Cross-Cultural Advancements in Positive Psychology 5

Series Editor: Antonella Delle Fave

Antonio Morandi
A.N. Narayanan Nambi Editors

An Integrated View
of Health and
Well-being
Bridging Indian and Western Knowledge
An Integrated View of Health and Well-being
 Cross-Cultural Advancements in Positive Psychology
Volume 5
Series Editor:
ANTONELLA DELLE FAVE
Università degli studi di Milano, Italy
Editorial Board:
MARTIN E.P. SELIGMAN ALAN WATERMAN
Positive Psychology Center, University of The College of New Jersey, USA
Pennsylvania, USA ROBERT A. EMMONS
MIHALY CSIKSZENTMIHALYI University of California, Davis, USA
Quality of Life Research Center, Claremont
Graduate University, USA
BARBARA L. FREDRICKSON
University of North Carolina at Chapel Hill,
USA

The aim of the Cross Cultural Advancements in Positive Psychology book series is to spread a universal
and culture-fair perspective on good life promotion. The series will advance a deeper understanding of the
cross-cultural differences in well-being conceptualization. A deeper understanding can affect psychological
theories, interventions and social policies in various domains, from health to education, from work to
leisure. Books in the series will investigate such issues as enhanced mobility of people across nations,
ethnic conflicts and the challenges faced by traditional communities due to the pervasive spreading of
modernization trends. New instruments and models will be proposed to identify the crucial components
of well-being in the process of acculturation. This series will also explore dimensions and components of
happiness that are currently overlooked because happiness research is grounded in the Western tradition,
and these dimensions do not belong to the Western cultural frame of mind and values.

For further volumes:

http://www.springer.com/series/8420
Antonio Morandi • A.N. Narayanan Nambi
Editors

An Integrated View of Health

and Well-being
Bridging Indian and Western Knowledge
Editors
Antonio Morandi A.N. Narayanan Nambi
Ayurvedic Point SNA Oushadhasala Pvt. Ltd
Milano, Italy Thrissur, Kerala, India

ISSN 2210-5417 ISSN 2210-5425 (electronic)

ISBN 978-94-007-6688-4 ISBN 978-94-007-6689-1 (eBook)
DOI 10.1007/978-94-007-6689-1
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Introduction

Antonio Morandi and A.N. Narayanan Nambi

Health, health care, and well-being promotion are pillars of any human social system.
However, the social representations of the body, the mind, and their pathologies are
strongly influenced by cultural norms and beliefs. The culture of India is a melting
pot of diverse philosophical visions translated in practical terms. Historically, Indian
tradition comprises nine main philosophical systems, or Dharshana, which were
formalized between the tenth century BC and the fourth century AD. In spite of their
differences, these systems of thought pragmatically coexisted in the foundation and
building of Indian culture, sharing a common core that is the realization of the
self in the society. The traditional health system of India – Āyurveda – has been
elaborated and formalized throughout the centuries as a practical application of the
Dharshana to the observation of human nature and behavior.
Āyurveda conceptualizes health, disease, and well-being as multidimensional
aspects of life, bringing philosophical principles into practice. Its approach to health
is basically integrated: in order to attain an optimal adaptation, individuals should
preserve a balance at the biological and psychological level, as well at the level of
their interaction with environmental demands. This balance is dynamic, and it is
based on the interplay between the specific individual biopsychic constitution on the
one hand and the ceaseless solicitations derived from the natural and social context
on the other hand. The harmonization of individuals’ needs and growth tendencies
with the environmental requirements fosters health and well-being.
This approach is remarkably close to the conceptualization of well-being proposed
by the most recent advancements in psychology, in particular to the eudaemonic

A. Morandi ()
Ayurvedic Point, Milano, Italy
e-mail: [email protected]
A.N. Narayanan Nambi
SNA Oushadhasala Pvt. Ltd, Thrissur, Kerala, India
e-mail: [email protected]

v
vi Introduction

approach developed within positive psychology. Moreover, the basic tenets of

Āyurveda are deeply consistent with the latest acquisitions in modern physics, which
stresses the substantial interconnectedness among natural phenomena and their
substrates. Finally, the growing emphasis of Western medicine on the bio-psycho-
social dimensions of health and the increasing claim for an integrated approach to
the treatment of chronic and degenerative diseases make the exploration of synergies
and complementarities among different healing systems a necessary step. This book
shows how the approach to health developed in Āyurveda can be useful and fruitfully
integrated in a general, global model of health and well-being encompassing cultural
and ideological boundaries. In particular, the conceptualization of health as an optimal
and mindful interaction between individuals and their environment will be
discussed as the core of a new paradigm of healthy life and behavior.
The book is articulated into four parts. The reader will be guided in a conceptual
journey that, moving from the Western perspective, will cross the immense land of
Indian knowledge, reaching a crossroad where an integration of the two approaches
will be proposed. The classical Ayurvedic texts cited and referred to in the chapters
of the second part comprise three main works: Ćaraka Saṃhitā, Suśruta Saṃhitā,
and Aṣṭāṅga Hṛdaya. These treatises, which were composed between the seventh
century BC and the sixth century AD, are considered the pillars of Āyurveda teach-
ings and practice.

Part I: Health and Well-Being in the Western Tradition

Corey L. M. Keyes and Kate Cartwright open the book with “Well-Being in the
West: Hygieia Before and After the Demographic Transition” (Chap. 1), an overview
of the historical and social factors that led to the current Western conceptualization
of health and disease. The Western culture inherited from ancient Greeks a dual
view of health – as the absence of illness (the pathogenic view, Panacea) and as a
positive event referred to as well-being (the salutogenic view, Hygieia). The modifi-
cations in fertility-mortality ratios that occurred throughout time, and the associated
economic changes, generated a swinging cycle of pathogenic and salutogenic views
of health. The increased citizens’ expectations related to a longer life expectancy
favor a growing attention to the identification of the causes of disease. At the
same time, the phenomenon of population aging, with its burden of chronic and
age-related problems, orients researchers’ interest and governments’ investments
toward prevention practices and quality of life improvement. Western society is in fact
facing the inappropriateness of the Panacea, disease-focused approach. Moreover,
the steadily increasing costs of health care make the switch to the salutogenic
approach mandatory. These considerations point to a broader conceptualization of
health, encompassing social and economic factors, as well as psychological dimen-
sions and their interplay with physical health.
Nicoletta Sonino and Giovanni A. Fava in “The Psychosomatic View” (Chap. 2)
describe one of the most rigorous approaches developed in the West to promote
the salutogenic view of health. Psychosomatic medicine takes into account the
Introduction vii

multifactorial determinants of health, with the aim to integrate psychological

dimension in the clinical practice. It considers the patient from a bio-psycho-social
point of view, emphasizing the importance of lifestyle and psychological balance
for a healthy living. Noteworthy, its conceptual framework represents an important
point of convergence between the Western and the Eastern medical approaches.

Part II: Health and Well-Being in Indian Traditions

Kiran Kumar K. Salagame in “The Perspectives on Reality in Indian Traditions and

Their Implications for Health and Well-Being” (Chap. 3) analyzes the differences
between the Western and Indian perspectives of reality and their influence on
the vision of health and disease in the two cultures. He also points to the changes
undergoing in the Western reductionistic view that is moving from a biomedical
disease-centered model toward a different conceptualization of health and well-being.
In this context the Indian system of knowledge and representation of reality is pro-
posed as a paradigm endorsing a holistic view of human nature and thus supporting
the adoption of intervention strategies aimed at pursuing prevention and optimal
health and well-being, rather than disease treatment. Among the health-related
knowledge systems of India, Āyurveda, the ancient traditional medicine, is the most
codified and representative, and its model of health is consistent with the paradigm
described by K.K.K. Salagame.
Ram Manohar in “Concept of Health in Āyurveda” (Chap. 4) discusses the
Ayurvedic vision of health as the integration of body, mind, and spirit, whose
interplay defines the individual’s interaction with the environment and its changes.
Processes such as psycho-spiritual growth and awareness are fundamental to establish
individual and social health and well-being.
The conceptualization of health and disease that characterizes Āyurveda is
further discussed by A.N. Narayanan Nambi in “Determinants of Health and
Well-Being in Āyurveda” (Chap. 5). This chapter analyzes the “bodies” identified
by Āyurveda – gross, mental, and subtle – and their interrelationships, from which
the experience of life, health, and well-being derive. The chapter emphasizes the
inherent interconnectedness between macrocosm and microcosm, humans and
environment, and the role of individual awareness and behavior in the fine-tuned
regulation of this interaction. In this view, mental and behavioral adequacy represents
the inner determinants of health and well-being.
The phenomenon of rituals in Indian culture and their relationship with health is
analyzed by P.R. Krishna Kumar in “The Role of Social Rituals in Well-Being”
(Chap. 6). Community rituals contribute to social well-being as behaviors that carry
information useful to maintain the correct relationship of each individual with the
environment and with other members of the community. The order principle under-
lying these relations in their ideal structure is the core of the concept of dharma.
Warning is also made to the risk of fixation and rigidity of rituals, which makes
them not only ineffective but also detrimental to the regulation of human actions and
transactions.
viii Introduction

A further analysis of health-related traditional values and customs is conducted

by Unnikrishnan Payyappallimana in “Health and Well-Being in Indian Local
Health Traditions” (Chap. 7). He analyzes the amazing diversity and plurality
of knowledge systems and traditions originated from the likewise mottled set of
ecosystems and human activities that characterize the Indian subcontinent, with
specific attention to health systems. The coexistence and deep interplay of oral
and codified knowledge have generated deeply rooted and sophisticated cultural
practices, in particular with regard to health. Attention is paid to the links and to
the shared elements of and codified health systems across diverse communities in
Southern India.

Part III: Bridging the Worlds

Western scientific research conducted in the last few decades brought about new
insights and models in the conceptualization of living systems and their functioning.
The attempt to integrate in the scientific domain psychological, social, and spiritual
dimensions is supported by concepts such as indetermination and interconnectedness,
which are not necessarily legitimated by sensory perception.
Rama Jayasundar in “Quantum Logic in Āyurveda” (Chap. 8) reviews the parallels
existing between the model of reality proposed by quantum physics and the Vedic
knowledge and highlights the potential of Āyurveda to integrate their common
elements in a shared view. The basic common element of the two models is the
ontological unity and interconnectedness of everything in the universe. The individual
is an indivisible network of relationships continuously promoting information
exchange within and without the body at different levels, including mind and con-
sciousness, which play a central role in maintaining the balance of the system.
The balance or the unbalance of these relationships defines the state or level of
health. The important contribution of the chapter is represented by the suggestion
that through Āyurveda it is possible to put into practice the common principles
underlying both quantum physics and Vedic logic.
The importance of individual agency and responsibility in health management
is specifically stressed by Antonella Delle Fave in “The Psychological Roots of
Health Promotion” (Chap. 9). The chapter examines the psychological dimensions
of health as identified within the framework of the Western bio-psycho-social
model, drawing parallels and highlighting connections with the Āyurveda’s
model of health, which similarly stresses the primacy of psychological variables
on physical ones in health management. While acknowledging cultural differences,
a substantial convergence is shown between the bio-psycho-social model and
Āyurveda, with particular regard to the pivotal role of individuals as main agents
and determinants of their own health.
Nevertheless, a further integration of the two systems would be welcome,
especially considering the potential contribution of Āyurveda in promoting an
active and aware prevention based on the articulated conceptual framework of
Introduction ix

interconnectedness. In order to pursue this integration, deeper levels of analysis

are needed with the aim of identifying the fundamental principles and logic shared
by the two systems. However, from the Western perspective, little is still understood
of the reality framework described in Āyurveda. Its inclusive logic is not easily
understandable according to Western scientific principles. To fill this gap and to
infer a possible, integrated definition of health, Antonio Morandi and Antonella Delle
Fave propose an original approach in their chapter “The Emergence of Health in
Complex Adaptive Systems: A Common Ground for Āyurveda and Western Science”
(Chap. 10). After an overview of the complex system logical framework, they
discuss the inclusive logic underpinning Āyurveda and its model of reality, exemplified
through a thorough description of the living beings’ components. These authors
suggest the convergence of the Western and Indian perspectives in the view of
individuals as complex adaptive systems, and of health as a phenomenon emerging
from their dynamic bio-psycho-social balance. The theoretical and practical impli-
cations of this approach pave the way to a unified and integrated vision of health,
overcoming the boundaries between disciplines and cultures.
Contents

Part I Health and Well-Being in the Western Tradition

1 Well-Being in the West: Hygieia Before and After

the Demographic Transition .................................................................. 3
Corey L.M. Keyes and Kate Cartwright
2 The Psychosomatic View ........................................................................ 25
Nicoletta Sonino and Giovanni A. Fava

Part II Health and Well-Being in Indian Traditions

3 The Perspectives on Reality in Indian Traditions

and Their Implications for Health and Well-Being ............................. 39
Kiran Kumar K. Salagame
4 Concept of Health in Āyurveda ............................................................. 59
P. Ram Manohar
5 Determinants of Health and Well-Being in Āyurveda ......................... 69
A.N. Narayanan Nambi
6 The Role of Social Rituals in Well-Being .............................................. 83
P.R. Krishna Kumar
7 Health and Well-being in Indian Local Health Traditions.................. 99
Unnikrishnan Payyappallimana

Part III Bridging the Worlds

8 Quantum Logic in Āyurveda ................................................................. 115

Rama Jayasundar
9 The Psychological Roots of Health Promotion ..................................... 141
Antonella Delle Fave
xi
xii Contents

10 The Emergence of Health in Complex Adaptive Systems:

A Common Ground for Āyurveda and Western Science .................... 163
Antonio Morandi and Antonella Delle Fave

Conclusions

11 Joining Knowledge Traditions: Towards an Integrated

Approach to Health and Well-Being ..................................................... 189
Antonio Morandi, A.N. Narayanan Nambi,
and Antonella Delle Fave

Index ................................................................................................................. 197

 Part I
Health and Well-Being
in the Western Tradition
Chapter 1
Well-Being in the West: Hygieia Before
and After the Demographic Transition

Corey L.M. Keyes and Kate Cartwright

1.1 Introduction

The Greek physicians and philosophers have been the inspiration for much of the
thinking and approaches to health and illness in the modern world. Hart’s (1965)
classic article ascribes the origin myth of modern medicine to the cult of Asclepius,
a deity in ancient Greece who is known as the father of medicine. As the story goes,
Asclepius gave birth to several daughters, two of whom represented the distinct but
complementary branches of medicine. The daughter named Panacea represented
the branch of medicine that focused on the remediation of illness, while the other
daughter named Hygieia represented the branch of medicine devoted to the promo-
tion of good health. To this day, the staff of Asclepius represents the symbol of
medicine, the snake that winds itself around the staff represents good health (i.e.,
Hygieia, because the snake regularly sheds its skin in the process of reestablishing
its health), and the Hippocratic oath taken by all new medical doctors swears allegiance
to Asclepius and to both branches of medicine—panacea and hygieia (see Hart 1965).
In short, we in the West inherited a view of health from the ancient Greeks as being
more than the absence of illness. However, until very recently, health as something
positive, or what we will refer to as “well-being,” has not been central to any discussion
of medical practice or to population health. In practice, most Western approaches to
health have focused almost exclusively on understanding pathogenesis, or the origin
and cause of illness or disease. The dominant view of health in the West is that health
is the absence of disease and illness. This view of health has not gone unchallenged,
but this challenge began only recently in the twentieth century as a result of the rise
of research on well-being that reflected the need to recover the hygienic perspective
rooted in the myth of Asclepius that health is the presence of positive qualities
and capacities.

C.L.M. Keyes () • K. Cartwright

Department of Sociology, Emory University, Atlanta, GA, USA
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 3
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_1,
© Springer Science+Business Media Dordrecht 2013
4 C.L.M. Keyes and K. Cartwright

The scientific study of well-being arose during the last third of the twentieth
century in the USA and has blossomed since then and brought increased attention
for the need to engage in promotion of good health in the population. In this chapter,
we will argue that the fall of hygieia occurs during the initial stage of the demo-
graphic transition in nations, when economic development hastens and then sets off
a sequence of changes called the demographic transition (Omran 1971) that results
in an increased population and life expectancy. The changes begin with the reduction
of deaths in the population that occurs while fertility rates remain high for a prolonged
period. During this period, the population of a nation increases, often dramatically.
In the wake of the population growth, changes occur in education and contraception
that usher in a reduction in rates of fertility in the population.
During this time when mortality declines and, later, fertility declines, the causes
of disease and death are also transformed from acute and infectious conditions to
chronic and preventable conditions. The result is increased pressure on the eco-
nomic development of a nation due to a larger population, an aging population that
is also living longer but often with chronic conditions that, though preventable, are
now managed through expensive medical systems which were originally designed
to deal not with chronic illness but with acute conditions (further discussion of these
topics can be found in Chaps. 9 and 10 of this volume). Early in the stage of the transi-
tion, medicalization, we argue, shifts away from the “art” of well-being or positive
health (i.e., away from Hygieia) and moves toward a strict scientific focus on patho-
genesis and illness (i.e., the rise of panacea). As the later stage of this transition, the
changes in life expectancy, causes of illness and death, and the aging of the popula-
tion place pressure on the economic system of a country that requires, we argue, a
return in focus on hygienic or well-being promoting activities that prevent chronic
conditions and physical and mental illness.

1.2 The Rise of Panacea and Demise of Hygieia

1.2.1 Rapid Industrialization and Urbanization

of Europe and the USA

Although the majority of disease reduction in the modern Western world is attribut-
able to advancements relating to hygieia (i.e., prevention), principles and practices
of panacea dominate contemporary Western medicine. This section of the chapter
addresses the question of what led to the rise of panacea in Western medicine and
what implications does this emphasis have on the profession of medicine and its
outcomes. The eighteenth and nineteenth centuries were periods of revolution in the
Western world: political, scientific, industrial, communication, transportation, and
agricultural. Along with the rapid industrialization and urbanization of Europe
came waves of concentrated illness including cholera, smallpox, and tuberculosis.
Societies were faced with high mortality rates, higher for the urban poor, and these
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 5

illnesses and mortality rates yielded the development of public health and the
institutionalization of modern medicine (Porter 2002; Starr 1982; Weitz 2010).
Due to advancements in public health and structural changes, such as sewer
systems, water treatment systems and advancements in general hygiene, deaths
from infectious diseases decreased rapidly by the end of the nineteenth century.
This led to important changes in society. Primarily, families had fewer children, as
the probability that the children would live to adulthood was much greater and the
vocational shift from agriculture to industry decreased the need for large families.
Due to smaller family sizes, more resources were available to each member. More
resources and a decrease in infectious diseases led to greater life expectancy.
Progress in modern medicine led to the rationalization and bureaucratization that
continues to frame Western medicine today. Although evidence suggests that prin-
ciples of hygieia were primarily responsible for the reduction of these illnesses
(McKinlay and McKinlay 1977), the emergent zeitgeist called for treatments and
cures, leading to the rise of panacea as the dominant focus of Western medicine.
While there is more balance in the hygieia/panacea continuum in some nations, the
contemporary focus of Western medicine continues to be on panacea.

1.2.2 Rationalization and Bureaucratization of Medicine

The institutionalization of medicine in the Western world accompanied the rational-

ization and bureaucratization of medicine. Before institutionalization, medicine was
practiced in more individualized ways and in more private of spaces, like patients’
homes. By the mid-nineteenth century, the differentiation of medical spaces was
firmly established. Instead of a patient’s home being the primary site of medical
practice, there were a number of formally legitimated spaces for medicine: the
doctor’s office, medical universities, hospitals, morgues, and laboratories (Rothman
et al. 1995).
As medicine advanced and knowledge became more widely agreed upon and
widespread, what constituted good medicine became standardized. The nineteenth
century ushered in the rationalization of many societal institutions. Primarily, ratio-
nalization of medicine worked to organize principles and practices into a standard-
ized system and rationale based on scientifically derived guidelines. Bureaucratization
accompanied the continuing development of division of labor that gave different
workers specialized roles in a hierarchy intended to streamline a process and keep a
system accountable and reliable. Rationalization and bureaucratization in society
became prevalent as means to promote equality, in the spirit of developing democracy
and efficiency in societies that valued progress (Weber 1947). They also resulted in
the commodification of many services that had previously never been considered a
commodity. This shift affected Western medicine greatly.
Prior to the rationalization and bureaucratization of medicine, doctors largely
worked independently, and their work was viewed as a service. However, rational-
ization and bureaucratization led to society viewing medicine as a potential business
6 C.L.M. Keyes and K. Cartwright

and health as a commodity to be sold (Starr 1982). This further led to an emphasis
on panacea, as peddling a treatment or a cure fit into the paradigm of supply and
demand much better than the more abstract concepts of prevention, regardless of the
fact that prevention offered the most efficient and reliable practices and outcomes.
A treatment or a cure offers a tangible product for which individuals have a clear
demand. In order to build a market for this product, the places where medicine was
practiced changed and the process of medicine shifted. An emphasis on panacea
and the rationalization and bureaucratization of medicine led to the development of
medicalized spaces, such as hospitals and doctors’ offices, and the formalization of
the diagnostic process. Hospitals shifted from being primarily institutions for the
poor to centers of scientific advancement in medicine (Porter 2002). Along with the
development of hospitals came the rise of the nursing profession. The focus on
treatment was reliant on the ability to correctly diagnose an ailment, which created
a demand for more skilled diagnosticians and a more reliable diagnostic process.
The development of diagnostic medicine shifted Western medicine from a
patient-centered practice to a doctor-centered one. Instead of valuing and prioritizing
information provided by patients, doctors focused on their own medical examination
and prioritized information gleaned from this practice to determine the patient’s
condition (Numbers 2001). The emphasis on diagnosis made disease and not the
patient the subject of medical intervention. The practice of diagnosis combined with
a business model of medicine created the dynamic in which the question of what
is wrong with the patient became more important than why is something wrong.
The “what” question leads to a culture of treatment and cures, which promotes not
only the diagnostic field of medicine but also the business of pharmaceuticals.
This helps explain why diagnosis and the scientific method value cures over pre-
vention. As the work of a doctor stems from an ability to diagnose and treat illness,
the highest levels of status and prestige are given to doctors who can cure or treat the
most difficult and rare conditions, as opposed to emphasizing lifestyles that would
prevent common ailments. This is particularly true for the American medical culture.
The payment structure of many Western nations reaffirms these priorities, as it com-
pensates doctors and medical professionals for particular diagnoses and treatments at
a much greater rate than prevention. The development of diagnostic medicine led not
only to a more standardized practice of medicine but also to a standardized process
of medical training, leading to a more formal professionalization of the field.

1.2.3 The Professionalization of Medicine

The rise and development of the medical profession is central to the current focus of
treatment and cures dominating contemporary Western medicine. Medical educa-
tion developed in the eighteenth century, which led to the establishment of medical
schools throughout the Western world. Formal education helped to legitimize the
field of medicine and practitioners such as physicians, surgeons, and pharmacists
became licensed. Along with professionalization of the field came prestige. Society
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 7

began to revere medical professionals instead of treating them with suspicion

(Numbers 2001). The job of healing shifted from being widely spread among
different entities to being carefully controlled. While these professions rose in
prestige, other healing professions, such as religious healers, herbalists, and mid-
wifes, became delegitimized, and formal steps were put in place to prevent these
non-authorized healers from practicing medicine. Western nations passed acts
that regulated the licensure of medical professionals, such as the 1858 British
Medical Act (Starr 1982). As a result of the rationalization of medicine, medical
associations were formed in the nineteenth century that authorized and monitored
medical professionals.
The legitimation of the medical field and the professionalization of medicine
highlighted the inequality of status and knowledge between doctor and patient,
which continues to influence contemporary dynamics. With the rising authority of
medicine, previously “normal” conditions, such as birth, many life events (including
menopause), and death become medicalized. Instead of being considered as expected
events for which most people’s bodies are prepared and which primarily could take
place in one’s home, these conditions came to require hospital stays and bureaucratic
procedures that made life more convenient for doctors as opposed to being medically
necessary. Childbirth practices in the United States are a good example of a common
condition that has become over-medicalized. The United States has the highest rate
of caesarean section births, reaching 32.3 % in 2008 (Martin et al. 2010). While the
increase in this rate is in part related to an increase in higher risk births (including
births to older women, women with obesity and diabetes issues, and an increase in
multiples due to fertility treatments), other nonclinical factors including maternal
choice, physician scheduling, and medico-legal pressures are large contributing forces
behind this trend (Martin et al. 2010). This is an expected result of a rationalized and
highly bureaucratic society that transforms a process, which was intended to make a
procedure safer, more efficient, and more egalitarian, into a procedure for procedure’s
sake. While this practice may be more efficient and predictable, especially for
doctors on tight schedules, statistics show that it is not safer for mother or child and
it is not being practiced in an egalitarian manner. Mothers have a greater risk of
post-pregnancy complications after a caesarean section; infants are more frequently
born preterm, thus being exposed to a greater risk for a variety of short-term and
long-term health challenges. Experts are so concerned about this practice in the
United States that a number of investigations have been conducted and goals for
decreasing the caesarean rate have been set. Caesarean section births have risen in all
Western nations in the past 30 years, but while some nations have higher rates than
the United States (also Italy and Australia), many other Western nations with more
collective health-care systems and systems focused more directly on outcomes have
much lower rates (the United Kingdom, Norway, and Sweden). The privatization of
medicine in the United States seems to have directly contributed to an increase in the
over-medicalization of the practice of childbirth.
Another contributor to the rise in medicalization of conditions is Western medicine’s
focus on specialists (Starr 1982). Along with the professionalization and progress
of medical fields came a division of labor that separated general practitioners
8 C.L.M. Keyes and K. Cartwright

from specialists. On average, specialists are regarded with higher prestige and are
compensated at greater rates, even though many of them treat conditions that afflict
a small percentage of the population. Of course, it is a testament to the amazing
capabilities of modern medicine that specialists are able to perform highly complex
interventions such as brain surgery, organ transplants, and treatment of difficult
forms of cancer. However, the focus on specializations in Western medicine raises
the prestige of medical doctors who can perform the most complicated and dangerous
procedures and diminishes the role of the general practitioner who has the ability to
affect the most people and prevent the most disease. This is both a product of and a
reification of Western medicine’s focus on panacea as opposed to hygieia.

1.2.4 The Rise and Role of Pharmaceuticals

If the nineteenth century established the superiority and authority of the doctor, the
twentieth century marked the legitimization of the pharmaceutical industry. While
the pharmaceutical profession had been growing, the potential for pharmaceuticals
to dominate the market was not fully realized until the twentieth century. Of course,
panaceas were peddled throughout the development of Western medicine, but only
after the epidemiological transition from infectious disease to chronic disease
pharmaceuticals became a part of everyday life (Weitz 2010). As infectious diseases
waned, chronic pathologies such as hypertension, diabetes, and heart disease grew.
These diseases could not be cured (although they could be prevented with lifestyle
changes), but through the development of drugs, they could be managed. The phar-
maceutical industry experienced the same rationalization and bureaucratization as
the rest of Western medicine, and the majority of national drug administrations
came into existence in the early twentieth century.
The US Food and Drug Administration (FDA) was founded in 1906, and this led
to many positive outcomes in regard to quality regulation of drugs and accountability
of the pharmaceutical industry. The development of the pharmaceutical industry
also differentiated types of drugs (prescription, generic, vitamins, food supplements,
homeopathic medicines) and created a market for advertising. To some degree,
marketing influences all of Western medicine (as also highlighted in Chap. 3 of this
volume). This is particularly true of the United States, where direct-to-patient
consumer advertising of pharmaceuticals is allowed, but also where the most
powerful marketing industries are settled. This affects the doctor-patient relation-
ship, as the patient is more likely to come in requesting information and perhaps
prescriptions for certain drugs.

1.2.5 The Social Meaning of Illness

In addition to scientific advances in medicine, social and cultural values play an

important role in the principles and practice of Western medicine. The range of
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 9

theories and practices employed by physicians is scientifically based and motivated,

but it is embedded within evolving cultures and values. In order to best understand
Western medicine, it is important to understand the social construction of disease
in Western societies. In this context, the medical model of illness stems from the
scientific method, where disease is determined by conditions that deviate from
the norms of health and is caused by unique biological forces. Definitions and
classifications of disease and conditions come from and are treated through an
unbiased scientific process (Weitz 2010). Throughout the history of Western medi-
cine, however, values, politics, and other social forces have influenced conceptions
of the nature of disease, of health, and of medicine.
The sociological perspective incorporates those social forces into the discussion
of what medicine is, acknowledging that illness is socially constructed and that it
exists because society has made it so. In addition to our discussion of childbirth
and pharmaceutically led disease mongering, another good example of this is the
journey of homosexuality. In the nineteenth century, homosexuality was medical-
ized as well as pathologized as a mental illness. This classification was fraught with
value judgments and was not based on evidence from an “unbiased scientific
process”. It was given even more authority when it was included in the Diagnostic
and Statistical Manual (DSM) of mental disorders in 1952. However, as values and
culture shifted, homosexuality experienced a de-medicalization and de-pathologi-
zation, and it was removed from the DSM in 1974. The case of homosexuality
shows that diagnosis is not an objective, neutral, scientific process, but in fact is
influenced by a variety of social forces. Social forces are also evident in the disparities
of diagnoses. Frequently patients with the same symptoms receive different diagno-
ses and differential treatment based not on comorbidities or scientific risk factors
but on factors such as race, gender, and class. Nations with nationalized health
care run lower risks of differential treatment based on financial resources, although
these systems are not immune to class bias in treatment either. For example, health-
care providers are products of their particular social situations, and these situations
bias the way in which doctors perform medicine. This makes the focus on panacea
in Western medicine even more problematic, because biases and social forces lead
to a disparity in treatment for different social groups and the panaceas produced are
unequally available. Means of mediating these biases include the adoption of
nationalized health-care systems, diagnostic audits of doctors, and studies of health
disparities in a society. Another way to prevent disparity in treatment of disease is
to shift from a focus on panacea to hygieia and prevent the conditions that need
treatment in the first place.

1.3 Return of Hygieia and Well-Being in the West

The rise of panacea corresponds to a focus on the quantity of life, because most
research on pathogenesis represent an attempt to reduce the leading, and more
proximal, causes of premature death. That is, extended life expectancy is among the
10 C.L.M. Keyes and K. Cartwright

leading goals during the rise of panacea. However, the return of Hygieia, which
includes a return to well-being, represents a shift toward the goal to increase the
quality of life.
The quality of an individual’s life can be assessed externally and objectively or
internally and subjectively. From an objective standpoint, other people measure and
judge another’s life according to criteria such as wealth or income, educational attain-
ment, occupational prestige, and health status or longevity. Nations, communities,
or individuals who are wealthier, have more education, and live longer are considered
to have higher quality of life or personal well-being. The subjective standpoint
emerged during the 1950s as an important alternative to the objective approach
to measuring individual’s well-being. Subjectively, individuals evaluate their own
lives after reviewing, summing, and weighing their substance. In short, subjective
well-being is an evaluation or declaration that individuals make about the quality of
their lives (Diener et al. 1999; Keyes et al. 2002).
Well-being has been a paramount concern of thinkers since ancient times, as
witnessed in much of Greek philosophical writings on the nature and pursuit of
happiness or the good life. Subjective well-being became a topic of scientific
inquiry during the 1950s when interest in fostering a better life was facilitated by the
Zeitgeist following World War II. The world’s recovery from the manifold
devastation—physical, psychological, social, and moral—of the war encouraged
commitment to social welfare, greater attention to the diversity of people and
viewpoints, and greater appreciation of the individual. This atmosphere manifested
itself in philosophical (e.g., phenomenology and existentialism), sociological (e.g.,
symbolic interactionism), and psychological (e.g., cognitive psychology and later
the focus on emotions) movements that focused on the centrality of the individual’s
perceptions and viewpoints and the importance of personal meaning and concerns
about life.
Subjective well-being therefore emerged as a scientific field in the late 1950s,
when social scientists developed indicators of quality of life to monitor social change
and to improve social policy (Land 1975) as well as pursue a more humanistic
scientific agenda. Humanistic writings emphasized several concerns and constructs
that buttressed the study of subjective well-being. In reaction to the negative por-
trayal of human nature and potential in orthodox psychoanalysis, humanistic scholars
catalogued the individual’s capacity for successful adjustment through the devel-
opment of positive characteristics such as maturity, ego-strength, generativity,
and virtues (see e.g., Erik Erikson’s writings) (Erikson 1950, 1959). In reaction to
the hegemony of behaviorism’s focus on only observable behavior as data, humanistic
writers lauded introspection and subjective appraisal as meaningful data. Humanistic
social scientists sought to understand whole lives by investigating how individuals
felt about their own lives. This strand of humanism was exemplified in the methods
of many personality psychologists, notably Gordon Allport (cited in Severin 1965),
who declared that
It is not enough to know how man reacts: we must know how he feels, how he sees his
world, … why he lives, what he fears, for what he would be willing to die. Such questions
of existence must be put to man directly. (p. 42)
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 11

In other words, introspection and self-reports on one’ own feelings and outlook
were once again important and legitimate sources of scientific data.
During this same historical period, the US Congress passed the “Mental Health
Act” that earmarked future funds for the creation of a “National Institute of Mental
Health” (NIMH), which was slated to come into being in 1949. The joint commission
on mental health and illness, which served as the advisory board for the creation of
the future NIMH, contained the intellectual seeds of the two dominant streams of
research on subjective well-being today. This commission, chaired and dominated
by psychiatrists, requested several reports ranging from the state of mental health
services to epidemiology of mental health and illness. Though clearly in the minority,
several Ph.D.s, including M. Brewster Smith (1959), were responsible for publishing
two separate reports on mental health, both of which reported on the status of theory
and research on subjective well-being.
The first publication was Marie Jahoda’s (1958) seminal volume on positive
mental health. This volume reviewed the personality and clinical psychology literatures
regarding dimensions of psychological well-being (e.g., purpose in life, personal
growth, and self-acceptance) that reflected aspects of eudaimonic stream of subjec-
tive well-being. The second volume, in terms of its publication, was Gurin et al.
(1960) book on the state of American’s mental health. It featured the hedonic stream
of subjective well-being with its focus on individuals’ assessments of their satis-
faction and happiness with life, overall and in specific domains of life (e.g., work
and family).
Notwithstanding this focus on subjective well-being and not only mental illness,
the Mental Health Act of 1946 gave way in title only to the National Institute
of Mental Health. In practice and programs, the NIMH remains committed to
the promotion of America’s mental health through the study of the etiology and
treatment of mental illness. Although subjective well-being did not become part of
this nation’s mental health agenda, the impetus to launch the NIMH may have
responsible for planting the seeds of the study of subjective well-being as it appears
today in the traditions of eudaimonic and hedonic well-being (Ryff 1989; Ryff and
Keyes 1995; Keyes et al. 2002).
Since Jahoda’s (1958) and Gurin et al.’s (1960) seminal work, social science
scholars (psychologists, sociologists, and economists) have spent the past 40 years
moving forward the nascent agenda of mental health via the study of subjective
well-being. In the 1980s, two seminal journal articles brought the study of subjec-
tive well-being and its two traditions into the mainstream of social psychological
inquiry. The first was Ed Diener’s (1984) review article of the state of the first
generation of research and theory on subjective well-being, which had focused
squarely on hedonic dimensions, such as happiness, life satisfaction, or affect bal-
ance. The second was Carol Ryff’s (1989) article that operationalized the theory
of psychological well-being outlined in Jahoda’s (1958) volume and argued that
happiness is not merely hedonic but also includes eudaimonic elements. These
influential and highly cited articles revitalized the traditions of subjective well-
being research that form the basis for much the today’s research on subjective
well-being.
12 C.L.M. Keyes and K. Cartwright

Until the late 1980s, research on subjective well-being was synonymous with
hedonic well-being (Kahneman et al. 1999). Despite this prejudice to equate subjec-
tive well-being with hedonic happiness (Ryff 1989), new research clearly shows
that subjective well-being is a multifactorial, multidimensional concept. One result
of the nearly 50 years of research on this important concept is that researchers have
proliferated, by my count (Keyes 2005a), at least 13 dimensions of subjective well-
being in the United States. Moreover, research has confirmed the meta-theoretical
hypothesis of hedonic and eudaimonic traditions of thought and functioning that
inform the study of subjective well-being (Keyes et al. 2002; King and Napa 1998;
Ryan and Deci 2001; Ryff 1989; Waterman 1990, 1993).
Hedonic, or emotional, well-being is a specific dimension of subjective well-
being that consists of perceptions of avowed interest in life, happiness and satisfac-
tion with life, and the balance of positive to negative affect (Bradburn 1969; Bryant
and Veroff 1982; Cantril 1965; Diener et al. 1985; Lucas et al. 1996; Shmotkin
1998). In contrast, eudaimonic well-being, sometimes referred to as positive func-
tioning, consists of individual’s evaluation of their psychological well-being (Ryff
1989; Ryff and Keyes 1995).
A variety of concepts from personality, developmental, and clinical psychology
have been synthesized as criteria of mental health (Jahoda 1958) and psychological
well-being (Ryff 1989). Elements of psychological well-being are descended from
the Aristotle’s position on happiness as eudaimonia, which states that the highest of
all goods achievable deliberately by humans is the development of a good life,
which mirrors concepts such as self-actualization (Maslow 1968), full functioning
(Rogers 1961), individuation (Jung 1933), maturity (Allport 1961), and successful
adult development that results in the realization of virtues (Erikson 1959). Ryff
(1989) integrated these writing into psychometrically sound measures reflecting a
multidimensional model of psychological well-being. Each of the six dimensions
of psychological well-being indicates the challenges that individuals encounter as
they strive to function fully and realize their unique talents (see Keyes and Ryff
1999; Ryff 1989; Ryff and Keyes 1995). The six dimensions encompass a breadth
of well-being: positive evaluation of oneself and one’s past life, a sense of continued
growth and development as a person, the belief that one’s life is purposeful and
meaningful, the possession of quality relations with others, the capacity to manage
effectively one’s life and surrounding world, and a sense of self-determination
(Ryff and Keyes 1995).
Within the eudaimonic tradition, there was scant recognition of the social
dimensions of an individual’s functioning in life. The quality of individuals’ rela-
tionships to, and functioning in, society and social groups remains understudied
aspects of individuals’ health. This is largely the reason why the first author of this
chapter initiated a study of social well-being (Keyes 1998), defined as individuals’
perceptions of the quality of their relationships with other people, their neigh-
borhoods, and their communities. As predicted theoretically, social well-being is
multidimensional, and Americans view the quality of their functioning in life based
on whether they see social life as meaningful and understandable (social coher-
ence), see society as possessing potential for growth (social actualization), feel they
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 13

belong to and are accepted by their communities (social integration), feel they
accept other people (social acceptance), and see themselves as having something
worthwhile to contribute to society (social contribution). In short, eudaimonia
consists of both private and public facets of positive functioning. Whereas psycho-
logical well-being is conceptualized as a primarily private phenomenon that is
focused on the challenges encountered by adults in their private lives, social well-
being represents primarily public phenomenon, focused on the social tasks encoun-
tered by adults in their social structures and communities.

1.3.1 Hygieia Enters the Debate About Mental

Health and Illness

Mental illness has always been seen as problematic but not as public health issue
until 1996, when the World Health Organization published the results of the first
Global Burden of Disease study (Murray and Lopez 1996). This study estimated
the total contribution of 107 acute and chronic medical conditions and illnesses
by including disability in the equation to calculate disability-adjusted life years
(DALYs). The DALY reflects the total number of years in a population that were
either lived with disability or abbreviated prematurely due to specific physical or
mental conditions. Depression was the fourth leading cause of disease burden,
accounting for 3.7 % of DALYs in 1990, 4.4 % in 2000, and projected to be 15 % of
DALYs by 2020 (Ustun 1999; Ustun et al. 2004). As such, the debate is over as
whether mental illness is a serious public health issue—it is.
The biggest issue facing governments is what can and should be done to reduce
the number of cases of mental illness and those suffering from it. Most govern-
ments choose the de facto approach of providing treatment to more individuals
(Chisholm et al. 2004). All evidence points to the fact that the de facto approach is
not reducing the prevalence, burden, or early age of onset for mental disorders
(Kessler et al. 2005; Insel and Scolnick 2006). A viable alternative is mental health
promotion, which seeks to elevate levels of positive mental health and protect
against its loss (Davis 2002; Jané-Llopis et al. 2005; Keyes 2007; Secker 1998).
Whereas treatment targets those with mental illness, and risk reduction prevention
targets those vulnerable to mental illness, mental health promotion targets those
with good mental health and those with less than optimal mental health—i.e., all
members of a population.
The World Health Organization (WHO 2004) recently highlighted the need to
promote positive mental health when it defined mental health positively as “ … a
state of well–being in which the individual realizes his or her own abilities, can
cope with the normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to his or her community” (p. 12). This is good news,
because it means the WHO has caught up with science, where positive mental health
has been operationalized under the rubric of subjective well-being, or individuals’
evaluations of the quality of their lives.
14 C.L.M. Keyes and K. Cartwright

Table 1.1 Tripartite structure and specific dimensions reflecting positive mental health
Hedonia (i.e., emotional well-being)
Positive affect: cheerful, interested in life, in good spirits, happy, calm and peaceful, full of
life
Avowed (or cognitive) affect: life satisfaction or satisfaction with domains of life
Positive psychological functioning (i.e., psychological well-being)
Self-acceptance: holds positive attitudes toward self, acknowledges, likes most parts of self,
personality
Personal growth: seeks challenge, has insight into own potential, feels a sense of continued
development
Purpose in life: finds own life has a direction and meaning
Environmental mastery: exercises ability to select, manage, and mold personal environs to suit
needs
Autonomy: is guided by own, socially accepted, internal standards and values
Positive relations with others: has, or can form, warm, trusting personal relationships
Positive social functioning (i.e., social well-being)
Social acceptance: holds positive attitudes toward, acknowledges, and is accepting of human
differences
Social growth (actualization): believes people, groups, and society have potential to grow
Social contribution: sees own daily activities a useful to and valued by society and others
Social coherence: interest in society and social life, and finds them meaningful and somewhat
intelligible
Social integration: A sense of belonging to, and comfort and support from, a community

When subjective well-being is measured comprehensively, the tripartite model

consisting of emotional, psychological, and social well-being is supported in studies
involving US adults (Gallagher et al. 2009), college students (Robitschek and Keyes
2009), and adolescents (Keyes 2006). Table 1.1 therefore includes a description of
each dimension of emotional, psychological, and social well-being and is organized
theoretically according to the categorization of well-being as either hedonic (repre-
senting how good individuals feel about their lives) or eudaimonic (how well indi-
viduals perceive themselves functioning psychologically and socially in life).
The 14 signs of well-being in Table 1.1 represent the questions in the Mental
Health Continuum “Short Form” (MHC-SF). The MHC-SF was created to address
the problem of the diagnostic threshold and to create a version more efficiently
administered in epidemiological surveillance. The MHC-SF derives from the long
form (MHC-LF) used in the Midlife in the United States (MIDUS) study (Keyes
2002, 2005b). While the MHC-LF consisted of 40 items, the MHC-SF consists of
14 of the most prototypical items representing the construct definition for each facet
of well-being. Three items (happy, interested in life, and satisfied) indicate emo-
tional well-being, six items measure the six dimensions of psychological well-
being, and five items represent the five dimensions of social well-being. The
response option for the short form was changed to measure the frequency (from
“never” to “every day”) with which respondents experienced each sign of mental
health during the past month, which provides a clear standard for the assessment
and a categorization of levels of mental health that is similar to the survey assess-
ment of mental major depressive episode according to DSM criteria.
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 15

The merger of feeling good about a life in which individuals are functioning
well, I have argued (Keyes 2002), constitutes the presence of good mental health.
In the same way that depression requires symptoms of anhedonia, mental health
consists of symptoms of hedonia. But feeling good only, in the same way as feeling
sad or losing interest in life, is not sufficient for the diagnosis of a clinical state.
Rather, and in the same way that major depression consists of symptoms of malfunc-
tioning, mental health must also consist of symptoms of positive functioning.
In turn, the mental health continuum (Keyes 2002) consists of three diagnostic
categories, or levels, of positive mental health: flourishing, moderate, and languishing
mental health. Individuals with flourishing mental health report feeling at least
one measure of hedonic well-being plus six or more of the measures of positive
functioning almost every day or every day during the past month. Individuals with
languishing mental health report feeling at least one measure of hedonic well-being
with six or more measures of positive functioning never or maybe once or twice
during the past month. Languishing is the absence of mental health—a state of
being mentally unhealthy—which is tantamount to being stuck and stagnant, or
feeling empty or that life lacks interest and engagement. Individuals who are neither
flourishing nor languishing are diagnosed with moderate mental health.

1.3.2 The Two Continua Model: Hygieia and Panacea

Are Both Important

The importance of measuring mental health in the same way as mental illness cannot
be overstated, because it allows us to finally adequately test the hypothesis that
mental health and illness belong to two separate continua. Indeed, mental health
promotion and protection is premised on the two continua model, because good
mental health is presumed to belong to a separate continuum from mental illness
(Health and Welfare Canada 1988). Yet, the studies that did exist on the subject only
measured mental health emotionally in terms of life satisfaction or happiness
(Greenspoon and Saklofske 2001; Headey et al. 1993; Huppert and Whittington
2003; Masse et al. 1998; Suldo and Shaffer 2008; Veit and Ware 1983). Numerous
studies in mainstream psychology of emotion have shown that positive and negative
emotions belong to separate continua (e.g., Bradburn 1969; Watson and Clark
1997), but as mentioned earlier, emotional disturbance or emotional vitality does
not, in themselves, constitute states of mental illness or mental health.
Findings based MHC-LF in the MIDUS study (Keyes 2005b) support the two
continua model: One continuum indicates the presence and absence of positive men-
tal health, and the other indicates the presence and absence of mental illness symp-
toms. For example, though the latent factors of mental illness and mental health
correlated (r = −.53), only 28.1 % of their variance is shared in the MIDUS data
(Keyes 2005a). The two continua model has been replicated in a nationally represen-
tative sample of US adolescents (ages 12–18) with data from the Panel Study of
Income Dynamics’s Child Development Supplement (Keyes 2009), in a national
16 C.L.M. Keyes and K. Cartwright

Fig. 1.1 The two continua model

study of Dutch adults (Westerhof and Keyes 2008, 2010) and in Setswana-speaking
South African adults using the MHC-SF (Keyes et al. 2008).
Based on the dual continua model shown in Fig. 1.1, individuals can be catego-
rized by their recent mental illness status and according to their level of mental
health—whether they have languishing, moderate, or flourishing mental health.
One implication of the dual continua model is that the absence of mental illness
does not imply the presence of mental health. In the American adult population
between 25 and 74 years, just over 75 % were free of three common mental disor-
ders during the past year (i.e., major depressive episode [MDE], panic disorder
[PD], and generalized anxiety [GAD]). However, while just over three-quarters
were free of mental illness during the past year, only about 20 % were flourishing.
A second implication of the dual continua is that the presence of mental illness does
not imply the absence of mental health. Of the 23 % of adults with any mental illness,
14.5 % had moderate, and 1.5 % had flourishing mental health. Thus, almost 7 of
every 10 adults with a recent mental illness (MDE, panic, or GAD) had moderate
or flourishing mental health. While the absence of mental illness does not mean
the presence of mental health (i.e., flourishing), the presence of mental illness does
not imply the absence of some level of good mental health.
Another important implication of the dual continua model is that the level of
mental health should differentiate the level of functioning among individuals free of,
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 17

and those with, a mental illness. Put differently, anything less than flourishing
mental health is associated with impaired functioning both for individuals with and
without a mental illness. Findings consistently show that adults and adolescents
who are diagnosed as anything less than flourishing are functioning worse in terms
of physical health outcomes, health-care utilization, missed days of work, and
psychosocial functioning (Keyes 2002, 2005b, 2006, 2007, 2009). Over all outcomes
to date, individuals who are flourishing function better (e.g., fewer missed days of
work) than those with moderate mental health, who in turn function better than
languishing ones—and this is true for both individuals with a recent mental illness
and those free of a recent mental illness.

1.3.3 Hygieia: Toward Promotion and Protection

of Flourishing

Progress has been slow in bringing mental health promotion and protection (MHPP)
into the mainstream of debates about how to address the problem of mental illness.
Admittedly, there has been a deficit of scientific evidence supporting the “promotion”
and the “protection” axioms of MHPP. Central to the argument behind promotion is
the hypothesis that gains in level of mental health should decrease the risk of mental
illness over time. Central to the argument behind protection is the hypothesis that
losses of mental health increase the risk of mental illness over time, and therefore
efforts should be made to prevent, and to respond to, the loss of good mental health.
Findings recently published (Keyes et al. 2010) using the ten-year follow-up of the
MIDUS national sample strongly supported the protection and promotion hypotheses.
In 1995 and in the 2005 follow-up of the MIDUS sample, adults completed the
long form of the Mental Health Continuum (MHC-LF; Keyes 2002, 2005a) and the
Composite International Diagnostic Interview Short Form (CIDI-SF; Kessler et al.
1998). Studies have shown that the CIDI-SF has excellent diagnostic sensitivity and
diagnostic specificity as compared with diagnoses based on the full CIDI in the
National Comorbidity Study (Kessler et al. 1999). During the telephone interview,
the CIDI-SF was used to assess whether respondents exhibited symptoms indicative
of major depression episode (MDE), generalized anxiety disorder (GAD), and panic
attack (PA) during the past 12 months.
We found that the prevalence of levels of mental health and illness in 1995 and
2005 was similar, suggesting the levels of positive mental health may be stable over
time. The prevalence of mental illness was about the same in 1995 (18.5 %) as in
2005 (17.5 %); approximately eight out of every ten adults were free of any mental
illness in 1995 and in 2005. The prevalence of any mental illness and the absence of
mental illness appear to be stable over time. However, of the 17.5 % with any mental
illness in 2005, just over half (52 %) were “new cases” insofar as these adults did
not have any of the three mental disorders in 1995. Thus, mental illness is dynamic
over time, with about half of the people recovering that is replaced by another half
of new cases.
18 C.L.M. Keyes and K. Cartwright

The prevalence of flourishing is 3.2 % higher in 2005, up from 19.2 % in 1995.

The prevalence of moderate mental health is 3.7 % lower in 2005, which is down
from 64.1 % in 1995. The prevalence of languishing is 0.5 % higher in 2005, slightly
up from 16.7 % in 1995. Compared with mental illness, levels of mental health—
particularly moderate mental health and flourishing—appear slightly more dynamic
at the level of the population. That is, there is a slight decline in moderate and slight
increase in flourishing mental health at the population level. Overall, mental health
appears to be relatively stable at this level. However, only 45 % of those languishing
in 1995 are languishing in 2005; 51 % improved to moderate and 4 % improved to
flourishing mental health. Only 51 % of those flourishing in 1995 are flourishing in
2005—46 % declined to moderate and 3 % declined to languishing mental health
in 2005. Two-thirds of those with moderate mental health in 1995 had moderate
mental health in 2005. Of those with moderate mental health in 1995, about 19 %
improved to flourishing, and 14 % declined to languishing, mental health in 2005.
Like mental illness, level of mental health is dynamic over time.

1.3.4 Hygieia Validated: Confirmation of the Promotion

and Protection Hypotheses

The changes in mental health level were strongly predictive of future mental illness.
First, findings supported the protection hypothesis. Those who declined to moderate
mental health were nearly four times (adjusted1 odds ratio [OR] = 3.7) more likely
to have a mental illness in 2005 as those who stayed flourishing. Thus, the first loss
of good mental health—from flourishing to moderate mental health—results in a
rise in the risk of future mental illness. Adults whose mental health stayed at moder-
ate were over four times (OR = 4.4) as likely to have a 2005 mental illness as those
who stayed flourishing. Compared to those who stayed at moderate mental health,
those who declined to languishing—almost all of whom had moderate mental health
in 1995—represented an 86 % increase in the odds ratio of a 2005 mental illness
(i.e., 8.2 − 4.4 = 3.2 ÷ 4.4 = .864). Thus, protection against the loss of moderate
mental health can mitigate the risk of future mental illness.
Findings also supported the promotion hypothesis. Individuals who stayed
languishing were over six times (OR = 6.6), while those who improved to moderate
mental health were over three times (OR = 3.4) to have a 2005 mental illness.
Compared to staying languishing, improving to moderate mental health cuts
the risk of future mental illness by nearly half (i.e., 6.6 − 3.4 3.2 ÷ 6.6 = .484).
Individuals who improved to flourishing—most of whom had moderate mental
health in 1995—had no more high risk of future mental illness than those who
stayed flourishing.

1
All models controlled for 1995 mental illness, age, sex, race, education, marital status in 2005 and
employment status in 2005, and whether respondents had any of 25 physical health conditions in 1995.
1 Well-Being in the West: Hygieia Before and After the Demographic Transition 19

Individuals who had any of the three mental illnesses in 1995 were five times
(OR = 5.0) more likely than those who stayed flourishing to have one of the same
mental illnesses in 2005. Our findings illustrate that the absence of flourishing
mental health is as serious a risk factor for future mental illness as those who started
with one of the mental illness. Almost half of the study sample who were free of any
mental illness in 1995 but had moderate mental health in 2005 (i.e., 7.8 % declined
+ 35.5 % stayed + 4.7 % improved = 48 % with moderate mental health in 2005) had
nearly as high an odds of mental illness in 2005 as the 18.5 % who had a mental
illness in 1995. Moreover, one in ten of the study sample was free of any mental
illness in 1995 but had languishing mental health in 2005 (i.e., 3.9 % stayed + 6.5 %
declined = 10.4 % with languishing in 2005) had a higher odds of mental illness in
2005 than the 18.5 % who had a mental illness in 1995. In short, nearly six in every
ten American adults (i.e., 48 % with moderate + 10.4 % with languishing mental
health = 58.4 %) otherwise free of MDE, GAD, or PA have about as high or even
higher risk of a future mental illness than individuals who had one of those mental
disorders to start.

1.4 Conclusion

Ancient civilizations in the West (viz., the Greeks) conceived of health and happiness
as ideals, as values, and as one of the highest goods in life (see Sigerist 1941).
Well-being was not merely an end; it also was a means to creating and sustaining a
good society. Today, mental as well as physical health are considered forms of
human capital, because studies consistently link the presence of mental illness and
chronic physical disease to high levels of social and economic burden to society, in
terms of disability, premature death, and direct and indirect costs. Health, and not
solely industriousness or creativity, is now viewed among the greatest sources of the
“wealth” of a nation, for it is tied to the growth and development of nations (Berger
et al. 2003; Bloom and Canning 2000; Sullivan 2004).
Many scholars and movements, such as positive psychology, lament that too
much research on “health” has focused mainly on the presence and absence of
disease and illness rather than also the presence and absence of health and well-
being (Keyes and Grzywacz 2005). In this chapter, we have argued there is a good
reason for the rise of the pathogenic (panacea) focus of nations due to the demo-
graphic transition that marks the change in economic development of a nation.
At the start, life expectancy is shorter, and the causes of illness and death are acute
and infectious. As a nation shifts away from a largely rural and agrarian subsistence
to an industrialized and more urban economic system, the nation develops a focus
on the causes of disease and death and focuses on the reduction of mortality. As it
gains control over the causes of death, fertility remains high, and during this period
the population grows. Life expectancy increases, meaning the population is growing
larger and aging as well (living longer), and the causes of illness and death shift
from mainly acute and infectious to chronic and preventable causes due to lifestyle.
20 C.L.M. Keyes and K. Cartwright

At this point, the economic pressure to sustain health-care systems with a larger
and older population exerts greater need to prevent chronic disease and promote
greater quality, not merely quantity, of life. In other words, if a nation, after having
increased life expectancy, can make the shift toward promoting greater health in
addition to life expectancy, it can mitigate chronic conditions and illness by
preventing through the promotion of better health as more than the absence of illness.
Put simply, as a nation completes the epidemiological transition, there is a need
to heighten a focus on salutogenic (hygieia) aspects of health, focusing on better
understanding the causes of well-being.
The rising cost of health care and the aging of the US population have made the
salutogenic approach more relevant today than ever. However, unlike most European
nations that used the recovery from WWII as an opportunity to nationalize health
care, the USA remains a highly medicalized system as described through the socio-
logical literature of medicalization reviewed in this chapter. Although WWII did
much to jump-start the study of subjective well-being in the USA, the salutogenic
approach to mental health in terms of promoting and protecting flourishing remains
a work in progress rather a reality at a national level. Nonetheless, well-being has
returned to the West precisely because it now encounters the challenges created by
successfully going through the demographic transition. In the same way, we believe
nations around the globe now undergoing development will need to confront many
of the same challenges of how to balance the pathogenic with the salutogenic
approaches and how to focus on quantity of life and illness and also make the shift
toward quality of life and well-being.

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Chapter 2
The Psychosomatic View

Nicoletta Sonino and Giovanni A. Fava

2.1 Introduction

The ongoing progress in scientific medicine and technology in recent years has led
to further splitting of knowledge and consequent fragmentation in the response to
health issues. On the other hand, this is in contrast with research evidence that
points to the importance of incorporating psychosocial aspects and holistic view in
the approach to the person presenting with any health problem. While nothing is
changing in clinical practice modalities of dealing with different phases of disease
management, there is a clear need to improve patient-physician relationships,
patient satisfaction and compliance, and final outcomes.
The interdisciplinary field of psychosomatic medicine has the potential to fill this
gap providing both the cognitive frame of reference and the practical tools that can
be employed in everyday clinical practice.

2.2 History and Current Developments

The term “psychosomatic” entails different meanings and connotations, which may
explain its varying degrees of popularity. Heinroth introduced the concept in 1818,
but modern psychosomatic medicine developed in the first half of the past century.

N. Sonino ()
Department of Statistical Sciences, University of Padova, Padua, Italy
Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
e-mail: [email protected]
G.A. Fava
Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
Department of Psychology, University of Bologna, Bologna, Italy

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 25
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_2,
© Springer Science+Business Media Dordrecht 2013
26 N. Sonino and G.A. Fava

It resulted from the interaction of different concepts having an ancient tradition in

Western medicine: psychogenesis of disease and holism (Lipowski 1986). The idea
of psychogenesis characterized the first phase of development of psychosomatic
medicine (1930–1960) and evolved toward the definition of “psychosomatic disease”
for a number of conditions in which psychological aspects seemed to have a prepon-
derant role. Despite early criticism, the psychogenic postulate continued to exert
explanatory power in the search for pathogenetic mechanisms. For example, a physi-
cal illness such as peptic ulcer was believed to be caused by psychological factors.
The term “psychosomatic disorder” was strongly criticized by several psychoso-
matic researchers, including Kissen (1963), Engel (1967), and Lipowski (1986).
Kissen (1963) provided a better specification of the term “psychosomatic.” He clari-
fied that the relative weight of psychosocial factors may vary from one individual to
another within the same illness and underscored the basic conceptual flaw of con-
sidering diseases as homogeneous entities. Engel (1967) wrote that the term “psy-
chosomatic disorder” was misleading, since it implied a special class of disorders of
psychogenic aetiology and, by inference, the absence of a psychosomatic interface
in other diseases. On the other hand, he viewed reductionism that overlooked the
impact of non-biological circumstances upon biological processes as a major cause
of mistreatment. Lipowski (1986) criticized the concept of psychosomatic disorder
since it tended to perpetuate the obsolete notion of psychogenesis, which is incom-
patible with the doctrine of multi-causality, a core postulate of current psychoso-
matic medicine. With his work, he gave an invaluable contribution in setting the
scope, mission, and methods of psychosomatic medicine.
Among major innovations stands the introduction of the biopsychosocial model
of illness by Engel (1977). It allows illness to be viewed as a result of interacting
mechanisms at the cellular, tissue, organismic, interpersonal, and environmental
levels. Accordingly, the study of every disease must include the individual, his body,
and his surrounding environment as essential components of the total system
(Novack et al. 2007). This model retains today its full impact in clinical research
and practice (Fava and Sonino 2008).
An updated definition of psychosomatic medicine and its boundaries with related
disciplines (Fava and Sonino 2010) are illustrated in Box 2.1.

Box 2.1 Psychosomatic Medicine

Definition
Psychosomatic medicine may be defined as a comprehensive, interdisciplinary
framework for:
(a) Assessment of psychosocial factors affecting individual vulnerability,
course, and outcome of any type of disease
(b) Holistic consideration of patient care in clinical practice
(c) Integration of psychological therapies in the prevention, treatment, and
rehabilitation of medical disease

(continued)
2 The Psychosomatic View 27

Box 2.1 (continued)

Boundaries
In the USA, psychosomatic medicine has recently become a subspecialty
recognized by the American Board of Medical Specialties. This may lead to
identifying psychosomatic medicine with consultation-liaison psychiatry
(Gitlin et al. 2004). Consultation-liaison psychiatry is clearly within the field
of psychiatry; its setting is the medical or surgical clinic or ward, and its focus
is the comorbid states of patients with medical disorders (Wise 2000).
Psychosomatic medicine is, by definition, multidisciplinary. It is not confined
to psychiatry but may concern any field of medicine. Not surprisingly, in
countries such as Germany and Japan, psychosomatic activities have achieved
an independent status (Deter 2004).

Subdisciplines
The general psychosomatic approach has resulted in a number of subdisci-
plines within their own areas of application: psychooncology, psychonephrol-
ogy, psychoneuroendocrinology, psychoimmunology, psychodermatology,
and others. Such subdisciplines have developed clinical services, scientific
societies, and medical journals.

2.3 Psychosocial Factors and Individual Vulnerability

It has become increasingly clear that we can improve medical care by paying more
attention to psychological aspects of medical assessment (Kroenke 2002; Fava et al.
2012), with particular reference to the role of stress (McEwen 2007; Fava et al.
2010). A number of factors have been implied to modulate individual vulnerability
to disease.

2.3.1 Stressful Life Events

The role of early developmental factors in susceptibility to disease has been a fre-
quent object of psychosomatic investigation (McEwen 2007; Romans and Cohen
2008). Using animal models, events such as premature separation from the mother
have consistently resulted in pathophysiological modifications, such as increased
hypothalamic-pituitary-adrenal axis (HPA) activation (McEwen 2007). They may
render the human individual more vulnerable to the effects of stress later in life.
There has been also considerable interest in the association of childhood physical
and sexual abuse with medical disorders later in life. This link has been postulated
28 N. Sonino and G.A. Fava

for chronic pain and irritable bowel syndrome and several adverse health outcomes
(functional disability and risk behaviors), yet the evidence currently available does
not allow any firm conclusion (Romans and Cohen 2008).
The notion that events and situations in a person’s life, which are meaningful to
him or her, may be followed by ill health has been a common clinical observation.
The introduction of structured methods of data collection and control groups has
allowed to substantiate the link between life events in the year preceding the onset
of symptoms and a number of medical disorders, encompassing endocrine, cardio-
vascular, respiratory, gastrointestinal, autoimmune, skin, and neoplastic disease
(Novack et al. 2007; Theorell 2012).

2.3.2 Chronic Stress and Allostatic Load

Subtle and long-standing life situations should not too readily be dismissed as minor
and negligible, since chronic, daily life stresses may be experienced by the indi-
vidual as taxing or exceeding his or her coping skills. McEwen (2007) proposed a
formulation of the relationship between stress and the processes leading to disease
based on the concept of allostasis, the ability of the organism to achieve stability
through change. Allostatic load reflects the cumulative effects of stressful experi-
ences in daily life. When the cost of chronic exposure to fluctuating and heightened
neural or neuroendocrine responses exceeds the coping resources of an individual,
allostatic overload ensues (Fava et al. 2010). Allostatic overload can be assessed on
clinical grounds. Biological parameters of allostatic load, such as glycosylated pro-
teins, coagulation/fibrinolysis, and hormonal markers, have been linked to cognitive
and physical functioning and mortality (McEwen 2007).

2.3.3 Health Attitudes

Unhealthy lifestyle is a recognized risk factor for most prevalent diseases, such as
diabetes, obesity, and cardiovascular illness (Tomba 2012). In 1985, Geoffrey Rose
showed that the risk factors for health are almost always normally distributed and
supported a general population approach to prevention, instead of targeting those at
the highest risk. Accordingly, switching the general population to healthy lifestyles
would be a major source of prevention.

2.3.4 Personality and Psychological Well-Being

The notion that personality variables can affect vulnerability to specific diseases
was prevalent in the first phase of development of psychosomatic medicine (1930–1960)
and was particularly influenced by psychoanalytic investigators, who believed that
specific personality profiles underlay specific “psychosomatic diseases.” This hypothesis
2 The Psychosomatic View 29

was not supported by subsequent research (Lipowski 1986). Two personality constructs
that can potentially affect general vulnerability to disease, type A behavior and
alexithymia (i.e., the inability to express emotion), have attracted considerable
attention, but their relationship with health is still controversial (Cosci 2012).
However, personality variables (e.g., obsessive-compulsive, paranoid, impulsive)
may deeply affect how a patient views illness, what it means to him/her, and his/her
interactions with others, including medical staff.
Positive health is often regarded as the absence of illness, despite the fact that, half
a century ago, the World Health Organization defined health as a “state of complete
physical, mental, and social well-being and not merely the absence of disease or infir-
mity” (further discussion of this issue can be found in Chaps. 1 and 9 of this volume).
Research on psychological well-being has indicated that it derives from the interaction
of several related dimensions (Ryff and Singer 1996; Fava and Tomba 2009). Several
studies have suggested that psychological well-being plays a buffering role in coping
with stress and has a favorable impact on disease course (Pressman and Cohen 2005).

2.3.5 Social Support

Prospective population studies have substantiated the role of social support in rela-
tion to mortality, psychiatric and physical morbidity, and recovery and adjustment
to chronic disease (Fava and Sonino 2010). An area that is now called “social neu-
roscience” is beginning to address the effects of the environment and social network
on the brain and the physiology it regulates (McEwen 2007).

2.3.6 Spirituality

Religiosity and spirituality (broadly defined as any feelings, thoughts, experiences, and
behaviors that arise from the search for the “sacred”) have been a matter of growing
interest in epidemiological research (Chida et al. 2009). Religiosity appeared to have a
favorable effect on survival, that is, independent from behavioral factors (smoking,
drinking, etc.), negative affect, and degree of social support. This topic is also addressed
in Chap. 9, as well as in the chapters included in Part II of this volume, since attention
to the spiritual dimension is an integral part of the Āyurveda approach to health.

2.4 Need for Holistic Consideration in Patient Care

Psychosocial and biological factors interact in a number of ways in the course of

medical disease. Their varying influence together with each individual response
determines the unique quality of the experience and attitude of every patient in any
given episode of illness.
30 N. Sonino and G.A. Fava

2.4.1 Psychiatric Disturbances

Psychiatric illness appears to be strongly associated with medical diseases. Mental

disorders increase the risk for communicable and noncommunicable diseases; many
health conditions increase the risk for mental disturbances; comorbidity compli-
cates recognition and treatment of medical disorders (Prince et al. 2007).
There is evidence that psychiatric disturbances in the course of medical disease
are substantially different from those which can be found in psychiatric settings in
terms of clinical characteristics, prognosis, and response to treatment.
Major depression has emerged as an extremely important source of comorbidity
in medical disorders (Katon 2003). It was found to affect quality of life and social
functioning and lead to increased health care utilization, to be associated with higher
mortality, particularly in the elderly, to have an impact on compliance, and to
increase susceptibility to medical illness.

2.4.2 Psychological Disturbances

Current emphasis in psychiatry is about assessment of symptoms resulting in syn-

dromes identified by diagnostic criteria (DSM). However, there is emerging aware-
ness that also psychological symptoms which do not reach the threshold of a
psychiatric disorder may affect quality of life and entail pathophysiological and
therapeutic implications. This has led to the development of Diagnostic Criteria for
Psychosomatic Research (DCPR) (Box 2.2) and a specific interview to assess
patients (see examples in Box 2.3). The DCPR were introduced in 1995 and tested
in various clinical settings (Porcelli and Sonino 2007).

Box 2.2 The Diagnostic Criteria for Psychosomatic Research (DCPR)

1. Health anxiety
2. Thanatophobia
3. Disease phobia
4. Illness denial
5. Persistent somatization
6. Conversion symptoms
7. Functional somatic symptoms secondary to a psychiatric disorder
8. Anniversary reaction
9. Demoralization
10. Irritable mood
11. Type A behavior
12. Alexithymia
2 The Psychosomatic View 31

The advantage of this classification is that it departs from the dichotomy between
organic and functional and from the misleading and dangerous assumption that if
organic factors cannot be identified, there should be psychiatric reasons which may be
able to fully explain the somatic symptomatology. The psychosomatic literature pro-
vides an endless series of examples where psychological factors could only account
for part of the unexplained medical disorder (Fava et al. 2012). Similarly, the presence
of an established medical disorder does not exclude but indeed increases the likeli-
hood of psychological distress and abnormal illness behavior (Fava and Sonino 2010).

Box 2.3 Examples of Questions Derived from the Diagnostic Criteria

for Psychosomatic Research (DCPR)
Demoralization
Do you feel you have failed to meet your expectations or those of other people?
Is there an urgent problem you feel unable to cope with?
Do you experience feelings of helplessness, hopelessness, and/or giving up?

Irritable Mood
When you feel irritable, do you need to make an increased effort to control
your temper?
Do you have uncontrollable verbal or behavioral outbursts?

Illness Denial
Have you ever neglected to bring to your physician’s attention serious symp-
toms or ignored your physician’s diagnosis and recommendations?
If the physician tells you that you have a disease and prescribe you drugs,
a diet, or physical activity, do you follow the medical advice?

2.4.3 Quality of Life

While there is neither a precise nor an agreed definition of quality of life, research in this
area seeks essentially two kinds of information: the functional status of the individual
and the patient’s appraisal of health. Indeed, the subjective perception of health status
(e.g., lack of well-being, demoralization, and difficulties fulfilling personal and family
responsibilities) is as valid as that of the clinician in evaluating outcome (Fava and
Sonino 2010). This is an aspect that deserves more attention in clinical assessments.

2.5 Integration of Psychological Interventions in Medicine

Psychological interventions in the medically ill may be performed by different

health professionals and may range from reassurance and effective communication
to specific psychotherapeutic and psychopharmacological treatments.
32 N. Sonino and G.A. Fava

2.5.1 Treatment of Psychiatric Comorbidity

Psychiatric disorders are frequently unrecognized and untreated in medical settings,

with widespread harmful consequences for the individual and the society (Prince
et al. 2007). Treatment of psychiatric comorbidity such as depression, with either
pharmacological or psychotherapeutic interventions, markedly improves health-
related functioning and the quality of life, although an effect on medical outcome
has not been demonstrated.

2.5.2 Psychosocial Interventions

The use of psychotherapeutic strategies (cognitive-behavioral therapy, stress man-

agement procedures, brief dynamic therapy) in controlled investigations has yielded
a substantial improvement in a number of medical disorders (Kaupp et al. 2005).
Examples are interventions that increase social support and enhance coping capac-
ity in patients with breast cancer and malignant melanoma or employ writing about
personal stressful experiences in asthma and rheumatoid arthritis (see Chap. 9 for
further details on this issue).
Research on psychotherapy has disclosed common therapeutic ingredients rele-
vant to any physician-patient relationship, listed in Box 2.4 (Fava and Sonino 2010).

Box 2.4 Nonspecific Therapeutic Ingredients

The therapist’s full availability for specific times = Attention
The patient’s opportunity to ventilate thoughts and feelings = Disclosure
An emotionally charged, confiding relationship = High arousal
with a helping person
A plausible explanation of the symptoms = Interpretation
The active participation of patient and therapist in a ritual = Rituals
or procedure that is believed by both to be the means
of restoring the patient’s health

Abnormal illness behavior may greatly benefit from this type of intervention. For
many years, abnormal illness behavior has been viewed mainly as an expression of
personality predisposition and considered to be refractory to psychotherapy. There
is now evidence to challenge such pessimistic stance. For instance, several con-
trolled studies indicate that hypochondriasis is a treatable condition by the use of
simple cognitive strategies (Fava and Sonino 2010).

Lifestyle Modification

A basic psychosomatic assumption is the consideration of patients as partners in

managing disease. The partnership paradigm includes both collaborative care, a
2 The Psychosomatic View 33

patient-physician relationship in which physicians and patients make health

decisions together (Joosten et al. 2008), and self-management, a plan that pro-
vides patients with problem-solving skills to enhance their self-efficacy
(Bodenheimer et al. 2002). The benefits of modifying lifestyle have been par-
ticularly demonstrated in coronary heart disease (Rozanski et al. 1999) and
type 2 diabetes (Sperl-Hillen et al. 2011; Sonino et al. 2007). As elucidated in
Part II and in Chap. 9 of this volume, attention to lifestyle is one of the pillars
of Āyurveda. Further, psychological treatments may be effective in health-damaging
behaviors, such as smoking (Tomba 2012).

2.6 Current Issues

There have been major transformations in health care needs in the past decades.
Chronic disease is now the principal cause of disability, and use of health ser-
vices consumes almost 80 % of health expenditures (Bodenheimer et al. 2002).
Current health care is still conceptualized in terms of acute care perceived as a
product processing, where the patients is a customer, who can, at best, select
among the services that are offered. Yet, as Hart (1995) has pointed out, in
health care the product is clearly health and the patients is one of the producers,
not just a customer. As a result, “optimally efficient health production depends
on a general shift of patients from their traditional roles as passive or adversarial
consumers, to become producers of health jointly with their health profession-
als” (Hart 1995, p. 383).
The need to include consideration of function in daily life, productivity, performance
of social roles, intellectual capacity, emotional stability, and well-being has emerged as
a crucial part of clinical investigation and patient care. Patients have become increas-
ingly aware of these issues. The commercial success of books on complementary medi-
cine and positive practices as well as the upsurge of mind-body medicine exemplify the
receptivity of the general public to messages of well-being pursuit. Psychosomatic inter-
ventions may respond to these emerging needs within the established medical system
and may play an important role in supporting the healing process.
Medically unexplained symptoms are common in medical patients and increase
medical utilization and costs (Hatcher and Arroll 2008). The traditional medical
specialties, based mostly on organ systems (e.g., cardiology, gastroenterology),
appear to be more and more inadequate in dealing with symptoms and problems
which cut across organ system subdivisions and require a holistic approach. The
interdisciplinary dimension that characterizes most rehabilitation units and pain
clinics exemplifies this concept.
The benefits of modifying lifestyle by population-based measures are increas-
ingly demonstrated (Fava and Sonino 2010; Sperl-Hillen et al. 2011; Tomba 2012).
Yet, at present almost all of health care spending is directed at biomedically oriented
care. Overemphasis on pharmacological treatment has led to a dangerous reduction-
ism and overlooks the fact that therapeutic outcomes are the result of several ingre-
dients, which may be specific or nonspecific, as outlined above. As Kroenke (2002)
34 N. Sonino and G.A. Fava

argued, neither chronic medical nor psychiatric disorder can be managed adequately
in the current environment of general practice, where the typical patient must be
seen in 10–15 min or less.
In clinical medicine, there is the tendency to rely exclusively on “hard data,”
preferably expressed in terms of laboratory results, excluding “soft information”
such as impairments and well-being. This soft information can be, however, reliably
assessed by clinical rating scales and indexes which have been validated and used in
psychosomatic research and practice (Fava et al. 2012). Box 2.5 illustrates how
“hard data” and “soft information” need to be incorporated in clinical encounters.
It is not that certain disorders lack an explanation; it is our assessment that is mostly
inadequate, since it does not incorporate a global psychosomatic approach (Sonino
and Peruzzi 2009; Fava et al. 2012). Similarly, within a biopsychosocial model,
addressing the origins of disparities in physical and mental health care early in life
may produce greater effects than attempting to modify health-related behaviors
later or to improve access to health care in adulthood (Shonkoff et al. 2009).

Box 2.5 This Case Illustrates How the Psychosomatic Consideration of a

Patient’s Complaints May Lead to Better Assessment and Management
A 54-year-old woman was diagnosed with hypothyroidism. She was pre-
scribed thyroid substitution which restored thyroid hormone levels within the
normal range but kept feeling miserable, with a very bothersome globus in the
throat. She consulted several endocrinologists, who all stated that her thyroid
replacement was fine and there was nothing wrong with her, which made her
angry and dissatisfied. She was then referred to a psychoneuroendocrinology
service. Careful interviewing disclosed the presence of agoraphobia (fear of
public spaces and going out alone) with sporadic panic attacks and that she
attributed the globus and panic to the thyroid, adjusting herself to thyroid replace-
ment in relation to her current feelings. She also reported marital problems.
The psychosomatic assessment and physical examination led to explaining
that agoraphobia is a psychological disorder, her globus was related to it,
not to the thyroid, and that changing herself thyroid replacement could only
make things worse. A brief course of cognitive-behavioral treatment by a
psychologist did improve her agoraphobia and marital problems greatly, with
disappearance of panic attacks. Only sporadic symptoms of globus related to
anxiety persisted.

In conclusion, appraisal of the multifactorial determinants of the cure process

may restore a trusting patient-doctor interaction, improving final outcomes. In the
late 1970s, a prominent psychosomatic investigator, Morton Reiser (1979), antici-
pated the success of oriental medical theory and practice in the Western world and
identified psychosomatic medicine as the most suitable meeting ground for the two
2 The Psychosomatic View 35

models. Indeed, the psychosomatic research background has consolidated over the
past decades in dealing with complex biopsychosocial phenomena and may now
provide new effective modalities of patient care.

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 Part II
Health and Well-Being
in Indian Traditions
Chapter 3
The Perspectives on Reality in Indian
Traditions and Their Implications
for Health and Well-Being

Kiran Kumar K. Salagame

3.1 Introduction

Health and well-being are often used together as an alliterative phrase, as in kith
and kin, to emphasize the positive state in human beings. Sometimes they are used
interchangeably, but they have different connotations. In recent times, two different
disciplines, viz. health psychology (Dimatteo and Martin 2007) and positive
psychology (Sheldon et al. 2011), have claimed health and well-being as their
primary subject matter, respectively. Though both are related, health and well-being
seem to vary independently. Brief et al. (1993) found people with poor health
having high subjective well-being and people with few objective health problems
who had low subjective well-being.
Central to the understanding of health and well-being is the famous Cartesian
duality between mind and body. Since Western intellectual tradition treated them
as separate for the past three centuries, modern medicine being a product of this
tradition has become primarily body centred. The notions of illness and health
including the so-called mental health have developed with a biological orientation.
All the efforts in treating illness or in promoting health have our physical body as
the focus resulting in trillion-dollar health-care industry globally. Thus we have
pharmaceutical industries, development of biomedical technologies and establish-
ment of diagnostic centres, private hospitals, medical education, research facilities
and medical insurance companies (see also Chap. 1 for detailed discussion on
Western health system and its origins). All these elaborate paraphernalia often focus
on aetiology, symptomatology, pathology, epidemiology, diagnostics and treatment
of illness, and one is often left to wonder whether it is illness care or health care.

K.K.K. Salagame ()

Department of Studies in Psychology, University of Mysore, Mysore, India
e-mail: [email protected]; [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 39
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_3,
© Springer Science+Business Media Dordrecht 2013
40 K.K.K. Salagame

Though these developments are not to be condemned or belittled, there is a flop

side of health-care industry. People are finding it difficult to afford the increasing
cost of modern health-care system. An article published in Chicago Tribune a few
years ago (Chicago Tribune, 8 August 2007) carries the story of an American who
chose to bring his aged parents to Pondicherry, in India, because he found out that
the health care is cheaper there than back home. Not only that, many more persons
from different countries have been finding that medical care and attention is more
sophisticated and technologically advanced in India but less expensive compared to
their own countries. However, for a vast majority of Indians, medical care is getting
really more expensive and unaffordable due to the increased corporate culture
surrounding such services.
I am reminded of an old saying in Sanskrit which reads thus: vaidyarāja namas-
thubhyam yamarāajahsahodarah| yamastu haratihprānān vaidyah prānān dhanāni
ca|| (Oh doctor, brother of Yama the Lord of death, salutations to you! Yama only
snatches life, whereas you take away both life and money!!). This ancient humour
probably is more apt in contemporary period, than any other time, when so much
money is involved in health enterprise.
The economic factors have been influencing even the illness that one can or can-
not afford to have and get treated. I remember here an amusing, yet instructive, TV
advertisement of an insurance company. A patient visits a clinic, and the doctor after
having examined the chest X-ray says he has a problem with his respiratory system,
for which the patient reacts with chagrin, ‘it could not be so’ and says ‘a kidney
problem is OK’, because insurance company pays for that not for a chest disease!
Thus, contemporary health-care practices have become artha pradhāna (money or
wealth predominant) than dharma pradhāna (moral or ethical predominant), though
Hippocratic oath continues to be administered to the new graduates!
Definitions of well-being are also loaded with economic considerations. The
clinical psychologist Paul Watchel (1989) notes that when gross national product
(GNP) is taken as a measure of well-being, even ‘the medical costs due to the dis-
eases caused by pollution are figured into the GNP as pluses … if less pollution
occurred, and as a result less medical treatment was required, this would show up as
a drop in the GNP!1’ (p. 88). It is what happens when the materialistic and economic
orientation is stretched to its logical limits.
There is a difference between the popular use of the term ‘well-being’, which
usually relates to health and the philosophical use of this term that is broader, but
related, and is concerned with the notion of a good life of which health is an aspect
(http://plato.stanford.edu/entries/well-being/). Hence, well-being is more related
to overall quality of one’s life, and economists and sociologists have attempted to
pin down the essential objective conditions required for a better quality of life.
While social scientists – economists, political scientists and sociologists – have
focused on the objective criteria, psychologists have looked into the subjective
evaluation of one’s level of satisfaction with one’s life as the criteria for well-being

1
‘!’ added for emphasis.
3 The Perspectives on Reality in Indian Traditions and Their Implications… 41

(Diener 1984; Hoorn 2007; Conceição and Bandura 2013). Diener and Seligman
(2004) found that mental disorders are a major cause of low well-being and poor
mental health almost always causes poor well-being. It is likely that mental health
is more related to well-being than physical health per se.

3.1.1 Contemporary Concerns About Well-Being

and the Reductionist Paradigm

As about the concept of health and health care, so it is about the understanding of
well-being and its enhancement strategies. The recent movement of positive psy-
chology, in its focus on studying positive subjective experiences and positive traits,
which include character strengths and virtues (Seligman and Ciszksenthmihalyi
2000), seems to be mind centred. Even here researchers are primarily guided by the
reductionist paradigm and tend to operate within the physicalistic view of the
universe. For example, researchers have examined the effect of laughter on health
and well-being, but most of them focus on the brain mechanisms involved and
neurochemicals released rather than on the psychological aspects. No one bothers
about the social aspects of it, let alone the spiritual. It is the same approach in under-
standing the effects of meditation or prayer, which are basically spiritual practices.
Thus, health psychology and positive psychology betray the underlying dichotomy
of mind-matter dualism. Though there has been much talk of mind-body interaction
in various ways and many researchers have spoken about holistic approach to health
often the discussion centres on how the psychological and social, nay even spiritual
aspects ultimately enhance certain neurochemicals and neurotransmitters essential
for healthy functioning of the body rather than on directly addressing them.

3.1.2 Paradigm Shift: Has That Really Occurred?

What if body in itself is not all that important in maintaining health? What if mind
plays a crucial role in causing illness and also in improving health? What if inter-
personal and social factors also have a say in our health? What if money has no value
for well-being, beyond a certain point? What if health and well-being are not always
related? What if subjective criteria are more important than objective criteria for
well-being? What happens to health-care industry? How do policymakers go about
improving the well-being of people in a nation? What is the role of social and
behavioural scientists? These and many other questions have been debated by
researchers. These debates call for a paradigm shift from a purely biomedical model
to a bio-psychosocial or to a holistic model that subsumes even the spiritual dimension.
Ever since Hans Selye’s (1955) concept of ‘general adaptation syndrome’ (GAS)
gained currency leading to research on life stress and strategies of coping, there has
been a talk of paradigm shift in the field of medicine. Researchers focused more on
42 K.K.K. Salagame

psychological and social factors determining illness and recovery and also the way
people manage their stress. Since then, there has been talk of ‘mind-body medicine’,
‘psychoneuroimmunology’, ‘energy medicine’, ‘alternative medicine’, ‘comple-
mentary medicine’, ‘holistic health’, ‘integrative medicine’, ‘mind-body therapy’,
‘energetic therapies’, ‘eastern therapies’ and so on (Eden 2008; Keegan 2002).
The primacy of body and body-centred approach was apparently giving way
gradually to the new ‘bio-psychosocial-spiritual model’, which addresses the issue
of illness and health taking into account not only biological functioning but also the
psychological condition, social aspects and the religio-spiritual dimensions of
human existence. The US National Institute of Health opened a new establishment
to fund research in alternative and complementary medicine more than a decade
ago. In India, a new initiative was mooted to bring together the different indigenous
systems of healing under the banner AYUSH (Āyurveda, Yoga, Unani, Siddha and
Homeopathy). It is interesting that this acronym also stands for life and longevity,
because in Sanskrit ayushya means longevity. With these developments, has the
paradigm shift really occurred in the world at large? Answer is no. Not much change
is visible in the medical establishment all over the world, and the health industry
(illness industry?) continues to thrive. Reason for this is not too difficult to find.
First, a large majority of physicians, psychiatrists, psychologists and other health
professionals primarily operate within the established canons of scientific tradition.
The most important of them is the fundamental assumption of primacy of materiality
of the universe and hence everything has to be demonstrated at a physical level,
i.e. in terms of biochemical and neurochemical activities, reactions and outcomes
to be accepted as efficacious. Ajaya (1983) termed this as ‘reductionist paradigm’.
The fundamental assumption of this paradigm is that the only principle in the
universe is matter and all other complex or abstract phenomena – be they psycho-
logical, sociological or spiritual – can be ultimately understood through a process of
reduction to basic components of matter. This demand is hard to meet. Many of the
so-called alternative or complementary systems involve interventions at psycho-
logical, social and even spiritual dimensions whose role in treatment outcome
cannot be accounted for scientifically in the same way as it can be done with the
administration of drugs. This is all the more evident when religious and spiritual
aspects are part of such intervention strategies. Many researchers have tried to
examine the role of spirituality in terms of prayer, healing through touch, meditation
and many other means. All of them indicate that somehow our health is significantly
determined by the spiritual aspect, though exact mechanisms are not understood.
While there are many first person accounts of healing narrated by those who
experienced it and there are a few physicians who vouch for it by and large, there is
a lot of scepticism about such possibilities.
Second, there is a financial angle to this. Insurance companies pay for those treat-
ment methods which are proven to be effective scientifically through randomized
controlled trials, and there has been a greater emphasis on evidence-based practice.
Consequently, investors are not willing to take risk in something not proved, lest
they incur loss.
Third, there are many instances where people have not benefitted from such
interventions, which further increase the scepticism towards them.
3 The Perspectives on Reality in Indian Traditions and Their Implications… 43

Fourth, an alternative system is chosen as second best either because the allopathic
system did not work, or because they found it less expensive, or for some other
reason, but not because it is more efficacious. Those who believe in the efficacy of
alternative systems are few compared to the vast majority. Here again our beliefs,
values and worldview seem to play a significant role.
The approach of ‘one size fits all’ in understanding the issues related to a disease,
in the practice of intervention, in prevention of disease, in promotion of health and
in the study of well-being is neither appropriate nor effective. Nor are we doing
justice to the intended purposes of many of the interventions developed from an
alternative perspective. In other words, however much modern psychology tries
to incorporate a broader perspective on human condition, its adherence to the reduc-
tionist paradigm retards its thinking and the prospect of achieving a truly holistic
perspective. So, we need to look elsewhere for an alternative way of approaching
reality to overcome this drag or inertial force (tamas according to Indian view) of
reductionism.
In this changing context, Indian perspectives on the nature of reality, on mind-
body relationship and on the nature of consciousness have been found to be of much
value as resources for developing the new paradigm. This chapter focuses on some
of the essential elements of Indian perspectives, which are relevant and significant
in this endeavour.

3.2 Perspectives on Reality in Indian Traditions

As indicated already, modern scientific approach to health and well-being as

reflected in different related branches of knowledge such as medicine, psychiatry,
psychology, economics and sociology is governed by the reductionist paradigm.
To be more specific, it is governed by a materialist-monist view of reality, where
primacy of matter is upheld. Even the Cartesian dualism of body-mind gets reduced
to physical matter. Within this paradigm, mind and consciousness are viewed as
synonymous, and consciousness is not accepted as an independent principle, in
addition to matter. Therefore, all the issues of health and well-being are understood
and dealt with materially. Even if one prays to God for better health, God is also
conceptualized as a psychological resource, and the effects have to be measured
in terms of the activity of the brain (neurochemistry) or of other bodily systems
(biochemistry).
While such an approach may help in certain ways, it fails to take into account a
macro perspective on the interrelation of different dimensions of the universe and
the interplay of many factors in a grid. Though, of late, ecologists have been trying
to impress upon policymakers the adverse impact on health of the human created
ecological imbalance, all those arguments are again presented within the materialist-
monist view of reality. There is no scope or role of any other factor. This is quite
understandable given the fact that modern science started as natural philosophy in
ancient Greece, which meant trying to understand the universal phenomena in natu-
ralistic terms without invoking any supernatural principle or factor (Leahey 2004).
44 K.K.K. Salagame

This view still rules the roost, despite contradictory evidences that point towards the
existence of the spiritual realms beyond the perceived physical reality (Church 2007;
Krippner and Friedman 2010a, b; Schwartz 2007, 2011).
In contrast to this scenario of the modern Western intellectual tradition, Indian
traditions have all along affirmed the existence of multiple realities (loka) in the
universe and a spiritual dimension to human nature that enables them to make
contact with those realities. Consequently, the entire human existence is viewed
with reference to a radically different perspective that may be characterized as
transcendental or spiritual vis-à-vis the material perspective of the modern Western
intellectual tradition. As a corollary, even the issues related to health and well-being
are appreciated in a different way. To understand this difference, we need to elabo-
rate on how such a perspective provides alternative views on the nature of reality
and on human nature.
Indian thinkers espoused different views on reality, and we have a complete
spectrum of them (Hiriyanna 1993), ranging from the absolute materialism or phys-
icalism epitomized by Chārvaka to the dualism of Sāmkhya on to the non-dualism
of Advaita Vedānta. It is important to note that there is an experiential base for such
views and they are not just matters of intellectual debate or argument. Such a base
can be found in the discussions on the nature of reality, self, consciousness and
mind in several Upanishad and later in the Yogavāsiṣta, Bhagavad Gita and Yoga
Sutras of Patanjali, just to speak of ancient original sources of sanātana dharma.
Frawley (1995) translated sanātana dharma as ‘the eternal tradition’ which literally
means the ‘eternal or universal truth’ and is ‘sometimes translated as the ‘perennial
wisdom’ … a tradition conceived as inherent in the cosmic mind, arising with
creation itself … [it] is a set of teachings which comprehend Universal Life and
Consciousness, including religion, yoga and mysticism, philosophy, science, art
and culture as part of a single reality’ (p. 18). Frawley identified the following
characteristics of sanātana dharma: (a) It is not limited to any messiah, prophet,
scripture or church. (b) It is not restricted to any particular community or looking
towards any particular historical end. (c) It embraces all aspiration towards the
Divine or Supreme Being by all creatures, not only human beings but also plants
and animals and the creatures, godly or ungodly, of subtle worlds beyond our physical
senses. (d) It maintains our connection with the universal tradition through all
worlds and all time, to the ancient past and the distant future ‘in the vision of a timeless
self-renewing reality (Brahman)’ (1995, pp. 20–21).
We find similar ideas though not the same, in the ancient sources of Jain and
Buddha traditions as well. From these, we can infer a set of fundamental assump-
tions, principles and practices that represent the Indian paradigm.

3.2.1 Non-dualism in Veda and Upanishad

Indian traditions subordinate physical reality to a higher spiritual reality. This is true
no matter which darsana (perspective) it is, be it Vedic (Pūrva Mīmāmsa and Uttara
3 The Perspectives on Reality in Indian Traditions and Their Implications… 45

Mīmāmsa/Vedānta), Vedic related (Sāmkhya-Yoga and Nyāya-Vaisheshika) or

non-Vedic (Jainism and Buddhism). The differences in these perspectives emerge in
view of how the higher spiritual reality is conceptualized. That in turn can be specu-
lated to arise from the nature and extent of the awareness (experiences) of the
ancient seer and sages who formulated them, just as we have Freudian and Jungian
psychologies. While this is not the place to review all these different perspectives,
at least highlighting some of their distinctive features can be useful.
The first view is that there is only the reality that governs everything, which is
designated as Brahman, and everything is its manifestation. So, there is no real
duality. The apparent duality of subject-object is ‘dream like’, and the manifested
multiplicity and variety of the world do not have substantiality. It can be compared
to the holographic images projected in the sky. This view has emerged from the
realization of many seers and sages of Vedic tradition, who vouch from their experi-
ence that behind and beyond the three states, viz. waking, dream and sleep, there is
a fourth (turīya) state (Māndukya Upanishad, 12th verse) (Nikhilananda 2000). It is
claimed to be pure awareness, or the awareness of awareness of the contents of mind
that supports, as the ground for the figure in Gestaltian sense. It is variously termed
as sat-chit-ānanda, shuddha chaitanya, sākshi chaitanya, Purusha, Ātman and so
on in different darsanas.
The fact that there have been annual conferences on non-duality and science
taking place for the last few years in California (SAND conferences – www.
scienceandnonduality.com) and that their logo is Om = mc2 highlights that Indian
perspectives are not to be misclassified as primitive as some anthropologists
of structuralist tradition attempted to do. Ken Wilber, a well-known transpersonal
theorist, distinguished between the ‘pre-personal’ and the ‘transpersonal’ and
pointed out that many researchers often confound the two (Wilber 1977).
Even Gautama the Buddha, who did not accept the Vedic teachings as authority
and also disagreed with the notion of a permanent or eternal Self-sense (Ātman), did
not deny a transcendental dimension of human consciousness. Some schools of
Buddhist tradition also hold a non-dualistic view of reality.

3.2.2 Dualism of Sāmkhya

A second major perspective in Indian traditions posits that there are two fundamental
realities instead of one. This is the perspective of Sāmkhya system. According to this
system, both the pure consciousness and the phenomenal universe are recognized as
independent realities. While the former is called Purusha, the latter is called Prakṛti.
Prakṛti again is understood to be constituted of three operational principles guṇa,
viz. satva, rajas and tamas. Each and every phenomenon in the universe – mental or
material – is understood in terms of these three principles. Sāmkhya system derives
from these two fundamental/primary realities 24 secondary principles (tattva) that
help to account for the origin, evolution and manifestation of universal phenomena.
Yoga philosophy of Patanjali is rooted in the Sāmkhya perspective.
46 K.K.K. Salagame

The dualism of Sāmkhya system is different from the Cartesian dualism of mind
and matter because in Sāmkhya, both matter and mind are viewed as the products of
satva, rajas and tamas (i.e. Prakṛti), and hence there is no essential difference
between the two. They may be considered to be on a continuum (these topics are
extensively developed also in Chaps. 4, 8, 9 and 10 of this volume). Though all
the three are present in what we recognize as mind and matter, gross matter is under-
stood to be preponderant of tamas, while mind is understood to be preponderantly
characterized by satva (Murthy and Kumar 2007). Though the three are described
to have many characteristics, prakāsha (illumination, brightness) for satva, pravrtti
(being active, being engaged) for rajas and moha (delusion, confusion) for tamas
are regarded as the cardinal features in the Bhagavad Gita (Chapter, 14, v.22).
In the Bhagavad Gita, this dualism is described as kshetra and kshetrajna (the
entire Chapter 13 is devoted to a detailed discussion of this distinction). The former
is the field, and the latter is the Knower of the field. The Knower here is the absolute
principle of reality, not the cognisor/subject/ego of modern psychology. For this
Knower, everything else is the field that includes mind-matter continuum. For a
psychological interpretation of the Bhagavad Gita, one can refer to Rama (1996).

3.2.3 Other Indian Perspectives

Jainism and Buddhism are two other major perspectives in India. Jaina tradition is
believed to be as old as Vedic tradition. There seem to be a lot of mutual influence
between these two traditions. Jainism has also influenced Buddhism to quite an extent.
Jainism and Buddhism, being non-Vedic in origin (meaning not accepting the
authority of Vedas as revealed scriptures), do not share all the fundamental assump-
tions of the Vedic tradition. Yet, they also recognize the transcendental dimension
of reality, the spiritual nature of humans, the notion of pure awareness, mind-matter
continuum and such like.

3.3 Some Basic Assumptions and Principles Derived

from Indian Perspectives

The possibility of the existence of another state beyond the three states normally
experienced by all human beings relativizes the experiences of our waking state.
Just as we tend to attach a secondary significance to our dream experiences, how-
ever good or bad they may be, after waking up, all the sages and saints of India have
time and again asserted that even our waking state experiences lose their intensity
once we ‘know’, i.e. experience, the higher state. The meaning and significance of
pain, suffering, illness, disease, health, happiness, well-being and related constructs
get radically altered.
3 The Perspectives on Reality in Indian Traditions and Their Implications… 47

This is not strange if we just look at it as another evolutionary possibility available

to humans. What prevents us from accepting such a possibility is that it changes
the figure-ground relationship to which we have accustomed to and also alters the
time-space relationship, which serves as the coordinates of our daily routine.
Adherence to the modern scientific framework adds to the disbelief in such a pos-
sibility, while many individuals irrespective of caste, creed, class, religion, gender,
age and nationality report such experiences all over the world. Modern evolutionary
perspective, with the view that humans are at the peak of evolutionary ladder, also
blinds our vision to the possibility of future evolution of mankind to a higher level.
The fact that Indian thinkers recognized the evolution of man, but did not limit
themselves by considering humans as the ultimate primates, enabled them to move
ahead and realize other human potentialities available (see Chap. 4 for further
discussions on this topic). Even the evolutionary perspective is regarded as a tale
told to a child to lull it into sleep, because it has validity only from a waking standpoint.
Just as a baby conceived, given birth, which grows into adulthood, marries, begets
children, reaches old age and dies – all in the dream – has no reality in waking state,
even the story of evolution is not valid from the ground state of consciousness.
This radical view of things is not limited to Indian seers and sages. Even mystics
of other traditions in other part of the world have reiterated it. So, what we consider
as Indian perspective is not exclusive or limited to India and hence universal in
nature. Probably, the only difference is due to some historical or environmental or
cosmological circumstance. Only Divinity perhaps knows why it is so that in India
we have had more seers and sages than those entire put together elsewhere in the
world, just like there are more cars in America than anywhere else in the world.
So our lifestyle has been determined by the vision of those ancient ones, and it con-
tinues to operate till date. We can summarize the Indian viewpoint as below.
Indian tradition upholds that (a) the spiritual reality can be perceived through
intuitive faculty; (b) the soul is independent of body; (c) consciousness, cit, is
different from mind/psyche; (d) body and mind are constituted of the same three
properties or guṇa – triguṇa – and hence they are not different in substance; (e) there
is life after death; (f) there are paranormal phenomena which can be experienced;
and (g) a human being can attain liberation from the cycle of birth and death through
Self-realization. These and other related beliefs have shaped the way of life in the
Indian subcontinent leading to a holistic perspective, in which a human being is
understood as biological, psychological and spiritual in nature and is in constant
relation with the whole cosmos.

3.3.1 Triguṇa

Among the above central themes and concepts, the one that has far-reaching implica-
tions for understanding the happenings in the universe is triguṇa, already referred
to in Sect. 3.2.2. This concept had its origins in the Vedas but was further developed
in the Sāmkhya perspective and has been found to be useful by all other systems.
48 K.K.K. Salagame

The concept of the three guṇa (satva, rajas and tamas) is widely used to understand
the properties of gross physical matter and its various inorganic and organic
manifestations in nature and also in accounting for psychological, social and religio-
spiritual phenomena. Hence, this concept has attracted the attention of psychologists,
and there have been many attempts to develop scales to understand the personality
with reference to the three guṇa (Murthy and Kumar 2007).
The three guṇa (also discussed in Chaps. 4, 9 and 10) operate in all the persons,
and the ancient literature has described the trait characteristics of those who are
predominantly governed by one of them. But these are not absolute, and it is quite
common that in a given situation or state, a person may be governed by a guṇa other
than the one which chiefly characterizes that person. Hence, the operation of guṇa
in human beings can be understood both as state and trait. Indian systems have
understood illness and disease as products of the predominance and malfunctioning
of rajas and tamas and health and well-being as the predominance of satva, both at
the level of a person and at social or even cosmic level. Increase in rajas and tamas
leads to negativity, and increase in satva leads to positivity. Since the three guṇa
always remain everywhere, the action and reaction, cause and effect are understood
with reference to them for everything. Just to take a simple example, if one consumes
more chillies, which is supposed to have an energizing property, it is rajas that is
acting and overacting to bring about certain effects. On the other hand, drinking
milk has the calming effect, and it is satva which is acting.
Since the triguṇa system allows for the interaction of mind and matter, a systemic
view is possible in which person and the environment mutually influence each other,
wherein the predominance of one of the three guṇa can affect one way or another.
Whether it is ecological imbalance at the macrocosmic level, biochemical imbalance
at the microcosmic level or cognitive/affective/conative disturbance at psychological
level, all are viewed as manifestations of negativity, and harmony at all levels is
understood in terms of positivity (as highlighted in Chaps. 5 and 10 of this volume).
Thus, illness or disease and health and well-being of a locale, a person, a society, a
nation or a culture reflect the dynamic equilibrium of the three guṇa. For example,
increased violence, aggression, crime, sexual assaults, corruption and such other
negative behaviours across globe are manifestations of increased dominance of
rajas and tamas over satva; so also the natural calamities and man created calamities
occurring all over the world. Understanding of global events in this way has led to
another popular conceptualization known as tāpa traya.

3.3.2 Tāpa Traya

The word tāpa means heat. It generates suffering and therefore is metaphorically
equated with suffering. Traya is three, and suffering is of three kinds originating
from three different sources, viz. physical (bhautika), supernatural (daivika) and
self (ātmika) since reality has many dimensions. Ādibhautika refers to all kinds of
suffering originating from physical or material causes, including environmental
3 The Perspectives on Reality in Indian Traditions and Their Implications… 49

factors, natural calamities, accidents, other physical beings – animal and human,
and all kinds of physical or material factors. Ādidaivika refers to all kinds of suffering
originating from discarnate entities and beings. Ādyatmika refers to all kinds of
suffering originated from personal factors – biological, psychological and social.
Thus, human suffering can take any form, and disease and illness are one such
manifestation.
Therefore, in Indian tradition, a person’s health and well-being are understood
not only with reference to gross physical body and its functional status but also in
relation to one’s mental status and supernatural aspects. A person’s illness, disease,
health and well-being may be influenced by one or more of these factors, and hence
they are understood multidimensionally. Thus, a person suffering from a prolonged
illness could be due to something that happened in this life in the physical world or
it may have been due to the action of a supernatural factor or it could have its origin
in the activities of a previous life or it could be due to one’s mental factors and so
on. Since the past can carry its effect into the present, present can equally affect the
future. Similarly, even health and well-being are also understood with reference to
past, present and future. Thus, interventions required have to be appropriate to the
dimension of reality from which the suffering has originated. This is reflected in
Āyurveda (which means theory and practice of longevity, not just medicine) that
speaks of three kinds of intervention: yuktivyapāshraya, daivavyapāshraya and
sattvāvajaya, which correspond to the three origins of suffering. The first one
involves all kinds of medical treatment, also known as kāya chikitsa (treatment for
the body); the second refers to all kinds of practices that are aimed at influencing
supernatural forces, also known as bhoota vidya; and the third refers to psychological
therapy and counselling which involves restrengthening sātvic tendency.
It is to be noted here that the concept of tāpa traya is meaningful only when one
understands it in the context of how a human being is viewed in Indian traditions.
The recognition and affirmation of the spiritual/transcendental dimension of human
nature led ancient Indian seer and sages to view human being as bi-dimensional
rather than uni-dimensional. In other words, human being is not understood only in
terms of gross physical body but also in terms of an extracorporeal soul/spirit that
transcends the limits of the physical body as well as the notion of space and time.
It is not that people and thinkers in other parts of the globe have not recognized
this dimension. The distinctiveness of India in this issue is its consistent and con-
tinuous affirmation of this dimension for the past thousands of years and upholding
that as the primary aspect of human nature rather than gross physical body.
This feature comes through very explicitly and forcefully in one of the verses of
the Bhagavad Gita, which when translated in English reads as follows: ‘just as
humans throw away a torn cloth/dress and wear a new one, the one who is in this
body takes upon a new one when it gets worn out (dies)’ (Chap. 2 v. 22) (translation
author’s). This distinction between dehi (own who is in the body or owns the body)
and deha (gross physical body) is fundamental in shaping the traditional views on
illness, suffering, health and well-being. It has made possible for people in India to
view the body as something that takes birth, develops/grows and decays and dies
eventually just as a plant or an animal. That provides a detached perspective on
50 K.K.K. Salagame

one’s body and understands illness and health, disease and recovery, treatment and
cure in a more natural way.
This distinction has also shaped the way such events as death are expressed
linguistically, with reference to dehi rather than deha. For example, in Kannada
language, which is my mother tongue, it is said jīva hoitu (soul has gone). Since
dehi or jīva is the same as prāna, life force, prāna hoitu (life force has gone) is also
another usage to refer to death. In Sanskrit literature and its derivatives, the prāna
is also equated with a bird, pakshi, and one’s death is referred to metaphorically
as the flying away of a bird from its nest. One can find such expressions in all
the Indian languages.
There are two important aspects here which require further elaboration. First,
since the gross physical body is not viewed as the primary aspect of a human being,
it does not get more attention than what it is due, either in birth or death or during
one’s life. Compared to Western culture, where lifestyle predominantly centres on
primary bodily needs and its secondary elaborations, Indian culture is centred on
dehi or jīva, its terrestrial and transmigratory existence and the eventual release
from the cycle of birth and death. Therefore, it is the culture of the soul that is prac-
tised rather than culture of the body. Sixteen culturing rites and rituals (shodasha
samskāra) are practised, starting from the stage of conception to death, aimed at the
development of the soul first, and only secondarily of the body, for it is the soul
which is on its journey from one bodily existence to the other (the importance of
rituals for health and well-being is thoroughly discussed in Chap. 6). Soul in this
journey can continue to actualize its immense potential for which body is a vehicle.
Thus, a yogi can leave his/her body and enter a dead body (para kāya pravesha),
dismantle one’s limbs and torso and reassemble (khanda yoga), cast of his/her aged
or worn out body at will (prāyopavesha), manifest simultaneously in more than one
place, transfer one’s youthfulness to an aged person, take on someone else’s physi-
cal illness and consciously suffer, self-cure one’s dreaded diseases and what not.
While the above examples are exceptions rather than rule and only adept yogi
could do all that, they are cited here to illustrate the fact that ancient Indian seer and
sages were well aware of the immense hidden potentialities of the soul that can
manifest through the body and hence cared and protected their body as an instrument
rather than body as the only living reality. Towards this end, they had developed
very sophisticated understanding of bodily organs and functions and their mainte-
nance, which modern medical science is yet to come to terms with.
There is enough traditional knowledge and wisdom available in folklore as
well as in classical texts related to medicine about how to care for the body from
birth to death. What it means is life of a human being was/is not construed in terms
of bodily existence alone, thereby attaching all the importance to bodily security
and bodily needs. In other words, it was/is not body centred still, despite all the
modern innovations like ventilators, pacemakers, plastic surgeries, transplantation
and implantations. The idea that body is like a cloth that gets worn out in due course
is an integral part of the Indian psyche.
If this is so, then how do we understand the place of body in human existence;
what is the purpose of bodily existence; what is the relation of body, mind and soul;
3 The Perspectives on Reality in Indian Traditions and Their Implications… 51

and what is the meaning of illness, disease, suffering, death, health, well-being and
so on? All the Indian systems have dealt with these issues as their central concern.
Gautama the prince became Buddha the realized one, in course of finding answer to
these questions. It is not possible to review all the different answers found by ancient
seer and sages for these questions. But what can be discussed is how their insights
shaped the cultural outlook of Indian civilization in general and issues related to
health and well-being in particular.

3.3.3 Perspectives on the Constitution of Human Beings

Though we speak so much about psychology and psychological effects, the existence
of mind, soul and Self remains controversial. However, in Indian traditions, soma
(body), psyche (soul/mind) and spirit (Self) are recognized as aspects of a human
being, and their experiential validity is affirmed time and again. In other words, man
is regarded as a complex of biological, psychological and spiritual features.
In Kathopanishad (a.k.a Kāthakopanishad), there is the metaphor of a chariot,
ratha, which describes the relationship between these three as follows: ‘one has
to understand the ‘self’ as the person seated in a chariot and the ‘body’ as the
chariot; ‘buddhi’ has to be considered as the charioteer; ‘manas’ as the bridle and
the ‘sense-organs’ as horses’ (I, 3, 3–4) (Hiriyanna 2004). As Jadunath Sinha (1961)
has noted, in this framework of understanding, manas is superior to sense organs;
buddhi, intellect, is superior to manas; self is superior to buddhi; and there is
nothing superior to the Self. The self mentioned here is identified with the supreme
Self (Brahman). From the Upanishadic point of view, the mind-body complex is an
organ of experience subordinated to the Self. The body, sense organs, manas
and buddhi exist for the Self, but the Self exists for itself, and there is no reality
beyond it (Sinha 1961). It is spiritual in nature and is different from the bio-psychosocial
identity or self-senses that we develop in our lifetime, which leads to a conditional
existence.
In Taittiriya Upanishad, the same idea is expressed in a different way, with
another metaphor: kosha. In this Upanishad (Section 2 – Ānandavalli), spiritual Self
is characterized as ānandamaya and is distinguished from the other four koshas
ordinarily translated as sheaths. They are labelled annamaya (gross physical body),
prānamaya (vital or life force), manomaya (emotions and drives) and vijnānamaya
(discriminative intellect and intuitive functions). From Taittiriya Upanishad point
of view, a person’s innermost essence or Self is itself blissful, ānandamaya, and at
the core all human beings have unbounded joy. However, people do not realize this
because this inner core is covered by the four sheaths from subtlest (vijnānamaya)
to grossest (annamaya).
A third way of understanding human being that we come across in Indian tradi-
tion is in terms of three types of body, viz. sthūla sharīra, sōkshma sharīra and
kārana sharīra. Sthūla sharīra refers to gross physical body. Sōkshma sharīra also
called linga sharīra termed as subtle body is understood as constituted of prānamaya,
52 K.K.K. Salagame

manomaya and vijnānamaya kosha as described in Taittiriya Upanishad. Kārana

sharīra, termed as causal body, represents the ānandamaya of Taittiriya Upanishad,
and deep sleep is the manifestation of causal body (Chap. 5 further describes the
three bodies). Beyond these three bodies is the Ātman, which is self-luminous,
pure, immutable and eternally free – the witness of the three empirical conditions of
waking, dream and deep sleep, and different from the five sheaths (Sinha 1961).
Hence, according to Indian traditions, when one realizes spiritual nature, his/her
locus of identity shifts from biological and psychosocial aspects to newly found
spiritual nature, and the person attains an inner sense of ‘peace’, ‘tranquillity’ and
‘bliss’, even if one is having some problem at the levels of the gross and subtle body.
Therefore, Indian traditions hold that the ultimate sense of well-being is not contin-
gent upon the absence of physical or psychological ailment. We have in India plenty
of instances of mahātma (as in Mahātma Gandhi, meaning an evolved soul) and
jeevanmukta (a person who is liberated from the cycle of birth and death through
Self-realization) who did suffer from certain physical diseases and yet could remain
in a state of bliss like Sri Ramana Maharshi who underwent surgical intervention for
a malignant cancerous growth without anaesthesia three times (see Swamy 1985).
Thus, from traditional Indian point of view, all issues related to disease, illness,
therapy and treatment are applicable only to gross physical body (sthūla sharīra)
and to what is understood as subtle body (sōkshma sharīra), not to Ātman, which is
free from all kinds of afflictions. Thus, health and well-being defined with reference
to gross and subtle bodies are considered relative, and one is urged to attain the
supreme well-being, which is associated with Atma sākshātkāra, Self-realization.
If we really think about the Cartesian differentiation of res cogitans and res
extensa, and also his famous statement cogito ergo sum (I think, therefore I am), we
find that Descartes was very near to Indian thought, except that he located himself
or his identity at the thinking principle, whereas Indian seer and sages went beyond
that and affirmed another level of identity, viz. I am, therefore I am.
While all the Indian systems recognized that level as pure awareness, different
systems spoke of it in different ways.2 Veda, Upanishads and other Vedic related
systems called this level as Ātman, the Sāmkhya referred to it as Purusha, Bhagavad
Gita called it kshetrajna and Patanjali in his Yoga Sutra called it drashtu. But
Buddha refrained from equating it with any first-person references. Whatever may
be the difference, the fact remains that the Indian systems recognized a level of
ground awareness. It is interesting, as I type this chapter sitting here in Conway, I
remember the difference in how we refer to the different floors of a building. What
we refer to as ground floor in India is termed as first floor in the USA. But the site
of demolished World Trade Centre is referred to as Ground Zero, because there are
no buildings and floors any more. What Indian thinkers are referring to is such a
Ground Zero State of Consciousness.
Operationally, this state has two aspects: intelligence/awareness/consciousness
and energy. The term caitanya embodies both of these connotations. So to have

2
Ekam sat viprā bahudā vadanti – Truth is one but knowledgeable persons speak of it differently
(trans. author’s).
3 The Perspectives on Reality in Indian Traditions and Their Implications… 53

realization of this fundamental principle is to be omniscient, omnipresent and

omnipotent. This can only be realized when one wakes up from a ‘grand dream’.
The seers and sages who had this realization (a) could manipulate the forces of
nature at will, (b) could be present simultaneously at different dimensions, (c) could
affect changes at distance and (d) could intervene in the life of people for their good
from a cosmic perspective and remove their karma. They were also embodiment of
great compassion, love, altruism, wisdom and such other virtues. They were the real
Guru, not the contemporary corrupt usage of that term appended to all kinds of
persons whether they have really attained that level or not.
In the presence of such great Guru, healing happens, illness gets cured, health
improves and the ultimate sense of well-being termed as ānanda is attained. All this
happens whether a person is near or far physically, because the ‘presence of a Guru’
is not the bodily presence, it is the presence of a spiritual kind. Autobiographies and
biographies of many great masters, day-to-day recordings in the presence of such
masters and first-person accounts of people who underwent healing experiences
shared in print in popular and academic sources document the myriad instances of
suffering being removed.
This sounds like a fairy tale to many, but there have been records and testimonies
of the existence of many such personages who include modern mystics and sages of
the twentieth century.

3.4 Implications for Health and Well-Being

Research and Practice

In the recent past, more and more researchers are willing to believe in mind and its
effects, though their views on mind differ. While some accept it as independent of
body, others consider it as an emergent phenomenon of the activity of the brain.
Either way it has been possible for researchers to speak of psychophysiological
disorders, mind-body medicine, psychosomatic medicine, and psychoneuroimmu-
nology, all resulting in bio-psychosocial models of illness and health. However,
beliefs in a soul and Self are a far cry, and holistic approaches which incorporate all
the three aspects of human nature are rare.
More recently, a new field known as ‘energy psychology’ has emerged, which
essentially deals with notions that are similar to the concepts of sōkshma sharīra
and kārana sharīra. Though we in India do not have scientific research to prove the
existence of sōkshma sharīra and kārana sharīra as described in our tradition, some
of the research studies conducted in Western countries on energy fields or aura
around the human body (referred to as subtle body) using imaging techniques such
as Kirlian photography lend some support to such a conceptualization. Such
researches and personal experiences of people there have led many Westerners to
take the concept of chakra seriously
Chakra is a Sanskrit term, which literally means a ‘wheel’. In the present context,
it refers to centres of energy located across the human spine, from lumbar region
54 K.K.K. Salagame

to the vortex/top of the head. They are totally seven in number. As Dale (2011) puts
it, ‘chakras regulate, maintain, and manage the physical, emotional, mental, and
spiritual aspects of our being on the physical plane. Chakras themselves serve as
revolving doors or portals between our body, mind, and soul’ (p. 23). The reports of
people who are endowed with clairvoyant abilities have provided some additional
evidence confirming the conceptualization of subtle and causal body (Dale 2009,
2011; Lockhart 2010).
Further, recent popularization of healing practices such as ‘pranic healing’ and
‘reiki’, which are known to operate on energy fields around gross physical body,
may be treated as another indirect evidence for the existence of subtle and causal
dimensions of human nature (Eden 2008). Many of the traditional healing practices
prevalent in India operate at these levels. Similarly, research on ‘out-of-body experi-
ences’ (OBEs), ‘near-death experiences’ (NDEs) and ‘reincarnation’ cases conducted
by both Western and Indian researchers (Krippner, and Friedman 2010a, b) may
also be taken as possible supportive evidence for the Indian belief system.
Second, in Indian traditional society, metaphysical beliefs – in karma, in God’s
will and in spirits – are presumed to be important determinants of many events in
one’s life including diseases and suffering of all kinds. Karma or karmaphala refers
to the suffering that is frequently attributed to one’s own misdeeds in this and/or previ-
ous lives. God’s will refers to the control of an external agent or power that governs
reward and punishment, not always according to what one deserves. Fate implies that
all life events are predestined and one can do little to alter them (Kohli and Dalal
1998). Hence, Indian tradition holds that disease and illness can be understood as
one manifestation of human suffering. A more recent development in the Western
world that lends some theoretical and empirical evidence is what is known as infor-
mation medicine (McTaggart 2008a, b; http://www.thelivingmatrixmovie.com).
These developments are interpreted with reference to the quantum view of the
universe, which is again coming closer to the non-dual and dualistic view of reality
espoused in the Indian traditions (in Chap. 8 the parallelism between quantum logic
and Vedic view of the universe is deeply discussed). While the dualist view of
two fundamental realities of purusha and prakṛti can be used as a framework to
understand, many healing approaches that involve invoking a higher power, the
spontaneous healing that take place in the presence of mystics or in sacred places
could be explained with reference non-dual perspective.
While the positive psychology movement is hotly debating on the nature and
sources of happiness and well-being, the ancient Indian seer and sage went a step
ahead and declared that the fundamental or essential sense of well-being lies in the
transcendental dimension and characterized it as ānanda. They did not make any
distinction in the quality of happiness associated with the material life and the spiri-
tual life. On the other hand, they treated ānanda as the basic experience and regarded
happiness related to mundane life as an aspect of this essential experience.
They also spoke of well-being as preyas and shreyas, the former corresponding to
the material and social levels of reality and the latter to the transcendental level
of reality. Contemporary distinction between hedonic and eudaimonic happiness
3 The Perspectives on Reality in Indian Traditions and Their Implications… 55

corresponds to preyas. Ancient seer and sages as well as modern ones have along
pointed out that shreyas is what matters ultimately (Salagame 2012).

3.5 Modes of Intervention from the Indian Perspective

In view of the multidimensional outlook on human nature and his/her suffering, the
modes of therapy and treatment range from the most mundane to the highly spiritual,
according to the level at which disease and illness are understood to have occurred.
To put it in medical terminology, the relation of symptomatology to aetiology and
pathology is governed by ontology, and therefore the modes of intervention become
multimodal.
Anand et al. (2001) have noted that healing systems differ in terms of explanations
of suffering, healing techniques and the types of healers. They distinguish between
three types of healers: (a) Professional healers, known as vaid (vaidya) and hakim,
who deal primarily with physical suffering though they frequently practice what we
can call ‘psychological medicine’. This corresponds to physical/bodily origin of
problems (ādhyatmika) already referred to in Sect. 3.3.2. (b) Folk and popular
healers, who include palmists, horoscope specialists, herbalists, diviners, sorcerers
(a variety of shamans) and ojhas. Their healing techniques draw from astrology,
medicine, alchemy and magic and thrive on folk and popular beliefs and practices.
(c) Mystical-spiritual healers, who include sādhus, saints, priests, and swāmis.
They primarily work on the religious faiths and belief systems of the community.
While a vaidya or hakim may address problems related to ādhyatmika source, the
other two – folk and mystic-spiritual healers – address problems emerging from all
the three ādibhautika, ādidaivika and ādhyatmika sources According to these
researchers, all these traditional healing practices share an element of mysticism
and a flavour of sacredness; they thrive on myths, legends, history, rituals and belief
systems of the local communities; and cultural symbolism is used to bring about a
transformation of consciousness (see Chaps. 6 and 7 in relation to these topics).
Thus, it is to be noted that Indian perspectives on health and well-being gain a
wider meaning than how it is understood in modern medicine, psychiatry and
psychology. Health and well-being of a person are integral aspect of the health and
well-being of the cosmos as a whole. Hence, the prayers – lokāh samasthāh sukhi-
nobhavantu – let the whole cosmos be well or let everyone in all the worlds be well;
sarve santu sukhinah, sarve santu nirāmaya, sarve bhadrāni pashyantu, ma kashid
dukhabhagbhavet, Om Shānti, Shānti, Shānti – let everyone be well, let everyone
remain at ease, let everyone have an auspicious view or outlook, let not sorrow
afflict any one, Om peace, peace, peace (author’s translation).
56 K.K.K. Salagame

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Chapter 4
Concept of Health in Āyurveda

P. Ram Manohar

4.1 Introduction

Āyurveda defines itself as the science or knowledge of life (Yadavji 1980), and its
primary focus is on the quality and span of life. Classical texts define Āyurveda as
that which enables the individual to obtain and know life (Suśruta Saṃhitā Sūtra
Sthāna 1, 15 in Yadavji 1980).
The formal definition of Āyurveda as expounded in the Ćaraka Saṃhitā states
that Āyurveda is the body of knowledge that describes the wholesome, unwholesome,
happy and unhappy states of life as well as what is wholesome and unwholesome
for life, in addition to defining the span of life (Cited in Ćaraka Saṃhitā, Sūtra
Sthāna, 1, 41 in Yadavji 1992). This definition succinctly summarises the subject
matter of Āyurveda and makes it clear that Āyurveda is a science of health manage-
ment more than being a medical system.
In another context, the same text defines Āyurveda as the knowledge that informs
about substances, properties and actions that are supportive of and antagonistic to
life (Cited in Ćaraka Saṃhitā, Sūtra Sthāna, 30, 23 in Yadavji 1992).
The primary goal of Āyurveda is therefore preservation of life. Longevity is the
ultimate endpoint of Ayurvedic interventions. However, longevity has no meaning
if it is not accompanied by health and well-being. The parameters for determining
quality of life are, therefore, based on the tripod of life, health and wellness in
Āyurveda (Harisastri 2002). By adopting the healthy lifestyle outlined here, one
attains longevity, health and prosperity at the same time (Aṣṭāṅga Hṛdaya Saṃhitā,
Sūtra Sthāna, 2, 48 in Harisastri 2002)
Āyurveda distinguishes between timely and untimely death and explains that
medical science has meaning and relevance in human life because premature
death can be prevented (Sharma 2012). There are hundred types of untimely death

P.R. Manohar ()

AVP Research Foundation, Coimbatore, Tamil Nadu, India
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 59
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_4,
© Springer Science+Business Media Dordrecht 2013
60 P.R. Manohar

and only one timely death (Aṣṭāṅga Saṃgraha, Sūtra Sthāna 9, 89 in Sharma 2012).
The latter is like the wearing out of a chariot that happens naturally in course of
time, and untimely death is like the premature damage to a chariot that happens due
to rough use (Aṣṭāṅga Saṃgraha, Sūtra Sthāna, 9, 95 in Sharma 2012).
To find out the ways and means to live the full human life span has been the pri-
mary goal of Āyurveda. For this reason, Āyurveda characterises itself as the knowl-
edge of life (Āyus (life), Veda (knowledge)) rather than as a medical system. The
opening chapters of the classical canon of medicine, the Ćaraka Saṃhitā, are therefore
named as the quest for longevity (dīrghaṃjīvitīyam) (Yadavji 1992). Sage Bharadvāja
set out to the abode of the King of Gods, Indra, to obtain the knowledge that will
give a long life (Ćaraka Saṃhitā, Sūtra Sthāna, 1, 3 in Yadavji 1992).
Vedic literature is replete with prayers for living the full life span. One mantra
goes thus: ‘May we live a hundred autumns, may we witness a hundred autumns’
(Sahebrao 2009). Another mantra aspires that the ears hear and the eyes see what is
auspicious and that we live the full life span with healthy organs (Sahebrao 2009).
The classical texts of Āyurveda reaffirm these sentiments stating that the human life
span is a hundred years and that by adopting a healthy lifestyle, it is possible to live
the full potential.
It is interesting to note that these prayers aim for collective well-being, hinting at
the importance of collective human effort and participation to create the social and
environmental conditions conducive for healthy life span (see Chap. 3 for further
discussion of this topic). The Ćaraka Saṃhitā makes a distinction between whole-
some, unwholesome, happy and unhappy states of life reconciling the conflict
between personal and communal well-being. Public health and the wellness of the
community as a whole has been given importance in Āyurveda. In accordance with
the tenets of the Sāṃkhya system of thought, Āyurveda posits that there are three
stressors in human life that lead to mental and physical illness and suffering. These
emanate from within the individual (adhyātma), from the external environment
(ādhibhautika) and by the act of providence (ādhidaivika) (Yadavji 1980).
There are three types of stressors that include the self, the environment and
beyond. Therefore, sorrow in the form of disease originates from three sources—the
individual, the external environment and by the act of providence (Suśruta Saṃhitā
Sūtra Sthāna 24, 4–5 in Yadavji 1980).
It is from this perspective that Āyurveda evolved a community-based and eco-
logical approach to health management. Forming the right relationships and net-
works between the individual and the world at large in a dynamic manner constitutes
the basis of good health (see Chaps. 6 and 7 for a thorough discussion on this point).
Longevity and healthy ageing are primary twin goals of Āyurveda and come
within the purview of preventive medicine. Preventive medicine is known as
Svastha Vṛtta in Āyurveda and is not a defensive approach to maintenance of
health. Āyurveda has developed a model of wellness as well as illness, and the
Ćaraka Saṃhitā clarifies that the purpose of Āyurveda is twofold, preventive and
curative (Yadavji 1992). The purpose of this treatise is twofold—the preservation
4 Concept of Health in Āyurveda 61

of health in the healthy and cure of the sick (Ćaraka Saṃhitā, Sūtra Sthāna, 30, 26
in Yadavji 1992).
Āyurveda advocates a proactive and interventional approach to promote higher
levels of health. In fact, Āyurveda emphasises that even the so-called healthy indi-
vidual needs to be treated to enhance immunity and health (Yadavji 1992). Medicines
or interventions are of two kinds—one that enhances the health of the healthy and the
other that cures the sick (Ćaraka Saṃhitā, Cikitsā Sthāna, 1, 1–4 in Yadavji 1992).
The section on treatment of diseases in the Ćaraka Saṃhitā begins with chapters
that deal with the enhancement of health in relatively healthy individuals (Yadavji
1992). Interestingly, the first two chapters in the section on treatments in the Ćaraka
Saṃhitā deal with ageing and reproductive medicine. By this arrangement, it is
being hinted that even a healthy individual needs to be treated systematically to
enhance immunity and the quality of the tissues.
Health is considered to be an outcome of an evolutionary and adaptive process of
interaction between the individual and the environment. Āyurveda defines health as
the harmonious interactions with appropriate objects in the world at the appropriate
moments. In other words, the right responses to relevant spatio-temporal matrices in
which the individual gets embedded in the journey of life lead to healthy outcomes
(a thorough discussion of this point is provided in Chap. 5). For this reason, a key
determinant of health is awareness of self and environment and optimal responses
to ever-changing external stimuli. Health is to be cultivated through an evolutionary
process of learning by actions based on informed decisions. In the ultimate analysis,
it is the lack of awareness known as prajñāparādha that is identified as the root
cause of disease and untimely death.
To respond appropriately to situations requires awareness of self and environ-
ment. Āyurveda defines the healthy individual as svastha, one who is centred in the
self or acts from awareness of the self when responding to the changing situations
in the external environment. It is this insight that underpins the personalised or
person-centred approach to medicine in Āyurveda.
Āyurveda has been propounded to discover customised solutions for the indi-
vidual, known as the karma puruṣa who gropes in the spatio-temporal matrix of
existence seeking life, health and longevity (Yadavji 1992). The conscious per-
son is the focus of Āyurveda, and it is for the sake of the person that this knowl-
edge has been propounded (Ćaraka Saṃhitā, Sūtra Sthāna, 1, 47 in Yadavji
1992). Karma puruṣa means the active person who is perpetually interacting
with and responding to the external and internal environment. Āyurveda empha-
sises that a person-centred approach is indispensable because each individual is
unique in terms of the mind, body, social relationships, spiritual outlook and so
on and so forth.
The cornerstone of the Ayurvedic approach to personalised medicine is the con-
cept of physical and mental constitution. Every individual is a complex and unique
expression of the dynamic interaction of their physical and mental make-up. The
mental constitution determines whether the individual engages in the world with
awareness, emotion or ignorance. The physical constitution determines whether the
62 P.R. Manohar

biological processes are oriented towards conservation, transformation or utilisation

of energy. The constitution of the individual sets certain limits as well as scope for
the individual to climb the ladder of higher levels of health.
Health is a state of equilibrium, the optimal balance in the process of preservation,
transformation and utilisation of energy that results in structural as well as func-
tional integrity of the body leading to a state of comfort and ease of the senses, mind
and self. Suśruta puts forth this idea explicitly in his famous definition of health:
When the physiological functions, digestion and metabolism, the structural elements and
the process of excretion are in balance, then one’s self, sense organs and mind are at ease
characterising the state of perfect health (Suśruta Saṃhitā Sūtra Sthāna 1, 15 in Yadavji
1980)

Āyurveda attempts to discover the optimal way to balance the body and mind
with proper understanding of the constitution of the individual that will enable to
establish the right relationships with the external environment.

4.2 Longevity and Healthy Ageing

Longevity is the primary goal of Āyurveda, and this goes hand in hand with healthy
ageing. Āyurveda considers ageing as a disease and therefore as a condition that can
be treated (Yadavji 1992):
These interventions pacify the disease of old age and confers cognitive powers and memory
(Ćaraka Saṃhitā, Cikitsa Sthāna, 3, 27 in Yadavji 1992)

The branch of Rasāyana, which improves immunity and delays ageing, is said to
be a remedy for the disease of old age. It is a fundamental precept in Āyurveda that
humans can not only live the full life span but also age healthily without cognitive
decline and physical debility (Yadavji 1992):
By implementing the rejuvenative treatment, one can attain long life span, memory, cogni-
tion, health as well as youthfulness. (Ćaraka Saṃhitā, Cikitsa Sthāna, 1, 7 in Yadavji 1992)

However, the foundation for healthy ageing has to be laid at a young age and not
later than the middle age of an individual (Sharma 2012). There is a limit to what
can be done after old age has set in:
Rasāyana or rejuvenative therapy must be performed before ageing sets in in the early or
middle phases of life (Aṣṭāṅga Hṛdaya, Uttara Sthāna, 39, 3 in Harisastri 2002)

In fact, Āyurveda has observed that interventions have to be initiated at the stage
of conception itself to enhance the quality of life in late stages (Harisastri 2002).
Physical constitution is formed at the time of conception and, like the genetic make-
up of the individual, cannot be changed (Aṣṭāṅga Hṛdaya, Sūtra Sthāna, 1, 9–10 in
Harisastri 2002). Detoxification programmes and strengthening of the tissues
through structured interventions aim to enhance and upgrade the hardware of the
body (Harisastri 2002):
4 Concept of Health in Āyurveda 63

As a result of the purificatory treatments followed by rejuvenation therapy done at the junc-
tions of the seasons, the tissues become healthy, immunity and resistance are improved and
the process of ageing is slowed down (Aṣṭāṅga Hṛdaya, Sūtra Sthāna, 7, 49 in Harisastri
2002).

Āyurveda points out that higher levels of health and well-being can be attained
through such interventions. The role of the mind is cardinal in the process of suc-
cessful ageing. One of the goals of Rasāyana is to keep one’s mind supple and active
in old age (Yadavji 1992):
The goal of Rasāyana or rejuvenation is not just to prolong life, but to also transform
consciousness to a higher level of awareness (Ćaraka Saṃhitā, Cikitsā Sthāna, 1, 80 in
Yadavji 1992)

Healthy ageing is an outcome of successful adaptation and evolution of the per-

son as a whole. Emotional stability and cultivation of insight and awareness are as
important as strengthening of tissues and immunity for healthy ageing. Āyurveda
offers many interesting ideas, psychosomatic approaches and pharmacological
interventions to facilitate successful ageing.

4.3 Physical and Mental Constitution

Āyurveda considers each individual to be unique, and consequently, a person-

centred approach is advocated to not only curative medicine but also preventive and
promotive interventions.
Variability between individuals stems from constitutional make-up. There are six
types of constitutions in Āyurveda: (1) Racial Constitution, (2) Familial Constitution,
(3) Geographical Constitution, (4) Temporal Constitution, (5) Age related Constitution
and (6) Individual Specific Constitution (Ćaraka Saṃhitā, Indriya Sthāna, 1, 5 in
Yadavji 1992). Certain characteristics of individuals may be specific to the race, fam-
ily, geographical location, seasonal cycles and age. These are characteristics that are
shared in common by the members of the group. Apart from that, there is the indi-
vidual specific constitution which is of two types—the physical and the mental.
The physical constitution is subdivided into three broad categories which are
further expanded to make seven phenotypes (Harisastri 2002). These seven types of
physical constitution derive from the dominance of the three doṣas—Vāta, Pitta,
Kapha, Vātapitta, Vātakapha, Pittakapha—and balance of all the three. The bal-
anced constitution is the most healthy, and the dual combinations are the worst
(Aṣṭāṅga Hṛdaya, Sūtra Sthāna, 1, 10 in Harisastri 2002).
Mental constitution is broadly of three types which when further subdivided
makes at least sixteen categories (Yadavji 1992):
Mental constitution is broadly of three types - satva, rajas and tamas. … Out of these which
can be subdivided into innumerable subtypes, there are 7 satva subtypes, 6 rajas subtypes
and 3 tamas subtypes (Ćaraka Saṃhitā, Śārīra Sthāna, 4, 35–40 in Yadavji 1992)
64 P.R. Manohar

The concept of the physical and mental constitution provides a framework to

understand the variations between individuals. Though these categories help to gen-
eralise individual variations within limited classification, they actually serve as a
flexible framework to pinpoint the peculiarities of an individual (see Chap. 9 for
further details on this topic).
The Ćaraka Saṃhitā explicitly explains the interplay of physical and mental
constitution in defining the health and well-being of an individual. The text clarifies
that the three doṣas define the scope of health in the body while the three guṇa
define the scope of well-being in the case of the mind (cited in Ćaraka Saṃhitā,
Śārīra Sthāna, 4, 34 in Yadavji 1992).
The physical constitution is determined by the inherent balance of the three doṣas.
While it is difficult to define and characterise the three doṣas within the scope of a
short paper, it can be generally stated that the three doṣas actually represent the
functional balance of the body. They are often erroneously translated as wind, bile
and phlegm. They represent the totality of the anabolic and catabolic activities of
the body (the concept of doṣas is deeply discussed also in Chaps. 3, 8, 9 and 10).
Many attempts have been made to correlate these entities with functional expres-
sions of the body. For example, Vāta is correlated with the nervous system, Pitta
with the digestive and endocrine system and Kapha with immunity and the physical
structures. In one sense, the doṣas represent the sum total of the exchange of matter
and energy between the internal and external environment. Vāta represents the utili-
sation, Pitta the transformation and Kapha the preservation of energy. These pro-
cesses generally tend to balance out each other. Depending on various factors
including genetics and influences at the time of conception, the baseline gets fixed
at different points in different individuals. As a result, there are individuals whose
bodies tend to behave like energy conservers, others like energy transformers and
still others like energy spenders. Thus, an individual with a Kapha constitution
tends to preserve more energy than is spent. This trend has an impact on various
physiological and psychological parameters and gives a calm, laid-back disposition
to the individual who puts on weight and has a stable body. The Vāta constitution
on the other hand tends to spend more energy than is conserved creating a psycho-
logical disposition characterised by thought diarrhoea, hyperactivity, anxiety and a
physique that is poorly built and thin. The Pitta constitution tends to be transforma-
tive and hence has a creative mind and is very organised. At the physical level, they
experience much heat and sweat in the body. The characteristics of different physi-
cal constitutions have been dealt elaborately in classical Ayurvedic texts. In recent
times, attempts have been made to scientifically validate the Ayurvedic concept of
prakṛti or physical constitution with encouraging results (Prasher et al. 2008;
Bhushan et al. 2005; Patwardhan et al. 2006; Patwardhan and Bodeker 2008).
The combination of two and three doṣas creates additional personality types
making seven broad categories in all. These combinations in different proportions
create variations of personalities. The physical constitution cannot be changed,
albeit it can be influenced by interventions at the time of conception (Yadavji 1992):
The constitution formed at the time of conception becomes the basis for all the expressions
of the individual. It is influenced by the sperm and ovum, the conditions in the uterus and
4 Concept of Health in Āyurveda 65

the diet and behaviour of the mother and the preponderance of the elements forming the
fetus (Ćaraka Saṃhitā, Vimāna Sthāna, 4, 8–95 in Yadavji 1992)

Though it cannot be changed, physical constitution can be managed. The physi-

cal constitution sets the scope and limits for achieving higher levels of health.
Assessment of the physical constitution is therefore the central component of per-
sonalised medicine in Āyurveda (Yadavji 1992; Harisastri 2002). In classical texts
like Ćaraka Saṃhitā and Aṣṭāṅga Hṛdaya, constitution has been listed as one of the
key factors to be checked to assess the disease and prescribe treatment. Physical
constitution becomes therefore the reference point for working out a customised
regimen for promotion and maintenance of health as well as for curative
interventions.
The human personality is complex, and physical constitution cannot capture this
complexity in totality. It is for this reason that Āyurveda discusses about racial con-
stitution, familial constitution and so on and so forth. Two individuals with appar-
ently similar physical constitution may have different expressions on account of
racial and familial inheritance. The human being is multidimensional and so is the
constitution. Apart from physical constitution, there is mental constitution that
accounts for variability of one individual from another.
Mental constitution is broadly of three types depending on the nature of the mind
to be aware, to be charged with emotion or just be ignorant. These three basic ten-
dencies of the mind are known technically as Satva, Rajas and Tamas. They are
known as guṇa or qualities, and these terms cannot be easily translated. We can only
attempt to provide approximate definitions. Satva is a state of awareness of reality
that brings calmness and quietude of the mind and an ability to respond to situations
with composure. Rajas, on the other hand, is a very agitated state of the mind which
distorts reality and leads the person to be overreactive to situations. Tamas is an
indulgent and inert state of the mind characterised by lack of awareness leading to
non-responsiveness to external situations. All the three are coexistent in everyone,
and Rajas and Tamas within limits aid in expression of emotions and help in relax-
ation, withdrawal and rest.
The mind of different individuals can predominate in Satva, Rajas or Tamas, and
thus, there are three broad mental types. However, there are many subtype varia-
tions within each category depending on the degree of dominance of the three guṇa.
At least sixteen types of mental constitutions are described in the Ayurvedic texts
(Yadavji 1992).
The complexity of the human personality stems from the dynamics or rather the
interplay between the physical and mental constitution in the backdrop of the ten-
dencies and traits inherited from one’s race, family, place, time and age. The physical
and mental constitution combines to create the unique individual. For example, a
person who has a Kapha constitution physically can be Sātvic in mind whereas
another person with the same physical constitution can be Rajasic in mind. An indi-
vidual who has a Rajasic mental disposition and a Pitta constitution can be extremely
explosive and violent, whereas one who has a Sātvic mental nature and a Kapha
constitution can be extremely calm and peaceful.
66 P.R. Manohar

A deep understanding of the complexity of human personality through the

study of constitution enables the physician to understand the vulnerabilities and
strengths of the individual from a medical point of view. The emotional tenden-
cies, susceptibility to disease and ability to respond to stress and recover from
illness are all anticipated with the help of analysis of the constitution of the
individual.
According to Āyurveda, the body and mind make up a continuum, and so they
influence each other profoundly. The relationship between the body and the mind
is compared to that of ghee and an iron vessel. If ghee is poured into a hot iron
vessel, then it becomes hot. Similarly, if hot ghee is poured into an iron vessel, the
vessel also becomes hot. This is because the body and mind rest on an axis of con-
tinuity, and what happens in the body reflects on to the mind and vice versa (Cited
in the commentary by Aruṇadatta on Aṣṭāṅga Hṛdaya, Sūtra Sthānaṃ, 1, 1 in
Harisastri 2002).
For this reason, the doṣas which are seemingly physical constituents of the body
are influenced and aggravated by psychological factors. For example, Vāta is asso-
ciated with craving, depression and fear. Pitta is associated with anger and aggres-
sion (cited in Ćaraka Saṃhitā, Cikitsā Sthāna, 3, 115 in Yadavji 1992). On the other
hand, Kapha is associated with calmness and joy (cited in Ćaraka Saṃhitā, Sūtra
Sthāna 25, 40 in Yadavji 1992).
The physical constitution of an individual sets the limits, while the mind and the
external environment sets the scope and potential for change and thereby enhance-
ment of states of health. An individual with Kapha constitution cannot radically
change his or her physical nature. But a Kapha type with Tamasic mind can trans-
form into a Rajasic or Satvic type. So also with the other types of physical constitu-
tion. The chapter known as Puruṣavicayaṃ Śārīraṃ in Ćaraka Saṃhitā discusses
about how the mind can be transformed into higher levels of consciousness with a
predominance of sattva quality (Yadavji 1992):
The cleansing of the mind is likened to the process of cleaning a dirty mirror. The satva
quality of the mind can be enhanced by practice (Ćaraka Saṃhitā, Śārīra Sthāna 5, 13 in
Yadavji 1992)

It is interesting to note that Āyurveda advises to allow the physiological urges of

the body to express and not to interfere with them (Harisastri 2002). The physiological
urges like flatus, faeces, urine, hunger, thirst and the like should not be provoked or
suppressed. They should be allowed to express naturally. On the other hand, the
emotional urges of the mind have to be checked (Harisastri 2002):
One desirous of well being in this and other life must keep under control the emotional
urges of greed, jealousy, aversion, competition and so on (Aṣṭāṅga Hṛdaya, Sūtra Sthāna 4,
24 in Harisastri 2002)

Emotional stability is itself synonymous with health. An emotionally stable person

becomes very responsive and appropriate in actions, so much so that the physician par
excellence is extolled as the one who eliminates the emotional instability of the mind
(cited in Aṣṭāṅga Hṛdaya, Sūtra Sthāna 1, 1 in Harisastri 2002). In other words, it is
by treating the mind of the person that wholeness is restored and established.
4 Concept of Health in Āyurveda 67

In a similar way, the environmental influences can be regulated to a great extent

to optimise the expressions of the physical constitution. For instance, an individual
of Kapha constitution can prevent imbalances by regulating exposure to environ-
mental influences including food that can cause an imbalance of Kapha.
Āyurveda advises that a lifestyle should be adopted that is in tune with the pecu-
liarities of the place as well as the season. Even the medicines used in treatment
should be derived from the locality. It is a fundamental precept in Āyurveda that for
the people living in a particular locality, the plants growing in that region are the
most suited (Sharma 2012):
The plants growing in the region where a person has been acclimatised is best suited for that
individual (Aṣṭāṅga Saṃgraha, Sūtra Sthāna 23, 95 in Sharma 2012)

The interplay of the body and the mind is the basis for health as well as disease.
In that sense, the Ayurvedic approach to management of health is psychosomatic in
its outlook. Āyurveda distinguishes between the mind and the body, which are both
considered as material and different from the self. The mind is subtle, and the body
is gross. In spite of the differences, the body and mind are continuous and flow into
each other. They cannot function without influencing one another or rather they can-
not function in isolation. The harmony between body and mind is the foundation for
good health, and body-mind conflicts are in the background of majority of diseases.
Understanding physical and mental constitution provides a framework to under-
stand the interactions of body and mind in each individual and to work out a strategy
to establish harmony. To put it in one phrase, the Ayurvedic approach to good health
is to ‘manage the body and to transform the mind’. There is a limit to changing the
nature of the body once constitution is formed at the time of conception. One has to
learn to manage the body by adopting appropriate lifestyle modifications. On the
other hand, there is greater scope for influencing and transforming mental states,
and with training, it is possible to attain emotional stability and mental well-being
that can enable the individual to cope with physical and environmental limitations
in the most effective manner.

4.4 The Person-Centred Approach to Health Care

Āyurveda offers an approach to health care that aims to achieve longevity and
healthy ageing. The constitution of the individual sets non-negotiable limits to
enhance health, and therefore a great deal of effort has been focused on prenatal and
postnatal interventions to develop a healthy constitution. Living to a ripe old age in
the pink of health is an outcome of a life that is established in a healthy lifestyle.
Health is a dynamic process that adapts to external circumstances and evolves to
higher levels of expression. The physical and mental constitution of the individual
sets the scope for each individual to discover the roadmap to attain the highest peak
of health that can be attained given the limitations of the constitution and the envi-
ronment in which the person is embedded.
68 P.R. Manohar

4.5 Conclusion

Āyurveda is the knowledge of life and much more than a medical system. Its pri-
mary focus is on longevity and healthy ageing. Curing diseases is only one of the
means to work towards the target of higher levels of health. Health is visualised as
a dynamic, adaptive and evolutionary process that has to be facilitated through inter-
ventions derived from a proper understanding of the constitution of the individual
and the environmental matrix. To sum up, the approach of Āyurveda is echoed in the
words of Osler: ‘The good physician treats the disease, the great physician treats the
person with the disease’. Āyurveda is concerned with the well-being of the person,
known as Karma Puruṣa, and the knowledge of Āyurveda has been revealed for the
sake of this person struggling to find his way up the ladder of healthy existence.

References

Bhushan, P., Kalpana, J., & Arvind, C. (2005). Classification of human population based on HLA
gene polymorphism and the concept of Prakriti in Āyurveda. Journal of Alternative and
Complementary Medicine, 11, 349–353.
Harisastri, P. V. (Ed.). (2002). Ashtanga Hridayam. Varanasi: Chaukhambha Orientalia.
Patwardhan, B., & Bodeker, G. (2008). Ayurvedic genomics: Establishing a genetic basis for mind-
body typologies. Journal of Alternative and Complementary Medicine, 214, 571–576.
Patwardhan, B., Joshi, K., & Ghodke, Y. (2006). Genetic basis to concept of Prakriti. Current
Science, 90, 896.
Prasher, B., Negi, S., Aggarwal, S., Mandal, A. K., Sethi, T. P., Deshmukh, S. R., et al. (2008).
Whole genome expression and biochemical correlates of extreme constitutional types defined
in Āyurveda. Journal of Translational Medicine, 6, 48.
Sahebrao, G. N. (2009). Vedic philosophy of values. New Delhi: Northern Book Centre.
Sharma, S. (Ed.). (2012). Ashtanga Sangraha. Varanasi: Chaukhambha Sanskrit Series Office.
Yadavji, T. A. (Ed.). (1980). Suśruta Samhita. Varanasi: Chaukhambha Orientalia.
Yadavji, T. A. (Ed.). (1992). Ćaraka Samhita. New Delhi: Munshilal Manoharlal Publishers Pvt. Ltd.
Chapter 5
Determinants of Health and Well-Being
in Āyurveda

A.N. Narayanan Nambi

5.1 Introduction

Eastern traditional medicine is one of the most sophisticated indigenous systems.

It holds an unbroken tradition spanning more than five millennia. Though this
medical heritage is many centuries old, even today millions of people in villages,
towns, and cities across eastern countries depend upon it for their daily health-
care needs. All these indigenous systems hold two kinds of tradition: folk and
structured. Folk tradition encompasses diverse practices, in which modifications
were introduced from time to time according to the changing needs of the society.
The structured systems of knowledge, like Āyurveda and Siddha, try instead to
find the rationality of each practice and record it in encrypted form, totally differ-
ing in this respect from the folk tradition. While the former focuses on the nature-
man relationship, the latter focuses on the man-self relationship. Both systems
survived over millennia, assimilated all the possible variations of human nature,
and projected possibilities for better survival and balance.
It is impossible to understand any system without the knowledge of its origin.
In biological systems, there is a deep unity between origin, structure, and function.
As aptly stated by the biologist Theodosius Dobzhansky (quoted in Ramachandran
2010, p. 14):
Nothing in biology makes sense except in the light of evolution.

As there is a close link between origin, structure, and functions in all biological
systems, there is an inseparable link between health and healing. From this

A.N. Narayanan Nambi ()

SNA Oushadhasala Pvt. Ltd, Thrissur, Kerala, India
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 69
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_5,
© Springer Science+Business Media Dordrecht 2013
70 A.N. Narayanan Nambi

perspective, as Gerald Larson suggested, South Asian medical theory and practice
can offer new and useful insights:
What is of importance in traditional medicine….is a way of valuing and a way of
conceptualizing “disease” and “illness” that is interestingly different from our own and that
is not at all incompatible with the rigorous precision of modern scientific methodology.
(Larson 1993, p. 104)

5.2 The Pursuit for Health

“Health” not only refers to a biological condition (Halfbass 1991). It rather

reflects a broader frame which includes aspects such as freedom from incapaci-
tation, vitality for successful action, and feeling of well-being. Health care
should be related to such a broader framework, encompassing traditional and
contemporary systems of medicine, preventive routines and treatment methods,
and social issues such as the economics of health insurance (as highlighted in
Chap. 3 of this volume). Unfortunately, the term health care has been very much
reduced to just illness care by contemporary biomedicine, where the medical
intervention is undertaken after the development of illness, neglecting the per-
son’s inherent vitality and immunity as well as the possibility to diagnose or
prevent potential problems (Chap. 3 of this volume provides a detailed descrip-
tion of this current trend). Āyurveda instead emphasizes the importance of pre-
ventive methods and fosters health as a positive state, providing a complementary
view to the more crisis-oriented self-managing model. While the biomedical
model gives most of its attention to the theory and treatment of disease, Āyurveda
shows more concern for the active development of health (see Chap. 10 for fur-
ther discussion of this topic).
In the preamble to the Constitution of the World Health Organization, health is
defined as:
…a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity (quoted in Caplan et al. 1981)

This definition recognizes the multiple domains of human life in which health
is important and regards health as a positive state, not merely as a concept whose
meaning is established in relation to illness, disability, or sickness. Total well-
being or perfect health is generally thought to be a utopian concept. Though we
think of health in various dimensions, medical science mostly limits it to the physical
and mental aspects, often neglecting the complex web of relationship existing
among all living systems. In fact, individuals are offered a wide range of possibilities
to maintain perfect health and functioning, thanks to their ceaseless interaction
with the environment and their responses to the various sociocultural demands.
5 Determinants of Health and Well-Being in Āyurveda 71

5.3 The Conceptual Core of Āyurveda

It has been correctly told that Āyurveda is the knowledge (veda) of life (āyu), but
the literal meaning of the word āyu implies something that is getting naturally and
progressively diminished. As a living being is constituted not merely by body but
also by senses (indriyas), mind (manas), and Self or Consciousness (ātma), this
conceptualization of āyu encompasses all these components. Since birth, all these
components undergo modifications and reformations, except ātma, the unchanging
and eternal consciousness principle that is hosted in individuals throughout their
life. Hence, āyu is also named as dhāri that literally stems from the word dhāraņa
(to hold the ātman). The period of ātma’s sojourn in the body is defined as jīvita or
lifespan. Since ātman is imperishable, it is also called nityaga, and since it endures,
it is also named anubandha (Ćaraka Saṃhitā, Suthrasthana 1, 42 in Brahmanad
Tripathi 1997).
Since āyu is progressive and deteriorative by nature, the only way to enjoy
life at its maximum is through maintaining an adequate balance in the complex-
ity of the system. Āyurveda provides a description of the interaction between
the pro-āyu (āyushaṣya) and against-āyu (anāyuṣhya), assuming that when such
knowledge gets translated into action, it can be fruitfully used in health-related
practices. To this purpose Āyurveda proposes specific śasana or canons of right
and wrong action and thought. Only the repeated practice of correct behaviors
and activities can bring benefits to a person as individual or to the society at
large. However, behaviors and activities are outcomes of the mind work, which
allows for correct understanding of the situation, also based on associations
with previous experience – anumāna or inference. This allows the formation of
a web of cause/effect relationships between the individual and the environment.
Knowledge is meaningless without the basic understanding of this relationship
network, acquired with the help of anumāna (inference) of the cycle of cause
and effect.
The ultimate aim of Āyurveda as śāstra (science) is to know all possible causes
and effects that come into play in both the conditions of wellness and illness. Only
by understanding its causes, a disease can be controlled; similarly, only by knowing
the causes of health, it may be maintained and pursued. A large amount of informa-
tion concerning these processes was collected by the ancient scholars on the basis
of direct perception (Pratyakṣa) as well as inferences, tested by time and named as
aptopadeśa or āgama. These terms refer to peculiar psychological features: though
everyone can exert direct perception and perform inference, the effectiveness of this
process depends on the refinement of sense organs and on the stability of mind.
People characterized by a condition of optimal functioning and balance are called
as āpta, and their knowledge is named as āpta upadeśa, meaning that it can tran-
scend time and space in its applications.
72 A.N. Narayanan Nambi

5.4 Theories of Existence of Life

With the help of the three knowledge forms (Pramāna), namely, Pratyakṣa,
Anumāna, and Āptopadeśa, the existence of life is explained by Ācharya Suśruta
through the acknowledgement of six possible existences of life:
Swabhāvam éswaram kālam yadruccham niyatim thadha.
Pariṇāmam ca manyanthe prakŗutim pradhu darśinah (Suśruta Saṃhitā, Sūtra Sthāna
1, 11 in Laxmidhar Dwivedi 1998)
1. Swabhāva – by its nature
2. Ēśwara – by divine support
3. Kāla – by time
4. Yadrucchā – by uncertainty
5. Niyati – by law
6. Pariṇāma – by evolution
The scholars of Āyurveda commonly accepted swabhāva as the main cause of
existence, though they did not negate the others. This primacy of nature makes the
definition of life universally valid in its outlook, as per Acharya Ćaraka:
So ayamāyurvedah śāśwato nirdiśyate anāditwat, swabhāva samsiddha lakshaṇatwat,
bhāva swabhāva nityatwat ca. (Ćaraka Saṃhitā, Sūtra Sthāna 30, 27 in Brahmanad Tripathi
1997)
(Ayurveda is said to be eternally continuous because of its beginningless-ness, the charac-
ters of entities having been determined by universal nature and the characters of substances
being eternal).

Within the perspective of Āyurveda, the following sections will illustrate the vari-
ous realms of the body in all possible levels and how they are connected in an inte-
grated and interrelated system.

5.5 Understanding the Body

In Indian philosophy each body is not singular; rather, it is a combination of three

bodies: the gross body (Sthūla śarīra), the one that is perceived by our senses, nour-
ished by food; the subtle body (Sūkṣma śarīra), the one that cannot be perceived by
the senses but it is known to each one of us, for example, I know whether I am
hungry or angry but others may not know it till I express it through my gross body;
and the causal body (Kāraṇa śarīra), which is the seat of all our inherent tendencies
(vāsanas) and the cause for the other bodies.

5.5.1 The Three Bodies and Their Relationship

Gross body is made up of five fundamental elements: space, air, fire, water, and
earth, as the outcome of the progressive grossification (Panjīkaraṇa) of reality
5 Determinants of Health and Well-Being in Āyurveda 73

(see Chaps. 3 and 10 for an overview of the conceptualization of reality and its
evolution in Indian tradition). This evolved body will dissolve back at the time of
death and will disintegrate into fundamental elements. Through this body, we
experience joy and sorrow. It temporarily ceases its functioning during sleep and
permanently at the time of death.
Subtle body, which pervades the gross body, is made up of a nascent form of
fundamental elements (tanmātra) that cannot be perceived by senses. We cannot see
other’s mind neither our own, yet we are aware of the thoughts occurring in our
mind. This subtle body consists of 17 components: five sensory organs of percep-
tion (sound, touch, vision, taste, smell), five organs of action (speech, hands, legs,
excretory, and reproductive organs), five vital principles or prāņas (Samāna, Vyāna,
Udāna, Prāņa, Apāna), the mind (Manas), and the intellect (Buddhi).
Causal body is the subtlest of three bodies. It pervades the other two and it is the
repository for all our inherent tendencies and lack of knowledge. It cannot be explained
and experienced, and it is carried from birth to birth (Tejomayananda 2000).
When the consciousness identifies itself with the gross body, it manifests as the
awakener that enjoys a wakened world and its myriad experiences. The same when
withdrawing from the gross body, it identifies with the subtle body. In this condi-
tion, it manifests itself as the dreamer experiencing the dream world. Similarly,
withdrawing from the gross and subtle bodies and identifying with the causal body,
it functions as a deep-sleeper who undergoes a homogeneous experience of void. In
addition to the three stages mentioned above, there is another stage which is termed
as “death” – a state of absolute cessation of all experiences. Hence, its antonym (of
death), the “life” is a stream of experiences, each of them becoming “unit of life”
just as a single brick in a wall. Just as the strength and the weakness of the wall
depends upon the quality and the texture of the bricks constituting it, the type of
experiences that individuals undergo shall determine the character and temperament
of their life. If their experiences are happy, their life is happy, and if they are miser-
able, their life is also miserable.

5.6 Experience and Life

An individual derives his experience from receiving and responding to various stimuli
from the external world. An experience therefore is constituted by the following three
entities:
The experiencer (who is experiencing) – the subject
The experienced (i.e., the outcome of experience) – the object
The experiencing – the relationship between the subject and the object
The primary field of enquiry among the eastern sages was the “experiencer,”
whereas that of western scientists is the “experienced.” The aim of the eastern sages
was to show the possibility to optimally develop the inner personality, in order to
develop independence from the changing environment and occurrences of the
74 A.N. Narayanan Nambi

Disposition Attributes Outcome

-
Brahma a (Spiritual) Atma (Consciousness) Mok ha (Salvation)

K hatriya (Intellectual) Buddhi (Intelligence) Dharma (Righteousness)

Vai ya (Psychological) Manas (Mind) Ka-ma (Desire)

Su-dra (Physical) arira (Body) Artha (Resources)

Fig. 5.1 The four-level categorization of personal dimensions and related outcomes

world. The result of this process is the elevation of the standard of life. On the other
hand, western scientists try to make the world a better place to living, in an attempt
to raise the standard of living.

5.6.1 Realms of Experience

The analysis of the experience led the Indian scholars to conclude that it ema-
nates from different levels within the person, all of them unique in themselves.
It was also acknowledged that the four different dimensions or disposi-
tions – physical, psychological, intellectual, and spiritual – work together in a
human being even though he himself may not able to comprehend it (Fig. 5.1).
When a subject comes in contact with an object, it does so, not as an integrated
whole but with four distinct personalities as it were from four layers of the person.
Four differently constituted entities, each having its own demands and values,
awake at the challenge of every situation created by an object or being, or thrust
upon to experience it.
Thus every moment, in each of our experiences, four different constituents are at
work within us, in order to comprehend the situation and earn the treasure of the
experience. When these four different powers – behaving as dichotomous strangers
from different realms, each characterized by different values and demands – come
together to enjoy any given object or situation, this event will invariably bring satis-
faction to one at varying degrees and dissatisfaction to the other three. This confu-
sion of personalities within ourselves creates a tragic chaotic condition which
disturbs peace and tranquility; the eternal human search for joy and happiness,
thrust for perfection, and sound health get blasted and push individuals to the edge
of restlessness, desperation, and subsequently ill-health. In his eternal search for
happiness, tranquility, and peace, individuals pursue new occasions to experience a
more perfect and complete well-being by changing the arrangement of things and
circumstances, in the ultimate hope that they may get eternal peace and happiness
to the fullest and deepest extent.
The ancient sages of health-care systems knew very well these desperate condi-
tions, into which humans are helplessly pushed by the circumstances, and they
5 Determinants of Health and Well-Being in Āyurveda 75

preached solutions by which individuals could efficiently and fruitfully integrate all
the distinct four personalities within themselves and find a condition conducive to
happiness with lesser efforts (Chinmayananda 2002).

5.6.2 Dispositions, Attributes, and Outcomes

According to Indian system of knowledge, it is possible to distinguish between four

basic personalities, which are manifestations based on the qualities and actions they
perform, as summarized in Fig. 5.1. This is portrayed in detail in Bhagavad Gita:
Chātuṛvarṇyam mayā sṛuṣtam guṇakarmavibhāgaśah (Bhāgavad Gita, IV/13 in Swami Rama
1998)
(I have created the four fold classification on the basis of their qualities and actions)

Unfortunately these grouping are well-known to western readers as the caste sys-
tem that characterized Indian society, but they were originally meant to explain the
various kinds of individuals according to their nature in qualities and actions. Here,
we consider these four groups as useful concepts to explain the nature of humans and
their opportunity to grow further or to move forward (from Rajasic or Tamasic
towards absolute Satwa – see Chap. 4 for a detailed analysis of these concepts).
The physical entity of a living being may be termed as Śūdra (literally a lower
class in the cast system, devoted to manual jobs), and it refers to the primitive
disposition. The Śūdra derives the resources for his survival from the other three
groups. His values are essentially mundane in character.
The psychological entity, which is in an elevated status compared with Śūdra,
enjoys the desires and aesthetics in nature and may be termed as the Vaiśya (which
literally means the business community). It holds its own values and virtues to be
adhered to in life.
Further, the intellectual disposition can be designated as a still higher class, the
Kṣatriya (literally the class of community of rulers), whose values are broader in
vision and are based on dharma.
Lastly, we reach the supreme personality of the Brahmaṇa (which literally means
the community of priests, whose ultimate aim in life is the attainment of mokṣa or
salvation or eternal bliss). Brahmaṇa means who knows Brahma – the ultimate
truth. In its search for the ultimate truth, this disposition becomes identified with the
infinite, whose boundaries are nowhere and whose center is everywhere.

5.7 The Health Status

In the light of the above discussed concepts, the ancient Āyurvedic scholars – especially
Ćaraka – propagated that the pathological disturbance of the fundamental principles
(doṣa) creates morbidity, whereas the balancing of the same to normalcy creates health:
Vikāro dhātu vaişamyam Sāmyam prakŗutiruchate (Ćaraka Saṃhitā, Sūtra Sthāna 9, 4 in
Brahmanad Tripathi 1997)
76 A.N. Narayanan Nambi

A similarly normative doctrine is exemplified by Georg Canguilhem (1989),

who uses the terms “health” and “disease” as normative terms. Health means that
a person functions well and disease makes him/her function badly:
Man feels in good health - what is health itself - only when he feels more than normal - that
is, adapted to the environment and its demands. - but normative, capable of following new
norms of life.…for man health is a feeling of assurance in life to which no limit is fixed.
Valere, from which value derives, means to be in good health in Latin. Health is a way of
tackling existence as one feels that one is not only possessor or bearer but also, if necessary,
creator of value, and establisher of vital norms (Canguilhem 1989, p. 200)
In an elaborative sense, a healthy individual is defined in Āyurveda as the swastha
expected to have balance in humors (doṣa), structural tissues (dhātu), excretory
functions (mala), and digestive capacity and the tranquility of consciousness
(Ātman), mind (Manas), and senses (Indriya).
Sama doṣa samāgnisca samadhātu malakriyah
Prasannātmendriya manah swastha etyabhidīyate…
(Suśruta Saṃhitā, Sūtra Sthāna 15, 41 in Laxmidhar Dwivedi 1998)

A biological perspective professed by Christopher Boorse (1977) also expressed

the same concept, defining health as “functional normality.” This perspective uses
the terms “health” and “disease” as descriptive, neutral-value terms. To say that a
person or an organ or system is healthy means that its functions are normal; to say
it is diseased means that its functions are abnormal, with biostatistical data provid-
ing the criteria of normality:
… diseases are internal states that depress a functional ability below species-typical levels.
Health as freedom from disease is then statistical normality of function, i.e., the ability to
perform all typical physiological functions with at least typical efficiency (Christopher
Boorse 1977, p. 542)
Hence, the doyens in Āyurveda emphasize a much wider framework within
which to analyze the whole process which is said to be the primordial cause of all
disease.

5.8 A Framework to Understand Health and Its Alterations

Figure 5.2 illustrates a model of health that encompasses not merely the body but
the person’s multiple attributes, including responses towards external environment.
It deals with the complete pattern of interactions within the individual and towards
the external environments as well as its ultimate balance. While the “balance” is
only one, “imbalances” are innumerable, and they comprise all possible deviations
from balance and their probable outcomes. In particular, at the level of actions,
imbalances can be due to an excess, an insufficiency, or an improper performance of
action.
The advantage of this framework is that it can transcend all geographical, cul-
tural, religious, and racial discriminations and can represent human entity as a
5 Determinants of Health and Well-Being in Āyurveda 77

Parina-ma - Environmental transference

Prjña-para-dha - Intellectual Blasphemy

Asa-tmedriya-rdha Samyoga - Sensory irreverence

Artha - Objects

Speech

Mind Karma - Action

Body

Ka-la - Time

Fig. 5.2 Factors contributing to the alterations of health and well-being

whole, observing its inherent universal tendencies. Moreover, any philosophical

system can find place within it. This idea is universal in it its outlook and it is
suggestive of a new vision of health.

5.8.1 Theory of Inherent Tendencies (Asātmedriyārtha

Samyoga)

According to Āyurveda, similarity increases similarity. Thus desires, habits, and

actions have the potential to shape the character of an individual. We ultimately
become what we desire, think, eat, and do. The activities we perform towards outside
are sensorial, and they can be of two types: perceptive and reactive. Perceptive activi-
ties are based on the perceptive senses – eyes, ears, nose, tongue, and skin – which
78 A.N. Narayanan Nambi

Fig. 5.3 Sense organs and Sense Organs Objects

their objects
Eyes Ru-pa (Sight)

Nose Gandha (Smell)

Tongue Rasa (Taste)

Skin Spar a (Touch)

Ears abda (Sound)

make contact with the external environment and collect the information from the
objects. The actions of the senses are limited in terms of site, range, as well as per-
formance, and they are controlled and regulated by Manas (mind) and Buddhi
(intellect). Reactive activities are based on the reactive senses that actively express
themselves through specific organs: tongue (by the act of speech), hands, legs, and
excretory and reproductive organs. Again, these are structurally bounded and con-
trolled by mind and intellect. Excessive, decreased, or abnormal use of them will
disturb the balance, resulting in ill-health. For example, eyes are the sense to see and
they collect vision related information. But if we over exert them, for example,
sitting in front of computers for long hours without break, it will result in eye dry-
ness, an alteration in their physiology. Since senses are limited in site, range, and
performance within an organ of perception, the violation of these limits leads to the
development of a diseased condition or at least to a deviation from the state of well-
being. If the individual is able to follow his own internal resonance defined by mul-
tiple determinants, he will get balanced.
In sensory perception, the action takes place when the stimuli received from
outside under the limited domain of sense organs reach the mind. Hence, it is impor-
tant to define the determinants involved in this process: object of sense, organ of
sense, presence of mind, and sensory intelligence.
Sense Objects: All the senses are bound to their own objects, and they are exclu-
sive in nature. One sense cannot accept the object specific of another sense, and
each one has an optimal range of perception which depends on the organ of sense
and its constitution. Beyond that range, it cannot perceive. For example, a continu-
ous highly illuminated light will hamper the vision.
Sense Organs: These are the structural entities of the body that participate in the
act of perception. However, the whole act of comprehending the perception is not
limited to a single organ, rather involving a chain of structures which collectively
carry out the process. If during the continuous flow of perception, any of the con-
stituents become damaged or unable to perform correctly, it becomes a determinant
of alteration of health (Fig. 5.3).
Mind: Mind (Manas) is the most crucial component in the whole activity of per-
ception, and its lack of participation creates absence of information. Hence again,
5 Determinants of Health and Well-Being in Āyurveda 79

the status of mind at its purest form will bring the best out of the perception process.
Āyurveda recommends purity of mind in the sense that it has not to be clouded with
emotions, such as anger, grief, or anger.
Sensory Intelligence: The intelligence represents the inherent ergonomic system
which regulates the sense organs. It is also a crucial element, and any damage to it
causes a variety of health problems.

5.8.2 Theory of Sin Against Wisdom (Prjñāparādha)

Asian philosophies believe that living beings have the inner capacity to follow the
suggestions and messages arising from their innermost core, in order to be guided
in achieving life’s goals. This capacity may be shadowed by individual tendencies
and inclinations, resulting in mistakes in life which are one of the root causes for
human miseries. This process is called Prjñāparādha; here the word “Prjñā” refers
to the inner source from where the messages originate, while aparādha refers to
negligence or infringement.
The mind always develops thoughts and desires which in turn create illusions of
separation. For example, the Indian philosophical system believes that death is only
a transient change of shelter for the imperishable Ātman. However, mind is always
ignorant of this true identity and, due to its attachment to the current life that it con-
siders as unique, it develops the fear of death. So mind acts through its desire. It will
grasp and get attached to pleasant experiences as a way to avoid changes that are
seen as a manifestation of separation, of death. Analogously, through unhealthy
aversions from negative experiences, the mind pushes away those experiences in
order to escape the associated changes. In this way desire and aversion become the
root cause for many diseases, if acted out without taking due consideration of bud-
dhi, also named as Prjñā in Āyurvedic literature. But if guided by inner wisdom, the
fruit of action will be true and genuine. The proximity with inner or external events,
phenomena, or entities – be it a pathogen or an emotion or a thought form – allows
for potentially fruitful exchanges, which are very vital for an organism as an open
system. This fosters a bio-moral-environmental transaction, based on the interrela-
tionship of all things and all possible interactions at every level. Any deviation from
this will obstruct the interrelationship, which in turn can generate an imbalance in
the system either sooner or later.
Prjñāparāda is thus a form of intransigence or inability, or desire for a difference
or separateness as microcosm, with the illusory aim to remain in the state of
harmony.
Āyurveda, in order to avoid such situations, focuses on daily regimen as a means
of balancing the mind and focusing desire through continuous repetitive behaviors
known as rituals. Daily regimen prescribes behaviors beyond desire or aversion in
terms of diet, exercise, routine prayers, and restrictions in life-style activities,
including sexual life. These practices facilitate the natural distancing from unhealthy
desires and aversions, and their consequences, bringing the individual microcosm
80 A.N. Narayanan Nambi

back into its inner balance or harmony. Daily, seasonal, or social regimens are
designed to ensure optimization in the bio-moral-environmental transactions, no
matter whether body or mind may like or dislike the whole act.

5.8.3 Theory of Environmental Transference (Pariṇāma)

As life originates and develops, it acts as an open system not separated from the
environment, being connected with it by the influx and efflux of nutritional materi-
als and waste products. This open system maintains a steady concentration of its
constituents, given their constant formation as well as the continuous exchange and
interplay of molecules and chemical groupings in virtually all body tissues and
fluids. The apparent stability and permanency of the living organism is the result of
a careful balancing between building up and breaking down processes in a steady
state, even though material is constantly passing into and out of the system. The
steady state is stable thanks to a long sequence of reactions, like what happens in
the metabolic processes of the living cell. Slight modifications in the reservoirs,
in the reaction rates, or at the beginning or end of the reaction chain have little
disturbing effect on the concentration of substances in the reaction chain.
As nature changes in time, human body also expresses its changes as an open
system. Body exhibits willingness to rearrange through alterations in the qualities of
principles (doṣa) manifesting a subclinical morbidity. Under customary circum-
stances, this alteration is balanced by various feedback mechanisms and is never
been noticed. Balance is achieved through two factors: (a) reduction of the contrast
between etiological factors and individual status (doṣa) and (b) coherence between
physiological principles (doṣa) and structural components (dhātu) (Ćaraka Saṃhitā,
Nidanasthana, 4, 4 in Brahmanad Tripathi 1997).
Changes in seasons and their influences on body systems may be taken as an
example. In normalcy, human body is exposed to the nature’s changes since birth,
and it will adapt to them in time. But if alterations take place in the natural pattern
of environmental changes, the body will need substantial efforts to understand them
and to adjust to the anomalous situation. Three varieties of change may occur:
hyper-expression of nature (e.g., flood instead of rain), hypo-expression of nature
(e.g., drought instead of rain), or improper expression of nature (e.g., untimely
seasons).
From this perspective, all expressions of nature can be transposed in terms of
unexpected experiences in day-to-day life at the level of the social and cultural con-
texts. Whatever may be the external factors or systems that get altered, Āyurveda
recommends to check the balance of principles (doṣa), structural tissues (dhātu),
and waste products (mala) at the individual level, which define vital harmony and
well-being.
In line with these concepts, Claude Bernard, working in the nineteenth-century
climate of Lamarck’s and Darwin’s evolutionary theories, regarded disease as a
result of an organism’s failure to adapt to environmental insults (Dubos 1979).
5 Determinants of Health and Well-Being in Āyurveda 81

Similarly, Brody and Sobel’s systems theory of health endorses Dubos’ position
according to which
states of health or disease are the expression of the success or failure experienced by an
organism in its effort to respond adaptively to environmental challenges. (Brody and Sobel
1979, p. 93).
The systems theory view of health incorporates various levels or domains,
through which information flows in a pattern of feedback loops. Brody and Sobel
summarize the concept of health as
the ability of a system (i.e., cell, organism, family, society) to respond adaptively to a wide
variety of environmental challenges (i.e. physical, chemical, infectious, psychological,
social). (Brody and Sobel 1979, p. 91)

5.9 Conclusion

The ancient wisdom of Āyurveda through its intricate analysis of Sthūla śarīra,
Sūkṣma śarīra, and Kāraṇa śarīra highlighted the subtle relationship among all the
possible levels of human being, understood the possibilities of human being’s multi-
plicity of experiences, and forecasted their possible outcomes as health and miseries.
By formalizing the theory of inherent tendencies, of sin against wisdom, and of envi-
ronmental transference, it vividly elucidates the existence of human beings both in
the individual and in the collective dimension. In particular, the theory of inherent
tendencies provides a core description of human existence and behavior, whose
validity can be ascertained across time and cultures. Moreover, Āyurveda empha-
sizes the importance of rituals not merely as a religious doctrine or dogma but as a
tool or vehicle to connect microcosm to macrocosm rather naturally than mechani-
cally. These areas surely require further study and research, since their potential for
application – largely proved by the uninterrupted and effective use of Āyurveda
across millennia in the Indian subcontinent – can provide new insights for the devel-
opment of a more integrated view of health that can overcome cultural boundaries.

References

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Brahmanad Tripathi. (1997). Ćaraka Samhitha Suthrasthana Ch.1/42. Varanasi: Chowkhambha
Sanskrit Pratisthan.
Brody, H., & Sobel, D. S. (1979). A systems view of health and disease. In D. S. Sobel (Ed.), Ways
of health: Holistic approaches to ancient and contemporary medicine. New York/London:
Harcourt Brace Jovanovich.
Canguilhem, G. (1989). On the normal and the pathological (C. R. Fawcett, English Trans.).
New York: Zone Books.
Caplan, A. L., et al. (1981). Constitution of the World Health Organization. In A. L. Caplan, H. T.
Engelhardt Jr., & J. J. McCartney (Eds.), Concepts of health and disease, interdisciplinary
perspectives (p. 83). Reading: Addison-Wesley.
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Dubos, R. (1979). Hippocrates in modern dress. In D. S. Sobel (Ed.), Ways of health: Holistic
approaches to ancient and contemporary medicine. New York/London: Harcourt Brace
Jovanovich.
Halfbass, W. (1991). Tradition and reflection: Explorations in Indian thought. Albany: State
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Larson, G. J. (1993). Āyurveda and the Hindu philosophical systems. In T. P. Kasulis, R. T. Ames,
& W. Dissanayake W (Eds.), Self as body in Asian theory and practice. Albany: State University
of New York Press. (Originally published in Philosophy East and West. 37, July 1987)
Laxmidhar Dwivedi. (Ed.). (1998). Sushrutha Samhitha. Varanasi: Chowkhamba Sanskrit Series
Office.
Ramachandran, V. S. (2010). Overview. The tell-tale brain, unlocking the mystery of human nature.
Delhi: Random House India.
Swami Chinmayananda. (2002). Kindle life. Mumbai: Chinmaya Mission Trust.
Swami Rama. (1998). Perennial psychology of the Bhagavat Gita. Honesdale, Pennsylvania, USA:
The Himalayan International Institute.
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Chinmaya Mission Trust.
Chapter 6
The Role of Social Rituals in Well-Being

P.R. Krishna Kumar

6.1 Introduction

Rituals are part and parcel of the daily life of people in the cultural traditions of
India. So much so that even routine activities have been ritualized. From simple acts
like salutation, eating, and bathing to complex temple ceremonies, rituals permeate
almost all aspects of the life of the people of India. Ritualization represents an attempt
to structure and regulate behavior, so that an environment and atmosphere conducive
to well-being is maintained in the inner life of the individual and the outer life of
society at large. The dictum “social order has its roots in rituals” seems to be the
underlying principle behind the ritualization of human behavior (cited in
Vishnusahasranama 2010). Regulated and ritualized behavior is considered to be the
source of law and order, or rather harmony in the inner and outer life of human beings.

6.2 Defining Rituals

A fundamental principle that characterizes the Indian approach to life is that happi-
ness or well-being is an outcome of a righteous life, a life that is grounded in dharma.
Dharma is a difficult word to translate, and literally it means any action that
leads to long-term stability and sustainability of any undertaking in the world.
In a restricted sense, dharma can be equated to law and order, morality, and ethics.
The classical texts of Āyurveda proclaim that happiness or well-being cannot be
obtained without adherence to dharma (Harisastri 2002):
The actions of all beings are aimed to achieve happiness. Happiness cannot be obtained
without dharma and hence one should adhere to dharma (Aṣṭāṅga Hṛdaya, Sūtra Sthāna, II,
20 in Harisastri 2002)

P.R.K. Kumar ()

Arya Vaidya Pharmacy, Coimbatore, Tamil Nadu, India
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 83
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_6,
© Springer Science+Business Media Dordrecht 2013
84 P.R.K. Kumar

Fig. 6.1 Rituals and well-being. This diagram shows the relationship between rituals (ācāra) and
well-being (saukhya). It illustrates the point that rituals help in achieving well-being through the
agency of dharma or social order

(See Fig. 6.1) Hence, a blessed life has three dimensions: life, health, and well-
being; āyurārogyasaukhyaṃ is a three-word summary indicating quality of life
embracing life span, health, and well-being, made popular through a verse in the
devotional poem Nārāyaṇīyaṃ composed in praise of Lord Viṣhṇu.
The purpose of rituals therefore is to establish dharma or harmony in human
society, which in turn leads to well-being and happiness. Vāgbhaṭa in his Aṣṭāṅga
Hṛdaya Saṃhitā makes this connection explicitly when he says:
This is the proper conduct in a nut shell and compliance with these guidelines helps one to
attain life, health, prosperity, fame and eternal realms of experience (Aṣṭāṅga Hṛdaya
Saṃhitā, Sutra Sthana, 2, 48 in Harisastri 2002)

In other words, ācāra impacts different dimensions of well-being: security of

life, security of health, standards of living, social recognition, and secure future.
The word ācāra cannot be exactly translated as ritual. It means good conduct and
behavior or rather formal behavior. Rituals and ritualized behavior come within the
scope of ācāra.
There are four basic elements that help us to distinguish ritual from ordinary
behavior; they are (1) formality, (2) pattern, (3) sequence, and (4) repetition.
When a particular behavior exhibits these four characteristics, we can identify it
as a ritual. Religious acts are most obviously identified as rituals, but it is impor-
tant to realize that human behavior in a nonreligious context can also be ritual-
istic. The significance of rituals can be well understood by observing animal
life. Animals are known to behave ritualistically when they court or fight. Such
ritualized behavior prevents the animals from reacting excessively to the con-
flicting situations.
Laboratory experiments have shown that rituals help to engage and focus atten-
tion, heightening discrimination, enhancing multidimensional generalization, and
improving associative learning (Fernald 2002). Rituals work by capturing attention
to the signal elements of the ritual that can evoke a response from the receiver.
Exaggeration of ordinary traits and behaviors is a characteristic feature of rituals.
The exaggeration of ordinary behavior makes a ritual very formal. This formality
helps to activate regions of the brain like reticular formation, basal ganglia, and
amygdala. This helps to gain control of emotions and focus the attention. This helps
the individual to respond to situations with awareness. Even in the animal species,
ritualistic behavior has been found to play a crucial role in successful adaptation by
bringing about alterations in neurophysiology (Hauser and Konishi 1999; Searcy
and Nowicki 2005). Rituals help in regulating behavior.
6 The Role of Social Rituals in Well-Being 85

6.3 Well-Being

We can thus see that ritual and dharma are intricately interconnected. Ritual helps
to establish dharma which in turn creates saukhya or well-being. Saukhya refers to
quality of life and must be distinguished from standard of living. The term for stan-
dard of living is kṣema. It has been shown that sense of well-being, as much as it can
be measured, does not necessarily increase correspondingly with the comfort that
results from increasing income. As a result, standard of living should not be taken
as a critical measure of well-being. Well-being is not just happiness, which can be
momentary. Well-being is a state of inner satisfaction that is more stable. In a state
of complete well-being, one is satisfied with one’s state of health, personal relation-
ships, safety, standard of life, achievements in life, social relationships, and identity,
as well as prospects for the future (see Chap. 9 in this volume). In Āyurveda, these
aspects of well-being have been considered under three categories: security of life
(praṇaiṣaṇā), standard of living (dhanaiṣaṇā), and secure future (paralokaiṣaṇā)
(Yadavji 1992).
There are three pursuits to be engaged in which are security of life, pursuit of wealth and
the afterlife (Ćaraka Saṃhitā, Sūtra Sthāna, 9, 3 in Yadavji 1992)

The well-being of the people of a nation can be measured in terms of these three
parameters: secure living conditions, high living standards, and good prospects for
the future.
In Āyurveda, well-being is defined at both the individual and social levels. A life
that leads to individual well-being is known as sukha āyu, and the life that promotes
social well-being is known as hitam āyu (Yadavji 1992). Pursuit of individual well-
being can run into conflict with social well-being. It is a challenging task to discover
a way of life that will be conducive to both individual and social well-being. The
solution is dharma.
Dharma helps one to establish a life that leads to personal and social well-being.

6.4 Dharma

The connection between rituals and well-being revolves on the fulcrum of dharma.
It is difficult to define dharma and therefore what is the right karma. The ancient
texts point out that even the most enlightened people in society are unable to define
what is dharma and what is not.1

1
http://sanskritdocuments.org/sites/completenarayaneeyam/new-fffsansMainIndex.htm. Accessed
in June 2012.
86 P.R.K. Kumar

Even the sages are confused when it comes to defining what is karma and what is akarma
(Bhagavad Gītā, 4, 16 in Ramsukhdas 1995)

One has to observe the actions of people who act with a clear conscience to
understand what is dharma.
The principle of dharma is hidden and elusive, the way of dharma is the life of the great
people itself (Mahābhārata, Vana Parva, 313, 117)2

In a broad sense, however, dharma is action that confirms to the basic unity of the
universe. To acknowledge the unity of the universe, it is needed to recognize the
relationships between different entities that will lead to harmony and sustainability
on a long-term basis. From this perspective, it has been said that the essence of
dharma is to put oneself in the position of the other in any given situation. Sage
Vyāsa appeals in the Mahābhārata to hear and understand that the essence of
dharma is to not do unto others what one would not do unto oneself.
Listen and understand that in the ultimate analysis dharma means not doing unto others
what you would not do unto yourself (Mahabhārata – Udyoga Parva, 15, 17)

In another context in the Mahābhārata, Sage Vyāsa is seen lamenting that his
advice is not being heeded by the people. He says that one obtains lasting wealth
and pleasure only by adhering to dharma, yet people refrain from complying with it
I am literally crying with both my arms lifted upwards but no one heeds my words. Both
wealth and pleasure are obtained by adhering to dharma, yet why is it that people do not
follow dharma? (Mahabhārata – Svargarohaṇika Parva 6)

In the social context, dharma is that which resolves the conflict between the
pursuit of personal and social well-being. It would be interesting to analyze how
some of the most common and simple social rituals aim to establish dharma and
thereby well-being.

6.5 The Ritual of Salutation

The ritual of salutation in the Indian tradition can be taken as a simple illustration to
drive the point home. The salutation that is exchanged when two people meet is
known as namaskāra in the Indian tradition. The namaskāra is a highly ritualized
form of salutation or greeting. It is different from a casual greeting because of its
ritualistic character. Many of the rituals are actually exaggerations of good conduct
in society. Namaskāra literally means to bow down. It is performed by bringing the
two palms of the hands together close to the chest in front of the region of the heart
and also slightly bowing the head forward at the same time. It is a noncontact form
of salutation unlike shaking hands, embracing, or kissing. It is, in fact, the gesture

2
http://www.holybooks.com/mahabharata-all-volumes-in-12-pdf-files/. Accessed in June 2012.
6 The Role of Social Rituals in Well-Being 87

of praying that is prevalent in many cultures of the world. Namaskāra is a ritualistic

way of preparing for a social interaction. The bringing together of the palms of the
two hands is to greet the other person in a prayerful mood. This symbolizes the
union of the heart of the two individuals before initiation of interactions. It is done
to invoke the mood of cooperation and mutual goodwill to ensure that personal
well-being does not conflict social well-being. The fact that there is no body contact
in namaskāra is an acknowledgement of physical differences between individuals.
Namaskāra is an acknowledgement of spiritual unity while accepting physical,
mental, and cultural differences.
There is an interesting narrative in the Bhāgavata Purāṇa that throws light on
the significance of namaskāra as a ritual for salutation. This narrative is also
thought provoking for pointing out the futility of rituals when they become rigid
and fixed. The context of the narrative is the encounter between Śiva and Dakṣa. To
cut a long story short, Dakṣa had to accommodate Śiva as his son-in-law when Sati,
his lovely daughter, offered herself in marriage to Śiva. During a gathering, Śiva
fails to salute Dakṣa, who takes offense and curses him. The sequel of events that
followed culminates in the self immolation of Sati. During a conversation in the
midst of all this drama, Śiva explains to Sati the meaning and significance of the
salutation ritual
As regards exchange of formalities in the shape of rising from one’s seat and advancing to
meet a friend, respectful behavior and salutation etc., O slender waisted lady, it is properly
done only by the wise, who do all this mentally with respect to the Supreme Person dwell-
ing in every heart, and not to him who regards the body as his own self. It is the absolutely
pure mind which is termed as Vāsudeva, because it is there that Supreme Consciousness is
realized in its unmasked glory. It is in the shrine of such a mind that I offer namaskāra or
salutation (Cited in Śrīmad Bhāgavata Purāṇa, by Anonymous 1989)

Śiva declines from performing salutation, the very namaskāra ritual, which had
become established by tradition as a mandatory custom in social interactions. Śiva,
the God himself, becomes a nonconformist. This narrative illustrates the point
that rituals have relevance so long as they serve the purpose of upholding dharma.
A ritual is broken when it fails to fulfill its purpose. Thus, the making and breaking
of rituals constitute a dynamic process to establish dharma in social life in the cul-
tural traditions of India.
Anthropologists have suggested that rituals in many societies serve the purpose
of resolving conflicts of reciprocal relationships between individual, small group,
community, and society. The analysis of the Bedouin practice of Bisha, the ordeal
of fire, by Al-Krenawi and Graham demonstrates that the ritual reflects the social
order and reinforces conformity to collective values (Al-Krenawi and Graham
1999). O’Gorman with the study of social norms put forth the argument that con-
firming to group identity and social norms affects individual and social success
(O’Gorman et al. 2008).
We can propose that social rituals help in executing social norms and patterns of
behavior, which in turn help groups and communities to be more successful by
collective action. These actions help in establishing collective identity (Hermanowicz
and Morgan 1999).
88 P.R.K. Kumar

6.6 Marriage, Animal Sacrifice, and Wine Ceremony

The Bhāgavata Purāṇa also discusses at length on the ritualization of marriage,

meat eating, and drinking liquor. This Purāṇa points out that the inclination towards
sex, meat, and alcohol is natural and people indulge and get infatuated by these
sensory pleasures without any provocation (cited in Srimad Bhagavata Purana by
Anonymous 1989).
People are prone to indulge in sex, meat and alcohol without any provocation, whatsoever
(Śrīmad Bhāgavata Purāṇa, 11, 5, 11 by Anonymous 1989)

In order to curb these tendencies, the institution of marriage, the ritual of animal
sacrifice, and the wine ceremony have been established (cited in Śrīmad Bhāgavata
Purāṇa by Anonymous 1989).
Marriage, animal sacrifice and wine ceremony are means to curb and regulate the instinct
for indulgence in sex, meat and alcohol (Śrīmad Bhāgavata Purāṇa, 11, 5, 11 by Anonymous
1989)

The institution of marriage has been ritualized to such an extent that the bonding
between the couple is made sacrosanct. And in the process, the sexual activities of
the individuals become confined within the boundaries of married life. The
Bhāgavata Purāṇa is explicit when it says that one of the purposes of marriage is to
regulate the sexual life of people. Unbridled sexual propensities can lead to violent
and criminal behavior in society and can also disrupt relationships and harmony in
society. From the point of view of health and well-being, Āyurveda imposes several
restrictions and regulations on sexual activity. Regulated sex is considered as one of
the three pillars of life and is an important component of lifestyle management.
If unchecked, the urge to eat meat can lead to widespread slaughter and cruelty
to animals. Traditions of health, like Āyurveda, acknowledge the utility of meat not
only in maintaining health but also in treatment of diseases. And the issue of whether
eating meat is against dharma is taken up for discussion in the medical texts. Eating
meat for the sake of sensual gratification is considered to be against dharma
(Harisastri 2002).
The killing of birds and animals to protect one’s body which is an instrument for yajna or
sacrifice is not against dharma. On the other hand, killing animals for the sake of pleasure
and enjoyment is adharma (Aruṇadatta on Aṣṭāṅga Hṛdaya Saṃhitā, Sūtra Sthāna, 1, 1 in
Harisastri 2002)

On the other hand, eating meat for medical reasons, to protect one’s body, is con-
sidered as dharma. The ritual of animal sacrifice was constituted to regulate the killing
of animals and overindulgence in eating meat. To eat meat, one should kill the animal
by performing a ritual, which imposed a restriction on widespread killing of animals.
The ancient texts also point out that one form of life is food for another, thus acknowl-
edging the food chain and food web in nature. The idea is that there is no need to
provoke people to eat meat; the tendency is instinctual. Animal sacrifice was a check
on cruelty to animals and not a sanction for animal slaughter. The Mṛgapakṣiśāstra, a
medieval text on Zoology, narrates the change in the mindset of a King who goes
6 The Role of Social Rituals in Well-Being 89

hunting to the forest. On reaching the outskirts of the forest, the King is suddenly
overwhelmed by the biodiversity and the richness of wild life that he encounters.
Remorseful of his hunting expedition, the King returns to the palace and commissions
the composing of a book that describes the different species of animals and birds to
create awareness of and respect for animal life (Nalini Sadhale 2008).
The worship of the cow is another related ritual that seeks to protect animal life.
The cow has been given the status of motherhood, and this is affirmed by the enact-
ment of rituals to ensure that cows are cared for like mothers. The simple fact that
cows provide milk for humans is sufficient reason to confer it with the status of a
mother. The purpose of the ritualistic worship is to establish an emotional bond
between cows and humans that would prevent exploitation and ensure care and pro-
tection. Snake worship and the concept of the sacred grove are likewise based on the
principles of protection of animal life and eco-conservation. Snakes were worshipped
in the sacred groves, and these rituals symbolized the allocation of habitat for snakes
that was kept undisturbed by human interference. The sacred groves were also biodi-
versity hotspots, where rare and endangered animal and plant species were preserved.
Such rituals are related to well-being at spiritual and ecological levels.
In one of the texts of Āyurveda, it is prescribed that one must look at even an ant
or insect as oneself (Harisastri 2002).
One must look upon even an ant as one’s own self (Aṣṭāṅga Hṛdaya Saṃhitā, Sūtra Sthāna,
2, 23 in Harisastri 2002)

While this is an attitude to be developed, the ritual of kolam, which consists of

decorating the front of one’s homes with patterns and designs made of rice flour, is
a practical way to provide food for ants and other lower forms of life.
Consumption of alcohol has great potential to turn into a social evil. And it is not
easy to keep people within restraints in this matter. The ritual of drinking wine was
established with the goal of regulating the use of liquor. As in the case of eating
meat, the wine ceremony is not a sanction for indulgence in liquor but rather a regu-
lation imposed by ritualizing it. Āyurveda is again quite explicit when it comes to
describing the medicinal properties of alcohol. Ayurvedic texts include a subsection
on liquors and wines in the chapter that lists food items. Āyurveda also suggests that
liquor inebriates in three stages and that the first stage of inebriation provides health
benefits. Specific liquors are recommended as appetizers and digestives. Fermented
products that have alcohol content are part of the most common dosage forms for
medicines used in Āyurveda. Āyurveda warns that liquor has very little medical
value in tropical climate but can be helpful in a cold environment (Harisastri 2002).
In the summer season, one must not consume alcohol or drink it after diluting it with plenty
of water (Aṣṭāṅga Hṛdaya Saṃhitā, Sūtra Sthāna, 3, 29 in Harisastri 2002)

But the fact that liquor can cloud one’s intelligence and provoke actions that
cause social disharmony is reason enough to keep it at a distance from oneself
(Harisastri 2002).
The use of liquor is prohibited for the simple reason that it clouds one’s intelligence
(Aṣṭāṅga Hṛdaya Saṃhitā, Nidāna Sthana, 6, 10 in Harisastri 2002)
90 P.R.K. Kumar

Moreover, liquor has poisonous and toxic properties that can wreak havoc on
one’s physical health (Harisastri 2002).
Alcohol is antagonistic to the inner vitality known as ojas (Aṣṭāṅga Hṛdaya Saṃhitā, Sūtra
Sthāna, 6, 1 in Harisastri 2002)

Ayurvedic texts have not absolutely contraindicated the consumption of alcohol,

while madyātisakti or excessive consumption is prohibited (Harisastri 2002).
The brewing, selling, buying, and distribution on a mass scale have been prohib-
ited outrightly (Harisastri 2002).
Marriage, animal sacrifice, and wine ceremony are examples of three rituals
originated in a religious context but aimed to regulate social behavior by tempering
instincts that could potentially lead to social disharmony and conflicts. We can thus
see that one purpose of rituals was to temper the instincts of the human mind.
Sensual propensities are compared with the power of horses. Just as one controls
the horses by alternatively releasing and pulling the reins, the sensual instincts can
be controlled only by indulging and restraining at the same time. This is exactly the
mechanism through which these three rituals are intended to work. The mind that
has tempered its instincts is composed and can participate in social interactions by
confirming to collective values.
Ironically enough, the rituals of animal sacrifice and the wine ceremony have
been abused to such an extreme that the very purpose for which they were conceived
has been defeated. The Bhāgavata Purāṇa itself talks about the violation of these
rituals and condemns the people who indulge in these rituals without understanding
their significance (cited in Śrīmad Bhāgavata Purāṇa by Anonymous 1989).
Ignorant people slaughter animals in the name of religious sacrifice and take false sanction
from the scriptures. They violate their own self and the Lord in other life forms and live a
wretched life. (Śrīmad Bhāgavata Purāṇa, 11, 5, 14 by Anonymous 1989)

6.7 Impact of Rituals on Different Aspects of Well-Being

Rituals impact well-being at different levels. In the Indian tradition, the main goal
of rituals has been to establish dharma, which is more than just social order. Rituals
also have preservation of life (āyu), promotion of health (ārogya), creating prosper-
ity (aiśvarya), social recognition (yaśas), and secure sense of future (śāśvata loka)
as their goals. These are all different dimensions of well-being. Rituals aim to estab-
lish both personal and social well-being (see Fig. 6.2).
There are many rituals that aim to promote health (Bradley 2008). A temple ritual
in Kerala distributes medicated buttermilk as the blessings (prasāda) of the deity. This
buttermilk improves digestion, metabolism, and immunity of the body. Ritualization
in a temple setting facilitated the distribution of this medicated drink to significantly
large number of people in the society. Another ritual, followed also in Kerala, is to
consume medicated rice gruel during the rainy season. The ingredients of this medi-
cated food help to strengthen the body and ward off diseases that manifest during the
6 The Role of Social Rituals in Well-Being 91

Fig. 6.2 The impact of rituals on well-being. The eight aspects of well-being that are experienced
by adherence to ritualized behavior are depicted in this diagram

rainy season. Once again, the ritualization of this practice makes a large section of the
society to follow and practice it. The practice of ritual fasting on prescribed days helps
to bring self-control, to moderate the diet habits, and also to tone up the digestive
system. Many of the temple rituals have been formulated with a view to inculcate
healthy lifestyle. These rituals require one to wake up in the wee hours of the morning,
take long walks in the temple, bathe in the pond, and get fresh air from the trees and
plants growing in the vicinity.
There are rituals that celebrate prosperity, and some of these coincide with har-
vest festivals. Such festivals kindle social cooperation and distribution of resources
in the society (Rappaport 1999). The Onam festival in Kerala is associated with a
variety of rituals and beliefs that aims to promote equality and prosperity in the
society. The Onam festival is based on the belief that King Mahābali, the ancient
ruler of Kerala, will visit the homes of his subjects once in a year. The reign of
King Mahābali represented prosperity and well-being par excellence. People
adhered to dharma and were blessed with all-round well-being. The rituals per-
formed during Onam festival highlight the values of equality, sharing of resources,
and harmony in social life by adherence to dharma. Temples have also served as
92 P.R.K. Kumar

centers for equitable redistribution of wealth. The temple is the altar to offer pos-
sessions that one is most attached to. In the act of offering, the donor chants – “this
is not mine, this is not mine.”
The temple becomes a resource pool to store and redistribute excess wealth accu-
mulated by individuals for social welfare. The recent discovery of unimaginable
riches stored at the Sri Padmanabha Swamy Temple in Thiruvananthapuram, Kerala,
testifies how effective temples were in collecting excess wealth from society. It is
estimated that the value of the riches of this temple is about US$23.94 billion, which
would make it the richest temple in the world. However, over a period of time, the
system of redistribution of the hoarded wealth declined and became dysfunctional.
Offering of free food on a daily basis (annadānaṃ) and distribution of clothes
(vastradānaṃ) are part of temple rituals to ensure that the basic needs of people in
society are met. The Ayurvedic texts insist that one should not be concerned with
one’s well-being alone (naikaḥ sukhī). Most of the temple rituals, called yajñas,
have fair distribution of wealth and resources as its basis. The Bhagavad Gīta, for
instance, explains that the concept of yajña is inbuilt with life. Yajña or cooperation,
sharing, and sustainable use of resources is the wish-fulfilling cow of human kind
(Ramsukhdas 1995).
The creator infused the principle of self sacrifice into the entire creation and proclaimed that
all living beings may procreate and flourish by relying upon this principle as their wish
fulfilling cow – (Bhagavad Gītā 3, 10 in Ramsukhdas 1995)

6.8 The Sixteen Civilizing Rituals

The sixteen civilizing rituals (ṣoḍaśa saṃskārās) are yet another example of
rituals that promote well-being in human life. These include sixteen rituals that
are performed from birth to death, which start from the prenatal period. The
samskaras help family and friends to get together and create social bonding,
which forms the basis for a peaceful life. They also create an identity to the
individual and help in establishing links and relationships with the society at
large. The civilizing rituals represent important stages in life. They alert indi-
viduals and society to prepare and come to terms with the key milestones in the
cycle of birth and death and take measures to preserve life, promote health, and
create prosperity. Of the sixteen rituals, three are performed before birth, six in
the stage of infancy, three in childhood, three in adulthood, and one at the time
of death. As it can be seen, the majority of the rituals pertain to childhood, and
by early adult life, all but the death ritual is completed. This points to the fact
that the foundation for a good life has to be laid during childhood and that the
effort has to start before conception itself. These rituals helped the people in the
society to consciously participate in the psychosocial evolution of life (see
Chap. 3 in this volume).
6 The Role of Social Rituals in Well-Being 93

The three rituals that are performed before birth are garbhādhāna (planned
pregnancy), pumsavana (exercising choice in the sex of the progeny), and
sīmantonnayana (ceremonial parting of the hair of the pregnant woman). A child
should be conceived by choice rather than chance. Attempt was made to beget a
male child by using medications in the early stage of pregnancy in families that
did not have a male child for many generations. The sīmantonnayana ritual aims
to protect the pregnant woman in the most critical stage of her pregnancy. It helps
to sensitize everyone in the family to provide extra care and attention for the
expectant mother.
The rituals that are performed in the stage of infancy aim to give identity and pro-
tection to the child and help in giving social recognition to the child. The jātakarma is
done immediately after birth and consists of medications that aim to enhance the
immunity of the child. The nāmakaraṇa, or naming ceremony, gives identity to the
child. The first outing of the child, when it is exposed to the external world and soci-
ety, is known as niṣkramaṇa. The child is given solid food for the first time by per-
forming the annaprāśana ritual. The child’s head is shaved in the third or fifth year
leaving a tuft of hair at the back, and this ritual is known as cūḍākaraṇa. It is believed
that this ritual helps the child to eliminate memories of past lives; in other words, it
symbolizes the beginning of a new life. It is also believed that shaving the head helps
to stimulate healthy hair growth. This is then followed by the karṇavedhana ritual,
which is the piercing of the earlobes. This is best done when the child is still in its
infancy and the earlobes are soft and easy to pierce. One obvious reason for piercing
the ears is to decorate it with earrings, but there is also a belief that it helps to stimulate
the vital point (marma) at the tip of the earlobe, providing some health benefits.
Three rituals are performed in the stage of childhood. When the child is about
5 years old, it is initiated into the process of education. The child becomes literate
by getting introduced to the letters of the alphabet. This ritual is known as
vidyāraṃbha. When the child is 8 years old, it is taken to the teacher for initiation
into formal schooling. This is symbolized by the wearing of the sacred thread called
upanayana. Upanayana means to bring close, and here it means to take the child to
the vicinity of the teacher. The ritual that marks the study of the scriptures is known
as praiṣārtha. This consists of two smaller rituals called upakarma and upasarjana
performed at the beginning and end of the academic sessions. These rituals aim to
enforce systematic education for the child.
The rituals of early adulthood mark the entry of the child into adult life. In males,
at the age of 16, the hair is removed ceremoniously. This is known as keśānta. This
marks a period of transition in the child’s life and the development of the adult per-
sonality. In case of the girl child, the ritual performed is known as ṛtuśuddhi, indi-
cating menarche marking the transition of the girl into a woman.
At the end of formal education, the ritual called samāvartana is performed.
This is very similar to the graduation ceremony and marks the end of the celibate
life of studentship. The next ritual is vivāha or marriage, and after this is com-
pleted, man and woman become husband and wife and enter the stage of the
householder (gṛhasthāśrama).
94 P.R.K. Kumar

Fig. 6.3 Fifteen of the sixteen civilizing rituals (saṃskāras) are completed by early adulthood
implying that the foundation for well-being has to be laid in early part of life. This diagram reveals
that ritualized behavior is more important in the younger formative stages of life

Fifteen of the sixteen rituals are completed with marriage, and the remaining
ritual is antyeṣṭi or the death rites. Death is tackled in a ritualistic manner, and this
helps the members of the family and society to manage the psychological trauma
caused by the separation and to come to terms with the inevitable consequence of
life.
The fifteen civilizing rituals pertain to important phases in human life, where
the correct attitude and decisions can make the difference between success and
failure in life. Some of the rituals represent phases in life, where the individual
goes through emotional or intellectual or social transformations. The message is
that if one takes the proper steps from prenatal life to marriage, then one can live
one’s life to its full potential and face death with a sense of fulfillment. Thus, the
sixteen ritual program aims to make best use of the early part of human life to
lay the foundation for a life that will be established in all-round well-being (see
Fig. 6.3).
There are different opinions on the number of the saṃskāra or civilizing rituals. The
number ranges from 12 to 42 in various ancient texts. It is likely that these rituals have
evolved and might have been modified in the course of time. But the underlying
6 The Role of Social Rituals in Well-Being 95

principles have remained unchanged. The rituals have been rediscovered and redefined
to save them from the rigidity that they acquire in course of time. And they serve as the
roadmap to prepare and come to terms with the changing phases in the journey of life.
So much so that one is established in a state of inner and outer well-being.
There are rituals that are based on the principle of using the power of intention of
the human mind to influence the course of life events of the individual as well as of
nature. It is beyond the scope of this chapter to enter into a discussion on these spe-
cialized rituals.

6.9 Transcending the Bondage of Rituals

Rituals will fail in their purpose if they do not succeed in achieving all the dimen-
sions of well-being. Spiritual well-being is an important goal of dharma and thereby
of rituals. True awareness of dharma is synonymous with spiritual well-being, as
both represent awareness of the unity of the universe. What then to say if rituals
come in the way of spiritual well-being? By spiritual well-being is understood the
expansion of awareness from self-centeredness to universe centeredness (see Chap. 9
in this volume).
When spiritual well-being is achieved, one perceives oneself in the universe and
the universe in oneself (Yadavji 1992).
True intelligence perceives the world in oneself and oneself in the world (Ćaraka Saṃhitā,
Śārīra Sthāna, 5, 7 in Yadavji 1992)

When the inner significance of rituals are not understood, rituals become mere
external enactments and devoid of purpose. The ancient texts have pointed out this
danger and strongly criticized people who perform and misrepresent rituals for self-
ish gains or without any purpose. The Bhagavad Gītā makes mockery of people
who indulge in rituals only for the sake of prosperity and individual well-being. It
points out that spiritual well-being is never attained by those who do not understand
the real implications of the rituals they perform (Ramsukhdas 1995).
The intelligence of those people will not attain equilibrium, who preach in flowery words
that there is nothing beyond the Vedas and who are lost in the pursuit of enjoyment and
wealth (Bhagavad Gītā, 2, 42–43 in Ramsukhdas 1995).

The Bhagavad Gīta outrightly rejects obsessive adherence to the Vedic rituals
and condemns such people as fanatic supporters of Veda (vedavādaratāh). The
same text also says that the Veda deals with the three guṇa of nature, purity, delu-
sion, and ignorance and that one must transcend the three guṇa to attain spiritual
well-being (Ramsukhdas 1995).
The subject matter of Veda is within the scope of the three material guṇa. O! Arjuna! Go
beyond the triguṇa (Bhagavad Gītā, 2, 45 in Ramsukhdas 1995).

When spiritual well-being is achieved, one is ever established in the awareness

of dharma. Rituals become superfluous in this state. The Nārada Bhakti Sūtra
96 P.R.K. Kumar

brings forth this idea very clearly by saying that a person who has attained spiritual
well-being forsakes rituals and the Veda (Ravisankar 2003).
A spiritually enlightened person discards all rituals and even the Veda – (Nārada Bhakti
Sūtra, 3, 15–16 in Ravisankar 2003).

Ādi Śankara points out that those who get carried away by the external pomp of
rituals fail to grow spiritually. People may quote the scriptures, make sacrifices to
the gods, perform actions, and pay homage to the deities, but there is no liberation
without recognizing the unity of the self with the universe, not even in the lifetime
of a hundred Brahma (countless millions of years).
Let them quote from the scriptures, offer sacrifices to the gods, perform many actions, and
pray to deities. Liberation will not be attained without realising the oneness of the individ-
ual and cosmic self. (Vivekacūḍāmaṇi of Ādi Śaṅkara 1, 6 in Madhavananda 1982)

Spiritual awareness comes with tempering of the mind. The mind is tempered by
adherence to dharma. Rituals help in establishing dharma, they create the circum-
stances for the psycho-spiritual evolution of the mind, which has to be initiated and
completed consciously. In modern times, Rabindranath Tagore has pointed out the
meaninglessness of rituals performed without sense of purpose. The lines from his
thought-provoking poem “Go not to the temple” are worth quoting here:
Go not to the temple to put flowers upon the feet of God, First fill your own house with the
Fragrance of love…, Go not to the temple to light lamps before the altar of God, First
remove the darkness of sin from your heart… Go not to the temple to bow down your head
in prayer, First learn to bow in humility before your fellowmen…Go not to the temple to
pray on bended knees, First bend down to lift someone who is down-trodden. …Go not to
the temple to ask for forgiveness for your sins, first forgive from your heart those who have
sinned against you3

That purity and innocence of the mind that is the true basis of temple worship is
highlighted by an anecdotal account from the life of Narāṇan the lunatic. Nārāṇan
was a vagabond-exhibiting eccentric behavior, but many of his actions, seemingly
conveyed profound messages, had a reformative influence on society. As he was
wandering around the village one day, he came in front of a temple, where the
priests were struggling to consecrate the deity. Elaborate rituals were being per-
formed, but the idol was not getting positioned in place. Nārāṇan was much amused
by what he saw and, without heeding the protests of the onlookers, took hold of the
idol in his hand, spat the betel quid that he was chewing on the altar, and placed
the idol over it saying “Now, you stay here in place.” The legend goes that much to
the surprise of everyone, the idol became stable and well positioned on the altar. The
moral of this story is that rituals are insignificant and meaningless when purity of
the heart is attained.
Rituals are practices that groom behavior and align the human mind with the
highest dharma: the appreciation of the unity of the universe. Rituals have relevance
until the sense of dharma is fully awakened, after which they become redundant.

3
http://mptbc.nic.in/books/class11/enggt11/ch1.pdf
6 The Role of Social Rituals in Well-Being 97

Rituals guide and regulate action in individuals who have not cultivated awareness
of dharma. On the other hand, rituals performed out of context do not lead to awak-
ening of the sense of dharma and in such cases become counterproductive and needs
to be discarded.

6.10 Conclusions

In the Indian cultural tradition, rituals have been associated with well-being. This
association is made explicit in the medical traditions of Āyurveda. Rituals establish
well-being by enforcing dharma, or the universal order. Dharma includes unity
among members of society, ethical values, sustainability of nature, and human
endeavors and stands for all actions that lead to social and individual well-being
(Sosis 2004; Rappaport 1999). Rituals also aim to inculcate control over senses and
emotions by enforcing discipline. This is achieved by ritualizing good conduct by
exaggerating behavior and formalizing them into repetitive and sequential patterns.
Rituals help to establish well-being in terms of preservation of life, enhancement of
health, creation of wealth, social identity, and sense of security for future life, by
creating unity in minds of individuals and grooming the emotions. Rituals lose their
power and significance when they become rigid and fixed. It then becomes neces-
sary to break, rediscover, and redefine them. The validity and utility of a ritual lies
in its power to establish dharma and thereby social and individual well-being. When
rituals are performed with awareness and conscious effort, it becomes a powerful
tool for self-transformation and well-being.

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Chapter 7
Health and Well-being in Indian Local
Health Traditions

Unnikrishnan Payyappallimana

7.1 Introduction

A description about health and well-being in Indian scenario is promising when

contextualized in a biocultural1 and an ecosystem perspective. An ecosystem
approach reiterates the innate, dynamic relationship between nature and human-
kind and hence biological and cultural diversity as well as communities’ belief
systems and perceptions of health and well-being. Such a consideration is espe-
cially important for local health traditions which are ecosystem and community
specific and health and well-being concepts and practices are highly embedded
in local worldviews and value systems. This exemplifies multiple benefits derived
from ecosystems towards health and well-being through various natural resources
such as food, medicine and shelter to recreational, cultural and aesthetic values
through ecological landscapes including sacred healing sites (Millennium
Ecosystem Assessment 20052). For instance, India represents around 7 % (num-
bering around 17,500) of all identified flowering species of the world. As high as

1
Biocultural diversity denotes an inherent linkage between a wide array of life forms and their
ecosystems and environments on the one hand and the range of human expressions. In totality this
diversity encompasses genes, species, ecosystems, landscapes and seascapes to worldviews, belief
systems, knowledge, morals, values, norms, languages, rules, artistic expressions, artefacts and
institutions of a region that have generally been passed on through an intergenerational transmis-
sion process and shared by a group. They mutually and constantly evolve in response to a changing
environment or world order (Haverkort 2006).
2
Millennium Ecosystem Assessment (2005) Biodiversity and Well-being: Synthesis Report, Island
Press.
U. Payyappallimana ()
United Nations University-Institute of Advanced Studies, Yokohama, Japan
Institute for Āyurveda and Integrative Medicine, Bangalore, Karnataka, India
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 99
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_7,
© Springer Science+Business Media Dordrecht 2013
100 U. Payyappallimana

9,000 plants are used in the traditional communities of the country for various
purposes such as food and medicine (AICRPE 1992–1998), of which around
8,000 are used for medicine (Shankar and Unnikrishnan 2004). This typifies the
deep human-nature relationship and the wealth of knowledge in local health
traditions.
For a clearer appreciation of this relationship, one may look at the classification
in classical Sanskrit literature of Indian cultural life into three categories: aranya
(forest related), gramya (rural) and nagarya (urban). Historically, while this classi-
fication may have corresponded to different levels of sophistication in lifestyles,
demographic patterns as well as knowledge codification, today it represents a more
complex yet nearly corresponding picture. Even as we recognize that such a distinc-
tion may be obscure as most communities are in rapid transition due to various
socioeconomic factors, it gives a broad framework for analysis on the influence of
nature in the sociocultural life and its impact on health and wellness.
According to 20013 census of India, out of total population of 1,027 million,
about 285 million live in urban areas (in over 5,100 towns and 380 cities) and 742
million live in rural areas. As per the census, India has a tribal population com-
prising of 8.2 % of total population, who live inside or in close proximity to the
forests. Also known as adivasis, they are categorized on the basis of geographi-
cal isolation, distinct culture, language and traditions by the Indian Constitution.
Even with relatively rapid urbanization in the country, many of the traditional
communities have retained their lifestyles, community life, knowledge and
related value systems. Some groups follow subsistence agriculture and land
holdings if existing are small. They continue to closely relate with the forests for
several of their needs such as food, fuel and medicine and earn livelihoods
through traditional occupations including selling minor forest produce like fruits,
honey, tubers and medicinal plants. The second group, which is considered here
as gramya, is involved in agriculture and related occupations and consists of
roughly 50–60 % of Indian population. This represents rural economies comprising
of communities from buffer areas of forests, villages to shanty towns or suburban
areas. The third group is those who live in urban areas, representing around 28 %
of the population.
The point to note is that roughly over half of the Indian population continues to
associate with natural landscapes and ecosystems and uphold traditional lifestyles
in their daily lives and occupations. Consequently, the health and well-being per-
ceptions of a large section of the population are around this relationship. The range
of social life represents a complex milieu with regard to status or perceptions of
health and well-being among rural communities. This varies vastly in terms of deter-
minants, access, availability, affordability and quality of health care. They also
continue to be guided to a considerable extent by access, belief systems and their
capabilities in traditional health practices.

3
See India census data: http://www.censusindia.gov.in/Census_Data_2001/India_at_glance/rural.aspx
7 Health and Well-being in Indian Local Health Traditions 101

7.2 Characteristics of Local Health Traditions

In India, in terms of knowledge or usage of traditional medicine, a clear geographical

or societal demarcation of folk as well as codified knowledge traditions is impossible.
Traditional lifestyles either deriving from codified knowledge traditions or from the
folk cultural practices are followed beyond geographical or class boundaries. Such
practices may relate to textual, inherited, incorporated or experiential knowledge
and skills (Sujatha 2007).
However, the phrase local health tradition here denotes the geographical and
ecosystem-specific practices, beliefs, customs, rituals related to health, nutrition or
broader well-being passed on from one generation to another mostly in oral trans-
mission. It is to be noted that folk knowledge practices also have been documented
and exist in the form of regional and vernacular literature, while a considerable part
of codified traditions is part of family traditions and not necessarily from classical
texts. Terms like folk, little traditions (as opposed to great) and indigenous knowl-
edge are used interchangeably to indicate such practices though any of these terms
may not fully represent the intricacies of this tradition. These traditional practices
represented by knowledgeable households, folk healers and other community
knowledge holders are mostly non-institutional and non-codified. It includes what
is popularly known as grandmothers’ remedies, the household knowledge about
primary health care, different health food recipes, seasonal health regimens and
health customs, rituals, etc. This also covers over a million community-based health
workers belonging to various specialties such as bone setting, specialized in jaun-
dice, paralytic conditions, children’s diseases, eye diseases, poison healers, spiritual
healers and birth attendants. They range from specialized diagnostic techniques to
management methods related to preventive, curative and promotive aspects of
health. Healing is mostly not a full-time profession for such practitioners, and they
may be a farmer, barber, shopkeeper, blacksmith, teacher or even priest or a monk.
One of the reasons for the widespread nature of this tradition even today is the low
sustenance cost and a noncommercial nature. Such practitioners have no formal
recognition of education but continue to serve in communities due to social legiti-
macy and community support (Shankar and Unnikrishnan 2004).
A recent study by Lohokare and Davar (2010) on traditional mental health practi-
tioners in Maharashtra says that ‘a nuanced approach that appreciates the centrality
of healing in the larger socio-cultural context of well-being and community life is
critical. Indigenous healing systems are mistakenly seen in a homogenous light,
completely obscuring their internal variations that exist between different systems’.
The study points out how such local traditions positively contribute to the transcen-
dental and existential aspects of health and well-being which are context specific and
beyond universalization, an important feature of local health traditions. Shared
explanatory frameworks, healing practices including rituals, physical healing envi-
ronment and so on become central in such a context. Despite variations in social
structures (such as caste or religion), the concept of ecology, body, health and disease
is more or less uniform among people, resulting in the medical lore of a particular
102 U. Payyappallimana

group. Such a ‘medical lore’ which is endured and refined through generations has
its ‘coherence’ and ‘epistemological autonomy’ and is quite different from ‘lay
knowledge’, and this is not an amateur version of classical, codified knowledge.
Such knowledge is mainly deriving from communities’ perceptions of bodies and the
outside environment (Sujatha 2007).

7.3 Co-evolution and Sharing Among Knowledge Traditions

Whereas there are two distinct knowledge streams such as the local health traditions
(loka) and the codified knowledge systems (śāstra, which are codified and institu-
tionalized), they share many of the concepts and practices in common and have a
complementary relationship. These are reflected in several of the cardinal concepts
and essential principles of these knowledge traditions. For instance, the loka-puruṣa
or the microcosm and macrocosm relationship as mentioned in Āyurveda is also a
central dimension in the local health traditions. Similarly underlying theoretical
aspects such as pañcamahā bhūta theory (theory of composition of matter) and
tridoṣa theory (theory of causation of health and disease) are also shared in various
ways by these systems. Though such classifications may not be obvious in folk
expressions, this can be deduced from the usage of several technical terms such
as uṣṇa, sīta, guru, laghu, vāta, pitta and kapha by the folk knowledge carriers
(Balasubramanian 2003, 2006). There is also a huge overlap of the medicinal
resources used by these knowledge streams. Some of the other aspects shared are
the focus on systemic understanding of health and diseases; multicausality approach;
a circular method of cause-effect reasoning; subjective, qualitative, individualized
and personalized management; preventive focus; attribution of importance to physi-
cian’s wisdom; and so on. Another unique shared feature is that knowledge genera-
tion is mostly through subtle observations and experiences within the context, i.e. an
individual or the nature (Payyappallimana 2010). Such interactions and exchanges
are core elements in health knowledge production in the subcontinent. Such con-
tinuum and complementarities are found also between Siddha medicine and current
folk perceptions of food and nutrition, health, illnesses and their management in
Tamilnadu. Often the outcomes of these exchanges are more complex and layered
than a mere dichotomy such as ‘folk’ or ‘classical’ systems (Sujatha 2007).
There are two dominant views related to the generation and codification of knowl-
edge in Indian health traditions. First, according to Ayurvedic classical literature, the
preceptor (brahma) ‘remembered’ the knowledge of life which was passed on to the
disciple prajāpati who in turn successively transferred this to Aswini kumaras, then
to Indra and his disciples who codified the knowledge in present form. The second
view is that local, oral health knowledge perceptions and practices (prākṛit) have
been collated, theorized and codified into textual traditions such as Āyurveda. In
such a view, forests and related communities are bestowed with abundant knowledge
and resources. Both positions receive equal attention right from the time of earliest
codified medical text, i.e. Ćaraka Saṃhitā. A passage in Ćaraka Saṃhitā says:
7 Health and Well-being in Indian Local Health Traditions 103

shepherds, cowherds, and those living in the forest are knowledgeable about medicinal
materials both by name and form (Ćaraka Saṃhitā, Sūtra Sthāna, 1, 120 in Sharma and
Dash 2001)
or in other words, wilderness is a rich repository of health knowledge. According to
Dhanvantari Nighantu (200–1000 AD), those who live in proximity to the natural
environments have a clear idea about the measurements (pramāņa), colour (varņa),
physical characters (ākriti) and the specific reproductive characteristics (jātiliñga) of
each plant, pointing to the fact that such traditions were consulted extensively.
Whereas there have been some changes in the relationship between these two streams
after institutionalization of the codified traditions in the last 100 years and their formal
recognition in the health system, there still exist active exchanges between these tradi-
tions. The following section will dwell briefly on the relationship between the two and
knowledge codification. This assumes importance in appreciating how health and
well-being perceptions and practices have evolved in communities.
According to Indian philosophical traditions, any knowledge or practice is con-
ceived at three levels of existence of a being. They are first, at the level of physical
existence relating to the practical aspects (vyavahāra – practical applications), second
at the mental level relating to the methodological/scientific aspects (śāstra – dos and
don’ts) and third at the level of inner self (ātman) where the individual becomes one
with the object (tattva – essential principle) or the essential nature of it. In other
words tattva is the essential truth/principle relating to a particular practice, symbol,
ritual, etc., and this is an understanding at the level of ātman (self). Śāstra relates to
the do’s and don’ts which is linked to manas and buddhi (mind and intellect) and
vyavahāra is related to indriyas (jñanendriya and karmendriya – tools of knowledge
and action). These three levels also correspond to the three frequent questions that
arise constantly in us such as ‘why’, ‘how’ and ‘what’, respectively. To put it in a
different way, through a repeated practical experience (vyavahāra), one recognizes
the sukha (pleasure) and the dukha (pain) of an experience. This experience gives
the individual a framework (the do’s and don’ts) of relating to that experience or
similar experiences in their temporal and spatial dimensions (śāstra). Through such
continuous experiences and reflection, one internalizes the tattva (essential nature)
of the experience. It is also indicated in classical texts of Āyurveda that tattva
reflects itself in a clear or uncomplicated mind (Payyappalli and Hariramamurthi 2011).
If one looks at the dynamic nature of traditional knowledge, it can be seen that
the ‘practical aspects’ are known to most members in a community; in other words
it is a shared community knowledge and varies or changes vastly based on the needs
of time and geographical context – while the ‘methodological aspects’ which are
more specialized also vary, though to a lesser degree, according to time and context.
But the third level which is the wisdom of ‘essential nature’ remains unchanged.
This describes the process on how practical or local knowledge experiences are
codified and theorized to apply in different spatial and temporal contexts as in the
classical literature; at the same time, how codified knowledge continuously verifies
and guides practical actions. It is explicit that the codification process need not
necessarily be textual. This also reiterates how the codified and non-codified knowl-
edge have had a mutually nourishing relationship and have been co-evolving.
104 U. Payyappallimana

7.4 Local Health Traditions, Ecosystems and Health

and Well-being

Defining health in a broader context of well-being is challenging due to the

encompassing nature of these terms and is often criticized as too idealistic. It is also
argued that such a definition aims at conceptualizing health as a positive attribute to
be achieved through universal health coverage of modern health care while neglect-
ing the understanding of health as a socioculturally constructed attribute. The much
acclaimed definition of WHO considers health as a ‘state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity’
(WHO 1948). In a similar optimistic tone, this view is also shared by the local
health cultures which take into account mental, social, spiritual, physical and eco-
logical dimensions of health and well-being. In local communities it emerges from
the idea of relationship between the being and nature or the macro- and microcosm.
A fundamental concept is of equilibrium of these dimensions within an individual,
individual and community, the two together with the environment and the larger
universal space. Any breach in this nexus leads to disease (Bodeker 2009), which is
a shared view of health in Indian traditions. In yet another view of Indian healing
traditions, the absence of incapacitating disease, good psychological functioning,
effective conduct of personal and social life and feeling of ethical and spiritual
well-being are defining elements of good health (Kakar 1982).
The intricate linkages of health and well-being with the nature and sociocultural
factors are reflected in these definitions. There is increasing realization that nature
and ecosystems are the bedrock of services that lead to health and well-being as
they provide health and nutritional resources, spiritual and recreational spaces,
inspiration and a learning and identity space for communities in proximity. This
indicates the centrality of the health of ecosystems to ensure health of individuals
and communities. In the contemporary view, health of the ecosystem correlates to
morbidity patterns, life expectancy and quality of life and the sustenance of a pro-
ductive engagement of the communities with the environment. Specifically, regula-
tion of pests and disease-causing pathogens, availability of good-quality water and
well-functioning ecosystem services are essential to ensure well-being. It is to be
noted that human health and well-being are dependent not just on the direct ecosystem
services derived from the proximate environment.
Various cultural expressions such as festivals, rituals, customs and value systems
in traditional communities reinforce this relationship with nature ensuring an inspi-
rational milieu. This also extends to a realm of knowledge generation in local healing
traditions. A healer derives inspiration for healing methods as well as medicinal
resources from the landscape with which he or she interacts. This is shared by tribal
healers in most other parts of the country. For instance, in Wayanad region of Kerala
state, healers mention that their healing prowess and approaches are revealed
through dreams or visions. They also say that the drugs reveal themselves to
(and often communicate with) them (Suneetha 2004). A healer in Gadchiroli in
Maharashtra, during a field visit, indicated that the constant interactions with the
7 Health and Well-being in Indian Local Health Traditions 105

natural environment give them a sense of what is good for health and what is poison.
This is a sense of heightened consciousness of the healer within the biocultural
mosaic. A child who grows up in such an environment instinctively learns about
processing and the use of medicinal resources for a variety of ailments. Following
her study in Baiga region of Central India, Sarangapani (2003) says, ‘In Baghmara
village, for instance, virtually all the adults have a fairly extensive knowledge of the
trees and plants in the forest, and varying degrees of knowledge about the medicinal
properties of various plants. Children, both boys and girls, from the age of about 5
or 6 years can identify several of the more common medicinal plants around the
village. On a few occasions they mentioned what it was used to treat; typically
stomach ailments. By the age of about 8 or 9 years, the scope of the child’s environ-
ment and knowledge both widen quite dramatically. On some of our visits together
to the forest, they named over 60 plants with medicinal properties, and many more
that bore fruits that could be eaten or were useful. They stopped their list out of
consideration for me because I could no longer keep track…’. Proximity to a biodi-
versity rich natural surrounding unsurprisingly provides a vast knowledge of medic-
inal plants and other resources. This continues to be a unique aspect of local health
traditions as against the institutionally qualified traditional medicine physicians
who today hardly recognize wild resources or appreciate the broader social and
environmental determinants of health and well-being.
Within this broad backdrop, an attempt is made as follows to illustrate some of
the distinctive features of local health traditions with regard to health and well-
being. These categories include underlying principles, beliefs, determinants, drivers
or means of health and well-being in local communities.

7.4.1 Microcosm and Macrocosm

A shared perspective across communities is the inherent relationship between the

‘outside’ and ‘inside’ worlds. Whereas this is refined in Āyurveda and other codi-
fied systems of medicine in terms of ‘loka’ (macrocosm) and ‘puruṣa’ (microcosm),
traces of this principle form an underlying basis for all local traditions. This is
apparent in the tenets of balancing the ‘internal’ and ‘external’ environments. This
then leads to identifying similarities and differences in rūpa (form), guṇa (quality)
and karma (action) of materials and methods which are central to recognizing drug
resources or health management principles. For example, in terms of medicinal
resources, body parts such as hair, skin, blood and flesh or their qualities or func-
tions are compared with external materials and in turn identified as medicines for a
condition in the corresponding body part or function. Use of haridra (turmeric) for
jaundice, lakṣa and manjiṣta (lac, Rubia cordifolia and other similar plants that are
red in colour) for haemorrhage or goat’s milk for respiratory disorders, in folk
knowledge traditions exemplify this principle. Another interesting and illustrative
example is the usage of Garudakodi (an Aristolochia species), literally translated as
eagle twiner for sarpaputtru (a viral condition literally translated as snake hills) and
106 U. Payyappallimana

articulated in a shared myth across communities, which exemplifies such local

taxonomies originating from this understanding of the nexus of inside and outside
worlds. Likewise, external manifestations such as flow, transformation or degenera-
tion in the form of metaphors are applied as diagnostic or therapeutic categories
which also represent the inherent link.

7.4.2 Spiritual Dimension and ‘Beyond Self’ Pursuits

Extending from the above, a human being is considered a miniature of the infinite
external world, as against an anthropocentric view. Therefore, this reflects the
need for a being to be integrated well with the larger whole, forming the basis of
a spiritual aspiration and pursuit. Divinity to the external world is attributed
through symbolic representations, earmarking sacred resources, spaces and time.
This is also echoed in the way a healer derives knowledge from his/her environ-
ment through dreams or intuition where there is a thinning of line between the
nature and the divine.
Likewise deep reverence to ancestry is an abiding tenet in traditional cultures.
This includes predecessors within the family, community and teachers. Such ances-
tors are invested with a guardian role of supporting, protecting and guiding various
activities of individual and communities. Hence, there is immense value placed on
appeasing ancestral spirits to ensure own well-being. The presence of a higher
power is also ascribed to the healing powers of a healer. Some healers are consid-
ered to have been gifted with special healing powers that is referred to as ‘the power
of the hand’ or Kaippunyam (see Box 7.1). Healers themselves consider that they
work as instruments of God, further affirming that the knowledge they possess is the
‘word of God’ (Suneetha 2004). The concept of the impact of positive and negative
actions of a being on the larger whole is also central. For instance, the practice of
offering prayers and conducting rituals before cutting a plant for medicinal purposes,
as seen in many traditional communities in India, is illustrative – the consequences
to the life form harvested is duly acknowledged.
Spirituality is also expressed in the material resources. For instance, some
disease conditions such as chronic skin ailments are believed to be caused by both
physical and spiritual factors, and it is common to find healers advise patients to
make specific offerings to the snake gods before starting the treatment. Offerings
are also made in the case of ailments such as chicken pox to the Goddess Kali
(Hafeel et al. 2003). The Gond community in Vishakhapatnam in Andhra Pradesh
believes in existence of an array of divine beings and ancestral spiritual forces that
dwell in houses, community spaces, fields, burial grounds and forest areas. It is
believed that they can help or harm and are beyond the control of human beings. It
is also believed that they help and protect in situations of danger. In order to appease
the spirits, so as to protect them from evil influences, the communities conduct rites
and rituals. This is also followed before any important event at home such as a house
construction, land preparation, tree felling or marriage proposals. There is the belief
7 Health and Well-being in Indian Local Health Traditions 107

Box 7.1 Healing Hands of Shimoga

Near Shimoga, southern India, Mr. Narayana Murthy is a living example of
how a local healer is effectively contributing to community health. For the
past two decades, he has been serving the people on 2 days (Thursday and
Sunday) every week. These days are considered as Siddhi varas – days which
give good effect. The healer and his family are strong believers of God and do
the daily rituals as per community rules. The blessing of the community deity
(Lakshmi narasimha) is an important factor which influences the patient’s
well-being and efficacy of the medicine given.
Healer Murthy treats the patients without any charge. The family’s source
of income is agriculture. Patients are allowed to put money in the metal box
with small opening, without any condition, and this amount is later used to
meet the expenses of their community temple. Most cases that come to him
are diagnosed cancer of different kinds (70 % according to him) and people
often consider this place as a final place of hope. Some patients carry labora-
tory reports of clinical diagnosis and hospital discharge summaries. His
‘one-day’ medication for the urinary calculi and medicines for heart blocks
are a well-known remedy in Karnataka and adjacent states.
According to the patients, their belief in the good heart and genuine mind
of the healer is essential in the healing. As they state: ‘we only want the
medicine from his hands’. The Murthy family has established 30 acres of land
with naturally grown medicinal plants and tree species. Healer Murthy views
the plant as a living and a life-giving organism and a specific ritual is needed
when collecting the required plant part. This ritual is a pradakshina, encir-
cling the divine body of the tree. He prays for the effect of the medicine
and asks permission of the tree to take its part with medicinal properties.
He says that this ritual bestows the effect of medicine. The ritual is also a
sincere prayer for the benefit of each patient who comes to him for treatment
(Adapted from Hafeel et al. 2003).

that Mother Nature guards and protects them, as they are believed to be the children
of nature. The sacredness is attributed to trees, grains, animals, hills, forests, streams,
mountains and caves that are worshiped through rituals, ceremonies, festivals and
fairs. Such knowledge, belief systems and worldview find expression in agro-ecological
traditions, arts, songs and other symbolic representations, practices linked to
well-being (Shankar 2003).
Individual well-being is achieved within the broader realm of community well-
being. While individual welfare is not ignored, it is dovetailed with the broader
well-being of the community of which the individual is a member. This gives rise to
a non-self-centred approach that provides for individual needs, while exacting
sacrifices for the overall welfare of the group or the community. Further, the concept
of rebirth and time as a cyclic phenomenon also plays down the finality of death,
108 U. Payyappallimana

sometimes even celebrating the occasion as a passage of rite. Therefore, among

some communities, well-being of current, past and future lives are believed to have
equal significance.

7.4.3 Natural Resources and Health

This covers aspects such as medicinal resources, nutritional resources and the rec-
reational aspects related to biocultural diversity. Diversity of foods, their availability
and processing methods during different seasons contribute to nutritional and health
security of communities. This perception of health is ingrained in local cuisines and
exemplified in the use of an array of spices and adjuvants in traditional cooking
methods specific to different agro-climatic regions. In a study in communities of
coastal Tamilnadu, Sujatha (2007) mentions, ‘the body is seen as being constituted
by food which is the vehicle by which the external ecology is internalized’.
Communities use regularly four to five millets such as finger millet, pearl millet,
kodo millet and little millet along with several different sources of vegetables.
Communities assert that diversity in food is important as it facilitates balancing
effects of deficiencies in a uniform diet, acclimatizes the body to diverse elements
in the habitat and thus contributes to a healthy body.
The diverse and continued use of medicinal plants, minerals, metals and animal
products/parts among some communities is astounding. For example, a study con-
ducted in the hamlet of Bommiampathy in the Attappady region of Kerala reveals
that around 500 medicinal plant species are used within the hamlet (Unnikrishnan
2009). It is noteworthy that each of such local communities uses about three times
as many resources as documented in Āyurveda. Local traditions swiftly incorporate
new additions to the repertoire of medicinal resources or knowledge which allows
the traditions to be in a state of dynamic refinement. There is a belief among com-
munities that plants available in local area will be more effective for a population
residing in a particular location. This has resonance in the classical Ayurvedic
understanding. Āyurveda adds that resources from place of origin will be effective
even if one has migrated to a new locale.
Festivals, ceremonies and rituals which continue to be practised in communities
have a direct bearing on well-being. There is growing body of research on the
impact of festivals on physical and mental health and in reinforcing identities, resil-
ience and capacity at individual level as well as at community level (Phipps and
Slater 2010). In India though many festivals and rituals have religious functions,
they also have strong links with local healing traditions. For instance, there are fes-
tivals or rituals such as for marking the harvest season and prosperity (i.e. Pongal),
related to procreation (i.e. Thiruvathira) and rejuvenation (i.e. Karkidaka regimen
in Kerala) to mention a few from South India. The direct health impacts are reflected
in the various medicinal and nutritional resources used in these festivities. For
example, the Ugadi festival marks the New Year in the states of Karnataka,
Maharashtra, Andhra Pradesh and Goa. It symbolizes the differing life experiences
7 Health and Well-being in Indian Local Health Traditions 109

of sadness, happiness, anger, fear, disgust and surprise which need to be greeted in
a balanced state and equanimity. A medicated mixture among several other tradi-
tional dishes consumed during the occasion is believed to represent these varied
experiences and consists of materials like neem buds and flowers (bitterness, signi-
fying sadness), jaggery and ripe banana pieces (sweetness, signifying happiness),
pepper (pungent, signifying anger), salt (signifying fear), tamarind juice (sour,
signifying disgust) and unripe mango (astringent, signifying surprise).4 The impact
of such festivals and rituals, both direct and indirect, on health and well-being has
not been well documented and studied in Indian context.

7.4.4 ‘Health Is from Within’

Health is an attribute of self-reliance and control of own life of an individual.

Though rapidly changing, there is a strong belief among older generation that health
cannot be created merely with external means such as medicines. In a recent recon-
naissance survey conducted in Kerala among elderly (75 years is the average life
expectancy in the state), the respondents mentioned that health is dependent on a
disciplined lifestyle, a life in moderation, promoting aspects of self-healing in the
body, regular exercise and having a composed approach. This also alludes to the
notion that health is a balance of internal and external elements mentioned earlier.
Based on a study in Thirupathur taluk area in coastal Tamilnadu, Sujatha (2007)
says that the communities in the region believe that disease is part of the body and
no one is free from it as its proneness or manifestation is linked to the constitution.
Owing to constitutional variations, different parts of processes are likely to mal-
function. Multiple causes are reasoned for a manifestation; however, the prime
source is within the body and the ‘quality of blood’ which is linked primarily to the
diet and lifestyle. If these two are taken care of, an external agent or pathogen
cannot breach the body.

7.4.5 Carriers of Health and Well-being

In an analysis of health-seeking behaviour of communities, Kleinman5 identifies

three arenas of care: home, nonprofessional and professional. He further adds that
at the home level, beliefs, choices, relationships and interaction with others, engage-
ments with institutions and health products play a critical role and that 75 % (750 of
every 1,000 illness episodes) never get outside of family sector. At the level of the

4
See http://www.manavata.org/Events/ugadi.htm
5
See Arthur Kleinman, National Institute of Health lecture, 2002: http://videocast.nih.gov/Summary.
asp?File=10463
110 U. Payyappallimana

nonprofessionalized folk sector, local healers and lay therapists play a vital role,
while in the professional sector, hospitals, clinics of biomedical medicine, Chinese
medicine or Ayurvedic medicine are important.
In the Indian context, it is true that most of the common ailments especially in the
rural milieu are managed at household level or within the community. Most household
women know local remedies for common primary health conditions. At the second
level, there exists variety of informal knowledge carriers such as local healers, divin-
ers, magic or religious practitioners engaged in community health. An important
agency of intergenerational transfer is through oral processes such as proverbs, songs,
stories involving health, healing resources and management approaches, which rein-
force ideas of health and well-being. Healers also pass on their knowledge to next
generation by choosing them based on qualities that are valued in tradition, such as
patience, faith, courage and keenness for healing (Payyappalli 2010).

7.5 Changes and Challenges

The concepts related to health and well-being in this context, as mentioned earlier,
are characterized by a dynamic nature. Due to rapid socioeconomic transition, these
practices are in a state of flux. The emergence of a mainstream market for health
products and services, more accessible than before; changes to the social relations
within a community to a more individualistic frame with resultant consequences to
resource ownership and use (such as land, waters); changes to extant percepts of
health and well-being among the community members; and increasing outmigration
away from their ecosystems into more prospective territories are some of the chal-
lenges. There is high erosion in the local traditional knowledge and practices both
in household as well as more specialized healers’ level. This is evidenced from the
fact that average age of a healer is over 50 years and there are not many successors.
At the household level, the reducing usage of local medicines can be attributed to
erosion of knowledge, inconvenience and improved access to and availability of
conventional medicines. Such erosion has a considerable impact on health and well-
being especially in areas where access to health care is a problem. Codification of
such traditions through documentation methods has risen in recent times through
various policy and implementation programs.

7.6 Conclusion

The central role of traditional medicine, conservation of ecosystems and natural

resources in achieving better human health and well-being, is being increasingly
recognized in multilateral policy discussions. There is also a renewed interest in
primary health care, with the revival of this approach by the World Health
Organization in 2008. Several multilateral conventions and resolutions uphold the
7 Health and Well-being in Indian Local Health Traditions 111

relevance of biodiversity and traditional knowledge in health and well-being of the

people especially in regions with poor access to health care, yet rich in natural
resources.6
This chapter attempted to highlight this relevance of informal health knowledge
streams of India in this context. The discussion was purposively positioned on the
contemporary relevance of local health traditions (than a historical or ethnographic
narration) with regard to community health and well-being. While a clear demarca-
tion of folk and classical knowledge or their geographical patterns of usage is not
possible, it can be assumed that roughly over 50 % of the population continues to
have strong association between their sociocultural landscapes and natural environ-
ments and thus actively engage with traditional medical knowledge systems for
their primary health and nutritional needs. This nexus extends over diverse aspects
such as medicinal resources, food and nutritional resources, protection from epidemics
or spiritual and recreational aspects which are central to health and well-being.
There are several challenges such as rapid changes in sociocultural life, erosion of
knowledge practices, emerging market forces, demographic changes, migration,
changing health and well-being perceptions in communities among others. Keeping
these in mind, effective policy interventions are essential to strengthening such
practices. This indeed calls for a participatory approach to health care in which
individuals and communities become active and self-reliant stakeholders in actual-
ization of health and well-being.

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 Part III
Bridging the Worlds
Chapter 8
Quantum Logic in Āyurveda

Rama Jayasundar

8.1 Healthcare: Emerging Trend

Western medicine, which is striving to provide professional healthcare system with

the aim of eradicating diseases, has undergone an explosion of knowledge leading
to diagnostic and therapeutic breakthroughs. Yet, the disease burden has not reduced
and the overall results in terms of complete cure without side effects have left much
to be desired (Dean 2005; Gandhi et al. 2003; Lazarou et al. 1998; Moore et al.
1998). A number of diseases previously under control are no longer manageable
with the currently available medicines. For example, new strains of drug-resistant
bacteria have developed, which defy treatment with conventional antibiotics
(Goossens et al. 2005; Hawkey and Jones 2009). In addition, factors such as altered
lifestyle and environmental conditions are also contributing to new health threats.
Diseases now defy state-of-the-art diagnosis and treatments (Avenell et al. 2004;
Illich 2003; Mackenbach 2006; Shahri and Hagemann 2011).
It is becoming apparent that despite specialised knowledge and use of sophisti-
cated technologies, modern medicine seems unable to handle the mushrooming of
diseases underscoring the need for a relook at alternative approaches to medicine.
Moreover, with an increasingly chemicals-weary population turning to alternative
systems, a pluralistic and integrated approach to healthcare is emerging world over
(Bishop and Lewith 2010; Wade et al. 2008). Even in Western countries at the fore-
front of modern medical research, there is growing interest in alternative systems of
treatment (Kemper et al. 2008; Morandi et al. 2011; Xue et al. 2007). This inevita-
bly brings into focus one of the longest unbroken healthcare system in the world, i.e.
Āyurveda, indigenous to Indian subcontinent. As Western medical science contem-
plates alternative approaches, it is pertinent to understand Āyurveda, whose

R. Jayasundar ()
Department of NMR, All India Institute of Medical Sciences, New Delhi, India
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 115
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_8,
© Springer Science+Business Media Dordrecht 2013
116 R. Jayasundar

concepts and approaches to health and diseases are at variance with that of Western
medicine (Jayasundar 2009, 2012a) but resonate with some of the concepts of quan-
tum physics applicable to the macroscopic world. This chapter explores points of
contact between Āyurveda and quantum physics, in particular quantum reality and
worldview. It also gives a bird’s-eye view of the two streams of medicine – the cur-
rently prevalent classical physics-based reductionistic Western medicine and the
vedic sciences-based holistic Āyurveda.

8.2 Classical Worldview and Western Medical Science

Physics has been very influential in shaping the development of biology and medi-
cine. It has contributed tremendously to the advancement of medical diagnostics
such as ultrasound, Computerised Tomography (CT) and Magnetic Resonance
Imaging (MRI) and therapeutics like nuclear medicine and radiotherapy. From
x-rays to laser, applications of physics have been successfully translated into medi-
cal technologies (Davidovits 2007; Kane 2009). While these contributions of phys-
ics are well appreciated, very little is understood about the impact of its worldview
in medicine. That it has influenced medicine in a way more than one can appreciate
is much less known. Before we explore how worldviews have shaped medicine, it is
imperative to know the development and specific viewpoints on health and disease
of both the Western and Āyurveda systems, both of which are outlined in brevity in
the following sections.

8.2.1 Classical Worldview

The classical/Newtonian physics deals with macroscopic objects and the forces
governing them. Its laws formulated in terms of physically describable variables
have been extended with tremendous success from atoms to terrestrial bodies.
Physics came to be known as deterministic physics since the entire physical uni-
verse from the smallest to the largest was seen to be bound by these laws and the
concept of physical determinism (Burtt 1952; Butterfield 1997). A worldview based
on this had emerged by nineteenth century, which considered the world as being
made up of building blocks of atoms. This Newtonian worldview considered every-
thing from human body to universe as a machine composed of separate interacting
material particles/objects behaving in accordance with the physical laws. According
to this worldview, even nature could be reduced to fundamental entities of matter.
This viewpoint became the platform from which everything, including biology and
medicine, was viewed and understood. Consequently, human body also came to be
considered as being made up of building blocks of atoms and molecules. More
importantly, the focus has been on the physical aspects (as in classical physics) with
elements of the mental realm completely left out. Consequently, body and mind also
came to be viewed as two entirely separate entities in Western medicine.
8 Quantum Logic in Āyurveda 117

8.2.2 Western Medical Science

Hippocrates, the father of Western medicine, brought in for the first time the concept
of logical rather than supernatural explanations for illness. Since dissection of
human cadavers was forbidden on religious grounds then, he relied primarily on
logic and tangible evidence to understand health and disease. He considered the lat-
ter a result of imbalance among the four humours (blood, black bile, yellow bile and
phlegm), each of which was also associated with a personality type. Centuries later,
Galen (130–201 AD), a Greek philosopher and physician, extrapolated human anat-
omy from that of pigs, which was considered most similar to humans. The
Hippocratic-Galenic theories on the body-mind-personality relationship and views
on anatomy dominated Western medicine for the next 1500 years (Conrad et al.
1995; Nutton 2004).
The dissection of human cadavers of executed criminals by Vesalius in 1539, fol-
lowing a landmark judgement, corrected the mistaken notions of human anatomy
proposed by Galen and marked a historical milestone in Western medicine. However,
developments such as the discovery of blood circulation by William Harvey in 1628
began an era of viewing human body as an assemblage of organs supplied with
energy/fuel by blood. The use of microscope to view cells by Robert Hooke in 1664
marked yet another stage of development in Western medicine. Slowly, symptoms
till then considered to be natural physiological responses to disease began to be
viewed as pathologic consequences and the body-mind-personality connection fun-
damental to Galenic medicine was also discarded (Conrad et al. 1995; Nutton 2004;
Ventura 2000). The concept of linear and singular causality for diseases, however,
started with Morgagni’s work connecting aetiology of diseases to specific anatomical
locations (Ventura 2000). This marked the beginning of pathological anatomy, which
focuses on a single, dominant factor considered responsible for a pathology and uses
it for targeting treatment.

Impact of Classical Worldview on Western Medicine: Reductionism

While the above-mentioned developments in the field of medicine set the stage for
understanding human body from a predominantly mechanical perspective,
advances in physics played a crucial role in catalysing and developing them fur-
ther. The Newtonian mechanistic worldview considering the world as being made
up of fundamental units of matter as building blocks became the platform for the
reductionistic approach in medicine. Reductionism as a systematic method to
understand the world was proposed by Descartes, who suggested the world was
clock-like and could be understood by reducing it to parts and studying the indi-
vidual components (Cottingham et al. 1988; Haldane and Ross 1911). This con-
cept of breaking down of a complex system into smaller parts and studying them
separately has been a very successful approach in biology for studies ranging
from understanding the working of cells to the unravelling of human genome
(Keller 2000; Morange 2001).
118 R. Jayasundar

The reductionist model is hierarchical, with atom in the lowest level forming the
basic building block. Atoms make molecules, which in turn form cells and then tis-
sues. A group of tissues working together form an organ and a group of organs
referred as an organ system perform a major function. The human body is understood
in terms of various systems such as skeletal, circulatory, and reproductive. Disease is
understood and treated at the lowest level of the structural hierarchy, i.e. at molecular
level (Conrad et al. 1995). Treatment is corrective and generally involves bringing
deviated parameters within normal range. For example, diabetes is marked by hyper-
glycaemia, making this parameter the focus of conventional diabetes manage-
ment – the treatment aims directly at correcting the deviated glucose level. Corrective
treatment is based largely on control or suppression of symptoms by manipulating
the body’s chemistry with drugs. Methodological reductionism, thus, pervades clini-
cal medicine from diagnosis to therapeutics (Morange 2001; van Regenmortel and
Hull 2002).

Caveats in Reductionism and Changing Perceptions

The reductionistic approach, though very effective in providing significant infor-

mation on biology and disease processes, has not been able to translate its success
from bench to bedside for delivering complete cure without side effects. Much of
this is attributed to the limitations of reductionism, which focuses on the identi-
fied molecular target but excludes the rest of the system (Beresford 2010; van
Regenmortel and Hull 2002). There is increasing realisation that this compart-
mentalised approach underestimates the complexities of biological systems. For
example, this approach views brain in terms of wired circuits and chemical pro-
cesses with even consciousness and mental states reduced to chemical reactions
(Bickle 2003; Ito 2006; Miller 2011). The classical idea of matter and linear cau-
sality of diseases may not be compatible with the complex nature of various pro-
cesses involved in brain because not only are the synapses non-linearly connected
but there is also causal effect by conscious experience (Libet 2003). Although one
cannot ignore the strengths of the reductionist approach, the question whether it is
still valid in clinical medicine as once thought is being increasingly asked by
biologists (Joyner 2011). There is now a slowly changing perception that the
structural/chemical constituents in an organism are not in isolation but are in
dynamic relationships, which decide the overall functioning of not only the cells
and organs but the entire organism. There is also a growing appreciation that no
part can be understood outside of the whole to which it belongs and is in relation-
ship with (Sauer et al. 2007). The need for a different framework considering the
complexly networked human system, taking into account the role of mind and
consciousness as well, is being felt. Realising that health cannot be limited to
parts, modern medicine is now striving for an integrated and systems biology
approach (Chaussabel 2004; Dinicola et al. 2011; Naylor and Chen 2010).
8 Quantum Logic in Āyurveda 119

8.3 Quantum Worldview and Medical Science

By the nineteenth century, physicists felt everything in the universe including

natural phenomena could be understood by Newtonian mechanics and expressed in
quantitative mathematical terms. Within a few decades, however, a major revolution
took place in the form of quantum mechanics, which studied atoms and beyond. The
submicroscopic realm of these particles, it was found, was not deterministic but a
very different one, where the particles can exist simultaneously in multiple states
and possess a number of other seemingly contradictory properties defying the care-
fully built-up logic of classical physics. While the classical worldview assumes real-
ity to be made of localisable material objects, the quantum world dealt with
probabilities of existence and energy states (Alistair 1988; Feyman et al. 1965).
Quantum theory did not stop at being a theory of atomic phenomena but had reper-
cussions for the macroscopic world as well. Challenging the conventional view of the
physical world as a solid and stable material body, quantum physics brought in radical
changes in the fundamental ideas about the nature of physical reality (Alistair 1988;
Heisenberg 1958a). The universe came to be understood as a dynamic web of intercon-
nected energy patterns, in which matter is a slowed-down form. In this web, no entities
including humans are isolated, i.e. there is logically no such thing as a ‘part’ in the uni-
verse. Although at a macro-level the organisation and behaviour of the atomic world are
stable giving the world an appearance of a solid form, the energies within this seemingly
solid realm are not only moving but are also interconnected (Heisenberg 1958a). This
new understanding of the universe as a stable pattern within which energy moves has
brought about a change in the worldview – a very different concept of reality from that
which grew out of the classical reductionistic physics. Quantum worldview has aban-
doned the idea of fundamental building blocks, which was central to the classical view.
The other radical shift brought in by quantum mechanics is the introduction of
mind into the basic conceptual structure of physical reality. The central role a con-
scious observer plays has also made the quantum physical worldview radically dif-
ferent from the conventional one, where the observer has no active role but only a
passive one (Stapp 2007). Interestingly, the practical successes of the Quantum
theory, such as the applications of MRI, lasers, electron microscope, transistors,
etc., have had significant impact in diagnostic and therapeutic medicine. The
changes that have taken place in the worldview, however, have not translated into a
new paradigm in Western medicine, which has persisted with the old reductionistic
worldview model of Newtonian physics.

8.4 The Quantum and Vedic Worldviews

Questions about the nature of matter and reality have been raised in all civilisations
and have been addressed by Indian seers of yore as well (Brunton 1939; Capra
1999; Jones 1986; Knapp 1990). These are elaborated in depth in vedanta,
120 R. Jayasundar

considered the culmination of vedic philosophies (Saraswati 2004) just as quantum

physics is seen as the cutting edge of modern science. Though both these disciplines
discuss the nature of reality, their approaches are from divergent viewpoints.
According to vedanta, nature exists as a continuum and common principles underlie
both the microcosm (individual) and macrocosm (universe) resulting in a unifying
law binding everything in the universe. It goes on to say that everything in this uni-
verse has evolved from a single entity and is an extension of that, and so everything
(including living beings) is interconnected and in a dynamic relationship (Saraswati
2004). The basic oneness of the universe is not only the essence of the vedic world-
view but also one of the most important revelation of quantum physics. Like the
vedic seers, the quantum physicists were also dealing with a nonsensory experience
of reality through their studies on atomic particles, which provided them the first
glimpses of the fundamental nature of matter. They found that underlying all physi-
cal matter is the intrinsically interconnected dynamic network of energy leaving
nothing isolated in the universe (Heisenberg 1958a).
That there is an undeniable correlation between what physicists have discovered
through observations, laboratory experiments and mathematical reasoning and what
the Indian seers inferred from their observations, experiential experiments and logi-
cal reasoning has been commented by none other than Heisenberg, the architect of
quantum mechanics. He says, ‘After the conversations with Tagore about Indian
philosophy, some of the ideas (of Quantum Physics) that had seemed so crazy sud-
denly made much more sense. That was a great help for me’ (Capra 1989). He also
says, ‘All the same, some statements of ancient philosophy are rather near to those
of modern science. This simply shows how far one can get by combining the ordi-
nary experience of nature that we have without doing experiments with the untiring
effort to get some logical order into this experience to understand it from general
principles’.
Erwin Schrodinger, one of the fathers of quantum mechanics, also known for his
deep interest in Upanishad (Capra 1989) had commented, ‘the unity and continuity
of vedanta are reflected in the unity and continuity of wave mechanics’ (Gewali
2009; Schroedinger 1944). The logical point of contact between quantum theory
and vedic thoughts, hence, lies in their worldviews and understanding of the nature
of reality. Worldview has a bearing on the way a biological system is understood.
We have seen the influence of classical worldview in Western medicine. The follow-
ing sections outline the role of the integrative worldview of veda in Āyurveda.

8.5 Āyurveda

Long been the major healthcare system in India, the beginning of Āyurveda is lost
in the mists of antiquity but is closely interwoven with the history and culture of the
Indian sub-continent. Āyurvedic thoughts and methods have had a deep impact on
the lifestyle of Indians. Its principles of healthy living, incorporated into day-to-day
practices, are reflected in the daily activities, traditional cuisine using spices and
medicinal ingredients, and even religious rituals of the Indians. In almost every
8 Quantum Logic in Āyurveda 121

household, there was (and still is) knowledge of āyurvedic treatment for common
ailments. Āyurveda continues to have a pervasive influence in the daily life of
Indians and has perhaps the longest unbroken health tradition in the world (Mukerjee
2006a; Varier 2005; Vidyanath and Nishteswar 2006).
Āyurveda is an applied science like Western medicine. While the basic sciences
of the latter are physics and chemistry, the fundamental basis of Āyurveda are found
in darśana, which are ancient Indian treatises on the physical and metaphysical
aspects of the universe (Cowell and Gough 1978; Tigunait 1983). It is interesting to
note the similarities between the words ‘theory’ and ‘darśana’. ‘Theory’ is derived
from the Greek root word ‘theoria’ (θεωρία) meaning to ‘view or observe’. Modern
science has many theories, such as those of motion, gravity and evolution. A num-
ber of them are named after the scientists who first described them – e.g. Newton’s
laws of motion, Einstein’s theory of relativity, etc. Although the word ‘darśana’ has
deeper philosophical meaning and implications, it also literally means ‘to see or
view’. As in modern science, the various ‘darśana’ are also associated with names
of those who formulated them: Kaṇāda’s Vaiśeṣika, Gautamā’s Nyāya, Jaimini’s
Purva Mimāmsa, Kapilā’s Sānkhya, Patanjali’s Yogā and Vyāsā’s Vedānta (Cowell
and Gough 1978; Muller 2003; Sandal 1999; Tigunait 1983).
The Indian seers of yore did not remain mere observers of nature but had theo-
rised their observations using logical reasoning. Sānkhya, Nyāya and Vaiśeṣika
explain the physical universe from a logical perspective, whereas Vedanta under-
stands it from a spiritual perspective. Nyāya and Vaiśeṣika are best known for their
rigorous analytical approaches and logical arguments (Tigunait 1983; Vidyabhushana
2003). Vaiśeṣika deals with the physical aspects of universe and their practical
implications and interestingly postulates atomic nature of matter (Muller 2003).
The concepts, logical reasoning and analytical methodologies of these materialistic
schools have been used by Āyurveda to understand human body, health and ill
health (Sharma and Dash 2001). While yoga focuses on the inner realms of humans,
Sānkhya and Vedānta deal with creation, worldview, relationships and their philo-
sophical implications (Saraswati 2004; Muller 2003; Nair 2005). These concepts
have been used by Āyurveda to understand the various relationships governing life,
its processes and also the relationship between humans and the cosmos (Rao 2002).
Āyurveda has thus provided a practical platform, elevating these concepts from
philosophical realms to that of science (Jayasundar 2008). The coherent theoretical
framework drawn from these different darśana has given the base for Āyurveda’s
comprehensive knowledge of life. Āyurveda is essentially a science of life
encompassing both health and ill health.

8.5.1 Impact of Vedic/Quantum Worldview on Āyurveda:

Holism and Interconnectedness

Āyurveda is based on a concept of wholeness and unity that goes beyond a purely
mechanistic view. Over the centuries, Āyurveda has collected enormous amounts of
empirical data on which it has based all its theoretical generalisations. Though a
122 R. Jayasundar

number of theories are used to describe the human system, its viewpoint is
predominantly functional (Jayasundar 2010). According to Āyurveda, the whole
organism constitutes a functional entity. Function is a collective effort of several
contributing factors ranging from structures, biochemical processes to various
activities such as electrical, mental and even spiritual. Functional perspective is
therefore inclusive, taking into consideration all the contributing factors including
those of structures and biochemistry. Of the various theories, that of tridoṣa (vāta,
pitta and kapha) runs as an undercurrent to the entire āyurvedic understanding of
health and ill health, defining its functional perspective. How the quantum concept
of interrelatedness is inbuilt into Āyurveda is best understood through the theory of
tridoṣa and hence discussed in detail in this chapter.
The Sanskrit words vāta, pitta and kapha are referred to as ‘doṣa’, meaning ‘that
which can become impaired and also has the potential to impair other tissues’. The
tridoṣa, as they are collectively known, are concepts derived from nature (macro-
cosm) to explain human beings (microcosm). The functional/governing factors of
tridoṣa were derived from those of the universe. Suśruta says,
‘just like moon, sun and wind sustain the universe by their cold, heat and dispersion/move-
ment, respectively, likewise kapha, pitta and vāta support the body with similar functions’
(Suśruta Saṃhitā 21, 8 in Sharma 2004)

These principles extend to all living beings from the smallest to the largest. Ćaraka
says (Sharma and Dash 2001)
‘this is a science for well-being of all creatures’ (Ćaraka Saṃhitā Sūtra Sthāna 1, 27 in
Sharma and Dash 2001)
‘these works were established on this earth for the good of all creatures’ (Ćaraka
Saṃhitā Sūtra Sthāna 1, 40 in Sharma and Dash 2001)

All biological systems from humans to animals and plants are thus described
within this single framework of tridoṣa. For example, vrkṣa Āyurveda (āyurvedic
botany) (Sadhale 1996; Sircar and Sarkar 1996) and mṛga Āyurveda (āyurvedic
veterinary science) (Anjaria 1894; Mukerjee 2006b; Somvanshi 2006) use the same
tridoṣic theory to explain their respective systems. It is, thus, a unifying theory
encompassing all living organisms.

Interconnectedness Within the System

Āyurveda has grouped the vast information in the human system into three most
fundamental functions and their contributing components/properties. These are
vāta, pitta and kapha, indicating respectively, movement, transformation and sup-
port as well as growth (Jayasundar 2010). Figure 8.1 shows the classification and
Figs. 8.2–8.4, the further sub-classifications of doṣa (Sharma and Dash 2001;
Srikantamurthy 2005). It is to be noted that an exhaustive list of functions and
parameters is not given in these figures. Vāta, pitta and kapha cover not only physi-
ological but also psychological parameters such as enthusiasm, memory, wisdom
8 Quantum Logic in Āyurveda 123

Psycho-physiological functions

Va-ta Pitta Kapha

all movements in body and all metabolic processes in responsible for and controls:
mind the body, i.e. digestion and stability of body
transformation at: compactness of joints
relates to movements
physical level(food) lubrication
in different systems such as:
mental level (thoughts, intelligence (wisdom)
skeletal
emotions) provides:
respiratory
sustains: structural basis for body
reproduction
heat cohesion
excretory
desire nourishment
circulatory
hunger virility
digestive
complexion strength
sustains:
retentiveness (memory) forbearance
all organs of the body
valour
enthusiasm
coordinates all sense faculties
prompts all actions

Fig. 8.1 Functional classification in Āyurveda (Source: Author, based on Ćaraka Saṃhitā and
Ashtanga Samgraha)

va- ta

pra- a uda- vya-na sama-na apa-na

maintains controls controls controls controls

intellect speech movements like movements in elimination of
sense organs activities expansion digestive system faeces
heart strength contraction retaining food in urine
mind discrimination upward alimentary tract semen
breathing awakening of downward separation of foetus
expectoration mind movements of essence of food
sneezing nourishes tissue eyelids and waste
pores yawning downward
flow of blood movement of
nourishment to waste
tissues
pervades entire
body

Fig. 8.2 Sub-classification of vāta (Source: Author, based on Ćaraka Saṃhitā and Ashtanga
Samgraha)
124 R. Jayasundar

pitta

pa-chaka rañjaka sa-daka a-locaka bra-jaka

maintains imparts associated with helps in associated with

digestion of red colour to discrimination vision skin
food blood intelligence complexion
pride
separation of associated enthusiasm helps in
the essence with blood digestion of
from the helps to achieve externally
wastes the aims of life applied
medicines
supports
other pitta

Fig. 8.3 Sub-classification of pitta (Source: Author, based on Ćaraka Saṃhitā and Ashtanga
Samgraha)

kapha

avalambaka kledaka bodhaka tarpaka sleshaka

associated with controls controls associated with controls

heart lubrication of taste fluids in head lubrication
fluids in: food during of all joints
saliva nourishment of
the digestive
chest process sense organs all joint
shoulder movements
arm, neck
supports other
kapha

Fig. 8.4 Sub-classification of kapha (Source: Author, based on Ćaraka Saṃhitā and Ashtanga
Samgraha)

and forbearance. Vāta indicates movement in the physical plane and also the flow/
movement of thoughts in the mental space. Similarly pitta refers to digestion and
transformation both at the physical and mental planes. The tridoṣa, thus, encom-
pass both the physical and mental frame of the individual. Between them, the three
doṣa and their 15 sub-classifications cover all psychophysiological functions in the
body and the associated properties (refer to Figs. 8.5 and 8.6 for a list of these
properties). Āyurveda also mentions the theory of three guṇa: sattva, rajas and
tamas, which make up one’s personality (Śārīra Sthāna, Sharma and Dash 2001).
8 Quantum Logic in Āyurveda 125

coarseness
stability (va-ta)
(kapha) coldness
(va-ta)
unctuousness
(kapha)
mobility
(va-ta)

softness
(kapha)
lightness
dryness (va-ta)

heaviness (va-ta)
(kapha)
roughness
(va-ta)

stickiness
(kapha)
subtleness
(va-ta)
heat
(pitta) sharpness
fluidity (pitta)
(pitta)

Fig. 8.5 Relation between the vāta factor of dryness and pitta, kapha and vāta parameters

v v
a- a-
dryness
t t
a cold lightness a
mobility roughness

heat heaviness

p acidity softness k
i a
fluidity unctuousness
t p
t sharpness stability h
a a
sour sweet

Fig. 8.6 Topological connectivities of doṣa factors

This is not discussed here since it is beyond the scope of this article. However,
there is close association between the three doṣa and guṇa (Sūtra Sthāna, Sharma
and Dash 2001).
Functions, unlike matter, cannot be reduced to fundamental entities like atoms
and molecules. There is, hence, no functional hierarchy or basic building blocks in
126 R. Jayasundar

this āyurvedic perspective. The doṣa, i.e. the functions and the associated proper-
ties, exist at all levels – from macroscopic to the subtlest like cells. As mentioned,
the tridoṣa, in addition to functions, also include physico-chemical and physiologi-
cal parameters as shown in Figs. 8.5 and 8.6 (Jayasundar 2010; Sūtra Sthāna,
Sharma and Dash 2001). For example, vāta includes parameters like dryness, light-
ness, coldness, roughness and subtleness, all of which influence movement. Pitta, in
addition to the function of metabolic transformation, includes parameters such as
heat (temperature), acidity (pH), unctuousness, penetrating power and fluidity.
Kapha indicates cohesion and structural growth and also properties such as cold-
ness, heaviness, softness, unctuousness, sliminess, stability and sweetness. These
physico-chemical and physiological properties are expressed through the physical
medium of dhātu (tissues) and give them their functionality. Without going into
details, it is pointed out that while some of the properties are overlapping (e.g. unc-
tuousness of pitta and kapha), some parameters such as dryness (vāta) and unctu-
ousness (kapha) are mutually contradictory.
Just as functions include structures, doṣa also encompasses structural entities.
This can be inferred from the physical attributes associated with doṣa. Moreover,
the three doṣa are constituted of pañcamahābhutā, which refer to the five basic
elements of the visible material world. These are earth, water, air, space and fire/
light. While the first three refer to the three states of matter, namely, solid, liquid
and gas, the latter two, i.e. space and fire/light, refer to other important elements
and aspects of the visible world. While vāta is constituted of space and air, pitta
is a combination of water and properties of fire and kapha is formed of earth and
water. That the doṣa are physical entities is also inferred from their clinical usage.
For example, during palliative treatment, doṣa are handled in the form of proper-
ties that have to be altered to maintain the doṣic balance. During elimination
therapy, however, they are handled as physical substances (Chikitsa Sthāna,
Sharma and Dash 2001). Thus, the doṣic functional model encompasses the
structural aspects as well. Doṣa at one level are functional properties yet at
another level are considered physical entities. They are dualistic on a pragmatic,
therapeutic level but are non-dualistic on a conceptual level.

Within the System: The Non-linear Functional Network

Life, in Āyurveda, is viewed as a complex network of interrelated functions and

properties and not as a system of chemicals or structures. Figure 8.5 is an illustrative
example of how the doṣa are intra- and inter-connected. For example, the vāta factor
dryness, is intra-connected with its own parameters and inter-connected with those
of pitta and kapha. A change in dryness, therefore, is likely to effect changes in
many other parameters. Āyurveda expresses these connections as a network of
interdependent relationships, where the functioning of one influences many others.
Figure 8.6 showing the relational interdependence between some of these param-
eters also indicates the intricate interplay between them. It can be seen that some of
the factors are connected to more than one parameter in this network. Consider a
8 Quantum Logic in Āyurveda 127

change in the factor ‘dryness’ associated with vāta. Dryness could occur at any
level, from cell to organs to the entire system. At whichever level it occurs, the
parameter can simultaneously reduce one doṣa and increase the other. For example,
when dryness increases, there will be reduction in the ‘unctuous’ property of kapha,
increase in the ‘heat/temperature’ of pitta and changes in a number of other param-
eters including those of roughness and lightness from its own category, i.e. vāta.
Interestingly, the resulting increase in temperature due to dryness will also cause
changes in other parameters. In fact, each of these parametrical changes will affect
the system in different ways leading ultimately to functional changes in movement,
both at the initial level ‘dryness’ had occurred and also at other interacting levels. It
is pertinent to note that Western medicine considers diseases such as keratoconjunc-
tivitis sicca, xerostomia, atrophic vaginitis and xeroderma as ‘medical dryness’
(Berk 2008; Haslett et al. 2001; Petrone et al. 2002). The parameters interact at all
levels and are continuously perturbed as a result of influences from other factors.
These properties are entangled, i.e. they are dynamically interlinked to one another
and form non-linear causal connections. The balance of the network depends on the
dynamical behaviour of the parameters.
In a complex biological system, there are various levels of functions such as cel-
lular, tissue, organ, etc., and multiple layers of integrative interaction to give func-
tionality to the system. A change at a lower level can produce changes at other
integrative levels and vice versa. For example, a mutation in a gene can be seen as a
DNA change at a macromolecular level, a histological change at the tissue level and
behavioural change at the organism level (Lobo 2008). Similarly, a change in one of
the doṣa parameter at one level will be reflected at various levels and exercise a
downward/upward control over the course of physiological events affecting the
entire system since these are system properties applicable at all integrative levels.
Through this tridoṣa theory, Āyurveda networks the complex human system as a
dynamic web of relationships defining functions.
The framework of tridoṣa thus connects the entire system encompassing its
inherent complexity with its various levels of interactions. The doṣa parameters are
not a set of rigid linear causal connections but rather interdependent non-linear
functional links encompassing also the physical entities. Doṣa thus offers a different
perspective of human body and provides a conceptual framework very different
from that of Western medicine. Āyurveda’s view of life as a dynamic interrelation-
ship between vāta, pitta and kapha gives it its distinctness in dealing with human
system in an integrated and holistic way.
The key to health is for these parameters to maintain stability in the network
despite perturbations, not only within the system, but also without. Vagbhata says,
‘equilibrium of doṣa is health and their imbalance denotes disease’ (Ashtanga Hridayam 1,
20 in Srikantamurthy 1999)

Health is indicated by the balanced interplay between the various functions and
parameters, while disease is viewed as a system perturbation and a functional
failure, because of which Āyurveda looks beyond the behaviour of individual
parts and addresses the system properties in an effort to rebalance the system.
128 R. Jayasundar

Āyurvedic treatment aims at restoration of the functional balance. The increase or

decrease of doṣa is accompanied by symptoms, which are described in detail in
āyurvedic texts. One can therefore infer the state of doṣa from the symptoms and
take corrective measures to bring it back to equilibrium state. What is interesting is
how Āyurveda has incorporated this concept of interrelatedness in a meaningful
way into its diagnostic decision and therapeutic management. Integration of the
theory of tridoṣa with clinical practice is discussed in detail by Jayasundar (2012a).
Since the doṣa are non-linearly networked, Āyurveda’s determinants of health and
disease do not follow the linear causal pathways of Western medicine. Response
of a non-linear system to variations in parameters is complex making causal
thinking difficult (Albert 2007; Variano et al. 2004).

Within the System: The Structural Network

Despite the importance of functional classification, Āyurveda recognises the struc-

tural aspects of human body as well. It very clearly says all physical entities, includ-
ing humans, are made of matter in five forms (pañcamahābhūta).
‘according to this science, all matter is constituted of five mahābhūta; some are animate and
some others inanimate’ (Ćaraka Saṃhitā Sūtra Sthāna 26, 10 in Sharma and Dash 2001)

Substances endowed with consciousness are considered as much the products of

matter as those without consciousness. This categorical statement and other similar
assertions in Ćaraka Saṃhitā give clear indication that Āyurveda has a structural
viewpoint as well. This is logical and understandable since the physical body,
where the clinical symptoms ultimately manifest, is the only tangible reality to the
treating physician. A physician cannot, therefore, but have a structural perspective
as well.
Ćaraka says in no uncertain terms, ‘Detailed knowledge of the human body is
useful to the well-being of the individual. Understanding the components of the
body provides knowledge regarding the factors responsible for its well-being. It is
because of this that experts extol the knowledge of the details of the body’ (Śārīra
Sthāna, Sharma and Dash 2001). He goes onto say,
‘when tissues (dhātu) in the body become discordant, then there is disease’ (Ćaraka Saṃhitā
Śārīra Sthāna 6, 3–4 in Sharma and Dash 2001)

It is important to note that surgical discipline, which gives importance to structures,

was a highly developed branch in Āyurveda. Suśruta, the āyurvedic surgeon
acknowledged as the father of surgery by Western medicine, emphasises the impor-
tance of anatomy and dissection and describes many surgical procedures (Chari
2003; Das 2001).
All the structural entities in the body are divided into minute units known as
‘paramāṇu’, which like cells are numerous, subtle and beyond sensory percep-
tions (Ćaraka Saṃhitā Śārīra Sthāna 7, 17 in Sharma and Dash 2001). All the
structural components (gross to subtle) are interconnected by srotas, a system of
8 Quantum Logic in Āyurveda 129

channels (Ćaraka Saṃhitā Vimāna Sthāna 5 in Sharma and Dash 2001). These
are a complexly networked system for bio-transport of all essentials in the body
such as fluids, nutrients, impulses and energies. The srotas system is a continuum
connecting structures, both subtle and gross. Despite these, Āyurveda goes
beyond a purely structural viewpoint. It considers life as a complex and coordi-
nated interaction of various functions and properties, encompassing also subtle
realms like mind and consciousness.

Within the System: Network of the Gross and Subtle

Āyurveda considers human being as a combination of two basic elements: con-

sciousness (cetana) and inert matter (jada). The relationship between these two
entities defines a human being. The realms within, hence, consist of not only physi-
cal and physiological but also mind and subtler levels of awareness/consciousness.
Āyurveda says that the subtler levels within influence the physiology. By connect-
ing these two realms, Āyurveda adopts a comprehensive view of life and health.
While Ćaraka says,
‘life is a combination of body, senses, mind and consciousness’ (Ćaraka Saṃhitā Sūtra
Sthāna 1, 42 in Sharma and Dash 2001),

Suśruta defines a healthy individual as,

‘a healthy person is one whose doṣa, dhātu (structural entities) and metabolic end products
are in equilibrium. And there must also be clarity in consciousness, senses and mind for a
healthy state’ (Suśruta Saṃhitā 15, 41 in Sharma 2004)

While the tridoṣa parameters (along with triguṇa) indicate the connection between
the physical and mental planes, the theory of pañcakośa, used more extensively in
yoga, deals in depth with the mental and subtler realms of existence. These are seen
as comprising of discrete yet interdependent levels of awareness. Āyurveda and yoga
are closely related disciplines. They share the common framework of tridoṣa theory,
and Āyurveda supports concepts and applications of yoga. So, although the āyurvedic
texts do not explicitly mention pañcakośa, it is understood that Āyurveda takes cog-
nisance of this when it discusses mind, buddhi (intellect) and the role of different
levels of consciousness in health and disease (Frawley 1998; Śārīra Sthāna, Sharma
and Dash 2001). For example, Āyurveda considers mind (manomayakośa) and intel-
lect (vijnānamaya kośa) to be separate (Ćaraka Saṃhitā Śārīra Sthāna 1, 23 in
Sharma and Dash 2001). Interestingly, faulty understanding or mistake at the level of
‘prañjā/buddhi’ (the capacity to understand and discriminate) is considered a major
causative factor for diseases (discussed in the next section).
According to the theory of pañcakośa, there are five hierarchical levels of aware-
ness/consciousness, from gross physical body (annamaya kośa) to the subtle spiri-
tual body (ānandamaya kośa) (Aurobindo 1981; Johnsen 2003). Each level, from
gross inwards, refers to a more refined dimension of awareness. The 5th level is the
state where impurities of mind are removed and realisation of self is experienced.
130 R. Jayasundar

What is of interest is the link between the subtlest level of consciousness

(ānandamaya kośa) and the gross physical body (annamaya kośa) through the inter-
vening layers of prānamaya, manomaya and vijñānamaya kośa. These levels are
progressive in scale of subtility and refinement. Moving from the gross to the subtle
helps one to develop discriminatory wisdom and detachment, enabling a shift
towards a more happy and productive and less destructive realms of existence. The
direction of evolution is towards subtler/higher levels of awareness culminating in
unity with the infinite, resulting in happiness and freedom from causes of
suffering.
The functions and purpose of each layer and their relation with other levels are
stated in the following lines from Yogavāsiṣta (Murthy 2002):
‘For one without discrimination (of what is right and wrong),
application of sciences is a burden;
For one with knowledge but unwilling to use it properly,
the knowledge itself is a burden;
For one who is agitated,
mind is a burden;
For one who does not understand oneself,
body itself is a burden’.

A mere possession of mental faculties and knowledge will not lead to one’s well-
being unless accompanied with right values and thinking to sustain harmony within
and without. Awareness of oneself is necessary for health.
Āyurveda refers to a healthy individual as ‘svastha’, which is defined as ‘sve
tiṣtati iti svastha’: one who is established in oneself. Implicit in this is the fact that
lack of awareness will lead to impaired knowledge, which Āyurveda points out is a
causative factor for diseases (Ćaraka Saṃhitā Nidāna Sthāna 1, 3 in Sharma and
Dash 2001). Any change in perception that takes place in buddhi is reflected in the
body/physiology. This is why training the intellect is considered important in main-
taining health. Regimens, which influence buddhi, are considered as important as
diet and behavioural routines. It helps bring mind under control so one does not
make errors in judgement and action. There are important chants like Gayatri man-
tra (GM), which help train the intellect and keep it in a healthy condition by their
sound and content. That GM has a measurable effect on brain metabolites has been
demonstrated using MR spectroscopy by Jayasundar and Rajshekar (2000).
Āyurveda clearly considers mind and body to be intrinsically linked with conscious-
ness, which acts as the fulcrum of health. Ćaraka says, ‘mind is the link between
consciousness and physical body’ (Ćaraka Saṃhitā Śārīra Sthāna 2, 13 in Sharma
and Dash 2001). Āyurveda thus links and networks the gross (physical body) and
subtle (mind and consciousness).
Figure 8.7 shows in a nutshell how the physical, physiological, mental and sub-
tler domains within the body are intra- and inter-connected. Each domain is not only
networked within but also connected to others. For example, srotas networks the
structures, doṣa the physiology, guṇa the mind and pañcakośa the levels of con-
sciousness. The structures and physiology are connected via doṣa and srotas,
8 Quantum Logic in Āyurveda 131

networked through
srotas

structures

networked networked
through through
consciousness H physiology

mind

networked through

Fig. 8.7 Intra- and inter- connections in the network of structures, physiology, mind and con-
sciousness. H refers to human being

physiology and mind through doṣa and guṇa and mind and consciousness through
pañcakośa. The consciousness is linked to the physical body (structures) through its
first level of awareness. So, each domain while acting as a network within itself is
also networked with others. They form several interlocking networks making a
coherent whole. The domains, which can be considered as subnetworks, are not
functionally insulated, so failure or imbalance in one affects the entire human
system. This highlights the centrality of the quantum concept of interconnectedness
in Āyurveda.

Interconnectedness Outside the System

Individual and the Universe

Human being is not a separate entity dissociated from the universe but is like an
open system. In other words, there is exchange/interaction with the environment
and also the universe. The subtlest level of consciousness (ānandamaya kośa) in
the human is linked to the cosmic consciousness, and yoga helps one connect these
two (Saraswati 1998; Ćaraka Saṃhitā Śārīra Sthāna I, 155 and V, 21 in Sharma and
132 R. Jayasundar

Dash 2001). In this connected state, the external universe is no longer considered
external, the internal no longer internal and everything is seen as an undivided
whole, i.e. there is no boundary. Thus, not only is the physiology linked to the
microcosmic world of consciousness, it is also connected through the levels of
awareness (kośa) to the macrocosmic consciousness. These theories (tridoṣa,
triguṇa and pañcakośa) thus provide a workable interface between the microcosm
(individual) and the macrocosm (universe). Ćaraka says the individual exists as a
continuum with the entire universe-
‘the whole universe is the expansion of one’s consciousness’ (Ćaraka Saṃhitā Śārīra Sthāna
5, 20 in Sharma and Dash 2001)

Ćaraka calls the microcosmic consciousness as ‘viśvarūpa’, meaning prototype

of the universe (Ćaraka Saṃhitā Śārīra Sthāna 4, 8 in Sharma and Dash 2001), and
establishes the relationship between the individual and universe by saying,
‘all the manifest objects in the universe are present in the individual and all that is present
in the individual manifests in the universe as well’ (Ćaraka Saṃhitā Śārīra Sthāna 4, 13 in
Sharma and Dash 2001)

Implicit in these statements is the understanding that the objective world is poten-
tially inherent in the individual, and everything within or outside is related to the
subject from which they expand. The relevance of this knowledge in the context of
medicine is also explained by Ćaraka. He says,
‘this (the above-mentioned) is true knowledge and realisation of this leads to serenity of
mind’ (Ćaraka Saṃhitā Śārīra Sthāna V, 6, 20–21 in Sharma and Dash 2001)

Serenity of mind in turn will lead to harmony and health.

Individual and the Environment

Āyurveda recognises that the health of an individual is dependent and intertwined

with that of the environment and advises a harmonious relationship between the
two. Maintenance of such a harmony is essential to the health of a living organism,
be it human, animal or plant. Doṣa increases or decreases naturally during different
seasons (seasonal rhythms) and also during the course of the day (e.g. diurnal cycle)
and influences one’s health. This interconnectedness of individual with the environ-
ment finds practical expression in various āyurvedic concepts such as causative fac-
tors during epidemics (Ćaraka Saṃhitā Vimāna Sthāna 3, 4 in Sharma and Dash
2001) and daily and seasonal regimens (Sūtra Sthāna, Sharma and Dash 2001).
These regimens, consisting of dos and don’ts for diet and activities, take care of the
response of the body to outside changes and establish a functional harmony between
the individual and environment. While personal interface with macrocosmic con-
sciousness is through yoga, that with the physical environment is through these regi-
mens, which ensure both individual and community health.
The case of a 45-year-old patient (personal communication 2009) is discussed
here to illustrate this point – the patient was suffering from heavy bouts of cough
8 Quantum Logic in Āyurveda 133

and cold every spring season for nearly 6 years and was on heavy antibiotics during
the affected period. From an āyurvedic perspective, this kapha-related seasonal
problem was identified as indulgence in diet and activities incompatible with spring
season, during which there is a general aggravated manifestation of kapha in every-
body. The patient had been indulging in kapha-aggravating foods such as citrus
fruits, yoghurt and fruit juice, all of which are incompatible with spring season. The
patient’s problem was addressed simply by correcting the diet and activities. Post
intervention, the patient has faced four spring seasons without recurrence of the
problem. This example shows how a person’s well-being is connected to environ-
mental changes, and how Āyurveda’s preventive routines can be effectively used to
avoid seasonal diseases. Āyurveda is peppered with information on how to achieve
welfare for all by working in conjunction with nature. It is a way of life contributing
to harmonious health within and without (Jayasundar 2012b).

8.6 Quantum Framework of Āyurveda

Is Āyurveda an ancient or a state-of-the-art science? It is an interesting question that

can be addressed by looking backwards from today’s vantage point of modern
scientific knowledge. Quantum physics, considered the cutting edge of Western
science has exposed concepts similar to those discussed in the Indian knowledge
system of veda (Capra 1999; Jones 1986; Talbot 1993). Two quantum concepts that
find practical expression in Āyurveda are interconnectedness and the role of
consciousness. The first concept relates to the fundamental interrelatedness of all
phenomena, and the dynamic and interdependent nature of reality.
The central core idea of Āyurveda is that everything within (microcosm) and
without (macrocosm) the human body is interrelated and their balance denotes
health or ill health. The whole existence is like a network, where a change in one
part is likely to perturb the entire system. Āyurveda has integrated and implemented
this concept through theories like tridoṣa and offers a practical method to sustain the
relationship between individual and the universe. Interconnectedness is part of the
terminology of both quantum and vedic/āyurvedic worldviews which sees oneness
in all things. Āyurveda’s paradigm thus is closer to the quantum physical
worldview.
The other quantum concept is the role of consciousness. An observer is critical
to the quantum concepts since behaviour of a quantum system cannot be predicted
without the involvement of this macroscopic conscious entity. There is, thus, an
interaction between observer and the observed in the microcosmic world of atoms,
where an object does not exist independent of its observer. Human consciousness
entered the realm of physics through this involvement of a conscious observer. John
Wheeler’s famous statement was ‘We are not only observers. We are participators’
(Wheeler 1990). Although the reference was initially to a conscious observer, later
on it was suggested by David Bohm that this consciousness was at a deeper level
and intrinsic to matter (Bohm and Hiley 1993; Penrose 1987).
134 R. Jayasundar

Human experience was thus elevated from the role of a detached observer in
classical physics to that of a participatory observer in quantum physics. As
Heisenberg notes in ‘The Copenhagen Interpretation of Quantum Theory’,
‘our scientific work in physics consists in asking questions about nature in the language that
we possess and trying to get an answer from experiment by the means at our disposal. In
this way quantum theory reminds us, as Bohr has put it, of the old wisdom that when
searching for harmony in life one must never forget that in the drama of existence we are
ourselves both players and spectators. It is understandable that in our scientific relation to
nature our own activity becomes very important when we have to deal with parts of nature
into which we can penetrate only by using the most elaborate tools.’ (Adams 2000)

Consciousness is an integral part of health in Āyurveda, which defines health as

a complete balance of body, mind and soul/consciousness. By including mind and
consciousness, Āyurveda has included the invisible realms within human body in its
understanding of health and disease. Just like the quantum model makes conscious-
ness causally effective (Heisenberg 1958b), Āyurveda also considers consciousness
causally effective in the emergence of disease (Ćaraka Saṃhitā Sūtra Sthāna 8, 13
in Sharma and Dash 2001; Ćaraka Saṃhitā Śārīra Sthāna 1, 35, 39–42 in Sharma
and Dash 2001). Consciousness and physical body are considered entangled in
Āyurveda. Although quantum physics’ usage of the term ‘consciousnesses’ may not
be the same as that in Āyurveda, the parallels and the inclusion in both are interest-
ing. The consciousness attributed to in quantum physics could refer to one of the
‘pañcakośa’ levels of awareness – manomaya or vijnānamaya kośa.
Āyurveda in the way it was originally developed and practised understood the
interaction between consciousness and physical body to be a major factor in creat-
ing health or illness. The main cause of disease in Āyurveda is ‘Prajnāparāda’, the
impairment of knowledge or fault of the intellect, a mistake at the level of the inner
consciousness (one of the kośa) (Ćaraka Saṃhitā Nidāna Sthāna 1, 3 in Sharma and
Dash 2001). It refers to the deliberate, wilful indulgence in unhealthy practices lead-
ing to imbalance in doṣa resulting in disease. Āyurveda’s concept that one’s thoughts
create health or ill health in the physical body resonates with that of quantum phys-
ics which says that our thoughts create the physical reality (Alistair 1988;
Stapp 2007). One’s perception of the world and the consequent behaviour affects
the physiology to an extent that errors in perception can lead to psychosomatic dis-
orders. Āyurveda emphasises the individual’s ability to shape his/her health based
on how they choose to think and behave. The physical event in gross body and
psychic event in the mental space are seen in Āyurveda as two correlated events.
There are also other interesting conceptual parallels between Āyurveda and
quantum concepts. For example, quantum physics highlights the fact that while
there is certainly a matter-based classical universe, there is also a mind-based quan-
tum universe. Nature is a continuum having both mechanical as well as quantum
aspects and quantum theory underscores this dualistic aspect of nature. According
to Āyurveda, human as an entity has two states, namely consciousness and inert-
ness, with two distinguishable aspects – dispersed and localised. The dispersed
aspect is mind and localised state is body. But both these states have a common
origin and hence are related to each other and incessantly dynamic. Āyurveda says
8 Quantum Logic in Āyurveda 135

mind and matter exist in a continuum. It has incorporated this concept by consider-
ing the human body as mechanistic at one level and as levels of consciousness in the
subtler realms. Mind and consciousness are thus inbuilt into āyurvedic’s under-
standing of humans. Ćaraka says, ‘mind, consciousness and body are like a tripod
(for sentient beings) and constitutes the subject matter of Āyurveda’ (Ćaraka
Saṃhitā Sūtra Sthāna 1, 46–47 in Sharma and Dash 2001). The seemingly different
worlds of gross (localised) and subtle (dispersed) are thus connected and networked
in Āyurveda.

8.7 Concluding Thoughts

The fundamental difference that exists between Western medicine and Āyurveda
largely stems from their worldviews – the former focuses on parts, while Āyurveda
on the system. The worldviews, rather than being merely topics of interest in
metaphysics, have influenced the perspectives of biology and medicine both in
Western medical system and Āyurveda. Classical physics remains an excellent
approximation at macroscopic level and Newtonian reductionism continues to be
a very successful approach in Western medicine for in-depth understanding of the
system components. However, by omitting all references to mental realities, clas-
sical physics has also produced a logical disconnect between the physical and
mental realms. The necessity for a system perspective in clinical medicine has
now been recognised. Science now acknowledges that human system cannot be
explained in purely deterministic and objective terms. It confirms that psychologi-
cal effects are not restricted to the psyche but get translated into the physical plane
and plays a crucial role in health and disease (Dubovsky 2008; Kubzansky and
Thurston 2007). Although the role of mind in health and disease is being increas-
ingly acknowledged in conventional Western medicine, it is yet to be successfully
incorporated into its health and therapeutic managements. Psychoneuroimmunology
is still a new medical speciality in modern medicine (Ader 2007).
Quantum physics has indicated a shift from the classical, reductionistic world-
view where consciousness has no role, to a holistic and non-deterministic concept
of nature with a definite role for consciousness. The detached, objective observer of
classical physics is actually consciously involved in the world he/she observes. The
concept of consciousness, however, finds no place in the current working of bio-
medicine, which connects physiology to structures in contrast to the ‘physiology to
consciousness’ connection in Āyurveda. In the Western approach, everything trans-
lates into chemical reactions at body level and therefore has to be treated from a
chemistry point of view. Biology is understood in terms of biochemistry and cellular
mechanics.
It is important to note that the basic logic system in Āyurveda has also been
derived by observing nature at the macroscopic level as in classical physics.
Āyurveda, while accepting the reality of gross physical body, also emphasises the
interplay of forces beneath the physical structures and has evolved a practical
136 R. Jayasundar

method of handling these through the functional theory of tridoṣa. However, since
Āyurveda is based on doctrines that understand the universe from both physical and
spiritual perspectives, it also encompasses mind and consciousness in its concept of
health and disease management. In fact, it uses both physical and metaphysical
methods such as yoga and mantra in its therapeutic management. Āyurveda under-
stands the human system as a network of relationships that includes consciousness
in a fundamental way.
Interconnectedness being an integral part of its understanding of health and dis-
ease, Āyurveda goes beyond linear relationships and single causative factors for
disease. It uses multiple parameters from different realms within and without the
system to achieve a holistic perspective of the individual and brings into focus the
contextual milieu responsible for a disease. By incorporating the vedic worldview,
which is similar to that of quantum physics, Āyurveda has integrated the concept of
interdependent interconnectedness in humans, thus opening the door to an interest-
ing dialogue between quantum physics and āyurvedic approach to health and dis-
ease. While Western medicine’s paradigm lies outside the quantum concepts of
interconnectedness and the role of consciousness, Āyurveda’s unifying approach
lies within this quantum framework. It is a health model that connects gross and
subtle within the body, individual and environment, and human and cosmos.

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Chapter 9
The Psychological Roots of Health Promotion

Antonella Delle Fave

9.1 Introduction

The increasing attention paid by Western researchers, professionals, and policy

makers to the active role and responsibility of the individuals in their own health
management and disease prevention is deeply related to a variety of new chal-
lenges that postindustrial societies are facing today at the epidemiological, social,
and economic levels. The relevance of this role is structurally embedded in the
approach to health that has been characterizing Āyurveda throughout the millennia
and across different social, historical, and natural contexts. Such a convergence
between two very different medical systems is an interesting phenomenon that
deserves deeper investigation, especially in the light of the potential of an inte-
grated and synergistic perspective between the two systems in fostering human
well-being and biopsychosocial health.

9.2 The Western Biopsychosocial Model

and the Development of Health Psychology

The Western biomedical approach to disease is prominently focused on the bio-

logical and thus objective aspects of health conditions. While this approach gave
great impulse to the advancements in the biomedical domain, its limitations were
firstly highlighted by Engel (1977), who claimed the need for a biopsychosocial
model, centered on the patient as a person with a cultural background and a sub-
jective experience of health, disease, and quality of life (as highlighted in Chap. 2).

A. Delle Fave (*)

Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 141
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_9,
© Springer Science+Business Media Dordrecht 2013
142 A. Delle Fave

This claim was followed by a growing attention of researchers and policy makers
to the individuals’ subjective evaluation of their own health conditions (Levin and
Browner 2005).
The relevance and the potentials of the biopsychosocial approach were promptly
acknowledged by most international health agencies and institutions. Far from
being a mere exercise of political correctness, this recognition stemmed out of the
necessities imposed by the epidemiological profile that was increasingly character-
izing human communities worldwide. The striking advancements in biomedical
knowledge that took place during the twentieth century led to an epidemiological
transition, particularly evident in postindustrial countries (Omran 1971; Barrett
et al. 1998). The amazing development of pharmacology, the spreading of health-
care facilities, improvements in diet, hygiene practices, and immunization cam-
paigns led to a substantial reduction of infectious and acute diseases and to a relevant
increase of life expectancy (as described in detail in Chap. 1). However, this positive
trend was counterbalanced by the increase of chronic and degenerative dis-
eases – prominently cardiovascular pathologies and cancer (WHO 2002) – partially
related to aging but partially derived from massive urbanization and consequent
lifestyle changes (Armelagos et al. 2005). The negative consequences of inappropri-
ate dietary regimes, excessive workload, or inadequate physical exercise on cardio-
vascular and immune system functioning became increasingly evident.
In order to cope with these new challenges, specific effort was required to iden-
tify personal and social resources that could promote health and prevent disease
onset or progression and complications, over and above medical interventions
whose relevance was anyway limited, in case of chronic or degenerative diseases.
To this purpose, in 1978 the division of health psychology was officially started by
the American Psychological Association.
The impressive amount of constructs, models, and research studies that mush-
roomed within this domain in the following decades was grounded into a very clear
evidence: two people sharing the same physical health conditions may largely differ
as concerns their quality of life and overall level of well-being, on the basis of envi-
ronmental and personal variables partially or totally independent of physical health
conditions. This evidence brought to the attention of physicians, psychologists, and
policy makers the necessity to systematically explore and operationalize the psy-
chological and social components of health (Veenhoven 2002).
Most individuals develop effective strategies to cope with disease and related
constraints that become prominently evident in conditions of chronic pathologies
(Delle Fave 2010; Lazarus 2000). This effectiveness implies the availability of
resources and positive dimensions in both the person and the environment, such
as the ability to identify opportunities for action and skill development in daily life,
the tendency to set and pursue goals, the detection and construction of meanings,
and the support derived from positive social relations, community cohesion, and
adequate health services (Joseph and Linley 2006; Kreuter 2000; Mytko and
Knight 1999). A large amount of studies have been conducted to identify the
mediating function on health of specific psychological features, such as perception
of control (Fisher and Johnston 1996), coping style (Folkman and Greer 2000;
9 The Psychological Roots of Health Promotion 143

Galvin and Godfrey 2001; Pennebaker 1997; Stanton et al. 2000), self-efficacy
(Bandura 1997, 2004; Kuijer and deRidder 2003), and resilience (Rolland and Walsh
2005). Other scholars have attempted to situate these psychological resources
within broader constructs, trying to develop complex and integrated models of
mental well-being.

9.2.1 Western Conceptualizations of Well-Being

Current conceptualizations of well-being in psychological terms involve two pri-

mary aspects: one related to pleasure and satisfaction derived from the fulfillment of
needs and another related to the actualization of one’s potentialities and pursuit of
goals. They are subsumed under two broader frameworks – hedonia and eudaimonia
(Ryan and Deci 2001; Delle Fave 2013a).
The hedonic approach moves from the core assumption that maximizing indi-
vidual well-being is the highest human goal (Kahneman et al. 1999). The construct
developed within this approach, subjective well-being (SWB, Diener 2000),
includes an experiential component and an evaluative one. The experiential compo-
nent consists in the presence of positive emotions and the absence of negative emo-
tions (Fredrickson 2001). The cognitive evaluative component is the individual
judgment on the level of satisfaction with one’s life (Diener et al. 1985).
The eudaimonic view stems from Aristotle’s concept of eudaimonia, described as
the fulfillment of one’s true nature, that includes both self-actualization and commit-
ment to socially shared goals. According to Aristotle’s conceptualization, well-being
derives from the cultivation of personal resources and strengths through commitment
to valuable activities and through the pursuit of both individual and collective goals.
Within the eudaimonic approach in psychology, one of the more systematic concep-
tualizations was developed by Ryff (1989). It was labelled psychological well-being
(PWB) and it comprises six dimensions: self-acceptance, positive relations, personal
growth, purpose in life, mastery of environment, and autonomy. Keyes (1998) added
to them five dimensions related to social well-being: social coherence, social actual-
ization, social integration, social acceptance, and social contribution.
More recently, in the effort to develop a unified model of well-being, including
both hedonic and eudaimonic components, Keyes (2003) revised the concept of mental
health, defining it as a “syndrome” characterized by positive emotions, satisfaction
with life, and optimal functioning at both the psychological and social levels.
Individuals with a high level of mental health thrive and flourish, and this condition is
relatively independent of their physical health conditions. On the opposite, the absence
of mental health is characterized by languishing, stagnation, disengagement, and per-
ception of an empty life. People who languish do not necessarily show symptoms of
mental illness: however, they lack most of the symptoms of mental health. Flourishing
and languishing represent two poles of the mental health continuum (MHC, Keyes
2005; Keyes et al. 2008), corresponding to health and absence of health, respectively
(a thorough description of this model is provided in Chap. 1 of this volume).
144 A. Delle Fave

This approach is consistent with the biopsychosocial model and with a definition
of health (be it physical or mental) which does not simply consists in absence of
disease, rather requiring the presence of “positive symptoms.” Research has high-
lighted the positive impact of flourishing on physical health (Keyes 2007) and the
usefulness of related tools and intervention strategies in the domain of clinical
psychology (Fava and Ruini 2003, and Chap. 2 of this volume). In particular, a clini-
cal approach focusing on inner resources and potentials, instead of weaknesses and
deficits, can promote development and well-being in any situation, including objec-
tively suboptimal conditions that cannot be substantially modified.
The conceptual relevance and practical usefulness of focusing on resources
rather than on deficits were also embodied in the most recent revision of the inter-
national classifications of diseases and disabilities, which brought forth the new
International Classification of Functioning (ICF; WHO 2001). ICF includes a
marked shift in terminology, from pathology and constraints (impairments, disabili-
ties, handicaps) to health and resources (functioning), from the consequences of
disease to the components of health. ICF aims at investigating what people with
different health conditions actually can do in their daily life and in their social con-
text, emphasizing the active interaction of the person with the environment, in terms
of physical resource mobilization, daily activity performance, and social participa-
tion. Far from being a pure linguistic convention, a relevant conceptual change
underlies this shift from disease to functioning, leading to the evaluation of health
conditions from a constructive and substantially positive perspective.
More recently, Western researchers have been paying growing attention to a spe-
cific and previously overlooked concept: well-being as harmony and balance, at
both the individual and the social level. From a need-focused perspective, Sirgy and
Wu (2009) defined balance as a state “reflecting satisfaction or fulfillment in several
important domains with little or no negative affect in other domains” (p. 185),
prominently referring to the satisfaction of needs and expectations in crucial life
areas such as family, work, and health. Another study (Wu 2009) highlighted that in
order to maintain high levels of life satisfaction humans tend to attribute higher
importance to the life domains characterized by a low discrepancy between need
perception and need fulfillment.
From a state-focused perspective, a recent study conducted in seven Western
countries (Delle Fave et al. 2011a) highlighted that when asked to define happiness,
lay people prominently refer to inner harmony and balance, describing it as inner
peace, self-acceptance, serenity, and as a condition of equipoise and evenness. Ryan
et al. (2008) identified the prominent outcome of a eudaimonically lived existence
with a feeling of inner harmony and connectedness with the environment leading to
self-transcendence.
By the way, the relevance of inner balance to a good life is not new in the Western
tradition (Delle Fave 2013b): Plato included harmony in his definition of the just
man; Aristotle invited to seek “the intermediate,” avoiding any excess or deficiency
in behaviors, attitudes, beliefs, and expectations; the Stoics pursued the ideal of
evenness of judgment and detachment; and Epicurus focused on ataraxia, the attain-
ment of balance and equipoise in both positive and negative situations. The concept
9 The Psychological Roots of Health Promotion 145

of inner harmony is also shared by all Asian philosophical traditions, in which it

was formalized in a much more systematic and effective way, as described with
regard to Āyurveda in the following pages.

9.2.2 The Active Role of the Person in Health Management

One of the prominent concerns shared by researchers and practitioners in the health
domain is the necessity to make people aware of their own active role in preserving
health and in adaptively managing disease. In the last three decades, several models
were developed, in order to identify the environmental and psychological mecha-
nisms underlying health-related behaviors, with the aim of promoting the agency
and responsibility of individuals in promoting and maximizing their own health and
well-being.
The most effective models focus on the human capacity for intentional goal set-
ting and its relevance to the pursuit of health behaviors, especially when changes in
lifestyle and behavior are required in order to maintain or retrieve health (smoke or
alcohol abuse, inappropriate diet, risk exposure, dysfunctional daily habits).
Prochaska and DiClemente (1984) proposed a dynamic model, the Transtheoretical
Model of Change, that has been extensively applied in prevention and healthcare
programs (Cropley et al. 2003; Prochaska et al. 1994; Spencer et al. 2002). The
model is articulated in five stages: individuals must first become aware of their
health problems and goals (the contemplation stage) and then develop an intentional
strategy to attain them, put it into practice, and actively contribute to the mainte-
nance of the achieved results, which can also imply to cope with possible relapses.
The intentional change process depicted in Prochaska and DiClemente’s model
can take place by virtue of the mobilization of psychological and social resources.
Among them, self-efficacy (Bandura 1977) is prominent. Self-efficacy can be
defined as the level of competence an individual perceives in facing a specific situ-
ation. It facilitates the intentional mobilization of personal resources and skills in
the long term. Self-efficacious people are relatively unaffected by failures, and they
show high levels of perseverance in pursuing their goals. Self-efficacy has proved to
be useful in coping with adverse health conditions, since highly self-efficacious
people face negative life events actively, perceiving themselves as directly respon-
sible for the outcome. Also in situations characterized by low controllability – such
as permanent disabilities or the terminal stage of a disease – self-efficacious indi-
viduals are advantaged, in that their perception of an adequate level of competence
allows them to develop effective coping strategies, a good management of emotions,
and the capacity to set and attain realistic goals (Merluzzi and Sanchez 1997; Hurley
and Shea 1992).
Other researchers have confirmed the role of intentional processing of informa-
tion in pursuing health goals (see, e.g., Gollwitzer and Oettingen 1998). Broadly
speaking, these models emphasize the importance of agency, a core construct in
psychology that has been conceptualized in various ways (for an overview, see
146 A. Delle Fave

Bassi et al. 2010). According to Bandura (1997), the sense of agency emerges from
intentional behavior and high self-efficacy beliefs. From a motivational and devel-
opmental perspective, Deci and Ryan (2000) refer human agency to motivated
behaviors that emanate from one’s integrated self. To be agentic is to be self-
determined and thus to be autonomous form environmental conditionings. The pro-
totypical activity from which agency emerges as an integrated process is the
intrinsically motivated behavior, performed when individuals perceive themselves
free from environmental demands and constraints. Agency is of paramount impor-
tance for the patients’ participation in any health-related process, ranging from
adherence to treatments to all the stages of prevention (Gregor et al. 2006; Kipling
et al. 2005; Sheldon et al. 2003). Agency as a condition of shared power and respon-
sibility is one of the five pillars of the patient-centered model of relationship, in
which the physician encourages patients’ active participation and decision-making
in the selection of their treatment and in the long-term monitoring of their disease
course (Mead and Bower 2000; Mead et al. 2002).
From a broader and eudaimonic perspective, the economist Amartya Sen (1992)
defined the sense of agency as the property according to which individuals under-
take relevant and meaningful actions taking into account the relation between the
person, the social context, and other people’s needs. This approach emphasizes the
mobilization and implementation of personal skills and resources, the cultivation
of social competencies and interpersonal relations, and the pursuit of aims and
activities which are meaningful for the individual and for the society. Research
studies have highlighted that agency and responsibility as eudaimonic resources
are actually mobilized in stressful situations. At the community level, natural
disasters are often opportunities to strengthen social ties and to promote solidarity:
for example, a decrease in the number of psychiatric hospitalizations, drug use, and
police reports was detected following a devastating tornado (Quarantelli 1985). At
the individual level, people are able to identify the positive consequences of a
negative event such as the onset of a disease (Sodergren and Hyland 2000). Most
often, these consequences refer to developmental changes that contribute to make
the individual a better person, more aware of own strengths and weaknesses, less
vulnerable to daily stressors, more open to relationships, and more focused on
meaningful goals and priorities.
The crucial importance of agency in health and well-being promotion is not sur-
prising. The most recent conceptualizations of human development have high-
lighted the process of daily psychological selection (Csikszentmihalyi and
Massimini 1985), through which individuals differentially replicate subsets of the
biological and cultural information available to them in their daily environment,
thus actively contributing to its survival and changes (Massimini and Delle Fave
2000). Psychological selection results from the person’s preferential investment of
attention and resources on a limited amount of the environmental opportunities for
action and engagement. In particular, when daily activities are perceived as sources
of well-being and positive experiences, their preferential cultivation provides the
individual with increasingly complex competences and skills, fostering personal
growth and development (Delle Fave and Massimini 2005). Several cross-cultural
9 The Psychological Roots of Health Promotion 147

studies (summarized in Delle Fave et al. 2011b) showed that two core elements play
a key role in guiding psychological selection. The first one is the association of
specific activities with optimal experience, or flow (Csikszentmihalyi 1975/2000),
characterized by engagement, skill investment, involvement, and enjoyment. The
second component is the long-term meaning individuals attribute to the daily activi-
ties available to them (Delle Fave 2009; Schlegel et al. 2011). Through the attribu-
tion of meaning to specific life activities and domains, individuals pursue goals they
deem as relevant, as well as consistent with social values and others’ needs.
Except for extreme conditions, each person usually has a more or less wide range
of activities at their disposal, on which to perform an active psychological selection
(Delle Fave and Massimini 2004). However, it is important to consider that the
evolution trend supported by this process does not necessarily lead to well-being or
higher quality of life. The ultimate result depends upon the type of activities and
goals individuals decide to pursue. In order to bring developmentally positive
effects, psychological selection has to promote internal order and integration of
the individual and at the same time constructive information exchange with the
environment, the latter comprising social integration as well as commitment to the
improvement of the culture and of the quality of life of the other community members
(Delle Fave 2007). These prerequisites are consistent with the conceptualization of
human beings as complex living systems, described in Chap. 10 of this volume.
Based on the WHO definition of health as a global condition of well-being that
includes biological, psychological, and social components, the active and long-term
involvement of each individual in preserving and improving it implies the develop-
ment of skills and competences, meanings and goals, behaviors, and relationships
that selectively allow for a positive health management. Far from being a simple
task, this endeavor requires high self-efficacy beliefs and commitment to long-term
goals, adaptive preferential selection of the environmental information, effective
coping strategies in the face of challenges and stressors, positive interpersonal rela-
tionships, and the ability to constructively interact with the environment (Cortinovis
et al. 2011; Ryff and Singer 2008). According to the Western psychological view, all
these competences and resources are not innate and genetically based features, but
they can be learned through commitment and practice. They can be therefore cultivated
by any individual. As described in the following sections, these features are consis-
tent with the Ayurvedic assumptions concerning healthy behaviors and lifestyle.

9.3 Life, Health, and Well-Being in Āyurveda

According to the Sāṃkhya conceptualization (referred to in Chap. 3), which is

followed by most Āyurveda scholars, the universe stemmed from the interaction
between two eternal and unmanifest principles: puruṣa (conscious and passive) and
Prakṛti (the dynamic and unconscious source of all manifestations). This interaction
led to the manifestation and differentiation of all living entities, starting from mahat
(the universal order) and ahaṃkāra (the individual identity). Ahaṃkāra has three
148 A. Delle Fave

different qualities (guṇa): sattva (balance, equilibrium, clarity), rajas (dynamism),

and tamas (inertia). The interaction between sattva and rajas produces eleven indriyas
(sense and motor organs) as well as manas (the mind, coordinating the senses’
activity). Tamas and rajas combine to produce five tanmātrās (primordial units of
perceivable matter), which in their turn produce the five mahabhutas (great elements):
ākash (ether), vāyu (air), tejas (fire), ap (water), and pṛthvi (earth), manifest aggre-
gates of matter. From these mahabhutas the entire material world is made up (Dash
and Junius 1983). Both unmanifest principles – eternal consciousness and the source
of nature – are thus embodied in each living being. The individual soul or self
(ātman), eternal and unchangeable, is ontologically identical to the universal
consciousness principle (also defined Brahman). Ātman is present in every living
being, and after the death of the body, it migrates in another being, carrying the
impressions (saṃskāra) of the previous lives.
Consistently with this perspective, the great Āyurveda scholar Ćaraka defines
life – Ayus – as composed by mind (manas), self (ātman), and body (sarira) (Ćaraka
Saṃhitā, Sūtra Sthāna: 1, 46–47 in Sharma and Baghwan Dash 1998). Within the
Ayurvedic mind-body system, the ātman plays the role of witness, taking no
active part in the interaction of the individual with the environment. The ātman is
therefore pure consciousness, and in essence it is happiness and bliss, ananda.
However, humans can hardly experience this condition due to a set of sheaths (kosha)
covering this core essence. The kosha are thoroughly described in Chap. 2,
Brahmānanda Valli of the Taittiriya Upanishad (Swami Chinmayananda 1992). The
most external one is annamaykosha, the physical body strictly related to food (anna),
followed by prānamayakosha (the vital energy, connected to breath), manomayakosha
(the mental sheath, in which the basic psychological functions related to perception
and memory take place), and vijnānamayakosha (the intelligence sheath, characterized
by discernment, discrimination, and determination). The core sheath, ānandamaya-
kosha, is the sheath of bliss, the abode of ātman: at this level “the individual is free from
the notions of egoism and sense of agency, the characteristic features of manomaya
and vijanamaya respectively” (Kuppuswami 1985, p. 20).
Individuals however differ according to the prominence they give to different
kosha, by relating their essential identity to a particular set of functions and dimen-
sions. The majority of people tend to identify themselves with the first three kosha,
thus being conditioned by positive and negative emotions, attachment to external
objects, and mind fluctuations (Kiran Kumar 2006). This is prominently due to the
fact that the ceaseless contact with external and internal stimuli makes the mind
wander like a “restless monkey” across different feelings, thoughts, and experi-
ences. This dependency of the individual on pleasure/pain feelings and subsequent
attraction/repulsion behaviors originates from the interaction of the mind with envi-
ronmental objects or inner triggers. It represents the ultimate cause of suffering in
that the transient nature of pleasure generates further desire, craving, and longing
for the associated objects, while pain directly produces suffering. This view of mind
is substantially shared by all the Indian philosophical systems (Kiran Kumar 2003).
Since the individual is entrapped into this web of unstable and ultimately distressing
experience fluctuations within the manomayakosha, human evolution is considered
9 The Psychological Roots of Health Promotion 149

as the progressive actualization of higher levels of consciousness towards the

experience of ānanda, in which the knower, the object of knowledge, and the act of
knowing merge into a single entity. The ultimate goal of human beings is to get rid
of the constraints of sensory attractions and mind fluctuations and to identify with
the state of perfect bliss which characterizes ātman.
In the Kena Upanishad, this concept is beautifully synthesized as follows:
If one knows That Brahman here, in this world, then the true end of all human aspirations
is gained. If one knows not That here, great is the destruction. The wise, seeing the one
Ātman in all beings, rise from sense-life and become immortal. (Kena Upanishad: 2, 5 in
Swami Chinmayananda 1952)

The concept of purushārtha, goals of human existence, is particularly relevant to

this purpose. Depending on one’s stage of psychological development, people
may pursue desires (kāma), wealth (artha), personal and collective values
(dharma), and liberation (mokṣa). The pursuit of desires and wealth to the exclu-
sion of pursuit of values and of liberation is however a sign of lower level of
evolution.
Individuals widely differ in their needs and aspirations; some of them are purely
hedonistic, a few are spiritual in nature, while the vast majority falls in between. In
the light of this evidence, in the Indian culture, a social framework and ground rules
were developed to promote good life by giving equal importance to dharma, artha,
and kāma (Kiran Kumar 2004):
the correct position is that the good of man consists of the harmonious co-ordination of the
three. (Manu, II: 224; in Banerjee 1980)

The relative importance of each of the three “lower” human goals clearly emerges
in the writing of Āyurveda scholars such as Ćaraka and Vagbhata, who relate it to
health:
So a wise person … should strive for discarding the harmful or unwholesome regimens and
adopt the wholesome ones in regard to dharma, artha, and kāma, for no happiness or
unhappiness can occur in this world without these three elements. (Ćaraka Saṃhitā, Sūtra
Sthāna: 11,46 in Sharma and Baghwan Dash 1998)
Person desiderous of (long) life which is the means for achieving dharma, artha, and
sukha should repose utmost faith in the teachings of Āyurveda. (Aṣṭāṅga Hṛdaya, Sūtra
Sthāna: 1,2 in Srikantha Murthy 2007)

9.3.1 Health and Well-Being as Balance

If we try to draw a comparison with the Western conceptualizations of well-being

described in the previous sections, the hedonic approach is more related to kāma
and to artha, while dharma with its different individual and social connotations
encompasses the concept of eudaimonia (Kiran Kumar 2003). Western theories
of happiness and well-being however limit their exploration and conceptualiza-
tion to the first three goals without considering the last one, mokṣa. On the opposite,
150 A. Delle Fave

in the Indian thought, the ideal well-being is understood as an outcome of the

expansion of consciousness and realization of a transcendent self whose very
nature is ānanda. Its manifestation is obstructed by the dullness of our mental
faculties, derived from the prominent investment of psychological resources on
inner or external sources of pleasure and pain, which – as discussed above – gen-
erates attachment and ultimately suffering. The increasing balance in the mental
functioning (i.e., the prominence of their sattva quality on tamas and rajas) facil-
itates the experience of ānanda. Patanjali’s Yoga Sūtras specifically describe the
process leading to liberation through the experience of identification with the
ātman, as well as the eight steps required to attain it (Feuerstein 1998). In the
Bhagavad Gitā, all these concepts are made accessible to a broader audience and
applicable to ordinary people’s life. In particular, the core concept of this scrip-
ture is the pursuit of nonattachment (anāsakti), a condition of mental balance and
equanimity in dealing with life events without being emotionally affected by
their positive or negative features and consequences (Swami Chinmayananda
1975). The ideal of anāsakti embodies spiritual growth as well as action orienta-
tion. To be detached does not mean to withdraw from life demands and duties.
Rather it implies to perform any action with dispassion, without concerns for
failure or success, loss or gains (Pande and Naidu 1992):
A courageous man is not one who does heroic acts but the one who is tranquil in mind under
any circumstances of agitation. (Kalidas, quoted by Thirumulpadu 2010, p. 55)

Therefore, well-being and good life can be achieved through surrendering rather
than controlling and holding on; minimization, restraint, and detachment from need
fulfillment are more effective in promoting well-being than maximization, indul-
gence, and striving for need fulfillment (Kiran Kumar 2004).
The focus on balance in mind and behavior as the basic prerequisite for health
and well-being is repeatedly stated by all the major scholars of Āyurveda with refer-
ence to body, mind, and behavior:
Disease is disequilibrium of the dhātu Health is equilibrium of dhātu. Health is known as
pleasure. Disease is known as pain. (Ćaraka Saṃhitā, Sūtra Sthāna: 9,4 in Sharma and
Baghwan Dash 1998)

In this quotation, dhātu refers to the structural constituents of the body that
can be loosely explained as tissues (a more detailed description of dhātu is pro-
vided in Chap. 10). Ćaraka attributed the state of perfect health/balance to the
ancestors living in the age of perfection, kritayuga, during which humans were
in direct contact with the divine, following the laws of dharma and a virtuous
lifestyle (Ćaraka Saṃhitā, VimanaSthāna 3:24–25, in Sharma and Baghwan
Dash 1998).
An effective synthesis of this interpretation of health can be found in Suśruta
Saṃhitā, where the term used for health is swasthya, that means “to be established
(Sthya) in oneself (Swa).” According to Suśruta (Suśruta Saṃhitā, Sūtra Sthāna: 15,
in Kaviraj Kunjalal Bhishagratna 1911), a person is established in oneself when her
physiological functions and structures are in a state of equilibrium, together with
contentment of mind, discriminative intellect, and senses.
9 The Psychological Roots of Health Promotion 151

9.3.2 Prakṛ ti and Health

At the psychophysical level, the natural state of balance was formalized in terms of a
key concept in Āyurveda: three principles known as doṣa – vāta, pitta, and kapha. They
are not thought of as specifically physiological but rather as principles that emerge in the
manifestation of the individual as a complex system (as described in Chaps. 4 and 10).
They derive from the combination of the five Mahabhutas: vāta is prominently consti-
tuted of vayu and ākash; pitta of tejas and ap; and kapha of ap and pṛthvi. Together
with the seven tissues and the waste products, they represent “the roots of the body
always” (Aṣṭāṅga Hṛdaya, Sūtra Sthāna: 11, 1, in Srikantha Murthy 2007).
The three doṣa as functional principles subsume all the strategic activities of
human life, at both the physical and mental levels (Subramanya Sastri 2009, and
Chap. 4 in this volume). More specifically, from a functional perspective, vāta is
expressed in the body and mind movements, such as blood flow, peristalsis, breath-
ing, changes and fluctuations in perception and thought, sensory activities, and gen-
eration of ideas. Vāta controls pitta and kapha and is usually the first cause of
disease. When in excess, at the psychological level, it leads to anxiety, insomnia,
and mood instability, while at the physical level, it generates increase in degenera-
tive processes, irregularity of system functions, and loss in tissue mass and com-
pactness. Pitta is manifest in the transformation processes that take place in the
mind and body, such as food digestion, hormone regulation, the processing and
elaboration of sensorial information, and the cognitive ability of discriminating and
discerning. Pitta must be kept in balance, too, since its excess may lead at the psy-
chological level to anger, aggressiveness, and competitiveness and at the physical
level to acceleration of metabolic processes and inflammatory pathologies. Kapha,
whose constituents are water and earth, is reflected in the body cohesion and stabil-
ity. It is related to physical strength and vigor, and it promotes immunity and resil-
ience to external injuries. It is associated with memory strength and emotional
stability; with calmness, forgiveness, and love; and with loyalty and patience. Too
much kapha leads to lethargy and drowsiness and to feelings of attachment, greed,
and envy at the psychological level; at the physical level, it leads to weight increase,
water retention, and a global reduction in metabolic processes.
The conceptualization of the doṣa is rooted into in the Vedic scriptures. In Prasna
Upanishad, for example, there is a detailed description of the vāta subcomponent,
called subdoṣa, starting from prana as the life principle (Swami Chinmayananda
1954). The three doṣa pervade the entire being encompassing the body, emotions,
and mind, and according to their relative proportions, they determine the constitu-
tional type of the individual, or Prakṛti (Ćaraka Saṃhitā, Sūtra Sthāna: 30,25, and
Aṣṭāṅga Hṛdaya, ŚārīraSthāna: 3, 83 in Srikantha Murthy 2007).
In Sanskrit Prakṛti means “the natural condition or state of anything, of nature,
of a natural form,” the root kri meaning “to make,” and the prefix pra “forward,
forth, in front, onward.” Thus, it evokes notions of first cause or first action. As a
matter of fact, individuals with different Prakṛti differ from one another in their
body structure and functioning, capacity for immunity from disease, emotional
responses, and psychological characteristics.
152 A. Delle Fave

The literature on doṣa and Prakṛti is extremely vast, and it was substantially
expanded by the recent scientific evidence derived from studies focusing on their
genetic bases (Juyal et al. 2012; Patwardhan and Bodeker 2008; Prasher et al. 2008).
For the sake of synthesis and to the purposes of this chapter, only the description of
the three basic typologies of Prakṛti, related to the predominance of one doṣa over
the other two, will be reported here. To this purpose, the description provided by
Ćaraka was selected, since further developments added very little to such an aston-
ishingly detailed and precise classification (Ćaraka Saṃhitā, VimanaSthāna 8: 96–98
in Sharma and Baghwan Dash 1998):
Vāta is ununctuous, light, mobile, abundant in quantity, swift, cold, rough and non-slime.
Various manifestations due to these attributes of vāta in human body having vātala type of
constitution are ununctuousness, emaciation and dwarfness of the body, longdrawn, low,
broken, obstructed and hoarse voice, and sleeplessness; light and inconsistent gait, activi-
ties, diet and movement; unstable joints, eyes, eye brows, jaws, lips, tongue, head, shoulder,
hands and legs; talkativeness, abundance in tendons and veins; quickness in initiating
actions, in getting irritated and in the onset of morbid manifestations, quickness in affliction
with fear, likes and dislikes, in understanding and forgetting things; intolerance to cold,
affliction with cold, shivering and stiffness; coarseness in the hair of the head, face and
other parts of the body, nails, teeth, face, hands and feet; cracking of the limbs and organs,
cracking sounds in joints when they move. By virtue of the above mentioned qualities,
persons having vātala1 type of constitution mostly have lesser quantity of strength, life
span, progeny, accessories of life and wealth.
Pitta is hot, sharp, liquid, of fleshy smell, sour and pungent. Various manifestations
due to these attributes in the human body having pittala type of constitution are intolerance
for of hot things, hot face, tender and clear body, freckles, black moles, pimples, exces-
sive hunger and thirst, quick advent of wrinkles, greying of hair and baldness, presence
of soft and brown hair in the face, head, and other parts of the body; demonstration of
sharp physical strength, strong digestive power, intake of food and drink in large quan-
tity, inability to face difficult situations and glutton habits; looseness and softness of
joints and muscles, excess sweat, urine and feces; putrid smell of axilla, mouth, head
and body; insufficiency of semen, sexual desire and procreation. By virtue of the above
mentioned qualities the person having pittala2 type of constitution is endowed with
moderate strength, life-span, spiritual and materialistic knowledge, understanding,
wealth, and the accessories of life.
Kapha is unctuous, smooth, soft, sweet, firm, dense, slow, stable, heavy, cold, viscous,
and clear. The various manifestations in the human body having śleṣmala3 type of con-
stitution are unctuous and smooth organs; pleasing appearance, tenderness and clarity of
complexion; abundant semen, desire for sex-act and number of progeny; firmness,
compactness and stability of the body; plumpness and roundedness of all organs; slowness
in action, intake of food and movement; slowness in initiating action, getting irritated
and morbid manifestations; non slippery and stable gait with the entire sole of the feet
pressing against the earth; little hunger, thirst, heat, and perspiration; firmness and com-
pactness in joints; happiness in the look and face; happiness and softness of complexion
and voice. By virtue of the above mentioned qualities, a person having śleṣmala type of
constitution is endowed with the excellence of strength, wealth, knowledge, energy, peace,
and longevity.

1
in which vata prevails.
2
in which pitta prevails.
3
in which kapha, also called śleṣma, prevails.
9 The Psychological Roots of Health Promotion 153

9.3.3 Vikṛ ti and Disease: The Role of Mind

The healthy Prakṛti is a state of a dynamic equilibrium of doṣa, dhātu, mala (waste
products), and agni (the principle of transformation and assimilation power); it
shows an intrinsic order that is disturbed by aggravation or decrease in the propor-
tion of its constitutive doṣa (vikṛti), which affect the body and mind functioning. It
is important however to consider that disease is only proximally due to doṣa imbal-
ance. The primary causes of this imbalance have to be identified at the mental level.
The interaction between the individual and environment occurs through three chan-
nels, namely, prajna (or buddhi, the intellective guṇa or quality of the mind, as
defined by the Nyāya Vaiśeṣika system and endorsed by Āyurveda scholars, e.g.,
Ćaraka Saṃhitā, ŚārīraSthāna: 1, 49 in Sharma and Baghwan Dash 1998), indriyas
(the senses), and kala (the seasons and nature rhythms). The deviations of prajna,
indriyas, or kala from their balanced state are the original sources of diseases,
whose prominent early symptom will be vitiation of doṣa (Ćaraka Saṃhitā: Sūtra
Sthāna: 20, 5; ŚārīraSthāna: 1, 198–132 in Sharma and Baghwan Dash 1998).
In particular, prajnaparādha refers to wrong understanding and decision-making,
wrong discernment, and going against knowledge. Asatmyendriyārthasamyoga
refers to wrong contact of the sense organs with the environmental stimuli, through
their abuse, misuse, or nonuse; and kala pariṇāma refers to the inability or inatten-
tion of the person to get tuned with the changing cycles of nature (see Chap. 5 for a
more detailed description of the factors contributing to imbalance and health alterations).
These errors lead to unwholesome behavior and thus generate doṣa imbalance and
disease. Ćaraka however highlights that
Neither the sense organs nor their objects alone can bring about happiness or miseries. The
latter are in fact caused by the fourfold combination (proper use, wrong use, excessive use,
non use). Even if there are sense organs and their objects present, there would be no disease, nor
any happiness unless the fourfold combination is involved. (Ćaraka Saṃhitā, ŚārīraSthāna : 1,
130–131 in Sharma and Baghwan Dash 1998)

It is therefore clear that since manas, the mind, coordinates and influences the
actions and contacts of the sense organs, on the one side, and the knowledge and
discrimination faculties of the intellect, or buddhi, on the other side, a perturbed
mind represents the basic source of ill-being and disease.
More specifically, a relevant role in disease onset is played by the three mental
guṇa: sattva, rajas, and tamas, which represent the principle of equilibrium, dyna-
mism, and inertia, respectively. Tamas is responsible for dullness, retardation, and
depression. Rajas is responsible for energy and action. Sattva is responsible for
balance, harmony, and awareness. The higher the proportion of sattva compared to
the other two guṇa, the more is the mind balanced, allowing for the achievement of
a closer identification with the ātman, beyond the emotional fluctuations generated
by the attachment to the sense objects.
These three maha guṇa, as described above and analyzed with greater details in
Chaps. 3, 4, and 10, are the substantial qualities that constitute the eternal and active
principle of Prakṛti. The original interaction between Prakṛti and puruṣa generates
154 A. Delle Fave

an imbalance among the three maha guṇa, leading to the development of the manifest
reality. Maha guṇa are thus constituents of the whole reality, including human
beings. All the three guṇa are present in all the individuals, regardless of their doṣa
Prakṛti, and they are involved in the deviations from the correct functioning of prajna,
indriyas, or kala perception, reported above as main causes of imbalance in the
doṣa. At the mental level, individuals can be differentiated as sāttvic, rājasic, and
tāmasic depending on the preponderance of one guṇa over the other two. Following
the synthetic description provided by Kiran Kumar (2003), a sāttvic person shows
discriminative intellect: self-control, serenity and equipoise, and freedom from
attachment and from the fruits of action. A rājasic person is driven into action by
passion; has desires, strong likes, and dislikes; and lacks clear discrimination. A
tāmasic person is depressed, lethargic, negligent, undisciplined, arrogant, ignorant,
and dull. The three guṇa, as the qualities of the mind, are responsible for the
individual differences in mood and attitudes.
The interplay between guṇa and doṣa is clarified by Ćaraka:
Mental faculty is of three types—Sattva, Rajas and Tamas. The Sattva is said as devoid of
defects due to having beneficial fraction whereas Rajas and Tamas are defective because of
the fractions of agitation and ignorance respectively. Out of these three types of psyche,
each one has got innumerable sub-divisions due to relative degrees and variations in inter-
action of psyche and body according to species. (Ćaraka Saṃhitā, ŚārīraSthāna: 4, 36 in
Sharma and Baghwan Dash 1998)

Recently, Frawley (2004) has stressed the importance to evaluate doṣa and guṇa
in their interplay, in order to cover all the biological, psychological, and spiritual
implications for well-being of their balance or imbalance. Western scholars are
presently exploring the scientific evidence and role of doṣa at the biological and
physiological levels and in different species (Hankey 2010).

9.4 The Psychological Roots of Health in Āyurveda

and in the Biopsychosocial Model: Convergences
and Divergences

The brief excursus provided in the previous pages on the role of the individual mind
in health promotion and disease prevention in Western medicine and in Āyurveda
allows for some comparative considerations that are aimed to highlight commonali-
ties and differences between the two approaches.

9.4.1 Health as a Multifaceted Construct

Both Āyurveda and the biopsychosocial model acknowledge the complexity of

health as a multifaceted outcome resulting from the interplay of several systems. As
concerns the conceptual background, however, Āyurveda situates individual health
9 The Psychological Roots of Health Promotion 155

within a unitary framework in which morphophysiological, psychological, and

behavioral features are taken into account all together and related to a whole set of
environmental dimensions that range from seasonal cycles to social relationships,
from collective dharma to cosmic influences. The Western biopsychosocial model,
though attempting to provide an interconnected view of the three different systems
involved in the evaluation of health, does not aim to bring them together into a uni-
fied conceptualization. In particular, the role of the psychological resources and
potentials of the person in dealing with health and disease (the “psycho”) has
become specific objects of investigation of health psychology, a new additional
branch of the discipline, separated and autonomous from medicine (the “bio”) and
from sociology and economics (the “social”). This approach is consistent with the
tendency towards compartmentalization typical of Western science.
An interesting convergence between Āyurveda and the Western conception of
well-being at both the psychological and overall health levels concerns the impor-
tance of balance, a dimension only recently rediscovered in Western psychology.

9.4.2 Disease Onset

In Āyurveda the interplay between the mind and the body is formalized in hierarchi-
cal terms, being grounded in a cosmological view in which subtler entities are supe-
rior to grosser entities: this is reflected in the five kosha representation and in the
classification of the three substantial causes of health and disease, all being located
at the level of manas – either in its connections with the sense organs and related
behaviors or with the discrimination and intellectual functions. This approach
clearly situates the prominent responsibility for health preservation in the person as
a psychic entity. In the Western approach, the relationships between biological and
psychological features are not hierarchically defined, although a tendency towards
biological reductionism cannot be denied: when speaking about health, Western
medicine usually refers to physical health. Causes of disease are usually identified
in external agents or in altered conditions of the body functions, and their effects are
evaluated prominently at the physical level. Even in case of psychiatric disorders,
the greatest efforts are put in detecting their biological and anatomo-physiological
origins or correlates. This substantial difference is surely due to the different con-
ceptualization of etiology and pathogenesis in the two medical systems: doṣa imbal-
ance (sañcaya) is the first stage of pathogenesis in Āyurveda, and treatment should
take place at this stage, where balance can be easily retrieved. The organ-related
manifestation of disease (vyadhi vyakti) represents the fifth stage that takes place
long time after the occurrence of doṣa imbalance and that is much more difficult to
treat. Within the Western model of medicine, people usually consult the physician
only when a manifest disease is present, ignoring the previous signals of imbalance
or treating them with generic and palliative medicaments. This neglect would be
classified in Āyurveda as prajnaparadha. The impressive increase in lifestyle-
related diseases in postindustrial countries has recently given impulse to a growing
156 A. Delle Fave

awareness of the importance of preventive healthy behaviors, thus calling into play
individual responsibility, agency, and psychological selection. As outlined in the
previous pages, various intervention models have been developed to help people
leave unhealthy habits or adopt healthy ones through the mobilization of psycho-
logical resources. However, in spite of such an overwhelming research evidence of
the potentials of prevention, most people still wait for the disease manifestation at
the organ level before seriously undertaking these efforts.

9.4.3 Health Management

In Āyurveda, the various manifestations of health and disease substantially depend

on the individual Prakṛti. As a consequence, remedies, treatments, and preventive
measures must be personalized according to the constitution of the single individual,
based on the proportion of guṇa and doṣa. Insomnia in a vātala person should be
treated differently from insomnia in a ślesmala one, through the prescription of
Prakṛti-specific medicaments, diet, and changes in lifestyle. The constructs and theo-
ries developed within Western health psychology are instead assumed as universally
valid for any individual, based on the Western view of psychological functioning as
a system of functions and mechanisms working in the same way across individuals.
From this perspective, all people are supposed to be able to mobilize the same inner
resources and to adopt the same prevention strategies when facing health problems.
In so doing, health psychology entails the risk of neglecting not only psychological
differences but also geographical and cultural variations. Specific behaviors, activi-
ties, or habits do not necessarily have the same meaning or function in different cul-
tures: therefore, we should not expect them to have an invariant relation to well-being
or health (Deci and Ryan 2000). For example, physical training – largely popular in
Western countries – can become problematic in a social context characterized by a
different emphasis on fitness and body image, a different gender role pattern, or a
different climate. Dietary regimens cannot ignore the food habits and related social
norms of the patients. Standardization of treatments at both the physical and psycho-
logical levels is one of the major weaknesses of the Western approach to health.

9.4.4 The Self

In Āyurveda, the mind is contextualized into an articulated philosophical and cosmo-

logical view, in which the dimension of transcendence plays a pivotal role. As briefly
outlined in the previous pages, the human being is constituted by the tripod of body,
mind, and ātman, the self, ontologically identical to Brahman, the all pervading eternal
principle of reality, without attributes and dimensions. Among the goals that indi-
viduals pursue in their life, the highest one is mokṣa, the liberation from the attach-
ment to passions and sense objects, that is grounded in the prominence of sattva
9 The Psychological Roots of Health Promotion 157

among the mental guṇa and in the progressive development of the person towards the
innermost layer of the individuality, the ānandamayakosha. In this lies the true
swāsthya, health and well-being (Kiran Kumar 2006). Āyurveda itself as a knowl-
edge system developed from the spiritual tradition of the Veda, Sākhya, and Yoga
Sutras. The spiritual component is thus seen as a substantial constituent of the person’s
health. In the Western biopsychosocial approach, spirituality and religion have been
indeed object of research, and several epidemiological studies have emphasized the
benefits of spirituality and religiosity on health. A positive correlation was detected
between religious practice and health (Larson et al. 1989; McCullough et al. 1999).
This has been ascribed to various factors: most religious systems prescribe healthy
lifestyles and food habits; prayer and meditation foster psychophysical relaxation;
practicing religion promotes social support through more stable family ties and the
participation to community rituals; and religiosity provides meanings and hope and
fosters a more active acceptance of negative events (Jenkins and Pargament 1995;
Park and Folkman 1997; McClain et al. 2003). However, the religious/spiritual
dimension is considered as a private issue, and it is not included per se in any model
of health and well-being, rather representing one of the psychological resources
available to the individual when facing health problems.

9.5 Concluding Remarks

The synthetic outline provided in the previous pages has clearly highlighted a conver-
gent pathway between Western science and Āyurveda in the evaluation of the indi-
viduals as primary and responsible agents of their own health. The psychological
dimensions, resources, and processes identified by health psychology are consistent
with the view provided in the classical texts of Āyurveda. Nevertheless, the two
approaches show major differences, especially as concerns the relevance attributed to
the transcendent dimension, the recognition of early symptoms, and the typological
distinction of the individuals based on their doṣa proportion. While the spiritual
aspects are grounded into traditions and cultural beliefs that cannot be generalized, the
Ayurvedic warning about the education to prevention, through a greater awareness of
one’s own healthy or unhealthy behaviors, food habits, and lifestyle, could be usefully
integrated in the Western knowledge. Similarly, more attention should be attributed to
the person’s psychophysical peculiarities, overcoming the tendency to standardize
treatments and behavioral guidelines. The growing concern for health and well-being
can find effective suggestions in the teaching of the ancient Indian scholars.

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Chapter 10
The Emergence of Health in Complex
Adaptive Systems: A Common Ground
for Āyurveda and Western Science

Antonio Morandi and Antonella Delle Fave

10.1 Introduction

Western medicine is undergoing deep conceptual changes, in the attempt to fill the
steadily increasing gap between the theoretical underpinnings of the scientific
method and the complexity of the observed reality. The compelling evidence of the
variety of expressions and multifaceted interactions of the social and individual
determinants of health challenges the current biomedical perspective, still centered
on the analytical investigation of isolated structures, functions, and mechanisms.
A growing amount of studies are showing the potential of system biology, an
approach grounded into the theories of chaos and complex systems that provides an
integrated view of the amazing intricacy of life, opening new perspectives to our
understanding of health and disease (Hood and Flores 2012; Mazzocchi 2012).
However, this integrated view is still far from being applicable to the daily clinical
practice, due to the lack of an overarching conceptual framework. Contemporary sci-
ence is split between the evidence of indeterminism, acausality, and non-localization
of the basic elements of nature brought forth by physics on the one side and the
phenomenic reality of biological systems undergoing ceaseless changes in time
under the pressure of internal and external causes on the other side. The connection
between these two contradictory aspects of reality is the core of a lively debate that
calls into play philosophical worldviews and religious beliefs besides experimental
evidence (Kaufman 2008).

A. Morandi (*)
School of Ayurvedic Medicine, Ayurvedic Point, Milano, Italy
e-mail: [email protected]
A. Delle Fave
Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 163
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_10,
© Springer Science+Business Media Dordrecht 2013
164 A. Morandi and A. Delle Fave

The major problem in this debate is the difficulty to integrate such a variety of
contrasting evidences within the Western cultural view of discontinuity between
domains of knowledge. An integrated perspective that overcomes these difficulties
is offered by Āyurveda, the ancient traditional medicine of India, grounded into the
Eastern view of the substantial interconnectedness of all aspects of reality. Āyurveda
shows amazingly modern features (Morandi et al. 2010, and Chap. 1 of this volume),
and its conceptual underpinnings can be fruitfully interpreted and explained to a
skeptical Western audience through the theoretical framework of complex systems
(Rioux 2012). Āyurveda is centered on an inclusive and dynamic conceptualization
of health, considered as an emergent phenomenon arising from the interplay of
different life components, at the physical, psychological, social, and spiritual levels.
This conceptualization is strikingly close to WHO’s definition of health as “a state
of complete physical, mental and social well-being, and not merely the absence of
disease or infirmity” (WHO 1978).
In this chapter, we will attempt to highlight the similarities between the Western
conceptualization of nature and living systems and the Ayurvedic one. Needless to
say, Āyurveda is a system of knowledge that was developed independently and
much earlier than modern science. Therefore, our aim is to not reduce Āyurveda
to a science in Western terms. We will rather attempt to highlight commonalities
and differences between the two approaches. A clear distinction between these two
perspectives must be maintained indeed, in order to escape the ethnocentric tempta-
tion to forcefully include any aspect of human knowledge into the Western interpre-
tation framework. As concerns Āyurveda, this means to tribute respect and
recognition to its philosophical and conceptual core, which in fact represents one of
its distinctive and most salient features, allowing for the interpretation of any phe-
nomenon within the realm of life from an unequivocally integrated perspective.
To this purpose, we will first briefly refer to the definition of health and disease
in the Western and Ayurvedic views, highlighting their different conceptual under-
pinnings, and then we will show how similarities between the two approaches can
be detected adopting a complex systems’ perspective.

10.2 Health and the Western Worldview

Modern medicine is currently dominated by the biomedical model, which is strictly

analytical and problem centered (Delle Fave and Massimini 2005; Chaps. 1 and 2
of this volume). Physicians pay attention to the specific symptoms reported by
their patients, trying to ascribe them to a well-defined pathology related to a spe-
cific body organ or apparatus. A treatment for each specific disorder is thus envis-
aged, disregarding how patients’ whole-body functioning, natural environment,
social context, and subjective experience can influence the onset and the outcomes
of disease. The limitations of this model were firstly pointed out by Engel (1977),
a psychiatrist who formalized the bio-psycho-social model, focused on the patient
as a person with a subjective interpretation of health, disease, and quality of life; as
10 The Emergence of Health in Complex Adaptive Systems… 165

a carrier of a specific cultural background; and as a member of a particular society,

that is, as a complex living system (a more articulated discussion of this topic is
provided in Chaps. 1 and 9).
Engel’s model actually echoes a core statement of the Declaration of Human
Rights (1948), according to which health is a state of physical, psychological,
social, and spiritual well-being, as well as the WHO’s definition of health reported
above. This definition, currently accepted by researchers, professionals, and institu-
tions worldwide, indeed provides a laudably bio-psycho-social view of health as a
complex phenomenon. At the same time, it shows a crucial weakness: it is not of
practical use (Saracci 1997). Can any common person’s health conditions satisfy
the assumption of completeness? The WHO definition is to be appreciated for its
utopian hope of the best imaginable life for every human being, but it does not
correspond to the experience of any real person (Delle Fave and Fava 2011).
Moreover, WHO’s definition of health is absolute. Health is either complete or it
cannot be defined as health. The typical Western tendency toward polarization is
clearly evident here. Objects, phenomena, and events investigated in any domain are
usually classified and measured on ranges or continua built between two opposite
poles, such as positive/negative, true/false, dynamic/static, global/local, and divisible/
indivisible.
This aspect is particularly problematic if we consider that WHO’s definition
of health focuses on three different levels at which complete well-being should
be identified – the physical, the psychological, and the social one. However,
these levels are interconnected, and the evaluation of health may vary within the
same individual across life stages, across individuals, across social conditions,
and across cultures.
At the individual level, each person develops a subjective evaluation of well-
being and health according to criteria such as values, beliefs, goal hierarchy, person-
ality, and idiosyncratic style of interaction with the environmental opportunities
(Delle Fave 2006). Physical health conditions only partially influence this evaluation.
For example, Albrecht and Devlieger (1999) found that 54.3 % of people with
serious disablement rated their quality of life as excellent or good. People currently
sick or recovering from disease can easily identify positive consequences of their
illness, such as improved interpersonal relationships, positive personality changes,
and reappraisal and restructuring of life (Sodergren and Hyland 2000). Two persons
with the same degree of physical health can have different levels of functioning
and well-being. This depends upon variables unrelated to physical conditions but
nevertheless connected with health: individual psychological features, family and
social support, material and economic resources, educational background, cultural
representations, and social policies (Ingstad 1999; Simeonsson et al. 2000; Űstün
et al. 2001). At the social and cultural levels, research has widely demonstrated that
persons with diseases or disabilities will only be disadvantaged in a social, cultural,
or attitudinal environment in which their condition brings about disadvantageous
consequences (Bickenbach et al. 1999).
Intrapersonal, interpersonal, and environmental factors therefore interact in
moderating the effects of illness. A pivotal role is played by the opportunities for
166 A. Morandi and A. Delle Fave

action and self-expression offered within the family life (Ünalan et al. 2001).
In addition social relationships, education and job opportunities, architectonic and
interpersonal facilitators, and barriers remarkably affect the quality of life of people
with chronic or disabling pathologies (Meyers et al. 2002).
The impact of cultural trends and beliefs on health and related behaviors is
particularly evident in postmodern societies. Improved living standards have
brought forth longer life expectancy. Technological and scientific advancements
allow people to survive and to attain a good quality of life in conditions that only
few decades ago entailed death or dramatic constraints. In this context, patients
expect to be offered solutions for any kind of problems, possibly by means of quick,
time-saving remedies. Paradoxically, at the same time people of all ages engage in
unhealthy but emotionally rewarding behaviors, such as substance abuse, excessive
food intake or too severe diet restrictions, exposure to health risks in sports and
sexual behaviors, and too much or too little physical exercise. For the abovemen-
tioned reasons, the growing investment on health in Western countries and – though
less incisively – all over the world gave rise to an “epidemiological paradox.” The
increase in life expectancy led to an increase in the number of years spent living
with chronic physical diseases and mental disorders, rather than greater health
(Keyes 2007 and Chap. 1 of this volume).
This problem has been very acutely addressed by Sri Thirumulpadu, one of the
most authoritative contemporary scholars in Āyurveda. He wrote “The current medi-
cal system is disease-centric … More medicines, more doctors, more hospitals only
ensure more diseases … Despite increased morbidity, efficient emergency manage-
ment has mitigated mortality. And morbidity reigns because of a bad philosophy
of disease management which does not insist on a correct lifestyle” (2010, p. 51).
The reason for this phenomenon, according to this scholar, lies in the lack of a
philosophical system guiding the development of science.

10.3 Philosophy, Science, and Health: The Indian

Perspective

The Indian culture developed a systematic and astonishingly deep knowledge about
well-being and health, integrating the investigation of physiological processes and
psychological functioning into the holistic perspective of the medical system of
Āyurveda. However, in the Indian tradition the investigation of physiological and
psychological functions and structures does not represent an independent knowledge
domain. On the contrary, it is substantially related to philosophy and spirituality
(Kuppuswami 1977; Rao 2008). According to Sri Thirumulpadu (2010) such a
relationship is grounded into the role attributed to philosophy and science in the
Indian tradition. Darśana or philosophy is generalized knowledge, offering a global
view of life and concerned with differentiating between good and bad, well and ill.
Śāstra or science is instead particularized knowledge, thus pertaining to practices
and applications developed to ensure beneficial outcomes. The definition of health
10 The Emergence of Health in Complex Adaptive Systems… 167

as a general and unitary human condition belongs to the domain of philosophy,

while science has the specific role to find efficacious remedies to treat the particular
and manifold conditions of disease.
Consistently with this view, the classical texts conveying the vision of
Āyurveda – Ćaraka Saṃhitā, Suśruta Saṃhitā, and Aṣṭāṇga Hṛdaya – prominently
follow the conceptualization of the Sāmkhya system. In particular the conceptual-
ization and systematization of health and disease first developed by Ćaraka emerged
from the complex interplay between different philosophical approaches, during a
period of great intellectual ferment. The Astika or orthodox philosophical sys-
tems – Mīmaṃsā, Upanishad and Advaita Vedānta, Sāmkhya, Yogā, Nyāya, and
Vaiśeṣika – based on the Vedic assumption of a universal and eternal conscious-
ness principle were challenged by new Nāstika, or heterodox, systems – Jainism
and Buddhism – that did not recognize Vedic authority and thus denied the existence
of a consciousness principle (Swami Prabhavananda 1977). In the effort to provide
a unified conceptualization of life, health, and disease, Ćaraka drew inspiration and
information from both the Astika and Nāstika systems. Far from just borrowing
ideas and concepts, however, he developed an original and articulated system of
knowledge joining philosophy and science. “Philosophical winds blew through his
mind but never lifted him off his feet from the bedrock of service to fellow beings”
(Valiathan 2009, p. ii). The subsequent contributions of Suśruta and Vagbhata added
elaboration and expansion to Ćaraka’s system, without however modifying its
core assumptions, solidly rooted into Indian philosophy.
According to the Sāmkhya conceptualization (also referred to in Chap. 3), followed
since Ćaraka by most Āyurveda scholars, the universe stemmed from the interac-
tion between the two eternal and unmanifest principles of Puruṣa – the conscious-
ness principle, passive and unchangeable, and Prakṛti – the material principle,
active and dynamic. This interaction led to the manifestation and differentiation of
all living entities. Both unmanifest principles – eternal consciousness and material
nature – are therefore embodied in each living being. Ćaraka provides a synthetic
description of this evolution process from consciousness to manifestation. For
example, in Sūtra Sthāna he states:
There was never non-existence of the flow of life or intellect (Ćaraka Saṃhitā Sūtra Sthāna
30, 27 in Sharma and Dash 2001).

This conceptualization implies – among other aspects – the ontological identity

between the individual soul (Ātman) and the universal consciousness principle
(Brahman), both eternal and unchangeable:
The embryo is produced of ātman (the self) ….known as jiva, eternal, not afflicted by
diseases, old age, death and decay; not subjected to incision, excision, agitation, having
universal forms and actions, unmanifest, beginning-less as well as endless and without any
transformation. He entering into the uterus and combining with sperm and ovum produces
himself in the form of embryo that is why the embryo is called as “the self.” The birth of
that self is not possible because of his beginning-lessness … In fact, birth is only transformation
in respect of age and conditions … In spite of sperm, ovum, and the self, they do not attain
the state of embryo until they are combined together; this comes into existence by combination.
(Ćaraka Saṃhitā ŚārīraSthāna 3, 8 in Sharma and Dash 2001).
168 A. Morandi and A. Delle Fave

Consistently with this perspective, Ćaraka defines life – Ayus:

Mind, self and body, these three make a tripod on which the living world stands. The (living
body) is Puruṣa sentient and location of this Veda (Āyurveda). For him alone, this Veda is
brought to light (Ćaraka Saṃhitā Sūtra Sthāna 1, 46–47 in Sharma and Dash 2001).

This description of life and of the individual is crucially different from the modern
Western scientific approach that systematically separates biomedical knowledge
(concerning the body) from psychology (concerning the mind) and theology or
philosophy (concerning the soul). This substantial separation is common practice in
spite of the bio-psycho-social model and the WHO’s definition of health.
The interplay among the various levels of human functioning in promoting or
hindering health is especially evident in the attention that Āyurveda scholars pay
to the importance of a balanced attitude towards the fulfillment of individual needs
and aspirations. Behavioral and psychological balance as the basic prerequisite
for health and well-being is repeatedly emphasized by all the major Āyurveda
scholars:
The sense organs should neither be troubled very much nor should they be coaxed very
much.

and
In all dealings, one should adopt the middle mean only (Aṣṭāṇga Hṛdaya Sūtra Sthāna 2,
29–30 in Srikantha Murthy 2007a).

An effective synthesis of this interpretation of health can be found in Suśruta

Saṃhitā. The term for health used here is Svastha that means “to be established
(Stha) in oneself (Sva)”:
One whose physiological functions (doṣa), metabolism (agni), body tissues (dhātu) and
excretory functions (mala) are in a state of equilibrium with cheerful mind, clarity of
intellect and contented senses is said to be established in oneself (swastha) (Suśruta
Saṃhitā Sūtra Sthāna 1, 15 in Srikantha Murthy 2007b).

Prasannata denotes happiness and equipoise. Health or swasthya is therefore

defined as the equilibrium between anatomical, biological, physiological, mental,
and spiritual components of the human being, involving the physical body (sthula
śārira), the subtle body (suksma śārira), and the causal body (karana śārira), as
described in detail in Chaps. 4 and 5 of this volume.

10.4 Life in the Western Perspective: Complexity,

Chaos, and Coherence

Aristotle claimed that the whole is more than the sum of its parts. This is one of the
founding concepts of the Western investigation of nature. The term complexity, first
used by European scientists and philosophers in the eighteenth century, synthesizes
the essence of this claim. It derives from the Latin verb complecti – “to encircle,
embrace” – composed by the preposition com- “with” and the verb plectere “to weave,
10 The Emergence of Health in Complex Adaptive Systems… 169

braid, twine.” Living organisms are complex systems in that they are composed by
different parts, each of them contributing to the system’s functioning and adaptive
interaction with the environment, by virtue of their integration as well as a specific
differentiation in role and structure. Complexity is grounded into two peculiar features
that characterize living systems: a far-from-equilibrium energetic structure, also
labeled as negentropic (Ayers 1997; Duke 1994; Prigogine and Stengers 1984), and
autopoiesis, or the intrinsic potential for self-organization (Maturana and Varela
1986). The process of development consists in an increase of the system’s complexity,
by virtue of the ceaseless exchange of information with the environment, thus intro-
ducing the concept of complex adaptive system (CAS) (Holland 1995, 1997, 1998;
Couture 2007).
A CAS is therefore an integrated collection of components that dynamically and
adaptively interact among each other and with the environment. The higher the
system adaptability, the higher is its resilience in the presence of perturbations.
Moreover, compared with inanimate physical entities, living systems are highly
differentiated. Their components are specialized at the anatomical and physio-
logical levels, each contributing to specific functions and being reciprocally
connected in a coordinated pattern that allows for the adaptive interaction of the
system with the environment (Tononi and Edelman 1998).
Miller (1970) summarized the features of complex negentropic systems by high-
lighting their statistical improbability: these systems are not derived from a casual
interplay of elements but from a developmental process at least partly determined
by the information embedded in the DNA. At the same time, living systems are
predictable, thanks to their teleonomy (Monod 1971), defined as the intrinsic project
that shapes their structures, functions, and stable features, as well as their behavioral
alternatives in the interaction with the environment. Complex living systems have
also been labeled as dissipative structures, in that the preservation and increase of
their complexity require a ceaseless consumption of energy, partly transformed into
activities and ordered structures and partly dissipated due to collateral phenomena
(Nicolis and Prigogine 1989). Without a steady supply of energy, any complex system
tends towards states of homogeneity, loss of specialization, disruption, and entropy.
In living systems these states can be assimilated to decay and death.
The pattern of stable features of a system that can be observed, and that allows to
identify the system as a well-defined entity, can be also interpreted as the coherence
of the system itself. Coherence is a state in which the system can be observed as a
whole integrated configuration, apparently “independent” of the environment.
The highest state of coherence is characterized by minimal uncertainty, and it
contributes to the predictability of living systems and their behavior (Couture 2007).
However, due to the ceaseless interactions with the environment, the intrinsic
developmental trends, and the varying amount of energy available to the system for
its own maintenance and transformation, the level and expression of coherence
undergoes changes, allowing for diverse system configurations.
A further peculiar feature of living systems, related to their adaptability and
flexibility, is their potential for manifesting emergent properties, in other terms for
creativity and innovation (Goldstein 1999; Fromm 2004, 2005). In the interaction
170 A. Morandi and A. Delle Fave

process with the environment and its demands, a living system can develop adaptive
behavioral strategies that were not previously part of its repertoire, or it can undergo
structural modifications that make it better fit the environmental pressures. These
processes and events allow for situating complex living systems beyond the realm
of determinism and for conceptualizing emergence – of new properties, structures,
and functions – as a distinctive aspect of the living world. In phylogeny, emergent
properties are the core elements of speciation and, more generally, of biological
evolution (Wilson 1975).
The above-described peculiarities of complex systems led to the development of
a new mathematical approach that could adequately represent their functioning
and dynamic adaptation tendency. This approach is grounded into Chaos Theory, a
mathematical framework that overcomes the boundaries of the methods traditionally
used to describe deterministic phenomena (Baranger 1999). Within this framework,
living organisms are considered chaotic systems. They are characterized by nonlin-
earity, which implies a nonproportional relationship between input received and
output produced. Chaotic systems are also highly sensitive to initial conditions, in
that any minimal variation or perturbation, either internal or derived from their
interaction with the environment, will multiply and spread its effects snowball-like,
leading to unpredictable outcomes – such as emergent properties or behaviors.
When transposed into geometry, solutions of mathematic nonlinear equations result
in fractals. Fractals are geometrical objects, characterized by a recursive and self-
generating structure, as well as by intrinsic order and beauty. They can be used to
describe the structure of leaves, nerve networks, or the circulatory system (Baranger
1999). Chaotic behavior has been detected in biological functions such as heart rhythm
and brain waves, whose shape cannot be described through traditional geometrical
models, due to their essential nonlinearity (Goldbergerer et al. 2002a). In nature chaotic
systems are massively present. Actually, nature as a whole appears intrinsically chaotic.
In particular, any complex system is characterized by the presence of so-called
chaotic or strange attractors. From a mathematical point of view, an attractor is
defined as an infinite set of points to which orbits, trajectories, and events emanating
from starting conditions tend in the course of the dynamic evolution of the system
examined (Couture 2007). In a chaotic system, these trajectories are “strange,” in that
they are neither linear nor periodic. They rather tend to be unique, never repeating
and never passing by the same point, though asymptotically close to each other. The
graphic representation of strange attractors shows bifurcations and convolutions,
folding and unfolding patterns that undergo changes consistent with the system
evolution and adaptation. Strange attractors can be considered specific patterns of
internal organization of the system, characterized by intrinsic sets of rules and proper-
ties that can shape structures and functions of smaller or larger portions of the system
itself. The pervasive sharing of the same set of rules and properties across the various
parts of a system corresponds to a high level of coherence of the system.
Finally, a living being is not an isolated entity, occasionally interacting with the
environment. It is rather part of it, as an essential component of the net of relation-
ships that constitutes the environment itself and that undergoes changes and trans-
formation. From this perspective, nature is an articulated web of complex systems
10 The Emergence of Health in Complex Adaptive Systems… 171

in dynamic interaction and transformation. These ceaseless interactions imply that

each component of the systems at any level of observation (cells in an organ, organs
in a body, organisms in an environment) undergoes continuous changes, fluctuating
between negentropic and entropic tendencies and dynamically pursuing the highest
possible levels of stability and coherence. The modern Western attempt to study
nature by isolating its components has fostered the development of distinct domains
of knowledge – physics, biology, chemistry, psychology – each of them investigat-
ing single aspects of an articulated web of complex systems. Researchers have
acquired a vast amount of information about these specific aspects – the elementary
structure, the molecular one, and the function of single organs or apparatuses – to
the detriment of an integrated view. All these specific aspects are in fact embedded
into the organisms’ complex functioning and organization, from which their con-
figuration itself derives. Body organs do not exist as such: the body is one and every
piece is part of it, and it is determined in structure and function by the whole sys-
tem’s teleonomy and adaptation trend.
Moreover, additional complex systems emerged from the biological ones.
Culture emerged from natural selection on the basis of peculiar biological features
of the human species, developing with time into a complex system itself, characterized
by intrinsic rules and patterns, and interacting with biology in the shaping of human
behavior (Boyd and Richerson 1985; Delle Fave et al. 2011; Jablonka and Lamb
2005). Conscious experience emerges from the moment-by-moment integration of
functional clusters of neurons – labeled dynamic cores – that selectively interact
(Tononi and Edelman 1998). Each specific state of consciousness arising from this
interaction represents one possibility among billions of others, showing a chaotic
pattern characterized by a peculiar configuration of neural activities that reduces
uncertainty and therefore can be considered an ordered and negentropic entity.
Moreover, “experience may arise from the physical, but it is not entailed by the
physical” (Chalmers 1995, p. 208), thus implying the emergent nature of the psychologi-
cal realm. Complexity and related concepts have proved to be heuristically relevant
also in the analysis of human communities and social organizations (Eldredge and
Grene 1992; Khalil and Boulding 1996).
These evidences provide a view of reality as a web of complex systems developing
and interacting at multiple levels. The paradigm shift necessary to understand it
requires not only to consider all the interconnections among the components of each
single system but also all the levels of complexity and the dynamic relationships
characterizing the environment with which the specific system interacts.

10.5 Āyurveda and Complexity

The representation of reality that characterizes Āyurveda well fits the theories of
chaos, complexity, and complex systems.
As reported in the previous section, according to Sāmkhya the whole universe
emerges from the primordial interaction between the eternal and unmanifest
172 A. Morandi and A. Delle Fave

principles of Puruṣa and Prakṛti. Prakṛti is the eternal principium of existence, the
background of all manifestations. It can be described as a balanced mixture of
the three basic qualities that characterize the perceivable world, called Maha Guṇa
(great qualities): Sattva – balance and intelligence; Rajas – acceleration, dynamic
and transformational energy; and Tamas – deceleration, inertia. According to
Sāmkhya these qualities are in fact the substantive entities that compose any mani-
festation of reality, be it mental or physical. Prakṛti however is totally devoid of
characteristics and thus indeterminate, indefinite, and lacking of coherence
(Dasgupta 1924). This is due to the fact that in Prakṛti the Guṇa are reciprocally
neutralized in a balanced and “homogeneous” pattern, so that none of them is mani-
fest. This condition of global balance represents a seminal state of infinite potential-
ity, open to developing into any possible manifestation, containing the seed of all
possible configurations of the perceivable reality (Guénon 1932).
It is worthy noticing that the Sāmkhya view considers Prakṛti not as a simple
substance but as the totality of guṇa in their state of reciprocal counter-opposition.
Apart from Guṇa there is no Prakṛti. Prakṛti as the equilibrium of the three Guṇa is
the absolute ground of all the mental and phenomenal modifications – pure potenti-
ality in which no complex qualities are manifested. In fact, this condition of
equilibrium is not a mere passive state, but one of utmost tension; there is intense
activity, but the activity here does not lead to the generation of new things and qualities
(Dasgupta 1922).
It is also important to clarify that in this view Guṇa are substances and not mere
qualities. In the Sāmkhya qualities do not exist by themselves; each unit of quality is
but a unit of substance without mass. In other words quality is but a particular manifes-
tation or appearance of a subtle entity. Things do not possess quality, but quality signi-
fies merely the pattern in which a substance behaves and reacts. Perceivable objects
apparently possess many qualities, but “corresponding to each and every new unit of
quality, however fine and subtle it may be, there is a corresponding subtle entity, the
reaction of which is interpreted by us as a quality” (Dasgupta 1922, vol.1, p. 261).
The interaction of Prakṛti with Puruṣa – the eternal and unmanifest conscious-
ness principle – gives rise to the manifestation of the cosmos, that fulfills the pur-
pose of the Puruṣa to fully enjoy experiences and to be released and liberated from
them. This introduces a conscious orientation into the intrinsic but nondirectional
tension of Prakṛti, breaking the balance between opposite Guṇa and leading to sys-
tems characterized by progressively increasing levels of organization, differentia-
tion, and complexity.
In this process of transformation, the three Guṇa interact in a variety of different
patterns and configurations, thus evolving from the indefinite and qualitatively inde-
terminate condition of Prakṛti to progressively more definite and qualitatively deter-
minate states. As clearly explained by Dasgupta (1922), though cooperating to
produce the manifest world, they never coalesce. A particular Guṇa can become
predominantly manifest in a specific phenomenon, while the others become latent.
In particular, the feature of energy in the manifest reality is due to the element
of Rajas; the features of resistance and stability are due to Tamas; all conscious
manifestation derives from Sattva.
10 The Emergence of Health in Complex Adaptive Systems… 173

The first system evolving from the Puruṣa-Prakṛti interaction and subsequent
imbalance in the Guṇa interplay is characterized by a prominence of the Sattva
Guṇa. As clarified by Dasgupta (1922), this system possesses the widest and most
universal existence and is thus called Mahat (the great one), the universal order or
intelligence. Subsequent modifications in the pattern of interaction among the Guṇa
within Mahat give rise to the individual Ahamkara, characterized by the predomi-
nance of one Guṇa over the other two, thus contributing to shape the determinate
structure of individual typologies. In fact the term Ahamkara means “what keeps
building the image of self,” that emphasizes the dynamic and transformational
nature of this system. A ceaseless process of change indeed characterizes the indi-
vidual’s self-perception, based on the moment-by-moment fluctuation of the differ-
ent Maha Guṇa and of their combination across a variety of patterns, depending on
internal as well as environmental pressures.
In the further evolution steps, a twofold process is envisaged: on the one hand,
the combination of Sattva and Rajas produces 11 different patterns of organization,
classified as subtle substances and instrumental to the interaction with the material
realm: five sense instruments (Jnanendriya), five action instruments (Karmendriya),
and Manas, the mind, with the role of coordinating the Indriya’s activities.
On the other hand, the interaction between Tamas and Rajas, between dynamism
and staticity, and between acceleration and deceleration gives rise to five Tanmātrā,
primordial units of matter that can be perceived by the Indriya.
Matter is the place where Guṇa (qualities) and Karma (action) are inherent (Ćaraka Samitha
Sūtra Sthāna 1, 50–51 in Sharma and Dash 2001)

The relation between Rajas and Tamas is well exposed as cause of recombination
and separation which is the definition of Karma (action) as per Ćaraka Samitha,
Sūtra Sthāna 1, 52 (in Sharma and Dash 2001).
The predominance of the Tamas, substantial inertia, allows for the manifestation
of perceptible mass; the interaction of Tamas with Rajas, substantial dynamicity,
leads to the manifestation of matter units, characterized by both mass and activity,
the core features of any living system in the realm of biology.
The emergence of Tanmātrā represents the transition from the domain of unman-
ifest reals to the domain of manifest elements. The word Tanmātrā literally means
“what is measurable,” evoking the smallest particle of detectable matter. At this
level, the first manifested entity is Shabda, the sound, bearing the primordial infor-
mation of matter, namely, space occupancy and spatial relationship resulting in
movement. Shabda is sequentially followed by four progressively more qualified
and determined Tanmātrā, each of them encompassing the features of the previous
Tanmātrā, as well as its own peculiarities: Sparsha, the touch, or potentiality of
contact; Rupa, the shape, or potentiality of structure; Rasa, the taste, or potentiality
of pervasion; and finally Gandha, the smell, or potentiality of subtle relationships.
The preponderance of Tamas within Tanmātrā finally gives rise to the Mahābhūta,
or great elements: ākash (ether), vāyu (air), tejas (fire), ap (water), and pṛthvi
(earth), five states of matter that, like Tanmātrā, derive one from the other in an
evolutionary cascade and constitute the entire material realm.
174 A. Morandi and A. Delle Fave

To summarize, the Mahābhūta are manifest material states comprising the

potentialities of Tanmātrā that in turn represent manifestations of Maha Guṇa.
The structure and functions of each Mahābhūta are related to its material density
level, from the lowest level in Ākash to the highest one in pṛthvi, in which Tamas is
prominently manifest. This relationship highlights the inextricable intermingling
of structure and function that occurs in any living system. Interestingly, the word
Mahābhūta is composed by Maha (great) and bhūta, meaning “that which is,”
“true,” but also “demon,” “spirit.” The substantial link between function and struc-
ture, quality and quantity, and energy and matter is embedded in this term.

10.5.1 Guruvadi Guṇa

As stated above, according to Sāmkhya, Guṇa are substances and not merely fea-
tures of substances. Moving from the unmanifest level of Maha Guṇa to the mani-
fest level of material entities, new Guṇa arise, progressively more determined and
more physical in their manifestation.
In order to provide a description of living systems that could be useful and func-
tional to the practical treatment purposes of Āyurveda, the ancient scholars and first
of all Ćaraka paid prominent attention to the 20 Guruvadi Guṇa (literally “qualities
related to heavy matter”), 10 couples of opposite physical qualities constitutive of
any living system: cold-hot, dry-unctuous, heavy-light, gross-subtle, static-dynamic,
dense-loose, rough-smooth, hard-soft, dull-penetrating, and viscous-fluid. Guruvadi
Guṇa primarily and exhaustively represent the perceivable aspects of the variety of
patterns of material aggregations, the Pañca Mahābhūta. As constituents of the
manifest realm, Guruvadi Guṇa derive from specific patterns of combination
between Rajas and Tamas; they provide information on the structure, functions, and
reactions of the organism they belong to. Interestingly, one of the Sanskrit meaning
of Guṇa besides “quality” is “rope,” suggesting the role of Guṇa as links between
the eternal and unmanifest consciousness and the material world.
Adopting a complex systems’ perspective, the set of Guruvadi Guṇa that charac-
terizes a living organism can be understood as expression of a far-from-equilibrium
negentropic pattern of organization. This set of qualities or properties undergoes
changes based on both the initial conditions of their manifestation and the ceaseless
interaction of the living system with the environment and its pressures. The higher
the internal coherence of the system, in terms of stability of relationships and inter-
action patterns among Guṇa, the more defined and determinate is the identity of the
system as perceived by external observers.

10.5.2 Doṣ a

As repeatedly highlighted, in the traditional Indian worldview, the manifest reality

emerges from basic qualitative units and their reciprocal interactions. Consistently
10 The Emergence of Health in Complex Adaptive Systems… 175

with this view, Āyurveda describes the human being – as the prominent target of its
intervention – as a complex manifestation of Guṇa’s interplay and transformation.
The focus of Āyurveda is thus not the organism as a set of specific and materially
observable parts or organs, but the variety of manifestation patterns of the Guṇa, as
perceivable in the structure, functions, and behaviors of the individual.
Since Guṇa do not manifest themselves in isolation but through their reciprocal
interactions and their effects on the organism’s material structure and functioning,
Āyurveda scholars developed a heuristically very powerful concept: the Doṣa. Doṣa
are coherent and integrated ensembles of Guruvadi Guṇa, expressing general func-
tional patterns of the organism as well as the related Mahābhūta, or matter constitu-
ents. Three Doṣa are identified in Āyurveda: Vata Doṣa, expression of the interplay
between ākash (ether) and vāyu (air), and of their constitutive Guruvadi Guṇa; Pitta
Doṣa, expression of the interaction between tejas (fire) and ap (water), and of the
related Guṇa; and Kapha Doṣa, expression of the interplay between ap (water) and
pṛthvi (earth), and of their Guṇa.
Considering that Guṇa are not stable entities but undergo ceaseless changes,
Doṣa are dynamic systems in permanent transformation as well. The word Doṣa
actually means “what is easily alterable; defect, perturbation,” pointing to the insta-
bility of these systems. Ćaraka calls them as “pathogenic factors of the body”
(Ćaraka Samitha Sūtra Sthāna I, 57 in Sharma and Dash 2001). At the same time,
Doṣa represent coherent groupings of Guruvadi Guṇa and Mahābhūta, showing
well-defined and typical features and thus allowing for their description as deter-
mined functional entities.
In each Doṣa the proportions of Guruvadi Guṇa and Mahābhūta are not fixed
and stable, leading to a wide range of property manifestations. Nevertheless, since
each Doṣa is expression of the interplay among specific Guṇa and Mahābhūta, its
features and manifestations are also determined and contribute to the definition of
the functions and influence pattern of the specific Doṣa on the whole living system’s
structure and functioning. More specifically, Vata Doṣa represents movement in all
its forms – from bowel motion to breath and cardiovascular dynamics – thanks to its
features of coldness, dryness, lightness, roughness, fluidity, and subtlety at the
Guṇa level and of ākash and vāyu at the Mahābhūta level. Pitta Doṣa presides
metabolic and transformational processes by virtue of its features of heat, lightness,
softness, and fluidity at the Guṇa level and of tejas and ap at the Mahābhūta level.
Finally, Kapha is the manifestation of the system’s stability and cohesion, based on
its Guṇa-related properties of staticity, grossness, density, coldness, dullness, and
heaviness and on its Mahābhūta constituents pṛthvi and ap (Ćaraka Saṃhitā Sūtra
Sthāna 1, 57 in Sharma and Dash 2001).
The concept of strange attractor developed in the complex systems’ theoretical
framework is very helpful to clarify the role of the Doṣa. Doṣa emerge from the
nonlinear chaotic behavior of the Guṇa/Mahābhūta system, each of them represent-
ing a well-defined and coherent functional pattern evolved within the system’s
adaptation process. As strange attractors with n-dimensions – where “n” is the
number of their property expressions, or Guruvadi Guṇa – each Doṣa funnels fluctua-
tions in specific domains of the system, as well as specific structural or functional
176 A. Morandi and A. Delle Fave

behaviors into nonlinear patterns of organization, thus providing flexibility to the

system’s adaptation trend. Moreover, the concept of Doṣa as entities that easily get
out of balance explicitly accounts for their sensitivity to both internal and external
perturbations. In fact, from this perspective Doṣa themselves behave chaotically,
since their manifestation and impact on the whole system’s conditions depend on
the organism conditions, within a feedback loop process whose ultimate meaning is
the preservation of an optimal level of balance in the system, matched with an opti-
mal level of adaptation to the environmental demands.
The analogy between Doṣa and chaotic attractors is supported by the evidence of
their extreme sensitivity to initial condition (Eckman and Ruelle 1985; Holden and
Muhamad 1986). A slight perturbation in the relationships between the constitutive
elements of the organism produces a remarkable change in Doṣa manifestation. In
Āyurveda the imbalance of Doṣa is the first stage of disease, deriving from a pertur-
bation in the Guṇa conditions.

10.5.3 Dhātu, Agni, and Energy Sources

In Āyurveda Dhātu are considered as the structural bases of an organism. Although

the term Dhātu is often translated as “tissue elements,” it rather means “that which
sustains the body” from the root Daa (dha) “support, that which bears,” conveying
a more functional and less morphological representation of Dhātu.
In the classical Āyurveda texts, seven Dhātu are described, derived from differ-
ent combinations of Guṇa and sequentially evolving one from the other, through a
progressive increase in complexity and morpho-functional specificity. The first
Dhātu is Rasa, the watery and least complex component of the organism, qualita-
tively defined as pervading, nourishing, and cohering liquid. The term Rasa has
numerous meanings, many of them referring to harmony and embracing and sug-
gesting all-encompassing potentiality. The second is Rakta, translated as blood and
referring only to its particulate component, but whose meaning include “color red,”
“passionate,” and “attached,” suggesting reaction, contact, and connection. The
third is Māṃsa, translated as “meat” but also “worm” and “time,” suggesting move-
ment, flow, and change. The fourth and most important Dhātu is Meda, fat: lipids in
fact represent the key structural component of cells, organs, and organisms as a
whole. The fifth is Asthi, or bone, meaning also “standing,” “to resist”; the sixth one
is Majja, the bone marrow, but meaning also “sinking” and “diving” which accounts
for the depth of the anatomical location but also for the functional depth being the
bone marrow related to staminal cells. The seventh and most complex Dhātu is
Śukra, meaning semen, but also “juice,” “essence of anything,” and “good action.”
The dynamic interaction of Dhātu through an evolving pattern is mediated by the
action of Agni, the power of digestion and transformation (Ćaraka Saṃhitā
Cikitsasthana 15, 1–16 in Sharma and Dash 2001).
Agni is the Vedic two-headed god of fire, representing the link between heaven
and earth, the messenger between gods and humans. In this connecting role, it
10 The Emergence of Health in Complex Adaptive Systems… 177

emerges from Pitta Doṣa, whose contrasting properties of hotness and dryness, on
the one side, and coolness and sliminess/unctuousness, on the other side, are
related to its constitutive Mahābhūta, Tejas, and Ap, respectively. The interaction
between these contrasting Guṇa results in the emerging feature of instability that
characterizes Agni. In its turn, Agni induces instability in any configuration pattern
it gets in touch with, leading it to transformation. In the case of Dhātu, Agni leads
to the gradual emergence of more complex patterns of organization from less com-
plex ones. In this milieu of stabilization/destabilization of the Dhātu coherence,
ultimately based on the reassembling and change of their Guṇa, other minor coher-
ent entities emerge: the upadhātu, functional and structural transitional forms of
Dhātu showing extreme and rigid pattern of coherence that do not allow them to
undergo any further transformation, and the mala, or waste products (Ćaraka
Saṃhitā Cikitsasthana 15, 15–35 in Sharma and Dash 2001).
Dhātu show a peculiar behavior, in that they tend to revert to normalcy “irrespec-
tive of any external causative factor” (Dasgupta 1922). This suggests the existence
of a range of fluctuation in the Dhātu organization around a stability point far from
the thermodynamic equilibrium, thus implying a resilience pattern that is typical of
complex adaptive systems (Couture 2007) and that allows them to absorb and/or
neutralize external perturbations, successfully adapting to environmental changes.
Resilience is primarily due to the self-organizing features of the system, in particu-
lar to the redundancy of inner interdependent pathways and relationships that
enhance the system’s flexibility and variety of adaptation strategies. Resilience can
be also defined as the autonomous healing capability of an organism that retrieves
its original state of health after a remarkable perturbation, such as an injury or an
environmental modification.
If the specific situation prevents the system from achieving a complete recovery,
a new state of balance will be nevertheless attained, characterized by organization
patterns and coherence levels differing from those typical of the original healthy
state. This is exactly what happens in complex adaptive systems, when perturbed
beyond their ability to retrieve their original state. In modern medical terms, it cor-
responds to the condition of chronic disease or to the aging process. In both cases
irreversible changes occur in the system’s physiological and structural pattern of
organization, giving rise to a new and more or less stable condition of balance.
Within the conceptual framework of complex systems, Dhātu could be explained
as specific material configuration patterns manifesting specific Guṇa and functions.
However, this definition and the definition of Doṣa substantially overlap. Where
does the distinction between Dhātu and Doṣa lie? Suśruta himself stated that “when
normally functioning, the Doṣa constitute the body and are called Dhātu; when out
of balance they create disease and discomfort and they are called Doṣa” (Bishagratna
1907). In Suśruta Saṃhitā the healthy state of an individual is defined as TriDhātu,
and Dhātu represents the stable version of Doṣa (Dasgupta 1922; Bishagratna
1907). The same description is provided in Rig Veda (Rigveda Saṃhitā, I, 3, 6 as
cited in Bishagratna 1907). It could be argued that the difference between Dhātu and
Doṣa lies in the emphasis on structure versus function: Dhātu are expressions of the
178 A. Morandi and A. Delle Fave

system’s structural patterns, while Doṣa are expressions of the system’s functional
patterns. Nevertheless, a clear demarcation between the two is not possible, since
the constitutive elements of both Doṣa and Dhātu are ultimately the three Maha
Guṇa. In fact, analogous to what happens for Doṣa, the balance of Dhātu is consid-
ered essential for the preservation of health. Ćaraka states, “The very object of
Āyurveda is the maintenance of the equilibrium of the Dhātu” (Ćaraka Saṃhitā
Sūtra Sthāna 1, 53 in Sharma and Dash 2001).
It is therefore reasonable to assume that Dhātu represent the optimal coherence
state of the Doṣa in their role of strange attractors: highly coherent Doṣa attain a
high level of stability within their dynamic and negentropic organization pattern.
This situation is coincident with an optimal function of the whole organism. It
ultimately entails coherence in the Guruvadi Guṇa setup, leading to a complex and
ordered morpho-functional pattern called Dhātu, whose main property is the capa-
bility to “sustain” the whole systems preserving its stability and integrity. Dhātu
are thus the structural and functional expression of the organism in its healthy state
and optimal function. This is consistent with the Ćaraka’s statement “Disease is
disequilibrium of the Dhātu. Health is equilibrium of Dhātu. Health is known as
pleasure. Disease is known as pain.” (Ćaraka Saṃhitā Sūtra Sthāna 9, 4 in Sharma
and Dash 2001).
The level of organization and coherence of the individual, considered as a com-
plex living system derived from the nonlinear interplay of Guṇa giving rise to
Mahābhūta, Doṣa, and Dhātu, is maintained through a ceaseless intake of energy.
Energy is necessary to promote the system’s far-from-equilibrium stability, the
related dissipation, and the elimination of substances that threaten the system’s
negentropic organization. The energy intake generally occurs through food, while
the potentially destabilizing elements to be eliminated are by-products of the inter-
nal transformation processes, called Mala in Āyurveda, whose organization pattern
does not fit the system’s coherence anymore. Due to the substantial interconnection
among Doṣa, Dhātu, and Mala, these three aspects cooperate to define the overall
health condition of the organism (Ćaraka Saṃhitā Sūtra Sthāna 28, 1–5 in Sharma
and Dash 2001).
The system’s autopoiesis and self-organization result in a coherent behavior
shaped and oriented by Guṇa and Doṣa; the latter, in their role of strange attractors,
are defined in their specific features by internal relationships, rules, and functional
patterns. However, without a continuous energy supply, Guṇa cannot maintain their
coherence that corresponds to Dhātu. In this condition the Doṣa configuration, char-
acterized by perturbation rather than stability, becomes prevalent. Interestingly, one
of the Sanskrit words used in Āyurveda to indicate the body – śārira – literally
means “what keeps decaying” suggesting the continuous struggle between destruc-
tion and construction, and catabolism and anabolism.
The balance between food intake and waste elimination is also crucial for main-
taining health. The key role in this interaction is played by Agni, the transformative
and destabilizing factor that assures the conversion of heterologous items into
homologous ones, ultimately leading to the stabilization of the main system, through
10 The Emergence of Health in Complex Adaptive Systems… 179

the creation of new components and the expulsion of unnecessary ones (waste)
(Ćaraka Saṃhitā Cikitsasthana XV, 16–20 in Sharma and Dash 2001).
Within this context, it is interesting to specify what is food in Āyurveda. The
Sanskrit word for food – ahāra – also means “fetching,” “bringing near,” “taking,”
“livelihood,” and “use,” thus comprising nutrition as well as, more generally, the act
of contact and interaction. Ahāra represents every heterologous item that can be
transformed into a homologous one through Agni, thus including any environmental
stimulus that “feeds” the sense organs. Within this view, food is the environment
itself. The act of living is an act of nutrition. This is consistent with the importance
that Āyurveda attributes to the individual’s relationship with the environment as the
primary action of prevention.

10.5.4 Ojas or Emerging Health

The state of optimal health, derived from the global coherence and balanced orga-
nization of Dhātu, is ultimately expressed through Ojas. Ayurvedic classical text
describe Ojas as the essence of Dhātu, deriving from their correct and coherent
functioning (Ćaraka Saṃhitā Sūtra Sthāna XVII, 73–74 in Sharma and Dash
2001). Ojas is a complex and multidimensional concept, and its translation in
Western words and meanings is extremely difficult. Ojas derives from the Sanskrit
root vaj “strong,” and it can be translated as “vigor,” “strength,” “vitality,” “luster,”
and “manifestation,” terms suggesting a function emerging from a background.
The concept of Ojas is a manifestation of overall health, a measure of Dhātu coher-
ence and organization and the resilience capacity of an organism. Overall, it is the
ultimate expression of the multilevel functioning of the whole organism as a com-
plex adaptive system. Ojas at its optimal level is the manifestation of a system
characterized by high levels of complexity, in terms of inner coherence, organiza-
tion, and, above all, resilience. If, for some reason, complexity is compromised
because of the disruption in the network of events and elements that determine the
system coherence, the resilience level decreases as well. The lower the resilience
level, the more difficult it will be to restore the original complexity of the system
after perturbations. This will eventually lead to a shift of the system towards a
stable state, however, characterized by lower levels of complexity and resilience
and consequently more fragile.
In line with this interpretation, Ojas is also commonly associated with the
immune system. The key role of immunity – protection of the organism from exter-
nal aggressions – is in fact consistent with the definition of Ojas as the overall
capability of the system to adapt and to be resilient, that arises from the balance and
coherence among its components.
This view is consistent with what is commonly observed in chronic diseases
and in the process of aging where, according to Āyurveda, the level and quality of
Ojas become suboptimal. The loss of Ojas integrity, corresponding to a reduction
in the organism’s functional and structural complexity, will result in a lower
180 A. Morandi and A. Delle Fave

adaptation potential. Low physiological complexity is an indicator of a relatively

simple control system, showing low adaptability under perturbation, and thus
higher vulnerability to the environmental stressors (Manor et al. 2010; Manor and
Lipsitz 2012). Loss of complexity and simplification of physiological pathways
represent typical features of many diseases as well as of the aging process
(Goldbergerer et al. 2002b; Kyriazis 2003; Mangel 2001). Aging is associated
with a progressively decreasing rate of dendrite formation in the brain (Schierwagen
1987), a lower complexity of EEG activity (Skinner et al. 1992), and a decline of
heart rate variability (Kaplan et al. 1991; Kresh and Izrailtyan 1998). In diseases
involving the motor system, such as Parkinson’s, arthritis, and stroke, a progres-
sive decrease of complexity is observed in the movement range (Edwards et al.
1999) and in gait dynamics (Hausdorff et al. 1997). In patients with Alzheimer’s
disease, the EEG pattern is slower and less complex that the pattern observed in
age-matched healthy people (Dauwels et al. 2011). In diabetes mellitus type 2,
there is a progressive loss of complexity in the glycemic profile, in association
with other markers of disease progression (Churruca et al. 2008).
On the opposite pole of life, namely, fetus formation, Ojas is considered a crucial
element as well, representing a measure of the positive outcome of the mother-child
exchanges (including exchange of Ojas itself) taking place during pregnancy
(Dasgupta 1922). Ojas is therefore the most general expression of the organism’s
coherence, organization, and complexity, largely overlapping the currently accepted
conceptualization of health.

10.6 The Health Continuum

The word Āyurveda includes the term Ayus, which means both life and health.
Āyurveda can thus be translated as knowledge/science of life and knowledge/sci-
ence of health. The most comprehensive manifestation and measure of health is
Ojas that corresponds to the capacity of an organism to survive in an optimal state
successfully adapting to the environmental conditions and changes. Within this
view, health represents a dynamic process rather than a discrete condition, ranging
from optimal to poor. “Optimal health” as strong Ojas emerges from the coherence
of Guṇa and Dhātu as the most global expression of the system’s complexity. It
reflects the system’s ability to successfully adapt to the environmental demands
through the ceaseless process of adjustment and coordination among structures and
functions that allows the system to maintain an optimal balance or to retrieve it after
intense solicitations. Conversely, “poor health” is a condition of inability to restore
the system’s original level of complexity after exposure to stressors. In the condition
of poor health, or poor Ojas, the system can find a new relative stability at a lower
level of complexity characterized by reduced Ojas, and thus reduced health, as what
happens in chronic diseases or aging. The whole negentropic organization of the
system is modified, with the definition of new patterns, limits, and resilience levels.
Finally, the extreme condition of “absent health” corresponds to the complete
10 The Emergence of Health in Complex Adaptive Systems… 181

disruption of the system’s coherence and complexity, corresponding to the biological

concept of death.
From this perspective, health is a continuously variable condition, rather than a
well-defined and discrete one. It reaches the optimal level when all system’s func-
tions and structures cooperate coherently and effectively, through highly complex
patterns of interactions. This balance gets however continuously disrupted by the
interaction with the environment, thus requiring a ceaseless readjustment process of
the whole system, whose effectiveness is represented by resilience. The wider is the
range of modifications and pressures that the system can absorb, being able to sub-
sequently retrieve optimal levels of health, the stronger is its resilience. However,
when the intensity of pressures or stressors overcomes the resilience limits, the
system starts manifesting functional alterations giving rise to a new state globally
acknowledged as disease. In this situation, external interventions known as thera-
pies are needed, in order to bring the system’s functioning back to a more complex
and resilient pattern of organization. Old age, fatigue, resource exhaustion, or other
conditions characterized by lower Ojas and resilience induce stable states of subop-
timal health – or disease – as reactions to stressors and pressures that are otherwise
tolerated as sources of only temporary imbalance.
The main goal of Āyurveda as a medical system is to keep the individual sys-
tem’s resilience at the highest possible level, in order to guarantee adaptation and
optimal health in the face of even very large fluctuations of environmental demands
and stressors. This is the purpose of the preventive practices known as Swasthavritta.
Swastha means healthy and Vritta means correct behavior, referring to the daily or
seasonal hygienic routines and overall lifestyle that promote optimal health. The
health status of each person depends therefore upon their awareness of life as a
continuous process in which every action influences the general psychophysical
balance and complexity.
From a broader perspective, individual health behaviors are connected through a
relation of reciprocal causality with social values and customs (Delle Fave 2010), as
described in Sect. 10.2. Healthy individuals build healthy communities, whereas
unhealthy lifestyles can generate negative consequences in the balance of society as
a complex system itself. In their turns, cultural norms and practices play a pivotal
role in promoting citizens’ healthy or unhealthy behaviors (Delle Fave and
Massimini 2005; Morandi et al. 2011).

10.7 The Implications of Āyurveda for Health Promotion

The conceptualization of health in Āyurveda has several relevant implications at

both the conceptual and practical levels.
First of all, health as a dynamic condition can achieve stable configurations at dif-
ferent levels of complexity, including states labeled as disease and death. In this view
disease is not a discrete entity, opposed to health. The various factors that influence
the level of health, and thus complexity of an organism, play a prominently
182 A. Morandi and A. Delle Fave

regulatory role rather than being direct and univocal causes of health, on the one side,
and disease, on the other side. According to their quantitative and qualitative fea-
tures, as well as according to the conditions of the organism they interact with, these
factors can either increase or decrease the level of health and thus complexity and
coherence of the individual system. Nothing is absolutely bad or absolutely good for
health in Āyurveda:
Health and disease have the same source; entities, which in suitable state, generate person,
cause various disorders in unsuitable state. (Ćaraka Saṃhitā Sūtra Sthāna 25, 29 in Sharma
and Dash 2001).

In this view we can identify one of the major differences between Āyurveda and
modern Western medicine that exclusively focus on disease, considering it some-
thing to be removed or expelled from the organism. By considering health as the
dynamic manifestation of life patterns characterized by different levels of coher-
ence, complexity, and integration distributed along a continuum, Āyurveda focuses
on the dynamics of health as a ceaseless process of change and adaptation.
The most immediate practical consequence of this view is the relevance attrib-
uted to primary prevention that calls into play individual responsibility and aware-
ness. Health is not dependent upon the absence of disease, but it rather derives from
everyday life, actions, and behaviors. However, individuals do not live in a vacuum.
Health results from the interaction between a complex adaptive system – the indi-
vidual – and the environmental demands. Therefore, the ecosystem and its balance
become substantial determinants of the individual level of health. In addition, con-
sidering the social nature of humans and their tendency to develop culture
(Baumeister 2005), the notion of environment needs to be broadened to include
social relations and cultural artifacts (Massimini and Delle Fave 2000). Overall,
prevention is both an individual and collective task, whose outcomes affect persons,
communities, and the surrounding nature.
A further implication of the Ayurvedic approach to health concerns the manage-
ment of chronic conditions. The failure of modern medicine to effectively deal with
these situations is mainly due to its prominent focus on the dysfunctions brought
about by chronic conditions, rather than on the optimization of the functions and
resources available at that level of health. The emphasis on resource empowerment
and development has extremely positive consequences on the individual psycho-
physical well-being, as clearly highlighted in the recent WHO Report on Disability
(2011) and in a large amount of studies in the domain of health psychology (see
Chap. 9 for an overview). It increases patients’ adherence to treatments, motivation
and engagement in daily life, quality of interpersonal relations, and social integra-
tion. However, these research evidences are not yet integral part of the current health
care in the Western medical system.
Overall, health according to Āyurveda is a relative condition, rather than an
absolute and discrete state. It is a dynamic process, and at its highest level it is the
expression of a highly negentropic pattern of organization emerging from the opti-
mal balance and coherence of a complex living system. Within the Indian view, at
the macrocosmic level the universe as a whole is a complex interconnected system
of relationships among unmanifest and manifest components of reality; health is the
10 The Emergence of Health in Complex Adaptive Systems… 183

prominent expression of the harmonization and integration among the various com-
ponents of the individual as a complex interconnected system at the microcosmic
level. No contradiction can be detected between this view and the most recent
Western conceptualizations of reality outlined in the previous sections. On the con-
trary, the deep analogies identified between these two views encourage to broaden
our culture-bound horizons in the pursuit of a shared understanding of life.

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Conclusions
Chapter 11
Joining Knowledge Traditions:
Towards an Integrated Approach
to Health and Well-Being

Antonio Morandi, A.N. Narayanan Nambi, and Antonella Delle Fave

This book was conceived as an attempt to bring together Western and Indian
approaches to the theme of health care and promotion, with the aim to propose an
integrated perspective that can help overcome the limitations of culture-bound
models and highlight the contribution potential of a complex and multidimensional
view to research and intervention practices.
As described in the first part of this book, during the twentieth century the focus
of Western medicine on illness care rather than on health care led to a substantial
neglect of prevention practices in favor of an almost exclusive attention to overt
physical symptoms and signs that can be objectively measured, exacerbated by the
necessity to cope with an increasing shortage of financial resources. Only recently
researchers and practitioners started considering the subjective perception of health
and the influence of mental conditions on physical functioning as crucial determi-
nants of health that must be scientifically studied and evaluated.
The bio-psycho-social model, developed with the aim of gathering the biological,
psychological, and social factors that influence health under a unifying framework,
is however still in its infancy. The difficulties in operationalizing it at both the
research and intervention levels are mainly derived from the typical fragmentation
of knowledge that characterizes Western culture.

A. Morandi (*)
Ayurvedic Point, Milano, Italy
e-mail: [email protected]
A.N. Narayanan Nambi
SNA Oushadhasala Pvt. Ltd, Thrissur, Kerala, India
e-mail: [email protected]
A. Delle Fave
Department of Pathophysiology and Transplantation,
University of Milano, Milan, Italy
e-mail: [email protected]

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 189
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1_11,
© Springer Science+Business Media Dordrecht 2013
190 A. Morandi et al.

In order to overcome these difficulties, a conceptual shift is required, from the

understanding of health as a utopian goal or an extraordinary condition to be
artificially achieved to the expression of a natural condition to be preserved. This
approach characterizes most traditional knowledge systems, including Āyurveda,
the system of medicine developed in the Indian subcontinent that is taken in this
book as an exemplary model. The integration of the two approaches may generate
a novel conceptualization of health and health care that could lead to fruitful
outcomes at both the research and practice levels.
The possibility of this integration emerges from the recurrence of some common
elements recurring across the different chapters, briefly summarized as follows:
1. Health can be conceptualized as a condition of coherence emerging from the
network of interrelated functions that characterizes any living being as a complex
adaptive system. It accounts for the system’s resilience and adaptability to the
environmental variations.
2. Increasing levels of global coherence in an organism are related to higher levels
of balance, self-sufficiency, resilience, and thus health. However, since organisms
are dissipative structures, they need to actively exchange information with the
environment in order to maintain their coherence. This information is repre-
sented by food at the physical level and by memes – cultural instructions and
rules, behavioral and interaction patterns, and outcomes of mental processes
(Richerson and Boyd 2005; Massimini and Delle Fave 2000) – at the psychological
level. Such a multifaceted information exchange can be broadly described as the
transformation of heterologous items into homologous ones through nutrition,
breathing, and sense-mediated perception. The global quality of the information
exchange with environment thus represents an indicator of the system’s health.
3. Health is a dynamic phenomenon rather than the opposite pole of disease. As a
process of adaptation to environmental conditions, it undergoes continuous
variations. From this perspective disease can be understood as a progressive
decrease in the living system’s resilience levels that can lead to different balance
configurations, progressively more distant from the optimal one but nevertheless
compatible with life – as happens in chronic conditions. This conceptualization
emphasizes preservation of a healthy balance, rather than intervention against
disease, as the key factor of prevention. Accordingly, cure itself should aim at
strengthening and possibly increasing residual levels of health and balance,
rather than only attack disease. In this model the definition of disease changes as
well, from a discrete and alien condition to be fought to an idiopathic condition
of suboptimal health.
4. Historical, cultural, social, and economic factors contribute to build the conceptual
framework in which health and disease are interpreted. The biomedical view of
medicine, based on the health-disease opposition, is grounded into the epistemo-
logical methodology of the binary system. The binary system has been charac-
terizing the history of Western thought, language, and worldview (Derrida 1978).
It is centered on the clear-cut definition and juxtaposition of two theoretical
opposites such as presence/absence, male/female, life/death, and health/disease,
11 Joining Knowledge Traditions: Towards an Integrated Approach to Health… 191

often implying a value hierarchy between the “positive” and the “negative” pole.
The binary opposition is built on “discontinuity rather than continuity” (Goody
1977, p. 81). Focusing on discontinuity is indeed beneficial in articulating crystal
clear categories, especially within disciplines such as the biomedical ones, where
organization and structure are helpful tools to describe the dynamics of living
systems. However, it runs the risk of an all-out dichotomization and hierarchical
organization of reality (Soosai-Nathan and Delle Fave in press). Although
quantum mechanics and systems biology have provided empirical evidence of
the limitations of this perspective, it is still dominating in the medical model, and
it substantially influences health representations and clinical practice. On the
contrary the Indian tradition, within which Āyurveda developed, is grounded
into the perspective of interconnectedness, as clearly elucidated throughout the
second part of this book.
5. Health represents a natural and basic condition, not a plus. Full health is the
optimal expression of each individual living being, and it is variably expressed
according to the individual’s specific balance and resilience potential. Conditions
of lower health may arise, while the health optimal baseline that characterizes
each organism cannot be exceeded.
6. Health is the outcome of the individual’s active process of interaction and
exchange with the environment, and consciousness represents a crucial factor for
preserving its balance and optimality. The level of individual awareness substan-
tially influences mind-set, daily behavior, and lifestyle, thus contributing to
define the degree of the person’s adaptation and resilience. As a matter of fact,
the healthy individual in Āyurveda is Svastha, the one who is centered into his/
her self, a definition encompassing self-awareness and agency. Interestingly, the
Indian system emphasizes the primacy of a ground level of self-awareness, related
to ātman, that underlies the self-awareness level related to individual identity,
considered instead the ground level in Western psychology. The ātman-related
self-awareness allows for the acknowledgement of the individual’s substantial
interconnection with the nature and with the universe, thus overcoming the self
vs. other polarization attitude. In spite of this crucial difference, the importance
of the spiritual dimension in well-being promotion is also recognized in Western
health psychology, as highlighted in several chapters.
7. The interpretation of health and human functioning proposed by Āyurveda (and
by other Eastern traditions) can be fruitfully described through the conceptual
framework of complex adaptive systems. The identification of a shared model of
understanding allows for envisaging an integration between the Western and
the Indian systems of knowledge. This may have useful implications for the
management of health and disease, facilitating the cross-fertilization and synergy
between the two approaches.
8. The active role of individuals in preserving and promoting their own health becomes
particularly evident in habits and lifestyle – comprising nutrition, biorhythms’
observance, and physical and mental exercise. These behaviors, considered since
millennia core dimensions of health by Āyurveda, are currently acknowledged
as central to well-being and prevention in Western biomedicine as well.
192 A. Morandi et al.

At the social level, Āyurveda attributes a central role in health promotion to rituals
and collective behaviors that often mark developmental passages and encompass
health practices. Also the relationship with the natural environment – that represents
a primary source of health, offering the whole range of remedies and medicaments
used by traditional medicines – gets strengthened by rituals and ceremonies transmit-
ted across generations, together with the practical knowledge embedded in them
(evident in the local systems of medicine). This dimension got lost in modern
Western medicine, based on synthetic drugs, but it is undergoing a revitalization
trend through thermal and wellness treatments, often taking place in natural
environments and fostering the adoption of a daily schedule more tuned with the
natural rhythms. However, the social and individual value of traditions and rituals
can represent an important source of knowledge and well-being promotion in
modern society, especially as concerns those rituals and collective behaviors that
encompass hygiene and health practices and that are still part of the folk knowledge
in most Western countries.

11.1 Implications for Practice and Applied Research

The implications of this perspective for health conceptualization and management

are far-reaching, and they involve both prevention and care systems.

11.1.1 Personalization

Both Āyurveda and the latest acquisition of Western medicine highlight the impor-
tance of personalizing prevention and treatment programs. As illustrated in several
chapters of this book, the western bio-psycho-social model stresses the centrality of
the person as a unique and dynamic blend of biological and cultural components
and as an active and mindful agent. From the perspective of Ayurveda, each person
is constitutionally characterized by a peculiar balance of the three doṣa that requires
customized intervention aimed at preserving – and if necessary restoring – that
specific balance pattern.
According to both approaches, this individual uniqueness must be reflected in
person-tailored intervention programs. There are several conceptual and operational
differences however in the way this assumption is translated into practice.
In Āyurveda, the personalization of treatment/prevention practice logically
derives from the conceptual framework, typological classification, and diagnostic
procedures the medical practice relies upon. Personalization has been structurally
characterizing this system of medicine since its foundations. In the Western
medicine, personalization is a very recent acquisition, and it is juxtaposed to a
whole tradition of standardized, protocol-based, and disease-centered procedures.
Therefore, it presently represents a laudable aspiration rather than a common
11 Joining Knowledge Traditions: Towards an Integrated Approach to Health… 193

practice, due to the lack of clear-cut conceptual underpinnings and empirically

grounded diagnostic and therapeutic tools. Advancements in genetics have provided
some insight into individual differences at the biological and physiological levels
that can orient pharmacological treatment choices. However, this approach is in its
infancy, and its effective development will depend upon investment of large amounts
of money, time, and research resources. Moreover, it only focuses on one of the three
dimensions of the person, neglecting the psychological and social components.
The Ayurvedic view of the individual is conceptually parsimonious and intrinsi-
cally dynamic. The doṣa imbalance gets reflected at the various levels of the person’s
system, and it is possible therefore to treat it by means of few systemic intervention
tools, effective at the various levels simultaneously. Moreover, the doṣa balance
undergoes changes across the different life stages, therefore allowing for an even
more fine-tuned intervention that takes into account not only the person’s prakṛti but
also her age and life stage. The Western approach to personalization is instead
substantially fragmented into sealed off, separated practices at the various levels of
the person’s system involving different practitioners who often neither know each
other nor the other’s discipline and intervention practices. Moreover, in the lack of
a unifying and systemic view, interventions are basically still disease focused, even
within the domain of personalized pharmacotherapy.

11.1.2 Interconnection

A convergence between the two perspectives in the domain of health management

is largely desirable, in view of its potential implications at various levels of
intervention:
The body/mind interplay. In spite of the laudable efforts of the psychosomatic
approach, the Western medical practice is still based on knowledge fragmentation,
and the lack of a unifying model does not allow the general practitioner to take
in due account the interplay between mind and body. Āyurveda provides instead
a comprehensive approach to such interaction, and some of its concepts and
models – such as Tridoṣa and Triguṇa – can usefully complement the Western
approach to diagnosis and care, in order to achieve an authentically psychophysical
description of the individual.
The person/environment interplay. Although the bio-psycho-social model acknowl-
edges the influence of environmental factors on health, it substantially focuses on
the social dimension and considers it prominently in terms of standard of living,
equality/inequality in the access to health care, gender roles, and education.
Moreover, the model is grounded into a monocultural, Western perspective that
does not consider national and cultural variations in the representations of health
and in the social actions undertaken to promote it. Āyurveda provides a more
articulated and at the same time exhaustive view of this interplay, distinguishing
its occurrence at various levels:
194 A. Morandi et al.

(a) The bioecological level. The importance of the natural environment emerges
in the concept of kalapariṇāma as a major source of disease and in the
importance attributed to the use of local foods and medicaments in order to
most effectively preserve and restore health. These aspects are largely
neglected in the Western lifestyle, though a more careful consideration of
them would substantially improve citizens’ health and quality of life – for
example, through a daily organization more consistent with biorhythms or
nutrition habits in harmony with local and seasonal food availability.
(b) The sociocultural level. Attention to sociocultural differences is steadily
growing in the Western social sciences – such as economics, sociology, and
psychology. Much less emphasis is put on these factors in the domain of
health care; more specifically, no systematic attempts have been made to
comprehensively describe the individual-community interplay as regards
health and to provide directions for harmonizing it. By including rituals and
relationships in its model of health, Āyurveda offers a pathway towards a
clearer evaluation of these factors in health promotion and management.
(c) The transcendental level. In the Western view the spiritual dimension is con-
sidered a useful tool to promote health, in light of its benefits at the psycho-
logical and lifestyle levels. It nevertheless remains a private issue that may or
may not be part of the individual’s reality, without substantial implications
for health management. On the contrary, the Indian vision endorsed by
Āyurveda locates the spiritual dimension at the core of individual life: Ātman
and ānandamayakosha are substantive components of any living system and
of the universe at the same time. From this perspective, the spiritual dimension
is not a matter of personal belief and choice, but it represents the ultimate
reality. It therefore occupies a central place in the promotion of health as
global balance and fullness. This approach is common to most non-Western
traditions. However, its implications for health are rooted into personal
adherence and choice, and it is very difficult to envisage their generalizability.
Anyway, its role in providing individuals with a worldview characterized
by substantial interconnectedness is surely crucial to orient behaviors,
meaning-making processes, attitudes towards life and death, health and
disease, self, and others.
The culture interplay. As repeatedly stated throughout this book, cultural cross-
fertilization can generate a more complex view of health and well-being, allowing
to overcome culture boundaries and to expand our understanding of human life
and functioning. A vision of reality that encompasses different perspectives in a
unitary and global framework can only provide benefits to our knowledge of the
processes that underlie the unfolding of life and health, presently threatened by a
strong fragmentation tendency. A broader outlook based on the emphasis on
commonalities rather than on differences and the identification of models facilitating
the integration of knowledge across cultures – such as the complex adaptive
system model proposed in this volume – can generate deep awareness of the
network of interconnections in which humans are immersed.
11 Joining Knowledge Traditions: Towards an Integrated Approach to Health… 195

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Index

A American Psychological Association, 142

Ācāra, 84 Ānanda, 53, 54, 148–150
Acausality, 163 Anāsakti, 150
Acceleration, 151, 172, 173 Anatomical, 115, 168, 169, 176
Activity(ies) Anatomy, 115, 126
daily, 14, 118, 144, 146, 147 Andhra Pradesh, 106, 108
perceptive, 77 Animal, 27, 44, 48, 49, 84, 88–90, 107, 108,
Actualization 120, 130
self-actualization, 12, 143 killing, 88
social, 12, 143 Anthropocentric, 106
Adaptability, 169, 179, 190 Anubandha, 71
Adaptation Anumāna, 71, 72
potential, 179 Anxiety, 30, 34, 64, 151
trend, 171, 176 Ap, 148, 151, 173, 175, 177
Adaptive, 61, 68, 147, 163–183, 190, 191, 194 Apāna, 73
interaction, 169 Aptopadeśa, 71, 72
Adharma, 88 Ārogya, 90
Ādi Śankara, 96 Aristotle, 12, 143, 144, 168
Adulthood, 5, 34, 47, 92–94 Artha, 40, 149
Advaita vedānta, 44, 167 artha pradhāna, 40
Age(ing), 13, 15, 18–20, 47, 60–63, 65, 67, Arthritis, 32, 180
68, 93, 105, 110, 142, 150, 166, 167, Asatmyendriyārthasamyoga/asātmendriyārtha
177–181, 193 samyoga, 153
Agency, 84, 110, 142, 145, 146, 148, 156, 191 Asclepius, 3
Agni, 153, 168, 176–179 Aṣṭāṅga Hṛ daya, 59, 62, 63, 65, 66, 84, 88–90,
Agriculture, 5, 100, 107 149, 151, 167, 168
Ahaṃkāra, 147, 173 Aṣṭāṅga Saṃgraha, 60, 67, 121, 122
Ahāra, 179 Asthi, 176
Aiśvarya, 90 Asthma, 32
Air, 72, 91, 124, 148, 173, 175 Astika, 167
Akarma, 86 Aswini kumaras, 102
Ākash, 148, 151, 173–175 Ataraxia, 144
Alcohol, 88–90, 145 Ātman, 45, 52, 71, 76, 79, 103, 148–150, 153,
Allostasis, 28 156, 167, 191, 194
Allostatic overload, 28 Atoms, 114, 116, 117, 123, 131
Alzheimer, 180 Attachment, 79, 148, 150, 151, 153, 154, 156

A. Morandi and A.N. Narayanan Nambi (eds.), An Integrated View of Health and Well-being, 197
Cross-Cultural Advancements in Positive Psychology 5, DOI 10.1007/978-94-007-6689-1,
© Springer Science+Business Media Dordrecht 2013
198 Index

Attappady region, 108 Birth, 3, 7, 47, 49, 50, 52, 71, 73, 80, 92, 93,
Attractor, 170, 175, 176, 178 101, 167
strange, 170, 175, 178 Bisha, 87
Autonomy, 14, 102, 143 Blessing, 90, 107
Auto-poiesis/autopoiesis, 169, 178 Blood, 105, 109, 115, 151, 176
Awareness Body
ground, 52 causal, 51, 52, 54, 72, 73, 168
individual, 191 gross, 72, 73, 132
levels of, 127, 128, 130, 132 gross physical, 49–52, 54, 127, 128, 133
of oneself, 128 material, 117
Āyu/āyus, 60, 71, 85, 90, 148, 168, 180 subtle, 51–53, 72, 73, 168
Āyurveda Body-mind, 43, 50, 54, 67, 115, 132, 150,
mṛga, 120 156, 193
vrkṣa, 120 Bohr, 132
Ayurveda, Yoga, Unani, Siddha Bommiampathy, 108
and Homeopathy (AYUSH), 42 Bone, 101, 176
Ayurvedic/āyurvedic, 59, 61, 64, 65, 67, 75, Brahman, 44, 45, 51, 148, 149, 156, 167
79, 89, 90, 92, 102, 108, 110, 118–120, Brahmaṇa, 75
124, 126, 127, 130, 131, 133, 134, 147, Brain, 8, 29, 41, 43, 53, 84, 116, 128, 170, 180
148, 157, 164, 179, 182, 193 Buddha, 44, 45, 51, 52
Buddhi, 51, 73, 78, 79, 103, 127, 128, 153
Buddhism, 45, 46, 167
B Buttermilk, 90
Baghmara village, 105
Baiga region, 105
Balance C
doṣic, 124 Caesarean section, 7
functional, 64, 126 Caitanya, 52
mental, 150 Cancer, 8, 32, 107, 142
optimal, 62, 180, 182 Canon, 42, 60, 71
Behavior Ćaraka, 151–154, 173, 174, 182
behavioural change, 125 Ćaraka Saṃhitā, 59–66, 71, 72, 75, 80, 85,
behavioural routine, 128 95, 102–103, 120–122, 126–130, 132,
chaotic, 170, 175 133, 148–150, 167, 168, 175–179, 182
collective, 192 CAS. See Complex adaptive systems (CAS)
health-related, 34, 145 Catabolism, 178
illness, 31, 32 Causal connection, 125
intentional, 146 Causality, 115, 116, 181
intrinsically-motivated, 146 Causative factor, 127, 128, 130, 134, 177
ritualized, 83, 84, 91, 94 Cell, 80, 81, 115, 116, 124–126, 171
unwholesome, 153 staminal, 176
Bhagavad Gīta/Bhagavad Gita, 44, 46, 49, 52, Census, 100
75, 86, 92, 95, 150 Ceremony/ceremonial
Bhāgavata Purāṇa, 87, 88, 90 naming, 93
Bhoota vidya, 49 parting of the hair, 93
Biochemical, 42, 48, 120 temple, 83
Biochemistry, 43, 120, 133 wine, 88–90
Bio-cultural, 99, 105, 108 Cetana, 127
Biodiversity, 89, 99, 105, 111 Chakra, 53, 54
Biology, 69, 114–116, 133, 163, 171, 173, 191 Channel, 127, 153
Bio-psycho-social/biopsychosocial, 26, 34, 35, Chaos, 163, 168–171
141–147, 154–157, 164, 165, 168, 189, theory, 170
192, 193 Chārvaka, 44
Biorhythm, 191, 194 Chemical, 80, 81, 116, 124, 133
Index 199

Chemistry, 116, 119, 133, 171 Coping, 28, 29, 32, 41, 142, 145, 147
Childhood, 27, 92, 93 Cow, 89, 92
Chronic Creation, 11, 44, 92, 97, 119, 178
disease, 8, 20, 29, 33, 177, 179, 180 Creativity, 19, 169
illness, 4 Culture, 6, 9, 40, 44, 48, 50, 81, 87, 100, 104,
pain, 28 106, 118, 147, 149, 156, 165, 166, 171,
skin ailment, 106 182, 189, 194
CIDI-SF. See Composite International cross-cultural, 146
Diagnostic Interview Short Form Cycle
(CIDI-SF) of birth and death, 47, 50, 52, 92
Classical texts, 50, 59, 60, 65, 83, 101, 103, of cause and effect, 71
157, 167, 179
Clinical practice, 25, 26, 126, 163, 191
Co-evolution, 102–103 D
Cognitive, 10, 14, 25, 28, 32, 48, 62, 143, 151 DALY. See Disability-adjusted life years
Coherence (DALY)
inner, 179 Darśana/darsana/darshana, 44, 45, 119, 166
internal, 174 DCPR. See Diagnostic Criteria for
social, 12, 14, 143 Psychosomatic Research (DCPR)
system, 179 Death
Coherent, 119, 129, 175, 177–179 rites, 94
Cohesion, 124, 142, 151, 175 untimely, 59–61
Cold, 89, 120, 130, 152 Deceleration, 172, 173
Compartmentalization, 155 Declaration of Human Rights, 165
Competence, 145–147 Degenerative, 142, 151
Complex adaptive systems (CAS), 163–183, Deha, 49, 50
190, 191, 194 Dehi, 49, 50
Complexity Demographic transition, 3–20
decrease of, 180 Depression, 13, 15, 30, 32, 66, 153
levels of, 171, 179, 181 Descartes, 52, 115
loss of, 180 Desire, 75, 77, 79, 113, 148, 149, 152, 154
physiological, 179 Detachment, 128, 144, 150
Composite International Diagnostic Interview Deterministic, 114, 117, 133, 170
Short Form (CIDI-SF), 17 Detoxification, 62
Computerised tomography (CT), 114 Dhanvanthari Nighantu, 103
Configuration, 169, 171, 172, 177, 181, 190 Dhāraṇa, 71
Connectedness, 144 Dharma
Connection, 44, 84, 85, 115, 124, 125, 127, dharma pradhāna, 40
129, 133, 155, 163, 176 sanātana dharma, 44
Consciousness Dhātu
cosmic, 129 disequilibrium of the dhātu, 150, 178
expansion of, 150 equilibrium of dhātu, 150, 178
principle, 71, 148, 167, 172 Diabetes, 7, 8, 28, 33, 116, 180
pure, 45, 148 Diagnosis, 6, 9, 15, 31, 107, 113, 116, 193
Constitution Diagnostic Criteria for Psychosomatic
mental, 61, 63–67 Research (DCPR), 30, 31
physical, 61–67 Diagnostics, 6, 9, 14, 15, 17, 39, 101, 106,
Continuum, 5, 15, 66, 102, 118, 127, 130, 132, 113, 114, 117, 126, 192, 193
133, 182 Diagnostic and Statistical Manual (DSM),
mind-matter, 46 9, 14, 30
Control, 19, 28, 31, 54, 66, 84, 90, 97, 106, Diet, 31, 65, 79, 91, 108, 109, 128, 130, 131,
109, 113, 116, 125, 128, 142, 151, 179 145, 152, 156, 166
Copenhagen Interpretation of Quantum dietary regime, 142, 156
Theory, 132 Differentiation, 5, 52, 147, 167, 169, 172
200 Index

Digestion, 62, 90, 122, 151, 176 Engagement, 15, 104, 109, 146, 147, 182
Disability, 13, 19, 28, 33, 70, 144, 145, 165, 182 Engel, G.L., 26, 141, 164, 165
Disability-adjusted life years (DALY), 13 Enjoyment, 88, 95, 147
Disease Entropic, 171
cause of, 13, 61, 132, 151 Entropy, 169
coronary heart, 33 Environment, 26, 29, 34, 48, 60–62, 64, 66,
disease-centric, 166 67, 70, 71, 73, 76, 78, 80, 83, 89, 99,
management, 25, 134, 166 101–106, 111, 129–131, 134, 142–144,
manifestation, 156 146–148, 153, 164, 165, 169–171, 174,
onset, 142, 153, 155–156 179, 181, 182, 190–194
prevention, 141, 154 Environmental, 14, 26, 48, 60, 66–68, 79–81,
seasonal, 131 105, 113, 131, 142, 145–148, 153,
treatment of, 9, 61, 70, 88 155, 165, 170, 173, 176, 177,
Disequilibrium, 150, 178 179–182, 190, 193
Disharmony, 89, 90 transference, 80–81
Dispersion, 120 Epicurus, 144
Disruption, 169, 179, 180 Epidemiological
Dissipation, 178 paradox, 166
Dissipative, 169, 190 transition, 8, 20, 142
Diversity, 10, 99, 108 Equality, 5, 91, 193
Diviner, 55, 110 Equilibrium
Divinity, 47, 106 dynamic, 48, 153
DNA, 125, 169 thermodynamic, 177
Doṣa/dosha Equipoise, 144, 154, 168
doṣa configuration, 178 Essence, 51, 86, 118, 148, 168, 176, 179
doṣa imbalance, 153, 155, 193 Established in oneself, 128, 150, 168
Dream, 45–47, 52, 73, 104, 106 Ether, 148, 173, 175
Dryness, 78, 123–125, 175, 177 Etiology, 11, 155
DSM. See Diagnostic and Statistical Manual Eudaimonia, 12, 13, 143, 149
(DSM) Eudaimonic, 11, 12, 14, 54, 143, 144, 146
Dualism, 43, 45–46 Evenness of judgment, 144
mind-matter, 41 Evolution, 45, 47, 63, 69, 72, 73, 92, 96, 119,
Dualistic, 54, 124, 132 128, 147–149, 167, 170, 173
Dukha, 103 Evolutionary, 47, 61, 68, 80, 173
Expectation, 31, 144
Experience
E conscious, 116, 171
Earth, 72, 120, 124, 148, 151, 152, 173, 175, 176 dream, 46, 73
Ecological, 43, 48, 60, 89, 99, 104, 107 non-sensory, 118
Ecology, 101, 108 optimal, 73, 147
Economics, 4, 19, 20, 40, 43, 70, 111, 141, waking state, 46
155, 165, 190, 194 Experiencer, 73
Ecosystem, 99–101, 104–111, 182 Experiential, 44, 51, 101, 118, 143
Education, 4, 6, 10, 18, 39, 93, 101, 157, 165, External, 54, 60–62, 64–67, 73, 78–80, 93, 95,
166, 193 96, 105, 106, 108, 109, 130, 148, 150,
EEG, 180 151, 155, 163, 174, 176, 177, 179, 181
Einstein, 119
Elderly, 30, 109
Emergence, 110, 132, 163–183 F
Emergent, 5, 53, 164, 169–171 Family, 5, 11, 31, 63, 65, 81, 92–94, 101, 106,
Emotion, 10, 15, 29, 51, 61, 65, 79, 84, 97, 107, 109, 144, 157, 165, 166
143, 145, 148, 151 Far-from-equilibrium, 169, 174, 177, 178
Energy Fasting, 91
source, 176–179 FDA. See Food and Drug Administration
transformational, 62, 64, 172 (FDA)
Index 201

Fertility, 4, 7, 19 H
Festival, 91, 104, 107–109 Haemorrhage, 105
Fire, 72, 87, 124, 148, 173, 175, 176 Happiness, 10–12, 15, 19, 46, 54, 74, 75,
Flourishing, 15–20, 143, 144 83, 84, 109, 128, 144, 148, 149, 152,
Flow, 67, 78, 81, 106, 122, 147, 151, 153, 168
167, 176 Harmony, 48, 67, 79, 80, 83, 84, 86, 88, 91,
Flower, 96, 99, 109 128, 130, 132, 144, 145, 153, 176, 194
Foetus, 121 Harvey, W., 115
Folk, 55, 69, 101, 102, 105, 110, 111, 192 Healer, 7, 55, 101, 104–107, 110
Food, 8, 67, 72, 88–90, 92, 93, 99–102, 108, Health
111, 131, 148, 151, 152, 156, 157, 166, community, 99, 101, 103–105, 107–111,
178, 179, 190, 194 130, 181, 194
Food and Drug Administration (FDA), 8 complexity of, 154, 180–182
Forest, 89, 100, 102, 103, 105–107 continuum, 15, 180–181
Fractals, 170 emerging, 113–114, 179–180, 182
Framework, 26, 47, 51, 54, 64, 67, 70, 76–81, holistic, 25, 41, 42
100, 101, 103, 111, 116, 119, 120, 125, ill-health, 28, 31, 74, 78, 119, 120, 131, 132
127, 131–134, 143, 149, 155, 163, 164, knowledge, 100, 102, 103, 111, 180,
170, 175, 177, 189–192, 194 189–194
Fulfillment, 94, 143, 144, 150, 168 management, 59, 60, 67, 105, 133, 134,
Functional 141, 145–147, 156, 182, 191, 193, 194
failure, 125, 129 mental, 11–20, 34, 39, 41, 101, 108, 143, 144
hierarchy, 123 Mental Health Act, 11
theory, 134 Mental health continuum (MHC), 14, 15,
Functioning 17, 143
coherent, 175, 179 optimal, 13, 33, 61, 62, 179–181, 191
optimal, 71, 143, 178 physical, 17–19, 34, 39, 41, 90, 108, 132,
142–144, 155, 164, 165
positive, 3, 4, 11, 13–15, 17, 29, 41, 70,
G 104, 147
Gadchiroli, 104 practice, 40, 53–54, 71, 99, 100, 102, 103,
Gait dynamic, 180 156, 189, 191, 192
Galen, 115 promotion, 3, 4, 13, 15, 17, 20, 43, 90,
Gandha, 173 141–157, 181–183, 189, 191, 192, 194
Garbhādhāna, 93 psychology, 39, 41, 141–147, 155–157,
Garudakodi, 105 182, 191
Gautamā, 119 public, 5, 13, 60
Gayatri mantra (GM), 128 sub-optimal, 181, 190
Gene, 99, 125 tradition, 39–55, 99–111, 119, 189–194
Genetics, 62, 64, 152, 193 Healthcare, 7, 9, 17, 20, 30, 33, 34, 39–41,
Genome, 115 67, 69, 70, 74, 100, 101, 104, 110,
Geographical, 63, 76, 100, 101, 103, 111, 156 111, 113–114, 118, 142, 145, 182,
Goa, 108 190, 193, 194
Goal, 7, 10, 59, 60, 62, 63, 79, 89, 90, 95, Healthy, 28, 41, 59–63, 67, 68, 76, 91, 93,
142, 143, 145–147, 149, 156, 165, 108, 118, 127, 128, 147, 153, 156, 157,
181, 190 177, 178, 180, 181, 190, 191
God, 43, 54, 60, 87, 96, 106, 107, 176 Heart
Gond community, 106 rate, 180
Growth, 4, 11, 12, 14, 19, 52, 93, 120, 124, rhythm, 170
143, 146, 150 Heat, 48, 64, 120, 124, 125, 152, 175
personal, 11, 14, 143, 146 Hedonia, 14, 15, 143
Gso-wa Rig pa, Hedonic, 11, 12, 14, 15, 54, 143, 149
Guṇa/guṇas, 65, 153, 154, 172–174, 178 Heisenberg, W., 117, 118, 132
Guru, 53, 102 Heterologous, 178, 179, 190
Guruvadi Guṇa, 174, 175, 178 Hippocrates, 115
202 Index

Histological, 125 Integrated, 12, 72, 74, 81, 106, 113, 116, 125,
Holism, 26, 119–131 131, 134, 141, 143, 146, 157, 163, 164,
Holistic, 25, 26, 29–31, 33, 41, 43, 47, 53, 169, 171, 175, 189–194
114, 125, 133, 134, 166 self, 146
Homogeneity, 169 Integration, 26, 31, 126, 147, 169, 171, 182,
Homologous, 178, 179, 190 190, 191, 194
Homosexuality, 9 social, 13, 14, 143, 147, 182
Hooke, R., 115 Integrative, 118, 125
Household, 101, 110, 119 integrative, 125
Humors, 76 Integrity, 62, 178, 179
Hygieia, 3–20 Intellectual, 11, 33, 39, 44, 74, 75, 94, 155, 167
Hygiene, 5, 142, 192 Intelligence, 52, 74, 78, 79, 89, 95,
Hygienic, 3, 4, 181 148, 172, 173
Hypochondriasis, 32 Interaction, 26, 29, 34, 41, 48, 61, 67, 70, 71,
Hypothesis, 12, 15, 17–19, 28 76, 79, 87, 90, 102, 104, 109, 125, 127,
129, 131, 132, 144, 147, 148, 153, 154,
163, 165, 167, 169–179, 181, 182, 190,
I 191, 193
ICF. See International Classification of social, 87, 90
Functioning (ICF) Interconnected, 85, 117, 118, 124, 126, 128,
Identity, 51, 52, 79, 85, 87, 92, 93, 97, 104, 155, 165, 182
108, 147, 148, 167, 174, 191 Interconnectedness, 119–131, 134, 164,
Illness 191, 194
care, 39, 70 Interconnections, 129, 171, 178, 191,
industry, 42 193–194
Imbalance, 43, 48, 67, 76, 79, 115, 125, 129, Interdependent, 124, 125, 127, 131,
132, 153–155, 173, 176, 181, 193 134, 177
Immunity, 61–64, 70, 90, 93, 151, 179 Interdisciplinary, 25, 26, 33
Immunization, 142 Internal, 10, 14, 61, 64, 76, 78, 101, 105,
Improbability, 169 109, 130, 147, 148, 163, 170, 173,
Indeterminism, 163 174, 176, 178
Indigenous, 42, 69, 101, 113 International Classification of Functioning
Individual, 6, 10–19, 26–29, 31, 32, 47, (ICF), 144
59–68, 70, 71, 73–81, 83–85, 87, 88, Interplay
92, 94–97, 102–104, 106–109, 111, body/mind, 193
115, 118, 122, 125–132, 134, 141–149, casual, 169
151, 153, 154, 156, 157, 163, 165, 167, guṇa, 154, 173, 175, 178
168, 173, 175, 177–179, 181, 182, non-linear, 178
191–194 person/environment, 193
Indra, 60, 102 Interrelated, 72, 124, 131, 190
Indriya, 71, 76, 103, 148, 153, 154, 173 Interrelatedness, 120, 126, 131
Industrialization, 4–5
Industry, 5, 8, 39–42
Inertia, 148, 153, 172, 173 J
Inertness, 132 Jainism, 45, 46, 167
Infancy, 92, 93, 189, 193 Jaundice, 101, 105
Inference, 26, 71 Jīva, 50
Inherent, 44, 64, 70, 72, 73, 77–79, 81, 99, Jñanendriya, 103, 173
105, 106, 125, 130, 173
Initial conditions, 170, 174, 176
Innovation, 26, 50, 169 K
Insomnia, 151, 156 Kaippunyam, 106
Instability, 66, 151, 175, 177 Kala, 153, 154
Insurance, 39, 40, 42, 70 Kala pariṇāma, 153, 194
Index 203

Kali, 106 Linear

Kāma, 149 causality, 116
Kaṇāda, 119 relationship, 134
Kapha, 63–67, 102, 120, 122–125, 131, 151, Lipids, 176
152, 175 Living organisms, 80, 120, 130, 169, 170, 174
Kapilā, 119 Logic, 54, 113–134
Kāraṇa śarīra/Kārana sharīra, 51, 53, 81 Logical, 40, 115, 118, 119, 126, 133
Karma Loka, 44, 55, 105
karmaphala, 54 loka-puruṣa, 102
karma puruṣa, 61, 68 Longevity, 10, 42, 49, 59–63, 67, 68, 152
Karmendriya, 103, 173
Karnataka, 107, 108
Kathopanishad, 51 M
Kāya chikitsa, 49 Macrocosm, 81, 102, 105–106, 118, 120,
Kerala, 90–92, 104, 108, 109 130, 131
Kirlian photography, 53 Macrocosmic, 48, 130, 182
Knower, 46, 149 Macromolecular, 125
Knowledge Macroscopic, 114, 117, 124, 131, 133
folk, 101, 102, 105, 111, 192 Magic, 55, 110
non-codified, 101, 103 Magnetic resonance imaging (MRI), 114, 117
Kośa/kosha Mahābhārata, 86
ānandamaya, 51, 127–129, 148, Mahābhūta/Mahabhutas, 148, 151
157, 194 Maha Guṇa, 153, 154, 172–174, 178
annamaya, 51, 127, 128 Maharashtra, 101, 104, 108
manomaya/manomayakośa, 51, 127, 128, Mahat, 147, 173
132, 148 Mahātma, 52
prānamaya, 51, 128, 148 Majja, 176
vijnānamaya, 51, 127, 132, 148 Mala, 76, 80, 168, 177, 178
Kritayuga, 150 Māṃsa, 176
Kṣatriya, 75 Manas, 51, 71, 73, 74, 76, 78, 103, 148, 153,
155, 173
Mantra, 60, 128, 134
L Marma, 93
Laghu, 102 Marriage, 87–90, 93, 94, 96, 106
Lakṣa, 105 Mass, 90, 151, 172, 173
Languishing, 15–19, 143 Materialism, 44
Layer, 74, 125, 128, 157 Mathematical, 117, 118, 170
Liberation, 47, 96, 149, 150, 156 Matter
Life aggregates of, 148
expectancy, 4, 5, 9, 19, 20, 104, physical, 43, 48, 118
109, 142, 166 Meaning, 8–10, 14, 19, 25, 46, 50, 52, 55, 59,
preservation of, 59, 90, 97 70, 71, 87, 119, 120, 130, 142, 147,
previous, 49 151, 156, 157, 174, 176, 179
purpose in, 11, 14, 143 Meaningful, 10, 12, 14, 28, 49, 126, 146
quality of, 10, 20, 30–32, 40, 59, 62, Meat, 88, 89, 176
84, 85, 104, 141, 142, 147, Mechanistic, 115, 119, 133
164–166, 194 Meda, 176
security of, 84, 85 Medicalization, 4, 7, 9, 20
span, 60, 62, 84, 152 Medicated
Lifestyle/life style, 6, 8, 19, 28, 32–33, 47, 50, buttermilk, 90
59, 60, 67, 79, 88, 91, 100, 101, 109, food, 90
113, 142, 145, 147, 150, 155–157, 166, rice, 90
181, 191, 194 Medicinal, 89, 102–108, 111, 118
lifestyle-related diseases, 155 plant, 100, 105, 107, 108
204 Index

Medicine/medicines MR spectroscopy, 128

alternative, 42 Multidimensional, 12, 55, 65, 85, 179, 189
bio-medicine, 70, 133, 191 Multilevel, 179
Chinese, 110 Multiple realities, 44
clinical, 34, 116, 133 Mutation, 125
complementary, 33, 42 Myth, 3, 55, 106
conventional, 110
information, 54
integrative, 42 N
local, 110 Nāmakaraṇa, 93
mind-body, 33, 42, 53 Namaskāra, 86, 87
nuclear, 114 Nārada Bhakti sūtra, 95, 96
psychosomatic, 25–28, 34, 53 Narayana Murthy, 107
Meditation, 41, 42, 157 National Institute of Mental Health (NIMH), 11
Meme/memes, 190 National Institutes of Health, 42
Mental Nature
disorder, 9, 13, 16, 17, 19, 30, 41, 166 nature-man relationship, 69
faculty, 128, 150, 154 rhythm, 153
illness, 4, 9, 11, 13, 15–19, 143 Need, 3–5, 9, 13, 14, 20, 25, 29–31, 33, 34,
Mental health continuum (MHC), 14–17, 143 43, 44, 50, 61, 69, 80, 88, 92, 97,
Mental health promotion and protection 100, 103, 106, 107, 109, 111, 113,
(MHPP), 15, 17 116, 141, 143, 144, 146, 147, 149,
Metabolic, 80, 124, 127, 151, 175 150, 168, 182, 190
Metaphysical, 54, 119, 134 Negentropic, 169, 171, 174, 178, 180, 182
MHC. See Mental health continuum (MHC) Network
MHPP. See Mental health promotion and complex, 124
protection (MHPP) dynamic, 118
Microcosm, 79, 81, 102, 104–106, 118, 120, functional, 124–126
130, 131 interlocking, 129
Microcosmic, 48, 130, 131, 182 srotas, 128
Midlife in the United States (MIDUS), stability of the, 125
14, 15, 17 Neuron, 171
Milk, 48, 89, 105 Newtonian, 114, 115, 117, 133
Mind NIMH. See National Institute of Mental
centred, 41 Health (NIMH)
fluctuations, 148, 149 Niṣkramaṇa, 93
Minimal uncertainty, 169 Nityaga, 71
Model Non-attachment, 150
biomedical/bio-medical, 41, 70, 164 Non-dual, 54
bio-psycho-social, 26, 34, 53, 141–147, Non-dualism, 44–45
154–157, 164, 168, 189, 192, 193 Non-dualistic, 45, 124
quantum, 132 Non-linearity, 170
Moha, 46 Non-linear/nonlinear, 116, 124–126, 170, 175,
Mokṣa, 75, 149, 156 176, 178
Molecular, 116, 171 Non-localization, 163
Molecule, 80, 114, 116, 123 Non-Vedic, 45, 46
Mood, 30, 31, 87, 151, 154 Nutrition, 101, 102, 179, 190, 191, 194
Morbidity, 29, 75, 80, 104, 166 Nyāya, 119, 153, 167
Morgagni, 115
Morpho-physiological, 155
Mortality, 4, 5, 19, 28–30, 166 O
Mother, 7, 27, 50, 65, 89, 93, 107 Obesity, 7, 28
Movement, 10, 19, 41, 54, 120, 122, 124, 125, Objective, 9, 10, 39, 130, 133, 141, 144, 189
151, 152, 173, 175, 176, 180 criteria, 40, 41
Index 205

Observer, 117, 119, 131–133, 174 coordinated, 169

conscious, 117, 131 demographic, 100
Ojas, 90, 179–181 interaction, 174, 190
Onam festival, 91 morbidity, 104
Oneness, 96, 109, 118, 131 morpho-functional, 178
Opposite poles, 165, 180, 190 resilience, 177
Optimal, 13, 61, 71, 78, 143, 147, 176, Perception, 10, 12, 31, 71, 73, 78, 79, 99, 100,
178–182, 190, 191 102, 103, 108, 111, 116, 126, 128, 132,
Optimality, 191 142–145, 148, 151, 154, 189, 190
Optimization, 80, 182 Personality, 10–12, 14, 28–29, 32, 48, 64–66,
Order 73–75, 93, 115, 123, 165
social, 83, 84, 87, 90 Personalization, 192–193
universal, 97, 147, 173 Person centred, 61, 67
Organism, 28, 79–81, 107, 116, 120, 125, 130, Perturbation, 125, 169, 170, 175–179
169–171, 174–182, 190, 191 Pharmaceutical, 6, 8, 9, 39
Organization, 170–174, 176–182, 191, 194 Pharmacology, 142
Organs Physical
of action, 73 body, 39, 49–52, 54, 126–129, 132, 133,
of perception, 73, 78 148, 168
determinism, 114
law, 114
P Physician, 3, 6, 7, 9, 31, 33, 42, 66, 68, 102,
Pain, 28, 33, 46, 103, 148, 150, 178 105, 115, 126, 142, 146, 155, 164
Panacea, 3–10, 15–17, 19 Physico-chemical, 124
Pañcakośa, 127–130, 132 Physics
Pañcamahābhutā/pañcamahā bhūta, classical, 114, 117, 132, 133
102, 124, 126 Newtonian, 114, 117
Panic, 16, 17, 34 quantum, 114, 117, 118, 131–134
Panjīkaraṇa, 72 Physiological, 62, 64, 76, 80, 115, 120,
Paradigm 124, 125, 127, 128, 150, 151,
reductionist, 41–43 154, 155, 166, 168, 169, 177,
shift, 41–43, 171 179, 180, 193
Paramāṇu, 126 urges, 66
Parameter, 28, 59, 64, 85, 116, 120, Physiology, 29, 78, 127–130, 132, 133
122–127, 134 Pitta, 63–66, 102, 120, 122–125, 151, 152,
Pariṇāma, 72, 80–81, 153, 194 175, 177
Parkinson, 180 Plants, 44, 49, 67, 89, 91, 100, 103, 105–108,
Participatory, 111, 131, 132 120, 130
Particle, 114, 117, 118, 173 Plato, 144
Patanjali, 44, 45, 52, 119, 150 Pleasure, 86, 88, 103, 143, 148, 150, 178
Pathogenesis, 3, 4, 9, 155 Poison, 101, 105
Pathogenetic, 26 Pongal, 108
Pathogenic, 19, 20, 175 Population, 108
Pathologic, 115 Potentiality, 47, 50, 143, 173, 174, 176
Pathology pure, 172
cardiovascular, 142 Praiṣārtha, 93
chronic, 8, 142 Prajāpati, 102
Pathways, 126, 157, 180, 194 Prajñāparādha/Prajnaparadha/Prjñāparādha,
interdependent, 177 61, 79–80, 153, 155
Patient care, 26, 29–31, 33 Prakāsha, 46
Patient-centered, 6, 146 Prakṛti, 45, 46, 54, 64, 147, 151–154, 156,
Pattern 167, 172, 193
complex, 177, 181 Pramāna, 72, 103
configuration, 177 Prāna/Prana, 50, 73, 151
206 Index

Prasāda, 90 Quantum
Prasannata, 168 logic, 54, 113–134
Pratyakṣa, 71, 72 mechanics, 117, 118, 191
Pravrtti, 46 theory, 117, 118, 132
Prayer, 41, 42, 55, 60, 79, 96, 106, 107, 157
Predictability, 169
Pregnancy, 7, 93, 180 R
Preservation, 59, 60, 62, 64, 90, 97, 155, 169, Rajas, 45, 46, 48, 63, 65, 122, 148, 150, 153,
176, 178, 190 154, 172–174
Prevention, 4, 6, 13, 26, 28, 43, 141, 145, 146, Rajasic, 65, 66, 75, 154
154, 156, 157, 179, 189–192 Rakta, 176
primary, 182 Rasa, 173, 176
Preyas, 54 Rasāyana, 62, 63
Process Reality
change, 145 perceivable, 172
codification, 103 phenomenic, 163
Procreation, 108, 152 physical, 44, 117, 132
Prosperity, 59, 84, 90–92, 95, 108 quantum, 114
Pṛthvi, 148, 151, 173–175 spiritual, 44, 45, 47
Psyche, 47, 50, 51, 133, 154 Rebirth, 107
Psychiatric, 29–32, 34, 146, 155 Reductionism, 26, 33, 43, 115–116, 133, 155
Psycho Reductionistic, 114–117, 133
psychophysical, 151, 157, 181, 182, 193 Regimen, 65, 79, 80, 101, 108, 128, 130,
psycho-physiological/psychophysiological, 149, 156
53, 122 Rehabilitation, 26, 33
psycho-social/psychosocial, 17, 25–29, Rejuvenation, 63, 108
32–33, 52, 92 Relation/relationship
psycho-spiritual/psychospiritual, 96 dynamic, 99, 116, 118, 171
Psychogenesis, 26 interdependent, 124
Psychogenic, 26 interpersonal, 146, 147, 165, 182
Psychological interrelationship, 79, 125
realm, 171 mind-body, 43
selection, 146, 147, 156 non-proportional, 170
Psychologist, 10, 11, 34, 40, 42, 48, 142 social, 61, 85, 110, 142, 155, 166, 182
Psychology Religion, 44, 47, 101, 157
clinical, 11, 12, 40, 144 Religiosity, 29, 157
positive, 19, 39, 41, 54 Religious, 7, 42, 55, 76, 81, 84, 90, 108, 110,
Psychoneuroimmunology, 42, 53, 133 115, 118, 163
Psychosomatic, 25–35, 53, 63, 67, practice, 157
132, 193 Resilience, 108, 143, 151, 169, 177, 179–181,
Psychotherapeutic, 31, 32 190, 191
Psychotherapy, 31, 32 Resilient, 179, 181
Purity, 79, 95, 96, 127 Resource/resources, 5, 9, 28, 43, 74, 75,
Puruṣa/purusha, 45, 52, 54, 61, 68, 105, 147, 91, 92, 99, 102, 104–106, 108–111,
153, 167, 168, 172 142–147, 150, 155–157, 165, 181,
Purushārtha, 149 182, 189, 193
Pūrva Mīmāmsa/Purva Mimāmsa, 44, 119 Ritual
of animal sacrifice, 88, 90
annaprāśana, 93
Q civilizing, 92–95
Quality/qualities, 3, 8, 10, 12, 13, 20, 29–32, of drinking wine, 89
40, 54, 59, 61, 62, 65, 66, 73, 75, 80, karṇavedhana ritual, 93
84, 85, 91, 100, 104, 105, 109, 110, of kolam, 89
141, 142, 147, 148, 150, 152–154, religious, 118
164–166, 172–174, 179, 182, 190, 194 of salutation, 86–87
Index 207

Ritualistic, 84, 86, 87, 94 Serenity, 130, 144, 154

Ritualization, 83, 88, 90, 91 Shabda, 173
ṛtuśuddhi, 93 Shape, 77, 87, 132, 169, 170, 173
Rūpa/rupa, 105, 173 Sheath, 51, 52, 148
Rural, 19, 100, 110 Shreyas, 54
Siddha, 42, 69, 102
Simplification, 180
S Sīta, 102
Sacrifice, 88–90, 92, 96, 107 Śiva, 87
Sadness, 108, 109 Skill, 28, 33, 101, 142, 145–147
Safety, 85 Smell, 73, 78, 152, 173
Salutogenic, 20 Social
Samāna, 73 contribution, 13, 14, 143
Samāvartana, 3 legitimacy, 101
Samçaya, 155 norms, 87, 156
Sāṃkhya/sānkhya, 44–47, 52, 60, 119, 147, participation, 144
167, 171, 172, 174 success, 87
Samskāra/samskara, 50, 92, 94, 148 Socio-cultural, 70, 100, 101, 104, 111, 194
Sanskrit, 40, 42, 50, 53, 100, 120, 151, 174, Socioeconomic, 100, 110
178, 179 Sociology, 43, 155, 194
Śarira/sharira ṣoḍaśa saṃskārās, 92
sthūla śarīra/sthūla sharīra, 51–53, 72, 81 Soma, 51
sūkṣma śarīra/sōkshma sharīra, 51, 52, 72, Soul, 47, 49–54, 132, 148, 167, 168
81 Sound, 12, 53, 73, 74, 128, 152, 173
Śāstra, 71, 102, 103, 166 Southern India, 107
Sat-chit-ānanda, 45 Space, 5, 6, 34, 49, 71, 72, 104, 106, 122, 124,
Satisfaction, 11, 12, 14, 15, 25, 40, 74, 85, 132, 173
143, 144 Sparsha, 173
Sattva/satva/satwa, 45, 46, 48, 63, 65, 66, Specialization, 8
75, 122, 148, 150, 153, 154, 156, loss of, 169
172, 173 Spice, 108, 118
Saukhya, 84, 85 Spirit, 5, 14, 49, 51, 54, 106, 174
Schroedinger, 118 Spiritual, 29, 41, 42, 44–47, 49, 51–55, 61, 74,
Science, 11, 13, 43–45, 50, 59, 70, 71, 87, 89, 95, 96, 101, 104, 106–108, 111,
113–120, 126, 128, 131, 133, 155, 157, 119, 120, 127, 134, 149, 150, 152, 154,
163–183, 194 157, 164, 165, 168, 191, 194
Scientific, 4–6, 8–11, 17, 25, 27, 42, 43, 47, Spirituality, 29, 42, 106, 157, 166
53, 70, 103, 131, 132, 152, 154, 163, Sri Padmanabha Swamy temple, 92
166, 168 Srotas, 126–128
Scriptures, 44, 46, 90, 93, 96, 150, 151 Stability, 28, 33, 63, 66, 67, 71, 80, 83, 124,
Season, 63, 67, 80, 89–91, 108, 130, 131, 153 125, 151, 152, 171, 172, 174, 175, 177,
Self 178, 180
cosmic, 96 Stable configurations, 181
self-acceptance, 11, 14, 143, 144 Standard
self-efficacy, 33, 143, 145–147 of life, 74, 85
self-organization, 169, 178 of living, 74, 84, 85, 193
self-realization, 47, 52 Stimuli, 61, 73, 78, 148, 153
self reliance, 109 Stoics, 144
self-transcendence, 144 Strategy/strategies, 32, 41, 42, 67,
Semen, 152, 176 142, 144, 145, 147, 151, 156,
Sense 170, 177
object, 78, 153, 156 adaptation/adaptive, 177
organ, 51, 62, 71, 78, 79, 153, 155, 168, 179 Stress, 13, 27–29, 32, 41, 42, 66
Sensitive to initial conditions, 170, 176 Stressor, 60, 146, 147, 180, 181
Sensitivity, 17, 176 Stroke, 180
208 Index

Structural, 5, 45, 62, 76, 78, 80, 116, 124, Teacher, 93, 101, 106
126–127, 150, 170, 175–179 Technology/technologies, 25, 39, 113, 114
Subdoṣa, 151 Tejas, 148, 151, 173, 175, 177
Subjective, 10–14, 31, 39–41, 102, 141, 142, Teleonomy, 169, 171
164, 165, 189 Theology, 168
criteria, 41 Therapeutic, 30, 32, 33, 106, 113, 117, 124,
Sūdra, 75 126, 133, 134, 193
Sukha, 85, 103, 149 Therapy/therapies
Śukra, 176 cognitive-behavioral, 32
Supernatural, 43, 48, 49, 115 eastern, 42
Surgery, 8, 50, 126 elimination, 124
Surgical, 27, 52, 126 energetic, 42
Surrender, 150 mind-body, 42
Suśruta, 76, 126 radiotherapy, 114
Suśruta Saṃhitā, 59, 60, 62, 72, 120, 127, Thirupathur taluk area, 109
150, 167, 168, 177 Tissue, 26, 61–63, 76, 80, 116, 120, 124–126,
Sustain, 20, 120, 128, 131, 176, 178 150, 151, 168, 176
Svastha/swastha, 60, 61, 76, 128, 168, Touch, 42, 73, 78, 173, 177
181, 191 Tradition
Svastha vṛtta/swasthavritta, 60, 181 family, 101
Swasthya, 150, 157, 168 folk, 69
Symbol, 3, 103 Indian, 39–55, 73, 86, 90, 104, 166, 191
Symptoms, 9, 15, 17, 28, 30–34, 115, 116, knowledge, 101–103, 105, 189–194
126, 143, 144, 153, 157, 164, 189 medical, 97
System philosophical, 103, 145
alternative, 43, 113 Transcendent/transcendental, 44–46, 49, 54,
belief, 54, 55, 99, 100, 107, 111 101, 150, 157, 194
binary, 190 Transtheoretical model of change, 145
biological, 69, 116, 118, 120, 125, 163 Tree, 91, 105–107
biology, 116, 163, 191 Trend, 7, 64, 70, 113–114, 142, 147, 166, 169,
caste, 75 171, 176, 192
chaotic, 170 Tribal, 100, 104
complex, 115, 151, 163, 164, 169–171, TriDhātu, 177
174, 175, 177, 181 Tridoṣa/tridosha/tridoṣic, 102, 120, 122,
healing, 55, 101 124–127, 130, 131, 134, 193
immune, 142, 179 Triguṇa, 47–48, 95
knowledge, 102, 111, 131, 157, 190
medical, 4, 33, 59, 60, 68, 133, 141, 155,
166, 181, 182 U
open, 79, 80, 129 Udāna, 73
religious, 157 Ugadi festival, 108
srotas, 127 Ultrasound, 114
Unani, 42
Uncertainty, 72, 169, 171
T Unconscious, 147
Tagore, 96, 118 Unctuousness, 124, 177
Tamas, 43, 45, 46, 48, 63, 65, 122, 148, 150, Unity, 69, 86, 87, 95–97, 118, 119, 128
153, 154, 172–174 Universe
Tamasic, 66, 75 mind-based quantum, 132
Tamilnadu, 102, 108, 109 physical, 114, 119
Tanmātra, 73, 148, 173, 174 Unmanifest, 147, 148, 167, 171–174, 182
Tāpa traya, 48–51 Upadhātu, 177
Taste, 73, 78, 173 Upakarma, 93
Tattva, 45, 103 Upanayana, 93
Index 209

Upanishad Vyāna, 73
Kena, 149 Vyāsā, 119
Prasna, 151
Taittiriya, 51, 148
Urbanization, 4–5, 100, 142 W
Uṣṇa, 102 Water, 5, 72, 89, 104, 110, 124, 148, 151,
Uttara mīmāmsa, 44–45 173, 175
Wayanad region, 104
Wealth, 10, 19, 40, 85, 86, 92, 95, 97, 100,
V 149, 152
Vāgbhaṭa, 84 Welfare, 10, 15, 92, 107, 131
Vaidya, 55 Wellbeing/well-being
Vaiśeṣika/vaisheshikha, 45, 119, 153, 167 eudaimonic, 12
Vaiśya, 75 hedonic, 11, 12, 15
Value psychological, 11–14, 28–29, 143
collective, 87, 90, 149 psychophysical, 182
ethical, 97 social, 12–14, 29, 70, 85–87, 90,
hierarchy, 191 104, 143, 164
Vāsana/Vāsanas, 72 subjective, 10–14, 20, 39, 143
Vāta, 63, 64, 66, 102, 120–125, 151, 152 Wellness, 59, 60, 71, 100, 192
Vāyu, 148, 173, 175 Wheeler, 131
Veda, 44–45, 52, 60, 71, 95, 96, 118, 131, 157, Wholeness, 66, 119
168, 177 World health organization/WHO, 13, 29, 70,
Rig, 177 104, 110, 111, 142, 144, 147, 164, 165,
Vedānta, 45, 117–119 168, 182
Vedic, 44–46, 52, 54, 60, 95, 114, 117–131, Worship, 89, 96
134, 151, 164, 167, 176 snake, 89
Vesalius, 115
Vidyāraṃbha, 93
Vikṛti, 153–154 Y
Village, 96, 105 Yajña/Yajna, 88, 92
Vishakhapatnam, 106 Yoga, 42, 44, 45, 50, 52, 119, 127, 129,
Vritta, 181 130, 134
Vulnerability, 26–29, 66, 180 Yoga Sutras, 44, 52, 150, 157
Vyadhi vyakti, 155 Yogavāsiṣta, 44, 128