 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 corre-
lated. 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 conform-
ity. Now it is doubtless true that con-
scious, deliberate attention is focused on
securing -external behavioral conformity;
for instance, to quote Westermann:
The gods and ancestors take but a slight in-
terest in the ethical behaviour of their wor-
shippers and are almost indifferent as to the
inner attitude in which they are approached .
What they demand is offerings and invoca-
tions. ' ... Ethics, in the sense of civic vir-
tues, are rooted in the traditional rulesregu-
lating the behaviour in social groups.22 ,
But the point, as ,1 see it, ' is .thatin' niany
if not all of these

bbtli

DiedrIch
. . TomOrrow;. London; : 1939: :"':" ; ;,
316
after all, the most fearful type of 'behav-
ior' 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 ap-
preciation 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 individ-
uals 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 can-
not 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 charac-
terize that movement. Some of these
oaths and rituals were obscene and shock-
ing, both by western European standards
and by the traditional standards of the
Kikuyu people themselves. They de-
pended, 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 subse-
quent difficulty in rehabilitating its ex-
ponents-or its victims-has been due to
this. Clearly, therefore, in this tradition-
directed people-the Kikuyu and certain
allied tribes-society does achieve con-
formity by constraining thought as well as
action. I have no reason to believe that
in this regard, they are likely to be p e c u ~
liar among such societies.
Piaget's studies .of the development of
thought.-Piaget, in his studies of Euro-
pean children,24 . has, broadly speaking,
recognized three major stages in the de-
velopment of their modes of thinking.
In the first stage, which lasts to the age
of two or three years, there is little self-
consciousness, 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, al-
though 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 ob-
jects 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 gen-
erality 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 Piag
et
,
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 Concep-
tion 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 ex-
plained in the monograph in terms of en-
vironmental factors and on the lines indi-
cated in earlier pages of this article, and it
is noteworthy that Dougall many years be-
fore had made closely similar observations
in regard to African psychology and in re-
lation 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 coin-
cidence 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 writ-
ten word is only one facet of a cultural
environment which differs in many others
from that of African children. Neverthe-
less, 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 illustra-
tion, however, would seem to demonstrate,
very much more definitely, that the acqui-
sition 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 ap-
peared 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 farreaching 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 willpower for
him to be faithful in uninteresting work, and
lack of interest brings fatigue.
The writer then described and illus-
trated the enhancement of interest in the
pleasures of taste and of sex, and the in-
318
crease in the sense of pain and in reason-
able fears which he had observed to oc-
cur in Africans when they received a lit-
tle education on European lines. He con-
cluded:
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
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 nearly all worked, will never
be seen agam. The new generation is com-
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 temp-
tations. African parents need to be taught
before it is too late so that they may real-
Ize 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 edu-
cation" on European lines that the Afri-
can's whole attitude toward life is
changed in the manner he describes. This
education often comprises little more than
some familiarity with written symbols-
in reading, writing, and arithmetic-and it
would seem that this alone can be effec-
tive 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 con-
fine their members within the bounds of
Piaget's second stage.
The influence of the invention of p1'int-
ing on thought.-Since printing can enor-
mously increase the availability of written
words, it is to be expected that its inven-
tion would have important effects on
thought. It worth while, therefore, to
consider very briefly the part that print-
ing 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-re-
quires much erudition for its understand-
ing. 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 pro-
digious 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 prepara-
tion. Composition is still more of a task. Few
Occidentals have achieved an acceptable style
and many a modern Chinese who is the fin-
ished 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. 301302. .
CULTURE, PSYCHIATRY, AND THE WRITTEN WORD 319
very much in the hands of a scholarly mi-
nority, 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 circum-
stances, 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 in-
herited 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 other-
wise, 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 dis-
tinct 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 be-
liefs, 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 revo-
lutionary inquiry and by inductive sci-
entific 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 consti-
tutions 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 deci-
pher it are not likely to be profitable. It is
far more profitable to study the psychol-
ogy 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 differ-
ences 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 conspicu-
ously and fundamentally on this basis. I
have endeavored, by considering some as-
pects of the psychology of nonliterate and
literate peoples, to show how this might
come about. It is postulated that the rec-
ognition 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 tenta-
tive, but are here put forward in the be-
lief 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