This is a syndicated post that first appeared on Patheos.com.
In the current dialogue between Buddhist traditions and the sciences—an engagement dominated by Tibetan and Zen Buddhists on one side and psychologists and neuroscientists on the other—the subject of health is featured prominently. However, despite the shared term, participants aren’t actually talking about the same thing.
Early proponents of the Buddhism-science dialogue, like Paul Ekman, Richard Davidson, Matthieu Ricard, and Alan Wallace, have focused on the theme of psychological health. One prominent outcome of this dialogue has been the mindfulness movement, which has grown out of the clinical study of Buddhist-based meditation practices. Recently, Buddhist scholars such as Robert Sharf and Jared Lindhahl have pointed out the ways in which Buddhism and mindfulness diverge on meanings of health and well-being.
Definitions of health, as they enter into a field of knowledge, also participate within fields of power, with social and economic consequences. The gay and lesbian social movements, for example, had to fight to remove homosexuality as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, in order to gain the right to be recognized as healthy. It took another 16 years for the World Health Organization (WHO) to remove homosexuality from its International Classification of Diseases in 1990. Conversely, individuals may wish to receive the unhealthy label because of the rights gained from such recognition, especially in the case of gray area or borderline conditions such as migraines, fibromyalgia, or chronic fatigue syndrome.
The current focus is on an individualized health, where the burden is placed primarily on individual autonomy to strive for improvement and maintenance. The power structure of contemporary society shifts responsibility away from corporations that are responsible for pollution and government policy that allow them to get away with it (or pay for carbon offsets) towards individuals who bear the consequences. In other words, social ills are pathologized or medicalized as individual disease. Reflecting on these assumptions of health is a first step in changing these conditions.
The concept of health is by no means easy to pin down. But just as with the definition of religion, so notoriously elusive, tackling and constantly revisiting definitions of health may uncover the unexamined assumptions that mask its social power. Definitions delineate and set bounds, but that is not the end goal. The intent is not to arrive at a perfect, unchanging definition of health, but rather illuminate what it means to be healthy and why.
Scientific studies of Buddhist meditation and mindfulness practices examine how they can promote mental and somatic health. Clinical research on these practices have done the most studies on stress, anxiety, depression, hypertension, cardiovascular diseases, and substance abuse disorders. Looking for the philosophical foundation of health on which this body of research rests allows us to examine how the Buddhism and science dialogue does not have a consistent idea of health.
The first definition to consider is by the WHO, drafted in 1946 and still unchanged: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” WHO, it should be noted, bases its approach in the Western scientific model of medicine, as evidenced by their exclusion of all else as complementary/alternative medicine. And like its conception of medicine, WHO’s definition of health assumes a paradigm situated in Western modernity. This definition of health, however, has been criticized as being vague, idealistic, conflating health with happiness, and difficult to operationalize or measure. Since scientific research need physically measurable and operationalized definitions, this is not the likely foundational model. For example, Erika Rosenberg et al.’s 2015 study that shows how meditation impacts compassion could not simply claim subjects showed more sadness when viewing upsetting images. Rather, they had to record physical data from all 44 muscle groups on the face to make the case that the subjects were indeed sad. This emphasis on concrete data suggests that the WHO’s difficult-to-operationalized definition does not support these studies.
A more likely candidate for the philosophical foundation of such research is a negative formulation of health, which defines health as the absence of disease, in contradistinction to WHO’s positive formulation. Bjørn Hofmann argues there is no positive definition of health in the philosophy of Western medicine because the field can function without it. Christopher Boorse articulated a definition that accommodates scientific research: a biostatistical definition of health.
In his widely cited 1977 essay Health as a Theoretical Concept, Boorse gives the following definition: “health is normal functioning, where the normality is statistical and the functions biological.” For example, since the biological function of the heart is to pump blood, an individual is healthy if her heart is able to perform within a statistical range compared to her peers. Boorse champions the biostatistical definition of health as “value-free”, which he considers a benefit, based on his desire to provide an objective scientific definition. However, his view has been criticized as not truly value-free, and also has been opposed by those who argue for “value-laden” accounts of health and illness. Problems with taking this definition for granted include reifying a statistical norm, which excludes the differently abled, neuroatypical, and other underrepresented minority groups (statistical, and otherwise) as healthy.
It is important to note the lack of attention towards this term in the Buddhism and science dialogue, despite its common usage. The surface compatibilities between the two conceptions of health dissolve upon further investigation, which reveals deep incongruities. For example, the studies on how Buddhism-based meditation can alleviate anxiety and prevent depression relapse presume the latter are unhealthy mental conditions. The contemporary understanding of these states associate them with loss of value, hopelessness, despair, distress, shame, and anger. Sharf develops Gananath Obeyesekere’s observation that these states reflect a good Buddhist who has overcome ignorance and are signs of Buddhist mental health, defined as wisdom and insight into the predicament of samsaric reality: that to live is to suffer. Lindhahl questions if the way suffering is addressed in mindfulness-based interventions is the same as how Buddhism addresses suffering. He notes that there is no agreed upon operationalized definition of suffering in psychology. Rather, there are components such as stress, anxiety, and depression. And the resulting reduction of suffering for the purposes of mental health rests in large part on reduction of symptoms. In contrast, he argues Buddhist models of health explains the origin of suffering, and thus the way to reduce, alleviate, or overcome it towards health and well-being, is in relation to ignorance, craving, and karma.
The Buddha said that health (arogya, literally the absence of illness), is “the highest gain (labha).” He is portrayed in the canon as the “king of physicians” (vaidyaraja), concerned with healing sentient beings from physical illness and soteriological dis-ease. The Four Noble Truths have been compared to four stages of medical treatment: diagnosis (the truth of dukkha), etiology (cause of dukkha), prognosis (cessation of dukkha), and cure (path to cessation). Pierce Salguero (2014) provides the following summary:
From its very inception in northeastern India in the last centuries BCE, the Buddhist tradition has advocated a range of ideas and a repertoire of practices that are said to ensure health and well-being. Early Buddhism also provided devotees with certain types of rituals to comfort the sick and dying, ascetic meditations on the structure and function of the body, and monastic regulations on the administration and storage of medicines. Buddhist texts also frequently used metaphors and narrative tropes concerning disease, healing, and physicians in discourses explaining the most basic doctrinal positions of the Dharma. As Buddhism developed in subsequent centuries, a number of healing deities were added to the pantheon, monastic institutions became centers of medical learning, and healer monks became famed for their mastery of ritual and medicinal therapeutics.
The above examples reveal that although Buddhism is concerned with health, its models of health are difficult to reconcile with the paradigm of health assumed by most researchers in this dialogue, who are conducting studies on how meditation affects health and well-being. To elaborate, the Pali canon mentions demons, imbalance of the four elements, and tridosa (the “three defects” or “three disturbances”)—Wind, Bile, and Phlegm—as causes of physical disease and suffering. Mental illnesses are caused by illusions or wrong views (greed, ill will, pride). In addition, Buddhist conceptions of health are intricately tied to ethics and karma. Unethical conduct may lead to karma that causes physical illness.
Though Buddhist meditation has been researched as a means to lower blood pressure and stress, in early Chinese Buddhism, meditation was prescribed as an activity to get rid of negative karma. According to Zhiyi’s classification of the causes of illness, one etiological category was improper meditative practice. Some Chinese and Japanese Buddhists warned of meditation sickness (禪病 Ch. chánbìng, Jp. zenbyō). Willoughby Britton’s work on “The Varieties of Contemplative Experiences” highlights potential adverse effects of meditation in Buddhist and other contexts. Thus, while meditation is currently promoted for health, it can have the opposite effect.
Even if one is not interested in Buddhist soteriology, or Buddhist conceptions of karma (which entails rebirth and is not a psychologized karma of “secular” or “atheist” Buddhist interpretations), looking to Buddhist models of health is a step away from accepting the contemporary biostatistical model. It is an open question if and how much Buddhist models can influence the current model. Nevertheless, raising this topic is a first step if the dialogue between Buddhism and science wishes to learn from each other.
What does a society look like if it treats the Buddhist poisons of greed and hatred quite literally as causing mental illnesses? What happens if people are deemed unhealthy when such greed and hatred leads to a lack of meaningful relationships to other sentient beings and the environment? Should there be more attention towards social defects and imbalances as causes of disease? While Buddhist societies in the past will never live up to a romanticized ideal, the supposed goal of the dialogue is toward mutual understanding and improvement.
Rather than leaving the term health unexamined, investigating science and Buddhism’s convergences and divergences on health sheds light on the relationship between the two fields, which are not monolithic unchanging entities. There may be few psychologists today who, taking after Freud, consider religion in general as a neurosis, or like his student Franz Alexander, understand the Buddhist obsession with self-absorption as mental illness. Yet, some scientists—like biologist Richard Dawkins and neuroscientist Sam Harris, or other “militant/new atheists”—consider religion as a social ill. On the other side, there are Buddhists like Tsültrim Lodrö, a contemporary Tibetan Buddhist scholar and head of a monastic college who criticizes the sciences as less rational than Buddhism. To invert Alexander, it is not difficult to imagine Buddhists who see modern psychology’s obsession with ego-self-development as deluded mental illness.
Looking at health also clarifies the relationship between Buddhism and mindfulness. Touted as a panacea, mindfulness has been advocated as mental hygiene, one of the newest health fads. Critics of the Mindfulness movement question what sort of mental health the practice of nonjudgmental, present-centered awareness cultivates. To obviate the problems with an unreflective definition of health, elucidating this term will lead to new directions in healthcare and clinical research, and provide fodder for the dialogue. It will challenge what it means for individuals, communities, and societies to be healthy.
Boorse, Christopher. 1977. “Health as a Theoretical Concept” Philosophy of Science 44 (4): 542-573.
Rosenberg, Erika L., et al. 2015. “Intensive Meditation Training Influences Emotional Responses to Suffering.” Emotion 15 (6): 775–90.
Salguero, C. Pierce. 2014. “Buddhism & Medicine in East Asian History.” Religion Compass 8 (8): 239–50.