forced by supernatural consent and coercion seems to be effective among many people who have been reared in an authoritarian family structure." 51 The Puerto Rican botanica, or folk pharmacy, adds spiritism (the teachings of Allan Kardec) to the practices of santeria. The faithful consult the medium for all problems, including exorcism of evil spirits. 52
Afro-American folk healers believe that all illness is theoretically preventable. They stress causes, not symptoms. Natural illness is caused by the environment or reflects Divine punishment. Unnatural or magical illness may be caused by worry or by evil influences or by sorcery. The healer may come by his powers by birth or learning or have them conferred during an altered state of consciousness. 53 Because Afro-Americans tend to mistrust all institutions except their own churches, it is likely that the availability of folk healers significantly reduces the use of conventional mental health facilities.
The various healers have in common that they do not separate physical and mental illness, science and religion, and that most of them deal with common problems of money, jobs, love, together with illness, whereas the psychotherapist is not concerned with the whole range of human afflictions and only the psychiatric social worker may try to deal with most of them explicitly. Altered states of consciousness, which might be labeled psychotic by the standard psychotherapist, are a characteristic of many folk healers and are part of their process of dealing with problems presented to them.
What we foresee is a convergence of much of the population on the prevailing professional attitude. Psychotherapy becomes perfectly acceptable, even fashionable, among some; it replaces intermediary structures of family and community, displaces alternative therapies, all of which play a diminishing role. We can foresee reduced acceptance of aberrant behavior and its classification as mental illness; rejection of individual (and family) responsibility for behavior, and the dominance of the philosophy of victimization, externalization of causation, which becomes attributable to another generation, another class, another race, or, for those who can do none of these, to abstract nouns such as society and business, of which we form no part.
Insurance coverage will greatly expand the demand for mental health care. But enlargement of the popular concept of treatable mental disorder to converge on that of psychotherapists could bring about a larger increase.