Medical Pluralism in Contemporary India

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Medical pluralism in contemporary India

View PDF. Save to Library. Create Alert. Topics from this paper. Citations Publications citing this paper. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries. Irrespective of whether or not non-orthodox medicine receives necessary financial and legal support to survive, both from the government and the public, the State's interest is to keep it alive, so that non-orthodox doctors take some burden off the orthodox ones Young, How can this be explained?

While the role of the State has been considered significant in the phenomenon of medical pluralism, attention has not been given to the ways in which non-orthodox medicine is linked to entrepreneurial activities as well as to the continuing process of capitalism in which the exploitation of labour is a necessity. This process is what brings about similarities between biomedicine and complementary medicine.

Non-orthodox healers may be more easily accessible geographically and financially Rahaman et al. People may be interested to take up any health services available in the hope that they may provide relief Durkin- Longley, ; Janzen, What makes medical pluralism possible from the viewpoints of cultural explanations? According to Weisberg , p. However, Weisberg neglects the fact that medical systems are also shaped by social factors such as pervasive relations of production. Thus, individual patients from low class backgrounds are virtually left with much more limited options. In fact, individual use of health services is enabled as well as restrained by pervasive socio-political factors.

Regarding complementary therapies, postmodernists are centred around 'particular, as opposed to universal, truths', and focus on 'encouraging the articulation of perspectives on health care practices besides those of the dominant biomedical approach' Gray, , p. Although postmodernists would encourage a high level of medical pluralism in terms of health care services, whether it is possible, and how, is open to debate. The ultimate problem with conservative cultural approaches as well as others which include postmodernist and poststructuralist approaches is that they often serve to justify the status quo.

Those views tend to downplay the fact that influential social factors are not always immediately observable, but they are real and functioning. According to this perspective, the ways in which orthodox medicine becomes the dominant medicine in most capitalist nations derive from underlying changes in social and economic relations. Coward , for example, argues that the prevalence of economic rationalism has reinforced a climate whereby society is not to blame and individuals are to care for their own health needs.

This leads people in upper social and economic levels to become more confined to orthodox medicine both in ideology and practice, even though they may continue to use non-orthodox medicine as well Comaroff, ; Similarly, Frankenberg , p. He also points out the close link between elite commitment to orthodox medicine and an ideological system characterized by 'an urban, male, technological, curative and individualistic world view' p. In this regard, non- orthodox healers may end up serving only those people for whom such an ideology or 'cash nexus' is least relevant Adams, ; Turner, However, a skillful synthesizing of the two broad schools may lead to a valuable result.

Critical realism is one way to achieve this goal. The consumers' level of education has not been an appropriate explanatory factor Miller, ; Understanding the phenomenon could be sought at least from two levels: individual and societal or structural. No doubt, the two levels are closely linked. Neither individualist voluntarism nor collectivist reification of social entities provide a satisfactory perspective.

Pluralistic Health Care Systems

This is because society does not exist independently of individual human agency. Following critical realism, I argue that patient health seeking behaviour is enabled and constrained by medical systems in the social context, but the action, in turn, reproduces or transforms the medical systems. That is, it is possible to apply the natural science model to the study of social reality.

Realists assume that reality in both the natural and social sciences has ontological depth; that is, it is structured in a hierarchical fashion. Generative mechanisms refer to the causal powers of entities, aspects of their nature which cause them to act in particular ways. For example, a study of a chemical reaction involves at least two levels of observation: firstly, surface phenomena, and secondly, the scrutiny of generative mechanisms or causal powers located at the level of underlying relations.

The surface level of phenomena does not exist independently of deeper underlying factors. Realists argue that a similar method applies to the social sciences where 'tendencies' are the equivalent of generative mechanisms and refer to the emergent natures of particular social relations. These underlying relations for Marxists are 'inner relations' and the observable phenomena at the level of the actual are known as the phenomenal realization of these inner relations Azevedo, ; Watson, , pp.

In natural science, mechanisms can be apprehended in terms of closed systems so that empirical regularities can be studied through manipulation, repetition of experiments, and so on. However, in social science, mechanisms need to be understood in terms of open systems situations because the realization of the mechanisms in contingency and the nature of social events in open systems is indeterminate. Generative mechanisms may be appreciated under the construction of closed systems.

However, within the social sciences, this is usually impossible. This is the limit of naturalism. Collier, Realists share the natural thesis with positivists but they reject two particular aspects of positivism. Positivism does not make a distinction between generative mechanisms and observable surface phenomena. Therefore, observable or empirical regularities are the only real phenomena.

That is, ontology is reduced to epistemology; 'what is to what can be known' Lovell, , p. In addition, positivists see abstractions as only heuristic intentions rather than concepts which refer to real entities. Thus positivists reject the ontological depth of social reality and operate 'with a flat ontology' Watson, , p.

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The inevitable result is relativism: knowledge depends on how we look at reality. A conventionalist position argues against the basic realist assumption about an independent and knowledgeable world. However, defending their position, realists acknowledge that knowledge may be 'theory laden' or socially constructed, but it is not 'theory determined' Sayer, ; The real world 'cannot be reduced to language or theory, but is independent of both, and yet knowable' Lovell, , p. It makes assertions about what the nature of the real world is ontology and the way the real world can be known on the basis of the ontology.

The observable empirical world is causally connected to 'deeper' ontological levels, and it is through these causal connections that we can use sense-data, experience and observation in formulating knowledge of the structure and processes of the real. These casual connections, Lovell 22 argues,.

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It is not the consciousness of the people that makes their being, but on the contrary, their social being determines the consciousness. The mode of production is critical for our understanding social reality because of our necessary transaction with nature in producing and reproducing our physical existence.

This is also the reason why productive involvement i. Prior to the occurrence of any individual action, social structure pre-exists. Thus individual action is enabled and restrained by the pre-existing societal conditions Bhaskar, In the study of both orthodox and non-orthodox medicine e. Of course, part of the structure is partially formed by the cultural elements Koreans have been bringing with them to Australia since the early s.

Again, this does not imply that individual health care utilization is predetermined by the medical structure to which patients are readily exposed. Rather, health care seeking behaviours will be influenced by the social position of individuals, in that social position provides them with the means, media, rules and resources e. This does not mean that, in a place where a diverse range of health care services is available, every patient will necessarily utilize all the available health services.

Indeed, every individual action entails the nature of open social systems. For instance, when an individual falls ill, the person's major interest in seeking health services is to recover from illness. The kinds of services available for a person to pursue depend upon the resources at the personal level as well as at the societal level which pre-exists the personal.

In seeking the services, the client is involved in reproducing existing health systems based on the principles of the dominant mode of production. First of all, what is a medical system? Medicine or a medical system is not just a thing; rather it refers to,. It could generally mean one of two things. The first meaning refers to the co-existence of various health care systems such as orthodox medicine, chiropractic, acupuncture, herbal medicine, osteopathy, bonesetting, and so on.

Consumers have a right to choose from the pool of various types of therapies, each of which is unique in its own right. The second kind of meaning refers to pluralism within a particular system. For example, with orthodox medicine, a client has a choice to go to a private or public hospital or to a doctor practising in a village, or a town, or a distant city, or overseas. This paper is concerned with the first kind. All aspects of social life are closely influenced by what is required by the work process Clement and Myles, ; Laurell, , p.

To put this differently, the basis of any society is what is produced, how it is produced and how it is distributed. Production is a critical factor in social formation and in the reproduction of society and its social phenomena, including health and disease. An extraction of surplus value at the site of production leads to fatigue and stress, that is, expropriation of health. The change of means of production has led to the intensification of work, the introduction of new forms of organization and new kinds of risks for health. As Palloix , cited in Navarro, a, p. Contemporary society is often characterized by large-scale monopoly capitalism.

Most individual activities and social- political institutions reflect a capitalist mode of production. It is thus defined by the area of class struggle at the core of the linked pair of exploiter and exploited, determined by specific relations of exploitation' their translation. What happens in other phases of society such as exchange and consumption and what happens on other levels such as ideological, economic and politico-juridicial maintains a relative autonomy of its own.

There is a mutual influence between production and various phases and levels of society, but the latter are constructed and articulated within a whole, that is, a social formation or society which is most significantly characterized by production. Why were naturopathy and nursing not worthy of an academic degree in the past, but are both worthy now Ellicott, ; cf.

Martyr, ? These are examples of articulation of medicine in the context of modes of production. In most societies, today, various kinds of medicine co-exist. Some evolved a few thousand years ago; others evolved as recently as a hundred years ago and many more are continually meeting to co-exist. Various kinds of medicines undergo changing processes for their survival. Whilst they still maintain the legacy of other kinds of modes of production out of which they grew in the past, they are articulated and re-articulated in the interaction of different modes of production.

Therefore, the complex relations between different kinds of medical systems or the juxtaposition of so-called orthodox and non-orthodox medicines cannot be explained simply by looking at the dominant and subordinate relations of one group of health workers over another involved in different medicines. But it is the relations of production which determine what, how, and why products are produced and exchanged. I mean, by relations of production,.

The former may be observed when one group of people the owners of the means of production live off the exploitation of the labour of the direct producers. They include relations of slavery whereby the master owns the means of production as well as the labour power the slave ; relations of servitude whereby the master owns the land, and the servant relies on him and has to offer free labour for a certain number of days every year; and finally, capitalist relations whereby the capitalist owns the means of production and the workers must sell their labour power in order to live.

Relations of reciprocal collaboration come into being when there exists a social ownership of the means of production and no group of people lives off the exploitation of another group. They include the relations between members of primitive societies, or the relations of collaboration that, according to Marx, characterize the communist mode of production Navarro, b, p. Most contemporary capitalist societies, for example, simultaneously contain some aspects of the feudal mode of production, the petty commodity mode of production, and the capitalist mode of production simultaneously.

In petty commodity production, the worker owns the object of work and the means of work and has control over the labour process. These different modes of production within the same social formation are closely related to each other, that is, dominating and dominated relationships.

The most dominant mode characterizes the mode of social formation e. Some of these are: a home mode of production, a petty commodity mode of production, and a monopoly-capitalist mode of production. A home mode of production is one whereby the purpose of medicine is to heal family members only; a petty commodity mode of production is one whereby a medical skill e. And lastly, a monopoly-capitalist mode of production is one whereby on the one hand, the private producers of a health commodity control its production which is highly centralized and concentrated Berliner, , and who employ the majority of health workers on a salaried basis in large scale health care organizations, and on the other hand, State-provided medical services offer a range of treatments partly on a commodity basis, partly 'free', and subsidized through taxation.

However, in general, most medicines are embedded in a broader context marked by a mixture of modes of production and are constantly articulated under the influence of the dominant mode of production Frankenberg, in that particular society that is not static or going through change. For example, Chinese medicine in Australia undergoes a changing process for its survival or expansion. For example, in the feudal Malay peninsula, although Western pills and potions are prescribed by the bomoh medicine man or shaman , they do not replace native herbs or non-orthodox medical practices.

Government-trained midwives were well accepted, but had not replaced non-orthodox ones and mothers had no preference. They had not taken advantage of surgery, however, since it is against the doctrine of Kor'an to cut or mutilate the body in any way Wolff, What Wolff's study argues overall is that the technology has been accepted but not the ideas behind it. Whether this kind of thesis is sustainable over a long period of time is doubtful.

Now, thirty five years since Wolff's study, it would be safe to say that there has been much change in the links between different kinds of medicine there. This change would take place, unlike as Wolff argues, not through either 'the Malayanization of Western cultural elements' or 'the Westernization of Malay culture', but by both. By holistic health practices, they mean those practices basically counter to scientific medicine which attempt to view the patient as an integration of body, mind, and spirit Berliner and Salmon, , p.

In the following discussion ideas shall be drawn from their work. And the terms, 'holistic' and 'non-orthodox medicines' will be used interchangeably. Their origins are as diverse as the names of practices show: transpersonal psychology, parapsychology, folk medicine, herbalism, nutritional therapy, massage, homeopathy, yoga, meditation, and parts of the martial arts. Indeed, there are numerous kinds of herbalism itself.

Nevertheless, there seem to be at least two basic characteristics central to the anti- 'scientific medicine' kinds of healing method: firstly, there is an assumed unity of mind, body and spirit, which implies that illness is other than just physical; and secondly disease is supposed to have reasons and dimensions not emanating from the purely biological.

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These imply that health is a process of everyday life rather than an outcome. Therefore it must be an important part of the daily understanding of individual and community activities. These critiques of orthodox medicine form the primary reason to advocate holistic medicine.

The main direction or thrust of the movement is a direct confrontation against the fundamental principles of orthodox medicine. The probing of psychic matters e. Other practices such as yoga and some forms of the martial arts are publicized as a means of forming an integrated concept of the health of individuals and a greater health consciousness.

Therefore, utilizing holistic medicine is a means to participate in the movement. The value of each holistic therapy may become established through practice and scientific investigation. The use of one or more kinds of holistic health services does not always imply the individual's total rejection of 'scientific' medicine.

This enables the possibility of the juxtaposition of orthodox and holistic medicine Cant and Sharma, However, having enjoyed a period of dominance in health services for a long time, orthodox medicine is now under attack by the holistic health movement, due to the broader economic crisis. This attack has been pervasive in the West since and in other parts of the world at various times depending on the socioeconomic and political context of local areas.

First of all, there has been a question about the level of effectiveness of modern medicine in alleviating the disease patterns in advanced capitalist society. The health sector in the West, now consuming about 10 per cent of the GDP, has become a leading growth industry. The cost of health care services for the poor and aged and other affiliated health costs such as environmental and occupational safety requirements and the purchasing of health insurance have been financial burdens for both corporations and the State. Whilst health care expenditure is blamed for limiting capital accumulation, reducing inflation in health costs has been a corporate strategy, which includes replacement of costly, high-technology medicine with cheaper, anti-technological therapies, and the promotion of new modes of healing.

A variety of self-help treatments and holistic medicine practices have been promoted and they tend to foster 'individual responsibility' for disease especially in the context of the decline of the welfare state Crawford, ; Han, The level of work intensity and alienation is high.