Social Relationships and Plans of Action: Cultural But Extrinsically Organized

For there to be a plan of action, or schema, enabling sick people to get medical care, they must be able to connect the understanding that they are ill with their understandings about the existence of a variety of types of medical care. We have seen that people share understandings about being ill and also about the existence of a variety of kinds of medical care. For the plan of action in dealing with illness to be cultural rather than idiosyncratic, however, the connections between the understandings about being ill and those concerning the existence of medical care must also be based on shared understandings.

Were the connection based on intrinsic relationships among the shared understandings, as are those, for example, that govern the playing of chess, the schemata would be culturally constituted in all its respects. In chess, the movement of the rook and the protection of the king are connected through understandings of how pieces move and how the game proceeds. For most people, such an intrinsic relationship between understanding one is ill and seeking help for the illness is not possible, since, as seen, they lack the medical and physical understandings such connections require. But this does not prevent them from having culturally constituted schemata, nevertheless.

These schemata are produced by connections between the understandings of the presence of illness and the availability of care which are shared but

not mainly concerned with medical care. For most community members, the advice of others is the basis for forming a schema that takes them from understanding they are ill to choosing among therapies and therapists. It is also true that roughly half of the advisers interviewed were themselves advised about the kind of care they recommended. The advisers got their advice, as the patients did, from people with whom they had multiplex relations. Thus, for many who give advice, as for those who receive it, the decision about what kind of medical care to choose involves a social relationship as a crucial link in the organization of understandings that guide their behavior in giving advice.

Some of the patients and advisers formed intrinsically based action plans after they had had experience with various medical experts. Their understanding about what was currently wrong with them contained within it an indication of what sort of therapist to consult on the basis of similar symptoms having led in the past to successful therapy from particular practitioners or kinds of practitioners. This, however, does not change the fact that in many cases, the original plan of action was founded on advice sought and/or accepted on the basis of general expectations in the relationship with the adviser, with these expectations not being limited to medical matters.

The use of advice to form plans of action led to what might be thought of as social relationship-based schemata. Nor were these social relationships always limited to those between the patient and her adviser. I did not investigate where the advisers' advisers got their introduction to the type of care they recommended, but it is very likely many of them got it in the same way the advisers and the patients did: from consulting people with whom they had multiplex relations.