Cultural interpretations of contagion


date Fondazione Angelo Celli per una cultura della salute, via del Giochetto 6, 06126 Perugia, Italia. E-mail: and since smallpox was officially eradicated in 1978, reference is presumably made to some exanthematic diseases such as chicken-pox. First of all it must be pointed out that the word indicates a benign disease. In fact, the Alladian have always feared nnowie akra-kra so much that the fact that the word means ‘benign disease’ indicates the wish to reduce its malefic power, and to prove that one is not afraid. This attitude towards the disease applies also at individual level: if for example a person is afraid to visit someone suffering from nnowie akra-kra, his fear can represent a reason why he will fall ill. But while at an empirical level experience shows that these infectious diseases can be transmitted through direct contact with infected persons and that therefore a certain behaviour must be adopted to keep the disease from spreading, this behaviour itself can be viewed as an expression of fear of the disease and be sufficient reason for contracting it. People may find themselves caught between contradictory interpretations that lead to diametrically opposed courses of action. Then there is the problem of individual transgression of the rules, of subversion of the established order; a key issue particularly within family contexts, in the relationships between father and son, husband and wife, but also between different generations, if the age groups' structure and the relationship between them are questioned. One example is niambure, a disease caused by incest between two people of the same maternal lineage (a man with his sister or cousin on the mother's side). For the disease to appear both sides must be willing to commit an infraction and to be aware that they are breaking a rule. It is not an incestuous relationship of the kind described by Héritier (1994), the specificity lies in the fact that to become infected, one must willingly break the rules. Pisa develops in the husband after the wife has committed adultery with another man and it involves the rules regulating sexuality and social behaviour. What is important to emphasize is that the disease can then be transmitted to other people through different forms of contagion involving the relationship between pure and impure, the concept of the body, of the individual, the relationship between men and women. The extreme aetiological variability requires an analysis of the forms of transmission of the disease case by case, taking into account the different circumstances.


Anthropological research in recent years has examined how single diseases such as Aids, tuberculosis, measles, malaria and leprosy are conceptualized by laypersons in non-Western societies. But how is disease transmission itself interpreted in other cultures? Data from ethnographical studies in Côte d'Ivoire and the Afro-Brazilian culture in Bahia, Brazil show that the interpretations of contagion and preventive practices cut across society involving five main relationships: empirical and analogical thinking, symbolic factors and social organization, the concept of person and body elements, natural and supernatural powers and individual and contextual factors. There is not a general theory, such as Pasteur's theory of germs. Instead,contagion presents itself as a transversal, multidimensional concept crossing and interconnecting society and culture. Public health programmes aimed at controlling infectious diseases need first to understand how contagion is conceptualized by laypersons, the extent to which diseases are considered infectious and the relation between perceptions and preventive practices. This would help in implementing infectious disease control programmes within local contexts based on meaningful community participation.