Princeton Weekly Bulletin April 12, 1999
Anthropologist studies medicine of Tibet
By Caroline Moseley
Vincanne Adams (r) with Tibetan doctors
at the Mentsikhang in Lhasa, Tibet
What is "truth" in medicine and healing? The question touches on social, cultural, political, moral and biological concerns.
It has led Assistant Professor of Anthropology Vincanne Adams as far as Nepal and Tibet (now part of China) in search of answers.
A medical anthropologist, Adams specializes in ethnomedicine, the study of non-Western medical systems. While she has studied both Chinese and Indian medical systems, her deepest interest is in Tibetan medicine, which she has been studying since 1982.
She has conducted research in Tibet over three visits, the first of which was in 1993. Her current research examines women's health disorders and their treatment in the traditional Tibetan medical hospital, the Mentsikhang in Lhasa, which is the capital of the Tibetan Autonomous Region. "Mentsikhang" translates, she says, as "the College of Medicine and Astrology" -- literally, "medical astrology house."
Elements, humors, perceptions
Tibetan medicine is based on a system of five "elements," says Adams: wind, earth, water, fire and space. "Wind is responsible for movement; earth gives substance; water holds things together; fire heats or transforms; and space is that within which something can exist." Tibetans make connections between these elements and three "humors": wind, bile and phlegm; the humors, she points out, "are systemic properties, not physical locations." The elements and humors, in turn, are related to human "perceptions." An example, she says, is the perception, or feeling, of anger. "Anger is connected to the bile humor and related to heat in the body, or fire. If you're angry, we say, 'Your blood is boiling.' To a Tibetan, that has an almost literal meaning: Wherever heat is being generated in your body, bile is present or activated and is usually accompanied by anger."
Tibetan medicine offers four categories of treatment, Adams says. There is diet, "which can bring the humors back into balance." Then, behavior or conduct, "which includes things like getting more rest or not going into cold places or hot places (depending on the condition)." Thirdly, there are "external therapies, such as massage, various pressure point treatments or burning incense."
And a fourth kind of treatment is medicinal. "The Tibetans have an elaborate pharmacopoeia," she says. "There are three groups of materials from which medicines are made: animal products (such as a rabbit's heart, a bear's gallbladder); plant products (such as herbs, barks, flowers); and earth products, which include various minerals and metals."
Acute vs. chronic disorders
One distinction between Tibetan and Western medical systems, Adams says, "is the idea of acute vs. chronic disorders. Western medicine tends to treat most diseases as acute. The basic model is a disorder with a beginning, a middle and an end; we expect cure and elimination of the problem." Westerners, she believes, "are less comfortable with chronic disorders, with the idea of maintenance, or living with a disease -- though we do have effective ways of dealing with such conditions."
A Tibetan doctor, however, "will ask about the history of a problem, and the patient will start with something that happened 20 years before. Both believe that event set up a physiological pattern in the body that continues to produce ill health."
Tibetans "see diseases not as fixed entities but as syndromes that emerge over long periods of time and develop in the body in many ways, depending on diet and behavior, the conditions in which the patient lives, and anything else she may be dealing with in her life."
The idea that you can identify a specific disease with symptoms and treatment shared by different patients does not exist in Tibetan medicine, Adams says. Diagnosis and treatment tend to be based more on the individual's personal physiology and circumstances than on an objective disease category.
"Suppose there are two women suffering from an inflammation of the reproductive tract," she says. "There might be three medicines given to one woman and three different medicines given to the other, because in one the disease is wind-bile related and associated with heat, and in the other it is wind-phlegm related and associated with cold."
Dissonant medical theories
In addition to teaching courses this semester on Medical Anthropology and Transnational Culture and Power, Adams is currently at work on two research projects.
One is an ethnographic study that examines the Tibetan medical approach to problems of women's health. She is assessing sexuality and reproduction "as important sites for understanding the really dramatic social changes faced by Tibetans." Tibetan medicine posits "unfulfilled desires" as disruptive of the body's wind humor, she explains. "Living under conditions that are in any way oppressive -- whether family arguments or political discontent -- can cause illness."
The second project is "larger and transnational, looking at how you negotiate between dissonant medical theories, such as Tibetan or other Asian medicines and our Western biomedicine."
Tibetan medicine, which is considered very scientific by its practitioners, she says, "deals with domains that, in our system, might be considered religious. When I say anger is connected to bile, which is connected to heat, it's not just anger in one's own body but expressing anger toward another person that is important. You're creating a moral wave, something that will have karmic effect later in your life. That starts to look religious to us, but to them it's a scientific idea -- it deals with elements, humors and perceptions, and there's nothing esoteric, ungrounded or spiritual about it."
Two little daughters
While doing her research, Adams has found the Tibetan people "very hospitable. The hard part is being away from my family -- my husband John and two little daughters." Her family did visit in Lhasa for the month of July 1998 and were regarded as "a phenomenon," she recalls. "The Tibetans have seen Westerners, but not many kids. There were always people around them, just looking; more than once the police had to come and break up the crowd."
Adams says she has been "very fortunate" to be allowed to pursue her researches in Tibet. There are a number of foreigners in Tibet, "thanks to government liberalization in recent years. There are people studying Tibetan language; there are missionary groups; there are foreign development people; there are representatives of aid organizations such as Doctors Without Borders and Save the Children; but there are very few researchers." She was granted permission to work in Tibet by the government's Ministry of Health, partly, she believes, because "medicine is regarded as a science and hence thought to be apolitical."
Adams joined the Princeton faculty in 1992 after teaching at the University of California, Berkeley and the University of Keele in England. A 1982 biology graduate of Brown University, she earned her PhD at the University of California, Berkeley and San Francisco in 1989. Her research has been supported by the University, the Wenner-Gren Foundation for Anthropological Research and the National Science Foundation.