Capturing Quicksilver: The Position, Power, and Plasticity of Chinese Medicine in Singapore 9781785337956

Citation preview

Capturing Quicksilver

Series: Epistemologies of Healing General Editors: David Parkin and Elisabeth Hsu, University of Oxford This series in medical anthropology publishes monographs and collected essays on indigenous (so-called traditional) medical knowledge and practice, alternative and complementary medicine, and ethnobiological studies that relate to health and illness. The emphasis of the series is on the way indigenous epistemologies inform healing, against a background of comparison with other practices, and in recognition of the fluidity between them. Volume 1 Conjuring Hope: Healing and Magic in Contemporary Russia Galina Lindquist Volume 2 Precious Pills: Medicine and Social Change among Tibetan Refugees in India Audrey Prost Volume 3 Working with Spirit: Experiencing Izangoma Healing in Contemporary South Africa Jo Thobeka Wreford Volume 4 Dances with Spiders: Crisis, Celebrity and Celebration in Southern Italy Karen Lüdtke Volume 5 The Land Is Dying: Contingency, Creativity and Conflict in Western Kenya Paul Wenzel Geissler and Ruth Jane Prince Volume 6 Plants, Health and Healing: On the Interface of Ethnobotany and Medical Anthropology Edited by Elisabeth Hsu and Stephen Harris Volume 7 Morality, Hope and Grief: Anthropologies of AIDS in Africa Edited by Hansjörg Dilger and Ute Luig Volume 8 Folk Healing and Health Care Practices in Britain and Ireland: Stethoscopes, Wands and Crystals Edited by Ronnie Moore and Stuart McClean

Volume 9 Moral Power: The Magic of Witchcraft Koen Stroeken Volume 10 Medicine between Science and Religion: Explorations on Tibetan Grounds Edited by Vincanne Adams, Mona Schrempf, and Sienna R. Craig Volume 11 Fortune and the Cursed: The Sliding Scale of Time in Mongolian Divination Katherine Swancutt Volume 12 Manufacturing Tibetan Medicine: The Creation of an Industry and the Moral Economy of Tibetanness Martin Saxer Volume 13 The Body in Balance: Humoral Medicines in Practice Edited by Peregrine Horden and Elisabeth Hsu Volume 14 Asymmetrical Conversations: Contestations, Circumventions, and the Blurring of Therapeutic Boundaries Edited by Harish Naraindas, Johannes Quack, and William S. Sax Volume 15 Healing Roots: Anthropology in Life and Medicine Julie Laplante Volume 16 Ritual Retellings: Luangan Healing Performances through Practice Isabell Herrmans Volume 17 Capturing Quicksilver: The Position, Power, and Plasticity of Chinese Medicine in Singapore Arielle A. Smith

Capturing Quicksilver The Position, Power, and Plasticity of Chinese Medicine in Singapore Arielle A. Smith

berghahn NEW YORK • OXFORD www.berghahnbooks.com

First published in 2018 by Berghahn Books www.berghahnbooks.com © 2018 Arielle A. Smith

All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system now known or to be invented, without written permission of the publisher.

Library of Congress Cataloging-in-Publication Data A C.I.P. cataloging record is available from the Library of Congress British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library

ISBN: 978-1-78533-794-9 hardback EISBN: 978-1-78533-795-6 ebook

For the first and final sparks, for unwavering support, and for literally and figuratively mapping the way … thanks, Mom.

Contents

List of Illustrations

viii

Preface

ix

Acknowledgments

xii

List of Abbreviations and Acronyms

xiv

Introduction: Mercurial Assemblages and Analytical Bricolage

1

1. Chinese Medicine Unbound

33

2. From Imaginative Geography to Collective Lobotomy

70

3. Power in Technique and Techniques of Power

105

4. Making Sense and Sensation

144

5. Heat, Health, and the Experienced Environment

178

6. Of Nutrients and Nourishment

211

7. Positionality, Power, and the Politics of Representation

251

Glossary of Transliterated Mandarin Chinese Terms

278

Bibliography

283

Index

297

vii

Illustrations

All photographs by the author 0.1 Popular Chinese food and medicine shop, Hock Hua (Fu Hua) in Toa Payoh 8 0.2 Phytopharmaceutical research and development at MediPearl 9 1.1 Luohanguo 39 1.2 Hock Hua liangcha cart 40 2.1 Commemorating colonial-era overseas Chinese in Telok Ayer Green (historic Chinatown) 77 2.2 Commemorating Malay heritage in Kampong Glam 82 2.3 Promotional vehicle used by the Aw family to promote Tiger Balm (Haw Par Villa/Tiger Balm Gardens) 87 3.1 Chinatown (New Bridge Road side) 120 3.2 Dr Wang filling a prescription using powdered polyherbal formulas from Taiwan 124 3.3 Professor Tan with a regular patient at Dazhong Yiyuan 137 4.1 Chinese medical prescriptions, prepared for convenience 157 5.1 View from MacRitchie Reservoir (central catchment) 183 5.2 HDB housing estate in Sengkang 185 5.3 Common materials for making liangcha: prepackaged polyherbal decoction, juhua, damai, and rock sugar 204 6.1 Old Airport Road hawker center 216 6.2 A selection of prepackaged herbal soups at Hock Hua 230 6.3 Yanwo and other luxury items at Hock Hua 244 7.1 Thian Hock Keng Temple (Telok Ayer/historic Chinatown) 268

viii

Preface

For more than six years I have danced with memories: earnest faces and loud chatter in clinic waiting rooms, a physician’s steady hand twisting acupuncture needles, and pharmacists assembling paper packets full of herbs; plastic tables and chairs, plumes of aromatic steam, and small dishes of fish sauce and fresh-cut chili padi (a very popular variety of chili pepper) in hawker centers; concrete pillars, tidy courtyards, and laundry poles jutting from row after row of windows in high-rise apartment complexes. These memories of Singapore shimmy and weave beside their Oxford fellows: students with furrowed brows bent over pen and paper, keyboards, and books; animated discussions in seminar rooms and muffled coughs in vaulted libraries; exposed rafters, polished hardwood bars and tables, and intimate nooks and crannies in pubs, old and new; porters’ lodges, quads, gardens, common rooms, dining halls, and cloisters adorned by elegant arches, impeccably manicured pathways, gargoyles, and spires. Threaded between these snippets of space and time are Rocky Mountain peaks and valleys; the familiar faces and embraces of family and friends; and the snows, spring runoff, autumn colors, and summer adventures of my western Montana home. Reconciling nearly seven years of life, travel, research, and writing in such different locales has taken time and careful consideration: memories can be unreliable (and field notes sometimes unintelligible), and are flavored by sentiment, shifting perspectives, disruptive and disjointed experiences, and the passage of time. From my undergraduate days at the University of Montana and the University of California, Berkeley, to doctoral study at the University of Oxford, I have tried to question what I think I know, accurately report what I learn, and refine my inquiries. Now, poised in the predawn of an entirely different set of life circumstances, I have cause to pause ix

Preface and reflect on this idiosyncratic collection of experiences. While reflection and reflexivity are complex topics that I will address in subsequent pages, here I would like to consider a more basic question: What do I hope to accomplish with this book? The following chapters are a collective account of my research in Singapore—in all its embodied, analytical, relational, and methodological ambiguity. They comprise a series of sometimes contradictory observations and musings, interspersed with theoretical or (loosely) interpretive commentary. It is an attempt to make sense of nearly two years of challenging, rewarding, and sometimes confounding experiences. It is an experimental trying-on of perspectives and concepts with which I have been able to identify, either prior to or as a direct result of these experiences. It presents an account of my exploration of Chinese medicine in, and of, everyday life in Singapore, particularly in relation to state agendas, individual and collective agency, embodied experience, and overseas Chinese heritage. It is therefore also a reflection of the kind of relationships I had with the people during my fieldwork, and of the difficulties that accurately representing such people and relationships pose in the act of writing up. In September 2015 I returned to Singapore for the first time since my fieldwork in 2006–2007 in order to participate in a workshop on the topic of governance and circulation of Asian medicines, coorganized by the Asia Research Institute (National University of Singapore) and Cermes3 (Paris). With some measure of trepidation I presented a much-abridged account of the research that informed this book, highlighting post-colonial identity politics and the regulation of Chinese medicine at the turn of the century. After the completion of our panel discussion, I was approached by an older Singaporean gentleman who had been in the audience for the majority of the workshop. To my delight, he shook my hand and thanked me for correctly narrating the story of his life (as he put it). It was the most personal—and perhaps one of the greatest—compliments I have received on my research. The most striking feature of this exchange—and the reason I decided to include it in this preface—was the tremendous sense of relief that his comment elicited, in stark contrast to the trepidation I had felt prior to presenting my research on Singapore to an unknown audience in Singapore. Lurking behind this concern was the suspicion that despite a year x

Preface



and a half of pre-fieldwork preparations, nearly two years of fieldwork, and even more time spent analyzing, writing, and rewriting, I had somehow gotten it wrong. As I will discuss in several of the following chapters, the mid twentieth-century crisis of representation in anthropology inspired an important, but sometimes paralyzing, caution with respect to ethnographic description and analysis. When we speak for “the Other,” even if we do not aspire to grand theories, we must nonetheless endeavor to say the right things, in the right way. Hence, I hope to present a sufficiently detailed account of my observations that once the theoretical frameworks and concepts I discuss have gone out of style, the ethnographic descriptions will still accurately evoke the space and time in which I worked and honor the people who generously shared their time and experiences with me.

xi

Acknowledgments

I would like to thank all the people who assisted, encouraged, and challenged me in the research and writing that resulted in this book. My life is graced with incredible moral and intellectual support, including a loving family—my mother, brother, and dad played strong (if silent) roles in this story—and a sturdy community of friends and colleagues. Without them, I would have no home and, thus, no foundation from which to work. First and foremost in the academic cast and crew is Professor Elisabeth Hsu—my gratitude for her patient, persistent, and detailed guidance continues even now, years after our last supervision. Prior to fieldwork I benefited from inclusion in the rigorous Chinese Studies Program at Oxford’s Institute for Chinese Studies, under the tutelage of Dr Tao Tao Liu. I am also grateful to Professor David Parkin, Dr Adam Chau, Dr Robert Parkin, Professor David Gellner, Dr Xiang Biao, Dr Frank Pieke, Dr Volker Scheid, Professor Marcus Banks, and Dr Claudia Merli for their extremely useful feedback on earlier drafts. Dr Merli’s erudite questions and comments, as well as the encouraging and critical comments of an anonymous reviewer, were particularly useful in the process of transforming earlier drafts into this book. While completing my fieldwork and initial post-fieldwork writing, I received grants from the Institute of Social and Cultural Anthropology (ISCA) and Green Templeton College at the University of Oxford (Lienhardt Grant, Writing-up Bursary, and Anthony Storr Bursary), and from Cambridge University (Evans Fund). I received excellent support from ISCA and Green Templeton College staff, and enjoyed affiliation at the Institute of South East Asian Studies in Singapore during my fieldwork. More recently, I was fortunate to receive the time and support necessary to write, reflect, discuss, and carry out preliminary postdoctoral research under the auspices of Cermes3 (a joint unit of Centre national de la recherché xii

Acknowledgments



scientifique (CNRS), École des Hautes Études en Sciences Sociales (EHESS), and Institut national de la santé et de la recherche médicale (Inserm) in Paris. The feedback and advice of Dr Jean-Paul Gaudillière and Dr Laurent Pordié, the academic gatherings they encouraged me to attend, and the discussions with other researchers on the GlobHealth-ERC project were inspiring and insightful. As anthropologists, we rely on the goodwill and contributions of other people to conduct our research—a debt that can never be fully repaid by simple acknowledgment. Nonetheless, I must say it was my humble privilege to work with several of Singapore’s most reputable Chinese medical physicians; this research would have been impossible without their generous provision of time, information, and guidance. I am also truly grateful for the wonderful conversations with friends and colleagues (Dr Lim Chee-Han, Jusman So, Kimberly Chew, Nisha Lee, and Ady Goh, to name a few), patients, shop managers, researchers, and many others along the way. Finally, I particularly wish to thank Mrs. Goh Foong Ying, whose kind introductions led to the heart of my research, and Wu Ziqi for his insights and continuing friendship. I sincerely hope this book speaks to your experiences.

xiii

Abbreviations and Acronyms

ASEAN CAM CMIO CPF CPM GP HDB HPB HSA MOH MRT NEA PAP PRC SCPA SCTCM T/CAM TCM TCMPB WHO

Association of Southeast Asian Nations complementary and alternative medicine Chinese, Malay, Indian, or other Central Provident Fund Chinese Proprietary Medicine general (biomedical) practitioner Housing Development Board Health Promotions Board Health Sciences Authority Ministry of Health Mass Rapid Transit National Environmental Agency People’s Action Party People’s Republic of China Singapore Chinese Physicians Association Singapore College of TCM traditional/complementary and alternative medicine Traditional Chinese Medicine Traditional Chinese Medicine Practitioners Board World Health Organization

xiv

xv m a

Borneo

Kalimantan (INDONESIA)

tr Java

INDONESIA

SINGAPORE

EAST TIMOR

Sabah (MALAYSIA)

PHILIPPINES

Manila

Taiwan

R i a u I s l a n d s BRUNEI Kuala Lumpur (INDONESIA) Sarawak (MALAYSIA) Malacca

MALAYSIA

South China Sea

Hainan

Hong Kong

a in Ch n er Fujian h ut So Guangdong

Hunan

VIETNAM

CAMBODIA

u a

Map of Southeast Asia (with the addition of southern China provinces mentioned in the book). Map courtesy of Free Vector Maps (http://freevectormaps.com), modified by Wendy Smith.

Indian Ocean

LAOS THAILAND

Penang

Strait of Malacca

Yangon (Rangoon)

MYANMAR

S

xvi

r

S

tr

a

Strait of Malacca

o

Jurong West

Nanyang Technological University Jurong East

Yishun

Haw Par Villa

Sentosa

Outram/ Chinatown Thong Chai Yiyuan Labrador Nature Reserve

Central Area

Kallang

Hougang

Sengkang

Batam, INDONESIA

Changi

Chek Jawa Wetlands

Pulau Ubin

Singapore Strait

Geylang Dazhong Yiyuan

Toa Payoh Chung Hwa Yiyuan/ S’pore College of TCM

MacRitchie Reservoir Park

Clementi Holland Village Buona Vista

Bukit Timah Nature Reserve

Central Catchment Nature Reserve

Woodlands

Map of Singapore (featuring place names mentioned in the book). Map courtesy of Free Vector Maps (http://freevectormaps.com), modified by Wendy Smith.

J

o

h

it

SINGAPORE

Sungei Buloh Wetland Reserve

Johor Bahru, MALAYSIA

Joh or R iver

Introduction

Mercurial Assemblages and Analytical Bricolage

Power is everywhere; not because it embraces everything, but because it comes from everywhere. … Power is not an institution, and not a structure; neither is it a certain strength we are endowed with; it is the name that one attributes to a complex strategical situation in a particular society. —Michel Foucault, The History of Sexuality

Southeast Asia is a region with a tumultuous history and an impressive diversity of religions, languages, and cultural practices. Within the region, Singapore is one of the most densely populated cities (7, 615 people per square kilometer and a total population of 5.47 million as of 2014), as well as the only nation-state with an ethnic Chinese majority (76.2 percent).1 In the three decades after separation from Malaysia in 1965, Singapore’s gross domestic product skyrocketed, transforming the country “from third world to first,” as founding father and first prime minister Lee Kuan Yew often remarked.2 This rapid transformation was facilitated by the deliberate and transparent engineering of the environment, the society, and the economy that established Singapore’s international reputation for austere governance. For these and other reasons, Singapore seems to stand apart from its neighbors, even amidst such regional diversity: it is the supposedly sterile metropolis (called the Switzerland of the East) and so-called economic miracle of Southeast Asia. “Singapore is very clean and safe.” “Singapore is a high-tech, Westernized city.” “Singapore is ‘Asia for beginners’.” “Singapore is a ‘fine’ city.”3 Over the course of the research and writing that informs this book, I heard many such generalizations, assessments, and jokes. 1

Capturing Quicksilver Although these expressions oversimplify an incredibly complex and dynamic environment, perhaps there is a kernel of truth in each. In my experience, Singapore’s visual cues often evoked European and American cities: towering concrete, steel, and glass buildings with climate-controlled interiors and maintained exteriors; tidy sidewalks and bus stops, traffic congestion, and a busy metro system; manicured parks and gardens, trimmed trees, and potted plants; people in suits and skirts bustling through the Central Business District; retired men playing cards over lager and women chatting over tea; giddy teens sporting the newest clothing fads, hairstyles, and technologies; and children in school uniforms laughing and running about in playgrounds and schoolyards. On the other hand, as the Singapore Tourism Board’s 2004–10 campaign asserted, there are many aspects of life in this tropical island city-state that are uniquely Singapore.4 Aside from this tourism-oriented branding, the government has embraced the labeling of Singapore as the Biopolis of Asia in foreign scholarship and media (Clancey 2012), encouraging their reputation for the most “advanced” biomedical facilities and research in the region. The Economic Development Board (the state agency responsible for economic planning) describes Singapore’s biopharmaceutical industry as “Asia’s fastest-growing bio-cluster.” As of 2017 the board’s website boasts seven biomedical research institutes, five research consortia, more than fifty research and development companies, numerous investigational medicine units, clinical trials in public hospitals and specialty centers, and the joint government-corporate Agency for Science, Technology, and Research.5 Singapore’s Biopolis is not only the name of a technology park in which public and private interests are brought together to produce marketable products, but it also describes a singular, technotopian vision for the bio-economic development of Singapore and its perfectible body politic (Waldby 2009). At the nexus of (cautious) scientific entrepreneurialism and post–severe acute respiratory syndrome (SARS) biosecurity concerns, the Biopolis ecosystem strategically positions Singapore as a global hub for cosmopolitan science and medicine with a supposedly Asian orientation (Ong 2016). This heavily subsidized “bio-cluster” is marketed to attract international investors, transnational biopharmaceutical companies, highly qualified scientists, and biomedical professionals (both expatriate and local), and to project the image of a “modern,” high-tech nation-state. 2

Introduction



Meanwhile, subsidized healthcare services and screenings are provided for the general populace at more than 1,500 private clinics and eighteen government polyclinics, eight public hospitals (six of which are acute general hospitals), and six national specialty centers. In the 1980s and 1990s Singapore’s acute hospitals and specialty centers were privatized—restructured as so-called private entities that were wholly owned by the government—while so-called public hospitals continue to be managed as not-for-profit organizations. In the 2010 National Health Survey, the Singapore Ministry of Health (MOH) reported that 74.6 percent of Singaporeans consulted private general or family practitioners, while 25.4 percent visited government polyclinics or military medical centers. Meanwhile, among Singaporeans aged forty to sixty-nine without prior medical diagnoses, 63.5 percent participated in diabetes screening, 61.2 percent had their cholesterol checked, and 70.8 percent were screened for hypertension, suggesting remarkable compliance with public health campaigns administered through the MOH and Health Promotions Board (HPB). Finally, 61.7 percent of Singaporeans aged eighteen to sixty-nine described their overall health as “very good” or “good,” 36 percent regarded their health to be “moderate,” and 2.3 percent reported it was “bad” (MOH 2010: 72–82). Along with declining rates of hypertension, high blood cholesterol, and behavioral risk factors like smoking and lack of exercise—and despite rising rates of obesity and diabetes—these statistics are used to highlight the successes (and potential areas for improvement) in Singapore’s biomedical healthcare system. Disregarding the widespread use of so-called alternative medicines and the creation of a statutory board under the auspices of the MOH to regulate the practice of Chinese medicine in 2001, these investments and figures have explicitly excluded what they refer to as traditional medicine.6 Nonetheless, Singaporeans persist in using and practicing Chinese medicine. As Loh Chee Hong (2009) notes, a 2001 survey found that 67 percent of Singaporean respondents received Chinese medical care, while Loh’s own study found that 84.3 percent of parents surveyed administered Chinese medical herbs to their children and 43.7 percent took them to receive acupuncture. Furthermore, since 2004 Singaporean hospitals have increasingly offered herbal and acupuncture therapies—albeit in separate wards—suggesting a gradual acknowledgment (of a sort) of 3

Capturing Quicksilver the role of Chinese medicine by both the state and biomedical institutions. This small, island nation-state off the tip of the Malaysian peninsula thus provides a fascinating opportunity to examine power, knowledge, and practice as negotiated with reference to the dynamic position, practice, and use of Chinese medicine and food. Beginning with the observation that Chinese medical materials, practices, and processes are assembled in different ways within various sociopolitical conditions, this book will describe the plasticity and positioning of one such mercurial assemblage.7 More precisely, I will examine the emerging practice, promotion, and use of Chinese food and medicine in Singapore in relation to post-colonial power dynamics, identity politics, sensorial experiences, and creative negotiations of convention. This research is theoretically and methodologically informed by critical medical anthropology, and includes a range of perspectives, including those of patients, caregivers, physicians, educators, legislators, shop owners, researchers, entrepreneurs, and students. This broad scope explores individual and collective agency vis-à-vis state agendas, and considers contemporary medical practice in relation to government policies favoring international investment, urban redevelopment, healthcare regulation, transnational flows and circulations, “multiracial” nationalism, and the management of history and heritage. This multifaceted orientation situates patients’ and physicians’ practices within a dramatically changing physical and sociopolitical landscape, with particular attention to the political economy of health and the mutual entanglement of (medical) theory and practice with everyday life. In order to ground theory, observed practice, and embodied experience in a particular place and time, my analysis includes politicolegal representations, restrictions, and campaigns; day-to-day clinic operations; patients’ bodily experiences; changes in the lived environment; and Chinese food and medical practices outside the clinic. This book therefore contributes to anthropological debates regarding the post-colonial intersection of knowledge, identity, and governmentality, and to transnational studies of Chinese medicine as a permeable, hybrid, and/or fluid practice. In the following chapters I will argue that, contrary to modernist discourses, Chinese medicine in Singapore is not a static and bounded practice that can be neatly captured within either a traditional or a complementary and alternative medicine (CAM) framework. Rather, 4

Introduction



it can be viewed in light of contemporary reformulations of identity and intersubjective expressions of heritage that are formed somewhat in tension with the “multiracial,” nationalist narrative of the Singaporean state. In repositioning their practices, Chinese medical physicians creatively negotiate Singaporean governmentality and biopower, along with the experiential body of knowledge, epistemology, and cultural authority associated with Chinese medicine. Furthermore, Chinese medical patients in Singapore assess Chinese food and medicine by means of embodied experiences within a dynamic lived environment, developing multifaceted healthcare strategies that cannot be reduced to rational choices. Again, these strategies are crafted with respect—but not absolute adherence—to state and public health discourses, often reflecting a pragmatic utilization of both biomedicine and Chinese medicine. They are also adjusted to environmental, seasonal, and dietary fluctuations, as well as to familial and social relations. Hence, pluralism and synthesis, fluidity, and complex power relationships appear to characterize both the post-colonial sociopolitical milieu of Singapore, and the use or practice of Chinese medicine therein. In this introduction I will suggest a framework of analysis that can attend to these (often competing) representations and interests. After a description of my research methods and field sites, and of some of the people who shared their time and expertise with me, I will introduce several disciplinary trends and concepts to which this book contributes. In particular, postcolonial/postmodern critiques of the grand narratives of modernity—as well as medical anthropology debates regarding medical pluralism and medical systems—have shed considerable light on the dynamic (re)positioning of Chinese medicine in contemporary Singapore. These discussions will provide the disciplinary and theoretical context in which my research and writing was conducted—a kind of wide-angled view in which I situate the more-specific focus on Chinese medicine presented in chapter 1. Finally, I will conclude this introduction with an overview of the book as a whole.

Methods, Settings, and Key Interlocutors In the course of twenty-two months of fieldwork—between January 2006 and October 2007—I investigated a wide range of processes 5

Capturing Quicksilver and experiences relating to the emergent position, use, and practice of Chinese medicine in Singapore. I conducted observations, interviews, and site visits at locations all over the main island, the adjacent resort island of Sentosa and, on one occasion, the nearby Indonesian island of Batam. To gain perspective and respite from the dense metropolis I also traveled within the region whenever practical, scheduling multiple visits to Thailand and Indonesia, a daytrip to Johor Bahru, Malaysia, and an excursion to Cambodia.8 The vast majority of my ethnographic data, however, was collected in clinics, shops, eateries, and neighborhoods on Singapore’s main island. In order to properly set the scene for the discussions that follow, I will introduce a few of the key people with whom I interacted, and the primary places in which I observed. This will illustrate the breadth of my research activities and sketch the field in which I observed various interests (by no means exhaustively presented here) competing to define and control Chinese medicine in Singapore. After a little over a year of Mandarin Chinese (Putonghua) instruction and study at the University of Oxford, I was able to follow some of the conversations held in Chinese medical clinics in Singapore.9 Many consultations were conducted in southern Chinese dialects such as Cantonese, Hokkien, or Hakka (or, rarely, in Malay) owing to the fact that the majority of Singaporean Chinese families emigrated from southern China, rather than from the predominantly Mandarin-speaking north, during the colonial or post-colonial eras.10 Hence, older Singaporean Chinese often spoke a southern Chinese dialect more fluently than Mandarin, and even the younger Singaporean Chinese I met often grew up hearing and/ or speaking Chinese dialects at home. Furthermore, although Malay is the official national language of Singapore (a reflection of colonial and immediately post-colonial political unity with Malaysia), at the time of my fieldwork English was the language of education, commerce, and law. Even older Singaporean Chinese educated solely in Chinese (bilingual education was introduced in 1956) were usually able to speak some English, and most people with whom I spoke were more or less fluent in the language known as Singlish. At the time of my fieldwork, Singlish was a lingua franca used by people of different nationalities, ethnicities, or dialect groups in Singapore.11 This relatively straightforward translation of Chinese into English often retained Chinese grammar or word order, while 6

Introduction



incorporating words and phrases from Malay, Mandarin, Hokkien, or other Chinese dialects as suited the speaker. For example, “What should we eat for dinner tonight,” was simplified in Singlish’s economical phrasing as, “Tonight eat what, ah?” Or, “Oh man! This movie is incredibly boring,” became, “Wah lau, this movie damn sian,” using the Hokkien adjective sian to convey boredom, weariness, or emptiness.12 To this American English speaker’s ear, Singlish was markedly different from the more formal English spoken in board rooms, schools, and political speeches. According to many Singaporeans with whom I spoke, Singlish was exemplified by taxi drivers and, in the case of Singaporean Chinese, was discouraged by the state in favor of what they considered proper English or Mandarin. For instance, the “Speak Good English” campaign was launched by Prime Minister Goh Chok Tong in 2000, similar to the “Speak Mandarin” campaign initiated by Prime Minister Lee Kuan Yew in 1979 to promote the use of Mandarin, rather than dialects, in the home.13 While both campaigns have no doubt enjoyed some success, during my fieldwork Singlish was still prevalent. While younger generations of Singaporean Chinese were often fluent in Mandarin (due to compulsory education in their state-ascribed mother tongue), dialects were still widely used. Because it was often immediately (and correctly) assumed that I spoke English, the vast majority of people with whom I interacted insisted on speaking English or Singlish with me, even if I initiated a conversation in Mandarin.14 In the nearly two years that I lived in Singapore I had the opportunity and privilege to speak with people operating in a wide range of capacities and contexts.15 Seeking insight into the intersections of regulatory activity, business and public health, I was fortunate to conduct a semistructured interview with the registrar of the Traditional Chinese Medicine Practitioners Board (TCMPB) and an informal discussion with an HPB dietician. I conducted five months of observations and informal interviews at the Toa Payoh branch of a popular Chinese medicinal herb and food shop called Hock Hua (or Fu Hua, in Mandarin), and was given tours of Chinese food and medicine factories and research facilities (Hock Hua, MediPearl, and Auric). These observations, augmented with informal discussions with Hock Hua’s branch manager, were supplemented by several lengthy interviews with Dr Song, a Chinese medical physician with 7

Capturing Quicksilver

Figure 0.1. Popular Chinese food and medicine shop, Hock Hua (Fu Hua) in Toa Payoh

a private practice who also consulted for Hock Hua. I also attended numerous public health events and lectures on topics as diverse as weight loss, Ayurvedic health and beauty products, the benefits of dongchong xiacao (cordyceps, Cordyceps sinensis), chronic pain management, arthritis, asthma, and many others to get a sense of the sources and content of health-related information disseminated to the public. To this end, I also paid particular attention to public health campaigns and commercial advertisements relating to health and the body (including ever-changing beauty product trends) that were posted in public spaces, distributed through the mail, and promulgated in the mass media. 8

Introduction



Figure 0.2. Phytopharmaceutical research and development at MediPearl

I also investigated a range of academic and institutional perspectives on Chinese medical practice and products in Singapore. I arranged three interviews with Chinese medical students at the Singapore College of Traditional Chinese Medicine (SCTCM): a stand-alone discussion with one student, followed by two lengthy discussions with another pair of students, one of whom I later observed volunteering at a medical mission in Batam, Indonesia. These interviews were complemented by observations and interviews with Professor Tan Chwee Heng, who lectured and demonstrated acupuncture techniques to SCTCM students and recent graduates at Chung Hwa Yiyuan, the charity clinic on the first two 9

Capturing Quicksilver floors of the building occupied by SCTCM in Toa Payoh. Hoping to broaden my perspective on academic approaches to Chinese medicine in Singapore, I interviewed Professor K. C. Lun who, at the time, served as vice dean (academic) of Nanyang Technological University’s School of Biological Sciences. After discussing Nanyang Technological University’s new double-degree program for biomedical and Chinese medical sciences in some detail I attended one of their student recruiting events on Professor Lun’s invitation. Finally, I arranged semistructured interviews with an environmental and occupational health researcher at the National University of Singapore who was working on cruciferous vegetables and herbs from the Chinese materia medica, and with a researcher and entrepreneur working on the popular Chinese fungus lingzhi (Ganoderma lucidum, also commonly referred to as Reishi mushroom). In addition to amassing field notes on everyday life in public places—hawker centers (public eateries), coffee shops, housing estates, public transit hubs, on board various modes of transportation (e.g., buses, taxis, and Mass Rapid Transit [MRT] trains), public health lectures, and exhibitions and so on—I conducted observations at three well-established Chinese medical charity clinics: Thong Chai Medical Institute in Outram (hereafter referred to as Thong Chai), Chung Hwa Yiyuan in Toa Payoh (hereafter, Chung Hwa), and Dazhong Yiyuan in Geylang (hereafter, Dazhong). I was also able to observe one of the physicians who volunteered at Chung Hwa practicing at his private clinic in Chinatown. These observations were supplemented by numerous discussions with the physicians with whom I worked, as well as interviews with two clinic administrators and a senior board member at Thong Chai. In order to understand institutional and clinical procedures I spent time in group consultation rooms under the auspices of one or more physicians and in waiting rooms as both an observer and, on occasion, as a patient. It was in the latter role that I felt most able to employ the anthropological method of participant observation. While I sat in multiple patient consulting rooms with my notebook and pens—a rather conspicuous fly on the wall—the slightest sniffle or appearance of ill health was usually noted by the attending physician. More frequently than not, they would insist on a diagnosis and treatment on the spot, requiring me to draw my observations inward and participate in the clinical reality I might have otherwise simply observed. 10

Introduction



These participant observation sessions, alongside numerous interviews with physicians and patients (and sometimes their families and friends), constituted the core of my fieldwork. I interviewed, observed, and conversed with Chinese medicine patients of many ages both inside and outside the clinics mentioned above, eighteen of whom agreed to lengthy (one and a half- to three-hour) semistructured interviews. I conducted the majority of these interviews in public places like cafes, hawker centers, or other air-conditioned environments; a few took place in interlocutors’ homes. Because I met many of these people in clinics where I observed regularly, I was able to conduct formal or informal follow-ups in most cases. With five respondents, I was able to schedule an additional semistructured interview (or, if I was particularly lucky, more) for further in-depth discussion. Naturally, these formal interviews were dispersed through nearly two years of everyday observations, interactions, and discussions with friends, colleagues, neighbors, and strangers. I became fairly well acquainted with two families in particular, interviewing and/or spending time with family members of multiple generations in each. First, a colleague and friend from the University of Oxford (an undergraduate at the time) who was also interested in Chinese medicine kindly introduced me to many of his family members. Often with the assistance of his mother (who generously facilitated meetings with Chinese medical professionals as well), he arranged for interviews with his grandfather and aunt, spent hours discussing Chinese medicine and heritage, arranged and/or attended various engagements, and answered seemingly endless questions about life and work in Singapore. I became acquainted with the second family when initially looking for housing because the head of the family, Tom, and his partner Adelle were housing agents. After spending quite some time at their multigenerational apartment and accompanying them on various family outings, I also came to know Tom’s two young children (a boy and an adopted Indonesian girl), mother, and several siblings, as well as their Indonesian maid, whom they considered a family member. Although Tom’s mother was the only family member I officially interviewed (Tom’s sister translated, as their mother only spoke Teochew), Adelle’s unsolicited updates, invitations to accompany her to shops and clinics, and kitchen demonstrations and discussions provided a rich example of healthcare management in a middle-class Singaporean Chinese family. 11

Capturing Quicksilver Most prominently, I was fortunate to conduct long-term participant observation with several full-time, highly esteemed Chinese medical physicians. I say “fortunate” not only out of gratitude for their generosity with time, information, and introductions, but also because at the time of my fieldwork there were relatively few well-established, full-time, registered Chinese medical physicians in Singapore. The first was Dr Li, a first-generation Singaporean Chinese woman who practiced general medicine and specialized in hypertension and diabetes at Thong Chai, while also maintaining a private practice. I observed her work with hypertension and diabetes patients in the morning and general practice in the afternoon (with ten to twenty patients per shift at Thong Chai), once per week for two and a half months.16 These observations were supplemented by several interviews with her and other physicians at the clinic, in addition to the aforementioned administrative interviews. The second physician with whom I worked was Professor Tan Chwee Heng, a lecturer, demonstrator, and senior Chinese physician at SCTCM/Chung Hwa who also maintained a private practice and taught and practiced qigong (a self-cultivation practice involving meditative movement and breathing).17 I interviewed him at his private clinic on several occasions, conducted observations and patient interviews during his Chung Hwa shifts for a little over five months, and then followed him to Dazhong in Geylang for a further eight months. These observations were (on average) once a week for two and a half hours, during which time he would typically see twenty to twenty-five patients. Outgoing and charismatic, Professor Tan was a reputable lecturer and physician, whose unwavering conviction in his innovative practices set him apart at SCTCM/Chung Hwa. He took great pride in his single-needle acupuncture technique, which he developed in pursuit of a master’s degree in China. Another senior physician at Chung Hwa with whom I worked was Dr Wang—a Taiwanese businessman who had come to Singapore to import and export cane, and then decided to study Chinese medicine at SCTCM. In addition to countless hours of discussion, Dr Wang kindly permitted me to observe and speak with patients in the afternoons at his private clinic in Chinatown twice a month for five months, to accompany and observe him on a medical mission to Batam, Indonesia, and to observe at Chung Hwa, where he volunteered once a week. On average, I worked with him two to three 12

Introduction



times a month for six months; in the two and a half hours he volunteered, he typically saw between twenty and twenty-five patients. Finally, as mentioned above, I also had several opportunities to speak with Dr Song—a Chinese medical physician who worked with the Chinese food and medicine chain Hock Hua. With degrees in both Chinese medicine and business, and a background in medical marketing, Dr Song consulted for Hock Hua on the import, processing, packaging, sale, and export of Chinese medicinal products. He also maintained a private practice and occasionally gave public lectures or media interviews on topics related to Chinese food and medicine. In his capacity as a physician, he negotiated the evolving regulation of clinical practice; as a consultant for Hock Hua, he also followed developments in manufacturing and import practice. Both tasks required a nuanced understanding of the changing social and political position of Chinese medicine in not only Singapore, but also Southeast and East Asia, Europe, and North America. The socio-intellectual matrix in which my research and writing developed—constituted largely by formal anthropological training at the University of Montana, the University of California, Berkeley, and the University of Oxford—provided both methodological and analytical guidance for the research that informs this book. Having already described my fieldwork methods and activities, I will now outline several of the core disciplinary trends and tools that prepared me for this fieldwork, and then influenced my orientation to its analysis.

“Modern” Ventures and Postmodern Adventures As described by Adam Kuper (1996), Katy Gardner and David Lewis (1996), Peter Pels (1997), and others, many mid twentieth-century anthropologists reflected on our discipline’s establishment in the colonial era and the ways in which this context biased representations of the Other. In the 1920s and 1930s anthropologists had been called on to help in the economic and administrative development of the colonies. After World War II, the increasing emphasis on welfare, the “civilizing mission,” and development in the colonies produced further opportunities for anthropological research (particularly in Africa), even as the colonial era was coming to a close (Kuper 1996: 99–103). However, in the post-colonial era (and 13

Capturing Quicksilver through postcolonial theory in particular), debates about the relevance and nature of anthropological knowledge challenged previous anthropologists’ claims to scientific objectivity, by evaluating the socioeconomic and political conditions in which their ethnographies were produced.18 While I will return to this theme in the conclusion of this book, in this section I will discuss how it relates to the postmodern/poststructuralist challenge of naturalized categories and concepts like modernity. I will then explore how this critical stance was adopted in medical anthropology and investigations of the political economy of health (albeit not always under the banner of postmodernism). These significant intellectual and social transformations inspired many of my research questions and provided various lenses through which I analyzed my data; they played a significant role in how I chose to interact with the people and institutions with whom I worked. They were also integral to the frequent reflexive consideration (and sometimes suspension) of my own epistemological, sociopolitical, and cultural biases as I engaged both the familiar and the strange in post-colonial Singapore. While early anthropological studies reinforced the idea that colonialism was an inevitable, evolutionary process of “civilization” (or, later, “modernization”), subsequent studies critiqued colonial domination and exploitation. The authoritative manner in which anthropologists generalized and catalogued the people with whom they worked was shown by critics like Talal Asad (1973) and Edward Said (1979) to distort the cultures and practices in question, while revealing broader power dynamics between subject (in this case, the anthropologist) and object (the people they objectified). Thus, in the mid- to late twentieth-century anthropologists began to reflexively consider the objectifying relations inherent in anthropological observations, and critiqued previous representations that depicted culture and practice in terms of static, reified, and discrete categories (Bourdieu [1980] 1990; Gardner and Lewis 1996; Schechner 2002). Early, ahistorical anthropological analyses—and the reification of culture therein (the depiction of immaterial phenomena and relations as static, material things)—often reinforced a hierarchical, taxonomic arrangement of societies. This supposedly natural arrangement, which placed Western European (and, later, North 14

Introduction



American) societies at the pinnacle of social evolution, justified ethnocentrism, imperialist expansion, racism, and early development discourses—ethnocentric and frequently exploitative practices widely criticized by the end of the colonial era. By contrast, later anthropologists (sometimes labeled postmodern or poststructuralist) critiqued grand narratives that sought to explain the world through an all-encompassing and Eurocentric paradigm (e.g., unilinear social evolution, modernity, Enlightenment, and so on), rather than attending to local experience and accounts of reality. In lieu of these master narratives—founded on naturalized and supposedly absolute Truth—postmodern theorists emphasized the plurality and relativity, as expressed through a multiplicity of voices. According to Jürgen Habermas, The project of modernity, formulated in the eighteenth century by the Enlightenment philosophes, consists of a relentless development of the objectivating sciences, the universalistic bases of morality and law, and autonomous art in accordance with their internal logic. … Proponents of the Enlightenment … still held the extravagant expectation that the arts and sciences would further not only the control of the forces of nature but also the understanding of self and world, moral progress, justice in social institutions, and even human happiness. (Habermas 1992: 162–63)

In a similar vein, Steven Best and Douglas Kellner (2001) compare the values of modernity and postmodernity. The former was predicated on sociocultural and political domination, the notion of limitless growth and resources, and mastery of nature. Meanwhile, the latter proposed reverence for nature and all life, sustainability, and ecological balance while retaining modernity’s emphasis on humanism, individuality, reason, rights, and so on. Postmodernism, then, could be understood (in the simplest of terms) as a broad cultural and intellectual rejection of the post-Enlightenment discourse of modernity. Such critique, however, is not the goal of theorists like Best and Kellner, who stress the need for sustained “critical reflection on the pathologies and illusions of the modern adventure and their continuation in the present” (Best and Kellner 2001: 11).19 During the last quarter of the twentieth century, postmodern and postcolonial critiques and deconstructions gained momentum in anthropology in general, and medical anthropology in particular. For instance, anthropologists illustrated the sociohistorical contingency of 15

Capturing Quicksilver naturalized concepts such as illness, sickness, and disease (Kleinman, Eisenberg, and Good 2006; Young 1982); knowledge and belief (Good 1994); race (Bibeau and Pedersen 2002); a singular, universal human body (Lock and Nguyen 2010; Scheper-Hughes and Lock 1987); and medicine defined as an activity isolated from other aspects of life and with exclusive reference to biomedicine. As I will describe later in this introduction, medical anthropologists also began to question the utility of the concept of medical pluralism, particularly where heterogeneous medical practices were arranged so that so-called modern biomedicine retained its air of superiority. Even when they used terms like “medical systems” and “medical pluralism,” scholars like Charles Leslie (1976, 1992) challenged the reification of traditional medicine and the false dichotomy between tradition and modernity on which it was based. Similarly, historical and anthropological studies called into question the “traditional” designation in the twentiethand twenty-first-century reinvention of classical Chinese medicine as “Traditional Chinese Medicine” (TCM).20 In contrast to their anthropological predecessors (who produced synchronic analyses theoretically classified as functionalist, structuralist, or structural-functionalist), postcolonial medical anthropologists increasingly viewed health, illness, healing, and embodied experience as embedded, or emerging, within particular political and economic conditions21. Early clinical (or applied) medical anthropology analyses often neglected sociohistorical context, focusing narrowly on the so-called problem of patient compliance and indigenous communities’ resistance to biomedical interventions. Such studies were later interpreted as cultural translation projects that unreflexively served to disseminate and reinforce biomedical goals and standards at the expense of local practices. As a more politicized, decolonized anthropology developed, critical medical anthropologists began to acknowledge material and social determinants of health and illness, as well as the importance of political and economic context in their analyses. In the spirit of critical theory and reflexivity, many critical medical anthropologists turned the anthropological gaze toward the “once-sacrosanct terrain of biomedicine” (Morsy 1996: 32), and interpreted embodied experiences and health-related practices within a framework of power dynamics. Nancy Scheper-Hughes’s (1992) study of mothering, hunger, illness, and child mortality in Northeast Brazil provides an example of 16

Introduction



this conceptual framework. Broadly speaking, Scheper-Hughes considers individual and collective experiences of the body “as socially represented in various symbolic and metaphorical idioms, and as subject to regulation, discipline, and control by larger political and economic processes” (Scheper-Hughes 1992: 175). This perspective integrates the three bodies heuristic she developed with Margaret Lock (Scheper-Hughes and Lock 1987): the individual body experiencing the world, the social body symbolizing nature and culture (following Douglas [1970]), and the body politic inscribed with power relations. Although I will focus on the body politic perhaps more heavily, this book will illustrate how all three analytical perspectives—and even a fourth, body ecologic, proposed by Elisabeth Hsu (1999, 2007)—can be intertwined in the observation of practice.22 Other powerful examples of the entwinement of political economy and suffering can be found in physician-scholar Paul Farmer’s research, writing, and medical practice in Haiti and the United States. Farmer explains how the uneven distribution and outcome of infectious diseases (1999), as well as experiences of suffering and structural violence (2003), are embedded within larger social, political, and economic dynamics. According to Farmer, the underlying conditions that perpetuate structural violence—extreme and relative poverty, social inequality, regular acts of violence, and so on—prevent people from satisfying basic human needs (e.g., food and water). Because structural inequalities and human rights violations are not haphazard or accidental, Farmer considers them to be “symptoms of deeper pathologies of power” (Farmer 2003: 7). Hence, he asserts, the experiences of everyday people are intimately connected with national and transnational processes (e.g., social inequality and political economy) and discourses (e.g., human rights and social justice). Similarly, numerous scholars have presented examples of the historical and contemporary entwinement of medical practices and political economy in Southeast Asia. For instance, Lenore Manderson (1990) describes inequalities in the distribution of medical resources, and the production of ill-health, in British Malaya (present day Singapore and Malaysia). Adopting an intentionally neutral stance on the impact of colonialism, Ing-Britt Trankell and Jan Ovesen’s (2004) account of French colonial medicine in Cambodia mediates between accounts that glorify the achievements 17

Capturing Quicksilver of European doctors in the colonies and those that critique colonial medicine as a tool of empire. Ayo Wahlberg (2006) explains how the revival and strategic modernization of herbal medicine in Vietnam integrated it within the national public health delivery system—a biopoliticization that promoted public health and encouraged medical self-sufficiency in rural areas. Davisakd Puaksom (2007) describes how the Thai state used Pasteurian medicine and the notion of germs as a hegemonic instrument of national development. Finally, Claudia Merli (2010) interprets sunat muu—an annual, collective male circumcision ritual—as “a conquest of the state and biomedical power” (Merli 2010: 735) that is, in turn, appropriated by some local Malay-Muslim men in southern Thailand in asserting their identity vis-à-vis the Thai Buddhist nation-state. These examples further illustrate how issues of power, political economy, and sociohistorical context have come to the fore in anthropological analyses of health, illness, and healing. Whatever we choose to call this artistic, social, and intellectual zeitgeist, post-colonial anthropology seems to be confronting a growing number of contradictions, competitive claims, and reformulations of theory and practice. As I will explore more fully in chapter 1, biomedical values and standards of evidence are frequently used in assessing Chinese medicine in Singapore and elsewhere, with little regard for the epistemological and ontological differences between the two medical practices. On one hand, such evaluations often marginalize or devalue Chinese medical drugs and other therapies. On the other hand, these values and standards are sometimes appropriated by Chinese medical physicians and entrepreneurs seeking to legitimize their practices and allay patient-consumer concerns about the safety and authenticity of their interventions. This is particularly apparent in integrated healthcare systems-cum-medical markets, where so-called traditional medicine is “modernized,” or otherwise refashioned, through industrialized production processes and standardized clinical practices. In consideration of these dynamics, I found inspiration—if not resolution—in a wide range of sometimes contradictory perspectives, perhaps in resonance with this ethos of ambiguity, negotiation, oscillation, and reinvention. This book will therefore draw on an assortment of complementary techniques and frameworks—including a critical, politico-economic orientation to medical anthropology, 18

Introduction



postmodern skepticism of naturalized Truth, and postcolonial critique of modernity. Like analytical bricolage, these disciplinary trends and concepts provide an eclectic but coherent framework on which my analysis of the competing interests and uneven distribution of medical authority in Singapore will accrete.

Assessing Medical Pluralism and Systems Despite the dubious distinction of being the only nonbiomedical practice under legislative scrutiny in Singapore, Chinese medicine continues to play a vital role in Singaporean daily healthcare strategies (both home based and clinical).23 Indeed, at the time of my fieldwork it was the only “traditional” medical practice to be included in the healthcare system at all, yet from a politico-economic standpoint, it might still be viewed as a marginalized practice.24 From the perspective of many members of the Chinese medical community, however, their ongoing efforts to reposition and professionalize their practice (discussed further in chapter 1) are dynamic negotiations rather than signs of a static and inherently subordinate position. Critical medical anthropologists have similarly highlighted the emergence of medical practices within dynamic sociohistorical, political, and economic processes, rather than judging them with reference to grand narratives, such as modernity, and exogenous standards and values. There have been a number of terms proposed to describe the relationship between coexisting medical practices: “synthesis,” “integration,” “hybridity,” “dominance,” “subjugation,” and “monism,” to name a few. Despite the nuances in perspective that differentiate these terms, each suggests an orientation to medical pluralism in general, and to the power dynamics of and between medical practices in particular. Medical anthropologists have especially noted uneven power distributions in colonial or post-colonial contexts, in which individuals often engage both indigenous practices and inherited practices such as biomedicine. Where indigenous medical practices have been disempowered by means of the same, or similar, dynamics that facilitated colonial exploitation of local people, biomedical monism (or hegemony) is considered to be prominent characteristic of medical pluralism. Where biomedicine is the dominant medical practice and so-called traditional practices are then subsequently 19

Capturing Quicksilver introduced, reinvented, or popularized, the latter is often referred to as “complementary and alternative medicine” (CAM) in popular and/or political discourse. In this section I will discuss anthropological debates regarding medical pluralism and medicine in everyday life in order to sketch an analytical framework for subsequent discussions of the contemporary status of Chinese medicine vis-à-vis biomedicine in Singapore. Charles Leslie’s work on Asian medical systems, and medical pluralism, has been particularly formative in the discipline of medical anthropology. Working around the theme of medical revivalism, Leslie’s (1976) edited volume, Asian Medical Systems: A Comparative Study, demonstrates variability in how medical pluralism is negotiated in a variety of settings. Rather than evaluating Asian medical practices from an epistemologically exterior point of view, Leslie advocates examining the underlying assumptions of cosmopolitan medicine (i.e., biomedicine) and the manner in which its privileged position subjugates other forms of medicine. Furthermore, he considers the term “modern medicine” to impose a false dichotomy of modernity and traditionalism onto cosmopolitan and Asian medicine respectively, and instead stresses that both are dynamic and open to innovation. Finally, Leslie stresses the exchanges and interplay between medical practices, highlighting the subtlety with which systems are interrelated.25 Similarly challenging the reification and analytical division of medical practices, Emiko Ohnuki-Tierney (1984) illustrates that medical practices do not remain neatly divided and isolated in medically plural societies but are instead mutually entrenched. Nor, she claims, do shifts in the dominant medical paradigm mean that prior concepts or practices are simply uprooted and replaced. Instead, she illustrates how Japanese health-related concepts and behaviors are consistent with historical cultural patterns but couched in biomedical terms. Similarly, Judith Farquhar (1987) observes that the notion of pluralistic medical systems is dependent on the division of reified practices, and that non-Euro-American scientific and philosophical discourses (e.g., Chinese medicine) are based on very different understandings of categories such as knowledge. Hence, she notes, the act of evaluating Chinese medicine set against biomedicine often entails an ethnocentric mode of description, based on naturalized constructions of subjects and epistemology in “Western” philosophy 20

Introduction



(see also Rabinow 1996). According to Elisabeth Hsu (2008), one of the strengths of medical pluralism appears to be its ability to challenge biomedical monism with viable alternatives. However, she notes, it has also been critiqued from a Marxist perspective for creating a false consciousness of choice that reifies capitalist values, and by subsequent deconstructions of the notion that biomedicine is monolithic to begin with. Meanwhile, Joseph Alter’s (2005) introduction to Asian Medicine and Globalization observes that practices and concepts sometimes restricted to the domain of medicine are also linked with other areas of life—from philosophy and religion, to sports and war. He claims that defining medicine exclusively in terms of the logic of healing inhibits a more inclusive, health-oriented framework by reducing broader issues of health, healing, and the body to biomedically defined questions of efficacy and legitimacy. Hence, Alter argues, the politics of culture in which the category of Asian medicine is constructed— bound within certain discourses and power dynamics—restrict the definition of what constitutes medicine to Euro-American scientific terms. This orientation is further illustrated by other contributors to the volume. For instance, Martha Ann Selby (2005) describes how the Euro-American wellness industry transformed notions of women’s health by repackaging and commodifying Ayurveda, which ultimately enabled them to sell abstract concepts such as purity, wellness, and so-called enlightenment. Similarly, Susan Brownell (2005) describes the impact of geopolitics on Chinese body perceptions and practices, manifest in the adoption of cosmetic surgery. Both authors demonstrate that the categorical boundary between medicine and beauty is, in reality, blurred by socioeconomic and political interests. The entanglement of socioeconomic and political interests with medical practices is also illustrated in Steve Ferzacca’s (2002) account of medical pluralism in post-colonial Indonesia and Soheir Morsy’s (1988) analysis of Islamic medicine in Egypt. Ferzacca illustrates how development ideology was used by the Indonesian government (during Suharto’s regime) to appropriate the concept of medical pluralism, which in turn served to control the population. He demonstrates how local and global power relations are intimately involved in the practice and perception of traditional medicine and discusses how the regulation and management of medicine served 21

Capturing Quicksilver development purposes, as well as ideologies of national identity and heritage. By contrast with developments in Indonesia (Ferzacca 2002), India (Alter 2005), or China (Taylor 2005)—where the revival of traditional medicine refashioned practice in accordance with political (and particularly nationalist) agendas—Egypt (like Singapore) developed a biomedical infrastructure that marginalized other medical practices. Morsy notes that while the Egyptian state subsequently moved to legitimize Islamic clinics, the state’s equipment, orientation to healthcare, practices, and political associations were based on a biomedical model. Thus, Morsy asserts, the growing number and power of Islamic clinics in Egypt reflects the dynamics of international biomedical hegemony, rather than a revival of traditional medicine. Other scholars have addressed the limitations of medical pluralism and the rationale for investing in what is described as traditional medicine by investigating the ways in which plural medical markets developed and are maintained in the first place. Craig Janes (2002), for instance, cites Cant and Sharma’s (2003) new medical pluralism—a reconceptualization of the concept in consideration of economics-driven global health policy. Assuming competition in a capitalist market fosters the structural (if not intellectual) decline of biomedical domination, Janes posits “a therapeutic pluralism structured along market, rather than cultural, or even political, lines” (Janes 2002: 285). Here, he explains, the definition of medicine and medical efficacy is conflated with efficacy in the market; measured in terms of cost, health care is moved into the private sector where higher prices reduce public access to care.26 Vineeta Sinha (1995) also critiques the concept of medical pluralism in Singapore, which she claims was appropriated as a political concession to “native” healing practices. This tacit acknowledgment established the coexistence of “discrete, bounded ‘systems’ of healing” through the circumscription of medical practices, the assumption of multiplicity, and the assertion of difference (Sinha 1995: 13). Sinha observes that not only do such constructions seem to privilege theoretical and textual sources above lay or informal healing strategies, but they also restrict the field of observation to formal medical practices and settings. By contrast, she explains, the “use of ordinary household, kitchen and garden articles for the everyday management of common medical ailments” (Sinha 1995: 22

Introduction



240) not only challenges the notion of expertise by exploring homemade wisdom,27 but also demonstrates that food and medicine are not necessarily mutually exclusive categories. The importance of home-based remedies and the conflation of the categories food and medicine—a challenge to a neatly circumscribed domain of medicine in addition to the tidy division of discrete systems in medically plural societies—is by no means unique to Singapore. For example, Hareya Fassil (2005) describes home-based medicinal plant use and lay traditional knowledge in Ethiopia, seeking to broaden discussion of Ethiopian traditional medicine beyond the formalized knowledge of professional practitioners. Alfred Maroyi (2012) explores the ethnomedical, dietary, and ornamental uses of garden plants—both indigenous and introduced—in Zimbabwe, suggesting that further botanical studies are necessary to protect the public from accidental plant poisoning. Furthermore, in the context of a traveling study abroad program for which I taught in 2014, representatives of the Hanoi Medical College in Vietnam described the Vietnamese healthcare system, the establishment of traditional Vietnamese medicine, and the government’s promotion of household medicinal gardens to our group of intrepid young explorers. In conjunction with broader initiatives to collect herbal materials and knowledge in rural Vietnam, we learned, both urban and rural Vietnamese communities have long been encouraged to grow particular plants for primary healthcare and dietary purposes.28 Sinha, Fassil, Maroyi, administrators at the Hanoi Medical College, and others have noted that traditional health practices— including lay or home-based remedies—hold great promise in the provision of affordable healthcare: Indeed, it appears that there is considerable traditional health knowledge in the public domain. The fact that traditional health knowledge is so pervasive, and the use of local medicinal plants so widespread, has staggering public health implications which simply cannot be ignored by those concerned with development and the promotion of public health and natural resources management (Fassil 2005: 47).

Accordingly, the preparation of home-based remedies and the observance of dietary proscriptions and prescriptions—practices that have been adjusted and adapted in form and composition over time—are essential to primary healthcare in many places, including Singapore. 23

Capturing Quicksilver Furthermore, food and medicine are interrelated concepts in Chinese medical theory and practice (both within and outside the People’s Republic of China [PRC]), and diet is a vital component of health as conceived by Singaporean patients, physicians, and public health officers alike. Hence, this book employs the broader definition of medicine suggested by Alter, Sinha, Fassil, and others. Beyond clinical interventions, I will consider home-based remedies, aspects of the natural and built environment, and social interaction and heritage in the larger processes of health maintenance and healing.

Context and Conclusions: An Outline With the increased attention to power relations in postcolonial anthropology, interaction between fluid practices—within and between societies—was often phrased in terms of competing interests, such as the tensions between biomedicine and traditional medicine (or CAM), or between formal and informal health sectors. While acknowledging how these boundaries might be produced or contested locally, many medical anthropologists have been careful to minimize the imposition of their own divisions of reality onto the practices and fields they observe. Hence, the implicit privileging of biomedical epistemology and practice that was present in early anthropological studies gradually gave way to critical consideration of how the power dynamics in medically plural societies encouraged this privileging to begin with. Despite the critiques of medical pluralism as an analytical concept, however, patients, medical professionals, and politicians around the world use and assess what they perceive to be distinct healthcare options. The manner in which these practices are assembled, disassembled, reassembled, evaluated, circumscribed, brought together, or differentiated in a given field of practice or social context therefore remains an important question. In Singapore’s tightly controlled sociopolitical and physical environment, the post-colonial state developed public health agendas and legitimized specific medical practices in accordance with a particular art of government (Foucault 1991). In addition to providing state-subsidized medical insurance and healthcare infrastructure, as well as enacting more recent legislation that finally drew Chinese medicine into its jurisdiction, the MOH has invested in public 24

Introduction



health education and surveillance campaigns. These efforts must be contextualized within a historical propensity to privilege the needs of economic development strategies over social welfare, to be discussed further in chapters 2 and 3. In particular, the post-colonial state took whatever measures were necessary to allay the fears of potential foreign investors, corporations, and talent. Thus, a tightly regimented and docile body politic was crafted to ensure a stable sociopolitical climate and labor pool that would be conducive to the dynamic economic visions of the state.29 Bearing this sociopolitical landscape in mind, this book will consider the meanings, junctures, and disjunctures associated with the supposed resurgence of Chinese medicine—an “icon of Chinese culture” in Singapore (Quah 2003: 1997). While this study was intentionally designed to examine the practice and use of Chinese medicine outside the PRC, it was also primarily oriented toward Singaporeans with ancestral or more-immediate familial ties to China. In the course of my fieldwork, the majority of people with whom I spoke asserted their Singaporean identity—more or less content with the lifestyle and opportunities provided in Singapore, they professed no desire to permanently return to China. Nonetheless, many Singaporean Chinese still maintained connections with their ancestral homeland and, through these connections or family traditions, preserved or reinvented elements of their Chinese heritage and identity. As Stella Quah notes, the use of Chinese medicine formed an essential part of how many Singaporean Chinese actively related to this “cultural inheritance” (Quah 2003: 2003). For many Singaporean Chinese patients and physicians, then, Chinese medicine was more traditional than the biomedical healthcare system with which they also engaged; at the same time, however, both biomedicine and Chinese medicine in Singapore were often depicted as “modern” or modernized. This stands in contrast with the government’s economic evaluation (or neoliberal valuation) of Chinese medicine as CAM. As I will describe in chapter 1, the dynamic position of Chinese medicine in medically plural Singapore was often negotiated with explicit reference to biomedical standards and political discourses of CAM. While a CAM-based framework aligns nicely with World Health Organization (WHO) categories and nationalist boundaries of medicine, I will argue, it cannot account for the way in which Chinese medical professionals 25

Capturing Quicksilver have professionalized, “upgraded,” and (re)invented their practice over space and time. Nor does it consider the complex relationship between the popularity of Chinese medicine and the contested cultural heritage of Singapore’s ethnic Chinese majority. Hence, I suggest we consider a broader sociohistorical and transnational context in which the contemporary assemblage of Chinese medicine in Singapore continues to emerge and transform. In chapter 2 I will outline a few key historical trajectories for this analysis, describing how Singaporean history and heritage were managed by the post-colonial state. In particular, I will argue that the political management of “race,” history, and national identity directly impacted practices associated with Chinese heritage, such as Chinese medicine. After a tumultuous history of migration and colonial identity politics, the Singaporean state sought to promote “racial harmony,” social and political consensus, and a productive population, using a logic of smallness that highlighted Singapore’s lack of natural resources, internal social divisiveness, and insecurity with respect to other nations. Through careful and overt social engineering, the state crafted a unified, yet ranked, “multiracial” national identity and an ex post facto desire for independence. While these nationalist efforts—based more or less on the European forms of political economy inherited from the British—were certainly successful, individuals, groups, and neighborhoods nonetheless generated a very different sense of community in their own ways. Hence, I conclude, collective or intersubjective expressions of heritage were still possible through annual or sporadic community events, and many Singaporeans continued to practice and/or use Chinese medicine, despite its political marginalization. In chapter 3 I will use Michel Foucault’s notions of governmentality (1991) and biopower ([1976] 1990) to analyze the development of Singapore’s healthcare system, the recent regulation of Chinese medicine, and the operation of Chinese medical institutions. Delving deeper into Singaporean biopower, I will describe how this technology of power is evident both in regulatory divisions and legislation (biopolitics) and in day-to-day, disciplined clinic operations (anatomo-politics). However, I will argue, not all physicians practiced Chinese medicine in the same way. Furthermore, we must account for practices that (even in institutional settings) appeal to forms of authority derived from other sources, as I will illustrate with 26

Introduction



reference to particular physicians’ practices and the notion of jingyan (experience). In addition to biopower, then, in this chapter I will describe key facets of the emergent (as opposed to static or exclusively historical) experiential archive that legitimizes and informs Chinese medical physicians in Singapore. Whereas chapters 2 and 3 focus on the historical, legislative, and conventional aspects of Chinese medical practice (as well as contravening practices), in chapters 4, 5, and 6 I situate Chinese medicine within everyday life by discussing patients’ sensorial experiences, embodied knowledge, the lived environment, lifestyle, and home-based remedies, as well as the conjunction of food and medicine. I will begin, in chapter 4, by illustrating how patients’ perception and use of Chinese medicine is closely tied to embodied experience. By exploring bodily and then verbal articulations I will illustrate patients’ (and caregivers’) active engagement in the clinical encounter, demonstrating how their healthcare strategies cannot be reduced to mere rational choices. The ethnographic examples presented in chapter 4 will therefore explore the relationships between bodily sensations, embodied and intersubjective experiences, and treatment selections and evaluations. This will be followed, in chapter 5, by an ethnographic elaboration of Elisabeth Hsu’s (1999, 2007) notion of body ecologic—an interpretive framework within which aspects of seasonality, the lived environment, and associated healthcare strategies can be explored. Whether in Singaporean clinics, homes, or public spaces, various representations of the relationship between (individual and collective) bodies and the physical environment competed for authority. Whereas the public health discourses of the state suggested that a potentially dangerous environment needed to be kept at bay by the detailed management of domestic spaces, bodies, and things (evident, for example, in antidengue campaigns), Chinese medical physicians relied on different metaphors and conceptualizations of the body ecologic. I will therefore describe how many Singaporeans negotiated their health within a dramatically transformed landscape, particularly in terms of experiences of heat and cold as well as seasonal and dietary fluctuations. I will argue that despite variation between patients (as well as between patients and physicians), the regulation of internal and external heat and cold was remarkably common in Singaporean Chinese healthcare strategies. 27

Capturing Quicksilver Furthermore, while these concepts and strategies were theoretically and materially related to Chinese medicine, they were not always described by patients in such terms. In chapter 6, I move even further beyond the clinic walls in order to consider common dietary practices in Singapore in relation to the healthy lifestyles promoted by the state, and Chinese medical concepts in turn. I will describe how various fields (including gastronomy, medicine, public health, and social or family relations) intersect in homes, Chinese medicine and food shops, hawker centers, and public spaces. Here, I return to Singaporean governmentality and self-care techniques—this time with reference to dietary prescriptions and proscriptions, and healthy lifestyle campaigns, to which the public has undoubtedly been responsive in many respects. This framework does not, however, sufficiently explain all aspects of Singaporeans’ food-related practices, particularly those linked with a deeper sense of tradition and heritage than that provided by the state. As a simultaneous evocation of and deviation from their cultural heritage, Singaporean Chinese gastronomic and dietary practices can therefore also be viewed as avenues for the creative negotiation of authority, heritage, identity, and health. Finally, in chapter 7 I will return to the main themes of the book in order to reflect on how the history of anthropological research and writing, and the mid twentieth-century crisis of representation in particular, guided my research and findings. I conclude that the plurality and plasticity of Chinese medicine in Singapore are salient features that resist its circumscription within a static, delimited medical domain. Hence, I emphasize its dynamic embedment within everyday life, alongside other practices associated with Chinese cultural heritage (including language, festival and religious observances, food, and so on). In light of Singapore’s tumultuous sociopolitical history, complex identity politics, plural healthcare fields, and constantly changing urban landscape, the adaptive persistence of Chinese medicine in Singapore can also shed light on the intersection of post-colonial agency, knowledge, and power. Despite the apparent strength of the Singaporean state, governmentality and biopower provide only one vantage from which to view the mercurial assemblage of Chinese food and medicine. By broadening the analysis to include physicians’ creative practices and patients’ embodied experiences, as well as dietary/culinary and medical practices outside 28

Introduction



of the clinic, we can begin to explore the larger tensions and processes in which Chinese medicine is embroiled.

Notes 1. National Population and Talent Division (Prime Minister’s Office), Singapore Department of Statistics, Ministry of Home Affairs, and Immigration and Checkpoints Authority. 2014: 2014 Population in Brief, Singapore: National Population and Talent Division. 2. This is, in fact, the title of one of Lee Kuan Yew’s memoirs (Lee 2000). As will be described further in chapter 2, Lee helped negotiate Singapore and Malaysia’s sovereignty at the end of the colonial period, becoming Singapore’s first prime minister in 1965—a position he maintained for thirty years. Lee passed away in March 2015, at the age of 91. 3. The word “fine” is a tongue-in-cheek allusion to the myriad fines imposed by the government—from trespassing to spitting or urinating in public. 4. In March 2010 the Singapore Tourism Board shifted to a new advertising campaign and online presence called “YourSingapore” (http://www. yoursingapore.com/en.html). 5. As reported on the Economic Development Board website: https://www. edb.gov.sg/content/edb/en/industries/industries/pharma-biotech.html. 6. According to Vineeta Sinha (1995), “traditional medicine” in Singapore— as defined in state, professional, and popular discourses—includes Chinese medicine (sometimes used interchangeably with traditional Chinese medicine, or TCM), Indian medicine and Malay medicine. To date, only Chinese medicine is regulated by the state. 7. This description of the local manifestation of a transnational practice owes much to Stephen Collier and Aihwa Ong’s notion of global assemblages—the new material, collective, and discursive relationships defined by specific territorializations of global forms (Collier and Ong 2005: 3–5, 9–14). 8. Subsequent to the fieldwork that informs this book, I returned to Southeast Asia four times: I visited Singapore and Indonesia for six weeks in 2008 (during which I conducted a few post-fieldwork interviews and site visits), I spent six weeks in Vietnam under the auspices of a traveling study abroad program for which I taught in 2014, I presented at a conference and conducted preliminary postdoctoral research in Singapore in 2015, and I traveled in Thailand for three weeks in 2016. 9. Unless otherwise specified, all Chinese terms in this book will be given in Mandarin Chinese, with pinyin Romanization. 10. The Mandarin term fangyan (regional speech) is used to describe all spoken Chinese variants. However, debate persists over whether the often mutually unintelligible regional speech groups of southern China are dialects of Mandarin or, in fact, distinct languages. While the more neutral neologism “topolect” might therefore be a prudent alternative, I 29

Capturing Quicksilver 11.

12.

13.

14.

15.

16.

17.

18.

19.

use the term “dialect” in deference to how these differences are usually described in Singapore and in Singaporean (English-language) literature. Mandarin was also occasionally used as a common language between members of different dialect groups, particularly among older Chinese Singaporeans and/or recent emigrants from the People’s Republic of China (PRC). In this context, ah and wah lau are exclamatory expressions (from the southern Chinese dialects Hokkien and/or Teochew) with no direct English translation. Goh Chok Tong succeeded Lee Kuan Yew as Singapore’s second prime minister in 1990, until Lee Kuan Yew’s son Lee Hsien Loong took office in 2004. At the time of my research, Lee Hsien Loong was still prime minister. This tendency was so prevalent that I was compelled to enroll in a Mandarin Chinese class offered by the Singapore Chamber of Commerce, and even joined a weekly elementary students’ Mandarin tutoring group (to somewhat comedic effect), in order to maintain my language competency. With the exception of scholars, people speaking in an official capacity, and Professor Tan (who specifically requested I use his name), the names in this book are pseudonyms. Despite my attempts to explain my research, which led me to conclude I had obtained the necessary permissions to observe in this manner, after two and a half months I was asked to stop observing inside Thong Chai’s consultation rooms. Although I was invited to spend time in the waiting areas, I decided to concentrate my efforts elsewhere. In this book I use “Dr” for biomedical physicians, Chinese medical physicians, and individuals with a PhD. The title of Professor is used for individuals bearing that title, regardless of their educational background (e.g., Professor Tan had neither an MD nor a PhD but adopted the title of “Professor” nonetheless because he lectured at the Singapore College of TCM). Throughout this book I will adopt Joanne Sharp’s (2009) distinction between post-colonialism and postcolonialism (sans hyphen): whereas the former refers to a period of time after colonialization (and has been critiqued for overemphasizing a conclusive temporal break), the latter refers to an anticolonial stance that acknowledges contemporary continuities with the colonial project (e.g., colonization of the mind). Hence, like postmodernism, postcolonialism analyzes and critiques the dominance of “Western” knowledge and practice by highlighting a multiplicity of voices, styles of knowing, and ways of being. Timotheus Velmeulen and Robin van den Akker (2010) and others have questioned or rejected the term “postmodern” as a descriptor of our contemporary ethos by citing the (inconsistent) persistence of modernist themes and practices. Similarly, Paul Rabinow uses the term “meta-modern” to describe the persistence of what is often referred 30

Introduction

20.

21.

22.

23. 24.

25.



to as modernity in our supposedly postmodern world. In his view, configurations of knowledge and power, as well as metanarratives that postmodernists sought to deconstruct, were still present in turn-of-thecentury discourses of techno-science and transnational capitalism (cited in Haraway 1997: 42). The abbreviation TCM is used in governmental and administrative discourses in Singapore, but Singaporean Chinese medical physicians and patients more often simply used the term zhongyi, its most direct English translation of Chinese medicine, or the name of a specific healing modality (e.g., acupuncture). I will refer to TCM in Singapore only in those contexts where the abbreviation is actually used or implied. The last decade of the twentieth century was marked by recurring (and largely unresolved) debates over the parameters of postmodernism and poststructuralism. Whether advanced under the title of postcolonialism, postmodernism, post-postmodernism, or another intellectual movement, many of the concepts and approaches associated with postmodernism were influential in the development of medical anthropology. While it is not my intention to label the scholars cited in this section as postmodernists or poststructuralists, I hope to illustrate how some of these techniques and perspectives were taken up in medical anthropology. These approaches are heuristic devices for thinking about the body outside biomedical (Cartesian) discourse. As such, they represent different models, or angles, from which to view bodily practice. I do not propose them as absolute definitions or descriptions of reality but, instead, as intersecting, interpretive facets. Several quantitative studies have also attested to this continued popularity (see, e.g., Lee 2006; Loh 2009). Considered in light of Singapore’s self-fashioning as the hub of a knowledge-based effervescent ecosystem with a disproportionate attention to the biopharmaceutical industry, the rationale for regulating Chinese medicine might be considered a neoliberal exception (Ong 2006). Alternatively, this legislative circumscription could be interpreted as a presenting a cost-effective solution for addressing the primary healthcare needs of Singapore’s majority ethnic Chinese population (Clancey 2012). While Leslie’s observations have been positively received within the social sciences, it is worthwhile to note that the modern/traditional dichotomy (as well as the similarly critiqued Western/Eastern medicine distinction) endures in a wide range of discourses—from development and humanitarian aid efforts, to public health and nationalist discourses. Furthermore, as noted by Ulrich Beck and Natan Sznaider (2006), “cosmopolitanism” is a contested term—particularly in light of twentyfirst-century trans-disciplinary and transnational challenges. In this book I use the term “biomedicine”—not because it is free of controversy (nonbiomedical practices also involve biological processes and effects, after all) but because it is a commonly understood referent for particular epistemological, theoretical, practical, and material lineages of medicine. 31

Capturing Quicksilver 26. As one of many examples worldwide, this (neoliberal) privatizing and economizing of medicine was certainly a vital factor in the development of Singapore’s healthcare system (Quah 1989). However, I contend that earlier (post-colonial) political economy of health and population management agendas, power dynamics, and personal negotiations of identity and heritage must also be considered when examining medical pluralism in Singapore. 27. From these experiences, Sinha insists that we expand our notion of expertise to include areas of the medical domain otherwise omitted. However, in doing so she does not account for the differences in the socialization of knowledge that creates a distinction between expertise and wisdom in the first place. See, for instance, Elisabeth Hsu’s (2000) article on shen (spirit) for a brief account of the difference between theoretical knowledge and active knowledge, attained from lived experience. 28. Despite the perceived value (and potential savings) of these endeavors, it is important to note that while medicinal gardens might appeal to public health administrators, they do not always result in everyday applications, particularly in fast-paced, urban environments. I had the opportunity to discuss this promotion of medicinal gardens with Ayo Wahlberg— an anthropologist with substantial experience studying Vietnamese traditional medicine—at an academic workshop in Singapore (September 2015). Despite the government’s promotion of medicinal gardens, he informed me, most of the urban Vietnamese people with whom he worked obtained their herbs from retailers or wholesalers, who sourced their materials from rural Vietnam or other countries. In his presentation at the workshop, Wahlberg discussed how urban residents’ removal from the immediate vicinity of the source of herbs fostered an increasing distrust of the supply chain (and, potentially, the herbs thereby circulated)—an issue that also emerged in my fieldwork with regards to the sourcing of food and herbs from the PRC. 29. These feats of social engineering were designed, in part, to attract international investment and serve the entrepôt functions that had made Singapore so successful in the colonial era (Grice and Drakakis-Smith 1985). After the 1997–98 financial crisis in Asia, the state envisioned a New Singapore centered on information technology and a burgeoning biopharmaceutical industry, seeking to foster an effervescent ecosystem with Singapore as the hub of a transnational knowledge-based economy (Ong 2006). 30. “Upgrading” is a term used by the Singaporean state, and in popular discourse, to refer to the near-constant urban redevelopment process that I will describe further in chapters 2 and 5. Whether or not Chinese medical practices in Singapore have been upgraded or not is a matter of perspective.

32

Chapter 1

Chinese Medicine Unbound

Global phenomena are not unrelated to social and cultural problems. But they have a distinctive capacity for decontextualization and recontextualization, abstractability and movement, across diverse social and cultural situations and spheres of life. Global forms are able to assimilate themselves to new environments, to code heterogeneous contexts and objects in terms that are amenable to control and valuation. At the same time, the conditions of possibility of this movement are complex. Global forms are limited or delimited by specific technical infrastructures, administrative apparatuses, or value regimes, not by the vagaries of a social or cultural field. —Aihwa Ong and Stephen Collier, Global Assemblages

Introduction Separated from peninsular Malaysia by the narrow Johor Strait, the Republic of Singapore consists of one relatively larger (682 square kilometers), diamond-shaped main island and sixty-three mostly uninhabited islets, positioned at the southern end of the Strait of Malacca (which flows between peninsular Malaysia and Sumatra). The overwhelming majority of Singapore’s population of 5.47 million people (3.87 million citizens and permanent residents plus 1.6 million nonresidents, as of June 2014) reside on the main island, making Singapore one of the most densely populated cities in the world (National Population and Talent Division 2014). Linking the South China Sea and the Indian Ocean, the Strait of Malacca was an integral part of the ancient maritime Silk Routes, connecting various trading empires in the region, as well as facilitating the circulation of 33

Capturing Quicksilver goods between East and South Asia, and then onward to Europe and back again. By no means restricted to historical records, the Strait of Malacca is still one of the world’s busiest shipping lanes and is likely to play an important role in China’s 21st Century Maritime Silk Road, part of President Xi Jinping’s One Belt, One Road Initiative (also known as the Belt and Road Initiative).1 The Port of Temasek, as Singapore was initially named by Javanese traders, was established sometime between the thirteenth and fourteenth centuries, in service to the larger Malay trading world (under rule of the Malacca Sultanate) that ranged from the Johor River to the Riau Islands during the sixteenth to eighteenth centuries.2 Folklore associated with this trading empire also accounts for Singapore’s current appellation: supposedly on visiting the island, a Sumatran prince saw what he took to be a lion and renamed the island Singapura (or lion city). While indigenous Malays were the primary occupants when Sir Stamford Raffles claimed it as a free port under the auspices of the British East India Company in 1819, Chinese traders had also long maintained activity in the area. A mere thirty years later, ethnic Chinese laborers, merchants, and entrepreneurs constituted the majority of the island’s population (Kwa 1999). This ethnic Chinese majority was subsequently maintained: as of 2014, Singapore’s ethnic composition was at a stable 76.2 percent Chinese, 15 percent Malay, 7.4 percent Indian, and 1.4 percent other (National Population and Talent Division 2014). Around the time of my fieldwork (2006 and 2007), Buddhism was the dominant religion (42.5 percent), followed by Christianity, Islam, and free thinker (approximately 15 percent each), Daoism (8.5 percent), and Hinduism (4 percent) (Lim et al. 2005: 19). To some extent, then, Singapore stands out for its clear and, some argue, carefully maintained ethnic Chinese majority. This demographic feature, however, should not minimalize the nation’s ethnic, religious, and linguistic diversity—a key issue in both colonial administration and post-colonial political rhetoric. Furthermore, as I will discuss in chapter 2, the political management of “race” and cultural heritage has impacted the practice and perception of Chinese medicine in Singapore. Singaporean Chinese often explained to me that their forebears emigrated from China in search of a better life for themselves and their families. Once settled in the colonial Straits Settlements, overseas Chinese merchants and entrepreneurs enjoyed a 34

Chinese Medicine Unbound



substantial economic advantage over other ethnic groups due to colonialists’ preferential treatment, as I will describe further in chapter 2. Although post-colonial development encouraged a productive, docile consumer society, by the 1980s social critics and politicians alike attempted to combat what they labeled as Western (materialistic) values, perhaps to no avail. By the end of the twentieth century, career and salary were inextricably bound with certain forms of status in Singapore. Popularly referred to as the five C’s, the majority of Singaporeans with whom I spoke associated success with cash, cars, credit cards, condominiums, and country club memberships. Even the Singaporean government’s social architect Goh Keng Swee lamented, “The prevailing practice is to judge a man’s worth by his bank balance” (cited in Kwok 1999: 67).3 Although Goh was referring to the lower salaries and status of teachers at the time, Chinese medical professionals confronted the same dynamic at the time of my fieldwork. Simply put, Chinese medical physicians did not enjoy nearly the same privileges and status in Singapore as biomedical physicians because they did not practice biomedicine and were not, consequently, considered to be doctors. Although from the perspective of patients, Chinese medical physicians were doctors—and were referred to as such in English, Mandarin (yisheng) or Southern Chinese dialects like Hokkien (sinseh)—they were nonetheless marginalized in economic and political terms as “practitioners” (e.g., by the TCM Practitioners Act passed in 2000 and implemented in 2001). Setting aside the political construction of multiracialism and ethnicity for a moment, this chapter will introduce one of the key problematics of the book: the manner in which Chinese medicine has been framed and negotiated in relation to both biomedicine and Singapore’s ethnic Chinese majority. I will begin with an autoethnographic vignette that illustrates the embedment of Chinese medicine in Singaporean life, particularly when used to ameliorate common everyday and seasonal conditions. I will then discuss the contemporary popularity and status of Chinese medicine in Singapore more broadly, as well as its political positioning as CAM. However persuasive or useful the CAM framework might be, I will argue, it does not adequately reflect the rich history, cultural relevance, or transnational flows associated with Chinese medicine. I will therefore reframe the discussion with respect to efforts to professionalize 35

Capturing Quicksilver Chinese medicine in Singapore, the (re)invention of TCM in the PRC, and scholarly accounts of TCM’s contemporary globalization. These perspectives will link the specificities of my fieldwork with deeper and more-expansive flows and transformations, and thus suggest a broader relevance for the ethnographic descriptions of Chinese medicine in Singapore that follow.

Medicine In and Of Everyday Life According to the National Environmental Agency (NEA 2009), the primary seasonal changes in Singapore are between monsoon and inter-monsoon seasons—marked by changes in wind, rather than by distinct wet and dry seasons. On average, rainfall begins to increase in October, peaks in December, and drops to a relatively dry period from February to early March. May, June, and July are meteorologically described as Southwest Monsoon season and are characterized by southerly or southeasterly winds, relatively less rain, and occasional Sumatra Squalls—thunderstorms that develop over Sumatra, Indonesia and travel eastward to peninsular Malaysia and Singapore, bringing one- to two-hour bursts of rain and sometimes strong winds. The coolest month of the year—and peak of the wet season—is December (calculated by averaging the daily mean temperature for each month between 1982 and 2008) at 26.4 degrees C (79.5 degrees F), with a gradual increase in mean temperature until reaching 28.3 degrees C (82.9 degrees F) in May and June; afternoons during inter-monsoon periods frequently reach temperatures above 32 degrees C (89.6 degrees F). Singaporeans with whom I interacted, however, rarely defined the summer in such formal terms. A facetious expression that I heard on numerous occasions during my fieldwork claimed, “Singapore has three seasons: rainy season, dry season, and shopping season.” Although in practice Singaporeans shop year-round—for subsistence, recreation, or retail therapy—the end of May until the end of July is a specially designated, official shopping season that coincides with the Great Singapore Sale. The Singapore Tourism Board and the Singapore Retailers Association initiated this event in 1994 with a S$3 million advertising budget targeting Southeast Asia and Australia. Another, less-publicized shopping season also extends from mid-December until the end 36

Chinese Medicine Unbound



of Chinese New Year (usually mid-February), when Singaporean Chinese spend much more money than typical on luxury goods, gifts, and festival commodities. This shopping, however, is usually justified in terms of Chinese culture and heritage and activities are associated with festival season, whereas the Great Singapore Sale is intended to stimulate tourism and shopping for its own sake. In as much as Singaporeans spoke of a summer in the first place it therefore tended to be associated with the hot, relatively dry weather in May, June, and July, extending through the Southwest Monsoon and shopping season. During this time of year, it was not uncommon to hear people complain of “summerheat” or “summerheat heatiness” (shure)— a seasonal form of heatiness (discussed further in chapter 5) that was often treated outside clinical settings by means of liangcha (cooling tea). Home-based remedies were an extremely common strategy for managing the embodied experience of Singapore’s climate, and were often the first step taken in health management. This was particularly the case when the condition occurred on a regular or seasonal basis, as was true in the following instance detailed in an excerpt from my field notes (dated July 2, 2007): It’s just after 6a.m. and I am sweating already. Just the effort of showering and dressing outside the path of a fan has produced a fine film over my forehead. I choose the lightest and loosest clothes in my wardrobe in anticipation of the long, hot day ahead. By the time I descend the escalator onto the Sengkang MRT platform (a seven-minute walk from home), my shirt is beginning to stick to my back and the frizzy little hairs at my hairline have staged a revolution against conformity with the bun on the back of my head. June was hot—July is almost unbearable. Singaporean summers feel only a shade away from Hades, especially once the “haze” begins.4 Being very hard to ignore, the weather seems to loom large in the consciousness of many Singaporeans at this time of year, becoming the scapegoat for the ills of life. Over the last week or so, I have been suffering from an odd cough—it began very shallow and dry but within a few days moved deeper and became phlegmy. Nearly everyone with whom I’ve spoken about it has attributed it to the weather, and has given some recommendation for cooling. Tim, manager of the Toa Payoh branch of Hock Hua—the Chinese food/medicine shop at which I observed—recommended I drink water and liangcha (especially the Buddha’s disciple fruit variety). He also kindly provided me with small bags of powdered herbs, carefully measured from 37

Capturing Quicksilver bottles stored near the liangcha cart at the front of the store (incidentally, the same brand used by Dr Wang at his private clinic in Chinatown), intended to reduce heat, phlegm, and coughing. A colleague at the early childhood development center where I worked recommended water, liangcha, and starfruit (which is considered cooling) as well as rest and reduced talking. Another friend suggested drinking water and liangcha, adding salt to any beer I drank, and avoiding heaty foods like peanuts. Although my cough gradually went away, by the end of August I developed symptoms of shure: mucous in my sinuses, a sore throat, and general weariness and disorientation, progressing to frequent and uncomfortable urination, an unquenchable thirst, and finally culminating in the telltale sign of small amounts of blood in my urine. After discussing these symptoms with my friends Adelle and Tom, I was assured that these experiences were extremely common at this time of year (particularly among women) and was encouraged to simply go to a Chinese medical hall— another term for Chinese pharmacies or food/medicine shops. They were aware of the most likely biomedical diagnosis (urinary tract infection) but saw little need for the use of pharmaceuticals for this condition. These pharmaceuticals were often considered, on the one hand, to be much weaker in Singapore than in many other countries and, on the other, to be toxic by comparison with the tonic qualities of Chinese medicine. “Waste your money for what, lah?!” Adelle demanded, after reporting that she successfully treated the same symptoms at approximately the same time every year with Chinese herbal remedies.5 Reassured by my already regular purchases of liangcha—particularly chrysanthemum and luohanguo (Buddha’s disciple/Arhat fruit, Siraitia grosvenorii)—I felt relatively confident following my friends’ advice.

I was most familiar with juhua (chrysanthemum, Chrysanthemum morifolium) and luohanguo liangcha, in which the primary herbs were steeped or briefly simmered in boiling water—sometimes along with other herbs like goujizi (wolfberries, Lycium chinense, Fructus Lychii) or jinyinhua (honeysuckle flowers, Lonicera japonica)—with rock sugar added to produce a sweetened beverage. These decoctions were considered mild remedies or simply pleasant beverages that one could drink as often as desired. Luohanguo—the fruit of a perennial vine indigenous to Guangxi province in southern China—produced a sweet, dark brown drink that was also often recommended for respiratory ailments, consistent with its use in the PRC (Hu 2005: 218–220).6 Although these grayish-brown dried fruits could be purchased whole from shops like Hock Hua, either 38

Chinese Medicine Unbound



Figure 1.1. Luohanguo

singly or in packaged herbal combinations, people often purchased premade drinks for convenience. Several varieties of dried chrysanthemum were available for sale in food and medicine shops, medical halls, and grocery stores across the island packaged in plastic bags or paper-wrapped bricks. Although the flowers of this species can be found in many colors, sizes, and shapes depending on the variety cultivated (Hu 2005: 723), yellow and white dried flowers were most commonly sold in Singapore. While chrysanthemum and Buddha’s disciple fruit teas were consumed in cases of minor heatiness symptoms, lingyangsi (shaved antelope horn) was commonly cited for more-severe symptoms.7 The typical name of this herb8 is actually lingyangjiao (Cornu Antelopis): lingyang means antelope and jiao means horn. The use of si here instead, which could be translated as silk, fine, or thread-like, refers to a processing technique that involves thinly shaving the horn (in this case jiao is implied by the presence of si and is therefore omitted). Food and medicine shops like Hock Hua sold small bottles of these shavings for home preparation. While observing at Hock 39

Capturing Quicksilver Hua in Toa Payoh, I noticed that the display on which these bottles were placed was frequently scrutinized by shoppers, who would occasionally engage a salesperson for information on the different grades available. However, I more commonly observed people buying the premade bottles of lingyangsi cha (antelope horn tea) from the liangcha cart at the front of the store than the materials with which to make it themselves. Like many Singaporeans opting for convenience, I decided to inquire at the Hock Hua branch closest to my apartment in Sengkang about what kind of liangcha might be appropriate for summerheat. Hock Hua liangcha carts were nearly always positioned in the entryways to their shops; customers could quickly and conveniently purchase a bottle directly from a clerk who stood at the stand, rather than queuing inside the shop, if they chose. As I noted at the Toa Payoh branch, large batches of liangcha were prepared and bottled each morning, kept in large coolers in the shop’s storeroom (at the back of the store) from which smaller coolers or refrigerators adjacent the carts were stocked throughout the day. The nonrefrigerated

Figure 1.2. Hock Hua liangcha cart 40

Chinese Medicine Unbound



carts were then stocked from these coolers as supplies waned. The carts in front of larger stores bore several bottles each of approximately fifteen types of tea, each row of bottles labeled with a small laminated sign indicating the name of the tea in Chinese characters and, with a few exceptions, English translations. A typical assortment included the following: 蜂蜜普洱茶 (fengmi puer cha)

Honey Pu Er Tea

金银花蜂蜜 (jinyinhua fengmi) Honey Suckle [with honey] 薏米水 (yimi shui) Barley [literally, barley water; also known as Job’s tears] 菊花茶 (juhua cha)

Chrysanthemum Tea

洋参菊花茶 (yangshen juhua cha) American Ginseng Chrysanthemum Tea 洋参茶 (yangshen cha)

American Ginseng [tea]

洋参罗汉果茶 American Ginseng Lo Han (yangshen luohanguo cha) [Guo] Tea 石斛茶 (shihu cha) [Not labeled in English; Dendrobium tea] 葛根湯
(gegen tang) Cold Remedy [literally, Pueraria root decoction] 止咳湯 (zhihai tang)

Anti-cough Tea9

羚羊水 (lingyang shui) Fever Remedy [literally, antelope water] 浓缩小麥草 (nongsuo xiaomaisuo) Concentrated Wheatgrass 蜂蜜水 (fengmi shui) Pure Honey [literally, honey water] 蜂蜜酸梅水 (fengmi xiyang shui) [Not labeled in English; honey with xiyang water] 马蹄水 (mati shui) Water Chestnut [literally, water chestnut water] 洛神花 (luo shen hua) [Labeled in pinyin, but not in English; Roselle flower tea] 柠檬蜜 (ningmeng mi) Honey Lemon

41

Capturing Quicksilver I inquired with the liangcha cart clerk about liangcha for summerheat and, just to be certain, confirmed the two indicated choices were specifically to be used for shure (in Mandarin). When I asked which of the two was stronger, he pointed to the more expensive one, which—on further inquiry—he explained was made from antelope horn. I bought a bottle of the murky white liquid for S$5 and was instructed to come back the next day for another bottle if my condition hadn’t improved. I subsequently drank one bottle per day for three more days, purchased from the same liangcha cart and supplemented with one to two pots of chrysanthemum decoction, which I brewed at home in the evenings. By the end of the second day I noted a steady improvement in my condition, and after three days the majority of my symptoms had been completely relieved. In Chinese medical terms antelope horn is classified as han (cold) and xian (salty), and acts primarily on the gan (liver) and xin (heart), subduing ganhuo shangni (liver fire and hyperactivity) as well as feng (pathogenic wind) (Liu 1995: 94). Like most Chinese medical herbs, in clinical practice it is typically combined with several other herbs in a formula, as I will describe in greater detail in chapter 6. In the course of my fieldwork, however, I often saw antelope horn and other cooling herbs used in isolation or in combinations of two or three herbs and served as liangcha outside a clinical setting. While Hock Hua salesclerks received ongoing training in the primary indications of the herbs they sold (as reported to me by the manager of the busy Toa Payoh branch as well as a Chinese medical physician employed to provide such training), they were not licensed Chinese medical physicians. A few branches hosted an independent Chinese medical physician available for consultations with customers on request but, by and large, most branches did not offer diagnostic services. When a customer inquired about the utility and properties of an herb or type of liangcha, clerks tended to simply match the customers’ stated symptoms or named illnesses with the type typically recommended in such cases. Of course, the importance of physicians’ practices (and, as I discuss in chapter 3, their specific techniques) cannot be understated—particularly as an authority around which struggles to articulate Chinese medicine coalesce. But by extending the medical domain beyond the technical skill of physicians operating within clinic walls we can incorporate popular health-related practices, 42

Chinese Medicine Unbound



rather than restricting our understanding of Chinese medicine to purely epistemological or theory-practice debates.10 This vignette illustrates the extent to which I respected both the efficacy of Chinese materia medica and the embodied knowledge of people for whom it was an everyday part of life. In concert with other examples cited in this book, it also suggests not only the popularity of Chinese food and medicine in Singapore, but also its embedment in the lives and seasonal experiences of Singaporeans.

Chinese Medicine’s Popularity and Designation as CAM A survey conducted by National University of Singapore medical students and faculty in 2002 indicated that 76 percent of Singaporeans had used CAM at least once in the twelve months prior (Lim et al. 2005). Of those who reported using CAM, 88 percent used TCM at least once in the specified period: 99 percent of Chinese, 66 percent of Indians, and 42 percent of Malays surveyed, resulting in an estimated 67 percent of the total Singaporean population. Meanwhile, 8 percent reported using jamu (traditional Malay medicine), and 3 percent reported using Ayurveda. Although the 2 percent “other” category included in the survey sample (a slightly higher ratio than the national average) is not discussed at all, the “cross-over usage of TCM by Indians and Malay” attracted special attention—particularly in the case of Singaporean Indians, only 24 percent of whom reported using Ayurvedic medicine (Lim et al. 2005: 19). Furthermore, the study’s authors note, whereas “Western” CAM users referred to in other studies (e.g., Ernst 2000; MacLennan and Wilson 1996) tend to be single, white, relatively affluent, middle-aged, well-educated women, Singaporean CAM users could not be characterized by income, marital status, age, or education (Lim et al. 2005: 21). These apparently surprising findings reveal the assumed correlation between ethnicity and particular forms of CAM, and can be viewed in light of Singapore’s “multiracial” national identity as a whole and mandatory “racial” profiling therein (to be discussed further in chapter 2). Apparently, in other industrialized countries, lower-income and less-educated members of the dominant culture do not tend to use traditional /complementary and alternative medicine (T/CAM) (Bodeker and Kronenberg 2002: 43

Capturing Quicksilver 1585). For instance, according to studies on the use of CAM in the United States (Eisenberg et al. 1993) and the United Kingdom (Ong et al. 2002), patients tend to be either relatively affluent members of the dominant culture or ethnic minorities culturally associated with a particular “traditional” medicine. Although certainly industrialized, Singapore is an exception to this observation. With inexpensive charity clinic prescriptions to high-priced medicinal items like birds’ nests and cordyceps—it is not surprising that Singaporean Chinese medical patients represent an equally wide range of socioeconomic statuses. Furthermore, unlike their British or American counterparts, the majority of these patients are self-identifying and politically recognized members of Singapore’s dominant ethnic group, which is in turn culturally associated with “traditional” Chinese medicine. Nonetheless, Singapore is by no means alone in the additional legislative attention granted to Chinese medicine over other CAMs. A 2001 survey conducted by the WHO notes that “Chinese traditional medicine” was the most widely used CAM worldwide at the turn of the century. In this context, CAM refers to a so-called traditional medicine that is practiced outside the country of its origin. Conversely, traditional medicine refers to a CAM that is practiced in its country of origin, and can include a range of practices that employ physical substances or tools, spiritual or manual techniques, and/or exercises, “singly or in combination to maintain well-being, as well to treat, diagnose, or prevent illness” (WHO 2001: 1–2). Although the report remarks on the connotation that CAM is presented as supplementary (and thus subordinate) to biomedicine, it also allows that some countries grant CAM a legal standing equivalent to biomedicine, and that many patients use CAM physicians as their primary healthcare providers. While a more recent WHO report (Faulkenberg 2012) acknowledges that the terms “complementary” and “alternative” are sometimes used interchangeably in this context, it nonetheless still maintains that traditional medicine is based on a given country’s traditions while CAM is not; meanwhile, CAM can include more-recently developed materials and technologies but traditional medicine does not (Faulkenberg 2012: 5.1). This nationalist distinction not only assumes that a country has a unified and singular set of traditions, but also that those traditions are static and unrelated to technological (or other) innovations. It 44

Chinese Medicine Unbound



therefore relies on bounded (and increasingly unrealistic) notions of both the nation-state and tradition. With these definitions in mind, the results of Lim’s study suggest that Chinese medicine in Singapore is complementary (as opposed to alternative), insofar as 95 percent of those who reported using CAM concomitantly used biomedicine (Lim et al. 2005: 19). Nearly all of the Chinese medical patients with whom I worked also reported consulting biomedical doctors and/or using pharmaceuticals. This designation also reflects the (re)positioning of Chinese medicine in political discourse. As I will discuss in chapter 3, in an informal interview with the registrar of Singapore’s TCMPB (a statutory board of the MOH) I was told that the medical services provided by the government are exclusively biomedical and that—despite recent regulation—Chinese medicine was strictly complementary. Thus, the contemporary position of Chinese medicine in Singaporean state discourse is consistent with growing recognition of CAM practices by European and American governments, despite the significant differences in patient demographics and their associated traditions. As noted by Sarah Cant and Ursula Sharma (2003), governmental responses to what is described as the contemporary reemergence of CAM are not uniform. Rather, they follow a “range of historical and geographical preconditions that shape the precise way in which various states privilege biomedicine and the means by which other forms of health care are disprivileged” (Cant and Sharma 2003: 129). Murray Last (1996) also takes this stance in his chapter on the professionalization of nonbiomedical practitioners. While noting the great variety between the types and quantity of subcultures acknowledged in different countries, he suggests at least three general governmental approaches to regulating CAM practitioners. First, exclusive systems such as France, the former Soviet Union, and the United States are medical monopolies; second, tolerant systems such as Britain and Germany employ market-based strategies; and third, integrative systems such as India, China, and various “Third World” countries constitute Asian pluralism (Last 1996: 380–87). Cant and Sharma (2003) add that rapid changes in policy, hybridity in governmental approaches to CAM, and finer distinctions regarding which practices are legitimated (and by whom) introduce even further complexities into this typology (Cant and Sharma 2003: 45

Capturing Quicksilver 129–32). As described in the introduction, they therefore suggest a new medical pluralism structured along market lines. Furthermore, the dynamic manner in which medical pluralism is negotiated by politicians and healthcare professionals is not a straightforward matter of CAM integrating with or overcoming biomedical hegemony. For instance, Ursula Sharma’s (1995) account of CAM in the United Kingdom describes how governments clearly benefit from promoting a single, unified medical profession that, in turn, benefits from statutory recognition. Although the healthcare systems of the United Kingdom and Singapore differ dramatically (the former being socialized and the latter ostensibly nonwelfarist), the governments of both consider biomedicine as orthodox. As Sharma notes of Britain, all other forms of medicine are similarly classified as nonorthodox in Singapore. Given Singapore’s status as an ex-British colony, these congruencies are hardly surprising. The British legislation delineating orthodox from nonorthodox medicine, as well as the lack of state support for nonbiomedical training and research, are also present in Singapore. Additionally, recent Singaporean legislation (to be examined in chapter 3) requires separate titles and registration for zhongyishi (TCM physicians) and zhenjiushi (acupuncturists), along the same lines as recommended by the United Kingdom’s House of Lords Select Committee (House of Lords 2000). The professionalization of British physicians, surgeons, and apothecaries in the nineteenth century allowed them to claim “control over the medical division of labour” (Sharma 1995: 119). Thus, the professionalization of CAM practices could be interpreted as a maneuver for similar status, although this repositioning comes at the price of state-imposed constraints. The formation of Singapore’s healthcare system—a dynamic process in relation to which the Chinese medical community has negotiated its status—indeed follows a similar pattern, as will be discussed in chapter 3. However, many of Chinese medical physicians’ professionalization efforts predate both the current healthcare system and even Singapore’s sovereignty. One cannot claim, then, that their recent organizational measures are exclusively a response to the post-colonial medical division of labor. In short, the manner in which Chinese medicine is circumscribed and defined as quite distinct from “medicine” (that is, biomedicine) in Lim et al.’s (2005) study is consistent with its political positioning 46

Chinese Medicine Unbound



in Singapore. As such, the study suggests the practice’s still marginalized status, despite its remarkable popularity among Singaporeans and relatively recent regulatory attention (i.e., the TCM Practitioners Act); this negotiated position is, of course, relative to the politically dominant medical paradigm. The conceptual division of Chinese medicine and biomedicine is also apparent in Singaporean scholars’ analyses, such as Lim’s study and Stella Quah’s (2003) emphasis on the different ethos underlying Chinese medicine and biomedicine.11 It also figures into Quah’s discussion of the contradictory mandates within Chinese medicine to, first, preserve Chinese medicine as “an icon of Chinese culture” (Quah 2003: 2003), and, second, to conform to scientific standards. One might scrutinize analyses like these for reproducing the sort of reified, discrete domains or systems critiqued in the introduction, but her insistence on the incompatibility of Chinese medicine’s ethos and the ethos of science usefully mirrors the attempted separation of the two medical practices in Singaporean biopolitics (see chapter 3). Insofar as Chinese medicine originated in China, its practice and political position in Singapore does fulfil the basic requirements of the WHO (2001) definition of CAM cited above. As such, the recent regulation of Chinese medicine could be interpreted as part of increasing global interest in CAM, and Singapore as a post-colonial recipient of European and American trends, in the same fashion that Chinese medicine is often evaluated against biomedical standards, values, and epistemology. Furthermore, Singapore’s regulatory division of Chinese medicine and biomedicine is more akin to the United Kingdom’s division of the two than to their integration in the PRC. However, there are several problems with considering Chinese medicine only in terms of CAM. First, it does not consider the continuous practice of Chinese medicine in Singapore since the early colonial era, which suggests a different historical trajectory than the supposed reemergence of CAM in other countries. Second, it obfuscates the significant differences in patient demographics that distinguish the use of Chinese medicine in Singapore from other countries. Third, it does not account for the use of Chinese materia medica, acupuncture, massage, and other healing modalities as a primary, or exclusive, method for addressing illness and other bodily experiences (particularly those of an everyday and/or seasonal nature). Finally, it does not take into consideration the fact that 47

Capturing Quicksilver Singapore is a predominately ethnic Chinese society in which people still find ways to relate to and express their cultural heritage.

Biomedical Standards and the Problem of Status The problem of status—and the manner in which Chinese medical physicians negotiated their practice vis-à-vis biomedical standards and values—was a recurring theme that emerged from the majority of my fieldwork observations and discussions. In particular, issues of safety, authenticity, and efficacy have reframed Chinese medical practice and materials in biomedical and legislative terms. Insofar as biomedical epistemology, theory, and practice are dominant in Singapore (and elsewhere), physicians, entrepreneurs, and researchers alike have also contributed to efforts to reframe Chinese medicine with reference to biomedical standards and values. Dr Song traced this effort at rebranding back three generations: while first generation (colonial era) Singaporean Chinese did not generally question Chinese medicine, by the third generation many began to reject Chinese values and practices. Under the split-stream education system, he explained, second-generation (mid twentieth-century) Chinese-stream Singaporeans often suffered economically and socially by comparison with their English-stream counterparts.12 Hence, third-generation (post-colonial) Singaporean Chinese were encouraged by their parents to study English and to “absorb Western values,” effectively marginalizing practices like Chinese medicine that nonetheless persisted. The majority of his new patients thus turned to Chinese medical clinics after being dissatisfied with biomedical treatment so “obviously, they [biomedical physicians] are the mainstream, we are the secondary,” he explained. “But in our heart[s] we told ourselves that we are the mainstream too.” “They use Western eyes—Western-trained eyes—to look at things,” Dr Song observed, “that sometimes makes things very difficult for us.” Nonetheless, he insisted that it was the Chinese medical community’s responsibility to demonstrate their suitability as a mainstream medical practice. The strategies for accomplishing this—nascent and established—were diverse and sometimes contradictory. Competing for scarce resources and medical authority, some companies and 48

Chinese Medicine Unbound



individuals engaged in discourses of efficacy, standardization, and modernity, seeking to elevate Chinese medical practice and products. Others appealed to history, collective medical experience, and/or Chinese tradition, evoking cultural values initially rejected and then subsequently promoted by the post-colonial state. Still others promoted Chinese medicine as CAM—a framework imported from the United States and Europe and adopted by the Singaporean government. According to Dr Song, this last strategy particularly appealed to younger Singaporeans, who sought what they considered natural or alternative remedies, generating a niche market in which even the biomedically oriented government saw potential. More recently, Singapore has been positioned as a regional clearinghouse for herbs and other products cultivated and/or processed in the PRC, because of their reputation for stringent safety and quality controls (e.g., ensuring authenticity and consistent grading). As Yunxiang Yan (2012) observes, the unmatched use of chemical fertilizers and pesticides, alongside large-scale adulteration and counterfeiting of food and medicine, has made food safety a particularly grave concern in China. As described in a news release published in advance of World Health Day by the WHO’s Western Pacific Region office (WHO 2015), food-related disease outbreaks are a serious problem in the region and globally. The Singaporean government has addressed contamination and counterfeiting concerns on several fronts, seeking to secure the nation-state’s role as a global trade hub. For instance, Singapore Customs’ strict enforcement actions and regulations—such as the 2007 Secure Trade Partnership (a supply chain security program)—have allayed consumer fears that punctuate the flow of Chinese food and medicine.13 Although far from exhaustive, the aforementioned strategies for negotiating Chinese medicine’s status allude to a variety of dynamics within which practices emerge, in and beyond Singapore, as physicians vie for authority, status, and security in increasingly transnational medical markets. Like the PRC, Singapore evaluated Chinese medicine against biomedicine in the course of post-colonial development. Unlike the PRC’s integrated healthcare system (which included the politically motivated creation of standardized TCM),14 biomedicine was selected as the sole authority for medical services and standards in Singapore. As I will explain in the following 49

Capturing Quicksilver chapters, the rationale for this choice can be viewed in relation to significant shifts in political economy. Thus, the increased political attention directed at Chinese medicine at the beginning of the twenty-first century can be analyzed in light of increasing economic and political stability, improved bilateral and trilateral relations with other Southeast Asian nations and the PRC, continued patient demand, and the appeal of a global market for Chinese medicine spurred by the opening of the PRC. As I will discuss in greater depth in chapter 3, this attention culminated in the TCM Practitioners Act, which has been credited by MOH officials and some physicians for the increased popularity of Chinese medicine in Singapore over the subsequent years. And yet, as of my fieldwork in 2006 and 2007, many Chinese medical physicians still reported lower salaries and difficulties in establishing a full-time, private practice. The physicians with whom I worked in Singapore were keenly aware of the practical, day-to-day implications of Chinese medicine’s position vis-à-vis biomedicine. In the first of what was to become many conversations with Dr Wang, he informed me that because Chinese medicine does not enjoy the same status as “Western” medicine in Singapore, the average salary was far less than in places like Taiwan.15 Considering the median rent for a two-room, government-subsidized high-rise apartment was more than S$1,000 a month at the time of our conversation, the S$1,500–S$1,800 a month he claimed most practitioners earned was not likely to be adequate. This was, as Dr Wang stated, “the Singapore way.” While Dr Wang was able to maintain a steady private practice in addition to his various voluntary activities, he was nonetheless concerned with a shortage of patients predicted by the MOH. Chinese medical treatments in Singapore were almost exclusively outpatient, he informed me, which limited the number of overall patients by comparison with places like Taiwan, where Chinese medicine was practiced in inpatient hospital wards. The fact that Chinese medical treatments were allowed in biomedical hospitals in any capacity, however, reflected a cautious relaxation of regulatory restrictions. In September 1995 the MOH established the first Acupuncture Research Clinic in Ang Mo Kio Community Hospital in order to study the management of acupuncture patients. Subsequently, similar clinical research endeavors were launched at 50

Chinese Medicine Unbound



National University Hospital, Singapore General Hospital, and Tan Tock Seng Hospital. In 2005 the MOH reviewed their restrictions on clinical practice, permitting these and other medical centers (eventually including Alexandra Hospital, Changi General Hospital, and Camden Medical Center) to offer a full range of Chinese medical services (Lee 2006). While the practice of Chinese medicine in biomedical hospitals was still restricted to outpatient care in sequestered wards, Chinese medical patients constituted a significant percentage of Singapore’s total outpatient population. As early as 1994, the MOH estimated that 12 percent of daily outpatient services were provided by Chinese medical practitioners (Lee 2006: 749), and this was prior to the increased popularity attributed to government regulation. As previously mentioned, a 2001 study projected that 67 percent of Singaporeans used Chinese medicine at least once per year, while a 2005 study estimated that up to 20 percent of the population predominantly used TCM (Loh 2009: 1162). Aside from clinical research and treatments provided in segregated wings of biomedical hospitals, a significant portion of this care occurred in Chinese medical institutes and charity clinics, private practices, and Chinese food and medicine shops like the ones in which I observed. Despite widespread aspirations to the five C’s, and the dominant rhetoric of Singaporean pragmatism, patients’ choices (biomedical or Chinese medical, charitable or private clinic) were not always a reflection of status or economics. For many regular Chinese medical patients with whom I spoke, the relationship they formed with a particular physician was an important criterion in their choice of clinic.16 When Professor Tan began volunteering at Dazhong a few months into my observations at Chung Hwa, for example, many of his Chung Hwa patients followed him. While the move did not increase the cost of registration fees or treatments, the accepted disruption in patients’ routines and commutes indicated his popularity and their loyalty. While their time and expertise was not rewarded with nearly the salary or status of biomedical doctors, the Chinese medical physicians with whom I worked were undoubtedly granted a great deal of authority and legitimacy by their institutions and patients. Furthermore, while Professor Tan’s institutional (and to some extent, his sociopolitical) status was directly tied to his work 51

Capturing Quicksilver at Chung Hwa, his authority with patients clearly extended beyond their walls.

Professionalizing and “Upgrading” Chinese Medicine in Singapore Singapore’s Chinese medical community has long included herbalists, acupuncturists, Chinese food and medicine shopkeepers, bonesetters, and zhongyi (Chinese medical physicians or, in Hokkien, sinseh). Their treatments included herbs at various stages of processing (bulk, powdered extracts, liquids, pills, and so on) to be taken orally or used as compresses, topical oils, acupuncture, moxibustion, tuina (massage), cupping, bloodletting, scraping, and qigong, to name the most common. Although some physicians were known to make house calls, either independently or as part of a service (e.g., the Mobile Free Clinic run by Dazhong), most operated in Chinese medical halls, institutes, dispensaries, and charity clinics. Prior to regulation, many were locally qualified professionals while others— such as bonesetters at Chinese Buddhist temples—practiced skills that did not originate in formal training, and were not recognized by any local institutions (Sinha 1995).17 At the time of my fieldwork, some Chinese medical physicians still practiced in traditional medical halls, sometimes assisted by their spouse or other family member. These consultation rooms were often located in small alcoves at the back of shops that sold both packaged products (e.g., Chinese proprietary medicines) and bulk herbs stored in rows of small compartments behind the counter, carefully weighed and packaged in paper packets according to the physician’s prescription. Most clinics and shops (large and small), however, had “upgraded” their environments and administrative procedures, as I will describe in this section. Many physicians and Chinese medical institutions (like Chung Hwa) established orderly, efficient and “modern” clinics with electronic queue boards in registration and physicians in white lab jackets. Although, for the time being, some of these clinics still dispensed herbal packets (e.g., Thong Chai), many had switched to liquid, pill, and/or powder forms.18 During the colonial era (1819–1959) Chinese medicine physicians in Singapore offered their services free of charge, through 52

Chinese Medicine Unbound



dialect or native place associations, as community service. These practitioners were typically new immigrants or their direct (usually male) descendants from China and, therefore, brought along a similarly wide range of healing modalities as could be found in southern China at the time. The oldest Chinese medical organization still in operation in Singapore by the time of my fieldwork was Thong Chai, which was founded by a small group of philanthropic businessmen in 1867. Initially run by twelve elected members—six from the Hokkien community and six from the Cantonese community—followed by an appointment system from 1930 onward, Thong Chai was one of the first such organizations to cross dialect groups (Quah 1989: 132–33). In response to the changing political climate of China in the mid twentieth century, new immigration policies created a shortage of Chinese physicians in Singapore, which in turn triggered an effort to further organize the existing Chinese medical community. As described by Sinha (1995), one such effort was the creation of the Singapore Chinese Medical Society in 1946—renamed the Singapore Chinese Physicians Association (SCPA) in 1947—which united the four major Chinese medical associations.19 In 1952 the SCPA formed a charity clinic, and in 1953 it opened the Chinese Physicians Training School (predecessor of the SCTCM).20 Entry requirements for this and other Chinese medical colleges were raised, as were the standards for recruitment of teachers from Hong Kong, Taiwan, and mainland China.21 Chinese medical institutions also increased the amount and variety of research on various aspects of Chinese medicine and began issuing certificates to qualified physicians. In the nearly seventy years since its foundation, the SCPA actively promoted Chinese medicine in Singapore and the Southeast Asia region. Some of their more prominent activities included exchange visits with associations and individuals in the PRC in the late 1970s and 1980s, organization of the Association of Southeast Asian Nations (ASEAN) Congress of Traditional Chinese Medicine in 1983, and active participation in the World Federation of Acupuncture Societies since 1987. They were also closely involved in the local legislative process outlined in chapter 3—for instance, SCPA president Neo Say Hai was elected chairman of the Singapore TCM Organisations Coordinating Committee and SCTCM director Teo 53

Capturing Quicksilver Eng Kiat was appointed chair of the MOH’s Acupuncture Advanced Course Organising Committee. The SCPA’s continuing popularity allowed them to establish additional clinical branches in the towns of Yishun (in 1995) and Woodlands (in 2000), as well as in Changi General Hospital (in 2005) and Ren Ci Community Hospital (in 2009). Based on the rapidly changing model being developed in China, reforms and other efforts were intended to ensure the proper training and professionalism of local practitioners and thereby alleviate the perception that physicians were uneducated. Even in the tumultuous decades following the formation of the PRC, Singapore’s Chinese medical community continued to organize and professionalize with reference to this model, albeit without an overtly political agenda backing them. Many personal, professional, and institutional linkages ensured the virtually continuous (if uneven) flow of people, materials, and ideas between the PRC and Singapore. Subsequent to the establishment of Singapore’s sovereignty in 1965 and the PRC’s opening in the 1980s, these linkages have moved into the open and expanded, and organizations like the SCPA have since fostered and maintained close international collaboration and exchanges with the PRC (Sinha 1995: 189–92). As Sinha explains, fears of quackery had tarnished the reputation of Chinese medical physicians and encouraged many patients to pursue biomedical treatment instead. For instance, in the 1990s, despite legislation that separated the two medical practices, cases of Chinese herbal preparations containing elements found in biomedical treatments, such as paracetamol or dexamethasone, were still found and prosecuted (Sinha 1995: 188–89). One high-profile case in 2002 involved a diet pill called Slim 10, advertised as a purely (Chinese) herbal remedy but actually found to contain N-nitroso fenfluramine—a chemical that has been linked with liver failure (Cullen 2002). The death of at least one Singaporean woman (from liver failure) and the emergency liver transplant of well-known local actress Andrea De Cruz, were both attributed to the women’s use of Slim 10 and thus fueled public concern about the safety of Chinese proprietary medicines. In response, the Chinese medical community continued to address its problematic reputation through the organization of physicians into associations, the so-callled modernization of clinics, 54

Chinese Medicine Unbound



and the regulation of physicians and materia medica. Furthermore, physicians and Chinese pharmacy proprietors demonstrated their willingness to adapt to consumer demands through a series of “modernization” efforts, incorporating new technology into their practices and renovating the buildings in which they practiced. By outward appearances, many Chinese medical clinics and shops strove for the same legitimacy afforded biomedicine, which set medical standards through the Singapore Medical Council (a statutory board of the MOH). Hence, many Chinese medicine and food shops, like Eu Yan Sang and Hock Hua, “upgraded” their appearance and operations in accordance with perceived consumer preferences and/or landlord requirements. For instance, the manager of Hock Hua’s Toa Payoh branch explained to me that Hock Hua was modernizing its stores one at a time (starting with the Jurong West branch in 2005), with reference to contemporary interior design standards: lighter colors, glass shelving, tidy new displays, and more lighting fixtures. Similar strategies have also been noted by Sherman Cochran in his discussion of Wuzhou Da Yaofang (Great Five Continents Drugstores)—a successful chain referred to as the “king of drugstores” in early twentieth-century China. In contrast with what he regarded as traditional Chinese shops—typically one or two dimly lit stories with wooden fronts, no windows, overhanging eaves, lacquered wooden shop signs, and cloth shop symbols—Five Continents shops were two or more brightly lit brick or concrete stories with “Western-style” decorations, eye-catching interiors, windows, and wide entrances (Cochran 2006: 77–80). Although these shops largely sold “Western-style” goods, while Hock Hua primarily sold Chinese foods and herbs, both accommodated local design tastes in their appearances.22 After years of governmental encouragement to “upgrade” Chinese medical practice in Singapore (Quah 1989: 152), in 1994 a committee was formed by Minister for Health George Yeo to further organize Chinese medicine in Singapore. Although intended to include local professionals, the committee was reputedly marked by a strong influence by medical experts from the PRC, and was therefore criticized for its lack of involvement of local institutions. Organized by the MOH, the Singapore TCM Organisations Coordinating Committee brought together eight of the largest Chinese medical organizations (including the SCPA), thus creating a dialogue partner between 55

Capturing Quicksilver Chinese medical practitioners from both Singapore and the PRC, and the MOH. A second group, the TCM Organisations Committee, was created under the Health Sciences Authority (HSA) to assemble the Chinese herbal trade organizations—importers and exporters, a few manufacturers, and retailers—in a similar fashion. These committees produced the “Report for the Committee of TCM,” which recommended a legal framework for both the practice of Chinese medicine and the regulation of Chinese materia medica.23 This became the foundation for the TCM Practitioners Act. Concerns about low standards and oversupply (and, thus unemployment) nonetheless persisted. The latter concern was addressed by the MOH in the standard economically oriented fashion: “Let market forces sort it out” (The Straits Times, March 10, 2005). Yet, by the time of my fieldwork, the market had not produced a drop in the number of physicians; to the contrary, the 2007 TCMPB annual report describes steady annual growth, resulting in 2,232 registered physicians as of December 31, 2007.24 As for low standards, the report listed only ten new complaints: four for professional negligence or incompetence, three for professional misconduct, two for prescribing, dispensing, or using “Western” medicines, and one listed as “other” (TCMPB 2007). Thus, according to the MOH’s method for evaluating patient satisfaction and practitioner compliance, it appears that Chinese medical practice standards—as set by the TCMPB—were being maintained by the vast majority of physicians. In conclusion, the colonial administration’s stance on Chinese medicine was primarily to exclude it from medical legislation entirely, tacitly tolerating its practice and popular use. The post-colonial government overtly maintained this strict separation from biomedicine in the interest of public safety. The conjoined problems of legitimacy and authority—and the manner in which Chinese medical physicians negotiated their practice with respect to Singapore’s exclusively biomedical healthcare system—were important themes that, in part, set the politico-medical scene in which my fieldwork was conducted. While we can speak of Chinese medical physicians being marginalized in the post-colonial healthcare system, the ongoing professionalization activities mentioned above illustrate their persistent, active engagement with both Singaporean sociopolitical processes and TCM as a global form. But before we can view the 56

Chinese Medicine Unbound



Singaporean assemblage of Chinese medicine in relation to this fluid and variable form, it is important to consider how TCM was (re)invented to begin with.

(Re)inventing TCM Scholarly constructions of zhongyi, the contemporary Mandarin term for Chinese medicine, have varied in approach and orientation over time. In China the practice of Chinese medicine developed heterogeneously, as reflected in two millennia of written commentaries, treatises, and reinterpretations. As described by Xu et al. (2013), over the past sixty years the modernization of Chinese medicine can be outlined in three major phases: first, the professionalization and institutionalization of education, clinical practice, and research from the 1950s to the 1970s; second, the development of legal, economic, and scientific frameworks and networks from the 1980s to 2000s; third, the consolidation of scientific evidence and clinical practice in the twenty-first century. In European and North American scholarship, particularly from the late imperial period onward, the stance taken on Chinese medicine has also shifted considerably. In this section I will highlight a very small portion of this scholarship in order to briefly review the Maoist-era, nationalist reinvention of Chinese medicine as traditional Chinese medicine (TCM). In the process I will illustrate a few significant shifts in how Chinese medicine has been framed in Euro-American scholarship. In seeking to demonstrate that Chinese medicine is a science, Manfred Porkert (1974, 1982) analyzes the syntactic, semantic, and technical inflections of Chinese medical terms. His account of Chinese medical theory stresses its internal logic and coherence by depicting basic theoretical constructs as fixed, abstract ideas, interrelated in a “system of correspondences” (Porkert 1974). By comparison with the “classical” practice of Chinese medicine, he views contemporary practice as the peddling of “make-shift expedients,” rather than as a process of determining treatments on the application of sound and historically continuous theoretical elaborations (Porkert 1982: 569). He thus adopts a revivalist perspective in which the golden age of traditional medicine has been supplanted by a “modern,” watered-down version. He attributes the reasons for this 57

Capturing Quicksilver continued decline almost exclusively to contact—and conflict—with “Western civilization”. Addressing similar issues, Ralph Croizier’s (1976) historical analysis asserts that, as a system of medical thought and practice more than two thousand years old, zhongyi was named as such only in the late nineteenth century, upon exposure to “Western” culture and medicine. Seeing science as the cure to China’s ills, he explains, factions within the new republic and the May Fourth Movement sought to eradicate Chinese medicine as an ancient symbol of Chinese culture, while others sought to conserve it. Subsequently, prominent voices in the PRC called for the preservation of Chinese medicine as an expression of both progress and patriotism by organizing and regulating practitioners (Croizier 1976: 341–43; Lei 2002). This ideological promotion of the “medical legacy of the Motherland” culminated in the compilation of folk remedies as proof of the people’s medical wisdom during the Great Leap Forward, but dwindled thereafter due to economic and political pressures (Croizier 1976: 346–48). Finally, during the Great Proletarian Cultural Revolution advocates once again took up the cause of preventing the dissolution of Chinese medicine by reorganizing medical schools to integrate Chinese and “Western” medicine (Croizier 1976: 351). These historical processes, and their impact on contemporary theory and practice, have been noted by most subsequent scholars on Chinese medicine—some in great depth, such as Kim Taylor’s (2005) book-length account. Paul Unschuld (1985) also examines the history and nature of medical plurality and change in China, framing the state’s management of Chinese medicine within a longer history of social metamorphosis. He highlights how the post-imperial management of Chinese medicine (reinvented under new political circumstances) was the third major attempt at its legitimization. This was preceded, Unschuld shows, by the much earlier shifts from magic-based herbal remedies to pragmatic remedies, and then to pharmacological doctrine (Unschuld 1985: 259). Once its foundation in systematic correspondence and corresponding imperial worldview had been removed in the mid twentieth century, he claims, a new form emerged that reflected Marxist–Maoist values.25 Meanwhile, Nathan Sivin (1987) claims that this refashioning of Chinese medicine produced—rather than resolved—further inconsistencies in Chinese medical accounts, resulting in an overall decrease 58

Chinese Medicine Unbound



in theoretical coherence. Sivin makes two general points in this vein: The first is that contemporary Chinese medicine is characterized by tumultuous change, evident in the politically motivated efforts to modernize medical practice in the twentieth century. The second is that this change can be differentiated from the constant accumulation and reinterpretation of Chinese medical knowledge over the previous two millennia, in which a common theoretical foundation provided the baseline for divergent practices. This contemporary theoretical incoherence, Sivin argues, has been exacerbated by the unsystematic synthesis of elements of “modern” medicine with “traditional” medicine, despite their radically divergent concerns, orientations, and conceptions of the body (Sivin 1987: 197–98). While Sivin employs a diachronic perspective that discusses specific theoretical developments within the sociopolitical context of China in general, Judith Farquhar (1994) links the two to actual practice. Her ethnography critiques analyses that divide theoretical foundations from their clinical application, which she regards as founded in a dualist division between theory and practice. By contrast, her analysis reintegrates theory and practice in order to examine the “practical logic of the clinical encounter” (Farquhar 1994: 61). With the caveat that a great deal of variation exists between clinics and between doctors, she presents a generalized account of the application of Chinese medicine’s dynamic body of knowledge in practice. Broadly speaking, Farquhar explains how physicians filter a patient’s specific complaints through a complex classificatory process in order to identify a particular syndrome and determine the appropriate treatment, thereby developing a highly personalized medical intervention. Elisabeth Hsu’s ethnography also contextualizes Chinese medical “reasoning as social practice” (Hsu 1999: 3) within specific social settings. She illustrates how concepts are socialized by describing how knowledge and the meanings of a given concept are contingent on their manner of transmission, the relationship between actors involved in this process, and an individual’s style of knowing. Hsu notes the discontinuity between contemporary Chinese medical textbooks and long-standing concepts and practices of Chinese medicine, demonstrating how the former are constructed with reference to political ideology and “Western” science, in order to produce biomedically oriented theory in place of Chinese medical doctrine. 59

Capturing Quicksilver She thus demonstrates that the practice–theory divide proposed by Porkert is not inherent to Chinese medicine, but has developed as a product of standardization (in the form TCM). Finally, Volker Scheid (2002) advocates multisited fieldwork and ethnographic analysis, while also relying on the canonical texts and commentaries of Chinese medicine as an epistemological reference point. Scheid insists that Chinese medicine is not a totality and thus cannot be reduced to a singular cultural logic or process, and that it is currently both emerging and disappearing, subject to global synthesis and local production. Using the term “Chinese medicine” to refer to the scholarly elite practice of the imperial, republican, Maoist, and post-Maoist periods, he notes that physicians frequently incorporate biomedical diagnoses and prescriptions into their practice, while Chinese biomedical doctors, in turn, use drugs based on the Chinese materia medica. In concert with earlier scholars, he agrees that historical interaction with biomedicine has created further diversity, without resolving the preexisting contradictions within Chinese medical doctrine. Particularly relevant to the formation of my own research, Scheid incorporates patient agency into his analysis, challenges earlier rational choice models, and describes how physicians’ practices must accommodate patients’ experience (and terminology) in their symptomatic descriptions. He suggests that this grassroots pressure, although exerted individually and locally, has the power to collectively shape the practice of Chinese medicine. These accounts indicate that both the practice of Chinese medicine and scholarly representations thereof—including analyses of its sociopolitical context, of its theoretical and practical development, and of its position relative to biomedicine—underwent significant changes in the mid twentieth century. From Manfred Porkert’s ahistorical separation of theory and practice to Volker Scheid’s emphasis on synthesis and plurality, one can observe an increasing emphasis on the representation of Chinese medicine in diachronic, particularistic, and nonreductionist terms. In many ways, the twentieth century reformulation of Chinese medicine seems to have worked in an opposite direction—that is, toward a synchronic, standardized, and essentialized reformulation of Chinese medical theory and practice, under the somewhat oxymoronic moniker of TCM. Whether one views this process as discontinuous with or embedded in longer processes of emergence, 60

Chinese Medicine Unbound



there seems to be general agreement that the politicized practice known as TCM (which highlights features commensurate with biomedicine) became the primary medical practice associated with Chinese culture and heritage around the world.

Chinese Medicine in Transit As described above, epistemological and sociohistorical analyses of the nationalist formulation of TCM seem to dominate contemporary studies on Chinese medicine in the PRC. Slightly less prevalent, but equally important, are patient-oriented studies (e.g., Kleinman 1980; Ots 1994), and those considering how Chinese medicine is framed as CAM or is globalized outside the context of the PRC (Barnes 1998; Hare 1993; Hsu and Høg 2002; Zhan 2009). In light of a rapidly developing global market for so-called traditional medicine, or CAM, these and other scholars are broadening their focus and/or moving beyond the historical or territorial boundaries of China to explore transnational flows, negotiations, and multilateral exchanges. In this section I will briefly outline a few examples of this approach, illustrated with reference to a case of early transnational Chinese medicine entrepreneurship in Singapore. Contrary to the observation of scholars who examine the use of traditional or alternative medicine in Europe and North America, Elisabeth Hsu (2002) notes that Tanzanian patients do not seek out Chinese medicine for what is sometimes referred to as its holistic approach (although they do similarly seek it as a “natural” remedy). While patients in the PRC (as well as Europe, the United States, and Singapore) note that Chinese medicine is slow-acting, Tanzanian patients remark on its “rapid effects” (Hsu 2002: 293–94). Furthermore, Hsu cites several social factors that contributed to the common negative perception of biomedicine among Tanzanian patients. They perceive Chinese medicine, on the other hand, as “advanced” or “scientific,” which Hsu asserts is associated with the evaluation of PRC socialism as superior to capitalism (Hsu 2002: 306).26 Other scholars have similarly taken up the issue of the local refashioning of Chinese medicine, situating its practice and/or use in specific (but certainly not isolated) social, economic, and political contexts. Vivienne Lo and Sylvia Schroer (2005), for instance, 61

Capturing Quicksilver take up the question of continuity and change in the meaning of the Chinese medical concept xie (evil) over space (from China to Europe) and time. Situating metaphorical representations of the body and health within broader conceptions of the environment, politics, and society, they demonstrate how medical theory reflects the perceived social and moral conditions of the time.27 Meanwhile, Martha Hare (1993) relates how Chinese medical patients not of Chinese descent, living in New York, emphasize bodily experiences and physician empathy in explaining and assessing the success of a treatment. In evaluating physicians as well, she notes that Chinese medicine in the United States combines Confucian and Daoist models of order with American individualism. Hare thus contrasts the experiences and ideologies of Chinese medicine physicians and patients with the fragmented experiences of technological and biomedical interventions, as situated within the cultural, economic, and sociopolitical milieu of the United States (Hare 1993: 42–43). In a similar fashion, Linda Barnes (1998) discusses the filtering of Chinese medical tradition through the psychotherapeutic language and correlated ways of thinking or behaving that are characteristic of the United States (Barnes 1998: 413). In PRC medical settings, she claims, emotional states are typically associated with and expressed in terms of bodily conditions, producing a “commonly understood language of distress” (Barnes 1998: 420).28 Because non-Chinese American patients do not learn this language, they resort to the paradigms with which they are familiar, understanding and explaining Chinese medical practices and notions in American terms—what Barnes calls psychologization.29 She predicts that cross-fertilization will bring these notions originating in the United States into the PRC, and then back into the teaching content of Chinese medicine in the United States, making it increasingly difficult to definitely differentiate the two. This process of cross-fertilization has indeed been outlined in various places by other scholars. For example, Mei Zhan (2009) discusses the “worlding” of Chinese medicine as a series of translocal movements, displacements, and reformulations. Based on multisited fieldwork in San Francisco and Shanghai, she illustrates how preventive aspects of Chinese medicine are highlighted in response to the expectations of CAM consumers in countries like the United States. Instead of focusing on either the universal and continuous aspects 62

Chinese Medicine Unbound



of Chinese medicine or spatially bounded, local variants, she thus situates this reinvention (as preventive medicine) within “uneven, interactive, translocal networks and processes” (Zhan 2009: 173). Highlighting this preventive medicine emphasis in multiple places and times—from the “Maoist worlding of Chinese medicine” in Africa (Zhan 2009: 176) to the trans-Pacific networks she later studied—Zhan notes how politics of difference are reinscribed in the production and negotiation of different worlds.30 A cogent example of this sort of negotiation, particularly relevant to Singapore, can be found in the adaptive marketing strategies of early twentieth-century Chinese medical tycoon Aw Boon Haw, one of two brothers responsible for the internationally recognized product Tiger Balm. In his detailed histories of early twentieth-century Chinese medical entrepreneurs (of which Aw was one example), Sherman Cochran (2006) examines the interrelated processes of globalization and localization, and the rise of Chinese consumer culture. In a similar vein as Pieke et al. (2004), Cochran critiques analyses of globalization that focus solely on the impact of Western-based corporations on non-Western consumers, highlighting the agency of Chinese entrepreneurs to operate “beyond the frontiers of globalization” (Cochran 2006: 4), evade political boundaries, localize goods, and facilitate cultural homogenization. He relates how aspects of the West and Chinese culture were locally defined, (re)invented, appropriated, and modified as these cultural mediators promoted their businesses and products. In doing so, he shifts attention from the political or intellectual spheres as the primary loci for change to individual entrepreneurs, and away from Western history as the exclusive context for globalization, to early twentieth-century China. For instance, Cochran describes how Aw Boon Haw and his brother Aw Boon Par (both born in Burma, of Hakka descent) successfully promoted their product Wanjin You (Tiger Balm, or Ten Thousand Golden Oils), throughout Asia during the first half of the twentieth century. Observing the marketing techniques and media usage of “Western-style” drugstores in Hong Kong, China, Japan, and Thailand, Aw Boon Haw sought to similarly overcome so-called cultural barriers by developing his own transnational, image-oriented advertisements. With a heavy visual bias on Tiger Balm’s trademark leaping tiger—accompanied by small amounts of text that was translated into local and colonial languages—the advertisements 63

Capturing Quicksilver had wide appeal among mainland Chinese, overseas Chinese, and Southeast Asian consumers alike. While overseas Chinese in the Straits Settlements (contemporary Singapore and Malaysia) identified and used it as Chinese medicine, Thais or Burmese considered it Southeast Asian and used it for amulets, medicines, and aphrodisiacs. In the 1920s Aw moved his headquarters from Rangoon (contemporary Yangon) to Singapore, and between 1929 and 1938 he founded eleven newspapers in Southeast Asia and China, which he used “as weapons for capturing medicine markets in the Chinese diaspora as well as China” (Cochran 2006: 133). Although his newspapers operated at a loss, these efforts constitute an intentional strategy on Aw’s part, who openly admitted to his dual interests of serving his country (at this point, Singapore) and marketing his medicine. In addition to posters and other printed advertisements, in the 1930s the Aws also built extensive culturally themed gardens in Hong Kong and Singapore, known as Tiger Balm Gardens (also referred to as Haw Par Villa in Singapore). Although these also served as sites for the Aw brothers’ homes, they were opened to the public for promotional purposes. Even after the start of the SinoJapanese War in 1937, Aw’s products continued to gain in popularity in China, and he was able to expand distribution from Southeast Asia to India, making 1937–45 Tiger Balm’s golden age. Drawing on Joseph Nye’s (1990) distinction between governments’ hard power and commercial or cultural media’s soft power, Cochran claims that Aw’s shortage of the former was overcome by an abundance of the latter.31 Aw’s ability to successfully negotiate these transnational and transcultural contexts relied on his flexible appropriation of “Western” drugstore marketing strategies, adjusted to local language and customs, through which consumers in turn imbued the products of this strategy with their own meanings. In summary, Cochran’s account illustrates the ability of Chinese medical entrepreneurs to negotiate various social and political processes, over space and time. Rather than describing the relationship between governments and business during this period as one of unilateral imposition and control, Cochran suggests it was a two-way process. Furthermore, he allows for the possibility that consumer demands and representations in turn influenced the direction of entrepreneurial efforts. Finally, he shows how individuals previously relegated to the periphery were able to produce and disseminate consumer 64

Chinese Medicine Unbound



culture across national boundaries. As I will describe in subsequent chapters, such transnational flows—and the explicitly problematized identity politics with which such flows were associated—were (and continue to be) important facets of Chinese medicine in Singapore.

Conclusion The contemporary scholars cited above illustrate how social and political changes of the twentieth century impacted the development of Chinese medical theory and practice around the world. Augmenting and building on earlier studies that sought to establish the systematic or scientific nature of Chinese medical theory, scholars like Sivin, Unschuld, and Scheid demonstrate the dynamic and politicized (re)invention of Chinese medicine (most recently in the form of TCM). Studies reflecting on the globalization of Chinese medicine—Vivienne Lo and Sylvia Schroer (2005), Iven Tao (2009), and others in Europe; Martha Hare (1993), Linda Barnes (1998), and Mei Zhan (2009) in the United States; and Elisabeth Hsu (2002) in Tanzania—also illustrate the fluidity, permeability, and plasticity of Chinese medical theory and practice. More broadly speaking, these approaches to studying Chinese medicine are consistent with anthropological analyses of medical practices and medical pluralism such as Leslie’s (1976) volume on Asian medical systems, Ohnuki-Tierney’s (1984) study in Japan, Sinha’s (1995) research in Singapore, and Alter’s (2005) edited volume Asian Medicine and Globalization. Collectively, they indicate that socially embedded medical practices do not remain static or bound by categorical divisions, despite the academic or state discourses that circumscribe them. As I have argued above, insofar as it tends to consider Chinese medicine in opposition with biomedicine, a purely CAM-based analysis nicely represents the political division, definition, and hierarchical arrangement of these two forms of medicine in Singapore. It does not, however, sufficiently explain the complex manner in which Singaporean patients and practitioners relate to, and enact, the practice. To this end, it is useful to concomitantly consider Chinese medicine in Singapore as a transnational “traditional” practice, associated with various waves of migration from southern China and other countries in Southeast Asia. Furthermore, the historical and contemporary transnational flows associated with TCM 65

Capturing Quicksilver do not simply move Chinese medicine from one location to another, but, rather, transform its theory, practice, and authority as conceived locally and, to some extent, globally. First practiced as a grassroots-level, nonregulated form of healthcare, Chinese medicine in Singapore has been increasingly reshaped within the political sphere. This partially reflected its standardization and scientization in the PRC as TCM, and partially accommodated the changing expectations and aesthetics of Singaporean patients as consumers. For several decades after the formation of the PRC, there was a decrease in the speed and frequency of exchange between Singaporean and China-based Chinese medical physicians and institutions. Nonetheless, one can still trace signs of a virtually unbroken flow between them, as long as there have been ethnic Chinese in Singapore. Hence, the TCM promulgated in the PRC—standardized and emphasizing features commensurate with “Western” medicine— has thus become the only politically acknowledged form of Chinese medicine (or of traditional medicine, for that matter) in Singapore. At the confluence of charitable and commercial work, Singaporean Chinese medicine emerges in somewhat strained relation to biopolitical processes. Appraised against an exclusively biomedical healthcare system, Chinese medicine (as TCM) has been most recently framed as a complementary practice with economic potential; at worst, it is depicted as antiquated and unscientific quackery. Lim et al.’s (2005) study indicates that Chinese medicine is remarkably popular in Singapore in general, and the physicians with whom I worked during my fieldwork were undoubtedly granted a great deal of authority by their institutions and patients. As I will describe in subsequent chapters, this authority cannot be reduced to mere compliance with or inclusion within the biomedical healthcare system. From the perspective of the Chinese medical community, the community’s ongoing efforts to professionalize and demonstrate the legitimacy of their practice reflect dynamic negotiations, rather than a static and subordinate position as a marginalized group.

Notes 1. The Belt and Road Initiative was announced by President Xi Jinping in March 2015 after the Silk Road Economic Belt was proposed during a state visit to Kazakhstan in September 2013 and the 21st Century 66

Chinese Medicine Unbound

2.

3.

4. 5. 6.

7. 8.

9.

10.

11.

12.



Maritime Silk Road was proposed during a visit to Indonesia in October 2013. For more information, see the State Council of the People Republic of China’s website: http://english.gov.cn/beltAndRoad/. The Johor River is located in the contemporary peninsular Malaysian state of Johor, immediately north of Singapore, while the Riau islands are part of the Indonesian archipelago to the south. An influential first-generation member of Singapore’s dominant political party, the People’s Action Party (PAP), Goh Keng Swee was appointed to a number of different political offices from 1959 to 1984, including minister of Finance, minister of Defence, deputy prime minister, minister of Education, and first deputy prime minister (Kwok 1999: 45–46). This refers to the thick annual smoke produced by slash-and-burn practices in Indonesia and Malaysia. In this context, lah is an emphatic final particle (most likely from the southern Chinese dialect, Hokkien) with no direct English translation. The process of steeping herbs in boiling water or simmering them over a longer period of time, to create a beverage or soup, is called decoction. Sometimes the product of this process is also called a decoction. Some Singaporeans referred to this as deer horn, although that is technically a different herb—lurong, or Cornu cervi. Medicinal plants, animals, and minerals are all classified in the materia medica as herbs. Reference to Chinese herbs, rather than to Chinese drugs, has been contested by Elisabeth Hsu (2009a), who notes that while the term “herb” is often used to imply a lack of purified chemical substances, it also suggests purely plant-based treatments when animal and mineral substances might also be included. She further critiques the use of the term “herb” because of the associated implication that Chinese medical formulas consist only of raw materials when, in actuality, most of the constituents are processed in some fashion before use. The third character, although translated here as tea, might be more accurately translated as decoction because no tea leaves are used in the formula. In addition to the medical anthropologists cited in the introduction, this strategy draws inspiration from Arthur Kleinman’s observation that despite the great deal of activity in the popular healthcare sector, the authority to define illness and legitimize particular constructs “as the only clinical reality” is not evenly distributed between popular, folk, and professional sectors (Kleinman 1980: 50–52). For instance, Quah applies Bates’s (1995) division between the gnostic knowing of traditional healing systems and the epistemic knowing of scientific epistemology, in order to compare and contrast these different domains (Quah 2003: 2001–8). Singapore’s split-stream education system was founded during the colonial period, when most ethnic Chinese children were taught in community-based Chinese-language schools (in which Mandarin or southern Chinese dialects were the languages of instruction), while the 67

Capturing Quicksilver

13.

14.

15.

16.

17.

18.

19. 20.

21.

22.

children of British expats and select ethnic Chinese children (future civil servants) were taught in English-language schools. In the mid-1960s, the post-colonial Singaporean government instituted a bilingual public education system in which English was the language of instruction, and mother tongues such as Mandarin, Malay, and Tamil were taught as mandatory second languages. In addition to regulatory approaches, Singaporean biomedical researchers, physicians and academics have offered techno-scientific solutions to counterfeiting and contamination risks. See, for example, Lee Tat-Leang’s (2006) article on outstanding issues of Chinese medicine and other CAMs in biomedically dominant societies and Kevin Yi-Lwern Yap, Sui Yung Chan, and Chu Sing Lim’s (2007) article on the authentication of Chinese materia medica. As noted in the introduction, the abbreviation TCM is found in governmental and administrative discourses in Singapore and elsewhere. It is also sometimes used to differentiate the product of Maoist-era reformulations from earlier (or geographically distant) forms of Chinese medicine. In this book I will refer to TCM in Singapore only in those contexts where the abbreviation is actually used or implied. Although Dr Wang resided in Singapore, he maintained personal and business ties in Taiwan and visited several times per year. Thus, he remained apprised of the current affairs and general economies of both Taiwan and Singapore. Many analyses of the doctor-patient relationship have been written, particularly (but not exclusively) within biomedical contexts; e.g., see Finkler (1984), Gould (1977), Hahn and Kleinman (1983), and Kleinman (1980). Subsequent to the TCM Practitioners Act, some unregistered practitioners continued to treat patients from their homes or in temples, although they did not advertise their services and therefore relied exclusively on patient referrals for continuing business. Cochran also notes that these ready-to-use preparations (chengyao) were sold in the famous Chinese medicine shop Tongren Tang and its familial affiliate Daren Tang in early twentieth century China (Cochran 2006: 32). These are the SCPA, Chinese Druggists Association, Association for Promoting Chinese Medicine, and Singapore Acupuncture Association. Chung Hwa was subsequently opened in 1979 in densely populated Toa Payoh—one of the Housing Development Board’s (HDB) first development areas. In this book, I use “mainland China” to refer to the geographically contiguous portion of China, while the “PRC” refers to the nation-state of China and is not limited to the mainland (e.g., it includes special administrative and autonomous regions such as Hong Kong and Macau). More will be said on the classificatory features of the term “taste” in chapter 6.

68

Chinese Medicine Unbound



23. Singapore Committee on Traditional Chinese Medicine. 1995. Traditional Chinese Medicine: A Report by the Committee on Traditional Chinese Medicine. Singapore Ministry of Health, Singapore. 24. This figure consisted of 1,219 registered as both TCM physicians and acupuncturists, 831 as TCM physicians only, and 182 as acupuncturists only (TCMPB 2007). 25. This was also noted by Croizier (1976: 351–53). 26. For example, the exorbitant cost—including bribes for doctors and pricy medications—long queuing, and physicians’ perceived lack of concern for the patient (Hsu 2002: 304). 27. For example, they claim that while the Huangdi Neijing (Yellow Emperor’s Inner Cannon) relates how physicians manipulate qi (a fundamental substance/force) to prevent xie (evil) qi from harming the body, such references to xie as evil (often associated with demonic beings) were “exorcised from the top down” in China starting in the 1940s (Lo and Schroer 2005: 57). 28. Barnes quotes Lu Weidong: “In China, they taught the traditional Chinese gentleman way. You can’t just cry in public or lose your temper and get angry or upset. You control your emotions more, because this will make the group or community work more as a unit and be more close” (Barnes 1998: 420). Hence, she claims, emotional states are expressed in bodily disorders. In light of the nuanced explorations of the topic by Thomas Ots (1994) and others, one might wonder if this is a somewhat overgeneralized explanation of the relationship between emotional and bodily experiences. 29. This contrasts with the manner in which Chinese medicine is physiologised in Germany, as described by Iven Tao (2009). 30. Elisabeth Hsu (1995) also discusses the cross-fertilization of practices in different sites when she explains how auriculotherapy was developed by a French acupuncturist and then reinterpreted as “ear acupuncture” in the nationalist ideology associated with Chinese medical practice in the PRC. 31. The problem of China’s soft power in Southeast Asia was a multifaceted and widely dispersed discourse during this time. For instance, in the former Straits Settlements the transnational culture and potential loyalties of the overseas Chinese (encouraged through China’s soft power) were considered a threat to post-colonial nation-building processes, as I will describe in chapter 2.

69

Chapter 2

From Imaginative Geography to Collective Lobotomy

I want to suggest another version of heritage: not a discovery of origins, but of the impossibility of specifying origins; not of history as a well-turned story—with a beginning, middle and an end—but as another, altogether unreadable story: namely, history as a realm of contradictions—unresolved; history as a series of alternatives— abandoned; history as a collection of intimations—refused. Such a view of history is truthful—but also, precisely for that reason, difficult to maintain. —Janadas Devan, “Forgetting to Remember”

Introduction During my tenure in Singapore I lived in two very different Housing Development Board (HDB) estates—uniform clusters of government-subsidized apartment buildings that consist of flats arranged along a common covered corridor. The first was relatively old, central (in Kallang), dilapidated, and small (only six floors), while the second was a more recent and medium sized (a more standard fifteen floors) high-rise development in the north of the island (in Sengkang). Although my perceptions of social life in these estates were no doubt heavily influenced by my own experiences growing up in a small town in Montana, my impressions of community in the two estates were radically different. In Kallang, many people left their doors open during the day, chatted with their neighbors in the evenings, and allowed their children to play together in the much-used common courtyards. Older women (called “aunties”) held vigil and council on their balconies and patios throughout the 70

From Imaginative Geography to Collective Lobotomy



day, while older men (called “uncles”) played games and talked in the courtyard, particularly in the evenings. In Sengkang this also occurred, but with far less regularity and openness—people left their doors closed and gathered in private locations or at nearby shopping complexes. Public events at the first housing estate, such as the Qing Ming festivities I will describe momentarily, occurred with greater frequency and broader public participation. Meanwhile, events at the second estate appeared to be more private, and apparently limited to one or more specific groupings of extended family and friends. This contrast evoked the distinction between historical kampongs (Malay: colonial-era farming or fishing villages) and contemporary HDB life that my friends and acquaintances often described, and demonstrated how community could manifest quite differently even in exclusively urban Singapore. These impressions were further reinforced by a Singaporean Chinese friend (in his early thirties at the time), who explained that he liked to visit the first estate in which I lived—despite the assault of smells and insects—because it reminded him of his childhood kampong. Life in a “modern” HDB unit, like the second housing estate, markedly did not evoke the kampong sense of community. One evening in late February 2006, a few months after my arrival in Singapore, I observed a Dragon Dance rehearsal in a courtyard of the first estate in which I lived. After a brief performance of each part, the dancers retrieved a long day-glow dragon, positioning one dancer at each of the long black poles that held up the dragon’s serpentine sections. Following the lead dancer, whose pole supported a day-glow ball the dragon was set to chase, they danced in and out of a tent in the background, dipping, diving, and spinning—raising and lowering the poles in succession to create the appearance of a dancing dragon. The tent was lit only by an ultraviolet light, so the dancing dragon glowed vibrantly through its clear sides. After several more rounds inside, the dragon snaked toward the back-side of the tent and out of view. Throughout the rehearsal, small clusters of people sat on curved concrete benches surrounding the courtyard, while children of various ages played on both the playground and exercise equipment set into the concrete or Astroturf. Groups of aunties laughed and chatted in Mandarin or Southern Chinese dialects, dispersing and 71

Capturing Quicksilver rejoining in various combinations as others walked into the courtyard. Young boys beat on the playground equipment with sticks or other small objects; one intently watched the drummers and at times matched one of the drums precisely. People in surrounding buildings looked down from their windows or stood on balconies for short intervals to observe the commotion. The event brought people from all over the estate together in a very informal and rather spontaneous fashion. Although the sights, sounds, and other sensorial aspects of this event were quite different from my childhood in Montana, the loose communal gathering felt unexpectedly familiar. It left me to wonder if this was how community (not to be confused with society or the nation) was enacted in contemporary Singapore—through small and largely unpublicized, nongovernment sponsored events. Or perhaps my own experiences in a tightly knit community, coupled with expectations of what community might look like in a huaren (ethnic Chinese living overseas) context, were generating an impression of solidarity against the otherwise atomized, urban hustle and bustle of daily life. A few months later, in April 2006, I came home to find one of the estate courtyards full of people celebrating Qing Ming.1 A strong smell of joss sticks, and the sight of burning candles and colorful flags accompanied three connected tents, the focal point of which was a tiered altar decorated in red and gold with Chinese characters. Most of the sixty or so participants shuffled in a procession that ended in a long queue, in which brightly dressed men waved flags over each participant’s head as they waited their turn to place their joss in a burner. There was also a small tent to one side that housed a puppet show and shielded a few musicians from an audience of only a few sideline spectators (all the chairs in front of it were empty). A Singaporean friend later informed me that the puppet show was not intended for the living but was instead staged for the dead, and he was not surprised that they were playing to an apparently empty audience. I encountered variations of these celebrations in many forms and places during the weeks surrounding this annual event— dynamic cultural practices that had resisted absorption into the political rhetoric of a purely national identity. In a more formal sense, community was cultivated in community centers or clubs, which constituted a focal point for many social activities in Singapore’s various towns. But, because the centers 72

From Imaginative Geography to Collective Lobotomy



once served as a platform for politicians to campaign to a given neighborhood (and some still do), many Singaporeans viewed these centers as extensions of the dominant political party, the People’s Action Party (PAP). In fact, the clubs and centers were all joined under the umbrella of the People’s Association, which maintained links with both grassroots and officially (PAP) sanctioned political groups. Many Singaporeans and scholars, such as Christopher Tremewan, emphasize the activities of the latter: Since the 1960s, the PAP has used state organisations in housing estates as its party apparatus, thereby monopolising the social space where most people live and preventing the emergence of autonomous social organisation. These PAP-dominated organisations include the People’s Association, Community Centre Management Committees, Citizens’ Consultative Committees, Constituency Committees, Town Councils and Residents’ Committees. The usual route to membership of these “grass-roots” bodies has been recommendation of a PAP MP [member of Parliament] or other senior functionary, vetting by the Internal Security Department and appointment by the Prime Minister’s Office. (Tremewan 1998: 95)

Although by the time of my fieldwork many community centers were referred to as community clubs to downplay this politicization, the reputation endured and their intended function of building a sense of community was somewhat eclipsed by the political sphere in which they were constructed. Thus, while community clubs certainly organized ethnic events—often in conjunction with seasonal festivals—I also frequently observed more-organic or more-spontaneous community events, like those described above.2 Although such communal expressions were apparently possible on the community level, state endorsement of Chinese cultural practices like Dragon Dance, Qing Ming, or Chinese medicine was discouraged for more than three decades. Externally, the official promotion of Chinese culture was discouraged by the anticommunist and anti-Chinese sentiments of neighboring nation-states, which arose in response to increasing Chinese nationalism in Southeast Asia around the end of the colonial era (Kong 2003: 64).3 Internally, it waned after independence due to the state’s necessary sensitivity toward non-Chinese Singaporeans (particularly those of Malay descent), an issue at the heart of the “race riots” of the 1950s and 1960s. The gradually improving relationship between Southeast Asia 73

Capturing Quicksilver and the PRC since the late 1970s—coterminous with a growing recognition of the economic and moral value of Chinese language and culture in Singapore—expanded the possibility of cultural growth at the turn of the century (Lee 2003: 234, 246). In the post-colonial nation-building era, however, state promotion of Chinese culture and medicine was seen as antithetical to economic viability and the “multiracial” nationalist sentiment they sought to inculcate. As I will illustrate in this chapter and the next, practices associated with the cultural heritage of Chinese Singaporeans—such as Chinese medicine—have been impacted by post-colonial economic strategies, social engineering efforts, and the state’s deliberate management of history and “race.” In this chapter I will review Singapore’s relatively recent sociopolitical history, with an emphasis on colonial and post-colonial governance strategies relating to political and cultural identity. In particular, I will highlight aspects of European political economy the post-colonial state retained upon independence, the state’s careful management of history and heritage, and the state’s rationale for promoting a “multiracial” national identity. Finally, I will illustrate the enactment of this national identity through the institutionalization of racial categories and the control of domestic space. Within this trajectory we get a sense of the dynamic relationship between governmentality and heritage in Singapore, setting the stage for more-detailed consideration of the political position of Chinese medicine vis-à-vis Singapore’s biomedical healthcare system (chapter 3), the state’s surveillance and transformation of the pathogenic city (chapter 5), and ongoing debates about medical authority, community, and lifestyle (discussed throughout the book).

Colonial Identity Politics In the late eighteenth and early nineteenth centuries, the British and the Dutch jostled over lucrative trade in Southeast Asia, which centered on the Strait of Malacca along the west coast of contemporary Malaysia. This struggle eventually resulted in Britain acquiring Penang, Malacca, and Singapore between 1786 and 1824—with Singapore declared a free port by Sir Stamford Raffles, a representative of the British East India Company, in 1819. The three cities were joined under the name “British Straits Settlements” in 1826. Singapore’s nearly immediate economic success prompted the 74

From Imaginative Geography to Collective Lobotomy



British East India Company to declare this small island off the tip of the Malayan peninsula the capital of the Straits Settlements in 1832. This declaration heralded the largest wave of Chinese immigration to Singapore in the course of its history. Migrating first from Malacca and Penang, and then from southern China, Chinese laborers had outnumbered Malays in Singapore as early as 1836 and constituted a numerical majority by 1849. By the second half of the nineteenth century Singapore had become Southeast Asia’s leading international port (Chiew 2002; Lee 2003; Yen 2003). Designated as an official British crown colony in 1867, Singapore attracted another boom of Chinese immigrants between 1887 and 1920 that peaked in the 1890s and increased the overseas Chinese community from 86,000 to 316,000. This migrant population has been characterized by its relative poverty, lack of urban skills, and the burning ambition to return to China and enjoy a higher quality of life (Warren 1990: 170–71)—an interpretation that is consistent with the huaqiao (sojourner) pattern of migration described by Wang Gungwu (1991) and others. As Pieke et al. (2004) note of Fujianese migrants in Europe, however, while a consistent objective of Chinese migrants was to generate enough income for remittances and an eventual return to China, individual choices also inevitably came into play. As much as migration was intended to protect the interests of the family, it also expressed a desire for “personal ambition, adventurism, and success” (Pieke et al. 2004: 195). Such aspirations for a better life (abroad or upon one’s return to China) were not always realized, as evidenced by colonial reports in the late nineteenth and early twentieth centuries that depict the dismal conditions of Singapore’s migrant laborer (also called coolie) communities. These reports often describe overdevelopment and overcrowding, poor hygiene, high morbidity and mortality levels (especially among infants), and the notable and indiscriminate presence of tuberculosis. The early Chinese community had primarily comprised men, some of whom married and had children with Malay or Indian women, thereby begetting the much-touted Peranakan culture of Malaysia and Singapore. Other men were already married or preferred to marry within their own ethnic or dialect group. In either case a steady increase in the number of female and child immigrants from the late nineteenth century onward resulted in a greater number of officially recognized families. The increase in 75

Capturing Quicksilver both immigrant and locally formed families consequently produced a greater demand for services such as healthcare and education (Wee 2003). Yet, despite widespread concern about health conditions in the colonies—culminating in a damning report filed by Dr W. J. Simpson to the colonial administration in 1907, and another filed by Dr Hunter in 19254—serious efforts to address public health were not made for another several decades (Manderson 1990), as I will describe further in chapter 3. Encouraging the three primary ethnic groups in Singapore (as defined by the colonial government)—Chinese, Malay, and Indian— to maintain isolation from each other, nineteenth- and early twentieth-century colonial officials gave preferential treatment to Chinese merchants and Straits-born Chinese. Aside from incentives given to some Straits Chinese to enroll their children in English education, however, little external pressure was placed on the community to either maintain or abandon their Chinese heritage and cultural practices.5 Rather, one could argue that by allowing the Chinese community to reproduce Chinese social institutions and practices in order to provide for themselves, the colonial authorities were freed to attend to the procedures, flows, and dynamics of their entrepôt economy. While some Straits Chinese took advantage of the English-language schools established by the colonial government, until the 1950s bang (dialect or native place associations) were responsible for educating a substantial portion of Singapore’s overseas Chinese children by founding, staffing, and administering Chinese schools (Wee 2003: 107). These schools were seen as particularly important to the preservation of Chinese language and values, and they provided the community’s most immediate link with activities in mainland China.6 For the majority of Singaporeans during and immediately following the colonial era, life revolved around the kampongs that dotted the coasts and radiated outward from the urban, administrative area known at the time as Singapore City.7 As described by Chua Beng Huat (1990), the local coffee shop provided a public arena for gambling and political discussion—a role carried into contemporary life as well, although by the time of my fieldwork the gambling was much more furtive and the bravado of political discussion much subdued. Describing life in Bukit Ho Swee village,8 Chua discusses the “collective idling” of villagers at coffee-shops: 76

From Imaginative Geography to Collective Lobotomy



Figure 2.1. Commemorating colonial-era overseas Chinese in Telok Ayer Green (historic Chinatown) A wide, open shop front with tables and chairs spilling beyond its sheltered premises on to the side of the road, all well shaded by a huge tree, this coffee shop was never without several men and teenagers in it, huddled in groups or scattering themselves at different tables. … During these routine idling sessions, one man stood out as a resource person. He was an opium addict who fed his habit as a numbers-game collector. He was 77

Capturing Quicksilver literate in Chinese and would read the Chinese newspaper aloud to the audience present. The latter would contribute their opinions at will. All was conducted in Hokkien, of course. The consensus was always based on immediate judgements of right and wrongs, wins and losses; and if China was one of the parties involved in the news item, then the audience’s sentiment was entirely predictable. It would be unembarrassingly pro-China, such was their taken-for-granted Chinese-ness. (Chua 1990: 1008–9)

Contrary to the contemporary self-consciousness of political conversations (outside the context of inebriated “talking cock,” meaning exaggerated tales or idle banter), unabashed public displays of Chinese nationalism were not out of the ordinary at the end of the colonial era.9 Furthermore, one might note Chua’s equation of “Chinese-ness” (as a presumed ethnic identity) with Chinese nationalism. While earlier migrants had also kept a close eye on their homeland, reputedly intending to return as Confucian ethos demanded, in the early twentieth century these sentiments were infused with a new nationalist fervor, stoked by the shifting political climate in China. Undoubtedly, not all overseas Chinese in Singapore maintained the same attachment to China. Nonetheless, according to Wang Gungwu, during this period their lives were generally “measured against original cultural values in China” and many ethnic Chinese children were discouraged from attending English schools (Wang 1991: 19). Furthermore, Chinese identity and nationalism was promoted by prominent Chinese politicians who visited the Nanyang in order to inculcate these values.10 Despite these visits, however, many of the linkages between Singapore and China were forged by educationalists and intellectuals. Hence, Chinese schools were often promoted in terms of both the advancement of overseas Chinese children and as a means of contributing to China’s development. Incidentally, this coincided with the ideology of the new republic in China, in which “modern” statehood was to be achieved through education, although this allegiance might also be read simply as a means of providing for the local community (Borthwick 1988; Yen 2003). Although in Singapore the educational model of mainland China was regarded as purely Chinese (relative to the English schools), it owed a great deal to the Euro-American educational systems that inspired the Chinese model in the first place—such as those found in early 1920s United States and later adopted by the Japanese. 78

From Imaginative Geography to Collective Lobotomy



Overseas Chinese children in colonial Singapore were thus exposed to many of the very notions and values that their parents and community had hoped to circumvent with the Chinese schools in the first place (perhaps ironic, from an essentialist or Orientalist view of China versus the so-called West). However, these “Western” notions—bundled within and transmitted via Chinese education— were relatively negligible when compared against the widespread Chinese nationalism in Singapore prior to World War II (Borthwick 1988; Yen 2003). In the late 1930s China’s appeal to overseas Chinese in Southeast Asia for financial assistance in their defense against Japanese invasion “marked a high point in the identification of the overseas Chinese with their homeland, while at the same time organizing the community in a hitherto unprecedented fashion” (Carstens 1988: 76). The fragmentation of overseas Chinese in Singapore had previously revealed itself in Singapore’s first “race riots” (between Chinese dialect groups), which preceded the conflicts between Malay and Chinese populations more often evoked by the post-colonial government. These tensions between “Chinese tribes” were seen as an obstacle by mainland Chinese politicians like Sun Yat Sen who sought support from the overseas Chinese (PuruShotam 1998). Meanwhile, the colonial administration had a vested interest in maintaining distinct ethnic groups and communities. For the most part, they tolerated the Chinese community’s distinguishing “emotional attachment to things Chinese” (Yen 1986: 17), as long as they did not interfere with the administration or profitability of the colony. By contrast, the threat of a united Malay society—mobilized by the increasingly active Malayan Communist Party—motivated the colonial government to encourage the separation of ethnic groups. Although by the 1930s and early 1940s Chinese, Indian, and Malay migrant workers had established relatively self-contained and segregated communities, local and international politics were to soon make such tidy separations impossible (Carstens 1988; Yen 1986). Despite the colonial administration’s best efforts to quell the momentum of the Malayan Communist Party, the latter not only united various elements of the Singaporean community under a single cause but also provided the strongest resistance against the Japanese occupation during World War II (late 1941 to mid-1945). As the British were sorely defeated by the Japanese, the Malayan 79

Capturing Quicksilver People’s Anti-Japanese Army formed from the ranks of the Malayan Communist Party to combat the Japanese in the jungle. Although ultimately unsuccessful, their efforts were valorized by much of British Malaya’s remaining population, and their members celebrated as heroes.11 While tension certainly existed between the various factions of the anticolonial movement—and particularly between Chinese and Malays—the Japanese occupation thereby produced an early sense of Malayan nationalism (Carstens 1988; Devan 1999). Notwithstanding this early nationalist sentiment, experiences of the occupation were far from uniform; for many Chinese in Singapore the Japanese occupation exacerbated ethnic divisions. Under the colonial administration (1819–1959) the Chinese majority was clearly given preferential treatment; under the Japanese (1941–45) they were actively persecuted. Although many of the older generation of Singaporean Chinese with whom I spoke were hesitant to discuss their experiences in detail, I was able nonetheless to gain a sense of the terror in which much of the Chinese community lived at the time. For instance, I became acquainted with a Singaporean Chinese woman named Margaret who was a teenager during the occupation. In chatting with her during one of her weekly visits to a Chinese medical clinic she recounted how, as a young Chinese female, she was afraid to walk alone outside her home. If she saw or heard strangers approaching she would immediately hide, even in nearby ditches if necessary. Although during this period she felt acutely Chinese, later in life she identified as “Singaporean, not Chinese”—a transition that must be contextualized within the dramatic social and political changes she experienced over the course of her life. When the PRC was established in 1949 and overseas Chinese were urged to decide between demonstrating their Chinese nationalism by returning to China, or their Malayan nationalism by remaining in British Malaya, many chose to remain. Those who had been previously ambiguous about this decision were forced to choose when, between 1956 and 1957, the PRC closed the possibility of dual nationality and encouraged overseas Chinese to either obtain citizenship in Southeast Asia or return to China (Carstens 1988). As the “era of direct influence from China” began to close, so did many of the linkages between Singaporean Chinese and their mainland Chinese counterparts (Borthwick 1988: 44). 80

From Imaginative Geography to Collective Lobotomy



Historical Narrative and Nationalism in the new Nation-state Among the Chinese who chose to stay in Singapore after the formation of the PRC, issues of cultural continuity were often less pressing than the economic and social positions, and survival, of themselves and their families. In some respects, these issues unified, and in others (particularly with regard to education) further separated the Chinese community. Yet questions of cultural preservation and representation still ran as undercurrents to everyday life and political agendas of the time (Carstens 1988). Hence, the political space in which Chinese ethnicity was circumscribed changed dramatically in the shift from colonial to post-colonial governments. In this section I will explore this ideological shift, outlining the state’s nation-building and nationalist productions (first called Malayan, then Singaporean), and the contestation of Chinese cultural heritage therein. In the early 1950s the English-educated Singaporean Chinese, led by Lee Kuan Yew’s Malayan-oriented PAP, represented the overseas Chinese community in negotiations with the British, Malays, and Indians.12 Meanwhile, Chinese-educated Singaporean Chinese tried to preserve the Chinese schools, in part by founding the much-beloved, but short-lived, Nanyang University in 1956. Chinese schools like Nanyang University provided the grounds for protests against political and living conditions that produced, “50 to 60 people living in a single shop house, widespread tuberculosis, an exploding birthrate—and a colonial government, followed by transitional regimes which they suspected of acting at the British behest” (Borthwick 1988: 47).13 Although the English-educated Chinese addressed these conditions in their negotiations, they depicted efforts to preserve the Chinese schools and culture as culturally chauvinistic at best and communist at worst. Such divisions and tensions within the Chinese community in Singapore indicate the extreme sensitivity and political entanglement that characterized notions of culture and identity at the time. The one area in which these communities seemed to be united, however, was in their political position vis-à-vis the rest of Malaya. Given Singapore’s long-established political and economic unity with the rest of British Malaya, when Lee Kuan Yew’s PAP began 81

Capturing Quicksilver

Figure 2.2. Commemorating Malay heritage in Kampong Glam

negotiations for self-government Singaporean leaders and the general populace expected to remain a part of Malaya. Achieving self-government first, the rest of British Malaya consolidated in 1957 to become the Federation of Malaya. Singapore attained self-government in 1959 with the PAP in power and Lee Kuan Yew as Singapore’s first prime minister. Vigorously pursuing the multicultural Malayan nationalism on which they had founded their vision of Singapore, the PAP entered into the 1961–63 Battle for Merger with the Federation of Malaya. In these negotiations, the terms of governance and representation within the newly independent federation were fiercely contested. Disputes led to an ostracized faction within the PAP, while the governments of Indonesia and the Philippines opposed the merger on the grounds that it constituted a neo-colonial creation. The PAP countered this opposition by insisting on a Malaysian national identity: “The internal politics of peninsular Malaya were at once affected by the new arrangements, for Lee Kuan Yew’s PAP not only decided to take part in the March, 1964, elections there, but did so on the 82

From Imaginative Geography to Collective Lobotomy



basis of the slogan, “a Malaysian Malaysia”—by which was meant a Malaysia in which no one community (the Malays were clearly intended) should have a monopoly in nation-building and its prerogatives” (Steinberg 1971: 371). Although the Federation of Malaysia was finally formed in 1963—including peninsular Malaysia, Singapore, Sarawak, and Sabah—Singapore’s merger was short lived.14 Lee Kuan Yew’s use of the term “Malaysian” (or, earlier, “Malayan”) rather than the ethnic term “Malay” was no doubt intentional and politically loaded. As he sought to align Singapore with the larger Malaysian political unit without sacrificing the interests of Singaporeans (particularly of the ethnic Chinese majority), he advocated the political rather than the ethnic term. His “multiracial” agenda did not resonate with the new Malaysian government who, after nearly a century and a half of colonialism (in which Chinese were often given preferential treatment), were eager to assert the rights and agenda of the Malay people.15 Additionally, by including Singapore in the federation, they risked good relations with neighbors like Indonesia, who opposed the merger. Thus, on August 9, 1965, Singapore’s attempted unity with the Federation of Malaysia failed and the small island nation was launched into independence. In addition to a disciplined and regulated labor force—vital for industrialization and capitalism—a loyal body politic (nationalism) was deemed essential to the new nation-state. As John Hutchinson and Anthony Smith (1994), Eric Hobsbawm (1983), Benedict Anderson (1991), and others have argued, the formation of many nation-states relied on the presence, creation, or consolidation of ethnic communities around which the state could develop loyalties. In the event this ethnic solidarity did not already exist, or was fragmented between multiple communities with competing territorial claims, it had to be created. Nationalism, in this context, can be understood as one of the ideological goals of the state: a sense of loyalty or affinity to a particular nation that offers popular freedom, sovereignty, and fraternity (or solidarity), and thus a common identity (Hutchinson and Smith 1994). Like ethnicity, nationalism draws boundaries and differentiates the Self from the Other (Eriksen 2002). One technique for creating a sense of shared history and identity involved the invention or reinvention of traditions. As described by Hobsbawm (1983), an “invented tradition [refers to] a set of practices, normally governed by overtly or tacitly accepted rules and of 83

Capturing Quicksilver a ritual or symbolic nature, which seek to inculcate certain values and norms of behaviour by repetition, which automatically implies continuity with the past” (Hobsbawm 1983: 1). Since the nationstate was historically unprecedented prior to the nineteenth century, a sense of unity had to be created to bind together newly conceived citizen-populations in Europe and elsewhere and, to some extent, conceal actual breaks in historical continuity. Anderson (1991) thus describes the nation as an imagined community—a socially constructed community of people who cannot possibly meet each other face to face (e.g., due to their geographical distribution and number) and so must simply imagine their solidarity. Both the nation and nationalism are therefore relatively recent innovations linked with deliberate exercises in social engineering, despite their claims to being supposedly natural human communities, rooted in antiquity (Hobsbawm 1983). Although these descriptions of the birth of the nation-state and nationalism largely reference European history, these processes were by no means confined to Europe. Napoleon’s revolutionary values provoked strong reactions in England, Germany, Poland, Russia, and Spain, which in turn intensified and “diffused the civic ideas of national autonomy, unity, and identity across Europe and throughout Latin America” in the nineteenth century (Hutchinson and Smith 1994: 7). The Meiji Restoration of 1868 ended the declining Tokugawa era in Japan, and in its place sought to implement a “modern” bureaucratic state based on the French model, with a mix of Japanese values and Euro-American arts and technology. Meanwhile, nationalisms in North Africa and the Middle East were founded on the basis of imperialist geographical boundaries and the civic concept of the nation in combination with local ethno-religious social identities (Hutchinson and Smith 1994). Similar processes were debated in China as the revolutionary nationalist movement sought to end nearly two millennia of imperial rule in the early twentieth century. In the Maoist era that followed, controversy continued over the nature of China’s development and the role of so-called traditional practices like Chinese medicine. Hence, civic discourses of the nation-state and nationalism spread quickly throughout Europe, European colonies, and beyond. Set adrift from Malaysia, Lee Kuan Yew’s government was similarly presented with the challenge of constructing an ex post facto 84

From Imaginative Geography to Collective Lobotomy



desire for independence, and sense of national pride or identity, among the Singaporean population. The PAP strove to somehow come to terms with the cultural legacy of a segregated, plural society promoted and left by the British, and craft a new (non-Malaysian) identity for Singapore. In order to remain in power, the PAP was thus faced with the task of bringing together Singapore’s various populations in the creation of a national identity that did not overtly privilege the language, political agenda, culture, or other needs of any single group over the others (Devan 1999; Kwa 1999). The challenges of building a nation-state in which the world placed little faith, out of a disjointed and potentially volatile multicultural population, was thus the burden left by the British. The PAP met this challenge by creating an economy-driven, authoritarian regime that knew no bounds when it came to manipulating the lives of the Singaporean people. Perhaps not unexpectedly, it was at this vital point that the state’s construction of an official historical narrative of Singapore, and with it the careful process of identity management, began in earnest. In order to tidy up the myriad issues that Singapore’s tumultuous history and multicultural composition generated, efforts were taken to downplay or even discard major historical elements from official histories and the social memory, to the extent possible. This endeavor has inspired Singaporean writer Janadas Devan to claim, “Forgetting is the condition of Singapore” (Devan 1999: 22). For instance, the promotion of a Malayan/Malaysian identity and nationalism (typified in the 1961–63 Battle for Merger) was forgotten in state discourse. Furthermore, the simple fact that Singaporeans did not want political autonomy in the first place (evident in the landslide popular vote for merger with Malaysia in a 1962 referendum) was obfuscated by the PAP’s rhetorical emphasis on voluntary separation, withdrawal, or even a self-initiated struggle for independence. Although “Singaporean History” was taught as an examination subject until 1968, it was completely dropped in 1972, reintroduced in 1975 as “Education for Living,” and finally dissolved again into general “Social Studies” in 1979 (Kwa 1999). This deemphasis on local history led to the often-lamented ignorance of national history among Singaporean youth. Although history is inextricably intertwined with ideology and “is always written out of the present … [as] an effect of present causes” (Devan 1999: 33), one is still left 85

Capturing Quicksilver to wonder how the Singaporean state rationalized this carefully constructed (and then neglected) history. The views of former senior minister S. Rajaratnam, author of the Singapore National Pledge—in which a “multiracial,” Singaporean Singapore was codified—provides a glimpse at the official justification: “The only proven history Singapore had was in the eyes of most nationalists a shameful episode of exploitation, oppression and humiliation of a people who nevertheless insisted on remaining in Singapore. Patriotism required that we performed some sort of collective lobotomy to wipe out all traces of 146 years of shame” (cited in Kwa 1999: 51). Hence, the many physical relocations, erasures, and “upgrading” of lived space over time, demanded by nation-building and continuing redevelopment processes, were replicated in the public perception of history. Around the time of the PRC’s reform and opening-up in the late 1970s and the 1980s, the Singaporean state began efforts to re-Sinicize the Singaporean Chinese. In preparation for economic dealings with the PRC, the Singaporean government promoted Mandarin Chinese (and discouraged the use of southern Chinese dialects) through the Speak Mandarin Campaign (launched in 1979). This was followed shortly thereafter by the promotion of Confucianism by means of a compulsory religions knowledge program introduced to secondary schools in 1982.16 Thus, in the 1980s the government developed yet another, slightly modified, position on Singaporean Chinese history and heritage, one of “situational ethnicity” (Tan 2003: 752), in which the national and ethnic identity of Singapore’s majority population was rearticulated by the state. Perhaps in response to local sentiment, and certainly motivated by a growing regional interest in the PRC’s expanding economy and friendly foreign relations, in the late 1990s the state (temporarily) proposed “to groom a Chinese cultural elite” (Lee 2003: 247).17 Aihwa Ong (1997) describes the promotion of traditional values, such as Confucianism, in Singapore as a political reinvention of moral economy that exchanges collective well-being for strong government control. Furthermore, she cites the provision of public housing as an example of a measure justified in terms of the public good that also served to ensure effective control and social consent. Finally, she discusses the biopolitics of labor management, observing that the Singaporean workforce was continually encouraged to upgrade their skills, as well as to value education and family 86

From Imaginative Geography to Collective Lobotomy



planning. “Asian democracy,” she claims, was thus defined by the Singaporean government in terms of limited individual rights and limited state liability, producing a “well-disciplined ‘Confucian’ capitalist society” (Ong 1997: 183). The Singaporean state, under the guidance of the Tourism Task Force, also became more active in the management of cultural resources and historic landmarks such as the Chinese cultural theme park Haw Par Villa or Tiger Balm Garden (introduced in chapter 1). As described by Jianli Huang and Lysa Hong (2007), the ceramic tableaus of Haw Par Villa initially portrayed various scenes from Chinese history and folklore, visually reinforcing Chinese codes of conduct and morality for the benefit of Chinese coolies. Once Singapore became a sovereign nation in 1965, however, the legacies of Chinese business leaders like Aw Boon Haw “had no place in the official Singapore memory” (Huang and Hong 2007: 46). By 1971 Haw Par Villa had fallen into disrepair and in 1985 the Singaporean government invoked the Land Acquisition Act to claim the land. In 1990 it was rebranded as a high-technology Chinese mythological

Figure 2.3. Promotional vehicle used by the Aw family to promote Tiger Balm (Haw Par Villa/Tiger Balm Gardens) 87

Capturing Quicksilver theme park and reopened as The Dragon World. The remodel featured Confucianism and the elite (dynastic) history of China, and references to Aw Boon Haw and the overseas Chinese were removed (Huang and Hong 2007). When this strategy proved a financial failure, the park was reverted to Haw Par Villa/Tiger Balm Gardens (between 1995 and 1997), amidst lively debates over its fate and potential value. The Heritage Society, for instance, sought its preservation as an emblem of the success of the overseas Chinese. Designated a historical site by the National Heritage Board in 2003, the theme park fixtures and features were removed and an overseas Chinese museum— highlighting the economic contributions of overseas Chinese to host countries—was built: “At the globalized turn of the millennium, the transnationalism of the overseas Chinese which Aw Boon Haw and his business empire epitomised during the era of colonial Southeast Asia has been harnessed to enlarge discursively this spatially-challenged island city-state. The extra-territorial narratives of the Chinese diaspora have been codified in the appended overseas Chinese museum in the Villa, with Singapore as the host, patron and living exemplar of this shrine and magnet of diasporic entrepreneurialism” (Huang and Hong 2007: 43–44). Among other values associated with the forebears of contemporary Singaporean Chinese, the Heritage Society argued that the civic responsibility, moral values, and creativity of these early overseas Chinese would inspire information age entrepreneurs. Along similar lines, Brenda Yeoh (2001) notes the emergence of heritage conservation in the midst of manufacturing slowdown and an erosion of Singapore’s competitiveness as a labor provider. She describes how the supposedly antiseptic and sanitized landscape produced by Singaporean (re)development was repackaged for tourists seeking what they considered to be an Asian experience: traditional-looking architectural forms were conserved and capitalized on; themes were invented and imposed on specific areas demarcated as emblematic of specific cultures (e.g., so-called ethnic enclaves like Chinatown); specialized shops and eateries that catered to tourists were created; and the lives of Singaporeans in HDB estates were appropriated to showcase the triumphs of the Singaporean lifestyle. Hence, she argues, attempts to address local concerns about the lack of moral values in Singapore simultaneously encouraged the 88

From Imaginative Geography to Collective Lobotomy



development of Singapore as an international business and service center, in part by catering to the tourist gaze. And yet, this ethnic governmentality—and the Asian values discourse on which it relied—was also short lived, replaced by notions of nation and citizenship tailored to a global-oriented, knowledge-driven economy. In the fashion of constant reinvention, the state’s high-tech Intelligent Island strategy made way for a thriving Biopolis strategy (Clancey 2012). The twenty-first-century state thereby sought to reposition Singapore “as the hub of an effervescent ecosystem”—an emerging, synergistic network of regional and global knowledge flows (Ong 2006: 26). Hence, the parameters of citizenship were reengineered to attract foreign researchers, investment, and talent, and to produce enterprising, knowledgeable, transnational subjects as well as new biogenetic forms/practices (Ong 2006, 2016).

Harmony Ideology and “Multiracialism” As described above, newly independent Singapore faced serious economic and social problems in the 1960s and 1970s. If this small and supposedly underdeveloped country was to succeed without its own natural resources to export, the PAP reasoned, social planning had to be “manipulated to meet the demands of foreign financed industrialization … to create a favorable climate for investment by building a stable and docile population” (Grice and Drakakas-Smith 1985: 348). The proposed solution to Singapore’s post-colonial burden thus lay in the populace itself: a diverse collection of people (perceived as potentially disorderly) that required careful management to ensure harmonious relations and, thus, productivity.18 In this section, I will describe how the post-colonial state sought to promote what they termed “racial harmony,” an integral element in its “multiracial” national identity, in part through the shaping of domestic space. Generally speaking, political consensus was assured in Singapore by the uninterrupted rule of the PAP since 1965. Although opposition parties have been permitted in the interest of maintaining procedural democracy, their efforts were stymied by various means.19 For instance, PAP tea sessions were rumored to poach the best opposition candidates before they could run in elections. As a result, it was not uncommon for opposition party members genuinely pursuing 89

Capturing Quicksilver change in Singapore to switch camps after being helped to the realization that the PAP’s virtual monopoly on power and resources would better enable them to achieve their goals. Furthermore, as opposition party members slowly gained control over a few group representation constituencies (manipulable geographic areas representing electoral divisions in Singapore), post-2015 elections rumors circulated that government contractors who had previously provided necessary services to these areas (e.g., maintenance, upkeep, and basic sanitation) would pull or, supposedly, lose their contracts. In other words, residents in opposition-held areas of Singapore felt pressured to support the PAP in future elections if they wished to retain government services. The PAP’s significant resources also enabled them to file defamation suits against opposition party members who criticized too liberally or openly; these candidates then had to defend themselves in court with far less financial backing (if any). This tactic began with Britishtrained lawyer J. B. Jeyaretnam, the first opposition party member elected to parliament (in 1981), who was bankrupted by an antidefamation suit in 2001. Although this case led Amnesty International to issue a public statement decrying the use of defamation suits for silencing opposition party members (as a violation of free speech), the practice continued. During my fieldwork, for instance, opposition leader Chiam See Tong faced a similar fate during the lead-up to the 2006 general election. This puts an interesting twist on Laura Nader’s (1990, 1996a) concept of harmony ideology, insofar as the avoidance of conflict in some cases also entails an avoidance of litigation (as she discussed with reference to the promotion of alternative dispute resolution in the United States). In Singapore, however, if one takes into consideration the financial disparity between the PAP and the opposition, it seems that litigation was a win–win strategy for the former and was justified in the interests of maintaining political stability (meaning single-party rule).20 This is not to say that the PAP filed frivolous lawsuits against opposition members who had, after all, broken the law. Nonetheless, with the financial backing, expert lawyers, and patience to drag a case out in court, the PAP had a distinct advantage over opposition members even in the unlikely event of losing. Because a deposit was required to run for office, and bankruptcy excluded candidates entirely, such suits (or the threat of them) effectively silenced dissent. 90

From Imaginative Geography to Collective Lobotomy



This silencing was further reinforced by laws against public gathering or speaking anywhere other than at the Speaker’s Corner, which was in itself considered something of a joke among Singaporeans. Located at the corner of a very busy intersection in the Chinatown area, any opinion expressed there (particularly during the day) was easily drowned by the sound of traffic. Sound amplification devices were, of course, prohibited. As reported in The Straits Times (Singapore) (October 20, 2007), Singapore Democratic Party secretary-general Chee Soon Juan commented at the 2007 International Bar Association conference that he had been jailed six times, most for speaking in public. Furthermore, the article reported, Worker’s Party chair Sylvia Lim expressed concern that “because 82 of the 84 seats in Parliament are held by the PAP and the party whip is strictly enforced, the executive government’s plans are likely to prevail.” In this manner, conflict was indeed discouraged within the PAP ranks and consensus retained in the larger political scene. Another area in which harmony ideology—as an instrument of power—was clearly embodied is in Singapore’s “multiracial” national identity, as enacted within the physical space of the city. Singapore consists of a small assortment of islands, with the main island bearing the nation’s name and vast majority of the population. Without a rural hinterland, and despite land expansion by means of soil and sand purchased from Malaysia, its territory and resources were repeatedly described as finite and scarce. Thus, fairly constant and indiscriminate redevelopment was maintained until the mid-1980s, when a drop in tourism and associated concern about Singapore’s so-called Asian identity stimulated the conservation of historic buildings and neighborhoods, as described above. Access to the everyday, lived sites of this past, however, were limited substantially by disruptive development strategies, including the compulsory resettlement of people from rural kampongs and crowded urban housing into high-rise public housing managed by the HDB. With the exception of designated heritage sites, the majority of the island has subsequently been subject to continuous “upgrading.” Focusing particularly on ethnic enclaves, the government enforced “racial” integration by tearing down old neighborhoods, relocating people into integrated high-rise housing estates, and imposing quotas on their ethnic composition. This urbanization (and suburbanization) forcibly relocated a substantial portion of 91

Capturing Quicksilver the population, and began to dissolve the spatial concentration and division of Singapore’s ethnic groups (Park 1998). The efforts of the HDB not only targeted the crowded urban center, but also the outlying kampongs, which tended to be similarly divided on ethnic (and dialect) lines, and therefore conflicted with the PAP’s vision for a united (i.e., “racially integrated”) Singapore. In most cases, the unemployment and illiteracy rates, lack of infrastructure, and serious public health issues associated with the kampongs were easy targets for the logic of development. Throughout the island, the material conditions inherited by the PAP in the 1960s left considerable room for improvement: many areas were plagued with high rates of infant mortality, tuberculosis, and other communicable diseases, poor or entirely absent sanitation, overcrowding, and so on. Furthermore, due to the colonial administration’s 1827 Jackson Plan, Singapore had been separated into discrete ethnic precincts, which tended to foster a divisive population (Kuah 2000). Because a disciplined, stable, and politically loyal population was deemed necessary to attract international investment, rectifying these conditions—largely by means of public housing—was a high priority for the PAP. The first phase of this planning, instituted by the newly formed (1960) HDB, involved the construction of more than one hundred thousand simple flats to be primarily rented to the poor. Once the basic housing needs of the majority of the population were met, the state encouraged homeownership, as a means to constructing an integrated and unified Singaporean citizenry (Park 1998). The Singaporean government ostensibly crafted a nonwelfarist nation-state engineered to attract international investment through a disciplined labor force, which was managed through explicitly authoritarian and highly detailed regulation. However, as noted by Christopher Tremewan (1998), this supposedly nonwelfarist nationstate was made possible by means of near universal consumption of welfare, which cast the state as sole or primary provider of infrastructure, union representation, labor supply, wages, subsistence provisions (housing, education, healthcare, pensions, and so on), land rights, and access to domestic and foreign capital. The “fractious electorate” of the mid-1960s were successfully “inducted into the routine of an industrial life-style as labour power,” largely through the provision of public housing, which stabilized the working class 92

From Imaginative Geography to Collective Lobotomy



and provided a mechanism to ensure political loyalty to the PAP (Tremewan 1998: 79). By 1997 over 86 percent of Singaporean citizens and permanent residents lived in public housing flats managed by the HDB, 90 percent of whom were owners—meaning they held a ninety-nine year lease with the government. Administration of welfare in Singapore relied on a compulsory Central Provident Fund (CPF) savings account to finance homeownership, healthcare, retirement, investments, dependent care and tuition, and so on. Originally established by the colonial administration in 1953, CPF was implemented in 1955 “as a straightforward savings and withdrawal retirement plan” in which a percentage of each employee’s pay was withdrawn (pretax) and matched by their employer (Tremewan 1998: 84). As a corrective to the poor response to the HDB’s Home Ownership Scheme introduced in 1964 (few people had the necessary disposable income to participate), an amendment was made in 1968 to allow residents to use CPF payments to finance down payments and loans on public housing. Demand for homeownership soared in response, creating a highly politicized waiting list for HDB flats, accompanied by a sharp increase in the wage percentages contributed to CPF by employers and employees. Without a rural hinterland in which people might develop subsistence strategies outside this political-economic system, wage labor, CPF membership, and the controls introduced through public housing became virtually inescapable for the vast majority of Singaporeans: “The relatively high cost of housing and its link to the forced saving regime of the CPF have compelled a high level of social discipline in that people have had to remain in formal employment in order to meet increasing costs and to provide for their future subsistence. Two or more household members may need to pool their incomes in order to meet housing costs (Tremewan 1998: 90). Thus, the changes in family values and interaction observed by many Singaporeans, such as Charlene in chapter 4, can be linked with CPF and public housing policies. In addition to maintaining ethnic quotas and a particular notion of the family, the state used public housing to encourage social and political practices. A specific notion of a so-called normal family was promoted by housing schemes that gave priority allocation to households with multigenerational families and to child-bearing couples, while excluding unmarried couples, single mothers, or young gay 93

Capturing Quicksilver couples. The HDB also limited the number and family status of residents in a given flat; required preapproval of renovations, rental, and resale; prohibited the conduct of business in domiciles; and reserved “the right to evict residents found guilty of morally inappropriate behaviour” (Lim 1989: 183, see also Tremewan 1998: 92). This social engineering was explicitly justified by Prime Minister Lee Kuan Yew in terms of the logic of development: “I am often accused of interfering in the private lives of citizens. Yet, if I did not, had I not done that, we wouldn’t be here today. And I say without the slightest remorse, that we wouldn’t be here, that we wouldn’t have made economic progress, if we had not intervened on very personal matters—who your neighbour is, how you live, the noise you make, how you spit, or what language you use. We decide what is right. Never mind what the people think. That is another problem” (Speech by Lee Kuan Yew, National Day Rally 1986, cited in Tremewan 1998: 77). Thus, highly intrusive regulations, laws, housing estate policies, and (of course) fines were employed to manage both space and the conduct of individuals within, disciplining the population, “in its depth and details” (Foucault 1991: 102). Additionally, by manipulating the order in which estates were “upgraded”—and thus manipulating the resale value of most residents’ primary financial asset—the PAP gave incentives for people to exhibit political loyalty and nationalism. Upgrading criteria included age of the estates, geographical location, cleanliness, and, from 1997 onward, community spirit—defined in terms of community leadership, the quality and attendance of grassroots activities, residents’ participation in national campaigns and National Day celebrations, and the caliber of communication between residents and community leaders. From the mid-1990s on, upgrading priority was also awarded to housing estates that exhibited political loyalty by voting for the PAP in primary elections.21 Thus, a flat’s worth in the resale market came to be determined not only by its size, amenities, and geographical convenience but also by its political location—in other words, the voting behavior of residents in a given area (Tremewan 1998). Upgrading not only ensured political loyalty but also encouraged homeowners to monitor the value of their property relative to others, increasing the competition and distance between neighbors. Furthermore, while “race” may not have represented Singaporeans’ actual experience of ethnic identity, it was also a useful tool of 94

From Imaginative Geography to Collective Lobotomy



governance. This is evident in the rigid categorizing of Singaporean citizens and permanent residents as Chinese, Malay, Indian, or Other (CMIO), as recorded on mandatory identity cards, on administrative forms, and in the 1994 National Day Parade song refrain, “every creed and every race, has its role and has its place” (PuruShotam 1998: 53). According to the rhetoric of Singapore’s “multiracial” nationalism, economically disadvantaged groups had to be liberated from their “racial handicap” (Thompson 1998: 18) and supposed economic irrationality without surrendering their distinctiveness, which was reinforced through the renovation of ethnic enclaves (appealing to the tourist gaze) and compulsory education in Singaporeans’ so-called mother tongues. Individuals within a “race” could then be ranked by their linguistic proficiency (PuruShotam 1998; Sinha 2001). This inheritance of colonial essentialism, modified in accordance with the needs of post-colonial “multiracial” national identity, was reflected in Singaporeans’ everyday interactions with each other: They [face-to-face encounters] usually run like this: “What are you?” (this is a fairly standard and common question that arises in daily life in Singapore). Most Singaporeans familiar with Singlish know that it is a question about your CMIO ethnicity. When I reply that I am a human being, I am usually met with laughter and the enjoinder “Aiyah you know what I mean, lah.” I have tried a variety of approaches to this: “Singaporean”; “my mother was born in Selangor,” “my family is very mixed, even got Hokkien, Cantonese and Ukrainian.” Thereafter, I will be subject to a cross-examination that I have yet to develop the skill to fence off. In this, inadvertently, I will refer to roots that reveal that I am also “Indian,” but this is then translated to, “Oh, that means you are Indian, lah.” (PuruShotam 1998: 54)22

This reflexive analysis suggests that the insistence on choosing between predetermined racial categories constitutes a kind of neo-Orientalism (the recycling of colonial divisions and systems of meanings attributed to the so-called East) with which Singaporeans themselves are complicit. It also illustrates how the construct of ethnicity has become, “a designer organism … bred in the laboratory and released into the world to be fed by politicians, journalists and ordinary citizens through their words and actions” (Banks 1996: 189).23 As Lily Kong (Kong 2001) explains, despite the overt show of respect to the idea of culture implied in Singaporean multiculturalism, 95

Capturing Quicksilver however, the efficient and disciplined use of scarce land prioritized what was regarded as modernist living over actual cultural practices. “Traditional” Chinese homes, for instance, emphasized a symmetrical layout reflecting geomantic principles and hierarchical family order that could not be easily achieved in standardized HDB flats. Thus, significant spatial and perceptual shifts were required to achieve the sense of symmetry—for instance, by changing the common location of the kitchen entrance to accommodate the central family altar. Meanwhile, Hindu concerns with purity and pollution demanded a strict separation of spaces associated with each, such as the kitchen and bathroom. However, these rooms were frequently built in close proximity in HDB flats, which often required symbolic separation of the spaces, by means of screens, for instance. Finally, Malay gender-based spatial arrangements dictated that separate spaces, and even separate entrances, be maintained for men and women—arrangements that, again, were not possible in HDB flats. Many Malay households also made symbolic adjustments like the addition of beaded curtains to demarcate the female space of the kitchen from the male space of the living room, or required creative behavioral adjustments: “Symbolic behavioural adjustments have also been made, for example, when women walking past a gathering of men in the living room to reach the kitchen ‘walk hugging the wall with a slight stoop and the right hand extended and raised above shoulder level, as if they were cutting a path through the living room.’ … They also avoid eye contact.” Thus, life in an urban HDB estate necessitated symbolic and structural changes in order to uphold cultural norms and values. Despite the ethnic quotas placed on HDB estates, justified in terms of “racial harmony,” the design of HDB flats followed the needs of economic development, disciplining their inhabitants at the expense of cultural considerations (Kong 2001: 121). In a literal sense, the PAP’s division of space reflects Foucauldian enclosing and partitioning—disciplinary techniques of power (anatomo-politics) to be described more fully in chapter 3. Additionally, the hygienic control of urban space as a potentially dangerous environment (the so-called pathogenic city) is another element of social control, as will be described in chapter 5. Careful regulation, laws, and fines have been employed to manage both space and the conduct of individuals within. Thus, the political division of both “races” and 96

From Imaginative Geography to Collective Lobotomy



physical space in Singapore can be interpreted as a form of social engineering that seeks to craft a unified, yet ranked, multicultural national identity out of an otherwise disparate population. This strategy—producing clearly demarcated, partitioned, and replicable units in which the productive capacity of a docile body politic can be facilitated—is also reflected in a variety of Singaporean institutional settings and regulatory processes, as I will illustrate in the next chapter.

Conclusion: Governmentality and Identity Politics In this chapter I have argued that colonial and post-colonial processes were integral to the representation and/or promotion of practices associated with transnational Chinese identity and heritage in Singapore. The circulation of people, materials, knowledge, and capital between Singapore and mainland China—including the promotion of Chinese schools and medicine—forged an enduring association between cultural activities and politics in Singapore. While permitted under a divide-and-conquer colonial rationale, this association became a very sensitive issue in the post-colonial era, discouraging the active promotion of Chinese culture and heritage in Singapore. Singapore and Malaya’s postwar political climate, volatile regional relations, the 1949 Chinese communist victory and establishment of the PRC, and the promise of self-governance thus prompted many Singaporean Chinese to reexamine their lives, practices, and identities as overseas Chinese. These contemporary and historical processes have been marked, in part, by the tension created by oscillating assertions of nationalism (whether Malayan, Malaysian, or Singaporean) and “invocation[s] of Chinese cultural affinity” (Ong 1997: 181). Against the state’s deliberate construction of a “multiracial” national identity, many Singaporean Chinese evoked their heritage by celebrating Chinese festivals, practicing and using Chinese medicine, speaking southern Chinese dialects, honoring their ancestors with offerings, and preferring to prepare and eat what they defined as Chinese cuisine. The “situational ethnicity” of Singaporean Chinese must therefore be contextualized within the complicated history of a heterogeneous population, crafted and managed by various political regimes (Tan 2003: 752). Given the historical and contemporary connectivity 97

Capturing Quicksilver between Singapore and the PRC, it is perhaps not surprising, then, that issues of identity and heritage were prolifically discussed in scholarly, political, and popular discourses. Nonetheless, the representation of identity and heritage is a complex, and often politicized, endeavor that necessitates reflection and reflexivity—as illustrated, for instance, in PuruShotam’s (1998) account of neo-Orientalist racial distinctions cited above. PuruShotam’s analysis references Edward Said’s (1978) seminal critique of essentialist representations of the so-called Orient, in which he views such written, visual, and performative depictions as products of a decidedly European historical and cultural trajectory. Orientalism is perhaps most easily understood as an academic designation describing those who teach, write about, or research “the Orient”; their body of knowledge was produced alongside artistic renderings, plays, literature, travelers’ tales, missionary accounts, colonial reports, and other representations of “the Orient” and so-called Orientals. These representations were problematic because they failed to represent the Other in their own terms and instead appeared as constructs of the similarly essentialized “West,” or “Occident.” Hence, Orientalism perpetuated prevailing motifs in “European imaginative geography … [in which] Europe is powerful and articulate; Asia is defeated and distant” (Said 1978: 57). Since the relationship between “Occident” and “Orient” was characterized by power, domination, and hegemony, the former had greater control over the manner in which the latter was depicted (and, to some extent, the manner in which it developed). Contemporary Southeast Asia is one product of that geopolitical imagination—delineated and labeled on maps and charts as discrete nation-states that were carved out by colonial boundaries, processes, and practices. At the end of the colonial era, power relations between colonizer and colonized (or between North and South more generally) were rearticulated and negotiated through discourses of modernization and development, and then through neoliberal globalization and, often, humanitarian aid. While certain aspects of Euro-American political economy and modernity were contested in this tumultuous period (and thereafter), Euro-American notions of the nation-state, nationalism, and governmentality nonetheless endured in many places as the region was carved into discrete territories. 98

From Imaginative Geography to Collective Lobotomy



In order to understand the political and economic legacy of European colonialism and Orientalism as they directed nation-building and the geopolitical division of Southeast Asia, I have argued, it is useful to consider enduring concepts of the nation-state and nationalism. In short, Europe’s failure to reunite after the fall of the Roman Empire provided the territorial and military basis for the formation of the nation-state, as various territories competed and separated into ethnically based states. Napoleon’s conquests at the end of the eighteenth and beginning of the nineteenth century spread the ideals of the French Revolution and, with them, early notions of the nation-state and nationalism.24 Furthermore, as Europe was dividing and solidifying its boundaries in new ways, it was also negotiating these identities and the identity of the so-called West with respect to an Orientalist Other. Although these discourses of the nation-state, nationalism, and governance were initially developed in Europe, they rapidly spread through imperalist and colonial networks and processes. The concept and discourses of the nation-state also developed in relation to other geopolitical transformations, such as the European shift from sovereignty to governmentality between the sixteenth and eighteenth centuries, as described by Michel Foucault (1991). This art of government was concentrated in the formal political domain and institutions, policies and procedures, and associated ideologies; it took populations (rather than families or individuals) as the target or focus of attention. In brief, the practices of governmentality were substantiated and justified through the body of knowledge and approach to society known as political economy and were practically executed with reference to security measures, whether conceived as internally or externally motivated. Thus, by the end of the eighteenth century the sovereign’s focus on the retention of territory, and right of death over his subjects, was replaced by governmentality’s management of the life of populations. This enduring form of governance was put into effect through a new science of government (political economy) and associated techniques of power. Between the seventeenth and eighteenth centuries, this power to manage life took two complementary forms: anatomo-politics and biopolitics (Foucault [1976] 1990). Foucault describes the first technique of power as anatomo-politics of the body, or procedures and practices that treat the body as a machine, disciplined to optimize its 99

Capturing Quicksilver productive capacities. The subsequent approach concerned governmental intervention and regulatory control of biological processes such as propagation, health, and mortality, referred to as biopolitics of the population. While these two techniques developed independently, once conjoined at the end of the eighteenth century they marked the beginning of an era of biopower: “The great technology of power in the nineteenth century” which was indispensable to the development of capitalism (Foucault [1976] 1990: 140). In addition to the concepts of the nation-state and nationalism described above, the colonial legacy in Singapore also included this art of government. Singaporean governmentality was conceived as a pragmatic, top-down process in which the PAP decided on policies and then immediately enacted them. Policies were communicated to the public through the state-controlled media, posters, mass mailings, and other such campaigns —published in English, Chinese, Malay, and Tamil. The state frequently reminded Singaporeans of the island’s lack of natural resources, internal (“racial”) divisiveness, and insecurity with respect to larger, more-established nations. Politicians often employed these themes when referring to Singapore as a little red dot—vulnerable among potentially hostile neighbors and the ascending giants of India and China (Heng and Devan 1992; Yao 2007). This emphasis on vulnerability and smallness was used to cement and ensure the continuation of social consensus (Chua 1995). Such evocations of fragility and crisis legitimized the authority of the Singaporean government and rationalized the regulation and discipline of daily life. While the particular character of Singapore’s national identity—and the role of Chinese culture and heritage therein—might have shifted according to dynamic demands of economic development, each strategy required a stable, productive, and harmonious “multiracial” population (considered to be Singapore’s only natural resource). Thus, the state’s management of history and ethnicity—with all its conflicts and contradictions—was justified as necessary to the nation-building and constant redevelopment process. This defense was echoed by many Singaporeans with whom I spoke during and after my fieldwork, who invoked the Singapore miracle to rationalize strict government controls: “from third world to first” in three decades, according to Lee Kuan Yew (2000). A history of colonial subjugation, a failed Malayan or Malaysian identity, and the fear of sparking “race riots” by promoting Chinese 100

From Imaginative Geography to Collective Lobotomy



culture in its place were all seen as antithetical to the post-colonial state’s ideal of a “multiracial” Singaporean national identity. Thus, history and heritage were carefully managed, and ethnic practices like Chinese medicine were politically marginalized. Nonetheless, many Singaporean Chinese—in concert with overseas Chinese around the world—have whenever possible maintained connections with their ancestral homeland and, through these connections, have preserved or reinvented elements of their Chinese cultural heritage and identity (Kuah 2000). Hence, in order to understand the contemporary position, practice, and use of Chinese medicine in Singapore—as part of the cultural heritage of the overseas Chinese and as a viable practice within an otherwise exclusively biomedical healthcare system—it is necessary to contextualize these processes within the legacy of colonialism, including discourses of nation-building, nationalism, and governmentality. In summary, under the British East India Company and as a crown colony, practices and loyalties associated with Chinese heritage were permitted insofar as they did not interfere with the administration of the colony. By the mid-twentieth century political developments in China and Southeast Asia (including regional anticolonial sentiment and concerns about Chinese nationalism) discouraged the overt promotion of Chinese heritage in Singapore. However, the Malayan identity promulgated at the end of the colonial era was soon curtailed by separation from the Federation of Malaysia in 1965. In its place, a “multiracial” Singaporean nationalism was developed, and a docile population was engineered in order to, first, provide the necessary labor force for manufacturing and industry and, then, to attract foreign investment and facilitate regional and global knowledge flows. Finally, the Singaporean government’s revalorization of Chinese culture and values in the last decades of the twentieth century repositioned the transnational cultural heritage of the Singaporean Chinese (including sites, products, and practices associated therewith). It is within this context that the state also began to more seriously examine the practice and use of Chinese medicine, particularly in relation to shifting discourses for economic development and their associated visions of the body politic.

101

Capturing Quicksilver Notes 1. Charles Stafford discusses the larger context of separation and reunion patterns, in which these rituals can be situated, and that produces Chinese communities (Stafford 2000: 70–86). 2. It is important to note that many Singaporeans did not participate in events like Dragon Dance or Qing Ming, whether through lack of opportunity or lack of interest. For many of the younger or middleaged people with whom I spent time, their busy daily schedules closely resembled urban life in other global cities: navigating public transportation/traffic, working in high-rise buildings, eating rushed meals, and spending time with family or friends in whatever time remained. Chinese cultural traditions nonetheless persisted, particularly when they could be observed or accommodated within the rapid flow of daily life. Chinese New Year was a notable exception to this tendency toward convenience/expediency, because the vast majority of Singaporeans (regardless of ethnicity) were given time off work in its observation. 3. Consequently, diplomatic ties with China were delayed until SinoIndonesian relations were normalized in 1990 (Tan 2003: 754). 4. This report attributed 25 percent of Singaporean deaths to poor housing and sanitation (Manderson 1990: 202). 5. This was intended to produce English-speaking intermediaries who could serve the colonial government. 6. Although Mandarin was not a dialect commonly found in Singapore at this time, it was often the language of instruction and served to unify the Chinese community to some degree. Most overseas Chinese families spoke southern Chinese dialects at home; a specialized market-form of Malay served as a local trade language up to and during the colonial period. 7. Near the mouth of the Singapore River—the historical location of the Port of Singapore—this area remained the center of trade, commerce, and finance; it is now referred to as the Central Area or Central Business District. 8. Bukit Ho Swee kampong was the site of one of the greatest fires in Singapore’s recent history. This event, in May 1961, precipitated the first official resettlement of Singaporeans (in this case, the former residents of Bukit Ho Swee) into a public housing estate built by the newly formed HDB. 9. It is suggestive of the efficiency and productivity of contemporary life in Singapore that the idling described by Chua was so noteworthy, and his description evokes a sense of nostalgia for the kampong days that was remarkably widespread during my fieldwork. 10. Usually translated as “south ocean” or “south seas,” Nanyang has come to mean Southeast Asia in the contemporary—but far from unanimous, and certainly not indigenous—characterization of the region (Sinha 1995: 51, fn7; Steinberg 1971). 102

From Imaginative Geography to Collective Lobotomy



11. Of course, this status lasted only until independence on August 9, 1965, when the Singaporean state’s historical reconstruction demanded that the actions of Malayan Communist Party members—based, as they were, on an idealized and unfulfilled Malayan nationalism—be reinterpreted in official discourse as misdirected and futile (Devan 1999: 30). 12. It is important to distinguish here between the terms “Malay,” “Malayan,” and the later “Malaysian,” as they come up in the context of the history of Singapore. “Malay” is a relatively constant signifier across time and space—for the trading empire associated with pre-colonial, diverse, and dispersed ethnic groups and a broad ethnic category into which these various groups were lumped from colonialism onward. Meanwhile, “Malayan” often refers to the political construct of the post-colonial peninsula and the states of Sarawak and Sabah, on the island of Borneo. “Malaysian” has now largely replaced this latter term, and is used in Singapore to politically define nationals of Malaysia. As PuruShotam (1998) discusses, however, the manner in which these terms developed and came to be defined in the colonial era is quite complex and inconsistent. 13. A 1957 census indicated that “Singapore had one of the highest birth rates in the world” (Borthwick 1988: 50). 14. Significantly, some say that Sarawak and Sabah—geographically situated on the island of Borneo, with Kalimantan in the south remaining part of Indonesia—were included to numerically offset the great increase of ethnic Chinese that Singapore contributed to the federation. 15. Indeed, this led to the pro-bumiputra (indigenous Malay, as defined by the Malaysian government) affirmative action policies (or bumiputeraism) that are, to date, still in effect. 16. Although the religious knowledge portion of the curriculum became optional seven years later, it is still mandatory for all Singaporean students to learn their so-called mother tongue (in this case Mandarin). As mentioned in the introduction, regardless of the fact that the majority of Singaporean Chinese families originally migrated from southern China, and the older generation therefore still speak southern Chinese dialects, their mandatory mother tongue is Mandarin. 17. See Lim (2004) for an argument for the role of Confucian values (cultivating the person, regulating the family, governing the state, and pacifying the world) in Singapore, as a counter to “undesirable western ideas such as individualism, materialism, utilitarianism and decadence” (Lim 2004: 186). 18. As noted by Claudia Merli (communication in person, November 2010), this scenario was not unique to Singapore. For instance, while Thailand was the only Southeast Asian country not colonized by European powers, the state nonetheless faced similar challenges in the process of midtwentieth-century nation-building, as they sought to develop a national identity around one particular ethnic group (the ambiguously defined Thai people) to the exclusion of others. 103

Capturing Quicksilver 19. Here, I draw from John and Jean Comaroff ’s distinction between procedural and substantive democracy (Comaroff and Comaroff 1997: 136–41). 20. Laura Nader (1990) describes how harmony ideology was imposed on the Zapotec of Oaxaca, Mexico during colonialism, and then subsequently appropriated by the villagers as a tool to minimize the encroachment of external powers. Despite the vast ocean separating them, parallels can be drawn between Oaxaca and Singapore, where colonial instruments of governance (e.g., a biomedically based healthcare system) were also appropriated by the post-colonial state. Additionally, Nader’s (1996a) description of harmony ideology in terms of consensus, homogeneity, agreement, and an intolerance of conflict was evident in Singaporean politics and everyday life. While the precise manner in which “harmony” was maintained in Singapore differs in a few important respects, the relevance of local histories and approaches to dispute resolution were components of Nader’s cross-cultural comparisons. She by no means claims that harmony ideology meant the same thing, or developed by the same means, everywhere. 21. At the time of my fieldwork, this was popularly referred to as the “upgrading carrot.” 22. In this context, both aiyah and lah are emphatic particles (most likely from the southern Chinese dialect, Hokkien) with no direct English translation. 23. In the conclusion of his overview of anthropological constructions of ethnicity, Marcus Banks (1996) delineates three general scholarly approaches to the topic. The first, primordialist, approach presents ethnicity as fundamental to identity—located in the hearts of individuals seen as belonging to a given ethnic group and expressed either for its own sake or in relation to other groups. The second, instrumentalist, approach places ethnicity in the heads of observed individuals and groups, expressed by them in pursuit of conscious gains. Finally, the third approach reflexively locates ethnicity in the analyst’s head as a “tool devised and utilized by academics to make sense of or explain the actions and feelings of the people studied” (Banks 1996: 186). However, Banks notes, the usefulness of these constructions is not limited to scholarly discourse. 24. In an interesting parallel, Edward Said also considers the Napoleonic invasion of Egypt in 1798 to be a pivotal point in history—a striking example of “a truly scientific appropriation of one culture by another, apparently stronger one” (Said 1978: 42). Although he does not go so far as to say this is the absolute origin of Orientalism, he does consider the occupation of Egypt to be a turning point in European authority over and about the so-called Orient.

104

Chapter 3

Power in Technique and Techniques of Power

By conceiving of medical innovation as an interplay between convention and controversy the historian stresses the importance of social processes for technological advancement. Innovation in this sense is seen not merely as knowledge production, “discovery,” or invention. Rather, problems related to the validation of newly produced knowledge are emphasized. —Elisabeth Hsu, Innovation in Chinese Medicine

Introduction With Euro-American political economy portrayed as a benchmark for progress around the world, notions of the nation-state, governmentality, and nationalism were variously adopted and adapted in many post-colonial countries. As described in the last chapter, the post-colonial Singaporean state carefully managed history and heritage in the nation-building process, efforts that were justified as essential to transforming this small, struggling island nation into a “modern” city-state. Chinese culture—and associated practices, like Chinese medicine—could not be overtly promoted to the exclusion of Singapore’s other major ethnic groups without risking both internal and external tensions, so a “multiracial” national identity was invented to bind Singaporeans together. Building on the colonial governmentality they inherited from the British, and driven by Euro-American discourses of modernity, the post-colonial state designed a healthcare system that politically marginalized Chinese medicine, Ayurveda, jamu, and other nonbiomedical practices while, to an extent, also tacitly relying on them for the provision of low-cost healthcare. 105

Capturing Quicksilver Although the twenty-first-century emphasis on biopharmaceutical research and development—as one pillar of an increasingly abstracted economy—had little room for Chinese medical epistemology or practice, the transition from Intelligent Island to Biopolis was roughly coterminous with the new regulation of Chinese medical practice. Building on the professionalization, standardization, and modernization efforts already undertaken by the Chinese medical community—and with reference to ongoing transformations in the PRC—several pieces of legislation were enacted at the turn of the century that drew Chinese medicine closer into the domain of biopower. This regulation, overseen by the MOH, politically legitimated only a portion of Singapore’s varied Chinese medical community, split into distinct parts. The clinical and institutional practice of Chinese medicine was regulated by the MOH (via the newly established TCMPB), while Chinese plant, mineral, or animal products were controlled by the HSA—one of two statutory boards of the MOH, alongside the HPB. Chinese materia medica was then differentiated into two further categories: bulk materials, controlled under the Poisons Act, and prepackaged (branded) products known as Chinese proprietary medicines (CPMs), controlled under a variety of pieces of legislation and standards of practice maintained by the HSA.1 Building from the conclusion of chapter 2, this chapter will demonstrate how these regulatory divisions can be understood in terms of governmentality and biopower (biopolitics and anatomo-politics), particularly in the context of the institutional organization of practice. After a brief outline of the formation of Singapore’s healthcare system, I will describe how the practice of Chinese medicine was repositioned in relation to Singaporean biopolitics (regulatory divisions) and anatomo-politics (institutional and bodily discipline). This analysis will be illustrated with ethnographic examples of how Chinese medical physicians and patients navigated these techniques of power in practice. In the second half of the chapter I will test and warp the boundaries of this framework to explore how certain physicians (especially senior physicians) established and maintained authority, particularly with reference to the Chinese medical notion of jingyan.

106

Power in Technique and Techniques of Power



Biopower and the Singaporean Healthcare System As discussed in the last chapter, governmentality can be characterized as an institutional, procedural, and analytical complex of power that seeks to foster the life of a population, disciplined and managed “in its depth and its details” (Foucault 1991: 102). Since the eighteenth century this art of government has involved the cultivation of biopower—the union of disciplinary techniques (anatomo-politics) and regulatory interventions (biopolitics) oriented toward the health and productivity of a population. Biopolitics is articulated, in part, through regulations, policies, and programs intended to encourage the life and productivity (in both economic and reproductive senses) of the population. While biopolitics can therefore be fairly easily understood in terms of the regulatory framework governing health and healthcare, reproductive rights, and so on, anatomo-politics warrants a bit more explanation. According to Foucault ([1975] 1995), the discipline of a manipulable, docile body (politic) constitutes a micro-physics of power that begins with the distribution and ranking of people in space. This process requires enclosure or confinement, and individualized partitioning within networks of relations (re)produced in functional sites such as factories, schools, and military barracks. Next, the activities within these disciplinary institutions are meticulously managed through an acute attention to time: idleness and wasted time is discouraged, a time-table is enforced and external rhythm imposed, precise sequences are defined and bodily gestures (including body-object articulations) prescribed. The productive capacity of the individual is thus optimized through careful discipline of the body’s movements in time, and choreographed within institutions in which the state’s power is invested and enacted. The discipline of individual bodies within educational, military, or medical institutions collectively ensured a docile population that facilitated capitalist production. As I will describe in the rest of this section, similar political economic strategies can be seen in the development of Singapore’s healthcare system. In the early colonial period, the interests of the British East India Company were purely commercial—thus, under its jurisdiction (i.e., until 1867) Singaporeans were left to their own devices with regards to medical care. Once the British government 107

Capturing Quicksilver extended its commercial interests to include regional development and diversification, a healthy labor pool demanded greater attention be paid to healthcare in the Straits Settlements (although the resulting regulations often meant more on paper than in practice).2 It was therefore not until the 1920s that concerted efforts to influence public health were undertaken, through campaigns to increase awareness of disease prevention measures (Sinha 1995). For the most part, the significant health problems facing residents of the Straits Settlements at the beginning of the twentieth century were written off as the inevitable result of cultural practices and intransigence. Despite the formation of a commission of inquiry to investigate the negligence of public health in Singapore, initially the “Western” medical facilities and services made available to redress these issues were provided only for European expatriates (Manderson 1990). Meanwhile, members of Singapore’s diverse overseas Chinese community provided for their own welfare through bang. These exclusive and sometimes mutually antagonistic groups provided accommodation and employment for new arrivals, minor dispute resolution, religious and festival services, healthcare, and funerary assistance (Yen 1986). Under the auspices of these associations, Chinese medical practitioners set up consultation services, often offering their expertise free of charge as community service. According to Vineeta Sinha (1995), after the end of the Japanese occupation in 1945, the colonial government sought to repair the degraded medical infrastructure and the general ill health of the population, exclusively through the promotion of English medicine. Thus, in 1947 the First Medical Plan was proposed, based on reports that emphasized the value of biomedicine, and the worthiness of investments in public health measures. However, it was never the intention of the First Medical Plan to provide completely free medical services. As such, the majority of patients were subsidized, while a minority of affluent Singaporeans paid for their healthcare in full. In 1955 the plan was revised to provide for better medical training facilities and to develop both curative and preventive institutions. In addition to broadening the medical infrastructure, the colonial administration pushed for centralization of administration and decentralization of health services (Sinha 1995). Efficient (and, ideally, low-cost) healthcare was seen as necessary for increased productivity of the population and, thus, the health 108

Power in Technique and Techniques of Power



of the economy. With these goals in mind, in the 1950s a Health Education Office and officer were designated within the colonial Medical Department to launch campaigns imploring the public to maintain their own health. Forming the basis for the post-colonial state’s orientation toward public health, these efforts mark a shift of responsibility away from the state in terms of cost, and toward the public in terms of compliance with state-issued health advice.3 Thus, under the PAP the MOH’s decisions were guided by pragmatism and bureaucratic efficiency, and often involved direct state intervention into people’s lives for the benefit of the nation (Sinha 1995). These early health education efforts eventually developed into the National Health Campaign, established in 1979 to educate the public about the relationship between their lifestyles and their health (discussed further in chapter 6). The National Health Plan of 1982 placed even greater emphasis on the responsibility of individuals to maintain their own health and required citizens to pay part of the cost for medical services through the compulsory Medisave scheme enacted in 1984. This scheme mandated that employees contribute 3 percent of their salary, matched by their employer, to a savings fund to be used for the employee’s and her immediate family’s health care. While the state continued to assume responsibility for the provision of medical facilities, these policies marked a general transition from free or subsidized health care to cost sharing (Sinha 1995). As explained by Minister for Health Goh Chok Tong at the Singapore Medical Association’s annual dinner in 1981, “There is no place for a cradle-to-grave welfare health scheme in Singapore. Such a system is politically motivated and disregards the basic truth that resources are finite in terms of funds, doctors, nurses and other supporting staff. It blunts the population’s incentive to work—so necessary to pay for the services they want. It is not even healthy for the medical service itself, as the experience of the British National Health Service has shown” (cited in Sinha 1995: 155). The state’s antiwelfare public health strategy ensured its authority to dictate preventive health regimes and maintain low-cost curative healthcare, while placing the burden of responsibility on the individual to prevent illness whenever possible and, when not possible, for the individual to pay for her own treatment. In 1990 the government’s voluntary insurance plan, MediShield was introduced to help pay for major or prolonged illnesses, 109

Capturing Quicksilver with premiums payable through Medisave accounts. Medifund was then enacted in 1993 as an endowment fund to help indigent Singaporeans pay for the cost of medical care (at approved public institutions), thus creating the healthcare system’s three Ms: Medisave, MediShield, and Medifund. The state also offered a basic medical package consisting of a tiered system of subsidized (labeled essential) medical care on the one hand, and nonsubsidized (labeled nonessential) services on the other. This package was premised not only on an economic orientation to healthcare, but also on a notion that if people were free to use medical services at will, their medical demands would be greater than their medical needs (as defined by the MOH of course). According to this logic, it was the government’s job to curb these demands by subsidizing only “essential” medical care so that individuals were more likely to use their Medisave accounts judiciously (Sinha 1995). Gregory Clancey (2012) notes that the mid-1980s manufacturing slump motivated the PAP to transform Singapore from a source of cheap labor and manufacturing to an Intelligent Island—a socially integrated, cohesive, fully networked society that was built, governed, and metaphorically conceptualized around telecommunications and computer technologies. This discourse represented sick bodies as “a reverse salient in the moving front of a digital economy” (Clancey 2012: 17), and the body politic as “an operating system geared toward increased productivity” (Clancey 2012: 24). The shift produced a degree of tension between public sector physicians and politicians who emphasized cost-effective measures to improve national health standards, and private hospital physicians who sought increased investments in medical specialization, research, and development: It was private medicine, and particularly the private hospitals that had the most to gain by promoting specialist medicine, research and imported technologies. The values of the government health sector were more socialistic, emphasizing the greatest good for the greatest number. … Given the already plural character of the Singapore health system, in which Chinese and other indigenous medicines actually served as an unsubsidized medical safety net for the majority of the population, doubts about not only the values but the efficacy of “Western medicine” always found a ready reception, even (or especially) if they came from inside the western medical community. (Clancey 2012: 19) 110

Power in Technique and Techniques of Power



Prior to the Biopolis strategy, then, healthcare and medicine were together less a sector of economic productivity than they were a drain on limited resources. In this context, Chinese medicine’s emphasis on volunteerism and community service provided a cost-effective, self-regulating (at least initially) solution for primary healthcare in Singapore. By the time of my fieldwork, Singaporeans were regularly admonished to lead healthy, illness-preventive lives in accordance with MOH advice, and only when this self-discipline failed to fall back on the insurance schemes provided by the government.4 In a televised forum in early April 2006, Prime Minister Lee Hsien Loong urged the public to be responsible for their own health—rather than relying on the government—and to seek early (biomedical) diagnosis and care: “If you wait until you’re sick to look for the doctor,” he admonished, “actually, it’s too late.” The Singaporean state thus not only established a cost-effective healthcare system but also disciplined a responsibilized body politic.5 This arrangement was facilitated, in part, by charitable Chinese medical institutions and other so-called traditional medicine practitioners in Singapore who provided lowcost primary healthcare, unsubsidized by the state. The Chinese medical community’s prioritization of public service over profit—historically rooted in the colonial era bang—was evident in many Chinese medical charity clinics, including Chung Hwa, Thong Chai, and Dazhong. Furthermore, Chinese medicine has a long-established emphasis on self-care, including a variety of yangsheng (nurturing life) techniques like dietary management and qigong. However, these techniques—as well as more-formal clinical practices—were explicitly excluded from the biomedical healthcare system and public health campaigns described above. Nonetheless, in the same time period as Singapore’s transition from Intelligent Island to Biopolis—not long after the state’s attitudes toward the value of Chinese language and culture began to soften—the all-seeing legislative eye finally turned toward the very active margins of the healthcare system.

Regulating and Disciplining Chinese Medicine During the colonial era (1819–1959) there was little impediment to the practice of Chinese and other “traditional” medicines in 111

Capturing Quicksilver Singapore. Nonetheless, they were generally depicted in a derogatory fashion within government documents, and were later presented as a potential obstacle to colonial health policies (Sinha 1995). On the other hand, some Europeans attempted to document the potential value of what they referred to as “native” medical therapies in the early twentieth century. For example, C. W. Daniels argued in 1905 that certain “traditional [drugs] may contain sufficiently controllable ingredients to be of distinct medicinal value” (Daniels quoted in Sinha 1995: 116).6 For the most part, however, early views depicted so-called traditional medicine as completely distinct from, and inferior to, European medicine. Despite its denigration by colonial officials, the documentation of Chinese medical practices that remains hints at its popularity: between 1870 and 1928 there were a reported fifty-eight Chinese pharmacies in Singapore (Yeoh 1991: 37, see also Sinha 1995). Within the first four months of my fieldwork I was granted an informal interview with the TCMPB registrar at the time, Dr Chris Chea Hean Aun, who insisted that the new regulatory efforts were not to be viewed as an endorsement or promotion of Chinese medicine in any way. The early Chinese medical community in Singapore was very loose, he explained, consisting of fifteen to twenty organizations, each with its own membership and desire to safeguard the interests of its own members. Considering this diversity to be a challenge to the legislative process, the MOH created a committee in 1996 with representation from eight of the largest organizations to consult on the regulation of Chinese medicine. This strategy was meant to allay criticism that previous regulatory efforts had excluded key members of Singapore’s Chinese medical community. Two years earlier, in 1994, Minister for Health George Yeo cited China’s “successful integration of Chinese and Western medicines” in justifying the formation of the National Committee on TCM to investigate the regulation of Chinese medicine in Singapore (Sinha 1995: 195). The results of this investigation, announced in 1995, focused on acupuncture as a first area of Chinese medicine to be regulated, due to the perception of its supposedly invasive nature and thus greater potential for harm (Sinha 1995: 196). Further recommendations of this committee led to subsidiary legislations under the Medicines Act governing the production, importation, and sale of CPMs, implemented in 1999 (Yee et al. 2005). Subsequently, and 112

Power in Technique and Techniques of Power



supposedly on consultation with local Chinese medical physicians and other professionals, the MOH implemented legislation that outlined the registration and professional guidance of Chinese medical physicians (the TCM Practitioners Act). Thus, representatives of the Chinese medical community (ostensibly, according to some) participated in the codification of a whole series of detailed divisions and definitions, in an ongoing attempt to elevate their practice to a minimum status of “complementary” within the biomedical healthcare system. Because the primary focus of my fieldwork was on healthcare practices (as opposed to CPM manufacturing processes), in this section I will discuss the details of the TCM Practitioners Act in greater detail. As I will argue, the shift in regulatory status that this entailed can be understood in terms of the creation and implementation of regulation (biopolitics) and the disciplinary techniques (anatomo-politics) that were enacted in Chinese medical clinics like Chung Hwa. To demonstrate these processes, I will first examine how the regulatory framework circumscribed and controlled the practice of Chinese medicine by defining parameters of inclusion and exclusion. Under the TCM Practitioners Act, the TCMPB was established as one of five professional boards of the MOH.7 Based on another of the five boards, the Singapore Medical Council (which regulates the practice of biomedicine in Singapore) the TCMPB’s functions, registration processes, and guidelines for conduct were founded on the biomedical model. The tasks of the TCMPB included approving, rejecting, revoking, or suspending registration applications; accrediting TCM courses and institutions; recommending continuing training for registered practitioners; regulating professional ethics and conduct; and otherwise fulfilling the provisions of the TCM Practitioners Act.8 Couched in terms of safeguarding the public, the TCM Practitioners Act took two forms: differentiating legal from illegal practice with one-time registration certificates, and ensuring ongoing appropriate behavior through annually renewable practicing certificates. Generally speaking, the right to issue, deny, or revoke these certificates gave the government legal power to determine which physicians were vested with official authority. Beyond the gross distinction between those who were allowed or denied the right to practice Chinese medicine, this regulation also made finer divisions. A physician could either obtain full registration 113

Capturing Quicksilver that enabled him or her to practice independently anywhere in Singapore, or conditional registration that first required a period of supervised clinical attachment. Nearly all applicants had to present a local diploma or graduation certificate from SCTCM or the Institute of Chinese Medical Studies, or a full-time bachelor’s degree in TCM from one of six institutions in the PRC.9 Almost all applicants, including those with noninstitutionalized experience, had to pass the Singapore TCM Physicians Registration Examination to demonstrate their knowledge.10 Furthermore, the TCMPB maintained a clear legal division between “TCM physicians” and “acupuncturists” (with separate titles and registration categories, despite their common foundation in Chinese medical theory and frequent inseparability in practice.11 While “TCM physicians” were able to practice a range of Chinese healing techniques (herbal, acupuncture-moxibustion, massage, etc.), “acupuncturists” were limited to only this modality.12 Despite the clear division of the two practices in Singapore, many aspects of biomedical anatomy, nosology, diagnostics, and treatment have been incorporated into Chinese medicine, particularly in the formation of TCM in the PRC (Hsu 1999; Taylor 2005). Part of the ease with which these practices were able to cooperate undoubtedly stems from their frequent interaction: in the healthcare strategies of patients consuming both Chinese herbs and pharmaceuticals, in the cross-practice referrals between physicians, in the English-language acupuncture course offered to biomedical doctors and dentists at the SCTCM, and in the use of biomedical diagnostic techniques and equipment (blood pressure readers, x-rays, and so on) in Chinese medical clinics. Nonetheless, “TCM physicians” were prohibited from practicing biomedicine. In the rare event that an individual held both biomedical and TCM physician registration and practicing certificates, she still had to maintain separation in her practices and spatial arrangements, going so far as to require two distinct clinics with separate entrances. For instance, as a Chinese physician for the Singapore branch of an international Buddhist organization, Dr Wang volunteered his clinic and time one day a week for free Chinese medical treatments. Until shortly after I left Singapore, the charity also operated another clinic on the same day every week next door where it offered biomedical consultations. In Singapore the charity’s clinics had to be thus clearly divided, although when organizing its annual medical mission (e.g., 114

Power in Technique and Techniques of Power



the mission to Batam, Indonesia, in March 2007, that I joined) they did not have to worry about this sort of redundancy. Furthermore, although Dr Wang received his earliest training in Singapore, he completed a master’s degree and three years of doctoral study at Nanjing University of TCM in China. The framed degree hanging on the wall behind his desk, he reported, was therefore an integrated medical degree but he could not fully apply his training in Singapore. Although compliant with all legal requirements, his incorporation of information obtained from reading x-rays and biomedical charts (which he either requested or that were automatically furnished by his patients) into diagnoses somewhat flexed these boundaries. The TCM Practitioners Act also provided a regulatory mechanism to ensure the approved Chinese medical curriculum was taught and applied in practice (particularly in the context of large institutions).13 Once a “TCM physician” or “acupuncturist” obtained a registration certificate, he was also required to obtain a practicing certificate, which he then had to renew annually. A physician deemed to be in violation of TCMPB guidelines, or convicted of an offence involving fraud, dishonesty or what the TCMPB defined as a defect of character, could have her practicing certificate revoked or suspended for one to three years; she could also be cautioned, censured, or fined. In extreme cases, she could be stricken from the register (i.e., have her registration certificate revoked), in which case she had to wait three years before earning the right to even appeal the decision. As the minimum standards of conduct for all Chinese medical physicians in Singapore, the TCMPB’s Ethical Code and Ethical Guidelines for TCM Practitioners (released January 2006 in English and Chinese but, notably, not in Malay or Tamil) claimed to protect not only the well-being of patients but also the autonomy and reputation of the profession.14 Referred to simply as the Code, this document provided standards of clinical practice—including proper management of relationships with patients and other physicians—and guidelines for advertisement of services, information dissemination to the public, and appropriate business and financial dealings. With regards to clinical practice, it outlined modes of evaluation, delegation of responsibilities, duty of care, and medical record keeping (including the proper names of herbal medicines). It is noteworthy that the public being safeguarded in this fashion is described in the Code with a slight connotation of gullibility: “Both members of the 115

Capturing Quicksilver TCM profession and the public require information about TCM practitioners whom they can refer patients to or seek consultation from. Patients seeking such information are entitled to protection from misleading information, as they are particularly prone to persuasive influence” (TCMPB 2006: 14–15, emphasis mine). Like the state’s definition of medical need in terms of their categories of essential and nonessential categories, and the general paternalistic tone of their public health campaigns, patients’ interests were meant to be protected through the rigorous regulation of Chinese medicine. In our 2006 interview, the TCMPB registrar commented that the implementation of the TCM Practitioners Act had produced an increased public confidence in Chinese medicine. This correlation between public trust and legislation was echoed by Dr Wang and Professor Tan, and was used to justify the TCMPB’s guidelines for conduct. Insofar as it legitimized only specific educational institutions and individuals, this regulatory framework not only differentiated legal from illegal practice (enclosed), but also sought to define authority (partitioned) and the proper transmission of knowledge and practice within clinical settings. In addition to these regulatory divisions (biopolitics), in the course of my observations at several large Chinese medical clinics in Singapore I also noted the disciplinary techniques (anatomo-politics) that constitute the second half of biopower. Reminiscent of Foucault’s description of the hospital as a “curing machine” (Foucault 1984b: 287), patients were processed within these clinics with stereotypical Singaporean efficiency, as the following example from Chung Hwa will illustrate. Established by the SCPA in 1952 at Chung San Huan Kuan (a local clan organization) under the name Zhong Hua Shi Zhen Suo, Chung Hwa was renamed when it moved to Telok Ayer Street in 1956. In 1979 the SCPA constructed new facilities in Toa Payoh in order to accommodate this outpatient clinic (Chung Hwa), the SCTCM, the Chinese Medical and Drugs Research Institute, and the Chinese Acupuncture Research Institute under one roof.15 In total, Chung Hwa branches saw an average of a thousand patients a day, as reported on their website at the time of my fieldwork.16 The Toa Payoh building housed not only the SCTCM and the SCPA headquarters, but also the most active branch of Chung Hwa where I conducted participant observation with Professor Tan and Dr Wang. 116

Power in Technique and Techniques of Power



Upon arrival at the Toa Payoh branch of Chung Hwa, all patients took a paper number. Once their number came up, new patients completed paperwork and were issued a patient card (and number), while returning patients simply produced their card and stated the purpose of their visit. At this point they could request a physician or the clinic assigned one to them in accordance with their complaint, preferred type of treatment, or, in the case of regular patients, their usual arrangements. Regular patients sometimes produced a second card on which their physician had written their appointment (one physician with whom I worked referred to these as his patients’ “passports”). All patients were charged a small registration fee and were issued a print-out with their details, the name and room number of the physician, and their number in line for that room. Depending on the location of the room, they then sat or stood in one of two open central areas (on the main floor or upstairs) and waited for their number to be listed next to the room number on an electronic queue board. Once their new number came up, patients entered their designated room. Depending on the type of treatment and the physician, they sometimes shared the room with other patients at various stages of treatment, and other times had the room (or a curtained bed) to themselves. Specialty consultations (e.g., fertility or weight loss) were usually held in small rooms, while general practice consultations were held in the larger rooms. In the latter case, senior physicians (sometimes assisted by a junior colleague and/or observed by students) saw multiple patients simultaneously, while junior physicians often shared a room, each physician with his own desk and a few curtained beds for patients. An orderly spatial partitioning was thus extended from arrival at the clinic to departure: first sorted as new, returning, or regular patients were numbered and divided by floor, by room, by physician, and then by bed. The details about each patient-as-number were digitized as the physician entered information about the consultation into a networked computer—including symptoms, diagnostic criteria, syndrome type, and treatment or prescription notes—which could then be accessed later by pharmacists if an herbal prescription was necessary. Once the consultation was completed, the patients were free to leave or to return to the reception area, which also housed the pharmacy window. If they needed to fill a prescription, they took another 117

Capturing Quicksilver number and waited for their order to be filled. At each step, information was collected and transmitted to staff at the next step, “through systems of observation, notation, and record-taking which [made] it possible to fix the knowledge of different cases” (Foucault 1984b: 287). Although these details were simple matters of administrative procedure, they produced an efficient healing environment that disciplined clinic inhabitants in the manner of anatomo-politics. The division of Chinese medicine from biomedicine in Singaporean biopolitics was explicitly upheld at Chung Hwa and at other Chinese medical institutions in Singapore (by contrast with integrated clinics in the PRC). Through ever-fine procedural prescriptions and proscriptions, the officially sanctioned curriculum and code of conduct dictated the manner in which physicians interacted with their patients, employed certain tools (e.g., acupuncture needles) but not others (e.g., hypodermic needles), and took records. Fine divisions occurred in the expedient processing of patients through this institutional curing machine, akin to the forms of discipline that optimized the population’s productive capacity during post-colonial development. In this manner, the efficient management of Chinese medical practice can be seen to reflect both disciplinary (anatomo-politics) and regulatory (biopolitics) techniques of biopower.

Conventional Institutional Practice As I described in the introduction, I was fortunate to work with several prominent physicians, two of whom I will describe in this section as examples of the daily practice of Chinese medical physicians in Singapore. More precisely, I will present Dr Li’s practice at Thong Chai as a parallel to the institutional curing machine of Chung Hwa and in contrast to Dr Wang’s private practice. Dr Li was a middle-aged, first-generation Singaporean Chinese woman who worked at Thong Chai, while also conducting consultations, providing tuina, and dispensing herbal prescriptions at her private practice. Her humble and friendly manner concealed a long list of qualifications including a diploma from SCTCM, an advanced degree from Thong Chai Institute of Medical Research, a master’s degree from Guangxi TCM University, and postgraduate studies at Fujian TCM University. At the time of my fieldwork she practiced two days per 118

Power in Technique and Techniques of Power



week at Thong Chai, with a morning shift in the hypertension and diabetes clinic and an afternoon shift in general medicine. Similarly, Dr Wang maintained a private practice in Chinatown while volunteering one day per week at Chung Hwa, both of which I was able to observe. Although Dr Wang had originally moved from Taiwan to Singapore as a businessman, after living and working there for several years he decided to study Chinese medicine at SCTCM. After completing this course, he went on to complete a master’s degree and doctoral study at Nanjing University of TCM (where he was still a doctoral candidate at the time of my fieldwork). An active member of multiple community organizations, he served as a council member of the SCPA, secretary of the Chinese Acupuncture Research Institute, medical advisor for the Singapore Fen Yang Guo Association, and head Chinese physician for the Singapore branch of an international Buddhist charity. In addition to his weekly shifts at Chung Hwa, Dr Wang volunteered his own clinic and services once per week for the members of this charity and helped to organize and implement their regular health screenings, as well their annual medical missions. With two field sites in the Chinatown area—Dr Li at Thong Chai and Dr Wang at his private clinic—I managed to acquire a good feeling for one of Singapore’s oldest neighborhoods. Called Niucheshui (meaning oxcart water), Chinatown has always had a great deal of activity. During the early colonial days, overseas Chinese would bring oxcarts from various kampong to the area in order to collect water. Despite the apparent redundancy of a Chinatown on an island with an ethnic Chinese majority—and the HDB’s ethnic integration policies—this area was still reputed to have a high concentration of ethnic Chinese, particularly newly arrived immigrants. It was also a colorful “ethnic enclave,” toward which the Singapore Tourism Board funneled tourists—one of several sites for the reinscription of historicity and Chinese identity in the aseptic, “Westernized” Singaporean landscape (Yeoh 2001). Two major roads ran side by side through the center of Chinatown, with a strip of manicured grass, or in some sections simply concrete, between them. Renovated colonial architecture stood for several blocks deep on the gentrified New Bridge Road side, painted in pastel hues and heavily laden with souvenir shops. Amidst the tailors, trinket shops, and relatively pricey restaurants on this side was 119

Capturing Quicksilver

Figure 3.1. Chinatown (New Bridge Road side)

Dr Wang’s private practice—a newly remodeled and tastefully decorated clinic with a small reception area, two consultation rooms, and two curtained beds in the back, located on the ground floor of an old colonial shop house. Meanwhile, the Eu Tong Sen Street17 side was dominated by large, boxy shopping complexes, HDB estates, and smaller provision shops. To observe at Thong Chai, I would walk several blocks back from Eu Tong Sen Street through old hawker centers, under multiple floors of laundry hung from apartment windows, and—depending on the season—carefully around various ritual offerings or ash remnants thereof on the ground.18 Heralded as Singapore’s oldest charitable institution, Thong Chai was established at a rented building in 1867 by a group of overseas Chinese businessmen. Their charitable works attracted the attention of the Straits Settlements governor Sir Cecil Clementi Smith, who granted them a piece of land in Kampong Malaka to build their own facilities (originally on Wayang Street, now renamed Eu Tong Sen Street), which were completed in 1892. Using public donations, Thong Chai’s building committee later purchased a piece of land on 120

Power in Technique and Techniques of Power



Chin Swee Road from the Urban Redevelopment Authority and a new ten-story building was officially opened by Prime Minister Lee Kuan Yew in 1976. At the time of my fieldwork, Thong Chai used the first four floors and rented out the rest. Reception, general clinic rooms, the dispensary, a central waiting area, and administrative offices (including Thong Chai Medical Research Institute) were on the ground floor. Meanwhile, bulk herb storage, a teaching classroom, conference room, and library were on the first floor; specialist clinics were on the second floor; and a meeting hall and outdoor herb garden (consisting of potted plants on a large balcony) were on the third floor. Patients underwent a remarkably similar administrative procedure as described above for Chung Hwa: after entering on the ground floor, they took a number at reception, stated the reason for their visit, were assigned a print-out with their room and queue numbers, and then waited until their number appeared on the electronic queue board (either on the ground floor for general medicine, or upstairs for a specialty clinic). Unlike Chung Hwa, which charged small administrative and prescription fees, consultation and treatment at Thong Chai was completely free for the five hundred to seven hundred patients they saw daily (according to their chief operations officer, Tok Kim Cheng). On the ground floor, once their number appeared patients proceeded to rooms one through six for general practice (herbal prescriptions), and rooms seven or eight for acupuncture (which sometimes also included herbal prescriptions). Serious cases, or returning patients, would be sent upstairs to a specialist. Diagnostic criteria and prescriptions were entered into networked computers by physicians and transmitted to the dispensary, where one of eight pharmacists prepared the formula, calling out the patient’s name when it was ready to be picked up. Dr Li’s days at Thong Chai were split into two shifts: in the morning, she worked with two other physicians specializing in hypertension and diabetes in a large room on the second floor, while in the afternoon she worked alone in one of the small ground floor general medicine rooms. After preparing the room and settling in at her desk, Dr Li pushed a button to call the first patient into the room; patients arrived singly or accompanied by a friend or family member, and sat in the plastic chair adjacent to her desk. She then reviewed whatever paperwork they provided and asked questions on the basis of their 121

Capturing Quicksilver records and/or complaints. Sometimes patients began the consultation with a narrative, other times they waited for her prompting. Dr Li took their pulse and blood pressure and (usually) examined their tongues, continuing the interrogatory in the meantime. With the addition of the blood pressure reading, she thus adhered to the standard Chinese medical diagnostic technique of the sizhen (four examinations): listening, looking, palpating, and smelling. This process of discussion and examination is the first step a practitioner takes in transforming her understanding of illness from surface-level manifestations to the underlying processes that produce them. Through the four examinations physicians engage in the process of reframing the patient’s experience within medical discourse. The physician also transforms signs into symptoms by selectively focusing on specific aspects—such as temporal elements—of the patient’s larger narrative, and by generalizing individual experience into conventional medical language and categories. The second step in translating specific complaints into medical categories involves employing one of several diagnostics in order to transform symptoms into a syndrome, through the classificatory logic of bianzheng (syndrome differentiation). Once a syndrome has been differentiated, an appropriate treatment can be determined (Farquhar 1994).19 Using these techniques Dr Li made notes pertaining to patients’ symptoms, syndrome, and treatment in either their paper file, to be entered into the computer later, or directly into digital records. At minimum, prescriptions were entered immediately into the computer (with few exceptions) so they could be sent electronically to the dispensary.­20 As I observed in nearly all the clinical settings in which patients had a direct line of sight to their paper chart or the physician’s computer, patients were visibly interested in what Dr Li wrote about them—often leaning over to get a better view of her work. Like Dr Wang, Dr Li’s bedside manner was friendly, professional, and deliberate. Although I rarely heard her explain the details of Chinese medical theory to her patients, she usually took the time to engage in conversation with her patients on a wide range of topics from their medical history and dietary advice, to their work situations and aspects of family life. While she did not employ humor quite as much as Dr Wang, her patients nearly always appeared grateful upon leaving, their mood seemingly lightened by the exchange. From her room, patients typically proceeded to the dispensary, where they 122

Power in Technique and Techniques of Power



waited for their prescription to be filled. Unlike the other charitable clinics at which I observed, Thong Chai still primarily dispensed herbs drawn from a bank of small wooden drawers in their pharmacy, carefully measured and then wrapped in pink paper, to be taken home and decocted by patients. Open seven days a week, they provided these packets until 3:00 p.m. and liquids or pills thereafter, although their chief operating officer Tok Kim Cheng mentioned that liquids were being phased out. Like Chung Hwa, the processing of patients through Thong Chai was remarkably orderly and efficient, maximizing productivity and the number of patients that could be seen on a given day. By contrast, the pace of Dr Wang’s private practice was slower and more flexible—almost leisurely. Against the clamor and heat of Chinatown on the opposite side of the glass door, the calm, tidy, and air-conditioned environment of Dr Wang’s small clinic offered an almost immediate reprieve. Patients arrived at their designated time and checked in with either Dr Wang or his wife at reception. They then sat on a chair or on the long, cushioned bench below a small television—directed toward the receptionist’s desk—that often played DVDs of Chinese or Korean serial dramas (particularly on slow days). When patients spoke with each other, they did so quietly, barely competing with the sound of the television or soft Chinese music playing over the clinic sound system.21 After Dr Wang called patients into the first of two small offices, new patients were asked to fill out a large index card with their personal information and basic medical history. Dr Wang explained that he filed this card, and often referred to it on subsequent visits, in compliance with TCMPB record-keeping requirements. In addition to reviewing any charts, documents, or images that patients provided (e.g., x-rays), Dr Wang used the Chinese medical diagnostic technique of the sizhen described above. He inquired as to their condition and/or medical history, took their pulse, checked their tongue and complexion, and, in some cases, felt the temperature of their skin (often on the forearm) with the back of his hand. Dr Wang often spent twenty to thirty minutes explaining the diagnosis and treatment strategy, and answering any questions they might have in a professional, friendly, and warm manner. After diagnosis and discussion, patients receiving acupuncture followed Dr Wang to one of two curtained beds at the back of the clinic, where they would 123

Capturing Quicksilver sit or lie down for needling. If there were no other patients waiting, Dr Wang sometimes remained at the bedside to chat after inserting the needles; otherwise, he inserted the needles and then returned to the front of the clinic to see his next patient, leaving the prior patient to rest behind on the curtained bed in the meantime. Appointments were concluded at the front of the clinic, where patients confirmed their next visit and/or waited while Dr Wang prepared their prescription. Behind the receptionist’s desk, just inside the front door, were shelves lined with plastic bottles imported from Taiwan, each containing the powdered form of one or more herbs. Many of these bottles bore the name of a common formula derived from the Chinese materia medica. For instance, Dr Wang showed me a bottle labeled wuwei xiaodu yin (decoction of five detoxicants), which included jinyinhua (honeysuckle, Flos Lonecerae), juhua, (chrysanthemum, Flos Chrysanthemi), pugongying (dandelion, Herba Taraxaci), tiankuizi (semiquilegia root, Radix Semiaquilegiae), and zihua diding (viola/purple ground-nail, Herba Violae). In the Chinese materia medica, this formula is used to clear heat toxins,

Figure 3.2. Dr Wang filling a prescription using powdered polyherbal formulas from Taiwan 124

Power in Technique and Techniques of Power



often manifest in superficial infections and inflammations of the skin (Liu 1995: 179). Dr Wang’s use of these powders somehow straddled the distinction between zhongyao (Chinese medical drugs) and zhongchengyao (Chinese formula drugs). Zhongyao, in this context, often refers to a single drug (plant, mineral, or animal materials) in various states of processing—from simple cleaning and slicing, to frozen and powdered—that a physician then combines in particular ratios (according to Chinese medical formulary, adjusted to the specific state of a patient at a given time) to create a polyherbal formula. Zhongchengyao, then, refers to a premade mixture of several of these powdered drugs (Hsu 2009a). As Dr Wang wrote fangji (individualized prescriptions) for his patients, rather than simply treating their primary complaint with a premade formula, his method of prescribing fits the description of zhongyao. The actual contents of these bottles, however, were more akin to zhongchengyao. Although each bottle bore a list of the herbs included therein (including both Chinese characters and their Romanized scientific name), Dr Wang informed me that knowing the proper quantities to use in general, as well as in specific cases, required training and experience. When filling a prescription, he selected several of these bottles, measured a specific amount of each into a bowl, mixed them together, and then carefully spooned small piles of the mixture onto a plastic sheet laid atop a machine. He then laid another plastic sheet on top of the first and fed them through the machine, which sealed the individual powder piles into small, perforated packets. He then folded these sheets and gave them to the patient in a plastic carrier bag, instructing them to drink one packet of powder mixed with warm water several times per day, every day until their next visit. Although not every patient received acupuncture, nearly every patient that I observed left Dr Wang’s clinic with this type of prescription, tailored not only to their individual condition on that day but also to the general Singaporean preference for convenience and expediency. Meanwhile, at Chung Hwa Dr Wang volunteered one Saturday morning per week for consultations in general medicine, providing acupuncture treatments in his ground floor room and writing prescriptions to be filled at the onsite pharmacy. Sometimes treating up to twenty patients in a three-hour shift, the procedures here 125

Capturing Quicksilver were somewhat different from his private clinic. From his desk near the center of the room, Dr Wang smoothly orchestrated the flow of patients, assistants, and himself into, through, and out of this space. Although his Chung Hwa consultations were shorter, with far less explanation, his movements were nonetheless still measured and deliberate, and his bedside manner was essentially the same: friendly, professional, and light-hearted. Once under full operation, his ground floor general practice room was usually occupied by no fewer than three patients (sometimes a bustling ten or twelve) in various stages of treatment, plus their assistants or family members. Patients waited their turn in chairs along the wall nearest the door, sat in the chair next to his desk for diagnosis and sat in additional chairs along the walls or laid down on one of four curtained beds for acupuncture. They usually left his room with a prescription to be filled by the clinic pharmacy in the form of a thick, bottled decoction—made onsite from boiled herbs—and/or pressed tablets. In contrast to Dr Wang’s more-flexible private practice, the administrative processes at both Chung Hwa and Thong Chai were remarkably consistent and mechanical. The Chinese medical community’s efforts toward “modernization,” standardization, and institutionalization—combined with the MOH regulation of practice and products—facilitated the enfolding of Chinese medicine into more formalized biopolitical dynamics. Furthermore, anatomo-politics were negotiated in the spatial and temporal divisions dictated by institutional practices. These spaces disciplined patients (e.g., in the orderly flows of and within their bodies) and physicians (e.g., in the application of approved techniques such as the sizhen). I emphasize the role of disciplining institutions here because, as noted in the case of Dr Wang above, the practices of a given physician could differ in private versus institutional settings—particularly in terms of procedures, materials (the form of prescriptions), and pace. As these institutional and practical arrangements have correlates and precedents elsewhere, one cannot claim that these procedures are neatly bound by and within Singapore’s national borders. At the very least, the approved curriculum instructing students on thesizhen was imported from Shanghai. Furthermore, as noted above, efforts of local organizations like the SCPA to manage the reputation of Chinese medicine often included transnational networks and activities. We cannot assume, therefore, that physicians’ only 126

Power in Technique and Techniques of Power



recourse to authority in negotiating their practices lay in local biopolitical and anatomo-political dynamics, regardless their degree of fit. As I will explore in the rest of this chapter, the standard by which a Chinese medical physician was evaluated in Singapore was not couched in terms of compliance with the TCM Practitioners Act or institutional procedures, but in terms of various forms of experience.

Chinese Medical Authority and Experience Whether in reference to the collective history of Chinese medicine, or the history of an individual physician, knowledge and authority were often intertwined with experience in my discussions with patients. As I will illustrate in chapter 4, some Singaporeans saw this reliance on history and experience as a weakness or, in the words of one interlocutor, “cultural baggage.” Most patients with whom I spoke, however, referred to a physician’s experience positively.22 For instance, in my second interview with Lena (whom I will describe in greater detail in chapter 6), she explained that Chinese medical physicians and shopkeepers employed knowledge derived from the experience of Chinese medical masters in the PRC: “The more people get well, the more confident he is [that] he must be right,” she explained. “But, saying that, now we have better procedures, since they—individually, they will have to give [prescriptions] according to the individual, rather than the general thing [illness].” According to Lena, the experience of a given shopkeeper or physician was thus partially a matter of inherited knowledge—itself acquired through the successful experimentation of a physician’s predecessors—and partially derived from the application of this knowledge in treating individuals. Lena: I would say that the doctor is equally important—in fact, more important because he knows how to combine [the herbs]. The doctor will be important. The medicines are there, but if you don’t know to combine well, it’s not going to cure you. Arielle: What about “Western” medicine? Is that the same? Lena: The same. I think so. I’ve been to clinic[s] where I can get well very fast and I’ve been [to places] where I can’t get well because he’s [the doctor] so mild in his dosage. You know? He can’t give—he don’t dare give me the right, or even a slightly stronger, one to make me … sleep and rest and get well faster. 127

Capturing Quicksilver Lena regarded a physician’s knowledge and experience to be equally important in both biomedicine and Chinese medicine. With respect to the efficacy of Chinese medical treatments, she felt that a physician’s knowledge was even more important than evaluation of prescriptions alone. The ability to correctly combine herbs and tailor the prescription to an individual patient was, in her opinion, a matter of experience. In practical terms, this experience was quantified through the strength of the physician’s references—that is, the number of people who knew and were successfully treated by the physician—which was the basis for Lena’s choice of Chinese medical physician in Singapore. Anna, an older Singaporean Chinese woman who will be introduced more fully in chapter 4, explained that while biomedicine was based on (standardized) university training, Chinese medicine was based on opinion. Notably, her reference to opinion was not in opposition to fact, and she was well aware of increasing standardization at institutions like Chung Hwa. Referring instead to a Chinese medical physician’s discretion with regard to diagnosis and treatment—individualized to a given patient, at a specific place and time—this opinion was based on “what they learn [and] what they treat.” Not only was experience necessary for proper diagnosis and treatment—and thus served as the primary criterion in her selection of a Chinese medical physician—but in its absence, a physician risked injuring their patient further. Experience was particularly important in determining dosage, which she considered Chinese medicine’s weak point: “So for me, I think uh, they [biomedical doctors] are trained, uh, in this university, so they come out [and] all the prescriptions [are] almost the same. But zhongyi [Chinese medicine] is according to the [physician’s] experience. … The one thing, weak point, is, ah, they might—because they don’t have a standard—they might [treat patients] according to what they experience.” According to Anna, this variation in experience produced variation in the quality of Chinese medical physicians practicing in Singapore: “Sometimes [a physician] is good and sometimes [he] is not, according to the experience.” It was therefore very important to select a Chinese medical physician carefully on the basis of their experience, which she evaluated with reference to their background (particularly their history and success rate), referrals by family members or friends, and her bodily experience of their first 128

Power in Technique and Techniques of Power



treatment (with particular attention to their promised timeline for improvement). Like Lena, Anna considered a Chinese medical physician’s success to be dependent on inherited knowledge (“what they learn”) and practical experience (“what they treat”). This notion of jingyan has also been described with reference to Chinese medical practice in the PRC. According to Farquhar (1994), jingyan can be understood on two levels, linked through teaching and study: first, the archive of experience from which an aspiring physician is taught and from which he can continue to draw in the course of practice, and, second, a given physician’s own experience. “Practice (of seeing patients, of studying, of teaching and being taught) accumulated as experience,” she explains, “is the ground on which the past can serve the present” (Farquhar 1994: 173). As Hsu (1999) notes in her discussion of the personal transmission of knowledge, jingyan is a central quality in Chinese medical practice that refers not only to cognitive ability, but also to the perceived efficacy of a respected senior physician. This manifests in popularity and success, and is developed through medical practice, life experience, and maturity. Jingyan is thus highly personal knowledge that is only partially transmissible, because it emphasizes experiencing medical doctrine in practice (Hsu 1999). Even in the case of physicians trained exclusively in Singapore, the notion of jingyan links them with a long tradition of knowledge and practice in China from which they derive a degree of authority. As Sean Hsiang-lin Lei (2002) notes, the use of the term jingyan to describe the basis of Chinese medicine can be traced to struggles between the Chinese medical community and “Western-style” doctors in early twentieth-century China. Lei notes that whereas the term was previously used in reference to a collection of jingyanfang (tested and respected formulas), jingyan was first used by opponents of Chinese medicine like Yu Yan to decouple effective Chinese drugs from supposedly groundless Chinese medical theory. Jingyan was subsequently described in terms of accumulated renti jingyan ([clinical] experience with the human body), as opposed to the dongwu shiyan (experimentation on animals) associated with “Western” science. Disqualified from scientifically evaluating Chinese drugs, Lei explains, Chinese medical physicians responded by developing the embodied understanding of jingyan employed today. Although used to describe the basis of Chinese medicine, in this historical context 129

Capturing Quicksilver jingyan articulated the boundaries of a medical-political struggle: “The strategic uses of jingyan in China in the 1930s reflected just one of many such efforts, which are simultaneously a political negotiation, epistemological formation, boundary-drawing work, and construction of professional identity—all of which are in marked contrast to “Western” biomedicine and the related positivist theory of knowledge. Consequently, jingyan concerns itself more with the power relationship between two medicines than an accurate representation of Chinese medical practice.”23 Twentieth-century laozhongyi (senior Chinese medical physicians) thus reestablished their professional identity and medical authority by creatively tweaking the notion of jingyan in response to the demands of highly politicized scientific discourse (Lei 2002: 358). In the course of my fieldwork I observed similar processes in the Chinese medical community’s struggle to establish professional identity and medical authority. An example of this can be illustrated by Professor Tan Chwee Heng. After obtaining a bachelor in science in biology from Nanyang University in Singapore in 1971, Professor Tan earned a diploma in TCM from the SCTCM in 1976. In the course of completing a master’s degree in acupuncture from Beijing University of Chinese Medicine in 1995, he developed a single-needle technique that he continued to use and research in Singapore. In 2006 and 2007 his primary activities included running a private practice, lecturing and demonstrating at SCTCM and Chung Hwa, teaching qigong, and serving on the examinations committee of the TCMPB. With an initial degree in biology but decades of subsequent experience in Chinese medicine—including training and research in Singapore and the PRC, as well as practice and teaching in Singapore—he sought to reconcile scientific and Chinese medical understandings (which he regarded as distinct from each other). In our first interview, Professor Tan highlighted his experience (and, by extension, authority) with reference to his various international and local activities, as well as a few remarkable cases from his clinical experience. He proudly described his involvement in numerous international congresses in acupuncture (e.g., in France and Japan), WHO events, and presentations at World Federation of Acupuncture-Moxibustion Societies conferences, with which he was an executive member. He showed me a plaque he was awarded for twenty-five years of teaching at the SCTCM and informed me 130

Power in Technique and Techniques of Power



that his research, society membership, local lectures (at SCTCM and as a guest elsewhere), and innovative practice played an integral role in the historical development of acupuncture in Singapore. He also made a point of showing me his licensing certificate and suggested I investigate the process of registration and licensing further. Finally, Professor Tan alluded to his practical expertise and authority by reference to several letters of gratitude from patients and their family members. Pointing to a letter from British Airways, he told me about saving a woman who had a heart attack on an airplane while he was on his way to a WHO congress in May 1998. Although a British doctor also answered the flight attendant’s call for assistance, he was unable to do anything so Professor Tan inserted a single acupuncture needle, which “immediately settled the thing” (by which he meant the heart distress). In appreciation of his assistance, he reported, British Airways wrote him the letter and gave him a bottle of port and a travel voucher without limitations. He also showed me a card thanking him (in English) for his successful treatment of a young man’s nerve disorder, and translated a letter written to him from a young man whose mother’s pain had been alleviated through Professor Tan’s acupuncture. In addition to these letters, Professor Tan’s authority at Chung Hwa, the esteem his patients held for him, his various positions and responsibilities (including collaboration with the TCMPB), and the many unsolicited referrals to him I received from his colleagues indicated he was an exemplary representative of Singapore’s Chinese medical community. While Professor Tan’s jingyan and advocacy of Chinese medicine in Singapore (both locally and internationally) was reminiscent of the activities of PRC laozhongyi described above, he would not refer to himself in this manner. Although Chinese medical physicians in Singapore were still popularly referred to as sinseh, yisheng, or doctor, the TCMPB attempted to implement more-rigid naming standards.24 Perhaps in line with their attempt to clearly define and delineate Chinese medicine from biomedicine, they specified that physicians of chuantong zhongyiyao (traditional Chinese general medicine) be referred to as zhongyishi.25 One day I made the mistake of calling Professor Tan by the colloquial sinseh and he corrected me with a terse, “Zhongyishi.” Thus, while the TCMPB’s preferences had not yet fully filtered into the popular vernacular by the time of my fieldwork, their 131

Capturing Quicksilver guidelines were clearly being upheld by at least some portion of the professional community. Nonetheless, Professor Tan did not restrict his experience to the official discourse of degrees and certificates, or even local professional activities. Instead, he defined and maintained his authority with reference to multiple fields—including local biopolitical dynamics, international networks and organizations, the historical archive of Chinese medical experience, and his own experience. His invocation of these various forms of experience bolstered his authority and, as I will discuss in the next section, granted him a degree of latitude in developing his innovative acupuncture practice.

Negotiating Political Authority and Jingyan As an appointed examiner for the TCMPB examination committee, Professor Tan was sensitive to the implementation of the committee’s rules and regulations. In many respects, he represented the sort of physician that the Chinese medical community as a whole was expected to emulate: successful, compliant, and professional. In other respects, however, he subtly challenged the tidy boundaries between Chinese medicine and biomedicine, as well as the standardized procedures taught in TCMPB-accepted curricula. Professor Tan was very keen to demonstrate the objectivity of his single-needle technique to me, often appealing to scientific criteria and rationale to discuss its efficacy. Nonetheless, he clearly based his technique on Chinese medical understandings of the body. In this section, I will describe a few theoretical concepts integral to the practice of acupuncture, as taught in standardized TCM education in the PRC and Singapore. This will illustrate key facets of the emergent experiential archive on which Professor Tan based his innovative practice; I will then describe it as I encountered it in fieldwork. One of the most fundamental concepts in contemporary Chinese medicine is the untranslatable substance/force qi. As Sivin (1987) describes, life is predicated by the accumulation of qi from the cosmos and sustained by drawing vitality (other forms of qi) from the air and food throughout life, while death results from its dissipation. Conceptions of the body and health are therefore also framed in terms of qi (plural), or “dynamic agents of change” (Sivin 1987: 46–53). Qi, along with xue (blood) and jing (essence) are carried through the jingluo, which are the tracts and channels that circulate 132

Power in Technique and Techniques of Power



these vital substances/forces through the body. Contemporary analytical constructions of the jingluo have been subject to doubts inspired by Euro-American anatomy, by internal criticism, and by the synthesis between “biomedicine” and Chinese medicine, which aroused concern about the anatomical status of the circulation tracts. The result was the reinterpretation of jingluo as pathways for the effects of acupuncture, with a much greater emphasis on the needling loci rather than the relative placement or qualities of the tracts themselves (Sivin 1987). Despite this contemporary accommodation of biomedical anatomy, jingluo are still spoken of in functional, rather than anatomical, terms. The jingluo unify and maintain harmony within the body, carry nourishment and strength, and connect the interior and exterior of the body. Conversely, they can also reveal disorderly relations between the body’s systems of functionality. Pain or illness in one part of the body might originate in disharmony or disorder in another part, through the interconnection of bodily substances/forces, visceral systems of functionality, and the jingluo. Thus, very broadly speaking, the manipulation of needles at certain loci (in practice, often wider than a single point), and at various depths, on the body’s surface is intended to regulate the flow of substances/forces (e.g., qi, xue, and jing) through the jingluo, thereby maintaining or restoring harmonious transformations within the body. Although this brief description relies on standardized theory, developed in the PRC and taught in approved Singaporean institutions, there is considerable variation in its actual application. Developed over the course of the last 2,500 years, the practice of acupuncture was refined according to the particular aspects different masters wished to emphasize, based on their practical experience (Lu and Needham 1980). This reflects the heterogeneity of Chinese medicine as a whole, and continues to allow for innovation and synthesis in contemporary practice. Volker Scheid (2002), for instance, emphasizes the syncretism and ambiguity evident in the individual styles of physicians who actively reshape Chinese medicine by drawing on both the historical archive of experience and biomedical knowledge and technology. This synthesis is particularly apparent in his presentation of the case of a doctoral student, named Dr Lin, who developed an innovative nosology and acumoxa treatment for speech impediments associated with cerebrovascular accidents. 133

Capturing Quicksilver Because Chinese medicine does not distinguish between variations of cerebrovascular accident–related speech impediments in the same way as biomedicine (in this case, the important distinction was between dysphasia and dysarthia), Dr Lin had to create his own treatment protocol. In a synthesis of his own experience and a variety of other infrastructures guiding him—including his supervisor’s expectations, university regulations, methodological considerations, patient expectations, and so on—he selected seven acupoints as the basis for his protocol (Scheid 2002). While the general understanding of bodily dynamics described above absolutely applies in both Dr Lin’s and Professor Tan’s practices, their applications of this understanding led to very different innovations. Working on the premise that disruption or intervention in one point of the body can produce effects in another (action at a distance, as described by Hsu [1995], or referred effect, as outlined by Lo [2001]), Professor Tan asserted that the lateral side of the second metacarpal region of the hand is holographic of the body as a whole. This principle in itself is not unprecedented. As Hsu (1995) explains, the idea of a manikin in man is present in nineteenth-century neurological research that led to reflexology and the development of auriculotherapy by French acupuncturist Paul Nogier in the mid-twentieth century, which was subsequently reformulated as erzhen (ear acupuncture) in the PRC. Professor Tan’s holographic second metacarpal region of the hand could be viewed as parallel to the idea of a manikin in the ear, or on the foot (as in the case of foot reflexology). Chinese medical physicians maintain that there are around two thousand possible loci on the human body, although approximately 150 are used today, typically in combinations of five to fifteen (often symmetrically placed on both sides of the body). Rather than using this wide distribution of loci across the body, Professor Tan focused on only twelve within this particular region of the hand to achieve the same ends. Whereas Dr Lin’s protocol was developed to treat a particular (biomedically defined) condition, Professor Tan used his technique with every patient. The vast array of symptoms and illnesses for which his patients sought treatment—from aches, sprains, skin disorders, cold and flu, to cancer or post-stroke recovery—were all treated by the insertion and manipulation of a single-use, disposable, 0.2 x 13–mm stainless steel needle in the lateral side of 134

Power in Technique and Techniques of Power



the second metacarpal region of the hand. As one of his stated intentions for the single-needle technique (and, indeed, a frequent explanation for his popularity given by patients) was to provide a less-threatening form of acupuncture for patients with an aversion to needles, the needles he used were extremely fine. Tan’s technique also differed from those of other acupuncturists at Chung Hwa because of his use of additional diagnostic tools. In the diagnostic process, he first employed the sizhen: palpating (taking his patients’ pulses); listening (asking questions); looking (inspecting faces, body language, and mobility and usually examining their tongues); and (presumably) smelling. Along with the patient’s record and other documentation he or she provided, these diagnostic techniques enabled him to determine the qualities of a patient’s syndrome, and thereby narrow down which of five general regions within the second metacarpal area of the hand to needle— corresponding with lung, spleen, heart, liver, or kidney. It did not, however, tell him the most tender and thus ideal locus. For this purpose, Professor Tan then used one or more additional methods. Through many years of practicing and teaching qigong he refined his own qi, and his ability to sense his patients’ qi, thereby developing what he called his qigong sword finger: after the standard diagnosis described above, he sometimes pointed his middle and index fingers over his patient’s hand in order to determine the precise point at which to insert the needle. Although his patients certainly accepted this subjective technique as legitimate, his insistence on scientific objectivity led him to use other tools, either in lieu of or in conjunction with qigong sword finger. He therefore almost always used a sound-based device, or, on occasion, a light-based device (both of which were pen-shaped acupoint detectors) to find the “most tender” point. In both cases, Professor Tan pressed the tip of the pen at specific points along the lateral side of the second metacarpal bone—the former emitted a constant sound that rose in pitch when it neared the ideal point, while proximity on the latter was indicated by a row of bars that lit up (the more bars, the more tender). Finally, Professor Tan himself invented a pressure meter roughly resembling a meat thermometer. Pressing with the tip of the meter at the same pressure according to the gauge, and inquiring of the patient which was the most tender point, would ensure that inconsistent application of pressure was not a variable in the selection of a locus. 135

Capturing Quicksilver However, perhaps because this simply exchanged the physician’s subjectivity for the patient’s, Professor Tan did not use this tool very often and seemed to prefer the sound-based acupoint detector, sometimes in conjunction with qigong sword finger. When explaining and demonstrating these methods to me, Professor Tan emphasized that the results were often dynamic, meaning that a given individual might have slightly different results from one moment to the next, even with the same tool. This confused “Western” acupuncturists, he informed me, because they desired more-concrete and more-predictable results, but failed to realize that the loci themselves are dynamic, in concert with the constant flows, transformations, and fluxes of the body. Although usually able to determine the most appropriate locus very quickly, Tan’s use of multiple tools in more difficult cases (and most certainly his invention of the pressure meter) indicated that he also sought to be as objective as possible in spite of the quicksilver nature of qi. This endeavor to represent the details of his research in a manner amenable to the scrutiny of others (no doubt including the aforementioned “Western” acupuncturists and an inquisitive American anthropologist) was also evident in his private documentation of this (clinical) renti jingyan. After completing his master’s thesis on the topic of his single-needle technique, Professor Tan continued to collect data in the course of his daily practice—particularly focusing on compelling evidence of the technique’s efficacy in the form of personal notes, video clips, and photographs. Despite his obvious confidence in the method, he was very aware of its controversial nature. In our first discussion of the technique he prefaced his explanation with a short commentary on the politics of innovation in Singapore. After telling me he would show me “the amazing effect, or miracle, of one-needle therapy,” he admitted that although (or perhaps because) it was a breakthrough, it had not yet been fully endorsed by the acupuncture field: “A new thing is difficult for people to accept. And, of course, there are very many reasons behind it—especially the protecting barrier. You know, even in all the fields—in business, in research (in academic research)—always, there are groups. If you are a group of professors, you will protect your group. Certain new ideas, whatever, although you know it, you admire it, still you have to [protect your group].”26 In sum, Professor Tan’s engagement with local and international professional development, biopolitical dynamics, scientific 136

Power in Technique and Techniques of Power



experimentation, and transnational or historical medical theory illustrate the intersecting fields on which a Chinese medical physician must negotiate experience and, particularly in this case, innovation in practice. For some time prior to and including the first several months I was allowed to observe him, Professor Tan was allowed to practice his innovative acupuncture at Chung Hwa. However, his single-needle technique was not included in the officially sanctioned curriculum, adopted from the seventh edition of the Shanghai TCM University curriculum. His ability to continue employing it under observation (by me and/or students) was therefore curtailed a few months after I began working with him at Chung Hwa. He was most certainly not asked to leave, but was merely asked to practice the acupuncture technique approved by the TCMPB and taught at the SCTCM. Thus, he retained his positions as demonstrator and physician, and simply began volunteering at Dazhong in Geylang, where I was invited to continue observing. The administration at Dazhong, he informed me, was quite happy to receive the patients he brought to their clinic and were more flexible with the specific technique that

Figure 3.3. Professor Tan with a regular patient at Dazhong Yiyuan 137

Capturing Quicksilver he employed. Indeed, at his request, many of his regular patients followed him from Chung Hwa to Dazhong. Chung Hwa’s discouragement of Professor Tan’s unique technique was very likely related to its need to comply with TCMPB regulations, part of which dictated the specific curricula to be used in Chinese medical schools. These procedures, in both their biopolitical and anatomo-political aspects, dictated who could teach and practice in the institution, the instruments and diagnostic tools they could use, the theories they had to promulgate, and the techniques they had to employ. Because Chung Hwa was the charity clinic in which SCTCM students obtained hands-on experience (in observation and practicum hours, as well as postgraduation residency), physicians and administrators therein were beholden to these guidelines. While a great deal of the institution’s authority derived from its strong reputation in Singapore’s Chinese medical community—long predating the TCM Practitioners Act—Chung Hwa undoubtedly had much to gain through its relatively new political authority. It also had a great deal of responsibility as a key site for the enactment of power relations and representative of the Chinese medical community.

Conclusion In the first half of this chapter I described how the regulation of Chinese medicine in Singapore fit within a framework of biopolitics and anatomo-politics (or, collectively, biopower). Most obviously, biopolitics was apparent in legislation that sought to ensure the safety, control, and boundedness of a practice that facilitated the population’s productivity with minimal cost to the state. This regulation was formulated with the cooperation of members of the Chinese medical community, now divided (on paper) by a new distribution of authority and parameters of practice. In addition to this conceptual and physical enclosure (especially relative to biomedicine), further partitioning of space and time within large charity clinics like Chung Hwa evoked the technique of anatomo-politics. These biopolitical and disciplinary divisions ensured that the ideal of a productive and harmonious population, described in the last chapter, was replicated within the walls of Chinese medical institutions: space and time were carefully managed to ensure the efficient processing of patients-as-numbers through these institutional curing machines. 138

Power in Technique and Techniques of Power



Based on standardized TCM theory, developed in the PRC and then approved as the official curriculum of Chinese medical schools in Singapore, the daily (conventional) practice of physicians was similarly constrained by biopolitics and anatomo-politics. This framework not only differentiated legal from illegal practice, and Chinese medicine from biomedicine, but also sought to define authority, proper transmission of knowledge, and aspects of daily practice. In this context, Professor Tan’s innovative practice could easily be interpreted in terms of power relations. The application of only a single needle and each of its subsequent twists, jabs, and pulls, could be viewed as an embodied act of resistance against both the standardized theory developed in the PRC and promulgated in Singapore, and the disciplinary power of the state. But such a reading cannot adequately account for the authority that afforded Professor Tan the latitude to continue practicing this unconventional technique, first at Chung Hwa and then at Dazhong, while simultaneously maintaining his political and professional affiliations. Thus, in the second half of the chapter I argued that the Singaporean political field was not the only generative source of authority or legitimization for practitioners, highlighting the importance of various kinds of experience evoked in negotiations of authority and practice in both the PRC and Singapore. As described by Farquhar (1994), Hsu (1999), and particularly Lei (2002), contemporary Chinese medical authority in the PRC has been asserted, in part, through a series of redefinitions of the notion of jingyan. This term was often used to describe the basis of Chinese medical practice, in its engagement with political practice and scientific discourse in the PRC. Although Professor Tan taught and practiced in accordance with standardized Chinese medical theory, his jingyan—part of the cultural capital of a senior Chinese medical physician—granted him a degree of latitude in technique. Individual practices, whether standard or innovative, are thus intertwined with Chinese medicine’s local and transnational histories, and with the personal experience of a given physician. In conclusion, the cautious process of reshaping Chinese medicine in Singapore in accordance with the priorities of biopower granted the practice a degree of politico-economic legitimacy but not medical authority (narrowly conceived)—controlling it through the process of inclusion and exclusion and the detailed disciplining 139

Capturing Quicksilver of institutions and bodies therein. The state was seen to be responsive to the demands of the public (who continued to use Chinese medicine and expected the government to ensure its safety), without having to overtly privilege the culture or heritage from which it originated. It was this heritage (including a transnational legacy of highly regarded physicians) that ascribed meaning to Chinese medical physicians’ jingyan, enabling the continuity of not only a supposedly complementary medical practice but also an alternative authority that quietly contested this “complementary” status. Hence, while the disciplinary techniques of the state were reflected in the wider Chinese medical field and standardized institutional practice, the popularity of a given physician—or ubiquitous home-based remedies—allowed room for individual negotiation and creativity that cannot be reduced to biopower alone.

Notes 1. This includes the Medicines Act 1975; Medicines (Traditional Medicines, Homoeopathic Medicines and Other Substances) (Exemption) (Amendment) Order 1998; Medicines (Chinese Proprietary Medicines) (Exemption) Order 1998; Medicines (Labelling of Chinese Proprietary Medicines) Regulations 1998; Medicines (Licensing, Standard Provisions and Fees) (Amendment) Regulations 2003; Medicines (Prohibition of Sale and Supply) (Amendment) Order 1998; and Medicines (Labelling of Chinese Proprietary Medicines) (Amendment) Regulations 2005. 2. Early legislation included the Quarantine, Registration of Births and Deaths, and Vaccination Ordinances of 1868, as well as the Contagious Diseases Ordinance of 1879 (Sinha 1995: 108). 3. Vineeta Sinha suggests that this is the root of the antiwelfarist attitude of contemporary Singaporean health policies (Sinha 1995: 139, fn10). Meanwhile, as I discuss in chapter 2, Christopher Tremewan (1998) describes how the creation of this supposedly nonwelfarist state was only possible through the near universal consumption of welfare. 4. As Clancey (2012) further explains, self and community surveillance had proven an effective strategy in combatting the 2003 SARS epidemic; it also reaffirmed the unity of Singaporeans and elevated both the status of medical researchers and public health endeavors (see also Fischer 2013). 5. As will be further explored in chapter 5, many of these preventive messages were also conveyed by the HPB, a division of the MOH that engaged in a wide variety of activities to educate the public on healthrelated matters. 6. Furthermore, a 1929 article in The Gardens’ Bulletin (Straits Settlement) discussed Chinese herbs that were collected and sent to the Royal 140

Power in Technique and Techniques of Power

7.

8. 9.

10.

11.

12.



Botanic Gardens, Kew in London for identification under the supervision of I.H. Burkill, the director of the Straits Settlements gardens (Sinha 1995: 116–17). The other four are the Singapore Medical Council, the Singapore Dental Council, the Singapore Nursing Board, and the Singapore Pharmacy Board. Information on the TCMPB was collected from their website, http://www. tcmpb.gov.sg, and from my informal discussion with the TCMPB registrar. These included Beijing University of Chinese Medicine (formerly known as Beijing TCM University), China Academy of TCM (also in Beijing), Chengdu TCM University, Guangzhou TCM University, Nanjing TCM University, and Shanghai TCM University. Because one of the two degrees awarded by the double-degree program at Singapore’s Nanyang Technical University was a bachelor of medicine (Chinese medicine) from Beijing University of Chinese Medicine (a recognized foreign institution), these graduates also qualified. While the registration process described above almost exclusively legalized an institutionalized (and standardized) authority and transmission of knowledge, it nonetheless provided a narrow loophole for highly respected physicians without formal credentials. Perhaps in acknowledgment of the manner of reckoning authority on the basis of experience (still common in the Chinese medical community and among patients), the TCM Practitioners Act empowered the TCMPB to register “applicants with outstanding TCM skills and expertise” (as outlined in the TCMPB’s website: http://www.healthprofessionals.gov.sg/content/hprof/tcmpb/ en/leftnav/registration_requirements.html). Such physicians (most likely coming from outside Singapore) were required to have foreign registration, practicing and good standing certificates; outstanding skills as defined by the TCMPB; fifteen years of clinical experience with at least five years as fuzhuren yishi (head physician); and proof of potential employment in Singapore. Thus, while governmental definitions and divisions dominated the general allocation of authority within the Chinese medical community, even legislation had to accommodate other definitions of experience and authority. Nonetheless, it was done in such a way (through rigorous criteria) as to minimize the potential use of this concession to experience. The TCM Practitioners Act defines acupuncture as “the stimulation of a certain point or points on or near the surface of the human body through any technique of point stimulation (with or without the insertion of needles), including through the use of electrical, magnetic, light and sound energy, cupping and moxibustion, to normalise physiological functions or to treat ailments or conditions of the human body” (TCM Practitioners Act, Cap. 333A, 2000 [2001]: Part I, section 2). Incidentally, this division also gave preferential treatment to biomedical doctors by allowing them to practice acupuncture—provided they had the proper certification—without violating the mandated separation 141

Capturing Quicksilver

13. 14.

15.

16. 17. 18. 19.

20.

21.

between Chinese medicine and biomedicine. TCMPB-designated “TCM physicians” with biomedical training, registration, and practicing certificates (either by virtue of an integrated education such as that found in the PRC, or purely biomedical training elsewhere) were not allowed to simultaneously practice biomedicine, whereas “acupuncturists” with dual certificates could do so. Additionally, after completing a recognized acupuncture training course and passing the Singapore Acupuncturist Registration Examination, registered biomedical doctors and dentists could practice acupuncture, without being subject to the Singapore TCM physicians Registration Examination. Furthermore, at the time of my fieldwork the acupuncture register was closed to all medical professionals except biomedical doctors and dentists. At the time of my fieldwork, the approved curriculum was the seventh edition of Shanghai TCM University’s curriculum. As noted in the code of conduct, “Adherence to the Code will enable the public at large to have trust and confidence in the profession” (TCMPB 2006: 07). Two branches were opened earlier than the Toa Payoh branch but each was forced to close due to “upgrading” activities of the Urban Redevelopment Authority (Serangoon Road from 1961 to 1986 and Geylang Road from 1967 to 1994). http://www.chunghwamedicalinstitution.com/ Named after the eldest son (named Eu Tong Sen) of the founder of the transnational Chinese medical company Eu Yan Sang. This practice, associated with the Hungry Ghost Festival, or Seventh Month, will be described in chapter 4. The five major classificatory methods Farquhar highlights are bagang (eight rubrics), bingyin (illness factors), zangfu (organs, or visceral systems of function), weiqi yingxue (four sectors), and liujing (six warps). The purpose of these diagnostics, in isolation or combination, is to relate the various symptoms to each other in order to reveal their underlying pattern—based on the known, stable relationships of their corresponding diagnostic categories—from which illness dynamics can be inferred (Farquhar 1994: 70–134). Chung Hwa and Thong Chai’s incorporation of networked computers into the therapeutic process evokes Gregory Clancey’s (2012) description of the information technology–based Intelligent Island approach to innovation in medical practice. Although his article was focused primarily on biomedical hospitals and clinics, it is not surprising that Chinese medical institutions would also adjust their practices to accommodate local expectations of professional medical practice. This environment contrasts sharply with the noisy chatter that was commonplace in two of the charity clinics at which I worked, Chung Hwa and Dazhong.

142

Power in Technique and Techniques of Power



22. This was by no means the only framework in which they discussed Chinese medicine; as I will illustrate in chapter 4, for instance, their own bodily experience was also integral to their evaluations. 23. In both the PRC and Singapore, the relationship between Chinese medicine and “Western” science has been at the heart of struggles over Chinese medical authority. For instance, in the 1980s, laozhongyi in the PRC—fighting to preserve Chinese medicine against efforts to scientize the practice—“openly seized the leadership of the field and inscribed themselves and their lives as national mentors for the young, exemplars for the future of Chinese medicine” (Farquhar 1994: 17). Subsequently, science (conceived as distinct from Chinese medicine) became a tool used to ensure the future of the profession in the PRC, Singapore, and elsewhere. This is nicely illustrated in Hsu’s description of the Chinese medical physician Zhang, who simultaneously promoted his knowledge of the Chinese medical classics (and thus the jingyan of the ancients) and, as a “modern” intellectual, attempted to reconcile science with the medical and philosophical observations of his predecessors (Hsu 1999). 24. TCM Ethical Code, Annex A: “Extracts from the TCM Practitioners Act and Regulations,” part B: “Definitions” and Annex B: “Guidelines on registered titles” (TCMPB 2006). 25. It is interesting to note that the term chuantong (traditional) is only used in regard to the practice as a whole in Mandarin, but is included in the English translations for both practitioners and the practice itself. 26. One might note that this statement could equally apply to the difficulty biomedicine and “Western” science sometimes has in accepting both internal challenges and innovations, and so-called alternative medical practices and their associated epistemologies. The history of science and medicine is riddled with examples of resistance against those who pushed the boundaries of thought and practice. For an entertaining selection of brief examples along these lines, see Julie Fenster’s (2003) book on medical mavericks.

143

Chapter 4

Making Sense and Sensation

The self is constituted in relation to a world, and it is not only through direct description of embodied experience but through the description of that lifeworld that we have access to the selves of others. —Byron Good, Medicine, Rationality and Experience: An Anthropological Perspective

Introduction One morning in late July 2006 I left Thong Chai, where I had been conducting participant observation with Dr Li, and walked my normal route through the Outram/Chinatown area toward the Chinatown MRT station. By contrast with Singapore’s stereotypical tidiness, the streets and alleys seemed unusually unkempt—black ash and bits of paper skittered about in the fading breeze, soon to be replaced by a hot, humid, and hazy afternoon. Recalling the advice of local friends, I stepped carefully to avoid chalk circles with char marks in their midst where guijie (Seventh Month, or [Hungry] Ghost Festival), offerings had been placed and burnt. “Seventh Month” refers to the seventh month in the Chinese lunar calendar, when the ancestors are freed from hell to visit their descendants.1 During this period Singaporean Chinese sought to appease their ancestors’ perceived needs and appetites, and thereby ensure good luck, by burning paper representations of a variety of goods—from hell money and clothing, to mobile phones and condominiums. Chinese opera or getai (song stage) performances were conducted in housing estate courtyards, parks and other public venues to entertain the visiting gui (ghosts). Nonfamilial ghosts, as well as bad luck, were warded off by means of a number of prescriptions, such as 144

Making Sense and Sensation



making offerings, wearing talismans, and proscribing certain activities—for instance, many people avoided swimming, moving to a new house, starting a business, giving birth (to the extent that deliveries could be planned), or getting married during Seventh Month. Associated with Buddhist and Daoist practices in China dating back at least as far as medieval times (fifth to fifteenth centuries CE), Seventh Month was observed by nearly all ages and classes of Singaporean Chinese, by means of a wide array of public and private rituals, offerings, and performances such as those just described.2 Arriving at People’s Park shopping complex on the Eu Tong Seng Street side of the center of Chinatown approximately ten minutes later on the day in question, I found a number of tables set up in the courtyard between the complex’s entrance and the escalators leading to and from the MRT. Covered in yellow or red cloth, they bore offerings of fruit (including oranges, grapes, bananas, pears, apples, pineapples, and lychees), bread, cakes, decorative boxes and bags, flowers, small dishes of cooked food covered in plastic wrap, sesame cookies, candies, and even a complete tea set. Tidy piles of joss sticks lay next to small glass and metal lanterns housing lit candles; urn-shaped vessels held burning sticks and their spent red bases, producing wafting, gray plumes of smoke in the air as the midday heat approached. Compelled by the imagery and energy of this high-traffic courtyard—densely packed with people going about their daily routines and/or stopping to engage in, and thus produce, the scene—I sat on a low concrete wall to observe. People frequently stopped at the tables to pick up joss sticks (sometimes in one cluster, other times in a series of clusters or even individual sticks), which they then usually lit in a lantern, held between two hands pressed together, raised to their chest or forehead, and lifted up and down a few times.3 Most people then stood still for a moment or two before finding a place to insert their joss in one or more of the crowded urns, and then walking away. Still others did not light joss or place an offering on the tables at all, but simply paused, clasped their hands near one of the tables for a moment and then moved on. In the usual din of conversation, traffic, and shop noises that filled the courtyard like any other day, people thus took a quiet moment to make their offerings. Although sometimes five or six people crowded near a table, they rarely interacted verbally, and yet their collective activity sustained a lively, intersubjective expression of heritage. 145

Capturing Quicksilver Stephen Teiser observes that historical documentation of Seventh Month in medieval China provides valuable data on the otherwise largely unrecorded lives of people outside scholarly bureaucratic fields (Teiser 1988: 10). Similarly, contemporary scholarship on Chinese medicine has been heavily weighted toward epistemological and sociohistorical accounts of physicians, creating a relative dearth of information on patients except as objects of medical practice.4 Again, scholarly bureaucratic practices are documented, largely to the exclusion of those of the everyday. By contrast, Seventh Month scenes in Singapore such as this one provide a glimpse into the sensorially produced sociality of Singaporeans—what Adam Yuet Chau (2008: 488–489) terms a “social sensorium.” They also evoke a sense of transnational and historical continuity between contemporary Singaporean Chinese and their mainland Chinese forbearers. As I have described thus far, this shared heritage constitutes an important, if contested, frame of reference for the practice and use of Chinese medicine in Singapore. Resonating with Martha Hare’s (1993) observations of Chinese medical patients in New York City, many of the Singaporean patients with whom I spoke evaluated Chinese medicine on the basis of subjective bodily experience. In this chapter, I will similarly explore the embodied experiences, agency, and perspectives of Chinese medical patients in Singapore. After touching on anthropological approaches to embodiment, I will provide ethnographic examples of bodily and verbal articulations of patients’ experiences with Chinese medicine in order to illustrate their active engagement in healthcare. First grounding patients’ clinical experiences within observable bodily articulations of suffering and healing, I will then describe how embodied experience informs their use and evaluations of Chinese medicine, as expressed in their own words. I will thus argue that patients’ exercise of agency in producing and modifying their healthcare strategies (and experiences) cannot be reduced to mere rational choice.

Embodied Practice and Bodily Articulations Although the body and embodiment are relatively recent preoccupations in anthropology, these foci have denaturalized, or otherwise challenged, many of the epistemological assumptions of biomedicine. 146

Making Sense and Sensation



For instance, Margaret Lock and Vinh-Kim Nguyen (2010) describe how notions of a single, standardized and universal human body (the body) constitute a technique to make bodies measurable, comparable, and commensurate that is linked with particular social and political contexts of knowledge production. While randomized controlled trials (the gold standard of evidence) discount biosocial differentiation, local biologies (plural), and embodied experience, ethnographic description insists that human bodies are inextricably “situated in evolutionary, historical, environmental, and social contexts” (Lock and Nguyen: 188; emphasis original). Such situated, ethnographic descriptions thus often counter biomedicine’s naturalized objectification of the body by exploring the subjectivity and intersubjectivity of embodied persons. According to Thomas Csordas (1994b), since the 1970s anthropological approaches to the body have ranged from the analytic body (cultural variation in practices, products, techniques, or processes relating to bodies), to the topical body (bodies in relation to specific cultural domains), to the multiple body (enumeration of simultaneous aspects or views of bodies). Once the body was analytically freed of the “monolithic objectivity” of biology—in which it is represented as “a fixed, material entity … existing prior to the mutability and flux of cultural change and diversity”—it was analytically “transformed from object to agent” (Csordas 1994b: 1–3). However, such an orientation nonetheless neglects the existential relationship between culture and Self, and therefore sets mind/subject/culture against body/object/biology—objectifying the body as a substrate on which culture operates. By contrast, the phenomenological tradition of Husserl, MerleuPonty and Sartre, as discussed by Byron Good (1994), has thus been taken up by Csordas and others seeking “to study the medium and structure of experience, conceiving the body as subject of knowledge and experience and meaning as prior to representation” (Good 1994: 55). In this context, the world of the patient (from Husserl’s Lebenswelt, or lifeworld)—subjectively perceived, sensually experienced, and represented—is also intersubjective. It is in relation to this world that the Self of others is constituted and observable, representations of which can reveal aspects of its everyday formation, or the manner in which it is unmade in the course of chronic pain and illness (Good 1994; Scarry 1985). Hence, the adequate 147

Capturing Quicksilver representation of suffering and experience, as well its relationship to narrative, are central concerns of phenomenologically oriented anthropology (Good 1994).5 Finally, in his detailed account of the conceptual background and potential contributions of sensorial anthropology, Mark Nichter (2008) describes six key interrelated concepts: embodiment, the mindful body, local biologies, mimesis, somatic idioms of distress, and the work of culture. Embodiment refers to the lived experience of one’s body, as engaged in particular contexts, historical processes, and environments (physical, psychological, social, economic, and so on). Nancy Scheper-Hughes and Margaret Lock’s (1987) mindful body describes the intersection of individual (phenomenological), social, and body politic dimensions of life, while Lock’s (1993) notion of local biologies describes bodies as active agents, and the intertwinement of culture and biology. Meanwhile, mimesis and the closely aligned notion of somatic idioms of distress suggest different kinds of resonances: the former describes the mirroring of social and mind–emotions–body experiences, while the latter illustrate how bodily “sensations resonate within one’s social universe” and can therefore serve as an expression of collective ills (Nichter 2008: 166). It is the work of culture, then, to translate these negative states and sensations into socially understood sets of meanings and symbols (Nichter 2008). For the purpose of discussing the experiences and perspectives of Chinese medical patients in Singapore I will focus on embodiment, although I will also mention other concepts mentioned above as appropriate. In order to explore patients’ situated, embodied experiences, I will first recount patients’ bodily articulations—acts of nonverbal expression I observed in clinical settings—and then their experiences as described in their own words. Particularly at the start of my fieldwork, this attentiveness to patients’ bodies involved observing their movements, mannerisms, and other dispositions. I noted the sequence and timing of events, the appearance, bodily gestures, demeanor, and facial expressions of patients as well as other aspects of doctor–patient or patient–patient physical interaction (or lack thereof), within the clinical environment. These bodily articulations revealed aspects of the patients’ experiences that were not always conveyed in words to the physician, as well as intersubjective aspects of suffering. 148

Making Sense and Sensation



At charity clinics in which I observed (Thong Chai, Chung Hwa, and Dazhong), some patients had an easy, friendly manner, seeming relaxed or even chatty and engaging in lengthy banter with their physician. Others appeared more intentionally composed with upright posture, restrained movements, and reserved interactions with others. Still others were earnest or distracted by their conditions—these patients often rubbed, pressed, or lightly slapped their various aches, fidgeted or sat stiffly in their chairs, and manifested their suffering in frowns or grimaces. As I discovered in the latter case in particular, aspects of raw, or immediate, suffering can sometimes be more clearly articulated through the body than within the constraints of language. Of course, one cannot generalize for all Chinese medical patients (neither those being treated by a given physician nor those afflicted with a given malady), and patients varied widely with regard to bodily articulations, as will be illustrated in the following examples. Consider, for instance, a series of observations I made at Thong Chai in late July to August 2006 while observing Dr Li, in her morning hypertension and diabetes clinic (conducted in a large shared room with two other physicians) and in her afternoon general medicine shift. In Dr Li’s morning shift, I had the opportunity to observe a supposedly more uniform group of patients, insofar as they were all being treated for syndromes associated with hypertension or diabetes. Despite this commonality, however, their bodily expressions ranged from stoic to highly animated, in association with an equally wide range of personalities and conditions. For instance, one morning in late July Dr Li’s second patient was a well-dressed (stylish long-sleeved black shirt, Capri trousers, leather sandals, and gold jewelry), middle-aged, Mandarin-speaking woman diagnosed with hypertension. After briskly entering the room, she sat quietly on the chair adjacent Dr Li’s desk and awaited her attention. Once she began describing her most immediate problem, she leaned forward with her left elbow on the corner of the desk and her head resting on her hand, lightly slapping the base of her neck and back of her head, and pressing behind her right ear with her pointer finger. As Dr Li entered information about the consultation into the computer, her patient sat poised on the chair and watched the monitor, still sporadically rubbing her neck. Her curiosity with the information Dr Li was entering into the computer was by no means 149

Capturing Quicksilver unique—the vast majority of patients with a view of the monitor would watch her work, some leaning forward or standing up for a better view. Although she had come to Dr Li’s hypertension/diabetes clinic, this patient’s primary complaint was neck pain: “Yidian dian suan le” (meaning a little bit painful, specifically “sour” pain), she reported, using gestures to indicate the source of the pain. Her body language suggested a familiar, engaged relationship with Dr Li. In contrast with the hesitancy I frequently observed in new patients trying to learn general clinic procedures, she exhibited curiosity and concern for the details of her diagnosis and treatment. Notably, her body was upright (to use an English translation of the Mandarin Chinese term zheng) in conversational interstices but leaned forward while she articulated (verbally and nonverbally) her suffering. Although proper posture is by no means unique to Singapore or Chinese culture—for example, many children in the United States are also lectured by their parents and teachers to sit up straight— this bodily expression can be interpreted in relation to Daoist and Confucian values, as well as Chinese medical theory. In Chinese medical theory, zheng is used to differentiate zheng qi (healthy, or proper, qi) from xie qi (pathogenic, or evil, qi),6 the struggle between which might contribute to the root of an illness (Farquhar 1994).7 Zheng (spoken and written) is used to describe proper or morally upright behavior, as in the Confucian contrast of xie (heterodox) and zheng (orthodox) moral values. Furthermore, control of bodily expression has some foundation in Chinese medical theory insofar as public expressions of emotion are considered pathogenic, and in classical Daoist thought, “Exemplary man cultivates his interior by staying calm and becoming unattached” (Ots 1994: 119).8 While the conditions of my observations did not permit me to unambiguously trace each bodily articulation to a specific theoretical or philosophical decree, I did observe the manner in which Chinese medical patients maintained remarkable composure despite their suffering. Arriving at Thong Chai shortly before Dr Li’s afternoon shift on another day in July, I followed her into the building after her lunch break to find a nearly full waiting room. Some patients awaited consultation, while others waited for the herbal packets prescribed during the morning shift to be dispensed at the pharmacy. After we proceeded into her shared ground floor office, I settled onto a plastic 150

Making Sense and Sensation



stool as she tidied the room, turned on a fan, and prepared for her shift. Dr Li’s first patient was an elderly Teochew-speaking gentleman—a stroke patient with short-cropped hair, tidy attire (white polo shirt tucked into blue slacks), and quite serious facial expression. After slowly entering the room with the assistance of a cane, he quietly shut the door, set down his cane, and stiffly sat in the chair adjacent Dr Li’s desk. After initiating conversation—speaking each word with deliberation—he slowly struggled to remove his watch from his left wrist with his right hand, the fingers of which were paralyzed in a curved shape. Dr Li then took his pulse, examined his tongue, paused to allow him to slip his watch back on his left wrist (loosely), took his blood pressure, and then typed notes into her computer. Meanwhile, he continued speaking with her while using his knee and the thumb of his right (paralyzed) hand to close the clasp of his watch on his left wrist. Observing him struggle with his watch, I wondered why he had not simply taken to wearing it on the other wrist. In any case, he persisted in wearing it in the same fashion, as I observed in future observations with Dr Li. Although by mid-August his speech was still forced and his movements slow (if perhaps more confident), this regular patient’s ability to clasp and unclasp his watch had improved and his demeanor was bright and alert. Dignified and deliberate, his general countenance and bodily mannerisms suggested an effort toward careful composure—somewhat of a struggle in his new experience of post-stroke embodiment. In addition to personal motivations to maintain bodily control, a social climate of discrimination on the basis of perceived physical or behavioral deviance might also be considered.9 In Singapore, discrimination against people with physical disabilities is often most apparent in issues pertaining to employment, as noted by Thirumalai Chandroo in an article in the Business Times Singapore: “I believe one of the main reasons that people with disabilities are consistently finding it difficult to gain employment is that employers tend to have this erroneous assumption that the disabled will likely under-perform in most areas of their duties. This is far from the truth, for many persons with disabilities are, in fact, intellectually superior and have innate talents. Another reason could be that a majority of office set-ups do not have the specifications to cater for disabled personnel” (Chandroo 2006). 151

Capturing Quicksilver Despite laws enacted by the Ministry of Manpower to protect the elderly and those on maternity leave from unfair labor practices, to date Singaporeans living with physical or mental disabilities still face difficulties in securing employment. Although the aforementioned patient was not seeking employment at Dr Li’s clinic, his post-stroke difficulties were situated within ubiquitous social and political pressure to conform and maintain productivity. This pressure, perhaps in conjunction with the avoidance of improper (i.e., uncontrolled) bodily articulations described above, was thus evoked in his struggle to maintain composure. An attention to bodily mannerisms not only illuminated facets of the embodied experience of patients, but also revealed how a patient’s suffering could acquire an intersubjective dimension visà-vis a caregiver. During Dr Li’s afternoon shift in mid-August, I observed how a married couple expressed (on the part of the patient) and attempted to alleviate (on the part of her spouse) physical discomfort. Approximately twenty minutes into Dr Li’s shift, an elderly gentleman assisted an elderly female stroke patient into the room and helped her into the patient chair. He then initiated conversation on her behalf (first in Mandarin and then switching to Hokkien) until Dr Li began asking the patient questions directly. As she explained her problems (with some apparent difficulty, as her speech was slurred)—gesturing to her knee and shoulder with her left hand—he stood nearby, ready to help. Throughout the consultation, Dr Li spoke with both of them but examined only the woman. While Dr Li entered information into the computer, the patient’s right hand lay limp in her lap and she occasionally massaged it with her left hand. Noticing this, her husband leaned over and took her right hand in his own, gently forcing it open and closed, and then pulled and exercised her arm from the shoulder. Twisting and rotating her arm and wrist, he massaged and pressed on her hand and shoulders with precise and quick movements. Once finished, he stood briefly near the door and then sat for the remainder of the consultation, after which he guided her out of the room, walking backward so as to better steer her shuffling movements. Risking the simplest level of interpretation, we might observe that his nonverbal responsiveness articulated the couple’s shared awareness of her suffering and a joint concern for its amelioration. Or, in terms of somatic idioms of distress, we might note how her bodily 152

Making Sense and Sensation



experiences communicated her angst to her significant other and elicited an “idiom of concern” (Nichter 2008: 182).10 Had I focused solely on verbal exchanges in the clinical environment, many of these bodily articulations might have gone unnoticed. On the other hand, despite the utility of such observations in grounding clinic interactions within embodied subjects, interpretation of such articulations can be highly speculative.11 In addition to the risk of not quite getting it right, without a fuller exploration of the intentionality or agency of patients one risks objectifying the body. Hence, I will heed Csordas’s suggestion that “language gives access to a world of experience in so far as experience comes to, or is brought to, language” (Csordas 1994b: 11). Hence, for the remainder of this chapter I will rely on patients’ verbal articulations—another form of bodily expression—to explore their embodied experiences of Chinese medicine, in their own words.

Anna Through participant observation and a series of interviews at Chung Hwa (and in Batam, Indonesia), I became acquainted with a regular patient of—and occasional volunteer for—Dr Wang, named Anna.12 Born in 1941 (the first year of the Japanese occupation), Anna was a middle-class, free thinker (secular) Singaporean Chinese who lived with her son and Fujianese daughter-in-law, with whom she shared a common dialect. Although both her parents were born in Singapore, she traced her paternal lineage to Fujian, China, and therefore grew up speaking Hokkien at home and Mandarin in school (she was educated in the Chinese stream). Later in life she also learned Teochew, Cantonese, Hainanese, Malay, English, and Japanese for business or personal reasons, as well as Hakka from her husband’s family. With a wry smile, she described her proficiency in these languages, however, as “half-past six.” In the course of her life she worked in a wide range of professions—from owning a provision shop, to real estate, to clothing alterations—with her most prolonged work as a psychiatric nurse at Woodbridge Hospital (also known as the Institute of Mental Health), presently at Buangkok Green Medical Park. In the course of this career, as well as a lifetime of observations and experiences with various medical practices, Anna developed a very clear opinion of both biomedicine and Chinese medicine. In 153

Capturing Quicksilver fact, at the onset of our first interview she presented me with an unsolicited, two-page handwritten list of the pros and cons of each— one page headed zhongyi and the other xiyi (“Western” medicine). This presentation not only echoed Singapore’s regulatory division of the two practices, but also her own assessment of their relationship: although individually beneficial, “the two kind[s] of medicine cannot go together,” she informed me. In Anna’s comparison, biomedicine operated quickly on “the sickness, the germ,” providing immediate relief from symptoms but often with undesired side effects that weakened the body. Chinese medicine, on the other hand, operated slowly on “the whole system,” providing treatments that could “cure the root lah, bingyin [illness factors],” strengthen the body, and protect against the side effects of “Western medicine.” She primarily saw biomedical doctors for check-ups, prescription medications, or when she needed medical leave from work. For the majority of other health-related matters she relied on a range of Chinese healing modalities, including regular and incidental home-based herbal remedies. She was particularly fond of decoctions like liangcha for heatiness or ganmao cha [tea for the flu]), tuina, dietary regulation, acupuncture, cupping, and/or herbal prescriptions.13 Anna explained that biomedicine and Chinese medicine each had its own utility and, in general, could be used jointly to manage both individual and public health. However, like most other patients with whom I spoke, she avoided simultaneous use of the two, consuming biomedical and Chinese medical prescriptions at least three to four hours apart. While she claimed that either practice could be used for the majority of medical conditions, she felt that certain conditions were best treated by biomedicine—such as infections, cancer, or internal conditions requiring surgery—while others were best treated with Chinese medicine—such as rheumatism, bone fractures, or the flu. Still others, such as stroke prevention and recovery, could be addressed with a general strategy that included both (what she referred to as a double effect), provided the consumption of these treatments were appropriately spaced in time. Here, Nichter’s description of the work of culture offers an interpretive framework that does not limit us to rational choice explanations: “Healthcare seeking in pluralistic healthcare arenas may well involve the matching of personal experience and ‘personal symbols’ to healthcare modalities that ‘make sense’ and resonate in 154

Making Sense and Sensation



visceral as well as cognitive ways” (Nichter 2008: 166). Anna associated biomedicine with accurate diagnosis by means of detailed anatomical understanding and equipment like x-rays, as well as accurate dosages due to standardized university training. The fact that Chinese medical physicians sometimes requested x-rays from their patients (particularly when treating fractures or other bone ailments) served to fortify her ascription of “advanced” diagnostics to biomedicine. Meanwhile, she emphasized the importance of experience in both Chinese medical training and a given physician’s practice, as described in the last chapter. In her opinion, because insufficient experience limited physicians’ ability to arrive at a correct diagnosis and determine proper dosage, it also posed a potential risk to patients’ health. However, she did not exclude biomedicine from this critique entirely. Instead, she asserted that Chinese medical and biomedical prescriptions alike can affect people differently. Hence, while she evoked symbols of modernity and experience in describing biomedicine and Chinese medicine, respectively, these distinctions were blurred as she recognized elements of each in the other—not unlike the carefully separated consumption of the two forms of medicine that then intermingle to produce the desired overall effect. Anna often explained the differences between Chinese medicine and biomedicine with reference to her bodily experiences. For example, she blamed a new prescription intended to lower her blood pressure for an inexplicable paralysis, which led her to immediately cease taking the medicine. In its stead, she monitored her stress level and regularly consumed xiyangshen (Western [American] ginseng; Panax quinquefolium). With multiple varieties and grades of ginseng widely available in Chinese food and medicine shops around Singapore, she explained that it was the clear choice because it was cooling and therefore able to lower blood pressure (as opposed to renshen [Chinese ginseng], which was relatively neutral or gaolishen [Korean ginseng], which was considered warm or heaty). In hot climates like Singapore, she explained, a standard dose of Korean ginseng could easily be an overdose. In her opinion, American or Chinese ginseng was therefore more suitable, but only if adjusted to the individual. She accomplished this individual tailoring by consuming different quantities and observing her body’s reaction. She reported that while her biomedical doctor scolded her for her 155

Capturing Quicksilver noncompliance and preference for Chinese medicine at first, in light of the desired outcome he ultimately supported her decision. Throughout our discussions, Anna described (often in detail) how her perspective on both Chinese medicine and biomedicine developed through observations of her body’s response to various treatments, which she situated within a lifetime of tumultuous socioeconomic change. She explained that in the 1940s and 1950s people were too poor to go to biomedical hospitals and typically arrived only once they were very ill (often too late to be assisted). Furthermore, they trusted Chinese medical physicians more because they were ethnic Chinese, and Singapore was “not so open to the West” at that time. According to Anna, this distrust of “Western” medicine and culture (now labeled old-fashioned) began to slowly change in the 1960s, and by the 1980s biomedicine was the dominant medical practice in Singapore. Prior to the 1960s and 1970s, however, Chinese herbs were less expensive and could even be grown in the kampong. Her grandfather and father, for instance, grew a medicinal garden near their home in order to treat her family and other community members. She recalled that every Sunday her family would gather to drink liangcha—a practice many families attempt to maintain today. She also frequently witnessed her grandfather or father preparing poultices and oils for boils, septic wounds, and young children with distended stomachs. However, she observed that “nowadays you hardly see this style of treatment,” and explained how pre-prepared treatment forms have replaced the treatments administered by her grandfather and father: Last time, ah, if we see Chinese sinseh, they will give us this [prescription that] says this type of treatment is how many doses (ji liang, nah—liang is the ounce)—how many doses of this one, how many doses of this … then we take like this and go [to a] medicine shop—we’ll go and buy that one, then go back [home] and boil. But now it’s different. Now everything— like Chung Hwa—everything is liquid type, tablet type, is more easy. Now, a lot of people [have] no time to do all these thing[s], so this is a short-cut, like that. … Nowadays, who got time to boil?

According to Anna, contemporary Singaporeans do not want to waste the time necessary to “stand by the fire” and ensure a Chinese medical decoction—which would traditionally be slowly simmered in a clay pot over a small fire—does not dry out (thus wasting the herbs). 156

Making Sense and Sensation



The perceived increase in the pace of daily life over the past three decades has thus resulted in the preference for, and therefore production of, more-expedient forms of Chinese herbal treatments. As will be elaborated shortly, Anna also believed this trend was partially responsible for the increased preference of biomedical treatments. While classical Han Chinese medicine used a wide range of delivery forms, including tang (decoctions), wan (pills), san (powder),

Figure 4.1. Chinese medical prescriptions, prepared for convenience 157

Capturing Quicksilver jiu (alcoholic drinks), and gao (oil mixtures) (Yamada 1998), most patients with whom I spoke in Singapore considered decoctions made at home from packets of herbs to be the old method, and premade liquids, powders, or pills to be their replacement. As indicated in Sherman Cochran’s description of Daren Tang—a chain of Chinese medicine shops established in early twentieth-century China—and its famous precursor Tongren Tang, chengyao (ready-touse herbal preparations) are by no means unique to contemporary Singapore (Cochran 2006).14 Nonetheless, in Singaporean clinical settings, paper packets filled with carefully measured herbs and tied with twine (still found at Thong Chai and some smaller traditional Chinese medical halls) had indeed been largely replaced by liquids, powder packets, or pressed tablets. Singaporean physicians and clinics were largely free to choose the forms in which their formulas were delivered until 2002, when the HSA began pressuring the Chinese medical community to slowly phase out liquids in favor of powders. As explained to me by Dr Song (the Chinese medical physician and consultant for Hock Hua discussed in the introduction), because many liquids included alcohol, sugar, or preservatives to prevent bacterial growth, the HSA considered them to be unstable and announced they would be banned in five years.15 Furthermore, he reported, because the liquid forms were often produced in China (or produced locally in similar fashion), they were perceived as cheap and poorly controlled. Powder forms, on the other hand, were imported from Taiwan and therefore associated with good manufacturing practices (signifying hygiene and safety) and proper controls, due to regulations that dated back to the 1950s. The HSA wanted to implement similar measures in Singapore, Dr Song explained, and thus encouraged either the importation of herbal powders from Taiwan or local manufacturing along these lines.16 The trend toward expediency and convenience also impacted the manner in which some home-based remedies were delivered. For instance, at the time of my fieldwork medicated oils were very popular for a wide range of ailments—from nasal congestion, to insect bites, to stomach wind. Teachers at an early childhood development center for which I briefly worked would on occasion rub Yu Yee oil (a CPM) on the stomachs of fussy children, who were often brought to school by their parents already smelling of Yu Yee. Thus, Anna’s statement 158

Making Sense and Sensation



about the decline of topical herbal treatments must be slightly qualified: while Chinese herbal preparations were still used to treat some young children suffering from gastric discomfort, they were more often in the form of a premade oil than a poultice prepared from herbs grown in a personal medicinal garden. While these shifts likely have much to do with changes in space associated with HDB living—occupying landed property on which one could garden had become a luxury—it was usually explained in terms of convenience. This term (in English) was used to explain changes in the production and consumption of many products, including liangcha, which until recently was almost exclusively prepared at home to be consumed by the whole family once per week (or more often, as needed). Most of the people with whom I spoke, however, described now decocting smaller batches for fewer people, and/or keeping leftovers in the refrigerator for consumption throughout the week. Liangcha carts were also frequently found outside Chinese herb and food shops like Hock Hua, in shopping malls, or along busy streets—a convenience designed for those lacking the time or inclination to decoct it at home. While many respondents separately described the hard work and long hours of both kampong and contemporary lifestyles, the latter was characterized by less time, or time that moved at an accelerated pace relative to kampong life. When I asked Anna why contemporary Singaporeans had less time than in her childhood, she explained that kampong mothers were not expected to work (although they often did) and therefore had, or were perceived to have, more time to attend to their families. By contrast, she explained, contemporary Singaporean men and women alike had to work to support the lifestyles to which they have become accustomed (and to compete with their neighbors), and therefore had less time to spend with their families or attend to other home-based activities. She also asserted that this has prompted many Singaporeans—including Anna herself—to use biomedicine solely for the purpose of obtaining medical leave allowances granted by their employers. Medical certificates were required by many employers (including all civil service jobs) in order to justify sick leave. We must [rest] a few days only, then our MC [medical certificate is] finish[ed] ah, [and] we must go and work. This is the reason, ah, nowadays 159

Capturing Quicksilver we see more, like, Western doctors: fast, fast. The only thing is, [the illness] is not totally cure[d], lah. But it cannot be helped. … We got no choice—we have to see Western doctor because of the MC [medical certificate]. I cannot bring the—you know, Chinese sinseh note. They don’t know some—the government will not recognize it. But now, I think they approve already, there’s certain physicians they approve.

Although some companies were beginning to accept MCs issued by Chinese medical physicians, at the time of my fieldwork the majority did not. With less time on a day-to-day basis, Anna explained, Singaporeans preferred treatments that required little or no preparation and offered immediate symptomatic relief. Furthermore, she noted that while Chinese medical treatments could cure the root (rather than just the symptoms), they operated too slowly. Biomedical treatments, on the other hand, might not actually cure the problem, but could often provide fast relief from symptoms. In light of this perceived need for fast and officially sanctioned treatments, she was therefore able to partially account for the increased use of both biomedicine relative to Chinese medicine, and pre-prepared Chinese medical treatments relative to slow-cooked decoctions in contemporary Singapore. Again, as she observed, “Nowadays, who got time to boil?” This case illustrates the consistent but not unyielding tension between biomedicine and Chinese medicine in Singapore, and parallels descriptions of patient perceptions of the two practices in Taiwan, the PRC, the United States, and Tanzania (e.g., Ahern 1975; Gould-Martin 1975; Hsu 1992, 2002). It also illustrates how bodily experiences and observations are an essential component in the perception of each treatment (in accordance with Hare 1993): “We must know ourselves,” Anna insisted. Notably, Anna’s evaluations of both practices were primarily based on such personal experiences— either her own, or those of family and friends—rather than emerging from debates of scientific efficacy or epistemology. Furthermore, her observations on changes in the practice and use of Chinese medicine—contextualized within lived socioeconomic changes over the course of her lifetime—were used to explain her own healthcare strategies and views. As will be illustrated in the following two cases, intersubjective experiences—sometimes conflicting and other times complementing—are also essential in understanding healthcare strategies. 160

Making Sense and Sensation



Wayne and Martha I met Wayne and Martha, an engaged couple in their late twenties, while conducting participant observation at Dr Wang’s private clinic in Chinatown. Middle-class Singaporean Chinese, they were both English-educated and had learned Mandarin as a second language in school, before going on to professional careers in which they primarily spoke English. Like many unmarried Singaporeans their age, they both still lived with their parents but intended to buy their own flat after their wedding. My interactions with them—in both the clinic and outside a clinical setting—provided an example how treatments are evaluated in accordance with intersubjective experience, as well as the perceived value of expediency in contemporary Singaporean healthcare strategies. At our initial meeting in Dr Wang’s clinic, Wayne and Martha informed me this was their first visit to a Chinese medical practitioner and agreed to an interview (which was scheduled for two months later) to allow for more discussion and a follow-up on their treatments. Although both conversations were relatively brief and split between the three of us (thus providing less depth than other patients with whom I spoke), their case nonetheless provides an interesting example of how some younger generation Singaporean Chinese—“used to a quick fix,” as Wayne put it—evaluate Chinese medicine. It also serves as a reminder that one cannot assume an imposed, or self-ascribed, ethnic identity results in automatic identification with the processes and products associated therewith. In this case, the couple’s joint evaluation of Chinese medicine reflected their individual and intersubjective bodily experiences far more than their ascribed cultural identity. After meeting, on their suggestion, at a new restaurant in Holland village (an expatriate-dominated neighborhood also popular with many “Westernized” Singaporean youth), I asked what had led them to Dr Wang’s office. Wayne recounted essentially the same story as he had provided in our first meeting: for three to four months he had suffered pain, swelling, and restricted movement in his right wrist— the latest instance of a recurring ailment, which he attributed to overactivity in sports. Previous episodes had been limited to stiffness when he played badminton, and were therefore deemed less serious, but this time the pain and restricted movement began to impede his ability to work at his computer. 161

Capturing Quicksilver On the recommendation of his (biomedical) doctor, he first consulted with a surgeon who diagnosed a ganglion cyst (a sac of fluid or noncancerous tumor that forms atop joints or tendon coverings). The surgeon suggested pain relief medication and/or surgery to remove the cyst, but could not guarantee the success of such treatments. Although Wayne had seen biomedical doctors and tuina specialists for the condition in the past, he was not satisfied with either treatment, as neither had yet to fully resolve the matter: “Usually what happens here is—at least here in Singapore, in our culture, is this: we will usually go for the tuina … to rub it, or we see a Western doctor. But I think a lot of us are more open to going for the rubs because it seems to work, you know, for any swelling, that kind of thing. Whereas usually [if you] go to a Western doctor, they will give you, like, something that reduces the swell[ing] and that’s all.” Wayne’s inclusion of tuina in his general healthcare strategy, despite a professed absence of experience with Chinese medicine (from childhood until our first meeting), reveals a boundary in his definition of Chinese medicine as well as the perceived jurisdiction of effective biomedical (pharmaceutical) treatments.17 The increased severity of his condition, the prospect of further reduction in productivity, and the inability of previous treatments to cure the ailment had thus prompted Wayne to reconsider his healthcare options. One day, while eating at a Taiwanese-style restaurant in Singapore, he had mentioned his problem to the chef, who recommended he visit Dr Wang. Although he had already heard of TCM, he had yet to try it and decided to “go for it” while still making an appointment for surgery in the event it was unsuccessful. On the basis of his initial visit with Dr Wang, Wayne signed up for a ten-session course of acupuncture and herbal prescriptions. Although Dr Wang asked Wayne for x-rays—despite the surgeon’s insistence they were not necessary—and disagreed with the proposed site of incision (referencing an anatomy book to illustrate his point), his disagreements with the surgeon did not dissuade Wayne. To the contrary, Wayne noted, “It sounded like he was experienced. He understood the problem of my hand and how—how he would go about it and how long it would take.” Although Wayne admitted he did not fully understand Chinese medical theory—which was explained to him in Mandarin, and he subsequently explained to me in English—he recounted four main 162

Making Sense and Sensation



components of Dr Wang’s explanations to the best of his ability. First, he recalled, the course of treatment as a whole would improve blood circulation, which would in turn reduce swelling. Second, he reported, needling areas other than the wrist would facilitate healing due to the association between “certain parts of the body” and “the organs.” This was to be accompanied, third, by needling “on the spot itself.” Finally (and perhaps most importantly), he explained, the course of treatment was not a quick fix of a single ailment, but concerned the entire body. By focusing on his general well-being, Wayne explained, Dr Wang thus offered to simultaneously treat his wrist as well as other apparent ailments, such as acne. While Wayne admitted there was much more to the underlying theory, he reported that he did not understand (or could not recall) further details. Nonetheless, his offering of such a detailed theoretical account was unusual among the patients with whom I worked, and suggested a method of coming to familiarity with a practice and epistemology very different from his previous medical experiences. Furthermore, in light of the drastically different treatment paradigms proposed by the surgeon (who intended to “just cut it off”) and Dr Wang (whose goal was “waking the whole flow of things”),it seems that incongruity was to be expected and accepted.18 I did not ask Wayne to compare his experiences with, or his opinions of, Chinese medicine and biomedicine—either in general, or in this particular case. Nonetheless, his simultaneous consultations with physicians of both practices positioned him to do so and he clearly felt the comparison was relevant. Dr Wang’s recommended course of therapy consisted of ten thirty-minute acupuncture sessions, each followed by a herbal prescription—modified in accordance with the day’s diagnosis—dispensed by Dr Wang in powdered form (as described in the last chapter). Martha often accompanied Wayne to Dr Wang’s clinic, also seeking treatment for a long-term cough; she received her own powder packets, but not acupuncture. At our initial meeting, Martha informed me that she had suffered a recurring cough for several months and had already sought help from her biomedical GP. This doctor gave her a liquid medication to reduce throat inflammation and her runny nose, as well as antibiotics, but would not give her cough syrup because she was not coughing at the time of the exam. While her other cold symptoms were thereby resolved, she 163

Capturing Quicksilver developed a deep, hacking cough and decided to try Chinese medicine along with Wayne. Although Martha was supposed to take the powder prescriptions three times a day, she usually managed to drink it only once a day; thus, she noted, the course of treatment took longer to finish than Dr Wang had anticipated. Although she did not take any other medications simultaneously with the powdered herbal prescriptions, she experienced symptomatic relief within a few days: “I’m not sure, is it a matter of time or what, but after about three days of taking the medication, it was a lot better already. I stopped having the cough. Yeah, so I’m not sure what to attribute it to—because, after all, the cough had been going for some time. … So I’m not sure: is it because it was already—the cough was very near [the end of] its course, or not? But I seldom have such deep, chesty coughs.” Previously, Martha had been quite resistant to the idea of seeing a Chinese medical physician because she associated the practice with a childhood memory in which she was disgusted by the thought of eating snakes, lizards, and “dead leaves.” Dr Wang’s powder packets, however, were more convenient and did not taste as bitter as the home remedies her mother had prepared for her when she suffered from a cough or sore throat as a child. While such reservations and comparisons undoubtedly flavored her experience of Dr Wang’s treatments, I will argue that the couple’s joint evaluation of Dr Wang and Chinese medicine was grounded in their subjective and intersubjective bodily experiences. By the time of our second interview, Wayne had undergone eight of the ten prescribed sessions and Martha had completed her course of herbal treatments. On the basis of Dr Wang’s tentative projections, Wayne had anticipated improvement by the eighth session but experienced only an increased sensitivity and pain deeper in his hand. He therefore decided to pursue the surgery—which was 80 percent covered by employer-provided insurance, and already scheduled at Paragon Medical (a private hospital in the heart of Singapore’s most popular shopping destination, Orchard Road)—instead of completing the remaining two sessions. Although Wayne concluded that this was “not quite a successful case for him,” his experiences did not cast doubt on his perception of Dr Wang’s expertise or the efficacy of Chinese medicine as a whole. 164

Making Sense and Sensation



This ambiguous assessment might have been made in consideration of the potentially positive outcome of his fiancée’s treatment, and suggests the moderation of subjective experiences and evaluations by intersubjective experience. I use the term “potentially” here because although Martha experienced symptomatic relief within the same timeframe as she sought treatment from Dr Wang, she did not unequivocally link the two causally. This case evokes what Nichter refers to as the “dividual” experience of sensations, or the “social relations of sensorial experience”: “In cultures where social enmeshment fosters close interpersonal as well as intrapersonal bodily monitoring, one’s experience of sensations is rarely solitary” (Nichter 2008: 166). Hence, her account of Chinese medicine was grounded in subjective, bodily sensations and intersubjective experience vis-à-vis Wayne’s unsuccessful case, both of which unfolded in a sociopolitical environment that strongly encouraged self-surveillance and interpersonal bodily monitoring. While it is easy to immerse discussion of Chinese medicine within epistemological debates—particularly when exploring its relation to biomedical practice (and such debates can, indeed, be fruitful)—such a framework often reflects the terms and priorities of academics, politicians, or physicians more than the bodily experiences or evaluations of patients. Even when Wayne recalled Dr Wang’s theoretical elaborations, this simply served as background for explaining his actions in terms of past and present experiences. Thus, bodily experience—situated in narratives that focused on observations of improved, sustained, or worsened conditions—was more directly responsible for his decision to try Chinese medicine than preconceived cultural attachments, epistemological considerations, or so-called rational choice. In accordance with Singaporean pragmatism and convenience, the rational choice in this case might have been the surgical intervention—a quick fix that was mostly covered by insurance—over the slow-acting recommendation of a chef, which had to be paid entirely out of pocket. However, Wayne’s previous negative bodily experiences with tuina and pharmaceuticals had inspired him to try something new. Although his decision departed from his previous healthcare strategy, he was able to provide an explanation that emplotted the choice and his subsequent experiences within a more continuous and shared narrative (Good 1994). In this case, as a 165

Capturing Quicksilver whole, a dialogic process can be seen wherein the subjective experiences of the two were complimentarily produced and evaluated in relation to each other, rather than in isolation.

Charlene and Chuck At the time of our interviews (conducted individually at different places and times), Charlene was a forty-five-year-old housewife and her brother Chuck was a forty-three-year-old engineer; both were middle- to upper-middle class Singaporean Chinese. Tracing their father’s lineage to Fujian, China, they grew up among Hokkien speakers but, because they were educated in the Chinese stream, primarily spoke Mandarin at home. As adults, they continued to speak Mandarin at home and with friends, and English at work. Noting that their parents did not take them to Chinese medical physicians as children, they tended to rely on biomedical professionals as adults. Nonetheless, they were administered home remedies consisting of Chinese herbs by their parents as children and had both tried Chinese medical treatments at least once as adults. Despite this common upbringing, however, their opinions of Chinese medicine, approaches to cultural heritage, and other aspects of daily life differed significantly, demonstrating the diversity possible even within a single Singaporean family. Charlene lived with her husband and three children in an estate on the east side of the island—a redevelopment near the area previously occupied by Changi fishing village. Life in this urban renewal project was a substantial departure from the kampong in which she and her four siblings grew up. Although noting that kampong life was very difficult—particularly for her mother, who worked on a peat plantation and cared for her five children—Charlene spoke fondly of the freedom, trust, community, and relaxed atmosphere of her childhood. By comparison, she lamented various aspects of HDB life: the restrictive architecture and danger of high rises, the fear of parents over their children’s safety, and the increased competition between neighbors. “People are not like the olden days,” she commented. “They do not trust each other as easily … because they live by themselves [rather than with their extended families], because they are rich. When you are poor, you have nothing to protect, nothing to lose.” Far from unique, these observations expressed her concern 166

Making Sense and Sensation



about the shifting values of Singaporeans over the past thirty years and a reflexive critique of her previous priorities. Although in the three years prior to our interview she had come to accept her relatively new role as a housewife, previously Charlene had striven to be outstanding. She had been career oriented, traveled every year, demanded good educational results from her children, and had owned two cars—one of which was a Mercedes. Although this pressure on children toward scholarly excellence did not seem unique to any particular demographic in Singapore, motor vehicles were visible indicators of socioeconomic status. With a finite amount of space and a growing population on the island, Singapore’s Land Transport Authority restricted the number of cars on the road by making car ownership rather expensive. In addition to licensing and registration fees, a potential car buyer had to bid for a certificate of entitlement which, if obtained, granted the right to buy a car. With a typical certificate of entitlement for a small car costing S$10,000 to S$20,000—not a penny of which was applied to the purchase of the vehicle itself—owning a car of any make (let alone a Mercedes) was a direct and public statement of income.19 Owning two vehicles was indeed considered by many to be outstanding. Retrospectively, Charlene viewed these priorities as a deleterious departure from the values taught to her by her “very traditional” mother, which were reinforced by popular culture and media representations of Chinese culture. She explained her relatively recent realization of this “value problem,” and the subsequent reorientation of her life, in terms of religious experience and a personal medical crisis. After a motor vehicle accident on the Seletar Expressway she was afflicted by persistent headaches and demanded an MRI, despite her (biomedical) doctor’s insistence that it was an elective procedure (and that she would therefore have to pay for it out of pocket). This procedure revealed a pituitary tumor, which she considered to be a very good result because it was an early diagnosis and retroactively justified the expense to both her doctor and her husband. Her doctor’s attempt to dissuade her on financial grounds was by no means a surprise to Charlene, who informed me that this is the typical treatment of a B-class patient:20 “If I want to own my human right[s], if I want to cut short my waiting time, if I want to have very good service in the hospital, of course I have to be in the A-class. So, for me, it is 167

Capturing Quicksilver nothing new when the doctor talk[ed] to me this way. They always talk this way to the C-class and B-class patients.” Although Charlene was accustomed to this differential treatment (anchoring her to a class from which she had striven to stand out), her main complaint was that the doctor’s first priority should be to heal, regardless of income. She tried to actualize this ideal through her choice of physicians; of the many doctors she had visited—nearly always on the recommendation of a friend or family member—the only ones she returned to were those “with heart.” She applied this criterion to both Chinese medical and biomedical physicians. In February 2004—seven months after her MRI—Charlene underwent surgery to remove the tumor and began a lifelong medication regime, for which she felt she had been insufficiently prepared. She therefore conducted library research and learned of a Japanese study that associated use of the drug with an increased likelihood of bone breakage. After a conversation with her doctor’s assistant about this potential adverse effect, as well as those she was already experiencing (gastric discomfort and a constant sensation of fullness), she made a series of appointments with both biomedical and Chinese medical doctors in an attempt to address her concerns. Although by the time of our interview she considered this rash of appointments to be a “silly” course of action, she nonetheless explained it in terms of her inability to continue working and an associated loss of self-confidence, which had led to a period of unhappy contemplation over the meaning of life, her self-worth, and the values that guided her decisions in life. She sought resolution to these queries and relief from the side effects of her medication through medical and religious avenues. Regardless of her postoperation consultations, Charlene did not find immediate relief from her discomfort and malaise and, even worse, began to suffer headaches again. Although her biomedical doctors insisted that there was nothing physical to worry about, and her Chinese medical physicians suggested it might simply be a matter of “thinking too much,” she was not satisfied with their psychological explanations. Thus, on a friend’s recommendation, she began consuming the well-publicized lingzhi: “When you go and see a GP, you said you’ve got a headache, they give you a painkiller. You complain again, they change [to] another, complain again, change [to] another. Just like that. You see Chinese doctor, OK, it really 168

Making Sense and Sensation



help, ah. Very slow—it takes time ah; it takes about three months to take the Chinese, all the Chinese medicine. After taking three months, you feel better, you stop for one week, it [the pain] comes back. So finally, I take this lingzhi.” Although the first type of lingzhi—a multiple-level marketing product produced in Taiwan and sold in Singapore by her “auntie”— was unsuccessful, she tried again a few months later with a box of Eu Yan Sang’s cracked lingzhi spore powder given to her by a friend. After an adjustment of dosage on the recommendation of an Eu Yan Sang sales clerk, she felt relief from her headaches, gastric discomfort, and feeling of fullness within two weeks. When I inquired if she told her biomedical doctors about her success with the lingzhi, she explained that this was futile: “My GP [is] Western-thinking. Another doctor, Professor Ong, if I mention [it] to him, he’ll say, ‘Ok, if [it is] good, then you carry on, lah.’ He’ll just say like this, but from his face you can see that he [does] not believe.” Such discouragements of Chinese medical treatments did not, however, convince her to stop taking the lingzhi, to which she attributed her symptomatic relief. Charlene further attributed a pivotal role in her recovery to a reorientation of values, which she summarized as obedience over rebellion, respect for one’s parents and elders, attention to one’s family rather than career, and her (Catholic) religious faith. While her husband was raised in a Catholic family, she described her family of birth as free thinkers and was baptized only after the premature birth of their youngest child, when she sought spiritual help with the infant’s survival. Years later, in the contemplative period after her operation, she began to truly “search for Him”—despite her family’s criticism for becoming a church-going housewife. She described this response as a “different way of thinking” that reflects the “cultural problem” of “Westernized” (English-educated) Singaporeans who sought to be outstanding, as she once had. On the one hand, these associations evoke political rhetoric about the importance of preserving cultural values, part of the Asian values discourse discussed in chapter 2. They also resonate with PuruShotam’s (1998) analysis of the neo-Orientalism within contemporary “racial” divisions insofar as categories of West and East or modern and traditional are reproduced in both cases to describe and evaluate difference. On the other hand, Charlene’s simultaneous 169

Capturing Quicksilver advocacy of both Catholic and Chinese values—and use of both biomedicine and Chinese medicine—suggest that, in practice, such divisions are constructed and contested, rather than given. While Charlene viewed Singapore’s socioeconomic transformation (in part) as a deterioration of values, her brother Chuck described it in terms of a practical shift in social relations and people’s relationship to medical knowledge. Living with his wife and two children among hundreds of families in a Hougang estate—rather than with extended family among the twenty or so families in his childhood kampong—he believed they no longer needed to depend on their neighbors. Thus, he claimed, Singaporeans did not interact with or depend on each other as much as they had in his youth— an independence that he saw reflected in contemporary healthcare practices. If a member of his family fell seriously ill, that person no longer had to rely on neighbors for help with getting to the doctor or suggesting treatments, but instead simply went to the hospital. By contrast, he explained, his parents’ generation often treated themselves and their families with Chinese herbal remedies drawn from hearsay, tradition, or personal experience. For instance, his mother treated fevers with liangcha and by applying blankets to increase the fever until it broke—still a common practice that he admitted was effective, but also very dangerous. According to Chuck, his parents used Chinese herbs on the basis of recommendations of friends and family (serious conditions were taken to a biomedical doctor) because they “did not have the luxury of information.” Contemporary Singaporeans, Chuck observed, were “more comfortable with reading” and could therefore verify medical knowledge through newspapers, books, or the internet. A highly educated professional himself (with a PhD in electromagnetics, he worked as an engineer), he considered the desire to verify information to be an innate characteristic—it was “in their blood,” rather than geographically determined (e.g., a product of “Western” science) or educationally acquired. This epistemological orientation led him to conclude that the Chinese medical model was “wrong.”: “When we try to understand science, there’s only one solution to the problem. OK? So there shouldn’t be any distinction [between medical models]. … Science will always converge, and those that fail will fall down. … They cannot coexist. If one is wrong, the other is right. If one is right, the other must be wrong.” 170

Making Sense and Sensation



Chuck therefore accepted the simple relationship of a well-studied single Chinese herb used to cure a specific human ailment (or reduce the symptoms thereof), but rejected the complex relationships of Chinese medical theory and polyherbal formulas: “To me, there is no way that they can figure out that you need these ten herbs or these twenty herbs for this disease. And [if] you ask them why, they will ask you to refer to an ancient book that was documented 5,000 years ago. So I don’t buy this.”21 Despite its resonance with the rationale of biological science, Chuck did not limit this critical analysis to only Chinese medicine, nor were his conclusions arrived at in a purely cognitive manner— bodily experience also played a role in his assessment. Although generally healthy, his first course of action when faced with a medical question was to gather information from the Internet in order to determine if seeing a doctor was necessary and, if so, to prepare for the visit. Acceding that a doctor might better understand the general functions of the body, he believed that he better understood the condition of his own body and exercised the right to verify the doctor’s opinion: “In Singapore, the doctor[s] think that they are one class higher than normal human beings. Some of them, they don’t even bother to explain everything. They will just—after you explain to them your symptoms, they just say, ‘Take this, take this, and do this, and do that. Don’t ask me why.’ OK. That is their attitude—very common in Singapore. So, to me, it’s not just to decide whether I should go and see a doctor. I also need to know why—if the doctor tells me to do something, whether it makes sense or not.” Chuck’s bodily awareness was also a factor in his analysis of qigong and taijiquan (an internal martial art practice), which he had experimented with, but that had not produced any observable “specific effect” on his body beyond what he had experienced as a result of other forms of exercise such as swimming. Furthermore, he reported seeing an acupuncturist for back pain two to three times per week for three months before determining that it also had “no special effects” above what he was able to gain from massage. Finally, he stated that his motive for drinking liangcha or herbal soups was a matter of taste, rather than personally experienced health benefits. In each of these evaluations, his bodily experiences confirmed the unsuitability of these practices for managing his health. 171

Capturing Quicksilver Chuck did not claim that acupuncture or Chinese herbs had no effect on the body whatsoever. To the contrary, he agreed that physiological responses to herbs or acupuncture needles were quite possible, and that proficiency in administering these techniques could indeed be related to a physician’s experience. In his view, however, a good medical model must be specific (i.e., treat a single symptom with a single ingredient), statistically demonstrable, useful in the prediction of health outcomes, and verifiable by means of clinical trials. Thus, while he saw the utility of home-based remedies in everyday life, without verification of the existence of qi, he claimed, the Chinese medical model is not scientific and therefore is wrong: It’s good that people are aware that certain things have no scientific basis. But nobody would [say this] because you’re only asking for trouble, and you’re challenging something with 5,000 years history. Who has the authority, you know, to say this kind of thing? … The danger of saying all these things: people think that, “How come you have no pride of your own culture, or your own race?” So, people do not like to say this kind of thing. And, of course, I am very proud of Chinese scientific achievement[s] … but there are also times where the model is wrong. So there’s no need to have the baggage of pride and history. Good means good, bad means bad. It’s very simple.

Unambiguously regarding Chinese medical theory as unscientific, Chuck therefore saw no point in institutionalizing or supporting practices associated therewith, despite the perceived danger of being seen as lacking cultural pride. Chuck was not the only person with whom I spoke to explicitly evaluate Chinese medicine relative to biomedicine, although the outcomes of such evaluations varied widely. Because so many Singaporeans made use of multiple healing modalities in managing their health, such comparisons frequently arose—either naturally in the course of conversation, or in response to my questions. However, the manner in which these comparisons developed, as well as the way in which they emerged in our conversations, were highly individual. Chuck had explicitly problematized the validity and efficacy of Chinese medicine vis-à-vis the biomedical model, through both bodily experience and in terms of an innate desire to verify information (a desire also located, in his opinion, in the body). Charlene’s evaluation, on the other hand, developed through the bodily experiences 172

Making Sense and Sensation



associated with an ongoing medical ordeal, and was contextualized within dramatic personal transformations. The intersubjective world of her free-thinking family—illustrated in their disparagement of her religious faith, and her brother’s evaluation of Chinese medical model and practices as ineffective—was unmade (in the sense proposed by Scarry [1985] and elaborated on by Good [1994]) by the failure of her previously established values to alleviate her suffering: If experience is intersubjective and evolves in dialogue with those in the social environment, this dialogue and the structures it mediates are also constitutive of experience. … In the case of chronic pain, much of the social and political world in which the sufferer engages is designed specifically to provide care and alleviate suffering. However, the institutions of modern medicine are most often shaped to the task of the “remaking” of the lifeworld with all too little cunning. Indeed, the irrationalities of medicine as a social and political institution often contribute, both overtly and subtly, to the unmaking of the everyday world of the sufferer. (Good 1994: 127)

The broader social world of a materialistic, career-oriented woman was thus also unmade by the inability of previous therapies to adequately redress her suffering. In its place, a new world of daily activities and values—as a housewife, mother, and religious convert—was fashioned that facilitated her recovery. Both siblings relied on bodily experiences in their evaluation of Chinese medicine and shared the experience of growing up in a biomedically oriented, free-thinking family (notwithstanding their use of home-based remedies). However, their resultant evaluations were moderated through very different subjective experiences— Chuck being generally healthy and Charlene having faced a serious and long-term health crisis. As Charlene’s world was unmade, their intersubjective world divided, Charlene being unable to sustain the same perspective as her brother in light of her medical condition and the religious faith of her husband’s family, and Chuck being unable to relate to the subjective experiences that led to her question their previously shared values.

173

Capturing Quicksilver Conclusion In this chapter, I have explored the embodied experiences and perspectives of Chinese medical patients in Singapore, as expressed in both bodily and verbal articulations. In contrast with Cartesian dualism—the separation of body from mind critiqued in medical anthropology as isolating and objectifying the body—I have proposed an emphasis on the sensorial and intersubjective aspects of embodied experience. To break with deeply engrained ways of thinking about the body, I began with an ethnographic description of Singaporeans observing Seventh Month in order to evoke intersubjective, sensorially engaged, agentic bodies. While often excluded from the formal medical domain—circumscribed through regulations, institutions, instruments, theories, and clinical practices—practices like Seventh Month constitute an important part of the embodied experience and intersubjective heritage of many Singaporean Chinese. As Chau (2008) points out, phenomenological investigations tend to focus on the reception and interpretation of stimuli (the sensory-interpretation approach), rather than on how human agents actively participate in the production of sensory stimuli. The emphasis here is on people doing things to produce sensorially rich social spaces: burning so-called hell money, conducting getai performances, making offerings of fruit and sweets, burning joss, and so on. This intersubjective experience thus involved active participation in “co-producing and co-consuming all kinds of ‘sensory utterances’: ambient/participatory, heat, proprioception, kinesthetic, noises, sights, smells and tastes” (Chau 2008: 495). Although the intense sociality of festivals described above and by Chau, might not be present in Singaporean Chinese medical clinics, his emphasis on active participation and “resonant body-person[s]” (Chau 2008: 492) suggests a vantage from which to explore patients’ clinical experiences without reducing them to objects of medical practice. First grounding the discussion within the observed bodily articulations of patients in the clinical setting, I explored aspects of their clinical experiences within broader social trends and intersubjective evaluations. While useful in providing access to facets of experience that are not amenable to verbal expression and grounding experiences of suffering within the lived body, I concluded that this technique was somewhat lacking with regards to the intentionality (and, hence, 174

Making Sense and Sensation



agency) of patients. Thus, while the elderly stroke patient’s effort to maintain composure “makes sense” as an embodiment of Chinese values regarding bodily carriage and public demeanor, or within the sociopolitical climate of discrimination against physically disabled Singaporeans, without actually inquiring after his intentions I risk pure speculation. Furthermore, and more broadly, I risk representing the lived body as operated on by culture/society/structure/ habitus, rather than embodying culture/society/structure/habitus. Nonetheless, I argue, an attention to bodily dispositions and mannerisms can shed light on intersubjective facets of healing such as the elderly gentleman’s resonant response to his wife’s pain, or patients’ engaged curiosity with the diagnostic process. In the latter half of the chapter I demonstrated how patient narratives could facilitate exploration of the relationship between bodily sensation, intersubjective experiences, and treatment selection and evaluation. These cases strongly suggest that a purely epistemological or rationalist orientation to patient healthcare strategies cannot adequately explain the use of Chinese medicine in Singapore, because neither addresses the bodily experiences that often guide patients in managing their health.22 Following Good, Nichter, Csordas and others, cases like these are instrumental not only in understanding health, healing, and illness, but also in contextualizing health and healthcare within more broadly lived experiences. In a reverse, but complementary way, they also illustrate the importance of grounding social practice within bodily sensations and experience.

Notes 1. Not to be confused with Judeo-Christian Hell, the Chinese underworld is said to consist of a number of courts (ten is the number depicted in Singapore’s Haw Par Villa) in which the dead are judged, and sinners are tortured, by yama (judge-kings). 2. The popularity and vibrant rites of this festival inspired Singaporean news anchor Genevieve Woo to produce a documentary film on the topic, titled A Month of Hungry Ghosts, released in 2008. 3. There was a great deal of variation in nearly all of these details; this account is therefore not intended to provide a generalized technique but, rather, an overall sense of people’s activity. 4. Arthur Kleinman’s (1980) discussion of patients’ explanatory models in Taiwan, and Thomas Ots’s (1994) account of qigong in the PRC are notable exceptions. 175

Capturing Quicksilver 5. Furthermore, as noted by Arthur Kleinman, ethnography of “local moral worlds” (within, but not reducible to, their socioeconomic and political contexts) is able to illustrate “how microcontexts mediate the relationship between societal and personal processes” (Kleinman 1992: 172). 6. See Lo and Schroer (2005), also discussed in the introduction, for a discussion of the problematic translation of xie into English. 7. While certainly an interesting parallel, this might not be the explicit basis for diagnosis in medical practice (Hsu 1999). 8. Thus, Ots explains, the late twentieth-century practice of crane-qigong— a form of qigong (an interior martial art, or exercise) featuring spontaneous (uncontrolled) movements—was contested in China, in part, because it challenged the values of quietness, relaxation, and harmony (Ots 1994: 124). 9. The most prevalent references to discrimination that emerged in my fieldwork pertained to homosexuality, mental or learning disabilities, and physical disabilities. The fact that discourses of discrimination developed in Singapore implies a conflict between those who saw such acts and opinions as discriminatory, and those who sought to maintain the definition of normalcy on which such acts are often justified. Although accounts of “racial” or religious discrimination also arose, they were less openly discussed, perhaps in deference to the “multiracial” nationalism promulgated by the Singaporean government. 10. While gender roles could also play a part in this scene, it is difficult to know for sure on the basis of a single observation. 11. This recurrent preoccupation of anthropological analyses was described by Clifford Geertz: “Cultural analysis is intrinsically incomplete. And, worse than that, the more deeply it goes the less complete it is. It is a strange science whose most telling assertions are its most tremulously based, in which to get somewhere with the matter at hand is to intensify the suspicion, both your own and that of others, that you are not quite getting it right. But that, along with plaguing subtle people with obtuse questions, is what being an ethnographer is like” (Geertz [1973] 1993: 29). 12. As stated previously, the majority of interlocutors’ names in this book are pseudonyms; no exceptions have been made for patients. 13. For further discussion of the management of heaty and cooling foods and medicine in Singapore, see chapters 5 and 6. 14. For instance, both shops dispensed da wan (big pills) that were waxcoated, walnut-sized pills that contained fifty to one hundred smaller pills inside (Cochran 2006: 32). 15. Dr Song explained that this five-year warning was intended to prevent a potential flooding of polyclinics (and thus a spike in demand for government-subsidized medications and services), which the HSA feared could occur if liquid forms of Chinese herbal treatments were suddenly banned. 16. Although liquids were still legal and used at the time of my fieldwork, many members of the Chinese medical community—such as Dr 176

Making Sense and Sensation

17.

18.

19.

20.

21.

22.



Wang—used powdered herbs nonetheless (either on their own aegis, or in response to this pressure). Although some Chinese medical physicians—such as Dr Li at Thong Chai—used tuina in their private practices, many Singaporean patients did not consider Chinese massage to be Chinese medicine. When I inquired what he thought was meant by the word “waking,” Wayne explained that Dr Wang had been speaking in Mandarin. When I then asked what the term was in Mandarin, he could not recall. Bearing these costs in mind, it is perhaps less surprising that in 1993 American expatriate Michael Fay was caned in Singaporean for motor vehicle vandalism, despite political pressure from the United States (most notably from President Bill Clinton) that decried the punishment as excessive. Singapore’s characteristic response noted that Fay was being treated in the same manner as Singaporean citizens. This patient classification refers to the type of ward (and, hence, room) in which medical services are provided: the broadest distinction is between private patients (class A) and government-subsidized patients (classes B1, B2, and C). Class A patients enjoy private rooms, equipped with air conditioning and television, while class B and C patients have fewer amenities and less privacy (in inverse relation to the percentage of their bill that is subsidized). Although the exact age of Chinese medicine is contested in scholarship, it is widely considered to be closer to two thousand than five thousand years old (see, e.g., Hsu 2001). Scheid (2002) also challenges earlier rational choice models for patients’ therapeutic choices, outlining how patients and their families relate to local embodiments of practice such as physicians, hospitals, and forms of treatment. Scheid insists that we consider the various struggles (or competing interests) in which decision makers must engage. For instance, matters of convenience and effort can influence choices in many ways— whether or not treatment is sought, where it is sought, and what type of prescription is preferred. These factors create “particular constellations in space-time” in which a patient’s needs and a physician’s practice intersect within the institutional setting of therapeutic encounters (Scheid 2002: 113). In evaluating individual behavior in the context of medical pluralism, Scheid thus asserts that patients are active agents who participate in their own therapy, rather than being passive recipients or rational choosers.

177

Chapter 5

Heat, Health, and the Experienced Environment

Disease occurs, of course, not in the body, but in life. Localization of a disorder, at very best, tells little about why it occurs when or how it does. Disease occurs not only in the body—in the sense of an ontological order in the great chain of being—but in time, in place, in history, and in the context of lived experience and the social world. Its effect is on the body in the world. —Byron Good, Medicine, Rationality and Experience: An Anthropological Perspective

Introduction As discussed in previous chapters, Singapore’s lack of natural resources and delicate political position at independence were tropes used to justify the careful engineering of a productive population, environment, and economy. While the political management of the body politic was certainly a dominant constellation of dynamics in Singapore at the time of my fieldwork, however, it did not fully encompass the everyday experiences of many Singaporeans negotiating health and illnesses in their tropical cityscape. As several of the case studies discussed in the last chapter suggest, the fluid healthcare strategies of the people with whom I interacted neither fully conformed to nor fully resisted biomedical or Chinese medical paradigms, and were developed within particular personal, social, economic, and environmental conditions. At one degree north of the equator, Singapore’s climate is warm to hot and humid year-round. Notwithstanding the shifts between monsoon and inter-monsoon periods, the temperature hardly seems 178

Heat, Health, and the Experienced Environment



to change from season to season, particularly in relation to more northerly parts of Asia, including the PRC. As Dr Teo explained to me at Thong Chai, the practice of Chinese medicine in Singapore therefore differed from how it was practiced in the context of four distinct seasons. For instance, whereas the relatively colder climate of northern China encourages the use of herbs that produce heat to harmonize bodies exposed to pathogenic cold, if one were to apply the same strategy in Singapore, one could easily overheat patients and exacerbate their condition or produce a new one. Conversely, the experience that physicians acquired in Singapore could not always be used directly in Beijing. Although the theory remained the same, its application had to be modified according to the physical environment. Furthermore, patients tended to situate their health-related experiences of the environment (seasonal or otherwise) in a simpler, but not unrelated, hot/cold paradigm. It is important to note that not all Singaporean Chinese “believed in” Chinese medicine,and not all Chinese medical patients in Singapore were ethnic Chinese.1 Yet, as I will show in this chapter, despite such variations one remarkably widespread theme—both within and outside clinics—was the regulation of internal and external heat and cold. Although often associated with Chinese medicine, patients’ embodied knowledge of hot/cold dynamics did not always perfectly overlap with Chinese medical theory. Nonetheless, bodily and verbal articulations of re (heat) were usually understood in relation to Chinese medical products and practices. In the previous chapter I suggested that embodied experience, articulated both verbally and nonverbally, informed Singaporean patients’ perception of Chinese medicine. In this chapter I will delve deeper into this topic by examining specific bodily experiences within a dynamic sociopolitical and physical environment. I will first explain how Chinese medical theory and the body ecologic framework proposed by Elisabeth Hsu (1999, 2007) view bodily experiences and practices in relation to broader environments. I will then explore how Singaporeans negotiated a dramatically transformed landscape, first in terms of post-colonial development and domestic spaces, then in daily experiences of heat and cold, and finally with regard to seasonal and dietary fluctuations. Following João Biehl, Bryon Good, and Arthur Kleinman’s (2007) formulation of creative, knowing, and acting subjects, I will thus situate patients’ 179

Capturing Quicksilver healthcare strategies within the dynamic conditions of a particular sociopolitical and physical environment, in which bodily experiences of heatiness are articulated and managed.2

Seasonality and the Body Ecologic Hot/cold idioms have been described in relation to medical practices around the world: for instance, in indigenous Mesoamerican and Hispanic medicine (e.g., Messer 1987); in Malay (e.g., Laderman 1981), Chinese (e.g., Anderson 1987), and Iranian (e.g., Good 1994) food practices; in India (e.g., Zimmermann 1987), and among Swahili communities in Kenya (e.g., Beckerleg 1994). For instance, Mark Nichter (2008) discusses the classification of food in India as hot or cold, as well as the interpretation of bodily experiences of “heat” and “inside fever”: “In coastal Karnataka, Indian mothers spoke of their children having ‘inside fever’ (Kannada: ole jwara), discernible to their touch at different parts of the body, although not necessarily registered by a thermometer in the usual locations temperature is taken. In some cases, internal fever was associated with other heat-related symptoms such as skin rashes that were noted along with other body sensations like a child’s thirst or even the cracking of the child’s feet (a place heat was thought to escape)” (Nichter 2008: 174). This description certainly resonates with the experience of heatiness that Singaporeans described and that I experienced myself, suggesting remarkable cross-cultural similarities in embodied experience. However, as I discussed in chapter 4, the particular meanings and symbols attached to these experiences are socially and, I would argue, environmentally specific. While many of these experiences and idioms are lumped together as “humoral,” we must be careful to not conflate these diverse and widely distributed practices with the specific substances or forces associated with Galenic or Ayurvedic humors.3 Although drawing parallels and comparisons between medical practices is certainly a strength and important contribution of medical anthropology, conflation of this sort risks obscuring the nuances and diversity of practice in and between sociopolitical and physical environments. Rather, one must properly contextualize experiences and practices pertaining to the hot/cold idiom in question within the emergent conditions of a particular space and time. As I will propose in this section, a 180

Heat, Health, and the Experienced Environment



body ecologic framework can be useful in exploring individual experiences and collective practices as situated within dynamic, lived environments. As described previously, in Chinese medical theory, life, vitality, illness, and ultimately death are explained in terms of the accumulation, sustenance, and dissipation of qi. The constancy of change—its force and substance constituted by qi—is characterized by the general cycle of natural processes, which serves as the governing principle of the cosmos and all things within it. From the astrological level to the details of an individual life, cyclical patterns of transformation link microcosms to each other and to the larger macrocosm (Sivin 1987). Thus, the universe, the seasons, the state, and the body are all conceived as part of the same complex of dynamics, united by the shared substrate of qi (Hsu 1999: 80).4 Meanwhile, the concept of wuxing (five phases or agents, namely wood, fire, earth, metal, and water) describes the spatiotemporal cycle of energetic change that governs these dynamics. Within the body, physiological (healthy) sequences describe harmonious dynamics, wherein one phase either produces or prevents the overproduction of another. Wood produces fire, fire produces earth, earth produces metal, metal produces water, and water produces wood. Conversely, wood checks the overproduction of earth, earth checks water, water checks fire, fire checks metal, and metal checks wood. Pathological (unhealthy) sequences, wherein these normal cycles are disrupted by surpluses or deficiencies of qi, blood, and other “liquids and fluids,” describe the conditions in which illnesses are understood to arise (Porkert 1974). In addition to wuxing, one of the most common frameworks used by Singaporean Chinese medical physicians was yinyang; these concepts constitute two pillars of Chinese medical theory and, as such, were frequently used to explain notions of heat and cold. Describing the dynamic internal relationships of temporal and spatial phenomena (e.g., the cycles of the sun and seasons, or the bodily changes that manifest as illness), yin and yang demarcate the significant aspects, and their subsequent relationship, of nearly any natural continuum. In other words, yin and yang form the abstract archetypical pattern on which all physical phenomena and situations, and their underlying dyadic relationships, are understood (Sivin 1987). 181

Capturing Quicksilver Individually, the yin and yang aspects of a phenomenon can be defined only relative to each other, to another phenomenon, or to the phenomenon itself in another phase of development.5 While heat is generally associated with yang and cold with yin, none of these terms can be described as absolutes or universally experienced, static bodily states.6 Harmonious transformation, or resonance, between yin and yang is desirable—not homeostasis. Hence, explanations of yinyang as a state of balance somewhat miss the mark by implying an ideal state that is static, rather than in constant transformation. In this framework, patients’ complaints of heatiness can be diagnosed as excess yang or deficient yin, relative to both an individual’s internal dynamic constitution, diet, and other everyday practices as well as his shifting relationship with a similarly dynamic environment. Chinese medical theory therefore considers the dynamic conditions of patients’ bodies in relation to patients’ changing environment, both of which are subject to the mutual transformations of yinyang and the cyclical pattern of wuxing. Elisabeth Hsu explains that the contemporary elevation of wuxing in TCM theory (as a politicized construct) developed out of a sixteenth- to seventeenth-century heuristic device for understanding “how apparent phenomena in the universe resonated with hidden ones inside the body-enveloped-by-skin” (Hsu 2007: 98). Previously, however, its primary purpose was in advocating moderation, regularity, and etiquette—in other words, a distinctive lifestyle—among an honor-seeking status group of the eighth century. Used by pre–Han Dynasty astronomers and other diviners, this numerology resulted in successful predictions and thus raised the status of court prognosticators. Hence, in the Han Dynasty (206 BCE to 220 CE), physicians of the newly instituted imperial administration started to use the numerology of five to account for the seasonality of illness. The relatively predictable relationships between seasonal changes and illness legitimized the incorporation of the moral values of a status-seeking elite group into a systematic understanding of the body, relative to the natural environment. To some extent, wuxing could therefore be viewed as a codification of a set of proposed relations between individual bodies and their physical environment—to use Hsu’s term, a body ecologic framework. Building on Scheper-Hughes and Lock’s (1987) concept of three bodies (individual and social bodies, and the body politic), 182

Heat, Health, and the Experienced Environment



Hsu suggests the body ecologic as a framework that considers people in interactions with their environment (Hsu 1999). Akin to the body politic, this describes an orientation toward the body as “intricately intertwined with its environment, so body and environment cannot be dealt with as separate entities” (Hsu 1999: 82). The framework also overlaps with that of the social body—in which bodies are seen as at least partially resulting from historical processes—but avoids sociocultural determinism by including social, geographical, and ecological factors (see also Zimmermann 1987). However, while the body ecologic Hsu describes successfully incorporates aspects of the body politic and the social body, the sensorially engaged individual body appears largely underrepresented. How might this framework inform our understanding of the everyday experiences and practices of Singaporeans? Because the body ecologic views environmental and bodily processes as mutually embedded, I argue, it is useful for exploring the interplay between the external, lived environment (physical and sociopolitical) and (naturalized) embodied practices. Hence, in the following sections I will describe subjective, experiencing, and articulating individuals (often engaged in collective practices) in relation to a dynamic

Figure 5.1. View from MacRitchie Reservoir (central catchment) 183

Capturing Quicksilver tropical cityscape carefully wrought by erasure and reformation. This will augment the sensorial exploration of embodied experience that I introduced in the last chapter with an ethnographic elaboration of the body ecologic.

Urbanization and Kampong Nostalgia In contrast with the “backward” conditions of the 1960s—overcrowding, rampant tuberculosis, poor sanitation, and so on—the gleaming façade of Singaporean modernity was referenced in both popular and political discourse as visual evidence of the post-colonial state’s success. With the demolition of the colonial era kampongs and relocation of people into dense urban clusters, everyday interactions of Singaporeans with their physical environment, and with each other, were increasingly defined by concrete and steel: “Living in the sky is a confining experience. There is little space immediately outside the flat to escape the four walls, unlike living on the ground where the outdoors is an extension of the house itself. Without access to the outdoors, the spontaneous casual encounters with other residents are seriously reduced, eliminating one of the fundamental building blocks of the sense of community. Even interaction between immediate neighbours is significantly affected by permanently closed doors, often encouraged by the police as a house-security measure” (Chua 1995: 233, see also Kong 2001: 122). Chua’s quote nicely illustrates the manner in which social interactions of Singaporeans—enclosed and partitioned within high-rise apartments—shifted in the post-colonial environment. It suggests a reformulation of a community-oriented and grounded landscape of the past, into the confined and controlled urban environment of a contemporary metropolis. In this section I will briefly outline how this lived environment was carefully crafted to serve specific agendas. I will also explore how nostalgia for the sense of community in the past, by contrast with lived experiences of the present, quietly critiqued these agendas and (in at least one case) provided an alternative understanding of a healthy environment. For several decades after independence (1965), residents of Singapore’s crowded urban center, its shantytown fringes, and kampongs alike were resettled in purpose-built high-rise apartment buildings arranged in clusters (called estates) that, in turn, were 184

Heat, Health, and the Experienced Environment



grouped in self-sufficient neighborhoods and/or towns. Each town had a transportation hub, a community center or club, shopping and eating establishments, schools, and other basic amenities; estates typically contained a courtyard or two, playground facilities for children and, in older neighborhoods, provision shops. Although there were a number of different apartment layouts, depending on the age of the estate and the size of the apartment (ranging from one room studios to multiroom, luxury condominiums), within each category apartment floor plans were identical in a given development. These beehive-like arrangements were managed by the PAP via the HDB and their affiliated organizations.7 Through the provision of subsidized housing (discussed in chapter 2), the Singaporean government was able to manage not only ethnic quotas, public health, and sanitation but also what they deemed to be appropriate social and political behavior. This division of space reflects Foucauldian enclosing and partitioning, which are elements of discipline discussed in chapter 3; it also overlaps with Foucault’s notion of a pathogenic city, the hygienic control of which justifies social control measures (Foucault 1984b).

Figure 5.2. HDB housing estate in Sengkang 185

Capturing Quicksilver The island, with its veins (streets) and arteries (expressways), its clearly defined but permeable skin (borders), and its interconnected organs (beehive-like towns) was carefully managed by the government in the same manner—and for the same purposes—as the docile body politic that was crafted to attract international investment. Although many of these activities were justified in terms of public and economic health, and undoubtedly conferred certain advantages on contemporary Singaporeans relative to both colonial times and their regional neighbors, many people conceptualized a healthy environment in very different terms. While the majority of Singaporeans with whom I interacted were grateful for the material improvements facilitated by the PAP, an undercurrent of quiet dissatisfaction could be discerned among Singaporeans who had grown up in the very different physical (and sociopolitical) environment of kampongs. For instance, Adelle, a Singaporean Chinese woman in her late thirties, fondly described playing with her friends—leaping out of hiding places to frighten them and climbing fruit trees—sharing food with neighbors, and being allowed to wander at will from house to house in the kampong. By contrast, her partner Tom’s children— like most Singaporean Chinese children—were carefully watched and managed, in this case by teachers, by their grandmother, by their live-in maid, and by Tom and Adelle. Even in this relatively relaxed family, their weekday routines were regimented and supervised from breakfast, through school and extracurricular activities, to dinner, studying, and tutorials. Similarly, Adelle and Tom worked long hours nearly every day of the week. As housing estate agents—tasked with finding renters and buyers for various properties owned by the government—they were perpetually on call and had to be prepared to meet a potential client or show a flat at any time. Although they were able to take short breaks between errands, showings, meetings, repairs, and other duties, Adelle’s waking hours were almost entirely defined by work and family responsibilities. She enjoyed the material comforts of her adult life, but often remarked to me that she missed the sense of freedom kampong life provided when she was a child. Like Charlene and Anna (described in chapter 4), many Singaporeans complained that contemporary life required both parents to work and that, as a result, they did not have as much time (real or perceived) for their families as they once had. This was particularly difficult for women juggling family duties and a career. 186

Heat, Health, and the Experienced Environment



Insofar as the state encouraged women to work and develop themselves professionally, yet also maintain “traditional views of gender roles and family structure,” Singaporean women were often “caught within the ambiguities” of conflicting messages (Lyons-Lee 1998: 316). Lyons-Lee highlights both governmental and social pressures for educated women to marry and have children: “The government’s stance on graduate women provided a context in which their families could read traditional values against the concept of ‘social good.’ They were letting down not only their families, but also their nation. Within these overlapping discourses of family values and national values, the unmarried graduate woman is rendered socially deviant” (Lyons-Lee 1998: 314). Thus, an educated Singaporean woman who chose to delay or forgo marriage and procreation had to defend her supposedly unnatural and immoral choices against both state and familial pressure. The “choices” available to Singaporeans women were therefore constrained by the expectations placed on them with respect to state priorities regarding traditional family values and economic productivity. By contrast, although many kampong mothers had worked to help support their families, there had been less social and political pressure on them to do so. They therefore felt they had more time for their families, even if their personal circumstances or preferences led them to work. The confining experience of HDB life described by Chua (1995) above is therefore replicated in the long working hours and family responsibilities of adult life, perceived in contradistinction to the relative freedom of kampong life. Such nostalgic sentiments were often intertwined with comparative evaluations of social and value changes, cultural preservation or degradation, and the practical realities of attending to the well-being of themselves and their families. This remarkably common nostalgia for the kampong days was reflected in a Temasek Polytechnic Media and Communications Studies film that was shown on board public buses of Singapore for a week or so during my fieldwork. The film consisted of photographs from Chinatown, circa 1955, accompanied by descriptive captions: “live chickens bought and sold,” “handmade noodles” and “mobile eating halls,” “laughing children,” and “produce and other goods sold without licenses (vendors disappear when police come, but only ‘for now’).” By the turn of the century, live chickens were indeed 187

Capturing Quicksilver rapidly becoming restricted to historical imagination (particularly in light of fears of avian influenza), mobile eating halls had been almost entirely replaced by permanent hawker centers, and few vendors dared to operate without licenses. It did not seem to me that the short film was condemning the past or heralding the glories of modernization. Rather, it echoed a common sentiment about the aspects of life that were lost in the development process, for better and for worse. In Brenda Yeoh and Lily Kong’s chapter on place as process, Singaporeans’ kampong nostalgia is described as a transformation of individual and collective memories that often glorifies lost time and place by comparison with an unfavorable present: “Nostalgia is hence a critique of the present time and place … a construction of the past but a condition of the present … [that] requires the presence of artifacts, images, texts and other visual and oral records of the past” (Yeoh and Kong 1999: 140–41). Thus, films such as the one described above could be interpreted as a critique of present conditions that also expressed a common sense of nostalgia, glorifying lost places and times. On the other hand, while kampong nostalgia was certainly widespread among the Singaporeans with whom I conversed, few pined for the material conditions of the kampong. Sarah, a middle-aged housewife and regular patient of Professor Tan’s, explained to me that the kampong in which she grew up (in the neighborhood now known as Novena) was inconvenient. She had to walk a long way in order to use a telephone, catch a bus, or do washing in a communal area; furthermore, she felt she had very little privacy in the kampong. HDB life, by contrast, was cleaner, more private—contemporary apartments had their own door and windows that could be covered, as well as private restrooms. Importantly, these apartments were more convenient. Although few people with whom I spoke shared this overall poor impression of kampong life, most acknowledged its disadvantages. Nobody informed me, for instance, that they preferred a shared well over running water, or an attap (a local plant with relatively durable leaves) roof over concrete and steel. The most common aspect that most people missed, then, was the communal conditions of the kampong, repeatedly cited in contrast to the social conditions of the contemporary metropolis. As illustrated in chapter 2, this sense of community could still be found—particularly in the older and/or smaller (lower-income) developments, or in 188

Heat, Health, and the Experienced Environment



connection with unpublicized events. However, in the contemporary Singaporean metropolis it was rapidly diminishing, sacrificed for economic growth and constant redevelopment (referred to in popular and political discourses as “upgrading”).

Environmental Engineering and Experience If not for a cluster of reservoirs, parks, and nature reserves located near the center of Singapore, accompanied by a few other small nature areas elsewhere, one might easily forget that this highly manicured island used to be covered in jungle.8 Although the 1993 Singapore Green Plan delineated nineteen sites (including extant reserves)—approximately 5 percent of the main island—as nature areas, it gave no guarantee against future development in many of these areas (Ho 1999). Furthermore, even these natural zones were monitored and controlled, permitted to exist under the careful management of the National Parks Board (previously a statutory board, now privately owned). With regard to the remaining 95 percent of land, Lee Kuan Yew implemented a garden approach to sustainable urban development, explicitly to attract foreign investors and soften the urban landscape for Singaporeans. A number of parks, tree-lined boulevards, nature reserves, and park connectors (green pathways between parks) were planned and implemented to produce a “garden city.” Nonetheless, Singaporeans encountered even the natural environment in a seemingly controlled and sanitized manner, while the vast majority (if not all) of their time was spent in an orderly environment of concrete, glass, and steel. The biomedically based public health efforts discussed in previous chapters—with their supporting imagery, and notions, of modernity and progress—found concrete manifestation (literally and figuratively) in improved infrastructure, efficient public transportation, sanitation measures, and city planning. In the course of these ongoing efforts, the potentially dangerous environment was kept at bay by the detailed management of bodies and things within a carefully designed cityscape. As I will argue in this section, the government’s evocation of a supposedly hostile natural environment that had to be controlled in the interest of public health—by both official measures and public vigilance—is evident in NEA anti-dengue campaigns. Despite the prevalence and day-to-day impact of these campaigns, 189

Capturing Quicksilver however, the intersection between environment and public health on which they were founded did not accommodate Singaporean’s widespread experiences of heat and cold. Dengue fever, a potentially lethal disease carried by Aedes mosquitoes (Aedes aegypti), or mozzies, is an intractable problem in Singapore that no amount of fogging or NEA propaganda has been able to fully eradicate. During the two years in which I lived there I encountered many messages associated with such campaigns, written in English, Chinese, Tamil, and Malay, throughout the island. Billboards erected in small grassy spaces near HDB estates depicted a fleet of giant mozzies hovering above the city and the fear-inducing directive, “When they strike, you can’t hide. Stop dengue. Act now!” Spaces normally reserved for advertising on the heavily used MRT trains were frequently appropriated by the NEA with illustrated instructions on the mandatory “ten-minute mozzie wipe-out.” These measures included changing the water in vases, flower pot plates, and any other household vessels every other day; turning over water storage containers (e.g., buckets); covering bamboo pole holders used for hanging laundry outside the windows of most HDB estates; and clearing and adding insecticide to roof gutters every month. Similar instructions were delivered by local celebrities in television advertisements, and in flyers mass-mailed to residents’ homes. One packet of antidengue information posted to each resident in the housing estate where I lived contained six small “DANGER ZONE!” stickers and instructions on where to place them in one’s home, indicated on a diagram of a typical three-bedroom HDB apartment. It also included a refrigerator magnet and small notepad reading, “If they breed, you will bleed,” coupons for discounts on anti-mozzie products, and a large, illustrated card that listed symptoms of dengue fever as well as useful telephone numbers (e.g., fire/ambulance, police, NEA hotlines, and various community development councils). Thus, the many potted plants one could find in the corridors of HDB estates—perhaps reminiscent of kampong gardening—became sites of contestation, depicted in NEA campaigns as dengue danger zones that required constant vigilance. Failure to comply with these “ten-minute mozzie wipe-out” instructions, as revealed by surprise NEA spot-checks at a home that produced mozzie larvae, could (and often did) result in a S$100 fine for the first infraction and S$200 for subsequent offenses. 190

Heat, Health, and the Experienced Environment



Individuals were thus held responsible for monitoring their own domestic spaces, and were implicitly encouraged to monitor neighbors, family, and friends for the benefit of society. Additionally, in 2007 the member of Parliament representing Hong Kah (a constituency in the northwest of the island) announced his intention to employ the region’s PAP community foundation to teach children to educate their families in antidengue measures, as reported in The Straits Times (Singapore) (September 17, 2007). The NEA also worked with grassroots organizations, which provided volunteers to disseminate anti-mozzie instructions and perform perfunctory checks in their neighborhoods. These anti-mozzie campaigns are a clear example of how self and neighborhood surveillance were integral elements of the political management of Singapore’s physical environment. As Gregory Clancey (2012) describes, the 2003 SARS epidemic was successfully contained through similar strategies of self-surveillance: “Being aware of, taking care of, and literally monitoring your own and others’ bodies (though with the help of sophisticated computer networks where one had to log in one’s temperature) made Singapore ‘one,’ if only for a couple of months, while strict border-control practices made it even more island-like” (Clancey 2012: 27–28). Hence, the body politic was protected by fortifying national boundaries and reaffirming national solidarity. As Clancey explains, this event also catalyzed the transition from Intelligent Island to Biopolis by highlighting the value of medical research and the importance of community health locally, and branding Singapore as a Biopolis abroad (Clancey 2012). Individuals thereby became vital agents of biopolitics and governmentality insofar as they were both surveilled by government representatives and they surveiled themselves, taking appropriate measures to moderate risk to their (and, by extension, the population’s) well-being. Thus, biopolitical and self-care discourses engaged all manner of individuals in Singaporean society, from political organs like the NEA to individual volunteers, to children tasked with educating their parents. Action and surveillance (of themselves and others) strove toward “health of all as a priority for all” (Foucault 1984b: 275). As Michel Foucault (1988) discusses with reference to ancient Greco-Roman literature, medical discourse prescribed self-surveillance and self-care through particular practices within a specific milieu: “Between the individual and his environs, one imagined a 191

Capturing Quicksilver whole web of interferences such that a certain disposition, a certain event, a certain change in things would induce morbid effects in the body. Conversely, a certain weak constitution of the body would be favorably or unfavorably affected by such and such a circumstance. Hence there was a constant and detailed problematization of the environment, a differential valuation of this environment with regard to the body, and a positing of the body as a fragile entity in relation to its surroundings” (Foucault 1988: 101). For instance, Foucault cites Antyllus’s description of the harmful or beneficial effects of a house’s architecture, geographical orientation, and interior design; Antyllus’s self-care practices also outlined seasonal and daily dietary regimes, correct sleeping patterns, and bodily exercise and anointment (Foucault 1988). Similarly, the NEA’s antidengue campaigns were oriented toward the domestic (as opposed to natural or public) environment and daily routines. Yet they mobilized people through evocations of a hostile tropical terrain capable of endlessly producing a potentially deadly fever, if not for the vigilance and preventive action of responsible, yet vulnerable, citizens. This supposed vulnerability resonates with the “little red dot” rhetoric described in chapter 2. Hence, the political rhetoric that justified the authoritarianism and legitimacy of the PAP in general was replicated within specific biopolitical agendas enacted within a specific landscape. As one of many efforts to manage the domestic spaces of Singaporeans, anti-mozzie campaigns met resistance not through public protest or debate, but through noncompliance. Many Singaporeans simply did not empty out the trays underneath their plants or cover the ends of their laundry poles (both of which could collect rain water and therefore provide the necessary conditions for mozzie breeding). Hence, the state maintained their ongoing and high-profile campaign that highlighted danger and responsibility, while reproducing the controversial climate of fear that was often (quietly) attributed to government propaganda. Many Singaporeans were compliant with public and environmental health initiatives— eating healthily (as defined by the state), exercising regularly, taking anti-mozzie measures, and so on. Others were noncompliant, acting in accordance with different preferences, habits, and notions of health (individual or environmental). Dengue fever—labeled or understood as such by patients, caregivers, or physicians—was almost exclusively treated within the 192

Heat, Health, and the Experienced Environment



domain of biomedicine in Singapore. Nonetheless, given the prevalence of these messages, it makes sense that despite its status as a biomedically defined and treated disease, concerns about dengue manifested even in Chinese medical clinics. The following ethnographic examples will explore sensorial experience in Singapore’s urban environment not in terms of danger and control, but rather in terms of heat and cold—experiences integral to many Chinese medical patients’ daily and seasonal health-related practices in the tropical cityscape. It will thus provide an example of the interpenetration of very different understandings of the relationship between individual bodies and their physical environment. The alternative formulation of a healthy social environment, described above in terms of kampong nostalgia, often accompanied an alternative understanding of a healthy physical environment. At the time of our two lengthy interviews, Kira was a forty-seven-yearold Singaporean Chinese woman who regularly brought her mother to see Dr Wang. Educated in the English stream as a child, Kira grew up speaking Teochew with her family, but as an adult spoke English at home with her husband and children. At the time of our interviews she lived in a middle-class apartment with her husband, children (aged sixteen, seventeen, and twenty), mother-in-law, and occasionally her mother (with whom she still spoke Teochew). She taught piano part time and frequently met with friends in and outside her home. By no means isolated from social interaction, Kira nonetheless lamented the loss of community that she had experienced in her childhood kampong, an environment she believed was ultimately healthier than the contemporary cityscape: Kira: Last time, when I was young, my mum scold[ed] me. I would go under the rambutan tree, I would lie down and sleep. The whole afternoon, I don’t go back. Now you ask me to lie down and sleep, I wouldn’t dare, because of insects. … I think nowadays things are dirtier—I don’t know, more contaminated. Last time, I lie down on [under] the tree, I don’t feel itchy, I don’t feel dirty. But now, I’m very afraid of those. Arielle: Why do you think it used to be cleaner? Kira: I don’t get any bites, I don’t get any disease; I don’t die from anything. Then, always barefoot—you run and play ball with neighbors—on my house there was a field [where] we plant[ed] those very 193

Capturing Quicksilver short grass. We enjoy playing, and then we were always barefoot—it’s meant to be healthier. But nowadays, I’m very careful and wear slipper[s] outdoors. Yeah, it’s so different. Even at the beach, we are all advised to wear slipper[s].”

When I asked if she would like to return to life in the kampong, Kira admitted that although she missed the freedom and community found therein, she would not choose to return because it was “very dirty.” In contrast with the unhealthy urban environment, however, activity within this dirt—playing barefoot in the grass or relaxing beneath a tree—was “meant to be healthier.” Although this dynamic (and somewhat contradictory) relationship with the physical environment derived from her embodied experiences in a variety of contexts, at least partially in dialogue with government development rhetoric, it must also be understood in light of her family history. Kira’s mother grew up on a farm between Hougang and the sea, on the northern side of the island. After marrying Kira’s father, they moved to the densely populated urban center then known as Singapore City (also known as Central Area), where they shared a small house with five other families. After living there for a few years, Kira’s mother became very ill. Attributing her poor health to this environment—compounded by improper observance of postnatal confinement practices—Kira’s father bought and moved his family onto an acre of land in rural (at the time) Jurong when Kira was five years old.9 Kira and her two siblings split their time between the nearby school and the kampong, where she helped with planting, pulling weeds, and housework; assisted her father with shopping; and played with neighborhood children. Surrounded by similarly spaced single-story houses and fruit trees, Kira’s mother’s health gradually improved and they remained there for another nineteen years. When Kira was twenty-four, the family was forced to move to Clementi because the government wanted to develop the land into what is now Boon Lay station (a public transportation hub in Jurong West): “They would come and ask what you have—so, how many fruit trees you have, how many square foot of cemented place, and then they will pay you back compensation. So we took about 30,000 Sing dollars at the time. … And then we used the money to renovate our new flat, HDB in Clementi (the present Sunset Way). So I lived there for three years and then got married, and then I stayed in Jurong East.” After 194

Heat, Health, and the Experienced Environment



living in Jurong East for ten years, she and her family moved to their present apartment near the Istana (the official residence and office of the president of Singapore in the Central Area), bringing her full circle back to the old urban center at the mouth of the Singapore River. Kira appreciated the convenience, cleanliness, and plumbing of contemporary Singapore (although her own apartment was “very old—40 years old”), but simultaneously missed the healthier physical and social environment of her childhood. She described with obvious nostalgia how neighbors would frequently stop by their home for tea, or would share extra food and garden produce with each other. In contemporary Singapore, she observed, people were more isolated and less friendly; at most, your neighbor might say “hello.” Although Kira suggested that maintaining close community relations was still possible, it required a great deal of effort and time that could be better spent with one’s family: “Maybe when we grow older we will be more free.” In explanation of how she cared for her and her family’s health in this context, and particularly with the perceived constraint on free time in mind, Kira observed, “Singaporeans want convenience.” Like Anna, she remarked that the manner in which CPMs were prepared and packaged catered to this preference.10 “Everybody works,” she explained. “[In] most families both parents are working, so they have very little time to brew those medicines.” Thus, she explained, when she or her children fell ill she would first purchase overthe-counter Chinese herbal combinations (packaged in tea bags for convenience), based on the recommendation of a shopkeeper in the Thompson Road area, rather than boil an herbal prescription at home herself. Similarly, while she acknowledged that many Singaporeans regularly made liangcha at home to moderate the effect of the climate on their health, she preferred the convenience of premade bottles. While she tended to treat her own heatiness with premade liangcha, she would nonetheless try to make it at home every Saturday for her family. Like her friends, she would alternate between damai (Chinese barley, Hordeum vulgare) with rock sugar one week, and juhua, and jinyinhua with rock sugar the next. Although the climate in Singapore felt essentially hot year-round, Kira explained, slight seasonal and daily fluctuations in temperature occurred; those who 195

Capturing Quicksilver did not take the proper preventive measures (largely dietary), or act swiftly on noticing heaty symptoms would often become ill. Thus, she observed, even Singaporean Chinese who didn’t “believe in” Chinese medicine still frequently ate and drank cooling things to maintain their health in the tropical environment. Kira thus claimed that this was a cultural practice of Singaporean Chinese, and not explicitly based on Chinese medical theory. On the other hand, while the selection, preparation, and method of consumption of these herbs might indeed differ from their use in clinical practice, they are nonetheless found in the Chinese materia medica.11 Like Kira, many of the Singaporean Chinese with whom I spoke did not articulate their practices in theoretical terms. Nonetheless, these practices and perceptions reveal a set of dynamic relations between individual (and collective) bodies and their surrounding environment that is perhaps more akin to Chinese medicine than the biomedically framed development or environmental health discourses of the state. This is not to say that any of these facets of experience—social, political, individual, or ecologic—can be completely disentangled from the others. Whether in clinics, homes, or public contexts, various depictions and explanations of the interdependence of individual and collective bodies with their physical environment competed for authority. As this case and the following examples illustrate, individuals negotiated these competing interests while caring for their own health and/or the health of others in the rhythm of daily and seasonal life.

Heat and Heatiness On a Tuesday morning in July, I took the bus from my apartment in the newly “upgraded” town of Sengkang to one of Singapore’s oldest HDB neighborhoods, Toa Payoh, as I did every week in order to observe Professor Tan’s practice at Chung Hwa. Although I had only walked a block from the bus stop, I was sweating by the time I reached the top of the clinic’s wide stone steps. Even in the morning, the summer sun pierced the hazy skies and bounced off Singapore’s utilitarian concrete and steel high-rise buildings, heating the island from above and below. On days like this it made sense to me why so many Singaporeans walked beneath umbrellas on sunny days. In addition to accommodating an aesthetic that favors pale skin (shared 196

Heat, Health, and the Experienced Environment



by many Southeast Asians), this portable shade provided slight relief from the heat when walking between buildings, crossing the street, and so on. Among those who were compelled to walk outdoors, the five-foot ways beneath awnings commonly found in front of ground-level shop houses—introduced in the colonial era to shield pedestrians from the sun and rain—were noticeably popular. Because Singapore lies only one degree north of the equator, the summer can feel incredibly hot, even by local standards. Upon entering Chung Hwa, I was greeted by the usual waft of air-conditioning and the surprised glances of several patients sitting in the crowded waiting area in the center of the ground floor. On most days, patients, students, physicians, and staff enjoyed air-conditioning throughout Chung Hwa, as they would in most public buildings in Singapore. A luxury in other parts of the region, air-conditioning was regarded as a necessity here—one of the indicators of Singapore’s dramatic economic success. In fact, it was common knowledge that the increased national productivity that resulted from the widespread use of air-conditioning in Singapore led Lee Kuan Yew to declare it the greatest invention of the twentieth century. Although a few older buildings in Singapore retained features that facilitated airflow (slatted windows instead of solid glass panes, for instance), most had been replaced by utilitarian designs that provided more-effective barriers between the heat outside and the air-conditioned space inside. This ubiquitous access to air-conditioning was taken for granted by many Singaporeans, becoming an automatic mechanism for moderating the heat while in public—particularly in the summer. In numerous discussions concerning where to meet with a Singaporean friend and colleague he would suggest McDonalds—not because of the quality of the food or the convenience of its numerous locations, but because of the air-conditioning. Walking to the MRT train from my second apartment in Sengkang on a weekend, I consistently observed noisy clusters of people around the few benches inside the Compass Point shopping mall (which houses the nearest MRT station). Although the closest public gathering points at housing estates were void decks (the open-sided ground floor) or courtyards of HDB buildings, these areas were not air-conditioned. Thus, such areas were often empty or underrepresented during the day—with the occasional exception of a few usually older people conversing at tables—whereas it was 197

Capturing Quicksilver commonplace to find crowds of ten to twenty people chatting around shopping mall benches designed for three people. This does not mean, however, that all Singaporeans responded to air-conditioning in the same manner, or experienced its effects on their bodies in a similar way. Nor should it imply that air-conditioning was considered appropriate to all locations or occasions. For instance, I was advised on several occasions by friends that I should not sleep with the air-conditioning blowing directly on me—a fan was usually acceptable, but air-conditioning was too cooling. Another friend cautioned me against the shock my body underwent in moving back and forth between hot and cold: from an air-conditioned apartment to a hot courtyard, to an air-conditioned bus, to a hot sidewalk, to an air-conditioned building, and so on. She advised me to use a fan at home, with limited air-conditioning during the heat of the day, to maintain a more constant temperature. Along similar lines, Kira described to me why her mother was sensitive to air-conditioning—a sentiment I found especially common among older Singaporean Chinese women. Shortly after Kira was born, her mother went to close a window to stop the rain from coming in and caught a “chill” (described in Chinese medical terms as feng, or pathogenic wind). Her exposure to the damp air outside was in violation of Chinese confinement practices meant to shield the weakened mother’s body from potentially harmful substances/ forces like wind and rain; touching water was strictly forbidden unless specific Chinese herbs were first boiled in it and, even then, was to be used sparingly. Kira explained her mother’s condition: She can now catch a … cannot fall under the rain, she will get very sick. She has been very ill for the last two months at my house, it’s like the air con is too cold [if] she is in the hot sun and goes [into] air con. … She will feel, you know feel cold all the time. It’s like when you have a flu, sometimes you have a flu right, you suddenly feel cold, feel goose pimples, she has that feeling all the time—most of the time. Yeah. So yesterday she was telling me, on Sunday she went home to shower, fine. Monday she showered, and then she could feel the wind blow, she felt that feeling again—feeling cold all the time again. So she has been like that all her life. She cannot go in the air con room, and you cannot blow strongly the fan. She is very scared of the fan, she will feel cold feel cold feel cold. And then she cannot wash things, then she will feel cold feel cold feel cold

198

Heat, Health, and the Experienced Environment



and then she was like, runny nose, and then she will feel exhausted, all her life was like that.

Kira’s mother explained that the “confinement wind” she caught after Kira’s birth remained with her for her whole life, making her susceptible to chills in the rain or under air-conditioning. Kira’s description of her mother being “scared” of the fan could be described in Chinese medical terms as pa leng (aversion to cold)—a recognized symptom that would be reported by the patient (independently or upon physician’s inquiry) during the diagnosis portion of consultation. Kira’s story demonstrates a common acceptance, among Singaporean Chinese medical patients in particular, of the power of intangible, environmental substances/forces to act on individual bodies—sometimes with lifelong repercussions. Furthermore, whereas Kira preferred to stay under air-conditioning (she also requested we meet at a McDonalds to take advantage of the cooler environment), her mother could not tolerate it. Not only were older people often said to be more sensitive to climatic changes and extremes, but it was also fully expected and accounted for that individual constitutions and life experiences would produce different reactions to hot and cold in both the environment and in foods or medicines consumed. The aversion to cold and rain was extremely common not only in relation to confinement practices, or in Chinese medical diagnosis but also in the everyday lives of Singaporeans, especially during monsoon seasons. I cannot count the number of times I was informed—usually by text message—that someone I was meeting was going to be late because they were caught in the rain. This usually meant that they did not want to walk to their preferred method of transport (even with an umbrella)—whether it be a bus, MRT, or their own vehicle—until it stopped raining. Of course this can be partially explained by the discomfort associated with having wet clothes; it often rained so hard that, even with an umbrella, one was drenched from above and below as the rain bounced off the ground. But more often people would cite the potential risk of illness caused by being in the rain as the reason for avoiding it. This aversion also extended to the period immediately following rain, when sometimes visible vapors rising from the ground (especially in the morning or evening) were said to cause all manner of 199

Capturing Quicksilver illnesses. I was therefore told by acquaintances on several occasions to avoid going out immediately after the rain. While doing so nonetheless with Adelle on the resort island of Sentosa (an island created as a pleasant distraction, like Aldous Huxley’s soma, for Singaporeans), I noticed her nervous expression and comments about the dangers of these vapors.12 Although she was not going to allow what she referred to as superstition to prohibit us from going out on this hard-won break (as mentioned above, she worked long hours every day), her mannerisms and verbal warnings revealed her conviction that the vapors were unhealthy. Returning to the Tuesday in question at Chung Hwa, however, the air-conditioning in Professor Tan’s room on the second floor was not working. Sunlight strained through the slats of blinds that mostly covered the large windows along the external wall—although it was still morning, the air was hot, humid, and still. Despite the heat, Professor Tan informed me, the clinic administrators had instructed him not to open the windows so as to prevent mozzies from entering. By insisting that the windows remain closed, they were doing their part to shield their patients from both the hostile environment and some of its more dangerous agents (mozzies). These concerns notwithstanding, Tan disregarded the instruction by opening all the windows, commenting with clear disdain in Singlish, “All the patients are, you know, fainted—who come and save them? Crazy lah!” Exercising the authority of a senior Chinese physician, this simple act of opening the windows resisted the clinic administrators’ adherence to environmental guidelines and thus, by extension, the NEA’s exertion of power within his consultation room. Tan’s blatant prioritizing of patient comfort also revealed to whom he was beholden: while administrators were liable for NEA compliance, he would be held accountable if a patient fainted from the heat. His comment sparked animated discussion in Mandarin, Singlish, and several Chinese dialects among the five SCTCM students, and ten or so patients distributed about the room in various stages of consultation. It is perhaps a reflection of the different arenas in which Chinese medicine operates in Singapore that while the clinic administrators were responding to recommendations based on NEA formulations of illness causation (mozzies transmit dengue), Tan was concerned with the patients’ immediate bodily experiences in the clinical environment (heat can be pathogenic). In doing so, he 200

Heat, Health, and the Experienced Environment



not only privileged patient comfort in their physical environment over governmental attempts to control both, but he also confirmed the bodily experience of heat as potentially unhealthy. Although patients’ notions of heatiness did not always exactly match those of Chinese medical physicians, their embodied experiences were nonetheless validated in Chinese medical consultations and treatments. As Farquhar (1994) notes, the diagnostic and therapeutic process in Chinese medicine relies on observations by both patient and physician. She references the term kanbing (looking at illness) to describe this joint effort, in which both patient and physician contribute their own perspectives and experiences, sharing authority over the “Truth” of the symptoms in a manner very different from the biomedical clinical encounter (Farquhar 1994: 45, 67). By contrast, a patient’s subjective symptoms and their description are often downplayed or denigrated in biomedicine’s overt preference for objective signs and material pathogenic agents. In many cases, Chinese medical physicians sought to explain patients’ bodily experiences through theoretical constructs (ranging from simple to complex) and, sometimes, with reference to their shared physical environment. For instance, after speaking with a patient, examining her tongue, and quietly taking her pulse for a few moments Professor Tan would, on occasion, suddenly look up, nod confidently and simply state, “Traffic jam.” Regardless of the language Tan used in conversation with his patients (Mandarin, Hokkien, Cantonese, Malay, or English), he used this English term quite frequently, either in the course of an explanation or as a sort of diagnostic declaration. In order to explain how his needling technique affected their bodies, he used the metaphor of qi as traffic in the city: in an ideal state it flows smoothly and regularly, while stagnations or other problems constitute traffic jams. Acupuncture, then, relieves the butong (congestion) and helps traffic resume its proper flow. While Professor Tan’s “traffic jam” metaphor was certainly tailored to contemporary Singaporeans, it also has an analogue in Chinese medical theory, particularly in descriptions of jingluo (Romanized in the Wade-Giles system as ching-lo)—the tracts and channels of the body. Lu Gwei Djen and Joseph Needham describe this network of twelve primary channels, additional channels, junctions, and short branches as “a complicated reticulate system, resembling at first 201

Capturing Quicksilver sight to modern eyes a map of the underground railway system in a great city” (Lu and Needham 1980: 15). However, they also note that the typical metaphor used in Chinese medical texts like the Ling Shu references networks of water: “There is no doubt that in the ching-lo system we have to deal with a very ancient conception of a traffic nexus with a network of trunk and secondary channels and their smaller branches. From the beginning these were thought of in terms analogous to those of hydraulic engineering, involving rivers, tributaries, derivate canals, reservoirs, lakes, etc.” (Lu and Needham 1980: 22–23). While the water metaphor was developed in the environmental context of imperial China, Tan’s automobile traffic metaphor was more relevant in contemporary Singapore, constituting a reconceptualization of jingluo within a modernized cityscape. Tan’s descriptions evoked the negative experience of busy Singaporeans, whose idealized efficiency and productivity was impaired by traffic delays—a commonplace and widely frustrating occurrence in the metropolitan environment. Tan explained that his traffic jam explanations—as well as his reference to the small card that Chung Hwa patients were required to present for their next appointment as a “passport”—was to facilitate better communication with his patients. Although this sort of metaphor might be analyzed within a structuralist framework of the social body (e.g., in the style of Mary Douglas [1970]), I suggest that Tan was not appealing to static, deep structures of the mind (the generative source of structuralist metaphors). Rather, Tan elicited the emotional reaction (perhaps irritation) and common embodied experience (suspended activity and reduced productivity) that traffic jams produced. Appropriating the terms of a traffic warden or immigration officer, his metaphors were also situated within a political landscape that promoted productivity and efficiency. Thus, as I regularly observed in Tan’s consultations, cityscape imagery did not solely belong to development and environmental health efforts, but was also intrinsic to the way at least one Chinese medical physician related his patients’ embodied experiences to their environment. Chinese medical physicians by no means limited themselves to cityscape metaphors. Time and interest allowing, all the physicians with whom I worked also made an effort to explain Chinese medical theory directly, typically using elements of yinyang wuxing xueshuo 202

Heat, Health, and the Experienced Environment



(the doctrines of yinyang and wuxing, as briefly described above). The subjective experience and specific manifestation of yinyang (or cold/heat dynamics specifically) in a patient’s body at a given place and time was considered very seriously in Chinese medical diagnosis and treatment. As such, Chinese medical theory provided a legitimizing framework for bodily experiences of heatiness, as well as the means of diagnosis and a range of therapeutic techniques and materials with which to ameliorate them. And yet the patients with whom I spoke rarely described their experiences in terms of yinyang and wuxing, although these correlations sometimes arose upon further inquiry or in clinical contexts. Despite the clear correlations between the bodily sensations of heatiness reported by Singaporeans and the pathogenic force re in Chinese medical theory, popular understandings and home-based practices did not always exactly match their professional counterparts. To illustrate this point, in the next section I will discuss several observations and accounts of heat, heatiness, and Chinese herbs in everyday life in Singapore.

Seasonality and Liangcha The bodily sensations that Singaporeans described as heatiness were quite diverse, including (but not limited to) otherwise inexplicable headache, fatigue, lack of focus, giddiness, a sensation of bodily warmth, yellow build-up in the eye, mouth ulcers, sore throat, dry mouth, and, of course, fever. Chinese medical physicians frequently dealt with these symptoms in the course of their practice, sometimes naming the condition as such (rebing, or illness caused by heat), and other times interpreting it as an element within a syndrome. But heatiness was such a common element of daily life for many Singaporeans—particularly throughout and immediately following the summer—that it was often managed outside the clinic entirely (as I described in the vignette in chapter 1). The materials for cooling soups, teas, and desserts were usually purchased in popular Chinese food and herb shops like Hock Hua or Eu Yan Sang, Chinese medical halls, clinics, or even large chain grocery stores. Grandparents and mothers prepared these remedies for mildly feverish children in lieu of taking them to the clinic, blue-collar workers and businessmen alike drank liangcha throughout the 203

Capturing Quicksilver year, and regular diets were adjusted according to apparently minute seasonal changes in climate. While the practices and materials associated with liangcha have correlates in the PRC and can be found in the Chinese materia medica, their (naturalized) everyday and seasonal use in Singapore suggests the “interpenetration of the corporeal and the environmental” emphasized by the body ecologic (Chau 2008: 501, fn6). Although the equatorial climate of Southeast Asia seemed particularly conducive to the consumption of liangcha, commercial production of cooling teas has also been documented in the PRC: “Liangcha in southern China is served on the side streets or small alleys in cities and shopping centers of large villages. Unlike bupin [tonifying materials], which is prepared from using small amounts of expensive classical medicinal products cooked with meat, poultry or sea-food requiring special labor-consuming technique, liangcha is prepared from wild plants collected locally, even with portions of the plants discarded by farmers and/or by the affluent people” (Hu 2005: 231).

Figure 5.3. Common materials for making liangcha: prepackaged polyherbal decoction, juhua, damai, and rock sugar 204

Heat, Health, and the Experienced Environment



Shiu-ying Hu (2005) has identified sixty-five source species used in liangcha in the PRC, 90 percent of which are common plants of tropical and subtropical southern China, where commercial development of liangcha is most prevalent. In addition to this production of liangcha from locally collected wild plants (particularly in Guangzhou, Hong Kong, and Macao), prepackaged cooling herbal combinations, intended for home decoction, are exported to metropolitan cities throughout the world. As Hu observes in Hong Kong, in Singapore the materials used for both premade bottles of liangcha and boxed herbal combinations are usually imported from mainland China; bupin (tonifying materials, usually herbs and/or foods) are also much more commonly used in these locales than in northern China (Hu 2005). Despite the historical and contemporary transnational ties between southern China and Singapore, however, subtle differences exist between their respective practices surrounding liangcha. Many of the herbs commonly used in the production of liangcha in Singapore—luohanguo, goujizi, juhua, and jinyinhua, for instance—are either missing from Hu’s list of sixty-five common liangcha herbs, and/or are listed instead as bupin. While bu herbs and foods will be discussed more fully in chapter 6, I will mention here that in Chinese medical theory they are typically indicated for “bolstering and tonifying the depleted or hypofunctional body” (Farquhar 2002: 51). Hu’s distinction between liangcha and bu herbs rests partially on the manner of preparation, and partially on the greater availability (and thus lower cost) of the former. In Singapore, liangcha herbs were usually prepared by briefly boiling or steeping one or more of them in hot water. They were widely available and relatively inexpensive by comparison with luxury items (bu supplements, according to Chinese medical theory) such as renshen,13 dongchong xiacao, or yanwo (swallow’s nest, Aerodramus fuciphagus or Aerodramus maximus). Additionally, while Hu observes that people in the PRC drink liangcha for health-related purposes rather than to quench thirst, I observed Singaporean Chinese drink it for both purposes. Although the majority of people with whom I spoke about liangcha cited its cooling properties in explanation for using it, some of the more skeptical Singaporeans—such as Chuck, described in chapter 4—simply enjoyed the taste. As mentioned in chapter 3, Elisabeth Hsu (2009a) distinguishes between zhongyao and zhongchengyao on the basis of 205

Capturing Quicksilver their composition and manner of prescription. The former were deep frozen and then powdered single drugs (plant, mineral, or animal materials) that were then combined in fangji by a physician. Meanwhile, the latter typically consisted of a mixture of several powdered drugs (sometimes with the addition of purified chemical substances), administered according to primary complaint or symptoms (Hsu 2009a). While Dr Wang’s method of prescribing powdered remedies seemed more akin to Hsu’s description of zhongyao (although the contents were often modified premixed formulas), the manner in which Hock Hua clerks advised customers was more consistent with her description of zhongchengyao (even if they were buying single ingredients). More often, however, customers already knew what to buy. The people with whom I spoke described their use of liangcha in terms of the amelioration or prevention of a range of undesirable bodily experiences associated with heatiness. Although they sometimes also mentioned pathogenic factors like wind, their explanations were nearly always grounded in the hot/cold idiom. Patients rarely spoke of the broader theories linking an herb’s activities or properties with zangfu (visceral systems of functionality), jingluo, or the concepts of wuxing and yinyang. More often, they would describe heatiness in terms of dietary imbalance (as I will explain further in chapter 6, foods were classified as heaty or cooling) or seasonal weather changes, which was commonly known to produce conditions like summerheat. Furthermore, with the exception of protracted or severe cases, heatiness tended to be prevented and treated outside the clinical context with only indirect reference to Chinese medical theory. The widespread experience and understanding of heatiness, and its alleviation through cooling remedies, was even reflected in the media. For instance, The Straits Times (Singapore) (May 2, 2006) described how a retired PAP activist volunteered to brew vats of liangcha, cheng tng (this is the Cantonese name for longan fruit and silver ear fungus soup), and ludou (green/mung bean, Cadelium radiatum) soup for eighty PAP campaigners during the 2006 general election canvassing. In explanation, she was quoted, “I cannot go walking from house to house, so this is what I can do. I make sure no one gets too ‘heaty’ and cannot campaign!” Apparently liangcha, longyan (longan fruit, Dimocarpus longan) and yin er (silver ear fungus, Tremella fuciformis) soup, and ludou soup, as well as the 206

Heat, Health, and the Experienced Environment



experience of heatiness itself, were so commonplace in Singapore as to require no further explanation or elaboration by either the volunteer, or the author of the article. Additionally, a television show called “Executive De-stress”14 advocated the regular consumption of juhua (chrysanthemum) based on information presented by Dr Lee from the Development Division of the prestigious transnational Chinese medical company Eu Yan Sang. According to the Chinese materia medica, he informed viewers (in English), chrysanthemum can be used to treat excessive heat, is good for eyes strained by computer work, and can reduce headaches caused by unexpressed anger. While these symptoms are clearly relevant to syndrome differentiation in Chinese medical theory, they also describe common everyday experiences of contemporary Singaporeans. Dr Lee also recommended that white chrysanthemum syrup—prepared with melted rock sugar—be kept at home to treat eyes taxed from study, highlighting the commonly lamented fact that Singaporean students (under great social and familial pressure to excel in their studies) must spend a lot of time studying. The consumption of liangcha for symptoms of heatiness—experienced in relation to dietary excesses or seasonal changes—was therefore often habitual and embedded in everyday activities. For instance, a colleague and friend described how his grandmother prepared lingyangsi cha at home whenever he had a fever as a child, keeping a small amount in the cupboard for just such occasions. Although he was exclusively taken to biomedical doctors as a child, focused on biology in his secondary education, and largely understood health and illness from the perspective of biomedical anatomy and physiology, he nonetheless modified his diet and classified foods according to the hot/cold idiom. Furthermore, he recognized the efficacy of cooling herbs for preventing or treating heatiness. Although, as an adult, he had developed an interest in Chinese medicine—a topic we had discussed on numerous occasions—he did not think to explain this everyday practice until I inquired and, even then, did not immediately recognize its relevance. To him, like many Singaporean Chinese with whom I spoke, heatiness and dietary management was simply an everyday habit—a naturalized practice of habitus (Bourdieu [1980] 1990)—connected with, but not explicitly understood within Chinese medical theory. 207

Capturing Quicksilver Conclusion The ethnographic examples in this chapter demonstrate the manner in which Singaporeans’ embodied experiences and practices are related to the sociopolitical and physical environment in and through which they coalesce. Resonating with humoral notions and associated medical practices found in many parts of the world, the vast majority of Singaporeans with whom I worked were astutely aware of both dietary excesses and slight fluctuations in climate, knowing heatiness through embodied experience and naturalized practices. Although these experiences, articulated through a hot/cold idiom, are clearly more closely associated with Chinese medicine than biomedicine, climatic and sociopolitical differences between the PRC and Singapore have localized practice in this tropical metropolis. Just as we must take into account how Singaporean physicians creatively adapt conventional Chinese medical theories, practices, and materials imported from the PRC, we must also consider how patients’ everyday applications of these concepts differ further. Finally, we must remember that Singaporean patients and practitioners negotiate health and illness not only with reference to daily and seasonal climates, but also within the highly manicured and sprawling cityscape in which they live. In doing so, they come into direct contact with the built environment of the state and its associated constructions of modernity and progress, thereby embodying and enacting biopower in both creative and compliant ways. As I will describe further in the next chapter, while the image of a gleaming metropolis is certainly representative of the appearance of the Central Business District, it does not describe Singapore as a whole. Many of the practices and situations described above suggest their emergence within the “strategic field of power relations” (Foucault [1976] 1990: 96) that sustains public and environmental health campaigns. For instance, compliance is apparent in volunteer-led antidengue campaigns and Professor Tan’s appropriation of terms and values derived from the physical/political landscape; resistance is apparent in noncompliance with anti-mozzie measures (keeping potted plants as contested “danger zones”) and Professor Tan’s act of opening the window. However, these particular power relations cannot exclusively account for all aspects of Singaporean Chinese medical patients’ embodied experiences, which occur in relation to 208

Heat, Health, and the Experienced Environment



a practice that, until relatively recently, was explicitly excluded from the political field. In a biopower framework, interpretation of the embodied practices described above might be limited to responses to power dynamics (e.g., compliance with or resistance to biopolitics). However, by considering their interpenetration with the dynamic, lived environment—the body ecologic—another dimension comes into view. Interestingly, the Greco-Roman regimen medicine Foucault describes in his work on ethical subject-formation also entailed an intensified “mode of attention to the self and to one’s body” (Foucault 1988: 103) that is reminiscent of Chinese medical practices: both concern relations between one’s constitution, the environment, diet, and seasonality. In conclusion, multiple experiences and practices converged in a variety of spaces (domestic, clinical, and public) in direct relation to the contemporary Singaporean cityscape, sometimes in resonance and other times in tension with biopolitics, public health endeavors, and evocations of a supposedly hostile environment. The Chinese medical patients with whom I spoke might not have cited Chinese medical theory in articulating their embodied experiences, but nearly all of them had experienced heatiness at some point, and Chinese food and/or medicine was usually their first port of call. Even among those who concomitantly used biomedicine, when it came to daily and seasonal healthcare management, Chinese medical products and/or practices situated and validated their embodied experiences with respect to established self-care techniques and environmental understandings—enacting both self and collective in a socially fractured cityscape.

Notes 1. For an interesting account of the notion of belief in the context of the assessment of medical practice, and the reason for my use of quotation marks here, see Good (1994: 1–24). 2. The Singlish terms “heaty” and “heatiness” were both commonly used by the Singaporeans with whom I spoke, although the former was slightly more prevalent. While I suspect they are derived from the translation of the Chinese term re, they occurred in the context of conversations in English. 3. As E. N. Anderson indicates, Galenic humors consisted of phlegm, bile, black bile, and blood, and therefore differ from the environmentally linked notions of hot, cold, wet, and dry that are often (erroneously, in his opinion) labeled “humoral medicine” (Anderson 1987: 335, fn3). 209

Capturing Quicksilver 4. Hsu was drawing on Lewis’s (1990: 213) term here in attempting to translate this fundamental concept; indeed, most scholars of Chinese medicine have grappled with translating qi. Sivin, for instance, (1987: 46–52) discusses qi in terms of processes and substances as “dynamic agents of change.” Farquhar (1994: 34) also describes both structural and functional aspects of qi—as a material fluid and an abstract notion, respectively. 5. For example, tian (sky) is considered yang by virtue of the fact that its standard of comparison is di (earth), which is relatively yin (Sivin 1987: 65). 6. In somewhat oversimplified terms, yin qualities are characterized as passive, internal, dark, feminine, and cool (among others); yang qualities are active, external, light, masculine, and hot. Importantly, there is always yin within yang and yang within yin (as the two, cyclically, transform into one another). 7. These organizations included the People’s Association, Community Centre Management Committees, Citizens’ Consultative Committees, Constituency Committees, Town Councils, and Residents’ Committees. According to Christopher Tremewan, “The usual route to membership of these ‘grass-roots’ bodies has been recommendation of a PAP MP or other senior functionary, vetting by the Internal Security Department and appointment by the Prime Minister’s Office” (Tremewan 1998: 95). 8. For a description of the rather arbitrary divisions of artificial versus natural landscapes in Singapore, see Ho (1999). 9. Kira mentioned that most of the houses in her kampong had concrete foundations, wooden walls, and zinc roofs, indicating that she grew up in one of the more affluent kampongs; most kampongs consisted of simple structures with attap roofs. 10. Specifically, Kira described a CPM called Five Pagoda (used for stomach aches and diarrhea) that was sold in a bottle of loose powder in Thailand but in packs of ten capsules in Singapore. 11. Insofar as the preparation and consumption of liangcha occurs in both Singaporean history and the PRC, one might indeed consider it a cluster of cultural practices. However, significant differences can be found between these instances, suggesting plurality rather than uniformity. 12. Although nobody in my presence ever referred to this as qi (instead using the English words “mist,” “fog,” or “vapors”), the same word or character as used for the Chinese medical term would be correct here as well. 13. Although ginseng will be discussed further in the next chapter, for the time being it should be noted that different types of ginseng are used for different purposes. Insofar as xiyangshen was considered cooling it was used for liangcha; meanwhile, renshen or gaolishen were considered neutral or warm and were used as bupin. 14. MediaCorp, Channel 5, aired Thursday, March 23, 2006 at 7:30 p.m.

210

Chapter 6

Of Nutrients and Nourishment

Chinese everywhere retain certain foods and cooking styles as conscious reaffirmations of ethnicity. Within the Chinese communities, local origin is expressed in foods, and certain foods become widely accepted and recognized markers, such as sweetsour dishes for Cantonese and stuffed bean curd for Hakka. In areas where many Chinese groups are living together, such as Singapore and Malaysia, there is much borrowing and learning of each other’s styles, and the styles tend to blur, especially since some members of some groups have assimilated in varying degrees into other groups. —Eugene N. Anderson and M.L. Anderson, “Modern China: South”

Introduction By and large, the Singaporeans with whom I interacted were discerning gourmets: as the common expression went, they discussed lunch over breakfast. Alongside shopping, eating was heralded as one of Singapore’s two national pastimes. While undoubtedly a great source of delight, the preparation, selection, and consumption of meals was also taken very seriously. Individual constitutions, bodily experiences, and health conditions were taken into consideration in the selection of foodstuffs, particularly with reference to the hot/ cold paradigm discussed in the previous chapter. Although often relatively reserved in public conversations, many of the Singaporeans with whom I spent time would become quite animated when discussing food. When I asked more than one person for advice on the best place to find a dish, heated debate often ensued—particularly when ubiquitous local specialties like chicken rice, laksa, or prawn mee were concerned. (I discuss these foods below.) As one of the 211

Capturing Quicksilver more pleasurable and individualized aspects of life in Singapore, eating and the discussion of food thus figured prominently in everyday practices, media representations, and popular literature. Debates regarding cuisine are by no means unique to Singapore. Priscilla Ferguson (1998), for instance, shows how French national identity and cuisine were part of a broader cultural nationalization, akin to the invented traditions described by Eric Hobsbawm (1983). According to Ferguson, in vying for authority over a given set of practices, individuals engage multiple, intersecting fields that, in turn, help to define local traditions relative to regional or even international correlates. Although cultural fields like gastronomy are self-validating and self-replicating, she notes, their ability to provide a framework for the reassertion of identity must be understood within broader social relations. It is important to note that Ferguson distinguishes between a gastronomic field and culinary culture, with the latter being more comprehensive and producing more-diffuse (as well as less-controversial) products. Like other artistic fields, production in a gastronomic field is divided among many sites and negotiates both invention and convention, by means of various networks and strategies (Ferguson 1998). Certainly on par with the French national cuisine Ferguson describes, mainland and overseas Chinese have a reputation for gastronomy, featuring practices that reflect both transnational continuity and local variability. Consistent with a common Chinese definition of a meal (as opposed to a snack)—staples like fan (rice, or staple starch) with vegetable or meat cai (side dishes)—many Singaporeans informed me that they had not eaten unless they had consumed rice. As I observed, noodles or rice were eaten with nearly every meal. With an ethnic Chinese majority, it is hardly surprising that many of the dishes I saw prepared in homes and eating establishments in Singapore were also found in southern China. The Hokkien noodle dishes like kway teow, Cantonese charsiew (red roasted meats) and dimsum (snacks), Hakka yong taufu (bean curd– stuffed vegetables), and, of course, Hainanese jifan (chicken rice) found in the PRC (Anderson and Anderson 1977) were also popular in homes and hawker centers throughout Singapore. However, wherever Chinese food was found—in hawker centers, shopping mall food courts, and even in home-cooked meals—there were usually Malay, Indonesian, Indian, and/or “Western” options as 212

Of Nutrients and Nourishment



well. Thus, while the majority of the most popular Chinese dishes might be associated with provinces in southern China, they were assembled in Singapore alongside—and sometimes with borrowings from—other cuisines. The celebrated Peranakan culture of Singapore and Malaysia (descendants of mixed heritage, most often Chinese fathers and Malay mothers) exemplified these assemblages in beloved dishes like laksa (spicy coconut noodle soup), ayam buah keluak (chicken and keluak nuts), and kaya (coconut custard flavored with pandan).1 As shown by Chua Beng Huat and Ananda Rajah (2001), while dishes found in Fujian and Guangdong might provide the foundation for much of what is labeled Chinese cuisine in Singapore, representations of these dialect-based or regional foodways are often essentialized. Chua and Rajah assert that Singaporean dishes and their associated “racial” categories of CMIO—inscribed and codified in menus and cookbooks as recognizably “ethnic”—are imagined (in the sense proposed by Benedict Anderson [1991]). Their hybridity is not simply a matter of blended categories, but rather is a reconstitution of whole dishes (or an appropriation of common ingredients) within these supposedly distinct categories.2 They therefore conclude that Singapore’s ethnic communities are misrepresented by menus and literature that describe Singaporean foodways exclusively in terms of Singapore’s “multiracial” national identity (Chua and Rajah 2001). This analysis illustrates how the neo-Orientalist CMIO distinctions critiqued by PuruShotam (1998) are reproduced both officially and popularly in ethnic cuisine. These observations suggest that the social and political significance of food and eating—noted in many places throughout the world—is very much present in Singapore. As Sara Delamont (1995) notes with regard to the origins of the European Economic Community, food—as a symbol of local, national, and regional culture—is an important element in politics and identity formation. Similarly, Sidney Mintz and Christine Du Bois discuss how “food serves both to solidify group membership and to set groups apart” (Mintz and Du Bois 2002: 109). Like national and ethnic identities, they suggest cuisines can be imagined (socially constructed and then naturalized) in association with specific identities that they then concretize. These broader observations have also been illustrated ethnographically as, for instance, in Yao Souchou’s (2003) detailed 213

Capturing Quicksilver account of the meanings and experiences associated with consuming bah ku the (a medicinal Chinese pork soup) in Malaysia, which he interprets as an affirmation of Self vis-à-vis state power and repressive identity politics. Yao also analyzes episodes of Singaporeans talking cock in hawker centers as a carnivalesque engagement with state power that is deeply entangled with everyday life. In this chapter I will similarly explore the relationships between Chinese food and medicine, identity, and politics in Singapore by describing how various fields (including gastronomy, medicine, public health, and family relations) intersected in homes, Chinese medicine and food shops, and public spaces. In order to illustrate the divergent interests that sought to establish authority over what Singaporeans consumed, I will discuss the manner in which the so-called healthy lifestyle promoted by the Singaporean state framed everyday dietary practices. Extending the discussion of the hot/cold idiom introduced in the last chapter, I will then provide ethnographic examples of the intersection of food and medicine in home-based remedies, with reference to the Chinese medical concept of yangsheng, the materia medica, and clinical formulas. Particularly focusing on the preparation and consumption of bu herbs, this topic will then be explored laterally with reference to everyday and festival consumption practices, and notions of taste. I will thereby argue that Chinese food/herbs are able to simultaneously unite and differentiate, in contradistinction to both the essentialized category of “Chinese” critiqued by Chua and Rajah and the undifferentiated “multiracial” Singaporean nationalism promulgated by the state.

Public Pleasures and Heartland Hawkers In his introduction to Empire of the Senses, David Howes (2005) proposes a sensual revolution in the social sciences that can account for the “social ideologies conveyed through sensory values and practices” (Howes 2005: 4). In contrast to the construction of sensory perception in “Western” science and psychology as private, internal, ahistorical, and apolitical, Howes suggests that sensory experience— like meaning—is shared, and must therefore be contextualized within specific histories and politics. This intersensoriality focuses on the emplacement of bodies within the sensuous materiality of 214

Of Nutrients and Nourishment



the physical and social environment, and implies an ordering of the senses that reflects social hierarchies and maintains social order. In this “age of mix-and-mutate when no one wants to match” (Howes 2005: 296), he claims, consumption is an active process in which preferences, meanings, and uses of various products are culturally produced and not simply a matter of personal choice. The active construction and engagement of the senses is also highlighted in Lisa Law’s (2005) chapter on Filipina domestic workers in Hong Kong. Recreating the sounds, tastes, and smells of home, these domestic workers spend their days off in the neighborhood called Little Manila eating Filipino food, reading Filipino media, and shopping at Filipino specialty shops. Prohibited from cooking in the (Chinese) homes in which they work and live, they are therefore able to creatively displace the power relations that characterize their lives in Little Manila. While Law describes how these women become “docile bodies [that] unwittingly participate in their own oppression” (Law 2005: 228), she also insists that this type of analysis deprives Little Manila of its broader political significance and risks reducing Filipinas to only domestic workers. Her focus on these women as creative, embodied subjects allows her to emphasize how they “exceed—rather than merely resist—their role as ‘maid’ ” (Law 2005: 228). She thus shows how the consumption of Filipino food in Hong Kong is a kind of “performative politics of ethnic identity” (Law 2005: 239) revealed in everyday experience. The sensorial aspects of popular public eating places (hawker centers and food courts) in Singapore were similarly produced in spaces that reflected local power relations and dispositions. As the cheapest, and often most popular, destinations for either a quick meal or more-leisurely social interaction outside of the home, hawker centers and food courts constituted a significant part of the Singaporean culinary field. The popularity of these eateries, and the state’s management of them, has historical precedence: By 1968, 36,000 street food vendors were in operation, many of whom contributed litter and waste to the already polluted Singapore River. By 1988, nearly all of these vendors had been relocated within permanent covered markets and food centers, connected to public sewers and provisioned with electricity and piped water (Kuan 1988). Of course, this project was very much in line with the biopolitical agenda to sanitize the pathogenic city mentioned in previous chapters. Despite 215

Capturing Quicksilver this constant process of urban renewal, however, it was often said that the older—and often more run-down—hawker centers had the best food, a sentiment that seemed to inspire large numbers of busy Singaporeans to eat outside their homes on a regular basis.3 While there are certainly many restaurants in Singapore that are known for their style and ambience, the majority of heated debates I heard on the topic of food focused on specific dishes and/or hawker centers. Hence, in even the oldest and most run-down eateries one can find businessmen, housewives, students, and blue-collar workers queued together at a popular stall. However, to say that hawker centers’ lack of elegance does not deter diners is not the same as saying it does not inform their experience of eating at all. As I will show in this section, the food served and senses evoked in hawker centers (particularly in older, heartland neighborhoods) were somewhat at odds with the healthy lifestyle (in a sterilized metropolis) envisioned by the post-colonial state. As such, they provided a site of contestation and reprieve from the orderly, efficient cityscape.

Figure 6.1. Old Airport Road hawker center 216

Of Nutrients and Nourishment



By the time of my fieldwork, hawker centers and food courts (the most dilapidated only an election or two away from being “upgraded”) had almost entirely taken the place of street vendors, which were limited to a few tourist-oriented areas of Singapore or in association with certain festivals and events. These eateries often had very basic décor: plastic tables and chairs that were usually fairly clean, and (in older, open-sided hawker centers) floors that might be patrolled by stray cats and the inescapable Singaporean cockroaches. They consisted of a number of small stalls (ranging from five to fifty or more, depending on the space available), each of which specialized in a particular dish and variants thereof. In some, tables of various sizes were arranged in the center of large open rooms with the stalls lined up around them; in others, rows of stalls were back-to-back with seating arranged in between and around the perimeter. Although there was sometimes overlap between stalls—larger centers often had several vendors offering the same dishes or beverages—diners nonetheless had a wide range of choices. A selection of popular dishes found at most hawker centers and food courts might include the following: • Hainanese chicken rice: An adaptation of a dish from the Chinese island of Hainan, Singapore’s national dish consists of rice cooked in chicken stock, served with chicken that has been simmered in water flavored with garlic, ginger, and sometimes other herbs, and then cut (skin-on) into strips. Served with cucumber slices and various dips including chili, ginger-garlic, and/or dark soya sauce. • (Katong) Laksa: A close second for Singapore’s national dish, this spicy Peranakan coconut soup (named after the neighborhood that made it famous) is made from prawn stock and coconut milk, ground dried prawn, laksa leaf (Vietnamese coriander), cut thick rice noodles or bee hoon (rice vermicelli) noodles, whole prawns, tofu puffs, and/or cockles. Served with sambal (chili paste). • Char kway teow (fried kway teow): Yellow and/or kway teow (broad rice) noodles stir-fried in chili, sweet black sauce, and dark soya sauce with bean sprouts with Chinese chives, boiled egg, lardons (cubed and fried pork fat), Chinese sausage, fishcake, prawns, and/or cockles. 217

Capturing Quicksilver • Hokkien mee (noodles): Yellow and/or bee hoon noodles stirfried in prawn stock with additional ingredients including spring onion, pork, chicken, bean sprouts, sliced cuttlefish, lardons, and/or boiled egg. Served dry or in stock with sliced red chili padi, light soya sauce, and sambal. A prawn version (prawn mee) is also very popular. • Char kway/chai tow kway (fried carrot cake): Daikon radish, diced and stir-fried with egg and fish sauce to produce a cake. Served with green onion and sliced chili or chili sauce, either chai tow kway (white, without sauce) or char kway (black, with sweet dark sauce). Taro is sometimes substituted for daikon. • Bak kut teh (pork-rib tea): Malaysian pork-rib soup made with a broth of herbs and spices (including star anise, cinnamon, cloves, danggui [Chinese angelica, Angelica sinensis], fennel seeds, and garlic cloves) and sometimes additional ingredients like offal, mushrooms, green onion, fried shallots, and/or tofu. Served with rice, soya sauce, and sliced chili padi. • Yong tau fu (stuffed bean curd): Traditionally, tofu in several forms stuffed with minced fish and pork paste, cooked in a clear broth. Additional items now include fish paste–stuffed bittergourd, ochre, and chili, as well as fish balls, cuttlefish, and other bite-sized vegetables cooked in broth. Served either dry (with broth on the side), in broth, or with gravy (e.g., laksa), with rice or noodles and dipping sauces such as chili, hoisin, or soya. • Nasi lemak (coconut rice): Rice cooked in coconut milk and various spices (including pandan leaf, lemongrass, and/or ginger). Served with ikan bilis (small, dried anchovies), roasted peanuts, cucumber slices, hard-boiled egg, and sambal (often sambal balacan—chili and shrimp paste); sometimes accompanied by vegetable side dishes, deep-fried chicken, or other meat dishes. • Fish ball noodles: Egg and/or rice (often kway teow) noodles stir-fried in chili and vinegar sauce and served dry or cooked in fish broth with balls made of white fish meat, fishcake, beansprouts, prawns, mushrooms, pork slices, and/or greens. Served with sliced chili padi (plain or in light soya sauce). • Kaya toast: Snack consisting of kaya and butter spread on toasted bread; often served for breakfast with kopi (coffee) 218

Of Nutrients and Nourishment



and a half-boiled egg. The egg is served partially warmed and brought to the table in a covered dish with a pot of boiling water. Diners pour the boiling water over the egg and let it sit for a few minutes before cracking it into a cup, often adding soya sauce, and drinking it.4 The prevalence of chili in Singaporean cuisine is often first experienced by olfactory senses—upon entering older hawker centers in the first months of my fieldwork, my lungs would react to the chili oils in the air, lifted in plumes above sizzling woks attended to by “uncles” in white tank tops. Particularly in the heartlands—older or less-developed neighborhoods on the island—the cooking oils, various sauces, spilled beverages, and general humidity that goes along with non-air-conditioned buildings created a patina on the tables to which one’s hands and arms inevitably stick. In the “upgraded” neighborhoods—and particularly in the new shopping malls that frequently and rapidly appeared in residential districts—food courts produced a very different sensory experience: sanitized, polished, brightly lit, and decidedly cat free. Such eateries appeared popular among people who lived or worked nearby but, in the course of my conversations, they were rarely recommended as the best places to eat. The frequency with which Singaporeans ate outside of the home meant that popular hawker centers (and, increasingly, food courts) were usually packed with people, and even in off hours one was likely to find older men sitting around outdoors kopitiams (coffee shops),5 sipping kopi-o (black coffee with sugar), tea, or beer, and smoking cigarettes or a pipe. Notwithstanding occasional snacks taken while standing—a quick curry puff or squid on a stick—Singaporeans appeared to usually eat meals while sitting down. During peak hours, finding an open table could present quite a challenge as people, burdened with plastic trays laden with dishes, competitively hunted for open tables or seats. In this context, a pocket-sized packet of tissues placed on an open seat or table (to chope, or reserve, a table) indicated it was held for someone who had gone away to order (a sign that was surprisingly often, if begrudgingly, respected) and a half-finished meal indicated that a table was about to become available. In the latter case, people sometimes hovered nearby watching the diners finish their meal and exerting pressure on them to finish and vacate the table quickly. Although normally appearing to prefer sitting alone 219

Capturing Quicksilver or with people they knew, at these crowded points of the day I sometimes observed individuals asking to join an occupied table. While television shows, printed and online guides, and a steady stream of advice from friends and colleagues were excellent resources for advice on what to eat and where, in the course of my fieldwork learning how to eat was largely a matter of observation and imitation. Traditionally, one would make a selection from a stall or two and then wait at a table for a server from each stall to bring out the food (at which point one would pay), although this was quickly being replaced by self-serve establishments. Dishware at hawker centers and food courts ranged from plastic or Styrofoam bowls, to painted ceramic dishes. Utensils typically included chopsticks— either the cheap wooden kind that leaves splinters in your mouth if you’re not careful, or the reusable plastic kind—and a Chinese soup spoon. Silverware was often available as well, although it was more common at Malay, “Western,” or Indian establishments. I typically observed men using chopsticks only to pick up meat, vegetable pieces, noodles, and rice and a soup spoon for broth or sauce, whereas women often picked up items with their chopsticks and put them in their spoon (with or without broth) before eating them. This careful arrangement of food avoided the mess and slurping that other methods often tended to produce. A Singaporean Chinese colleague reported to me that this style contradicted the typical eating style found in China of holding the bowl (of rice) up to one’s mouth and quickly “shoveling” food in, which was considered unrefined in Singapore. Nonetheless, aside from the occasional use of a fork when eating loose rice dishes like chicken rice, Chinese dishes were nearly always eaten with chopsticks and a Chinese soup spoon. While the aforementioned practices certainly defined the majority of meals I observed in the course of my fieldwork, it is important to note that food—specifically hawker fare—also provided a somewhat acceptable means of breaking convention. When sharing a meal of fish-head curry at an old hawker center with an elderly Singaporean Chinese gentleman named Mr Wu, my curiosity was piqued by his tendency to spit the fish bones directly onto the table. When I mentioned this practice to one of my friends (a young Singaporean Chinese man) it was met with slight disapproval (but not surprise), but I certainly observed other people—particularly older men— following suit. Furthermore, there were certain popular dishes 220

Of Nutrients and Nourishment



that—although still roughly conforming to the gendered distinctions regarding tidiness mentioned above—seem to defy standard dining conventions by their nature. For instance, in February 2006 I had the opportunity to sample a local favorite: black pepper crab, a variant of standard pepper crab (served with a red chili sauce). First Grade Seafood Restaurant was apparently the most popular stall at Eng Seng Restaurant in Kallang—a small open-sided hawker center consisting of an L-shaped arrangement of approximately five stalls, covered by a permanent roof. Plastic tables and chairs were carefully arranged on the concrete floor to maximize space, and stray cats slunk around the outside tables searching for scraps. Diners sat casually at their tables, chatting and drinking beer (usually a Singaporean lager called Tiger) or various drinks; some smoked cigarettes. The men tended to dig into their pepper crab with greater gusto than the women I observed, who delicately picked at the crab with two fingers and a thumb of each hand, sometimes sucking the meat out or pulling it with their teeth and managing nonetheless to remain remarkably clean. While I started out trying to remain as clean as possible, black pepper crab is smothered in a sticky black sauce that somehow leaps onto the eaters’ fingers, hands, elbows, and face at any opportunity. As it turns out, this was not only appropriate, but expected. At one point, the gentleman who brought out drinks told us to just drop or spit the shells out on the table. “They clean up after you,” he explained, gesturing to a woman clearing a table by sweeping the totality of its contents—shells, dishes, tissues, and all—into a large bucket. Although these instances might be particular to this occasional luxury meal, or to Singaporeans of a certain age or gender, they do highlight the capacity of food (consumed by means of certain techniques in a specific context) to defy the sterilized, orderly, and “Westernized” image of modernity promulgated by the state. To some extent, this landscape—and state power therein—has been internalized by many Singaporeans in daily life. However, as Yao’s (2007) account of talking cock in hawker centers suggests, certain environments and activities offer another kind of engagement. Many of these practices reflect a general disposition to make meals a pleasurable (rather than an obligatory, health-oriented) experience, whether achieved through social interaction or in a moment to oneself. It is 221

Capturing Quicksilver perhaps partly for this reason some public health campaigns were not able to produce their desired results.

Healthy Lifestyles and Consumption Contemporary economic prosperity enabled a much wider portion of Singaporeans to consume previously less accessible foods in greater quantities and with greater frequency. From a traditional emphasis on fan, accompanied by side dishes in which vegetables were the primary ingredient, Singaporean Chinese diets gradually incorporated more meat and oils—particularly with the introduction and growing popularity of fast food. On the one hand, this was accompanied by a variety of chronic health conditions termed diseases of modernity, which figured prominently in Singaporean public health and academic discourse. On the other hand, the hot/cold idiom linked with Chinese medicine provided another framework for negotiating the bodily effects of these dietary changes. In this section I will focus on the former, describing the Singaporean government’s promotion of a particular healthy lifestyle. In the course of establishing and refining a healthcare system, the post-colonial state crafted an evolving notion of health that had to be communicated to the public. On the basis of the colonial Medical Department’s Health Education Office (established in the 1950s), the MOH developed the Training and Health Education Branch in 1963 to promote awareness about nutrition, exercise, and general health maintenance through health fairs, exhibitions, and other events. These priorities were further instantiated in the 1979 National Health Campaign and the National Health Plan of 1982, as discussed in chapter 3. By 2006 the Training and Health Education Branch had been renamed the HPB, and engaged in a wide variety of activities to educate the public on health-related matters. Increasingly concerned with Singaporeans’ “harmful” lifestyles, the National Healthy Lifestyle Programme was launched by Prime Minister Goh Chok Tong in 1992 to promote a healthy lifestyle. This annual, month-long campaign sought to educate Singaporeans on various health promotion and disease prevention measures, many of which focused on nutrition and exercise. The often rich and oily food sold at hawker centers was perhaps an obvious target. Although the HPB implemented an Ask For (less oil, sauce, or chicken skin) 222

Of Nutrients and Nourishment



program—in which hawkers posted a sign on their stalls encouraging diners to request less oil and so on—I did not once hear a diner do so (despite HPB claims to the contrary). In 2006 an alternative Healthier Hawker Food Programme was announced, which encouraged hawkers to use what the HPB deemed healthier ingredients so as to improve the nutritional status of Singaporeans without relying on them to ask. This shift in strategy suggests the persistence of Singaporeans’ gustatory delight, which apparently required the adjustment of public health campaigns to the actual practices of their target audience. More-detailed information about the HPB-defined healthy lifestyle was disseminated by means of lectures and exhibitions in various public locations—in schools, museums, libraries, community centers, and even shopping complexes. Much of this information was oriented toward maintaining a healthy diet and cooking practices (as defined by biomedical research) in domestic spaces. In July 2006 I attended a two-day exhibition (sponsored in part by The Straits Times’ weekly health insert “Mind Your Body,” as well as by the HPB) called “Health and You,” held at the new Suntec City shopping complex convention center (Central Area). Among healthfood vendors, dietary supplement, and beauty product companies, hospital-sponsored health screening booths, CPM producers, and so on was an HPB display and demonstration area. Arranged on a long table was an array of kitchen equipment—a countertop oven, food processor, liquidizer, blender, and a microwave, with an attached laminated article entitled “Tests Prove: Microwave Healthier”—as well as bowls of commonly used cooking ingredients (ginger, chili, lime, shallots, lemongrass, garlic, and so on). While examining this area, I noticed approximately twenty to thirty attendees, mostly middle-aged to elderly women, waiting for the advertised healthy cooking workshop, and I decided to join them. Over the next twenty minutes or so, two women—one from the HPB and the other a Panasonic sales representative—demonstrated healthy cooking techniques, while most of the attendees took notes or followed along with handouts. The audience was advised to reduce salt and oil, add more fruits and vegetables, remove the skin from chicken to reduce fat, and purchase products with HPBapproved “Healthier Choice” labels. Singaporeans are lucky, we were told, because the HPB had worked with manufacturers to create 223

Capturing Quicksilver these “Healthier Choice” options for a variety of commonly used items—like soya sauce and chili sauce—but they should still be used in moderation. While the use of the (Panasonic) microwave was frequently encouraged, and the use of a wok or other means of frying discouraged, the HPB representative conceded that some might have difficulty adjusting to this technique. If you must use more traditional methods, she noted, you should reduce the amount of oil, skim off as much as possible, and strain or sieve it when done. For those opting for the “healthier” (Panasonic) microwave technique, however, a sales representative was on hand to take orders. Although at the end of the demonstration there was the usual kiasu (Hokkien: fear of losing out) rush for free samples of the dishes prepared, I did not see anyone place an order for a microwave. Upon returning to the HPB displays—featuring posters urging attendees to maintain a healthy diet, and spoonsful of something resembling oil representing the fat content of various plastic wrap-covered popular dishes—on the second day of the exhibition, I had the opportunity to (unofficially) speak with an HPB dietician. Public health messages, I was informed, had to be kept simple and relevant to the population. Hence, cooking tips were provided so that participants knew how to apply the information in their daily lives. Rather than telling them to completely cut out oil (used in the vast majority of locally popular dishes), they were advised to reduce the quantity used. The HPB was encouraging healthy consumption (both in the sense of eating and shopping), according to the most recent scientific data: what type and brand of equipment to use, what type and brand of food to purchase, what quantities of certain ingredients to use, and so on. “Traditional” recipes (including those modified to local tastes), banquets, buffets, and hawker fare— some might say the greatest pleasures of life in Singapore—did not conform to these standards and therefore had to be altered in the interest of personal, family, and public health. These efforts, alongside other public health campaigns, were intended to reduce individuals’ chances of developing or exacerbating the five major problematic diseases associated with rapid economic development: lung cancer, ischemic heart disease, hypertension, diabetes mellitus, and mental illness (Sinha 1995). Since my fieldwork, stroke was added to the aforementioned list, and the aims of the healthy lifestyle program were redesigned to promote 224

Of Nutrients and Nourishment



regular exercise, healthy eating, smoking abstinence/cessation, and stress management. From the vantage of the HPB, it would seem that the distinctive lifestyle (Bourdieu [1979] 1984) of Singaporeans aspiring toward the five C’s—marked by private means of transportation, rich diets, material comforts, and relatively sedentary daily activities—had increased wealth at the expense of health. Meanwhile, the continuing popularity of hawker fare and the necessity of restrategizing initiatives like the “Ask For” program suggest that many Singaporeans’ culinary practices were guided by different interests. As I have shown thus far, the sensory environment of hawker centers contrasted with the sterilized, orderly metropolis carefully designed by the Singaporean government. Although the state successfully controlled the basic conditions of public eateries (location, sanitation, and so on), its ability to intervene in the daily practices therein was minimal by comparison, for example, with their management of public housing. Whether intentional or not, this relaxation of discipline can be viewed in relation to the persistence of collective dispositions, within relatively controlled sites. This contested field also extended into the domestic sphere, as illustrated by the apparent need for ongoing campaigns that—like the antidengue campaigns described in chapter 5—sought to define what was considered to be the healthy behavior and lifestyle of Singaporeans cooking and eating in their homes.

Yangsheng: Nurturing Life and Family At various points thus far I have highlighted how the interests and materials of Chinese medicine intersect (however jaggedly) with biomedically oriented public health concerns. Like the HPB’s ideals just described, Chinese medicine also provides preventive or healthy lifestyle advice, including an emphasis on diet, regular exercise, and mental calmness (stress reduction, in HPB terms). These preventive methods are intended to minimize deviations from a particular healthy ideal—either in terms of biomedical homeostasis (or the absence of disease) or the Chinese medical understanding of resonance, with proper flows and transformations. Both recommend a moderate lifestyle, including proscriptions and prescriptions in types and quantities of food. 225

Capturing Quicksilver Having already discussed one way in which a biomedically defined healthy lifestyle was promoted in Singapore, in this section I will introduce Chinese medical concerns for lifestyle and diet. I will then provide ethnographic examples of how medicinal foods—and particularly Chinese herbal soups—fit into Singaporean diets, negotiated in relation to both individuals’ health and family relations. In so doing, I will show how Chinese food not only provides an avenue for the expression and reproduction of Singaporean Chinese cultural heritage, but also nurtures both individual bodies and social interaction. Within the context of Chinese medical theory and practice, the maintenance of a healthy lifestyle can be understood in relation to the concept of yangsheng. In its broadest terms yangsheng literature “brings a metaphysical language into the realm of human physical experience” by linking the physiology of the body with the cosmos (Lo 2001: 22). Yangsheng thus encourages a lifestyle that facilitates the harmonious resonance of cosmic, environmental, social and political, and physiological processes, by means of techniques emphasizing longevity over pathology—including diet, breath-cultivation, physical exercises, and bedchamber arts (Lo 2001; Farquhar 2002). Thus, dietary measures intended to preserve and strengthen the body, or nurture life, could be classified as yangsheng.6 Like the majority of Chinese medical patients with whom I interacted, an older Singaporean Chinese woman named Margaret made use of both biomedical and Chinese medical services in maintaining her rather precarious health. At seventy-seven years old, Margaret had a clear complexion, bright eyes, a tidy appearance, and a generally good memory. However, she reported that she had high blood pressure, heart problems, diabetes, high cholesterol, and was “sick in the liver.” Every three months she saw her GP to get medication for her diabetes, blood pressure, cholesterol, and heart condition. Every couple of days she gave herself a blood-sugar test for her diabetes, and every six months she had an overall check-up. Additionally, Margaret visited Professor Tan up to twice per week for single-needle acupuncture. She treated her arthritis with Chinese medicated oils and by avoiding direct exposure to air-conditioning (which she described as “damp”), took a variety of over-the-counter supplements and prescription medications, made herbal soups and other home-based remedies, and carefully minded her diet. Because she did not have insurance, she paid for all this out of pocket; even 226

Of Nutrients and Nourishment



her heart surgery was partially paid by her savings and partially by her daughter’s MediSave account. “I’m a really expensive woman,” she told me. “I spend a lot of money on my life.” The healthcare strategy over which Margaret had the most direct control, and a frequent topic of our conversations, was the preparation of herbal remedies and regulation of her diet. Some of the advice on the latter—such as diabetes-related restrictions—came from her GP or popular literature like Reader’s Digest. However, much of her daily activity—particularly the careful management of heaty and cooling foods—was clearly not based on biomedical notions of health and the body. Furthermore, Margaret worried, echoing countless other patients with whom I interacted, that the side effects (most often giddiness and gastric pain) of the medication were indications that they are actually harming her. On the other hand, she explained, Chinese medicine doesn’t affect the body as strongly as what she called English medicine. With faith in Chinese medicine’s ability to improve health in a “slow way,” every week she prepared liangcha and soups from herbs purchased at a Chinese medical hall near her home for herself, her husband, and any children or grandchildren that were around. The specific combinations, she explained to me, quite simply depended on the weather: for cool weather she prepared warming foods, and in hot weather she prepared cooling foods. Not all people in Singapore experienced heat (external or internal) in a uniform fashion, or agreed on which foods are heaty and which are cooling (Wu 1979). Nonetheless, I did encounter a great deal of consistency—not only between patients, but also between patients and Chinese medical physicians—with regard to certain kinds of food. For instance, the sweet, creamy, and extremely stinky liulian (durian fruit, Durio zibethinus) and fried (or oily) food were almost universally considered to be heaty. I also frequently heard reference to mangguo (mango, Mangifera indica), lajiao (chilies, Capsicum annuum), hongzao (red date/Chinese jujube, Fructus Zhziphus jujuba), luohuasheng (peanuts, Arachis hypogaea), meat, stout beer, and ice being heaty. Meanwhile, I also encountered widespread agreement that juhua, xigua (watermelon, Momordica lanata), lingyangjiao, xiyangshen, and ou (lotus root, Nelumbo nucifera) were cooling. Additional foods commonly placed in the cooling category included yang luohanguo (mangosteen, Garcinia mangostana), 227

Capturing Quicksilver donggua (winter melon, Benincasa hispida), luohanguo, damai, zhuzhe (sugar cane juice, Saccharum sinense), and ludou. It is no accident that durian and mangosteen were usually sold and/or eaten together, as the latter counteracted the tendency of the former to overheat the body in Singapore’s hot climate. Similarly, most hawker centers (with many stalls serving relatively oily food) had one or more drink stalls that sold warm drinks, fresh and canned sugarcane juice, young coconut water, and/or liangcha. Furthermore, many Singaporean Chinese with whom I shared a meal refused ice in their drinks. Those who wished for a soda, water, or juice often drank it at room temperature with the explanation that ice was too heaty and inhibited digestion. Warm tea and water, by comparison, were said to aid digestion—a perception shared by physicians and patients alike. I found that many applied the hot/cold idiom to their descriptions of virtually all food and beverages, even those that originated outside Chinese culture. Although a relatively recent addition to the Chinese diet, different kinds of beer were also classified as heaty or cooling—lagers and other light beers were cooling while stouts were heaty. Many items in Singaporean diets (both common and luxury items) can also be found in the Chinese materia medica, representing the intersection of Chinese food and medicine described in the statement, “Yao shi tong yuan” (meaning, drugs and food come from the same source). In addition to the bulk herbs she purchased at Chinese medical halls, Margaret was a proponent of the tang (prepackaged materials decocted to make soups) one can find at shops like Hock Hua and Eu Yan Sang. After several discussions of her soup recipes—acquired from her ancestors, who had emigrated from Guangdong—she kindly brought me a small, aged booklet published by Eu Yan Sang. Listing the purpose, cooking instructions, and contents of ten soups, these recipes were based on ingredients that were easy to find in Singapore either in bulk or in prepackaged combinations. At Eu Yan Sang, prepackaged soups were available for sale largely under the same names as listed in this booklet, although the wording of their stated purposes—in both Chinese and English—had changed slightly over the years. For instance, in the (unfortunately undated) booklet, the stated purpose of Bazhen Tang (literally, “Eight Treasures Soup,” translated as “Longevity Tonic Soup” by Eu Yan Sang),7 was “to activate blood circulation and 228

Of Nutrients and Nourishment



revitalise energy.” By contrast, in a more recent pamphlet, the soup is intended “to restore and rejuvenate life-force for long life and youthful resilience.”8 In the course of observations and conversations with staff (and occasionally customers) at one of Hock Hua’s busiest branches (in Toa Payoh), I noted identical or very similar soups for sale as those listed in Margaret’s booklet. These were among the more popular items purchased—as I observed myself and verified with the branch manager Tim—and were often selected by customers after consulting a shop employee. The more common varieties of these soups (e.g., Bazhen Tang) were also readily available in large chain supermarkets in Singapore, alongside other common Chinese medicinal foods like juhua, various mushrooms, and goujizi. Although they certainly have precise uses within Chinese medical theory and formulas, many of these herbs were also used in home-based remedies for overall tonification or longevity and, thus, fell under the category of yangsheng. Dr Song (a Chinese medical physician and consultant for Hock Hua) informed me that many of the items sold at shops like Hock Hua were dietary supplements. Rather than being used explicitly for therapeutic interventions, he explained, they were used to keep people healthy: “So we don’t wait for the person to get bad, or turn ill. We maintain them as well.” Goujizi, for instance, is a longevity herb noted by Li Shizhen in the Hierarchically Classified Materia Medica (1596) for its use among Nan-Qui villagers well-known for their long lives. Although its red, fruity seeds are most commonly used—often in combination with juhua for the purpose of clearing heat and detoxification, or in soups—the roots can also be used in herbal formulas (Lu 1991). In Singapore, shops like Hock Hua sold a variety of packaged containers of goujizi, imported from the PRC and priced according to quantity and grade—first, superior, or special. According to a superior grade package (sold at S$9 for 180 grams): “Fructus Lychii [goujizi] tonifies the kidneys. It is good for vertigo and lumbago due to kidney and liver deficiency. The nourishment of the liver helps sharpen blurred eye vision.” Goujizi were also a common ingredient in prepackaged soups. For instance, the remarkably popular Dihuang Dunji Tang (Emperor’s Stewed Chicken Soup)9 contained eight ingredients, including goujizi. According to the packaging, it “improves complexion, stamina 229

Capturing Quicksilver and rejuvenates the body.” A similar soup that also contained goujizi called Renshen Dunji Tang (Ginseng Stewed Chicken Soup), “strengthens the heart and energy. Helps rejuvenate the body,” while Paoshen Tang (Paoshen Soup),10 “improves stamina and general health.” Of course, goujizi were not included in every soup sold by Hock Hua but, as indicated in the purposes enumerated above, it was often used in combinations associated with general well-being and longevity. By contrast, soups like Mingmu Tang (Clear Vision Soup) had more specific purposes, referencing Chinese medical theory: “Replenish liver, kidneys, blood and yin to sustain good vision.” Offering the convenience of prepackaged combinations, these soups catered to busy contemporary lives while evoking ancient Chinese medical authority, as indicated on their packaging: “Hock Hua soup series are strictly made up of genuine herbs, based on ancient Li Shi Zen Chinese pharmacopoeia by the sophisticated professional.” The medicinal value of these soups is also revealed by their name: tang. This is the same spoken word and written character used to refer to a decoction of herbs (Farquhar 2002), such as that produced by boiling herbal packets traditionally prescribed by a physician. As

Figure 6.2. A selection of prepackaged herbal soups at Hock Hua 230

Of Nutrients and Nourishment



noted by Keiji Yamada (1998), among other scholars, methods of preparing soups and decoctions are remarkably similar.11 Decoctions refer to “the extract of medicines which was boiled in water and given to the patient without being limited to various kinds of illness” (Yamada 1998: 93). This definition is quite consistent with the instructions found on prepackaged soups available at Eu Yan Sang and Hock Hua, which directed users to combine the herbs (typically 100–200 grams total) and 300 grams meat in 1.5 liters boiling water and simmer over low heat for two to three hours. The ideal reduction of liquid, was phrased in the same manner as physicians described the preparation of herbal prescriptions: three bowls of liquid, down to one. During observations at the busy Toa Payoh branch of Hock Hua I noted how customers made their selections, particularly when assisted by one of the many stockers or salesclerks employed there. Overall, the sales-oriented (as opposed to medical) training of Hock Hua employees described to me by Tim was reflected in employees’ tendency to introduce as many products as appropriate to a customer’s request, rather than making a singular recommendation. Employees were generally friendly and helpful without being pushy; indeed, if a customer waved them away, ignored them, or expressed no need for assistance they nearly always complied immediately, leaving the customer to make her selection unassisted. At the glass-topped consultation counter (which included drawers of high-priced products like ginseng, cordyceps, and fish maw as well as jars of birds’ nests and other luxury items), however, employees engaged more fully with the customers who approached them for assistance. A significant strategy employed in this part of the shop involved the stimulation of a wide range of senses: in addition to hearing (discussion of the properties, uses, and preparation of various herbs), customers’ olfactory and gustatory senses were stimulated by the roasting of herbs at the far end of the counter and free cups of decocted ginseng provided by staff at the counter. Customers were also encouraged to visually inspect the herbs they discussed with the staff, who often described features they should look for; furthermore, many smelled and tactilely inspected the herbs. In addition to this full engagement of the senses, most of the people who informed me about their consumption of soups like Bazhen Tang admitted to further modifying recipes on their own, 231

Capturing Quicksilver according to taste. Like Margaret (and Lena, described below) they tended to purchase the prepackaged soups and/or talk to shopkeepers in order to learn and try out the appropriate combinations, and then added a little extra of one or more ingredients to suit their preferences or dispositions. Some, like Margaret, drew on knowledge passed on to them by their mothers (which they, in turn, then passed on to their daughters or daughters-in-law), or by friends. Others adjusted the soups according to personal taste or the constitutions of specific family members. In addition to the ability to (re)affirm Chinese familial relationships and oral traditions in this manner, Chinese (medicinal) foods literally brought families together over the dinner table, as nicely articulated by Dr Song: Soup—you know, soup for the whole family. … You know, some of the families still maintain very good relations among them: the brothers and sisters, they still eat together. OK? And these soups are good to have because it’s hot—warm—and so everyone is sitting together at the table and they enjoy the soup at the same time. So this is culture. And then, for certain herbs … let’s say the mother brews the soup for the grandma, alright, and this is good for rheumatism, good for eyesight, good for backache—this shows the concern and respect. Culture comes in. And then, care of the children— different soups [have] different roles, different functions.

The culture Dr Song mentions refers to Singaporean Chinese heritage and family values, such as demonstrating care and respect for one’s elderly relatives and ancestors. For instance, when my friend Tom’s mother fell ill and was hospitalized in 2007, his partner Adelle assumed responsibility for purchasing and preparing a variety of dishes to facilitate her recovery. While accompanying her on a search for the ingredients for cod soup, Adelle explained to me that she would normally purchase a fish (ideally live, from a wet market), ask the vendor to clean it, and then take it home to prepare it in the fashion of an herbal soup. Once boiled, the flesh, bones, and skin would be discarded and the liquid retained, to be drunk by the ill patient. This recipe—as well as the cod-liver oil that she sometimes bought instead (a more expedient substitute)—would “make your body more stronger,” she informed me, and therefore help to prevent postoperative infections.12 Adelle explained that she had to cook for Tom’s mother every day, delivering medicinal dishes as well as standard meals like fried fish, 232

Of Nutrients and Nourishment



even though the two women did not get along. These activities were conducted with the explicit intention of nurturing Tom’s mother into a better state of health and the implicit intention of fulfilling her role as a “daughter-in-law” (although this was a somewhat contentious role because Tom and Adelle were not actually married). This example presents a very clear example of how food constitutes a social language (Chang 1977). Chinese herbal soups, then, were not only “good for rheumatism, good for eyesight, good for backache,” but they were also good for the expression of cultural values and the nurturance of family relations.

Home-based Remedies and the Chinese Materia Medica Over the course of several lengthy interviews in her home, a middle-aged Malaysian Chinese woman named Lena (introduced in chapter 3) described and showed me various herbal remedies—including packaged combinations and bulk individual ingredients—that she kept on hand for maintaining her own, and her family’s, health. During these conversations, she frequently consulted with her mother-in-law, Madam Chung, kindly translating the latter woman’s views and experiences from Cantonese into English. Both women were born in Malaysia—Lena grew up speaking Cantonese at home and English in school and Madam Chung grew up speaking Hakka at home and Mandarin in school. Eighty years old at the time of our interview, Madam Chung primarily spoke Cantonese and Mandarin while Lena, in her late forties, spoke a mix of Cantonese, Mandarin, and English. By the time of our interviews, they had lived in Singapore together for eight years—all were permanent residents with the exception of Madam Chung, who was classified as a long-term visitor.13 Lena devoted a significant amount of time to her family members’ health by escorting her mother or mother-in-law to doctors’ visits, purchasing herbs for soups and tonics, cooking meals, and so on. She explained that proper dietary maintenance required managing the consumption of hot and cold foods. In cases of heatiness, the herbs and foods she used depended largely on the severity of the symptoms, which she explained can include a sore throat, yellow 233

Capturing Quicksilver build-up or discharge from the eye, ulcers on the tongue, a hard cough, a fever, or a general sensation of bodily warmth: “You know, it’s like when we feel heaty—body heat [or] you have a sore throat— we will buy this sort of herb, boil it, then we put sugar and then we drink it.” For instance, if one of her family members ate too much heaty food, such as durian fruit or fried/oily food, or suffered from a lack of sleep (which she interpreted as a symptom of mild heatiness), she would make tea from xiyangshen root or juhua. Other times, she prepared lotus root “to cool down the system,” or served foods classified as cooling such as watermelon or yezi (young coconut water, Cocos nucifera). For more-severe symptoms of heatiness, she recommended xijiao (rhinoceros horn, Cornu Rhinoceri)14 or lingyangjiao—shaved and then double boiled, or brewed as a decoction (for fever)—or zhenzhumu (pearl shell, Concha Margaritifera usta), ground and mixed with warm water to make a paste (for phlegm and a hard cough). Like many of the people I described in chapter 5, Lena and Madam Chang were sensitive to changes in both the environment and the bodily sensations of heatiness and coolness. Their basic treatment strategies were largely dependent on direct bodily experiences (symptoms and responses to prior remedies), compared with the advice of friends, family members and shopkeepers. If, after a few days of home-based treatment, these symptoms did not improve or Madam Chang’s jingshen (energy level, vitality) did not return, they would visit a Chinese medical doctor recommended by friends or family members. Thus, intersubjective embodied experience constituted a fluid body of knowledge and practice from which strategies could be drawn and revised, with or without direct recourse to professional medical expertise. Lena described illness in terms of the presence of symptoms and defined health in terms of a lack of symptoms. By contrast, when I asked Madam Chung how she knew she was healthy, the older woman responded simply (in Mandarin): jingshen. After a period of illness, Lena explained further, Madam Chung knew she was feeling healthy, again because of her jingshen: “For her, it’s quite easy to identify because I know that she always feel[s] like she’s very tired— tired and not attentive. But if she’s been perk[ed] up—where she suddenly feels she’s energized—then that is her consistent feeling [of 234

Of Nutrients and Nourishment



health].” As translated by Lena, Madam Chung understood health in terms of her ability to eat, sleep, concentrate, and maintain daily activities uninterrupted by the “mei you jingshen” (no jingshen) feeling: “So long as she’s jingshen, she knows that she’s healthy.” Madam Chung had lived with Parkinson’s for more than fifteen years, and the condition was very well controlled through regular biomedical check-ups and daily medication. Aside from worrying about the side effects of pharmaceuticals in general, Lena felt that they were both in generally good health. She therefore relied on a variety of Chinese herbs to maintain her mother-in-law’s jingshen (to “perk her up”), as well as her own and other family members’ general health: “She [Madam Chung] will normally take something like Korean ginseng once in awhile to perk up and, you know, the combination of herbs called Bazhen. Yeah, that one. And danggui— she can take danggui. And at home, we—once a week, sometimes, if I remember to make herb soup like paoshen, ginseng soup or the cordyceps. … Yes, we all take cordyceps [for] kind of a general maintenance. Kind of … and we also do bird’s nest.” Lena normally used herbal combinations, served as soups or with other food items in a cooked dish, although several of the homebased remedies she prepared involved a single herb (e.g., ginseng or chrysanthemum). For more general ailments she frequently used standard combinations like Bazhen Tang—the combination of eight or nine herbs typically prepared in the form of a slowly simmered soup, as described above. Lena differentiated these herbs—bazhen, danggui (Chinese angelica, Angelica sinensis), paoshen (Adenophora, Adenophora tetraphylla), ginseng, dongchong xiacao, and yanwo— from those used by Chinese medical physicians insofar as they were used to strengthen the body, rather than treat a specific illness. As described by Shiu-ying Hu (2005), such herbs are considered bu, and are often used in making teas, food, and tonics for bolstering general health and helping people adjust to seasonal changes. In contrast to liangcha herbs described in the previous chapter, which are generally classified in Chinese medicine as cool or cold, bu herbs are generally mild (neutral) or warm (Hu 2005). For example, juhua is classified as moderately cold, whereas jinyinhua and lingyangjiao are classified as cold. Meanwhile, lingzhi is classified as moderately warm; renshen and hongzao are classified as mild; and dongchong xiacao and danggui are classified as warm (Liu 1995). 235

Capturing Quicksilver Because the bu medical technique and associated (warming) herbs and foods are used for “bolstering and tonifying the depleted or hypofunctional body” (Farquhar 2002: 51), they are therefore commonly used in medicinal tonics or rejuvenating soups like bah kut teh (Malysian pork rib soup; Yao 2003). Farquhar notes that in the PRC (in the latter half of the twentieth century), periodicals, medicinal food books, and culinary books often recommend bu foods within the context of seasonal dietary adjustments. She explains that bu foods and herbs are associated with yangsheng techniques because they are used to fortify bodily resources and thereby forestall the inevitable decline of life. Furthermore, she notes their use in medicinal meal restaurants—such as one she observed catering specifically to the health of middle-aged men—and as gifts for senior male relatives, teachers, and supervisors (Farquhar 2002). These convergences of Chinese food and medicine are also relevant in Singapore, where luxury items like bird’s nest and cordyceps (mentioned by Lena above) are similarly given as gifts or consumed in association with an upper-middle class lifestyle.15 Whereas in the PRC access to bupin (tonifying materials) is often limited to “political leaders, professionals and rich merchants whose salaries are high enough to buy expensive, classical bupin or imported American ginseng” (Hu 2005: 163), a wide range of Singaporeans used these herbs to strengthen the body. Among the Singaporean Chinese with whom I interacted, danggui and ginseng varieties were perhaps the most commonly cited herbs used for this purpose, either singly or in combination with other herbs and/or foods. Xiyangshen was classified as cooling, renshen, was relatively neutral, and gaolishen was considered heaty, although the latter two products are considered variants of the same species.16 Hu notes that since World War II botanical, phytochemical, and medical research on ginseng (including a series of international symposia held in Europe, Korea, and Singapore from 1965 to 1985) has provided a great deal of “scientific truth backing what was before assumed to be myth created through Chinese experiences” (Hu 2005: 182).17 Increasing interest in, and demand for, ginseng after World War II presented a problem for governments seeking to regulate the trade of ginseng: “Now, cultivated ginseng from East Asia and North America flood the market, in groceries as well as in herb shops. This condition has created problems for governmental agents 236

Of Nutrients and Nourishment



in charge of trade regulations and the consumers who want to recognize the quality of the ginseng that they purchase in order to get their money’s worth” (Hu 2005: 183).18 Indeed, issues of contamination, authentication, and consistent grading continue to plague the wholesale trade of Chinese materia medica, despite Singapore’s reputation as a clearinghouse for products originating in the PRC or other Southeast Asian countries.19 As noted by Tim at Hock Hua, this reputation was attributed to strict government regulation: “Singaporeans trust Singapore [products] because of the control.” Although many Singaporeans with whom I spoke preferred CPMs and prepackaged herbal combinations, others, like Lena, preferred to purchase their herbs in bulk from local wholesalers where they could get a discount and still feel assured of quality.20 Most of these wholesalers imported their herbs, Lena informed me, but Singapore got the best quality products in the region (whether it be fish from peninsular Malaysia or yanwo from Sarawak) because they fetched a higher price than anywhere else in Southeast Asia. Additionally, the government was considered to have, and enforce, strict guidelines on the importation of food (the legislation under which bulk Chinese herbs fall).21 Thus, Lena felt confident buying bulk gaolishen, danggui, yanwo, dongchong xicao, and the combination of herbs used in Bazhen Tang and Paoshen Tang, locally, but was hesitant to buy them when traveling abroad. While Chinese medical formulas typically differ from home-based remedies in form and content, the herbs Lena mentioned are certainly derived from the Chinese materia medica. As described by Liu Yanchi (1995), Chinese medical formulas can be divided into therapeutic methods and concrete methods for treating specific illnesses. In the former category, there are traditionally eight methods—diaphoresis, emesis, regulation, purgation, elimination, invigoration, febrifugal (heat reduction), and tonification—although additional methods have also been developed more recently. Very briefly, diaphoresis dispels pathogenic factors from the body’s exterior, emesis is an emergency measure that induces vomiting to expel noxious substances, and regulation restores flow and coordination among the zangfu, jingluo, qi, and xue (blood), and other primary bodily systems. Purgation and elimination each removes accumulated pathogenic factors from the body’s interior, but each focuses on different forms of stagnation and operates at different paces (the former works substantially more 237

Capturing Quicksilver rapidly than the latter). Finally, invigoration dispels pathogenic cold and activates vital function, febrifugal methods dispel pathogenic heat, and tonification corrects deficiencies in qi, jingqi (essential qi), xue, and vital function (Liu 1995).22 Although, in general, the herbs Lena described could be classified as bu, formulas in which such herbs are an element might be associated with more than one treatment method. For instance, danggui is considered to be a blood tonic that nourishes xue, regulates menstruation, activates blood circulation, and relieves constipation; it is classified as warm, sweet, and pungent and acts primarily on the liver, heart, and spleen (Liu 1995). It can be used in a wide range of formulas including mild purgative and purgative and tonic prescriptions (purgation), toxic heat elimination and internal heat elimination prescriptions (febrifugal), prescriptions for warming the channels and dispelling cold (invigoration), qi reinforcing and blood tonifying prescriptions (tonification), and so on (Liu 1995). This is not to say, however, that danggui is used in the same manner, or for the same purposes, in all of these formulas. An herb’s activity can be understood in interrelated terms of quantity, qualities, and position relative to other herbs in a given formula. Often, a rulership analogy was used to describe the relative position of herbs in terms of junchen (monarch-minister), zuo (assistant), and shi (emissary), but this metaphor was deemed inappropriate in post-imperial times. In the scheme subsequently developed, zhu (ruling) herbs play the main role in countering illness factors, fu or fuzhu (supporting) herbs help strengthen the therapy, zuo herbs treat secondary syndromes or moderate other elements in the formula, and shi herbs act on circulation tracts or regulate other herbs (Farquhar 1994). In this hierarchy, the ruling drug is used in the greatest quantity and is afforded the widest powers, “but requires the support and assistance of other drugs to pick out some of its efficacies as primary functions and to specify and direct others as secondary functions” (Farquhar 1994: 188). Thus, while danggui might be in the ruling position in one formula, it might be supporting in another. Furthermore, despite the primary activities or position of an herb such as danggui in a formula, it must be borne in mind that Chinese medicine treats contextualized individuals rather than universalized diseases. As several of the physicians with whom I worked explained, in diagnosing and treating patients they had to consider 238

Of Nutrients and Nourishment



the individuals’ tizhi (constitution). This is part of the process of “making a concrete analysis of concrete conditions” (Liu 1995: 11), in which seasonal weather patterns and geographic features are considered alongside a patient’s sex, age, constitution, customs, and habits (Liu 1995: 11–14). Furthermore, physicians cannot simply select and apply a universal formula because “illnesses are more individual than the standard formulae imply” (Farquhar 1994: 180). Thus, a given formula will be customized in accordance with the range of particularities relevant to a given patient, in a given space and time. Aware of the ability of a given herb to have multiple uses, Lena explained that she made danggui “tea” to stimulate Madam Chung’s jingshen, while its role in the combination bazhen was to promote the general well-being of the whole family. Additionally, she was familiar with the manner in which general knowledge and standard formulas were individualized by an experienced Chinese medical master, in accordance with the specific constitution and condition of a patient. Indeed, a Chinese medical physician’s ability to successfully tailor individual treatments was a mark of experience in her opinion. She factored these considerations into the home-based remedies and meals that she made for herself and her family. In preparing Chinese herbal soups, for instance, Lena recognized a marked distinction between her own, her mother’s, and her mother-in-law’s constitutions, particularly in regard to heat. Because her mother-in-law could “take more heaty stuff” than others in the household, she had to be careful in preparing even general well-being soups. Thus, Lena explained the different bodily responses within her household to the same herb (in this case, danggui) in terms of different constitutions and different ages. Because her mother-inlaw’s constitution was relatively cool, she could take danggui to “perk up.” If Lena took it, however, her already heaty constitution would stimulate the opposite effect: the weariness often associated with heatiness.23 Despite these correlations, Lena did not articulate her understanding of Chinese medical herbs and practice in theoretical terms. Rather, she modified standard herbal combinations on the recommendations of friends and family members, as well as on the basis of bodily experience. In addition to the recipes she had inherited from both her own mother and Madam Chung, she also based the 239

Capturing Quicksilver types and quantities of herbs she purchased on the proportions used in prepackaged combinations, and on the advice of Chinese medical hall shopkeepers. Such modification was possible because the ingredients were not hidden, and were therefore identifiable—a significant advantage of Chinese medicine, in her opinion. Thus, while Madam Chung had to take standard biomedical medications for Parkinson’s, regardless of their potential or actual side effects, Chinese medical treatments (home-based or prescribed) could be individualized. “In Chinese medicine, one herb cannot cure you— you need to combine them. So you have to combine the Chinese herbs, but unless she [Madam Chung] knows what she’s combining she wouldn’t dare. Or she’ll follow what her friends combine, then she’ll come: “Oh, this is what I was told to combine” and we’ll combine. After the first, if it’s not right for us, we feel—oh, the next day we all feel very heaty, or something. And then we know it’s probably not right for us, and we have to stop drinking [it].” Home-based remedies like Bazhen Tang could thus be tailored according to the health requirements of individuals or their family members, on the recommendations of others, by taste, and/or in response to bodily experiences. Like the examples presented in the previous section, Chinese medicinal foods (prepared in combination or isolation) thus provided a flexible means of managing both family relations and individual members’ health.

Feasts and Distinctive Foods As the examples above suggest, Singaporeans affirmed aspects of familial and cultural identity by means of foodstuffs and food practices, expressing dispositions and pleasures that did not always conform to state agendas. In these contexts, it becomes clear how the production and consumption of Chinese foods (medicinal or otherwise) differentiated: first, the ethnic Chinese majority in Singapore from their “multiracial” compatriots and mainland Chinese, and second, certain classes within this majority from each other. Highlighting the distinctive capacities of certain foods, this section will illustrate how Singaporean Chinese also expressed aspects of their heritage and class status through feasts associated with festivals like Chinese New Year. 240

Of Nutrients and Nourishment



Based on the Chinese lunar calendar, Chinese New Year usually falls around the end of January/beginning of February, and is celebrated to herald the coming of the spring and a prosperous new year. In Singapore, Chinese New Year celebrations were marked by family gatherings around large meals, with the New Year’s Eve dinner often seen as the pinnacle event. While quantity seemed to be a relatively commonplace variable in these feasts, the specific items served varied from family to family, with the degree and nature of conspicuous consumption being relative to the income and traditions of the family in question. Although the events associated with Chinese New Year in Singapore typically took place in a family home, in 2007 Adelle and Tom decided to rent a large hotel room near the beach on Sentosa, sponsored by Tom’s elder sister. The evening’s meal—prepared and eaten at the hotel’s poolside picnic area—and general activities conformed to local custom. Marinated chicken wings and skewered chicken pieces, fish balls, tiger prawns, pork strips, and hot dogs were grilled by Adelle and her maid on open barbeque pits. Alongside a largely ignored small plate of celery sticks and lettuce was a hotpot of simmering broth, mandarin oranges, and rice. Tom’s mother, siblings, and their children converged for the meal, played card games, and gave money-filled hongbao (red packets, or small, decorative red envelopes) to the younger children. The older children (young adults) were enticed to gamble with Tom, who later confided that he intentionally lost the games in order to increase their hongbao. In the slightly more forgiving temperature of evening, the afternoon’s Tiger beer (considered cool) was replaced by whiskey (considered heaty), and the remaining family members snacked and played cards late into the night. Aside from the quantity of food purchased and prepared (which was far more than the group could possibly consume), the items themselves were not atypical of a middle-class meal; the luxury of this event was in the location. Meanwhile, the host of another Chinese New Year meal, Mrs. Lee, spent every Chinese New Year Eve with her children and her husband’s family. However, for her the real celebration was Day One when she and her husband hosted their annual lunch for her side of the family—an event precipitated by three days of shopping and cooking. The thirty or so guests were each served a single small portion of rice on a plate, distributed by Mrs. Lee’s maid and a 241

Capturing Quicksilver few other family members’ maids. Mrs. Lee served pork in at least three ways—stewed, braised belly with homemade buns, and braised knuckles. Also on the buffet table was an array of other beautifully cooked dishes: sautéed vegetables and prawns, roast chicken and roast duck, homemade fish ball soup, sautéed mushrooms, black moss and mushrooms, red yanwo, fish maw, abalone, and so on. After the first round of guests had eaten, the adults handed out hongbao to the loud approval of the children—an event that sparked a great deal of running about, talking, and laughing among family members—and then played mahjong. Although festivals like Chinese New Year are historically marked by a relative abundance of cai and neglect of fan in the PRC (Hsu and Hsu 1977), the proportion of meat to starches at Mrs. Lee’s feast did not differ drastically from everyday meals I had enjoyed in homes and hawker centers in Singapore. In other words, the wide variety of meat dishes—by virtue of their lack of distinction from everyday Singaporean diets—highlighted the prosperity Singaporean Chinese now enjoyed relative to their ancestors. The Chinese New Year feasts described above starkly contrasted with stories like the one related to me by a middle-aged Singaporean sous-chef, who described eating chicken once per month, pork once per month, and beef once per year when he was a child. Were he not Buddhist and therefore vegetarian, he explained, he could now eat meat at every meal like the people for whom he cooks professionally. This is not to say that “traditional” everyday Chinese cuisine does not include meat. Bamboo slips found in the famous Mawangdui tomb (dated to the second century BCE) in Hunan, “reveal how discriminating the Chinese taste had become in terms of the use of the various parts of different animals by the Han Chinese,” including deer, beef, dog, lamb, and pork (Yu 1977: 58). However, one could argue, these documents reflect the cuisine developed by the literate elite, and might not therefore reflect the practices of other economic classes (or regional variations) of the time.24 Rather, it is likely that the distribution of foodstuffs—including meat and other luxury items—was not even across all classes or periods of history in Chinese society; the same could be said of Singapore.25 Contemporary Singaporean abundance was also marked during Chinese New Year by the tossing of yusheng (raw fish salad)—often referred to in Singapore as lohei (tossing prosperity salads). In this 242

Of Nutrients and Nourishment



practice, each participant (friends, colleagues, and/or family members) stood around a table and lifted the “salad”—usually consisting of noodles, shredded root vegetables, peanuts, and raw fish among other variable ingredients—with chopsticks as high into the air as possible, so as to increase their individual and collective fortunes in the new year.26 Although we did not toss lohei at Mrs. Lee’s feast, many of the foods she prepared were equally significant in Chinese culture and cuisine. Of particular note were dishes of black moss and mushrooms, red yanwo, yellowish fish maw, and white abalone—luxury items that, particularly when considered in the context of the landed property in which it was served, marked the upperclass status of the Lees. For example, yanwo have been luxury trade items that have circulated between southern China and Southeast Asia since the sixteenth century, although they are now predominantly exported to Singapore, Indonesia, Thailand, Taiwan, and Hong Kong (Leh 1993).Traditionally harvested from limestone caves in Malaysia (particularly the states of Sarawak and Sabah, on the island of Borneo), they were said to strengthen the lungs, enhance the complexion, and improve the overall health (sometimes referred to informally in terms of the immune system) of consumers. Prized for both their medicinal and status value, white, red, yellow, and black nests were also recommended for a wide range of ailments including weak blood, heatiness, cold, influenza, asthma, and convalescence after illness or surgery (Leh 1993). Over a series of conversations, Hock Hua’s Toa Payoh branch manager Tim explained that the red variety of yanwo was particularly nourishing, but did not sell as well in Singapore because of the cost.27 Hock Hua carried white and yellow varieties of yanwo in a range of grades (largely differentiated by the density of construction and size of pieces), typically displayed in a neat row of glass jars behind their consultation counter. Although, by weight, yanwo were among the most expensive items sold at Hock Hua (alongside dongchong xiacao and various grades of ginseng), Tim reported that they constituted approximately 30 percent of the Toa Payoh branch’s daily sales. During festivals like Chinese New Year, when items such as yanwo were purchased for gifts and/or consumption at family meals, he noted, both overall and specialty item sales tended to increase. 243

Capturing Quicksilver

Figure 6.3. Yanwo and other luxury items at Hock Hua

Beyond their ascribed medicinal value, then, yanwo and other luxury items also represent distinctive foods that signify membership—first, in the ethnic Chinese majority, and second, in a particular class. I refer here to Pierre Bourdieu’s notion of distinction, which is based partially on aesthetic taste. Simply put, “taste classifies, and it classifies the classifier” (Bourdieu [1979] 1984: 6). Broadly speaking, we can see this classification at work in menus, guidebooks, and television shows that cater to the tastes of a particular ethnic group. However, even within the dominant ethnic group of a given society, the uneven distribution of economic and cultural capital produces finer distinctions, thus demarcating different lifestyles and social identities (Bourdieu [1979] 1984). In the context of Singapore, the first level of differentiation would be between Chinese, Malay, Indian, and “Others,” as expressed by supposedly distinctive (“racialized”) cuisines. On the other hand, the extent to which the taste (aesthetic or sensorial) of many Singaporean Chinese has been modified by virtue of their interaction with other ethnicities further distinguished them from mainland Chinese.28 Within the ethnic Chinese majority of Singapore, taste (represented, 244

Of Nutrients and Nourishment



e.g., by variations in the choice of foodstuffs served at Chinese New Year meals) served to distinguish members according to class. Chinese food and food practices therefore simultaneously reinforced cultural heritage, distinguished Singaporean Chinese from other ethnic groups within a “multiracial” society, differentiated them from both their ancestors and contemporary mainland Chinese, and introduced finer distinctions within the ethnic majority itself.

Conclusion The gastronomic field in Singapore, while clearly owing much to recipes and materials imported from southern China, accommodated locally available ingredients and tastes, as well as those of farther provenance. Tropical fruits like coconut and durian, and spices imported from India (e.g., turmeric, cardamom, and peppercorns) or other parts of Southeast Asia (e.g., fresh ginger from Malaysia) were regular features in Singaporean diets. Additionally, Singapore’s colonial legacy could be found in easy access to “Western” foods and restaurants throughout the island. Thus, while food and eating practices labeled as Chinese still dominated in Singapore, even this essentialized cuisine accommodated local tastes, preferences, and conditions, producing a remarkably diverse assemblage of food and ingredients. Like so many other aspects of life in Singapore, the practice of eating and the foods consumed thus reflected Singaporean Chinese’s simultaneous evocation, and adaptation, of their cultural heritage. Meanwhile, the state developed an evolving set of personal and social responsibilities that guided Singaporeans toward a lifestyle intended to maximize their economic productivity and minimize their reliance on state-subsidized healthcare. To some extent, this HPB-defined healthy lifestyle was promoted at the expense of individual pleasures and the continuity of social relations. Thus, in the increasingly busy, sanitized, and individualistic cityscape in which Singaporeans ate, their leisurely, messy, rich, and communal meals acquired a new significance. Old hawker centers stood in contrast to the gleaming Central Business District, while Chinese feasts and medicines (even if essentialized constructions) contrasted with a decidedly non-Chinese “multiracial” national identity that privileged a biomedically defined notion of health. 245

Capturing Quicksilver Again, one could easily interpret these sites of performance and contestation in terms of power relations and resistance. In many respects, Singaporeans conformed to (and undoubtedly benefited from) the state’s efficient, productive, and hygienic healthy lifestyle—working stereotypically long hours, maintaining a healthy diet, exercising regularly, and so on. In other ways, they appeared to resist state agendas by smoking, idling, drinking alcohol, talking cock, and continuing to eat rich, oily, and so-called unhealthy foods in sense-provoking hawker centers. Of course, they did so with the assurance of relatively high standard of public safety and hygiene, as provided by a government concerned with managing a potentially dangerous pathogenic city. If I were to conclude analysis here, I would have already said much about power relations, everyday acts of resistance, and even the possible benefits of allowing spaces (e.g., hawker centers) that provide momentary reprieve from the pressures of busy metropolitan life. However, as I have shown with regard to taste (whether gustatory and employed in the modification of conventional recipes, or aesthetic and implicated in class distinctions), the dietary practices of Singaporeans also emerged in contexts other than discourses of power. Like the hot/cold dispositions and practices with which they are linked, these dietary practices can be viewed in relation to Chinese medical theory, individualized healthcare strategies, and family relations. Hence, I have argued, Chinese foods, medicines, feasts, and other eating practices nurture not only individual bodies and lives, but also families and the cultural identities associated therewith. More than simple acts of compliance or resistance, Chinese food and medicine practices in Singapore can also be viewed as avenues for the creative negotiation of authority, heritage, identity, and health.

Notes 1. Such assemblages are by no means unprecedented. For instance, in their analysis of the dietary classic Yin-shan Cheng-yao, Paul Buell and Eugene Anderson (2000) describe the complicated cultural background of the Mongol court during the Yuan dynasty (1279–1368). With only a small Mongol minority, the middle and lower echelons of the court consisted of other ethnic groups, each contributing its own foodstuffs and recipes. Thus, Iranian and Mesopotamian dishes, “Turkic noodle dishes, Chinese 246

Of Nutrients and Nourishment

2.

3.

4. 5.

6.

7.

8. 9.

0. 1 11.



fish and chicken recipes, and Tibetan tsampa [roasted barley flour] were part of a collective culinary heritage” recorded in this nutritional manual (Buell and Anderson 2000: 9). Furthermore, they note that food and foodways from the “Western” world and Central Asia had already been introduced, and in some cases Sinicized, long before the Mongols conquered China in 1279 (Buell and Anderson 2000). Although Peranakan is notably absent from in the CMIO classificatory scheme (usually subsumed under Chinese on the basis of surname), this ethnic identity is partially marked by a cuisine that includes Malay, Chinese, and blended dishes. Although by no means unique to Singapore—or to Chinese culture—the gustatory zeal I observed among Singaporean Chinese has also been noted with reference to mainland Chinese. Anderson and Anderson, for instance, describe the latter’s concern for the quality of food over the environment in which it is consumed: “There was, and at last report (1971) still is, a wonton shop in Yün Long, in the New Territories of Hong Kong, that was famous throughout the western New Territories; everyone yearned to eat there. It was a perfectly ordinary, working-class neighbourhood wonton and noodle place, a small bare room with a few tables and chairs, not a fancy restaurant; yet people from all walks of life flocked to it. Western gourmets tend to require an elegant ambience as part of a meal. The Chinese are concerned with the food” (Anderson and Anderson 1977: 363). Despite the rather sweeping generalizations of this statement, the point regarding food quality over ambience in Chinese culture is apparent in Singapore as well. Are you hungry yet? Although there is also a specific chain of hawker centers in Singapore called Kopitiam, I am here referring to the more general term that inspired this name. While breathing and sex techniques are perhaps the most commonly discussed yangsheng techniques, I follow Ute Engelhardt (2001) in exploring dietetics. Eu Yan Sang’s prepackaged variety included nine herbs: chuanxiong (Sichuan lovage, Lingusticum wallichii), danggui (Chinese angelica, Angelica sinensis), baishao (peony root, Paeonia lactifiora), shudihuang (Rehmannia root, Rehmannia glutinosa), dangshen (poor man’s ginseng, Codonpsis pilosula), baizhu (large-headed atractylodes, Atractylodes macrocephala), fushen/fuling (China root, Poria cocos), gancao (Chinese licorice, Glycyrrhiza uralensis), and daizao (jujube, Ziziphus jujuba). Collected from their head office in Chinatown in April 2007. Because the packaging of these, and the majority of other products, is in English all the translations in this paragraph are Hock Hua’s and not my own, unless otherwise noted. No translation for this name was provided on the packaging. As noted in chapter 4, decoctions are one of several medicinal preparations used in classical Han Chinese medicine, also including wan, 247

Capturing Quicksilver

12.

13.

14.

15.

16.

san, jiu, and gao, each with its own distinct effects (Yamada 1998: 90). See also Volker Scheid, Dan Bensky, Andrew Ellis, and Randall Barolet’s (2009) volume on Chinese medical formularies, which outlines the various forms in which formulas are administered. A few days later, Adelle also prepared black chicken soup for Tom’s mother. She selected a bag of Chwee Song brand Bazhen Tang —the packaging for which indicated it was “for good health and vitality, recommend[ed] especially for families”—and a whole (black-skinned) chicken, and we returned to their home to prepare it. While Tom watched television in the living room, Adelle and her Indonesian maid prepared the soup according to the recipe Adelle had learned from her own mother: they sautéed the whole chicken (after trimming off the claws, which Tom’s mother did not like) and half an onion briefly, and then boiled it along with the herbs and a bit of salt in water for three hours. When I commented on the number of categories in the Singapore immigration system, Lena laughed and remarked, “Well, you know Singapore—they love to label you. Everything has got a label.” Although Singapore became a party to the Convention on International Trade of Endangered Species of Wild Fauna and Flora (CITES) in 1987, making the importation and sale of rhinoceros horn illegal, relatively small amounts are still smuggled into the country, as indicated a seized consignment of ten horns from Indonesia in 1991 (Leader-Williams 1992). As Elisabeth Hsu observes, although rhinoceros horn is reputed to be an aphrodisiac its actual value in Chinese medicine (as based on the Bencao gangmu, or The Compendium of Materia Medica) is to “cool blood,” “discharge fire,” and “dissolve poison” (Hsu 2009b: 136, fn16). Restaurants focusing entirely on medicinal meals, such as the one described by Farquhar, were not as common in Singapore; nonetheless, there were a few in operation during my fieldwork, and I would occasionally see a hawker center stall offering herbal soups. Other establishments offered popular dishes that incorporated or highlighted the tonifying properties of bu foods. For instance, the first location of a popular chain called Soup Restaurant opened in 1991 in response to the increasing popularity of herbal soups in Hong Kong. In light of the discussion on the prevalence of kampong nostalgia in the previous chapter, it is also interesting to note that Soup Restaurant dishes were advertised as Chinatown heritage cuisine, and were explicitly “designed to evoke a nostalgia for nutritious home-cooked food” (as reported on their website: http://www.souprestaurant.com.sg/aboutus_ourhistory.html). At the time of my fieldwork Soup Restaurant primarily catered to young professionals with dishes like “double-boiled waisan and ginseng roots with chicken soup,” advertised as ideal for stressed and fatigued people. As implied in their English names, these ginseng varieties are cultivated in East Asia and North America; the latter has been exported to China for more than 150 years.

248

Of Nutrients and Nourishment



17. For instance, Chinese and Korean ginseng (characterized as warming) contains a stimulant ginsenoside (a glycoside), while American ginseng (characterized as cooling) contains a tranquilizing ginsenoside (Hu 2005). 18. Hu, a well-regarded taxonomist and economic botanist, notes that she received a letter from an officer of the Singaporean government in 1986 asking for her assistance in distinguishing between wild and cultivated ginseng, which they had received from China, Korea, and the United States via Hong Kong (Hu 2005). 19. As mentioned in chapter 3, Chinese materia medica were differentiated in Singapore into two categories by the HSA (one of two statutory boards of the MOH). Bulk materials were controlled under the Poisons Act, and prepackaged (branded) CPMs were controlled under a variety of pieces of legislation: the Medicines Act 1975; Medicines (Traditional Medicines, Homoeopathic Medicines and Other Substances) (Exemption) (Amendment) Order 1998; Medicines (Chinese Proprietary Medicines) (Exemption) Order 1998; Medicines (Labelling of Chinese Proprietary Medicines) Regulations 1998; Medicines (Licensing, Standard Provisions and Fees) (Amendment) Regulations 2003; Medicines (Prohibition of Sale and Supply) (Amendment) Order 1998; and Medicines (Labelling of Chinese Proprietary Medicines) (Amendment) Regulations 2005. 20. Lena typically shopped at Ong Liang Seng, a large shop on the second floor of People’s Park shopping complex on the Eu Tong Seng Street–side of the center of Chinatown, which sold bulk and packaged Chinese herbs to individual customers, Chinese medical halls, and smaller food and medicine shops around Singapore. 21. By contrast, China’s unmatched use of chemical fertilizers and pesticides, alongside large-scale adulteration and counterfeiting of food and medicine, has made food safety a particularly grave concern in the PRC and countries receiving their exports (Yan 2012). 22. Additional methods mentioned by Liu include regulating the flow of qi, regulating blood conditions, relieving rheumatic conditions, resuscitation, causing contraction or arresting discharges, and treating mental strain with tranquilizing drugs (Liu 1995). 23. Based on her own experiences of heatiness and the reported experiences of Madam Chung, Lena concluded that presently Madam Chung’s constitution was cooler than her own. I emphasize “presently” because she also acknowledged that jingshen fluctuated throughout one’s life with an overall tendency, particularly by Madam Chung’s age, toward decline. This understanding coincides with the Chinese medical consideration of age as an important factor (and part of the theoretical foundation for yangsheng) in “making a concrete analysis of concrete conditions” (Liu 1995: 11). On the other hand, it also reflects her experiences with biomedical doctors, who explained Madam Chung’s no jingshen feeling in terms of the normal aging process. 24. Social stratification, as revealed in the distribution of food resources, has been discussed by Chang as an important threshold in the historical 249

Capturing Quicksilver

25.

26.

27.

28.

development of (mainland) Chinese cuisine: “On one side were the food-producers who tilled the land but had to submit much of what they produced to the state, and on the other stood the food-consumers who administered instead of toiled, which gave them the leisure and the incentive to build up an elaborate cuisine style. … It was this event— the split of the Chinese population along food lines—that created the economic subsegmentation of the Chinese food culture” (Chang 1977: 20–21). One of the overt goals of Maoist-era proscriptions and prescriptions on eating practices was the more even redistribution of food (Chang 1977). The repercussions of these ascetic policies on post-socialist Chinese embodied experiences are discussed at some length by Farquhar (2002). This goal was also evoked in the common greeting exchanged between friends and family in Singapore during Chinese New Year: “Gongxi facai,” a Mandarin expression used to wish someone prosperity and happiness. Tim also explained that Hock Hua did not stock the black variety of birds’ nests because, although they were high grade, Singaporeans considered them dirty and therefore too time consuming to clean and prepare. For instance, the “all-consuming need and desire for the gastronomic pleasures of chilies are an index of their differentiation from other ethnic Chinese and, indeed, Chinese in China” (Huat and Rajah 2001: 178).

250

Chapter 7

Positionality, Power, and the Politics of Representation

Distance is not abolished by bringing the outsider fictitiously closer to an imaginary native, as is generally attempted; it is by distancing, through objectification, the native who is in every outside observer that the native is brought closer to the outsider. —Pierre Bourdieu, The Logic of Practice

Introduction As an undergraduate, studying at a U.S. university with a four-fields or areas studies approach to anthropology, I quickly decided that sociocultural anthropology best suited my disposition and seemingly insatiable curiosity about the world outside my small, Rocky Mountain hometown. As my studies progressed I was encouraged to focus on people in a particular part of the world, rather than tackling the human condition in toto, and I found my attention drawn to Southeast Asia. Repeatedly, Singapore stuck out as a most peculiar exception, with its ethnic Chinese majority, metropolitan landscape, relative economic prosperity, and social controls that fell somewhere between those described by Aldous Huxley ([1932] 1998) and those of George Orwell ([1948] 1950). After transferring to UC Berkeley for the second half of my undergraduate program, I was introduced to the political economy of health, Foucauldian power relations, and Gramsci’s notion of hegemony; my passion for medical anthropology was germinated in the conceptual substrate of medical pluralism and biomedical hegemony. While the latter’s critique of asymmetrical power relations was revelatory in many ways, by the conclusion

251

Capturing Quicksilver of these seminal studies I began to wonder about the viability of nonbiomedical practices with similar mobility and tenacity. Enter, stage left, my interest in the transnational flows and transformations of Chinese medicine, as (possibly counterhegemonic) sites of contestation and resiliency. If I wanted to study the practice, plasticity, and power dynamics of this mercurial assemblage outside the PRC, I reasoned, what better place to start than Singapore— with its ethnic Chinese majority and a well-established history of Chinese medical practice? Having presented the research that was born of these curiosities, I will now consider the sociopolitical and disciplinary conditions that facilitated my experiences and inspired my approach. How might the analytical trends and tools that I mentioned in the introduction and chapter 1 shed light on Chinese medicine in Singapore vis-à-vis state agendas and a biomedical healthcare system? How might they introduce unintentional biases or blind spots? In the preceding chapters I explored how Chinese medicine has developed with respect to the various political and economic conditions in which it circulates, disassembles, and reassembles, revealing an emergent field in which the creative (re)generation of practices is possible. In this final chapter I will discuss how the interpretation of these findings has arisen within ongoing scholarly discourse first on power, agency, and practice; and second within debates about (health) identities and transnationalism. I will return to the discussion of the twentieth-century crisis of representation and reflexive turn in anthropology, and describe a few of the approaches or strategies that have been developed in response. Reflecting on enduring questions of knowledge and power, identity, agency, rationality or epistemology, and the boundaries of practice, I will argue that the implications of these intellectual trends extend beyond problematizing authority and heritage in a particular sociopolitical milieu, suggesting Chinese medicine’s broader capacities with respect to globalization and biomedical hegemony.

Where Were We? In an article in Current Anthropology, Diane Lewis opens with the assertion : “Anthropology is in a state of crisis” (Lewis 1973: 581). This was evidenced, she claims, by growing criticism (internal and 252

Positionality, Power, and the Politics of Representation



external) of anthropologists’ apparent lack of concern for the political implications of their work. Associated with the colonial quest for knowledge over so-called primitive peoples in pursuit of better ways to manipulate and control them, early anthropological studies were critiqued for framing their field sites as laboratories to which the observer was external, and therefore supposedly objective. As Lewis notes, even those who rejected colonialism operated within, rather than calling into question, the power relations of colonialism; their reified representations of culture therefore often reflected colonial assumptions and racist ideology (Lewis 1973: 581–84). The anthropologists’ privileged position, outsider status, and insistence on objectivity to some extent devalued and objectified the groups with whom they lived and worked. By reflexively examining the conditions in which anthropological knowledge was produced, postcolonial and postmodern anthropologists began to analyze the preconceived notions and assumptions that directed the anthropological gaze. Reflecting on the works of Edward Said and Michel Foucault, geographer Joanne Sharp (2009) describes how many eighteenthand nineteenth-century European writers depicted themselves and their own societies as dynamic and vibrant, while the Other was represented as timeless or decaying. In the context of the eighteenth-century Enlightenment in Europe, she explains, science and technology were viewed as the basis for economic and social comparisons that differentiated civilization from the natural world of the so-called savages. This racialized “science” suggested mastery over nature and superiority over the people associated therewith. Effective rule required colonists to “know their natives”: “Knowledge was the charter for domination. … Knowledge was used to produce a skilled and pliant labour force; to reduce resistance; to establish forms of governance and taxation; to maximise resource usage” (Sharp 2009: 34). Hence, various organizations, institutions, and disciplines were established to facilitate colonial projects. Especially prior to the professionalization and acknowledgement of anthropology within academic institutions, anthropologists often turned to colonial authorities for both legitimacy and financial support. As part of this process of professionalization, in the late 1920s anthropologists like Bronislaw Malinowski suggested that to avoid colonial struggle (and, thus, bloodshed), colonists should use anthropological knowledge and planning (Pels 1997). Malinowski 253

Capturing Quicksilver was not alone in attempting to demonstrate the utility of anthropology; by the 1930s anthropologists were frequently called on to help in the economic and administrative development of the colonies. This call for assistance was marked by increasing appointments of social scientists in the colonies, the foundation of a number of research institutes, and the earmarking of unprecedented funding for anthropological research. Much of this research was oriented toward understanding the outcome of culture contact on colonized people—in other words, issues of cultural continuity and change (Kuper 1996). In the late nineteenth century diffusionist theories of social change, culture contact, and difference were confronted with the increasing popularity of evolutionary theory. Diffusionists argued that social change could be explained in terms of borrowed traits: culture contact produced the diffusion of characteristics from their site of origin, like ripples in a pond. Meanwhile, evolutionists used theories of biological evolution to explain social change, referencing a culture’s internal dynamics rather than haphazard borrowings (Kuper 1996). These theories of social evolution mirrored the unilinear model of change and hierarchical ordering presented in biological evolutionary theory. Just as the planet’s species were taxonomically ordered and ranked, with man at the apex of evolution, so too could “races” be ordered and ranked, with European civilization at the pinnacle. This hierarchical ordering underpinned Orientalism, justified colonial exploitation in the nineteenth and early twentieth centuries, and provided the basis for modernization theory. As an extension of the civilizing mission of colonialism, modernization theory promoted forms, styles, and metrics of change experienced in Europe and North America (labeled “progress”) throughout the world, and particularly in newly sovereign nation-states. Katy Gardner and David Lewis (1996) explain that modernization theory—most prevalent in the 1950s and 1960s— had its roots in nineteenth and early twentieth century political economy. Reinforcing Orientalist/colonial dichotomies, modernization theory and early development discourse described “traditional” societies as poor, irrational, and rural, while “modern” societies were described as developed, rational, and urban. The model for modernity was thus, still, European civilization— contrasted with “primitive” or “backward” societies—although the 254

Positionality, Power, and the Politics of Representation



dominant geopolitical division of the world began to shift from West versus East to North versus South in the post-colonial era. Regardless of geopolitical designation, markers of modernity and development included industrialized modes of production, subsistence strategies (cash-cropping), urbanization, and the institutionalized adoption and acceptance of biomedicine. So-called obstacles to development (e.g., local customs and worldviews) could be overcome with guidance and capital from the North, it was argued, particularly in the take-off phase (Gardner and Lewis 1996). Whether in early anthropological descriptions of social change, modernization theory, development discourse, or treatises on economic globalization, the notion of an inevitable march of progress carried a great deal of power.1 By the time of Diane Lewis’s article, however, these distinctions and attendant values—associated with “the traditional anthropologist’s syndrome”—were being challenged by postcolonial or postmodern theory, revolutionary wars, and new modes of thinking (Lewis 1973: 590). For instance, Edward Said (1978) argues that both gross and subtle distinctions between people were overlooked by literary, theatrical, and scholarly essentializations that sought to establish and maintain a distinction between the supposedly superior, “Occidental” Self from an ever-expanding “Oriental” Other. Central to these imaginative geographies were the notions that, first, the Other could not represent themselves; thus, second, European and American scholars, writers, and artists had to study and represent them on their behalf. Quoting Marx—“Sie können sich nicht vertreten, sie müssen vertreten werden” (they cannot represent themselves, they must be represented)—Said emphasizes that these efforts produced exterior “representations” rather than interiorly circulated cultural “truths” (Said 1978: 21). If, as Said argues, knowledge and representation are key to domination, how could anthropologists accurately represent the marginalized, post-colonial Other from their positions of socioeconomic and historical privilege? Representations, Paul Rabinow (1996) reminds us, are social facts. Contrary to the efforts of Enlightenment philosophers who sought to establish a universal epistemology, the notion of knowledge as accurate representation has been repeatedly challenged by analyses that historicize truth, falsity, and styles of reasoning. The problem of correct representations thus plagues multiple domains and practices: “It is linked to the wide range of disparate, but interrelated, social and 255

Capturing Quicksilver political practices that constitute the modern world, with its distinctive concerns with order, truth, and the subject” (Rabinow 1996: 34). If a concern with epistemology constitutes a sociohistorical movement specific to European philosophy, Rabinow suggests, we need not project our projects and priorities onto the Other but should still investigate those contexts in which claims to epistemology are made. Furthermore, we should examine the constitution of our own social realities with the same level of scrutiny as that of the Other, and with a similar allowance for plurality, in order to avoid essentializing the Other and reverse essentializing the West: “Occidentalism is not a remedy for Orientalism” (Rabinow 1996: 36). Hence, among other struggles, the mid-twentieth-century anthropological crisis of representation engaged issues of accuracy, appropriateness, epistemology, and ethics. Accordingly, anthropologists came to redefine not only their approach to understanding rapidly changing communities, but also the manner in which their observations and interpretations thereof reflected (or perpetuated) European politico-philosophical priorities and the power asymmetries of colonialism. As Pierre Bourdieu and others suggested, postmodern or postcolonial anthropologists began to examine the objectifying relations inherent in anthropological observations: “Social science must not only, as objectivism would have it, break with native experience and the native representation of that experience, but also, by a second break, call into question the presuppositions inherent in the position of the ‘objective’ observer who, seeking to interpret practices, tends to bring into the object the principles of his relation to the object.” In the most general terms, then, reflexivity entailed the observation of one’s self, one’s culture, or one’s discipline in relation to the Other, and particularly the knowledge-power relations inherent in the act of representation. Practically speaking, this often entailed consideration of the context in which knowledge was produced and evaluated, or analysis of the objectifying relations inherent in observation (Bourdieu [1980] 1990: 27). The colonial science in which objectified colonial peoples were characterized by “false and mystifying differences” (Kuper 1996: 180) gave way to more reflexive engagements with marginalized subjects. Feminist theory drew attention to women’s role in society and gender-based status differences, and Marxist political economy investigated how the capitalist mode of production resulted in class 256

Positionality, Power, and the Politics of Representation



domination. The latter was particularly popular in the early development of critical medical anthropology, which sought to challenge the biomedical hegemony implicated in analyses of the social relations of illness and healing. As part of the larger postmodernist approach to objects as multifaceted, dynamic, and relative (as opposed to singular, static, and absolute), critical medical anthropologists took on topics like medicalization and scientific authority, insisted on analysis of nonbiomedical practices in their own terms, and reframed health institutions as sites of power and resistance (Scheper-Hughes 1990). Accounting for at least some of the objectifying relations imported by the observer, the implicit assumption of biomedical superiority was made overt and its potential to color anthropological evaluations of nonbiomedical practices at least confronted, if not resolved. This reflexive consideration of the objectifying relations between observer and observed produced some interesting results that were by no means limited to anthropology. The scholarly approach to Chinese medicine adopted by Joseph Needham, Manfred Porkert, and others can be viewed, to some extent, as a similar response to the (unreflexive) representation of Chinese medicine within European and American literature as unscientific. Porkert’s (1974) description of Chinese medical theory as a “system of correspondences,” for instance, sought to establish Chinese medicine as an exact science, in a similar fashion that Scheper-Hughes’s critical medical anthropology suggested heterodox medical practices as “possible, indeed valid, alternatives to biomedical hegemony” (Scheper-Hughes 1990: 193). An important distinction between the two, however, can be found in their respective attitudes toward science. Porkert’s study uncritically uses “Western” science as a baseline against which Chinese medicine is measured and found to be sufficient. While there is certainly utility in demonstrating this internal logic (particularly when writing for a Euro-American audience), critical medical anthropology goes one step farther in interrogating the notion of scientific superiority that inspires such comparisons in the first place. Although many contemporary writers (particularly within science and technology studies) have commented on scientific ideology and hegemony, an early scholar, Paul Feyerabend (1978), helped set the stage with two fundamental questions: “What is science?” and “What’s so great about science?” The assumed excellence of science 257

Capturing Quicksilver is rarely argued for or challenged, he claims, and has thus transformed from a potentially liberating force “balanced by alternative views and alternative institutions” to dogma (Feyerabend 1978: 75). Furthermore, he asserts that rationalists often insist on only one Truth that is superior to all others; this Truth is largely justified by reference to objectivity, in much the same way that Professor Tan demonstrated the efficacy of his single-needle technique (described in chapter 4) in Singapore. This, in my opinion, partially reflects his background in biology, his training in the integrated TCM of the PRC, his expectation of the sorts of evidence that a doctoral candidate at Oxford would find acceptable, and his membership in a society that increasingly inculcates a preference for rationalism over relativism (as discussed by Chuck in chapter 5). Reflecting the post-Enlightenment emphasis on reason and hierarchy, nineteenth-century anthropologists reinforced the boundaries between science and the pseudoscience, magic, or religion they encountered by adopting an authoritative, supposedly objective stance vis-à-vis their objects of study. As Byron Good (1994) points out, this tendency emphasized and elevated rational thought, or what was referred to as “knowledge,” by contrast with “belief.” E.E. Evans-Pritchard, for instance, attempted to explain what some might consider irrational beliefs (like witchcraft) in terms of a proto-science that rationalizes noncausal aspects of an event (like illness) with reference to a moral universe. Despite his serious consideration (rather than dismissal) of local explanations, he nonetheless regarded ideas conforming to scientific discourse to be “knowledge” while he attributed the term “belief” to anything else. By contrast, Good explains, contemporary medical anthropology suggests that “all medicine joins rational and deeply irrational elements, combining an attention to the material body with a concern for the moral dimensions of sickness and suffering” (Evans-Pritchard quoted in Good 1994: 24). Anthropologists like Good and Rabinow thus responded to the crisis of representation by not only questioning the possibility of anthropological objectivity in the field or in analysis, but also abandoning the rationalism versus relativism debate in lieu of a more critical approach to rationality itself. Even the innovative endeavors of anthropologists like Evans-Pritchard to explore local knowledge did not eradicate bias or self-serving interests from anthropological 258

Positionality, Power, and the Politics of Representation



interpretations. With increasing reflexivity in the discipline, however, there has been a slow (if uneven and incomplete) shift away from using narrowly conceived “Western” rationality as a standard against which other forms of knowledge should be evaluated.

Where Are We? In the introduction and chapter 1 I proposed a bricolage approach that pairs anthropological analysis of the post-colonial intersection of knowledge, identity, and governmentality with a perspective on Chinese medicine as a transnational, permeable, hybrid, and fluid practice. Through this approach I then demonstrated how Chinese medical physicians and patients creatively negotiated a range of competing interests within an incessantly dynamic sociopolitical and physical environment. Hence, I argued, both contemporary Singapore and the use and practice of Chinese medicine therein can be characterized by pluralism and synthesis, fluidity, and complex power relationships. In this section I will briefly return to these issues, taking a moment to highlight a few core theoretical contributions Pierre Bourdieu and Michel Foucault have made to these ongoing debates. I will then review conclusions and points in my own research where these concepts have been most illustrative. As Helle Samuelsen and Vibeke Steffen (2004: 4) observe, “With the notion of agency researchers have stressed the status of individuals as subjects rather than objects by demonstrating that individuals act and maneuver in the world, make strategies and reflect in spite of the frames and perhaps limitations set by the structures of societies.” The works of Pierre Bourdieu and Michel Foucault, they argue, have been instrumental in this endeavor. While both scholars were largely concerned with European phenomena, the former’s notions of habitus, field, and capital, and the latter’s work on power relations and techniques of the self (subject-formation) have been increasingly applied to ethnographic contexts farther afield. Importantly, Bourdieu insists, the logic behind everyday practices should not be confused with rational choice (resonating with the critique of a post-Enlightenment rationalist bias or calculations)—although this by no means renders them irrational. Rather, everyday practices are performed within a particular domain of social relations, or field. 259

Capturing Quicksilver Bourdieu’s notion of capital describes one or more kinds of power relations—economic, social, cultural, and/or symbolic—the types and strengths of which help to position an individual within a given field. For instance, Samuelsen and Steffen (2004) describe how healers and institutions position themselves in Burkina Faso’s medical field in a similar fashion as I explored the position of Chinese medical physicians, associations, and clinics with respect to Singapore’s healthcare system in chapter 4. Akin to the experience-based form of authority exercised by physicians like Professor Tan, Samuelsen and Steffen illustrate how social relations and indigenous healing knowledge constitute important qualifications that government health officials do not possess. Meanwhile, Foucault’s notion of power seems particularly appropriate to studies of health, illness, and healing in both its institutional or authoritative dimensions and its capacity to describe self-discipline and subject formation. In addition to the disciplinary and biopolitical techniques (biopower) that I outlined in previous chapters, Foucault also described techniques of the self, whereby people understand themselves and transform their bodies and ways of being. Stefan Ecks (2004), for example, applies Foucault’s notion of self-care to understanding Ayurvedic understandings of digestion in relation to (post)colonial anxieties about power, modernity, and sovereignty in Kolkata, India. Referencing colonial era writings that described bodily sovereignty as the path to cultural and political sovereignty, Ecks concludes that contemporary digestive self-care seeks to liberate Indian bodies from “modern” dependencies: “One day, we will not just become modern subjects, but sovereigns of modernity. One day, we will hold health in our own hands again. One day, modernity will be digested” (Ecks 2004: 86; emphasis original). The Greco-Roman medicine Foucault describes in Ethics: Subjectivity and Truth (edited by Rabinow, 1997) emphasizes individual freedom and self-reliance by providing guidance on health and self-care. Meanwhile, the Greco-Roman care of the self he describes in volume 3 of The History of Sexuality ([1986] 1988) centered around philosophy as an art of existence, but was not confined to the domain of philosophy: “It also took the form of an attitude, a mode of behavior; it became instilled in ways of living; it evolved into procedures, practices and formulas that people reflected on, developed, perfected, and taught. It thus came to constitute a social practice, 260

Positionality, Power, and the Politics of Representation



giving rise to relationships between individuals, to exchanges and communications, and at times even to institutions. And it gave rise, finally, to a certain mode of knowledge and to the elaboration of a science” (Foucault [1986] 1988: 45). Self-care advice was meant to be taken up by all people at all times, every day, from youth to old age. Furthermore, care of the self was connected with other occupations and relations in life—being master of the household or a ruler over his subjects, caring for the sick or wounded, and honoring the gods or the dead—and required designated time every day to commune with oneself. Hence, care of the self was a social practice conducted in a somewhat institutionalized manner (in schools, formal mentoring, private consulting or confidant relationships, and so on) with reference to a collaborative social hierarchy (Foucault [1986] 1988). Self-care also necessitated moderation, discipline (regimen), self-surveillance, and attention to disruptive external factors. Hence, in Greco-Roman and Ayurvedic medicine—not unlike the healthy lifestyle and yangsheng advice of the Singaporean state and Chinese medicine, respectively—individuals were held responsible for their own health; these responsibilities included regular eating habits, mindfulness, and other activities not circumscribed within a proper medical domain. Hence, while Foucault’s notion of biopower (biopolitics and anatomo-politics) leaves very little room for agency beyond compliance or resistance (power inscribed on bodies), his work on governmentality and self-care emphasizes self-surveillance and self-discipline (power enacted through bodies and families). The themes of self-surveillance and self-discipline emerged repeatedly throughout my fieldwork: in the post-colonial engineering of a disciplined and productive population; in antidengue campaigns and SARS-era medical testing and monitoring; in the mirrored anatomo-politics of bodily, institutional, and cityscape flows; in upright bodily articulations and reserved public discussions (talking cock notwithstanding); and so on. While the vast majority of Chinese medical patients also relied on biomedicine, certain subjective experiences—situated within a tropical cityscape—were more readily validated and incorporated within a Chinese medical framework. Nonetheless, both the healthy lifestyle promoted by the Singaporean state and the Chinese medical concept of yangsheng can be understood in terms of care of the self. 261

Capturing Quicksilver Both emphasized a moderate diet, exercise, mental calmness, and an attentiveness to the self that is remarkably similar to the GrecoRoman self-care advice Foucault describes. These preferences and practices, as well as the materials employed therein, connected experiencing individuals and collectives with both national and transnational processes that guided their notions and expressions of health and heritage. As I have explained in the previous chapters, heritage, nationalism, development, and “multiracialism” are all notions that were employed and reformulated to suit the variable interests struggling to define both the Chinese medical field and, more broadly, medical authority in Singapore. The ethnographic and historical accounts I presented depict an enduring tension between biopolitical agendas oriented toward the cultivation of biopower and the naturalized dispositions and practices associated with cultural heritage and embodied knowledge. Whether appealing to Euro-centric notions of progress and economic necessity (rhetorical devices of the former) or to history and heritage (associated with the latter) patients, physicians, and legislators each sought to define identity, the body, health, and illness in accordance with their particular interests. As such, each set of interests generated its own forms of authority and its own sets of practices (disciplines and dispositions). Nonetheless, these interests and strategies are intertwined; we cannot, therefore, understand the shifting position, practice, or use of Chinese medicine in Singapore without reference to both. Colonial and immediately post-colonial events in Singapore, and between Southeast Asia and China, promoted the construction of a “multiracial” national identity and discouraged the expression of Chinese heritage and cultural practices as a foundation for nationalism. Drawing on Foucault’s notion of biopower, it is not difficult to see how it was in the state’s interests to craft a set of bodily disciplines designed to optimize the population’s capabilities while ensuring its docility (anatomo-politics). The regulatory controls (biopolitics) and accompanying ideology that resulted, engineered a population suited to the needs of an emerging, dynamic, capitalist market and yet depended on the compliance of individuals and collectives in society. Hence, the top-down biopolitics and anatomo-politics of the state, enacted in institutions (e.g., large Chinese medical charity 262

Positionality, Power, and the Politics of Representation



clinics) and in both public and domestic spaces, relied on the cooperation and self-surveillance of Singaporean citizens. Given the post-colonial state’s preservation of European governmentality and the healthcare system put into place by the British colonial government, it would appear that Chinese medicine’s marginalized status in the healthcare system was largely established, and maintained, by the state’s economic and social development strategies. Nonetheless, Chinese medicine’s provision of low-cost primary care was a necessary component of Singapore’s twentieth century informal healthcare system. In the last decades of the twentieth century, stabilized political and economic relations with the PRC and in the region—as well as a burgeoning global interest in CAM— coincided with state efforts to regulate and circumscribe Chinese medicine, drawing the practice more closely in line with biopower agendas. However, as I have argued, Chinese medicine in Singapore is not a static and bounded practice that can be adequately understood within a CAM framework. Rather, its contemporary position in Singapore must be analyzed with reference to the post-colonial state’s “multiracial” national narrative and economic strategies on the one hand, and intersubjective expressions of heritage and embodied knowledge on the other. At the time of my fieldwork, twenty-first century regulatory controls were reputed to have increased public confidence in Chinese medicine (with both Singaporean practices and products and those imported from elsewhere)—supposedly to the benefit of Chinese medical physicians, druggists, and entrepreneurs. Some patients with whom I spoke indeed purchased Chinese medicinal products with a greater sense of confidence in Singapore than in other countries but, as I have argued, patients’ perception and use of Chinese medicine cannot be reduced to so-called rational choices—whether guided by government approval or not. Additionally, while the status of physicians who worked with the TCMPB or approved political entities might have been enhanced by increased regulation, not all physicians benefited equally or complied evenly. Their ability to practice nonetheless, or practice in an innovative or unconventional manner (like Professor Tan’s single-needle technique), suggests a patient- and experience-based authority that is not solely derived from compliance or collaboration with state agendas. While the disciplinary techniques of the state are reflected in the wider Chinese 263

Capturing Quicksilver medical field and standardized institutional practice, the popularity of a given physician allowed for individual negotiation and agentic creativity (rather than simply compliance or resistance). If, as Judith Farquhar (1987) notes, biomedicine and Chinese medicine are based on different notions of the subject and knowledge, what kinds of identities are produced at their juncture? Susan Reynolds Whyte (2009) outlines two overlapping approaches to describing health identities: first, a focus on social movements and identity politics, and second, analysis of subjectivity and biopower. Identity politics, she reminds us, is a concept very much aligned with U.S. social history and, particularly, the leftist movement of the 1960s, which demanded reassessment of plurality, difference, and the subaltern. The term is thus often used to refer to the political position and shared experiences of marginalized groups who have mobilized around their gender, sexual orientation, class, ethnicity, or other minority status. In the United States, identity politics often referred to consciousness-raising or social justice movements such as second-wave feminism, black civil rights, gay and lesbian liberation, or American Indian movements, although it could also be used to describe self-determination or nationalist movements centered around a particular identity (Eriksen 2002). Contemporary identity politics are often expressed in rights-based approaches to health and development, as well as ethnographic explorations of the conditions in which certain identities are asserted or denied—particularly with respect to minority groups. Unlike the social movements and public actions observed in identity politics, the problematization of health and power in terms of biopower and the subject often revolves around more-subtle processes that seek to shape subjectivity, bodily practice, and embodiment. For example, based on Adriana Petryna’s (2002) notion of biological citizenship, Nikolas Rose and Carlos Novas (2005) describe how people organize around biological identities or, conversely, how biological presuppositions underlay citizenship projects in particular nation-states (see also Ong 2016). As Reynolds Whyte points out, rather than seeking to establish rules or unambiguous elaborations of the workings of biopower, ethnographic descriptions of these new health identities are often concerned with variability between individuals and (borrowing from Rayna Rapp, 1999) the uneven seepage of science. Furthermore, as I 264

Positionality, Power, and the Politics of Representation



have already explained in relation to the tensions between Singapore’s “multiracial” national identity, intersubjective expressions of heritage, and persistent evocations of Chinese cultural authority, these processes are not simply a matter of identities imposed from above but are formed by individuals and groups themselves: “The active biological citizen informs herself, and lives responsibly, adjusting diet and lifestyle so as to maximize health” (Reynolds Whyte 2009: 11). Many of the Singaporeans with whom I spoke regularly indulged their taste in rich Southeast Asian–Chinese foods in contradistinction to the idealized lifestyle of a “responsibilized citizen” (Robins 2006: 312–14, 321). Others continued to speak southern Chinese dialects despite their English education and exposure to the Speak Mandarin campaign, or cared for their health and their families by means of Chinese materia medica (dispensed at clinics or in home-based remedies) instead of government-subsidized biomedical healthcare. As I have described, in some respects these practices directly contradicted state agendas and campaigns, particularly in the context of the twenty-first-century biopolis of Asia branding. As such, they not only suggest an intersection of Foucault’s notions of power and resistance and self-care with Bourdieu’s concepts of habitus, field, and capital, they also speak to the post-colonial formation of health identities and subjectivity from below. On the other hand, this book represents a slightly different approach to identity politics and biopower than the one described by Reynolds Whyte. Whereas her discussion largely pertains to the claims and assertions of difference by minority groups, my research was situated in a context where the practices and identities in question were associated with the ethnic majority but had been devalued in the interests of nation-building. And yet the identities being asserted, formed, and redefined around Chinese food and medicine in Singapore were no less political, and no less implicated in the dynamics and relations of biopower. Although many Singaporeans undoubtedly conformed to the biomedically grounded healthy lifestyle promulgated by the state, the practices of many (also) perpetuated Chinese definitions of cuisine, health, self-care, and social relations passed down through their families and communities. By this point, we hopefully do not need Said’s admonishments of essentialism to realize that Singapore’s ethnic majority do not constitute a homogeneous community. Although the vast majority of 265

Capturing Quicksilver Singaporean Chinese originated from southern China, the cultural and linguistic variety of this region was replicated in Singapore and was, in fact, attended by a fair amount of tension (between dialect groups) during the colonial era. While identities based on native place (e.g., Fujianese) might have organized social life among the Southeast Asian Chinese to a greater extent than among overseas Chinese communities in Europe (Pieke et al. 2004), Singaporean Chinese were nonetheless historically more differentiated than united. Indeed, Singapore’s first “race riots” were not between Chinese and Malay groups (an often-cited justification for a “multiracial” national identity) but, rather, involved what were then referred to as different Chinese tribes (PuruShotam 1998). Thus “ethnic Chinese” does not always carry the same meaning: individuals variably identify this term with their common Chinese heritage, the region and dialect of their lineage, or even their specific ancestral village (Kuah 2000). Additionally, the shortage of Chinese women in early Singapore fostered the development of more permanently settled creolized communities of Straits Chinese (also known as Peranakan Chinese or Babas) that mixed elements of Chinese and Malay or Indian (similarly diverse groups, themselves) culture in their speech, dress, and cuisine. This, of course, further confounds a neat (but ultimately unrealistic) division between Singapore’s primary ethnic groups. Thus, at the level of the individual, the political construct of Chinese as one of four possible “races” in Singapore is as tenuous as its academic counterparts. As mentioned above in the context of the twentieth-century crisis of representation, it is not advisable for anthropologists to speak of their respondents as “Westernized”—lest we perpetuate the Occidentalism proscribed by Rabinow and others, while simultaneously casting “the Orient” as a passive recipient of this reverse-essentialized Euro-American culture. Nonetheless, many Singaporeans used the term “Westernized” (or colloquial versions thereof) to describe their everyday lives, values, social behaviors, and socioeconomic positions relative to Southeast Asian and/or mainland Chinese “Others.” As Malaysian writer Tash Aw reported recently in The New York Times, The visible influence of China in the everyday lives of Singaporeans has sharpened their sense of identity as Singaporean rather than as the 266

Positionality, Power, and the Politics of Representation



descendants of Chinese mainlanders. If the Chinese of Singapore once defined their Chineseness in opposition to Malaysia, today they are distancing themselves from China … But at the Thian Hock Keng temple, as I join other worshipers in preparing traditional offerings of incense, it’s hard for me to think of my surroundings as “not Chinese.” Most Singaporeans I speak to (in Mandarin) still refer to themselves as hua ren, or linked to the customs and traditions of China. Yet in harnessing its ancient heritage to a newer national identity, the Chinese diaspora in Singapore has created a hybrid culture that questions the idea of a single Chinese identity. (Aw 2015)

Hence, as the Singaporean state’s current policies attract more foreign talent and tourists from the PRC, Singaporeans are confronted with significant differences between themselves and contemporary mainland Chinese. If we are to avoid essentializations and reification—academic preferences that were reinforced by encounters of diversity and plurality in my fieldwork—we cannot assume that all Singaporean Chinese share the same sense of history, heritage, and identity. Although popular awareness of identity and ethnicity was a conspicuous feature of contemporary Singaporean life (reflected in a robust literature, popular media, and in conversations I had during my fieldwork), it is not my intention or place to define what either precisely means in Singapore. Accordingly, I have not sought to ascribe a single, multiple, or even variable identity to Singaporean Chinese, but have rather discussed identity politics in terms of shifting political and nationalist ideologies over the past two hundred years. By evoking the connections that Singaporean Chinese maintained with mainland China and their Chinese heritage, I simply intend to call into question what kind of relations (power, social, or otherwise) suffused practices that were consistent with Chinese medicine as historically developed in China. Although there might not be one unified experience of being Singaporean Chinese (regardless of the “race” listed on their identity cards), many of the individuals within this category are nonetheless moored to a common cultural and national identity, produced by shared historical and contemporary conditions of existence. The enduring disposition for things considered Chinese discussed earlier has certainly been subject to government agendas, but it also precedes the current art of government in Singapore. Singaporean history has 267

Capturing Quicksilver

Figure 7.1. Thian Hock Keng Temple (Telok Ayer/historic Chinatown)

been clearly marked by ruptures, erasures, and significant change, but also by continuity. Thus, we might speak of a common heritage that encourages the dispositions of those Singaporean Chinese who observe Chinese ritual festivals, prefer Chinese food, or use Chinese medicine, without essentializing or limiting the internal variety of such a group. Similarly, I have proposed a perspective on Chinese medicine that attends to its multifaceted, permeable, adaptive, and innovative capacities as well as its embedment within life beyond formal medical domains. As mentioned in the introduction, Joseph Alter (2005) also challenges the boundaries that demarcate and restrict analysis of Asian medicine. He suggests that the association of specific medical traditions with singular geopolitical units like the nation-state, not only ignores the permeability of national boundaries but also creates a reified set of practices structured by state priorities. This exclusive demarcation of medical practice—supposedly contained and defined within the borders and political discourses of the nation-state— obscures the historical integration and interrelated development of 268

Positionality, Power, and the Politics of Representation



various forms of medicine through international trade, conquest, religious proselytization, and transnational circulations. Underlying this apparent conflict is the contemporary paradox of nationalism (and nationalized medical practices) viewed in light of increasing transnationalism. Whereas nationalist formulations delineate so-called traditional medical practice as a discrete category with a bounded nation-state, transnational linkages between nation-states and medical practices destabilize these categories. The conflict between these two perspectives becomes most apparent when a practice develops in response to transnational flows and yet is locked into a rhetoric of nationalism that denies these transnational exchanges. Alter is not only interested in the boundaries that are drawn between nation-states and their respective medical practices, but he is also interested in the boundaries that are drawn around medical practice within a given society. Practices and concepts normally assigned to the domain of medicine, he argues, are also linked with other areas of life—from philosophy and religion to sports and war (Alter 2005). Alter is by no means alone in insisting that practices and concepts associated with the realm of medicine—including health, illness, and healing—are also linked with facets and activities of everyday life. Through ethnographic examples of interlocutors’ family and personal histories, domestic spaces, foodways (including common and distinctive foodstuffs), healthcare evaluations, self-care techniques, social relations, and so on, this book has explored the embodied experiences and practices of the individual body, culturally inscribed social body, disciplined body politic, and body ecologic. This wide-angled lens allowed us to situate Chinese medical patients’ and physicians’ practices within a dynamic physical and sociopolitical landscape, with particular attention to the mutual entanglement of (medical) theory and practice with everyday life. Furthermore, a medical domain defined exclusively in terms of the logic of healing (particularly within institutional or clinical settings) often reduces complex healing strategies to biomedically defined questions of efficacy and legitimacy. As Laura Nader (1996b) remarks, Euro-American science is not only engaged in categorizing, ordering, and drawing boundaries in the world around us, but it is also instrumental in categorizing itself in relation to other, excluded, forms of knowledge. These boundaries lend themselves to taxonomy, hierarchy, and the privileging of certain categories and people over 269

Capturing Quicksilver others. Furthermore, she notes, the very act of ordering the world by means of these categories implies a privileged position—in other words, there is a certain authority that goes along with the ability to divide up and order the world (Nader 1996b). This might call to mind Said’s (1979) observation that Europeans’ ability to travel to, study, and represent “the Orient” was both a sign and product of the power dynamics that led to their ability to dominate others. Similarly, scientists’ ability to order the world by means of predetermined categories assumes and perpetuates a sense of domination, or control, over the natural world. Furthermore, having assumed the authority to determine what is and what is not scientific—and, by extension, what is and is not Truth—extends this power into and over the knowledge of the Other. In the process of dividing the world into binaries like nature versus culture, traditional versus modern, and rational versus magical, Nader notes, science came to be understood outside the contexts in which it was produced—viewed as autonomous and separate from society, politics, or economics. Through cross-cultural comparison and ethnography written for a wide audience, anthropologists historically reinforced these boundaries and thus the isolation and elevation of science (Nader 1996b). The contemporary assemblage and status of Chinese medicine visà-vis biomedical standards and authority in Singapore provides an opportunity to examine many of these enduring issues of power asymmetry, but also the fluidity and permeability of medical practice. For instance, we might consider the post-colonial Singaporean state’s construction of a “multiracial” national identity, and their discouragement of Chinese heritage and cultural practices, as part of the nationalist boundary drawing that Alter describes. Chinese medicine was regarded as traditional to China—a discrete category being defined within a bounded nation-state with a very different sociopolitical trajectory than Singapore’s—and was therefore marginalized in favor of a biomedical healthcare system that more effectively represented the nationalist agenda. More recently, however, improved political and economic relations with the PRC and in the region—as well as a burgeoning global market for CAM—have destabilized these nationalist divisions. Perhaps not surprisingly, these post-national neoliberal processes have roughly coincided with Singaporean regulations that resituate the practice in relation to both Singaporean biopower and biomedical or scientific scrutiny. 270

Positionality, Power, and the Politics of Representation



However, the Singaporean state’s attempt to clearly circumscribe and isolate Chinese medicine from biomedicine (and other facets of life) was not so easily managed outside legislation, as illustrated in previous chapters. Furthermore, Chinese medicine’s development in China has been characterized by a diverse, dynamic, often contradictory, and relatively ambiguous set of theories and practices. A long history of innovation in Chinese medical theory and practice (Hsu 2001), as well as the practical accommodations physicians must make while operating within a biomedical healthcare system (e.g., to patient expectations, as discussed by Scheid 2002) complicate efforts to quarantine it from other medical practices. Although the physicians with whom I worked maintained the mandated physical separation of Chinese medical practice and products from biomedical practice and products, overlap between the two manifested in other ways. For example, Singaporean Chinese medical patients carefully combined the two in managing their health, and the health of their families. Although a few Singaporeans with whom I spoke emphasized the supposed incompatibility of Chinese medicine and biomedicine, the majority stated that they could be used concurrently as long as they were consumed three to four hours apart. Beyond the metabolic processes and harmonious (or disharmonious) transformations of patients’ bodies, I observed Singaporean Chinese medical physicians incorporate biomedical nosology, terminology, diagnostics, and equipment into their practice and research. Additionally, Chinese medical physicians, researchers, and entrepreneurs used “Western” epistemology and empiricism to demonstrate the efficacy of particular treatments. Finally, laboratory research of Chinese materia medica—whether conducted under the auspices of Nanyang Technological University’s double-degree program or by the transnational Chinese medical company Eu Yan Sang—also traversed these boundaries in the interests of herb authentication and public safety. Thus, as suggested by Alter and Nader, the boundaries drawn between techno-science and other forms of knowledge like Chinese medicine are often highly permeable. Chinese medicine is increasingly being redefined, both within and outside the territorial boundaries of the PRC, transforming and reassembling in response to transnational flows of people, products, and knowledge and multilateral exchanges with other medical practices. Mei Zhan (2009) refers to this as the worlding of Chinese medicine: 271

Capturing Quicksilver a series of translocal movements, displacements, and reformulations. These transnational flows do not simply move Chinese medicine from one location to another, but instead transform its theory, practice, and authority (as conceived locally and, to some extent, globally) through various linkages and disjunctures. As the dynamic status of Chinese medicine in Singapore suggests, these processes emerge somewhat in tension, and somewhat in conjunction, with EuroAmerican modernization discourses and scientific epistemology. The implications of these negotiations and reformulations extend beyond problematizing authority and heritage in a singular sociopolitical milieu, however, and instead suggest Chinese medicine’s transnational creative capacity within much broader fields of exchange.

Where Do We Go from Here? As I mentioned briefly in the introduction, in 2014 I taught for a study abroad program that facilitated cross-cultural exploration of issues relating to health, illness, medicine, and community by traveling with undergraduate students to four countries over the course of a single semester. In Hanoi we learned about Vietnamese history, epidemiology, the healthcare system, and traditional Vietnamese medicine (among other topics) from local experts and community members at Hanoi Medical College. One afternoon a college administrator presented a lecture on the history, foundation, and utility of traditional Vietnamese medicine. Struck by uncanny similarities to Daoist philosophy and Chinese medical theory, I asked if she could tell us a bit more about where these ideas came from (she had referred, for example, to what she called the important Vietnamese concepts of yinyang and “five elements”). Briskly, and much to my surprise, the speaker referenced a very vague “Oriental philosophy” and moved on to the next question. Quite unsatisfied with this answer, and somewhat confounded by her neo-Orientalist language, I subsequently spoke with a traditional Vietnamese medicine physician at the college to see if he could shed more light on the relationship between “traditional” Chinese and Vietnamese medicines. Alas, while he acknowledged that my understanding of yinyang and wuxing was consistent with traditional Vietnamese medical theory, he would not comment on its relationship to Chinese medicine either. Although I did not have 272

Positionality, Power, and the Politics of Representation



the opportunity to explore the issue further before we departed for South Africa (the next country on our itinerary), I continued to puzzle over this apparent aversion to discuss traditional Vietnamese medicine in relation to Chinese medicine. Perhaps, I speculated, the complex history of Chinese culture and imperialism in Vietnam—or more recent nationalist projects to define their own, distinct traditional medicine—played a role in this lack of acknowledgment. Over the subsequent year I participated in several academic gatherings organized around the theme of Asian science and medicines—namely, a large conference in Paris and then a smaller workshop in Singapore. Among other inspiring and fascinating topics discussed at these events, I found my attention drawn to additional examples of the conflicted relationship between Chinese medicine and other nonbiomedical practices, such as Vietnamese and Tibetan medicine. I began to wonder if I had not quite grasped some larger, vital perspective on Chinese medicine. Might my failure to examine Chinese medicine with respect to other nonbiomedical practices have produced a blind spot to the former’s possible role as a hegemon (particularly in light of regulations imposed on Tibetan medicine and Chinese soft power elsewhere)? To what extent was my interest in the counterhegemonic possibilities of Chinese medicine—contra biomedical hegemony—a bias of postcolonial and postmodern anthropological critique that obscured other social relations? Writing at the end of the twentieth century, Robyn Kliger notes the “current intellectual zeitgeist” in which resistance is valorized in order to empower the post-colonial subject (Kliger 1996: 137). She accounts for the increased emphasis on human agency by (1) reviewing the models of resistance proposed by Frantz Fanon, Karl Marx, and Sigmund Freud; (2) critiquing medical anthropology’s association between somatization and resistance; and (3) elucidating the role of postmodernity and post-colonial guilt in this epistemic shift. Within certain medical anthropological analyses, she notes, bodily praxis—particularly somatization—is often seen as a form of resistance: “Power and repression are decoupled; in this instance, power produces resistance in somatic forms” (Kliger 1996: 147). The body, she notes, thus becomes a trope on which theories can be imposed. For example, citing Arthur Kleinman’s (1986) differentiation between somatic expression in Chinese medical contexts and psychological expression in industrialized (“Western”) contexts, she 273

Capturing Quicksilver questions the equation of somatization with resistance in societies where the former is a dominant mode of expression. Reminding us that both somatization and resistance are culturally and historically specific, she concludes that the widespread interpretation of practice in terms of micro-strategies of resistance might better reflect the postmodern attempt to restore dignity to post-colonial subjects than the latter’s own definitions of power and resistance. Similarly, Jeremy Narby (1999) succinctly summarizes how the anthropological study of shamanism reflected disciplinary priorities and biases over time: When anthropology was a young science, unsure of its own identity and unaware of the schizophrenic nature of its own methodology, it considered shamans to be mentally ill. When “structuralist” anthropology claimed to have attained the rank of science, and anthropologists busied themselves finding order in order, shamans became creators of order. When the discipline went into a “poststructuralist” identity crisis, unable to decide whether it was a science or a form of interpretation, shamans started exercising all kinds of professions [e.g., physicians, pharmacologists, priests and so on]. Finally, some anthropologists began questioning their discipline’s obsessive search for order, and they saw shamans as those whose power lies in “insistently questioning and undermining the search for order.” It would seem, then, that the reality hiding behind the concept of “shamanism” reflects the anthropologist’s gaze, independently of its angle. (Narby 1999: 16)

Bearing these parallels in mind we might conclude that while the critical turn in postcolonial anthropology has provided a crucial impetus for examining power relations, avoiding essentialism, and confronting the implicit assumptions of one’s own background, one must apply the technique judiciously. The disciplinary lineage I described above, and throughout this book, guided my training as a student of anthropology, and inspired the critical medical anthropology approach I adopted in my research. On the one hand, the reflexive turn inspired me to think critically about the standards and values that underpinned my evaluation of difference and to be cautious in my interpretations and representations of the Other. As I tried to convey to my colearners over the years I taught anthropology courses, this process can show us a great deal about our Selves (in both the personal or possessive and 274

Positionality, Power, and the Politics of Representation



the abstract senses) and the sociohistorical lenses through which we observe and engage the world. On the other hand, this process also raised a number of outstanding issues regarding disciplinary priorities and our responsibilities to the people with whom we work. For instance, if mid-twentieth century reflexive anthropologists were able to demonstrate the discipline’s complicity in colonial power relations only in retrospect, what conditions and asymmetries might currently enable twenty-first-century anthropology? Furthermore, what are we to make of, or to do with, the naturalized concepts we have deconstructed? Take, for example, the deconstruction of “Western” versus “Eastern,” and “traditional” versus “modern” binaries in academic discourse. As described previously, Edward Said demonstrated how so-called Western representations of “the Orient” were problematic insofar as they failed to represent the Other in their own terms and instead produced representations that reflected “Occidental” agendas and imaginations. In addition to their ethnocentrism and inaccuracy, Said explains, these constructions facilitated the domination of “the Orient.” Similarly, as Charles Leslie and Allan Young (1992) describe, the designation of Asian medicine as traditional often implies inferiority. This, they explain, is because (by contrast) so-called modern medicine “embodies an ontologically privileged understanding of the world and because it represents the victory of reason and pragmatism over culture and tradition” (Leslie and Young 1992: 3). While scholars and other individuals speaking from a postmodern positionality might reject these binaries as an extension of asymmetrical power relations, many of the people and communities with whom we work cite the benefits of aligning their projects and practices with what they regard as modernity or—on the other hand—differentiating their practices from “Western” approaches. Are their practices any less authentic for this pragmatic approach and, perhaps more importantly, who are we judge them so? In this context, our insistence that “traditional” is an inaccurate label and that “modernity” is a hegemonic concept sets us at odds with people, and practices, that are more flexible and more adaptable than we often acknowledge. It also raises another controversial question: If many of the people performing dynamic practices are interested in rejecting, adapting, or otherwise changing their enactments in order to negotiate current conditions of existence, why do we (as 275

Capturing Quicksilver anthropologists) continue to highlight efforts to preserve, conserve, and maintain? In other words, what is the value of cultural conservation, and according to whom? By the beginning of the twenty-first century, sinologists, anthropologists, and others cited Chinese medicine’s adaptability, variability, and permeability to other medical traditions (e.g., Hsu and Høg 2002; Scheid 2002; Zhan 2009). Such analyses challenged not only biomedical monism, but also the description of medical theory and practice in terms of static, reified systems. Yet, there appears to be utility in accommodating dominant (or dominating) epistemologies and their associated signs of Euro-centric modernity, as several generations of physicians and politicians in East and Southeast Asia have suggested. Hence, the viability of Chinese medicine is often negotiated with particular emphasis on its systematic and biomedically commensurate aspects, without abandoning its “traditional” basis and cultural authority. Chinese medicine is thus simultaneously “modern” and “traditional” in a most fashionably metamodern way. Thus, we place quotation marks around problematic terms like “traditional,” “modern,” and “Western” while nonetheless recognizing their unresolved persistence in emic discourses. We evoke the “modern” that we seek to critique by debating alternative modernities, and we enact biomedical hegemony by focusing on the continued displacement of traditional medicine or its subjugated repositioning and commodifcation as CAM. Having explored the negotiation of Chinese medicine and heritage in the midst of Singapore’s mercurial socioeconomic and political milieu, I have concluded that Singaporean governmentality has retained many features of its colonial legacy, including discourses of the nation-state, nationalism, modernity, and biopower. Nonetheless, to interpret the practice or use of nonbiomedical treatments and/or bodily experiences simply as resistance (e.g., to biomedical hegemony or an authoritarian state that facilitates it) would be incomplete at best, particularly in light of the state’s increased regulatory cooption of Chinese medicine. Furthermore, the uncritical ascription of resistance sidesteps the continuity between practices and materials associated with Chinese medicine and the naturalized practices and dispositions of Singaporean Chinese. It simultaneously ignores the considerable interaction and exchange between Chinese medicine and biomedicine, reasserting a politically motivated, nonpermeable 276

Positionality, Power, and the Politics of Representation



boundary between the two against which resistance is applied (on one side or the other). As Rabinow, Narby, and Kliger suggest, we must recall the sociohistorical context in which deconstructions and reflexivity came into vogue in the first place. Situating people and processes within a familiar trajectory and set of relations (e.g., colonialism to post-colonialism to neo-colonialism) might render subjects knowable, but it also risks projecting prevailing tropes onto the complex and variable fields we observe. By limiting interpretation of the practice or use of Chinese medicine to a framework of power and resistance, I suggest, we are replicating the very construction of biomedicine, or “Western” culture, as the standard of comparison that self-reflexive anthropology sought to redress. In other words, by denying Chinese medical physicians, druggists, entrepreneurs, caretakers, and patients the capacity to creatively generate practice, we analytically perpetuate the subordination of Chinese medicine to biomedical hegemony. And yet, by exclusively focusing on these creative negotiations and permeable boundaries, at the expense of lateral power relations (e.g., the assertion of Chinese medicine as the standard for other nonbiomedical practices to follow) we risk valorizing a complex, fluid, and multifaceted practice with its own hegemonic capacity.

Note 1. In her distinguished lecturer speech at the American Anthropological Association annual meeting in 2000, Professor Laura Nader described this notion of inevitable progress as one that discourages looking backward as we advance through time in a supposedly linear trajectory (Nader 2001).

277

Glossary of Transliterated Mandarin Chinese Terms

eight rubrics peony root (Paeonia lactifiora) largehead atractylodes (Atractylodes macrocephala) bang dialect/native place association Bazhen Tang Eight Treasures Soup bianzheng syndrome differentiation bingyin illness factors bu tonifying bufa tonification method bupin tonifying materials butong congestion cai side dish chengyao ready-to-use herbal preparations chuantong traditional chuanxiong Sichuan lovage (Lingusticum wallichii) daizao jujube (Ziziphus jujuba) damai Chinese barley (Hordeum vulgare) danggui Chinese angelica (Angelica sinensis) dangshen bellflower/poor man’s ginseng (Codonopsis pilosula) di earth Dihuang Dunji Tang Emperor’s Stewed Chicken Soup dongchong xiacao cordyceps (Cordyceps sinensis) donggua winter melon (Benincasa hispida) dongwu shiyan experimentation on animals erzhen ear acupuncture fan rice; staple starch bagang baishao baizhu

278

Glossary



(Chinese medical) individualized prescriptions feng wind; pathogenic wind; chill fu/fuzhu supporting fushen/fuling China root (Poria cocos) fuzhuren yishi head physician gan liver gancao Chinese licorice (Glycyrrhiza uralensis) ganhuo shangni liver fire and hyperactivity ganmao cha tea for the flu gao oil mixture gaolishen Korean ginseng (Panax ginseng) getai song stage goujizi wolfberry (Lycium chinense, Fructus Lychii) gui ghost guijie (Hungry) Ghost festival han cold hongbao red packet; small red envelope, often containing money hongzao red date/Chinese jujube (Fructus Zhziphus jujuba) huajiao dried air bladders of fish Huangdi Neijing Yellow Emperor’s Inner Cannon jiaozi dumpling jing essence jingluo circulatory tracts and channels jingqi essential qi jingshen vital spirit; vitality; energy level jingyan experience jingyanfang tested and respected formula jinyinhua honeysuckle flower (Lonicera japonica) jiu alcoholic drink juhua chrysanthemum (Chrysanthemum morifolium) junchen monarch-minister kanbing looking at illness lajiao chilies (Capsicum annuum) laozhongyi senior Chinese medical physician liangcha cooling tea fangji

279

Glossary Ling Shu lingyangjiao lingyangsi cha lingzhi liujing liulian longyan ludou luohanguo

The Spiritual Pivot antelope horn (Cornu Antelopis) antelope horn tea Reishi mushroom (Ganoderma lucidum) six warps durian fruit (Durio zibethinus) longan fruit (Dimocarpus longan) green/mung bean (Cadelium radiatum) Buddha’s disciple/Arhat fruit (Siraitia grosvenorii) luohuasheng peanuts (Arachis hypogaea) lurong deer horn (Cornu cervi) mangguo mango (Mangifera indica) Mingmu Tang Clear Vision Soup Nanyang south ocean or south seas (Southeast Asia) Niucheshui oxcart water (Chinatown) ou lotus root (Nelumbo nucifera) pa leng aversion to cold paoshen adenophora (Adenophora tetraphylla) Paoshen Tang Paoshen Soup pugongying dandelion (Taraxacum officinale) Putonghua common speech; Mandarin Chinese qi qi (fundamental substance/force); air; mist; vapor qigong self-cultivation practice of movement and breathing re heat rebing illness caused by heat renshen Chinese ginseng (Panax ginseng) Renshen Dunji Tang Ginseng Stewed Chicken Soup renti jingyan (clinical) experience with the human body san powder shen spirit shi emissary shudi Chinese foxglove (Rehmannia glutinosa) shure summerheat sizhen four examinations taijiquan internal martial art practice tang decoction; soup 280

Glossary

tian tiankuizi



sky semiquilegia root (Semiaquilegiae adoxoides) tizhi constitution tuina massage wan pill Wanjin You Ten Thousand Golden Oils (Tiger Balm) weiqi yingxue four sectors Wuwei Xiaodu Yin Decoction of Five Detoxicants wuxing five phases or agents (namely wood, fire, earth, metal, and water) Wuzhou Da Yaofang Great Five Continents Drugstores xian salty xiansheng gentleman; mister xie evil; heterodox; pathogenic xigua watermelon (Momordica lanata) xijiao rhinoceros horn (Cornu Rhinoceri) xin heart xiyangshen Western (American) ginseng (Panax quinquefolium) xiyi Western medicine xue blood yanwo swallow’s nest (Aerodramus fuciphagus or Aerodramus maximus) yang luohanguo mangosteen (Garcinia mangostana) yangsheng nurturing life (techniques) yezi young coconut water (Cocos nucifera) yin er silver ear fungus (Tremella fuciformis) yinyang abstract archetypical concept yinyang wuxing xueshuo the doctrines of yinyang and wuxing yisheng doctor yiyuan hospital yuan yuan (base unit of contemporary Chinese currency) yusheng raw fish salad zangfu organs, or visceral systems of function zheng upright; proper; orthodox zhenjiushi acupuncturist zhenzhumu pearl shell (Concha Margaritifera usta) 281

Glossary Chinese formula drugs Chinese medical drugs Chinese medicine; Chinese medical physician zhongyiyao Chinese (general) medicine zhongyishi Chinese medical physician zhu ruling zhuzhe sugar cane juice (Saccharum sinense) zihua diding viola/purple ground-nail (Viola yedoensis) zuo assistant zhongchengyao zhongyao zhongyi

282

Bibliography

Ahern, Emily M. 1975. “Chinese-style and Western-style Doctors in Northern Taiwan.” In Kleinman, Kunstadter, Alexander, and Gale, Medicine in Chinese Cultures, 209–18. Alter, Joseph (ed.). 2005. Asian Medicine and Globalization. Philadelphia, PA: University of Pennsylvania Press. Anderson, Benedict. 1991. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso. Anderson, Eugene N. 1987. “Why Is Humoral Medicine So Popular?” Social Science and Medicine 25 (4): 331–37. Anderson, Eugene N., and Marja L. Anderson. 1977. “Modern China: South.” In Chang, Food in Chinese Culture, 317–82. Asad, Talal (ed.). 1973. Anthropology and the Colonial Encounter. London: Ithaca Press. Aw, Tash. 2015. “Being Chinese in Singapore.” New York Times, February 13, Op-Ed. Banks, Marcus. 1996. Ethnicity: Anthropological Constructions. New York: Routledge. Barnes, Linda L. 1998. “The Psychologizing of Chinese Healing Practices in the United States.” Culture, Medicine and Psychiatry 22 (4): 413–43. Bates, Don. 1995. “Scholarly Ways of Knowing: An introduction.” In Knowledge and the Scholarly Medical Traditions, edited by Don Bates (1–22). Cambridge, UK: Cambridge University Press. Beck, Ulrich, and Natan Sznaider. 2006. “Unpacking Cosmopolitanism for the Social Sciences: A Research Agenda.” The British Journal of Sociology 57 (1): 1–23. Beckerleg, Susan. 1994. “Medical Pluralism and Islam in Swahili Communities in Kenya.” Medical Anthropology Quarterly 8 (3): 299–313. Best, Steven, and Douglas Kellner. 2001. The Postmodern Adventure: Science, Technology, and Cultural Studies at the Third Millennium. New York: Guilford Press. Bibeau, Gilles, and Duncan Pedersen. 2002. “A Return to Scientific Racism in Medical Social Sciences: The Case of Sexuality and the AIDS Epidemic in Africa.” In Nichter and Lock, New Horizons in Medical Anthropology, 141–71.

283

Bibliography Biehl, João, Bryon Good, and Arthur Kleinman (eds.). 2007. Subjectivity: Ethnographic Investigations. Berkeley, CA: University of California Press. Bodeker, Gerard, and Fredi Kronenberg. 2002. “A Public Health Agenda for Traditional, Complementary, and Alternative Medicine.” American Journal of Health 92 (10): 1582–91. Borthwick, Sally. 1988. “Chinese Education and Identity in Singapore.” In Cushman and Wang, Changing Identities of the Southeast Asian Chinese, 35–59. Bourdieu, Pierre. (1979) 1984. Distinction: A Social Critique of the Judgement of Taste. London: Routledge and Kegan Paul. ———. (1980) 1990. The Logic of Practice. Stanford, CA: Stanford University Press. Brownell, Susan. 2005. “China reconstructs: cosmetic surgery and nationalism in the reform era.” In Alter, Asian Medicine and Globalization, 132–50. Buell, Paul, and Eugene N. Anderson. 2000. A Soup for the Qan. London: Kegan Paul International. Cant, Sarah, and Ursula Sharma. 2003. A New Medical Pluralism?: Alternative Medicine, Doctors, Patients and the State. London: Routledge. Carstens, Sharon. 1988. “Chinese Publications and the Transformation of Chinese Culture in Singapore and Malaya.” In Cushman and Wang, Changing Identities of the Southeast Asian Chinese, 75–95. Chandroo, Thirumalai. 2006. “Enabling the Disabled.” Business Times Singapore, December 11. Chang, Kwang-Chih (ed.). 1977. Food in Chinese Culture: Anthropological and Historical Perspectives. New Haven, CT: Yale University Press. Charney, Michael, Brenda Yeoh, and Tong Chee Kiong (eds.). 2003. Chinese Migrants Abroad: Cultural, Educational, and Social Dimensions of the Chinese Diaspora. Singapore: Singapore University Press. Chau, Adam Yuet. 2008. “The Sensorial Production of the Social.” Ethnos 73 (4): 485–504. Chiew Seen Kong. 2002. “Chinese Singaporeans: Three Decades of Progress and Change.” In Ethnic Chinese in Singapore and Malaysia: A Dialogue between Tradition and Modernity, edited by Leo Suryadinata (11–44). Singapore: Times Academic Press Chua Beng Huat. 1990. “The Business of Living in Singapore.” In Management of Success: The Moulding of Modern Singapore, edited by Kernial Singh Sandhu and Paul Wheatley (1003–21). Singapore: Institute of Southeast Asian Studies. ———. 1995. “That Imagined Space: Nostalgia for Kampungs.” In Portraits of Places: History, Community and Identity in Singapore, edited by Brenda Yeoh and Lily Kong (222–41). Singapore: Times Editions. Chua Beng Huat, and Ananda Rajah. 2001. “Hybridity, Ethnicity and Food in Singapore.” In Changing Chinese Foodways in Asia, edited by David Y. H. Wu and Tan Chee-beng (161–97). Hong Kong: Chinese University Press.

284

Bibliography



Clancey, Gregory. 2012. “Intelligent Island to Biopolis: Smart Minds, Sick Bodies and Millennial Turns in Singapore.” Science, Technology and Society 17 (1): 13–35. Cochran, Sherman. 2006. Chinese Medicine Men: Consumer Culture in China and Southeast Asia. Cambridge, MA: Harvard University Press. Collier, Stephen, and Aihwa Ong. 2005. “Global Assemblages, Anthropological Problems.” In Ong and Collier, Global Assemblages, 3–21. Comaroff, John, and Jean Comaroff. 1997. “Postcolonial Politics and Discourses of Democracy in Southern Africa: An Anthropological Reflection on African Political Modernities.” Journal of Anthropological Research 53 (2): 123–46. Croizier, Ralph. 1976. “The Ideology of Medical Revivalism in Modern China.” In Leslie, Asian Medical Systems, 341–55. Csordas, Thomas. 1993. “Somatic Modes of Attention.” Cultural Anthropology 8: 135–56. ——— (ed.). 1994a. Embodiment and Experience: The Existential Ground of Culture and Self. Cambridge, UK: Cambridge University Press. ———. 1994b. “Introduction: The Body as Representation and Being-in-theworld.” In Csordas, Embodiment and Experience, 1–24. Cullen, Lisa Takeuchi. 2002. “Asia’s Killer Diet Pills.” Time, August 5. Cushman, Jennifer, and Wang Gungwu (eds.). 1988. Changing Identities of the Southeast Asian Chinese since World War II. Hong Kong: Hong Kong University Press. Delamont, Sara. 1995. Appetites and Identities: An Introduction to the Social Anthropology of Western Europe. London: Routledge. Devan, Janadas. 1999. “Forgetting to Remember.” In Kwok, Kwa, Kong, and Yeoh, Our Place in Time, 21–33. Douglas, Mary. 1970. Natural Symbols: Explorations in Cosmology. London: Barrie and Rockliff, Cresset Press. Ecks, Stefan. 2004. “Bodily Sovereignty as Political Sovereignty: ‘Self-care’ in Kolkata, India.” Anthropology and Medicine 11 (1): 75–89. Eisenberg, David, Ronald C. Kessler, Cindy Foster, Frances E. Norlock, David R. Calkins and Thomas L. Delbanco. 1993. “Unconventional Medicine in the United States: Prevalence, Costs and Patterns of Use.” New England Journal of Medicine 328 (4): 246–52. Engelhardt, Ute. 2001. “Dietetics in Tang China and the First Extant Works of Materia Dietetic.” In Hsu, Innovation in Chinese Medicine, 173–91. Eriksen, Thomas. 2002. Ethnicity and Nationalism: Anthropological Perspectives. London: Pluto Press. Ernst, Edzard. 2000. “Prevalence of Use of Complementary/Alternative Medicine: A Systematic Review.” Bull World Health Organization 78 (2): 252–57. Farmer, Paul. 1999. Infections and Inequalities: The Modern Plagues. Berkeley, CA: University of California Press. ———. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA: University of California Press. Farquhar, Judith. 1987. “Problems of Knowledge in Contemporary Chinese Medical Discourse.” Social Science and Medicine 24 (12): 1013–21. 285

Bibliography ———. 1994. Knowing Practice: The Clinical Encounter of Chinese Medicine. Oxford, UK: Westview Press. ———. 2002. Appetites: Food and Sex in Post-Socialist China. Durham, NC, and London: Duke University Press. Fassil, Hareya. 2005. “Beyond Plants, Professionals and Parchments: The Role of Home-based Medicinal Plant Use and Traditional Health Knowledge in Primary Health Care in Ethiopia.” Ethnobotany Research and Applications 3: 37–49. Faulkenberg, Torkel. 2012. “Chapter 5: Traditional and Complementary Medicine Policy.” In MDS-3: Managing Access to Medicines and Health Technologies, ed. Martha Embrey and Marian Ryan (5.0–5.17). Geneva: World Health Organization. Fenster, Julie. 2003. Mavericks, Miracles and Medicine Men: The Pioneers Who Risked Their Lives to Bring Medicine into the Modern Age. New York: Carroll and Graf. Ferguson, Priscilla. 1998. “A Cultural Field in the Making: Gastronomy in 19th-century France.” American Journal of Sociology 104 (3): 597–641. Ferzacca, Steve. 2002. “Governing Bodies in New Order Indonesia.” In Nichter and Lock, New Horizons in Medical Anthropology, 35–57. Feyerabend, Paul. 1978. Science in a Free Society. London: NLB. Finkler, Kaja. 1984. “The Nonsharing of Medical Knowledge among Spiritualist Healers and Their Patients: A Contribution to the Study of Intra-cultural Diversity and Practitioner–patient Relationship.” Medical Anthropology 8 (3): 195–209. Fischer, Michael. 2013: “Biopolis: Asian Science in the Global Circuitry.” Science, Technology and Society 18 (3): 379–404. Foucault, Michel. 1982. “The Subject and Power.” Critical Inquiry 8 (4): 777–95. ———. 1984a. “Truth and Power.” In Rabinow, The Foucault Reader, 51–76. ———. 1984b. “The Politics of Health in the Eighteenth Century.” In Rabinow, The Foucault Reader, 273–89. ———. (1986) 1988. The Care of the Self: The History of Sexuality, vol. 3. New York: Vintage Books. ———. (1976) 1990. The History of Sexuality: An Introduction. New York: Vintage Books. ———. 1991. “Governmentality.” In Burchell, Gordon, and Miller, The Foucault Effect, 87–104. ———. (1975) 1995. Discipline and Punish: The Birth of the Prison. New York: Vintage Books. Gardner, Katy, and David Lewis. 1996. Anthropology, Development and the Postmodern Challenge. London; Chicago, IL: Pluto Press. Geertz, Clifford. (1973) 1993. The Interpretation of Cultures: Selected Essays. New York: Basic Books. Good, Byron. 1994. Medicine, Rationality and Experience: An Anthropological Perspective. Cambridge, UK: Cambridge University Press.

286

Bibliography



Gordon, Colin. 1991. “Governmental rationality: an introduction.” In Burchell, Gordon, and Miller, The Foucault Effect, 1–51. Gould, Harold. 1977. “Modern Medicine and Folk Cognition in Rural India.” In Culture, Disease and Healing: Studies in Medical Anthropology, edited by David Landy (249–305). New York: Macmillan. Gould-Martin, Katherine. 1975. “Medical Systems in a Taiwan Village.” In Kleinman et al., Medicine in Chinese Cultures, 115–42. Grice, Kevin, and David Drakakas-Smith. 1985. “The Role of the State in Shaping Development: Two Decades of Growth in Singapore.” Transactions of the Institute of British Geographers 10 (3): 347–59. Habermas, Jurgen. 1992. “Modernity: An Unfinished Project.” In The PostModern Reader, edited by Charles Jencks (162–63). New York: St. Martin’s Press. Haraway, Donna. 1997. Modest_Witness@Second_Millennium. FemaleMan©_ Meets_OncoMouse™: Feminism and Technoscience. New York: Routledge. Hahn, Robert, and Arthur Kleinman. 1983. “Biomedical Practice and Anthropological Theory: Frameworks and Directions.” Annual Review of Anthropology 12: 305–33. Hare, Martha. 1993. “The Emergence of an Urban U.S. Chinese Medicine.” Medical Anthropology Quarterly 7 (1): 30–49. Heng, Geraldine, and Janadas Devan. 1992. “State fatherhood: the politics of nationalism, sexuality, and race in Singapore.” In Nationalisms and Sexualities, edited by Andrew Parker, Mary Russo, Doris Sommer, and Patricia Yaeger (343–64). New York; London: Routledge. Ho Hua Chew. 1999. “The Place of Nature in Singapore.” In Kwok, Kwa, Kong, and Yeoh, Our Place in Time (156–77). Hobsbawm, Eric. 1983. “Introduction: Inventing Traditions.” In The Invention of Tradition, edited by Eric Hobsbawm and Terence Ranger (1–14). Cambridge, UK: Cambridge University Press. House of Lords. 2000. “House of Lords Select Committee on Science and Technology. Complementary and Alternative Medicine, Session 1999–2000 6th Report.” Stationary Office, London. Howes, David (ed.). 2005. Empire of the Senses: The Sensual Culture Reader. Oxford; New York: Berg. Hsu, Elisabeth. 1992. “The Reception of Western Medicine in China: Examples from Yunnan.” In Science and Empires: Historical Studies about Scientific Development and European Expansion (Boston Studies in the Philosophy of Science), edited by Patrick Petitjean, Catherine Jami, and Anne Marie Moulin (89–101). Dordrecht, Netherlands: Kluwer. ———. 1995. “The manikin in man: cultural crossing and creativity.” In Syncretism and the Commerce of Symbols, edited by Göran Aijmer (156–204). Göteborg, Sweden: Institute for Advanced Studies in Social Anthropology. ———. 1999. The Transmission of Chinese Medicine. Cambridge, UK: Cambridge University Press. ———. 2000. “Spirit (shen), Styles of Knowing, and Authority in Contemporary Chinese Medicine.” Culture, Medicine and Psychiatry 24: 197–229. 287

Bibliography ———. (ed.). 2001. Innovation in Chinese Medicine. Cambridge, UK: Cambridge University Press. ———. 2002. “‘The Medicine from China Has Rapid Effects’: Chinese Medicine Patients in Tanzania.” Anthropology and Medicine 9 (3): 291–313. ———. 2007. “The Biological in the Cultural: The Five Agents and the Body Ecologic in Chinese Medicine.” In Holistic Anthropology: Emergence and Convergence, edited by David Parkin and Stanley Ulijaszek (91–126). New York, Oxford: Berghahn Books. ———. 2008. “Medical Pluralism.” In International Encyclopedia of Public Health 4, edited by Kris Heggenhougen and Stella Quah (316–21). San Diego: Academic Press. ———. 2009a. “Wonders of the Exotic: Chinese Formula Medicines on the East African Coast.” In Knowledge, Renewal and Religion: Repositioning and Changing Ideological and Material Circumstances among the Swahili on the East African Coast, edited by Kjersti Larsen (280–99). Uppsala, Sweden: Nordiska Afrikainstitutet. ———. 2009b. “Chinese Proprietary Medicines: An ‘Alternative Modernity?’ The Case of the Anti-malarial Substance Artemisinin in East Africa.” Medical Anthropology: Cross Cultural Studies in Health and Illness 28 (2): 111–40. Hsu, Elisabeth, and Erling Høg (eds.). 2002. “Countervailing Creativity: Patient Agency in the Globalisation of Asian Medicines.” Anthropology and Medicine 9 (3) 205–18. Hsu, Vera, and Francis Hsu. 1977. “Modern China: North.” In Chang, Food in Chinese Culture, 295–316. Hu, Shiu-ying. 2005. Food Plants of China. Hong Kong: Chinese University of Hong Kong. Huang Jianli, and Lysa Hong. 2007. “Chinese Diasporic Culture and National Identity: The Taming of the Tiger Balm Gardens in Singapore.” Modern Asian Studies 41 (1): 41–76. Hutchinson, John, and Anthony Smith (eds.). 1994: Nationalism. Oxford, UK: Oxford University Press. Huxley, Aldous. (1932) 1998. Brave New World. HarperCollins: New York. Janes, Craig. 2002. “Buddhism, Science and the Market: The Globalisation of Tibetan Medicine.” Anthropology and Medicine 9 (3): 267–89. Kleinman, Arthur. 1980. Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine and Psychiatry. Berkeley, CA: University of California Press. ———. 1986. Social Origins of Distress and Disease. New Haven, CT: Yale University Press. ———. 1992. “Pain and Resistance: The Delegitimation and Relegitimation of Local Worlds.” In Pain as Human Experience: An Anthropological Perspective, edited by Mary-Jo Delvecchio Good, Byron Good, Paul Brodwin, and Arthur Kleinman (169–97). Berkeley and Los Angeles, CA: University of California Press.

288

Bibliography



Kleinman, Arthur, Leon Eisenberg, and Byron Good. 2006. “Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-cultural Research.” Focus 4: 140–49. Kleinman, Arthur, Peter Kunstadter, E. Russell Alexander, and James Gale. 1975. Medicine in Chinese Cultures. Bethesda, MD: Fogarty International Center, National Institutes of Health. Kliger, Robyn. 1996. “‘Resisting Resistance’: Historicizing Contemporary Models of Agency.” Kroeber Anthropological Society Papers 80: 137–56. Kong, James Chin. 2003. “Multiple Identities among the Returned Overseas Chinese in Hong Kong.” In Charney, Yeoh, and Tong, Chinese Migrants Abroad, 63–82. Kong, Lily. 2001. “Culture and Urbanisation: Selected Perspectives from Singapore.” In Osman, Cultures in ASEAN and the 21st Century, 113–25. Kuah Khun Eng. 2000. Rebuilding the Ancestral Village: Singaporeans in China. Hants, UK: Ashgate Publishing. Kuan Kwee Jee. 1988. “Environmental Improvement in Singapore.” Ambio 17 (3): 233–37. Kuper, Adam. 1996. Anthropology and Anthropologists: The Modern British School. London; New York: Routledge. Kwa Chong Guang. 1999. “Remembering Ourselves.” In Kwok, Kwa, Kong, and Yeoh, Our Place in Time, 47–58. Kwok Kian-Woon. 1999. “The Social Architect: Goh Keng Swee.” In Lee’s Lieutenants: Singapore’s Old Guard, edited by Lam Peng-er and Kevin Y. L. Tan (45–69). St. Leonards: Allen and Unwin. Kwok Kian-Woon, Kwa Chong Guan, Lily Kong, and Brenda Yeoh (eds.). 1999. Our Place in Time: Exploring Heritage and Memory in Singapore. Singapore: Singapore Heritage Society. Laderman, Carol. 1981. “Symbolic and Empirical Reality: A New Approach to the Analysis of Food Avoidances.” American Ethnologist 8: 468–93. Law, Lisa. 2005. “Home Cooking: Filipino Women and Geographies of the sSenses in Hong Kong.” In Howes, Empire of the Senses, 224–41. Leader-Williams, Nigel. 1992. The World Trade in Rhino Horn: A Review. Traffic Network report. Cambridge, UK: Traffic International and the People’s Trust for Endangered Species. Lee Guan Kim. 2003. “Singapore Chinese Society in Transition: Reflections on the Cultural Implications of Modern Education.” In Charney, Yeoh, and Tong, Chinese Migrants Abroad, 229–51. Lee Kuan Yew. 2000. From Third World to First: the Singapore Story, 1965– 2000. New York: HarperCollins. Lee Tat-Leang. 2006. “Complementary and Alternative Medicine, and Traditional Chinese Medicine: Time for Critical Engagement.” Annals Academy of Medicine Singapore 35 (11): 749–52. Leh, Charles Mu. 1993. A Guide to Birds’ Nests Caves and Birds’ Nests of Sarawak. Kuching, Sarawak: Lee Ming Press. Lei, Sean Hsiang-lin. 2002. “How Did Chinese Medicine Become Experiential? The Political Epistemology of Jingyan.” Positions 10 (2): 333–64. 289

Bibliography Leslie, Charles (ed.). 1976. Asian Medical Systems: A Comparative Study. Berkeley, CA: University of California Press. Leslie, Charles, and Allan Young (eds.). 1992. Paths to Asian Medical Knowledge. Berkeley, CA: University of California Press. Lewis, Diane. 1973. “Anthropology and Colonialism.” Current Anthropology 14 (5): 581–602. Lewis, Mark. 1990. Sanctioned Violence in Early China. Albany, NY: State University of New York Press. Lim Chong Yah.1989. “From High Growth Rates to Recession.” In Management of Success: The Moulding of Modern Singapore, edited by Kernial Singh Sandhu and Paul Wheatley (201–217). Singapore: Institute of Southeast Asian Studies. Lim Chee Then. 2004. “The Confucian Tradition and Its Future in Singapore: Historical, Cultural and Educational Perspectives.” In Asian Traditions and Modernization: Perspectives from Singapore, edited by Yong Mun Cheong (177–207). Singapore: Eastern Universities Press. Lim M. K., P. Sadarangani, H. L. Chan, and J. Y. Heng. 2005. “Complementary and Alternative Medicine Use in Multiracial Singapore.” Complementary Therapies in Medicine 13: 16–24. Liu Yanchi. 1995. The Essential Book of Traditional Chinese Medicine, Vol. 2, Clinical Practice. New York: Columbia University Press. Lo, Vivienne. 2001. “The Influence of Nurturing Life Culture on the Development of Western Han Acumoxa Therapy.” In Hsu, Innovation in Chinese Medicine, 19–50. Lo, Vivienne, and Sylvia Schroer. 2005. “Deviant Airs in ‘Traditional’ Chinese Medicine.” In Alter, Asian Medicine and Globalization, 45–66. Lock, Margaret. 1993. Encounters with Aging. Berkeley, CA: University of California Press. Lock, Margaret, and Vinh-Kim Nguyen. 2010. “Grounds for Comparison: Biology and Human Experiments.” In An Anthropology of Biomedicine, edited by Margaret Lock and Vinh-Kim Nguyen (176–202). Oxford, UK: Wiley-Blackwell. Loh Chee Hong. 2009. “Use of Traditional Chinese Medicine in Singapore Children: Perceptions of Parents and Paediatricians.” Singapore Medical Journal 50 (12): 1162–68. Lu Gwei Djen, and Joseph Needham. 1980. Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Cambridge, UK: Cambridge University Press. Lu, Henry. 1991. Legendary Chinese Healing Herbs. New York: Sterling Publications. Lyons-Lee, Lenore. 1998. “The ‘Graduate Woman’ Phenomenon: Changing Constructions of the Family in Singapore.” Sojourn: Journal of Social Issues in Southeast Asia (special issue) 13 (2): 309–27. MacLennan, Alastair H., David H. Wilson, and Anne W. Taylor. 1996. “Prevalence and Cost of Alternative Medicine in Australia.” Lancet 347: 569–73. 290

Bibliography



Manderson, Lenore. 1990. “Race, Colonial Mentality and Public Health in Early Twentieth Century Malaya.” In Rimmer and Allen, The Underside of Malaysian History, 193–213. Maroyi, Alfred. 2012. “Garden Plants in Zimbabwe: Their Ethnomedical Uses and Reported Toxicity.” Ethnobotany Research and Applications 10: 45–57. Merli, Claudia. 2010. “Male and Female Genital Cutting among Southern Thailand’s Muslims: Rituals, Biomedical Practices, and Local Discourses.” Culture, Health and Sexuality 12 (7): 725–38. Messer, Ellen. 1987. “The Hot and Cold in Mesoamerican Indigenous and Hispanized Thought.” Social Science and Medicine 25 (4): 339–46. Ministry of Health (MOH). 2010. National Health Survey 2010. Singapore Ministry of Health, Singapore. Mintz, Sidney, and Christine Du Bois. 2002. “The Anthropology of Food and Eating.” Annual Review of Anthropology 31: 99–119. Morsy, Soheir. 1988. “Islamic Clinics in Egypt: The Cultural Elaboration of Biomedical Hegemony.” Medical Anthropology Quarterly 2 (4): 355–69. Nader, Laura. 1990. Harmony Ideology: Justice and Control in a Zapotec Mountain Village. Stanford, CA: Stanford University Press. ———. 1996a. “Coercive Harmony: The Political Economy of Legal Models.” Kroeber Anthropological Society Papers 80: 1–13. ———. (ed.). 1996b. Naked Science: Anthropological Inquiry into Boundaries, Power, and Knowledge. New York: Routledge. ———. 2001. “Anthropology! Distinguished Lecture—2000.” American Anthropologist 103 (3): 609–20. Narby, Jeremy. 1999. The Cosmic Serpent: DNA and the Origins of Knowledge. New York: Jeremy P. Tarcher/Putnam. National Population and Talent Division. 2014. 2014 Population in Brief. National Population and Talent Division (Prime Minister’s Office), Singapore. National Environmental Agency (NEA). 2009. “WEATHERwise Singapore.” Meteorological Services Division Report. National Environmental Agency, Singapore. Nichter, Mark. 2008. “Coming to Our Senses: Appreciating the Sensorial in Medical Anthropology.” Transcultural Psychiatry 45 (2): 163–97. Nichter, Mark, and Margaret Lock (eds.). 2002. New Horizons in Medical Anthropology: Essays in Honour of Charles Leslie. London: Routledge Press. Nye, Joseph S. Jr. 1990. Bound to Lead: The Changing Nature of American Power. New York: Basic Books. Ohnuki-Tierney, Emiko. 1984. Illness and Culture in Contemporary Japan: An Anthropological View. Cambridge, UK: Cambridge University Press. Ong, Aihwa. 1997. “Chinese Modernities: Narratives of Nation and of Capitalism.” In Ungrounded Empires: The Cultural Politics of Modern Chinese Transnationalism, edited by Aihwa Ong and Donald Macon Nonini (171–202). New York; London: Routledge. ———. 2006. Neoliberalism as Exception: Mutations in Citizenship and Sovereignty. Durham, NC; London: Duke University Press.

291

Bibliography ———. 2016. Fungible Life: Experiment in the Asian City of Life. Durham, NC; London: Duke University Press. Ong, Aihwa, and Stephen Collier. 2005. Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Malden, MA: Blackwell Publishing. Ong, Chi-Keong, Sophie Petersen, Gerard C. Bodeker, and Sarah StewartBrown. 2002. “Health Status of People Using Complementary and Alternative Medical Practitioner Services in 4 English Counties.” American Journal of Public Health 92 (10): 1653–56. Orwell, George. (1948) 1950. 1984. Signet Classics/Penguin Books: New York. Osman, Mohd. Taib (ed.). 2001. Cultures in ASEAN and the 21st Century. Kuala Lumpur: University of Malaysia Press. Ots, Thomas. 1994. “The Silenced Body—The Expressive Leib: On the Dialectic of Mind and Life in Chinese Cathartic Healing.” In Csordas, Embodiment and Experience, 116–36. Park, Bae-Gyoon. 1998. “Where Do Tigers Sleep at Night? The State’s Role in Housing Policy in South Korea and Singapore.” Economic Geography 74 (3): 272–88. Pels, Peter. 1997. “The Anthropology of Colonialism: Culture, History and the Emergence of Western Governmentality.” Annual Review of Anthropology 26: 163–83. Petryna, Adriana. 2002. Life Exposed: Biological Citizens after Chernobyl. Princeton, NJ: Princeton University Press. Pieke, Frank, Pál Nyiri, Mette Thunø, and Antonella Oeccagno. 2004. Transnational Chinese: Fujianese Migrants in Europe. Stanford, CA: Stanford University Press. Porkert, Manfred. 1974. The Theoretical Foundations of Chinese Medicine: Systems of Correspondence. Cambridge, MA: MIT Press. ———. 1982. “The difficult task of blending Chinese and western science: the case of modern interpretations of traditional Chinese medicine.” In Explorations in the History of Science and Technology in China: A Special Number of the “Collections of Essays on Chinese Literature and History,” edited by Li Guohao (553–72). Shanghai: Shanghai Chinese Classics. Puaksom, Davisakd. 2007. “Of Germs, Public Hygiene, and the Healthy Body: The Making of the Medicalizing State in Thailand.” Journal of Asian Studies 66 (2): 311–44. PuruShotam, Nirmala. 1998. “Disciplining Difference: ‘Race’ in Singapore.” In Southeast Asian Identities: Culture and the Politics of Representation in Indonesia, Malaysia, Singapore, and Thailand, edited by Joel Kahn (51–94). Singapore: Institute of Southeast Asian Studies. Quah, Stella. 1989. “The best bargain: medical options in Singapore.” In Stella Quah (ed.), The Triumph of Practicality: Tradition and Modernity in Health Care Utilization in Selected Asian Countries. Singapore: Institute of Southeast Asian Studies, pp. 122–159. ———. 2003. “Traditional Healing Systems and the Ethos of Science.” Social Science and Medicine 57: 1997–2012. Rabinow, Paul (ed.). 1984. The Foucault Reader. London: Penguin Books. 292

Bibliography



———. 1996. Essays on the Anthropology of Reason. Princeton, NJ: Princeton University Press. Rabinow, Paul (ed.). 1997. Ethics: Subjectivity and Truth (The Essential Works of Michel Foucault, 1954–1984). New York: The New Press. Rapp, Rayna. 1999. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. New York: Routledge. Reynolds Whyte, Susan. 2009. “Health Identities and Subjectivities: The Ethnographic Challenge.” Medical Anthropology Quarterly 23 (1): 6–15. Rimmer, Peter, and Lisa Allen (eds.). 1990. The Underside of Malaysian History: Pullers, Prostitutes, Plantation Workers. Singapore: Singapore University Press Robins, Steven 2. 2006. “From ‘rights’ Rights’ to ‘ritual’Ritual’: AIDS activism Activism in South Africa.” American Anthropologist 108 (2): 312–323. Rose, Nikolas, and C. Novas. 2005. “Biological Citizenship.” In Ong and Collier, Global Assemblages, 439–463. Said, Edward. (1978) 1979. Orientalism. New York: Vintage Books. Samuelsen, Helle, and Vibeke Steffen. 2004: “The Relevance of Foucault and Bourdieu for Medical Anthropology: Exploring New Sites.” Anthropology and Medicine 11 (1): 3–10. Sargent, Carolyn, and Thomas Malcolm Johnson (eds.). 1996. Medical Anthropology: Contemporary Theory and Method. London: Praeger. Scarry, Elaine. 1985. The Body in Pain: The Making and Unmaking of the World. Oxford, UK: Oxford University Press. Schechner, Richard. 2002. Performance Studies: An Introduction. New York: Routledge. Scheid, Volker. 2002. Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham, NC: Duke University Press. Scheid, Volker, Dan Bensky, Andrew Ellis, and Randall Barolet. 2009. Chinese Herbal Medicine: Formulas and Strategies (2nd ed.). Seattle, WA: Eastland Press. Scheper-Hughes, Nancy. 1990. “Three Propositions for a Critically Applied Medical Anthropology.” Social Science and Medicine 30 (2): 189–97. ———. 1992. Death without Weeping: The Violence of Everyday Life in Brazil. Berkeley, CA: University of California Press. Scheper-Hughes, Nancy, and Margaret Lock. 1987. “The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.” Medical Anthropology Quarterly 1 (1): 6–41. Selby, Martha Ann. 2005. “Sanskrit Gynecologies in Postmodernity: The Commoditization of Indian Medicine in Alternative Medical and New Age Discourses on Women’s Health.” In Alter, Asian Medicine and Globalization, 120–31. Sharma, Ursula. 1995. Complementary Medicine Today: Practitioners and Patients. London: Routledge. Sharp, Joanne. 2009. Geographies of Postcolonialism: Spaces of Power and Representation. London: Sage.

293

Bibliography Sinha, Vineeta. 1995. “Theorizing the Complex Singapore Health Scene: Reconceptualizing ‘Medical Pluralism.’ ” PhD dissertation, Johns Hopkins University, Baltimore, MD. ———. 2001. “Problematizing ‘Culture’ and ‘Community’ in Singapore.” In Osman, Cultures in ASEAN and the 21st Century, 335–46. Sivin, Nathan. 1987. Traditional Medicine in Contemporary China (A Partial Translation of Revised Outline of Chinese Medicine [1972] with an Introductory Study on Change in Present-day and Early Medicine). Ann Arbor, MI: Center for Chinese Studies, University of Michigan. Stafford, Charles. 2000. Separation and Reunion in Modern China. Cambridge, UK: Cambridge University Press. Steinberg, David J. (ed.). 1971. In Search of Southeast Asia: A Modern History. New York: Holt, Rinehart and Winston. Tan, Eugene K. B. 2003. “Re-engaging Chineseness: Political, Economic and Cultural Imperatives of Nation-building in Singapore.” China Quarterly 0 (175): 751–74. Tao, Iven. 2009. “A Critical Evaluation of Acupuncture Research: Physiologization of Chinese Medicine in Germany.” East Asian Science, Technology and Society: An International Journal 2 (4): 507–24. Taylor, Kim. 2005. Chinese Medicine in Early Communist China, 1945–63: A Medicine of Revolution. London; New York: Routledge Curzon. Traditional Chinese Medicine Practitioners Board (TCMPB). 2006. “Ethical Codes and Ethical Guidelines for TCM Practitioners.” Traditional Chinese Medicine Practitioners Board, Singapore. ———. 2007: “Traditional Chinese Medicine Practitioners Board Annual Report 2007.” Traditional Chinese Medicine Practitioners Board, Singapore. Teiser, Stephen F. 1988. The Ghost Festival in Medieval China. Princeton, NJ: Princeton University Press. Trankell, Ing-Britt, and Jan Ovesen. 2004. “French Colonial Medicine in Cambodia: Reflections of Governmentality.” Anthropology and Medicine 11 (1): 91–105. Tremewan, Christopher. 1998. “Welfare and Governance: Public Housing under Singapore’s Party-state.” In The East Asian Welfare Model: Welfare Orientalism and the State, edited by Roger Goodman, Gordon White, and Huck-ju Kwon (77–105). London and New York: Routledge. Unschuld, Paul. 1985. Medicine in China: A History of Ideas. Berkeley, CA: University of California Press. Velmeulen, Timotheus, and Robin van den Akker. 2010. “Notes on Metamodernism.” Journal of Aesthetics and Culture 2 (n.p.). http://www. tandfonline.com/doi/full/10.3402/jac.v2i0.5677. Wahlberg, Ayo. 2006. “Biopolitics and the Promotion of Traditional Herbal Medicine in Vietnam.” Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 10 (2): 123–47. Waldby, Catherine. 2009. “Singapore Biopolis: Bare Life in the City-state.” East Asian Science, Technology and Society: An International Journal 3: 367–83.

294

Bibliography



Wang Gungwu. 1988. “The Study of Chinese Identities in Southeast Asia.” In Cushman and Wang, Changing Identities of the Southeast Asian Chinese, 1–21. ———. 1991. China and the Overseas Chinese. Singapore: Times Academic Press. Warren, James F. 1990. “Prostitution in Singapore Society and the Karayukisan.” In Rimmer and Allen, The Underside of Malaysian History, 161–76. Wee Tong Bao. 2003. “Chinese Education in Pre-war Singapore: A Preliminary Analysis of Factors Affecting the Development of Chinese Vernacular Schools.” In Charney, Yeoh, and Tong, Chinese Migrants Abroad, 101–13. World Health Organization (WHO). 2001. “Legal Status of Traditional Medicine and Complementary/alternative Medicine: A Worldwide Review.” World Health Organization, Geneva. ———. 2015. “Ensuring Food in the Region Is Safe from Farm to Plate.” World Health Organization, Geneva. Wu, David. 1979. “Traditional Chinese Concepts of Food and Medicine in Singapore.” Occasional Paper no. 55. Institute of Southeast Asian Studies, Singapore. Xu Qihe, Rudolf Bauer, Bruce Hendry, Tai-Ping Fan, Zhongzhen Zhao, Pierre Duez, Monique Simmonds, Claudia Witt, Aiping Lu, Nicola Robinson, De-an Guo, and Peter Hylands. 2013. “The Quest for Modernisation of Traditional Chinese Medicine.” BMC Complementary and Alternative Medicine 13 (n.p.). https://bmccomplementalternmed.biomedcentral.com/ articles/10.1186/1472-6882-13-132. Yamada, Keiji. 1998. The Origins of Acupuncture, Moxibustion and Decoction. Kyoto, Japan: International Research Center for Japanese Studies. Yan Yunxiang. 2012. “Food Safety and Social Risk in Contemporary China.” Journal of Asian Studies 71 (3): 705–29. Yao Souchou. 2003. “Tasting the Night: Food, Ethnic Transaction, and the Pleasure of Chineseness in Malaysia.” In Charney, Yeoh, and Tong, Chinese Migrants Abroad, 41–62. ———. 2007. Singapore: The State and the Culture of Excess. London; New York: Routledge. Yap, Kevin Yi-Lwern, Sui Yung Chan, and Chu Sing Lim. 2007. “Authentication of Traditional Chinese Medicine Using Infrared Spectroscopy: Distinguishing between Ginseng and Its Morphological Fakes.” Journal of Biomedical Science 14: 265–73. Yee Shen-Kuan, Chu Swee-Seng, Xu Yi-Min, and Choo Peck-Lin 2005. “Regulatory Control of Chinese Proprietary Medicines in Singapore.” Health Policy 71(2): 133–149. Yen Ching-Hwang. 1986. A Social History of the Chinese in Singapore and Malaya 1800–1911. Oxford, UK: Oxford University Press. ———. 2003. “Hokkien Immigrant Society and Modern Chinese Education in British Malaya, 1904–1941.” In Charney, Yeoh, and Tong, Chinese Migrants Abroad, 114–44.

295

Bibliography Yeoh, Brenda. 1991. “Municipal Sanitary Surveillance, Asian Resistance and the Control of the Urban Environment in Colonial Singapore.” DPhil dissertation, School of Geography, University of Oxford, Oxford, UK. ———. 2001. “Managing Singapore’s Cultural Heritage for the Tourist Gaze.” In Osman, Cultures in ASEAN and the 21st Century, 219–231. Yeoh, Brenda, and Lily Kong. 1999. “The Notion of Place in the Construction of History, Nostalgia and Heritage.” In Kwok, Kwa, Kong, and Yeoh, Our Place in Time, 132–51. Young, Allan. 1982. “The Anthropologies of Illness and Sickness.” Annual Reviews of Anthropology 11: 257–85. Yu Ying-shih. 1977. “Han.” In Chang, Food in Chinese Culture, 53–83. Zhan, Mei. 2009. “A Doctor of the Highest Caliber Treats an Illness before It Happens.” Medical Anthropology 28 (2): 166–88. Zimmermann, Francis. 1987. The Jungle and the Aroma of Meats. Berkeley, CA: University of California Press.

296

Index

acupuncture, 50, 69n24, 114, 132–34 Dr Wang’s technique, 123–24, 162–63 erzhen (auriculotherapy), 69n30, 134 in biomedical contexts, 3, 133, 136, 141n12 in Chinese medical clinics, 121, 123–24, 125–26, 135, 137–38 loci, 133, 134, 135–36, 141n11 needles, 118, 124, 133, 134–35, 139, 141n11, 172 Professor Tan’s technique, 9, 12, 130–32, 134–38, 139, 201–2, 258, 263 regulation of, 46, 112, 114–15, 141n11, 142n12 use/ experiences of, 3, 47, 154, 162–63, 164, 171–72, 226 Adelle (interlocutor), 11, 38, 186, 200, 232–33, 241, 248n12 agency, 4, 28, 63, 177n22, 252, 259, 261, 263–64, 273 and creativity, 5, 28–29, 130, 140, 179–80, 208, 215, 246, 264, 277 of patients, 60, 146, 153, 174–75 Alter, Joseph, 21, 22, 24, 65, 268–69, 270, 271 anatomo-politics, 26, 96, 99–100, 106–7, 113, 261–63 in Chinese medical clinics, 116–18, 126, 138–39 See also discipline Anderson, Benedict, 83–84, 213

Anna (interlocutor), 128–29, 153–60, 186, 195 assemblage, 24, 28, 29n7 of Chinese medicine, 4, 26, 57, 252, 270, 271 of food, 213, 245, 246n1 See also localization authenticity, 18, 48, 49, 68n13, 237, 271, 275 authority, 27–28, 56, 141n10, 172, 246, 252, 262 biomedical, 49, 270 Chinese medical, 66, 138–40, 141n10, 143n23, 230, 272, 276 Chinese medical physicians’, 26–27, 42, 49, 51–52, 66, 113, 126–32, 139–40, 200–1, 263 institutional, 132–38, 141n10 medical, 19, 48–49, 67n10, 74, 139–40, 143n23, 262 over public practices, 109, 196, 212, 214 over Truth, 19, 67n10, 201, 236, 258, 270 political, 100, 109, 113, 116, 138–40 scholarly, 14, 104n24, 253, 258 scientific, 104n24, 132, 143n23, 170–71, 172, 236, 253, 257–59, 269–70 sociocultural, 5, 26–27, 129, 139, 260, 265, 272, 276 See also authority: Chinese medical physicians’ Aw Boon Haw, 63–64, 87–88. See also Haw Par Villa Aw, Tash, 266–67

297

Index bak kut teh (Malaysian pork rib soup), 218, 236 Barnes, Linda, 62, 65, 141n9 Bejing University of Chinese Medicine, 130, 141n9 Best, Steven, 15 bianzheng (syndrome differentiation), 122 biological citizenship, 89, 192, 261–63, 264–65 and responsibility, 109, 111, 191, 192, 245–46, 265 biomedicine, 3, 24, 31n25, 146–47 and development, 2, 5, 16, 24–25, 105–6, 107–11, 156, 170, 222–25, 262–63, 270 (see also political economy: of health) and patient compliance, 3, 16, 68n16, 108, 109, 155–56, 192 and patient dissatisfaction, 48, 61, 162, 165, 167–68, 201 and power, 16, 18, 19–22, 24, 104n20, 256–57, 269–70 as “modern” medicine, 16, 20, 25, 59, 133, 155, 173, 275 as a model, 20–21, 22, 46, 113, 172–73, 277 as cosmopolitan medicine, 2, 20, 31n25 as dominant, 16, 19–20, 22, 44, 46, 47, 48, 156, 257, 275–76 infrastructure, 2–3, 22, 24, 107–11, 189 monism, 16, 19, 21, 45–46, 146–47, 170, 276 side/adverse effects of, 38, 154, 168, 227, 235, 240 standards and values of, 16, 18, 25, 47, 48–51, 55, 115–16, 128, 146–47, 224, 246, 277 See also Chinese medicine vis-à-vis biomedicine Biopolis, 2, 89, 106, 110–11, 191, 265 biopolitics, 18, 99–100, 107 and Chinese medicine, 66, 113– 16, 118, 126–27, 138–39

Singaporean, 26, 47, 86, 191, 209, 262–63 biopower, 5, 26–27, 28, 99–100, 107–11, 208–09, 261–62, 264–65 and Chinese medicine, 111–18, 138–40, 262–63, 273 body ecologic, 5, 17, 27, 179–209 (passim), 226, 234 body politic, 2, 17, 101, 111, 148, 178, 182–83 and docility, 25, 35, 97, 186 and labor, 25, 26, 35, 86, 97, 108, 110 and nationalism, 83, 191 See also three bodies Bourdieu, Pierre, 14, 207, 225, 244, 251, 256, 259–60 British East India Company, 34, 74–75, 101, 107 British Malaya. See Straits Settlements Brownell, Susan, 21 Cambodia, 6, 17 Cant, Sarah, 22, 45–46 capitalism, 22, 61, 83, 86–87, 99–100, 107, 257, 262 Chandroo, Thirumalai, 151 Charlene (interlocutor), 93, 166–70, 172–73, 186 Chau, Adam Yuet, 146, 174, 204 Chea Hean Aun (Chris), 7, 45, 112, 116 Chee Soon Juan, 91 Chiam. See Tong, 90 China, 12, 53, 68n21, 61, 63 Belt and Road Initiative, 34, 66n1 changes in political economy, 50, 53, 54, 58, 78, 86, 100, 101 Chinese medical theory and practice in, 24, 38, 54, 57–61, 62, 69n27, 129–30, 134, 139, 143n23, 178–79, 201–2 Chinese physicians from, 53, 55–56, 66 diplomatic relations with, 50, 73–74, 86, 102n3, 270

298

Index food and materia medica in, 32n28, 38, 49, 63, 64, 158, 204–6, 212–13, 229, 236–37, 243, 245, 246n1, 249n21 history of Chinese medicine in, 22, 47, 49, 54, 55, 57–61, 66, 106, 129–30, 182, 270–71 integrated healthcare system, 45, 49, 112 Singaporeans’ ties to, 25, 50, 53, 54, 66, 76–80, 97–98, 153, 263, 266–67 See also migration; nationalism: Chinese Chinatown (Singapore), 10, 12, 38, 77, 88, 91, 119–20, 123, 144, 145, 161, 166, 187, 248n15, 268 Chinese dialect, 6–7, 29n10, 35, 67n12, 71, 86, 97, 102n6, 103n16, 265 bang (associations), 52–53, 76, 108, 111, 278 groups, 6, 30n11, 52–53, 75, 76, 79, 92, 213, 266 Chinese materia medica, 3, 4, 8, 9–10, 43, 55–56, 60, 67n8, 106, 124–25, 203, 248n14, 265 as foods, 22–24, 27–28, 203–5, 206–7, 215, 225, 226, 227–40, 243–44, 255 as gifts / luxury items, 36–37, 44, 205, 228, 231, 236, 242–45 bupin (tonifying materials), 204–5, 210n13, 214, 228–32, 234–40, 248n15 liangcha (cooling tea), 37–42, 154, 156–59, 170, 171, 195–96, 203–7, 210n11, 214, 227–28, 234, 235 prepared for convenience, 39–40, 125–26, 156–60, 177n22, 195, 230 research on, 7, 9, 10, 46, 48, 53, 57, 68n13, 271 See also formularies, Chinese medical; home-based remedies; hot/cold idiom



Chinese medical hall. See Chinese pharmacies Chinese medicine vis-à-vis biomedicine, 10, 20, 35, 58, 66, 141n12, 257, 270–71, 276–77 circumscription of, 3–4, 47, 50–51, 54, 56, 65, 114–15, 118, 141n12, 169–70, 245 in patient discourses, 38, 48–49, 54, 61–62, 128, 153–73 (passim), 207, 209, 226–27, 235, 240, 265, 271 in theory and/or practice, 48–50, 58–61, 129–34 (passim), 249n23, 271, 276 intersection of, 5, 43–45, 48, 54, 60–61, 114–15, 133–34, 193, 225, 261, 271 Chinese medicine: as “modern” medicine, 25, 49, 52, 155, 276 (see also modernization: of Chinese medicine) as a symbol of Chinese culture, 25, 47, 58, 101 as CAM, 4, 25, 35, 43–49, 61, 62, 65, 66, 68n13, 113, 140, 263 as primary care, 23–24, 31n24, 47, 105, 110–11, 176, 263 as scientific, 10, 47, 57–66 (passim), 68n13, 125, 129–30, 132, 135–37, 139, 143n23, 160, 236, 257, 269–72 as TCM, 16, 29n6, 31n20, 35–36, 43, 49, 56–66, 68n14, 69n24, 113–16, 130, 139, 162, 182 (see also TCM Practitioners Act; TCM Practitioners Board) as traditional medicine, 4, 16, 19, 22, 25, 44, 47, 55, 65, 270, 275 marginalization of, 18, 19, 22, 26, 35, 47, 48, 56, 66, 101, 105, 111, 263, 270 professionalization of, 19, 25–26, 32n30, 35–36, 46, 52–56, 57, 66, 106, 112–16, 129–30, 142n20 (see also authority: Chinese medicine physicians’)

299

Index standardization of, 18, 48–49, 56, 57–61, 66, 106, 115–16, 126, 128, 132–33, 139–40, 263–64, 270 transformations of, 16, 18, 25–26, 35–36, 56–66, 69n30, 101, 105, 106, 130–40, 252, 268, 271–72 See also acupuncture; Chinese materia medica; Chinese medicine vis-à-vis biomedicine Chinese New Year, 36–37, 102n2, 240–43, 244–45 Chinese pharmacies, 38, 39, 52, 55, 112, 123, 125, 126, 158, 203, 227, 240 Chinese proprietary medicines (CPMs), 52, 54, 106, 112, 158–59, 195, 210n10, 223, 237, 249n19 Chinese, overseas, 34–35, 63–64, 69n31, 72, 75–81, 86–88, 97–98, 100–1, 108, 119, 120, 212, 266 Chua Beng Huat, 76–78, 100, 184, 187, 213, 214 Chuck (interlocutor), 127, 166, 170–73, 205, 258 Chung Hwa Yiyuan, 51–52, 111, 121, 142n21, 149, 153 clinic operations, 52, 117–18, 126–27, 138, 158 clinical practice, 125–26, 128, 134–35, 137–38, 139, 156, 201–2 fieldwork at, 9–10, 12, 116, 119, 196–97, 200–1 history of, 68n20, 116 Chung Hwa. See Chung Hwa Yiyuan Chung, Madam (interlocutor), 233, 234–35, 239–40, 249n23 Clancey, Gregory, 2, 31n24, 89, 110–11, 140n4, 142n20, 191 Cochran, Sherman, 55, 63–65, 158 cold. See under hot/cold idiom Collier, Stephen, 29n7, 33 colonialism, 6, 13–15, 17–18, 19, 83, 253–54, 260

legacy of, 26, 46, 47, 81, 85, 89, 92, 95, 98–101, 105, 245, 263, 276 neo-colonialism, 82, 95, 277 postcolonialism, 5, 13–19, 24, 30n18, 31n21, 252–53, 252–59, 273–74 See also history, Singaporean: colonial; history, Singaporean: post-colonial community health. See public health community, 26, 67n12, 69, 75–83, 102n1, 108, 211, 213, 256, 265–66, 275 centers/clubs, 72–73, 185, 190, 223 Chinese medical, 19, 48–49, 52–56, 66, 106, 112–13, 119, 129–30, 132, 138, 141n10, 158 imagined, 83–84 sense of, 26, 70–73, 94, 166, 184, 188–89, 193–95 (see also kampong) service, 12–13, 50, 51–53, 108, 111, 114–15, 119, 125, 137–38, 153, 156, 191 See also surveillance: community complementary and alternative medicine (CAM), 4, 19–20, 24, 25, 43–48, 49, 61, 66, 113, 140, 143n26, 276 See also Chinese medicine: as CAM Confucianism, 62, 78, 86–88, 103n17, 150 consumerism, 35, 36–37, 62, 71, 185, 197–98, 211, 219, 223–24, 225 and Chinese medicine, 18, 39–40, 49, 55, 62, 63–65, 66, 206, 236–37, 243–44 and conspicuous consumption, 241–45 Croizier, Ralph, 58 Csordas, Thomas, 147, 153, 175 Daoism, 62, 150, 272

300

Index Dazhong Yiyuan, 52, 111, 142n21, 149 clinical practice, 51–52, 137–38, 139 fieldwork at, 10, 12 Dazhong. See Da Zhong Yiyuan Delamont, Sara, 213 dengue fever, 27, 189–93, 196, 200, 208, 225, 261 See also environment: hostile (pathogenic); public health: campaigns Devan, Janadas, 70, 80, 85, 100 development: and housing, 92–93, 96–97, 184–86, 188–89 economic, 1, 25, 32n29, 35, 74, 81–101 (passim), 110, 184–86, 197, 222, 242–45, 263 ideology, 14–15, 18, 21–22, 253–55, 264 logic of, 26, 89, 92, 94–96, 100, 192, 194, 262 urban, 32n30, 70–71, 86, 88–89, 91–94, 142n15, 166, 184–89 See also biomedicine: and economic development; political economy diet, 5, 23–24, 28, 179–80, 195, 203–7, 209, 211–36, 239–46, 262, 265 See also Chinese food and medicine discipline, 106–7, 116–18, 138–40, 184–85, 262–63 of Chinese medical clinics, 26, 113, 116–18, 126, 138–40 of the body politic, 17, 83, 87, 92, 94, 96, 99–100, 111, 225, 263–64 self, 111, 260–62 (see also surveillance: self) See also anatomo-politics East Asia, 13, 34, 236 Ecks, Stephan, 260 efficacy, 22, 48–49, 110 as scientific discourse, 160, 258



biomedically defined, 21, 48, 172, 269 of Chinese medicine, 43, 128, 129, 132, 136, 164, 207, 271 Egypt, 21, 22, 104n24 embodiment, 27, 91, 139, 146–56, 160–73 (passim), 191–96, 208–9, 215, 233–35, 264 and experience, 5, 16–17, 27, 28, 129–30, 144, 174–75, 179–86 (passim), 200–4, 206–7 See also environment: lived (cityscape); knowledge: embodied environment, 62, 147, 148, 178–84, 204, 209n3, 214–17, 219, 226, 234, 247n3 and climate, 36–37, 155, 178–79, 195–200, 204–5, 208, 228 clinical, 52, 116–18, 119–21, 123–24, 142n21, 148, 153 hostile (pathogenic), 27, 74, 96, 185–86, 209, 215–16, 246 lived (cityscape), 1–2, 5, 28, 70–72, 91–97, 119–20, 184–96, 201–2, 208–9, 214–17, 219, 221–22, 225, 261 See also body ecologic; seasonality epistemology, 14, 18, 20, 30n18, 43, 143n26, 175, 252, 255–56, 273 biomedical, 24, 31n25, 47, 48, 146–47 Chinese medical, 5, 59, 60, 61, 106, 130, 146, 163, 165, 271 scientific, 67n11, 160, 170, 257–58, 269–70, 272 “Western,” 20, 130, 258–59, 271, 276 Ethical Code and Ethical Guidelines for TCM Practitioners, 115–16, 118, 142n14 ethnicity, 25, 26, 34–35, 43–44, 75–76, 83, 97–99,102n2, 104n23, 161 and a Chinese majority, 1, 26, 31n24, 34, 35, 48, 75, 80, 83, 86, 119, 212, 240, 244–45, 251–52, 265–66 301

Index and discrimination, 48, 80, 95, 176n9 and identity, 76–81, 211, 213–14, 215, 226, 232–33, 239–46, 247n2, 250n28, 264–68 and preferential treatment, 34–35, 67n12, 76, 80, 83, 103n14–15, 105, 156 and tourism, 87–89, 91, 95, 119, 266–67 CMIO designation, 34, 43, 76, 79, 81, 94–97, 100, 115, 213, 244, 247, 266 management of, 73–74, 76, 79, 81–89, 91–92, 94–97, 100–1, 105, 119, 185, 270 See also Chinese dialect: groups; Chinese, overseas; nationalism: Singaporean (“multiracial”); Straits Chinese Eu Yan Sang, 55, 169, 203, 207, 228–29, 231, 247n7, 271 Europe, 14–15, 33–34, 75, 84, 98–99, 213, 253–56, 266 and colonial medicine, 17–18, 108, 112 CAM in, 45, 47, 49 Chinese medicine in, 13, 49, 61, 62, 65, 236 See also political economy: European forms of Evans-Pritchard, E.E., 258 fangji (individualized prescriptions). See under formulary, Chinese medical Farmer, Paul, 17 Farquhar, Judith, 20, 59, 129, 139, 201, 210, 236, 238, 239, 250, 264 Fassil, Hareya, 23, 24 Federation of Malaysia. See Malaysia: Federation of, feng (pathogenic wind; chill), 42, 198–99, 206 Ferguson, Priscilla, 212 Ferzacca, Steve, 21–22 Feyerabend, Paul, 257–58

formularies, Chinese medical, 42, 67n8, 129, 158, 171, 214, 229, 230–31, 237–39, 247n11 (zhong)chengyao (Chinese formula drugs), 68n18, 124–25, 156–59, 195, 205–6 fangji (individualized prescriptions), 52, 117, 121–28 (passim), 154, 163–64, 206, 238–39 See also Chinese materia medica Foucault, Michel, 1, 26, 99–100, 107, 116, 118, 185, 191–92, 208–9, 259–62 Fu Hua. See Hock Hua Fujian (PRC), 75, 118, 153, 166, 213 Gardner, Katy, 13, 14, 254–55 global forms, 29n7, 33, 56, 65–66, 254 globalization, 21–22, 49, 60, 63, 88–89, 98, 101, 255, 270 of CAM, 47, 263 of Chinese medicine, 35–36, 50, 56, 60, 61–66, 252, 271–72 (see also Chinese medicine: as TCM) Goh Chok Tong, 7, 30n13, 109, 222 Goh Keng Swee, 35, 67n3 Good, Byron, 15–16, 144, 147–48, 173, 175, 178, 179, 258 governmentality, 4, 24, 26, 86–89, 98–101, 105, 107, 267 Singaporean, 5, 28, 74, 100–1, 185–86, 191–92, 237, 261–63, 276 Guangdong (PRC), 213, 228 Habermas, Jürgen, 15 habitus, 175, 204, 206–7, 208, 225, 240, 259, 262, 265, 267–68, 276 Hare, Martha, 61, 62, 65, 146, 160 harmony: ideology, 26, 89–97, 104n20, 138 physiological, 133, 179, 181–82, 225, 226, 271

302

Index Haw Par Villa (Singapore), 64, 87–88, 175n1 hawker centers, 187–88, 212–13, 214, 215–23, 225, 228, 245–46 Health Promotions Board (HPB), 3, 7, 106, 222–25, 245 Health Sciences Authority (HSA), 56, 106, 158, 176n15 healthcare system, 3, 24–25, 32n26, 46, 66, 113, 222–25, 245, 263, 271 formation of, 105–11, 222 heat. See under hot/cold idiom hegemony, 98, 251–52, 257–58, 273, 275, 277 biomedical, 18, 19, 22, 46, 251, 252, 255, 257, 273, 276–77 herbs, Chinese. See Chinese materia medica history, Singaporean: Chinese medicine in, 47, 52–56, 156 colonial, 6, 26, 34–35, 52–53, 63–64, 74–82, 92, 97–98, 101, 107–9, 111–12, 119 (see also Straits Settlements) post-colonial, 1, 6–7, 24–28 (passim), 34–35, 53–56, 81–98, 100–1, 109–11, 112–13, 184–89, 193–95, 222–23 pre-colonial, 33–34 Hobsbawm, Eric, 83–84, 212 Hock Hua, 7–8, 12, 13, 38–40, 55, 203, 228–31, 243, 244 consultations at, 37–38, 40, 42, 206 home-based remedies, 3, 19, 22–24, 28–29, 140, 154–60 (passim), 164, 166, 172, 195, 214, 226–40, 248n12 for heatiness, 37–43, 195–96, 203–7 Hong Kong, 53, 63, 64, 68n21, 205, 215, 243, 247n3 Hong, Lysa, 87–88 hot/cold idiom, 27–28, 179, 180–82, 189–90, 193, 203, 206–8, 209n3, 211, 214, 222, 227, 228, 246



cold, 179, 182, 197–200, 235, 238 cooling materials, 37–39, 41–42, 124–25, 155, 196, 203–7, 210n13, 227–28, 229, 234, 241, 248n14, 249n17 (see also Chinese materia medica: liangcha [cooling tea]) heat, 37–38, 179, 182, 196–98, 200–1, 203, 229, 238 heatiness, 154, 179–80, 195–96, 201, 203, 206–9, 209n2, 223–34, 239–40, 249n23 shure (summerheat heatiness), 37–42, 206 warming materials, 38, 155, 179, 210n13, 227–28, 234–37, 239, 241, 249n17 (see also Chinese materia medica: bupin [tonifying materials]) See also environment: climate; home-based remedies: for heatiness Housing Development Board (HBD), 70, 91–94, 119, 185 housing, public, 50, 70–71, 88, 91–97, 159, 166, 184–95, 197–98 and political loyalty, 73, 86, 92–93, 94 and resettlement, 91–92, 102n8, 184–85, 194 See also kampong Howes, David, 214–15 Hsu, Elisabeth, 21, 67n8, 69n30, 114, 125, 134, 139, 143n23, 181, 205–6, 248n14, 271 on the body ecologic, 17, 27, 179, 182–83 on the globalization of Chinese medicine, 61, 65, 69n30, 160, 276 on the socialization of knowledge, 32n27, 59–60, 105, 129 Hu, Shiu-ying, 38–39, 204–5, 235, 236–37, 249n17–18 Huang, Jianli, 87–88 Hutchinson, John, 83, 84

303

Index identity politics, 4, 26, 28, 43, 65, 74–89, 91–101, 213–14, 264–68 See also ethnicity: identity; nationalism: Singaporean (“multiracial”) India, 22, 45, 64, 100, 180, 245, 260 individual body, 17, 27, 146–48, 174, 182–83, 193, 199, 226, 258, 269 See also three bodies; embodiment Indonesia, 6, 9, 12, 21–22, 36, 82, 83, 102n3, 103n14, 243, 248n14 innovation, 9, 12, 20, 44, 105, 130–40, 142n20, 143n26, 263, 268, 271 and experimentation, 127, 129, 136–37, 171 Janes, Craig, 22 Japan, 20, 63, 78–80, 84, 130 Jeyaretnam, J.B., 90 jing (essence), 132–33 jingluo (tracts and channels), 132–33, 201–2, 206, 237 jingshen (energy level; vitality), 234–35, 239, 249n23 jingyan (experience), 26–27, 106, 129–40 See also authority: Chinese medical physicians’ kampong, 71, 76, 91–92, 102n8, 119, 156, 159, 166–67, 170, 190, 210n9 nostalgia, 71, 184–89, 193–95, 248n15 kanbing (looking at illness), 60, 62, 122, 123, 135, 149–50, 201, 203 See also sizhen (four examinations) Kellner, Douglas, 15 Kira (interlocutor), 193–96, 198–99 Kleinman, Arthur, 16, 61, 67n10, 68n16, 175n4, 176n5, 179, 273 Kliger, Robyn, 273–74, 277 Kong, Lily, 95–96, 184, 188

laozhongyi (senior Chinese medical physician), 129–31, 141n10, 143n23 Last, Murray, 45 Law, Lisa, 215 Lee Hsien Loong, 30n13, 111 Lee Kuan Yew, 1, 7, 29n2, 30, 81–84, 94, 100, 120–21, 189, 197 Lei, Sean Hsiang–lin, 58, 129–30, 139 Lena (interlocutor), 127–28, 129, 232–40 (passim), 248n13, 249n20, 249n23 Leslie, Charles, 16, 20, 31n25, 65, 275 Lewis, David, 13, 14, 254–55 Lewis, Diane, 252–53, 255 Li (Chinese medical physician), 12, 118–19, 121–22, 144, 149–52, 177n17 Lim, MK et al., 34, 43, 45, 46–47, 66 Liu Yanchi, 42, 125, 235, 237–38, 239, 249n22–23 Lo, Vivienne, 61–62, 65, 69n27, 176n6, 226 localization, 4, 28, 29n7, 55, 60–66, 139, 142, 155, 178–79, 208, 212–13, 238–39, 245, 271–72, 275–76. See also assemblage Lock, Margaret, 16, 17, 147, 148, 182 Loh Chee Hong, 3, 31n23, 51 Lu Gwei Djen, 133, 201–2 Lyons-Lee, Lenore, 187 Malaya, British. See Straits Settlements Malaya, Federation of, 81–83, 97 Malaysia, 1, 4, 6, 33–34, 36, 74–75, 91, 95, 97, 103n12, 233, 267 Federation of, 82–83, 84, 101 food and materia medica from, 211–14 (passim), 218, 237, 243, 244, 245, 247n2, 266 Singapore’s merger with, 6, 81–83, 85, 103n14 See also nationalism: Malayan Malinowski, Bronislaw, 253–54

304

Index Manderson, Lenore, 17, 76, 102n4, 108 Margaret (interlocutor), 80, 226–27, 228–29, 232 Maroyi, Alfred, 23 medical anthropology, 5, 15–24, 31n21, 174, 180, 251–52, 258, 273 clinical, 16 critical, 4, 14, 15–17, 257, 274 medical pluralism, 31n25, 45–46, 58, 60, 154–55, 177n22, 251 anthropological analyses of, 5, 16, 19–23, 24, 65 in Singapore, 5, 19, 22–23, 25, 32n26, 28, 110, 259 medical system, 5, 16, 19–22, 47, 57–61, 65, 269, 276 MediPearl, 7, 9 Merli, Claudia, 18, 103n18 migration, 6, 26, 30n11, 34–35, 52–53, 65, 75–80, 119, 202, 228, 248, 233, 265–67 Ministry of Health (MOH), 3, 24, 45, 55 106, 109–11, 140n5, 222 and Chinese medicine, 50–51, 55–56, 112–13, 126 See also Health Promotions Board (HPB); Health Sciences Authority (HSA); TCM Practitioners Board modernity, 30n19, 16, 20, 31n25, 260, 275–76 and progress, 58, 94, 105, 189, 208, 254, 255, 262, 277n1 and tradition, 16, 20, 31n25, 49, 59, 169, 270, 275–76 critique of, 13–19, 254–55 discourses of, 4, 15, 30n19, 48–49, 105, 276 diseases of, 222, 224–25 grand narrative, 15–16, 19, 254–55 Singaporean, 2, 70–72, 95–96, 105–6, 159–60, 184–89, 193–95, 202, 208, 221, 245 See also Chinese medicine: as “modern” medicine;



modernization: of Chinese medicine modernization, 14, 18, 98, 254–55 of Chinese medicine, 25, 52, 54–55, 57–61, 106, 126, 272 Morsy, Soheir, 16, 21–22 “multiracialism.” See nationalism: Singaporean (“multiracial”) Nader, Laura, 90, 104n20, 269–70, 271, 277n1 Narby, Jeremy, 274, 277 National Environmental Agency (NEA), 36, 189–91, 192, 200 nationalism, 5, 26, 72, 83–84, 186–87, 217 and historical narrative, 81, 84, 85–89 and medicine, 18, 21–22, 25, 43–45, 57–61, 69n30, 100–1, 191, 245–46, 262–63, 268–70 Chinese, 73, 78–80, 84, 101 Malayan, 79–83, 85, 100, 101, 103n11–12 Singaporean (“multiracial”), 26, 43–44, 72, 74, 81–89, 91–101, 105, 176n9, 212–14, 245–46, 265–68 See also identity politics Needham, Joseph, 133, 201–2, 257 Nguyen, Vinh-Kim, 16, 147 Nichter, Mark, 148, 153, 154–55, 165, 175, 180 North America, 14–15, 21, 45, 61, 254 Chinese medicine in, 13, 57, 236, 248n16, 257 Ohnuki-Tierney, Emiko, 20, 65 Ong, Aihwa, 2, 29n7, 31n24, 32n29, 33, 86–87, 89, 97 Orientalism, 79, 98–99, 104n24, 254, 255–56, 266, 270, 275 Neo-Orientalism, 94–96, 98, 169, 213, 272 See also representation Other, the, 13, 83, 98, 99, 253, 255–56, 266, 270, 274, 275

305

Index Ovesen, Jan, 17–18 People’s Action Party (PAP), 72–73, 81–83, 84–97, 100–1, 109, 110, 113, 185–86, 192 See also power: political (PAP) People’s Republic of China. See China Peranakan. See Straits Chinese Philippines, 82 Pieke, Frank et al, 63, 75, 266 political economy, 26, 32n29; 49–50; 74–89, 92–93, 96–97, 98–101, 107 European forms of, 26, 83–84, 98–100, 105, 253–56 of health, 4, 14, 16–18, 19, 21–22, 24–25, 32n26, 105–11, 222–25, 245, 261–64, 270 See also development: economic population. See body politic Porkert, Manfred, 57–58, 60, 181, 257 postmodernism, 5, 14, 15–16, 30nn18–19, 31n21, 252–59, 273–74, 275 poststructuralism, 14, 15, 31n21, 274 power: and resistance, 16, 139, 143n26, 178, 192, 200, 208–9, 215, 245–46, 257, 261, 265, 273–77 in scholarly analyses, 1, 13–22, 24, 98, 251–59, 275, 277 political (PAP), 81–83, 84–97, 100–1, 113, 192, 206–7, 210n7 relations, 5, 28, 98–100, 129–30, 138, 208–9, 213–14, 215, 260, 267 soft, 64, 69n31 See also authority; biomedicine: and power; biopower Puaksom, Davisakd, 18 public health, 8, 10, 18, 23, 24, 28, 31n25, 75–76, 92, 107–11, 140n4, 191, 208–9

campaigns, 3, 24–25, 27, 108–9, 116, 189–93, 222–25, 261 (see also dengue fever) qi (fundamental substance/force), 69n27, 132–33, 135, 136, 150, 172, 181, 201, 210n4, 210n12, 237–382, 49n22 qigong (self-cultivation practice), 12, 52, 111, 130, 135–36, 171, 176n8 Quah, Stella, 25, 32n26, 47, 53, 55, 67n11 Rabinow, Paul, 20–21, 30n19, 255–56, 258, 260, 266, 277 “race.” See nationalism: Singaporean (“multiracial”) Raffles, Sir Stamford, 34, 74, 214 Rajah, Ananda, 213, 214, 250n28 Rajaratnam, S, 86 re (heat). See hot/cold idiom: heat reflexivity, 13–15, 16, 95, 98, 104n23, 166,67, 252, 253–59, 269–70, 273–77 representation, 110, 167, 212 and essentialism, 60, 94–95, 98, 213, 214, 245, 255–56, 265–68, 274 (see also Orientalism) of Chinese medicine, 57–65, 97, 130, 131–32, 138 political, 65, 81–83, 90, 92, 112–13 scholarly, 13–15, 28, 147–48, 175, 252–59, 264, 265–67, 269–70, 272–77 revivalism, medical, 18, 20, 22, 25, 57 See also Chinese medicine: transformation of safety (of food and medicine), 18, 48, 49, 54, 56, 110, 113, 115–16, 138, 140, 158, 249n21, 271 Said, Edward, 14, 98, 104n24, 253, 255, 265, 270, 275 Samuelsen, Helle, 259, 260 Sarah (interlocutor), 188

306

Index Scheid, Volker, 60, 65, 133–34, 177n22, 247n11, 271, 276 Scheper-Hughes, Nancy, 16–17, 148, 182–83, 257 Schroer, Sylvia, 61–62, 65, 69n27, 176n6 seasonality, 5, 27, 35–38, 42–43, 178–82, 195–96, 199, 203–4, 206–9 (passim) See also body ecologic Selby, Martha Ann, 21 self-care, 28, 111, 191–92, 209, 260–62, 265 self, the, 14, 15, 20–21, 83, 144, 147, 209, 214, 255, 256, 259, 260 Sharma, Ursula, 22, 45–46 Sharp, Joanne, 30n18, 253 Sinha, Vineeta, 22–23, 24, 29n6, 32n27, 52, 53–54, 65, 102n10, 108–10, 112, 140n3, 224 Sivin, Nathan, 58–59, 65, 132–33, 181, 210n4–5 sizhen (four examinations), 122, 123, 126, 135 See also kanbing (looking at illness) Smith, Anthony, 83, 84 social body, 17, 27, 62, 110, 183, 201–2, 269 See also three bodies social engineering, 1, 25, 26, 32n29, 74, 84–97, 100–1, 261–62 See also discipline Song (Chinese medicine physician), 7–8, 13, 48–49, 158, 176n15, 229, 232 Steffen, Vibeke, 259, 260 Strait of Malacca, 33–34, 74 Straits Chinese, 75–76, 213, 217, 247n2, 266 See also Chinese, overseas Straits Settlements, 17, 34–35, 64, 69, 74–82, 107–9, 120, 140n6 See also history, Singaporean: colonial surveillance: community, 94, 140n4, 159, 166, 190–91



self, 140n4, 155, 165, 190–92, 261, 262–63 state, 24–25, 74 Taiwan, 50, 53, 68n15, 119, 124, 158, 160, 169, 175n4, 243 Tan (Chinese medical physician), 9, 12, 30n15, 30n17, 51–52, 116, 200–2, 208, 226, 258, 260 authority and innovation, 130–32, 134–38, 139, 263 See also acupuncture: Professor Tan’s technique Tanzania, 61, 65, 160 Tao, Iven, 65, 69n29 TCM Practitioners Act, 26, 35, 44–46, 47, 50, 126–27, 263 history of, 53–56, 111–13 provisions of, 113–16, 141n10–11 TCM Practitioners Board, 7, 45, 56, 69n24, 106, 113–14, 115–16, 123, 131–32, 137–38, 263 Teiser, Stephen, 146 Teo (Chinese medical physician), 179 Thailand, 6, 18, 29n8, 63, 103n18, 210n10, 243 Thong Chai Medical Research Institute, 121 Thong Chai Yiyuan, 30n16, 53, 111, 149 clinic operations, 52, 121, 122–23, 126–27, 138, 158 clinical practice, 12, 118–19, 121–23, 139, 149–53 fieldwork at, 10, 30n16, 120 history of, 53, 120–21 Thong Chai. See Thong Chai Yiyuan three bodies, 17, 182. See also body politic; individual body; social body Tiger Balm Gardens. See Haw Par Villa Tiger Balm, 63–64, 87–88. See also Haw Par Villa Tim (manager of Hock Hua), 37–38, 55, 229, 231, 237, 243, 250n27 Tok Kim Cheng, 121, 123

307

Index Tom (interlocutor), 11, 38, 186, 232–33, 241, 248n12 tourism, 2, 29n4, 36–37, 88–89, 91, 95, 119, 217, 266–67 Traditional Chinese Medicine (TCM). See Chinese medicine: as TCM Trankell, Ing–Britt, 17–18 Tremewan, Christopher, 73, 92–94, 140n3, 210n7 tuina (massage), 52, 118, 154, 162, 165, 177n17

Wang Gungwu, 75, 78 Wayne and Martha (interlocutors), 161–66, 177n18 Whyte, Susan Reynolds, 264–65 World Health Organization, 25, 44–45, 47, 49, 130, 131 wuxing (five phases or agents), 181–82, 202–3, 206, 272

United Kingdom, 44, 45, 46, 74–75, 79, 81, 84, 107–8, 109, 266 Chinese medicine in, 46, 47 United States, 17, 21, 44, 45, 49, 65, 78, 90, 150, 177n19, 264, 266 Chinese medicine in, 61, 62–63, 65, 160 Unschuld, Paul, 58, 65 Urban Redevelopment Authority, 121, 142n15 urbanization. See development: urban

Yamada, Keiji, 158, 231, 247n11 yangsheng (nurturing life), 111, 225–26, 229, 233, 236, 246, 247n6, 249n23, 261 Yao Souchou, 100, 213–14, 221, 236 Yeo, George, 55, 112 Yeoh, Brenda, 88–89, 112, 119, 188 yinyang (abstract archetypical concept), 181–82, 202–3, 206, 210n5—6, 272 Young, Allan, 16, 275

values, 15, 19, 21, 33, 58, 95–96, 110, 166–73 (passim), 186–87, 254–55, 274 Chinese (cultural), 48, 49, 76, 78–79, 87, 88–89, 101, 175, 176n8 (see also Confucianism) civic, 83–84, 88, 187 family, 93, 186–87, 232–33 moral, 88–89, 93–94, 150, 182 “Western” (cultural), 35, 48, 78–79, 266 See also biomedicine: standards and values Vietnam, 18, 20n8, 23, 32n28, 272–73

zangfu (visceral systems of functionality), 142, 206, 237 Zhan, Mei, 61, 62–63, 65, 271–72, 276 zhongyao (Chinese medical drugs). See Chinese materia medica

xiyi (“Western” medicine). See biomedicine xue (blood), 132–33, 237–38

Wahlberg, Ayo, 18, 32n28, Wang (Chinese medical physician), 12–13, 50, 68n15, 114–15, 116, 119–20, 122–26, 161–65, 177n18, 193 herbal formulas, 38, 124–25, 163–64, 206 308