Alternative Medicine? A History (review)

Roberta Bivins has given herself an almost impossible challenge in writing a popular history about a very slippery subject. She is among those who quite sensibly think that medicine, even today, comes in a great and almost indefinable variety of changing forms, so that if the history of past practices is also considered, one can say only that multiplicity is the watchword. Is there, then, anything such as “alternative medicine” per se? Her answer is also unsurprising: there is one standard modern medicine (which she also calls “regular,” “orthodox,” “universal,” “scientific,” and “biomedical”) by comparison with which everything else becomes an alternative. One might put the question mark at the end of the book’s title, then, for in such a case there can be no history of alternative medicine per se, only a history of the rise to dominance of scientific medicine. Hers is also an Anglo-American perspective, since the integration of homeopathy and traditional Chinese medicine into regular primary care in modern Germany, for instance, might qualify some of her assumptions about biomedicine in important ways. Nevertheless, Bivins goes on to argue a common view: that scientific medicine is an agent of political power domestically in Europe and North America and of Western imperialism abroad. For instance, she claims that although Enlightenment ideals of egalitarianism were subversive of the established order, “anatomy offered elites a way around these . . . conclusions” by “painting a picture of immutable ‘natural’ differences between the sexes, races, and eventually classes.” Anatomy’s “social utility” therefore allowed it to gain “social authority” (p. 44). It is a view of the history of medicine familiar since the 1970s, although it is getting somewhat long in the tooth.

Unfortunately, this argument does her little service in accounting for the events she details. In her own description of being a sick child in eastern Africa, for instance, Bivins writes about the eclectic and undefined nature of her encounters with various treatments and practitioners, which depended very much on circumstance, availability, and her parents’ very evident need to do something; in the main text, she also recounts many episodes in which people tried things out to see whether they worked. She therefore frequently must shift from her main orientation toward political ideology to a history of ideas and, sometimes, even to a history of commerce. The introductory chapter, for instance, sets up an oppositional intellectual history. Bivins argues that despite the “supremacy of biomedical orthodoxy,” it is contingent and “contested in no small part” by Asian and “pre-modern” European medicine (p. 28). To demonstrate this, she offers a series of thumbnail sketches of the essential characteristics of the main “systems” of “medical thought” in East Asia, the Indian subcontinent, and Europe. (Presumably, the Arabic-Persian is left aside as a derivation of the Greek, whereas only a few will notice the absence of the Tibetan.) On one hand, she argues that the three systems once had so much in common that one can think of the four humors as “like” the three Sanskrit dosas or the Chinese “fundamental substances” or consider Chinese qi to be like Indian ojas “while the aether or pneuma of the ancient Greeks and the spiritus animalis of Galen fulfil the same roles in the West” (pp. 25–26). These “broad similarities between medical thought in East Asia, the Indian subcontinent, and Europe endured into the eighteenth century,” when the “new orthodoxy” of scientific medicine arose in Europe (p. 31). Unfortunately, Bivins’s attempt to be succinct about the intellectual “systems” sometimes results in caricature and even error (she insists on the humors being nothing more than “fluids,” for instance), and she has nothing to say about whether they might have had their own social utility, instead allowing them to float in the realm of ideas as holistic and mainly concerned with maintaining health rather than treating disease. In later chapters, she gives accounts of the introduction of moxibustion and acupuncture into seventeenth-century Europe, the rise of mesmerism...