On the 24^th and 25^th of June 2006, the BAPU Trust organized a workshop to present some preliminary findings of their project and study on, “Health And Healing in Western Maharashtra: Role of Traditional Healing Centers in Mental Health Service Delivery”. The purpose of the workshop was to review the project to make the study richer through a critique and suggestions for further analysis of the findings. The expert group at the workshop included those engaged in the fields of philosophy, law, anthropology, cultural studies, feminist studies, and from the field of mental health. A list of participants is attached in Annexure 1. The schedule is attached as Annexure. A brief introduction to the BAPU Trust and its work was given.

The project for review was supported by IDPAD/ ICSSR and came at a time when a lot has been happening in the mental health sector in terms of changes in laws and policies. Old laws are being revised and new ones are being suggested. There is also advocacy for a national mental health policy. Such a situation was seen as an opportunity by the organization to work on research that would enable the influencing, if not the framing of mental health policy, in a manner that was socially equitable and just for users, carers, service providers and other stakeholders in the mental health sector. While the primary purpose of the workshop was to present research and obtain academic feedback from a group of experts in the field it was also hoped that discussions and debate among the group would help in framing a perspective and deepening the current understanding on topics of relevance to the subject of mental health, cultural healing, mental health law / policy and scientific rationality.

The objectives of the workshop were:

• To review the IDPAD / ICSSR supported project on “Health and healing in western Maharashtra: the Role of traditional Healing Centers in Mental Health Service Delivery.”
• To brainstorm on theoretically positioning the local healing traditions vis a vis the development discourse
• To situate the local healing traditions within the present policy and legal debates within the mental health sector.

Areas of Interests Shared by the Group:

During the introduction the expert group expressed different interests in attending the workshop. In addition to contributing to it from their diverse positions and a general curiosity in the findings, members also looked forward to understanding and clarifying the following

During the introduction the expert group expressed different interests in attending the workshop. In addition to contributing to it from their diverse positions and a general curiosity in the findings, members also looked forward to understanding and clarifying the following

During the introduction the expert group expressed different interests in attending the workshop. In addition to contributing to it from their diverse positions and a general curiosity in the findings, members also looked forward to understanding and clarifying the following   What is the place of traditional healing in the more prevalent mainstream medicine? Does it need to be integrated into this, or the other way or should it remain as a stand alone practice by itself? How should the integration question in mental health policy be answered?   Learning and understanding the different methods of care and treatment – sociological and psychological, practiced by traditional healers. Further, to look at allopathy and traditional healing within a continuum of care for persons with disabilities, even though they sound seemingly incompatible.   Since there seems to be a rather delicate and difficult balance between modern methods and traditional ones, an attempt must be made to build as many bridges between them by building an understanding both for their strengths and limitations.   While challenging the dichotomies of the scientific and traditional, there is a great need for education for the non traditional fraternity about things beyond their narrow understanding.   Design and methodology of the study by the review committee   How sexuality and sexual minorities were placed within traditional healing and how would the discourse address the issues of discrimination against marginal genders and alternate sexuality   How does the issue of rights (patients, carers etc.) especially those of women get addressed   Understand the configuration between modern and traditional methods and their conflict and confluence in various aspects of life    Understanding the legal issues surrounding the debate about traditional method

Film Screening

A first cut version of a film on possession and trance called “Trick or Treat” was shown. This 19 minute film captures the phenomenon of trance and spirit possession that people at traditional healing sites often demonstrate. The response of the group to film was reserved for later and a presentation on the concept and findings of the project was made.

Concept paper

The concept paper presented by the research team attempted to establish the position of the study and situate the debates on the subject within the paradigm of development. There is a need to debate and define traditional healing. The concept paper was developed keeping mental health and anthropology as its basic pillars. Therefore for some it may appear extremely conceptual, while others in the review group would find scope for more theory. The group was thus requested to locate their experiences and reactions from this perspective. For this reading before the group, “faith healing” was used to refer to traditional healing.

“FH” refers to pre-modern indigenous and local cultural healing practices continuing to exist in renewed forms in most parts of contemporary India. Examples are the sufi dargahs, local deity shrines, matts, local non-religious healing traditions, herbalists, soothsayers, saints or sadhus, christian healers, those who are possessed or who trance, mediums, exorcists, nomadic healers, and healers recognized by the community as having special healing powers.

“The study was located within institutions. We found that this brought its own learnings, which would probably have been different if we had studied individual healers”.

The study focused on the following issues:

1. Situating faith healing within the “development” discourse: the “right to mental health care”, the medico-legal and policy concerns
2. Understanding community pathways to well being and cultural understandings of psycho social needs
3. The role and function played by faith and ritual practice in well being, healing and recovery
4. The contemporary studied descriptions of human consciousness, and pathways to recovery: the psycho-biological and experiential aspects of it
5. Understanding the role played by the Divine Other in the human experience of well being

Within the development discourse there are many medico-legal concerns which determines the right to mental health care. The study tried to capture the role and function played by health and healing practice, in people’s lives and how they viewed these. Most of the institutions studied had a spiritual component to healing. The role of the Divine Other was seen in terms of what it meant to people who seek healing and the role of spirituality in health and human consciousness. Spirituality could also be understood simply as the human struggle for transcendence instead of looking at existence of God itself and the proof of it or the lack of it.

Rationalist proposals to development thinking in mental health

In the mental health sector “modernity” is embedded in both scientific as well as empowerment based strategies. These include:

(i) Psychiatry, psychology, cross-cultural psychology, ANIS (Anda-shraddha nirmoolan samiti, Maharashtra)

(ii) Functionalism, functionalist feminism, psychology, anthropology

While the causality hypothesis of the natural sciences is essentially biological and subscribes to the psychiatric model of symptom relief, the social deprivation model explains mental health stressors as originating from the social environment and inequality within it. We in the development sector seem to prefer the social empowerment model of illness. The biological model calls for a “modernisation” of the mental health sector by providing improved mental hospitals, medical services and medical cures. The social vulnerability model calls for the replacement of medical cures and illness model with “social cures” and “empowerment” endeavours. The discourses on modernity, both scientific as well as reformist (ANIS), are underscored by a stress on the biological model and psychiatry. However the social empowerment model has equally rejected the faith healing systems as “superstitious” and “blind faith”, providing social development as panacea.

Legal activism in development thinking

Recent SC intervention: Recently, following the Erwadi tragedy, there have been efforts to reform the mental health system by creating more mental hospitals, and by phasing out the faith healing centers. This initiative has been taken by the Supreme Court through a suo moto petition in 2001. The SC, in trying to bring faith healing centers under the mental health system, is recognizing the important place played by these centers as a parallel system of care. However, the faith healers are aligned with the doctors in this instance, as the Mental Health Act under which the SC has initiated action, is a medical act.

Anti-superstition Bill, GoM, 2005, awaiting to be gazetted as an Act: The Government of Maharashtra is poised to enact an “Anti superstition” Bill pending before the Assembly. This Bill sees the faith healing centers as perpetrating anti scientific activities, leading upto superstition and blind faith. In this instance the proposal waiting to be enshrined as law, is viewing the faith healers as tricksters.

There is a legal double bind here – are faith healers doctors, as the supreme court is implying, or are they frauds, as suggested by the anti superstition bill? It is not easy to answer this question as who would decide what they are. In neither case were the faith healers consulted. The process of law making has been carried out without any inputs from the community which have been using these centers and upon whom the legal force will apply. Thousands of people access these sites of healing. It is a local system of support for the communities, families, and also for the healers. In bringing about these legal interventions, did anybody ask them, the users, and the healers?

Features of the extant MH services

1. Custodial hospital based: The mental health system is still driven by the mental hospitals, which are large, overcrowded, with very poor quality of care. 
2. Law driven (MHA, ILA): The sector is driven by laws, civil, criminal as well as custodial
3. Gaps in norms setting: no mental health policy in India
4. Poor community mental health services (Failure of the National Mental Health Program / District Mental Health Program)
5. There are human resources issues in the mental health sector. The deficit of HR in the sector is as high as 90%
6. Bio-medical dominance: Treatment has primarily been tertiary care, with over use of drugs and shock treatments, other than hospitalisation
7. Poor human rights compliance

Mental Health Services are to be seen in the context of human resources issues with a paucity of health personnel in MH. It is also seen as a human rights issue. There are several reports including the NHRC report, 1999, which elaborates on the violations that take place in mental hospitals and in the sector.

Use of FH

Literature suggests that between 50% to 75% of psychiatric patients would have visited a faith healer, or several faith healers, before reaching a psychiatric service. Many will have used both services simultaneously at any point in time.

Policy Solutions / Alternatives for Traditional Healing

There are policy debates about what to do with faith healing practices. Some proposed solutions are as follows:

1. Traditional healers should be phased out as promoters of superstition and blind faith and replaced by modern institutions
2. Traditional healers should case identify and refer mentally ill patients
3. Traditional healers should send SMD cases to doctors and should manage CMD alone with some additional learned skills
4. Their practice and autonomy should be protected and knowledge transfer should be a two way process through mutually respectful dialogue

Our preference and argument is for the fourth alternative. The fact remains that the state has no knowledge base or research on the area to justify their choices as far as setting up a policy is concerned.

Whether Mental Illness?

There is always a question of whether possession and trancing are mental illnesses. A range of disorders have been given out and they have been made to fit into these. Further, there is a reformist position which considers them superstitions, and must be replaced by “awareness” on mental illness (ANIS).

“Modernity” in psychiatry: the philosophical strife to demarcate science from superstition, belief and opinion, and align psychiatry with medicine and the natural sciences

Traditional practices such as possession have been seen as schizophrenia, dissociative disorder, neurosis, obsessive compulsive disorder, hysteria, mania, etc.

“Cure” using medicines as the promise of scientific reason

Challenges to this view of modernity

1. Foundational questions can be raised about the status of psychiatry as a “science”. Psychiatry is a statistical science. Its evidence base is nebulous. There are no biological markers of disease, as in the case of physical disease, making diagnosis itself suspect.
2. Ethnocentric presuppositions of psychiatry– the “normal” human mind as western - evolved, rational, cognitive, logical, masculine, expressive, whereas the non-western mind was “insane”, “idiotic”, primitive, irrational, emotional, “somatising”, feminine or living in bodies
3. Categories describe only a small part of consciousness, i.e. thoughts, emotions and behaviours. Other emotions such as devotion, joy, bliss, surrender, etc. which are so much part of our life experiences, have been omitted from the discourse. The intuitive, imaginative, unconscious and adaptive parts of human consciousness have not figured in the psychiatric discourse.
4. Gender bias is widely prevalent in psychiatry
5. Subjectivity and self experiences of distress, healing and recovery are not valued, as the psychiatric patient is largely considered as “incapable”

The mainstream medical idea which accepts the DSM as the bible finds it difficult to grant any space for experiences outside of it. There continues to be a debate about the presuppositions of psychiatric definition of the “normal”, which has been critiqued for its racist, sexist and imperialist connotations. The content of the diagnosis does not matter to the psychiatrist only the form. This is taken to be universal across all cultures, whereas cultural and feminist studies pose a strong challenge to this view.

Functionalism and its interpretation

Functionalism is another modernist discourse, which, along with feminism, poses deprivation and social empowerment as an explanatory model for cultural practices such as trance and spirit possession.

1. The phenomena of trance and spirit possession are seen within this paradigm in the broader context of the underlying hierarchy, distribution of social power, social structures and social relationships within that particular community
2. Or as institutionalized outlets for expressing frustration and anger 
3. As “…thinly disguised protest movements directed against the dominant sex”
4. As “deprivation” cults – implying manipulation of the social circumstance
5. Spirit possession is seen as a coping mechanism in the face of repression and a site for negotiation
6. As an opportunity to manipulate the situation - a semblance of agency
7. The structural barrier in feminist theory is identified as patriarchy. Cultural practices are seen altogether as against empowerment and against universal human rights principles.

Challenges to this perspective

1. This empowerment model sees social structures as rigid and unchanging (status quo) leading to a notion of engulfing victimhood
2. The perspective obscures the diversity, specificity, rich symbolic content and process oriented nature of faith healing practices. They assume that "All FH is one and the same”
3. We propose that social analysts and empowerment theorists as another type of “empowerment” experts, comparable to psychiatric experts, where they offer “Empowerment” as cure and promise. Such “social evils” are said to disappear if empowerment of marginalized groups was addressed.

The salient principles of both these models (scientific and empowerment) are:

1. Dependence of the theory on Universals (medical / social)
2. view of human beings as using only the top brain (rationality and rational emotions)
3. Emotional pigeonholing (only emotions of distress and sickness are recognised)
4. Myth making, meaning making and story building of people, their self journey through ups and downs of life, are not taken into account. Considering that both the modernist approaches are aiming to build a community of care, these gaps are prominent and need to be addressed.

Internal concepts and individual imagination about these things goes beyond the universal principles general principles. The two streams of thought in development – medicine is cure; social therapy is the cure; are too narrow and generalist.  The cultural practices must be studied with a person centered ethnographic orientation, which is more rooted in community and individual processes. Rationalism in the development debate allows for the use of only the top part of the brain and the rest of human consciousness is considered to be non functional. Emotional pigeon holding leads to establishment of mutually exclusive and essentialist constructs in which to fit all human feelings. Meaning making and story building – the semantics of the process special to each individual and to each community gets left out

Our synthesis

1. People have transcendental motives as well, going much beyond the immediate (whether this is Revolution, self development or God)
2. The need to be connected to the sacred part within oneself is an important human motive (something within as well as beyond themselves- a cosmic vision)
3. The movement from the mundane to the transcendent, and ritual use, is adaptive
4. A cultural as well as individual variance in the repertoire of behaviours is possible, increasing self centering and problem solving, if we utilize all parts of human consciousness
5. A broader spectrum of emotions is a part of the human condition (joy, bliss, peace of mind, devotion, surrender, etc.)
6. We are endowed with an expansive consciousness with a higher range of biological capabilities
7. We note the biologically adaptive function of cultural practices
8. Meaning of life and beyond questions is addressed for the people accessing the faith healers, and not just “symptom relief”. This is an important aspect of holistic well being.
9. Holistic healing spaces and ambiance found in FH (healing through use of all the senses and all the body parts) can be emulated in modern medicine

People have transcendental motives as well, going much beyond the immediate. There is a need to connect with the large human community and collective to beyond that. In the rationalist discourse we forget that we are a part of the animal species with an intuitive connection to the cosmos. It is important to understand that alternate states of consciousness bring the body back to a natural state of existence. When the sacred is evoked it is done in the capacity of it being an entity beyond the individual, a cosmic force. There is a movement from the mundane to the transcendent, and the use of ritual is adaptive in this process. A variance in repertoire of emotions and behaviours, and openness to different kinds of non-rational knowledge, is possible. There is diversity of healing practices in the faith healing centers. More than just symptoms are treated – existential questions are answered.

Conclusion

1. Modernity as phasing out pre-modern practices through the use of “science” and “empowerment”
2. Need to bring current understanding of human consciousness to this debate.

We have to debate whether the faith healing practices and what they value / assume, can serve as a way of re-organising the modern psychiatric services?

A brief presentation of the study was given after this concept note.

Purpose of the study

To examine culturally acceptable, Congruent, strategies of integrating traditional healing centers (THCs) into mental health service delivery in western Maharashtra. This did not cover witchcraft, sorcery etc.

The study was carried out in 9 districts, 21 healing centers including: dargahs, temples, churches and individual healers

Problem statement

Our two research questions were-

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

Hypotheses

1. Local mental health needs of communities are not being met by the mental health service delivery system.
2. Even if such services are available, communities prefer to go to THCs
3. THCs are addressing community well-being in culturally important ways: People experience healing in these places.

Activities and Methodology

1. Review of literature and concept development (cf. concept paper)
2. Tools development: Advisory review meetings, capacity building sessions, identifying themes for research and questions for themes, coding responses, pilot field testing, recoding, finalization, Standardising tool delivery in the field work team
3. Training in film documentation, photo-documentation, visual data management
4. Field work and data collection, SPSS training translation, data entry and management, archiving AV
5. Developing research analysis questions (cf. review workshop report)
6. Analysis (SPSS, qualitative), case study development, describing visual data
7. Film footage screening, story board development, guidelines and data for scripting and narration, finalisation
8. Other data / activities: healers’ workshops (2006), photo exhibition (2006), film festival (2004), review workshop (2006)

Types of data collected on the project

1. Secondary data through review of literature and locally  available materials (written and visual) in the vernacular; policy and legal documents; social economic profile and population of region
2. Semi-structured interviews using schedules (Total interviews: 275): Users – 108; Carers – 66; Service Providers – 58; Healers – 43
3. Ethnographic field notes and observations
4. Film footage (20 hours) and photographs

Information collected included:

• Socio-economic details of Respondents: Age, gender, caste, religion, occupation, family members, number of children, education, professional qualifications, vidya / traditional knowledge, place of origin, sources of income (personal and family), assets, type of housing, water and fuel source, details about accompanying person, circumstances of seeking care, profile of clients
• Reasons for health care seeking: Health, mental health, mind / body, cultural, family, interpersonal, social, economic; existing medical conditions
• History: When problem started, first experience of problem/ healing; experience in healing; identity as healer; history of icon / traditional centers / spiritual guidance;
• Relationship between services: Community mental health services available, awareness about services, quality of services (cost, facilities available, access, client management), perceptions about local healers; pathways to care; experiences with both types of services; preference for services; referral; regulation; integration.
• Meaning of sickness and healing: Perceptions about witchcraft / mental illness / distress; awareness of, diagnosis and management of witchcraft & spirit possession; medical views of SP / WC.
• Ritual healing: Practices and process; origin myths, miracles, source of information, cult formation; what helps; self help; cure process; spirit possession.
• Stigma: Disclosure, effect on life, burden of care, healers’ stigma

Some preliminary findings were presented Consent: 96% of users, 98% of carers and 100% each of healers and service providers gave written consent. The remaining users and carers gave verbal consent. An equal number of clientele came from both urban and rural areas. About half were visiting temples, the remaining half visiting dargahs, churches or individual healers. About 60% of clientele were men, 40% being women. 50% of users and 64% of carers belong to backward, scheduled or tribes castes 66% of users and 54% of carers had studied upto high school or above. 40% or less of clientele were holding steady jobs. Others were in unorganised sector, household labour or agriculture. Among users, 73% owned pucca houses; 61% owned land; but only 37% earned > 3000/-. A similar trend was seen among the carers Approx 25% were in the >50 age group; another 50% were in the 20-50 age group. 73% users and 58% carers came from nuclear households There was a small category of single or deserted users. Land owning did not improve socio economic condition. Farms did not yield, were dry, etc. Eking out a livelihood from different odd jobs was noticed. While most owned a home, kuccha or pucca, sources of fuel and water were unreliable for the poorer sections. 30% SPs and 41% healers were from backward, scheduled, tribes. 88% SPs and 95% healers were male. 88% SPs and 54% healers were hindu. 5% SPs and 44% healers were muslim. Over 80% of both were married. 54% of healers had finished upto high school, 30% having studied less, main reason for discontinuing being poverty. Healers shared a comparable socio-economic profile with the clientele. More than half of healers earned <3000/= p.m. 95% of SPs earned more than 5000/= per month. Healers held land, agricultural assets, SPs held appliances. Equal numbers of both had personal vehicles.

Users Carers 69% (health) 45% 64% (mind / body) 43% 75% (mental health) 49% 54% (cultural) 40% 34% (family) 11% 20% (IP) 8% 28% (Eco.) 10% 20% (Social) 3%

1. Holistic sense of “well being”
2. Family, interpersonal, SE problems were reported together in the narrative about “problem”
3. “Cultural” (inferred) were among the top 4 reasons
4. “Mental health” was inferred, not reported
5. A small population with chronic, life threatening or highly disabling conditions, not only psychiatric
6. “Problems” were inter-generational for about half
7. High mental health “need” can be inferred
8. Healers picked out “problems” in more than health / mental health area; SPs report of “problems” was more limited.

More Findings

• Nearly 75% healers had been practicing for 15 years or more, some having been serving god since childhood.
• Faith, mental strength, moral character, ritual purity, and vidya were top on their description of a “good healer”.
• 74% did not think they were a kind of doctor.
• 33% felt that there was no problem that they could not cure. Others reported physical ailments and alcoholism, and 70% referred for these problems. The clientele also reported going to doctors only for medical problems.
• Is mental health their speciality? 97% of healers reported that persons with mental health problems approached them.
• Healers and clientele shared a common world view about witchcraft explanations for psychosocial problems. SPs world view clearly differed.
• Most clients had gone to several medical places before coming to the THCs. For many, it was the last resort.
• For “witchcraft”- FH, and “illness” – medical cure, was a common perception.
• Those with chronic, life threatening or severe medical problems continued to access both places.
• People with SMD had tried psychiatric / institutional care.
• 92% of users and 93% of carers reported bad experiences with doctors.
• 67% user responses and 83% carer responses, the doctors spoke kindly to them. The remaining responses expressed that they were badly treated, most common reasons given being: diagnosis / medication did not help, followed by ‘was not treated well’, ‘feeling neglected’ and ‘doctors were cheats’.
• For only 6% of users & 9% of carers, medical assistance had helped.
• 65% healers reported that mentally ill people are tied up and brought.
• Poor community mental health programs
• 51% doctors said that healers can provide mhc
• Equal numbers of SPs opted for or against integration
• 50% felt that more research should be conducted on FH
• Over 50% talked about “awareness” and “referral”
• Against views: TH are backward, superstitious, commercial were most commonly reported
• Local tradition was acknowledged by most SPs as main reason why TH is accessed. But superstition was the highest cited reason (89%).
• “Placebo” most commonly cited reason for “cure”.

Generalisations… Local community mental health services are poor. Deprived communities access THCs. People have a high “need” of mental health services- inference “Well being” experienced holistically, (including spiritual components) Traditional healers and clientele share a common world view Ritual healing helps the people who use them. People prefer and seek TH for (mental health / existential) problems ? From healers to SPs one way traffic existed. SPs are not averse to “integrating” TH into the health system, whereas, healers don’t see themselves as “doctors”- they were quite clear about the spiritual role they played in the community Voluntarism in the sector Stigma- less compared to the mental hospital

Feedback on the Study Findings and Critique

Discussion on the presentation of the project and its finding resumed after lunch. The responses, feedback and comments are as follows.

Since the data is very rich qualitatively converting it to percentages may result in loss of important experiential information. If the methodology and design are primarily qualitative and robust, then a quantitative analysis must be used only if absolutely crucial.

It was felt that there was ambivalence in the positions with regard to traditional healing that was being put forth. It was unclear if traditional healing was seen as an alternate to psychiatry or the other way round. The findings would need to be looked at closely to see what position emerged as the approach in terms of recommendations; suggestions and conclusions would change depending on this position. If the findings show that people prefer traditional healing methods to psychiatry then it should be clearly put forth as a straightforward choice, and not an “alternative”. This way of formulation is trying to sugar coat it or apologizing for the way it is. The study must be purely descriptive, and not rationalize what was seen.

It was suggested that in the title of the study “Western Maharashtra” would indicate that only that area had been covered, but all the main regions of the state had been covered and therefore there was no need to continue with “Western” in the title.

A concept clarification with regard to dichotomy between the biological and social was sought. Was this difference very clear and if not along with the sociological cures, would cure for biological disability not form a part of the treatment regime if it had to be holistic? It would be important to challenge our notions on healing while we look at the findings. Further, empowerment in itself allows for the space to cope with mental stress while it may not be a cure in itself. We also need to look at the resistance that there is to patriarchal structures like marriage, caste etc. to better understand the cause of mental stress and emotional trauma and to place a concept like empowerment with this paradigm.

A majority of healers and carers are male and users are female, it would be interesting to study and explore this further.

It was felt that while the income (in cash) of the healers may be low but they receive many gifts in kind (livestock, grain, jewelry etc.) as well and if those were to be added then it would be a substantial amount. It would also give a clearer picture and understanding of the economic working within the traditional healing center. 

In faith healing – is the healer important or the faith? While people may begin with faith, once treatment / relief is found, irrespective of whether it is from an allopathic medical doctor or a traditional healer it gets established in her/him and will remain like that for the person as well as told to others in similar situations.

One question which was raised frequently was whether people turned eventually to traditional healers or to medical doctors. The debate was left open as there were incidents cited for both cases.

According to one of the participants, human rights violations must be looked at more objectively. They are very quickly raised in the case of mental hospitals and psychiatrists. We need to question whether in the case of a mentally ill or challenged girl who cannot manage herself during menstruation, is it really wrong to perform a hysterectomy. Similarly if a schizophrenic is restrained because of a violent state where she or he may hurt someone or even kill them is it really a violation? Usually in these cases the police are not interested in taking care nor is there enough facility at the hospital so options like restraining patients or giving people ECT should not be completely rejected especially when we do not have any alternatives. Even at faith healing centers people are chained and their condition is so bad that there are no proper personal hygiene or sanitation facilities, and no one bothers about them. Another fact is that carers purposely leave patients at THCs or at any other place because they cannot go back due to the lack of mental ability to find their way back. Further, shock treatment is always given under anesthesia and there is no pain involved. Even in western countries it is used because it is a life saving treatment for severe depression and suicidal people. The only issue concerning it is that it may be indiscriminately used which may happen in any other branch of medicine or occupation and that should be regulated. It would be unfair to blame the efficacy of the treatment for misuse by individuals. Also the efficacy is so high that patients voluntarily come back for follow up ECTs and even demand them. In India where persons/patients work on daily wages it is an instant treatment – it is much faster and it is not inhuman.

It was felt that it was important to contextualize the study – it could either be located in economics and poverty or it could be raised as a question of the lack of (infrastructure) development. Where there is poverty of economics there is also a poverty of services and this perspective would be helpful in building the study within the context of the development debate and addressing the questions of human and social aspects of treatment while looking at service provisioning and access.

In the Indian context we are used to residing in collectives like large families etc. There is a large significance of personal contact in our social environment but allopathy being an impersonal science does not take this into consideration. There is a need to critique this. It is interesting to note that faith healing centers are closer to our social environments and are able to contextualize the dispensation of their therapy. The findings could be explored to see if faith healers are able to instill a feeling of belonging among those who come to them.

It would be interesting to document if these sciences have been able to and construct knowledge by listening to other voices, especially those of the patients or they evolve irrespective of these. How do users feel “cured”? Is there a preference depending on the researchers’ bias, the users, carers or type of illness?

The issue of regulation of these practices was raised. Where would people go for a second opinion if they needed to or is it a series of alternatives one after the other? With regard to standardization it was felt that using yardsticks of the allopathic stream may not be a good idea but standardization is crucial and would need to be looked at as an issue.

Traditional Health would include ayurveda, unani etc., however the study has included only faith healing and therefore prudence in defining and using exact nomenclature was expressed. Further even mental health services would need to be listed and clearly stated.

As far as integration was concerned, the study pointed that it is only one way traffic. It is not just referral but what to get from one provider and another, that is integration.

From the policy point of view the one way traffic would be viewed as a healthy trend, as the faith healers are aware that there is a treatment for the people who are coming to them, as complementary to each other not supplementary for this or that situation.

It would be useful to decipher the science behind the methods used by the faith healers. Here it was felt by some other members of the group that science was being viewed in the very narrow allopathic psychiatric sense which is the mainstream method. These healing ways were very different and they’d have to be understood from a different stand point and not through the popular biological medical one. Expectations of a science, defined in a modernist way, cannot apply to these practices. An EMIC view was necessary.

It was then discussed that psychiatry was not just biological and social but there was also a bio-psychological and social model which integrated all of these broadening our understanding. Also besides biological and social issues there are also personality issues that need to be looked at.

The findings could look at the experience of healing by the different providers. A systematic line of analysis to explain the entire healing process along with the user too and determine the basis of choice of healer and the experiences of healing would help to clarify several aspects of these processes. If the first contact point was a faith healer, then what were the reasons for the choice? Did this bring relief or did the patient go to another healer or a doctor; why was the doctor chosen after the faith healer and what was that experience like – effective or not? And so on.

While dealing with mental health, it is necessary to keep in mind that users’ voices are not heard, carers take most of the decisions and sometimes this results in patient abuse. The question then is who has more faith, the patient or the carer?

When we speak of faith healing is it only healing by faith? Because there are a number of rituals involved and these cover a whole range of practices which also come from a variety of world views. The documentation of the variety of these practices among faith healers would perhaps also help in weeding out the frauds, and those who encourage superstitions. These differences should be documented. Demystification is required in traditional healing. An issue of concern here is that these methods cannot be grouped together like the allopathic stream which may be unified in some sense, because of the singularity of the discipline and the uniformity in the method used by it (drug dispensation). Thus, this exploration should not be placed in the conventional psychiatric cradle.

In every treatment faith is an integral part irrespective of whether the healer is a doctor or TH.

Since traditional healers do not see themselves as doctors they cannot be absorbed into the existing system. Only some kind of informal monitoring could be mutually discussed with each of these healers and put into place. Not as it is done in allopathy but that which is intelligible to everyone and includes everyone.

A comparison between dargas, independents, churches, temples would be interesting as all of them would be different in terms of process and also the way they view psychosocial distress.

Instead of looking at how many healers and users were men and women if a qualitative assessment of healing from the woman’s domain and the construction of this space could be done, this would give certain crucial insights into the issues of gender.

There is a scarcity of resources and personnel in the services of the mental health sector. If the large number of traditional healers are added to the MH sector, the issue of paucity of the work force could be addressed.

It is important to estimate the number of successfully treated people and the methods used for treatment in faith healing centers in order to establish their effectiveness for policy makers to take them seriously. They should be compared instead of contrasted. Cases of deaddiction are common at these sites and rehabilitation of these patients through traditional healing would be a useful strategy.

Methodology – research design etc. must be elaborated as this is a unique study and maybe the single one of its kind. The credibility and validity as well as the process of it would be of interest to those wanting to undertake further research in the area. As far as faith and faith healing is concerned, the data itself would give a number of leads. It would open many questions and even to list these would be useful.

It is evident that there is a lot of physical movement and postures demonstrated by users at faith healing centers. A strong sense of the body being in a state of positive energy seems to be central to this form of healing. Data on the spatial quality of healing, using different postures, and the direction of the body movement, may also lead to special insights.

It is crucial to include women oriented data, especially of women healers. Such a commentary would bring out the issues of expression, safety etc.

Another question that must be addressed is how do researchers locate themselves in the biases that they carried into the field.

Why were more men interviewed, even though more users were women?

It was felt that inductive logic should be used and presented in a scientific manner. This would translate into a systematic analysis of the process instead of going back to numbers which may reduce the richness of the data.

We should convince policy makers about them being effective. We must speak their language. Just because users go there it does not mean that they should remain or that they are effective. Proper effectiveness studies must be taken up.

Policy has organised mental health interventions in a particular manner. If the findings of the study are placed within this structure, it gets subsumed within that established method, limiting it and resulting in the loss of its value. It must be presented on its own terms, rather than in terms of how people want to hear it. If it is altered, to use the language that people are used to hearing, it will not be looked at on the basis of its own principles. The study has clearly brought out the need to treat the individual as a whole, situating the healing within a life struggle rather than pathology. It will not be doing justice to the study to put it as yet another intervention.

With regard to human rights it is understood that there is a manner of treatment which is per se wrong irrespective of where ever it happens.

The issue of the anti superstition bill which would delegalise traditional healers was discussed. When people are walking voluntarily and taking the treatment, then are the policy makers really justified in taking this position.

While it is agreed that there must be a code of ethics for traditional healers we must also realize that there is an inherent bias against them. When we talk of psychiatrists we never feel uncomfortable that there is no law against them having sexual relations with patients. These biases need to be recognized and questioned realising the power that doctors have compared to healers.

The best thing the study captured about the TH was the treatment of the individual as a whole and the lack of judgment or labeling which is so common in our hospitals.

In response to the earlier issue about hysterectomy in the context of human rights which was raised earlier, it was felt that it is crucial to look at human rights holistically. While we look at the rights of a 70 year old mother let us not forget the rights of the young 13 or 17 year old young girls. Further the concept of human rights itself needs to be examined. Earlier homosexuality was looked at as deviance and it found a place in the DSM as a mental disorder. This changed when the DSM IV was introduced. What may be treated as unacceptable at one point of time it may be irrelevant at another because we are addressing essential parts of human life and lobbying for the respect of individual choices.

Do we feel that mentally retarded girls have no rights over their bodies because of their mental states? When Hitler had begun his dive to eliminate “impure” people, it wasn’t the Jews or the Poles or homosexuals that he targeted, it was mentally retarded children, children who were unfit to survive on their own and who did not have a voice.

It is precisely because they are unable to ask for resources of their own accord that the state has a special responsibility to provide to them all resources needed to live a life of dignity. It may also be worth while in this context to remember that there were incidents of sexual abuse of such girls that was hushed up earlier. Was it then the management of their menstruation alone that was the reason for the hysterectomy or was it a way to brush under the carpet any outcome of the sexual abuse thereby also making space for the abuse to continue? Then, if the uterus of the girls was removed because it was difficult to manage menstruation the next logical step would be to remove their digestive systems since toilet training and management would then be just as challenging. Let us try and understand the correlation we make between useless organs of useless people, and how easily we build logical, rational cases for their removal and how skillfully we pass these under the garb of human rights.

Some of the participants wanted to know how the findings were to be disseminated. It was shared that the organization planned to publish in journals and as a book.

The session closed with a brief synopsis and acknowledgement of the critique given by the group. Some basic questions had already been answered through the process and these included

1. What should be seen in the data and the questions of analysis that can be included
2. What are the cautions that should be exercised
3. What are the biases that should be avoided

As the review progressed, it was hoped that more feedback on the same would be accumulated

Panel Discussion on Culture, Science and Traditional Healing

Dr Kamala Ganesh, Head, Sociology Department, Mumbai University – Chair

Dr Raghu Rama Raju, Professor, Political Philosophy, University of Hyderabad, Trustee, Bapu Trust

History – The 17th century laid down the foundation of things we are saying today. Descartes, the father of modern thought introduced the idea of reason. Reason, according to him, has to be necessarily cognitive and by definition, this excluded the body. Once this idea was instituted, everything else got excluded from modern philosophy, one of them being “tradition”. Tradition and modernity, the two never go together. This is important because in the case of India, this is not the formula we are facing today: tradition or modernity. It is tradition and modernity, simultaneously. We have two types of healing systems in India, both living and surviving together.

In the case of allopathy in the west, they have no comparative access to traditional practices. Allopathy goes without evaluation or challenge. What are the parameters of neutrality cannot be discussed in the western context. Allopathy is evaluated against allopathy. In India, we have many systems to evaluate against each other. This is a much richer situation. A comparative framework which can take the basic principles of both allopathy and traditional healing needs to be developed.

If we were to accept what Descartes propounded, childhood also would have to be excluded. That is why we have adult franchise. Further, he even excluded the study of languages, poetry etc., as it would not be part of modernity. These parts of human existence would have to be dismissed as only cognition existed in his discourse on modernity.

Rousseau stressed on the family being the only natural phenomenon in all societies. Children were attached to their fathers, only till they needed them. Any further associations between them are voluntary and maintained only by convention. This thought gave birth to old age homes where children cleared the debt they owed to their parents.

Philosophical underpinnings change as regions, time and contexts change. Tradition and modernity have found co-existence in most spheres in India. From the point of view of the study it is therefore critical to not be apologetic for the qualitative information that has emerged and seems “contradictory” to western scientific thought. It must be offered as descriptive ethnographic material. The findings must be presented as evidence from the field. If there is a difference of opinion or theory on the same the onus for taking this up lies with the others.

Dr Kusum Dhar Prabhu, Jungian psychoanalyst, Bangalore

The panelist shed light on the origin of healing. The word healing “Healing” is taken from “making whole”. That’s where it comes from. She then shared experiences of her own training in the field of mental health. Being modern, she felt disconnected from tradition and it existed as a parallel entity in her mind. But her healing came when she reverted back to it through Jung’s thought.

Psyche, according to Jung, is layered and exists in many different spheres. In each of our psyches, there is a layering of the archaic as well as the contemporary. Like there was a physical restructuring in the origin and evolution of species, there was an evolution of the mind as well. Thus the mind contains a history of its own collective experiences through its evolution and development. Therefore even legislators are a part of our own make up and they come from the same make up as us. It is difficult to hold an “us” vs “them” position.

The techniques of healing were then listed. The Western psychotherapeutic tradition dwells on the rational, cognitive, ego part of the personality. Jung speaks of psychic reality. One part of us is modern and far from the older part of life, which is ancient and instinctual. If they do not meet, we become ill. Traditions and modernity and the relation between them are manifested through our dreams.

The case of a family from Bihar of two sons and their father was presented. The youngest son was able to make a good balance between modernity and tradition and this helped him to cope with the differences in his background in Bihar and his modern job in Bangalore. For the older person psychological reality comes in the form of myths and he wanted to seek protection from his wife, who he believed was doing black magic on him. The father was more or less living with his conventional views and dealing with it from there having in some senses withdrawn from the current situation and therefore addressing it as an objective observer. In therapy, neither position was judged, and each person’s experience had to be validated and taken as the starting point of therapy.

Dr Janet Chawla, Director, Matrika, New Delhi

Janet gave two examples of data from her work with traditional midwives.

Example 1
There is a process of ritual facilitation of labour in Indian tradition. In Jharkhand the mother in law dips her big toe in a container of water and the daughter in law who is in labour and about to deliver, drinks it. Though this seems an insensitive practice from the point of view of modernity, patriarchy and gender relations, there was a reason behind it. A vaidya who she worked with revealed that the Praann Vayu or life force is released from the big toe, and therefore when the mother in law dipped her big toe in the water, she was actually transferring the Praann Vayu to the unborn child through its mother as the medium.

Example 2
Another example shared was that of Narak (hell). The body and palcenta are also called Narak. Narak means the underworld. The fertility of wombs and earth is placed there. However the semantics of use is a matter of interest. It’s use by the pandits versus dais brings out two different contexts. Similarly, breath is the same as hawa or wind. This is not a metaphorical or symbolic relationship, but rather, a synchronous relationship. The relationship is one of reality, not one thing standing for another (metaphor). Womb is narak, and narak, womb. Here, we can talk about synchronity or co-existing phenomena. The churael is the woman who dies in child birth. She is considered the worst kind of bhoot. The bhoot is derived from the panch mahabhoota, meaning the five elements. If the person dies, it indicates the disintegration into these five elements. If an element does not return it is called bhoot.

There is some internal rigour and consistency which belongs in the Asian traditions. There is also a translation from the microcosm to the macrocosm of existence. The microcosm or the individual is seen as a minuscule but whole segment of the cosmos. What exists in my body exists in the cosmos. Synchronicity plays a special role in most of these traditions.

Most traditional healing methods emphasise the body and touch. While we look at the data and material that the present study has generated, we should look at the tactile aspects of it.

Dr Satwant Pasricha, Clinical psychologist, NIMHANS, Bangalore

A presentation was made by Dr Pasricha on unorthodox healing. When the patient – doctor relationship is examined we find that empathy plays a vital role in the therapeutic relationship but often there is also telepathy. For example when one of his patients was shot in head, Jung had a severe headache. 

Healing is a complex procedure and many things contribute to it. In Spiritual healing it is believed that the body has the ability to heal itself.

Definition of Unorthodox Healing

Unorthodox Healing refers to the alleviation of physical or psychological disease in the absence of adequate medical, biological or psychological explanation for healing in terms of; a) unusual rapid recovery and; b) spontaneous remission beyond medical expectations.

Types of Unorthodox Healing Mental Healing Psychic Healing Paranormal Healing Prayer Healing Traditional Healing

There has been an increase in interest in Traditional Healing in the West. Nearly 6000 registered spiritual healers practice within or outside NHS in UK. It is one of the most talked about and least researched areas especially in India. In view of the inadequate patient-doctor ratio, there is a feasibility of alliance with genuine or qualified healers. There are only a handful work in NHS surgeries and hospitals. Their work is regulated by a code of conduct set down by the National Federation of Spiritual Healers. A large body of research data on healers is available; suggests merit in further research

Techniques of Healing

Beliefs about Miraculous Cures Work of God Saints Healers Shamans Witch doctors Power spots (Temples etc.)

1. Faith healing
2. Spiritual Healing includes - Laying-on-of-hands and distance healing
3. Therapeutic Touch
4. Possession or trance

Scientific Criteria for Healing and examples of the same were illustrated. This was followed by presenting the scope for involving traditional healing. The paucity of medical mental health personnel was presented and has been elaborated in the table below.

Scientific Criteria for Healing and examples of the same were illustrated. This was followed by presenting the scope for involving traditional healing. The paucity of medical mental health personnel was presented and has been elaborated in the table below.

Case Load	Karnataka	All India
Major Disorders	527339	1,02,70,165
Minor Disorders	2636695	5,12,51,625
Psychiatrists (@ 1.0/100, 000)	198	2219
Ideal Requirement	527	9696
Deficit	329	7477
Clinical Psychologists (@ 1.5/100, 000)	69	343
Ideal Requirement	762	13259
Deficit	693	12926

Source: DGHS, Min.H&FW; 2002

Mental Health Care Services & Scope for Traditional Healers

• Traditional Healers may be involved after careful evaluation of their, credentials, abilities and techniques
• They should register and practice in the same place where a medical person is available to attend to medical emergencies
• They should be a two way referral system
• They should be involved in the treatment of minor mental problems WITHOUT VIOLATING HUMAN RIGHTS OF PATIENTS

Recommendation for Participation of Traditional Healers

• Mental Health Care Services Highly disproportional doctor-patient ratio; more so in mental health work Need to involve/train other professionals PHC doctors /psychologists/social workers to meet the increasing demands under NHMP & DMHP Identification and assessment of mental health problems: minor ailments to be treated at PHC level; major ones to be referred

  Initially to be monitored and should agree  to  allow researchers to evaluate the outcome of their treatment for: a) establishing authenticity b) Referrals
• Ethical guidelines MUST be followed
• Taking a statement about the reduction in symptoms or cure from the patient or his family would not suffice
• The condition of the patient has to be assessed pre and post treatment by a qualified professional

Eligibility Criteria of Healers

• Presence of Psi abilities
• Integrity
• Willingness to Register
• Allow Evaluation of cases treated
• Not using any coercive methods
• Willing to work in coordination with medical personnel
• Follow Ethical guidelines

Conclusion

• Increasing interest and acceptance of unorthodox healing
• More than 1800-2000 registered healers in UK within and outside NHS
• More scientific research required with stringent criteria
• A large number of patients may benefit from interventions by traditional healers if code of conduct is followed

Dr Kamala Ganesh who was chairing the session summed up the presentations of the panelists. The panel raised broad issues about traditional healing, philosophy and practicing. She opened the discussion.

If tradition and modern practices are two distinct categories, then how are same sex relationships seen in traditional practice? As in clinical practice, are they closeted or addressed differently, in traditional practice? There seems to be openness in traditional healing to these relationships. Yet, exorcising the lesbian person and of her love is practiced by communities. What is the understanding of human rights within faith healing? Is there any discrimination in the way they are viewed considering that the methods and techniques used for healing are different. How are children looked at in traditional practices, how is their distress, anxiety etc. viewed?

PSI refers to para-psychological and paranormal abilities available to some people. Where these abilities have to be used is conditional, and it should be applied when all else fails.

At one level we have trained Dais and co-opted them into the medical agenda. At another level there is romanticisation of traditional practices. We need to guard against both. While not getting medicalised, we must also generate evidence-based, scientific studies for alternatives. Since thee is a large amount of funding for safe mother hood practices and techniques, traditional techniques should also be supported with the help of collecting evidence about their existence and working.

There was a suggestion that there should be a detailed documentation of the steps of healing, used in traditional healing and then translating it into modern psychiatric language.

In the practice of traditional healing, good and evil are conversing with each other and this is acted out. Modernity does talk of this battle, but still does not recognize its dramatic expression. The Good exorcises Evil. This is the basic age old battle, but it is not as simple as removal of one or the victory of one, over the other. It is a tedious, tiring, purging process which may or may not take time depending on the state of its existence in a person. Instead of discarding the procedure, it may be suggested that less violent ways of dealing with it be used.

WHO recognizes the folk and formal streams, but India recognizes only the latter. There is a constellation of paradigms. There are caste and cultural hierarchies practiced in the AYUSH, which are as exclusive as medical science. While there is the womb and placenta in Ayurveda, there is no Dai.

There are several issues in the legalization of healing and regulation of it vs criminalization of it. This is perhaps the same as prostitution.

Documentation of such kind of practices is very relevant. Research has always been in academia. It has to be placed in the arena of public.

There was a debate about whether these practices should be deciphered or translated into the language used by the mainstream. There was another opinion put forth, which felt that such a translation would be reductionist for traditional healing which uses its own expression and must be understood as such.

The discussion was concluded for the day.

25th June, 2006

The day began with a Panel discussion on ‘Law, Policy and Traditional Healing’

The panel was chaired by Sandhya Rao. The Panelists included Dr Shirish Sule, Dr.Ravindra Bakre, Dr Mira Sadgopal and Dr Amita Dhanda

Dr Ravindra Bakre and Dr Ajay Chauhan, Gujarat Mental Health Office, Government of Gujarat

The panel began with Dr Bakre speaking about integration of services of traditional and modern service providers. The example of the Miradatar Project in Gujarat was presented to illustrate this. The Miradatar Darga is an old traditional healing center, where many people come for healing. The Hospital for Mental Health approached this Center and began to work with them. The need for this collaboration was a result of the reality of the dire lack of capacities within public mental health services and institutions. A camp was established by the Hospital in the premises of the darga so that identification of cases could be done, and if consented, then treatment would be given. The Trust of the Miradatar Darga allowed this and a clinic in the Darga was opened. This is a rare example of the integration of services. This Pilot project was for the sensitization and training of faith healers (Mujavars) and to establish linkages for the mental health service delivery at Miradatar Dargah, Unava, District Mahesana, Gujarat. The details of the project were presented by Dr Chauhan.
Background Information

1. 800 years old Dargah of Miradatar
2. Second biggest holy place in the India.
3. More than 500 Mujavers and 2000 families dependent on Dargah
4. Average 80-90 persons with mental –behavioral problems are brought from mainly Rajasthan, Gujarat, Maharshtra, Madhya Pradesh and northern part of the country. 

Treatment approach by Mujavars

Consequences of faith healing   Self harm/Poor impulse control Physical ill health /skin disease  Injuries and Disabilities Violation of persons basic human right

1. Holy water bath
2. Loban dhoop & other rituals
3. Sacred threads for 1 to 60 days
4. Patients usually stay there up to 2 months and being involved in daily rituals.
5. Patients are also kept chained.
6. 80 rooms available

Purpose of the project

1. To understand practices of Mujavers in Mental illness
2. To understands knowledge, beliefs and attitudes of Mujavers towards MI

   Objectives of the Project To sensitize Mujavars regarding different mental illnesses. To provide medical help to patient, coming to Mira Datar dargah. To provide referral and follow-up system for treatment. To make awareness about mental illnesses among general public attending such religious places. Protection against indiscrimination harassment and maltreatment

3. To established linkages of faith healers in Mental Health (Dava and Duva concept)
4. To sensitize the Mujavers towards the Rights of Mentally ill

Activities for the project

Project Phase-20 months

• Training and sensitization through workshops followed by review and refresher trainings
• Camp Organization
• OPD
• Public Awareness

Training workshop

• Identification of MI
• Common behavioral problems & causes
• Consequences of the   faith healing
• proper referral system
• Basic & Human Rights of MI
• Legal & Supreme courts direction

Camp Organization

• To create awareness among the relatives of mentally ill
• To provide medical treatment and counseling to patients and caregiver.
• Mental health awareness exhibition (audio-visual)

Distribution of IEC material.
Self help groups

• Promote positive mental health
• Liaison with general health care & mental health professionals.

Outcome of project

1. Chaining of mentally ill patients has stopped
2. Sanitation of campus improved
3. Holy water of Hoj is changed regularly
4. Acceptance of behavioral symptoms as MI by Mujavers (168 patients referred )
5. Increase awareness of general public about the mental illness
6. Established linkages with Mujavers
7. Psychiatry OPD started weekly at dargah
8. 30 mujavers have been trained 
9. Development of a sensitization & training module for faith healers
10. Self help group formed

Dr Sule, Psychiatrist, Nashik
Dr Sule spoke of faith healers, modern therapies and the need for efforts to bring them together. He elaborated that placebo treatment may not be the only reason for people going to Faith Healers. There may be several other reasons including:

1. Lack of availability of trained mental health personnel
2. Lack of money to access and travel t places where mental health services are available
3. High levels of acceptance of faith healing by patients and their families
4. Lack of awareness and education on metal health among the public
5. An element of blind faith - even those people who want to adopt modern medicines fear the reaction from their community and society, and therefore do not come to mental health professionals.

Through examples in his practice he related instances when it became difficult to treat people as the patient and the relatives have faith in a spirit and that is not something a doctor could heal, therefore they would have to go to a faith healer. He then used several cultural methods for “curing”, such as, ventilation, catharsis – releasing emotions, conflicting thoughts are all characteristic of people who are mentally ill and it is not necessary to go to a faith healer for these. Even counselors, psycho therapy do the same thing that faith healers do with better results.

With regard to the method of faith healers, especially of trancing, he explained that when states are produced in people they become highly suggestible, and the guru (faith healer) or the priest gives them suggestions, which they feel make them well.

According to him, there are several problems with faith healing centers and practices. There is a large amount of exploitation- violation of human rights and inhuman ways of treatment. For e.g. chaining in the dargah is a part of the treatment itself. This leads to several physical complications, skin diseases and sanitation issues as the person has to do everything in one place. Sexual exploitation is also rampant.

Several psychological problems are biological, neurological or due to chemical imbalances. Even for stupor, there may be several reasons, biological, physical etc. The sooner the diagnosis is done for these, the better is the outcome, but this is not possible in the THCs. They are ineffective in dealing with bio-chemical imbalance.

There are many problems with these institutions also. There is a lack of health personnel. People who need treatment do not come, because they are dependent on daily wages. For those who are dependent on agriculture, time becomes an important issue. They will not come during the sowing and cutting seasons. It is a question of both time and money and this is understandable. With faith healers, they are in a better position to go to patients, and they are better accepted, as they belong to the same social milieu.

It is therefore important to look for integration. If healers are taught some basic treatment by modern methods and for some common ailments, they can deal with them at the local level itself. For more complicated issues and problems that are biological / chemical imbalance related, they can be taught to identify these. A proper system of referral can be instituted where they can send these cases to a psychiatrist or a trained mental health service provider. It is important that we aim at an amalgamation of services and service providers, instead of competition.

Mira Sadgopal, Ashoka Fellow, Director, Tathapi Trust
The context of mental health is important it raises more delicate issues. It is understood that community level health care is vital for any health care services. When we speak of community level primary health care, and the role of community workers, the issue of legality arises. This is very ambivalent. For a community worker, to give emergency first contact care like an injection, she has to have a doctor standing by. But this is not a very good situation. It immediately puts her in the defensive position: She is used to provide health care (injection) as the doctor for several reasons is not there to do the same. Even though he may assure her that he will stand by her, if something goes wrong and there is a negative outcome of the medication she will be blamed doing it in the absence of the doctor. It is a double loss situation for her and legally, she has to take responsibility in both cases.

There are many inter- and intra-hierarchies inbuilt into the medical system. In allopathy, it is the doctor on top with the health worker right at the bottom. In streams of medicine, it is allopathy above ayurveda, homeopathy, etc. and these are above the folk streams. In the case of folk streams, the modern stream, feel that they should set standards for all. The question that arises here is that, why should those in the hierarchy interfere with those outside the sphere of their activity. The other issue is how violations of human rights at THCs should be handled.

With the coming of NRHM and the establishment of AYUSH, the Tibetan Amchi system of medicine and the folk streams have been left out. Integration is a very large problem. The system of public health from 18th and 19th century has been very dominant in the west. They are also insensitive. There is a large gap in communications between the systems. These include rural, urban divides, caste and tribal divides, and gender divides among others. There are some organizations working on the issue of public health in the urban and rural areas but these are scattered, and the agendas are different. Funding is also of a different kind and supporting different endeavours, mostly modern. In this scenario, the issues become more complex. It is imperative to sensitize the public health system, to mental health issues, and there is a large gap as far as this is concerned in NRHM which is a nation wide mission. A lot of standards are going to be set by it especially with regard to community work. 

At the conceptual level, we need to clarify what we define as faith healing. We also need to be clear about how we see tradition itself. Tradition need not be static. Folk systems are not devoid of problems and in these, as in other systems, there is a large amount of gender bias. New traditions can be formulated keeping these in mind. As far as the language of this study goes, it may be better to use traditional health and healing systems instead of traditional healing practices. If we only say practices, it means that we will be selective in adopting their system. The panelist concluded by stressing that there needs to be clarity about the definition of faith healing itself and the position on it. 

Dr Amita Dhanda, Prof of Law,  NALSAR, Hyderabad.
The law expert spoke about law and legal interventions in the sector. The proposed Anti Superstition Bill would result in the supposed cleaning up of Traditional Healing Centers (THC) and dumping of people using these services in Mental Hospitals. This Bill has been suggested for approval by the state assembly of Maharashta. Is this intervention the way to go for the rest of the country? When talking of legal interventions in mental health, we talk of one kind of law which is prohibitory in nature. This kind of law essentially specifies what we cannot do. In order to introduce or establish law, there has to be some social consensus for its establishment. This is imperative, when it is a criminal law. If there is no social consensus, then there is disconnect between law and practice. It would also mean that a law is being created, which is not implementable, considering the enormous magnitude of users in Maharashtra. However, the state’s stand on this issue may be problematic, as faith healing has been categorised as evil, and that is the rationale for it to be ousted. This means that the work to remove these would require additional personnel as Vigilance Officers along with setting up imprisonment structures, fines, punishment etc. Is the state in a position to do all this?

Is criminalizing, then, the only method of realization? If there is no general social consensus, then a law cannot be put under Criminal Law. If we were to look at the other angles to this, then we must critique state intervention in personal life. When people are voluntarily accessing a certain kind of service, how can the state ban it? Why is legislation required? It would be more a case of infringement of rights. This leads us to the obvious conclusion of whether there is a role for the law at all, so far as ousting of these practices is concerned.

The panelist concluded by raising some questions and placing them on the floor

1. Firstly, is the criminal angle really needed?
2. Secondly, when the state has failed to provide public health why take out something people have chosen and set up by themselves.
3. Thirdly, the Bill should be tested in the context of the rights regime

If we are looking at human rights violations, then these take place in all streams of medicine including allopathy, and maybe even more there, as they are indirectly or directly condoned. If we are going to look at chaining only from human rights angle, then there is a need to broaden our approach to realizing or recognizing that there is an element of healing and rituals, when this is done in THCs which is not the same in the case of medical mental health. In the latter it is used more for restraining an individual from “hurting” herself and other, not as part of a healing procedure. We must be willing to realize that such acts are used as symbols, and they are a matter of faith over which people are exercising their right.

“Its justice for the rich, its human rights for the poor, if you can access them.” – Arundati Roy

The language of the law is harsh, judgemental and there is a conscious effort to alienate traditional health care providers and users from the law and from people. Certain kinds of laws are put in the purview of the “protection of society”. The notion of harm is embedded in the process of the law dealing with mental health. There is also culture ignorance and an ignorance of tradition.

A clarification on the kind of interaction between the Hospital of Mental Heath in Gujarat and the Miradatar Darga revealed that the former had initiated a dialogue with the traditional healers in order to understand their belief, rituals. This examination was done with an openness which has led to a change in the mind set of the medical mental health providers. Attempts were made to try and understand the science behind techniques used by them. Referrals are now made by the healers at the Darga to the clinic in the premises.

Most neurosis is symbolic. If a psychiatrist knows what to do with a holy spirit, people will trust that he has some connection with the sacred. If the doctor views the individual with their psychological distress as a whole, rather than symptomatically, then the reading and the treatment of the person would be different.

There are different readings of the act of chaining. It can be symbolic of chaining an overwhelming enemy, an agency beyond the control of the individual which the ego can engage with and the chaining grants strength to the ego, which may make it easier for a person to better handle.

The idea of being bound and then of being released is something of an idiom and we need to understand this in cultural contexts.

Incorporation and co-optation of traditional healers would subsume them into mainstream practice and they will become secondary messengers or middle men in the hierarchical chain of medicine. When we speak of monitoring and evaluation of their work, then who will decide the criteria for this? It should be from dialogue rather than imposition.

If we look at a child, we find that an imagination that is difficult for us to fathom. Myths and miracles are embedded in a child’s everyday life and children have amazing capabilities of integrating themselves into the cosmic whole. With no cultural imagination these childhood capacities which are far superior are reduced, resulting in adults who are “top brained out”. There must be protection of cultural imagination and intuition in modernizing societies.

There is a need for acknowledging diverse frameworks of understanding. There cannot be a superimposition from above. Law should be kept out of these practices. It is better not to have interventions which take away from people their own community psychological resources. It is necessary to grant different people the space to live out their choices in their own ways. If traditional healers are done away with, the market would take their place. This has its own problems which are larger, because of the stakes that are involved. Drug companies function from a profit position that would be based on selling more drugs, not more health. Eventually, people would be left with lesser control over their health and well being. When ousting out a range of indigenous practices, we will be reducing our choices and our control.

On this note the panel discussion was concluded and a final synopsis of the learning and knowledge generated through the review process presented to the group.

Synopsis of the Learning and Knowledge generated It was suggested that there is a need to describe and document the processes and the methods of traditional/folk medicine. As a response BAPU Trust shared that it would be interested in carrying out long term work on this in this area beyond the project period. It was established that mental health is not just an expert subject and well being had to be understood from the context of human life experiences. The presence of participants from multi-disciplinary fields had made this clear. From the point of view of philosophy, modernity and tradition and the dialogue and relationship between them had been discussed. We saw the construction of reason and how the modern thought left out many methods of meaning making. The challenge was how we place it here and now. There was a contestation of reason and the need to look at the positive construction of human experience. Gender, caste, poverty and other states of maginalisation and their interplay in the human mind was discussed. Concern had been expressed about human rights and its place in the sector and violation of these could not be cited as the reason to get rid of traditional health practitioners as these were present in all streams. The need to work on reducing these in all sectors was more necessary. There was a need to re-look at the quantitative presentation of the data of the study and ascertain that it did not take away from the richness of the ethnographic qualitative material gathered. An elaboration on the methodology of the study would also need to form an important part of the report. We examined what constituted science and whether double bind control studies were sufficient to conclude on aspects of mental health. We saw the space and need for documentation of cases, experiential statements etc in the process. We tried to understand mechanisms and determine if diagnostic categories are capable of giving us explanations for intra-psychic processes. We examined the micro-environment and mechanisms in which we see behaviours and look at the meaning people make out of these and the associated life choices and process that are made in this context. The state response to mental health needs was discussed. Herein we saw how the public metal health system is processing faith healing and creating an environment where voluntary health care is never given, thanks to the law. We saw a glimpse of the diverse paradigms of healing that had been put forth. Is there an interpretation of only one model in terms of the modern which is applied to all or is there a space for different models of providing health care? We also saw the requirement for reformation of the modern medical system in terms of creating norms, values and systems for itself instead of getting into monitoring of another world view. We saw a variety of solutions - from placebo to symbolic route to recovery. We critiqued the legal options provided and discussed how to break though these legal barriers. A need to respond to the AP government affidavit was also expressed.

An interesting issue that was raised and is relevant to the study was whether we wanted to use faith healing as a term and how do we define it in the study. The term “traditional” has collected a baggage of meanings in terms of gender and patriarchy, so how can that be removed? There is a problem with consolidating existing terms. There is a certain level of rendering of a set of cognitive processes in people’s healing traditions, which must be brought out in the terms that are used. Tradition as a term has a sense of the static in it. This sense of the static is convenient for those who want to wipe out such practices. Lok swasth parampara was given as an alternative phraseology. The problem with using folk or local streams was that they may not cover the diversity. It was concluded that whatever be the terminology it should reflect the subject being addressed along with the position that it has in the study.

In terms of policy, it would be important to make place for the integration of the psychosocial realm in the NRHM either through AYUSH or in addition to it. Suggestions for the same were invited.

A discussion on the Anti Superstition Bill ensued. It was felt that the imminence of the Bill must be ascertained. Sometimes Bills are introduced only for political reasons. It may have a quiet burial and then it can be used as an example of how things should not be done. If it does get enacted, then it should be advocated against using good hard information at the local level.

It was shared that the people who have got this Bill together have been lobbying, through a movement for a long time and it is quite well run and institutionalized through the Andha Shraddha Nirmulan Andolan. They had exposed human rights violation in traditional healing centers, set up several activities to disprove the existence of spirits and ghosts. They have thought of several imaginative ways to undermine these establishments and the Bill was an eventual culmination of their efforts.

It is important to first have rationalist critiques of the methods used by the groups supporting the Bill to convince them that there is no need for the law. As a strategy, it would be better to dialogue with these people rather than wage a war with them. It would do well to explain that such a Bill or Law would only further empower the existing powers against those who are in any case disempowered. It would be a loss to people and a gain to the established powers. We need to point out who gets left out of the law. It is clear that the state is not a solution to our problem and this should be put forth before them, that we are in this sense working together.

Another interesting point that was shared during the discussion was that in the workshop held with the traditional healers, they were ready to have a united forum. However the danger cited was that, it may acquire a political and religious flavor which may become more detrimental and out of control. Also the healers felt that only those from the shastric tradition should be a part of the uniting forum which would again have led to exclusion. However, it was encouraging to note that they are well aware of good practices and bad practices and their accountability has to the population they service, because they are right there in the community. When a counter structure is suggested, this horizontal space would become vertical and hierarchical, and there would be a select few spokespersons from among them. This is again dangerous.

As the review workshop came to an end members of the group congratulated the team and the organization that had undertaken this work. They felt it had added to the body of research. The interaction with the variety of individuals who had come together in for the review had enabled an enrichment of their own understanding and knowledge.

A wide spectrum of thought and ideas had been generated by the group as they put forth their points of view and tried to understand and respond to those of others. The process was an extremely enriching one in terms of discussion, knowledge, information presentation and critique. The organization expressed its gratitude to all present for this.

Annexure 1
LIST OF PARTICIPANTS

S.No.	Name and Address	Phone and email
1.	Dr.Ajay Chauhan Superintendent, Hospital for Mental Helath Ahmedabad, behind Kapadia High School, Outside Delhi gate, Shahi Baug Road, Ahmedabad – 380 004 Gujarat	(079) 25624583, 25622485. rajaypc@yahoo.com
2.	Ami Mehra Lecturer Psychology Dept., St.Zavier's  College, Navrangpura, Ahmedabad 380 009	09898028973 ameemehra@ yahoo.co.in
3.	Prof. Amita Dhanda 21/1 Janakpuri, Gunrock Enclave Secunderabad-500 009 Andhra Pradesh	(040)27816033 amitadhanda@ gmail.com
4.	Dr.Anil Saraf/  Dr.Shailesh Deshpane C/o BAIF Development Research Foundation Dr. Manibhai Desai Nagar, National Highway No. 4, Warje, Pune - 411 029	(020) 25231661 baif@vsnl.com
5.	Aparna Joshi Bapu Trust, Flat No. 10, 3rd floor, Shubha Akshaya Mayur Soc. Near times of India Bldg., Bhaskar colony, Naupada, Thane (W) – 400 602	(020) 25443384 baputrust.mumbai@gmail.com
6.	Cath Slugget Consultant, Save the Children Canada, Sanepa Road, Kunpondol, Lalitpur, GPO Box 5850, Kathmandu, Nepal.	09881281037 sluggett66@ yahoo.com
7.	Janet Chawla 120, Sundernagar, New Delhi 110003.	(011) 24351190 09810240416 janchawla@ gmail.com
8.	Kamala Ganesh Dept. of Sociology, Mumbai University, Mumbai	09820073244 kamala.s.ganesh@gmail.com
9.	Ketki Ranade Bapu Trust, Pune B1/11&12, Konark Puram, 6th floor, Kondwa Khurd, Pune 411 048 .	(020) 26837647        26837644 wamhc@vsnl.net
10.	Kusum Dhar Prabhu Apt.1,Rosdale, 102, IIIrd main ,IIIrd Cross, Defence Colony, Indiranagar, Bangalore 560038	(080) 25298676 (M) 09845506155 thejungcenter@ rediffmail.com
11.	Manisha Gupte MASUM, 11, Archana Apartment, Kanchjunga Arcade,163 Solapur Road, Hadapsar Pune 411 028	(020) 26875058 masum@ vsnl.com
12.	Medha Kotwal/ Nirmala Sathe Aalochana, Center for Docume-ntation and Research on Women 1st Floor, Sunlit Apt., Opp. FTII, Prabhat Nagar, Law College Road, Pune -411 030	(020) 25444122 alochana@ vsnl.com