Healing at the periphery; Ethnographies of Tibetan Medicine in India. Laurent Pordié, Stephan Kloos Editors. Contributor(s): Sienna Craig, Calum Blaikie, Barbara Gerke, Isabelle Guérin, Kim Gutschow, Pascale Hancart Petitet, Fernanda Pirie, Florian Besch. Duke University Press. Durham and London. 2011.

The field of cultural anthropology, in particular medical anthropology, is here expanded with a very special collection of detailed scholarly studies on the secluded and less-explored area of Tibet in India. Each case study presents Himalayan medical practitioners, named amchi in traditional Tibetan medicine, and the complex social and medical roles they play in the community. Caught in the early stages of the modernization process in Tibetan medicine, these practitioners endure the consequences of transformations in these small communities, analyzed in the contributions to this volume.

For the longest time, Tibetan medicine's history and development was under the Indian umbrella. The archaic strong relations between practitioners of Tibetan medicine, the amchi, and the rgya gar in India, developed under the influx of Buddhist values. Each chapter in Healing at the Periphery, authored by an ethnographic researcher, examines the beginning of a period of social change and medical professionalization, a time of crisis that started in the early 2000s, particularly in Ladakh, Zangskar, Sikkim, and the Darjeeling Hills, small communities situated on the borders of modern India.

In the first chapter, “The Amchi as Villager: Status and Its Refusal in Ladakh,” Fernanda Pirie writes of taking advice offered by members of a Ladakhi development organization and accepting housing in the amchi’s dwellings, the home of the only practitioner of Tibetan medicine in the village. This gave her the opportunity to experience firsthand the medicine man’s active role in village affairs and to learn from him local customs and practices as he became her best informant.

Chapter 2, “Good Medicines, Bad Hearts: The Social Role of the Amchi in a Buddhist Dard Community,” by Stephan Kloos, discusses various aspects of amchi functions in a community that was experiencing stress following several armed conflicts between India, on one side, and Pakistan and China, on the other. The growing exposure of local economies to capitalism in Ladakh had influenced many long-established medical practices, norms, and values. The changes brought by this modernizing of medicine led to changes in the role of medical practitioners. Historically, the amchi stood at the forefront of their communities, ensuring social stability and playing an important social role beyond the provision of medical services, yet devoid of any political role. His main preoccupation was to provide for his family through his practice; paradoxically, his wife as a teacher in the local school had a more active social influence than her husband.

In chapter 3, “Where There Is No Amchi: Tibetan Medicine and Rural-Urban Migration among Nomadic Pastoralists in Ladakh,” Calum Blaikie presents us with yet another aspect of relationships between socio-economic and medical changes. Blaikie discusses ethnographic data collected in the Changthang region of western Ladakh in 2002, giving special attention to the reaction of Tibetan medicine to social changes, particularly in the context of the rural-to-urban migration of Changpa nomadic pastoralists.

The fourth chapter, “The Modernization of Tibetan Medicine: An Ethnography of Village-Based Development Activities in Lingshed,” by Florian Besch and Isabelle Guerin, examines the villagers’ intentions, at amchi initiative, to revitalize Tibetan medicine and healthcare in their region, a project that could not have been implemented without international non-governmental organization support. After crises and difficulties, such as the effect on the healer-patient relationship, and with stages allowing for necessary adjustments, the project emerged structurally stronger than anywhere else in rural Ladakh.

Chapter 5, “The Amchi at the Margins: Notes on Childbirth Practices in Ladakh,”by Laurent Pordié and Pascale Hancart Petitet, treats medical practices concerning childbirth. Traditional childbirth specialists, who are predominantly males, have retained some of their symbolic functions. Obstetric practices in the villages are embedded in complex issues pertinent to the anthropology of reproduction, tied to relationships between nature and culture, production and reproduction, and individual body and body politics. In the village Shun-Shade the widespread belief was that a child about to be born was the reincarnation of a dead person’s spirit. Women gave birth at home surrounded by family and neighbors, and were unconcerned about receiving care from a male practitioner. In recent decades, Tibetan medicine has gradually received more female practitioners in the process of medical modernization.

In “A Case of Wind Disorder: The Interplay of Amchi Medicine and Ritual Treatments in Zangskar,” Kim Gutschow offers a well-described case study of mental illness metaphorically named “wind disorders” (rlung) and the amchi’s efforts to help the young patient, a victim of theft and other misfortunes. From the onset of disease through diagnosis and the healing process intended to restore the individual into social well-being, the amchi’s actions and treatment goes through identifying its probable causes, seeking to disarm the causal factors through medical or ritual means, and restoring individuals and their communities to a state of health and harmony.

Chapter 7, “Allegiance to Whose Community? Effects of Men-Tsee-Khang Policies on the Role of Amchi in the Darjeeling Hills,” authored by Barbara Gerke, explores the contemporary social situation of Tibetan amchiin the Darjeeling Hills of West Bengal, India. The centralized institution of Tibetan medicine in Dharamsala in the northwestern Indian state of Himachal Pradesh, the Men-Tsee-Khang (MTK), is shaped by the rotational work-scheme it has implemented. The specific effects of this system on the personal lives of amchiand their role in a pluralistic multiethnic community are detailed in this chapter.

Written mostly from the perspective of social studies, Healing at the Periphery provides little information on the folkloric aspects of practices in these regions, limiting its coverage to the consequences of the transformation of traditional practices. Readers interested in the traditional medicine of the amchi, or in ritual formulas and associated medicinal practices offering insight into the archaic culture of these populations, will be disappointed. We do find in the book information on childbirth practices, for example, on what is pure and impure in the act of birth, who is allowed to help or be present, and customs related to social order in the community, but there is no record of folktales, myths, poems, or other literary forms related to this or to other important events in the life of the community And we do learn that a terma (gter ma) is a “hidden treasure” in Tibetan religious traditions, sometimes referring to a material object, a text, or a ritual implement hidden in a rock, buried under earth, or hidden in the sky or in water—teachings to be revealed when practitioners are ready to receive their wisdom. Finally, in “A Case of Wind Disorder” (chapter 6), there is a description of a ritual as a public performance of exorcism, attempting to defuse the demons, symbols of psychological turbulence and intended to benefit the community, as the individual karma and the collective karma of the village are improved through public rites.

Healing at the periphery; Ethnographies of Tibetan Medicine in India offers a unique collection of studies on the social evolution of traditional medical practices as they experience difficulties and successes in the process of modernizing medical practices.

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[Review length: 1155 words • Review posted on December 16, 2022]