combining stories: reading tibetan medicine as a western narrative of healing
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Devin GonierProfessor Ivette Vargas-OBryanDepartment of Religious StudiesFinal ReportMellon Project 2008-09
Combining stories: Reading Tibetan Medicine as a WesternNarrative of Healing
This project was funded by the Carnegie Mellon Grantfrom Austin College in 2008-09 under the supervision offaculty-advisor Ivette Vargas-OBryan from theDepartment of Religious Studies. My faculty advisor wasof critical help throughout the entire process, and tookgreat care in mentoring me in the projects research andwriting. The research for this paper took place over thecourse of a year in India (Dharmasala, Darjeeling,Ladakh), Kathmandu, Nepal and Boulder, Colorado. Itinvolved interviewing ten Tibetan medicine doctorsthroughout the regions and two religious experts, as wellas conducting library research in the U.S. The followingreport will describe what I learned throughout the termsof the grant about U.S. healthcare and Tibetan medicine.
The real narrative of dying now is that you die inside a machine1 Broyard
We are thus not at the end but at the beginning of the beginning, andeven with the best of tools, our task of negotiating the new healthcare
may be much more complex and multifaceted than initially realized.
2
Michael Cohen
It would be very useful for humanity if Tibetan and Western medicinewere practiced on a parallel basis. 3 The Dalai Lama
Introduction
Healing as we know and understand it today has both a historical
and cultural context. It has evolved and events will continue to change
it in the future. There will be technological advancements that improve
1 David B Morris, Illness and Culture in the Postmodern Age. California:University of California Press, 1998. pg. 442 Michael Cohen, Healing at the Borderland Between Medicine andReligion. North Carolina: UNC Press, 2006. pg. 161 (last sentence)3 H.H. Dalai Lama. The Knowledge of Healing. Dir. Franz Reichle. Perf.14th Dalai Lama, Dr. Tenzing Choedrak,. First Run Features, 2005.
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our ability to treat future and current illnesses, but beyond this, the
discourse on health and the philosophical assumptions inherent within
the Western health model will adapt and evolve too. When many
Westerners think of the verb heal they carry with it the cultural
baggage that shape the way we understand healing, baggage like the
view that disease is something objective and that it can be cured
through objective processes. But, one must tread carefully in this
thinking, since different cultural and historical contexts change how a
person thinks of his or her body and what it means to heal. It is much
easier to see the effect cultural and social contexts have on medicine
by looking closely at the diversity of medicines throughout the world.
Different socio-cultural situations influenced or not by religion have
directed medicine and health in unique ways. Different types of
medicine have a long history of intersection and these intersections
continue to grow today. The focus of this paper will be specifically on
the intersection of biomedicine and Tibetan medicine, and it will argue
that current U.S. healthcare discourse creates barriers for religious
healing systems like Tibetan medicine. Unless cultural and institutional
changes are made, it will continue to be difficult for Tibetan medicine
and other healing systems similar to it to have a legally and culturally
accepted role in U.S. healing.
Thesis and Structure
This final report reflects upon findings that the U.S. healthcare
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discourse and treatment process are predominately influenced by
scientific materialism and the hegemonic status of biomedicine in
healing. The U.S. healthcare discourse creates great difficulties for
alternative, complementary, and integrative models of healing, which
cannot be entirely reduced to a biomedical scientific model, to become
popular or legally acceptable in the U.S. This paper will draw heavily on
the views of postmodern medicine, because of its basic advocacy for
empowering marginalized voices in the pursuit of a more
heterogeneous healthcare system. The focus will be on the particular
relationship between Tibetan medicine and biomedicine in the U.S.,
and how this relationship can be improved based on the principles of
postmodern medicine. There are two supporting arguments. First,
postmodern medicine reconceptualizes the relationship between
religion and healing by disrupting the hegemonic biopolitical status of
secular healing in the U.S. In other words, postmodern medicine
creates space for religious healing in a system dominated by secular
healing. Second, the principles of postmodern medicine suggest a
heterogeneous globalization model, which resists what medical
anthropologist Vincanne Adams4 calls erasure.
4 Vincanne Adams is a noted scholar of Tibetan medicine. She is amedical anthropologist teaching at UCSF school of medicine. Hernotion of erasure comes from a work titled Integration or Erasure:Tibetan Medicine in the Contemporary World that explores twopossible ways for different medical systems to integrate. She explainsthe difference on page 110, Integration in its best possible senseresults in the sharing and exchange of knowledge and practices, asopposed to its opposite: the substitutions and erasure of one for the
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The first section of this paper outlines some crucial concepts
about Tibetan medicine and also explains the status of complementary
and alternative medicine (CAM)5 in the U.S. The second section defines
the tenets of reconstructive postmodern medicine, and examines how
Tibetan medicine fits within the paradigm of postmodern medicine. The
third section outlines the deconstructive elements of postmodern
medicine, which critique biomedicines hegemonic status within the
U.S. After this description of postmodern medicine and its relationship
to biomedicine and Tibetan medicine, the paper will analyze how
religion and medicine intersect in the U.S. mainstream health care
system, and will suggest moving away from a system where secular
healing is hegemonic. Finally, it examines the concept of globalization,
and utilizing much of Vincanne Adams work, analyzes the biopolitical
role of the NCCAM6 and suggests a more heterogeneous model for
sake of incorporating the other.Vincanne Adams, and F. F. Li. "Integration or Erasure: Modernization atthe Mentsikhang." Tibetan Medicine in the Contemporary World GlobalPolitics of Medical Knowledge and Practice (Needham ResearchInstitute). New York: Routledge, 2008:1105 Often times the terms alternative medicine, complementarymedicine, and integrative medicine get confused. Alternative Medicinerefers to treatments that are used instead ofconventional medicine.Complementary Medicine refers to treatments that are used inconjunction with conventional medicine. Integrative medicine refers tothe process of taking two systems and attempting to bring theirphilosophical and procedural qualities together in one combined formof medicine. The section providing an overview of insuranceregulations and the National Center for Complementary andAlternative Medicine (NCCAM) will refer to both Complementary andAlternative Medicine, as understood by the NCCAM.6 National Center for Complementary and Alternative Medicine
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thinking about healing in the U.S. as a result of the application of
postmodernism. Based on some of the principles of postmodern
medicine, the paper concludes by suggesting that our healthcare
system should be more open to other forms of healing which cannot be
easily integrated into the biomedical secular model of thinking. Before
getting into background information about the U.S and alternative
medicine, Tibetan medicine will be summarized and its most basic
features explained in a way that makes its relevance clear.
Introducing Tibetan Medicine
The Basics
It is difficult to pinpoint the exact beginnings of Tibetan medicine
(called Gso ba Rig pa in Tibetan), especially since many believe it to
have a religious beginning originating from the Medicine Buddha
himself. The primary text of Tibetan medicine is the rbgyud-bzhi,
because it is the first text to outline all the essential features for
practicing Tibetan medicine. This text is still used today and it is
currently in the process of being translated to English at the Men Tsee
Khang in Dharamsala. One way of pinpointing a beginning for Tibetan
medicine would be to focus on the creation of this text, since it
represents the first synthesis of the main ideas and principles of
Tibetan medicine. Scholars who focus on the rbgyud-bzhi, like
Thakchoe Drugtso, put its beginning around 1126-1202 A.D. when
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Youthog Yonten Gonpo and his son are thought to have authored or
consolidated the rbgyud-bzhi.7
Structure of the Body:
Theoretically the body is viewed as a collection of three humors
(nyes-pa): Wind (rLung). Bile (Khris pa), and Phlegm (Bad-kan). When
these elements are in harmony, a person is considered to be healthy,
and when they are not in harmony a person has an illness of some
sort. These humors are further subdivided into 15 categories that are
much more specifically aimed at certain functions within the body.8
Thus, Tibetan medicine sees the body as a balanced system, where
different parts are interconnected and dependent upon the rest of the
whole in order to be functionally healthy.
Diagnostic technique
Typically a Tibetan medicine doctor or amchi uses three main
diagnostic techniques. Almost every visit will include an interview with
questions about diet, lifestyle, and symptoms, and a pulse reading. The
specific technique used for pulse reading is completely unique to
Tibetan medicine, although similar approaches are used in Chinese
medicine. Dr. Tenzin Choedrak, a senior personal physician for the
Dalai Lama notes that,
The movement of the wind is comparable towhat drives the waves of the ocean. Whenever
7 Thakchoe Drungtso, Tibetan Medicine: The Healing Science of Tibet.Men Tsee Khang, Dharamsala: Drungtso, 2004: 238 Ibid. pg 108
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a wave arrives, it makes a human beingadvance. When it recedes it pushes him furtherback. Once the wave is at its crest, it breaks. Inthe human body this wave can be felt in thepulseWind is responsible for all that moves in
the body.9
When pulse reading is explained in this way it often makes it easier for
western practitioners to bracket it off as religious practice. A person
could think of pulse reading as a religious or transcendental
investigation into the deeper energies of the body, but there is also a
scientific side to it that has strict guidelines and can take many years
to be fully grasped. The final diagnostic technique is urine analysis,
which is typically studied under very specific conditions (and is thus
less common with very minor illnesses) in order to better understand
the balance of humors within the body.
Treatment
Treatment usually consists of moxibustion (a type of treatment
using heated needles), cupping (a procedure where a vacuumed cup is
placed on the body to influence bodily channels), diet changes, Tibetan
herbal medication, or a change in lifestyle. Interviews are usually very
crucial in assigning the proper treatment. Tibetan medicine usually
involves non-synthesized combinations of herbs (sometimes up to
sixty) that are to be taken at low dosages frequently throughout a
period of time. Since the dosage is low and non-synthesized it can
9 Dr. Tenzing Choedrak. The Knowledge of Healing. Dir. Franz Reichle.Perf. 14th Dalai Lama, Dr. Tenzing Choedrak. First Run Features, 2005.
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typically be used with other Western drugs. Alfred Hassig, an M.D. in
Immunology, explains
Such a plant mixture can be extremely beneficial,
because the individual plants react reciprocally togreater effect. Since the single components are onlypresent in small quantities any side effects they mayhave are diminished in such a way that these plantcompounds are very effective and well tolerated.Thats the problem with pharmaceutical substances:being chemically determined uniform substances,they exert a specific influence in the body and, in sodoing, often effects and side effects interfere.10
If properly diagnosed there is little to no risk involved in Tibetan
medicine. This is a huge reason why Tibetan medicine is popular. The
only disadvantage is that Tibetan medicine works slowly, whereas
biomedicine works quickly. Obviously, Tibetan medicine is not best for
every illness, but it can be an effective solution to many common
illnesses without being potentially harmful by having many unwanted
side effects.
Tibetan Medicine and its Effectiveness
When Tibetan medicine began to be introduced to Western
doctors (samples were given of its medicine for certain treatments)
there was a great deal of skepticism.11 One of Tibetan medicines
earliest introductions to the west came as a result of Karl Lutzs
10 Alfred Hassig. The Knowledge of Healing. Dir. Franz Reichle. Perf.14th Dalai Lama, Dr. Tenzing Choedrak. First Run Features, 2005.11 Karl Lutz. The Knowledge of Healing. Dir. Franz Reichle. Perf. 14thDalai Lama, Dr. Tenzing Choedrak. First Run Features, 2005.
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pharmaceutical company Padma AG in Europe in 1970, which began
manufacturing Padma 28 based on a recipe introduced by a
Mongolian amchi-family Badmajew.12 Eventually many of the doctors
that used the medicine were surprised by the effectiveness of the
treatment Padma 2813. In the documentary The Knowledge of Healing,
Dr. Isaac Ginsburg, a researcher in Microbiology and Bacteriology in
Jerusalem, outlines two major western illnesses that Tibetan medicine
has shown impressive success in treating.
Heart Attacks
First, as is widely known, coronary heart disease is the single
leading cause of death in America causing heart attack and
angina.14 Much of this can be linked to bad diet and poor exercise.
Cholesterol and many other substances create blockages within
important arteries that prevent blood flow.15 The Tibetan medicine
Padma 28 has shown great success in treating this problem. In the
documentary, The Knowledge of Healing, one patient is questioned
12 R. G. Landgraaf, "AMFI-TIBETAN MEDICINE RESOURCE GUIDE." Alternative Medicine Foundation, Inc., Bethesda, MD - Welcome. 6 Apr . 2009. New Resource Guide. 03 May 2009 .13 Padma 28 is a medicine that can be taken once a month to improve
health in general. It is based on an ancient Tibetan formula calledGabur. It is not available in the U.S., but can be found in Europe.14 National Health and Nutrition Examination Survey (NHANES, 200506). "Heart Attacks and Angina Statistics." American Heart Association.2005-06. American Heart Association. 03 May 2009.15 Isaac Ginsburg, The Knowledge of Healing. Dir. Franz Reichle. Perf.14th Dalai Lama, Dr. Tenzing Choedrak,. First Run Features, 2005.
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about his experience with Tibetan medicine. He explains that Tibetan
medicine saved his life. Severe blockage had been building up, and
surgery was unlikely to help solve the problem. Doctors had predicted
he would die within five months. But after taking Padma 28 and some
other herbal medications recommended, he was able to overcome his
problem. This patient argued that, Sixty to eighty percent of all heart
operations wouldnt need to be performed, if people used the same
treatment as I did! And although every professor and doctor had given
up on me, its been over ten years that Ive managed to save
myself.16
Cancer
Second, Isaac Ginsburg explains that when a person has cancer a
tumor caused by malignant cells develop. If the tumor does not spread
the cancer can be cured by removing it through surgery. But, if the
tumor is broken into smaller pieces it can travel and spread throughout
the body. Blood cells are capable of destroying 99.9% of small bits of
tumor that travel through the blood, but if the remaining .1% manage
to create another tumor in a vital area a person is likely to die.17
Ginsburg explains that cancer patients are dying because of the
spread of cells, and that
we can already prove that in the presence of the
16 The Knowledge of Healing. Dir. Franz Reichle. Perf. 14th Dalai Lama,Dr. Tenzing Choedrak,. First Run Features, 2005.17 Isaac Ginsburg, The Knowledge of Healing. Dir. Franz Reichle. Perf.14th Dalai Lama, Dr. Tenzing Choedrak,. First Run Features, 2005.
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Tibetan drug, that the tumor cells are not able totake a large molecule from the vessel wall and breakthem into small pieces. So we hope that in thiscollection of materials in the Tibetan drug we canfind the component which is good for inhibiting
tumor cells growth and invasion.18
Research being done right now with Tibetan medicine could
prove crucial in discovering the cure for cancer.
There are many other areas that credit Tibetan medicine
as being successful, such as treatment of chronic kidney
problems. Currently the Men Tsee Khang in Dharmsala is working
with Western doctors on a number of illnesses in order to try and
create better cures to diseases that have been extremely
problematic for biomedicine. Tibetan medicines potential is only
barely being realized, and if it receives the recognition it
deserves (a commonly cited problem by many of the doctors I
interviewed at the Men Tsee Khang) the potential for its benefit
could be very great indeed. Furthermore, in comparison to other
pharmaceutical drugs, and the diagnostic procedures of western
medicine, Tibetan medicine is significantly cheaper and has little
to no side effects. Thus, when one takes cost into account (which
is a very significant factor for many people), and when one
considers the great deal of suffering that occurs from painful and
often dangerous treatments performed by western doctors, the
benefit and effectiveness of Tibetan medicine could prove
18 Ibid.
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extremely great.
Tibetan Medicine and its Religious Influences
There are a few important features of Tibetan medicine that are
religious and that need to be explained in order to make sense of
many of the difficulties Tibetan medicine experiences when it is
introduced to the West. It is quite common for patients to first
encounter the religious elements in Tibetan medicine when receiving
treatment from amchis, because when they are giving the
medication sometimes the amchi either prays or recites mantras.19
One of the most crucial religious aspects of Tibetan medicine is that
the rbgyud-bzhi, a foundational medical text for Tibetan medicine,
contains elements influenced by religion. This text serves as the
synthesis and foundation for Tibetan medical knowledge. Doctors
trained at the Men Tsee Khang College in Dharmsala must fully
understand the rbgyud-bzhi. Usually large portions of the rbgyud-bzhi
must be memorized in order for a student to officially become an
amchi.
rbgyud-bzhi is traditionally translated as the four tantras, and is
shortened from its full title, bDud- rsis sNying-po Yan-lags brGyad-pa
gSang-ba Man-ngag gi rGyu,which means The Essence of the Secret
19 H.H. Dalai Lama. The Knowledge of Healing. Dir. Franz Reichle. Perf.14th Dalai Lama, Dr. Tenzing Choedrak,. First Run Features, 2005.
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Instruction on Eight Branches. 20 The four tantras of the rbgyud-bzhi
are the Root Tantra (rTsa-rGyud), the Explanatory Tantra (bShad-
rGyud), the Quintessence Oral Instruction Tantra (Man ngag-rGyud),
and the Subsequent Tantra (Phyima-rGyud). 21
rbgyud-bzhi and its Origin
The origin of the rbgyud-bzhi is somewhat controversial. According
to Dr. Tsering Thakchoe Drungtso22 there are four competing
hypothesis about the texts beginning. The first is that it is the exact
words of Sangye Menla (the Medicine Buddha). The second is that
Vairochana and Kashimiri Pandi Chandrananda translated it from the
Sanskrit text Legs-sByar nas bsGyur-ba. This is probably the least
tenable hypothesis due to a number of inconsistencies; one is that it
would imply that Tibetan medicine originated from Indian culture
(when there are many references of ancient Tibetan cultural icons and
medicinal procedures like pulse diagnosis, which did not appear in
Ayurvedic medicine until 200 years after the rbgyud-bzhi was written).
The third interpretation is that it is a rediscovered treasure (gter ma)
after being hidden by Guru Padmasambhava in the central pillar of
Samye monastery and later discovered by gTer-sTon Grawa
mNgonshes around 1012-1091 A.D.23 Finally, many believe that
20 Thakchoe Drungtso, Tibetan Medicine: The Healing Science of Tibet.Men Tsee Khang, Dharamsala: Drungtso, 2004: 3621 Ibid.22 Ibid. pg. 2323 Ibid. pg. 23
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Youthog Yonten Gonpo and his son were the authors of the rbgyud-
bzhi, and it is largely based on an early medical text calledZhang
Zhung around 1126-1202 A.D. Dr. Drungtso suggests that it is not the
direct word of the Medicine Buddha based on a few inconsistencies
within the text itself and the history of some of its principles in Tibetan
culture. Thus, while it might not be a popularly held belief that the text
originated from the Medicine Buddha directly, its references to the
Medicine Buddha and some of its other structural components cause it
to be considered a divine work, and traditional accounts of text or
the history of Tibetan medicineplace the work in a category with the
other sutras and tantras.24
Rbgyud-bzhi and its Content
The second important feature of the rbgyud-bzhi to look at is its
content. There are 5,900 verses spanning over 156 chapters in the
rbgyud-bzhi25. There is a diversity of topics explored throughout each
tantra, and each tantra has a specific purpose. The rbgyud-bzhi begins
with the prayer to the Medicine Buddha, Homage to the King of
Aquamarine Light and Supreme Benefactor, who has attained perfect
fulfillment and overcome all obstructions, he who has reached the
ultimate reality and become the fully-endowed conqueror who
24 Todd Fenner, The Origin of the rbgyud-bzhi: A Tibetan MedicalTantra. Snow Lion Publications. Pg. 46125 Thakchoe Drungtso, Tibetan Medicine: The Healing Science ofTibet. Men Tsee Khang, Dharamsala: Drungtso, 2004: 36
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surpasses all bounds.26 This prayer immediately sets the structure and
tone of the rest of the text as being inspired by Buddhist principles.
The entire text explores eight branches of medicine: The body,
pediatrics, gynecology, harmful evil spirits, wounds inflicted by
weapons, toxicology, rejuvenation, and aphrodisiacs.27 The fourth
branch immediately implies certain religious beliefs i.e. the belief in
evil spirits. Chapter 73 and Chapters 77-81of the Quintessence Oral
Tantra, and Chapter 9 of the Explanatory Tantra deal directly with
spirits that have a direct effect on human health. Chapter 13 (called
rGyun-Spyod) of the Explanatory Tantra deals with behavior (a
potentially major cause for illness) and the ways in which certain
religious practices and moral acts can have a strong effect on illness.
Finally, discussions about the amchis role and treatment of the patient
in chapters 25 (Ngan-gYo-sKyon-brtag) and chapter31 (sMan-paI leu)
are very invocative of the Buddhist concept ofBodhicitta.
The rbgyud-bzhi, both in its origin and content, largely incorporates
Buddhist and Bon imagery. Because of the tendency of biomedicine to
value only what can be scientifically proven, there is often great
controversy when western doctors try to understand Tibetan medicine
through the rbgyud-bzhi. As Craig Janes notes, It is the overarching
26 Yeshi Dhonden, and Jhampa Kelsang. The Ambrosia Heart Tantra.New Delhi: Educa Books /Paljor pg.1 This text contains the translationof the Root Tantra, and the second half of the Explanatory Tantra fromthe rbgyud-bzhi.27 Thakchoe Drungtso, Tibetan Medicine: The Healing Science of Tibet.Men Tsee Khang, Dharamsala: Drungtso, 2004. pg. 36
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theoretical logic found in the core texts, a logic which references
principles that might be glossed as spiritual or religious, that has
become entangled in the debate over the distinction between the
sacred and the scientific.28 The rbgyud-bzhi is a foundational text for
Tibetan medicine, and Buddhism and Bon heavily influences it.
Karma
Furthermore, karma plays an important role in Tibetan medicine. In
the thirteenth chapter of the Explanatory Tantra, it specifies two types
of actions that can affect illness and more broadly about happiness:
sacred and worldly activities. The rbgyud-bzhi recommends doing
worldly activities in a safe and healthy way; for example, avoid
dangerous places, and get enough sleep. Sacred activities are
activities that can also have a great impact on a persons health
because they promote good karma. The rbgyud-bzhi states,
Living in accordance with the religions of the world is thefoundation of all virtueswithout a religious approach tolife happiness itself is a cause of discontent...Subdue theactions of your body, speech and mind and have agenerous attitude free of attachment.29
The religious foundation reflects of Buddhist principles on how one
should live their life in order to be happy and healthy.
In Tibetan medicine, there are traditionally four classifications of
illness. There are 101 superficial or ostensible diseases (ltar snang
28 Craig R. Janes, "Buddhism, Science, and Market: the globalization ofTibetan medicine." Anthropology and Medicine 9 (2002): 27529 Yeshi Dhonden, and Jhampa Kelsang. The Ambrosia Heart Tantra.New Delhi: Educa Books /Paljor: 106-107
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phral-nad), 101 diseases of this life time (yong grub tshe-nad), 101
diseases of harmful evil spirits (kun brtags gdon-nad), and 101
untreatable karmic diseases (gZhan dbang sNgon las).30 Karmic
diseases are diseases that simply dont respond to treatment, and no
possible explanation other than karma can be attributed to them. The
diagnosis usually consists of treatment using whatever medicine that
may be helpful (but will not result in a cure) and typically consultation
with a lama alongsidepujas31.
Many have heard stories of people with conditions that would
normally seem curable either through biomedicine or Tibetan
medicine, but for some reason the treatment seems to consistently
fail. For example, while in Kathmandu, I interviewed a Geshe32 at the
White Temple named Karma Gyurme who claimed to have a karmic
disease. He had consulted biomedical and Tibetan medicine doctors
about the problem (stomach pains) and none could explain or cure his
illness. However, he was not bitter about having a karmic illness. In
fact, when I asked him how having a karmic illness effected him, he
quoted Santideva saying, If anything happens that can be changed,
why worry, it can be changed; and if anything happens that cannot be
changed what is the point in worrying? In Geshe Gyurmes mind, a
30 Thakchoe Drungtso, Tibetan Medicine: The Healing Science ofTibet. Men Tsee Khang, Dharamsala: Drungtso, 2004: 37131 religious offering ceremonies32 A Geshe is an academic degree within the Monastic tradition thatrequires a person to be a monk and to have studied for the degreefrom a time span of 12-20 years.
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karmic illness was an opportunity to work off negative actions from the
past. Suffering from illness now, meant that he would not have to
suffer some terrible tragedy in the future to make up for his evil deeds
of the past. Thus, built into the very structure of Tibetan medicine is
the Buddhist principle of karma. Our bodies are constantly changing,
and this change is a result of our actions. Part of the justification for
this is that the humors themselves are manifestations of the three
poisons; rLung (wind) is connected with desire and attachment,
mKhris pa (bile) with hatred, and Bad-kan (phlegm) with ignorance.33
These actions directly affect the physical humors. Thus, karmic
illnesses are incurable, because the body has changed as a result of
behavior, not behavior like smoking or eating too much, but moral
behavior.
The Spirit World and Demons
There are also spirits and demons that have an effect on illness.
As was briefly mentioned earlier, Tibetan medicine states that there
are 101 diseases caused by harmful spirits. The idea that spirits are a
causal agent in disease immediately presents problems for most
Western doctors. Most cases of possession or spiritual influence deal
with the humor rLung (wind), which typically is most associated with
the mind, and is the pervasive life force of the body. Dr. Terry Clifford,
33 Jampa G. Dagthon, "The Importance of Astro. Science in Medicine."Tibetan Astronomy and Astrology: A Brief Introduction. Dharamsala,India: Tibetan Medical and Astro. Institute, 1995:34
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a psychiatrist who took great interest in Tibetan medicine and
psychiatry, presents the variety of interpretations regarding demons
when he writes,
An uneducated Tibetan might actually believe in them as malevolent embodied hobgoblins; a yogimight think of them as negative energies or fields of forcethat exist in the universe; and yet more sophisticatedlamas and doctors and laymen might perceive them asunconscious tendencies deep within the psyche that havethe power to overwhelm normal consciousness.
He defines demon very broadly as, any unseen force that obstructs a
psychological or spiritual development.34
There are eighteen different
types of spirits that can affect the body. For example, there is a spirit
called a Klu or Naga, which is a serpent spirit or spirit, which reside on
land and in water. When possessing a person these spirits cause
sickness and symptoms like, fondness for meat, milk and other dairy
products, constant licking of lips, and the desire to lay on ones belly
rather than back.35 Sometimes these spirits can be upset by pollution
or mistreatment of the land, and sometimes they may even cause
epidemics within a small community. However one chooses to consider
the ontology of such spirits, it is clear that they play a part in the
treatment and understanding of the body for Tibetan medicine.
34 Dr. Terry Clifford, "Tibetan Psychiatry and Mental Health." Bulletinof Tibetology 1993 (Aspects of classical Tibetan Medicine). Gangtok:Namgyal Institute of Tibetology, 1993:1035 Thakchoe Drungtso, Tibetan Medicine: The Healing Science of Tibet.Men Tsee Khang, Dharamsala: Drungtso, 2004: 375
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Astrology
Tibetan medical hospitals are called Men Tsee Khang,which
literally breaks down to Men (medicine) Tsee (Astrology) khang (house)
meaning Tibetan medicine and Astrology House. Astrology is typically
also required material for most students studying at the Men Tsee
Khang institute in Dharmsala. In fact, the truly effective healer within
the Tibetan tradition will have studied both medicine and Astro.
Science, since the influences on the body comes from both within and
without.36
In order to understand the role of spirits, you need to
understand astrology and the role of the elements. Tibetan medicine
describes five elements that make up the existence of the entire
universe; medicine observes Fire, Earth, Water, Air and Space,
astrologers observe instead Fire, Earth, Water, Wood, and Metal.
[Elements that are adapted from Chinese medicine]37 These elements
also make up the various aspects of the body and play an important
part in the formation of the humors. Whereas, Tibetan medicine
focuses on the internal relation of the elements as they manifest in the
harmony of the humors, astrology focuses on the outside of the body
by looking to places like the stars, the seasons, and the temporal
location of the individual in relation to the time of the universe. By
doing this, astrologers are able to diagnose present problems or future
36 Jampa G. Dagthon, "The Importance of Astro. Science in Medicine."Tibetan Astronomy and Astrology: A Brief Introduction. Dharamsala,India: Tibetan Medical and Astro. Institute, 1995:2937 Ibid. Pg. 36
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problems that might develop as a result of changes in the universe.
Thus, effective amchis are able to understand the balance of the
elements both inside and outside the body through a holistic
understanding that transcends even the body.
Some religious features of Tibetan medicine might eventually be
explained through scientific study, and other features of Tibetan
medicine might be transformed to more modern scientific practices.
This is something that the XIVth Dalai Lama has emphasized should be
the case, and he recommends in certain situations amending old
religious beliefs on the basis of modern development in a cautious
manner. Based on some traditional views, replacing these religious
aspects with science alone would be a violation of the very integrity
and coherence that makes Tibetan medicine function. Tibetan
medicine as an effective religious healing system has great potential
for success in the U.S., but in order to understand how Tibetan
medicine can fill an important demand in the U.S., it is important to
explain how demand for healing has changed in contemporary
healthcare for the U.S.
Background: The Status of Complementary, Alternative, and
Integrative Medicine in the U.S.
In the United States our healthcare system has become more
diverse, but the supply of diversity in healing is mitigated by a few
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policy factors that will be discussed in this section. The Enlightenment
Period witnessed the rise of scientific thinking. Science became a
coherent framework that began to have great sway over the common
persons understanding of the world and their body. With the
introduction of new technologies and techniques, modern medicine
throughout the 20th century developed at an astounding rate, and was
able to radically change the way we understand the human being and
treat suffering.
Demand for CAM and the NCCAM
In the U.S.A. demand for CAM has grown a great deal over the
past few decades. According to the National Center for Complementary
and Alternative Medicine (NCCAM), 36% of adults are using some
form of CAM. When megavitamin therapy and prayer specifically for
health reasons are included in the definition of CAM, that number rises
to 62%.38 According to a different study done by David Eisenberg39
and colleagues (1998) that appeared in theJournal of the American
Medical Association it estimated that in 1997, 42.1 percent of all adult
Americans had used some form of alternative therapies (including
chiropractic, relaxation techniques, biofeedback, and acupuncture) in
the past twelve months, a significant increase from the 33.8 percent
38 PM Barnes, B. Bloom, R. Nahin Complementary and AlternativeMedicine Use Among Adults and Children: United States, 2007. CDCNational Health Statistics Report #12. December 200839 David Eisenberg is a Director of the Osher Institute at HarvardMedical School and the Division for Research and Education inComplementary and Integrative Medicine.
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estimated to have done so in 1990.40 This indicates that there is a growing demand for
CAM in the U.S. People are beginning to become more interested in treatments other than the exclusive
use of conventional allopathic41
biomedicine.
As will be developed more in the following sections the NCCAM
uses the principles of biomedicine as templates for legitimizing
alternative medicinal treatments in the U.S. The consequences of the
way in which the common American not only treats their illnesses, but
also on how they understand their body have been profound. U.S
society is changing, but policy is struggling if not completely failing to
keep up. Patients seeking medical treatment outside of traditional
allopathic medicine encounter problems with insurance companys lack
of coverage, and physicians from other medical philosophies encounter
problems with legally being allowed to practice medicine. Much of this
change in demand makes sense when one considers the ideological
change that has been occurring in U.S. society and throughout the
world from the modern to the postmodern. In order to understand the
cultural and philosophical reasons for this struggle to achieve a
heterogeneous healthcare system this paper will draw heavily upon the
40 Robert Tillman, "Paying for Alternative Medicine: the Role of HealthInsurers." Annals of the American Academy of Political and Social
Science 583 (2002): 64-75.141 Many doctors view the word allopathic to be pejorative, and do notaccept its use. For the sake of this paper it will refer to westernmedicines that use biomedical epistemologies and are the result ofDescartes analytic principles that founded reductionism. The term ismost commonly used to juxtapose medicines like Osteopathy, whichwould be considered holistic, from other western medicines that arenot holistic.
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principles of postmodern medicine.
Postmodern Medicine
What is Postmodernism?
Lyotard defines Postmodernism in broad terms as,
an incredulity towards metanarratives. Ametanarrative is a theory or story that passes itselfoff as a truth without exception, generalized truthsthat pretend to be true for all objects in a category,such as all Priests are pure, all people in a certaincountry think a certain way, or science is the bestapproach to solving all human problems.Metanarratives, it seems to the postmodern, aremyths belonging to modernity, myths that simplify
and blind us to subtleties and exceptions around us,myths that are often more false than true, butseldom completely true.42
Michel Foucault, one of the premier thinkers of postmodernism,
argues that within every society there is a complex system that he
calls the microphysics of power. These systems of power discipline our
bodies and produce certain actions that are complicit with a set of
assumptions within a discourse. Various systems of power
conceptualize truths in terms of the processes involved in the
application of power. As Vincent B. Leitch notes of Foucault,
Nothing-whether selves, desires, or truth-is externalto the productive power/knowledge that creates thecategories by which it is known. Thus, the truth towhich dissidents appeal is no less a product of
interested strategies- in this case, their own thanthe truth spoken by the officials whom they oppose.Truths are not all born equal, because somediscourses are more powerful than others. But
42 L. Shawver, Notes on reading the Birth of the Clinic. 16 May1998.http://www.california.com/~rathbone/foucbc.htm
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Foucault does not recognize any component of truthseparate from power.43
Thus, truth is a function of power, it is something which power
produces and is a product of discourses that are shaped by power
structures. For example, in our justice system a person is considered
trulyguilty after he has gone through a procedural process in which
people evaluate him and his actions in relation to a system of laws.
This truth of guilt is a product of the power people place in the judicial
system and its processes. In this way, a modernist metanarrative
might say that the justice system upholds truth by determining what is
true or false regarding a particular persons actions based on a
particular process (i.e. two sides compete in order to convince a jury of
peers that their position is the true position). Another metanarrative
that postmodern medicine will be examining closely are those
involving healing and healthcare in the U.S. The dominant framework
for understanding the body and identifying the correct procedures for
healing would be the biomedical narrative. If the metanarrative that
biomedicine is the only way to conceptualize and cure the body is
accepted in our society, then biomedicine is hegemonic at the expense
of other narratives of healing. In other words, the truths and
knowledge people have about their bodies is the product of discourses
on the body that exist within a system of power. At the moment, this
43 "Michel Foucault." The Norton Anthology of Theory and Criticism.Ed. Vincent B. Leitch. New York, NY: Norton & Company, Inc., 2001.1620.
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system of power is dominated by the discourse of biomedicine, so what
biomedicine asserts becomes the dominant truth of the body, because
it holds more power than other healing systems in our healthcare
discourse.
Postmodernism and Heterogeneity
One aspect of postmodernism, and postmodern medicine
especially, is the emphasis on achieving a heterogeneous discourse.
Rather than one narrative of healing (biomedicine) having biopolitical
hegemony over the rest of society, postmodernists believe that
multiple narratives of healing can coexist. As David Morris44, a premier
postmodern medicine thinker notes, Postmodernism is normally
described as inherently heterogeneous marked by the absence of a
single dominant style or mode of thought. It splinters unified
discourses, decenters orthodox beliefs, validates marginal positions
endlessly deferring full knowledge, adding supplement on
supplement.45
Medicine is not just a system of healing, but also a power
structure. Medicine is a power structure in so far as it represents our
understanding of our bodies and how we care for our bodies. It is a
cultural force of discipline by virtue of what Foucault has
44 David B. Morris, winner of a 1992 PEN award for The Culture of Pain(California, 1991) and author of the award-winning Alexander Pope:The Genius of Sense (1984), lives and writes in Albuquerque, NewMexico.45 David B. Morris, Illness and Culture in the Postmodern Age.University of California P, 2000: 136
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called a clinical gaze that transforms the body into anobject of scientific scrutiny. Patients often note how thepower implicit in the physician and in the medical settingcan reduce us to a state of passive and dependenthelplessness, in which we sit for hours in a crowded waiting
room until the busy doctor at last finds time to see us.46
The medical discourse and the power relationships within it have a
large impact on our identity and the way we conceptualize our
relationship with our body and the rest of society.
The state regulates narratives of healing because a paternalistic
state always sees it as advantageous to have some sort of systematic
bureaucratic control over the body (what Foucault calls biopower).
Thus, many governments including the U.S. federal government have
in place certain federal organizations in charge of regulating what
qualifies as legitimate medicine. Arthur Kleinman47 writes of
biomedicine that,
in the postmodern state, biomedicine has come toserve a major political mission it has outstripped itsown professional autonomy and become inseparablefrom the state. In Western countries, biomedicineoccupies the chief legitimized role for supplying healthservice to the populace, a role48, as Waldrum pointsout, that it protects with diligence. Chief among itsrepertoire of responses to heterodox challenges is itsuse of state power to both generate and enforce theground rules and criteria for establishing efficacy.Alternatives to biomedicine, when they cannot be set
aside as inefficacious or simply labeled as quackery,are often co-opted or tamed by state-supported
46 Ibid. pg. 14647 Arthur Kleinman is a professor of medical anthropology and crosscultural psychiatry at Harvard University.48 Craig R. Janes, "Buddhism, science, and market: the globalizationof Tibetan medicine." Anthropology and Medicine 9 (2002): pg. 35
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biomedicine.49
In the U.S. one of the primary organizations for regulating what
qualifies as legitimate medicine is the NCCAM. The movement called
postmodern medicine is a movement which focuses on healthcare
through a postmodern lens, and which typically advocates diverse
ways of thinking and conceptualizing the body and healing.
Constructive Postmodern Medicine
Multidimensional Realism
Elliott S. Dacher50 helps to identify some of the central
components and advocacies of postmodern medicine. The first
component he discusses is called Multidimensional Realism. It is
neither radical subjectivism nor scientific materialism, but is a
multidimensional amalgam of sensory and non-sensory knowledge.51
Neither radical subjectivity, nor radical objectivity is as fruitful as they
can be when both are given value. It is important to recognize that this
is something that develops historically. Healing was once very religious
and subjectively understood, then after the scientific revolution of the
enlightenment, medicine tended towards objective science as a
metaphysical foundation. Postmodernism however acknowledges that
both the subjective and the objective are critical parts of the healing
49 Ibid. pg. 3650 Elliott S. Dacher is an M.D. that has written a number of books onhealthcare including Integral Health: The Path to Human Flourishing.51 Elliot Dacher, M.D. "Towards a Postmodern medicine." The Journalof Alternative and Complementary Medicine 2 (1996): 532.
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process, and the exclusion of one for the other inevitably reduces the
effectiveness of healing. Healing should include both subjective
understandings of health that account for perceptions of pain and the
power of the mind in healing the body, and objective standards for
evaluating the disease as a physical entity to be treated through
physical processes like medicine. This aspect is critical in the
understanding of religion and healing (as will be discussed later on).
What should be taken away from this is that, science and religious
modes of healing do not have to be exclusive of one another, and
when techniques from both are used in a complementary way, a more
successful style of healing will result. For Tibetan medicine, subjectivity
and objectivity come together in the sense that the subjective
condition of the mind, religious experiences, and karmic consequences
are just as valuable as the objective circumstances and physiological
circumstances in treating illness.
Intentionality
The second quality that Dacher emphasizes is Intentionality,
which validates the causal nature of consciousness which is
individually willed.52 Both Intentionalityand Mutlidimensional realism
acknowledge the value of consciousness and the mind in the healing
process. Intentionality, postmodern medicine advocates, is the
importance of understanding sickness as an illness rather than a
52 Ibid.
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disease, giving place to subjectivity as an agent in healing rather than
a passive recipient of the objective disease. Once again, this aspect
opens up new possibilities for understanding the techniques of
religiously inspired healing. Religious techniques tap into the deeper
more subjective aspects of consciousness, and by doing so those
techniques can cure the illness, but sometimes not necessarily the
disease.Expanding our conception of being unhealthy to include the
subjective term illness and the objective term disease creates space
for the more ritualistic modes of healing inspired by religion. Dachers
principle of intentionality is also relevant to Tibetan medicines account
of karmic or demonic illnesses, which do not have scientific
explanations based upon universal laws. Tibetan medicine teaches that
certain states of mind produce imbalances in the body and qualities
that might be dismissed as subjective are causally linked to the more
objective physiological elements of the body.
Holism
The third quality that Dacher focuses on is Holism, whichrejects
the duality of mind and body, the subjective and objective, and other
such dualities in exchange for the belief that they remain
interconnected. In other words, part of the problem with scientific
materialism and radical subjectivity comes about as a result of thinking
of objectivity and subjectivity in a completely binary manner. A deeper
understanding and application of both as one interconnected whole is
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essential for effective healing. One of the bigger criticisms of
biomedicine (as will be noted later on) is that it views the mind as a
biological entity and the body as a machine, which prevents the
possibility of healing via the mind. However, Tibetan medicine believes
the mind is crucial in the healing process, and it emphasizes practices
that are aimed at lifestyle choices and religious practices that utilize
the mind in the process of healing.
Clearly, the previous three elements of postmodern medicine are
related to each other. The first understands that subjective and
objective approaches can work together. This idea is related to the fact
that consciousness and the subjective elements of consciousness can
have an effect on the objective physiological body. And, finally Holism
breaks down the separation between the mind and the body, which is
consistent with the belief, that consciousness and more subjectively
understood approaches to healing could be effective.
Personal Authenticity
The final characteristic is Personal Authenticity, which empowers
the individual beyond the authority from belief systems, institutions,
and professionals by recognizing that authentic individualism comes
into being in the context of relationship.53 The dynamic of healthcare
is evolving away from power structures where the patient has no real
53 Elliot Dacher, M.D. "Towards a Postmodern medicine." The Journalof Alternative and Complementary Medicine 2 (1996): 533
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influence in their own healing process. For example, the movement
away from reductive medicine, where healing is understood as a
treatment of symptoms, to the view that healing should be about
locating the causes of illness, results in active dietary and lifestyle
changes on the part of the patient. In other words, postmodern
medicine advocates a system where people can take an active role in
their own health, and can develop their own specific view about how to
treat it. This is made more possible in a heterogeneous healthcare
system, because a person can make the choice about what type of
healthcare is the best fit for them.
Comparing Gray and Dacher
J.A. Muir-Gray,54 writer of Postmodern medicine,also makes a
few important observations about postmodern medicine. His
observations are much less theoretical and are aimed at practical and
concrete applications. Rather than articulating all of his observations,
this paper will focus on the few that are most relevant to the argument
presented, and will explore the ways in which a healthcare system with
both Tibetan medicine and biomedicine reflects the advocacy of
postmodern medicine. Many of Grays ideas are similar to Dachers.
Grays principle of a Value Based Healthcare and his emphasis on
Experience over Satisfaction of Care really address some of the ways in
which the entire process of allopathic biomedicine can be overly
54 J.A. Gray has been involved with Public healthcare for over 25 years.
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reductive and mechanistic. Grays point is that the doctors visit should
involve better verbal and non verbal communication, and a style of
consultation and decision making that involves and empowers the
patient.55 Thus, the patient and the doctors relationship should be
one that is less mechanistic and open to the views and opinions of the
patient, since it is their body that is in danger.
Tibetan medicine accounts for this problem of disempowerment
and over-mechanization on a number of levels. Most of the diagnostic
procedures in Tibetan medicine come from detailed questioning that is
meant to find the root cause of imbalances within the body.
Treatments are always specific to the patient. In other words, a
biomedical doctor treats the patient by attacking the disease, but the
Tibetan medicine amchi treats it by understanding the body of the
patient and the ways in which imbalances have developed. Thus, a
biomedical doctor would most likely treat a group of people exhibiting
one type of disease in roughly the same way, but a Tibetan Medical
doctor might treat the same biomedical illness in different ways based
on the specific body type of the patient.
Furthermore, Grays points about Treating Disease vs Healing
dis-ease and his account ofmultiple realities address the need for
viewing the illness as something that has both subjective and objective
components. Both of these ideas have already been addressed through
55 J.A. Gray, "Postmodern medicine." Lancet Oct 30 (1999): 1552
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the Dachers account of utilizing both subjective and objective
elements in healing by placing emphasis on consciousness as an agent
in the healing process.
The various elements of postmodern medicine that have been
articulated here can be mostly summed up by a general suspicion of
the purely objective and scientific approach to medicine. Gray notes
that, Postmodernism also challenges the objectivity that science has
claimed is its defining characteristic as spurious and unsupportable,
and although many different theories are encompassed by the term
postmodernism, a suspicion of science lies at the core of such
theories.56 Postmodern medicine is not trying to suggest that science
ought to be eliminated from medicine and healing. Rather, it is
suggesting that objective approaches to healing have become for
various social reasons the exclusive mode of thinking about and
treating the body. The effects have been that the patient becomes
disconnected from the healing of their own body, and the process of
healing has become less about meaningful human interaction, and
more about a market driven exchange of goods and services meant to
stream line the elimination of symptoms. If the healthcare system
opens itself up to different epistemologies (epistemologies that
incorporate subjective approaches to healthcare as well as objective
approaches) of healing, then there can be more of a balance between
56 J.A. Gray, "Postmodern medicine." Lancet Oct 30 (1999): 1550
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the purely subjective and purely objective modes of healing.
Criticisms of Postmodernism
One of the most relevant and effective criticisms of viewing
postmodernism as a tool for expanding the interaction of medical
epistemologies comes from Allen Wallaces Buddhism and Science.
Wallace argues that there is great potential for Buddhism and Science
to collaborate on trying to further our understanding of this world. For
example, Wallaces book includes discussion about the potential for a
productive discussion between Quantum scientists and the Buddhist
philosophers in understanding complex problems of existence. In a
section called, The Dogma of Postmodernism Wallace argues that
postmodernism undermines the potential for Buddhism and science to
cooperate in the advancement of knowledge. If Wallace were correct
then this would do great damage to the position that postmodern
medicine could facilitate a more balanced healthcare system in which
Tibetan medicine (largely built around Buddhist principles) can grow
along side the scientifically based biomedicine.
Wallace chooses to focus on Jacksons postmodernism,57 which
he considers dogmatic. Wallace might be correct about Jacksons
specific rendition of postmodernism and perhaps his dogmatic
application of postmodernism, but this paper will argue a more
57Alan Wallace, Buddhism and Science. Columbia University Press,2003pg. 23
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moderate form of postmodernism that is centered around thinkers like
Morris, Dacher, and Gray who argue for postmodern medicine
specifically.
Wallaces first criticism is that Jacksonss postmodernism
emphasizes cultural particularism, which asserts that different
societies are culturally unique, incommensurable and hence
fundamentally unknowable by outsiders. This would imply that various
schools of Buddhism are culturally unique to the Asian societies in
which they developed, therefore their theories and methods of inquiry
cannot be compared to those of science.58 This is a good point, but
does not represent the way many postmodernists choose to interpret
the role of culture. For instance, Bell Hooks argues that postmodernism
can be a huge step in the advancement of civil rights in the U.S.
Postmodernism allows the recognition that we are all socially and
culturally constructed creatures, and that we should each respect each
other for our uniqueness. Wallace does not consider those
postmodernists that want to protect the autonomy of the unique
culturally produced individual by preventing hegemonic narratives
from silencing marginal voices. This could be misinterpreted as the
position that says all narratives are mutually exclusive so that
everyone is speaking a different language and there is no room for
collaboration. But in reality postmodern medicine (and more
58 Ibid. pg. 20-21
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specifically the way in which I choose to interpret postmodern
medicine, especially within the context of Tibetan medicine and
biomedicine in the U.S. heath care system) creates a framework of
mutual respect in which dialogue is generated with the premise that
differences ought to be celebrated and appreciated by acknowledging
the cultural uniqueness of each individual.
Wallace then criticizes Foucault in particular. He suggests that
Foucault reduces religion to nothing more than a power mechanism. In
Foucaults defense, what he is doing is choosing to focus on power
mechanisms. This criticism represents a fundamental
misunderstanding of Foucaults methodology. Foucaults methodology
is meant to explain how contemporary discourse has developed as a
result of social circumstances in the past and that the contemporary
discourse is shaped by various power structures that have developed
and become more or less powerful because of historical events.
Foucault is not asserting that all religions are wrong, and serve a
purely social disciplinary function. Rather he is demonstrating how
certain historical developments have arranged discourse in a way that
is shaped by the power of certain ideologies. This criticism would be
akin to suggesting that an anthropologist reduces religion to
something that is only a cultural product. Just because the
anthropologist evaluates religion through a cultural lens does not imply
that the anthropologist views religion as something that is only
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culturally produced and has no right to transcendental claims.
Along these lines, Wallace also criticizes Foucault, because
Foucault argues that there is no absolute truth, and the insistence on
the lack of absolute truth in any worldview other than postmodernism
appears to be one of the fundamental articles of faith of this dogma,
which indicates its close similarities with scientism and other forms of
fundamentalism.59 Wallace argues that postmodernisms claim that
there is no absolute truth is itself a truth claim, which makes
postmodernism dogmatic in so far as it grants itself a truth claim, but
denies all other ideologies such a privilege.
However, Foucaults position is more complex than simply the
rejection of absolute truth. In order to respond to this criticism a brief
return to Foucaults explanation of truth will be helpful. Foucault
believes that truth and power are related. He argues that discourse is
shaped by power mechanisms, and thus certain things become true as
a result of how discourse is shaped by power. Wallace is right that
Foucault would disagree with the view that Truth is something with
pure objective value and can be absolute. For Foucault, truth is a
product of a discourse shaped by history, and the standards of truth
are constantly shifting based upon changing power structures. But, this
evolution of truth does not disrupt the ability of science and religion to
interact with one another. On the contrary, Foucaults description
59 Ibid. pg. 21-22
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opens up the ability for dialogue to occur. By empowering marginalized
voices, postmodern medicine aims at making the contemporary
discourse open to other less powerful explanations. Thus, the attempt
is not to argue that either biomedicine is True in an objective and non-
socially constructed sense or that religious claims are true in a
transcendental sense. But, postmodern medicine aims at creating
dialogue between different power structures by leveling the playing
field. One of the ways that this is possible is by flagging the moments
in our discourse that have become dominated by a particular
episteme. By bringing attention to these hegemonic epistemologies
within our discourse, the healthcare system can recognize the ways in
which it marginalizes other ways of thinking about and healing the
body.
Finally, Wallace suggests that Postmodernism emphasizes
aesthetics as the primary mechanism for determining belief. In other
words, a person chooses to believe a Buddhist principle or a scientific
principle, because it has a subjective appeal to them. A belief is
aesthetically chosen, when it lacks an objective basis, and is chosen
from a personal connection to an idea or belief that an idea is beautiful
or personally meaningful. This is very reminiscent of Dachers Personal
Authenticityprinciple. Postmodernism would support the autonomy of
the patient in choosing the best type of medicine for their treatment. In
many cases this is an aesthetic choice. If a person is a fundamentalist
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Christian, then they might find trouble with the underlying Buddhist
principles within Tibetan medicine. Or if a different person is looking for
a type of healing that involves spirituality, energy, and consciousness
they might seek out Tibetan medicine or Reiki healing, because it
offers them the mechanisms of healing that are consistent with their
beliefs and would best provide them with the necessary confidence to
achieve health.60 In this way postmodern medicine would emphasize a
certain aesthetic choice of the patient but this choice assumes that
the patient is well informed about the advantages and disadvantages
of various systems of healing (a knowledge that will continue to grow
for the everyday person).
Wallaces criticism is very poignant. But, many of his criticisms
seem specific to Jacksons postmodernism, and certainly are not very
applicable to the characteristics pointed out by Morris, Dacher and
Gray. The few that are applicable seen under a different light are not
really that troublesome. There is no perfect system for conceptualizing
the relationship between Tibetan medicine and biomedicine within the
U.S. healthcare system; there will always be criticisms, but there is still
great potential for postmodern medicine to help bring balance to the
U.S. healthcare system. In order to establish balance there has to be
recognition of the imbalances within the system already, and so it is
60 It is well known that confidence in recovering from illness plays abig part in the effectiveness of treatment. Typically this is calledpsychosomatic healing, and it will be discussed more thoroughly lateron.
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necessary to explore the elements of biomedicine that have become
problematic.
Deconstructive Postmodern Medicine and Biomedicine
Biomedicine has saved and extended the lives of countless
individuals over the past few centuries. Scientific advancements made
by brilliant physicians and laboratory workers have revolutionized the
ways in which we treat illness and cure those who are suffering. Any
critique of biomedicine ought to be prefaced with the
acknowledgement that biomedicine has done a great service to the
advancement of health throughout the world.
When people speak of the U.S. healthcare system, they are
typically referring to biomedical treatment. On the contrary, healthcare
refers to a much broader system of health that includes not just the
primary biomedical treatment, but non-biomedical treatment as well
that may be considered alternative, complementary, or integrative. So,
when discussing the future of healthcare, and what it will take to make
that healthcare the best model possible it is important to look at the
entire spectrum of health and not just biomedicine. In order to address
the broader question of healthcare, this section will evaluate those
aspects of biomedicine that could potentially be greatly improved by
other systems of healing.
The criticisms addressed in this section are well known by many
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physicians, and some actively, and sometimes very successfully, try
and solve these problems. A diverse healthcare system could provide
different epistemologies for healing. Like two puzzle pieces fitting
together, one epistemological disadvantage of biomedicine might be
an advantage for Tibetan medicine, and vice versa. The only way to
truly compensate for fundamental problems with biomedicine is to
allow other systems of healing to function along side biomedicine.
Drawing mostly upon postmodern medicine thinkers like David Morris,
this section will outline three main criticisms of biomedicine:
biomedicine is reductive, dualistic, and mechanistic.
Biomedicine is Reductive
What is meant by reductive here? George Engel61 defines
reductionism within the context of medicine as, the philosophic view
that complex phenomena are ultimately derived from a single primary
principle.62 This view is typically juxtaposed to holistic medicine. Tom
Dummer characterizes Tibetan medicine as holistic in his book Tibetan
Medicine and Other Holistic Healthcare Systems. He defines holistic as
the understanding of reality, in terms of integrated wholes whose
properties cannot be reduced to those of smaller units.63 This
61 George L. Engel is a psychiatrist in America best known for hiscreation of the biopsychosocial model. He has spent most of his careerat the University of Rochester Medical Center.62 GL. Engel, "The Need for a New Medical Model." Science 196(1977): 13163 Thomas G. Dummer, Tibetan Medicine and Other Health-Care
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difference between holistic ways of looking at medicine and reductive
ways of analyzing medicine might make more sense when one
understands its cultural origins. Pre-Socratic philosophers in the West
like Heraclitus believed all of nature could be reduced to fire, and
Thales believed all of existence was some manifestation of water. In
fact, these thinkers were among many pre-Socratics that tried to find
the ultimate essence of existence by reducing the whole down to its
most essential part or parts. So, from the very beginning of Western
philosophy we find the roots of what can best be described as
reductionism. This became a major foundation for most of modern
science.
George Engel offers one very specific starting point for
reductionism in Western Medicine. According to Engel, five centuries
ago there was one very critical concession of established Christian
orthodoxy to permit dissection of the human body. The Church
allowed scientists to examine the body through autopsy on the sole
condition that these scientists do not involve the mind in their
investigation. The reasoning was that the mind and soul are subject
areas that belong to the Church. This beginning point was combined
with analytic philosophers like Descartes and scientists like Newton
and Galileo, who believed that investigations could be resolved into
isolable causal chains or units, from which it was assumed that the
Systems. London: Routledge, 1988. 127
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whole could be understood, both materially and conceptually, by
reconstructing the parts.64 Thus, the doctrine of the Church and the
scientists of the time both moved biomedicine in the direction of
viewing the body as a machine, of disease as the consequence of the
breakdown of the machine, and of the doctors task as the repairer of
the machine.65 It was from these roots that reductionism was able to
gain such a strong foothold within medicine. Foucault might look at
these events and argue that they played an important part in changing
or shaping the power dynamic of medical discourse so that biomedical
doctors evaluates the body in a way that is distinct from the mind and
can be analyzed through reductive techniques.
This narrow approach was no doubt a great success, but
because it has been restricted to this approach alone, certain problems
have inevitably followed. 66 Many of the problems of allopathic67
medicine can be balanced by emphasizing holistic epistemologies for
healing in the U.S. healthcare system so that they can become more
popular. There are some limitations that exclusive allopathic medicine
creates. A holistic and allopathic approach will be compared.
1. Preventative Treatment vs. Fixing the Problem.
64 GL. Engel, "The Need for a New Medical Model." Science 196(1977): 13165 Ibid. 13266 Ibid. 13267 For the criticism of reductionism specifically, this paper will use theterm allopathicmedicine, since some forms of medicine like osteopathymight be considered biomedical but not reductive.
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One primary difference between allopathic and holistic medicine is
the difference between preventative and immediate treatment.
Allopathic medicine is less effective at preventing future illness, but is
exceptional at treating problems as they arise especially during
emergencies; holistic medicines like Tibetan medicine are not well
known for emergency care, but demonstrate great success at
promoting long term health and treatment of chronic diseases. Dr.
Dorje, a Tibetan Amch at the Men Tsee Khang in Dharamsala,68 helped
illustrate the difference between preventative treatment and
immediate treatment by using an analogy of a pipe. Imagine for a
minute you have a pipe that looks like so:
WATER
The pipe is a representation of the body. In order to have a healthy
pipe, water must effectively be transported from one place to another.
The water is a representation of the various factors involved in the
maintenance of health, such as diet, lifestyle, and environment.
WATER XXXXX No Water
Then, there is a problem. The pipe is now diseased and has a clog. At
this point there are two main ways to deal with this infection. The first
way is to find the clog and remove it. This would be akin to surgery or
strong medicine.
68 An interview with Dr. Dorje.
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Water XXX
Water
Once the clog or disease is removed, and there are no longer any
remnants of the infection it appears as if our pipe is healthy again. But,
it isnt long before a similar type of problem manifests in an entirely
different way.
Water XXXX
At this point we might recognize that there is something wrong with
the whole system. Rather than remove the specific dysfunction by way
of treating the symptoms it would be better to understand what is
unhealthy about the system holistically. In other words, fixing the clog
metaphorically represents isolating and treating symptoms of a
specific dysfunction, rather than approaching the problem by
attempting to disrupt the root cause for the problems or clogs in the
first place. For instance, we might analyze the water, representing the
many factors that are involved in the maintenance of both subjective
and objective health like diet, exercise, emotional stability, etc. in
order to see if it is the source of clog or infection. Occasionally, it might
be discovered that the water is in fact filled with mud and dirt, and
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longer-term adjustments to diet and other supplementary treatment
might prevent future illnesses from arising. If we fix the system itself
and focus on preventing future clogs by cleaning the source (i.e. the
water) then it wont be necessary to make invasive treatments on the
pipe to clean out every clog. Holistically speaking it would look like
this:
WATER
Allopathic medicine tends to focus on the treatment of symptoms, but
holistic medicine focuses on root causes for problems of the entire
system. As one anthropologist notes, we need to fill the gap. Holistic
medicines like Tibetan medicine look for underlying patterns of
imbalance that may have systemic symptoms in the body emerging in
different places at different points in time. In contrast, biomedicine
[allopathic biomedicine] tends to focus on the disease as an isolated
phenomenon that can be targeted for intervention as if it were free
standing in the body and frozen in time (or over time), preferably as an
acute disorder (though not always). 69
Holistic medicine acknowledges that bacteria and viral infections
are more likely to affect those who have a weakened body on a holistic
level. Maintaining the patients health consistently is just as important,
69 Vincanne Adams, Randomized Controlled Crime: PostcolonialSciences in Alternative Medicine Research. Social Studies of Science,Vol. 32, No. 5/6 (Oct. - Dec., 2002). JSTOR. Sage Productions, 2002:671
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if not more important, than identifying the bacterial or viral source of
an illness. Mary Coddington in her book In Search of the Healing
Energy notes that,
Traditional medicine (conventional medicine) adheres, byand large, to the germ theory of disease. The holistichealer, although he recognizes that bacterial or viralinfection is present during illness, is apt to postulate thatgerms alone do not cause disease but move in only whenthe individual is in a poor state of health with weakenedpowers of resistance. It is the holistic doctors goal tomaintain his patients in a stable condition of physical well-being.70
Thus, reductive medicine might serve effective and important in the
quick fix problems of medicine, and in the curing of emergency or one-
time problem illnesses, but it ultimately fails at the long-term picture of
health and well-being. By not providing a solid foundation for health in
general, allopathic biomedicine does not ensure the prevention of
illnesses to come. Part of the reason for the difficulty in treating long-
term illnesses stems from the fact that allopathic medicine treats
illness by identifying the singular source for a disease rather than
understanding the illness to be the result of a multiplicity of causes
that interact with one another.
2. Multiple Causation vs. Single Causation
When analyzing the body as a whole there is almost never one
single cause to an illness. But, when the approach to medicine is
reductive the opposite is the case. Holistic medicines like Tibetan
70 Mary Coddington, In search of the Healing Energy. New York:Destiny Books, 1983: 169
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medicine believe the body is constantly changing and each imbalance
leads to other imbalances in the future until the body is temporarily
changed to resolve back into harmony. There is never a single cause in
Tibetan medicine for an illness, because an illness may be caused
karmically, (i.e. as a consequence from an action in this or a previous
lifetime) from an improper diet, an infection, or any combination of
these things. In Tibetan medicine, illness is never an isolated incident,
it is always something that has multiple causes and will ultimately
become the cause of some future shift in balance of the body. This is
because, as Dr. Ivette Vargas notes, Tibetan medicine focuses on the
occurrence of disease as a particular event (an imbalance that may
lead to other imbalances) and that such imbalances may have multiple
causes. This is clearly in opposition to Western biomedical approaches,
which focus on diseases as generic entities, which must therefore have
a cause.71
With a reductive approach, if a patient claims to be having liver
problems, then a doctor would most likely focus almost exclusively on
the liver. But from a holistic approach this doesnt work. A liver
problem is a sign that there is a greater imbalance in the body. So, for
a holistic practitioner it might be just as valuable to analyze the eye or
71 Ivette Vargas, "Tibetan Medicine Revisited in the West: Notes on theIntegrative Efforts and Transformative Processes Occurring inMassachusetts, USA." Laurent Pordie, ed. Tibetan Medicine in theContemporary World: Global Politics of Medical Knowledge andPractice. London: Routledge, 2008: 224
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the stomach to see all the possible causes and effects in the entire
body associated with that liver problem. It might seem like a random
choice for a doctor to analyze the stomach based upon a liver problem,
but because of the nature of a holistic approach doctors are trained to
understand in great detail the relationship between the different parts
of the body so as to have a greater picture of the whole. They thus are
more intuitive in their abilities to understand causality within the body.
By understanding how the liver affects other functions in the body as a
whole, a holistic doctor should be able to locate the root causes rather
than the immediate cause and by doing so will not only solve the
immediate problem but prevent future problems from occurring.
Cartesian Dualism, Physicalism, and the Importance of the Mind in
Healing the Body
As was mentioned briefly earlier, Descartes has had a profound
impact on the way Westerners think generally, and how doctors think
specifically. Rene Descartes argued that the mind and body were
functionally two different types of substances. For Descartes, the body
is essentially a machine, which follows basic laws of physics and can
be described as completely material. In contrast to this the mind is
non-material, does not follow the laws of physics, and can control the
machine via the pineal gland (which was not well understood at the
time, and which he considered the seat of the soul.). Obviously,
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