ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

A+| A| A-

Recovering from Psychosocial Traumas: The Place of Dargahs in Maharashtra

Recovering from Psychosocial Traumas: The Place of Dargahs in Maharashtra

Dargahs have come under attack in recent times, following the tragic death of 25 mentally ill people at Erwadi in Tamil Nadu. The tragedy invited a Supreme Court suo motu intervention against local healing shrines all over the country that also included reform of the mental health system in general. This set of medico-legal events has led to the exclusive targeting of local healing shrines by various statutory agencies evoking human rights, ignoring the primary intent of the court that was reform of the mental health system in general. Against this context, we are presenting case studies of dargahs in Maharashtra which serve the purpose of healing from psychosocial traumas and argue for a more deliberate response to the vexed question of mental healing and overall health.

INDIAN SYSTEMS OF MEDICINE

Recovering from Psychosocial Traumas: The Place of Dargahs in Maharashtra

Bhargavi V Davar, Madhura Lohokare

Dargahs have come under attack in recent times, following the tragic death of 25 mentally ill people at Erwadi in Tamil Nadu. The tragedy invited a Supreme Court suo motu intervention against local healing shrines all over the country that also included reform of the mental health system in general. This set of medico-legal events has led to the exclusive targeting of local healing shrines by various statutory agencies evoking human rights, ignoring the primary intent of the court that was reform of the mental health system in general. Against this context, we are presenting case studies of dargahs in Maharashtra which serve the purpose of healing from psychosocial traumas and argue for a more deliberate response to the vexed question of mental healing and overall health.

Financial support for this study (2003-06) was provided by IDPAD/ ICSSR. The Bapu Trust, Pune, housed the programme and provided appreciable administrative and library support. Deepra Dandekar, the project coordinator and Deepak Salunke were other team members of the project, whose contributions are deeply appreciated. Mira Oke, P Joglekar and Sadhana Natu provided ethical and technical advisory inputs into the project, for which we are very grateful.

Bhargavi V Davar (bvdavar@gmail.com) is at the Centre for Advocacy in Mental Health, Pune and Madhura Lohokare is currently pursuing a PhD in social sciences at the University of Syracuse.

T
here was a faith healing centre, the Erwadi dargah, in R amanathapuram district in Tamil Nadu. Near here, p rivate parties had set up many hutments to keep persons labelled as mentally ill. On 6 August 2001, the hutments in which 43 people were housed, chained to their beds, caught fire, resulting in many deaths. Remarkably, the local government awarded families who had dumped their mentally ill relatives in these private asylums with monetary “compensation”, instead of applying penalties under the Mental Health Act.1 The government i nstructed district collectors to examine such shelters for their l icences. The Supreme Court initiated suo motu action against the Tamil Nadu government and all other states of India (vide Writ Petition Civil No 334 of 2001). The Supreme Court asked all the state governments to implement the Mental Health Act, 1987, and to close all shelters not covered by the act. It demanded to know whether mentally ill people were treated badly or kept in chains anywhere in the respective states. The state governments found it expedient to immediately supply information on this last aspect, while r emaining defensive or non-committal about other queries.

1 The Supreme Court Intervention

Of special significance is the Saarthak petition,2 Paragraph 9, which referred to human rights violations in “certain institutions” where mentally ill are kept, expressing deep concern “about the inadequate and inhuman conditions in which mentally ill persons live”. Paragraph 9 can be read as implying all private institutions as borne out by the annexure.3 The state responses have also reflected this inclusion of indigenous healing institutions within the ambit of the “private sector”. The state of Kerala did an extensive survey and inspection of indigenous healing and presented their affidavit.4 While largely denying other Supreme Court remarks about state apathy, the Punjab government admitted to the “prevailing poor and inhuman conditions of mentally ill patients in certain institutions, but not in every such institution”.5 Proposing a 50 bedded mental hospital, the Manipur government said that “Due to lack of modern treatment facilities, people are following the traditional methods of treatment and families are losing confidence”.6 The Andhra Pradesh (AP) government was highly denouncing:

In order to prevent mentally ill persons flocking to places such as d argahs, temples, religious places and other unlicensed places for treatment and rehabilitation, it is necessary that the state of Andhra Pradesh has adequate rehabilitation services for the chronic mentally ill and persons with mental disability.

Further, Provision of such services would go a long way in preventing society

april 18, 2009 vol xliv no 16

EPW
Economic & Political Weekly

from utilising services at unlicensed places such as dargahs, temples, churches and other religious institutions which do not have proper facilities and expertise.7

The Supreme Court did not consider the conflict of interest in involving the state governments as an examiner, in fact, the only examiner, of their own practices. The Erwadi related actions taken by the Supreme Court resulted in greater authority to mental hospitals and the professionals and to a change in the relationship between the professional authority and society, while not changing much within the mental health system. Vigilance over indigenous healing increased since the Supreme Court action. The state of Haryana sent the vigilance officers under the Mental Health Authority (MHA) to visit local healing centres. In Tamil Nadu (TN), district committees had the mandate of “making periodic inspections of places where mentally ill persons are detained and ensure the human rights of mentally ill”. Due to the vigilance set up locally around dargahs, 50 mentally ill people at a famous dargah in Kolar district were chased away. Vide D irectorate of Medical Education (DME) Rc No 22181/MS.ZA/2001, dated 10 August 2001, issued from the DME, AP, a five-member “expert” medical committee, visited the Syed Miran Hussaini Quadri Bagdadi dargah and submitted a report about conditions in the dargah. Subsequently, the licensing authority (director, ME) issued notice to the dargah, asking to hand over the mentally ill persons for medical treatment.8 The DME inspection committee took the assistance of local police for the process. Permission from the dargah was obtained to assess the “patients” visiting the dargah. Whether this medical evaluation procedure included the consent of people is not known. A sizeable population needing psychiatric treatment was identified through diagnostic procedure and referred. The MHA was enjoined to take suitable action against the dargah. The AP affidavit suggested that such centres must be “licensed” facilities and should comply with the MHA, as if dargahs were a kind of mental institution. On the question of voluntarism and patients’ rights, the DME report’s comments on “free movement” are remarkable:

Mentally ill persons staying in the dargah without any relatives may be handed over by the dargah authorities either to the relatives whose addresses they have, or to the local police station, so that appropriate reception order may be obtained for their involuntary admission into the mental hospital….

While the DME report scowls on the chaining of persons in the dargah, it notes with equanimity, arrest by the police and the use of solitary confinement in the mental hospitals for unmanageable patients and the unconditional use of forced treatment. The Tamil Nadu government, while closing down indigenous healing centres, evolved a sophisticated procedure for physical restraint and solitary confinement.9

Subjective Nature of Personal Distress

The said dargah’s response is the single presenting voice, as well as the single dissenting voice. Noting the “ancestral” nature of the dargah, Syed Mohd Qadiri emphasised the belief and faith that the dargah instilled in its devotees. He noted the voluntary nature of people with problems visiting the centre and that persons get “consoled with the spiritual powers of the saint”. The

Economic & Political Weekly

EPW
april 18, 2009 vol xliv no 16

letter concludes by noting that as the dargah is not a “mental hospital” and there are no “patients”, the question of handing over patients does not arise! The Supreme Court, in an order dated 5 February 2002, among other directives, directed as follows:

Both the central and state governments shall undertake a comprehensive awareness campaign with a special rural focus to educate people as to provisions of law relating to mental health, rights of mentally challenged persons, the fact that chaining of mentally challenged persons is illegal and that mental patients should be sent to doctors and not to religious places such as temples or dargahs.

The court ordered the construction of mental hospitals in states where none exist. The union ministry, while making bland responses to the continuing abysmal situation prevailing in the mental health sector, decided to map out all the faith healing c entres frequented by psychiatric patients.10 Witch hunting of such places was propagated by the newspapers:11 Maharashtra Herald noted that thousands of people “obsessed by blind faith go to the village [Erwadi]”.12 Papers presented glowing tributes to mental hospitals: “…regional mental hospital is just like a carnival for the rural patients of Maharashtra” said one newspaper,13 subverting the intent of the Supreme Court suo motu action. Ironically, while the caption of the article read “No Chains at Asia’s Largest Mental Hospital”, the photograph attached showed a p atient lying on the floor tightly curled up, in a small locked room with grilled iron bars, like a cage. In this instance, a legal c hallenge has been mounted on these institutions from a most improbable critic, the public mental health sector, itself under s evere criticism from all quarters for poor services and human rights violations, a sector which is most non-compliant with e xtant legal prescriptions (Goel et al 2005; NHRC 1999).

Our paper derives from a three-year field project undertaken in nine districts of Maharashtra with an objective to explore s ubjective meanings attached to people’s personal distress and healing, with special reference to emotional health, as they are mediated by indigenous healing. Indigenous mental healing i ncluded several traits: having a local origin, being vernacular/ oral, being unorganised, and having the function of healing people through shamanic or faith healing methods. Sites included mandirs, dargahs, churches, shrines and cults. The d argahs visited during the study period were the Hazrat S hahadval Baba Rahmatullah Aliha Dargah Sharif (Sadal Baba, Pune); Mirawali dargah (Ahmednagar); Mira Saheb dargah ( Miraj); Mira Rehan Mira Saheb dargah (Vishalgad); Khwaja Kabir dargah, (Nandre); Sailani Baba dargah (Sailani); Babu Jamaal dargah (NesKumbhoj and Kolhapur). We also recorded 25 hours of visual data at various sites. We interviewed four types of respondents, viz, sufferers, care-givers, indigenous faith or shamanic healers, and the medically qualified doctors and psychiatrists serving in the local area. Multiple data sets were compiled and analysed, including in-depth interviewing, case studies, field observations and focus group discussions. I n-depth interviews that were conducted were 283 in number (43 healers, 57 service providers, 108 users, 75 carers). The s ample was selective, including those who volunteered for the study. After initial screening, we included users who came to a local shrine for a “problem”.

INDIAN SYSTEMS OF MEDICINE
2 Story of Origin and the Role of Pirs

Dargahs retain a distant relationship with formal Islam and a close relationship with the function of healing. Formal Islam frowns upon what it sees as expressions of abandonment, such as shamanism, ecstatic trancing, drumming, music and possession found in these places. Ozturk and Goksel (1964) write that the Turkish government outlawed magical religion in 1925. The w riters observed a discrepancy in what the Koran actually says and how it is interpreted in folk practice. The “Koran does not a pprove it either, and does not attribute supernatural powers to mankind” (ibid: 350). Attacks (even life threatening) by the religious purists on Sufi pirs is not unknown in the history of Sufism and of Islam. All dargahs are syncretist and local, and cater to a wide diversity of people from different caste and religious backgrounds in the locality.

Dargahs are local healing sites with ritual healing practices dating back to five or more centuries (Bihari 1962). A pir’s journey from west Asia seeking the subcontinent, carrying on the teachings of Prophet Mohammed or his descendants, are a part of the healing myth and origin of a dargah. Some pirs of Maharashtra are associated with the world famous patron saint of Ajmer, Khwaja Garib Nawaaz Moinuddin Chisthi. The Mirawali dargah is dedicated to a pir, Mirawali Baba, who is said to have come to India at the time of the Mughal invasion. The name of Sadal Baba dargah in Pune reads as Hazrat Shahadval Baba Rahmatullah Aliha Dargah Sharif, the history of which goes back to almost 800 years to medieval India. Shahadval Baba was said to have belonged to Medina, the holy city. He travelled through Afghanistan and entered the subcontinent with Mohammad Ghori’s army, when the latter attacked India in the year 1192. After reaching India, the Baba went to Ajmer and became Moinuddin Chisthi’s disciple and then came to this area. The Shamna Mira dargah mujawars (head priest in the dargah) consider themselves as descendants of the pir. The Khwaja Kabir dargah, dedicated to two pir brothers, Khwaja and Kabir are depicted as coming to I ndia with the specific mandate of ridding and protecting people from evil spirits and black magic. Local legend has it that Malik Rahen, the Sufi pir of Vishalgad, near Kohlapur, came to India from Iran.

The “sacred” plays a crucial role in the healing process (Kakar 1982). Healing is a central theme of Sufi life. Mirawali Baba s ettled down in Ahmednagar and soon his healing powers started attracting scores of sufferers to this area. Large numbers of p eople come here to get cured of mental illness. Sadal Baba received his healing powers in Ajmer. Kabir Baba at Khwaja Kabir was said to have performed healing miracles. Shamna Mira of Miraj grew up aspiring to serve people just like his parents did. Sailani Baba is believed to have come with a mission to heal and protect devotees from evil influences and injustice.

Many a dargah served as shelter for wandering, homeless and destitute people. In western medicine, wandering is considered a psychotic symptom, but wandering sufferers and healers are well accepted in the local healing centres. Sadal Baba, under Moinuddin’s Chisthi’s tutelage, served the poor. At the Mirawali dargah, Ahmednagar, there is a sizeable population of homeless persons, fed by the mujawar and the management. The living conditions

62 in one of the far-flung dargah was unacceptably squalid, with a population of about 5,000 sufferers staying in a slum, in the f orest land surrounding the dargah. Such places are a human rights disaster and swift and sensitive interventions are required. The dargahs are not provided with any kind of infrastructure, civic services or other supports by the government.

3 Why People Approach Local Healing Centres

A significant proportion of population access local healing systems, spiritual or secular, in the context of mental health problems, across varied cultural settings (Amarsingham 1980; Harding 1975; Kapferer 1991; Ngoma 2003; Nichter 1981; Ruiz and Langrod 1973; Somasundaram 1973; Skultans 1987, 1991; Satija et al 1982). Health service-seekers traverse between these seemingly contradictory systems in their search for healing (Asuni 1979; Kapur 1979). In the Indian context, 74.7% of psychiatric p atients had consulted a traditional healer before coming to the hospital. Out of these, 33.3% had consulted one place only, while 17.3% had gone to more than 10 such places. According to the study 30% of the patients expressed satisfaction and noted improvements in their condition, 45% were not satisfied and expressed disappointment and 25% suggested that they will advise others to go to traditional healers (Gujarat Mental Health Mission 2003). Goldberg and Huxley (1992) cited data from a famous World Health Organisation (WHO) 11-centric study in the year 1991, including European, American and south-east Asian countries’ pathways to care. They noted that in Pakistan, India and Indonesia, people accessed a wide variety of pathways with different types of native or faith healers (ibid: 30). A study (Kapur 1979) carried out in western India showed that a majority of respondents do not wish for help for “possession” but among those who do, a mantarvadi (traditional healer working magic) is the healer of choice. Men and women who had consulted both doctor and indigenous healer were 48%, while 18% and 19% of men and women, respectively, had consulted only an indigenous healer.

We have described in another paper,14 that people approach the local healing sites with an explicit expectation of being healed from their problems. The relationship is perceived as s uccessful because of the shared cosmology of health and wellbeing. Jain (2006) observed that while the healthcare system was at the p eriphery of a notion of “community” among villagers, bhagat, (the shamanic healer) and objects of local healing – bhut, chaitan, churel, devi, devta (ghost, satan, female devil, goddess, god) were central. The literature and our study also suggest that people choose to go to local healing centres for e xpressly psychosocial problems.

Approximately, one-fourth of the people living with afflictions, who we interviewed were from dargahs. Poverty was commonly observed. More than half the users interviewed by us were e xtremely poor, being on below poverty line (BPL) card, earning in kind, earning less than Rs 3,000 or having no earnings w hatsoever. But nearly one-fourth had earnings of more than Rs 5,000 per month and many had a personal vehicle. Most users reported having a “roof above their heads”, using liquid petroleum gas (LPG) and had access to a municipal tap in their homes. Onethird of the users interviewed however were in insecure

april 18, 2009 vol xliv no 16

EPW
Economic & Political Weekly

h ousing. Homelessness was evident in a small sub-group of p eople attending the traditional healing centres (THCs). Nearly one-fourth of the users interviewed were unemployed. Women, when asked about their occupation, routinely reported family

o ccupation or husband’s occupation. Many users, male and f emale, were involved in small trade or occupation, in the u norganised sector. Half the users (50.48%) interviewed by us were educated till their schooling. Professionals constituted a small percentage; one person we interviewed was a doctor. The data also suggests that indigenous healing centres are popularly frequented by the deprived caste groups. The dargahs attracted the more poor and the marginalised sections of society, even though here too, we interviewed people who came from the more privileged classes and castes. A content analysis of our in-depth interviews with the afflicted persons about the reasons for v isiting dargahs is presented in Table 1 (p 64).

Manifestations of Suffering

People access local healers for curing what is primarily experienced as a “problem”. The definition of a problem may describe an important life event or process which suddenly disrupted mundane life. But it is not presented as a “symptom” located at a specific locality of the body. The manifestation can be called psycho-social-spiritual: There are physical, psychophysical, psychological, psychosocial as well as spiritual dimensions, which are individualised and diverse. This is a crucial pointer towards how communities frame their well-being and health: There is no artificial division between “health problem” and one’s emotions, relationships, socio-economic context, and life experiences surrounding it. Aches and pains in different parts of the body, particularly head and joints, spasms, clicking, fatigue, fits, immobility, weakness, and head burning were commonly reported. Giddiness, lightness in the head, stomach problems, and fevers were reported. An individualised expression of the “problem” was the rule, rather than the exception – scratching in left foot, feel like someone is strangulating him, sometimes a snake has wrapped him in his coils, something wriggling in his stomach, the limbs were joined together. We also interviewed people who had a specific disability (e g, alcoholism, childlessness or disability caused by polio). Women talked about various reproductive health problems. Users had a wide ranging vocabulary about their mental states. In our larger study, mental health and psychosomatic experiences figured very high among the list of problems reported. Problems ranged from what would in modern terms be called psychotic – seeing visions, strange behaviour, someone whispering in the ears, could not keep clothes on, wandering, suicidal, to a more diverse range of emotional states – sadness, worry, fears, lack of concentration, sleeplessness, anger and tension.

Many people came to the dargahs to be “cured” of karni (witchcraft) problems and other existential, psychological or spiritual questions manifest as mental disturbance. Not only is witchcraft/ evil spirit possession not mental illness, but mental illness, physical health problems, and a host of other thraas (troubles) are the consequence of witchcraft and spirit possession. Of the 95 responses received from all users (n =103), 85% said that all mental illness happens due to witchcraft or black magic. Jealousy or

Economic & Political Weekly

EPW
april 18, 2009 vol xliv no 16

s uspicion (which psychiatry may characterise as “paranoia”) is a major interpersonal theme of witchcraft afflictions. Differences in caste, religion and gender and sexual taboos (for example homosexuality or prostitution) find linguistic expression as psychosocial, spiritual or moral suffering and as witchcraft. Our study clearly showed a pattern that for medical problems, healthcare was sought; and for psychosocial-spiritual problems, including witchcraft and evil spirit possession, local healers were sought (also confirmed, for example, by Ozturk and Goskel 1964). It was difficult to differentiate the purely psychological, physical, or the spiritual in the manifestations of the suffering.

4 Ritual as Healing

Healing is a process that takes place via an individual’s world of experience and the meaning that they attach to it. Glik (1988), in a comparative study, demonstrates how locally contextual symbols pervade all facets of healing – in the mythologies of the healing ideologies, the persona of the healer, family-like nature of the group of sufferers and the rituals themselves. Since in any healing context, empowerment of the sufferer constitutes a crucial milestone in the healing process, language assumes unprecedented importance (McGuire 1983: 234). Dyadic categories, light and darkness, higher and lower worlds, purity and impurity, wellness and illness, good/evil, death/rebirth, devi/pischach (deity/demon) are integral to the language, providing people with surrogates to express their emotions and feelings. The r hetoric used in the sessions creates a predisposition in the person to be healed, akin to placebo, a process central to mental healing. In this way, the ritual language not only creates in the person an awareness of a “larger” purpose for her healing, but also assures her of the help given by transcendental as well as social factors. Csordas’ (1983) account of a healing ritual within the Pentecostal church describes the healer as directing the person in prayer to positive aspects of every stage in the afflicted persons’ life, while distracting the person’s attention from traumatic events through visualisation of Jesus Christ. It gives the power back to the person and her relatives to do something about it.

Psychosocially relevant practices in the dargahs play upon various ritual dimensions of the embodied and psychological, both at the individual level and at the level of social groups. The Sufi form of spiritual practice involves intense personal and group expression of bhakti (ecstatic worship) and union with god through song, drumming, music and verse (Bihari 1962). Expression of intense emotion, crying, ecstasy and altered states of perceptions which in normal life may be seen as violent mood swings, mania, or symptoms of other mental illnesses, has a very high value in the shrine. Union (with god or spirit) bringing about ecstasy or separation causing agony, is freely expressed: A person may cry for hours or maintain a blissful emotional state for hours, preoccupied with his or her own emotions. Sufi poetry describing this process is vivid: “every pore of the body… a tongue” (Bihari 1962: 66); “feel His fragrance coming and invigorating me” (ibid: 66); not eating and “being reduced to bones by austerities” (ibid: 68); unseen voices reprimanding (ibid: 68); being inhabited by beings other than self; divine visions (ibid: 75); etc. Deprivation of food and sleep is common and because it is accepted as

INDIAN SYSTEMS OF MEDICINE
Table 1: Reasons for Visiting Darghas

User code Physical Mental Socio-economic Cultural

Sangli_01 (M) Khwaja K abir, Nandre body swelling and pain Childlessness karni done on wife
Sangli_02 (M) dizzy; could not sleep; could not felt scared evil influence karni
eat because of stomach ache done by relatives
Sangli_03 (F) used to feel giddy, very often feeling tired; used to babble husband died of alcoholism, driven mad
eyes used to pain; body ache strangely; thought of dowry harassment; driven through witchcraft
committing suicide many times out of the home; children
dying (repetitive theme)
Sangli_04 (M) continuous nausea; breathlessnes; karni
could not eat or drink anything;
would feel ill instantly
Sangli_05 (M) neck hurts; limbs feel weak; wobbly, fever; bladder and stomach is not clean, in spite of cleaning cannot sleep at night; the effect of pills wears off; Baba wakes her up dreams of Baba; pradakshina helped
Sangli_06 (F) Shamna Mira dargah Miraj body ache; pricking sensation; swelling in legs and face; limbs were joined together; could not see at all could not do anything
Sangli_07 (M) fever; cough; cold all the time; body pain; could not eat or digest food no medicine helped; only ash and water from here helped
Sangli_08 (M) since 14, stomachache; headache; could not digest food; swelling of body “lahari” , tension, the head was light to get released from witchcraft
Kolhapur_11 (M) Babu Jamaal Dargah had an accident; head received a crack; became unconscious, after five months, when on duty in the factory; became blind and started feeling giddy; was in coma; there was a blood clot and operation was done Daughter (MA, BEd) was fixed to be married; some people broke it up Baba’s miracle, mujawars prayed and did pradakshina, after 13 days, the problem was resolved; ate angara and felt better; could come back home; did a check-up and was declared “clear” after that
Kolhapur_12 (M) Angry; unhappy; grew sad since whole life seemed ruined economic problems, failures in life; family conflict; wife left him left home and stayed here for many years; dreamed of Baba; stayed at the dargah in Kumbhoj as well; lived like a beggar; praying to god; two visions of Baba; went to Kumbhoj to live for two days; someone came at 2:00 am in
the night and offered water; these are Baba’s miracles; wife returned
Kolhapur_13 (M) Kolhapur_14 (M) Kolhapur_15 (M) felt like two needles were being pierced in forehead; 3rd, 4th and 5th discs of spinal cord had slipped; admitted in hospital developed backache and after some time could not get up or sit; loss of semen through urine felt scared if I looked at anybody had strayed daughter got divorced immediately after marriage; dragged on in court for many days, she could not have remarried till the divorce was finalised working in a pin factory for about 12-13 hours a day the operation was necessary but Baba’s vision one night made everything alright; due to Baba’s blessings, the case results were favourable and daughter remarried
Pune_01 (F) feeling fatigue feels worried all the time sisters not getting married;
brother’s wife had two
abortions; spent Rs 1.5 lakh on
marriage; violence and dowry
harassment; desertion; husband
remarried; remarriage; similar
problems including desertion.
Pune_02 (F) weakness
Pune_03 (F) Pune_04 (M) Buldhana_01 (M) Buldhana_02 (F) Buldhana_03 (F) Buldhana_04 (F) Buldhana_05 (F) 64 feel worried and fearful problems and tensions in the witchcraft by relatives about family house (repetitive theme); no work; living on daughter’s support; many mouths to feed in the house feel ill; limbs fall loose; giddy, feel or feel extremely claustrophobic; sometimes a snake has wrapped him like someone is strangulating in his coils; weak limbs; no appetite him; cannot sleep the whole night hence weakness stomach bloated up, body was burning; very scared suffering from cancer of the throat scratching in left foot; breathlessness; losses in business witchcraft full left side in pain; fever; clicking in neck spasms and pain in back brain had become dysfunctional; witchcraft through food could not concentrate on job and work dysmenorrhoea; bleeding would not stop mooth mari (a type of for 20 days during menstruation; could working witchcraft); karni not digest anything; suddenly felt a jolt and bleeding started and vomited horribly; it was nearly fatal. together bloody vomits; giddiness strange behaviour; could not would not feed child. ‘mooth mari’, I am suffering keep clothes on; would eat faeces; from karni from 36 years was wandering here and there april 18, 2009 vol xliv no 16 Economic & Political Weekly
EPW

e vidence of surrender, it does not elicit censure. Abuse of god for abandoning a devotee may come across as great anger or great grief or even as madness.

The conferment of a vision by the pir is a valued state, and a person so graced is validated. In narrations of this experience, it may be characterised as a “bliss” experience, involving higher skin sensitivity and conductance, an emotional state of euphoria, lightness, forgetfulness of self, feeling disembodied and expansive, etc. While the initial vision may result in seriously altered states of perception, it is not pathologised as a hallucination and individual interpretation of the vision is accepted. This is usually an embodied, a tactile or a multi-sensory phenomenon, where the pir touches or embraces the devotee. It is believed that “the pursuers of the path should laugh less and weep more” (ibid: 79), as a certain emotional fulfilment is sought in negative emotions. Sufis like to live close to death – they are enjoined never to forget death (ibid: 79), again, a spiritual question close to many people living with a mental illness.

Healing Traditions

All the healers that we interviewed in the dargahs mentioned that they were only “servants” of the pir, refusing to “take credit” for the healing. Several of the healers we interviewed had gone through a “purification” process themselves, particularly the indi vidual female mediums of the Khwaja Kabir dargah in Nandre

– they had initially approached the dargahs for their own healing and after being healed, became healers themselves. They are o ften visited by the baba, and are possessed by him. They described these experiences as making them feel “happy” and “content”, and achieving “mental satisfaction”. Chanting or vocalisation of some kind is associated with the experience. The possession experience made some of them pleasantly tired, as there was some physical pain due to the frantic body movements. Another healer felt energised after the sanchar (divine trance). One healer said, “If I don’t get hajeri (deity possession), I feel dull”. Another compared the experience to a deep sleep state and coming out feeling refreshed. Some healers in the dargahs had a vision or a dream from the pir, and consider it their personal calling to serve the ailing. None of the healers whom we interviewed believed that they were a kind of a doctor, but some said that they were “doctors of the soul”. Some male healers even talked about offering “maternal love” to the devotees, and most claimed to use their intuitive faculties, more than linguistic or logical faculties. Some healers were trained in Koranic methods, such as aayats (couplets from the Koran). For most, their work (no one saw it as a “profession”) was a customary practice, and included a ncestral worship.

What we witness in faith healing is mundane life mixing with a quest for the psycho-spiritual using everyday spaces, and language. The magic number is 40 days and people tend to stay at the dargah, or in nearby areas during this ritual time period. Having a specified ritual time builds faith, and heightens efforts on as well as faith in one’s own recovery.

My depression went, self-confidence grew. I regained faith in my own recovery. I had left all hope of getting well. Here, hopes grew. I b elieved I would get well (Male user, Ahmednagar).

Economic & Political Weekly

EPW
april 18, 2009 vol xliv no 16

I was brought in an auto, but went back on my own two legs. Hence I

felt good about it (Male user, Ahmednagar).

People who do not recover in the ritual time intensify their e fforts at recovery. Others, with a complex set of problems, p articularly incurable medical conditions such as cancer, use as many resources as they can find to seek solace and cure. T ypically, the rituals are simple, and may include making ritual offerings to the pir; making wishes (mannat mangna); tying s acred threads, lemons, bangles or other artifacts for wish fulfilment; drinking holy water; eating holy ash; bathing and personal cleansing; lighting incense; pradakshina (circumambulation), seva (selfless service) at the dargah; wearing locked chains around one’s ankles or hands in the pir’s name (baba ki bedi); making an application to the pir (arzi); trancing, mediumship, undertaking physical o rdeals, and exorcism from spirit possession and witchcraft.

Dargahs allow for the acting out of emotions, which is seen in psychotherapy as “cathartic”. The healing propensity of the local healing traditions is attributed to several factors like arousal of faith, complete emotional commitment of the sufferer, affirmation of shared beliefs, the symbolism entailed in healing rituals and their dramatic quality having effects akin to therapeutic techniques like placebo, catharsis and suggestion (Kleinman and Sung 1979; Kleinman 1980; Jadhav 1995; Helman 2001). The healing process has also been seen as symbolically representing values, emotions, social relationships and normative codes, which are a part of the participants’ phenomenological world as well as their external social environment (Brown 2001; Glik 1988; Csordas 1983; McGuire 1983). The value of shamanic practices of possession and trancing are seen as a form of psychodrama, another postmodern therapeutic technique, by some writers (Casson 2004).

Linking Religion and Health

Healing in these centres is achieved by involving the sufferer’s body in the healing process, since for a sufferer, a physical experience is the most immediate and concrete means of experiencing the divine power (Csordas 1983; Seligman 2005). Various other physiological responses of the participants like possession, trancing, fainting, tingling sensation, buzzing in the ears and burning, denote the affirmation that the divine power is indeed being manifested, convincing them of their healing experience. An extraordinary variety of repetitive, swift, jerky involuntary body movement is seen in possession and trance, for e g, twitching, twisting, trembling, shaking, head banging, slow body rotation, crouching, running, somersaulting, swaying, heaving, turning from side to side, body thrashing, jumping, fast movements of hands and legs. Such bodily sensations may be seen as trauma or stress discharge responses according to some neuroscientists (Levine and Frederick 1997). Facial muscles move and distort into various involuntary movements, such as eye ball rolling, grimacing, etc. The use of the vocal chords and the abdomen to exhale forcefully or to make repetitive, mumbling, moaning, groaning, screaming, guttural sounds which may or may not be words is very common. Possession and trance states that we have studied and filmed in the many dargahs we visited are indicative of the

INDIAN SYSTEMS OF MEDICINE

emotional absorption of users and their altered states of e mbodiment, perception and experience. Most women we interviewed, who were possessed reported feeling warm, light, fresh, peaceful and relaxed after the experience. While evil spirit possession is shamed by the community, deity possession is revered. Women journey from evil spirit possession to deity possession, becoming healers themselves, as oracular or mediumistic.

In our interview of users of indigenous healing, people reported benefits. Various dimensions of well-being that were reported are feeling peaceful, contented, gaining in confidence, hope returning, getting more will power, wanting to get on in life, body healed, reduction of conflict, improvement in domestic and financial situations, social status. The afflicted, who visited the centres have been doing so for long periods of time, sometimes even after the problem is resolved. Many had been visiting for five years and more, long enough to warrant the l abel of “chronic” patients within the modern medical system. However, such sufferers are not so labelled in the centres, and often become local anchors for the centres, taking responsibilities in the upkeep of the centres. We interpret this as a different experience of well-being with r espect to time and self history: the “early intervention” and treatment schedule of modern medicine, makes health and sickness a determinate temporal event. There is also acceptance, and surrender, that not everything needs to be intervened with. People r eported that they visited the shrine to “stay well”.

Lee and Newberg (2005), exploring the link between religion and health, conclude that being religious offers positive health and mental health benefits in the areas of disease incidence and prevalence, disease and surgical outcomes, promoting general well-being, in the specific area of depression (also see Azhar et al 1994; Valla and Prince 1989; Raghuram et al 2002; Razali et al 2002). Recent advances in psycho-biology and in cultural healing practices (Jilek 1989; Winkelman 2000; Csordas 1983; West 2000; Krippner 1989; Koenig and Cohen 2002; Seligman 2005) describe the positive, recovery oriented, neuro-endocrine changes effected by certain ritual, embodied practices routinely found in the dargahs, including possession, trancing, alternative states of consciousness and meditative (non-cognitive psychophysical) states. Some people with psychosocial disabilities have found that a connection with the sacred within oneself showed the path towards self-recovery and its maintenance. This pathway also gave the necessary strengths and capacities required to lead others into their own recovery (Stastny and Lehmann 2007; Minkowitz and Dhanda 2006).

The research indicates that psychosocial realities for many i ndividuals do include a person-centric relationship with some notion of the transcendental. The transcendental concept with which a person relates psychosocially and spiritually may be god, a guru, sant, pir, or in fact, a revolutionary notion of utopia. The healing at the dargahs suggests that rather than any structured system of religion, theology or the primacy of (any kind of) word or scripture, a chaotic and spontaneous approach to an intensely personal embodied and multi-sensory experience of transcendence, including shamanic and primal practices and experiences, may bring psycho-spiritual relief in everyday life to a vast number of people.

Conclusions

Several concerns are raised by the legal interventions into the l ocal healing sector. Of primary concern is the fact that, these institutions are facing an immediate threat and closure by the so-called “modern” mental health institutions. Second, the mental health authorities at various departmental levels have absolutely no knowledge cover or evidence base for their witch hunt. Third, given their poor track record in establishing a human rights compliant health service, they do not possess the necessary credentials in mounting a challenge to the local healing sector. Finally, in this process, the local healing community, comprising the institutional authorities, healers, users and communities, has not ever been a part of or even a passive listener to these normative processes. Our workshops with the local healers showed that there is little awareness among them about the recent legal frameworks coming into their work with so much force. In the absence of data from local contexts, there is no reason to abandon the value of such centres in psychosocial recovery and empowerment. Available evidence endorses the positive aspects of healing and recovery through holistic methods in the shrines that offer social and safe spaces for experiencing life at moments of vulnerability and crisis. Our study has shown that, having more number of, or professional mental health services may not necessarily change the significance of this established pathway to care.

Seeing the dargahs as a social healing institution does not necessarily erase the looming questions about human rights. Just as human rights violations can happen in all kinds of community spaces, such as schools, hospitals and offices, they can happen in the faith healing sector also. The push of the neoliberal economic development process has its impact on such centres, where the powerful management can predate upon the poor, homeless and deprived people living off the philanthropy of the centres, b ecause they have no other livelihood option. Common law and extant human rights laws have a big role to play in bringing h uman rights sensitivity into the faith healing sector. In the healers’ workshops that we did at the end of our project (2007), the faith healers had acknowledged this fact and talked about establishing a collective that will develop good practices. The need for such initiatives is indeed immense.

Notes Commissioner and other state governments.government of Kerala. 3 Times of India, 8 July 2001, “Story of the Shackled 5 28 February 2002, Affidavit filed by the principal lating mental institutions. It provides the neces

1 The Mental Health Act, 1987 is a penal Act regu

in Hyderabad”, featuring Syed Meeran Hussaini secretary, health and family welfare department sary powers to state machinery (government, Quadri Bogdad in Hyderabad”; (ibid). “Nine of Punjab, Chandigarh. hospital, families and police) to detain mentally Chained in Patiala Too”; Hindustan Times, 19 Au-6 26 February 2002, Affidavit filed by chief secreill people involuntarily in specified i nstitutions. gust 2001, “Erwadi Waiting to Happen Near Del-tary, Government of Manipur. 2 Writ 562 of 2001, Saarthak and Achal Bhagat ver-hi” featuring the Shastriji Dharamshala at Farida-7 18 March 2002, affidavit filed by joint commissus Union of India, Ministry of Social Justice and bad near Delhi, run by a vaidya. sioner and incharge special officer, Legal Cell, Empowerment, Ministry of Health, Disabilities 4 15 March 2001, Affidavit filed by health secretary, Government of Andhra Pradesh.

66 april 18, 2009 vol xliv no 16 Economic & Political Weekly

EPW

8 18 March 2002, Affidavit filed by joint commissioner and incharge special officer, Legal Cell, Government of AP.

9 “Solitary confinement” or the “cage beds” are small 6×6 cage like rooms, walled on three sides and grilled on the fourth. They are bare cells with no bedding, fans, toilets, or anything. Persons restrained here often are reduced to living there naked for days or even months. Food is passed through a small hole in the grill. The persons entombed here are forced to urinate and defecate in the open and await staff mercy to reach a state of better hygiene. All private and public institutions have cage beds. The existence of such “facilities” has been challenged before the Supreme Court.

10 11 August 2001, “Faith Healing Centres for Mentally Ill to be Monitored”, The Hindu.

11 10 August 2001, “Another Yerwadi Is Right Next Door: Temple Town in Rajasthan Offers Kill-or-Cure Treatment for Mentally Disabled” (New D elhi: The Indian Express).

12 9 August 2001, Maharashtra Herald, “Ban Misuse of Faith Healing: Those Shielding Asylum Owners Should Be Charged”.

13 8 August 2001, “No Chains at Asia’s Largest Mental Hospital”, Pune Times. At the point of writing this article, a public interest litigation is pending before the Bombay High Court against the said hospital.

14 M Lohokare and B V Davar (2008; under review) “Client Provider Relationships in Indigenous Healing Traditions: Two Case Studies”.

References

Amarsingham, L R (1980): “Movement among Healers in Sri Lanka: A Case Study of a Sinhalese Patient”, Culture, Medicine and Psychiatry, 4: 71-92.

Asuni, T (1979): “The Dilemma of Traditional Healing with Special Reference to Nigeria”, Social Science and Medicine, Vol 13B: 33-39.

Azhar, M Z, S L Varma and A S Dharap (1994): “Religious Psychotherapy in Anxiety Disorder P atients”, Acta Psychiatrica Scandinavica, 90: 1-3.

Bihari, B (1962): Sufis, Mystics and Yogis of India, (Bombay: Bharatiya Vidya Bhavan).

Brown, S L (2001): “God and Self: The Shaping and Sharing of Experience in a Cooperative, Religious Community” in Carmella C Moore and Holly F Mathews (ed.), The Psychology of Cultural E xperience (Cambridge: Cambridge University Press): 173-95.

Casson, J (2004): Drama, Psychotherapy and Psychosis: Dramatherapy and Psychodrama with People Who Hear Voices (Sussex: Brunner Routledge).

Csordas, T J (1983): “The Rhetoric of Transformation in Ritual Healing”, Culture, Medicine and P sychiatry, 7: 333-75.

Friedson, S M (2000): The Dancing Prophets: Musical Experience in Tumbuka Healing (Chicago: University of Chicago Press).

Glik, D C (1988): “Symbolic, Ritual and Social D ynamics of Spiritual Healing”, Social Science and Medicine, 27(11): 1197-1206.

Goel, D S, S P Agarwal, R L Ichhpujani and S Srivastav (2005): “Mental Health 2003: The Indian Scene”, Mental Health: An Indian Perspective, New Delhi.

Goldberg, D and P Huxley (1992): Common Mental Disorders: A Bio-social Model (London and New York: Tavistock Routledge).

Gujarat Mental Health Mission (2003): Strategy Paper for Mental Health Sector Strengthening (Ahmedabad: Government of Gujarat).

Harding, T W (1975): “Traditional Healing Methods for Mental Disorders”, WHO Chronicle, 31:436-40.

Helman, C G (2001): “Placebos and Nocebos: The Cultural Construction of Belief” in Peters, D (ed.),

Understanding the Placebo Effect in Complementary Medicine (Edinburgh: Churchill Livingstone): 3-16.

Economic & Political Weekly

EPW
april 18, 2009

Jadhav, S (1995): “The Ghostbusters of Psychiatry”, The Lancet, Vol 345: 808-09.

Jain, Sumeet (2006): “Traditional Healing and Community Mental Health”, Paper presentation at a seminar and photo exhibition on Faith Healing: Going Beyond Medicine, at Balagandharv Kaladalan (Pune: Bapu Trust), 13 January.

Jilek, W G (1989): “Therapeutic Use of Altered States of Consciousness in Contemporary North American Indian Dance Ceremonials” in Colleen A Ward (ed.), Altered States of Consciousness and Mental Health: A Cross-Cultural Perspective (L ondon: Sage Publications).

Kakar, Sudhir (1982): Shaman’s, Mystics and Doctors: A Psychological Inquiry into India and its Healing Traditions (New Delhi: Oxford University Press).

Kapferer, Bruce (1991): A Celebration of Demons: Exorcism and the Aesthetics of Healing in Sri Lanka (USA: Berg and Smithsonian Institution Press).

Kapur, R L (1979): “The Role of Traditional Healers in Mental Healthcare in Rural India”, Social Science and Medicine, 13 B: 27-31.

Kleinman, Arthur and H Lilias Sung (1979): “Why Do Indigenous Practitioners Successfully Heal?” S ocial Science and Medicine, Vol 13B: 7-26.

Kleinman, Arthur (1980): Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine and Psychiatry (Berkeley: University of California Press).

Koenig, H G and H J Cohen (ed.) (2002): The Link between Religion and Health: Psychoneuroimmunology and the Faith Factor (Oxford: Oxford University Press).

Krippner, S (1989): “A Call to Heal: Entry Patterns in Brazilian Mediumship” in Colleen A Ward (ed.), Altered States of Consciousness and Mental Health: A Cross-Cultural Perspective (London: Sage P ublications).

Lee, B Y and A B Newberg (2005): “Religion and Health: A Review and Critical Analysis”, Zygon, 40(2): 443-68

Levine, P and A Frederick (1997): Waking the Tiger: Healing Trauma (California: North Atlantic Books).

McGuire, M B (1983): “Words of Power: Personal Empowerment and Healing”, Culture, Medicine and Psychiatry, 7: 221-40.

Minkowitz, T and A Dhanda (2006): First Persons S tories of the Use of Forced Treatment and Legal I ncapacity (Pune: WNUSP and Bapu Trust).

Ngoma, M C (2003): “Common Mental Disorders among Those Attending Primary Health Clinics and Traditional Healers in Urban Tanzania”, The British Journal of Psychiatry, 183: 349-55.

NHRC (1999): “Quality Assurance in Mental Health” (New Delhi: National Human Rights Commission).

Nichter, Mark (1981): “Idioms of Distress: Alternatives in the Expression of Psychosocial Distress: A Case Study from South India”, Culture, Medicine and Psychiatry, 5: 379-408.

Orzturk, O M and F A Goksel (1964): “Folk Treatment of Mental Illness in Turkey” in Ari Kiev (ed.), M agic, Faith and Healing (New York: The Free Press): 343-63.

Raghuram, R, A Venkateswaran, J Ramakrishna and M G Weiss (2002): “Traditional Community R esources for Mental Health: A Report of Temple Healing from India”, British Medical Journal, 325: 38-40.

Razali, S M, K Aminah and U A Khan (2002): “Religious Cultural Psychotherapy in the Management of Anxiety Patients”, Transcultural Psychiatry, 39(1): 130-36.

Ruiz, P and J Langrod (1973): “Psychiatrists and S piritual Healers: Partners in Community Mental Health”, Paper presented at the International Congress of Anthropological Sciences, Chicago.

Satija, D C et al (1982): “A Study of Patients Attending Mehandipur Balaji Temple: Psychiatric and P sychodynamic Aspects”, Indian Journal of P sychiatry, 24(4): 375-79.

Seligman, R (2005): “Distress, Dissociation and Embodied Experience: Reconsidering the Pathways to Mediumship and Mental Health”, Ethos, 33(1): 71-99.

Skultans, V (1987): “The Management of Mental Illness among Maharashtrian Families: A Case Study of a Mahanubhav Healing Temple”, Man, New Series, 22(4): 661-79.

– (1991): “Women and Affliction in Maharashtra: A Hydraulic Model of Health and Illness”, Culture, Medicine and Psychiatry, 15(3): 321-59.

Somasundaram, O (1973): “Religious Treatment of Mental Illness in Tamil Nadu”, Indian Journal of Psychiatry, 15: 38-48.

Stastny, P and P Lehmann (2007): Alternatives B eyond Psychiatry (Germany: Peter Lehmann Publishing).

Valla, Jean-Pierre and R H Prince (1989): “Religious Experiences as Self-Healing Mechanisms” in Colleen A Ward (ed.), Altered States of Consciousness and Mental Health: A Cross-Cultural Perspective (London: Sage Publications).

West, W (2000): Psychotherapy and Spirituality: Crossing the Line between Therapy and Religion

(London: Sage Publications).

Winkelman, M (2000): Shamanism: The Neural Ecology of Consciousness and Healing (Westport: B ergin and Garvey).

Review of Labour
Forthcoming (May 30, 2009)
Power, Inequality and Corporate Social Regimes: The Politics of Ethical Compliance in the South Indian Garment Industry – Geert De Neeve
De-Fragmenting Global Disintegration of Value Creation and Labour Relations: From Value Chains to Value Cycles – Vijay Gudavarthy
The Effects of Employment Protection Legislation on Indian Manufacturing – Aditya Bhattachajea
Revisiting Labour and Gender issues in Export Processing Zones: The Cases of South Korea, Bangladesh and India – Mayumi Murayama, Nobuko Yokota
Work and the Idea of Enterprise – Nandini Gooptu
Household as a Site of Production: Informalisation and Fragmentation of the Workforce – Kalyan Sanyal

vol xliv no 16

Dear reader,

To continue reading, become a subscriber.

Explore our attractive subscription offers.

Click here

Comments

(-) Hide

EPW looks forward to your comments. Please note that comments are moderated as per our comments policy. They may take some time to appear. A comment, if suitable, may be selected for publication in the Letters pages of EPW.

Back to Top