Advice in Multiplex Relations with General Expectations

As shown in table 14C, the adviser was a parent for a substantial majority of those who lived with or close to one or more parents. Next most common as a source of advice was a spouse with neighbors, kinsmen, and persons with

similar illnesses (three of these were co-workers) taken together as the final, and smallest, category of advisers. The important common feature these advisers all have is that their relations with the patients were of the sort I have been calling multiplex. The responses to my questions about why the advisers were chosen and/or listened to all indicated that the patients accepted the advice because they viewed those who gave it as being truly interested in their welfare.

In almost all cases, the advisers had relationships with the patient that went far beyond medical matters and involved mutual expectations of a broad sort in many domains. This is unquestionably true of the parents and spouses, of course, and is hardly less true of the assorted kin and neighbors informants mentioned as advisers. Even the co-workers, in the few cases where they were the advisers, seemed to be understood by the patients as having a general concern about the patients' welfare, and it is probably more accurate to refer to them as friends. In the terms used in chapter 4, the expectations in all these relationships were general rather than specific and the relationships were multiplex rather than simplex.

In addition to being subjects of general expectations, the advisers were often characterized as "knowing about illness." This special knowledge was often seen as deriving from the adviser having had a similar illness or being familiar with it through a third person who did. In some cases, the adviser was characterized as having a good deal of knowledge about medical matters generally, and a few of the advisers actually gave medicine or other treatment to the patient as an early step in treating the illness.

The belief in special knowledge or experience does not obviate the importance of the generalized expectations in the relationship between the patient and her adviser; it supplements or focuses them. That is, patients usually have generalized expectations of help and concern of a number of people and they choose among these according to which of them presents herself (the majority of advisers are women, as were the majority of my informants about this) as willing to help and as particularly able to do so.^[13] As would be anticipated given the importance of generalized expectations, in none of the cases was specialized knowledge or experience the sole basis for seeking and/or accepting medical advice. Thus, several of the patients reported that in addition to their advisers, there were people (almost always women) in their neighborhoods with whom they had no close ties but who had the reputation of knowing about medical matters. None of the informants reported going initially to these knowledgeable, relative strangers for advice, although several seem to have indirectly been influenced by them through their direct advisers talking with them.

It might seem likely that advisers had at least some medical understandings that many patients did not since the patients viewed them as qualified to give advice in this area. As seen in table 15B, however, only about half of those

who had advised someone to consult an herbalist had substantial understandings about the Galenic view of the body's elements and in what ways illness was helped by the sort of treatment the herbalists gave.^[14] Only a third of those who recommended Western medical care had substantial understandings about that view of the body and treating illness. The special knowledge the

advisers had, in many instances, was the result of their experience in consulting practitioners rather than their having understandings of their own about how the body works and how illness comes about.

The interviews with advisers included discussion of all the advice they recalled giving rather than only the advice they had given the patient I interviewed. Thus, the twelve advisers told me about twenty instances of recommending therapists rather than only twelve.

Table 15C shows that the advisers recommended hospital doctors slightly more often than they did herbal doctors. Those who reported more than one recommendation—four told of two each and two of three—divided them almost equally between herbal and hospital doctors, with only two of the six multiple recommenders referring people to only one kind of therapist. A major appeal of hospital doctors, the interviews make clear, is that such care is free and provides treatment quickly. Herbal doctors have to prepare the medicines they give, which sometimes takes hours or days while the herbs are found (generally in the same shops where laymen buy them) and compounded. In contrast, as informants say, the hospital doctor simply fills his syringe and uses it.

When the advisers recommend herbal doctors, they report, it is either because hospital doctors have already been tried and have not produced the desired results or, for some of the advisers, because they view the Galenic approach as superior in some or all kinds of illnesses. One adviser told me that hospital doctors get faster results but that their cures do not last. "Real" cures, in her view, came from herbal doctors, and she recommended hospital doctors only for quick relief.