Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A valuable work
- Mainak Mukherjee (5 July 2002)
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Good God
- sakathevan somasundram (6 July 2002)
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Temple as disturbing factor, rather than healing context
- Andrew H. Bowdler (7 July 2002)
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Soothing Lessons for Hospital Design
- Anthony S Hale (7 July 2002)
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Re: Temple as disturbing factor, rather than healing context
- Mainak Mukherjee (8 July 2002)
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Re: Temple as disturbing factor, rather than healing context
- G Eastgate (11 July 2002)
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Re: Temple as disturbing factor, rather than healing context
- Anand R T (11 July 2002)
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Spiritual Care is Important
- Cyrus A Abbasian (12 July 2002)
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Re: Re: Temple as disturbing factor, rather than healing context
- Andrew H. Bowdler, CF10 (12 July 2002)
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A Transcultural Message for Multicultural Britain
- K Valsraj (18 July 2002)
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Misleading Study
- Santhosh Rajagopal (19 July 2002)
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Time for Psychiatrists to grow spiritually .......
- Jatinder Singh Randhawa (19 July 2002)
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Healing temples may breed superstitions
- SP Kalantri (3 August 2002)
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Author's response
- Ramanathan Raguram, Venkateswaran, Mitchell Weiss, Jayashree Ramakrishna (12 August 2002)
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Researching Spiritual Healing
- Bridget T Heelan, Bridget Heelan (12 February 2003)
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Tradition/Psychiatry/clue
- captainjohann samuhanand, 560076 (4 September 2005)
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Mainak Mukherjee, Consultant Private Psychiatrist West Bengal, India - 713101
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Thank you for publishing the paper on Temple healing in India. Ours is a poor country with inadequate health service facilities and people take resort to traditional healing methods/cultures quite frequently. This is true for both physical and mental health. In any Indian community, religious healing or faith healing plays an important role in the overall healing scenario. This kind of work is unique in its class and is hence highly welcome. I thank the investigators for their serious attempt to capture the healing spirit of the temple in discussion and an unbiased opinion about the phenomenon. This is a pioneering work, which needs to be replicated at other sites and cultures too. Best regards. |
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sakathevan somasundram, Consultant Anaesthesiologist Pantai Cheras Medical Centre. 1 Jalan 1/96A, Taman Cheras Makmur, 56100 Kuala Lumpur, W.Malaysia.
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Everybody can benefit from visiting the House of God, as we all know there is a certain element of madness in all of us,except that the degree varies from individual to individual. |
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Andrew H. Bowdler, Teacher of EAL, Cardiff Cardiff County Council, CF10
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I read the article by Raguram et al, 'Traditional community resources for mental health: a report of temple healing from India', with interest. I am not a medical person, but rather a teacher. For most of the 1990's I lived and worked, with my family, in the Nepalese town of Pokhara, and within easy reach of several of the Hindu temples there. We were interested to see how many people we met with serious mental illnesses, who had had considerable contact with these or other temples. Whilst I cannot comment on the validity or accuracy of the particular case referred to in the article, I would like to point out that, as Hinduism is largely based on fear of the gods and what they might do to one, the prevalence of mental disturbance associated with such places is not surprising: simply attending some of these temples at important festivals, with the amount of blood and violence often adversely affected those Hindus with whom I was working on a daily basis. Yours Andy Bowdler |
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Anthony S Hale, Professor of Psychiatry, University of Kent at Canterbury, UK. St Martins Hospital, Canterbury CT1 1AZ
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Raguram et al have valuable lessons to teach the designers of modern mental health services in the UK. The enthusiasm for community care has had a profound impact on inpatient services, where the very disturbed who cannot be managed elsewhere are packed together with few thoughts for the quality of their environment, undiluted by the more mildly disordered. These environments are often counter-therapeutic and it is difficult to justify admitting patients to them except where issues of risk over-ride those of the benefit of a calming environment. This emphasis on the community at the expense of the hospital was emphasised by the findings of the CHI visit to North Birmingham (1). Somewhere in our system we have lost the asylum funtion along with the word. 1.CHI Clinical Governance Reports August 2001 North Birmingham Mental Health NHS Trust. http://www.chi.nhs.uk/eng/organisations/west_mid/north_brm/index.shtml |
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Mainak Mukherjee, Consultant Private Psychiatrist West Bengal, India - 713101
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Bowdler is wrong when he writes that "Hinduism is largely based on fear of the gods and what they might do to one...". From his limited and fragmented experience, he has tried to arrive at a generalized conclusion, which is a mistake. If there is anything wrong, it is with the interpretation of Hinduism, not Hinduism itself. Temples and other religious enviornments have profound soothing effect on the psyche of majority of Indian population and temples are often the centres for meditation for the common people. As Prof. Anthony Hale has correctly pointed out in his 'Rapid response', the role of community care has also played a very important part in the healing process in this particular situation. Best regards. |
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G Eastgate, Senior Lecturer, Developmental Disability Unit, University of Queensland Developmental Disability Unit, Mater Misericordiae Hospital, Raymond Terrace, South Brisbane, Queens
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Andrew Bowdler must be talking about a different Hinduism from the one I experienced travelling and working in India and Bangladesh some years ago. I found it to be a religion of noisy, rather chaotic joy. Or is Mr Bowdler a Christian missionary with the blinkered views I've seen before in such people? In a country where only the privileged can afford professional medical care and where social support is determined solely by the wealth and generosity of one's family, it's hardly surprising that people with mental illness gravitate to the temples. And so much the better if there is now evidence that the temple environment may actually aid recovery. Thank you to the researchers, and may the spirit of Muthuswamy live on. Regards, Gillian Eastgate |
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Anand R T, Visiting Faculty National Institute of Health and Family Welfare, New Delhi - 110067, INDIA
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Andrew H. Bowdler has misunderstood the concepts of health and religion as whole and Hinduism in particular. In the research done by Mr.Raghuram et al., I think the findings emphasised the spiritual belief which has a soothing effect on the mind and the body. Its not the place of worship of a particular religious group.
In the definition of health by WHO, it mentions spiritual well being also apart from physical, mental, social etc. It is the holistic approach to health that is being recognised off late by the so called 'modern world', which has been in the philosophy of hinduism and being practiced as away of life. The following studies substantiate the role of religion in health. - Spiritual beliefs may affect outcome of bereavement: prospective study Kiri Walsh, Michael King, Louise Jones, Adrian Tookman, and Robert Blizard BMJ 2002; 324: 1551. [Abstract] [Abridged text] [Full text] - THIS WEEK IN THE BMJ Spiritual belief resolves grief BMJ 2002; 324: [Full text] |
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Cyrus A Abbasian, SHO York Clinic, Guys Hospital, 47 Weston St. London SE1 3RR
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EDITOR - As an SHO on an acute psychiatric ward in Central London, I can understand why there was improvement in the condition of the psychiatric patients who resided in the Muthusamy temple in India as reported by Raguram et al. (1) Patients were brought into a place of ‘refuge’, with people similar to them who have understanding of their condition. This would mean less expressed emotion and distress, and better care of the individual, not only by the relative present, but also by temple staff, in a supportive, non-threatening environment. Here they can make sense of their mental illness. This is good ‘psychosocial’ psychiatric care. How does this contrast with an acute psychiatric ward? Patients are placed in a busy and emotionally charged environment, with others who may be more disturbed, usually with little support from relatives. There is in fact a limit on the latter’s visiting rights and patients may not have anyone to confide in. Here there is good ‘biological’ psychiatric care with emphasis on psychotropic medication. What is the way forward? We need a more holistic approach to inpatient psychiatric care, in order to try to ‘heal’ our patients, rather than just treat their psychopathology. Family members need to be fully involved. For serious mental illness, this needs to be done in a place where the individuals spiritual needs, which is important to most people, is looked after. Power of cultural beliefs and spirituality is very important, as seen by belief in the healing power of the Temple, and this is largely neglected in modern psychiatry. (2) This leads to increased stigmatisation of psychiatric wards, which are being seen more and more as places of containment instead of refuge. I wonder what would have happened if Raguram et al distributed psychotropic medication to the temple patients. I am sure there would be more improvement in their condition in a shorter period of time, as there would be ‘holistic biospychosocial healing.’ I hope for the day when psychiatric temples, or places of worship, which are not stigmatised, and where a cultural belief of healing prevails, will replace psychiatric wards. Here holistic biopsychosocial care of mental illness can truly be achieved. References; (1) Traditional community resources for mental health: a report of temple healing from India. BMJ 2002;325:38-40 (2) Spiritual care and psychiatric treatment, an introduction. Larry Culliford. Advances in Psychiatric Treatment, July 2002;Vol8:249-261 |
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Andrew H. Bowdler, Teacher of EAL Cardiff County Council, CF10
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I was interested in Mainak Mukherjee's reply to my post. I should, perhaps, have pointed out that I worked for a health and sustainable development organisation which celebrates its 50th year of service in Nepal this year. My comments were based on both my own experiences and comments made by medical people who have worked with the organisation for between 5 and 25 years. Interestingly, similar conclusions have been made by mental health workers with a second group which celebrates its 50th anniversary next year. Yours |
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K Valsraj, Staff Grade St. Thomas' Hospital London SE1 7EH
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Dear Editor It's interesting to note that this article has raised so much discussion and the responses are of varying views. The most striking feature of this article is the fact that the authors have attempted to make a very systematic approach to what had previously been documented as ethnographic accounts(1). This is a pointer in the right direction as the authors have approached this sensitive topic on a scientific basis and have tried to find answers in tune with the 'evidence base era' and at the same time respecting the traditions and beliefs of the people, the organisaton as a whole and the temple. The way forward would be for a randomised controlled study, but the authors have discussed the limitations at lenght(2). The relevance of this study particularly for transcultural Britain is the 'Transcultural Message' that it conveys. The reported evidence that it can match the effects of the new atypical antipsychotics is worth considering as we tend to focus very closely on the biological model and it is likely that people from ethnic backgrounds would prefer a psychosocial model of treatment to biological model and will still have the similar effects to the treatment and would accept the managemnet plan with utmost satisfaction. The possibility is that these findings could be replicated in other cultural beliefs as well and this would not be confined to the Indian subcontinent. This could have an important impact in planning service provisions catering to the local community needs and developing locally relevant services in muticultural Britain. The hidden messages in this article is that occupational therapy is a part of this healing process and the individual is motivated to engage in a structured daily activity. The process of healing is complete or 'holistic' as the focus is on the integration of the individual into the community. There is also lot of interpersonal therapy and supportive therapy that would be taking place. With the emphasis on new methods of service delivery like the home treatment teams, these community settings will have a leading role. These can lead to greater community participation and will also be a way forward in addressing stigma. Let us hope that there would be more studies of similar kind in the future and then we could read a review article. With stronger evidence there could possibly be more places of 'refuge' that would be set up in the local community. References 1Pakaslahti A Family Centered Treatment of Mental Health Problems at the Bajaji Temple in rajasthan In: Parpola A, Tenhunen S, eds. Changing Patterns of family and Kinship in South Asia. Helsinki: Finnish Oriental Society,1998 2Traditional Comunity Resources for Mental Health: A report of temple healing from India BMJ2002;325:38-40 |
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Santhosh Rajagopal, Jr.Specialist District Hospital,Thrissur,Kerala,India
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Dear Sir I read the aforesaid article with great trepidation. I am appalled that a team of eminent psychiatrists in this era of evidence-based medicine could even think of designing such a study. The urgent need in India today is to liberate Mental Health from the dark anterooms of black magic and sorcery. While it is conceded that the regimen followed in the said temple does not fit itself into such description, the study does not help in the endeavor of demystifying mental illnesses .The tragedy in one such “faith healing centre” in the same state in which a lot of mentally ill people were charred to death is too recent to have been forgotten. The tragedy happened because people were bound by chains .In the aftermath of the incident all such healing centres came under scrutiny. I was at the time attached to the District Medical Office in my home disrict.We received instructions from our Director to inspect all such centres. The clamp down ordered on such centres will have no meaning if such studies justify their acceptance. The fact that not a single patient had received Psychiatric help underscores the point that India needs more awareness regarding the rational understanding of mental illness. These kind of studies will ultimately lead to enforcing the traditional beliefs and myths about mental illnesses. Now the faith healers can quote BMJ!! The final conclusion regarding the explanation is almost ridiculous ,since nonthreatening environment etc .has always been known to improve symptoms .So should we revert to sanatoria? It is not often that one feels so strongly about such a paper in a reputed journal Thanks Dr.Santhosh Rajagopal District Hospital; Thrissur |
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Jatinder Singh Randhawa, Locum SHO in Psychiatry Fieldhead Hospital, Wakefield, WF1 3SP
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Firstly, i would like to congratulate Raguram and his team on making health professionals aware of the healing powers of temples and thus sowing the seed for spiritual care in the management of psychiatric disorders . We all understand that in his study, most of the patients had schizophrenia related dsorders, and if people with schizophrenia can benefit from being in temple then there is lot that depressed and personality disordered people can achieve .In my personal experience ,patients with personality disorder never get satisfactory Psychiatric help .It is nobodys fault .... the fault lies in understanding their needs .They dont need much medication ,what they need is spiritual boost up .I think through spirituality we can remodel their deranged thought process and prevent their mental status from further deterioration (that happens infew cases)!!! As far as healing is concerned , i think India is known for it, not just Hindu temples, there are numerous Mosques and Churches in India famous for healing.It is true that the places provide an excellent environment for the disturbed people but then it would be difficult to deny the fact that some priests have that power of healing and the person benefits without actually staying in the temple.Whatsoever it is ,faith is very important ;faith begets confidence and positive thinking ,which restores lost self esteem , all very important for mental health . It would take a very long time for a developing country like India to spread the message of spirituality in psychiatric care across the world.At this juncture, i believe a nation like Britain can actually contribute a lot and thats because Britain has a rich multicultural society ready to accept psycho-social model of treatment apart from Psychiatry being well developed here (plus good funding). can something be better than delivering mental health without adverse efects ? |
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SP Kalantri, Professor of Medicine MGIMS, Sevagram 442102,India
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EDITOR- Raguram et al report that when patients with psychiatric disorders stay briefly at a healing temple, most of them improve significantly.1 The authors describe at length the legend of Muthuswamy and endorse the local notion that the temple is indeed endowed with mysterious healing power. This suggestion could leave unwary patients with an unjustifiably favourable impression that healing temples can cure their diseases. An average Indian is deeply religious and superstitious. In Indian villages myths and misconceptions, blind beliefs and superstitions abound. Quacks and local healers thrive on illiteracy and ignorance of naïve and gullible people and try to hoodwink them into believing that they have magic cures for their ills. Muthuswamy temple might be an exception, for it doesn’t charge those who stay there, and more importantly, offers no specific healing rituals. But local newspapers and quacks may distort the conclusions of the study by pointing out that even a western journal recognises-and endorses-the hidden healing powers of Indian temples. The news might make thousands of people seek cure for their chronic diseases in temples and shrines. Even those with potentially curable diseases may choose not to see doctors in the hospitals, but seek shelter in holy places. The consequences of such an attitude could be terrible. History tells us that when TB was a formidable foe in the nineteenth century, people thought that their best chance of conquering TB was residing in a sanatorium.2 Patients-and their doctors-all over the world believed that salubrious environment, clear mountain air and nutritious food was the best way to ensure cure. Thousands of patients with TB chose Switzerland as their health destination. Myths were woven around sanatoriums, and those who could afford resided in what they considered ‘magic mountains’ for as long as ten years. The sanatorium made most patients feel better for a while, but their infection progressed unabated and killed all of them. Doctors and lay people took nearly seventy-five years to realise that sanatorium was a highly expensive- and terribly ineffective- intervention for getting rid off TB. I think healing temples for alleviating psychiatric disorders and magic mountains for curing TB share one thing: strong placebo effect fostered by local superstitions and traditions. It is true that patients with chronic and psychiatric diseases often do not go to their doctors. But we should avoid creating an impression among the public at large that healing temples are capable of restoring their health. SP Kalantri 1 Raguram R, Venkateswaran A, Ramkrishna J, Weiss M. Traditional community resources for mental health: a report of temple healing from India. BMJ 2002; 325:38-40. (6 July.) 2 Reichman LB, Tanne JH. Timebomb: the global epidemic of multi-drug resistant tuberculosis. New York: McGraw Hill Press, 2002: 20-21. |
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Ramanathan Raguram, Professor of Psychiatry National Institute of Mental Health & Neurosciences, Bangalore, India, 560 029, Venkateswaran, Mitchell Weiss, Jayashree Ramakrishna
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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. |
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Bridget T Heelan, locum consultant immunologist Dept of Immunology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, Bridget Heelan
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Researching Spiritual Healing EDITOR - - According to the report carried out by Raguram et al, patients with psychiatric disorders significantly improve when they stay in the Muthuswami temple, India.1 This study attributes improvements in the symptoms of patients, particularly those with chronic mental illnesses, to the effect of a caring milieu in which healing derives its power from cultural and religious values (the kind of supportive as well as family-centred environment that is greatly lacking in Western psychiatric institutions). Importantly, Raguram himself makes it clear in his response to those who have commented on the report that, while he does not endorse temple healing or wish to encourage sufferers of psychiatric illnesses to have recourse to traditional forms of spiritual healing in lieu of psychopharmocological or clinical treatments, he does offer a strong case for combining the two.2 However, the extent to which temple healing as found in India (or as found in other similar forms of traditional healing practice) could be incorporated into current drug- based psychiatric or neurophysiological frameworks has to be, as Raguram himself indicates, decided by the outcome of results of much needed additional research. Besides investigating the cultural epidemiological features of mental health problems, which makes reference to local experience and behaviour as well as to local understandings, Raguram correctly emphasises that greater assessment of the impact of traditional healing and its potential value is required. On this very point, and for the particular attention of those already engaged in this field of research (or who may be considering it) I would like to draw attention to one recent study of medical anthropology authored by Graham Dwyer.3 His work is a major new study of a healing temple in north India, a temple to which many psychiatric patients (as well as non-psychiatric sufferers) are brought for treatment and who appear to experience, the author attempts to demonstrate, a reduction in the symptoms of their disorders. Importantly, the author reveals that the family-centred therapy on offer at the temple, as well as the caring environment found there, both have beneficial effects for patients. He also discusses how some patients receive clinical attention and how this may be combined with traditional curing, suggesting the kind of combination Raguram speculates may be helpful is indeed well founded. Finally, it should be noted that Dwyer’s book is critical of psychiatric paradigms; yet it is of much value, and not least because it provides an assessment of key studies of spiritual healing undertaken in India (psychiatric investigations as well as studies with different or related research concerns). In my view, this book is most relevant for all researchers who wish to test or to explore further the findings and implications of the Raguram et al report, and I recommend Dwyer’s book to them. Bridget Heelan 1 Raguram R, Venkateswaran A, Ramakrishna J, Weiss MG. Traditional community resources for mental health: a report of temple healing from India. BMJ 2002; 325: 38-40 . (6 July.) 2 Raguram R. Author’s reply to responses. BMJ 2002; 325: 369 . (26 October.) 3. Dwyer G, The Divine and the Demonic: Supernatural Affliction and its Treatment in North India. London & New York: RoutledgeCurzon. (2003.) Competing interests: BH is married to Graham Dwyer |
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captainjohann samuhanand, retirred jet pilot Bangalore INDIA, 560076
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In StMathew 17/19 the disciples ask the Healer "why can't we cast him out?" Psychiatry has been asking this question in various forms and has given conflicting answers. We are now told that mentalillness is a biological based Brain discease.But it never provides a bilogical tool like brainscan,MRI,bloodtest etc to conclusively prove that this person is suffering from schizophrenia,OCD etc.They come out with the examples of Migraine headache and hypertension were biological markers are not available. This study would have not seen the light of the day in India where the organised associations will find this as a threat to their beliefs/livelihood but not as an attempt to find the TRUTH. One of the commentators has pointed out the case of 2002 when 25 mentallyill who were chained and burnt to death at the darga of Erawady.He forgets to mention that out of the 987 patients who continued to stay there AFTER the fire there were 217 patients who had inpatient/outpatient treatment in various mentalhospitals in chennai kilpauk.There were 19 patients who had inpatient treatment at NIMHANS ( to which the authors belong).Only Erawady PHS out of 470 PHS in tamilnadu had a fully qualified psychiatrist posted.Those patients at erawady were there not because of ignorance about psychiatry but inspite of it. The authors have thought out of Box and they should be commended for their effort. Before 1980s all the wandering mentallyill in India who used to be covered under the Indian Lunacy act enacted by the Britishers, used to be locked up in Prisons(whether criminal or not). some Prison officials who thought out of Box found that many mentallyillprisoners get cured of their positive symptoms when they were lodged in Cuddalore jail.May be the water in cuddalore,jail ambience or any other reason would have been a reason to enquire.But no one cares in India unless a journal like BMJ publishes it. I have seen my friends sister who must have been sufferring from schizophrenia being cured of her violence by a witch doctor.In a country of 1 billion people we have 3600 qualified psychiatrists.It is these traditional temples, dargas,churches which have been solace from time immemorial to all those who could not go to switzerland. My only daughter is currently under treatment at NIMHANS from 1996 for schizophrenia.Psychiatry(4 relapses and clozapine) has defenetily given her cure from violence but she is diasbled and in India our main worry AFTER OUR DEATH WHAT? It is here the traditional temples which give SECURITY,FOOD,SELFRESPECT can play a large part. Competing interests: None declared |
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