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Social death, melancholia, and zombies: Same patterns?
Accepted Manuscript Social death, melancholia, and zombies: same patterns? P. Charlier, S. Deo, J. Hassin, C. Hervé PII: DOI: Reference:
S0306-9877(16)30919-7 http://dx.doi.org/10.1016/j.mehy.2017.03.001 YMEHY 8488
To appear in:
Medical Hypotheses
Received Date: Revised Date: Accepted Date:
1 December 2016 27 February 2017 1 March 2017
Please cite this article as: P. Charlier, S. Deo, J. Hassin, C. Hervé, Social death, melancholia, and zombies: same patterns?, Medical Hypotheses (2017), doi: http://dx.doi.org/10.1016/j.mehy.2017.03.001
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title Social death, melancholia, and zombies: same patterns? Authors Charlier P (1,2), Deo S (1), Hassin J (2), Hervé C (1,2). Affiliations 1. Section of Medical and Forensic Anthropology, UFR of Health Sciences (UVSQ & EA 4569 Paris-Descartes), 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France. 2. CASH & IPES, 203 boulevard de la République, 92000 Nanterre, France. 3. Laboratory of Medical Ethics and Forensic Medicine (EA 4569 Paris-Descartes), 45 rue des Saint-Pères, 75006 Paris, France. Corresponding author Philippe Charlier MD PhD LittD 2 avenue de la Source de la Bièvre 78180 Montigny-Le-Bretonneux, France Email [email protected] Tel. +33 664210700
Text Social death involves living persons in situations of poverty, isolation or suffering from serious illnesses symbolically regarded as « dead » [1]. The notion of cuts, separation, distance from society in the broad sense of the term, is of particular importance. Individuals in this situation become physically and socially separated from the rest of the living community. This concept also applies to those who have consciously and voluntarily left their social environment, the voluntarily marginalized, who give up their social identity to assume another one. Populations implicated in social death are: end-of-life patients, homeless people, subjects in longterm medical/social institutions, uprooted immigrants, long-term unemployed, retirees without any persistence of activity, the elderly, and long-term prisoners. In short, all those who are no longer recognized as (or no longer recognize) members of society in their own right, who are « cut off » or excluded from society, who live « outside » social space, the « social invisibles » considered to have left the active community. Those who are biologically alive, and already considered missing or absent, knowing that there is a fundamental difference between recognition and existence based on the gaze of others and personal experience. What strikes this reflexion is that unless one is active in a certain, accepted and expected way (which always ties itself to economic utility of a person), one is considered dead. So, are only the people who make money (or are « useful » in some other way, say, for reproduction, in the case for a lot of women), are only they considered alive? What are the economics of a social space? Who decides who is alive and who is not? What are its politics? Why must a person be « useful » to be considered alive? The underlying pattern of thought is the economic usefulness (or reproductive usefulness of women in a domestic space - which again is structurally similar to economic usefulness, albeit a latent one, i.e. if one is not contributing to the work force, one can contribute by a child who would later contribute to the work force). It's about serving the economic interests of a society. This question points what does life mean and who decides this definition? And this is where the arbitrariness of both psychological diagnosis and social exclusion comes in: psychiatry diagnoses are usually rather arbitrary (with strong criteria such as DSM-V), as are decisions of social exclusion. Are some people excluded by others because of disease or something else? Maybe the abandoned Hindu widows could enter into this category of « social death »? They are sometimes left to die in ancient holy cities, have no way to reintegrate into society, have little to no contact with outside world, and are forced to live by a very strict religious code. The abandonment of Hindu widows is still practiced (about 38,000 widows in Varanasi alone, more in Vrindavan), though it’s lessened over time [2]. What about the Untouchables of India? Probably not, because they have a society of their own, plus they are « useful » for the upper castes (for various things they will not do themselves) and society in some ways. They are in a distant interaction, they just cannot be touched by the upper castes [3]. They are more marginalised than socially dead, contrary to Haitian zombies, who are made absolutely unnecessary to society by sorcery practices. Or lepers, exth cluded from the Middle Ages (in Europe) till the beginning of the 20 c. (in Japan) [4], as were stigmatised AIDS patients in the first decades of the epidemics [5]. Seven clinical criteria have recently been proposed to characterize a patient as in a state of « social death »: irreversibility of the condition, abolition of linear time, restriction of the area of life, modification of the body representation, transformed tolerance to pain, degradation of hygiene, and athymic state (with excessive guilt). Biological perturbations have also been shown, without it being possible to determine whether they are primary (having participated in the establishment of social death) or secondary (consequences of social death and/or by perpetuating the vicious circle): serotonin disorders [6], secondary amenorrhea, thermostatic anomalies, etc. It appears that these clinical and biological criteria are largely superimposable to those described in patients diagnosed with melancholia [7] and those considered socially as zombified in the context of Haitian voodoo (change of identity under the effect of a magico-religious sanction with forced withdrawal from society, in particular by measurement of toxic products) [8]. Our hypothesis is whether these 3 diagnoses would in reality cover the same pattern, in the structural sense of Levi-Strauss, that is to say, « the search for the underlying patterns of thought in all forms of human activity » [9]. Could these three medical/anthropological concepts be the same en-
tity with different names, i.e. different « traductions » (according to the expression of Paul Ricoeur), according to the geographical place and culture of the patient [10]? References 1. Charlier P, Hassin J. Social death: ethical and medical anthropology aspects. Ethics Med Public Health 2015;1:512-516. 2. Smith L. City of widows: the 38,000 forgotten women of Varanasi. International Business Times. June 23, 2015 (http://www.ibtimes.co.uk/city-widows-38000-forgotten-women-varanasi1505560, accessed December 1, 2016). 3. Sharma RK. Indian society, institutions and change. New Delhi, Atlantic, 2015, pp. 79sq. 4. Grzybowski A, San J, Pawlikowski J, Nita M. Leprosy: social implications from Antiquity to the present. Clin Dermatol. 2016;34(1):8-10. 5. Alexias G, Savvakis M, Stratopoulou I. Embodiement and biographical disruption in people living with HIV/AIDS (PLWHA). AIDS Care 2016;28(5):585-90. 6. Séjourné J, Llaneza D, Kuti OJ, Page DT. Social behavioural deficits coincide with the onset of seizure susceptibility in mice lacking serotonin receptor 2c. PLoS One 2015;10(8):e0136494. 7. Orsolini L, Tomasetti C, Valchera A, et al. Current and future perspectives on the major depressive disorder: focus on the new multimodal antidepressant Vortioxetine. CNS Neurol Disord Drug Targets 2016; Oct 25 [Epub ahead of print]. 8. Charlier P. Zombis. Enquête sur les morts-vivants. Paris, Tallandier, 2015. 9. Levi-Strauss, C. Structural Anthropology, trans. Claire Jacobson and Brooke Grundfest Schoepf. New York: Basic Books, 1963. 10. Ricœur P. Sur la traduction. Paris, Bayard, 2004.
S0306-9877(16)30919-7 http://dx.doi.org/10.1016/j.mehy.2017.03.001 YMEHY 8488
To appear in:
Medical Hypotheses
Received Date: Revised Date: Accepted Date:
1 December 2016 27 February 2017 1 March 2017
Please cite this article as: P. Charlier, S. Deo, J. Hassin, C. Hervé, Social death, melancholia, and zombies: same patterns?, Medical Hypotheses (2017), doi: http://dx.doi.org/10.1016/j.mehy.2017.03.001
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title Social death, melancholia, and zombies: same patterns? Authors Charlier P (1,2), Deo S (1), Hassin J (2), Hervé C (1,2). Affiliations 1. Section of Medical and Forensic Anthropology, UFR of Health Sciences (UVSQ & EA 4569 Paris-Descartes), 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France. 2. CASH & IPES, 203 boulevard de la République, 92000 Nanterre, France. 3. Laboratory of Medical Ethics and Forensic Medicine (EA 4569 Paris-Descartes), 45 rue des Saint-Pères, 75006 Paris, France. Corresponding author Philippe Charlier MD PhD LittD 2 avenue de la Source de la Bièvre 78180 Montigny-Le-Bretonneux, France Email [email protected] Tel. +33 664210700
Text Social death involves living persons in situations of poverty, isolation or suffering from serious illnesses symbolically regarded as « dead » [1]. The notion of cuts, separation, distance from society in the broad sense of the term, is of particular importance. Individuals in this situation become physically and socially separated from the rest of the living community. This concept also applies to those who have consciously and voluntarily left their social environment, the voluntarily marginalized, who give up their social identity to assume another one. Populations implicated in social death are: end-of-life patients, homeless people, subjects in longterm medical/social institutions, uprooted immigrants, long-term unemployed, retirees without any persistence of activity, the elderly, and long-term prisoners. In short, all those who are no longer recognized as (or no longer recognize) members of society in their own right, who are « cut off » or excluded from society, who live « outside » social space, the « social invisibles » considered to have left the active community. Those who are biologically alive, and already considered missing or absent, knowing that there is a fundamental difference between recognition and existence based on the gaze of others and personal experience. What strikes this reflexion is that unless one is active in a certain, accepted and expected way (which always ties itself to economic utility of a person), one is considered dead. So, are only the people who make money (or are « useful » in some other way, say, for reproduction, in the case for a lot of women), are only they considered alive? What are the economics of a social space? Who decides who is alive and who is not? What are its politics? Why must a person be « useful » to be considered alive? The underlying pattern of thought is the economic usefulness (or reproductive usefulness of women in a domestic space - which again is structurally similar to economic usefulness, albeit a latent one, i.e. if one is not contributing to the work force, one can contribute by a child who would later contribute to the work force). It's about serving the economic interests of a society. This question points what does life mean and who decides this definition? And this is where the arbitrariness of both psychological diagnosis and social exclusion comes in: psychiatry diagnoses are usually rather arbitrary (with strong criteria such as DSM-V), as are decisions of social exclusion. Are some people excluded by others because of disease or something else? Maybe the abandoned Hindu widows could enter into this category of « social death »? They are sometimes left to die in ancient holy cities, have no way to reintegrate into society, have little to no contact with outside world, and are forced to live by a very strict religious code. The abandonment of Hindu widows is still practiced (about 38,000 widows in Varanasi alone, more in Vrindavan), though it’s lessened over time [2]. What about the Untouchables of India? Probably not, because they have a society of their own, plus they are « useful » for the upper castes (for various things they will not do themselves) and society in some ways. They are in a distant interaction, they just cannot be touched by the upper castes [3]. They are more marginalised than socially dead, contrary to Haitian zombies, who are made absolutely unnecessary to society by sorcery practices. Or lepers, exth cluded from the Middle Ages (in Europe) till the beginning of the 20 c. (in Japan) [4], as were stigmatised AIDS patients in the first decades of the epidemics [5]. Seven clinical criteria have recently been proposed to characterize a patient as in a state of « social death »: irreversibility of the condition, abolition of linear time, restriction of the area of life, modification of the body representation, transformed tolerance to pain, degradation of hygiene, and athymic state (with excessive guilt). Biological perturbations have also been shown, without it being possible to determine whether they are primary (having participated in the establishment of social death) or secondary (consequences of social death and/or by perpetuating the vicious circle): serotonin disorders [6], secondary amenorrhea, thermostatic anomalies, etc. It appears that these clinical and biological criteria are largely superimposable to those described in patients diagnosed with melancholia [7] and those considered socially as zombified in the context of Haitian voodoo (change of identity under the effect of a magico-religious sanction with forced withdrawal from society, in particular by measurement of toxic products) [8]. Our hypothesis is whether these 3 diagnoses would in reality cover the same pattern, in the structural sense of Levi-Strauss, that is to say, « the search for the underlying patterns of thought in all forms of human activity » [9]. Could these three medical/anthropological concepts be the same en-
tity with different names, i.e. different « traductions » (according to the expression of Paul Ricoeur), according to the geographical place and culture of the patient [10]? References 1. Charlier P, Hassin J. Social death: ethical and medical anthropology aspects. Ethics Med Public Health 2015;1:512-516. 2. Smith L. City of widows: the 38,000 forgotten women of Varanasi. International Business Times. June 23, 2015 (http://www.ibtimes.co.uk/city-widows-38000-forgotten-women-varanasi1505560, accessed December 1, 2016). 3. Sharma RK. Indian society, institutions and change. New Delhi, Atlantic, 2015, pp. 79sq. 4. Grzybowski A, San J, Pawlikowski J, Nita M. Leprosy: social implications from Antiquity to the present. Clin Dermatol. 2016;34(1):8-10. 5. Alexias G, Savvakis M, Stratopoulou I. Embodiement and biographical disruption in people living with HIV/AIDS (PLWHA). AIDS Care 2016;28(5):585-90. 6. Séjourné J, Llaneza D, Kuti OJ, Page DT. Social behavioural deficits coincide with the onset of seizure susceptibility in mice lacking serotonin receptor 2c. PLoS One 2015;10(8):e0136494. 7. Orsolini L, Tomasetti C, Valchera A, et al. Current and future perspectives on the major depressive disorder: focus on the new multimodal antidepressant Vortioxetine. CNS Neurol Disord Drug Targets 2016; Oct 25 [Epub ahead of print]. 8. Charlier P. Zombis. Enquête sur les morts-vivants. Paris, Tallandier, 2015. 9. Levi-Strauss, C. Structural Anthropology, trans. Claire Jacobson and Brooke Grundfest Schoepf. New York: Basic Books, 1963. 10. Ricœur P. Sur la traduction. Paris, Bayard, 2004.