The Need to Expand Palliative Care with an Understanding of Yoga and Meditation to Provide Modern Day Integrative Therapy

Elderly and Hospice with changing times.
Elderly and Hospice with changing times.

“The ocean of Spirit has become the little bubble of my soul. Whether floating in birth, or disappearing in death, in the ocean of cosmic awareness the bubble of my life cannot die. I am indestructible consciousness, protected in the bosom of Spirit’s immortality." Paramhansa Yogananda

Healthcare delivery systems in America, especially in large cities, have to deal with a significant population of patients of the Hindu faith. The newly released 2016 Yoga in America study, conducted by Yoga Journal and Yoga Alliance, shows that the number of US yoga practitioners has increased to more than 36 million, up from 20.4 million in 2012. These practitioners, however, do not necessarily practice Hinduism, but rather the non-sectarian practice of yoga and meditation. Thus, it is vitally important that physicians and others who deliver healthcare must have some sort of foundational knowledge about the philosophical perspectives and spiritual dimensions associated with yoga and meditation.

"Health", according to modern concepts, and in accordance with the age old Hindu concept, goes beyond a mere absence of disease. It is a way of life, healing and coping with the outcomes of many conditions of life in a way which may seems to many to be incomprehensible. The idea of health now encompasses not only biological wellbeing, but also the psychological, social and spiritual dimensions of health care. The pursuit of health should continue, even in situations where a person receiving treatments for his existing conditions fails to respond. Otherwise, he or she will be vulnerable to the slow and sure consequences of a failure to survive. It is vital, therefore, to keep a patient motivated, psychologically nourished and spiritually nurtured, in order to come to terms with an unsure physical future and cope with not only the physical trauma of pain, but also mental stress.

Palliative care is of prime importance for individuals facing potentially fatal diseases, since these are associated with severe anxiety and depression, along with the acute pain and physical symptoms of the disease.

Within the wide range of coping techniques recommended for palliative care, the most widely used and popularly practiced techniques belong to the field of spirituality. Spiritually viable techniques bring comfort and meaning to human suffering, not by making disease curable, but by making the condition more acceptable and bearable. Spirituality has been defined in different ways and has been misinterpreted as a religion by many. Spirituality is the journey on a path of self-exploration to determine the relationship with transcendental energies and the portal to tapping these energies to gain self-balance.

The Indian spiritual literature and philosophical systems that are the source of yoga and meditation have served as a conduit to comprehending the significance of death in an individual’s life. There has been a very elaborate description of the concept of death and rebirth in the Bhagavad Gita in Indian spiritual literature. Paramhansa Yogananda, one of the greatest teachers of Kriya Yoga, who has initiated thousands of Americans into this powerful ancient Indian technique of self realization, talks about the concept of death with reference to the Bhagavad Gita as follows:

“At death, you forget all the limitations of the physical body and realize how free you are. The soul feels a joyous sense of relief and freedom. You know that you exist apart from the mortal body. Every one of us is going to die someday, so there is no use in being afraid of death. You don’t feel miserable at the prospect of losing consciousness of your body in sleep; you accept sleep as a state of freedom to look forward to. So is death; it is a state of rest, a pension from this life”.

Indian spirituality elucidates the belief that our real self, the soul, is immortal. Death is merely a change of state from one physical existence to another; it is a bridge between lives when we take a leap from one form of matter to another. The human existence is considered to be physical, as well as spiritual or subtle. Death is the end of physical continuity but there is something that remains and lives even beyond physical death. That eternal substance is the soul, the spiritual substance which is what transmigrates to other lives.

There have been an large number of studies done in an attempt to establish the fact that patients should try to move towards spirituality, especially in cases of terminal diseases when death is inevitable. Spirituality helps minimize suffering and expands hope towards a peaceful finitude. It helps the patients and their family members maintain a positive atmosphere while preparing for the final passing. There is now an ever increasing need for health professionals to recognize the need for providing spiritual support to their patients, in addition to the physical treatment plan, to ensure that the patient lives in peace and passes with dignity.

People with incurable diseases often try to seek answers for their situation about why they and not others are the victims of such terminal medical conditions. Why do they not stand a good chance of survival? They also harbor anger, frustration, helplessness, hopelessness and fatigue from their everyday medical parades of medicines and medical consultations. They are saturated to a point where struggle is the other word for life and in such times, spirituality seems to be one ray of hope for understanding the meaning of their life, to see connections and start developing hope to manage their life, if not cure their disease.

Healing is very different from curing. Healing means trying to understand and accept one’s medical fortune and accommodate one’s life to the medical condition. Healing involves a sense of coping rather than curing. Spirituality is all about healing cognitive powers and preparing the body to face medical outcomes.

In a systematic review of published data from 26 surveys in 13 countries, the use of complementary or alternative medicine (CAM) in adult cancer populations ranged from 7% to 64%, with an average prevalence across studies of 31.4%. A US survey found that 91% of cancer patients (n= 752) reported using at least one form of CAM while receiving treatment. In the UK and US, complementary therapies are widely available to people with incurable progressive disease through palliative care services and appear to be highly valued by service users. Yoga is one of the most popular complementary therapies in the Western world.

Another very interesting study mentions that in a survey of hospital inpatients conducted to review the role of spirituality in cancer patients, it was found that 77% of patients reported that physicians should take patients' spiritual needs into consideration, and 37% wanted physicians to address religious beliefs more frequently. A large survey of cancer outpatients in New York City found that a slight majority felt it was appropriate for a physician to inquire about their religious beliefs and spiritual needs, although only 1% reported that this had occurred.

A pilot study of 14 African American men with a history of prostate cancer found that most had discussed spirituality and religious beliefs with their physicians. They expressed a desire for their doctors and clergy to be in contact with each other. Another study of advanced cancer patients in New England and Texas assessed their spiritual needs. Almost half (47%) reported that their spiritual needs were not being met by a religious community, and 72% reported that these needs were not supported by the medical system. When such support existed, it was positively related to improved quality of life. Furthermore, having spiritual issues addressed by the medical care team had more impact on increasing the use of hospice and decreasing aggressive end-of-life measures than did pastoral counseling.

Spiritual well-being, particularly a sense of meaning and peace, is significantly associated with an ability of terminal patients to continue to enjoy life despite high levels of pain or fatigue. Spiritual well-being and depression are inversely related. Studies have proven the relation between spirituality and relief from major concerns such as anxiety, depression, pain and psychological distress in palliative care. People who have received some form of spiritual support tend to have a greater efficiency in the hypothalamic-pituitary-adrenal system in response to painful stimuli and the release of important elements such as serotonin and dopamine into the brain. Spiritual well-being reduces the counts of immune cells involved in stress.

Given the growing number of practitioners of yoga and meditation, it is increasingly important for providers in the medical fraternity to include spiritual nurturing in healthcare. From physicians to those providing pastoral care, caregivers should become acquainted with the philosophy behind yoga and meditation in order to provide this additional healing dimension to alleviate patient suffering, particularly at a time when they need it most.

This article has been coauthored by Dr. Mona Rawal, PhD. Faculty at the Foothill College, California

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