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Uhm Phd 9129680 R.Pdf INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adverselyaffect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyrightmaterial had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand corner and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. U·M·i University Microfilms International A Bell & Howell Information Company 300 North Zeeb Road. Ann Arbor. M148106-1346 USA 313: 761-4700 800 521-0600 Order Number 9129680 A sociohistorical analysis of the crown-based health ensembles (CBHEs) in Hawaii: A Sartrean approach Kamakahi, Jeffrey Jon, Ph.D. University of Hawaii, 1991 Copyright @1991 by Kamakahi, Jeffrey Jon. All rights reserved. U·M·I 300N. Zeeb Rd. Ann Arbor.MI48106 A SOCIO-HISTORICAL ANALYSIS OF THE CROWN-BASED HEALTH ENSEMBLES (CBHEs) IN HAWAII: A SARTREAN APPROACH A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAII IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN SOCIOLOGY MAY 1991 by Jeffrey J. Kamakahi Dissertation Committee: Eldon Wegner, Chairperson Harry V. Ball Kiyoshi Ikeda Deane NeUbauer Abraham Pi1ianai'a Albert B. Robillard (c) Copyright by Jeffrey J. Kamakahi 1991 All Rights Reserved iii DEDICATION I dedicate this dissertation to my three soul mates: Katie, Lindsay, and Hattie. You have taught me so much about living and have certainly given me more than my share of happiness. I love you. iv ACKNOWLEDGEMENTS A sociologist, perhaps more than others, should be acutely aware that a dissertation like this one is a social production of astonishing complexity. Without the effort and cooperation of numerous people, both conspicuous and unsung, the final product would never come to fruition. In these few short paragraphs, I hope to identify some of those who have been especially helpful. First, I would like to thank the members of my dissertation committee. Eldon Wegner has been supportive of my efforts throughout this ordeal while continually having to remind me to stay within the realm of medical sociology. Harry Ball, our resident expert on the sociology of law and the Hawaiian Kingdom, has kept me honest with regard to historical grounding and personal networks. Kiyoshi Ikeda has provided a wealth of information on the cultural complexities in Hawaii as well as being a continual believer in my abilities as a scholar and a public relations committee of one. Deane Neubauer assured that my sociologese could also be understood by non-sociologists and was particularly helpful with the incorporation of political-economic influences in the interpretation of events. Abe Pi'ianai'a; noted Hawaiiana scholar; provided v the knowledge of his years and experience in pointing out certain nuances and networks in Hawaiian and political circles. Britt Robillard was particularly influential in ll arduously converting me to "postmodernism : this work being a moderate step in that direction. I'd like to thank the members of my committee both individually and collectively. And I would like to recognize Michael weinstein for acting as a proxy member of the committee for my oral defense. There are several others associated with the Department of Sociology that I would like to acknowledge as well. Heather Hammer, with whom I've worked on countless computer runs, datasets, and projects has allowed me to develop my ll "methodological and quantitative selves • Lloyd Kuniyoshi has always been available to remedy my ignorance of computers and certain facets of data management and analysis whenever they arose. The "Local Connection", Keith Nagai, Wesley Uenten, Lloyd Kuniyoshi, and others often "power lunched" through many a trial and tribulation; thanks to them all. Deanna Chang was her immutable, micro­ functionalist self at all times. Richard Chabot and I struggled along parallel paths in an attempt traverse our graduate careers. I wish to express thanks to all graduate students and students of sociology in general with whom I have come into contact. I wish to recognize Helen, Jessie, and Jan, staff of the Department of Sociology, and Lincoln for their vi formidable assistance and companionship throughout my years at the University of Hawaii. It would be no exaggeration to say that they kept me abreast of many important deadlines and events. The Department of Sociology, the Hawaiian Studies Program, and Minority Fellowship Program of the American Sociological Association, and assorted contracts have provided me with financial support and assistance over the past five years. This project would never have been completed without them. Finally, I would like to thank my family for IIdoing withoutII for so long so that I could research, write, and revise various versions of this project and complete the various stages of my graduate career. I couldn't imagine accomplishing anything of this or any magnitude without their cooperation. vii ABSTRACT The expansion of Western powers into the Pacific reached Hawaii in the 18th century. Within the course of a century and a half, Hawaiian society was transformed from an isolated Polynesian culture into part of the world's most hegemonious wo~ld power. This study examines the historical development of four focal health care insitutions within the context of such rapid political-economic and socio-cultural transformations. The emergence of philanthropy epitomizes this Western influence. It's appearance merged the general commodification of space and time, the decimation of the Native Hawaiian cultural practices and population, and the arrival of early capitalism. The Crown-Based Health Ensembles (CBHEs) marked the use of philanthropy on the part of the Native Hawaiian aristocracy's Western weltanschauung with the adoption of an interventionist and reductionist "clinical gaze". Jean-Paul Sartre's theory of practical ensembles is employed as a theoretical heuristic by which to characterize moments in the CBHE trajectories. Practical ensembles are collectivities of various types. Sartre's framework provides the means by which institutional discontinuities viii can be situated within the relevant milieu which surround them. Project definitions and redefinitions are continually linked to institutional policy as well as to socio-cultural and political-economic contexts. Each of the four institutions is seen as a case within the broader CBHE panel. The historicity of concepts and the emergent properties of societal reorganization are constantly highlighted. Three themes, though, are settled upon as coordinates to assess the overall movement of the CBHEs and the structuration of the health sector in this interpretive study. The three themes are universality (i.e., the characteristics which underlie notions of equal access), social buffers (i.e., the extent to which institutions are encompassed by intermediary agencies), and health sector position (i.e., the location of an institution in relation to the political-economic contours of the health practice). The study concludes by arguing that the trajectories of institutions cannot be accounted for by determinist, reductionist perspectives which assume contextual homogeneity. Sartre's orientation is viewed as a viable non-determinist, non-reductionist approach to the study of ensembles. ix TABLE OF CONTENTS DEDICATION ..•...••••••..••••..•...••..••...•..... iv ACKN'OWLEDGEMENTS . v ABSTRACT ••••••••••••••••••••••••••••••••••••••••• ix LIST OF TABLES ••••••••••••••••••••••••••••••••••• xiii PREFACE .......................................... xiv CHAPTER 1. INTRODUCTION .•..•..••.•••••.•...•.•... 1 The Crown-Based Health Ensembles (CBHEs) ••..•.• 4 The Theoretical Construct .•...••.•.••..•..... 4 Theoretical Orientation ..••••..•••.•.•..••..... 8 A Sartrean Approach .•..•..••••••...•...•••••. 9 The Progressive/Regressive Method ..•••.••.•.. 10 Practical Ensembles . 13 Ensemble categories Versus Ideal Types •••.•.. 16 A Sartrean Approach to the Study of the CBHEs. 17 Method: A study of Documents •.••••..•..•••.•.• 19 Documents as Social Productions ••.••..•••••.• 19 Outline of the Dissertation .••.•••.•.•...••.•.• 22 CHAPTER 2. THE CONTEXT OF PHILANTHROPy .•.••••.••• 26 Philanthropy: Transfer of Private Wealth ••.••• 26 Dissection of Philanthropy ..••.••..•••...••.••• 28 Aspects of Philanthropy •...•..••••.•...•...•• 29 setting the stage . 32 Accumulation . 34 Humanitarianism . 39 Societal "Needs" . 41 Emergence of a Westernized Hawaii ..•.•.••••.••• 43 The continuing Legitimation .•..••..••.••.••..•. 45
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