by Sudhir Kakar
After Ramnath has left, Guruji is in the mood to talk about himself and his profession. He belongs to a vanishing breed of purists, he says. Most Ayurvedic physicians have few qualms about displaying the insignia of Western medicine—stethoscopes and thermometers for instance—in their consulting rooms. It is not really their fault, he concedes; many patients, especially in the rural areas, will not come to you if you don’t give them injections.4 Similarly, Ayurvedic medicines cannot be given in their traditional form as bitter decoctions, crude powders or hand-rolled pills but must come in modern dosage forms such as coated tablets, blister-packed capsules and syrups even if they are five times as expensive as their traditional counterparts.5 This is what the modern middle-class consumers want, in their movies as in their medicines, indeed in their idea of themselves—Indian souls packaged in a slick Western style.
Turning more philosophical, Guruji continues: ‘Medicine exists to fight diseases, not death. When death comes, holding hand with disease, then the doctor should prepare the patient for its arrival.
‘The enemies of health are man’s natural tendencies—greed, lust, anger and so on. You can conquer some but one or the other of the enemy always survives and it is he who brings death into the house of your life. Man lessens his lifespan due to his own sins and invites untimely death.’6
In the olden days, many patients asked for and accepted the tidings of their approaching death. An old potter, for instance, had once asked him during a sickness whether his time had come, so that he could return an outstanding loan before he departed from this world. Whatever the reason, the people of this country have always known that to go before your time has come is as great a sin as to try and cling to life when death is knocking at your door. A good death is an end that needs to be prepared for.
All this is changing with the advent of Western medicine, Guruji reflects. A Western-style doctor sees every sickness as a challenge to be overcome. And, indeed, the progress made by the technology of Western medicine is astonishing, although Guruji feels that perhaps its drugs are somewhat strong for the metal of which we in this country are made. Although he disapproves of modern manufacturers of traditional medicine, he would agree with one of their marketing managers who said that Ayurvedic and Unani medicines give Indians ‘what they really are—their history, their culture and their health’.7
In any event, India and Indians are changing and there are not too many patients left like the old man he had tried to persuade the other day to go to the Moolchand hospital. ‘If I have any life left, you will save me,’ the man said. ‘If not, then you will tell me well in advance and I will remember the goddess and make my preparations. As much as it is humanly possible, you will reduce my suffering. What else can a doctor do?’
FOOD AND THE INDIAN MIND
There are few other people as concerned with food as Indians, especially the Hindus—not only with its preparation, but with the effect it has on the human body and mind. Thus, food taboos abound. Most of these beliefs have their source in Ayurveda, even when the person acting on them is unaware of this origin. With the postulated equivalence of the body and the universe, the microcosm and the macrocosm, as far as their basic constitutive elements—the five bhutas of air, water, earth, fire and ether—are concerned, a person is literally what he eats. Diet is viewed as the mainstay of physical and mental health—as also the cause of disease. The basic principle is that diet should contribute to the balance of the human body, mimicking the universal balance around it. Such balance can only be achieved by consuming the right foods at the right time in the right season and avoiding incompatible foods, thus compensating for the dominance of or the disproportionate increase in a particular dosha.
Foods (and drugs) are, then, variously classified. The first classification is according to taste: sweet, sour, salty, pungent, bitter or astringent. And each taste comprises two bhutas; for example, sweet foods like rice, milk, wheat are comprised of earth and water, while sour foods like yoghurt, lemon, tamarind are comprised of earth and fire.
The second classification of food is according to its post-digestive taste, in contrast to the initial ‘tongue’ taste. The two may not coincide. For example, eating bananas with milk decreases the digestive fire and can give rise to colds, coughs and allergies. The two are examples of incompatible foods because although both have a sweet taste, the post-digestive taste of bananas is sour while that of milk is sweet.
The third classification is whether the food is ‘heating’ or ‘cooling’ in its action on the body—a classification that thus provides a guideline for foods that should be consumed in a particular season or at a particular time of day. Sweet, bitter and astringent tastes are generally cooling whereas sour, salty and pungent tastes are heating.
The final classification is according to the ‘personality’ of the food—whether a food has a purgative or a binding quality. To take an example, eating melon together with milk is not recommended. Both are sweet and cooling, yes, and thus compatible on the criteria of taste and action, yet their personalities are incompatible: milk is a laxative while melon is a diuretic.
Ayurvedic dietetics, then, is a complex matter. Its application not only requires knowledge of the various qualities of different foods but also how these qualities interact and are influenced by different seasons, climatic zones and methods of cooking. One of the ten techniques in which a traditionally trained Ayurvedic physician was expected to excel was cooking. Most Indians do not possess such expert knowledge. What they have internalized, though, are rough and ready guidelines picked up from family elders in the process of growing up. Thus, for instance, they have lists of ‘hot’ and ‘cold’ foods and thus know which foods should not be eaten during a certain season or time of day; the most common example of this would be the prohibition on the consumption of yoghurt at night. In a commonly believed linkage of foods to emotions, onions, garlic and meat are believed to increase the sexual urge; tea and chillies make the mind restless; sour foods are bad for self-control and so on. The most common, pan-Indian preoccupation with food relates to its digestion, that is, with matters of defecation. Stools are carefully observed to see whether they are soft and even a little runny. Constipation is taken infinitely more seriously in India than in the West. The inability to defecate even for a day is as bad as a minor illness, ruining the mood of the afflicted person for the rest of the day.
There is one aspect of Ayurvedic discourse on food which, we believe, has been relatively neglected in the description of Indian social relations. Since a person is what he eats, his consciousness is not only formed by the ‘consciousness’ that is present in the food but also by the consciousness of the cook. This view is most developed among the Jains, as also in one of the largest of the Hindu communities, the Vaishnavas.
The strict vegetarianism of these two and other such Indian religious communities is partly dictated by the image of the extreme pain and terror of the animal while being slaughtered, a pain and terror that becomes a part of the animal’s very flesh. In the West, it is only a great chef who would echo this and go so far as to allow that one can taste the emotional state of the animal one is eating. In an article in The New Yorker on two great chefs, Adam Gopnik quotes Fergus Henderson, famed for his devotion to meat, on the difference in muscle tension between Welsh and Yorkshire rabbits which a discerning diner can taste on his plate. ‘Rabbits, when they’re wild, have a very different temperament, which is expressed in their muscles. Welsh rabbits used to have a certain...tension; you could taste their tension. Now we’ve been using more relaxed Yorkshire rabbits, which are splendid in their way, but not as tense and interesting.’8 Alain Passard, an icon of French cuisine, who famously converted to vegetarian cooking, unwittingly embraces Vaishnava food ideology when he says, ‘...every day I was struggling to have a creative relationship with a corpse, a dead animal! And I could feel inside me the weight and sadness of the cuisine animate. And since [he turned vegetarian]—gone.’ He goes on to say t
hat the switch to vegetarian cooking not only changed his digestion but also brought a new lightness of step and spirit into his life.9
Many Indians, of course, go even further than the great French chef’s epiphany. Their dietary habits are dictated in part not only by the consciousness in the food but also of the cook. One of the most respected figures in Vaishnava history, Rupa Goswami, wrote: ‘If you eat food prepared by the wicked, you will become wicked.’10 The kitchen, then, becomes one of the most important places in the house, an extension of the Vedic altar, its sanctity guarded by many taboos, such as not entering it with one’s shoes (of leather) on, or not allowing into it people whose consciousness is presumed to be in a state of impurity and thus of a lower order. Even today in most well-to-do, traditional households, the cook is invariably a brahmin, whose consciousness is believed to be more evolved than that of other castes.
The ‘bad’ consciousness in food (even vegetables are believed to suffer when cut) is sought to be mitigated by viewing it as a preparation for the gods, the humans only consuming the ‘leftovers’, the prasad, after the god or goddess has been ritually fed. Even animal food becomes ‘better’ if it is seen as a sacrifice to the gods. All meat eaters and eaters of food prepared by those of an impure, lower consciousness—Muslims, Europeans and the lowest castes—must then be kept far away from the kitchen and the dining space so that they do not contaminate the family with their inferior consciousness. The pollution feared is not only of the body through touch but also of the mind. The lower consciousness of the lowest castes is, in turn, also related to their ingestion of ‘bad’ foods.
Of course, things have changed, and caste Hindus cannot afford to be as puritanical and fastidious as before. Does the explosion in the number of restaurants in large cities and towns following the economic liberalization of the 1990s then mean that the traditional ideology in relation to food is in a state of decline? The mushrooming of restaurants that serve all kinds of food and meats from various cuisines of India and the world would suggest that this is indeed the case. What has happened, however, is a modification rather than jettisoning of the traditional food ideology. We should not underestimate the Indian affinity for tradition and for contextualization, the latter constantly amending the former in service of pragmatic ends. Just as in the past any hand engaged in work—the carpenter’s hand hammering in a nail; even the smith’s, using the ‘impure’ leather bellows—was declared to be always ritually pure, thus avoiding severe disruptions in economic activity, the traditional food ideology no longer applies to public spaces such as restaurants, although there are certain taboos which continue to be observed. Thus it will be a very rare Hindu who will eat beef in a restaurant in India, or not feel uneasy in the company of someone eating beef at the same table. Yet contextualization can apply even to this strictest of prohibitions, as in the case of Hindus eating steak with all apparent signs of enjoyment in restaurants outside India, with the explanation—given sometimes in all seriousness—that it is only the Indian cow that is holy!
HEALTH AND MODERN MEDICINE
Considering the extent to which Ayurveda shapes an Indian’s ideas about the body, one would expect that Hindu patients, at least, would primarily seek treatment from Ayurvedic practitioners. But this is not the case. The number of patients who resort exclusively to Ayurveda is minuscule. If we exclude self-medication—the so-called grandmother’s remedies consisting of herbs, spices and particular foods which may have Ayurvedic knowledge at their base—Ayurveda becomes an option only after bio-medical treatment has been tried and has proved ineffective. Studies in ‘health-seeking behaviour’ show that Western biomedicine enjoys widespread acceptance and an allopath may be the first point of a medical consultation. This differs, of course, according to rural-urban location, by economic status, age and gender; urban, adult male patients with higher income are more likely to consult an allopath than are the rural poor, especially if the sick person happens to be a woman or a child.11 Yet, overall, most Indians today, if they seek medical intervention at all, will first go to an allopathic doctor. This is surprising, considering the cost and the appalling quality of biomedicine available to the rural or, for that matter, the urban poor, who still form a majority of India’s population of over a billion people.
Western biomedicine in India is provided by large public and private hospitals in cities and towns, by private practitioners and by the state-run primary health centres in villages which are meant to serve the health needs of the rural poor. These last are in an abysmal state of disrepair, lacking even basic infrastructure, equipment and drugs. They are also marked by a high rate of absenteeism of health care providers who are supposed to be manning them—that is, when qualified doctors, many of whom dream of emigrating to the West, are willing to be located in rural areas in the first place. The result is that even though primary health care is notionally ‘free’, most people turn to private practitioners for medical care. Naturally, then, an episode of serious illness in a poor family can plunge it into abject poverty.12
Private medical practitioners in India span the whole range of qualified doctors trained in Western medicine, physicians trained in modern colleges of Ayurvedic and Unani medicine (who have also been taught some fundamentals of biomedicine as a part of their curriculum) and pharmacists and other partially qualified people, almost three times the number of trained doctors, who have picked up the basics of biomedicine from experience. Excepting the high-quality care available to the well-off in urban areas, much of the practice of biomedicine, even by trained doctors, consists of hurried consultations lasting barely two to three minutes. The physical examination, in the absence of diagnostic tests, seldom involves anything more than listening to the lungs, the heart and the abdomen with a stethoscope. Common to all, the trained and the untrained, is aggressive interventions and a rampant misuse of antibiotics. Thus, in an average Indian village, a trained doctor would give a two-year-old with a three-day history of cough a vitamin B complex and a gentamycin intramuscular injection—not because the doctor suspected pneumonia but as a placebo, while an experienced but untrained healer would give someone with a fever a single injection of amoxicillin and treat a lack of appetite with penicillin...13
Most trained medical practitioners recognize this as over prescription, especially since seventy per cent of patients come with complaints that would disappear in the natural course over time. However, they justify this practice by referring to the expectation an Indian patient has from a practitioner of biomedicine. The expectation is of receiving strong medication leading to immediate relief. Injections are a perennial favourite, politely insisted upon by patients, and many doctors prescribe them as a matter of course in over three quarters of their cases.
Here we return to Ayurveda and the Indian predilection for assimilating alien systems of thought without worrying too much about the contradictions that might crop up in such an exercise. From the patient’s point of view nothing needs to change except an acknowledgement that the drugs of biomedicine are strong in the sense that the ‘hot’ drugs are hotter and the ‘cold’ drugs colder than their indigenous counterparts. The ‘strength’, ‘heat’ and ‘aggressivity’ of these medicines—not dissimilar to the reputed attributes of India’s ex-colonial overlords and of the white races in general—is a reason why some modern Ayurvedic physicians while explaining and treating a disease in Ayurvedic terms have little compunction in prescribing or dispensing drugs derived from penicillin, sulpha or cortisone. Health and healing, then, are as much in flux today as other areas of Indian life. Depending on an individual’s life history, the stage of his life and the beliefs of his social group, modern Western and traditional Indian ideas on illness and its cure coexist in varying proportions in the mind of every Indian, informing the life of the body.
VIEW OF DEATH
In a people whose consciousness is partly shaped by their rituals and a vast storehouse of mythological images, a Hindu myth relating to death and its relation t
o disease is a good place to begin any discussion of mortality.
Out of the happiness of his heart, Prajapati (Brahma, the Creator) began to create our universe. Each of his creatures was unique and wonderful. The ones on earth had everlasting life. Then, one day, a sound of pain reached Prajapati’s ears and a smell of something rotting assailed his nostrils. He saw that a large number of his creations on earth had become old, weak, almost lifeless, and the stink arose from their old and wasted bodies.
Prajapati closed his eyes and was lost in meditation. His forehead creased in worry, his smiling visage became an unhappy one, as if clouds had darkened a sunlit sky. Just at that moment, a shadow emerged from inside him and slowly took on a body. Soon, it was a woman, with hands folded in supplication, who stood in front of him. ‘Who am I, Father? Why have I been created? What is my work?’ she asked.
Prajapati replied: ‘You are my daughter—Death. You have been created to do the work of destruction.’
The woman said: ‘I am a woman and yet you have brought me into existence for such heartless work! My woman’s heart and woman’s dharma will not endure such cruelty.’