Mental Factors in Health Care / Dr. Paulos Mar Gregorios PDF File
1. Though mental health, peace and joy are by-products of religious faith, it does not follow that religion is merely a means of attaining mental peace. The purpose of religion is to find one’s grounding in God, and to work out that faith-grounding through worship and work.
2. The most fundamental problems of human existence are anxiety about the future and a sense of guilt about the past and the present. The two are interconnected. The anxiety factor includes an element of fear of punishment for the sins one committed.
3. The sense of guilt seems also the root of a great deal of hypocrisy, dissimulation, pretension and falsehood. Precisely because I have an anxiety that others may not accept me as I am, I try, unconsciously, to pretend that I am something else, something bigger and better than what I really am. This falseness in its turn creates the anxiety that someone may discover one’s true “self.” Thus guilt, anxiety, and falseness reinforce each other in human existence.
4. The combination of guilt, anxiety and falseness, seems what lies under the heightened phenomenon of stress, (The classical discussion of Stress is in Hans Selve M.D., The Stress of Life, (1956), Revised edition, Mc-Graw Hill, 1976) or as it is technically called in medical literature “stress syndrome” or “General Adaptation Syndrome.” Medically this relates to disease in which non-specific bodily or mental stress plays a decisive role.
5. The false distinction which medical science itself makes between “bodily” and “mental” in diagnosing the origin (aetiology) of diseases, belongs to the “total stress” of the civilisation which we have now adopted from the west. Its science and knowledge itself have been produced by the stress of a guilt-and-anxiety-lader culture – guilty about its colonial past, actrocities, exploitations, wars, concentration camps and holocausts. Mind and body cannot be thus distinguished. The mind is part, integral part, of a living body, and what affects the body affects the mind, and vice versa. We will not arrive at a healthy society until we overcome this false mind-body dualism, and the regarding of the body as inferior, which is an aspect of Indian culture.
6. The Stress Syndrome or the General Adaptation Syndrome, as described by Dr. Selye, affects the whole body and mind. When the Body-Mind confronts a general stress situation, the kidney has to work extra hard to maintain stability of blood pressure; there are changes in the walls of the arteries; it affects all connective tissues and can lead to inflammation; it affects also the lymphatic cells and eosinophil cells; it causes the pituitary, thyroid and adrenal gland tissues, the liver, the adrenaline medulla, and the whole nervous system, to produce chemical changes. The high incidence of stress and maladaptation of the body-mind system in coping with stress, accounts partially for increases in diseases like high blood pressure, diseases of the heart and blood vessels, diseases of the kidney, eclampsia in pregnant women, rheumatic and rheumatoid arthritis, inflammatory diseases of the skin and eyes, allergic and hypersensitivity diseases, sexual derangements, digestive diseases, cancer, and of course nervous and mental diseases. It increases general irritability in men and women and often wreck marriages. It can also create hyper-excitation as well as depression, both of which affect human relations and lead to various bodily and nervous diseases. Impulsive behaviour, emotional instability, inability to concentrate, loss of the joy of life, insomnia, predilection to fatigue, and hypermobility (inability to sit still, be silent, or relax), can all result from stress. And many patients who consult a physician, only to be told that they have no disease, experience even more stress. They feel that they have to prove that they are sick. And this only adds to the general stress syndrome, and could lead to increase in self-medication (pain killers and tranquillisers), increased smoking, loss of appetite, missed menstrual cycles in women, or increased pre-menstrual stress, migraine head-aches, and even alcohol and drug addiction. It makes people more self-hating and accident prone.
7. This brief and non-professional description of the General Adaptation Syndrome accounts for some 60% of the people coming to a hospital for treatment, sometimes with a localized and identifiable symptom but more often without. It is no use telling them that their disease is “psychological.” It has affected their physical body as well as their psychic equipment.
8. The modern doctor recognizes this as a case calling for administering some placebo or palliative, some pink tablet or red ‘mixture’, and in some cases it works, because the very falling sick and going to hospital help to win the sympathy of the family and to relieve some of the stress.
9. It is at this point that the renewal of the patient’s religious faith can very effectively be used as a better cure than the placebo or palliative. It is therefore imperative that at least in all hospitals run under private auspices, and desirably in other hospitals as well, there should be more than just a chaplain or psychiatrist. We need in each major hospital a team of skilled, gifted and well-trained religious counsellors, who can help renew the patient’s faith without any pressure to impose the categories of another religion on the patient. If it is a Hindu patient, there are enough resources in the Hindu tradition itself for a substantial evocation of the patient’s faith within the categories of the Hindu tradition itself-using the Fita, the Vedas, Upanishads and Hindu rites and forms of worship. The same for a Muslim or a Christian patient. A Christian hospital should not impose a Christian religious categories on a Hindu or a Muslim patient. This is difficult to accept for Christians who have been brain-washed in one or other particular form of Christianity which emphasizes the “sacred duty” of converting everyone to Christianity.
10. I would like to see a Christian hospital taking the initiative in this area, by employing a team of three to five religious counsellors, perhaps starting with two Hindu and two Christians and a Muslim when a suitable person is available. These persons should have some elementary knowledge of the body including the nervous and glandular systems, of pathology, and of psychology, in addition to a good grounding in one’s own religious tradition. The Mandiram Hospital and Mandiram Mental Health Centre should do some pioneer work at this point and set a pattern for the other hospitals. I would like to be involved in the earlier stages of pioneering if a decision can be made to proceed in this direction and some funds set aside for the preliminary work. We should look around for a Hindu Chaplain, preferably a young sanyasi with some training in counselling. If necessary appropriate persons should be advertised for, recruited, sent for training in counselling at Vellore, and then given special training locally.
11. I shall conclude this paper by pointing to some of the beliefs and practices directly related to Christianity, but with parallels in other religions, which have direct relevance for mental and physical health. The “beliefs and practices” should not be understood as intellectual ideas or activistic exercises. They belong to a corpus of life within a religions tradition, and therefore demand changes not only in individual minds, but in collective practice as well. Religion should not be reduced to therapy, though the therapeutic function of good religion can never be ignored. Perhaps we should also think about the pathogenic function of bad religion, and make sure that these do not create new problems in the hospital. The kind of religion which the Christian hospital promotes should be therapeutic, healing, wholesome, whether it is Hindu, Muslim or Christian. Some Christian elements are highlighted in the following paragraphs, as a starting point for further discussion.
12. Freedom from anxiety is perhaps the most important single element which must ensue from any healthy religious tradition. In the Christian faith, freedom from anxiety is a consequence of a complete trust in God through Jesus Christ. “Do not be anxious about your life, what you shall eat or what you shall drink” (Mt. 6:25, Lk 12:22). “Do not be anxious about how you are to speak” (Mt. 10:19, MK 13:11, LK 12:11). “Do not be anxious about tomorrow” (Mt. 6:34). These negative injunctions of our Lord have to be transformed into a positive experience for the patient, who has to be helped “to cast all your care on Him, for He cares” (1 Pet. 5:7). Like Martha we are all basically “anxious and troubled” (LK 10:41), and the passage from anxiety to trust is a great healing experience. It is the duty of a hospital to provide opportunities for the patient to find this basic trust, which will remove half of the stress involved.
There are similar sources in other religions. The Gita as a whole is set in the context of Arjuna’s anxiety on the field of battle, and the stress situation. And the Gita solution is in the peroration of Lord Krishna’s words in the 18th chapter of the Gita.
“With the Lord in thy heart take refuge with all thy being; by His Grace thou shalt attain to the supreme peace and the eternal standing. …. Become Me-minded, devoted to Me, to Me do sacrifice and adoration. …. Put aside all laws of conduct. Seek refuge in me alone. I will release thee from all sin; do not be sad.”
I am sure that many similar texts can be found in all scriptures.
18:62 Tameva Saranam gachcha
Tad prasadatparam Santim
Sthanam Prapyasi Sasvatam
65 Mannana Chava mad
madhaji mam namaskuru
mamecai shyasi satyam te
pratijane priyo: si me
66 Sarvadharmani parityajaya
mamekam Saran vraja
mokshayisyasi aham tva Sarvapapesye
13. The Gita passage connects deliverance from anxiety with trust in God and at the same time the acceptance of forgiveness of all sins as a gift of grace from God’s hand. Along with anxiety guilt is the most powerful factor at the root of a great deal of general stress and disease. The heart of the Christian faith is in God’s grace and love which forgives sins and accepts the sinner as son or daughter. God gives forgiveness freely: but we find it difficult to accept that forgiveness; the hardest thing for me is to forgive myself, and to accept the grace of forgiveness. I fear that I will lose my independence if I accept forgiveness, for to acknowledge forgiveness is to recognize a permanent obligation to the forgiver. I would much rather be punished than forgiven; for if I am punished, then I have no further obligation to the one against whom I have sinned. Helping people to accept forgiveness is one of the hardest tasks in patient counselling, and in healing people. The toughest struggle is against sin and guilt. Many Christians who glibly and knowingly talk about sin and guilt and forgiveness in a naive way, (of saying some words of confession and accepting some words of absolution) do not know either the power of guilt or the power of God’s love which overcomes it.
Here both Christian teaching and Hindu doctrine need deepening. Hindu thought finds the source of papa in the lower nature – in the tamo and rajo gunas. These are the desire aspects of the soul – kama operating through thought and action at the level of the desire – soul, yielding to passions of the ego, swayed by the unstable plays of the gunas in the mind and the will. The purpose of Yoga then is to rise above the level of the desire-soul, to the higher atman, which knows itself as divine. Sri Aurobindo defines the Hindu conception of sin in the following words:
“Sin is the working of the lower nature for the crude satisfaction of its own ignorant, dull or violent rajasic and tamasic propensities in revolt against any high self-control and self-mastery of the nature by the spirit.”
(Essays on the Gita, Pondicherry, p. 267)
Sri Aurobindo goes on to say that the way “to get rid of this crude compulsion of the being by the lower prakrti in its inferior modes ‘is by’ recourse to the highest mode of that Prakrti, the Sattwik, which is seeking always for a harmonious light of knowledge and for a right rule of action” (ibid).
This is also Christian ascetic teaching – that the higher aspects of the human spirit, controlled by the divine Spirit, should in turn control the lower aspects of feeling, will and mind, passion and desire and error.
But in order to get going in such a discipline of overcoming the lower elements in me, I need the starting push of grace as forgiveness and the sustaining grace for perseverance. Here both the Christian teaching and the Gita teaching are extremely helpful and the tradition is full of profound insights about overcoming sin and guilt should be taught to the healing team, so that they are able to mediate the deepest mysteries of the tradition to the true seekers. Our usual theology, both Christian and Hindu, are quite superficial. There is a lot of work to be done here in relation to the deeper elements of the Tradition.
14. The third element we spoke about at the beginning is falsity of being, connected with and reinforced by anxiety and guilt. We have to be very brief here, precisely because even a cursory analysis of falsity in our being would take several pages. Healing comes from removal of falseness, not just in speech, but also in our very pretensions, illusions and attitudes. Here perhaps religion too often encourages falsity, in the form of hypocrisy, sanctimoniousness, and blind prejudices springing from utter selfishness. Only a deep experience of being accepted by God as I am, can release me from the need to pretend. So long as my estimate of myself is based on other people’s ideas about me, I will be false. To accept forgiveness at a deep level, removes the need for pretension and hypocrisy. But this is a life-long process, and the skilled healer has to be able to assist the patient at a deep level.
15. One of the manifestations of anxiety, guilt and falsity, can be an acute sense of boredom. People try to overcome this boredom by overwork and drinking; but both are counterproductive, and the boredom becomes deeper and deeper at the subconscious level, and makes people frighteningly unhappy. This is happening to many successful businessmen, managers, and doctors among others. Much of the sickness comes from that terrible combination of non-specific stress and boredom interacting with work-a-holism or alcoholism and the extra stress on body and mind produced by either or both in combination.
Here no other healing is possible except through a deep faith and a comprehensive compassion for all people, especially the suffering and the victims of injustice. The human capacity for feeling, and the human will for doing, as well as the human mind thinking and knowing has to be disciplined together for a life of compassionate understanding of identification with, and curative action to heal, the suffering in own society. This includes socio-economic as well as political study and action. As part of the healing process, the healing team will have to help the patient to find his or her way to make full use of one’s mind, will and feeling for the good of others. That is the way to overcome boredom and to find the way to joy.
16. The most important point to be taken into account by religious people concerned about healing cannot be treated here at any length. This has to do with the socio-economic structures which are at the root of much disease. We need to be concerned not only with the individual patient who comes to the hospital to be healer, but also with the social, economic and political structures which are the cause of such disease. One could also dwell at length on how corruptions in the religious institutions are themselves responsible for much ill health.
17. There is not enough time to speak about the practice of meditation which now has been proved to have tremendous healing powers. I am sure other religious leaders will speak at length about these. I only want to point out that almost any form of meditation, if it does not come out of anxiety and self-condemnation will have healing effects. Practices like Transcendental Meditation have proved to be capable of bringing tranquility to restless spirits and minds. Yoga is the combination of exercise and meditation. Stretching, twisting, reaching and bending are good for body and mind. In Christianity and Islam as well as in Hinduism this is achieved through the religious practice of prostrations (Kumbidil, nisar, Sashtangapranam and Yogasanas) as part of daily hours of prayer. Modern research teaches that two hours of standing every day is good for body and mind. Traditional religious practices has incorporated these elements.
But let me issue a warning here. No meditation technique can be developed into a complete religion. Meditation and Yoga are merely methods, instruments, leading to the realisation of truth in wisdom and love. Meditation is for concentration, for deliverance from the distraction of many ideas, many desires, many drives, in order to enable us to seek “the one good thing” which Mary chose, over against Martha who was busy with “many things” (LK 10:41). Meditation helps us to get out of our “thinking” which is the root of much ill-health. To stop thinking and start being still is a very curative technique. Good meditation decreases the restless alpha waves from the brain and increases the more quiet beta and these waves, and better synchronizes the waves from the two hemispheres of the brain.
In spite of all that, meditation cannot solve all problems. If you are interested in a technical critique of the techniques of meditation, I would draw your attention to Chapter 7, entitled “Caveat Meditator” in Robert E. Ornstein, The Mind Field A Personal Essay, (Viking Press, New York, 1976.
“In the absence of anything more highly developed, such programms impress their followers, and yield great benefits to their leaders…..
From one system, one can learn to relax; from a second, to relate; from a third, to respond…. (But) the primary function of the diverse techniques of meditation is to begin to answer the basic questions of life, such questions as …. What is the purpose of existence?…. (which) cannot be answered in the same rational, verbal manner as can questions about the nature of the physical, or even social environment, Meditation, then, is ‘a-logical’, intended to defeat the ordinary sequential and analytic approach to problem-solving in situations where this approach is not appropriate” (pp. 87-88).
Meditation is curative, because it helps to move away from the discursive, analytical conceptual frame of mind within which much of the anxiety functions. But religion itself cannot be reduced to any meditation technique. And if one thinks that only meditation techniques have value in healing, one is selling good religion very much short.