Causation as Strategy: Interpreting Humours among Tibetan Refugees

Abstract

The article focuses on the incidence of humoural wind (rlung) disorders among Tibetan exiles in India. It investigates the reasons behind the emergence of rlung as a significant problem among Tibetan exiles, and seeks to unpack some of the local meanings of this ‘epidemic’. Previous studies have generally described rlung disorders as symptomatic of political and moral concerns, highlighting the connections that Tibetans make between physical, moral and psychological states in the context of Buddhist practice and everyday life. This paper aims to further nuance these findings by showing that, while Tibetan exiles include complex causes linked to morality and psychosocial wellbeing in their explanations of rlung disorders, they also ‘cut’ into this explanatory network in strategic ways, sometimes bypassing religious or psychosocial interpretations of illness altogether. Drawing on this analysis, the article warns researchers against literal readings of general religious precepts when analysing people's everyday negotiations of illness and wellbeing: the attribution of causation is always strategic, and religious observance should never be assumed to be uniform, or taken as a given.

Notes

Notes

[1] The principle of dependent arising stipulates that all mental and physical phenomena are conditioned and ultimately caused by ignorance, which is the fundamental misconception of reality as having inherent existence. The twelve links of dependent origination arise when ignorance gives rise to consciousness and karmic acts, which in turn make one enter the cycle of death and rebirth. Understanding the principles of dependent origination is fundamental to attaining enlightment, as explained by Nagarjuna in the Madhyamika-karika 24, 40: ‘The one who sees Dependent Origination, sees this precisely as Suffering and the Source, precisely as Cessation [of suffering] and Path [to the cessation of suffering]’. There are competing interpretations of this principle: some see dependent origination as causing the rebirth of individual bodies, others understand it as a more generic principle guiding the emergence of all phenomena and beings as conditioned. For a detailed exposition of the Tibetan view, see Napper (1988). The Tibetan Gelugpa view of dependent origination is outlined extensively in Tsongkhapa's 15th century Lam rim Chen mo or ‘Great Exposition of the Stages of the Path’.

[2] These are perceived to be ‘secondary’ factors in Tibetan medicine. The primary cause of illness according to the rGyud bZhi is ignorance (ma rig pa) and its associated three poisons (dug gsum), desire, hatred and delusion:’dod chags, zhe sdang and gti mug.

[3] Such modernestic metaphors are also common employed by exile doctors. For instance, MTK doctors often compare the tsa (pulse) to a telephone line, and the practitioner to the device that interprets the electric signal.

[4] For example, fainting or comatose states are referred to as rlung gis khyer te grong thengs yang byung [when the wind carries one off].

[5] See also Jacobson (2002) for an explanation of srog rlung as ‘panic attack’.

[6] Accounts of Tibetan ethnoanatomy, aetiological systems and ‘idioms of distress’ that may enlighten us on this relationship between Buddhism, medicine and the self ‘outside’ the conventional works on Tibetan medicine are scarce. They are mostly derived from historical inquiries (Tucci 1956; Snellgrove & Richardson 1968), or from more recent anthropological work on illness in the TAR and among Tibetan Sherpas of Nepal (Ortner 1978; Adams 1998; Desjarlais 1992) and biographical accounts of life in Tibet (Taring 1970; Norbu 1987).

[7] Some of the interviews were pre-scheduled and others were conducted on the premises. Many of the persons interviewed in the Men-Tsee-Khang were previously interviewed in December 2000 because they were regular patients there.

[8] Sems khral byed pa, skyo ngal ba, sems sdug pa.

[9] Tibetans who have arrived in India post-1980 are commonly referred to as newcomers (gsar byor ba). Here I refer specifically to the very recently arrived young refugees who are accommodated in the reception centre in Dharamsala and then later sent to ‘Transit schools’ to further their education. Torture survivors constitute a special group within the newcomer community and special facilities have been designed to accommodate them and facilitate their integration in the refugee community. For an account of the politics of a psychosocial care project for torture survivors in Dharamsala, see Mercer et al . (2005).

[10] Chenrezig (Avalokiteshvara) is the protective deity of Tibet, a bodhisattva who has made the vow not to leave the world until all sentient beings have attained liberation. The Dalai Lama is seen as a manifestation of Chenrezig. Migmar's dream vision incorporates this ubiquitous and highly significant religious figure and the sequence of the dream itself is culturally encoded: the metaphor of flowers opening is commonly used to describe Chenrezig's compassionate care for sentient beings.

[11] The equivalent of ‘Doctor of Philosophy’ in the monastic curriculum.

[12] The diagnosis and rapid treatment of diabetes has become a public health priority in the Tibetan community, as diabetics are very prone to infections, particularly to tuberculosis.

[13] This is of course not a new preoccupation for anthropologists. Geertz (1973, pp. 119–120) asserts: ‘the movement back and forth between the religious perspective and the common sense perspective is actually one of the more obvious empirical occurrences on the social scene … human beings move more or less easily, and very frequently, between radically contrasting ways of looking at the world, ways which are not continuous with one another but separated by cultural gaps for which Kierkegaardian leaps must be made in both directions’.

[14] A powerful critique of the orientalism entrapping Tibetans is Donald Lopez’ (1998) ‘Prisoners of Shangri-La’.

[15] The term ‘cutting’ is employed intentionally here for its highly significant use in Tibetan Buddhism. The practice of cutting (gcod), rooted in the teachings of the Prajnaparamita and set down by Padhampa Sangye and Machig Labdrön, consists of ritually ‘severing’ the ego, for example, by offering one's body to a deity. Yet the term also means to define, restrict, and circumscribe.

[16] What Veena Das (1995) has termed the ‘burden of proof’ in her analysis of the Bhopal crisis and has of course elsewhere been linked to the wrongful appropriation of victims’ suffering by Joan and Arthur Kleinman (1997).