116: History is Not a Placebo: Chinese Medicine in America (w/Tamara Venit-Shelton)
Traditional Chinese Medicine is an ancient medical system that has persisted in its homeland for countless generations before being exported to the rest of the world—right? Well, not exactly, but that doesn’t mean the varying sets of practices have not made an impact in China and abroad.This week, historian Tamara Venit-Shelton joins the podcast to talk to Derek about the history of Chinese Medicine in America. The author of Herbs and Roots: A History of Chinese Doctors in the American Medical Marketplace, they discuss the xenophobia and racism that Chinese encountered in the 19th century West, how early Chinese doctors used the exoticism of their system to their advantage when advertising to disaffected Americans who were suspicious of the dominant health care system, the moment that these varying practices became unified by Chairman Mao in the middle of the 20th century, and how the acupuncture needles we use today are not actually Chinese in origin—we can thank the Japanese for the world’s recent widespread adoption of that practice. Show NotesHerbs and Roots: A History of Chinese Doctors in the American Medical MarketplaceTamara Venit-Shelton gets to the roots of Chinese medicine in AmericaEvidence Map of Acupuncture review of systematic reviews on 1,500 RCT’s.David Gorski “Acupuncture is a theatrical placebo, retconned beyond recognition.”$2.5 Spent—No Alternative Cures Found by the NCCIH
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Conspirituality 116.
History is not a placebo.
Chinese medicine in America with Tamara Vennett Shelton.
Traditional Chinese medicine is an ancient medical system that has persisted in its homeland for countless generations before being exported to the rest of the world.
Right?
Well, not exactly.
But that doesn't mean the varying sets of practices have not made an impact in China and abroad.
This week, historian Tamara Venitch Shelton joins the podcast to talk with Derek about the history of Chinese medicine in America.
The author of Herbs and Roots, a history of Chinese doctors in the American medical marketplace.
They discuss the xenophobia and racism that Chinese encountered in the 19th century West.
How early Chinese doctors used the exoticism of their system to their advantage when advertising to disaffected Americans who were suspicious of the dominant healthcare system.
the moment that these varying practices became unified by Chairman Mao in the middle of the 20th century, and how the acupuncture needles we use today are not actually Chinese in origin, we can thank the Japanese for the world's recent widespread adoption of that practice.
Okay, Derek, so we enter once again into the controversial territory of Chinese medicine.
We've talked about it on the pod several times, most notably in episode 38, and each time we've gotten some pushback from listeners who are either acupuncturists themselves or who have beneficial relationships with Chinese medicine.
We'll talk today about the complexities of the topic and some of that audience feedback a little later, but this time around, we have this excellent interview you've done with an academic scholar and author, Tamara Bennett Shelton, who brings a historical and cultural lens to the topic.
Her book, Herbs and Roots, starts by taking us back to the Gilded Age of the 1870s, which was characterized by American graft and corruption, as critiqued most famously by Mark Twain in his book of that name.
It was also a time in which conventional medical science was still in its infancy and had many drawbacks.
So what made you want to talk to her specifically?
And was there anything in the book or the interview that surprised you or added to your knowledge?
Specifically, Natalia Petrozzella reached out to me on Twitter after seeing my posts about TCM in May and said, hey, my friend Tamara, you have to talk to her and read her book.
And so I did.
Got it.
Which was excellent.
And I was really happy because I wanted to talk to someone about the historical aspects.
I know we're going to talk a little bit about efficacy today as we go through this episode leading up to the interview.
One thing that I had noticed, both when I talked about the totoaba trade in Mexico and how that was bankrupting an entire ecosystem, and I had interviewed a documentary filmmaker about that, and it was all supporting TCM, and then also when I made that post in May, were that people were conflating The Asian-American hate and racism, which is horrible, with medical efficacy.
And this idea that you can't test TCM by Western standards.
So I wanted to tease apart the historical, cultural aspects of how Chinese medicine came into America.
So Tamara and I don't talk at all about efficacy.
We just talk about the cultural aspects, and as in the intro, as you mentioned, One of the surprising things I didn't know was that for most of history acupuncture was a little more akin to bloodletting where you wanted to get the chi to flow literally so the needles were a lot more aggressive and made you bleed and it was the Japanese that evolved the form which became There's a bunch of real nuggets that she shares with us, but that one definitely jumped out at me.
But really I just wanted to talk to a historian to really lay the framework for at least understanding how Chinese medicine came into America.
And we can't use the term TCM at that point because that was invented by Chairman Mao in the 1950s, which is another fascinating aspect that we'll get to.
Yeah, I think that it was true that there were some sloppy conflations between, as you say, sort of interpersonal racism and critiques of the efficacy of Chinese medicine or traditional Chinese medicine.
But also critiques of environmental impact.
Right.
Right.
I mean, and those, you know, conflations can happen because of social media, because a kind of justice seeking that.
May or may not have a performative element to it.
It can happen because there are a lot of very strong feelings and long histories.
We see this when we talk about yoga, we see this when we talk about Ayurveda, but there's usually something driving that and I think the criticism of our previous coverage that sticks Is that to talk about efficacy in terms of Chinese medicine without talking about the structural, not the interpersonal aspects of racism that will value one epistemology over another and how that evaluation is embedded in
colonial and post-colonial inequalities and humiliations, that kind of just makes for a two-dimensional presentation.
So, with our crowd, you know, three white guys sidelining the cultural sensitivity piece, or at least not giving it equal weight, carries the echoes, or it can carry the echoes, fairly or not, with aspects of the skeptical or new atheist online movements which explicitly don't give a fuck about cultural realities and have generally tracked towards reactionary centrism or even right-wing heterodox takes.
And so, as Tamara points out, focusing on efficacy has been a way of xenophobically alienating immigrant practitioners in the U.S.
from the very start.
Well, hold on a second there.
I would actually put a little point on that and say focusing prematurely and falsely on efficacy in the early days was a manipulative strategy of xenophobic, oppressive, monopoly-seeking, right?
Right, and it's hypocritical because conventional doctors in the 1890s in the U.S.
were standing on super shaky ground when they decided to call an out-group quacks.
So yeah, memories run deep, structural racism is real and palpable.
So, I think the task that's really difficult, and I'm not quite sure who else tries to do these two things at the same time, is that it's never just a medical debate.
I mean, we can try to separate out efficacy from Cultural issues.
We can get into the weeds of whether or not there's any proof that acupuncture works in the ways in which it's said to work.
But we also have to look at how that discussion interacts with the contexts where community stakeholders use these practices towards a variety of goals.
And it's not easy.
Yeah, I'm not surprised it's hard.
Hearing about the history in the interview, Derek, had me thinking about how during the late 19th century, 20,000 of the roughly two and a half million Chinese immigrants who'd been flooding into the U.S.
would be instrumental in building the transcontinental railroad.
And as many people will know, they were incredibly poorly treated.
They were paid often half as much as whites.
And the whites were accommodated in train cars as they built the railroad out on the hard ground where the Chinese were just set up in tents.
And this entire project was utilizing cheap immigrant labor, not only the Chinese, also the Irish, also the Mormons who'd been migrating across the country.
And these were people who were willing to do back So, in addition to what Tamara talks about regarding kind of racialized medical marketing in the service of monopolies, we find, I think, that the tensions that arise today when we're critical of Chinese medicine have these complicated roots that understandably evoke echoes, as you were saying, Matthew, of past discrimination and oppression.
You know, I think one of the ways we can reflect on the pushback from our listeners is to acknowledge this history.
I mean, like it's easy to see how people sympathetic to Chinese medicine might interpret critiques as an expression of this long-standing bigotry.
So, how we acknowledge this, how we tease that apart from scientific data and perhaps environmental impacts and relate it back to valid critiques of today's conventional medicine and the role that Chinese medical practitioners play All of that seems crucial to moving this sticky conversation forward.
And at the same time, I think comparisons between Chinese medicine and what we might call traditional Western medicine of that time, going back to like the late 19th century, play out very differently now because of the progress of medical science.
One thing that comes to mind is you mentioned the railroads, and this has long been a critique that I've had of the way that certain Americans on both right and left look at other cultures as if they're a monolith.
So you did have this incredible, horribly incredible movement of the workers, the indentured servants basically that were brought over, but those were not the people that were coming over to practice medicine.
So the idea that other cultures are all of the same class, as if class systems don't exist in other cultures, I think that gets also confused sometimes because sometimes there were movements of sending people to America in order to promote their own agendas that sometimes gets lost in this conversation.
Yeah.
And one other thing that Tamara points out in our interview in the book is that There has always been an exchange between science and medicine between China, Asia, largely in the West, and as I've mentioned before, the very first citation of anything resembling vaccination comes from Chinese medicine.
Yeah, and we have to ping Annie Kelly's vaccine podcast here as well because she's got amazing early stories out of China with regard to inoculation against smallpox using ground-up scabs.
Totally, it's amazing.
And blowing them up the noses.
So that emperor faced a Fauci-sized backlash as well in the eighth century or something like that.
And I think it was from the yoga moms at the time.
I think it was, didn't she say it was mainly the women in his court?
Yeah, the Karens.
The earliest citation in the literature is actually, I think it was for rabies, but the remedy was to ground up a piece of a dog brain and then put it on your skin in the sight of infection.
So that it got into your bloodstream.
So you can see this idea of like cures like, which is vaccination, but that's where it comes.
And so that goes way back, probably I think about 12 centuries.
But in the 19th and 20th century, the exchange between Asia and American Western medicine continued.
And again, we're going to get into this more.
One thing that frustrates me is this idea that Chinese medicine can be treated as something completely different or other than Western medicine because, first off, as I said, it was a specific agenda by Mao, the idea of traditional Chinese medicine.
In the same vein, Western scientists have always been curious about the herbs and roots in Chinese apothecaries, which led to a lot of research for pharmaceuticals and different interventions in Western medicine.
So to treat them as completely separate domains just shows a lack of understanding of the historical impacts of migration and trade, and eventually a large number of Chinese settling in America, and specifically it was the West Coast where all of the medicine really took root here.
Yeah, and if we're going back into that period of time, you really are comparing two systems that are very, very similar and that have very, very similar approaches to how they're using herbs and how they're diagnosing at a time when medical science is still very new.
Something that came to mind for me about all of this as well is that today's traditional Chinese medicine really in the US has professionalized itself very effectively.
It's become embedded not only in the marketplace but also in relationship to medical science, educationally to some extent, but also in terms of being somewhat legitimized as seen as a valid and a useful adjunct by a lot of conventional doctors.
It's also framed as being more about wellness than about making the kinds of outrageous usually counterfactual anti-scientific claims about cancer and other serious diseases that we see from conspiritualists and from some more or less reputable kind of alternative medicine approaches.
We haven't covered on the podcast any specific acupuncturists or traditional Chinese medicine groups who've been COVID denialists or anti-vaxxers or who've claimed that these herbs or that acupuncture protocols would be all you need to boost your immunity.
This is a crucial point, right?
And many people pointed out in the feedback that Hey, this community is not the conspirituality problem.
Look at how we've organized ourselves in support of public health.
Yeah, and I think in terms of the professionalization, there is a much more sober attitude in terms of how they interact with big topics like a pandemic.
It's very complimentary and often seen as having a kind of harmonious relationship with what we might call Western medicine today.
I've also never talked to anyone, just anecdotally, who had a serious disease, a spinal injury, a psychiatric emergency or something of that level of severity, who was told by their Chinese doctor to forego medical care and rely instead on traditional Chinese medicine.
So I think as a discipline, it does sit in a fairly unique institutional position.
And I really want to acknowledge that.
I think it should be appreciated.
Of all the major alternative medicine approaches, I think it does the least harm.
Actually, that idea was brought up to me by Kevin Russell, who's a listener of this podcast.
He's a practitioner of TCM for about 25 years, he told me, and often comments.
It's funny because a lot of times, even the pushback I got from the Rogan episode is in the comments sections can be trash bins.
But in DMs, I have very good conversations with people sometimes.
And not all comments, of course.
There are some really good ones as well.
It's very hard to have progressive debates and dialogues in the comments section, but when you're one-on-one with someone, you can usually get somewhere.
And I think that is a very important point that Kevin specifically brought up to me, which you just reflected, Julian, that it does relatively little harm.
He actually told me that it was unfair to lump TCM with homeopathy and Kelly Brogan, I completely agree with.
So I don't necessarily agree with all of the efficacy claims that people say.
I still am looking for evidence, but conflating it with the more egregious pseudoscience is unfair and I will not be doing that anymore.
And, however, we did and we have and will continue to talk in bits and pieces, I'm sure, about traditional Chinese medicine because it is adjacent to the conspirituality-laden wellness disciplines that we cover.
Sayerji's website is chock full of TCM materials and marketing.
You can come for the Chinese herbs and you can stay for the Satanic Panic.
And of course he was, he's tied right, he was anyway, tied right into Brogan's marketing machine and everybody else, including Mercola's.
But, you know, Julian, you're right that we haven't clocked a single educated TCM practitioner who promoted anti-vax conspiracy theories, and as many listeners said, you know, this community is just, it's not the issue.
In fact, they argued they might provide a threshold space between forms of alternative medicine that are truly unregulated and irresponsible, And conventional medicine, because while it would be standard for the skeptic of mainstream medicine to walk into a chiropractor's office and find anti-vax materials, that would be extremely unusual to find in a TCM clinic.
But isn't this, I want to ask you both, isn't the stickiest part of this argument is that if a practitioner is telling clients and the public that health or disease states are dependent on the proper balance of chi or prana or the doshas.
They might be drawing people away from evidence-based knowledge that could actually empower them to make sound decisions.
Is that fair?
Is there a slippery slope?
And if there is, which way does it slide?
Which way does it roll?
Yeah, I mean, you're making my sort of default case.
And so, what I would say is, Chinese medicine has a model of the body and a way of thinking about diagnosis and prescription that is based on, you know, a set of ideas, a set of practices, specific protocols that are said to balance out your energy system.
All of which has failed every time it's been tested in the same rigorous way that we've developed all the scientific knowledge we have and why medical science has progressed in the ways that it has so that we can sequence the human genome and predict whether or not you're going to be susceptible to certain cancers, for example.
Put a rocket on Mars and drop off a rover to gather, you know, rock samples.
Like, we know that this method really works.
Brain surgery, you know, there are just so many things that are both medical and technological where we see the scientific method showing us reliable, replicable maps of reality.
And in terms of that purely empirical examination, Chinese medicine hasn't met those standards and so yeah when you're when you're talking about Health and illness and healing, using a model like that, there is a slippery slope there.
And I think the reason why it's been adjacent to conspiracism and conspirituality is that it is offering a completely alternative model of reality that appeals to people who really want to believe in things like that as opposed to more quote-unquote mainstream narratives.
And then you start to argue that the lack of evidence is really because it's been suppressed and there's a conspiracy, etc.
Yeah, but at the same time, all of what we're speaking about in these practices speak to emotional needs and intuitive disposition that You know, is punctured by what you're saying, right?
I mean, that's the tricky thing, right?
There's a category that we don't have in our culture where something like that could exist in a very, I think, valid and beneficial way without the additional claims that encroach on medical science or that can be tested by medical science and shown to be not particularly robust.
Right.
I don't have as much of a problem with it when you're talking about diseases that are Or in this case, disorders like psychiatric disorders.
I've talked about my own experience with acupuncture.
I've had about 25 sessions.
Speaking of TCM, I got my first massage in Portland last week and the therapist said, can I do some cupping and I didn't yell at her.
I let her do it.
And it was nice.
Did she use IPA classes?
Of course, of course.
I appreciate the ritual and care that go into practices like this.
And so framing that, if someone has something that's harder to diagnose, like Like a recurring bouts of depression or anxiety and they get something out of these practices and if there's a little more imaginative language used, I have never been anything but fine with that.
It's really when you start saying, so I went to those acupuncture sessions for a specific problem and it was never addressed.
Or if you get something which relies on disease specificity like a cancer and you're using something that has not been shown to work, that's where the question of efficacy really—that's where it becomes a slippery slope.
If you're using a language that's not suited for disease specificity in such a manner, I think it's problematic.
If it's more ambiguous and you like the ritual and it's helpful, then that's totally fine.
You know, there's a way too.
I also, if I went to get a massage and the person offered to do cupping on me, I'd be like, yeah, go ahead.
I'm curious to see how that feels, you know, to see if I like it and to see what it is about it that people feel is beneficial.
But, you know, I think like if you think about massage and even something like chiropractic, right?
These are approaches that sometimes Sometimes people who employ them or schools of thought around them will make various kinds of pseudoscience medical claims.
But then there's also just the practice of them in a way that feels healing and beneficial and relaxing and interpersonally kind of loving and caring and maybe helps you with like your sports injury or the fact that your neck is just out of alignment or something.
I think that there's a way that I could see Chinese medicine practices kind of sitting in that area.
And I'm comfortable receiving those kinds of treatments too, but it's not something I would seek out if I had serious illness.
And that's the place where I think a lot of people in our community, they cross that line, both as practitioners and as recipients.
So they're like, no, no, no, this is the thing that don't go to that like stodgy old Western medicine.
This is what's going to save your life.
Yeah, I mean, I think I've said this before, but when I was in Endeavor Academy, one of the senior members was a traditional Chinese medicine guy, and one week I lost my voice during a period of great stress, which was probably related to being in the cult more than anything else.
And, you know, he gave me one needle to the throat, and it seemed to miraculously reverse the condition.
But, you know, looking back, I can see that the whole experience was completely confounded by, first of all, the cult environment.
Second of all, not having a GP in the middle of, you know, rural Wisconsin.
And thirdly, getting attention from a kindly senior cult member who seemed to make it okay that I was there.
And I would add something else, which is that, have you guys heard of a psychotherapy modality called narrative therapy?
Yeah.
Okay, well, so I think part of what happens with the poetic language of Ayurveda or the language of qi is that a story is told about your body to you, and that can feel really sort of holistically integrated.
It can feel like, I'm actually attached to all of my parts and the stress that I'm going through or the physical symptom that I'm having, it's meaningful in terms of my sort of bodily presence in the world.
And I think that's a factor as well.
And I think for Derek, I mean, I gotta say that did your cupping, did it also like enhance your tattoos as well?
I didn't actually look at it afterwards.
You didn't look?
You're supposed to post the picture, man.
No.
I know, I know.
I don't know if it made any difference.
She was a wonderful therapist.
I'm so glad I have someone close to me who's that good, and she was not woo at all.
It's just something she did, and if she does it again, that's fine.
I'm not going to make any gripes about it, but yeah, next time I will take photos.
Excellent.
So, like, we get into this territory here where, you know, I think all three of us have experience of this.
I may be the one who's still sort of the most immersed in and sympathetic to this attitude, but it's that there are experiential kind of ritual healing practices and spaces and ways of like exploring your inner life.
And even if there isn't this, because I don't think there is, even if there isn't this top down sort of mind over matter thing that you can utilize, where if you just think the right thoughts or if you just get into the right kind of spiritual experiential kind of higher truth that you will then transcend or completely resolve where if you just think the right thoughts or if you just get
There is a lot of interesting stuff about the interplay between mental states and neurotransmitters and hormones and how you can actually, quote unquote, support your immune system through the way you're managing stress and the way you're entering into beneficial experiential states. support your immune system through the way you're managing stress Again, I just think we don't have a category for that specific kind of, quote unquote, healing.
And I think that's part of the reason why in our culture it is so popular because it's missing from how people experience the current medical model.
There isn't that experiential richness, there isn't that interpersonal care, there isn't that sense of going on a journey to discover meaning or to like shift your mental state in such a way where you feel relief Separate from, like, I got the surgery and now I think I'm going to be okay, you know?
You asked me earlier with my interview, and I don't want to give too much away, but something that Tamara wrote and then we talked about was that Chinese doctors were excellent diagnosticians, whereas the American doctors were excellent surgeons.
So the Chinese doctors could look holistically and think about the entire landscape of health, whereas the American doctors were so good at identifying the problem and then going right to it.
And speaking to that as well, she also talks about how the apothecaries were also where you would get your mail and where you would go play cards with your friends.
It was a social center.
So not only would your doctor prescribe and then actually distribute the herbs to you right there, but as soon as you walk out of the office, you're surrounded by your community.
And all those aspects definitely played a role in healing in some capacities.
There's been plenty of research that shows like where your hospital window faces, whether it's a wall or nature, will influence your healing process.
And so I don't think we have enough of that in our current model.
Yeah.
I mean, just to do my usual kind of making a stand for some sense of scientific clarity, you know, I feel like everything that we've just said, I stand by.
And at the same time, there are things that are absolutely testable, that are being claimed, that are not simply poetic, that are not simply experiential, right?
The claim is, body is made of these meridian lines that issue forth from the different organs.
They have these specific acupressure or acupuncture points where you can stimulate and impact how the chi is flowing through those lines.
I'm very sympathetic to that at an experiential level and from my background.
But then it is that you can read the pulses coming from those meridian lines from special points on the wrist.
And that that can tell you if the pulse is dry or damp or slippery or hot or whatever the different diagnostics are.
Again, which is poetic language.
But it's used then as a way of diagnosing and then prescribing specific herbal remedies which can be tested.
You can test how effective that diagnostic process actually is.
And if all Chinese doctors would agree on the diagnosis based on what they're feeling intuitively coming from your wrist.
It results in then specific acupuncture protocols being prescribed.
You can test how effective those are.
And the unfortunate reality is that when all of that stuff is tested carefully in the way we test everything else...
It's just not found to be conclusive.
The evidence is not strong enough for the scientific consensus to say, yes, there's something really here.
And I think that Tamara in the interview uses the term gatekeeping, and she's using it to talk about this very specific period in the late 19th century where Western doctors are trying to gain monopolistic ascendancy.
And part of how they're doing that is through this bigotry and this defaming of Chinese medicine as being quackery, even though, as you said, Matthew, they're on shaky ground at that time.
But what happens, there's a point of divergence within kind of, you know, if we're just talking about medical science, and as opposed to what today we think of as pseudoscientific alternative medicine approaches, And even though we've lost so much richness that I think we do well to try to reclaim and to consider carefully, what we haven't lost is our way in terms of like that how we apply scientific method to really seeing if something works.
And so that just gets us into this place where I end up saying where we're at today, Chinese medicine has not been shown to work.
And that might change.
There may be some new evidence that shows us otherwise in the future.
And that's great.
And so I think people in the research community should keep investigating, keep trying to shoulder the burden of proof.
That's great.
At the same time, I think that practitioners who are approaching Their Chinese medicine practice with a lot of sincerity and integrity and not being irresponsible in terms of serious disease and patients who are benefiting from and enjoying the experiential aspects, the community aspects, the meaning-seeking aspects of like being engaged in their mind-body health and wellness journey.
I think all of that is really fine, but it doesn't change the scientific facts as I understand them.
I think what's really interesting about what we're trying to do, and I'm sure we're going to get a lot of feedback, is that, you know, there is, as I said before, this double task of looking at efficacy and culture, and it's given me a little bit more clarity on the spectrum of possible positions.
Through this in this tangle.
I actually think I'm gonna make one of those brain expanding brain memes where the end point is the skull exploding in light where you know, you have that right you have those, you know, this kind of like Neanderthal skull where the you know, new atheists are saying like, you know, they're Dawkins are saying like TCM is bullshit.
Fuck this and all of their you know, non doctors.
They're all charlatans and then and then secondly we can have kind of like Normie alt-med apologetics, where the person says, well, it's worthwhile to examine traditional Chinese medicine scientifically, but we can't expect concrete outcomes to research because it's holistic.
And of course, that can't be tested.
That's a very common objection.
And it's really a way of saying, it works.
I know it works.
I know it works anecdotally, but I can't prove it to you.
And I can't tell you how.
And that's not a particularly strong position to come from.
And it causes a lot of stalemating, right?
Because I think the expanded brain endpoint is evaluating, and I think all consumers and practitioners of Chinese medicine that listen to this podcast would agree with this, that evaluating the efficacy of Chinese medicine should be a component of its public health application.
Given that biomedical policies like vaccination protect all people, and especially the marginalized, but while doing this we can also remain sensitive to the facts of this practice's cultural meanings, its histories, its communities, and understand that epistemology has definitely in the past
and can still carry a kind of cultural bigotry or racialized bigotry wrapped up in the projects of things becoming more efficient or the state-managing disease in particular ways.
Tamara, thank you for joining Conspirituality today.
Thanks for having me.
We're going to talk a bit about your book, Herbs and Roots.
A lot of what we cover on the podcast and yoga and wellness writ large really began in the late 19th century.
And of course, history is always occurring and there's precedent for every movement.
But there was definitely something occurring in those years that was unique to the American view of health and society overall.
And you wrote an essay for one of my favorite publications, Lapham's Quarterly, on California's 1876 Anti-Quackery Act, and you also write about that in your book.
So, let's start with that, because can you explain a little about what the Anti-Quackery Act is, and given the fact that it was passed during a decade when 100,000 immigrants had come over from China, what were that act's implications for Chinese medicine overall?
Great question.
And now I get to talk about the Gilded Age, which is 100% my favorite era in American history.
So let me, before going to the Anti-Quackery Act, which is just one of many laws like it passed in that era, let me just start by talking about kind of what's going on in the late 19th century.
Because as you said, there seems to be kind of a lot happening in, let's say, just sort of the space of health and wellness, the American medical marketplace.
And I think it has everything to do with modernization, industrialization, what's happening in the American political economy writ large as the Civil War has ended and the federal government has emerged from that war, kind of newly empowered to intervene in the economy and really Scale everything up.
So this is kind of the important backstory to why we see so many more health movements, why we see so many more health products, advertising of medicines and various kinds of remedies, both natural, whatever that means, and let's say more pharmaceutical in origin.
It is also a moment where elite practitioners of what we now think of as Western-style medical science have started to consolidate their power.
And this, again, starts with the Civil War, that these elite practitioners kind of get in at various levels of military and government offices And they really use those positions to lobby for their own monopoly, to lobby for their rights to control and really gatekeep the American medical marketplace in a number of ways.
So the anti-quackery law that you mentioned, which, like I said, is just one of a number of laws like it at that time, a result of the new power of elite Western-style medical scientists to pull those levers of government and to basically start to draw a circle around what is going to be considered regular medicine and what is going to be considered irregular medicine, right?
These are terms that we kind of bandy about as if they always existed, but really in the 1870s and increasingly in the last decades of the 19th century and the Gilded Age, we see what is now considered regular medicine becoming defined by laws like the anti-quackery law.
Which basically makes it very expensive or very difficult to practice medicine that is not formally approved, again, by these bureaucracies of elite Western-style medical scientists.
You brought up the fact that something you write about often in the book which is the Chinese medicine relies on herbs and then we have pharmacology in the West, in America specifically.
And I think sometimes people don't understand the differences between them or the fact that a lot of pharmacology is based on herbs, including Chinese medicine herbs, as you write about.
Those lines are not always clear.
And you also write that in the 1880s, American doctors were considered better surgeons and Chinese doctors were considered superior diagnosticians.
And obviously there's racial implications, which you just hinted at, but can you talk a little bit more about the push and pull between these two medical forms that was happening at that time?
Sure.
So one thing, let me just start off here by talking a little bit about what we mean when we say herbal medicine or what we mean when we say traditional Chinese remedies.
What does that mean?
This is a kind of umbrella term for actually medicines that are based not only in plants, but also animal and mineral sources.
And really, up until the early 20th century, when medical scientists become very good at synthesizing drugs kind of in mass ways, all medicines were herbal.
All medicines were plant or animal or mineral based.
I mean there really was No difference.
So what we see in an American pharmacopoeia is a kind of assemblage of medicines from these three sources, and it's maybe different in its distribution from a Chinese pharmacopoeia.
So Chinese pharmacopoeia might have a higher percentage of plant-based medicines and a lower percentage of mineral-based medicines, but In the 19th century, really up until the first couple decades of the 20th century, everyone, no matter what medical or pharmacological tradition, is drawing on the same sets of medicinal substances for what it considers to be healthful or healing.
But as he said, there is this way in which Chinese medicine gets racialized at the end of the 19th century.
Chinese medicine had really always been a part of Euro-American pharmacological knowledge.
There's a sort of Centuries-long history of Europeans and then Americans bioprospecting in Asia for medicinal ingredients.
And so Chinese medicine has always kind of been in the mix.
But by the end of the 19th century, and I think this really has to do again with this Gilded Age moment of modernization, industrialization, new flows of labor from overseas, including China.
In the late 19th century, Chinese medicine takes on a new racialized cast, and it becomes something that is both attractive and repulsive.
That is to say, it's something that American patient-consumers still very much use, they still very much desire.
As I say in the book, it's part of the sort of buffet of medical offerings that American patient-consumers are sampling from all the time.
But it also becomes a kind of rhetorical tool that Western-style medical scientists are using to define themselves.
So they're trying to say, what is it that medical science is and is not?
Medical science is not quackery.
Okay, well what is quackery then?
Quackery is Chinese medicine, right?
Chinese medicine which is based in a very different kind of conception of the body.
Chinese medicine which is racialized in these American Orientalist terms, racialized to be backwards, maybe deviant, maybe dangerous.
So Chinese medicine starts to take on these new meanings at the end of the 19th century that are very much useful for a set of elite practitioners Who do not, in fact, have all the answers, who do not, in fact, have a monopoly on the American medical marketplace, but would very much like to, or they very much aspire to control and gatekeep the American medical marketplace.
And so racializing Chinese medicine, defining it as quackery, defining herbal medicine as inferior, that becomes a really powerful tool In the consolidation of Western-style medical science, its meanings, and its power.
I worked for about a decade as a world music journalist, and this was in the first decade of the 21st century.
And there was still this, I would argue it still exists today, this idea of the exotic foreign culture, which kind of clouds our views on international citizens in some ways.
And this was very much going on at the turn of the 20th century.
And you also write that some of the Chinese doctors self-orientalized as a way to promote their medicine.
My question is, what do you think were the main appeals of Chinese medicine to the white culture and white, predominantly middle-class female white Americans that were going to see these doctors?
What do you think were the main drivers of why they were going to these apothecaries?
The appeal of Chinese medicine, I think, is...
Fairly constant over time from the late 19th century to now.
So I think in a lot of ways it's not hard to understand why people in the late 19th century medicine, especially women, actually middle-class women, would have gone looking for a Chinese herbalist, would have maybe preferred to be healed by someone using pulsology, which is diagnosis by pulse, or herbal remedies.
It largely has to do with the way that western-style medical scientists, science rather, was defining itself and setting the terms for care.
So in the late 19th century, surgery was neither safe nor terribly successful.
Pretty much you had a just as good a chance of recovering from surgery, as you did from dying from it, up until the first decades of the 20th century.
Western-style medical scientists were pretty quick to cut.
They were sort of fans of heroic-style interventions, including surgery, including very powerful drugs and medics and other purgatives.
And so I think for a lot of American patients who still did not have a lot of confidence in Western-style medical science, to go to a practitioner of Chinese medicine was really to opt for something far less invasive, something that was likely to be more gentle, and frankly something that seemed a little closer to domestic remedies with which Americans were already familiar, right?
American patient consumers were still very much from a culture of growing their own Medicines in the garden, taking sort of habits of self-dosing, caring for themselves.
This was still not an era where you went to the hospital very much.
So again, we have to think of the late 19th century as a time when there is not a lot of confidence in medical science, when there's not a lot of faith in their drugs, when surgery was still something that was really to be avoided if possible.
And so Chinese practitioners offered all of that.
For women especially, gynecology was a field that was surgical.
Obstetrics and gynecology actually were both considered to be surgical fields.
That was really what made it reputable for men, white men, to become specialists in that area was that it was considered to be both technical and surgical.
So if you have a choice as a woman between a gynecologist who is going to, say, treat your prolapsed uterus, which is a condition that happened to women through childbearing, you could go to a surgeon and maybe face which is a condition that happened to women through childbearing, you could go to a surgeon and maybe face a hysterectomy or a kind
Or you could go to a Chinese herbalist who would treat your prolapsed uterus with herbs, something non-invasive.
So I do see in the sources quite a few women writing to Chinese doctors and saying, I'm afraid of the knife.
I'm afraid of surgery.
Can you please help me?
I have a cancerous growth.
I have a prolapsed uterus.
I need an abortion.
Again, all of these sorts of experiences that are common to women and they really were not being well serviced by Western style medical science.
So they look to Chinese doctors.
And again, I think that's something that holds true into our time, that for many people who now go to herbalists or might go to acupuncturists, they're people who do not feel well cared for under a rubric of allopathic or Western-style medical science.
You also write later in the book about a danger that that brings about though, which is that, and this isn't specific to Chinese medicine, but herbalism in general, this idea of natural can inspire people toward anti-vaccination.
So, is that something that's always been the case?
Or is that, have you noticed an uptick in that more lately?
The language of natural medicine is, I think, one of the reasons I wanted to write this book.
I find this whole kind of culture of naturalism so fascinating.
Because what is nature?
I mean, what is natural medicine?
It comes to mean an extraordinary constellation of things, right?
And natural medicine is not something that Chinese doctors invent.
There's a long history of that kind of language of natural medicine or nature's remedies in the United States.
It goes back probably at least to the early 19th century.
But it does, I think, take on certain new meanings at the end of the 19th century in a moment when people are feeling kind of especially alienated from nature, whatever that means to that individual.
When people are living in cities more, people feel as though they're consuming products that do not resemble something coming up out of the ground or out of the field anymore.
So I think there's a certain feeling of alienation from nature that starts with large-scale mass industrialization at the end of the 19th century and feeds this kind of impulse to seek out nature's remedies, whatever that might mean.
I don't know what's in the COVID-19 vaccine.
to that.
I think that we see that a lot, gosh, we see that a lot right now with anti-vax discourse, this sort of, you know, I'm not going to put chemicals in my system.
I don't know what's in the COVID-19 vaccine.
I think we also actually see it in this propensity to trust herbal remedies without really knowing what's in them.
So, you know, herbal medicine, herbal supplements are not regulated in the same way as drugs are in this country.
And in fact, a lot of herbs coming from China are not regulated by the government in China, nor are they regulated aside from very kind of sporadically and in an ad hoc way once they get here to the United States.
So I think there is a tendency to look at the label and think because it's marketed as something close to its natural form, that somehow that's safer, somehow it's easier to understand, less enshrouded in the mystery of the lab or the mystery of the scientific process.
And I do think that there are real dangers to that, not simply just not getting vaccinated as one should, but also that there are lots of things we don't know about herbal medicines, right?
We don't know how they interact with one another, how they interact with, let's say, more conventional pharmaceuticals.
There's just a lot more that we need to understand before kind of going down that path.
And I think I think people think they can trust in nature without really critically examining what they mean by trusting in nature.
Remember, nature is not always here for our benefit.
That it is a fight.
That is true.
That is very true.
You write early in the book that this is not a book about efficacy, and I said when I first reached out to you that I'm not interested in talking to you about efficacy.
Personally, I'm very skeptical of a lot of medicines, some forms of TCM.
I'm very skeptical of the American healthcare for-profit system, mostly homeopathy, which I That's another podcast episode.
But you just mentioned safer, and the American system is very good, I believe, at disease specificity.
And where it lacks is often wholism, because it misses the environment and the social relations that also go into healing.
Chinese medicine covers that very well and has a blend of remedies or interventions that they use, at least in America.
And there is a lot of safeguards, not that they're always put into place, but in case doctors mess up or do something wrong or you need a second opinion.
And just in general, does Chinese medicine have these sorts of safeguards if remedies don't work on any legislative level?
So to talk about What medicine in China is to talk about something that changed enormously between the early 20th century and the Maoist revolution, the communist revolution in 1949.
Traditional Chinese medicine, what we call traditional Chinese medicine with like a lowercase t and a lowercase c and a lowercase m is really a whole bunch of medical traditions, some dating back thousands of years.
So it's herbalism, it's acupuncture, I mean it's bone setting, it's augury, I mean it's probably at least like 35 different things.
It was practiced, all these things were practiced in China, basically without any regulation.
There were schools of medicine in China in the 19th century.
Not very many people went to them.
If you went to them, you were in good shape because you were guaranteed a job for life working for the emperor and or some kind of member of his Family, some kind of member of his government.
Very, very few people were formally educated in medicine of any kind in China.
Most people learned in the home.
Most people learned by apprenticeship.
Most people learned in a shop.
And what they learned was very specialized.
So if you were an herbalist in China, you learned how to compound one remedy in your shop in China.
Okay.
So this is all of the 19th century is basically like this.
This is an era when some Chinese people start to go abroad, start to get educated in Western-style medical colleges, but for the most part this is true for the whole of the 19th century.
When Chinese immigrants start coming to the United States after about 1850, some of them come over with that kind of apprenticeship, remedy-specific training, and they bring with them to the United States textbooks.
They bring with them books so they can teach themselves how to Be general practitioners, because that's what they became in the United States.
So no formal education as we would recognize it, no credentialing, no licensing in China.
They were self-taught.
When they got to the United States, a lot of them started to claim that they had education.
They brought in degrees and they, you know, they kind of invented a story for themselves.
But they were unregulated.
Really entirely unregulated until you get, in the 1970s, the first licensing in acupuncture and oriental medicine in this country.
So, you know, does that mean it's unsafe or ineffective?
I don't really go into that and I'm a historian and it's just not, you don't really want to be asking me, you know, was it safe or was it effective?
People in the 19th century believed that it was.
I have evidence that it was and evidence that it wasn't.
So I think it was sort of a mixed bag.
But yeah, as far as regulation went, no.
It was the Wild West.
They regulated each other.
I mean, there was a lot of knowledge shared, both good and bad.
There's a sort of Yelp system about Chinese herbalists.
We're got around about who might be committing more errors or whatever, but no, there's no regulation.
Accountability is important, but of course this is still a newer concept in medicine overall.
I think we're still figuring that in some ways, in good ways and bad ways.
Related question though, one thing that always annoyed me throughout my life as someone who's been injured and had cancer and has been in the hospital a lot is the fact that you would go to a doctor and then you would get a script and have to go somewhere completely else for your prescription.
I was a member of Kaiser in Los Angeles when I lived there.
So that was kind of nice because the units are all together, but it's still separated, doctor, pharmacist.
But that's not the case.
And that's one thing I'm actually fascinated by with the apothecaries is that the person who is diagnosing is prescribing and there's a social element to it because you're right, they could be the post office, social clubs, everything was related.
I'd like to hear a little bit about your thoughts about how medicine seems so much more social in Chinese medicine than in America.
Certainly that site of the apothecary served a lot more functions than our American drugstore ever did, right?
Because it was the place that you went to be diagnosed.
It was the place where they would compound the medicines and they would sell them to you.
And then it also might be the place that there was a shrine and you'd go worship there.
You'd play cards.
The pharmacist, the apothecary, might lend you some money if you needed, you know, you needed it.
And I think that was Largely a function of the community that for Chinese immigrants, Chinese doctors played a really important role as a sort of center of their community.
They were often literate.
They're often maybe one of the few people in the community who could read and write.
And so they might be responsible for reading your labor contract and helping you understand what you were signing up for or sending mail home to your family, letting them know that you were all right.
So it is partly that.
I also think just Chinese culture and this might go a little bit more toward the way that traditional Chinese medicine with the lowercase TCM versus American medical science, you know, the way those cultures kind of developed.
I mean, traditional Chinese medicine is much more domestic in its orientations.
So there's a, you know, a famous saying in Chinese about, you know, food is your medicine.
And it's true.
What Chinese people consumed, the tradition has always been to sort of think about the health and healing properties, healthful and healing properties of food.
Food.
So you would consume medicines in teas or in soups more than you would say, like pill form as it evolves in the American context or even tinctures or that sort of thing.
So I think there is a little bit more of a integrated way that medicine is integrated into Chinese family life.
Whereas, and I think in American culture, at least as it evolves in the late 19th and into the 20th century, it does become kind of more siloed out, you know, it's, you know, It's something that, you know, you go to the hospital or you go to the doctor's office, you know, it becomes professionalized and outsourced over time.
You touched upon this about traditional Chinese medicine, capital TCM, the fact that a lot of times people are like, oh, this medicine is thousands of years old.
And yes, there are folk medicines.
In fact, when I was writing about vaccinations, I found the earliest citation of the idea of vaccination comes from China in something like the ninth century.
So there has been medicine everywhere for a long time, but Capital TCM is very specific, as you said, to the Maoist revolution.
So can you talk about what he did and how he changed the perception of Chinese medicine, both in China and maybe around the world?
This to me is so interesting.
I am not a historian of China, so I really rely on Chinese historians and the amazing work that they've done on Mao and the medical revolution.
As I understand it, Chairman Mao inherits a nation that is in a shambles.
They've been at war with the Japanese, then they're at war with each other.
This is just a country that's infrastructure has been devastated, its population is malnourished.
And he has a kind of twin problem of uniting the country politically but also rebuilding it with very little help and few resources.
So traditional Chinese medicine with the lowercase t becomes a kind of intriguing prospect for him because it's cheap, because you know you can kind of assemble a bunch of unregulated, unlicensed, unformally educated individuals and with a very few tools Send them out into the countryside to do medical work, to be a kind of front line for a medical practice.
And it also can be brought into the hospitals in urban centers at lower costs there too.
So bringing acupuncturists in to work alongside surgeons and do acupuncture anesthesia, which becomes a thing in some surgical procedures.
Treating people with inexpensive herbal remedies instead of more expensive synthesized drugs.
So it solves this sort of practical problem that Mao has.
It also solves a political problem because it becomes a kind of rallying point.
Like, this is part of our culture.
This is part of our heritage.
We can be proud of these traditional methods.
But they're all revised and simplified and reinvented under Mao, too.
And he really recreates TCM.
And that's why we talk about Mao's traditional Chinese medicine with a capital T and a capital C and a capital M.
He really takes a kind of kernel of it and then brings it into the 20th century, the second half of the 20th century.
He employs scientists to try to sort of fit traditional modes of thinking about the body.
into modern scientific frameworks.
He tries to apply a modern scientific process to the discovery of what the active agents are in traditional herbal medicine.
So he scientificizes traditional practices, I think, in very important ways because then that is the product that gets exported to the world in the 1970s when there's a sort of normalization of relations between China and the rest of the world.
This is what European and American doctors go to see.
They go to see a capital TCM at work in Chinese hospitals or at work with the barefoot doctors going out into the countryside.
And I don't know that they always know what is truly ancient and what is, in fact, this Maoist reinvention and simplification.
It all kind of just gets lumped together in their imagination as traditional Chinese medicine.
One thing I get in trouble with often with our listeners is acupuncture specifically.
Dr. Offit is how I feel about medicine.
There is no such thing as alternative medicine.
There's medicine that works and medicine that doesn't.
And I've always questioned some of the thoughts around meridians and the ways of healing.
And that's fine.
That's a separate thing.
But specific to acupuncture, what I found fascinating about your book is A, you write about the fact that Acupuncture was pretty negligible in the 19th century, and that was in part because an emperor was scared of the scalpels and possibly being killed.
But then also, and I didn't know this, that acupuncture used to be a little bit more like bloodletting.
Not completely, but that the blood let the chi move through the body and the needles were bigger and it was actually Japanese needles that are used today.
So can you talk a little bit about acupuncture's evolution and how it came to be what it is, really in the 1970s when it had a resurgence?
Acupuncture is so popular today and it's entirely because of the Japanese, that little thin needle.
I had acupuncture.
I had it because actually I was writing this book and realized, you know, I had very little contact with Chinese medicine.
I am, my mother's family is Chinese American.
I had consumed some herbs as a younger person, but I really like never had acupuncture, never had cupping or any of that sort of stuff.
So I kind of anthropologically, I took myself to an acupuncturist.
And I said, oh, I'm having trouble sleeping or something, and I got it.
And you don't feel those needles going in, right?
If it's a good acupuncturist, they tap, tap, tap, and they're in, and you don't feel them.
Not so for actual acupuncture from the olden days in China up until really the end of the 19th century.
Acupuncture needles looked like scalpels, or they were tiny retractors.
And really, acupuncture up until the early 20th century was more like straight surgery.
It was something lower class people, poorer people did.
So respectable Chinese people really wouldn't go to an acupuncturist.
Because as you said, it wasn't like bloodletting as we think about it.
But the purpose was to let the blood flow.
I mean, to open up Yeah, it was not popular.
The emperor did ban it because he thought that those scalpels would actually be used like knives, that it would be a way for an assassin to smuggle in weapons and get close to him, the emperor, or his family.
So Chinese doctors really didn't train in it.
The folks who immigrated to the U.S., some of them were aware of it.
It was not practiced by kind of quote-unquote respectable people.
And then in the early 20th century, the Japanese rediscover these older textbooks on acupuncture.
And because they have, you know, through the wonders of industrialization, they have machines that can produce those really fine needles that you don't feel going in.
They revolutionize The way acupuncture is done, so there's no blood flow, there's no opening up of those channels, and they end up training Chinese medical students in Japan.
So Chinese medical students go to Japan in the early 20th century and that's where they learn to do the acupuncture with that hollow core, very fine needle.
So that is what gets exported eventually in the 1970s.
I mean, acupuncture today bears no resemblance to acupuncture of the late 19th century.
I don't think it would be so popular if it did.
Just for the record, I've had about 25 sessions in my life, and I very much enjoy the ritual of it on a number of levels.
It's very relaxing.
But last question, I know you're a historian, but I'm gonna ask for a little bit of speculation, because at the end of the book, you kind of catch up to the modern date of how Chinese medicine has been integrated into American medical culture.
What do you see for the future?
What are your hopes for the combination?
Because there is a cultural exchange Between these ancient practices and both in China and America.
So what else do you would you like to see in this exchange happening?
I think something you said earlier for me is really true that it seems to me historically Western style medical science has been very good at systems.
So your cardiovascular system or your endocrine system but not actually very good at looking at the whole body and I think so much more Now, maybe more than ever, we understand how integrated these systems are and also how integrated you are as a body in space, and that space is environmental, it's social, right?
So I think that traditional Chinese medicine, what it's always done very well is that kind of holistic Look at a human.
You know, so for Chinese, the sources of disease might be systemic.
It might be a problem with your heart, right?
Or it might be emotional.
It might be something that's happening in your physical environment or relationships you have with your family.
I think Chinese doctors have always been very good at being attentive to that way of thinking integratively.
And that's really what I see among medical colleges that have Attempted to bring more complementary and alternative medical practices into the training.
I think that's what they seem to be borrowing most from traditional Chinese medicine.
And to me, that seems like a really good thing.
That seems like a really hopeful thing.
I know that cost-cutting isn't always an issue in modern healthcare.
I don't know that I'm as excited about that, but of course that seems very practical and important.
I would say maybe more than kind of cost-cutting and even more than the integrative look at the human body.
I think it's great whenever the American medical system is reaching out and speaking to people from different cultures and bringing people from different cultures into the clinic and the hospital, demystifying those spaces.
I think now more than ever with COVID and the kind of health care inequalities that we've seen Across the United States, we need to be reaching out and making these spaces accessible.
We need to be speaking one another's language.
Anybody who's paying attention has to be sort of horrified at the spike in anti-Asian violence that COVID-19 has precipitated.
So the extent to which Healthcare practitioners can draw on other medical traditions, maybe in this case traditional Chinese medicine, to make the American healthcare system more equitable, more understandable, and more usable.
I mean, all the better to me.
Hey everybody, Matthew here with some closing thoughts.
Derek and Tamara spoke at some length about the appeal of holism with regard to Chinese medicine and traditional Chinese medicine, and the links between holism and the idea of the natural.
Derek rightly pointed out that biomedicine often seems to be blind to social and environmental contexts, especially in clinical settings.
And the professor spoke about the enduring appeal of healing modalities that seem to look at the whole person, and how that is wrapped up in ideas and beliefs about expertise, and therefore power.
Especially the power to know things.
And all of this got me thinking about an old thing in a new way that didn't quite fit into the flow of the conversation, so I'm tacking it on here at the end.
So when enthusiasts for TCM or Ayurveda or naturopathy use the word holistic, they technically mean that the discipline covers many categories.
That biology cannot be separated out for treatment from psychology, from environment, or from social circumstances.
Now oddly, I rarely hear advocates for holism discuss class and poverty, but ideally holism would cover those categories as well.
So that's the premise.
But beneath that premise, I think there's an underlying feeling always being communicated that holism is, in general, a more empathetic mode of being, allowing a clinician to appreciate the whole person and to therefore speak to many layers of need.
And so the picture that emerges is one of a soulful doctor who is more receptive, who listens better, connects the dots, has better bedside manner, knows you, knows your family, has more time for you.
And this is the impression that I've gotten from US-trained TCM practitioners, and there's a very palpable way in which it puts me at ease.
But the image wouldn't shine so brightly without a foil, which would be the lab-coated clinical robot who sees a conveyor belt of patients, never looks you in the eye, can't possibly imagine what your stresses at home might have to do with your high blood pressure, doesn't care about what you eat but is really focused on weighing you in.
So this is the medical bean counter, and he doesn't really appreciate your complex humanity.
You know, he looks at your chart more than he looks at you.
So, does this dissociative caricature ring true?
For some people, yeah.
Some of the time.
Foucault wasn't wrong about biopower and the medical gaze and its role in citizen compliance achieved through assessing and controlling the body politic.
And for all of the right-wing hatred of critical theory, they have adopted, pretty much whole cloth, Foucault's vision of medical bureaucracy as a pillar of governmental power, surveillance, and control.
Likewise, they are not wrong that Northrup, Brogan, and Dr. Bush all presume to challenge that system as former insiders with an holistic view.
So it all makes sense.
People have terrible experiences of neglect in clinical and hospital settings, and those experiences are multiplied by factors of identity, as when the physical distress of women or black people is routinely underestimated by doctors prescribing pain medication.
But on the personal level, the caricature of the robot doctor of the state might fall apart.
Because I think many of us have met deeply caring conventional practitioners who would not elicit the complaints of holistic consumers or the complaints of holistic marketing.
Because of policy limits, my own GP may not have more than 15 minutes per issue to spend with me, but she always manages to address a well-rounded picture through a broad range of questions.
She always makes me feel seen, and I would tell her anything.
But she also doesn't pretend to know or understand everything about me.
So, I feel very lucky with her, and then I know that luck should not be a factor in the care that people receive.
I think what we've seen over our years and years of covering this stuff is that holism can easily, efficiently, and dependently generate its own caricature.
And this is why it's so easy to make fun of some of the influencers we make fun of.
You know, things like the balanced blonde, Jordan Younger, talking about Lyme disease as if it's a gift for people with spiritual courage.
You can look up that post on our Instagram.
And we've pointed out thousands of examples, it feels like, of this on this podcast.
And they're funny and they're horrifying in part because they take the premise of holism to a kind of logical absurdity.
Which is that every phenomena can and should be understood within the broadest possible context.
But all of these examples also spotlight some very common features of the holistic affect and persona.
Namely, insufferable grandiosity and the narcissism of thinking that you can possess complete and final answers for complex questions.
So I don't think we've actually spelled it out quite so clearly yet, that the vulnerability of the holistic instinct is its boundarylessness, its potential for hubris, how easy it is for a charismatic to co-opt it.
It's an invitation to the practitioner to say, I should know something about everything about this person or about this subject.
And if you take this out of the healthcare context, out of the clinical setting, this is the Jordan Peterson instinct, the willingness and even necessity to develop an opinion about every part of the world.
And that's where the irony lies.
Because holism often positions itself as humility.
As opposed to the know-it-all conventional doctor with their conventional processes who can never learn anything and who follows care instructions by rote.
But what if it is possible that in some cases it's the other way around?
That the holistic practitioner's accusation That the conventional medic is proud and elitist is actually a projective defense against the nagging feeling that the holistic practitioner has to mobilize a complete view of the person and that that's actually impossible.
On episode 77 about homeopathy, our guest was Jonathan Jerry.
Derek told a harrowing story about going to this swanky homeopath in New York City for help with his anxiety.
Now this guy grilled Derek for three hours about his entire life before prescribing the precise pills filled with nothing that he claimed Derek needed.
They didn't work because homeopathy is literally nothing.
But the ritual of intrusive interviewing made Derek wonder whether it was a form of psychotherapy and wondering whether that was part of the point.
Because for a modality that works through literally nothing, something has to impress itself as being engaged and immersive and functional.
If the homeopath wants his magic to work, he really needs to present himself as being fully attuned.
He has to perform a kind of all-encompassing knowledge.
What else does he have?
And that's exactly what alt-med consumers criticize conventional doctors for when they complain about elitism.
I'll take this just one step further.
There's a rich feminist valence on the term holism that's powerful and makes a lot of sense.
And for sure, it emerges through things like midwifery culture, in which communal teams of women attended birth and its medical, domestic, social, and psychological needs.
And it probably goes back much further.
In India, for example, various masalas are said to have medicinal properties.
These are spice blends for foods and they're passed down matrilineally with an understanding that medicine and food and household care are not really separable tasks.
These are cultures in which being well is understood to be an holistic endeavor.
But in contemporary wellness discourse, these feminist undertones of holism show up in opposition to what is described as the compartmentalized, rules-based, expert-driven, top-down edicts of biomedicine, which is often characterized as patriarchal in nature and therefore authoritarian.
It all makes sense.
And in fact, Kelly Brogan knows that it makes so much sense because she makes it into her explicit argument when she mocks, you know, who she would describe the sheeple having a fixation on quote mommy medicine and daddy government.
But Brogan is someone who dissuaded her psychiatric clients from taking any medications, including Tylenol and birth control.
This is a person who pretends to know about epidemiology, who pretends to know about how germ theory is wrong, and more recently, how cryptocurrency is a good choice.
So this is the curdling of the holistic instinct.
to believe that you can and should address everything, with the end result being that you possibly wind up just ordering people around.
And so this is where I want to land.
Holism offers itself as a rejection of patriarchy and authoritarianism, as enacted by the top-down organization of the hospital and clinic.
Yeah, that makes sense.
However, because the holistic practitioner is burdened with an absence of boundaries and guardrails, they are too often, or maybe, let's say, too often in the position of being at the top of their own power pyramid and encouraged to exert outsized epistemological control over the too often in the position of being at the top of their own power pyramid and encouraged
By contrast, the best MDs I have been with who have cared for me have always been clear with statements like, I don't know, or that's a question for a specialist, or I'm not a psychologist.
They don't have to be experts in everything, and they don't want to be.
I think a lot of them have a strong sense of how difficult it is to retain competency in their own specialization, let alone give opinions beyond it.
They also don't need to overly attune to me, because that attunement, that connection, is not their product, offered in place of something like homeopathy, which doesn't even exist.
There are docs with crappy bedside manner, but sometimes I wonder how much of what gets called coldness is simply the affect of being modest and even humble with the evidence.
So, bottom line, I think there can be a patriarchal and authoritarian side to holism, and it might be good if we started to think a little bit more about that.
