UBC Theses and Dissertations

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UBC Theses and Dissertations

A transactional quest for health Soux, Susan Isabel


The present thesis is a study of the process of development of specific health care services in lower mainland B.C. The major questions posed are: how does personal experience relate to one's choice of therapeutic service, and how do interacting social factors direct or influence the form and content of a selection of health care services? The institutions examined are family medicine, a feminist health centre and acupuncture. Ethnographic research was carried out through informal, loosely directed interviews with practitioners and patients or clients of these institutions. The study focusses on the choices made by individuals as outcomes of personal experience; experience seen in the context of transactions. Transactions occur between individuals, between individuals and ideas, between individuals and institutions, and between two or more institutions. Transactions, when successful, reinforce previously established behavioural patterns. When unsuccessful they bring about changes in behaviour and are identified here as articulations. Behavioural patterns develop within individual lives and when these patterns take on aggregate form, new services or modification of pre-existing services emerge. Decisions and choices are made on the basis of personal and shared values, values which are situational. Outcomes of transactions reflect a negotiation process between transactors which frequently involves the juxtaposition of divergent values and goals. Personal experience, or transactions, occur within a framework of incentives and constraints imposed by broader, interacting social factors. When these factors are supportive of, or complementary to personal choices they facilitate the development of services. When social factors, external to the actual transaction occuring, are in conflict with personal choices they then restrict the development of services. Personal choice, mediated by interacting social variables, directs the formation of social structure, the network in which personal experience is enacted, and this very structure in turn affects personal experience. The types of health care services described to me under the rubrics of biopsychosocial medicine and holistic health are examples of services that reflect a highly differentiated social structure and respond to it by attempting to integrate the diversity. The services examined in this thesis reflect the values of the individuals that were instrumental in their development and consequently of the society of which they are a part.

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