Combining Stories Reading Tibetan Medicine As A Western Narrative of Healing

1
Devin Gonier
Professor Ivette Vargas-OBryan
Department of Religious Studies
Final Report
Mellon Project 2008-09
Combiningstories:ReadingTibetanMedicineasaWesternNarrativeofHealing
This project was funded by the Carnegie Mellon Grant from Austin College in
2008-09 under the supervision of faculty-advisor Ivette Vargas-OBryan from
the Department of Religious Studies. My faculty advisor was of critical help
throughout the entire process, and took great care in mentoring me in the
projects research and writing. The research for this paper took place over the
course of a year in India (Dharmasala, Darjeeling, Ladakh), Kathmandu, Nepal
and Boulder, Colorado. It involved interviewing ten Tibetan medicine doctors
throughout the regions and two religious experts, as well as conducting library
research in the U.S. The following report will describe what I learned
throughout the terms of the grant about U.S. healthcare and Tibetan medicine.
The real narrative of dying now is that you die inside a machine1 Broyard
We are thus not at the end but at the beginning of the beginning, and even with the best of tools,
our task of negotiating the new healthcare may be much more complex and multifaceted than
initially realized. Michael Cohen
It would be very useful for humanity if Tibetan and Western medicine were practiced on a
parallel basis. 2 The Dalai Lama
Introduction
Healingasweknowandunderstandittodayhasbothahistoricalandculturalcontext.It
hasevolvedandeventswillcontinuetochangeitinthefuture.Therewillbetechnological
advancementsthatimproveourabilitytotreatfutureandcurrentillnesses,butbeyondthis,the
discourseonhealthandthephilosophicalassumptionsinherentwithintheWesternhealthmodel
willadaptandevolvetoo.WhenmanyWesternersthinkoftheverbhealtheycarrywithitthe
culturalbaggagethatshapethewayweunderstandhealing,baggageliketheviewthatdiseaseis
somethingobjectiveandthatitcanbecuredthroughobjectiveprocesses.But,onemusttread
carefullyinthisthinking,sincedifferentculturalandhistoricalcontextschangehowaperson
thinksofhisorherbodyandwhatitmeanstoheal.Itismucheasiertoseetheeffectculturaland
1DavidBMorris,Illness and Culture in the Postmodern Age. California: University of
California Press, 1998. pg. 44
Michael Cohen, Healing at the Borderland Between Medicine and Religion. North Carolina:
UNC Press, 2006. pg. 161 (last sentence)
2H.H.DalaiLama.TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
TenzingChoedrak,.FirstRunFeatures,2005.
DevinGonier
socialcontextshaveonmedicinebylookingcloselyatthediversityofmedicinesthroughoutthe
world.Differentsocioculturalsituationsinfluencedornotbyreligionhavedirectedmedicine
andhealthinuniqueways.Differenttypesofmedicinehavealonghistoryofintersectionand
theseintersectionscontinuetogrowtoday.Thefocusofthispaperwillbespecificallyonthe
intersectionofbiomedicineandTibetanmedicine,anditwillarguethatcurrentU.S.healthcare
discoursecreatesbarriersforreligioushealingsystemslikeTibetanmedicine.Unlesscultural
andinstitutionalchangesaremade,itwillcontinuetobedifficultforTibetanmedicineandother
healingsystemssimilartoittohavealegallyandculturallyacceptedroleinU.S.healing.
ThesisandStructure
This final report reflects upon findings that the U.S. healthcare discourse and treatment
process are predominately influenced by scientific materialism and the hegemonic status of
biomedicine in healing. The U.S. healthcare discourse creates great difficulties for alternative,
complementary, and integrative models of healing, which cannot be entirely reduced to a
biomedical scientific model, to become popular or legally acceptable in the U.S. This paper will
draw heavily on the views of postmodern medicine, because of its basic advocacy for
empowering marginalized voices in the pursuit of a more heterogeneous healthcare system. The
focus will be on the particular relationship between Tibetan medicine and biomedicine in the
U.S., and how this relationship can be improved based on the principles of postmodern medicine.
There are two supporting arguments. First, postmodern medicine reconceptualizes the
relationship between religion and healing by disrupting the hegemonic biopolitical status of
secular healing in the U.S. In other words, postmodern medicine creates space for religious
healing in a system dominated by secular healing. Second, the principles of postmodern
medicine suggest a heterogeneous globalization model, which resists what medical
anthropologist Vincanne Adams3 calls erasure.
3VincanneAdamsisanotedscholarofTibetanmedicine.Sheisamedicalanthropologist
teachingatUCSFschoolofmedicine.Hernotionoferasurecomesfromaworktitled
IntegrationorErasure:TibetanMedicineintheContemporaryWorldthatexplorestwo
possiblewaysfordifferentmedicalsystemstointegrate.Sheexplainsthedifferenceonpage
110,Integrationinitsbestpossiblesenseresultsinthesharingandexchangeofknowledgeand
practices,asopposedtoitsopposite:thesubstitutionsanderasureofoneforthesakeof
incorporatingtheother.
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ThefirstsectionofthispaperoutlinessomecrucialconceptsaboutTibetanmedicineand
alsoexplainsthestatusofcomplementaryandalternativemedicine(CAM)4intheU.S.The
secondsectiondefinesthetenetsofreconstructivepostmodernmedicine,andexamineshow
Tibetanmedicinefitswithintheparadigmofpostmodernmedicine.Thethirdsectionoutlinesthe
deconstructiveelementsofpostmodernmedicine,whichcritiquebiomedicineshegemonicstatus
withintheU.S.Afterthisdescriptionofpostmodernmedicineanditsrelationshiptobiomedicine
andTibetanmedicine,thepaperwillanalyzehowreligionandmedicineintersectintheU.S.
mainstreamhealthcaresystem,andwillsuggestmovingawayfromasystemwheresecular
healingishegemonic.Finally,itexaminestheconceptofglobalization,andutilizingmuchof
VincanneAdamswork,analyzesthebiopoliticalroleoftheNCCAM5andsuggestsamore
heterogeneousmodelforthinkingabouthealingintheU.S.asaresultoftheapplicationof
postmodernism.Basedonsomeoftheprinciplesofpostmodernmedicine,thepaperconcludes
bysuggestingthatourhealthcaresystemshouldbemoreopentootherformsofhealingwhich
cannotbeeasilyintegratedintothebiomedicalsecularmodelofthinking.Beforegettinginto
backgroundinformationabouttheU.Sandalternativemedicine,Tibetanmedicinewillbe
summarizedanditsmostbasicfeaturesexplainedinawaythatmakesitsrelevanceclear.
VincanneAdams,andF.F.Li."IntegrationorErasure:ModernizationattheMentsikhang."
TibetanMedicineintheContemporaryWorldGlobalPoliticsofMedicalKnowledgeand
Practice(NeedhamResearchInstitute).NewYork:Routledge,2008:110
4Oftentimesthetermsalternativemedicine,complementarymedicine,andintegrativemedicine
getconfused.AlternativeMedicinereferstotreatmentsthatareusedinsteadofconventional
medicine.ComplementaryMedicinereferstotreatmentsthatareusedinconjunctionwith
conventionalmedicine.Integrativemedicinereferstotheprocessoftakingtwosystemsand
attemptingtobringtheirphilosophicalandproceduralqualitiestogetherinonecombinedformof
medicine.ThesectionprovidinganoverviewofinsuranceregulationsandtheNationalCenter
forComplementaryandAlternativeMedicine(NCCAM)willrefertobothComplementaryand
AlternativeMedicine,asunderstoodbytheNCCAM.
5NationalCenterforComplementaryandAlternativeMedicine
DevinGonier
IntroducingTibetanMedicine
TheBasics
It is difficult to pinpoint the exact beginnings of Tibetan medicine (called Gso ba Rig pa
in Tibetan), especially since many believe it to have a religious beginning originating from the
Medicine Buddha himself. The primary text of Tibetan medicine is the rbgyud-bzhi, because it is
the first text to outline all the essential features for practicing Tibetan medicine. This text is still
used today and it is currently in the process of being translated to English at the Men Tsee Khang
in Dharamsala. One way of pinpointing a beginning for Tibetan medicine would be to focus on
the creation of this text, since it represents the first synthesis of the main ideas and principles of
Tibetan medicine. Scholars who focus on the rbgyud-bzhi, like Thakchoe Drugtso, put its
beginning around 1126-1202 A.D. when Youthog Yonten Gonpo and his son are thought to have
authored or consolidated the rbgyud-bzhi. 6
Structure of the Body:
Theoretically the body is viewed as a collection of three humors (nyes-pa): Wind (rLung). Bile
(Khris pa), and Phlegm (Bad-kan). When these elements are in harmony, a person is considered
to be healthy, and when they are not in harmony a person has an illness of some sort. These
humors are further subdivided into 15 categories that are much more specifically aimed at certain
functions within the body.7 Thus, Tibetan medicine sees the body as a balanced system, where
different parts are interconnected and dependent upon the rest of the whole in order to be
functionally healthy.
6ThakchoeDrungtso,TibetanMedicine:TheHealingScienceofTibet.MenTseeKhang,
Dharamsala:Drungtso,2004:23
7Ibid.pg108
DevinGonier
Diagnostic technique
Typically a Tibetan medicine doctor or amchi uses three main diagnostic techniques. Almost
every visit will include an interview with questions about diet, lifestyle, and symptoms, and a
pulse reading. The specific technique used for pulse reading is completely unique to Tibetan
medicine, although similar approaches are used in Chinese medicine. Dr. Tenzin Choedrak, a
senior personal physician for the Dalai Lama notes that,
Themovementofthewindiscomparabletowhatdrivesthewaves
oftheocean.Wheneverawavearrives,itmakesahumanbeing
advance.Whenitrecedesitpusheshimfurtherback.Oncethewave
isatitscrest,itbreaks.Inthehumanbodythiswavecanbefeltin
thepulseWindisresponsibleforallthatmovesinthebody.8
When pulse reading is explained in this way it often makes it easier for western practitioners to
bracket it off as religious practice. A person could think of pulse reading as a religious or
transcendental investigation into the deeper energies of the body, but there is also a scientific side
to it that has strict guidelines and can take many years to be fully grasped. The final diagnostic
technique is urine analysis, which is typically studied under very specific conditions (and is thus
less common with very minor illnesses) in order to better understand the balance of humors
within the body.
Treatment
Treatmentusuallyconsistsofmoxibustion(atypeoftreatmentusingheatedneedles),
cupping(aprocedurewhereavacuumedcupisplacedonthebodytoinfluencebodilychannels),
dietchanges,Tibetanherbalmedication,orachangeinlifestyle.Interviewsareusuallyvery
crucialinassigningthepropertreatment.Tibetanmedicineusuallyinvolvesnonsynthesized
combinationsofherbs(sometimesuptosixty)thataretobetakenatlowdosagesfrequently
8Dr.TenzingChoedrak.TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,
Dr.TenzingChoedrak.FirstRunFeatures,2005.
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throughoutaperiodoftime.Sincethedosageislowandnonsynthesizeditcantypicallybeused
withotherWesterndrugs.Alfred Hassig, an M.D. in Immunology, explains
Suchaplantmixturecanbeextremelybeneficial,becausetheindividual
plantsreactreciprocallytogreatereffect.Sincethesinglecomponentsare
onlypresentinsmallquantitiesanysideeffectstheymayhaveare
diminishedinsuchawaythattheseplantcompoundsareveryeffectiveand
welltolerated.Thatstheproblemwithpharmaceuticalsubstances:being
chemicallydetermineduniformsubstances,theyexertaspecificinfluence
inthebodyand,insodoing,ofteneffectsandsideeffectsinterfere.9
IfproperlydiagnosedthereislittletonoriskinvolvedinTibetanmedicine.Thisisahugereason
whyTibetanmedicineispopular.TheonlydisadvantageisthatTibetanmedicineworksslowly,
whereasbiomedicineworksquickly.Obviously,Tibetanmedicineisnotbestforeveryillness,
butitcanbeaneffectivesolutiontomanycommonillnesseswithoutbeingpotentiallyharmful
byhavingmanyunwantedsideeffects.
Tibetan Medicine and its Effectiveness

When Tibetan medicine began to be introduced to Western doctors (samples were given of its
medicine for certain treatments) there was a great deal of skepticism.10 One of Tibetan medicines
earliest introductions to the west came as a result of Karl Lutzs pharmaceutical company Padma
AG in Europe in 1970, which began manufacturing Padma 28 based on a recipe introduced by a
Mongolian amchi-family Badmajew.11 Eventually many of the doctors that used the medicine
9AlfredHassig.TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
TenzingChoedrak.FirstRunFeatures,2005.
10KarlLutz.TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
TenzingChoedrak.FirstRunFeatures,2005.
11R.G.Landgraaf,"AMFITIBETAN
MEDICINERESOURCEGUIDE."Alternative
MedicineFoundation,Inc.,Bethesda,MD

Welcome.6Apr.2009.NewResource
Guide.03May2009<http:/www
DevinGonier
were surprised by the effectiveness of the treatment Padma 2812. In the documentary The
Knowledge of Healing, Dr. Isaac Ginsburg, a researcher in Microbiology and Bacteriology in
Jerusalem, outlines two major western illnesses that Tibetan medicine has shown impressive
success in treating.
Heart Attacks
First, as is widely known, coronary heart disease is the single leading cause of death in
America causing heart attack and angina.13 Much of this can be linked to bad diet and poor
exercise. Cholesterol and many other substances create blockages within important arteries that
prevent blood flow.14 The Tibetan medicine Padma 28 has shown great success in treating this
problem. In the documentary, The Knowledge of Healing, one patient is questioned about his
experience with Tibetan medicine. He explains that Tibetan medicine saved his life. Severe
blockage had been building up, and surgery was unlikely to help solve the problem. Doctors had
predicted he would die within five months. But after taking Padma 28 and some other herbal
medications recommended, he was able to overcome his problem. This patient argued that,
Sixty to eighty percent of all heart operations wouldnt need to be performed, if people used the
same treatment as I did! And although every professor and doctor had given up on me, its been
over ten years that Ive managed to save myself.15
.amfoundation.org/tibetanmedicine.htm>.
12Padma28isamedicinethatcanbetakenonceamonthtoimprovehealthingeneral.Itis
basedonanancientTibetanformulacalledGabur.ItisnotavailableintheU.S.,butcanbe
foundinEurope.
13NationalHealthandNutritionExaminationSurvey(NHANES,200506)."HeartAttacksand
AnginaStatistics."AmericanHeartAssociation.200506.AmericanHeartAssociation.03May
2009<http://www.americanheart.org>.
14IsaacGinsburg,TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
15TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.Tenzing
Choedrak,.FirstRunFeatures,2005.
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Cancer
Second, Isaac Ginsburg explains that when a person has cancer a tumor caused by malignant
cells develop. If the tumor does not spread the cancer can be cured by removing it through
surgery. But, if the tumor is broken into smaller pieces it can travel and spread throughout the
body. Blood cells are capable of destroying 99.9% of small bits of tumor that travel through the
blood, but if the remaining .1% manage to create another tumor in a vital area a person is likely
to die.16 Ginsburg explains that cancer patients are dying because of the spread of cells, and
that
we can already prove that in the presence of the Tibetan drug, that the
tumor cells are not able to take a large molecule from the vessel wall and
break them into small pieces. So we hope that in this collection of
materials in the Tibetan drug we can find the component which is good for
inhibiting tumor cells growth and invasion.17
ResearchbeingdonerightnowwithTibetanmedicinecouldprovecrucialindiscovering
thecureforcancer.
TherearemanyotherareasthatcreditTibetanmedicineasbeingsuccessful,suchas
treatmentofchronickidneyproblems.CurrentlytheMenTseeKhanginDharmsalais
workingwithWesterndoctorsonanumberofillnessesinordertotryandcreatebetter
curestodiseasesthathavebeenextremelyproblematicforbiomedicine.Tibetan
medicinespotentialisonlybarelybeingrealized,andifitreceivestherecognitionit
deserves(acommonlycitedproblembymanyofthedoctorsIinterviewedattheMen
TseeKhang)thepotentialforitsbenefitcouldbeverygreatindeed.Furthermore,in
comparisontootherpharmaceuticaldrugs,andthediagnosticproceduresofwestern
medicine,Tibetanmedicineissignificantlycheaperandhaslittletonosideeffects.Thus,
16IsaacGinsburg,TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
17Ibid.
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whenonetakescostintoaccount(whichisaverysignificantfactorformanypeople),and
whenoneconsidersthegreatdealofsufferingthatoccursfrompainfulandoften
dangeroustreatmentsperformedbywesterndoctors,thebenefitandeffectivenessof
Tibetanmedicinecouldproveextremelygreat.
TibetanMedicineanditsReligiousInfluences
There are a few important features of Tibetan medicine that are religious and that need to be
explained in order to make sense of many of the difficulties Tibetan medicine experiences when
it is introduced to the West. It is quite common for patients to first encounter the religious
elements in Tibetan medicine when receiving treatment from amchis, because when they are
giving the medication sometimes the amchi either prays or recites mantras.18
One of the most crucial religious aspects of Tibetan medicine is that the rbgyud-bzhi, a
foundational medical text for Tibetan medicine, contains elements influenced by religion. This
text serves as the synthesis and foundation for Tibetan medical knowledge. Doctors trained at the
Men Tsee Khang College in Dharmsala must fully understand the rbgyud-bzhi. Usually large
portions of the rbgyud-bzhi must be memorized in order for a student to officially become an
amchi.
rbgyud-bzhi is traditionally translated as the four tantras, and is shortened from its full title,
bDud- rsis sNying-po Yan-lags brGyad-pa gSang-ba Man-ngag gi rGyu, which means The
Essence of the Secret Instruction on Eight Branches. 19 The four tantras of the rbgyud-bzhi are
18H.H.DalaiLama.TheKnowledgeofHealing.Dir.FranzReichle.Perf.14thDalaiLama,Dr.
DevinGonier
10
the Root Tantra (rTsa-rGyud), the Explanatory Tantra (bShad-rGyud), the Quintessence Oral
Instruction Tantra (Man ngag-rGyud), and the Subsequent Tantra (Phyima-rGyud). 20
rbgyud-bzhi and its Origin
The origin of the rbgyud-bzhi is somewhat controversial. According to Dr. Tsering Thakchoe
Drungtso21 there are four competing hypothesis about the texts beginning. The first is that it is
the exact words of Sangye Menla (the Medicine Buddha). The second is that Vairochana and
Kashimiri Pandi Chandrananda translated it from the Sanskrit text Legs-sByar nas bsGyur-ba.
This is probably the least tenable hypothesis due to a number of inconsistencies; one is that it
would imply that Tibetan medicine originated from Indian culture (when there are many
references of ancient Tibetan cultural icons and medicinal procedures like pulse diagnosis, which
did not appear in Ayurvedic medicine until 200 years after the rbgyud-bzhi was written). The
third interpretation is that it is a rediscovered treasure (gter ma) after being hidden by Guru
Padmasambhava in the central pillar of Samye monastery and later discovered by gTer-sTon
Grawa mNgonshes around 1012-1091 A.D.22 Finally, many believe that Youthog Yonten Gonpo
and his son were the authors of the rbgyud-bzhi, and it is largely based on an early medical text
called Zhang Zhung around 1126-1202 A.D. Dr. Drungtso suggests that it is not the direct word
of the Medicine Buddha based on a few inconsistencies within the text itself and the history of
some of its principles in Tibetan culture. Thus, while it might not be a popularly held belief that
the text originated from the Medicine Buddha directly, its references to the Medicine Buddha and
some of its other structural components cause it to be considered a divine work, and
20Ibid.
21Ibid.pg.23
22Ibid.pg.23
DevinGonier
11
traditional accounts of text or the history of Tibetan medicineplace the work in a category
with the other sutras and tantras.23
Rbgyud-bzhi and its Content
The second important feature of the rbgyud-bzhi to look at is its content. There are 5,900
verses spanning over 156 chapters in the rbgyud-bzhi24. There is a diversity of topics explored
throughout each tantra, and each tantra has a specific purpose. The rbgyud-bzhi begins with the
prayer to the Medicine Buddha, Homage to the King of Aquamarine Light and Supreme
Benefactor, who has attained perfect fulfillment and overcome all obstructions, he who has
reached the ultimate reality and become the fully-endowed conqueror who surpasses all
bounds.25 This prayer immediately sets the structure and tone of the rest of the text as being
inspired by Buddhist principles. The entire text explores eight branches of medicine: The body,
pediatrics, gynecology, harmful evil spirits, wounds inflicted by weapons, toxicology,
rejuvenation, and aphrodisiacs.26 The fourth branch immediately implies certain religious beliefs
i.e. the belief in evil spirits. Chapter 73 and Chapters 77-81of the Quintessence Oral Tantra,
and Chapter 9 of the Explanatory Tantra deal directly with spirits that have a direct effect on
human health. Chapter 13 (called rGyun-Spyod) of the Explanatory Tantra deals with behavior (a
potentially major cause for illness) and the ways in which certain religious practices and moral
acts can have a strong effect on illness. Finally, discussions about the amchis role and treatment
23ToddFenner,TheOriginoftherbgyudbzhi:ATibetanMedicalTantra.SnowLion
Publications.Pg.461
25YeshiDhonden,andJhampaKelsang.TheAmbrosiaHeartTantra.NewDelhi:Educa
Books/Paljorpg.1ThistextcontainsthetranslationoftheRootTantra,andthesecondhalfof
theExplanatoryTantrafromtherbgyudbzhi.
Dharamsala:Drungtso,2004.pg.36
DevinGonier
12
of the patient in chapters 25 (Ngan-gYo-sKyon-brtag) and chapter31 (sMan-paI leu) are very
invocative of the Buddhist concept of Bodhicitta.
The rbgyud-bzhi, both in its origin and content, largely incorporates Buddhist and Bon
imagery. Because of the tendency of biomedicine to value only what can be scientifically proven,
there is often great controversy when western doctors try to understand Tibetan medicine through
the rbgyud-bzhi. As Craig Janes notes, It is the overarching theoretical logic found in the core
texts, a logic which references principles that might be glossed as spiritual or religious, that
has become entangled in the debate over the distinction between the sacred and the scientific.27
The rbgyud-bzhi is a foundational text for Tibetan medicine, and Buddhism and Bon heavily
influences it.
Karma
Furthermore, karma plays an important role in Tibetan medicine. In the thirteenth chapter of
the Explanatory Tantra, it specifies two types of actions that can affect illness and more broadly
about happiness: sacred and worldly activities. The rbgyud-bzhi recommends doing worldly
activities in a safe and healthy way; for example, avoid dangerous places, and get enough sleep.
Sacred activities are activities that can also have a great impact on a persons health because they
promote good karma. The rbgyud-bzhi states,
Living in accordance with the religions of the world is the foundation of all
virtueswithout a religious approach to life happiness itself is a cause of
discontent...Subdue the actions of your body, speech and mind and have a
generous attitude free of attachment.28
The religious foundation reflects of Buddhist principles on how one should live their life in order
to be happy and healthy.
27CraigR.Janes,"Buddhism,Science,andMarket:theglobalizationofTibetanmedicine."
AnthropologyandMedicine9(2002):275
28YeshiDhonden,andJhampaKelsang.TheAmbrosiaHeartTantra.NewDelhi:Educa
Books/Paljor:106107
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13
In Tibetan medicine, there are traditionally four classifications of illness. There are 101
superficial or ostensible diseases (ltar snang phral-nad), 101 diseases of this life time (yong
grub tshe-nad), 101 diseases of harmful evil spirits (kun brtags gdon-nad), and 101 untreatable
karmic diseases (gZhan dbang sNgon las).29 Karmic diseases are diseases that simply dont
respond to treatment, and no possible explanation other than karma can be attributed to them.
The diagnosis usually consists of treatment using whatever medicine that may be helpful (but
will not result in a cure) and typically consultation with a lama alongside pujas30.
Many have heard stories of people with conditions that would normally seem curable
either through biomedicine or Tibetan medicine, but for some reason the treatment seems to
consistently fail. For example, while in Kathmandu, I interviewed a Geshe31 at the White Temple
named Karma Gyurme who claimed to have a karmic disease. He had consulted biomedical and
Tibetan medicine doctors about the problem (stomach pains) and none could explain or cure his
illness. However, he was not bitter about having a karmic illness. In fact, when I asked him how
having a karmic illness effected him, he quoted Santideva saying, If anything happens that can
be changed, why worry, it can be changed; and if anything happens that cannot be changed what
is the point in worrying? In Geshe Gyurmes mind, a karmic illness was an opportunity to work
off negative actions from the past. Suffering from illness now, meant that he would not have to
suffer some terrible tragedy in the future to make up for his evil deeds of the past. Thus, built
into the very structure of Tibetan medicine is the Buddhist principle of karma. Our bodies are
constantly changing, and this change is a result of our actions. Part of the justification for this is
that the humors themselves are manifestations of the three poisons; rLung (wind) is connected
30religiousofferingceremonies
31AGesheisanacademicdegreewithintheMonastictraditionthatrequiresapersontobea
monkandtohavestudiedforthedegreefromatimespanof1220years.
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14
with desire and attachment, mKhris pa (bile) with hatred, and Bad-kan (phlegm) with
ignorance.32 These actions directly affect the physical humors. Thus, karmic illnesses are
incurable, because the body has changed as a result of behavior, not behavior like smoking or
eating too much, but moral behavior.
The Spirit World and Demons
Therearealsospiritsanddemonsthathaveaneffectonillness.Aswasbrieflymentioned
earlier,Tibetanmedicinestatesthatthereare101diseasescausedbyharmfulspirits.Theidea
thatspiritsareacausalagentindiseaseimmediatelypresentsproblemsformostWestern
doctors.MostcasesofpossessionorspiritualinfluencedealwiththehumorrLung(wind),which
typicallyismostassociatedwiththemind,andisthepervasivelifeforceofthebody.Dr.Terry
Clifford,apsychiatristwhotookgreatinterestinTibetanmedicineandpsychiatry,presentsthe
varietyofinterpretationsregardingdemonswhenhewrites,
An uneducated Tibetan might actually believe in them <demons> as malevolent
embodied hobgoblins; a yogi might think of them as negative energies or fields of
force that exist in the universe; and yet more sophisticated lamas and doctors and
laymen might perceive them as unconscious tendencies deep within the psyche
that have the power to overwhelm normal consciousness.
He defines demon very broadly as, any unseen force that obstructs a psychological or spiritual
development.33 There are eighteen different types of spirits that can affect the body. For
example, there is a spirit called a Klu or Naga, which is a serpent spirit or spirit, which reside on
land and in water. When possessing a person these spirits cause sickness and symptoms like,
fondness for meat, milk and other dairy products, constant licking of lips, and the desire to lay
on ones belly rather than back.34 Sometimes these spirits can be upset by pollution or
mistreatment of the land, and sometimes they may even cause epidemics within a small
32JampaG.Dagthon,"TheImportanceofAstro.ScienceinMedicine."TibetanAstronomyand
Astrology:ABriefIntroduction.Dharamsala,India:TibetanMedicalandAstro.Institute,
1995:34
33Dr.TerryClifford,"TibetanPsychiatryandMentalHealth."BulletinofTibetology1993
(AspectsofclassicalTibetanMedicine).Gangtok:NamgyalInstituteofTibetology,1993:10
DevinGonier
15
community. However one chooses to consider the ontology of such spirits, it is clear that they
play a part in the treatment and understanding of the body for Tibetan medicine.
Astrology
Tibetan medical hospitals are called Men Tsee Khang, which literally breaks down to
Men (medicine) Tsee (Astrology) khang (house) meaning Tibetan medicine and Astrology
House. Astrology is typically also required material for most students studying at the Men Tsee
Khang institute in Dharmsala. In fact, the truly effective healer within the Tibetan tradition will
have studied both medicine and Astro. Science, since the influences on the body comes from
both within and without.35 In order to understand the role of spirits, you need to understand
astrology and the role of the elements. Tibetan medicine describes five elements that make up the
existence of the entire universe; medicine observes Fire, Earth, Water, Air and Space,
astrologers observe instead Fire, Earth, Water, Wood, and Metal. [Elements that are adapted from
Chinese medicine]36 These elements also make up the various aspects of the body and play an
important part in the formation of the humors. Whereas, Tibetan medicine focuses on the internal
relation of the elements as they manifest in the harmony of the humors, astrology focuses on the
outside of the body by looking to places like the stars, the seasons, and the temporal location of
the individual in relation to the time of the universe. By doing this, astrologers are able to
diagnose present problems or future problems that might develop as a result of changes in the
universe. Thus, effective amchis are able to understand the balance of the elements both inside
and outside the body through a holistic understanding that transcends even the body.
35JampaG.Dagthon,"TheImportanceofAstro.ScienceinMedicine."TibetanAstronomyand
1995:29
36Ibid.Pg.36
DevinGonier
16
Some religious features of Tibetan medicine might eventually be explained through

scientific study, and other features of Tibetan medicine might be transformed to more modern
scientific practices. This is something that the XIVth Dalai Lama has emphasized should be the
case, and he recommends in certain situations amending old religious beliefs on the basis of
modern development in a cautious manner. Based on some traditional views, replacing these
religious aspects with science alone would be a violation of the very integrity and coherence that
makes Tibetan medicine function. Tibetan medicine as an effective religious healing system has
great potential for success in the U.S., but in order to understand how Tibetan medicine can fill
an important demand in the U.S., it is important to explain how demand for healing has changed
in contemporary healthcare for the U.S.
Background:TheStatusofComplementary,Alternative,andIntegrativeMedicineinthe
U.S.
In the United States our healthcare system has become more diverse, but the supply of diversity
in healing is mitigated by a few policy factors that will be discussed in this section. The
Enlightenment Period witnessed the rise of scientific thinking. Science became a coherent
framework that began to have great sway over the common persons understanding of the world
and their body. With the introduction of new technologies and techniques, modern medicine
throughout the 20th century developed at an astounding rate, and was able to radically change the
way we understand the human being and treat suffering.
Demand for CAM and the NCCAM
In the U.S.A. demand for CAM has grown a great deal over the past few decades.
According to the National Center for Complementary and Alternative Medicine (NCCAM),
36% of adults are using some form of CAM. When megavitamin therapy and prayer specifically
DevinGonier
17
for health reasons are included in the definition of CAM, that number rises to 62%.37 According
to a different study done by David Eisenberg38 and colleagues (1998) that appeared in the
Journal of the American Medical Association it estimated that in 1997, 42.1 percent of all adult
Americans had used some form of alternative therapies (including chiropractic, relaxation
techniques, biofeedback, and acupuncture) in the past twelve months, a significant increase from
the 33.8 percent estimated to have done so in 1990. 39Thisindicatesthatthereisagrowing
demandforCAMintheU.S.Peoplearebeginningtobecomemoreinterestedintreatmentsother
thantheexclusiveuseofconventionalallopathic40biomedicine.
AswillbedevelopedmoreinthefollowingsectionstheNCCAMusestheprinciplesof
biomedicineastemplatesforlegitimizingalternativemedicinaltreatmentsintheU.S.The
consequencesofthewayinwhichthecommonAmericannotonlytreatstheirillnesses,butalso
onhowtheyunderstandtheirbodyhavebeenprofound.U.Ssocietyischanging,butpolicyis
strugglingifnotcompletelyfailingtokeepup.Patientsseekingmedicaltreatmentoutsideof
traditionalallopathicmedicineencounterproblemswithinsurancecompanyslackofcoverage,
andphysiciansfromothermedicalphilosophiesencounterproblemswithlegallybeingallowed
topracticemedicine.Muchofthischangeindemandmakessensewhenoneconsidersthe
37PMBarnes,B.Bloom,R.NahinComplementaryandAlternativeMedicineUseAmong
AdultsandChildren:UnitedStates,2007.CDCNationalHealthStatisticsReport#12.
December2008
38DavidEisenbergisaDirectoroftheOsherInstituteatHarvardMedicalSchoolandthe
DivisionforResearchandEducationinComplementaryandIntegrativeMedicine.
39RobertTillman,"PayingforAlternativeMedicine:theRoleofHealthInsurers."Annalsofthe
AmericanAcademyofPoliticalandSocialScience583(2002):6475.1
40Manydoctorsviewthewordallopathictobepejorative,anddonotacceptitsuse.Forthe
sakeofthispaperitwillrefertowesternmedicinesthatusebiomedicalepistemologiesandare
theresultofDescartesanalyticprinciplesthatfoundedreductionism.Thetermismost
commonlyusedtojuxtaposemedicineslikeOsteopathy,whichwouldbeconsideredholistic,
fromotherwesternmedicinesthatarenotholistic.
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18
ideologicalchangethathasbeenoccurringinU.S.societyandthroughouttheworldfromthe
moderntothepostmodern.Inordertounderstandtheculturalandphilosophicalreasonsforthis
struggletoachieveaheterogeneoushealthcaresystemthispaperwilldrawheavilyuponthe
principlesofpostmodernmedicine.
PostmodernMedicine
WhatisPostmodernism?
Lyotard defines Postmodernism in broad terms as,
an incredulity towards metanarratives. A metanarrative is a theory or
story that passes itself off as a truth without exception, generalized truths
that pretend to be true for all objects in a category, such as all Priests are
pure, all people in a certain country think a certain way, or science is the
best approach to solving all human problems. Metanarratives, it seems to
the postmodern, are myths belonging to modernity, myths that simplify
and blind us to subtleties and exceptions around us, myths that are often
more false than true, but seldom completely true.41
Michel Foucault, one of the premier thinkers of postmodernism, argues that within every society
there is a complex system that he calls the microphysics of power. These systems of power
discipline our bodies and produce certain actions that are complicit with a set of assumptions
within a discourse. Various systems of power conceptualize truths in terms of the processes
involved in the application of power. As Vincent B. Leitch notes of Foucault,
Nothing-whether selves, desires, or truth-is external to the productive
power/knowledge that creates the categories by which it is known. Thus,
the truth to which dissidents appeal is no less a product of interested
strategies- in this case, their own than the truth spoken by the officials
whom they oppose. Truths are not all born equal, because some discourses
are more powerful than others. But Foucault does not recognize any
component of truth separate from power.42
41L. Shawver, Notes on reading the Birth of the Clinic. 16 May 1998.
http://www.california.com/~rathbone/foucbc.htm
42"MichelFoucault."TheNortonAnthologyofTheoryandCriticism.Ed.VincentB.Leitch.
NewYork,NY:Norton&Company,Inc.,2001.1620.
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19
Thus, truth is a function of power, it is something which power produces and is a product of
discourses that are shaped by power structures. For example, in our justice system a person is
considered truly guilty after he has gone through a procedural process in which people evaluate
him and his actions in relation to a system of laws. This truth of guilt is a product of the power
people place in the judicial system and its processes. In this way, a modernist metanarrative
might say that the justice system upholds truth by determining what is true or false regarding a
particular persons actions based on a particular process (i.e. two sides compete in order to
convince a jury of peers that their position is the true position). Another metanarrative that
postmodern medicine will be examining closely are those involving healing and healthcare in the
U.S. The dominant framework for understanding the body and identifying the correct procedures
for healing would be the biomedical narrative. If the metanarrative that biomedicine is the only
way to conceptualize and cure the body is accepted in our society, then biomedicine is
hegemonic at the expense of other narratives of healing. In other words, the truths and
knowledge people have about their bodies is the product of discourses on the body that exist
within a system of power. At the moment, this system of power is dominated by the discourse of
biomedicine, so what biomedicine asserts becomes the dominant truth of the body, because it
holds more power than other healing systems in our healthcare discourse.
Postmodernism and Heterogeneity
One aspect of postmodernism, and postmodern medicine especially, is the emphasis on achieving
a heterogeneous discourse. Rather than one narrative of healing (biomedicine) having
biopolitical hegemony over the rest of society, postmodernists believe that multiple narratives of
healing can coexist. As David Morris43, a premier postmodern medicine thinker notes,
43DavidB.Morris,winnerofa1992PENawardforTheCultureofPain(California,1991)and
authoroftheawardwinningAlexanderPope:TheGeniusofSense(1984),livesandwritesin
Albuquerque,NewMexico.
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20
Postmodernism is normally described as inherently heterogeneous marked by the absence of a

single dominant style or mode of thought. It splinters unified discourses, decenters orthodox
beliefs, validates marginal positions endlessly deferring full knowledge, adding supplement on
supplement.44
Medicine is not just a system of healing, but also a power structure. Medicine is a power
structure in so far as it represents our understanding of our bodies and how we care for our
bodies. It is a
cultural force of discipline by virtue of what Foucault has called a clinical gaze
that transforms the body into an object of scientific scrutiny. Patients often note
how the power implicit in the physician and in the medical setting can reduce us
to a state of passive and dependent helplessness, in which we sit for hours in a
crowded waiting room until the busy doctor at last finds time to see us.45
The medical discourse and the power relationships within it have a large impact on our identity
and the way we conceptualize our relationship with our body and the rest of society.
The state regulates narratives of healing because a paternalistic state always sees it as
advantageous to have some sort of systematic bureaucratic control over the body (what Foucault
calls biopower). Thus, many governments including the U.S. federal government have in place
certain federal organizations in charge of regulating what qualifies as legitimate medicine. Arthur
Kleinman46 writes of biomedicine that,
in the postmodern state, biomedicine has come to serve a major political
mission it has outstripped its own professional autonomy and become
inseparable from the state. In Western countries, biomedicine occupies the
chief legitimized role for supplying health service to the populace, a role47,
as Waldrum points out, that it protects with diligence. Chief among its
44DavidB.Morris,IllnessandCultureinthePostmodernAge.UniversityofCaliforniaP,
2000:136
45Ibid.pg.146
46ArthurKleinmanisaprofessorofmedicalanthropologyandcrossculturalpsychiatryat
HarvardUniversity.
47Craig R. Janes, "Buddhism, science, and market: the globalization of Tibetan medicine."
Anthropology and Medicine 9 (2002): pg.35
DevinGonier
21
repertoire of responses to heterodox challenges is its use of state power to

both generate and enforce the ground rules and criteria for establishing
efficacy. Alternatives to biomedicine, when they cannot be set aside as
inefficacious or simply labeled as quackery, are often co-opted or tamed by
state-supported biomedicine.48
In the U.S. one of the primary organizations for regulating what qualifies as legitimate medicine
is the NCCAM. The movement called postmodern medicine is a movement which focuses on
healthcare through a postmodern lens, and which typically advocates diverse ways of thinking
and conceptualizing the body and healing.
Constructive Postmodern Medicine
MultidimensionalRealism
Elliott S. Dacher49 helps to identify some of the central components and advocacies of
postmodern medicine. The first component he discusses is called Multidimensional Realism. It is
neither radical subjectivism nor scientific materialism, but is a multidimensional amalgam of
sensory and non-sensory knowledge.50 Neither radical subjectivity, nor radical objectivity is as
fruitful as they can be when both are given value. It is important to recognize that this is
something that develops historically. Healing was once very religious and subjectively
understood, then after the scientific revolution of the enlightenment, medicine tended towards
objective science as a metaphysical foundation. Postmodernism however acknowledges that both
the subjective and the objective are critical parts of the healing process, and the exclusion of one
for the other inevitably reduces the effectiveness of healing. Healing should include both
48Ibid. pg. 36
49ElliottS.DacherisanM.D.thathaswrittenanumberofbooksonhealthcareincluding
IntegralHealth:ThePathtoHumanFlourishing.
50ElliotDacher,M.D."TowardsaPostmodernmedicine."TheJournalofAlternativeand
ComplementaryMedicine2(1996):532.
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22
subjective understandings of health that account for perceptions of pain and the power of the
mind in healing the body, and objective standards for evaluating the disease as a physical entity
to be treated through physical processes like medicine. This aspect is critical in the understanding
of religion and healing (as will be discussed later on). What should be taken away from this is
that, science and religious modes of healing do not have to be exclusive of one another, and
when techniques from both are used in a complementary way, a more successful style of healing
will result. For Tibetan medicine, subjectivity and objectivity come together in the sense that the
subjective condition of the mind, religious experiences, and karmic consequences are just as
valuable as the objective circumstances and physiological circumstances in treating illness.
Intentionality
The second quality that Dacher emphasizes is Intentionality, which validates the causal
nature of consciousness which is individually willed.51 Both Intentionality and
Mutlidimensional realism acknowledge the value of consciousness and the mind in the healing
process. Intentionality, postmodern medicine advocates, is the importance of understanding
sickness as an illness rather than a disease, giving place to subjectivity as an agent in healing
rather than a passive recipient of the objective disease. Once again, this aspect opens up new
possibilities for understanding the techniques of religiously inspired healing. Religious
techniques tap into the deeper more subjective aspects of consciousness, and by doing so those
techniques can cure the illness, but sometimes not necessarily the disease. Expanding our
conception of being unhealthy to include the subjective term illness and the objective term
disease creates space for the more ritualistic modes of healing inspired by religion. Dachers
principle of intentionality is also relevant to Tibetan medicines account of karmic or demonic
illnesses, which do not have scientific explanations based upon universal laws. Tibetan medicine
51Ibid.
DevinGonier
23
teaches that certain states of mind produce imbalances in the body and qualities that might be
dismissed as subjective are causally linked to the more objective physiological elements of the
body.
Holism
The third quality that Dacher focuses on is Holism, which rejects the duality of mind and
body, the subjective and objective, and other such dualities in exchange for the belief that they
remain interconnected. In other words, part of the problem with scientific materialism and
radical subjectivity comes about as a result of thinking of objectivity and subjectivity in a
completely binary manner. A deeper understanding and application of both as one interconnected
whole is essential for effective healing. One of the bigger criticisms of biomedicine (as will be
noted later on) is that it views the mind as a biological entity and the body as a machine, which
prevents the possibility of healing via the mind. However, Tibetan medicine believes the mind is
crucial in the healing process, and it emphasizes practices that are aimed at lifestyle choices and
religious practices that utilize the mind in the process of healing.
Clearly, the previous three elements of postmodern medicine are related to each other.
The first understands that subjective and objective approaches can work together. This idea is
related to the fact that consciousness and the subjective elements of consciousness can have an
effect on the objective physiological body. And, finally Holism breaks down the separation
between the mind and the body, which is consistent with the belief, that consciousness and more
subjectively understood approaches to healing could be effective.
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24
Personal Authenticity
The final characteristic is Personal Authenticity, which empowers the individual beyond
the authority from belief systems, institutions, and professionals by recognizing that authentic
individualism comes into being in the context of relationship.52 The dynamic of healthcare is
evolving away from power structures where the patient has no real influence in their own healing
process. For example, the movement away from reductive medicine, where healing is understood
as a treatment of symptoms, to the view that healing should be about locating the causes of
illness, results in active dietary and lifestyle changes on the part of the patient. In other words,
postmodern medicine advocates a system where people can take an active role in their own
health, and can develop their own specific view about how to treat it. This is made more possible
in a heterogeneous healthcare system, because a person can make the choice about what type of
healthcare is the best fit for them.
Comparing Gray and Dacher
J.A. Muir-Gray,53 writer of Postmodern medicine, also makes a few important
observations about postmodern medicine. His observations are much less theoretical and are
aimed at practical and concrete applications. Rather than articulating all of his observations, this
paper will focus on the few that are most relevant to the argument presented, and will explore the
ways in which a healthcare system with both Tibetan medicine and biomedicine reflects the
advocacy of postmodern medicine. Many of Grays ideas are similar to Dachers. Grays
principle of a Value Based Healthcare and his emphasis on Experience over Satisfaction of Care
really address some of the ways in which the entire process of allopathic biomedicine can be
overly reductive and mechanistic. Grays point is that the doctors visit should involve better
52ElliotDacher,M.D."TowardsaPostmodernmedicine."TheJournalofAlternativeand
ComplementaryMedicine2(1996):533
53J.A.GrayhasbeeninvolvedwithPublichealthcareforover25years.
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25
verbal and non verbal communication, and a style of consultation and decision making that
involves and empowers the patient.54 Thus, the patient and the doctors relationship should be
one that is less mechanistic and open to the views and opinions of the patient, since it is their
body that is in danger.
Tibetan medicine accounts for this problem of disempowerment and over-mechanization
on a number of levels. Most of the diagnostic procedures in Tibetan medicine come from detailed
questioning that is meant to find the root cause of imbalances within the body. Treatments are
always specific to the patient. In other words, a biomedical doctor treats the patient by attacking
the disease, but the Tibetan medicine amchi treats it by understanding the body of the patient and
the ways in which imbalances have developed. Thus, a biomedical doctor would most likely treat
a group of people exhibiting one type of disease in roughly the same way, but a Tibetan Medical
doctor might treat the same biomedical illness in different ways based on the specific body type
of the patient.
Furthermore, Grays points about Treating Disease vs Healing dis-ease and his account of
multiple realities address the need for viewing the illness as something that has both subjective
and objective components. Both of these ideas have already been addressed through the Dachers
account of utilizing both subjective and objective elements in healing by placing emphasis on
consciousness as an agent in the healing process.
Thevariouselementsofpostmodernmedicinethathavebeenarticulatedherecanbe
mostlysummedupbyageneralsuspicionofthepurelyobjectiveandscientificapproachto
medicine.Graynotesthat,Postmodernismalsochallengestheobjectivitythatsciencehas
claimedisitsdefiningcharacteristicasspuriousandunsupportable,andalthoughmanydifferent
54J.A.Gray,"Postmodernmedicine."LancetOct30(1999):1552
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26
theoriesareencompassedbythetermpostmodernism,asuspicionofscienceliesatthecoreof
suchtheories.55Postmodernmedicineisnottryingtosuggestthatscienceoughttobeeliminated
frommedicineandhealing.Rather,itissuggestingthatobjectiveapproachestohealinghave
becomeforvarioussocialreasonstheexclusivemodeofthinkingaboutandtreatingthebody.
Theeffectshavebeenthatthepatientbecomesdisconnectedfromthehealingoftheirownbody,
andtheprocessofhealinghasbecomelessaboutmeaningfulhumaninteraction,andmoreabout
amarketdrivenexchangeofgoodsandservicesmeanttostreamlinetheeliminationof
symptoms.Ifthehealthcaresystemopensitselfuptodifferentepistemologies(epistemologies
thatincorporatesubjectiveapproachestohealthcareaswellasobjectiveapproaches)ofhealing,
thentherecanbemoreofabalancebetweenthepurelysubjectiveandpurelyobjectivemodesof
healing.
Criticisms of Postmodernism
One of the most relevant and effective criticisms of viewing postmodernism as a tool for
expanding the interaction of medical epistemologies comes from Allen Wallaces Buddhism and
Science. Wallace argues that there is great potential for Buddhism and Science to collaborate on
trying to further our understanding of this world. For example, Wallaces book includes
discussion about the potential for a productive discussion between Quantum scientists and the
Buddhist philosophers in understanding complex problems of existence. In a section called, The
Dogma of Postmodernism Wallace argues that postmodernism undermines the potential for
Buddhism and science to cooperate in the advancement of knowledge. If Wallace were correct
then this would do great damage to the position that postmodern medicine could facilitate a more
55J.A.Gray,"Postmodernmedicine."LancetOct30(1999):1550
DevinGonier
27
balanced healthcare system in which Tibetan medicine (largely built around Buddhist principles)
can grow along side the scientifically based biomedicine.
Wallace chooses to focus on Jacksons postmodernism,56 which he considers dogmatic.
Wallace might be correct about Jacksons specific rendition of postmodernism and perhaps his
dogmatic application of postmodernism, but this paper will argue a more moderate form of
postmodernism that is centered around thinkers like Morris, Dacher, and Gray who argue for
postmodern medicine specifically.
Wallaces first criticism is that Jacksonss postmodernism emphasizes cultural
particularism, which asserts that different societies are culturally unique, incommensurable and
hence fundamentally unknowable by outsiders. This would imply that various schools of
Buddhism are culturally unique to the Asian societies in which they developed, therefore their
theories and methods of inquiry cannot be compared to those of science.57 This is a good point,
but does not represent the way many postmodernists choose to interpret the role of culture. For
instance, Bell Hooks argues that postmodernism can be a huge step in the advancement of civil
rights in the U.S. Postmodernism allows the recognition that we are all socially and culturally
constructed creatures, and that we should each respect each other for our uniqueness. Wallace
does not consider those postmodernists that want to protect the autonomy of the unique culturally
produced individual by preventing hegemonic narratives from silencing marginal voices. This
could be misinterpreted as the position that says all narratives are mutually exclusive so that
everyone is speaking a different language and there is no room for collaboration. But in reality
postmodern medicine (and more specifically the way in which I choose to interpret postmodern
medicine, especially within the context of Tibetan medicine and biomedicine in the U.S. heath
56Alan Wallace, Buddhism and Science. Columbia University Press, 2003pg.23
57Ibid.pg.2021
DevinGonier
28
care system) creates a framework of mutual respect in which dialogue is generated with the
premise that differences ought to be celebrated and appreciated by acknowledging the cultural
uniqueness of each individual.
Wallace then criticizes Foucault in particular. He suggests that Foucault reduces religion
to nothing more than a power mechanism. In Foucaults defense, what he is doing is choosing to
focus on power mechanisms. This criticism represents a fundamental misunderstanding of
Foucaults methodology. Foucaults methodology is meant to explain how contemporary
discourse has developed as a result of social circumstances in the past and that the contemporary
discourse is shaped by various power structures that have developed and become more or less
powerful because of historical events. Foucault is not asserting that all religions are wrong, and
serve a purely social disciplinary function. Rather he is demonstrating how certain historical
developments have arranged discourse in a way that is shaped by the power of certain ideologies.
This criticism would be akin to suggesting that an anthropologist reduces religion to something
that is only a cultural product. Just because the anthropologist evaluates religion through a
cultural lens does not imply that the anthropologist views religion as something that is only
culturally produced and has no right to transcendental claims.
Along these lines, Wallace also criticizes Foucault, because Foucault argues that there is
no absolute truth, and the insistence on the lack of absolute truth in any worldview other than
postmodernism appears to be one of the fundamental articles of faith of this dogma, which
indicates its close similarities with scientism and other forms of fundamentalism.58 Wallace
argues that postmodernisms claim that there is no absolute truth is itself a truth claim, which
makes postmodernism dogmatic in so far as it grants itself a truth claim, but denies all other
ideologies such a privilege.
58Ibid.pg.2122
DevinGonier
29
However, Foucaults position is more complex than simply the rejection of absolute truth.
In order to respond to this criticism a brief return to Foucaults explanation of truth will be
helpful. Foucault believes that truth and power are related. He argues that discourse is shaped by
power mechanisms, and thus certain things become true as a result of how discourse is shaped by
power. Wallace is right that Foucault would disagree with the view that Truth is something with
pure objective value and can be absolute. For Foucault, truth is a product of a discourse shaped
by history, and the standards of truth are constantly shifting based upon changing power
structures. But, this evolution of truth does not disrupt the ability of science and religion to
interact with one another. On the contrary, Foucaults description opens up the ability for
dialogue to occur. By empowering marginalized voices, postmodern medicine aims at making
the contemporary discourse open to other less powerful explanations. Thus, the attempt is not to
argue that either biomedicine is True in an objective and non-socially constructed sense or that
religious claims are true in a transcendental sense. But, postmodern medicine aims at creating
dialogue between different power structures by leveling the playing field. One of the ways that
this is possible is by flagging the moments in our discourse that have become dominated by a
particular episteme. By bringing attention to these hegemonic epistemologies within our
discourse, the healthcare system can recognize the ways in which it marginalizes other ways of
thinking about and healing the body.
Finally, Wallace suggests that Postmodernism emphasizes aesthetics as the primary
mechanism for determining belief. In other words, a person chooses to believe a Buddhist
principle or a scientific principle, because it has a subjective appeal to them. A belief is
aesthetically chosen, when it lacks an objective basis, and is chosen from a personal connection
to an idea or belief that an idea is beautiful or personally meaningful. This is very reminiscent of
DevinGonier
30
Dachers Personal Authenticity principle. Postmodernism would support the autonomy of the
patient in choosing the best type of medicine for their treatment. In many cases this is an
aesthetic choice. If a person is a fundamentalist Christian, then they might find trouble with the
underlying Buddhist principles within Tibetan medicine. Or if a different person is looking for a
type of healing that involves spirituality, energy, and consciousness they might seek out Tibetan
medicine or Reiki healing, because it offers them the mechanisms of healing that are consistent
with their beliefs and would best provide them with the necessary confidence to achieve health.59
In this way postmodern medicine would emphasize a certain aesthetic choice of the patient but
this choice assumes that the patient is well informed about the advantages and disadvantages of
various systems of healing (a knowledge that will continue to grow for the everyday person).
Wallaces criticism is very poignant. But, many of his criticisms seem specific to
Jacksons postmodernism, and certainly are not very applicable to the characteristics pointed out
by Morris, Dacher and Gray. The few that are applicable seen under a different light are not
really that troublesome. There is no perfect system for conceptualizing the relationship between
Tibetan medicine and biomedicine within the U.S. healthcare system; there will always be
criticisms, but there is still great potential for postmodern medicine to help bring balance to the
U.S. healthcare system. In order to establish balance there has to be recognition of the
imbalances within the system already, and so it is necessary to explore the elements of
biomedicine that have become problematic.
59Itiswellknownthatconfidenceinrecoveringfromillnessplaysabigpartinthe
effectivenessoftreatment.Typicallythisiscalledpsychosomatichealing,anditwillbe
discussedmorethoroughlylateron.
DevinGonier
31
Deconstructive Postmodern Medicine and Biomedicine

Biomedicinehassavedandextendedthelivesofcountlessindividualsoverthepastfew
centuries.Scientificadvancementsmadebybrilliantphysiciansandlaboratoryworkershave
revolutionizedthewaysinwhichwetreatillnessandcurethosewhoaresuffering.Anycritique
ofbiomedicineoughttobeprefacedwiththeacknowledgementthatbiomedicinehasdonea
greatservicetotheadvancementofhealththroughouttheworld.
When people speak of the U.S. healthcare system, they are typically referring to
biomedical treatment. On the contrary, healthcare refers to a much broader system of health that
includes not just the primary biomedical treatment, but non-biomedical treatment as well that
may be considered alternative, complementary, or integrative. So, when discussing the future of
healthcare, and what it will take to make that healthcare the best model possible it is important to
look at the entire spectrum of health and not just biomedicine. In order to address the broader
question of healthcare, this section will evaluate those aspects of biomedicine that could
potentially be greatly improved by other systems of healing.
The criticisms addressed in this section are well known by many physicians, and some
actively, and sometimes very successfully, try and solve these problems. A diverse healthcare
system could provide different epistemologies for healing. Like two puzzle pieces fitting
together, one epistemological disadvantage of biomedicine might be an advantage for Tibetan
medicine, and vice versa. The only way to truly compensate for fundamental problems with
biomedicine is to allow other systems of healing to function along side biomedicine. Drawing
mostly upon postmodern medicine thinkers like David Morris, this section will outline three
main criticisms of biomedicine: biomedicine is reductive, dualistic, and mechanistic.
DevinGonier
32
Biomedicine is Reductive
What is meant by reductive here? George Engel60 defines reductionism within the context of
medicine as, the philosophic view that complex phenomena are ultimately derived from a single
primary principle.61 This view is typically juxtaposed to holistic medicine. Tom Dummer
characterizes Tibetan medicine as holistic in his book Tibetan Medicine and Other Holistic
Healthcare Systems. He defines holistic as the understanding of reality, in terms of integrated
wholes whose properties cannot be reduced to those of smaller units.62 This difference between
holistic ways of looking at medicine and reductive ways of analyzing medicine might make more
sense when one understands its cultural origins. Pre-Socratic philosophers in the West like
Heraclitus believed all of nature could be reduced to fire, and Thales believed all of existence
was some manifestation of water. In fact, these thinkers were among many pre-Socratics that
tried to find the ultimate essence of existence by reducing the whole down to its most essential
part or parts. So, from the very beginning of Western philosophy we find the roots of what can
best be described as reductionism. This became a major foundation for most of modern science.
George Engel offers one very specific starting point for reductionism in Western
Medicine. According to Engel, five centuries ago there was one very critical concession of
established Christian orthodoxy to permit dissection of the human body. The Church allowed
scientists to examine the body through autopsy on the sole condition that these scientists do not
involve the mind in their investigation. The reasoning was that the mind and soul are subject
areas that belong to the Church. This beginning point was combined with analytic philosophers
60GeorgeL.EngelisapsychiatristinAmericabestknownforhiscreationofthe
biopsychosocialmodel.HehasspentmostofhiscareerattheUniversityofRochesterMedical
Center.
61GL.Engel,"TheNeedforaNewMedicalModel."Science 196 (1977): 131
62 Thomas G. Dummer, Tibetan Medicine and Other Health-Care Systems. London: Routledge,
1988. 127
DevinGonier
33
like Descartes and scientists like Newton and Galileo, who believed that investigations could be
resolved into isolable causal chains or units, from which it was assumed that the whole could be
understood, both materially and conceptually, by reconstructing the parts.63 Thus, the doctrine of
the Church and the scientists of the time both moved biomedicine in the direction of viewing the
body as a machine, of disease as the consequence of the breakdown of the machine, and of the
doctors task as the repairer of the machine.64 It was from these roots that reductionism was able
to gain such a strong foothold within medicine. Foucault might look at these events and argue
that they played an important part in changing or shaping the power dynamic of medical
discourse so that biomedical doctors evaluates the body in a way that is distinct from the mind
and can be analyzed through reductive techniques.
This narrow approach was no doubt a great success, but because it has been restricted
to this approach alone, certain problems have inevitably followed. 65 Many of the problems of
allopathic66 medicine can be balanced by emphasizing holistic epistemologies for healing in the
U.S. healthcare system so that they can become more popular. There are some limitations that
exclusive allopathic medicine creates. A holistic and allopathic approach will be compared.
1. Preventative Treatment vs. Fixing the Problem.
One primary difference between allopathic and holistic medicine is the difference between
preventative and immediate treatment. Allopathic medicine is less effective at preventing future
illness, but is exceptional at treating problems as they arise especially during emergencies;
holistic medicines like Tibetan medicine are not well known for emergency care, but
64Ibid.132
65Ibid.132
66For the criticism of reductionism specifically, this paper will use the term allopathicmedicine,
since some forms of medicine like osteopathy might be considered biomedical but not reductive.
DevinGonier
34
demonstrate great success at promoting long term health and treatment of chronic diseases. Dr.
Dorje, a Tibetan Amch at the Men Tsee Khang in Dharamsala,67 helped illustrate the difference
between preventative treatment and immediate treatment by using an analogy of a pipe. Imagine
for a minute you have a pipe that looks like so:
WATER
The pipe is a representation of the body. In order to have a healthy pipe, water must effectively
be transported from one place to another. The water is a representation of the various factors
involved in the maintenance of health, such as diet, lifestyle, and environment.
WATERXXXXX
No Water
Then, there is a problem. The pipe is now diseased and has a clog. At this point there are two
main ways to deal with this infection. The first way is to find the clog and remove it. This would
be akin to surgery or strong medicine.
Water
XXX
Water
Once the clog or disease is removed, and there are no longer any remnants of the infection it
appears as if our pipe is healthy again. But, it isnt long before a similar type of problem
manifests in an entirely different way.
Water
67AninterviewwithDr.Dorje.
XXXX
DevinGonier
35
At this point we might recognize that there is something wrong with the whole system. Rather
than remove the specific dysfunction by way of treating the symptoms it would be better to
understand what is unhealthy about the system holistically. In other words, fixing the clog
metaphorically represents isolating and treating symptoms of a specific dysfunction, rather than
approaching the problem by attempting to disrupt the root cause for the problems or clogs in the
first place. For instance, we might analyze the water, representing the many factors that are
involved in the maintenance of both subjective and objective health like diet, exercise, emotional
stability, etc. in order to see if it is the source of clog or infection. Occasionally, it might be
discovered that the water is in fact filled with mud and dirt, and longer-term adjustments to diet
and other supplementary treatment might prevent future illnesses from arising. If we fix the
system itself and focus on preventing future clogs by cleaning the source (i.e. the water) then it
wont be necessary to make invasive treatments on the pipe to clean out every clog. Holistically
speaking it would look like this:
WATER
Allopathic medicine tends to focus on the treatment of symptoms, but holistic medicine focuses
on root causes for problems of the entire system. As one anthropologist notes, we need to fill the
gap. Holistic medicines like Tibetan medicine look for underlying patterns of imbalance that
may have systemic symptoms in the body emerging in different places at different points in time.
In contrast, biomedicine [allopathic biomedicine] tends to focus on the disease as an isolated
phenomenon that can be targeted for intervention as if it were free standing in the body and
frozen in time (or over time), preferably as an acute disorder (though not always). 68
68VincanneAdams,Randomized Controlled Crime: Postcolonial Sciences in Alternative
DevinGonier
36
Holistic medicine acknowledges that bacteria and viral infections are more likely to affect
those who have a weakened body on a holistic level. Maintaining the patients health consistently
is just as important, if not more important, than identifying the bacterial or viral source of an
illness. Mary Coddington in her book In Search of the Healing Energy notes that,
Traditional medicine (conventional medicine) adheres, by and large, to the germ
theory of disease. The holistic healer, although he recognizes that bacterial or viral
infection is present during illness, is apt to postulate that germs alone do not cause
disease but move in only when the individual is in a poor state of health with
weakened powers of resistance. It is the holistic doctors goal to maintain his
patients in a stable condition of physical well-being.69
Thus, reductive medicine might serve effective and important in the quick fix problems of
medicine, and in the curing of emergency or one-time problem illnesses, but it ultimately fails at
the long-term picture of health and well-being. By not providing a solid foundation for health in
general, allopathic biomedicine does not ensure the prevention of illnesses to come. Part of the
reason for the difficulty in treating long-term illnesses stems from the fact that allopathic
medicine treats illness by identifying the singular source for a disease rather than understanding
the illness to be the result of a multiplicity of causes that interact with one another.
2. Multiple Causation vs. Single Causation
When analyzing the body as a whole there is almost never one single cause to an illness. But,
when the approach to medicine is reductive the opposite is the case. Holistic medicines like
Tibetan medicine believe the body is constantly changing and each imbalance leads to other
imbalances in the future until the body is temporarily changed to resolve back into harmony.
There is never a single cause in Tibetan medicine for an illness, because an illness may be caused
karmically, (i.e. as a consequence from an action in this or a previous lifetime) from an improper
Medicine Research. Social Studies of Science, Vol. 32, No. 5/6 (Oct. - Dec., 2002). JSTOR.
Sage Productions, 2002: 671
69MaryCoddington,InsearchoftheHealingEnergy.NewYork:DestinyBooks,1983:169
DevinGonier
37
diet, an infection, or any combination of these things. In Tibetan medicine, illness is never an
isolated incident, it is always something that has multiple causes and will ultimately become the
cause of some future shift in balance of the body. This is because, as Dr. Ivette Vargas notes,
Tibetan medicine focuses on the occurrence of disease as a particular event (an imbalance that
may lead to other imbalances) and that such imbalances may have multiple causes. This is
clearly in opposition to Western biomedical approaches, which focus on diseases as generic
entities, which must therefore have a cause.70
With a reductive approach, if a patient claims to be having liver problems, then a doctor would
most likely focus almost exclusively on the liver. But from a holistic approach this doesnt work.
A liver problem is a sign that there is a greater imbalance in the body. So, for a holistic
practitioner it might be just as valuable to analyze the eye or the stomach to see all the possible
causes and effects in the entire body associated with that liver problem. It might seem like a
random choice for a doctor to analyze the stomach based upon a liver problem, but because of
the nature of a holistic approach doctors are trained to understand in great detail the relationship
between the different parts of the body so as to have a greater picture of the whole. They thus are
more intuitive in their abilities to understand causality within the body. By understanding how
the liver affects other functions in the body as a whole, a holistic doctor should be able to locate
the root causes rather than the immediate cause and by doing so will not only solve the
immediate problem but prevent future problems from occurring.
CartesianDualism,Physicalism,andtheImportanceoftheMindinHealingtheBody
70IvetteVargas,"TibetanMedicineRevisitedintheWest:NotesontheIntegrativeEffortsand
TransformativeProcessesOccurringinMassachusetts,USA."LaurentPordie,ed.Tibetan
MedicineintheContemporaryWorld:GlobalPoliticsofMedicalKnowledgeandPractice.
London:Routledge,2008:224
DevinGonier
38
As was mentioned briefly earlier, Descartes has had a profound impact on the way
Westerners think generally, and how doctors think specifically. Rene Descartes argued that the
mind and body were functionally two different types of substances. For Descartes, the body is
essentially a machine, which follows basic laws of physics and can be described as completely
material. In contrast to this the mind is non-material, does not follow the laws of physics, and can
control the machine via the pineal gland (which was not well understood at the time, and which
he considered the seat of the soul.). Obviously, biomedicine has come along way from believing
that the body is controlled by the mind through the workings of the pineal gland. Nonetheless,
biomedicine has not come a long way from the more basic philosophy that Descartes proposed.
Biomedicine still works off the assumption that the body is a machine and the doctors role is to
repair that machine.71 After Descartes, further advancements in biomedicine entrenched this
idea as well:
Technologicaladvances(e.g.,microscopy,thestethoscope,thebloodpressure
cuff,andrefinedsurgicaltechniques)demonstratedacellularworldthat
seemedfarapartfromtheworldofbeliefandemotion.Thediscoveryof
bacteriaand,later,antibioticsfurtherdispelledthenotionofbeliefinfluencing
health.Fixingorcuringanillnessbecameamatterofscience(i.e.,
technology)andtookprecedenceover,notaplacebeside,healingofthesoul.
Asmedicineseparatedthemindandthebody,scientistsofthemind
(neurologists)formulatedconcepts,suchastheunconscious,emotional
impulses,andcognitivedelusions,thatsolidifiedtheperceptionthatdiseases
ofthemindwerenot"real,"thatis,notbasedinphysiologyand
biochemistry.72
Furthermore,biomedicinemakesthedistinctionbetweenanillnessandadisease.Illness
representsthesubjectiveimpressionofthepatientthatthereissomethingwrongwiththe
body,whereasdiseaserepresentsanobjectiveobservableproblemwiththebody.Morris
explainsthatWhatthepatientreportsissubjective(anduntrustworthy),whatthelab
reportsisobjective(andtrue).73Thisdistinctionmakesiteasyfordoctorstodiscardthe
72NoAuthor.MindBodyMedicineanOverview.NationalCenterforComplementaryand
AlternativeMedicine.www.nccam.nih.gov
DevinGonier
39
moresubjectiveandmentalaspectsofillness,becausetheyareirrelevantinthecuringof
disease.Theseadvancementsinmedicinecombinedwiththephilosophicalinfluenceof
Descarteschangedthecourseofbiomedicinetobecomecompletelycenteredonthebody.
Once again, this provides an interesting contrast to Tibetan medicine, which works off of
the principle that the mind is an essential part of the healing process. Tibetan amchis consider
factors involving lifestyle and emotional stability in the diagnosis of disease, and because
Tibetan medicine is so intricately linked to Tibetan Buddhism many of the fundamental
principles used to understand and diagnose disease come from the Buddhist conception of the
mind. In this sense Tibetan medicine represents what Morris advocates when he refers to
postmodern illness. For Morris, this transition implies a shift, incomplete and ongoing, in which
the patient, no longer merely a bundle of symptoms reported by an unreliable, subjective ego,
emerges at moments as a valued participant in the medical process of diagnosis and treatment. In
this shift disease and illness also undergo change.74 This difference in thinking about the role of
the mind in healing also affects the way in which Tibetan medicine and biomedicine understand
psychosomatic healing.
1. Psychosomatic Healing
MostWesterndoctorswhendoinglaboratorytestsonmedicinesacknowledgepsychosomatic
healing.Thisisthereasonwhydoubleblindtestprocedurescanbeeffective,becauseitis
important,accordingtoawesternbiomedicalmodel,tounderstandtheeffectsofthemedicine
excludingthementaleffectsofthepatientbelievingintheeffectivenessofamedicine,asis
sometimesthecasewithplacebos.Inwesternbiomedicinepsychosomatichealingessentially
representsavariabletoavoid;somethingthatcannegativelyaffecttheresultsofanexperiment
2000:38
74Ibid.Pg.39
DevinGonier
40
meanttodiscovertheeffectivenessofamedicine.VincanneAdamsnotesthattheideaof
psychosomaticasitisunderstoodtodayintheWesterncontextisnotappropriatetoapplyin
Tibetan.ThereasonsuchadistinctiondoesnotexistisbecauseinTibetanmedicineandTibetan
culturemoregenerally,thebodyandthemindarenotunderstoodasparallelprocessesthathave
noaffectononeanother.InTibetanmedicineifapersonishealedandtheonlyexplanationfor
thathealingisamentalone,thenthehealingwassuccessful.InTibetanmedicinefocusingonthe
mindisaninvaluableapproachtohealingthebody.Curethemindandyouwillcurethebody.In
awesterncontext,themindisirrelevant;onesimplycuresthebody.
Recentresearchdemonstratessomeofthesignificantwaysinwhichthemindhaspower
overthebody.Forexample,oneveryobviousintersectionbetweenthemindandthebodyisthe
relationshipbetweenmentalstressandbackpain.Infact,astudyinvolving48,000meninthe
Swedisharmyconcluded,Jobstresswasrelatedtoemotionaldistress,andthisdistresswas
directlyrelatedtoclinicvisitsforbackpain.Themoreemotionaldistressasoldierhad,themore
returnvisitstotheclinicittooktosolvethebackpain.75Onecouldeasilyfindmanymorecases
wherethemindplayedasurprisinglysignificantroleinthehealingprocess.76Onereasonfor
whythereismoreemphasisonthemindinTibetanmedicineisthatitdrawsheavilyupon
Buddhistwaysofunderstandingthemind.Thisdifferenceinthinkingdrawsuponanimportant
distinctionbetween1stpersonand3rdpersonobservationinthequestforknowledge.
2. !st Person vs. 3rd Person Observation

75"JohnHopkinsHealthAlert:HowtoCopewithStressInducedBackPain."BackPainand
Osteoporosis(2007).JohnHopkinsHealthAlert.JohnHopkinsMedicine.
<http://www.johnshopkinshealthalerts.com/alerts/back_pain_osteoporosis/JohnsHopkinsHealthA
lertsBackPainOsteoporosis_14491.html>.
76Ibid
DevinGonier
41
The Dalai Lama explained one very interesting cultural difference between the way the Western
scientific system has developed and the way in which Buddhist thought has developed over
time.77 He suggests that there are two ways to understand any object of knowledge: a 1st person
perspective observation and a 3rd person perspective observation. The 3rd person perspective most
clearly represents the Western way of knowing. This perspective dictates that there is an object
that is to be observed following a strict procedure of inductive reasoning in order to come to
certain conclusions about that object. With the 1st person observation technique, a person follows
procedures developed by previous masters to observe themselves in order to understand deeper
realizations about their own existence and human nature more generally. The West often
disregards this perspective because it is considered subjective. However, notice that this
subjectivity/objectivity distinction is precisely the division between illness and disease and the
mind and the body. The Dalai Lama suggests that both procedures for observing fail and succeed,
and the best way to learn about the body and Human nature is to combine both methods. Because
of its Cartesian influences, biomedicine gives greatest value to knowledge that can be verified
as objective.78
The 1st person observational perspective coming from Buddhist and Hindu approaches to
meditation have surprised many Western scientists. Dr. Benson once performed an experiment
with the permission of the Dalai Lama to observe gtum mo meditation and its effect on the body.
What most surprised the scientist was one particular event in which a group of highly skilled
monks were able to completely dry wet sheets in freezing temperatures by increasing their body
temperature through meditation. These exceeded the doctors expectations, and surprised most
77H.H. Dalai Lama. The Universe in a Single Atom: The convergence of Science and Morality.
TBWA Morgan Rd. Books, 2005
2000:38
DevinGonier
42
Western scientists, as no physiological explanation seemed to make sense. In this particular

circumstance it was nothing other than a group of very skilled practitioners using their minds to
influence their bodies. The problem with these studies for many Western scientists is that there is
no way to internally observe, beyond the physical effects of increased body temperature, what is
happening with the meditators; the type of tantric energy being harnessed was ultimately not
scientifically provable. However, there can
be little doubt that this energy call it orgone, chI, mana, prana, Innate,
or vital force- does indeed exist. It is, after all presently being harnessed,
or released from blockage, by the various therapies of acupuncture,
homeopathy, bioenenergetics, kinesiology, hypnosis, chiropractic, yoga,
psychic healing, biofeedback and others. The healing energy can be
harnessed, yes, but still not scientifically measured. 79
The Dalai Lamas wisdom about combining different approaches to knowing can be quite useful
to the advancement of healthcare in the U.S. In fact his recommended approach returns one
previous criticism Wallace had of Foucault and absolute truth. The Dalai Lama suggests that in
the different discourses on Buddhism and science there are different epistemologies for
understanding ideas. Thus, the possibilities for science to interact with Buddhism are largely
shaped by socially produced power structures that construct what is deemed to be acceptable
standards for knowing something. Biomedicines physicalist approach is the result of its
reductive framework, and this approach limits its potential for healing because it is too restrictive
in its view of the minds potential. Combining the 3rd person technique and the 1st person
technique in an effective way is precisely what is meant by multi dimensional realism as an
advocacy of postmodern medicine mentioned earlier. Only by harnessing the power of subjective
and objective observation can the greatest potential for success be achieved.
79DavidB.Morris,InSearchoftheHealingEnergy.NewYork:DestinyBooks,1983:169170
DevinGonier
43
Anothercritiqueisthatbiomedicine is mechanistic in two ways. First, it lacks intuitive

attention to the individual patient and it is formulaic in the way in which medicine is prescribed
to patients. Secondly, biomedicine is mechanistic in the way doctors are taught to be empathetic
towards the patient.
1. Intuition, Mapping the Body, and Healing the Specific Illness

Traditionally, doctors are taught that certain medicines correspond to certain diseases. These
diseases have certain signs, which can be apparent in the symptoms of the patients or through lab
results. Regardless of the individual person, a disease is treated through medication or therapy
that has been discovered to be effective through research and development. Based upon their
knowledge of how to treat the disease they prescribe the appropriate treatment. The only reason
the doctor would avoid one medicine over another medicine in this situation is if the patient is
allergic to some of the medication, or if one medicine has a better record from clinical trials, or if
that medicine would negatively counteract with other medicines taken by the patient. To most
Westerners this experience seems fairly typical and not that problematic. Biomedicine has a
greater emphasis on curing the specific disease for the average person than curing the disease
relative to the specific person.
During an interview with Dr. Dorje at the Men Tsee Khang in Dharmsala, India, he said
that Tibetan medicine places great emphasis on what he called mapping the body. This refers to
a very deep examination of the patient (especially those patients with chronic illness) in which
the body type is classified according to the most dominant humor. In Tibetan medicine, each
body has a certain humor (Phlegm, Bile, or Wind or a combination like Phlegm-Bile) that
DevinGonier
44
predominates (there are seven possible variations of body type), but this predominance changes
throughout the course of life depending on a number of factors including the age of the person.
The first task of an amchi mapping the body is to identify the body type of the patient. After this,
an amchi must evaluate the season, time of day, psychological influences (such as troubles at
home), diet, and lifestyle. Each one of these factors helps the doctor understand what the
body/mind is going through at the time of the illness. After evaluating the patient, then the doctor
tries to understand where the imbalance is in the body, and what might be causing the imbalance.
This is where Tibetan medicine and biomedicine go down different paths. A patient with a
biomedicine doctor displaying X symptoms will be treated with Y medicine, but in Tibetan
medicine X symptoms dont necessarily imply a Y treatment; it all depends upon the patient and
his mind/body condition. Vincanne Adams gives a good example of this type of approach,
Tibetan medicine classifies diseases according to the humoral constitution of the
patient and its relationship to other simultaneous disorders, not on the basis of
disease resemblances between patients only. For example, a person with a blood
growth in the uterus may be diagnosed as having the growth because of weak
downward expelling winds accompanied by strong bile energy. Another patient
with a growth in the uterus that looks just like the first patient in an ultrasound
diagnosis, will be diagnosed as having a flesh growth from an overly strong
phlegm presence accompanied by strong winds. Thus, two patients with the
same biomedical disease can be seen as having different Tibetan diseases. But,
even if the patients are identified with the same Tibetan disease, they may be
diagnosed with different etiological pathways, and so needing different
treatments.80
Thisdifferenceinmethodologyfortreatingapatientmeansthatanamchihasmoreroomto
beintuitiveinthetreatmentofapatient.Byfollowinghisorherexperienceandtrainingeach
diagnosisisspecifictonotonlytheillness,butalsothebody/mindofthepatient.Itisexactly
becauseofthisapproachthatTibetanmedicinehasfacedmanydifficultiesintheprocessof
gettingmedicineslegalizedandsoldthroughouttheU.S.TheNCCAMfollowsstrictprocedures
fordeterminingtheeffectivenessofmedicine,followingbiomedicalguidelines.Understanding
Sage Productions, 2002:671
DevinGonier
45
thespecificcharacteristicsofthepatientsbodyincludestryingtounderstandthepatientslife
circumstancesandemotionalwellbeing.Thisapproachhelpstobuildastrongdoctorpatient
relationshipthatpromotesempathyovermoremechanisticandgeneralprocedurestotreating
illnessthatarecharacteristicofbiomedicine.
2.Empathy
Empathywithinthecontextofbiomedicinehasalonghistoryofcomplicationsandchange.How
adoctorrelatestoapatientcanoftenbeadelicatematter.Infact,empathyineffect,hasno
fixedmeaningorvalueinthehistoryofmedicine.Itisacontestedtermwhosehistorical
complicationsitsopponentsandproponentssilentlyaskustoforget.81Thetroublefroma
biomedicalperspectiveisthatdoctorsmaybecometooattachedtotheirpatientssuffering,and
areunabletocarryoutnecessaryfunctionsthatwouldeffectivelyhealtheperson.Lorraine
Code82,authororRhetoricalSpaces,explainsthatempathyisathoroughlydoubleedged
phenomenon:itsexpressionisnotanunqualifiedgood.Henceitisvitalthatitswouldbe
advocatesdevelopaselfcriticalpoliticsofempathy,tokeepthemascognizantofitspitfallsas
theymaybeofitspromise.83Oftentimes,genuineempathyisdiscouragedorrepressed.Rafael
CampoinhisworkTheDesiretoHealdiscussessomeofthedifficultiesheexperiencedwhile
trainingtobeaphysician.HisworkdealtprimarilywithAIDS,andhedevelopedstrong
connectionswithhispatients.Infact,thesefeelingswerestrongenoughtoleadtoan
anonymoushandscrawlednoteplacedinmyevaluationfilesayingthatIhadproblemswith
identifyingtoostronglywithmypatientsandthatIhadatendencytoletmyemotionsgetin
thewayofpatientcare.84
Empathyisnotconsidereduselessinbiomedicalpractice,butthewayinwhichthebiomedical
communityacknowledgesandpromotesempathyisultimatelyartificial.Itunderstandsempathy
assomethingofinstrumentalvalue.Beingabletomakethepatientfeelthattheyarecaredfor,or
thatthephysicianempathizeswiththem,canleadthemtoshareinformationandfacilitatetheir
ownhealinginamoreeffectiveway.Inthebiomedicalcommunity
itisfarsafertofocusonbehaviorsthatreduceempathytoapracticedsmile,a
firmhandshake,andaglanceatthewristwatchtoleteighteensecondspassbefore
interruption.Lostisthechanceforahumanencounterthat,asforCampo,allows
healerstoconfront,andiftheyarelucky,tolearnfromtheirownvulnerability
andunacknowledgedbrokenness.85
Thus,empathyexistsinthebiomedicalcommunity,butitisencouragedtoexistonlyasan
artificialtooltofacilitatetreatment.
Partoftheproblemisthatbiomedicinefocusesondiagnosesandmechanisticelementsof
applyingbiomedicalprinciplestotreatment.Thus,Morrisnotesthatitshouldnotseema
81David B. Morris, "How to Speak Postmodern: Medicine, Illness, and Cultural Change." The
Hastings Counter Report. Vol. 30 No. 6 (Nov-Dec. 2000) JSTOR. Hastings Center, 2000:pg.10
82LorraineCode.RhetoricalSpaces.NewYork,NY:Routledge,1995.pg.121
83LorraineCodeisDistinguishedResearchProfessorintheDepartmentofPhilosophyatYork
UniversityinToronto,CanadaandaFellowoftheRoyalSocietyofCanada.
84David B. Morris, "How to Speak Postmodern: Medicine, Illness, and Cultural Change." The
Hastings Counter Report. Vol. 30 No. 6 (Nov-Dec. 2000) JSTOR. Hastings Center, 2000:pg.11
85Ibid.pg.11
DevinGonier
46
surprisethatbiomedicinehasmostlyignoredsufferinginfavorofproblemsnotalwaysequally
pressingwheretheboundariesarelessvagueandthecomplicationsmoreresponsiveto
innovationsintechniqueandinpharmacology.86Oneoftheprimaryargumentscomingfrom
narrativemedicinethinkerslikeRitaCharonisthatbiomedicineisunempathetic,becauseitfails
torelateandempathizewiththenarrativeofstrugglethatthepatientundergoesthroughoutthe
pathtohealth.RitaCharonexplainsthat
Despitesuchimpressivetechnicalprogress,doctorsoftenlackthehuman
capacitiestorecognizetheplightsoftheirpatients,toextendempathytoward
thosewhosuffer,andtojoinhonestlyandcourageouslywithpatientsintheir
strugglestowardrecovery,withchronicillness,orinfacingdeath.Patientslament
thattheirdoctorsdontlistentothemorthattheyseemindifferenttotheir
suffering.Fidelityandconstancyseemtohavebecomecasualtiesofthecost
consciousbureaucraticmarketplace.Insteadofbeingaccompaniedthroughthe
uncertaintiesandindignitiesofillnessbyatrustedguidewhoknowsthem,
patientsfindthattheyarereferredfromonespecialistandonprocedureto
another,perhapsreceivingtechnicallyadequatecarebutbeingabandonedwith
theconsequencesandthedreadofillness.87
Thishighlymechanizedprocessofbiomedicinecreatesagreatdisparitybetweenthe
patientsexperienceandthedoctorsexperienceintreatingthem.
DespiteMorriscriticismofartificialempathyinbiomedicine,hesuggeststhat
genuineempathymightbeimpossible.ExploringthewritingsofLevinas,Morris
suggests,TheassumptionthatwecanfeelsomeoneelsesfeelingisforLevinasan
exerciseinselfdeceptionthattransformserosintoaninstrumentofpower.88Inother
words,genuineempathyisimpossible,sincenohumancaneverfullyrelatetoanother
humaninthewaythattheconceptempathyrequires.Partoftheproblemisalackof
clarityonwhatexactlydefinesempathy,andhowadoctorexperiencesandutilizes
empathy.Itdoesntbecomesurprisingthen,thatinawesterncontextauthorslikeLevinas
questiontheconceptofempathyasevenapossibility.However,Levinascriticismof
empathyisspecifictowaysinwhichempathyisunderstoodinthewest.Tibetan
medicineutilizestheBuddhistideaofbodhicitta,whichisonewayofunderstanding
empathy,initstreatmentofillness.
BodhicittainTibetanMedicine
BodhicittaliterallytranslatestothemindoftheBuddha,oraspirationoftheBuddha
(howevertherearemanyothercomplexwaysoftranslatingthisSanskritwordintoEnglish).
Thisaspirationforenlightenmentisnotselfish,becauseonestrugglestoachievegreaterpower
andinsightinordertohelpthosewhosuffer.Bodhicittavaluestheotherbeforetheself,and
2000.pg.193
87RitaCharon,NarrativeMedicine:HonoringtheStoriesofIllness.Oxford:OxfordUP,2006:
3
2000:11
DevinGonier
47
seeksnotnecessarilytounderstandtheperceptionoftheotherasLevinaswouldattemptto
conceptualizeempathybutattemptstodevelopadeepsenseofcompassiontowardscuringthe
otherspain.Bodhicittatranscendentlyinvokesforcesthatarebeyondtheabilitiesofthedoctor,
andthefeelingofempathythatitgeneratesisequallydividedamongallsentientbeings,whether
theyaremotherorenemy.MarionL.Matics,acommentatorandtranslatorofSantidevas
Bodhicaryavatarawrites,Bodhicitta(likeCitta)partakesofaquasiuniversalaspect,because
itisaforceletlooseintheuniversetoworkforthegoodofall.89LamaZopaRinpocheargues
fromtheTibetanNyingmatraditionthatwhenthistranscendentforceisusedbyhealersand
patientsitisthebestmedicineforthemindandforthebody.90Thus,manyamchisthattry
andincorporateBuddhistprinciplesintotheirpracticebelievethatbodhicittaisnotonlyavirtue,
butthatitcanalsoinvokeordrawuponhealingsourcesliketheMedicineBuddhathatare
outsideofSamsara.ThereisnothingaboutthepracticeofTibetanmedicinethatstructurally
requiresbodhicitta,butmanyamchisutilizetheBuddhistideaofbodhicittaintheirmedical
practiceasanextensionoftheirreligiouspractice.Infact,in every interview in Dharamsala each
amchi explained that bodhicitta is an essential aspect of practicing Tibetan medicine. Bodhicitta
is not something that is achieved without effort; it is something that many Tibetan amchis try to
develop, which is quite different from the repression of genuine feelings of empathy in
biomedicine. This specific rendition of compassion far more complex than the western word
empathy- could be very valuable within a western context in facilitating a connection between
patient and doctor that is genuine.
Basedonthepreviousobservations,themainargumentofthispaperisthatpostmodern medicine
creates space for religious healing systems like Tibetan medicine to function effectively in the
U.S. One way that postmodern medicine can be productive in modern American healthcare
discourse is by minimizing the power scientific materialism and scientific fundamentalism have
on healing in the U.S.
Scientific Materialism and the Development of an Areligious Healing Metanarrative
Scientificmaterialismassertsthattheuniverse,consciousness,andmostquestionsthat
areespeciallymeaningfulforreligionscanbeentirelyexplainedbyempiricalobservation.The
positionofscientificmaterialismwhencompletelyacceptedpresentsradicalproblemsfor
religiousstatementsofsubjectivityandtheimmaterial.Medicinehascometoembodythe
89MarionL.Matics,EnteringthePathofEnlightenment.London:Macmillian.(BCATrsl)
1970.pg.34
90Lama Zopa Rinpoche. Ultimate Healing: The Power of Compassion. Boston: Wisdom
Publications, 2001. Pg.18
DevinGonier
48
principlesofscientificmaterialism,andasaresultametanarrativewithinU.S.societyhas
developedwherereligionandtheorieswhichmaketranscendentclaimsthatareirreducibleto
scientificprincipleshavenoplaceintheroleofhealing.Thus,whenhealingsystemslike
Tibetanmedicinethatutilizesubjectivemethodsofthemindorincorporatereligiousidealsin
theirpracticeofhealingareintroducedtotheU.S.healthsystemtheyfacehostility.Alargepart
ofthishostilityhappensbeforemedicineslikeTibetanmedicinehavetheopportunitytobe
introducedtothesocietybygovernmentorganizationsliketheNCCAM.Theoverwhelming
powerofscientificmaterialismwithinthehealthcarediscoursehastransformedthewaypeople
conceiveoftheirbody,howtheytreattheirillbody,andhowtheyconceiveofwhatistrueof
theirbody.
Scientific materialism can be understood as an extension of the epistemological view
called logical positivism. For logical positivists like Rudolf Carnap91 concepts like God and love
are only emotive expressions, and all religious and philosophical views that cannot be
empirically verified do not serve a purpose in advancing our knowledge of the world. Therefore,
academic systems like religion, ethics, and metaphysics embody meaningless statements, and
only represent attitudes of the people who discuss them.
This view is in radical contrast to Postmodernism, which asserts an entirely different
understanding of experience and language. As Zygmunt Bauman notes in his article Postmodern
Religion?
Postmodern mindaccepts the fact that all too often experience spills out of the
verbal cages in which one would wish to hold it, that there are things of which
one should keep silent since one cannot speak of them, and that the ineffable is as
much an integral part of the human mode of being-in the world as is the linguistic
91SeeRudolfCarnap,"TheEliminationofMetaphysicsThroughLogicalAnalysisof
Language".In:A.J.Ayer,ed.,LogicalPositivism.Glencoe,Ill.:TheFreePress,pp.6081.
TranslationofCarnap1931.
DevinGonier
49
net in which one tries (in vain, as it happens, though no less vigorously for that
reason) to catch it.92
From this one can conclude that postmodernism and logical positivism do two very opposite
things. Whereas logical positivism tries to eliminate certain linguistic statements and terms,
because they cannot be verified, postmodernism argues that experience is more complex than
language can articulate. So, whereas many scientific materialists93 will assert that the human
experience can be reduced to logical statements of neuroscience, postmodernism argues that not
only is such a reduction impossible, but human experience cannot even be expressed through the
mechanism of language.
Postmodernism
Languageexpressesmeaning,but
genuinehumanexperienceisineffable,
andbeyondlanguage
HumanExperience
Languag
e
Logical Positivism
Languageexpressestoomuchthatis
meaningless,anditmustbereducedto
statementsthatareverifiable.
Language
Verifiablelanguagethatcan
meaningfullyexplainexperience
This linguistic distinction is an important one to make, because it demonstrates how postmodern
medicine is aimed at expanding healthcare discourse to include ideas that might not be
empirically verifiable, but still have the potential to save or improve lives.
Postmodern medicine therefore theoretically disrupts the metanarrative of healing that
asserts that subjectivity cannot be an agent in healing because subjectivity is an illusion it is
something which is essentially organic matter or a collection of neurotransmitters in the proper
92ZygmuntBauman,"PostmodernReligion?"Religion,ModernityandPostmodernity
(ReligionandModernity).NewYork:Blackwell,1998:1.
93Morespecificthanscientificmaterialismiseliminativematerialism.Eliminativematerialism
referstotheviewthatallhumanexperiencecanbefullyexplainedandunderstoodthrougha
completedneuroscience.
DevinGonier
50
order. Postmodern medicine does not eliminate the possibility of this interpretation; it simply
eliminates its status as a hegemonic metanarrative. Postmodern medicine views logical
positivism as just another coherent way of thinking about the world, and not the only coherent
way of thinking about the world. Therefore, postmodern medicine can and by its nature does
disrupt the metanarrative of an exclusively scientific materialist medicine, by expanding the
possibilities of healing to include subjectivity and consciousness in such a way that may not
reduce to logical principles or scientific understanding. Perhaps, one way to expand our
healthcare discourse is to begin finding successful models of integration that can include both
religious and secular modes of healing.
Integration, Globalized Tibetan Medicine, the NCCAM, and the U.S.

VincanneAdamsseparatestwomodesofintegration.Thefirstisintegration,whichin
itsbestpossiblesenseresultsinthesharingandexchangeofknowledgeandpractices94between
twoormorehealthcaresystems.Forexample,Tibetanmedicineincorporatesbiomedical
principleswithinitsframework,andbiomedicineincorporatesTibetanmedicalprinciplewithin
itsframework.Ontheotherendofthespectrumiserasure,whichiswhereone healthcare
system eliminates another one for the sake of incorporating the other. For example,
biomedicine incorporates Tibetan medicines pharmacopeias and other advantageous principles
within the biomedical framework, such that there is less demand to practice exclusively Tibetan
medical principles and less demand for patients to seek out Tibetan medicine.
94VincanneAdams,andF.F.Li."IntegrationorErasure:ModernizationattheMentsikhang."
DevinGonier
51
Integrating two systems would be a sort of mutual growth in which both systems
acknowledge the autonomy and legitimacy of the others epistemology. By integrating healthcare
systems it is much easier to adopt a heterogenous healthcare system that can prescribe multiple
types of treatments using multiple diagnostic procedures. These procedures and treatments can
significantly improve the healthcare system more broadly because they allow for specialization
in certain areas specific to indigenous and foreign types of healing. Integration is about
adaptation and improvement of a healing system in response to new ideas found in other systems
of healing, but this adaptation never compromises the core beliefs or epistemologies.
However, erasure functions in a way that would promote homogenous globalization. It
does this through the mechanisms of capitalism. One of the greatest structures that can
perpetuate erasure within a capitalistic framework would be a legal barrier. As long as legal
barriers are in place medicines must undergo a validating process within the hegemonic medical
framework. If these legal restrictions are too severe a foreign healing system will suffocate in a
marketplace of supply and demand, and the hegemonic healing system will benefit from the
foreign healing system by incorporating any research that can be considered relevant or suitable
to its hegemonic model of healing.
Most of the legal suffocation comes from the NCCAM. As Vincanne Adams notes in her
article, Randomized Controlled Crime: Postcolonial Sciences in Alternative Medicine
Research the NCCAM carries out a number of biopolitical functions in the process of validating
certain types of medicines. As was mentioned earlier, interest in alternative medicine has been
growing very significantly over the past few decades, making the role of the NCCAM more and
more important. As she notes, The branch of NIH devoted to studies in CAM had a 1993 budget
of US $2 Million (it was then the office of Alternative Medicine) and, by March of 2000, it was
DevinGonier
52
$68.7 million dollars (as the National Center for complementary and alternative Medicine
NCCAM.95 This organizations function is to evaluate alternative medicines in the U.S. and
determine licensing qualification and testing for foreign medicines that will be sold as treatment
in the U.S. However, in the act of evaluating what counts as legitimate medicine, the NCCAM
has to decide what counts as legitimate science, and what counts as a cure to the disease based on
a biomedical model.
The NCCAM presupposes a biomedical model in a number of ways that Vicanne Adams
outlines. The first, deals with the diagnostic techniques, which include both the identification of
the illness based upon its symptoms, and the etiology of that illness. This is important, because
Tibetan medicine functions on an entirely different epistemology. Vincanne Adams explains that,
starting with biomedical diseases results in a disorganization of the
Tibetan approach, undermining the logic of its etiology and treatment
resources, and making it most likely that it will not produce statistically
successful outcomes. In the end, medicines that cant show effectiveness in
treating biomedical diseases are considered a failure. Practitioners who use
them are at risk of accusations of medical fraud.96
Furthermore, Tibetan medicines diagnostic technique is fundamentally different in
how it evaluates the correct disorder of the patient. In the Western system, the primary variables
of determining the disease are based on the symptoms of the patient. In Tibetan medicine, one
must not only understand the symptoms, but also understand the body type of the patient. This
means that where biomedicine may say that one subject group has a distinct illness/disease,
Tibetan medicine will see different imbalances in different patients of that group. As a result,
taking a large category of patients who all exhibit the conditions for a biomedical classification
of a disease will inhibit the potential for success of Tibetan medicine, because some patients
Sage Productions, 2002:668
96Ibid. Pg.671
DevinGonier
53
within the biomedical category might require one type of medicine for their imbalance while
another patient will require another type of medicine for their specific imbalance. Like trying to
fit a square peg in a round hole, the system that qualifies legal medicine presupposes a particular
medical episteme, and thus prevents or limits epistemologies that are significantly different. The
NCCAM would take a sample group all exhibiting symptoms of disease X (as interpreted from
a biomedical perspective) and then would expect one medicine from Tibet to cure disease X.
But, the problem is that within group X, a Tibetan Amchi would diagnose people with having X,
Y, and Z imbalances (because of their specific body types), and all the different imbalances
would require different medication. So to run an experiment where Tibetan medicine must treat
a group X (as identified by biomedicine) with treatment X, when the Tibetan Amchi would
diagnose patients in Group X with X, Y, and Z would almost entirely eliminate the possibility
for success.
NCCAM and Success of Treatment

Secondly, the NCCAM utilizes different standards of determining whether or not
the disease/illness is cured. For Tibetan medicine, the permanent elimination of symptoms and
the balancing of the various humors constitute a healthy body. For biomedicine in the case of
bacterial illnesses and viruses, the elimination of the bacteria (discovered as a result of lab
testing) constitutes the successful curing of a patient. In one trial in particular (a trial on a group
of HP positive patients) this was especially noticeable,
The symptoms were eliminated, but the Hp was notWere the
collections of symptoms named as the set of some six disorders in Tibetan
medicine, the disease being studied? If so, then Tibetan medicine cured
them. Or was infection with Hp the disease, therefore ongoing infection
evidence that Tibetan medicine ultimately did not work to cure these
patientson the one hand powa ching cha mu bu, along with several
DevinGonier
54
other Tibetan diseases, was cured, but, when the disorder was called Hp,
in the terms of biomedicine, Tibetan medicines proved to be ineffective.97
This study is a good example of a situation in which data is simply understood differently
depending on the medical system being used. Forcing Tibetan medicine to work entirely within a
biomedical diagnostic framework prevents Tibetan medicine from being able to demonstrate its
effectiveness and earn a higher legal status within the U.S.
NCCAM and Architecture of Medicine

Finally, the way in which the medicine itself is constructed is unique to the medical
system being used. In Tibetan medicine it is not uncommon for dozens of ingredients to be
used in a single pill. But, organizations like the NCCAM dont acknowledge this architecture,
and prefer to focus on the effectiveness of single ingredients. This prevents the effectiveness of
most Tibetan herbal medicines; in order to be tested these herbal medicines must be stripped of
some of their most valuable components. The RCT method advocated by NCCAM allows for
Investigational New Drug Status for Tibetan medicines, but it also limits the number of drugs
and ingredients that can be tested in clinical trials The model of singular magic bullet drugs
or treatments that can eliminate identifiable acute diseases runs counter to the model of
treatment for diseases that are humorally-based and change as treatments progress, requiring
subtle re-combinations of sometimes over 60 ingredients and, for many patients, constantly
shifting combinations of different medicines.98 This limitation on the number of ingredients
creates a huge barrier to Tibetan medicine entering into the U.S healthcare system. Thus, some
97VincanneAdamsandF.F.Li."IntegrationorErasure:ModernizationattheMentsikhang."
Sage Productions, 2002673
DevinGonier
55
of the most valuable and potent medicines, which carry a large number of ingredients, either
must become less potent or have no chance of ever even being tested in the U.S.
All of these evaluations are ultimately standards that were developed by an
organization with political authority that organizes its experiments on the presuppositions of a
biomedical framework. In other words, any other foreign medicine that is tested through the
NCCAM must fit cleanly into a biomedical framework. But, for one framework (i.e. the
biomedical) to hold such sway over the legal validation process for other types of medicines is
a form of biopolitical control meant to entrench certain ways of thinking about the body and
analyzing the body.
What Vincanne Adams suggests is that the NCCAM is making biopolitical choices,
such that it controls what qualifies as legitimate conceptions of the body and the treatment of
the body. The consequence extends beyond the legal apparatus to the discourse on the body and
healthcare itself, and the government functionally empowers biomedical assumptions over
other power structures within the discourse. All patients seeking treatment must conform to
certain standards set up by the NCCAM that specify to what extent a physician can be
considered liable for prescribing a medicine that might be unsafe for a patient. Thus, discourse
of the body is produced by the NCCAM, because the validation process presupposes a
biomedical way of understanding the body, and this filtration process limits the potential for
other ways of healing the body. The result is that biomedicine becomes what Engel calls the
dominant folk model for the body.99
What this ultimately means is that as long as this biopolitical framework remains in
place that entrenches biomedical principles as the only validating standard, then erasure is the
only possibility for Tibetan medicine in a Western context. In other words, Tibetan medicine
99GL.Engel,"TheNeedforaNewMedicalModel."Science196(1977):132
DevinGonier
56
can only be practiced in the U.S. within a biomedical framework and through a biomedical
justification. In order to practice Tibetan medicine one must receive a license in biomedicine
first, and any Tibetan medicine prescribed in the U.S. is considered a supplement. Thus, to
bring about a heterogeneous healthcare system in the U.S., many of the procedures of the
NCCAM will have to be reconsidered so that they are more open to different medical
epistemologies. Only when this happens is it possible to have integrative medicine in the U.S.
that grants Tibetan medicine its own autonomy in relation to biomedicine.
Mostamchisinterviewedduringtheprocessofresearchforthisprojectlistedthe
greatestbarriertochangeasrecognition.Thisrecognitionwillonlybepossibleifthereare
avenuesforTibetanmedicinetodemonstrateitseffectivenessintermsofTibetanmedicine.This
willrequirecooperationandaframeworklikepostmodernmedicinethatsupportsa
heterogeneoushealthcaresystem.
Conclusion: From the Theoretical Back to the Practical

In contemporary society, policy is such that biomedical principles are reinforced and entrenched
by government agencies whose job it is to determine the legitimacy of alternative healing
systems. Great strides have been made in the past few decades in both academic thought and in
popular demand for new ways of thinking and healing the body. This is largely a reflection of the
shift in history from modernity to postmodernity. However, despite a lack of insurance coverage
for most systems of healing outside of biomedicine, with the exception of acupuncture and
chiropractic treatment, demand has increased and policy has not kept up with this ideological
shift. Organizations like the NCCAM, which utilize a very profound biopolitical function, are
still working within the ideology of modernity, and continue to ingrain biomedical thinking. As
DevinGonier
57
was mentioned earlier it is as if we are trying to fit a square peg in a round hole, where the peg
represents medicines like Tibetan medicine and the hole represents the NCCAM. The advocacy
of this thesis is that we should expand the hole, so that it may incorporate different coherent
models of thinking about the body.
One of the problems with making this shift is the constitutional status of religion and
state in the U.S. To what extent can the state legitimize religious principles used for healing? The
problem is that not legitimizing these principles is itself a position in affirmation of one coherent
model over another, namely a secular biomedical model. Scientific materialism can be just as
much a fundamentalism as any religious fundamentalism. The scientist that refuses to evaluate
claims prima facie because they are religious or cannot be reduced to some empirical verification
principle is as fundamentalist in epistemology as the religious zealot who refuses to acknowledge
scientific claims. The position of having no position in terms of religion and healing is
impossible, since secularizing medicine is a position of biopolitical hostility towards religious
ways of conceiving of the body. The argument is not that the government should necessarily
endorse religious healing; rather it should expand the definition of healing so that it allows for
other coherent models, which include religious principles, to have a legitimized avenue to heal
within society.
Future Possibilities
What would such a society look like where scientific models exist side by side with other
models that are inspired or influenced by religious teachings? David Cohen explains the Dalai
Lamas position at a conference on religion and science,
Scientific inquiry has a shadow aspect that manifests as dominance, exploitation,
subjugation, and arrogant imposition of authority. The opposite involves a posture
of humility and surrender in the face of what is unknown and what is given in
stewardship. In his keynote the Dalai Lama did not suggest either abdicating
DevinGonier
58
science for religion, on one hand, or abdicating religion for science, on the other;
rather, he expressed his respect for science alongside, religion, and he offered his
hope that our age would find a union between scientific and religious perspectives
in the search for knowledge of the healing traditions.100
BiomedicineandsystemsofhealinglikeTibetanmedicinecanoperatebothintegrativelyand
paralleltoeachother.Thedangerofintegration,aswasnotedearlier,isthatitcaneasilyslipinto
erasure.ThedifficultyismaintainingtheautonomyofTibetanmedicinewhenitmustexistin
cooperationwithanothersystemthatisantitheticaltosomeofitsphilosophicalpresuppositions.
But,ifbothcanacknowledgeanepistemologicalautonomyfortheother,byacknowledgingthat
eachhasacertaincoherentmodelforunderstandingthebody,thenbothcanpotentiallyprosper
sidebyside.Inorderforthistohappen,biomedicaldoctorsmayattempttotakeaninterestin
healingsystemslikeTibetanmedicine,sothattheymayknowwhatworkswellinTibetan
medicine.Inorderforthistohappen,doctorsmustlearnthelanguageofTibetanmedicine,and
learnaboutitonitsownterms.MakingconnectionsbetweenTibetanmedicineandbiomedicine
isimportant,buttheybothutilizedifferentepistemologies,andthoseepistemologiesmustbe
protectedfromerasure.But,simultaneouslythesedoctorsmustalsobegintoacknowledge
alternativestothebiomedicalmodel,sothattheycanfillinthosegapsbyrecommendingother
modelsofhealing.ThesamemustbetrueforahealingsystemlikeTibetanmedicineifitistobe
successfulinthewest.ItisquitecommonforaTibetanmedicinedoctortorecommenda
biomedicaldoctorincertaincases.Thefutureparadigmofhealthcarecanbeincooperationand
understandingofseparatecoherentmodelsofthinkingofthebody.Oneday,ahospitalmight
haveAyurvedicmedicine,Tibetanmedicine,Reikihealing,andbiomedicine.101Eachhospital
100Michael Cohen, Healing at the Borderland Between Medicine and Religion. North Carolina:
UNC Press, 2006: 4
101SuchClinicsalreadyexistinNepalandChina,liketheSheChemcliniclocatedin
Kathmandu,Nepal,whichhasanallopathicphysician,Ayurvedicphysician,andTibetan
DevinGonier
59
mightbeuniqueinitsowncoherentinternalsystems.Eachphysicianiftheycanmaintainan
openmind,willbeabletoprovideagreateropportunityforhealingbyunderstandingthesuccess
andfailingsoftheothersystems.Thismaymanifestintheformofcaregiversbeingfluentin
multipleWesternandEasternmodalities,frombiomedicinetotraditionalorientalmedicine,and
tobeabletoshifteffortlesslybetweenthetwointhebestinterestinthepatientorIn
institutionalterms,suchintegrationorsynthesismightmeantheabilitytoprovideacareteam
conversantinmultipleclinicaldisciplinesandlanguagesthatcaninteractivelyassess,respond,
andrefine,initiallydiagnosingandsubsequentlymeasuringthepatientsprogressthrough
multiplechannels.102Furthermore,suchasystemwillaccommodatethegrowingdesirefor
patientstochoosewhatkindofhealthcaretheydesire.Ratherthanthesesystemscompeting,or
onesystemerasinganother,thesesystemscouldbecooperatingandgrowingtogether.Healing
hasabrightfutureifthiscanbeachieved;afuturewheredoctorsworksidebysidedoctorsfrom
entirelydifferenttraditions,andknowledgeofthebodyisorganizedintocoherentmodels,but
evenmoresignificantlywherethepatientcanchoosehowtheyshouldtreattheirillness,andin
whatwaytheyshouldunderstandtheirbody.
medicineAmchionstaffinoneplaceallthetime.
102Michael Cohen, Healing at the Borderland Between Medicine and Religion. North Carolina:
UNC Press, 2006: 11
DevinGonier
60
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Interviews:
Name
Position
Time
Place
DevinGonier
LamaLodru
KarmaGyurme
PadmeYudron
Name
DrDhondup
DrKunchokTsering
64
LamaofSakyaMonastery Early
March
2008
GesheofWhiteTemple
LateApril
2008
Darjeeling,
WestBengal
Kathmandu,
Nepal
TibetanTeacherforthe MidMay Dharamsala

perspectiveofaTibetan 2008
personinDharmsala
Position
Time
Place
AmchiofTibetanmedicine Early
Darjeeling,
Clinic
March
WestBengal
2008
AmchiofTibetanmedicine LateApril Leh,Ladakh
Clinic
2008
AmchiNgawang
Thinley
HeadAmchioftheShe
ChenClinic
Dr.GyalmoKhangkar
AmchiofTibetanmedicine LateMay Mccleoud

clinic
2008
Ganj
Dr.Tamdin
PresidentoftheMenTsee June2008 Dharamsala

KhangCollege
Dr.Dolma
HeadoftheR&DDept.of June2008 Dharamsala

MenTseeKhangHQ
Dr.TenzinNamdul
ClinicalResearcheratthe June2008 Dharamsala

R&DDeptofMenTsee
KhangHQ
Prof.Dr.Tsering
Drungtso
TheTranslationDept.of June2008 Dharamsala

theGyushiand
accomplishedwriterforthe
MenTseeKhang
MemberoftheR&DDept. June2008 Dharamsala
ofMenTseeKhang
Dr.TseringDorje
MidMay Kathmandu,
2008
Nepal
DevinGonier
Dr.PhilWeber
65
AmchiataHolistic
Medicineclinic
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July2008 Boulder,CO

Combining Stories Reading Tibetan Medicine As A Western Narrative of Healing

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Combining Stories Reading Tibetan Medicine As A Western Narrative of Healing

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Tibetan Medicine and its Effectiveness

Some religious features of Tibetan medicine might eventually be explained through

Postmodernism is normally described as inherently heterogeneous marked by the absence of a

repertoire of responses to heterodox challenges is its use of state power to

Constructive Postmodern Medicine

Deconstructive Postmodern Medicine and Biomedicine

2. !st Person vs. 3rd Person Observation

Western scientists, as no physiological explanation seemed to make sense. In this particular

Anothercritiqueisthatbiomedicine is mechanistic in two ways. First, it lacks intuitive

1. Intuition, Mapping the Body, and Healing the Specific Illness

Integration, Globalized Tibetan Medicine, the NCCAM, and the U.S.

NCCAM and Success of Treatment

NCCAM and Architecture of Medicine

Conclusion: From the Theoretical Back to the Practical

Tibetan Medicine and the Healing Science of Tibet. Drungtso

TibetanTeacherforthe MidMay Dharamsala

AmchiofTibetanmedicine LateMay Mccleoud

PresidentoftheMenTsee June2008 Dharamsala

HeadoftheR&DDept.of June2008 Dharamsala

ClinicalResearcheratthe June2008 Dharamsala

TheTranslationDept.of June2008 Dharamsala

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