Illness, Nonsharing and "Patterns"

Earlier, it was shown that there is a "pattern" in Swahili culture of the sort Benedict made widely known. This pattern is the result of a common element, the understanding that balance is essential to proper functioning, that is present both in the complex of understandings concerned with proper social relationships and in the Galenic view of body functioning. The relations between the two are similar to those Evans-Pritchard demonstrated as present regarding the Azande's views of morality and their views of affliction. As for the Azande, the understandings concerning affliction are more acceptable and forceful because they are linked to broader moral understandings commonly shared throughout the community.

The effectiveness of this link as an influence on the behavior of community members, however, is put in serious doubt by the fact that many, even most, of them do not share the Galenic understandings. The understandings about social relationships are widely shared, in part because of the constant exposure group members have to the cultural models contained in relationship terms (this is a central topic in chap. 7), but the desired state of these relationships, balance, can hardly be connected to the Galenic understandings about health for those who do not share those understandings.

This does not mean that the pattern is without influence even on the behavior of those who do not share Galenic understandings. As seen earlier, for many people, advice from someone of whom they have generalized expectations is the link between the understandings indicating that they are ill and the understandings about what action to take to alleviate the effects of the illness. Many of the advisers, however, were themselves originally led to the kind of therapist they ultimately recommended by advice they had themselves received earlier.

Still, some of the advisers did share at least some understandings about Galenic medicine. For these individuals, the fact that both the body's healthy

functioning and proper social relationships depend on balance would, it is worth hypothesizing, tend to make balance seem an obvious and attractive force in keeping things "right." If this is so, and I have only the limited evidence concerning the acceptance of explanations to be examined in a moment, the "common element pattern" involving balance would encourage using doctors whose approach to illness was based on reestablishing the body's balance.

More than this, those who share the Galenic understandings may well be readier to recommend Galenic doctors than those who do not, because, in part at least, they take the approach to illness these doctors use as self-evidently correct. In fact, all those who shared Galenic understandings recommended herbal doctors, while all those who shared Western understandings were almost as likely to recommend herbal doctors as they were hospital doctors.

Granting that sharing Galenic understandings increases the likelihood that herbal doctors will be recommended, the pattern would affect even those who do not themselves share the Galenic understandings through making it likelier that advisers would recommend herbal doctors. That is, even if those who give advice in particular instances do not themselves share the Galenic understandings, their advisers—those at a second remove from the patient whose illness is being considered—might. This would lead the pattern to affect those who do not share it in just the same way that understandings about the body affect those who do not share them: by being transmitted through social relationships in which the patients (or the advisers of the patients) have generalized expectations of benefit from those they consult.

And that is not quite all. The existence of the balance pattern may well give balance explanations of illness a certain validity even when those hearing the explanation had not previously known about the four elements in the body and the significance of their being in balance. Only a few patients told me that the herbal doctor they consulted explained to them why they were ill and why he was giving them the medication he did. But those few uniformly reported that they found these explanations satisfying and easy to accept. One of the reasons I was given for the popularity of the leading herbal doctor in Old Town was that he explained things so clearly and well. The similarity between the widely shared belief in the importance of balance in social relations may well be involved in making such explanations of illness easy to accept.

This "pattern-based" process was not seen for those who consulted hospital doctors, although they shared few or no understandings of the Western view of the body and illness. These few reported that the accounts they got were difficult to follow and not couched in terms they found familiar. This is surprising since the Galenic scheme also involves terms and understandings that are not encountered in ordinary affairs. There is no reason to believe hot, cold, wet, and dry as body processes are more obvious or initially convinc-

ing than infection, immunity, and vascular blockage. But it may be that the former scheme receives a friendlier reception than does talk of microbes, immunities, and cholesterol because health, like proper social relationships, results from the balanced participation of the different involved "elements."