Reevaluating “Constitution”: A Challenge to Popular Ayurveda

 

As the cosmic movement of air, sun and moon are difficult to know,
so is that of vāta, pitta, and kapha in the body.
Caraka Samhita VI 28:246

 

This post deconstructs what I feel are some common but avoidable problems with the practice of Ayurvedic constitutional typology. I realize that there are several forms of Ayurveda (including that represented by the modern BAMS syllabus) that do not necessarily foreground constitution in practice. My focus here is limited to the popular and global modes of practice supported by English language literature and often associated with modern global yoga culture. My intention is to clear a path for future research into what the old insights of typology might reasonably offer today. Because this piece is lengthy, I’ll begin with a redux of themes:

1. While Ayurveda and contemporary science share a common empirical root in the systematic observation of natural patterns, Ayurveda no longer belongs to the discipline of  “science” as it’s commonly understood today. It is now perhaps more properly understood as an interpersonal and intersubjective art form, ideal for any therapy and counseling that seeks to bridge categories of body and mind. Claiming that it does more than this makes Ayurveda vulnerable to the charge of pseudoscience.
2. The popular and now global practice of Ayurvedic constitutional typology (prakṛti) is particularly vulnerable to pseudoscientific claims, cognitive fallacies, essentialism, unchecked transference and countertransference, and blindness to how bodies are assigned meanings through social construction. These flaws are often amplified or excused by romantic Orientalism.
3. If they can first uncover and then reach beneath these flaws, modern Ayurvedic practitioners may be able to access layers of awareness rooted in the intimacy of their mirror neurology — a kind of  “hardwired empathy.” Their task, if it is possible, would be to isolate this “first sense” of how another person feels themselves in the world towards therapeutic ends, before it is distorted by the sweep of cultural ideology, whether global-capitalist or antique-Orientalist.
4. If it resists cultural ideology, the art of constitution can utilize the poetry of bodily states to initiate empowering dialogue about how different subjects experience the world organically, emotionally, and socially. In this way, a truly dynamic theory of “constitution” might take shape and be of benefit to a wide spectrum of healing disciplines.
5. The most empirically honest and psychologically effective use of typology leaves the subject unlabeled and undetermined, and therefore able to construct for themselves a rich dialogue with their evolving body-mind patterning.

 

 

images by Howard Schatz

 

What does the body really say?

Let’s talk about Alexi, Brandon, Alonzo, Lisa, and Rulon (left to right above). They’re some of the elite athletes captured by Howard Schatz in this riveting collection of photos. They also make for rich speculation in the game of beginning Ayurvedic constitutional analysis. I project this image in the classes I teach as a learning tool.

What do we see first? Rulon’s barrel chest, Lisa’s leg-to-torso ratio, Brandon’s heated forward gaze? Do we see the upward movement of Alonzo’s frame? Do we see his top quarter weighted by heavy conditioning that pulls his upper arms into internal rotation and cervical spine into kyphosis? Or does he just feel more assertive standing like that? Did he discover that it felt safer to keep his head ducked a bit during that first growth spurt at nine years old?

Do we see how confidently Rulon and Alexi seem to present, ready for any challenge, earthy, resilient, knowing they shall not be moved? What qualities will their postures and quiet strength afford them? How far can we go into “What kind of people are they? What are their strengths? What will they do under stress?”

If you bring Brandon and Lisa to the blood donor clinic, who will have the easier time (i.e., feel less queasy or faint) with the needle and the blood loss? If you sit Rulon down at a desk job for a decade, what health issues would he be vulnerable to? Who is more prone to anxiety? Depression? Rage? Diabetes? What do you think each of these five would be like as friends? Or lovers?

If you have Ayurvedic language on board, or are a practitioner already, are you satisfied with visually classifying Alexi and Brandon as pitta-kapha, Rulon as kapha, Alonzo as vata-pitta, and Lisa as more vata than Alonzo? So what? What will you do with these immediate impressions? Are you already predicting things about Lisa’s digestion or sleep habits, Brandon’s aggression, or Rulon’s attachment to family and oversleeping? How well can you hold yourself back from what you cannot know, but are encouraged to guess at through Ayurvedic constitutional practice? How can you protect your client and yourself from the confirmation bias that every initial visual contact with a person sets you up for?

When you start asking Rulon your consultation questions, will it “innocently” occur to you to ask about sweet cravings? How will this drive the rest of the conversation? When Lisa tells you that she’s not particularly anxious, that she’s just fine at the Red Cross — she gives blood every month in fact and never feels dizzy afterwards — how will this alter your understanding of her vata frame? If you feel her pulse and it’s broad, slow, and rolling – what will you do?

But wait! There’s more! What about the performance embedded in their presentations? Aren’t they trying to project themselves in a certain way, coherent with their professions? Can structural constitution be a show? Is Brandon wearing a kind of pitta-competition-drag? Could he pretend to do otherwise? How would these athletes look minus their intense conditioning? How early in life did they start to train? How did their work either change them, or quite literally guide their development? How did their work become them?

And finally – how are we constructing these humans through the endless imagery that has trained us to see certain people in certain ways? What ableism, sexism, and racial stereotyping informs what we think we are instinctually seeing?

Welcome, everyone, to the mess of popular Ayurvedic constitutional analysis. Here, practitioners try to cultivate their initial visceral impressions of others into a sense of who they are, what their patterns might be, what they may need, and how to best interact with them. It is an ancient practice, fraught with fallacy, and reified by contemporary forces of reductionism and commodification. But it also hearkens to a bygone developmental innocence and a neurological honesty we may be missing or suppressing. Something deep and distant in us asks: Can’t one body see and feel and understand another body directly without the stories of the social mind intervening?

Ayurveda says yes.

I say… maybe – but we’re going to have to work out how.

 

Prakṛti: a lens to examine an entire system

In a previous discussion, I laid some groundwork for how contemporary Ayurveda carries temptations toward pseudoscience, and how it can and should avoid/resist them. I argued that its practitioners must own up to its prescientific heritage, poetic use of language, subjectivist bias, and lack of testability and peer-review. These are features that will always limit Ayurveda’s full participation in biomedical discourse. Further, I suggested that this barrier is a good thing, inasmuch as it can allow Ayurvedic practitioners to focus on how their practice is both distinct from and complementary to biomedicine — empowering clients with holistic self-inquiry, encouraging them to value the phenomenology as well as the biomedical data of a condition, and contributing a wide range of “meaning responses” (Moerman, 2002) to the self-care journey.

If Ayurveda tries to go head-to-head with biomedical practice in addressing complex and/or acute conditions, and tries to use biomedicine’s definitions of successful cure, it will likely fail. More importantly, it may lose its soul. Lab-testing Ayurvedic theories and methods may be both impossible and antithetical. Its theories are constructed from poetic, indefinable quantities like agni and ojas, and its methods are never repeated exactly, because treatments must be completely individualized. The drive to medicalize Ayurveda seems to be the inevitable result of its integration with the commodification methods of global capitalism.

In this article I’ll dig a little deeper to argue that Ayurveda today may be more properly regarded as an interpersonal, intersubjective art form, with great potential for fostering an appreciation for embodied difference. I’ll suggest that nowhere is this potential skill more called upon than in the practice of considering “constitution”: the individual’s unique psychosomatic profile, known as prakṛti. And in no other subject, in my experience so far, is the promise of Ayurveda more confused and oversold.

I would like to argue through this and future articles that the principle of constitution as popularly practiced is an ideal lens through which we can see not only the shortcomings of an old medicine that has not consistently exposed itself to the epistemological rigours of our time, but also the potential Ayurveda has to model therapeutic intimacy in an increasingly data-driven world. When it stereotypes, pigeonholes, and essentializes, the theory of constitution presents the shabbiest type of pseudoscience. When it sees, feels, reserves judgment, resists interfering, and strengthens the intersubjective feeling of a healing encounter, the practice of Ayurvedic typology – and we really need to find a better word for it – holds promise as a dialogical tool.

It’s taken me more than a thousand clients to come to the conclusion that the theory of constitution (prakṛti) as it’s typically presented doesn’t work very well, and confers questionable benefit. Typically presented, Ayurveda is said to be able to identify the essential, stable, unchanging, almost-destined psychosomatic qualities of a person. This is impossible, because there are none. (I’ll get into this near the end of this post.) It can also be unhelpful for a host of disempowering reasons I’ll also describe. But my intention is to try to show that if the theory loosens up on its claims and understands its potential fallacies, I believe that it has power to help a client enter into dialogue with the qualities of her internal, social, and environmental relationships with such refinement that she becomes more resourceful and responsive to her challenges, in ways that biomedicine rarely encourage. This responsiveness, I will argue, depends on both her and her practitioner leaving her constitution, like a work of art, ultimately undefined.

How do the terms “interpersonal,” “intersubjective,” and “art-form” relate to the practice of typology?

Ayurveda is interpersonal in the sense that its insights are not theoretically static (or preservable by statisticians) but continually created within the full range of human-to-human, human-to-society, and human-to-environment relationship. It matters far less what Iśvarakṛṣṇa might say about “earth element” in the Sāṁkhyakārikā than how practitioners and subjects create and recreate the meanings of earth element situationally, in dialogue.

Ayurveda is intersubjective in the sense that a practitioner cannot analyze the constitution of a subject except through his or her own unique, sensual responses. When the practitioner encounters a subject, they are also encountering their own subjectivity. Feeling the other reveals the feeling self. This is why practitioners should learn all they can about modern psychodynamic psychotherapy, which resists the common fallacy of telling people who they are without recognizing that other-description is also self-description, and that the real point of any meeting is to acknowledge shared subjectivity, and to explore the sensations of that sublime paradox.

Ayurveda is an art-form in the sense that its meanings are co-created by its participants, and because it is never finished. In these ways, it is very much like science, but without the definitions and controlled repeatable testing. Truth in art is leveraged through ineffability and unrepeatability, which is why it mirrors the experience, if not the data, of life so well.

Why is constitutional typing so attractive?

To analyze how the popular presentation of constitution fails the broader potential of Ayurveda, it might help to start by describing why it is so popular. I can think of four dubious reasons that the practice of Ayurvedic typology feels so good:

1. Typology can validate our first impressions of others, which are commonly repressed. It permits the feeling that our impulses don’t necessarily imply harsh or cruel judgments.
2. It allows us to indulge cognitive fallacies that are otherwise forbidden.
3. It nurtures an orientalist fantasy of pre-and-post scientific enlightenment.
4. Without constitutional typology, Ayurveda loses target markets.

1. Freedom to feel taboo things. Typology can feel like a new door of honesty opening. When Ayurveda gives us permission to relax some of the disembodying effects of the morally necessary values of liberal democracy, i.e., “we are all the same”, it gives us permission to look again at all the silent things we feel when we encounter the mysterious differences of others. We typically try to control our “othering” impulse by throttling it through a spectrum of controls. At best, we understand othering as a form of superficial, style-based categorization: goths, suburbanites, yuppies, hipsters, DINKs. At worst we know it can be at the root of ableist, healthist, or racial or gender stereotyping and hatred. But when an Ayurvedic practitioner suggests that there’s essential psychosomatic meaning to be drawn out of a person’s skeletal structure, weight, complexion, and movement patterns, we can feel relieved from repressing what seem to be the “pure” or “raw” responses that we have to people. Ayurveda promises a gaze that can see through the social constructions of personhood, to a definable essence. What a relief this would be to generations of humans abused by commodity advertising to feel that every uniqueness is a liability.

Morris Berman (1989) describes the relief of this apparent embodied honesty as overcoming the “somatic gap”: the persistent social repression of our knowledge that we are bodies before we are citizens, and that as bodies we are strange to each other, unconsciously welcoming, motivating, inspiring, or repulsive. Our shapes and movements and smells are sending out distinct codes to which our pre-civilized selves are alert. Typology seems to forgive us for our unconscious and instantaneous classifications of fellow citizens as being more or less attractive or copasetic or suited to a particular type of work or interaction.

2. Relaxing into cognitive bias. Common constitutional analysis can validate deep-seated cognitive fallacies that are exhausting to struggle against if we ever become aware of them. Here’s a short list, paraphrased from the ever-useful and accessible Wikipedia:

• The anchoring effect: the tendency to rely too heavily on a single datum when assessing a system. I.e., a person’s square frame becomes the determining factor in assigning “kapha” as the primary constitution.
• The clustering illusion: to actively look for apparent streaks of data (phantom patterns) in large random samples. I.e.: clustering “square frame”, “broad teeth”, and “thick hair” into a “kapha” designation, while downplaying data beyond the cluster.
• Confirmation bias: more general than clustering — looking for data that confirm a pre-conceived thesis. “Rulon is obviously kapha. I wonder if he’s a faithful friend?”
• Essentialism: the habit of categorizing people according to an imagined permanent nature. “The kapha woman has good fertility and a special connection with the Divine Mother.” This is a philosophical fallacy as well, and tends to obscure Ayurveda’s naturalism with a religious air.

In the interpersonal work of an Ayurvedic appointment, typology is also liable to the unexamined play of transference and countertransference. Transference initiates with the credulity of the client, along with their desire to be assigned a constitution in order for life to make more sense. Practitioners who wield strong community power will draw strong transference. The deference of the client can make her vulnerable to the Barnum Effect, in which the practitioner’s generalized statements of constitutional analysis or imbalance seem to be intimately personalized and resonant, as in a horoscope. The client’s deference also allows her to be baptized into the new identity of the constitution, joining others in a community of practitioners who share the revelation of a discourse with which alienates them less than biomedicine.

Countertransference emerges on the part of the practitioner in several ways. First, as a snap-projection of what a client needs based upon a few presenting and highly subjective details. Second, in the unchecked assumptions a practitioner can make about what a client should want for themselves. And lastly, through the “fundamental attribution error”, in which the practitioner will over-emphasize explanations for presentations and conditions based on a client’s constitution, rather than their circumstances. The worst instance of this third error would be the practitioner who made a client feel that their constitution was somehow the cause of their circumstance, or that biology equals behaviour, and even destiny. “Naturally you gravitated towards childcare: you are kapha!” “It’s very common for the vata person to struggle to find grounded relationships.” “Of course you’re angry – look at all the pitta you have!” And so on. (The alternative would be to resist assertions altogether. A purely Socratic method is probably most effective, i.e.: “You say you feel ‘disoriented’ in the late afternoon. Are there distinct physical sensations or emotions that often come along with that?” Ask the questions, let the patterns reveal themselves.)

3. Orientalism. Loads to say here, but I’ll keep it brief. Orientalism is the reductive and dehumanizing assumption that all things eastern or Indian express a statically exotic knowledge or value. (Said 1979) In the colonial context, orientalism helped to objectify Asian resources and knowledge as the desirable spoils of expansion. In contemporary Ayurveda its mechanism shifts from the colonial-hegemonic to the Romantic-reductionist. Whether global capitalism is trying to control India’s material resources or to define its intellectual heritage, the same extractive methods are in place. As my colleague Sean Feit described via email: “Where it once was cotton and tea, now it’s call centers, yoga, and Ayurveda.” 

A mystical glow commodifies Indian knowledge and essentializes the otherness of Ayurvedic healing practices. Analyses seem truer if delivered in Sanskrit, herbs more potent if grown in Indian soil. Then, when it comes to constitution, all humans can become “otherable” by the new-but-old, “sacred” categorizations of typology. Romantic orientalism in global Ayurveda is consistent with other yoga-related discourses in which the fantasy of an eternally perfect cultural wisdom (posed as the bright shadow of the assumption of western inferiority) overrides basic standards of critical thinking. Two examples might help. In asana practice, we see it in the unquestioning acceptance of prominent teachers who have never formally studied biomedical anatomy as being experts in biomechanics. In yoga philosophy we see it in the persistent effort to sanitize the reality of the Bhagavad Gita’s political narrative – that Arjuna is being encouraged to slaughter his kin to serve the state and glorify its deity. All such simplifications rob Indian culture of its complexity. Spa-type Ayurveda and status-update philosophy are the natural outcomes: ancient wisdom that is reduced, homogenized, bottled and labelled.

4. Constitution as commodity. Dividing humanity into three, seven, or ten constitutions grants an equal number of demographics to which standard remedies can be marketed and sold. But when constitution is presented along an infinite spectrum of variability, there is little use for standardized blends and protocols. Constitutional theory has the potential to aid or resist commodification in healing practices. In my view, Ayurveda cannot be about products. It’s about empowering people to make sense of how they are feeling, and the contexts for those feelings, using non-specialized, sensual language.

 

Why is constitutional typing so problematic?

Because of a thousand reasons. Let’s continue the discussion by talking about Kim, Tara, Cheryl, Olga, and Aliane. I mean — by talking about some pictures of them.

 

At this point in my presentation, the room usually gets quiet. There are many reasons for this, all amplified, I think, by the fact that over 80% of any group I present to is female, and an image like this sends many attendees into uncomfortable self-reference. We live in a culture in which female bodies are not only commodified, but comparisons between them are as well. So here I am, presenting a spectrum of female bodies for an analysis I will claim has an empathetic objective – trying to understand the potential meanings of difference. But I’m using an image that cannot help but to carry a residue of this pervasive cultural violence. Naming and labeling and judging bodies visually is what we do with every minute of every day. We do it to female bodies more than male bodies. How do I avoid perpetuating this violence? How does Ayurveda avoid becoming just another way by which women are judged and judge themselves and each other according to the whims of capitalist patriarchy? (One participant told me: maybe this exercise needs a trigger warning. I think she’s totally right.)

The first comment on this photo online comes from one “Nacho Garcia III”. Nacho says:

“I like allane Baquerot more feminine”(sic).

Why, Nacho, Why? What part of her is “more” feminine? Her hip-to-waist ratio? Her bust size? Her muscular tone? Or could it be her strappy toeshoes? Or her tippy-toe pose, suggestive of how heels can make a person appear tottery and easy to sweep away? Or is it her slightly demure, indirect head-angle and gaze?

Whatever else we might learn from this picture, it should be clear that we are filtering all of our imagery through an intense tangle of social conditioning, in-group bias, not to mention class, racial, ableist, ageist, weightest and sexist stereotypes. To make things more complicated, our objectifications of the image of Aliane may often be met by Aliane’s performance to satisfy those very expectations, whether it ultimately serves her or not.

Our stereotyping has only accelerated as the visual advertising, surveillance, and responsibilist white noise of global capitalism has increased. Visual advertising works precisely by highjacking the lower-brain reflexes that Ayurveda relies upon for impression-formation, and then crafting them into the service of whatever normativity will sell best. The aesthetic values and intentions of advertising are clear. How are the aesthetics of Ayurvedic typology any different? Because they’re supposed to be value-neutral? Life-supporting? But are they really neutral in practice? What kind of life do they support? A more “natural” life? What is “natural”? Does Deepak’s family have a more “natural” life in sunny San Diego? Is a “natural” life pre-technological? Is it pre-feminist?

The overarching challenge is clear. Can we look at these images and separate our cultural judgements from our ideas of Ayurvedic health? The detailed questions are many:

Let’s consider Kim and Tara first. Do we talk about Kim’s performative fire or Tara’s rep-reduced BMI without invoking the suggestion of “machismo”, and all of the conflicting values that would come with it? If they are so pitta that they are amenorrheic, is this a problem? Most Ayurvedic practitioners would say it is. Why? Is a lack of fertility more of a health issue for female bodies than male bodies? With regard to bone density in middle age, it actually is. For centuries, Ayurveda has recognized the relationship between body fat ratios and fertility in women, and also the relationship between body fat and the strength of bone tissue. Old Caraka could have easily predicted the Female Athlete Triad syndrome, in which intense exercise is linked with disordered eating, lost fertility, and brittle bones over time. But the problem is that he — along with the vast majority of his inheritors down to the present day — would have worried about this primarily from a gender-essentialist perspective. The tradition would argue that female bodies should menstruate regularly and in a particular way, not simply for their own health, but primarily to harmonize with the larger (dominant) natural/social order.

Even more uncomfortably — how do we speak of the structural differences between Cheryl and Aliane in a way that doesn’t make one seem more “attractive”? Or in a way that equally appreciates how they have each mobilized their genetics and training opportunities to express high levels of proficiency at what they do? In short — how do we avoid sounding like Nacho Garcia III? I’m not joking: implicit in Nacho’s remark is that Aliane is the acceptable woman who faithfully and attractively performs what is most expected of the female body. Unfortunately, his remark is in line with both Ayurvedic gender essentialism and its Orientalist apologetics. A woman’s form is privileged over function, unless the function we’re talking about is reproduction.

Of course in Ayurveda our values are supposed to be therapeutic rather than aesthetic. So at this point I turn to the class and say: “Imagine that these five people come to your asana class.” (Many of my students are yoga teachers or teachers-in-training.) “What would you instinctively want to give each of them?”

The answers flow freely, because now I’ve given permission for people to mobilize their initial responses — which might otherwise provoke a kind of social guilt — into imagined gifts. The answers are also pretty unanimous.

• People would offer Kim techniques to help relax her drive and soften her rigid muscle tone.
• They would give Tara shoulder alignment and upper-chest-opening exercises to counteract her humeral inward roll and over-tightened pectoral muscles.
• They would give Cheryl spinal extension exercises and breathing techniques for mobility and suppleness. (Some people shyly pipe up to say they think she would benefit from a hot room and rigorous cardio.)
• They want to give Olga centering, grounding, strengthening sequences to do, and encourage her to build more muscle to protect her joints over time. Most people will predict that Olga is hypermobile.

People always have more suggestions for Olga. Perhaps because she seems delicate or child-like in the line-up. How old do we think she is, anyway? There’s something about her that students just want to hold and cradle. Caraka says: treat the vata person as if you were holding a little bird. What do these impressions and judgements do to Olga’s strength, her autonomy? How can speaking about Olga avoid othering her with infantilization? At what point does what feels like an instinctive protective reflex really just patronize her?

When it comes to Aliane — students take a little longer to come up with suggestions, if they do at all. There’s a palpable sense of “she’s just fine” — which is really just the value-neutral expression of Nacho Garcia III’s confession of attraction. It seems that the more you like something, or the more it conforms to a preconceived model of fitness or normalcy, the less therapy comes to mind. Aliane becomes normative: to Nacho in terms of her “femininity”, and to budding Ayurvedists in terms of her perceived general balance, even proportions, and strength.

Where do all of these senses, intuitions, and snap-judgments lead?

 

What can bodies tell us? Ask them. (Putting darśana on the back burner until sparśana and praśna weigh in.)

If the class feels comfortable enough (that we’ve all, and especially me as the “authority” in the room, been transparent about the social construction issues) I keep the slide up and zero in on something very particular, hopefully less-gendered, and seemingly functional in scope. I ask the group to consider the difference between Cheryl’s shoulder joints and Olga’s shoulder joints. I ask them what they imagine scapular stabilization is like for each.

“Who needs to take more care of their shoulders over time?” I ask.

Students are happy to point to Olga.

“Why?” I ask.

“Because she looks hyperflexible” comes the typical answer, “and her profession is going to stress and stretch her tendons and ligaments. She’ll need to work hard to build muscle to protect her joints, or she might wind up in a lot of constriction and pain.”

It’s a good answer, as long as we register all of the caveats: Cheryl’s shoulders may look more stable, but we don’t know her injury history. If we imagine Cheryl flowing through a sun salutation, we can’t know how much more stress she will put on her shoulders than Olga will, given their different weight distributions, centers of gravity, and the angles at which their arms hang from the joints. On the other side, we don’t know how skillful Olga has become at managing her shoulder stability. It must be considerable, given her profession.

If we’re generally on-track and unpresumptuous with the shoulder discussion (having proposed that “Olga’s shoulders are more vulnerable”) where would we go from there? I say to the group:

“If it’s true that Olga wants to have stable shoulders over time – and we’d have to get clear on our countertransference issues first – we might want to recommend that she add resistance training and especially rowing into her conditioning routine. But we’d also have a to consider her nutritional needs and digestive function. Between her and Cheryl, who do you think will have an easier time at building and retaining muscle?”

Everybody points at Cheryl.

“Why?” I ask.

“Well it looks like Cheryl has a ‘thrifty’ type of metabolism that uses every calorie towards building strength.” This sounds okay.

“Anything else?” I ask. There’s a pause.

Someone offers: “I wonder whether Olga eats enough. I wonder if she’s anorexic.”

It’s a fair comment, but it raises even more projection problems. Olga could indeed be anorexic, or she could have a long-standing digestive disorder such as Celiac or Crones that inhibits absorption and stunts growth. She could have high thyroid function that burns through calories way too fast. We might be fooled by her Eastern European name beside the label “gymnast” into conjuring images of a gulag-type training in which she’s been weighed every day since preschool and constantly harassed about the smallest gains of fat on her chest and hips. She could carry all of these influences and have also decided to commit to a raw food lifestyle. Or she could be burning 4K calories a day in training. But we don’t know any of this story. We’ll have to put all of these ideas on hold until we talk to her. Obviously.

An experienced Ayurvedic practitioner might bypass all of these problems to pick out something that seems to be as phenomenological (and not-socially-constructed) as the difference between Cheryl’s and Olga’s shoulders: the basal temperature differences as evident in their complexion. Cheryl’s rosier cheeks might indicate a stronger digestive fire and therefore stronger tissue-building metabolism. By comparison, Olga seems slightly wan in this picture – a possible indication that her digestion and even appetite are typically low. To the practitioner it would be all fine and well to recommend that Olga builds muscle over time, but the first order of business that would even make this possible would be to help her invigorate digestion. But is this any less speculative than supposing Olga’s eating is disordered because of her training culture and heritage? No. But it is at least beginning with an embodied sensation: there is something meaningful to be discovered in the difference between the different temperatures that Cheryl and Olga appear to generate. We won’t know more until we meet them, and learn more.

So with all our efforts so far with these pictures, what do we have left? Little more than this: Cheryl’s and Olga’s physiques, which are so highly conditioned by their sports — but also by our own constructions of meaning, function, and beauty — seem nonetheless to suggest key structural patterns and possibilities from which we can generate exercise advice. But only if we factor out injuries etc. Further, we have the suspicion that weight gain and retention might be a challenge for Olga, but we don’t know why.

Is any of this any better than common sense? What is particularly Ayurvedic about how we’ve encountered these images, resisted their social significations to the extent we were able, and made two very modest observations related to structure and digestive vigour?

Not much, I’d say. The real Ayurveda – in all its glory and trouble and marketability – comes in what follows: the correlation of character and behavioral qualities to physical attributes. Wondering, based on stature and body heat alone, whether Cheryl is more prone to melancholy and is inclined to reach out to family for comfort, while Olga is more prone to anxiety, and seeks to soothe her nerves in solitude. Where will this wondering lead the conversation with these two if they were clients?

Beyond very common-sense appraisals of form and structure, Ayurvedic typology uses the horizontal thinking and intuitive leaping that are natural to every artistic effort but forbidden in science, which must keep its categories of study strictly separated while formulating claims that can be tested. In this way, popular Ayurveda can look very much like the discredited quackery of old physiognomy, which translates roughly as “I know who you are and what you are like by looking at you.” In order for typology to not descend (or return) into physiognomy, which has been used globally for everything from assigning work duties to reading the birthmarks of reincarnated gurus to fascist eugenics, I argue that Ayurvedists have to remain committed to a path of not-knowing, which means limiting the practice of typology to the purpose of simply beginning a conversation about how a person uniquely feels themselves to be in the world. And nothing more. The Ayurvedic practitioner knows only enough to help the client ask the questions that will expose (or even create) the patterns that connect their embodied and psychic lives.

What is typically done is that darśana, the “seeing” of the client in person yields to sparśana, touching the client. The visual bias of darśana – amplified in our exercise through the photos here – must now be fully sensualized with touch and hearing. In my practice this begins with holding the client’s hand in the sunlight to examine the flow and texture of lines. I feel the weight of the hand, the stiffness or flexibility of the fingers, the fleshiness of the thumb-mound, and the roundness of the ulnar curve. Each one of these observations gets silently cross-checked for meaning against the library of lore that long-term study builds up. Then, I feel into the person’s pulse, and an inner sensation emerges that seems to begin a dialogue with what I had previously only seen. I feel for pace, texture, weight, regularity, and what I can only describe as music.

Sometimes the dialogue follows a coherent line: the kapha structure yields a slower, rounder, more relaxed and fluid pulse. But often it does not. A person with the kapha structure can present a thin, wispy, fast, inconstant pulse. Is there something wrong here, or is this “innate” to them? (More on prakṛti and vikṛti below.) I want to hold the dissonance as long as I can, because I’ve learned that more dissonance equals less projection. If I want to encounter the other with depth, I have to welcome dissonance. And as the third part of traditional assessment begins – praśna (the interview) – I have to avoid falling into that world of cognitive fallacy, transference and countertransference. I have to hold the physical data lightly enough to not let it distort the emotional and narrative data that will now start flowing, but not so lightly that I reinforce the body-mind split that Ayurveda is uniquely positioned to heal. I have to hold the fact that biology is psychology, but not destiny, and that neither are fixed, or ever entirely knowable.

On a beginner’s level, with students working with photographs or with each other, I encourage an imaginative transition from darśana to sparśana by telling students to imagine hugging the client, chest to chest. How would putting your arms around Rulon feel? How would this add depth and texture and empathy to what may be distorted or minimized through visually-based stereotyping? What might it tell you about the types of encouragement he might benefit from in physical activity? I tell students that when I feel a pulse, a certain quiet develops in my office. Perhaps the client feels “heard” in a new way. Throughout the consultation, I tell my students, I’m careful to be transparent and verbal about what I’m doing and feeling, because this makes it less likely that the client will feel invaded or objectified by my presumed expertise, or as though they’ve had their identity secretly defined, as with blood in little vials that go to a lab no one ever sees.

Sparśana can confirm, enrich, or problematize darśana, but the whole encounter remains in the present phenomenological moment, until you start asking questions. Then cognition seems to stretch time and identity out into past and future.

It’s praśna that fills in the context and background. If the Ayurvedic practitioner is aware of of the fallacies, transferences and countertransferences the meeting will provoke, patient and mindful praśna might be able to sift visceral intuition from social conditioning. Darśana may not tell us any more than advertising does. Yet it makes a loud impression that’s not entirely discountable, being partially rooted in our preverbal selves. It must be held patiently as the intersubjective encounter develops what advertising can’t: intimacy.

 

Undoing constitution as identity

Above, I wrote: I have to hold the fact that biology is psychology, but not destiny, and that neither are fixed, or ever entirely knowable. Further above, I wrote: Typically presented, Ayurveda is said to be able to identify the essential psychosomatic qualities of a person. This is impossible, because there are none. If good typological practice is possible, it will resist the overdetermining tendencies of not only the complex of fallacies I’ve outlined, it will resist something much more deeply ingrained: our yearning for a stable identity.

There is an excellent and beloved Indian-born vaidya working in the U.S. who has arguably done more to help globalize Ayurvedic knowledge than any other living practitioner today. My clients include several people whose first encounter with Ayurvedic medicine were with this doctor anywhere from five to twenty years ago. Without exception, each person is able to report in decimal-point form the doctor’s assessment of their constitution.

“I’m Vata 3.1, Pitta 2.8, and Kapha 2.2, but I have a pitta vikṛti” is a typical self-description.

I ask them what this means to them. They often paraphrase the assessment: “Vata is highest, followed by pitta and then kapha, but vata and pitta are closest. But he said I have to be careful of my fire.”

I ask them what they do with this sometimes decade-old information. If the doctor had prescribed supportive herbs for them, many will be still taking them faithfully, all these years later, often going to great trouble to secure their supply when they move or as various herbal companies go in and out of existence. I ask if they know what the herbs are for. “Sort of.” Did the doctor suggest a deadline for taking them and checking back in? “I can’t remember,” or “I never made it back to see him.”

Then I ask: “So what have you learned about taking care of yourself constitutionally since then?” Sometimes there’s a well-informed answer, but this is rare. I’m sure that in part this speaks to the naïveté of popular Ayurvedic practice outside of India today, in which subjects often travel several time zones to meet with well-regarded practitioners for ephemerally brief consultation, but then are largely left without cultural support for what they are trying to learn. I do not know how much of the good doctor’s nuance was missed by his clients, but I’m sure he is painfully aware of how difficult his pioneering efforts are.

And yet something about these brief interactions was very meaningful to these clients. The process gave them something to hold onto, something that sounded precise and scientific and yet was imbued with mystical power. They spoke of the encounter with reverence, even awe. For many it was a highlight in a period of more youthful self-discovery. It often involved a yearning for new-but-ancient identity that medical anthropologist Jean Langford (2002) describes as a particularly western desire when encountering Ayurveda. One wonders if the popular modern fascination with constitution has been aided by Indian vaidyas acquiescing to the Western request for new Ayurvedic self-perceptions.

When these former clients of the famous doctor come to me, they are often looking to reconnect with that experience of being named with a label that recalls the Vedic gods of earth, fire, and wind. In a way, they come to be blessed. They often assume that I will feel the same uniqueness in their pulse as the doctor did, because as Ayurvedic practitioners, we must be tuned into the same unified wisdom that Knows Such Things, instead of two artisans of vastly different skill and orientation who each have their own ways of asking questions to expose patterns. I have the feeling they want me to look into their souls. I disappoint them when all I can feel is pulse textures, vocal tones, breath rhythms, and the twisting and unfinished story that weaves them all together. I can never know who they are, much less say. But I can reflect back to them the patterns they seem to be presenting, and then ask the questions that may weave them together. It’s a start.

The yearning for a more stable identity isn’t just romantic or orientalist. It shows up in the recent biomedical race to unlock the human genome. Not so long ago the gospel was that if we can crack our DNA, we’ll understand who we are and what our destiny is. But this was before epigenetics – the study of changes in gene expression that are not caused by changes in DNA – began to make it all relative again. The preliminary findings of the field suggest that the very gene sequences (where “genes” = “prakṛti”) that we once described as though they determined our disease vulnerabilities are not only prone to expression or suppression, they can literally be rewritten by both environmental factors and behavioral choices. In simple terms: epigenetics is the study of how software rebuilds the hardware that runs it. It is a non-dual science if I ever saw one.

Interestingly, Ayurveda has always made a distinction that might predict the difference between genetics (hardware) and epigenetics (software). “Natal constitution” (prakṛti) is said to be in constant dialogue with the “force of change” (vikṛti). Vikṛti is used to describe an enormous range of variability: seasonal illnesses, pregnancy, times of life… but also the results of injury or trauma, chronic digestive distress, and long-term diseases that Ayurveda depicts as distorting natal constitution beyond recognition, perhaps to the point of erasure. In the three last stages out of a possible six in Ayurveda’s etiological scheme, the tissues are said to become gradually indistinguishable from the qualities of the disease itself. The software of circumstance rebuilds the hardware we thought equaled destiny.

Separating out prakṛti from vikṛti is therefore a highly dubious proposition. Trying to access “pure” prakṛti is so complex, buried as it is under a thousand changing conditions, that some traditional practitioners insist that reading it from a pulse requires the pulse to be taken under the appearance of highly controlled circumstances: let’s say, at four in the morning, facing east, at the end of a three-day fast, etc. Or there are systems of divination: entire books have been written about “Ayurvedic Astrology”, proposing that our genetic inheritance is written in our birth horoscopes. Such esoteric drives communicate the paradoxical notion that prakṛti is so difficult to discern by those with mystical powers that it must be real. This dribbles down into the clear bias in contemporary Ayurveda towards valuing prakṛti as the heart of a person’s identity – a kind of “true self” that can be called upon, marketed to, surrendered to. A self blessed by a call-center worker for the Chopra Center, or a bona-fide vaidya from India who you mistook for a pre-modern person but who actually uses the same smart phone as you do. A doctor you imagined was able to see into your eternal soul and give you something to hang onto in a fracturing world.

Epigenetics is only one of the many contemporary disciplines that blows Ayurvedic (and every other) essentialism out of the water. DNA is no longer the stable coding structure we once knew. And then there’s the neurology of brain plasticity (Doidge, 2007) and the social self (Hood, 2013), both of which show that the very root of the central nervous system – the heart of our agency and pretensions to free will – is framed and programmed intersubjectively through countless relationships, interactions, and mirrorings. The feeling that we make ourselves is an illusion. The feeling of an “original me” prior to experience is an illusion. Experience makes us. The changing world makes us. Yes, we are running hard genetic programmes, but those programmes are downloading apps from the biosphere day by day. It’s all looking like vikṛti now.

What would popular Ayurveda lose if it had to give up prakṛti, or rather redefined it as a range of possible change? What would happen if practitioners related to clients as if everything was fluid with vikṛti? Would this encourage them to pay exclusive attention to the minutest sensations of change? Would they let go finally of their instinct to determine who the subject is and who they should become?

Let’s come back to our athletes for a moment, and flesh them some more complexity.

Schatz’s book was published in 2002. Olga Karmansky was 15 at the time. She’s actually American. She’s gone on to a successful performing arts career on Broadway and beyond. Her BMI and complexion have have clearly changed, and she seems utterly relaxed and affable. Even grounded. If you click through to the video she shows the same ridonkulous mobility she’s probably always had, but her movements are powerfully contained and controlled. Her facial structure presents a number of broad and rounded kapha-like features that I hadn’t seen in the previous image. Were her teenage years one long vata vikṛti?

Cheryl Haworth. From the age of 14 through her retirement at the age of 26, Cheryl dominated women’s weightlifting in the U.S. All while developing skills as a fine artist. Her mother reports that as a child Cheryl was underweight and plagued by constant respiratory infections and allergies. At six, she had her adenoids and tonsils removed, and her appetite surged. How many questions would we have to ask her to suss out the “naturalness” of Cheryl’s size and strength? She’s 31 now. Five years after her intensive training has ended (she would commonly lift 25 tons per day), is a more natural Cheryl emerging?

What do we know about people? Who has an “essential” constitution? And at the same time, who doesn’t feel a thread of unique continuity joining our difference selves and ages together? From time out of mind, Ayurveda has been asking: What is that thread? Now we have to ask: Why does that thread seem to unravel as we pull on it?

 

The practice of constitution: what’s left? Embodied empathy?

The danger of close cultural analysis and deconstruction is that it can leave us with the feeling that nothing works, nothing can be trusted, and everything we thought we knew is stupid. I really hope this post has done more than this, because I don’t actually have these feelings. I mean for this post to be a necessary preview to an ongoing discussion about how some exquisite insights from the Ayurvedic tradition continue to reach out to us from the past, and that we’ll be able to use them well if we interrogate them thoroughly.  I’ll finish with a few simple ideas that I hope to flesh out in the near future:

• The immediate visceral responses individuals have to otherness are real and they matter. They are rooted in the instant but tricky wisdom of mirror neurology. There is no doubt that we would feel different things when standing in front Cheryl and Olga – feelings that precede cognition and indicate our limbic brain’s basic levels of comfort and approachability. But on the cognitive level, our responses tell us about ourselves more than anything. If we can first see and then see through our cognitive fallacies and socio-cultural projections, perhaps we can re-connect with a more “raw” knowledge that doesn’t exclude the palpable differences of bodies.
• Constitution cannot be firmly categorized, but it can be seen as expressing along an infinite continuum. It seems instinctual to visualize this continuum as linear – perhaps utilizing the qualitative progression implied by the traditional ordering of the elements: earth, water, fire, air, and space. But blendings of the elements that people present cannot be expressed in continuous gradients. More often than not, people present qualities that are discontinuous from each other – from opposite sides of the colour spectrum, as it were. I would love someone to help me graph a non-gradiated matrix of constitutional possibilities. It might look like a holographic cross between a colour-wheel and Indra’s Net.
• Physiognomy is bunk, so we have to find a non-essentializing way to show our respect for how the textures of psyche and soma are in constant dialogue, informing each other, revealing each other, changing each other.
• Fruitful evidence-based paths for typology exist in at least two areas. First is the research of inhibition/uninhibition in developmental psychology (Kagan, 1994). Kagan shows that high inhibition in infants (fear of novelty, clinginess), which is associated with lower birth rate among other physiological markers, has a high correlation with vata-temperment traits in later life. Low inhibition (relaxed startle response, adaptability to novelty) correlates with kapha-temperament in later life. Is pitta somewhere in between? Secondly, neuroscience is doing a lot of work currently to clarify the near-instant communication between the amygdala, which alerts us to stimulus, and the hippocampus, which interprets it precognitively (Cozolino, 2010). I imagine these studies will shine light on the immediate “approachability” or “receptivity” of the other, which is not a bad lens for understanding the visceral responses at the root of beginning to assess constitution. The amygdala assigns instant values to both Cheryl and Olga. Then the hippocampus refines that scan with nonverbal memories of what interactions with similar shapes and movement patterns generally mean. Can various forms of mindfulness meditation slow down this process to access a wisdom prior to social construction? I feel that this is what I try to do in my practice, but it’s very hard to tell how successful I am.
• What is constitution, but the ineffable impressions we gather about how best to interact with the other? What is Ayurveda, but the sculpting of those impressions into a highly refined art of empathy? How can developmental psychology and neuroscience help us sort out what the ancients were trying to do with ruder tools?

 

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Special thanks to my assistant Jason Hirsch and my partner Alix Bemrose for invaluable feedback. And also to readers James Bae, Aimee Morrison and Lisa Wells. Also — thank you to the athletes.

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References:

Berman, Morris. Coming to our senses: body and spirit in the hidden history of the West. New York: Simon and Schuster, 1989. 

Cozolino, Louis J.. The neuroscience of psychotherapy: healing the social brain. 2nd ed. New York: W.W. Norton & Co., 2010.

Doidge, Norman. The brain that changes itself: stories of personal triumph from the frontiers of brain science. New York: Viking, 2007.

Hood, Bruce M.. The self illusion: how the social brain creates identity. Oxford: Oxford University Press, 2012.

Kagan, Jerome. Galen’s prophecy: temperament in human nature. New York, NY: Basic Books, 1994.

Langford, Jean. Fluent bodies: Ayurvedic remedies for postcolonial imbalance. Durham: Duke University Press, 2002.

Moerman, Daniel E.. Meaning, medicine, and the “placebo effect”. Cambridge: Cambridge University Press, 2002. 

Said, Edward W.. Orientalism. New York: Vintage Books, 1979.

Wujastyk, Dagmar. Modern and global Ayurveda pluralism and paradigms. Albany: State University of New York Press, 2008.