Combining stories: Reading Tibetan Medicine as a Western Narrative of Healing

8/6/2019 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.

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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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Documents

Combining stories: Reading Tibetan Medicine as a Western Narrative of Healing