Misunderstanding as therapy: doctors, patients and medicines in a rural clinic in Sri Lanka.

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through - rather than despite - "misunderstandings" based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems.