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Mind/Body Theory and Practice in Tibetan Medicine and Buddhism CHIKAKO OZAWA-DE SILVA and BRENDAN RICHARD OZAWA-DE SILVA Abstract The model of mind and body in Tibetan medical practice is based on Buddhist theory, and is neither dualistic in a Cartesian sense, nor monistic. Rather, it represents a genuine alternative to these positions by presenting mind/body interaction as a dynamic process that is situated within the context of the individual’s relationships with others and the environment. Due to the distinctiveness, yet interdependence, of mind and body, the physician’s task is to heal the patient’s mind (blo-gso) as well as body. This in turn emphasizes the central importance of ‘compassion’ in the physician/patient relationship. This article investigates how Tibetan medical practitioners understand and enact the mind/ body and physician/patient relationships, and how this relates to theoretical explications of these relationships in Tibetan medical and Buddhist teachings. Furthermore, Tibetan medicine provides an interesting model for comparison with embodied theories of cognition, which see consciousness, the body and its environment as integral parts of a complex, dynamical cognitive system. Keywords body/mind dualism, Buddhism, consciousness, doctor/patient relationship, self, Tibetan medicine In recent sociological and anthropological studies of the body, the Cartesian dichot- omy of body and mind has been widely challenged (Blackman, 2008; Falk, 1994; Featherstone et al., 1991; Scheper-Hughes and Lock, 1987; Shilling, 1993; Synott, Body & Society Copyright ª The Author(s) 2011, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav Vol. 17(1): 95–119; DOI: 10.1177/1357034X10383883 www.sagepublications.com

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  • Mind/Body Theory andPractice in TibetanMedicine and Buddhism

    CHIKAKO OZAWA-DE SILVA andBRENDAN RICHARD OZAWA-DE SILVA

    Abstract The model of mind and body in Tibetan medical practice is based on Buddhist theory, and isneither dualistic in a Cartesian sense, nor monistic. Rather, it represents a genuine alternative to thesepositions by presenting mind/body interaction as a dynamic process that is situated within the context ofthe individuals relationships with others and the environment. Due to the distinctiveness, yetinterdependence, of mind and body, the physicians task is to heal the patients mind (blo-gso) as well asbody. This in turn emphasizes the central importance of compassion in the physician/patientrelationship. This article investigates how Tibetan medical practitioners understand and enact the mind/body and physician/patient relationships, and how this relates to theoretical explications of theserelationships in Tibetan medical and Buddhist teachings. Furthermore, Tibetan medicine provides aninteresting model for comparison with embodied theories of cognition, which see consciousness, the bodyand its environment as integral parts of a complex, dynamical cognitive system.

    Keywords body/mind dualism, Buddhism, consciousness, doctor/patient relationship, self, Tibetanmedicine

    In recent sociological and anthropological studies of the body, theCartesian dichot-omy of body and mind has been widely challenged (Blackman, 2008; Falk, 1994;Featherstone et al., 1991; Scheper-Hughes and Lock, 1987; Shilling, 1993; Synott,

    Body & Society Copyright The Author(s) 2011, Reprints and permissions:http://www.sagepub.co.uk/journalsPermissions.navVol. 17(1): 95119; DOI: 10.1177/1357034X10383883

    www.sagepublications.com

  • 1993; Turner, 1984, 1987, 1992) and has been shown to be a specific socially con-structed notion, rather than a natural reality. As an alternative systemof knowledge,Eastern thought is sometimes invoked as an advocate of the unity or oneness ofmind and body (Scheper-Hughes and Lock, 1987). However, although Asian sys-tems can provide useful alternatives to the dualistic view of mind and body that isthe Cartesian legacy of Western thought, such presentations tend to be mistakenlyunderstood as representing a monistic view of body and mind. However, an inves-tigation of self-cultivation practices in Japan indicates that this unity is often under-stood as a potential, and that mind-body unity is not a natural state, but rathersomething to be achieved (Ozawa-de Silva, 2002: 30; see Fraleigh 2004: 2631).

    As a medical system that recognizes both a dualism of body and mind oncoarser levels and an inseparability of body and mind on subtler levels, Tibetanmedicine provides a useful model for comparison with modern biomedicine,because it presents a dynamic, interdependent relationship between body andmind. Neither classically dualistic nor monistic, it lies between the so-calledCartesian dualism of body and mind and the contemporary rejection of thatdualism in favor of a view that reduces the mind to the brain. This model of bodyand mind, and its basis in Buddhist thought, is something that is both apparentand hidden in the theory and practice of Tibetan medicine. This is because Tibe-tan medical doctors must navigate a fine line in their presentations of Tibetanmedicine to outsiders. On the one hand, they are quick to defer to spiritual teach-ers (bla-ma, lamas) on matters of Buddhist thought and practice, and they alsotake pains to stress that the benefits of Tibetan medicine, and even its practice,do not require faith in or adherence to Buddhism. Tibetan medicine is, after all,understood as a science of healing (gso-ba rig-pa) and should not be mistaken formere faith healing. On the other hand, Buddhist thought pervades Tibetan med-ical texts, and when the authors probed Tibetan medical doctors about key Bud-dhist concepts and how they relate to Tibetan medical concepts, their responsesrevealed an intimate relationship between the two that formed the basis for theTibetan medical model of mind and body presented here. Given the tenuoussituation of Tibetan exile culture, there are no doubt exigencies that would makeTibetan medical doctors very careful about the way they present Tibetan medi-cine, particularly to outside researchers. However, the model presented here wasdrawn out from numerous interactions with doctors over a period of time, is con-firmed by the observation of Tibetan medical doctors in practice, and correspondsto accounts in Tibetan medical texts that pre-date Tibets current political situa-tion. We therefore feel it has a degree of legitimacy not overly compromised bythe need to fashion presentations of Tibetanmedicine that directly address the cur-rent socio-political realities of Tibetan medical doctors in exile.

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  • Specifically, this article draws on in-depth interactions over the last fiveyears with Tibetan physicians in a variety of settings, most notably with DrPema Dorjee and Dr Yeshi Khandro in Dharamsala, India, and during their vis-its to the USA. The authors observed Dr Dorjee and Dr Khandro as they prac-ticed Tibetan medicine, offered consultations, delivered talks and trainingworkshops, and engaged in symposia with Western medical doctors. Addi-tional interviews were conducted with Tibetan physicians Dr Tsering Namgyaland Dr Tsultrim Kalsang in Dharamsala.1 We also draw from the writings ofother contemporary Tibetan medical doctors and the growing body of anthro-pological literature on Tibetan medicine. In addition, we draw from thebroader Tibetan Buddhist philosophical and cultural tradition, a traditionwhich may have much to offer to scholarship, not merely as an explanandum,but also as an explanans, as has been shown in other contexts (McHugh, 2002;Ozawa-de Silva, 2007).

    Investigating how Tibetan medical practitioners understand and enact themind/body and physician/patient relationships, and how this relates to theoreti-cal explications of these relationships in Tibetan medical and Buddhist teachings,provides a comparative lens that throws into relief how a particular concept ofperson or self lies at the core of the problematic Cartesian dichotomy ofbody and mind. This is because it posits neither a reified, metaphysical selfbeyond empirical observation nor a reduction of the self into purely physicalprocesses. Moreover, such questions regarding the self relate to anthropologysrecent turn to subjectivity (Biehl et al., 2007: 5) and to questions in medicalanthropological scholarship regarding meaning and what makes life worth living questions with a moral dimension that are frequently ignored, despite theiressential importance in any medical system (Kleinman, 2006).

    The Cartesian divide of mind and body is closely connected to a conceptionof selfhood that includes a sharp divide between the individual self and its envi-ronment; however, recent trends in cognitive science are increasingly calling intoquestion the stability of such divides (Barsalou et al., 2003; Niedenthal et al.,2005). Francisco Varela and Evan Thompson have proposed an enactive modelof embodied cognition that recognizes the mind/body/environment continuumas a complex, dynamical system that involves constant negotiation and mutualinfluence (Varela et al., 1991). Their model not only places the mind back in thebody, but it also places the individual back into the environment, which is alwaysalready a constitutive, essential part of mind/body interaction and not merely abackground setting for it. The environment thereby becomes not only the situ-ated context that provides the stimuli that trigger cognitive processes, but part ofthe dynamical system itself. They write:

    Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 97

  • The nervous system, the body and the environment are highly structured dynamical systems,coupled to each other on multiple levels. Because they are so thoroughly enmeshed biolo-gically, ecologically and socially a better conception of brain, body and environment wouldbe as mutually embedded systems rather than as internally and externally located withrespect to one another. Neural, somatic and environmental elements are likely to interactto produce (via emergence as upward causation) global organismenvironment processes,which in turn affect (via downward causation) their constituent elements. (Thompson andVarela, 2001: 4234)

    Importantly, this model also involves an active role for consciousness; thus, likethe Tibetan medical and Buddhist model, it is neither strictly dualistic nor mon-istic. It should be noted that while Varela explicitly drew from Buddhist thoughtin forming some of his theories, many other figures in cognitive science workingon embodied models that expand on traditional accounts of cognition in similarways have come to their models without any reference to Buddhist thought(Barsalou et al., 2003; Clark, 2008; Clark and Chalmers, 1998; Niedenthalet al., 2005). The Tibetan medical system similarly understands the environmentas a crucial component of mind/body interaction. It thus bears resemblance tothe vitalist conception of the body developed by Sheets-Johnston (1992), whocontrasts such a model, based on the concepts of relationality and proportional-ity present in Greek medicine, with the more static Cartesian model of mind andbody that fails to account for the bodys being fully situated in and integratedinto its environment.

    Body and Mind in Tibetan Medicine

    A foundational tenet in Tibetan medicine is that the root cause of all illness, dis-ease and suffering is the mind (Clifford, 1984; Dorjee, 2005). This notion can beseen as a cultural or religious belief, and the fact that the power of belief, symbolsand meaning is significant in matters of health, illness and magic, has been notedby scholars from Levi-Strauss (1963, 1966) to, more recently, Daniel Moerman(1979, 2002). In Tibetan medicine, however, this saying also points to a theore-tical and practical recognition of the importance of mind/body dynamics in thearising of disease and in its treatment. The recognition by Tibetan doctors of theimpact of the mind on the body and on health necessitates that they relate topatients out of this understanding, and that they seek to influence patients men-tal states in a positive way as part of their work of overall treatment. These twosets of interdependent relationships (mind/body and physician/patient) emergeas closely related, and this broader dynamical system itself forms an importantpart of the treatment of the patient as a whole person. Both diagnosis and treat-ment in Tibetan medicine therefore emphasize the agency of the patient, because

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  • the intimate connection between mind and body means that every person hasthe capacity for self-healing and self-regulation (Dorjee, 2005: 269).

    The specific understanding of mind/body interaction present in Tibetanmedicine provides a theoretical basis for the clinical importance of gratitude,kindness and compassion in the treatment and healing process. This humanizingdimension may work against a tendency to see the patient as a disease object,stripped of their personhood by a medical gaze (Foucault, 1975; Turner, 1987,1992). In contemporary biomedical practice, the importance of doctors relatingto their patient as a whole person is also recognized (Mol, 2002), but the fact thatthe mind/body relationship remains a problematic issue in the biomedicalcontext (as seen in the discussion of placebo and meaning effects [Moerman,2002]) means that the importance of a compassionate and caring relationshipwith the patient exists, in a sense, parallel to the theory of the understandingof mind and body in biomedical practice. In Tibetan medicine, by way of con-trast, the cultivation of compassion and empathy is seen as central to the logicof health itself, because such psycho-physical states are the very opposite of thenegative emotions that give rise to the imbalances in the three psycho-physicalenergies (rlung, mkhris-pa and bad-kan) that lead to disease.

    Tibetan medicine takes a very particular understanding of health as the start-ing point for medical understanding and as the ultimate goal of treatment. Healthin Tibetan medicine is commonly defined as the balance of the five elements andthree nyes-pas (or energies) in the body. Interestingly, while the balance of thethree nyes-pas is considered the source of health, the word nyes-pa itself literallymeans fault or defect, and the nyes-pas are understood as also being the cause ofthe separation of mind and body, that is, death (Dorjee, 2004). However, concep-tions of health in Tibetanmedicine go beyond this, and ultimately cannot be sepa-rated from questions of meaning and what would be considered in the West areligious dimension although it would be better, as Csordas notes (1985), notto submit too readily to this bifurcation, as medical and sacred realities are indeedcompletely fused in the Tibetan medical system.

    Attempts have been made to view Tibetan medicine as an entirely separatesystem independent of Buddhism, some of these arising out of a desire to presentTibetan medicine as a scientific system that can be applied cross-culturally andthat does not require religious belief or faith to be effective, some because of thepressures that Tibetan medicine faces within China and its project of moderni-zation (Adams, 2001; Bradley, 2003; Janes, 2001; Komatsu and Namba, 2005a:136, 2005b: 1723, 181; Takeuchi, 1995: 18694). While Tibetan medical practi-tioners, as noted, agree that Tibetan medicine does not require faith in, or adher-ence to, Buddhism in order for it to be effective, on a theoretical level the basic

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  • tenets of Tibetan medicine are closely intertwined with those of Buddhism, andthese interconnections manifest in the practice of Tibetan medicine. It is also rel-evant to note that the problem of the mixing of religion and medicine does notarise from within the Tibetan tradition itself at least, certainly not in the sameway as it does in biomedicine because science as a valid form of knowledgeand religion as a valid form of knowledge are not separated out in the Tibetantradition in the way they have been in the history of Western thought. Both canbe considered rig-pa, meaning science or knowledge.

    In their classic article Scheper-Hughes and Lock (1987: 10) note the diffi-culty in achieving a coherent conceptualization of body and mind that goesbeyond the now recognized inadequacies of the Cartesian dichotomy:

    As both medical anthropologists and clinicians struggle to view humans and the experienceof illness and suffering from an integrated perspective, they often find themselves trapped bythe Cartesian legacy. We lack a precise vocabulary with which to deal with mind-body-society interactions and so are left suspended in hyphens, testifying to the disconnectednessof our thoughts.

    Since Scheper-Hughes and Lock, the body has been the subject of a great dealmore critical investigation in areas such as the rapidly emerging field of sociologyof the body (Blackman, 2008). Yet while the mind/body dichotomy in modernbiomedicine, and in Western thought in general, remains an object of dissatisfac-tion, it remains a challenge to develop conceptual clarity around a new, moresatisfactory model. Bio-psycho-social or integrated approaches may representa recognition of the added complexity necessary in analyses and the need tomove towards a recognition of interdependence, multiple factors, multipleperspectives and multiple levels of analyses. Nevertheless, the challenges mayrun deep, in part because rethinking the body/mind dichotomy requires arethinking of several other closely related dichotomies that have perplexed mod-ern scholarship, including that of biology/culture (or nature/nurture) andindividual/society (or self/environment).

    Consciousness and Materialism

    Although it is widely recognized that the Cartesian dichotomy between bodyand mind does not apply to Asian systems of knowledge, including medicalknowledge (Ozawa-de Silva, 2002), a common misperception is that this isbecause Asian medical traditions never developed the conceptual distinction inthe first place and therefore still view the body and mind as one, as if they werethe same entity. Another misconception is that neuroscience and other modernscientific disciplines are moving in a similar direction, because the Cartesian

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  • dualism of mind and body is being superseded by a view that the mind is ulti-mately reducible to brain function. This is at least in part due to increasingsophistication in the study of the neural correlates of mental states, made possi-ble by technological advances in brain imaging.

    The debate on this issue in contemporary neuroscience centers around thequestion of how something immaterial and subjective could arise from some-thing material and objective, or how something immaterial (consciousness,mind) could affect something material (brain, body) (Crick, 1994; Koch, 2004;Thompson, 2007; Wallace, 2006). One of the most popular positions in thisdebate is that consciousness arises as an epiphenomenon of neural activity, butcannot itself affect neural activity. This would not be a satisfactory answer in aBuddhist context (nor is it considered fully satisfactory by many modern scien-tists and philosophers), since it claims that a material cause (neural activity) cangive rise to an immaterial result (consciousness), yet at the same time rejects thatan immaterial cause (consciousness) could give rise to a material result (a changein neural activity). Within the context of the development of Western science, ithas been pointed out that this one-sided approach has arisen at least in part fromWestern sciences significant discomfort in opening the door to non-materialcauses of any kind, since this might be perceived as opening the door to divineactivity and other religious explanations that lie beyond the domain of science,or threaten the integrity of science. (Indeed this problem of consciousness, calledthe hard problem, is often explicitly connected with a rejection of the religiousnotion of the soul [see Crick, 1994].) Nevertheless, this significant problemregarding the relationship of consciousness to neural activity remains, and thisis the mind/body problem from a Buddhist or Tibetan medical perspective.

    In many cases, the physicalist bias has actually changed the terms of thedebate to speak of the mind/body problem as a brain/body problem, or to usethe terms mind and body to refer to brain and body. According to this view,everything can then be viewed and explained physically. Thus, the line of argu-ment would go, modern science is now proving through its empirical methodswhat other traditions intuited: that mind and body are one. Since mind hereis actually understood as brain, however, this is actually nothing more than say-ing that the brain a physical entity and part of the body affects, and is affectedby, other parts of the body. This silent appropriation of the non-material into thematerial, and non-biological into the biological, is itself a result of the confusionunderlying contemporary Western thought in the shadow of the Cartesiandichotomy, already noted by Scheper-Hughes and Lock (1987). Transposing theentire problem into the purely material realm, however, skirts the whole issue ofconsciousness, subjectivity and first-person experience.

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  • The reduction of mind into brain is clearly not what is being presented inBuddhist thought, and it is a fundamental error to think that the brain/body rela-tionship in biomedicine parallels the mind/body relationship in Buddhism. InTibetan Buddhism, the mind is understood as consciousness, which is definedas gsal-rig, that which is luminous (gsal-ba) and cognizing (rig-pa). Here,luminous refers to the minds ability to reflect any object of cognition, in the waya mirror can reflect anything placed in front of it. Knowing refers to the mindsability to apprehend, perceive or cognize an object (not necessarily a physicalobject, but also including thoughts, concepts, mental images, etc.). Thus mindis luminous and it illuminates (Geshe Lobsang Tenzin Negi, personal commu-nication). Although intimately tied with physical matter on gross, subtle and verysubtle levels, consciousness itself is not physical ormaterial; moreover, its cause isnot physical ormaterial either, but rather a priormoment of consciousness. This isbecause the Buddhist tradition considers it illogical to believe that something thatis not physical could be caused by something physical, or that something physicalcould be caused by something non-physical; hence material entities can only giverise to other material entities, not immaterial ones, and vice versa.

    Tibetan medical and Buddhist thought explains the relationship between animmaterial entity such as consciousness and a material entity such as the bodyor brain (a part of the body) by differentiating distinct levels of consciousness:gross, subtle and very subtle. Consciousness andmind, therefore, do not refer onlyto what a person is consciously aware of; rather, there are a vast number of men-tal processes occurring with great rapidity, most of which individuals are not con-sciously aware of. This particular aspect falls in line with psychoanalytic thoughtand contemporary discourse in cognitive neuroscience. As Lane and Nadel (2000:7) write: Within cognitive neuroscience, however, it is now well accepted thatmuch of cognition is implicit or outside of conscious awareness. Similarly,according to the Tibetan Buddhist view, ordinary individuals are not even ableto be fully aware of all the activity occurring on a gross consciousness level, muchless what is happening on the subtle level. Accessing the subtle level of conscious-ness requires quieting gross conscious activity, which would otherwise block orcloud ones awareness of subtle conscious activity. Activity on the very subtle levelcan only be accessed by highly trained meditators, as it requires quieting bothgross and subtle levels of consciousness. As this also calms the physical processesconnected with these levels of consciousness, the person enters a state similar todeep sleep or a stage in the dying process, which ordinarily a person would notbe consciously aware of. Yet, having entered into it voluntarily and through med-itation training, such trained meditators are able to be aware of and use this subtleconsciousness to engage their object of meditation.

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  • Each level of consciousness therefore, is correlated with a level of physical/physiological activity in the body. Gross or coarse levels of consciousness areassociated with sensory perception, as well as afflictive mental states such asanger, desire and gross ignorance. The subtle level of consciousness is associatedwith subtle mental activity, for example the mental activity that a meditator canbecome aware of after letting gross mental activity subside.2 It is at the subtlestlevel of consciousness that the Tibetan Buddhist tradition speaks of mind andbody (at this level, body is understood as subtle energy) as being indivisible.While the subtlest level of mind and body are always present, they are usuallymasked by grosser levels of consciousness, such as sensory perception.

    The inseparable relationship between this very subtle consciousness and verysubtle energy is likened to two sides of the same coin or a lame rider atop a blindhorse. The rider here refers to the mind/consciousness, which can see (perceive,cognize) but which cannot act or move by itself. The blind horse refers to themobile energy (rlung), which is a subtle physical, material process; this energy can-not see (perceive, cognize) anything, as it is not itself consciousness, but it has theability to act on the physical world. At this subtlest level, mind and body alwaysmove together; there is not one without the other. Therefore one can speak of amind/body unity and this obviates the problem of dealing with a completely dis-embodied mind and how it relates to the physical world. At the same time, thisexplanation clearly shows that mind and body are not the same thing; they are dis-tinct in their function and status (one physical, the other non-physical), and at lev-els above the very subtle, they are effectively separate and distinct entities, albeitrelated on a deeper level. This avoids the problem of a purely physical explanationthat reduces the mind/body relationship to a body/body relationship and there-fore cannot explain subjectivity and consciousness.

    Such an intricate explanation of the relationship between body and mind isnot often presented by Tibetan medical doctors, and some who have engaged inanthropological scholarship on Tibetan medicine may feel that Tibetan medicaldoctors do not employ such a sophisticated model of mind/body interaction oracknowledge such an affinity with the explanations that are in common with theTibetan Buddhist philosophical and psychological traditions. While it is true thatnot all Tibetan physicians may be aware of these aspects of the foundations ofTibetan medical practice, many well-trained physicians certainly are, and it wasacknowledged in our interviews with Dr Dorjee and Dr Namgyal that a physi-cian with a deep knowledge of Buddhist philosophy is better equipped to helphis or her patients. In fact, the understanding of the interaction of body and mindin Tibetan medicine is ultimately related to the way this interaction is explainedin the esoteric tantric teachings of Buddhism, which explicitly deal with the

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  • subtle mind/body processes within an individual, and this is something that well-trained physicians are aware of, as indicated by their references to it whenquestioned.

    The dominant discourse revolving around the mind/body issue has predo-minantly stemmed from a simple binary classification. This often results in anessentially static model that fails to capture the dynamic nature of developmentover the life-course and techniques of transformation and self-cultivation, whichare essential elements of Buddhist and certain other Asian traditions that inves-tigate the question of the mind/body relationship.3Tibetan medicine may be ableto contribute to recent attempts to move away from such static models towards amore dynamic understanding of mind/body interaction (Blackman, 2008) byproviding a concrete example of a tradition based around a view of mind/bodyinterdependency that is considerably more complex than many of the modelsbeing considered. Such static notions of mind/body dualism also explain why theterm psychosomatic is inappropriate as a way of understanding Tibetan medi-cine. As Vargas notes (forthcoming), citing Jacobson, Tibetan medical doctorsview psychological and physiological systems as integrated so that both psy-chosocial and biological circumstantial causes impact the same system, andgive rise to illnesses that have both psychic and somatic symptoms.4

    Tibetan Medicine and Buddhism: The Mind and the Nyes-pas

    Tibetan medical doctors explain the relationship between body and mind byturning to the notion of the five elements that make up all existence. Regardingthe actual arising of disease and its treatment, however, the concept of the threenyes-pas of rlung, mkhris-pa and bad-kan is just as important. Nyes-pa is oftentranslated as humor and hence the three nyes-pas are often translated as wind,bile and phlegm. Tibetan medical doctors, however, often find fault with thistranslation, and since the parallels to humoral theory in Western thought arepotentially misleading, we retain the Tibetan names here. It is the balance of thenyes-pas that allows for health, and the imbalance of the nyes-pas (specifically, ifone or more of the nyes-pas is overly increased, decreased or out of place) thatcauses disease (Dorjee, 2004). Although many factors can influence their balanceor imbalance, the most fundamental is the mind itself. The Four Tantras (rgyud-bzhi), the foundational medical text in the Tibetan medical tradition, attributedto the Buddha appearing in the form of the Medicine Buddha, states:

    The sole cause of all disease is said to be ignorance due to lack of understanding of the mean-ing of selflessness . . . Specific causes: from ignorance arise the three poisons of attachment,hatred and closed-mindness whence are produced in turn in the humors wind, bile and

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  • phlegm. Undisturbed wind, bile and phlegm are the causes of disease whilst disturbed,imbalanced humors are the nature of disease. They harm the body and life, and give riseto suffering. (Clark, 1995: 756)

    This short passage encapsulates concisely the relationship between mind, body,illness and health in Tibetan medicine; it remains for us to investigate in a moreelaborated manner the complex nature of this relationship.

    The ultimate state of health in Tibetan medicine is the state of a fully enligh-tened Buddha (Adams, 1992: 171). Achieving this state, which is the goal of Bud-dhist practice, is not understood as simply having a mystical experience that hasno effect on the persons mind or body. Rather, it is the result of a completetransformation of the psychophysical aggregates, a process that requires study,ethical discipline, meditation training and, ultimately, the concentrated harnes-sing of the bodys energies through yogic meditation practices (Gethin, 1998;Gyatso, 1995, 2002). A fully enlightened one, that is, a buddha, does not have thenyes-pas, and therefore does not have an ordinary body at all (although he or shecan display a body that appears to be ordinary). He or she is therefore free fromthe final result of the nyes-pas, which is to separate the mind from the body andthereby cause death. For ordinary beings, however, the nyes-pas are necessaryfor life, although they will ultimately result in death. Within the Buddhist world-view, ordinary existence is explained as a cycle of life and death (Tib. khor-ba,Skt. samsara) characterized by suffering, whereas enlightenment is freedom fromthat cycle (Tib. mya ngan las das pa, Skt. nirvana).

    The reason why the ultimate state of health and well-being in the Tibetanmedical system is understood as full enlightenment, or buddhahood, is becauseof the etiology of disease, which links cognitive and afflictive obscurationswithillness. Someof themost interesting andunique features ofTibetanmedicine comedirectly from this intimate relationship with Buddhadharma, such as Tibetanmedicines presentation of the close and causal relationship between afflictivemental states (Tib. nyon-mong, Skt. klesa) and imbalances in the bodys nyes-pas.5

    The root cause of all unenlightened existence, and hence all illness, is fundamentalself-grasping ignorance, a cognitive distortion in themind that causes themind tograspontomental andphysical phenomena (including the I or self) as permanent,independent realities not contingent uponother factors.All ordinary beings sufferfrom this distortion, and therefore cannot perceive or relate to reality as it is. As aresult, they fail to see the interdependent nature of reality and react to phenomenawith attachment, aversion and closed-mindedness. These three afflictive mentalstates give rise to the three corresponding nyes-pas of rlung (pronounced loong),mkhris-pa (pronounced treepa) andbad-kan (pronounced beckon).Within thisetiology, one can then understand why, according to the Tibetan medical system,

    Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 105

  • ultimate health is the state of enlightenment in which ones mind is free of anyafflictive emotions. Rlung is especially important as a link between the mind andbody. The Four Tantras states (Clark, 1995: 64):

    Specifically, the life-sustaining wind [rlung] is located in the crown of the head and travelsthrough the throat and the breastbone, swallows food and drink, inhales, spits, sneezes,belches, endows the mind and sense organs with clarity and holds the mind [and bodytogether].

    One of the most eminent contemporary Tibetan physicians, Dr Yeshi Don-den (1986: 15), notes that:

    In the Tibetan system we believe that whether we are physically healthy or not, basically allof us are sick. Even though disease might not be manifest, it is present in dormant form. Thisfact makes the scope of disease difficult to fathom.

    Similarly, Dr Dorjee writes of:

    . . . the essential root of all suffering themind, whichmust be tamed, for it is veiled by a formof ignorance that is blind and leads to the arousal of what are termed the threemental poisonsof desire, anger and closed-mindedness. These in turn negatively affect three fundamentalenergies in the body called the three humors and thereby their twenty characteristics. Thesehumors are termed rLung, amobile energy,Tripa responsible for heat in the body andBadkanwhich is cooling. (2005: 1245)

    Although it would be easy to dismiss these as mystical or cultural forces dis-tant from a biomedical view, it is important to take seriously the physical natureof the nyes-pas as they are understood in Tibetan medicine. Janes, for example,refers to rlung imbalance as a psychosocial disorder (1995: 9) and claims thatrlung refers to a cluster of somatic-emotional complaints, particularly dizziness,headaches, back and neck pain accompanied by insomnia, dysphoria, anger, orfrustration (2001: 211). However, it would be more correct to say that these aresymptoms of rlung imbalance rather than rlung itself. Elsewhere he calls rlung:an idiom of distress . . . developed, via the productive work of culture, as a state-ment of personal and social suffering that reflects a mix of classical Buddhistontology with the modern politics of Tibetan identity (Janes, 1999: 407). Thisis helpful in connecting this Tibetan medical concept to broader social and polit-ical factors; however, Tibetan medicines understanding of rlung is also a crucialconcept in understanding the fundamental way body and mind operate andinteract. It is important therefore to employ an expansive understanding of rlungthat encompasses its uses in Tibetan medical practice, that is, as a diagnosticand explanatory concept in its treatment of a wide variety of disorders, includingchronic diseases resistant to biomedical treatments, such as hepatitis and cancer,

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  • among both Tibetan and non-Tibetan populations throughout the world, andnot restricted to Tibet.

    When Tibetan medical doctors treat patients, especially those who are not atall familiar with Tibetan medicine, they tend to provide the explanations anddiagnoses that are mainly at the level of the so-called proximate causes. Whenexplaining their work in greater depth, however, they claim that Tibetan medi-cine addresses the root causes of illness, in contrast to merely addressing theproximate causes of illness as is often the case in Western biomedicine (Clifford,1984; Dorjee, 2005). The following quote from Tibetan physician Yeshi Donden(1986: 1516) illustrates this point:

    With respect to the origins of illness, Shakyamuni Buddha propounded that there are 84,000different types of afflictive emotions, such as desire and hatred, which have correspondingeffects on beings, thus producing 84,000 different types of disorders. . . . The proximatecauses are wind, bile, and phlegm. With regard to the distant [causes], the distinct causes foreach disorder are difficult to enumerate because basically all disorders have their origin in themental environment of the past prior afflictive emotions and it is these mental factors thatare ultimately responsible for all types of disorders. These afflictive emotions impel actions(karma) that establish potencies in the mind, ripening later as specific diseases. Hence, it isimpossible to determine all the specific distant causes involved in a particular disease; how-ever, the basic entities of those causes are the afflictive emotions of desire, hatred, andobscuration. These three, in turn, depend upon ignorance.

    Unlike in Western thought, where emotion and reason (or cognition) havebeen separated philosophically (a split also blamedonDescartes often enough, buttraceable back to Aristotle as well, and also found in much of contemporary psy-chology and cognitive science), theBuddhist tradition recognizes a very close rela-tionship between emotion and reason. The relationship between cognition andemotion is now increasingly being recognized by modern science as well (Dama-sio, 2000a, 2000b; Goleman, 1995, 2003, 2006; Lane andNadel, 2000). As the neu-rologist AntonioDamasiowrites (2000b: 14), Well-tuned and deployed emotion,as I see it, is necessary for the edifice of reason to operate properly. This may helpto explain why one of the afflictive emotions is closed-mindedness (gti-mug) orignorance (ma-rig-pa), which does not sound like an emotion in aWestern con-text. Second, it is important to recognize the relationship that the three primaryafflictive emotions have with each other and with secondary afflictive emotions.On the basis of fundamental ignorance (ma-rig-pa), a cognitive distortion thatgrasps at an object as inherently existing, as having own-being or essence (Tib.rang-bzhin, Skt. svabhava), and hence inherently possessing certain characteris-tics (such as being good or bad, pleasurable or painful), attachment or aversionarise (the former if the object is seen as good, pleasurable, etc. for the self, and thelatter if the object is seen as bad, painful, etc. for the self). All other afflictive

    Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 107

  • emotional states in some way derive from this basic cognitive, affective and moti-vational stance (towards or away from the object).

    Again, this recognition of the centrality of attachment or aversion ofwishing to seek pleasure and well-being and avoid pain, suffering and loss bearsa striking resemblance to contemporary thought in cognitive neuroscience. AsDamasio (2000b: 20) writes: The emotions are inseparable from states of pleasureor pain, from the idea of good and evil, of advantageous or disadvantageous con-sequences of an action, and of reward or punishment for an action (see also CloreandOrtony [2000: 2930] on positive and negative appraisal).Where theBuddhistand Tibetan medical tradition diverges from current thought in cognitive neu-roscience is of course in claiming that both these drives of attachment and aversionare actually rooted in fundamental ignorance;modern science tends rather towardsaccepting these drives as the result of evolution and as therefore necessary and ben-eficial for survival (see Goleman, 2003, 2006; Gyatso and Ekman, 2008; Pinker,1997).

    Understanding the root of all suffering, including physical and mental ill-ness, to be the mind itself fundamentally connects Tibetan medicine and Bud-dhadharma, as the purpose of the Dharma is to purify the mind and therebyeliminate all suffering. As Clifford writes (1984: 132): Dharma is not only thebasis of the theory of the nature of mind, it is also a preventative medicine formental sickness. This points to an important difference in the Tibetan tradition,in that religious or spiritual teachings and practices are not separated out fromthe practice of medicine and healing (Tib. gso-ba rig-pa); rather, spirituality andmedicine are seen as intimately interconnected, and hence the patients spirituallife and health cannot be separated. Spiritual practices related to cultivating emo-tional, cognitive, attentional and motivation balance are therefore understood asthe best kind of preventative medicine in the Tibetan tradition.

    The Patient in Tibetan Medical Practice

    The intimate relationship between body and mind, which takes place on bothgross levels and on the subtlest of levels, explains the care with which Tibetanphysicians consider the role of the mind on health and with which they approachthe question of the mental states of their patients. In an interview with theauthors, Dr Pema Dorjee related:

    For example, I can give you pills like this. I just pack them and say, This is for you (leansback in his chair and throws a bag of pills casually onto the table between us). Immediatelyyoull have the thought How rude DrDorjee is to give it to me in this way. If instead, I handit to you nicely and say, Here are some instructions (offers the bag of pills, holding it in both

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  • hands, leaning forward), immediately youll think, How kind Dr Dorjee is. I would like tocome see him again. So my actions of body, mind and speech affect your mind. They giveyour mind some strength. How kind this doctor is. I think his medicine must be very good.I will definitely get better from this doctors medicine. This is what we call trust and faith,which form a bridge between the two persons [of patient and physician]. This is very impor-tant. (2007)

    In another interview, Dr Tsering Namgyal independently mentioned the impor-tance of speaking gently and lovingly to patients, using a very similar example(Namgyal, 2009). Both Tibetan doctorsmentioned that, in some cases, the kindnessthat the physician shows the patient can even by itself cure the patient of whateveris ailing them, so showing such kindness and compassion is of great importance.

    In a system in which the minds relationship to the body is unclear, the phy-sicians primary responsibility is to treat the body, and his or her actions on thepatients mental states, while certainly recognized to be of importance by manyphysicians who treat patients, are of lesser or secondary significance. Yet in theTibetan medical system, which recognizes the minds ability to affect the body,the physician becomes responsible not only for treating the patients body andinfluencing it positively (through medication and other treatments) but also fortreating the patients mind by having a positive influence on the patient. Tibetandoctors call this blo-gso, or healing the mind, and see it as a critical componentof patient interaction and patient care. Blo-gso involves showing kindness, com-passion and general friendliness to the patient, as well as giving advice that canhelp the patient to achieve a calm and healthy mind, which is especially impor-tant for patients suffering from rlung disorders, since these disorders are espe-cially connected with mental disturbances. Often this advice is in the form of,or based on, Buddhist teachings. Thus the emphasis in Tibetan medicine thatphysicians must cultivate genuine compassion and empathy for the patientsappears to be not only a moral injunction but also a logical part of the systemsgeneral understanding of health, which encompasses the role of the physician/patient relationship (Nyima Rinpoche and Schlim, 2006). Moreover, compassionis important both for the physician and the patient. When asked by the authorswhether he might ever advise a patient to cultivate compassion, and whether cul-tivating compassion would help a patient recover, Dr Namgyal stated:

    Yes. . . . Our medicine says that there are three poisons in our body: ignorance, [attachmentand aversion]. If we get rid of all three of them, we are really a healthy person, with no causefor disease in our body. When the three poisons remain in our body, the cause of disease isstill in our body. How is disease created? It is due to external conditions: diet, lifestyle andother things they create disease. But really . . . we say that the cause of disease doesnt comefrom outside it exists in our body, but due to [external] conditions, these aggravate it andcreate disease. So compassion and love they are the opposite of the three poisons; they are

    Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 109

  • the antidote. So, if you gain or cultivate a lot of compassion and love in yourself, then thethree poisons decrease more and more, and you become more and more healthy. Then if[they are completely eliminated], you are enlightened, and then [there is] no disease, no ten-sion, no [problems whatsoever].

    The importance placed on the way Tibetan medical doctors interact with theirpatients (a recurring theme in the Four Tantras) calls to mind Csordas workon somatic modes of attention, which he defines as culturally elaborated waysof attending to and with ones body in surroundings that include the embodiedpresence of others (2002: 244). From a Tibetan medical perspective, a medicalgaze that rendered the patient a mere object (a body, or even a mind) to be ana-lyzed and treated (Foucault, 1975; Turner, 1987, 1992) would be medically coun-terproductive. Instead of a gaze there must be a warm, humanizing regard (inboth senses: attending to and esteeming).

    This notion is not, of course, absent in biomedical practice. Based on an in-depth ethnography of the everyday practice of medicine, Mol (2002) shows thatdoctors view and relate to their patients as whole persons, and not merelyobjects or cases of disease in the hospital. Furthermore, the importance of empa-thy among medical professionals and in the patient/physician relationship hasbeen receiving increasing attention in recent years (Charon, 2001; Larson,2005; Norfolk et al., 2007; Pembroke, 2007). Charon, for example, proposes theconcept of narrative medicine (which she contrasts with logicoscientificknowledge) as a new frame for clinical work that will give physicians and sur-geons the skills, methods, and texts to learn how to imbue the facts and objects ofhealth and illness with their consequences and meanings for individual patientsand physicians (2001: 1898). Charons recommendation for physicians to engagemore in the practice of listening to their patients is an interesting parallel to Tibe-tan medical practice, where the art of questioning the patient is consideredcentral to proper diagnosis, alongside the other two techniques of tactile (includ-ing pulse-reading) and visual (including urinalysis) examination. Charon specu-lates that physicians skilled in narrative medicine may be able to achieve moreeffective treatment than those unskilled in this frame; however, she does not pro-vide any theoretical explanation for why this might be the case. Like Charonssuggestion of narrative medicine as a skill, the work of Norfolk et al., (2007)argues that empathy is a skill that can be cultivated to facilitate rapport in thepatient/physician relationship, and Larson (2005) argues that the cultivation ofempathy by physicians can be seen as emotional labor, as conceived of inHochschilds (1983) classic study. Larson (2005: 1100) acknowledges, however,that there are many obstacles to physicians ability to develop empathy, includ-ing little importance attached to empathy and cynicism.

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  • Therefore, while there is increasing recognition of the importance of empathyin the clinical practice of biomedicine, one difference between the two traditionsappears to be that in biomedical practice the role of non-physical factors, such asfeelingsof empathyor compassion in the physician/patient relationship, lacks a the-oretical account of any kind of mechanism that would make such practices centralin the application of healthcare. Themost popularmechanism proposed, that of theplacebo effect, is a highly problematic notion in itself, as it is defined as the absenceof amechanism (Harrington, 1997;Moerman, 2002). In Tibetanmedical practice, itis understood that the interdependence ofmind and bodymeans that themind has arole to play even in apparently physical ailments, and the body has a role to playeven in apparently psychological or psychiatric ailments. Therefore, healing themind of the patient and paying attention to the nature of the physician/patient rela-tionship is an important part of all treatment and healing. Some have seen this itselfas a crucial aspect ofTibetanmedicine (Bradley, 2003);moreover,DrDorjees com-ments, and our observations of his interactionwith patients, indicate that this inter-dependence is not only theoretical, but is also reflected in physicians practice. Iteven extends as far as statements that, for a minority of patients, and especially incases of rlung disorders associatedwith themind, the compassionate attitude of thephysician may itself be enough to effect a cure.

    The distinctive understanding of the relationship between body and mindalso affects the understanding of the personhood of the patient in Tibetan med-ical practice. As Dr Dorjee notes: Since body and mind are seen as a compositewhole in the Tibetan medical system, all manner of diagnosis and treatment takesthis into account (2005: 129). This is an interesting consideration from the per-spective of medical anthropology. Pollock (1996), for example, argues for a con-sideration of the concept of personhood in the study of ethnomedicine, asopposed to merely the reified concepts of the Body and the Self, which he seesas closely connected to the mind/body dichotomy in American culture and med-ical thought, which makes illness something that the mind or the body has, ratherthan the person. He writes:

    The fundamental bifurcation of persons in American culture into bodies and minds surelyforms the cultural and historical ground for the parallel fundamental bifurcation of illnessesinto the physical and the mental, and of professional medical specialties into physical med-icine and psychiatry/clinical psychology. Within each of these spheres of medicine, concep-tions of illness as well as forms of practice tend to reflect and reproduce basic aspects ofAmerican personhood. This point has been made in a slightly different form with regardto American assumptions about the mental makeup of persons. Lutz, for example, has notedthat Americans posit an essential difference between emotion and thought, a culturalassumption that is elevated to scientific salience as affect versus cognition (Lutz,1988). (Pollock, 1996: 321)

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  • Understandings of the mind and body and their interrelation are inevitably inex-tricable from understandings of personhood. As Kirmayer notes (1988: 81): Themoral dimension of medicine, then, is not something imposed by doctors onpatients, it arises from the cultural concept of the person. Given the currentWestern concept of the person, some form of mind-body dualism is inescapable.

    The Tibetan Buddhist and medical tradition presents an alternative under-standing of the mind/body relationship predicated upon a unique understandingof the human person that is non-dualistic in the sense that it does not admit thestandard dichotomies of physical vs mental illness, individual vs society, or affectvs cognition. It is a medical tradition based on the concept of interdependence,rather than on substantially real and separate entities, and it therefore presentsa relational understanding of personhood and health that places the individualback into a situated environment and that places the cultivation of positive rela-tionships (through compassion and empathy between patient and physician, forexample) at the heart of good health and good medical treatment. We must becareful, however, in navigating the similarities and differences between Westernand Tibetan Buddhist thought, because they are neither simple nor straightfor-ward. Buddhism is neither monistic, nor does it fail to recognize the existenceof distinct individuals. Rather, the alternative model it offers for mind/body andself/environment interaction is based on the concept of interdependence and ofrelational entailment.

    Conclusion

    What we call the mind/body problem may be, as Michael Lambek notes, butone particular historical expression of what are universal existential conundrarooted in the human capacity for self-reflection (1998: 106). In that case, itwould be right to be wary of seeking a straightforward solution to the mind/body problem through a casual or cursory look at other cultures and traditions.Nevertheless, it is unquestionable that cross-cultural investigations have greatpotential to shed light on our own wrestling with the mind/body relationshipby providing comparative lenses through which unquestioned assumptions inour own discourse may come to light. In this sense, the mind/body relationshipthat emerges in both Tibetan medical practice and theory represents a genuineand useful alternative to the strict, so-called Cartesian mind/body dualism thathas become such a problematic issue not only with regard to biomedicine butalso much of modern thought. It acknowledges mind/body dualism (mind isunderstood as consciousness, and hence is subjective, experiencing and immater-ial, whereas body is understood as physical and material) on coarser levels,

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  • while also admitting an inseparability, and therefore a degree of unity, of mindand body on subtler levels, thereby establishing a basis for a sophisticated theo-retical account for the interactions and mutual influences of mind and body.Mind and body are therefore neither the same nor entirely separate. Rather, theyare interdependent, and because the relationship between mind and bodydepends on what level of subtlety one is dealing with, this relationship isdynamic and complex.

    The recognition of this interdependence emerges also in the dynamics ofphysician/patient interaction, and affects the role of the physician. Religiousunderstandings of karma underpin the responsibility of the physician to thepatient, but the Tibetan scientific understanding of the mind/body dynamicprovides another logic regarding the importance of the physician exhibitingcompassion, empathy and encouragement to the patient as part and parcel ofactual treatment. The dynamics of mind/body interaction in Tibetan medicine,therefore, orient Tibetan medical practitioners to focus on the patient as a personirreducible to mind, body or specific illness. This affects the role of physician andthe actual physician/patient relationship by making central the importance ofcompassion and empathy as crucial elements of effective healthcare in a way thatdirectly relates to difficulties currently facing biomedical theory and practice.6

    The case of Tibetan medical practice reveals that the difficulty faced in bio-medicine and Western thought is not merely the result of a legacy of thinking interms of mind/body dualism, but also the manner of the contemporary rejectionof that very dualism. This pendulum-like swing is not a real solution, and it failsto deal with the problem of consciousness. Either position complete mind/body dualism, or a complete rejection of mind/body dualism, i.e. monism isan extreme position that leads to impossibilities and dead-ends in our thinkingabout the mind and body. Tibetan medical practice shows that, contrary to con-temporaryWestern beliefs, admitting that there is a difference between mind andbrain in no way necessitates the acceptance of a soul, the existence of God, orany other theological or religious position. An investigation of the interdepen-dence of body and mind will likely result in a much more complex, and moresatisfactory, understanding in this area. It also has the not insignificant poten-tial of providing a humanizing influence in modern medicine, by providing atheoretical basis for making the essential importance of compassion and empa-thy in healthcare central once again.7 In Tibetan medical theory and practice,compassion is crucial both for the physician and the patient, and plays a ben-eficial role in the healing process. Importantly, this is understood not becauseof the role of belief or a placebo effect in treatment; rather it is understoodthrough the mind/body connection. The fact that mind and body are always

    Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 113

  • interconnected and interdependent in any situation of health or disease there-fore configures the physician/patient relationship along the lines of compas-sionate care, and mandates that the physician must treat the patient withkindness, empathy and sincerity.

    The anthropological study of selfhood in cross-cultural context can begreatly benefited by concrete analyses of practices, especially practices thatthrow into relief unquestioned assumptions about constructs such as body,mind, and their interaction, which tend to be intimately related to questionsof the self. The case of Tibetan medical practice, we believe, offers one suchopportunity because it presents a subtler understanding of body and mindthan is currently found in much of biomedical and medical anthropologicaldiscourse. By doing so, it presents a challenge and invites further compara-tive reflection that could prove extremely fruitful. Further systematic clinicalethnographic work would be most beneficial in investigating the mind/bodyrelationship in Tibetan medical theory and practice and would complementthe general framework presented here.

    Notes

    1. Within the sub-field of the anthropological study of Tibetan medicine, much attention has beenpaid to the important question of how Tibetan medical practice differs within the Tibetan Autono-mous Region (TAR), the refugee communities in India, and in non-Tibetan societies in Europe andNorth America. Audrey Prost (2006: 52) notes that:

    While Tibetan medicine in the TAR is being transformed into a quasi secular, aspiringly sci-entific and lucrative enterprise, Tibetan doctors in exile are more cautious in secularisingtheir curriculum and practice. This may be explained by the fact that the Tibetan Govern-ment in Exile has invested the Men-Tsee-Khang with the mission of preserving traditionalmedicine as one of the great Tibetan traditions, one that is inextricably tied to Buddhism.

    It is relevant, therefore, to point out that all of the Tibetan physicians interviewed for this study areprominent in the Tibetan exile community and closely affiliated with Men-Tsee-Khang and practicingboth in India and abroad. The close connections between Tibetan medicine and Buddhism analyzed inthis article would be less apparent in Tibetan medical practice in the TAR, although that does notnecessarily mean that they would be less relevant. We plan to extend this research by examining thisimportant comparative dimension.

    2. This is not suppression of gross mental activity; the gradual subsiding of coarse thoughts andincreasing clarity and calmness of the mind that is achieved through prolonged mental training islikened to the water of a thunderous waterfall that calms and becomes like a stream flowing, and thencalms even more to be like a vast ocean.

    3. This dynamic nature of the body/mind relationship in India, for example, is briefly touchedupon by Cohen in a section of his book where he discusses the difference between the subtle bodythat survives death to pass on to the next life, and the coarser, gross body that dies (1998: 213). Reflect-ing on this, he points out:

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  • The frequent but ethnographically crude invocation of Cartesian/non-Cartesian distinctionsin medical anthropology viewing cultures as more or less dualistic in their construction ofbody and mind must be sensitive to the dialogic constitution of the split self, to the dangerof equating mind (rather than body, or both) with identity, and, in particular, to the variablepossibility of balance and dualistic thought across class. (1998: 21314)

    4. Millard (2006) provides a good example of this in his study of a Tibetan medical clinic in westNepal. After recording clinical interactions with 153 patients visiting the clinic, he notes that noneof these patients used words, neither in Tibetan nor in Nepali, that related directly to their psycho-logical condition (2006: 259).

    5. As Clifford (1984: 131) writes:

    This relationship between the three humors and the three primary mental defilementsexpresses the basic psychosomatic theory of Tibetan medicine and psychiatry. Differenttreatments and medicines are applied to influence the mind through the body. All thisimplies that Tibetan medicine presupposes that emotions have physiological functions,perhaps like the biochemical correlates of emotions that modern science is discovering.Further, that the substances used in Tibetan psychiatric medicine are said to have thecomposition (in terms of elements, tastes, etc.) that is deficient in the disorder they rem-edy also echos the latest research findings the psychoactive drugs mimic the bodysown neurochemistry.

    6. We believe this connection between body/mind interaction and the physician/patient relation-ship provides a fuller explanation for the recurring themes of compassion and kindness that appear inTibetan medical writings and in the oral explanations of Tibetan medical doctors. In the sectionexplaining the etymology of the physicians title (sman-pa), the Four Tantras states (Clark, 1995:228), he is like a father (pha) in protecting migrant beings (i.e. all sentient beings). Furthermore, theFour Tantras lists as among the six prerequisites for being a Tibetan physician that of altruism, whichentails:

    seeing [that the three realms are in the nature of] suffering, [having the wish to] benefit [sen-tient beings and having sincere] faith [in the Triple Gem], rather than cling [to notions of]love and hatred [towards others] as being good or bad, by means of even-mindedness [onecomes to abide in the four limitless attitudes of] compassion, love, joy, and equanimity.(Clark, 1995: 224)

    Another prerequisite is social mores, which includes the instruction that the physician should beaffable to patients and please others (Clark, 1995: 227). The physician is enjoined to do everythingpossible to contribute to the mental and physical strength of the patient, even to cultivate charisma andrenown if it aids in this purpose (see Clark, 1995: 199201; see also Nyima Rinpoche and Schlim,2006).

    7. We would like to note that modern healthcare is far from bereft of those who take holisticapproaches and place care of the whole person at the center of their clinical and research agendas; thefield of nursing is one clear example.

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    Chikako Ozawa-De Silva is an Associate Professor of Cultural Anthropology and Medical Anthro-pology at Emory University. She received her DPhil. in Social and Cultural Anthropology fromOxford University in 2001. She was a Visiting Research Fellow at Harvards Department of Social

    118 & Body & Society Vol. 17 No. 1

  • Medicine, and a Post-doctoral Fellow at the University of Chicago. Her academic vision is tocontribute to cross-cultural understandings of health and illness, especially mental illness, and to makea contribution to the field of medical anthropology by bringing Western and Asian (particularlyJapanese and Tibetan) perspectives on the mindbody, religion, medicine, therapy, and health andillness into fruitful dialogue. [email: [email protected]]

    Brendan Richard Ozawa-de Silva received his DPhil. in Modern History fromOxford University in2003. From 2004 to 2005 he was a Postdoctoral Fellow at Emory University and from 2005 to 2006 aVisiting Professor of World Religions at the same university. Since 2006 he has served as AssociateDirector for Buddhist Studies and Practice at Drepung Loseling Monastery in Atlanta, Georgia, andas Program Coordinator for the EmoryTibet Partnership at Emory University. His research focuseson the interdisciplinary study of contemplative practices, and he is currently pursuing a seconddoctorate in Tibetan Buddhism and cognitive science. [email: [email protected]]

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