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| A fox usurper on the throne |
“One who out of desire for material gain merely assumes the guise of a physician is a destroyer of life.”
— Bshad-rgyud, ch. 31.
Even if it isn’t always transparent, people who know me and know my blogs know I always write in response to events in my life. That’s why I have to tell you right away, I am not experiencing any new health issues, certainly nothing life-threatening that I’m aware of. Health is the least of my worries (insert wry grin).
It’s just that recently a family member told me about visiting a very impatient M.D. He wished nothing more than to chase people out of his office and cancel his appointments. It showed. So instead of carefully questioning and listening, instead of seriously seeking a diagnosis, he basically dismissed my close relative with the equivalent of ‘Go home, exercise more, and stop taking up my time!’ If you think about it, I imagine you would come up with similar examples of your own, times you were manipulated or managed instead of getting the attention and care you required.
I think we have good reasons to approach health professionals with skepticism or at least caution. After all, the human body is a set of complex systems interacting in ways that can be very difficult for anyone to predict. Just look into the chemistry that kicks into gear whenever food falls into a stomach.
My previous General Practitioner took credit for things I did all on my own and of my own initiative. We could say that it doesn’t matter how a positive outcome actually comes about, yet what truly matters to the physician is how to take full credit for it. And I haven’t often had any of my problems resolved at their hands except minor ones like cyst removals or wound treatments. Much more frequently their advice and their medicines did nothing good. Is it because our expectations are too high, or because our ailments are so intractable? Awed by those craftily cultivated auras of authority built up out of questionable claims of success we readily hand over our power over ourselves. And this even when it is a fox sitting with pride on that lion’s throne.
At the risk of self-contradiction, we know that doctors have spent a lot of effort accumulating what knowledge they do have, so we shouldn’t just dismiss them. They can’t all be fake, can they? If by chance we happen to receive good treatments we are bound to appreciate it. Admit it, there are doctors located at every point along the spectrum from superbly good to unutterably bad.
While I worked on translating a 13th-century Tibetan work that criticizes bad doctors a few years ago, it didn’t occur to me to look into similar genres elsewhere. It practically goes without saying that some people everywhere would find reasons to complain about them. I only recently acquainted myself with a 1352 CE work by Plutarch, the famed classical revivalist, called Invective Against a Doctor. Petrarch’s work is framed as a critique of medicine as practiced in his day, all of it (this despite his protest*). The gist of it seems to be: That the secrets of the body are for divine intellect alone to know. Disregarding this truth, doctors mask their ignorance behind fanciful Latin terms to cheat people into thinking they know things. And if anyone brought about the deaths of as many people as they do, they would surely have to face legal punishments.
*Petrarch at one point vehemently denies he is attacking the entire profession (for the quote see the MARSH translation listed below). However, since he knows next to nothing about the life and practice of his addressee, he can in truth only speak in generalities.
I have to say, the Tibetans expressed skepticism against the bad ones for pedagogical purposes. Their skepticism was wasn’t just vituperative. They were all practicing physicians, and obviously not against the profession as a whole. They meant to convince future physicians NOT to do badly. That makes their words quite different in tone and in targeting compared to the Europe-cradled rhetorical tradition within which Petrarch figures so largely.
I would truly like to see more thinking about these kinds of issues in the various fields of Tibetology. When we compare we see things in common, and this allows the contrasts to appear all the more starkly. Is there some bigger message lurking here? Is Euro-American culture more prone to the dismissive type of cynicism and skepticism that says, Just toss the whole thing out the window? Is that some ponderous doctoral dissertation I see peeking in through the same opening?
So many questions. And so little time. As the doctors of days gone by liked to repeat, “Life is short and the Art is long.”
They act like big know-it-alls without ever studying,
not even knowing the distinction between vital points and gsang-s,
overconfidently administering treatments.
Such physicians are simply madmen.
— The Tsangtö Teacher
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| Shot in the dark |
Reading list for me and for you
Robert B. BAKER and Laurence B. McCullough, eds., The Cambridge World History of Medical Ethics, Cambridge University Press (Cambridge 2009).
I can’t pretend to have read this encyclopedic tome, but for present interests I much recommend section 5: “Medical Ethics in Medieval Europe,” on pp. 373-375, part of the essay by Klaus Bergdolt, who died last year. This succinctly places Petrarch in a larger context of the European tradition.
BYANG-PA Rnam-rgyal-grags-bzang (1395-1475), “Advice to Physicians,” translated by Kurtis R. Schaeffer, contained in: K.R. Schaeffer, M.T. Kapstein & G. Tuttle, eds., Sources of Tibetan Tradition, Columbia University Press (New York 2013), pp. 480-484. The Tibetan title of the text is འཚོ་བྱེད་རྣམས་ལ་སྙིང་ནས་བརྩེ་བའི་མན་ངག་འཕྲུལ་གྱི་ཡིག་ཆུང་།
Andrea CARLINO, “Petrarch and the Early Modern Critics of Medicine,” Journal of Medieval and Early Modern Studies, vol. 35, no. 3 (Fall 2005), pp. 559-582.
Stefano CRACOLICI, “The Art of Invective: Invective contra medicum,” chapter 16 contained in: V. Kirkham & A. Maggi, eds., Petrarch: A Critical Guide to the Complete Works, University of Chicago Press (Chicago 2009), pp. 255-262, 440-449.
See p. 260, where we learn that Petrarch’s use of the invective tone was likely due not only to his professed concerns about the medical treatments being done to Pope Clement VI, but also the recent devastations of the plague (from 1346 to 1353), including the death of his own son, Giovanni. His vitriol against the medical profession and its failures had reasons to run deep. It wasn’t entirely rhetorical.
Christopher CRAIG, “Audience Expectations, Invective, and Proof,” chapter 7 contained in: J. Powell & J. Paterson, eds., Cicero the Advocate, Oxford Academic (2004), pp. 187-214. Open access at Oxford Academic website:
I recommend this not only because it is freely available, but because it gives insight into the situated meanings of invective and vituperation, rhetorical moves far too familiar to us in both national and academic politics.
Penpa DORJEE and Dan Martin, “Verses on Good and Bad Physicians, Composed by the Tsangtö Teacher,” contained in: Charles Ramble & Ulrike Roesler, eds., Tibetan and Himalayan Healing: An Anthology for Anthony Aris, Vajra Books (Kathmandu 2015), pp. 529-541.
This contains translation and discussion of 13th-century sets of verses by Gtsang-stod Dar-ma-mgon-po (BDRC no. P4987 dates him to the 11th, but no, he’s definitely 13th century). It bears an overall title that actually only applies to the initial set of verses: Arguments of Novices in the Medical Arts Rebutted, or, གསོ་བ་རིག་པ་ལ་འཇུག་པའི་རྩོད་སྤོང་།
David V. FIORDALIS, “Medical Practice as Wrong Livelihood: Selections from the Pali Discourses, Vinaya & Commentaries,” contained in: C. Pierce Salguero, ed., Buddhism & Medicine: An Anthology of Premodern Sources, Columbia University Press (New York 2017), pp. 105-112.
It seems early monk followers of the Awakened One were discouraged from practicing medicine, probably because of problematic situations that might ensue with the local lay community. Doctoring is a worldly profession, or at least has the danger of becoming one when payment is involved, making it a business unbefitting monastics. That monastics did for all that go on to practice medicine in various ways shouldn’t go without at least saying it.
Barbara GERKE & Florian Ploberger, “The Final Doubt and the Entrustment of Tibetan Medical Knowledge,” contained in: C. Pierce Salguero, ed., Buddhism & Medicine: An Anthology of Premodern Sources, Columbia University Press (New York 2017), pp. 593-601.
If we recognize that there indeed are deplorable doctors, we can also admit there are people who should never be allowed to become candidates. This issue of unsuitable vessels who should not be entrusted with medical knowledge to begin with, is another one covered in the Four Tantras, in the final 26th chapter of the fourth tantra.
Virginia Teas GILL, “Doing Attributions in Medical Interaction: Patients’ Explanations for Illness and Doctors’ Responses,” Social Psychology Quarterly, vol. 61, no. 4 (December 1998), pp. 342-360.
I’m sure there are more studies like this out there that come to conclusions about just how deferential we can be when we have to talk to our doctors (the author did a whole dissertation on the subject). There is an “unequal distribution of knowledge and authority.” As we know even without doing a study of it, we can never make it sound as if we know what our problem is, even when we do. The patient is a supplier of data that can be analyzed and given meaning only by the doctor.
LAMA JABB, “A Poem-Song on the Perfect Tibetan Physician,” contained in: Charles Ramble & Ulrike Roesler, eds., Tibetan and Himalayan Healing: An Anthology for Anthony Aris, Vajra Books (Kathmandu 2015), pp. 419-434.
This example is by Sun of Men (མིའི་ཉི་མ་མཐོང་བ་དོན་ལྡན་ aka ལྷ་བཙུན་བྱམས་པ་དཀོན་མཆོག་རིན་ཆེན་), a Tibetan physician who flourished in the mid-15th century, based on an incomplete citation of it in a later work (this being the reason we have no title for it). It portrays the ideal physician, ignoring the bad. The author was asked to speak about himself, and does so in a way cynics are bound to hear as boastful. The author’s medical works are said to fill eight volumes, but as of today I haven’t learned of their publication.
William A. McGRATH, “Reconciling Scripture and Surgery in Tibet: Khyenrab Norbu's Arranging the Tree Trunks of Healing (1952),” contained in: C. Pierce Salguero, ed., Buddhism and Medicine: An Anthology of Modern and Contemporary Sources, Columbia University Press (New York 2020), pp. 94-99.
The translated passage from Khyenrab Norbu (མཁྱེན་རབ་ནོར་བུ་) starts out with the bad ones, then goes on to speak of the good ones. In this 20th-century treatment of the bad ones we detect the more or less direct inspiration of the 12th-century Yuthok passage (listed below), so the two ought to be compared.
Francesco PETRARCA, Invectives, tr. by David Marsh, I Tatti Renaissance Library (Cambridge 2003), pp. 2-179.
“You should know that I couldn’t help laughing when I read your letter. How could you more clearly prove the truth of what you deny? You abandon your own territory to wander in someone else’s domain, thus placing in the greatest danger those patients who blindly follow your advice. You promise them the fruits of good health. But although they need action rather than words, all you give them are the immature flowerets of your worthless verbiage.” [p. 3]
“Thus, I have absolutely nothing against medicine. I have said this a thousand times, but apparently it doesn’t suffice. So if I seem to have spoken against physicians, I shout it out passionately so that the whole class of the learned may hear me. Against you alone, and men like you, have I spoken and will speak in what follows.” [p. 107]
Lee SIEGEL, “How Many Vaidyas Does it Take to Change a Lightbulb? The Satire of Physicians in Sanskrit Literature,” Bulletin d'Études Indiennes, vol. 3 (1985), pp. 167-193.
This isn’t actually available to me, but to judge from the title it might well be relevant or, at the very least, hilarious.
Nancy STREUVER, “Petrarch’s Invective contra medicum: An Early Confrontation of Rhetoric and Medicine,” MLN, vol. 108, no. 4 (September 1993), pp. 659-679.
YUTHOK Yontan Gönpo (གཡུ་ཐོག་ཡོན་ཏན་མགོན་པོ་,1127-1203), “On Physicians,” contained in: K.R. Schaeffer, M.T. Kapstein & G. Tuttle, eds., Sources of Tibetan Tradition, Columbia University Press (New York 2013), pp. 282-291.
This is an extract from Barry Clark, The Quintessence Tantras of Tibetan Buddhism, Snow Lion (Ithaca 1995), pp. 223-233. The same chapter can be seen in an alternative English translation, together with the Tibetan text, in The Explanatory Tantra from the Secret Quintessential Instructions on the Eight Branches of the Ambrosia Essence Tantra (བོད་ཀྱི་གསོ་བ་རིག་པའི་རྒྱུད་བཞི་ལས་རྩ་བའི་རྒྱུད་དང་བཤད་པའི་རྒྱུད་), Bod-gzhung Sman-rtsis-khang (Dharamsala 2008 [2011]), pp. 281-299.
Primarily about good physicians — and probably the most important of texts for both prescribing Tibetan medical ethics and understanding it — you will not fail to notice toward the end a few pages on the bad ones.
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- Today’s illustrations are both drawn from thangka painting no. 37 meant to illustrate Desi Sangyé Gyatso’s classic Blue Beryl commentary on the Four Tantras, more specifically his commentary on the Explanatory Tantra, chapter 31 (for translations, look just an inch above). It would be fun to look at this chapter and its illustrations more closely.
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