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Modernity and Indigenization a Study Into Bio Medical Discourses in India

Modernity and Indigenization a Study Into Bio Medical Discourses in India

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This article was published in ANTHROPOLOGY ON THE MOVE: CONTESTING CULTURE STUDIES IN BANGLADESH, ed. Zahidul Islam and Hasan Safie (Dhaka: Dept. of Anthroplogy, University of Dhaka, 2006), 231-254.
This article was published in ANTHROPOLOGY ON THE MOVE: CONTESTING CULTURE STUDIES IN BANGLADESH, ed. Zahidul Islam and Hasan Safie (Dhaka: Dept. of Anthroplogy, University of Dhaka, 2006), 231-254.

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Published by: Jayanta Bhattacharya on Dec 05, 2009
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 1
Modernity and Indigenization: A Study into Biomedical Discourses in India
 Jayanta Bhattacharya
The figures of pain are not conjured away by means of a body of neutralizedknowledge; they have been redistributed in the space in which bodies and eyes meet. What haschanged is the silent configuration in which language finds support: the relation of situationand attitude to what is speaking and what is spoken about.– Michel Foucault,
The Birth of the Clinic: An Archaeology of Medical Perception
, xi.
Introduction
There is a story about the physicist Enrico Fermi (1901-1954). Thanking a guestspeaker for a lecture he had just given, Fermi told him that before the lecture he had beenconfused about the subject. Now, having heard him, he was still confused – but at a higherlevel. I am afraid talking about biomedical discourses in India may have caught us into asimilar confusing situation. But, confusion – or at least, a lack of certainty – is, I believe, a veryimportant thing for investigation. There is not a single frame through which we can view theentirety of nuances in these discourses. Search for the meanings of health and disease ishaunted by two originary questions which have not yet been answered satisfactorily – Whyme? Why now? So, let us fall into the maze of confusion – at least, for the time being.R. M. Hare, the philosopher of medicine, asks, “Why do attacks of viruses count asillness, but not the attacks of larger animals or of motor vehicles? Is it just a question of size?Or of invisibility?…Does a disease have to be something
in
me? And in what sense of ‘in’?”
1
 To reconcile opposing concepts and confusion, may be to lesser extent, the concept of diseasebecomes normative – where, what counts as the ‘norm’ is prescribed rather than statisticallyderived. In effect, we decide what constitutes a disease. What do we mean when we use theword ‘disease’ and when we use the word ‘health’?
2
Sometimes the debate seems to be merelyabout our use of words. Sometimes little consideration is given to the underlying biology.Arthur Kleinman offers an example from the front page of the
 New York Times
of Tuesday,March 10, 1998, to show “the immense disjunction between the claims for what is supposedlyknown about the biological bases of human nature and what is actually known about humanconditions.” He concludes, “Viewed from the decidedly ordinary practices of everydayexperience, human conditions certainly have a biology, but they have a history, a politics, aneconomics, and they reflect cultural and subjective differences.”
3
I may now ask what ishealing? “Clearly, it is a somewhat different thing for patient (and perhaps family),practitioners, and researcher.”
4
Most Western-style doctors communicate in a technical,
1
R. M. Hare, “Health” in
 Journal of Medical Ethics
1986; 12: 172-181.
2
For a brilliant discussion about normativity of the normal, pathological, health, and disease see, GeorgesCanguilhem,
On the Normal and the Pathological
(Holland, Boston, London: Doerdrecht, 1978).
3
Arthur Kleinman,
 Experience and Its Moral Modes: Culture, Human Conditions, and Disorder 
(TheTanner Lectures on Human Values), delivered at Stanford University, April 13-16, 1998.
4
Kleinman,
Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry
(Berkley, London: University California Press, 1981), 354.
 
 2professional, Western idiom that is not readily accessible to most patients. The idiom ismechanistic and somatic. Western-style clinical reality is
secular 
. Although it is suffused withWestern values. Western-style doctor-patient interactions do not depend on their clinical realityfor their efficacy, but, as several of examples illustrate, the clinical reality they construct oftenyields negative consequences. Among the rural populations and lower class, and lower middle-class urban dwellers in developing societies, clinical reality often combines
secular 
and
sacred 
components. But for the educated middle class, it is increasingly secular.
5
 
There should be acautionary note at this juncture, “It remains altogether necessary for lay people who for theirpolitical action want not only to be guided by prepared information but to form a judgement. Inthis flood of information the orientation of the layperson is peculiarly mediated and, hence,dependent.”
6
 Moreover, there is a serious problem about taking the objective scientific picture as the‘true’ view of the ‘real’ world. The ‘objective’ picture is then taken for granted “as the realworld around us.”
7
This is particularly true for Western societies. But when doctors andmodern healing (with the normative concept of health and disease) confront people combinedin the ‘secular and sacred’ in developing societies an altogether different situation may arise. Inthis situation modernity stands vis-à-vis indigenization, possibly, contesting, complying andoverdeterming each other at some or other moments. Some issues become more important thanothers: (1) how the body is positioned in these two differing paradigms, (2) how lay knowledgecomes into terms with expert knowledge and vice versa, (3) how medicalization of indigenouslife world insidiously occurs, and finally, (4) how metonymic reconstitution of epistemologicalcategories and disembodiment of knowledge take place. Here an interdisciplinary approachinto anthropological, sociological, philosophical and clinical perspectives of medicine mayhelp give some plausible and satisfactory answers. My paper is a preliminary journey in thisdirection.
A few notes on anthropology of medicine
Biomedicine is not a homogeneous monolithic entity. The medical world, by virtue of its origin narrative, becomes a melting pot of contradictory theories and practice, controversiesand inexplicable phenomena about which doctors and laypeople are in constant debate.“However, can we place ‘authentic’ knowledge directly opposite knowledge which has beentainted by medicalization? Laypersons against the experts? Is the dividing line between theman absolute one?”
8
Medical practitioners from within their discipline may throw some light onthese vexing questions as, in a unique way, they may be called ‘un-academic’ anthropologists.Being an ‘anthropologist’ there remain some advantages to experience encounter betweennarrative and technology on the one hand, and body and society on the other. Medicalanthropology is about how people in different cultures and social groups explain the causes of 
5
Ibid, 304-308
6
Hans-Georg Gadamer,
The Enigma of Health: The Art of Healing in a Scientific Age
(Cambridge: PolityPress, 1977), 8.
7
For an exhaustive account of this issue, and more, see, Kenneth M. Boyd, “Disease, illness, sickness,health, healing and wholeness: exploring some illusive concepts” in
 J Med Ethics: Medical Humanities
 2000; 26: 9-17.
8
Els Bransen, “Has menstruation been medicalized? Or will it never happen….” In
Sociology of health and  Illness
1992; 14(1): 98-110.
 
 3ill health, the types of treatment they believe in, and to whom they turn if they do get ill. It isalso the study of how these beliefs and practices relate to biological, psychological and socialchanges in the human organism, in both health and disease.
9
When we study a group of humanbeings, we would better engage ourselves to study the constituent elements and features of their society and their culture and, to add, their perception of health. Kleinman notes, “Culturalprocesses include the embodiment of meaning in habitus and physiological reactions, theunderstanding of what is at stake in particular situations, the development of interpersonalconnections, religious practices, and the cultivation of collective and individual identity.”
10
 Any anthropological study taking into account these nuances would reveal the perpetualconfrontation and assimilation between modernity and indigenization. Indigenization may beunderstood as an ensemble of dynamic processes (within the porous micro world of the locale)which try to adapt, reconfigure, translate and work out some different operative mechanismswhile interacting with the outer macro world loaded with global flow of surpluses, signifiersand deterritorialized desire. But, as no life process can be fully reduced or be made amenableto
only
discursive practices, a set of structures and theories or some ‘normalizing’ processes,modernity and indigenization go on overdetermining each other within the interstices of thisdiscursive instability. In Indian perspective, the process of indigenization signifies, possibly, aparadigmatic shift from methodological individualism to methodological relationalism.With these preliminary remarks I like to rather pursue a not-so-anthropological studyinto the stated theme. I would try to follow, on the contrary, non-linear and overlappingmovements between postcolonial predicaments and colonial moments within the purview of medicine and health. Besides some general observations, I would also try to focus on this issueexploring some of the aspects of traditional and ‘medicalized’ childbirth in India. There willalso be an attempt to show how this process can be primarily located through: (1) body-community separation as conventionally practiced in biomedical system, and (2)technomedical hegemony and hierarchical organization (as in case of health care andchildbirth). To remember here, “expanding metaphors usually only modify rather than radicallyalter thought or action already also oriented by other powerful metaphors…But problems mayarise when a metaphor expands in a sphere where it is not challenged or complemented byequally powerful metaphors which are also expanding…Metaphorical ideals such as “healthybehaviour” and “mental health” propounded by doctors and others who are perceived to be“objective” and to have no ideological axe to grind, have expanded to fill the vacuum as itwere.”
11
Hence, there erupts the absence of any metaphors more convincing than
therapeutic
 ones. This perhaps becomes the existing milieu of an indigenous world.The new scientific healing emphasized objectivity in the collection of data, largelydispensing with the patient’s narrative in favour of specific measurements of biologicalactivity. It is not difficult to understand that different corporeal ambiguities, as perceived inpre-colonial India, began to be subsumed by powerful scientific rhetoric of medicine. Thelocalization of disease, for the first time in medical history, to the lesion inside the body caused
9
Cecil G. Helman, “Introduction: the scope of medical anthropology”, in
Culture, Health and Illness
, 4
th
 edition (London: Arnold, 2001), 1.
10
Arthur Kleinman, “Culture and Depression” in
 New England Journal of Medicine
2004; 351(10): 951-953.
11
Kenneth Boyd, “Disease, illness…”, 15.

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