Book Review
Transcultural Psychiatry 
Revenge of the Windigo. The Construction of the Mind and Mental Health of North American Aboriginal People. James B Waldram. Toronto: University of Toronto Press; 2004. 414 p. CAN$29.95.
Reviewer
rating*: Excellent
Review by: Frank Frantisek Engelsmann, PhD, CSc
Montreal, Quebec
JB Waldram, a medical anthropologist and professor in the Department of Psychology at the University of Saskatchewan, spent considerable time in Algonkian communities in Northern Canada, where he heard stories of the windigo, the cannibal monster. In this book, he presents a remarkable critical review of studies of North American Aboriginal people. He tries to show how 3 disciplines— anthropology, psychology, and psychiatry— created and distorted our image of Aboriginal people. The author does not offer new data but, rather, points out the problems scholars and researchers have encountered with concepts, methods, and theories—problems that have led to questionable conclusions and generalizations often devoid of historical and social context.
The book has 12 chapters divided into 3 parts. The first part reviews efforts in the first half of the 20th century to identify basic Aboriginal personality structure; it discusses classic approaches by anthropologists such as Ruth Benedict and her contemporaries, who were influenced by the pioneering work of Franz Boas. Their projects aimed to preserve the vanishing North American Aboriginal cultures and explore their patterns. Benedict’s work is criticized for omissions or selective use of nonconforming data, for example, in regard to violence and alcohol abuse (p 25). Waldram concludes that Benedict’s classic examination was fundamentally flawed (p 26). He describes the emergence of psychoanalytical anthropology and the influence of Sigmund Freud’s evolutionary ideas that sought parallels between “primitive” people and neurotic behaviour. Culture-and- personality studies came under attack by the middle of the 20th century, however, with new interest in the trait list approach to personality and problems of acculturation.
One of the most documented efforts to focus on the psychological consequences of acculturation was the Indian Education and Administration Research Project, initiated in 1941 at the University of Chicago. This interdisciplinary project aimed to improve Indian schooling and administration. It involved some 50 eminent scientists and used standardized psychological tests such as the Rorschach, Thematic Apperception Test, Goodenough Draw-A-Man, Wechsler Intelligence Scales, and other methods. The tests might have failed to measure “Native intelligence,” but they helped to refine cross-cultural techniques. Some of the monographs produced became ethnographic classics, although cautionary notes warned readers not to overgeneralize. The project was a testing ground for cooperation among anthropologists, psychologists, and psychoanalytic psychiatrists. Anthropologists persevered in their use of tests and generated psychological profiles for many different Aboriginal North American groups. Rorschach was useful for cross-cultural comparison, although some results were too general or vague to be of value. The Minnesota Multiphasic Personality Inventory (MMPI) was also widely used, but acculturation and socioeconomic status—especially education or occupation—affected scores on the abbreviated MMPI 168-item scale. Psychometric approaches to the study of personality and intelligence attempted to capture the essence of the Aboriginal in terms of a few items and scale scores used to differentiate among groups and cultures—but whatever culture is, it is certainly not simply a variable (p 101).
The second part of the book examines both early and contemporary studies of Aboriginal psychopathology, with specific attention to concepts of acculturative stress. Some early acculturation studies held the view that utopian, “genuine,” internally harmonious Aboriginal cultures existed before the arrival of Europeans. Other early studies described Aboriginals as unbalanced, childlike, and simplistic. Echoing the views of Ruth Benedict, George Devreux, a psychoanalyst with an anthropological inclination, questioned the appropriateness of Western psychiatric diagnosis for American Indian peoples. Nevertheless, ethnography and psychiatric epidemiology are compatible, even though psychiatric diagnostic methods have limited cross-cultural validity.
No single Aboriginal mental health topic has dominated the research as much as alcohol abuse, a topic that has generated genuine concern as well as absurdities with racist overtones. To review the literature on the drinking habits of Aboriginal people is a monumental task. In short, drinking can have destructive as well as adaptive effects, and contradictory evidence has become a part of research. Many individuals and communities are, in fact, doing well.
Aboriginal depression and suicide show high and increasing rates linked to cultural discontinuity (acculturation or anomie), physical illness, accidents, and social disorganization. Waldram calls for the development of an integrated explanation to account for the variability of depression and suicide patterns or why some individuals, but not others, suffer so much distress. He singles out 3 culture-bound syndromes—windigo psychosis, pibloktoq (arctic hysteria, a dissociative trance disorder), and ghost sickness—as “unparalleled examples of wayward psychiatric mythologising . . . folklore, errant historical documents and naive scholarship” (p 211). The author holds that posttraumatic stress disorder, one of the recently defined and significant psychiatric diagnostic categories, needs analysis and conceptualizing in regard to the historic, cultural, collective, and other types of trauma found in the Aboriginal mental health discourse. Trauma is a common part of human experience, but some described traumas reach extreme and tragic proportions.
The third and last part of the book deals with treatment. It focuses on ethics and values believed to be effective in therapeutic interventions. In retrospect, some of the guidance for culturally competent treatment appears absurd (p 246). The author discusses issues of therapist and counsellor compatibility with Aboriginal clients, as well as the utility of individual and group-oriented treatment. Aboriginal values have been presented as categorical and absolute, despite evidence of extensive ambivalence and contradiction. No clear definitions of Aboriginal traditional healing exist, which may be a metaphor for social change as well as personal recovery. The last pages of the book call attention to so-called “creolization,” a process promoting the exploration of the ethnocultural interplay with mental health within a context of cultural heterogeneity, globalization, increased communication, and social change.
It is not easy to report in detail on this comprehensive and highly informative book. It is clearly written and shows profound knowledge of the field. There are over 800 references, although the reader would benefit from more demographic data. A lack of solutions to problems of culture and Aboriginal mental health seems frustrating. Criticism is pointed and sharp. Perhaps, many have failed to comprehend the meaning of Aboriginality in terms of mind and mental health, yet the complexity of these issues calls for tolerance. We try to cope with inconsistencies in empirical research, without compromise on ethics. Awareness of possible errors can help improve methods and make findings more useful, leading to better solutions. Perhaps then can researchers avoid windigo’s symbolic revenge. This scholarly book will interest students, practitioners, and researchers in medical anthropology, cultural psychiatry and psychology, and related disciplines.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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