© 2013 Kharitonova V.I.
2014 – № 1 (7)
Key words: biomedicine, non-conventional medicine, ethnomedicine, folk medicine (FM), traditional medicine (TM), traditional medical systems (TMC), folk healing (FH), complementary and alternative medicine (CAM); integration of medical systems, practices and methods; magico-medical and magico-mystical practices; medical ethnography, medical anthropology (MA).
Abstract: The article considers the situation with non-conventional medicine, which has developed in our country by now. The main focus is on institutionalization and legitimation of folk healing and attempts to introduce the system, practices and methods of alternative and complementary medicine into the legal field.
The article analyses how non-conventional medicine has developed since 1970s (at that time it was called folk medicine). For ethnographers and ethnologists of that time, the specialized All-Union Conferences served as a signal that this field should be taken up more actively, including theoretical research. Some of those conferences were “Expansion of the use of natural resources of medicinal plants in light of the studies of traditional medicine” (1971, Tbilisi), and “Ethnographic aspects of the study of traditional medicine” (Leningrad, 1975) (see: Pestriakov 1975, abstracts of conferences were published: Ethnographic aspects … 1975).
The Leningrad conference confirmed the principles of classification of medicine, based on its transformations in the development of human society. Two approaches were defined that do not contradict each other, at least in the differentiation of types of medicine. From the standpoint of information theory, I.I. Brekhman (Brekhman 1975: 4; cf .: Medical … 1976: 7-8) singled out folk medicine (loose), traditional (relatively fixed) and scientific (fixed). Yu.V. Bromley, considering medicine as part of the traditional culture from ethnographic standpoint, also put the way information is transmitted at the basis of classification. His ideas were reflected in the summarizing article of Yu.V. Bromley and A.A. Voronov “Folk Medicine as a Subject of Ethnographic Research” in the journal “Soviet Ethnography” (1976, No. 5); this publication for many years has become a powerful incentive to explore the various components of non-conventional medicine.
Despite the fact that the title of the article mentioned only folk medicine, the work itself was not just about it. In particular, it was in this article that a clear distinction was made between folk medicine and traditional medicine, based not only on oral and written forms of information transfer (oral instruction, book texts), but also on the existence, functioning, and preservation of medical knowledge. The authors characterized folk medicine as “traditional-oral medicine”, emphasizing the importance of the fact that it is included in the traditional -popular sphere and the preservation of tradition. The traditional medicine itself was called “traditional-written medicine”. Scientific medicine (now more widely called “biomedicine”) was of less interest to these researchers.
Methodologically speaking, two important approaches were identified in the work: historical and complex.
Issues related to the spread and possible co-existence of folk medicine and traditional medicine (the components of ethnomedicine or ethnic medicine (compare: Vlasov 2006)) with biomedicine, have become especially important only in the post-Soviet period (since the 1990s, when an active “revival of traditions” started and there appeared numerous options for health practices, borrowed from a wide variety of world sources, while the healthcare system faced serious problems).
From medical ethnography to medical anthropology
The researchers’ natural interest in the problems of medical practice increased after the publication of the article in the leading journal. This was due to the intensification of research in folk and traditional medicine in international community stimulated by the World Health Organization (WHO), which in 1980 developed a special program (“Folk Medicine … 1980”), as well as revival of cultural traditions in our country (see, for example: Kharitonova 2000, 2006). In the last years of the twentieth century ethnographic and biomedical research began to develop more intensively than in the previous period. At this time, ethnographers and folklorists registered and generalized more information about the use of certain methods and means of treatment, widely known in the folk environment (see, for example: Vasilenko 1987, Grigorieva 1992).
In the post-Soviet period, with the beginning of the “revival of traditions” and appearance of magico-medical and magico-mystical services of numerous specialists on the market (along with their new methods and practices), ethnographic research was combined with ethnological and sociological studies. In medical anthropology, in addition to biological anthropology studies which were more typical for the Soviet science, research in social anthropology started (Kharitonova 1995, Mikhel 2004, etc.). It should be noted that among new publications appeared works of interdisciplinary teams, comprising both doctors and ethnographers (Khasnulin et al, 1999). At the same time, sociology of medicine has formed as a separate sub-discipline (see: Reshetnikov 2000a, 2000b, etc.), with similar methodological principles to medical anthropology (Yarskaya-Smirnova et al., 2004, Michel 2010, 2013).
The change in methodological paradigms in medical ethnography / anthropology was caused, on the one hand, by direct contacts between Russian scientists and their foreign colleagues, and, on the other hand, by changes in the market of medical services themselves, whose study according to ethnographic descriptions and classifications was already unproductive. The situation began to change in the late 1980s. On the scientific level, it is necessary to point out the appearance of the article by V.A. Tishkov and V.V. Tishkov “Dialogue between anthropology and medicine.” In the books of Arthur Kleinman “Patients and healers in a cultural context,” “The social roots of disasters and diseases,” “Notes and texts in the fields. Discourse between anthropology and medicine” in the new “Journal of Applied Psychology” (1988, No. 1) But not only the methodological approaches in science have changed, but also the field of research for medical ethnologists and anthropologists – as in Russia new variants of medical prophylactics, medical and psychological assistance were forming.
“Folk healing” in Russia: the formation of new forms of practice and their legitimization
A significant starting point for a radical change in the ratio of conventional medicine (forms of medicine which make part of the healthcare system) and rapidly reviving, transforming or reappearing forms of non-conventional medicine became year 1993, when the first Russian Law on Health Protection appeared (“Fundamentals of the Russian Federation’s legislation on the protection of public health” of July 22, 1993 No. 5487-1), in which articles 56 and 57 (“The right to practice folk medicine (healing)”) declared the presence in Russia of a new phenomenon – folk healing (extract from the legislative acts see: Gal’perin 2000) .
I should note that at that time specialists (mainly physicians) who initiated the inclusion of article on folk medicine in the text of the Law, they conceived of it as introduction of ethnic medical practices (folk medicine) into the legal field. But the same specialists with their efforts have already created a new phenomenon, which was more similar to the traditional medical systems (TMS) formed in Asian countries on the basis of eastern traditional medicine. There, traditional medicine (TM) was subjected to a certain degree to biomedicalization (primarily in external manifestations, it acquired a biomedical “appearance”) and copied socio-economically the work of healthcare system and official medical education (in India, for example, there is a special department that oversees various TM and TMS – the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy, (AYUSH)).
It is interesting that the transformation of some forms of medicine into others has occurred with some oddities: on the basis of Eastern Slavic practices (oral folk medicine), with the advent of writing, there were no variants of traditional (traditional-written) medicine either in the Middle Ages or in later periods. However, with the development of folk healing, medical schools began to be created, the authors of which sought to write their own practices and transfer their knowledge and experience through teaching. Thus, in our unconventional medical environment, it is now possible to observe a combination of simultaneously co-existing and developing, as well as integrating three different-stage forms of medicine.
In the new Russia, specialists classified as folk healers, were later registered as professional groups of folk healers and folk (spiritual) healers. The law defined only the general status of folk healing, and later the activities of these practitioners were regulated in the “All-Russian Classificator of Occupations of the Civil Code of the Russian Federation for Standardization and Metrology” (Decree No. 298 of 30.12.93). The two groups of diverse specialists were singled out:
– Group 324 “Healers and practitioners of non-traditional medicine” who “… consult about the state of health, as well as methods of its preservation and improvement, treat physical and mental diseases with the help of folk methods that stimulate life processes, or through suggestion, bioenergetic and other effects.
The duties usually include: counseling on proper behavior, nutrition and lifestyle, helping to maintain or restore mental and physical health; treatment of patients using traditional medicine methods, including herbal treatment, suggestion, correction of bioenergetic fields, etc. “
Group 324, in turn, was divided into 2 basic subgroups:
ÞPractices of nontraditional medicine (3241)
“Practices of nontraditional medicine treat mental and physical diseases with the help of herbs, medicinal plants and other traditional folk methods that stimulate the processes of vital activity of the organism and restore its protective forces.
Their duties include:
* Treatment of diseases and injuries with the help of herbs, medicinal plants, insects and other folk remedies and methods;
* Advice on the proper use of herbs, medicinal plants, nutrition and behavior in order to preserve health and improve well-being; …
Examples of occupations included in the basic group: healer-herbalist; rural doctor … »;
ÞHealers (treating with suggestion and prayers) (3242)
“Healers, who treat with suggestion and prayers, treat psychic and physical diseases with the help of bioenergetic influence, suggestion, prayers and similar methods.
Their duties include:
* Treatment of mental and physical diseases by the power of suggestion of prayers, by correcting bioenergetic fields;
* Counseling on correct behavior, lifestyle and faith in order to maintain mental and physical health and improve well-being; …
Examples of occupations (occupations) included in the base group: healer, who cures with suggestions and prayers ... “
Obviously, all the definitions were poorly thought through, therefore they were met with serious criticism post factum from the representatives of biomedicine and medical science. It was especially embarrassing that healers who did not have medical education could “treat” (although receiving medical education by healers was initially included by law; alternatively, traditional healers were invited to work together with medical professionals). But one way or another, folk healing, which came as a spontaneous wave in the late 1980s and early 1990s and was skillfully taken over by some medical representatives, appeared in the legal field with a rather fuzzy regulation (see in detail: Kharitonova 2000; 2009a, 2011, etc.)
The attitude towards folk healing from the side of legislators has changed more than once, as reflected in numerous additional documents. As a result, in the new Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation”, adopted by the State Duma of the Russian Federation on November 1, 2011, appeared the Article 50 with the title “Folk medicine”, which indicated an attempt to legally regulate only legislative (magico-medical) practices, not related to spiritual healing (magico-mystical practices) – see the division of activities into folk doctors (lekary) and folk healers in the professional “All-Russian Classifier …”. This was done at the insistence, first of all, of biomedical specialists.
The Article 50 states:
“Folk medicine is the methods of recovery rooted in folk experience, based on the use of knowledge and practical skills in assessing and restoring health. Folk medicine does not include the provision of occult-magical services, as well as the performance of religious rites … (italics by me, – V.Kh.) “.
The second phrase clearly indicates a complete lack of understanding by law-makers of the essence of ethnic medicine, especially folk (oral) medicine, where lekar (medicinal) practices and healing spiritual rituals inextricably coexist. Neither folk lekarstvo (i.e., magico-medical practices) nor, especially, folk (spiritual) healing (i.e. magico-mystical practices) exist without what is denied in the Article 50 “Folk medicine”. In addition, in reality, one and the other are closely interrelated. Even if the current “professors of traditional medicine” and “academicians of energy and information sciences” (and such “academic titles” are awarded by various non-state organizations together with issuing “official papers” confirming them) use in their vocabulary not the usual words “dykhi”, “evil spirits”, etc., but such terms as “electromagnetic”, “torsion”, “energy-informational” fields etc., the depth of their understanding of “medical processes” will not differ much from the perception of practitioners of traditional medicine. And this is no coincidence.
The situation shows that the problem requires not just a denial (“this should not be, because it can not be – as we believe at the moment, guided by modern scientific knowledge”). Now serious research is needed in the sphere of para-scientific knowledge, referred to by those who explain principles of influence within frameworks of various variants of nonconventional medicine, whether homeopathy, bioenergetics, enio-suggestive practices, etc. Such research is underway, although not without difficulties and opposition from the adherents of traditional sciences. Let’s note that modern immunology, for example, tries to explain some aspects of traditional medicine, and quantum sciences, most likely, in due course can decipher “work of spirits”.
Existing article 50 “Folk medicine” allows – quite legitimately – to multiply “representatives of traditional medicine”. That’s why the Health Committee of the State Duma of the Russian Federation is trying to rewrite it. However, to seriously address the issue, it is necessary to attract not only physicians who believe that they know the specifics of “traditional medicine” and understand the processes taking place in modern medicine, but, first of all, medical ethnographers studying the specificity of traditional medicine and medical anthropologists engaged in the study of systems of health maintenance (both folk traditions and contemporary practices).
Non-conventional medicine: problems of differentiation
Folk healing was formed at the intersections of ethnic / folk medicine (magico-medical and magico-mystical practices); health practices of non-religious movements, which developed actively in the post-Soviet period; Eastern medicine, poured into Russia by flows of different variants of TM and TMS; parapsychological concepts; hypnosis practitioners, etc. At the same time, folk healing has borrowed psycho-psychotherapeutic knowledge from various fields of activity of professionals engaged in the rehabilitation of the psyche and psychosomatics of man (Kharitonova 2014). Note that in the 1990s in Russia there were virtually no psychotherapists and psychoneurologists. Naturally, this allowed folk healers to quickly fill in the appropriate niches, where they later competed with a new pleiad of psychologists who are educated in various psychological fields previously underrepresented in our country.
Folk healing is more than a heterogeneous phenomenon (Kharitonova 1994). It includes not only widely known practices and means, but also a mass of unapproved methods that arise on the basis of personal creativity. This is characteristic, first of all, of oral folk medicine, but lies at the heart of writing-traditional medicine. However, researchers try to emphasize their “traditionality”; let’s not forget that the most important in the art of oral practitioners was the ability to creatively approach each person. In oral folklore culture, the art of creative personalities always combined tradition with improvisation, and at times relied for the most part on improvisation (this depended, on the one hand, on the very folklore, on its genres, and on the other – on the psychophysiological characteristics of the performer / compare, for example: Kharitonova 1983). This largely explains the individualization of the approach to the improvement of the patient in popular medical practices. This should not be forgotten when their features are emphasized in contrast to traditional medicine (written) and especially to standardized biomedicine. The “individual approach” in folk healing is not exactly the individualization to which health care is now coming in the form of emerging 4P medicine or personalized medicine.
With time the field of activity of some traditional healers (and doctors, spiritual practitioners, and those who combine one with another), evolves, among other things towards creation of schools and movements that establish written principles for the transfer and existence of practices. In this way folk healing becomes similar to some forms of traditional medicine, which is based on written canons; such a version of folk healing, of course, begins to function according to the principles of traditional- written medicine).
However, the ethnic magico-medical and magico-mystical practices that existed at the end of the 1980s, naturally, did not turn into established folk healing (which was expected by its organizers from the field of biomedicine), but continued their natural existence in rural areas and remote regions, changing in accordance with socio-economic, ethnopolitical, cultural and religious components of our lives (Ermakova, 2005; Popovkina, 2006; Paniukov, 2008, etc.). National-cultural revival in the field led them to various modifications and modernization, as well as widespread distribution throughout the country and even exports to foreign lands. This applies primarily to (neo)shamanic practices. On the one hand, they were rather artificially activated through the attribution of shamanism to official traditional religions in several republics of Russia (this spurred their “revival” – see: Kharitonova 2006), and, on the other, they started to function in a variety of forms due to active development of the Western version of global shamanism.
Let’s not forget that in addition to these widely spread medical, therapeutic and preventive practices, already during the period of perestroika, we had numerous neo-pagan and other non-religious groups, some of whom claimed to have specific therapeutic and prophylactic systems (see, for example: Ozhiganova, Filippov 2006). Besides, different religious traditions also have their own systems of healing and treatment. Nowadays, spiritual (psychological) help (for example, for drug addicts) is also available. Thus, the picture of nonconventional medicine is seen as extremely kaleidoscopic. A multitude of diverse methods of treatment, preventive and medical care have also been attributed to this sphere: from homeopathy to leech therapy, osteopathy, aromatherapy, etc.
It should be noted that some authentic ethnic health preservation systems still keep their folk medicine (lekarstvo) and spiritual healing practices to this day; they exist in different versions and types. The doll healing processes turned out to be “superstructural”: they included a certain number of people who had a relationship with their ethno-cultural traditions. However, for the most part people who were aiming at finding specific abilities came there: after all, folk healing was formed at the moment of activation of ideas about extrasensory medicine, bioenergetics, energy informatics, enio-suggestology, etc., as well as in the time of a massive influx of Western specialists in psychology and New Age practices, including shamanism (see in detail: Kharitonova, 2000, 2010, 2010b, Kharitonova et al. 2008)
In Russia – a multinational and multi-confessional country – there was already a rather confused situation with the spread and application of multi-ethnic health practices. For example, as indicated, we have not formed (Eastern) Slavic / Russian traditional medicine (as a written form of magico-medical practices). However, already in tsarist Russia Tibet-Buryat medicine (based on ‘Jude-Shi’ treatise) was widespread, thanks to work of P.A. Badmaeva. In Buryatia and other regions of Russia it began to actively spread and develop at the end of the 20th century (there appeared competing companies – see, for example, the activities of the clinics “Naran” and the Buryat Center for Oriental Medicine: Kharitonova 2009).
During the years of perestroika, various specialists (of different level and quality of training) began to come to Russia, presenting themselves as practitioners of Chinese, Tibetan, Vietnamese, Korean and other traditional medicines (TM) and traditional medical systems (TMS).
Let’s pay attention to the specific terminology, which in this situation must be introduced for a clear definition of concepts. The fact is that both traditional oriental medicines and traditional medical systems formed on the basis of biomedicalization and globalization were imported into Russia (for example, the Indian “modern Ayurveda” in its different variants and the “global Ayurveda” that spread throughout the civilized world). It should be borne in mind that some traditional medicines came to us indirectly, in variants of conglomerates formed under the influence of foreign practices (for example, “Chinese medicine” or “Tibetan medicine” could appear in our country through Mongolian practice, since the specialists from Mongolia initially came easier to work in Russia).
Institutionalization of traditional medicine and traditional medical systems
The question of how these practitioners do their job in the Russian Federation, where these activities are not regulated by law, or more precisely, are simply not allowed, remains open (in every particular case there is a solution). However, the Article 50 “Folk medicine” mentioned above and the vaguely prescribed legislative aspects in it with ambiguous terms and concepts behind them allow dragging quite big camels “in the eye of a needle”. This aspect is one of the most fundamental for nowadays attempts to reform the 50th article – what different organizations are engaged in (so far unsuccessfully), including the Committee for Health Protection of the State Duma mentioned above. The proposed variants of the changes seem even more confusing and ridiculous than the text of the article itself. For example, lawmakers are ready to replace “folk medicine” with “complementary” and write these two terms side by side – as one-level and equivalent. The article is written in such a way that even the original meaning of the term “complementary medicine” remains unclear.
If it were a serious reform, then the article should define the complementary and alternative forms of legislative powers of various medical and therapeutic and preventive systems, practices, methods in public health. Thus, different medical, therapeutic and preventive systems, practices, methods should be first determined by themselves, after which it is necessary to decide which of them can be used in a complementary version, and which ones should be left alternative (not prohibited or, in case of some of them, even prohibited). What happens in reality? Let’s pay attention to one of the suggested variants of the article (discussed on February 20, 2014 in the Committee for Health Protection of the State Duma of the Russian Federation):
“Article 50 Complementary medicine and healing.
Complementary Medicine (hereinafter referred to as CM) is the medical and preventive treatment systems and methods established in the cultural traditions, widespread and counting long term of practical application, and modern medical technologies developed on their basis, entered in the CM Register and applied in accordance with the established order of medical care for CM.
It is allowed to provide medical services with the help of systems, facilities, drugs, methods and technologies entered in the KM Register, if their provision is stipulated in the terms of the contract with the patient, concluded in writing.
The right to provide services with the help of KM is available to persons with a higher or secondary medical education of any medical specialty who have completed postgraduate training in KM and who are admitted to provide medical services in the manner prescribed by this Law. … “
Obviously, the proposed version (given only the beginning of the text) does not stand up to criticism at many points, for example: it is unclear what the article will regulate (especially if we look at two terms that are strangely combined in its name). It is equally unclear who will select these systems and methods – since the established in the cultural traditions therapeutic and prophylactic systems and methods are in the vast majority associated with magic and mysticism, which was denied in the main article. “Modern medical technologies developed on their basis” is an even more vague definition that will eventually lobby all that will be profitable for traders (given that the second part shifts the right of choice and responsibility for it to the patient – “complementary medicine” in this option promises to become a very profitable business for someone). The hope for the retraining of medical personnel is simply ridiculous, given that in ethnic medical practices the selection was based on the availability of specific human abilities, and in traditional medicines people learned their practice for many years, not to mention that they learned – through direct continuity – from the Teacher, and not at short-term courses of new specialists. In a word, the haste and lack of elaboration of such formulations is quite obvious.
It is also obvious that in our days in the market of near-medical services there is a huge amount of systems, methods, specialists who have studied or invented something, thanks to transformations of their own world view and psyche. Taking into account that everyone who wants to get through to the market tries to force one’s way, this situation requires, more likely, prohibitive articles, and only after that recommendations to the column “complementary forms of treatment and prevention practices, systems, methods.”
So, even from this cursory review it becomes quite obvious that the situation with nonconventional medicine in our country requires a serious interdisciplinary understanding of its components, their conceptual and terminological delineation and subsequent proper legislative design. These are all difficult tasks, as difficult as the task of understanding the specifics of activities of many representatives of nonconventional medicine (see, eg: Kharitonova, Kopeliovich 2012).
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