ABSTRACT.
Although the social sciences have studied the influence of social environment on individual behaviors regarding medication, very little research has been done on the variations that exist between patients in equivalent social contexts but with diverse religious backgrounds. This article presents the results of research on the correlation between patients' religious–cultural background (Catholic, Protestant, Jewish, or Muslim) and their behaviors regarding medication. It shows that the cultural origin as well as the collective history of the groups to which patients belong impacts their attitudes toward prescriptions, medicines, their own bodies, and doctors.
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After examining the literature on the subject, Ankri et al. (1995) note, for instance, that there are few convincing relations, or contradictory relations, between observance, on the one hand, and the age, gender, or intellectual level of patients, on the other.
With the exception of the expression of pain (cf. Zborowski 1952; Zola 1966).
In this respect, the attempt to distinguish characteristics by country is, in my opinion, too simplified to be of heuristic value. Even if its validity can be shown for the analysis of health systems in different countries (cf. Payer 1988), it cannot account for the complexity of the systems of thinking involved in individuals' representations and attitudes regarding disease.
As regards this issue of impact, for convenience we use the terms Catholics, Protestants, Jews, and Muslims to refer to people “of Catholic family background,” of “Protestant background,” and so on. Reference sometimes made to religious belief or practice is specified.
As regards Muslims, the fact that they were born in France, or were not, did not appear to make a difference as far as the relation to their body and to their doctor is concerned, probably because most of them have been in France for a long time.
As we will see, apart from obvious reasons for not taking medicines they have been prescribed or have bought on their own initiative, including disappearance of the symptoms, there are more complex mechanisms that account for patients' noncompliance, such as the symbolic association between the body space and the domestic space (see below).
Use of the notion of underconsumption does not refer to a good norm in either therapeutic or economic terms. It is justified with regard to the choice that the actors themselves have made by buying the medicines (whether or not prescribed).
On the issue of the scepticism toward medicines and doctors prescribing them, see Whyte et al. 2002.
Certain patients' lying to their doctor about taking medicines or not was studied with regard to the relationship of power that prevails in doctor–patient relations (cf. Fainzang 2002).
“If a drug is not appropriate to me and it has unpleasant effects, I stop taking it. But I do not say it to my doctor! I am afraid that he will say that I am making fun of him. It is true that if I consult him, it is not to tell him, afterwards, that I don't want what he prescribes for me!” (statement by a Muslim woman with an advanced education, daughter of a senior official of the French administration); “One cannot negotiate a treatment as one negotiates a cow! One cannot dispute the opinion of a doctor! If you go to his place, and you ask him something because you feel sick, you cannot tell him that you don't want what he tells you to take” (statement by a Muslim biologist); “All that my doctor tells me to do, I do it; in any case, I will never say to him that I don't want to do it!” (statement by a Muslim farm laborer).
Note that this tendency to put one's fate into the doctor's hands coincides with the wish of many doctors, generally of Catholic origin, to assume the right to knowledge of the patient's body and to refuse the patient choices concerning him- or herself. Deborah Gordon (1991) talks in this respect of the cultural base underlying the practice of not telling and not knowing a cancer diagnosis. She notes a cultural consensus in Italy around the fact of not saying and not knowing the truth on this subject, unlike in the United States. It is regular practice in Italy not to inform patients that they have cancer.
Patients thus maintain a different relation with the doctor according to the way in which the image of the authority figure within the various religious doctrines is built. The doctor is readily considered as the priest among Catholics, receiving confidences, managing treatments, or ordering behaviors, the doctor's word being attentively regarded. On the other hand, among Protestants, the doctor tends to be considered the holder of some knowledge whom one can possibly consult but to whom one does not limit his or her choices. In the same manner, the attitude of the Jews with regard to the doctor is aligned with the attitude that practicing Jews have toward the rabbi. Ready consultation with a doctor does not necessarily imply obedience to the doctor, and the consultant engages with the doctor in long discussions within which the consultant can express disagreement. In contrast, among Muslims, the word of the doctor is never contradicted, at least not openly, no more than that of the imam or the mufti would be. The displayed respect is a moral and social requirement unceasingly reaffirmed, even if the patient secretly circumvents the doctor's instructions.
This is also attested by the disagreement sometimes observed in mixed couples when they express different understandings.
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FAINZANG, S. RELIGIOUS ATTITUDES TOWARD PRESCRIPTIONS, MEDICINES, AND DOCTORS IN FRANCE. Cult Med Psychiatry 29, 457–476 (2005). https://doi.org/10.1007/s11013-006-9003-5
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DOI: https://doi.org/10.1007/s11013-006-9003-5