Real actions are overdetermined by multiple motivation types that can undermine each other.

Evidence

In a modern state, people are motivated by some version or degree of each of the sorts of motivations that have been distinguished, and their actions are often overdetermined, quite often by all four. The right question to ask, at this level of generality, is not which of these simple models could be made to do all the work, but rather what combinations of such motivations make sense. How are they disposed to undermine one another? It will be particularly important here to ask what kinds of non-egoistic micro-motivation there are, and which of them might relate coherently (more coherently than national-level thick trust could) to both the egoistic micro-motivations and the large impersonal structures of a modern state. — Diego Gambetta, Trust - Making and Breaking Cooperative…, 231

Categorization

• XREF: Connects to the reader’s Luhmann/Hardin integration: the wife’s caregiving is not egoistic micro-motivation nor nation-scale thick trust but a middle-level non-egoistic motive that must combine coherently with both.
• QUESTION: Which specific ‘non-egoistic micro-motivations’ does the author have in mind that bridge egoist action and impersonal state structure? The doctor’s wife in Saramago seems exactly this bridge.