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Moral Medicalizing, Cultural Survival (Review)

Reviewed item: 

Theresia Hofer. 2018.
Medicine and Memory in Tibet: Amchi Physicians in an Age of Reform
Seattle: University of Washington Press
ISBN 9780295742984

Overview
Theresia Hofer’s Medicine and Memory in Tibet is a captivating ethnographic and historical exploration focused on the amchi in the rural Tsang area, local highly engaged medical practitioners on the peripheries of Tibetan society, whose medical presence reflect shifting dialogues with their more institutional and politicized pan-Chinese and Tibetan Autonomous Region’s healthcare counterparts in monasteries, medical schools, clinics, and hospitals. Among the plethora of studies in recent years on the politicization, scientization. and commodification of Tibetan medicine in present-day Tibetan areas[i] and explorations of Tibetan assertions to maintain or preserve the religious within the scientific or amongst political forces,[ii] this study focuses on the lesser known and neglected realm of the rural amchis, whose varied perspectives acutely illuminate the complex relationship between Tibetan medical practice and identity amongst modern political pressures and transformations. Hofer’s work represents an adept balancing act of close ethnographic lenses of particular amchis like Yonten Tsering and medical houses like Tѐrap within the wider historical landscape of the political and economic transformations of Tibetan medicine on the Mainland. In six rich and intriguing chapters, the author provides the reader the basic trajectories that Tibetan medicine has taken in the 20th century with a close study of the authority and lineage of ‘medical houses’, the historical intersections of religion and medicine in public health campaigns in narratives of the nation and Tibetan identity, the state orchestration of the past, or of what Hofer aptly refers to as ‘state time’, and the effects on individuals’ memories in ‘oppositional practices of time’, the political impact on Tibetan medicine from 1966 to the present moment, and the presence of a moral economy within an underlying persistent political landscape. The significant role of male and female amchi practices of Tibetan medicine is weaved throughout her study.

Core Features
The core of this study culminating in the sixth chapter is the moral economy of the Sowa Rigpa, a technical name for Tibetan medicine, which I will refer to as ‘Tibetan healthcare’ in order to align closely with this exploration rather than using the typical translation of Tibetan healing or science of Tibet. In Hofer’s study, we are reminded that Tibetan identity has been historically, and is still, closely aligned with Tibetan healthcare. Although Tibetan identity within the realm of human rights and Chinese politics is well known in various scholarly studies, its connection to healthcare is not always clearly apparent. In this study, we are informed in well-crafted descriptions that healthcare is not the mere act of dispensing medicine of materia medica to a disconnected other, but is rather a careful balancing of politicized persons, Tibetan cultural identity, medical ethics, physical survival, and bodily well-being. With a more nuanced understanding of Tibetan perspectives of illness and healthcare within Tibetan cultural and political contexts, Hofer alludes that different conclusions of Tibetan identity and representations are evident. Rural practitioners, who wield different signs of Tibetanness and hold diverse political wands, act as voices of the local people holding on to some version of a hybridized representation of a modern Tibetan with disparate memories of Tibetanness depending on his or her past experiences and placement in a highly politicalized and commercialized society. What is also apparent is that despite social and political inequalities, local amchis’ practices represent a ‘selective’ and ‘practical resistance’ to the ‘increasingly capitalist-driven government primary care and Tibetan pharmaceutical industry’ (p. 118), which supports the well-being and health of Tibetan identity and everything else that health normally refers to. This is reminiscent of what Craig Janes saw on a local level with the high cases of ordinary Tibetans’ manifestations of wind diseases as a reflection of suffering resistance.[iii] What is critical to understand in this study is that after close examination of amchi practices, the remnants of what is often perceived as marginalized local practices are in fact the core – the center of Tibetan healthcare – weaving past traditional practices and current local manifestations, thus linking rural Tsang to urban Lhasa.

As I peruse several of the tidbits of this study, I am hopeful that others will soon pick up from where Hofer left off, conducting local studies with wider significance in Tibetan areas as the door opens and closes to scholars in such regions. This unique study will be of interest to scholars of Tibetan medicine, public health, cultural and social anthropology, political economy, religious studies, and history.

[i] Martin Saxer, Manufacturing Tibetan Medicine and the Moral Economy of Tibetanness, Oxford: Berghahn, 2013; Vincanne Adams, Mona Schrempf, and Sienna Craig, Between Science and Religion: Explorations on Tibetan Grounds, Oxford: Berghahn, 2010; Vincanne Adams and Fei Fei Li, Integration or erasure?: Modernizing medicine at Lhasa’s Mentsikhang, in Laurent Pordie (ed.) Exploring Tibetan Medicine in Contemporary Context: Perspectives in Social Sciences, London: Routledge, 105–31.
[ii] Ivette Vargas-O’Bryan, Balancing tradition alongside a progressively scientific Tibetan medical system, in Ivette Vargas-O'Bryan and Zhou Xun (eds) Disease, Religion and Healing in Asia: Collaborations and Collisions, New York: Routledge, 2015, 122–45; Vincanne Adams, The sacred in the scientific: Ambiguous practices of science in Tibetan medicine, Cultural Anthropology 16(4), 2001: 542–75.
[iii] Craig Janes, Imagined lives, suffering, and the work of culture: The embodied discourses of conflict in modern Tibet, Medical Anthropology Quarterly 13(4), 1999: 391–412.

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