May 16, 2011

Let’s Get Dirty Together: Towards Ecology in Spirituality and Medicine

By Matthew Remski, Scott Petrie, and Jason Hirsch

A continuation of the yoga 2.0 Eight Limbs series. This article is a discussion of sauca: commonly translated as “purity”. The scope is broad: from the origins of asceticism to the biomedical view of the body; from the Oracle at Delphi and Ayurveda to the emergence of ecological medicine and spirituality. Enjoy the ride, and please offer your thoughts below.


The fact of self-loathing in the Yoga Sutras: 2.40

We have remarked repeatedly on the now-perverse view of Patanjali in Yoga Sutra 2.40, which states that the goals of purification (sauca) are to make you see how disgusting (jugupsa) your body is, how disgusting the bodies of others are, and to dissuade your deluded interest in contact with them. Swami Satchidananda translates the verse as: “By purification arises disgust for one’s own body and for contact with other bodies.”

In case we are tempted to apply the deodorant of apology to this stinker, Vyasa, Patanjali’s core commentator, clears up any ambiguity. When the yogi realizes, says Vyasa, that no amount of purification will ultimately cleanse his inherently impure flesh, why would he ever want to have sex with another, who might be even more filthy, given the fact that they are likely less virtuous? Vyasa hits it all of the ascetic themes at once: the body’s inherent dirt, the extra filth of non-virtuous people, and how dangerous and disgusting it would be to sleep with them. He unwittingly describes how the neurosis of personal cleanliness will infect our perception of the other.

Regardless of the esteem one holds for Patanjali’s incredible work and lineage, this aphorism cannot survive present knowledge. This particular yogic view on cleanliness is worse than irrelevant in our time. Even in its vestiges, it tacitly supports the alienating principles that mar the biomedical model. Covering it over or apologizing for it is disingenuous. We either have to ignore it, or radically revise it, and be honest and confident in doing so, as Nischala Joy Devi is with her interpretative version quoted by Ramesh Bjonnes a few weeks ago:  ““Through simplicity and continual refinement, the body, thoughts, and emotions become clear reflections of the self within.”

Because we are postmodern readers, it is possible to read 2.40 ironically, against its original intention, so that it does not promote what most of the educated world would deem a destructive view.  The ironic re-reading might be: “Obsession with purification will reflect and promote a dissociative hatred of self and other.” In this reading, everyday truths of modern psychology emerge. Cleanliness can be a control-fantasy. Fascination with purity can break relationships. Purity-fetish and self-disgust can merge in instances of disordered eating, hypochondria, and psychosomatic sensitivity disorders.

In other words, we can be creative, and read Patanjali as though he’s describing a problem (uncleanliness), or as though he’s critiquing the potential neurosis of its solution (purity-fetish). Unfortunately, he intends the first.

But why is his attitude towards the body so negative? How does our natural impulse for orderliness, which we share with any nesting creature, bootstrap itself into this disgust for the body? The robin doesn’t arrange her nest and groom herself to become enlightened to her self-loathing. She does it because it’s pleasurable. Where do we jump overboard into this caustic sea of metaphysics and cleaning products?


Population density, disease taboos, and the birth of asceticism: a speculative history

Patanjali is compiling his aphorisms in a period of baffling social change. Along with other thinkers of the Axial age, who give rise to the roots of every modern philosophy, he is attempting to digest enormous shifts in the scope of human identity and consciousness.

The issues begin sociologically. Population density is swelling, which brings alien cultures into proximity. New diseases are communicated between previously isolated groups. Additional fears of cultural and gene-pool pollution arise. Various taboos are instituted, and those under taboo are often thought of as “unclean”. In the Indus valley and beyond, Vedic culture institutionalizes these taboos, giving birth to the caste system, which separates out hereditary lines and social roles. With time, settled agriculture and urbanization bring epidemics unknown to tribal life. Growing population density also increases the economic liability of childbearing. The conscious split between sexual pleasure and reproduction deepens. Mating can become “unclean” through its tendency to both violate social law and overburden detribalizing domestic structures.

These logistical issues provoke transcendent visions. The old Vedic reliance upon rta (rhythm, seasonality, everything in its proper place) cannot absorb the groundswell of social change, and becomes insufficient to quell the dread of disorder. Priestly culture responds by upping the ante of caste, taboo and ritual until an inevitable backlash occurs. The ascetics respond by rising up and dropping out. They proclaim freedom from caste, and allegiance to a deeper, non-denominational, apolitical identity: the individual soul, or atman. The poetry of the Upanishads is uttered, and then written on leaves in forest retreats.

The ascetic movement is a strange blend of rebellion, intellectual brilliance, universalism, poetic reverie, anti-social behaviour, and bodily dissociation. It develops a spiritualized escape for the social danger that previous centuries of exploding population density had exposed. Traumatized by the claustrophobia of civilization, and enamoured by the incorruptible atman, ascetics begin to describe the flesh itself as a liability, a vestment worn by the soul that hides its glory and true romantic purpose: something that must be cleansed to the point of transparency, or death. The body becomes a central problem, at most to be used as a vehicle for understanding that it is ultimately worthless.

The ascetic body-meme might be familiar with those of Christian heritage, who have been told that the ultimate expression of a body’s worth is for it to be tortured and executed – for the purification of immorality. The Christ cannot be contained by flesh, it would seem, and so his flesh must therefore be pierced and bled for its divine essence to be unbound. Jesus’ body is crucified because it is a body. To this day, in many yogic streams, the body is also a sign of fallenness, and extreme measures are necessary to hoist it back up, or to abandon it altogether.

Perhaps, along the way, a process of psychological transference takes hold that actually confirms the disease taboo: as your body is to your spirit, so becomes someone else’s body to your body: a contagious pollutant. The internal splitting of spiritual and bodily selves can then mirror interpersonal frictions. Heavy dualism envelops the body in conflict, from within and without. Long gone are the halcyon days of the original matriarchal and wildcrafted ayurveda, in which the body expressed an assumed harmony with the earth and its currents. The ascetic view begins with disillusionment as this harmony breaks down through wave upon wave of civilizing pressure. It sees the world as a cesspool of bodily ferment, to be escaped at all costs.


Ayurveda: ancient eco-medicine


Ayurveda, which predates the Yoga formalized by Patanjali by a millennium or more, was originally a medicine of connectivity. It belonged to an earlier order of consciousness, in which the bodymind contained and expressed elemental forces, all of which were necessary for the coherence between persons and places. There is no concept of inherent filth in early Ayurveda, nor is there an obsessive desire to escape it. Rather, the body courses with tissues-in-development (what we would call flesh), and tissues-in-dissolution (what we would call wastes). There are no literal “wastes” in Ayurveda, in the sense of useless and toxic byproducts of metabolism. Sweat (which we currently deodorize) has an inherent cleansing function, especially to fat tissue. Urine (which we currently dispose of in drinking-quality water) regulates bodily heat and glandular balance. Stool (at which we currently turn up our noses so reflexively we rarely assess the efficiency of our digestion) gives the grounding of earth element where it is most needed – the quivering hollowness of the colon.

In Ayurveda, the only filth that the body contains is accumulated from overuse, circulatory suppression, and the inefficient digestion (ama) of inimical experience.  In other words: the body is just fine when in natural relationship. This is a view that predicts the most powerful medical realizations of the 20th century, as we’ll suggest below. The ascetic view suggests the opposite: that the body, as a natural entity, is flawed from the outset by change and corruption, and its continued relationship with what is natural can only make it worse. This “problem” of the living body is solved only by its death, which is the end of conscious relationship.


Purification gets you into the temple, where you find yourself all alone

Another sentiment lurking behind 2.40 might be the nostalgia for invisible gods. Most purification rites in Patanjali’s day had been and would continue to be induction practices for temple worship. What has come down into our culture as “putting on our Sunday best” originated with intense cleansing rituals that allow the supplicant to be made presentable to an assumed spiritual presence.

Patanjali’s era straddles the decline of the tribal gods of the Vedic pantheon, the appropriation of these same gods into the Trimurti (Brahma, Visnu, and Siva), and the divinization of mythic heroes.  His Axial Age is a period of intense philosophical exploration, in part because the old gods of the forests and mountains have been shut out of the city walls, and have lost their voices to legal codes and writing. And the new gods have not yet found stable enough institutions to wrap themselves around. Patanjali is writing in an era of theological flux, in which the devas and sprites and elohim of former generations have vanished into empty altars and silent books.

The impact here upon cleansing is speculative, but surely worth further exploration: the farther you feel you are from the intimacy of divine help, the more you may have to scrub yourself clean in order to re-establish the connection.

Further speculation: although ascetic lineages such as Jainism, Yoga, and Buddhism built themselves in part upon a stalwart rejection of the ritualism (including, for some yogis at least, purity-rituals) of the late-Vedic and Brahminical periods, it might be argued that they simply internalized the meme of “the pure”. Whereas once the yagna or temple was a site of material and (somewhat) shared purity, now the individual body became the site upon which they struggled to establish an isolated spiritual purity. (In this, we might find the root of the homestatic body, upon which much of our biomedicine is based.)

purity can be a zero-sum game

The problem with purification is that if you think the body is inherently unclean and separating you from god, the only bathing ritual that can really satisfy you is the one in which you drown. Purity, whether physical or metaphysical, is an impossible ideal removed from real interaction with the world.  And it doesn’t strengthen us, individually, or socially.

Take our present fetish for hand-sanitizers. We’re starting to realize that they are simply provoking viral mutation and weakening our physical immunity. Similarly, the neurotic cleansing of an identity soiled by a legacy of dirty karma might well depress psychological immunity, by increasing paranoia and diminishing self-esteem. Cleanliness seems to hit an asymptote en route to both bodily health and enlightenment. The closer you get to purity on either path, the farther you get from dynamic immunity and personal integrity, which are both a kind of attunement between self, other, and world.

The annals (anals?) of ascetic history are littered with stories of sects battling to out-purify each other. The cleanest group is always the smallest and least relevant to the rest of humanity. At the top of Mount Sparkle sits some sorry fellow on a sterilized zafu, gritting his teeth to hold his poop, wiping away his lonely tears with a handful of sani-wipes.


The atman and the biomedical magic bullet

Vestigial beliefs in the “pure” dating back to the ascetic era may well be interfering with our health and well-being today. We don’t think that the cleanliness we commonly practice today relies on spirit-matter splits, caste taboos, or metaphysical escape-plans such as the atman. But it does, through the biomedical model that has enjoyed prominence since the late Renaissance. To this day, biomedicine embodies key aspects of the ascetic ideal: isolate the person from their environment, isolate people from each other on the basis of income, and meditate hard on the possibility of miracle cures. But there is a new medicine brewing – “eco-medicine” – that is increasingly informed by social considerations that express collective intelligence in the face of shared epidemiological threats.

Biomedicine is starting to show its weaknesses. A different approach is forming through an emergent eco-epidemiology, along with contemporary holistic health. We are starting to accept the fact that we need to include the social and ecological spheres in all of our health considerations.  Hearkening back to Ayurveda, holistic health understands and treats a homeodynamic body, in which the internal state is in constant fluid relationship with the external environment.  (For more on homeodynamism, see this report by the American Academy of Environmental Medicine — a short and superb read for anyone interested in health.) The primary view of the homeodynamic model is the environment and our social relationship to it. In the homeodynamic model, there is no body that you can permanently shield from its context with drapes and barriers and vaccines. (Read: There is no shining, extractable atman that you can protect from the corruptible world with prayers and solitary retreats. There’s just relationship.)

The difference between these two approaches – body-as-ecology, and body-as-isolated-fortress – can be told through the sibling rivalry of the two daughters of Asclepius, the Greek god of medicine: Hygeia (who de-divinizes into “hygiene”) and Panakea (who de-divinizes into “panacea”). Hygeia inspires social cooperation towards a shared improvement of health, while Panakea seeks out the magic bullet for human impurities, whether in the form of a universal spiritual principle like atman, or – in the industrial era and afterwards – a vaccine, or antiobiotic.

Hygeia, in "Medicine" by Klimt, 1901.

The goddess Hygeia was recognized by the Oracle at Delphi immediately following the Plague of Athens (430-427 BCE), and over time became identified with the Italian goddess Salus, who governed social welfare. The worship of Hygeia expressed not only a shared wish for safer health conditions, but also a tacit realization that epidemics come not through inherent bodily filth, but from imbalanced relationship, and are healed through rebalancing. The anthropology agrees, showing that major shifts in human economy – hunting-gathering to settled agriculture, settled agriculture to early cities, and early cities to industrial cities – are always followed by precipitous drops in the health of the group, only then to be followed by a long, slow climb back up to better health – the result of an adaptive process that makes use of plain old better living standards.

Hygeia makes her modern appearance as “hygiene” in the Europe of the 19th and early 20th centuries, when infectious diseases are running rampant on the heels of industrial urbanization.  The Sanitary Movement arises in England and France, fronted by doctors who lobby for greater public cleanliness. Hygiene was thus a social response to an environmental problem. The human community comes together and literally cleans the shit out of the streets. It is an incredibly effective communal evolution in health, based upon problem-solving at the level of relationship, rather than self-scrubbing neuroticism.

But whenever Hygeia makes social advances, Panakea is brewing up physically fortuitous, but philosophically problematic solutions. Just as the “universality” of atman is discovered by the rebels of the ascetic movement and is deployed to combat the onslaught of spiritual and bodily defilements, the Industrial era witnesses the discovery of the universalizable germ theory of disease. The refinement of vaccination – a panacea – quickly follows, which is so starkly effective at eradicating infectious diseases that the biomedical model upon which it operates is elevated to near-religious status.

The biomedical body comes to be seen as a fortress to be protected against outside invaders.  When something gets in, you have to attack it through self-mortification (penitential pharmacology) to cleanse it, restoring self-contained balance (homeostasis).  In biomedicine there is little concern for healing interaction between the body and its environment, and so the environment and social space both come to be seen as areas less worthy of investigation. The antisocial streams of yoga take the same position.

On the medical side, the mistake has become plain to see. In 1970, Thomas McKeown published massive statistical evidence on the fight against infectious disease in industrial England, showing that while biomedical vaccines did indeed effectively contain viral contagion, most of them only arrived after the biggest reductions in mortality had already occurred through generalized health improvements. His findings were earth-shattering because biomedicine predicated its glory on the very same period. Researchers have since followed in McKeown’s steps to show that the basic practices of communal hygiene, public sanitation, and nutrition were by far the more important ingredients of health improvement.

Of course, Hygeia insists on equitable wealth distribution, rather than the specialized work of the lab or the temple. By contrast, Panakea promotes the divinely inspired or lab-invented miracle, to be administered universally from a central authority. Usually someone makes a lot of money. But if the panacea works at all, it’s because it rests on top of an infrastructure of general social welfare, which biomedicine usually ignores. The magic bullet is always a lot easier to shoot than the public-works project is to fund and implement. But in the end, it is public works health projects that elevate us all. Because real filth doesn’t come from caste or alienation from god, or even from one virus as distinct from another. Real filth comes from the inequality that depresses our collective immunity.


Ascetic medicine for contemporary disease?

Our dominant health rhetoric today suggests that lifestyle improvement will beat chronic disease: diet, exercise, smoking cessation.  This is the medical field’s attempt to respond to the anti-biomedical sentiment that followed the publication of McKeown, Ivan Illich, and even a world-famous report from the Canadian Ministry of National Health and Welfare (Lalonde Report, 1974).  The medical field is currently saying: “Yes, look: we are now seeing beyond the body to the environment!” But while it’s true that diet and exercise and smoking are considerations beyond the germ theory, the upshot of lifestyle-health is as old as Patanjali’s 2.40. The message is: you are unhealthy because you are corruptible, unvirtuous, and attracted to impure things.

The current healthy-lifestyle focus is no different from a pure germ-theory approach. We are still using the ascetic model of the body as a fortress to be protected from invaders. Fat, salt, smoke and sloth are the current invaders, where once it was cholera microbes, or malefic spirits. We still neglect the broader environment in our investigation, because of this individualized view of the body’s salvation. We can’t see how small a shift we have made from health that is the domain of the body alone, to health as the domain of “the body and its direct inputs and behaviours.” We can’t see that we are asking ourselves to be gatekeepers against disease agents entering our bodies, while swimming in a cesspool of chemicals and stress that generates enormous profits for people who, like gods, we never see or know. We can’t see that we are unhealthy mainly because we have built an unhealthy society. In 1986, Canadian Health Minister Jake Epp wrote: “…we cannot invite people to assume responsibility for their health and then turn around and fault them for illnesses and disabilities which are the outcome of wider social and economic circumstances.”We should strive for the same clarity in our yoga discourse, with regard to the difference between personal and communal karma.


Sibling rivalry: coping with change

By the grace of the daughters of Asclepius, we have two opposing visions of health strategy.  Each arises in response to our historical wealth and population explosions, some of which we’ve outlined – axial India and Greece, Industrial Europe, and Post-War consumerist global village. In physical terms, these explosions bring, respectively, the diseases of early cities (E.coli, et al), industrial cities (cholera, et al), and suburbs (diabetes, et al).

Metaphysical health strategies arise in a parallel arc, married to the same anthropological shifts. Tribalism through to early agriculture focuses on balanced relationship to maintain natural order and console the stress of rhythmic change. Ascetic scholasticism arises to cauterize the wound of consciousness-complexity that urbanization brings, along with its disease of existential realization. Currently, a spirituality of connectivity is emerging to confront the diseases of alienation.

Through these arcs, we can see that the vision that worships Panakea is held in varying degrees by Patanjali, ascetic culture in general, and later, biomedicine.  It is based on the trauma of dealing with massive social and consciousness changes, and it consists largely of separating from newness and complexity to concentrate on the control of internal variables. It can tend towards control fantasies.  It can play with reductionist generalization and miracle cures, both metaphysically and medically, to keep reality within a realm it thinks it can control.  This reductionism can become religious and/or neurotic, because it knows subconsciously that its control is always on the verge of failure.

The vision that worships Hygeia is held by the Greeks, the Sanitary Movement epidemiologists, the ecosocial epidemiologists, and holistic practitioners.  It is based on relationship and balance. It believes in trial-and-error in the restoration of harmony, gradually rebuilding the way we live together on the levels of public policy and community action to regain balance with the natural world.

Of course, the biomedical model has produced as many wonders for the body as the ascetic model has produced for cognitive theory and psychology. They share the power of focus, isolation, and control. The lessons they offer are now ready to be taken up by a new attitude of connectivity and interdependence.


Example: Patanjali, biomedicine, and eco-medicine on the disease of obesity

(Obviously, as Patanjali never addresses the issue of obesity directly, we are left to speculate as to the nature of his thoughts on this modern disease.)

Patanjali: The impure body can’t stop creating more of its disgusting self. Its desires are boundless, its infatuation with materiality is unstoppable. Impurity builds on impurity, to produced ever-thickening attachments to suffering. The atman is ever further enshrouded until the samskaras of delusion are exhausted. This will take an indefinitely long period of time, because the non-virtue of each desire-laden reach for every extra ladoo creates new karmic seeds.

Answer: The yogi must pull himself out of his samsaric cycle of food and filth through great austerity, bitter herbs, devotion to god and discovering the atman, and avoidance of influences that further corrupt his already-corrupted flesh.

Biomedical perspective: Psychological defects, neurological miscommunication, and unvirtuous behaviour such as overeating combine to produce an internal pathology of weak metabolism and diminished organ function.

Answer: The patient should change her diet and outlook, and should exercise more, or she will develop a serious illness, for which she will be responsible.

Eco-medicine: Obesity has numerous interpenetrating causes.  These include: social alienation, food-knowledge breakdown on the level of the family, overproduction of corn syrup manipulated in commercial food-labs to possess addictive qualities, poverty, unemployment, domestic instability, the thrifty metabolism of our ancestors colliding with excess calories, factory farming that squelches local production and produces excess calories, preservation methods designed to maximize profits from excess calorie production, alienation from land and backyard food growing, food derivatives brought to market with little or no testing, and the dissociative fetish for nutritionism (assessing food value through chemistry alone), as opposed to the natural medicines of whole food and wholesome preparation.

Answer: People can work together to change the many social, economic, and personal contexts of obesity, thereby coming to a greater understanding of their health interdependence.


Nobody profits from social hygiene and connective spirituality, but everyone benefits

Looking over the three options above, we can imagine how difficult it would be to manage #3, and make it feasible, especially in relation to options #1 and #2. To be blunt, there is money to be gained in not adopting the social-hygiene perspective.  Simon Szreter points out the tragic story of London’s private water companies employing legal measures to try to block water purification legislation in the mid-19th century. The dynamics of Big Tobacco and cancer research play out a similar scene in our day. Dr. Samuel Epstein’s 1998 The Politics of Cancer, Revisited explores how the big funding agencies (American Cancer Society, etc.) deliberately ignored cancer prevention because it would mean opening a can of whoop-ass on several industries: tobacco, primarily.  The funding agencies, Epstein argues, made a calculated bet that they’d be better off by raising big corporate donations for intervention treatments and miracle cures (Panakea is spinning her web!) than by shedding light on the eco-social issues, calling for wealth equality and cleaning up our air and food, which collectively would constitute political suicide. He also points a finger at the networks that connect the industries of cancer drugs, mammography, tobacco, pesticides and fiberglass in a carcinogenic-industrial complex. It sounds an awful lot like the revolving doors of sin and forgiveness: we pay the same priest for both diagnosis and cure.

The cancer story is one of big money, elite-driven campaigns and centralized authority. It is told by Panakea.  It is very different in substance and tone from the AIDS story, which at least recently tells of citizens’ movements suing governments to force the breakage of international patent law to make medications widely available. But antiretrovirals aren’t the central human story here. With AIDS, the new epidemiology has been field-tested with great success, promoting a sane balance of attention upon lifestyle change, treatment, sophisticated drugs, and root causes like poverty, depletion of natural resources and gender inequality. In stark difference from cancer, the incidence of new AIDS cases is going down. Hygeia is telling the AIDS story, and it is one of grassroots movements and political change.  There is less money to be made when Hygeia speaks, but there is far more benefit.

Cancer work tends to centralize profits, while AIDS work tends to claw away at profits, because eco-medicine is a grassroots, democratic endeavour.  The comparison may well apply to spirituality. The spirituality of profiteers seeks status in making and keeping the temple as a fortress, guarded and interpreted by experts, who are dispensers of miracles and boons. A spirituality of connection, however, tears down the temple walls, shares resources, and threatens profits.  It will be resisted.


A usable translation of YS 2.40

Through both biomedicine and vestigial asceticism, we become unhealthy from three directions.  First, we have such excessive scrubbing in search of the impossible ideals of sterility or enlightenment that our physical and psychological immunity fails.  Second, we so ignore the relevance of the material and social environment that we provoke epidemics of obesity, heart disease, cancer, asthma, food allergies, depression/anxiety, etc.  Third, we collude with the socioeconomic inequalities between people that constitute the best predictors of poor health. The Spirit Level, by Wilkinson and Pickett, is an excellent expose of the plague of the modern caste system.

Just as body-hating asceticism fails to produce happy and well-socialized people (who knew?) the individualism of biomedicine has made halting progress. Both tend to isolate and alienate. Asceticism falls prey to misanthropy. Biomedicine becomes myopic through the medical gaze (cf. Foucault).

Inspired by how eco-medicine has the potential to correct the isolationism of biomedicine, the 2.0 crowd feels it’s time to retranslate ‘sauca’ in a way that reins in dissociative asceticism. We propose that instead of “cleanliness”, which carries the ghost of social separation, or “purification”, which carries the ghost of metaphysical body-hatred, we simply use the word “ecology”. Thus, we offer this remix of 2.40 for consideration:

“Ecology allows you to honour your body, and the bodies of others.”

(This verse is excerpted from threads of yoga: a remix, which we’ll be presenting at Yoga Festival Toronto, on August 20th of this year.)


Mud and burrs and nits

It used to be simpler. For tens of thousands of years, we groomed each other within our extended family groups. Evolutionary biologists now believe that the intimacy of grooming is a key birthplace of complex language. We picked mud and burrs and nits out of each other’s matted hair, and chattered about life, and learned how to share, speculate, and ruminate. It seems that a little dirt brought us all together.


Jason Hirsch provided essential research and co-writing for this article. He has researched in Aboriginal health and eco-social health policy with the Ontario Government.

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