Important: more on Volker's menopause article

[Guest guest]

Dear Chinese Herbal Medicine,

 

I hope you will excuse me if it seems like I am

suddenly dominating this mailing list with long, wordy

posts. Upon re-reading my comments on Volker’s

menopause article, I realized, to my own horror, that

I have grossly misrepresented certain aspects of

Volker’s work, quite egregiously in one instance. In

my attempt to keep things simple and my haste to get

something off to the group in the wee hours of Monday

morning, it appeared as if I was making a critique of

Volker’s article rather than challenging some of the

very same misconceptions that he was attempting to

address. So before I address any responses to my first

post, please allow me to make a few corrections and

clarifications. I do want to apologize for any

mischaracterizations I have made of Volker’s work. I

have the highest regard for his scholarship, and I

can’t encourage you enough to read and study his

writings. I would be ashamed of myself if I led you to

think otherwise, or if I somehow damaged his

reputation through my carelessness.

 

It’s probably fair to say Volker and I are both deeply

interested in thinking about the challenge of

practicing of Chinese medicine in a world dominated by

biomedicine. In my research, I have been struggling to

theorize this problem in terms of “postcolonialism.? I

borrow this term from a group of South Asian scholars

(and others) who have been trying to understand the

continuing cultural dominance of the West in South

Asia (and elsewhere in the Third World) following the

end of European imperialism. I like this term for two

reasons: 1) it emphasizes the continuing power

asymmetries between East and West in the absence of

overt political domination; 2) it also emphasizes the

innovative and hybrid responses that Third World

peoples have made to these power inequalities. The

basic claim of my dissertation is that we need to

understand contemporary Chinese medicine as thoroughly

“postcolonial.? Now that’s a controversial contention

to some, and I don’t want to get into all the debates

surrounding this term here. But in plain English, I

argue that just about every aspect of the theory and

practice of contemporary Chinese medicine has somehow

been transformed by the encounter with biomedicine.

Volker’s article on menopause is an excellent example

of how this transformation has taken place in the case

of menopause. Although the notion that we are

practicing some “colonized? (to use Volker’s term) or

“postcolonial? (to use my term) form of medicine might

sound depressing, especially to those of us who got

into Chinese medicine as an alternative to

biomedicine, I don’t think it should necessarily be

understood in that way. (I will explain why below.)

Volker’s call to vigilance and for greater attention

to history is the first step in avoiding some of the

pitfalls of standardized, textbook TCM. I can’t second

this point strongly enough.

 

If I were to quibble with Volker’s characterization of

this “colonization? process (and let me emphasize this

might seem like the sort of hair splitting better left

to academic conferences), it is that I think the term

“colonization? itself is too sweeping. One danger of

this word is that it might give the impression that

textbook editors were just capitulating to or selling

out to the forces of modernization, somehow selling

you (students) a false bill of goods. In academia and

China studies more specifically, one typical critique

of this term is that it erases the agency of the

colonial subject, making him or her appear to be a

mere puppet of global forces. China scholars, by the

way, make the very same critique of the term

“postcolonialism.? Although I think there are some

good reasons for preferring the latter term in the

case of Chinese medicine, I won’t address them here

for the sake of space. Regardless of which term one

chooses, I think the important point is that if one

wishes to speak about the power asymmetries that

doctors of Chinese medicine face, it is imperative to

also recognize their agency in the face of these

challenging historical conditions. So my first

correction is that I want readers to be aware of the

dangers of these terms - colonization and

postcolonialism. But I certainly don’t want to imply

that Volker isn’t cognizant of these issues! Moreover,

I think his work is a real exemplar for scholars who

are struggling to adjudicate between these two

contradictory tasks!

 

The second, and more important, clarification that I

want to make is that I charge Volker with not

recognizing the difference between textbook medicine

and clinical practice. This is an appalling error that

I can only chalk it up to late night delirium. Mea

maxima culpa. Of course, the point of Volker’s article

is to illuminate precisely these discrepancies. As he

points out and as I echo, even the textbook editors do

not practice what they preach. For those of you who

may have been taught to rely exclusively on your

textbooks, the revelations in Volker’s menopause

article might seem quite devastating. As I mentioned

in my first message, the general clinical irrelevancy

of the textbooks, in particular the clinical

textbooks, is not news to anyone in China. I don’t

think this problem makes the textbooks pedagogically

useless, but it can be very demoralizing for Chinese

students when they come to this realization

themselves. The difference between most students

trained in the West and those trained in China is that

the latter have a great many other resources to turn

to. There are countless books, both contemporary and

classical, on clinical practice and clinical cases.

Unfortunately, most of these never get translated into

English. Even more importantly, students in China go

through years of residency (5 years) and perhaps many

more as attending physicians or graduate students

before they begin to actually start treating patients

on their own. In this intervening period, they will

often have the opportunity to learn a wide range of

clinical strategies (completely different from the

textbooks) from their colleagues, from senior doctors,

from their own reading, or from their own research.

 

But this leaves an important question unresolved: why

must students learn from textbooks that they will

never use in practice? This question brings us back to

the issue of colonization / postcolonialism. Here is

my second quibble with Volker’s article (again let me

emphasize that we are splitting hairs again) that got

mangled in some very embarrassing late night

gibberish. Volker’s answer, to which I concur

completely, is that the textbooks have helped build

the institutions of Chinese medicine in China and

around the world. But I think this achievement needs

greater emphasis than Volker’s gives it in his

article, otherwise it is hard to understand why

textbook editors (many of whom are superb doctors in

their own right) keep churning out such mediocre

textbooks. So I agree with Volker’s analysis that much

has been lost in the textbook editing process. But we

should also remember that there have been gains, as

Volker points out but not strongly enough for my

tastes, beyond the realm of clinical practice.

 

I think there is one further point that can be made

here and I am not sure where Volker’s stands on this

issue. As he clearly states, the textbooks are part of

a larger project in the Chinese medicine community to

accommodate Chinese medicine to the standards of

Western medicine. (We both agree on this point,

although I would hasten to add that I doubt most

scholars in China would speak about the textbooks in

this way.) Most scholars in China will admit that the

textbooks are deeply flawed, especially as clinical

guides to practice. But I don’t think that means we

should abandon the overall project of integrating

Western medicine and Chinese medicine. Furthermore, I

don’t think doctors in China can afford to abandon

this project, at least not at this moment in history

when their profession is clearly marginalized both

inside and outside of China. (I call this situation a

“postcolonial? predicament.) But there is also room

for hope. As disappointing as the textbooks are, there

is lots of other scholarship that attempts to

integrate the two medical systems in innovative and

clinical useful ways. (Most of this literature again

probably never gets translated.) Although I was

initially quite opposed to such attempts (what’s wrong

“traditional? Chinese medicine, I used to think), I

have grown to appreciate them over the years. One of

the most common ways to integrate the two medical

systems is to combine Western medicine disease

categories with Chinese medicine patterns. The

textbooks sometimes do this surreptitiously with

invented new disease / bing names, such as in the case

of menopause. While I think many of these attempts are

failures for precisely the sorts of reasons that

Volker identifies, I don’t want to reject the idea

outright. I’m not sure how I would feel about a

Chinese medicine clinical textbook that was completely

organized around Western medicine disease categories.

But this is precisely what was done with the Chinese

Internal Medicine textbook during the Cultural

Revolution. When I had the good fortune to interview

one of the editors of this textbook (who happened to

also participate in earlier editions that look more

like today’s internal medicine textbook), he made a

very cogent argument for why the Cultural Revolution

edition was the best ? it’s the closest to what

doctors actually do, he said among other things. I was

shocked by this claim at first, but I have to admit

that I kept replaying this conversation in my mind,

and I no longer feel so certain that he was wrong.

 

I hope these comments have clarified my thoughts

vis-?-vis the colonization / postcolonial issue in

Chinese medicine. More importantly, I hope they made a

more accurate representation of Volker’s work. His

research in this field has been nothing short of

ground-breaking, not to mention extremely influential

for my own research. I hope that these comments have

enriched your understanding of his excellent article

on menopause.

 

 

Kind regards,

Eric Karchmer

 

 

--- chineseherbacadem

[Guest guest]

Eric,

 

Is your dissertation available? Forthcoming?

 

Thanks for your original post, and following clarifications. I've

enjoyed the dialogue it has inspired.

 

Sincerely,

 

Brandt Stickley

 

, Eric Karchmer

<eikarchmer wrote:

>

> Dear Chinese Herbal Medicine,

>

> I hope you will excuse me if it seems like I am

> suddenly dominating this mailing list with long, wordy

> posts. Upon re-reading my comments on Volker's

> menopause article, I realized, to my own horror, that

> I have grossly misrepresented certain aspects of

> Volker's work, quite egregiously in one instance. In

> my attempt to keep things simple and my haste to get

> something off to the group in the wee hours of Monday

> morning, it appeared as if I was making a critique of

> Volker's article rather than challenging some of the

> very same misconceptions that he was attempting to

> address. So before I address any responses to my first

> post, please allow me to make a few corrections and

> clarifications. I do want to apologize for any

> mischaracterizations I have made of Volker's work. I

> have the highest regard for his scholarship, and I

> can't encourage you enough to read and study his

> writings. I would be ashamed of myself if I led you to

> think otherwise, or if I somehow damaged his

> reputation through my carelessness.

>

> It's probably fair to say Volker and I are both deeply

> interested in thinking about the challenge of

> practicing of Chinese medicine in a world dominated by

> biomedicine. In my research, I have been struggling to

> theorize this problem in terms of " postcolonialism.? I

> borrow this term from a group of South Asian scholars

> (and others) who have been trying to understand the

> continuing cultural dominance of the West in South

> Asia (and elsewhere in the Third World) following the

> end of European imperialism. I like this term for two

> reasons: 1) it emphasizes the continuing power

> asymmetries between East and West in the absence of

> overt political domination; 2) it also emphasizes the

> innovative and hybrid responses that Third World

> peoples have made to these power inequalities. The

> basic claim of my dissertation is that we need to

> understand contemporary Chinese medicine as thoroughly

> " postcolonial.? Now that's a controversial contention

> to some, and I don't want to get into all the debates

> surrounding this term here. But in plain English, I

> argue that just about every aspect of the theory and

> practice of contemporary Chinese medicine has somehow

> been transformed by the encounter with biomedicine.

> Volker's article on menopause is an excellent example

> of how this transformation has taken place in the case

> of menopause. Although the notion that we are

> practicing some " colonized? (to use Volker's term) or

> " postcolonial? (to use my term) form of medicine might

> sound depressing, especially to those of us who got

> into Chinese medicine as an alternative to

> biomedicine, I don't think it should necessarily be

> understood in that way. (I will explain why below.)

> Volker's call to vigilance and for greater attention

> to history is the first step in avoiding some of the

> pitfalls of standardized, textbook TCM. I can't second

> this point strongly enough.

>

> If I were to quibble with Volker's characterization of

> this " colonization? process (and let me emphasize this

> might seem like the sort of hair splitting better left

> to academic conferences), it is that I think the term

> " colonization? itself is too sweeping. One danger of

> this word is that it might give the impression that

> textbook editors were just capitulating to or selling

> out to the forces of modernization, somehow selling

> you (students) a false bill of goods. In academia and

> China studies more specifically, one typical critique

> of this term is that it erases the agency of the

> colonial subject, making him or her appear to be a

> mere puppet of global forces. China scholars, by the

> way, make the very same critique of the term

> " postcolonialism.? Although I think there are some

> good reasons for preferring the latter term in the

> case of Chinese medicine, I won't address them here

> for the sake of space. Regardless of which term one

> chooses, I think the important point is that if one

> wishes to speak about the power asymmetries that

> doctors of Chinese medicine face, it is imperative to

> also recognize their agency in the face of these

> challenging historical conditions. So my first

> correction is that I want readers to be aware of the

> dangers of these terms - colonization and

> postcolonialism. But I certainly don't want to imply

> that Volker isn't cognizant of these issues! Moreover,

> I think his work is a real exemplar for scholars who

> are struggling to adjudicate between these two

> contradictory tasks!

>

> The second, and more important, clarification that I

> want to make is that I charge Volker with not

> recognizing the difference between textbook medicine

> and clinical practice. This is an appalling error that

> I can only chalk it up to late night delirium. Mea

> maxima culpa. Of course, the point of Volker's article

> is to illuminate precisely these discrepancies. As he

> points out and as I echo, even the textbook editors do

> not practice what they preach. For those of you who

> may have been taught to rely exclusively on your

> textbooks, the revelations in Volker's menopause

> article might seem quite devastating. As I mentioned

> in my first message, the general clinical irrelevancy

> of the textbooks, in particular the clinical

> textbooks, is not news to anyone in China. I don't

> think this problem makes the textbooks pedagogically

> useless, but it can be very demoralizing for Chinese

> students when they come to this realization

> themselves. The difference between most students

> trained in the West and those trained in China is that

> the latter have a great many other resources to turn

> to. There are countless books, both contemporary and

> classical, on clinical practice and clinical cases.

> Unfortunately, most of these never get translated into

> English. Even more importantly, students in China go

> through years of residency (5 years) and perhaps many

> more as attending physicians or graduate students

> before they begin to actually start treating patients

> on their own. In this intervening period, they will

> often have the opportunity to learn a wide range of

> clinical strategies (completely different from the

> textbooks) from their colleagues, from senior doctors,

> from their own reading, or from their own research.

>

> But this leaves an important question unresolved: why

> must students learn from textbooks that they will

> never use in practice? This question brings us back to

> the issue of colonization / postcolonialism. Here is

> my second quibble with Volker's article (again let me

> emphasize that we are splitting hairs again) that got

> mangled in some very embarrassing late night

> gibberish. Volker's answer, to which I concur

> completely, is that the textbooks have helped build

> the institutions of Chinese medicine in China and

> around the world. But I think this achievement needs

> greater emphasis than Volker's gives it in his

> article, otherwise it is hard to understand why

> textbook editors (many of whom are superb doctors in

> their own right) keep churning out such mediocre

> textbooks. So I agree with Volker's analysis that much

> has been lost in the textbook editing process. But we

> should also remember that there have been gains, as

> Volker points out but not strongly enough for my

> tastes, beyond the realm of clinical practice.

>

> I think there is one further point that can be made

> here and I am not sure where Volker's stands on this

> issue. As he clearly states, the textbooks are part of

> a larger project in the Chinese medicine community to

> accommodate Chinese medicine to the standards of

> Western medicine. (We both agree on this point,

> although I would hasten to add that I doubt most

> scholars in China would speak about the textbooks in

> this way.) Most scholars in China will admit that the

> textbooks are deeply flawed, especially as clinical

> guides to practice. But I don't think that means we

> should abandon the overall project of integrating

> Western medicine and Chinese medicine. Furthermore, I

> don't think doctors in China can afford to abandon

> this project, at least not at this moment in history

> when their profession is clearly marginalized both

> inside and outside of China. (I call this situation a

> " postcolonial? predicament.) But there is also room

> for hope. As disappointing as the textbooks are, there

> is lots of other scholarship that attempts to

> integrate the two medical systems in innovative and

> clinical useful ways. (Most of this literature again

> probably never gets translated.) Although I was

> initially quite opposed to such attempts (what's wrong

> " traditional? Chinese medicine, I used to think), I

> have grown to appreciate them over the years. One of

> the most common ways to integrate the two medical

> systems is to combine Western medicine disease

> categories with Chinese medicine patterns. The

> textbooks sometimes do this surreptitiously with

> invented new disease / bing names, such as in the case

> of menopause. While I think many of these attempts are

> failures for precisely the sorts of reasons that

> Volker identifies, I don't want to reject the idea

> outright. I'm not sure how I would feel about a

> Chinese medicine clinical textbook that was completely

> organized around Western medicine disease categories.

> But this is precisely what was done with the Chinese

> Internal Medicine textbook during the Cultural

> Revolution. When I had the good fortune to interview

> one of the editors of this textbook (who happened to

> also participate in earlier editions that look more

> like today's internal medicine textbook), he made a

> very cogent argument for why the Cultural Revolution

> edition was the best ? it's the closest to what

> doctors actually do, he said among other things. I was

> shocked by this claim at first, but I have to admit

> that I kept replaying this conversation in my mind,

> and I no longer feel so certain that he was wrong.

>

> I hope these comments have clarified my thoughts

> vis-?-vis the colonization / postcolonial issue in

> Chinese medicine. More importantly, I hope they made a

> more accurate representation of Volker's work. His

> research in this field has been nothing short of

> ground-breaking, not to mention extremely influential

> for my own research. I hope that these comments have

> enriched your understanding of his excellent article

> on menopause.

>

>

> Kind regards,

> Eric Karchmer

>

>

> --- chineseherbacadem

>