Entre ‘sickness’ et ‘illness’: De la socialisation a l'individualisation de la ‘maladie’

Abstract

In biomedicine, psychiatry and psychoanalysis, there are not sicknesses but rather individual illnesses. If medical anthropology takes for granted the universality of this Western medical, cultural axiom, it will hardly be able to understand traditional conceptions of sickness, which do not separate what is individual from what is social in pathological and therapeutic processes. One of the main tasks of contemporary medical anthropology is to discover the devices and processes that connect these two spheres—the states of health of the person's body and of the social body/group of which he is a part—through the origin, development and experience of illness. To do this, the distinctive properties of sickness as an event must be defined: its individual selectivity and social reactivity; its recurrence and reversibility; its individual and collective history as a singular event or as a ‘pathotype’ that, by means of bodily or material ‘memorials’, is part of the pathohistory of the sick person and of his group; its social recessiveness; and its interconnections with other types of ill. In traditional societies, individual ills are, through magico-religious interpretations, converted into social disorder. Each referent (divinity, ancestor, magic, witchcraft, etc.) of such interpretations is a cognitive, subjective and social entity that activates the individual through the social, and the social through the individual, by bringing into play the interpretors' personal and collective strategies. Magico-religious interpretations of illness rely on psychic processes of projection and persecution. Contrary to biomedicine, traditional practices activate, shape and legitimate the universal propensity of the sick to expell ills from inside and to locate their outside, either in an invisible or a human being. In African societies, persecutive interpretations are not only normal, frequent and legitimate but also normative since they underlie the various social or political uses to which illness is put. Persecutive communication is the process by which an individual trouble, ill or woe is converted into social disorder. This intersubjective process cannot be defined without distinguishing explanations from interpretations of illness. The latter are metacommunicative acts by which the sick person's ‘social partners’ use his illness to promote their own strategies. Healing the patient is the obvious issue in persecutive communication, but its hidden stakes are how to define, face and settle the various social conflicts that indwell the group. The effect of this intersubjective process is both to modify, positively or negatively, the state of the sick person and to change the relational ‘contexture’ of the group affected by his illness. Accordingly, treating the person's body involves healing the social body/group to which he belongs. A case study of the successive interpretations of the troubles of a Wolof secondary school student is used to illustrate these remarks. In conclusion, the major differences between the medical systems that socialize illness and those that individualize sickness are pointed out. The medical Westernization of the Third World implies the ‘therapeutic’ promotion of the individual as a producer. Gradually passing from the persecutive consciousness of ill to a conscience of guilt means, in particular, that sickness is being turned into an individual, somatic, desocialized experience. Hence, Africans very often perceive biomedicine as a powerful technology for treating symptoms that needs to be completed by traditional practices for etiological healing. Will this view of the complementarity of treatment administered at the hospital and of healing in the village be abandoned? If so, what will be the price—will it be the individualization of sickness?