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Poor, tragic India, with 1.4 billion people and only a handful of psychiatrists. Here in the enlightened West, we need only go online, choose an appointment time, answer questions from a checklist, and leave the gleaming white facility with an amber plastic cylinder of hope. If someone suffers from hallucinations, paranoia, depression, or intense anxiety in, say, northern India, what can they do?
They can visit a Sufi shrine. Badaun, for example, has more than 30,000 visitors a day, and people have been showing up there to be healed for more than 800 years. The opposite of sterile white, Badaun is full of color and fragrant with incense. It welcomes poor and rich alike, offering places to sleep for those who need long stays. And according to Bhrigupati Singh, an anthropologist from the Carney Institute for Brain Science who has researched there for eight years, they have more reason to hope than we do. The Sufi methodology—which we would dismiss as medieval, superstitious, at best a placebo and at worst, barbaric—often has far better outcomes than Western psychiatry.
If I went to Badaun, I would no doubt be appalled. On the rare occasions when visitors turn violent, they are chained to trees. But are a padded room, a straitjacket, and chemical sedation better? We remove someone’s ability to feel, to yell, to think, to gesture. Badaun simply restrains their ability to do harm. Many of their practices make our more advanced methods feel like euphemism—or dehumanization.
A woman Singh writes about for Psyche, giving her the pseudonym Madhavi, used Western medicine first. Clonazepam and lithium only dulled her. Psychiatrists asked about her childhood; no clues emerged. Still beset by episodes of rage, she and her husband drove six hours to Badaun, where, finally, he said, “the thing revealed itself fully, who did it, what it was.”
We would call that “individualized treatment,” and here, it would be a luxury. Most of us can only afford the sort of care that asks checklist questions from the Diagnostic and Statistical Manual of Mental Disorders.
The stats for treatment of severe mental illness have embarrassed and puzzled the West since the 1960s, when a series of studies by the World Health Organization showed that countries without extensive, advanced psychiatric support systems had better outcomes. Singh runs through possible explanations. First, these are “spirit-infused” cultures where hallucinations, voices, and wild fluctuations in mood are more common, less pathologized. He brushes this aside; he has seen how frightening and troubling the symptoms remain. Still, anything that removes that sense of dread and pathology seems an improvement.
Second, maybe the mental illnesses themselves are different? People at Badaun speak of an asrat, which can be translated as an effect or a difficulty, and they believe it to come from some rupture in close relationships. Does this mean they are not suffering from lifelong, chronic, severe illnesses but just family stress and conflict? They speak of shaq (suspicion) and vehem) unfounded doubt; of chinta (worry), tenshun (stress), and udasi (sadness). Are those symptoms different from paranoia, mania, anxiety, and depression? Doubtful. What is more likely is that the sense of isolation is relieved by seeing the asrat not as a psychotic break or permanent illness but as a distressing state that emerged from interactions with others and will affect, could even sicken, the entire family.
Benighted, an ignorant contradiction to our scientific knowledge. Yet mental illness does affect the entire family. We pay lip service to that fact, scolding people for “enabling” or being “codependent” or urging them to come to support groups for education and solace. But they remain the healthy, compassionate caregivers, and the person who is ill remains separated, labeled, cut out of the herd by their diagnosis.
Madhavi blamed her asrat on a property dispute with her brother-in-law’s family. Others blame sorcery, grudges, rivalries, business disputes. Those are far more comfortable causes than some invisible, incurable chemical imbalance that has arisen for an unknown reason and must be tinkered with using more chemicals. The latter view is closer to the empirical truth—but has more side effects. Blaming someone close to you might leave you stewing in bitter resentment, but it removes the stigma of having a broken or unreliable brain.
In Western culture, while familial or close interpersonal conflicts cause stress, we are more likely to shatter our nerves obsessing about work or money. Maybe we are lucky not to live so tightly bound, psychologically vulnerable to those around us? If we fall ill, we wind up with only ourselves to blame. In more group-oriented cultures, it is, as Madhavi’s husband said, “always someone from home, never an outsider. The nearer they are, the more dangerous they are.” For us that is only true of homicide.
No doubt I would be unnerved to see visitors to Badaun circling the shrine again and again, whipping themselves in ritual self-flagellation. We do that sort of thing privately, invisibly, blaming and ruminating and letting shame spiral into self-loathing—and our circles are harder to stop. No doubt I would also be upset by all the whirling and screaming—that, too, we do differently, spinning metaphorically, unable to be still, focus, or choose a path, and unleashing hysterical tirades when the confusion builds.
We are human; nothing is alien to us. The same experiences have different names, different assumed causes, different consequences. But the overlaps contain clues. Throughout South Asia, Singh says, the same treatment practices are used. There is no scripture that prescribes them; no diagnostic manual that dictates their conduct. Instinctively, people use water to cool the heat of hysteria or rage; amulets as talismans to draw strength from (like our amber bottles); daily circumambulations (we would urge a walk in nature); the expulsion of harmful spirits (we urge people to relive what haunts them, talk it out, find catharsis); and forms of trance (we lie someone on a couch and lead them into the past, zap their brain with electricity, or teach them mindful meditation).
How much healthier it would feel, if I felt a mental illness beginning to spiral into a psychotic episode, to stay a while at the shrine of a saint rather than checking myself into a mental hospital. I say this, but I would not go. I would opt for the little bottle filled with one of the miraculous drugs that have allowed so many people to live full lives. But why not a combined approach? Less pathologizing and compartmentalizing here; more resources and science there. What is done without money or expertise is of necessity more creative, and it stays more human. What is done with money is smarter (if not wiser) and can work different sorts of miracles. But those glorious feats do little good if they are offered with cool detachment and used by people who still feel disconnected, purposeless, and outcast.
Read more by Jeannette Cooperman here.
