Multiple therapeutic use in urban Nepal

Studies of resort to healers in medically pluralistic settings in different geographic and cultural areas reveal two basic patterns of resort--illness specific and multiple use. This paper suggests that the particular pattern inferred from a study may depend largely upon whether the data consist of general attitudes and preferences or actual therapeutic choices. Moreover, it proposes that interview responses concerning general attitudes toward and preferences for available therapies tend to show illness-specific patterns, while observations of actual therapeutic choices during illness episodes more often portray multiple use. Consistent with this proposition are findings presented here from a recent study of attitudes and help seeking behavior in Kathmandu, Nepal as well as the overall results of twenty-four other ethnographic studies reviewed of therapeutic resort in medically pluralistic settings. An important implication of these findings for the validity of ethnographic description is that attitudes and preferences of individual patients do not necessarily predict or describe actual strategies of resort. Finally, this paper presents a partial explanation for the pervasiveness of multiple therapeutic use and the disparity between attitudes and behavior in Kathmandu.