We have all heard of the practice in the West where physicians swear on some version of the Hippocratic oath as the basis for offering medical assistance, as well as for ethical accountability. Yet, I feel it is safe to say that I am not the only one who has been treated by a doctor or therapist whom I thought could improve their bedside manner, or left me pondering whether they possessed solely financial motives for assisting me. As the commercial social paradigm drives us toward its adjudged version of abundance and achievement, I see the counterweight quest for whole health is growing paramount. Whomever we consider ourselves to be, we are all susceptible to illness and death. Let us take a look at what traditional moral qualifications a Thai doctor is required to possess, and consider how those qualifications can inform our own practices.
Ethical Standards in Traditional Thai Massage
Ancient Buddhist medical practices were passed down through the ages from their homeland in Northern India before migrating to other lands. One such place was Thailand. The influence of Buddhism, and thus Buddhist medical practices, on Thailand has impacted the people and the land since before its recorded formation.
The Thai term given to massage therapists in Thailand is Maw Nuad, literally translated as “doctor (of) massage,” owing to the fact that Thais revere qualified massage therapists as doctors and expect them to act as such. Traditionally, as well as in current accordance with the Thai Ministry of Public Health, Thai massage is seen as an integral subsect of traditional Thai medicine.
In the old Buddhist medical tradition, aspiring doctors would spend seven years or longer in training to become a qualified doctor of medicine. As a standard, the first few years were spent cultivating ethical behavior, until it became second nature in their everyday life. They would not only study spiritual texts on moral conduct, such as Shantideva’s Bodhisattvacaryāvatāra, but would also become proficient at putting them into practice. Doctors-to-be would read through Sanskrit scriptures or the Pali Canon every day. This proceeded in conjunction with putting medical manuscripts to memory; for example, the rGyud-bZhi (“Four Tantras”) if in the Tibetan tradition, or the khampi-wetchasueksa1 and phaet-saat-songkroh if in the Thai tradition. To help inspire, as well as remind practitioners of their accountability to the tradition, many would receive some type of initiation upon which they would take up vows and moral practices. An example of practices would be to regularly hold and practice the following five disciplines, or training exercises, known as the pañca-sīlāni in Pali:
1. Refrain from killing any sentient being.
2. Refrain from stealing.
3. Refrain from sexual misconduct (e.g., adultery, those in chastity, or underage).
4. Refrain from lying (false, divisive, harsh, and gossip/idle chatter).
5. Refrain from becoming intoxicated (i.e., alcohol, drugs).
Brahmaviharas
As the Thai medical profession evolved, surrounded by its social and political environment, what remained constant was the perfecting of the brahmavihāras, also known as the “Four Immeasureables.” Masters considered the brahmavihāras to be the pillars of one’s practice, because if a practitioner genuinely followed them, they would automatically follow the rest of the established ethical code expected of traditional Thai doctors.
A common thread in the modern Thai massage world is the practice of mettā-bhāvanā, the spreading (or distribution) of loving kindness. This is but one quarter of the brahmavihāras, a fact that aspiring Thai-massage therapists ought to remember. The four brahmavihāras are comprised of:
1. Mettā: loving kindness—the wish that a person, or all sentient beings without exception, be happy and have the cause of happiness.
2. Karuā: compassion—the wish that a person’s suffering, or that of all sentient beings without exception, will diminish and they will be free from suffering and the cause of suffering.
3. Muditā: empathetic joy—rejoicing in and encouraging the happiness, success, and accomplishments of a person, or all sentient beings without exception; the genuine wish that a person or all sentient beings never be separated from happiness.
4. Upekkhā: equanimity, impartiality, nonprejudice—removing any partiality toward those with whom one practices the three previous brahmavihāras; remaining in equanimity (unaffectedness) to the Attha Loka Dhamma (eight worldly concerns).
Without upekkhā, the practice of mettā-bhāvanā is limited, incomplete, and biased. Through the brahmavihāras, we arrive at the next moral bastion of a Maw Nuad. Doctors of Thai medicine give sincere effort to rid themselves of attachment or aversion to the Attha Loka Dhamma. Through this practice, they see and clarify their motivations behind pursuing a profession in Thai medicine, and thus massage, including how they continue to treat patients.
The four pairs of the Attha Loka Dhamma are:
1. Loss and Gain.
2. Fame and Censure.
3. Praise and Slander.
4. Sorrow and Happiness.
Thai Ethics
Should a Thai-massage therapist or Thai doctor treat patients solely with a heartfelt grasping, attachment, or aversion to any of these eight factors, they would be practicing impurely, in a traditional sense. Attachment to happiness can turn into a form of suffering. To us in the social structure of this modern commercial world, these may present a glaring conundrum. “How can I make a living and support myself or my family if I don’t focus on the bottom line?” “How can my business and brand grow without promoting myself?”
What these eight factors do is remind us of the true intention and purpose of the medical profession: to remove the sufferings of sentient beings. If we are good therapists or doctors, practice well, and train ourselves well, then people will want to come to us because we are good at what we do and we have genuine hearts with our offerings. Word of mouth is activated and spread, electronically and physically. These eight factors are not telling us that we have to be poor or meek. In fact, traditionally, it is important for the client-patient to not just offer something of value in exchange for a doctor’s aid, but to give them their full trust. Without the offering, the exchange becomes unbalanced and unfair, to both parties. The grey area of what constitutes an equal exchange is where exploitations take place.
For these reasons, students are required to learn and observe a set code of conduct. The following is a translation of 10 regulations used by the famed Wat Po Thai Traditional Massage School in Bangkok:2
1. Possess mettā toward all patients equally, refraining from selecting patients based on their wealth, fame, and preference.
2. Do not treat patients solely out of greed and desire for money.
3. Speak the truth and remember humility.
• Be honest and confident about one’s capabilities and knowledge, but do not advertise or tell patients that one is better than other doctors.
• Do not brag, boast, or advertise about one’s knowledge and capability, either in order to get more patients or especially to the point where patients lose faith in other doctors.
4. Know your community and your limitations. Share your patients. Do not obstruct other doctors and/or speak poorly of other doctors’ capabilities, most especially if they currently have more knowledge than oneself.
5. Refrain from prejudice and bias. A good doctor has a heart geared toward helping alleviate the suffering of everyone. Thus, do not treat people out of:
• Chandāgati: treating patients one endears, or has partiality toward, with extra care while showing carelessness and indifference to those one does not have an affinity toward.
• Mohagati: delusion; believing one possesses extraordinary skill to the point where one treats patients with overconfidence and carelessness.
• Dosagati: treating a patient with annoyance, frustration, or anger in one’s heart to the point where one does not give their all to their patient.
• Bhayāgati: unfounded fear or worry while giving a treatment (e.g., fear that the client will not be able to pay, or will be completely cured and never come back, or that they will go elsewhere and prefer that doctor instead).
6. Remain unaffected by and indifferent to the Attha Loka Dhamma.
7. Possess refinement and subtlety of character, with a healthy fear of bad deeds in body, speech, and mind. A good doctor remains loyal and honest to their duty and themselves.
8. Be cautious and thorough. Avoid carelessness and laziness.
9. Possess thoughtfulness, consideration, and methodology. Rationally and meticulously analyze the causes and conditions of the patient’s suffering. A good doctor fully utilizes their intelligence, knowledge, capability, skills of reflection, and experience when giving treatments.
10. Remove oneself from all habitual behavior leading to ruin and corruption, i.e., laziness, adultery (womanizing/man-izing), binge drinking, outlandish nightlife activities, indulgence in entertainment, gambling, and keeping the company of those leading such lifestyles.
What a different world this Western health-care system would be if we could incorporate these noble ideals into our medical culture. In applying the famous quote of Laozi, perhaps the first step in this “journey of 1,000 miles” starts with ourselves; to look within and examine our personal motivations and incentives as to why we offer what we do. From honest introspection, we bring our inner world into our outer world of speech and action. Putting this into the massage world, through deepening our own morals, we honor the profound opportunity we have in putting our hands on those sentient beings that come to us for assistance.
Notes
1. C. P. Salguero and N. Jacobsen, Thai Herbal Medicine, 2nd ed. (Scotland: Findhorn Press, 2013).
2. I personally translated these 10 codes while I was studying at the Chetupon School of Traditional Medicine in Bangkok.
A former Buddhist monk, Josh Jayintoh received bodywork training from the Wat Po Thai Traditional Massage School, Triple Gem School of Thai Massage, Noam Tyroler’s School of Thai Acupressure for Orthopedic Disorders, and the Naga Center. For more information, visit www.joshuajayintoh.com.