Medicine and Memory in Tibet: Amchi Physicians in an Age of Reform. Theresia Hofer, Seattle: University of Washington Press, 2018, 286 pp.
Medicine and Memory in Tibet offers “the first full-length ethnography of Tibetan medical practitioners in central Tibet working outside the well-documented Tibetan medical institutions in Lhasa” (p. 2). Theresia Hofer recounts and analyzes the narratives of amchi (am chi) living and working in rural Tsang—now under Shigatse Prefecture of the Tibet Autonomous Region—and their struggles before and after the Chinese communist occupation in 1951. As Hofer explains in the Introduction, this study aims to complement extant anthropological and historical scholarship on 20th-century Sowa Rigpa (gso ba rig pa, Tibetan for “the science of healing”) in four main ways: (1) by contributing hitherto lacking local perspectives of practitioners “on the margins,” operating largely outside the Tibetan and later Chinese state health care apparatus; (2) through a critical enquiry into how socio–political dynamics influence memory and oral history in (post)socialist contexts; (3) through sensitivity to gender issues; and (4) by emphasizing the significant agency of rural amchi within harsh regimes and reforms and their role in the survival, revitalization, and continued transformation of Sowa Rigpa. The focus on these nonelite, subaltern oral histories and practices is laudable and much-needed, especially within Tibetan studies. It enables a move beyond a historiography hijacked by central institutions and highly politicized state-approved sources, either Chinese or Tibetan-Exile.
This monograph is based on long-term fieldwork commencing with a six-week official research stay in Ngamring County in the summer of 2003, and continuing from September 2006 to August 2007, while Hofer was enrolled as a language student at Tibet University (with more than three months spent in total in Shigatse and rural Tsang). This is not the stereotypical “anthropologist living with the locals for a year,” but it is impressive nonetheless considering the stringent political restrictions in place and realizing how few scholars have been able to conduct research in this understudied area. Hofer conducted interviews (semi-structured, oral histories, and discussions of patient consultations) and informal conversations, witnessed more than 1,000 consultations (of two to 10 minutes usually, mostly with amchi Yonten Tsering), engaged as a consultant for the Swiss Red Cross as part of a project supporting the Pelshung Tibetan Medicine School, and in the meantime gathered funds to strengthen endangered lineages of Sowa Rigpa knowledge and practice.
In Chapter 1, Hofer introduces the concept of the “medical house” (sman grong) and the related “medical households” (sman gyi khyim tshang). This concept is an essential addition to existing studies of Tibetan medical knowledge transmission, which focus mostly on androcentric “bone lineages” (gdung rgyud) and master–discipleship. The house concept accentuates the flexibility and diversity of kinship forms other than patrilineal descent. Following Lévi-Strauss, Hofer approaches medical houses as moral persons. Both the house and the body are agents that reproduce wealth and a symbolic order and maintain a socio–economic hierarchy and medico–ritual authority. These inherited resources facilitate lineage-restricted secret knowledge (man ngag, reflected, for instance, in what Hofer describes as “cultures of recipes”), yet they also make it possible for amchi to treat a lot of patients without any remuneration.
Besides the central argument on medical houses, this ethnography provides several other noteworthy contributions. Chapter 2 gives insight into the emergence of public health initiatives under the Lhasa government of the Thirteenth Dalai Lama (1876–1933). These initiatives included a secularized medical school and a child health campaign. Relying on the oral accounts of elders from several districts within Ngamring, Hofer questions the reach of these programs as well as exaggerations of the availability of amchi in (rural) Tibet at the time. Hofer shows that affordable medical care was locally available to some extent—giving due attention to female practitioners—and that it was indirectly facilitated by tax exemptions for lay amchi coming from households with higher social status. This nuanced approach of contrasting personal narratives (on the margins) with (central) state discourses and written sources is a key methodology of this ethnography. It allows the researcher—and the reader—to go beyond (post)socialist oral history regimes while unveiling how the memories of amchi continue to be shaped by “enforced” and “absent narratives” (pp. 91–92 and 113–115).
As Hofer convincingly shows in Chapter 4, “The Medico–Cultural Revolution,” the onset of the Cultural Revolution (1966–1976) delivered communist integrated health care to the rural masses for the first time through “barefoot doctors” (Tib. am chi [sman pa] rkang rjen ma). Besides laying the foundations for biomedical hegemony, this also led to dramatic shifts in official policy toward Sowa Rigpa. While many institutions and practitioners were violently attacked after 1966, attitudes towards plant-based Tibetan medical knowledge began to change by 1974. Interweaving a clear outline of the major events with fragments of published historical analyses and harrowing oral history accounts, Hofer recounts how some amchi managed to continue to practice, often secretly and in highly innovative and simplified ways. Her revealing coverage of the beginnings of a newly fashioned “revolutionary (Tibetan) pharmacology,” encapsulated in the politically correct “gso rig dang sman rigs” (lit., “healing and types of medicines,” p. 136), deserves special mention. This new genre entailed a (single) substance-focused, European-style, botanically classified and illustrated approach—infused with Chinese (bio)medicine. Though this type of publication continues up to this day, amchi in Tsang have largely not taken on this rarefied reinvention.
Finally, in Chapter 6, it becomes painfully clear how Sowa Rigpa’s Buddhist-cum-socialist moral economy of practice clashes with large-scale industrialization and the privatization of primary health care. Moving descriptions of how “[h]undreds of patients flocked to see the doctor” (p. 204) in remote villages indicate a present-day “medical crisis on the margins” (p. 212) in the wake of neoliberal reforms, and that in the continuation of Sowa Rigpa much more is at stake than cultural survival alone.
The book includes a number of telling photographs of medical house architecture, rare medical texts as well as formative communist Sino-Tibetan books, portraits of practitioners diagnosing and treating patients, different stages of medicine production, tables with timelines of key historical events (pp. 90 and 117), and a two-page table (pp. 200–201) containing a sample of (translated) patient case records. These illustrations give vivid impressions of the field, provide clarifying frameworks, and a pleasurable reading experience. A list of illustrations is not included, which would have made these little gems more accessible. Theresia Hofer’s book is a must-read for anthropologists focusing on Sowa Rigpa, and for historians studying the modern history of medicine of Tibet and rural China. It would also be highly insightful for those interested or involved in the implementation of rural health policies related to traditional medicine, and it is very suitable for upper-level undergraduate modules on these subjects.