Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2008; 13: 254–6
At the beginning of the twentieth century, it had become fairly obvious that non-scientific therapeutic practices were bound to be eliminated by medical science: our grandmothers’ medication would gradually disappear and give way to ‘modern’ medicine. At the turn of the twenty-first century, CAM – a set of various therapeutic practices which do not belong to official scientific medicine and which focus on natural treatments – is still used and even expanding every day. We can see that in France, 75% of the population have resorted to CAM at least once; 38% in Belgium and 70% in Canada.1 Scientific advances in medicine that are perceived by patients as rendering medicine less compassionate and more obscure, and that dehumanise it and compartmentalise it, are usually pointed out as major drawbacks.2 In response to the increasing use of CAM and in accordance with the rationality principles at work in conventional medicine, CAM practitioners and patients are usually blamed for irrational beliefs and behaviours because CAM is – according to its opponents – not based on scientific studies.
There are two dominant approaches within social psychology that have been regularly used to study this kind of subject. The first one focuses on the irrationality of CAM practitioners and patients, while the second one looks at the processes of the social construction of reality through the theory of social representations.
Notions of rationality have regularly been used by experts as a means of explaining and simultaneously discrediting the behaviours and beliefs of studied subjects. It is also a common enough practice in the field of social sciences dating back to the early works of anthropologists who, much at the same time as they tackled the description of primitive peoples, first reported their erring reasoning (a deviation from reasoning).3 For example, Frazer described magical thinking using an evolutionist model which took it for granted that people evolved thanks to a gradual achievement of rationality from the stage of magic to religion, and eventually to science.4 Thus, an explicit hierarchy was set between a scientific and civilised way of thinking on the one hand and a magical and primitive way on the other hand. Such views were later rejected thanks to the works of Levy-Bruhl and Durkheim.
In social psychology, the study of common-sense thinking led to research on cognitive bias. Concerned with the interpersonal relations of individuals, Heider inaugurated a new field of investigation in social psychology.5 In the wake of the cognitivists, it aimed at exposing the individuals’ errors of reasoning. Thus, researchers have found various systematic distortions of common-sense thinking through different biases such as the representative bias,6 behavioural confirmation7 or illusory correlation.8 Within this approach, the conception of the individual was then based on the comparison between a rational subject whose reasoning would be deemed optimal, and a social subject whose reasoning would be less than optimal. The reasoning on which researchers used to base the comparison with the reasoning made by ‘subjects’ under laboratory conditions was usually based on a mathematical model of probability. This research was instrumental in highlighting the individual’s irrationality and urged researchers in social psychology to perpetuate – in imitation of the early anthropologists – a hierarchy between the magical and social thinking of an ordinary individual and the scientific and rational thinking of an optimal individual, the latter being regarded as the most fully accomplished and proficient way of thinking. This hierarchy between two different modes of thinking can be construed as a hierarchy between social groups; on the one hand the rational or scientific elite and on the other hand the common people, the rank and file.9
From this point of view, both a practitioner who prescribes CAM medication or a patient who asks for such treatment, will be deemed irrational. They both resort to a primitive form of reasoning stemming from erroneous commonplace thinking. It is then of paramount importance that an effective and appropriate way of functioning, which is likely to show individuals how to reason properly, be restored. Such a way of perceiving common-sense thinking corresponds to the traditional resort to sole-expert thinking as one that is apt and able to tell whichever reaction is best when faced up to whatever event may occur in society, as for example the risks linked with the outbreak of AIDS10 or bovine spongiform encephalopathy (BSE).11 Such an approach aims at bringing out universal cognitive reasoning. It simply dismisses the fact that the way individuals think is deeply grounded in their social context (i.e. as sex, age, socioeconomic categories, cultural groups, etc.) and cannot be separated from them.
In contrast to the approach described above, an alternative way in social psychology of considering individual thinking holds that individuals apprehend ‘reality’ through a combination of their personal and collective experiences.
Moscovici put forward the theory of social representation in his seminal work about psychoanalysis.12 Using the collective representation concept proposed by Durkeim, he studied the gradual integration of a scientific theory into the field of common sense. Moscovici opposes the notion of scientific vulgarisation which entails the passivity of individuals when faced with a new scientific theory and the use of erroneous thinking. The theory of social representation allows him to describe the process of science socialisation and to insist upon the individual’s activity and the creative dimension of this socialisation process. According to him, social representations constitute true common-sense theories which are defined as shared realities that form part of a specific mode of knowledge and communication.13 They are formed through interactions within groups, the implementation of social practices or all sorts of media communications. Jodelet defines a social representation as “a form of knowledge, socially formed and shared, with practical purposes, and which contributes to the construction of a reality shared by a social group”.14
Basically, social representations make it possible to integrate what is strange or new. They are formed using the two processes of ‘objectification’ and ‘anchoring’: what is new is integrated into the thinking categories that pre-exist and are, for example, grounded in collective memory.15 Furthermore, social representations guide individual practices thanks to the significations they carry, and account for an individual’s actions. Much research has brought to light the importance of practices in the development of social representation: social representation and its transformations are thought to be caused by social practices.16 Lastly, representation fulfils an identity function. As the representation is formed within a group, it is part of the group’s identity and thus it becomes instrumental in preserving some distance between groups or even in increasing it. In one of our projects (unpublished data), medical students from Brest, France, built up a CAM representation focusing on the themes of psychosomatic approach and the lack of adverse effects in treatment. This representation field of significance is quite different from that of conventional medicine which has been developed in accordance with medical training, and discredits CAM as a range of lesser healing techniques and disqualifies them as an ineffective treatment. Thus, the conventional medical representation of CAM allows medical students to keep their perceived superiority as healthcare workers. It will deter them from prescribing CAM and will, at the same time, legitimate their course of action. On the contrary, nurses, also from Brest, France, who use CAM, form a representational model which is supported by the notion of complementarity between CAM and conventional medicine and the concepts both being equivalent. According to these nurses/health practitioners, both medicines are necessary for proper treatment.
The theory of social representation highlights the specific logic inherent in the individuals’ opinions and behaviours and allows questioning of the clear-cut distinction between a rational and objective way of thinking, and a social and irrational way of thinking derived from the individuals’ imagination. Therefore the hierarchy between the scientific and expert mode of thinking and the lay person’s mode of thinking is dissolved. The goal is no longer to spot good or bad perceptions of individuals – as could have been the case for AIDS, or as it still is the case for CAM – but to identify the inner logic of the representation formed by a group compared with other groups in a given society, as well as the functions fulfilled by this representation.
It seems essential to try to understand representation and belief through criteria other than those of scientific rationality. Instead, by focusing on common-sense thinking, we aim to reveal the gaps that might exist during an interaction between practitioner and patient. Trying to define belief and representation with rationality boils down to finding what is false compared with medical knowledge at a given moment in history. This is why patients and practitioners who do not abide by the norm of rationality because they resort to alternative therapeutic cares, get stigmatised. Hence there is a clash between two different, unequal paradigms. The first one – conventional, orthodox – is deeply grounded in rationality while the other one – heterodox – refers to something that is yet to be defined. As Favret-Saada wrote: “Between farmers and the medical corps, there is the distance from a norm’s system to another, but not the distance from the reason to the delirium.”16 By highlighting two different normative systems, we move away from the rationality criterion. It seems more fruitful and relevant to look at the functions that spawn social representations rather than to bring into light the individual’s – the patient’s or the practitioner’s – irrationality.
