A Metamodern Approach to Asian Medicine

Pierce Salguero

Part I in the “Meta Approaches to Asian Medicine” series

This post first appeared on Medium.com.

Are we all taking ourselves a little too seriously? (Source: Wikimedia Commons, Carnaval Madrid 2015.)

The traditional Asian medicine community has a communication problem. We know it all too well. Lawrence Cohen identified it decades ago when he wrote about the Third International Congress of Traditional Asian Medicine (ICTAM) in Bombay in 1990. He observed that conferencegoers who were practitioners were congregating in certain parts of the conference talking among themselves, while the scholars occupied their own separate spaces. This divide was not only physical but also intellectual: each community’s conversations inhabited radically different conceptual worlds. Cohen wryly summed up the scene as an “epistemological carnival.” [1]

I have been for the past 25 years or so a practitioner, teacher, and scholar of traditional Asian medicine (below abbreviated TAM, by which I intend to include acupuncture, Sowa Rigpa, hatha yoga, Thai massage, mindfulness meditation, qigong healing, and all the other contemporary Asian healing systems that claim to have premodern origins). Having attended numerous conferences and gatherings on both sides of that aisle (including several ICTAMs of my own); having edited an academic journal on TAM, a practitioner-oriented blog site, and a Facebook group for both communities, I can attest to the fact that there have been an increasing number of interdisciplinary collaborations in our field since Cohen wrote his piece (such as this one). However, I all too often have also seen practitioners and scholars speaking past one another. All too often, to quote Cohen again, the air has still been “thick with colliding assumptions and bad tempers.”

Irreconcilable epistemes

Below I’ll introduce a way forward, but first, in order to understand the rancor that still persists, I think we need to take the time to appreciate where the participants in this carnival are coming from. My assessment is different than Cohen’s in that I see not two but three groups, but I agree that each is beholden to its own episteme (or, you might say worldviews or paradigms, let’s not get too hung up on the terminology). For purposes of our conversation here (and again, let’s not focus on the terminology), we’ll call these three groups “traditionalists,” “modernists,” and “postmodernists.”

The first group, the traditionalists, are characterized by a deep commitment that their particular brand of TAM is a genuine font of wisdom. The knowledge carried by their traditions transcends historical epochs and geography. It is possible to practice these ancient traditions today because they have been handed down by a continuous lineage of masters and through authoritative texts. Because the biggest danger to the authenticity of these practices is the corruption of tradition by misunderstanding or modification, tradition must be preserved and continue to be handed down in a pristine way. The traditionalists see themselves as doing precisely that. (As did I when I started out in the practice of Thai medicine, meditation, and yoga.)

A high profile Asian medicine traditionalist is Dr Nida Chenagtsang, popularizer of a system of Tibetan Buddhist healing based on the 12th-century writings of Yuthok the Younger. (Source: Wikimedia Commons.)

The highest status among traditionalists — if one is not a wizened practitioner from Asia oneself — comes from having a reputation for being able to access such people. Better yet, being authorized by such people to share the inner teachings of the tradition. Or, at the very least, being able to read ancient texts that have a quasi-sacred status within the community. But, gaining support from science or academia is helpful. Traditionalist practitioners often appeal to contemporary scientific or academic concepts, and they may even avidly follow these literatures.

The traditionalists’ claim to authenticity is established, conferred, and reinforced largely via non-scientific and non-academic media ecosystems, such as social media, YouTube videos, trade journals, and various other popular media. Professional accolades, membership in certain professional bodies, and personal websites are also often important, although all of these are always secondary to claims of direct access to the “true” tradition.

The second group, modernists, are far less concerned with tradition and authenticity than with empiricism and universality. For them, TAM practices also transcend time and place — not because of the continuity of lineage, but because of their ability to be scientifically verified. The modernist is convinced that the active ingredient in any given TAM intervention can be isolated. Whether it’s a chemical derived from an herbal medicine or the proper “dosage” of mindfulness, once it’s identified, it can be explained, understood, and practiced independently from the “cultural trappings” of the tradition of origin. Also, once extracted in this way, it can be studied in the lab.

A well-known Asian medicine modernist is Tu Youyou, recipient of the 2015 Nobel Prize in Physiology or Medicine based on her research on the traditional Chinese medicine artemisia. (Source: Wikimedia Commons.)

The modernist is fully confident in the power of science, biomedicine, and public health to explain the efficacy of TAM. But, this does not mean the modernist is necessarily a scientist. Of course, there are scientists, medical researchers, and others who investigate TAM in labs around the world who win accolades and legitimacy by publishing novel findings in research journals, landing prestigious postdocs, and even winning Nobel Prizes. A quick PubMed search will reveal that these individuals are responsible for a robust and growing scientific literature on all manners of TAM.

But, there is also a sizeable swathe of non-scientist TAM practitioners — acupuncturists, massage therapists, herbalists, and others — who also prioritize science over tradition even if they personally have never looked through a microscope. They justify their acupuncture practice not with ancient texts but with modern kinesiology, say, thinking primarily in terms of fascia and electromagnetic fields rather than channels of qi. For these practitioners, success comes when an inscrutable TAM practice is made legible to modern medicine, when it can be bottled (literally or metaphorically) and spread far beyond its original cultural milieu, and when it finally becomes recognized by international healthcare regulators.

The third group of participants in our carnival are the postmodernists. Postmodernists style themselves as observers of TAM instead of practitioners of it. Most are scholars trained in Western universities, or they are analysts who primarily take this scholarly approach. In actual fact, a good number of postmodernist scholars (present company included) either were or still are practitioners, but, if so, these two sides of their life are well compartmentalized. The central questions of the postmodernists are not about how to tap into an authentic tradition or how to scientifically prove that TAM works. Instead, they are interested in how power dynamics, discourse analysis, nationalism, gender, race, class, identity, and a number of other historical and sociocultural forces shape the practice of TAM. Scholars may indeed talk about tradition or empirical proof — but only about how these concepts are socially constructed.

Nathan Sivin, one of the pioneering scholars of the sociological and historical dimensions of Chinese medicine. Photo by the author.

The intellectual and disciplinary underpinnings of the postmodernist are similar to what you would find in other academic fields. Injected with a critical edge by post-Foucaultian histories and anthropologies of medicine, the academic study of TAM is housed within the fields of Anthropology, History, and Religious Studies, and comprises a group of scholars whose primary commitments are to those fields.

Though gaining increasing recognition as a legitimate area of study since the 1990s, the study of TAM is still quite marginal within the academy more broadly. When not among their fellow TAM enthusiasts, the postmodernist scholar is therefore likely to be found in a defensive crouch, constantly deconstructing the other epistemes in order to demonstrate to the broader academy that they too belong at the seminar table.

An increasing number of scholars of TAM can be found attending academic conferences, publishing in the journals, and professionally affiliating with this field, and so its profile has grown a bit since Cohen published his write-up of ICTAM. Works by these scholars are consequently coming to be more accessible to traditionalist and modernist practitioners; nevertheless, for the most part, non-scholars tend to continue to hold the postmodernists at arm’s length, if they notice their presence at all.

Let the jousting begin!

While individual members of these three groups have often played nice together in the TAM field, these three factions just as often have expressed — how shall we put it? — a rather low estimation of each other. For example, the most withering critiques of traditionalists made by those outside the episteme center on their extreme naïveté and blind faith in the wisdom of the ancients. Their fetishization of Asian tradition smacks of orientalism and cultural appropriation.

The modernist, on the other hand, is quickly accused of scientism. The detraditionalization of thousands of years of cultural production, boiling it all down into a synthetic pill or an 8-week practice protocol is laughably reductionistic. The ease with which the modernist tells us “what is true” about the tradition smacks of arrogance and neo-colonialism — not to mention that many of them are complicit in the actual colonialism of bio-prospecting.

Often it’s the postmodernists who are lobbing these very accusations. But of course, to anyone outside of academia, the ivory tower has its own obvious flaws. Like traditionalists, the postmodernists have the habit of fetishizing their Asian culture of choice, and eternally dwell on the narcissism of minor differences. The moral relativism and the hermeneutic of suspicion behind the academic stdy of TAM is also seen as leading to paralysis: steeped their privilege and hopelessly aloof from the real world, the professors have no reply to the needs of the present moment.

To be clear, what I’m presenting here are the negative stereotypes. These are the maximally uncharitable views each of the epistemes have expressed about the others, and I’m overstating their differences to make my point. But only slightly.

In addition to stereotyped views of each other, each episteme is continually policed against intrusions. Each of the three factions has its own well-defined body of “unmentionables,” things that simply cannot be said in polite company because they would undermine the principal commitments of the episteme. For example, it is allowable for a Western-trained historian of Japanese medicine returning from a Reiki conference to admit to colleagues that they “enjoyed doing field work.” But, would they wax poetic about the scientific evidence for ki-energy at the seminar table during a job interview for a history department? Likewise, would a student in a yoga therapy program vocally protest the Western yoga industry’s rank orientalism, cultural appropriation, and neo-colonialism? Would a qigong master with a strong traditionalist following highlight the fact that they simply invented their routine last Tuesday based on reading kinesiology textbooks? Not if they don’t want to commit professional suicide.

In practice, it is clear that some territories are more vehemently guarded than others. The grant proposal and the conference panel are especially well-defended, for example. The parameters dictating what’s allowable are also well-fortified in departmental policies, peer review processes, international healthcare policy debates, and other institutional structures. And thus they inescapably shape the limitations of our professional identities, our research agendas, and our collaborations with one another. There are some individuals who appear to be able to successfully navigate between two or more of these worlds with a certain amount of “medical bilingualism.” But, more often than not, such people have had to learn to self-silence, to edit themselves, or to code-switch in different environments. For the most part, our disciplinary rules limit our abilities to speak, or eventually to even think, across the epistemic boundaries.

A metamodern solution

So far, I have only been speaking in relation to TAM, but the reader may already have intuited that the stakes are so much bigger than that. For, doesn’t the basic problem of irreconcilable epistemes apply to every aspect of twenty-first century life more generally? Isn’t this the same exact impasse that prevents us from developing any solutions to climate change, to economic inequality, or to global armed conflict? Isn’t the fundamental problem behind all of these issues — and all the other huge unsolvable problems — that we simply do not know how to engage in productive dialogue with people who see the world drastically differently than we do?

Surely we must see by now that consensus on any of these truly tough problems simply cannot be won by argumentation. Let’s make no mistake: the epistemes are irreconcilable. When I find myself operating from a different epistemic perspectives than someone else, no matter how logical my arguments seem to me, they will fall on deaf ears. I may tell myself that my interlocutor is too stupid to understand what I’m saying, but the true barrier is that my ideas literally make no sense within their worldview. My words are unspeakable, my ideas unthinkable within the reality they inhabit.

How to communicate across epistemes and achieve mutual understanding is, you might say, the central question of the era of globalization. Recently, the word “metamodernism” has been floated as a name for the solution to this kind of epistemological impasse. I am going to use that term here as well, although I need to introduce a caveat, because there are at least two drastically different interpretations or approaches to metamodernism. On the one hand there are models associated with Hanzi Frienacht, Integralism, and the likes, which arrange divergent epistemes hierarchically and developmentally (i.e., modern is more advanced than traditional, postmodern is more advanced than modern, metamodern most advanced of all). That form of metamodernism has all kinds of issues, and is in fact the antithesis of what I’m advocating here.

What I am interested in is what we might call the “oscillatory” model of metamodernism that the Dutch academics Timotheus Vermeulen and Robin van den Akker proposed in a 2010 paper, in this follow-up piece, and in a 2017 volumeco-edited with Allison Gibbons. This form of metamodernism has been used by scholars of aesthetics and media studies, as well as by artists and commentators, to describe a wide variety of global cultural forms, particularly in the realm of film, art, and popular media. What makes a work metamodern, in their estimation, is the juxtaposition of postmodern and modern elements, not resolved within some larger hierarchical scheme, but rather coexisting in an unreconciled tension. Having both the naïve emotionality of the modernist and the cynical deconstruction of the postmodernist equally prominent within the same frame could potentially be jarring or even disorienting for the viewer, but the hallmark of metamodernism is that this juxtaposition is emotionally rich, exuberant, heartfelt, and most of all, fun.

The theory has also been taken up by religious studies scholar Linda Ceriello to discuss the “productive destabilizations” available by juxtaposing traditional and modern visions of Asian mysticism, among other things. Although all of its main proponents have been adamant about this form of metamodernism being a descriptive term for a “structure of feeling” in culture and the arts, and not a cultural or social program of any kind, here I am going to extend their model in a prescriptive direction. Essentially, I’d like to argue that, in order for genuine constructive dialogue between different players in the TAM space to emerge, we need to start intentionally fostering a metamodern sensibility. That is to say, we need to combine the naïve convictions of the traditionalist and modernist practitioners with the cynicism of the postmodernist academics within a single social frame (such as an ICTAM conference) in a way that is both productive but also fun.

I’ll get into more specifics about how precisely to make these changes in Part II of this series. For now, I’ll simply emphasize that approaching TAM in this spirit would lead practitioners and academics alike to be able to oscillate among epistemes with a lightness of being, without feeling tied down by any particular disciplinary restrictions. We would become able to appreciate the paradoxes that arise from the juxtaposition of different truths, without feeling the need to resolve those tensions. A practitioner of qigong, for example, may learn to entertain serious doubts about the Daoist origins of this practice that is so meaningful to them, even while simultaneously being at one with the Dao when they practice it. Or, a scientific researcher of mindfulness may find themselves genuinely excited about the potential health benefits of our mindfulness practice, while also having strong objections to the way that mindfulness science is appropriating and commodifying Buddhist meditation practices. Or, a scholar may find themselves believing they have the power to communicate with disease-causing ghosts even while knowing perfectly well that that spirits are just social constructs.

From carnival to Carnaval

In the end, of course, all of this is not just about improving our collaborations in TAM; it’s also about each of us learning to to enhance our own cognitive flexibility, to transgress the limits places on our thinking by our professional identities, and to expand our imaginations beyond our self-imposed boundaries.

Cohen’s notion of the carnival was meant to draw attention to the negative consequences of miscommunication. When cross-epistemic translation fails, it’s a Tower of Babel, it’s chaos and disappointment. If there is any conversation at all, it is contentious cacophony. Each faction competes to have the loudest voice, each striving to enforce a master perspective that can “make sense of it all,” while in actual fact just speaking past one another.

What is needed is not a louder voice in the mix, or a bigger and better master perspective. A oscillatory metamodern approach would instead allow us to celebrate our radical differences without being threatened by the dissonance. Yes, there would be cacophony, but we would experience it as a joyous and party-like atmosphere. The competitive carnival would be transformed into the playful spirit of Carnaval (please read that word with a Spanish accent).

Carnaval, as we know, is a time for feasting and revelry. It’s a time when the usual social norms are suspended, when roles are reversed, when the “unmentionables” that usually are hidden from polite society are embodied and put on full, garish display. Carnaval is an invitation to temporarily cease grasping so tightly to what we normally hold to be right and true. For a limited time, we don our feathered headdresses and besequinned masks, taking on alternate identities. (We might even drop all of our defenses altogether, nakedly hurling ourselves into the festivities with drunken abandon!)

Carnival vs Carnaval: is this a distinction without a difference? I don’t think so. When we are able to hold our disciplinary identities as lightly as if they were Carnaval masks — to switch masks midstream, or to discard them altogether — we become able to experiment with different ways of knowing and different ways of being. When we stop taking ourselves so seriously — or better yet, throw away our rigid concepts of self altogether — I think we will become light and experimental and non-self-serious with each other and with ourselves. We will not need to identify so strongly with any one way, and will value plurality more than ever. I am certain we will have better interactions with others in our field, and we will all definitely have more fun. Who knows, together we might even find ways to solve much bigger problems… or maybe even save the world.

Oh, sorry, was that too naïve?…. well, feliz carnaval!

[1] Lawrence Cohen, “The epistemological carnival: meditations on disciplinary intentionality and Āyurveda,” in Don Bates, ed., Knowledge and the scholarly medical traditions, Cambridge UP 1995.

This the first in a three-part series:

  1. A Metamodern Approach to Asian Medicine
  2. A Metadisciplinary Approach to Asian Medicine
  3. A Metamorphic Approach to Asian Medicine

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