Ethical Dilemmas from New Delhi to Dharamsala
By Ciaran Tobin, UCL Masters Student
Early one morning in the summer of 2009, I boarded the daily public bus from New Delhi to Dharamsala; a fourteen-hour journey ending high in the foothills of the Indian Himalayas. A silent collective of Asian women, men and children, and one solitary Western backpacker departed the insufferably sticky 38-degree blanket heat in the 4am darkness. I half-slept, as best one can on Indian public transport, with a semi-lucid conscious awareness that our 6pm arrival time seemed both a long time, and a world away. As I alighted the bus for lunch break at a roadside teashop, the bus driver noticed I was unsure of which direction I should go. He kindly pointed me in the right direction and upon boarding the bus, and to my surprise, offered me the seat next to him. His assistant, the ticket-taking fare collector sat in the seat I had occupied, and I got a front row semi-panoramic view of an exciting journey along the wending and wildly archaic mountainside roads.
As the driver rounded each sweeping and scary overhanging precipice, with great speed and precision (as though he was on auto-pilot), and our conversation began to flow, he proudly and happily began to tell me about his life, and his culture. He was a young dark-skinned Hindu man, and was born in New Delhi where he had a large circle of family and friends. While he spoke of them with great affection, it became apparent that he rarely got to spend time with them. He told me that he worked each day; in a thirty-one-day calendar month, he would typically work twenty-eight or twenty-nine days. He would sleep that night (and each night) in the vacated baggage undercarriage of his bus, only to return to New Delhi the following morning at 6am, arriving at approximately 8pm. There he would sleep in the blanket heat of his empty baggage undercarriage, amidst a chaotically loud and busy bus station.
As a Westerner, I was initially a little shocked at how one could live this way, and I politely and respectfully asked him if he missed spending time with the people that he loved. Through a bumpy and beaming smile, and in what I can only describe as great spiritual pride he replied:
“No… This is my Karma. This is my duty.”
Upon seeing that I didn’t entirely understand what he meant…
“It is my Karma… my duty. If I do my job well in this life, if I am kind and helpful and good to people and do my duty well, I will have a better life in the next life.”
So convinced in this belief, of his purpose and meaning in this life, his worldview, his experience and this logic made complete sense to him. His acceptance and confidence in the psycho-moral continuity of ‘Karma’, empowered his life and embodied his identity in a way that clearly made him feel strong, and proud in his duty.
My encounter with this man raised many ethical questions within me. Despite his clear and contagious enthusiasm, I initially felt quite sad for him. The perceived harsh circumstances and conditions in which he lived; rarely seeing the people he cared for most; and in my own naïve perhaps cultural bias, I felt as though he was trapped in a system of morality that constructed and controlled his function and freedom in life. But who was I to judge this way of life, and a man that clearly appeared genuinely happy. He had a confidence in his karmic convictions, and an inner (spiritual) strength that I had not. His duty was enough for him; it wasn’t a material or monetary thing; in simplifying the complexity of life, his duty gave him what many search for in life – purpose and meaning. The felt-nature of this encounter initially left me conflicted, and allowed me a glimpse of what many set off to find in the “Spiritual Disneyland” of India – my own purpose and meaning… and thankfully, an expert driver!
From an ethics and morality standpoint, this was my first real cross-cultural anthropological encounter, which set-in motion my desire to study diverse and disparate ontologies with impartial respect and sensitivity.
In 2013, I returned to Dharamsala to conduct fieldwork research exploring mental health amongst the Tibetan community in exile (TCiE). I was very fortunate to meet and interview several senior government, religious, and medical scholars. A doctor from the Tibetan Medical and Astrological Institute, shared his insight and personal lived experience of karma:
“When His Holiness met Mao, he said religion is poison. Now religion is not poison. Now it’s proving as a panacea…
“Me, I have no parents. I haven’t seen my father… And I haven’t seen my mother too… I can’t remember her. But I don’t feel upset, otherwise I cannot be in this position as a physician and a healthy person.”
“In childhood I lost them. And I was so depressed I cannot do anything. But I changed my mind. I believe my mind in karma. And I put myself as a hope. And I determined myself to be a physician. So, that is why I’m saying that religion, to believe in karmic action… helps me to increase my power to stand or to do something.”
“So, that basis we always believe and we people suffer less inside, emotionally.”
The doctor grew up without parents… in a refugee diaspora. He was visibly quite animated and open in recounting his moving experience; one that spoke volumes of his character and resilience. His heartfelt and inspiring story offered an example of how karmic ethics may serve as a powerful psycho-spiritual coping mechanism.
The Administrator… and The Monk
An objective of my research sought to understand whether a concept of ‘mental health’ exists amongst the TCiE (in contrast to the Western definition of mental health that has been developed by UN/WHO). Interestingly, the UN definition appeared incomplete to respondents as it fails to address ethics. The WHO (2001) defines mental health as:
“A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
An administrator from the Office of His Holiness the Dalai Lama, suggested that peace of mind comes when one lives life ethically, and explained:
“Being able to contribute to society, doesn’t necessarily mean that you’re ethical. The aspect of ethics has been lost in many peoples’ life because they consider it to be religious, which is not. The UN has to deal with the reality that the world is in, where people are not so religious, maybe they avoid the ethical side.”
Consequently, the UN definition of mental health may be applied to unethical people, yet they may still be deemed healthy. The UN definition will continue to appear incomplete until it addresses the dimension of ethics.
A monk from the Library of Tibetan Works and Archives voiced his concerns regarding ethics in Western treatment:
“This mentality to adopt the ‘quick fix’ solution. Human beings are treated almost like a broken car. To see us exactly like a mindless machine is big mistake. We have a tradition in Tibetan medicine. We say when a patient comes in, the doctor’s gentle attitude and smiling welcome heals half of the sickness. That means human feeling, genuine concern. The doctors in many countries worried about how to get the money. They build really nice shiny looking buildings and nice bed. But what about the actual treatment?”
What about the treatment is a good question. Compare the Tibetan approach to Fadiman’s (1997) description of the Western archaic and automaton student medical culture where dissociation and separation of emotions are encouraged – “The cartoon-version M.D., the all-head-no heart formalist who, when presented with a problem, would rather medicate it, scan it, suture it, splint it, excise it, anesthetize it, or autopsy it than communicate with it.”
To which I would question, where is the human feeling, the genuine concern? The ethics of compassion that are at the root of the Tibetan health system? If the system itself appears sick, would one want to feel well adapted to it? Is it ethical that the system appears set up for self-interest and monetary gain at the expense of the vulnerable?
Research has shown that the very act of thinking about science triggers moral behaviour (Ma-Kellams & Blascovich, 2013). Health education and practice therefore plays an important role in shaping our experience of the world, and may benefit by addressing cultural competence and the lack of colloquy in medical pluralism. By broadening our sense of identity to extend an ethics of compassion we may recognise the unifying attributes that resonate with our most basic understanding of human nature, and further our understanding of what mental health entails in the increasingly networked and interconnected world in which we live. A viable definition and understanding of mental health needs to incorporate and reflect this.
My time, experience and encounters from New Delhi to Dharamsala allowed me to see that researchers must ethically develop a more holistic awareness of reality; to challenge, experientially explore and think for oneself – not just follow the existing tradition or system. If the researcher does not have equal respect for foreign concepts, they may not come to understand and appreciate their value.
Fadiman, A., (1997) The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures, Farrar, Straus and Giroux, New York.
Ma-Kellams C., Blascovich J. (2013) ‘Does “Science” Make You Moral? The Effects of Priming Science on Moral Judgments and Behavior.’ PLoS ONE 8(3).
World Health Organization. (2001) Strengthening Mental Health Promotion. Geneva, World Health Organization (Fact sheet no. 220), WHO, Geneva.