Facilitating an Ideal Death: Tibetan Medical and Buddhist Approaches to Death and Dying in a Tibetan Refugee Community in south India Open Access
Namdul, Tenzin (Fall 2019)
Abstract
The Tibetan cultural conceptualization of death and care for the dying are informed and shaped by the intersection of Tibetan medical and Buddhist practice. In Tibetan culture, death is generally seen as a process of transition from one life to another through reincarnation, as well as a critical opportunity for adept practitioners to emerge into full enlightenment. In a Tibetan refugee community in south India, the care for the dying is a culturally orchestrated process involving Tibetan doctors, Tibetan Buddhist monks, and family members of the dying person. While Tibetan doctors assist in promoting a peaceful death through herbal remedies and counseling, Tibetan monks facilitate a smooth transition from one life to the next. Employing a variety of ethnographic methods—participant observations, unstructured and semi-structured interviews, and surveys—this dissertation examines how Tibetan doctors, monks, and family members collaborate in facilitating an ideal death; and how these collaborators understand and negotiate their roles in caring for the dying person. Importantly, through this nexus of cultural actors supporting the dying in this universal existential moment, the dissertation explores the central question: what constitutes an ideal death in Tibetan Buddhist culture?
This dissertation focuses on how the Tibetan medical paradigm, structurally integrated with the Buddhist cultural model, offers family members the freedom to seek medical and spiritual care concurrently and to seek guidance from both Tibetan doctors and monks. My research demonstrates how Tibetan doctors, incorporating philosophical and psychological features of Tibetan Buddhism in their practices, employ personalized care to dying persons based on their “constitutional nature” (Tib. rang bzhin). This enables Tibetan doctors to provide more holistic care that addresses not only biophysiological, but also psychological, social, and spiritual aspects of their patients. I propose that the inextricable integration of Tibetan medicine and Buddhism during end-of-life care addresses the overall needs of the patient.
Finally, this work challenges the suitability of a descriptor such as “dying well” based on the binary of a good and a bad death understood in the modern biomedical and palliative/hospice care. Instead, I argue that it would be more fitting to refer to a good death as an “ideal death.” In so doing, any particular way of dying does not have to be labelled as good or bad, rather it could be viewed as an appropriate death in its own context.
Table of Contents
List of Figures
INTRODUCTION: DEATH IS NOT A DEAD-END 1
Central Questions...................................................................................................................2
Relationship Between Life and Death....................................................................................3
Close Encounter with Death...................................................................................................6
Why Talk about Death? .........................................................................................................10
Biopsychosociospiritual Approach to Death and Dying……………………………………............12
The Field Site.........................................................................................................................17
Methods.................................................................................................................................22
Modes of Inquiry...................................................................................................................22
Context.................................................................................................................................26
Study Participants Recruitment...........................................................................................29
Procedure.............................................................................................................................32
Studying Tibetan Doctors and Monks...................................................................................33
Studying Family Members....................................................................................................35
Anonymity and Data Protection...........................................................................................37
Chapter Overview.................................................................................................................37
CHAPTER 1: DEATH AS A MORAL-HEURISTIC GROUND 43
Introduction............................................................................................................................43
First Encounter with thugs dam.............................................................................................46
Supranormal Experience........................................................................................................48
Thugs dam: Nexus of Supreme Technique and Sublime Knowledge……………………….........53
Consciousness (Tib. rnam par shes pa): Clear and Knowing……………………………...............56
Eight Stages of Dying.............................................................................................................59
Investigating the Ultimate Truth...........................................................................................61
stong nyi and Wellbeing........................................................................................................64
Cultivation of Compassion and Resilience............................................................................66
Nothing is Permanently Attached..........................................................................................68
What is Death?.......................................................................................................................73
Conclusion…………………………………………………………………………………...........................74
CHAPTER 2: RE-EXAMINING DEATH 76
Introduction............................................................................................................................76
What is Death: New Answers to an Old Question...................................................................79
Cardiorespiratory to Neurocentric Death...............................................................................83
Historical and Theoretical Background..................................................................................84
Biological and Sociocultural Death........................................................................................85
The Problem with Biological Death........................................................................................91
Tibetan Buddhist notion of Death..........................................................................................95
Bardo: Death as a “Moment of Transition” ...........................................................................97
How do We Respond to Death?..............................................................................................99
Terror Management Theory: Mortality Salience....................................................................100
Death as a Collective Cultural Tool........................................................................................102
Death as a Psychological Adaptation Cultural Tool...............................................................103
Death as a Moral Supervisor...................................................................................................104
Death as a Means to Attain a Better Life................................................................................105
Death as a Means to Unmask Ultimate Reality......................................................................109
How Can We Die? .................................................................................................................111
Tibetan Cultural Models of Ways of Dying...........................................................................112
Conclusion..............................................................................................................................113
CHAPTER 3: CARE FOR DYING 116
Introduction............................................................................................................................116
The Intersection of Medicine and Religion............................................................................120
The Integration of Tibetan Medicine and Buddhism..............................................................123
Epistemological Framework: The Four Noble Truths............................................................124
Reincarnation: The Symbol of Hope......................................................................................125
Twelve Interdependent Links.................................................................................................128
Lobsang Nyima Rinpoche’s Reincarnation............................................................................131
What does Reincarnation Entail? ..........................................................................................133
Reincarnation in the Scope of Tibetan Medical Practice.......................................................135
Seeking Help from Tibetan Doctors and Monks....................................................................136
The Importance of State of Mind...........................................................................................137
The Interplay of Mind and Body............................................................................................144
Mind as a Basis of Suffering..................................................................................................146
Mental Strength: Hope and Purpose.......................................................................................147
The Power of Being Reaffirmed.............................................................................................150
Conclusion..............................................................................................................................156
CHAPTER 4: PERSONALIZED CARE 158
Introduction............................................................................................................................158
Lost and Confused..................................................................................................................159
Trust and Openness................................................................................................................160
Karmic and Genetic Predisposition........................................................................................163
Conception of Human Body...................................................................................................166
Addressing a Dying Patient’s constitutional Nature...............................................................167
Seven Constitutional Natures..................................................................................................170
Diagnosis and Making Prognosis............................................................................................179
Pulse and Urine Analysis in Terminal Patients.......................................................................183
Death Pulse..............................................................................................................................185
Death Urine.............................................................................................................................187
Signs of Death and Dying.......................................................................................................188
Dreams: Interpreting the Third Eye........................................................................................189
Imminent Signs of Death........................................................................................................191
Treatment................................................................................................................................194
Conclusion..............................................................................................................................195
CHAPTER 5: DEATH RITUALS 198
Introduction............................................................................................................................198
Collaboration Amidst Conflict................................................................................................200
Ritual as Illogical Religious Act..............................................................................................205
What does Rituals do? ...........................................................................................................209
Ritual as a Response to Emotional Vulnerability....................................................................211
Ritual as a Dialectical Tool.....................................................................................................213
Ritual as a Source of Intention and Sincerity.........................................................................214
Familiarizing Consciousness to the Unfamiliar World...........................................................216
Tibetan Book of the Dead......................................................................................................220
Universality of Ritual.............................................................................................................221
Guiding Consciousness to the Next Life...............................................................................225
Death Horoscope: Instructions for Family Members............................................................231
Disposal of the Body.............................................................................................................234
Conclusion.............................................................................................................................238
CHAPTER 6: RETHINKING A GOOD DEATH 241
Introduction...........................................................................................................................241
The Dichotomy of a Good and a Bad Death............................................................................244
Preparing for Death................................................................................................................248
Sleeping in Mother’s lap: Joy, Love, and Trust.......................................................................249
Conception of Death and How to Die ....................................................................................251
Dealing with Pain and Suffering............................................................................................257
Culturally Infused Attitudes toward Pain and Death.............................................................263
Practicing Tonglen (Tib. gtong len): Others Before Self........................................................264
Compassion as a Supreme Tool.............................................................................................266
Dying with Multiple Options.................................................................................................271
Tibetan Medical Perspective: Anxious, Anger, Depressed....................................................272
Tibetan Buddhist Perspective: Content, Fearless, Joyful......................................................274
Conclusion.............................................................................................................................278
CHAPTER 7: CONCLUSION 281
Reaffirming Tibetan Buddhist Models of Death and Dying.................................................281
Potential Contributions.......................................................................................................291
Consequences and the Next Steps.......................................................................................295
APPENDICES: 297
Appendix 1: Semi-structured Interview Schedule................................................................298
Appendix 2: Conception of an Ideal death among Tibetans.................................................299
Appendix 3: Variations in the Conception of an Ideal Death...............................................299
Appendix 4: Most Important Component in Caring for a Dying Person………………...........300
BIBLIOGRAPHY 301
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