TRANS Nr. 16: Jan Bärmark (Göteborg University, Institute for History of Ideas and Theory of Science, Sweden): Science and Wisdom: Tibetan Buddhist Medicine and Anthropology of knowledge

Jan Bärmark (Göteborg University, Institute for History of Ideas and Theory of Science, Sweden)

Ways of world making

Anthropology of knowledge implies in a sense a relativizing of our concepts of "knowledge" and "realism". There are many ways of world making and the objective world is capable of being represented in many ways. In anthropology of knowledge it is understood that it is possible for us to have important knowledge of the world even if this objective world is subject-dependent and our knowledge of it is culturally moulded; and even if we give up trying to describe the world independent of our involvements with it or conceptions about it. There are many points of view and not only one kind of rationality in understanding them.

A tension between romanticism and the philosophy of enlightenment

Anthropology of knowledge implies an epistemic break with traditional scientistic philosophy of science. Ever since the beginning of modern science, the typical strategy of scientistic minded philosophers, when confronted with the claim that there are other forms of knowledge in addition to those evidenced by the formal and natural sciences, has been to argue that whatever is rational in other forms of knowledge can be translated and assimilated or reduced to the standards and criteria of scientific discourse. What cannot be translated, assimilated and reduced must be labeled pseudo-knowledge and rejected. What is at stake here is an ongoing critique of the West’s most confident characteristic discourse. But there is a paradox here, and this paradox is situated in the very heart of anthropology of knowledge. In criticizing Eurocentrism, logocentrism, phallocentrism and scientism the anthropologist of knowledge is him or herself an exponent of the typically European tradition of doubt and self-reflexivity, the capacity to look at oneself through the eyes of the others. Europe’s cultural identity contains precisely this element of uncertainty and inquietude. Thus anthropology, in a sense, is caught up in the classical paradox of skepticism. In the very denial of Europe’s unique intellectual position, the anthropologist of knowledge inevitable confirms and recognizes it. There is a tension in the very heart of anthropology of knowledge: it is a science rooted in a particular culture and a particular epistemic region that claims to be universalistic in scope and capable of covering and understanding the reality of all human cultures.

Anthropology of knowledge contextualizes such categories as "knowledge", "rationality" and "truth", seeing knowledge claims in relation to cultures and their cosmologies. It is a critical analysis of the meaning of rationality, not a denial of rationality. Rationality might be an Occidental obsession, but so are self-criticism and skepticism. In the very questioning of the Western ethnocentrism, anthropology of knowledge inevitably presupposes and confirms the universal value and validity of critical reflexivity itself. The wisdom of anthropology of knowledge should be that the anthropology of rationality should not destroy the rationality of anthropological knowledge. Instead of paralyzing the anthropological project, the doubts of anthropology of knowledge should contribute to a real human science by successively eliminating dimensions of ethnocentric bias. In trying to point out the limits of Enlightenment, anthropology of knowledge still continues and deepens the Enlightenment. But anthropology of knowledge is not just an outgrowth of Enlightenment, it is as much moulded by romanticism. There is a continuous tension between romanticism and Enlightenment here, a tension between the willingness to listen to the idioms of other cultures and their cognitive styles and a nearness to rational criticism. I can see this tension in my own texts. The texts are polyphonic. The voices mirror a tension between romanticism and enlightenment. The tension between romanticism and enlightenment is essential and creative too.

Who is speaking through the text?

There is a discussion in contemporary anthropology about the construction of texts and about the polyphonic text. Many voices are heard in a text. What is meant here is that the informant enters into the text and is a partner in a dialogue with the anthropologist. I would like to mention a kind of polyphonic text where the many voices belong to the author of the text. Thanks to critical readers of my texts on Tibetan medicine, I have been conscious of the many voices of the author of the text. It is not one author of the text but many. One of the voices belong to the ardent student of Buddhism who has been following a Tibetan lama for some fourteen years, listening to his teachings, reflected upon them and meditating in order to make them alive in one’s life. He speaks with the voice of the insider. Then, there is the voice of the skeptical philosopher of science talking about "the native’s mind", "the superiority of Western science", and the cognitive styles of a "pre-scientific culture". This voice belongs to a believer in the Scientific World-view. The two voices live side by side in the same author almost without knowing each other. There are many voices here, but who is authoritative? It depends on the context. In the Buddhist context it is of course the insider who is authoritative. Among anthropologists of knowledge, the voice of enlightenment is authoritative.

Hermeneutic philosophy in its varying styles, from Wilhelm Dilthey and Paul Ricoeur and Hans Georg Gadamer, reminds us that the simplest cultural accounts are intentional creations that interpreters construct themselves through the other they study. It becomes more and more clear that every version of an "other" wherever found, is also the construction of a "self" and the construction of texts in anthropology of knowledge, always involves a process of "self-fashioning". The project in anthropology of knowledge is also a personal quest of self-knowledge. We think through other cultures in order to learn also about our own. This learning about our selves through the thinking through culture is a kind of self-fashioning.

I think through Tibetan Buddhist medicine in order to learn something about my own mind and about existential problems. The two go together. I think through Tibetan Buddhist medicine in order to learn about myself. In listening, reflecting and meditating on teachings from Tibetan lamas in order to gain some kind of self understanding I am in a sense a romanticist. In trying to make my self-understanding into a theoretical discourse within anthropology of knowledge I am likewise a child of the Western philosophy of enlightenment. It is still too early to say to where this schizophrenia will take me. Meanwhile I continue listening to lamas, meditate on their teachings on Tibetan medicine on the one hand and confronting my experiences and ideas with Western theory of science and anthropology of knowledge. In this essay, however, I will restrict myself to present some ideas about the relation between Buddhism and medicine. I will also reflect upon the tension between romanticism and enlightenment in anthropology of knowledge.

At the same time, there is both a wealth of variation in observation and taxonomic stringency as well. Tradition has carefully charted different conditions of the mind and of illness related to or thought to have their roots in them. Reading books on Tibetan or listening to Tibetan physicians talking about medicine, one notices the richness of metaphors, mirroring a closeness to earth, to everyday life and to nature.

On the growth of knowledge

The philosopher and anthropologist Robin Horton makes a distinction between scientific and "progressivistic", and "raditionalistic" cultures such as Buddhism (Horton, 1982). In a progressivistic culture such as ours there is much emphasis on the growth of knowledge. The idea of rationality is linked to the idea of social and cultural progress and the promise that there is a continual growth of knowledge. Every scientific progress is at the same time a cultural and social progress. The knowledge of yesterday is no longer relevant and tomorrow the knowledge of today will be surpassed, if not today, then some by tomorrow. In a traditionalistic culture, on the other hand, there is a transmission of what is considered to be knowledge and wisdom from one generation to another. There are few or no changes within the tradition. The source of knowledge in a traditionalistic culture is the ancients and it is transmitted through the tradition from person to person. Beliefs are accepted, not just because they are seen as age-old, but because they are seen as time-tested. In a traditionalistic culture, such as the Tibetan Buddhism, consensus is stressed, while in a Western progressivistic thinking competition is valued.

In a progressivistic culture the growth of knowledge is enhanced through competition between theoreticians who invent theories just in order to defeat their opponents. A result we get a progressive divorce of secondary theory from practical life. In Tibetan Buddhism and medicine we do not find anything like this critical secondary theory. The medical knowledge is transmitted from teacher to disciple and is close to practical treatment. It is to a high degree a practitioner’s knowledge. "Tradition" and "authority" are central concepts in the Buddhist tradition of philosophy. The Buddha’s teachings, for example are considered authoritative. The tradition gives access to the collective experience within the tradition. For Horton progressivness and traditionalism are measures of rationality. A traditionalistic culture is according to Horton less rational than a progressivisitic one. I doubt that. All forms of rationality do not follow the patterns of progressivistic thinking. Let me quote Hans Georg Gadamer (1983, pp.104-105):

The existential dimension

The idea of a human science according to the anthropology of knowledge stresses the existential dimension. It is a continual ontological quest. The dominant Anglo-American tradition of human and social science believes that true knowledge only can be achieved through method. Hence epistemology is the key to the social sciences and humanities, and ontology is shunned. I think that the reverse is true: the human sciences, and anthropology of knowledge among them, are ontological in the broad sense of concern with human existence. Any attempt to divorce ontology from epistemology cannot succeed but can only produce a shallow ontology. The advance of knowledge in human sciences entails a parallel advance in our knowledge of being cultural and human. The questions to which science does not know the answers should not be shunted aside as they still concern the human mind and have called forth the grand answers of religions such as Buddhism, the mythologies, artistic creations like the tragedies or intellectual works like Aristotle and his vision of phronesis, practical wisdom. This ontological vision must then be self-consciously and explicitly recognized and used as a ground for developing epistemology, and so the process must move back and forth from epistemology to ontology. There are existential themes for us to learn about from Tibetan Buddhism and this conviction is my motivation for studying Tibetan culture. There is, for example, a dimension we may call wisdom which we lack very much in our knowledge society and with which we cannot come to terms by means of scientific rationality. The kind of wisdom I refer to is very akin to Aristotle´s phronesis, practical wisdom. This kind of knowledge is concerned with how to live and with human happiness. That kind of knowledge is different from theoretical knowledge. I think that a view of knowledge that acknowledges that the sphere of knowledge is wider than the sphere of science is a cultural necessity if we are to arrive at a sane and human view of ourselves and our science.

Wisdom according to Buddhism has two dimensions. There is wisdom that inheres in one’s own mind and there is wisdom to be attained through meditation. In both cases wisdom is realized through an inner transformation. While we in the West are mainly concerned with studying the outer reality, Buddhism is a science of the inner (nang pa). The wisdom to be attained through a progressive path comes very close to Arisotelian phronesis, practical wisdom. The Tibetan sherab could roughly be translated as discriminatory wisdom. In order to grasp all the nuances in the word we must understand it in its proper contexts. There are six virtues that accompany discriminatory wisdom. These are generosity, patience, morality (tsultrim), enthusiasm, mindfulness and wisdom. All these virtues open the door to a well balanced way of life in which we can cultivate wisdom.

Science has to do with public knowledge. Wisdom is concerned with personal knowledge. We need both in to create a better society. Wisdom and science are complementary. They need each other. Science should be in the hands of wise men and women. The way to develop our inner wisdom is likened to purifying gold. We must purify our inner gold, our Buddha-nature, our potential for enlightenment, from disturbing emotions and distorted concepts. The Buddha also thought about the two truths, a central idea in Nagarjuna´s philosophy. There is the conventional truth and the absolute truth. Conventional truths are all the ways of understanding we take for granted in our everyday life such as the idea of having an inherent self. Scrutinizing phenomena closer in meditative analysis we realize that all phenomena lack inherent self. All phenomena arise because of interdependent causes and disappear because of interdependent causes. No phenomenon exists due to itself. No phenomenon can be understood in isolation. Everything is interconnected. The essence of all phenomena is shunyata which could be rendered as no-thing-ness. Phenomena do not have the character of things.

Thinking through cultures.

Richard A. Schweder`s expression (1991) "thinking through culture" catches something important in our version of anthropology of knowledge. We think through Tibetan Buddhism in order to get a perspective on Western idioms of thinking, science, psychoanalysis, philosophy, feminism and why not ecology. We approach epistemological and ontological problems by thinking through other cultures, Buddhism for example. Thinking through cultures means that we "anthropologize" Western science: showing how exotic its constitution of reality has been; emphasizing those domains most taken for granted as universal and make them objects of critical reflection. Anthropology of knowledge is basically a feeding of methodological doubt. As an anthropologist of knowledge I expose my own habits, ideas, concepts and values to those of the other culture. In order to understand alien concepts, one has to entertain doubts about the absolute validity of those in one’s own culture. The exploration of Tibetan Buddhist ideas about karma and rebirth for example is also to scrutinize our Western conceptions about life and death.

This thinking through cultures and thought styles could take place in the form of a dialogue. I will give you an example, the Mind & Life dialogues in which H.H. the Dalai Lama and a group of Western and Tibetan Buddhists and Western scientists since 1987 have gathered to share ideas about such diverse topics as science and Buddhism, artificial intelligence, science and ethics, body-mind, the significance of emotions for physical and psychic wellbeing. The dialogues are documented in a series of books the latest of which is called Destructive emotions. There are many ways to think through other cultures. We think through other cultures by means of the other (viewing the other as an expert in some realm of human experience). I follow the traditional way in Tibet which means that I listen to the teachings given by lamas on Buddhist philosophy and medicine, reflect upon it and meditate. When I interviewed the Tibetan lama Khenpo Tsultrim Gyamtso about Tibetan medicine he gave me the advice to practice a series of meditations on Sangye Menla. He also very much stressed the importance of my motivation for studying Tibetan medicine. My motivation, he said, should be to study Tibetan medicine in order to be able to benefit others. We can also think through other cultures by deconstructing and going right through and beyond the other (revealing what the other has suppressed and kept out of sight) In order to do this kind of deconstruction we have to introduce theoretical concepts and theories from theory of science. We need so to say a meta-platform from which we can see what is not possible to see from within the culture. So, there is a continual shifting between a willingness to listen and a willingness to suspect, a perspective from inside and a perspective from outside.

Examinations of the mind

Examinations of the mind through different kind of meditations are considered to give reliable knowledge about mental processes and even the nature of the mind itself. Understanding the mind is essential to understanding Buddhism in its theoretical and practical aspects, for the process of achieving enlightenment. Consciousness is examined mainly by dividing it into types and subtypes from several points of view, whereby a student develops a sense of the variety of consciousnesses, their functions and interrelationships. Besides these theoretical studies the students also have to learn about their minds through meditation practices. Different kinds of meditation work like effective means for an analysis of our ways of world making. The analysis is directed to the role played by different mental factors in our perception of the world. As we can see there are many topics here for a conversation between Buddhists and psychologists, psychiatrists and psychologists. While the Western sciences of mind are studying the mental processes in other persons in different ways, Buddhist "psychology" is an ongoing quest about one’s own mind, a mindfulness about our inner life, how our emotions and concepts influence our way of thinking and behaving. Mindfulness is a means for observing our mind stream in a detached way. To put it in Jürgen Habermas´ terms: Buddhism and psychoanalysis share the same hermeneutic emancipatory knowledge interest, to liberate man from false self-understanding.

All medical knowledge stems from the Buddha´s wisdom

The relationship between Buddhism and healing is innate and extraordinary. According to the traditional life of Sakyamuni, the historical Buddha, the sight of a sick man was one of the catalytic events that awakened the young prince to the problem of human suffering and inspired him to begin his spiritual search. Sakyamuni´s Four Noble Truths provide a key to the fundamental significance of healing in Buddhism, for they indicate that he who is not enlightened is by definition "ill". Sakyamuni Buddha is portrayed as a great healer in the Pali Canon. It is said that the Buddha is the Supreme Physician, the healing treatment, the medicine and the therapeutic regimen - is the Dharma: and the attendants are the members of the Order. The Buddha frequently made analogies to disease and healing to explain various facets of the teachings. The entire teaching of the Buddha is on how to prevent suffering. The healing process is akin to the enlightenment process. His healing methods were twofold: healing through teaching, and psychic or "miraculous" healing. The Buddha taught patients according to the severity of the disease. Those with fatal diseases received lessons on impermanence, while those who could be cured were taught to meditate on the "seven limbs of enlightenment". (1. mindfulness, 2. investigation of things, 3. striving, 4. joy, 5. tranquility, 6. meditative trance, and 7 equanimity). The seven limbs are sometimes used as a device for summarizing the Buddhist teaching. In the context of healing they are used as successive steps in meditation.

The prescription of meditative exercise as a cure for disease indicates that illness, from a Buddhist point of view, are intimately linked to mental states gone awry. If the mental currents of the patient can be clarified and rectified, then the cause of the illness will be removed, and the patient will be cured. From a traditional Buddhist point of view, the meditation on the seven limbs of enlightenment can be seen as a method for overcoming the interior poisons often mentioned in the teachings - lust, anger, and delusion. These interior poisons are related to the three physiological humors (phlegm, bile and wind), which in imbalance cause disease. According to the Buddha, we suffer from the inherent frustration of conditioned existence, and our suffering is caused by the fact of the impermanence of all entities and by the endless craving that arises from the basic delusion of the ego´s self-existence. "There is but one cause for all illness, and this is ignorance due to not understanding the meaning of ‘identitylessness’ (lack of an in-dependently-existing ego)". In the typical way of reasoning with metaphors a Tibetan doctor explains that even when a bird soars in the sky, it does not part from it shadow. Likewise, even when all creatures live and act with joy, because they have ignorance, it is impossible for them to be free from illness. The Tibetan doctor, Yeshe Donden, expresses the matter drastically. "All people are basically sick." The medicine that the Buddha prescribed to overcome our suffering and delusion is his teachings, the Dharma. And the essence of these teachings is to tame the mind and transform the negative emotions.

Because Buddhist teachings are primarily on the nature of the mind, it is not remarkable that psychiatry holds a unique position in Tibetan medicine. As with regard to all forms of suffering, somatic or existential, one sees the root of evil in man’s confusion, his misconceptions about his own mind. Too much confusion, hate or craving leads to an imbalance and thus to illness. However, in a more limited perspective, five causes of psychological ill health are primarily pointed out: karma, sorrow/worry, imbalance of the humors, poisons and demons. By demons the Tibetan medicine means different types of non visible powers and emotions that have the power to create imbalance.

The continual emphasis on the Supreme Physician (the Buddha) and his medicine

His teachings indicate a fundamental attitude of Buddhism: dispassionate compassion. The great physician, a model of selfless compassion devotes his life to easing the pains of others. Retaining an attitude of detachment, he does not allow his emotions to be tangled with his work, and he cures his patients in an efficacious manner. The Buddha, the Supreme healer should be the ideal for all Buddhists. The doctor in Tibetan medicine is the ethical paradigm for the Buddhists. The Buddhist poet Shantideva uses the metaphor of the doctor to describe the Bodhisattva.

The Bodhisattva, out of love for all beings, tiny bugs and kings equally vows to put off his own entrance into nirvana so that he may stay in the world to liberate all other beings from suffering before himself. In this ideal there is no separation of healing skills from Dharma. The greater a person’s realization of Dharma, the greater a doctor can be, for he will have the two-fold Buddha-nature aspects of wisdom and compassion, rendering him more capable of understanding the depths of medical science and serving the physical, emotional and spiritual needs of the patient.

The education of doctors

The first dimension in Tibetan medicine is the concrete material reality, the social context of the monastic environment and its place and function within the wider culture. Amchi is a doctor and a monk. Medical science and religion are integrated. Amchi was educated in a culture permeated with Buddhist philosophy, just like doctors in many other Buddhist cultures. His education took about thirteen years, during which he studied medicine and learned to recognize, collect and make herbs into medicine. Like other medical students, he began his studies at three o´ clock in the morning with prayers to Manjushri, the Buddha of wisdom. Thereafter he studied medical and astrological texts which he recited and memorized until six o´ clock. Physical exercises came next on the schedule, and at eight o´ clock prayers were offered to Sangye Menla, the medicine Buddha. After breakfast there was time for individualized instruction depending upon the level of the student. Astronomy and medicine were studied in parallel with oral commentary to the texts. New students were required to learn grammar and write poetry. Studies continued the rest of the day until near evening, when students gathered to debate medical and astrological questions. After many years of studying, at student is allowed to train together with a doctor, in order to gain further proficiency. The doctor’s mental characteristics are valued very highly. The training of doctor is more than a matter of intellectual training. The doctor also has to learn about his own mind, and the means for that are many types of meditation. Through recitations and visualizations where the doctor sees him self as the Medicine Buddha, he tries to transform negative emotions such as greed, egotism or attachment into wisdom and compassion. The Buddha is the ideal doctor and the meditations are means for awakening the latent potentials for enlightenment in the medical student.

The recounting of my visit to Shekar Amchi is a "thin" description of Tibetan Buddhist medicine. How may we come to a thicker description? The very socio-cultural context in which Shekar Amchi works is interesting. We have to articulate the worldview in the medicine, its ontological as well as epistemological and ethical assumptions. A thick description of the clinical reality in Tibetan medicine implies an analysis of the social structuring of the medical reality. How are the realities of illness constructed? How does the medical treatment transform the reality of illness into restored health from the perspective of the patient, those in the patient’s social network and the physician?

"Knowledge" in Tibetan Medicine

As in all other areas of Tibetan medicine, the Buddha is a paradigm also in epistemological matters. Therefore it is said that all medical knowledge stems from the wisdom of the Buddha. The very "philosophical" basis of Tibetan medicine, its image of man and its cosmology is an outcome of "Buddha´s enlightenment". Tibetan medicine has changed very slowly. Reading books on Tibetan medicine or listening to Tibetan physicians talking about medicine, one notices the richness of metaphors mirroring closeness to earth, to everyday life and to nature. At the same time, there is both a wealth of variation in observation and a taxonomic stringency as well. Tradition has carefully charted different conditions of the mind and of illness related to or thought to have their roots in them. It has its beginning in a practitioner’s tradition woven into a prolonged religious tradition which has changed very slowly. Analogies play a central role both in Buddhist philosophy and in medicine. In a chapter about embryology, for example, the following analogy is given. "Just as the combination of three things together (that is dry soft wood, tinder, and their preparation) causes fire, so three things are needed for the formation of a body; perfect semen without any flaw caused by diseases, menstrual blood, and the mind of the intermediate (bar-do) state driven by the right karma." According to Tibetan medicine physical diseases always have "psychological" dimensions and vice versa. Tibetan medicine can be characterized from considerations such as these as craftsmanship based on Buddhist philosophy and influences from a number of the culture’s traditional medicines, together with their own experiences.

Sources of knowledge

What are the sources of knowledge according to Tibetan medicine and how are they related to the Buddhist philosophy? What are the epistemological assumptions behind all this? Sources of knowledge are socially and culturally determined. The central concepts in any epistemology are relative to cultural frameworks and are the result of social consensus. There are many such sources of knowledge and we will just give a partial list here: experience, the evidence of one’s senses, clear and distinct ideas, tradition, authority, revelation, novelty, beauty, intuition and analogy.

If we apply this list to Tibetan medicine we may note that "experience" plays a central role: experiences from making medicines, from treating sick people and animals, from analyzing dead bodies etc. One learns from the experience of treatment. The doctors observe the sick bodies, but they do not do experiments. Their observations have an experiential flavor. Their knowledge of health and sickness comes mainly from observations of the body together with meditative experiences concerning the more subtle energy-body which is impossible to see with one’s naked eyes. Thousands of channels in the body transport different kind of energies and only meditative experiences can give us information about these energy channels. It requires great meditative skills in order to "see" these channels with one’s "mental eyes" The greater one’s meditative skills are the better perceiver one will be. In Tibetan medicine and in the Buddhist philosophy it is the perceiving mind that is crucial while in Western science it is our models. Experience in Buddhist philosophy and in Tibetan medicine is personal. It is a personal knowledge.

Bärmark, J. (1991). Tibetan Buddhist Medicine from the Perspective of Anthropology of Knowledge. Tibetan Medicine, 13, 3-37.

Horton, R. (1982). Tradition and Modernity Revisited. In M.Hollis & S.Lukes (Eds.), Rationality and Relativism. Oxford: Blackwell.

Schweder, R. (Ed.).(1991). Thinking Through Cultures. Cambridge: Harvard University Press.

For quotation purposes:
Jan Bärmark (Göteborg University, Institute for History of Ideas and Theory of Science, Sweden): Science and Wisdom: Tibetan Buddhist Medicine and Anthropology of knowledge. In: TRANS. Internet-Zeitschrift für Kulturwissenschaften. No. 16/2005. WWW: http://www.inst.at/trans/16Nr/09_2/baermark16.htm