May, 1996, 2-3

To the Editor of ASCAP 23 April 1996

Dear Russ,

I am now at the end of the third week of my five week stay with you, and I am having the unusual pleasure of writing to you from the next door office.

The first thing I should tell ASCAP readers is that you have a heavy clinical schedule, quite apart from teaching, research and administration, and, of course, your editorial duties. You head one of the two "consultation and liaison" teams at UTMB (which are responsible for all psychiatric referrals from the medical and surgical wards, including attempted suicides), and this means meeting every morning at 8.30 with your two residents and about five students to hear about new referrals and to check on the progress of continuing cases - this takes about 1.5 hours, and is followed by a procession around the wards to see those referrals who need seeing. There have been several deliria of various aetiology, some chronic brain syndromes and, of course, cases of depression associated with serious physical disease; one morning we heard about two heart- and one liver-transplant patients who were undergoing their routine pre-op psychiatric screening. After this, there is not much left of your morning, and much of the afternoon is taken up with seeing out-patients and supervising residents. We spent one day in Houston at your Prader-Willi clinic and another in Beaumont, some two hours away across the ferry, where you consult at a day centre on cases of Prader-Willi syndrome, autism and suchlike, and where you battle with the problem of inordinate hunger which is such a marked feature of Prader-Willi, but also affects other people, patients and staff alike. Back here, I heard you present a paper to the psychiatric research group on the designer drug butabindide, which inhibits the peptidase which breaks down cytokine CCK8, which reduces food intake in mice. Cytokines are a major focus of interest here.

Two revelations make me want to eat the words of my contribution to the April ASCAP, in which I lamented the lack of any normative studies of human agonistic behaviour or reconciliation. First of all, I have been monopolising a fascinating book (1) that you are supposed to be reviewing for Ethology and Sociobiology, entitled Emotions in Command by an Australian called Frank Salter who is currently at the Max Planck Institute for Human Ethology in Andechs (with Eibl-Eibesfeldt), which contains an account of his work on agonistic relations in various type of organisation, and also an excellent review of the literature which was quite an eye-opener to me. This book certainly deserves a review in ASCAP too.

Then, browsing in UTMB's luxurious medical library, I came across, in a journal hitherto unknown to me, an article about feuds and reconciliation in Iran (2). It seems that the Persians are well aware that relationships tend to switch into the agonic mode, and usually, with the help of mediation, switch back into the hedonic mode through a process of reconciliation. These processes have been subsumed under two cultural devices called qahr and ashti, so that if you feel your relationship with someone becoming agonic you can say to them, "I am now going into a state of qahr with you" and everyone then knows their social roles, including those whose job it is to act as mediators and, after a cooling off period, re-establish the state of ashti. Qahr is also used for disciplining disobedient and disrespectful children, and its use throws light on the relationship between the agonistic behaviour of adults and the punishment of children. Only 50% of the states of qahr studied by the author had been reconciled by the time the paper was written - between adults, especially between males, qahr can last for many years. This paper confirmed my view that the idea of agonic and hedonic modes is very useful when applied to dyadic relationships (3), but that when applied to groups the situation is much more complex - but that the concepts are still useful. One objection to the two modes idea is that there are too many intermediate states to justify the use of categories - but it appears that in Iranian relationships, everyone knows whether they are in a state of qahr or ashti. (Can anyone help with the pronunciation of these two words?)

All in all, this is proving to be a most enjoyable and instructive attachment for me, and it seems a shame that one has to wait for retirement before such a thing becomes possible.

1. Salter, F.K. (1995) Emotions in Command: A Naturalistic Study of Institutional Dominance. Oxford: Oxford University Press.

2. Behzadi, K.G. (1994) Interpersonal conflict and emotions in an Iranian cultural practice: qahr and ashti. Culture, Medicine and Psychiatry, 18, 321-359.

3. Price, J.S. (1992) The agonic and hedonic modes: definition, usage, and the promotion of mental health. World Futures, 35, 87-115.