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Metaphysical fitness and Ayurvedic medicine - Medical Anthropology
Townsend Letter for Doctors and Patients, April, 2003 by Tim Batchelder Metaphysical fitness and Ayurvedic medicine - Medical Anthropology Townsend Letter for Doctors and Patients, April, 2003 by Tim Batchelder Better understanding of alternative medicine including medicines from other cultures, involves rethinking the basis for our understanding of medicine, health and fitness in Western society and how this colors our perception of other medical systems. Alter (1999) has written an excellent article that addresses just this sort of shift in perspective using the case of Ayurvedic medicine as an example. In particular, he considers how Ayurvedic medicine works to promote the overall fitness of the individual, defined in a much broader ecological, spiritual and biological sense than we use the term, rather than just cure disease. In this column I discuss Alter's work in detail. Escaping Remedial Medicine Alter (1999) notes that most scholars including anthropologists accept that medicine involves healing problems of poor health and that good health is a natural, normal state even while accepting that illness, disease, and pain are culturally relative. According to Alter, most medical systems are by definition remedial and applied, retroactive, problem orientated, and backward looking, looking for defects, causes, risks and genetic markers. Western medicine considers disease and death to be natural facts of life which leaves good health as the absence of these states, a default category. However, Ayurvedic medicine makes no such assumptions and embodies health in a proactive, whole body fitness approach rather than focusing on illness or disease. Ayurveda is a science of medicine that escapes the ontology of health defined in terms of disease and rather aligns itself with the forces of nature and ecology, opens the realm of optimal, maximal, unlimited health promotion and provides a better point of reference f or understanding the great diversity of medical systems. Ayurveda in Academia Alter (1999) acknowledges that his perspective on Ayurveda parallels a theme from the holistic health movement which began in 19th-century America (Edlin and Golanty 1985, Gevitz 1988, Goldstein 1992, Paul 1983; see also Berryman 1982, Betts 1972). Yet outside of popular movements, little value has been given to traditional medicine systems such as Ayurveda in academia. Even medical anthropology has focused excessively on cross cultural therapies that are remedial and the cultural construction of the experience of ill health, medicalization of the body, and ways people try to "get back to where they were" before the onset of disease, illness, or pain (Csordas; Good 1994; Jordanova 1989; Kleinman 1986, 1988; Martin 1987, 1994; Scheper-Hughes and Lock 1987; Strathern 1996; Taussig). Medical anthropologists have spent most of their energy studying symbolic structure and meaning of the body (Bettelheim 1962; Douglas 1966, 1970; Levi-Strauss 1966; Mauss 1973, 1979; Turner 1968, 1969) and altered states of consciou sness, trance, charismatic healing (Comaroff 1985, Osordas 1994, Desjarlais 1992, Laderman 1991) and other non-medical types of embodied experience (Blacking 1977, Boddy 1989, Gallagher and Laqueur 1987,Gottlieb 1988, Jacobus, FoxKeller, and Shuttleworth 1990, Lutz 1988, Sault 1994, Turner 1984). These studies focus on the relationship between various somatic experiences and their cultural context and tend to avoid addressing physiological and anatomical health, instead concentrating on aesthetics, religion, politics, philosophy, and economics. The assumption that good health is a natural, biological given with universal significance creates serious problems for the cross-cultural study of health, since it does not allow for alternative perspectives on what the goal of medicine might be. Fortunately, in the past 5 years other researchers have attempted to examine medicine in South Asia using approaches similar to Alter's (Daniel and Pugh 1984; Trawick 1988, 1987, 1991, 1992; Leslie 1983, 1992; Obeyesekere 1982, 1992; Zimmermann 1987, 1992; Zysk 1985, 1986, 1991; White 1996). Zimmermann focused on the logic of Ayurvedic theory. White looks at the science of Siddha medicine in medieval South Asia and the connections between alchemy, yoga, and Ayurveda that produce its complex physiology linked with the metaphysics of asceticism and world renunciation (see also Hausman 1996). Even so, writers, while pointing toward an alternative perspective on the ontology of medicine operate out of the standard remedial perspective and so view Ayurveda as a technique to cure sickness. Metaphysical Fitness Physical fitness has been a key part of alternative medicine in Europe and the United States (de France 1987, Fellman and Fellman 1981, Hoberman 1992, Porter and Porter 1988, Whorton 1982) and has also been considered at times important to so-called mainstream biomedical theories of disease, contamination, and pathology (Berryman 1982, 1992; Park 1992, 1994; Rippe 1992) but has recently been exiled from the clinic and the realm of science and consigned to the gym and amorphous recreation and leisure studies (Green 1986, Mangan and Walvin 1987, Smith 1972). Anthropologists have given little attention to physical fitness so the concept is contaminated heavily, Alter explains, by biased Western concepts of fitness that obsess about incremental enhancements of mechanical function or muscle bound morphology rather than transformation to expand the limits of experience, achieve perpetual growth and metamorphosis. Alter attempts to develop a more flexible concept of physical fitness that can be used by people intere sted in alternative medical systems and coins the phrase "metaphysical fitness" to describe this approach. Holistic Health, Natural Medicine and Ayurveda Alter (1999) notes that even practitioners of holistic health work from the limited perspective of Western physical fitness in which a predetermined state of balance or homeostasis needs to be maintained rather than pursuing unbounded goals. Thus holistic health is only "alternative" in a very narrow sense since it is overly influenced by the epistemological hegemony of the remedial bias that dominates institutionalized medical practice. It is used in a defensive manner to prevent getting sick and is simply the defensive side of the remedial approach. Alter advocates for seeing "normal good health" as limited and compromised and making the concept of health unbounded and uninhibited and medicine, the pursuit of this unbounded health, quite apart from finding cures. He advocates for looking at traditional medical systems such as Ayurveda as a mode of "radical self-improvement" rather than primitive methods of curing disease through application of humoral medications and more "natural" or "ecological" therapies . Similarly, Zimmermann (1992) deplores the recent tendency in both India and other countries to conflate Ayurveda with any notion of "natural healing" and mystical holism (for examples see Chopin, Rothenberg, and Averbach 1990, Frawley 1997, Hope-Murray 1997, Lad 1990, Sachs 1996, Svoboda 1982, 1996, Tiwari 1995, VanHowten 1997, and Verma 1995.) Counteracting the holistically natural, somewhat eco-mystical self-help orientation of much of this literature, Zimmermann shows that Ayurveda is a rational science based on logical principles that entail the transformation of a natural ecology into the cultural practice of clinical medicine. Institutionalized Ayurveda has gained recognition as a modem medical system, but as with all "holistic" medical systems it has been turned into an indigenous form of remedial, allopathic medicine and, on a more transnational plane, into a so-called "natural" alternative to biomedicine. As a result, its ontological concern with physiological fitness and humoral self-perfection has been misinterpreted, in epistemic terms, as a remedial quest for recovery and as a holistic form of preventive medicine. This is not at all surprising, given that immortality is usually regarded as a philosophical and mythological question -- not a biological one in the West. Alter explains that Ayurvedic science as described in the canonical literature (translations of and commentaries on the three primary medical treatises, those of Caraka, Susruta, and Vagbhata) as opposed to the modern, clinical practice of it in hospitals and clinics in South Asia (which is highly influenced by remedial tendencies) is not holistic, nor is it based on an ideal of body-mind synthesis or restoring homeostasis to diseased bodies. The Transformation of Ayurveda by the West
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