This is an electronic copy of Mathieu Deflem's first academic publication. The article was published in Social Science & Medicine 29(5):627-634 (1989). Also available in pdf format.
Please cite as: Deflem, Mathieu. 1989. “From Anomie to Anomia and Anomic Depression: A Sociological Critique on the Use of Anomie in Psychiatric Research.” Social Science and Medicine 29(5):627-634.
This paper critically evaluates the way in which the sociological concept of anomie has been used in two approaches in the field of social and cross-cultural psychiatry. First, Leo Srole's research in social psychiatry is discussed. In this research, the concept of anomia is introduced to refer to a state of mind expressed by individuals who, according to Stole, live under conditions which Durkheim described as anomie. Srole first applied his approach in a study in Springfield  and he later also adopted his ideas in the Midtown Manhattan Study . Soon after Srole's first exploratory study of anomia, the concept received widespread attention in empirical and theoretical studies and it has remained a focus of interest over recent years. Second, this paper evaluates Wolfgang Jilek's contribution to the study of mental illness among the Coast Salish Indians of British Columbia and Washington [3, 4]. Jilek introduced the concept of anomic depression to account for the revival and changed nature of the guardian spirit ceremonial in Coast Salish Indian society. His study is of particular relevance because it applies insights deriving from the sociological theory of anomie in a cross-cultural perspective.
The central thesis of this paper is that a clear understanding of the sociological theory of anomie reveals several weaknesses in the theoretical foundations of Stole's and Jilek's research. While acknowledging that on the empirical level these approaches may offer fruitful insights to our understanding of mental illness and its relationship to socio-cultural factors, it is argued that the transformations which the concept of anomie has undergone in these pieces of psychiatric research are in several instances no longer congruent with the initial sociological accounts of anomie.
The argument is developed as follows. First, an outline is presented of the sociological theory of anomie, with special attention to the contributions by Durkheim and Merton. Next, the major elements of Srole's and Jilek's views on respectively anomia and anomic depression are dealt with. Finally, the main points of critique to these approaches are discussed in the light of the sociological accounts of anomie.
THE SOCIOLOGICAL CONCEPT OF ANOMIE: DEFINITIONS AND APPLICATIONS
The concept of anomie was originally introduced in sociology by Emile Durkheim who used the term at the end of the nineteenth century to offer a sociological insight into the social problems of his days. After Durkheim, the concept did at first not get the full attention it was to enjoy in modern sociology. It was not until the 1940s and especially the 1950s that the concept of anomie was brought into vogue in sociology, notably since Robert K. Merton's treatise of the subject. From then onwards, anomie has become one of the truly central and widely discussed concepts in sociological theory.
Durkheim first employed the concept of anomie in his doctoral thesis The Division of Labor in Society in which he devoted a chapter to the "anomic division of labour" [5, 6]. Here Durkheim argues that under normal circumstances the division of labour produces social (organic) solidarity. Under exceptional circumstances, i.e. when all the conditions for the existence of organic solidarity have not been realized, the division of labour presents pathological or anomic forms. The conditions for the existence of organic solidarity are two-fold: first, there should be a system of solidary organs, and, second, the way in which these organs come together must be predetermined, i.e. regulated by a set of rules. In the case of industrial or commercial crises and with respect to the conflict between labour and capital, and the lack of unity in the sciences, regulation does not exist or is not in accord with the degree of development of the division of labour. In these cases, the relations among the organs are not regulated, they are in a state of anomie.
Durkheim paid further and far more attention to the concept of anomie in his classical work Suicide .As Douglas rightly claims , Durkheim's study of suicide starts off with a preconceived idea of man and society. According to Durkheim, man's needs are in themselves unlimited: reflective thought enables man to always imagine better conditions and more desirable goals in his life. Since unlimited desires are insatiable, a force must regulate man's passions: man's needs must be sufficiently proportioned to his means. The individual however has no way of limiting his own needs, so it must be done by a force exterior to him. To Durkheim, it is the central task of society to play this regulating role: "for it is the only moral power superior to the individual, the authority of which he accepts. It alone has the power necessary to stipulate law and to set the point beyond which the passions must not go" [p. 249]. Under exceptional circumstances, when society is disturbed by abrupt transitions, it is incapable of regulating man's passions, it is then in a state of anomie. Such abrupt transitions, including both painful and favourable crises, cause society to lose its effectiveness in guiding man's behaviour. Durkheim also points out that anomie in the sphere of trade and industry is a chronic phenomenon. Regulations in the economic sphere are almost completely absent: "For a whole century, economic progress has mainly consisted in freeing industrial relations from all regulation" [p. 254].
Summing up, Durkheim's concept of anomie in Suicide refers to: (a) the acute ineffectiveness of society's regulative power, due to painful or beneficial, but always abrupt, transitions, and (b) the chronic lack of social rules limiting man's needs in the world of trade and industry. Durkheim employed the concept to explain differences in (anomic) suicide rates. First, the variations in suicide rates that occur whenever there is an abrupt disturbance in society (e.g. financial crises or divorce) are explained by the acute form of anomie. Second, chronic anomie in the world of trade and industry explains the prevalence of (anomic) suicide as a regular, constant factor in society.
Merton relates the concept of anomie to the sociological study of deviant behaviour. He published his theory first in 1938  and later revised  and extended  his initial ideas. Merton's main purpose was to set out the social and cultural sources of deviant behaviour and to discover how the social structure can exert a pressure on certain individuals to engage in non-conforming conduct. He distinguishes two important elements of social and cultural structures: culturally defined goals, on the one hand, and the institutionally prescribed means of striving toward these goals, on the other. Cultural goals and institutionalized means do not always operate jointly in society: there may be a differential emphasis on the goals or on the means. Merton describes in particular a social situation in which there is an exceptionally strong emphasis upon the cultural goals without a corresponding emphasis upon the institutional norms. Under these circumstances, human conduct is not guided by the institutionally prescribed means but by the most effective procedure, whether legitimate or not, of striving for the cultural goals. When this dissociation between goals and norms continues, "the society becomes unstable and there develops what Durkheim calls 'anomie"' [10, p. 135]. Merton's concept of anomie thus refers to a demoralization, a de-institutionalization of means, resulting out of a dissociation between cultural goals and institutional norms.
Merton finds an example of such a disjunction between goals and norms in American culture in which an emphasis upon the goal of success, monetary success in particular, occurs without equivalent emphasis upon the institutionalized means to strive for this goal. Persons facing this social situation then exhibit five possible modes of individual adaptation according to whether they accept or reject the cultural goals and/or the institutionalized means. These modes of adaptation are, according to Merton, differentially distributed over the different social strata of society, depending on the accessibility of legitimate means and the degree of assimilation of goals and norms in each stratum.
The first possible mode of adaptation is conformity: both the goals and norms of society are accepted. The other four categories can be considered forms of deviant behaviour: (a) innovation: the institutional means are rejected and replaced by other means to achieve the culturally prescribed goals, a type of adaptation which Merton considers especially prevalent in the lower social strata; (b) ritualism: the individual holds on to the institutional means in spite of the fact that the cultural goals cannot be reached, the category of deviant behaviour which Merton expected to be most common in American society; (c) retreatism: both society's goals and norms are rejected, a form of deviant adaptation which Merton believed to be the least common; and (d) rebellion: the rejection of prevailing norms and goals and the substitution thereof by new values, a mode of adaptation which is a potential for the formation of subgroups set apart from the rest of the community.
In sum, then, Merton's concept of anomie refers to a de-institutionalization of social means, caused by a differential emphasis on the cultural goals and the institutional norms, and resulting, depending on the characteristics of the social strata, in five possible types of role behaviour.
For the sake of completeness, it should be added that after Durkheim and Merton the concept of anomie has received considerable further attention in the field of sociology. Parsons , for instance, adopted Durkheim's notion of anomie to denote the "state of disorganisation where the hold of norms over individual conduct has broken down" [p. 377]. He also developed a theory of deviant behaviour which he regarded a further elaboration of Merton's typology of modes of adaptation . Other modifications or extensions of Merton's theory have been proposed by Dubin , Cloward and Ohlin [15,16] and Cohen [17, 18]. Suffice it to say that these authors, amongst others, employ sociological notions of anomie which are not always fully congruent with the original accounts of Durkheim and Merton. The concept of anomie has thus also undergone transformations within the field of sociology. The psychiatric approaches using anomie which are discussed in this paper, however, claim to be based on the original insights of Durkheim and Merton which have here been set forth in sufficient detail.
ANOMIA, SOCIO-ECONOMIC STATUS AND MENTAL ILLNESS
The first approach in psychiatric research to be considered here was developed by Stole in a study, conducted in Springfield, Massachusetts, to measure and assess the impact of a series of 'Anti Defamation League' card advertisements (anti-discrimination and American Creed messages) that were posted in vehicles of the public transit system . In this study, Srole found it useful to test hypotheses with relation to Durkheim's concept of anomie which, according to Srole, refers to "the breakdown of those moral norms that limit desires and aspirations" [p. 712]. To this end, he developed a scale to measure the individual's degree of anomia. Srole applies the term to explore the "molecular view of individuals as they are integrated in the total action fields of their interpersonal relationships and reference groups" [p. 710]. Anomia —Srole uses "social malintegration" and "interpersonal alienation" as equivalent terms— refers to a socio-psychological condition of individuals' perception of 'self-to-others distance' and 'self-to-others alienation', a condition which is considered dependent on both sociological and psychological processes.
Srole is well aware of the fact that both Durkheim's and Merton's concept of anomie refer to a state of society: Durkheim's anomie as described above and Merton's concept to denote "the disparity between culturally emphasized goals and socially inaccessible means to actualize them" [2, p. 272]. Anomia, on the other hand, refers to an individual state of mind and is, according to Srole, more related to: (a) MacIver's definition of anomie as "the breakdown of the individual's sense of attachment to society" , and (b) Laswell's definition of the "lack of identification on the part of the primary ego of the individual with a 'self' that includes others" .
The scale which Srole developed to measure the individual's degree of anomia consists of five opinion statements' of the agree-disagree type. Each statement represents one of five distinct dimensions of anomia [1, pp. 712-713]: (a) the individual's sense that community leaders are detached from and indifferent to his needs; (b) the individual's perception of the social order as essentially fickle and unpredictable, i.e. orderless; (c) the individual's view that he and people like him are retrogressing from the goals they have already reached; (d) the individual's sense of the meaningless of life itself, and (e) the individual's perception that his framework of immediate personal relationships is no longer predictive or supportive.
In the Springfield study, Srole used the anomiascale to test the hypothesis that anomia is associated with a rejective orientation toward outgroups in general and minority groups in particular. The results of the study, in which 401 individuals were interviewed in their homes, confirmed the hypothesis. Moreover, anomia was found to be significantly related in an inverse direction to the respondents' socio-economic status as measured by their education and occupation of head of the household.
In the Midtown Manhattan Study, Srole applied the anomia approach to an examination of the prevalence of mental disturbances in a sample of 1660 non-hospitalized Manhattan residents . The respondents were asked questions about, among other things, their mental health and socio-economic status. The information obtained from each respondent was rated by two independently working psychiatrists. The results showed that in the sample about 18% were mentally well, about 36% showed mild, about 22% moderate and about 25% severe and marked symptoms of mental illness. In addition, Srole found that in the Midtown Study anomia was a corollary of mental disturbance , and that anomia was inversely related to socio-economic status independently of the mental disturbance factor. Thus, the inverse relationship between anomia and socio-economic status found in the Springfield study was confirmed: the frequency and intensity of individuals' state of anomia were most heavily concentrated in the lower socio-economic strata.
ANOMIC DEPRESSION IN COAST SALISH INDIAN SOCIETY
The second approach which is critically examined in this paper has been developed by Wolfgang Jilek in his research on the guardian spirit ceremonials of the Coast Salish Indians of British Columbia and Washington [3, 4]. In this study, Jilek introduced the concept of anomic depression to explain the specific nature of the relation between the socio-cultural context of Coast Salish Indian society with a particular type of mental illness. Jilek (partly in collaboration with L. Jilek-Aall) also applied the approach in a study of initiation rituals in Papua New Guinea , and in accounts of epidemic koro in Thailand [23, 24] and transient psychotic reactions in Africa [25, 26]. The present examination of the concept of anomic depression focuses on Jilek's study of the guardian spirit ceremonials in Coast Salish Indian society.
According to Jilek [3, 4], the revival of the Salish Indian guardian spirit ceremonial in the 1960s reflects an evolution from psychohygienic ritual to ritual psychotherapy. Jilek argues that the ceremonial in its traditional form responded to a seasonally limited, goal-directed state of mind, identified by stereotyped symptoms. This condition was referred to as sya'wan or spirit sickness: a pathomorphic or illness-like state which inevitably led to the spirit dance initiation. The initiation was regarded as a necessary test and collective confirmation of individually acquired spirit powers. In its contemporary form, Jilek argues, the nature of spirit sickness has changed in response to the altered socio-cultural conditions of Salish Indian society. Spirit sickness now refers to a psychosocial syndrome defined as anomic depression. This concept is introduced to denote "an affective, psychophysiologic and behavioural syndrome developing in reaction to alienation from aboriginal culture under Westernizing influence" [4, p. 46]. The syndrome derives from experiences of anomie, relative deprivation and cultural identity confusion.
Anomie refers to the sociological concept as introduced by Durkheim and elaborated by Merton. According to Jilek, Durkheim's concept of anomie indicates "the absence of an effective normative structure", while Merton applied anomie to "the dissociation between culturally defined aspirations and socially structured means" [4, p. 47]. Relative deprivation, as defined by Aberle , refers to the "negative discrepancy between a minority group's legitimate expectations and actuality" [4, p. 47]. Cultural identity confusion is a term applied by Leighton et al.  to denote the "weakening of norms derived from membership in a particular cultural group when the members of this group are brought into close contact with the contrasting norms of a different cultural group, and are unable to integrate the two sets" [4, p. 47].
It is the social state of anomie, in combination with relative deprivation and cultural identity confusion, that accounts for the main socio-cultural characteristics of Salish Indian society. More specifically, Jilek  points out a social situation in which the Salish Indians have gradually been forced into a minority position after the arrival of white settlers. The structure of the traditional Indian society has disintegrated due to cultural changes resulting out of a process of imposed rapid Westernization. The subjective experience of these conditions of rapid cultural change led in many Indian individuals to a state of anomic depression.
Jilek abstracts the sociodynamic and psychodynamic pattern of anomic depression from case histories of Indian patients showing symptoms of spirit sickness. The following sequence of life experiences is revealed : "acculturation imposed through Western education —vying for acceptance by White society— attempts at White identification feelings of rejection, discrimination and relative deprivation-cultural identity confusion-moral disorientation often with acting-out behaviour under the influence of alcohol-guilt over the denial of Indianness-anomic depression which fails to respond to Western medical, psychotherapeutic and social intervention" [p. 161]. On a theoretical level, the sequential course of life experiences can be presented in the following conceptual scheme: anomie-relative deprivation-cultural identity confusion-anomic depression.
Jilek [3, 4] shows how anomic depression among Salish Indians is characterized by feelings of frustration, defeat, discouragement and lowered selfesteem. It is often associated with randomly aggressive behaviour against self or others, moral disorientation, and alcohol abuse. Jilek argues that, by accepting anomic depression as a variant of the traditional spirit sickness (sya'wan), Salish ritualists have made anomic depression amenable to ritual psychotherapy. Thus, the main purpose of contemporary guardian spirit ceremonials is to treat pathological symptoms and behaviour seen as resulting out of processes of cultural change; the initiation rituals should be understood as a healing process, a therapeutic psychodrama that, as the most important therapeutic aspect, has an ego-strengthening effect of positive reidentification with native Indian culture.
A CRITICAL EVALUATION OF ANOMIA AND ANOMIC DEPRESSION
The approaches followed by Srole and Jilek exhibit certain problems related to their theoretical foundations on the sociological theory of anomie. First, there are problems concerning the way in which these approaches transform the concepts of anomie as they were defined by Durkheim and Merton. Second, there are difficulties concerning the relationship between anomia and anomic depression, on the one hand, and anomie, on the other.
Two approaches to anomie: Durkheim and Merton
Both Srole and Jilek claim to base their accounts on, first of all, Durkheim's concept of anomie. However, in their reading of Durkheim's theory, both authors fail to adopt, firstly, Durkheim's distinct usages of anomie in The Division of Labor in Society and in Suicide, and, secondly,, Durkheim's distinction between the acute and chronic form of anomie.
Apart from this and more importantly, it should be added that in Srole's research, anomia is not investigated in relation to Durkheim's (or Merton's) anomie but only in relation to indices of socio-economic status, prejudice to minority groups and mental illness. Srole in fact questioned the possibility of operationalizing the sociological concept of anomie for empirical research. He preferred to measure the individual's degree of anomia since it is "more readily accessible to the instruments of the researcher than is the operationally complicated abstraction [of anomie]" [1, p.71]. Seeman  made the same remark when he claimed that anomie's "structural definition, in any case, remains more a hope (or a guiding orientation) than an empirical accomplishment". However, Lander  has proposed a set of anomic variables with which the degree of society's state of anomie could be empirically investigated. In Srole's research, Lander's, or any other similar, approach to examine society's anomie is not employed.
Jilek's account of anomic depression, on the other hand, does provide a description of the basic sociocultural characteristics of Coast Salish Indian society which, according to Jilek, can be circumscribed as being in a state of anomie. However, as indicated above and argued elsewhere , Durkheim's concept of anomie does not simply refer to society's lack or ineffectiveness of norms which, as Jilek argues, characterizes Coast Salish Indian society. Durkheim instead applied anomie to denote the lack of ineffectiveness of society's norms limiting man's passions and needs: a society is in a state of anomie only if it loses its regulating power to limit man's desires. As Parsons  has aptly stated, the rules of society are in Durkheim's perspective at the same time social and moral: it is because the rules are social and regulating man's conduct that they are moral. Therefore, Coast Salish Indian society, in which the traditional norms through a process of acculturation are oppressed by values of Western origin, is only in a state of anomie when it is ineffective in limiting individuals' passions and needs, but not, as Jilek seems to suggest, because of the changed, Westernized and non-Aboriginal origin and nature on the Indians imposed values. The latter would only be the case if the Western values promote individuality and 'egoistic' attitudes, a condition which would indicate a chronic state of anomie as the one Durkheim described in the world of trade and industry.
It seems then that Jilek too loosely adopts Durkheim's concept of anomie to refer to processes of acculturation, Westernization and cultural change. It has however been argued [32, 33] that, when adopting Durkheim's concept of anomie, the term should best be reserved to denote the specific meaning which Durkheim has given it.
Next, with regard to the use of Merton's concept of anomie, it should be pointed out quite clearly that Merton's concept of anomie does not refer to the value-conflict of a dissociation between culturally defined goals and institutional norms, as both Srole and Jilek argue. As mentioned before, Merton defines anomie as a de-institutionalization of means, which is the consequence of the dissociation between cultural goals and institutional norms. Anomie is conceived of as a "breakdown in the cultural structure, occurring particularly when there is an acute disjunction between the cultural norms and the socially structured capacities of members of the group to act in accord with them" [11, p. 162, my emphasis]. The dissociation between goals and norms is thus a sufficient but not a necessary condition for anomie: Merton's theory sees "the conflict between culturally defined goals and institutional norms as one source of anomie" [11, p. 190].
Srole and Jilek however equate the value-conflict of goals and norms with anomie. In Jilek's case, this misinterpretation of Merton's concept of anomie may be due to the fact that Jilek only refers to Merton's first approach to anomie  and does not take into account Merton's reformulation  and extension  of the theory. Merton foresaw the problem and admitted that, with regard to the equation of valueconflict and anomie, "As first formulated, the theory is evidently more than usually obscure on this point" [11, p. 190n].
Finally, Srole and Jilek adopt both Durkheim's and Merton's concept of anomie. A combination of these two sociological approaches is however not unproblematic: first, and most evidently, it should be reminded that Durkheim and Merton applied their concepts of anomie to explain different social phenomena, respectively suicide and deviant behaviour, and, second, more importantly, their definitions of anomie do not refer to the same condition of society.
As argued above, Durkheim's concept of anomie refers to a de-regulation, i.e. a de-stabilization (acute or chronic) of the goals, of society, while Merton applies anomie to a de-institutionalization of the means of society. Therefore, if the two approaches are to be combined, as Srole and Jilek claim to do, a theoretical framework has to be developed to outline the way in which society's regulation of goals and its integration by institutionalized means are interrelated. Such a framework has been presented by Johnson  who argues that regulation and integration are in Durkheim's approach identical. (It is worth remembering that Durkheim not only discussed society's regulation, which could lead to the extreme, pathological states of anomie and its counterpart 'fatalism', but also integration to society, with as its pathological states 'egoism' and 'altruism'.) Durkheim defined a lack of integration as ,egoism' (leading to egoistic suicide) and a lack of regulation as anomie (leading to anomic suicide). Johnson argues that Durkheim's 'egoism' refers to the weakness of the common conscience. This weakness results in a lack of social regulation which Durkheim labelled anomie. Thus, 'egoism' and anomie are, according to Johnson, identical and the dimensions regulation and integration are unseparable. Among sociologists, Johnson's view has found support  but has also been criticized since it fails to take into account that Durkheim thought it necessary to distinguish regulation from integration . In any case, regardless of the fact whether or not regulation and integration can possibly be combined, and thus whether or not Durkheim's concept of anomie (referring to regulation) and Merton's anomie (referring to integration) can be combined, both Srole and Jilek do not offer a framework to support such a combination.
Anomie as an objective social condition versus anomia and anomic depression as individual states of mind
In the light of the above presented outline of the sociological theories of anomie, it is clear that Durkheim and Merton apply the concept of anomie to indicate a particular, though in the case of both authors not identical, state of society. The anomic state of society should, as Merton  rightly stresses, be clearly distinguished from the experiences of individuals confronting an anomic society. To denote the individual experiences of anomie, Srole introduced the concept of anomia. Srole's concept of anomia and similar notions have gained wide attention in sociology and psychology [19, 20, 37-50]. A few problems however with regard to the psychological conceptions of anomie have as yet not been resolved.
First, specifically with respect to Stole's concept of anomia, the correlation which Srole found between socio-economic status and anomia has been confirmed [43-46], but also rejected or modified in other empirical studies. Roberts and Rokeach , for instance, found that, when education was held constant, there is no relation between anomia and socio-economic status, while Killian and Grigg  discovered that socio-economic status is inversely related to anomia only for whites and urban Negroes, but not for rural Negroes. Srole's initially found correlation between anomia and socio-economic status thus seems to be empirically variable and cannot be assumed to be universally valid.
Second, it has as yet not been unequivocally established to what extent and in what way anomie, as a state of society, and anomia, as an individual state of mind, are related to one another. According to Merton , amongst others [43, 44, 50], the proportion of anomic individuals within a society, as a measurement of the prevalence of anomia within that society, gives an indication of the degree of anomie of that society. Srole  however suggests that anomie and anomia are mutually indicative of each other; their relationship is reciprocal. (It is this a priori assumption that probably caused Srole not to investigate anomia in relation to anomie. If anomic and anomia are reciprocally related, an assumption upon which there is no agreement, an investigation of one of the two variables is indeed sufficient since the proven existence of one variable would necessarily imply the existence of the other.)
If we now take a second look at Jilek's concept of anomic depression, it is evident that, since Jilek applies the concept to a psycho-physiologic and behavioural syndrome of individuals, anomic depression refers to anomia rather than to anomie. Consequently, what is called for in Jilek's approach is a specification of the nature of the relationship between (a) individuals' anomic depression, conceived of as a variant of anomia, and (b) society's (presumed) state of anomie. Jilek clarifies this relationship by relating anomie to the concepts of relative deprivation and cultural identity confusion (see above). However, the combined use of these concepts poses another problem.
Jilek's combination of the three concepts related to anomic depression rests on a reductionist view of, especially, Durkheim's sociological concept of anomie, because Jilek explains a psychosocial syndrome of individuals, anomic depression, by referring to a particular state of society. Reductionist interpretations of Durkheim's theory have been suggested in sociology. Lindenberg , for instance, argues that Durkheim's sociological theory can in fact be translated in a psychological-reductionist approach. It has however also been argued , and the author of this paper agrees, that Durkheim's theoretical assumptions are clearly sociologistic and cannot be reduced to psychological propositions.
Therefore, when adopting Durkheim's concept of anomie, as Jilek claims to do, a reductionist view of sociology is not acceptable. Durkheim  clearly stated that social facts can only be explained by and can thus only explain other social facts. Moreover, social facts, as they form a reality sui generis, cannot be equated with their individual manifestations. Social facts, in Durkheim's perspective, then form "a category of facts with very distinctive characteristics: it consists of ways of acting, thinking, and feeling, external to the individual, and endowed with a power of coercion, by reason of which they control him" [p. 3]. Within the Durkheimian perspective, individual experiences such as anomic depression cannot be explained by reference to a state of society such as anomie. It should be remembered that Durkheim did not relate the concept of anomie to individual incidents of (anomic) suicide but to the total of (anomic) suicides committed in a given society during a given period of time and "this is not simply a sum of independent units, a collective total, but is itself a new factsui generis, with its own unity, individuality and consequently its own nature-a nature, furthermore, dominantly social" [7, p. 46]. Hence, although Jilek claims to rely on Durkheim's concept of anomie —Srole makes the same claim but, as argued before, does not investigate anomie in his studies— the psychological-reductionist approach of anomic depression neglects some of the basic theoretical assumptions of Durkheim's sociology.
In this paper, I have tried to demonstrate that, when a clear understanding of Durkheim's and Merton's sociological theory of anomie is taken into account, the transformations of the concept of anomie in Srole's and Jilek's contributions to social and cross-cultural psychiatry encounter difficulties in their theoretical foundations.
Summing up, this paper yielded the following criticisms:
(a) Srole does not investigate anomia, an individual state of mind, in its relation to the social state of anomie;This sociological evaluation does not deny the fruitfulness of some of the interesting insights which Srole and Jilek have offered. Srole's anomia concept has deservedly received wide attention in many empirical and theoretical studies. The hypothesis that anomia is related to socio-economic status and mental illness is indeed worth investigating since it could lead to marked progress in our understanding of the socio-cultural determinants effecting mental disturbance.
(b) Jilek carelessly uses Durkheim's (and Merton's) concept of anomie to denote processes of acculturation, Westernization and cultural change;
(c) both Srole and Jilek wrongly equate Merton's concept of anomie with the valueconflict of cultural goals and institutional norms;
(d) in both approaches, a theoretical framework to combine Durkheim's with Merton's concept of anomie is not offered; Srole arguably assumes a reciprocal relationship between anomia and anomie;
(f) Jilek's relationship between the (presumed) state of anomic and anomic depression, a term referring to anomia rather than to anomie, rests on, in the Durkheimian perspective unacceptable, reductionist assumptions.
Jilek's research of the guardian spirit ceremonials has also proven its significance, especially with regard to the cross-cultural perspective. Jilek has convincingly demonstrated how many Coast Salish Indians expressing symptoms of spirit sickness (alcohol abuse, anxiety, depression) show significant improvement of behaviour and symptoms after initiation in the guardian spirit ceremonial. The therapeutic effects of the initiation rituals have to be acknowledged and Jilek rightly adopts a non-ethnocentric approach in the study of these rituals and argues "at no time should culturally sanctioned ritual practices be interpreted as illogical or irrational thinking and as evidence of mental illness" [26, p. 56].
In conclusion, the present sociological examination of anomie's transformations in psychiatric research draws attention to one of the fundamental problems and challenges in attempts at combining insights deriving from the social and the medical sciences, in general, and from sociology and psychiatry, in particular. A combination of the knowledge gained in both scientific domains is obviously most desirable and can lead to useful contributions in the study of mental illness and its relation with the socio-cultural characteristics of society. It should however be evident that attempts at such a combination must take into account not only the empirical findings but also the full weight of the implications of the theoretical achievements in both sociology and psychiatry. In the case of Srole's and Jilek's accounts, which, as I have argued, in several instances represent, in Kleinman's words , a 'misuse' of the social sciences, this implies that the criticisms of this paper should be considered to support their approaches with a more justified use of the sociological concept of anomie.
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