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中參西錄--一間中醫診所中醫師的專業認同初探 - 政大學術集成

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(1)國立政治大學國際傳播英語碩士學程 International Master‟s Program in International Communication Studies College of Communication National Chengchi University. Master‟s Thesis. 學 ‧. ‧ 國. 立. 政 治 大 碩士論文. n. er. io. sit. y. Nat. 論文題目 Chinese at Heart, Western Where Appropriate: An Exploration of Professional Identity ina a Chinese Medical Clinic. iv l C n hengchi U. Student: Viktorija Laurinaityte (劉瑋佳) Advisor: Mei-Ling Hsu, Ph.D. (徐美苓教授). 中華民國 99 年 3 月 March 2010.

(2) 論文題目 Chinese at Heart, Western Where Appropriate: An Exploration of Professional Identity in a Chinese Medical Clinic 研究生:Viktorija Laurinaityte (劉瑋佳) 指導教授:Mei-Ling Hsu, Ph.D.(徐美苓教授). 治 政 國立政治大學大. 立國際傳播英語碩士學程 ‧. ‧ 國. 學. 碩士論文. A Thesis. y. Nat. a. Communication Studies. er. io. sit. Submitted to International Master‟s Program in International. n. v National Chengchi University l ni Ch. U. i Requirement e n g cofh the In partial fulfillment For the degree of Master in International Communication Studies. 中華民國 99 年 3 月 March 2010.

(3) CHINESE AT HEART, WESTERN WHERE APPROPRIATE: AN EXPLORATION OF PROFESSIONAL IDENTITY IN A CHINESE MEDICAL CLINIC. 立. 政A Master治Thesis 大 National Chengchi University. ‧. ‧ 國. 學 er. io. sit. y. Nat. n. al. iv n C hIn Partial Fulfillment of the Requirements e n g c hfori theUDegree Master of Art. by Viktorija Laurinaityte March 2010.

(4) Acknowledgement In the first place, I deeply thank to my advisor, Prof. Mei-ling Hsu, whose help, advice and supervision were invaluable not only for accomplishing this Master‟s degree but also for my overall academic development. I would also like to record my gratitude to the evaluation committee members, Prof. Leonardo Chu and Prof. Wen-ying Liu, for their precious insights and. 政 治 大 My sincere thanks go to Huiting Yu, our academic angel, for her patience and 立. interesting discussions.. ‧ 國. 學. assistance with a thousand and one things. I am also grateful to all IMICS community members (both professors and students) for their company, making my experience in Taiwan unforgettable.. ‧. I would also like to thank my family and friends (you know who you are!) for their constant. sit. y. Nat. support and for boosting my optimism in hard moments.. io. er. Last but not least, I want to express my special gratitude to Dr. Chen-yu Lee and all the. al. n. members of Yusheng Chinese Medical Clinic who introduced me to the world of Chinese. i n Ch medicine and made this research possible. engchi U. i. v.

(5) Abstract Chinese at Heart, Western Where Appropriate: An Exploration of Professional Identity in a Chinese Medical Clinic By Viktorija Laurinaityte. 政 治 大 exchanges between Chinese and Western medicine. However, there is a lack of literature 立 Studies in medical anthropology and health sociology have shown the intensification of the. exploring this phenomenon from the human communication perspective. To fill this gap, this. ‧ 國. 學. study aims to analyze patterns and processes taking place in the interaction between Chinese and Western medicine by inquiring into professional identity of the Chinese medical practitioners. To. ‧. implement this goal, a qualitative exploratory research was conducted in the Yusheng Chinese Medical Clinic, employing the methods of participant observation and interviewing.. y. Nat. sit. Drawing on the communication theory of identity and applying positioning as an analytical. al. er. io. tool, it was found that professional ideology, adherence to Chinese medical theory, and. n. sociohistorical situatedness were the most salient factors determining positional shifts in the. Ch. i n U. v. discourses with Western medicine. In some discursive practices, the relationship between the two. engchi. medical systems was dichotomized. In other ones, it was perceived in terms of partnership or even unification. Accordingly, the complex and dynamic picture of professional identity was captured. The shift from emphases on being a good physician to being a good Chinese medical physician, as well as discrepancies between perceived professional self and enacted professional self, were observed. Based on the findings, this study calls for the discussions on the relevance of the yin-yang mode in interpreting the interaction between Chinese and Western medicine in the context of globalization. Keywords: Chinese medicine; Western medicine; professional identity; communication theory of identity, positioning; globalization; yin and yang. ii.

(6) TABLE OF CONTENTS Acknowledgment ...............................................................................................................................i Abstract............................................................................................................................................ ii 1. Introduction .................................................................................................................................. 1 2. Literature Review ......................................................................................................................... 5 2.1 Setting the Context ................................................................................................................. 5. 政 治 大. 2.1.1 Medicine as Culture ....................................................................................................... 5. 立. 2.1.2 Great Divides ................................................................................................................. 8. ‧ 國. 學. 2.1.3 Different Globalization Modes of Chinese Medicine.................................................. 10. ‧. 2.1.4 Chinese Medicine Meets Western Medicine ............................................................... 15 2.1.5 Chinese Medicine in Taiwan ....................................................................................... 20. y. Nat. io. sit. 2.2 Discussing Identity ............................................................................................................... 23. n. al. er. 2.2.1 Conceptual Confusion About Identity ........................................................................... 23. Ch. i n U. v. 2.2.2 Identity from the Communication Perspective .............................................................. 25. engchi. 2.2.3 Positioning and Identity Construction ........................................................................... 29 3. Method ........................................................................................................................................ 33 3.1 Introducing the Case: Yusheng Chinese Medical Clinic .................................................. 33 3.2 Data Collection and Analysis ........................................................................................... 36 3.3 Stance of the Researcher and Ethical Concerns ............................................................... 39 4. Results ........................................................................................................................................ 43 4.1 Primary Observations ....................................................................................................... 43. iii.

(7) 4.2 Professional Obligations ................................................................................................... 47 4.2.1 Correct Diagnosis .................................................................................................. 47 4.2.2 Effective Communication with Patients ................................................................ 50 4.2.3 Optimal Treatment ............................................................................................... 54 4.3 Issue of Confidence .......................................................................................................... 57 4.4 One Patient vs. Two Medical Systems ............................................................................. 63. 政 治 大. 5. Discussion and Conclusions ....................................................................................................... 67. 立. References ...................................................................................................................................... 75. ‧ 國. 學. Appendix 1: Schedule of Participant Observations ........................................................................ 84 Appendix 2: Schedule of In-Depth Interviews ............................................................................... 85. ‧. n. er. io. sit. y. Nat. al. Ch. engchi. iv. i n U. v.

(8) LIST OF TABLES AND FIGURES Table 1. Profile of the Research Participants ................................................................................. 36 Figure 1. Layout of the Research Setting ....................................................................................... 44 Figure 2. Picture of the Wooden Board with the Inscription of Dr. Lee‟s Name and Title ........... 45 Figure 3. Picture of the Herbal Compounds ................................................................................... 46. 政 治 大. Figure 4. Picture of the Spinal Nervous System Chart ................................................................... 52. 立. Figure 5. Picture of the Newspaper Clipping Introducing a Successful Dr. Lee‟s Case of Paralysis. ‧ 國. 學. Treatment ........................................................................................................................ 59. ‧. Figure 6. Picture of Newspaper Clippings Pasted by the Entrance to Yusheng Clinic. ................. 60 Figure 7. Picture of Dr. Lee‟s Certificates...................................................................................... 61. n. er. io. sit. y. Nat. al. Ch. engchi. v. i n U. v.

(9) 1. Introduction Communication between the East and the West has been taking place for ages, from Silk Road trade in the Middle Ages to exchanges of bits and bytes through digital highways in the Information Age. The world has witnessed tightening relationships and increasing interaction which have deepened both understanding and misunderstanding between the two regions. Chinese medicine has been one of the topics surrounded by discussions, negotiations and. 政 治 大. exchanges under the East-West rubric in public discourse and in both natural and social sciences.. 立. Its reception in the Western world has ranged from xenophobia to romanticism, from total. ‧ 國. 學. rejection to admiration. However, while emphasizing differences between Western and Chinese. ‧. medicine, rejecting either one of the two or trying to convince which one represents the “truth,” it has often been forgotten that above all the differences there is a common goal – to heal illnesses.. y. Nat. io. sit. Studies in sociology of health and illness, medical anthropology, history of sciences and. n. al. er. medicine, cultural studies and other disciplines have shown that medicine can be perceived not. Ch. i n U. v. only as a natural science but also as a cultural phenomenon situated in a particular cultural. engchi. environment and sociohistorical context and possessing unique social and cultural features (e.g., Baer, Singer, & Susser, 2003; Foucault, 1994; Lupton, 2003; Taylor & Field, 2007). Sociohistorical circumstances have determined that biomedicine has been seen as a normative and “true” one since the nineteenth century in many parts of the world, placing other medical systems on the complementary, alternative or folk (as opposite to science) level if not in the realm of magic or quackery. In the second half of the twentieth century, under the growing influence of postmodernism and poststructuralism, the situation yet started to change (Fox, 1993).. 1.

(10) The cross-cultural perspective towards medicine provided by anthropologists and the history of medicine highly influenced by Foucault‟s writings have shown that “conventions of western medicine are no more „scientific‟ or „objective‟ than medical systems in other cultures or in other times” (Lupton, 2003, p.17). In terms of Chinese medicine, it is recognized now as: [A] coherent and independent system of thought and practice that has been developed over two millennia. Based on ancient texts, it is the result of a continuous process of critical. 政 治 大. thinking, as well as extensive clinical observation and testing. It represents a thorough. 立. formulation and reformulation of material by respected clinicians and theoreticians. It is also,. ‧ 國. 學. however, rooted in the philosophy, logic, sensibility, and habits of a civilization entirely foreign to our own. (Kaptchuk, 2000, p. 2). ‧. This turn of understanding in social theory and public discourse goes in step with the spread. Nat. sit. y. of Chinese medicine. Nowadays, the attributes Western and Chinese thus have not much to do. n. al. er. io. with geographical location. Due to the development of modern science and unquestionable. i n U. v. reliability of experiment-based knowledge, biomedicine has become a normative medicine all. Ch. engchi. around the world. During the last few decades, Chinese medicine has also made a worldwide migration and it is “no longer confined to locations such as Shanghai, Seoul, or Singapore, it has become a vibrant component of health care from Sidney to Seattle to Stockholm” (Kaptchuk, 2000, p.1). In other words, Chinese medicine has trespassed borders of Chinese societies, making boundaries between global and local blur. Following changing geographies of the two medical systems, globally recognized Western medicine is beginning to be questioned as being the only right way of healing. Chinese medicine provides alternative ways of conceptualizing health and illness. It is unquestionable thus that the 2.

(11) dialogue, negotiation, exchange, or as Breslau (2001) calls it, meeting between two medical-cultural systems is definitely taking place. Further questions thus follow: How does this meeting proceed? What processes are taking place? What kind of new agreements and compromises are reached? These are relevant questions nowadays, especially in medically pluralistic countries and societies. Taiwan‟s society is one of those where both kinds of medicine have been widely practiced.. 政 治 大. Taiwan‟s medical pluralism is marked by a dual system. The dialogue between the two systems is. 立. very lively what makes it topical for studying (e.g., Chan, 2005; Chen, Shum, & Hsieh, 2002;. ‧ 國. 學. Hsu, Hsieh, Huang, & Wang, 2007; Kleinman, 1980; Lew-Ting, 2005; Wu, 1982) Early scholarship has shown that Chinese medicine, just as biomedicine, has its own. ‧. logical structures and principles (e.g., Porkert, 1974). Nevertheless, this early scholarship left the. Nat. sit. y. impression that it is a closed system of practice and knowledge, totally different from that of. n. al. er. io. biomedicine. Reacting to this problem, later studies, especially those in the field of history of. i n U. v. sciences and cultural anthropology, have presented much more complicated social and cultural. Ch. engchi. contexts surrounding Western and Chinese medicine separately and together (e.g., Hsu, 1999; Kleinman, 1980; Kuriyama, 1999; Unschuld, 1992, 2003). Most recent works on Chinese medicine from the intercultural perspective emphasize the importance of historical, cultural and social contexts while conducting research in different parts of the world (Hinrichs, 1998). The largest part of the scholarship examining contemporary processes in Chinese medicine and its encounter with Western medicine and culture is found in the field of medical anthropology. There are studies exploring Westerners‟ motivation for engaging in Chinese medicine (Barnes, 2009), globalization of Chinese medicine (Hsu, 2001; 3.

(12) Zhan, 2001, 2009), perception of Chinese medicine in different cultural systems (Barnes, 2005; Ho, 2006). However, little work in this area has examined the processes taking place in contemporary Chinese medicine from the prism of human communication. There is even less literature dealing with the professional identity of practitioners of Chinese medicine in the context of interaction with Western medicine. In order to fill this gap, I will draw on the multilayered concept of. 政 治 大. identity developed in communication theory of identity (CTI), which provides multiple. 立. perspectives and starting points for a scholarly inquiry. In this study, identity is seen as. ‧ 國. 學. communicative, emergent, enacted, and relational. The communication process is an arena where people‟s self-perception and self-expression can be caught (Hecht, Warren, Jung, & Krieger,. ‧. 2005). Moreover, the concept of positioning is employed as an analytical tool for capturing this. Nat. sit. y. communication process. In this study, identity emerging in the communication process is thus. al. n. observed.. er. io. seen as one of the sites where the meeting between Chinese and Western medicine can be. Ch. engchi. i n U. v. In sum, what gives a stimulus for the research is an increasing interaction and intensification of dialogue between Chinese medicine and its Western counterpart and the lack of literature on identity from human communication perspective in this area. The goal of this study is thus to comprehend what patterns and processes emerge during the meeting of the two medical systems in the context of globalization. To do so, I will inquire into the professional identity of practitioners of Chinese medicine and will explore what messages and meanings are brought with it when encountering Western medicine. First, I turn to the broader sociohistorical context and to the discourse on medicine and identity in social sciences and humanities, and next, using 4.

(13) qualitative tools of participant observation, the phenomenon in question is explored.. 立. 政 治 大. ‧. ‧ 國. 學. n. er. io. sit. y. Nat. al. Ch. engchi. 5. i n U. v.

(14) 2. Literature Review This chapter introduces the epistemological position, the contextual background, and the theoretical framework of this research. First, I will discuss the main trends and approaches towards Western and Chinese medicine in modern social sciences and humanities and define the epistemological basis which informs the methodology of this study. Second, I will provide an overview of the sociohistorical context by introducing the development of Chinese medicine in. 政 治 大. the twentieth century in China and Taiwan, respectively. Third, I will review recent studies of. 立. theoretical framework and concepts employed in this research.. 學. ‧ 國. Chinese medicine situated under the context of globalization. Finally, I will explicate the. ‧ sit. y. Nat. 2.1 Setting the Context. io. er. 2.1.1 Medicine as culture. al. Studies in social sciences have illustrated that medicine belongs not only to the realm of natural. n. iv n C sciences. It is also a cultural and social carrying its own artifacts, symbols and patterns, h esystem ngchi U which can tell numerous stories about societies, cultures and people it is situated in. Over the past three decades, the status of biomedicine has witnessed a paradoxical situation. On the one hand, a well-established medical system has become one of the most important indicators of development in many countries; people‟s lives are increasingly dependent on biomedicine. On the other hand, globalization and familiarization with other medical systems “began to call into question the claims to „truth‟ and political neutrality of biomedical knowledge (that which is founded upon scientific principles and understandings)” (Lupton, 2003, p. 5).. 6.

(15) Changes of perception in public life and discourse go in step with changes in social sciences and humanities. Inquiries into medicine have been made from different fields, such as sociology, anthropology, history and cultural studies. Development and changes in conceptualization of medicine have been affected by main intellectual traditions and paradigms at large and have influenced all of these disciplines. In the beginning, theorizing about medicine in social sciences was merely based on positivist values and empiricism. Only under the impact of. 政 治 大. postructuralism, postmodernism, feminist studies and Foucauldian reassessment of medicine,. 立. have new perspectives of approaching medicine and society been introduced into social theory. ‧ 國. 學. (Lupton, 2003; Scambler, 1987).. Social constructionism has become one of the most influential perspectives in social. ‧. sciences and humanities. Although it gained importance in social theory in the mid-1960s when. Nat. sit. y. Berger and Luckmann (1967) published their influential book The Social Construction of Reality:. n. al. er. io. A Treatise in the Sociology of Knowledge, the linkage of social constructionism to medicine did. i n U. v. not become prominent until the 1980s. This turn was largely influenced by Michel Foucault, who. Ch. engchi. argued that nothing in history is given or natural, that all so-called natural categories are social constructs, articulated by discourse, and nothing can be taken for granted (Jones & Porter, 1995). In terms of medicine, Foucault (1994) raised a question of sociohistorical contextuality of medical knowledge, in this way rejecting the objectivity of contemporary biomedicine and exposing it as being discursively constructed. The most valuable input for introducing medical knowledge from intercultural cultural perspective was done by anthropologists. As argued by Kleinmann (1980), “in the same sense in which we speak of religion or language or kinship as cultural systems, we can view medicine as a 7.

(16) cultural system, a system of symbolic meanings anchored in particular arrangements of social institutions and patterns of interpersonal interactions” (p. 24). Medical anthropologists‟ engagement with ethnic minorities and different cultures brought the perception of medicine as culture into humanities and social sciences. In this study, I follow social constructionism and see medicine as a discursively constructed cultural system.. 1.1.2 Great divides. 政 治 大. While helping to widen horizons of medical knowledge and introducing different health care. 立. systems into scholarship, medical anthropology at the same time has too often been trapped in the. ‧ 國. 學. polarity of biomedicine (as a normative system of medical knowledge) and other knowledges (Zhan, 2001). The trinity of magic, religion, and science has been a very influential framework in. ‧. anthropological inquiries into construction of knowledge, especially knowledge of others (e.g.,. Nat. sit. y. Evan-Prichards, 1981; Malinowski, 1948; Nader, 1996). These three concepts have been widely. n. al. er. io. used as major analytical categories in comparative studies (Tambiah, 1990). They played a. i n U. v. critical role by demarcating boundaries of other knowledge measuring them against science. Ch. engchi. (Zhan, 2001). As Good (1994) indicated, the main concern of anthropologists has been to show how they “make sense of cultural views of the world that are not in accord with contemporary natural sciences” (p. 10). Turning to medical anthropology, Lupton (2003) and Leslie (2001) pointed out similar problems. For many years, biology was considered objective and universal, and culture – an external phenomenon. Different perspectives of illness, body, and healing were thus thought to be superstitions emerging out of sociocultural realm and being inferior to “real” biomedical illness. 8.

(17) and healing practices as diagnosed by doctors and described in medical books. For example, Stoekle and Barsky (1981) wrote that “folk and primitive beliefs persist today, even in the attributions offered by the modern „well-educated‟ patient, not only in those of the less educated, ethnic minorities” (as cited in Lupton, 2003, p. 16). Ever since the 1960s, social constructionism and political economy approaches have encouraged the emergence of critical and interpretive medicine-related theorizing. However, the. 政 治 大. aforementioned processes have brought what Latour (1993) called the “great divides” between. 立. culture and nature, tradition and modernity, global/universal and local. In times of boundary. ‧ 國. 學. blurring between disciplines, these divides have penetrated humanities, social sciences and intellectual thought at large.. ‧. Historical circumstances and modern sciences made an enormous impact on dividing the. Nat. sit. y. so-called traditional Chinese medicine and modern Western medicine. In the context described. n. al. er. io. above, the word modern bears meanings of progress, advance and efficiency, alluding to. i n U. v. technological advancements, efficiency of organization and moral improvement (Knauft, 2002,. Ch. engchi. p.9). Modern is also often understood as universal and globally recognized. Traditional, by contrast, can refer to anything that is local, not Western nor modern, and varying from place to place. Although this approach has been successfully challenged by cultural studies under the context of globalization, it is still very strong in the realm of medicine. Nevertheless, according to Foucault (1994) and Latour (1993), even biomedicine cannot claim to be modern because the distinction between modernity and tradition is merely rhetorical.. 9.

(18) 1.1.3 Different globalization modes of Chinese medicine In the era of the global economy, the world has become interconnected more tightly than ever before. Discussions about present political, economical, social, cultural and other processes cannot spare the frame of globalization. The interface between Chinese and Western medicine is taking place not only in Chinese societies but also all around the world. Recent intercultural studies tend to choose globalization as a general contextual frame. A similar development can be seen in the field of Chinese medicine.. 立. 政 治 大. By inquiring into the discourse of acupuncture in the United States, Ho (2006) explored. ‧ 國. 學. conversations among practitioners of Chinese and Japanese acupuncture focusing on the concept of qi ( 氣). Acupuncturists expressed their dissatisfaction over the tendencies to evaluate. ‧. traditional acupuncture by the standards of biomedicine. Ho‟s results thus show that the qi-related. y. Nat. sit. discourse among physicians advocates classical perception of the concept of qi and is a form of. n. al. er. io. resistance to the scientific integration of Chinese medicine into the health system. The study. i n U. v. suggests that there is a discursive tension between the two medical traditions.. Ch. engchi. Breslau (2001) explored the meeting between Chinese medicine and biomedicine in the Department of Psychiatry at Kobe University, Japan. He inquired into the stories of four Chinese physicians working in this psychiatry department. Their stories revealed that the tensions between biomedicine and Chinese medicine were overcome by using hybrid practices developed during the meeting between the two medical systems. In Taiwan, Lew-Ting (2005) conducted a survey to explore patients‟ health-seeking strategies for choosing between biomedicine and non-biomedical healing techniques. The results. 10.

(19) show that the main reason for choosing non-biomedical treatment is the antibiomedicine beliefs, mostly related to inefficiency and incompetence of xiyi (Western medicine). Nevertheless, biomedicine per se was not rejected by people who chose Chinese medicine. Instead, the phenomenon which can be called integrative/hybrid medicine seeking has been emerging in Taiwan. Jennings (2005) analyzed the role of Chinese medicine, as a cultural system, in Tanzania‟s. 政 治 大. pluralistic health system. He approached medicine from the perspective of culture stating that. 立. “health and healing are rooted in the social and cultural order” and that “Western biomedicine is. ‧ 國. 學. not founded upon unarguable, unchallengeable scientific facts that fit easily within all cultures and societies across the world” (p.459). Jennings thus introduced Tanzanian health system as a. ‧. site of cultural exchange between indigenous healing techniques, biomedicine, Ayurvedic1 and. Nat. sit. y. Chinese medicine. He criticized against adopting the perspective of cultural imperialism in. n. al. er. io. viewing the impact of the globalization on medicine, which suggests that local medical traditions be replaced with the universal biomedicine.. Ch. engchi. i n U. v. Instead, Jennings emphasized that the cultural exchange between Chinese medicine, biomedicine and local African healing techniques should be seen through the prism of glocalization. Glocalization, as proposed by Robertson (1992), refers to “the synthesis of the local and the global to create something that both reflects its constituent parts and functions as something distinctive” (as cited in Jennings, 2005, p. 467). Jennings thus rejected the approach that globalization is merely a binary process of developed vs. underdeveloped, rich vs. poor, strong vs. weak, for the case of Chinese medicine in Tanzania shows global flows between two 1. Ayurvedic medicine is a traditional medical system originating from India.. 11.

(20) developing regions. Jennings thus concluded that under the impact of globalization, not only Western cultural, economical and political notions have been traded around the world. Chinese medicine in Africa can be also seen as global. In addition, the flexible local (in this case, traditional Tanzanian) healing can be transformed without alienation to foreign and its own traditions at the same time. Globalization (as cultural imperialism) and glocalization are usually understood as. 政 治 大. spreading of one culture to other, from global to local (e.g., Giddens, 1990; Robertson, 1995). A. 立. seemingly give-and-take relationship underlies these concepts. Therefore, the adaption of these. ‧ 國. 學. conceptual frameworks becomes troublesome in the context of Taiwan‟s pluralistic health care system. In other words, the relationship between Western and Chinese medicine does not fit into. ‧. the binary system of global-local. While the majority of the local population is ethnic Chinese, at. Nat. sit. y. the first sight, Chinese medicine appears as a local phenomenon. Nevertheless, it has been. n. al. er. io. exported to the other parts of the world and thus can be seen as another global as well. Therefore,. i n U. v. I argue that the global/local prism for looking at the relationship between Western and Chinese. Ch. engchi. medicine is not adequate in the Taiwanese context.. Variations in medical pluralism from country to country have induced the need for developing new approaches towards globalization process in the medical arena. For example, the journal Medical Anthropology has dedicated a special issue to the topic “Globalizing Chinese Medicine.”2 In this issue, Linda Barnes, Elizabeth Hsu, and Mei Zhan discussed globalization of Chinese medicine from the bottom-up perspective. Hsu (2009) explored the globalization processes of Chinese medicine and inquired into the 2. See Medical Anthropology, Issue 2, Vol. 28, 2009.. 12.

(21) debates of Chinese propriety medicines in East Africa in the context of political economy. Her research results show that, according to the Western biomedical criteria, Chinese propriety medicines are modern Western drugs. Despite this fact, practitioners of Chinese medicine consider them to be modernized form of traditional herbal remedy. The latter perception fits into the concept of “alternative modernity,” which refers to “the understanding of modernity as a differentiated and variegated process” that accounts for “global political economy and regional. 政 治 大. histories in appreciation of culturally shaped subjective dispositions” (Knauf, as cited in Hsu,. 立. 2009, p.118). Hsu (2009) thus proposed to see the processes taking place in Chinese medicine. ‧ 國. 學. from the perspective of alternative modernity.. In the same issue of Medical Anthropology, Barnes (2009) inquired into practitioners‟. ‧. motivations to be engaged in the practice of Chinese medicine in the United States and China,. Nat. sit. y. respectively. Barnes employed theories of agency and decision making to study how and why. n. al. er. io. practitioners chose to engage in Chinese medicine. She also drew on the non-Eurocentric concept. i n U. v. of xin (心 heart-mind) as an analitycal frame to enrich the discussion of agency and decision making.. Ch. engchi. Furthermore, Zhan (2009) examined how the meanings of Chinese medicine had shifted in the previous decades since Chinese medicine was commoditized and reinvented as a new type of preventive medicine fitting into the cosmopolitan, middle-class lifestyle. She pointed out that this was an outcome of the competition with biomedicine for both medical authority and patient-clientele under the global economy. Findings of this research show that practitioners and proponents of Chinese medicine “insist as much on continuity and antiquity, cosmopolitanism. 13.

(22) and globalization” (Zhan, 2009, p. 169). Zhan developed an alternative perspective and concept for looking at the globalization of Chinese medicine. She proposed the term worlding which “indexes the constant making, unmaking, and remaking of the histories and routs through which knowledge travel and, in due course, take on new and sometimes unexpected meanings and forms” (Zhan, 2009, p. 172). Zhan suggested that the perspective of worlding of Chinese medicine allows escaping the binary mode of global/local, which is often inaccurate when describing. 政 治 大. processes taking place in the Chinese medicine:. 立. Choice of the word “worlding,” then, is a conscious effort to distance from globalist. ‧ 國. 學. assumptions of totality and transcendence. It is critical to bear in mind that globalization does not invariably produce free-floating nomads. Nor does it equally embrace all corners. ‧. of the world. Difference […] is neither entrenched in the local nor easily transcended. Nat. sit. y. through the global. (p.172). n. al. er. io. Zhan thus tried to avoid the global/local perspective by criticizing an overemphasis on the. i n U. v. economic processes and underestimation of cultural logics in analyzing globalization of Chinese medicine.. Ch. engchi. The purpose of highlighting the aforementioned studies is to show that there are many points of departure for approaching the processes taking place in Chinese medicine under the contextual umbrella of globalization: Glocalization, hybridization, alternative modernity, integration, worlding, just to name a few. In addition, sometimes the meeting between the two medical systems under the processes of globalization produces tension, at other times it results in collaboration or integration. Although this study is placed in the context of globalization, I refrain from forehanded application of globalization modes developed in other societies to the context of 14.

(23) Taiwan‟s health care system in order to avoid a preconceived conceptual divide. I only adopt Zhan‟s (2009) approach of studying the relationship between Western and Chinese medicine as a relationship between the specific translocal systems which generates various new processes in the realm of medicine (including theory, practice and sociocultural aspects). Taking this approach as a departing point, I will explore the culture of Chinese medicine in its exclusive mutual interaction with biomedicine.. 政 治 大. 2.1.4 Chinese medicine meets Western medicine. 立. The beginning of Western medicine can be traced to the 5th century BC. A few centuries later, a. ‧ 國. 學. different medical system had been developed on the other side of the world, in China (Unschuld, 2003). Although both medical systems have their roots in much older healing techniques, here. ‧. medicine is referred to as an independent system of knowledge and practice which was developed. Nat. sit. y. from long lasting observations and explorations of illness and the human body. It took two. n. al. er. io. thousand years for both Chinese and Western medicine to evolve into complex formations. i n U. v. encompassing “natural science and philosophy, ethics and religion, language and literature,. Ch. engchi. society and economics, technology and handwork” (Unschuld, 1997, p. 11). Due to the lack of space and the different scope of this research, it is impossible to review the whole history. In addition, there is already a bunch of valuable literature from historical and comparative perspectives discussing the development of Chinese medicine and its encounters with Western counterpart (e.g., Hsu, 2001; Kaptchuk, 2000; Kuriyama, 2003; Li, 1998; Li, 2009; Qu, 2004; Unschuld, 1997; Unschuld, 2003). Here I will only provide a short overview of the development of Chinese medicine in the twentieth century in China and Taiwan as a sociohistorical. 15.

(24) background of the phenomenon explored in this study. The kind of Chinese medicine found today has been highly affected by sociohistorical circumstances and events since the turn of the twentieth century. At that time, inner upheavals, social unrest, political instability, and unsuccessful struggles against Japanese and European imperialist powers had greatly weakened China. The overall atmosphere in the country forced intellectuals to rethink traditional Chinese values, cultural principles and practices which had. 政 治 大. been considered universal and supreme (Spence, 1990). According to Fruehauf (2009), despite. 立. the fact that many aspects of society at that time were in the state of collapse,. ‧ 國. 學. [T]he culture of traditional medicine was alive with the multihued color and texture of a 2,500 year-old art. There was the stimulating discourse between the newly founded fever. ‧. school and the school of the neo-classicists, there were numerous scholar physicians. Nat. sit. y. publishing influential discourses, and there was the arcane realm of esoteric discipleship,. n. al. er. io. alchemical experimentation, and the kaleidoscopic facets of folk wisdom that have always. i n U. v. characterized the sensuous heart of the profession. (para.5). Ch. engchi. The critique against “old” culture reached its apogee in 1910s-1920s during the New Culture Movement informed by European intellectual traditions. One of the most escalated topics in this modernization movement was science. Modern sciences were seen as a salvation bringing enlightenment, progress, and prosperity to China. New medicine (xinyi 3 新 醫 ) challenged traditional healing system which became estranged as old, unscientific and therefore inferior (Liu, 3. In this study, I use Hanyu Pinyin Romanization system, except for Chinese proper nouns (mostly Chinese names and surnames or names of certain places) which have standardized international usage or refers to the identification of a person whose name is transcribed according to other Romanization systems. For example, Taipei is used instead of Taibei, Chiang Kai-shek instead of Jiang Jieshi (蔣介石), etc.. 16.

(25) 1995). This was the first (but not the last) big challenge for Chinese healing tradition which at that time lost its status of the only kind of medicine and became jiuyi (old medicine 舊醫), guoyi (national medicine 國醫), or zhongyi (Chinese medicine 中醫) (Liu, 1995). Under these sociohistorical circumstances, harsh debates between the so-called modern Western medicine and traditional Chinese medicine4 began. Reacting to this situation, some progressive practitioners and theoreticians of Chinese medicine tried to integrate some aspects of. 政 治 大. modern medicine. Now they are known as Integration School of Chinese and Western Medicine. 立. (zhong xi yi huitong pai 中西醫匯通派). The main representatives were Wang Qingren. ‧ 國. 學. (1768-1831), Tang Zonghai (1851-1908), Zhang Xichun (1860-1933), and Zhang Shouyi. ‧. (1873-1934). These early integrators advocated an ideal vision of integrating the two medical systems by adopting some elements from Western medicine into their own system in order to. y. Nat. io. sit. benefit its development. Although these integrators adopted some aspects of Western medicine,. n. al. er. they insisted on keeping the holistic principle of Chinese medicine. This way, the representatives. Ch. i n U. v. of Integration School remained “Chinese at heart” as the title of Zhang Xichun‟s collective. engchi. writings suggests, “Chinese at heart but Western where appropriate” (as cited in Fruehauf, 2009, para.6). More serious challenges for classical medicine were presented officially. Although contemporary scholarship shows that Chinese medicine has been neither a closed and coherent system unchanging for several millennia nor an antipode of modern Western science (Farquhar, 4. Here traditional Chinese medicine refers to classical Chinese healing tradition as contrasted to modern Western medicine. It should not be confused with TCM (Traditional Chinese Medicine), which refers to Chinese medicine today and is broadly used in contemporary analyses of Chinese medicine. Because of this terminological ambiguity, in this study, we simply use Chinese medicine.. 17.

(26) 1987; Hsu, 2001; Sivin, 1981), statesmen and modernizers were not aware of this fact. During the first half of the twentieth century, Nationalist Party (guomintang 國民黨) government launched several campaigns against jiuyi (Zhan, 2001). For example, in 1929, public health officials presented a radical proposal called A Case for the Abolishment of Old Medicine to Thoroughly Eliminate Public Health Obstacles (feizhi jiuyi yi saochu yishi weisheng zhi zhangai an 廢止舊醫以掃除醫事衛生之障礙案). The proposition. 政 治 大. suggested that “the theories of yin and yang, the five elemental phases, the six atmospheric. 立. influences, the zang-fu systems, and the acupuncture channels are all illusions that have no basis. ‧ 國. 學. in reality” and warned that “old medicine is still conning the people with its charlatan, shamanic, and geomancing ways” (Wa, as cited in Fruehauf, 2009, para.9). It also included three major. ‧. clauses: to restrict the practice of Chinese medicine, to ban its advertisements, and to prohibit the. y. Nat. io. sit. establishment of Chinese medicine schools.. n. al. er. The proposition passed the first legislative session of the Central Ministry of Public Health.. i n U. v. However, it was not implemented due to the harsh public reaction and protests by thousands of. Ch. engchi. doctors and patients. Despite the failure of the proposition, the anti-traditional sentiment of the document influenced the general mood in the realm of medicine during the first half of the twentieth century (Fruehauf, 2009; Li, 1998). It was followed by an introduction of administrative, curricular, and pedagogical styles of biomedicine into academies of Chinese medicine. A similar attitude towards Chinese medicine was held by the founder of People‟s Republic of China (PRC), Mao Zedong, and his communist government. In order to establish model public. 18.

(27) health villages, Mao instructed to root out “all shamanic beliefs and superstitions,” grouping Chinese medicine doctors together with circus entertainers, snake oil salesmen and street hawkers in to the same category (Fruehauf, 2009, para.10). In 1954, after the establishment of the PRC, Mao, however, declared Chinese medicine to be a “treasure house” of the country emphasizing its uniqueness of being “native,” “patriotic,” and “among people.” It became a tool for promoting the uniqueness of Chinese communism (Farquhar, 1987).. 政 治 大. Nevertheless, this turn in Mao‟s policy did not equate the status of Chinese medicine to. 立. that of Western medicine. The former was forced to be standardized and modernized under the. ‧ 國. 學. guidelines of the latter. Following Mao‟s revolutionary vision to integrate Chinese and Western medicine (zhongxiyi jiehe 中 西 醫 結 合 ), zhongyi was adopted to biomedical sciences,. ‧. institutionalized and professionalized. It became a subject of national health and educational. Nat. sit. y. systems. Itinerant healers and literati doctors (ruyi 儒醫) were excluded from the official version. n. al. er. io. of Chinese medicine as being “superstitious” and “unprofessional” practitioners (Zhan, 2001).. i n U. v. This resulted in an emergence of what is presently called TCM (Traditional Chinese Medicine), a. Ch. engchi. contemporary form of Chinese medicine.. In the first half of the 20th century, both governments, Nationalists and Chinese communists, used Chinese medicine as a mean for defining national identity. In addition, they tried to put classical medicine into the controlled existence replacing its original parameters with “objective” and “progressive” standards of modern sciences (Chan, 2005; Chen, Shum, & Hsieh, 2002; Farquhar, 1987; Fruehauf, 2009). Heretofore, the historical overview has shown that there have been different kinds of. 19.

(28) understanding of what integration of Chinese and Western medicine means, including scientification of Chinese medicine, complementary usage of Chinese medicine in biomedical health care system, and remaining zhongyi in the core but not rejecting the employment of biomedical tools if needed, etc.. 2.1.5 Chinese medicine in Taiwan After 1945, the Chinese Nationalist government continued its policy on Chinese medicine in. 政 治 大. Taiwan. Chinese medicine was allowed to coexist with Western medicine but at the same time it. 立. was pushed towards modernization and scientification. Under American influence after the. ‧ 國. 學. Second World War, the practice of biomedicine has been the main stay of the healthcare system. The practice of Chinese medicine was officially recognized in 1956. Chinese Medicine Education. ‧. Act passed in the same year provided a legal ground for establishing research and educational. Nat. sit. y. institutions of Chinese medicine. It aimed to overall modernization of Taiwan‟s health system.. n. al. er. io. Although the act gave the same status to both medical systems, “the path [of Chinese medicine]. i n U. v. to respectability and acceptability among the general public, academic and healthcare. Ch. engchi. professionals has been arduous” (Chen, Shum, & Hsieh, 2002, p.303). In terms of education, before the late 1960s, all Chinese medical practitioners acquired their education through apprenticeship and self-study. The development of institutionalized Chinese medical education has been led by College of Chinese Medicine (established in 1958 in Taichung, now China Medical University), which since 1966 has offered the formal professional training and the medical degree of Chinese medicine (Chi et al., 1996). Modernization of Chinese medicine and integration of Chinese and Western medicine have been the unwavering guiding. 20.

(29) principles of the medical curriculum in China Medical College since its establishment. To date, Taiwan has five major institutions offering undergraduate and post-graduate programs and conducting different kinds of research projects (Chen, Shum, & Hsieh, 2002). In terms of licensing, under the Western medicine-dominated health care system, the licensing system has also “contributed to the secondary role of Chinese medical practitioners in providing health care” (Chi et all, 1996, p. 1330). According to Chi et al. (1996), there are five. 政 治 大. types of Chinese medical practitioners in Taiwan: Chinese medicine physician (CMP), Chinese. 立. medicine pharmacist (CMPharm), Chinese medicine registered nurse (CMRN), Chinese medicine. ‧ 國. 學. nurse (CMN), and Chinese medicine physician‟s aid (CMPA).. However, only the first two categories, CMP and CMPharm, are official titles. There are no. ‧. separate examinations for CMRN, CMN and CMPA. CMN yet can take a licensure examination. Nat. sit. y. for Western medicine nurses thus becoming CMRN. Until 2010, there have been two systems of. n. al. er. io. licensing CMP: Chinese Medicine Physician License Exam (CMPLE) and Chinese Medicine. i n U. v. Physician Special License Qualifying Exam (CMPSLQE). The former exam can be taken only by. Ch. engchi. physicians with medical degrees in Chinese medicine. The latter licensure system has been offered for physicians who have acquired their education in the traditional way of apprenticeship and self-study. The CMPSLQE includes two levels of examination: Qualifying Examination and Special License Examination. Only by passing both can one obtain the CMP license (Chi et al., 1996). However, the CMPSLQE will be suspended in 2011 (Qualifying Examination was held for the last time in 2008 and Special License Examination will be concluded in 2011) because, according to the Taiwan‟s Ministry of Examination, the CMPSLQE has had its historical meaning but does not correspond to modern professional standards: 21.

(30) Considering that the traditional private training of the doctors of Chinese medicine did not fit well with the social demands for independently arrived professional assessment and official accreditation, the Special Examination for Doctors of Chinese Medicine has been set up as a provisional means to approve the credentials of doctors of Chinese medicine. The Examination has its historical function. However, as the formal education system has begun to offer structured Chinese medical instruction with results becoming steadily in. 政 治 大. tune with the social expectations and professional standards, the need for the Initial. 立. Qualifying and Special Examinations for Doctors of Chinese Medicine has decreased over. ‧ 國. 學. time. (Ministry of Examination, 2005). In sum, nowadays Taiwan is acknowledged as a medically plural society where both. ‧. biomedicine and Chinese medicine are officially recognized healing practices. Western medicine. Nat. sit. y. yet dominates the orthodox establishment of health care system (Hsu et al., 2007; Kleinman,. n. al. er. io. 1980; Lew-Ting, 2005). For example, in 2008, Taiwan had 3,160 clinics and 22 hospitals of. i n U. v. Chinese medicine, compared unfavorably with 10,326 clinics and 493 hospitals of Western. Ch. engchi. medicine (Department of Health of Republic of China, 2009). Nonetheless, even though the science-based Western medicine has a more predominant voice in the orthodox establishment, Chinese and folk medicine have still been widely practiced by local people (Wu, 1982; Chan, 2005). This situation thus results in the uniquely dual health care system. The aim of this part of the literature review is to illustrate the sociohistorical background of present dialogue between Western and Chinese medicine which has been taking place since the nineteenth century. In fact, these discussions are still taking place nowadays.. 22.

(31) Several statements must be made before continuing further with the literature review. First, I acknowledge the invaluable input of postmodernism and Foucauldian theory as major players in the paradigmatic changes in social sciences and intellectual history at large. The critique of objective knowledge and empiricism has provided a new perspective for understanding the world, including medicine, by allowing scholars to see it as a cultural phenomenon. Second, in this study, I make extensive references to the irreplaceable anthropological scholarship of Chinese medicine.. 政 治 大. However, I distance from the understanding of Western science and medicine as a universal,. 立. modern and progressive entity and Chinese medicine as a traditional and local system. Instead, I. ‧ 國. 學. will follow social actors and their own understandings about traditional and modern, xiyi and zhongyi, and about the integration of both. Third, although this study is placed under the context. ‧. of globalization, the literature review suggests that patterns and processes of globalization vary. Nat. sit. y. place to place. Therefore, I refrain from adopting any of the aforementioned perspectives towards. n. al. er. io. globalization of Chinese medicine to Taiwan‟s context. I will engage in an exploratory and. i n U. v. interpretive qualitative study in order to acquire an understanding of the phenomenon.. 2.2 Discussing Identity. Ch. engchi. 2.2.1 Conceptual confusion about identity Although in the history of social sciences and humanities, the modern term identity accounts only several decades, its extensive and diverse usage in academic literature makes it an unclear and complicated concept. One can find national identity, race identity, gender identity, online identity, illness identity and others in anthropology, sociology, psychology, political sciences, cultural studies, communication studies, etc.. 23.

(32) Conceptual diversity of identity as an analytical concept has its dual roots in the philosophical traditions of modernism and postmodernism. Modernism was an era of “untrammeled individualism” and the search for individual realization (Harvey, 1990, p. 19). It was also marked by the scientific enquiry focused on the self. Thus, modern identity is marked with a search for “real” and “true” self. In contrast, postmodernism introduced an idea that there is no ultimate truth and that people may have diverse perspectives of reality. A new perspective. 政 治 大. of “freely chosen and multiple identities of the modern self that accepts and affirms an unstable. 立. and rapidly mutating condition” (Kellner, 1992, p. 158) has emerged. Postmodernism thus. ‧ 國. 學. created a new concept of complex, contextual and changing identities. Intellectual thoughts of modernity and postmodernity have laid the foundation for. ‧. essentialists‟ and constructivists‟ conceptualization of identity in social sciences. Although the. Nat. sit. y. essentialists‟ viewpoint and the search of the real identity had been harshly criticized by. n. al. er. io. constructivists who have theorized about identities as multiple, constructed and changeable. i n U. v. (Calhoun, 1994), both perspectives are still present in social scientific studies.. Ch. engchi. According to Brubaker and Cooper (2000), identity in the social sciences encompasses “not only great heterogeneity but also a strong antithesis” (p. 10). It becomes very controversial when taking into account “strong” and “weak” understandings of identity. The former one emphasizes fundamental or abiding sameness over time and across persons, while the latter takes a position rejecting notions of sameness. Brubaker and Cooper (2000) thus argued that identity is an ambiguous term and “too torn between „strong‟ and „weak‟ meanings, essentialist connotations and constructivist qualifiers, to serve well the demands of social analysis” (p.2). They stated that the only way out from this conceptual chaos is to retract the term from the academic vocabulary 24.

(33) overall because it embraces several, and even contradictory, meanings. They thus suggested using three different clusters of terms that are embedded in the word identity. Those terms are identification and categorization, self-understanding and social location, and commonality, connectedness or groupness (Brubaker & Cooper, 2000).. 5. I argue yet that Brubaker and Cooper (2000) not only have failed to manage the confusion they described, they followed the same path of those they had criticized. Using categorization,. 政 治 大. self-understanding, groupness and so on does not protect these concepts from being too strong or. 立. too weak, and the issue is still stuck between the constructivists‟ or essentialists‟ positions.. ‧ 國. 學. Therefore, it is suggested that, instead of radically removing identity – the term that has been used for years in a broad range of disciplines – from scholarship, its meaning should be further. ‧. clarified according to the context. The main problem of identity research is not whether identity. Nat. sit. n. al 2.2.2 Identity from the communication perspective Ch. engchi. er. io. approached.. y. is fluid, negotiated, constructed or originally embedded and persistent. The question is how it is. i n U. v. Other scholars have tried to solve the aforementioned conceptual problem of identity differently – by creating a more comprehensive concept. One of the theories trying to widen the understanding of identity is the communication theory of identity (CTI) developed by Michael L. Hecht and his colleagues (see, for example, Jung & Hecht, 2004; Hecht, Warren, Jung, & Krieger, 2005). CTI emerged out of the research examining the effective intergroup communication and 5. Identification and categorization refer to processes of how people define and characterize themselves vís-a-vís known others and situate themselves and others in social categories (such as race, ethnicity, social stratum, gender, etc.). Self-understanding and social location are dispositional terms referring to a person‟s sense of who he/she is, of his/her social location, and of how he/she is prepared to act. Commonality, connectedness, and groupness are the terms defining the sense of belonging to a certain group (Brubaker & Cooper, 2000).. 25.

(34) has its metaphysical roots in three different cultural traditions. It attempts to “integrate holism from Asian and African conceptions, polarity from the Greeks, harmony from African views, collectivism from Asian ideas, and the individual orientation in the Greek perspective” (Hecht et al., p.257). CTI also has its origins in modernity and postmodernity incorporating the notion of identity located in the individual and the conceptualization of fluid, complex and changing identity, respectively. In addition, CTI has imported the notion of group-based identities and. 政 治 大. categorization from social identity theory (SIT)6 and social roles and ascriptions from identity. 立. theory (IT)7. SIT derives and is closely related with the social cognition theory, and IT follows. ‧ 國. 學. the tradition of symbolic interactionism. These two theories have set the agenda for theorizing about identity in many academic fields (Hecht, Warren, Jung, & Krieger, 2005). Nevertheless,. ‧. CTI differs in the dimension of communication.. Nat. sit. y. Although SIT and IT, as well as most of the other identity-related theories, recognize. n. al. er. io. identity as communicated, expressed in the act of communication, they usually do not. i n U. v. conceptualize how it is communicated. In contrast, CTI conceptualizes the act of communication. Ch. engchi. as part of identity; social behavior is an aspect of self – the enacted identity. That is, “a person‟s sense of self emerges and is defined and redefined in social interaction” (Hecht et al., 2005, p. 6. Social identity theory (STI) was developed by Henri Taijfel and John Turner in late 1970s. It is largely influenced by social cognition theory which analyzes how people store and process information. SIT‟s primary focus is on cognitive and motivational basis of intergroup differentiation and on identity formation as a product of social categorization. Social categories can be understood as parts of structured society, such as gender, ethnicity, religion, political affiliation, age group, etc. According to this theory, individual has several selves, or several social identities. In the different social contexts individuals think, feel, or act on the basis of his personal, family, or national level of self (Hogg, 1993; Turner, 1991). 7. Identity theory (IT), one of the most influential theories in identity research, was developed by Sheldon Stryker in the 1970s. This theory conceptualizes identity in terms of role relationships. The self is seen consisting of many identities, each of which is based on a certain social role, such as a father, a teacher, a priest, etc. It also incorporates the meanings and expectations associated with a certain role and its performance (Stets & Burke, 2000).. 26.

(35) 260). It is also important to note that “the mutual interaction between an individual and society is reflected in identity… [I]dentity can be regarded as a pivotal point interrelating individual with society” (Hecht et al., 2005, p.260). In other words, communication is seen as a process constructing or reconstructing identity which is relational and discursive. CTI posits that identity consists of four layers (Jung & Hecht, 2004; Hecht et al., 2005). The personal layer refers to the individual as a locus of identity. It appears as self-concepts and. 政 治 大. self-images (e.g., “I am a tolerant person”). The relational layer is where relationship is the locus. 立. of identity. Relational identity has several levels. For example, individuals may develop and. ‧ 國. 學. shape their identities through internalizing how others view them; individuals also identify themselves through their relationships with others in terms of social roles (i.e., a spouse, a friend,. ‧. a boss, a doctor, etc.). The communal layer refers to a group as a place where identity exists;. Nat. sit. y. members of a group establish common group identities, share same characteristics and collective. n. al. er. io. memories which form a content of the group‟s identity. The enactment layer refers to. i n U. v. communication as a locus of identity. Identity is enacted in social behavior and symbols; self is. Ch. seen as a performance, as expressed.. engchi. These four layers are perspectives to a whole, integrated identity. They are interpenetrated in a number of ways. In some situations, the layers are complementary. In other situations, they may contradict each other. Nevertheless, even if the layers contradict each other, they coexist and compose a complex identity. Hecht and his colleagues (Jung & Hecht, 2004, 2008; Hecht et al., 2005) proposed that the four layers can be seen as functioning independently for analytical purposes. However, a concurrent analysis of two, three or all four would enrich the research (Jung & Hecht, 2004). 27.

(36) Jung and Hecht (2004, 2008) analyzed interconnection of personal-enacted and personal-relational identity layers. The researches were conducted in the communities of university students (Jung & Hecht, 2004) and Korean immigrants (Jung & Hecht, 2008). Research results indicated that discrepancies between identity layers are significantly related with communication outcomes, such as communication satisfaction, different levels of depression, feeling understood, conversational appropriateness, etc.. 政 治 大. Wadsworth, Hecht and Jung (2008) discussed personal-enacted and personal-relational. 立. identity interpenetration among international students in the United States and how this. ‧ 國. 學. interpenetration was related to educational satisfaction. Acculturation and perceived discrimination were found to be important factors to the formation of discrepancies, or identity. ‧. gaps, between or among the layers.. Nat. sit. y. CTI offers a theoretical basis for this research, in which identity is seen as enacted, relational. n. al. er. io. and consisting of multiple but interconnected elements. I adopt CTI‟s perspective that. i n U. v. communicative acts are a part of identity, not only a medium for identity expression. This study. Ch. engchi. yet does not aim to introduce the overall picture of identity of an individual. Here I will focus on the professional identity of Chinese medical practitioners (which directs to the relational layer) and its enactment during the medical practice. Nevertheless, if any elements of personal and group identity appear to be salient and influencing professional identity, they will also be taken into consideration. Professional identity informs practice and influences behavior in a workplace and is tightly related to social roles. Banton (1965) suggested that “a person‟s role is a pattern of social behavior that appears appropriate to the expectations of others and to the demands of the situation” 28.

(37) (as cited in Hecht et al., 2005, p.260). Thus roles form identity. Identity is built in opposition to and in relation to others (Charon, 1992). In medicine, for example, professional identity may include teamwork, relationships with patients and colleagues, communication, moral, ethical and clinical decision making, and engagement with professional development (Griffin, 2008; Jones & Green, 2006). The role doctor also prescribes an expected behavior attached to the position (Lynch, 2007). In other words, being a Chinese medical practitioner defines a certain identity. 政 治 大. based on a social role with particular values, duties and responsibilities, and determines a. 立. particular behavior.. ‧ 國. 學. However, the identification in terms of social role merely highlights what the relationship with surrounding society people have in a consistent form (for example, duties, obligations,. ‧. responsibilities, rewards, expectations, etc.) (Davies & Harre, 1990). It does not reflect how. Nat. sit. y. identity is constructed and negotiated. In the next section, I will introduce the concept of. n. al. er. io. positioning which provides an analytical tool for understanding identity not only in terms of structure but also in terms of processes.. Ch. engchi 2.2.3 Positioning and identity construction. i n U. v. The research under structural-functionist tradition has concentrated on social roles and identity as fixed components of complex structures which define social behavior. Scholars representing symbolic interactionism tradition have paid more attention to the way identity emerges in social interaction (Lynch, 2007). Positioning theory originated in discussion of limitations of social role. Davies and Harre (1990) argued that relationships defined merely by social roles, such as. 29.

(38) mother-son, teacher-student, doctor-patient, etc., are relatively static categories and fail to represent how these relationships are actually experienced and enacted by their participants. Shotter (1996, as cited in Linehan & McCarthy, 2000) suggested that there are many different ways in which people can relate themselves to their surroundings. Positioning theory, developed by Harre and his colleagues (Davies & Harre, 1990, 1999; Harre & Van Langenhove, 1991), focuses specifically on how people relate themselves to their surroundings. According to. 政 治 大. Davies and Harre (1999), “an individual emerges through the process of social interaction not as. 立. relatively fixed end product but as one of who is constituted and re-constituted through the. ‧ 國. 學. various discursive practices in which they participate” (p. 35). In social interactions, individuals position themselves in relation to the surrounding social context. According to Davies and Harre. ‧. (1999), positioning thus is:. Nat. sit. y. [T]he discursive process whereby selves are located in conversations as observably and. n. al. er. io. subjectively coherent participants in jointly produced storylines. There can be interactive. i n U. v. positioning in what one person says positions another. And there can be reflexive. Ch. engchi. positioning in which one positions oneself. (p. 37). It is worth noting that people position themselves not merely through conversations. In positioning theory, the understanding of discursive practice includes language-like sign systems (Linehan & McCarthy, 2000). Social acts through which people position themselves consist of conversations, institutional practices and societal rhetoric (Harre & Van Langenhove, 1991). This requires “a focus on an ongoing discursive process … which is influenced by the history of interactants and the kind of storylines that the community has produced and through which selves are enacted” (Linehan & McCarthy, 2000). 30.

(39) Hsu and Lin (2006) employed the concept of positioning for analyzing interpretation of SARS in Taiwan‟s printed media. Their study indicated that Chinese and Western medical experts used different positioning strategies to interpret SARS. Nonetheless, both Chinese and Western medical representatives employed scientific evidences to defend their positions. It was also found that the content and dynamics of positioning were influenced by Taiwanese policy towards Chinese medicine and folk practices as well as by long-term self perception of practitioners.. 立. 政 治 大. In another study, Hsu and Wang (2007) analyzed positioning in the controversy related to. ‧ 國. 學. aristolochid acid. The analysis of dynamics of positioning and power struggle between Chinese and Western medicine revealed multiple identities of Chinese and Western medical. ‧. practitioners/experts. It was found that positioning was an important tool in creating or. Nat. sit. y. re-creating group identity as reflected in the news discourse.. n. al. er. io. The concept of positioning offers a dynamic model of identity construction where social. i n U. v. actors identify themselves in a particular context through active positioning in relation/opposition. Ch. engchi. to elements in their discursive sociocultural context (Linehan & McCarthy, 2000). Nevertheless, social actors do not necessarily build a unified identity during these processes. Their positions, and thus identification, may change with the discursive shift and the emergence of new storylines (Davies & Harre, 1990). This concurs with the CTI‟s perspective of multiple layers of identity which may either enhance or contradict each other (Jung & Hecht, 2004). However, just as the majority of identity-related approaches, Davies and Harre‟s conceptualization continues to see identity as being created and negotiated through social interactions and communication. Here I adopt CTI‟s approach that identity is not only 31.

(40) communicated and expressed in the social relationships; more than that, social behavior is seen as a part of identity. The way Chinese medical practitioners act and communicate is thus also perceived as a part of their professional identity. Based on CTI‟s communicative approach towards identity and employing positioning as an analytical tool, this study aims to understand how Chinese medical practitioners construct and negotiate their professional identity, be it perceived or enacted, within their discursive practices. 政 治 大. related to Western medicine. The answer to this question will contribute to a better understanding. 立. of some patterns and processes taking place in the meeting of Western and Chinese medicine in. ‧. ‧ 國. 學. Taiwan‟s health care system.. n. er. io. sit. y. Nat. al. Ch. engchi. 32. i n U. v.

(41) 3.. Method. The perspective on identity as enacted and emergent points to the realm of communication. In this study, processes of communication are seen as a site where identity can be grasped. Accordingly, I examined communication processes taking place in the meeting between Chinese and Western medicine through a case study of a selected Chinese medical clinic. I employed participant observation and in-depth interviews to study the culture of the clinic. This chapter. 政 治 大. explicates the methodology of the research.. 立. ‧ 國. 學. 3.1 Introducing the Case: Yusheng Chinese Medical Clinic. ‧. Yusheng Chinese Medical Clinic (育生中醫診所) was chosen for this case study following. sit. y. Nat. logics deviant, or extreme, case sampling. According to Patton (2002), deviant case sampling is. io. er. used for selecting cases that exemplify characteristics of interest and are information rich because. al. “they are unusual or special in some way” (p. 231), for example, outstanding successes or notable. n. iv n C failures, exotic events, crises, etc. Yusheng is considered as exemplifying characteristics of h e nClinic gchi U interest. The main criterion was a noticeable meeting between Chinese and Western medicine taking place in this clinic. Yusheng Clinic was established by Dr. Chen-Yu Lee (李政育) in 1977. Lee graduated from National Chengchi University as journalism major in 1973. While pursuing studies in the university, he individually studied Chinese medicine. In 1978, Lee obtained his license of Chinese Medicine Physician. Apart from the position of a senior doctor and a director of Yusheng Clinic, Lee is an honorary chairman of Taiwan‟s Neurological Association of Integrated 33.

(42) Chinese and Western Medicine. He has also been a visiting professor and a research fellow in several schools in Taiwan and China. Along with the medical practice and involvement in educational activities and research projects, Lee publicizes his medical writings. His works often introduce diseases and their treatment from integrated Chinese-Western medical perspective.8 Lee‟s involvement in the integration of Chinese-Western medicine is also represented by Taiwan‟s media (see, for example, Wan, 2008; Zhang, 2008; Li, 2010).. 政 治 大. On the one hand, Lee is known as an innovative Chinese medical practitioner (Altschuler,. 立. 2005). On the other hand, he is recognized as a representative of traditional transmission of. ‧ 國. 學. knowledge and practice (Zeng, 2003). 9 Having acquired his skills by self-study and apprenticeship, Lee promotes this form of knowledge transmission by accepting and tutoring. ‧. students in the clinic.10 Therefore, it is expected that the medical theory of Chinese-Western. Nat. sit. y. medicine integration advocated by Lee has been transmitted to his students and co-workers,. n. al. er. io. emergent in daily medical practice and might be related to the professional identity construction.. i n U. v. The intriguing questions yet arise here: Why is there a need to integrate Chinese and Western. Ch. engchi. medicine? What is meant by integration of Chinese and Western medicine in Yusheng Clinic? How does it manifest in the daily practice? How is this integration reflected in professional self-identification of the Chinese medical practitioners? 8. For example, Theory and Practice of Chinese-Western Medical Exchange, Practical Geriatrics of Chinese and Western Medicine, Series of Chinese and Western Medicine Consultation: Insomnia, Neuropathy: Integrated Chinese-Western Medical Therapy, to name just a few. According to Hsu (1999), traditional transmission of knowledge and practice is based on “the personalities of mentor and follower and their choice to maintain personal relationship of mutual trust within which the follower acquires medical knowledge and practice” (p. 2).. 9. 10. Since 1982, the number of students has reached almost ninety.. 34.

數據

Figure 1. Layout of the research setting.
Figure 2. Picture of a wooden board with the inscription of Dr. Lee‟s name and title.
Figure 3. Picture of herbal compounds.
Figure 4. Picture of the spinal nervous system chart.
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