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Health and Cultural Identity: The Chinese Community in England
From: London School of Economics and Political Science
| By:
Marie-Claude Gervais |
EDITOR'S INTRODUCTION |
 For the Chinese community in England, maintaining traditional beliefs about health and illness is also a way of preserving a Chinese identity in the face of an alien culture. Yet more often than not, the community is forced to resort to Western biomedical institutions and practices. In this article, Marie-Claude Gervais, lecturer in social psychology at the London School of Economics and Political Science, considers the implications of the peculiar mixture of Chinese and Western medical beliefs and practices for the cultural identity and health of the Chinese community in England. |
Challenges to identity
  he world today is a challenging place. Not many of the beliefs that we cherish survive intact the constant exposure to the different worldviews that reach us as we encounter people from different backgrounds, both in everyday life and via the media. The pace and scope of change affect not only our beliefs but, in a fundamental way, our sense of who we are. |
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| Hippocampus, translated from the Latin meaning Horse-monster, is used as a remedy for impotence and as an aphrodisiac in Chinese medicine. | |
These processes are probably most acutely felt among migrant or displaced communities. As they attempt to find their place in a new world, members of such communities bring with them the knowledge, values and traditions of their culture of origin. But they also become deeply aware of the impossibility of "carrying on as always" in a society where their own cultural knowledge has often lost both relevance and legitimacy. Indeed, they often realise that the world which they used to take for granted is but one fragile and culture-specific version of reality. Quietly assumed beliefs and practices are now open to questioning. In the process, the very nature of tradition changes. People now invoke it in a self-conscious way as a means of reclaiming a distinct position in a world. Loyalty to tradition is now declared rather than being simply lived as a matter of course. |
Chinese conceptions of health and illness
This piece addresses the maintenance and transformation of tradition and cultural identity among the Chinese community in England. Specifically, it reports on the ways in which Chinese people in England both keep alive and change their traditional knowledge in relation to issues of health and illness, and how these processes relate to matters of cultural identity. |
 The Chinese community presents a fascinating case, since, perhaps more than any other ethnic minority group in England, it can boast a rich and long-established cultural and medical tradition. Yet, Chinese people must somehow reconcile this tradition with an English culture and a dominant biomedical tradition which differ from their own in important ways. In this meeting of cultures, both health beliefs and identities are being questioned. How do Chinese people engage with biomedical knowledge? What kind of resources do they draw on to prevent or cure illness? Do they keep their traditional Chinese health knowledge firmly separated from the biomedical knowledge to which they are exposed in England, or are both knowledge systems integrated? |
We found that, for members of the Chinese community in England, thinking about health and illness is very much informed by traditional Chinese concepts. Chinese people possess a highly structured system of knowledge to define health and illness, to explain the causes of disease and to devise appropriate treatments. This system of knowledge is rooted in the Confucian ideal of maintaining some balance and harmony between the complementary but opposite forces of yin and yang, which regulate the universe. |
 From this perspective, the healthy working of the body is thought to depend on the harmonious balance between elements and forces within the body, and between the latter and the social, natural and supernatural environments. Excesses and imbalances in any of these domains can bring about illness. Thus, good health is deemed to result from such factors as having a good disposition, leading a disciplined lifestyle, having a balanced diet, avoiding extreme weather conditions and respecting one's family members and ancestors. Illness, on the other hand, is the symptomatic manifestation of an energy imbalance, which, in turn, may be caused by a poor hereditary disposition, old age, an unsuitable diet, extreme emotions, exposure to overly hot/cold or humid/dry atmospheric conditions, or the wrath of ancestors. |
Clearly, the Chinese conception of health and illness extends far beyond a mere preoccupation with the human body; it encompasses all aspects of life. It is therefore impossible to be socialised into Chinese cultures without at the same time acquiring traditional notions concerning the nature and the causes of health and illness, as well as appropriate therapeutics to handle diseases. To be Chinese is to share ideas and practices about health and illness which are embedded in linguistic categories, in food and in social relations, and which correspond to a whole cosmogony. |
Complementary medicines
It would be misleading, however, to conclude that the Chinese way of thinking about health and illness is exclusively derived from Chinese classical medicine and folk observations. On the contrary, Chinese and Western notions coexist in a complementary fashion. In the Chinese way of thinking, biomedical and traditional Chinese notions and prescriptions belong to different realms and do not compete. Rather than turning these systems into mutually exclusive domains, Chinese people reconcile them in order to suit their different purposes and to meet their different needs. |
 A close examination of the ways in which Chinese people describe the two systems of knowledge and the relationships between them reveals the role which traditional Chinese health beliefs play in the construction and maintenance of a sustainable social identity. We can observe that these shared beliefs are an important symbolic resource in the construction of a common cultural identity. They cement together in pride a diverse collection of Chinese people, even if some question the validity of specific beliefs and practices. |
First, Chinese knowledge is passed on from one generation to the next and it expresses the wisdom and history of Chinese people. One believes and trusts Chinese medicine because, by learning its fundamental constituents, one also learns how to be Chinese. Biomedical knowledge, by contrast, is grounded in science, which, by its very nature, challenges beliefs. Second, traditional Chinese knowledge is learned, transmitted and enacted through the most fundamental dimensions of culture: language, food and kinship relations. Biomedical knowledge, by contrast, comes from the doctor; it is associated with suffering, serious conditions and invasive treatment. |
Thus, Chinese people in England tend to combine all sorts of health resources (provided they have easy access to Chinese health professionals and remedies, and there are no major barriers to the uptake of what the National Health Service provides). Chinese medicine and folk observations are used in everyday life in order to maintain good health and to prevent illness; they are also used to treat minor conditions or ailments for which traditional or folk aetiology is widely endorsed. Moreover, the Chinese believe that their traditional knowledge is better equipped to handle the roots of disease, which, in turn, explains why it works slowly. |
Conversely, Chinese people in England will use the Western treatment regimen in order to alleviate acute pain or to cure severe and life-threatening illnesses. They will also draw upon Western medicine when the aetiology of disease is unclear and not established by classical Chinese medicine. Finally, both systems will be used to compensate for the limitations or failures of the other; in other words, they are both used as "last resort" when one of the systems does not work. |
The grounding of traditional Chinese health knowledge in the most basic aspects of cultural life, its acknowledged association with "belief" and "trust" rather than with the logic of science, and the assumed complementary nature of biomedical and traditional Chinese health practices are all crucial factors in explaining the role which health beliefs play in the maintenance of a Chinese cultural identity. Indeed, Chinese people can continue to endorse and draw on Chinese health understandings, without such emotional and intellectual investment impeding in any way their engagement in mainstream English society. |
The generation gap
There are, however, important generational differences in the ways in which Chinese people in England use their traditional health beliefs. These differences correspond to different degrees of acculturation to English society and to the different relationships which Chinese people entertain with English culture. For the older generation (or those who have arrived in England recently and are little educated), traditional Chinese health knowledge is never questioned; it is just there, like life itself. It is, as they often remarked, what "we, Chinese people, know." They know it with the paradoxical intensity and indifference with which one knows that which is taken for granted. |
For the younger generations who either grew up in England or were born here, and who are confronted with the difficult and painful effort of calling into question an entire way of life, this knowledge needs to be assessed and evaluated. The process of assessment is conducted from a shaky position that varies from that of the extreme "outsider" to that of a relative "insider." |
This becomes extremely clear in one sector of our sample: those referred to by the somewhat derogatory term "bananas"--yellow on the outside, white on the inside. The term "banana" is given by Chinese people themselves to the more Westernised members of their community. Being a "banana" often entails deeply painful experiences which are concealed by the oversimplification implied by the name itself. One is never simply "white inside," not least because of one's physical appearance. Being a "banana" involves being split between the expectations and aspirations, the knowledge system and the values of two cultures. |
For young parents, it means being constantly challenged by their children as they come back from school, and blamed by their own parents for failing to hold on to traditions. Intense feelings of guilt and shame, of confusion and conflict, all are integral to the experience of the Chinese who seek integration. A redefinition of one's identity--from a primarily relational being enmeshed in a network of roles and obligations to an atomistic individual caught in a web of ill-defined and relatively egalitarian relations--is necessary. |
For the youngsters born and raised in England--the so-called "BBCs": British-born Chinese--who hardly speak the dialect of their parents, who reject the catering trade, who refuse to live up to their parents' expectations and yet honour them, who suffer discrimination because they look Chinese but cannot be proud of a culture which is no longer theirs, the existential crisis is profound. |
And so we find that Chinese people of all generations at times invoke traditional Chinese health beliefs and use associated therapeutics. The elderly do so frequently, immediately, unquestioningly. The middle and young generations alternate and hesitate, sometimes distancing themselves from Chinese "superstitions," and sometimes, almost simultaneously, bestowing their unshaken trust upon the "Chinese way." |
The simple assumption that greater integration, more Westernised identity and more biomedically informed understandings of health and illness will necessarily go together breaks down. For the "bananas," asserting a belief in Chinese notions of health and illness and using Chinese treatment regimens are part of a reflexive process. They are a means of asserting that, somehow, one remains Chinese. They are a means of belonging when this is no longer easy. As they reinvent their selves with painful freedom, they draw on mixed knowledge systems, as a way of recovering and proclaiming their identity, sometimes Chinese, sometimes English. When their fragile identity is threatened, they may appeal to their rich, long-established, powerful knowledge system to retain some dignity. |
Conclusion
Health beliefs and practices, therefore, are not just about being healthy and avoiding illness; they are first and foremost about being Chinese or not, about being able to claim a Chinese identity and to have it recognised, about remembering and performing the stock of symbols and practices handed down by generations of Chinese people, and about deciding how to cope with the differences between "the Chinese way" and the indigenous English approach. Different health knowledge and practices are combined as Chinese people try to establish who they are in an English society which is itself ambivalent about the Chinese medical tradition. |
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