Medical anthropology at home

Full text

Anthropology at Home via Anthropology Abroad:
The Problematic Heritage
Sylvie FAINZANG
CERMES / INSERM
Published in: Anthropology & Medicine, 1998, 5, 3: 269-277.
Abstract: Medical anthropology "at home" owes an important debt to the methodological,
epistemological, and theoretical research traditions developed by anthropologists working
"abroad". In turn, medical anthropology "at home" has much to offer to social anthropology as a
whole, since the field brings a fresh gaze to familiar phenomena. By constructing new objects of
research and new methods, and in particular through the effort of distancing — which is both
more crucial and also harder to achieve at home than abroad — the study of medical anthropology
in one's own society suggests new pathways towards the understanding of the individual in
society.
The questions raised in the European Conference "Medical Anthropology At Home" (Zeist,
The Netherlands, 1998) seem to me to be part of the critical re-examination now underway of
social anthropology as a whole, involving methodological, epistemological, and theoretical
questions. The theme of this issue ("Medical Anthropology At Home") suggests a focus on the
domestic nature of the research carried out by certain medical anthropologists, and also the
medical dimension of anthropology carried out in one's own society. Bringing together these two
dimensions raises several questions: what can the field of medical anthropology at home
contribute to medical anthropology as a whole? What can it contribute to social and cultural
anthropology? Finally, what are the constraints and difficulties arising from the practice of this
kind of anthropology?
Maintaining the identity of the discipline
It seems to me that the contribution of "medical anthropology at home" to medical
anthropology as a discipline and to social and cultural anthropology as a whole can only occur
under certain conditions, the most important being the preservation of anthropology's comparative
vocation. When medical anthropology sets out to study the cultural logics underlying the
management and interpretation of illness as expressed in the behaviour of Westerners – as is done
for other societies – then can the field generate data for reflection on cultural differences, on
constants and variations regarding attitudes towards affliction and illness.
The contribution of medical anthropology at home both to medical anthropology and to social
and cultural anthropology as a whole is of great significance, insofar as medical anthropologists
working in our societies and medical or social anthropologists in general, may have common
objects of study and common questions, of universal validity. Medical anthropology at home

2
shows that in western societies, the manner in which individuals conceive of and handle illness
teaches us about the relationship between them and society. Indeed, both at home and abroad,
attitudes towards affliction are extremely revelatory, functioning as a kind of grid for
understanding social relations and symbolic systems in a given society. A research I made on
interpretation of illness abroad and at home allows to confront the logics to which these models
respond. After working in Africa (among the Bisa of Burkina-Faso), where a large portion of my
work was devoted to the study of explanatory patterns of sickness, I decided to study the patterns
of illness interpretation in a multicultural township in the periphery of Paris. The study was run
through concrete cases, in different cultural groups (French, Gypsies, Portuguese, etc.). I came
across four patterns of accusation within the interpretative patterns of illness: 1. self-accusation, 2.
accusation of the intimate other, 3. accusation of the distant other, 4. accusation of society.
By comparing the patterns of accusations revealed by the study of the representations of illness
in this French township with those found in the interpretation of illness in a village of a lineage-
based African society such as the Bisa of Burkina, I found striking analogies but also marked
differences. I found that some of the patterns above exist in both types of society, whereas one is
characteristic of western society. More specifically, in lineage-based African societies patterns 1
and 2 (self-accusation and accusation of the intimate other) are the ones most frequently given as
the cause of a sickness, but there is no accusation of society as in the west. The use of one of the
four patterns expresses the link between an individual and society in heterogeneous social,
historical and cultural contexts. While self-accusation and accusation of the intimate other in
traditional societies explain a sickness by referring to the behaviour of the sick person, or of a
close other, the fourth pattern explains it by referring to the nature of western society. In the first
case, making the individual responsible aims at maintaining his permanent obedience to the codes;
in the second case, making society responsible, indicates the desire to change it. The comparison,
which aims at highlighting both constants and differences in these various types of accusation,
allows to notice the existence of what I called a "reproductive causality" in Africa, and a
"subversive causality" in the western countries, in the sense that the first one expresses the wish to
reproduce society in the same state as that left by the ancestors while the second one aims at
changing society (Fainzang, 1989).
So the question set at the beginning by the perception of illness in France leads us to put into
new ways one of the questions in medical and social anthropology in general (that is causality) but
also more general questions about one's relationship towards the others and about the political
relationship of the individual towards the society in which he/she lives. It is thus through the
confrontation between societies which seem to have little in common, such as exotic societies and
western societies that we can get the data necessary to find constants and variations, allowing for
the formulation of general laws.
Nevertheless, this contribution can only happen if the field of medical anthropology at home
maintains its identity as a discipline. This identity must be maintained on two levels:
- as a practice emerging from the study of exotic societies, thus distinct from sociology (since the
data can sometimes be collected only thanks to a long-lasting direct observation), and
- as a social science discipline, thus distinct from the medical disciplines (that is to say not with
the perspective to use social material in order to serve medicine, but rather with the perspective to
use medical phenomena to serve our knowledge and our understanding of human societies).
The difficult task required of medical anthropologists working in their own societies is to
construct themselves through difference, distinguishing themselves from sociologists and also
from doctors.
But are the research traditions developed for the study of exotic societies useful and pertinent
for the study of contemporary post-industrial society? Scholars offer very different answers to this
question. As Messerschmidt (1981) reminds us, some social scientists such as Gillin are sceptical
about the ability of studying complex contemporary society with either anthropological theory or
method; some assume like Cohen that the concepts and methods developed in tribal and peasant

3
groups are inadequate for the study of industrial societies. On the other hand, Despres thinks our
theoretical and methodological traditions are directly applicable to modern and complex research
settings, and Weaver and White consider that anthropology doesn't need being made over anew to
study complex society (cf. Messerschmidt, 1981).
My personal opinion is that these traditions are of evident value, both methodologically and
theoretically. To deny this is to fail to reckon that anthropology has learned, from its birth and
experience abroad, to formulate both questions and to elaborate methods differently from
sociology. Anthropology must remain complementary to sociology but not confounded with it:
each has a specific contribution to make to social sciences.
Methodologically, anthropological research traditions teach us to carry out long-term
observation of the practices of individuals and groups, and also to connect relevant data
concerning the domain studied (health and sickness) to other domains and other levels of social
life. I subscribe to the idea that social anthropology is a unified whole: that is to say; there is only
one anthropology which, although it studies distinct empirical objects, yet is not fragmented. My
position here is similar to that of Augé (1986), and to that of the anthropologists of the Ecole des
Hautes Etudes en Sciences Sociales in Paris. Therefore, I believe that the practice of medical
anthropology, whether in Western or in other societies, should not be separated from the other
fields of anthropology.
This remark, epistemological in nature, is not intended to reduce the level of the debate by
claiming that anthropology abroad and medical anthropology at home are indistinguishable and
that in the end, it all comes down to the same thing! Rather, I mean to emphasize that the specific
focus of medical anthropology on the medical field does not make it any less imperative to study
the links between this object and other domains, even if the fact of practicing in one's own society
makes this difficult. This is the specificity of research "at home." For the anthropologist working
"abroad," it seems obvious that a given therapeutic practice must be linked to the political and
religious domains, to kinship or to social organization. But for the anthropologist "at home," this
same step (which makes medical anthropology a simple bridge towards a better understanding of
the individual in society) seems much more complex, the phenomena and data associated with
illness being perceived – perhaps wrongly – as operating with greater autonomy.
Theoretically, the questions raised by an exotic field help to formulate questions about our own
society. For example, I recently began a study of the handling of prescriptions and medication by
individuals of diverse cultural and religious origins. This approach was suggested to me by
reflections on the particular relationship of individuals living in Islamicized African societies to
writing (and to what is written): working on the ways people behave when confronted with illness
in an African islamicized village among the Bisa of Burkina Faso, I had noticed the part played by
the words (the religious words, actually koranic sourats) in the treatment, and the use of them as
medicine (for instance, rubbing one's body with - or else drinking - some water resulting from the
washing of a piece of wood where a koranic verse had been written, in order to cure the patient).
Owing to the difficulty to distinguish between the role of religious beliefs and the powerfulness
attributed to writing in the construction of efficacy, I wondered whether the same strength was
likely to be attributed to secular writing as to religious writing. It urged me to formulate a new
question in the frame of western societies: Is the significance attributed to writing likely to be
found in other religious and cultural settings? Namely, has the importance granted to the Bible and
to the Scriptures among the Protestants some thing to do with a supposedly greater respect
towards the prescription (the doctor's writing?) and maybe with a different kind of observance,
compared with Catholics, Jews or Muslims? But also, what can we learn from the way people
behave, in their daily life towards this piece of paper that is the medical prescription? What can
we learn from the gestures people have concerning prescriptions and medicine, whether they are
integrated or not in the course of treatment?
It is the detour abroad which in this case allowed me to problematize this research in these
terms. As a matter of fact, the question set by prescriptions is not only that of compliance which is

4
a medical as much as a social question. But it is that of what people do with their prescriptions. To
know if people comply with prescriptions is not the same as to know what they do with them. The
fact they keep them or throw them away, that they tear them or burn them, the place where they
store them in the domestic space, etc., all these questions and the observations made about them
among these different communities inform us about their perception of efficacy, but also about
their perception of medical authority, of the body, or of the place devoted to the individual versus
the collective in the management of health and sickness (cf. Fainzang, 1998).
Therefore, the comparative vocation of anthropology, itself born out of the confrontation
between different exotic societies, leads to the construction of problems that are fruitful for the
understanding of our own societies and human societies in general.
The redefinition of concepts
The repatriation of anthropology at home induces various kinds of attitudes that should be
examined, since the epistemological posture that they presume is inextricably linked to their
heuristic scope.
The rethinking of medical concepts is one of the major contributions that researchers working
"at home" can make to the disciplines of medical anthropology and also to social anthropology as
a whole. I am not suggesting that we import concepts elaborated abroad in an arbitrary way (to
refer to a professional group as a "tribe" of doctors in no way adds to our understanding). What is
indispensable is to rethink our categories in the light of what we know about other societies, and
to detach these categories from the meaning assigned to them by the medical sciences in order to
consider their social significance.
This can be applied to notions such as "prevention" or "contagion," whose content is often
quite different from the meaning given to them by health professionals. In the framework of exotic
medical anthropology, it is no surprise to find such terms used to designate systems of
representation that do not coincide with the Western vision of contagion or prevention. But in
studies of Western societies, it is rare to find these concepts considered with enough distance.
Nonetheless, the "Western vision" is far from unified and homogenous, and the content of these
notions as constructed by the subjects studied is far from identical to the meaning assigned in
medical discourse. Anthropological fieldwork "at home" puts us to the test, forcing us to re-
examine the content of these notions and to relativise their meaning and scope. Therefore, notions
such as "prevention" and "contagion," like "effectiveness," should not be conceived from within
the medical perspective. In order to decode their content the anthropologist must adopt an emic
posture, apprehending these categories from the individuals' point of view.
It is clear that the place from which one considers prevention for instance, (according to the
fact one is a medical doctor or an anthropologist) is likely to give a different content to things and
to words used to designate them. For instance, the very idea of prevention, considered by medical
doctors as a set of measures taken against the appearance of disease, is a category that the
anthropologist may use only in relation to the content that people he studies confer to it. Some
examples drawn from populations living in France (though their system of thought seems foreign
to us) illustrate easily this point. In African families immigrated in France and living in
polygamous marriage, for instance, a woman's recourse to a "marabout" (the man who uses his
koranic knowledge to magical ends) is aimed at neutralising the supposed percecutive action of
her co-spouse. This recourse is seen as a way of preventing any disease associated to her
reproductive power, in the same way as sterility (or lost of a child before his birth or miscarriage)
is attributed to the co-spouse's action, because of the rivalities between women inherent to
polygamic institution (Fainzang & Journet, 1989). The anthropologist doesn't have to judge the
validity of such recourse. It is prevention.

5
Another example is that of a practice which has been observed among the Gypsies. It consists
in displaying an object which belongs to a child (a hair slide, a ribbon, a shoelace, a medallion,
etc.) on the gravestone of a dead she-healer. The object is aimed at receiving the protection of the
healer through contact with the gravestone, and is then given back to the child, in order to prevent
any disease to affect him. This practice is thus aimed at preventing the child from being sick.
Though irrational and magical it may be, it is comparable, in terms of symbolic logic, to
prophylactic measures.
The reader may say these examples are drawn from populations which are foreign to western
culture even if they live in France. But other types of practices in western culture may be analysed
in the same way, proving that some behaviours, namely social behaviours, may be adopted in a
purpose of prevention. Even though they are not justified on a medical level, they may be
motivated by the adherence of the subject to one particular system of thought.
It is the case for instance with abstinence, advocated and by the members of an association of
ex-alcoholics (Vie libre) and which leads some of them to break off all social relationships
considered at risk. They may namely forbid themselves to visit any person in the house of whom
they risk to see a bottle of alcohol on the table, not only because they sometimes fear temptation
but also because alcohol has become an enemy to them; so they choose to remain in an avoidance
relationship. Frequenting the enemy would engender relapse. This tendency to remain away from
any friendly and family relations (except those offered by the group of which they are members) is
a behaviour intended to prevent from the coming back of what they call "alcoholic disease".
Prevention is here the avoidance of a pathogenic agent: alcohol. Even if they may have perverse
effects, by creating new troubles through aggravating the state of depression (induced by isolation,
loneliness) in which they are those behaviours are preventive behaviours. The notion of
prevention is thus a cultural construction, such as health and illness (cf. Fainzang, 1992).
The notion of contagion has also to be reconsidered, from an anthropological point of view, if
we want to account for the fact that, as I have observed in this association (gathering former-
drinkers and their spouses), many people consider, even if they do not drink, that their spouse's
alcoholism makes them sick and tend to find the same symptoms as those of the drinker's
"alcoholic disease" on their own body. To understand what the idea of alcoholism as a
"contagious" disease may mean, anthropology has to dismantle this concept. It must distance itself
from the ideas elaborated by other disciplines and, to this end, keep from analysing a phenomenon
by relying on the way it is considered by western scientific thought. The analysis of the situations
in which people feel at risk through contagion help elaborating an anthropological notion of
contagion, that accounts for the perception of the impact of the other's sickness one oneself, by
physical and social proximity to the sick person, due to what alcohol represents for the subjects in
the symbolic system elaborated by the group (Fainzang, 1996a; 1996b).
This work of redefining the categories used by the medical community is all the more useful
that, by creating distance from our objects, it allows for the refinement of our conceptual tools: it
allows actually to make clear that these notions are of real interest for anthropologists as long as it
is their social and cultural construction which is at stake and not the biologically proven reality of
the phenomenon they aim at referring to. This work of endowing a true anthropological content to
these notions is one way of sharpening the tools useful for understanding social and cultural
realities.
The anthropologist-Subject
This distanciation is hard to achieve, because the representations studied in Western societies
are often those shared by the ethnologist himself. After all, the ethnologist is also, at times, a
patient! In this respect, the methodological difficulties involved in the practice of medical
anthropology in the West are not always the same as those encountered in social and cultural
anthropology as a whole. The ethnologist is implicated from the outset in the field as a subject,

6
because in every day life he comes into contact with the object under study. The practices and
representations relative to illness are commonplace, and it takes an enormous effort to view them
from afar; whereas if the ethnologist was studying political or religious questions, it might be
easier for him to maintain a distance from his object of study.
This difficulty is even greater if the ethnologist is also a medical doctor. Maybe if one is to do
research in medical anthropology, it is better not to be a doctor (since a doctor would find it hard
to disengage from medical categories), just as it is better not to be a priest doing research in
religious anthropology.
Another challenge in studying representations of illness in the West arises if one works in a
social and cultural milieu similar to one's own. The difficulty arises from the necessity of
recreating distance from individuals who are culturally close, just as - we've just seen it - one must
recreate distance from objects that are existentially familiar. A fertile intellectual posture is to
learn to be astonished at everything, and when one studies those near to one, to look at them as if
they were culturally distant. From this point of view, it seems to me entirely false and even
detrimental to anthropology to believe, as do certain authors – cf. Hennigh (1981) – that Western
scholars can be their own informants. It is true that anthropologist may draw some knowledge
from their own subjective experience of illness and use it as a material for their analyses, but they
can't confine themselves to it and must add an outer look on the object they study. Just as someone
can't see himself the way others see him: he can watch himself in a mirror, his vision will be
distorted and incomplete.
But even if I perceive the other as an other, if I manage to construct him as an other although
he is in fact a peer – how does he perceive me? Does he see me as an other or as a peer? How will
he accept those "cultural blunders" that I may make in the field (such as offering cough syrup –
made with alcohol – to an individual belonging to this association of ex-alcoholics, which, as we
have seen, may be in a relation of total avoidance of alcohol, seen as an enemy with which one
must cease any relation (cf. Fainzang, 1996b). When the cultural context is sufficiently foreign, I
may be pardoned for my blunders. But how will my informants consider me if I commit blunders
"at home," my immersion in the group studied further reducing any distance that might excuse
me? …It is clear that the passage from anthropology abroad to anthropology at home forces us to
take a new look at the crucial issues of immersion and participation, and their consequences for
the collection of material.
One last remark. Just as it would be simplifying to reduce all of the experiences of exotic
anthropology to one model when there is great diversity among non-Western societies, so
reflections on the practice of anthropology at home should not imply a uniform vision of Western
societies. Rather, anthropology at home must be accompanied by a reflection on cultural
differences. The homogenizing tendency of the concept "Western society" must be countered by
an attempt on the part of anthropologists, to achieve its fragmentation, in order to isolate internal
cultural units.
For instance, is there any relevance of studying western, or European, or even French attitudes
towards drugs and medicine? What would such qualifier mean from an anthropological
perspective? Indeed, the study I presently lead on the way people behave with their prescriptions
shows differences, not only between social categories of course (as sociology has shown for long),
but between people with different cultural origins, and particularly with different religious origins,
independently of the role of religious beliefs. For instance, French protestants prove much more
inclined towards self-medication than Catholics while, in the same time, they are more reluctant to
take a great number of drugs (especially psychotropic drugs) than Catholics are. The goal is not to
return to a baseless culturalism, but to make a place for the cultural and historical characters of the
symbolic systems studied.
In conclusion: medical anthropology "at home" owes a great debt to exotic anthropology
because the research traditions developed by anthropologists working "abroad" allow us here "at
home" to produce a distanced analysis of our most everyday conduct. In turn, medical

7
anthropology at home has much to offer to social anthropology as a whole, by formulating in new
terms fundamental questions concerning the behaviour of the individuals in society, and not by
contenting itself with posing them in the context of the great divide between "the West and the
Rest."
References:
Augé M. L'anthropologie de la maladie, L'Homme, 26 (1-2), 1986, p. 81-90.
Fainzang S. Réflexions anthropologiques sur la notion de prévention, in: (Aïach P., Bon N. &
Deschamps J.P. eds.) Comportements et santé. Questions pour la prévention, Presses
Universitaires de Nancy, 1992, p. 18-27.
Fainzang S. & Journet O. La femme de mon mari. Etude ethnologique de la polygamie en Afrique
et en France, Paris, L'Harmattan, 1989.
Fainzang S. Pour une anthropologie de la maladie en France. Un regard africaniste, Paris,
Editions de l'Ecole des Hautes Etudes en Sciences Sociales, 1989.
Fainzang S., 1996a, Alcoholism, a contagious disease. A contribution towards an anthropological
definition of contagion", Culture, Medicine and Psychiatry, 20, 473-487.
Fainzang S., 1996b, Ethnologie des anciens alcooliques. La liberté ou la mort, Paris, Presses
Universitaires de France.
Fainzang S., 1998, Attitudes culturelles des catholiques et des protestants à l'égard de
l'ordonnance médicale, in Malattia, Culture e Società, Atti del 3° Colloquio Europeo di
Etnofarmacologia e della 1° Conferenza Internazionale di Antropologia e Storia della Salute e
delle Malattie, a cura di A. Guerci, Erga Edizioni, Genova.
Hennigh L., 1981, The Anthropologist as Key Informant: Inside a Rural Oregon Town", in:
Anthropologists at Home in North America, Methods and Issues in the Study of One's Own Society
(Messerschmidt ed.), Cambridge, Cambridge University Press: 121-132.
Messerschmidt D. A., 1981, On Anthropology 'at Home', in: Anthropologists at Home in North
America, Methods and Issues in the Study of One's Own Society (Messerschmidt ed.), Cambridge,
Cambridge University Press: 3-14.