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Workshop report: Situating the Subaltern in South Asian Medical History
A workshop was held at the Institute of Advanced Studies of the University of Warwick on 7-8 May 2009 on the subject ‘Situating the Subaltern in South Asian Medical History’. It was organised by David Hardiman through the Centre for the History of Medicine in the Department of History. The aim was to set out the terms and conditions for a field of study that can set itself apart from most of the existing studies in South Asian medial history, which focus either on the history of biomedicine, particularly colonial biomedicine, or the classical systems of Ayurvedic, Unani Tibb, and Siddha as practised by elite South Asian physicians.
Ayurveda, Unani Tibb and Siddha are seen principally to be humoral systems of medicine. They were augmented under British colonial rule by modern scientific medicine, or biomedicine, that in India is known generally as ‘allopathic’ or ‘English’ medicine. Even today, this imported medical system has won only patchy acceptance, and is still hardly available for large numbers of people, either on grounds of cost or because of lack of facilities. Indeed, Ayurveda and Unani – in their more erudite, textually grounded forms – have been, and still are, largely inaccessible for the mass of the people. This situation has allowed for a range of healing practices to flourish alongside each other. There are unqualified or so-called ‘quack’ healers who mix allopathy and popular remedies together eclectically, local bonesetters and masseurs, cauterisers, village midwives, travelling mendicants with their cures, priest at healing shrines, faith healers, diviners, exorcists, and herbalists. Many cures are carried out within the home, using charms, rituals, and plant-based remedies. For the purposes of this workshop this was defined as the ‘subaltern’ realm of health and healing.
In his opening remarks, David Hardiman pointed out that since Subaltern Studies I appeared nearly thirty years ago, it has received much praise as well as criticism. It has also evolved and has been deployed by many historians in very different ways, so that it is hard to now distinguish any obvious ‘subaltern’ positions. Many have sought to write the obituary of Subaltern Studies, and it might be asked why we still using it as a frame for analysis. He argued that the history of medicine is an area which may both show that the exercise not only has life in it yet, but in fact is still very necessary. As people who study the history and anthropology of medicine and healing in South Asia, we are well aware of the gross inequalities of access to safe and reliable health care in South Asia. We see people suffering and dying because doctors treat the poor with contempt. We see health provision being continually misused for political ends. We see health policies by the state that ignore realities on the ground. We see a huge growth of so-called indigenous medicine – in particular Ayurveda – that markets itself with the most questionable claims for both efficacy and antiquity. There is much to anger us, and he felt that such anger might inform our engagement with the health care that exists for the subordinated people of South Asia – the ‘subaltern’. In the process, we engage ourselves in a critical dialogue with much modern development driven by the state – what the BJP, memorably, defined as ‘Shining India’ – bringing out what it entails for the mass of the people.
The papers (in order of presentation)
Vishvajit Pandya, in his paper titled ‘ “Pain in all the wrong Places”: The experience of biomedicine among the Ongee of Little Andaman Islands’, examined the way in which an Ongee family of the Little Andamans experienced state-provided biomedical treatment. Classed as a Primitive Tribal Group by the Indian state, the Ongee have beenthe object of welfare policies that have been frequently insensitive and neglectful of their needs. After setting out the history of contact between the colonial and then the Indian state and the Ongee, Pandya focused on the story of a young Ongee man called Jain who had fallen sick. His father Totanagey, who had spent his life trying to mediate between his Ongee community and the medical workers, took him for treatment. The doctors treated them in a callous and uncomprehending manner, branding Jain as a ‘drunkard’ and incarcerating him in the mental wing of their hospital. Jain’s real issue, which appears to have been sexual abuse by a nurse as a child, went unaddressed. Totanagey eventually lost faith in the system that he had tried to serve with such diligence. All of this, Pandya argues, shows that the Andaman islanders continue to be treated by Indian state employees as ‘primitives’ who are considered to be by nature ignorant, deviant, sexually transgressive and morally corrupt. Their experience of illness and expression of pain is dismissed without understanding or indeed any diagnosis of value. In such a situation, the outside medical practitioner never ‘hears’ the voice of the subaltern. In the discussion, when questioned as how typical this history was, Pandya said that this was not the only such case he had come across in the records or in his fieldwork and that it revealed systemic problems with medical care for the Ongee.
The next paper was by Gabriel Alex, titled ‘Narikuravar folk medicine’. The focus here was on a system of healing practised Narikuravar community of Tamil Nadu. This group has an extremely low status and is largely marginalized and heavily stigmatised. In the past they were branded as a ‘criminal tribe’. One of the occupations of the Narikuravar has been that of healers and fortune-tellers; they are specifically famous for treating impotence and infertility. The paper described how, despite their poverty and supposed criminality, they are popularly believed in Tamil Nadu to possess great strength, health, beauty and sexual potency. They become an embodiment of the rural and ‘natural’, and are seen in this respect to resist the debilitating effects of modern civilisation and city life. In recent years, some Narikuravar healers have exploited these perceptions to establish thriving practices as healers and suppliers of aphrodisiacs. Some go out as itinerant hears, others have established shops to which patients travel. Alex has found that there is great diversity in their practice and in the remedies they use. Healing is in some respects a performance, with the healer projecting an image of vigour and strength, wearing a lungi, turban, necklaces, perhaps a tiger skin, and with a bare tattooed chest. The aim is to give the impression of a charismatic male strength that makes to ordinary Tamil feel weak by comparison. Their cultural distinctiveness thus becomes a selling point. They resist being modernised in a conventional way through schooling and upwardly-mobile professional jobs. The discussion of the brought out how ‘tribal medicine’ has become increasingly popular in India, being depicted as a remedy for the evils of modern civilisation. The way in which the Narikuravar negotiate the system were also discussed, by, for example, obtaining certificates as ‘Siddha’ healers, even though they distance themselves from this system in practice. They add supposed ‘horns’ to the skullsof foxes that they tote around with them, claiming that these horns have powerful healing properties. Vishvajit Pandya suggested that they operate as ‘tricksters’ in this respect. William Sax agreed that some communities certainly assert their power through trickery – including of the anthropologists who study them – but he preferred to understand such practice among the Narikuravar as ‘performance’, as ‘trickery’ is too value-loaded a term.
David Hardiman’s paper was titled ‘A Subaltern Modernity: Christian Faith Healing in Southern Gujarat’. In conventional narratives of medical progress, forms of healing associated with spirit possession and religious devotion are supposed to give way in time to modern biomedical practices based on science and rationality. The paper argued that in the case of healing provides by Christian missionaries in the adivasi tracts of South Gujarat, this has not been the case. The earlier focus on biomedical healing by Christian missionaries has been eclipsed through faith healing that caters to a strong popular demand. The position of faith healing within the Christian missionary movement of the colonial period was examined, bringing out how it was not a feature of most western mission work at that time, and was indeed spurned as a form of charlatanry. Tamil Christian missionaries from South India began to proselytise amongst the adivasis if South Gujarat in the 1970s and, inspired in part by Pentecostalism, deployed faith healing to advantage. There was a wave of conversion to Christianity that was brought about to a large extent through such healing. Taking on a momentum of its own, it is now sustained largely by local adivasi Christians. It was argued that it hadbecome a strongly subaltern practice, rooted in adivasi communities. The success of the Christians in this area attracted the attention of the Hindu right in the 1990s, leading to a divisive politicisation of such practice. Embracing Christianity and faith healing has in this respect come to represent a rejection of the Brahmanical Hinduism of the Gujarati Hindu elites. However, while the Hindu right holds that ‘Indian’ culture is under threat from a ‘foreign’ imported culture, it was argued in the paper that an older adivasi practice had been replaced by a modern one, and that faith healing represents a form of indigenous subaltern modernity.
Gauri Raje spoke on ‘The fallacy of the traditional-modern divide in the practice of tribal healers in contemporary western India’. This focused on the bhagat healers of the Dangs in Gujarat, who practice divination, exorcism and herbal treatment. They describe their practice as their bhakti, in other words as a devotion towards their craft. Their status rests on the recognition they receive from the community of bhagats in the Dangs. She focused on one particular bhagatfrom the village of Shivarimal who has updated his practice in a range of ways. Most notably, he deploys a sauna bath which he uses to expose patients to the smoke from healing herbs. He claims to be able to treat ‘new’ diseases that have come to the Dangs in recent years, something that he alleges other bhagats are not competent to do. He uses herbal treatment and divination as and when required. He travels all over the region in a large vehicle that he has purchased from his earnings, going as far as the city of Baroda. He advises serious cases to visit his home in the Dangs for the sauna cure. Although very ‘modern’ in these respects, he insists strongly that he is a bhagat and not a ‘doctor’. Raje found, however, that other bhagats considered him something of a maverick. She shows, however, how he had managed to negotiate his position with great skill. To officials, he projects himself as a herbalist in a climate in which traditional herbal remedies are being promoted by the state as an important resource. He and his sons have attended health training schemes run by the state, where they have gained certificates that are displayed so as to legitimise their practice. These appear to recognise them as ayurvedic practitioners, even though the bhagat himself is adamant that he is not in this category. Raje came across another bhagat who has linked up with a private ‘doctor’ to establish a so-called ‘polyclinic’ in which both practice in their discreet ways. In the discussion, Guy Attewell asked whether the clientele of the Shivarimal bhagat differed significantly from that of other bhagats. Raje replied that they all attract a number of patients from outside the Dangs, but that the others tend to treat working class people from the cities using divination, while the clientele of the Shivarimal bhagat is more middle class, and less likely to demand divination. Helen Lambert pointed out how in Rajasthan diseases are popularly described as devtaki bimari or daktarki bimari – that is, diseases from deities that have to be treated through divination and offerings, and disease that can be cured by doctors. The Shivarimal bhagat, she observed, appeared to be eating into the latter sphere through his claim to be able to treat ‘new’ diseases. Vishvajit Pandya noted how the similar budvahealers of Chhota Udaipur claim to be able to read X-rays, even though they do not use them in diagnosis. By doing so, they are claiming an expertise that is on a par with that of ‘doctory’.
David Arnold presented a paper on ‘The Politics of Poison: Crime, Toxicology and Empowerment in 19th-Century India’. He argued that while studies of medical history conventionally focus on healing practices and therapeutic substances, it should be recognized that the dividing line between what heals and what kills is a slim one. Many of the substances used in nineteenth-century India as medicines, whether by colonial or indigenous physicians, by elite or subaltern practitioners, were (like nux vomica or aconitum) extremely dangerous substances that could be highly toxic if used incorrectly or in excess. Some of the principal aphrodisiacs, designed to give pleasure or aid procreation, could also be fatal to those who consumed them, and a range of herbal and mineral substances (notably the trinity of opium, arsenic and aconitum) doubled as both poisons and medicines. Despite legal attempts to police the division between acceptable medicine and toxic misdemeanour, and to establish a pharmacopoeia that could delineated between the two, such widely available substances repeatedly evaded control. Problems of identification and diagnosis further aided uncertainty as to cause and intent. The implications of such toxic substances were examined in a range of situations – in healing, the use of elixirs and aphrodisiacs, abortion, infanticide, suicide, in the deliberate killing of humans and animals, and in accidental deaths – in an attempt to establish how ‘subaltern’ and subversive such practices might be considered, what motivated them and how they came to be configured as part of the negative representation of certain sections of Indian society or even of India at large. Projit Mukharji asked whether the discourse on poisoning was very different to that of medicine and healing. Vishvajit Pandya pointed out that deities and sadhus have a reputation of being able to consume poison without harm, in the process demonstrating their power.
Helen Lambert spoke on ‘De-composing traditions: Bonesetting, ethnophysiology and other conundrums of subaltern therapeutics in Rajasthan’. She noted that subaltern forms of therapy were not practised in a systematic way in the past, but represented a fragmented form of knowledge. They had resisted, and continue to resist, the systematisation of more elite forms of therapy. This was a conceptual resistance that rested on different notions of health and the body, rather than any overt political resistance. For example, there is a popular notion that a good healer can tell what is wrong with a patient by merely examining the pulse, without having to ask any questions. Healing is also seen as a vocational service, rather than as something that is carried out for gain. She examined these issues in terms of the pahalvan and bonesetters of Rajasthan. Pahelvan were patronised by royalty as wrestlers during the princely era, but afterwards turned to the practice of massage and bonesetting to earn a livelihood. In the process, they incorporated elements of popular practice. One Jaipur pahelvan told her how he could diagnose a complaint by merely looking into the eyes of a patient, and contrasted this with the biomedical doctor who asks lots of question. He did not need to take X-rays, but merely feel for a fracture with his hands. He used ‘country medicine’ (desdvai) that he said could get rid of a malady more permanently than biomedicine could. The latter acted in a ‘fast’ manner, but failed to deal with the root cause of an illness. He insisted on the importance of faith in treatment. He represented his work as a vocation, and not for gain, and he limited the number of patients he treated in a day. He charged according to what the patient could afford. Pahelvan were not found in rural areas, only bonesetters, who tended to be less professional. They had varying levels of skill, and patients would choose a practitioner on the basis of what was known about his skill.
In the discussion, William Sax said that such healers did not have a ‘system’ as such, but generally gained their knowledge through work in a family practice. Often, they were associated with particular places, such as Ramchandra Meerutwallah in Delhi. He preferred to see this as a form of ‘distributed cognition’, with popular practice, religious beliefs and other elements feeding into the mix. Guy Attewell addressed the problem of historicising such practice, due to the lack of adequate historical sources. Vishvajit Pandya said that this was an example of ‘total body practice’, in which the therapy is for the whole body and not just for a part, with the body being understood in a way that differed profoundly from that of biomedical science. This was linked to ayurvedic notions of the body, but adapted and modified through subaltern practice.