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Towards an Anthropology of Childhood Sickness: an Ethnographic Study of Danish Schoolchildren

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Towards an Anthropology of Childhood Sickness: an Ethnographic Study of Danish Schoolchildren The University of Hull TOWARDS AN ANTHROPOLOGY OF CHILDHOOD SICKNESS: AN ETHNOGRAPHIC STUDY OF DANISH SCHOOLCHILDREN Being a thesis submitted for the Degree of Doctor of Philosophy in the University of Hull by Pia Haudrup Christensen Magister Scientarum Anthropologicarum (Institute of Anthropology, University of Copenhagen) January 1999 Summary This thesis is an analytical ethnography of children, aged between six and twelve, who live in Vanlose, a local district of Copenhagen, Denmark. The data were produced during fourteen months of fieldwork in the children's homes, their local school and two after school centres. The methodological insights produced through this point to the importance of a dialogical, reflexive ethnography in conducting research with children. The thesis develops synergies between two theoretical frameworks: first, a reformed anthropology of children; second, critical medical anthropology, in particular the notion of sickness as cultural performance. The study focuses on children as individual and collective actors in interaction with other children and with adults during everyday illness and minor accidents. The cultural performance approach allows illness to become a lens revealing key aspects of childhood in contemporary Danish society. The substantive chapters of the thesis are organised around the five themes that emerged during the fieldwork: illness as a variety of `time-off' and its cultural similarities and differences with family holidays; children's collective action in help-giving at school and after school centres; children's cultural learning about the body in its subjective and objective forms; the cultural constitution of children as vulnerable and the implications of this for interactions during illness; and, finally, the constitution of children's' competence in illness and treatment. A key theme developed through the thesis is the cultural representation of children in the past, present, and future. It is shown that children's present lives and subjective experiences tend to be subordinated to understandings that give priority to childhood as a symbol of a nostalgia for the past or as a hope for the future. The thesis ends with a discussion of children's greater potential as contributors to health and self care and its implications for their wider participation in social life. To the children who said, 'We want to be world famous.' To their friends, families, teachers and staff at two after school centres in Vanlose. To my own children, Josefine and Tobias. Contents List of Figures Preface Chapter 1 Towards an Anthropology of Children 1 Chapter 2 Understanding and Interpreting Illness: Childhood Sickness as Cultural Performance 36 Chapter 3 The Ethnographic Study of Children 62 Chapter 4 Childhood Illness at Home: The Cultural Performance of Childhood Sickness as Family Holidays 106 Chapter 5 The Social Construction of Help among Danish Children: Health and Illness at School 141 Chapter 6 Children's Cultural Learning: the Subjective and Objective Body 177 Chapter 7 Vulnerable Bodies: Cultural Meanings of the Child, the Body and Illness 217 Chapter 8 Children's Competence and its Constitution in Illness and Treatment 249 Chapter 9 Conclusion 278 References 305 List of Fi2ures All Figures are children's drawings of 'The last time I was ill'. Figure 1. Drawing by girl, seven years old. Figure 2. Drawing by boy, ten years old. Figure 3. Drawing by girl, ten years old. Figure 4. Drawing by girl, six years old. Figure 5. Drawing by boy, seven years old. Figure 6. Drawing by boy, seven years old. PREFACE 'Ethnographic fieldwork and writing take a long time. They depend on intimate ties and attachments, and they entail a good deal of travelling.' (Scheper Hughes 1992: 534) When I began this research in the early nineties, it was the first ethnographic study focused on children's own perspectives of their social and cultural world to be conducted in Denmark and, at that time, only a few studies had been published internationally. Within the last few years, interest in the field of anthropological and sociological studies of children has burgeoned. I have seen this as an exciting support and confirmation of the relevance of my own work and its approach. During the last six years, in particular, research milieux in both Denmark and in Britain have emerged, developed and been established. I have followed these developments and participated in them very closely. Workshops, seminars, conference streams and whole conferences have been dedicated to work within the new social studies of childhood. These are significant achievements for anthropological and sociological child research. Also, national and international networks have been created and intersected across Europe and North America. Most recently the growing awareness that this represents has been made evident in the funding of some large, multi-disciplinary research initiatives. The British ESRC Research Programme 'Children 5-16: Growing into the Twenty-first 11 Century', announced in 1995, was followed by the Danish Research Council's Programme 'Children and Welfare'. Both of these relate in some ways to the Norwegian Programme 'Family, Youth and Children', which includes, rather than focuses on, children's own perspectives. However, it is worth noticing that, of the three research programmes, the British Programme is the one most radically committed to the newer research perspectives, formulated as seeing children as social actors and childhood as a diverse rather than as a unifying category. Over these years, I feel that my work has been well received, appreciated and critiqued. However, I have found that to begin such an endeavour in a relatively unexplored empirical and theoretical field of studies has proved a sometimes challenging affair. This experience does not relate to occasions where my work has been criticised or discussed from a theoretical or methodological viewpoint but to those where my academic work has been challenged by commonly held convictions, such as 'We all know how children are and how they behave.' Such convictions are often based on people's own childhood experiences or their experience as a parent, rather than in anthropological insights and knowledge. Although I agree that one's own experiences as a child or a parent may well be uniquely important for the development of personal understanding, it cannot form the basis of an anthropology of children. In other words it cannot substitute for critical, systematic and detailed ethnography. 111 Today, however, it also seems like a long personal and professional journey from 1991, when I gave my first presentation on this subject, to 1998, as I complete the writing up of this thesis (as well as take part in other pieces of ethnographic research on children). In my first public lecture in the Institute of Anthropology at the University of Copenhagen, I considered some theoretical and methodological consequences of working with children's own perspectives in ethnography by questioning their, hitherto, 'muteness' and lack of visibility in anthropology. This preliminary work formed part of the skeleton for my doctoral research. This was in the summer 1991 and marked achieving my degree as Magister in Ethnography. The lecture, entitled 'To be as a Child: Reflections on the Representation of Children in Anthropology' was dedicated to my six-year-old son, Tobias. (The English Pronunciation of 'To be as' is equivalent to the Danish pronunciation of Tobias). Josefine, my daughter, was still only a baby. Today, I have other research studies behind me and years signified by what, sometimes, seems like endless travelling between Denmark and England: Denmark, which embodies my home and cultural inheritance; England, which has hosted my home and work for the last six years. Travelling between close relatives, family, friends and academic colleagues has tied me to both sides of the North Sea. I came to Britain in August 1992, having finished the main part of my fieldwork in Denmark. I was to present the first piece of my doctoral research at the Conference of Medical Sociology, in Edinburgh, and afterwards take up a Visiting Fellowship in research at Brunel, The University of West London. My stay in London brought me in close iv contact and connection with colleagues (around Britain but also internationally) who are engaged in the sociological and anthropological study of children. After the first six months I decided to stay in England in order fiirther to explore this new academic environment. During the following years I went on frequent visits to my family in Denmark and spent the first two summer holidays each year carrying out additional fieldwork among the children in the institutions where the main body of my research had taken place. The analysis and writing up of the large body of data produced during fieldwork in Denmark have been at universities in London and Hull, England. During the writing of the thesis I have changed supervisor twice. First, after about half a year in England, because I saw that formalising my links to the University would provide a more secure ground for the supervision and the direction of my work. I had to change supervisor for the second time in spring, 1995, when I moved away from London to take up a full-time research post at Hull University. This was, again, to overcome the geographical distance between my work and its supervision. My years in England have been characterised by 'struggles', for example, in familiarising myself with English academic language and culture and in personal endeavours to bridge the gaps that my travels and movements have inevitably caused in my relationships. These many shifts and turns have not always helped me to establish a sense of continuity in my own work or consistency in working with a supervisor. However, having said that, it has allowed me to develop my work with great independence and I have always found myself v working with colleagues who have shared, or have come to share, my own 'burning' interest and engagement.
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