Conceptualising a global history of healing

In this blog post, me and my colleague Markku Hokkanen share our thoughts on writing medical history from a global history perspective. We have recently completed editing a book titled Kiistellyt tiet terveyteen (Contested Ways to Health, Finnish Literature Society, forthcoming in 2017), in which we examine healing from a cultural and social perspective in global history.

Curing illness and maintaining health and wellbeing have been crucial issues for individuals and societies throughout human history. People have sought many ways to health. These means have often been contested and winding. The chapters in our forthcoming edited volume consider what has constituted acceptable and forbidden healing, and what have been the central arguments for or against different healing systems. Our point of departure is that, from the time immemorial, medical cultures have been plural. Within these cultures, medical systems have competed but also complemented each other.

The influence of popular healing, defined as opposite to learned or university healing, has been the more meaningful the further one looks in the past. For a long time, university-trained physicians served exclusively upper class patients while the majority of people relied on folk medicine and popular healers. Our work focuses on encounters between popular and learned medicine. Hybrid healing and contestation over meaning can often be found in the intersection of these differing traditions and ways of conceptualising health and illness.

We approach the medical past from a cultural, not biomedical, perspective. Our main focus is on the meanings, experiences, and definitions of health and healing, as well as on the attempts to evaluate and control different forms of healing. Furthermore, our work shows how healing systems have often become hybridized. Health can be defined culturally as a socially constructed and subjectively experienced state of wholeness. Yet, healing should not be studied only as a social construction. Combining cultural and clinical approaches would be ideal, but this often raises the problem of retrospective diagnoses and discussing the effectiveness of past forms of healing.[1]

Due to the influences of anthropology, medical pluralism has in recent years emerged as a significant theme in the social history of medicine. Medical anthropologists have focused their gaze on different healing systems and medical cultures for several decades. Interest in medical pluralism has been fueled in part by disappointment in western medicine, and the contemporary emphasis on patients as consumers in the globalizing medical market place. As Waltraud Ernst has pointed out, pluralism is both a liberating and a problematic concept. Focus on medical pluralism effectively questions dichotomization and homogenic medical systems. Yet, an uncritical pluralistic approach can lead to forgetting questions of power or to a naive view of the world in which everyone has similar options to choose from. A simple definition of medical pluralism is that two medical systems exist side by side, competing but also complementing each other. Yet, medical pluralism can be defined not only as the plurality of systems but also as an inner pluralism of medical systems. The latter definition points to the healers’ and patients’ multiple creative choices and hybrid influences on forms of healing.[2]

Medical pluralism is not a recent phenomenon: it can be found in different historical eras and societies. Neither is it simply a growing phenomenon, although globalization and the Internet have sped up the dispersal of both modern and traditional medicines. The interest on pluralism has however clearly grown recently, and this needs to be understood in a wider context of cultural development, the interplay of tradition and modernity, and questions related to national identities and globalization. Historically it is worth noting that different healing traditions or ostensibly unified medical systems have been created and legitimized by different actors in complex processes of negotiation and contestation. ”Mainstream” medicine as well as ”traditional” healing in different constellations of time and space are results of processes with multiple pluralistic elements.[3]

In studying healing in global historical context, we must emphasise connections between geographical regions and the worldwide motion of people, commodities, ideas and institutions as well as their effect on regional and national dynamics. Global history recognizes the problems and limitations of an Eurocentric approach. In history of medicine, a global approach is not unprecedented; William McNeill’s classic Plagues and Peoples (1976) demonstrated that placing Europe in the margins can open important new perspectives on world history. Challenging Eurocentric ideas is possible both on the macro and micro level of history, and the social history of medicine is an excellent field for probing the global turn in historical research. For large parts of the world and for the majority of its peoples, Western medicine has been a marginal and a late newcomer in medical culture.[4]

 

 

Medical Cultures and Systems

 

Medical systems and cultures are socially and culturally constructed, complex and dynamic phenomena. They contain the thinking, actions and interactions between the patients and healers. Medical culture, in turn, is a wider concept than medical system. We use the term medical culture to refer to the cultural field containing several medical systems that exist side by side and interact with each other.[5]

Ludmilla Jordanova has emphasized a cultural approach to the social history of medicine, which takes into account both ideas and social processes within medical cultures. This approach can also shed light on the relationship between medicine and religious or judicial systems.[6] Our book falls naturally into this research tradition. Questions related to the lawfulness and acceptability of healing are intimately related to its credibility. The rhetoric of healers and patients as well as explanations given to illness and curing are central aspects of studying past and present forms of healing.[7] Healers employing unsuccessful, suspicious or otherwise strange methods have often been defined as quacks, charlatans, witches, criminals or even insane. However, it is difficult to assess which healers have been deliberate ”fraudsters”; whether healers believed in their own methods is often impossible to assess.

The concept of alternative medicine usually refers to healing systems that differ from Western biomedicine. However, from a global historical perspective alternative medicine is a problematic concept, because before the breakthrough and hegemonization of biomedicine in the twentieth century, university medicine was an alternative among many other medical systems.[8] It was often a marginal and exclusively urban form of healing. Roberta Bivins has argued that conceptually, Western humoral theory was not far from South Asian and Chinese healing traditions. These premodern medical systems were globally unified by a view of the human body as a microcosm of the universe. Healers with different cultural backgrounds were able to benefit from the thinking of others; linguistic boundaries put more limits to sharing ideas than the differences between medical systems.[9]

In a longue durée perspective, the contemporary hegemony of biomedicine or a single medical system is exceptional. However, this hegemony is far from complete even in the western world, where medical cultures remain pluralistic without exception. In many developing countries, hospitals remain marginal institutions in advancing national health.[10] In these circumstances, Western medicine can hardly be defined even as an alternative but people largely rely on medical systems defined as traditional medicine or complementary and alternative medicine (CAM) by the World Health Organization (WHO). From the patients’ point-of-view, CAM is a fitting term for describing the global history of healing. Ways to health have often included many alternative and complementary healing practices.

It is worth bearing in mind that, globally, traditional medicines have developed in creative historical processes of pluralistic interaction. Even medical systems codified in writing, such as Chinese and Tibetan medicine, South Asian ayurveda or Islamic unani traditions have undergone dynamic changes leading to hybridization, often influenced by European medical thought. For example, the use of radical and rough healing methods, such as bloodletting and purging, has decreased in modern ayurveda while ”soft” methods have become more popular.[11]

In global history, many healing methods have been categorized as magic or sorcery. The meanings and definitions of magic have evolved in different eras and cultures. In medieval and early modern Christian Europe, magic was conceptualized as invoking the Devil to provide assistance in life’s challenges, such as attempts to restore health. In other words, magic was seen as the opposite of Christian religion. However, separating magic from religion is not always simple, as many ritual and ceremonial practices in world religions resemble magical practices.[12] In the contemporary world, separating magic from science is a more relevant division. In this perspective, attempts to control physical reality or human psyche with means that cannot be explained scientifically are categorized as magic. Thefefore, belief in magic is defined as superstition. Historically, magic and superstition have a strong association with creating otherness and confrontations between groups of people; people from different cultures or of certain social classes have been labeled as superstitious.

In subsequent blog posts, we plan to explore medicine and medical cultures in global history in more detail by focusing on transformations of healing systems in time and space.

[1] On the social constructionist approach, see Ludmilla Jordanova 1995: “The Social Construction of Medical Knowledge.” – Social History of Medicine 8, 361–381. On effectiveness and retrospective diagnosis, see David Harley 1999: “Rhetoric and the Social Construction of Sickness and Healing.” – Social History of Medicine 12, 407–435.

[2] Waltraud Ernst 2002: Introduction. In Plural medicine, tradition and modernity, 1800–2000, edited by Waltraud Ernst. Routledge, London, 1–9.

[3] Ernst 2002, 7–9.

[4] William H. McNeill 1976: Plagues and Peoples. New York: Anchor.

[5] Murray Last 1992: The Importance of Knowing about Not Knowing: Observations from Hausaland. In The Social Basis of Health and Healing in Africa, edited by Steven Feierman & John M. Janzen. Berkeley: University of California Press, 393–406.

[6] Jordanova 1995.

[7] Harley 1999.

[8] Robert Jütte  1996: Geschichte der Alternativen Medizin. Von der Volksmedizin zu den unkoventionellen Therapien von heute. München: C.H. Beck.

[9] Roberta Bivins 2007: Alternative Medicine. A History. Oxford: Oxford University Press, 13–29.

[10] Barbara McPake 2009: “Hospital Policy in Sub-Saharan Africa and Post-Colonial Development Impasse.” – Social History of Medicine 22, 341–360.

[11] Ernst 2002, 5–8.

[12] On magic and religion divide, see e.g. Robin Horton 1993: Patterns of thought in Africa and West. Essays on magic, religion and science. Cambridge: Cambridge University Press.