The Position, Power, and Plasticity of Chinese Medicine in Singapore

Smith’s monograph is based on nearly two years’ studious fieldwork in medical (clinics) and non-medical (hawker center, neighborhoods) settings on Singapore’s main island, meanwhile contextualized within historical and political details of the country. Through ethnographically exploring ‘Chinese medicine in, and of, everyday life in Singapore, particularly in relation to state agendas, individual and collective agency, embodied experience, and overseas Chinese heritage’ (p. x), the author argues, the position of Chinese medicine in Singapore is constantly changing, not only shaped through sociohistorical transition from British colony to post-colonial state, but also affected by heterogenous bodily experiences and attitudes towards heritage. In concert with her main argument, this book is well-structured into two interconnected parts. The first three chapters emphasize historical and legislative aspects of Chinese medicine under the sociopolitical history. Chapters four to six focus on everyday sensation, body ecology and cuisine within this highly modernized tropical island. The author uses the critical medical anthropology approach, primarily inspired by Foucault’s concepts of biopower and governmentality, to reflect on several popular frameworks restraining the understanding of Chinese medicine, and further to find ways to go beyond them. The critiques of these frameworks crucially thread together all of the literature reviews, historical narratives, and ethnographic discoveries in this book.

The first framework considering the position of Chinese medicine. As Smith points out, neither ‘traditional medicine’ nor ‘complementary and alternative medicine’ (CAM) is sufficient to grasp the contemporary position of Chinese medicine in Singapore. This is because the former neglects the ongoing transformation of Chinese medicine inside and outside of China, while the latter is built on a dehistoricized and depoliticized framework imported from the United States and Europe. The Singaporean government’s adoption of CAM to categorize Chinese medicine needs to be regarded as a means of governance in pursuing Singaporean modernization. This process towards modernization, on the one hand, is permeated by the government’s eagerness for economic development and embraces the project of nation-state building on the other.

The Euro-American notion of nation-state and nationalism is the second powerful framework examined in the book. The essentialized Chinese nationalism in the colonial era (1819–1959) was carefully replaced by Lee Kwan Yew’s multiracial agenda through the nation-state building process. Under the regime of the People’s Action Party, this Singaporean multiracial nationalism was carefully managed through the CMIO (Chinese, Malay, Indian or Other) citizen identity system and subsidized public housing agenda which created a modern and ethnic integration space. The rearrangement of history and ethnicity shows the intention of the state to build a modern multiracial but ahistorical city-state in which Chinese medicine as CAM presumably fits well. However, just as the categories of traditional medicine and CAM are inadequate in explaining Chinese medicine in Singapore, neither essentialized Chinese nationalism nor the undifferentiated Singaporean multiracial nationalism can capture the ongoing national identity of Singaporean Chinese. Here, the author stresses repetitively it is the intricate power relationships that configure these settled categories, specifically the political and intellectual legacy of the colonial era, the employment of biopower by the Protected Area Permit regime, the influence of China as a rising power, etc.

By exploring everyday experiences in detail, anthropologists usually argue that common people have social agencies to resist hegemonies in different ways. But in this book, the author argues, limiting to the resistance framework is another way to reproduce the power and structure of Eurocentric knowledge so that it is not enough to follow the anthropological routine of power and resistance in which the practice of Chinese medicine acts against biomedical hegemony and biopower agendas. Nevertheless, it is this unbound transnational Chinese medicine that comprises a variety of social actors including practitioners and patients who are capable of inventing creative practice and negotiations beyond the binary choice between compliance and resistance. She emphasizes the Chinese word experience (經驗) to analyze how Chinese medical physicians are enabled to negotiate and engage in an alternative authority differentiated from complementary status. Furthermore, using notions of ‘self-care’ from Foucault and ‘habitus’, ‘field’ and ‘capital’ from Bourdieu as the theoretical resources, Smith explores the practice of Chinese medicine and daily use of Chinese materia medica in relation to sensory and embodied experience, environment, diet, and seasonality, through which the formation of patients’ and users’ subjectivity becomes possible.

Due to the author’s intentionally irreducible narrative and travels back and forth within related themes and repetitive arguments, this book is not very easy to read. When nearly all of the cases provided in the book are about people in middle- to upper-middle class Singaporean Chinese families, readers will probably be curious to know the use and practice of Chinese medicine in varied class and ethnical groups, or if the group she concentrates on are its core users, and how this will affect the position of Chinese medicine in Singapore. Considering the Chinese medicine in Singapore as ‘mercurial assemblages’ (p. 4, 28, 252) of governmentality, identity, knowledge, and experiences, however, Smith’s book makes contributions to research on medical anthropology, history of medicine, medical and pharmaceutical policy. It invites more researches both on transnational Chinese medicine and on other nationalized medicine affected by Chinese medicine, such as Kampo in Japan, Korean medicine and Vietnamese medicine. Meanwhile, it also suggests that we should carefully examine the position of Chinese medicine in China, especially to notice its potentially unequal power relations with nationality medicine. In doing so, critical medical anthropology has the potential to overstep the medical domain and contribute to the broader discussion of ethnicity, nationalism, and post-colonial theory. In this sense, this book is also highly recommended for anyone interested in Southeast Asian society and the study of overseas Chinese more generally.