Practitioner Decisions to Engage in Chinese Medicine: Cultural Messages Under the Skin

Abstract

Theories of agency and decision making have been applied to processes by which patients select therapeutic interventions. Another kind of decision making occurs when individuals choose to engage in the practice of a therapeutic modality. This article draws on fieldwork and interview data with non-Chinese and immigrant Chinese practitioners of Chinese medicine in the United States, focusing on Boston, Massachusetts, and New York City, as case illustrations. I apply theories of agency and decision making to how and why these practitioners chose to engage in Chinese modalities. I build on Volker Scheid's (2002) analysis of agency, grounded in Chinese medicine theory, to propose the Chinese concept of xin ( heart-mind) as an analytical frame, suggesting that it can fruitfully be set in tension with Pierre Bourdieu's notion of habitus and Antonio Gramsci's discussion of the “common-sense” nature of hegemony. I draw on a non-Eurocentric concept to enrich the theoretical discussion of agency and decision making.

Key Words:

• acupuncture
• agency
• Chinese medicine
• decision making
• habitus
• hegemony
• schema
• xin

ACKNOWLEDGEMENTS

The author thanks Elisabeth Hsu and Gunnar Stollberg for organizing the panel at the 2005 meeting of the International Congress for the History of Science in Beijing at which some of the authors came together to present our work, and then for proposing, coordinating, and editing this issue of the journal. She is particularly grateful for their thoughtful and detailed editorial feedback. She appreciates as well the enormously helpful input from Steve Ferzacca, Lisa Kozleski, and from her anonymous reviewers.

Notes

I conducted interviews and fieldwork in Boston, Massachusetts between 1991 and 2006, and in New York City in 2007, with 80 practitioners of acupuncture and other Chinese health-related modalities. Twenty-four were Chinese American (11 women, 13 men); 52 were European American (25 women and 27 men). Other racial-ethnic groups included Japanese (1 man), Korean (1 man), and African American (2 men). Individuals quoted by name agreed to my doing so.

From pre-modern China through the PRC, other medical styles, practices, and modalities—including popular ones—were regularly incorporated into the scholarly tradition. Within that process, “Western medicine” was gradually incorporated as well in complex ways beyond the scope of this article to discuss.

Discussions of motivation in relation to acupuncturists—although not through theories of agency or decision-making—have focused on China (Hsu 1999), Norway (Sagli 2005), and Germany, (Frank and Stollberg 2004).

“TCM” refers to the system formulated under the People's Republic of China, which entered the United States in the 1970s. Other systems include the Five-Elements or Worsley school of practice, which was developed by Jack Reginald (“J.R.”) Worsley beginning in the 1950s in England, as well as Japanese, Korean, and Vietnamese styles (see Barnes 2005).

Dr. James Tin Yau So and some of his students founded NESA, in Watertown, Massachusetts, in 1975.

This is regardless of whether those being analyzed are familiar with the term, much as we utilize terms like habitus and hegemony.

Claude Larre and Elisabeth Rochat de la Vallée comment, “the character for taking charge or taking responsibility for is ren …. It is to have or be capable of assuming a charge or responsibility which is vital for life…” (1996:73).

I am deeply indebted to T. J. Hinrichs for her help with this translation. Note that the Lingshu remains a core text in practitioner training related to acupuncture.

Affective dimensions are further complicated by contradictory “emotional codes” governing what are viewed as “correct” responses to different social domains (Luhrman 2006:356).

Physician adoption of acupuncture is itself, a hybridizing process discussed in the German context by Frank and Stollberg (2004, 2006).

Elisabeth Hsu (1999) found that medical students in China varied in their appraisal of “Western” medicine, but generally concurred in finding it “good.”

For an in-depth illustration in the PRC, see Hsu 1999.

In this context, TCM acupuncturist/herbalist Ching Linggong's experience stands out. No one in her family had studied medicine; she pursued it based on her own interest.

Although practitioners sometimes linked this objective to the Maoist slogan “to serve the people” (wei renmin fuwu ), the slogan generally followed upon something they already felt.

Additional information

Notes on contributors

Linda L. Barnes

LINDA BARNES is an Associate Professor of Family Medicine and of Pediatrics at Boston University School of Medicine. Her research focuses on the historical anthropology of Chinese medicine and healing traditions in the United States. Recent publications include “Five Ways of Rethinking the Normal” in Religion & Theology (Theme Issue: Theology, HIV/AIDS and Public Policy in Africa) 2007, 14(1–2):68–83; and “Plural Health Systems: Meanings and Analytical Issues” in ARHAP International Colloquium 2007, James Cochrane, Ed. (Cape Town, South Africa: African Religious Health Assets Programme, 2007), pp. 46–54.