6 - Group Identity, Power Relationships, and Medical Legitimacy

Summary

In his Profession of Medicine, Eliot Freidson showed that in all societies people diagnose sickness and devise methods for its management. Some individuals are thought to be especially knowledgeable about sickness and are regularly sought out by patients or their families. In many cases, these individuals have other trades or professions and simply perform healing tasks on the side to supplement their income, while others develop a sufficient practice to make a living solely from healing and so develop a specialist vocation. He notes that not all healers are called doctors or physicians, nor are they necessarily considered professionals. Freidson’s general observations apply to the traditional medical world of rural China. In his investigation of rural doctors in Ding County, northern China, Li Jinghan said, “Naturally, the medical expertise of these doctors is mediocre. Anyone willing to treat illnesses could be counted as a doctor.” He also pointed out that most rural doctors practiced medicine as a secondary occupation, rather than depending solely on it to make a living. In the eyes of the peasants of Ding County, old age and experience signified reliable medical expertise and an increased likelihood of effective treatment. Patients were not required to make monetary payments to doctors—instead, they gave “acknowledgments” (daxie) of gratitude, often in the form of a few gifts during a community festival.

This general pattern continued in China’s villages into the late 1950s, in part because of the absence of an alternative. Most people continued to seek medical care from their local folk healers, fellow villagers who were deemed to have special healing talents. Both patients and healers depended on agricultural labor to make a living—very few professional doctors supported themselves entirely from their medical practice. By the early 1960s, the situation had not changed much in this respect: the newly designated health workers also labored alongside their fellow villagers and still received payment in the same way as the village healers of earlier decades. The difference was that they carried medical kits into the fields to perform basic first aid on the spot, such as daubing cuts and grazes with mercurochrome solution or gentian violet and bandaging open wounds to minimize infection.