Combining Stories: Reading Tibetan Medicine As A Western Narrative Of Healing

Devin Gonier
Professor Ivette Vargas-O’Bryan
Department of Religious Studies
Final Report
Mellon Project 2008-09

Combining stories: Reading Tibetan Medicine as a Western Narrative of Healing

This project was funded by the Carnegie Mellon Grant from Austin College in 2008-09 under the supervision of faculty-advisor Ivette Vargas-O’Bryan 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 project’s 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

Healing as we know and understand it today has both a historical and cultural context. It has evolved and events will continue to change it in the future. There will be technological advancements that improve our ability to treat future and current illnesses, but beyond this, the discourse on health and the philosophical assumptions inherent within the Western health model will adapt and evolve too. When many Westerners think of the verb “heal” they carry with it the cultural baggage that shape the way we understand healing, baggage like the view that disease is something objective and that it can be cured through objective processes. But, one must tread carefully in this thinking, since different cultural and historical contexts change how a person thinks of his or her body and what it means to heal. It is much easier to see the effect cultural and social contexts have on medicine by looking closely at the diversity of medicines throughout the world. Different socio-cultural situations influenced or not by religion have directed medicine and health in unique ways. Different types of medicine have a long history of intersection and these intersections continue to grow today. The focus of this paper will be specifically on the intersection of biomedicine and Tibetan medicine, and it will argue that current U.S. healthcare discourse creates barriers for religious healing systems like Tibetan medicine. Unless cultural and institutional changes are made, it will continue to be difficult for Tibetan medicine and other healing systems similar to it to have a legally and culturally accepted role in U.S. healing.
Thesis and Structure
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 Adams’3 calls erasure.
The first section of this paper outlines some crucial concepts about Tibetan medicine and also explains the status of complementary and alternative medicine (CAM)4 in the U.S. The second section defines the tenets of reconstructive postmodern medicine, and examines how Tibetan medicine fits within the paradigm of postmodern medicine. The third section outlines the deconstructive elements of postmodern medicine, which critique biomedicine’s hegemonic status within the U.S. After this description of postmodern medicine and its relationship to biomedicine and Tibetan medicine, the paper will analyze how religion and medicine intersect in the U.S. mainstream health care system, and will suggest moving away from a system where secular healing is hegemonic. Finally, it examines the concept of globalization, and utilizing much of Vincanne Adams’ work, analyzes the biopolitical role of the NCCAM5 and suggests a more heterogeneous model for thinking about healing in the U.S. as a result of the application of postmodernism. Based on some of the principles of postmodern medicine, the paper concludes by suggesting that our healthcare system should be more open to other forms of healing which cannot be easily integrated into the biomedical secular model of thinking. Before getting into background information about the U.S and alternative medicine, Tibetan medicine will be summarized and its most basic features explained in a way that makes its relevance clear.

Introducing Tibetan Medicine
The Basics

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.
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,
The movement of the wind is comparable to what drives the waves of the ocean. Whenever a wave arrives, it makes a human being advance. When it recedes it pushes him further back. Once the wave is at its crest, it breaks. In the human body this wave can be felt in the pulse…Wind is responsible for all that moves in the body.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
Treatment usually consists of moxibustion (a type of treatment using heated needles), cupping (a procedure where a vacuumed cup is placed on the body to influence bodily channels), diet changes, Tibetan herbal medication, or a change in lifestyle.
Interviews are usually very crucial in assigning the proper treatment. Tibetan medicine usually involves non-synthesized combinations of herbs (sometimes up to sixty) that are to be taken at low dosages frequently throughout a period of time. Since the dosage is low and non-synthesized it can typically be used with other Western drugs. Alfred Hassig, an M.D. in Immunology, explains
Such a plant mixture can be extremely beneficial, because the individual plants react reciprocally to greater effect. Since the single components are only present in small quantities any side effects they may have are diminished in such a way that these plant compounds are very effective and well tolerated. That’s the problem with pharmaceutical substances: being chemically determined uniform substances, they exert a specific influence in the body and, in so doing, often effects and side effects
interfere.9

If properly diagnosed there is little to no risk involved in Tibetan medicine. This is a huge reason why Tibetan medicine is popular. The only disadvantage is that Tibetan medicine works slowly, whereas biomedicine works quickly. Obviously, Tibetan medicine is not best for every illness, but it can be an effective solution to many common illnesses without being potentially harmful by having many unwanted side effects.

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 medicine’s earliest introductions to the west came as a result of Karl Lutz’s 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 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 wouldn’t need to be performed, if people used the same treatment as I did! And although every professor and doctor had given up on me, it’s been over ten years that I’ve managed to save myself.”15
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

Research being done right now with Tibetan medicine could prove crucial in discovering the cure for cancer. There are many other areas that credit Tibetan medicine as being successful, such as treatment of chronic kidney problems. Currently the Men Tsee Khang in Dharmsala is working with Western doctors on a number of illnesses in order to try and create better cures to diseases that have been extremely problematic for biomedicine. Tibetan medicine’s potential is only barely being realized, and if it receives the recognition it deserves (a commonly cited problem by many of the doctors I interviewed at the Men Tsee Khang) the potential for its benefit could be very great indeed. Furthermore, in comparison to other pharmaceutical drugs, and the diagnostic procedures of western medicine, Tibetan medicine is significantly cheaper and has little to no side effects. Thus, when one takes cost into account (which is a very significant factor for many people), and when one considers the great deal of suffering that occurs from painful and often dangerous treatments performed by western doctors, the benefit and effectiveness of Tibetan medicine could prove extremely great.

Tibetan Medicine and its Religious Influences
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 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 text’s 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 “traditional accounts of text or the history of Tibetan medicine…place 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 amchi’s role and treatment of the patient in chapters 25 (Ngan-gYo-sKyon-brtag) and chapter31 (sMan-pa’I le’u) 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 person’s health because they promote good karma. The rbgyud-bzhi states,
Living in accordance with the religions of the world is the foundation of all virtues…without 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. 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 don’t 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 Gyurme’s 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 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
There are also spirits and demons that have an effect on illness. As was briefly mentioned earlier, Tibetan medicine states that there are 101 diseases caused by harmful spirits. The idea that spirits are a causal agent in disease immediately presents problems for most Western doctors. Most cases of possession or spiritual influence deal with the humor rLung (wind), which typically is most associated with the mind, and is the pervasive life force of the body. Dr. Terry Clifford, a psychiatrist who took great interest in Tibetan medicine and psychiatry, presents the variety of interpretations regarding demons when he writes,
“An uneducated Tibetan might actually believe in them 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 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.
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: The Status of Complementary, Alternative, and Integrative Medicine in the 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 person’s 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 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.” 39 This indicates that there is a growing demand for CAM in the U.S. People are beginning to become more interested in treatments other than the exclusive use of conventional allopathic40 biomedicine.
As will be developed more in the following sections the NCCAM uses the principles of biomedicine as templates for legitimizing alternative medicinal treatments in the U.S. The consequences of the way in which the common American not only treats their illnesses, but also on how they understand their body have been profound. U.S society is changing, but policy is struggling if not completely failing to keep up. Patients seeking medical treatment outside of traditional allopathic medicine encounter problems with insurance company’s lack of coverage, and physicians from other medical philosophies encounter problems with legally being allowed to practice medicine. Much of this change in demand makes sense when one considers the ideological change that has been occurring in U.S. society and throughout the world from the modern to the postmodern. In order to understand the cultural and philosophical reasons for this struggle to achieve a heterogeneous healthcare system this paper will draw heavily upon the principles of postmodern medicine.
Postmodern Medicine
What is Postmodernism? 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

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, “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 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

Multidimensional Realism

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 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. Dacher’s 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 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.

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 Gray’s ideas are similar to Dacher’s. Gray’s 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. Gray’s point is that the doctor’s visit should involve “better 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 doctor’s 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 Dacher’s account of utilizing both subjective and objective elements in healing by placing emphasis on consciousness as an agent in the healing process.
The various elements of postmodern medicine that have been articulated here can be mostly summed up by a general suspicion of the purely objective and scientific approach to medicine. Gray notes that, “ Postmodernism also challenges the objectivity that science has claimed is its defining characteristic as spurious and unsupportable, and although many different theories are encompassed by the term “postmodernism,” a suspicion of science lies at the core of such theories.”55 Postmodern medicine is not trying to suggest that science ought to be eliminated from medicine and healing. Rather, it is suggesting that objective approaches to healing have become for various social reasons the exclusive mode of thinking about and treating the body. The effects have been that the patient becomes disconnected from the healing of their own body, and the process of healing has become less about meaningful human interaction, and more about a market driven exchange of goods and services meant to stream line the elimination of symptoms. If the healthcare system opens itself up to different epistemologies (epistemologies that incorporate subjective approaches to healthcare as well as objective approaches) of healing, then there can be more of a balance between the purely subjective and purely objective modes of 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 Wallace’s 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, Wallace’s 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 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 “Jackson’s postmodernism,”56 which he considers dogmatic. Wallace might be correct about Jackson’s 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.
Wallace’s first criticism is that Jacksons’s 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 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 Foucault’s defense, what he is doing is choosing to focus on power mechanisms. This criticism represents a fundamental misunderstanding of Foucault’s methodology. Foucault’s 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 postmodernism’s 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.
However, Foucault’s position is more complex than simply the rejection of absolute truth. In order to respond to this criticism a brief return to Foucault’s 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, Foucault’s 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 Dacher’s 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).
Wallace’s criticism is very poignant. But, many of his criticisms seem specific to Jackson’s 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.

Deconstructive Postmodern Medicine and Biomedicine
Biomedicine has saved and extended the lives of countless individuals over the past few centuries. Scientific advancements made by brilliant physicians and laboratory workers have revolutionized the ways in which we treat illness and cure those who are suffering. Any critique of biomedicine ought to be prefaced with the acknowledgement that biomedicine has done a great service to the advancement of health throughout the world.
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.

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 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 medicine’s like Tibetan medicine are not well known for emergency care, but 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. WATER XXXXX 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 isn’t long before a similar type of problem manifests in an entirely different way.

Water XXXX

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
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 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 doesn’t 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.

Cartesian Dualism, Physicalism, and the Importance of the Mind in Healing the Body 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 doctor’s role is to “repair that machine.”71 After Descartes, further advancements in biomedicine entrenched this idea as well:
Technological advances (e.g., microscopy, the stethoscope, the blood pressure cuff, and refined surgical techniques) demonstrated a cellular world that seemed far apart from the world of belief and emotion. The discovery of bacteria and, later, antibiotics further dispelled the notion of belief influencing health. Fixing or curing an illness became a matter of science (i.e., technology) and took precedence over, not a place beside, healing of the soul. As medicine separated the mind and the body, scientists of the mind (neurologists) formulated concepts, such as the unconscious, emotional impulses, and cognitive delusions, that solidified the perception that diseases of the mind were not "real," that is, not based in physiology and biochemistry.72

Furthermore, biomedicine makes the distinction between an illness and a disease. Illness represents the subjective impression of the patient that there is something wrong with the body, whereas disease represents an objective observable problem with the body. Morris explains that “What the patient reports is subjective (and untrustworthy), what the lab reports is objective (and true).”73 This distinction makes it easy for doctors to discard the more subjective and mental aspects of illness, because they are irrelevant in the curing of “disease.” These advancements in medicine combined with the philosophical influence of Descartes changed the course of biomedicine to become completely centered on the body.
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 Most Western doctors when doing laboratory tests on medicines acknowledge psychosomatic healing. This is the reason why double blind test procedures can be effective, because it is important, according to a western biomedical model, to understand the effects of the medicine excluding the mental effects of the patient believing in the effectiveness of a medicine, as is sometimes the case with placebos. In western biomedicine psychosomatic healing essentially represents a variable to avoid; something that can negatively affect the results of an experiment meant to discover the effectiveness of a medicine. Vincanne Adams notes that “the idea of ‘psychosomatic’ as it is understood today in the Western context is not appropriate to apply in Tibetan.” The reason such a distinction does not exist is because in Tibetan medicine and Tibetan culture more generally, the body and the mind are not understood as parallel processes that have no affect on one another. In Tibetan medicine if a person is healed and the only explanation for that healing is a mental one, then the healing was successful. In Tibetan medicine focusing on the mind is an invaluable approach to healing the body. Cure the mind and you will cure the body. In a western context, the mind is irrelevant; one simply cures the body.
Recent research demonstrates some of the significant ways in which the mind has power over the body. For example, one very obvious intersection between the mind and the body is the relationship between mental stress and back pain. In fact, a study involving 48,000 men in the Swedish army concluded, “Job stress was related to emotional distress, and this distress was directly related to clinic visits for back pain. The more emotional distress a soldier had, the more return visits to the clinic it took to solve the back pain.”75 One could easily find many more cases where the mind played a surprisingly significant role in the healing process.76 One reason for why there is more emphasis on the mind in Tibetan medicine is that it draws heavily upon Buddhist ways of understanding the mind. This difference in thinking draws upon an important distinction between 1st person and 3rd person observation in the quest for knowledge.

2. !st Person vs. 3rd Person Observation 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 doctor’s expectations, and surprised most 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, ch’I, 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 Lama’s 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. Biomedicine’s 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.
Another critique is that biomedicine 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 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 don’t 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

This difference in methodology for treating a patient means that an amchi has more room to be intuitive in the treatment of a patient. By following his or her experience and training each diagnosis is specific to not only the illness, but also the body/mind of the patient. It is exactly because of this approach that Tibetan medicine has faced many difficulties in the process of getting medicines legalized and sold throughout the U.S. The NCCAM follows strict procedures for determining the effectiveness of medicine, following biomedical guidelines. Understanding the specific characteristics of the patient’s body includes trying to understand the patient’s life circumstances and emotional well-being. This approach helps to build a strong doctor-patient relationship that promotes empathy over more mechanistic and general procedures to treating illness that are characteristic of biomedicine.
2. Empathy Empathy within the context of biomedicine has a long history of complications and change. How a doctor relates to a patient can often be a delicate matter. In fact, “empathy in effect, has no fixed meaning or value in the history of medicine. It is a contested term whose historical complications its opponents and proponents silently ask us to forget.”81 The trouble from a biomedical perspective is that doctors may become too attached to their patient’s suffering, and are unable to carry out necessary functions that would effectively heal the person. Lorraine Code82, author or Rhetorical Spaces, explains that “empathy is a thoroughly double edged phenomenon: its expression is not an unqualified good. Hence it is vital that its would be advocates develop a self critical politics of empathy, to keep them as cognizant of its pitfalls as they may be of its promise.”83 Often times, genuine empathy is discouraged or repressed. Rafael Campo in his work The Desire to Heal discusses some of the difficulties he experienced while training to be a physician. His work dealt primarily with AIDS, and he developed strong connections with his patients. In fact, these feelings were strong enough to lead to “an anonymous hand-scrawled note placed in my evaluation file saying that I had ‘problems with identifying too strongly with my patients” and that I had a “tendency to let my emotions get in the way of patient care.”84 Empathy is not considered useless in biomedical practice, but the way in which the biomedical community acknowledges and promotes empathy is ultimately artificial. It understands empathy as something of instrumental value. Being able to make the patient feel that they are cared for, or that the physician empathizes with them, can lead them to share information and facilitate their own healing in a more effective way. In the biomedical community it is far safer to focus on behaviors that reduce empathy to a practiced smile, a firm handshake, and a glance at the wristwatch to let eighteen seconds pass before interruption. Lost is the chance for a human encounter that, as for Campo, allows healers to confront, and if they are lucky, to learn from their own vulnerability and unacknowledged brokenness.85

Thus, empathy exists in the biomedical community, but it is encouraged to exist only as an artificial tool to facilitate treatment.
Part of the problem is that biomedicine focuses on diagnoses and mechanistic elements of applying biomedical principles to treatment. Thus, Morris notes that “it should not seem a surprise that biomedicine has mostly ignored suffering in favor of problems – not always equally pressing- where the boundaries are less vague and the complications more responsive to innovations in technique and in pharmacology.”86 One of the primary arguments coming from narrative medicine thinkers like Rita Charon is that biomedicine is unempathetic, because it fails to relate and empathize with the narrative of struggle that the patient undergoes throughout the path to health. Rita Charon explains that
Despite such impressive technical progress, doctors often lack the human capacities to recognize the plights of their patients, to extend empathy toward those who suffer, and to join honestly and courageously with patients in their struggles toward recovery, with chronic illness, or in facing death. Patients lament that their doctors don’t listen to them or that they seem indifferent to their suffering. Fidelity and constancy seem to have become casualties of the cost-conscious bureaucratic marketplace. Instead of being accompanied through the uncertainties and indignities of illness by a trusted guide who knows them, patients find that they are referred from one specialist and on procedure to another, perhaps receiving technically adequate care but being abandoned with the consequences and the dread of illness.87

This highly mechanized process of biomedicine creates a great disparity between the patient’s experience and the doctor’s experience in treating them.
Despite Morris’ criticism of artificial empathy in biomedicine, he suggests that genuine empathy might be impossible. Exploring the writings of Levinas, Morris suggests, “The assumption that we can feel someone else’s feeling is for Levinas an exercise in self-deception that transforms eros into an instrument of power.”88 In other words, genuine empathy is impossible, since no human can ever fully relate to another human in the way that the concept empathy requires. Part of the problem is a lack of clarity on what exactly defines empathy, and how a doctor experiences and utilizes empathy. It doesn’t become surprising then, that in a western context authors like Levinas question the concept of empathy as even a possibility. However, Levinas’ criticism of empathy is specific to ways in which empathy is understood in the west. Tibetan medicine utilizes the Buddhist idea of bodhicitta, which is one way of understanding empathy, in its treatment of illness. Bodhicitta in Tibetan Medicine
Bodhicitta literally translates to the mind of the Buddha, or aspiration of the Buddha (however there are many other complex ways of translating this Sanskrit word into English). This aspiration for enlightenment is not selfish, because one struggles to achieve greater power and insight in order to help those who suffer. Bodhicitta values the other before the self, and seeks not necessarily to understand the perception of the other – as Levinas would attempt to conceptualize empathy – but attempts to develop a deep sense of compassion towards curing the others pain. Bodhicitta transcendently invokes forces that are beyond the abilities of the doctor, and the feeling of empathy that it generates is equally divided among all sentient beings, whether they are mother or enemy. Marion L. Matics, a commentator and translator of Santideva’s Bodhicaryavatara writes, “Bodhicitta (like Citta) partakes of a quasi-universal aspect, because…it is a force let loose in the universe to work for the good of all.”89 Lama Zopa Rinpoche argues from the Tibetan Nyingma tradition that when this transcendent force is used by healers and patients it “is the best medicine for the mind and for the body.”90 Thus, many amchi’s that try and incorporate Buddhist principles into their practice believe that bodhicitta is not only a virtue, but that it can also invoke or draw upon healing sources like the Medicine Buddha that are outside of Samsara. There is nothing about the practice of Tibetan medicine that structurally requires bodhicitta, but many amchi’s utilize the Buddhist idea of bodhicitta in their medical practice as an extension of their religious practice. In fact, 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 amchi’s 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. Based on the previous observations, the main argument of this paper is that postmodern 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
Scientific materialism asserts that the universe, consciousness, and most questions that are especially meaningful for religions can be entirely explained by empirical observation. The position of scientific materialism when completely accepted presents radical problems for religious statements of subjectivity and the immaterial. Medicine has come to embody the principles of scientific materialism, and as a result a metanarrative within U.S. society has developed where religion and theories which make transcendent claims that are irreducible to scientific principles have no place in the role of healing. Thus, when healing systems like Tibetan medicine that utilize subjective methods of the mind or incorporate religious ideals in their practice of healing are introduced to the U.S. health system they face hostility. A large part of this hostility happens before medicines like Tibetan medicine have the opportunity to be introduced to the society by government organizations like the NCCAM. The overwhelming power of scientific materialism within the healthcare discourse has transformed the way people conceive of their body, how they treat their ill body, and how they conceive of what is true of their body. 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 mind…accepts 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 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 Logical Positivism

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 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. Vincanne Adams separates two modes of integration. The first is integration, which “in its best possible sense results in the sharing and exchange of knowledge and practices”94 between two or more healthcare systems. For example, Tibetan medicine incorporates biomedical principles within its framework, and biomedicine incorporates Tibetan medical principle within its framework. On the other end of the spectrum is erasure, which is where one” 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.
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 $68.7 million dollars (as the National Center for complementary and alternative Medicine NCCAM.”95 This organization’s 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 medicine’s 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 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 not…Were 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 patients…on the one hand “powa ching cha mu bu,” along with several 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 don’t 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 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 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.
Most amchi’s interviewed during the process of research for this project listed the greatest barrier to change as “recognition.” This “recognition” will only be possible if there are avenues for Tibetan medicine to demonstrate its effectiveness in terms of Tibetan medicine. This will require cooperation and a framework like postmodern medicine that supports a heterogeneous healthcare system.

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 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 Lama’s 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 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

Biomedicine and systems of healing like Tibetan medicine can operate both integratively and parallel to each other. The danger of integration, as was noted earlier, is that it can easily slip into “erasure.” The difficulty is maintaining the autonomy of Tibetan medicine when it must exist in cooperation with another system that is antithetical to some of its philosophical presuppositions. But, if both can acknowledge an epistemological autonomy for the other, by acknowledging that each has a certain coherent model for understanding the body, then both can potentially prosper side by side. In order for this to happen, biomedical doctors may attempt to take an interest in healing systems like Tibetan medicine, so that they may know what works well in Tibetan medicine. In order for this to happen, doctors must learn the language of Tibetan medicine, and learn about it on its own terms. Making connections between Tibetan medicine and biomedicine is important, but they both utilize different epistemologies, and those epistemologies must be protected from erasure. But, simultaneously these doctors must also begin to acknowledge alternatives to the biomedical model, so that they can fill in those gaps by recommending other models of healing. The same must be true for a healing system like Tibetan medicine if it is to be successful in the west. It is quite common for a Tibetan medicine doctor to recommend a biomedical doctor in certain cases. The future paradigm of healthcare can be in cooperation and understanding of separate coherent models of thinking of the body. One day, a hospital might have Ayurvedic medicine, Tibetan medicine, Reiki healing, and biomedicine.101 Each hospital might be unique in its own coherent internal systems. Each physician if they can maintain an open mind, will be able to provide a greater opportunity for healing by understanding the success and failings of the other systems. This may manifest in the form of caregivers being “fluent in multiple Western and Eastern modalities, from biomedicine to traditional oriental medicine, and to be able to shift effortlessly between the two in the best interest in the patient” or “In institutional terms, such integration or synthesis might mean the ability to provide a care team conversant in multiple clinical disciplines and languages that can interactively assess, respond, and refine, initially diagnosing and subsequently measuring the patients progress through multiple channels.”102 Furthermore, such a system will accommodate the growing desire for patients to choose what kind of healthcare they desire. Rather than these systems competing, or one system erasing another, these systems could be cooperating and growing together. Healing has a bright future if this can be achieved; a future where doctors work side by side doctors from entirely different traditions, and knowledge of the body is organized into coherent models, but even more significantly where the patient can choose how they should treat their illness, and in what way they should understand their body.

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