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International Journal of Disability, Development and Education
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Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan
Yasmin Nilofer Farooqia a University of the Punjab, Pakistan
To cite this Article Farooqi, Yasmin Nilofer(2006) 'Traditional Healing Practices Sought by Muslim Psychiatric Patients in
Lahore, Pakistan', International Journal of Disability, Development and Education, 53: 4, 401 — 415 To link to this Article: DOI: 10.1080/10349120601008530 URL: http://dx.doi.org/10.1080/10349120601008530
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International Journal of Disability, Development and Education Vol. 53, No. 4, December 2006, pp. 401–415
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Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan
Yasmin Nilofer Farooqi*
University of the Punjab, Pakistan
[email protected] Yasminand Francis Ltd 0 400000December 2006 Disability, Development and Education 53 2006 OriginalLahoreFarooqi 1034-912X (print)/1465-346X International Journal 10.1080/10349120601008530 (online) CIJD_A_200748.sgmof Taylor &Article Francis
This research explored the type of traditional healing practices sought by Muslim psychiatric patients treated at public hospitals of Lahore city, Pakistan. The sample comprised 87 adult psychiatric patients (38% male and 62% female). The patients self-reported on the Case History Interview Schedule that they had sought diverse traditional healing methods, including Homeopathy, Naturopathy (Tibb), Islamic Faith Healing, and Sorcery, for their psychiatric disorders prior to their current treatment from licensed psychiatrists, with the majority indicating they had sought more than one of these traditional healing practices. Patients with different psychiatric disorders sought multiple traditional healing methods for the treatment of their mental disorders: somatoform (73%); personality/conduct disorders (73%); schizophrenia (70%); affective disorders (68%); and anxiety disorders (55%). Proportionately more male than female patients used multiple traditional healing practices. The male patients showed a higher number of visits per week to traditional healers than their female counterparts. These different help-seeking practices may be attributed to gender discrimination in mobility and taboos attached to women’s consultation of male traditional healers. The study demonstrates Islamic religious traditions and Pakistani cultural norms affected the health care choices of Pakistani psychiatric patients.
Keywords: Gender discrimination; Islamic faith healers; Pakistani cultural norms; Psychiatric/mental disorders; Sorcerers; Traditional healing practices Introduction Communities that consider religion as the fundamental resource for their legislative framework give rise to cultures that knead traditions that are practiced through generations with faithful devotion (Al-Krenawi & Graham, 1997; Eliade, 1964;
*School of Psychology and Applied Psychology, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan. Email: [email protected] ISSN 1034-912X (print)/ISSN 1465-346X (online)/06/040401–15 © 2006 Taylor & Francis DOI: 10.1080/10349120601008530
402 Y. N. Farooqi Fillon, 2002; Spickard, 1995). Consequently, religio-cultural rituals influence thought and belief systems about the universe, creation, creator, human nature, health, disease, life, and death. Pakistan is one such country where religio-cultural traditions are a way of life and influence health-related practices (Atherton, 2005; Farooqi, 2005; Qidwai, 2003; Raja, 2004; Rizvi, 1989). This article explores the traditional healing practices used by patients in Lahore city of the Islamic Republic of Pakistan. The findings of this research may promote international understanding and sensitivity towards Pakistani Muslim healing practices, which are primarily based upon a body of traditional knowledge derived from unique Islamic religiocultural norms and values. The Islamic faith and values are the means by which the Pakistani community conceptualises and interprets mental health and mental illness. Policy-makers and providers of mental health services in Pakistan and other Islamic faith countries interested in launching mental health programmes that are responsive to patients could address patients’ unique religio-cultural norms and values. Religio-cultural Traditions in Pakistan Pakistan comprises more than 136 million identified Muslims who adhere to the Islamic faith (Ash, 1997). Pakistanis regard submission to the will of Allah (God) as fundamental to their existence, and strive to develop a strong super-ego (conscience) that is considered imperative to the development of a healthy personality. The majority of Pakistanis follow the teachings of the Holy Book of Quran and Hadith in their everyday life. The word Islam comes from the Arabic root word “Salaam” (Peace) and literally translates from Arabic to English as “Surrender—devotion to surrender/submit oneself to Allah’s will … accepting everything that happens in life, as it is and as it comes, with trust and serenity, listening with hope to the teachings of life” (Farooqi, 2005 p. 2). However, this “surrender” does not refer to a passive attitude of submission but a continued volitional effort to attune oneself to the eternal realities of which the focus is Allah. This deep acceptance of being in relation to Allah is believed to be health-promoting and to have healing qualities. Pakistanis believe that by observing life in unity with the will of Allah, the ego transcends all boundaries of concern for power, success, and wealth. Thus, for Muslims, submission to Allah becomes the ethical way of being for optimal mental health and lasting joy. Pakistan is a developing Muslim country with an alarmingly low literacy rate, a weak democratic system, a patriarchal system of status and role, and an unstable economy (Farooqi, 2005). It also has a culture that is an amalgam of rituals, traditions, and folk beliefs (Ghouri, 2004; Hassan, 1991; Hussain, 1998; Mubbasher & Saeed, 2001; Qidwai, 2003; Raja, 2004; Rizvi, 1989). Many of these rituals and traditions are based upon the Islamic ideology derived from Quran and Hadith— therefore, the beliefs in the existence of ghosts, jins, demons, and apparitions; the existence of the spirits of good and bad; miracle healing; the cult of saints; witchcraft; and pilgrimage (Ahmed, 1981; Akhtar, 1987; Eliade, 1964; Majid, 2001;
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Qidwai, 2003; Raja, 2004; Rizvi, 1989). There also are traditional and informal Pakistani explanations for the fortune or misfortune, luck or bad luck, and health or illness. Such traditions also include beliefs in dreams, premonitions, fairies, spirits (good and evil), use of certain items (taweez) for protection or to bring good luck, bad luck signs (e.g., the colour black); or folk beliefs and rituals about dying, burial, and the funeral. Some Pakistanis consider Sufis (a type of traditional healer) capable of applying magic to speak to the spirits of nature, performing both physical and spiritual healings, and discovering supernatural powers through ecstasy and fasting. Some Pakistanis also believe in the supernatural power and divine role of inanimate or non-living things or objects, such as Lake Saif-ul-Maluk in Kaghan, a scenic city in North West Frontier province of Pakistan (Almeida, 1996; Biddulph, 1986; Muhammad, 1980). They may also believe in exorcism, ancestor worship, voodoo or charms, or the supernatural powers of some individuals (Pirs) and Black magicians who can cast spells/magic or haunt or have “second sight”. Magicians are also believed to carry out other forms of communication through time and space. In their ancestor worship, some Pakistanis may also believe in the divine power and divine guidance of the dead (sajjada). The use of voodoo and charms with spirit possession that is prevalent in Africa, North America, Cuba, and Haiti is also practiced by some “Aamils” in Pakistan (Actionaid, 2002; Traditional Healers Fellowship, 2005). Some of the main reasons for these folk beliefs and rituals (e.g., exorcism, voodoo death, ancestor worship) seem to be the following: 1. The deep impact of Hinduism on the Pakistani Muslim community for more than two centuries prior to the partition of the Indo-Pak subcontinent in 1947. 2. The misunderstood Islamic religious beliefs due to ignorance, poverty, political and economic instability, poor formal education, and the deplorably low literacy rate. 3. The blaming of others (supernatural) for one’s misfortune or failures. 4. The lack of costly mental health services, especially in the rural remote areas of Pakistan. As a result, the material and cultural aspects of the aforementioned folk beliefs are manifested in relics of saints, voodoo dolls, and certain carvings. Believers also make pilgrimages to sacred groves and graveyards or shrines that also serve as sources of faith healing. The Central Role of Islam in Pakistani Perceptions of Health and Healing The majority of Pakistanis believe in the Islamic concept of self and metaphysical theory that furnished the very foundation of Humanistic and Existential theories. They believe that human beings are created on ahsan-ul-taqvim (the best of designs), but have also been given the choice of doing evil and, thus, descending into a state that is the lowest of the low. By observing life in accordance with the teachings of Quran and Hadith, an individual can differentiate what is good and what is evil.
404 Y. N. Farooqi Thus, the Islamic perspective of a normal person is not that of a hermit, but an active member of society whose needs are met in a spiritual or moral framework without causing a conflict with Islamic ideology. The Islamic faith explanation of mental illness is that it is caused by doubt and dissociation due to one’s own compelling needs or outer pressures that are counter to the teachings of the prophet and Quran. As doubt and conflict increase, the person may develop symptoms of mental illness. As a result, the majority of Pakistanis adhere to Shahaada—belief in One Allah and the Final Prophet Muhammad (peace be upon him)—to five prayers a day, to Zakat, to fasting, to Haijj/Pilgrimage to Mecca, and to other obligatory practices pertaining to diet, gender roles, dress, interpersonal relationships and family values to promote their mental and physical health (Hassouneh-Phillips, 2001; Lumumba, 2003; Mazhar, 2000; Mehmud, 2000). However, the ethnic, cultural, and national differences can influence the status, role, and mental health of Muslim women in each Islamic community (Haddad & Esposito, 1998; Hasan, 2002). There is an acute shortage of trained, licensed, clinical psychologists and psychiatrists in the public hospitals in Pakistan. As a result, many Pakistanis seek the most affordable spiritual/traditional treatment from Pirs, Aamils, Hakims, magicians, palm readers, folk healers, and other “quacks” rather than seeking medical, psychological, or psychiatric help from the licensed mental health professionals. The costly services available at private clinics and hospitals are beyond the capacity of the average Pakistani patient. The standard medical, surgical, and psychiatric facilities are available only in few large Pakistani hospitals and in big cities like Lahore, Karachi, and Islamabad. Consequently, all types of traditional faith healers enjoy a flourishing business in remote areas of Pakistan where people are mostly ignorant and mental health facilities are almost non-existent. However, the limited number of costly mental health professionals would not be able to cope if traditional healers stopped working (Naeem & Ayub, 2004). Mubbasher and Saeed (2001) and Qidwai (2003) found that in Pakistan the most commonly used traditional healing practices are: Homeopathy, Naturopathy (Tibb), Acupuncture, Chiropractics (Jerrah), Islamic Faith/Spiritual Healing, Sorcery, and Danyalism. Homeopathy is a therapeutic method that clinically applies the law of similarities and uses medically active substances in infinitesimal doses. The underlying rationale is that the same thing that causes the disease can also cure it (World Health Organization, 2001). Unani Tibb (or Naturopathy) uses herbs as its tool to fight ailments of any sort. The underlying rationale is that the dominant quality of an herb, coupled with its specific pharmacological action, counteracts the opposite abnormal quality in the body or any of its organs, or subsides, evacuates, alters, strengthens, or tones up as the case may be (Chishti, 2005). Islamic Faith/Spiritual Healing focuses on helping individuals clarify their values and work out a meaningful way of “being in the world”; that is, submission to the will of Allah and adherence to the teachings of the Quran and Hadith. The spiritual bond between Muslim Saints/Sufis and their followers facilitates empathetic understanding, catharsis, and insight into one’s intrapsychic and interpersonal conflicts.
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These Islamic faith healers are well versed in Quranic verses; Sunnah and Hadith. They recite some verses from the Holy Book of Quran that are related to the symptoms and then breathe onto a piece of cloth or paper, or a container filled with water, or an edible element or an amulet (taweez) that is then considered “blessed with Allah’s approval”. Then the patient is asked to keep it, and is promised that they will be normal soon. The patient is also given detailed instructions about their daily chores and advised to be regular in prayers and never loose hope in Almighty Allah. This process may be repeated depending upon the severity of the mental or physiological symptoms of the patient. Such faith healers are reported to be the major source of care for Pakistani people who have different mental disorders; particularly the women from the rural areas of Pakistan who are the most underprivileged, economically deprived, and poorly educated group. Sorcery practitioners use black magic and claim to have extraordinary powers through which they can hurt or help a person. Their therapy consists of first convincing the patient that someone (an enemy) has put a magic spell on them or on their son or daughter and that it will cost a certain sum of money or a particular number of goats or chickens for sacrifice to break the spell. The patient usually comes to the healer every week. Sometimes the healer (usually a man) may give some written magic words, which are usually written on paper, or numbers to the sick person to be worn near the neck (it is usually wrapped by the patients in a small piece of cloth or gold or silver so that it would appear like a chain/locket) or the sick person is advised to keep the words in their room. The palmists and soothsayers read the lines of the palm of patient’s hand and forecast the future. Or they claim to have knowledge of future events by calculating the movements of stars and their association with one’s birth date. Danyalism is a form of “Shamanism” that exists in northern areas of Pakistan. A study was carried out in the traditional village (Chaprote) Gilgit, in northern Pakistan, on the healing techniques of a native spiritual practitioner known as “Danyal” (Hussain, 1998). A Danyal is a village man/woman, who after satisfactorily completing a recruiting process, becomes an expert in applying indigenous methods to summon his/her Baraies (Spirits). In the village of Chaprote, where people relied more on spiritual thinking than on social sanctions, Danyal’s role seemed very important. In this northern region of Pakistan, a Danyal (as they now have become known) has various roles. He is a spiritual practitioner who provides information about the spiritual world, a healer who cures mental and physical illnesses; and a foreteller who predicts future events. Majid (2001) conducted a study in Allama Iqbal Medical College, Lahore, Pakistan on the effects of Tahajjid Sawlaat (the late night prayer) in curbing depression. In this study, the experimental group was advised to recite the Holy Quran; offer prayers and be busy with invocation (Zikr). The control group was advised to remain busy with home tasks. The Hamilton Depression Rating Scale was used as a pre–post measure with both groups. Twenty-five out of the 32 patients recovered from depression. The control group showed no change at all in their depressive symptoms.
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406 Y. N. Farooqi Goals of the Study The current research study investigated the following questions: 1. What types of traditional healing practices are sought by psychiatric patients of Lahore city, Pakistan? 2. Is the Islamic faith/spiritual healing method sought more often than homeopathy, Tibb, and sorcery? 3. Are there any differences in the choice of treatment for a particular mental disorder? 4. Are there any gender differences in the type of traditional healing practices sought by the psychiatric patients? 5. Do female psychiatric patients visit the male traditional healers as frequently as their male counterparts? Method Research Design For the present study, a retrospective ex post facto research design was used. Ray (2003) defined an ex post facto design as an attempt “… to use empirical procedures for suggesting meaningful relationships between events that have occurred in the past” (p. 248). Elmes, Kantowitz, and Roediger (2003) argued that in ex post facto research designs, “the results usually have occurred because of some naturally occurring events and are not the result of direct manipulation by an experimenter. Thus, the researcher categorizes or assesses the data and then probes for relationships” (p. 101). In the current research, the groups are naturally formed as per their diagnosis and gender; thus, an ex post facto design seemed to be the most suitable for this study. Goodwin (2003) also stated that in such designs “… groups are formed ‘after the fact’ of their already existing subject characteristics” (p. 215). Participants and Setting A purposive sampling technique was used, which resulted in a sample of 87 psychiatric patients (38% male patients and 62% female) who were hospitalised during a period of 7 months (February–August 2005), in the psychiatry departments of different public hospitals in Lahore City. Lahore is Pakistan’s largest city. The hospitals included the Services, Mayo and Jinnah Hospitals. Purposive sampling was used because of convenience, economy of time, and money (Goodwin, 2003). A probability sampling strategy could not be used due to the lack of a sampling frame applicable to Pakistani public hospitals and the high risk of attrition due to the stigma attached to psychiatric disorders in Pakistan. The inclusion criteria for the participants were adult psychiatric patients, treatment by a psychiatrist at a public hospital in Lahore city at the time of this study, and those who volunteered to participate in the project.
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All of the patients had been diagnosed for affective disorders, schizophrenia, anxiety, somatoform, or personality/conduct disorders by their treating psychiatrists. However, at the time of interview the patients’ psychiatric symptoms were in remission. Details of the demographic characteristics of the sample (from selected items of the Case History Interview Schedule (see Instrument) are presented in Table 1. Instrument
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A Case History Interview Schedule (in Urdu) and hospital records (in English) were used to gather a range of information (see Appendix). However, in this article only the information about demographic data, the type of traditional healing practices/ methods sought, and the number of times each traditional healer had been visited per week prior to receiving the psychiatric treatment are presented. The interview was conducted in Urdu, which is the local language and was well understood by the patients. It is the language used in Pakistani’s public hospitals. (Appendix is a translation of the Case History Interview Schedule.) Shaugnessy, Zeichmeister, and Zeichmester (2003) argued that “case histories are a source of hypotheses and ideas about normal and abnormal behavior” (p. 290). However, observer bias and biases in data collected through case history interview can lead to incorrect interpretations of case history outcomes. To control for this bias in the current research, hospital medical/psychiatric records were used to verify the data in relationship to diagnosis collected by Case History Interview Schedule. The hospital records were accessed by the author to verify the diagnosis and demographic data of the patients. Written notes were made to record the diagnosis. The responses regarding the number of visits were classified into three categories as follows: 0–1 visits per week = Few; 2–4 visits per week = Many; and 5–7 visits per
Table 1. Characteristic Gender Male Female Diagnosis Affective disorders Schizophrenia Anxiety disorders Somatoform disorders personality/conduct disorders Age Income (monthly) (Pakistani Rupees) Years of schooling/education Socio-Economic Status Descriptive characteristics of the sample (N = 87) Frequency Percentage
33 54 35 17 13 11 11 Range = 18–70 years Range = Rs. 300–10,000 Range = 0–14 Low and low-middle class
38 62 40 19 15 13 13
408 Y. N. Farooqi week = Almost Always. Numeric values of 0, 1, and 2 were then assigned for Few, Many, and Almost Always, respectively. Procedure The researcher sought official written permission from the administration of the aforementioned hospitals to include their hospitalised patients in the study. The interviewers sought verbal informed consent (in Urdu) from each of the patients. Verbal consent was sought because most of the patients had very little education and would have felt more comfortable with this mode of communication. The patients were interviewed by three Masters-level students of applied psychology with specialisation in the field of clinical psychology from the University of the Punjab, Lahore. The interviews took place at the patients’ bedsides in the wards and private rooms in various hospitals during a 1- to 2-week period. Uniform questions based on the Case History Interview Schedule were asked and the interviewers wrote the patients’ responses verbatim on to the Interview Schedules. Data Analysis The Statistical Package for the Social Sciences, Version 12 (SPSS 12.0) was used to analyse the data. The responses of the patients were tallied as per their options for the six types of responses related to the traditional healing practices (Homoeopathy, Tibb, Islamic Faith Healing, Sorcery, Multiple Traditional Healing Practices, and None). The nominal values of 1, 2, 3, 4, and 5 were used to dummy code Homeopathy, Tibb, Islamic Faith Healing, Sorcery, and Multiple Traditional Healing Practices. Bar diagrams were plotted to examine gender differences in the type of traditional healing practices sought and the number of visits per week to the healer(s). Differences in the treatment choices of different psychiatric groups and of male and female patients were established. Results All the patients indicated they had sought some type of traditional healing practices prior to seeking their current treatment. Female patients outnumbered male patients in the use of Multiple Traditional Healing Practices. The results in Table 2 indicate that more men than women sought Homeopathy (5% versus 2%). This is an interesting finding given that Homeopathy is considered relatively more advanced and a more expensive mode of treatment for psychiatric patients than Tibb, Islamic Faith Healing, or Sorcery. Indeed, more women than men sought Tibb (7% versus 1%), Islamic Faith Healing (7% versus 2%), Sorcery (9% versus 1%), and Multiple Traditional Healing Practices (37% versus 29%) for their psychiatric disorders. Table 3 presents the differences in the choice of treatment by type of illness. The findings suggest that 73% of both those with Somatoform and Personality/Conduct
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Table 2. Gender differences in type of traditional healing practices Type of traditional healing practices (%) Gender (N = 87) Male patients (N = 33) Female patients (N = 54) Homeopathy 5 2 Tibb 1 6 Islamic Faith Healing 2 6 Sorcery 1 9
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Multiple Healing Practices 25 32
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Disorders were likely to seek Multiple Traditional Healing Methods. The likelihood of opting for more than one traditional healing method showed a gradual decline for those with Schizophrenia (70%), Affective Disorders (68%), and Anxiety Disorders (55%) in this sample. Unfortunately, Anxiety Disorders are the most under-diagnosed and under-treated of the mental illness in Pakistani society because they are perceived to be an outcome of the patients’ “weak will-power”. This may be why those with Anxiety Disorders were least likely to seek multiple traditional healing methods. With respect to the question of frequency of visits to healers per week, the data shown in Figure 1 indicate that the male patients visited the healers more frequently than their female counterparts. This may be due to men’s mobility and economic autonomy within the patriarchal society of Pakistan.
Figure 1. Gender difference in traditional healing treatment choices
Discussion This study explored type of traditional healing practices sought by Muslim psychiatric patients being treated at the time of the study in public hospitals in Lahore City, Pakistan. It further investigated gender differences and differences among various sorts of psychiatric patients in the type of healing methods and in the number of visits they made per week to traditional healer(s) prior to their hospital treatment. The findings of this study suggest that traditional healing practices are prevalent among Pakistani psychiatric patients. Ironically, most of these traditional healing
Table 3. Type of traditional healing practices by diagnosis Type of traditional healing practices (%) Islamic Faith Healing 9 18 0 18 0 Multiple Healing Practices 68 70 55 73 73
Gender (N = 87) Affective disorders (N = 35) Schizophrenia (N = 17) Anxiety disorders (N = 13) Somatoform disorders (N = 11) Personality/conduct disorders (N = 11)
Homeopathy Tibb 9 0 15 0 9 3 0 15 0 9
Sorcery 11 12 15 9 9
410 Y. N. Farooqi
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Figure 1.
Gender differences in traditional healing treatment choices
methods were utilised more frequently by the female patients who are the most under-privileged, uneducated, vulnerable, and suggestible group in Pakistan, probably due to the patriarchal system, poverty, and illiteracy. The male patients reported more frequent visits to traditional healers. This is probably because Pakistani men are more mobile, educated, economically independent, and secure when compared with Pakistani women. Another reason may be that all traditional healers are men, and Pakistani women may be too shy and inhibited to consult these men for their personal and psychiatric problems. There are stigmas and taboos attached to female patients consulting male traditional healer(s). Consequently, traditional conservative Pakistani women would be inhibited in visiting them for treatment of their psychiatric disorders. Another reason may be that Pakistani Muslim women are dependent upon their male relatives to escort them to male traditional healer(s). Often, these male relatives are reluctant to take their female family members to male healers, mainly due to shame, embarrassment, and taboos attached to female patients’ mental illnesses. Consequently, in this study, fewer female patients received treatment from multiple healers, and made fewer visits per week compared with their male counterparts. In contrast, more male patients sought treatment from homeopathic practitioners probably because of the male patients’ freedom in their mobility, choice of treatment, and economic autonomy The findings of this study are consistent with the prior research (e.g., Hassan, 1991) that suggested most Pakistani psychiatric patients, especially the female patients, opted for Multiple Traditional Healing Practices. Such treatment choices seem to be closer to the patients’ religious and cultural traditions concerning mental health and mental disorders (Ghouri, 2004; Hasan, 2002; Hassan, 1991; Majid, 2001; Mazhar, 2000; Qidwai, 2003; Raja, 2004; Rizvi, 1989). This may be the
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reason why these researchers have advocated an integrated health care approach, which would lead to a more consistent, religiously and culturally sensitive health care system in Pakistan. The current study was limited to the psychiatric patients from public hospitals of Lahore City. Thus, the results cannot be generalised to the whole of Pakistani society or to its Muslim population in general. Future research must be carried out with larger samples of patients from public and private hospitals, with different religious and ethnic backgrounds, and from rural and urban communities in other provinces of Pakistan. Pakistani Muslims share common cultural elements with Muslim people of many developing South Asian countries who generally do not discuss their personal, physical, or mental problems with any one outside their family. Shame and guilt often are used to enforce norms in the family, which may lead to anxiety and depression. An individual’s emotional problems often bring shame and guilt to the family, and these in turn prevent family members from reporting psychological problems to licensed mental health professionals. Under such circumstances, traditional healers may be the best choice for the treatment of mental disorders in a religiously conservative country like Pakistan. In my clinical practice I have found that anxiety and affective disorders are the most under-diagnosed and under-treated mental disorders. Usually, patients with anxiety and depression are blamed for being weak-willed or guilty of violating Islamic religious traditions and cultural norms. However, in the cases of schizophrenia, somatoform, and personality/conduct disorders, the course of these illnesses is usually more chronic and the level of impairment in terms of the global functioning is so pervasive and threatening that families seek a variety of traditional healing methods for their family members. Conclusions An understanding of the religio-cultural background of patients with a mental illness and the strengths and weaknesses of the traditional healing practices should be known to all health care professionals in Pakistan so that they could treat the patient with less resistance from the patients and their relatives. Interestingly enough, most Pakistani traditional healers treat their patients tactfully in their religio-cultural context, at a very affordable cost. Consequently, patients prefer to seek help/counselling from these traditional healers rather than seeking timely, but costly, treatment from the well-trained and qualified psychiatrists. These traditional healers regularly advertise in newspapers and in the form of graffiti without any check from the Pakistani law enforcement agencies. Thus, further research work is recommended to find out exactly why patients prefer to seek treatment from traditional healers, especially from spiritual healers and sorcerers, for the treatment of their mental disorders Some questions remain regarding how Pakistani traditional healing practices would fare in comparison with modern psychotherapeutic and pharmacological
412 Y. N. Farooqi interventions in an era of evidence-based medicine (Raja, 2004). Moreover, it is debatable whether seeking treatment from spiritual/traditional healers would delay patients in receiving diagnoses and appropriate treatment via modern western medicine and psychiatry. Perhaps, in an age of information technology, there is a need for cooperation between spiritual healers and westernised health care workers. A positive interaction between the two health care systems could improve the mental health and well-being of people in the East and the West. References
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Majid, A. (2001). Healing power of faith and prayer: Religious and scientific perspectives. Journal of Hazara Society for Science-Religion Dialogue [electronic version]. Retrieved September 20, 2005, from http://www.hssrd.org/journal/spring2003/healing.htm Mazhar, U. (2000). What is spiritual abuse? Survivors of Spiritual Abuse. Retrieved September 14, 2005, from http://www.sosa.org/ Mehmud, H. T. (2000). The teachings of the prophet and modern sciences. Lahore, Pakistan: Illmourfan Publishers. Mubbashar, M. H., & Saeed, K. (2001). Development of mental health services in Pakistan. Eastern Mediterranean Health Journal, 7(3), 392–396. Muhammad, G. (1980). Festivals and folklore of Gilgit. Unpublished manuscript, Islamabad. Naeem, F., & Ayub, M. (2004). Psychiatric training in Pakistan. Medical Education Online [serial online]. Retrieved August 15, 2005, from http://www.med-ed-online.org Qidwai, W. (2003). Use of the services of spiritual healers among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan. Pakistan Journal of Medical Science, 19(1), 52–56. Raja, R. (2004). The role of religion and spirituality in health care. Journal of College of Physicians and Surgeons Pakistan, 14(8), 1–3. Ray, W. J. (2003). Methods toward a science of behaviour and experience (pp. 248–249). Belmont, CA: Wadsworth. Rizvi, A. A. (1989). Muslim tradition in psychotherapy and modern trends. Lahore, Pakistan: Institute of Islamic Culture. Shaugnessy, J. J., Zechmeister, E. B., & Zechmeister, J. S. (2003). Research methods in psychology (6th ed., p. 290). New York: McGraw Hill. Spickard, J. V. (1995). Body, nature and culture in spiritual healing. Retrieved November 30, 2005, from http://newton.uor.edu/FacultyFolder/Spickard/BodyNat.htm Traditional Healers Fellowship. (2005). Traditional healing. Retrieved September 12, 2005, from http://www.traditionalmedicine.net.au/tradheal.htm World Health Organization. (2001). Legal status of traditional medicines and complementary/alternative medicine: A worldwide review. Retrieved April 19, 2006, from http://whqlibdoc.who.int/hq/ 2001/WHO_EDM_TRM_2001.2.pdf
414 Y. N. Farooqi Appendix. Case History Interview Schedule (English translation) Name: Education: Monthly Income: Marital Status:
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Age: Occupation: Any other Income: Dependents in Family: Diagnosis given:
Hospital:
Q1.
What brought you here?
Q2.
Who brought you to this hospital and why?
Q3.
How long you have been here?
Q4.
Do you have any past history of this illness?
Q5.
What treatment was given for it in the past?
Q6.
During the last one year, which type of traditional healing method/s have been sought by you for the treatment of your current illness?
a. Homeopathy b. Tibb c. Islamic Faith Healing Practices d. Sorcery e. Multiple Traditional Healing Practices (more than one of a, b, c, or d) f. None.
Pakistani Traditional Healing Practices Q7.
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How frequently have you visited the healer/s per week during the last one year?
a. 0–1 visits b. 2–4 visits
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c. 5–7 visits
Q8.
How did you come to know about this healing practice/s?
Q9.
Has it helped you?
Q10. Is there anything else you would like to share with me?
Thanks for your cooperation!
International Journal of Disability, Development and Education
Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713425407
Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan
Yasmin Nilofer Farooqia a University of the Punjab, Pakistan
To cite this Article Farooqi, Yasmin Nilofer(2006) 'Traditional Healing Practices Sought by Muslim Psychiatric Patients in
Lahore, Pakistan', International Journal of Disability, Development and Education, 53: 4, 401 — 415 To link to this Article: DOI: 10.1080/10349120601008530 URL: http://dx.doi.org/10.1080/10349120601008530
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International Journal of Disability, Development and Education Vol. 53, No. 4, December 2006, pp. 401–415
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Traditional Healing Practices Sought by Muslim Psychiatric Patients in Lahore, Pakistan
Yasmin Nilofer Farooqi*
University of the Punjab, Pakistan
[email protected] Yasminand Francis Ltd 0 400000December 2006 Disability, Development and Education 53 2006 OriginalLahoreFarooqi 1034-912X (print)/1465-346X International Journal 10.1080/10349120601008530 (online) CIJD_A_200748.sgmof Taylor &Article Francis
This research explored the type of traditional healing practices sought by Muslim psychiatric patients treated at public hospitals of Lahore city, Pakistan. The sample comprised 87 adult psychiatric patients (38% male and 62% female). The patients self-reported on the Case History Interview Schedule that they had sought diverse traditional healing methods, including Homeopathy, Naturopathy (Tibb), Islamic Faith Healing, and Sorcery, for their psychiatric disorders prior to their current treatment from licensed psychiatrists, with the majority indicating they had sought more than one of these traditional healing practices. Patients with different psychiatric disorders sought multiple traditional healing methods for the treatment of their mental disorders: somatoform (73%); personality/conduct disorders (73%); schizophrenia (70%); affective disorders (68%); and anxiety disorders (55%). Proportionately more male than female patients used multiple traditional healing practices. The male patients showed a higher number of visits per week to traditional healers than their female counterparts. These different help-seeking practices may be attributed to gender discrimination in mobility and taboos attached to women’s consultation of male traditional healers. The study demonstrates Islamic religious traditions and Pakistani cultural norms affected the health care choices of Pakistani psychiatric patients.
Keywords: Gender discrimination; Islamic faith healers; Pakistani cultural norms; Psychiatric/mental disorders; Sorcerers; Traditional healing practices Introduction Communities that consider religion as the fundamental resource for their legislative framework give rise to cultures that knead traditions that are practiced through generations with faithful devotion (Al-Krenawi & Graham, 1997; Eliade, 1964;
*School of Psychology and Applied Psychology, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan. Email: [email protected] ISSN 1034-912X (print)/ISSN 1465-346X (online)/06/040401–15 © 2006 Taylor & Francis DOI: 10.1080/10349120601008530
402 Y. N. Farooqi Fillon, 2002; Spickard, 1995). Consequently, religio-cultural rituals influence thought and belief systems about the universe, creation, creator, human nature, health, disease, life, and death. Pakistan is one such country where religio-cultural traditions are a way of life and influence health-related practices (Atherton, 2005; Farooqi, 2005; Qidwai, 2003; Raja, 2004; Rizvi, 1989). This article explores the traditional healing practices used by patients in Lahore city of the Islamic Republic of Pakistan. The findings of this research may promote international understanding and sensitivity towards Pakistani Muslim healing practices, which are primarily based upon a body of traditional knowledge derived from unique Islamic religiocultural norms and values. The Islamic faith and values are the means by which the Pakistani community conceptualises and interprets mental health and mental illness. Policy-makers and providers of mental health services in Pakistan and other Islamic faith countries interested in launching mental health programmes that are responsive to patients could address patients’ unique religio-cultural norms and values. Religio-cultural Traditions in Pakistan Pakistan comprises more than 136 million identified Muslims who adhere to the Islamic faith (Ash, 1997). Pakistanis regard submission to the will of Allah (God) as fundamental to their existence, and strive to develop a strong super-ego (conscience) that is considered imperative to the development of a healthy personality. The majority of Pakistanis follow the teachings of the Holy Book of Quran and Hadith in their everyday life. The word Islam comes from the Arabic root word “Salaam” (Peace) and literally translates from Arabic to English as “Surrender—devotion to surrender/submit oneself to Allah’s will … accepting everything that happens in life, as it is and as it comes, with trust and serenity, listening with hope to the teachings of life” (Farooqi, 2005 p. 2). However, this “surrender” does not refer to a passive attitude of submission but a continued volitional effort to attune oneself to the eternal realities of which the focus is Allah. This deep acceptance of being in relation to Allah is believed to be health-promoting and to have healing qualities. Pakistanis believe that by observing life in unity with the will of Allah, the ego transcends all boundaries of concern for power, success, and wealth. Thus, for Muslims, submission to Allah becomes the ethical way of being for optimal mental health and lasting joy. Pakistan is a developing Muslim country with an alarmingly low literacy rate, a weak democratic system, a patriarchal system of status and role, and an unstable economy (Farooqi, 2005). It also has a culture that is an amalgam of rituals, traditions, and folk beliefs (Ghouri, 2004; Hassan, 1991; Hussain, 1998; Mubbasher & Saeed, 2001; Qidwai, 2003; Raja, 2004; Rizvi, 1989). Many of these rituals and traditions are based upon the Islamic ideology derived from Quran and Hadith— therefore, the beliefs in the existence of ghosts, jins, demons, and apparitions; the existence of the spirits of good and bad; miracle healing; the cult of saints; witchcraft; and pilgrimage (Ahmed, 1981; Akhtar, 1987; Eliade, 1964; Majid, 2001;
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Qidwai, 2003; Raja, 2004; Rizvi, 1989). There also are traditional and informal Pakistani explanations for the fortune or misfortune, luck or bad luck, and health or illness. Such traditions also include beliefs in dreams, premonitions, fairies, spirits (good and evil), use of certain items (taweez) for protection or to bring good luck, bad luck signs (e.g., the colour black); or folk beliefs and rituals about dying, burial, and the funeral. Some Pakistanis consider Sufis (a type of traditional healer) capable of applying magic to speak to the spirits of nature, performing both physical and spiritual healings, and discovering supernatural powers through ecstasy and fasting. Some Pakistanis also believe in the supernatural power and divine role of inanimate or non-living things or objects, such as Lake Saif-ul-Maluk in Kaghan, a scenic city in North West Frontier province of Pakistan (Almeida, 1996; Biddulph, 1986; Muhammad, 1980). They may also believe in exorcism, ancestor worship, voodoo or charms, or the supernatural powers of some individuals (Pirs) and Black magicians who can cast spells/magic or haunt or have “second sight”. Magicians are also believed to carry out other forms of communication through time and space. In their ancestor worship, some Pakistanis may also believe in the divine power and divine guidance of the dead (sajjada). The use of voodoo and charms with spirit possession that is prevalent in Africa, North America, Cuba, and Haiti is also practiced by some “Aamils” in Pakistan (Actionaid, 2002; Traditional Healers Fellowship, 2005). Some of the main reasons for these folk beliefs and rituals (e.g., exorcism, voodoo death, ancestor worship) seem to be the following: 1. The deep impact of Hinduism on the Pakistani Muslim community for more than two centuries prior to the partition of the Indo-Pak subcontinent in 1947. 2. The misunderstood Islamic religious beliefs due to ignorance, poverty, political and economic instability, poor formal education, and the deplorably low literacy rate. 3. The blaming of others (supernatural) for one’s misfortune or failures. 4. The lack of costly mental health services, especially in the rural remote areas of Pakistan. As a result, the material and cultural aspects of the aforementioned folk beliefs are manifested in relics of saints, voodoo dolls, and certain carvings. Believers also make pilgrimages to sacred groves and graveyards or shrines that also serve as sources of faith healing. The Central Role of Islam in Pakistani Perceptions of Health and Healing The majority of Pakistanis believe in the Islamic concept of self and metaphysical theory that furnished the very foundation of Humanistic and Existential theories. They believe that human beings are created on ahsan-ul-taqvim (the best of designs), but have also been given the choice of doing evil and, thus, descending into a state that is the lowest of the low. By observing life in accordance with the teachings of Quran and Hadith, an individual can differentiate what is good and what is evil.
404 Y. N. Farooqi Thus, the Islamic perspective of a normal person is not that of a hermit, but an active member of society whose needs are met in a spiritual or moral framework without causing a conflict with Islamic ideology. The Islamic faith explanation of mental illness is that it is caused by doubt and dissociation due to one’s own compelling needs or outer pressures that are counter to the teachings of the prophet and Quran. As doubt and conflict increase, the person may develop symptoms of mental illness. As a result, the majority of Pakistanis adhere to Shahaada—belief in One Allah and the Final Prophet Muhammad (peace be upon him)—to five prayers a day, to Zakat, to fasting, to Haijj/Pilgrimage to Mecca, and to other obligatory practices pertaining to diet, gender roles, dress, interpersonal relationships and family values to promote their mental and physical health (Hassouneh-Phillips, 2001; Lumumba, 2003; Mazhar, 2000; Mehmud, 2000). However, the ethnic, cultural, and national differences can influence the status, role, and mental health of Muslim women in each Islamic community (Haddad & Esposito, 1998; Hasan, 2002). There is an acute shortage of trained, licensed, clinical psychologists and psychiatrists in the public hospitals in Pakistan. As a result, many Pakistanis seek the most affordable spiritual/traditional treatment from Pirs, Aamils, Hakims, magicians, palm readers, folk healers, and other “quacks” rather than seeking medical, psychological, or psychiatric help from the licensed mental health professionals. The costly services available at private clinics and hospitals are beyond the capacity of the average Pakistani patient. The standard medical, surgical, and psychiatric facilities are available only in few large Pakistani hospitals and in big cities like Lahore, Karachi, and Islamabad. Consequently, all types of traditional faith healers enjoy a flourishing business in remote areas of Pakistan where people are mostly ignorant and mental health facilities are almost non-existent. However, the limited number of costly mental health professionals would not be able to cope if traditional healers stopped working (Naeem & Ayub, 2004). Mubbasher and Saeed (2001) and Qidwai (2003) found that in Pakistan the most commonly used traditional healing practices are: Homeopathy, Naturopathy (Tibb), Acupuncture, Chiropractics (Jerrah), Islamic Faith/Spiritual Healing, Sorcery, and Danyalism. Homeopathy is a therapeutic method that clinically applies the law of similarities and uses medically active substances in infinitesimal doses. The underlying rationale is that the same thing that causes the disease can also cure it (World Health Organization, 2001). Unani Tibb (or Naturopathy) uses herbs as its tool to fight ailments of any sort. The underlying rationale is that the dominant quality of an herb, coupled with its specific pharmacological action, counteracts the opposite abnormal quality in the body or any of its organs, or subsides, evacuates, alters, strengthens, or tones up as the case may be (Chishti, 2005). Islamic Faith/Spiritual Healing focuses on helping individuals clarify their values and work out a meaningful way of “being in the world”; that is, submission to the will of Allah and adherence to the teachings of the Quran and Hadith. The spiritual bond between Muslim Saints/Sufis and their followers facilitates empathetic understanding, catharsis, and insight into one’s intrapsychic and interpersonal conflicts.
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These Islamic faith healers are well versed in Quranic verses; Sunnah and Hadith. They recite some verses from the Holy Book of Quran that are related to the symptoms and then breathe onto a piece of cloth or paper, or a container filled with water, or an edible element or an amulet (taweez) that is then considered “blessed with Allah’s approval”. Then the patient is asked to keep it, and is promised that they will be normal soon. The patient is also given detailed instructions about their daily chores and advised to be regular in prayers and never loose hope in Almighty Allah. This process may be repeated depending upon the severity of the mental or physiological symptoms of the patient. Such faith healers are reported to be the major source of care for Pakistani people who have different mental disorders; particularly the women from the rural areas of Pakistan who are the most underprivileged, economically deprived, and poorly educated group. Sorcery practitioners use black magic and claim to have extraordinary powers through which they can hurt or help a person. Their therapy consists of first convincing the patient that someone (an enemy) has put a magic spell on them or on their son or daughter and that it will cost a certain sum of money or a particular number of goats or chickens for sacrifice to break the spell. The patient usually comes to the healer every week. Sometimes the healer (usually a man) may give some written magic words, which are usually written on paper, or numbers to the sick person to be worn near the neck (it is usually wrapped by the patients in a small piece of cloth or gold or silver so that it would appear like a chain/locket) or the sick person is advised to keep the words in their room. The palmists and soothsayers read the lines of the palm of patient’s hand and forecast the future. Or they claim to have knowledge of future events by calculating the movements of stars and their association with one’s birth date. Danyalism is a form of “Shamanism” that exists in northern areas of Pakistan. A study was carried out in the traditional village (Chaprote) Gilgit, in northern Pakistan, on the healing techniques of a native spiritual practitioner known as “Danyal” (Hussain, 1998). A Danyal is a village man/woman, who after satisfactorily completing a recruiting process, becomes an expert in applying indigenous methods to summon his/her Baraies (Spirits). In the village of Chaprote, where people relied more on spiritual thinking than on social sanctions, Danyal’s role seemed very important. In this northern region of Pakistan, a Danyal (as they now have become known) has various roles. He is a spiritual practitioner who provides information about the spiritual world, a healer who cures mental and physical illnesses; and a foreteller who predicts future events. Majid (2001) conducted a study in Allama Iqbal Medical College, Lahore, Pakistan on the effects of Tahajjid Sawlaat (the late night prayer) in curbing depression. In this study, the experimental group was advised to recite the Holy Quran; offer prayers and be busy with invocation (Zikr). The control group was advised to remain busy with home tasks. The Hamilton Depression Rating Scale was used as a pre–post measure with both groups. Twenty-five out of the 32 patients recovered from depression. The control group showed no change at all in their depressive symptoms.
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406 Y. N. Farooqi Goals of the Study The current research study investigated the following questions: 1. What types of traditional healing practices are sought by psychiatric patients of Lahore city, Pakistan? 2. Is the Islamic faith/spiritual healing method sought more often than homeopathy, Tibb, and sorcery? 3. Are there any differences in the choice of treatment for a particular mental disorder? 4. Are there any gender differences in the type of traditional healing practices sought by the psychiatric patients? 5. Do female psychiatric patients visit the male traditional healers as frequently as their male counterparts? Method Research Design For the present study, a retrospective ex post facto research design was used. Ray (2003) defined an ex post facto design as an attempt “… to use empirical procedures for suggesting meaningful relationships between events that have occurred in the past” (p. 248). Elmes, Kantowitz, and Roediger (2003) argued that in ex post facto research designs, “the results usually have occurred because of some naturally occurring events and are not the result of direct manipulation by an experimenter. Thus, the researcher categorizes or assesses the data and then probes for relationships” (p. 101). In the current research, the groups are naturally formed as per their diagnosis and gender; thus, an ex post facto design seemed to be the most suitable for this study. Goodwin (2003) also stated that in such designs “… groups are formed ‘after the fact’ of their already existing subject characteristics” (p. 215). Participants and Setting A purposive sampling technique was used, which resulted in a sample of 87 psychiatric patients (38% male patients and 62% female) who were hospitalised during a period of 7 months (February–August 2005), in the psychiatry departments of different public hospitals in Lahore City. Lahore is Pakistan’s largest city. The hospitals included the Services, Mayo and Jinnah Hospitals. Purposive sampling was used because of convenience, economy of time, and money (Goodwin, 2003). A probability sampling strategy could not be used due to the lack of a sampling frame applicable to Pakistani public hospitals and the high risk of attrition due to the stigma attached to psychiatric disorders in Pakistan. The inclusion criteria for the participants were adult psychiatric patients, treatment by a psychiatrist at a public hospital in Lahore city at the time of this study, and those who volunteered to participate in the project.
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All of the patients had been diagnosed for affective disorders, schizophrenia, anxiety, somatoform, or personality/conduct disorders by their treating psychiatrists. However, at the time of interview the patients’ psychiatric symptoms were in remission. Details of the demographic characteristics of the sample (from selected items of the Case History Interview Schedule (see Instrument) are presented in Table 1. Instrument
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A Case History Interview Schedule (in Urdu) and hospital records (in English) were used to gather a range of information (see Appendix). However, in this article only the information about demographic data, the type of traditional healing practices/ methods sought, and the number of times each traditional healer had been visited per week prior to receiving the psychiatric treatment are presented. The interview was conducted in Urdu, which is the local language and was well understood by the patients. It is the language used in Pakistani’s public hospitals. (Appendix is a translation of the Case History Interview Schedule.) Shaugnessy, Zeichmeister, and Zeichmester (2003) argued that “case histories are a source of hypotheses and ideas about normal and abnormal behavior” (p. 290). However, observer bias and biases in data collected through case history interview can lead to incorrect interpretations of case history outcomes. To control for this bias in the current research, hospital medical/psychiatric records were used to verify the data in relationship to diagnosis collected by Case History Interview Schedule. The hospital records were accessed by the author to verify the diagnosis and demographic data of the patients. Written notes were made to record the diagnosis. The responses regarding the number of visits were classified into three categories as follows: 0–1 visits per week = Few; 2–4 visits per week = Many; and 5–7 visits per
Table 1. Characteristic Gender Male Female Diagnosis Affective disorders Schizophrenia Anxiety disorders Somatoform disorders personality/conduct disorders Age Income (monthly) (Pakistani Rupees) Years of schooling/education Socio-Economic Status Descriptive characteristics of the sample (N = 87) Frequency Percentage
33 54 35 17 13 11 11 Range = 18–70 years Range = Rs. 300–10,000 Range = 0–14 Low and low-middle class
38 62 40 19 15 13 13
408 Y. N. Farooqi week = Almost Always. Numeric values of 0, 1, and 2 were then assigned for Few, Many, and Almost Always, respectively. Procedure The researcher sought official written permission from the administration of the aforementioned hospitals to include their hospitalised patients in the study. The interviewers sought verbal informed consent (in Urdu) from each of the patients. Verbal consent was sought because most of the patients had very little education and would have felt more comfortable with this mode of communication. The patients were interviewed by three Masters-level students of applied psychology with specialisation in the field of clinical psychology from the University of the Punjab, Lahore. The interviews took place at the patients’ bedsides in the wards and private rooms in various hospitals during a 1- to 2-week period. Uniform questions based on the Case History Interview Schedule were asked and the interviewers wrote the patients’ responses verbatim on to the Interview Schedules. Data Analysis The Statistical Package for the Social Sciences, Version 12 (SPSS 12.0) was used to analyse the data. The responses of the patients were tallied as per their options for the six types of responses related to the traditional healing practices (Homoeopathy, Tibb, Islamic Faith Healing, Sorcery, Multiple Traditional Healing Practices, and None). The nominal values of 1, 2, 3, 4, and 5 were used to dummy code Homeopathy, Tibb, Islamic Faith Healing, Sorcery, and Multiple Traditional Healing Practices. Bar diagrams were plotted to examine gender differences in the type of traditional healing practices sought and the number of visits per week to the healer(s). Differences in the treatment choices of different psychiatric groups and of male and female patients were established. Results All the patients indicated they had sought some type of traditional healing practices prior to seeking their current treatment. Female patients outnumbered male patients in the use of Multiple Traditional Healing Practices. The results in Table 2 indicate that more men than women sought Homeopathy (5% versus 2%). This is an interesting finding given that Homeopathy is considered relatively more advanced and a more expensive mode of treatment for psychiatric patients than Tibb, Islamic Faith Healing, or Sorcery. Indeed, more women than men sought Tibb (7% versus 1%), Islamic Faith Healing (7% versus 2%), Sorcery (9% versus 1%), and Multiple Traditional Healing Practices (37% versus 29%) for their psychiatric disorders. Table 3 presents the differences in the choice of treatment by type of illness. The findings suggest that 73% of both those with Somatoform and Personality/Conduct
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Table 2. Gender differences in type of traditional healing practices Type of traditional healing practices (%) Gender (N = 87) Male patients (N = 33) Female patients (N = 54) Homeopathy 5 2 Tibb 1 6 Islamic Faith Healing 2 6 Sorcery 1 9
409
Multiple Healing Practices 25 32
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Disorders were likely to seek Multiple Traditional Healing Methods. The likelihood of opting for more than one traditional healing method showed a gradual decline for those with Schizophrenia (70%), Affective Disorders (68%), and Anxiety Disorders (55%) in this sample. Unfortunately, Anxiety Disorders are the most under-diagnosed and under-treated of the mental illness in Pakistani society because they are perceived to be an outcome of the patients’ “weak will-power”. This may be why those with Anxiety Disorders were least likely to seek multiple traditional healing methods. With respect to the question of frequency of visits to healers per week, the data shown in Figure 1 indicate that the male patients visited the healers more frequently than their female counterparts. This may be due to men’s mobility and economic autonomy within the patriarchal society of Pakistan.
Figure 1. Gender difference in traditional healing treatment choices
Discussion This study explored type of traditional healing practices sought by Muslim psychiatric patients being treated at the time of the study in public hospitals in Lahore City, Pakistan. It further investigated gender differences and differences among various sorts of psychiatric patients in the type of healing methods and in the number of visits they made per week to traditional healer(s) prior to their hospital treatment. The findings of this study suggest that traditional healing practices are prevalent among Pakistani psychiatric patients. Ironically, most of these traditional healing
Table 3. Type of traditional healing practices by diagnosis Type of traditional healing practices (%) Islamic Faith Healing 9 18 0 18 0 Multiple Healing Practices 68 70 55 73 73
Gender (N = 87) Affective disorders (N = 35) Schizophrenia (N = 17) Anxiety disorders (N = 13) Somatoform disorders (N = 11) Personality/conduct disorders (N = 11)
Homeopathy Tibb 9 0 15 0 9 3 0 15 0 9
Sorcery 11 12 15 9 9
410 Y. N. Farooqi
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Figure 1.
Gender differences in traditional healing treatment choices
methods were utilised more frequently by the female patients who are the most under-privileged, uneducated, vulnerable, and suggestible group in Pakistan, probably due to the patriarchal system, poverty, and illiteracy. The male patients reported more frequent visits to traditional healers. This is probably because Pakistani men are more mobile, educated, economically independent, and secure when compared with Pakistani women. Another reason may be that all traditional healers are men, and Pakistani women may be too shy and inhibited to consult these men for their personal and psychiatric problems. There are stigmas and taboos attached to female patients consulting male traditional healer(s). Consequently, traditional conservative Pakistani women would be inhibited in visiting them for treatment of their psychiatric disorders. Another reason may be that Pakistani Muslim women are dependent upon their male relatives to escort them to male traditional healer(s). Often, these male relatives are reluctant to take their female family members to male healers, mainly due to shame, embarrassment, and taboos attached to female patients’ mental illnesses. Consequently, in this study, fewer female patients received treatment from multiple healers, and made fewer visits per week compared with their male counterparts. In contrast, more male patients sought treatment from homeopathic practitioners probably because of the male patients’ freedom in their mobility, choice of treatment, and economic autonomy The findings of this study are consistent with the prior research (e.g., Hassan, 1991) that suggested most Pakistani psychiatric patients, especially the female patients, opted for Multiple Traditional Healing Practices. Such treatment choices seem to be closer to the patients’ religious and cultural traditions concerning mental health and mental disorders (Ghouri, 2004; Hasan, 2002; Hassan, 1991; Majid, 2001; Mazhar, 2000; Qidwai, 2003; Raja, 2004; Rizvi, 1989). This may be the
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reason why these researchers have advocated an integrated health care approach, which would lead to a more consistent, religiously and culturally sensitive health care system in Pakistan. The current study was limited to the psychiatric patients from public hospitals of Lahore City. Thus, the results cannot be generalised to the whole of Pakistani society or to its Muslim population in general. Future research must be carried out with larger samples of patients from public and private hospitals, with different religious and ethnic backgrounds, and from rural and urban communities in other provinces of Pakistan. Pakistani Muslims share common cultural elements with Muslim people of many developing South Asian countries who generally do not discuss their personal, physical, or mental problems with any one outside their family. Shame and guilt often are used to enforce norms in the family, which may lead to anxiety and depression. An individual’s emotional problems often bring shame and guilt to the family, and these in turn prevent family members from reporting psychological problems to licensed mental health professionals. Under such circumstances, traditional healers may be the best choice for the treatment of mental disorders in a religiously conservative country like Pakistan. In my clinical practice I have found that anxiety and affective disorders are the most under-diagnosed and under-treated mental disorders. Usually, patients with anxiety and depression are blamed for being weak-willed or guilty of violating Islamic religious traditions and cultural norms. However, in the cases of schizophrenia, somatoform, and personality/conduct disorders, the course of these illnesses is usually more chronic and the level of impairment in terms of the global functioning is so pervasive and threatening that families seek a variety of traditional healing methods for their family members. Conclusions An understanding of the religio-cultural background of patients with a mental illness and the strengths and weaknesses of the traditional healing practices should be known to all health care professionals in Pakistan so that they could treat the patient with less resistance from the patients and their relatives. Interestingly enough, most Pakistani traditional healers treat their patients tactfully in their religio-cultural context, at a very affordable cost. Consequently, patients prefer to seek help/counselling from these traditional healers rather than seeking timely, but costly, treatment from the well-trained and qualified psychiatrists. These traditional healers regularly advertise in newspapers and in the form of graffiti without any check from the Pakistani law enforcement agencies. Thus, further research work is recommended to find out exactly why patients prefer to seek treatment from traditional healers, especially from spiritual healers and sorcerers, for the treatment of their mental disorders Some questions remain regarding how Pakistani traditional healing practices would fare in comparison with modern psychotherapeutic and pharmacological
412 Y. N. Farooqi interventions in an era of evidence-based medicine (Raja, 2004). Moreover, it is debatable whether seeking treatment from spiritual/traditional healers would delay patients in receiving diagnoses and appropriate treatment via modern western medicine and psychiatry. Perhaps, in an age of information technology, there is a need for cooperation between spiritual healers and westernised health care workers. A positive interaction between the two health care systems could improve the mental health and well-being of people in the East and the West. References
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414 Y. N. Farooqi Appendix. Case History Interview Schedule (English translation) Name: Education: Monthly Income: Marital Status:
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Age: Occupation: Any other Income: Dependents in Family: Diagnosis given:
Hospital:
Q1.
What brought you here?
Q2.
Who brought you to this hospital and why?
Q3.
How long you have been here?
Q4.
Do you have any past history of this illness?
Q5.
What treatment was given for it in the past?
Q6.
During the last one year, which type of traditional healing method/s have been sought by you for the treatment of your current illness?
a. Homeopathy b. Tibb c. Islamic Faith Healing Practices d. Sorcery e. Multiple Traditional Healing Practices (more than one of a, b, c, or d) f. None.
Pakistani Traditional Healing Practices Q7.
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How frequently have you visited the healer/s per week during the last one year?
a. 0–1 visits b. 2–4 visits
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c. 5–7 visits
Q8.
How did you come to know about this healing practice/s?
Q9.
Has it helped you?
Q10. Is there anything else you would like to share with me?
Thanks for your cooperation!
