ACCESS/HEALTH DISPARITY ISSUES
“The country has a large stock of health manpower comprising private practitioners in various systems, for example – Ayurveda, Unani, Siddha, Homeopathy, Yoga, Naturopathy, etc. This resource has not so far been adequately utilised. The practitioners of these various systems enjoy high local acceptance and respect and consequently exert considerable influence on health beliefs and practices. It is, therefore, necessary to initiate organised measures to enable each of these various systems of medicine and health care to develop in accordance with its genius” (India’s National Health Policy Document 1983, quoted in Balasubramanian 2000, 3).
One of the main reasons Siddha medicine has been utilized in India and other regions of South Asia is the cost-effectiveness of employing such systems. In contrast with the quotation above, the money allocated to traditional systems of medicine has “never been more than 5% of our total health budget,” according to the Director of the Centre for Indian Knowledge Systems in Chennai, Dr. A.V. Balasubramanian (Ibid.).
A great deal of research shows that marginalized communities generally have the least access to health care (Lamm 2003; LeBow 2004; Spector 2000). This may occur along class, ethnic, linguistic, gender, mobility, and other factors that reduce or even prohibit access to healthcare. One way to understand these disparities is to invoke the concept of “institutional discrimination – the uneven access by group membership to resources, status, and power that stems from facially neutral policies and practices of organizations and institutions” (Smedley, Stith & Nelson 2003, 95). However, “it is difficult to distinguish the extent to which many racial and ethnic disparities are the result of discrimination or other social and economic forces” (Ibid.).
Whether these disparities are a result of social forces or institutional discrimination or some combination, the fact is they exist. The concept of “choice” in regard to medical choices may not be applicable to rural settings in India where up to 2/3 of the population lives and nearly ¾ use traditional medicine. One source cites the following reasons for their prevalence of traditional medicine outside of the infrastructure of professionalized medicine:
“these medicines have been in use for thousands of years, the easy (OTC) availability of these drugs, their inexpensiveness, and also the frequent inability of modern medicine to provide satisfactory cures in resource poor settings and the ever increasing list of adverse reactions attributable to the use of western medicines” (Bhatt et al. 2004, 74).
What kind of access is really available to the poorest sections of Tamil Nadu’s population? What health outcomes result from these policies? These are more interesting criteria to examine for understanding the disparities that result from policies which relate to professionalization, but are currently beyond the scope of this work.
4.10.06
THE PULSE OF SIDDHA MEDICINE
A basic understanding of the Siddha tradition’s understanding of the human system and its constituents is a prerequisite for an appreciation of what the physician is reading in the “pulse.” Within this tradition it is held that there are 96 different tattvas, or basic essences, which compose the human body. Here three are important; the muppini or the three “humours.” Similar to the three doshas in Ayurvedic medicine, these three humours are sometimes described as air/wind, heat/bile and water/phlegm. Traditionally they are labeled vatham, pittam and kapham. When a physician is reading the pulse of a patient, he/she is reading the three humours, which are important not merely in themselves, but also in their proportions to one another.
It is crucial to understand that the pinis in Siddha medicine reveal different types of relationships via physiology than ones traditionally held in biomedical models. First, Siddha medicine posits that the ratios of humours reflect either a state of health or a state of disease. Next, these different humours correspond to various systems and functions within the body, which are all connected via the interaction of the pinis. Thus basic Siddha physiology reveals that the pulse is a microcosm of sorts for elucidating the Siddha medical tradition as a whole.
As Kamil Zvelebil writes, “no disease can be purely local, isolated, unconnected with other parts and functions of the organism; hence no disease should be treated in isolation” (Zvelebil 1996, 35). Furthermore, treatment is understood as a way of assisting the human system to return to an optimal state of balance, rather than getting rid of a disease. In sum, taking the pulse in Siddha medicine is an evaluation of the quality and relationship of different humours in the body as a whole. Each of these humors relates to different tattvas, or elements of the body, which are understood as interconnected and interdependent. Further, the treatment of imbalance is an attempt to restore equilibrium within the humours, rather than the isolation of a symptom and its treatment as in biomedicine.
Biomedical doctors are trained to read a single diastolic-systolic pulse, which they interpret as a sign or index of the patient who they are observing often with the assistance of a stethoscope. Generally, the pulse is used as an indicator of regular heartbeat, and once the rate, rhythm and character are deemed acceptable, the doctor proceeds with other diagnostic procedures. Often considered a cursory or even perfunctory procedure, taking the pulse in biomedicine has a relatively small place in the process of diagnosis, unless something is noted to be significantly deviant from the norm.
In contrast, reading the pulse in the Siddha medical tradition is central to diagnosis. The physician reads not just one pulse, but six different pulses, and this method requires significant time and physical contact with the hands. Taking the pulse has three stages: stula nilai (the gross sensory stage), ul nilai (the inner stage) and cama nilai (the equal stage) (Daniel 102-3, in Howes 1999). Through each stage, the Siddha physician moves more closely to a diagnosis, and in the final stage literally “takes the place” of the patient.
In the first stage, the “apparently ‘passive’ fingertips of the physician objects and objectifies the dynamic and hitherto unrestricted flow of blood in the radial artery” Next, the “physician becomes aware of the rhythmic undulations of his own pulses in addition to the ones felt in the patient’s radial artery” (Ibid.). Finally, “the physician modulates the etai and natai of his own pulses so that they become confluent and concordant with the pulses of the patient… It is only at this stage that the Siddha physician believes that he ‘knows the humoral disorder of the patient” (Ibid.).
These three stages of pulse reading disclose a fundamental feature of Siddha medicine which is infinitely different than Western biomedicine. A Siddha physician’s skill in diagnosis is defined by his/her ability to become the same, however briefly, with the patient. Only after experiencing this state in his/her body is the Siddha physician able to diagnose and prescribe treatment.
To conclude, it is interesting to note the way that suffering is understood in the Siddha medical tradition in contrast to biomedicine. Within Siddha medicine, “Suffering is something that can be shared and must be shared by someone else, especially the physician.”(Daniel 109, in Howes 1999) This perspective on suffering is a radical departure from the objectification and alienation often experienced by patients in the Western biomedical system.
In sum, Siddha physiology itself presents a completely different model for understanding disease and health. This is a world where the forces of nature are connected to the forces of illness and also of recovery. In other words, Siddha medical philosophy extends beyond the boundaries of physical, social and environmental factors. The forces and influences that are understood to operate in the universe are an integral part of the human system.
Most importantly, the Siddha physician is understood as one who shares in suffering and who literally in-corporates the patient’s illness, for a brief moment. This relationship between patient and doctor reveals the general orientation in Siddha medicine which prioritizes the relationship and connection between elements rather than their distinction and separation.
A basic understanding of the Siddha tradition’s understanding of the human system and its constituents is a prerequisite for an appreciation of what the physician is reading in the “pulse.” Within this tradition it is held that there are 96 different tattvas, or basic essences, which compose the human body. Here three are important; the muppini or the three “humours.” Similar to the three doshas in Ayurvedic medicine, these three humours are sometimes described as air/wind, heat/bile and water/phlegm. Traditionally they are labeled vatham, pittam and kapham. When a physician is reading the pulse of a patient, he/she is reading the three humours, which are important not merely in themselves, but also in their proportions to one another.
It is crucial to understand that the pinis in Siddha medicine reveal different types of relationships via physiology than ones traditionally held in biomedical models. First, Siddha medicine posits that the ratios of humours reflect either a state of health or a state of disease. Next, these different humours correspond to various systems and functions within the body, which are all connected via the interaction of the pinis. Thus basic Siddha physiology reveals that the pulse is a microcosm of sorts for elucidating the Siddha medical tradition as a whole.
As Kamil Zvelebil writes, “no disease can be purely local, isolated, unconnected with other parts and functions of the organism; hence no disease should be treated in isolation” (Zvelebil 1996, 35). Furthermore, treatment is understood as a way of assisting the human system to return to an optimal state of balance, rather than getting rid of a disease. In sum, taking the pulse in Siddha medicine is an evaluation of the quality and relationship of different humours in the body as a whole. Each of these humors relates to different tattvas, or elements of the body, which are understood as interconnected and interdependent. Further, the treatment of imbalance is an attempt to restore equilibrium within the humours, rather than the isolation of a symptom and its treatment as in biomedicine.
Biomedical doctors are trained to read a single diastolic-systolic pulse, which they interpret as a sign or index of the patient who they are observing often with the assistance of a stethoscope. Generally, the pulse is used as an indicator of regular heartbeat, and once the rate, rhythm and character are deemed acceptable, the doctor proceeds with other diagnostic procedures. Often considered a cursory or even perfunctory procedure, taking the pulse in biomedicine has a relatively small place in the process of diagnosis, unless something is noted to be significantly deviant from the norm.
In contrast, reading the pulse in the Siddha medical tradition is central to diagnosis. The physician reads not just one pulse, but six different pulses, and this method requires significant time and physical contact with the hands. Taking the pulse has three stages: stula nilai (the gross sensory stage), ul nilai (the inner stage) and cama nilai (the equal stage) (Daniel 102-3, in Howes 1999). Through each stage, the Siddha physician moves more closely to a diagnosis, and in the final stage literally “takes the place” of the patient.
In the first stage, the “apparently ‘passive’ fingertips of the physician objects and objectifies the dynamic and hitherto unrestricted flow of blood in the radial artery” Next, the “physician becomes aware of the rhythmic undulations of his own pulses in addition to the ones felt in the patient’s radial artery” (Ibid.). Finally, “the physician modulates the etai and natai of his own pulses so that they become confluent and concordant with the pulses of the patient… It is only at this stage that the Siddha physician believes that he ‘knows the humoral disorder of the patient” (Ibid.).
These three stages of pulse reading disclose a fundamental feature of Siddha medicine which is infinitely different than Western biomedicine. A Siddha physician’s skill in diagnosis is defined by his/her ability to become the same, however briefly, with the patient. Only after experiencing this state in his/her body is the Siddha physician able to diagnose and prescribe treatment.
To conclude, it is interesting to note the way that suffering is understood in the Siddha medical tradition in contrast to biomedicine. Within Siddha medicine, “Suffering is something that can be shared and must be shared by someone else, especially the physician.”(Daniel 109, in Howes 1999) This perspective on suffering is a radical departure from the objectification and alienation often experienced by patients in the Western biomedical system.
In sum, Siddha physiology itself presents a completely different model for understanding disease and health. This is a world where the forces of nature are connected to the forces of illness and also of recovery. In other words, Siddha medical philosophy extends beyond the boundaries of physical, social and environmental factors. The forces and influences that are understood to operate in the universe are an integral part of the human system.
Most importantly, the Siddha physician is understood as one who shares in suffering and who literally in-corporates the patient’s illness, for a brief moment. This relationship between patient and doctor reveals the general orientation in Siddha medicine which prioritizes the relationship and connection between elements rather than their distinction and separation.
TAMIL SIDDHA MEDICINE
A major issue in defining Siddha medicine is its relatively recent status as a Tamil cultural heritage marker. In the last 50 years, a great deal of the promotion of Siddha medicine has been couched in the language of the Tamil revivalist notions of ancient Tamil history, the importance of the Tamil language, and other essentialist discourses. Part of the reason Siddha medicine is linked with Tamil heritage is the fact that many of the original palm-leaf manuscripts written about Siddha medicine are written in Tamil.
The politics of identity; linguistic, cultural, or otherwise, have been explosively polarized for centuries in South India. In the 1960’s, one man even performed self-immolation while screaming “Death to Hindi! May Tamil Flourish!” (Ramaswamy 1997). These 20th century issues have their roots in the ongoing clashes between different socio-economic groups, especially along divisions of caste, ethnicity, and religious practice.
Two early 20th century critiques show an even greater range of perspective on the way which Siddha medicine is located within Indian culture. Purnalingam Pillai, a literary historian, writes a mixed review of the Siddhas and their works:
“They are most popular works in Tamil and there is no pure Tamilian, educated or uneducated, who has not committed to memory at least a few stanzas from one or another of them… Their aim was to get at the eternal light… They were haters of the Aryan social fabric, religious rites, and the Vedic authority and were addicted to opium eating… they formed the noblest order who viewed the Vedanta and Siddhanta alike”
(Zvelebil 1996, 8).
Another early 20th century critique reveals an even more critical perspective of the
Siddha tradition. M. Srinivassa Aiyangar writes:
“They were yogis as well as medical men… Most of them were plagiarists and impostors, while some assumed the names of the great men of antiquity like Agastyar, Kapilar and Tiruvalluvar. Being eaters of opium and dwellers in the land of dreams, their conceit knew no bounds… Their religion was theism; sometimes the stress they laid on the siddhis or powers a man can acquire over nature gave it a secularist colour which occasionally comes very near atheism and may be mistaken for it” (Zvelebil 1996, 8).
These two accounts provide a perspective on the Siddha tradition which speaks to the unorthodox, anti-establishment foundations of the tradition as a whole. They also reveal outsider perspectives of the tradition as a whole, and some of the common accusations made against the Siddhas, or the original practitioners of Siddha medicine.
Within Tamil culture the term Siddha is used to delineate three distinct yet sometimes overlapping groups:
“(1) A group of alchemists and physicians, who have composed in Tamil a vast number of alchemic and medical treatises, both in verse and prose, and who belonged to what is termed cittavaitiyam or ‘Siddha medicine’ and cittaracavaatam or ‘Siddha alchemy’... (2) a group of thinkers and poets who have composed a large but better manageable number of stanzas in Tamil, more or less based on tantric yoga in outlook and religious philosophy and practice, between roughly the 10th-15th Centuries A.D... (3) A few ‘Siddha-like’ poets who have been ‘appended’ to the Siddha school by posterior generation, or who called themselves cittar without properly belonging to the esoteric group itself” (Zvelebil 1973, 18).
From these sources we can summarize that the Siddhas were involved in many activities, especially alchemy, medicine and spiritual practice.
Another way of understanding these Siddhas and their teachings/practice is “a ‘popular’ soteriology, which had little in common with the ‘authorized’ soteriologies of Vedic and classical Hinduism” (White 1996, 3). This is related most closely to the pan-Indian traditions of Tantra. T.N. Ganapathy further explains the position of the Siddhas vis-à-vis Tantra:
“There has been a strong prejudice against Tantra-Yoga, the method adopted by the Siddhas. Furthermore, the doors of Tantric yoga have ever been open to all classes of people, and some of the Siddhas are from the lower strata of society. This led people to hold the view that Tantras were meant for the degenerate and the fallen, and they were considered to be in vogue among the low-class people. To add to all this, the science of healing, to which a number of Siddhas are devoted, was relegated to the class of avidya or false knowledge. What is the need for medicine when disease is caused by the karma of a past life?” (Ganapathy 2003, 14).
Thus there is a distinct affiliation of the Siddha tradition with lower-caste sections of society, due to its connection with tantric philosophy. Further, medical knowledge in itself was devalued because of its ineffectiveness in terms of “healing” karma. That is, Siddha medicine was often viewed as simplistic, low-brow, and even worthless by some segments of Hindu society. The practice of tantra yoga, and thus Siddha medicine, is often considered antinomian and even heretical within orthodox Hinduism.
It is also noteworthy that their influences were not only indigenous to South Asia but also extended beyond those geographical and even religious boundaries:
“Indian tantrism, in its Hindu, Buddhist and Jain varieties, did not emerge out of a void. It was on the one hand influenced by cultural interactions with China, Tibet, central Asia, Persia, and Europe, interactions which had the Silk Road and medieval maritime routes and ports as their venue” (White 1996, 2).
Whatever the true origins of Siddha medicine actually are is in some sense a moot point.
The way the initial formulations and development of Siddha medicine are understood and then discussed is actually a far more interesting topic to examine, especially with a post-colonial lens. Here it appears that the bid for cultural pride is one strategy for gaining patronage in a system where Siddha medicine must “compete” with not only biomedicine but also Ayurveda, Homeopathy and Unani.
Medical anthropology shows that traditions are much more malleable within the context of shifting the way they are represented reveals a great deal about the relationships between practitioners, their culture, religion, language, and other sociological variables that influence healthcare “choices:”
“The practices of doctors, and the decisions of patients, are forged out of a myriad of concerns that are much more complex than straightforward belief that a particular practice ‘works.’ In the context of competing medical systems, the politics of culture and identity are important factors in the bid for medical authority” (Weiss 2003, ii).
These represent some of the factors which might be considered as points of resistance, strategic positions from which Siddha medicine might be seen as having value for its affiliation with Tamil culture. Often this is contrasted with Sanskritic, orthodox, brahminical traditions, thus construed along lines of class, caste, and religious affiliation. In closing, perhaps the strongest iteration of this argument comes through in the voice of a student enrolled in a Siddha medical college:
“Since, I belong to Tamil Nadu, I like to practice, our own system of medicine which is born in Tamil Nadu. I consider Allopathy as a foreign import. As a mark of giving respect to my community, I wish to practice Siddha medicine. I never think/thought/will think of other occupation” (Hausman 1996, 331).
A major issue in defining Siddha medicine is its relatively recent status as a Tamil cultural heritage marker. In the last 50 years, a great deal of the promotion of Siddha medicine has been couched in the language of the Tamil revivalist notions of ancient Tamil history, the importance of the Tamil language, and other essentialist discourses. Part of the reason Siddha medicine is linked with Tamil heritage is the fact that many of the original palm-leaf manuscripts written about Siddha medicine are written in Tamil.
The politics of identity; linguistic, cultural, or otherwise, have been explosively polarized for centuries in South India. In the 1960’s, one man even performed self-immolation while screaming “Death to Hindi! May Tamil Flourish!” (Ramaswamy 1997). These 20th century issues have their roots in the ongoing clashes between different socio-economic groups, especially along divisions of caste, ethnicity, and religious practice.
Two early 20th century critiques show an even greater range of perspective on the way which Siddha medicine is located within Indian culture. Purnalingam Pillai, a literary historian, writes a mixed review of the Siddhas and their works:
“They are most popular works in Tamil and there is no pure Tamilian, educated or uneducated, who has not committed to memory at least a few stanzas from one or another of them… Their aim was to get at the eternal light… They were haters of the Aryan social fabric, religious rites, and the Vedic authority and were addicted to opium eating… they formed the noblest order who viewed the Vedanta and Siddhanta alike”
(Zvelebil 1996, 8).
Another early 20th century critique reveals an even more critical perspective of the
Siddha tradition. M. Srinivassa Aiyangar writes:
“They were yogis as well as medical men… Most of them were plagiarists and impostors, while some assumed the names of the great men of antiquity like Agastyar, Kapilar and Tiruvalluvar. Being eaters of opium and dwellers in the land of dreams, their conceit knew no bounds… Their religion was theism; sometimes the stress they laid on the siddhis or powers a man can acquire over nature gave it a secularist colour which occasionally comes very near atheism and may be mistaken for it” (Zvelebil 1996, 8).
These two accounts provide a perspective on the Siddha tradition which speaks to the unorthodox, anti-establishment foundations of the tradition as a whole. They also reveal outsider perspectives of the tradition as a whole, and some of the common accusations made against the Siddhas, or the original practitioners of Siddha medicine.
Within Tamil culture the term Siddha is used to delineate three distinct yet sometimes overlapping groups:
“(1) A group of alchemists and physicians, who have composed in Tamil a vast number of alchemic and medical treatises, both in verse and prose, and who belonged to what is termed cittavaitiyam or ‘Siddha medicine’ and cittaracavaatam or ‘Siddha alchemy’... (2) a group of thinkers and poets who have composed a large but better manageable number of stanzas in Tamil, more or less based on tantric yoga in outlook and religious philosophy and practice, between roughly the 10th-15th Centuries A.D... (3) A few ‘Siddha-like’ poets who have been ‘appended’ to the Siddha school by posterior generation, or who called themselves cittar without properly belonging to the esoteric group itself” (Zvelebil 1973, 18).
From these sources we can summarize that the Siddhas were involved in many activities, especially alchemy, medicine and spiritual practice.
Another way of understanding these Siddhas and their teachings/practice is “a ‘popular’ soteriology, which had little in common with the ‘authorized’ soteriologies of Vedic and classical Hinduism” (White 1996, 3). This is related most closely to the pan-Indian traditions of Tantra. T.N. Ganapathy further explains the position of the Siddhas vis-à-vis Tantra:
“There has been a strong prejudice against Tantra-Yoga, the method adopted by the Siddhas. Furthermore, the doors of Tantric yoga have ever been open to all classes of people, and some of the Siddhas are from the lower strata of society. This led people to hold the view that Tantras were meant for the degenerate and the fallen, and they were considered to be in vogue among the low-class people. To add to all this, the science of healing, to which a number of Siddhas are devoted, was relegated to the class of avidya or false knowledge. What is the need for medicine when disease is caused by the karma of a past life?” (Ganapathy 2003, 14).
Thus there is a distinct affiliation of the Siddha tradition with lower-caste sections of society, due to its connection with tantric philosophy. Further, medical knowledge in itself was devalued because of its ineffectiveness in terms of “healing” karma. That is, Siddha medicine was often viewed as simplistic, low-brow, and even worthless by some segments of Hindu society. The practice of tantra yoga, and thus Siddha medicine, is often considered antinomian and even heretical within orthodox Hinduism.
It is also noteworthy that their influences were not only indigenous to South Asia but also extended beyond those geographical and even religious boundaries:
“Indian tantrism, in its Hindu, Buddhist and Jain varieties, did not emerge out of a void. It was on the one hand influenced by cultural interactions with China, Tibet, central Asia, Persia, and Europe, interactions which had the Silk Road and medieval maritime routes and ports as their venue” (White 1996, 2).
Whatever the true origins of Siddha medicine actually are is in some sense a moot point.
The way the initial formulations and development of Siddha medicine are understood and then discussed is actually a far more interesting topic to examine, especially with a post-colonial lens. Here it appears that the bid for cultural pride is one strategy for gaining patronage in a system where Siddha medicine must “compete” with not only biomedicine but also Ayurveda, Homeopathy and Unani.
Medical anthropology shows that traditions are much more malleable within the context of shifting the way they are represented reveals a great deal about the relationships between practitioners, their culture, religion, language, and other sociological variables that influence healthcare “choices:”
“The practices of doctors, and the decisions of patients, are forged out of a myriad of concerns that are much more complex than straightforward belief that a particular practice ‘works.’ In the context of competing medical systems, the politics of culture and identity are important factors in the bid for medical authority” (Weiss 2003, ii).
These represent some of the factors which might be considered as points of resistance, strategic positions from which Siddha medicine might be seen as having value for its affiliation with Tamil culture. Often this is contrasted with Sanskritic, orthodox, brahminical traditions, thus construed along lines of class, caste, and religious affiliation. In closing, perhaps the strongest iteration of this argument comes through in the voice of a student enrolled in a Siddha medical college:
“Since, I belong to Tamil Nadu, I like to practice, our own system of medicine which is born in Tamil Nadu. I consider Allopathy as a foreign import. As a mark of giving respect to my community, I wish to practice Siddha medicine. I never think/thought/will think of other occupation” (Hausman 1996, 331).
3.10.06
SECRECY IN SIDDHA MEDICINE
Professionalization has been a crucial axis in the transformation of Siddha medicine in the 20th century. This is certainly not the entire story, for there have been many points of resistance and re-visioning from the Siddha community. One of the primary “barriers” in this movement has been the cultural and social aspects of the way in which knowledge is transmitted within some of the Siddha lineages. One aspect of this is the guru-shishya paramparai, or that of a teacher-disciple lineage. As Kamil Zvelebil notes in his book The Siddha Quest for Immortality, “Siddha doctrines have been considered an esoteric teaching which may be revealed only by oral instruction” (Zvelebil 1996, 121).
Thus from the very outset, research into the Siddha medical tradition is suspect. In other words, a closely guarded, secretive tradition is not well-positioned for a full exposition that should necessarily be published and distributed widely, either in medical colleges or research literature. Second, these sources are written largely in samdhyabhasa or “twilight” language. That is, they are encoded in such a way that requires a certain level of sophistication in order to understand what they are trying to express. Thus the initial challenge is of translation, even before professionalization is an option.
T.N. Ganapathy, the director of the Yoga Siddha Research project based in Tamil Nadu, has written extensively on the language used by the Siddhas. In his book The Yoga of Siddha Boganathar he notes:
“The essential characteristic of the language is its polysemantic nature, its multivalence, its capacity to express at the same time a number of meanings both at the level of ordinary experience and at the level of transcendence. The suggestive, epigrammatic, and enigmatic nature of the language itself is mystical in nature, where the highest is clothed in the form of the lowest. The Siddhas make free use of typology, wordplay, paradox, repetition, and metaphor to convey to the listener the richness of the reality hidden in the visible terms and symbols. The paradoxical expressions and their explanations are accessible only to the initiated. Probably the Siddha poems themselves function as an initiation” (Ganapathy 2003, 11).
It is clear from this quotation that the tradition of the Siddhas is one where knowledge is expressed and transmitted in such a way that can be useful for both a general audience as well as a select group which is “initiated.”
Nevertheless, it speaks to a certain inaccessibility of the tradition to “outsiders” and calls attention to aspects of translation and privileged access to the process of understanding. This feature of the tradition necessitates an “insider” perspective and shows the importance of a highly refined study of the tradition. In other words, it shifts the authority of Siddha medicine directly to the practitioners themselves. This inaccessibility is further bolstered by the manner in which knowledge is transferred: orally.
Siddha medicine has largely been a spoken, and thus, remembered tradition passed down from generation to generation largely in secret and often within family lines. This is because Siddha medical knowledge is considered precious, worthy of being preserved in such a way that creates a sacred relationship between teacher and student. More importantly, it highlights the way that this knowledge is embedded in community, that the tradition is not something that can be studied merely through written sources but requires guidance from practitioners themselves.
It is also noteworthy that Siddha medicine is considered by some to be relatively simple and firmly rooted in family and community relationships:
“One of the underlying beliefs of Siddha medicine is that lay people should be able to make some simple medicines for themselves and their families. Traditionally, many families in Kerala and Tamil Nadu made their own medicines from family recipes. The vaidyars often merely wrote out the recipes and asked the patient to make the medicine at home… Medicine was a profession which was pursued by generation after generation of particular families, and practicing it for the good of the community was a matter of honour” (Thottham 2000, 111).
From this quote it appears that Siddha medical practice and knowledge is in some sense widely available, which expands the previous notion of Siddha medicine as a completely closed, secretive tradition. This is perhaps one aspect of the tradition which is sometimes overlooked. It may be that the secretive and initiatory aspects of the tradition are limited to a select few while the more widespread use of Siddha remedies or principles of healing is fairly well understood by a more general audience.
To return to the concept of professionalization, these aspects of the tradition make it exceedingly difficult to centralize knowledge and gather it in a formal or even methodical manner:
“Yet, for all these efforts, the government remains as distant in the mid-1990’s from penetrating into indigenous medical lore as it was early in this century. Beyond the reach of Government, out in the ‘traditional’ realm of village practice, the search for ‘hereditary’ medicinal panaceas continues unabated, for such ‘incurable’ diseases such as cancer and, more recently, AIDS” (Hausman 1996, 346-7).
Functionally, secrecy may then serve multiple functions, especially as a way to make unsubstantiated claims. In other words, one of the critiques repeatedly leveled at the “professionals” of Siddha medicine, the vaidyas, is that they will not share their knowledge or allow it to be scientifically tested. This issue strikes to the heart of the enforcement of professional standards; for the dominant biomedical discourse is able to impose its own knowledge, political or institutional power, and attempt to marginalize a whole system of knowledge. Here it is important to recall that one of the four agendas of imperialism is “the subjugation of “others,” here the “others” being other systems of medicine.
Professionalization has been a crucial axis in the transformation of Siddha medicine in the 20th century. This is certainly not the entire story, for there have been many points of resistance and re-visioning from the Siddha community. One of the primary “barriers” in this movement has been the cultural and social aspects of the way in which knowledge is transmitted within some of the Siddha lineages. One aspect of this is the guru-shishya paramparai, or that of a teacher-disciple lineage. As Kamil Zvelebil notes in his book The Siddha Quest for Immortality, “Siddha doctrines have been considered an esoteric teaching which may be revealed only by oral instruction” (Zvelebil 1996, 121).
Thus from the very outset, research into the Siddha medical tradition is suspect. In other words, a closely guarded, secretive tradition is not well-positioned for a full exposition that should necessarily be published and distributed widely, either in medical colleges or research literature. Second, these sources are written largely in samdhyabhasa or “twilight” language. That is, they are encoded in such a way that requires a certain level of sophistication in order to understand what they are trying to express. Thus the initial challenge is of translation, even before professionalization is an option.
T.N. Ganapathy, the director of the Yoga Siddha Research project based in Tamil Nadu, has written extensively on the language used by the Siddhas. In his book The Yoga of Siddha Boganathar he notes:
“The essential characteristic of the language is its polysemantic nature, its multivalence, its capacity to express at the same time a number of meanings both at the level of ordinary experience and at the level of transcendence. The suggestive, epigrammatic, and enigmatic nature of the language itself is mystical in nature, where the highest is clothed in the form of the lowest. The Siddhas make free use of typology, wordplay, paradox, repetition, and metaphor to convey to the listener the richness of the reality hidden in the visible terms and symbols. The paradoxical expressions and their explanations are accessible only to the initiated. Probably the Siddha poems themselves function as an initiation” (Ganapathy 2003, 11).
It is clear from this quotation that the tradition of the Siddhas is one where knowledge is expressed and transmitted in such a way that can be useful for both a general audience as well as a select group which is “initiated.”
Nevertheless, it speaks to a certain inaccessibility of the tradition to “outsiders” and calls attention to aspects of translation and privileged access to the process of understanding. This feature of the tradition necessitates an “insider” perspective and shows the importance of a highly refined study of the tradition. In other words, it shifts the authority of Siddha medicine directly to the practitioners themselves. This inaccessibility is further bolstered by the manner in which knowledge is transferred: orally.
Siddha medicine has largely been a spoken, and thus, remembered tradition passed down from generation to generation largely in secret and often within family lines. This is because Siddha medical knowledge is considered precious, worthy of being preserved in such a way that creates a sacred relationship between teacher and student. More importantly, it highlights the way that this knowledge is embedded in community, that the tradition is not something that can be studied merely through written sources but requires guidance from practitioners themselves.
It is also noteworthy that Siddha medicine is considered by some to be relatively simple and firmly rooted in family and community relationships:
“One of the underlying beliefs of Siddha medicine is that lay people should be able to make some simple medicines for themselves and their families. Traditionally, many families in Kerala and Tamil Nadu made their own medicines from family recipes. The vaidyars often merely wrote out the recipes and asked the patient to make the medicine at home… Medicine was a profession which was pursued by generation after generation of particular families, and practicing it for the good of the community was a matter of honour” (Thottham 2000, 111).
From this quote it appears that Siddha medical practice and knowledge is in some sense widely available, which expands the previous notion of Siddha medicine as a completely closed, secretive tradition. This is perhaps one aspect of the tradition which is sometimes overlooked. It may be that the secretive and initiatory aspects of the tradition are limited to a select few while the more widespread use of Siddha remedies or principles of healing is fairly well understood by a more general audience.
To return to the concept of professionalization, these aspects of the tradition make it exceedingly difficult to centralize knowledge and gather it in a formal or even methodical manner:
“Yet, for all these efforts, the government remains as distant in the mid-1990’s from penetrating into indigenous medical lore as it was early in this century. Beyond the reach of Government, out in the ‘traditional’ realm of village practice, the search for ‘hereditary’ medicinal panaceas continues unabated, for such ‘incurable’ diseases such as cancer and, more recently, AIDS” (Hausman 1996, 346-7).
Functionally, secrecy may then serve multiple functions, especially as a way to make unsubstantiated claims. In other words, one of the critiques repeatedly leveled at the “professionals” of Siddha medicine, the vaidyas, is that they will not share their knowledge or allow it to be scientifically tested. This issue strikes to the heart of the enforcement of professional standards; for the dominant biomedical discourse is able to impose its own knowledge, political or institutional power, and attempt to marginalize a whole system of knowledge. Here it is important to recall that one of the four agendas of imperialism is “the subjugation of “others,” here the “others” being other systems of medicine.
PROFESSIONALIZATION OF SIDDHA MEDICINE
The movement towards the professionalization of Siddha medicine has been supported by the central government of India. It is incorporated into medical colleges, hospitals and other clinical settings through policies which support its “development” alongside biomedicine and other medical systems. However, this process has not been “natural,” nor even desirable to certain Siddha medical practitioners. This is primarily because professionalization is a double-edged sword: it gives credibility and institutional support on the one hand, yet also steals authority and places Siddha medicine in a subordinate position to Western biomedicine.
The authority which is inherent in professionalization is well-understood as a gradual construction, rather than a pre-fabricated, “given” status. Paul Starr writes:
“the legitimation of professional authority involves three distinctive claims: first, that the knowledge and competence of the professional have been validated by a community of his or her peers; second, that this consensually validated knowledge and competence rest on rational, scientific grounds; and third, that the professional’s judgment and advice are oriented toward a set of substantive values, such as health” (Starr 1982, 15).
These three claims are rather problematic in the case of Siddha medicine. First, there has been little cooperation and even commonality between Siddha medical practitioners as a community. This has definitely shifted in the past few decades, but has been an issue historically and continues to create division. Next, the agreed upon knowledge and competence of the system of Siddha medicine is something which has been contested, re-formulated, and hotly debated. Further, as the process of medicalization shows, moving towards rationalizing or scientifically verifying Siddha medicine requires a great deal of strategic negotiation, at best. Finally, values such as health, immortality, integrity and others held by Siddha physicians can vary widely between practitioners.
Professionalization is primarily a movement towards homogenization; a subtle yet forceful movement that is closely allied with the project of imperialism. In practical terms, part of the difficulty in incorporating Siddha medicine into the biomedical system is the danger of mainstreaming:
“Alternative practitioners, if mainstreamed into the current hierarchy of the medical model, would be relegated to a subservient position under Western medical doctors. Rather than working side-by-side in their respective philosophies, they would be forced into a paraprofessional role, leaving Western doctors with the final approval in a power-based model” (Phalen 1998, 176).
This cautionary advice is relevant for appreciating the complexity of the issues around professionalization, and its complicit alliance with imperialism, colonialism and orientalism.
To summarize, the professionalization of Siddha medicine is a rather sensitive issue among government sponsors and practitioners alike. This tenuous alliance is fraught with tactical blunders, miscommunication and power struggles. Professional authority is neither dispensed nor requested without considerable re-structuring, co-creation and compromise. The very “tradition” of Siddha medicine is itself inextricably linked to this process of historical and political agendas, especially along the lines of professional authority vis-à-vis Western biomedicine.
Nevertheless, the policies of the Central Government of India have been designed to assist Siddha medicine in the last 50 years:
“On May 25th, 1956, a letter from the Central Government was sent to all state governments stressing the importance of giving medical students a course in the history of medicine; ‘Encouragement of the study of the history of medicine is specially important in this country, not only in the training of physicians but also in reviving, assessing and reconstructing the indigenous systems of medicine’” (Hausman 1996, 56).
More concretely, the infrastructure to support these priorities includes 14 research units, including a Central Research Institute, Regional Research Institute, Drug Standardization Units, Mobile Clinical Research Units, Clinical Research Units, Tribal Health Care Units, and Medicinal Plant/Other Research Units. The state governments in India support 106 Siddha hospitals and 225 dispensaries which provide 983 beds for patients. There are 2 Government supported Siddha medicine colleges, and a handful of other non-certified institutions which teach Siddha medicine. These generally lead to Siddha MD degrees.
In sum, the process of professionalization has proceeded largely as a result of policies determined out by the Indian government itself:
“Over the course of the past three decades, various steps have been taken by the Tamilnadu State, as well as the Central, Governments to promote Siddha medicine. Siddha colleges have been established and expanded; Siddha conferences have been conducted; Siddha medicinal and pharmacological research has been pursued; and the number of Siddha hospital wings and dispensaries has been continually increased” (Hausman 1996, 346).
The movement towards the professionalization of Siddha medicine has been supported by the central government of India. It is incorporated into medical colleges, hospitals and other clinical settings through policies which support its “development” alongside biomedicine and other medical systems. However, this process has not been “natural,” nor even desirable to certain Siddha medical practitioners. This is primarily because professionalization is a double-edged sword: it gives credibility and institutional support on the one hand, yet also steals authority and places Siddha medicine in a subordinate position to Western biomedicine.
The authority which is inherent in professionalization is well-understood as a gradual construction, rather than a pre-fabricated, “given” status. Paul Starr writes:
“the legitimation of professional authority involves three distinctive claims: first, that the knowledge and competence of the professional have been validated by a community of his or her peers; second, that this consensually validated knowledge and competence rest on rational, scientific grounds; and third, that the professional’s judgment and advice are oriented toward a set of substantive values, such as health” (Starr 1982, 15).
These three claims are rather problematic in the case of Siddha medicine. First, there has been little cooperation and even commonality between Siddha medical practitioners as a community. This has definitely shifted in the past few decades, but has been an issue historically and continues to create division. Next, the agreed upon knowledge and competence of the system of Siddha medicine is something which has been contested, re-formulated, and hotly debated. Further, as the process of medicalization shows, moving towards rationalizing or scientifically verifying Siddha medicine requires a great deal of strategic negotiation, at best. Finally, values such as health, immortality, integrity and others held by Siddha physicians can vary widely between practitioners.
Professionalization is primarily a movement towards homogenization; a subtle yet forceful movement that is closely allied with the project of imperialism. In practical terms, part of the difficulty in incorporating Siddha medicine into the biomedical system is the danger of mainstreaming:
“Alternative practitioners, if mainstreamed into the current hierarchy of the medical model, would be relegated to a subservient position under Western medical doctors. Rather than working side-by-side in their respective philosophies, they would be forced into a paraprofessional role, leaving Western doctors with the final approval in a power-based model” (Phalen 1998, 176).
This cautionary advice is relevant for appreciating the complexity of the issues around professionalization, and its complicit alliance with imperialism, colonialism and orientalism.
To summarize, the professionalization of Siddha medicine is a rather sensitive issue among government sponsors and practitioners alike. This tenuous alliance is fraught with tactical blunders, miscommunication and power struggles. Professional authority is neither dispensed nor requested without considerable re-structuring, co-creation and compromise. The very “tradition” of Siddha medicine is itself inextricably linked to this process of historical and political agendas, especially along the lines of professional authority vis-à-vis Western biomedicine.
Nevertheless, the policies of the Central Government of India have been designed to assist Siddha medicine in the last 50 years:
“On May 25th, 1956, a letter from the Central Government was sent to all state governments stressing the importance of giving medical students a course in the history of medicine; ‘Encouragement of the study of the history of medicine is specially important in this country, not only in the training of physicians but also in reviving, assessing and reconstructing the indigenous systems of medicine’” (Hausman 1996, 56).
More concretely, the infrastructure to support these priorities includes 14 research units, including a Central Research Institute, Regional Research Institute, Drug Standardization Units, Mobile Clinical Research Units, Clinical Research Units, Tribal Health Care Units, and Medicinal Plant/Other Research Units. The state governments in India support 106 Siddha hospitals and 225 dispensaries which provide 983 beds for patients. There are 2 Government supported Siddha medicine colleges, and a handful of other non-certified institutions which teach Siddha medicine. These generally lead to Siddha MD degrees.
In sum, the process of professionalization has proceeded largely as a result of policies determined out by the Indian government itself:
“Over the course of the past three decades, various steps have been taken by the Tamilnadu State, as well as the Central, Governments to promote Siddha medicine. Siddha colleges have been established and expanded; Siddha conferences have been conducted; Siddha medicinal and pharmacological research has been pursued; and the number of Siddha hospital wings and dispensaries has been continually increased” (Hausman 1996, 346).
CLINICAL RESEARCH:
One illustration of the way the biomedical paradigm re-defines and re-shapes the field of medical knowledge is its reliance upon clinical research. Basically, the power dynamic which arises is one where Siddha medicine must be measured by conventional biomedical standards to have worth. Verification and valuation comes after randomized, controlled, double-blind studies, a clear and almost palpable example of domination and authority. This is a perfect example of Said’s argument, for it shows that orientalism as a style of thought is connected to the West (science) having authority over and re-structuring the East (Siddha medicine). Most recently, scientific researchers in India, Europe, and the USA are studying the benefits of Siddha medicine for treatment of various chronic, life-threatening illness including cancer and AIDS.
Methodologically this movement is worth a second look, for the basic ontological framework of Siddha medicine is vastly difference than that of Western biomedical science. While it might be informative and even effective to study Siddha medicine in clinical studies, they will always miss the mark in some sense. For the very measure of what is health, what constitutes the human body, and the processes and mechanisms which govern those relationships are immensely different in these two systems.
Nevertheless, clinical researchers such as Sowmyalakshmi and Ranga et. al. have researched the efficacy of Siddha medicines for prostate and breast cancer treatment, with some success. Dr. Henry Sacks was awarded a grant from the NIH (NCCAM division) to research potential treatments in Siddha medicine for slowing the progress of HIV/AIDS, and this project was completed early last year. These examples show that it is possible to study Siddha medicine from a biomedical perspective, but these studies must be understood as limited and potentially misleading.
From a post-colonial research methodological perspective, studying Siddha medicine from a biomedical system approach is further perpetuating the power dynamic between colonizer and colonized. One way to replace or transform the biomedical research of Siddha medicine is to localize and personalize the research methodology. Narrative research methodology and other anthropologically-oriented approaches are considered to be more appropriate for determining the “effectiveness” of Siddha medicine.
Above all, biomedical research should not be the final word on Siddha medicine, but must be tempered with a keen observation of the manner in which Siddha medicine is practiced. A thorough and lengthy discussion must take place between the practitioners themselves and biomedical researchers so that the methodological constructs are appropriate for the subject matter. This is not to say that Siddha medicine should not be studied clinically, but rather that this process of research must be carefully monitored in such a way that it is not taken as the final word on the usefulness of Siddha medicine.
One illustration of the way the biomedical paradigm re-defines and re-shapes the field of medical knowledge is its reliance upon clinical research. Basically, the power dynamic which arises is one where Siddha medicine must be measured by conventional biomedical standards to have worth. Verification and valuation comes after randomized, controlled, double-blind studies, a clear and almost palpable example of domination and authority. This is a perfect example of Said’s argument, for it shows that orientalism as a style of thought is connected to the West (science) having authority over and re-structuring the East (Siddha medicine). Most recently, scientific researchers in India, Europe, and the USA are studying the benefits of Siddha medicine for treatment of various chronic, life-threatening illness including cancer and AIDS.
Methodologically this movement is worth a second look, for the basic ontological framework of Siddha medicine is vastly difference than that of Western biomedical science. While it might be informative and even effective to study Siddha medicine in clinical studies, they will always miss the mark in some sense. For the very measure of what is health, what constitutes the human body, and the processes and mechanisms which govern those relationships are immensely different in these two systems.
Nevertheless, clinical researchers such as Sowmyalakshmi and Ranga et. al. have researched the efficacy of Siddha medicines for prostate and breast cancer treatment, with some success. Dr. Henry Sacks was awarded a grant from the NIH (NCCAM division) to research potential treatments in Siddha medicine for slowing the progress of HIV/AIDS, and this project was completed early last year. These examples show that it is possible to study Siddha medicine from a biomedical perspective, but these studies must be understood as limited and potentially misleading.
From a post-colonial research methodological perspective, studying Siddha medicine from a biomedical system approach is further perpetuating the power dynamic between colonizer and colonized. One way to replace or transform the biomedical research of Siddha medicine is to localize and personalize the research methodology. Narrative research methodology and other anthropologically-oriented approaches are considered to be more appropriate for determining the “effectiveness” of Siddha medicine.
Above all, biomedical research should not be the final word on Siddha medicine, but must be tempered with a keen observation of the manner in which Siddha medicine is practiced. A thorough and lengthy discussion must take place between the practitioners themselves and biomedical researchers so that the methodological constructs are appropriate for the subject matter. This is not to say that Siddha medicine should not be studied clinically, but rather that this process of research must be carefully monitored in such a way that it is not taken as the final word on the usefulness of Siddha medicine.
MEDICAL SYSTEMS:
Many people would argue that medical systems from India are repositories of tradition, a deep and spiritual understanding of the human system, and ancient lineages which are unbroken and carefully preserved. In contrast, Western biomedicine is rational, modern, scientific, and evidence-based. The issue of description and definition of these systems is in many ways tantamount to the context of their relationship and the power dynamic inherent in the very way each has been constructed in contrast to the other. In other words, medical systems are not monolithic entities, but rather a shifting and somewhat amorphous amalgamation of multiple alliances.
In addition, a medical system, like any other living system, is subject to all of the processes of growth, change, and even decay. Some components within medical systems include the physicians, patients, knowledge via written and oral tradition, centers for treatment, and the treatments and medicines themselves. More importantly, the relationships between these various aspects of the system function within certain limits and have multiple qualities and possibilities for exchange.
Though it is often practiced side-by-side with Western biomedicine, the epistemological and ontological foundations of Siddha medicine are vastly different than those of Western biomedicine. Historically speaking, the contemporary interaction between Siddha medicine and biomedicine can be treated as a specific outcome of various trajectories. These include the history of colonial and imperial domination, anthropological research, pharmaceutical corporate interests, and many other dynamic forces that have created the system as it exists today.
The influence of biomedicine is perhaps the most pervasive and certainly the earliest in the history of Siddha medicine. Empiricism, science and the power to know for oneself are key in understanding many 20th century discourses. Science and empiricism are often classified as the dominant “gazes” within the West. These ways of knowing depend on reason and locate truth in that which can be measured. Further, one of the most important concerns of both the Siddha medical system as well as the biomedical system is to define itself articulately in contradistinction with other systems.
Though it is beyond the scope of this paper to examine Siddha medicine or Western biomedicine in-depth, we can briefly classify some of the key components of each. The biomedical, or “technocratic” model of medicine is defined by the following features:
1. mind/body separation
2. the body as machine
3. the patient as object
4. alienation of practitioner from patient
5. diagnosis and treatment from the outside in (curing disease, repairing dysfunction)
6. hierarchical organization and standardization of care
7. authority and responsibility inherent in practitioner, not patient
8. supervaluation of science and technology
9. aggressive intervention with emphasis on short-term results
10. death as defeat
11. a profit-driven system
12. intolerance of other modalities
(Davis-Floyd 1998, 16).
In contrast, the “holistic” model is described in this way:
1. oneness of body-mind-spirit
2. the body as an energy system interlinked with other energy systems
3. healing the whole person in whole-life context
4. essential unity of practitioner and client
5. diagnosis and healing from the inside out
6. networking and organizational structure that facilitates individualization of care
7. authority and responsibility inherent in each individual
8. science and technology placed at the service of the individual
9. a long-term focus on creating and maintaining health and well-being
10. death as a step in a process
11. healing as the focus
12. embrace of multiple healing modalities
(Ibid., 110)
An important disclaimer is necessary here, as expressed so cogently in From Doctor to Healer: “People think; paradigms provide templates for thought” (Ibid., 20). In this discussion, looking at the theoretical foundations assists in understanding the system as a whole. It is not the case that all people who adhere to one or another system will necessarily follow the pattern or template of that system, but rather tend to follow these guidelines as a model of praxis.
Here there are at least two radically different ways of looking at disease and health. The above lists show the broader concerns of each system and their orientation. Applying a post-colonial medical anthropological perspective to these categories forces a closer look not only on the definitions, but on the way in which they operate within the infrastructure of healthcare delivery. In the same way that biomedicine was able to create the language used to describe itself and other systems, it is able to set values upon the orientation to knowledge within each system.
In other words, biomedicine uses the terms to assign payment schemes, such that its priorities and abilities are prioritized economically and clinically. In practical terms, biomedicine uses its power to make the models outlined above operate under different billing schedules, so that the most scientific is also the most expensive. Conversely, the most traditional is the least expensive and potentially the easiest to access. This is but one example of the way medicalization, i.e. the dominance of biomedicine over other systems, is reminiscent if not identical to imperialism. Richard Weiss echoes this sentiment in his dissertation: “The history of the introduction of biomedicine in India and throughout the world is as much a history of imperialism as it is one of the spread of rationality” (Weiss 2003, ii-1).
Altogether, the overarching theme of the history of the interaction between the system of Western biomedicine and Siddha medicine is one where the power dynamic is unbalanced. That is, Western biomedicine has become a totalizing discourse, a system which negates all other ways of knowing so forcefully that it threatens to eradicate entire models of knowledge and healing.
Many people would argue that medical systems from India are repositories of tradition, a deep and spiritual understanding of the human system, and ancient lineages which are unbroken and carefully preserved. In contrast, Western biomedicine is rational, modern, scientific, and evidence-based. The issue of description and definition of these systems is in many ways tantamount to the context of their relationship and the power dynamic inherent in the very way each has been constructed in contrast to the other. In other words, medical systems are not monolithic entities, but rather a shifting and somewhat amorphous amalgamation of multiple alliances.
In addition, a medical system, like any other living system, is subject to all of the processes of growth, change, and even decay. Some components within medical systems include the physicians, patients, knowledge via written and oral tradition, centers for treatment, and the treatments and medicines themselves. More importantly, the relationships between these various aspects of the system function within certain limits and have multiple qualities and possibilities for exchange.
Though it is often practiced side-by-side with Western biomedicine, the epistemological and ontological foundations of Siddha medicine are vastly different than those of Western biomedicine. Historically speaking, the contemporary interaction between Siddha medicine and biomedicine can be treated as a specific outcome of various trajectories. These include the history of colonial and imperial domination, anthropological research, pharmaceutical corporate interests, and many other dynamic forces that have created the system as it exists today.
The influence of biomedicine is perhaps the most pervasive and certainly the earliest in the history of Siddha medicine. Empiricism, science and the power to know for oneself are key in understanding many 20th century discourses. Science and empiricism are often classified as the dominant “gazes” within the West. These ways of knowing depend on reason and locate truth in that which can be measured. Further, one of the most important concerns of both the Siddha medical system as well as the biomedical system is to define itself articulately in contradistinction with other systems.
Though it is beyond the scope of this paper to examine Siddha medicine or Western biomedicine in-depth, we can briefly classify some of the key components of each. The biomedical, or “technocratic” model of medicine is defined by the following features:
1. mind/body separation
2. the body as machine
3. the patient as object
4. alienation of practitioner from patient
5. diagnosis and treatment from the outside in (curing disease, repairing dysfunction)
6. hierarchical organization and standardization of care
7. authority and responsibility inherent in practitioner, not patient
8. supervaluation of science and technology
9. aggressive intervention with emphasis on short-term results
10. death as defeat
11. a profit-driven system
12. intolerance of other modalities
(Davis-Floyd 1998, 16).
In contrast, the “holistic” model is described in this way:
1. oneness of body-mind-spirit
2. the body as an energy system interlinked with other energy systems
3. healing the whole person in whole-life context
4. essential unity of practitioner and client
5. diagnosis and healing from the inside out
6. networking and organizational structure that facilitates individualization of care
7. authority and responsibility inherent in each individual
8. science and technology placed at the service of the individual
9. a long-term focus on creating and maintaining health and well-being
10. death as a step in a process
11. healing as the focus
12. embrace of multiple healing modalities
(Ibid., 110)
An important disclaimer is necessary here, as expressed so cogently in From Doctor to Healer: “People think; paradigms provide templates for thought” (Ibid., 20). In this discussion, looking at the theoretical foundations assists in understanding the system as a whole. It is not the case that all people who adhere to one or another system will necessarily follow the pattern or template of that system, but rather tend to follow these guidelines as a model of praxis.
Here there are at least two radically different ways of looking at disease and health. The above lists show the broader concerns of each system and their orientation. Applying a post-colonial medical anthropological perspective to these categories forces a closer look not only on the definitions, but on the way in which they operate within the infrastructure of healthcare delivery. In the same way that biomedicine was able to create the language used to describe itself and other systems, it is able to set values upon the orientation to knowledge within each system.
In other words, biomedicine uses the terms to assign payment schemes, such that its priorities and abilities are prioritized economically and clinically. In practical terms, biomedicine uses its power to make the models outlined above operate under different billing schedules, so that the most scientific is also the most expensive. Conversely, the most traditional is the least expensive and potentially the easiest to access. This is but one example of the way medicalization, i.e. the dominance of biomedicine over other systems, is reminiscent if not identical to imperialism. Richard Weiss echoes this sentiment in his dissertation: “The history of the introduction of biomedicine in India and throughout the world is as much a history of imperialism as it is one of the spread of rationality” (Weiss 2003, ii-1).
Altogether, the overarching theme of the history of the interaction between the system of Western biomedicine and Siddha medicine is one where the power dynamic is unbalanced. That is, Western biomedicine has become a totalizing discourse, a system which negates all other ways of knowing so forcefully that it threatens to eradicate entire models of knowledge and healing.
ACKNOWLEDGEMENTS
It is customary in the Siddha tradition to pay homage to teachers before saying anything at all. None of this work would have been possible without the support and guidance of friends, teachers, and many Siddha vaidyas (doctors) both in South Asia and in California. First, Dr. Venkatraman, a well-known scholar in the area of Siddha practice, was the initial spark for my interest in this topic. More recently, my time with Gayatri Siddhar Swami Murugeshu and his disciple Swami Shankarananda was invaluable in understanding the living tradition of Siddha medicine. My time at the California Institute of Integral Studies in the Integrative Medicine program has provided the academic preparation for this research, especially under the guidance of Arisika Razak, Julia Zarcone, Jim Ryan and Steven Goodman. Funding was provided by the Kranzke fellowship, thanks to the generosity of Robert Barnhart and his family. Scholarly researchers such as Kamil Zvelebil, David Gordon-White, Gary Hausman and Richard Weiss were formative my understanding of Siddha traditions in general and more specifically, Siddha medicine. Last but not least, Dr. Rajkumar Reghunathan and his students provided me with the practical hands-on knowledge of Siddha medicine which was the most rewarding aspect of this work.
It is customary in the Siddha tradition to pay homage to teachers before saying anything at all. None of this work would have been possible without the support and guidance of friends, teachers, and many Siddha vaidyas (doctors) both in South Asia and in California. First, Dr. Venkatraman, a well-known scholar in the area of Siddha practice, was the initial spark for my interest in this topic. More recently, my time with Gayatri Siddhar Swami Murugeshu and his disciple Swami Shankarananda was invaluable in understanding the living tradition of Siddha medicine. My time at the California Institute of Integral Studies in the Integrative Medicine program has provided the academic preparation for this research, especially under the guidance of Arisika Razak, Julia Zarcone, Jim Ryan and Steven Goodman. Funding was provided by the Kranzke fellowship, thanks to the generosity of Robert Barnhart and his family. Scholarly researchers such as Kamil Zvelebil, David Gordon-White, Gary Hausman and Richard Weiss were formative my understanding of Siddha traditions in general and more specifically, Siddha medicine. Last but not least, Dr. Rajkumar Reghunathan and his students provided me with the practical hands-on knowledge of Siddha medicine which was the most rewarding aspect of this work.
2.10.06
ANNOTATED BIBLIOGRAPHY
AYUSH website, http://www.indianmedicine.nic.in/html/research/srmain.htm
This website is a gateway for information on Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy sponsored by the Dept. of AYUSH [Ayurveda, Yoga, Unani, Siddha and Homeopathy], part of the Ministry of Health & Family Welfare, Govt of India. It contains basic definitions, updated information about practice, links to various related organizations, and even a list of “eminent people” who are considered to be experts in their respective fields.
http://www.thehindu.com/2005/07/25/stories/2005072509300300.htm
The Hindu is one of India’s national newspapers, published in English and founded by Subramanya Aiyer, a South Indian. It is generally critical of “neo-liberal” policies within India.
Balasubramanian, A.V. The Relevance of a Vibrant Tradition. Special Issue: The Hindu
Folio, 8 October 2000.
See above, as The Hindu Folio is a special publication of The Hindu. This article outlines the classical and folk traditions of medicine and their relevance to contemporary health concerns, with an explicit critique of modern science and technology.
Ganapathy, T.N. The Yoga of Siddha Bogananthar. Quebec: Babaji’s Kriya Yoga and
Publications, Inc., 2003.
Ganapathy is a scholar who is deeply committed to bringing forth the traditions of Siddha lineages, and is working to translate various texts. He provides a rich account of the texture of Siddha practitioners, and in this publication he focuses on Bhogar’s hagiography and teachings.
Hausman, Gary. Siddhars, Alchemy and the Abyss of Tradition: 'Traditional' Tamil
Medical Knowledge in 'Modern' Practice (INDIA) Dissertation, University of Michigan, 1996.
This dissertation is a balance between ethnographical accounts and government archives, revealing the fascinating melding of the world of secrecy and unambiguousness. It is one of the few sources where the voices of practitioners are documented and compared with policies.
Ranga, Rama S. et al. Rasagenthi Lehyam (RL) a novel complementary and alternative
medicine for prostate cancer. Cancer Chemotherapy Pharmacology, Vol. 54: 7-15. Published Online: Springer-Verlag, 24 March 2004.
This research was a collaborative effort between the University of Kentucky and institutions and practitioners in India. Though it is a preliminary study, it looks to the future in producing an effective anti-tumor agent.
Sacks, Henry S. Collaborative HIV/AIDS Development Project India. National Center
for Complementary and Alternative Medicine (NCCAM), National Institutes of Health: 22 September 2003 – 31 March 2005. Grant # 5R21AT002000-02.
Couched in collaborative terms, this alliance building research sought to evaluate Siddha interventions for managing HIV.
Sowmyalakshmi, Srinivasan, et al. Investigation on Semecarpus Lehyam – a Siddha
medicine for breast cancer. Planta, Vol. 220: 910-18. Published Online: Springer-Verlag, 28 October 2004.
Almost identical to Ranga et al.’s work.
Subbarayappa, B.V. Siddha Medicine: An Overview. Lancet pp. 172-5, Vol. 350:
December 20/27, 1997.
Summary of the major aspects of the tradition and its contemporary practice.
Thottam, Dr. Paul Joseph. Siddha Medicine: A Handbook of Traditional Remedies. New
Delhi: Penguin Books India, 2000.
This is indeed a handbook, and reads like a training manual for a budding Siddha physician. Written by a practitioner, it is clear and easy to understand the basics of diagnosis, treatment, and even the preparation of medicines. Also reviews the practice of Siddha medicine historically and in recent times.
Weiss, Richard. The Reformulation of a Holy Science: Siddha Medicine and Tradition in
South India. Dissertation, University of Chicago, 2003.
This is primarily a critical-terms approach to the history of religion, especially around the topic of “tradition.” It is guided by an excellent analysis of language, the politics of representation and the major issue of secrecy in the Siddha tradition. Mostly text-based, it provides documentation of the gradual incorporation of Siddha medicine into the Indian government’s system of healthcare, and highlights the way that medical systems compete for authority and authenticity as well as clients and practitioners.
World Health Organization. WHO Traditional Medicine Strategy.
(WHO/EDM/TRM/2002.1.) WHO: Geneva, 2002.
Reflects a commitment to facilitating integration, promoting safe use, and preserving information in regard to traditional medicine.
World Health Organization. Review of Traditional Medicine in the South-East Asia
Region. (WHO/IND/EDM/050/2004) WHO: New Delhi, 2004.
A window into how some advocates of traditional medicine argue for their rights. This reflects a high-level of political and strategic positioning, and the challenge in gaining power against multinational corporations.
Zvelebil, Kamil V. The Poets of the Powers: Freedom, Magic, and Renewal. London:
Rider, 1973.
Zvelebil is considered one of the foremost academic scholars on the topic of Tamil Siddhas. His orientation is towards translation and the poetry of the Siddhas, and his books are among the first written in English about the Siddhas.
Zvelebil, Kamil V. The Siddha Quest for Immortality Oxford: Mandrake of Oxford, 1996.
This work is largely repetitive of the work noted above, but also includes useful information on the preparation of medicines as well as the constituents of the preparations.
AYUSH website, http://www.indianmedicine.nic.in/html/research/srmain.htm
This website is a gateway for information on Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy sponsored by the Dept. of AYUSH [Ayurveda, Yoga, Unani, Siddha and Homeopathy], part of the Ministry of Health & Family Welfare, Govt of India. It contains basic definitions, updated information about practice, links to various related organizations, and even a list of “eminent people” who are considered to be experts in their respective fields.
http://www.thehindu.com/2005/07/25/stories/2005072509300300.htm
The Hindu is one of India’s national newspapers, published in English and founded by Subramanya Aiyer, a South Indian. It is generally critical of “neo-liberal” policies within India.
Balasubramanian, A.V. The Relevance of a Vibrant Tradition. Special Issue: The Hindu
Folio, 8 October 2000.
See above, as The Hindu Folio is a special publication of The Hindu. This article outlines the classical and folk traditions of medicine and their relevance to contemporary health concerns, with an explicit critique of modern science and technology.
Ganapathy, T.N. The Yoga of Siddha Bogananthar. Quebec: Babaji’s Kriya Yoga and
Publications, Inc., 2003.
Ganapathy is a scholar who is deeply committed to bringing forth the traditions of Siddha lineages, and is working to translate various texts. He provides a rich account of the texture of Siddha practitioners, and in this publication he focuses on Bhogar’s hagiography and teachings.
Hausman, Gary. Siddhars, Alchemy and the Abyss of Tradition: 'Traditional' Tamil
Medical Knowledge in 'Modern' Practice (INDIA) Dissertation, University of Michigan, 1996.
This dissertation is a balance between ethnographical accounts and government archives, revealing the fascinating melding of the world of secrecy and unambiguousness. It is one of the few sources where the voices of practitioners are documented and compared with policies.
Ranga, Rama S. et al. Rasagenthi Lehyam (RL) a novel complementary and alternative
medicine for prostate cancer. Cancer Chemotherapy Pharmacology, Vol. 54: 7-15. Published Online: Springer-Verlag, 24 March 2004.
This research was a collaborative effort between the University of Kentucky and institutions and practitioners in India. Though it is a preliminary study, it looks to the future in producing an effective anti-tumor agent.
Sacks, Henry S. Collaborative HIV/AIDS Development Project India. National Center
for Complementary and Alternative Medicine (NCCAM), National Institutes of Health: 22 September 2003 – 31 March 2005. Grant # 5R21AT002000-02.
Couched in collaborative terms, this alliance building research sought to evaluate Siddha interventions for managing HIV.
Sowmyalakshmi, Srinivasan, et al. Investigation on Semecarpus Lehyam – a Siddha
medicine for breast cancer. Planta, Vol. 220: 910-18. Published Online: Springer-Verlag, 28 October 2004.
Almost identical to Ranga et al.’s work.
Subbarayappa, B.V. Siddha Medicine: An Overview. Lancet pp. 172-5, Vol. 350:
December 20/27, 1997.
Summary of the major aspects of the tradition and its contemporary practice.
Thottam, Dr. Paul Joseph. Siddha Medicine: A Handbook of Traditional Remedies. New
Delhi: Penguin Books India, 2000.
This is indeed a handbook, and reads like a training manual for a budding Siddha physician. Written by a practitioner, it is clear and easy to understand the basics of diagnosis, treatment, and even the preparation of medicines. Also reviews the practice of Siddha medicine historically and in recent times.
Weiss, Richard. The Reformulation of a Holy Science: Siddha Medicine and Tradition in
South India. Dissertation, University of Chicago, 2003.
This is primarily a critical-terms approach to the history of religion, especially around the topic of “tradition.” It is guided by an excellent analysis of language, the politics of representation and the major issue of secrecy in the Siddha tradition. Mostly text-based, it provides documentation of the gradual incorporation of Siddha medicine into the Indian government’s system of healthcare, and highlights the way that medical systems compete for authority and authenticity as well as clients and practitioners.
World Health Organization. WHO Traditional Medicine Strategy.
(WHO/EDM/TRM/2002.1.) WHO: Geneva, 2002.
Reflects a commitment to facilitating integration, promoting safe use, and preserving information in regard to traditional medicine.
World Health Organization. Review of Traditional Medicine in the South-East Asia
Region. (WHO/IND/EDM/050/2004) WHO: New Delhi, 2004.
A window into how some advocates of traditional medicine argue for their rights. This reflects a high-level of political and strategic positioning, and the challenge in gaining power against multinational corporations.
Zvelebil, Kamil V. The Poets of the Powers: Freedom, Magic, and Renewal. London:
Rider, 1973.
Zvelebil is considered one of the foremost academic scholars on the topic of Tamil Siddhas. His orientation is towards translation and the poetry of the Siddhas, and his books are among the first written in English about the Siddhas.
Zvelebil, Kamil V. The Siddha Quest for Immortality Oxford: Mandrake of Oxford, 1996.
This work is largely repetitive of the work noted above, but also includes useful information on the preparation of medicines as well as the constituents of the preparations.
TERMINOLOGY
It is useful to understand a few critical terms around the topic of Siddha medicine. The first of these is Traditional Medicine (TM). Although it is unclear when this term became common parlance, it is generally used to describe that which is not Western biomedicine. According to the World Health Organization’s definition of TM, there is a
“diversity of health practices, approaches, knowledge and beliefs incorporating plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises, applied singly or in combination to maintain well being as well as to treat, diagnose or prevent illness” (WHO traditional medicine strategy 2002-2005).
TM is further qualified by such terms as local, indigenous, and in the case of India, there is even the appellation ISM, or Indian Systems of Medicine. These include Unani, Ayurveda, Homeopathy and Siddha. Ayurveda and Siddha are considered indigenous to India, while Homeopathy and Unani are considered exogenous, imported from European and Middle-Eastern countries respectively. However, there is at least 150 years of documented use of Homeopathy in India and a few centuries of the use of Unani. Nevertheless, Siddha and Ayurveda are considered to be the oldest practices which have been used for thousands of years rather than hundreds.
There is even continual debate about whether or not Siddha medicine came before Ayurveda or vice-versa, as Harmut Scharfe writes in his article: “The Doctrine of the Three Humors in Traditional Indian Medicine and the Alleged Antiquity of Tamil Siddha Medicine” (Scharfe 1999, 609). The next important distinction or classification is the difference between a classical and folk tradition. Here, classical is understood to be a codified or written system that is characterized by “institutionally trained practitioners, a body of texts and highly developed theories to support their practices.” The folk tradition on the other hand is that “which is an oral tradition passed on from father to son or mother to daughter (or daughter in-law) or from guru to sishya” (Balasubramanian 2000, 1).
According to the Indian Government, there are approximately 14,000 registered practitioners of Siddha medicine in South India as well as Sri Lanka, Malaysia and Singapore (AYUSH website). Of these, an overwhelmingly large percentage are hereditary, or “Folk” practitioners (12,000). The remaining 2,000 are institutionally qualified. Within the folk tradition, there are various approaches and practitioners, including: bone-setters, birth attendants, folk/tribal practitioners, and other specialists who treat specific diseases (Balasubramanian 2000, 2).
These terms are worth discussing not only because they frame and delineate the scope of Siddha medical practice, but also because of the connotation of these words in the larger socio-cultural context of medical practice as a whole.
It is useful to understand a few critical terms around the topic of Siddha medicine. The first of these is Traditional Medicine (TM). Although it is unclear when this term became common parlance, it is generally used to describe that which is not Western biomedicine. According to the World Health Organization’s definition of TM, there is a
“diversity of health practices, approaches, knowledge and beliefs incorporating plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises, applied singly or in combination to maintain well being as well as to treat, diagnose or prevent illness” (WHO traditional medicine strategy 2002-2005).
TM is further qualified by such terms as local, indigenous, and in the case of India, there is even the appellation ISM, or Indian Systems of Medicine. These include Unani, Ayurveda, Homeopathy and Siddha. Ayurveda and Siddha are considered indigenous to India, while Homeopathy and Unani are considered exogenous, imported from European and Middle-Eastern countries respectively. However, there is at least 150 years of documented use of Homeopathy in India and a few centuries of the use of Unani. Nevertheless, Siddha and Ayurveda are considered to be the oldest practices which have been used for thousands of years rather than hundreds.
There is even continual debate about whether or not Siddha medicine came before Ayurveda or vice-versa, as Harmut Scharfe writes in his article: “The Doctrine of the Three Humors in Traditional Indian Medicine and the Alleged Antiquity of Tamil Siddha Medicine” (Scharfe 1999, 609). The next important distinction or classification is the difference between a classical and folk tradition. Here, classical is understood to be a codified or written system that is characterized by “institutionally trained practitioners, a body of texts and highly developed theories to support their practices.” The folk tradition on the other hand is that “which is an oral tradition passed on from father to son or mother to daughter (or daughter in-law) or from guru to sishya” (Balasubramanian 2000, 1).
According to the Indian Government, there are approximately 14,000 registered practitioners of Siddha medicine in South India as well as Sri Lanka, Malaysia and Singapore (AYUSH website). Of these, an overwhelmingly large percentage are hereditary, or “Folk” practitioners (12,000). The remaining 2,000 are institutionally qualified. Within the folk tradition, there are various approaches and practitioners, including: bone-setters, birth attendants, folk/tribal practitioners, and other specialists who treat specific diseases (Balasubramanian 2000, 2).
These terms are worth discussing not only because they frame and delineate the scope of Siddha medical practice, but also because of the connotation of these words in the larger socio-cultural context of medical practice as a whole.
BACKGROUND
Right now there is a significant gap in the historical research of Siddha medicine written in English. A handful of scholars including Kamil Zvelebil, Richard Weiss, Gary Hausman, and others have started preliminary research on the history and development of Siddha medicine. However, there are few translations of the major texts; little is known about its development over time; and even less is written about its contemporary practice.
This blog will provide a framework for understanding the chronological trajectory of Siddha medicine, beginning with the original texts and concluding with recent scholarship. Using source documents, we will examine the diverse origins of Siddha medicine, which span multiple cultural, religious and even regional boundaries. By tracing the initial foundations of Siddha medicine and their subsequent transformation we can identify the relationships between major figures, ideas, texts, events and locations. This timeline will extend through the colonial and post-colonial era to the current practice of Siddha medicine.
Some of the questions addressed will center around the extent to which indigenous and exogenous influences have shaped this medical tradition. This will include alchemical and Tantric-yoga practices, Saiva-Siddhanta and other systems of belief, Ayurveda, and other local health practices.
Further, what kind of sharing occurred between Siddha medicine and other regions such as Tibet, China, the Middle East, and other South/Southeast Asian areas?
More recently, how has Siddha medicine interacted with the global community in the 20th century especially in regard to biomedical knowledge? At this time scientific researchers throughout the world are studying the benefits of Siddha medicine for treatment of various chronic, life-threatening illness including cancer and AIDS.
Concurrently, there is also a move towards preserving and protecting this indigenous knowledge through various governmental and non-governmental organizations. Intellectual property rights and the commercialization of Siddha medicine are poignant issues for practitioners and scholars alike.
Right now there is a significant gap in the historical research of Siddha medicine written in English. A handful of scholars including Kamil Zvelebil, Richard Weiss, Gary Hausman, and others have started preliminary research on the history and development of Siddha medicine. However, there are few translations of the major texts; little is known about its development over time; and even less is written about its contemporary practice.
This blog will provide a framework for understanding the chronological trajectory of Siddha medicine, beginning with the original texts and concluding with recent scholarship. Using source documents, we will examine the diverse origins of Siddha medicine, which span multiple cultural, religious and even regional boundaries. By tracing the initial foundations of Siddha medicine and their subsequent transformation we can identify the relationships between major figures, ideas, texts, events and locations. This timeline will extend through the colonial and post-colonial era to the current practice of Siddha medicine.
Some of the questions addressed will center around the extent to which indigenous and exogenous influences have shaped this medical tradition. This will include alchemical and Tantric-yoga practices, Saiva-Siddhanta and other systems of belief, Ayurveda, and other local health practices.
Further, what kind of sharing occurred between Siddha medicine and other regions such as Tibet, China, the Middle East, and other South/Southeast Asian areas?
More recently, how has Siddha medicine interacted with the global community in the 20th century especially in regard to biomedical knowledge? At this time scientific researchers throughout the world are studying the benefits of Siddha medicine for treatment of various chronic, life-threatening illness including cancer and AIDS.
Concurrently, there is also a move towards preserving and protecting this indigenous knowledge through various governmental and non-governmental organizations. Intellectual property rights and the commercialization of Siddha medicine are poignant issues for practitioners and scholars alike.
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