Investigaciones Nacionales

Phenomenologically informed medical anthropology advocates a radical role for the body as “the existential ground of culture.”¹ This “anthropology of em- bodiment,” drawing on Merleau-Ponty’s phenomenology of perception and Bourdieu’s theory of practice, locates culture in “the lived body” of everyday practice and directs analytical attention to the experiential aspect of culture in everyday life. The concept of “embodiment” with its intended resistance to mind/body and subject/object dichotomies in understanding human experi- ence lends a conceptual bridge in talking about Chinese conceptions and expe- rience of shenti 身体 (body-person).² In my analysis of qingzhi 情志 (emotion) disorder, I seek to situate the Chinese experience of illness and healing in the context of “embodied culture.” By this, I mean the persistent and pervasive cultural values and sensibilities that are deeply rooted in bodily practices of the everyday and thus have become “natural” or habitual ways of being and doing for the local people. The idea is to make “embodied culture,” or “cultural aesthet- ics,” to follow Robert Desjarlais’ use,³ an interpretive context for understanding emotion-related disorders in the context of contemporary Chinese medicine. In this chapter, I consider how ordinary Chinese construe and experience their bodies in everyday life, what meanings and sensibilities such bodily knowledge and dispositions embody and communicate, and how these sensibilities reflect a world orientation of the people, which is also embodied in the knowledge and practice of Chinese medicine. My concern is fundamentally with meaning and the “felt quality” of cultural experiences.

This chapter centers on an exploration of the Chinese notion of “shenti” (routinely translated as “body” in English) and the related categories. Before we step into this Chinese world, a critical examination of the Western body in the context of Chinese culture and medicine is necessary, because when we use the English word body as a neutral analytical concept, there is always the possibility that we unconsciously read the Euro-American body into the cultural expe- rience that is based on a different tradition of embodiment, and “necessarily

import a variety of Western value orientations.”⁴ This problem is particularly evident in the discussions of somatization in Chinese society.

THE PROBLEM OF SOMATIZATION AND THE BODY

Chinese are widely believed to be “particularly prone to somatization.”⁵ A sim- ple and familiar logic goes: psycho-emotional disorders are psychobiological entities; while cultural legitimization of emotional disorders leads to an em- phasis on the psychological aspect of the disorders, the cultural stigmatization of emotional disorders leads to an emphasis on the somatic aspects of such dis- orders.⁶ Psychologization and somatization are therefore seen as two opposite illness constructions. The former is dominant in Western industrialized society, and the latter is characteristic of more tradition-oriented society, such as China, where a “long-standing tradition of repression of emotions leads to utmost emphasis on somatic dysfunctions.”⁷ Seeking help with Chinese medicine for emotion-related disorders is an utmost evidence of Chinese somatization.⁸

Yet my fieldwork reveals that Chinese patients frequently relate their suf- ferings to emotional, psychological, and social factors in the clinics of Chinese medicine. As a matter of fact, most patients I observed in Shenjing Ke 神经 科 (the Clinic of Neuropathic Disorders) of the hospital presented emotional distress as well as bodily complaints. In my observation, Chinese patients have no problem with emotions as a source of their sufferings. They are more likely to hide from others their problem of infertility rather than their feelings of anger or sadness.⁹ In some cases, instead of “somatizing” their emotional distress, Chinese patients are inclined to reject the diagnosis of an organic disease.

Ms. Wang’s case is an example. Ms. Wang, in her fifties, was diagnosed as having coronary disease (guanxin bing 冠心病) in a biomedical hospital and was hospitalized for one month. Soon after she was discharged from the bio- medical hospital, she went to see a senior zhongyi physician. She claimed one month of hospitalization and medication failed to cure her illness, and her symptoms became even worse. She complained about a sense of blockage (du 堵) in her heart, palpitation of her heart (xinhuang 心慌), frequent hicuups, difficulty sleeping, depletion of sweat (xuhan 虚汗) and cold extremities. She refused to accept that she had coronary disease and insisted that her illness was anger related (qide 气的). According to the zhongyi doctor, the patient suffered from liver qi stagnation (ganqi yujie 肝气郁结), obviously, a qingzhi (emotion) related disorder. For many patients, the emotion-related quality of their suf- ferings is precisely the reason why they come to zhongyi.¹⁰ Zhongyi doctors accordingly see themselves as particularly strong in treating emotion-affected functional disorders, that is, qingzhi disorders.

Most zhongyi doctors simply dismiss the concept of “somatization” as ir- relevant, whereas Chinese psychiatrists find themselves caught at the center of the controversy. On the one hand, they feel it important to “fit” in (jiegui 接轨) with the international community of psychiatric medicine; on the other hand,

the epistemological tension between the Chinese culture of health and the modern biomedicine has to be addressed. Many of them question the general application of somatization and the related concepts to the Chinese context and suggest limiting its use.¹¹ For example, on the one hand, Xu argues that Chinese patients from the rural areas do not make a distinction between or- ganic and functional disorders. On the other hand, patients from cities readily present emotional symptoms and acknowledge emotions as the source of their illness in the context of a good doctor-patient relationship.¹² For them, “bodily distress and psychic suffering are integrated and context-specific.”¹³ Indeed, as Yamamoto and colleagues report, instead of finding somatizing Asians ver- sus depressive Caucasians as expected, their study of psychiatric outpatients in California reveals that symptoms of both depression and functional somatic complaints are higher among the Taiwanese than in the Caucasian comparison group.¹⁴

Adding complexity to this problem of somatization, Chinese verbal ex- pressions cannot be easily categorized as somatic and psychological. For exam- ple, common symptoms presented by Chinese patients in the clinic of Chinese medicine, “blockage in the heart” (xinli du 心里堵) and “vexation” (xinfan 心烦) are experienced both somatically and psychologically. Zheng and his colleagues in their studies of styles of verbal expression of emotional and physical experi- ence in China notice that many of the Chinese expressions do not easily fall into the categories of psychologization and somatization. They have to label the same expression, “do not want to do anything,” in one place as psychologi- cal and in another place as somatic.¹⁵ Apparently, Chinese verbal expressions of distress are mostly experiential, both emotional and somatic, neither purely psychological nor purely somatic. To categorize embodied experience according to dualistic categories can be very confusing.

In a way, this picture of somatizing Chinese represents a classic example of the Western “ethnocentrism” which, in this case, involves redefining the Chinese experience within modern Western biomedical epistemology that presupposes an essentialistic distinction between mind and body, psyche and soma, and thus psychiatric and general medical diseases. This biomedical epistemology, as Fa- brega shows, postulates a “model of illness” that connects illness process and behaviors to correspondent changes in body and in mind.¹⁶ Deviations from these norms imply either somatizing or, possibly, psychologizing. In applying this dualistic model of illness to the Chinese illness experience, researchers in fact create the very image of somatizing Chinese, which they believe to be their discovery. In fact, as illness constructions, both somatization and psychologi- zation are products of a cultural tradition that essentializes and dichotomizes body and mind, and should only be understood in that context. They are two- way reductions of the same dualistic process.

Ironically, somatization makes much more sense in the context of modern American culture. As Pollock points out, “The fundamental bifurcation of per- sons in American culture into bodies and minds surely forms the cultural and

historical ground for the parallel fundamental bifurcation of illnesses into the physical and the mental, and of professional medical specialties into physical medicine and psychiatry/clinical psychology.”¹⁷ Within each of these spheres of medicine, conceptions of illness as well as forms of practice tend to reflect and reproduce the basic aspect of American personhood. American patients are noticeably oriented to this dualistic principle of body and mind. As Jean Jackson shows in her study of chronic pain, patients “protest loud and clear at any hint that a given pain is ‘emotional’ and therefore not ultimately produced by a physical cause,” because they are aware that their problems could be in- terpreted as “not real” or explained as mental illness or “some form of character flaw.”¹⁸ In the context of the contemporary general biomedical epistemology, a physical pain must be accompanied with a physical cause, therefore, a given pain without a physical explanation implies an illness “inauthentic if not fic- tive.”¹⁹ Similarly, the name of chronic fatigue syndrome (CFS) has been a topic of controversy for some time in North America. Some medical professionals feel they need to legitimatize a disorder by implying a biological basis, such as an immune dysfunction or virus infection. Patients, too, do not like the label of CFS. They insist that without a reference to a biological cause their sufferings are trivialized.²⁰ This type of illness experience contrasts sharply with what I observed in the clinics of Chinese medicine, where pain is simply pain experi- ence and event, legitimate in itself, regardless of whether it is emotionally or organically caused.²¹

The cultural dualism that bifurcates the American person and medicine has a firm grounding in the Western mainstream philosophic tradition, which from its classic beginning posits inherent determinate essence as the defining principle for things.²² Things are different by virtue of their fixed essences. The language of essentialism and the separation of the determining and the deter- mined paved the way for the post-Cartesian framework of mind versus body, which has since permeated every aspect of the modern Western commonsense world and grounded the Western views of nature, culture, the individual, and society. They are not just “cognitive habit”²³ or a philosophic presumption; they are social values and aesthetic orientations embodied in everyday practices of the people.

Although the essentialized material body has been challenged in various postmodern writings, the fundamental dualism of mind/body “seems to be es- pecially difficult to theorize into abandonment.”²⁴ One reason for this tenac- ity lies perhaps in the English language itself. As Nancy Sheper-Hughes and Margret Lock point out, “we lack a precise vocabulary with which to deal with mind-body-society interactions and so are left suspended in hyphens, testifying to the disconnectedness of our thoughts.”²⁵

Whenever we use English key terms, such as body, emotion, or disease, we invoke a variety of cultural and philosophical assumptions. In the context of Chinese medicine, taking these assumptions for granted, we in fact read an ontology of substance into a more process-oriented “ontology of events,”²⁶ an

epistemology that privileges structure and form into a more temporally or- ganized process of transformation, a representation into more experientially oriented presentation, and a strict dualism into correlatively situated polar rela- tions. The bodies that Chinese medicine works on and Chinese patients experi- ence take different forms and entail a different set of vocabularies.

A SEMANTICS OF SHENTI (BODY-PERSON)

By semantics, I do not refer to an ethnosemantic analysis of the concept of

shenti, which only deals with referential meaning. My approach, in principle,

resembles Good’s “semantic network analysis,” which “seek(s) out for analysis the potent elements in the idiom of social interaction and explore(s) the as- sociated words, situations and forms of experience which they condense.”²⁷ In fact, Chinese culture is biased toward such sense of meaning in which “a term is defined non-referentially by mining relevant and yet seemingly random associations.”²⁸

In the contemporary Chinese language, the most commonly used expres- sion denoting “body” or “bodily” is shenti, which, in fact, is composed of two root words shen 身 and ti 体. Both can be translated as “body,” but the differ- ence between shenti and the English word body is crucial. The English body comes from Old German budha meaning “tub” or “container.” When body is used without further explanation and definition, it evokes in readers an image of physical, objective, or anatomic entity separate from what is spiritual and social. It requires further modification and explanation in order to convey the nondualistic experience of embodied person, such as using combined or hy- phenated terms: lived body, perceiving body, mindful body, or body-mind. The English body speaks of and to a dualistic reality. In contrast, when shenti is used without further clarification, it implies a person or self with all the con- notations of the physical, social, and mindful. As May Tung reports in her study of symbolic meanings of body in Chinese culture, with no exception, all her informants identify shenti with the person, the self. Some of her infor- mants simply substituted body (shen 身) in her questionnaire for “the person,” “the self,” or simply used a personal pronoun.²⁹ It is the specific meaning of

shen (regarding specifically physical, emotional, spiritual, or social aspects of a

person or self ) that requires further context. In other words, Chinese shenti is undifferentiated; its specific meaning, sometimes, requires a second character as an environment, as in the words of shenqu 身躯 (body trunk) or xingti 形体 (shape of a body).

Mark Elvin also notices that shen appears in most Chinese phrases that imply “person,” “self,” or “lifetime” in English translations. For example, anshen 安身—settle down in life; shenfen 身分—social status; benshen 本身—oneself;

zhongshen 终身—to the end of one’s life; shenshi 身世—personal history. It is

for this reason that Elvin translates shen as “body-person.”³⁰ The claim that due to increasing dichotomization between heart-mind and bodily emotions,

the meaning of Chinese shen has been reduced to “body-object” seems to be problematic.³¹

Similar to shen, ti 体, the second character of shenti, has polysemic dimen- sions in use. Surely it denotes physical body, but it also extends to include meanings of form, shape, convention, style, and so on, as in wenti 文体 (writ- ing style), and zhengti 政体 (polity). What is remarkable about ti is that it is often used as a verb or in a verbal phrase, meaning “to contain,” “to intimate,” “to implement,” “to formalize,” and “to understand,” suggesting an agency of lived body that perceives and acts. Chinese common expressions are full of such verbs, such as tiyan 体验 (experience body personally) and tihui 体会 (under- stand body personally), and even tiren 体认 (know body personally).³²

Susan Brownell, comparing the Chinese words shen and ti, with German

leib and korper, suggests that shen is similar to the German concept of “leib”

which is the subjective, experienced body, while ti somehow resembles the con- cept of “korper,” the “alienated object body.”³³ However, she seems not quite comfortable with this comparison herself and suggests that one should not take the parallels between the two Chinese and German conceptions of the body too literally because the Chinese does not exhibit strict subject-object dualism as the German does. Recognizing that in fact both shen and ti contain a subjective, experiential component, she qualifies her observation: “(N)either word has the disembodied Western sort of connotation in which a person is somehow inside the body that is experiencing life—a body that is separate from the experiencing subject.”³⁴ If we have to make a distinction between shen and

ti as bodies, we may say that shen implies a socially informed body-person or

body-self, while ti, frequently used in or as a verb, emphasizes “embodying” as a process of knowing and acting. Both concepts resist dualistically positioned mind and body, subject and object. Even the modern concept of “tiyu” 体育 (physical education) need not be reduced to training a physical body object.³⁵

Tiyu is still very much an intense process to embody social values and ideol-

ogy through a highly formalized body. In this sense, shenti (both shen and ti) is centrally important in Chinese social life.

Besides shen and ti, other single characters may also have the connotations of “body,” for example, xing 形 (form, shape), qu 躯 (body trunk), and shi 尸 (corpse). In modern Chinese, they are often combined with either shen or ti to create multiple senses that indicate different states of embodiment, for example,

xingti 形体 (body shape) and shenqu 身躯 (body build). Jing 精, Shén 神, and Qi 气

Within the Western cultural dialectic going back to Plato, mind has been de- fined typically as a quality that transcends the body (as something that ani- mates the body and is distinct from it). So to claim that mind is part of the body evokes contradictions. Although jingshen精神 is translated in English as “mind” or “spirit,” it is very much part of shenti. Jingshen is formed by two

root characters: jing 精 (concentrated basis of vitality)³⁷ and shén 神 (vitality as manifested through functional activities of mind and body as a whole). To understand the concept of “jingshen,” we may first go to its root words: jing and

shén. Both are centrally important in the Chinese conceptualization of life.

As is stated in Neijing: Suwen (Inner Classics: Simple Questions), “jing is the (concentrated) basis or root of life” (shen zhi ben 身之本). In contem- porary Chinese medicine, it is often described as “tangible/visible life-giving substance” (you shengming huoli de youxing wuzhi 有生命活力的有形物质). It is implied in this statement that tangible human bodies (or any bodies), composed of muscles, skin, hair, viscera, and bones, are the results of jing trans- formation, and that jing as a life-giving substance is itself alive, constantly gen- erating the new and transforming the old. Jing also has a narrower definition (xiayi 狭义), which refers to the functions of shèn (the kidney system). This jing is sometimes translated as semen that is stored in the viscera of the kidney and is responsible for reproductive functions, affecting growth and aging.³⁸ It is therefore also called “kidney essence” (shenjing 肾精). In addition to reproduc- tive functions, shenjing is also said to be responsible for bone growth (zhugu 主骨) and for producing marrow and brains (shengsui 生髓), therefore affecting the development of intelligence. The narrower definition of jing bears more clinical relevance. The symptoms of deterioration of memory, poor concentra- tion, and mental retardation are all seen as connected to deficiency in shenjing (kidney essence).

Jing 精 is further differentiated as “primary jing” (xiantianzhijing 先天之

精), which is inherited from one’s parents (bing yu fumu 秉于父母) and “ac- quired jing” (houtianzhijing 后天之精), derived from food. Primary jing pro- vides the basis for the process of transforming the energy distilled from food and is enriched and strengthened by “acquired jing.” Chinese medical theories view jing and qi 气 (air, breath, vital energy) as the same life-giving energy. When it is concentrated, it is jing; when it is dispersed, it turns into qi. If jing