The level of a patient's sattva –
mental stamina – is a determining factor in their prognosis;
strongminded patients sometimes experience remission from what appear
to be terminal illnesses, whereas apathetic or depressed patients who
give up hope or feel like victims tend not to do so well. High sattva
implies taking responsibility for the situation and taking positive
action to try to improve it, though not necessarily ''fighting'' the
illness or disease with an aggressive attitude. Sattva's mental
clarity may derive from genetic inheritance and karmic influence but
it can be improved if the patient takes the correct attitude and is
able to calmly look at the situation.
Given that what we focus our attention
on (in terms of time, money and energy) tends to increase the patient
should focus on improving his health rather than obsessing about his
illness.
When the patient constantly thinks and
talks about what he is not able to do, eat, enjoy or have, suffering
is increased. Instead of lamenting the gap between what he wants and
what he can have, the patient should try to reduce it by becoming
more realistic about his possibilities. Focusing on what is still
possible and finding creative alternatives to what is not keeps the
patient's spirits up and prevents deterioration.
Patients with little direction in life
or those who feel they are lacking affection and attention from
others may develop a tendency to cling to, or even exaggerate, their
illness. The illness may be perceived unconsciously as a friend and
companion, something which has given them a certain status or
identity or which becomes an excuse not to engage intensely with
life. While the 12 Step Programme (on which Alcoholics Anonymous et
al are based) has been a lifesaving support for many people with
addictive behaviours it is problematic in that it encourages them to
define themselves, reductively as their illness. This tendency
should be resisted. Ayurveda recognises that people are much more
than just their minds and bodies and so evidently much more than
their mental or physical illnesses! In other words it is important
for the patient to remember that they have an illness but that
they are not their illness, although this is easier when the
illness is physical rather than mental.
Patients should not isolate themselves
from others to obsess on their illness, symptoms or prognosis but
continue with their everyday activities as much as possible. It would
be better to view illness as a guest who is passing through rather
than giving it a permanent place at the table. By withdrawing from
everyday life the patient actually deprives himself of the enjoyment,
pleasure and happiness that are still available to him, thereby
weakening his optimism and will to recover. If the patient expands
himself to contain the illness the illness becomes proportionally
less important. If on the other hand, the patient allows his world
(and self) to shrink to the confines of the sickbed, the illness may
become all consuming and incurable. Giving ''sick notes'' (ie a
doctor's note to exempt the patient from work) for depression or
anxiety is often counterproductive as without the distraction or
responsibility of work the person becomes more depressed and less
functional and the problem becomes chronic.
Sometimes the patient's family and
friends also become over-involved with the patient's illness, further
disabling the patient with their anxiety or fearfulness. In the case
of a young woman suffering ulcerative colitis and chronic diarrhoea
her husband and whole family so dedicated themselves to fighting her
illness that they lost sight of the bigger picture of who she was.
Her husband left his job and heroically devoted himself to finding a
cure for her illness. However in the process of becoming an expert,
he began to behave more like a doctor than a husband, neglecting the
gestures of simple affection that might have helped his wife feel
loved as a woman rather than cared for as a helpless patient. The
Dharma of a husband in these circumstances might have been to help
his wife maintain contact with life beyond her sickroom, perhaps by
bringing affection, laughter and news from outside into it,
supporting her to look beyond her physical illness.
The doctor can also support the patient
by paying attention to what improvements are made or on giving
positive feedback to the patient. It is important not to criticise
the patient or give information in a tactless manner but to help the
patient maintain a positive frame of mind. In the above mentioned
situation the patient was still able to enjoy spectacular scenery,
fresh air and the company and affection of her family, something her
loved ones had lost sight of.
Another factor that impacts healing is
the patient's ability to trust the doctor's competence and good will
(surrender). While it is fine for someone to be careful in choosing
the right doctor, once they have begun treatment they should not
continue ''shopping''. Following one treatment or philosophy
properly is of far more value than stopping and starting with
different doctors or cherrypicking the doctor's orders according to
whim. The patient should also resist the temptation to ''apply extra
mind'' by trying to find out more and more about their illness, and
setting this superficial information against their doctor's training.
This will only lead to confusion and doubt. The patient should avoid
self-diagnosis and trying to know better than the doctor. This lack
of trust will be an impediment to healing, whether openly
acknowledged or not. Faith and openmindedness are important to
recovery.
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