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Te Whare Tapa Wha - A Presentation at the MindBody Conference November 2006
Margaret Poutu Morice
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In 1947, the World Health Organisation gave a definition of health which still stands
today as a benchmark of wholistic human understanding. In the WHO definition: “Health
is a state of complete physical, mental, and social wellbeing and not merely the absence
of disease or infirmity.” Despite the many technical advances in medicine since 1947, we
have yet to take up the challenges posed by an inclusive understanding of health.
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Today we will be speaking to you about a wholistic perspective on body and mind that is
both ancient and modern – the Maori perspective. Contemporary Maori models of health
seek to widen our understanding of the meaning of health, help us to recover from an
excessively narrow focus on illness and restore us to a more balanced and holistic
perspective on wellness. The particular contribution of models of health that invoke
traditional Maori values and belief systems is their ability to translate health into terms of
cultural significance, and to balance the medical model with an awareness of social and
cultural factors.
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Dr. Mason Durie has been presenting an integrated approach to healthcare for more than
twenty-five years. His model, known as Te Whare Tapa Wha, brings together the
physical, mental, social and spiritual dimensions of health and healing. Durie
(1998, 1999, 2001) has repeatedly challenged the monocultural assumption that health is
the same thing for all people. Durie view’s culture and cultural experience as crucial to
the development and maintenance of good health. Where loss of culture is a threat to
health, culture also has the potential to become a positive resource for health promotion.
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Commenting on the crisis of Maori health today Durie writes:
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“where lifestyles create health risks and where there is aimlessness made worse
by cultural alienation, confused notions of self, and threats to physical health, then
a focus on external relationship within the context of cultural identity offers a
chance for restoration of spirit and the resolution of loss.”
Our intention today is to review Durie’s Te Whare Tapa Wha model, link this model to
concepts of wholistic health as these are understood by Maori and bicultural practitioners,
and consider the application of this model not only to issues of Maori health but as an
assessment tool for health professionals generally.
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The Whare Tapa Wha model was first presented in a training session to the Maori
Women’s Welfare League research project Rapuora in 1982. Durie, at that time the
senior psychiatrist of Manawaroa, the psychiatric unit of Palmerston North Hospital, was
able to weave together the themes of the other speakers preceding him to arrive at this
model, which compares health to:
the four walls of a house, all four being necessary to ensure strength and symmetry,
though each representing a different dimension: taha wairua (the spiritual side), taha
hinengaro (thoughts and feelings), taha tinana (the physical side), and taha whanau (the
family).
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Taha Tinana (The Physical Domain)
Maori health perspectives are wholistic, inclusive and relational. Maori have always
assumed a psychosomatic unity. In a Maori world view, the language of the body is
inextricably linked to relationships. This is apparent in our language – whenua is ‘land’
as well as ‘placenta’, iwi is ‘tribe’ as well as ‘bones’, hapu is ‘extended family group’ as
well as ‘pregnant’. The body/tinana, and the extended family/whanau, affirm their
connection to each other and with Papatuanuku/Earth Mother (and Ranginui/Sky Father),
through whakapapa, mythology, creation stories, lore and waita/song.
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Taha tinana or bodily wellbeing is maintained through customary observances as well as
the usual Western practices of public health and healthcare services. Customary
observances recognize that we do not just have a body, but are embodied in the world.
We dwell in our body as our everyday environment. The body is the physical container of
the self, but it is more, for it is also a fundamental aspect or dimension of self. Shaking
hands or pressing noses is more than a physical meeting; it is an intimate encounter
between selves. We cannot elect to not be a body. When we are physically present we are
potentially available to others, open to their presence and their proximity, their gestures
and their gaze, as they are to ours. It is the body that first seeks nourishment and nurture:
that first facilitates movement and intention. Both our being and our doing are founded
on our body, and there is a natural human tendency to take this body for granted until
something goes wrong. In other words, underneath the so-called ‘objective’ conditions of
health, the smooth working of the body’s ‘machinery,’ is the issue of our relationship to
our physical being. Many people are unhappy with their bodies and suffer body image
problems. They may experience shame or embarrassment about their body. They may
treat their body harshly, despise or abuse it. They may dissociate from their body and lose
touch with their physical needs. They may believe they are ugly and not fit to be seen, or
at the opposite extreme come to believe that their body is the only part of them that has
value to others.
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All of these considerations underpin and deepen our understanding of whaiora – the
search for health and wellbeing. Physical health results from the interaction of genes and
environment, but it is also the consequence of a lifetime of living in a particular way.
Obviously our biological endowment is important. Likewise our physical environment,
Exposure to toxins or other harmful agents may override and eventually destroy our
natural immunity. But the sources which nourish our health include many different
variables. Our values and beliefs about what constitutes health or illness, ease or disease
have an enormous influence on our physical state. Health problems, whether they result
from genes or environment or a combination of both, always exist within a particular
cultural context. This context provides much of their meaning. Culture can intensify or
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ameliorate the impact of health problems. What we call deprivation, abstinence, addiction,
excess, accident or lifestyle choice is a matter of definition, socially and culturally
constructed by individuals and the groups to which they belong. For the person who is ill
or disabled, part of healing or becoming healthy involves reframing or reclaiming their
embodiment. This means recovering or developing a personal and subjective way of
being physically in the world that feels natural, congruent and connected.
(slide 9) Te Whare Nui
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Taha Hinengaro (The Domain of Thoughts and Feelings)
Within the holistic world-view of Maori, the individual psyche is understood as a
microcosm of the greater universe. In the Maori world, our inner world is populated with
nga tupuna, all those who have gone before. What lies within us includes hau muri
(literally the wind/breath behind, associated with the future, what is yet to be) and hau
mua (literally the wind/breath before or in fro associated with what is already past). The
future, unseen behind us and the past, visibly apparent before us are real and immediately
present in this moment. The past secures the present and the present ensures the future.
We, in this present moment, are the connection, the indissoluble link between past and
future.
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Taha hinengaro includes the full expression of thoughts and feelings, emotional
communication and the unspoken signals of body language as well as the spoken word.
In Maori understanding, these all derive from the same source. Durie writes:
Healthy thinking from a Maori perspective is integrative not analytical;
explanations are sought from searching outwards rather than inwards, and poor
health is typically regarded as a manifestation of a breakdown in harmony between
the individual and the wider environment.
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Research in counselling and psychotherapy suggests that the basic attributes of successful
counsellors and psychotherapists include qualities of non-possessive warmth,
genuineness and unconditional positive regard for the client. These attributes are not
limited to the non-directive counsellor but reside at the core of basic psychotherapeutic
skills. Practitioners in diverse schools and modalities of counselling and psychotherapy
have suggested an expansion and transformation of the traditional psychoanalytic attitude
of receptivity. We can appreciate, admire and welcome the client while maintaining at the
same time a balanced and non-judgmental regard. This attitude encourages the health
professional to work with clients in a synchronous, alongside and intimate manner that
emphasises attachment rather than detachment and values interdependence as much as
independence and autonomy. Maori value lived experience above objectivity, and
engage in active support rather than maintaining neutrality. In a Maori world-view, it is
the force of connection that holds the Universe and everything in it together. This
recognition predisposes us to be generous rather than withholding and to actively respond
to the other rather than simply observing or listening. When we work with our clients we
strive to freely express our appreciation and our admiration for all the diverse parts of
that person. This should not prevent us from listening to all the voices, containing all the
contradictions, or waiting patiently and attentively for a deeper unity to emerge.
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Taha Whanau (The Social Domain)
The Maori view of the self is much less individualistic than its European counterpart,
more focused on identity with the kinship group. Traditional Maori social values
emphasised collective action and responsibility. Individual achievement was encouraged,
however, these achievements were evaluated in terms of their contribution to enhancing
the wellbeing of the group.
(slide 14) Tukutuku Pou Tama
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Maori Marsden writes:
Because the members were united on the basis of kinship ties, the whanau or hapu
group was regarded as organism rather than organisation. That is, that the group
shared a corporate life and each individual an integral member of that body or
organism performing a particular function and role. Therefore, to serve others is
to serve the corporate self. Thus, loyalty, generosity, caring, sharing, fulfilling
one’s obligations to the group, was to serve one’s extended self.
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Traditional Maori society was tightly structured and organized according to its own
beliefs and values. Colonisation has forced Maori to live as a disadvantaged minority
group within an alien culture in their own country. Continuity between home and family
and the wider society has been deeply fractured. As all available health statistics will
attest, this has had devastating consequences for Maori. This situation has worsened since
the dismantling of the socialized public health system in Aotearoa/New Zealand and its
replacement with privatized ‘Crown Health Enterprises’ and private healthcare. Nor has
the recent return to District Health Boards succeeded in reversing the negative effects of
the ‘economic rationing’ of healthcare services. Access to effective healthcare is
becoming increasingly dependent on social and economic privilege, and the provision of
healthcare has become an economic opportunity.
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World-wide, globalisation and neoliberal economic policies have led to economic
deprivation and social breakdown. War, intolerance, discrimination, poverty, violence,
ignorance and shame create unhealthy family and social environments. The growing
disparity between the haves and the have-nots is a critical health issue in virtually all
societies today. Uprooted, alienated and dispossessed people struggle to exist, let alone
flourish. Approximately five of the six billion people on the planet today live in poverty,
probably the single greatest cause of ill-health. We can also appreciate that unhealthy
environments do not support healthy lives. Our relationship to the natural environment
and the Earth has been profoundly disrupted. For the one billon or so relatively
privileged middleclass citizens of the world, the contribution of the modern lifestyle itself
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to ill-health deserves consideration, not only physically in terms of high stress, processed
food, and lack of exercise, but socially in terms of disconnection from each other and
from the land which sustains us.
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For Maori, the issue of ownership over our own healthcare is critically important. Maori
insist on the need for shared decision-making because we believe that ultimately, the selfdetermination by a people of their own aims, goals and priorities is a health issue and a
vital key to good health. Durie writes:
Central to the notion of Maori health development is Maori control. While there
is no denying the benefits of well-meaning health practitioners or major advances
in medical science, good health cannot be simply prescribed by
politicians or
health professionals...if there is a lesson from the past century it is that advances
in Maori health have been associated with strong Maori leadership.
From a Maori perspective, the social world is basically an extension of the family.
Society is woven from the fabric of kinship relations. The family is the microcosm,
society or civilization is the macrocosm. It follows that social problems have a family
solution, that the extended family is naturally the first place to seek support.
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Durie writes:
Taha whanau acknowledges the relevance of the extended family to health...The
family is the primary support system for Maori, providing care and nurturance,
not only in physical terms but culturally and emotionally. Reported rises in the
prevalence of family dysfunction, including signs of abuse, do not lessen the point
but underline its significance. Maori still maintain that ill health in an individual
is a reflection on the family...the much lauded state of self-sufficiency or selfrealisation does not convey a sense of health to Maori. Quite the reverse, since an
insistence on being overly independent suggests a defensive attitude, while a
failure to turn to the family when the occasion demands is regarded as immaturity,
not strength. Interdependence rather than independence is the healthier goal.
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Durie has proposed five positive capacities inherent within the whanau structure:
Manaakitia, the capacity to care for whanau members, particularly children, the elderly
and the less able; tohatohatia, the capacity to share, to provide a safety net by distributing
money and goods to those in need; pupuri taonga, the capacity to provide guardianship,
to act as trustees and manage resources; whakamana, the capacity to empower, develop
human capital and engage in advocacy; and whakatakoto tikanga, the capacity to plan
ahead and provide for the future. Whanaungatanga refers both to the overall sense of
family cohesion and to the specific processes by which whanau ties are strengthened. In
a practical sense, responsibility to relatives might be enacted in many ways and the
rewards are significant – access to a shared pool of resources, guidance and emotional
support, practical assistance in times of need, and a sense of identity that comes from a
life lived in close cooperation with an extended group of significant others. From a Maori
perspective, it is not principally our mental activity that connects us to each other and to
the world we share in common, but rather the interpenetration of lives lived together in a
particular place and time.
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Taha Wairua (The Sacred or Spiritual Domain)
Wairua means, literally, two waters. The ‘two waters’ may be understood as the flowing
together of two realms or domains of human existence: heaven and earth, the spiritual
and the physical, the potential and the actual, existence in its intangible and tangible
aspects.
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Maori Marsden explains:
It is obvious that the Maori does not, and never has accepted the mechanistic view
of the universe which regards it as a closed system into which nothing can
impinge from without. The Maori conceives it as at least a two-world system in
which the material proceeds from the spiritual, and the spiritual (which is the
higher order) interpenetrates the material physical world of Te Ao Marama.
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Wairuatanga, then, refers to spiritual matters or the practice of spirituality. Maori remain
lineage holders of an ancient wisdom, a creation theology in which all life is sacred and
all beings possess soul. Maori hold the universe to be a decentred and diverse whole, a
self-organising, self-regulating system that is dynamic, complex, and continuous. All is
interconnected process in constant play, nothing is sovereign and autonomous, fixed or
unchanging. Reciprocity is the central feature of all these relationships. The human is not
the centre of the universe. The wisdom of the universe flows through us as it does all
things. We are a small part of a much larger tapestry. All things are living, related, and
sacred. Whanau, whakapapa, and whenua form a necessary unity. They anchor and
ground us, creating the ever present link between ahau (I, myself) and the more
encompassing hau (wind or breath of life). Maori self-understanding begins at the
beginning, telling us where things come from and how they came to be.
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Creation narratives follow the continuous unfolding of the universe from its primal
beginnings to the rise of the phenomenal world of sense perception in all its richness and
diversity. The human world is a relatively recent chapter of the universe story and is
based on its genealogical (whakapapa) relationship to prior creation. The foundations of
the human world are the natural order, all the citizens of the world of whom human
beings are but one species. We are inseparably and inescapably a manifestation of the
greater whole, formed of the living body of Papatuanuku, Mother Earth, infused with the
breath of Tane Mahuta, the God of humankind. The Earth is our mother and all life
springs forth from her. Accordingly, we should take from the Earth only what we need
and protect and nourish the source for all future generations. Maori environmental
philosophies affirm the sanctity of life, affirm the lives of all creatures and places, heed
the voice of the earth, recognise the sentient qualities of nature, celebrate the intricate
interdependence of environments and their ecosystems, oppose the objectification of the
natural world, and prohibit its wanton destruction.
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(slide 24) Tauparapara
(slide 25) Te Kore
(slide 26)
Durie explains:
Taha wairua is generally felt by Maori to be the most essential
requirement for health. It implies a capacity to have faith and to be able to
understand the links between the human situation and the environment.
Without a spiritual awareness and a mauri (spirit or vitality, sometimes
called the life-force) an individual cannot be healthy and is more prone to
illness or misfortune. A spiritual dimension encompasses religious beliefs
and practices but is not synonymous with regular churchgoing...Belief in
God is one reflection of wairua, but it is also evident in relationships with
the natural environment. Land, lakes, mountains, reefs have a spiritual
significance quite apart from economic or agricultural considerations, and
all are regularly commemorated in song, tribal history and formal oratory.
A lack of access to tribal lands or territories is regarded by tribal elders as
a sure sign of poor health since the natural environment is considered
integral to identity and fundamental to a sense of well-being.
Underlying Te Whare Tapa Wha is the consistent theme of integration. The boundary
between personal identity and family identity is seen as fluid and permeable. Opposites
such as temporal and spiritual, body and mind, thought and feeling are understood in
relative rather than absolute terms. Dualism and discontinuity are returned to their
rightful place within a convergent continuum. The optimal treatment of ill-health, then,
does not exclude scientific and technical practices, but integrates these with spiritual,
relational and ecological dimensions. Te Whare Tapa Wha is a wholistic assessment tool
for any physical, mental, social or spiritual condition. In this frame, any objective
condition or concern is linked not only to effective treatment but also to personal
meaning and overall quality of life.
(slide 27)
A wholistic assessment might include the following questions:
1. Is effective treatment for this condition possible?
2. Has an accurate diagnosis been made?
3. What resources are needed?
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4. What are the major obstacles to obtaining or applying resources for effective
treatment?
5. How does this condition affect quality of life?
6. What can be done to maintain or enhance quality of life notwithstanding this
condition?
7. What is the personal meaning attached to this condition?
8. How does this personal meaning serve an active, collaborative approach to
treatment?
9. How does this personal meaning support maintaining and enhancing quality of
life?
10. What other physical resources, mental resources, wider family and social
resources and spiritual resources could be made available to assist with this
condition, develop personal meaning and enhance quality of life?
(slide 28) Tukutuku Patiki
(slide 29) Tukutuku Niho Taniwha
(slide 30) Tukutuku Tuwatawata
To conclude, we refer back to the report written about the Rapuora project where Te
Whare Tapa Wha was conceptualised. This report stated:
To say that a person is a psychosomatic unity, a personality formed jointly by
physical and mental processes, only partly embraces the Maori concept. A study
of Maori health must follow more than two strands. Tinana is the physical
element of the individual and hinengaro the mental state, but these do not make
up the whole. Wairua, the spirit and whanau, the wider family, complete the
shimmering depths of the health pounamu, the precious touchstone of Maoridom.
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