You are on page 1of 25

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 individuals relationships with others and the environment. Due to the distinctiveness, yet
interdependence, of mind and body, the physicians task is to heal the patients 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 dichotomy 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.nav
Vol. 17(1): 95119; DOI: 10.1177/1357034X10383883

www.sagepublications.com

96 & Body & Society Vol. 17 No. 1

1993; Turner, 1984, 1987, 1992) and has been shown to be a specific socially constructed notion, rather than a natural reality. As an alternative system of knowledge,
Eastern thought is sometimes invoked as an advocate of the unity or oneness of
mind and body (Scheper-Hughes and Lock, 1987). However, although Asian systems can provide useful alternatives to the dualistic view of mind and body that is
the Cartesian legacy of Western thought, such presentations tend to be mistakenly
understood as representing a monistic view of body and mind. However, an investigation of self-cultivation practices in Japan indicates that this unity is often understood as a potential, and that mind-body unity is not a natural state, but rather
something 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 on
coarser levels and an inseparability of body and mind on subtler levels, Tibetan
medicine provides a useful model for comparison with modern biomedicine,
because it presents a dynamic, interdependent relationship between body and
mind. Neither classically dualistic nor monistic, it lies between the so-called
Cartesian dualism of body and mind and the contemporary rejection of that
dualism in favor of a view that reduces the mind to the brain. This model of body
and mind, and its basis in Buddhist thought, is something that is both apparent
and hidden in the theory and practice of Tibetan medicine. This is because Tibetan medical doctors must navigate a fine line in their presentations of Tibetan
medicine to outsiders. On the one hand, they are quick to defer to spiritual teachers (bla-ma, lamas) on matters of Buddhist thought and practice, and they also
take 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 for
mere faith healing. On the other hand, Buddhist thought pervades Tibetan medical texts, and when the authors probed Tibetan medical doctors about key Buddhist concepts and how they relate to Tibetan medical concepts, their responses
revealed an intimate relationship between the two that formed the basis for the
Tibetan medical model of mind and body presented here. Given the tenuous
situation of Tibetan exile culture, there are no doubt exigencies that would make
Tibetan medical doctors very careful about the way they present Tibetan medicine, particularly to outside researchers. However, the model presented here was
drawn out from numerous interactions with doctors over a period of time, is confirmed by the observation of Tibetan medical doctors in practice, and corresponds
to accounts in Tibetan medical texts that pre-date Tibets current political situation. We therefore feel it has a degree of legitimacy not overly compromised by
the need to fashion presentations of Tibetan medicine that directly address the current socio-political realities of Tibetan medical doctors in exile.

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

Specifically, this article draws on in-depth interactions over the last five
years with Tibetan physicians in a variety of settings, most notably with Dr
Pema Dorjee and Dr Yeshi Khandro in Dharamsala, India, and during their visits to the USA. The authors observed Dr Dorjee and Dr Khandro as they practiced Tibetan medicine, offered consultations, delivered talks and training
workshops, and engaged in symposia with Western medical doctors. Additional interviews were conducted with Tibetan physicians Dr Tsering Namgyal
and Dr Tsultrim Kalsang in Dharamsala.1 We also draw from the writings of
other contemporary Tibetan medical doctors and the growing body of anthropological literature on Tibetan medicine. In addition, we draw from the
broader Tibetan Buddhist philosophical and cultural tradition, a tradition
which 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 the
mind/body and physician/patient relationships, and how this relates to theoretical explications of these relationships in Tibetan medical and Buddhist teachings,
provides a comparative lens that throws into relief how a particular concept of
person or self lies at the core of the problematic Cartesian dichotomy of
body and mind. This is because it posits neither a reified, metaphysical self
beyond empirical observation nor a reduction of the self into purely physical
processes. Moreover, such questions regarding the self relate to anthropologys
recent turn to subjectivity (Biehl et al., 2007: 5) and to questions in medical
anthropological scholarship regarding meaning and what makes life worth living
questions with a moral dimension that are frequently ignored, despite their
essential importance in any medical system (Kleinman, 2006).
The Cartesian divide of mind and body is closely connected to a conception
of selfhood that includes a sharp divide between the individual self and its environment; however, recent trends in cognitive science are increasingly calling into
question the stability of such divides (Barsalou et al., 2003; Niedenthal et al.,
2005). Francisco Varela and Evan Thompson have proposed an enactive model
of embodied cognition that recognizes the mind/body/environment continuum
as a complex, dynamical system that involves constant negotiation and mutual
influence (Varela et al., 1991). Their model not only places the mind back in the
body, but it also places the individual back into the environment, which is always
already a constitutive, essential part of mind/body interaction and not merely a
background setting for it. The environment thereby becomes not only the situated context that provides the stimuli that trigger cognitive processes, but part of
the dynamical system itself. They write:

98 & Body & Society Vol. 17 No. 1


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 biologically, ecologically and socially a better conception of brain, body and environment would
be as mutually embedded systems rather than as internally and externally located with
respect to one another. Neural, somatic and environmental elements are likely to interact
to produce (via emergence as upward causation) global organismenvironment processes,
which in turn affect (via downward causation) their constituent elements. (Thompson and
Varela, 2001: 4234)

Importantly, this model also involves an active role for consciousness; thus, like
the Tibetan medical and Buddhist model, it is neither strictly dualistic nor monistic. It should be noted that while Varela explicitly drew from Buddhist thought
in forming some of his theories, many other figures in cognitive science working
on embodied models that expand on traditional accounts of cognition in similar
ways have come to their models without any reference to Buddhist thought
(Barsalou et al., 2003; Clark, 2008; Clark and Chalmers, 1998; Niedenthal
et al., 2005). The Tibetan medical system similarly understands the environment
as a crucial component of mind/body interaction. It thus bears resemblance to
the vitalist conception of the body developed by Sheets-Johnston (1992), who
contrasts such a model, based on the concepts of relationality and proportionality present in Greek medicine, with the more static Cartesian model of mind and
body that fails to account for the bodys being fully situated in and integrated
into its environment.
Body and Mind in Tibetan Medicine
A foundational tenet in Tibetan medicine is that the root cause of all illness, disease and suffering is the mind (Clifford, 1984; Dorjee, 2005). This notion can be
seen as a cultural or religious belief, and the fact that the power of belief, symbols
and meaning is significant in matters of health, illness and magic, has been noted
by scholars from Levi-Strauss (1963, 1966) to, more recently, Daniel Moerman
(1979, 2002). In Tibetan medicine, however, this saying also points to a theoretical and practical recognition of the importance of mind/body dynamics in the
arising of disease and in its treatment. The recognition by Tibetan doctors of the
impact of the mind on the body and on health necessitates that they relate to
patients out of this understanding, and that they seek to influence patients mental states in a positive way as part of their work of overall treatment. These two
sets of interdependent relationships (mind/body and physician/patient) emerge
as closely related, and this broader dynamical system itself forms an important
part of the treatment of the patient as a whole person. Both diagnosis and treatment in Tibetan medicine therefore emphasize the agency of the patient, because

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 99

the intimate connection between mind and body means that every person has
the capacity for self-healing and self-regulation (Dorjee, 2005: 269).
The specific understanding of mind/body interaction present in Tibetan
medicine provides a theoretical basis for the clinical importance of gratitude,
kindness and compassion in the treatment and healing process. This humanizing
dimension 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 relating
to their patient as a whole person is also recognized (Mol, 2002), but the fact that
the mind/body relationship remains a problematic issue in the biomedical
context (as seen in the discussion of placebo and meaning effects [Moerman,
2002]) means that the importance of a compassionate and caring relationship
with the patient exists, in a sense, parallel to the theory of the understanding
of mind and body in biomedical practice. In Tibetan medicine, by way of contrast, the cultivation of compassion and empathy is seen as central to the logic
of health itself, because such psycho-physical states are the very opposite of the
negative emotions that give rise to the imbalances in the three psycho-physical
energies (rlung, mkhris-pa and bad-kan) that lead to disease.
Tibetan medicine takes a very particular understanding of health as the starting point for medical understanding and as the ultimate goal of treatment. Health
in Tibetan medicine is commonly defined as the balance of the five elements and
three nyes-pas (or energies) in the body. Interestingly, while the balance of the
three nyes-pas is considered the source of health, the word nyes-pa itself literally
means fault or defect, and the nyes-pas are understood as also being the cause of
the separation of mind and body, that is, death (Dorjee, 2004). However, conceptions of health in Tibetan medicine go beyond this, and ultimately cannot be separated from questions of meaning and what would be considered in the West a
religious dimension although it would be better, as Csordas notes (1985), not
to submit too readily to this bifurcation, as medical and sacred realities are indeed
completely fused in the Tibetan medical system.
Attempts have been made to view Tibetan medicine as an entirely separate
system independent of Buddhism, some of these arising out of a desire to present
Tibetan medicine as a scientific system that can be applied cross-culturally and
that does not require religious belief or faith to be effective, some because of the
pressures that Tibetan medicine faces within China and its project of modernization (Adams, 2001; Bradley, 2003; Janes, 2001; Komatsu and Namba, 2005a:
136, 2005b: 1723, 181; Takeuchi, 1995: 18694). While Tibetan medical practitioners, as noted, agree that Tibetan medicine does not require faith in, or adherence to, Buddhism in order for it to be effective, on a theoretical level the basic

100 & Body & Society Vol. 17 No. 1

tenets of Tibetan medicine are closely intertwined with those of Buddhism, and
these interconnections manifest in the practice of Tibetan medicine. It is also relevant to note that the problem of the mixing of religion and medicine does not
arise from within the Tibetan tradition itself at least, certainly not in the same
way as it does in biomedicine because science as a valid form of knowledge
and religion as a valid form of knowledge are not separated out in the Tibetan
tradition in the way they have been in the history of Western thought. Both can
be considered rig-pa, meaning science or knowledge.
In their classic article Scheper-Hughes and Lock (1987: 10) note the difficulty in achieving a coherent conceptualization of body and mind that goes
beyond the now recognized inadequacies of the Cartesian dichotomy:
As both medical anthropologists and clinicians struggle to view humans and the experience
of illness and suffering from an integrated perspective, they often find themselves trapped by
the Cartesian legacy. We lack a precise vocabulary with which to deal with mind-bodysociety interactions and so are left suspended in hyphens, testifying to the disconnectedness
of our thoughts.

Since Scheper-Hughes and Lock, the body has been the subject of a great deal
more critical investigation in areas such as the rapidly emerging field of sociology
of the body (Blackman, 2008). Yet while the mind/body dichotomy in modern
biomedicine, and in Western thought in general, remains an object of dissatisfaction, it remains a challenge to develop conceptual clarity around a new, more
satisfactory model. Bio-psycho-social or integrated approaches may represent
a recognition of the added complexity necessary in analyses and the need to
move towards a recognition of interdependence, multiple factors, multiple
perspectives and multiple levels of analyses. Nevertheless, the challenges may
run deep, in part because rethinking the body/mind dichotomy requires a
rethinking of several other closely related dichotomies that have perplexed modern scholarship, including that of biology/culture (or nature/nurture) and
individual/society (or self/environment).
Consciousness and Materialism
Although it is widely recognized that the Cartesian dichotomy between body
and mind does not apply to Asian systems of knowledge, including medical
knowledge (Ozawa-de Silva, 2002), a common misperception is that this is
because Asian medical traditions never developed the conceptual distinction in
the first place and therefore still view the body and mind as one, as if they were
the same entity. Another misconception is that neuroscience and other modern
scientific disciplines are moving in a similar direction, because the Cartesian

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 101

dualism of mind and body is being superseded by a view that the mind is ultimately reducible to brain function. This is at least in part due to increasing
sophistication in the study of the neural correlates of mental states, made possible by technological advances in brain imaging.
The debate on this issue in contemporary neuroscience centers around the
question of how something immaterial and subjective could arise from something 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 this
debate is that consciousness arises as an epiphenomenon of neural activity, but
cannot itself affect neural activity. This would not be a satisfactory answer in a
Buddhist context (nor is it considered fully satisfactory by many modern scientists and philosophers), since it claims that a material cause (neural activity) can
give rise to an immaterial result (consciousness), yet at the same time rejects that
an immaterial cause (consciousness) could give rise to a material result (a change
in neural activity). Within the context of the development of Western science, it
has been pointed out that this one-sided approach has arisen at least in part from
Western sciences significant discomfort in opening the door to non-material
causes of any kind, since this might be perceived as opening the door to divine
activity and other religious explanations that lie beyond the domain of science,
or threaten the integrity of science. (Indeed this problem of consciousness, called
the hard problem, is often explicitly connected with a rejection of the religious
notion of the soul [see Crick, 1994].) Nevertheless, this significant problem
regarding the relationship of consciousness to neural activity remains, and this
is the mind/body problem from a Buddhist or Tibetan medical perspective.
In many cases, the physicalist bias has actually changed the terms of the
debate to speak of the mind/body problem as a brain/body problem, or to use
the 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 argument would go, modern science is now proving through its empirical methods
what other traditions intuited: that mind and body are one. Since mind here
is actually understood as brain, however, this is actually nothing more than saying that the brain a physical entity and part of the body affects, and is affected
by, other parts of the body. This silent appropriation of the non-material into the
material, and non-biological into the biological, is itself a result of the confusion
underlying contemporary Western thought in the shadow of the Cartesian
dichotomy, already noted by Scheper-Hughes and Lock (1987). Transposing the
entire problem into the purely material realm, however, skirts the whole issue of
consciousness, subjectivity and first-person experience.

102 & Body & Society Vol. 17 No. 1

The reduction of mind into brain is clearly not what is being presented in
Buddhist thought, and it is a fundamental error to think that the brain/body relationship in biomedicine parallels the mind/body relationship in Buddhism. In
Tibetan Buddhism, the mind is understood as consciousness, which is defined
as 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 way
a mirror can reflect anything placed in front of it. Knowing refers to the minds
ability to apprehend, perceive or cognize an object (not necessarily a physical
object, but also including thoughts, concepts, mental images, etc.). Thus mind
is luminous and it illuminates (Geshe Lobsang Tenzin Negi, personal communication). Although intimately tied with physical matter on gross, subtle and very
subtle levels, consciousness itself is not physical or material; moreover, its cause is
not physical or material either, but rather a prior moment of consciousness. This is
because the Buddhist tradition considers it illogical to believe that something that
is not physical could be caused by something physical, or that something physical
could be caused by something non-physical; hence material entities can only give
rise to other material entities, not immaterial ones, and vice versa.
Tibetan medical and Buddhist thought explains the relationship between an
immaterial entity such as consciousness and a material entity such as the body
or brain (a part of the body) by differentiating distinct levels of consciousness:
gross, subtle and very subtle. Consciousness and mind, therefore, do not refer only
to what a person is consciously aware of; rather, there are a vast number of mental processes occurring with great rapidity, most of which individuals are not consciously aware of. This particular aspect falls in line with psychoanalytic thought
and contemporary discourse in cognitive neuroscience. As Lane and Nadel (2000:
7) write: Within cognitive neuroscience, however, it is now well accepted that
much of cognition is implicit or outside of conscious awareness. Similarly,
according to the Tibetan Buddhist view, ordinary individuals are not even able
to be fully aware of all the activity occurring on a gross consciousness level, much
less what is happening on the subtle level. Accessing the subtle level of consciousness requires quieting gross conscious activity, which would otherwise block or
cloud ones awareness of subtle conscious activity. Activity on the very subtle level
can only be accessed by highly trained meditators, as it requires quieting both
gross and subtle levels of consciousness. As this also calms the physical processes
connected with these levels of consciousness, the person enters a state similar to
deep sleep or a stage in the dying process, which ordinarily a person would not
be consciously aware of. Yet, having entered into it voluntarily and through meditation training, such trained meditators are able to be aware of and use this subtle
consciousness to engage their object of meditation.

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 103

Each level of consciousness therefore, is correlated with a level of physical/


physiological activity in the body. Gross or coarse levels of consciousness are
associated with sensory perception, as well as afflictive mental states such as
anger, desire and gross ignorance. The subtle level of consciousness is associated
with subtle mental activity, for example the mental activity that a meditator can
become aware of after letting gross mental activity subside.2 It is at the subtlest
level of consciousness that the Tibetan Buddhist tradition speaks of mind and
body (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 usually
masked by grosser levels of consciousness, such as sensory perception.
The inseparable relationship between this very subtle consciousness and very
subtle energy is likened to two sides of the same coin or a lame rider atop a blind
horse. 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 the
mobile energy (rlung), which is a subtle physical, material process; this energy cannot see (perceive, cognize) anything, as it is not itself consciousness, but it has the
ability to act on the physical world. At this subtlest level, mind and body always
move together; there is not one without the other. Therefore one can speak of a
mind/body unity and this obviates the problem of dealing with a completely disembodied mind and how it relates to the physical world. At the same time, this
explanation clearly shows that mind and body are not the same thing; they are distinct in their function and status (one physical, the other non-physical), and at levels above the very subtle, they are effectively separate and distinct entities, albeit
related on a deeper level. This avoids the problem of a purely physical explanation
that reduces the mind/body relationship to a body/body relationship and therefore cannot explain subjectivity and consciousness.
Such an intricate explanation of the relationship between body and mind is
not often presented by Tibetan medical doctors, and some who have engaged in
anthropological scholarship on Tibetan medicine may feel that Tibetan medical
doctors do not employ such a sophisticated model of mind/body interaction or
acknowledge such an affinity with the explanations that are in common with the
Tibetan Buddhist philosophical and psychological traditions. While it is true that
not all Tibetan physicians may be aware of these aspects of the foundations of
Tibetan medical practice, many well-trained physicians certainly are, and it was
acknowledged in our interviews with Dr Dorjee and Dr Namgyal that a physician with a deep knowledge of Buddhist philosophy is better equipped to help
his or her patients. In fact, the understanding of the interaction of body and mind
in Tibetan medicine is ultimately related to the way this interaction is explained
in the esoteric tantric teachings of Buddhism, which explicitly deal with the

104 & Body & Society Vol. 17 No. 1

subtle mind/body processes within an individual, and this is something that welltrained physicians are aware of, as indicated by their references to it when
questioned.
The dominant discourse revolving around the mind/body issue has predominantly stemmed from a simple binary classification. This often results in an
essentially static model that fails to capture the dynamic nature of development
over the life-course and techniques of transformation and self-cultivation, which
are essential elements of Buddhist and certain other Asian traditions that investigate the question of the mind/body relationship.3 Tibetan medicine may be able
to contribute to recent attempts to move away from such static models towards a
more dynamic understanding of mind/body interaction (Blackman, 2008) by
providing a concrete example of a tradition based around a view of mind/body
interdependency that is considerably more complex than many of the models
being considered. Such static notions of mind/body dualism also explain why the
term psychosomatic is inappropriate as a way of understanding Tibetan medicine. As Vargas notes (forthcoming), citing Jacobson, Tibetan medical doctors
view psychological and physiological systems as integrated so that both psychosocial and biological circumstantial causes impact the same system, and
give 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 by
turning to the notion of the five elements that make up all existence. Regarding
the actual arising of disease and its treatment, however, the concept of the three
nyes-pas of rlung, mkhris-pa and bad-kan is just as important. Nyes-pa is often
translated as humor and hence the three nyes-pas are often translated as wind,
bile and phlegm. Tibetan medical doctors, however, often find fault with this
translation, and since the parallels to humoral theory in Western thought are
potentially misleading, we retain the Tibetan names here. It is the balance of the
nyes-pas that allows for health, and the imbalance of the nyes-pas (specifically, if
one or more of the nyes-pas is overly increased, decreased or out of place) that
causes disease (Dorjee, 2004). Although many factors can influence their balance
or imbalance, the most fundamental is the mind itself. The Four Tantras (rgyudbzhi), the foundational medical text in the Tibetan medical tradition, attributed
to 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 meaning 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

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 105
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 rise
to 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 more
elaborated manner the complex nature of this relationship.
The ultimate state of health in Tibetan medicine is the state of a fully enlightened Buddha (Adams, 1992: 171). Achieving this state, which is the goal of Buddhist practice, is not understood as simply having a mystical experience that has
no effect on the persons mind or body. Rather, it is the result of a complete
transformation of the psychophysical aggregates, a process that requires study,
ethical discipline, meditation training and, ultimately, the concentrated harnessing of the bodys energies through yogic meditation practices (Gethin, 1998;
Gyatso, 1995, 2002). A fully enlightened one, that is, a buddha, does not have the
nyes-pas, and therefore does not have an ordinary body at all (although he or she
can display a body that appears to be ordinary). He or she is therefore free from
the final result of the nyes-pas, which is to separate the mind from the body and
thereby cause death. For ordinary beings, however, the nyes-pas are necessary
for life, although they will ultimately result in death. Within the Buddhist worldview, ordinary existence is explained as a cycle of life and death (Tib. khor-ba,
Skt. samsara) characterized by suffering, whereas enlightenment is freedom from
that cycle (Tib. mya ngan las das pa, Skt. nirvana).
The reason why the ultimate state of health and well-being in the Tibetan
medical system is understood as full enlightenment, or buddhahood, is because
of the etiology of disease, which links cognitive and afflictive obscurations with
illness. Some of the most interesting and unique features of Tibetan medicine come
directly from this intimate relationship with Buddhadharma, such as Tibetan
medicines presentation of the close and causal relationship between afflictive
mental 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 fundamental
self-grasping ignorance, a cognitive distortion in the mind that causes the mind to
grasp onto mental and physical phenomena (including the I or self) as permanent,
independent realities not contingent upon other factors. All ordinary beings suffer
from this distortion, and therefore cannot perceive or relate to reality as it is. As a
result, they fail to see the interdependent nature of reality and react to phenomena
with attachment, aversion and closed-mindedness. These three afflictive mental
states give rise to the three corresponding nyes-pas of rlung (pronounced loong),
mkhris-pa (pronounced treepa) and bad-kan (pronounced beckon). Within this
etiology, one can then understand why, according to the Tibetan medical system,

106 & Body & Society Vol. 17 No. 1

ultimate health is the state of enlightenment in which ones mind is free of any
afflictive emotions. Rlung is especially important as a link between the mind and
body. The Four Tantras states (Clark, 1995: 64):
Specifically, the life-sustaining wind [rlung] is located in the crown of the head and travels
through 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 body
together].

One of the most eminent contemporary Tibetan physicians, Dr Yeshi Donden (1986: 15), notes that:
In the Tibetan system we believe that whether we are physically healthy or not, basically all
of us are sick. Even though disease might not be manifest, it is present in dormant form. This
fact makes the scope of disease difficult to fathom.

Similarly, Dr Dorjee writes of:


. . . the essential root of all suffering the mind, which must be tamed, for it is veiled by a form
of ignorance that is blind and leads to the arousal of what are termed the three mental poisons
of desire, anger and closed-mindedness. These in turn negatively affect three fundamental
energies in the body called the three humors and thereby their twenty characteristics. These
humors are termed rLung, a mobile energy, Tripa responsible for heat in the body and Badkan
which is cooling. (2005: 1245)

Although it would be easy to dismiss these as mystical or cultural forces distant from a biomedical view, it is important to take seriously the physical nature
of 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 that
rlung refers to a cluster of somatic-emotional complaints, particularly dizziness,
headaches, back and neck pain accompanied by insomnia, dysphoria, anger, or
frustration (2001: 211). However, it would be more correct to say that these are
symptoms of rlung imbalance rather than rlung itself. Elsewhere he calls rlung:
an idiom of distress . . . developed, via the productive work of culture, as a statement of personal and social suffering that reflects a mix of classical Buddhist
ontology with the modern politics of Tibetan identity (Janes, 1999: 407). This
is helpful in connecting this Tibetan medical concept to broader social and political factors; however, Tibetan medicines understanding of rlung is also a crucial
concept in understanding the fundamental way body and mind operate and
interact. It is important therefore to employ an expansive understanding of rlung
that encompasses its uses in Tibetan medical practice, that is, as a diagnostic
and explanatory concept in its treatment of a wide variety of disorders, including
chronic diseases resistant to biomedical treatments, such as hepatitis and cancer,

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

among both Tibetan and non-Tibetan populations throughout the world, and
not restricted to Tibet.
When Tibetan medical doctors treat patients, especially those who are not at
all familiar with Tibetan medicine, they tend to provide the explanations and
diagnoses that are mainly at the level of the so-called proximate causes. When
explaining their work in greater depth, however, they claim that Tibetan medicine addresses the root causes of illness, in contrast to merely addressing the
proximate 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 84,000
different types of afflictive emotions, such as desire and hatred, which have corresponding
effects on beings, thus producing 84,000 different types of disorders. . . . The proximate
causes are wind, bile, and phlegm. With regard to the distant [causes], the distinct causes for
each disorder are difficult to enumerate because basically all disorders have their origin in the
mental environment of the past prior afflictive emotions and it is these mental factors that
are 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 is
impossible to determine all the specific distant causes involved in a particular disease; however, the basic entities of those causes are the afflictive emotions of desire, hatred, and
obscuration. These three, in turn, depend upon ignorance.

Unlike in Western thought, where emotion and reason (or cognition) have
been separated philosophically (a split also blamed on Descartes often enough, but
traceable back to Aristotle as well, and also found in much of contemporary psychology and cognitive science), the Buddhist tradition recognizes a very close relationship between emotion and reason. The relationship between cognition and
emotion is now increasingly being recognized by modern science as well (Damasio, 2000a, 2000b; Goleman, 1995, 2003, 2006; Lane and Nadel, 2000). As the neurologist Antonio Damasio writes (2000b: 14), Well-tuned and deployed emotion,
as I see it, is necessary for the edifice of reason to operate properly. This may help
to explain why one of the afflictive emotions is closed-mindedness (gti-mug) or
ignorance (ma-rig-pa), which does not sound like an emotion in a Western context. Second, it is important to recognize the relationship that the three primary
afflictive emotions have with each other and with secondary afflictive emotions.
On the basis of fundamental ignorance (ma-rig-pa), a cognitive distortion that
grasps at an object as inherently existing, as having own-being or essence (Tib.
rang-bzhin, Skt. svabhava), and hence inherently possessing certain characteristics (such as being good or bad, pleasurable or painful), attachment or aversion
arise (the former if the object is seen as good, pleasurable, etc. for the self, and the
latter if the object is seen as bad, painful, etc. for the self). All other afflictive

108 & Body & Society Vol. 17 No. 1

emotional states in some way derive from this basic cognitive, affective and motivational stance (towards or away from the object).
Again, this recognition of the centrality of attachment or aversion of
wishing to seek pleasure and well-being and avoid pain, suffering and loss bears
a striking resemblance to contemporary thought in cognitive neuroscience. As
Damasio (2000b: 20) writes: The emotions are inseparable from states of pleasure
or pain, from the idea of good and evil, of advantageous or disadvantageous consequences of an action, and of reward or punishment for an action (see also Clore
and Ortony [2000: 2930] on positive and negative appraisal). Where the Buddhist
and Tibetan medical tradition diverges from current thought in cognitive neuroscience is of course in claiming that both these drives of attachment and aversion
are actually rooted in fundamental ignorance; modern science tends rather towards
accepting these drives as the result of evolution and as therefore necessary and beneficial for survival (see Goleman, 2003, 2006; Gyatso and Ekman, 2008; Pinker,
1997).
Understanding the root of all suffering, including physical and mental illness, to be the mind itself fundamentally connects Tibetan medicine and Buddhadharma, as the purpose of the Dharma is to purify the mind and thereby
eliminate all suffering. As Clifford writes (1984: 132): Dharma is not only the
basis of the theory of the nature of mind, it is also a preventative medicine for
mental sickness. This points to an important difference in the Tibetan tradition,
in that religious or spiritual teachings and practices are not separated out from
the practice of medicine and healing (Tib. gso-ba rig-pa); rather, spirituality and
medicine are seen as intimately interconnected, and hence the patients spiritual
life and health cannot be separated. Spiritual practices related to cultivating emotional, cognitive, attentional and motivation balance are therefore understood as
the 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 both
gross levels and on the subtlest of levels, explains the care with which Tibetan
physicians consider the role of the mind on health and with which they approach
the question of the mental states of their patients. In an interview with the
authors, Dr Pema Dorjee related:
For example, I can give you pills like this. I just pack them and say, This is for you (leans
back in his chair and throws a bag of pills casually onto the table between us). Immediately
youll have the thought How rude Dr Dorjee is to give it to me in this way. If instead, I hand
it to you nicely and say, Here are some instructions (offers the bag of pills, holding it in both

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 109
hands, leaning forward), immediately youll think, How kind Dr Dorjee is. I would like to
come see him again. So my actions of body, mind and speech affect your mind. They give
your 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 important. (2007)

In another interview, Dr Tsering Namgyal independently mentioned the importance of speaking gently and lovingly to patients, using a very similar example
(Namgyal, 2009). Both Tibetan doctors mentioned that, in some cases, the kindness
that the physician shows the patient can even by itself cure the patient of whatever
is 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 physicians primary responsibility is to treat the body, and his or her actions on the
patients mental states, while certainly recognized to be of importance by many
physicians who treat patients, are of lesser or secondary significance. Yet in the
Tibetan medical system, which recognizes the minds ability to affect the body,
the physician becomes responsible not only for treating the patients body and
influencing it positively (through medication and other treatments) but also for
treating the patients mind by having a positive influence on the patient. Tibetan
doctors call this blo-gso, or healing the mind, and see it as a critical component
of patient interaction and patient care. Blo-gso involves showing kindness, compassion and general friendliness to the patient, as well as giving advice that can
help the patient to achieve a calm and healthy mind, which is especially important for patients suffering from rlung disorders, since these disorders are especially connected with mental disturbances. Often this advice is in the form of,
or based on, Buddhist teachings. Thus the emphasis in Tibetan medicine that
physicians must cultivate genuine compassion and empathy for the patients
appears to be not only a moral injunction but also a logical part of the systems
general understanding of health, which encompasses the role of the physician/
patient relationship (Nyima Rinpoche and Schlim, 2006). Moreover, compassion
is important both for the physician and the patient. When asked by the authors
whether he might ever advise a patient to cultivate compassion, and whether cultivating compassion would help a patient recover, Dr Namgyal stated:
Yes. . . . Our medicine says that there are three poisons in our body: ignorance, [attachment
and aversion]. If we get rid of all three of them, we are really a healthy person, with no cause
for disease in our body. When the three poisons remain in our body, the cause of disease is
still in our body. How is disease created? It is due to external conditions: diet, lifestyle and
other things they create disease. But really . . . we say that the cause of disease doesnt come
from outside it exists in our body, but due to [external] conditions, these aggravate it and
create disease. So compassion and love they are the opposite of the three poisons; they are

110 & Body & Society Vol. 17 No. 1


the antidote. So, if you gain or cultivate a lot of compassion and love in yourself, then the
three 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 tension, no [problems whatsoever].

The importance placed on the way Tibetan medical doctors interact with their
patients (a recurring theme in the Four Tantras) calls to mind Csordas work
on somatic modes of attention, which he defines as culturally elaborated ways
of attending to and with ones body in surroundings that include the embodied
presence of others (2002: 244). From a Tibetan medical perspective, a medical
gaze that rendered the patient a mere object (a body, or even a mind) to be analyzed and treated (Foucault, 1975; Turner, 1987, 1992) would be medically counterproductive. Instead of a gaze there must be a warm, humanizing regard (in
both senses: attending to and esteeming).
This notion is not, of course, absent in biomedical practice. Based on an indepth ethnography of the everyday practice of medicine, Mol (2002) shows that
doctors view and relate to their patients as whole persons, and not merely
objects or cases of disease in the hospital. Furthermore, the importance of empathy among medical professionals and in the patient/physician relationship has
been receiving increasing attention in recent years (Charon, 2001; Larson,
2005; Norfolk et al., 2007; Pembroke, 2007). Charon, for example, proposes the
concept of narrative medicine (which she contrasts with logicoscientific
knowledge) as a new frame for clinical work that will give physicians and surgeons the skills, methods, and texts to learn how to imbue the facts and objects of
health and illness with their consequences and meanings for individual patients
and physicians (2001: 1898). Charons recommendation for physicians to engage
more in the practice of listening to their patients is an interesting parallel to Tibetan medical practice, where the art of questioning the patient is considered
central to proper diagnosis, alongside the other two techniques of tactile (including pulse-reading) and visual (including urinalysis) examination. Charon speculates that physicians skilled in narrative medicine may be able to achieve more
effective treatment than those unskilled in this frame; however, she does not provide any theoretical explanation for why this might be the case. Like Charons
suggestion 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 the
patient/physician relationship, and Larson (2005) argues that the cultivation of
empathy by physicians can be seen as emotional labor, as conceived of in
Hochschilds (1983) classic study. Larson (2005: 1100) acknowledges, however,
that there are many obstacles to physicians ability to develop empathy, including little importance attached to empathy and cynicism.

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 111

Therefore, while there is increasing recognition of the importance of empathy


in the clinical practice of biomedicine, one difference between the two traditions
appears to be that in biomedical practice the role of non-physical factors, such as
feelings of empathy or compassion in the physician/patient relationship, lacks a theoretical account of any kind of mechanism that would make such practices central
in the application of healthcare. The most popular mechanism proposed, that of the
placebo effect, is a highly problematic notion in itself, as it is defined as the absence
of a mechanism (Harrington, 1997; Moerman, 2002). In Tibetan medical practice, it
is understood that the interdependence of mind and body means that the mind has a
role to play even in apparently physical ailments, and the body has a role to play
even in apparently psychological or psychiatric ailments. Therefore, healing the
mind of the patient and paying attention to the nature of the physician/patient relationship is an important part of all treatment and healing. Some have seen this itself
as a crucial aspect of Tibetan medicine (Bradley, 2003); moreover, Dr Dorjees comments, and our observations of his interaction with patients, indicate that this interdependence is not only theoretical, but is also reflected in physicians practice. It
even extends as far as statements that, for a minority of patients, and especially in
cases of rlung disorders associated with the mind, the compassionate attitude of the
physician may itself be enough to effect a cure.
The distinctive understanding of the relationship between body and mind
also affects the understanding of the personhood of the patient in Tibetan medical practice. As Dr Dorjee notes: Since body and mind are seen as a composite
whole in the Tibetan medical system, all manner of diagnosis and treatment takes
this into account (2005: 129). This is an interesting consideration from the perspective of medical anthropology. Pollock (1996), for example, argues for a consideration of the concept of personhood in the study of ethnomedicine, as
opposed to merely the reified concepts of the Body and the Self, which he sees
as closely connected to the mind/body dichotomy in American culture and medical thought, which makes illness something that the mind or the body has, rather
than the person. He writes:
The fundamental bifurcation of persons in American culture into bodies and minds surely
forms the cultural and historical ground for the parallel fundamental bifurcation of illnesses
into the physical and the mental, and of professional medical specialties into physical medicine and psychiatry/clinical psychology. Within each of these spheres of medicine, conceptions of illness as well as forms of practice tend to reflect and reproduce basic aspects of
American personhood. This point has been made in a slightly different form with regard
to American assumptions about the mental makeup of persons. Lutz, for example, has noted
that Americans posit an essential difference between emotion and thought, a cultural
assumption that is elevated to scientific salience as affect versus cognition (Lutz,
1988). (Pollock, 1996: 321)

112 & Body & Society Vol. 17 No. 1

Understandings of the mind and body and their interrelation are inevitably inextricable from understandings of personhood. As Kirmayer notes (1988: 81): The
moral dimension of medicine, then, is not something imposed by doctors on
patients, it arises from the cultural concept of the person. Given the current
Western concept of the person, some form of mind-body dualism is inescapable.
The Tibetan Buddhist and medical tradition presents an alternative understanding of the mind/body relationship predicated upon a unique understanding
of the human person that is non-dualistic in the sense that it does not admit the
standard dichotomies of physical vs mental illness, individual vs society, or affect
vs cognition. It is a medical tradition based on the concept of interdependence,
rather than on substantially real and separate entities, and it therefore presents
a relational understanding of personhood and health that places the individual
back into a situated environment and that places the cultivation of positive relationships (through compassion and empathy between patient and physician, for
example) at the heart of good health and good medical treatment. We must be
careful, however, in navigating the similarities and differences between Western
and Tibetan Buddhist thought, because they are neither simple nor straightforward. Buddhism is neither monistic, nor does it fail to recognize the existence
of distinct individuals. Rather, the alternative model it offers for mind/body and
self/environment interaction is based on the concept of interdependence and of
relational entailment.
Conclusion
What we call the mind/body problem may be, as Michael Lambek notes, but
one particular historical expression of what are universal existential conundra
rooted in the human capacity for self-reflection (1998: 106). In that case, it
would 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 great
potential to shed light on our own wrestling with the mind/body relationship
by providing comparative lenses through which unquestioned assumptions in
our own discourse may come to light. In this sense, the mind/body relationship
that emerges in both Tibetan medical practice and theory represents a genuine
and useful alternative to the strict, so-called Cartesian mind/body dualism that
has become such a problematic issue not only with regard to biomedicine but
also much of modern thought. It acknowledges mind/body dualism (mind is
understood as consciousness, and hence is subjective, experiencing and immaterial, whereas body is understood as physical and material) on coarser levels,

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

while also admitting an inseparability, and therefore a degree of unity, of mind


and body on subtler levels, thereby establishing a basis for a sophisticated theoretical account for the interactions and mutual influences of mind and body.
Mind and body are therefore neither the same nor entirely separate. Rather, they
are interdependent, and because the relationship between mind and body
depends on what level of subtlety one is dealing with, this relationship is
dynamic and complex.
The recognition of this interdependence emerges also in the dynamics of
physician/patient interaction, and affects the role of the physician. Religious
understandings of karma underpin the responsibility of the physician to the
patient, but the Tibetan scientific understanding of the mind/body dynamic
provides another logic regarding the importance of the physician exhibiting
compassion, empathy and encouragement to the patient as part and parcel of
actual treatment. The dynamics of mind/body interaction in Tibetan medicine,
therefore, orient Tibetan medical practitioners to focus on the patient as a person
irreducible to mind, body or specific illness. This affects the role of physician and
the actual physician/patient relationship by making central the importance of
compassion and empathy as crucial elements of effective healthcare in a way that
directly relates to difficulties currently facing biomedical theory and practice.6
The case of Tibetan medical practice reveals that the difficulty faced in biomedicine and Western thought is not merely the result of a legacy of thinking in
terms of mind/body dualism, but also the manner of the contemporary rejection
of that very dualism. This pendulum-like swing is not a real solution, and it fails
to deal with the problem of consciousness. Either position complete mind/
body dualism, or a complete rejection of mind/body dualism, i.e. monism is
an extreme position that leads to impossibilities and dead-ends in our thinking
about the mind and body. Tibetan medical practice shows that, contrary to contemporary Western beliefs, admitting that there is a difference between mind and
brain in no way necessitates the acceptance of a soul, the existence of God, or
any other theological or religious position. An investigation of the interdependence of body and mind will likely result in a much more complex, and more
satisfactory, understanding in this area. It also has the not insignificant potential of providing a humanizing influence in modern medicine, by providing a
theoretical basis for making the essential importance of compassion and empathy 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 beneficial role in the healing process. Importantly, this is understood not because
of the role of belief or a placebo effect in treatment; rather it is understood
through the mind/body connection. The fact that mind and body are always

114 & Body & Society Vol. 17 No. 1

interconnected and interdependent in any situation of health or disease therefore configures the physician/patient relationship along the lines of compassionate care, and mandates that the physician must treat the patient with
kindness, empathy and sincerity.
The anthropological study of selfhood in cross-cultural context can be
greatly benefited by concrete analyses of practices, especially practices that
throw into relief unquestioned assumptions about constructs such as body,
mind, and their interaction, which tend to be intimately related to questions
of the self. The case of Tibetan medical practice, we believe, offers one such
opportunity because it presents a subtler understanding of body and mind
than is currently found in much of biomedical and medical anthropological
discourse. By doing so, it presents a challenge and invites further comparative reflection that could prove extremely fruitful. Further systematic clinical
ethnographic work would be most beneficial in investigating the mind/body
relationship in Tibetan medical theory and practice and would complement
the general framework presented here.
Notes
1. Within the sub-field of the anthropological study of Tibetan medicine, much attention has been
paid to the important question of how Tibetan medical practice differs within the Tibetan Autonomous Region (TAR), the refugee communities in India, and in non-Tibetan societies in Europe and
North America. Audrey Prost (2006: 52) notes that:
While Tibetan medicine in the TAR is being transformed into a quasi secular, aspiringly scientific and lucrative enterprise, Tibetan doctors in exile are more cautious in secularising
their curriculum and practice. This may be explained by the fact that the Tibetan Government in Exile has invested the Men-Tsee-Khang with the mission of preserving traditional
medicine 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 are
prominent in the Tibetan exile community and closely affiliated with Men-Tsee-Khang and practicing
both in India and abroad. The close connections between Tibetan medicine and Buddhism analyzed in
this article would be less apparent in Tibetan medical practice in the TAR, although that does not
necessarily mean that they would be less relevant. We plan to extend this research by examining this
important comparative dimension.
2. This is not suppression of gross mental activity; the gradual subsiding of coarse thoughts and
increasing clarity and calmness of the mind that is achieved through prolonged mental training is
likened to the water of a thunderous waterfall that calms and becomes like a stream flowing, and then
calms even more to be like a vast ocean.
3. This dynamic nature of the body/mind relationship in India, for example, is briefly touched
upon by Cohen in a section of his book where he discusses the difference between the subtle body
that survives death to pass on to the next life, and the coarser, gross body that dies (1998: 213). Reflecting on this, he points out:

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 115
The frequent but ethnographically crude invocation of Cartesian/non-Cartesian distinctions
in medical anthropology viewing cultures as more or less dualistic in their construction of
body and mind must be sensitive to the dialogic constitution of the split self, to the danger
of equating mind (rather than body, or both) with identity, and, in particular, to the variable
possibility 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 west
Nepal. After recording clinical interactions with 153 patients visiting the clinic, he notes that none
of these patients used words, neither in Tibetan nor in Nepali, that related directly to their psychological condition (2006: 259).
5. As Clifford (1984: 131) writes:
This relationship between the three humors and the three primary mental defilements
expresses the basic psychosomatic theory of Tibetan medicine and psychiatry. Different
treatments and medicines are applied to influence the mind through the body. All this
implies 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 the
composition (in terms of elements, tastes, etc.) that is deficient in the disorder they remedy also echos the latest research findings the psychoactive drugs mimic the bodys
own neurochemistry.
6. We believe this connection between body/mind interaction and the physician/patient relationship provides a fuller explanation for the recurring themes of compassion and kindness that appear in
Tibetan medical writings and in the oral explanations of Tibetan medical doctors. In the section
explaining 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, the
Four Tantras lists as among the six prerequisites for being a Tibetan physician that of altruism, which
entails:
seeing [that the three realms are in the nature of] suffering, [having the wish to] benefit [sentient 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 [one
comes 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 be
affable to patients and please others (Clark, 1995: 227). The physician is enjoined to do everything
possible to contribute to the mental and physical strength of the patient, even to cultivate charisma and
renown 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 holistic
approaches and place care of the whole person at the center of their clinical and research agendas; the
field of nursing is one clear example.

References
Adams, Vincanne (1992) The Production of Self and Body in Sherpa-Tibetan Society, pp. 14989 in
M. Nichter (ed.) Anthropological Approaches to the Study of Ethnomedicine. Amsterdam: Gordon
and Breach Science Publishers.

116 & Body & Society Vol. 17 No. 1


Adams, Vincanne (2001) Tibetan Theorizing of Womens Health, pp. 22246 in L.H. Connor and G.
Samuel (eds) Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in
Asian Societies. Westport, CT: Bergin and Garvey.
Barsalou, Lawrence W., Paula W. Niedenthal, Aron K. Barbey and Jennifer A. Ruppert (2003) Social
Embodiment, pp. 4392 in Brian R. Ross (ed.) The Psychology of Learning and Motivation, vol.
43. San Diego, CA: Academic Press.
Biehl, Joao, Byron Good and Arthur Kleinman (2007) Introduction: Rethinking Subjectivity,
pp. 133 in Joao Biehl, Byron Good and Arthur Kleinman (eds) Subjectivity: Ethnographic
Investigations. Berkeley, CA: University of California Press.
Blackman, Lisa (2008) The Body: Key Concepts. Oxford: Berg.
Bradley, Tamdin Sither (2000) Principles of Tibetan Medicine. New York: HarperCollins.
Charon, Rita (2001) Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,
Journal of the American Medical Association 286(15): 1897902.
Clark, Andy (2008) Supersizing the Mind: Embodiment, Action and Cognitive Extension. Oxford:
Oxford University Press.
Clark, Andy and David J. Chalmers (1998) The Extended Mind, Analysis 58: 1023.
Clark, Barry (1995) The Quintessence Tantras of Tibetan Medicine. Ithaca, NY: Snow Lion
Publications.
Clifford, Terry (1984) Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. York
Beach, ME: Samuel Weiser.
Clore, Gerald L. and Andrew Ortony (2000) Cognition in Emotion: Always, Sometimes, or
Never?, pp. 2461 in L. Nadel, R. Lane and G.L. Ahern (eds) Cognitive Neuroscience of
Emotion. Oxford: Oxford University Press.
Cohen, Lawrence (1998) No Aging in India: Alzheimers, the Bad Family, and Other Modern Things.
Berkeley, CA: University of California Press.
Crick, Francis (1994) Astonishing Hypothesis: The Scientific Search for the Soul. New York: Scribner.
Csordas, Thomas (1985) Review of Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing by Terry Clifford, Medical Anthropology Quarterly 16(4): 1034.
Csordas, Thomas (2002) Body/Meaning/Healing. New York: Palgrave Macmillan.
Damasio, Antonio R. (2000a) Descartes Error: Emotion, Reason and the Human Brain. New York: Quill.
Damasio, Antonio R. (2000b) A Second Chance for Emotion, pp. 1223 in Richard D. Lane and
Lynn Nadel (eds) Cognitive Neuroscience of Emotion. Oxford: Oxford University Press.
Donden, Yeshi (1986) Health through Balance: An Introduction to Tibetan Medicine, trans. and edited
by Jeffrey Hopkins, co-trans. Lobsang Rabgay and Alan Wallace. Ithaca, NY: Snow Lion
Publications.
Dorjee, Pema (2004) Transcript from a workshop on Tibetan medicine given at the Drepung Loseling
Institute, 14 November, Atlanta, GA.
Dorjee, Pema (2005) The Spiritual Medicine of Tibet: Heal Your Spirit, Heal Yourself. London: Watkins Publishing.
Dorjee, Pema (2007) Ethnographic interview with the authors, 11 February, Atlanta, GA.
Falk, Pasi (1994) The Consuming Body. London: SAGE.
Featherstone, Mike, Mike Hepworth and Bryan S. Turner (eds) (1991) The Body: Social Process and
Cultural Theory. London: SAGE.
Foucault, Michel (1975) The Birth of the Clinic: An Archaeology of Medical Perception, trans. A.M.
Sheridan Smith. New York: Vintage Books.
Fraleigh, Sondra (2004) Dancing Identity: Metaphysics in Motion. Pittsburgh, PA: University of Pittsburgh Press.
Gethin, Rupert (1998) The Foundations of Buddhism. New York: Oxford University Press.
Goleman, Daniel (1995) Emotional Intelligence. New York: Bantam Books.

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 117
Goleman, Daniel (2003) Destructive Emotions. New York: Bantam Dell.
Goleman, Daniel (2006) Social Intelligence: The New Science of Human Relationships. New York:
Bantam Books.
Gyatso, Tenzin (the XIV Dalai Lama) (1995) The World of Tibetan Buddhism. Boston, MA: Wisdom.
Gyatso, Tenzin (the XIV Dalai Lama) (2002) How to Practice: The Way to a Meaningful Life. New
York: Pocket Books.
Gyatso, Tenzin (the XIV Dalai Lama) and Paul Ekman (2008) Emotional Awareness: Overcoming the
Obstacles to Psychological Balance and Compassion. New York: Times Books.
Harrington, Anne (ed.) (1997) The Placebo Effect: An Interdisciplinary Exploration. Cambridge, MA:
Harvard University Press.
Hochschild, Arlie Russell (1983) The Managed Heart: Commercialization of Human Feeling. Berkeley, CA: University of California Press.
Janes, Craig (1995) The Transformations of Tibetan Medicine, Medical Anthropology Quarterly 9(1):
639.
Janes, Craig (1999) Imagined Lives, Suffering, and the Work of Culture: The Embodied Discourses of
Conflict in Modern Tibet, Medical Anthropology Quarterly 13(4): 391412.
Janes, Craig (2001) Tibetan Medicine at the Crossroads: Radical Modernity and the Social Organization of Traditional Medicine in the Tibet Autonomous Region, China, pp. 197221 in Linda H.
Connor and Geoffrey Samuel (eds) Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies. Westport, CT: Bergin and Garvey.
Kirmayer, Laurence J. (1988) Mind and Body as Metaphors: Hidden Values in Biomedicine, pp. 57
93 in Margaret Lock and Deborah R. Gordon (eds) Biomedicine Examined. Dordrecht: Kluwer
Academic Publishers.
Kleinman, Arthur (2006) What Really Matters: Living a Moral Life Amidst Uncertainty and Danger.
Oxford: Oxford University Press.
Koch, Christof (2004) The Quest for Consciousness: A Neurobiological Approach. Denver, CO:
Roberts and Co.
Komatsu, Katsuko and Tsuneo Namba (2005a) Zoden Bukkyo to Iryo [Tibetan Buddhism and Medicine], pp. 12338 in Tsuneo Namba and Katsuko Komatsu (eds) Bukkyo Igaku no Michi wo
Saguru [Exploring the Path of Buddhist Medicine]. Osaka: Tohoshuppan.
Komatsu, Katsuko and Tsuneo Namba (2005b) Chibetto Igaku [Tibetan Medicine], pp. 13981 in
Tsuneo Namba and Katsuko Komatsu (eds) Bukkyo Igaku no Michi wo Saguru [Exploring the
Path of Buddhist Medicine]. Osaka: Tohoshuppan.
Lambek, Michael (1998) Body and Mind in Mind, Body and Mind in Body: Some Anthropological Interventions in a Long Conversation, in Michael Lambek and Andrew Strathern (eds) Bodies and Persons:
Comparative Perspectives from Africa and Melanesia. Cambridge: Cambridge University Press.
Lane, Richard D. and Lynn Nadel (2000) Cognitive Neuroscience of Emotion. Oxford: Oxford University Press.
Larson, Eric B. (2005) Clinical Empathy as Emotional Labor in the PatientPhysician Relationship, Journal of the American Medical Association 293: 11006.
Levi-Strauss, Claude (1963) Structural Anthropology. New York: Basic Books.
Levi-Strauss, Claude (1966) The Savage Mind. Chicago, IL: University of Chicago Press.
McHugh, Ernestine (2002) Contingent Selves: Love and Death in a Buddhist Society in Nepal, Cultural Anthropology 17(2): 21045.
Millard, Colin (2006) Tibetan Medicine and the Classification and Treatment of Mental Illness, pp.
24783 in Mona Schrempf (ed.) Soundings in Tibetan Medicine. Boston, MA: Leiden.
Moerman, Daniel (1979) Anthropology of Symbolic Healing, Current Anthropology 20(1): 5980.
Moerman, Daniel (2002) Meaning, Medicine, and the Placebo Effect. Cambridge: Cambridge University Press.

118 & Body & Society Vol. 17 No. 1


Mol, Annemarie (2002) The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke University Press.
Namgyal, Tsering (2009) Ethnographic interview with the authors, 6 June, Dharamsala, India.
Niedenthal, Paula, Lawrence W. Barsalou, Piotr Winkielman, Silvia Krauth-Gruber and Francois Ric
(2005) Embodiment in Attitudes, Social Perception, and Emotion, Personality and Social Psychology
Review 9(3): 184211.
Norfolk, Tim, Kamal Birdi and Deirdre Walsh (2007) The Role of Empathy in Establishing Rapport
in the Consultation: A New Model, Medical Education 41: 6907.
Nyima Rinpoche, Chokyi and David R. Schlim (2006) Medicine and Compassion: A Tibetan Lamas
Guidance for Caregivers. Somerville, MA: Wisdom Publications.
Ozawa-de Silva, Chikako (2002) Beyond the Body/Mind? Japanese Contemporary Thinkers on
Alternative Sociologies of the Body, Body & Society 8(2): 2138.
Ozawa-de Silva, Chikako (2007) Demystifying Japanese Therapy: An Analysis of Naikan and the
Ajase Complex through Buddhist Thought, Ethos 35(4): 41146.
Pembroke, Neil Francis (2007) Empathy, Emotion, and Ekstasis in the PatientPhysician Relationship, Journal of Religion and Health 46(2): 28797.
Pinker, Steven (1997) How the Mind Works. New York: W.W. Norton.
Pollock, Daniel (1996) Personhood and Illness among the Kulina, Medical Anthropology Quarterly
10(3): 31941.
Prost, Audrey (2006) Sa cha di ma phrod na . . . Displacement and Traditional Tibetan Medicine
Among Tibetan Refugees in India, pp. 4564 in Mona Schrempf (ed.) Soundings in Tibetan
Medicine. Boston, MA: Leiden.
Scheper-Hughes, Nancy and Margaret Lock (1987) The Mindful Body: A Prolegomenon to Future
Work in Medical Anthropology, Medical Anthropology Quarterly 1(1): 641.
Sheets-Johnston, Maxine (ed.) (1992) Giving the Body its Due. Albany, NY: State University of New
York Press.
Shilling, Chris (1993) The Body and Social Theory. London: SAGE.
Synnott, Anthony (1993) The Body Social: Symbolism, Self and Society. London: Routledge.
Takeuchi, Hiroshi (1995) Yakusha Atogaki [Translators Postscript], pp. 18694 in Tsewang Dolkar
Khanghar, Shoho no Chibetto Igaku [Introduction to Tibetan Medicine], trans. Hiroshi Takeuchi.
Osaka: Tohoshuppan.
Thompson, Evan (2007) Mind in Life: Biology, Phenomenology, and the Sciences of Mind. Cambridge,
MA: Belknap Press.
Thompson, Evan and Francisco J. Varela (2001) Radical Embodiment: Neural Dynamics and Consciousness, Trends in Cognitive Sciences 5(10): 41825.
Turner, Bryan S. (1984) The Body and Society: Explorations in Social Theory. Oxford: Basil Blackwell.
Turner, Bryan (1987) Medical Power and Social Knowledge. London: SAGE.
Turner, Bryan (1992) Regulating Bodies: Essays in Medical Sociology. London: Routledge.
Varela, Francisco J., Evan Thompson and Eleanor Rosch (1991) The Embodied Mind: Cognitive
Science and the Human Experience. Cambridge, MA: MIT Press.
Vargas, Ivette M. (2008) Tibetan Medicine Revisited in the West . . . , in Laurent Prodie (ed.) Tibetan
Medicine in the Contemporary World: Global Politics of Medical Knowledge and Practice.
London: Routledge.
Wallace, Alan B. (2006) Contemplative Science: Where Buddhism and Neuroscience Converge. New
York: Columbia University Press.
Chikako Ozawa-De Silva is an Associate Professor of Cultural Anthropology and Medical Anthropology at Emory University. She received her DPhil. in Social and Cultural Anthropology from
Oxford University in 2001. She was a Visiting Research Fellow at Harvards Department of Social

Mind/Body Theory and Practice in Tibetan Medicine and Buddhism & 119
Medicine, and a Post-doctoral Fellow at the University of Chicago. Her academic vision is to
contribute to cross-cultural understandings of health and illness, especially mental illness, and to make
a contribution to the field of medical anthropology by bringing Western and Asian (particularly
Japanese and Tibetan) perspectives on the mindbody, religion, medicine, therapy, and health and
illness into fruitful dialogue. [email: cozawad@emory.edu]

Brendan Richard Ozawa-de Silva received his DPhil. in Modern History from Oxford University in
2003. From 2004 to 2005 he was a Postdoctoral Fellow at Emory University and from 2005 to 2006 a
Visiting Professor of World Religions at the same university. Since 2006 he has served as Associate
Director for Buddhist Studies and Practice at Drepung Loseling Monastery in Atlanta, Georgia, and
as Program Coordinator for the EmoryTibet Partnership at Emory University. His research focuses
on the interdisciplinary study of contemplative practices, and he is currently pursuing a second
doctorate in Tibetan Buddhism and cognitive science. [email: bozawad@emory.edu]