Modernity And Indigenization A Study Into Bio Medical Discourses In India

1 Modernity and Indigenization: A Study into Biomedical Discourses in India Jayanta Bhattacharya

The figures of pain are not conjured away by means of a body of neutralized knowledge; they have been redistributed in the space in which bodies and eyes meet. What has changed is the silent configuration in which language finds support: the relation of situation and attitude to what is speaking and what is spoken about. – Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, xi. Introduction There is a story about the physicist Enrico Fermi (1901-1954). Thanking a guest speaker for a lecture he had just given, Fermi told him that before the lecture he had been confused about the subject. Now, having heard him, he was still confused – but at a higher level. I am afraid talking about biomedical discourses in India may have caught us into a similar confusing situation. But, confusion – or at least, a lack of certainty – is, I believe, a very important thing for investigation. There is not a single frame through which we can view the entirety of nuances in these discourses. Search for the meanings of health and disease is haunted by two originary questions which have not yet been answered satisfactorily – Why me? Why now? So, let us fall into the maze of confusion – at least, for the time being. R. M. Hare, the philosopher of medicine, asks, “Why do attacks of viruses count as illness, but not the attacks of larger animals or of motor vehicles? Is it just a question of size? Or of invisibility?…Does a disease have to be something in me? And in what sense of ‘in’?”1 To reconcile opposing concepts and confusion, may be to lesser extent, the concept of disease becomes normative – where, what counts as the ‘norm’ is prescribed rather than statistically derived. In effect, we decide what constitutes a disease. What do we mean when we use the word ‘disease’ and when we use the word ‘health’?2 Sometimes the debate seems to be merely about our use of words. Sometimes little consideration is given to the underlying biology. Arthur Kleinman offers an example from the front page of the New York Times of Tuesday, March 10, 1998, to show “the immense disjunction between the claims for what is supposedly known about the biological bases of human nature and what is actually known about human conditions.” He concludes, “Viewed from the decidedly ordinary practices of everyday experience, human conditions certainly have a biology, but they have a history, a politics, an economics, and they reflect cultural and subjective differences.”3 I may now ask what is healing? “Clearly, it is a somewhat different thing for patient (and perhaps family), practitioners, and researcher.”4 Most Western-style doctors communicate in a technical, 1

R. M. Hare, “Health” in Journal of Medical Ethics 1986; 12: 172-181. For a brilliant discussion about normativity of the normal, pathological, health, and disease see, Georges Canguilhem, On the Normal and the Pathological (Holland, Boston, London: Doerdrecht, 1978). 3 Arthur Kleinman, Experience and Its Moral Modes: Culture, Human Conditions, and Disorder (The Tanner Lectures on Human Values), delivered at Stanford University, April 13-16, 1998. 4 Kleinman, Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry (Berkley, London: University California Press, 1981), 354. 2

2 professional, Western idiom that is not readily accessible to most patients. The idiom is mechanistic and somatic. Western-style clinical reality is secular. Although it is suffused with Western values. Western-style doctor-patient interactions do not depend on their clinical reality for their efficacy, but, as several of examples illustrate, the clinical reality they construct often yields negative consequences. Among the rural populations and lower class, and lower middleclass urban dwellers in developing societies, clinical reality often combines secular and sacred components. But for the educated middle class, it is increasingly secular.5 There should be a cautionary note at this juncture, “It remains altogether necessary for lay people who for their political action want not only to be guided by prepared information but to form a judgement. In this flood of information the orientation of the layperson is peculiarly mediated and, hence, dependent.”6 Moreover, there is a serious problem about taking the objective scientific picture as the ‘true’ view of the ‘real’ world. The ‘objective’ picture is then taken for granted “as the real world around us.”7 This is particularly true for Western societies. But when doctors and modern healing (with the normative concept of health and disease) confront people combined in the ‘secular and sacred’ in developing societies an altogether different situation may arise. In this situation modernity stands vis-à-vis indigenization, possibly, contesting, complying and overdeterming each other at some or other moments. Some issues become more important than others: (1) how the body is positioned in these two differing paradigms, (2) how lay knowledge comes into terms with expert knowledge and vice versa, (3) how medicalization of indigenous life world insidiously occurs, and finally, (4) how metonymic reconstitution of epistemological categories and disembodiment of knowledge take place. Here an interdisciplinary approach into anthropological, sociological, philosophical and clinical perspectives of medicine may help give some plausible and satisfactory answers. My paper is a preliminary journey in this direction. A few notes on anthropology of medicine Biomedicine is not a homogeneous monolithic entity. The medical world, by virtue of its origin narrative, becomes a melting pot of contradictory theories and practice, controversies and inexplicable phenomena about which doctors and laypeople are in constant debate. “However, can we place ‘authentic’ knowledge directly opposite knowledge which has been tainted by medicalization? Laypersons against the experts? Is the dividing line between them an absolute one?”8 Medical practitioners from within their discipline may throw some light on these vexing questions as, in a unique way, they may be called ‘un-academic’ anthropologists. Being an ‘anthropologist’ there remain some advantages to experience encounter between narrative and technology on the one hand, and body and society on the other. Medical anthropology is about how people in different cultures and social groups explain the causes of 5

Ibid, 304-308 Hans-Georg Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age (Cambridge: Polity Press, 1977), 8. 7 For an exhaustive account of this issue, and more, see, Kenneth M. Boyd, “Disease, illness, sickness, health, healing and wholeness: exploring some illusive concepts” in J Med Ethics: Medical Humanities 2000; 26: 9-17. 8 Els Bransen, “Has menstruation been medicalized? Or will it never happen….” In Sociology of health and Illness 1992; 14(1): 98-110. 6

3 ill health, the types of treatment they believe in, and to whom they turn if they do get ill. It is also the study of how these beliefs and practices relate to biological, psychological and social changes in the human organism, in both health and disease.9 When we study a group of human beings, we would better engage ourselves to study the constituent elements and features of their society and their culture and, to add, their perception of health. Kleinman notes, “Cultural processes include the embodiment of meaning in habitus and physiological reactions, the understanding of what is at stake in particular situations, the development of interpersonal connections, religious practices, and the cultivation of collective and individual identity.”10 Any anthropological study taking into account these nuances would reveal the perpetual confrontation and assimilation between modernity and indigenization. Indigenization may be understood as an ensemble of dynamic processes (within the porous micro world of the locale) which try to adapt, reconfigure, translate and work out some different operative mechanisms while interacting with the outer macro world loaded with global flow of surpluses, signifiers and deterritorialized desire. But, as no life process can be fully reduced or be made amenable to only discursive practices, a set of structures and theories or some ‘normalizing’ processes, modernity and indigenization go on overdetermining each other within the interstices of this discursive instability. In Indian perspective, the process of indigenization signifies, possibly, a paradigmatic shift from methodological individualism to methodological relationalism. With these preliminary remarks I like to rather pursue a not-so-anthropological study into the stated theme. I would try to follow, on the contrary, non-linear and overlapping movements between postcolonial predicaments and colonial moments within the purview of medicine and health. Besides some general observations, I would also try to focus on this issue exploring some of the aspects of traditional and ‘medicalized’ childbirth in India. There will also be an attempt to show how this process can be primarily located through: (1) bodycommunity separation as conventionally practiced in biomedical system, and (2) technomedical hegemony and hierarchical organization (as in case of health care and childbirth). To remember here, “expanding metaphors usually only modify rather than radically alter thought or action already also oriented by other powerful metaphors…But problems may arise when a metaphor expands in a sphere where it is not challenged or complemented by equally powerful metaphors which are also expanding…Metaphorical ideals such as “healthy behaviour” and “mental health” propounded by doctors and others who are perceived to be “objective” and to have no ideological axe to grind, have expanded to fill the vacuum as it were.”11 Hence, there erupts the absence of any metaphors more convincing than therapeutic ones. This perhaps becomes the existing milieu of an indigenous world. The new scientific healing emphasized objectivity in the collection of data, largely dispensing with the patient’s narrative in favour of specific measurements of biological activity. It is not difficult to understand that different corporeal ambiguities, as perceived in pre-colonial India, began to be subsumed by powerful scientific rhetoric of medicine. The localization of disease, for the first time in medical history, to the lesion inside the body caused 9

Cecil G. Helman, “Introduction: the scope of medical anthropology”, in Culture, Health and Illness, 4th edition (London: Arnold, 2001), 1. 10 Arthur Kleinman, “Culture and Depression” in New England Journal of Medicine 2004; 351(10): 951953. 11 Kenneth Boyd, “Disease, illness…”, 15.

4 the individual to become the constant object of medical attention. The ‘modern’ individual, it may be argued, transforms from Durkheim’s ‘discrete identity’ to Foucault’s ‘concrete reality.’ The body becomes ‘given’ within a new matrix of experience because body, subjectivity and experience are bound together within the same ‘code of language.’12 The subject is thus positioned in relationship to its anatomy in terms of that anatomy’s social meaning. As such, the image of the body which it constructs is one that is inherently fragile always potentially contestable.13 [I will discuss this issue later at a greater length.] Some Aspects of Biomedicine Medicine (or biomedicine) was the first scientific discourse concerning the individual in the formation of the human sciences, which subsequently discursively transformed the human body into an object of empirical knowledge through the medical gaze.14 Biomedicine gradually becomes a particular regime of truth whose sociopolitical power and hegemonic authority is based on the firm belief in the rationality and veracity of empiricism and positivism. The exclusive and highly specialized nature of human biology and physiology has afforded biomedicine, as an institution, the power to assert (without restraint) truth claims about the body, and the nature of disease and illness. This has consequently made it one (if not ‘the’) most powerful regimes of truth of all times. ‘Modern medicine’ then, as a phrase which seems to describe a specific temporal stage in medical practice and knowledge, actually reinforces a tenacious trope: medicine is always, by definition, ‘modern.’ Tropes of modernity such as the autonomous individual and nature, and independence of both nature and medicine from either society or culture, are integral aspects the biomedical origin-narrative.15 As much as thought, personality and other intangibles define the uniqueness of a person, it is ultimately on the human body that these characteristics are expressed and recognized. We can also say that human identity is a very much physical phenomenon. It is involved in the politically charged production of human bodies and ‘modern’ Subjectivity with a coherence, core and unique historicity of the self quite different from pre-colonial world, and the dispositif within which the body acquires its specific ontology. It is evidently not possible to separate the understanding of disease from bodies, agencies and subjectivities. This very intertwining – the hybrid collective – surfaces as the object of analysis. Neither community nor modernity appears in themselves, nor have they ever done so.16 “Within its symbolic meanings and social interactions our senses form into a patterned sensibility, our movements meet

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For a better discussion in this line of reasoning see, David Armstrong, “Review Essay: The subject and the social in medicine: an appreciation of Michel Foucault” in Sociology of health and Illness 1985; 7: 108117. 13 Harri Roberts, “Embodying Identity: Class, Nation and Corporeality in the 1847 Blue Books Report” in North American Journal of Welsh Studies Winter 2003; 3(1): 1-21. 14 Michel Foucault, “Two Lectures” in Michel Foucault: Power/Knowledge: Selected Interviews and Other Writings, 1972-1977, ed. Colin Gordon (New York: Pantheon Books, 1980), 78-108. 15 Deborah Gordon, “Tenacious Assumptions in Western Medicine” in Biomedicine Examined, eds. M. Lock and Deborah Gordon (Boston: Kluwer Academic Publishers, 1988), 19-56. 16 Gyan Prakash, Another Reason: Science and the Imagination of Modern India (Delhi: Oxford University Press, 1999), 237.

5 resistance and find directions, and our subjectivity emerges, takes shape, and reflexively shapes our local world.”17 In the first article of the inaugural issue of Sociology of Health and Illness, Peter Conrad explored the ways medicine increasingly functioned as an institution of medical social control. According to Conrad, “On the most abstract level, medical social control is the acceptance of a medical perspective as the dominant definition of certain phenomena. When medical perspectives of problems and their solutions become dominant, they diminish competing definitions.”18 Conrad specifies three forms through which this control operates: medical technology, medical collaboration, and medical ideology. Medical ideology is different from other two forms. It is “a type of social control” which “uses medical authority by way of language.”19 Specifically in Indian context, this ideological hegemony was instituted through: (a) a correlation between manifestation of disease and its organ localization inside the body in a three-dimensional space which made speculative logical pattern and the concept of microcosmic-macrocosmic disease distribution (in Indian healing traditions) marginal, (b) primary emphasis on ‘cure’ (as opposed to prognosis in traditional practice), (c) a uniform, standardized pharmacopoeia poised against un-standardized, non-uniform patterns of pharmacopoeia, and (d) the transformation of social, ethical and constitutional history and prognosis of a disease by clinical history-taking and diagnosis - assigning the privilege of knowing to the voice/gaze of medicine.20. This process of marginalization was enhanced by addition of newer examination tools like stethoscope (instead of pulse watching in traditional practice), microscope, ‘magic bullets’, marvels of surgical practices and the rise of hospital medicine against a setting of community care in India. It would possibly inspire us to look into the importance of meaning and translation and their shifting characters in the construction of the concept of the ‘medical’ body (out of the ‘community’ body and self in India) on the one hand, and reconstitution of traditional medical epistemological categories and a different ontologization of the body on the other. When epistemological root is reconstituted and floating signifiers coalesce to produce different meaning, a different ontologization of the body occurs.21 [It may be mentioned here that in Indian common life-world the observer is supposed not to be epistemologically detached from the observed one. This particular epistemology is better termed as ‘psychologized’ epistemology.]22 Modern Western medicine or the universal biomedicine encompasses multiple forms of practice in diverse settings. Despite its pretenses to scientific rigor, the Western medical system is less grounded in science than in its wider cultural context; like all health care systems, it 17

Arthur Kleinman, Experience and Its Moral Modes: Culture, Human Conditions, and Disorder (The Tanner Lectures on Human Values), delivered at Stanford University, April 13-16, 1998. 18 Peter Conrad, “Types of medical social control” in Sociology of Health and Illness 1979; 1(1): 1-11. 19 Ibid, 6. 20 Robert A. Arnowitz, Making Sense of Illness: Science, Society, and Disease (NY: Cambridge University Press, 1998), 130-136. 21 Jose Gil, Metamorphosis of the Body, trans. Stephen Muecke (Minneapolis, London: University of Minnesota Press, 1998). 93.5-104.5. 22 For an illuminating study on this particular epistemological issue see, Bimal K. Matilal, Logic, Language & Reality (Delhi: MLBD, 1997); The Character of Logic in India, eds. Jonardon Ganeri and Heeraman Tiwari (Delhi: Oxford University Press, 1999), 1-33, and J. N. Mohanty, Explorations in Philosophy: Essays by J. N. Mohanty, Bina Gupta ed. (Delhi: Oxford, 2001).

6 embodies the biases and beliefs of the society that created it. Western society’s core value system is strongly oriented toward science, high technology, economic profit, and patriarchally governed institutions. In more recent times, “the professional culture, driven by the political economy of the pharmaceutical industry, may represent the leading edge of a worldwide shift in norms.”23 Our medical system reflects that core value system: its successes are founded in science, effected by technology, and carried out through large institutions governed by patriarchal ideologies in a profit-driven economic context. Among these core values, in both medicine and the wider society, technology reigns supreme. Technology-as-politics occurs when the introduction of a particular technological system becomes a way of setting an issue in a community, or when technologies require particular kinds of political relationships.24 In our limited context I define technology as any intervention which affects health and/or society. The formal discourses of biomedicine are still perceived as predominantly informed by a philosophical stance of non-reflective positivist empiricism that privileges neutrality and objectivity as epistemological positions. “This has led to the charge that biomedicine is primarily concerned with the objectified bodies of patients rather than the embodied patient as an experiencing person, as is manifest in the compartmentalisation of the person into specialty specific components – for example, psychiatry and gynaecology – and clinical focus that is reductionist in seeking the organic specifics of disease.”25 As has been clear for over twenty years, for example, most routine obstetrical procedures have little or no scientific evidence to justify them. They are routinely performed not because they make scientific sense but because they make cultural sense.26 Following this trajectory the obstetrician replaced the midwife as the primary attendant of childbirth and a new era in childbirth began. The early technology of obstetrics was a technology of domination and control organized around a mechanistic conception of the body.27 Also, the history of Western obstetrics is one example of the history of technologies of separation. As a result a split occurs between ‘embodied’ subjecthood of indigenous world and ‘objectified’ body of biomedicine which led into a struggle between ‘material’ and ‘non-material’ components of the body. Nowadays we call this necessary inhumanity ‘clinical detachment’ or somethimg similar which sounds less emotive, more scientific.28 We should remember that such objectivist approach of medicine is frequently critiqued in recent time, “This reductionist or mechanistic view of patients is no longer satisfactory. Patients and physicians have begun to realize the value of elements such as faith, hope, and compassion in the healing process.”29 To emphasize, it is not to romanticize the ‘embodied’ knowledge but to problematize the ‘authentic’ biomedical knowledge reigning supreme in everyday life under medicalization. 23

Kleinman, “Culture and Depression” in N Eng J Med, 2004; 350: 952. Stefan Timmermans and Marc Berg, “The Practice of Medical Technology” in Sociology of Health nad Illness 2003; 25(3): 97-114. 25 C Jaye, “Talking around embodiment: the views of GPs following participation in medical anthropology courses” in J Med Ethics: Medical humanities 2004; 30: 41-48. 26 Robbie Davis-Floyd, “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth” in International Journal of Gynecology and Obstetrics 2001; 75(Supplement 1): S5-S23. 27 William Ray Arney and Jane Neill, “The location of pain in childbirth: natural childbirth and the transformation of obstetrics” in Sociology of Health and Illness 1982; 4(1): 12-24. 28 Ruth Richardson, “A Necessary Inhumanity?” in J Med Ethics: Medical Humanities 2000; 26: 104-106. 29 Larry Culliford, “Spirituality nad clinical care” in British Medical Journal 2002; 325:1434-5. [Emphasis in original.] 24

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A Few More Comments We are not bodies, we have bodies through which we act in the outer material world. Western medicine (or biomedicine) arrived in this subcontinent in the baggage of Modernity. It was organized to a great extent through an uncoercive management of desire. Virtually, all societies have more than one conceptions or cultures centering the notion of the body within their borders. The rules that underpin the organization of a society and the ways that it is symbolized and transmitted are all part of that society’s culture. The dominant representation of the body in modernity has been provided by the biomedical discourse which, in the nineteenth century, became a science of universal bodily processes. Biomedical study was the quintessential epistemology of scientific, ‘civilized’ man (as opposed to bodily-being-in-theworld), a systematic division and reduction of the material world, a triumph of reason over emotion. It is, subsequently, this rewritten body that is the site of the diagnostic and therapeutic interventions. That is why Margaret Lock is “concerned with the relationship among politics, scientific knowledge production and its application, and the creation of so-called “needs” among population, together with the search for moral order and control in contemporary society.”30 A dominant theme with regards to the rise of advanced medical care is how these new technologies affect patients and their experience of illness.31 Biomedical technologies are by no means autonomous, and moreover that the characterization of suffering and needs, being culturally constructed, has a profound influence on the development, associated discourse, and application of these technologies.32 A trenchant critique comments, “Today's technical and dehumanised medicine has no past, has no cultural language, has no philosophy, does not even have any books: how many young doctors have perused nothing but stencilled notes? The year 2000 will witness the triumph of medicine, but also the substitution of doctors by health technicians.”33 In leading academic journals issues like ‘politics and health’ assumes importance to the extent as “The way societies organize themselves through their political regimes and their egalitarian policies could have more important role in health than standard variables such as wealth and the size of public sector.”34 In sum, the spectrum of health and disease makes its journey from body to context-sensitivity of medicine to religious belief to political structure of a society to semiotic process of construction of biomedical hegemony. Encounter between modernity and indigenization is a point of reference in this broad spectrum. All these components intertwine and intersect one another at some point of time. Two Paradigms and the Indian Body

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Margaret Lock, Deadly Disputes: Biotechnology and Reconceptualizing the Body in Death in Japan and North America, Occasional Papers Series (Berkley: The Doreen B. Townsend Center for the Humanities, 1987), 5. 31 Frederick K. D. Nahm, “Neurology, Technology, and the Diagnostic Imperative” in Perspectives in Biology and Medicine 44.1 (2001) 99-107 32 Lock, Deadly Disputes, 7. 33 Danielle Gourevitch, “The history of medical teaching” in Lancet Volume 354, Supplement 4 18 December 1999. [Accessed on 14 April 2005. Page numbers are not mentioned in free online access..] 34 Alvaro Franco, “Effect of democracy on health: ecological study” in British Medical Journal 2004; 329: 401-4. [Emphasis added.]

8 “The quest for presence has marked the history of Western philosophy…The Orient could be included in this, with one remarkable difference: the East has kept the body as the means of direct activity for the production of presence, while the West, from a given point of history, lost all visible links with the body.”35 One of the ways in re-establishing ‘visible links with the body’ was to know the body through anatomical and biomedical knowledge. It resulted in the production of the ‘concrete reality’ of an individual medical body. In the Eastern tradition, however, we have a very different view of the body. Eastern thought traditionally tends to emphasize the inseparability of mind and body. Here, the notion of the body is of a self-active one. It is a subject which sees as well as an object which is seen – the embodied self. Eastern thought traditionally tends to emphasize the inseparability of mind and body. The dividing line between psyche and soma or between soma and nature is much weaker than is the case with Western concepts of the person. A fundamental postulate in this tradition (particularly, in Ayurveda) is that the body, the physical part of the person, is in perpetual flux with nature, the physical part of the cosmos, for ceaseless transformations of matter through a dense circulation of symbols with a polysemy of meaning. As a result the body and embodiment often intertwine to unfold a semiotic function where the body and person were perceptive of and expressive of one another.36 With respect to the biomedical concept it is not the body per se, rather the bodily being-in-the-world.37 The scientific view of the body (or the ‘medical’ body) appeared as “reified, isolated, decontextualized, and abstracted from real time, actual location and social space.”38 In a different context Stanley Tambiah reminds us, “The alleged incompatibility between science and religion in the West, and the thesis of the inevitable secularisation and rationalization of the world as a world historical process, make sense only if we see them as the accompaniment of the central energizing role of science and technology in the industrial West as the motor of history.”39 In the late 20th century, no one set of ideas about medicine, religion, economics, culture or anything else is shared by everyone. The notion of a Western conception of self or personhood that is essentialist, autonomous, bounded, stable, enduring, continuous, and impermeable is itself a selective creation from among the diversity of cultural realities of the past. “Because we are self-aware…the study of the human has a unique place in establishing the image we have of ourselves; ultimately the prosaic descriptions of the bones, muscles, blood vessels and neural pathways are the context of our experience of life…If we are ever to gain any real understanding of the human body’s nature in all its complexity, and begin to answer the questions ‘Who we are, and from whence did we come’?”40 Semiotics of Encounter 35

Jose Gil, Metamorphosis of the body, 186.9 Sudhir Kakar, Shamans, Mystics and Doctors (Delhi: Oxford University Press, 1982), 219-251. 37 Thomas J. Csordas, “Words from the Holy People: a case study in cultural phenomenology.” In Thomas J. Csordas (ed.) Embodiment and experience: The existential ground of culture and self” (Cambridge: Cambridge University Press, 1994), 269-290. Also see, Sudhir Kakar, ibid. 38 Margaret Lock, Encounters with ageing: Mythologies of Menopause in Japan and North America (Berkley: University of California Press, 1993), 370-371. 39 Stanley J Tambiah, Magic, science, religion, and the scope of rationality (New York, Cambridge: Cambridge University Press, 1993), 152. 40 Introduction, Gray’s Anatomy, 38th Edition, (London: Blackwell, 2000). Gray’s Anatomy is regarded as a ‘hard’ textbook of anatomy. [Emphasis added.] 36

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When a word (examples being health, disease, body etc.) pervades the history of a language and the multiple discourses of a culture, it typically accumulates diverse meanings and representations. To state this is not merely to assert the obvious but to suggest that the coexistence of multiple and often contradictory meanings of the word childbirth is significant and complicates the task of identifying a ‘dominant’ meaning or ideology. 41 Following the American anthropologist Edward T. Hall, in each human group there are actually three different levels of culture – primary, secondary, and tertiary. While the manifest, tertiary level of culture is easiest to observe, change and manipulate, it is the deeper levels (primary and secondary) that are the most hidden, stable and resistant to change.42 The French sociologist Marcel Mauss shows the extent to which society inscribes itself on human bodies. It is now regarded as a foundational contribution to the two fields of the anthropology of the body and semiotics.43 We, languaged humans, are rarely out of the community of words. Community is also the semiotic setting of life among humans, our inescapable sociality. It is sign-use that initiates an open-ended process of semiosis. Identity of any sign (or, any entity at all) is constituted on the basis of defining and asserting itself in terms of that which it is not that is on the basis of difference. An idea (symbol) is brought into reality indexically, and once there emerges socially in material reality, where its use might spawn a rethinking of the symbol, a new idea, an idea that might change other ideas, change habits and hence change “actual behavior in the outer world” in a continuous dialectical process.44 It is through the reconstruction of the indexical parts of a sign system the entire symbolic order can be reconstructed insidiously – without changing the sign-uses of a local cosmos. This is that very contested space where by maneuvering through the webs of power both the ‘normalizing’ regime and the local knowledge system try to gain authority of making/breaking of sign-use. All systems of signification and, by implication, systems of communication possess synchronic (paradigmatic) and diachronic (syntagmatic) axes. These are also known as metaphorical (associative) and metonymical juxtapositional/contiguous) axes. Baudrillard shows how the ‘functional space’ is dominated by the metonymical (i.e., contiguous). Ambiance is constructed through difference and relation. The process, by which cultural hegemony is expressed as the reduction of all objects to sign value, does not eliminate either the practices of daily life which is based on use value or the system of capital accumulation which relies on exchange value.45 The indexical parts of these semiotic symbolic assertions, expressed metonymically through actions in the life-world, can be appropriated to reconstitute the existing ones explained mytho-historically. Thus, without changing the prevailing icons of

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Paula A. Treichler, “Feminism, Medicine, and the Meaning of Childbirth” in Body/Politics: Women and the Discourses of Science, eds. Mary Jacobus, Evelyn Fox Keller, and Sally Shuttleworth (New York: Routledge, 1990), 113-138. 42 It has been nicely explained by Cecil Helman in Culture, Health, and Illness. 43 Marcel Mauss, “Body Techniques”, in Sociology and Psychology: Essays by Marcel Mauss, trans. Ben Brewster (London: Routledge and Keagan Paul, 1979), 97-119. 44 Charles S. Pierce, Philosophical Writings, ed. Justus Buchler (New York: Dover Publications, 1955), 283-288. 45 Jean Baudrillard, The System of Objects, tr. James Benedict (London: Verso, 1996).

10 an indigenous society cultural hegemony can be insidiously constructed.46 The body as a social construction with its continuous reference to a vivacious dialectics of identity and difference, presents itself as a set of potential sociological signs and indicators, which we need to decipher in order to understand dynamics, structures, events, transformations and underlying conflicts. During a period of violent change in sign-system (as was the case during colonial medical encounter) defining characteristic of the symbol becomes the overflowing of the signifier by the signified. Semiotics calls ‘denotation’ cannot be divorced from its ‘connotation’ and both the connotation and denotation of a signifier will always be established within the confines of a certain context, the same signifier will connote and denote very different things (signifieds or referents) in different contexts, depending on the context in which it occurs.47 The meaning of an event is open to the possibility of being re-narrated in different contexts, so that it will mean and ‘be’ something entirely different: meaning of all events will be overdetermined by the ‘revolutionary’ factors being on their significance or status as events.48 It is the “intermeshing of the body with signifying systems that produce meaning and identity, it also provides the possibility of their disruption or collapse.”49 Within a context of cultural change and during an asymmetric exchange of social forces, some forces spilling out of the domain of social exchange continually escape it. “These are floating energies that are not yet fixed or invested in techniques and signs.”50 Because cultural reproduction depends upon human reproduction, questions of childbearing are invariably significant in the life of a culture, and significant changes in childbearing patterns often signal broad cultural change.51 The way people treat their bodies reveals the deepest disposition of the habitus. Here a Bourdieusian approach is a more productive alternative than the still dominant biomedical and social constructionist approaches to the body. It correlates well with Bourdieu’s notion of habitus.52 In this analysis, individuals are explicitly situated within specific historical and spatial contexts, participating within a collective habitus. This habitus is defined in terms of its own history, and shapes or influences the bodily practices of participating individuals. Bourdieu states that habitus constructs the world by a particular way of orienting itself towards the world and focusing attention upon it. It is not a question of identifying an image (body) with a representation, but of the analogical production of space.

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Diane P. Mines, “From Homo Hierarchicus to Homo Faber: Breaking Convention Through Semiosis”, in Irish Journal of Anthropology, 1997; 2:33-44. URL: http://www.may.ie/academic/anthropology/AAI/UA/vol2/mines.html. Accessed 2 November 2002. 47 Paul de Man, “The Epistemology of Metaphor” in On Metaphor, ed. S. Sacks (Chicago and London: Chicago University Press, 1978), 22. 48 J. Derrida, Limited Inc (Evanston: Northwestern University Press, 1977), 1-25. 49 Harri Roberts, “Embodying Identity: Class, Nation and Corporeality in the 1847 Blue Books Report.” In North American Journal of Welsh Studies, Winter 2003; 3(1) 3. 50 Jose Gill, Metamorphosis of the Body, 94.5. 51 Paula A. Treichler, “Feminism, Medicine, and the Meaning of Childbirth” in Body/Politics: Women and the Discourses of Science, eds. Mary Jacobus, Evelyn Fox Keller, and Sally Shuttleworth (New York: Routledge, 1990), 113-138. 52 S. P. Wainwright, B. S. Turner, “Reflections on embodiment and vulnerability” in J Med Ethics: Medical Humanities 2003; 29: 4-7.

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Epistemology, Medicine, and Indigenization Western biomedicine (and other social institutions) is the product of their episteme, their underlying epistemological superstructure, which in the case of biomedicine has evolved into a hegemonic ideology. A reassuring cultural order is imposed on the otherwise frightening and potentially out-of-control chaos of nature. Epistemological reconstruction becomes the primary focus of the ‘normalizing’ regime. Conscious deductive reasoning, which can be logically explained and replicated, is the most machine-like form of human thought. Thus, ratiocinative (‘to ratiocinate’ means ‘to reason methodically and logically’) processes are reified in the West and often couched in terms of normative rules. Intuition, in contrast, refers to our experience of the results of deep cognitive processes that occur without conscious awareness and cannot be logically explained or reproduced.53 I would like to refer to the example of an eminent Ayurvedic practitioner, Gananath Sen, of twentieth-century India who was well educated in English education too. He wrote a textbook of ‘Ayurvedic’ anatomy in 1924: Shàrir-Parichay (Introducing Anatomy). In his Introduction he stressed, “Due to lack of anatomical knowledge it is not possible to attain desired knowledge in therapeutics too…Primarily due to this fact only, Ayurvedic practitioners have now become bereft of authority and unwelcome as well.”54 In his act of introducing anatomy he unhesitatingly reproduces diagrams from Gray’s Anatomy or Cunningham’s Manual regularly used by the students of Medical College. Explaining these diagrams in Sanskrit, he staked his claim on two fundamental grounds: (1) that all these concepts remained hidden in ancient ‘authoritative’ texts; and (2) this understanding would prepare the premise to combat all-powerful “English” medicine. Ancient Ayurvedic anatomical terms of different connotations were conflated with modern concepts. As a result, he, like many other colleagues of him, perhaps inadvertently opened up a space of Foucauldian objectifying clinical gaze. On the one hand, there occurred an insidious spatial shift in perception from macrocosmicmicrocosmic distribution/arrangement of the ‘Indian’ body to the circumscribed, threedimensional anatomical space, and on the other, a shift from traditional philosophy of tri-dosha theory to ‘modern’ notion of pathology of a disease. He even compared the body with a clock in a Descartian way. Ironically, in doing so he himself was reconstituted by the language of modern anatomy and biomedicine. No wonder that the philosophical matrix of Ayurveda was dislocated through this ‘modernization’ of Ayurvedic knowledge of anatomy. PostRenaissance medical concepts insinuated into the interstices of classical Ayurvedic concepts and, consequently, reconstituted their meanings. His epistemological inquiries were surreptitiously sublated and dislocated by metonymic and hegemonic language-metaphors of Western medical vocabulary. In this reconstituted epistemological position, the ‘Ayurvedic’ body perceived as a self-reflexive active agent metamorphoses into an inert dead body, an ‘object’. The only journey he could make to come out of this impasse was to insinuate into the interstices of ontology of the body – socially anchored, catechised in traditional ethics and 53

Robbie Davis-Floyd, “Intuition as Authoritative Knowledge in Midwifery and Home Birth” in The Social Production of Authoritative Knowledge in Childbirth, a special edition of the Medical Anthropology Quarterly, eds. Robbie Davis-Floyd and Carolyn Sargent, 1996; 10(2):237-269. 54 Gananath Sen, Shàrir-Parichay (Introduction to Anatomy) (Calcutta: Kalpataru Ayurveda Bhavan, 1924), 1-2.

12 moral values, differing from ethics- and value-neutral, corporeal body. There was insidious evacuation of the core of indigenous categories, analytical tools and conceptual cosmos by Western connotations. This becomes an illuminating example of how idioms of expression unique to a particular set of epistemology can be insidiously transformed and a unique hegemony of text can operate. Trawick notes, “in a complex civilization, as culture changes and innovations are introduced, healers and patients must continually adapt their perspectives to one another…healing systems adjust to the conditions imposed by the general culture and by one another.”55 Techniques or technologies go on generating their new meanings and subsequent translation into the larger society. It produces its legitimacy from within a society. The production and dissemination of newly acquired ‘medical knowledge’, harnessed by the impact of technology and the existence of hierarchies, went on generating tirelessly new contexts of legitimacy.56 But there always remains strife between detached, authoritative and overriding biomedical model and indigenous knowledge of the body, health and disease. There always remain intersections, sometimes turbulent sometimes insidious, between modernization and indigenisation. For the vast, non-metropolitan, heterogeneous and illiterate population of India it resulted in some awful admiration and, yet, distancing themselves from the hegemonic praxis of colonial knowledge production. To them, the body posited “as an a priori object, as an entity whose existence preceded the discourse within which it appeared as a matter of medical scrutiny and regulation.”57 When knowledge systems diverge, women and families must sometimes make trade-offs between their assessment of how to ensure the survival of mother and baby and their assessment of how to achieve the comfort of a socially valued form of birth; and they don’t always make the choices that fit the worldviews of their caregivers, health planners, or the state-supported medical system that organizes the possibilities available to them.58 There remains a contested space between these two epistemological positions. Childbirth and Indigenization While the emphasis in biomedicine is on individuals, based on a positivist conception that by understanding individual behavior, it becomes possible to understand the total. In this conceptualization the body becomes ‘medical’ instead of ‘social’. If we follow further this reductionist line of reasoning it may be inferred that patients are no longer individuals with their particular set of symptoms and problems, but come increasingly to be seen as ‘cases.’ Disease becomes more important than the sick person. It was the loss of self in a complex social system where professionalism and individualism were on the rise. Philosophical foundations such as underlying ontological notions are rarely part of public health discussions, but these are always implicit and lie behind the arguments and reasoning of different

55

Margaret Trawick, “Death and Nurturance in Indian Systems of Healing” in Paths to Asian Medical Knowledge, eds. Charles Leslie and Allan Young (Delhi: Munshiram Manoharlal, 1993), 129-159. 56 John C. Burnham, (Garrison Lecture) “How the Concept of Profession Evolved in the Work of Historians of Medicine” in Bulletin of the History of Medicine 1996 70(1): 1-24. 57 Gyan Prakash, Another Reason: Science and Imagination of Modren India (Delhi: Oxford University Press, 2000), 128. 58 Rabbie Davis-Floyd et al, “Introduction” to “Daughters of Time: The Shifting Identities of Contemporary Midwives”, a special triple issue of Medical Anthropology 2001; 20 (2-3 and 4): 105-139.

13 viewpoints or traditions. 59 The question of childbirth and its attendants are more a social than a medical question in indigenous world. In its effort to contest with the hegemonic biomedical discourses shaping the ‘modern’ Indian ethos, local cosmos (or microcosm) split a space between practical therapeutics and ontology of health. “Where, for example, the practitioner’s goals may be a satisfactory clinical outcome such as cure or management, the patient may seek healing which involves the restoration of a sense of connectedness, coherence, control, wholeness, or integrity.”60 Within the space of childbirth, the body – disciplined, normalized and made subservient to the practice of becoming-a-citizen – is made ‘pure’ by introducing it to indigenous rituals. “Obstetrics formulated a technology that met the force and violence of birth with the force and violence of scientific medicine.”61 In childbirth, one of the most graphic demonstrations of the power of ‘doctor’s choice’ is the lithotomy position so popular with doctors not because it is physiologically sound, but because it enables them to attend births standing up, with a clear field for maneuvering. It is not unknown that this position complicates childbirth, but the many good physiological reasons to allow women to give birth in upright positions (which include increased blood and oxygen supply to the baby, more effective pushing, and wider pelvic outlets) are far less important to most physicians than their own comfort, convenience, and status.62 Despite this fact, “Around the world the pressures that, a priori, define biomedicine as structurally superior to traditional medicine, doctors as superior to midwives, and professional midwives as superior to folk midwives have not so much supplanted various ethno-obstetric systems with a set of universal ‘modern’ practices (or resistances to them) as they have produced a multiplicity of practices of accommodation and negotiation.” 63 There is a tension between what is defined medically, socially and politically and what is actually lived. It is within this fissure that a woman and her community can both resist and recreate their experience of their bodies.64 The transformation of childbirth in India occurred at the turn of the nineteenth century as birth was transferred from the domain of women and the female dai or midwife (a term meaning ‘with women’) to the dominant realm of male obstetrics (from the Latin word obstare meaning ‘to stand before’). The male-midwifery required both social and medical legitimacy to overcome the suspicion with which it was viewed. Such legitimacy came in the form of an alliance between midwifery and anatomical dissection: a scientific practice that had long been considered one of the most important sources of medical knowledge. To assess the significance 59

Vinay Kumar Yadavendu, “Changing Perspectives in Public Health” in Economic and Political Weekly December 6, 2003. 60 C Jaye, “Talking around embodiment: the views of GPs following participation in medical anthropology courses” in Medical humanities 2004; 30: 41-48. 61 William Ray Arney nad Jay Neill, “The location of pain in childbirth: natural childbirth and the transformation of obstetrics” in Sociology of Health and Illness 1982; 4(1): 1-24. 62 Robbie Davis-Floyd, “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth” in International Journal of Gynecology and Obstetrics. 63 Robbie Davis-Floyd, Stacy Leigh Pigg, and Sheila Cosminsky, “Introduction” to “Daughters of Time: The Shifting Identities of Contemporary Midwives”, a special triple issue of Medical Anthropology, Vols. 20 (2-3 and 4): 105-139. 64 Alisson Bittiker, “Making Visible the Invisible: A Brief History of Gynecological Practice and Representation” in Journal of Undergraduate Research, December 2002. URL: http://web.clas.ufl.edu/CLAS/jur/1202/bittikerpaper.html. Accessed 12 January 2003.

14 of medical intervention in childbirth in India, no matter how limited its impact, we must try to recapture the natures of traditional management of birth. After all, birth is never a purely natural event in an animal sense, but proceeds in a cultural setting.65 Whereas medicine is marked by tell tale signs of professionalism and specialized knowledge, midwives (or ‘dais’ in Indian vocabulary, particularly in Bengal and northern India) clearly belongs to a pre-modern area of occupation. Without any formal training, they form a hereditary, caste-based group. They have neither the anatomical knowledge of the body, nor are they any sort of professional salary. A certain community feeling becomes a strategy for survival in an often uncertain world. It seems that home delivery or non-medical attendance is somehow more natural.66 “A further subdivision of culture within complex societies is seen in the various professional subcultures that exist, such as the medical, nursing, … In each case these people form a group apart with their own concepts, rules and social organization” and, during a process of enculturation, “they also acquire a very different perspective on life from those who are outside the profession.” 67 Childbirth takes place in hospitals because there are few alternatives: obstetrics has been successful – not in creating safe childbirth but in creating a monopoly; for its own professional gain; organized medicine has ‘medicalized’ childbirth, a process that in other cultures and other countries frequently takes place outside hospitals with little medical intervention.68 It is useful to note how the subculture of dais (midwives) keeps on surviving within a space encroached on by public health care, ‘medicalized’ childbirth, and traditional childbirth techniques. It is also a history marked by resistance and struggle. Besides the economic potential of gaining control of childbirth practices, obstetricians in India were eager to use new European surgical instruments, such as forceps, and interventions that quickly became their specialty, using them to assist with labors which had become obstructed. This division also included a distinction between a midwife's knowledge, gained through apprenticeship, and the new formal education that came with the proliferation of medical school across the country (which excluded women for many years). The new scientific knowledge and development of new technologies provided the theory on which the female midwives' definition of normal could be challenged and were used to construct the pathological potential of pregnancy and childbirth. Obstetricians were able to gain control over all births by exploiting this pathological potential and treat childbirth with an ‘as if’ or ‘in case’ syndrome that could only view childbirth as ‘normal’ in retrospect.69 When an ideology is hegemonic, all other competing ideologies become ‘alternative’ to it. Thus healing modalities such as midwifery and so forth have been viewed as alternative to allopathy. While these modalities 65

Carol P. McCormack (ed.), Preface, in Ethnography of Fertility and Birth (London: Academic Press, 1982). Referred to by Supriya Guha, “From Dias to Doctors: The Medicalization of childbirth in Colonial India.” URL: http://www.hsph.harvard.edu/Organizations/healthnet/SAsia/suchana/0603/guha.html Accessed 12 January 2003. 66 For an interesting discussion on “natural childbirth” and its transformation in Britain see, O. Moscucci, “Holistic obstetrics: the origins of ‘natural childbirth’ in Britain” in Postgrad Med J 2003; 79: 168-173. 67 Cecil G. Helman, “Introduction: the scope of medical anthropology”, in Culture, Health and Illness, 6. 68 Paula A. Treichler, "Feminism, Medicine, and the Meaning of Childbirth," in Body/Politics: Women and the Discourses of Science, eds. Mary Jacobus, Evelyn Fox Keller, and Sally Shuttleworth, (New York: Routledge, 1990), 113-138. 69 Amy Schriefer, Shifting the Medical Gaze: Towards a Feminist Ethic of Childbirth. URL: http://www2.gwu.edu/~medusa/articles.html. Accessed 16 Nov 2004.

15 command increasing respect and usage, allopathic technomedicine still sets the standards for care.70 During childbirth, medical gaze, and its accompanying power, are directed at the woman in labor, rendering her a patient under an obstetrician's supervision. This surveillance and normalization operate as part of a structure of control. For pregnant women, biomedical hegemonic rituals or processes begin well before labor and continues in the hospital as nurses meticulously charting notes for the doctor, medical student observing and using women as tools of practice, and even partners or friends serving as labor ‘coaches’ combine to participate in the panopticon. She is fully divorced from her own real world: community, family care, enshrouding concern for the mother and child to be born. The success of the panopticon during labor is aided by the hospital layout. Though a woman in labor may have all her mental and physical faculties upon entering the hospital, she is immediately reduced to and restricted to a patient role, which is one of subordination and loss of autonomy. The initial move to this subject position may be as subtle as a change in dress from a woman's own clothing to a revealing hospital gown. Knowledge, as discussed earlier, is fundamental to this situation. The scientific knowledge of childbirth produces the hierarchical separation of the patient and the doctor. One of the first things a delivering woman will notice in the hospital is the use of a specialized medical jargon. It is one of the strands in the overall web of power through which the doctor and staff are able to sustain superiority over the patient, using the power of medical discourse over everyday speech. This constant use of coded language operates to exclude the patient from medical discourse, a language heavily bound with knowledge. A woman during childbirth, unable to decode this speech, is denied the opportunity to participate in the decision making process surrounding the course of her labor. Even though she may have an acute understanding of the situation from her own perspective, the authoritative knowledge of the doctor and hospital are valued over a woman's embodied knowledge of herself. This authoritative knowledge is persuasive because it seems natural, reasonable and consensually constructed. A subject's experience or action is alienated when it is defined or controlled by a subject who does not share one's assumptions or goals. Though, in recent observation social conceptions of the body “establish community identification…set acceptable priorities for group activities…the critical importance of coherence and body integrity to a person’s development and sense of self.”71 Trust and affection, it is being argued after a long history of domination and usurpation, often render other forms of expert therapeutic language unnecessary.72 There is increasing evidence that midwife-assisted home birth is as safe as, and often safer than, hospital birth), this evidence is little known and not at all acknowledged in the wider culture, which still assumes the authority of the technomedical tenet that hospital birth is far superior to birth at

70

Robbie Davis-Floyd, “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth” in Medical Anthropology Quarterly 2001; 20(2,3 and 4): 105-139. It is a special issue on theme of “Daughters of Time: The Shifting Identities of Contemporary Midwives,” 71 Lori Andrews and Dorothy Nelkin, “Whose body is it anyway? Disputes over body tissue in a biotechnological age” in Lancet 3 January 1998; 351(9095): 53-7. 72 Steve Kroll-Smith and H. Hugh Floyd, Bodies in Protest: Environmental Illness and the Struggle over Medical Knowledge (New York: New York University Press, 1998), 151-155.

16 home.73 Clients experience, in the traditional home-delivery setting, mutual respect, shared cultural understanding and a continuum of care that is not possible in the medical set up. The reality of India’s maternal health is that majority of maternal health care providers (those assisting most births) represent the widespread indigenous system of dais, cord cutters, Unani and Ayurvedic practitioners and a host of other women who cannot be dismissed. By far the majority of births in the country continue to occur at home with indigenous practitioners or ‘other’ women. This reflects a global phenomenon – the differences between the rich and the poor in utilization of delivery care services.74 We should try to understand the line of reasoning behind decisions made by pregnant women, their families and the indigenous practitioners to whom they turn in times of pregnancy-related complications. In the fast changing scenario of today’s world, trust and affection dissipate, however, as we move farther out into secondary association and beyond. What is then required, for the most part, are the objective discourses of modernity, particularly expertise.75 Yet, the inability of biomedicine to account for a patient’s symptoms and desire opens interpretive space and confronting this reductionism, patients’ and community’s individuality reasserts itself.76 Zygmunt Baumann argues in a different context, “Psychically, modernity is about identity … unfulfilled identity looks uncannily like recoiling from the flawed, illegitimate reality of the present…Definitions are born with; identities are made”77 This particular ‘recoiling’ of indigenous childbirth on to ‘medicalized’ childbirth, even at the beginning of 21st century, is an intriguing area to ponder upon. Must we lose the viable indigenous birthways that still exist before we rediscover how valuable many of them were? Must the professionalization of midwifery mean its colonization by biomedicine? To stress again, symptoms of diseases themselves are indexical signs. There is a system of signifiers that reveal a hermetic code of signs. Medicine is an essentially semiotic discipline: it observes natural events, interprets them as signs of diseases, and concludes from this diagnosis what therapy to apply. Medical semiotics emphasizes the role of interpretation in the diagnostic process whereby different perspectives of interpretation may lead to various readings of the same sign; all of them are valid. The cultural hierarchy of biomedicine assigns low status to subjective symptoms or signs which are to be legitimated by objective findings. Conclusion Our study how family and community care of the sick and mother is displaced and relocated in hospital setting where cognition is insulated from affect. Besides institutionalizing 73

Robbie Davis-Floyd, “Intuition as Authoritative Knowledge in Midwifery and Home Birth” in Medical Anthropology Quarterly (special issue on “The Social Production of Authoritative Knowledge in Childbirth”) 1996; 10(2): 74 Lok Swaasthya Parampara Samvardhan Samithi (LSPSS), Mother and Child Care in Traditional Medicine, Parts I and II. URL: http://www.healthlibrary.com/reading/ncure/mother/. Accessed 20 January 2005. 75 J. Habermas, The Theory of Communicative Action, Vol. 2, Lifeworld and system: A Critique of Functionalist Reason, trans. T. McCarthy (Boston: Beacon Press, 1987). 76 Robert A. Aronowitz, Making Sense of Illness; Science, Society, and Disease (New York: Cambridge University Press, 1998), 166-171. 77 Zygmunt Baumann, “Parvenu and Pariah: Heroes and Victims of Modernity,” in The Politics of Postmodernity, eds. James Good and Irving Velody (London: Cambridge University Press, 1998), 23-25.

17 linguistic, professional, conceptual, cognitive or spatial hegemony, this new medical surveillance and birthing technique entails an epistemological authority which fundamentally reconstitutes all other components of selfhood. It may be summarized thus: (1) dislocation of experiential and intuitive knowledge with ‘scientific’ knowledge as the only valid form; (2) introducing a ‘secular’ operating mechanism embedded in secular ontology of the body (and health); and (3) reconstituting ‘psycholized’ epistemology, unknowingly practiced in everyday life world, by faceless scientific care in hospital setting. The body and the process of birthing, eventually, belong no more to community or religious group. It belongs to the state, to the deliverer of scientific knowledge. But, in its attempt to rewrite its own self the body, as Zygmunt Baumann informs us, uncannily recoils back into the community. In its contestation, the community re-inscribes the indigenous body with pre-, peri-, and post-birthing rituals. It is made ‘pure’. The child is home delivered in families of vast, non-metropolitan, heterogeneous Indian population. ‘Indigenization’ of childbirth occurs. At the moment of intersection, the community in which the mother (or, the patient) is situated constructs and applies a ‘practical epistemology’ that “may be said to begin when people appropriate a language of expertise and organize their personal lives their personal lives around it. It becomes a unique way of knowing insofar as people modify and change its conventional strategies of defining and organizing.”78 Man’s creative freedom consists precisely in his ability to devise cultural perspectives and meaning systems in form and content that cannot be wholly and significantly understood in terms of any objective logic of adaptation.79 The knowability and representability of ‘Indian bodies’ – of its moments of resistance, of submission and assimilation, and of many its scars left behind by the histories of domination – is actively suppressed within the time horizon of capital itself (entailing the introduction of Western medicine in India), while the indigenous body’s spectral part-narratives continue to circulate in often unknowable fashion among more or less reticent, particularly non-metropolitan heterogeneous, Indian populations.80 Do we really succeed for any meaningful talk about indigenization of modernity once we fail to initiate a sort of dialogue between epistemologies of modern/global and indigenous/local? Going beyond indigenization, we need to focus on methodological relationalism rather than methodological individualism.81 The crucial question becomes how to conceive the constructive moment which exceeds the repetitive possibilities opened by a sedimented social framework. Failing to notice this basic fact of social and lived reality is to slip into the interstices of universalizing hegemonic Western discourse where, in spite of our best of intentions, the discourse remains epistemic while the actors within that discourse turn out to be ontic ones. To de-essentialize this universalised epistemological/ontological preoccupations we have to search for different 78

David M. Frankford, “Social and Political Disease” (Book Review Essay), in Journal of Health Politics, Policy, and Law February 1999; 24(1): 181-196. 79 Stanley J Tambiah, Magic, science, religion, 153. 80 I adopt the notion of part-narrative – and, indeed, Gyan Pandey’s defense of the fragments – as discussed by Gareth Williams, “Subalternity and the Neoliberal Habitus: Thinking on the El Salvador/South Central Interface” in Nepantla: Views from South 2000; 1(1):139-170. 81 D. Y. F Ho et al, “Indigenization and beyond: Methodological relationalism in the study of personality across cultures” in Journal of Personality, 2001; 69(6):925-933.

18 epistemologies, corporeities and selves.82 One has to emphasize that power-knowledge matrix of biomedicine never succeeds in completely overcoming the body. The body always exceeds the power frame that attempts to control it. This exceeding is possible partly because of the internal conflicts and contradictions among the various discourses that attempt to control the body.

[The author is a medical practitioner as well as a PhD student at the Dept. of Anatomy, North Bengal Medical College, University of North Bengal, India. E-mail: [email protected], [email protected]]

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Kumkum Sangari, “The Politics of the Possible” in Interrogating Modernity: Culture and Colonialism in India, eds. Tejaswini Niranjana and Vivek Dhareswar (Calcutta: Seagull, 1993), 242-272.