Medical Analogies in Buddhist andHellenistic Thought: Tranquillity andAnger
CHRISTOPHER W. GOWANS
Medical analogies are commonly invoked in both Indian Buddhistdharma and Hellenistic philosophy. In the Pli Canon, nirvana (or,in Pli, nibbna) is depicted as a form of health, and the Buddha is por-trayed as a doctor who helps us attain it.1 Much later in the tradition,ntideva described the Buddhas teaching as the sole medicine forthe ailments of the world, the mine of all success and happiness.2Cicero expressed the view of many Hellenistic philosophers when hesaid that philosophy is a medical science for the mind. He thoughtwe should hand ourselves over to philosophy, and let ourselvesbe healed. For as long as these ills [of the mind] remain, he wrote,we cannot attain to happiness.3 There are many different forms ofmedical analogy in these two traditions, but the most general formmay be stated as follows: just as medicine cures bodily diseases andbrings about physical health, so Buddhist dharma or Hellenisticphilosophy cures mental diseases and brings about psychologicalhealthwhere psychological health is understood as the highestform of happiness or well-being. Insofar as Buddhist dharma involvesphilosophy, as it does, both renditions of the analogy may be said todeclare that philosophy curesmental diseases and brings about psycho-logical health. This feature of the analogyphilosophy as analogous tomedical treatmenthas attracted considerable attention.4
1 For example, see Bhikkhu namoli and Bhikkhu Bodhi, eds. andtrs., The Middle Length Discourses of the Buddha (Boston: WisdomPublications, 1995), pp. 6146 and 867 (I 51012 and II 260). For ancienttexts, ordinary pagination is followed by standardized pagination (inparentheses).
2 ntideva, The Bodhicaryvatra, Kate Crosby and Andrew Skilton,trs. (Oxford: Oxford University Press, 1995), p. 143 (10.57).
3 Cicero, Cicero and the Emotions: Tusculan Disputations 3 and 4,Margaret Graver, tr. (Chicago: University of Chicago Press, 2002), pp. 5and 70 (3.6 and 4.84).
4 For example, with respect to Buddhism, see Richard Gombrich,Theravda Buddhism: A Social History from Ancient Benares to Modern
11doi:10.1017/S1358246109990221 The Royal Institute of Philosophy and the contributors 2010
Royal Institute of Philosophy Supplement 66 2010
My thesis in this chapter is that in both Indian Buddhism andHellenistic philosophy the medical analogy in its various formshas some importance, but not as much importance as its intuitiveappeal and the frequency with which it was invoked might leadone to suspect. There are good reasons why these traditions weredrawn to the analogy. However, there are significant disanalogiesbetween medical practice and physical health on the one hand,and philosophy and psychological health as understood in thesetraditions on the other. These differences turn on three central fea-tures of Buddhism and Hellenistic philosophy: their radical con-ceptions of psychological health; the inevitable moral questionsthese conceptions raise; and the assumption that attaining psycho-logical health requires modifying or eliminating beliefs in responseto rational argument (at least to some extent), in order to attainwisdom.
The Meaning of the General Form of the Medical Analogy
Any assertion of medical analogies presupposes some understandingof medicine in the primary sense. In both India and theMediterranean world, in the time periods we are considering, therewere on-going traditions of medicine that may be interpreted, froma contemporary standpoint, as involving, on the one hand, an arrayof religious, ethical, and magical approaches and, on the otherhand, emerging empirically-based techniques (emphasizing empiri-cal observations in understanding diseases, their causes and theirremedies). In both contexts, the practice of medicine was bothmore fluid and less autonomous than in modern Western medicine.It is hard to know how effective these ancient medical practiceswere, but presumably claims of expertise were made on theirbehalf, however well-founded, and the assertion of the medical ana-logies obviously presupposes respect for at least some of these
Colombo (London: Routledge, 1988), pp. 2 and 59, and with respect toHellenistic philosophy, see Martha Nussbaum, The Therapy of Desire:Theory and Practice in Hellenistic Ethics (Princeton, NJ: PrincetonUniversity Press, 1994) and Julia Annas, Philosophical Therapy, Ancientand Modern, in Mark G. Kuczewski and Ronald Polansky, eds.,Bioethics: Ancient Themes in Contemporary Issues (Cambridge, MA: TheMIT Press, 2000), pp. 109127. They are briefly compared in ThomasMcEvilley, The Shape of Ancient Thought: Comparative Studies in Greekand Indian Philosophies (New York: Allsworth Press, 2002), pp. 5967.
Christopher W. Gowans
claims. There were, in fact, significant interactions between medicalpractice and both Buddhism and Greco-Roman philosophy.5These interactions probably played some role in the developmentof the medical analogies.The practice of medicine employs the contrary concepts of physical
disease and health. To some extent, these concepts were, and still are,contested. However, there is likely to be considerable overlap in theirreferents, consistent with considerable diversity in their meaning andinterpretation. Physical disease (including injury) presumably refersto such things as: physical pain that is abnormal, excessive, orchronic; failures or disruptions of basic bodily functions; and con-ditions that threaten premature death. Physical health, by contrast,involves the absence of these things and perhaps, more positively,some notion of well-being characterized as an optimal bodily con-dition. These ideas of disease and health inevitably depend onsome beliefs about what is normal for the species. It is reasonableto suppose that ancient medical practices, in India and theMediterranean world, assumed some such understanding of diseaseand health, and claimed to have some expertise in promoting healthby preventing or curing disease. This expertise must have rested onsome purported understanding of the causal conditions of diseaseand health, and skill in influencing these conditions so as topromote health.If we think ofmedical practice in these terms, then the general form
of the medical analogies (hereafter, the medical analogy) may beunderstood asmaking two points: first, there are some analogous con-cepts of disease and health in the mental or psychological realm, andsecond, Buddhist dharma or Hellenistic philosophy has an analogousexpertise in promoting this state of health, an expertise that involvessome knowledge of the causal conditions of disease and health, andsome skill in affecting these conditions in ways that promote health.In fact, in Buddhism and the Hellenistic schools, both of theseclaims were regularly made.
5 In the case of Buddhism, see Kenneth G. Zysk, Asceticism andHealing in Ancient India: Medicine in the Buddhist Monastery, CorrectedEdition (Delhi: Motilal Banarsidass Publishers, 1998). In the case ofHellenistic philosophy, see Ludwig Edelstein, The Relation of AncientPhilosophy to Medicine, in Ancient Medicine: Selected Papers of LudwigEdelstein, Owsei Temkin and C. Lilian, eds. (Baltimore: Johns HopkinsUniversity Press, 1967), pp. 34966 and James Longrigg, Greek RationalMedicine: Philosophy and Medicine from Alcmaeon to the Alexandrians(London: Routledge, 1993).
Medical Analogies in Buddhist and Hellenistic Thought
There are, however, some complications. One is that both of thesetraditions purported to be concerned with physical disease itself. InBuddhism, bodily illness was one of the primary forms of sufferingthat enlightenment enables us, in some way, to overcome, andHellenistic philosophy was no less preoccupied with the threat thatphysical illness was thought to pose to our well-being. However,neither tradition presented itself as offering an alternative tomedical practice in the primary sense. In various ways, the value ofthis practice was affirmed. But it was tacitly assumed that medicalpractice has significant limitations and that physical disease is amore or less inevitable feature of human life. There is, perhaps,some incongruity in this stance, at least insofar as the assertion ofthe medical analogy may be interpreted as claiming an authoritysimilar to that possessed by medical practice. Nonetheless, the aimof these traditions was not in any direct way to prevent or cure phys-ical diseases, but to enable us to achieve a superior mental or psycho-logical attitude with respect to these diseases (among other things).However, unlike medical practice, which cannot guarantee goodphysical health even when done well, these traditions claimed thattheir practices did guarantee psychological health when done well.In this respect, they claimed greater authority than could plausiblybe claimed for medicine itself.Both Buddhist thought and Hellenistic philosophy may be inter-
preted as defending philosophies of what it means to live a goodhuman life or to live well (in Buddhism, this is nirvana as an enligh-tened condition in this life; in Hellenistic philosophy, it is eudaimo-nia, often translated as happiness). A striking common feature ofthese two traditions is that they believe that tranquillity is a necessaryand important feature of living such a life. By tranquillity theymeant,broadly speaking, a stable long-term psychological state that ischaracterized by the absence of many or all emotional oscillationsand is brought about, not by what happens to a person, but by apersons achieving a proper orientation to the world through someform of wisdom. Hence, in their appeals to the medical analogy,these traditions interpreted living well as implying a form of psycho-logical health characterized by tranquillity. By the same token, theyund