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COLLECTIVE MEMORY, A FUSION OF COGNITIVE MECHANISMS AND CULTURAL PROCESSES Aaron V. Cicourel * Abstract: The paper assumes a theoretical‑empirical interface exists between top‑down (structural concepts) and bottom‑up (cognitive mechanisms and socio‑cultural interactions) approaches to collective memory. Both deal with collaborative group accounts, material culture such as artefacts and representational re‑descriptive techno­ logies. Anthropology has shown how communal life was based on story telling, rituals, artefacts, routine practices constitutive of daily life representational re‑descriptions and the reproduction of implicit and explicit emotional normative belief systems embedded in kinship and social network relations. Keywords: cognition, collective memory, demography, health care delivery.

LA MÉMOIRE COLLECTIVE, UNE FUSION DE MÉCANISMES COGNITIFS ET DE PROCESSUS CULTURELS

Résumé : L’article propose d’établir une interface théorique et empirique entre les approches de la mémoire collective de haut en bas (structurale) et de bas en haut (cognitive et interactionniste). L’une et l’autre, en effet, prennent acte des solidarités collectives et des cultures matérielles. Narrations historiques, rituels, objets, pratiques routinières constitutives des re‑descriptions représentationnelles banales fondent ainsi la vie collective. Perdurent, inscrits dans la parenté et les réseaux de relations sociales, des systèmes implicites et explicites de croyances normatives et affectives. L’analyse est étendue jusqu’aux élaborations démographiques contemporaines. Mots‑clés : cognition, mémoire collective, démographie, pratiques de soin.

* Aaron V. Cicourel, born in 1928, is Emeritus Professor of Cognitive Science, Pediatrics, and Sociology, University of California, San Diego, San Francisco and Berkeley. He recently published “Origin and Demise of Socio‑cultural Presentations of Self from Birth to Death etc.“, Sociology, February 2013, 47, 1, p. 51‑73. Address: The Institute for Health and Aging, Department of Social and Behavioral Sciences, Laurel Heights, Suite 340, 3333 California Street, San Francisco, CA 94118, USA ([email protected]). Revue de synthèse : tome 135, 6e série, 2014, 20 p.

DOI 10.1007/s11873-014-0258-7

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KOLLEKTIVE GEDÄCHTNIS, EINE FUSION VON KOGNITIVEN MECHANISMEN UND KULTURELLEN PROZESSEN

Zusammenfassung : Der Artikel schlägt vor, eine theoretische und empirische Schnitt‑ stelle zwischen zwei Ansätze zur kollektiven Gedächtnis zu etablieren: eine, von oben nach unten (strukturell) und zweitens, von unten nach oben (kognitive Mechanismen und sozio‑kulturellen Wechselwirkungen). Beide befassen sich mit kooperativen Gruppen, materielle Kultur, wie Artefakten und repräsentationalen Neubeschreibungen. Implizite und explizite Systeme der normativen und affektiven Überzeugungen fortbestehen, in Verwandtschaftsnetze und soziale Beziehungen eingeschrieben. Diese Analyse ist der zeitgenössischen demografischen Ausführungen erweitert. Schlagworte : Kognition, Kollektive Gedächtnis, Demographie, Gesundheitsversorgung.

Editorial information: A first version of this article was proposed by the author to the Journal, in October 2013, following the publication of the “Sociologie générale : éléments nouveaux” folder in vol. 133, n. 1, 2012 (http://link.springer.com/journal/11873/133/1/), continued in n. 3, the same year and vol.; this last version, established in January 2014, is published on line first during the summer of 2014 and will be included as such in a forthcoming issue (http://link.springer.com/journal/11873/136/2/). [É. B.] Author’s acknowledgements: I am grateful to Bruce Miller, Director, Memory and Aging Center (Neurology), University of California, San Francisco, and Robert Levenson, Director, Psycho‑ physiology Laboratory (Psychology), University of California, Berkeley, for allowing me to conduct the research presented herein, accessing data from their respective research clinics and laboratories. The research reported below could not have been undertaken and completed without their essential encouragement and support. I also thank Mathew Crowdon, Baber Khan, Teresa Wu, Trishna Subas, Nieolas Block, and Oscar Calderon for helping me make contact with patients and family members, and coordinate and observing various testing sessions, and clinical meetings between fellows and patients, and members of the clinical team meetings between patients and family members. Robin Ketelle has facilitated the study from its inception, and Deepak Paul has provided continuous technical advice through­out the study. Winston Chiong, Maya Henry, and Virginia Sturm have enlightened me about clinical elicitation and testing procedures. The an early draft of the paper has benefited from comments by Corey Abramson, Jacob Habinek, and Roi Levine. The present version of the paper has benefited from a number of suggestions from Roy D’Andrade. [A.V.C.]

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ocial science research, in some ways, is a history of the creation of methods to retrieve memory‑based information from individuals, groups, and institutions. The notion of “collective memory” also mirrors the use of culturally evolved information embedded in linguistic notions like metaphors, metonyms, and dialects. Individual and collective memory presupposes different levels of interpenetration, apparent and “invisible” meaning requiring integration of different levels of analysis 1. A challenging problem is the fact that the “context” or “framing” attended at each level of analysis can differ vis‑à‑vis what is to be called “data”. Thus, face‑to‑face encounters can signify different meanings and consequences in public, familial, intimate, spatiotemporal institutional settings. Socially organized connected speech act settings, therefore, are herein assumed to consist of, and produce, differential cognitively and culturally organized representational re‑descriptions 2 of individual and collective memory inherent in, and essential for, communal life. Collective memory, however, cannot emerge without individual memory, and vice versa, despite traditional resistance among some social scientists preoccupied with the belief that reductionist‑sounding concepts like “cognitive mechanisms” and data are anathema to the serious study of social structure. Collective memory, as a cultural imperative of human communal life, presupposes essential cognitive mechanisms for survival by integrating the recall, recognition, maintenance, and modification of individual and collective sense of self within the emergence and reproduction of socio‑cultural institutions and practices. Such practices are always embedded in direct and indirect social interaction; face‑to‑face encounters, telephone, computer, manual sign language, and the use of related technological forms of communication. Social scientists often favor abstract, top‑down, structural conceptions and data sets yet acknowledge, but seldom integrate bottom‑up social interaction theories, direct observation, and labor‑intensive, moment‑to‑moment analysis of recorded events of daily life communicational settings into studies of collective memory. The present work suggests the necessity of an interface between the study of individual memory and bottom‑up social interaction, and the study of collective memory and top‑down structural approaches. Neither type of memory can emerge nor exist without the other. Whereas structural approaches often view demographic and archival data as self‑ evident and received resources (with obvious concerns about measurement error and the authentication of sources), social interaction approaches often view participation and/or observation, and field notes as also possessing self‑evident sources of valid evidence. Collective memory in the present work refers to the evolved human capacity to employ different memory systems necessary for physical survival by enabling a division of labor, and the production and reproduction of socially organized systems of verbal and nonverbal communication. Communication systems enable the emergence of personal and collective knowledge systems. Structurally, collective knowledge systems may consist of artifacts,

1. Cicourel, 2006; Feldman, 2006. 2. Karmiloff-Smith, 1992.

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paintings, symbols, signs, written archives, electronic storage technology, and algorithmically driven data mining systems. The social interaction, cognitive perspective also presupposes the essential necessity of short‑term, locally bounded working memory, episodic and procedural memory associated with the implementation of tools and practical skills, and semantic memory (often called “world knowledge” and relationships between cultural entities). Episodic memory or the associative ability to recall daily life experiences and events, whose content and organization can conflate and/or inflate scope and depth, will be a focus of attention in the pages that follow. The structural view of collective memory assumes an institutionalized, intentional attribution of agency to truncated or encapsulated forms of behavioral outcomes such as distributed demographic data, archival depositories, letters, and a host of related informational resources without having to study their origin in observable, situated, real time social interaction, and agency associated with social cognition such as a role‑taking social self or theory of mind. The structural view, therefore, avoids real time observation of continuous daily life events presupposed in the notion of collective memory. By ignoring observable real‑time interaction, the structural perspective can create impressive correlations through the elimination of much of the uncertainty of limited capacity processing of information inherent in human dependency on cognitive mechanism and what D’Andrade calls cultural pools of knowledge 3, and what Schütz calls knowledge taken for granted and assumed to be known in common 4. The virtually sole reliance on correlations, however, precludes a concern with feasible forms of invariance and possible causational properties. An essential aspect of social interaction and social cognition is the creation of distributive cultural beliefs and practices 5, necessarily sustained and reproduced by truncated individual memoirs (letters, annotated notes about experiences and observations), collective sample surveys, and organizationally‑based memory. Specifically, how encapsulated forms of human collective memory emerge from telling and reformulating stories, events, rituals, and gossip necessary for the emergence and reproduction of structural systems of knowledge. Structural sociologists have shown renewed interest in the concept of collective memory 6. The present work has benefited from Olick, Seroussi, and Levy (2011) 7, an informative, detailed and useful overview of primarily structural collective memory and aspects of cognitive memory. A subsequent version of the present paper (in preparation) will include historical materials from several recent books which exemplify historical research on different forms of documentary evidence used to interpret past events and reported autobiographical and biographical experiences.

3. D’Andrade, 1981. 4. Schütz, 1962. 5. Roberts, 1964; D’Andrade, 1989; Hutchins, 1991. 6. Olick, Seroussi and Levy, 2011; Brian, Jaisson and Mukherjee, 2011. 7. Especially p. 16-23.

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COLLECTIVE MEMORY AS SOCIAL COGNITION IN A DEMOGRAPHIC FIELD STUDY

The first example is from a field research report of how demographers use elicited collective memories of siblings contrasted with directly elicited genealogies to estimate maternal and fetal mortality. The second example reports on how a clinical neuroscience research team achieves a differential diagnosis of dementia. Collective memory can be viewed as a way bridging an analogical‑digital disjuncture between measures of process and structure in medical and social science research by a combination of analogical, open‑ended elicitation of socio‑cultural and clinical markers, and their conversion into digital outcomes 8. The examples presented below will suggest how collective memory can bridge the analogical‑digital divide. A demographic study of maternal mortality in a Senegal village employed open‑ended elicitations of siblings to estimate digital information within a village and compare such data with independent genealogies to simulate an analogical/digital interface, and ecological validity 9. Contemporary demographic research employs focused, systematic, fixed‑choice digital outcome surveys conducted by academic, governmental, and nonprofit agencies. The study of a village in Bandafassi, Senegal, however, addressed the difficulties of establishing aggregated data from settings where traditional socially organized, fixed‑choice surveys are not feasible. The Senegal study sought [episodic, semantic] memories from family members about siblings’ and infant mortality. The two elicitation strategies (sisters’ reports and genealogies) produced individual and collective memories of direct or reported experiences and events. Helleringer et al. 10 challenges the achievement of accurate measures of maternal mortality and other demographic concepts in developing countries where routine mortality information (vital registration systems) are lacking. Eliciting connected speech from siblings about their personal experiences pertaining to family members required open‑ended questions initially to stimulate the sisters’ experiences and obtain details about focal events. Although the author did not provide details about the elicitation procedures, the research team is an experienced field research unit and accustomed to working in Senegalese ethnographic settings. Helleringer and his colleagues at Ined (the French National Institute for Demographic studies) estimated adult maternal mortality by using siblings’ survival histories (SSHJ) to infer the occurrence and nature of the death of a sibling (“sisterhood methods”). Demographic and Health Surveys (DHS) often include siblings’ survival histories, but their precise form is not reported in the paper. The Ined study provides a useful summary of local, village collective memories of maternal deaths in a community without established registration procedures. The research team relied on a nationally improvised method for eliciting information from siblings about someone who had been reported as having died before or after their infant was born and/or, the infant having died at childbirth or after 42 days or two months.  8. Cicourel, unpublised ms.  9. Helleringer et al., 2012. 10. Id.

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Ethnographic collective memories are contingent on elicitations which access respondents’ episodic memory to maximize the sibling’s ability to recall information. For example, did the author first ask about the circumstance of first learning of a sibling’s death, and if others (and their kinship ties to the deceased) were present before and after the death? Were there clan and/or family meetings immediately or soon after the event? Elicitation procedures in surveys and demographic studies seldom include recorded details about informal discussion employed to orient the respondents to the task at hand, activate and redirect the respondent’s episodic and semantic memory vis‑à‑vis a general sense of topics to be addressed. In the present case, the ethnographic conditions are especially relevant; asking for sequential accounts of socially organized settings can activate (and can reorganize) memory of a sense of factual and emotional circumstances, artifacts, and who participated in group discussions about a death, including the role of kinship practices. Helleringer et al. note the Ined team obtained genealogies for all inhabitants of the village of Bandafassi. These latter data, with the use of a “verbal autopsy” (VA) questionnaire normally completed by “close relatives,” identify deceased children less than 15 years of age to obtain data from individuals rather than relying solely on aggregated data from SSH and DSS sources. Ined’s research team clearly recognized the greater likelihood of valid data elicited from “close relatives” despite the lack of details of step‑by‑step procedures employed. Aggregated organizational and demographic digital sources of collective memory are amenable to generalizations, yet lack the validity of the ethnographic setting of the Helleringer et al. study. In the concluding remarks, Helleringer et al. state: “Demographic models used to count the number of maternal deaths worldwide (Hogan et al. 2010 ; WHO, 2010) need to incorporate this potential source of uncertainty and bias. Finally, our study highlights again the need for continual improvements in vital registration systems in sub‑Saharan countries to measure trends in maternal mortality with confidence 11.”

The useful study by Helleringer et al. underscores problems social scientists’ face when creating a vital registration system in countries (e.g., sub‑Sahara areas) where formal demographic methods are difficult to employ. Instead, the Ined team notes the necessity of using quasi‑controlled ethnographic methods “…to measure trends in maternal mortality and with confidence.” The accuracy of a vital registration system in a field setting can be enhanced by recognizing the necessary combination of using open‑ended probing questions with individuals, and asking kinship focus groups to discuss their experiences after first learning of the maternal and/or infant deaths. For example, obtaining substantive details from respondents’ individual and collective representational re‑descriptive episodic 11. Id., ibid., p. 20, quoting: Hogan M. C., Foreman K. J., Naghavi M. et al. (2010) “Maternal mortality for 181 countries 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5”, Lancet, 375, p. 1609-23; and: World Health Organization etc., 2010, Trends in Maternal Mortality: 1990 to 2008. Geneva, WHO.

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and semantic memory using recorded elicitation procedures and explicit analysis of actual transcripts of individual and group sessions. The accuracy of siblings’ episodic memory is contingent on locating the events within the context of tribal and local daily life practices associated with births and deaths, indicating how a research team creates village genealogies, and the extent to which particular tribal and local genealogical knowledge is known, in what form, by whom, how, and transmitted to others. Two anecdotes come to mind based on problems associated with historical documents (e.g., diaries, letters, governmental archives) and “politics” of social interaction within governmental settings before they are summarized in unofficial or official reports. The anecdotes were told to me by a ``long‑time friend, Norton E. Long, deceased political scientist who worked for the director of two important government agencies in World War II. After WWII, Long initially accepted a position at Queens College, New York City, and what is now Case Western University, Cleveland, Ohio. One day at lunch on campus, an historian approached Norton to ask for his advice about a book the historian was writing on government agencies during WWII. The historian was especially interested in the reports of two agencies (at which Long had worked), especially one directed by Chester Bowls. Long agreed to meet with the historian and the latter brought a number of documents submitted to appropriate congressional committees. It only took Professor Long a matter of minutes before he began to express his amusement at the contents of the documents. He told the historian that the agency routinely altered all reports sent to congress in order to obscure policy differences in the agency’s day‑to‑day decision‑making and practical outcomes. In 1960‑61 when Long was a professor of political science at Northwestern University, he became the speechwriter for the newly elected Governor of Illinois, Otto Kerner. I had met Kerner before his election at a cocktail party organized by the faculty at Northwestern (I had been a visiting professor of sociology for 1958‑60) ; Norton and I had purchased the drinks for the occasion. We subsequently attempted to do research on decision making in the Kerner administration. I was able to learn about similar “backstage” decisions, which often occurred on Wednesday evenings at the home of the Governor’s most trusted secretary (she had worked for him when he was a judge in Chicago prior to his election). Participants included all of the Governor’s primary advisors (“cabinet”), and the discussion was open and quite candid, but I was not allowed to take notes. The issues discussed included resolving policy differences, how to address legislators who were creating problems for the Governor’s program, and included how to control the Governor’s wife who was described as an “alcoholic.” The lively discussions covered every issue the Governor’s office faced weekly. I was also allowed to observe, but not take notes, when the Press Secretary spoke (and “leaked”) privately to selected members of the press about the Governor’s future plans and actions. The brief remarks on former governor Kerner of Illinois suggests the “obvious”; “official” documents often have other purposes than simply recording what happened on particular occasions. Research on decision‑making can be improved when there is an explicit recognition of the essential role of participants’ memories when researchers employ connected speech events in a hoped‑for informal interview setting designed to facilitate social interaction about (“sensitive”) past events.

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DIAGNOSING DEMENTIA IN A CLINICAL NEUROSCIENCE RESEARCH CLINIC

Clinical neuroscientists rely on initial reported and elicited episodic and semantic collective memory of family members, patients, and a clinical team to achieve a differential diagnosis. The clinic studied employed several batteries of controlled neuropsychological and psychometric tests including emotional, linguistic, and social function digital measures, Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI, functional or fMRI), and related biochemical measures, including patients’ subsequent progress by repeating aspects of earlier controlled testing, remedial therapies, all of which constitute temporal changes of formal organizational collective memory. The author also engaged in recorded follow‑up visits of patients in their homes. Individual and collective memories, inevitably, are subject to limited capacity processing constraints inherent in all memory systems. Memories are selective representational re‑descriptions often altered unwittingly in real time when experiences and events are discussed, reported or re‑told as “stories” within daily life settings. Information processing constraints are not always recognized as an unavoidable source of change when clinicians (and all interview strategies) seek documentation of a patient’s cognitive, emotional, and social deficits in semi‑controlled and controlled testing, laboratory, imaging or related procedures. In addition to individual and group limited capacity processing constraints, all personnel in institutionalized settings are trained to describe, wittingly or not, taken for granted routines and practices which constrain what is perceived, remembered and recorded as “within normal” behavioral limits and/or as “deficits”. Medical bureaucracies epitomize explicit rules and regulations yet are highly dependent on often unreported, tacit, analogical interpersonal relations and communication activities. Narrative and digital official, institutionalized collective memories, therefore, seldom include systematic study of taken for granted, organizational daily life routines and practices reported by Blau, among countless subsequent studies 12. Roy D’Andrade raises a pertinent issue 13: if detailed daily life routines were included in clinical reports, would they improve decisions? Further, “a difference [exists] between an accurate report based on undescribed and taken for granted daily life routines, and an inaccurate report which is inaccurate precisely because the taken for granted material was not understood correctly.” My initial response to D’Andrade’s observations is that physicians’ intuitions are always partially reliant on memories of analogical events. But D’Andrade also asks if I suspect that physicians’ intuitions are often mistaken because the physician does not recognize that judgments are being made on taken for granted material? I assume that all daily life decision making invariably requires judgments based on taken for granted observation and intuition. And because physicians’ (and countless others’) decisions are embedded in and constrained by socially organized institutional 12. Blau, 1960. 13. Personal communication with the author.

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rules and guidelines, physicians’ decisions inevitably are sometimes “being made on taken for granted material,” but I quickly underscore my belief that such claims would be difficult to demonstrate empirically. An attending (board‑certified, “expert”) physician’s highly informed medical intuition is especially activated and guided by several memory systems and her or his implicit and explicit pool of knowledge essential for creating and interpreting analo­ gical and digital outcomes within “evidence‑based medicine”. Familiar forms of human dementia, Alzheimer’s disease (AD), Frontotemporal Temporal Dementia (FTD), Parkinson’s Disease (PD), and semantic variant Primary Progressive Aphasia (svPPA) were examined, but the present work focuses on a semantic variant of PPA. The diagnosis of dementia begins when family members, friends, work colleagues, and/or the presumed patient individually and collectively describe fragments of their episodic memories of patients as “unusual,” “different,” “disturbing,” “worrisome,” “strange,” and the like. We lack consistent evidence vis‑à‑vis when and how family members, others, and patients informally begin to sense culturally framed cognitive deficits leading to one or more visits to health care providers. Lay episodic memories, truncated “stories,” or partial accounts of events are constitutive of organizational healthcare collective memory. Truncated or encapsulated narrative accounts, highly suggestive, yet weakly favored cognitive and cultural clinical markers, have acquired diminishing status in evidence‑based medicine. The goal of health care delivery systems, therefore, is to present and legitimate a rigorous collective memory of dementia by replacing clinical markers with digital testing data and biomarkers derived from laboratory (e.g., cerebrospinal fluid) and imaging studies which then serve as proxies for molecular level details and truncated or adumbrated or “sketchy,” partial stories or accounts by patients, family members, and analogical clinical interviews. The later view of research‑oriented evidence‑based clinical medicine, therefore, is the hallmark of healthcare delivery systems’ understanding of dementia. In the clinic studied herein, assessment of patients’ dementia includes detailed neurobiological, cognitive, emotional, linguistic and social function testing, laboratory findings, scanning assessments, among others, and a caregiver questionnaire of patients’ social functions. Two vignettes of early symptoms associated with dementia reported by caregivers during home visits by the author illustrate the notion of “sketchy” accounts and the necessity of recorded behavioral observations to better validate after the fact episodic and semantic memory reports (paraphrased from recordings of the two caregiver spouses). Experienced clinical neurologists (an “attending”) are skilled at using “sketchy” accounts to infer dementia, especially when they combine such accounts with the use of simulated testing procedures. The early onset case of AD (male, age 52) had been manager of a large warehouse in northern California. One day, the patient’s work supervisor called his wife and reported her husband had been falling asleep during recent important business meetings. The wife, a financial adviser, stated her husband seemed “fine” at home and surprised

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by the reported information. She noted that her husband worked long hours and endured a very stressful workday. The patient’s employer noted his work had always been satisfactory. The patient reported “problems” but continued using his computer, was able to drive an automobile locally, but fearful of dense traffic, and uses his bicycle. The interview was conducted with both parties present. The wife noted her husband was able to do the shopping and cook meals. The patient’s connected speech was fluent and coherent. Many details are available from a recorded transcript of my home visit. I omit them here and pursue the details in a subsequent publication. I suggest the truncated vignette is characteristic of how clinical information is obtained initially before systematically pursuing a presumed patient’s deficits by administering a battery of tests. The vignettes are commensurate with health care organizational archives. The wife of a second patient reported the following episode. Her husband was driving them from a city in Nevada to a small city in the San Joaquin Valley of California on route 99. After approximately 15 minutes, the husband suddenly exited from the highway when he observed the exit’s name as the same as the city to which they were driving. The exit was not the exit for the designated city, but to a road of an agricultural orchard many miles from the city. After driving for about an hour or more, the husband again exited the highway when the same name appeared. They again ended in an agricultural area. The wife reminded her husband the exit was again a street with the same name as the city to which they were driving. The wife then asked her husband to change seats and she drove to the designated city. The wife reported the above incident alarmed her and she related the story to her oldest daughter who lived nearby. The daughter stated that she had not noticed anything different about her father. Some weeks later, the older daughter accompanied her father to purchase furniture for apartments the family owned. After the purchases, the daughter told her father she was going back into the store for something and that he should tie up the furniture on their small truck while she was gone. He assured her he would do so. When she returned, her father was still in the truck and the furniture had not been secured. When she told her father that he had not tied the furniture, he “looked” surprised. He then tied the furniture and they drove to the apartments. The daughter reported the incident to her mother. A few weeks later, the wife took her husband to a large medical center for an examination. The physician, a general practitioner stated he did not believe the husband was having any problems. The wife insisted on seeing a specialist. The husband was examined by a neurologist who told the wife her husband was showing signs of dementia. The wife subsequently took her husband to the research‑oriented clinic studied by the author. He was diagnosed as having frontotemporal dementia. The two vignettes are similar to truncated narratives elicited and reported in medical histories and resemble descriptive formats of ethnographic observation. An essential collective memory resource in clinical neuroscience research settings is a meeting of a team of clinical personnel presided over by an attending physician (a Board Certified Neurologist) who orchestrates the reports of other members of the clinical team.

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CLINICAL SUMMARY AS COLLECTIVE MEMORY

A fellow (a neurologist who had completed his three years of residency) described the scope of the clinical team’s diagnostic activities and begins his clinical interview report. “The team evaluation consisted of a neurologic evaluation, neuropsychological testing, caregiver interview, psychological screening, and functional assessment, and this document summarizes the findings of the team’s clinicians. He came with his wife Maria, who assisted greatly in providing collateral information.” “History of present Illness: Mr. S’s first symptoms occurred three years ago, when he started having difficulty remembering famous people’s names (such as the Rolling Stone’s vocalist or the owner of a famous boat)... That symptom progressed and about two years ago, he also started having trouble remembering names of people he knew socially, such as people he knew from the yacht club. He reported having no difficulty recognizing faces.”

The fellow’s narrative is an explicit example of organizational collective memory summarizing the patient’s difficulty “remembering famous people’s names” and “trouble remembering names of people he knew socially…” at his yacht club, suggesting an inability to recall, produce culturally appropriate lexical items (“names”) and noted below by the fellow as “anomia”. According to the fellow, the patient’s inability to retrieve lexical items suggests a problem of semantic memory; an inability to recall lexical items about assumed common knowledge about the world; the Rolling Stone’s lead vocalist, the name of a famous yacht despite the patient’s strong familiarity with sailing and well‑known boats. For the fellow (and subsequently the attending), the reported retrieval deficit is assumed to be a self‑evident clinical marker. Patients with svPPA experience “occasional but persistent” anomia often retain considerable knowledge about the meaning and use of lexical item(s), can negotiate daily life activities without notable difficulty (e.g., driving, executing problem solving tasks, completing appointments, maintain a checking account), and engage in conversation about the inaccessible lexical item(s). The patient, therefore, provided truncated (that is, condensed) diagnostic elements suggesting a social‑cognitive deficit; the disruption of smooth flowing communication, and a source of embarrassment. The fellow paraphrased the patient’s responses and reported difficulty remembering lexical items believed to be particularly indicative of dementia. The reference to the “first symptoms occurred three years” ago suggests an implicit episodic time‑line of the patient’s problems, but does not indicate how and when they were experienced initially and subsequently by the patient and perceived by his wife. Clinical summaries reflect routine organizational constraints found in all archival data; they truncate many details. Yet, scholars working with historical documents might be especially interested in the kinds of events available to clinicians if they probed a patient’s family members’ daily life experiences. The extensive neuropsycho­logical, linguistic, and social functions testing are not recorded for possible details about the patient’s comprehension of the tasks. Anecdotal remarks are sometimes noted by

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the clinical team, but the focus of attention are crisp summaries and their interpretation vis‑à‑vis clinical and biomarkers of dementia. The fellow provides additional signs of cognitive deficit: “About a year ago, Mr. S began noticing that he was slower to read. He described having difficulty with longer words (more than 7‑8 letters) and having to break the words down into syllables so he could understand them. He did not endorse changes in his reading, writing or comprehension abilities, and his wife agreed on that.”

The fellow’s paraphrasing of remarks by the patient stands as clinical proxies for the patient’s unexamined episodic memory of events three years earlier and evidence of early onset semantic dementia. The fellow’s report, therefore, includes a useful, plausible summary of clinical markers to authenticate the differential diagnosis, and parallels all social interaction elicitation procedures employed in a in a wide variety of governmental, commercial, and educational settings, among others, in which formally organized information is sought because it is amenable to convenient electronic storage and retrieval using algorithmic or related search engines. The fellow’s clinical summary continues: “About six months ago, he began having trouble with naming and would point to an orange and not know how it is called; or refer to a raspberry as ‘that red fruit’). He also made some mistakes while talking, such as saying ‘Wednesday’ instead of ‘Tuesday’.”

Semantic speech errors such as pointing to “an orange” and not knowing how it is called, or referring to a raspberry as “that red fruit,” and saying “Wednesday” instead of “Tuesday” were briefly reported, but details of particular occasions not deemed necessary; when, where, and with whom such speech problems emerged. The truncated remarks about connected speech events of language problems became an integral part of the medical history and reflect how particular elements elicited during social interaction are incorporated into collective memory. The fellow’s account is adequate to support his diagnosis despite not seeking details of past behavior. I assume the same use of plausible truncated information occurs in all structural studies of collective memory. Clinical medicine, laboratory and testing results provide independent cross‑sectional sources of data on individuals, and actual clinical intervention is not only a clearly articulated goal, but is also backed by a long history of therapeutic remedies, massive financial assistance, and can include subsequent data on a patient’s progress and the use of clinical trials. Direct, detailed observations, much less recordings of contemporary settings are seldom a goal, and often not desired in structural social science studies. A major part of macro‑level social science seeks generalization based on digital correlations. Why, therefore, should the present work suggest an integration of concepts and methods derived from detailed observation, and analysis of recordings and moment‑to‑moment

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social interaction? Structural social science research does not seek information paralleling medical methods and measures of individual impairment. Cognitive problem solving skills and memory driven by cultural processing constraints inherent in social interaction are noted by historical studies and survey data 14. Yet these studies, though acknowledging a role for aspects of memory and daily life practices, do not examine how individual and institutionalized cultural reporting activities routinely frame inferences about what is termed autobiographical, biographical experiences, socially organized family relations, and bureaucratic activities called structural outcomes. In other words, research scholars who address collective memory in medicine, historical, and contemporary social science are aware of the existence of the constraints and limitations of cultural practices and limited capacity processing of information by individuals and institutional personnel on what is to be called and gathered as “data,” but do not view such constraints as necessary topics of empirical inquiry for the study of collective memory. PATIENT‑ATTENDING CONNECTED SPEECH EVENTS AND CREATING INSTITUTIONAL COLLECTIVE MEMORY

Healthcare delivery systems epitomize the systematic production of institutional archival medical records. For example, before seeing the patient and family, the attending physician acquires summaries of the clinical team by first asking for the fellow’s oral and written report of the patient’s condition, an official part of the fellow’s post‑doctoral training. The attending invites each member of the team to present their assessment of the patient’s behavior according to their testing of the patient’s neuropsychological, cognitive, spousal interview, social function, and language outcomes. The fellow and attending review MRI scans and indicate atrophied areas of the brain associated with semantic dementia. A few excerpts follow to give the reader a sense of how social interaction frames elements of collective memory. The attending begins with what appear to be fairly routine clinical elicitations, asking the patient (at 0.28 seconds, lines 1‑3) if he has experienced “cognitive problems”. Excerpt 1 1. A: – Now around the time of your surgery [for a liver trans‑plant] and after the surgery, 2. did you notice any trouble thinking of words, 3. and [P: No] any cognitive problems at all? The initial question reflects information the attending gleaned from the fellow’s medical history of the patient. During his meeting with team members, the latter had described “progressive language problems.” In excerpt 1, the attending, primed by the clinical team and fellow’s medical history, asks if the patient noticed “any trouble thinking of words, and [P: ‘No’] any cognitive problems at all?” The patient stated 14. Olick, Seroussi and Levy, 2011, especially p. 16-23.

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[‘No’] vis‑à‑vis trouble “thinking of words,” but in line 3, the patient does not respond to “any cognitive problems at all?” The attending does not explore “any trouble thinking of words” and “any cognitive problems at all?” by asking for a recent example of the patient experiencing “…trouble”: Excerpt 2 [F = 2.57 seconds.] 1. A: – So let me ask you about the trouble with words and meanings, 2. I’ve heard from F [fellow], N [nurse consultant] and everyone. 3. So tell me in your words. The reference to ‘trouble with words and meanings’ now appears as self‑evident and consistent with prior discussions between the patient and the clinical team, namely, “F, N, and everyone.” Details about the “trouble” were specified earlier by the fellow when noting semantic speech errors such as pointing to “an orange” and not knowing how it is called, or referring to a raspberry as “that red fruit,” and saying “Wednesday” instead of “Tuesday.” The patient’s episodic and semantic memory were not probed for details of actual speech events and how, when, where, contextualized cultural settings emerged. I assume the attending viewed the patient’s responses as self‑evident indicators of aphasia. Excerpt 3 – Patient’s response 1. 2. 3. 4. 5. 6.

P: – I noticed this about three years ago, talking about three, well‑known people, I couldn’t come with the names, talk about Rolling Stones and I couldn’t come up with the name of the lead guy [A: ahuh], while people you see, you know, in the movies and things like that, when I go to mention the names, I couldn’t, that was the first thing that I was aware of.

In Excerpt 3 (line 1), the patient refers to the same time line “about three years ago,” noted earlier by the fellow in his “history of present illness” about language use and [semantic] memory problems (lines 2‑3) and an inability to remember names associated with the musical group the Rolling Stones and the lead singer, Mick Jagger at some unspecified time and place. The patient then elliptically refers to his inability to remember the names of (unstated) persons he would see in cinemas, “things like that.” Again, there is no specification of time, place, nor probing the patient’s account for a recent episode by the attending. The patient’s syntax (lines 4‑6) appears somewhat incoherent. The patient generalizes his problem by reference to “…people you see, you know, in the movies and things like that,” and states an inability to “mention the names”. The patient’s summary of his episodic memory of anomia remains abstract yet provides signs of clinical deficits sufficient for a formal differential diagnosis and documentation of clinical markers associated with the diagnosis of svPPA.

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Excerpt 4 9. A: – And if someone reminds you of the names, did they sound familiar? 10. P: – Oh yeah, it came right back. 11. A: – It came right back. And is that still the case now? 12. P: – Yes. Oh yah. 13. A: – Always recall who the person is? And what they did? 14. P: – Oh yah, yah. And sometimes... those things do come back, 15. rarely, but they occasionally do. (3:50 secs.) In Excerpt 4 (lines 9‑13), the attending seeks to confirm the patient’s earlier reported difficulty in recognizing the names of others by asking: “And if someone reminds you of the names, did they sound familiar?” The patient replies affirmatively, “Oh yeah, it came right back.” The clinical framing of the question in line 9 and the response in line 10 remain unclear empirical issues; probing questions about time, place, and topic(s) of a recent occasion(s) are absent. The empirical issues, however, do not alter the perception of relevant clinical markers inferred from the patient’s summaries of his experiences necessary for the creation of an organizational diagnostic collective memory of dementia. The attending (line 11) then asks “And is that still the case now?” suggesting a recent event. The patient (line 12) states another ambiguous response (“Yes. Oh yah.”), and the attending (line 13) appears to pursue the issue: “Always recall who the person is? And what they did?” but does not ask for specific details nor or a recent occasion nor their frequency. The patient’s first three lexical items of line 14 (“Oh yah, yah”) suggest his affirmation of the query (“Always recall who the person is? And what they did?”), but then hedges his affirmation; “And sometimes, ... those things do come back,” yet in lines 14‑15 (“rarely, but they occasionally do”), suggesting his affirmative response in lines 10 and 12 were problematic. The patient’s use of “hedges” like “sometimes,” “rarely,” and “occasionally,” appear confusing and substantively uninformative. The attending does not seek clarification of the circumstances of the connected speech associated with when “those things do come back.” The substantive remarks by the patient and the digital outcome of systematic, controlled testing become sufficient organizational evidence for a diagnosis and treatment program. Lacking real‑ time details of patients’ and family interviews about contextualized daily life communal settings of reported behavior deemed “deficient” or unexpected makes it imperative for research neuroscience clinicians to obtain adequate individual and aggregated data necessary for comparable diagnoses. Controlled testing, scanning technology, and related non‑invasive methods, therefore, play an essential role in the inference and understanding of plausible diagnoses of dementia. Fellow and attending, therefore, can plausibly infer degenerative conditions like Alzheimer’s disease and other dementias using available interview elicitations to identify clinical markers despite the sometimes tenuous temporal ambiguity associated with questions and responses employed, especially with patients deemed to be afflicted with “mild” cognitive impairment (MCI). The validation process, however, begins with the patient, family, and other reports of “difficulties”.

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DISCUSSION

Focused clinical interviews and controlled neuropsychological, emotional, linguistic, and social function testing create a succinct, useful set of quasi‑digital clinical and survey‑like markers readily codified into a dataset comparable across clinical neuroscience research groups. Analogical clinical and evidence‑based medicine transcend yet interface with cultural differences in health care delivery. Culturally motivated bureaucratic constraints guide the costs, quality, and availability of healthcare delivery to individuals and collective subsets of communal life. Normatively organized evidence‑based medicine varies systematically by culturally driven practices, including identification of basic research funding, healthcare facilities and relevant clinical trials. Demographic and clinical healthcare reports exemplify aggregated datasets of “problem solving” (responses to questions) under controlled elicitation conditions and, following Roberts 15, are analogous to, but not addressed as, cultural information economies whereby “information is received or created, stored, retrieved, transmitted, utilized, and even lost.” Commensurate with Roberts, how cultures frame, alter, and modify information by aggregating information from individuals’ organizational practices remain daunting challenges. The cultural origins of cognition enabled human cultures to evolve more rapidly than other animals relative to their biophysical environment 16. The interface of cognition and culture means that neither can emerge nor exist without the other, and both are essential for the production and understanding of collective memory at every level of communal life. Early human cultures developed various ways of preserving what D’Andrade calls cultural “pools of information” essential for human survival and evolution 17. Cultural pools of information enabled the acquisition of individual and communal knowledge of daily life patterns of social interaction transmitted by, preserved, and modified through the evolution of informal and formal socially organized institutional practices, and progressively massive archival resources. The neurobiological emergence of memory systems and the fusion of cognitive and cultural skills enabled humans to enhance cooperative social relationships inherent in hunting and gathering, shelter, tools, symbols, visual representations, music, sculptures, architecture, and myriads of practical technological and archival resources. Conceptual and practical accumulation of collective memories, cultural pools of knowledge, shaped and guided the exploration and maintenance of increasingly more complex and diverse forms of communal life. Tomasello stipulates that “[...] cultural evolution has worked faster than organic evolution, is species‑specific, and only could have occurred with species‑unique modes of cultural transmission 18.” Humans, notes Tomasello, are unique because of “ […] so‑called cumulative cultural evolution, or the modification of accumulated cultural practical and ceremonial traditions and artifacts over time not acquired by other species. 15. Roberts, 1964, p. 438-9. 16. Tomasello, 1999. 17. D’Andrade, 1981, p. 189. 18. Tomasello, 1999, p. 4-5.

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The invention of a primitive version of an artifact or practice and its modification or improvement enabled others to adopt it, perhaps without change for several generations.” Tomasello calls this “the ratchet effect.” Creative invention and faithful cultural transmission [collective memory] prevent slipping backward, and holding on to the new and improved forms until modifications or improvements came along. A key issue of primate cultures is the intentional significance of tool use and symbolic practices; what it is “for,” and what others do with it. Thus, though not using the term “collective memory,” states : “Processes of cultural learning are especially powerful forms of social‑collaborative creativeness and inventiveness, that is, processes of sociogenesis in which multiple individuals create something together that no one individual could have created one ’another’, she identifies with that other person and his intentional and sometimes mental states….” [Thus] “…only human beings understand conspecifics as intentional agents like the self and so only human beings engage in cultural learning 19.” The explicit, real‑time cognitive view of culture by Tomasello, and anticipated by Roberts and D’Andrade 20, underscores the social interaction origins of human collective memory. Roberts in his work on Native American Tribes noted that cultures can be viewed as information economies whereby “ […] information is received or created, stored, retrieved, transmitted, utilized, and even lost 21.” Socialization to adulthood and death, is embedded in an information economy that is “stored in the minds of its members and, to a greater extent, in artifacts.” Roberts’ study of non‑western communities is notable for its focus on distributed individual and collective memory, and a view of culture in which no one member can represent the cultural depth and diversity of a community’s collective knowledge. For D’Andrade, culture is an immense, distributed, productive system, an explicit reference to human daily life encounters and the necessity of individual and collective memory systems or what D’Andrade calls large collections of sustainable, partial re‑descriptive problem‑solving solutions 22. Building on Roberts and D’Andrade, Hutchins proposed the existence of socially distributed cognition in locally “ […] cooperative efforts of humans working in socially organized groups […]” within different task environments 23. Hutchins states that a socially organized task environment “[…] involves the distribution of two kinds of cognitive labor: the cognition that is the task, and the cognition that governs the coordination of the elements of the task. In such a case, the group performing the cognitive task may have cognitive properties that differ from the cognitive properties of any individual 24.” Structural collective memory mirrors the cultural organization of reported events; the way “stories” and accounts are summarized by natives to convey the expected and 19. Tomasello, 1999, p. 6, himself referring in particular to Tomasello and Call, 1997, and to chapter 2 of Tomasello, 1999. 20. Roberts, 1964; D’Andrade, 1981; D’Andrade, 1989. 21. Roberts, 1964, p. 438-9. 22. D’Andrade, 1981. 23. Hutchins, 1991, p. 284. 24. Id., ibid.

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practical normative gist of their experiences, beliefs, aspirations, doubts, fears, and the like, and expressed by human reference to beliefs and practices called religion, politics, kinship, rules, laws, norms, values, music, art, and science. CONCLUDING REMARKS

The notion of collective memory consists of emergent, cultural pools of knowledge expressed in social interaction and organizational practices which often assume self‑ evident status in daily life when embedded in connected speech events, documents, and beliefs we attribute to material objects and the plausibility and/or trust humans attribute to events, speakers’ or writers’ communicative representations. Survey methods enabled humans to truncate their episodic and semantic memory such that fixed‑choice, digitally coded elicitation strategies emerged allowing researchers to presume simulated, but unobserved yet supposedly experienced and/or imagined or recalled behavior in respondents’ daily life activities. Social scientists engaged in ethnographic research vary vis‑à‑vis their assessment of the value of using transcribed, recorded speech events (and videotapes) to document participant observation of a group or community. The analysis of recorded materials remains a labor‑intensive challenge and difficult to integrate with evidence from notes and memories of participation in daily life activities of a group and the use of open‑ended questions. Ethnographic research, however, suffers from limited top‑down conceptual frames of reference and sampling constraints inherent in shadowing selective individual and group activities even when recording is possible. Can limited theoretical frames of reference be compensated by labor‑intensive participation and observation of selective groups? I think not, unless patterned elements of invariance can be specified which are inherent across human communities. The truncated descriptions of clinical events reported by physicians are not actually viewed as ‘data,’ but background information supporting a diagnosis and illustrate how bureaucratic procedures (often ‘invisible’ decisions) ‘digitalize’ analogical data, but are not, suggests D’Andrade (personal communication) examples of how bureaucratic procedures can create invalid diagnoses. I have not sought to document invalid diagnoses within the framework of the present work, nor would it be feasible within current research regulations governing human subjects’ privacy and ethical standards. Survey questions favored by structural studies parallel controlled testing batteries employed in studies of dementia and myriad assessments ranging from human development to senility. The use of archival documents poses validity issues due to the problem of encapsulated, that is, truncated, edited descriptions of reported events, correspondence, the selectivity of eyewitness observation and testimony, opinions, tacit elements associated with decision making, and the inherent encapsulation of expressed attitudes, norms and values. Structural analysts often suggest that recorded, moment‑to‑ moment, directly observable behavior is cumbersome, labor‑intensive, weak, subjective evidence, along with field notes and memory‑based observations. Yet all survey research and clinical elicitation procedures cannot escape the inherent constraints that forms of memory impose on the content of questions and required elicited responses.

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All research on structural collective memory is constrained by an institutionalized setting of organizational normative rules, expectations, and explicit and implicit practices; individuals and groups make unavoidable judgments of what information should and can be elicited and viewed as evidence. In the case of a clinical research team, the initial bottom‑up, truncated, guided elicitation of responses do not encourage probing the patient’s comprehension of each task pursued by the diagnostic team nor allowing the patient to ask about the meaning and/or relevance of a question and/or response; to do so would compromise the simulated experimental design, yet conveniently satisfies organizational cost/time limitations. The parallel issue exists in survey metho­ dology; respondents are not encouraged (often not allowed) to ask questions about the “meaning” or relevance of a query and fixed‑choice responses. The focus on digital measures, the research analyst’s request for fixed‑choice responses minimizes or eliminates the study of the respondents’ and patients’ daily life conceptions within daily life decisions obtainable by “shadowing” subjects, and inviting respondents’ queries about the content and sense of the questions, and a use of simple, probing questions, especially when the content of the interrogative procedures are presumed to be commensurate with known in common and taken for granted cultural representations. For example, presumed self‑evident questions about age, years of schooling, decisions about immigration, number of desired offspring, contraceptive use, and related issues. The use of elicitation procedure using recorded audio‑visual devices avoids compressed details when taking copious notes during group participation and informal clinical interviewing, including the truncated way respondents or patients are given explanations of the elicitation tasks they are asked to perform. The material presented earlier assumes that transcribed materials provide a necessary, minimal level of validity, especially if they combine recorded survey questions and responses which allow respondents and patients to ask for clarification of the tasks, the questions, and controlled testing activities. Surveys, health care elicitations, and testing rely primarily on a use of a culture’s “standard” language and compositional (dictionary) semantic memory or daily life experiences whose cultural distribution is ambiguous. Ethnographic studies of human animals presume a (often unexamined) familiarity of local dialects, gestures and facial (emotional or affective) expressions, and nuanced prosody, pragmatic aspects of connected speech, including the use of locally and more widely acquired cultural metaphors and metonyms. Systematic linguistic anthropological studies traditionally sought familiarity of local language use, facial expressions, and subtle bodily movement. Contemporary field research studies are not as preoccupied with such subtleties. The structural study of collective memory using archival data varies vis‑à‑vis examination of subtleties of language variation and standardization, depending on the research analyst’s knowledge of and access to more than formal documents and truncated elicited data. The present study has underscored that demographic, survey, and ethnographic research presupposes a tacit reliance on taken for granted and essential taken for granted, socially distributed, cultural pool of knowledge, unavoidably inherent in the interpretation of all social science results, substantively and theoretically.

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