Agendas

The system as a whole has also been characterised as one of ‘medical pluralism’. While social scientists and historians often use this term to include all forms of practice and therapy found in a given setting, policymakers in India have generally deployed it more narrowly to refer to the presence of certain categories of non-allopathic medicine (‘AYUSH’) within the formal health care sector. These types of medicine have been legitimated and incorporated through conformity to certain regulations and accreditation requirements imposed by the state at central and provincial levels. However used, the term, in our view, has only limited value, since it effaces stratifications across and within therapeutic domains, asymmetries in the kinds of treatments and resources available in different localities, as well as different modes of governance in the name of health. It also, in the governmental use of the term, tends to exclude the non-regulated sector. Here, we are proposing a different approach to the issue that focuses far more centrally on the relationships of power that run though the whole field of medicine and therapeutics and its governance. We distinguish between practice that is sanctioned and regulated by the state – whether it is biomedicine or the AYUSH cluster – and that which is not. The latter we define as the realm of subaltern therapeutics. In addition to this realm, we also consider the subaltern encounter with and experience of statist medicine (whether biomedicine or AYUSH) as integral to the examination of medical subalternity and some of our case studies are concerned with this dimension. The two domains are, of course, intimately interconnected since experiences of economic or social exclusion from statesanctioned medical institutions and discrimination at the hands of elite practitioners are frequently associated with continuing preferment of unregulated or non-legitimated forms of therapy. Some of the major forms of subaltern therapy that interest us are as follows (often one category may shade into another in practice, and the list is not exhaustive):

• Popular practice by vaids, hakims, kabirajs, Siddha-style healers, which incorporate an eclectic bricolage of methods, with a focus on ‘traditional’ medications and dietary and lifestyle advice, but which may include the use

of charms and rituals. They may practice from homes, from shops, on street corners, at weekly markets, or on an itinerant basis, and often evade state rules and regulations. They are subversive in this respect, being seen by the state and mainstream practitioners as endangering the reputation of medicine and the medical profession in general.