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Illness, Biomedicine, and Alternative Healing in Brittany, France

2008; Taylor & Francis; Volume: 27; Issue: 2 Linguagem: Inglês

10.1080/01459740802017439

1545-5882

Ellen Badone,

Health, Medicine and Society

Abstract Through the lens of an illness narrative, this article focuses on the complex relationships between biomedicine and alternative therapies in Brittany, France. Themes drawn from the illness narrative highlight Breton ideas about the body, the source of healers' legitimacy, and the authority of the biomedical system. I argue that in this region, both biomedical and religious authorities are perceived to be allied to non-local elites, and both are subject to antagonistic criticism. Nonetheless, resistance to biomedicine through recourse to alternative therapies is mixed with ongoing dependence on the biomedical system, since patients seek strategic combinations of both systems to maximize health and other benefits. Pursuing alternative therapies empowers patients by enabling them to negotiate treatment options and to choose among competing narrative constructions of illness. By highlighting parallels between the Breton material and published work based elsewhere in Europe and North America, I argue that this case study has useful implications for anthropologists and medical practitioners working in broader Western contexts. Key Words: cancercomplementary/alternative medicineFranceillness narratives ACKNOWLEDGMENTS The fieldwork on which this article is based was carried out in 1989 funded by McMaster University, with a return visit in 1993 supported by the Social Sciences and Humanities Research Council of Canada. Preliminary versions of the article were presented at the 1990 meetings of the American Anthropological Association and in February 1992 in the Department of Anthropology at the University of Chicago. A special debt of thanks is owed to Janine, whose story, with some details altered to protect her anonymity, is presented in this article. All personal names cited in the article are pseudonyms. Notes In order to enable the reader to judge the issue of representativeness, it should be clarified that Janine's narrative was collected during an intensive four-month period of fieldwork in rural Finistère in 1989, during which I was based in the same community where I had previously conducted 13 months of fieldwork in 1983–1984 (Badone Citation1989; Citation2004a; Citation2004b). My earlier research had introduced me to alternative healers, and I was able to benefit in 1989 from my close familiarity with local culture. Fieldwork in 1989 involved lengthy, open-ended interviews with alternative healers, biomedical doctors, and people in Finistère who had either consulted an alternative healer or expressed an interest in my research. I interviewed patients while they waited to be treated in the waiting rooms of healers, and in some cases, patients and healers allowed me to be present during the treatment itself. On three occasions, I was myself treated as a patient by alternative healers. See Badone (Citation1991; Citation1995). The French social security system provides medical insurance, workers' compensation, and retirement benefits. The system is characterized by universal and compulsory enrolment in health insurance funds, of which there are several corresponding to different occupational sectors. These funds are financed through a tax on total income and to a lesser extent, payroll deductions from employees and employer contributions. Although some hospital-based physicians are salaried, the majority of doctors are paid on a fee-for-service basis according to an official fee schedule. Patients are free to consult the physician of their choice and are required to pay the full charge for most medical services directly to the physician. Patients are then reimbursed by the social security system at an average level of 80 percent. Many patients also hold complementary health insurance through mutual associations or private, for-profit insurance companies, which reimburse some or all of the 20 percent patient co-payment. In cases of hospitalization, 80 percent of costs are deducted directly from the social security insurance fund. For hospital stays of over 30 days and for certain costly therapies and lengthy illnesses, the 20 percent patient co-payment is waived. While the majority of hospitals in France are public there are also private hospitals specializing primarily in maternity care and routine surgery. All public and private hospitals are supervised by the Ministry of Health (Sandier, Paris, and Polton Citation2004). In terms of numbers of acute hospital beds per 1,000 inhabitants, Brittany and the département of Finistère rank slightly above the national average, whereas Brittany has slightly lower numbers of specialists per 100,000 inhabitants relative to the southwest of France, Alsace, and the Paris region (but ranks higher than other parts of northern and central France) (Sandier, Paris, and Polton Citation2004: 72, 88). Although these four categories encompass the most frequently consulted types of alternative healers, there are also other non-biomedical practitioners in Finistère, such as iridologists, aromatherapists and osteopaths. Significantly, both acupuncture and homeopathy are covered by the French social security system if performed by a qualified biomedical physician. To some extent, therefore, these techniques, often considered alternatives to allopathic medicine in other Western contexts, have been recuperated by biomedicine in France. Although beyond the scope of the present article, an important area for future research concerns the question of how state involvement in regulating and financing specific types of alternative therapies impacts peoples' attitudes toward these therapies and biomedicine itself. For this reason, these healers are also sometimes called diskonteurs. While referring specifically to those healers who use verbal formulas, “guérisseur” is also a more inclusive term that is used in Finistère to refer to all types of alternative healers. For parallels elsewhere in Europe, see Cátedra (Citation1992: 98, 103–105), Kerewsky-Halpern (Citation1985), and Kerewsky Halpern and Foley (Citation1978). Hinojosa (Citation2004) discusses bonesetters in highland Guatemala. Compare Latry (Citation1996); also Fuller (Citation1982), Gevitz (Citation1988: 126–127), and Wardell (Citation1988: 157). http://www.science-et-magie.com/sm50/gnoma.html, consulted 3/8/2006; http://gnoma.com/index-gb.htm, consulted 3/8/2006. See also Garro and Mattingly (Citation2000a: 29). As noted above (Note 2), homeopathic medications may be prescribed in France by biomedical doctors who have a specialization in homeopathy. During my 1989 fieldwork, 29 general practitioners advertised a specialization in homeopathy in the Yellow Pages for the département of Finistère, serving a population of approximately 800,000. In her study of breast cancer in Québec, Saillant documents a similar belief that surgery represents “an act against nature” that can lead to radical deterioration in a patient's condition, even causing benign lumps to become cancerous (Saillant Citation1990: 98–99). Almost identical views are expressed by U.S. patients (McGuire Citation1988: 190). Compare Cant (Citation2005: 192–193). In the late 1980s, Le Menn's rates were 180 FF for a consultation and 500 FF for medications. Similarly, users of alternative therapies in the United States tend to be suffering from chronic conditions (Ruggie Citation2004: 45). Compare Cant (Citation2005: 195); also Cant and Sharma (Citation1999: 43). Compare Hinojosa (Citation2004: 265). For Breton attitudes toward cremation, see Badone (Citation1989: 154–156) and Badone (Citation2004a). For similar opinions in the United Kingdom, see Cant and Sharma (Citation1999: 38). Likewise, magnétiseurs will sometimes treat patients who have been hospitalized, entering the hospital wards as ordinary visitors and performing their therapy surreptitiously, avoiding discovery by the biomedical staff. For similar practices elsewhere in France, see Bouteiller (Citation1987: 242) and Loux (Citation1990: 279–280). Compare Ruggie (Citation2004: 52–54). Recall Janine's assertion that her family doctor reprimanded her for consulting a radiesthésiste. Another family practitioner in the Monts d'Arrée told me that she had to scold a patient who insisted on consulting a magnétiseur for shingles. Elsewhere in France, differences in class and geographical origins between biomedical practitioners and their rural patients have been underscored by Loux (Citation1990: 264) and Bouteiller (Citation1987: 214). For parallels to Québec and northern Spain, see Saillant (Citation1990: 90, 93–94, 97, 100) and Cátedra (Citation1992: 83–84, 113–114). Compare McGuire (Citation1988: 198), Loux (Citation1990: 281), and Cátedra (Citation1992: 114). Compare Cátedra (Citation1992: 86). The larger issue of the symbolic significance of money and reciprocity in healthcare is an important one, which merits further investigation. http://www.letelegramme.com/archives/, consulted 13/9/2006. http://www.pagesjaunes.fr/pj.cgi, consulted 13/9/2006. For other examples of medical pluralism in European contexts, see Romanucci-Ross (Citation1983; Citation1986) and Cátedra (Citation1992: 82–116), who sees recourse to alternative healers in Asturías as part of a continuum of health-seeking strategies involving both biomedical and non-biomedical options. Compare Luhrmann (Citation1989: 168–170) and Hinojosa (Citation2004: 265). See Badone (Citation2004b) for a parallel discussion of the way in which omens of death in Brittany are interpreted as evidence for the existence of underlying patterns that frame and direct human experience. Significantly, some Breton patients prefer radiesthésistes precisely because they prescribe “scientific” medications, rather than therapists who use only occult techniques. Compare Hinojosa (Citation2004). Additional informationNotes on contributorsEllen Badone ELLENBADONE is an Associate Professor in the Departments of Anthropology and Religious Studies at McMaster University. Her research interests include medical anthropology and the ethnography of popular Roman Catholicism. She is the author of The Appointed Hour: Death, Worldview and Social Change in Brittany (California, 1989).