Medicine and Colonial Identity

Bridie Andrews, Mary P. Sutphen, Bridie Andrews, Mary P. Sutphen

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134441174
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

Over the last century, identity as an avenue of inquiry has become both an academic growth industry and a problematic category of historical analysis. This volume shows how the study of medicine can provide new insights into colonial identity, and the possibility of accommodating multiple perspectives on identity within a single narrative. Contributors to this volume explore the perceived self-identity of colonizers; the adoption of western and traditional medicine as complementary aspects of a new, modern and nationalist identity; the creation of a modern identity for women in the colonies; and the expression of a healer's identity by physicians of traditional medicine.

1 Introduction

Bridie Andrews and Mary P. Sutphen

This volume examines aspects of medicine in relation to the articulation of identity in colonial settings. All of the chapters were presented at the 1996 “Medicine and the Colonies” Conference which the Society for the Social History of Medicine (SSHM) hosted in Oxford. At that conference, we were struck by the ways in which the study of medicine repeatedly threw up new insights on aspects of identity. There were papers on the perceived self-identity of colonizers (something represented here by David Gordon (Chapter 3), Hilary Marland (Chapter 4), Suzanne Parry (Chapter 6), and Roy MacLeod (Chapter 7)) while others highlighted the adoption of Western and traditional medicine as complementary aspects of a new, modern, and nationalist identity (represented here by Maneesha Lal (Chapter 2)). The creation of a modern identity for women in the colonies (Lal (Chapter 2) and Marland (Chapter 4)) was another aspect, as was the expression of a healer’s identity by physicians of traditional medicine (Gordon (Chapter 3)).

Over the last century, identity as an avenue of inquiry has become an academic growth industry. There are two issues bound up in this: one is the distinctly Western notion of the discrete, bounded self; the Cartesian self which, in Michel Foucault’s words, “places its own point of view at the origin of all historicity [and] which, in short, leads to a transcendental consciousness.”¹ This individual identity has been the subject of extensive study since Freud and the rise of psychoanalytic theory in the early twentieth century. The second issue is group or collective identity, and the processes of identification by which people sort their environment into like and unlike, self and other. It is identity in this second sense which has generated so much recent scholarly attention from historians, sociologists, and anthropologists, and with which we are mainly concerned.

Feminist scholars have been carving out new fields in the study and critique of gendered identities in modern societies since the mid-twentieth century.² Much literature, both feminist and otherwise, has drawn on Foucault’s work to emphasize corporeal aspects of identity: the body as the substrate upon which particular aspects of identity are performed.³ In both of these trends, the interplay between individual and group identities has served to problematize categories of identity: as elsewhere in scholarship, much emphasis has been on heterogeneity, hybridity, and difference.

Recent work on nationalism as the dominant modern form of collective identity has led to a spirited debate on its relationship to colonialism. The dissolution of the Soviet Union after 1989 and the subsequent resurgence of national and ethnic identities, often with violent consequences, has given this debate special urgency.⁴ In colonial history, an important part of daily life for colonial subjects was coming to terms with the identity labels that colonists applied to them. This became evident in 1997 during the debates over how many residents of British Hong Kong could be “awarded” full British citizenship before Hong Kong was returned to the People’s Republic of China in 1997. In the early twentieth century, leaders of nationalist movements in the colonies claimed the right to local self-definition (today we might say “self-determination”) as a crucial part of their agendas. This applied at the local level as much as at the national: for example, women identified as “female laborers” by colonial observers might have described themselves very differently. Instead of “workers”, they were just as likely to think of themselves in kinship terms: as daughters-in-law, wives, and mothers. The negotiation of other people’s identity labels was constitutive of colonial society long before it became the integral aspect of modern life that it is today.

Twenty-odd years ago, several historians of India proposed the study of a group they dubbed subalterns, both as a correction to the metropolitan focus of most colonial historiography, and also as creative response to Foucault’s emphasis on the discourses of power and Antonio Gramsci’s investigations of the mechanisms of political hegemony.⁵ In 1981, when the Subaltern Studies collective began to publish, they privileged the experiences of these non-élite, aiming to resurrect local identities from the silence of the existing, élitist historiography. They were motivated to demonstrate how subjective identity, local concerns and the unseen workings of the imperial order could be used to explain Indian history from the bottom up. The founding editor of Subaltern Studies, Ranajit Guha, claimed that “subordination cannot be understood except as one of the constitutive terms in a binary relationship of which the other is dominance.”⁶ Without limiting themselves to a single defining identity of colonial subjectivity, subalternist historians have tended to make the praxis of rebellion the primary focus of their inquiries. Problematically, however, few sources survive in which the subalterns of Subaltern Studies expressed themselves directly. An apparently bipolar and one-dimensional relationship between dominant imperialists and subaltern subjects is exaggerated by the fact that many of the sources for subaltern history published to date are the same as those of the old imperial history. That is, although the Subaltern Studies collective aimed to undermine the view from the metropolis, it has been restricted by the relative abundance of sources in the archives of the colonial powers. They may be able to read these sources “against the grain,” but the range of subjects that can be explored in this way has been determined in advance by the nature of the imperial collections. Gayatri Spivak cites Ranajit Guha’s manifesto for recovering subaltern agency despite this lack:

It is of course true that the reports, despatches, minutes, judgements, laws, letters, etc. in which policemen, soldiers, bureaucrats, landlords, usurers and others hostile to insurgency register their sentiments, amount to a representation of their will. But these documents do not get their content from that will alone, for the latter is predicated on another will – that of the insurgent. It should be possible therefore to read the presence of a rebel consciousness as a necessary and pervasive element within that body of evidence.⁷

Reading sources against the grain allows historians to discuss the agency of subjects who left behind no archival sources of their own: people otherwise without a history. Yet this agency, or will, is – according to Spivak – no more than a subject-effect. The effect of insurgency demands a “continuous and homogenous cause for this effect, and thus posits a sovereign and determining subject.”⁸ As she maintains in a later article, the subaltern – this posited, homogenized subject – cannot speak.⁹

Yet the category of “subaltern classes” is one which Guha himself acknowledges to include, “ideally speaking [emphasis in original] the lowest strata of the rural gentry, impoverished landlords, rich peasants and upper-middle peasants.”¹⁰ It would be surprising if all of these historical subalterns turned out to have been illiterate and to have left no written records at all. In fact there were many Indian newspapers in various vernacular languages, starting as early as 1810, and published in substantial numbers by the 1830s and ‘40s. It is hard to say why these and other vernacular sources have received so little attention in the rewriting of Indian history “from the bottom up.” Much of the early vernacular literature was published under religious auspices of various kinds: some newspapers in local languages were funded by foreign missionaries; others were published in Urdu for a Muslim readership; and still other Indian-run papers displayed a Hindu religiosity far removed from the secular Hindu nationalism that modern scholarship is comfortable with. The historical interplay of religious issues with the development of insurgency towards colonial rule and the growth of nationalism is a particularly thorny field in the context of modern India. We suggest, however, that there are more subaltern voices in the historical record than are often acknowledged. In the field of medical history, a recent article by Deepak Kumar demonstrates how the use of sources in Telugu, Tamil, Malayalam, and Kannada as well as Hindi and English may shed useful new light on the interplay of Western and indigenous medicine from the point of view of “subaltern” medical practitioners.¹¹

The inability to speak in an unmediated way is by no means confined to the subalterns of colonial history. In 1986, a group of anthropologists aired their discomfort with the relationship between anthropologists as authors and the subjects of anthropology, their “informants.”¹² Contributors to a volume devoted to the debate questioned the representation of foreign cultures by students who were in the process of building careers for themselves; they doubted the reliability of informants when so many narrated their culture in return for an exchange of money, gifts, or social capital; and they indicated that the act of “giving voice” to previously silent peoples was in itself patronizing, if not also imperialist. In the soul-searching that followed what was dubbed the “Clifford and Marcus” debate, it seemed that all representations of “others” were hopelessly tainted, undermining the entire project of ethnography.

The “Clifford and Marcus” debate was, in part, a response to the writings of Edward Said. In Orientalism, Said drew on Michel Foucault’s development of the notion of a discourse that is the extension and expression of a power relation to describe western writings on the East. “In brief,” he wrote, “because of Orientalism the Orient was not (and is not) a free subject of thought or action.” And: “European culture gained in strength and identity by setting itself off against the Orient as a sort of surrogate and even underground self.”¹³ As James Clifford noted in his introduction to the volume, Said documented the creation of a coherent “Orient” from multiple sources, a creation which “confer[ed] on the other a discrete entity, while also providing the knowing observer with a standpoint from which to see without being seen, to read without interruption.”¹⁴

The undermining of this standpoint, this “place of overview” was the aim of the authors of the volume, but to the degree that they were successful, it left scholars in a quandary. As George Marcus put it: how can ethnography “define its object of study in ways that permit detailed, local, contextual analysis and simultaneously the portrayal of global implicating forces?”¹⁵ To translate this problematic into the terms of our project, the crass lumping of colonial subjects by an imperial power and the local subjectivity of individuals are two ends of the spectrum of perceived identity. At the one end we find historians writing studies where diplomats play the starring roles, and at the other end, we find others trying to coax rebellious subalterns to speak more loudly.¹⁶ Perhaps these two disjunctures are less serious than Marcus suggests: in studying local cultures, we often find that global forces are turned to unexpected ends. Detailed field study makes possible new understandings of the transnational context. This is true of several of the studies presented here.

Identity, then, is a kind of cultural commodity, important as a political or economic asset. While individuals or groups define their identities in particular ways, government officials, researchers, neighbors, or television reporters may impose different labels. They may choose from a long list of social variables: nationality, class, race, gender, age, sexuality, occupation, or marital status, all of which may change, either by choice or fiat. Thus a wife who kills her husband after a violent disagreement may be regarded as a murderess, as a victim of domestic abuse, or simply as a widow. The advantages to the woman of claiming the identity of victim may make the difference between life imprisonment or immediate freedom. Clearly, all ascriptions of identity status depend upon the context of the observer and the subject; they are open to multiple interpretations; and they are negotiable.

For all of these reasons, identity is a problematic category of historical analysis. Even when silences in the historical record do not force historians to focus on one aspect of identity, in practice it is still very difficult to write history that does justice to more than a couple of strands of identity. Should region trump class, and sex trump religion? Our understanding of these categories is in itself a modern phenomenon, and as outlined above, controversies over their importance are recent and rarely integral to the historical record. Scholarly studies reify the separation of particular strands of identity, as we can see in the thorough Manchester University Press series, History and Related Disciplines: Select Bibliographies, where one of the recent volumes organizes studies under the apparently exclusive headings of race, or gender, or religion, etc.¹⁷ Other volumes are devoted entirely to a single characterizing identity.¹⁸

One way to get around this dearth of independent source materials is to look for topics that open up new windows on colonial existence. We suggest that medicine may provide a means to accommodate multiple perspectives within a single narrative. Although rarely talking with each other, the historical record is full of diplomats and peasants discussing medicine and health concerns. To pursue a metaphor, we use medicine as a shuttle to traverse the many strands of identity and attempt to weave an account that has the potential to reconcile a number of perspectives. The topics we cover in medicine – professionalization, therapeutic choice, medical education, and medical practice – allow us to juxtapose a number of strands of identity, without privileging one or two.

Other historians of medicine have done this to good effect, as we can see in a recent example on American medicine by Judith Leavitt.¹⁹ She demonstrates that for American doctors, medicine has often been only one aspect of their identity as breadwinners. A day’s work for nineteenth-century doctors might involve as much farming, trading, and child-care as it did medicine. As fathers or mothers, wives or husbands, businessmen and women, many doctors practiced medicine in a variety of settings – their own homes or in other people’s – and within a large economic web. We found this study of doctors in their day-to-day rounds useful in its illumination of medical identity outside of the territory that historians have traversed so often in their discussions of professionalization.

We are, of course, not the first to notice how usefully the study of medical issues can illuminate aspects of social history. The literature on the medicine of empires is already rich.²⁰ In focusing on medicine and identity, we argue that the contributors to this volume inflect previous scholarship on the “medical pluralism” of many colonial situations with new meaning.²¹ The idea of “pluralism” in medicine has been used to describe situations in ideologically neutral terms. A new clinic opens and people quickly learn how its services can benefit them, given their existing health-seeking behavior patterns. Resembling the rational choice model of economic behavior, studies of medical pluralism often interpret the health-seeking behavior of colonial subjects as based on their assessments of medical efficacy and social and monetary cost. The studies collected here argue that medicine can also be a key aspect of the cultural positioning by which colonists and colonized alike defined both themselves and the colonial other.

The sociologist Stuart Hall has arg...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Acknowledgments
• 1 Introduction
• 2 “The ignorance of women is the house of illness”: gender, nationalism, and health reform in colonial north India
• 3 A sword of empire?: medicine and colonialism at King William’s Town, Xhosaland, 1856–91
• 4 Midwives, missions and reform: colonizing Dutch childbirth services at home and abroad ca. 1900
• 5 New Zealand milk for ‘building Britons’
• 6 Tropical medicine and colonial identity in northern Australia
• 7 Colonial doctors and national myths: on telling lives in Australian medical biography
• Index