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Traditional community resources for mental health: a report of temple healing from India

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7354.38 (Published 06 July 2002) Cite this as: BMJ 2002;325:38

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Author's response

We appreciate the interest, comments, and discussion of our article .
In response, several points concerning background and clarification may be
useful. We initiated this study after a previous enquiry into the cultural
aspects of schizophrenic illness among patients seeking treatment in a
psychiatric clinic. Not surprisingly, we found that traditional sources of
help, such as visiting traditional healers and healing temples, figured
prominently among patterns of help seeking. Previous studies of
schizophrenia in India have identified similar patterns of help-seeking
behaviour, and they have also acknowledged the positive impact on illness
course and outcome of a religious orientation of the families and persons
with psychotic illness. Motivated by our findings and the literature, we
wanted to examine more closely the process of healing in such treatment
settings, and we initiated an extensive ethnographic enquiry. Our recent
paper reports findings from one small component of that research.

Employing clinical epidemiological methods in the study of one
particular temple, we aimed to provide a descriptive account. The findings
concerning improvement in symptomatology were, in fact, as surprising to
us as to many readers of the article. In view of the variety of practices
and approaches that are employed in diverse traditional healing settings,
however, we emphasised a key point in the article that findings from one
site cannot, and should not, be generalized to all healing temples and
traditional healers, and our findings should not be construed as
endorsements of diverse practices.

On the other hand, consideration of our findings in the context of
thoughtful critiques of allopathic mental health systems and psychiatric
practices suggests that we should pay attention to the positive impact of
other approaches to helping people with mental illness, inasmuch as people
derive benefit from these practices. Our study shows the value of a caring
environment that endorses cultural values of a community in promoting
positive changes in serious, chronic mental illnesses. Insofar as this
simple ingredient may be lacking in many credentialed institutions for
mental health care, we should welcome—rather than fear misuse of—evidence
that psychopharmacological and neurophysiological frameworks are not the
only ones pertinent to effective psychiatric practice.

Our study was also concerned with the larger questions about the
sociocultural context of mental health care for the chronically mentally
ill in India. Community initiatives in this country have too often been
planned and implemented without sufficient consideration of the existing
institutions and practices that exist in all communities—diverse as they
are—for responding to mental illness. Before implementing policies and
establishing community programmes, it is important to inquire about the
nature of the existing system, so that it is clear what the interventions
intend to replace and/or complement. Proceeding with such a task is, of
course, not a trivial matter. Careful attention to the interactions
between modern professional and local traditional approaches, and how they
may relate to one another, is needed. Two aspects of such required
research involve an assessment of their impact with reference to local and
professional criteria, reported in this article. A second task involves
accounting for the cultural epidemiology of mental health problems as they
are understood locally, with reference to experience, meaning, and
behaviour. These findings have been presented in the thesis of
Venkateshwaran (2001), and will be elaborated elsewhere.

With growing interests in complementary approaches to health care,
and recognising that no community programme can be established or operate
in a sociocultural vacuum, we feel that such scientific studies are both
warranted and needed to encourage ongoing critical rethinking of
psychiatric practices, and to ensure the relevance, acceptance, and
effectiveness of community mental health programmes.

Competing interests: No competing interests

12 August 2002
Ramanathan Raguram
Professor of Psychiatry
Venkateswaran, Mitchell Weiss, Jayashree Ramakrishna
National Institute of Mental Health & Neurosciences, Bangalore, India, 560 029