Sharing Identifying Understandings
What seems most consistently and broadly shared by participants in multiplex relationships are the understandings that identify participants to one another. Such sharing of identifiers is characteristic of all relationships, especially multiplex relationships. The sharing of the identifying understandings may not be quite as complete as community members sometimes indicate it is, since people sometimes do identify as "friends" those who privately identify themselves as only acquaintances or who even understand themselves to be enemies. But the sharing is usually general, so that almost everyone is quite sure who their partners in multiplex relationships[17] are. Given the importance of general expectations in multiplex relationships, the sharing of identifiers (which sometimes include these expectations) for these relationships entails a sharing of such expectations as well.
As we will now see, these expectations play a key role in cultural dynamics beyond their direct service in multiplex relationships. Working together with the ability to identify those in multiplex relationships and the indefinite boundaries of expectations in those relationships, these inclusive expectations are an essential basis for transmitting, so to speak, the effects of understandings to those who do not share—or even know about—them.
It may well be that there are a considerable variety of processes by which this takes place. Two of them were recognized among the Swahili. In one, understandings are "imported" from one relationship to another. In the other, limitations in similar expectations in all but one in a set of connected multiplex relationships give a highly distinctive character to the one relationship, husband-wife, that does not have those limitations.
Importation in Swahili Medical Treatment: It isn't What You Know
An instance of the transmitting of understandings and their effects through what might be called importation was seen in the examination of Swahili understandings about the body and illness and how people choose among types of medical care (see chap. 9). This choice was not commonly made on the basis of intrinsically organized schemata involving selecting a medical practitioner on the basis of understandings about the practitioner's views of illness being in accord with the patient's. Most patients were found to have few understandings of any kind about either the treatment of illness or differences among types of practitioners.
Rather, the choices were made according to the advice of people, usually kin or neighbors, of whom the patients had general expectations to the effect that the adviser would help the patient and could be trusted. These expectations made the advice worthy of following. When it was followed, it led to the patient being affected, in the choice made and the treatment received, by understandings about medical care held by the adviser or often, at a further remove, only by the adviser's adviser or her adviser.
What is particularly striking about the advice is that it is usually accepted. The patient goes, or allows himself or herself to be taken, to the kind of medical practitioner the adviser recommends. When this happens, the nonsharers are affected by the medical understandings that are, according to the definition of "culture" used here, part of the community's culture despite the patient's ignorance of them. If two or more members of the community who maintain some sort of an active relationship with one another share an understanding, it is part of the culture of the group. The fact that there are individuals who do not share the element does not bar it from being part of the culture. Swahili culture would consist of nothing save understandings such as that one must not go naked in public if only universally shared items were included.
Nor is this only an arid definitional matter. If culture's ability to promote individual life and social relationships is to be explained, and if a substantial proportion of culture's contents is less than universally shared, it is obviously essential to examine closely whether understandings shared by only a few affect others who do not share them. When this does happen, and it is surely quite a common phenomenon, the processes whereby it happens call for description and analysis. The Swahili medical care study is an attempt to do just that for one domain.
The understandings that lie behind medical care affect those who receive that care just as the understandings behind the generation of electricity affect people who read by electric light even if they are innocent of understandings about coils and magnetic fields. Medical care, unlike electricity in modern cities, is not "just there," that is, so much a part of life that it requires effort to avoid.
Everyone I talked to knew that Mombasa has a variety of different medical practitioners, and everyone was quite clear about knowing that different people consulted various of them when ill. But understanding that there are practitioners who can be consulted about your illness does almost nothing to lessen the effects of that illness. Only choosing one and accepting the treatment offered may do that. Having no clear understandings about how illness arises and none about how different medical practitioners deal with illness, the basis for this choice is not obvious. It is constantly made, of course, but the basis for it cannot, for most, be understandings concerning the body and its treatment since they do not have these.
For most people, the choice is made on the basis of advice from partners
in multiplex relationships. Their advice is taken seriously enough to be the immediate basis for action as a consequence of the general expectations in those relationships. These relationships "transmit medical understandings" in the sense that they expose patients to activity based on them (what practitioners do when the patients come to them) whether the patients themselves have any familiarity with those understandings or not.
Repeatedly, informants said that they sought the treatment of a practitioner recommended to them not because of what they directly knew about the practitioner or the theory of body functioning and illness he or she followed but because of their relationship with the adviser who recommended the practitioner. When asked why they followed the advice given them, the patients usually said that the adviser "cared about" them (and so would give "good advice") or that the patients "trusted" the adviser or, less often, that the adviser "knew about" the illness in question or medical matters generally. Thus, for the overwhelming majority of the community who are ignorant of medical understandings, these understandings affect their lives through the agency of quite different understandings; namely, the expectations in their relations with others when these others were kin, friends, or neighbors.
There is little new or enlightening in observing that medical knowledge is limited in its distribution and that medical practitioners share understandings (with other practitioners and, to a limited extent, with a relatively few "dedicated amateurs") that most group members do not share. What is worth noting is that the medical understandings affect people because those people have expectations of others, including others as free of medical understandings as they themselves are, which lead them to accept the treatment of the medical experts.
Those in the relationships who give advice are only sometimes more knowledgeable about body functioning and medical care than are the patients they advise. When they are not, they get information from a third person about what should be done. This third person may share a substantial body of medical understandings with practitioners, but it appears that the "chains" of social relationships between the medical practitioner who ultimately treats the patient and the patient can sometimes be rather long. In each link of this chain, the connection between adviser and advised is more often through shared general expectations than through shared understandings about the body and illness.