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Self-Medication as a Social Action

Text by Freya Brosterhus (Freie Universität Berlin)


Image by RE


I am sitting in the office of my working place when two of my colleagues come in to discuss a work related topic. We are having some small talk, about how we are doing, and my colleague S. is telling us that she has headaches. She assumes that it is probably due to wearing a mask and because she has a lot of different things to manage at the moment, like moving to a new flat. My colleague F. and I are both nodding understandingly, and F. says that she can relate to her situation and that wearing a mask also triggers her headaches. She finishes her sentence by asking if S. wants a painkiller (Ibuprofen). S. smiles grateful and says that she will first have a little break to move for fresh air, but maybe later if the headaches won’t go away.


This observation reveals interesting facts about the meaning of pharmaceuticals as a social instrument and as a communication medium. Offering someone familiar a painkiller seems to be a normal act of caring and solidarity and is often the first choice of care. This situation indicates already that a pharmaceutical is not only a biomedical medicine that changes biochemical processes in the body. A lot of different meanings are attached to a pharmaceutical which I will show in this essay, which embeds the pharmaceutical self-medication in its social context. What makes the consumption of a pill so attractive and which values are connected to this kind of self-medication?


Pharmaceuticals regarding the contemporary conception of the self


Van der Geest et al. write in their popular essay about the social life of pharmaceuticals, that “[…] self-medication is a natural, self-evident act. It is by far the most common medical action” (ebd. 1996: 164). But what exactly is meant by self-medication? What will be understood in the following as self-medication is based on the definition by the medical anthropologist Sylvie Fainzang. She describes self-medication “to be the use of a medicine on one’s own initiative, without consulting a doctor for the problem in question, whether the medicine is already in one’s possession or whether one procures it to this end (in a pharmacy or from another person)” (ebd. 2013: 494). In this definition, the attribute of autonomy seems to be very present, which also fits the image of pharmaceuticalisation. The pharmaceuticalisation is mostly connected to individualisation and autonomy which is emphasised in advertisements of antidepressants. A Paxil advertisement promotes antidepressants with slogans like “life is too precious to let another day go by feeling not quite ‘yourself’. […] Feeling balanced, more like ‘yourself’, is within reach.” (GlaxoSmithKline 2002: 67). Slogans like this create the idea of an uncomplicated and easily available solution in the form of antidepressants. At the same time, this idea is making the individuum responsible for its own well-being which produces a self-reliant, autonomous, and free-in-choice image of the individuum (Walker and Kavedžija 2015: 8). This image fits the contemporary conception of the individualistic self, which is characterised by key values such as “responsibility, choice, and active self-fulfilment” (Rose 2003: 54). In this context, pharmaceuticals seem to be the ideal product of this conception, while producing an image of health as a consumer good (cf. Petryna and Kleinman 2006; Nichter 1996).


Especially self-medication fits perfectly into this image of the self-reliant individuum. But referring to the situation described above, I am wondering about the social dimensions of taking a pharmaceutical, especially for self-medication. How could a social dilemma like a sickness be satisfied by an individualistic action such as pharmaceutical self-medication? Which social potential does pharmaceutical self-medication offer, and how important is it? My hypothesis is that in self-medication, pharmaceuticals work as a social instrument to express and receive care and social connection. The pharmaceutical is thereby an accepted medium of conversation because it is communicating through a language of contemporary values by representing modernity, autonomy, and individualism.


Van der Geest analyses the meanings attached to pharmaceuticals in the context of their popularity. He reveals five fundamentals for their popularity: “practical experience, the tangibility of drugs, xenophilia, the symbolic exchange of medicines and their empowering potential” (ebd. 2010: 15). Pharmaceuticals are known for their fast effects: Taking a painkiller under applicable conditions, the pain gets reduced in more or less 30 minutes which noticeably proves the efficiency of the painkiller. The individuum links the act of taking-a-pill to the reduction of pain. This experience is what van der Geest describes as practical experience. With the tangibility of drugs, van der Geest analyses, how the thingness of a pharmaceutical makes the disease tangible. The very complex and subjective process of feeling bad becomes an objective thing attached to a simple-seeming explanation (ebd.: 15, 16). To understand better the condition of feeling unwell, it is useful to have a look at the process of healing rituals. Linked to Victor Turners[1] description of rituals as a social act that is defined by a crisis, a solution, and a reintegration, feeling bad can be described as a chaotic crisis. Sicknesses disturb the structure of our lifeworld, and the healing process is used to reconstruct the order of our world. By the demarginalisation of our sick status through healing therapies, we get reintegrated into society (Ostenfeld-Rosenthal 2012: 331). Taking a pharmaceutical helps to make the chaotic status of a sickness concrete by offering a simple solution to the crisis. Through concreteness and tangibility one regains the feeling of control and order.


Another reason for the popularity of pharmaceuticals is the modern image of drugs as progressive technologies which connect drugs to values like power and prestige (Van der Geest 2010: 16). As Van der Geest et al. wrote already earlier in their essay, a lot of different meanings are attached to pharmaceuticals: “they are vehicles of ideologies and fashions and are thus convenient means by which globalization runs its course” (ebd. 1996: 169). The image of advanced technologies produces confidence in the correctness of the chosen therapy which gives you a feeling of safety in a condition of crisis.


Self-diagnosis for constructing a norm


Despite their role in handling sickness, pharmaceuticals are also important for social exchange. Van der Geest focuses on the doctor-patient relationship and notes that drugs and their prescription show the concern of the doctor meanwhile the patient feels taken seriously. In the context of self-medication, the social exchange outside the professional medical context is more interesting (ebd. 2010: 16). This becomes very visible in the above-mentioned observation between my two colleagues. S. had to smile instantly after the offer of a painkiller which demonstrates that she understood this expression of concern. The reaction of F. on the other hand conveys that the pain S. is feeling is something normal. To classify a body sign as a norm, demarginalises the sick status and gives hope to recover. Fainzang analyses this construction of the norm in the context of self-diagnosis and mentions the internet as an important research tool for the identification of body signs (ebd. 2013: 495). If I am feeling body signs that I consider not to be usual, I also search on the internet first, to figure out what it could be and how serious it is. And I also experience that I feel released when I read, that it is a normal body sign which appears sometimes without serious consequences. After believing that, I can value this body sign as something normal, which influences my handling of it. Then again, if it is written that the felt body sign is something serious, I will act differently and may consult a doctor. This means, that depending on what is expressed as a norm on the internet leads to different medication practices. But the internet might not be the only tool of assessment, the social environment can also function to set the norm. Before the self-medication begins, processes like self-diagnosis are necessary. These processes often involve social actions like interchanging experiences with other familiar people or connecting with other people online in discussion forums (cf. Fainzang 2013: 496).


Self-Medication as an individualising tool


The connection to the body seems to be a very important factor. Things, written on the internet function to understand and judge the own body signs. In this context, I am wondering about the role of the professionalised biomedical practice. Biomedicine perceives the body as a machine, which generalises the bodies as well as objectifies them (cf. Gaines and Davis-Floyd 2004). Isn’t that generalised image of a body contrary to the promoted conception of an autonomous and individualistic self? Regarding this thought, the action of self-medication seems to empower the individuum again.


Whether the consumer follows a former prescription or not, and whether he takes the advice of another person or not, in the case of self-medication, the emphasis is on the role of his choices and the exercise of his autonomy. The choice to self-medicate indicates a personal choice in the sense that, though resulting from these influences, it does not depend on medical prescriptions. (Fainzang 2013: 494)


Fainzang refers here to the fact that everyone is influenced by exterior factors, like advertisements, the internet, social environment, etc. But the important factor of self-medication seems to be the independence of generalised medical practices. The biomedical system includes hierarchical structures. Especially between the patient and the doctor which entails a significant power relationship. This becomes obvious if the explanatory model of the patient differs from the one of the doctors. The explanatory model of the doctor will almost always win (cf. Scheper-Hughes 1990). Self-medication appears as a tool to regain autonomy for the own well-being because aspects such as individualisation and autonomy are seen as very desirable values of modern life. Furthermore, self-medication individualises the own body and the generalised biomedical practice becomes personalised through the modification of the medicine on the own body (Fainzang 2014: 333). Due to the generalisation of medical practice in the contemporary medicine of the global north, the consultation of a doctor normally lasts about 5-15 minutes. Within this time, the doctor tries to categorise the symptoms and social components of the interaction are subtle. The need for solidarity during sickness is mostly not satisfied during the short biomedical consultation. Instead, the social dimension of pharmaceutical self-medication seems to answer this need. Pharmaceutical self-medication combines autonomy and social interaction and is at the same time an image of modern technologies and progressiveness.


Conclusion


In summary, it becomes clear, that pharmaceuticals are much more than biochemical substances to change internal bodily mechanisms when feeling unwell. As Fainzang points out, improving health “must not be the prime and sole aim” (ebd. 2014: 335) of self-medication. Self-medication also leads to a supposed autonomy and has important social dimensions of societal cohesion. The social dimension of sickness is also represented in pharmaceutical self-medication. To deconstruct individualism and autonomy as a motivation based on our conception of the self-reliant individuum opens the perspective on pharmaceutical self-medicalisation as social action. Self-medication appears under the guise of independence and self-determination and thereby gives the individual back their autonomy in the hierarchical structure of the medical system. In addition, self-medication strengthens the confrontation with one's own body which results in the capacity to decide if a body sign fits into the constructed norm or not. In that way, pharmaceutical self-medication satisfies the modern need for autonomy and individual independence at the same time as it is producing solidarity.



Endnotes:

[1] Turner, Victor W. 2003: Liminalität und Communitas. In: Belliger, Andréa und David J. Krieger (Hg.), Ritualtheorien. Ein einführendes Handbuch. Wiesbaden: VS Verlag für Sozialwissenschaften, 251-262. (Original 1967: Liminality and Communitas. In: The Ritual Process: Structure and Anti-Structure. Chicago: Aldine Publishing: 94-113).


References:


Fainzang, Sylvie (2013): “The Other Side of Medicalization: Self-Medicalization and Self-Medication”. Cult Med Psychiatry 37: 488-504.


Fainzang, Sylvie (2014): “Managing Medicinal Risks in Self-Medication”. Drug Saf 37(5): 333-342.


Gaines, Atwood D. and Robbie Davis-Floyd (2004): “Biomedicine”. In: Ember, Carol R. and Melvin Ember (eg.): Encyclopedia of Medical Anthropology: Health and Illness in the World's Cultures. New York: Springer, 95-109.


GlaxoSmithKline 2002: “Paxil CR Paroxetine HCI. Controlled-Release tablets. Your life is waiting!”. Times 160 (17): 67.


Nichter, Mark (1996): “Pharmaceuticals, the commodification of health, and the health care-medicine use transition”. In: Nichter, Mark and Mimi Nichter (ed.): Anthropology and international Health. South Asian case studies. Amsterdam: Gordon und Breach, 268-333.


Ostenfeld-Rosenthal, Ann M. 2012: Energy healing and the placebo effect. An anthropological perspective on the placebo effect. Anthropology &Medicine 19 (3): 327-338.


Petryna, Adriana and Arthur Kleinman (2006): “The Pharmaceutical Nexus”. In: Petryna, Adriana, Andrew Lakoff and Arthur Kleinman (ed.): Global Pharmaceuticals. Ethics, Markets, Practices. Durham and London: Duke Univ. Press, 1-32.


Rose, Nikolas 2003. “Neurochemical Selves.” Society 41 (1): 46–59.


Scheper-Hughes, Nancy (1990): “Three Propositions for a Critically Applied Medical Anthropology.” In: Social Science & Medicine 30(2): 189-197.


Van der Geest, Sjaak, Susan Reynolds Whyte and Anita Hardon (1996): “The Anthropology of Pharmaceuticals. A Biographical Approach”. Annual Review of Anthropology 25: 153-178.


Van der Geest, Sjaak (2010): „Why are pharmaceuticals sometimes liked and sometimes disliked?“. Viennese Ethnomedicine Newsletter 12 (2-3): 15-21.


Walker, H. and I. Kavedžija. 2015. “Values of Happiness.” HAU: Journal of Ethnographic Theory 5(3): 1-23.

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