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Transcultural Psychiatry 2016, Vol. 53(6) 766–782 !The Author(s) 2016
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DOI: 10.1177/1363461516679352 tps.sagepub.com
The Global Mental Health movement
and its impact on traditional healing in
India: A case study of the Balaji temple
in Rajasthan
Anubha Sood
Southern Methodist University, USA
Abstract
This article considers the impact of the global mental health discourse on India’s trad-
itional healing systems. Folk mental health traditions, based in religious lifeways and
etiologies of supernatural affliction, are overwhelmingly sought by Indians in times of
mental ill-health. This is despite the fact that the postcolonial Indian state has historically
considered the popularity of these indigenous treatments regressive, and claimed
Western psychiatry as the only mental health system befitting the country’s aspirations
as a modern nation-state. In the last decade however, as global mental health concerns
for scaling up psychiatric interventions and instituting bioethical practices in mental
health services begin to shape India’s mental health policy formulations, the state’s
disapproving stance towards traditional healing has turned to vehement condemnation.
In present-day India, traditional treatments are denounced for being antithetical to
global mental health tenets and harmful for the population, while biomedical psychiatry
is espoused as the only legitimate form of mental health care. Based on ethnographic
research in the Hindu healing temple of Balaji, Rajasthan, and analysis of India’s mental
health policy environment, I demonstrate how the tenor of the global mental health
agenda is negatively impacting the functioning of the country’s traditional healing sites. I
argue that crucial changes in the therapeutic culture of the Balaji temple, including the
disappearance of a number of key healing rituals, are consequences of global mental
health-inspired policy in India which is reducing the plural mental health landscape.
Keywords
global mental health, India, psychiatry, South Asia, traditional healing
Corresponding author:
Anubha Sood, Department of Anthropology, Southern Methodist University, 8528 Lockhaven Drive, Dallas,
Texas 75238, USA.
Email: anubha.sood@gmail.com
Introduction
In the medically plural landscape of the Indian subcontinent, folk mental health
traditions based in religious lifeways serve as the predominant mode of mental
health care for the population. A great variety of such healing sites in the
region, including Hindu and Buddhist temples, the pervasive Sufi dargahs,
1
and places of Christian healing, involve therapies based on etiologies of super-
natural affliction and the use of an array of intense bodily practices. In fact, a
range of religious penance and mortification rituals such as fasting, binding
oneself in chains, and extreme feats like the renowned fire-walking and hook-
swinging ceremonies of Sri Lanka’s Kataragama devotees (Derges, 2013) con-
stitute core elements of treatment in these folk healing sites. In contrast to
Western psychiatric understandings that generally categorize voluntary pain
and dissociative states as expressions of psychopathology, in South Asian
mental health traditions these practices serve, instead, as systematized thera-
peutic techniques (Sood, 2013).
In contemporary India, despite the widespread popularity of these unorthodox
treatments, their use as suitable modes of mental health care has become a serious
point of contention for those structuring the country’s mental health sector. While
‘‘archaic’’ images of bodies possessed or constrained in ‘‘divine’’ chains in healing
temples and dargahs have always been unappetizing for the postcolonial Indian
state in pursuit of modernity and development (Davar, 2014), in recent years the
rising tenor of the Global Mental Health (GMH) movement has given a more
serious direction to the state’s ire against these practices. What had once been
benign disapproval of ‘‘superstitious’’ beliefs is now becoming a consolidated
policy stance of the Indian state against the continuation of folk healing—a pos-
ition that, I argue in this article, draws upon GMH principles that prioritize the
provision of evidence-based mental health care and human rights protection as key
concerns in the formulation of policies and delivery mechanisms across the globe
(World Health Organization [WHO], 2001, 2012).
In this article, I demonstrate how India’s adoption of the GMH agenda at the
turn of the 21st century, while intended to repair the country’s flailing mental
health sector, is endangering its local mental health traditions. To illustrate,
I present the case of the Balaji temple—a popular healing center for treating psy-
chological afflictions in North India, where I conducted ethnographic research
between the years 2009 and 2012.
2
I discovered that a range of healing practices
once considered vital to the Balaji temple’s therapeutic milieu had completely dis-
appeared in the last 7 to 10 years, while others were undergoing gradual changes
that threatened to seriously diminish the healing character of the site, a situation
that was deeply lamented by those who regularly sought healing in the temple.
I argue that these radical changes occurring in Balaji’s lifeworld are the effects of an
increasingly influential GMH agenda in India that considers clamping ‘‘dubious’’
folk mental health treatments in favor of expanding biomedical psychiatry as a
crucial step towards mending the ‘‘underdeveloped’’ mental health sectors of the
‘‘Third World’’ (Fernando, 2014).
Sood 767
In the following pages, I will first briefly chart India’s mental health policy
directions over the past decade to understand why Balaji’s therapeutic context is
transforming so rapidly. I will show how incipient GMH discourses were endorsed
in India at the time of the ill-famed Erwadi incident in 2001, when a fire accident in
a healing dargah in South India led to the death of 29 mentally ill persons; these
individuals had purportedly been tied with ‘‘divine’’ chains and were unable to
escape when the fire broke out. After the tragedy, allegations of human rights
abuses in ‘‘faith-healing’’ places and the ‘‘alarming’’ paucity of modern, psychiatric
care took on jingoistic proportions (Sood, 2015), serving as catalyst for formulating
the country’s mental health reform in line with GMH principles.
While the antitraditional healing sentiment that swayed India after the Erwadi
tragedy could be seen simply as a continuation of the postcolonial state’s long-
standing condemnation of ‘‘antiquated’’ cultural practices, I analyze government
documents from the period to argue that it reflected a more decisive qualitative shift
in the country’s mental health policy climate. This involved the use of (a) moral
arguments about eradicating ‘‘cruel’’ religious treatments to safeguard the human
rights of mental patients, along with (b) formulaic expressions of the urgent need
for psychiatric literacy and resources in the country, and the simultaneous formu-
lation of procedural solutions to address this need (Bemme & D’souza, 2014).
A new language that explicitly utilized the logic of an emergent GMH movement,
thus, entered India’s policy articulations at this time.
The remainder of this paper is devoted to the case study of the Balaji temple to
illustrate how religious healing, an important part of India’s mental health land-
scape, may slowly be decimated under the shadow of GMH. By presenting the
Indian case, this essay explores the role that the movement for GMH might play in
shaping the future of traditional mental health systems.
Charting the influence of global mental health in India
When viewed from a GMH perspective, folk healing traditions pose a number of
vexing problems. A common claim put forth is that the unavailability of mod-
ern psychiatric medicine in towns and villages pushes people towards ‘‘magico-
religious’’ alternatives; associating mental ill-health with such methods of cure,
in turn, exacerbates stigma and misconceptions about psychiatric problems
(Armstrong et al., 2011). More recently, as the concept of ‘‘evidence-based prac-
tice’’ begins to serve as the basis for strategizing GMH, it raises concern about
‘‘what constitutes evidence to guide policy and practice’’ (Patel, 2011) in the trad-
itional mental health sector.
Critics argue, however, that evidence-base, as well as other criteria for
examining folk healing within the GMH framework are embedded in Western
epistemological assumptions, and disregard a whole range of culturally diverse
ways of knowing and healing (Kirmayer, 2012a). The GMH movement’s emphasis
on locating mental illnesses primarily in individual biology, and on protecting the
human rights of mentally ill persons conceived as autonomous from their
768 Transcultural Psychiatry 53(6)
communities of belonging (Campbell & Burgess, 2012), for instance, draws upon
Euro-American constructions of personhood that are starkly different from those
of cultures where persons, health, and rights are conceived in relational and col-
lectivist terms (Kirmayer, 2012b). The effectiveness of traditional systems has been
supported by a large body of social science research despite remaining untranslat-
able in GMH language (Summerfield, 2008). As innumerable studies suggest, the
availability of plural mental health options (Gureje et al., 2015; Halliburton, 2004;
White, Jain, & Giurgi-Oncu, 2014) and an attending holistic approach to mental
health offers culturally ‘‘well-adapted’’ (Sax, 2014, p. 14) responses to human dis-
tress in societies around the world. In fact, traditional mental health treatments
may even ‘‘compare favorably with standard psychiatric therapies’’ in the Indian
context (Sax, 2014, p. 9), and many others as well.
As I demonstrate in this section, the mental health arena in contemporary India
serves as an example of how the indictment of folk healing and the simultaneous
promotion of biomedical psychiatry in the GMH movement is a direction fraught
with inconsistencies. While GMH concepts such as evidence-base, treatment gap,
and the imposition of universalizing diagnostic labels onto local ‘‘ecologies of
suffering’’ (Bayetti, Barua, Kannuri, Jain, & Jadhav, 2015) mute the value of trad-
itional systems as uniquely productive forms of mental health care (Sax, 2014),
such silencing has been compounded in India after the Erwadi incident by accus-
ations of grave harm wrought by traditional healing. In its stead, psychiatry has
been offered as the panacea despite ongoing issues including a subpar ‘‘custodial
medico-legal’’ model of treatment (Davar, 2014, p. 271), unregulated psychotropic
use (Ecks & Basu, 2009), and other serious problems that plague the country’s
psychiatric system (Murthy, 2015). In such a scenario, the aim of scaling up psy-
chiatric infrastructure ‘‘to improve access to evidence-based care and to promote
human rights for people with severe mental disorders’’ (Guan et al., 2015) seems a
misguided objective at best (Cooper, 2015; Orr & Jain, 2014).
Legal and policy actions after Erwadi
The first set of legal actions against traditional healing centers in India began in
2001,
3
when the Supreme Court of the country initiated suo motu action via the
Writ Petition Civil No. 334 (Government of India, 2004), directing all state gov-
ernments to regulate sites within their ambit and shut down those that were
‘‘harming’’ people. A part of this directive entailed implementing the Mental
Health Act 1987 in these spaces,
4
that is, requiring the traditional healing centers
to obtain legal licenses from state mental health authorities and having them follow
the same rules and procedures applicable to the admission, detention, and dis-
charge of ‘‘psychiatric patients’’ in a psychiatric facility. The ruling, though
never forcefully enforced likely because of the vast bureaucratic machinery
needed to police the hundreds of religious healing sites frequented by millions in
the country, became highly significant for the tone it set for it denied the social and
religious context of these healing spaces (Bellamy, 2011) and imposed upon them
Sood 769
the medico-legal, psychiatric frame dominant in the country’s official mental health
structure (Davar & Lohokare, 2009).
Despite lacking forceful implementation however, the policy drift towards ‘‘psy-
chiatrizing’’ the functioning of traditional healing centers still impacted the larger,
more ‘‘visible’’ healing sites. In Balaji, for instance, local healers (also known as
bhagats) who had earlier been pervasive actors in the therapeutic activities of the
temple (Dwyer, 2003), were refrained by the temple administration in 2003 from
conducting healing activities inside the perimeter of the temple complex. As I
learned, the temple officials saw this ban as a step towards streamlining the
social and spatial life of the temple to reflect its religious and devotional character,
while downplaying the ‘‘mental health treatment’’ aspect to ward off potential
meddling by the state.
5
Another set of actions taken in tandem with the Supreme Court directives was
the Writ Petition Civil No. 562 of 2001 (Government of India, 2004), filed by a
civil society group, Saarthak. The petitioners demanded that the regional state
governments undertake strict actions to ensure the protection of the human
rights of the mentally ill in the country.
6
The points made in the Saarthak petition
about grave human rights violations in psychiatric facilities in the country
(National Human Rights Commission of India, 1999) were ignored by state gov-
ernments in counterresponses and affidavits that dwelt at length on the ‘‘evils’’ of
traditional healing. As one response to the petition noted, ‘‘[D]ue to lack of modern
treatment facilities, people are following the traditional methods of treatment and
families are losing confidence.’’
7
Another state government’s reply stated,
‘‘[P]rovision of [psychiatric] services would go a long way in preventing society
from utilizing services at unlicensed places such as dargahs, temples, churches
and other religious institutions which do not have proper facilities and expertise.’’
8
The final blow to the traditional mental health sector was delivered in early 2002,
when the Supreme Court of India passed the following ruling in the conclusive
stage of the Writ Petition hearings in the order dated February 5, 2002:
Both the Central and State Governments shall undertake a comprehensive awareness
campaign with a special rural focus to educate people as to provisions of law relating
to mental health, rights of mentally challenged persons, the fact that chaining of
mentally challenged persons is illegal and the mental patients should be sent to doctors
and not to religious places such as temples or dargahs. (Government of India,
2004:512)
This ruling became an important influence on the direction of future mental health
policy formulations in India, and impacted the functioning of traditional healing
sites across the country in a number of ways.
9
Quack (2012), for instance, reports
from a study conducted by the Bapu Trust, Pune, in the years 2008–2009, of 22
traditional healing centers in the Western Indian state of Maharashtra, in which it
was found that a number of the healing centers had either closed down or consid-
erably altered their therapeutic services in the years following the Supreme Court
770 Transcultural Psychiatry 53(6)
ruling of 2002 (Quack, 2012: 283) (p. 283). In Balaji too, many key healing rituals
considered ‘‘violent’’ and ‘‘harmful’’ by the state were banned in succeeding years,
causing much consternation among the long-time healing seekers at the site.
A change of episteme
While the legal and policy actions after Erwadi predictably evoked the discursive
contrast of tradition/modernity inescapable in postcolonial imaginaries as evidenced
in the official pronouncements mentioned above (Siddiqui, Lacroix, & Dhar, 2014),
what set them apart was the introduction of a novel set of arguments that stressed the
moral imperative to protect the human rights of the mentally ill by shunning trad-
itional healing sites and expanding biomedical psychiatric interventions. That these
two measures were chosen to build a moral case for India’s mental health reform while
other serious issues that affected the country’s mental health sector—including the
malpractices and poor infrastructure that beset the dispensation of psychiatric care
(National Human Rights Commission of India, 2008)—were ignored, is telling given
the timing of the pronouncements briefly after the release of the World Health
Organization’s (WHO, 2001) seminal report on mental health status.
The World Health Report of 2001—the most influential precursor of the GMH
movement (Patel, Minas, Cohen, & Prince, 2013) that provides a convincing argu-
ment for fashioning national and international mental health policies based on a
universal biomedical paradigm—had two clear-cut connections with India’s 2002
Supreme Court judgments (Jain & Jadhav, 2009). First, the WHO report made a
number of statements about traditional healing that were reflected in the Indian
Supreme Court rulings. For example, the report notes,
Since there are few specialized professionals, the community turns to the available
traditional healers. A result of these factors is a negative institutional image of the
people with mental disorders ... these [traditional] institutions are not in step with the
developments concerning the human rights of people with mental disorders. (WHO,
2001, p. 52)
The report reflects the Supreme Court order to legally regulate traditional healing
under the Mental Health Act, 1987: ‘‘Governments should also consider regulating
specific provider groups in the informal health sector, such as traditional healers.
Such regulations might include the introduction of practice registration to protect
patients from harmful interventions’’ (WHO, 2001, p. 95). Significantly, one of the
principal writers, R. S. Murthy who was the chief bureaucratic advisor to the
Indian government at the time, was also editor-in-chief of the WHO 2001 report.
The language and posture of the Supreme Court directives was thus not simply a
reflection of a long-standing ‘‘tradition vs. modernity’’ ideological undercurrent,
but indicated a decisive ‘‘change of episteme’’ (Davar, 2014, p. 275). In the next
section, I discuss the repercussions of this development in relation to the trans-
forming milieu of the Hindu healing temple of Balaji.
Sood 771
The Balaji temple: Changing ethos in the shadow of GMH
The Balaji temple, located 170 miles south of India’s capital Delhi in Rajasthan, is
an immensely popular site for treating psychological ailments that present as spirit
afflictions. In local parlance, the common term for spirit affliction is ‘‘sankat,’’
meaning distress/danger/misfortune in Hindi. Those who come to the temple to
seek healing from spirit afflictions are known as the ‘‘sankat-wale,’’ meaning ‘‘those
afflicted with the spirit.’’ The sankatwalas (anglicized) are often accompanied by
close relatives, who are referred to by the same term in the temple, since spirit
affliction in Balaji is regarded as a crisis that originates from conflicts in the social,
relational, psychological, and spiritual dynamics of the family’s life, not just the
individual. The resolution of such a crisis, too, requires extended commitment, for
which the sankatwalas spend long periods in the temple town.
Generally speaking, spirit affliction is assigned as a reason for visiting Balaji if a
person behaves in a socially inappropriate or destructive manner, suffers from
disturbing thoughts (mann mein sh
anti na hona), unexplainable fears (binn k
aran
bhay), vague bodily aches (shareer dard/ akarna), or physical symptoms unexplain-
able in medical terms. In terms of psychiatric diagnoses, although they are difficult
to ascertain given the sheer distinctiveness of illness categories in the temple, the
sankatwalas may be seen as presenting symptom complexes akin to psychosomatic,
dissociative, affective, and sometimes, psychotic disorders.
The demographic profile of the visitors to the temple is generally urban, middle-
class, and educated; seeking help from Balaji is not related to illiteracy, low caste
status or rural domicile (Dwyer, 2003; Pakaslahti, 2009). The majority of sankat-
walas cite two primary reasons for seeking treatment in Balaji: (a) the failure of the
biomedical system in treating their conditions, and/or (b) the temple as the last
resort of help after having tried multiple treatment options. In fact, more than 90%
of sankatwalas report having sought biomedical doctors, including psychiatrists,
before seeking treatment in Balaji (Pakaslahti, 2009).
In the past 10 to 12 years, the therapeutic milieu of the Balaji temple has trans-
formed in irrevocable ways and these changes are a topic of everyday conversations
among long-time visitors, which made it central to my experience of the field-site as
well. As I compared my observations with research on the temple conducted prior
to the 2000s, the changing ethos of Balaji gained even greater salience. In this
section, I show how changes in the therapeutic culture of the temple reflect the
rising influence of the GMH discourse in India, and how it has impacted the
healing experiences of the sankatwalas in negative ways.
Healing in Balaji
Healing in Balaji takes place by practicing ritualized trance (called ‘‘peshi’’), and a
range of religious prescriptions for remedying spirit affliction, which are elaborated
in temple booklets and manuals and shared among the community of healing-
seekers through word-of-mouth.
10
These sets of practices tend to be largely
772 Transcultural Psychiatry 53(6)
self-directed and flexible in both form and meaning, tailored as compilations of
disparate religious activities that gain therapeutic valence within the overarching
logic of Balaji as a site of healing. While the afflicted individual carries out the
majority of these therapeutic activities, the family members accompanying her are
active facilitators in the process, and may sometimes even become the primary
practitioners in the afflicted person’s stead. Continued engagement in these activ-
ities becomes transformative for the sankatwalas in a ‘‘cognitive-discursive’’ sense
(Seligman, 2010) as well as by means of the concrete bodily effects the performance
of these activities generates over a period of time. The sankatwalas’ everyday prac-
tices in the temple constitute a ‘‘therapeutic self-process’’ (Lester, 2005), engaging
both bodily sensibilities and rhetorical practices over a sustained period of engage-
ment to garner concrete healing effects.
As a way of delineating the rhetorical and embodied effects of the sankatwalas’
healing praxis, I present two key elements of the sankatwalas’ experiences of per-
forming these practices.
11
The first element is ‘‘tapasya’’—which may be translated
as the ‘‘practice of austerity,’’ which the sankatwalas use to define a broad orien-
tation to their daily practices in the temple. As Kirin Narayan (2008, p. 597)
describes, ‘‘Tapasya implies great self-restraint, physical endurance, dedication
and concentration; it is often undertaken with a goal in mind.’’ The sankatwalas
view their everyday lives in Balaji as being propelled by such an orientation of
tapasya, focusing as they do on inculcating strict discipline in daily bodily and
mental conduct, and undergoing long-term physical and emotional hardships to
receive the boon of health from the deities of the temple.
The sankatwalas who have been performing the temple practices for many years
begin to experience them as generative of ‘‘spiritual energy’’ or tapas/tap, which
they claim, lends fervor and vigor, and healing to their lives. Prema was one such
sankatwala I met in the temple,
12
who expressed her relationship with Balaji in
terms of a long-drawn practice she expressed as tapasya. Prema had more than a
decade long association with Balaji, and was considered a mentor by many long-
staying sankatwalas in the temple. As Prema put it: ‘‘the best way to understand
how Balaji heals is to say that it happens when we understand that suffering is
necessary for healing. It generates tap. Tap heals.’’
The sentiment that suffering through tapasya is a necessary precondition for
healing was routinely expressed by the sankatwalas as a way of explaining the
effects of their daily routines in Balaji. In a conversation with another sankatwala,
Shammi, she said ‘‘Our life in Balaji is tapasya . . . we try to generate tapas by living
in hardship and inculcating bhakti.’’ Here, Shammi mentions the second key elem-
ent that defined the sankatwalas’ daily practices, the notion of ‘‘bhakti’’ or devo-
tional love and belief in the miraculous grace of God that was actively nurtured by
the sankatwalas in the span of living in the temple. Prentiss (1999) sees the premise
of bhakti to be ‘‘active human agency,’’ one describing a certain kind of human
response to God that encourages ‘‘participation’’ (which is the root meaning of
bhakti) and ‘‘engagement with’’ God. Prentiss (1999) considers bhakti to be a ‘‘the-
ology of embodiment’’ because it is embedded in ‘‘all of one’s activities in worldly
Sood 773
life’’ (1999, p. 6). In speaking of bhakti, the sankatwalas invoke such a sense of
‘‘embeddedness,’’ an engrossment, both mental and physical, in the various
practices they perform in the temple, and which gives them a sense of agency in
directing their healing process themselves.
The religious notions of tapasya and bhakti translate into practices that often
involve causing extreme discomfort and pain (kasht dena;dandit karna) to the body
of the sankatwalas for the purpose of restraining/expelling the illness’ bad effects
(sankat b
andhna/k
atna).
13
Rituals involving extreme austerities, such as depriving
oneself of sleep, consuming tasteless or bitter-tasting foods, doing hard physical
labor for many hours of the day in the service (seva) of the temple’s deities as a
form of bhakti or devotion, hitting the body against the walls or moving the head in
repeated, circular motion for long periods of time to trigger dissociative states, are
only a few of the common practices that the sankatwalas engage in the temple to
achieve healing.
It is in doing these activities (Lester, 2005), in involving one’s body and submit-
ting these embodied experiences to the logic of the religious context in which they
are carried out that healing is accomplished in Balaji. As I discovered by closely
following the lives of the sankatwalas in the temple, the therapeutic process in the
Balaji temple may be especially powerful because it involves engagement with a
range of rhetorical strategies and embodied practices derived from religious dis-
course and rituals (Sood, 2013).
Balaji: A transforming milieu
The treatment process in Balaji, involving extreme acts that engage the body in
pain, does not align with GMH definitions of humane or evidence-based care.
However, as I have attempted to describe, understandings about what constitutes
bodily harm as well as evidence of treatment efficacy are complicated and conten-
tious in a place such as Balaji where healing is conceived as being self-directed and
its value garnered only within a complex web of dynamic cultural, religious, and
personal meanings. The repercussions of mental health policies blind to these
nuances of traditional healing are, nonetheless, evident in Balaji where certain
key healing rituals have been banned since 2002. These include, but are not limited
to, the practice of placing heavy stones on the body for extended periods of time,
14
standing on one’s head or being swung upside-down,
15
and constraining oneself
with lock and chains to restrict bodily movement (Dwyer, 2003; Halder, 2009;
Kakar, 1982). A large notice board announcing the outlawing of such prac-
tices—deemed ‘‘violations of the human rights’’ of those seeking treatment in
Balaji—has been displayed at the entrance of the temple (Figure 1).
The notice board located by the clock at the entrance of the temple states that
‘‘extreme’’ practices in the name of healing are considered a human rights violation
and the temple Trust mandates that the healing-seekers should not practice them.
In my last visit to the temple in 2012, I noticed steps taken by the temple
authorities to remove yet another crucial therapeutic ritual in the temple. A lock
774 Transcultural Psychiatry 53(6)
had been placed on a recently constructed tin-sheet door at the quad known as the
bhangiwara, a tiny space that had earlier been used by sankatwalas believed to be
afflicted by especially difficult spirits, and where these individuals spent long times
sitting, or hitting against the walls, as a symbolic way of ‘‘containing’’ their illness
(sankat b
andhna). In 2009–2010, the temple administration had begun regulating
the use of the space by allowing access to it only at certain times of the day on
selected days. When I asked a number of temple functionaries about the reason for
regulating access to the Bhangiwara, they collectively cited the temple’s concern for
the potential of ‘‘harm’’ (chott lagne ka darr) to those practicing the ritual. This
system of controlling the communal spaces inside the temple was new and con-
trasted with the open access that everyone had to the temple earlier. It indicates the
temple Trust’s effort to shun practices that are viewed as particularly ‘‘violent’’
(uttejit karne waali/daraane waalie/hinsak), or as too ‘‘treatment-focused’’ (ilaaj
sambandhi) in the eyes of the state.
As mentioned earlier, another important change at Balaji involves the local
healers or bhagats who had offered personalized healing services to a subset of
attendees inside the premises of the temple, where the power of the deities is
believed to be incarnate. In his ethnographic study of Balaji in 1992–1993,
Graham Dwyer (2003) wrote that these healers were a significant presence in the
temple’s day-to-day life. This no longer holds true. In 2003, the bhagats were
barred from conducting healing services inside the temple, even though they
have continued to do so in areas peripheral to the temple complex. This rule is
clearly a step towards delineating Balaji’s place as one of worship rather than as a
‘‘treatment facility,’’ for as temple functionaries consistently articulated, the temple
needs to move away from its image as a place meant only for ‘‘exorcisms’’ and
Figure 1. Notice board with government’s directive at the entrance of the Balaji temple.
Sood 775
‘‘occult’’ ritual practices (t
antrik gatividhiy
an), to one that any lay person could
visit as a devotee of the deities.
The manner in which the administration of Balaji upholds the government dir-
ectives adds another layer of complexity to how the GMH rhetoric works on the
ground. Even though the temple administration is aware that the temple’s raison
d’e
ˆtre is its reputation as a healing shrine, it is also highly conscious of how trad-
itional temple practices might be viewed negatively by the state. My conversations
with temple functionaries revealed that they were keen, in the longer term, to
attract a broader pool of general Hindu devotees to the temple, instead of only
those seeking healing. The temple administration was keen to change the image of
the temple that, as one temple functionary mentioned, creates ‘‘fear’’ (bhay) of the
place among the general public. My findings as consistent with those of Halder
(2009) who noted that ‘‘because of the spread of the reputation of the shrine, it is
possible that certain practices which could offend pilgrims have now been discour-
aged’’ (p. 163).
It would seem that the discourse on the objectionable nature of traditional
healing practices has been absorbed by the temple Trust, subject to the overarching
disciplinary power of the state only in as much as it constitutes a governable entity;
however, this change is not a blatant acceptance of state discourse on traditional
healing, nor is it motivated by the state’s punitive powers alone. Rather, it is a more
subtle and gradual shift in the everyday life of the temple that serves the future
interests of the temple as well.
The sankatwalas in Balaji, however, repeatedly told me that following the dis-
appearance of key healing rituals, and the temple Trust’s increasing control over
communal spaces, the power of the site had been becoming weaker. Prema, who
was among the longest visiting sankatwalas to the temple I knew, told me, ‘‘They
[security personnel in the temple] tell us now that if we still want to practice the
rituals we should do so in the privacy of our rooms in the dharmsh
ala [guesthouse],
not in the temple.’’ When I suggested that the reason for these rules could be that
they were harmful, Prema strongly disagreed; she claimed with certainty that no
sankatwala had ever been hurt by these practices in her long years of association
with Balaji. In fact, as I found later, the claim no one was ever harmed in practicing
these rituals was what authenticated the miracle (chamatk
ar) of Balaji’s healing for
the sankatwalas. None of the sankatwalas I met supported the disappearance of the
traditional healing practices and many of them voiced their concern that some-
thing of the healing powers of the temple had been lost since these practices had
disappeared. It remains to be seen how profound these transformations in the
Balaji temple will eventually be, and if the therapeutic culture of the site will be
entirely lost in a matter of decades or reconstitute itself in novel ways.
Conclusion: Consolidating two deeply opposed systems?
Despite the ubiquity and popularity of traditional mental health systems across the
world, international health policy historically has either ignored their contribution
776 Transcultural Psychiatry 53(6)
altogether, or viewed them as culturally appropriate but poor alternatives to bio-
medicine (Naraindas, Quack, & Sax, 2014). The latter view has become conspicu-
ous in GMH literature, in which traditional systems are described either as
‘‘irrational and inappropriate interventions [that] should be discouraged and
weeded out’’ (Patel, Boyce, Collins, Saxena, & Horton, 2011 cited in Mills, 2014,
p. 78), or selectively utilized for their mass appeal to facilitate the dissemination of
modern psychiatric knowledge and interventions to hitherto ‘‘ignorant’’ popula-
tions (Quack, 2012). In this article, I suggest that both of these approaches to
traditional healing are flawed. My description of the Balaji temple’s therapeutic
milieu suggests that attending to the nuances of traditional healing processes—to
how psychological suffering is conceived as a relational and spiritual concern, how
healing is approached and practiced with focused intention, and the collective
meaning-making that lends it effect—may be critical to assess the value of folk
healing sites as mental health resources.
As Cox and Webb (2015) point out, the mental health knowledge and practices
of the Global North draw upon certain conceptions of personhood and ethics that
can be problematic when exported to the Global South. They show how in some
non-Western settings, notions of personhood defined by greater emphasis on social
and ecological connectedness rather than individual strengths and deficits, as well
as an absence of formal discourses of legalization and medicalization of psycho-
social problems, offer distinctive ways of conceptualizing mental health. In the folk
healing traditions of South Asia, notions such as consent for treatment, violence,
healing, and recovery are socially derived dynamic constructs that differ from the
ways human rights or ideas of cure versus chronicity are operationalized and
applied in GMH. For example, while Western biomedicine views physical and
emotional pain as inherently undesirable, in many indigenous therapies it is actively
sought as a therapeutic experience (Glucklich, 2001).
16
The idea that pain, when
used in systematic ways as in traditional healing settings, can facilitate positive
psychological outcomes is supported by scientific research as well (Bastian, Jetten,
Hornsey, & Leknes, 2014; Sood, 2013; Xygalatas et al., 2013). Similarly, while
biomedicine assesses the efficacy of medical treatments in terms of how well they
eliminate ‘‘symptoms,’’ traditional mental health systems may aim for a range of
alternative outcomes, including an aesthetically pleasing healing experience
(Halliburton, 2009), communities of sufferers (Ranganathan, 2014b), and places
that offer hope and spiritual resilience to cope with suffering (Sood, 2013).
Thus, while ensuring the ethical and proper care of those with mental health needs
must remain the foremost GMH priority, the movement may, at the same time, need
to adopt a culturally nuanced perspective to distinguish malpractices that occur in
some traditional healing sites (which may be just as common in some psychiatric
settings across the world) from the overarching therapeutic philosophies that guide
these folk healing traditions. By offering a therapeutic practice that is self-directed
and fundamentally agentic, and that engages the individual’s larger relational,
social, and spiritual context, folk healing sites such as Balaji may offer an especially
effective healing process. Rather than being viewed as disposable, the availability of
Sood 777
plural medical systems in countries such as India can confer many advantages for the
goals of GMH (Basu, 2014; Halliburton, 2004; Sood, 2015), and needs to be studied
in greater depth to refine the GMH agenda and strategy.
Acknowledgements
I would like to acknowledge the support of the documentation center of the Bapu Trust for
Research on Mind and Discourse for the secondary research presented in this article. I
would like to thank Shri Balaji Maharaj Ghata Mehndipur Temple Trust, Dausa, and the
research participants of the study this article is based on for their generosity and hospitality.
Finally, I would like to thank the anonymous reviewers for their very helpful feedback.
Funding
The author(s) disclosed receipt of the following financial support for the research, author-
ship, and/or publication of this article: This work was funded by a National Science
Foundation Doctoral Dissertation Improvement Grant (Award # 0938889) and a
Wenner-Gren Foundation for Anthropological Research Dissertation Fieldwork Grant
(Grant# 8006).
Notes
1. Dargahs, or the shrines of Sufi saints, have served as an age-old subculture of Islamic
healing in South Asia (Bellamy, 2011).
2. The ethical clearance for this study was obtained from the IRB of the Washington University
in St. Louis, Missouri, USA—the author’s institution of graduate study.
3. Details of the legal actions initiated after the Erwadi tragedy have been accessed through
the Library and Documentation Center, Bapu Trust, Pune (Patel, 2011).
4. The Mental Health Act 1987 pertains to the functioning of Indian psychiatric institutions.
The Act may be replaced by the Mental Health Care Act in the future (‘‘The Mental Health
Care Bill,’’ n.d. The Mental Care Bill was introduced in 2013 and finally passed the Rajya
Sabha in 2016. It is still pending final approval in the Lok Sabha. http://indianexpress.com/
article/explained/new-mental-health-bill-provisions-rajya-sabha-2964545/).
5. Helene Basu (2014), in her ethnographic research on the ‘‘Dava & Dua’’ project at the
Mira Dattar dargah in West India offers another powerful example of how traditional
healing sites came to be viewed (and in the Mira Dattar case, co-opted and institutiona-
lized through a state-sponsored program) as spaces requiring psychiatric mediation after
the Erwadi incident.
6. Writ Petition (Civil) No. 562 of 2001, Saarthak and Achal Bhagat v. Union of India,
Ministry of Social Justice and Empowerment, Ministry of Health, Disabilities
Commissioner and other State Governments (Government of India, 2001).
7. Affidavit filed by Chief Secretary, Government of Manipur February 26, 2002, Accessed
from Erwadi Case Study Files, Library and Documentation Center, Center for Advocacy
in Mental Health, Pune, India.
8. Affidavit filed by Joint Commissioner and in-charge Special Officer, Legal Cell,
Government of Andhra Pradesh, March 18, 2002. Accessed from Erwadi Case Study
Files, Library and Documentation Center, Center for Advocacy in Mental Health, Pune,
India.
778 Transcultural Psychiatry 53(6)
9. The Anti-Superstition Act 2013 of the Maharashtra State Assembly (Maharashtra Act
No. XXX (No.30) of 2013) sees traditional healing as perpetuating superstition and
causing harm. Ranganathan (2014a) discusses the impact of this Act on the famous
Mahanubhav healing temples in Maharashtra.
10. As Carla Bellamy (2011) notes, healing in South Asian healing sites is often conducted
as a self-propelled, communal praxis among collectives of healing-seekers, bypassing the
therapeutic dyad of healer and patient common to religious therapies elsewhere in the
world.
11. One might think about these elements as akin to the ‘‘psychocultural themes’’ that
Thomas Csordas (1994) speaks of, which inform the supplicants’ self-orientation
within a healing system (p. 18).
12. The names of research participants have been changed.
13. Sankatwalas often literally ‘‘tie up’’ (baandhna) their sankat with an amulet thread to
the gates of the temple if they need to leave Balaji for brief periods; this ritual is viewed
as a ‘‘safety’’ practice that serves to indicate that the sankatwala will return to resolve the
troubles she is leaving behind in Balaji.
14. Perhaps, the last description of this practice comes from Smith (2006), from his visit to
Balaji in April 2001. He writes, ‘‘On a wide dirt track immediately behind the temple, the
visitor may see on any day a fairly large number of people with large heavy stones either
balanced on their heads or placed on several parts of their supine bodies. These are
meant to press on the bhut-prets (demonic spirits) in order to help expel them from the
victims’ bodies’’ (p. 160).
15. This practice, called ‘‘the hanging’’ (phansi) symbolized the hanging of the errant spirit
by the deity Bhairav, much like the practice of putting a culprit to death as capital
punishment. It was performed by standing upside down, and was banned sometime in
the early 2000s.
16. Ariel Glucklich (2001) suggests that the use of pain as catalyst for healing in
traditional mental health systems is akin to the meaning and power ascribed
to ‘‘sacred pain’’ in religious contexts around the world, that is, the notion that pain
acts as a ‘‘socially and spiritually integrative force’’ (p. 34), as a tool for self-
transformation.
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Anubha Sood, PhD, is a research affiliate in Anthropology at Southern Methodist
University, Dallas, USA. Her research interests lie at the intersection of psycho-
logical and psychiatric anthropology, the anthropology of religion, and gender
studies. She has worked extensively on gender and human rights concerns in
state-run psychiatric facilities in India. Her doctoral research project was a com-
parative study of women’s therapeutic experiences with psychiatry and religious
healing in urban North India. She recently completed her postdoctoral research on
a federally funded anthropological study looking at the experiences and treatment
decision-making of youth with first-episode psychoses in the American mental
health system.
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