Facilitating an Ideal Death: Tibetan Medical and Buddhist Approaches to Death and Dying in a Tibetan Refugee Community in south India Restricted; Files Only

Namdul, Tenzin (Fall 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/zg64tn20n?locale=es
Published

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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