Class and the clinic: the subject of medical pluralism and the transmission of inequality

Abstract

This article, based on ethnographic work in rural Tamil Nadu, explores the relative invisibility of class and its characteristic modes of operation in the literature on medical pluralism in India. Using, as key concepts, habit, comfort, pre-familiarity and familiarization, the article suggests that we can shift the way we think of ‘pragmatism’, the term that is routinely used to describe subjects who follow pluralist strategies. In reconceptualizing pragmatism, we can allow ourselves to glimpse anew the workings of class within pluralist strategies. The article takes inspiration from Gramsci's critique of the self-evidence of ‘common sense’, as well as from the phenomenological aspects of Bourdieu's understanding of class and habitus. It explores the very different levels of comfort and authorization that different classes display in relation to biomedical spaces and practices, as well as towards non-biomedical discursive practices. ¹

Key words:

• class
• medical pluralism
• biomedical clinic
• pragmatism
• familiarization

Notes

1. A note on Transliteration: This method is commonly employed in the English language academic transliteration of Tamil words as an alternative to the use of diacritical marks. For full details, refer to Ram, Mukuvar Women.

2. Field notes, coastal Kanyakumari, 1996. Names have been altered to protect privacy.

3. Bourdieu, Outline of a Theory of Practice.

4. Leslie, ‘Pluralism and Integration’, 517, Emphasis added.

5. Berger, ‘Ayurveda and the Making of the Urban Middle Class’.

6. Bharadwaj, ‘Sacred Conceptions’, 454.

7. Ibid., 453.

8. Davar and Lohokare, ‘Recovering from Psychosocial Traumas’, 61.

9. Mandelbaum, ‘Transcendental and Pragmatic Aspects of Religion’, 176.

10. Lock and Kaufert, Pragmatic Women, 7.

11. Ibid., 2.

12. Leslie, ‘Pluralism and Integration’, 517.

13. Gramsci, Prison Notebooks, 325–6.

14. Romanucci-Ross, ‘The Hierarchy of Resort’.

15. Landy, Culture, Disease and Healing, 469–74.

16. Sujatha, ‘The Patient as a Knower’, 78.

17. Nichter, ‘The Layperson's Perception of Medicine’, 226.

18. Mathews, Health and Culture, 367.

19. Conversation with Santhoos Mary, coastal village, 1994.

20. Nichter, ‘The Layperson's Perception of Medicine’, 227.

21. Nichter, ‘The Layperson's Perception of Medicine’.

22. Ibid., 228–9.

23. Zhang, ‘Switching Between Traditional Chinese Medicine and Viagra’.

24. Naraindas, ‘Of Spineless Babies and Folic Acid’, 2667.

25. Prakash, Another Reason, 144ff.

26. Ibid., 145.

27. Seth, Subject Lessons, 1.

28. Wujastyk, ‘The Evolution of Indian Government Policy on Ayurveda’, 60.

29. Bhore's 1946 Report is cited in Wujastyk, ‘The Evolution of Indian Government Policy’, 54.

30. See, for example, Khan, ‘Systems of Medicine and Nationalist Discourse’; Naraindas, ‘Of Spineless Babies and Folic Acid’; and Wujastyk ‘The Evolution of Indian Government Policy’.

31. See, for example, Ram, ‘A New Consciousness Must Come’.

32. See Ram, ‘Modernity as a “Rain of Words”’.

33. Mehrotra, ‘Well-Being and Caste in Uttar Pradesh’.

34. Ibid.

35. Ram, ‘A New Consciousness Must Come’.

36. Pinto, ‘Development without Institutions’, 341.

37. Kapadia, Siva and Her Sisters.

38. For an early account of such treatment, see Gould's vivid description: ‘But the peasant sees hospitals and clinics as places where he will be compelled to wait endless hours in congested anterooms, castigated and mocked by officious attendants, and finally examined and treated by a doctor who will show no personal interest in him whatsoever.’ Gould, ‘Modern Medicine and Folk Cognition’, 502.

39. Donner, ‘The Place of Birth’.

40. Ibid., 312.

41. Ibid., 324.

42. Chatterjee, ‘The Nationalist Resolution of the Women's Question’.

43. Hancock, Womanhood in the Making, 61.

44. See Chatterjee, ‘The Nationalist Resolution of the Women's Question’, 247.

45. Young, Presence in the Flesh.

46. There are entire dimensions to the performativity of authority wielded by doctors in family planning clinics, which rely, for instance, on discourses and policies forged by the state. On the latter, see Ram, ‘Rationalizing Fecund Bodies’.