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A whole realm of unregulated healing

July 9, 2014
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Subaltern therapeutics in Indian medical history – by David Hardiman and Projit Bihari Mukharji

In India, government health facilities have been notorious for their inadequacy, whether in British colonial times or under subsequent independence. State hospitals are frequently overcrowded, offering a much poorer service than private hospitals. Local public health centres are run by staff who lack commitment to their work and indeed are often absent. Money is often demanded for treatment that should be free of charge. These limitations provide the conditions for a large and flourishing healthcare sector that is entirely unregulated. This ranges from modern medicine provided by unqualified or inappropriately qualified people who style themselves ‘doctors’ to popular remedies and spiritual cures. Their care is usually cheap and easily available, though its quality is highly variable and often questionable. In the absence of regulation, the sector is wide open to malpractice.

While medical historians of India have in recent years studied biomedicine and the systematised and regulated indigenous systems, such as Ayurveda, in some depth, the unregulated sphere has been largely ignored. We know of it mainly through the work of medical anthropologists, and however fine their studies may be, they are usually of contemporary times and not the past. ‘Folk’ therapies appear in their writing as timeless and unchanging; history, if visible, appears as a benign background rather than a dynamic site of analyses. Moreover, the vast majority of these anthropological works study ‘folk medicine’ without any reference to the vernacularised biomedicine that is practised so widely by unqualified ‘doctors’. As historians, we are not satisfied with this state of affairs, as it excludes from the history books any adequate recognition and analysis of large areas of healthcare in South Asia. The challenge for us has been to construct a history of this whole realm of unregulated healing, and to situate it in relation to the histories of the better-known and better-researched spheres of regulated practice.

A display for a pharmacy in Delhi. By Ben Dray, 1993. Wellcome Library

A display for a pharmacy in Delhi. By Ben Dray, 1993. Wellcome Library

Although this realm is often described as ‘folk medicine’, we prefer to use the term ‘subaltern therapeutics’. The idea of ‘folk medicine’ was first formulated in the late 19th century by folklorists such as the Glaswegian solicitor William George Black. It was seen to exist in stark contrast to and in isolation from the world of ‘rational medicine’, and was understood either as a remnant from a primitive past or as a debased form of an earlier ‘classical’ form of medicine. It was associated almost exclusively with marginal groups such as women, the unlettered and the rustic. Imported to South Asia as part of the armature of colonial knowledge, through administrator-scholars such as William Crooke, L S S O’Malley and others, the anachronistic, irrational, oral and marginal associations of ‘folk medicine’ were easily mapped onto colonial visions of caste. Thus while an earlier generation of classically trained Indologists had studied and admired Sanskrit (and to a much lesser extent Perso-Arabic) medical texts, by the end of the 19th century a new generation of scholars argued that the vast majority of the country, composed as it was of non-elite caste populations, was cut off from those textual traditions and practised instead a jumble of irrational therapeutics. This assertion resonated closely with the emerging notion of ‘popular religion’, and authors spoke, with thinly veiled disdain, of the numerous ‘godlings of disease’ found throughout South Asia.

All these alleged attributes of ‘folk medicine’ are patently incorrect. Much of this sphere – such as massage – is unrelated to any putative ‘godling’. Moreover, in cases where there is indeed an association with some specific disease deity – such as the fever-demon Jwarasur – these deities are often equally present in the textualised, ‘classical’ traditions. Far from being anachronistic, ‘subaltern therapeutics’ is deeply historical – appropriating ideas, images and, most prominently, materials from their historical context. Even more interestingly, the ‘godlings’ so disdainfully discussed as primitive leftovers have frequently been found to be fairly modern developments in their own right. Similarly, the aspersions of exclusively non-elite or lower-caste affiliations of such cults are also misleading. While there is often a decided prominence of marginal groups in such healing cults, they seldom if ever wholly lack some sociological and cultural overlap with more elite groups.

In preferring to talk about ‘subaltern therapeutics’ rather than ‘folk medicine’, we want to address some of the inaccuracies of the latter designation. ‘Subaltern’ shows that we are dealing here with relationships of power in which the popular therapist is both marginalised and stigmatised by the medical establishment. It also allows us to escape from the essentialised conceptions of ‘folk’/‘volk’. Then ‘therapeutics’ covers much more than the combination of ritual and placebo that is implied by the term ‘medicine’ in this context. As Charles Rosenberg has argued, ‘therapeutics’ entails “a complex and interactive system, centring on the doctor–patient interaction but incorporating the specific physiological activity of drugs, social relationships at the bedside, and the expectations of participants as well as views concerning the nature of the human body and the physiological basis of health and disease”.

Having reached this point, we needed to devise a way to grasp this multi-dimensional sphere of therapy. Yet it eludes crisp and pithy definition. We have therefore provided the following taxonomy:

Body work: This is of two broad types. First, there are massage-oriented traditions and techniques. They are applied on the surface of the body. They claim to either enhance internal flows or set right displaced vessels, nerves and muscles, all within the body. A second form of body work utilises more interventionist techniques, such as moxibustion, cupping, seton insertion and so on.

Spirit work: This is perhaps the most easily recognisable, though it incorporates many types of practice, such as shamanism, the exorcising of malign spirits, the propitiation of disease deities, miracle cures, and faith healing. As this domain continues to grow, its repertoire of spiritual agents and practices does too.

Domestic medicine: This has been studied in South Asia largely in the context of popular midwifery. Other forms of domestic healing, usually carried out by women, have been almost entirely ignored by historians. Since the late 19th century it has been the target of criticisms for its supposed irrationality. However, attempts have also been made to train local midwives and bring them within the orbit of the regulated sector. This is normally dominated by men, and thus women lose their earlier autonomy.

Remedy-based traditions: Throughout South Asia, numerous localised traditions of healing have developed around particular remedies. There are village herbalists who have a detailed knowledge of the curative powers of various plants. There are healers who have a local reputation for their particular remedies. These can be directed at specific illnesses, such as the fish therapy of Hyderabad for asthma and Chandshi medicine for piles and fistulas, or they can be relatively broad-spectrum remedies such as Babon Gaji’s oil in Tajpur, West Bengal, which cures both broken bones and burns. These remedies are frequently tied to a particular family, cult, shrine or a small local community.

Vernacularised biomedicine: Today this is undoubtedly the most robust strain of ‘subaltern therapeutics’ in South Asia, and it thrives in rural locations as much as in urban slums. The incapacity of the postcolonial state to extend universal access to reliable biomedicine, particularly for the poor, has sustained this sector. The government and the medical establishment frequently pour scorn on such ‘quackery’. It is reported on in a generally unsympathetic media and is the subject of the occasional academic study. There is however little detail on the history of this thriving sector of medical practice. How such practitioners diagnose and treat diseases and how they have come to apply biomedical technologies like injections and X-rays is an ill-understood area that requires urgent engagement. Instead of simply dismissing it as quackery, we need to acknowledge it as a robust therapeutic alternative for the majority of South Asians and engage with it seriously in order to come to firmer and better-informed conclusions about it.

In all these healing spheres, we argue, there are distinctive histories to be written, and it is only by doing this that we can provide an adequate medical and therapeutic history of India. We have ourselves made a start in this direction in a recent publication. Do get in touch if you have a contribution to make too.

David Hardiman is Emeritus Professor of History
 at the University of Warwick (d.hardiman@warwick.ac.uk). He is a founder member of the Subaltern Studies group, and in recent years has been working on popular forms of healing in South Asia. Projit Bihari Mukharji is Martin Meyerson Assistant Professor in Interdisciplinary Studies at the University of Pennsylvania (mukharji@sas.upenn.edu). He is interested in the intersection of the histories of science, religion and subalternity. Together, they have recently edited the volume ‘Medical Marginality in South Asia: Situating subaltern therapeutics’ (Routledge, 2012).

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