Heaps of health

Thuli Whitehouse, GP and yoga instructor

Published in JHH 18.2-Frontiers of self-care


As I embarked on my medical training in 1999, I began to seek out alternative perspectives on both how to stay well and how to heal. One perspective I dived deeper into was Ayurveda, both through book work and spending time in a clinic in India. I further explored this interest in new ways of seeing and understanding during my intercalated BSc in Medical Anthropology. Part of this discipline is the cross-cultural comparative study of medical systems. It was here I came across the article, Heaps of health, meta – physical fitness: Ayurveda and the ontology of good health in medical anthropology by Joseph Alter. This long and densely packed paper challenges assumptions we make in our definition of health and disease and expounds principles that viscerally and subtly shifted my perspective on the idea of wellness. These ideas continue to inform my approach towards the people I care for today. Here I summarise and discuss them.

Our medical system in the west, sometimes called ‘modern medicine’ is what Alter describes as reactive or remedial healthcare. While incredibly useful, it is also limited in scope, primarily because of the way it defines health and illness. The starting point, in the theory of modern medicine, is that we begin life naturally healthy, then fall ill and later – through medical intervention – are restored to our former state of health. Within this model, we are inherently healthy but it therefore follows, ironically, that because of this we are prone to disease.

Ayurvedic medicine can be practiced in this remedial way but Alter interprets Ayurvedic medicine as defining the human ‘body as naturally imperfect – and therefore ironic as it may seem – naturally perfectible’. This opens up the idea of being proactively ever improved upon, something he calls ‘hyperfitness’. He considers this split between remedial and proactive healthcare, to be as significant a problem for medicine as that created by the Cartesian dualism that divides the body and mind. In Alter’s interpretation of Ayurvedic medicine, for remedial medicine to be effective, we must also follow a daily routine of health development and personal hygiene.

Because Ayurvedic theory understands health and illness differently, it naturally – obviously and nonjudgementally – places responsibility on us for the daily practices that refine and develop our imperfect being. In contrast modern medicine tends to place responsibility for wellness with the expert other, be that a surgeon, physician or GP; researcher, technician or therapist. This reliance on external locus of control may be at the heart of many problems generated by contemporary attitudes to health and wellness. It also means a person can be ‘blamed’ for allowing themselves to fall ill, through lack of expert remedial work. This is in contrast to the subtle but positive reframing that comes with knowing ourselves to be intrinsically out of balance and therefore ever improvable.

Rather than thinking of ourselves as naturally having good health that we must try to maintain, Alter’s interpretation of Ayurveda allows us to think about ourselves as potentially perfectible: that good health is a process rather than a static state, a process continually moving towards optimum balance. Rather than preventive or prophylactic healthcare, it reframes such practices as ‘vigorous self-development’ or refinement. These ideas are shared with other ideologies of wellness development from yoga to traditional Chinese medicine. The theory of Ayurvedic physiology and anatomy goes beyond the triad of mind, body and emotions and describes a multitude of intrinsic factors that contribute to wellbeing. Consequently Alter describes the human being as a ‘heap person’.

While perfection is impossible, we do have the option of an ever-improving balance. The better balance we attain, ‘the greater the approximation to the ‘ideal state’, the healthier we are. Each of us has a unique constitution made up of these multiple factors in different combinations. Therefore, we are all unique and need our own mixture of food, activity, sleep etcetera to approximate our ideal state. It seems the modern notion of ‘individual biology’ is far from modern.

In summary, this approach to understanding and improving health and the human experience steers the focus away from combating morbidity and mortality towards an individualised, affirmatory and exciting process of self-activation.


  • Alter JS (1999) Heaps of health, metaphysical fitness. Ayurveda and the ontology of good health in anthropology. Current Anthropology, 40, Supplement 43– 63.