ICH as a Legitimation Strategy for Traditional and Complementary Healing Methods?

Intangible Cultural Heritage as a Legitimation Strategy for Traditional and Complementary Healing Methods?
By Michaela Noseck-Licul, Krems

 

As a cultural anthropologist with a special interest in healing knowledge situated outside classic biomedicine, I have been observing Austria’s implementation of the UNESCO Convention for the Safeguarding of the Intangible Cultural Heritage (ICH) since 2007—from when it first became a topic all the way through to its ratification by Austria and subsequent implementation. One of the first tasks involved was to survey healing and health practices as possible elements of Austria’s cultural heritage. What criteria would have to be defined and applied in order to decide whose practical and theoretical healing knowledge should and may be included in such an inventory? What applications would have to be rejected based on these criteria, and who would decide what is cultural heritage worthy of preservation and what is not? These were the most urgent questions at the beginning of what was to be an extremely interesting learning process.

In the interest of exploring these core questions, the 2007–2010 period saw a research project conducted under my leadership that had been initiated by the Austrian Commission for UNESCO and was financed by both the Austrian Federal Ministry of Health and the insurance company UNIQA.

An initial step in this research was to examine the terms commonly used in this field, terms that are by no means randomly chosen by the various actors but rather make very clear reference to various types of positioning and conceptions of the human being that are prevalent in the area of complementary and traditional healing methods, an area that is the object of surprisingly controversial discussion. In Austria, for example, naturopathy tend to be regarded as part of established medicine and are for the most part applied by physicians working at spas. While applications to admit natural healing practices to the National Inventory of the Intangible Cultural Heritage do exist, they have thus far been rather rare. This could have to do with the fact that such practices are well anchored within the healthcare system—for which reason the practitioners may not need the media attention that can result from inscription onto this list. And herein may lie the difference between such techniques and other elements of ICH in Austria: the living traditions from the category of social practices, rituals, and celebrations listed in the inventory are hardly threatened in their continued existence and also receive a great deal of attention from the tourism industry, whereas the area of complementary and traditional medicine suffers frequent loss of knowledge due to state and other regulations as well as due to the reservation of various services for certain dominant occupational groups in the healthcare system. For the protagonists whom I encountered, the ability to make reference to immaterial cultural heritage was frequently a political strategy linked to rights of self-provision and self-determination in medical matters, which they viewed as being increasingly limited and threatened.

Another challenging aspect of this survey was the term “traditional medicine”, which incites controversial discussion of what criteria should go into determining whether something is “traditional”: a major point here is the regional anchoring of an element within a nation-state and beyond said nation-state’s borders. Dittmann suggests an orientation less toward the tradition-as-object than toward the act of passing on a tradition. When a tradition is passed on, the following occurs: a person conveys something to someone else, and we call this first person a tradent. The second individual, to whom the content it is conveyed, is the accipient, and that which the tradent gives the accipient is the material of the tradition or tradendum (Dittmann 2004: 120). This description, while simple, places the focus on the act of transferral. But now the question arises as to whether the mere act of transferral is already a completed transfer. Something is still missing, after all, and that thing is repetition: “Traditionality, the materials of tradition, and the notion of tradition relate to one another like hearing something and telling it to the next person, like the content of a rumour and the notion of the rumour as such. So if we consider the treatment of individual acts as parts of a chain to be a sort of reconstruction, we can say that by reconstructing a chain of acts of transfer, we identify individual acts in this chain as acts of tradition.” (Dittmann 2004: 122) Absorbing, applying, and ultimately passing on knowledge effects a self-determined way of handling resources based on experience. And in the health promotion field, the frequently used term “empowerment” refers to an aspect of intangible cultural heritage that, in my view, is central and harbours a great many opportunities with regard to enabling individuals to take responsibility for themselves in health matters—insofar as relevant legislation does not stand in the way.

Who benefits from intangible cultural heritage?
In Austria, applicable law entails that only physicians and certain other health professionals (under a physician’s supervision) may treat illnesses. There exist no official occupational categories such as “alternative practitioner” for people who work in a way that is complementary or otherwise separate from the conventional health professions, but there are many professional and lay practitioners in Austria who work in the realm of folk medicine and so-called energetics, an unregulated trade and professional grey zone that encompasses 18,000 individuals. So in this respect, as well, the label of immaterial cultural heritage could be interesting, but the relevant legislation places limits on what is possible. A lively tradition remains lively through actual practice, which is subject to limits due to the statutory reservation of certain areas for other occupational groups, for which reason those who preserve and apply such knowledge may not necessarily want to call attention to themselves. But when they do, the question remains whether we can still speak of tradition, or whether such claims are more for the purpose of legitimation—and to what extent they are justified.

Legitimation strategies in CAM
In Austria, complementary medicine is a tension-laden field in which various positions and definitional powers are subject to negotiation between various occupational groups that use various legitimation strategies. In keeping with Pierre Bourdieu’s Outline of a Theory of Practice (1976), one can identify orthodox and heterodox groups that employ claims to scientificity as their primary strategy of legitimation. The protagonists who dominate this field define what is effective, doing so on the basis of their own scientific backgrounds and claiming their statements to be based in science. In Austria, those wishing to provide therapy to ill individuals need either a medical degree or training in a recognised health profession. Although a conventional physician may also offer complementary therapies (which are not always of proven effectiveness), there exists the caveat that what they do must be based in science.

 

In clinical studies, both the cultural context and that which one could call a general healing effect are excluded to the greatest extent possible; i.e., the symbolism of the objects employed, ritual components, patients’ expectations and prior knowledge, and patient-healer communication are virtually ignored in studies of efficacy in the interest of arriving at a practice of medicine that functions identically for all people regardless of their backgrounds. But traditional and complementary healing methods live from precisely such backgrounds, the significance of which has been recognized via the detour of placebo research, and which can be alternatively subsumed under the term “meaning response” (see Moerman 2002).

The reference to tradition and experiential knowledge is an alternative strategy of legitimation in cases where legitimation via clinical studies promises no success due to the abovementioned differences. Through the activities of UNESCO in the area of intangible cultural heritage, such an alternative was perhaps made more visible as an option for the protagonists in question. This was shown in particular by the ratification process that preceded implementation of the Convention, when the process of exploring just what ICH can be in the first place, and what advantages it might entail, was still underway. Many protagonists probably hoped to find more esteem in the populace, in the media, and with the relevant authorities via this route.

Challenges of the initial phase of implementation
Some of the questions that arose over the course of time while dealing with ICH have already been addressed above: it was fundamentally unclear what exactly distinguishes ICH or tradition and how it can be recognized. Problems arose specifically with the definition of tradition in the context of ICH. Although the concepts of ‘uniqueness’ and ‘authenticity’ are not an issue of the Convention itself (the use of the terms ‘unique’ or ‘authentic’ in descriptions of elements is even considered as ‘inappropriate’ language) recurring questions involved: how long-running should a tradition eligible for inclusion in the inventory be, how much new content may it contain, and how unique must it be? What is authentic? Is authenticity necessary? And who makes the decisions, here? Even though the 2003 Convention is not about uniqueness or about authenticity, but about intangible cultural heritage that is ‘constantly recreated by communities and groups in response to their environment’ this is often misunderstood.

An initially surprising challenge in dealing with ICH was the fact that some bearers of knowledge—such as individuals who practice generations-old Alpine healing methods based on magic words—did conform perfectly to my notions of ICH but wanted absolutely nothing to do with it. These people preferred to remain out of the public eye: they form no community of their own to begin with, rather working alone and maintaining distance from other practitioners—and they viewed media attention as a threat to themselves and their secret knowledge. This fear can be explained by long-running historical experiences of exclusion and persecution by church and state authorities.

In other cases, it was recognised that there is a need to act in order to preserve knowledge that is gradually disappearing, but no community could be identified whose identity could have been strengthened via inscription onto the ICH Inventory. Knowledge of healing herbs and home cures good for first aid or coping with minor ailments on one’s own is disappearing across the entire population—particularly among young people, who do have in common their youth and being subject to conditions that lead to this loss of knowledge and competence, but who do not form a community as such. One cannot speak of community and identity in terms of the health competency of the entire populace, which is losing its knowledge of home cures and self-provision of herbs and other tools of the traditional pharmacopeia. There is a need to act, here, if the desire is to enable people to act self-responsibly and independently. But this concern cannot be brought into harmony with the criteria for inscription on the ICH Inventory. This pan-societal phenomenon, which matches ICH in a thematic sense, was indeed an argument in conversations I had with authorities and insurers about the significance of ICH—but as an element in the inventory, it was not an option as such. Some initial success in terms of consciousness-raising, of course, has been achieved with the inscription of the healing knowledge of Pinzgau residents along with the house specialities of that region’s pharmacies—since these are groups who actually pass on such knowledge. However, the objective of promoting healthcare self-competency among all Austrians has remained unmet.

Recognising experience as a resource
Particularly in cases where implementation of the Convention in the sense of keeping a list fails to do justice to the reality and needs of those who possess relevant knowledge (i.e., where ICH status is not directly useful), one sees important themes that consequently deserve to be given some thought. And in retrospect, for me as a researcher in complementary medicine, dealing with experiential knowledge (tacit knowledge, embodied knowledge) is the most important impulse and indeed a way to understand traditional healing methods and their value to the individual and to society—regardless of whether or not this is reflected by concrete examples in the Inventory. Pursuing this idea via research and showing the protagonists an adequate form of legitimation, thereby reinforcing their decision-making ability and the self-empowerment of the populace, is a viable approach, for experiential knowledge is the essence of traditional and complementary healing methods; in German, accordingly, this approach is referred to as Erfahrungsmedizin [experiential medicine].
In this field, experience is an indicator of quality. Without experience, we have nothing to hold onto, and the discussion concerning ICH helps to make this clear. Embodied knowledge includes the sensory realm and equips us with abilities and resources in all areas of life. Alongside explicit knowledge (i.e., the knowledge generated, tested, and reflected on in the natural sciences), this form of knowledge is very important. There exist many points here to which science can latch on, for example the discourses on embodiment and the body that are developed further in dealing with traditional and spiritual healing methods (see Csordas 2002). When the Heidelberg-based philosopher and psychiatrist Thomas Fuchs wrote about implicit knowledge, he was probably not thinking of intangible cultural heritage—but even so, he does express an essential concern that is brought into focus by the Convention:

“For homo sapiens is not the expert who is equipped with all possible information, but quite literally the “tasting human” (Latin: sapere = to taste, to know)—in other words, the being that is possessed of a special taste or sense for complex situations, and who is able to master life through precisely such implicit, intuitive experiential knowledge. If we lose personal experience and instead rely only on maps, we will have a hard time weathering future storms.” (Fuchs 2008:257)

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Abstract

Die Beschäftigung mit Immateriellem Kulturerbe rund um Gesundheit, Leiden und Heilen gibt Einblick in einen international geführten Diskurs, der in Österreich eine besondere Ausprägung hat: im Spannungsfeld zwischen der etablierten Biomedizin und um Anerkennung bemühten Anwendern/innen von komplementären Methoden abseits davon, geht es für die Wissensträger/innen vor allem um Möglichkeiten der Legitimation des eigenen Tuns. Sich auf Tradition zu berufen ist eine Möglichkeit dazu, allerdings stellt sich die Frage, ob die Konvention zum Erhalt des IKE hierfür immer geeignet ist. Der Artikel zeigt anhand der begrifflichen Vielfalt im Feld diese Problematik und die Herausforderungen und Chancen im Umgang mit IKE auf.

Dealing with intangible cultural heritage in the area of healthcare, suffering, and healing provides insight into an international discourse that exhibits special characteristics in Austria: due to the conflicting priorities of established biomedicine and complementary approaches that lack the recognition enjoyed by the former, practitioners of such complementary methods seek above all ways to legitimate what they do. Referring to tradition is one possible way in which to do so, but this raises the question of whether the Convention for the Safeguarding of the Intangible Cultural Heritage can fulfill such expectations. Based on the terminological and conceptual breadth of the field in question, this article points out the challenges and opportunities involved in an approach based on intangible cultural heritage.

Biography

Michaela Noseck-Licul is a cultural anthropologist specialised in medical anthropology. From 2007–2010, she conducted a survey of traditional and complementary healing methods in cooperation with the Austrian Commission for UNESCO; since that time, she has dealt with issues related to quality assurance and effectiveness research in complimentary medicine. In addition to lecturing on the anthropology of healing, she also teaches ethics for music therapists. Furthermore, she is currently researching CAM methods and their effectiveness in Lower Austria in cooperation with the IMC University of Applied Sciences Krems.