Review by David Kilgannon.
That familiar ache in your lower back makes you reach for the ibuprofen, while the watery eyes of allergies compels you to keep antihistamines nearby. In these small and normal (even boring) everyday actions an individual is actually engaging in the complex practice of self-medication. It has become part of our daily lives, as the influence of the pharmacy has played an increasing role in public health across the twentieth, and into the twenty-first, century. Yet, as Sylvie Fainzang demonstrates in her new book, Self-Medication and Society: Mirages of Autonomy (Routledge, 2016), an analysis of the underlying dynamics that shape the self-medication process is long overdue.
Fainzang is a French medical anthropologist, who has demonstrated a long-standing interest in the involvement of non-medical actors within the medical sphere, having previously published books on the medical practices of the Bissa people of Burkina Faso (L’intérieur des choses: maladie, divination et reproduction sociale chez les Bisa du Burkina, 1986), the role of medicines in wider society (Médicaments et société. Le patient, le médecin et l’ordonnance, 2001) as well as popular efforts against alcoholism (Curar-se do álcool: antropologia de uma luta contra o alcoolismo, 2007). These studies have demonstrated the influence of groups of patients operating on the fringe of medical orthodoxy. In Self-Medication and Society, Fainzang examines a more nebulous grouping of such patients: those who have eschewed ‘traditional’ approaches towards disease in favor of a personalized treatment carried out without medical supervision.
Using recent developments in France as a starting point, Fainzang analyses the different forces that are influencing the growing trend towards self-medication in that country. Her range of sources is extensive and persuasive, using a combination of interviews, anthropological research, and public policy documents to demonstrate the way in which the idea of autonomy is constructed and reconstructed within discussions of self-medication. Indeed, the book is at its most effective in its interrogation of the wider political forces that shape the trend towards self-medication in France. The act of self-medication is shown to be a contested arena, in which an array of actors (including doctors, pharmacists and public health officials) compete for position. Self-Medication is also shown to be a fertile cipher in which to understand developments in the relationship of patients to doctors, as well as the evolution of healthcare policy.
If one is to quibble with any element of the book, it is in the text’s almost exclusive focus on France. Of course, the central aim of the text is the study of self-medication within a single national context. Nevertheless, Fainzang repeatedly alludes to the ways in which this Gallic narrative may be an anomaly within wider European society. Her restraint, in this respect, cannot help but feel like a lost opportunity to further understand the wider dynamics at play in this process across Europe. Nevertheless, Self-Medication and Society is an incisive, cogently written and convincingly argued introduction to this topic within the context of France, and will surely appeal to sociologists, anthropologists and students of public policy alike.
David Kilgannon is a Wellcome Trust PhD researcher based in the History Department of the National University of Ireland, Galway. He was previously a Hardiman Scholar, a Kirkpatrick History of Medicine Finalist and a Wellcome Trust MA student. His research looks at the varied experiences of persons with intellectual disabilities in Ireland from 1947 to 1996.