The Meaning of Illness.

The Meaning of Illness. – book reviews

Cynthia Hunter

This collection of seven essays, translated from the original French, centres on interpretations (representations) and explanations of the social dimension of illness. The book’s span of anthropology, history and sociology is divided into two parts. The first four chapters discuss illness and/or ill-fortune in non-industrialized societies as forms of biological and social disorder, specifically through the ethnology of African lineage societies. Part II shifts attention to a hegemonic modern medicine with its focus on ‘health’ through examples of 20th century urban, rural and neo-rural communities in France.

Chapter one by Marc Auge examines illness as an elemental event (similar to birth and death), based on the hypothesis that the same intellectual logic controls the biological and the social order and that a single interpretive framework of the world applies as much to the individual body as to social institutions (pp.23-24). Auge is at pains to explicate a truly anthropological, as opposed to medical, analysis of the meaning of illness. He attempts to correlate social characteristics with the different logics that can be derived from the voodoo systems of the Benin regions where there are two possible routes to therapy–one which prioritizes symptoms, the other causes. The ethnologist, it becomes apparent, cannot analyse illness as she or he would a ‘medical system’ in industrialized societies.

Nicole Sindzingre follows with an examination of the state of illness and the quest for its origin in biophysiological disorder. She evaluates local ideas of causality in terms of notions of ill-fortune and biophysical disorder, and as a source of remedy. Her example of the Senufo (Ivory Coast) shows the less-than-systematic nature of illness conceptions. Here the field of illness is linked to religion, to symbolic categories and rites because of traditional communities’ focus on causality and local treatments. She finds that the (recognized) efficacy of Western biomedicine has no effect on causal thought, since the primary concern of the latter is explanation.

Francoise Heritier’s chapter three examines representations of sterility. In conjunction with Sindzingre, she adopts a Durkheimian approach according to three sets of characteristics: sterility is a discourse on social practice and the rules related to it; it is feminine; and the discourse expresses a homology between the nature of the world, the human body, and society, containing the possibility of transferring elements from one register to another. Her analysis encompasses an extensive body of literature on cause-effect relationships between biological evolution and social rules. Herifier’s conclusions are that in traditional societies sterility may be seen as punishment for transgressions, the disorder of the generations or male errors which affect world orders and that in the West, until recently, the likelihood of a similar ideological prevalence of the woman’s purported responsibility for sterility held sway (p.103).

Chapter four is by an historian, E. M’Bokolo, who offers a rich and fascinating Africa-centred account of the history of illness, of different epidemiologies and medical topographies, with an overview of current and projected work. M’Bokolo undertakes three studies: the history of particular epidemics and pandemics; illnesses and their relationship with economics and demography based on existing medical geography and historical demography; and illnesses in their complex and multiple relationships with global society. Although a nosological picture has been developed, the author believes it is difficult to distinguish characteristics of the environment from specific historical conditions. Political tensions and periods of change affected diseases and health systems as did colonial conditions and attitudes. All this points to a need for a thorough chronology of the different diseases of the region. Diseases need to be the main point of the study, examined as collective phenomena with their own evolution, to add their effects to those of other social facts. The author advocates a methodology for much more joint analysis by anthropologists and historians.

The subject matter of the three chapters in Part II is the social construction of illness in contemporary France. Claudine Herzlich provides an overview and presses the need for sociologists to disengage from a clinical representation and, instead, to regard illness as a social signifier. Her critical account documents the developments sociologists have made in recognizing social class factors and medicine’s role in producing social categories of health and illness. These two levels of analysis must be combined to apprehend the social construction of health and illness in its entirety. This approach rests on two oppositions – the health/illness antithesis duplicates and objectifies the individual/society antithesis. Herzlich claims that representations of illness, health and the body provide the metaphorical basis for the meaning of our relations to society. She argues that there are debates and movements, e.g. ‘bioethics’, which highlight illness and medicine as one of many ‘dilemmas expressing our ambiguous relationship with scientific and social change’ (p.165).

Chapter six, by Jean Pierret, is the only essay which accentuates ethnography by incorporating data from his survey of lay perceptions of health. We learn that laypeople have several ways of speaking about health because it ‘implies… illness, medicine, work, education, and family and behind these different conceptions … the meaning that individuals give to their social behaviour and habits’ (pp. 175-176). Pierret concludes that prevention-oriented medicine is replacing cure because the right to health has been replaced by the obligation to be healthy. The notion of health is seen as a key to the system of interpretation, beliefs and values of the different social classes.

Lastly, Daniele Leger’s contribution documents the place of healing of the body and the salvation of the soul in apocalyptic consciences, ecological movements and salvation movements. There are ties here with Herzlich’s work on ‘quests for meaning’ manifested through forms of opposition to medical power. These movements are widespread among middle-class intellectuals. With a distrust of heavy medical technology, there is a growth in herbal medicine, iridology, health food and other anti-institutionalisms. Leger concludes with the notion that ‘natural medicine’ has a distinctive mobilizing function which has connections with the renewed interests of these groups in religious traditions. According to Leger there are stages of transformation from an ecological apocalyptic movement to a religious apocalyptic movement in which illness and recovery play central roles because the sick/healed contrast provides the link between order/disorder and salvation/damnation, the two forms of contrast which converge paradigmatically in the sacred and secular (p.221).

This concludes a well integrated collection, with each contributor rigorously addressing the theoretical, historical and methodological issues involved. The dense text, demanding of the reader at times, is an illuminating one from which I have learnt a great deal about medical anthropology. I think biographical notes of the authors would be useful to English readers in particular. I recommend it as an important text for academics and all researchers interested in medical anthropology.

COPYRIGHT 1997 Australian Anthropological Society

COPYRIGHT 2004 Gale Group