The
Institutionalization of Healing Traditions
Boon
or Death Sentence ?
(Preliminary Reflexions for a Research Project
with the French Institute of Pondichery (IFP) and the Foundation for the
Revitalization of Local Health traditions (FRLHT), Bangalore)
In numerous non-Western countries such as
India, indigenous systems
of healing continue to provide the majority of health services to the population.
Modern medicine, even where programmes exist to make it available on the grassroots,
continues to be mainly reserved for the urbanized middle classes and does not
touch the majority of the population. In a global context where development
based solely on modern Western promises has shown its limits and where terms
such as codevelopment, participation etc. have become fashionable, there is
an increasing trend to value an articulation of traditional medicines with
the modern medical system, especially in the field of primary health care (Alok
1998 ; Antia & Bhatia 1993 ; Dozon
1987; Rohde & Viswanathan 1995). To explore these paths appears even
more urgent in a context where public health policies are getting increasingly
dismantled under the attack by logics of privatization (CETRI 2004 ; Rao 1999 ;
Qadeer et al. 2001). But this endeavour and its correlative processes of
institutionalization pose many challenges. The Indian experience may permit to
reveal some of them. Indeed, unlike other contexts, India has an experience of
over a century of cohabitation, competition and integration of modern medicine
and local systems of healing which can be divided into classical traditions and
more popular ones.
Notwithstanding this long
history of cohabitation, competition and integration and although the classical
healing traditions (Ayurveda, Siddha, Unani, Yoga) have now been
institutionalized, they continue to be considered only as second hand
medicines, which are almost completely neglected in public health policies (see
for example Qadeer et al. 2001), although lipservice is paid to the fact that
reflecting on the role of Indian Systems of Medicine (ISM) in India's public
health policy is paramount today and that we can witness a recent rush towards
these systems, as they seem to become potentially very rewarding investments,
especially in the case of Ayurveda (see Bode 2004). The encompassing category
providing the general medical paradigm remains the one of modern Western
medicine. ISM seem to be constructed according to the principle of the
encompassing of the contrary : although they are officially recognized and are
formally put on the same level as modern medicine, implicitely it is the modern
medical paradigm and its underlying worldvision and epistemology which are the
reference. Beyond this construction of the traditional systems as inferior to
the modern one, the process of institutionalization by the modern State also
implies a whole reinterpretation of these systems of healing while they are moulded
to fit the modern frames. Darshan Shankar and Ram Manohar (1995 : 99) note that
Unfortunately () the myth of there being one universal science modern
Western science dominates the thinking of a large section of the scientific
community. In fact, this view has served to block a healthy dialogue in India
between those trained in Western allopathic medicine and those trained in the
indigenous sciences. () Thus from one perspective, the inner state of Ayurveda
is a picture of struggle to establish its epistemological identity and retain
its integrity. From another, it is a picture of unhappy compromise with modern
medicine seeking justification in terms of modern medical theory and its
parameters, and trying unsuccessfully to prove itself to be scientific. This
remark can be extended from the epistemological to the social consequences as
modern medicine sets the standards not only for research, but also for
education and for all public health policies. This process reminds the legal
anthropologist of what could be observed for instance in the legal field in
African contexts in the recognition of custom by the state where the original
logics got completely destroyed in the process, the transformation of custom
into customary law through its codification resulting in nothing less than its
death. Anthropology of Law has shown with no ambiguity that putting into forms
of social relations is not neutral. Writing down custom and thus turning it
into customary Law is not continuing the same thing in a different form. Rather
than its continuation in another form codification constituted its death
sentence. It is legitimate to wonder if the same danger does not also lurk
behind the institutionalization of healing traditions and its many facets. Is
this official recognition a boon ensuring the perennity and maybe the
development or revitalization of these traditions ? Is it a tool for better
health for more people ? Or may it be a death sentence in disguise for the
traditional ISM ?
Hence the question of the processes of
institutionalization ISM, their stakes and challenges arises. What happens when
they get organized by the state and moulded in a shape influenced by modern
Western concepts of science, medicine and health and the market ? It is very nave,
and ignorant of the teachings of the anthropology of Law[1],
to think that to integrate the diverse systems of healing will assemble the
positive aspects of all systems and will thus be able to provide better health
and for more people as a universal panacea. This approach fundamentally ignores
that the process of the meeting of traditions[2],
their mutual interpretation, or the domination of one over the other are not at
all neutral, neither on the epistemic level of the traditions involved, nor on
the level of social consequences. There are huge stakes in working out the
premises and the conditions for a genuinely dialogical encounter[3].
They do not seem to have been widely addressed yet.
In
current discussions on democratisation, sustainable development and good
governance these stakes are usually neglected, and especially the challenges
posed by the forms intended to shape these processes, or in other words Law
understood in a broad sense. Anthropology of Law has highlighted the fact that
law in its Western understanding is not a universal concept. It is but the tip
of the iceberg of Law understood as juridicit, as that which puts forms and puts into forms
or patterns our living together and our conflict resolution. In the latter
sense, the Law of each culture is inscribed in different underlying logics and
worldviews. Modern, Western law is no exception, although it does present
itself as abstract, neutral and universal[4].
From this
perspective it does not seem sufficient to try to copy the Western model of
governance, development, democratisation, rule of law or medicine in
other cultural contexts. There is a need to address the intercultural challenge
of adapting and enriching these approaches in a dialogue with local realities
and points of view. This is very much in line with governance's announced
requirement of participation. Real participation entails more than trying to convert all the
citizens of non-Western countries to the Western model an endeavour which,
incidentally, has proven in the last decades to be no more than a utopia. As we
will show to work out the bases for real participation or cooperation bears
important consequences on the sociological as well as on epistemological
levels.
I have
been working for the last ten years on issues of intercultural approaches to
Law and I am now engaged in a project on Law, governance and sustainable
development whose aim it is to highlight the intercultural challenges. The
process of institutionalization of healing traditions in India constitutes a
prism via which the challenges of the meeting of different systems of knowledge
and their effects on the patterning of reality, both social and epistemic, can
be analyzed. It also constitutes a great challenge for intercultural governance,
meaning governance where the difficulties and stakes of the meeting of
different worldviews is acknowledged and where indeed a participation of all
actors of society is sought and not only of the modernized ones Thus the
study which will be focused predominantly, although not exclusively on India
will reveal much more general issues which can be encountered in other cultural
contexts. Indeed as Baer, Singer and Susser (2003 : 322) point out Medical
pluralism in the modern world is characterized by a pattern in which
biomedicine exerts dominance over alternative[5]
medical systems, whether they are professionalized or not.
This
article is intended to be a roadmap of the research. It should also be clear
that it is intended as a provocation for thought which explains its title. It
is obvious that the point of the research will not be to prove one or the other
pole of the question, boon or death sentence. By introducing the second
pole my aim is rather to draw attention to the vital stakes underlying the
processes of institutionalization and to shed light on one possible in-between
on which the research can focus : the in-between of transformation which can
result in survival or extinction of the systems of healing in interaction.
This article is a first attempt to paste together
different pieces of a puzzle that I started to be interested in over the last
years. The more
institutionalized pieces of this puzzle consist of my research over the last
ten years in the field of legal anthropology trying to move towards a more
interculturally valid understanding of Law (see Eberhard 2001, 2002a, 2006).
They have been complemented in the last two years by research on Law,
governance and sustainable development in the light of intercultural dialogue
(see Eberhard 2005a). The more informal pieces consist in a number of
experiences, one could call them participatory research , I
gathered in order to prepare my study on the institutionalization of healing
traditions. I was indeed lucky over the last years, parallelly to my academic
obligations, to have been able to take the time to explore a number of paths
without being accountable to any institution. This allowed me to take the time
to crystallize a research object over a few years and with the possibility to
let it emerge in extended participatory observation in the fields I am
interested in but without having to immediately mould these experiences into
research projects or articles
This article is thus not an article
concluding a research. Although it is the fruit of four years of experiences,
observations and reflexions it rather constitutes the opening up of a research
plan through the crystallization of a problmatique
which seems essential to me : The institutionalization of healing
traditions. A Challenge for Intercultural Governance.
If for me the provisional results
presented here constitute the beginning of a research dynamic which will
probably keep me busy for the next years, for the other readers it is intended
to be provocative : provoking a different point of view, unveiling new paths to
rethink old questions. I needed to explore many facets before being able to
understand what I was actually looking for and what I think is missing in contemporary
research on healing traditions and their institutionalization. I hope the
findings will also inspire fellow researchers in the field. And as what I have
to say will also have some impacts on questions of methodology it seems
necessary to provide the reader with an account of how the present intuitions
emerged. Indeed as will become clear in my case I approach my
fields rather in terms of a really participatory research than as
simply ethnography[6]. This means
that I do not content myself in the role of an observer who is present in the
situations he describes, but that I actually take part in the practices, or
traditions I try to understand (see in that context Pordi 2005). There are
different ways to practice anthropology and different reasons why one does it.
For me, the essential question is the one of intercultural dialogue. Thus I am
not only interested in giving account of the situation as an observer but the
role of anthropologist takes on a more dialogical requirement : how to become a
bridge between cultural universes, un passeur entre les mondes to
refer to the title of the book in honour of Michel Alliot (Le Roy 2000) one of
the founding fathers of French legal anthropology ? I have therefore invested
quite some time in trying to get an idea of these practices before actually
starting to write about them, or to try to put the experience in a more
scientific context. And for me the whole endeavour, ethnographic as well as
more theoretical, only makes sense as far as it is informed by the
participation in two worlds meeting inside of oneself intra, so that one can
become an agent of inter-cultural dialogue. As Raimon Panikkar (1978) noted
in the realm of interreligious dialogue, it always has to start with an
intrareligious dialogue.
The research symbolically started in November
2001 in Barcelona during a Unesco conference on intercultural dialogue where I
met Darshan Shankar, the director of the Indian Foundation for the
Revitalization of Local Health Traditions (FRLHT). We started to talk about the
possibility of a common research project on healing traditions and
intercultural dialogue and I spent two weeks in Bangalore at FRLHT in December
2001 to explore the question more deeply[7].
I realized that it is not possible to do a meaningful research without some
personal knowledge of the traditions to be studied. Thus, because of my
previous background and because I think that the comparative perspective is
paramount in the construction of anthropological problmatiques, I decided to spend a year in China
at the Northern China Shaolin Martial Arts Academy near Siping (Jilin Province)
to study Chinese internal martial arts, especially Baji Quan and Taiji Quan
from September 2002 to September 2003. These arts are indeed linked to systems
of traditional medicine[8].
And it seemed important to me to work on my body in a traditional way in order
to be able to understand from inside the theorization of these systems of
knowledge functioning in terms of energy flows and centers (see for example Frantzis
1997 & 1998 ; Svoboda & Lade 1995 ; Wang 2005 ; Yang 1997). On my
return from China, I became responsible of an international research dynamics
on Law, governance and sustainable development based at the Facults
Universitaires Saint Louis in Brussels which focuses especially on the
intercultural challenges. In this context, it did not seem farfetched to link
my interest of the challenges related to traditional systems of healing facing
the contemporary world with the issues of public health policies in non-Western
settings. Meanwhile the French Institute of Pondichery (IFP) had launched a
research project on healing traditions in South Asia coordinated by Laurent
Pordi in January 2005. This seemed to be the perfect plan to join an
international and interdisciplinary team but in which a more legal point of
view, even understood in its broad anthropological sense, was absent. My
subsequent stay in India to familiarize myself with the question of healing
traditions within the frame of public health policies from january to may 2005
at the French Institute of Pondichery has revealed that there are indeed many
challenges in the organization, or patterning, of the in-between of the
different systems of knowledge or between traditions and modernities.
Understanding the processes going on in these in-betweens and highlighting
what is at stake needs to be studied in order to open pathways for genuine
intercultural governance aiming at the access to health for everybody in India[9].
Legal anthropology crossing perspectives with medical anthropology, political
science and law seemed to be a fruitful approach. The stay was also very
fruitful from another point of view : it put me in touch with the locally based
International Center for Yoga Research and Education (ICYER) whose student I
became in Yoga and in Bharata Natyam, Indian classical dance.
But it is a recent participatory
observation at Beijing Sports University where I studied two internal martial
arts Taiji Quan and Bagua Zhang in june / july 2005 which started to bring the
different pieces of the puzzle together and which triggered the cristallization
of what I was looking for. So I will start with an account of this experience.
I will then from there try to disentangle a number of issues and to line out
some important issues to be explored in the field of the institutionalization
of healing traditions.
A Chinese Detour as a Trigger : Observations on the
Transformation of Traditional Arts in a Modern Setting
The following reflexions must be put into
context. It is the experience I have accumulated over the years in my own
practice of internal arts and exchanges with more advanced students or masters
which permitted me to assess what I experienced during my stay at Beijing
Sports University (BSU). During my training at BSU, I parallelly also trained
Bagua Zhang and Taiji Quan with teachers outside of the University who shared
useful insights with me. I was also lucky to be in class with a French
practitioner, Franois Hainry, who is part of the pioneers of the Chinese
internal arts in France and who helped me a lot to decode what was going on.
Indeed, I realized on the very first days that the training was wrong, at
least according to traditional standards and that the Taiji Quan and Bagua Zhang
taught there did share no more than the name and some exterior resemblance to
the traditional arts. They have become modern sports. I decided to stay on at
university and to follow the classes in order to find out through practice,
what felt wrong, what constituted this difference between the modern sports
practice and the more traditional approaches. I must emphasize here that I do
not use the term traditional in an opposition to modern, thus falling into
the trap of the encompassing of the contrary outlined above. I do not use it in
the sense of more authentic, immemorial to oppose it to modernity which
would be unauthentic, recent. In my eyes the modern sports form is also a
tradition, as is in a wider context the Western scientific or medical
tradition. If I differentiate between a modernized version and traditional
versions I solely want to emphasize the differences which can be observed on
the level of the aims and epistemology and method of the different approaches.
In my eyes traditions of knowledge, as systems of healing, martial arts,
continue to be part of that tradition as long as they keep on sharing the same
goals and adequate method to pursue these goals. Let us illustrate this on the
example of Taiji Quan[10].
Initially Taiji Quan was a martial art. As long as it is taught as a martial
art with a training aiming at transforming the practitioner into an efficient
fighter through the use of this style, by applying methods which have been
tested in the past and which may have been transformed, complemented or
improved but with the same aim and by competent people, we are indeed inside of
the tradition of Taiji Quan. At the moment the aim becomes to perform beautiful
choreographies, sportive feats, the practice becomes something else and the
methods of training also start to emphasize different aspects. It is the start
of a new tradition, of something new, which will be handed down, tradere, to
others. This is not to say that any of the two traditions is better or worse,
more or less authentic. They just do not do the same thing. And it is
problematic when the modernized forms, which may appear as neutral because
objective and rational, take on the old name and through their institutional
power start to redefine what the original practices ought to be So the
problem is not one of better or worse. The problem is that they present
themselves as being the same thing and the institutional back up they have from
the state and from modern science turns them into the standards, into the
references of what Taiji Quand or Bagua Zhang are supposed to be. It is yet
another application of the trap of the encompassing of the contrary : the
different practices are encompassed in one general category even using the
traditional designation - but then the new category is redefined implicitely
through the modern values of rationality and objectivity. Insofar as the arts
get moulded into the new modern forms they are accepted and legitimized in the
modernized forums which have a tendency to present themselves as universal,
notwithstanding the very real pluralism of existing forums which may for some
of them be completely secret to the non-informed public. What stays reluctant
is expulsed from the category and starts to become a passeist way of practice,
a traditional practice not in a positive sense but in a negative construction
in reference to enlightened modernity : a backward, irrational practice which
has no legitimacy and usefulness anymore in the contemporary world This is
not without creating major difficulties for the traditional arts On a very
concrete level one only needs to think about the situations where state
recognition is needed to be allowed to teach these arts as is for example the
case in France a field gets monopolized by modern conceptions and other
practices and epistemologies are pushed into marginality or even illegality
But let us start with the experience before deepening these questions.
From the point of view of somebody who has
an experience of the internal arts, it is quite a shock to see to what extent
the sports' version of the internal martial arts have completely destroyed the
roots of these arts. I expected them to be a lower level of the real arts,
without all the martial applications and so on, but still founded on a valid
basis. But this turned out to be wrong. The aim of internal arts is to
integrate your whole body and your mind and energy. In the sports version this
very basic principle is lost. The dynamic goes towards disintegration by focusing
the attention on the outside rather than on the inside : you are taught to
perform choreographies which scatter your mind as you have to focus on many
details to look good from outside, rather than integrating one basic principle.
Instead of feeling things from inside leading to an integration and harmony of
your external movements, the focus is on the external. The result is a
disharmonization and a loss of inner unity and energy. The forms may be
acrobatically difficult to perform and do indeed constitute a challenge from a
modern sports point of view. And it cannot be denied that they do necessitate
a lot of work and effort and that they do develop certain skills. But the
criteria have changed. The aim of the training is not anymore to shape an efficient
fighter who can use all the resources of body, energy and mind to survive. Now,
the moves must look esthetic according to standards which can be evaluated
and which come close to what has been developed in the field of modern
gymnastics. But the focus on esthetics and muscular performance alone is a
complete nonsense from the energetic point of view which is the focus of the
more traditional practice. It is
worthwhile to note that many practitioners (and very high level practitioners
including those who set the standards of what the practice should be) seem not
even to be aware anymore of the fact that they practice something different
and have probably no idea of the scope of the arts to which the names of what
they practice point.
This experience referred me back to my
research in India. The same trend can be observed there with Yoga, Indian
martial arts, healing traditions. In my interviews I had also gathered
testimonies pointing to the fact that all these arts are also getting
transformed. I must emphasize that this was even the case from people who do
themselves promote an opening up of their traditional system of knowledge to
modern settings as for example ICYER or FRLHT and who in the process got aware
of the implicit changes which suddenly started to take place. And often it was
implied that this transformation was perceived as a watering down and as loss
of their essence. As a pure anthropologist I would probably have taken these
testimonies as discourses among others which are more optimistic and defining
the emergence of a new field of health practices. And taking them seriously has
exposed me to many comments by fellow researchers who pointed to the trap I may
have fallen into of essentialism,
the myth of authenticity etc.
Now my point is the following. I do not
deny that things change and that it is interesting to study processes of
change. Bagua Zhang for instance, one of the internal traditional arts I
practiced seems to be not older than 100 years and has given rise already to
numerous schools It is itself a mixture of practices and has inspired new
evolutions (see for example Wong 1998). Tradition if it is what is handed
down is obviously also something which is changing and taking on new forms. The
question is to what point can we speak of the continuity of a tradition and
when do we face its transformation into something else ? And this
transformation can also be a transformation in terms of destruction of
knowledge. Imagine that for some reason modern scientists and engineers would
be integrated in some imaginary system of knowledge not having the same
scientific premises and not understanding them. The focus to continue the
tradition would maybe become the stress on wearing white uniforms and
performing daily rituals where you have to sit in front of computers for some
hours pushing buttons. New rituals of exchange of experience may emerge and
after some time, once the first generation is dead, and maybe after a second
generation who at least still had some idea about what the scientific
tradition was about, nobody manages any more to make an airplane fly. Is this
just a transformation of a given tradition ? Has the anthropologist done his
work by just describing how one tradition turned into this new one ? Or could
part of his research not also be to try to understand what is happening on the
qualitative level ? On how processes of change may have affected the knowledge
system as such, maybe destroying it ? And in the contemporary world is one of
the challenges not to try to seek out the conditions for a meeting in between
traditions where what is valuable in each of them is not lost, but recognized
and then maybe enriched in the dialogue ?
My example above of a tradition of
scientists and engineers not being able anymore to make a plane fly may seem
nave or exaggerated. But it seems to me that it is not if we accept to look
at things not from the point of view of the predominant modern system of
understanding but if we accept to assess things from traditional points of
views. Both perspectives are at the same time objective and subjective. Social
sciences may be the victims of an idealistic fallacy : our world appears as
just being discourses, texts, fields of intersubjectivity. But we are also
real people connected to an objective world, even if the connection is through
our subjectivity. The plane really flies And modern scientific tradition,
although being a historically rooted and thus also a subjective perspective on
the world makes it fly. In the same way the different systems of healing
although representing different subjectivities are also rooted in objective
realities[11].
I think that in the contemporary world
many traditional arts try to find an in-between mode of existing between
pure tradition and modernity . To explore this
challenge is what I am concerned with, keeping in mind that many arts have
never been taught in the official circuits and will probably remain in the
parallel and even secret ones.
Return
to India : Intercultural Challenges in the Field of the Institutionalization of
Indian Systems of Healing
As I
have mentioned in the introduction the aim of this article is to sketch a few
challenges and to be a provocation for further thinking and research. I will
thus remain here at a very general level just pointing to a number of issues
which started to appear as paramount to me in my preliminary research I have
carried out until now on the institutionalization processes of Indian systems
of medicine (ISM) and which will have to be substantiated by further research,
and a fieldwork sensitive to the constraints and requirements of
interculturality. I will not go here into a detailed description of legal
developments in the field of ISM[12].
I will highlight a few different faces of institutionalization and unveil the
underlying intercultural challenges : education, professionalization,
commodification, research, intellectual property rights, participation in the
public health sector and indirect effects of law on healing traditions. The
list may not be exhaustive. To some it may seem a bit too heterogenous. The aim
is to illustrate the importance to take the issues of the institutionalization
of Indian systems of medicine very seriously if we are concerned in a genuinely
dialogical approach between the different systems of knowledge involved. The
underlying questions may be summed up into two : 1) how was the development,
transmission, evaluation of standards organized in ISM by those who knew, and
how were they inscribed in their wider social context, how was their legitimacy
or authority constructed there ? 2) What is happening in the modern context
where the master / disciple relationship (guru shishya paramparai)
characteristic of most ISM is replaced by modern education and where local
construction of authority and legitimacy is superseded by legitimation through
the state or modern science ?
1.
Education
According
to Darshan Shankar and to Ram Manohar, (1995 : 102) () while there has been
quantitative development in terms of the number of Ayurvedic institutions in
the post-Independence period, the quality of Ayurvedic medical practice has
deteriorated. Although it is present, political patronage of Ayurveda is poorly
informed about the difference in the epistemological foundations of Ayurveda,
and does not therefore understand the requirements for its proper growth and
flowering.
It is
interesting to note that there has been a long history of the
institutionalization of Indian systems of medicine in India. It is nevertheless
not innocent to note that it was preceded by the establishment of Western
medical colleges the first of which were established in the first half of the
19th century[13].
And the first non-allopathic teaching institution was a homeopathic school
that was opened in the end of the 19th century and not a school
teaching ISM. The first Ayurvedic college was only opened at Calcutta in 1916
followed by colleges of Unani. And it is in 1920 that the Indian National
Congress passed its first resolution giving poltical support to ISM for the
first time in 200 years (see Mukhopadhyay 1992 : 142). It should be noted that
this modern institutionalization of ISM was preceded by the
professionalization of ayurvedic practice and the commercialization of
ayurvedic drugs on the lines of the Western model which had already had
happened by 1900 (Kumar 1998 : 70).
It must also be underlined that it was largely influenced by a political
move towards nationalism[14]
which is not the recognition of local cultures but an intrinsic modern
phenomenon, often triggered by a feeling of self-defence against a perceived,
today often Western, steamroller (see Nandy 2000 ; Nandy et al. 1997; Sharma
2003). It seemed important to sustain national culture, but this necessitated
to turn the Indian systems of knowledge in an acceptable modern form. Anil
Kumars reflexions are enlightening (1998 : 71). For the redressal of
grievances and the restoration of offended pride, the indigenous practitioners
had to turn their gaze from the imperialists to the nationalists by the close
of the nineteenth century. On the nationalist agenda too, the indigenous
medical men had to face discrimination. Being basically a party of the urban
elite in the beginning, the Indian National Congress first raised its voice in
favour of the Indian practitioners of Western medicine. () Revival,
preservation and reinvigoration of the traditional medical systems became the
cultural symbols of the nationalist struggle only after the Swadeshi movement
picked up the peoples fancy and got turned into the most potent anticolonial
weapon. () They, however, had to make compromises and accept their systems
backwardness and stagnation in the sphere of medical research. They compromised
in the preparation of curriculum which contained surgery, anatomy, chemistry,
midwifery, etc. on the model of Western medicine.[15]
This
predicament does not seem to have changed very much until today and the
teaching of ISM continues to be determined by the modern frame[16].
A major change is nevertheless that since the seventies practitioners
of ISM must attend academic training and get university degrees[17].
The traditional channels of teaching in the guru / shishya paramparai do
not have recognition anymore. The recognition of the systems by the state has
thus lead to the monopolization of the field by the state taking away the
legitimacy and authority of those practitioners who are out of the system who
have become illegal. In my interviews I found it interesting to also realize
that it seems that nowadays many formal students of ayurveda also seek
complementary training from traditional vaidyas.
This seems to be the case as much to further ones knowledge, to get really
prepared for ones job, as also in order to gain a traditional legitimacy
through the inscription in a traditional lineage. Unnikrishnan Payyappallimana
from FRLHT pointed out to me that today it is the double legitimacy which seems
to be the emerging requirement of the patients, even in the countryside[18].
The vaidyas themselves seem to face questions of identity as how to position
themselves in-between the modern medical system and ayurveda. It is clear that
learning the content of ayurveda in a completely different container, has deep
impact on the whole method and view of medicine itself (see Mihaela Painas work).
For
V. Sujatha (2005 : 159), Modernization of indigenous medicine in the sense of
adaptation to changing need is desirable. Expansion of the social base of the
knowledge of Ayurveda and creating links with local health traditions could
help in laying a strong foundation for improving the health conditions of the
people. But this will be problematic in the current situation where Ayurveda
and Siddha are taught in colleges and universities in metropolitan cities.
Certain unique features of indigenous medicine that are incompatible with
classroom teaching have to be gradually excluded from the curriculum. Most
modern ayurvedic doctors may be reluctant to restore the folk moorings because
they do not acknowledge it. With the influx of company made drugs, it is
convenient to teach and practice Ayurveda and Siddha only as a therapy. The
selective accentuation of the therapeutic aspects to the exclusion of the
social features has hijacked Ayurveda for the market, leaving it to be purchased
by the highest bidder.
2.
Professionalization and commodification
As we
have hinted above, the process of the professionalization of ISM and the
commodification of its services dates back over a century. I cannot address all
aspects here. Let me just point to two issues here.
The
first is the questions of the transformation of ISM through the commodification
of its medicines. Ayurveda for instance has become a big business and its
expansion is on the rise. This process has a deep going influence on its
perception and self-perception. As Martin Bode (2004 : 127) notes, Large
producers of Indian indigenous pharmaceuticals shape Indian medical systems
such as Ayurveda and Unani tibb. Their use of modern product forms such as
capsules, pills and syrups as well as sophisticated production and packing
technology have changed the outlook of Indian bioceuticals. () By updating
their products the three companies () have changed the archaic image of
Ayurveda and Unani tibb away from the domain of the vaidyas and hakims dealing
in outdated ideas and products.
They have made these traditional systems contemporary. Hence for many Indians
indigenous medicines are no longer substances prepared and prescribed by traditional
healers but modern over-the-counter products used for self medication. It is
clear that this shift in perception also entails a deep going shift in the
methodology itself of ISM. Their original perception of health and healing gets
replaced by the modern view of treatment of symptoms by specialized drugs. ISM
get reduced to the role of provider of drugs (see the forthcoming reflexions on
drug testing below). And in the process their legitimacy starts to be redefined
according to the modern view of health and healing. Increasingly it even seems that
it is the modernization of the traditional knowledge which makes it legitimate
the traditional authorities like traditional vaidyas or hakims become
outdated This process of reorientation also leads to substantial shifts in
the fields ISM are dealing with which may uproot the possibility of ISM as
foundations which can help to address public health issues which reaches out to
Indias countrysides. Indeed Increasingly the consumption of Indian medicines
has become an urban middle class phenomenon. Consequently the importance of
Indian medicines for diseases such as cholera, elephantiasis and goiter
health hazards that mainly affect the poor has diminished. Nowadays, the
industry projects its products as safe and effective remedies for both chronic
and common ailments. The rise of chronic diseases among the Indian middle
classes as well as the popularity of preventive health products among these
groups has created a favourable epidemiological context for Indian indigenous
pharmaceuticals. Because many of these new consumers have a modern education
the producers of Indian pharmaceuticals cannot only refer to traditional
medical authorities for the marketing of their products. Therefore to
legitimize their products, the industry has added science to culture (Bode
2004 127-128). If it appears clearly that in the process ISM get hybridized
with modern outlooks it seems also clear that this hybridization is happening
in the modern terms and that the reference to them is rather in terms of a
folklore intended to underline the traditional and divine aspects of
these medicines, than in terms of a serious dialogue.
The
second issue is the professionalization of practitioners of ISM. This issue has
multiple facets. The most well documented is the fact that people if they
manage to enter university for a degree in ISM - who move to a city in order to
study there for a few years, usually do not want to return into rural areas.
Also they want to reap the gains of their investment and open a professional
clinic with which they can make money but this means that little by little
local medical care disappears. And the underlying issue is that the whole
thinking gets colonized by the professionalized, money oriented world view.
Darshan Shankar pointed out this problem in an interview about the
revitalization of local folk healers[19].
There are indeed NGOs who revitalize certain local folk healing dynamics by
opening centers where these healers get hired, get professionalized. This may
seem a good idea. The problem is that it is dependant on the input of external
resources. As soon as the money pipe gets closed, the activity also dies as it
is not self sustainable it is not sustained by the local communities. And
there is chances that the folk healers who got used to professional practice
will, if they are good enough, try to continue to tread along that path. In a
reflexion on a policy of health for all, it thus is primordial to decolonize
our minds of statist, scientist or marketist preconceptions. If new forms may
be needed, as for instance maybe the creation of an association of folk healers
which could promote exchange among them, recreation of a visibility and
reconstruction of a certain self confidence, it must be very carefully
investigated how to address the situations of in-between in order not to
eradicate, sometimes with the best intentions, one of the partners of the
encounter. In the field of folk healers it should also be noted that they do
not all have homogeneous training their areas and degrees of expertise vary
widely. The acceptance of this pluralism is also important : everybody must not
be qualified for everything in order to be able to specifically address certain
issues. The requirement of general diploma may be a safeguard for quality in a
modernized context. But it may turn counterproductive if this leads to exclude
from practice many skilled practitioners who are eagerly needed in order to
evolve effective and people centred health care. Especially if this is the case
in contexts where local social control is in fact by far more efficient than
what a state diploma could guarantee[20].
Modern logics which underly the state, the market, science, law, have an
underlying tendency to universalization and uniformization. The big challenge
consists in recognizing that their constructs are not universal, that it is
even counterproductive to try to mould existing pluralism in their terms, and
to explore the modalities of the recognition of this pluralism in the
contemporary settings.
3.
Research and Drug Testing
ISM
are widely constructed as traditional in confrontation to the modern
system. Modernity is equated to progress, change, critical evaluation,
furthering of knowledge. Whereas the traditional systems could only be the passing
down of reified knowledge. Nothing is further from the truth (seef or example
Obeysekere 1993). Ayurveda for instance, although its origins can be traced
back to a few millennia has kept on evolving, even though its development knew
serious drawbacks with colonization. Nowadays research has taken on an
interesting turn. Since around five years there is increased funding by the
state to scientifically test drugs of ISM[21].
The interest for the drug industry seems clear. As for the traditional
practitioners there is also the very important stake of recognition. ISM need
the scientific stamp in order to be recognized, to be able to stand
legitimately and to get rid of their inferiority complex and the always lurking
suspicion of quak medicine. The problem is that the procedure forces a frame on
the ISM which is not their frame. Drug testing is profoundly rooted in the
Western scientific and medical paradigm. The latter is based on Aristotelian
logic, concepts of physics and chemistry, an atomistic theory of the world, an
explanation of biological phenomena on the basis of anatomy and physiology and
of drug action on the basis of biochemistry and pharmacology. Antigen and
antibody are key concepts and the focus is on curative health. Measurment and
quantification are standardized and of primary importance. ISM are based on
nyaya, vaisesika, sankhya, yoga, mimamsa and Vedanta schools. They are
underlied by the pancha mahabhuta theory. The biological phenomena are
explained on the basis of dosha, dhatun malu, siddhanta and drug action on the
basis of rasa, guna, virya, vipaka, siddhanta. The key concepts are agni and
aama. Not only curative health but also prevention and health promotion are
emphasized. Measurement and quantification are individualized and of secondary
importance (see Mukhopadhyay 1997 : 70). So what happens in drugtesting ? A
whole epistemology gets ignored and ISM get only recognized insofar as they can
be fit into the modern epistemology.
It
thus seems much more adequate to operate in terms of process testing[22]
than mere product testing. This means for instance that instead of asking
ayurveda which of your drugs cures malaria and then to test the drug which
may be provided, one may ask a vaidya to make his own diagnosis of what has
been diagnosed in the Western system as malaria, and to apply his own
treatment. The whole process can be tested to see if it effective or not. Here
we would be in a more dialogical and interculturally sensitive approach, which
nevertheless takes into account hard facts : the evolution of the person who
is being treated. This kind of approach does not seem to be very widespread
yet. It also requires, if one
wants to go further, to work out how to compare different systems of healing
and how to move from the mere juxtaposition of traditions to a real dialogue
(see Payyappallimana
2002).
The
issue of drug testing is also closely related to the question of the protection
of intellectual property rights (IPR). The latter are also inscribed in the
modern world view and fit the more atomistic modern medical approach where
active agents are sought to be identified and where the author of the
invention is traceable. But they do not fit the epistemology and the
transmission / innovation processes as they can be found in ISM. If it has
become vital to create databases containing the knowledge of ISM in order to
protect it from undue exploitation and in order to prevent intellectual
property rights to be mainly used in the field of ISM as intellectual piracy
rights by pharmaceutical companies (see Shiva 2001) it is nevertheless
important to be aware of the implicit transformations of the knowledge which
occur through its codification. And on the mid and long term it seems important
to work out alternative models to the existing IPR system which are better
related to traditional systems
of knowledge.
Conclusion
: Towards an Exploration of the In-Betweens
In
his introduction to a collective book on Ayurveda at the crossroads of care
and cure A. Salema (2002 : 15-16) noted that Aware of the
potential power of such crossroads, as well as of the potential fragility of
their diversions, the focus of the hour seems to be the creation of some sort
of an interface where ethnomedicines and bio-medicine can have a meaningful encounter,
with an efficient outcome for the understanding of local and global health.
Such encounter unfolds at different levels : clinical practices, technologies
and validation parameters. Then, as a conceptual approach of contemporary
experimental events, this meeting still missed finding out that methodological
interface between knowledge, practices and experiences. It could possibly be
overcome by some sort of field work as the conditions for a new
intelligibility presupposes a new operative mode in order to assign its place
in the wide landscape of contemporary knowledge, that cannot be anymore a
European or Western one. The new understanding is still awaiting to come of
age.
This
new understanding must also take into consideration the normative effects of
the organization and/or institutionalization of ISM. As pointed out above the
main challenge seems to be to open up the modern uniformizing logics inherent
to law, the state, the market and science to the inherent pluralism of healing.
But in order to be able to establish criteria for a pluralist modus vivendi it
is paramount to leave the postmodern universe of mere intersubjectivity. If the
different partners to the dialogue must first of all be recognized and their
worldvisions, epistemologies and methods taken into account, it is important to
be aware that all systems have their more or less capable representatives and
also their quacks. So it seems important to relate the different systems and
their interplay to the concrete effects they produce. And this entails from the
researchers point of view that he must educate himself to a certain degree in
this different fields of knowledge if he wants to be able to play the role of a
bridge between systems or traditions. It is not essentialism to take into
account effectiveness of diverse traditions as a tool to assess their change :
it is only by taking the practical effects seriously that an assessment can be
made on the formalization of new syncretisms which could be a boon for some
traditions, but which could also turn out to be their death sentence.
As far as I am concerned, I have now
identified two institutions who locate themselves consciously in these dynamics
between tradition and modernity and which have accepted that we work
together to highlight the issues of intercultural dialogue from their
experiences: ICYER, the International Center for Yoga Research and Education
based in Pondichery and FRLHT, the Foundation for the Revitalization of Local
Health Traditions based in Bangalore[23]. I will try to deepen the questions
sketched out above in the next years focusing on the question of the
institutionalization of healing traditions as a challenge for intercultural
governance by exploring the positioning of these institutions in their wider context,
their strategies and the issues they encounter. This research could then be
deepened by reaching out on the one hand to traditional practitioners who do
not explicitely locate themselves in this in-between but who also have to adapt
to the new environment and on the other side to the modern institutional
environment which is increasingly starting to deal with ISM. This article is just a first step of
this research. I hope it may already stimulate some fellow researchers in their
present investigations.
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Researcher and
invited Professor at Facults Universitaires Saint Louis and European Academy
of Legal Theory Brussels. Associate researcher of the French institute of
Pondichery and of the Foundation for the revitalization of Local Healing
Traditions, Bangalore.
[1] For an
introduction to legal anthropology see for example Alliot 2003 ; Le Roy 1999 ; Rouland 1995.
[2] I understand by
tradition the dynamic transmission and development of a system of knowledge
and of its related practices and methods. From that point of view Modern
allopathic medicine is a tradition as much as Ayurveda, Siddha or Unani. I do
thus not refer to tradition as opposed to modernity in a broader sense,
modernity is also a tradition.
[3] See in this
context the reflexions that Robert Vachon develops in three issues of the
journal Interculture which are dedicated to a dialogue between Mohawk
Nations and the North American states : n 127 Towards a New Language,
n 128 A Common Horizon and n 129 A New Method. Also see Panikkar 1978
& 1984.
[4] See for example
Alliot 2003, Eberhard 2001 & 2006, Le Roy 1999, Rouland 1988.
[5] The usage of
alternative underlines the dominance of the modern system :
all other systems are not seen in themselves but as alternatives to the
dominant one. See in this context Eberhard 2002b.
[6] This distinction
has been brought to me by Olivier Schmitz an anthropologist who is researcher
at the Facults Universitaires Saint Louis in Brussels and who addresses this
question in his teachings in anthropology.
[7] The first
research project that we worked out together Protection and
Revitalization of Local Health Traditions and Biodiversity - An Intercultural
Challenge can be consulted on http://www.dhdi.org
at http://www.dhdi.free.fr/recherches/environnement/articles/eberfrlhtproject.htm
[8] And many of the
internal martial arts are nowadays widely practiced only as health practices
devoid of their martial meaning. The link between martial arts and healing arts
and the existence of internal aspects of the arts linked to the control of body
energies are not a Chinese specificity. For an Indian example see for example
Zarrillis presentation of Kalarippayattu (2000).
[9] My one week stay at FRLHT during that period also proved very
useful to crystallize my interrogations.
[10] I use this
example because of its convenience and because I have personal experience of
it. Nevertheless Qi Gong as taught at BSU reveals the same processes of change
towards gymnastics, as Franois Hainry who also followed the Qi Gong classes
there confirmed to me.
[11] See in this
context Obeyesekere 1993.
[12] To get a an
overview see Alok 1998 : 22 ss ; Annoussamy 2001 and especially
Wujastyk 2005).
[13] And to complete
the picture it should not be forgotten that Western medicine only started to
take predominance in a second phase of its historical encounter with
non-Western medicines in the colonies. In a first phase the relationships seem
to have been quite egalitarian (see Harrison 2001).
[14] This aspect
continues to make discussions difficult even nowadays as often knowledge rooted
in traditional Indian systems is termed Hindu and bears
undertones of Hindutva, Hindu nationalism. It is probably not possible to
unlink the question of ISM from its political instrumentalizations. The
researcher must be aware of this politization but this should also make him
very careful not to fall himself in ideological traps while carrying out his
research. See on this question also Eberhard 2005b.
[15] It is
interesting to contrast the Indian situation with the Chinese situation in the
field of the institutionalization / invention / reinterpretation of Qi Gong in
relationship to nationalist stakes (see Palmer 2005).
[16] In that context it is interesting to notice that until now
only students of ISM were obliged to also learn modern medicine. It is only in
2004 that it has been decided also to include ISM in the modern medicine
curriculum in India.
[17] The Central
Council of Indian Medicine (CCIM) was established in 1971 by an act of parliament
in order to bring uniformity and maintain standards of education in Ayurveda.
In due course the Ayurvedic qualifications were regulated (see Shankar &
Manohar 1995 : 101). To
practice medicine one now needed to have a diploma from a University recognized
by the state. To assure the transition those practitioners proving five years
of medical practice anterior to the promulgation of the law could also get
registered without further requirements (see Annoussamy 2001).
[18] Interview at
FRLHT, Bangalore, on 7th march 2003.
[19] Interview at
FRLHT, Bangalore, 4th march 2005 & interview on 5th march 2005 with Darshan
Shankar & Unnikrishnan Payyappallimana. See also Sujatha 2005.
[20] As V. Sujatha (2005 : 158) notes Quakery is also likely to
increase due to the anonymity of the city. In the community, the folk
practitioner accountable to the villagers, most of whom know him personally. A
quack cannot manage in the village for long because people would pull him/her
up if the medicines continuously produce deletorous effects.
[21] Interview with
Dr. Adithan, Director of the Department of Pharmacology of JIPMER, Pondichery,
22nd february 2005.
[22] Interview with
Darshan Shankar at FRLHT, Bangalore, 4th march 2005.
[23] Itcan be noted
that FRLHT is participating in the creation of databases on Indian medicinal
plants and ICYER is contributing its expertise to the Indian Traditional
Knowledge Digital Library (TKDL) to protect Indias Yoga heritage from being
copyrighted or patented by unscrupulous elements around the world. (Yoga
Life, Vol. 37, n 2, February 2006, p 26).