Editor’s Note: “Medicine and Empire” was written by, Tai Lahans, who passed away on May 31, 2024. Tai was one of my teachers at Middle Way Acupuncture Institute, where she taught two classes: Integrative Medicine and Public Health. Although I did not know Tai for very long, but her words and presence made an impact on me.
For her integrative medicine class, Tai would write an essay for each class, and instead of lecturing, would read her essay to us, interspersed with colorful commentaries and unforgettable stories. Tai felt that we could not truly consider integrative medicine without understanding the history of medicine in the West, a history inextricable from politics, society, and prejudice.
Tai was not one to mince her words. She was not afraid to explore the uncomfortable dualities of East and West, imperialism and indigenous rights, white privilege and misogyny, integration and pluralism. Her clear perspectives on medicine as a cultural phenomenon made her impulse toward integrative care depthful and sincere.
A biography shared by Middle Way Acupuncture Institute summarizes Tai’s diverse life-experiences and contributions:
Tai began her studies in medicine by earning a Ph.D. from UC Berkeley in Medical Anthropology. Her dissertation was on the Ayurveda Shastras. She lived in Mumbai for six years serving the poor of Dharavi Slum as part of a team of medical providers who utilized Ayurvedic, Western medicine, homeopathy, and Chinese medicine. The clinic she co-founded served the very rich of Bollywood in order to subsidize the medical care for the outcaste poor of Dharavi which at that time was the largest slum in the world with over one million people living in it. She began studying Chinese medicine in the 1970s and practiced Chinese medicine for the past 38 years serving mainly patients with chronic viral diseases and cancers.
Tai taught at several schools, including Bastyr University and Seattle Institute of Oriental Medicine. She has also taught in several clinical settings including integrated hospital oncology units. She lived in the PRC for four years studying and working on oncology units. She held a Ph.D. in Integrated Oncology from the China Academy of Chinese Medical Sciences in Beijing. Tai also wrote Integrating Conventional and Chinese Medicine in Cancer Care: A Clinical Guide and The Geology of the Modern Cancer Epidemic: Through the Lens of Chinese Medicine.
In addition to her medical knowledge, Tai had an interest in astrology, and considered herself a Buddhist. I remember discussing Pluto in Aquarius, Dane Rudhyar, Liz Greene, and the Sabian symbols. She was hopeful that Pluto in Aquarius would initiate a cultural transformation.
On the first day of her integrative medicine class, Tai presented “Medicine and Empire” to the class. Moved by her provocative discussion of medicine and culture, I asked Tai if she had the intention of publishing the essay. In response, Tai said:
I feel that anything I say in class has barbed wire around it for some people and a purple ribbon around it for others. As for the little paper I wrote for this class on empire and its effects on medicine: I rarely ever sign anything that comes from my mind. I feel it is a download from above. I consider it or really all that I say, for better or for worse, as part of the Commons. To be used. So use it in any way you feel moved. Others have written similarly on this subject. I believe that truth is a constantly evolving transformation. And can be used to move us down the road. We desperately need that movement down the road right now.1
Tai’s remarks function as a preface to her essay. Take the purple ribbon or barbed wire comment as a trigger warning, as Tai’s writing is passionate, ecological, anthropological, and unabashedly polemical. As her response makes clear, Tai did not believe in the concept of “intellectual property”. When I told her I would love to publish “Medicine and Empire” on my Substack, she gave an enthusiastic, “Thank you!!!!”. This was in December 2023, and I did not know then that I would end up publishing her essay posthumously six months later. But it feels like a way that I can honor Tai, by sharing “Medicine and Empire”, as it so beautifully summarizes the themes of her thinking.
When I wrote “Medicine and Imagination”, I was remembering Tai, and knew she had been in the hospital. In some sense, “Medicine and Imagination” is my consideration of the concluding query she poses in “Medicine and Empire”: Integrated or not, what do you want for the future of our medicine? As Tai vividly illustrates, empire tried to destroy the indigenous imagination of medicine and replace it with the barren landscape of monoculture. Yet, as she says, “We’re still here”. We need medicine that participates again in the cultural and collective imagination it originally came from.
Despite her tenacity for addressing difficult and uncomfortable topics, Tai never lost hope for the future, and was always looking for ways to empower it—in service to her students, patients, and community. If anything, Tai wants us to remember the good, the true, and the beautiful before we go too far in the name of progress.
My introduction, “Patient and Polis”, offers some context for Tai’s essay. Due to the length of “Medicine and Empire”, I have taken the liberty of adding numbered sections with titles for ease of reading amidst topical shifts. Minor adjustments were made to punctuation for the sake of flow or clarity of argument. All bold words were bolded by Tai and are not my additions. I have added footnotes where I felt a concept benefitted from a definition or elaboration. In-text links to Tai’s references have been added where possible. “Medicine and Empire” has not been published before, though a precursor of its focus can be found in Disease, Medicine, and Empire by Roy Macleod and Milton Lewis.
Lastly, a GoFundMe page was made to raise funds for Tai’s end-of-life care, and now all contributions go to the Indigenous Student Scholarship at Middle Way Acupuncture Institute. Organizers write:
One of Tai's final wishes was that any extra funds go to an Indigenous Student Scholarship at Middle Way Acupuncture Institute. Tai saw the power of our medicine as an Indigenous medicine and a bridge across the oppression of colonization. With your support, we hope to make Tai's final wish a reality.
Patient and Polis
An Introduction to Medicine and Empire
By Neeshee Pandit
The first task of the doctor is . . . political: the struggle against disease must begin with a war against bad government. Man will be totally and definitely cured only if he is first liberated”.2
“Medicine and Empire” follows in the footsteps of Foucault’s structuralist critique of power relations and asks the important questions: How can we approach integrative medicine without acknowledging power and its relationship to knowledge, specifically European medical knowledge? How can indigenous forms of medicine integrate with Western medicine, without ignoring the history of imperialism? How do we integrate without being categorized professionally but pejoratively as “alternative”, “complementary”, or what these words really mean: subordinate, lesser than, irrelevant. Integration has become the official cover for assimilation, where validity and efficacy are defined by Western medicine alone, with traditional physicians forever cow-towing for approvals. Our only peers are journal reviews documenting clinical trials and studies conducted with both eyes closed. Placebo, once pejorative, has been re-assigned as the mechanism of “alternative” therapies—read: it works for subjective reasons only, the real medicine is in science.
Tai manages to raise all of these issues while remaining an advocate for integrative care. Tai was one of the first acupuncturists licensed in the State of Washington and her journey reaches into the history of American counterculture. She has been on the frontlines of the struggle to legitimize Chinese medicine in the United States. She worked in hospitals abroad where integrative care is normative. She passed through her own health struggles with the aid of Chinese medicine and Western medicine. Perhaps most importantly, Tai is an indigenous person, belong to the Anishinaabe tribe. Her mother was forcibly taken to residential schools in Canada, and the trauma of her ancestors reverberates in the psyche of her writing.
The history of American acupuncture begins in 1971, when James Reston published an article about acupuncture in The New York Times—“Now, About My Operation In Peking”. The article details Reston’s experience undergoing an appendectomy in China with acupuncture anesthesia. Reston was awake for the entire surgery. Reston also recounts receiving acupuncture for post-operative pain management. His editorial brought acupuncture into mainstream American curiosity. Reflecting after surgery, Reston writes:
Since then I have lived with the rhythm of what must be the quietest city hospital in the world, constantly regaining strength and acquiring an intense curiosity about the politics and medical philosophy of the doctors in attendance.
They insist that the two cannot be separated and they are quite frank in saying that the sole purpose of their profession since the Cultural Revolution of 1966‐ 1969 is to serve all the people of China, 80 percent of whom live on the land.3
Indeed, since the cultural revolution in China, indigenous forms of Chinese medicine suffered at the hands of a growing empire. The moniker, “Traditional Chinese Medicine”, refers to a Maoist revision of Chinese medical thinking, re-purposed and standardized for the masses. We need not dig into the ancient annals of history to discover the influence of empire upon medicine, and of politics upon patient.
With “TCM”, Mao supposedly sought an integration between Chinese medicine and Western medicine. By standardizing Chinese medicine, Mao was able to extend medical care into rural areas with “barefoot doctors”. But Mao did not truly integrate two medical traditions, he reduced one to the other, removing indigenous forms of thought (now “superstition”) and replaced it with the naive rationalism of Western scientism. Therefore, if we laud Mao for his progressive vision, then we have lost sight of medicine in the aegis of empire.4
In “Medicine and Empire”, Tai asserts that medicine and politics are not merely related to one another, but nested within each other—historically and culturally. We cannot divide or enclose these fields from each other without feigning ignorance. Medicine has not emerged in isolation, somehow separated from society and its politics. Medicine is not only of the human body, but the culture in which it lives—the body politic. Within our theories and diagnoses lays a complicated foundation, informed by prejudice and poison just as much as nectar and nirvana. Tai elucidates these nuances with an anthropological perspective of medicine, assigning a socio-cultural basis to medical theories and practices. In other words, the phenomenology of medicine is cultural, its syndromes societal, its patients citizens.
Tai defines medicine as “the art of healing and of preventing diseases” and calls for a resolution of its identity crisis:
We need to regain and maintain agency over our own medicine. At a basic level, agency is the essence of being human . . . We cannot wait for conventional medicine to tell us who we are.
In the same breath, she defines the physician as “a sage, a counselor, a community activist, a medical doctor, a spiritual adviser” who realizes that “poverty is a major cause of illness” and that “capitalism, urbanization, commercialization of agriculture and our food system are not working to promote health”.
In the medical focus on internal and external pathogenic factors, we have missed the biggest one of all: civilization itself. We have to ask ourselves if our profession exceeds the parameters of merely doing no harm. Does the practice of medicine not carry within its germ a civic duty? Our patients are citizens before they are cases, and persons before they are citizens. This lends a cultural etiology to every illness, since every person is a microcosm of the polis. The clinic appears within the city like an inner sanctum, a refuge for one’s ills, a cure for the disease of culture. Our symptoms are more than our own, they are given to us by nature, and against it.
In Civilization and Its Discontents, Freud explored the issue of culture as a repressive force, the so-called individual deeply conditioned and hardly independent. The repressive force of civilization displaces our agency, and drives our individual instincts deeper into the collective mud, where it awaits sublimation in war. We are guilty for all that we cannot be, and for the damage we cannot undo. Ecological havoc pervades the system, and we are inside of it, a growing sickness. Ecological wounds are the trauma of warfare, of life against life, where death is done before its overture. Medicine is ostensibly the cure that arises in a self-correcting system; a physician is ideally one who cultivates natural order, but medicine cannot correct what it does not acknowledge.
In Tai’s vision, medicine becomes meaningful as an individual and collective force, a pressing upon society from its own physiology. She argues that medicine has been shaped by empire for hundreds of years, and has lost its cultural roots while being subjugated to the ongoing hegemony of scientific-materialist medicine.
Empire conquers civilization. Empire invades and takes the territory of any tradition it so desires to de-flower with heads of war. Empire is imperialism, an opus contra naturum, the opiate repressing the masses everywhere. Empire is the fault line where no boundary exists. Empire is the eye of evil, looking for its next meal. And we are its citizens.
The problem is that politics are polarizing. Social media gives us a world in apparent dialogue with itself on virtual sides of the internet. Disagreement breeds conflict, limited contexts foster misunderstanding—we cannot see over the line in the web. We are triggered, our fingers pointed like guns, typing on frontlines we’ve never seen. If we define people by their beliefs, then a conceptual disagreement breeds estrangement. We need to agree to disagree. The ethic of therapy necessarily contains dualisms, and medicine widens the container that accommodates them. Jung defined neurosis as “one-sidedness”. Medicine is working with neurosis itself, in various forms and levels. Therefore, medicine has to free itself from all “sides” to become a true vessel of wholeness, a temenos amidst the secular.
The question is—who is the patient? On one level, the patient is an individual, a person. On another level, the patient is also part of society, and therefore a citizen. In other words, “who” has a personal and collective ontology. Do our cities have souls or only the ghosts of persons past? Is the metropolis a cemetery of the collective unconscious, a polis without a psyche? Whether shaman or surgeon, the patient is body and soul.
The problem is that the polis is in our psyche, and we can’t get it out of our heads. It stares back at us when we didn’t think we were looking. It infiltrates our lives with algorithmic invasions. Our synchronicities are nothing more than programmed eavesdropping, a calculated coincidence waiting to startle us. Our memories are fake recollections of a new design. There is no déjà vu, only a vague illusion of familiarity to leave us vacant and agape.
The problem is progress. The privilege of civilization, the onward march, the omega-point of Westernized culture. Postmodern egalitarianism postures justice by neutralizing our values and destroying its hierarchies. But do we not have a hierarchy of needs? We don’t need neutrality or moderation, but a radical voice that pleads for understanding from the rubble.
How can a doctor remain walled in cloaks when a war continues, delivered in our hands, like a cup of coffee? Our phones are the new dawn, the first light of sleep, and what rises there is ravenous. We risk repressing our patients with medicine, keeping their symptoms quiet like a sanitized gestapo delivering legal aid. Our sins are sanitary now, but we’ve had a hundred years of it—and our sickness is getting worse.5
Discovery, empire, and progress are the troubles of today. They pollute our minds and then our body politic. For all this disdain of “primitivity”, our civilizing cures seem more savage by the hour, at ever more cost to the consumer. Progress pre-empts tradition, empire co-opts it, “pioneers” replace it. We self-destruct because there is nothing left to create. Suicide in the city. Drowning in the workforce. Cancer in the collective. A polis that has no telos reaches the point of no return. Only a perpetual precipice is provided to volunteer our death upon.
Tai tackles these issues and deconstructs them, paragraph by paragraph. She criticizes colonialism, imperialism, misogyny, patriarchy, racism, nationalism, and materialism. She raises the issues of settler responsibility, indigenous rights, ecological awareness, and spiritual understanding. Tai poses a query to all of us, patients and practitioners: What kind of a world do we want to see? What does it mean to integrate indigenous systems of medicine within colonial paradigms? Where is the reunion of medicine and meaning? In her concluding remarks, Tai writes of the current moment:
“We’re in it—a massive rethinking of the meaning of life and how we want to live it”.
Medicine and Empire
by Tai Lahans
I. The Doctrine of Discovery
The Doctrine of Discovery is the first mandate to codify the rules of the road, so to speak, about how an explorer in the early days of discovery was to handle the fauna and flora of the new places discovered as a result of searching for a circular trade route between Spain and India. It was written by a Roman Catholic Pope and given to Ferdinand and Isabella of Spain exemplifying the connection of church and state at the time in the 1400s CE. It came about as the result of the “discovery” that the world was, in fact, round and not a flat disc floating in space off of which one could fall. This mandate was both a Christian and a European political statement. It stated many things but one was especially ominous for human beings; it said that all humans that were encountered who were not baptized in the name of Jesus Christ could be considered as normal fauna and dealt with in any manner necessary. This set the stage for all future explorations across the world. And since no one outside of the Middle East and Europe had ever heard of Jesus Christ at that time, it meant that a great many peoples of the Earth were purged in the name of progress. It is estimated that when Columbus reached the New World there were already approximately 100 million people living in South, Central, and North America. In the first 50 years after Columbus made landfall in the Caribbean it is estimated that 60 million human beings died of disease, starvation, and murder. Almost two thirds of the people already here were extinguished. The Doctrine codified the concept that humans were one thing and nature was another and it codified what was the definition of a human, that is, a Christian.
This period of time of discovery overlapped with many events in Europe including the Inquisition that went on from 1100 to 1700 CE. At this time a great many people were found guilty of heresy as defined by the Roman Catholic Church at the Vatican in Rome. The Malleus Maleficarum—the Hammer of God against evil—was instituted against anyone who could be proven to be a disciple of Satan. And 80% of all the people burned at the stake or hung or drowned were women. Good witches, midwives, nurses, herbalists, farmers; these were the people who took care of the common people. The elite saw doctors most of whom were also clergy. The inquisition was a war of class and religious elites against common people who worked the land, had a different set of values and knowledge, and were a community of vast numbers. It was also an Abrahamic patriarchal indictment against women with knowledge and skills that served people.
How did the landed gentry and the European religious establishment build global empires from the 15th century on? During the Age of Commerce that followed the Age of Discovery new trade routes were discovered by mainly the Spanish and the Portuguese as they built maritime empires in the Atlantic and Indian oceans. Other European nations like the Dutch and the French and British entered the maritime expansion in the 17th century, leading to major colonial warfare in the 18th century. Trade and commerce were the critical components of power and prosperity in this period. Historians have described this as the first age of globalization in modern history. It was mainly European nations sanctioned by the Roman Catholic church in the Vatican gathering resources and accruing wealth and power by scavenging the Earth outside their own countries.
The Age of Empire followed in the 19th century. In this period, European nations, especially France and Britain, established vast territorial empires in Asia and Africa. They devised colonial administrative services, developed new agrarian policies, instituted laws, started universities, and established their own medical ideas and practices in the colonies as the mainstay of their rule. The industrialization in Europe led to the colonies gradually becoming the suppliers of raw materials for European industries. The use of the human body as a form of raw material and a beast of burden began in earnest in the 1600s, peaked in the 19th century and in many ways continues to this day in the form of men, women, and children in colonized countries being used to supply cheap labor and goods to the Global North.
The high point of imperialism culminated in the First World War with the European colonial powers expanding across all the continents of the Earth. European medicine specialized to serve colonial purposes and interests, including tropical medicine and the use of bits and pieces of indigenous medicine to treat diseases and conditions relevant to the Global South acquisitions and European people living and working in them.
In the 1800s medicine in China was mostly indigenous and that medicine was the equivalent and often the superior medicine when compared to European medicine. It was the missionary effort of colonization that combined the proselytization of Christianity with Western or European medicine and sold it as superior. People could not receive medical care from missionaries without being subjected to constant efforts to reform them and make them Christian. However, there was a cross pollination of Western herbalism and medicine and Chinese herbalism and medicine. Early Jesuit priests brought back to Europe much of the first information of acupuncture and herbal medicine in a codified form. Before that the Dutch East India Company in the early 1600s had been the vehicle for the acupuncture modality of Chinese medicine from Japan into northern Europe but that effort was small and died out in the first 100 years after arrival in Europe. Elizabeth Rochat de Vallee is a student of a Jesuit priest, Claude Larre, who studied in China and Vietnam the native medicine of those places; i.e. Chinese medicine. Some of the finest translations and interpretations of Chinese medicine and the philosophy from which it comes are from Monkey Press founded by Elizabeth and Claude in France in the 20th century. And auricular medicine was a modern interpretation of the microsystem concept of acupuncture by Nogier, also French. And in modern France, advanced palpation skills were evolved into visceral manipulation and other techniques in the osteopathic repertoire—also an energetic medicine like acupuncture.
Decolonization began after WW1. The missions by the Spanish in the Americas, the French in parts of Africa, and most of the European nations involved in the Age of Discovery were justified in terms of a religious mission to bring Christianity to peoples they considered to be savages. This mission began to unravel as people viewed the atrocities of the WW1 and decided that perhaps Christianity and the superiority of the West was not what it was cracked up to be. If Christianity was to transform and save the world, the atrocities by Christian nations in Europe during WW1 could not be justified, and therefore, Christianity was not a saving grace. Christians were doing the same things in Europe that they espoused to be against, better than, inoculated against with Baptism.
All of the countries inhabited and colonized by Europeans were used as a collecting expedition for specimens (including human ) of flora and fauna to study and display in museums in Europe. These overlaps are important in our history of medicine as they help us to note and compare the connections and similarities of historical events across continents and periods of time. Each of these phases of imperialism was marked by almost corresponding changes in the history of medicine—not only medicine in Europe but all indigenous forms of medicine where colonization had occurred. European medicine was an important component of European imperialism from the 16th century on and it also evolved along with the history of imperialism. The European materia medica expanded and diversified rapidly from the 17th century in the Age of Commerce. Exotic drugs came into European markets. Even the tulip for which the Netherlands is famous is actually a Turkish plant. Huge amounts of money were made off of the tulip and still are today. The list of plants imported to the West is humongous. And today the national website of the PRC states that one of their goals is to become the world’s leading exporter of herbal plant materials and herbal medicine. What this means for us is predictable: industrial monocultural agriculture and everything that means. The PRC is a pseudo-capitalist country running on the fumes of communism and ruled by a CCP dictatorship or emperorship with lackeys underneath.
All that suffering—what was the point?
II. The Age of Empire
Physicians reworked their traditional medical theories to explain diseases, especially when it came to fevers because of their experience in tropical hot weather and the fevers some diseases caused—like malaria. Putrid or pestilential fevers that ravaged the health of European sailors were re-evaluated. Theories of sanitation and hygiene, the disposal of waste, maintaining cleanliness and ensuring ventilation all became part of general European preventive medicine but they were, in fact, imports from the indigenous cultures of the global South. Preventing cholera was a main effort in the 19th century. And in the USA the treatment of mid-century cholera was with naturopathy, herbal medicine, Eclectic medicine,6 and homeopathy. And of all those efforts, the most successful treatment was with homeopathy. Homeopathy is a German evolution of herbal medicine that includes plant materials from Greece and beyond and also includes European plant materials. It is still considered a world heritage medicine by some American institutions but is actually a part of naturopathy which those same institutions now consider to be Western medicine, i.e. modern medicine based in Western science. All of the nature-based components have been lost from naturopathy. This may happen to Chinese medicine also.
Although many components of Western medicine are actually imports, the medical systems from which Western medicine came are now bending the knee to Western science as the modus operandi of that system of medicine, changing it into a western adaptation of the original nature-based medicine. This is imperialism. It is part of a playbook of changing common sense into mistrust, failure to believe the truth in front of your eyes, the complex simplicity of the mechanisms of life, the reality of living in and knowing deeply the place where you live, the connections between all of nature of which we are a part.
In the nineteenth century, the Age of Empire, laboratory-based medicine transformed European medicine. Industrialization in Europe became important in producing modern drugs and pharmaceuticals. This movement away from plant-based medicines that were compounded to pharmaceuticals that were extracted and synthesized (often from petroleum) was shaped by colonialism. The emergence of germ theory from the 1880s led to the development of vaccines for viral infections. The Chinese had used a form of vaccination called variolation since the 1400s.7 Soon the French Pasteur Institutes spread to the French colonies in Africa and South-East Asia and germ theory and vaccines became part of global and imperial medicine as an expression of progress. The Pasteur Institutes became a part of the “civilizing mission” of imperialism. Modern pharmaceuticals were presented as symbols of European modernity and superiority. We still deal with this reality in many forms whether or not we practice something other than “Western medicine”.
III. The Spirit of Medicine
What is medicine and why do we need to categorize it into different types, forms, or other frames? I think that at an essential level, medicine is the art of healing and of preventing diseases. This art took different shapes in different social, cultural and historical contexts. The Yi Jing, possibly the oldest and therefore first book of medical philosophy and theory from China, says that the true healer leads people to an encounter with their true being, their essential Self. This is the truly ancient interpretation of healing when humans were simply not what we have become. They lived not on the Earth but as an expression of Earth in the Earth community. They held spirit as a living reality surrounding them always—and to which they could communicate. Energetic medicine was all that was needed to right the ship of the human body and soul—shamanic medicine.
In nineteenth-century parlance, definitions of modern medicine and science as singular, universal and progressive are still persistent today. The JAMA editor of a few years ago said, “there is only one science and that is Western science”.8 Amen. The context was in relation to a query about perennial medicines and the role that they play in defining medicine and, therefore, treatment. It was basically an early negation of integration of systems. It was saying that indigenous systems of medicine are ethnological and historical discussions but not clinically relevant in modern times. It was saying that the primary reason that these systems are not relevant today is because they insist on including a meaning to the workings of life. This meaning is the expression of belief in the sacred which is not definable nor measurable and therefore, non-Western science is not the expression of the truth because it is inherently biased. Taking the meaning out of science, medicine and truth equals the only truth because it is the only truth that can be measured. In other words, there is only material life in medicine and science. This eliminates agency and leaves us where we are recipients of a form of knowing that does not include spirit. Medicine has evolved in this reality as a “fix it” and not as a teacher or a revealer of the sacred in life.
Another question that is problematic and complicated in the idea of integration is the practice of naming medical specializations. In general, this is a practice of modern Western medicine. This particular view of medicine sees the human enterprise as a set of systems but rarely as a whole. Perennial systems as a whole—so to speak—see the human enterprise primarily as a whole and existing within working systems of other whole environmental systems: as Arthur Lovejoy said—The Great Chain of Being comprised of nests within nests of organic and emotional and spiritual structures all simultaneously intercommunicating with one another as a single thread of life.9
It appears that part of what makes modern medicine modern is the elimination of knowledge and understanding that sees life as a universal enterprise with each apparently separate part related to other wholes and perhaps The Whole (whatever we might call it). This is the crux of the polarity of Western and Eastern science and medicine. And it becomes the crux of how to integrate the two.
IV. Colonial Medicine
There were two key phases in European history of medicine. The first began in the thirteenth century when classical Greek medical and scientific traditions were gradually severed from their Arabic or Islamic lineage and ensconced within European and Christian thought and tradition. Greek texts were translated into Latin and Hippocratic and Galenic medicine in Europe. This means that those translations did not capture the entire message of Middle Eastern philosophy and interventions. And if they did, those elements were discarded as irrelevant to European culture, language, and intellectual modus operandi.
The second key episode started in the late-seventeenth century when European natural historians sought to develop objective views of nature. In China this effort actually began around 100 CE with the systematic correspondences. Those people tried to place a systematic orientation and understanding of myriad bits and bobs of knowledge to date using nature as the fulcrum. Isn’t that a kick? So natural history was incorporated as a key aspect of their medical knowledge. Alongside that were changing views of the human constitution and its relationship with the environment. These views in the context of empire were richly informed by colonial experiences but filtered through a clearly European intellectual and social understanding of nature. That understanding was a hybrid of Christianity and a hierarchical format plus a systems approach that had separate silos of anatomy and function. Rarely was there an attempt to combine them nor was there a definition of health. We still wait today for Western medicine to give us a definition of health.
The search for a European antiquity and an objective understanding of nature was done primarily in institutions and this search is what gave them pre-eminence. For example, the British Royal Society in London and the famous quote of Sir Francis Bacon, “This new science has the capacity to not only control Mother Nature but to bring her to her knees”. This is exactly what has happened. But it happened not as evidence of that particular science but as a result of that particular science. And this is one reason why only today indigenous knowledge that grew as a part of being within nature and not separate from it is highly valued. This is the knowledge that was so expertly annihilated by colonialism and the Inquisition and the institutionalized intellectual enterprise that falsely claimed superiority and progress.
During the seventeenth century, precisely when medicine in the West was becoming modern or European, it was becoming colonial and dominant as well. The growing influence of natural history in early modern medicine; the growth and expansion of European drug markets; the rise of surgeons in status and influence within the medical profession; developments in ideas of sanitation, hygiene and public health in the wake of cholera epidemics; growth of modern quarantine systems; the search for active ingredients of cinchona, opium, and tobacco leading to the birth of modern pharmaceuticals; and finally the emergence of germ theory and prophylactic vaccination, and ideas of global health conjoined European and colonial histories.
In other words, medicine and science need not only be understood within laboratories, in scientific formulas and theories, or within esoteric texts and mathematical calculations; the social and cultural historical contexts of these intellectual traditions are equally instructive.
Historians have shown that colonial medicine (European medicine in colonial settings) was deeply implicated in promoting ideas of difference, in terms of race, gender, and class. These ideas became critical in modern medicine. The integration of medicine within colonial economy and governance was intrinsic to colonial administration and economy whether we are talking about West Indies rubber plantations, diamond mines in Southern Africa, the urban administration of Mumbai or Kolkata. There was a straightforward cause-effect relationship that medicine helped in colonization, benefitted from colonization in terms of absconding from other knowledge bases, set up ideas of color and race and gender as hierarchical, and fostered a system of European superiority that became global.
Nineteenth-century writings represented imperialism as a triumph of European cultural superiority and military power over other races and regions in the Americas, Asia, and Africa. These accounts were all written by Europeans and described this dominance as “beneficial”, as it spread ideas of progress, rationality, humanitarianism, and Christianity to those who were backward or less civilized. Modernity was tainted with paternalism which in turn has instructed even people of today to feel as though medicine is god and the doctor knows everything ever to be known. This orientation, I feel, has grossly contributed to people no longer taking care of themselves, understanding what their own health is materially and in terms of how they feel. We are cut off from our bodies and live in our heads.
The general tone of conquest of the Americas was a tale of European discovery (although the 100 million people already here at the time of Columbus would disagree), then of glorious European adventurism, and finally of the introduction of European civilization and modernity to the “savage” people. Even as late as the 1920s, Canadian and American planes flew over reservations and tribal communities seeking to identify children to be later removed to residential schools. By removing children, the language, the culture, the family structures of natives were lost and this became a new and “humane” form of colonization, otherwise known as genocide. The European project of the slave trade was never mentioned.10
There are many books of various genres that all speak to this interpretation of history. The Competition Wallah about waking up Indians in India to a modern life of competitive self-reliance through Western education and Christianity. Forget about Buddha, Sri Aurobindo, Ashoka, Nanak, and many others whom we study today. Stanley wrote the travel book about Africa, Through the Dark Continent. And Joseph Conrad wrote The Heart of Darkness outlining how European imperialism was a form of enlightenment. The ethos of this imperialism was to transform Africa into a modern economy for and by Europeans. The indigenous people of those places were colonized to be the workforce enabling this economy in exchange for becoming enlightened.
In the 19th century, Lenin wrote a book called Imperialism, the Highest Stage of Capitalism. Later Hobsbawm wrote Industry and Empire in which he linked imperialism with pressures produced from within Western capitalism to export capital to colonial dependencies. These later ideas of economic imperialism have remained an important means by which historians explained the rise of colonialism. The colonized were not only stolen from in terms of resources of all kinds including intellectual but also stolen from again in terms of selling products made from their own national resources back to them.
A truly vicious cycle. This world system remains today—a globally connected network of economic exchange relationships. Europe was the center and at the periphery were the colonies, with a unilateral flow of capital and wealth from the periphery to the center. Think of the throw away clothing trade. Think of the Amazon and beef and soy to feed the beef that ends up in North America or at McDonald’s in Beijing.
Writings on the history of medicine show that imperialism played a negative role, especially amongst indigenous communities, by spreading epidemics, destroying local medical institutions, and transforming the colonies into markets for expensive European drugs and vaccines while simultaneously stealing many of the effective interventions local to those same communities. Medicine ultimately became a tool of empire.
Wherever Europeans went they spread ghastly epidemics like smallpox, typhus, and TB to virgin populations who had no resistance. This devastation of local indigenous peoples helped to spread and expand European colonial territories. General Amherst here in Massachusetts spread smallpox to American Indians in the northeast by gifting to them smallpox laden blankets.11 They all died. Today, there are 580 recognized tribes in the USA but the percentage of the indigenous population is 5 million, 78% of whom do not live on a reservation. They live off the rez because there is no viable survival there. The highest rates of suicide in the USA are amongst Native American children. This holocaust remains active even today.
In the book Orientalism (1978), Edward Said argued that imperialism led to cultural hegemony—dominance of the Western tradition and philosophy. He felt that the European division of the world into the Orient (those countries East of the Roman Empire) and the Occident (referring to the Western Empire) equaled Europe being the Occident and Asia being the Orient. These divides became prominent during the Crusades (1095-1291). The Arab world was viewed as backward and treacherous. During colonialism, these divides acquired new significance, especially when Europe colonized large parts of Asia.
Europeans could travel to parts of the world they never could before. Universities and museums developed large collections of Asian texts and artifacts because the countries they were made in could not afford to protect them as a result of imperialism. Cultural imperialism was a form of dominance that disrupted indigenous cultures and knowledge traditions, resulting in loss of agency in writing their own histories and in defining their own destinies.
In the 1980s, more autonomous subaltern collectives of people from various disciplines wrote new histories in an attempt to recover agency for their people, cultures, and knowledge base. This is especially true for Africa and South Asia. These writings affected the questions that writers were asking. Did Western medicine play a disruptive role in the colonies by destroying indigenous institutions, co-opting indigenous medical ingredients and methods into modern medicine?
Colonialism in East Africa led to a series of environmental and medical disasters affecting animals and agriculture. The clearing of forests led to droughts, and modern plantation-style farms destroyed old pastoral systems and lifestyles. This was in many ways the beginning of the extinction of species in those places due to land loss, water displacement for a new way of agriculture, removal of whole forests, opening the land to mining and extraction. The horn of Africa is still trying and mostly failing to recover. South Africa has become a democracy and often the administrators of that democracy are black but the truth is black Africans still live in poverty. The horse was long out of the barn by the twentieth century. Colonial investments in these areas, and in Africa in general, have forever changed the landscape and cultures of native peoples—and not for the better.
The rapid increase in malaria in Asia and Africa during colonialism has been definitively linked to deforestation, expansion of the railways and consequent ecological changes. The British put in 44,000 miles of canals to irrigate a quarter of India’s total crop area. Flooding and salination of the canals led to more mosquitoes and breeding areas. Simultaneously, the advent of Western medicine in these same areas pushed out indigenous and effective medicines to deal with malaria and other infectious diseases. It was a win-win for the colonizer and a loss-loss for the native people in very many places across the world.
One could say that modern monocultural agriculture requiring inputs from the chemical industry were/are also destroying the land everywhere, including North America, and creating diseases that then require Western medicine via pharmaceutical medicine that also relies on the chemical industry to supply.
V. Efficacy, Agency, and Art
European germ theory and laboratory medicine were represented as a crusade not merely against disease, germs and social/cultural practices and prejudices but also against the land itself. Mother Nature became Terra Nulla—good only for extraction of resources. The dominator role played by missionaries was used to introduce medicine to empire. Imperial medicine from Europe focused on Western science, great men evolving it, ideas of progress, and ideas of cultural and racial deficiencies. The truth is that we can now—looking back—trace the history of diseases and medicine through long-term changes across centuries that connect the histories of Amerindian depopulation in the sixteenth century to the sleeping sickness, HIV, ebola, and malaria epidemics in Africa in the twentieth century.
People fought back. There is evidence that indigenous medical workers in various places who worked as orderlies, nurses, ward attendants in hospitals and clinics in many places across the world translated their everyday practices and Western medical practices into languages and “heathen” concepts in order to translate Western medical terms and technologies—and thereby drained Christian medicine of its scientific connotations and simultaneously invested it with pagan meanings. In a sense, this happening in Africa ended in a new hybrid and complex medicine. In many ways, this is happening now within the growing event of integrated medicine.Western science is becoming dislocated from its European problematic and is becoming part of mostly Indian, Chinese, and nature-based medicines of Europe while becoming a new cultural and intellectual experience. This has happened where there is an equally strong and persevering culture of medicine that is local and highly developed.
Some of the issues that we face as “alternative” providers are overcoming a sense of nostalgia and romanticism for the past. Although the double-blind placebo-controlled study is almost always a very poor way to analyze the efficacy of an intervention from Chinese medicine, still we need to evaluate whether or not what we understand as the truthful basis of our medicine is of value, and if so, how and why. The way that we have always done this is through case studies. Case studies do require an objective observer. We can train ourselves to be active and objective observers of our medicine. In fact, there always has been and is now a resurgence of accruing case studies across our profession to be utilized in analyzing efficacy. We have to be engaged and maintain our medicine as an art. Colonialism manufactured a major break in and disruption of history, especially since 1600 CE. What would those indigenous medicines that were changed forever have evolved into without being pre-empted by European medicine?
We need to regain and maintain agency over our own medicine. At a basic level, agency is the essence of being human. We need to form ourselves into collectives of activity, preservation, and transformation of our medicine. We cannot wait for conventional medicine to tell us who we are. To have agency, we need to understand in modern language the material conditions that caused disease and death. This means in modern times all of the negative impacts on our environment; it means caring for the poor and working within the precepts of our medicine as a sage, a counselor, a community activist, a medical doctor, a spiritual adviser. It means realizing that poverty is a major cause of illness; it means that capitalism, urbanization, commercialization of agriculture and our food system are not working to promote health. The profit motive is an example of imperialism and when it comes to providing service to our human condition, it is part of the problem and not the solution. Service and profit do not work well together and require a new way of managing the human sin of greed.
VI. The Flexner Report
In the context of all that was just said and in the hay day of imperialism (the early 20th century) the AMA and the Carnegie Foundation paid to have an individual named Abraham Flexner come up with a report on the status of American medical schools. They had an agenda as the representative professional organization of regular medicine—now called biomedicine or conventional medicine. In 1904 the AMA created the Council on Medical Education and Flexner was hired, and in 1910 his report was made final. In a nutshell it stated that:
Standards should be increased to include anatomy and physiology and chemistry
Partnerships should be formed between schools and hospitals for clinical training
Schools that could not meet the new standards should be closed
Prior to the report there were 20 black medical schools in the USA. Ten years later, two remained (Howard and Meharry). Between 1910 and 1970, there was a near elimination of women physicians. Before the report came out, there were 155 medical schools of all kinds, representative of the forms of interventions and systems of medicine used until that time. There were chiropractic schools, herbal medical schools, eclectic medicine schools, naturopathy schools, osteopathic schools, and regular doctor schools (this last category referred to European modern medicine—the people who had orchestrated the Flexner Report). After the report came out, 89 medical schools immediately closed as they were unable to meet the standards of adding a surgical theater, adding labs, and maintaining upkeep of all of these mandated improvements.
In effect, the perennial forms of medicine that had existed before the 20th century were eliminated. Two remained—schools of chiropractic medicine and osteopathy were able to meet the standards. This is why osteopathy today reflects modern European medicine and not advanced manipulation of the cranial system of original osteopathy. This old system of osteopathy is considered (along with the acupuncture modality of Chinese medicine and homeopathy) to be the only surviving systems of medicine maintaining themselves as energetic systems—that is, systems that approached dysfunction from the place of energetic origins rather than the place of material symptoms. In other words, they practiced a medicine that had as a goal what the Yi Jing called an encounter with one’s true Self.
In 2018, only 5% of American physicians are black whereas blacks make up 14% of the population. The Flexner Report exacerbated racism in medicine because the remaining medical schools to survive this particular inquisition would not accept black students nor physicians due to racist policies.
In 1900, women were 6% of practicing physicians and in 1909 they were accepted at 91 of the 155 medical schools. Women were rising as advanced practitioners of medicine. Many of the schools that closed were the ones that also accepted women. By 1940, just 4% of physicians were women, whereas it should have been about 40%. Not until the 1960s did women begin to catch up again. Women still lag males in compensation, leadership positions, and research publications. Flexner said that black students could be trained as sanitarians and their primary role should be to protect white people from disease. He also said that women were showing a decreased inclination to enter medicine at the time of his report and those that did go into medicine had obvious limitations.
The AMA has recently renamed the Abraham Flexner Award of Medical Excellence in light of the blatant racist and misogynist philosophy that underlies the Flexner Report. In regard to the systemized elimination of the perennial systems of medicine and our ability to learn them here in the United States, even Western trained physicians are beginning to see that the Flexner Report had a mercenary agenda akin to the playbook for imperialism. It was an attempt to couch the elimination of perennial forms of medicine in the name of progress. Progress was grossly tied to capitalism and the evolution of a medicine that required many inputs of fossil fuel-based chemical compounds as opposed to plant materials, that were hugely more expensive than natural medicines, treated only symptomatically except for a few wonder drugs and curative or preventive techniques, and held surgery as the top of the chain of interventions. An entire system of research at the new medical schools (many of which were or became public non-profit institutions) led to production of medical products by for-profit companies. The public who were told they could not understand the complexity of it all accepted this new medicine as progress, but it is ultimately a renewed form of imperialism.
Humans, being what they are, once again fought back. Guess what: We’re still here. Although Flexner called all of the extant systems of medicine at the time non-conformist and medical sects (this is where the term “alternative medicine” came from), by the 1960s, my generation (thank you very much) evolved new philosophical views regarding biomedical reductionism, and new views on the place of the patient in medical treatment and even in medical development. Medical holism led to intense debates/disputes even within biomedicine. The increasing use of “alternative medicine” was driven mainly by the public but also by the biomedical industry. The term “CAM” came about—“complementary and alternative medicine” was a new word mainly concocted by biomedicine to place alternative medicine in its proper place (that is, as a subsidiary of biomedicine to be used alongside of but not as an alternative to biomedical interventions).
Postmodernism, feminism, and environmentalism also greatly contributed to changes in beliefs about what characterized the existence of truth, objectivity, determinacy, causality, and impartial observation. Individuality, complexity, and personal experience played a role in integrating into the social construction of curricula and values, especially when it came to health, belief, science, and medicine. We’re still in it—a massive rethinking of the meaning of life and how we want to live it.
NCCAM (National Center for Complementary and Alternative Medicine) was founded in 1991—a landmark event. People from various traditions of medicine, many from Bastyr University, approached Tom Harkin (Senator of Iowa) and Jesse Helms (Senator of Utah, where there is a large herbal industry influenced by Mormons) to lobby the legislature mandating some form a public funded process by which research could be done in alternative forms of medicine. Medical providers who were legally allowed to practice could finally have proof of efficacy. This proof would also allow those providers to utilize medical insurance third-party reimbursement for their services, making them more accessible by the public who wanted them.
NCCAM was instituted under the NIH and originally called the “OCAM” (Office of the Center for Alternative Medicine). Then it became NCCAM. And most recently, it became the NCCIH (National Commission of Complementary and Integrative Health). Each step in the change of nomenclature has moved the Center away from utilizing the term “alternative”.
Integrated or not, what do you want for our medicine and profession?
Personal communication of December 25, 2023. In saying that “others have written similarly on this subject”, I suspect that Tai was referring to Disease, Medicine, and Empire by Roy Macleod and Milton Lewis as a notable influence.
Foucault, M. (1994). The Birth of the Clinic: An Archaeology of Medical Perception. Vintage.
Reston, J. (1971, July 26). Now, About My Operation in Peking. The New York Times.
For a comprehensive examination of “TCM” as a socio-political phenomenon and its clinical implications, see “Chinese Medicine In Crisis: Science, Politics, and the Making of ‘TCM’” by Heiner Fruehauf.
I am drawing on a sentiment expressed by James Hillman in the title of his book, We’ve Had A Hundred Years of Psychotherapy—and the World’s Getting Worse (1992).
“Eclectic medicine” refers to a period of American medicine, spanning from the late 19th-century to the early 20th-century. Eclectic medicine was an approach infused with European vitalism and Native American herbalism that also employed manual therapies.
Variolation was practiced across the Asian continent, by Indian, Tibetan, and Chinese physicians. Infectious material (such as a scab) is collected from a sick patient and administered to a healthy individual. The healthy person then develops a mild infection that ensures immunity. Variolation pre-dates vaccination, but operates on a similar premise as vaccines.
Tai may be paraphrasing the following remark, published in The New York Times on August 10, 2015 in “Labels Like ‘Alternative Medicine’ Don’t Matter. The Science Does”:
In an accompanying editorial, Phil Fontanarosa and George Lundberg, two of JAMA’s editors, wrote: “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.”
Arthur Lovejoy published The Great Chain of Being in 1936 and is credited with the idea, which became influential in perennial philosophical movements. Ken Wilber has notably carried the idea forward as the “great nest of being”, a foundational concept of his integral philosophy. The concepts of “holon” and “holarchy” are parallel ideas, credited to Arthur Koestler in The Ghost in the Machine (1967).
Tai is referring to the “transatlantic slave trade” from Africa to the Americas, from the sixteenth to nineteenth centuries.
The use of contagious diseases as a tool of biological warfare is well-documented. See “Empire’s Little Helper: Chinese history shows that where soldiers march, plague follows” by Peter C. Perdue.
This is very interesting and important -
My personal fascination is music as medicine , and the use of the conga drum and drum beats to energize the brain tree . It is one thing to make connections , but if there is no structure to make the connections with , it does not matter what is going on . I feel that we are tranferring this structure that normally would be formatted by rythms , onto the computerized mechanics that we call AI -- in lieu of understanding the primary structuring of our natural tree like brain structure .
Healing in general is about making new connections , repairing connections , and preventing disconnection -- getting back to base , what I like to call it . I want to study this article more and will comment if I think I have anything valuable to offer .