I was talking with a friend recently about constitution. I often hear people talk about this – “he has a weak constitution”, or “she has a strong constitution”; “I never get sick” or “I always get sick.” There’s a sense that there’s something fundamental in each of us that determines how we exist in the world.

 

Different people respond to the world in different ways. Constitution is a way to try and help us understand these differences. And several constitutional paradigms exist. As with any classification system, each has imprecision and imperfection, and if not used carefully may lead to bias and rigidity in thinking, or a sense that one doesn’t have control over their own life (“this is just how I am and I can’t change”). But it’s interesting that this constitutional approach has developed in many different cultures—and there tends to be overlap between them.

 

One constitutional paradigm, the Somatotype Theory, comes from the Western world. It was developed in the 1940s by an American psychologist, Herbert Sheldon, and classifies individuals based on their physical characteristics. The theory groups people into three primary body types, which also reflect personality traits and tendencies.

 

These are the three somatotypes:

 

Ectomorph – Ectomorphs are characterized by a lean, slender body. They typically have a low percentage of body fat, narrower shoulders, and a delicate bone structure. Ectomorphs generally find it difficult to gain weight or muscle mass and may have faster metabolism. They tend to be more introverted, shy, and sensitive.

 

Mesomorph – Mesomorphs tend toward a more muscular, athletic body type. They have a well-defined, proportionate physique, with a broad shoulder and narrower waist. They tend to have easier time building muscle, and are more naturally inclined toward physical activities. They tend to be assertive, competitive, and energetic.

 

Endomorph – Endomorphs have a higher percentage of body fat and a rounder, softer body shape. They tend to have a wider waist and hips and often find it difficult to lose weight. Endomorphs tend to be sociable, relaxed, and comfort-seeking.

 

The Somatotype theory has been criticized for its lack of empirical evidence and oversimplification—it doesn’t take into account interactions between genetics, environment, behavior, and psychology.  This may be a fair criticism. Yet there may also be a kernel of truth in the system.  Does one of these somatotypes resonate with you? Or perhaps you have a sense that you are a blend of several types?

 

 

The Somatotype Theory has some similarities to an older constitutional paradigm that comes from Eastern medicine. In Chinese medicine, constitution is an important variable when considering health and well-being. Chinese medicine has a more developed framework to examine constitution and can become quite precise. The most well-known of these is the Five Phases theory, which describes five constitutional types based on the Five Phases (Wood, Fire, Earth, Metal, and Water). Each phase, or element, is associated with specific organs and qualities, and the typology is used to help practitioners understand a person’s physical, emotional, and psychological traits.

 

These are the Five Phases constitutional types:

 

Wood – Associated with the liver and gallbladder, they tend to be energetic, assertive and creative. They may be prone to irritability and may have a tendency to overwork.

 

Fire – Associated with the heart and small intestine, they tend to be passionate, enthusiastic, and social. They may be prone to excessive joy or restlessness.

 

Earth – Associated with the spleen and stomach, they tend to be nurturing, practical, and grounded. They may be susceptible to worry and overthinking.

 

Metal – Associated with the lungs and large intestine, they tend to be organized, disciplined, and structured. They may struggle with grief and loss.

 

Water – Associated with the kidneys and bladder, they are introspective, determined, and adaptable. They may struggle with fear and insecurity.  

 

In Chinese medicine, further systems can also be used to describe constitution. These include the yin-yang constitutional system (in which individuals are yin-dominant or yang-dominant), the eight principles constitutional system (in which individuals are characterized based on eight fundamental principles: interior/exterior, cold/heat, deficiency/excess, and yin/yang), and the organ (zang fu) constitutional system in which individuals are characterized by the relative balance and functioning of the 12 organs of the body.

 

Other constitutional paradigms exist too. In Ayurveda, the dosha constitutional type is a central concept (in which each individual is a unique combination of three doshas: vata, pitta, and kapha). Tibetan medicine also has an element system, in which individuals are influenced by rlung (wind), tripa (bile), and pekan (phlegm). Each system is organized around its core components in a unique way.

 

Are constitutional types real? Does one framework resonate with you more than another? I’ve found them interesting in thinking about myself, and they can also be a helpful way to communicate with others about challenges that arise in their lives. They can be, to some degree, an oversimplification. Rarely is anyone “pure ectomorph” or “pure wood”. But if you examine and combine the components of constitutional types within a system, a nearly infinite degree of precision and refinement can be achieved. This is useful insofar as it serves as a way to gain a sense of what is happening in a patient’s life, and if it can help foster a connection between the patient and the practitioner. It can be a helpful way to make sense of the world and health.