Asian Medicine and Globalization (Encounters with Asia)

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9780812238662: Asian Medicine and Globalization (Encounters with Asia)
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Medical systems function in specific cultural contexts. It is common to speak of the medicine of China, Japan, India, and other nation-states. Yet almost all formalized medical systems claim universal applicability and, thus, are ready to cross the cultural boundaries that contain them. There is a critical tension, in theory and practice, in the ways regional medical systems are conceptualized as "nationalistic" or inherently transnational. This volume is concerned with questions and problems created by the friction between nationalism and transnationalism at a time when globalization has greatly complicated the notion of cultural, political, and economic boundedness.

Offering a range of perspectives, the contributors address questions such as: How do states concern themselves with the modernization of "traditional" medicine? How does the global hegemony of science enable the nationalist articulation of alternative medicine? How do global discourses of science and "new age" spirituality facilitate the transnationalization of "Asian" medicine? As more and more Asian medical practices cross boundaries into Western culture through the popularity of yoga and herbalism, and as Western medicine finds its way east, these systems of meaning become inextricably interrelated. These essays consider the larger implications of transmissions between cultures.

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About the Author:

Joseph S. Alter is Professor of Anthropology at the University of Pittsburgh. He is the author of Gandhi's Body: Sex, Diet, and the Politics of Nationalism and Knowing Dil Das: Stories of a Himalayan Hunter, both available from the University of Pennsylvania Press.

Excerpt. Reprinted by permission. All rights reserved.:

Chapter 1

Introduction: The Politics of Culture and Medicine
Joseph S. Alter

The chapters in this volume deal with the ways in which the body and bodies of knowledge are manipulated to produce coherence and health, broadly defined. They focus on forms of medicine that tend to be linked, in both practice and the imagination, to specific national entities: India, China, England, and the United States, most directly, but also Australia, Tibet, Japan, Singapore and Germany. And yet, in both practice and in the imagination, the manipulation of health in any one of these places, that involves ideas borrowed from any combination of the others—or from no clearly defined place at all—confounds the boundedness of these national entities. In other words, there is a powerful paradox manifest in the relationship between nationalism and transnationalism. This volume is designed to explore the nature of this paradox as it relates to medical practice and the development of medical knowledge.

Within the rubric of modernity it has become necessary, as Prasenjit Duara puts it, to "rescue history from the nation" (1995). The reason is that the legitimacy and power of nationalism is deeply vested in a particular construction of history. This construction is defined as an objective, authoritative, disinterested account of the past as such. It is, in part, the open endedness and inherent interpretability of the past that allows for it to be both captured and rescued; defined and redefined according to different priorities. In this sense history is, simply, a more flexible medium than culture. As anthropologists have pointed out, culture can also be captured and rescued. However, by virtue of present tense, empirical temporality the capture of culture—its strategic interpretation and manipulation—is often more covert than the capture of history. The heroic rescue of culture is championed overtly by those who claim value-free objectivity.

Culture and history come together at various points, and some of these points of convergence are much more prone to capture than others. Think of borders—what they mean, when they were drawn and what the convergence of signification and demarcation means with regard to a whole spectrum of things for which the lines on a map are not only not particularly relevant, but also distorting and disorienting. If history must be rescued from the nation, the convergence of history and culture—as well as each of these unto itself—must be rescued from a world of partitioned and bracketed nation states, and also from a world view, reflected in academia as clearly as in business, that is predicated on the fractured and highly politicized nationalist perception that this entails. There are serious problems, in other words, in thinking about a large region of the world such as Asia—and where, too, does that entity begin and end—as though its history and culture can be subdivided into the history and culture of geopolitical entities called China, India, Thailand, Korea and Taiwan, for example. And this is a problem even for those whose topic of study—Buddhism in the 10th century, let us say—obviously cross cuts the borders of both relatively old kingdoms and empires and modern states.

As more and more research is conducted on various medical systems in Asia by scholars from a range of disciplines, there is a tendency for the questions being asked to become more and more specific to the uniqueness of each particular case. This is good. We now know much more about medicine in China, Japan, Korea, Malaysia, Thailand, Sri Lanka, India and Nepal—to string a somewhat random list of countries together—than we did even ten years ago. But it is also unfortunate. The structure of scholarship is invidiously and often invisibly structured by the priorities of the state: funding for research is linked to government interests and is often channeled through state bureaucracies. This can inadvertently produce the illusion that there is a "tradition" of medicine linked to each of these political entities, even when part of the illusion is that that "tradition" has undergone change through contact with other such traditions. So-called Traditional Chinese Medicine and Ayurveda provide the most striking examples. The fact that Ayurveda is the medical system of India goes almost without saying—and that is precisely the problem—even though the history of its development took place only in various parts of what is now India, in parts of what is now Pakistan, Afghanistan, Nepal and Bangladesh, and through an exchange of ideas that is probably more extensive than the borders of any one of these states and even of all of them put together.

Even a cursory overview shows that there is a tremendous amount of historical, theoretical, applied, and practical overlap between key concepts in the various medical systems of Asia. The similarity of such principles as yin/yang and prak{{rudot}}ti/puru{{sudot}}a, qi and pr?{{nudot}}?, the three do{{sudot}}a and the four "Greek" humors, or the five evolutive phases and the five mah?bh?ta elements in the respective traditions of East and South Asia almost seem to demand a cross-cultural comparative analysis. Similarly, various forms of "Western" medicine have been integrated into the practice of medicine to the east of wherever it is that the West is thought to begin, and this dynamic process of exchange has been important from the time of Scythian nomadism through to modern colonialism and the peripatetic introduction of German, Dutch, French, English and American medicine into various parts of Asia.

To date, however, the extensive and detailed analyses of Asian medical systems have tended to focus on the bounded regional form of practice within the framework of contemporary nation states. On the one hand there are studies of the introduction of Western medicine into specific countries. On the other hand there are studies of Chinese traditional medicine, Tibetan medicine, Malay humoralism, Japanese Kanpo therapeutics, and Ayurveda in India, Sri Lanka or Nepal, for example. Even Unani, or so-called Islamic humoral medicine, which in its span from the Middle-East to Southeast Asia seems to resist narrow, regional demarcation, has tended to be studied within the confines of sub-regional local practice.

There is no denying the fact that the local, regional, and national appropriation of medical traditions is a common and important framework within which theoretical and practical innovation has occurred. In the scheme of historical time, however, centralized state demarcation—at least on a regional scale—is a relatively recent development, and tends to obscure the way in which Asia, however that entity might be defined, is characterized by an integrated history of practice and theoretical innovation as concerns the development of medicine. Stretching from the periods of "classical civilization" up to the advent of European colonialism in West, East, Southeast and South Asia, history suggests extensive inter-regional contact and communication by way of trade, political conquest and religious proselytization. Beyond this, the seemingly more hegemonic and seamless forms of medical practice in the colonial and post-colonial periods also cross-cut regional and state boundaries in important ways.

This volume explores the nature of the tension between nationalism and transnationalism on a smaller, more geographically delimited scale. The focus is on the following key question: When, why and how is medicine linked to the social, political, religious and economic culture of a state, and when, why and how does it extend beyond these delimited, bounded frameworks of legitimation? In many ways this question is framed by institutionalized state politics—that which, quite literally, is established to police the borders. However, reflecting current developments in social theory and cross-cultural comparative analysis, this volume focuses on the nationalistic politics of culture rather than the politics of governments as such. It is focused on transnationalism as a cultural process rather than on the formal structure of economic trade or international relations.

Apart from the relatively numerous works on medical knowledge and practice in various specific regions of Asia, there is a small but significant body of literature that has clearly laid the foundation for an examination of the relationship between nationalism, transnationalism and medicine in Asia. First and most significant is the work of Charles Leslie, whose two volumes Asian Medical Systems (1976) and Paths to Asian Medical Knowledge (coedited with Allan Young) (1992) have implicitly if not explicitly defined the link between regional expressions of nationalism and health care. Both volumes are comparative and force a consideration of parallel and converging themes in the history and culture of medical systems that have become associated with different state entities. This theme, along with the question of medical syncretism—which foregrounds questions of transnationalism and globalization—is taken up by Waltraud Ernst in Plural Medicine, Tradition and Modernity, 1800-2000 (2002). Although many contemporary anthropological and sociological studies of local practice situate medicine in the context of globalization, Connor and Samuel's Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies (2001) is particularly noteworthy on account of the way in which each of the chapters problematizes the relationship between local and global manifestations of medicine and medical knowledge, and how the volume as a whole engages with medicine in the context of state entities, without presuming that the states in question exclusively defines the context of practice. By bringing together essays that focus on healing in the modern states of Korea, Malaysia, and India, healing on the margins of Malaysia, Indonesia, and China, and healing that involves Tibetan Medicine as practiced in China, Tibet and India—and by integrating a concern with both shamanic practice and institutionalized medicine—this volume clearly and effectively anticipates a direct and critical problematization of the link between medicine and nationalism.

Clearly colonialism and the study of medicine under imperial regimes forces a consideration of the intersection of ideas about the body, health and healing as these ideas intersect in the context of politicized culture. Beyond David Arnold's Colonizing the Body (1993) there is a rapidly growing literature in the field of colonial medicine and science studies (See, for example, Ernst and Harris 1999; A. Kumar 1998; D. Kumar 1991, 1995; Pati and Mark 2001). Two other edited volumes, Imperial Medicine and Indigenous Societies (Arnold 1989) and Disease, Medicine, and Empire (McLeod and Milton 1988) situate medicine within colonialism, pointing out—implicitly if not always explicitly—the connection between the flow of knowledge through various parts of the Empire and the connection therein between nationalism and proto-transnationalism. As several scholars have pointed out (Chakrabarty 2000, Dirks 1998, Duara 1995, Kelly and Kaplan 2001, Prakash 1996) historians of colonialism must work against the logic of imperialism by refusing to let the trajectory of modern nationalism define the structure of history. By doing this it is possible to critically examine events that were leading up to the construction of state and cultural boundaries, without presuming where those boundaries are drawn, what they contain or that the natural outcome was the formation of a thing called a state.

In his recent book The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (1999) Shigehisa Kuriyama directly takes on the question of how, when and on what terms it is possible to compare medical knowledge that is deceptively similar and linked both to the history of different regions and the history of contact between those regions. What is unique about Kuriyama's analysis, and why it is particularly significant here, is that it demonstrates how, apart from the sociology of practice—which is the primary concern of most anthropologists and historians of colonial medicine—medical theory is defined in the context of local practices that are influenced by the global flow of ideas and technology. As Kuriyama clearly points out, what seems to be identical in fact—the pulse or a concept of vital breath—can be radically different in interpretation, and this disjuncture even cross-cuts the "genetic kinship" between various theories and therapeutic techniques. For example, there may well be a direct, developmental link between bloodletting and acupuncture (1999: 204)—a link that also connects Europe and Asia through an exchange of ideas about etiology and cure—but this does not at all mean that either one in either place is conceptualized in the same way as it is in the other. There is, consequently, a critical tension, both in terms of theory and practice, in the different ways in which "traditional" Asian medicine is conceptualized as either "nationalistic" or inherently transnational. Stretched to its extreme this tension is reflected in questions that are probably impossible to answer, and thereby betray their own geopolitical bias—where does Greek medicine end and Chinese medicine begin? What sort of medicine does a physician practice when he is trained in the West—say Philadelphia—but gains experience that is integrated into practice while treating people in the East—say Beijing (See Brownell, this volume)?

Building on the ideas developed by these and other scholars, this volume is designed to examine the relationship between medicine and the national and transnational politics of culture in terms of two sets of thematic questions.

The first set of questions concern the production of medical theory. How does theory reflect the political culture of its production, and does this political culture reflect a concern for containment and control or dissemination, teaching and "popularization?" When medical knowledge moves "across borders"—between India and China (Alter), between China and England (Lo and Shroer), between India and the United States (Selby and Van Hollen), between British India and England (Habib and Raina), between England and British India and the Dutch East Indies and the Netherlands (Kumar), and between China and the United States (Brownell)—does it retain its character as the medicine of a particular region or state? If so, how and why?

The second set of questions focuses on the modern, transnational flow of knowledge, capital and people. Within Asia how do states concern themselves with the modernization of "traditional" medicine? How does the transnational hegemony of science enable or limit the nationalist articulation of alternative medicine in the context of specific states? How do discourses of science and "new age" spirituality facilitate the transnationalization of "Asian" medicine?

Alter focuses primarily on the first set of questions by looking at how a quintessentially Chinese mode of therapy—acupuncture—has been integrated, both in theory and practice, into an ?yurvedic framework. The modern development of a distinct theory of ?yurvedic acupuncture is, in some sense, motiv...

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