Health Care at Evolution of Balance

I have been referred to and embrace being called a holistic doctor. From my perspective, holistic care is thought to encompass attention to the whole person. In 1848, the idea of whole person health was adopted by the World Health Organization (WHO) when they defined and continue to define “health” as: “a state of complete physical, mental and social well-being….” Later in 1977, Dr. George Engel, MD, published the Biopsychosocial Model (BPS) of health care, with the idea that we need to address the physical body, our mental health, and our social habits to best help patients toward health; and not just that they need to be addressed, but that these three areas directly and consistently influence the others.

Fibromyalgia makes for an easy example of the inter-relatedness between these three areas of focus and a BPS model treatment strategy. A person with Fribromyalgia Syndrome typically experiences chronic pain and tenderness in many locations of the body as a chief complaint; however, depression, anxiety and insomnia or poor sleep are almost always co-occuring symptoms. Care for a person with fibromyalgia is most effective when we help them with physical symptoms of pain, help them find ways to get quality sleep (social habits), and provide referral to a counselor or recommend strategies to help with depression (psychological).

Some examples of how our physical or biological health effects psychological and social well-being:

Chronic pain or illness can cause or contribute to depression.

Physical injury can make us fearful of motions or activities increasing anxiety and stress.

Pain, in general, can cause poor sleep.

Pain often leads to coping mechanisms like drug use or abuse or even just overeating to take our mind off our symptoms.

An injury can prevent us from taking part in activities that bring us joy that we identify with, that we have social circles built around that provide community.

Our psychological health does not need to be in a diagnosed state to have an effect on our physical and social health. Mild anxiety can cause stress and muscle tension. Judgmental/critical self talk (the Ego) can have effects on how we interact, how we perceive, and how we are perceived in social circles.

Depression causes fatigue, poor sleep and reduced social connection or even avoidance.

Many more severe psychological conditions are combined with social health difficulties and have associated physical signs and symptoms.

Some easy examples of social habits influencing our physical and psychological health states:

Smoking causes lung disease.

Poor dietary habits and lack of activity frequently lead to being overweight and can lead to metabolic disorders and diabetes.

Alcohol and drug use/abuse can lead to psychological disorders and can have a major impact on the physical health of the next generation when these social habits are not avoided during pregnancy.

These examples so far have been presented because they are easy to illustrate but this health care model acts on a very subtle level and not just in the negative. When we have work or social success it often lifts our mood. Making love often brings attributes of physical, emotional, and social health. Exercise can reduce high blood pressure. Exercise (physical and social health) is the best treatment for mild to moderate depression.

As modern science based institutions, like the WHO, and other health care individuals advocate for expanded philosophies in personal health, and health care in general, it is very interesting to explore the overlap between ancient yoga philosophy and this “new modern view”. In ancient yoga texts, the Upanishads, we find, outlined, the idea of ourselves having five layers of being and that each layer has the capacity to influence the other and that all of the layers need to be balanced and nourished for a healthy self. In Yogic tradition, these layers are referred to as the “Panca Maya Koshas” or the Panca maya model of Self or, simply, the “Koshas”. The five Koshas, or layers of being, are:

– Physical Body (Annamaya kosha)

– Energetic Body (Pranamaya kosha)

– Thinking Body (Manomaya kosha)

– Wisdom Body (Vijnanamaya kosha)

– Bliss Body (Anandamaya kosha)

In this model, the Physical Body or, in Sanskrit, Annamaya kosha is exactly what it sounds like, our bones, muscles, ligaments, tendons, organs, and the nourishment put in to sustain it all. This is where most of health care focuses, including the typical chiropractic practice. The Energetic Body or, in Sanskrit, Pranamaya kosha is represented by breath. It is the energetic flow through the body. The circulatory system and nerve conduction through the body may be included in the thought process surrounding the energetic body. Both the Physical and Energetic bodies or layers could be thought to fall under the Bio (biological) perspective in the BPS model.

The Thinking Body, or Manomaya kosha in Sanskrit, is our ability to form thoughts and memories; it is the ability to consider and to reason; it is what we hold as knowledge and how we use it. The Wisdom Body, Vijnanamaya kosha in Sanskrit, is sometimes subtly, but often profoundly different than the Thinking Body. The Wisdom Body is or sense of “I”. While self-understanding is important, the Ego crops up within the Wisdom body. Our Thinking Body and Wisdom Body strongly influence our social habits and mental or emotional state.

Our deepest layer, or kosha, is Anandamaya kosha in Sanskrit and is referred to as the Bliss Body when interpreted to English. The idea of Bliss or enlightenment is thought to be experienced when we are in balance and harmony through the other layers and in connection with our “true self” or to a sense of deep connection with divinity, god, your higher power, the life energy which connects all living things. A beauty of yoga is that it provides space for this connection and experience without defining it to any particular religion or thought. The Yoga Sutra is written to be accessible to the atheist or the devout from any religion.

As a doctor and yoga instructor, practicing with an attention to the BPS model and Kosha models helps me to feel confident that I am providing holistic care.

At Evolution of Balance, I work to help patients out of the discomfort as quickly and effectively as possible. By applying a holistic, or BPS, or Kosha model of health, I teach patients stretches, exercises and activities for self care, I offer sleep and nutritional counseling, I am willing to coach or counsel the practice of meditation for mindfulness and self-exploration, and I do my best to recognize need and provide referrals to other professionals when it is appropriate. As a patient at Evolution of Balance, you are offering me the opportunity to be your partner in health; as your partner, I do what I can to give you information and options so that you can make the most informed decisions for your health, well-being, and lifestyle.

If you have questions or would like to schedule an appointment, please call or email:

406-577-2742 or

-Dr. Steven Blair