Spirituality, Religious Wisdom, and the Care of the Patient

Denial in the Context of Illness: A Hindu Perspective

Siva Subramanian, M.D.
subramas@gunet.georgetown.edu

In order to address the role that 'denial' plays in a Hindu patient, it is imperative to discuss some of the salient points of Hinduism and its application in health care. To begin with, the correct terminology for this religion is 'Sanatana Dharma,' or the Eternal Way or Religion.  During the Hellenic Age, the Greeks referred to the people living near the river Sindhu as 'Hindoos,' to the region as 'Hindoostan,' and to their religion as 'Hinduism.'  Because the term Hinduism is in common usage, it will be used here.

 

Hinduism is a non-founded religion, and no central organization or hierarchy exists. The scriptures are called Vedas ("vid" in Samskrit means "to know").  Hinduism's major concepts include Brahman, Atman, Moksha, Karma, reincarnation, and Dharma.

 

Brahman is the Hindu concept of God - the unchanging, undying reality that pervades the entire cosmos. Everything else in the cosmos changes and, hence, is called Samsara (that which always moves). The changing world within man/woman/child is based upon the undying Atman. Atman is the Hindu concept of Self; it is the immortal, divine spark in each person. Atman is born again and again, gathering experiences and slowly moving towards the possibility of perfection. Brahman and Atman are essentially one and the same, which the scriptures refer to as 'That thou Art' (Tat Tvam Asi) or 'the Self is Brahman' (Ayam Atma Brahman). The Supreme goal of life is Moksha, or liberation, which lies in spiritual realization whereby the individual becomes aware of the immortal, divine Atman within him/her.  This realized soul transcends the cycle of suffering, illness, old age, and death.

 

The Hindu concept of Karma encompasses action, causality, and destiny.  It is the moral equivalent of the law of conservation of energy or the law of physics that states 'for every action there is equal and opposite reaction.'  Karma gives tremendous responsibility to the individual and places in his/her hands the key to his/her future destiny.  Each person is responsible for their good and bad deeds, which will reap appropriate results in this or future lives.  Naturally, the unerring law of Karma can work itself out only over a sufficiently long period of time, hence the belief in Reincarnation (Atman being reborn again and again until the attainment of Moksha).

 

Another concept of Hinduism is Dharma ('dhru' in Samskrit means 'to uphold'), which means the "privilege, duties and obligations of person, a standard of conduct as a member of the community and as a person in a particular stage of life".  "Dharma laid down the rules and ordinances for actions in all situations.  Always steering away from absolutes, always sensitive to context, the laws allow qualifications for time, place and exceptional circumstances".  For example, it is acceptable to seek wealth (Artha) and pleasure (Kama) as long as they conform to Dharma.

 

Religion and medicine are intertwined in Hinduism.  Hinduism and the healthcare called Ayur (life) Veda (knowledge) was practiced for thousands of years and addresses many physical, emotional and mental illnesses and their treatments. Concern for both the individual and the community are addressed.  Although suffering is considered part of one's Karma, it is acceptable to get relief and treatments.  In fact, according to Hinduism, since the body encloses the Godliness in the soul, it is important to maintain good health and seek medical care.  Death is considered opposite of birth and NOT of life, and the Hindu concept denies the finality of death.  Since reincarnation is almost certain for most of the Hindus, death is just a passage to next life.

 

Denial of critical illness and death obviously exists both with health care givers and patients. In Hinduism because of the strong belief in Karma and reincarnation, the finality of the consequence of critical illness, namely death, is sidestepped. Even though psychologically and emotionally a patient may still fear death resulting from the illness, the Hindu faith gives the patient the hope of a better life in the next birth.  However, getting treatment to maintain body's health is recommended because body encases the soul which is an immortal spark of God.  So from a religious point of view there is no need for denial of critical illness or death, especially with the concepts of Karma and Reincarnation for both the patients and the health care givers; you give and receive care as long as that is beneficial.  Similarly for families, the critical illness and potential death of a patient will be part of the Samsara (that which always moves), which allows coping with the grief.  It still does NOT prevent the individual and family from seeking treatment and care.

 

Even though denial is part of human emotion, it is not rooted in the Hindu faith as something that affects the response to illness.  The concept of denial for Hindus will be almost an emotional and/or psychological reaction, not one based on religion. Divine cure is always seen as possible, but that is based more on faith in prayers than on denial of the criticality of the illness or suffering.  Prayers form a central part of most of the Hindus in any treatments, including during critical illness. The expectation of cure by prayers and alternate or complimentary aspects of care are encouraged in Hinduism. The belief that a supernatural intervention by God could cure any illness is also very strong among Hindus but it does not result in denial because of simultaneous strong belief in Karma and reincarnation. In general the fear of death causes the denial of the critical illness. But in Hindus since the finality of death is denied by the doctrines of Karma and Reincarnation the denial of illness in not a predominant feature. This divergent point of view needs to be understood by health caregivers for many Hindu patients.

 

From the health caregiver's point of view, Hindu scriptures advise the physician to give treatments only until he/she feels the care is beneficial. Otherwise, the physician should give only comfort care.  The physician is forbidden to give useless treatments against the wishes of the patient or the patient's parents in the case of children.  Humility and compassion should be fundamental requirements of a physician.  The physician should neither deny the illness or potential death nor overestimate the benefits of treatments.  The Hindu faith asks the physician not to deny the patient's illness.

 

Similarly, the relatives of the patient are also asked not to grieve.  The doctrine of Karma and Reincarnation addresses the impermanence of our existence in this world and of many future generations to come in the cycle of births and deaths, so there is no need to deny suffering and illness.  It is acceptable and necessary to seek medical care for the patient since the body contains the divine spark of God.  But once the inevitable death nears, praying God for a better next life is the best option and not unnecessary prolongation of life.

Chaplain Barry C. Black, "Denial in the Context of Illness- An Evangelical Protestant Perspective"
Denial: Introduction
Table of Contents

Published: April 21, 2005