A Cultural Pattern: An Intrinsic Organization

For the experts who share both the medical and moral understandings to be discussed, the presence of a common, basic understanding in both gives the medical understandings a force they would not otherwise have. For most members of the community, however, this appeal can hardly be present since, as shown below, more than 85 percent of them do not share the experts' understandings about how the body works. Nevertheless, it will be shown that the "balance pattern" does have a positive, if indirect, effect on the acceptance of medical care from practitioners who follow the balance theory of disease.

Another and more pervasive source of the ability of medical understandings to guide behavior will be shown to involve other cultural elements that often have no necessary reference to medical issues. These other understandings are the general expectations that are characteristic of relationships of the sort referred to in chapter 7 as "multiplex." These provide the basis for an organization of understandings that directly guides many patients' behavior. These general expectations lead the patient to accept advice on medical care, and this advice links the patient's understanding that treatment is needed with understandings about what sorts of treatment are available and desirable. This organization is not based on intrinsic relations among understandings with interlocked contents as some organizations are but is mediated through understandings about actors and the statuses of those actors.

This organization of medical understandings through the agency of cultural elements guiding social relations is broadly important in organizing Swahili culture generally. The organizational contribution of social relations in a different domain, kinship and marriage, will be seen in the next chapter. Organizations based on intrinsic relations among understandings are, of course, also vital. These are the organizations that most readily call themselves to attention and that have traditionally received close anthropological scrutiny. One of them, mentioned above, serves to strengthen the medical understandings held by practitioners and serious amateurs.

To examine the two types of organization closely, it is necessary to consider the understandings about the body and medicine held by experts and, separately, those held by interested laymen.