Creating post-modern practitioners: state practice and Thai traditional medicine

Abstract

This thesis argues that state health policies in Thailand have attempted to shape the modernisation and professionalisation of Thai traditional medicine practitioners. Since 1978 the Thai state has supported a new kind of modern health care practitioner, the Thai Traditional Medicine (TTM) practitioner, through the increasing standardization of a formal curriculum for the licensing of practitioners. I demonstrate how the re-interpretation of Thai traditional medicine and the creation of modernised professional practice, kaanphaet phaen thai (การแพทย์แผนไทย) Thai Traditional Medicine (TTM), has been a project of the Thai state. I trace the social and cultural context of the professionalisation of Thai traditional medicine in 20th century Thailand and argue that modernised Thai Traditional Medicine (TTM) has been recruited as part of an ideological narrative that encourages economic self-sufficiency in Thailand. Traditional medicine with its links to magic and religion has been reframed as a scientific body of knowledge which is becoming increasingly medicalised through university teaching and hospital practice. Modernised Thai Traditional Medicine (TTM) has been integrated into the Thai health system is now practiced in hospitals and specific treatments and some traditional medicines are subsidised by the state.

In addition, the influence of the tourism industry and especially health tourism and the spa industry, have encouraged the commercialisation of Thai traditional medicines and specific forms of massage for tourists. The teaching of Thai Traditional Medicine has been influenced by the allure of tourist oriented practice for young graduates and the impetus of government health policies, which have emphasised the importance of health tourism. Changes in the orientation of Thai traditional medicine and Thai massage have produced new medicines and new forms of massage which are tourist commodities.

I argue that state health policies in Thailand have re-shaped the practice of Thai traditional medicine through university-based education and the introduction of a scientific rationale for treatment. This has transformed the status and aspirations of students studying Thai traditional medicine at universities and has created tensions within the traditional medicine community. I examine the acquisition and creation of professional expertise in a rapidly modernising country and explore how notions of expertise are intimately connected to forms of education and to cultural understandings of knowledge, legitimacy and value.

The traditional medicine community has contested the state supported accreditation of modernised TTM practitioners and the legitimation of a specific kind of practitioner by developing their own hierarchies of cultural value and respect. In response to this, hybrid forms of post-modern practice have emerged in the traditional medicine community. Teachers, students and educational practices are mobile and the transnational influences of tourism and global economics have produced what I have called the post-modern Thai traditional medicine practitioner. These are practitioners with a range of educational backgrounds who move between traditional and modernised styles of practice, negotiating between different epistemological approaches and understandings. Teachers have established styles of teaching and practice which reflect the increasing hybridity of knowledge creation. The traditional medicine community continues to include those whose skills and training are not recognised through licensing.

This thesis contributes to broader debates within the fields of medical anthropology, Thai studies and globalisation studies. It positions traditional medicine in Thailand in the ranks of Asian medical systems that have been incorporated into the health systems of their countries of origin, and it traces how certain practices have gained an international profile through links to tourism and transnational mobility. This research demonstrates the linkages between the modern institutions and structures which have governed and regulated traditional medicine and describes the assemblage of capital, expertise and information which have contributed to the globalisation of Thai traditional medicine. In addition it adds to discussions about knowledge creation and the transformation of apprenticeship learning into formal educational and curriculum. The adoption of westernized styles of cultural knowledge has been a particular strategy for Thai elites. At the same time the nationalist narrative has emphasised the valorization of traditional forms of knowledge and the presentation of the Thai cultural heritage as a tourist commodity. As a consequence hybrid forms of knowledge and practice have flourished in modern Thai culture. I argue that globalisation has encouraged the emergence of new forms of local knowledge and this has been the source of innovation which has stimulated global networks of knowledge creation.