Funding support: Indian Council for Social Science Research / Indo-Dutch Partnership in Alternatives to Development, Grant 5.3.11, 2003

Introduction to the study:
In India, traditional healing systems co-exist with modern mental health care, and they are seen as providers of curative, rehabilitative and restorative benefits. Traditional healing systems and practices play an important but controversial role in mental health service delivery. Westernised studies on traditional healing systems tend to be derogatory, exposing only what are seen as “abusive” in such methods. Indian psychiatrists, with rare exceptions, dismiss traditional healing as abusive, and ridden with blind faith. At the same time, there seems to be a great deal of “export” value for traditional healing, with new age thinking on “mental health” in the western countries repeatedly glamorising eastern philosophy, value system and practices. THCs have come under attack in the media and even in the supreme court as spreading “myths” about mental health and as “human rights” violative. This point of view does not appreciate the fact that western science too is a cultural and value based intellectual product, and that western psychiatry can be equally coercive. Negative presentations of traditional healing systems (THCs) give only one side of the total picture. Traditional healing sites and local healing practices have to be studied within their cultural / life context in terms of the meanings, “cognitive schemas” and the plural inter-personal strategies that they offer for those who use them. This will attest to the very complex community mechanisms available within cultures for dealing with psychosocial stresses.

(a) (i) Purpose of study: To find culturally appropriate strategies of integrating traditional healing centers (THCs) into mental health service delivery in western Maharashtra.

(ii) Problem statement: Our two research questions are-

• What are the community perceptions and practices towards healing in western Maharashtra?
• What role do THCs play in mental health service delivery in western Maharashtra?

(iii) Our Hypotheses:

• THCs are addressing community mental health needs in some culturally important ways.
• Communities are aware of and may even prefer the role that THCs play in meeting their life and health needs, irrespective of the available local mental health capacities.
• Local mental health needs are not adequately met by the mental health service delivery system.
• There is a creative role for THCs in mental health service delivery in Maharashtra.

(iv) Areas for exploration:

Problem statement (1) What are the community perceptions and practices towards healing in western Maharashtra?

Data elicited will address following questions:

Meaning of healing: Why patients come to THCs, how they explain ill health and healing (causality), whether the community possesses a local vocabulary for mental illness, scientific awareness versus cultural relevance, tradition versus modernity in help seeking.

Victimhood and Agency: Mainstream discourse (professional, legal) sees THCs as abusive and superstition fostering. Users are seen as exploited victims. We will explore the user’s perceived agency, the play of agency and victimhood, in using THCs for help seeking and self-care.

Healing practices: Documentation of rituals and practices from the user entry to exit, role of priest, rituals and traditions, geneology, diet and medicines prescribed, length of stay, cost of care, healing relationships, spatial organisation of healing sessions, role played by audiences, art forms used (fragrances, drums, dance, music, etc.) and emotional / sensory experiences involved in the healing encounter.

Problem statement (2) What role do traditional healing centres have to play in mental health service delivery in western Maharashtra?

Data elicited will address following questions:

Socio-economic details of user: Age, caste, religion, gender, place of origin, sources of income, details about accompanying person, circumstances of seeking care, preceding events (e.g. trauma)

Status of mental health service delivery in the region. Access and availability of mental health service, patient flow over time, PHC / NGO activities in the region, expectations from and experiences with services, quality and cost of care

Integration of THCs in mental health service delivery: Attitudes towards THCs, local dynamics / partnerships with THCs, development initiatives of THCs, if any, quality and cost issues in using THCs

(b) Methodology: Our study is ethnographic, using key informant interviews, participant observation, personal interviews, and focus group discussions as the main methods of data collection. We will interview users, families, NGOs, center managers and local doctors / mental health professionals. We will use semi-structured questionnaires for the core areas of study and we will videotape healing practices. For the government data, we will rely on government sources of information, published academic data on service delivery as well as local information. For policy influencing and dissemination, we will use consultative forums.

Areas of Research: Twenty traditional healing centres have been identified in western Maharashtra located within the 9 districts of Solapur, Sangli, Satara, Ahmednager, Buldhana, Pune, Raigarh, Mumbai and Nasik.

These THCs have been classified into the following types-
(1) Hindu temples of healing;
(2) Muslim durgahs of healing;
(3) Centres of alternative healing (yoga, nature cure) and (4) Tribal / indigenous / folk medicine.

Our study is inspired by the seemingly incredible fact that communities consistently and predictably choose THCs, often as first choice of help seeking. The community logic of this choice has to be understood before evaluation of the choice. Our research study will extend the frontiers of knowledge in mental health in multiple ways. There are few social science perspectives in mental health in India. Our research will be among the few in India, which explores non-medical therapeutic spaces for addressing psychosocial distress. We hope that holistic aspects of self-experience and personal growth (expansive sensory experiences, emotional catharsis, use of art forms) will be evident, giving content to “healing” (versus symptom relief). Our research will be among the first to give an informed basis for policy influencing and advocacy with respect to THCs (vis-a-vis recent Supreme Court judgement regarding THCs). Extreme positions with respect to THCs can be mediated by data into a more realistic assessment of their roles and limitations. Pathways to care studies in the Indian context looks at “erratic patient flow” and “non-compliance”. These studies do not address the socio-cultural context of help seeking nor how rural communities view and experience western psychiatry, which our study hopes to do. In doing this, the study will also hopefully highlight quality of care issues from the perspective of users, an aspect completely missing from the mental health discourse. We hope to show that “lack of awareness” is not the primary reason for help seeking in THCs. Rather, in an increasingly alienating globalising society, THCs offer opportunities for rootedness / cultural affirmation / even identity closures. Establishing forward linkages between traditional healing systems and psychiatric service delivery in western Maharashtra forms an ideal role model for other state initiatives, as recent SC interventions force all states to respond to this issue. Databases (World Health Report, 2001, WHO, Geneva) underscore the enormous predictable “burden” of mental disorders in economically liberalising societies. Even professionals have to accept today that THCs are here to stay, as a part of the development scenario in mental health. Against this scenario, we hope our study will create a meaningful and critical social discourse about mental health.

Health and Healing in Western Maharashtra
Role of Traditional Healing Centers (THCs) in Mental Health Service Delivery