Reification and the consciousness of the patient.

The signs and symptoms of disease do something more than signify the functioning of our bodies: they also signify critically sensitive and contradictory components of our culture and social relations. Yet, in our standard medical practices this social “language” emanating from our bodies is manipulated by concealing it within the realm of biological signs. I try to show this by means of a patient’s interpretation of the meaning of her illness. This case study illustrates that in denying the human relations embodied in signs, symptoms, and therapy. we mystiiy those relations and also reproduce a political ideologv in the guise of a science of physical things. This I call reificarion, following Karl Marx’s’analysis of the&mmodzy and Georg Luk&s’ gpplication of this analysis-to the interpretaiion of capitalist culture and its mode of objectifying social relations. I argue that in sustaining reification, our medical practice invigorates cultural axioms as well as modulating the contradictions intrinsic to our culture and views of objectivity. In this way disease is recruited into serving the ideological needs of the social order, to the detriment of healing and our understanding of the social causes of misfortune. THE MARXIn PROBLEM: RElFlCATlON By means of a cultural analysis of an illness and its treatment in the USA in 1978, I wish to direct attention to the importance of two problems raised by Marxism and by anthropology concerning the moral and social significance of biological and physical “things”. I am going to argue that things such as the signs and symptoms of disease, as much as the technology of healing, are not “things-in-themselves”, are not only biological and physical, but are also signs of social relations disguised as natural things, concealing their roots in human reciprocity. The problem raised by Marxism comes from the famous essay of Georg LukLs published in 1922 entitled “Reification and the Consciouness of the Proletariat”, an essay which had explosive impact on the European Communist movement, in good part due to its critique of “historical materialism” as developed by Engels, Lenin, and the theoreticians of the German Social Democrat Party. In essence, Luklcs charged that the concept of objectivity held by capitalist culture was an illusion fostered by capitalist relations of production and that this concept of objectivity had been thoughtlessly assimilated by Marxist critics who were, therefore, upholding basic categories of the social form they thought they were impugning. Lukics attempted to construct a critical sociology of bourgeois knowledge which assailed the very theory of knowledge or epistemology which he felt was basic to capitalist culture. The Kantian and neo-Kantian antinomies between “fact” and “value”, as much as the empiricist copy-book theory of knowledge sharply dividing “objectivity” from “subjectivity”, were, in LukPcs opinion, tools of thought which reproduced capitalist ideology (even if they were deployed within a so-called “historical materialist” framework of analysis). The roots of the thought-form which took the capitalist categories of reality for granted were to be found, he argued, in what he called the “commodity-structure”, and a chief aim of his essay was to draw attention to the central importance of the analysis of commodities in Marx’ portrayal and critique of capitalism. There was no problem in this stage of history, claimed LukBcs, that did not lead back to the question of the commodity structure, the central, structural problem of capitalist society in all its aspects. Intrinsic to this problem lay the phenomenon of reification-the thingification of the world, persons, and experience, as all of these are organized and reconstituted by market exchange and commodity production. The basis of commodity-structure, wrote Luklcs, “is that a relation between people takes on the character of a thing and thus acquires a ‘phantom objectivity’, an autonomy that seems so strictly rational and all-embracing as to conceal every trace of its fundamental nature: the relation between people” [ 11. It is with the phantom-objectivity of disease and its treatment in our society that I am concerned, because by denying the human relations embodied in symp toms, signs, and therapy, we not only mystify them but we also reproduce a political ideology in the guise of a science of (apparently) “real things”-biological and physical thinghood. In this way our objectivity as presented in medicine represents basic cultural axioms and modulates the contradictions inherent to our culture and view of objectivity. Rather than expound further, I now wish to exemplify these all too abstract orienting premises by means of a concrete ethnographic analysis of a sickness. But before doing so, I have to draw attention to a problem raised by anthropology, namely by Evans-Pritchard’s classic analysis of Azande witchcraft published in 1937 [2]. THE ANTHROPOLOGICAL PROBLEM: THE BIOLOGICAL BODY AND THE SOCIAL