The Function of Medical-Care Systems: A Logical Analysis

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THE FUNCTION OF MEDICAL-CARE SYSTEMS: A LOGICAL ANALYSIS HORACIO FABREGA, JR., M.D.* Disease is a recurring phenomenon which is disruptive and poses problems, and because of this groups have beliefs or theories about why disease prevails and how it is produced [I]. Theories of disease are devices for classifying and explaining disease, and they also articulate treatment practices. By the use of such theories, people are able to order and give meaning to medical transactions. When considered together with the personnel, resources, and medical institutions of a group as a whole, theories of disease rationalize and give a distinctive configuration to what can be termed the group's medical-care system (MCS) [2]. The function of MCS is to control the recurring and concrete medical problems which face the group. Among nonliterates, MCS clearly overlaps the religious system, which provides the group with standard formulae , practices, and personnel whose function it is to explain and control a host of dilemmas and existential predicaments, some of which include those of disease. In more complex groups or nations, MCS is separated from religion and from other subsystems which in the less complex groups are frequently connected, if not fused. In this paper, the way in which a group's MCS functions will be explored . The aim of the paper is to discuss how one might go about evaluating a group's MCS and, for purposes of analysis, the MCS of simpler, nonliterate societies will be compared with that ofmore complex, literate ones. Pursuing the question of evaluation of an MCS will make clearer the rationales, modes of functioning, and purposes which are served by MCS. Preliminary Considerations Disease constitutes one of the elemental problems which any group must deal with, and this is especially the case among nonliterates. This may be a reason why in these groups theories of disease rest on religious *Professor of psychiatry and adjunct professor of anthropology and sociology, Michigan State University, East Lansing, Michigan 48824. 108 I Horacio Fabrega, Jr. · Medical-Care Systems premises. Anthropologists interested in social adaptation have therefore been forced to study the functions ofreligion or sanctity in social groups. Important links are thus established among four sets of factors: disease, theories of disease, sanctity, and social adaptation. Theories of disease also involve what others have termed the "cognized" model of a people—that is, the model which they have of the world and in terms of which they manage their affairs [3]. Cognized models are to be distinguished from the "operational" models of the analyst. The latter, in applying his model, is interested in understanding how groups function and maintain themselves in their physical setting. The actions of people performed in the light of their cognized model have determinate effects on processes and happenings which the analyst describes in his operational model. The analyst's model is very often articulated in terms of a general theory of systems [4]. An attempt is made to evaluate the consequences of a group's actions in terms of processes which the analyst identifies in his systems interpretation. The following question can be posed: how might a people's medical activities be approached from a systems frame of reference? A person is "made up" ofopen, connected, and hierarchically ordered chemical, physiological, and psychological systems which in turn connect with any number of external social systems. In order to interpret the person's actions and behaviors, however, his view of himself and of his situation needs to be represented. This raises the question of a people's cognized model of themselves and of their world, both of which come into play when they explain disease by means of their theory. Thus a person can describe himself in terms of souls which are located in sacred mountains, spirits which are drawn from animals or streams, or "parts" which are located inside his body, and all ofthese are somehow felt to be involved in an episode of disease. It is the analyst's hierarchical model of the person and of his life situation, however, which is used to understand and make sense of the person's actions. These actions may be judged as "regulated" by developments in systems...

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