This book concerns the use of the drug qat in North Yemen (Yemen Arab Republic), a country lying on the southwestern corner of the Arabian Peninsula. However, because this substance is so interwoven into the fabric of society and culture, it is also necessarily about Yemen itself. The history and culture of South Arabia are still relatively unknown to the rest of the world, and the drug qat, so widely used there, is equally unknown. Thus, the material we present here should be of interest to all of those concerned with drug use, those who wish to understand more about Yemen and the Middle East, and to the Yemenis themselves. Another purpose is to develop some general understandings about sub stance uses and their effects which are less clouded by the mass hysteria and political considerations which often obscure drug issues in our own society. Examination of drug-use patterns in a country where millions of people are users on a regular basis, and where there has been familiarity with the drug for several hundred years, offers an opportunity to achieve perspectives not possible in countries with different attitudes and without such histories. I am not sanguine about the prospects of our abilities to learn from others or from the past, but I do not think we should abandon hope of doing so."

Mental retardation in the United States is currently defined as " ... signif icantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the development period" (Grossman, 1977). Of the estimated six million plus mentally retarded individuals in this country fully 75 to 85% are considered to be "func tionally" retarded (Edgerton, 1984). That is, they are mildly retarded persons with no evident organic etiology or demonstrable brain pathology. Despite the relatively recent addition of adaptive behavior as a factor in the definition of retardation, 1.0. still remains as the essential diagnostic criterion (Edgerton, 1984: 26). An 1.0. below 70 indicates subaverage functioning. However, even such an "objective" measure as 1.0. is prob lematic since a variety of data indicate quite clearly that cultural and social factors are at play in decisions about who is to be considered "retarded" (Edgerton, 1968; Kamin, 1974; Langness, 1982). Thus, it has been known for quite some time that there is a close relationship between socio-economic status and the prevalence of mild mental retardation: higher socio-economic groups have fewer mildly retarded persons than lower groups (Hurley, 1969). Similarly, it is clear that ethnic minorities in the United States - Blacks, Mexican-Americans, American Indians, Puerto Ricans, Hawaiians, and others - are disproportionately represented in the retarded population (Mercer, 1968; Ramey et ai., 1978)."

When confronted by the concerns of human sexual function or dys function, American medicine finds itself well impaled on the horns of a dilemma. Currently it is acceptable medical practice to treat sexual dysfunctions, disorders, or dissatisfactions that arise from psy chogenic etiologies, endocrine imbalances, neurologic defects or are side effects of necessary medication regimes. In addition, implanta tion of penile prostheses in cases of organic impotence is an increas ingly popular surgical procedure. These clinical approaches to sexual inadequacies, accepted by medicine since 1970, represent one horn of the dilemma. The opposite horn pictures the medical profession firmly backed into a corner by cultural influences. For example, when hospital admissions occur, a significant portion of the routine medical history is the section on system review. A few questions are asked about the cardio-respiratory, the genito-urinary, and the gastro-intestinal sys tems. But in a preponderance of hospitals no questions are permitted or, if raised, answers are not recorded about human sexual functioning. Physicians tend to forget that they are victims of cultural imposition first and of professional training a distant second."

Over the past two decades increasing interest has emerged in the contribu tions that the social sciences might make to the epidemiological study of patterns of health and disease. Several reasons can be cited for this increasing interest. Primary among these has been the rise of the chronic, non-infectious diseases as important causes of morbidity and mortality within Western populations during the 20th century. Generally speaking, the chronic, non infectious diseases are strongly influenced by lifestyle variables, which are themselves strongly influenced by social and cultural forces. The under standing of the effects of the behavioral factors in, say, hypertension, thus requires an understanding of the social and cultural factors which encourage obesity, a sedentary lifestyle, non-compliance with anti-hypertensive medica tions (or other prescribed regimens), and stress. Equally, there is a growing awareness that considerations of human behavior and its social and cultural determinants are important for understanding the distribution and control of infectious diseases. Related to this expansion of epidemiologic interest into the behavioral realm 'has been the development of etiological models which focus on the psychological, biological and socio-cultural characteristics of hosts, rather than exclusive concern with exposure to a particular agent or even behavioral risk. Also during this period advances in statistical and computing techniques have made accessible the ready testing of multivariate causal models, and so have encouraged the measurement of the effects of social and cultural factors on disease occurrence."

In the last few years there has been a great revival of interest in culture-bound psychiatric syndromes. A spate of new papers has been published on well known and less familiar syndromes, and there have been a number of attempts to put some order into the field of inquiry. In a review of the literature on culture-bound syndromes up to 1969 Yap made certain suggestions for organizing thinking about them which for the most part have not received general acceptance (see Carr, this volume, p. 199). Through the seventies new descriptive and conceptual work was scarce, but in the last few years books and papers discussing the field were authored or edited by Tseng and McDermott (1981), AI-Issa (1982), Friedman and Faguet (1982) and Murphy (1982). In 1983 Favazza summarized his understanding of the state of current thinking for the fourth edition of the Comprehensive Textbook of Psychiatry, and a symposium on culture-bound syndromes was organized by Kenny for the Eighth International Congress of Anthropology and Ethnology. The strong est impression to emerge from all this recent work is that there is no substantive consensus, and that the very concept, "culture-bound syndrome" could well use some serious reconsideration. As the role of culture-specific beliefs and prac tices in all affliction has come to be increasingly recognized it has become less and less clear what sets the culture-bound syndromes apart."

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After putting down this weighty (in all senses of the word) collection, the reader, be she or he physician or social scientist, will (or at least should) feel uncomfortable about her or his taken-for-granted commonsense (therefore cultural) understanding of medicine. The editors and their collaborators show the medical leviathan, warts and all, for what it is: changing, pluralistic, problematic, powerful, provocative. What medicine proclaims itself to be - unified, scientific, biological and not social, non-judgmental - it is shown not to resemble very much. Those matters about which medicine keeps fairly silent, it turns out, come closer to being central to its clinical practice - managing errors and learning to conduct a shared moral dis course about mistakes, handling issues of competence and competition among biomedical practitioners, practicing in value-laden contexts on problems for which social science is a more relevant knowledge base than biological science, integrating folk and scientific models of illness in clinical communication, among a large number of highly pertinent ethnographic insights that illuminate medicine in the chapters that follow."

Within the past two decades, there has been an increased interest in the study of culture and mental health relationships. This interest has extended across many academic and professional disciplines, including anthropology, psychology, sociology, psychiatry, public health and social work, and has resulted in many books and scientific papers emphasizing the role of sociocultural factors in the etiology, epidemiology, manifestation and treatment of mental disorders. It is now evident that sociocultural variables are inextricably linked to all aspects of both normal and abnormal human behavior. But, in spite of the massive accumulation of data regarding culture and mental health relationships, sociocultural factors have still not been incorporated into existing biological and psychological perspectives on mental disorder and therapy. Psychiatry, the Western medical specialty concerned with mental disorders, has for the most part continued to ignore socio-cultural factors in its theoretical and applied approaches to the problem. The major reason for this is psychiatry's continued commitment to a disease conception of mental disorder which assumes that mental disorders are largely biologically-caused illnesses which are universally represented in etiology and manifestation. Within this perspective, mental disorders are regarded as caused by universal processes which lead to discrete and recognizable symptoms regardless of the culture in which they occur. However, this perspective is now the subject of growing criticism and debate.

The idea of reviewing the ethical concerns of ancient medicine with an eye as to how they might instruct us about the extremely lively disputes of our own contemporary medicine is such a natural one that it surprises us to real ize how very slow we have been to pursue it in a sustained way_ Ideologues have often seized on the very name of Hippocrates to close off debate about such matters as abortion and euthanasia - as if by appeal to a well-known and sacred authority that no informed person would care or dare to oppose_ And yet, beneath the polite fakery of such reference, we have deprived our selves of a familiarity with the genuinely 'unsimple' variety of Greek and Roman reflections on the great questions of medical ethics. The fascination of recovering those views surely depends on one stunning truism at least: humans sicken and die; they must be cared for by those who are socially endorsed to specialize in the task; and the changes in the rounds of human life are so much the same from ancient times to our own that the disputes and agreements of the past are remarkably similar to those of our own."

like other collections of papers related to a single topic, this volume arose out of problem-sharing and problem-solving discussions among some of the authors. The two principal recurring issues were (1) the difficulties in translating anthropo logical knowledge so that our students could use it and (2) the difficulties of bringing existing medical anthropology literature to bear on this task. As we talked to other anthropologists teaching in other parts of the country and in various health-related schools, we recognized that our problems were similar. Similarities in our solutions led the Editors to believe that publication of our teaching experi ences and research relevant to teaching would help others and might begin the process of generating principles leading to a more coherent approach. Our colleagues supported this idea and agreed to contribute. What we agreed to write about was 'Clinically Applied Anthropology'. Much of what we were doing and certainly much of the relevant literature was applied anthropology. And our target group was composed-mostly of clinicians. The utility of the term became apparent after 1979 when another set of anthropologists began to discuss 'ainical Anthropology'. They too recognized the range of novel be haviors available to anthropologists in the health science arena and chose to focus on the clinical use of anthropology. We see this as an important endeavor, but very different from what we are proposing."

Bioethics is a discipline still not fully explored in spite of its rather remark able expansion and sophistication during the past two decades. The prolifer ation of courses in bioethics at educational institutions of every description gives testimony to an intense academic interest in its concerns. The media have catapulted the dilemmas of bioethics out of the laboratory and library into public view arid discussion with a steady report of the so-called 'mira cles of modern medicine' and the moral perplexities which frequently accom pany them. The published work of philosophers, theologians, lawyers and others represents a substantial and growing body of literature which explores relevant concepts and issues. Commitments have been made by existing in stitutions, and new institutions have been chartered to further the discussion of the strategic moral concerns that attend recent scientific and medical progress. This volume focuses attention on one of the numerous topics of interest within bioethics. Specifically, an examination is made of the implications of the principle of justice for health care. Apart from four essays in Ethics and Health Policy edited by Robert Veatch and Roy Branson 4] the dis cussion of justice and health care has been occasional, almost non-existent, and scattered. The paucity of literature in this area is regrettable but perhaps understandable. On the one hand, Joseph Fletcher, one of the contemporary pioneers in bioethics, can hold that "distributive justice is the core or key question for biomedical ethics" ( 1], p. 102)."

Bioethics is a discipline still not fully explored in spite of its rather remark able expansion and sophistication during the past two decades. The prolifer ation of courses in bioethics at educational institutions of every description gives testimony to an intense academic interest in its concerns. The media have catapulted the dilemmas of bioethics out of the laboratory and library into public view arid discussion with a steady report of the so-called 'mira cles of modern medicine' and the moral perplexities which frequently accom pany them. The published work of philosophers, theologians, lawyers and others represents a substantial and growing body of literature which explores relevant concepts and issues. Commitments have been made by existing in stitutions, and new institutions have been chartered to further the discussion of the strategic moral concerns that attend recent scientific and medical progress. This volume focuses attention on one of the numerous topics of interest within bioethics. Specifically, an examination is made of the implications of the principle of justice for health care. Apart from four essays in Ethics and Health Policy edited by Robert Veatch and Roy Branson 4] the dis cussion of justice and health care has been occasional, almost non-existent, and scattered. The paucity of literature in this area is regrettable but perhaps understandable. On the one hand, Joseph Fletcher, one of the contemporary pioneers in bioethics, can hold that "distributive justice is the core or key question for biomedical ethics" ( 1], p. 102)."

by MICHEL FOUCAULT Everyone knows that in France there are few logicians but many historians of science; and that in the 'philosophical establishment' - whether teaching or research oriented - they have occupied a considerable position. But do we know precisely the importance that, in the course of these past fifteen or twenty years, up to the very frontiers of the establishment, a 'work' like that of Georges Canguilhem can have had for those very people who were separ ated from, or challenged, the establishment? Yes, I know, there have been noisier theatres: psychoanalysis, Marxism, linguistics, ethnology. But let us not forget this fact which depends, as you will, on the sociology of French intellectual environments, the functioning of our university institutions or our system of cultural values: in all the political or scientific discussions of these strange sixty years past, the role of the 'philosophers' - I simply mean those who had received their university training in philosophy department- has been important: perhaps too important for the liking of certain people. And, directly or indirectly, all or almost all these philosophers have had to 'come to terms with' the teaching and books of Georges Canguilhem. From this, a paradox: this man, whose work is austere, intentionally and carefully limited to a particular domain in the history of science, which in any case does not pass for a spectacular discipline, has somehow found him self present in discussions where he himself took care never to figure."

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