Technology and Culture: A Review of Some Critical Issues - The case of Medical Science and Technology
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- Title
- Technology and Culture: A Review of Some Critical Issues - The case of Medical Science and Technology
- Creator
- Dhruv Mankad
- Date
- 1989
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-
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COMMUNITY HEALTH CELL.
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■_?.§’?Z»28_JANUAHY,1989
TECHNOLOGY AND CULTURE : A REVIE'.' OF SOME CRITICAL ISSUES
-'-tThe case of Medical Science and Technology
- DHRUV MANKAD
" Men co not. know how what
is at variance agrees with itself"
- HERACLITUS.
1) SOME DEFINITIONS;
Before we begin to explore the inter-relationship
between Science. Technology and Culture we need to define.,
if we can. that is, what is meant by these terms.
(A) SCIENCE AND TECHNOLOGY;
, "Science traditionally may be taken to mean the
advancement of our understanding of the 'way in which the
observable world works, the development of logical and
self-consistent description of why and how such and such
individual happenings occur, why a -pies fall from trees, why
they are coloured red and__green, why they are good to eat
irrespective of the immediate utility of these statements.
That is to say that a derivation of the laws of gravity, or
of opties, chemical analysis of the constituents of the apole,
or a knowledge of physiology of digestion is not suoposed to
make us immediately richer, stronger or with greater power
over nature. On the other hand the invention of the telescope,
of Techniques of cooking .... of apoles or medicaments to
alleviate the stomach pains we will get if we ate too many
of them are seen as technologies- they do not add to our
understanding of the working of the laws of nature, but
they add to our control over the world around us"
(Rose and Rose 1970, p 1; emphases mine - DM).
However, the distinction is more for convinences
sake, than in actual existence Electrocardiograph in its
'
t
•
primitive stage added to our understanding of the physiology
of cardiac action, the invention of electrocardiograph
itself was preceded by the discovery of neuroelectricity.
Since these early scientific insights, there is a growing
■t.’p.T.O.
*
f
r
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2
-
scientification of technology and technification of science.
"So science and technology must be seen as interacting terms,
discovery precedes invention and invention in turn presages
And because of this elision between science
discovery
and technology, between scientific methodology and scientific
culture, which together form the totality of science, it often
becomes difficult to talk about any specific meaning of the
word "science" (Bose and Bose 1970 P2).
Even in this paper, I have not been able to maintain
the distinction, where often have failed.
To a considerable
extent, the meaning of the terms have to be derived contextually.
B. Culture:
Raymond Williams in his glossary of keywords points out
that " culture " is one of the most complicated words in the
English language. Even in the field of anthropology, which
specialises in the subject of culture, a multitude of definitions
prevail ( See Elzinga and Jamison 1981 p). However, without
splitting hair over the nuances of these definitions, a general
notion of culture is emphasised here.
Malinowski defines culture as comprising of "...
inherited
artefacts, goods, technical processes, ideas, habits and values"
(Kalinowski 1931, as quoted in Elzinga and Jamison, 1981 p) Leach,
however differentiates between "ideas, habits and values" as
"culture proper" and goods, artefacts and technical processes'"
as " products of culture"
( Leach 1965 as quoted in Elzinga and
Janilson 1981 p) This narrower definition has been resorted to
in this paper. Ideas in the form of natural science, those
reflecting the
'laws' of nature must necessarily stand somewhere
in between because they imply human beings' most direct,
1 unmediated'
theoretical relationship with nature.
Bit this is true only if we
accept the total authonomy
of positive sciences which consider the laws of nature as
operating independent of the human observer. However,
obsurer herself/himself is considered to be a
'nature'
if human
part of the
s/he is observing, then the natural events or the
’Laws' governing them as well as the different perceptum
that human observer may have, are to be considered as a single
entity comarising contradictory aspects. It is in this context
of differing - what are basically philosophical - position
... 3/-
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»
that the question of the interrelationship between Science,
technology and culture becomes a big question. In short , "Is
science culturally determined?" is a major issue deserving
our consideration.
In the following pages, I have tried to review certain
crucial issues being debated and which are woven around this
basic question with specific reference to medical science and
technology. If no attempt has been ma de to resolve them, it is
because they are largely irresolvable. If the positions taken
here sometimes seem contradictory, it is because the reality
is contradictory, if they seem extreme in nature and provocative,
they are mea nt
to provoke further debate.
IS SCIENCE CULTURALLY DETERA'I NED?
In order to make an attempt to search for a coherent
view of this issue, let us take a look at the conditions under
which the modern clinical m°dicine arose.
" THE BIRTH OF THE CLINIC"
The stage for this turning of the light of human reason
on the hidden recesses of human body and its afflictions was
set in France. The period 17th century. The ground was pre pare dxiay.1
by the claneleshine rebellion by Vesalius and others during the
Duropean Rennaissance, against the authority of Church and of
the Aristotle an view of reality. Dissection of human corpses,
coupled with an accurate description of the organs which
accompanied this new medical 'gaze' - to use the term employed
by Foucault (Foucault 1976) - Shook the foundations of Galenic
anatomy and alongwith that of the largely speculative, hierarchi
cal view of nature and the human bo$y. However, this transafor-
mation itself was preceded by the rise of humanistic and
m
naturalistic philosophies, wherein human concern took jbrecedence
over the divine ones and nature began to be described as it is
without cosmological, religious or speculative elements attached
to it.
This das realisation of nature - where nature stopped
being an object of reverence and began to be probed, explored,
'penetrated' and transformed - and preoccupation with human
affairs, did not spare medical thought either from the
clasifactory - the nosological organisation of diseases
... 47-
4
*
began to emerge the pathologicoanatomical view. In the words of
Foucault. " The space of configuration of disease and the space
of localisation of the illness in the body have been superimposed
(during) the period that coincides with nineteenth century
medicine ..." (Foucault,1976 p ) He maintain that this transforma
tion cannot be accounted for by any directly social economic or
politieal cause. He calls it a syntactical change of medical
* gaze ', which began to see and discribe disease in a different
way altogether. It was as it a new language consistine of a new
grammar, of more accurate term and new meanings was evolving
under the observations of physiciam. It also entailed new values
regarding doctor-patient relationship a® well as a wholly
original origanisation of ' Space ' within which this relationship
was to manifest itself i. e. the clinic (1) In short, it was a
cultural transformation.
This transformation brought about and in turn was brought
about by a change in the ethical attitude towards a patients. It
involved a moral question:" by what right can one transform into
an object of clinical observation a patient whose poverty had
compelled him to seek assistance at the hospital ?" (Foucault,1976)
He asserts further. "But to look in order to know, to show in order
to teach is not this a slient form of violence .... ? Can pain
be a spectacle ?" His answer reflecting the ethics prevalent
then, covers one of the most crucial area of even the contemporary
ethics of science. "Not only it can be, it must be, by virtue
of a subtle right that resides in the fact that no one is alone,
the poor man less to than others .... Since disease can be cured
only if others intervene with their knowledge .... it is just
that the illnesses of some should be transformed into the
experience of others ...."
(Foucault 1976).
All this not a post-facto rationalisation of an
f
■f
accomplished historical event. French Liberals and conservative
fiercely debated the issue of municipalisation of hospitals and
of converting some of these infirmaries into workshops of
medical knowledge. The Liberals argued that if the patients
refused to offer himself to as an object of instruction, he
would be guilty of ingratitude for ’ he would have' enjoyed
the advantages resulting from sociability without paying the
tribute of gratitude" ( de Montaur 1787 as quoted in Foucault
1976 p.84). Foucault observes further. "These wthen were the
terms of contract by which rich and poor participated in the
... 5/-
11
. - 5 organisation of the clinical experience..
(These terms
represent)... the interest paid by the poor on the capital the
rich have consented to invest in the hospital". This interest
is actually a heavy surcharge paid by the poor" Since it is the
compensations that is of the order of Objective interest for
science (without which science could not be what it is supposed
to be - Dm) and of vital interest for the rich (without which
the rich...carli.-1p.t_phe survive an_.attaqk of..diseases appearing
in the Clinic - DM) Helping ... ended up by paying, thanks
to the clinical gaze" (Foucault, 1976).
A far more crude, example of the liberal attitude which
forms the basis of the constitution of the workshops of modern
medical science and technology is reflected in the statement
exolaining the functioning of the newly opened maternity clinic
at Copenhagen in 1787. It stated that only "unmarried women or
those who claimed to be such were admitted. It seems that hothing
better could be imagined for it is precisely this class of
women whose feelings of modesty are likely to be least delicate"
(Demangen year VII a..s quoted in Foucault 1976. p. 85 ) Thus, this
morally disarmed and socially so dangerous a class was to be
of the greatest possible use to honourable families.
.
Thus was born the modern clinical medicine. To be sure,
it did provide the posterity with an entirely new framework
with an entirely new framework within which to understand
human diseases and their treatment, was to give a century and
a half later miracle cure '. in the form of antibioties but
nonetheless it rose over the fall of and with a derisive
attitude towards lower classes and women.
Thus the bias
against the poor, and the women- particularly those placed
in oppressive circumstances is built, into the very organisation
. of. the.space within which clinical medicine was born and
continuous to flourish. "A. doctor's gaze, is a very small
saving in the calculated exchanges of the liberal world ... "
(Fo.ucault, 1976).
It could be argued that the birth of the clinic is
not'the birth of clinical medicine ' per sc. True, but only
partially, because where would clinical medicine be without
the clinic 7 A look at history of medicine would reveal
that most of the major discoveries and inventors in the
field of medicine have come about in
the clinic. Bichat,
- 6
Dupuytren and Pinel during the early years and later Laennec, the
(2 )
father of modern chest medicine. Trousseau, Bouillardv ' from
France; Johan and William Hunter, Hodglein, Bright, Graves, Addison
stokes from London and Skoda from Vienna are all products of this
cultural transformation of which was born the Clinic.
STETHOSCOPB A TECHNICAL MEASURE OF CHANGING CULTURE:
A single example would suffice to leave
the development
of clinical medicine in Groups for the time being, an example
which shows up the interrelationship between science, Technology
and Culture in all its complexity,
viz. the invention of
stethoscope. Regarding the conditions under which he invented it,
Laennec writies, "In 1816, I
was consulted by a young person who
presented symptoms of heart diseasea and in the case of whom the
application of hand and percussion yielded poor result on account
of her plumphess of figure, iince the age and sex of the
patient,
forbade me the ....'examination (the application of ear to the
precordial region). I happened to recall a well known acoustical
phenomenon....
" (Laennee 1819 as quoted in Foucault 1976 p
164 parentheses and emphasis mine- DM).
■_7a s it a cultural prohibition that prevented laennec from
putting his ear to the woman’s breasts or was it that " the moral
obstacle was experienced only when the epistemological need had
emerged, scientific necessity revealed the prohibition for what
it was ... ? "
(Foucault 1976)
Foucault quotes Zimmermann who
".... had expressed a wish that ' doctors should free to make
their observations in this resoect by placing their hands
directly on the heart’;
-x-..
but he added that 'our delicate morals
prevent us from doing so, especially in case of women’
(
Zimmerman 1774 as quoted in Foucault 1976 p 163) Then,
"the
moral screen.... was to become a technicalmediation.
....
(
The libido sciendi... provides it (the prohibition - DM) with
scientific and social Justification inscriting it within
necessity in order to ... build upon it the structure that
traverses it and maintains it.
At present, it is not modesty
that prevents a doctor from putting his/her ears to a patient's
breast but “dirt and poverty"
.... " Unaided auscultation is
not only direct but inconvenient for both doctor and patient,"
only disgast, makes it impracticable in hospitals, it is
scarcely mentionable in the case of most women and in the
case of some women, the size of the breasts is a physical
obstacle to its practice. The stethoscope is the measure of
... 7/-
7
prohibition transformed into disguest and (then) into a material
obstacle".(Foucault,1976)
CULTURE AS IA-PEDEf-ENT: ANCIENT INDIA AND AYURVEDA:
Let us leave Europe to its philosophical debtes for a
while and turn our attention nearer home, albert at-a period
far away in the past.
In Ancient India, Ayurveda arose and developed as a
counter-culture. In the brahmin dominated social hierarchy of
the Yajurvedic period, which upheld mysticism, ritualism and
religionism, Ayurveda -strove to retain its rigorous commitment
to empiricism, rationalism and secularism. In a culture dominated
by the mystifying philosophy of the. brahmin priests who decried
direct knowledge of reality.
The ancient Indian Physicians
uphold and develop their own variety of naturalism, and
humanism :
".... the physicians take the step of insisting on
the importance of the knowledge of nature or the material
world as an essential precondition for the right understanding
and therefore also for better mastering of the mechnism of
human body"
(Chattopadhyay 1977).
They work out an essentially unified view of man and
nature- that makes man a microcosm of world. In consequence,
it removes all the claptrap about the atman, the karma theory
and the varnasharam. Thus Ayurveda emerges as the sole rational
scientific discipline in the ancient Indian culture. Its
unified view of man and-nature has an obverse also: it tends
to treat nature and the human body as sacred,
therefore beyond
a certain limit, its exploration becomes impeded because of the
fear of its becoming an object of man’s profane manipulations.
Lastly, Ayurveda developed in a culture of a rigid
caste-hierarchy which considered manual work fit only for the
low castes. In Yajurveda, physicians come under strong
condemnation because of their association with manual work
involved in growing and collecting of herbs, and treating a
patient. This devision continues throughout the later legal
EC
literature- from Apastamba and Gautama, a few centuries/before
KChrist to
'Manu and his later commentation of the 12th and 13th
Century Kulluka Bhatta (Chattopadhyay 1985). The reason:
"The
-Brahmin must not practice medicine, because the physician is
impure....
(Tailtariya Samhita vi 4.9)" And why is the
... 8/-
8
physician considered impure ? "The practice entails promiscuom,
unaristocratic mingling with men" (Bloomfield as quoted in
chattopadhyay 1985). In modern terms, this means that the
predominantly Brahmin culture considers physicians impure
because "their science commies them to a democratic norm,
incompatible with the requirements of the varnashrama society.
With the growing strength of this hierarchical norm, intensifies
the contemu'- Lr medical science. The ultimate result is its
complete stagnation" (Chattopadhyay 1976).
What ancient - and modern as well Indian Culture lost
thereby is to be judged by from what the ancient Indian medicine
once promised. A sound epistemological basis, a meticulously
scientific methodology and a cdossal formulary of therapeutic
agents the utility of which is yet to be exhausted even for
modern phanmaccology.
If the story of European Medicine emphasized the cultural
milien that gave birth to the modern scientific medicine, that
of the Indian medicine underlines the cultural conditions that
retended an ancient scientific medicine.
Tnus, it can be argued that cultural influences playx a
crucial role in retarding or accelerating ( or even causing)
the development o" science in a given society. But then what
about the medical science per sc; the scientific philosophy
that inform it and more impartantly the methodology it uses in
its study of the human body? Does its essential elements derive
their intel tactual nutrients from Prevalent culture ? Without
answering the Question precisely, let us review the basic
premises of modern scientific medicine.
FUNDAMENTAL PHILOSOPHICAL FRAMEWORK OF SC I IN TIFIC ME DICI NE:
1) Positivist Outlook: The basic premise of positivism is that
a scientific proposition must be rooted in empirical statements
of facts i.e. all of its theories must be verifiable and
verified experimentally and demonstrated to be existing as a
'fact'. Tailing this a hypothesis or theory falls' to ground
It is precisely this outlook of mdoern medical though that
has prevented the Chinese science of acupuncture to be accepted,
because modern day physiologists have been unable to find
the anatomicophysiological counterpart of acupunture meridians
and points. Thus positivistn methodology in its fact-fetishism
ends
up by denying reality itself if it fails to fit its
philosophical straitjacket.
9
Incidentally, positivism assumes that facts and therefore the
positive science based on facts, stand above culture or more
precisely the question of cultural determination of science
is itself a non-ouestion because it is unverifiable and
unverified empirically ?
2) Cartesian model of life and human body;
■'The human body is regarded, (by modern medical
science) as a machirae that can be analysed in terms of its
parts; disease in seen as the malfunctioning of biological
mechanism ... the doctor's role is to intervene physically
or chemically to correct malfunctioning of a specific
biological mechanism (Capra 1982).
as
a result, the human being behind the diseased part
is lost sight of and by reducing health to mechnical functioning
it is no longer able to deal with the phenomenon of heding, which
involves a complex interplay of social and environmental factors
resides the purely biological ones.
The situation is compounded by the acceptances of the
Cartesean duality of body and mind. Before Descartes, most Uaxkgxx:
healers accepted a free interplay between the two and treated
patents within the context of their social and spititual
-environments (See Kakar 1982). The duality learn so heavily
in the favour of the machine notion of human body that even
the problems’ of human mind are now brought to psychiatry clinic
with its anxiolytic and other behaviour changing drugs. He
shall return to this later.
PLAIMT N TURd: PASSIVE '.'OREN;
Yet another important aspect of the paradigmatic
shift accompanying the rise of clinical medicine has been
the view which considers nature as capable of bending to
human will and hence passive. A similar view its held
regarding women, whose'feminity' is metaphorically used
while describing nature and its exploration.
□ayyed Nossain Jasr, a historian of Arabic science
maintains that the 'gnostic' value of traditional rites
and learning is more important than their 'truxth' value.
In Islam as in China, observation of nature and even
experimentation sttod.... on the side of the gnostic'
and the mystical element of tradition while logic and
rationalistic thought usually remained aloof from actual
... 10/-
19 observation of nature. (Nasr 1969 as quoted in Aant & Jamison
1981 p.10).
The later view that resulted in, accomoanied and
reinforced scientific exploration of human body, considered nature
and hence the" human body as inert and passive,: always being acted
upon new, by external disease-causing germs, new by the well
intentioned physician. Ini-one this view looked for the cause of
f its doom, in the other for its salvation.
J.
;
...
Similar qualities were assigned to woman who were geen
basically as being passive partners in the act of generation.
Such a view pervaded writings on reproductive anatomy of women
particularly during the Re nnaissance.
Nature as a nurturing mother was a concept held by as
diverse philosophers as Aristotle, Plato and Galen, but profonnd
changes were brought about in this view, when the now profanse
(3)
nature began to be 'Penetrated^ ' and explored to find the
secrets hidden in her-bosom. A new concent of the female nature
and the 'human female', began to emerge. It is classically
illustrated by Harvey's work on reoroduction.
"Harveys'work on generation .... reflected the cultural
sex bias i.n his society, .. He differed from Aristotle in ...
maintaining that the sperm was superior to egg as an efficient
cause",-and also in concluding that"... impregnation took
place without contact" (between the egg and the sperm) "This
meant that., the male semen must be endowed with an extraordinary
power? cd.jsoxe of affecting female ulerus and mind from a
distance" (Merchant 1983).
ouch views of female passivity did not get reflected
only in the scientific writtings of medieval and early modern
age. Later Darwinian theory was also used to keep 'women in
their place'. Variability was correlated with greater spread
of physical and mental variation in males, and this was used
to demonstrate differences which would explain females
intellectual inferiority. 'Women’s reproductive function
reguired that more energy be directed towards pregnancy and
maternity, hence len was available for higher, functions
•The adventurous sperm and 'passive ovum' continued to serve as
reproductive metaphors" (Merchant,1983)
11
Twentieth century medical science conjured up normonal
ghosts to explain 'uonormal' intellectualism of women with
high IQ, competitive behaviour and 'executive ability1, even now
reproduction hormones and pregnancy - is used to perpetuate
similar ideas. ..'omen as passive receivers of family.planning
techniques or as inert, frigid receiptents of male sexuality
are not image( created a new nor are they mere aberrations in
the otherwise sane, objective, rational search for scientific
truth". They lie at th? very roof of the new scientific insights,
the new technologies and they have canied alongwith them these
cultural membranes while arising from the primitive concepts.
CULTURAL LIA.ITS TO SCIENTIFIC INQUIRY: ;
/hatever the reason, science is classified differently in
different culture. While certain branches develop to a much
further level than the general technological level should
logically allow, certain branches do not arise at all. Nathan Sivin
notes (Jivin 1973 as referred to in Aant and Jamison 1981 p 12)
how misleading it would be "to.judge Chinese medicine by Western,
standard as positivists do, for being purely empirical or rational.
According to him the subspecialities of Chinese medicine are quite
different; from those of the... .estern medicine. He suggests further
that the general concepts of different branches of sciences are
determined by cultural factors and 'the role of the scientist, hss
self understanding and his ideal of the proper type of knowledge,
the delimitation and the orientation of research programme',were
very different in different cultures (This is not to suggest
that each cul^
...co tad only one coherent world view as reflected
in its science, in fact each culture had its 'heretical' tradition
even within science, the Taoists in oonosition to confucians in
China, Naiyayya '/aisheshikas in opposition to the Vedantins in
Indian or the Naturalists-Humanist Philosophier against the
Aristothean and Platonic philosophies in Europe Feminist
Philosophy against 1 androcentric' ohilosophies, ancient and
modern.
Now if medical.science and technology are so integrally
related to culture,, coming alongwith them -the cultural integumen
of the milieu of their origin and development, are retarded
of accelerated by this mi-lieu and their content too, is
influenced deeply by the prevalent cultural attitude, the
second major question that should be considered in.
...12/-
2. IS MEDICAL SCI i ACE AN ELHNOi1. EDICTNE:
Yes, says Claude Alvares in his book ( Alvares *1979) He finds
fault with the arguments says that Taoism'was more progressive than
confucianism because the latter retarded the growth of science.
Alvares argues that it is fertile to look for social or ideo
logical factors that may have supported or inhibited the growth
of science as we understand it, in the non western cultures .
If the Chinese experience in analysed on its own terms and not by
any western Cultural standards, therein no room for criticism
of confucians (and praise for the Taoists) because the farmer's
philosophy did not facilitate growth of science. It is only when
we consider mastering nature as the ideal for scientifico-
tecnnological endeavoun tnat western science become a universal
standard for measuring 'Progren' elsewhere. However if we
consider harmony btween man and nature, between Yin and Yang in
the Chinese medicine, between the
Tridoshas, Saptadhalus or
Panchabhutas in Ayurveda, as a predominant positive value, then
the Chinese and Indian cultures' scientific achievements stand
out as more advanced for they did not need western type of
science and technology to understand and 'control' the material
wo rld.
Thus for Alvares, every medical system is an ethnomedicine,
with its own basic thought categories having been determined by
thb cultural settings of its origin. To. ask why the Ayurveda did
not, despite early insights, develop a pathologico-anatomical
picture of disease or the Chinese did not have an indigenous
germ theory and that non-western cultures did not encourage a
mechanistic and quantitative approach to nature is the same as
asking why they did not have a European culture.
Josaph Needham counten the type of 'cultural relativism'
while sympathising with tnose wanting to do justice to the
achievements of the science of pre-modern, non-western cultures,
warns of the dangers of slipping into relativism, "the dangers
.of falling into the other extreme, and of denying the fundamental
continuity and universality of all science". By considering
the sciences from difference cultures as 'totally separate,
immiscible thought patterns... irreconciliable and unconnected',
such a view may be used as 'the cloak of some historical
racist doctrine" (Needham 1954).
... 13/-
13
There are two objections implied here. One, the position
is considered to be historically incorrect. The ide^s developing
in the philosopnical framework leading to the rise of mooern
medicine itself could be traced to the Greco-Arabic tradition
developed in Arabia, which in turn was deeply influenced by
Ayurveda (refer Kutumbiab,1971) Therefore, there is a direct
continuity, though marked by distinct and brilliant conceptual
breaks that characterise any original scientific endeavour,
between the Indian, Chinese, Arabic, Greek and the European
medicine ,
The second objection is political, the ideas of
distinctiveness, incommensuribility of cultural sciences, if
absolutized, can present a politically conservative oicture
of science as well as that of culture.that is, ine traditionally
and much more in the present technological era, science has
become 'ecumenical', 'a part of humanity's broad onward march,
secondly, the denial of the possibility of common understanding
and mutual exchange may legitimize racial and elitist doctrines.
Needham, however recognises the difficulties in aporoaching
scientific^T.ra'difi'bhs"in different cultural settings. Tne
theoretical -system in each setting vias' ethnic bound arid therefore
cannot be compared directly. However, without absolutizing
categories used in the 'ethnic' science, and modern science; a
mediated comparison can be made (refer iviankad
); In the
field of medical science, this can be done partly by studying
the relative successess Scheived in understanding and altering
natural processes by each of- these ethnic medical sciences incl
uding the modern medical Science...
While upholding the 'discovery of the method of discovery*
elements of which are found even in the writings of ancient
Indian physicians (refer Chhattopadhyay 1977) which took its
underlying philosophical limitation (see Kuhn 1962, Feyerabend
amongst others). It is to be upheld not only for its 'truth'
value but much more so far its inherent commitment to democxratic
values. "It is democratic because it presupposes the possibility
of repeatibility and the reachingof a universality of results
that transcends mere majority consensus" (Aant and Jamison
1981 p.18).
'
This brings us to the third important issue in this
complex ihter-relationship whatever may be the birthplace
and birth date of modern science and technology, as well as
...14/-
14
its cultural garments, it has come to stay. Not only that it has
pervaded the popular culture. What role has modern medical science
and technology played in moulding "the present day. culture ?
3) CULTU AL IMPACT OF'MODERN EPICAL, SCIENCE' A \'D TiiClNJLOGY!;
A very specific feature, of modern day medical science and
technology is that here the 'consumer* Who is also the object of
its use has little or no voice in choosing the technology once
s/he has chosen the '.technologist' the physician. This situation
is partially inevitable being the result of the highly specialised
nature of the medical knowledge. But partly, this knowledge is
made out to be more special and esoteric than it really is.
Mystifying language employed by the doctor, the term of which
are beyond the semantic limits of an ordinary, literate person
and the fancy gadgetary employed by the doctor, legitimately or
otherwise, in coming to terms wlhth a patient's sufferings, has
created a culture of idolatry towards modern medicine and
medical'men'.
Medical technology, ..while claiming to have dispelled the
medieval 'myths- of humours, .spirits and evil eyes have created
new myths and reinforced old ones. Some fcof the myths which
existed earlier on and which'are perpetuated by modern medical
technology are.
a) Myth of the Omniscient and Omnipotent Physician:
’■ The 'physician with his/her supposed power over death and
suffering have always held a position far above the rest of the
profession, cvenwhile Yajurveda divided'his profession, when the
ancient Indian physiden relinquished direct observation, he
found a place in royal courts with a large pension. This elitist
attitude, despite the democratice norm propounded by the
scientific Method, has been perpectuated and strengthened fruther
on the basis of modern medical technology and science.
For most patients, their rights, and responsibility as
independent citizens and 'consumers' stand suspended at the
doorstep of a ohysiciand clinic. The language employed.by the
doctor kte in this discourse with the patient, the grammar' of
his investigation of and his intervention in the patient
suffering, employed by the modern medical technology is little
understood by even the literate. Gone are the days when his
suffering'was due to 'pitta' or to eating 'cold' foods-concepts
... 15/-
15
which were and shill are part of his popular culture and
which was familiar. Now, the terminology of medicine is
largely incomprehensible to him. This lack of comprehension
perpetuate the attitude of awe towards medical technology
generating either a blind faith in its ability to cause
miracles or a distant distrust. This contradictory attitude
is well illustrated in the view rural folks have of a simple
technology 'injections'.
On the one hand, they are the very much overwhelmed
by the supposed by miraculous effects of an injection and
demand it/accept it even for the most minor of ailments. On
the other hand, they;would strongly object to give much needed
OPT immunisation to their children, the less clear his/her
illness and/or its treatment is to him/her, the more awe his/
her physician commands. This is one of the reasons why doctor
treating common illnesses only are held in less reverence
than those treating rare, specialised illnesses.
b) .Myth of Women's passivity in general and in reproduction in
particulars
earlier we have seen, how Narvey's research in
reproduction perpectuated the myth of essential inferiority
of women. Modern day science'and practice of Gynaecology and
Obstetrics has reinforced this myth. This issue has been
hotly debated in this forum time and again and therefore, I
would avoid taking it up again (see papers and report of the
IX Annual Meet of the MFC held at Anand, January,1983, Also
see Gupte M.-1987, Savara M, 1987) for the sake of comprehen
siveness the example of injectable contraceptive would suffice.
Under the guise of ease of its administration, a
women can be subjected to contraception without her knowledge
using injectable contraceptives. This is being promoted
because she is seen only as a bearer of children and a passive
target for Family Planning Programme. v7hat is worse is that
in the prevalent injection culture, it may receive respect
ability' even by the women themselvers.
Besides perpetuating these old myths, modern medical
science and technology has created some new myths, the
most prominent and
preponderant of them being.
...16/-
16
iy<y^h_ofc;hno 1 ogiGa 1 solutions to health problems:
As pointed out earlier, a mechanistic world view coupled
with a dichotomous concept of human body has lent credence to the
view of human body as machine and illness as a mechanical fault.
This view has driv?n medical scientist to a every narrowing study
of the human body " by reducing it to its basic building blocks
and fundamental functions. This technologisation of medicine and
health is reflected in the statements of Donald Fredrickson, the
then Director of National Institute of Health of the USA, who says
"the reduction of life in all its complicated forms to certain
fundamentals that can then be resynthesized for a better under
standing of man and his ills, is the basic concern of bio-medical
research (Fredrickson 1977 as quoted in Capra 1983 p.138)
Here 'the man as machine' metapher is quite evident anda
so is the idea of healing as a technique". Such a narrow view of
healing will result in its exclusion' from medical science, as
long as researchers limits themselves to a framework that does
not allow them to deal significantly with the interplay of body
mind and environment.
One example which very, clean shows up the limitation of
this ultratechnological view o.f human illness is that of the
concept of
madness and other 'psychiatric illnesses' Being
perhaps the outermost interfan between a human individual and
the culture, it offen a large' field aforr interplay of. factors
; internal to human organism and these external to it ; his/her
cultural socio-economic, ideologico-policical environment. The
technological imperative that pervades the present culture has
resulted at in extension of the biomedical approach to mental
illnesses. Such a view has certainly helped control the- acute
symptoms of mental illnesses and of, providing useful treatment
for those illnesses of clearly organic oogin, it is quite
in appropriate for certain other kinds of problems for which
specifically psychological models are of fundamental signifi
cance ( See Kakar, 1982). The filility of applying concepts
.developed in connection with the technological approach to
human illnesses-is becoming clear ensuing in a lively debate .
about the nature of mental illness itself. While Thomas Szaaz
who considers it as a myth, perhaps takes the most extreme
position (Szasz 1972). A more balanced view
though radically
differing from the current medical understanding is put
- 17
forward by Foucault. (Foucault,1967)" Foucault makes it quite
clear that the 'invention of madness as a disease is a fact
nothing less than a peculiar disease of our civilization"
(Cooper, David in Faoucault 1967, Introduction p viii).
Madness which was considered a vicu in the middleages
became a subject of ridicule only to become a moral default
in 17th Century in the very strictly righteous atmosphere
reigned over by the Church. Beginning of 19th Century saw
temofuomg vopjemce /er/etrated on the insance. It was later
that it came to be identified as a disease. With the first
connection speculated by Pinal between the uterns and
hysteria, the foundations of the rudimentary form of clinical
psychiatry .ere laid. "It was in these diseases of nerves
and in these hysterias that psychiatry took its origins (
^'oucault 1976, p 158) Now it was only a matter of time that
drugs would be used in psychiatry when the basic Philosophical,
foundation was laid down.
Psychiatric illnesses whose causes, if the factors
contributing to its occurrence can at all he called causes,
lie in the family, in the society and in the cultural
surroundings, came to be treated much in the same way as any
bodily illness, by removal of the internal cause either by
using drugs or through more violent procedures. ' I am made
to", to use cooper's words in a different context, "... break
through a certain delimitation of what I am, towards a version
of myself hinted at" (through normative social, moral or even
political behavioural expectations - DM) (Cooper in Introduc
tion, Foucault 1967 p ix). Thus instead of altering the
unrealistic, often undemocratic expectations by the family,
the society or the polity from an individual or more
appropriately emending the culture which breeds such expectations
it is the individual that is bent using medical technology
while the unchaining of the insane may ha/e been a step forward,
it has led to the chemical
1 straitjacketing' of those with
deviant behaviour - neurotic or psychotic. What's worse is
that this usurping of the cultural territory is accepted
by the technologised culture in the name of science.
The foregoing namely, culturally accepted exclusiveness
ofphysicians, faith in omnipotency of
technology and an
... 18/-
- 18
encroachment of medical technology upon the territory of culture
proper, are the mainstay of what Illich calls 'cultural iatroqen-.
sis’
(Illich,1977) brought, about by modern medicine. Mow if the
modern medical science and technology is culturally inappropriate
and ideologically value-loaded, should we reject it altogether
as Illich suggests, or is there a middle way ?
4) ALTERNATIVE "'EDIC1.-E: A REJECTION OF r.'OuERN rEDICINE ?
Avoiding w foreclose a potential debate, a few pointers
a re ra i se d he re .
A)
There can be no doubt that modern medical science and
technology has provided great in sights into the working of
the human organism, has provided relief and cure for a numbrr
of diseases, and has given us tools to contribute to healing
process in a postive manner. But it is equally true that its
cultural integuments has impeded its progress by nbncrwingto
outlook or by introducing an inherent bias in its methodology
and/or its epistemology or has omitted a prior to look into
certain areas declaring them irrelevant, unscientific or
traditional, bu the very definition of modern science. How
can this contradiction be resolved could these insights and
curves been obtained without nanowing of its outlook? In short,
i s the reductionism, an essential prerequisite of any scientific
enquiry ?
B)
The cultural context of modern science and technology on the
one hand reveals the cultural biases inherent to them. On the
other hand, it also reveals what was hidden till now. vVhat «
was invisible, or what was considered absent, has become
visible. In that, it has enriched our understanding of the
limits of scientific understanding. By its limitations beco
ming visible, science has become amenable to reinterpreta
tion, and to re-evaluation. Can this visibility <t»f cultural
i<x limits provide a new framework where in every concept of
science, whether traditional or modern could be judged a fresh
from its utility-not only strictly scientific - but social
political and philosophical and reintergrated ?
C)
Any technology when used in a cultural context that is
different from the one inherent to it would need to be
sham of its cultural garments. It would necessarily have
...19/-
19
have to be judged a fresh regarding its appropriateness
to the altered framework. It this possible ? Gaia technological
tool thatcarries a stamp of one culture, he used in a
different culture ? And would this re-evaluation itself not
involve a new attitude towards reality as one consisting of
different systems autonrnous but interdependent, capable of
being analysed in its own terms without upsetting its rela
tionship with other ? (Newtonian mechanics for mundane
ordinarily sensible world, Quantum mechanics for the sub
atomic, ordinarily insensible world, to quote an example from
physics)
D) Can such a frame work be considered internally consistent?
One such view has begun to emerge in the ecological
movement. The solution to the technological riddle lies not
in wholesale repection or alteration of technologgy. It
lies in chagging the cultural settings in whi-ch they arose.
It is only by changing the relationship between human being
and human beings, can a change come about in the relationship
between h.uman'bei’ng and nature, the theoretical of this
relationship being science and the practical one being the
technology.
TECHNOLOGISATION OF DEATH CULTURE OF TRIUMPH OR DEFEAT
of culture ?
No matter what culture, what science and wha t technology
prevails, death remains and will remain one absolute
biological limit to technological intervention. It can be
delayed statistically by few years, postponed clinically
by few months or even years, can be made painless and
sufferable but never conquered. Senility and death is the
ultimate culmination of all things living and non-living.
In death of man, the individual resides the immortality of »
man the species, because that is one 'was in which human
species. Thus not only it is inevitable, it is.indeed welcome
a necessary premise for a healthy life in its most general
sense.
The final form techooogisation of culture has taken
is in its encroachment upon the cultural meaning of death
Physician has come to replace the priest during the final
moments of life; nurses and other patients, the place of
20
family; drugs and oxygen cylinders, the place sorrowful but
comforting hands and finally when the end comes the ritual 6f
pouring 'Gangajal* down the throat is replaced by egually
ritvalistic-in most cases, at least procedure of cardiac massage
Now in the intensive care units, whirring of resuscitation
apparatuses replace the wail of the bereaved.
This is because, clinical medicine in its objectivity about
life has avoided paying any attention to existential issues, the
ultimate being death, when it is finally faced with it, clinical
medicine like an inexperienced batsman facing
fast bowler,
instictively hangs out its technological oat.
ishile for most traditional peasant culture death is cultu
rally accepted, lay welcome. The terminally ill and old people
expect and are exoected to die. "While the modern technological
society's lack of concern for spiritual issues is reflected in
the fact that the medical profession, like the society as a
whole is death denying. The distinction between a good death
and a bad death does not make sense, for k death becomes simply
the total standstill of body machine" (Caora
).
The age old art of dying is no longer practiced... and the
fact that it is possible to die in. good health seems to have
been forgotten bv the medical profession. It demands that every
death must have a preceding illness causing it. While. in the oast
one of important role of a good doctor was to orovide comfort
and support for dying" patients.... " (besides diagnosing the
imminence of death " Now... (they) ... find it extremely
difficult to cope with it. They tend to view death on a failure
... and... seem significantly more afraid of death than other
peo pie ....(Capra
)
It is this fear that lies at the root of the technological
imperative of supporting artificially, persons with irreversible
brain death, irrespective of its .emotional and social cost.
The technological arrogance has created a culture which shows
more concern for the insensibly comatose than for the sensibly
alive. Culture is being sought to be driven. Out from the.last
of its legitimate areaas. A new view of technology and
culture must endeavour to enrich life - the ultimate moment of
life beina death.
... 21
«
N u TEE
1)
For Foucault, clinic means both clinical hospital as well
as teaching hospital,
before the French Revolution,
oatients in France were treated under individual
physicians and nursed by the family at home. Doctors
were trained under these individual physicians, working
under them as apprentices. This m^ant that the poor had
no access to medical care or to medical education,
because both had to be paid for.
2)
Bouilland was the first clinician to point out the
correlation between occurrence of heart disease and
acute articular
rheumatism, b?sides describinq the
jugular venous Dulse seen in the neck, qablop rhythm
- the double hea.rt sound heard at the apex in mitral
slenosics (
narrowing of the valve separating the
Iseft ventricle and atrium.) the friction in the
pericarditis swelling of the outermost layer covering
the heart,,
the extrasystole (those of heart beats
responsible for the sudden and disturbing palpitation)
and auricular fibrillation.
3)
(Kutumbian 19).
The use of sexual metaphor is well brought out by
Carolyn merchant "Mere ia bold sexual imagery is the
key feature of modern experimental method, constraints
of' nature in the lab, dissection by hand and mind and
the penetration of hidden secrets ... language still
used today in praising a scientist's 'hard'
'penetrating' mind or the
facts,
'thrust' of his arguments...
She further asserts that ".For- Bacon, as for Hanrey,
sexual politics helped-to structure the nature of the
empirical method that would oroduce new form of
knowledge and new ideology of objectivity seemingly
devoid of cultural and political assumption".
(Merchant 1983 , p. 172)
22
HaFSRc.NCcS AMD 3I3LIOGRAPHY
1)
Homo Faber:
Alvares, Claude
Technology and Culture
in India, China and the ’Jest 1509-1972.
Allied Publishers (P) Ltd., 1979.
2)
Bloomfield (Jr)
i
Ya j urveda,;
Sacred Books of the East
Vol XLII.
3)
Caora, Fritjof
The Turning Point;
Scie nee, Society
and the Rising Culture, Flumings
oooks, Fontana Paperbacks London,1983.
4)
Chattopadhyaya D.
Science and Society in Ancient fndaa.
Research India publications Calutt^
1977.
Knowledge and Intervention:
A study in society and consciousness
Firma KlM PVT. Ltd., Calcutta,1985.
5)
I
6)
Elzinga Aant and
Jamison Andrew;
Cultural coruponents in the Scientific
Attitude to Mature:
.Astorn iVo.'!es 7
Eastern and
Research Policy
studies Discussion Paper 146 of
Research Policy Institute, Lund
University, Sweden, May,1981.
7)
Foucault, Michel:
The dir th of the Clinic: Tavistock
Publishers, London,1976.
8)
9)
;..adn°ss and Civilization: A History
of Insanity in the Ane of Resason,
Tavistock Publishers, London
(English Ed. )1967.
Fredrickson, Donald,o;
Health and Search for Hew
Knowledge in Knowles John H (ed).
Doing oetter and Feeling .<orse"
New York,1977.
10) Quote, Manisha
The Social Trap in In search of
Our Bodies, Shakti Ed. Collective
(Ed) Shakti, Bombay,1987 op 6-12.
t
I
-sa
il. lllich, Ivon
12. Kakar, Sudhir
Medical Nemesis Bantam Bo o k s,
New York, 1977.
Shcmams Mystics and Doctors:
Oxford Univ. Press, New Delhi,1982.
13^ Kuhn Thomas 3.
The
cructure of Scientific
lievo 1 ution, Chicago University
Press, Chicago,1962
14. Kutumbiah, P.
Evolution of Scientific iv.edicine,
Ovient Longman, 1971.
15. Leach, Edmund R.
Culture and Social Cohesion:
An Anthropological view in
Ge raid Ho1 to n (Ed.) Science and
Cuiture , Flouqhton Mifflin,
Boston, 1965.
16. Malinowski B.
'Culture' in Encyclopaedia of
Social Sciences Vol.4, New
York, 1931.
17. l.ankad, Dhruv
A Dialectical Approach to
Traditional Medicine - A case
of Traditional Chinese, Medicine
in Socialist Health review Vol 2
No.4. Sombay,1986.
18. Medico Friend Circle
..omen and Health - Papers of the
X Annual Meet, January,1983.
19. Merchant, Carolyn
The- Death of Nature: women,
Ecology and the Scientific
Revolution, Harper & Row, San
Fransisco, 1983.
23. Nasr, S.H.
Man and Nature: The Spiritual
crisis of Modern Man, George
Allen and Unwin, London,1969
(1976).
21. Needham, Joseph
Science and Civilization in
China Vo1.5 Cambridge University
Press, Cambridge 1954.
...24/-
I
24
I
22. Rose, Hilary and
Rose, Steven
Science and society Penguin Books
23. Sa va ra, Mira
Why not the 1PD in In search of
Ltd., Hammonds worth, 1970.
Our Bodies op cit pp 54-57.
24. Sevin, Nr than
In Naskayana Shigeru and Sevin
Nathan (Ed.) Chinese Science:
explorations of An Ancient Tradition
M.I.T. Press Cambridge, Mass, 1973.
25. Szasz, Thomas
The Myth of Mental Illness
Seeker and Narburge London, 1972.
26) Williams, Raymond
Key,'or d s
A Vocabulary of Culture
and Society, Montana Books, Galsgow
1976.
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