The Hierarchy of Food Consumption and Tibetan Experiences of Gastric and Gallbladder Disorders in Amdo

Abstract

This article examines Amdo Tibetan people's experiences of gastric (pho nad) and gallbladder disorders (mkhris nad) in rural Qinghai. I illustrate how different and multifaceted the experience of illness can be when viewed from a home-based perspective in contrast to perspectives that have prevalently favored as a starting point health professionals or medical texts. I pay particular attention to the use of domestic space and practices pertaining to food and show how these uphold hierarchical kinship relations. Then I show how the upholding of hierarchical kinship arrangements in Tibetan households is a far greater concern than addressing individual health requirements. Tibetan people are portrayed as entangled in a demanding and complex web of social obligations and expectations, which are reinforced by religious beliefs and have an important impact on the Tibetan experience of illness and the trajectory of health-seeking behavior. Although people attempt to cure the symptoms through the intake of medicines in the acute phase of their illness experience, these ailments often fail to break the cycle of illness, as hierarchical family arrangements and religious preoccupations often override “biomedical” risks.

Keywords:

• Domestic space
• food
• illness
• Amdo
• Qinghai

Acknowledgments

I thank Geoffrey Samuel and the anonymous reviewers who helped improve this article with their feedback on the original draft.

Notes

1 Ethnographic material highlighting the important role of the family in the health-seeking process can be found throughout South Asia. Some classic examples are Amarasingham 1980 and Jeffery, Jeffery, and Lyon 1988.

 2 See Ortner 1979: 75, Havnevik 1989: 159, and Gutschow 2004: 201.

3 For a discussion of the concept of “harmony” in relation to “hierarchy” in Tibetan notions of health, see Bassini 2013: 235–55.

4 Here I have offered the Amdo Tibetan spoken form. Please note that the correct written Tibetan transliteration is nga ’khyags song ba red.

5 Tibetan doctors in Amdo asserted that the medicines believed to have a warming effect and hence to be beneficial in counteracting gastric disorder are se 'bru dwangs gnas and se 'bru lnga ba. I thank the anonymous reviewer for pointing out that having a strong enough digestive heat is a cornerstone of Tibetan medical theory and cannot be seen as purely a folk understanding.

6 C. G. Helman, who is trained in medicine and anthropology, states: “[Diarrheal diseases], which kill about 5–7 million people every year, are largely linked to poverty, with the resultant poor nutrition, water supplies, housing, sanitation and garbage disposal. Before diarrhoeal illness can be permanently reduced, or eliminated, these socio-economic issues will have to be addressed” (2000: 248).

 7 In addition, people from eastern China had a hard time adjusting to Qinghai cuisine. Indeed, they would complain that “rice and wheat flour taste good and are easy to digest; when you get barley noodles in your belly, they are hard to digest” (Rohlf 1999: 186). Tibetans and Han Chinese alike consider food to be an ethnic marker.

 8 Chang (1979: 314) states that pork is “the preferred meat of the Chinese.”

 9 See Schrempf 2010 for an in-depth discussion of the widespread use of intravenous injections among Amdo Tibetans.

10 This is also in line with the Chinese rationale, as Ludman et al. (1989: 1122–23) state, that “animal foods, including meat [usually meaning pork], beef, pork liver, eggs, poultry, and beef or pork blood” also help against “too much coldness.”

11 In my view, attributing responsibility for illnesses to the divine realm also allows Tibetans in Amdo to save face and preserves harmonious relationships within the family. Discussing responsibility for infections such as hepatitis B within families and among villagers can cause embarrassment. Although some people argue that hepatitis B has been chiefly spreading within the Tibetan rural community due to reuse of needles, the increased mobility especially of Tibetan men to towns and cities could also force them to discuss the increasing problem of sexually transmitted diseases. A great number of Tibetan people with whom I have had the chance to discuss the topic are not aware of or have difficulties talking about the health risks of unprotected sex.

12 Amdo Tibetans refer regularly to a plethora of healing traditions. On one hand, we find ritual practitioners such as lamas (bla ma), monks (grwa ma), lhawa (lha ba), lhamo (lha mo), nachpa (sngags pa), and elderly village men (rgan po) who are expert at chanting mantras. On the other hand, there are people that practice medicine such as barefoot doctors (rkang rjen sman pa), Tibetan doctors (sman pa), and so-called Chinese doctors (rgya sman pa) who practice biomedicine. For a more detailed description of the Amdo healing context, see Bassini 2007: 58–62.