La lepra y sus imágenes, enfermedad estigmática y muerte social

La lepra y sus imágenes, enfermedad estigmática y muerte social

Sot. Sci. Med.Vol. 3. No.7.p.745,1986 Pergamon Journals Ltd. Pnntcd in Great Britain BOOK REVIEW La Leprn y sus Imlgenes, Enfermednd Esligmitica y M...

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Sot. Sci. Med.Vol. 3. No.7.p.745,1986 Pergamon Journals Ltd. Pnntcd in Great Britain


La Leprn y sus Imlgenes, Enfermednd Esligmitica y Muerte Social, by ALICIAE. KAUFMANN. Institute National de Servicios Sociales, Madrid, 1985. 165 pp. No price given. Aside from factual data, gathered from 296 leprosy patients in Spain, this book offers an insightful discussion of several problems germane to the already venerable topic of the social dimensions of disease and illness. It opens with a short treatment of the notion of social image, implicitly cultural expressions of disease in society, their organization, transformation and mediating function. These social images guide individual behavior as implicit rules and as a filter for perceptions originated in social and non-social sources. It is indeed of particular importance to find out how the social representation of disease in general and of any one disease in particular define the space in which remedial action will be permitted or stimulated. In the case of leprosy, its metaphoric dimension is, as in other cases, an instrument of social control, indicating who should be segregated, who is sick, who is cured. There is enough information to take at face value the assertion that language is the medium by which this social control is exerted. Already the very notion of leprosy, as the literary arguments put forward by the author demonstrate, or even the word as such, is endowed with connotations that make afflicted people feel marginal. Comparative data on etiology are interesting and quite useful, provided one is aware of the limitations imposed by cursory descriptive terms, without in-depth explanation. One of the points that deserves special mention is the conflict between the metaphoric and the scientific images of the disease. We all know how astonishingly diverse the perception of a given event, a given disease, or a given outcome can be for people who are conversant with scientific biomedicine. Transfer of knowledge is much more effective than expensive technology for improving health conditions, not only in the Third World. The author arrives at several important conclusions. Metaphors about diseases serve the function of control

devices, along with scientific information through mass media. Social images of leprosy, although related to biblical antiquity, do not derive directly from biblical texts, but from their elaboration. As a severe condition. leprosy is related to death, and its social representation can be linked to beliefs about death and dying, not only in terms of physical annihilation but also, and critically, in terms of social death, that is, the interruption of vital social bonds, which, in turn, psychologically impacts with loss. About 40% of patients belong to the age group between 50 and 64 years, and most of them live in areas where the disease is endemic, such as Jatn, MBlaga, Barcelona, and Madrid. Most are active Catholics. The sequelae of leprosy make for a degree of labor readjustment. Compliance with treatment is moderate, since about 60% of all interviewed patients indicate interruption of treatment, attributed to the limited impact of symptoms. A negative correlation between social integration and negative self-image is stressed. On the basis of the data presented, the author makes some recommendations, among which the reduction of the negative social reaction to the disease and the transference of knowledge are the most salient ones. Like many other researchers in the field, the author feels that health education at the societal level must coincide with education at the individual level, since health and disease are a matter not only for experts but for people. The book as a whole constitutes a valuable contribution to medical sociology. Except for minor printing errors and inaccuracies in citation, it is highly readable, and can be used not only by experts, but also by lay persons. So better recommendation can be made of a book dealing with biopsychosocial principles


Psychophysiology Unit Faculty of Medicine University of Chile Santiago,