Reviewed Book
Healing at the Periphery: Ethnographies of Tibetan Medicine in India By Laurent Pordié and Stephan Kloos (Eds.), Durham, NC: Duke University Press. 2022. 211 pp.
Tawni Tidwell
University of Wisconsin-Madison
Healing at the Periphery is a collection of critical ethnographic works nearly two decades in the making, edited by Laurent Pordié and Stephan Kloos, that focus on Tibetan medical practice on the outer edges of its historical dissemination in India, both in the trans-Himalayan context of Ladakh and the Tibetan exile community from the late 1990s to early 2000s. A nomadic Ladakhi’s quote closing Blaikie’s contribution aptly epitomizes the framework for the volume as a whole: “This yul [village; home pastoralist region] is not whole without an amchi: it is like we are missing our heart” (85). It shows the amchi, or Tibetan medical physician, and Tibetan medicine more broadly, at the heart of community and social life serving as foundation for health, moral exemplar, and spiritual leader. In each contribution, the role of the amchi provides a lens into how specific cultural paradigms engage major socioeconomic shifts that transformed how we understand this region in its political, economic, and social significance today.
Tibetan medicine, otherwise known as Sowa Rigpa, or “Science of Healing” in Tibetan, is called by various names regionally, “Amchi medicine,” “Ladakhi medicine,” “Bhutanese medicine,” and “Mongolian medicine” and represents a broad dissemination of Tibetan medical theory-praxis stemming from central Tibet across much of central and southeast Asia. As the primary healthcare system for this region for over a millennium, Sowa Rigpa is showcased in these collated works at a pivotal moment, where major social, economic, legal, and political transformations occurring on the subcontinent are shaping how Sowa Rigpa affects the health resources and health identities of peoples’ lives. It demonstrates specific historic undercurrents configuring the state of Sowa Rigpa in India before its official recognition in 2010 and driving the subcontinent’s influence on Sowa Rigpa as it was leveraged into a geopolitical and medical phenomenon across Asia (Kloos et al., 2020).
In line with MAQ’s aims to facilitate explorations of important links between medical anthropology and neighboring fields in the humanities, social sciences, and health-related disciplines, Kloos and Pordié enrich anthropological analyses and ethnographic insights on Sowa Rigpa in the Ladakhi Himalayas with critical perspectives from the fields of law, economics, development studies, ethics, and public health. They fuse these narratives into a larger ethnographic tapestry that sheds light on how the ‘periphery’ details critical systemic processes shaping the Tibetan medical field more widely and foreshadowing critical developments in how Sowa Rigpa will take shape over the decades to come—prognostic signals that we have now seen unfold elaborately in the contemporary landscape.
The volume features key scholars in the anthropology of Sowa Rigpa, building upon foundations of those who contributed formative works to the field, such as Vincanne Adams, Sienna Craig, Theresia Hofer, Craig Janes, and Martin Saxer. Yet simultaneously they amplify voices underrepresented in scholarship on Sowa Rigpa, namely the stories of Ladakhi amchis, who, in this part of the narrated history, are yet to fully arrive as the global actors we see them become in the subsequent decades. By detailing these purportedly subaltern spaces as related to the central institutions of Lhasa, Dharamsala, and later Xining, we see clearly how practices and engagements on the margins can radically shape dominant forces in the field. Kloos and Pordié precisely unveil the blueprints of such manifestations. By doing so, Kloos and Pordié contribute to a growing body of work that investigates these peripheries.
As a highly relevant correlating example from inside Tibet, Hofer (2018), in her book Medicine and Memory, examines the reestablishment of Tibetan Medical Houses (sman grong), the revival of medical work among Buddhist monastics, and the reestablishment of a private Tibetan medical school, critically illustrating the revitalization of Tibetan medical cultures operating outside of governmental Tibetan medicine institutions and state-sponsored activities by examining three generations of Tibetan medical physicians on the periphery. In a similar grand narrative illustrating how the periphery can dynamically shape the center, Kloos and Pordié unveil undercurrents that foreshadow major processes to come, providing a window into the critical liminality of this formative period in Ladakh which is now the leading administrative, financial, and political center of Sowa Rigpa on the Indian subcontinent, arising amidst a broader socioeconomic, military, and ecotourism dialogue between urban India and the world (97).
One of the great strengths of this volume is its multifaceted depiction of the “Indian face of Sowa Rigpa” as a critical dimension of the Sowa Rigpa world from Tibetan medicine’s partial Indian origins derived from the transmission of Buddhism from India to Tibet and a shared intellectual history with what became Ayurveda in India. Kloos and Pordié’s eloquent introduction articulates the significance of India historically for Tibetan medicine but also in contemporary times with the Tibetan exile population, trans-Himalayan communities, and current identity politics of minoritized groups in India.
Some common threads of the contributions include examining how traditional reciprocal systems of amchi compensation for therapeutic care were dismantled vis-à-vis government subsidies between 1989 and 1994 and through additional non-governmental and private voluntary organizational support in the late 1990s and 2000s. The inconsistently provisioned financial support of amchi thereby deteriorated amchi ability to provide healthcare and cultivate trust amidst villagers’ expectation of free treatment and minimal monetary benefit or acceptance to amchi (chapters by Pirie, Kloos, and Blaikie). Besch and Guérin’s contribution examines the failures and successes of a development project solicited by villagers and amchi themselves to logistically and financially support a new health care system including a community fund to support medicine supplies and amchi livelihood. They argue that failure was narrowly circumvented by bolstering older community values and norms related to collective decision-making and ideals of reciprocity supporting medical care.
Models of the ‘good’ and ‘bad’ amchi are present throughout the volume. The former is characterized by Pirie, Blaikie, Gutschow, and Besch and Guérin’s contributions highlighting the idealized character traits of the ‘good’ amchi with their ethnographic examples. These traits include skill, knowledge, and compassion; community integration; displays of humility, honesty, generosity, and fairness; participation in customs of reciprocity; hereditary lineage; strong educational background; etiological communication that supports sociocultural paradigms of transformation and healing; and providing quality medicine either from one’s own compounding or procuring from trusted sources (103). The ‘bad’ amchi characterization is illustrated in descriptions by Kloos of Tashi Bulu, Blaikie of Ngawang Gilak and Karma Targais, more generally in Pordié and Petitet, as well as in Gerke’s discussions as we see physicians seeking social power and financial gain above providing quality medical care at times (77), while more broadly negotiating regimes of compensation for medical care; dynamics of out migration, upward mobility, and community belonging; local/regional policy negotiation; and community support. The rich subjects of childbirth, psychiatric illness, social loss and distress, epidemic prevention, public health care, and medicinal supplies provide contexts these collected works explore.
This volume will benefit scholars, researchers and students of medical, sociocultural, legal, development, and reproductive anthropology; medical humanities; South Asian, Tibetan, and Himalayan studies; medical and political history; development studies; public health; and subaltern studies. It provides critical ethnographic data to these diverse fields, helping us understand the underlying sociocultural, political, and environmental legal processes that have shaped Ladakh as a central region for India politically and Sowa Rigpa as a cultural and public health institution. It could be used well for both undergraduate and graduate courses on ethnographic methodologies, medical pluralism, illness narratives, medicine as a form of social knowledge, South Asian studies, anthropology of public health and Asian medical traditions, and historicized narratives.