Northern Thai health care alternatives : Patient control and the structure of medical pluralism

Two distinct features characterize village behavior in dealing with health care alternatives in Northern Thailand. First, the individual strives to preserve a secure social environment by controlling the course and choice of treatment during an illness crisis. Second, there are two spheres of health care discernible beyond any division based solely on type of medical technology, or urban-rural or modern-traditional dichotomies. One sphere, 'officially-sanctioned', is socially distant from the patient and totally dependent on the support, and under the aegis of central authority; the other sphere, 'locally-sanctioned', is socially close to the patient and dependent on the approval and support of only the local population. The nature of each sphere is dependent upon (1) the way in which practitioners are validated and sanctioned; (2) the internal organization of each practitioner group; and (3) the style of interaction between the practitioner and patient and his or her family. The variable success of patients in controlling the course of their treatment is demonstrated by the styles of interaction in the respective spheres. Attempts to manipulate the healer by influencing the context of healing, the amount and terms of payment for services rendered, and the type of therapy given are major parts of this control. The history of the local medical system suggests that patients in the research area became accustomed to these efforts to control quite early. Such attempts have been instrumental in shaping the present form of the medical system; therefore, a connection between those efforts to control the course of healing and the shape of the medical system is postulated and explored here.