“Let’s agree to disagree.”
“Hinduism is known for its acceptance of other faiths.”
“Tolerance is a virtue.”
“Respect others’ beliefs, do not hurt their sentiments.”
The above assertions, prescriptions and exhortations are based on a view of human condition which perpetuates the misery and malice all around us.
Facts cannot be disputed, if there be a dispute there is usually a definite way to settle the dispute. Beliefs can not be proved (otherwise they would no longer require the act of believing).
One can disagree only about whether one believes in a certain opinion or not. To disagree about facts is just madness.
Regarding what is still unknown, there are many choices, based on the importance of knowing about the matter at hand. In science one usually hypothesizes and then tests that hypothesis by experimentation. In other cases, one generalizes based on past experience and generic knowledge about the processes involved (for example, in boarding a train expecting that it will reach the destination), in still other cases, one can accept one’s ignorance and carry on.
Beliefs, in the sense I mean them, are emotional investments in certain unverifiable opinions.
It is sensible to see the cause of a belief and one’s (or another’s) emotional stake and involvement, and it is silly to just agree or disagree with it. Both agreeing and disagreeing with a belief leave intact the process of belief and emotional vulnerability, and perpetuate the sense of a separated identity with its opinions and subjectivity.
Accepting or agreeing with another’s faith is foolish. It might make the other feel better, but what has been accomplished? Instead of enquiring into the facts of the matter, the available evidence and its implications, one reacts emotionally (for example, following the hoary adage that “you may win the argument, but you have lost a friend.”) instead of rationally.
Isn’t it evident when two people are arguing about a metaphysical belief, that they are not at all concerned about the facts or the truth of the matter, and that their aim is merely to forcefully and wittily present their case and to convince the other person by every kind of manipulation? Isn’t it evident that the parties have an emotional stake in the matter? A “heated” debate tinged with anxiety, agitation and pugnacity surely indicates that feelings are involved.
In a similar vein, tolerating other faiths and superstitions might be great for a facile harmony and a temporary truce but the very fact that there is a phenomenon requiring tolerance makes it obvious that it somehow pinches oneself. What is the need to tolerate something if it is of no consequence to oneself? The very need of tolerance, patience and equanimity indicate that the basis of antipathy is alive. Merely applying these cover-ups over an essentially malicious nature accomplishes at best a tense equilibrium.
One frequently reads about peoples’ religious sentiments getting hurt, judges issuing restraining orders on the publication of a book or on the screening of a movie on the grounds that it offends the public morality or sensibilities.
While to allow otherwise in animals masquerading as intelligent human beings would be an invitation to civil war, one must look into whether tolerance and acceptance of diverging beliefs is a lasting solution for human peace.
Tolerance is not a virtue, it is only suppression and control of one’s aggression.
Agreeing to disagree might keep alive a friendship, but it also keeps alive the identities involved. Without an identity within, friendship and animosity both are seen as the need-based psychic relationships that they are.
If somebody is psychologically hurt by a word or a statement or an act, then the full and square blame for this hurt lies with the aggrieved party. The other may or may not be malicious in its provocations, but it is certainly up to oneself to not get affected by them.
Nobody is responsible for your psychic suffering and for your happiness than you yourself. To ask others to be sensitive to yourself or to your feelings is to abdicate this responsibility.
Saturday, December 24, 2005
Monday, December 19, 2005
On Bringing a Child Into the World
What urges are involved in having or not having a child in the modern world? And what are the implications of having a child?
This is a monologue based on observation, not on personal experience.
Of the instincts or pressures which lead one to procreation, first and foremost is the biological imperative to continue the genetic flow. The basic purpose of life, birth and reproduction for human beings is the propagation of genes. This instinct is extremely deep rooted and hard to consciously investigate.
This urge manifests itself as the ideal of mother and care-giver as the ultimate role for a woman, and as a provider and a mentor as the ultimate role for a man.
As a woman turns 30, she becomes worried that as a reproductive entity, her time is limited. The pressure to become a mother becomes increasingly more insistent after this age. Probably she has experienced love, intimacy and marriage by this age. Motherhood, however, still remains a fresh territory which she would not want to remain off for very long.
Coupled with this inner pressure is the pressure from others. Friends and family are curious as to why the couple is not taking the next step, whether there is a physical reason, whether there is some emotional problem or lack of love and so on. A woman or man would be called selfish for not wanting to have a child, as it would be perceived that their own freedom is more important to them than their "natural drive" to bring and nurture another life in the world.
The parents of the couple would express their need to see their grandchildren. Bringing up one's children is an anxiety-ridden process for most, but bringing up grandchildren can be a pleasant chore at a stage in life when nobody else needs you. Grandparents are usually more accepting, tolerant and loving to kids than the kids' own parents. And of course, seeing one's clan propagated can give a peculiar pleasure.
Fear of loneliness and age-related degeneration is also a major factor in having a baby. In most human societies, children take care of their parents or their grandparents (to various extents). If a child is born when a couple is around 30, nearly 50 years will pass before the parents themselves reach the age where they need physical care. It is not too realistic to expect a son who is fifty (or a daughter, who has her own family) to care for oneself when one is eighty. And even the grandchildren will be having their own life by then. Hence, this need is seldom met properly by one's children or grandchildren. At most, they can provide financial or emotional support or allow the parents to live with them in the same home and take care of their basic needs.
For poor people who have no significant savings, having children is an insurance against starvation and abandonment in old age (or when they are incapacitated).
Another pragmatic reason for having a child (for the reasonably well-off) is to have a heir for the property and wealth accumulated (or inherited) during one's life. One would obviously like one's "own" to make use of the property and wealth that one has.
Frequently, this expectation of care from one's children and this dangled carrot of inheritance causes messy disputes, lawsuits, resentment, petty politics and infighting in an extended family.
There are other reasons for having a child which are emotional and which can prove stronger than pragmatic considerations.
When a couple has been through three or four years of marriage, a state of meaninglessness, ennui or boredom sets in with hardly anything fresh to look forward to in life. A child can provide a welcome relief from this state. It can provide a goal, a meaning to one's life, a reason to live, a reason to be happy or sad, a way for the self and the feelings to re-emerge and express themselves.
And, especially in modern times, as a couple grows into marriage, a child can be a means to cement the emotional bond between the parents. The child can be a device to bring back a oneness of purpose in the life of the parents. A man who does not like to come home early from work, will often do so because he enjoys the company and affection of the child. A woman will value the presence of the father more now that there is a child who needs both of them (as the father assumes the role of the bread-winner whereas the mother is the primary care-giver for the baby).
There is always something to be done in a home with a child, hence boredom (or having nothing to do) is temporarily banished. However, the constant effort of caring for the child (for a nuclear family) can be overwhelming, frustrating and an enclosing activity. One has little time to pursue one's own interests, to eat out, to travel etc. (more on this later)
A child is totally dependant on its parents. This can provide a feeling of gratification for them (especially for the mother). "I am important for somebody", "I am someone's mother or father", "My child needs me more than anything else", such thoughts and the associated feelings can provide a great deal of nourishment to the self. Many people report a wordlessly intense experience as they hold their child in their arms for the first time, or hear the child calling out "Papa" or "Mummy" to them.
The usual relationships in the world are tinged with ego, with manipulations thrown in. A mother's or father's relationship with their child is devoid of self-concern, as they see the baby as their own selves. As such, it is the closest to unconditional and transcendent love that a normal human can aspire to. And in a marriage where the husband and wife do not love each other anymore (or where the intensity of their love keeps waning), the love (or rather, the dependence) of the child for its parents can be very fulfilling.
A child cherishes its mother. It loves her, needs her, cannot be without her for long, quietens in her arms, its language is privately understood by her. It is like a new love affair for the mother.
A child is innoncent to the ways of the world. The parents experience the baby's innocence and ignorance, its naivete, its simple questions, its joy and sorrow at small things as a breath of fresh air in their own usually jaded lives. They relive their innocence through the child. Caring for the child, answering its questions, playing with it, showing it the world for the first time is a transcending, relaxing experience which takes one away from the worries and fears of one's own life.
For a father, teaching the child about the world, about the ways to survive and flourish can be a deeply satisfying experience. A father wants the child to do better in the world than himself. Teaching the child, mentoring and guiding it, grooming it for success and knowledge, feeling proud at its achievements (or the obverse, feeling disappointed at it having failed to be what one wanted it to be) are deep emotional processes and events.
The deepest emotional aspect of having a baby is that it is seen as a propagation of one's self. One achieves a spurious immortality by becoming a parent. One will live on and continue in this new form. One may be nothing in the world, one may not be famous or known, one may have created nothing of lasting value, but at least this trace of oneself, as one's child, will remain in the world and will continue through the centuries through its progeny and so on.
A strange satisfaction is there of having achieved something mystical by bringing forth a new life into the world. One is almost a God, having created a new life out of nothing. One transcends one's humanity by becoming aware of another life created through oneself.
...
I will attempt only a short take at the demonstrable implications of having a child in an urban setting.
First of all, in a nuclear family, caring for a child can be quite a chore. A single person taking care of the baby for most of the time can easily become impatient, angry, frustrated and tired. Sleepless nights, frequent cleaning of linen, not understanding the reason for the child's distress, trying to teach it the basic things about its body processes, feeding it inspite of the baby's resistance, protecting it from illness, frequent visits to the doctor because of undue fears about some symptoms in the baby's body, all contribute to nervous exhaustion and tiredness.
If there be grandparents in the home, the burden is considerably lessened. Otherwise, there can be resentment in the mother at being confined to home while the husband is free to come and go as he pleases.
The mother's body undergoes various transformation during pregnancy and after delivery, and this can lead to a concern in her about her attractiveness. As caring for the child is a taxing chore, sex and sharing of one's free time with one's spouse becomes absent or extremely infrequent. Coupled with the unattractiveness factor, this can induce tension into the marital relationship. The husband finds the wife unwilling as well as unattractive. If he becomes distant from her, resents the child, and tries other avenues of entertaining himself, it can cause a great deal of distress for the mother. For her, the child is a joint creation and responsibility. And her body has borne the brunt of bearing the child. The father's callous attitude towards the wife or the child can lead to depression in the mother.
Both of them recognize the lack of freedom that the child now represents to them. The implications, as they become more obvious, can turn into a battle with one's spouse for space, time for oneself and one's freedom.
As the child grows up, there is anxiety and fear over its health and future. The child's peers, TV, targeted advertising and almost everything which comes in contact with it condition it in various ways. It can become manipulative and blatantly selfish and hedonistic. This can be a trying period for the parents. It can be quite an effort for them to instill the "right values" in the child. There are varied influences in a modern city which can lead a child "astray" and it requires quite a bit of sensitivity and intelligence to gently encourage discrimination in the child. Especially during and after puberty, it can be extremely hard to keep the instinctual drives under check.
Coupled with this is the difficulty of ensuring a good schooling for the child. Good schools in India are hard to find, with admissions being notoriously tough and expensive. As the child grows older, such concerns become more pronounced, now that education and competitive examinations leading to various career paths enter the picture.
...
Bringing a child into the world is a serious responsibility. It is perhaps unrealistic to expect that people will understand and free themselves from their own incompleteness and emotional urges. But a wise assessment of the implications might not be too much to ask.
This is a monologue based on observation, not on personal experience.
Of the instincts or pressures which lead one to procreation, first and foremost is the biological imperative to continue the genetic flow. The basic purpose of life, birth and reproduction for human beings is the propagation of genes. This instinct is extremely deep rooted and hard to consciously investigate.
This urge manifests itself as the ideal of mother and care-giver as the ultimate role for a woman, and as a provider and a mentor as the ultimate role for a man.
As a woman turns 30, she becomes worried that as a reproductive entity, her time is limited. The pressure to become a mother becomes increasingly more insistent after this age. Probably she has experienced love, intimacy and marriage by this age. Motherhood, however, still remains a fresh territory which she would not want to remain off for very long.
Coupled with this inner pressure is the pressure from others. Friends and family are curious as to why the couple is not taking the next step, whether there is a physical reason, whether there is some emotional problem or lack of love and so on. A woman or man would be called selfish for not wanting to have a child, as it would be perceived that their own freedom is more important to them than their "natural drive" to bring and nurture another life in the world.
The parents of the couple would express their need to see their grandchildren. Bringing up one's children is an anxiety-ridden process for most, but bringing up grandchildren can be a pleasant chore at a stage in life when nobody else needs you. Grandparents are usually more accepting, tolerant and loving to kids than the kids' own parents. And of course, seeing one's clan propagated can give a peculiar pleasure.
Fear of loneliness and age-related degeneration is also a major factor in having a baby. In most human societies, children take care of their parents or their grandparents (to various extents). If a child is born when a couple is around 30, nearly 50 years will pass before the parents themselves reach the age where they need physical care. It is not too realistic to expect a son who is fifty (or a daughter, who has her own family) to care for oneself when one is eighty. And even the grandchildren will be having their own life by then. Hence, this need is seldom met properly by one's children or grandchildren. At most, they can provide financial or emotional support or allow the parents to live with them in the same home and take care of their basic needs.
For poor people who have no significant savings, having children is an insurance against starvation and abandonment in old age (or when they are incapacitated).
Another pragmatic reason for having a child (for the reasonably well-off) is to have a heir for the property and wealth accumulated (or inherited) during one's life. One would obviously like one's "own" to make use of the property and wealth that one has.
Frequently, this expectation of care from one's children and this dangled carrot of inheritance causes messy disputes, lawsuits, resentment, petty politics and infighting in an extended family.
There are other reasons for having a child which are emotional and which can prove stronger than pragmatic considerations.
When a couple has been through three or four years of marriage, a state of meaninglessness, ennui or boredom sets in with hardly anything fresh to look forward to in life. A child can provide a welcome relief from this state. It can provide a goal, a meaning to one's life, a reason to live, a reason to be happy or sad, a way for the self and the feelings to re-emerge and express themselves.
And, especially in modern times, as a couple grows into marriage, a child can be a means to cement the emotional bond between the parents. The child can be a device to bring back a oneness of purpose in the life of the parents. A man who does not like to come home early from work, will often do so because he enjoys the company and affection of the child. A woman will value the presence of the father more now that there is a child who needs both of them (as the father assumes the role of the bread-winner whereas the mother is the primary care-giver for the baby).
There is always something to be done in a home with a child, hence boredom (or having nothing to do) is temporarily banished. However, the constant effort of caring for the child (for a nuclear family) can be overwhelming, frustrating and an enclosing activity. One has little time to pursue one's own interests, to eat out, to travel etc. (more on this later)
A child is totally dependant on its parents. This can provide a feeling of gratification for them (especially for the mother). "I am important for somebody", "I am someone's mother or father", "My child needs me more than anything else", such thoughts and the associated feelings can provide a great deal of nourishment to the self. Many people report a wordlessly intense experience as they hold their child in their arms for the first time, or hear the child calling out "Papa" or "Mummy" to them.
The usual relationships in the world are tinged with ego, with manipulations thrown in. A mother's or father's relationship with their child is devoid of self-concern, as they see the baby as their own selves. As such, it is the closest to unconditional and transcendent love that a normal human can aspire to. And in a marriage where the husband and wife do not love each other anymore (or where the intensity of their love keeps waning), the love (or rather, the dependence) of the child for its parents can be very fulfilling.
A child cherishes its mother. It loves her, needs her, cannot be without her for long, quietens in her arms, its language is privately understood by her. It is like a new love affair for the mother.
A child is innoncent to the ways of the world. The parents experience the baby's innocence and ignorance, its naivete, its simple questions, its joy and sorrow at small things as a breath of fresh air in their own usually jaded lives. They relive their innocence through the child. Caring for the child, answering its questions, playing with it, showing it the world for the first time is a transcending, relaxing experience which takes one away from the worries and fears of one's own life.
For a father, teaching the child about the world, about the ways to survive and flourish can be a deeply satisfying experience. A father wants the child to do better in the world than himself. Teaching the child, mentoring and guiding it, grooming it for success and knowledge, feeling proud at its achievements (or the obverse, feeling disappointed at it having failed to be what one wanted it to be) are deep emotional processes and events.
The deepest emotional aspect of having a baby is that it is seen as a propagation of one's self. One achieves a spurious immortality by becoming a parent. One will live on and continue in this new form. One may be nothing in the world, one may not be famous or known, one may have created nothing of lasting value, but at least this trace of oneself, as one's child, will remain in the world and will continue through the centuries through its progeny and so on.
A strange satisfaction is there of having achieved something mystical by bringing forth a new life into the world. One is almost a God, having created a new life out of nothing. One transcends one's humanity by becoming aware of another life created through oneself.
...
I will attempt only a short take at the demonstrable implications of having a child in an urban setting.
First of all, in a nuclear family, caring for a child can be quite a chore. A single person taking care of the baby for most of the time can easily become impatient, angry, frustrated and tired. Sleepless nights, frequent cleaning of linen, not understanding the reason for the child's distress, trying to teach it the basic things about its body processes, feeding it inspite of the baby's resistance, protecting it from illness, frequent visits to the doctor because of undue fears about some symptoms in the baby's body, all contribute to nervous exhaustion and tiredness.
If there be grandparents in the home, the burden is considerably lessened. Otherwise, there can be resentment in the mother at being confined to home while the husband is free to come and go as he pleases.
The mother's body undergoes various transformation during pregnancy and after delivery, and this can lead to a concern in her about her attractiveness. As caring for the child is a taxing chore, sex and sharing of one's free time with one's spouse becomes absent or extremely infrequent. Coupled with the unattractiveness factor, this can induce tension into the marital relationship. The husband finds the wife unwilling as well as unattractive. If he becomes distant from her, resents the child, and tries other avenues of entertaining himself, it can cause a great deal of distress for the mother. For her, the child is a joint creation and responsibility. And her body has borne the brunt of bearing the child. The father's callous attitude towards the wife or the child can lead to depression in the mother.
Both of them recognize the lack of freedom that the child now represents to them. The implications, as they become more obvious, can turn into a battle with one's spouse for space, time for oneself and one's freedom.
As the child grows up, there is anxiety and fear over its health and future. The child's peers, TV, targeted advertising and almost everything which comes in contact with it condition it in various ways. It can become manipulative and blatantly selfish and hedonistic. This can be a trying period for the parents. It can be quite an effort for them to instill the "right values" in the child. There are varied influences in a modern city which can lead a child "astray" and it requires quite a bit of sensitivity and intelligence to gently encourage discrimination in the child. Especially during and after puberty, it can be extremely hard to keep the instinctual drives under check.
Coupled with this is the difficulty of ensuring a good schooling for the child. Good schools in India are hard to find, with admissions being notoriously tough and expensive. As the child grows older, such concerns become more pronounced, now that education and competitive examinations leading to various career paths enter the picture.
...
Bringing a child into the world is a serious responsibility. It is perhaps unrealistic to expect that people will understand and free themselves from their own incompleteness and emotional urges. But a wise assessment of the implications might not be too much to ask.
Monday, December 05, 2005
The Deterioration of the Body
The body has to deteriorate and die.
The change can be sudden. One can suffer from an accident, or an acute infection or the malfunctioning of an important organ.
Even a slight disturbance in the body's systems, an eye infection, pain in a tooth, dandruff, a corn in a toe, a stomach upset can lead to a general feeling of malaise, of being un-well, of not liking to eat, of not being able to enjoy anything, of a lack of energy, listlessness, irritability and so on.
Good health is a gift which is seldom enjoyed consciously. Only in illness or in pain do we usually become conscious, aware of our body and wish for things to get back to normal...
The body has an innate intelligence which can guide the will to make decisions conducive to a quick recovery. Not liking to eat when ill is the body's way of ridding itself of toxins and of resting the metabolic system, for example.
Many of us spend an unreasonable amount of thought and energy in warding off imaginary illnesses, in keeping more fit than is required, taxing our bodies thinking that dis-use leads to dis-ease.
In the modern world, physical activity is mostly voluntary. We don't usually need to exert our muscles in our daily lives. That is why the plethora of gyms, the fads of yoga and various new-age therapies, the urban maladies (due to a stressful lifestyle and of a polluted, noisy and crowded environment) of chronic constipation, high blood pressure, stress, balding, early graying of hair, myopia, diabetes, back pain, obesity, acidity, ulcers, cysts and so on.
It is important to use the body and the various muscles on a regular basis. Just washing a few of one's clothes, or the dishes, or walking to the grocer and carrying the bags home, of climbing the stairs, a few minutes of aerobics or yoga asanas in the morning, an occasional set of push-ups or sit-ups or crunches can keep the body in good shape. Also important is moderation in one's diet and regularity in the food habits. Eating at almost the same time everyday, having a regular calorific intake, eating fruits and vegetables, having juices, not having many cups of coffee or tea or carbonated water, limiting one's drinking and smoking, not eating red meat, all contribute to good health.
...
Even so, no one can escape age-related degeneration. The eyes become weak, the ears hard of hearing, the muscles lose their stamina, the joints become weak, the bones soft, the heart frail, the brain not as active, the teeth start falling, the hair start graying and falling and so on.
If one is conscious of the body's needs and does not under-use or over-use it, the degeneration is slow and graceful. One frequently comes across a village-folk or a a hill-woman who is pleasant to look at even in old age. One may not look desirable, but there is such a thing as healthy old age in which one is not suffering but is just slowed down. On the other hand, most of the urban people look ugly in their old age, their gait ungraceful, their faces contorted with stress and a thousand fears and regrets, their bodies and faces displaying the tell-tale signs of a life lived hastily and restlessly and their talk becomes bitter, cynical and critical.
It is not hard to understand why such people would not be able to command care and respect from their children. Caring for a selfish, demanding, irritable, moody and cynical man or woman is not a pleasant chore. Is it a surprise why in cities, old people are seldom tolerated in the homes of their children? One can forgive the degeneration of the old person's body as inevitable but it is hard to live with a degenerate or manipulative brain.
I have had the opportunity of caring for many of my grandparents in my life. One of them died of Alzheimer's disease at the age of 85, the other of a heart attack at the age of 90, another of cerebral haematoma as a result of a failing heart, again at 85, and my grandfather, who died the last, died of right ventricular block at the age of 93.
It is not a chore to care for another if one doesn't have cares or desires of one's own. A hedonist will be ill at ease caring for another. He will consider caring for another as an imposition, a burden, an intrusion into his pursuit of pleasure. A depressed person will lack the will to care well. An impatient or emotional person will lack the stability and calmness to care without getting agitated. A person with strong likes and dislikes will easily get disgusted and lose his/her temper.
However, since almost all of us suffer from some care or desire, it is unrealistic to expect someone to care well for someone else for long. Even a mother gets irritated and angry at her child after a couple of sleepless nights.
If the prognosis of someone's illness (or the possibility of a treatment which might cure one) is not very positive, but the degeneration is not sufficientt to cause a quick death, depression might set in at the un-ending days and nights of care which await the care-giver(s).
Sometimes the care-givers resort to radical surgery to attempt to get the patient either back to reasonable good health and independence or to a quick detereoration and death. For the care-givers, death of the patient is only a half-tragedy. It is also a relief.
The ill person can also feel the demands he/she is making on the care-givers, and this can lead to a feeling of depression, of helplessness and of a tendency to suicide. As these feelings are not helpful for the patient's recovery, these lead to a progressive degeneration and to a demand of higher and more insistent care.
Hence, if care is sought to be given, it should be given joyfully. Otherwise it is counter-productive. In private nursing homes also, nurses are usually under-paid and over-worked. It cannot be expected of them to be considerate and caring at the same level as the patient's relations.
When a patient is terminally ill, assisted dying so as to minimize the pain, suffering and humiliation becomes a possiblity. As far as possible, the patient should be kept un-sedated. Sedatives, tranquilizers and sleeping pills can reduce the burden of care, but it also makes such aids mandatory for the future. It is a downhill slope from there. If a patient is unusually irritable or in pain, a mild anti-anxiety drug such as Alprazolam is prescribed. Efforts should be made to make the patient as calm, undisturbed and close to normal as he/she can be even when bed-ridden. A quiet and calm atmosphere, availability of reading material, normal conversation, a dispassionate attitude towards the bodily secretions can make the patient feel at ease and un-distressed. Analgesics (painkillers) should be moderated, as they can easily cause GI upsets. Some mild exercise involving the abdominal muscles can be beneficial for bowel movements. Natural/herbal laxatives (e.g. Isabgol and Triphala) and milk of magnesia are preferable to harsh contact laxatives.
In many countries, it is legal to give a lethal dose of tranquilizers (for example, a 9g oral dose of Nembutal) to let a patient die quickly and painlessly. In India, however, it is not legal yet. But if a terminally ill patient himself declines to have food or liquids, they should not be forced upon him as they might contribute to distress. However, adequate oral hydration (optionally with glucose and electrolytes) can be provided by asking the patient, as it causes little or no metabolic activity.
Hygiene for a bed-ridden patient should be maintained as far as possible as it can be a mood elevator. Mouthwash, sponge-baths, washing of the patient's hands and face before and after his meals, keeping his bed-linen clean and dry and keeping the room ventilated with fresh air, all contribute to a general feeling of well-being.
One might ask what is the purpose of keeping a terminally patient alive. And it is a difficult question. Most of us consider human life as sacred and a gift which should be maintained even when there is no value addition by the person alive to his environment. An old man of 90, who is bed-ridden, can continue to live for many more years if proper care is taken of him, without him being in any way enjoying life, learning anything new or adding anything of value to his environment or to his care-givers.
So what can be the justification of caring for him? Sometimes people do it due to feelings of obligation, filial respect and piety. Sometimes, due to a fear that they themselves might one day face the same and so they should do their part (and subconsciously expect the same care when they reach old age). Sometimes people think that giving care is a good deed which will be rewarded in due course by God.
I took care of my grandfather and others because I had time on my hands, I knew (or learnt) how to care, I had a superficial knowledge of physiology and medicine, and I wanted to learn about old age and death. I am not sure if I would have been willing or patient enough to care for them for years and years while they were bed-ridden. The longest period when I took care of a completely bed-ridden patient (my grandfather) was four months. He recovered well, was back on his feet, and lived on for four more years. I remember that I also got irritated a few times when I felt he lacked the will to get well and that he was taking my care for granted. It took a lot of effort for me to change his mind-set. There were a few times when I wanted him to die and to leave me alone;in retrospect, I consider those moments a failure of my equanimity. What contributed to my impatience was that his own sons were unwilling to take care of him (they were busy in their respective professions) while I, a young man of 25, was made to be a nurse all day just because I had resigned from my job and wanted to spend time on my own.
I learnt a few things about death and dying on the way. No matter how much a person consciously wants to die, the body's main function is to ward off death. Discounting suicidal actions by the patient, the body will continue to remain alive even in apparently life-threatening conditions. There are reserves of energy in the body which get activated only in trauma or when close to death. And also, the person himself, once he/she loses control over his speech and actions, will plead for life and never for death. The body takes over the mind in extreme conditions. Even a person who has been through an attempted suicide will pray to the doctors to save him/her from pain and death.
The will of the patient to live can be quickly sapped by his care-givers if they get tired of him and want him to die. On the other hand, a depressed patient can be brought back to optimism by sustained and patient efforts of a care-giver.
The body becomes restless when death is at hand. One starts recollecting faint events and people far forgotten. One calls out to only those whom one trusts (or has loved in the past). One frequently starts hallucinating. After a threshold, bodily pain ceases to bother one. Unless a person has been deeply religious, religion and God is far from the mind of a dying person. Bitterness, unfulfilled desires and deeply held regrets come to the fore.
Life and death are the greatest of teachers, indeed. Other than the joy of learning and the desire to be happy, what more motivation is required to be a sincere student?
The change can be sudden. One can suffer from an accident, or an acute infection or the malfunctioning of an important organ.
Even a slight disturbance in the body's systems, an eye infection, pain in a tooth, dandruff, a corn in a toe, a stomach upset can lead to a general feeling of malaise, of being un-well, of not liking to eat, of not being able to enjoy anything, of a lack of energy, listlessness, irritability and so on.
Good health is a gift which is seldom enjoyed consciously. Only in illness or in pain do we usually become conscious, aware of our body and wish for things to get back to normal...
The body has an innate intelligence which can guide the will to make decisions conducive to a quick recovery. Not liking to eat when ill is the body's way of ridding itself of toxins and of resting the metabolic system, for example.
Many of us spend an unreasonable amount of thought and energy in warding off imaginary illnesses, in keeping more fit than is required, taxing our bodies thinking that dis-use leads to dis-ease.
In the modern world, physical activity is mostly voluntary. We don't usually need to exert our muscles in our daily lives. That is why the plethora of gyms, the fads of yoga and various new-age therapies, the urban maladies (due to a stressful lifestyle and of a polluted, noisy and crowded environment) of chronic constipation, high blood pressure, stress, balding, early graying of hair, myopia, diabetes, back pain, obesity, acidity, ulcers, cysts and so on.
It is important to use the body and the various muscles on a regular basis. Just washing a few of one's clothes, or the dishes, or walking to the grocer and carrying the bags home, of climbing the stairs, a few minutes of aerobics or yoga asanas in the morning, an occasional set of push-ups or sit-ups or crunches can keep the body in good shape. Also important is moderation in one's diet and regularity in the food habits. Eating at almost the same time everyday, having a regular calorific intake, eating fruits and vegetables, having juices, not having many cups of coffee or tea or carbonated water, limiting one's drinking and smoking, not eating red meat, all contribute to good health.
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Even so, no one can escape age-related degeneration. The eyes become weak, the ears hard of hearing, the muscles lose their stamina, the joints become weak, the bones soft, the heart frail, the brain not as active, the teeth start falling, the hair start graying and falling and so on.
If one is conscious of the body's needs and does not under-use or over-use it, the degeneration is slow and graceful. One frequently comes across a village-folk or a a hill-woman who is pleasant to look at even in old age. One may not look desirable, but there is such a thing as healthy old age in which one is not suffering but is just slowed down. On the other hand, most of the urban people look ugly in their old age, their gait ungraceful, their faces contorted with stress and a thousand fears and regrets, their bodies and faces displaying the tell-tale signs of a life lived hastily and restlessly and their talk becomes bitter, cynical and critical.
It is not hard to understand why such people would not be able to command care and respect from their children. Caring for a selfish, demanding, irritable, moody and cynical man or woman is not a pleasant chore. Is it a surprise why in cities, old people are seldom tolerated in the homes of their children? One can forgive the degeneration of the old person's body as inevitable but it is hard to live with a degenerate or manipulative brain.
I have had the opportunity of caring for many of my grandparents in my life. One of them died of Alzheimer's disease at the age of 85, the other of a heart attack at the age of 90, another of cerebral haematoma as a result of a failing heart, again at 85, and my grandfather, who died the last, died of right ventricular block at the age of 93.
It is not a chore to care for another if one doesn't have cares or desires of one's own. A hedonist will be ill at ease caring for another. He will consider caring for another as an imposition, a burden, an intrusion into his pursuit of pleasure. A depressed person will lack the will to care well. An impatient or emotional person will lack the stability and calmness to care without getting agitated. A person with strong likes and dislikes will easily get disgusted and lose his/her temper.
However, since almost all of us suffer from some care or desire, it is unrealistic to expect someone to care well for someone else for long. Even a mother gets irritated and angry at her child after a couple of sleepless nights.
If the prognosis of someone's illness (or the possibility of a treatment which might cure one) is not very positive, but the degeneration is not sufficientt to cause a quick death, depression might set in at the un-ending days and nights of care which await the care-giver(s).
Sometimes the care-givers resort to radical surgery to attempt to get the patient either back to reasonable good health and independence or to a quick detereoration and death. For the care-givers, death of the patient is only a half-tragedy. It is also a relief.
The ill person can also feel the demands he/she is making on the care-givers, and this can lead to a feeling of depression, of helplessness and of a tendency to suicide. As these feelings are not helpful for the patient's recovery, these lead to a progressive degeneration and to a demand of higher and more insistent care.
Hence, if care is sought to be given, it should be given joyfully. Otherwise it is counter-productive. In private nursing homes also, nurses are usually under-paid and over-worked. It cannot be expected of them to be considerate and caring at the same level as the patient's relations.
When a patient is terminally ill, assisted dying so as to minimize the pain, suffering and humiliation becomes a possiblity. As far as possible, the patient should be kept un-sedated. Sedatives, tranquilizers and sleeping pills can reduce the burden of care, but it also makes such aids mandatory for the future. It is a downhill slope from there. If a patient is unusually irritable or in pain, a mild anti-anxiety drug such as Alprazolam is prescribed. Efforts should be made to make the patient as calm, undisturbed and close to normal as he/she can be even when bed-ridden. A quiet and calm atmosphere, availability of reading material, normal conversation, a dispassionate attitude towards the bodily secretions can make the patient feel at ease and un-distressed. Analgesics (painkillers) should be moderated, as they can easily cause GI upsets. Some mild exercise involving the abdominal muscles can be beneficial for bowel movements. Natural/herbal laxatives (e.g. Isabgol and Triphala) and milk of magnesia are preferable to harsh contact laxatives.
In many countries, it is legal to give a lethal dose of tranquilizers (for example, a 9g oral dose of Nembutal) to let a patient die quickly and painlessly. In India, however, it is not legal yet. But if a terminally ill patient himself declines to have food or liquids, they should not be forced upon him as they might contribute to distress. However, adequate oral hydration (optionally with glucose and electrolytes) can be provided by asking the patient, as it causes little or no metabolic activity.
Hygiene for a bed-ridden patient should be maintained as far as possible as it can be a mood elevator. Mouthwash, sponge-baths, washing of the patient's hands and face before and after his meals, keeping his bed-linen clean and dry and keeping the room ventilated with fresh air, all contribute to a general feeling of well-being.
One might ask what is the purpose of keeping a terminally patient alive. And it is a difficult question. Most of us consider human life as sacred and a gift which should be maintained even when there is no value addition by the person alive to his environment. An old man of 90, who is bed-ridden, can continue to live for many more years if proper care is taken of him, without him being in any way enjoying life, learning anything new or adding anything of value to his environment or to his care-givers.
So what can be the justification of caring for him? Sometimes people do it due to feelings of obligation, filial respect and piety. Sometimes, due to a fear that they themselves might one day face the same and so they should do their part (and subconsciously expect the same care when they reach old age). Sometimes people think that giving care is a good deed which will be rewarded in due course by God.
I took care of my grandfather and others because I had time on my hands, I knew (or learnt) how to care, I had a superficial knowledge of physiology and medicine, and I wanted to learn about old age and death. I am not sure if I would have been willing or patient enough to care for them for years and years while they were bed-ridden. The longest period when I took care of a completely bed-ridden patient (my grandfather) was four months. He recovered well, was back on his feet, and lived on for four more years. I remember that I also got irritated a few times when I felt he lacked the will to get well and that he was taking my care for granted. It took a lot of effort for me to change his mind-set. There were a few times when I wanted him to die and to leave me alone;in retrospect, I consider those moments a failure of my equanimity. What contributed to my impatience was that his own sons were unwilling to take care of him (they were busy in their respective professions) while I, a young man of 25, was made to be a nurse all day just because I had resigned from my job and wanted to spend time on my own.
I learnt a few things about death and dying on the way. No matter how much a person consciously wants to die, the body's main function is to ward off death. Discounting suicidal actions by the patient, the body will continue to remain alive even in apparently life-threatening conditions. There are reserves of energy in the body which get activated only in trauma or when close to death. And also, the person himself, once he/she loses control over his speech and actions, will plead for life and never for death. The body takes over the mind in extreme conditions. Even a person who has been through an attempted suicide will pray to the doctors to save him/her from pain and death.
The will of the patient to live can be quickly sapped by his care-givers if they get tired of him and want him to die. On the other hand, a depressed patient can be brought back to optimism by sustained and patient efforts of a care-giver.
The body becomes restless when death is at hand. One starts recollecting faint events and people far forgotten. One calls out to only those whom one trusts (or has loved in the past). One frequently starts hallucinating. After a threshold, bodily pain ceases to bother one. Unless a person has been deeply religious, religion and God is far from the mind of a dying person. Bitterness, unfulfilled desires and deeply held regrets come to the fore.
Life and death are the greatest of teachers, indeed. Other than the joy of learning and the desire to be happy, what more motivation is required to be a sincere student?
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