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The Conceptual
Evolution of DSM-5
This page intentionally left blank
The Conceptual
Evolution of DSM-5
Edited by
Darrel A. Regier, M.D., M.P.H.
William E. Narrow, M.D., M.P.H.
Emily A. Kuhl, Ph.D.
David J. Kupfer, M.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this
book is accurate at the time of publication and consistent with general
psychiatric and medical standards, and that information concerning
drug dosages, schedules, and routes of administration is accurate at the
time of publication and consistent with standards set by the U.S. Food
and Drug Administration and the general medical community. As med-
ical research and practice continue to advance, however, therapeutic
standards may change. Moreover, specific situations may require a spe-
cific therapeutic response not included in this book. For these reasons
and because human and mechanical errors sometimes occur, we rec-
ommend that readers follow the advice of physicians directly involved
in their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the
views and opinions of the individual authors and do not necessarily
represent the policies and opinions of APPI or the American Psychiatric
Association.
If you would like to buy between 25 and 99 copies of this or any other
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Copyright © 2011 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
14 13 12 11 10 5 4 3 2 1
First Edition
Typeset in Caecilia and Cantoria.
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
The conceptual evolution of DSM-5 / edited by Darrel A. Regier .. .
[et al.]. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-388-4 (pbk. : alk. paper)
1. Diagnostic and statistical manual of mental disorders. 2. Mental
illness—Diagnosis. 3. Mental illness—Classification. I. Regier, Darrel A.
[DNLM: 1. Diagnostic and statistical manual of mental disorders.
2. Mental Disorders—diagnosis. 3. Mental Disorders—classification.
WM 141]
RC469.C654 2011
616.89′075—dc22
2010026845
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
PART I
Diagnostic Spectra:
Assessing the Validity of Disorder Groupings
1 Diagnosis of Mental Disorders in Light

of Modern Genetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Steven E. Hyman, M.D.
2 Integration of Dimensional Spectra for Depression and

Anxiety Into Categorical Diagnoses for
General Medical Practice. . . . . . . . . . . . . . . . . . . . . . . . . 19
David Goldberg, D.M., F.R.C.P.
Leonard J. Simms, Ph.D.
Richard Gater, M.D.
Robert F. Krueger, Ph.D.
3 One Way Forward for Psychiatric Nomenclature:

The Example of the Spectrum Project Approach . . . . . 37
Ellen Frank, Ph.D.
Paola Rucci, Dr.Stat.
Giovanni B. Cassano, M.D.
4 Meta Effects of Classifying Mental Disorders . . . . . . . . 59

Norman Sartorius, M.D., Ph.D., F.R.C.Psych.
PART II
Integrating Dimensional Concepts Into
a Categorical System
5 A Proposal for Incorporating Clinically Relevant

Dimensions Into DSM-5 . . . . . . . . . . . . . . . . . . . . . . . . . 81
John E. Helzer, M.D.
6 Empirically Derived Personality Disorder Prototypes:

Bridging Dimensions and Categories in DSM-5 . . . . . . . 97
Nicholas R. Eaton, M.A.
Susan C. South, Ph.D.
Lee Anna Clark, Ph.D.
7 Options and Dilemmas of Dimensional Measures

for DSM-5: Which Types of Measures Fare Best
in Predicting Course and Outcome? . . . . . . . . . . . . . . . 119
Hans-Ulrich Wittchen, Ph.D.
Michael Höfler, Ph.D.
Andrew T. Gloster, Ph.D.
Michelle G. Craske, Ph.D.
Katja Beesdo, Ph.D.
PART III
Assessing Functional Impairment for
Clinical Significance and Disability
8 Clinical Significance and Disorder Thresholds in DSM-5:

The Role of Disability and Distress . . . . . . . . . . . . . . . .147
9 Assessing Activity Limitations and

Disability Among Adults . . . . . . . . . . . . . . . . . . . . . . . .163
Michael Von Korff, Sc.D.
Gavin Andrews, M.D.
Madeleine Delves
10 Measuring Disability Across Physical, Mental,
and Cognitive Disorders . . . . . . . . . . . . . . . . . . . . . . . .189
Martin Prince, M.D.
Nick Glozier, Ph.D.
Renata Sousa, Ph.D.
Michael Dewey, Ph.D.
PART IV
Identifying Important Culture- and Gender-
Related Expressions of Disorders
11 Assessing Mental Disorders and Service Use

Across Countries: The WHO World
Mental Health Survey Initiative. . . . . . . . . . . . . . . . . . .231
Philip S. Wang, M.D., Dr.P.H.
Sergio Aguilar-Gaxiola, M.D., Ph.D.
Jordi Alonso, M.D., Ph.D.
Sing Lee, M.B., B.S., F.R.C.Psych.
Michael Schoenbaum, Ph.D.
T. Bedirhan Üstün, M.D.
Ronald C. Kessler, Ph.D.
Ronny Bruffaerts, Ph.D.
Guilherme Borges, M.Sc., Dr.Sc.
Giovanni de Girolamo, M.D.
Oye Gureje, M.D., Ph.D., D.Sc.
Josep Maria Haro, M.D., M.P.H., Ph.D.
Stanislav Kostyuchenko, M.D.
Viviane Kovess Masféty, M.Sc., M.D., Ph.D.
Daphna Levinson, Ph.D.
Herbert Matschinger, Ph.D.
Zeina Mneimneh, M.P.H., M.Sc.
Mark Oakley Browne, Ph.D.
Johan Ormel, Ph.D.
José Posada-Villa, M.D.
Soraya Seedat, M.B.Ch.B., F.C.Psych., Ph.D.
Hisateru Tachimori, Ph.D.
Adley Tsang, B.So.Sci.
12 The Intersection of Race, Ethnicity, Immigration, and
Cultural Influences on the Nature and
Distribution of Mental Disorders:
An Examination of Major Depression . . . . . . . . . . . . . 267
James S. Jackson, Ph.D.
Jamie M. Abelson, M.S.W.
Patricia A. Berglund, M.B.A.
Briana Mezuk, Ph.D.
Myriam Torres, M.S.
Rong Zhang, Ph.D.
13 Gender and Gender-Related Issues in DSM-5 . . . . . . . 287

Kimberly A. Yonkers, M.D.
Diana E. Clarke, Ph.D.
PART V
Incorporating Developmental Variations
of Disorder Expression Across the Lifespan
14 Increasing the Developmental Focus in DSM-5:

Broad Issues and Specific Potential
Applications in Anxiety . . . . . . . . . . . . . . . . . . . . . . . . 305
Daniel S. Pine, M.D.
E. Jane Costello, Ph.D.
Ron Dahl, M.D.
Regina James, M.D.
James F. Leckman, M.D.
Ellen Leibenluft, M.D.
Rachel G. Klein, Ph.D.
Judith L. Rapoport, M.D.
David Shaffer, M.D.
Eric Taylor, M.A., M.B.
Charles H. Zeanah, M.D.
15 Diagnostic Issues Relating to Lifespan From
Adulthood Into Later Life . . . . . . . . . . . . . . . . . . . . . . 323
Warachal Eileen Faison, M.D.
Susan K. Schultz, M.D.
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Contributors
Institute for Social Research, University of Michigan, Ann Arbor,
Michigan

Professor of Internal Medicine and Director, Center for Reducing
Health Disparities, University of California, Davis School of Medi-
cine, Sacamento, California

Senior Investigator and Head, Health Services Research Group,
IMIM-Institut de Recerca, Hospital del Mar, Parc de Salut Mar
Gavin Andrews, M.D.

Professor of Psychiatry, Clinical Research Unit for Anxiety and De-
pression, University of New South Wales at St. Vincent’s Hospital,
Sydney, NSW, Australia
Katja Beesdo, Ph.D.

Assistant Professor, Institute of Clinical Psychology and Psycho-
therapy, Technische Universitaet Dresden, Dresden, Germany

Michigan

Professor, Department of Epidemiological Research, Division of Ep-
idemiological and Psychosocial Research, National Institute of Psy-
chiatry (Mexico) & Metropolitan Autonomous University

Professor, Discipline of Psychiatry, School of Medicine, University of
Tasmania
xi
xii THE CONCEPTUAL EVOLUTION OF DSM-5

Associate Professor, Department of Neurosciences , Katholieke Uni-
versiteit Leuven
Giovanni B. Cassano, M.D.

Professor and Chair, Department of Psychiatry, Neurobiology, Phar-
macology, and Biotechnology, University of Pisa, Pisa, Italy
Lee Anna Clark, Ph.D.

Professor, Department of Psychology, University of Notre Dame,
Notre Dame, Indiana

Research Statistician, American Psychiatric Association; Adjunct
Assistant Professor, Johns Hopkins School of Public Health, Balti-
more, Maryland

Professor, Department of Psychiatry and Behavioral Sciences, Cen-
ter for Developmental Epidemiology, Duke University Medical
School, Durham, North Carolina

Professor, UCLA Anxiety Disorders Research Center, Department of
Psychology, UCLA, Los Angeles, California
Ron Dahl, M.D.

Professor of Psychiatry and Pediatrics, University of Pittsburgh
School of Medicine, Western Psychiatric Institute & Clinic, Pitts-
burgh, Pennsylvania

Scientific Director, IRCCS —St. John of God, Clinical Research Centre
Madeleine Delves
Clinical Research Unit for Anxiety and Depression, University of
New South Wales at St. Vincent’s Hospital, Sydney, NSW, Australia

Professor, Health Service and Population Research Department,
Institute of Psychiatry, London, United Kingdom

Graduate Student, Department of Psychology, University of Minne-
sota, Minneapolis, Minnesota
Contributors xiii
Warachal Eileen Faison, M.D.

Medical Director, Primary Care Neuroscience, Pfizer Inc., New York,
New York
Ellen Frank, Ph.D.

Professor, Departments of Psychiatry and Psychology, University of
Pittsburgh School of Medicine, Western Psychiatric Institute and
Clinic, Pittsburgh, Pennsylvania
Richard Gater, M.D.

Mental Health and Neurodegeneration Research Group, University
of Manchester, Manchester, England

Assistant Professor, Institute of Clinical Psychology and Psycho-
therapy, Technische Universitaet Dresden, Dresden, Germany
Nick Glozier, Ph.D.

Associate Professor, Disciplines of Psychiatry and Sleep Medicine,
Sydney Medical School, The University of Sydney, Brain and Mind
Research Institute, Camperdown, NSW, Australia

Professor Emeritus, Institute of Psychiatry, London, England

Professor and Head of Department , Department of Psychiatry, Uni-
versity of Ibadan, University College Hospital

Director of Research, Parc Sanitari Sant Joan de Déu

Professor Emeritus, Department of Psychiatry, University of Ver-
mont College of Medicine, Burlington, Vermont

Researcher, Institute of Clinical Psychology and Psychotherapy,
Technische Universitaet Dresden, Dresden, Germany

Provost, Harvard University, Cambridge, Massachusetts

Director and Research Professor, Institute for Social Research, and
Daniel Katz Distinguished University Professor of Psychology, Uni-
versity of Michigan, Ann Arbor, Michigan
xiv THE CONCEPTUAL EVOLUTION OF DSM-5
Regina James, M.D.

Director, Division of Special Populations, National Institute of child
Health & Human Development, Bethesda, Maryland
Ronald C. Kessler, Ph.D.

Professor, Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts

Fascitelli Family Professor of Child and Adolescent Psychiatry, New
York University Child Study Center, New York, New York

Assistant, Department of Psychiatry, National Medical Academy of
Postgraduate Education

Hathaway Distinguished Professor, Department of Psychology, Uni-
versity of Minnesota, Minneapolis, Minnesota

Science Writer, Division of Research, American Psychiatric Associ-
ation, Arlington, Virginia

Thomas Detre Professor, Department of Psychiatry, University of
Pittsburgh and Western Psychiatric Institute & Clinic, Pittsburgh,
Pennsylvania; Chair, DSM-5 Task Force
James F. Leckman, M.D.

Neison Harris Professor of Child Psychiatry and Pediatrics, Yale Uni-
versity School of Medicine, Yale Child Study Center, New Haven,
Connecticut

Professor, Department of Psychiatry, The Chinese University of
Hong Kong

Chief, Section on Bipolar Spectrum Disorders, Emotion and Devel-
opment Branch, Mood and Anxiety Program, National Institute of
Mental Health, Bethesda, Maryland

Director, Research and Planning, Ministry of Health, Mental Health
Services
Contributors xv

Professor and Directrice, Département of Epidémiologie; Directrice,
Fondation MGEN; Head, L’Université Paris Descartes Research Unit,
Ecole des Hautes Études en Santé Publique, Paris, France

Senior Researcher, Department of Psychiatry and Psychotherapy,
University of Leipzig
Briana Mezuk, Ph.D.

Department of Epidemiology and Community Health, Virginia
Commonwealth University School of Medicine, Richmond, Virginia

Survey Director, University of Michigan/Survey Research Center,
Institute for Social Research, Ann Arbor, Michigan

Associate Director, Division of Research, American Psychiatric As-
sociation, Arlington, Virginia; Research Director of the DSM-5 Task
Force
Johan Ormel, Ph.D.

Professor of Psychiatric Epidemiology, University Medical Center
Groningen

Chief of Developmental Studies, Mood and Anxiety Disorders Pro-
gram, National Institute of Mental Health, Bethesda, Maryland

Professor, Instituto Colombiano del Sistema Nervioso, Clinica Mont-
serrat
Martin Prince, M.D.

Professor, Centre for Public Mental Health, Health Service and Popu-
lation Research Department, Institute of Psychiatry, London, United
Kingdom

Chief, Child Psychiatry Branch, National Institute of Mental Health,
Bethesda, Maryland
xvi THE CONCEPTUAL EVOLUTION OF DSM-5

Executive Director, American Psychiatric Institute for Research and
Education and Director, Division of Research, American Psychiatric
Association, Arlington, Virginia; Vice-Chair, DSM-5 Task Force
Paola Rucci, Dr.Stat.

Visiting Research Assistant Professor, Department of Psychiatry,
University of Pittsburgh School of Medicine, Western Psychiatric In-
stitute and Clinic, Pittsburgh, Pennsylvania; Fellow, Department of
Medicine and Public Health, University of Bologna, Bologna, Italy

President, Association for the Improvement of Mental Health Pro-
grammes, Geneva, Switzerland

Senior Advisor, Office of the Director, Division of Services & Inter-
vention Research, National Institute of Mental Health, Bethesda,
Maryland
Susan K. Schultz, M.D.

Professor of Psychiatry, University of Iowa Carver College of Medi-
cine, Iowa City, Iowa
Soraya Seedat, M.B.Ch.B., F.C.Psych., Ph.D.

Co-Director, Medical Research Council Unit on Anxiety and Stress
Disorders, Cape Town, South Africa
David Shaffer, M.D.

Irving Philips Professor of Child Psychiatry and Professor of Pediat-
rics, Child & Adolescent Psychiatry, New York State Psychiatric In-
stitute, New York, New York

Associate Professor, Department of Psychology, University at Buf-
falo, The State University of New York, Buffalo, New York
Renata Sousa, Ph.D.

Psychologist and Researcher, Health Service and Population Re-
search Department, Institute of Psychiatry, London, United Kingdom

Assistant Professor, Department of Psychological Sciences, Purdue
University, West Lafayette, Indiana
Contributors xvii

Section Chief, National Institute of Mental Health, National Center
of Neurology and Psychiatry

Emeritus Professor, King’s College London, Institute of Psychiatry,
London, United Kingdom
Myriam Torres, M.S.

Michigan

Senior Research Assistant, Hong Kong Mood Disorders Center,
Prince of Wales Hospital

Coordinator Classifications Terminologies & Standards, World
Health Organization, Geneva, Switzerland
Michael Von Korff, Sc.D.

Senior Investigator, Group Health Research Institute, Seattle, Wash-
ington

Deputy Director, National Institute of Mental Health, Bethesda,
Maryland

Chairman and Director, Institute of Clinical Psychology and Psycho-
therapy, and Professor, Technische Universitaet Dresden, Dresden,
Germany
Kimberly A. Yonkers, M.D.

Professor, Department of Psychiatry, Yale School of Medicine, New
Haven, Connecticut
Charles H. Zeanah, M.D.

Professor, Department of Psychiatry, Tulane University, New Or-
leans, Louisiana
Rong Zhang, Ph.D.

Blue Cross Blue Shield of Michigan
xviii THE CONCEPTUAL EVOLUTION OF DSM-5
Disclosure of Competing Interests

The following contributors to this book have indicated a financial interest
in or other affiliation with a commercial supporter, a manufacturer of a
commercial product, a provider of a commercial service, a nongovernmen-
tal organization, and/or a government agency, as listed below:
Darrel A. Regier, M.D., M.P.H.—The author, as Executive Director of
the American Psychiatric Institute for Research and Education,
oversees all federal and industry-sponsored research and re-
search training grants in APIRE but receives no external salary
funding or honoraria from any government or industry.
Lee Anna Clark, Ph.D.—The author receives research support and
royalties from the University of Minnesota Press for the Schedule
for Adaptive and Non-adaptive Personality (SNAP) measure.
Warachal Eileen Faison, M.D.—The author is a full-time employee
at Pfizer Inc. and owns stock in Pfizer Inc.
Ellen Frank, Ph.D.—The author receives royalties from Guilford
Press. The author is on the Advisory Board for Servier Interna-
tional.
Nick Glozier, Ph.D.—The author has received research support
from the Australian Research Council, the National Health and
Medical Research Council, Servier Laboratories, BOHRF, Beyond
Blue, and the Heart Foundation. The author conducts medico-le-
gal disability assessments for NSW Fire Brigades, NSW Police,
RailCorp, the Worker’s Compensation Commission, and several
law firms, both appellant and respondent. The author is a mem-
ber of the NSW Worker’s Compensation Commission medical ap-
peal panel for disability compensation.
Steven E. Hyman, M.D.—The author is a member of the Novartis
Science Board but does not receive direct payment of honorar-
ium.
Ronald C. Kessler, Ph.D.—The author has been a consultant for
GlaxoSmithKline, Kaiser Permanente, Pfizer Inc., Sanofi-Aventis,
Shire Pharmaceuticals, and Wyeth-Ayerst. The author has
served on the advisory boards for Eli Lilly & Company and Wy-
eth-Ayerst. The author has received research support from Bris-
tol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson
& Johnson, Ortho-McNeil Pharmaceuticals Inc., Pfizer Inc., and
Sanofi-Aventis.
James F. Leckman, M.D.—The author receives research support
from the National Institutes of Health, Tourette Syndrome Asso-
ciation, and Klingenstein Third Generation Foundation. The au-
thor receives royalties from John Wiley and Sons, McGraw Hill,
and Oxford University Press.
Contributors xix
Paola Rucci, Dr.Stat.—The author has received research support

from Forest Research Institute and Fondazione IDEA.
Susan K. Schultz, M.D.—The author has received research support
from the National Cancer Institute and the National Institute of
Aging, with partnership from Baxter Healthcare. The author re-
ceives support from the American Psychiatric Association for ed-
itorial duties with the American Journal of Psychiatry.
Soraya Seedat, M.B.Ch.B., F.C.Psych., Ph.D.—The author has re-
ceived research support from GlaxoSmithKline, Lundbeck, Astra-
Zeneca, and Servier.
Michael Von Korff, Sc.D.—The author receives research support
from Johnson and Johnson.
Kimberly A. Yonkers, M.D.—The author has received research sup-
port from Eli Lilly. The author has received publishing royalties
from Up to Date Inc.
Charles H. Zeanah, M.D.—The author has received royalties from
Guilford Press.
The following contributors to this book have indicated no competing inter-

ests to dsiclose during the year preceding manuscript submission:
Gavin Andrews, M.D.
Katja Beesdo, Ph.D.
Ron Dahl, M.D.
Madeleine Delves
Richard Gater, M.D.
Regina James, M.D.
xx THE CONCEPTUAL EVOLUTION OF DSM-5

Briana Mezuk, Ph.D.
Johan Ormel, Ph.D.
Martin Prince, M.D.
David Shaffer, M.D.
Renata Sousa, Ph.D.
Myriam Torres, M.S.
Rong Zhang, Ph.D.
Introduction

Over the past 30 years, there has been a continuous testing of mul-
tiple hypotheses that are inherent in the Diagnostic and Statistical
Manual of Mental Disorders, from the third edition (DSM-III; American
Psychiatric Association 1980) to the fourth (DSM-IV; American Psy-
chiatric Association 1994). Although DSM-III was the first official
classification from the American Psychiatric Association (APA) to
embrace these hypotheses, their intellectual origin is more properly
attributed to Eli Robins and Samuel Guze’s landmark 1970 article on
the establishment of diagnostic validity in psychiatric illness (Rob-
ins and Guze 1970) and the subsequent 1972 release of the St. Louis
“Feighner diagnostic criteria” (Feighner et al. 1972). These formed the
basis for the 1978 Research Diagnostic Criteria (Spitzer et al. 1978),
which were used in the longitudinal collaborative study on the psy-
chobiology of depression supported by the National Institute of Mental
Health (Rice et al. 2005) and ultimately were the prototypical diagnoses
adopted in DSM-III in 1980.
The expectation of Robins and Guze (1970) was that each clinical
syndrome described in the Feighner criteria, Research Diagnostic
Criteria, and DSM-III would ultimately be validated by its separation
from other disorders, common clinical course, genetic aggregation in
families, and further differentiation by future laboratory tests—which
would now include anatomical and functional imaging, molecular ge-
netics, pathophysiological variations, and neuropsychological testing.
Reprinted from Regier DA, Narrow WE, Kuhl E, Kupfer DJ: “The Conceptual
Development of DSM-V.” American Journal of Psychiatry 166:645–650, 2009.
Copyright 2009, American Psychiatric Association. Used with permission.
xxi
xxii THE CONCEPTUAL EVOLUTION OF DSM-5
To the original validators Kendler (1990) added differential response

to treatment, which could include both pharmacological and psycho-
therapeutic interventions.
After almost 40 years of testing these hypotheses, we are im-
pressed by the remarkable advances in research and clinical prac-
tice that were facilitated by having explicit diagnostic criteria that
produced greater reliability in diagnosis across clinicians and re-
search investigators in many countries. The benefit of using explicit
criteria to increase reliability in the absence of etiological under-
standing was an outcome predicted by the British psychiatrist Ervin
Stengel (1959). However, as these criteria have been tested in mul-
tiple epidemiological, clinical, and genetic studies through slightly
revised DSM-III-R (American Psychiatric Association 1987), DSM-IV,
and DSM-IV-TR (American Psychiatric Association 2000) editions, the
lack of clear separation of these syndromes became apparent from
the high levels of comorbidity that were reported (Boyd et al. 1984;
Regier et al. 1990). A particularly clear discussion of the inability to
identify “zones of rarity” between mental disorders was presented by
Kendell and Jablensky (2003). In addition, treatment response be-
came less specific as selective serotonin reuptake inhibitors were
found to be effective for a wide range of anxiety, mood, and eating dis-
orders and atypical antipsychotics received indications for schizo-
phrenia, bipolar disorder, and treatment-resistant major depression.
More recently, it was found that a majority of patients with entry
diagnoses of major depression in the Sequenced Treatment Alter-
natives to Relieve Depression (STAR*D) study had significant anxi-
ety symptoms, and this subgroup had a more severe clinical course
and was less responsive to available treatments (Howland et al.
2009). The lack of clear separation between current disorders de-
fined by DSM-IV-TR was clearly illustrated in a survey of primary
care patients (Lowe et al. 2008), which found that among individuals
with the most severe ratings of depression, anxiety, or somatiza-
tion, more than one-half in each syndrome group also had at least
one, if not both, of the other two disorders. Furthermore, the com-
bined influence of the three syndromes on functional impairment
was far more significant than any of their individual effects. Like-
wise, we have come to understand that we are unlikely to find sin-
gle gene underpinnings for most mental disorders, which are more
likely to have polygenetic vulnerabilities interacting with epigenetic
factors (that switch genes on and off ) and environmental exposures
to produce disorders.
In retrospect, it is interesting that there was such a strict separa-
tion of mood, anxiety, psychotic, somatic, substance use, and per-
sonality disorder symptoms for the original Feighner diagnoses
(Regier et al. 2005). It is clear that an hierarchy was present that
tended to suppress the significance of lower-order symptoms in the
syndrome definitions in order to achieve such pure types. This hier-
Introduction xxiii
archical arrangement of disorders was implicit in the Kraepelinean

classification tradition of ranking organic mental disorders, nuclear
schizophrenia, manic-depressive illness, and neurotic illnesses
from higher- to lower-order conditions (Surtees and Kendell 1979).
It was followed by an explicit statement of Jaspers (1963): “The prin-
ciple of medical diagnosis is that all the disease-phenomena should
be characterized within a single diagnosis . . . in any one person”
(p. 611). Although the idea of a strict hierarchy, in which the pres-
ence of any disorder could cause manifestations of disorders lower
in the hierarchy, was explicitly abandoned for DSM-III-R after pub-
lication and review (Regier 1987) of the article by Boyd et al. (1984),
the strict separation of symptoms and disorder types has persisted
through DSM-IV-TR. Some remnants of the hierarchy persist in a
few areas, such as the diagnosis of autistic disorder (299.00), in
which there is still an explicit exclusion of a diagnosis of attention-
deficit/hyperactivity disorder (ADHD) if autistic disorder is present.
The practical effect of this exclusion is that insurance reimburse-
ment is often denied for co-occurring symptoms of ADHD in the
presence of a diagnosis of autism. To support this strict separation,
we now have a plethora of comorbidity—because patients do not usu-
ally have only mood, somatic, or anxiety symptoms but tend to come
with a mix from multiple symptom groups. Hence, we have hetero-
geneous conditions within single diagnostic groups, a remarkably
high rate in specialty mental health settings of “not otherwise spec-
ified” diagnoses that do not quite fit the existing criteria, as well as
high rates of “subsyndromal” mixed anxiety-mood-somatic disorders
in primary care settings.
How then are we to update our classification to recognize the most
prominent syndromes that are actually present in nature, rather than
in the heuristic and anachronistic pure types of previous scientific
eras? A serious consideration from the aforementioned study by Lowe
et al. (2008) is that some patients with clinically significant distress
and impairment might have only a few symptoms from mood, anx-
iety, and somatic diagnostic criteria sets that do not qualify for a
formal diagnosis in any one disorder, although the aggregate bur-
den requires a not-otherwise-specified diagnosis and treatment. A
more important clinical consideration is that the clinical course and
treatment response for anxious depression, posttraumatic stress
disorder with depression, and other mixed disorders cannot be pre-
dicted from clinical trials of medications or psychosocial interven-
tions that are based on outcomes with patient groups selected for
pure categorical disorders or that contain an unknown heteroge-
neous mix of comorbid conditions. In addition, supraordinate di-
mensional measures may provide better phenotypic expressions
for linkage to illness susceptibility substrates identified by neuroimag-
ing and genetic studies. Common genetic determinants of schizo-
phrenia and bipolar disorder have resulted in calls for a reappraisal of
xxiv THE CONCEPTUAL EVOLUTION OF DSM-5
these disorders as distinct diagnostic entities (Lichtenstein et al.

2009; Owen and Craddock 2009).
As we began the DSM-5 developmental process in 1999, a major
concern was to address a range of issues that had emerged over the
previous 30 years. These included the basic definition of a mental
disorder, the potential for adding dimensional criteria to disorders,
the option of separating impairment and diagnostic assessments,
the need to address the various expressions of an illness across de-
velopmental stages of an entire lifespan, and the need to address
differences in mental disorder expression as conditioned by gender
and cultural characteristics. The opportunity to evaluate the readi-
ness of neuroscientific advances in pathophysiology, genetics,
pharmacogenomics, structural and functional imaging, and neuro-
psychology was also a priority. All of these areas were summarized
in a series of white papers published as A Research Agenda for DSM-V
(Kupfer et al. 2002). A second volume of white papers was then com-
missioned by the APA to address developmental psychopathology
issues across the lifespan (in very young children and in geriatric
age groups) as well as gender-related differences in the occurrence
and expression of mental disorders, titled Age and Gender Consider-
ations in Psychiatric Diagnosis: A Research Agenda for DSM-V (Narrow et
al. 2007).
In the next stage of DSM development, the American Psychiatric
Institute for Research and Education was able to work jointly with
the World Health Organization (WHO) and leaders of the World Psy-
chiatric Association to develop a National Institute of Mental Health
(NIMH) research conference grant application to review the research
base for a wide range of mental disorder diagnoses. In addition to
NIMH, the National Institute on Drug Abuse (NIDA) and the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) agreed to sup-
port this effort and to transform it into a cooperative agreement
grant in which a steering committee was formed, consisting of rep-
resentatives from the American Psychiatric Institute for Research and
Education, each of the three National Institutes of Health institutes,
and WHO. One of us (D.A.R.) was the principal investigator, and the
coinvestigators included another author (W.E.N.) and Michael First,
as well as Bridget Grant from NIAAA; Wilson Compton from NIDA;
Wayne Fenton and then Bruce Cuthbert, followed by Michael Kozak,
from NIMH; and Benedetto Saraceno, who designated Norman Sar-
torius to represent WHO. The 5-year grant from 2003 to 2008 sup-
ported 13 international conferences that have produced more than
100 scientific articles, many of which have now been compiled into
monographs for use as reference volumes for the DSM-5 Task Force
and the WHO ICD-11 Mental Disorders Advisory Group (Andrews et
al. 2009; Helzer et al. 2008; Kupfer et al. 2002; Narrow et al. 2007;
Philips et al. 2003; Saunders et al. 2007; Sunderland et al. 2007;
Widiger et al. 2006). One consistent recommendation that emerged
Introduction xxv
most strongly from the initial methods conference (Kraemer 2007;

Kraemer et al. 2007), the conference on dimensional measures
(Helzer et al. 2006), and the conference on public health was the call
for better integration of categorical and dimensional assessment
criteria for the next revision of DSM. Previous editions had ques-
tioned the clinical feasibility of establishing dimensional measures
to assess thresholds and severity of disorders but had adopted
“clinically significant distress or impairment” assessment require-
ments for all disorders in DSM-IV (pp. xxi–xxii). The only dimen-
sional component of DSM-IV is Axis V, which mixes both symptoms
and functional impairment for a Global Assessment of Functioning
scale.
In April 2006, the DSM-5 Task Force chairperson (D.J.K.) and vice-
chairperson (D.A.R.) were named by APA President Steven Sharfstein
and Medical Director James Scully. This was followed by nomina-
tions of a substantial number of the task force members. However,
before members of the task force could be fully approved, the Board
of Trustees established principles for appointment that required lim-
its on investments and income that could be received from pharma-
ceutical companies, the requirement that no more than two repre-
sentatives from any one university participate in the task force or on
the same work group, and a vetting and review process by a subcom-
mittee of the board (www.dsm5.org). This process took almost 2 years
to complete, with the task force members publicly announced in July
2007 and the work group members announced in May 2008. During
the time needed to appoint and review the work group members, the
task force was assigned the responsibility of addressing conceptual
issues through study groups that would guide the overall development
of revisions for specific diagnostic areas.
The focus of the study group on spectrum disorders included as-
sessment of the spectra of mental disorder syndromes that cross
existing diagnostic boundaries, recommendations for the overall
structure of DSM categories, and identification of 11 potential crite-
ria useful for testing the validity of mental disorder diagnoses—a
marked expansion beyond the original criteria proposed by Robins
and Guze (1970). A second study group, addressing developmental is-
sues, focused on assuring attention to different expressions of mental
disorders that might emerge at progressive ages and human devel-
opmental life stages. A third study group, on gender and culture, was
established to assess the different expression or symptom equivalents
of mental disorders that are mediated by gender and culture. A fourth
study group, on the interface with general medicine, was formed to
address approaches that would facilitate a better interface between
general medical and mental disorder approaches to diagnosis.
A major initial concern identified by the fourth study group was
the need to review disability assessment strategies and instruments
that could apply across all of medicine and potentially replace the
xxvi THE CONCEPTUAL EVOLUTION OF DSM-5
Global Assessment of Functioning scale, which currently serves as

Axis V of DSM-IV-TR. As a result of their recommendations, a fifth
study group, for functional impairment and disability assessment, was
formed that would specifically address the development of global
impairment and disability assessment strategies. Finally, the need to
address measurement and assessment issues in all of the diagnostic
areas undergoing revisions resulted in the establishment of a sixth
study group that will focus on diagnostic assessment instruments.
Representatives from each of the work groups will work with a core
group of diagnostic instrument experts who can evaluate methods for
facilitating measurement-based care for clinicians, making clinical
research assessments, and determining rates of mental disorder di-
agnoses in community populations for epidemiological studies. This
final group had its first organizational meeting in January 2009 and
will be working with each of the work groups to facilitate a bottoms-
up approach for instrument development that will begin with the di-
agnostic criteria and determine how relevant dimensional metrics
can facilitate measurement-based care (Trivedi et al. 2006).
Each of the 13 diagnostic area work groups has been responsible for
conducting literature reviews that build on the relevant work from
phases one and two of the DSM-5 development process. A research
methods group has been established to review secondary data analy-
ses proposed for funding by the APA to assess the evidence base for
proposed revisions. The work group process has been supported by
conference calls that occur at least monthly, with some work groups
having subgroup meetings every 2 weeks. Face-to-face meetings have
been supported at APA headquarters at least twice each year, and
multiple work groups often meet simultaneously to facilitate cross-
group collaborative discussions about issues of overlapping concern.
Task force and work group members have participated actively in
professional meeting presentations and town hall meetings, con-
ducted surveys of published colleagues in their areas, provided sum-
maries of major work group issues on the DSM-5 development Web
site (www.dsm5.org), and received recommendations from the public
and professional colleagues directed to the Web site.
As the DSM-5 process now moves into a field trial phase of second-
ary data analysis and primary data collection to test diagnostic op-
tions, there will be an intensification of the interactions between the
cross-cutting study groups and the diagnostic work groups. Of major
concern will be an attempt to address the consequences of continuing
to use the original Feighner criteria, Research Diagnostic Criteria, and
DSM-III hierarchical structure of “pure” diagnostic categories. The
high rate of co-occurrence, frequent use of the “not otherwise speci-
fied” designation, and heterogeneous mix of conditions within current
diagnostic boundaries are all major problems that we would like to
address with the revision in DSM-5. The original Robins and Guze val-
idators have not confirmed the wisdom of the current structure. The
Introduction xxvii
expanded set of validators recommended by our study group on spec-

trum disorders provides a framework for considering how disorders
might be grouped into larger, supraordinate categories in DSM-5.
Mental disorder syndromes will eventually be redefined to reflect
more useful diagnostic categories (“to carve nature at its joints”) as
well as dimensional discontinuities between disorders and clear
thresholds between pathology and normality. However, our immedi-
ate task is to set a framework for an evolution of our diagnostic system
that can advance our clinical practice and facilitate ongoing testing
of the diagnostic criteria that are intended to be scientific hypothe-
ses, rather than inerrant Biblical scripture. The single most impor-
tant precondition for moving forward to improve the clinical and
scientific utility of DSM-5 will be the incorporation of simple dimen-
sional measures for assessing syndromes within broad diagnostic
categories and supraordinate dimensions that cross current diagnos-
tic boundaries. Thus, we have decided that one of the major—if not
the major—differences between DSM-IV and DSM-5 will be the more
prominent use of dimensional measures in DSM-5.
The readiness of biological markers to serve as associated features,
risk factors, or diagnostic criteria will be of major concern. Likewise,
the clinical utility and validity of age-, gender-, and culture-related
specifiers or subtypes of disorders will need to be assessed. Measure-
ment-based approaches for field testing new criteria sets will need to
be reviewed and selected as part of the field test procedures.
As chairpersons and coordinators of this revision process, we are
keenly aware of the rapidly changing research base for the description
and treatment of mental disorders that include neurodevelopmen-
tal, neurocognitive, and addictive disorders. We are reevaluating
the structure of the manual itself to facilitate both clinical practice
and better research criteria to guide clinical trials, genetics, imag-
ing, and treatment guideline development. More specifically, we
anticipate that we will have a structure that contains “receptors” for
new biological, neurocognitive, and environmental risk factors as
they emerge to guide future research and clinical practice (Hyman
2007). As a result, we expect that DSM-5 will be a living document with
a permanent revision infrastructure to enable revisions of specific
diagnostic areas in which new evidence is replicated and reviewed
as ready for adoption.
Such regular revisions are already routine for practice guidelines,
for the reviews of new diagnostic categories in International Classifica-
tion of Diseases, 9th Revision, Clinical Modification (National Center
for Health Statistics and Centers for Medicare and Medicaid Services
1997), and for the American Medical Association (2007) Current Pro-
cedural Terminology codes used by the Centers for Medicare and Med-
icaid Services and all of medicine.
We look forward to a vigorous interactive process over the com-
ing years before the publication of DSM-5 in May 2013.
xxviii THE CONCEPTUAL EVOLUTION OF DSM-5
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PART I
DIAGNOSTIC SPECTRA: ASSESSING THE

VALIDITY OF DISORDER GROUPINGS
CHAPTER 1
Diagnosis of Mental Disorders

in Light of Modern Genetics
Historically, a pressing need for interrater reliability in psychiatric

diagnosis has contributed to wide acceptance of operationalized
diagnostic criteria, beginning with DSM-III (American Psychiatric
Association 1980). As has long been noted, reliability became a pri-
ority at a time when validity could not be scientifically achieved. It
was hoped, nonetheless, that further research on DSM-III disorders
might ultimately yield a valid classification. It now appears that the
accreting failures of the current diagnostic system cannot be ad-
dressed simply by revising individual criterion sets and certainly not
by adding more disorders to DSM-5. The emerging field of genetics
provides one useful window into the nature of mental disorders. In-
sights emerging from genetics and, increasingly, from neuroscience
suggest that the exclusive use of categorical diagnoses and the pre-
dominant “splitting” approach of DSM-III and DSM-IV (American
Psychiatric Association 1994) represent obstacles to the near-term
development of a more scientifically and clinically satisfactory clas-
sification.
This chapter represents my personal viewpoint and does not represent an

official position of the DSM-5 Task Force, of which I am a member, or of the
International Advisory Group to the World Health Organization for the Re-
vision of ICD-10, Chapter V (Mental and Behavioral Disorders), of which I am
the chair.
3
4 THE CONCEPTUAL EVOLUTION OF DSM-5
Introduction and Background

Disease definitions that facilitate interrater reliability are the bed-
rock of replicable clinical investigation, including clinical trials. As
a result, such definitions form the basis for rational treatment deci-
sions and, indeed, all clinical communication. In general medicine,
the wide availability of objective tests has meant that interrater re-
liability is often taken for granted. In contrast, the lack of objective
tests for mental disorders has made reliability a significant challenge
because diagnoses must be based on verbal reports and behavioral
observations. DSM-III was the first systematic and relatively com-
plete platform for psychiatric diagnosis that had a clear focus on in-
terrater reliability. In the DSM-III approach to reliability, also adopted
by the ICD-10 chapter on Mental and Behavioral Disorders (World
Health Organization 1992), each diagnosis was based on a set of op-
erationalized diagnostic criteria that had been field tested. This fea-
ture contributed to the rapid and widespread acceptance of DSM-III.
DSM-III and its successor volumes—along with ICD-9 and ICD-10
(World Health Organization 1977, 1992)—have become global stan-
dards for the diagnosis of mental disorders. Although significant
problems with reliability remained, the DSM-III approach contrasted
markedly with the brief clinical descriptions provided by prior edi-
tions of the manual (see American Psychiatric Association 1952,
1968); these early descriptions gave little guidance as to how diagnoses
should be applied.
The proximate intellectual foundation for DSM-III was the seminal
work of Robins and Guze (1970), followed by two sets of diagnostic
criteria for research, based on the Robins and Guze approach (Feigh-
ner et al. 1972; Spitzer et al. 1975). Using schizophrenia as their ex-
ample, Robins and Guze (1970) argued that a valid diagnosis
(presumably, a diagnosis that would represent a “natural kind,” sep-
arable from other diagnostic entities), could be achieved by 1) identi-
fication of symptoms and signs that cluster together, 2) laboratory
studies, 3) a clear separation of one disorder from another, 4) long-
term follow-up studies to establish the stability of the diagnosis
over time, and 5) family studies. A critical assumption underlying the
work of Robins and Guze was that psychiatric disorders were best cap-
tured as discrete categories, discontinuous from each other and from
health. These authors did not take an alternative approach—com-
mon in general medicine—that represents at least some disorders
as quantitative deviations from health. Because quantitative (or di-
mensional) descriptions of disorder are continuous with a normal
state, there must be thresholds—ideally set using outcomes data—
that call for different levels of observation or treatment. Examples
of disorders that are usefully represented as discontinuous catego-
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The Project Gutenberg eBook of The South
African Question
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Title: The South African Question
Author: Olive Schreiner
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*** START OF THE PROJECT GUTENBERG EBOOK THE SOUTH

AFRICAN QUESTION ***
THE SOUTH AFRICAN
QUESTION
BY
AN ENGLISH SOUTH AFRICAN

(Olive Schreiner)
AUTHOR OF “THE STORY OF AN AFRICAN
FARM,” “DREAMS,” ETC.
CHICAGO
CHARLES H. SERGEL COMPANY
1899
Copyright, 1899, by Olive Schreiner.
“Then let us pray that come it may,

As come it will for a’ that;
That truth and worth, o’er a’ the earth,
May bear the gree, and a’ that;
For a’ that, and a’ that;
It’s coming yet, for a’ that;
That man to man, the world o’er,
Shall brothers be for a’ that.”
“Put up thy sword: they that hold the sword shall perish by the
sword.”
THE SOUTH AFRICAN
QUESTION.
Many views have found expression in the columns of papers
during the last weeks. The working man only a few weeks or months
from England has expressed his opposition to those stratagems with
war for their aim which would leave him without the defence he has
at present from the pressure of employers. Journalists only a few
years, months, or weeks from Europe, have written, not perhaps
expressing a desire for war, but implying it might be well if the wave
swept across South Africa, and especially across that portion which
is richest in mineral wealth, and, therefore, more to be desired.[6]
South Africans and men from Europe alike have written deprecating
war, because of the vast suffering and loss it would occasion to
individuals. Dutch and English South Africans have written (as one in
an able and powerful letter dated from Vrededorp, which appeared a
few days ago) proving the injustice that would be inflicted on the
people of Africa, the violation of treaties and trust. But, amid all this
chorus of opinion there is one voice which, though heard, has not
yet been heard with that distinctness and fulness which its authority
demands—it is the voice of the African-born Englishman who loves
England, the man who, born in South Africa, and loving it as all men,
who are men, love their birth-land, is yet an Englishman, bound to
England not only by ties of blood, but[7] that much more intense
passion which springs from personal contact alone. Our position is
unique, and it would seem that we are marked out, at the present
juncture of South African affairs, for an especial function, which
imposes on us, at whatever cost to ourselves, the duty of making
our voices heard and taking our share in the life of our two nations,
at their
MOST CRITICAL JUNCTURE.
For, let us consider what exactly our position is.
Born in South Africa, our eyes first opened on these African hills
and plains; around us, of other parentage but born with us in the
land, our birth-fellows, were men of another white race; and we
grew up side by side with them. Is it strange that, like all men[8]
living, who have the hearts of men, we learnt to love this land in
which we first saw light? In after years, when we left it, and lived
months or years across the seas, is it strange we carried it with us in
our hearts? When we stood on the Alps and looked down on the
lakes and forests of Switzerland, that we have said, “This is fair, but
South Africa to us is fairer?” That when on the top of Milan Cathedral
and we have looked out across the wide plains of Lombardy, we
have said, “This is noble; but nobler to us are the broad plains of
Africa, with their brown kopjes shimmering in the translucent
sunshine?” Is it strange that when, after long years of absence,
years it may be of success and the joy which springs from human
fellowship and youth, our ship has cast its anchor in[9] sight of Table
Bay, and the great front of Table Mountain has reared up before us,
a cry of passionate joy has welled up within us; and when we saw
the black men with their shining skins unloading in the docks, and
the rugged faces of South Africans, browned with our African sun,
we put our foot on the dear old earth again, and our hearts have
cried: “We are South Africans! We have come back again to our land
and to our people?” Is it strange that when we are in other lands
and we fear that death approaches us, we say: “Take me back! We
may live away from her, but when we are dead we must lie on her
breast. Bury us among the kopjes where we played when we were
children, and let the iron stones and red sand cover us?” Is it
strange that wherever we live we all want to[10] go home to die; and
that the time comes when we know that dearer far to us than fame
or success is one little handful of our own red South African earth?
Is it strange that, when the
TIME OF STRESS AND DANGER
comes to our land, we realize what, perhaps, we were but dimly
conscious of before, that we are Africans, that for this land and
people we could live—if need be, we could die?
Is it strange we should feel this? The Scotchman feels it for his
heathery hills, the Swiss for his valleys. All men who are men feel it
for the land of their birth!
What is strange is not that we have this feeling, but that, side by
side with it, we have another. We love Africa, but we love England
also. It is not[11] merely that when for the first time we visit the old
nesting place of our people it is rich for us with associations, that we
tread it for the first time with something of the awe and reverence
with which men tread an old cathedral, rich with remains of the
great dead and past; it is not merely that the associations of
language and literature bind us to it, nor that in some city or country
churchyard we stand beside the graves of our forefathers, and trace
on mould-eaten stones the names we have been familiar with in
Africa, and bear as our own; nor is it that we can linger yet on the
steps of the church where our parents were united before they
moved to the far South, and made of us South Africans. Beyond all
these impersonal, and more or less intellectual ties, we[12] form a
personal one with England. Whether we have gone home as
students to college or university, or for purposes of art, literature, or
professional labor, as time passes there springs up around us
A NETWORK OF TENDER BONDS;
there are formed the closest friendships our hearts will ever know,
such as are formed only in the spring time of life; there is gained our
first deep knowledge of life, and there grow up within us passions
and modes of thought we will carry with us to our graves. After
years, it may be after many years, when we return, on the walls of
our study in South Africa we still keep fastened in memory of the
past the old oar with which we won our first boating victory on Cam
or Thames; and the faces of the men who shared our victory with us
still look down at us from our walls. Not dearer to any Englishman is
the memory of his Alma Mater than to him who sits thousands of
miles off in the South, and who, as he smokes his last pipe of African
Boer or Transvaal tobacco, is visited often by memories of days that
will never fade, evenings on the river with bright faces and soft
voices, long midnight conclaves over glimmering fires, when, with
voices and hearts as young and glowing as our own, we discussed
all problems of the universe and longed to go out into life that we
might settle them—they come back to us with all the glitter and light
which hangs only about the remembrances of youth: and for many
of us the memory of fog-smitten London is inextricably blended with
the all profoundest emotions, the most passionate endeavors,
noblest relations our hearts will ever know. The steamers that come
weekly to South Africa are not for us merely vessels bringing news
from foreign lands; nor do they merely bring for us the intellectual
pabulum which feeds our mental life; they bring us
“NEWS FROM HOME.”
In London houses, in country cottages, in English manufacturing
towns, are men and women whose life and labor, whose joy and
sorrows our hearts will follow to the end, as theirs will follow ours to
the end, and across the seas our hands will always be interknit with
theirs. Our labor, our homes, our material interests, may all be in
South Africa, but a bond of love so strong that six thousand miles of
sea can only stretch it, but never sever it, binds us to the land and
the friends we loved in our youth. We are South Africans, but
intellectual sympathies, habits, personal emotions, have made us
strike deep roots across the sea; and when the thought flashes on
us, we may not walk the old streets again or press the old hands,
pain rises which those only know whose hearts are divided between
two lands. We are South Africans, but we are not South Africans
only—we are Englishmen also:
Dear little Island,
Our heart in the sea!
If to-morrow hostile fleets encompassed England, and the tread of
foreign troops was on her soil, she would not need to call to us; we
would stand beside her before she had spoken. This is
OUR EXACT POSITION.
Side by side with us in South Africa are other South Africans
whose position is not and cannot be exactly what ours is. Shading
away from us by imperceptible degrees, stand, on one side of us,
those English South Africans who, racially English, yet know nothing
or little personally of her; the grandparents, and not the parents of
such men, have left England; they are proud of being Englishmen,
proud of England’s great record and great names, as a man is proud
of his grandmother’s family, but they are before all things essentially
South African. They desire to see England increase and progress,
and to remain in harmony and union with her while she does not
interfere with internal affairs of South Africa, but they do not and
cannot feel[17] to her as those of us do whose love is personal and
whose intellectual sympathies center largely in England.
Yet further from us on the same side stand our oldest white
fellow South Africans; who were, many, not of English blood
originally, though among that body of early white settlers, men who
preceded us in South Africa by three centuries, were a few with
English names, and though by intermarriage Dutch and English
South Africans are daily and hourly blending, the bulk of these folk
were Dutchmen from Holland and Friesland, with a few Swedes,
Germans and Danes, and later was intermingled with them a strong
strain of Huguenot blood from France. These men were mainly of
that folk which, in the sixteenth century, held Philip and the Spanish
Empire at bay,[18] and struck the first death-blow into the heart of
that mighty Imperial system whose death-gasp we have witnessed
to-day. A brave, free, fearless folk with the
BLOOD OF THE OLD SEA KINGS
in their veins; a branch of that old Teutonic race which came with
the Angles and Saxons into England and subdued the Britons, and
who, in the persons of the Franks, entered Gaul, and spread its
blood across Europe. They are a people most nearly akin to the
English of all European folk, in language, form and feature
resembling them, and in a certain dogged persistence, and an
inalienable indestructible air of personal freedom.
Even under the early Dutch Government of the East India
Company, they[19] were not always restful and resented interference
and external control. They frequently felt themselves
“ondergedrukt,”[A] and, taking their guns, and getting together wife
and children and all that they had, and inspanning their wagons,
they trekked[B] away from the scant boards of civilization into the
wilderness, to form homes of freedom for themselves and their
descendants.
In 1795 England obtained the Cape as the result of European
complications, and the South African people, without request or
desire on their part, were given over to England. England retired
from the Cape in 1803, but, owing to other changes in Europe, she
took the Cape again in 1806, and has since then been the
GUARDIAN OF OUR SEAS,
and the strongest power in our land. Since that time, for the last
ninety years, Englishmen have slowly been added to the population,
but the men of Dutch descent still form the majority of white South
Africans throughout the Cape Colony, Free State, and Transvaal,
outnumbering at the present day, even with the accession of the
foreigners (Uitlanders mean foreigners in Dutch) to the goldfields of
the Transvaal, those of English descent, as probably about two to
one.
So we of England became step-mother to this South African
people. We English are a virile race. There is perhaps no one with a
drop of English blood in his veins who does not feel pride in that
knowledge. We are a brave and, for ourselves, a freedom-loving[21]
race; the best of us have nobler qualities yet—we love justice; we
admire courage and the love of freedom in others as well as
ourselves; and we find it difficult to put our foot on the weak, it
refuses to go down. At times, whether as individuals or as a nation,
we are capable of the
MOST HEROIC MORAL ACTION.
The heart swells with pride when we remember what has been done
by Englishmen, at different times and in different places, in the
cause of freedom and justice, when they could meet with no reward
and had nothing to gain. Such an act of justice on the part of the
English nation was done in 1881 when Gladstone gave back to the
Transvaal the independence which had been mistakenly taken. I
would not say policy had no part in the action of the wise old man.
No doubt that keen eagle-eye had fixed itself closely on the truth
which all history teaches that a colony of Teutonic folk cannot be
kept permanently in harmony and union with the Mother Country by
any bond but that of love, mutual sympathy and honor. The child
may be reduced by force to obedience; but time passes and the
child becomes a youth; the youth may be coerced; but the day
comes when the youth becomes a man, and there can be no
coercion then. If the mother wishes to retain the affection of the
man, she must win it from the youth. This the wise old man saw;
but I believe that, over and above the wisdom, he saw the right, and
the action was no less heroic because it was wise; for other men see
truth who have not the courage to follow her, and accept present
loss for a gain which lies across the centuries.
We English are a fearless folk, and in the main I think we seek
after justice, but we have our faults. We are not a sympathetic or a
quickly comprehending people; we are slow and we are proud; we
are shut in by a certain
SHELL OF HARD RESERVE.
There are probably few of us who have not some consciousness of
this defect in our own persons; it may be a fault allied to our highest
virtues, but it is a fault, and a serious one as regards our relations
with peoples who come under our rule. We may and do generally
sincerely desire justice; we may have no wish to oppress, but we do
not readily understand wants and conditions distinct from our own.
Here and there great Englishmen have appeared in South African
history as elsewhere (such as Sir William Porter and Sir George
Grey) who have been able to throw themselves sympathetically into
the entire life of the people about, to love them, and so to
comprehend their wants and win their affections. Such men are the
burning and shining lights of our Imperial and Colonial system, but
they are not common. Undoubtedly the officials sent out to rule the
Cape in the old days were generally men who earnestly desired to
do their duty; but they did not always understand the folk they had
to rule. They were generally simple soldiers, brave, fearless and
honorable as the English soldier is apt to be, but with hard military
conceptions of government and discipline. Our Dutch fellow South
Africans are a strange folk. Virile, resolute, passionate with a passion
hid far below the surface, they are at once the gentlest and the most
determined of peoples. When you try to coerce them they are hard
as steel encased in iron, but with a large and generous response to
affection and sympathy which perhaps no other European folk gives.
They may easily be deceived once; but never twice. Under the
roughest exterior of the up-country Boer lies a nature strangely
sensitive and conscious of personal dignity; a people who never
forgets a kindness and does
NOT EASILY FORGET A WRONG.
Our officials did not always understand them; they made no
allowances for a race of brave, free men inhabiting[26] a country
which by the might of their own right hand they had won from
savages and wild beasts, and who were given over into the hands of
a strange government without their consent or desire; and the
peculiarities which arose from their wild free life were not always
sympathetically understood; even their little language, the South
African “Taal,” a South African growth so dear to their hearts, and to
all those of us who love indigenous and South African growths, was
not sympathetically and gently dealt with. The men, well meaning,
but military, tried with this fierce, gentle, sensitive, free folk force,
where they should have exercised a broad and comprehensive
humanity; and when they did right (as when the slaves were freed),
they did it often in such manner, that it became[27] practically wrong.
A little of that tact of the higher and larger kind, which springs from
a human comprehension of another’s difficulties and needs, might,
exercised in the old days, have saved South Africa from all white-
race problems; it was not, perhaps under the conditions, could not,
be exercised. The people’s hearts ached under the uncompromising
iron rule. In 1815 there was a rising, and it was put down. As the
traveler passes by train along the railway from Port Elizabeth to
Kimberley, he will come, a few miles beyond Cookhouse, to a gap
between two hills; to his right flows the Fish River; to his left,
binding the two hills, is a ridge of land called in South Africa a “nek.”
It is a spot the thoughtful Englishman passes with deep pain. In the
year 1815 here were hanged five[28] South Africans who had taken
part in the rising, and the women who had fought beside them (for
the South African woman has ever stood beside the man in all his
labors and struggles) were compelled to stand by and look on. The
crowd of fellow South Africans who stood by them believed,
HOPED AGAINST HOPE,
to the last moment, that a reprieve would come. Lord Charles
Somerset sent none, and the tragedy was completed. The place is
called to-day “Schlachter’s Nek,” or “Butcher’s Ridge.” Every South
African child knows the story. Technically, any government has the
right to hang those who rise against its rule. Superficially it is a short
way of ending a difficulty for all governments. Historically it has
often been found to be the method for perpetrating them. We may
submerge for a moment that which rises again more formidably for
its blood bath. The mistake made by Lord Charles Somerset in 1815
was as the mistake would have been by President Kruger if, in 1896,
instead of exercising the large prerogative of mercy and
magnanimity, he had destroyed the handful of conspirators who
attempted to destroy the State. Both would have been within their
legal right, but the Transvaal would have failed to find that path
which runs higher than the path of mere law and leads towards
light. Fortunately for South Africa our little Republic found it.
The reign of stern military rule at the Cape had this effect, that
men and women, with a sore in their proud[30] hearts, continued to
move away from a controlling power that did not understand them.
Some moved across the Orange River and joined the old
“Voortrekkers” that had already gone into that country which is now
the Free State. England kept a certain virtual sovereignty over that
territory, till, in 1854, she grew weary of the expense it cost her, and
withdrew from it in spite of the representations of certain of its
inhabitants who sent a deputation to England to request her to
retain it. Thereupon the folk organized an independent State and
Government; and the little land, peopled mainly by men of Dutch
descent, but largely intermingled with English who lived with them
on terms of the greatest affection and unity, has become one of the
most
PROSPEROUS, WELL-GOVERNED AND PEACEFUL
communities on earth. Others, much the larger part of the people,
moved further; they crossed the Vaal River, and in that wild northern
land, where no Englishman’s foot had passed, they founded after
some years the gallant little Republic we all know to-day as the
Transvaal. How that Republic was founded is a story we all know.
Alone, unbacked by any great Imperial or national power, with their
old flint-lock guns in their hands as their only weapons, with wife
and children, they passed into that yet untrodden land. The terrible
story of their struggles, the death of Piet Retief and his brave
followers, killed by treachery by the Zulu Chief, Dingaan, the victory
of the survivors over him, which is still commemorated by their
children as Dingaan’s Day, the whole, perhaps, the most thrilling
record of the struggle and suffering of a people in founding their
State that the world can anywhere produce. Paul Kruger can still
remember how, after that terrible fight, women and children left
alone in the fortified laager, he himself being but a child, they carried
on bushes to fortify the laager, women with children in their arms, or
pregnant, laboring with strength of men to entrench themselves
against evil worse than death. Here in the wilderness they planted
their homes, and founded their little State. Men and women are still
living who can remember how, sixty years ago, the spot where the
great mining camp of Johannesburg now stands was a great silence
where they drew up their wagon and planted their little home, and
FOUGHT INCH BY INCH
with wild beasts to reclaim the desert. In this great northern land,
which no white man had entered or desired, they planted their
people, and loving it as men only can love the land they have
suffered and bled for, the gallant little Republic they raised they love
to-day as the Swiss loves his mountain home and the Hollander his
dykes. It is theirs, the best land on earth to them.
They had fought not for money but for homes for their wives and
children; when they battled, the wives reloaded the old flint-lock
guns and handed them down from the front chest of their wagon for
the men who stood around defending them. It was a wild free[34]
fight, on even terms; there were no Maxim guns to mow down
ebony figures by the hundred at the turn of a handle; a free even
stand up fight; and there were times when it almost seemed the
assagai would overcome the old flint-lock, and the voortrekkers
would be swept away. The panther and the jaguar rolled together on
the ground, and, if one conquered instead of the other, it was yet a
fair fight, and South Africa has no reason to be ashamed of the way
either her black men or her white men fought it.
If it be asked, has the Dutch South African always dealt gently
and generously with the native folks with whom he came into
contact, we answer, “No, he has not”—neither has any other white
race of whom we have record in history. He kept slaves in[35] the
early days! Yes, and a century ago England wished to make war on
her American subjects in Virginia for refusing to take the slaves she
sent. There was a time when we might have vaunted some
superiority in the English-African method of dealing with the native.
THAT DAY IS PAST.
The terrible events of the last five years in South Africa have left us
silent. There is undoubtedly a score laid against us on this matter,
Dutch and English South Africans alike; for the moment it is in
abeyance; in fifty or a hundred years it will probably be presented
for payment as other bills are, and the white man of Africa will have
to settle it. It has been run up as heavily north of the Limpopo as
south; and when our sons stand up to settle it, it will be Dutchmen
and Englishmen together who have to pay for the sins of their
fathers.
Such is the history of our fellow South Africans of Dutch
extraction, who to-day cover South Africa from Capetown to the
Limpopo. In the Cape Colony, and increasingly in the two Republics,
are found enormous numbers of cultured and polished Dutch-
descended South Africans, using English as their daily form of
speech, and in no way distinguishable from the rest of the
nineteenth century Europeans. Our most noted judges, our most
eloquent lawyers, our most skillful physicians, are frequently men of
this blood; the lists of the yearly examinations of our Cape University
are largely filled with Dutch names, and women, as well as men,
rank high in the order of merit.[37] It would sometimes almost seem
as if the long repose the people has had from the heated life of
cities, with the large tax upon the nervous system, had sent them
back to the world of intellectual occupations with more than the
ordinary grasp of power. In many cases they go home to Europe to
study, and doubtless their college life and English friendships bind
Britain close to their hearts as to ours who are English-born. The
present State Attorney of the Transvaal is a man who has taken
some of the highest honors Cambridge can bestow. Besides, there
exist still our old simple farmers or Boers, found in the greatest
perfection in the midland districts of the Colony, in the Transvaal and
Free State, who constitute a large part of the virile backbone of
South Africa. Clinging to their old[38] seventeenth century faiths and
manners, and speaking their African taal, they are yet tending to
pass rapidly away, displaced by their own cultured modern children;
but they still form a large and powerful body. Year by year the lines
dividing the South Africans from their more lately arrived English-
descent brothers are
PASSING AWAY.
Love, not figuratively but literally, is obliterating the line of
distinction; month by month, week by week, one might say hour by
hour, men and women of the two races are meeting. In the Colony
there are few families which have not their Dutch or English
connections by marriage; in another generation the fusion will be
complete. There will be no Dutchmen then and no Englishmen in
South Africa, but only the great blended South African people of the
future, speaking the English tongue, and holding in reverend
memory its founders of the past, whether Dutch or English. Already,
but for the sorrowful mistakes of the last years, the line of
demarcation would have faded out of sight; external impediments
may tend to delay it, but they can never prevent this fusion; we are
one people. In thirty years’ time, the daughter of the man who
landed yesterday in South Africa will carry at her heart the child of a
de Villiers, and the son of the Cornish miner who lands this week will
have given the name of her English grandmother to his daughter,
whose mother was a le Roux. There will be nothing in forty years but
the great blended race of Africans.
These South Africans, together with those of English descent, but

who have been more than two generations in the country and have
had no—or very little—personal and intimate knowledge and
intercourse with England, may be taken as standing on one side of
us. They are before all things South Africans. They have—both
Dutch and English—in many cases a deep and sincere affection for
the English language, English institutions, and a sincere affection for
England herself. They are grateful to her for her watch over their
seas; and were a Russian fleet to appear in Table Bay to-morrow
and attempt to land troops, it would fly as quickly from Dutch as
English bullets.[41] Neither Dutch nor English South Africans desire to
see any other power installed in the place of England. Cultured
Dutch and English Africans alike are fed on English literature, and
England is their intellectual home. Even with our simplest Dutch-
descent Africans the memories of
THE OLD BITTER DAYS
had almost faded, when the ghastly events, which are too well
known to need referring to, awoke the old ache at the heart a few
years ago. But even they would see quietly no other power standing
in the place of England. “It is a strange thing,” said a well-known
Dutch South African to us twenty-one years ago, “that when I went
to Europe to study I went to Holland, and loved the land and the
people, but I felt a stranger; it was the same in Germany, the same
in France. But when I landed in England I said, ‘I am at home!’” That
man was once a passionate lover of England, but he is now a heart-
sore man. There have been representatives of England in South
Africa who have been loved as dearly by the Dutch as by the
English. When a few years ago there was a talk of Sir George Grey
visiting South Africa on his way home from New Zealand to England,
old grey-headed Dutchmen in the Free State expressed their resolve
to take one more long train journey and go down to Capetown only
once more to shake the hand of the old man who more than forty
years before had been Governor of the Cape Colony. So deeply had
a great Englishman, upholding the loftiest traditions of English
justice and humanity, endeared himself to the hearts of South
Africans. “God’s Englishman”—not of the Stock Exchange and the
Gatling gun, but of the great heart.
But great as is the bond between South Africans, whether Dutch
or English, and England, caused by language, sentiments, interest
and the noble record left by those large Englishmen who have
labored among us, the South African pure and simple, whether
English or Dutch, cannot feel to England just as we do. Their
material interest may bind them to England as much as it binds us,
but that deep passion for her honor, the consciousness that she
represents a large spiritual factor in our lives, which, once gone,
nothing replaces for us; that her right-doing is ours, and her wrong-
doing[44] is also ours; that in a manner her flag does not represent
anything we have an interest in, or even that we love, but that in a
curious way it is ourselves—this they cannot know. Therefore, while
on our side we are connected with them by our affection for South
Africa and our resolute desire for its good, our position remains not
exactly as theirs. Our standpoint is at once broader and more
impartial in dealing with South African questions, in that we are
bound by two-fold sympathies.
On the other hand of us, who are at once South Africans and
Englishmen, stand in South Africa another body of individuals who
are not South African, in any sense or only partially, but to whom
from our peculiar position we also stand closely bound.
[45]Ever since the time when England took over the Cape, there
has been slowly entering the country a thin stream of new settlers,
English mainly, but largely reinforced by people of other
nationalities. Eighty years ago, in 1820, a comparatively large body
of Englishmen arrived at once, and are known as the British Settlers.
They settled at first mainly in Albany, and certain of their
descendants are to-day, in some senses, almost as truly and typically
South African as the older Dutch settlers.
THEIR LOVE FOR AFRICA
is intense. Some years later a large body of Germans were brought
to the Kingwilliams town division of South Africa. They, too, became
farmers, and their descendants are already true South Africans. For
the rest, for years men continually dribbled in slowly and singly from
other countries. Whether they came out in search of health, as
clergymen, missionaries, or doctors, or in search of manual
employment, or as farmers, they almost all became, or tended to
become almost immediately, South Africans. They settled in the land
permanently among people who were permanent inhabitants, they
often married women born in South Africa, and their roots soon sank
deeply into it. They brought us no new problem to South Africa.
They have settled among us, living as we live, sharing our lives and
interests. It is said that it takes thirty years to make a South African,
and in a manner this is true. Even now, more especially in times of
stress or danger, it is easy to distinguish the African-born man from
the man of whatever race and however long in the country who has
not been born here. But in the main these newcomers have become
South Africans with quickness and to an astonishing degree, and
coming in in driblets they were, so to speak, easily digested by
South Africa.
But during the last few years
A NEW PHENOMENON HAS STARTED
up in South African life. The discovery of vast stores of mineral
wealth in South Africa, more especially gold, has attracted suddenly
to its shores a large population which is not and cannot, at least at
once, be South African. This body is known under the name of the
Uitlanders (literally “Foreigners”).
Through a misfortune, and by no[48] fault of its own, the mass of
this gold has been discovered mainly along the Witwatersrand,
within the territory of the Transvaal Republic, and more especially at
the spot where the great mining camp of Johannesburg now stands,
thus throwing upon the little Republic the main pressure of the new
arrivals.
To those who know the great mining camps of Klondike and
Western America, it is perhaps not necessary to describe
Johannesburg. Here are found that diverse and many-shaded body
of humans, who appear wherever in the world gold is discovered.
The Chinaman with his pigtail, the Indian Coolie, the manly Kafir,
and the Half-caste; all forms of dark and colored folk are here, and
outnumber considerably the white. Nor is the white population less
multifarious and complex. On first[49] walking the streets, one has a
strange sense of having left South Africa, and being merely in some
cosmopolitan center, which might be anywhere where all nations and
colors gather round the yellow king. Russian Jews and Poles are
here by thousands, seeking in South Africa the freedom from
oppression that was denied that much-wronged race of men in their
own birth-land; Cornish and Northumberland miners; working men
from all parts of the earth; French, German and English tradesmen;
while on the Stock Exchange men of every European nationality are
found, though the Jew predominates. The American strangers are
not large in number, but are represented by perhaps the most
cultured and enlightened class in the camp, the mining engineer and
large importers of[50] mining machinery being often of that race; our
lawyers and doctors are of all nationalities, while in addition to all
foreigners, there is a certain admixture of English and Dutch South
Africans. In the course of a day one is brought into contact with men
of every species. Your household servant may be a Kafir, your
washerwoman is a Half-caste, your butcher is a Hungarian, your
baker English, the man who soles your boots a German, you buy
your vegetables and fruit from an Indian Coolie, your coals from the
Chinaman round the corner, your grocer is a Russian Jew, your
dearest friend an American. This is an actual, and not an imaginary,
description. Here are found the most noted prostitutes of Chicago;
and that sad sisterhood created by the dislocation of our yet
uncoordinated civilization,[51] and known in Johannesburg under the
name of continental women, have thronged here in hundreds from
Paris and the rest of Europe. Gambling, as in all mining camps, is
rife; not merely men but even women put their money into the
totalisator, and
A LOW FEVER OF ANXIETY
for chance wealth feeds on us. Crimes of violence are not unknown;
but, if one may speak with authority who has known only one other
great mining center in its early condition, and whose information on
this matter has therefore been gathered largely from books,
Johannesburg compares favorably, and very favorably, with other
large mining camps in the same stage of their existence. The life of
culture and impersonal thought is largely and of necessity among a
new and nomadic population absent; art and science are of
necessity unrepresented; but a general alertness and keenness
characterizes our population. In the bulk of our miners and working
men, of our young men in banks and houses of business, we have a
large mass of solid, intelligent, and invaluable social material which
counter-balances that large mass of human flotsam and jetsam
found in this, as in all other mining camps; while among our
professional men and mining officials is found a large amount of the
highest professional knowledge and efficiency. Happy would it be for
the gallant little Transvaal Republic, and well for South Africa as a
whole, if the bulk of this little human nature could become ours
forever, if they were here to stay with us, drink out of our cup and
sup out of our platter. But in most cases this is not so. The bulk of
the population, and especially its most valuable and cultured
elements, are here temporarily; as persons who go to Italy or the
south of France for health or sunshine, who, even when they go
year after year, or buy villas and settle there for a time, yet go to
seek merely health and sunshine, not strike root there; and as men
go to Italy for health and sunshine, the bulk of us here come to seek
gold or a temporary livelihood, and for nothing more. Even our
miners and working men in Johannesburg, the most stable and
possibly permanent element in our population, have, in many
instances, their wives and families in Cornwall or elsewhere; and
when they have them here they still think of the return home for
good in after years; while with the wealthier classes this is practically
universal. Not only have our leading mining engineers and the great
speculators not the slightest intention of staying in Johannesburg
permanently; most have their wives and families in England,
America, or on the Continent, and project as soon as possible a
retirement from business, and return to the fashionable circles of
Europe or America. Even among South African-born men the large
majority of us intend returning to our own more lovely birthplaces
and homes in the Colony sooner or later; and the only element
which will probably form any integral part of the South African
nation of the future and become subject to the Transvaal Republic is
the poorer, which, from the larger advantages for labor here, will be
unable to return to its natural home.
The nomadic population of Johannesburg undoubtedly consists of
men who are brave and loyal citizens in their own States and
nations. To-morrow,
IF AMERICA WERE IN DANGER,
probably almost every American citizen would troop back to her
bosom, and spend not only life, but the wealth he had gained in
South Africa from South African soil, in defending her. Every German
would go home to the Fatherland; every Englishman, every
Frenchman, would, as all brave men in the world’s history have
done, when the cry arises, “The birth-land in danger!” The few
Spaniards here trooped back to Spain as soon as the news of war
arrived.
One of the most brilliant and able of[56] English journalists (a
man whose opinion on any subject touching his own land we would
receive almost with the reverence accruing to the man who speaks
of a subject he knows well and has studied with superior abilities;
but who had been only a few months in our land, and, therefore,
had not full grasp of either our people or our problems, which from
their complexity and many-sidedness are subjects for a life’s
devotion) that man, three and a half years ago, when brave little
Jameson—brave, however mistaken—was sent in to capture the
mines of Johannesburg for his master, and when the great mixed
population of Johannesburg, Germans and French, English and Jews,
Arabs and Chinamen, refused to arise and go to aid him, and when
hundreds of Englishmen, Cornishmen and others fled[57] from
Johannesburg, fearing that Jameson might arrive and cause a
disturbance—said that Johannesburg would be known forever in
history by the name of Judasburg! and that the Cornish and other
Englishmen who fled from the place were poltroons and cowards.
But he was mistaken.
JOHANNESBURG IS NOT JUDASBURG,
and the Englishmen who fled were not poltroons. There ran in them
blood as brave as any in England, and if to-morrow a hostile force
attacked their birth-land, those very Cornish miners and English
working men would die in the last ditch defending their land. Those
men were strangers here; they came to earn the bread they could
with difficulty win in their own land; they were friendly treated by
South Africa and made money here; but were they bound to die in a
foreign land for causes which they neither knew nor cared for?
One thing only can possibly justify war and the destruction of our
fellows to the enlightened and humane denizen of the nineteenth
century; the unavoidable conviction that by no other means can we
preserve our own life and freedom from a stronger power, or defend
a weaker state or individual from a stronger. Nothing can even
palliate it but so intense a conviction of a right so great to be
maintained that we are willing, not merely to hire other men to fight
and die for us, but to risk our own lives,
A LIFE FOR A LIFE.
This the Englishmen in Johannesburg and foreigners of all
nations could not possibly feel. They were not more[59] bound to die
to obtain control of the gold mines of Johannesburg for a man
already wealthy or his confederates, than to assist South Africans in
defending them; or than we who visit the south of France or Italy for
health should feel ourselves bound to remain and die if war breaks
out between the Bonapartists and the Republicans, or the Pope and
the King. If by a process of abstract thought we have arrived at a
strong conviction of a right or human justice to be maintained by a
cause with which we have no practical concern, we may feel morally
compelled to take a part in it; but no man can throw it in our teeth if
we refuse to die in a strange land for
A CAUSE THAT IS NOT OURS.
The Englishmen and others who refused[60] to fight in
Johannesburg, or fled rather than run the risk of remaining, pursued
the only course open to wise and honorable men. Had they resolved
to remain permanently in South Africa, and to become citizens of the
Transvaal Republic, the case might have been otherwise. As it was,
they could not run a knife into the heart of a people which had
hospitably received them, and attempt to destroy a land in which
they had found nothing but greater wealth and material comfort
than in their own; and they could also not enter upon a deadly raid
for a man whom personally the workers of Johannesburg cared
nothing for, and with whom they had not a sympathy or interest in
common. In leaving Johannesburg and refusing to fight, they
pursued the only[61] course left open to them by justice and honor.
Rightly to understand the problem before the little Transvaal
Republic to-day, it is necessary for Englishmen to imagine not merely
that, within the space of ten or twelve years, forty millions of
Russians, Frenchmen and Germans should enter England, not in
driblets and in time extending over half a century, so that they
might, in a measure, be absorbed and digested into the original
population, but instantaneously and at once; not merely, that the
large bulk of them did not intend to remain in England, and were
there merely to extract wealth; not merely, that the bulk of this
wealth was exported at once to other countries enriching Russia,
France and Germany out of the products of English soil; that would
be[62] comparatively a small matter—but, that the bulk of the wealth
extracted was in the hands of a few persons, and that these persons
were opposed to the continued freedom and independence of
England, and were attempting by the use of the wealth they
extracted from England to stir up Russia and France against her, that
through the loss of her freedom they might the better obtain the
command of her wealth and lands. When the Englishman has vividly
drawn this future for himself, he will hold, as nearly as is possible, in
a nutshell an image of the problem which the people and
government of the Transvaal Republic are called on to face to-day;
and we put it straightly to him whether this problem is not one of
INFINITE COMPLEXITY AND DIFFICULTY?
Much unfortunate misunderstanding has arisen from the simple
use of the terms “capitalist” and “monopolist” in the discussion of
South African matters. Without the appending of explanation, they
convey a false impression. These terms, so familiar to the students
of social phenomena in Europe and America, are generally used in
connection with a larger, but a quite distinct body of problems. The
terms “capitalism,” “monopolist,” and “millionaire” are now generally
associated with the question of the forming of “trusts,” “corners,”
etc., and the question whether it is desirable that society should so
organize itself that one man may easily obtain possession of twenty
millions, while the bulk of[64] equally intelligent and equally laborious
men obtain little or nothing from the labor of humanity. This
question is a world-wide question; it is not one in any sense
peculiarly South African; it is a world-wide problem, which, as the
result of much thought, careful consideration and many experiments,
the nations of the civilized world will be called to adjudicate upon
during the twentieth century; but it is not the question with which
South Africa stands face to face at this moment. The question before
us is not: Shall one South African possess twenty millions, live in his
palace, live on champagne, have his yacht in Table Bay, and deck
women with a hundred thousand pounds’ worth of jewels, while the
South African next door has nothing? This is not our question. Our
problem[65] is not the problem of America. In America there are
many individuals possessing wealth amounting to many millions, but
when the United States in their entirety is taken the £40,000,000 of
the richest individual sink to nothing; and, were it the desire of the
richest millionaire in the States
TO CORRUPT AND PURCHASE
the whole population for political purposes, he could not pay so
much as £1 a head to the 80,000,000 inhabitants of the country.
Further, the bulk of American millionaires are American! They differ
in no respect, except in their possession of large wealth, in interest
or affections, from the shoemaker in the alley or the farmer at his
plough. They are American citizens; their fate is bound up with that
of the land they live in; their ambitions are American. If a great
misfortune should overtake America to-morrow there is no reason to
suppose that the heart of a Rockefeller or a Vanderbilt would not
ache as that of the simplest cowboy in the States. When they die, it
is to American institutions that they leave their munificent donations,
and the colleges and public institutions of America are endowed by
them. The mass even of that wealth they expend on themselves is
expended in America, and, whether they will or no, returns to the

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