Pinit Ratanakul, Ph.D.: Director of the College of Religious Studies, Mahidol University, Salaya, Puthamoltoll 4, Nakornpathom, 73170, Bangkok, Thailand
Health and disease are among the common experience of human life that is the special concern of religion. Religion, in every society, in every stage of history, upholds the value of well-being and health as necessary for a meaningful life, and provides its adherents with ways and means to enhance their health and to enable them to deal creatively with human vulnerability to disease, pain and suffering.
There is a consensus that health and well-being does not mean only or simply the absence of pain and suffering or the lack of disease, disability, defect and death, but has a positive meaning. There is much debate today over what this positive meaning is. This article is a short introduction to the Buddhist approach to health and disease. After all Buddhism has over 2,500 year history of involvement in medical theory and practice. As a living religion its teachings have much influenced the ways Buddhists think and act in matters of life and death. Since health is a human value that all of us are concerned with, it is hoped that this introduction will serve as a Buddhist contribution to the ongoing discussion on how to define health and therefore the role and function of the modern health care professionals who represent and serve this crucial human value.
Buddhist worldview, dependent origination, and kamma
The Buddhist worldview is holistic and is primarily based on a belief in the interdependence of all phenomena and a correlation between mutually conditioning causes and effects. This belief is formulated by the principle of dependent origination, also referred to as the law of conditionality, the causal nexus that operates in all phenomena – physical, psychological, and moral. In the physical realm, for example, all things in the universe are intimately interrelated as causes and effects without beginning and end. And the world is an organically structured world where all of its parts are interdependent. Similarly in human society every component is interrelated. The same is also found in the psycho-physical sphere, in which the mind and the body are not separate units but an interdependent part of the overall human system1.
The Buddhist worldview also comprises a belief in kamma, the correlation between deed and its subsequent consequences, as in the moral realm this principle of dependent origination operated by the name of the law of kamma stating the conditionality of this causal relation2. This implies that the Buddhist law of kamma does not entail complete determinism. If such a determinism were accepted there would be no possibility of the eradication of suffering. A man would ever be bad for it is his kamma to be bad. But this is not so and the effect of kamma can be mitigated not only in one life but even beyond, as, according to Buddhism, life is not limited to a single, individual existence. Present life is only a part of the round of existence (samsara) which stretches out across space and time. A single existence is conditioned by others proceeding it and in turn conditions one or a series of successive existences. Existence is thus at the same time and effect in one respect and a cause in another. This imprisonment in the round of existence is the result of one’s own deeds (kamma), good or bad. Conditioned by deeds, the present form of existence can be changed or dissolved by deeds. This is possible because the present is not the total effect of the past. It is simultaneously cause and effect. As an effect, we are conditioned by the causal matrix made up of the social and biological continuities of life themselves and thus are the effect of our past deed. What we are now is the result of what we have been before. But as a cause, we are the absolute master of our destiny. The present, though elusive, is the building block of the future. What we shall be depends on what we are and shall do, with our own choice.
Dependent origination, health, and kamma
Within this worldview, health and disease involve the overall state of a human being and are interwoven with many factors such as economics, education, social and cultural milieu. All these conditional factors need to be seriously taken into account in the understanding of health and disease. Health is therefore to be understood in terms of holism. It is the expression of harmony – within oneself, in one’s social relationships, and in relation to the natural environment. To be concerned about a person’s health means to be concerned with the whole person, his (her) physical and mental dimensions, social, familial, and work relationships, as weel as the environment in which he (she) lives and which acts on him (her). Therefore the tendency to understand health only in relation to particular parts of the human organism such as the defects in unacceptable to Buddhism. In the Buddhist holistic perspective, disease is the expression of the disturbed harmony in our life as a whole. By its physical symptoms, disease draws our attention to this disturbed harmony. Hence healing in Buddhism is not the mere treatment of these measurable symptoms. It is more and expression of the combined effort of the mind and the body to overcome disease than a fight between medicine and disease. Its real aim is to enable the patient to bring back harmony within himself and in his relationships with the others and the natural environment. In this context healing is not an end in itself, but rather a means by which medicine helps to serve the value of human health and well-being.
Apart from this holistic approach, Buddhism attributes kamma as an important contributing factor to health and disease. In the Buddhist perspective good health is the correlated effect of good kamma in the past and vice versa. This interpretation of health and disease in terms of kamma is to emphasize that there is a relationship between morality and health. Health depends on our life-styles, i.e. the way we think, the way we feel, and the way we live. Illness is the consequence of an unhealthy life-style such as one characterized by sensual indulgence, for example. This is the normativistic component of the Buddhist perspective on health which involves the practice of moral and religious values such as compassion, tolerance, and forgiveness. This is the underlying reason why Buddhism advises those who want to be healthy to practise morality (sila), mental discipline (samadhi), and wisdom (panna), in the Noble Eightfold Part.
Perhaps we will understand the role of kamma in health and illness as we look at the following cases. For example, in the time of an epidemic there are usually some people who succumb while others escape even though both groups are exposed to the same conditions. According to the Buddhist view the difference between the former and latter is due to the nature of kamma of each in the past. Other examples are the cases where though the treatment given was successful the patient died, and where in spite of ineffective treatment the patient lived. There have also been cases of remarkable and unexpected recoveries when modern medicine has given up all hope for remission. Such cases strengthen the Buddhist belief that besides the physical cause of disease, illness can be the effect of bad kamma in past lives. A disease with a kammic cause cannot be cured until that kammic result is exhausted. But the kamma of every person is a mystery both to himself and others. Hence no ordinary person can definitely know which disease is caused by kamma. Therefore one has to be careful in imputing kamma especially for disease because it may lead to a fatalistic attitude of not seeking any cure at all or giving up treatment out of despair. Buddhism advises us that for practical purposes we have to look upon all diseases as though they are produced by mere physical causes. And even if the disease has a kamma cause it should be treated. As no condition is permanent and as the causal relation between deed and its correlated consequence is more conditional than deterministic there is the possibility for the disease to be cured so long as life continues. On the other hand we cannot tell at what point the effect of bad kamma will be exhausted. Therefore we need to take advantage of whatever means of curing and treatment are available. Such treatment, even if it cannot produce a cure, is still useful because appropriate physical and psychological conditions are needed for the kammic effect to take place. The presence of a predisposition to certain diseases through past kamma and the physical condition to produce the disease will provide the opportunity for the disease to arise. But having a certain treatment will prevent a bad kammic result manifesting fully. This kind of treatment does not interfere with the working of the individual kamma but reduces its severity. The advice of Buddhism to a person with and incurable disease is to be patient and to perform good deeds to mitigate the effects of the past bad kamma. At least the individual effort to maintain or recover is itself good kamma.
The belief in kamma in relation to health and disease does not lead to fatalism, nor to pessimism. As mentioned before, the law of kamma does not rule with an iron hand or bring a curse. This law only stresses the causal relation between cause and effect. It does not entail complete determinism. Te believe in kamma is to take personal responsibility for health. Health is not given. It has to be gained by one’s own efforts, and one should not blame others for the suffering one is going through because of the disease. Besides, it may be a comfort to think that our illness is no fault of our present lives but the legacy of a far distant past, and that by our own attitudes and efforts towards illness good kammic effects can arise. The belief in kamma also enables us to cope with the painful aspects of life, for example suffering from terminal illness such as leukemia or a more malignant form of cancer with tranquility and without fruitless struggle, nor negative and depressing mental states. Such acceptance will also enable us to overcome despair, endure the condition to the last days, and thus die a peaceful death.
The emphasis on the kammic cause of health and disease implies individual responsibility for health and illness. Kamma is created by choices we made in past lives. Health is to be gained by continuing personal efforts in this life. Good deeds (e.g.regular exercise, proper nutrition, etc.) lead to good health whereas bad deeds (e.g. poor living habits, abusing the body and the mind) in this and previous lives bring illness. The sense of responsibility is much needed in health care. At present, with the invention of “miracle drugs” and the development of new technologies, many people tend to have the illusion that all pain and suffering in life can be eliminated and that all suffering is bad, whether physical, mental, emotional, moral, or spiritual. And by blaming it on external forces people seek external means (e.g. pills, injection, therapies, etc.) of alleviating suffering rather than examining themselves and their own lives and seeking to change what it is within themselves that has resulted in illness. The Buddhist kamma view of health and disease, on the contrary, recognizes the reality of self-inflicted disease that can be traced to an individual’s own life-style and habits, and encourages one to seek also for the cause of our disease, pain, and suffering within oneself, e.g. in relation to one’s own life-styles, decisions, attitudes, and relationships that must be changed. It also recognizes the positive role of disease and suffering in refining our spirit and in strengthening our moral character, e.g. courage, self-understanding, and sympathy towards others.
However, the Buddhist emphasis on individual kamma or personal responsibility for health does not mean that Buddhism assigns personal responsibility for all illness. In the Buddhist view kamma has both individual and social dimensions. This latter component is what may be termed as social kamma which, in health care, refers to the environmental factors that could aggravate or mitigate and individual kamma. These factors such as socio-economic factors, e.g. unhealthy and dangerous working conditions, can act as the hazardous/supporting environment for health/illness of and individual. And society could hold employers and businesses responsible if they did not maintain a healthy environment for their workers or provide safety measures. This concept of social kamma also implies responsibility on the part of government to provide adequate health care services to all its citizens in proportion to their health needs and medical conditions.
The body and physical health
In the Buddhist perspective the unique body of each of us, both in appearance and structure, is a result of our past kamma. The human body is at the same time the means by which we contact the world and the physical manifestation of our mind. Being such an important instrument, the body must be duly attended to, i.e. one must not abuse it through food, alcohol, drugs, or by taxing it with over-indulgence and deprivation. Even enlightenment, the highest goal of Buddhism, cannot be attained by the mortification of the body, as witnessed in the personal experience of the Buddha. This is due to the interdependency of the mind and the body. Intellectual illumination can be attained only when the body is not deprived of anything necessary for the healthy and efficient functioning of all bodily organs.
According to Buddhism, any life lived solely for self-seeking or self-indulgence is a life not worth living. Buddhism therefore encourages us to make use of the body for higher purposes, particularly for attaining the highest goal, nibbana, liberation from the endless cycle of birth and rebirth (samsara) as subjects of contemplation. Constant practice of morality and meditation will enable us to have self-control over the appetites, sensations, and egoistic drives.
Physical health is viewed by Buddhism as constituted by the normal functioning of the body and its organically interrelated organs. When one of them fails to function, debility and disease set in. The normal function of the body organs is the result of the harmony and equilibrium of the four primary elements in the body, i.e. earth (pathavi), water (apo), wind (vayo), and fire (tejo). If the balance is disturbed, the normal function is disrupted and a state of disease appears. Curing is the restoration of this balance, i.e. putting the entire physical being, and not just the pathologically afflicted part, into good condition. Since each part of the human body is organically related to all other parts, for good health the entire body must be in good condition. In view of the fact that the body, like all phenomena, is always in a state of change, decline, and decay, physical health cannot last long. It is impossible for the body to be perfectly healthy and free from all diseases at all times. Human life is vulnerable to disease at very stage. Disease is a reminder of human fragility. This implies that (complete) health is not a totally attainable state. Human wholeness or well-being, therefore, does not mean the absence of all pain and suffering in life, but learning to deal with pain and suffering, how to use it and transcend it for the sake of personal growth and sympathetic understanding of others.
The Buddhist understanding of physical disease in terms of the disturbance of the harmony and equilibrium in the body is different from the militaristic view of disease focused on the hostile germs. According to this view disease is caused by the attack of the hostile germs in the environment to a particular part of the body. These different views lead to different ways of curing. The Buddhist way is to bring harmony to the body where disharmony has taken place either by medicine or by the change in thought and way of living. Medicine is used to boost the body’s self-healing power i.e. to be able to deal with the disease, to restore the balance in its own way. Healing is more an expression of the combined efforts of the mind and the body to overcome disease than a fighting between medicine and disease. On the contrary the other way is to fight back the germs with drugs which usually are chemical. The effectiveness of these drugs depends on their attacking power on the inflicted part and not on the restorative power as in the case of Buddhism.
The mind and mental health
Physical health is important because Buddhism regards is to be the means to intellectual enlightenment. Buddhism does not want people to spend a large part of their lives in poor health or else they will not be able to devote themselves to the highest purposes. Although Buddhism views the mind and the body in interdependence, its teaching gives special attention to the mind and its power. It is stated in the very first verse of the Dhammapada that what we are is the result of our thoughts. The source of our lives and hence of our happiness or unhappiness lies within our power. No one can harm us but ourselves. It is the kind of thought we entertain that improves our physical well-being or weakens it, and also ennobles us or degrades us. This it the reason why Buddhism designates thought as the cause of both physical are verbal actions with their kammic results and considers mental health of the utmost importance and the training of the mind to attain the highest stage of health as its sole concern. This preoccupation with mental health is also regarded as the true vocation of Buddhist monks. The training is based on the belief that both the body and the mind are prone to sickness. But since the mind is able to detach itself from the body it is possible to have a healthy mind within a sick body.
According to Buddhism for the mind to be healthy, first it is necessary to develop a correct view of the world and ourselves, i.e. a realistic acceptance of the three traits of existence: impermanence, insubstantiality, and suffering of unsatisfactoriness. The adoption of the wrong views makes us see the transitory as permanent, the painful as happy, the impure as pure, and what is not-self as self. Consequently we crave and struggle for what is not something that does not seem to change, e.g. the illusory permanent and identical self and the permanent object od desire -and we always suffer disappointment. By accepting thing as they reality nothing more than a name for the complex of psycho-physical elements (nama-rupa) – the mind no longer strives for the satisfaction of self-seeking impulses nor clings to objects. As a result the mind is at rest and thereby psychological suffering is eliminated leading to improved mental health.
Apart from changing our thought by the adoption of this correct view and by developing an attitude of detachment towards the world and ourselves, our mental health is dependent on our power to rein in our appetites and to restrain and/or eradicate negative motions much as greed (lobha), hatred (dosa), anger (moha), and our possessive and aggressive tendencies. All these unwholesome states can act as the cause of mental and physical illness. Such control can be achieved through the practice of morality and meditation. Every set of Buddhist precepts and every type of meditation are aimed at controlling the senses, impulses, and instincts and easing the tension and eliminating the unwholesomeness of thoughts that tend to make the mind sick.
Buddhist meditation is not only a means to cure the mind from its ailments caused by incorrect views, self-indulgence, hatred, and anger of all forms, but is also devised as a means to induce positive wholesome mental states, particularly the four sublime states: loving kindness (metta), compassion (karuna), sympathetic joy (mudita), and equanimity (upekha). Loving kindness enables us to love and be kind to one another while compassion wants us to help those in distress. Sympathetic joy is an ability to rejoice in the joy of others and equanimity is the equanimous temperament without being either elated or dejected in the face of the vicissitudes of life – gain and loss, fame and lack of fame, praise and blame, happiness and sorrow. The continual cultivation of these wholesome mental states is an important Buddhist way of making the mind healthy. Actions spring from this healthy mind are always good and wholesome and thus conductive to our holistic health. This over-all health is reflected in all aspects of life including thinking, speaking, living and doing.
The Buddhist concept of health and disease is formulated within the context of the principle of Dependent Origination and its related law of kamma. Accordingly health and disease are to be understood holistically in their over-all state in relation to the whole system and environmental conditions-social, economic, and cultural.
This view is diametrically opposite to the analytic view which tends to dissect human beings into different segments both in the physical and mental realms. As a result health is defined too narrowly as the mere absence of measurable symptoms of disease. Doctors and other medical personnel who hold such view direct their attention to particular parts of a person when considering whether or not a person is healthy and have not been concerned enough with their patients as whole human beings, reducing their care of them to the quantifiable control of physical symptoms. The Buddhist holistic perspective, on the contrary, focuses on the whole person and argues that since human beings are not merely physical creatures but mental, emotional, social and spiritual beings as well and that, as a psychosomatic unity, bodily illness affects the mind and emotions and emotional, mental and social maladjustments can affect the body, then to be concerned about a person’s health one must be concerned about his entire person, body, mind and emotions, as well as his social environment. This may seem an utopian goal that medicine or health care services alone cannot accomplish. But it should be thought of and striven for Perhaps this overall health could be made possible only through the concerted efforts of medicine, the individual and social agencies concerned.
1. The most detailed and coherent systematic exposition of the principle of Dependent Origination is given in Visuddhi Magga: The Path of Purification.
2. This law is also referred to as the law of causality according to which a deed is likened to a seed which will sooner or later result in certain fruits.