Discussion

Although explanations of pica vary with the type of substance consumed and with the cultural context, there are several consistent themes in the literature. One is that whereas men do practice pica, the behavior is most frequently associated with women and children. Second, regardless of cultural context and whether pica is considered acceptable among adults, there seems to be a uniform concern about the practice of pica by children.

A third has to do with similarities shared by the substances most frequently consumed. They tend to be brittle, dry, and crunchy. Moreover, the smell of the clay and soil is cited as important in a variety of cultural contexts, as is the location from which the clay or earth is obtained. These sites are frequently the homes of living things such as termites or crayfish. There is also a pattern, historically and geographically, of consumption of earth or clay from sites of special significance. Such sites may be religious, as in Latin America and Africa, locally distinctive, as in the southern United States, or they may be places of burial, as in Asia, Africa, and Europe. Finally, there is a cross-cultural consistency in the debate concerning the relationship of pica to iron and other mineral deficiencies, and in the debate over whether the practice is psychologically or physiologically based.

One question that remains unexplored (in fact, it is barely mentioned in the literature) is why the definitions and syndromes associated with pica are not extended to the many practices in which men rather than women more typically engage, such as chewing tobacco and cigars or pipe stems, using snuff, and chewing toothpicks, betel nut, and chewing gum. While these habits may not generally involve consumption, they are not so dissimilar from the practices of pagophagia. Certainly, it appears that the relationship between the forms of pica we have discussed and other cravings and sources of oral satisfaction is an area in need of further investigation.

Margaret], Weinberger

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