New Horizons in Medical Anthropology

Essays in Honour of Charles Leslie

Margaret Lock, Mark Nichter

• Publisher: Routledge
• Year: 2003
• eBook ISBN: 9781134471270
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

New Horizons in Medical Anthropology is a festschrift in honor of Charles Leslie whose influential career helped shape this subfield of anthropology. This collection of cutting-edge essays explores medical innovation and medical pluralism at the turn of the 21st century. The book accomplishes two things: it reflects recent research by medical anthropologists working in Asia who have been inspired by Charles Leslie's writing on such topics as medical pluralism and the early emergence of what has become a globalized biomedicine, the social relations of therapy management, and the relationship between the politics of the state and discourse about the health of populations, illness, and medicine. The book also takes up lesser known aspects of Leslie's work: his contribution as an editor and the role he played in carrying the field forward; his ethics as a medical anthropologist committed to humanism and sensitive to racism and eugenics; and the passion he inspired in his co-workers and students.
Charles Leslie is a remarkable and influential social scientist. New Horizons in Medical Anthropology is a fitting tribute to a sensitive scholar whose theories and codes of practice provide an essential guide to future generations of medical anthropologists.

Chapter 1

---

Introduction

From documenting medical pluralism to critical interpretations of globalized health knowledge, policies, and practices

Margaret Lock and Mark Nichter

---

Medical anthropology has a history that covers nearly four decades. Although Charles Leslie’s career is much longer, this volume is devoted almost exclusively to recognition of his unsurpassed contribution to medical anthropology from the time of its formal inception in the late 1960s to the present day. The authors represented in this volume, three generations of social scientists, one or two themselves close to retirement, all acknowledge a debt to Charles for intellectual stimulation through interactions with him and reflections on his writings on Asian medical traditions. He has frequently influenced the course of our professional lives, facilitated many of our publications, and provided forums in various locations for an exchange of ideas, most of which have become central to medical anthropology.

Considering the range of age and experience of the authors, one might expect to find quite dramatic differences in the perspectives taken in these chapters. But a critical, and in some cases, activist approach to the subject matter unites them, one in which a sensitivity is evident to both globalized political and economic issues as well as to a situated meaning-centered approach to ethnography. Above all, everyone is alert to global pluralism in medical knowledge and practice, a lesson first disseminated by Charles Leslie many years ago and one that has proved to be indelibly robust.

Toward a comparative study of medical traditions

The obvious place to start when tracing Charles Leslie’s contribution to medical anthropology is with the symposium funded by the Wenner Gren Foundation and held in 1971 at the gothic castle in Burg Wartenstein in Austria that the Foundation kept at that time for such gatherings. Out of that conference came the now classic Asian Medical Systems: A Comparative Study published in 1976 by the University of California Press. In the introduction Charles set out the project that would occupy him for many years and become a source of inspiration for numerous others. This book was the first collection of essays to undertake a study of the professional, literary, medical traditions of Asia, highlighting characteristics in the production, organization, and communication of medical knowledge. The styles of thought used in these traditions are explicitly compared with those characteristic of medicine in the West.

It was of particular interest to Charles to show the historical processes that have mediated the relationship of these medical systems to modern science and technology. The integrity of each of the “great medical traditions” is stressed, but at the same time it is argued that Galenic/Arabic, Indian, and Chinese medicine exhibit epistemologies and features of social organization permitting general comparisons with each other as well as with “cosmopolitan medicine.” Charles favored this latter term (first coined by Fred Dunn in 1976) to “Western medicine” because it drew attention to the manner in which biomedicine and other forms of medicine were adopted in and adapted to cosmopolitan lifeworlds, thereby contributing to lifestyles concordant with capitalist expansion. Charles Leslie challenges the dualism commonly made at that time between “traditional” and “modern” medicine and insists that all bodies of medical knowledge are dynamic and change as the result of political and social factors as well as the diffusion of knowledge and technological innovations.

Warning against the reification of “traditional medicine,” Charles argues that no medical traditions are inherently conservative. Similarly he challenges the use of “scientific” medicine to describe biomedicine alone and argues forcefully for acknowledgement of the scientific and rational principles present in Ayurvedic, Unani, and Chinese medicine. In a later paper (Leslie 1995), where Charles revisits his reflections on comparative medical systems, he calls for recognition of the power of aesthetics associated with medical systems. Reacting to the tendency to dismiss those aspects of medical systems that cannot be assessed scientifically as having any value, Charles’ observations suggest that we consider not only symbolic and performative dimensions of healing but aesthetic dimensions as well. The work of such medical anthropologists as Briggs 1994; Csordas 1996; Desjarlais 1992, 1995; Farquhar 1994a, 1994b; Roseman 1988, 1991; and You 1994 (to name a few) lend support to this position.

Even though Charles’s vision of a medical system has always been of an entity that is open and infinitely malleable, nevertheless a certain amount of conflict arose among the contributors to Asian Medicine as to how best to delineate the idea of a medical “system.” Some authors emphasized historical continuities whereas others stressed discontinuities. But one theme that emerged vividly across many of the essays was that of revivalism. Several authors made it clear that not only had the “great tradition” retained a firm foothold in the face of modernization and the spread of biomedicine, but the politics of nationalism was in many instances giving the indigenous literate medical traditions a powerful boost, assuring continued legitimization and even expansion.

A second ground-breaking conference was organized in Washington DC by Charles in 1977, sponsored jointly by the National Science Foundation and the Wenner Gren Foundation. Allan Young and Gilles Bibeau both participated, as did several well-known specialists in Asian medicine, including Francis Zimmerman, Paul Unschuld, and Arthur Kleinman. Theories of medical pluralism were central to this conference, and the majority of the papers were published in a special edition of Social Science and Medicine in 1978 entitled “Theoretical Foundations for the Comparative Study of Medical Systems.” During the course of developing this Festschrift, Francis Zimmerman reminded us of Charles’ important role in fostering dialogue between scholars engaged in classical and philological studies of Asian medical traditions and anthropologists studying contemporary medical practices. Charles more than anyone else attempted to analyze what was at stake in such an exchange. In particular, the different emphasis given to continuity and change, theory and practice, notably textual knowledge and contemporary clinical practice, and the knowledge and interests of healers as opposed to patients, were flashpoints for disagreement, as was the interest of many anthropologists in the political dimensions and applied aspects of health care. Zimmerman notes with sadness that today the close ties forged by Charles between scholars of classical medical texts and of contemporary medical practices have dissipated, although ensuing generations of scholars, including Vincanne Adams, Lawrence Cohen, Judith Farquhar, and others have been busy building new bridges.

In 1980 Charles Leslie edited a special issue of Social Science and Medicine entitled “Medical Pluralism in World Perspective.” In the introduction Charles sets out his vision of Asia medical traditions as part of the globalized world. He revisits the notion of a medical “system,” arguing that the very idea is a product of ordering and systematization integral to modernization and the emergence of so-called scientific medicine. The result is that all other forms of medicine are marginalized and the assumption is that they will shortly die out, although the goal in many Asian countries is to create a standardized medical system into which some aspects of local medical practices are incorporated. Charles notes that health care planners have often assumed that these national medical systems will eventually become part of a worldwide “cosmopolitan” medicine. Modern science will be used benevolently and rationally in the relief of human suffering and distress. Charles points out that nowhere has such a vision been realized, and that in reality pluralism and complementarity are the norm. Economic necessity has, of course, been a driving force in sustaining this situation.

This 1980 special issue explicitly questions the entrenched habit of judging medical practices everywhere in terms of measures of efficacy based on proscribed scientific (biomedical) standards. Critical medical anthropologists today question the alleged neutrality of such standards and recognize them as an instrument of governmentality (Foucault 1979). One way governmentality is exercised is through codification – be this the establishment of a system of weights and measures that govern trade and commerce (Appadurai 1996b), professional accreditation (for example, of medical practitioners) that determines legitimacy to practice, or an “evidence-based approach” to evaluating the efficacy of healing modalities through proscribed methods such as double blind trials. At issue in the case of efficacy is who gets to define what constitutes evidence, what sources of information and forms of knowledge are privileged as well as overlooked, and who determines the way “disease categories” are classified as well as samples of subjects selected (Kleinman 1980; Nichter 1992a).

This issue of Social Science and Medicine also highlights how patients are, almost without exception, pragmatic, and see nothing inconsistent about liberally combining different forms of therapy in their quest for restored health. These observations, commonplace today, were conceptualized clearly among relatively few medical anthropologists of the time (see also Janzen 1978; Kleinman 1980; Lock 1980; Nichter 1978).

A third conference organized by Charles Leslie in 1985 was also held in Washington DC. Like the Burg Wartenstein Symposium, it limited its sights to Asian medicine and was entitled “Permanence and Change in Asian Health Care Traditions.” This, too, was sponsored by the Wenner Gren Foundation, with the support of the Department of Anthropology at the National Museum of Natural History, the Smithsonian Institute. The meeting was held in concert with the American Anthropological Association meetings at which 48 papers related to this theme were presented. Selected papers from the conference were published in a special edition of Social Science and Medicine edited by Beatrix Pfleiderer bearing the same name as the conference (1988, Vol. 12, no. 2B) and in a book published in 1992 by the University of California Press entitled Paths to Asian Medical Knowledge, co-edited by Charles Leslie and Allan Young. The presumption of so many intellectuals and medical professionals throughout the second half of the last century that, with “modernization” and “westernization,” a scientific medicine would fully emerge, one that is, in effect, epistemologically free and corresponds closely with reality, is rigorously challenged in this book (see also Lock and Gordon 1988; Wright and Treacher 1982). Similarly, the idea that people everywhere, once exposed to modernization and a modicum of scientific knowledge, would rescind on “tradition” and resort only to “modern” medicine is refuted. For example, in a chapter examining local responses to an emergent disease in South India associated with deforestation (Kyasanur Forest Disease), Nichter presents a political ecological analysis that examines how the disease was interpreted within the local cosmology. Although ticks infected with arbovirus came to be recognized as an instrumental cause of the disease, the reason particular communities were affected was linked to such things as neglect for the shrines of patron deities associated with land reform. Scarce resources were expended on rituals and government hospitals set up to take care of the emergency were avoided by some as places of a bad death. A good death emerged as a primary health concern in a cosmology where disposition of one’s spirit after death was taken seriously (Nichter 1992b).

The editors of Paths to Asian Medical Knowledge remind their readers that the medical systems of contemporary Asia are intellectually coherent, embedded in distinct cultural premises, but cannot be fully understood outside of the stream of history as they are intrinsically dynamic and continually evolving. They note that by the early 1990s these observations were not particularly remarkable, but nevertheless they need repeating for the benefit of some readers, including many anthropologists. The editors acknowledge the remarkable contribution of several historians and philologists, the majority of them European, to the study of Asian medicine. Given the vast corpus of written texts associated with the Asian medical traditions, the prodigious and patient work of these scholars, including Joseph Needham, Nathan Sivin, Paul Unschuld, Francis Zimmerman, Laurence Conrad, and Dominik Wujastyk, among others, provides invaluable insights that complement the work of social scientists studying change and continuity in healing traditions.

The shared perspective of Paths to Asian Medical Knowledge is epistemological. The authors each ask in their own way:

How do patients and practitioners know what they know? What are their various rules of evidence, what kinds and categories of information do they find persuasive, and under what circumstances? How do they know when a medical judgment is wrong or correct? What do “wrong” and “correct” mean to patients, to village practitioners, and to experts trained in the great tradition? What sorts of inductive logic and analogy are at work here? Under what circumstances are these people inclined to accept or ignore novel medical ideas and practices?

(Leslie and Young 1992: 14)

Responding to such theorists as Horton (1967) who argue that “traditional” thought systems are past oriented and therefore relatively closed to other possibilities and options, authors in this volume (for example, Obeyesekere; see also Trawick 1987) illustrate how multiple streams of reasoning guide the development and practice of major medical traditions such as Ayurveda. Although medical traditions like Ayurveda and the Chinese tradition are past oriented, they are also open to new sources of knowledge and empirical observation. They are dynamic and not static, capable of creative syntheses, not just a mere encompassment of ideas and resources. Case studies in Paths to Asian Medical Knowledge illustrate how practitioners base their diagnosis and treatment on both abstract principles as well as embodied knowledge and guided sensibility and on ad hoc experimentation as well as the formulations found in texts. The production of knowledge within great scholarly traditions of medicine both past and present is further examined by Judith Farquhar, Peggy Trawick, Francis Zimmerman and colleagues in a volume edited by the historian Don Bates (1995) and dedicated to Charles Leslie and the historian Owsei Temkin. In this book, the epistemology of medical traditions is expicitly examined and the question is posed: just how do practitioners of such medical systems convince others that they have privileged knowledge?

In addition to the organization of conferences and publication of books and special issues of Social Science and Medicine, Charles Leslie has carried out several other distinguished services for the medical anthropology community and for specialists in East Asian medicine over the years. He founded and was the General Editor between 1971 and 1985 of a book series in medical anthropology entitled “Comparative Studies of Health Systems and Medical Care,” published by the University of California Press, and then was an editorial board member of the series until 1995. During his time as general editor, 21 volumes were published, including many books that have become classics in the sub-discipline of medical anthropology. The series acted as a catalyst for new scholarship as the critical mass of case studies published raised awareness about this domain of multidisciplinary scholarship, encouraging younger scholars to pursue research around new lines of research being modeled.

Charles has contributed to the field in yet other important ways. Between 1977 and 1989 Charles was the Senior Editor of the Medical Anthropology section of the journal Social Science and Medicine and a regular participant in the bi-annual conferences, usually held in Europe, under the auspices of the journal. In this capacity, Charles was able to encourage and shape the publication of medical anthropological articles that would be read by numerous social scientists from a range of disciplines. He actively encouraged contributions from scholars worldwide, making the journal truly international and opening up exchanges between south and north, east and west. Charles did not teach graduate students directly in his capacity as professor at the University of Delaware, but he helped scores of young scholars from all over the world publish their first articles and establish their careers.

Charles was also Secretary-General of the International Association for the Study of Traditional Asian Medicine (IASTAM) from its founding by A. L. Basham in 1984 until 1990, an organization that is still in existence. He has been deeply involved in the organization of the conferences held every five years under the auspices of IASTAM in Australia, Indonesia, India, Japan, Germany, and elsewhere. These conferences have been 6 Margaret Lock and Mark Nichter forums where historians, social scientists, and other intellectuals have made presentations together with practitioners of East Asian medicine. Several of the contributors to this volume (Adams, Ferzacca, Lock and Nichter) have served as office bearers in this organization nationally or internationally.

Medical pluralism and medical revivalism

Charles Leslie’s own work on medical pluralism focused primarily on Ayurvedic practitioners and the conflict and accommodation that were apparent as they were increasingly confronted with cosmopolitan medicine. He was able to show conclusively how self-conscious attempts at revivalism of an “authentic” Ayurvedic tradition were closely associated with nationalism and were in large part responses to perceived threats by forces for modernization and, by implication, “westernization,” emanating from both inside and outside India. This is a topic that is of ongoing importance to scholars of Asia and elsewhere. For example, Prakash (1999) points out that in India many Western-educated intellectuals and scientists found themselves in an acute dilemma: on the one hand they assumed that an embrace of Western science was a sign of modernity and progress, while on the other they were keen to identify evidence of scientific thought in indigenous knowledge and thus advance its claim to universalism. This dilemma is particularly fraught in India because to claim that a scientific tradition existed in India long before colonialism runs contrary to the assumptions of many Indians, namely, that what makes India unique are distinct rationalities juxtaposed to those of modernity and colonial power in which spiritual and practical interventions are blended. Indeed, Chatterjee (1993) argues that in India “anticolonial nationalism” emerged at a time when Western superiority in the domain of the material was recognized in large part through the conscious efforts made to preserve the distincti...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contributors
• Acknowledgements
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Chapter 9
• Chapter 10
• Chapter 11
• Charles Leslie’s Publications