The Management of Mental Illness Among Maharashtrian Families

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The Management of Mental Illness Among Maharashtrian Families: A Case Study of a

Mahanubhav Healing TempleAuthor(s): Vieda SkultansSource: Man, New Series, Vol. 22, No. 4 (Dec., 1987), pp. 661-679Published by: Royal Anthropological Institute of Great Britain and IrelandStable URL: http://www.jstor.org/stable/2803357

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THE MANAGEMENT OF MENTAL ILLNESS AMONGMAHARASHTRIAN FAMILIES: A CASE STUDY OF A

MAHANUBHAV HEALING TEMPLEVIEDASKULTANSUniversityofBristol

Fieldwork was carried out in a Mahanubhav healing temple in Maharashtra. Women'sresponsibility for the health andwell-being of the family is given a novel andliteralinterpretationin this setting. Women come as care givers accompanying a mentally ill family member. Butalthough they arrive as care givers and, indeed, continue to fulfil that function, they becomeafflicted by trance soon after their arrival. Women see this transformation into patienthood asresulting from their devotion to their families. Indeed, they pray that the illness be transferredfrom their sons, husband or daughtersto themselves. It is thought thatregulartrance will channelthe force of the earlierafflictionaway from the original patient. Thus women cultivate trance as asacrificial device to ensure the health andwell-being of the rest of the family. This view of tranceisvigorously contested by the temple experts, however, who see trance assymptomatic of femininepollution and character weakness. This lack of consensus regarding the nature of trance and thedistribution of affliction has cautionary implications for a monistic approach to religious andmedical institutions.

Women, illness and treatmentopportunitiesFieldwork was carriedout in a Mahanubhav temple in Maharashtrarenownedfor its trance inducing propertiesand its therapeuticpowers in relation to mentalillness. This setting was chosen because it was anticipatedthat large numbers ofpeople who considered themselves, or were considered by others, to bementally ill would gather there. The research had two kinds of distinct butinterrelated aims: one being of a psychiatric epidemiological nature and theother socio-anthropological. The psychiatric questions were prompted bythe apparentcontrast between the sex distributionof psychiatric disorderin thewest and in traditional societies. Western mental health surveys, admission andconsultation figures all point to the greater psychiatric morbidity of women.Psychiatric surveys in developing countries do not follow this trend.Epidemiological studies in non-industrialised societies do not appear toconfirm the excess psychiatric morbidity found among women in the westernworld. Although the field of cross-cultural psychiatry is large and flourishing,however, and although women's mental health is a topic of concern, theinteresting apparent difference between women's mental health in westernindustrialised societies and non-industrialised societies has not been investi-gated. A review of population surveys in India suggests the direction ofresearch. Incidentally, 'more population surveys for psychiatric illness havebeen conducted in India than in any other developing country' (Leff I98 I:90). A

Man (N.S.) 22, 66I-79


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662 VIEDA SKULTANSstudy of the prevalence and type of mental disorder in a village of West Bengalfound a lower rate of psychiatricmorbidity for women than for men (Elnagaretal. I97I: 50I). Astudy ooking attheprevalence f mental llnessamongfamiliesregistered with an urban health centreat Lucknow again found women to haveslightly lower rates of mental illness than men (Thacore et al. I975: 365). Thework of Carstairs and Kapur in Karnataka State in south India provides anexception in that their survey found a slight excess of female psychiatricmorbidity: only 6o per cent. of women in their sample were symptom free, asopposed to 68 per cent. of men (Kapur I975: 37). However, this slight biastowards women in no way approachesthe situation obtaining in the west (seeCarstairs& Kapur 976: I04). Epidemiologicalindings must, of course,beapproached with caution, since each survey employs different criteria forassessing mental illness, but it remains true that whatever the threshold levelused, a more equal male/female ratio is found than western findings would leadone to expect.Hospital in-patient andout-patient figures show that men outnumber womenby 3 to I (Kynch& Sen 983: 372) andpsychiatric dmissioniguresappear obein line with general hospital figures. It therefore seemed to be important toestablish the psychiatric morbidity of supplicants seeking indigenous forms ofcure at a healing temple, particularlysince there appears to be an implicit andwidely held assumption that 'neurotic' women form the bulk of the clientele oftraditional healersandhealing temples. Although unforeseenpracticalproblemsmeant that psychiatric assessments using the Present State Examination (astandardisedpsychiatric interview schedule, see Wing et al. I974) could not bemade, the anthropological interviews throw some light on the direction inwhich answers to the epidemiological puzzles might be sought.It is generally recognised that Indian women are held responsible for thefamily'shealth see,forexample,Abdullah& Zeidenstein982: 52). Moreover,health and, in particular,mentalhealth, may be viewed as aproperty of familiesratherthan individuals: 'South Asian ruralfamily members may not have anyclear perception of individual welfare, having instead some unsplittable com-pound notion of family well-being' (Kynch & Sen I983: 364). However, datafrom the Mahanubhav temple suggest that this compound notion of familywell-being remains intact when mental illness of a male family member isinvolved whereas when women encounter mental healthproblems the notion offamily wellbeing is not as 'unsplittable'as Kynch and Sen imply. It may be thatthe threat of separation from the family as well as the active role assigned towomen in the promotion of family health all contribute towards a lower rate ofmental disorder among Indian women.

Mysticalaccounts f illnessCommon to Maharashtrianpopular culture is a set of beliefs regarding illnessand misfortune: namely, that they are frequently the result of possession by aspirit or bhutbhada. n general, little interestis shown in discovering the identityof the bhutor its characteristics.Possession by bhutmay sometimes give rise totrancing, but more often it results in ill-health or bad luck. Often possessed


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VIEDA SKULTANS 663persons are not aware of suffering from bhut bhadauntil they come into thevicinity of ahealing temple. Here the power of the God or saint associated withthe temple or shrineis thought to draw out the possessing spirit, thus encourag-ing trance. In most cases of bhutbhada,karanis involved. Literally translatedtheword means 'things done' and there is an implicit understandingthat the thingsdone are bad. Stanley, in a paper on possession in Maharashtra,has translatedkaranias black magic (Stanley n.d.: 3). Perhaps the more general word witch-craft best covers the several uses of the term karani. tis thought that bhutbhadasusually brought about by means of karani. In such instances an angered orenvious person will either ask God to send a bhutupon their enemy, or else willrequest a mantrik magician)or devrishi shaman)to do so. Again, there appearsto be little interest in the technical details of karani,although the reasons for thebad feelings will be spelt out in some detail. Thus there exists a set of commonbeliefs about the spiritual provenance of illness which underpinthe widespreadresort to healing centres. Throughout Maharashtra many healing templesspecialise in the management and cure of spiritual afflictions. The Muslimshrines or dargahs n Bombay and Pune cater for many thousands a weekwho present with a wide variety of afflictions. The temples of the HinduMahanubhav panth (sect) also cater for spiritualafflictions, in particular,thosewhich give rise to mental illness.The Mahanubhav sect arose in the thirteenthcentury forming part of a widermovement of the time which emphasisedbhaktior devotion. The characteristicsof this sect which set it apartfrom orthodox Hinduism have been describedbyother scholars (Raeside I976; Feldhaus I983). Feldhaus cites the rejection ofcaste and the worship of idols, the refusal to acknowledge the scripturalauthority of the Brahmins, the creation of a female order of sannyasis andthe belief in a single God Parmeshwar as evidence of the heterodoxy of theMahanubhavs (Feldhaus n.d.: i) Despite doctrinal differences, however, theMahanubhav temples are frequented by all Hindus in times of trouble and atthe major Mahanubhav festivals. Temple users have in common poverty andilliteracy rather than sect affiliation.Feldhaus describes the Mahanubhav God as one who 'can be addressed in thelanguage of the people, not just in the Sanskritof the erudite and the religiousprofessionals, and can be approached by members of all castes and both sexes'(I984: 4). Thus the Mahanubhav temples provide the setting for a directexperience of and dialogue with God. Given the nature of the problemsbesetting many of the supplicants the immediacy of this relationship is impor-tant. Individuals and theirfamilies are drawn to the temples because they can getdetailed and personal information and advice about their particular health orfamily problems. Here unconventional and uncontrolled behaviour is toleratedand even encouraged. For example, dialogues with God take place duringtrance. Indeed, there is a divine precedentfor outrageous behaviour. Accordingto Mahanubhavbelief, Parmeshvar hastaken five avatars rhuma-n ncarnations:Krishna, Dattatreya, Cakradhara, Govindaprabhu, also known as GundamRaul, and Cangdev Raul. The biography of Gundam Raul portrays him asbreaking all the social and religious rules regarding proper behaviout. Feldhauswrites: 'The text shows that God transcends not only the rules of ritual and


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664 VIEDA SKULTANSmorality and the hierarchiesof caste, sex and learning, but the conventions ofpoliteness and sanity as well. For the text shows that Gundam Raul was God,and it shows thathe was mad' (I984: 4). Indeed, that madness is itself evidence ofhis divinity. Thus the Mahanubhav writings suggest that their temples areparticularlywell suited to the management of madness.

The Mahanubhav empleOne such centre which attracts large numbers of people considered mad isPhaltan. Phaltan is a small town with a population of about 40,000 in districtSatara. In terms of the religious geography of the Mahanubhavs, Phaltanoccupies animportant position. Itis thebirthplaceof Cakradhara, he founderofthe sect. There are three Mahanubhav temples in the town. One of these, theAbbasai temple catersfor the mentally ill. Here accommodation is provided forpatients and their families. Thirty-five small open dormitories surround thetemple (see fig. i). Each family is assigned a space measuring about 4' X IO'where they can store their cooking pots, bed rolls and other belongings.Families come from the whole of Maharashtraalthough most are from districtSatara.The average stay lasts threeto four months, although families areusuallypreparedto stay until the sick person is cured. Whatever the turnover of templeresidents, the temple remains full at all times. During the period of the study(November I984 to April I985) there were forty-one 'cases' for which aspiritualresolution or cure was being sought. All the caseswere investigated by lengthyinterviews with the patients and their families.The following picture emerged: therewere fifty-six women and twenty-eightmen supplicants. These figures appear to confirm both the anthropologists'account of healing temples and trancing and the views of priests and localtownspeople. However, when each case was looked at more closely a differentpicture emerged (see fig. 2). Twenty-two families came on behalf of a man,twelve came on behalf of a woman and nine women came alone. There weremore women than men accompanying the sick person. The greaternumber offemale caretakers and the fact that middle-aged and older women were oftenunaccompanied accounts for the greater overall number of women in thetemple. This might prompt a casual observer to conclude that the temple caterslargely for women's needs. In fact, the temple answers the needs of two quitedifferent categories of persons. In one category are women who come to thetemple because of some major upheaval or conflict in family relationships.Nearly all the women in this category aredivorced, widowed or childless andthey come to the temple alone. Frequently, their husbands have remarried.They come to the temple feeling depressed and tired. Without exception allthese women learn to trance at the temple. In a few cases women who appeartobe expressing family problems through theirtrancingareaccompaniedby otherfamily members. Although psychiatric interviews were not carriedout,1 it wasmy impression that many of these women would not score high on neuroticism.These women come to the temple, not so much because their symptoms areintolerable, as because their social situation is intolerable: they have failed toattainor have lost a respectable position in the family. In these cases the temple


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VIEDA SKULTANS 665

provides a refuge which in some cases becomes a permanent home.In the other category are people brought by their families because theirbehaviour has become intolerable and unmanageable. Many of them have spentlong periods in psychiatric hospitals and have been discharged as incurable.Everyone in this category manifests behaviour which falls far beyond thebounds of the socially acceptable. Quite how madness is defined, and the

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666 VIEDA SKULTANSbounds of social acceptability delineated, is not made altogether explicit.Although there is no dispute over who is designated as mad, the criteriadetermining madness do not appearto be given much thought. Given that thetemple is considered the appropriate refuge for the mad, there is a curiousabsence of reflection or theorising about madness. Answers to questions abouthow madness was recognised were hesitant and it became clear that there wereno explicit and detailed theories of the kind that anthropologists often expect.

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The Management of Mental Illness Among Maharashtrian Families