On August 6, 2001, twenty eight people labelled “mentally ill” died in a fire that burned down the makeshift hut in which they were kept chained in Ervadi, Tamil Nadu. The incident caused widespread public outrage and invoked pleas for preserving the human rights of mentally distressed people from the media, mental health and human rights activists, legal experts, professionals, NGOs and the general public.
Since 2001, it has become an annual media ritual to expose the government’s failure to regulate mental health care and highlight “the plight of the mentally ill,” by carrying a story on a faith healing place. This year NDTV carried a report on the Langar House Darga in Hyderabad1, alleging that “the mentally ill still continue to be chained in gross violation of human rights.” “With limited room in mainstream institutions of mental care, many who need attention get pushed to where either hope or desperation takes them,” the report concluded.
The NDTV report instigated discussions among some mental health and human rights activists, members of the Jan Mansik Arogya Abhiyan, and other interested parties. An immediate suggestion was to file a Public Interest Litigation against the Darga, and to use the law to shut it down. Others felt that legal intervention, while putting an end to inhuman practices like chaining, will also take away important community support systems that these places provide for people experiencing mental distress. This article presents some thoughts arising from these discussions.2
The Langar House Darga
The Darga of Syed Meeran Hussaini Quadri Bogdad at Langar Houz has long been a location of faith healing for people from all religions in Andhra Pradesh. Apart from a large number of people who come here seeking healing and cure, people also come to visit the tombs of saints and the mosque. The Centre for Advocacy on Mental Health, the convenor of the Jan Mansik Arogya Abhiyan, proposed its own investigation and organised a fact-finding visit to the Darga.
M.A. Moid and Mohammed Afzal undertook the visit and submitted a report. At the time of their visit, they found one person chained to a gravestone. Having talked to the people visiting the Darga, they found that there is a strong faith in the healing power of the Darga among the people and communities who came there. They saw the Darga as offering an alternative to state run mental hospitals which are seen as callous and costly. Distressed people come to the Darga on their own accord or are brought there by their families. Some had already tried allopathic doctors and had come to the Darga as a last option. In one case, a person who was unwell, found on the roadside, was brought there by the Police, as it was seen as a safe space within the community.
The Darga is also the location of informal community based care. Local NGOs are involved in distributing free medicines through a doctor who visits weekly. Another NGO provides food to everyone daily in the evening.
After the NDTV report, the Darga officials have stopped allowing people to stay overnight on the premises. This, in effect, has denied access to shelter from rain and sun and also to the healing process. Asked about the practice of keeping people in chains, the Darga officials disowned such practices and left it to the caretakers and families of people visiting the Darga. One official said: “We don’t ask anybody to stay or leave. It is a matter of their faith and well being but after the TV news we are asking the people to get a certificate from the police and mental hospital if they want to stay in this Darga.”
The Law as Recourse
Following the Ervadi incident the Supreme Court asked all states to submit a report on unregistered bodies detaining persons with mental distress. Several such bodies were shut down. The people who were in these places at the time of shutting down, and seen as needing treatment, were sent to state-run mental health facilities. Following the NDTV report, the Andhra Pradesh Human Rights Commission (APHRC) visited the Langar House Darga, and demanded that “those needing hospitalisation be shifted to the government hospital and others moved to government homes if they have nowhere else to go.”3
Both the Supreme Court and the APHRC see state-run mental hospitals as the “correct” place for treating people experiencing distress. But as any of us who have had the misfortune of spending time in one of these “institutions of care” can testify, they do not stand up to scrutiny. An empirical study of state run mental hospitals in the country by the National Human Rights Commission4 classified these institutions of care into two: one, hospitals that were “dumping grounds,” where people experiencing mental distress were incarcerated in violation of all human dignity; two, hospitals which provided some basic amenities, but were predominantly custodial, violating people’s rights to appropriate treatment and life in the community. The situation has not improved since 1999. Those who invoke state-run hospitals as appropriate healing spaces do not seem to think that the deprivations, control and restraint – both medical by use of drugs and ECT, and physical by strapping to beds, solitary cells and locked wards – within the walls of these hospitals constitute human rights violations. Would it constitute less violation of human rights because they are done within the legal boundaries of the Mental Health Act, in registered institutions, away from the eyes of cameras?
In the discussions that followed the NDTV report, the voices in favour of invoking the law to shut down faith healing spaces seemed to stem from a belief that such proactive action would have an impact on other institutions and make them re-examine their inhuman practices. However, as Moid and Afzal’s report showed, the increased scrutiny had resulted in the Darga disowning such practices and withdrawing even some of the beneficial services.
The Meaning of Healing
In the modernist discourse on health, mental health provision through regulated medical models is seen as progressive. Other knowledge systems and healing practices are considered reactionary. A good example of this is the WHO discourse on mental health in the so-called developing countries. The 1979 WHO study5 reported that people in India (Agra to be specific) did not possess correct knowledge of schizophrenia and that there were superstitious beliefs and misconceptions in how to get treatment. “Correct knowledge” meant western medical understanding of mental illness and “superstitious beliefs” referred to faith and religious healing. Yet, several WHO-sponsored studies in the following decades showed that people diagnosed with schizophrenia and related illnesses in so-called developing countries like India (including people in Agra who were part of the 1979 study) had better outcome measures compared to their counterparts in the so-called developed countries.6
Murphy Halliburton, in his study of experiences of people accessing ayurvedic, allopathic and religious healing in Kerala, posits the idea of “psychiatric pluralism” as a possible answer to why India is among the countries with the “wrong” knowledge and “right” outcome measures.7 He argues that it is the “fit” that people see between a regime of treatment and their own ideas of illness and wellness, and the access to different kinds of regimes that make people “get better.” What is considered “alternative mental health systems” in western countries – ayurveda, faith and religious healing, native medicine – is an integral part of what people in India access in times of need. While no regime worked for everyone across the board, the people interviewed for this study showed a great deal of initiative in moving from one system to another until they found what worked for them.
One of the few studies that compared outcomes of healing temples with that of clinical psychiatry was conducted in Tamil Nadu. They found a 20% reduction in the symptoms of schizophrenia, and commented that this “represents a level of clinical improvement that matches that achieved by many psychotropic agents, including the newer atypical agents.”8 They found that people saw this temple as providing them a supportive, non-threatening, reassuring setting, an “asylum” in the sense of sanctuary.
The above studies represent a welcome tendency in that they take community healing spaces and their roles more seriously. But generally, such spaces come into public attention or into discussions on mental health provision only in the wake of an incident like Ervadi, riding the waves of fear and revulsion. Liberal secular sections of the society see them as reactionary. Yet a large number of people use them regularly and arguably with less stigma than psychiatric hospitals.
We need to do more work in understanding what “healing” means to people who access these spaces. An insufficient understanding of these spaces creates confusions about the services that they provide. How can these important community resources be supported to provide their services more efficiently? For example, it is argued that some people are kept in chains in order to protect themselves and others from risk in a public open space like the Langar House Darga. Could it be possible to envisage the provision resources to create living spaces close to the Darga where people who visit the Darga for healing can remain safe yet unchained?
The Discourse of Human Rights
In the discussions, the concept of “human rights” remained unexamined. Is it a concept that has one universal meaning, despite the Universal Declaration of Human Rights? How do we respond to situations that we see as violations of human rights? In the discussions, an example of a single mother with a young child with autism was presented. Living close to railway tracks, the mother had taken to tying the child up in their home, while she worked in her small shop. The local Red Cross filed a police report against her for violating the child’s human rights. It did not occur to them that what the mother actually needed was some support to look after her child, day care or babysitting services, while she earned a living. In this case, the child definitely has a right not to be restrained. However, the disproportionate action to punish the already vulnerable mother only makes a vulnerable situation worse.
One of the suggestions that came out of our discussions was that Dargas and other such places should be studied as institutions so that there is a much better understanding of how they respond to people’s problems, their limitations and dynamics. They provide an important social function. It would be more appropriate to strengthen and nurture these spaces through resource allocation, improved management, and support through health and education centres.
Access to appropriate treatment is a human right – who better to decide what is appropriate than the person looking for healing? The right to family and community life is also a human right. Would these rights be granted if healing spaces are closed down and people forcefully taken to mental hospitals? Right now, that’s all that the law can offer.
1. Uma Sudhir, “Mentally ill patients chained for cure.” 6 August 2007.
2. I’d like to thank everyone who participated in the e-mail discussions after the NDTV report and Bhargavi for forwarding the mails.
3. NDTV correspondent, “APHRC reacts to treatment of mentally ill.” 7 August 2007.
4. NHRC, Quality of Mental Health Care. New Delhi: 1999.
5. WHO. Schizophrenia: An International Follow-Up Study. New York: Wiley.
6. Norman Sartorius, et al (1996). “Long-term follow-up of schizophrenia in 16 countries.” Social Psychiatry and Psychiatric Epidemiology, 31, 249–258; Hopper, K (2003). “Interrogating ‘culture’ in the WHO international studies of schizophrenia. In Robert Barrett & Janis Jenkins, Ed., The Edge of Experience: Schizophrenia, Culture, and Subjectivity. Cambridge: Cambridge University Press.
7. Murphy Halliburton (2004). “Finding a Fit: Psychiatric pluralism in South India and its Implications for WHO studies of mental disorder.” Transcultural Psychiatry, 41: 80-98.
8. Raguram et al (2002). “Traditional community resources for mental health: a report of temple healing from India.” British Medical Journal, 325: 38-40.