Relevance of Bhagavad Gita for healthcare workers amidst the COVID -19 crisis

मात्रास्पर्शास्तु कौन्तेय शीतोष्णसुखदु: खदा: |

आगमापायिनोऽनित्यास्तांस्तितिक्षस्व भारत || Chapter2: verse - 14||

(“O son of Kunti, the contact between the senses and the sense objects gives rise to fleeting perceptions of happiness and distress. These are temporary, as they come and go like the winter and summer. One must learn to stand them without being disturbed.”)

COVID-19 - an acute respiratory disease which is highly contagious, has taken the form of a pandemic triggering a global mayhem. It is caused by a novel coronavirus. As on 10th October 2020, 1,073,055 people have lost their lives and there are 37,135,041 confirmed cases across 213 countries/territories. The medical responders - doctors, nurses, paramedics, and other hospital staff, are frontline soldiers in this global crisis. Studies have shown that the medical responders are facing increased mental health challenges while handling this crisis (Chen et al., 2020; Duan and Zhu, 2020). A survey concluded that 50.7 % of the Medical responders suffered from depression, 44.7 % experienced anxiety and 36.1 % had sleep disturbances (Ho et al., 2020).

So far, the focus of the international bodies has largely been on vaccine, treatment, and infrastructural bottlenecks, while a specific strategy to deal with the mental health issues of medical responders is yet to be devised (Kar et al., 2020b). WHO has issued guidelines highlighting the importance of psychological well-being of the medical responders and instructing the managers of healthcare facilities to ensure that they have access to mental health support services (WHO, 2020, p. 3). At best, the guide enlists the “best practices” and suggests availability of support, as and when a staff gets affected. However, treating/counselling stressed medical responders individually may not be sufficient in the current crisis, as they are getting affected in masses. Moreover, a preventative solution should aid and complement a curative one.

By and large the studies have recommended traditional methods for Medical responders to fight stress like - aerobic exercises, meditation, relaxation exercises (Kar et al., 2020b), peer support programs, and counselling at staff rest areas (Selikowitz and Rege, 2020). Nevertheless, we propose to include an oriental solution alongside these conventional measures. Bhagavad Gita, a Hindu scripture, is a popular source of wisdom for the world community and the very purpose of its narration was to lift the morale of a warrior (Arjuna) who was caught up in psychological distress. As such, Gita is full of teachings relevant to the present scenario, and can motivate the corona warriors to march along the path of their duty, unperturbed by all the psychological obstacles. Although the cause of Arjuna’s psychological turmoil had moral bearings, which is different from that of the healthcare workers, the resultant i.e. the anxiety, can be addressed with the help of Bhagavad Gita which “provides a cookbook approach to positive mental health” (Balodhi and Keshavan, 2011). A few sessions imparting the lessons of Gita to the Medical responders can prevent anxiety & distress; and work hand in hand with other solutions suggested by the existing studies and practiced in the health facilities currently.

The medical responders are dealing with a gamut of issues that can cause stress. Fear of contracting the coronavirus, risk of passing it on to their family members, shortage of protective gear, burnout due to longer shifts without regular holidays, physical hardships of wearing an uncomfortable protective gear for long durations, staying isolated from their family, incidents of aggression towards them, are enlisted as “Significant stressors” (Selikowitz and Rege, 2020). Another study (Kar et al., 2020a, b)shows similar findings and points out that the common challenges for the medical responders in the isolation ward are – working conditions, workload, coordination, consoling patients, anxious patients, demanding-people, training and hygiene. The workers are running out of patience as the hospitals are getting inundated with patients, increasing their workload, while the medical workforce is diminishing in size as some of them are falling ill. They are staring at an uncertain future, as the cure remains elusive. As a result, a large number of doctors & nurses are contemplating resignation (Vaishya, 2020).

Bhagavad Gita offers three paths to develop psychological resilience for the individuals, viz. Jnana Yoga- the awareness of self that “flattens” the ego, Karma Yoga- the selfless action that detaches emotion and desire from action, and Dhyana (Raja) Yoga- the meditation and self-reflection that leads to stress reduction and a healthy lifestyle (Keshavan, 2020). In addition, the Bhakti Yoga- the path of faith which includes rituals like “Japa’’, “Homa’’, “Archana’’, “Vandana’’ etc. can also be of therapeutic importance (Balodhi, 1984). Performing one’s duty in an earnest manner, without attachment to the results, is arguably the most important lesson that Gita teaches through its theory of Karma Yoga (Verse 2.38, 2.44, 2.47, 2.48, 2.49). Through the concept of “Niskama Karma”, Gita teaches that duty should not be performed with an external motivation (just for material benefits), rather for the sake of “Swadharma” which essentially means - one should be internally motivated to perform one’s duty. Gita emphasizes on the importance of duty from the beginning of the narration (Chapter 2), till the end (Chapter 18). It equates fulfilling of duty to worship of God (verse 18.45), in the sense that, performing duty can lead to a rewarding life, spiritual well-being and liberation. But who can discharge their duty without any mental clutter? For that, Krishna teaches about “Sthitaprajna”, one who remains unperturbed by grief, desire, anger, and has control over senses. Bhagavad Gita’s principles of “Jnana’’ (cognitive appraisal of nature of the universe and one’s place in it), “Karma’’ (appropriate action as directed by Dharma – code of conduct), and “Bhakti” (devotion to personal God dissolving the egocentricities) are of therapeutic importance for distressing problems that have anxiety at the center (Balodhi and Keshavan, 2011).

In addition, Gita also teaches qualities that are specifically revenant to the common challenges of the medical responders, like fear, workload, tough working conditions etc. It teaches how to develop endurance to corporeal experiences of pleasure, pain, heat cold etc. through a virtue- “titiksha” (Verse 2.14). It teaches how to discharge duty with courage in the face of dread, through a virtue “Abhayam” (Verse 16.1) which means fearlessness. Another virtue- “apalayanam” (Verse 18.43), meaning determination to continue on the path of duty, is extremely pertinent to the medical responders who are considering resignation. Gita teaches the virtue of “ksantih” (Verse 18.42) meaning patience, which is of utmost importance in a crisis with an uncertain end. The battle against COVID-19 is long, and it’s natural for medical responders to run out of enthusiasm. For this, Gita teaches “tejah” or enthusiasm (Verse 18.43) which can help them remain energetic at a mental level. In addition, Gita teaches qualities like “Damah” meaning self-discipline (Verse 16.1) and “Tapah” (Verse 4.28, 4.32, 16.1, 18.5, 7.9, 10.5, 17.5, 17.7) which roughly translates to sacrificing worldly pleasures / undergoing hardships for higher goals. This can help them remain focused on their duty over longer periods notwithstanding all the impediments. Apart from the framework to handle mental conflicts, Gita provides physical approaches for positive mental health like- Yuktaharavihara (good nutrition & relaxation), Pranayama (breathing exercises), Asanas (physical training/postures), Pariprashna (discussion), Ekagramana -concentration/meditation (Balodhi and Keshavan, 2011).

Positivity is contagious. Once the lessons of Bhagavad Gita lift the spirits of the medical workers, they can carry forward the motivation to the patients under their care. Some advantages of imparting Gita lessons are shown in Fig. 1 .

Fig. 1.

Advantages of Imparting Gita Lessons to the Medical Responders.

This crisis has taken a huge toll on the medical responders and with each passing day, the COVID-19 crisis is further eroding their patience, enthusiasm, and grit, rendering them vulnerable to more mental health issues, bit by bit. This is where sessions on Gita’s motivational lessons come in handy. Equipped with Gita’s wisdom, medical responders would be able to focus solely on their duty, ignoring all the hurdles. They would be mentally prepared to handle the psychological strain ensuing from all the aforementioned “significant stressors” faced during the COVID-19 crisis. Neither the uncertain future nor the isolation from their family, would be able to deter them from the path of their duty. A medical responder with internal motivation will never entertain questions like “why should I continue performing my duty, why not resign?”.

Nonetheless, we do not claim universal applicability of this spiritual approach, we only highlight a possible innovative solution. Here, the underlying assumption is that the therapist relishes the lessons of the Gita himself/herself and takes help of religious teachers to deliver the teachings more effectively. Moreover, the belief system of the recipients needs to be taken into consideration so that there is no imposition of values on the recipients which can render the therapy ineffective and also cause unnecessary conflicts. Given the unmistakable equivalence between the despondent position of Arjuna and that of the corona warriors, who are in the middle of a battlefield, we believe, they can easily relate to this sermon, that connects us to our deepest inner-self. Teachings of Hindu scriptures have been utilized to suggest possible mitigation strategies of crises like Global Warming (Agoramoorthy and Hsu, 2011), Economic crises (Ramrattan, 2009). Religion and spirituality have been used to provide a healing touch during the natural calamities, by the missionaries and gurus who visit the victims.

Of course, future studies, accompanied with surveys are needed to validate our findings.

“You find peace not by rearranging the circumstances of your life, but by realizing who you are at the deepest level.” —Eckhart Tolle

Declaration of Competing Interest

The authors report no declarations of interest.