Ministry with Hindu Patients
On April 15, 2002, the Chaplaincy hosted a presentation by Swami Tyagananda on Ministry with Hindu Patients. The Swami provided an overview of the Hindu concept of medicine called Ayurveda, as well as a basis of the Hindu philosophy regarding death.
Ayurveda- The Hindu System of Medicine
Hindu Conception of Death
Hindu Conception of God
Dealing with Hindu Patients in a Hospital Setting
Questions Asked by participants
Swami Tyagananda is a monk of the Ramakrishna order of India, and the Associate Minister of the Ramakrishna Vedanta Society of Boston. He came to Boston three years ago from India, and currently serves as a chaplain and a student counselor both at MIT and Harvard, as well as the chaplain for Hindu patients at MGH.
Swami is the title of a Hindu Monk, and Swami Tyagananda explained the meaning of his name, which was given to him when he became a monk. In Sanskrit, "tyaga" means detachment and "nandana" means bliss, thus his name means "the bliss of letting go." As the Swami explained, "The more we let go, the more bliss we are able to experience."
Ayurveda - The Hindu System of Medicine
Swami Tyagananda presented an overview of the Hindu system of medicine, known as Ayurveda, and provided some Hindu religious concepts regarding death. His presentation provided a basic philosophy of this ancient practice of medicine, however, as in most cultures and religions, there are variances in the traditional practices and the Swami's explanations may differ from others. The basic philosophy of the Ayurvedic system is that it is not only a body that is being treated, but rather the patient is always seen as whole, consisting of a physical, mental, and spiritual being. This is based on "dharma," a basic tenet of the Hindu religion, which means "anything that keeps something together." According to Hinduism and to Ayurvedic medicine, this concept is applied by keeping the mind, body, and spirit together as a whole. Hindus believe that the natural state of the body ("kaya" in Sanskrit) is harmony, and that if there is an illness, harmony must be restored. In his article "Love in Medical Ethics in South Asia," (Eubios Journal of Asian and International Bioethics 9, 1999), V. Manickavel, MD, explained that in ancient times, this medical and spiritual knowledge was considered sacred, and thus was often only permitted to be studied by brahmins, the highest level in the Hindu caste system and traditionally priests. This has changed in modern times, but the Hindu physician practicing Ayurveda is still considered a spiritual leader whose primary responsibility is using his knowledge to heal the patient.
Based on the Ayurvedic system of medicine, the body consists of seven bodily constitutions: nutritive fluid, blood, fat, muscle, bone, nerves, and semen. Also, there are three operating principles in the body - wind, bile, and phlegm - and different portions of these three components make each body different. Wind (vata) is seated in the intestines, including the urinary tract, colon, waist, legs, and feet. It controls "movement," and is the dynamic force generating the somatic and psychic processes. It includes the five major winds: breathing (prana), outbreath (udana), discharge (apana), digestion (samana), and pervasive breath (vyana), as well as the five minor winds: reflexes and contraction of limbs, appetite and anger, yawning, expectoration, and nourishment. Bile (pitta) exists in the stomach, sweat, chyle, lymph, and blood, and controls metabolism. It governs vision, digestion, heat-production, suppleness of body, intelligence, and cheerfulness. Phlegm (kapha) is in the chest, head, neck, joints, stomach, and fat, and serves to conserve, protect, and stabilize structure. It controls courage, forbearance, zest, virility, bodily strength, and smooth bodily function.
Any illness or disturbance in the body occurs when one or more of these fluids are out of balance, and as a way of understanding why something bad is happening to the body there are several sources of medical problems that are attributed to the illness. These include: an inherited problem, something that occurred in the womb, an imbalance, trauma, environmental factors, curses or accidents, and natural causes (i.e., aging, hunger, lack of sleep).
Ayurveda uses nine types of medical activity to attempt to heal the patient. Practical analysis (chikitsam) is used to analyze and remove the causes of the disease. Positive activity (bheshajam) is the preservation of health, defeat of the disease, and promotion of strength and virility. Purification (samshodhana) is the removal of morbid factors. Herbal means (ausjadham) involve removing the disease through the use of medicines. Complete means (sadhana) involves mitigating both the causes and the effects. Quieting (shamana) involves the use of palliatives and sedatives. Correction (prayaschittam) is removing the fear of the disease. Teaching self-discipline (satvavajaya) involves calming the mind and turning it from what is unhealthy. And religious means (daivavyapashraya) is the use of rituals, pilgrimages, etc. to restore health.
The Swami explained that the body and mind are separate, but that an important question in Hinduism is what part of us is our soul, and how does it relate to the mind? As mentioned previously, according to Hinduism and Ayurveda, the human personality consists of all three components - the body, the mind, and the spirit. The body and mind are considered material matter, the body being physical and the mind being "subtle matter." But the spirit ("atman" in Sanskrit) is one's true identity, according to Hinduism, and the body and the mind serve as a covering of one's true identity. There are also different masks or personalities that one uses in various social groups which also cover who a person truly is. "Moksha" is the freedom of being who we truly are. Everyone is trapped within the body and the mind, and the goal is to break free of these limitations.
Hindu Conception of Death
The Swami then turned to the Hindu concept of death (mrityu, or dehanta - "the end of the body") which is believed to be a natural occurrence, as everything that has a beginning must have an end. However, the spirit is eternal and does not have a beginning, so it will never die. The body and the mind are born, therefore they must die. The Swami explained that "brahma" is the concept of a "life force," and that this life force is what allows people to live, which is in itself a miracle. He used the analogy of a clay pot that has many holes. If you fill it with water, it would be natural for the water to escape. However, if you filled it with water and the water remained in the pot, that would be a miracle. Similarly, according to Hinduism, there are many holes in the body through which the life force can escape, but it is a miracle that people live because death is natural.
Clinging to life is not considered virtuous in Hinduism, but because death is still a mystery, the fear of death is natural. However, death is not the "end," and because of spiritual evolution, death does not mean the end of a person. The Swami explained that there are non-existential problems, such as poverty, that don't effect everyone, and existential problems, such as illness, aging, and death, from which no one is exempt. He said that all of one's existential problems are dependent upon their identification with one's body and mind. If one identifies too much with his/her body, death will be the end, but if one is able to dissociate with the body they know they will live on. When one dies, that person's soul and mind don't end, they just take up another body through rebirth or reincarnation.
Swami Tyagananda told a story of his mother explaining to his five-year-old nephew the death of the Swami's father. She explained to his nephew that his grandfather was born as another baby somewhere else. The nephew asked if the baby would be able to recognize them when he saw them and the Swami's mother explained that it was like when you write something on a board and then erase it, you don't know what was there anymore. Likewise, his grandfather's mind had been erased and he wouldn't be able to remember them.
The Swami then explained that in Hinduism, in an attempt to make sense of reality and why we are here, there is the idea of "karma" which essentially means "what comes around goes around." This helps Hindus understand the ups and downs of life, or why someone is rich and another is poor, or someone is ill while another person is healthy. The present is the result of one's past, and what someone is experiencing in the present is the result of something they did, felt, or thought in the past. Therefore people have the ability to shape their future, and are responsible for their actions.
Hindu Conception of God
Also, Swami Tyagananda clarified that despite what most people believe, Hinduism is not a polytheistic religion. There is "one reality," but that one reality can be seen in many different ways. These ways are the best ways to be able to connect to the higher reality. Hindus believe God's presence is seen in every molecule in the world, and that one can see the presence of God in everything. For example, rain is a natural force, so there might be something called a rain god, but this is not the same thing as the "higher reality," just a way of acknowledging God's presence. Even the fact of death is part of the divine, and Yama is the god of death.
Dealing with Hindu Patients in a Hospital Setting
In a hospital setting, one will come across a wide spectrum of Hindus and their levels of observation. Although Hinduism originated in India, and there are large populations of Hindus concentrated in India, Nepal, and Tibet, it is important to remember that Hindus come from all over the world. Today in America, it is likely that many of the Hindus one might encounter have lived in America for a while. However, there are difficulties for both the newly arrived as well as people who have lived here for some time and their children (2nd and 3rd generations). Hindus who have grown up in America are dealing with trying to exist between two cultures - they are neither American because of their skin color, nor Indians, as many haven't even visited India. Their parents have difficulties because they are a hybrid of their Indian culture and the American culture in which they have lived for so long. Newly arrived Indians are in a very stressful situation, as they are trying to acclimate to the differences in American society, as well as likely a new job, and perhaps trying to get visas for the rest of their family to come to America. In a hospital setting, someone facing an illness can find all this even more stressful, as things are so different.
The Swami recommended when you encounter a Hindu patient, a good way to help put the person at ease is by letting them know you are aware of some of their cultural differences and asking them if there is anything special they might need. He explained two areas of particular sensitivity to Hindus.
When it comes to food, although not all Hindus are not necessarily vegetarian, they don't eat beef as the cow is considered sacred. Also, the "kaya" (body) is a product of food. "We are what we eat," he explained. Starting out as a baby, the food that we eat is transformed into the growth of the body. So it is a good idea to inquire about a patient's dietary needs.
Also, cleanliness is a very important issue for Hindus. Indians eat with their fingers, and do not use utensils. It is also considered very unclean to pick something from someone else's plate or to place something from one's own plate onto someone else's. Indians also use one hand to eat, and will not touch anything else with that hand while they are eating. They will use their other hand to take more food from a serving bowl. And washing one's hands and mouth after eating is very important.
Swami Tyagananda suggested that the best way to work with a Hindu patient is to talk to them and find out their needs.
Questions asked by participants:
Q: In terms of cleanliness, what is an appropriate way of greeting someone? Is shaking someone's hand ok?
A: If one wants to put someone at ease, greeting them with your hands together and head bowed is the best thing to do. However, most Hindus have been in the country long enough to understand hand shaking and don't have a problem with it.
Q: What about life support?
A: Whatever are the wishes of the family.
Q: Since death is considered natural, what kind of response in terms of grief and bereavement can one expect?
A: There will still be physical grief. The family is still losing a loved one, and that parting is painful.
Q: In what kinds of situations should one call the Swami to visit a patient?
A: If the family requests a visit, or if the patient is alone.
There is an abundance of information about Hinduism and Ayurveda, both ancient and modern, on-line. Following are some of the websites that were referenced for this article:
4/02