Angst in London
The understanding of experienced pain has recently moved from the biological to the metaphorical. Detailed interviews withtwelve Turkish and Kurdish patients in London who had been unsuccessfully investigated medically for chronic pain showed thattheir understanding reflected local, typically humoural, conceptions of self and body. However there was little to suggestinterpretation of the illness as a more specific and grounded idiom for social or political experience. It is suggested that the currentvogue for 'interpretation' in medical anthropology and social psychiatry may occasionally be, as Umberto Eco puts it, INTRODUCTIONIt is common in cultural and historical theorising to attribute changing social patterns to some 'deeper' transformation of self orsociety, such that fashionable hemlines or illnesses represent changing class relations, gender roles, social crises, or whatever(Littlewood, 1997). At its most sophisticated, this logic presumes an affinity between a wider social patterning and its individual
What actually constitutes a plausible interpretation of this sort is none too clear, and historians and social scientists rely on anumber of rather different procedures (Littlewood, 1997): an identified similarity between illness experience and the presumedstate of other individuals undergoing the same social experiences (the illness as a reified exaggeration of the everyday), a formalequivalence between an individual and the society which experiences change (the individual as an analogue of the body politic), anexpressed interpretation given by the sick individual themselves (local motivation or exegesis) or a more tenuous connectionbetween individual illness as a direct representation of social circumstances (for example tuberculosis or AIDS as a consequenceof a society's moral laxity). Does the emphasis on 'meaning' do justice to theimmediate concerns of those involved situationally as sick individuals? As Ernest Gellner (1973) noted some years ago, a problemlies with what we mean by 'interpretation'. 1992, Kleinman and Kleinntan, 1994, Skultans 1995, 1998). The understanding of physical pain within social medicine itself has moved from a recognition of it as simply reflecting biologicaldamage of the body, to the psychodynamic argument that it may represent 'psychological pain', now to a recent understanding ofit as a conventional metaphor used by a society to signify some especial social dislocation or disharmony (Kleinman, 1986,Morris, 1991, Good et al. The medical anthropological and cultural psychiatric shift from a necessary internal mechanism to abiologically quite arbitrary interpretation is characteristic of recent hermeneutic developments in the social sciences, away from theidea of privileged superordinate explanations about one, 'real', analytical level, which determines subjective agency and intention atanother, to a single understanding in which both the naturalistic and social structural perspectives are themselves reduced to acultural and historical datum. In the course of this, the thinking of theolder sort of psychosomatic medicine -- in which particular bodily symptoms referred directly to a particular psychologicalprocess -- has passed to social science where symptoms are now seen as the equally specific and encoded consequence of socialor cultural events (Note 1). Interpretation is some form of translation, but is it a systematisation and codification oflocal social facts which would make sense to the people themselves (a position influenced by the work of Wittgenstein), or is it anexplanation couched in familiar forms of Western scientific discourse, whether biological or socialogical, and which presumablymakes sense in these terms? (Such as for example Weber's well-known argument about Calvinist beliefs subserving a socialinstitution, capitalism, an argument which would presumably have been unintelligible to the early Protestants themselves. It is particularly in psychological distress or illness that such an analogy may be sustained, presumablybecause the physical body is more resistant to metaphorical use in current Western scientific thinking compared with thosetraditional societies typically examined by social anthropologists. ) And ifthe latter, what are the limits of plausibility within a particular discipline? To interpret an illness as representative of its culture in thesecond sense presumably requires both some temporal relationship of social events or structure to illness, as well as some sort offormal and logical similarity between illness and a particular individual experience (Littlewood, 1997). Whilst we have criticised elsewhere (Littlewood, 1993) anthropology's abandonment of the objectified naturalistic body as onevalid commentary on human experience, our concern here is rather different. The extent to which this sort of metaphorical thinking is plausibledepends in part on intellectual climate, in part on our disciplinary convention (Lenclud, 1996). Kenny, 1980); sicknesses are taken as characteristic of their age or of shared socialexperience (Sontag, 1979).
Common topics in this essay:
Umberto Eco,
Kleinman Kleinntan,
Ernest Gellner,
Turkish Kurdish,
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littlewood 1997,
western scientific,
cultural historical,
similarity illness,
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