Iournal of Clinical Pharmacy and Therapeutics (1992)17,319-320
COMMENTARY
What is medicine? A. Strathern Department of Anthropology, University of Pittsburgh, Pittsburgh, PA 15260, U.S.A.
Medicine, when I was a child, was a nasty liquid or a bitter pill which I was periodically forced to swallow at times when I was already feeling ill and therefore badly disposed to swallowing anything. ’What the doctor ordered or what my parents coaxed me into accepting was definitely not what I myself wanted. ‘But it’s good for you!’ ’Get that down you and keep it down!’ they would say. Medicine meant authority, power, coercion. For years, when visiting doctors, I would feel a mixture of fear and rebelliousness recalling those days of my childhood. Later I made my peace with the strange substances of medicine: I collected them. To have them made me feel safe, just in case they were needed. When feeling ill I would run through a whole series of pills and syrups, each one producing side-effects, no doubt, that made me need the next. Until, in 1977, when I was undergoing an extensive set of hospital tests after a partial collapse, one of the doctors in the hospital found my medicine bag (or ’shrine’ as it really was), and ordered me to throw it away. Since then my health has been generally better. Perhaps everyone would have a comparable narrative to tell of their relationship to medicine (and medical practitioners). Such stories would make it clear that medicines are not emotionally neutral. They become charged with our own projections of love and hate, are tied to the contexts in which we have experienced them; in short, become a part of our subjective reality. Advertisements play on this fact. But if this is true at an individual level, it is even more strikingly so when we consider the matter cross-culturally. Medicines are part of wider medical systems to which they belong, and these in turn are embedded in wider and deeper patterns of society. They are a microcosm of what anthropologists call cultural ethos: the general set of attitudes and values prevalent in a population at a given time. An aspect of this that interests me, for Series-editor:Professor J.H.Kilwein
reasons that my opening remarks probably indicate, is how medicine is given, orally or externally, and what it is like. Is it thought of as ’like a food or as ’like a poison’? We can draw a semantic triangle, with ‘medicine’ at its apex, connected equally to ’food and ’poison’ at its base. Then we can say that the potential relationships generated will vary by cultural preference as well as individual experience. (My triangle is in fact a transformation of one originally invented by the famous French anthropologist Claude Lkvi-Strauss. His was called the culinary triangle and its points were labelled the raw, the rotten, and the cooked.) Pharmacologists should be aware, by the way, that the Greek term from which their profession’s name is derived, pharrnakon, originally denoted magical potions, used either to destroy others or to attract them erotically, as well as healing drugs. Phamaka (pl.) were, inter aha, a kind of ‘poison’.In new Guinea Pidgin English (Tok Pisin or TP for short) a similar twist appears. In taking over the word ’poison’ from the English language into their lingua franca, TP, the people of New Guinea have given it a range of meanings: death-magic by sorcery and love magic as well as ’white men’s poisons’ such as battery acid or Gramoxone weedkiller. The same ambiguity is found in the name of the Christian Dior perfume ’Poison’ (Its heavy, sweet scent is appropriately excessive)and in the ironic phrase of invitation to drink alcohol: ’name your poison’. All these examples show the same ambivalence between ‘poison’ as a substance used to attract others and ’poison’as a substance that can kill. In either case, forms of ’excess’are at work. But what of medicine here? Some cultures seem to employ medicines that are more closely linked to poison, others those that are psychologically associated with food. It depends whether aggressive power is being emphasized or the comfort of sustenance, in other words, on what the medicine is expected to do to or for the body as a whole.
320
A. Strathern
The peoples in New Guinea with whom I have worked over the years as an anthropologist tend to make a sharp distinction between food and poison (as one might imagine), while recognizing that there is an intimate connection between them. In one language I have studied, for example, the word kopna means both ‘ginger root’, which is used as a condiment and also as a medicine against colds, and poison (here again covering both lethal substances and love magic, the latter being seen as destroying the desired one’s ability to resist). Poison is nini kopna ’ginger not for eating’. In concealed references to such poison, however, it may be called ring, ’food! So one may ask the question ’How did X die?‘ and get the answer ’X died by eating foods‘! Most often for these people, while poison is something that must be ingested to work, their medicinal substances are rubbed on the skin. Here another association appears, between medicine and paint. While we use paint to protect metal from rusting, New Guineans sometimes use it to protect their bodies against the incursions of spirits. Their ’paints’are usually earth or plant dyes, and it is often the colours of these which carry a symbolic significance and make them into medicines. White earth may be associated with coolness and so with health (as sickness is ’hot’); yellow earth with warmth (like the sun); red with vitality (like blood). Red ochre is most frequently used to celebrate good health; white and yellow are rubbed on patients to cure their sickness or to ward off attacks by witches. This emphasis on doing things to the skin is a reflection of the idea that skin is both a sign of a person’s inner condition and the point of contact with the outside world from which attacks by spirits come. The ’medicines’ that are rubbed on in this way also include pork fat and blood, two vital substances that are otherwise consumed as food. The same items are used to anoint sacred stones that are buried in the ground to ensure the fertility of people, their crops, and their pig herds. These examples from New Guinea show that medicine can be like paint (a protective covering), or like food (vital substance, either ingested or rubbed on the skin). In general health is ’read off from the condition of people’s skin. Their external appearance reveals their inner condition. In Japanese culture another set of equations appears. Chinese herbal medicine known as kanpo has a tradition of many centuries in Japan; originally it was adopted
through Mahiiyha Buddhist missionary priests arriving in Japan from the sixth century AD onwards. Kanpo received official government support in the 1970% and is now practised alongside westem-style biomedicine, with a mutual referral arrangement between the two systems. When I visited Japan in 1986 to talk to doctors there about the possibility of carrying out some research, one young biomedical doctor commented, ‘western biomedicine uses such strong ingredients, it causes too many side-effects, and our people do not like that’. His view is a common one in Japan. Clearly biomedicines sometimes appear to the Japanese (especiallymiddle-aged and older patients) as ’poisons’. The key word involved is ’strong’, by which is meant ’aggressive’, and Japanese herbal therapy by contrast is gentle and long-term. Patients consume large quantities of herbs over periods of weeks, months, or years, with frequent visits to the kanpo clinics and discussion of their symptoms. The pattern of consumption here clearly makes medicine into a kind of meal, rather like a diet supplement in fact. It is at this point that we can turn back to the American system. People in America also experience an overlap between medicine and food; and it is well known that many aggressive (and thereby effective) medicines do have dangerously adverse side-effects that can be called toxic. Thus foods become valued for their contribution to health as medicines. ’Diet’versions of almost all foods have emerged: none tasting as pleasant as the originals. In addition, there is a huge array available of herbs and synthesized vitamins; witness the category of ’health store’, half-way between a pharmacy and a grocery shop. Instead of medicines being like food, in America, foods have become like medicine, with or without that nasty or merely insipid taste experienced when one was young. The question ’what is medicine?’ is, then, susceptible to varying answers both across cultures and within them, just as the question ’what is sickness’? is. Despite this variability, the classificatory (or gustatory) triangle that I have sketched here can be used to give comparative coordinates to the discussion of variations. Try it. See whether it suits your taste. Of course, I know that ’one man’s meat is another man’s poison’, but it may be worthwhile for scientists to recognize that the technical substances with which they deal professionally are also recategorized by people in terms that they can relate to their own overall cultural categories and individual experience.
COMMENTARY
What is medicine? A. Strathern Department of Anthropology, University of Pittsburgh, Pittsburgh, PA 15260, U.S.A.
Medicine, when I was a child, was a nasty liquid or a bitter pill which I was periodically forced to swallow at times when I was already feeling ill and therefore badly disposed to swallowing anything. ’What the doctor ordered or what my parents coaxed me into accepting was definitely not what I myself wanted. ‘But it’s good for you!’ ’Get that down you and keep it down!’ they would say. Medicine meant authority, power, coercion. For years, when visiting doctors, I would feel a mixture of fear and rebelliousness recalling those days of my childhood. Later I made my peace with the strange substances of medicine: I collected them. To have them made me feel safe, just in case they were needed. When feeling ill I would run through a whole series of pills and syrups, each one producing side-effects, no doubt, that made me need the next. Until, in 1977, when I was undergoing an extensive set of hospital tests after a partial collapse, one of the doctors in the hospital found my medicine bag (or ’shrine’ as it really was), and ordered me to throw it away. Since then my health has been generally better. Perhaps everyone would have a comparable narrative to tell of their relationship to medicine (and medical practitioners). Such stories would make it clear that medicines are not emotionally neutral. They become charged with our own projections of love and hate, are tied to the contexts in which we have experienced them; in short, become a part of our subjective reality. Advertisements play on this fact. But if this is true at an individual level, it is even more strikingly so when we consider the matter cross-culturally. Medicines are part of wider medical systems to which they belong, and these in turn are embedded in wider and deeper patterns of society. They are a microcosm of what anthropologists call cultural ethos: the general set of attitudes and values prevalent in a population at a given time. An aspect of this that interests me, for Series-editor:Professor J.H.Kilwein
reasons that my opening remarks probably indicate, is how medicine is given, orally or externally, and what it is like. Is it thought of as ’like a food or as ’like a poison’? We can draw a semantic triangle, with ‘medicine’ at its apex, connected equally to ’food and ’poison’ at its base. Then we can say that the potential relationships generated will vary by cultural preference as well as individual experience. (My triangle is in fact a transformation of one originally invented by the famous French anthropologist Claude Lkvi-Strauss. His was called the culinary triangle and its points were labelled the raw, the rotten, and the cooked.) Pharmacologists should be aware, by the way, that the Greek term from which their profession’s name is derived, pharrnakon, originally denoted magical potions, used either to destroy others or to attract them erotically, as well as healing drugs. Phamaka (pl.) were, inter aha, a kind of ‘poison’.In new Guinea Pidgin English (Tok Pisin or TP for short) a similar twist appears. In taking over the word ’poison’ from the English language into their lingua franca, TP, the people of New Guinea have given it a range of meanings: death-magic by sorcery and love magic as well as ’white men’s poisons’ such as battery acid or Gramoxone weedkiller. The same ambiguity is found in the name of the Christian Dior perfume ’Poison’ (Its heavy, sweet scent is appropriately excessive)and in the ironic phrase of invitation to drink alcohol: ’name your poison’. All these examples show the same ambivalence between ‘poison’ as a substance used to attract others and ’poison’as a substance that can kill. In either case, forms of ’excess’are at work. But what of medicine here? Some cultures seem to employ medicines that are more closely linked to poison, others those that are psychologically associated with food. It depends whether aggressive power is being emphasized or the comfort of sustenance, in other words, on what the medicine is expected to do to or for the body as a whole.
320
A. Strathern
The peoples in New Guinea with whom I have worked over the years as an anthropologist tend to make a sharp distinction between food and poison (as one might imagine), while recognizing that there is an intimate connection between them. In one language I have studied, for example, the word kopna means both ‘ginger root’, which is used as a condiment and also as a medicine against colds, and poison (here again covering both lethal substances and love magic, the latter being seen as destroying the desired one’s ability to resist). Poison is nini kopna ’ginger not for eating’. In concealed references to such poison, however, it may be called ring, ’food! So one may ask the question ’How did X die?‘ and get the answer ’X died by eating foods‘! Most often for these people, while poison is something that must be ingested to work, their medicinal substances are rubbed on the skin. Here another association appears, between medicine and paint. While we use paint to protect metal from rusting, New Guineans sometimes use it to protect their bodies against the incursions of spirits. Their ’paints’are usually earth or plant dyes, and it is often the colours of these which carry a symbolic significance and make them into medicines. White earth may be associated with coolness and so with health (as sickness is ’hot’); yellow earth with warmth (like the sun); red with vitality (like blood). Red ochre is most frequently used to celebrate good health; white and yellow are rubbed on patients to cure their sickness or to ward off attacks by witches. This emphasis on doing things to the skin is a reflection of the idea that skin is both a sign of a person’s inner condition and the point of contact with the outside world from which attacks by spirits come. The ’medicines’ that are rubbed on in this way also include pork fat and blood, two vital substances that are otherwise consumed as food. The same items are used to anoint sacred stones that are buried in the ground to ensure the fertility of people, their crops, and their pig herds. These examples from New Guinea show that medicine can be like paint (a protective covering), or like food (vital substance, either ingested or rubbed on the skin). In general health is ’read off from the condition of people’s skin. Their external appearance reveals their inner condition. In Japanese culture another set of equations appears. Chinese herbal medicine known as kanpo has a tradition of many centuries in Japan; originally it was adopted
through Mahiiyha Buddhist missionary priests arriving in Japan from the sixth century AD onwards. Kanpo received official government support in the 1970% and is now practised alongside westem-style biomedicine, with a mutual referral arrangement between the two systems. When I visited Japan in 1986 to talk to doctors there about the possibility of carrying out some research, one young biomedical doctor commented, ‘western biomedicine uses such strong ingredients, it causes too many side-effects, and our people do not like that’. His view is a common one in Japan. Clearly biomedicines sometimes appear to the Japanese (especiallymiddle-aged and older patients) as ’poisons’. The key word involved is ’strong’, by which is meant ’aggressive’, and Japanese herbal therapy by contrast is gentle and long-term. Patients consume large quantities of herbs over periods of weeks, months, or years, with frequent visits to the kanpo clinics and discussion of their symptoms. The pattern of consumption here clearly makes medicine into a kind of meal, rather like a diet supplement in fact. It is at this point that we can turn back to the American system. People in America also experience an overlap between medicine and food; and it is well known that many aggressive (and thereby effective) medicines do have dangerously adverse side-effects that can be called toxic. Thus foods become valued for their contribution to health as medicines. ’Diet’versions of almost all foods have emerged: none tasting as pleasant as the originals. In addition, there is a huge array available of herbs and synthesized vitamins; witness the category of ’health store’, half-way between a pharmacy and a grocery shop. Instead of medicines being like food, in America, foods have become like medicine, with or without that nasty or merely insipid taste experienced when one was young. The question ’what is medicine?’ is, then, susceptible to varying answers both across cultures and within them, just as the question ’what is sickness’? is. Despite this variability, the classificatory (or gustatory) triangle that I have sketched here can be used to give comparative coordinates to the discussion of variations. Try it. See whether it suits your taste. Of course, I know that ’one man’s meat is another man’s poison’, but it may be worthwhile for scientists to recognize that the technical substances with which they deal professionally are also recategorized by people in terms that they can relate to their own overall cultural categories and individual experience.
