Shortages of psychiatrists and continuing social stigma mean many mental illnesses remain untreated.
Erwadi, India – On a hot-humid day, Arun Kumar, 23, walks barefoot to a clinic near the entrance to the holy Erwadi Dargah shrine in India’s southern state of Tamil Nadu.
At the clinic, a nurse asks him what seems to be an incongruous question: “Have you finished your prayer?” When Kumar answers in the negative, the nurse firmly tells him to finish his prayer and then come back for medicine.
“Remember: first dua [prayer], then dawa [medicine], and then dua again,” she tells him.
Kumar grins widely on his way out.
“My mother and brother brought me here and left me,” explained Kumar, who works at a footwear shop nearby but originally comes from Sivaramnagar village, almost 200km away.
“They brought me here because I used to fight a lot and get very angry. My brother said he would come and take me home this month, but he has not appeared so far. Do you think he will come?” he asked anxiously.
Kumar’s notebook contains his diagnosis: mood disorder and mania. He was chained to a tree for a month by his family within the dargah’s premises, because he was violent and uncontrollable.
“They were afraid I will run away,” said Kumar. “But now I am taking medicines, and there is no anger in me. I smile now.”
Kumar’s story is different from those of thousands of other mentally ill Indians in only one respect: He has received treatment at Erwadi’s new psychiatric clinic, Dawa-Dua, which means medicine and prayer in Hindi.
For the past 200 years, people in southern India have believed the Hazrat Sultan Syed Ibrahim Shaheed shrine, popularly known as the Erwadi Dargah, has the power to cure the mentally ill.
“Dargah” is the name given to the tomb or shrine of a Muslim saint. Legend has it that the Raja – king – Ramnad, who was childless prayed here and was then blessed with a male heir. The ecstatic king gifted 2,428 hectacres of land to the shrine, and the belief was born that the holy seer in the dargah could work miracles.
The shrine receives an average of 100 devotees a month, including many families with mentally ill sons and daughters, who come to pray for the improvement of their children’s condition. In the past, many violent patients were chained for years to trees and poles within the dargah’s premises as spiritual healers prayed for them.
In 2001, however, tragedy struck. A fire broke out, burning alive 40 mentally ill patients who were chained up and unable to escape the flames. Regarded as one of the worst tragedies in the state, the horrific incident galvanised government authorities to begin a clean-up of the dargah.
Later that year, India’s District Mental Health Programme was launched, and funds were made available to help Erwadi’s devotees obtain comprehensive mental healthcare. But it was not until 2013 that government efforts to reach out to the religious establishment would bear fruit.
“The common belief is that illness, whether physical or mental, was God’s punishment and that medicine cannot cure it,” said Dr J Periyar Lenin, a psychiatrist and a key proponent of the Dawa-Dua initiative.
“We tried to convince the dargah committee for many years to allow the government to set up a psychiatric clinic to treat mentally ill patients [at the dargah], but they did not allow it,” the doctor said.
In 2013, the Tamil Nadu government sponsored a trip to the western Indian state of Gujarat, where the first Dawa-Dua programme had been launched. When the committee saw that medication was helping many patients in Gujarat, they agreed to allow Dawa-Dua.
“Religious leaders in the Gujarat Dargah told us that there was nothing wrong in allowing a clinic to be set up to help patients coming to our dargah,” said Amjad Hussain, president of the Erwadi Dargah committee.
“They told us that the medicines had more power since it was being administered within the holy premises of the dargah. They said that the medicines would not work outside the dargah, and that the holy seer magnifies the power of these medicines. We were convinced and decided to allow the clinic to be set up,” said Hussain.
Government doctors then swung into action. Spiritual healers within the dargah were trained to identify mental illness, and a small space within the dargah was allocated for a clinic. Slowly patients began to trickle in, sent to the clinic by spiritual healers in the Erwadi Dargah.
“Initially there was much scepticism,” said Lenin. “People used to ask us, ‘What can your pills do that prayers cannot?’ But eventually mothers saw their sons and daughters getting better. They kept returning to the clinic. We managed to treat people who had been wandering around in Erwadi with mental illness for 20 years.”
Saravanan Damodaran, 39, is a testimony to that. Damodaran had suffered from extreme schizophrenia and lived at Erwadi Dargah for seven years with his mother, sleeping on roads and eating donated food.
Now he has undergone treatment and is able to work at the Dawa-Dua programme’s vocational training centre, packaging cleaning powder for sale.
The government pays him $7.60 a month as part of the programme. “I used to feel weird, but I am better now,” said Damodaran shyly. “My mother is very happy that I am now able to earn money.”
‘We do not question beliefs’
Most family members of the patients say evil spirits have taken possession of their bodies, and only prayer can rid their children of these.
The dargah committee shares these beliefs. “You may say what you want but we have seen things here which are inexplicable,” said Hussain. “Only those affected by witchcraft can undergo such suffering, and these are not mental illnesses.”
Since its inception in October 2014, almost 1,000 cases have been registered with the clinic. Lenin, the lone psychiatrist at the clinic, treats 60 patients a day on average.
“We are aware that this clinic exists only because of the dargah. People come here only due to faith in the dargah’s powers,” said Lenin.
“We do not get into arguments over faith versus medicine or science. We do not question beliefs. Medicine works alongside religion here. That is why we ask all our patients to finish prayers first before they come for treatment.”
So successful is the programme the state government has earmarked an additional 7.5 million rupees ($114,000) to build a 50-bed psychiatric hospital in the area.
Doctors working with the Dawa-Dua programme are excited that it has sparked interest in other religious establishments as well. Nuns from the nearby Puliyangudi church, another place where the mentally ill are brought for prayers, have studied the programme in Erwadi and are keen on setting up a similar clinic.
“The idea is simply to help as many of the destitute and the mentally ill as possible,” said Dr C Ramasubramanian from Tamil Nadu’s District Mental Health Programme. “The government is keen on extending the programme across the state and rehabilitating more mentally ill patients.”
And when Kumar’s brother finally does come to take him home, he may not need to return to Erwadi to continue his treatment.
The government has launched an ambitious project of telepsychiatry through mobile vans that reach the most remote villages in southern India. Kumar could continue his treatment from his home in Theni, and keep the wide grin on his face.
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