Faith, fetters and freedom

Srivelayuthapalayampudur – the name of the village has more syllables than even someone with conversational ease in Tamil can manage. It lies in the shadow of the Palani hills in Tamil Nadu. At first glance it is no different from the myriad other villages that dot the landscape of rural India..It is a fine mid-morning in January, a week before the pongal harvest. A schoolboy whips a discarded bicycle tire down an alley in the enduring amusement of the hinterland. At the community well, young girls, their hair oiled and braided, skin seasoned with turmeric paste, dexterously balance heavy head-loads of water. A woman flattens spherical cakes of dung onto the walls of her home to dry in the scorching sun. A scared rooster scampers out of the way of an oxcart, returning with its modest harvest. Except for the dish antennae protruding out of a few roofs, this could be the timeless India of the imagination..To a large extent, it may still be that India – not the modernising country, the nuclear power, which boasts the world's largest pool of scientific talent. There are no scouts here looking for call-centre operatives or software code-writers. The only outsiders in Srivelayuthapalayampudur are those who arrive unannounced, asking simply for "the shrine"..The shrine is unlike the typical temples of southern India with their giant gopurams and intricately sculpted arches. Instead the Muthuswami shrine is built without embellishment, enclosing a simple courtyard over a grave. There is a single-storey structure with idols of local deities, and a complete absence of the major gods of the Hindu pantheon. This is the final resting place of a man who used to live in this village. His name was Muthuswami..In the sweltering heat of a South Indian afternoon, the priest has gone home for his obligatory siesta. He will only return for the evening puja. The temple is open and unguarded, and the only people about are a half-dozen young men, all wrapped in veshtis – a single piece of homespun cotton, loosely knotted at the waist..Each of them is shackled. There is a metal ring that wraps their feet, and a chain leads to cuffs on both hands. While their movement is impeded, the men are allowed to roam about the small campus. Despite this semblance of freedom, they can be pulled in at the whim of their minders..Inside the courtyard, those minders, a small group of women, are cooking a simple lunch. As the pots blacken with soot, neem twigs stir the rice and curry, and the rising fumes dye the air with both colour and aroma of spice..Singing Ravi.One of the young teenagers, Ravichandran, is keenly interested in the sudden presence of this writer, but unwilling to respond to overtures. His grandmother, Kanakambal, is nearby. "We will be here for as long as it takes, around four weeks or so," she says. "My grandson is the future hope of the family. I know that Muthuswami will cure him..Kanakambal is keen to demonstrate that there is nothing wrong with her grandson. She asks Ravi to speak in English, but he is not interested. Instead, he wants to sing, which is what he proceeds to do. With an excellent school record, a few months back Ravi's family had enrolled him with much fanfare in a college near their village. Then, however, something changed.."The boy was alright," Kanakambal explains. "He had just started college, but came unhinged when he was badly ragged there. Now he is unable to do anything. We have to be here till the priests tell us it is all right to go – this is our last refuge.".For the rural adolescent, going off to college had meant leaving the comfort of his village home and the embracing insurance of his extended family. Instead, he was suddenly living in a hostel full of city slickers. Within three days, the warden had called Ravi's relatives, asking them to take him back. The young man had barely been stopped from jumping off the roof of the college building..The family took him to what they call the Big Hospital, where, like many such places in India, resources were overstretched. In addition to a shortage of doctors, medicine and beds, the overworked staff had been inured by too many years of working under pressure to be of any real help. It took just one glimpse of the psychiatry ward, and Ravi's father whisked his son and family back home. Instead, they came to the temple of Muthuswami..Here, Ravi spends most of his time singing. Unlike at other Hindu temples, the curing process at Muthuswami's happens with neither Brahminical rituals nor the chanting of prayers. In fact, priestly intervention is minimal. The patients take part in a morning puja, and spend the rest of the day helping out with routine duties. No patients are charged for the temple's services, although most leave a donation when they depart. Over the last six decades, hundreds of mentally ill people have come to seek cures at the Muthuswami shrine. For centuries, people in similar situations have been visiting temples, Sufi dargahs and churches across Southasia, looking for peace and an answer to their troubles..Friday night séance.Some years back, the Muthuswami shrine also attracted another group of seekers – a team of Indian psychiatrists. They spent six months researching the clinical efficacy of the healing process, and published their findings in the British Medical Journal in 2002..Professor Ramanathan Raguram first heard about the village in the spring of 2001. At that time, he was working in Bangalore at the National Institute of Mental Health and Neurosciences, the country's premier research institute on mental illness. Raguram and his team found that the stories of the 'cure' available in Srivelayuthapalayampudur began about 60 years ago, around the time that Muthuswami died. For most of his life, Muthuswami had been considered a ne'er-do-well, who spent most of his time idling about the village. A few years before he died, however, a belief grew that his mere touch could cure people, particularly those who behaved 'funny'. After Muthuswami died, the stories about his 'gift' grew.."There is power in this place", one of the long-term residents told the visiting doctors. "A great man is buried here and, though he is dead, his healing presence is felt all the time. Otherwise how do you explain that with so many mentally ill patients, the place is so calm and peaceful?".According to the local folklore, Muthuswami's spirit eventually entered the body of his son, Palaniswami. Although Palaniswami himself says he cannot recall what happened that day, Ramani, the owner of the village's only teashop, was an eyewitness, and provides free beedis and biscuits to anyone who will listen to the story. According to Ramani, on that day the teenage Palaniswami first went into convulsions, and then blacked out. When he came to, he began speaking in his father's voice, recalling details from the past that Palaniswami himself would not have known..The 'spirit' said that it would visit every Friday. And so, the villagers built a small memorial, a samadhi, over Muthuswami's grave, which over the years has become the temple. At nine in the evening every Friday, 55-year-old Palaniswami arrives at his father's temple and squats on the floor. The large courtyard fills up with people. There is no music, no cacophony. Suddenly and without warning, Palaniswami goes into convulsions and collapses..When he comes to, there is silence. According to those who have gathered, this is no longer Palaniswami but Muthuswami himself, come again to visit his kinsmen and solve their problems. Subjects then appear to be 'chosen' by the spirit at random; a chosen medium suddenly goes into convulsions, and the gathered people are then able to ask the spirit personal questions..Temple respite.For millennia, Southasia has evolved a wide variety of approaches to mental healthcare. It is this wide mix that Raguram believes is the real strength of the Subcontinent's healing traditions. Having such a breadth of options, he says, allows the individual to negotiate illness with minimal influence by mental health professionals. "While we have always known that mentally ill people do seek traditional and non-formal modes of treatment," he says, "the 'establishment' has been prone to consider them irrational and unhelpful – not worthy of being bestowed with scientific scrutiny.".Raguram and his colleagues set out to address that oversight. For a period of six months, the team surveyed patients at the Muthuswami temple, identifying many with severe psychiatric illnesses, from depression to schizophrenia. They delved deeply into the backgrounds of both the patients' and those who cared for them, particularly focusing on individual experiences of the healing process. They attended the séances, followed patients back to their villages, and watched for any progress in those who stayed at the temple for longer periods of time. They also used a clinical psychiatric rating scale to test for any improvement. On average, the team found that the patients improved by around 20 percent – a figure comparable to patients given the latest medication in Western healthcare settings, and one that surprised the entire team..Raguram believes that it is the experience of residing in the temple for a period of time, rather than the therapy offered by the healer, that brings relief. "What they actually got for certain was tender loving care, in an environment in tune with their own cultural beliefs," he says. In the report published by the British Medical Journal, he argues that the Muthuswami temple in fact provides the refuge suggested by the term 'asylum', but in its most positive sense. "Instead of the long, often lifetime's stay in hospital, which became characteristic of asylum treatment, here a stay of only five weeks could bring notable improvement, indicating the value of a brief sojourn in a supportive environment.".Selvam, a 22-year-old tailor from Dharmavaram, 300 km away, could not agree more. "I first came here four or five years ago, and stayed for five weeks. I used to be afraid of everything. I went home when I got better, but the attacks returned and so I have come again. I like the atmosphere here – I don't feel that scared anymore.".The healing traditions at shrines like Muthuswami should not be dismissed as quaint anachronisms. Rather, says Raguram, they should be seen as cultural anchors, constituting a vital community resource for the mentally ill. He is concerned that discomfort about one's own cultural moorings, coupled with a lack of interest in exploring our traditional influences, has significantly hampered the psychiatric profession in Southasia..But Raguram is quick to insist that these temples are not magical remedies. "I must emphasise that it was not our intention to demonstrate the effectiveness of temple healing practices, but to draw attention to the need for empirical validation of these practices.".People, especially rural and low-income patients, are often brought here or arrive because of a loss of faith in the established system. The stigma attached to mental hospitals is also an important barrier. The mother of another patient at Muthuswami's says, "Nobody should know that our daughter is unwell. If we take her to a doctor, everyone will come to know. People will avoid us, stop visiting our home. They will also think less of us. That's why we brought her here. This is just like visiting a temple.".As such, these temple-based centres have remained the preferred ports of call for a vast segment of the public. Without any official recognition, however, this remains a completely unregulated sector, a fact that in the past has led to both manipulation and even catastrophe..Erwadi inferno.A few hundred kilometres to the south, where the narrowing tip of peninsular India tapers into the Indian Ocean, foam-flecked waves relentlessly lash the rocks that skirt the postcard-like serenity of the Sufi dargah in Erwadi. In the azure light of dawn, to the sound of the conch being blown for morning rituals, several hundred devotees throng to pay homage in a uniquely syncretic style of worship. In this shrine dedicated to a Muslim saint, the faithful use flowers, oil lamps and holy water in their prayers – a fluid adaptation of local symbols of worship, which explains the enduring popularity of Sufism in Southasia. This is the grave of Ebrahim Shah Valiyullah, a 12th century Moroccan mystic. For 800 years, devotees have believed that the blessings of the saint, the heat on the sands, the holy water and the oil from the lamps can cure mental illness..Wherever a shrine attracts large numbers, such as the Erwadi dargah, exploitation of the gullible is bound to happen. The langar, or community kitchen, provides free food for several hundred people every day. Add to this the innate charity of visiting pilgrims, and together there is an irresistible assurance of free food and a good potential income. Years back, enterprising individuals had set up around 15 illegal mental homes, charging fees to families and promising to send back their relatives when they recovered, or to simply take them off their hands for good. In fact, the patients were forced to beg at the shrine and eat for free at the communal kitchen. At night, some were shackled in shelters without even the most basic of facilities..Early one morning in August 2001, a spark at one of these illegal operations spread into a massive inferno, quickly engulfing the brittle thatch structure. By the time it was put out, 28 patients, all of whom had been in chains, had been charred to death, and 47 more grievously burnt. This was an even to make headlines throughout the region..Today, in the teeming bazaar outside the dargah, the usual suspects remain. Shamans and charlatans sell their own brands of taveez, or blessed talismans, which visitors queue up to buy. But ask around for directions to the illegal mental homes, and eager volunteers will hasten to tell you that those days are gone. The police now come and check every week to make sure that the mental homes remain closed..Indeed, convulsed into action by the horror of the Erwadi tragedy, the older and more famous faith-healing centres across Tamil Nadu are now stringently policed. According to officials, all of the inhumane shackles are off. But the Muthuswami temple falls outside the radar. Here, the inmates are constrained – although, unlike at Erwadi, they are not made immobile. Nonetheless, the manacling at Muthuswami is a deeply disturbing sight.."It is a discomforting experience, an affront to personal freedom," Raguram agrees. "Was there some metaphorical significance? Crucially, it is family that puts on these chains – not a legal authority, as happens elsewhere in the world. Also, here the chaining is not an act of abandonment like in Erwadi. The family stays with the patient throughout, and cares for them. There are no easy answers, but places like Muthuswami are well worth exploring before enforcing a change, legally or otherwise.".Past to future.The Erwadi tragedy galvanised a sleeping mental healthcare establishment. The government of India's district-level mental health programme swung into action – raiding illegal mental homes, closed them down and issuing warnings to faith-healing temples that chained their inmates. The response to official offers to transfer patients to state hospitals, however, was very weak. Many patients refused to move until they received 'divine' commands. If patients were forcibly ejected from one shrine, many would simply to go another..As early as 1999, the National Human Rights Commission (NHRC) in India indicted the severe state of the country's mental health sector. "The living conditions in many of these settings are deplorable, and violate an individual's right to be treated humanely and live a life of dignity," an NHRC report stated. "Despite all advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration.".There is a yawning gap between the formal and traditional systems of mental healthcare, even though the needs of patients are constantly expanding. For the sakes of the patients and their families, a way must be found to bring these two approaches together..In Gunasheelam, on the banks of the Kaveri River near Tiruchi in Tamil Nadu, is another famous healing centre. This is the Sri Prasanna Venkatachalapaty temple, a place full of ritual, and managed by traditional and taciturn Ayyangar Brahmins. For many years the temple has followed a routine of holy baths, Vedic ritual, flogging and fetters as the cure for its mentally ill patients. But after Erwadi and the resulting ban, a group of psychiatrists from the town managed to convince the trustees that they could work together..Pichumani Ayyangar, scion of a long line of hereditary priests at the temple and now its chief trustee, has been known in the past to be scornful of scientific enquiry into the temple's healing processes. "This is a matter between God and devotee. What role does a doctor have to play?" he once demanded. But he has mellowed in recent years. Perhaps it was due to the Erwadi tragedy and government fiat, or some other cause, but the traditional cure in Gunasheelam is now tempered with the caution of a modern clinician..The clinical intervention was the brainchild of a local psychiatrist, Dr G Gopalakrishnan, director of the Tiruchi-based Sowmanasya Hospital and Institute of Psychiatry. He approached the temple authorities in the aftermath of the Erwadi tragedy. "We explained to them that we wouldn't interfere with the ritual process," he explains. "They could continue with that as long as they also took the medicine we prescribed. They were quite amenable to that, and the patients are cooperative too.".The floggings have stopped, and the patients have been built a clean, well-lit hostel. There are fulltime social workers and regular clinical visits. Every patient's progress is monitored and they are administered recommended medicine, even as they follow the rest of the ritual therapy. Although the project is only two years old, the doctors believe that the non-hospital atmosphere is conducive to curing the patients. Traditional and modern healing practices are allowed to complement one another in Gunasheelam, in an approach that could be an important pointer to the future care of the mentally ill all over..Mental healthcare in the Subcontinent is in crisis due to the huge population and significant gaps in the system. Community initiatives, however, are often planned without adequate understanding of what is offered by existing institutions and established practices. Today's growing interest in complementary medicine should be seen less as a rejection of modern methods than as an embracing of the most basic of healing traditions: the importance of peace, time and tender care..For the health of both systems, neither modern medicine nor traditional healing should be allowed to exist in a vacuum, blithely ignorant of the benefits of the other.