Coping with Illness: Insight from the Bhagavad Gita

Abstract

The Shrimad Bhagavad Gita enlightens everyone on how to cope up with various situations in life. It uses the conversation between Lord Krishna and Arjuna to highlight initial negative coping mechanisms exhibited by the latter. It goes on to showcase positive coping skills suggested by Lord Krishna and implemented by Arjuna. The Bhagavad Gita, through this “case-based methodology,” teaches us how to cope with a demanding situation. Diabetes is a lifestyle disease, which warrants a thorough change in one's lifestyle, including changes in basic activities such as diet and exercise. This brief communication utilizes the teachings of Bhagavad Gita to help in coping with illness, especially chronic illness such as diabetes. The article cites verses from the Bhagavad Gita to show how one may cope with the stress of illness such as diabetes.

INTRODUCTION

The Bhagavad Gita, the divine song, records the advice given by Lord Krishna to Arjuna, on the battlefield of the Mahabharata War.[1,2] The Gita is basically a conversation between Arjuna, who succumbs to dejection when he realizes he has to fight his kinsmen, and Lord Krishna, who helps him cope with this dilemma and stress. The Bhagavad Gita is much more than a religious or philosophical text: it's 700+ verses offer insight into every aspect of life and are universally relevant. The text has been used to plan healthy nutrition and classify modern endocrine and metabolic diseases as well.[3,4]

Diagnosis of diabetes is also associated with a feeling of shock. The subject is faced with stress due to diagnosis and may experience a sense of grief as he may have to part with some of the most beloved things in life. He also has to be motivated to exercise self-restraint, change lifestyle, and comply with medical advice. Management may include components such as self-blood glucose monitoring and insulin administration, which are not perceived well by most.

We present a list of curated verses, which describe the reactions of Arjuna to stress and explain how Lord Krishna encourages him to develop and use positive coping skills. This abridged selection can help cope with illness as well. Although we use diabetes as an exemplar, we hope that this communication will be useful in any illness. The verses contained herein may be used by health-care professionals to encourage healthy coping in all individuals seeking medical care.

THE STRESS

In the subconscious mind, Arjuna knows that most warriors of the Kaurava army are not good people even though they are his relatives. Similarly, we know that habits such as overeating, wrong eating as well as a sedentary lifestyle are not healthy. At diagnosis of diabetes, the subject suddenly realizes that these actions pose a threat to healthy life. This leads to feelings of stress, anxiety, and nervousness.

Arjuna's feelings of stress of possible threat and compulsion to fight against own relatives are described as follows:

“limbs of my body quivering and mouth drying up, whole body trembling, hairs standing on end, and skin burning all over.”

Sidanti mama gatrani, mukham cha parishushyati (1:28)

Vepathushya sharirene, romaharshascha jayate; twakchaiva paridahyate (1:29).

Like a patient with newly diagnosed diabetes feels that his most important weapon, i.e., self-belief and self-confidence are deserting him, Arjuna describes a similar emotion:

“My master weapon, the gandiva dhanushya is falling from my hand.”

gandiva shamaste hastat (1:29).

Sanjay, who narrates the Bhagavad Gita to the blind King Dhritarashtra, describes Arjuna's mental and physical response as follows:

“Arjuna, whose mind was agitated by grief,… cast aside his bow and arrows, (and) sank into the hinder part of his chariot.”

Evam uktvarjunah sanhkye, rathopastha upavishat, visrujya shariram chapam, shoka samvigna manasah (1:46)

“overwhelmed with pity, …eyes…filled with tears and agitated,…full of sorrow.”

Ashrupurna kulekshanam, vishadantamidam vakyam (2:01)

NEGATIVE COPING

In the majority of patients with type 2 diabetes, the condition is precipitated, to some extent, by an unhealthy lifestyle. Many self-indulgent habits, which have been pleasurable till date, now become threatening. Some participants may question the importance of having a life deprived of the various materialistic pleasures that they had been enjoying till date. Others may wonder what sense it makes to give up all the worldly pleasures, for which they have been striving. How can one give up all that he loved once in his life?

Similarly, Arjuna feels what good he is going to achieve by killing his own relatives, with whom he has been associated till now.

Na cha Shreya punaschami, hatva swajanam ahave (1:31)

Arjuna questions the usefulness of availing a kingdom when many he liked are now against him.

Kimo rajyena govinda, kim bhogair jivetena wa (1:32)

He also asks how he can derive pleasure by killing his own people.

Swajanam hi katham hatva, sukhinah shyama madhavaha (1:36)

Arjuna expresses his grief of fighting against own people.

Yadrajya sukha lobhena, hantum swajana mudyataha (1:44)

He expresses desire to be killed unresisting without fighting by hands of sons of Dhritarashtra.

Yadi mama apratikaram, ashastram shastrapanayaha, dhratarashtra rane hanyus (1:45).

These feelings are sometimes akin to the feelings of a person with diabetes when faced with the relenting task of coping with the demanding illness and giving up pleasures he/she cherished.

Arjuna's symptoms can be summarized as grief, fear, and pessimism. Other verses of Bhagavad Gita describe his initial coping mechanisms, which are characterized by extreme and pervasive negative thoughts.

The adjective-noun “dejection” or “distress” is an apt word to describe the initial response that most of us exhibit when faced with illness, especially chronic illness. This means that our feelings, emotions, and concerns are “normal,” just like Arjuna's were. It also implies that we may read the Bhagavad Gita to find out how Lord Krishna helps Arjuna cope with his stress. We can then utilize the same coping skills to cope with illness-associated stress such as diabetes distress.[5]

ARJUNA'S CONFUSION

After the initial feelings of anxiety, stress, and negativity from the diagnosis of diabetes, come feelings of confusion. This confusion relates to the dilemma of choosing the right path of action. Similarly, in the Gita, Arjuna is confused and uncertain about what to do.

“How–shall I fight…?”

Ishubhi pariyotsami, pujarha Madhusudhanaha (2:04)

“Now I am puzzled, confused about my duty, about what is wrong and right. I am your disciple and please guide me the right way.”

Karpanya dosho pahata swabhavaha, pruchyati tvam dharma sammudha santetaha, yacheya sannischyati brumhi tanme, shishyasteha sadhimam twam prapannam (2:07)

However, Arjuna does realize his confusion and requests Lord Krishna to help him. This is the first, and perhaps the most important and rate limiting step in coping with illness. We realize that we have an illness, we find that we are unable to cope with it, for which we consult a health-care provider to seek help.

Arjuna is faced with multiple, conflicting emotions. This creates further stress and leads him to a state of extreme depression and inaction.

“I do not see any means that can drive away the grief which is drying up my senses.”

Nahi prapashyami mamapnudya (2:08)

Arjuna again said…”I will not fight,” and became silent.

Na yotsya iti govinda muktaha (2:09)

KRISHNA'S ANALYSIS

Lord Krishna motivates Arjuna to fight, using a direct approach.

“Yield not to unmanliness, Arjuna; this does not befit you”

“Stand-up”

Naitatwayu prapashyate, kshudro hridaya durbalyam, tyaktwo tishtha parantapaha 2:03

The Bhagavad Gita is an analysis of coping mechanisms, followed by an effort to eliminate negative mood states such as grief and anger. Lord Krishna helps Arjuna analyze his feelings so that he can overcome his negative coping style. In diabetes, we expect our caregivers (health-care professionals, family members, and community members) to do the same. The caregiver has the most important responsibility of motivating the person with diabetes. She/he must be able to make the person diagnosed with diabetes understand that for a meaningful life she/he has to be strong, get rid of wrong habits, stop grieving about same, and then only life can shape up.

“You grieve over those who should not be grieved for…”

Ashochyanan vashochyashwa, pradnya wadanschya bhasmase (2:11).

POSITIVE COPING: EQUANIMITY AND ACCEPTANCE

Lord Krishna, while describing the immortality of the soul, sings verses which help us understand how to tackle illness. There is no better example of motivation to perform the right action, in an unbiased manner, than these slokas by Lord Krishna, which precede the description of sthipradhnya. The first step, he states, is equanimity coupled with acceptance of reality.

Yogastha kurukarmani, sangamtyaktva dhananjaya (2:48).

This acceptance allows us to handle the various conflicting positive and negative emotions, thoughts, and information that we are exposed to when illness is diagnosed. Moreover, finally, we are able to choose the right ones, in an unbiased manner, reaching the state of yoga.

Siddhya siddha samobhutva, samatvam yoga uchyate (2:48).

Lord Krishna tells Arjuna to keep all abominable activities away from himself, similar to a health-care professional who guides the patient to stay away from things that worsen diabetes.

Durena hravaram karma, buddhiyoga dhananjaya (2:49)

Finally The Lord says:

When your mind is no longer disturbed by flowery language and it remains in a stance of self-realization, then you have attained divine consciousness

Shrutivipratipannate, yadasthasyati nischalaha, samadhawachala buddhihi, stada yogamawapsyasasi (2:53)

A relaxed mind is a prerequisite for diabetes management. Glycemic control cannot be achieved until your mind is stable and calm. The Gita helps reduce counter regulatory hormone levels by promoting calmness of mind.

POSITIVE COPING: ANGER AND BLAME MANAGEMENT

Lord Krishna also cautions Arjuna against misplaced anger (or blame), in one of the most important slokas of Shrimad Bhagavad Gita. Anger is one of the most important negative emotions. Anger against medication, lifestyle modification, glucose monitoring, or health-care provider detracts the person with diabetes from the right path required for diabetes management. Such a person can never be happy and successful. Hence, it is important for the health-care provider to build a relation of trust and pacify the patient, for his own benefit.

“From anger arises infatuation; from infatuation, confusion of memory; from confusion of memory, loss of reason; and from loss of reason one goes to complete ruin.”

krodhat bhavati sammoha, sammohat smritivibhramaha, smruti bhranshat buddhinashi, buddhinashat pranashyati, nachabhava yatah shantir, shantasya kutaha sukham (2:63)

“…how can there be happiness for one lacking peace of mind?” (2:66)

Anger and blame are natural reactions to a diagnosis of diabetes. However, these emotions serve no purpose and are self-defeating. Anger clouds our reasoning and prevents us from taking correct decisions.

POSITIVE COPING: FOCUS ON ACTION

Lord Krishna supports action, rather than grief or depression, as a means of coping with a stressful situation. Multiple slokas of the Gita reinforce this message, which is equally relevant for persons with diabetes.

“…stand up, Arjuna, determined to fight”

tasmad uttishtha kaunteya, yuddhaya kritanischayaha. 2:37

“ …nor let your attachment be to inaction”

Ma karma phala he turbhur, mate sangastva karmanihi 2:47

Lord Krishna promotes both the paths of knowledge and action but clearly supports action. This is true in health as well. While we should equip ourselves with knowledge and information about our illness, we should not limit ourselves to this. It is more fruitful to take tangible action to fight disease. This may be in the form of investigations, nonpharmacological therapy, drug treatment, or other modalities such as surgery.

“The Yoga of Action, being easier of practice, is superior to the yoga of knowledge 5:2

Sanyasa karmayogaschya nishreya sakara ubhau, tayostu karma sanyasat karmayogo vishishyate

“…he is no yogi who has merely given up all activity”

Na sanyasi cha yogicha, na niragnir na chakriyaha 6:1

“Man does not attain freedom from action without entering upon action”

Nakarmanam anarambham, naishyakarmyam purushoshrute 3:4

“He who outwardly restraining the organs of…action,…is called a hypocrite.”

Indriyarthe vimudhatma, mithyacharsa uchyate (3:6)

PHYSICAL ACTIVITY

Lord Krishna emphatically calls for maintenance of physical health though activity and exercise. He clearly states that one cannot even maintain his body without physical exercise. This is an apt reminder for people to remain physically active so as to prevent diabetes (the need of the hour), as well as for persons with diabetes/other lifestyle disorder patients to view exercise as an important part of disease management.

“Desisting from action, you cannot even maintain your body”

Niyatam kuru karmatwam, karmajayo hrukarmanaha 3:8

The Gita clearly states that one who engages merely in materialistic pleasures and not in sacrifice, does not lead a meaningful life. The real meaning of life is in sacrifice and doing your karma rather than engaging in worldly pleasures. This narration gives meaning to life of a person with diabetes.

“He…who does not perform his duties,…he lives in vain.”

Aghayur indriyarmo mogham, partha SE jivati 3:16

“…go on efficiently doing your duty…”

Tasmad asaktha satatam, karya karma samachara 3:19

Lord Krishna has a word of advice for diabetes care professionals, too: He observes that great men should lead by example and “work” (remain active) even if they do not need to.

MODERATION: THE MIDDLE PATH

The Bhagavad Gita contains explicit instructions for self-control and self-discipline. After having been diagnosed with diabetes, people react in different manners. Some begin extreme diets, while others continue unhealthy lifestyles. What is correctly advised is eating a balanced diet at appropriate times. The Master elaborates the same in a very articulate manner, in the slokas below, the importance of right diet and sleep.

“…this yoga is neither for him who overeats, nor for him who observer a complete fast; it is neither for him who is given to too much sleep, nor even for him who is ceaselessly awake.”

Natyas natas 'to yogo' sni, nachaukanta manashnataha, nachati swapna prashilasya jagrate, jagrato naiva charjunaha. 6:16

“Yoga is accomplished only by him who is regulated in diet and recreation, regulated in performing actions, and regulated in sleep and wakefulness.”

Yukta hara viharasya, yukta cheshtasya karmasu, yukta swapnava bodhasya, yogo bhavati dukhaha 6:17.

Diabetes does not mean sacrificing all enjoyment in life. The Gita calls for discipline and moderation in all spheres of life, as a means of healthy living. This call is reinforced in the definition of Sattvikta (balance) that it provides for various thoughts and actions.

TRUST AND RESPECT

The Bhagavad Gita goes on to discuss various facets of action and inaction. This discussion provides relevant insight and guidance, for situations where the person with diabetes feels that treatment is not proceeding as per his wishes.

“Attraction and aversion… are the two major stumbling blocks in way of redemption, which is achieved by only one who overcomes these.”

Indriyasyendriya sarthe, raga dwesha vyasthetau, tayorna vachama gachhe tau hrasya paripanthanau 3:34

Action is mandatory in life. If faced with illness, it becomes imperative on our part to fight it. To do so, we need to understand our challenges and their solutions. The Gita is a clear call to all of us to act in the face of adversity such as diabetes.

INDIVIDUALIZED CARE

Action does not mean any action. What Lord Krishna suggests is the right action, performed with right intent, in right direction. It is important to understand what right action (e.g., having balanced diet and regular exercise), forbidden action (e.g., eating junk is also an action but in the wrong direction), and inaction (e.g., complete starvation or lack of physical activity) are. Following the right path (right lifestyle and habits) will help prevent diabetes and delay complications.

“—Mysterious are the ways of action”

Karmanyo hrupi boddhavyam, boddhavyam cha vikarmanaha, akarmanyascha boddhavyam, gahanam karmano gatihi 4:17

“He who sees in action, and action in inaction, is wise among men; he is a Yogi, who has performed all actions.”

Karmanya karmadaha pashyeda, akarmanicha karmayaha, sa buddhiman manusheshyu, sa yukta krtsna karma krut 4:18.

There may be times when we do not fully understand a course of treatment being prescribed to us by our health-care provider. Although it is the physician's duty to ensure shared decision-making, this is sometimes not possible because of lack of information equipoise. In such a case, it would be prudent to trust an experienced physician, who “has performed all actions.” At times, inaction (“let us not go for bariatric surgery right away”) may be appropriate or of medical action. In other situations, action can promote inaction (“let us take insulin to achieve good glycemic control now so that we do not need dialysis later”).

CHOICE OF HEALTH-CARE PROVIDER

“He who lacks discrimination, is devoid of faith, and is at the same time possessed by doubt, is lost to the spiritual path. For the doubting soul, there is no happiness.”

Adhnyashwa shradhanschya, samshayatma vinashyati, nayam lokasti na paro, na sukham samshayatmanaha 4:40.

In illness, we often tend to distrust the very persons and interventions that are trying to make us healthy. We should be able to discriminate rational and evidence-based schools of medicine from others, identify qualified and experienced health care providers, and utilize their services. The chronic care model is based on a trusting patient–physician relationship: It will not work unless reciprocal respect, trust, and honesty are integrated into this interaction.

On a separate role, we must ensure that we choose the correct (qualified and experienced) health-care provider. One of the reasons, why Arjuna was victorious in the Mahabharata, was that he sought support from the correct teacher, Lord Krishna.

FREEDOM OF CHOICE

Lord Krishna is a beautiful example of a person-centered personality. He does his best to guide Arjuna, but nowhere does he force his views upon either Arjuna or other individuals.

“Thus has this wisdom, more profound than all profundities, been imparted to you by Me; deeply pondering over it, now do as you like.”

Iti te Dhyana makhyatam, guhyad guhya taram maya, vimrusheta dasheshena, yatheshasi tatha kuru 18:63

CONFIDENCE

“Have you,…heard this gospel…attentively? And has your delusion born of ignorance been destroyed…?

Twaye kagrena chetasa, kacchida Dhyana sammoha, pranaste dhananjayaha 18:72

After listening to the advice of health-care provider, the person with diabetes should have the feeling of.s

“…this delusion of mine has entirely disappeared”

mohoyam vigato mama 11:1

“…I have gained wisdom. I am free of all doubt…”

Sthitosmi gata sandeha, karishye vachanam tavaha 18:73

The Bhagavad Gita ends on a positive note, and Arjuna understands that salvation lies in appropriate action. Similarly, every life with diabetes should be marked by timely action, to ensure optimal therapeutic outcomes. The Bhagavad Gita, thus, offers optimism to the person with diabetes and to his caregivers.

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Conflicts of interest

There are no conflicts of interest.