gerke 2010 tibetan treatment choices book section

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TIBETAN TREATMENT CHOICES IN THE CONTEXT OF

MEDICAL PLURALISM IN THE DARJEELING HILLS

BARBARA GERKE

Tibetan medicine1 is part of the medical syncretism found among communities

living in the Darjeeling Hills, an area nestling the foothills of the IndianHimalayas of West Bengal. The multi-ethnic societies, comprised of people

who have mostly migrated to this region since British colonial times, present an

eclectic mix of the neighbouring societies of Sikkim, Bhutan, Nepal, Tibet, and

lowland Bengal. This paper2 presents ethnographic examples from my doctoral

fieldwork (20042006), carried out in the two major urban centres of the Hills,

Kalimpong (altitude 4,200 ft.) and Darjeeling (altitude 7,000 ft.). In the course

of this paper I analyse how Tibetans make their treatment choices between

varieties of available healing modalities. How do they go about finding the

suitable medical and/or ritual practitioner to treat their illness within the array

of pluralistic medical practices available in the Hills? The ethnographic

examples show that Tibetans freely choose between biomedicine,3 Tibetan

1 By Tibetan medicine here I mean the institutionalised versions of the otherwise

largely heterogeneous body of Tibetan medical knowledge practised at the Men-Tsee-

Khang and Chakpori medical clinics in India.2 I am grateful to Sienna Craig and Stephan Kloos for their valuable comments and to

Geoffrey Samuel for his feedback on an earlier version of this paper. 3 I avoid the term Western medicine because of its ethnocentric character and use the

term biomedicine in its widest sense, being aware that it is not a unified medical

system and is open to local interpretations. Tibetans do not look at biomedicine

necessarily as Western medicine, but call it Indian medicine or rgya gar gyi sman,

lit. medicine from India. This is a widespread term among Tibetans in India, and is


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medicine, and other available medical systems, consult Hindu as well as

Buddhist diviners, and attend rituals in Buddhist monasteries as well as in

Hindu temples. Popular perceptions of illness causation and medical efficacy

strongly influence Tibetans in their treatment choices. In pinning down the

larger trajectories that influence contemporary modes of Tibetan treatment

choices in the Hills, I argue that biomedicine, religious practice, ritual healing

and divinations are deeply interrelated in this process, and, despite theirepistemological contradictions, do not oppose or compete with each other in

practice.4 The processes of making treatment choices are flexible and

pragmatic; they accommodate parallel treatment in modern and traditional

forms of medicine and at the same time accommodate larger cosmological ideas

about spirit-causation, karma (las), obstacles (bar chad), merit (bsod nams), and

the power of blessing (bying rlabs). This situation is quite contrary to the

common view that there is a growing separation between medicine and religion,

especially in urban areas. This perspective is particularly prevalent among

Tibetan communities in China, as studied by Adams (e.g. 2001, 2002), Craig

(forthcoming), Janes (e.g. 1999a, 1999b, 2001), and others. Here, I seek to

simply note the differences between the Chinese and Indian contexts; my

arguments only pertain to India.

used in Dalhousie (Samuel 2001:250) and in Dharamsala (Prost 2004:115); in

Dharamsala the term also includes Indian $yurvedic medicine (Prost 2004:115).

Likewise, in China,biomedicine is often called rgya sman, where rgyareferes to rgya

nag (China) or tang sman, a combined Chinese-Tibetan word meaning party

medicine.4

Mona Schrempf in her paper on health-seeking behaviour of Amdo Tibetansappearing in a forthcoming volume (Medicine between Science and Religion:

Explorations on Tibetan Grounds) documents similar cases in Eastern Tibet, where

biomedical and Tibetan spiritual therapeutic treatment options are easily combined.


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mountain cults (except Mt. Kanchendzonga, prominent in Sikkim), a

phenomena central to the creation of Tibetan identity across the Himalayan

enclaves (Ramble 1997:406).

Since the 1990s, with the growing influence of globalisation in the area,

consumerism has set in as a principal factor of peoples lives. Within the rising

Indian market economy, Tibetans have done well with their business skills.

Their earlier refugee and trading experience, as well as the internationalattention and the marketing of Tibetan Buddhism, makes it easier for them to

migrate between places and take advantage of globalisation.

Tibetans in the different social arenas of the Hill societies have shown an

often effortless and unconscious assimilation of intercultural realities, which

have led to an ability among many Hills Tibetans (and other ethnic groups for

that matter) to move between various social and political settings with

considerable ease. Therefore, being a Tibetan in the Hills does not conform to

any straightforward, unitary definition. Today, it primarily means having

Tibetan ancestors, adhering to various sorts of popular Tibetan Buddhism, but

living a modern Nepali-Indian urban life-style. My studies differ from other

Tibetan identity studies based mainly in or near Dharamsala (for example,

Klieger 2002; Korom 1997; Prost 2004), in that they focus on Tibetan societies

outside the Dharamsala enclave in a region that is not dominated by a Tibetan

government-centred administration and massive Tibet tourism. The multi-ethnic

variations in the Darjeeling Hills and a strong presence of other non-Tibetan

Buddhist communities (for example, Sherpa, Yolmo, Gurung, Tamang), merge

into a kaleidoscopic ethnic mix on the roads of Darjeeling and Kalimpong.

They all mingle in all kinds of silhouettes of society and often present and live

multiple identities. Just as this scene is distinct from life in Dharamsala, so, too,is it different than other, more isolated Tibetan settlements across India, where


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TREATMENT CHOICES IN THE DARJEELING HILLS

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the younger generations of Tibetans in India tend to have first resource to

biomedicine. Older patients, however, are often more comfortable with Tibetan

medicine (McKay 2007:26). These are general observations. No major

quantitative studies have been conducted on how many Tibetans actually use

Tibetan medicine or biomedicine and why.33 All we have at this point are

observations by various researchers and a few documented individual case

studies.

Despite Men-Tsee-Khangs overall rapid growth and success in India,34

many Tibetans in the Darjeeling Hills were not convinced of the efficacy of

Tibetan medicine. Young Tibetans had especially little knowledge of Tibetan

medicine. In 2004, I questioned twenty-one class XII students at the Central

School for Tibetans in Kalimpong using bi-lingual questionnaires (Tibetan and

English). Seven students had never taken Tibetan medicine, nine once or

twice, and four occasionally. For none was Tibetan medicine the regular

choice of medication when ill. Those who had taken Tibetan medicine thought

the advantage was the the lack of side-effects. At the Dalai Lamas birthday

celebration the same students prepared various exhibits of Tibetan culture at

33 Craig Janes mentions follow-up case study interviews with fifty-six patients in Lhasa.

His general consensus is that Tibetans pragmatically and frequently mix biomedicine

and Tibetan medicine. On the study he comments, albeit briefly, that slightly less than

one-half (48%) of the case study patients had used Tibetan medicine exclusively for the

present diagnosis and treatment, and did so at the advice of family members and friends

(38%), because of a strong faith in the efficacy of Tibetan medicine (34%), and

reluctance to use biomedicine (18%) (Janes 2002:279). There is also a forthcoming

study by Stephan Kloos, which involves a questionnaire survey with about seventy

patients at various Men-Tsee-Khang and other Tibetan clinics (Kloos forthcoming).

34 The number of branch clinics is now 50, with nine new branches having opened

since 2000.


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McKay, A. 2004. The introduction of biomedicine into the Indo-Tibetan Himalayas.

IIAS Newsletter33(March), 14.

2007. Himalayan medical encounters: the establishment of biomedicine in Tibet

and in Indian exile. In M. Schrempf (ed.) Soundings in Tibetan Medicine.

Anthropological and Historical Perspectives. Proceedings of the 10th Seminar of

the International Association for Tibetan Studies (IATS) Oxford 2003. Leiden:

Brill Academic Publishers.

Millard, C. 2002. Learning Processes in a Tibetan Medical School. PhD thesis,

University of Edinburgh.

Mills, M.A. 2005. Living in time's shadow: pollution, purification and fractured

temporalities in Buddhist Ladakh. InW. James and D. Mills (eds) The Qualities

of Time: Anthropological Approaches. Oxford, New York: Berg.

Mumford, S. 1989. Himalayan Dialogue: Tibetan Lamas and Gurung Shamans in

Nepal. Madison, Wis.: University of Wisconsin Press.

Nichter, M. 2001. The political ecology of health in India: indigestion as sign and

symptom of defective modernization. In L.H. Connor and G. Samuel (eds)

Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science

in Asian Societies. Westport, Connecticut; London: Bergin & Garvey.Norbu, N. 1995. Drung, Deu and Bn: Narrations, Symbolic Languages and the Bn

Tradition in Ancient Tibet. Dharamsala: Library of Tibetan Works and Archives.

Pigg, S. 1996. The credible and the credulous: the question of villagers' beliefs in

Nepal. Cultural Anthropology11(2), 160201.

Planning Council. 2000. Tibetan Demographic Survey 1998. Dharamsala: Central

Tibetan Administration.

Pordi, L. 2003. The Expression of Religion in Tibetan Medicine. Vol. 29. Pondy

Papers in Social Sciences. Pondicherry: French Institute of Pondicherry.

Prost, A.G. 2004. Exile, Social Change and Medicine among Tibetans in Dharamsala

(Himachal Pradesh), India. PhD thesis, University College London.

2006. Causation as strategy: interpreting humours among Tibetan refugees.

Anthropology and Medicine13(2), 119130.


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