One of the most well-known parts of the medical doctors’ Hippocratic Oath includes a commitment to treating disease wherever it exists, and in whomever it exists. On a daily basis, physicians treat medical conditions for people who may have very different values than they might have, such as people who physically abuse their children, or people who may be racist. Thankfully, I am not a physician.
Psychologists have a bit more leeway in who they choose to see. If you have such significant bias against a person that it would compromise the quality of care that they would receive, it is ethical to refer them to another provider. That isn’t to say that you can refer someone out every time you disagree with them over something. You generally have to have a strong ethical case for refusing to treat someone (i.e., seeing them for treatment would cause more harm than good).
When talking about patients which I may have radical value differences with, one of my patients, Tom*, comes to mind. I enjoy working with Tom, for the most part. For someone who has endured severe chronic illness since childhood, he is a positive, upbeat, and compassionate individual. Most people in his situation would probably be severely depressed. On the other hand, Tom frequently shares beliefs with me that, unbeknownst to him, I am completely against. His views are often quite bizarre, and are generally a part of persecutory delusions stemming from trauma earlier in life.
For example, Tom believes that government is deliberately introducing widespread illnesses to the public through vaccinations. He believes that vaccinations actually make people sick, physically and mentally, and that they are a clandestine way for the government to control the population. So, he is what is known as an “anti-vaxxer.” He has identified a number of subtle ways in which the government purportedly spreads the “vaccination agenda,” including Hollywood’s collusion in this initiative through creating medical television shows like Grey’s Anatomy, House, and even The Mindy Project, which normalize vaccination.
Tom’s delusions seem quite outlandish, but they can be viewed more simply as personal fears gone out of control. I came to discover Tom’s deep-seated anxiety and anger about a lack of support from his family for helping him seek treatment for his chronic illness in childhood. This grew to become a delusion in adulthood. Tom’s unconscious childhood anxiety of, “My family [i.e., the main system in which I am embedded] does not care about my illness; my family doesn’t care if I die,” has ballooned into an anxiety-tinged psychotic delusion in adulthood of, “The government [system] does not care about anyone’s health. The government sadistically imposes illness onto all of us, and does not care if we die.”
That said, Tom’s commitment to the anti-vaxxer cause is relatively harmless. He has about five people he regularly speaks to about “activism” on these issues, all completely through social media. Even among these few friends, there is no risk of them committing any aggressive acts based on their beliefs. They believe completely in non-violence, and spread word about their movement through their personal social media accounts with limited followings. None of them have children of their own whom they may be endangering by not vaccinating them.
I still find myself conflicted about treating Tom. As I help to treat some of Tom’s depressive symptoms, he is more able to engage socially with others. Psychological research shows how perceived social support can lessen one’s perception of physical pain. So, I generally find it beneficial to do anything to encourage his interaction with his social media friends. Tom’s complaints about his physical symptoms certainly do decrease the more he interacts with his friends. But as treatment progresses positively, and Tom interacts more with his social group, I can’t help but feel that I am aiding, if in any small way, the anti-vaxxer movement! Yet, sabotaging Tom’s treatment is not an ethical option, nor is transferring him out simply because I don’t agree with his values.
There’s no doubt that I will continue treating Tom. Despite my internal reservations, we have developed a great rapport. But, I can’t help but wish he wasn’t the way he was. Maybe then, I’d enjoy talking to him more, and maybe treatment could be even more fruitful. One day, in the midst of contemplating his treatment, I found myself reading the story of the deity Vitthala.
Vitthala/Vithoba is a well-known avatara (incarnation) of Vishnu/Krishna. Well, not “well-known” for all Hindus — as a Guyanese Hindu, I never heard of him until I was in my teens and I heard a wonderful and haunting kirtan to Vitthala which stays with me up to today. People of various social standings, from potters to prostitutes to priests, have written poems and songs dedicated to Vitthala. Even one Muslim mystic, Sheikh Muhammad, has written verses about Vitthala! There are many iterations of the legend of Vitthala, but I will relate the best amalgam of the stories I have heard here:
A man named Pundalika was haughty and rude to his parents. Pundalika and his wife would ride on the horses while traveling, while he would make his elderly and infirm parents walk. He frequently told his parents that he could not afford any food for them, while Pundalika and his wife enjoyed lavish meals.
One day on their travels, Pundalika and his family stopped in an ashram to rest for a few days. Pundalika saw three women dressed in dirty saris walk into the temple on the ashram premises with pots of filthy water. They came out some time after emptying their vessels, miraculously in divine clothing, looking beautiful and radiant. Pundalika observed these women in secret for a few days.
Finally, when they were walking out of the temple one day, he asked them who they were and what they were doing there. The women said that they were the embodiments of the holy rivers Ganga, Yamuna, and Saraswati. They showed up looking dirty every day because they absorb all of the regrets and misdeeds of the people who bathe in them so that those devotees can leave with a fresh slate and renewed heart. They dumped the dirty water/clothes (symbolic of the devotees’ hurtful thoughts/actions) at the feet of God in the temple every day and walked out clean again. They told Pundalika that the “dirt” he added to their waters was worse than others’ because he neglected to help those nearest to him (his parents) daily. He fell at their feet, realizing the errors of his ways.
From that day forth, Pundalika settled in that ashram and not only dedicated himself to taking care of his parents, but tended to anyone else who would come for help. He took in people from all socioeconomic strata and castes, which was unheard of in a place where that sort of special treatment was only reserved for Brahmins.
This story actually happened in the time of Shri Krishna. One day in his travels with Rukmini, Krishna stopped at Pundalika’s ashram. He wanted to stay at the ashram, so he went to meet Pundalika. At that time, Pundalika was in the middle of serving other people. Usually, people might have stopped what they were doing immediately to go and serve Krishna. Pundalika didn’t do this. He kept serving the people he was tending to at the time with full concentration. He was so absorbed in his tasks that instead of offering Krishna a comfortable grass mat to sit on, he threw a brick out of the door to where Krishna was standing. Krishna was so impressed by Pundalika’s unwavering concentration in service to others, that he stood on that brick and waited for Pundalika to finish.
When Pundalika was done with his tasks, he realized he had thrown a brick out at Krishna, and he rushed out to apologize. But Krishna used this opportunity to thank Pundalika for his selfless service to others, and to bless him such that Krishna’s loving presence would always be there waiting for him, standing on a brick. This form of Krishna is known as Vitthala or Vithoba, “the Lord who stands on the brick.”
If you lose yourself in the devotion of serving others, no matter how hard it seems at times, God will be waiting outside of your door, “standing on a brick” (ready to accept whatever have to offer, whether a brick or grass mat). Selfless service is mindful service, in which you don’t worry about what others are saying (praise or insult), how smart or politically astute you seem, or how worthy the people you serve are of receiving your love.
Interestingly, worship of the form of God named Vitthala preceded Krishna. It seems like the legend of Vitthala already existed in that area of India as an amalgam of the stories of different local heroes who were selfless in the service of animals. I like this message too, that animals are worthy of our selfless service and love.
I have been reflecting on this story in relation to my treatment of Tom. Complete, selfless service is a hard standard to live up to. What if I had a patient who actively sought to damage the lives of LGBTQ+ people, for example? How would that change things? Would such a person be worthy of my care? Would I be able to selflessly commit to helping them? Should I even care about them?
I can’t say I always feel Tom is “worthy” of my care, but I also am not sure that loving and healing have anything to do with worthiness. I can say that I give Tom the entirety of my presence and attention when I am with him. I sincerely want him to feel better — I just need to let go of my attachment of hoping that “better” means “thinking more like me!”
Disclaimer: This article is not meant to be used for personal medical or psychological diagnosis/treatment. If you or somebody know has experienced any symptoms of mental illness, please contact your primary care physician or a therapist for consultation, treatment or further guidance.
*All identifying information has been significantly changed to protect the identity of individual(s) mentioned in this article.