Body & Society

http://bod.sagepub.com Meridians, Chakras and Psycho-Neuro-Immunology: The Dematerializing Body and the Domestication of Alternative Medicine
Judith Fadlon Body Society 2004; 10; 69 DOI: 10.1177/1357034X04047856 The online version of this article can be found at: http://bod.sagepub.com/cgi/content/abstract/10/4/69

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Meridians, Chakras and Psycho-Neuro-Immunology: The Dematerializing Body and the Domestication of Alternative Medicine
JUDITH FADLON

Introduction The relationship between conventional biomedicine and a range of therapeutic modalities that have been grouped together under various titles such as marginal, complementary, alternative, unorthodox or non-conventional, to name but a few, has changed over the past three decades. Modalities that are now considered as complementary medicine were once regarded as an anti-establishment alternative, and in recent years several modalities of complementary and alternative medicine (CAM, in short) have undergone a process of legitimation. The objective of this article is to explore the domestication of CAM. I shall argue that the domestication of CAM followed a process of cultural negotiation in which both the dominant narrative of biomedicine as well as that of CAM changed. The article begins by outlining various theoretical approaches to CAM and comparing them to the perspective of domestication advocated here. The
Body & Society 2004 SAGE Publications (London, Thousand Oaks and New Delhi), Vol. 10(4): 6986 DOI: 10.1177/1357034X04047856

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70 Body and Society Vol. 10 No. 4

narratives of biomedicine and CAM are further explored through their respective imagery of the body, and these images are drawn on to suggest a new phase in the relationship between body and society. I then move on to consider the specics of the Israeli setting, in which the ethnographic data on CAM and biomedicine were collected. The presentation of data focuses on images of the body in the dissemination of CAM in the popular press, as well as in the professionalization and socialization that takes place in CAM colleges and clinics. My contention is that the domestication of CAM reects an epistemological shift in biomedicine, on one hand, alongside its continued hegemony, on the other. CAM, I argue, has become fashionable as part of the postmodern spectacle of the body and has developed into a new means of medical surveillance. Theoretical Approaches to CAM Domestication, which has become a prominent theme in the socioanthropological study of the ow of culture (Appadurai and Breckenridge, 1988; Der Derian and Shapiro, 1989; Hannerz, 1989; Wilson and Dissanayake, 1996), carries novel implications, both theoretical and analytical, for the study of CAM. This focus is different from prior conceptualizations that hinged on a dichotomous interpretation of either dominance or resistance. The rst and earliest approach to the study of CAM entertained a dichotomy between traditionalism and modernity and predicted that a gradual process of modernization would eventually bring about the abandonment of traditional, non-scientic medical practices (Finkler, 1981; Haram, 1991). Farge (1977), for example, described recourse to traditional health systems by Mexicans as an indicator of low acculturation into the mainstream of modern, American society, while Miller (1990) discussed the weakening of traditional health beliefs in non-Western medicine as a function of successful acculturation to the host society. Subsequent studies conducted on heterogeneous population groups in Western countries (Astin, 1998; Ronen, 1988) showed that CAM users came from all sectors of society and two new theoretical themes developed in order to explain this growing popularity of CAM. The rst theme explained CAMs popularity as a rejection of biomedicine due to iatrogenesis, deleterious side effects, growing alienation caused by highly technological procedures and growing specialization. For example, in a study conducted by Cant and Calnan (1991), a CAM practitioner is quoted as saying that for 20 percent of her patients she served as a rst resort for primary care since they had adopted a natural life style. CAM was therefore seen as counter-culture and equated with ideological concern for the ecology (Bakx, 1991), preoccupation with the body (Glassner,

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Meridians, Chakras and Psycho-Neuro-Immunology 71

1989) and fascination with the cultural other, the esoteric and the super-natural (Lupton, 1994). Mary Douglas (1994), a proponent of the counter-culture view, saw CAM as an alternative in the full counter-cultural sense, spiritual in contrast to material and provides a cultural alternative to Western philosophical traditions. However, recent empirical studies conducted on heterogeneous population groups (Astin, 1998; Fadlon, 1999; Furnham and Forrey, 1994) have not been able to illustrate the existence of a comprehensive and consistent cultural prole of CAM users. Whereas the rst theme viewed recourse to CAM as a reection of general disappointment with conventional medicine as a system, the second theme viewed recourse to CAM as a result of disappointment with a specic facet of conventional medical treatment. Specic health problems which had not been solved by conventional medicine, rather than a specic cultural outlook, would bring the patient to the doorstep of the CAM practitioner (Goldstein, 1988; Gray, 1985; Kronenfeld and Wasner, 1982). According to this approach, CAM users can be characterized by dual use of both systems, CAM and conventional biomedicine. They consult with a naturopath for colds, a chiropracter for back pain and a conventional MD for an acute infection. CAM is not perceived as an esoteric choice, nor does it usually reect a rejection of biomedicine. It is more in the line of a practical choice made among the many options which the postmodern environment offers (Kelner and Wellman, 1997; Sharma, 1992). Indeed the tendency to move between CAM and conventional medicine was found in surveys conducted in Australia (McGregor and Peay, 1996), Canada (Kelner and Wellman, 1997), Israel (Fadlon, 1999), and the USA (Druss and Rosenheck, 1999). These ndings caused researchers to claim that the recourse to medical care had undergone a pluralistic process. In this process, institutionalization, licensing, training and patient reimbursement through HMOs was perceived as leading to a multiple co-existence of CAM modalities alongside biomedicine (Cant and Sharma, 1999). My contention is that the focus on pluralism is not equal to domestication as this approach does not explain the process of cultural translation and modication that enabled the integration of CAM in the rst place. In my view, this integration did not entail the legitimation of pluralism but rather abolished many of the original differences between CAM and biomedicine. Domestication, the force behind this integration, is a process by which the foreign is rendered familiar and palatable to local tastes. This process comprises combining elements of an imported entity such as food, clothing, philosophy, religion or medicine with elements of the local culture. The new hybrid forms that are constructed in this process epitomize the essence of the host culture,

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representing at once what it yearns for together with what it cannot give up. For example, Unschuld (1987) describes the practice of Chinese medicine in the USA and Europe as a limited form of practice of so-called Chinese medicine that appears to mirror Western ideas of what alternative medicine should be like rather than original Chinese thought. Body Images and the Domestication of CAM CAM and conventional medicine appear to entertain different notions of the body. However, examination of recent studies focusing on the body and society suggests that there may be more similarities than differences between the two paradigms. In his conceptualization of somatic society Turner (1992: 12) describes the body as the dominant means by which the tensions and crises of societies are thematized, thereby rendering it a principal eld of political and cultural activity. Considering the body as the locus for the exercise of social control enables us to observe changes in the dominant organizing principles in society through changes in modes of controlling the body. Recent studies have illustrated the contemporary dominance of the narrative of biomedicine as an organizing principle for judging, maintaining and controlling the body. This shift towards biomedical control is evident in the work of Turner (1995, 1996), Lupton (1994) and Lee (1998), to name but a few. Indeed the gaze of biomedicine can now penetrate, evaluate and control the body in ways never possible before. Modern techniques of diagnosis and monitoring use sophisticated technological apparatuses to penetrate the body, rendering it transparent by means of advanced techniques such as CT scans, breoptics and 24-hour cardiac monitoring. Modern biomedical techniques therefore constitute innitesimal renement of Benthams panopticon and Foucaults stethoscope, and as the body has become increasingly fragmented under the gaze of biomedicine, its techniques have contributed to the alienation, overspecialization and depersonalization of the human body. This is one part of the context which has provided fertile soil for the narratives of CAM to ourish, propagating a discourse of holism, energy and empowerment. The question to be addressed is whether the narrative of CAM that focuses on the notion of a dematerializing body, dened by energy, chakras, auras, and the vital force, points to a new phase in the relationship between the body and society. Moreover it is interesting to ask whether the CAM narrative of energy and dematerialization constitutes a discourse of resistance to biomedicine or merely reects domestication to its dominant paradigm.

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Meridians, Chakras and Psycho-Neuro-Immunology 73

A number of recent studies have pointed to a changing relationship between the body and society suggesting, on the whole, a shift in medical imagery of the body from the mechanical and material to the virtual and dematerialized. Emily Martin (1990), for example, has argued that the central organizing principal of the heart as a pump has lately given way to a new organizing principle, namely that of the immune system. According to Martin, this reects a change in the nature of industrial production in American society from the early 20th-century paradigm of a Fordist body that centered on standardized mass production into a consumerist paradigm of individual, exible adaptation to the demands of the changing work market. Wiener (1948 in Featherstone and Burrows, 1995) suggests four stages in the history of automation that are reected in four corresponding models of the human body. He traces developments in imagery of the body, starting with the conception of the body as a clay gure, progressing to clockwork metaphors, metaphors of the combustion engine, and culminating in the least material metaphor of all, the body as an electronic system. Lupton (1994), too, has discussed the changing metaphors used to discuss the functioning of the body and has illustrated the progression from clockwork to hydraulic to computer metaphors. The latest phase, that of the computer metaphor, perceives the body as an information system and, in this capacity, cyborgs constitute the central image of the body/machine interface based on the paradigm of virtual reality (Tomas, 1995). The notion of virtual reality and the body has been discussed by Williams (1997), who claims that advances in medical science and technology have already made our bodies increasingly plastic. Bodies can be molded, synthesized and engineered (Balsamo, 1995; Haraway, 1991) according to medical necessity or fashionable whims, and Deitch (1992 in Featherstone and Burrows, 1995) has wondered whether the next generation will be the last of pure humans. One of the latest developments in which the boundaries of the human body are negotiated in yet another manner, can be found in Chrysanthous (2002) conceptualization of the transparent body. This body, a result of advances in information and medical technologies, can simultaneously exist in a number of dimensions and planes. In Williams (1997: 1047) words, a modernist concern with corporeality is slowly but surely giving way to a postmodernist concern with hyper-reality. According to this analysis we have indeed entered a new phase in the relationship between body and society. This phase, reected in imagery of the body in biomedicine, suggests a shift from corporeality and the material into a new phase of virtuality and dematerialization. I would therefore like to suggest that the image of the dematerialized body with its focus on energy advocated

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by CAM should be examined as part of the postmodernist concern with hyperreality. In the course of this article I shall use three ethnographic foci the popular press, a clinic where CAM treatments are offered and a college where CAM modalities are taught in order to illustrate the domestication of CAM to the biomedical paradigm and show that CAMs discourse on energy as a key organizing metaphor of the body is in fact one more facet of this domestication. CAM in Israel In Israel, there has been a steady rise in the use of CAM. In a study conducted by Bernstein and Shuval (1997), 6 percent of Israelis reported having used CAM in the previous year, and Grinstein et al. (2002) report on even more extensive use. In a survey conducted among individuals with a chronic health problem, the number of CAM users rose to 30 percent (Fadlon, 1999). The institutionalization of CAM has grown along with its popularity. Some 15 colleges currently offer courses in a variety of CAM modalities. These courses can last from four years in the case of naturopathy and Chinese medicine to a few months in the case of reexology, shiatsu or Bach ower remedies. A popular locus for CAM treatment in Israel is the multi-modality CAM clinic. These clinics are adjacent to (although not part of) general hospitals or may be run by HMOs on a fee-for-service basis. Between 1991 and 1998 the number of hospitals adjacent to clinics rose from one to ten, and at present all of the four HMOs operating in Israel offer CAM treatments under the auspices of specially established clinics. These clinics are conducted under the supervision of MDs, and all patients seeking CAM treatment are required to be examined rst by a sorting MD who then refers them to one of the modalities available at the clinic. The treatment chosen is then generally given by a non-MD practitioner. The rise of these clinics can probably be explained by medico-legal requirements due to the fact that in Israel, strictly speaking, treatment administered by non-MDs is illegal. For this reason medical supervision of the work of non-MDs is acceptable and this has probably been the force behind the establishment of this particular type of clinic. The status of non-MD CAM practitioners is an issue which is continually under discussion with the Israeli Medical Association although, to date, certain concessions allowing independent practice have been made only for chiropractors. From a consumerist point-of-view these clinics have become popular for a number of reasons. First, new patients seeking CAM treatment, who are not versed in the various modalities, can consult such clinics for advice on the

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Meridians, Chakras and Psycho-Neuro-Immunology 75

method of treatment most suitable for their problem. Second, a hospital or sickfund afliated clinic is usually perceived as a relatively more respectable and safe venue for receiving unfamiliar treatments with less likelihood of patients being exploited or mistreated. Lastly, CAM treatment is partly reimbursed by health insurance in the framework of these clinics only. The domestication of CAM that transpires in the multi-modality clinics in Israel may be unique to Israel but nevertheless exhibits common characteristics with the overall domestication of CAM in Western industrialized countries (Dew, 2000; Johnson and Kurtz, 2002; Schneirov and Geczik, 2002). Domestication by Means of Dissemination and Professionalization I focus on two major processes through which domestication can be observed: dissemination, by which the discourse of CAM reaches the public via the popular press; and professionalization, where CAM colleges and clinics create a new conceptualization of the body and CAM. These examples are drawn from an ethnography conducted in Israel. The ethnography was conducted between 19922000 and included observations at a clinic and a college, open interviews with MDs, practitioners, and patients, and narrative analysis of CAM stories that appeared in the popular press. The Popular Press Disseminating CAM The popular press has served as a vehicle for playing out the supposedly epistemological differences between CAM and conventional medicine (CM) for the lay public. In this capacity an interesting process can be observed that creates, on one hand, a dichotomy between CAM and CM, and on the other hand uses CM to justify and legitimize the practices of CAM. This results in the creation of a vision of CAM which is at once foreign and familiar. For example, a practitioner of Chinese medicine visiting Israel at the invitation of one of the CAM colleges pointed out what he saw as one of the basic differences between CAM and CM:
Chinese medicine is built on the theory of roots and branches. Whereas western medicine tends to deal with the branches, that is, the symptoms of the disease, Chinese medicine deals with the root of the problem, with the deep reason which causes the body to have a problem. (Maariv [Israeli daily newspaper], 3 May 2000)

Indeed, the root of the problem is something that cannot be scientically meausured, as is the case of two additional dominant notions imbalance and

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energy which serve as key symbols in the etiology of the body in CAM discourse. A homeopath describes the energetic state as
something intangible, not actually physical. It is a condition of ow or of movement which is connected to the vitality of the organs or the blood, and it is possible to adjust or correct it. (Maariv, 20 May 1996)

Introducing the notion of energy offers innumerable opportunities for diagnosis, treatment, and ultimately, control. A practitioner in Ayur Vedah contends that I can diagnose where energy is blocked. Wherever energy is blocked, something goes wrong (Maariv, 28 November 1994) and his counterpart practising homeopathy continues:
Even when a person does not have any disease and he assumes that he is healthy, he has no way of knowing what is seeping through his body. . . . According to the method in which I work, it is possible to diagnose the weak points in the body, understand what might develop, and treat it before great distress develops. (Maariv, 20 May 1996)

Treatment of energy blockages and system imbalances is described using language of cleansing and revival. For example, a practitioner specializing in the treatment of infertility using traditional Yemenite techniques says that Often the blockages are in energy. A uterus can be traumatized as in the case of an abortion or a uterus can be cold or irritable . . . a uterus is an emotion (Maariv, 2 February 2000). According to this practitioner her treatments, which draw on elds of energy, blow life into the uterus, charge the bloodstream with new energies and get rid of waste matter in the uterus which prevents pregnancy. Using similar imagery, another practitioner describes cleansing of energies as a standard part of a diagnostic and therapeutic system called bio-dynamic energy:
The purpose of this cleansing is to free all the energy blockages that are caused by mental crises by freeing the seven principal energetic centers and by opening the channels of energy known as meridians. (Maariv, 3 July 2000)

It is interesting to note that the discourse on energy observable in these articles serves as the single unifying etiology for four very different kinds of treatments that originated in different geographical regions and historic periods Indian Ayur-Vedah, traditional Chinese medicine, homeopathy, and traditional Yemenite medicine. This could point to the fact that this discourse is closer to the dominant, post-modern paradigm of the virtual body than to the original theoretical and philosophical bases of these modalities. Indeed a homeopath interviewed summarizes the encompassing issue of energy as follows:
The energy which drives us has many names according to the various modalities of nonconventional medicine. Energy is responsible for generally organizing the entire system. . . .

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Meridians, Chakras and Psycho-Neuro-Immunology 77

When this energy, which is called the life force, cannot provide a suitable response to a given situation, the system enters into a state of imbalance . . . an external symptom is always a result, and not a cause, of an illness and therefore alternative medicine will always make an effort to discover the original pattern of imbalance. (Yediot Aharonot [Israeli daily newspaper], 12 July 2000)

This language of energy, imbalance and detection of deep, dormant problems constitutes the heart (or perhaps the soul) of the CAM narrative and is observable not only in the discourse of non-MD practitioners, but is also used by MDs who practise CAM. For example, Dr D. (a practising homeopath) discussed the misuse of antibiotics in the treatment of recurrent throat infections. According to him, homeopathic medication
activates the bodys healing power and therefore the improvement or cure are real, not articial. An antibiotic kills the germ and although the inammation is stopped, the root of the problem remains untreated, causing recurrent inammations. (Maariv, 15 May 1996)

Dr D. criticizes conventional practices such as removal of tonsils or adenoids, saying that

the recurrent throat infections will stop, but due to the fact that the source of the problem has not been treated, the sickness will return, at a later stage, possibly in other systems of the body, usually in more important internal organs and even as behavioural problems. The real solution must contend with the underlying reason which is behind the throat infections. And that is what the homeopathic cure does. That is why its cure is real. (Maariv, 15 May 1996)

Conventional MDs serve as a strong domesticating force. They make every effort to emphasize their status and conventional specialities alongside their nonconventional practices and use the same type of imagery and discourse on the body and illness as their non-conventional counterparts. These personae are representatives of biomedicine and science, and the fact that they use the narratives of CAM has a marked impact in the process of legitimizing, familiarizing and domesticating CAM. These are what Hannerz (1992) describes as cultural brokers who translate the unfamiliar into a product digestible by local consumers. In this process, conventional medicine and scientic method constitute the ultimate legitimizing force of CAM. Spokespeople from the realm of biomedicine such as MDs, nurses and pharmacists promote CAM to the public. A nurse turned CAM practitioner is quoted as saying: . . . at a certain stage I felt very limited in my ability to help, treat and heal by means of conventional medicine alone. I looked for something more whole. (Maariv, 20 May 1996). In another newspaper interview a pharmacist advocated a typical integration of CAM and biomedicine by recommending that

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in every treatment for children its worthwhile to use homeopathic medicines rst. There are homeopathic medicines for teething problems, restlessness, waking at night, and even for apprehension from the rst day at kindergarten. However one should also be under the supervision of a conventional doctor. (Maariv, 7 August 2000)

An additional interesting phase in the domestication of CAM and the creation of hybrids can be observed in the bio-technolization of CAM which is evident in Chinese acupuncture administered by means of laser beams for example (Maariv, 7 August 2000), electro-magnetic pulses used to renew the bodys energies and treat pain (Maariv, 19 June 2000), or in the description of a machine designed to detect and rectify energy imbalance:
I am able to discern a change in the body even before the laboratory is able to identify it. The machine I use can distinguish a healthy wave from a sick wave. Both these waves exist within every one of us because no-body is balanced. . . . Diagnosis with the bicom (machine for detecting and rectifying energy imbalance) picks up these oscillations from the patient and differentiates between the sick and healthy oscillations . . . in the course of the entire treatment process, which lasts for an hour, one electrode takes waves from the body and puts them through the machine; the other electrode returns the wave to the body through a different cable at a corrected wavelength. (Maariv, 18 December 1995)

The combination of CAM diagnosis and treatment with high technology such as laser beams and magnetic resonance, thus creating hybrids of high technology and ancient modalities, also serves to familiarize CAM and promote its domestication to conventional medicine.

Clinics and Colleges: Professionalization of CAM In the teaching of CAM, as in its dissemination, two main processes are observable: First, the emergence of new ways to view and diagnose the body; and second, the exercise of medical and scientic hegemony over these new methods. In an introductory lecture to potential students, delivered by the dean of a successful CAM college in Israel, the lecturer introduced concepts such as system imbalance and impaired ow of energy. Diagnostic methods deriving from traditional Chinese medicine, such as evaluating the radial pulse and examining the tongue, were described and the 40-odd people sitting in the room were asked to stick out their tongues. The dean then moved down one row and up another, inspecting the tongues while making humming and hawing sounds. Some were approved as all right, and remarks were ventured about others. Passing by a young woman in the back row he remarked: Oh, youre having a period now, arent you? and without waiting for her response, moved on. The woman nodded animatedly at the young man sitting beside her, an expression of

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Meridians, Chakras and Psycho-Neuro-Immunology 79

amazement spreading across her face. The deans presentation illustrates new pathways to enter, observe and ultimately control the body. While lectures in the college typically present an alternative conceptualization of the etiology and diagnosis of disease, this is framed by the legacy of biomedicine. The curriculum places great emphasis on combining conventional methods of diagnosis with CAM treatments; learning and using the terminology of biomedicine; constructing biomedical space such as a laboratory for the demonstration of acupunture points; and the use of scientic protocol and statistical design in order to prove the effectiveness of alternative methods. The alternative courses offered in the college also promote two further entities: the wisdom of nature and a pronounced interest in the Far East. This is observable in the incorporation of extra-curricular options such as oriental martial arts, meditation, yoga or Chinese food. In this manner biomedicine, nature and the Far East are combined. The packaging of CAM as an alternative is therefore itself a hybrid a bricolage in Claude Levi-Strauss terms. This construct comprises elements such as authentic representations of the orient, nostalgia for the potency of nature, synchrony between man and his environment, and homage to ancient and/or primitive wisdom, all under the gaze of biomedicine. These elements, which are sought after and revered in the other, are in fact a mirror image of modern society and its discontents delivered in a form which is not too challenging to the scientic paradigm. Compared to CAM colleges in the USA, for example, the characteristics of CAM colleges in Israel seem to represent the rule rather than the exception. In a study conducted on a college teaching acupuncture in San Francisco Bay, Baer et al. (1998) discussed two dimensions of professionalization: the very establishment of these schools, and acculturation to the biomedical model in the teaching of CAM. Baer points out that students are required to spend a considerable amount of time studying courses in Western sciences. Alongside this acculturation to biomedicine, professional behavior is also formulated in the image of biomedical symbolism. Cant and Sharma (1996), in their interviews with a number of practitioners who were engaged in the practice of homeopathy in the UK, have pointed out that although no ofcial harmonization of standards existed, homeopathy has realized that reference to the biomedical model is imperative. One practitioner interviewed admitted: We have to interpret homeopathy according to our modern understandings. I prefer to talk about homeostasis rather than the vital force; the meta-matter understanding is inappropriate (1996: 583). The effect of domestication on the professionalization of CAM can further be illustrated in the case presentation that regularly took place in staff meetings at a non-conventional clinic I observed. The case in point was presented by an MD

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trained as a homeopath, who was at the time also acting as a sorting doctor at the clinic. His presentation was in the format of any conventional medical write-up and full of detailed biomedical descriptions of procedures and treatments, even though the majority of practitioners attending the meeting were not MDs. The case description was divided into subsections chief complaint, examinations and tests performed, and medical history. The patient, a 40-year-old married mother of four who worked as a secretary, complained of dysphagia a swallowing disorder, as the non-MDs were informed. The problem discussed had developed ve months prior to the present consultation when the patient had been hospitalized following acute inammation of the gall bladder. In the course of hospitalization, insertion of a gastric tube was required, and since then the patient has complained of difculty swallowing, especially solids, the sensation of a lump in her throat and heartburn. Weight loss of about 20 kilograms was also reported. The patient was described as generally stressed and anxious, dependent on tranquilizers and sleeping pills. The complaint was described as psychosomatic and conventional medicine was indirectly blamed for aggravating the problem. The choice of treatment for the patient was shiatsu due to the pronounced element of stress in her complaint and the impression that she would benet from therapy through touch. The patient subsequently reported that her complaints had generally been relieved to a moderate degree. However, the nature of her complaint had changed somewhat: she now experienced the sensation that something is stuck in her throat, a sensation relieved by eating. This patient proved to be a particularly difcult case as extensive use of both conventional and nonconventional methods had not cured the problem. In the course of the discussion, a non-MD practitioner of traditional Chinese medicine observed: Chinese medicine has a name for such a condition. It is a condition characteristic of middle-aged women and is called the plumstuck-in-the-throat syndrome. Chinese medicine also has a specic therapy for this syndrome. Youre quite right! Very good, very good indeed!, exclaimed the clinic chairman (an MD who practised acupuncture). The forum was not, however, offered further explanation of the syndrome or its cure in terms of Chinese medicine, which was unfamiliar to the participants in the staff meeting. In this manner, an alternative form of discourse on the etiology and treatment of disease was not allowed to develop, while biomedicine dominated the case presentation as well as the discussion. It is interesting to note that a recurrent theme in all interviews with MDs afliated with the clinic was the fact that the person was rst an MD and then a CAM practitioner. This resulted in interesting attempts to reconcile the

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Meridians, Chakras and Psycho-Neuro-Immunology 81

philosophical bases of biomedicine and CAM through Hippocrates, the father gure of biomedicine. CAM was conceived as being a true representation of Hippocratic lore, whereas conventional, biomedicine had gone astray. One MD interviewed justied the use of non-scientically proven methods by claiming that he didnt have to understand something in order to believe that it had a therapeutic effect. To his mind, as long as patients were being helped, he was doing exactly what Hippocrates had decreed in 400 BC: A doctor has one purpose: to heal. In this manner CAM is incorporated into the Hippocratic tradition, now enjoying common origin with conventional biomedicine. These descriptions of professionalization in the clinic and the college revolve around a common theme. They promote the use of CAM, but within Western institutions and under the supervision of medical doctors. The lecturers and practitioners of CAM carefully construct an alternative narrative whilst manipulating and negotiating the borders of biomedicine. These are tales of reconciliation rather than differentiation and critique. In a nutshell, this is domestication. The Dematerializing Body A New Medical Paradigm? The ndings reported here refer to Israeli society and further research in other societies and forms of CAM dissemination and professionalization is needed before they can be generalized. However, these observations of the practice, teaching and dissemination of CAM in Israel point at two distinct themes. First, CAM is undergoing a process of domestication that is rendering it an acceptable and feasible health choice to the consuming public by presenting it in a form that is at once foreign and familiar. This hybrid form of CAM is achieved by combining its more esoteric notions with biomedical practices, symbolism and discourse. The processes by which CAM is domesticated to the biomedical paradigm, often by representatives of biomedical institutions such as doctors, nurses and pharmacists, highlight the domestication of CAM as a potentially homogenizing process achieved through cultural brokers who nd their own market segment by developing products more specically attuned to the characteristics of their local consumers (Hannerz, 1992: 74). Institutions such as the CAM college and particularly the multi-modality, medically-supervised CAM clinic seem to atten out cultural differences. The second theme observed is that the foreign attraction of CAM, achieved by re-dening notions of health and illness through the predominant symbol of energy, is not that foreign after all, but part of a much broader process that can be observed within the dominant paradigm of biomedicine. The dematerialized body, central to the narrative of CAM, might seem at rst glance to be a symbol

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of resistance to the fragmented, over-specialized view of the body in conventional medicine. However, closer examination shows that this dematerialized body is not an ex-paradigmatic entity that is exclusive to the subversive discourse of CAM, but part of the dominant biomedical paradigm in which the boundaries of the body have already become increasingly blurred. This is observable, for example, in postmodern medical technologies such as in-vitro fertilization, video consultation, genetic engineering, transplantation and diagnostic imaging, all of which are techniques that re-draw the boundaries of the physical body. The energy (whether metaphor or reality) characterizing the CAM narrative is no longer an aberration within the postmodern context of hyper-reality. It can be added to the now-familiar list of postmodern biomedical concepts that deal with virtual bodies. Although common biomedical practices fragment, reconstruct and virtualize bodies, biomedicine is now also moving in the direction of holism. This is evident in the emerging eld of mind-body medicine and psycho-neuro-immunology. Numerous books and articles have been published by scientists whose work has pointed to the existence of a biochemical link between mind and body (Pert, 1999). These studies analyse the mind-body interplay from a medical viewpoint and focus on a broad spectrum of problems ranging from chronic pain syndromes, irritable bowel syndrome, and chronic fatigue syndrome, as described by Melmed (2001), to cancer predominant in the work of Deepak Chopra. He summarizes this new eld, alluding to a hidden physiology and stating that:
Western medicine has recently begun to move away from drugs and surgery, the mainstay of every doctors practice, toward the amorphous, often perplexing eld known as mind-body medicine. The move was almost a forced one because the old reliance on the physical body alone had become to crumble. (Chopra, 1999: 1819)

The conceptual similarity between this approach and the holistic model propagated by CAM is remarkable and strengthens the sense of a common cultural context in which conventional and alternative medicine are converging. Furthermore, it shows that the CAM discourse on energy and holism is neither ex-paradigmatic nor subversive, but part of the dominant medical discourse on the body. This carries profound implications for patients of CAM and probably biomedicine as well. The focus on energy, imbalance and depth, as opposed to superciality, provides a new mode of medical surveillance of the body as CAM practitioners set out to detect and repair impaired energy ow and system imbalance. This points to a paradox inherent in the original promise of CAM. The discourse of empowerment, individualism and holism has not liberated the

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patient from the medical gaze, but rather has introduced a new ock of specialists who dominate new modes of observing, penetrating, treating and thereby controlling the body. While it appears that alternative medicine has adjusted to the dominant medical paradigm, it would be simplistic to view this adaptation as unidirectional. The host culture has also changed, though to a lesser degree, as a result of domestication. From within biomedicine, forces of specialization and interdiciplinarity have led to greater exibility and diversity, perhaps as part of the postmodern collapse of boundaries. As different groups within medicine started to voice different opinions, biomedicine embraced a discourse which was not entirely scientic, at least according to the positivistic criteria of the past. The process by which the alternative came to be called complementary assumes a shift in the hegemonic as well as the challenging paradigm. A study conducted by Schachter et al. (1993) showed that Israeli general practitioners were willing to refer patients to alternative practitioners despite the fact that they did not believe that alternative medicine had a scientic basis. This could indicate that the unquestioned status of science as the basis for healing has been eroded. Studies conducted in the USA and Britain (Gordon, 1996; Verhoef and Sutherland, 1995; White et al., 1997), have shown similar practices in GPs referral of patients to CAM practitioners. Moreover, the increasing incorporation of courses in CAM into medical schools (Wetzel et al., 1998) will undoubtedly contribute to this process in the future. It is within this context that the current rising popularity of CAM and future trends should be discussed. Fueled by consumerist demand, CAM could grow in two categories: differentiation or domestication. The option of differentiation (i.e. developing an alternative ideology) seems to have failed in Israel due to a number of factors. First, this was thwarted by a medical establishment that enforced its hegemony through exclusion of alternative practitioners, supervision of their practice by MDs, and withholding of licensing. Indeed one very senior Israeli physician involved in the Israeli Medical Association stated that licensing of CAM practitioners would be interpreted as recognition and that this was undesirable. Second, differentiation was not popular among the majority of consumers, as pronounced paradigmatic differences often proved to be too foreign and thus ultimately unacceptable. Domestication, therefore, proved to be the winning option, as is often the case in postmodern consumer culture (see Featherstone, 1991; Hannerz, 1992, 1996; Turner, 1992). A self-propagating circle emerged in which public demand resulted in the establishment of CAM clinics, which in turn amplied public demand. It would be wrong to offer a complete analysis of the case of CAM since we

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are in the midst of a process. The popularity of CAM is still on the rise as it continues to entrench itself as a taken for granted option in the health care market. One possibility is that it could continue to develop in the path of domestication and become even more complementary. In the process, it could ultimately change biomedicine from within. As more MDs become exposed to CAM and its growing popularity among health consumers, biomedicine could undergo a paradigmatic shift that would promote the inclusion of CAM into biomedical practice, possibly even in hospital wards and in medical schools. The discourse of energy and vital forces would then become part of the gaze of biomedicine. Such dual transformation the complete domestication of CAM alongside a parallel change in biomedicine would be a culmination of de-differentiation, that all-consuming power of postmodern culture. Conversely, CAM could start to develop along a different path, leading away from domestication and towards the creation of enclaves of counter-culture. This might occur in the case of persistent biomedical refusal to incorporate CAM or permit licensing. Another viable option would be a combination of these possibilities, with some branches of CAM (e.g. chiropractic and acupuncture) becoming more domesticated whilst others (e.g. reexology and classic homeopathy) retain their differentiated status. Whichever of these options transpires, it seems that the patient has been paradoxically empowered as a consumer while being further objectied by the medical gaze. Others are still speaking for him, this time in terms which extend the scope of medical control from body to mind to the elusive elds of energy. References
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