The Global Mental Health movement and its impact on traditional healing in India: A case study of the Balaji temple in Rajasthan

Abstract

This article considers the impact of the global mental health discourse on India's traditional 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

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 supernatural 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) constitute 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 therapeutic 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 position 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 psychological 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 disappeared 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).

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 formulation 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 landscape, 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 modern 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 practice” 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 traditional 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 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 collectivist terms (Kirmayer, 2012b). The effectiveness of traditional systems has been supported by a large body of social science research despite remaining untranslatable 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 distress 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 traditional systems as uniquely productive forms of mental health care (Sax, 2014), such silencing has been compounded in India after the Erwadi incident by accusations 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 psychiatric 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 governments 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 discharge 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 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 “psychiatrizing” 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 governments 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 considerably altered their therapeutic services in the years following the Supreme Court 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 traditional 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 argument 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 transforming milieu of the Hindu healing temple of Balaji.

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 shānti na hona), unexplainable fears (binn kāran bhay), vague bodily aches (shareer dard/ akarna), or physical symptoms unexplainable 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 sankatwalas 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 transformed 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 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 activities 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 practices in the temple constitute a “therapeutic self-process” (Lester, 2005), engaging both bodily sensibilities and rhetorical practices over a sustained period of engagement 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 performing 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 orientation 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 element that defined the sankatwalas' daily practices, the notion of “bhakti” or devotional 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 “theology of embodiment” because it is embedded in “all of one's activities in worldly 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 bāndhna/kātna).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 submitting 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 discourse 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 contentious 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 practices—deemed “violations of the human rights” of those seeking treatment in Balaji—has been displayed at the entrance of the temple (Figure 1).

Figure 1.

Notice board with government's directive at the entrance of the Balaji temple.

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 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 bāndhna). 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 contrasted 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 “occult” ritual practices (tāntrik gatividhiyān), 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 directives 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'être is its reputation as a healing shrine, it is also highly conscious of how traditional 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 discouraged” (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 disappearance 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 dharmshāla [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 (chamatkār) 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 something 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 altogether, or viewed them as culturally appropriate but poor alternatives to biomedicine (Naraindas, Quack, & Sax, 2014). The latter view has become conspicuous 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” populations (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 psychosocial 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 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.

Footnotes

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, authorship, 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

Anubha Sood, PhD, is a research affiliate in Anthropology at Southern Methodist University, Dallas, USA. Her research interests lie at the intersection of psychological 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 comparative 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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