Paths to Asian medical knowledge: edited by Charles Leslie and Allen Young. University of California...
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Sot. Sci. Med. Vol. 36, No. 8. pp. 1105-1108, 1993 Printed in Great Britain BOOK REVIEWS 0277-9536/93 $6.00 + 0.00 Pergamon Press Ltd Paths to Asian Medical Knowledge, edited by CHARLES LFSLIE and ALLEN YOUNG. University of California Press, California, 1992. 288 pp., U.S. $40.00 (hardback) and $15.00 (paperback). This collection is a welcome follow up to Leslie’s seminal edited volume, Asian Medical Systems (1976). The contri- butions derive mainly from a 1985 AAA meeting (one wonders why it took so long to publish such a useful collection) and variants of most have already appeared elsewhere. Nonetheless, resonances and linkages between their foci and approaches provide justification for this collection well beyond the practical usefulness of their being gathered in a single volume. The book concerns the character of medical knowledge and is divided into three sections: Chinese and other medical traditions in East Asia, Ayurveda and other medical tra- ditions in South Asia, and Islamic humoral traditions. An underlying conceptual difficulty thereby becomes apparent; does Asian medicine refer (as is generally implied in the editors’ Introduction) to the indigenous textually based traditions, or (as appears evident from the inclusion of the relatively thin third section and from the subject matter addressed by several authors) to medicine practised in Asia? That this question is more than a matter of mere pedantry is evident in a consideration of the dominant themes emerg- ing from the volume as a whole. Whether Asian medical systems are coherent bodies of knowledge or heterogeneous and syncretic accretions of speculation and practice, and whether these traditions are inextricably rooted in local conceptual systems or are transferrable to other settings, are two predominant and recurring issues. Addressing the former, Unschuld’s and Farquhar’s essays effectively challenge the myth subscribed to by both earlier Western scholars and Chinese revivalists, that ancient Chinese texts describe an internally consistent and complete system of medicine. Unschuld’s identifies Chinese medicine as a “patterned knowledge” (p. 58) based on a conception of truth defined through usefulness and thereby able to encompass contradiction, but irreconcilable with Western science’s criteria for logical truth. The notion of ‘usefulness’ as a defining criterion for knowledge echoes one of the preceding chapter’s conclusions. Kuriyama’s study of anat- omy in eighteenth century Japan analyses the process through which Western anatomy became ‘visible’ to Japanese scholars, and thereby assimilable into Japanese medicine for the first time, because of a socioeconomic situation in which its mode of anatomical realism gained acceptance according to the indigenous criterion of ‘useful- ness’ in visual representation. These impressive contributions thus imply different answers to the second problematic concerning the trans- ferrability of medical systems and possibilities of transform- ation in Asian medicine. This question is one version of a fundamental anthropological problem concerning the uniqueness of cultural forms. Good and Goods’ essay on the spread of Islamic medicine argues that its ready acceptance in diverse settings demands an explanation in culturally specific terms, while Laderman documents such a process on the Malay peninsula. The ‘how’ of incorporation does indeed constitute a question to be answered in this way for each instance; the ‘why’ may however be better approached by considering the particular relations between oral and literate medical traditions and the forms of political power and economic domination that lend authority to the latter, than by assuming that Graeco-Arabic medicine carries unusual or even unique cultural resonance or adaptability. Zimmerman’s analysis of the ‘cornmodification’ of Ayurveda to suit the tastes of Westerners for whom the attractions of biomedical science have palled, approaches another aspect of the problem. His convincing demon- stration that clinical practice as represented in the ‘classical’ Ayurvedic texts rests on a therapeutic dialectic between violence and nonviolence, accompanies an assertion that this balance has been abandoned specifically in Westernised Ayurveda. The assumption of direct comparability between ancient theoretical text and current clinical utilization, though, lacks easy justification. A study of contemporary Ayurvedic practice in India (in its mundane, commoditised and syncretic forms employing pills, tonics and injections) is called for as an intermediary step against which to compare Ayurveda’s Westernised forms. Without this the distortion and misrepresentation of Western Ayurvedic practice for which Zimmerman finds evidence is not self- evidently so different in kind from some forms of ‘syn- cretism’ that Leslie discovers in his exploration of modern South Asian Ayurveda. Texts are always transformed in local practice, as Obeyek- ere demonstrates in a paper on scientific experimentation and clinical practice in Sri Lankan Ayurveda. A learned practitioner is shown to reject Sanskritic Ayurveda’s myths of divine origin because of his interest in empirical exper- imentation and his Buddhist background. Obeyesekere’s contribution also provides one answer to the puzzling absence of case histories in Ayurveda noted by the editors in their Introduction to Section 2. In Section 1, Farquhar argues that published case histories are the means by which ambiguities and applications of Chinese medicine are worked through and transmitted between practitioners. Obeyesekere suggests that in Sri Lankan Ayurveda, prescip- tions may perform a partially equivalent function in that by reading past prescriptions, the vaidya can ascertain the previous practitioner’s diagnostic interpretation and the nature of the disease. In their Introduction, Leslie and Young consider the past neglect of Asian medical systems (attributing it to Western logical empiricism and Whiggish tendencies in histories of Western science) and newly declare them as worthy objects of study “in their own right” (p. 1). Nevertheless only two of the 12 contributions (Seaman on Chinese geomancy and Trawick on Indian systems of healing) focus exclusively on internal aspects of Asian medical traditions. The rest deal in varying degree with interactions between biomedicine and the construction of indigenous medical knowledge or be- tween classical traditions and, autochthonous health cul- tures. Awareness of the dynamic character of Asian medicine and of the comparativism and historicity necessary for its analysis is thereby amply demonstrated, but it is interesting that in a postmodern world biomedicine/Western science re-emerges as a necessary dimension of study. While the editors’ Introduction suggests that moderniz- ation theory is outdated, two contributions consider differ- ent aspects of modernization and notably, both point to positive side-effects of the process. Lock’s perceptive study of Japanese concerns about the nuclear family and the adverse health effects of modernisation, exemplified in the attempted medicalisation of menopause, concludes that despite the medical profession’s efforts there is a trend 1105
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Transcript of Paths to Asian medical knowledge: edited by Charles Leslie and Allen Young. University of California...
Sot. Sci. Med. Vol. 36, No. 8. pp. 1105-1108, 1993 Printed in Great Britain
BOOK REVIEWS
0277-9536/93 $6.00 + 0.00 Pergamon Press Ltd
Paths to Asian Medical Knowledge, edited by CHARLES LFSLIE and ALLEN YOUNG. University of California Press, California, 1992. 288 pp., U.S. $40.00 (hardback) and $15.00 (paperback).
This collection is a welcome follow up to Leslie’s seminal edited volume, Asian Medical Systems (1976). The contri- butions derive mainly from a 1985 AAA meeting (one wonders why it took so long to publish such a useful collection) and variants of most have already appeared elsewhere. Nonetheless, resonances and linkages between their foci and approaches provide justification for this collection well beyond the practical usefulness of their being gathered in a single volume.
The book concerns the character of medical knowledge and is divided into three sections: Chinese and other medical traditions in East Asia, Ayurveda and other medical tra- ditions in South Asia, and Islamic humoral traditions. An underlying conceptual difficulty thereby becomes apparent; does Asian medicine refer (as is generally implied in the editors’ Introduction) to the indigenous textually based traditions, or (as appears evident from the inclusion of the relatively thin third section and from the subject matter addressed by several authors) to medicine practised in Asia? That this question is more than a matter of mere pedantry is evident in a consideration of the dominant themes emerg- ing from the volume as a whole. Whether Asian medical systems are coherent bodies of knowledge or heterogeneous and syncretic accretions of speculation and practice, and whether these traditions are inextricably rooted in local conceptual systems or are transferrable to other settings, are two predominant and recurring issues.
Addressing the former, Unschuld’s and Farquhar’s essays effectively challenge the myth subscribed to by both earlier Western scholars and Chinese revivalists, that ancient Chinese texts describe an internally consistent and complete system of medicine. Unschuld’s identifies Chinese medicine as a “patterned knowledge” (p. 58) based on a conception of truth defined through usefulness and thereby able to encompass contradiction, but irreconcilable with Western science’s criteria for logical truth. The notion of ‘usefulness’ as a defining criterion for knowledge echoes one of the preceding chapter’s conclusions. Kuriyama’s study of anat- omy in eighteenth century Japan analyses the process through which Western anatomy became ‘visible’ to Japanese scholars, and thereby assimilable into Japanese medicine for the first time, because of a socioeconomic situation in which its mode of anatomical realism gained acceptance according to the indigenous criterion of ‘useful- ness’ in visual representation.
These impressive contributions thus imply different answers to the second problematic concerning the trans- ferrability of medical systems and possibilities of transform- ation in Asian medicine. This question is one version of a fundamental anthropological problem concerning the uniqueness of cultural forms. Good and Goods’ essay on the spread of Islamic medicine argues that its ready acceptance in diverse settings demands an explanation in culturally specific terms, while Laderman documents such a process on the Malay peninsula. The ‘how’ of incorporation does indeed constitute a question to be answered in this way for each instance; the ‘why’ may however be better approached by considering the particular relations between oral and literate medical traditions and the forms of political power
and economic domination that lend authority to the latter, than by assuming that Graeco-Arabic medicine carries unusual or even unique cultural resonance or adaptability.
Zimmerman’s analysis of the ‘cornmodification’ of Ayurveda to suit the tastes of Westerners for whom the attractions of biomedical science have palled, approaches another aspect of the problem. His convincing demon- stration that clinical practice as represented in the ‘classical’ Ayurvedic texts rests on a therapeutic dialectic between violence and nonviolence, accompanies an assertion that this balance has been abandoned specifically in Westernised Ayurveda. The assumption of direct comparability between ancient theoretical text and current clinical utilization, though, lacks easy justification. A study of contemporary Ayurvedic practice in India (in its mundane, commoditised and syncretic forms employing pills, tonics and injections) is called for as an intermediary step against which to compare Ayurveda’s Westernised forms. Without this the distortion and misrepresentation of Western Ayurvedic practice for which Zimmerman finds evidence is not self- evidently so different in kind from some forms of ‘syn- cretism’ that Leslie discovers in his exploration of modern South Asian Ayurveda.
Texts are always transformed in local practice, as Obeyek- ere demonstrates in a paper on scientific experimentation and clinical practice in Sri Lankan Ayurveda. A learned practitioner is shown to reject Sanskritic Ayurveda’s myths of divine origin because of his interest in empirical exper- imentation and his Buddhist background. Obeyesekere’s contribution also provides one answer to the puzzling absence of case histories in Ayurveda noted by the editors in their Introduction to Section 2. In Section 1, Farquhar argues that published case histories are the means by which ambiguities and applications of Chinese medicine are worked through and transmitted between practitioners. Obeyesekere suggests that in Sri Lankan Ayurveda, prescip- tions may perform a partially equivalent function in that by reading past prescriptions, the vaidya can ascertain the previous practitioner’s diagnostic interpretation and the nature of the disease.
In their Introduction, Leslie and Young consider the past neglect of Asian medical systems (attributing it to Western logical empiricism and Whiggish tendencies in histories of Western science) and newly declare them as worthy objects of study “in their own right” (p. 1). Nevertheless only two of the 12 contributions (Seaman on Chinese geomancy and Trawick on Indian systems of healing) focus exclusively on internal aspects of Asian medical traditions. The rest deal in varying degree with interactions between biomedicine and the construction of indigenous medical knowledge or be- tween classical traditions and, autochthonous health cul- tures. Awareness of the dynamic character of Asian medicine and of the comparativism and historicity necessary for its analysis is thereby amply demonstrated, but it is interesting that in a postmodern world biomedicine/Western science re-emerges as a necessary dimension of study.
While the editors’ Introduction suggests that moderniz- ation theory is outdated, two contributions consider differ- ent aspects of modernization and notably, both point to positive side-effects of the process. Lock’s perceptive study of Japanese concerns about the nuclear family and the adverse health effects of modernisation, exemplified in the attempted medicalisation of menopause, concludes that despite the medical profession’s efforts there is a trend
1105
1106 Book Reviews
among women toward self-help discussion groups rather than seeking of medical advice. Nichter’s comprehensive analysis of an outbreak of Kyanasur Forest Disease in South India explores the patterning of response to a new disease produced by ecological disruption within a specific regional and historical context. In the turning of local community activists to address other local development-re- lated issues once the threat of KFD had subsided. Nichter too finds evidence for positive indirect effects in the shape of enduring community engagement and awareness.
The interweaving of topics and theoretical approaches summarised briefly here is an example of the great value to specialists of one or other region (in any social or medical discipline) of reading this important and consistently schol- arly volume in its entirely.
London School of Hygiuw and Tropicul Medicine
HELEN LAMBEK~
L;niwr.sify q f London Keppel St, London WClE 7HT, U.K.
Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s. by NANCY WAINEK COHEN. Bergin & Garvey, London, 1992. 407 pp., $16.95 (paperback).
I received this book to review while I was in my 9th month of pregnancy. I was unable to write the review because I was so moved (as perhaps in disbelief) at America’s reliance on cesarean sections and the patriarchal myths that have existed since the beginning of time. Now. that my birth experience has occurred, I have rcvicwed the book for a second time. And again, 1 experienced so many emotions. But what better complement could I give this book than to say that it will provide the reader with the opportunity to be moved emotionally. ChildbearIng couples. educators. health professionals. scholars. grandparents. friends of women experiencmg VBAC (Vaginal Birth after Cesarean) should read this book as an excellent resource for the information needed to be supportive and caring of a woman‘s declslon for the natural path of childbirth.
Many of you will remember Silenr Kn@: Cc~.wrrm Pre- clenrion and Vaginal Birth After Cesarcwn (Bergin & Garvcy. 1983) as the book of the 80s. Open Season is the book of the 90s which builds upon the content of the first book. If you haven’t had the opportunity to read Silerzr Knife. don’t miss reading Oprrt Seuson. This book will lead you through the American birth experience as a model to be housed in the Smithsonian Institute. I am in agreement with Cohen, when she states that the majority of births in America are so controlled by the medical establishment that one questions whether natural childbirth can ever be possible?
Cohen’s most provocative chapter. “Birth Crap! Inter- ferences and Interventions.” brings to the forefront a new paradigm to be embraced by society. She has synthesized a
cadre of data which examines all the paraphernalia that medicine has associated with a ‘natural’ birth and hundreds of stories gathered from her counseling experience. Anesthe- sia, drugs, electronic fetal monitors. episiotomy, forceps, IVs, and ultrasound are just a few of the procedures presented from many angles, but certainly the sarcastic humor interwoven into the text provokes a great many insights. The section on vacuum extractors is a prime example, when Cohen quotes one parent as stating, “The next thing on ACOG’s list of things to do to get a baby out (if vacuum extractions don’t seem to do the trick) is: Blast the thing out with a keg of dynamite.” This is well articu- lated, because when a doctor is ready to deliver (not necessarily the woman) often he will go to great lengths to find the one thing (forceps, vacuum extraction. pitocin drip or even C-section) to get the baby out. Many examples are based upon the experience of women, as it should be; a truly beautiful and important aspect of the entire book.
The ultimate outcome of this book is to help the reader realize the importance of women reclaiming their birth experience. Should birth be enjoyed or controlled? When women discover their own personal power perhaps the codependent relationship between women and obstetricians may make hospital deliveries obsolete. Now wouldn’t that make a difference in the National Health Agenda?
College o/’ Nursing Adult Health Departmenr L’nkersiiy of North Carolinn
ut Charlotte Churlorre. NC 28223 C,‘.S..4.
SONYA R. HARDIN
Feminist Perspectives in Medical Ethics, edited by HELEN BEQUAERT HOLMES and LAURA M. PUKDY. Indiana University Press, Bloomington, 1992. 320 pp.. $14.95 (paperback).
This collection of papers on feminist medical ethics was reproduced from two special issues of Hypariu: A Journal qfFeminisr Philosop/zy. The editors have selected an eclectic group of essays that represent five sections: The Medical Ethics Community: Feminist Views; The Role of Caring in Health Care; Women and Clinical Experiments; Women and New Reproductive Choices; and Contract Pregnancy.
Each group of essays will provoke debate among scholars and students interested in medical ethics, especially those concerned with feminist thought. With limited space it is impossible to highlight each section. Hence, an intriguing
article by Susan Wendall. on a feminist theory of disability, found in the section on “Feminist Views of Medical Ethic” will be discussed.
Susan Wendall illuminated the social and political reali- ties of women and disabled women in American society. The interface of sexism, racism, and classism with social oppres- sion of disabled women enlightens one to the primary causes of a person’s limited activity as being related to a denial of opportunities, lack of accessibility, lack of services, poverty, and discrimination. One of the most profound statements made by the author, who is also disabled, referred to answering the question of “How are you?’ For someone who is disabled this question becomes one of conflict. Society is conditioned to hear the answer of “fine”, yet when one is disabled things are not “fine”. Suffering caused by the body is not an acceptable topic. Able-bodied people fear the inability to be in control.
