Indian J Psychiatry 55 Indian Mental Concepts I – Supplement,.docx

Indian J Psychiatry 55: Indian Mental Concepts I – Supplement,
January 2013 S243
in this world; those who have wives truly have a family life;
those who have wives can be happy; those who have wives
can have a full life.”[2] For a Hindu marriage is essential, not
only for begetting a son in order to discharge his debt to the
ancestors, but also for performance of other religious and
spiritual duties. The institution of marriage is considered
sacred even by those who view it as a civil contract.
Wife is the ardhangini (half of man) according to Satpatha
Brahmana “The wife is verily the half of the husband. Man
is only half, not complete until he marries.” The Taittiriya
Samhita is to the same effect. Manu declared that mutual
fidelity between husband and wife was the highest dharma.
According to Mahabharata, by cherishing the woman one
virtually cherishes the Goddess of prosperity herself. Wife
under Hindu law is not only a “grahpatni,” but also a “dharma
patni” and “shadharmini.” The wife is her husband’s best
of friends. She is the source of Dharma, Artha, Kama, and
Moksha. The husband is known as bharthi. He is supposed
to support his wife. He is also known as pati because he is
supposed to support her.
INTRODUCTION
Since time immemorial marriage has been the greatest
and most important of all institutions in human society. It
has always existed in one form or another in every culture,
ensuring social sanction to a physical union between man
and woman and laying the foundation for building up of the

family – the basic unit of society.[1]
MARRIAGE AND HINDUISM
The Hindus have idealized marriage in a big way. In the
patriarchal society of Rig Vedic Hindus, marriage was
considered as a sacramental union, and this continued to be so
during the entire period. In the Shastric Hindu law,[2] marriage
has been regarded as one of the essential sanakaras (sacrament
for every Hindu). Every Hindu must marry. “To be mothers
were woman created and to be fathers men.” The Veda ordains
that “Dharma must be practiced by man together with his wife
and offspring”. “He is only perfect who consists of his wife and
offspring.” “Those who have wives can fulfill their obligations
Hinduism, marriage and mental illness
Indira Sharma, Balram Pandit, Abhishek Pathak, Reet Sharma1
Departments of Psychiatry, and 1Physiology, Institute of
Medical Sciences, Banras Hindu University, Varanasi, India
Address for correspondence: Prof. Indira Sharma,
Department of Psychiatry, Institute of Medical Sciences,
Banras Hindu University, Varanasi ‑ 221 005, India.
E‑mail: indira_06 @ rediffmail.com
Access this article online
Website:
www.indianjpsychiatry.org
Quick Response Code
DOI:
10.4103/0019‑5545.105544

For Hindus, marriage is a sacrosanct union. It is also an
important social institution. Marriages in India are between
two families, rather two individuals, arranged marriages and
dowry are customary. The society as well as the Indian
legislation attempt to protect marriage. Indian society is
predominantly patriarchal. There are stringent gender roles,
with women having a passive role and husband an active
dominating role. Marriage and motherhood are the primary
status roles for women. When afflicted mental illness married
women are discriminated against married men. In the
setting of mental illness many of the social values take their
ugly forms in the form of domestic violence, dowry
harassment, abuse of dowry law, dowry death, separation, and
divorce. Societal norms are powerful and often override
the legislative provisions in real life situations.
Key words: Hinduism, marriage, mental illness
ABSTRACT
How to cite this article: Sharma I, Pandit B, Pathak A, Sharma
R. Hinduism, marriage and mental illness. Indian J Psychiatry
2013;55:243-9.
[Downloaded free from http://www.indianjpsychiatry.org on
Sunday, July 26, 2015, IP: 122.172.163.228]
Sharma, et al.: Hinduism, marriage and mental illness
January 2013S244
The sacramental aspect of marriage under Hindu law has

three characteristics: (1) That it is a sacrament union, which
means that marriage is not to gratify one’s physical needs;
but is primarily meant for the performance of religious
and spiritual duties; (2) a sacramental union implies that a
marriage once entered cannot be dissolved on any ground
whatsoever; and (3) a sacramental union also means that it
is a union of soul, body and mind. It is a union not only for
this life, but for all lives to come. The union is not only for
this world, but also for other worlds.
Performance of certain Sastric ceremonies, which have been
laid down in detail in Griha Sutras, are necessary for a Hindu
marriage.
Marriage as a social institution
Marriage has been an important social institution. It is
the basis for the family. The functions of marriage include
regulation of sexual behavior, reproduction, nurturance,
protection of children, socialization, consumption, and
passing on of the race.[1]
Hindu marriage is regarded as a means to establish a
relationship between two families. Free intermixing
between two sexes is a taboo. Thus most marriages are
arranged by parents or relatives, even in the educated class.
Children are expected to accept their parents’ decision
with respect to marriage unconditionally, extra‑marital
relationships, separations, and remarriage have been
looked down upon. For most people in India, marriage
is a one‑time event in life, which sanctified and glorified
with much social approval. Marriage is a social necessity;
marrying children is the primary responsibility of parents
in India. Daughters should be married as soon they become
young in early twenties and sons married as soon as
they start earning. Married couples are accorded respect
in the community. Non‑solemnization of marriage is a

social stigma. Social values, customs, traditions and even
legislation have attempted to ensure stability of marriage.
The goal of marriage in Hinduism is to foster, not
self‑interest, but self‑restraint and love for the entire family,
which keeps the family united and prevents its breakdown.
Sex roles and marital adjustment
India is largely a patriarchal society. The traditional dyad
is the husband with high masculinity and the wife with
high femininity.[3] An important observation is that across
generations, while women show less femininity, masculinity
remains stable.[4] Bharat[5] reviewed the published studies
relating to sex roles amongst Indians and reported as follows:
Cross‑culturally, the masculine stereotype remains stable, the
female one changes; family‑orientated traits which are seen
as feminine in western culture are seen as gender‑neutral and
valued in India; both traditional and modern traits are valued
in Indian women; and sex differences are mainly along the
lines of greater autonomy for men. A recent study by Issac
and Shah[3] reported a positive link between androgyny and
marital adjustment, and a trend for couples to move toward
gender‑neutral dyads.
Dowry and Hindu marriage
Dowry is a custom in Hindu marriage since times
immemorial. According to Dharmashastra, the meritorious
act of “kanyadan” is not complete until the bridegroom is
given a “Varadakshina.”[2] After decking the daughter with
costly garments and ornaments and honoring her with
presents of jewels, the father should gift the daughter
a bridegroom whom he himself has invited and who is
learned in Vedas and is of good conduct. The presents
given to the daughter on the occasion of marriage by her
parents, relations, or friends constituted her “Stridhan.”

Both “Varadakshina” and “Stridhan” were given out of love
and affection. These two aspects got entangled and in
due course assumed the frightening name of dowry. For
obtaining dowry compulsion, coercion and occasionally
force had to be exercised. Ultimately most marriages
became a bargain. Over the years dowry has turned into a
widespread social evil. Surprisingly, it has spread to other
communities, which were traditionally non‑dowry receiving
communities. Demand for dowry has resulted in cruelty,
domestic violence, and death by homicide or suicide.
Marriage of women
The prescription of marriage is more stringent for women.
Women must get married. “Doosre ki amanat hai” (She is
another person’s property). “Jawan ladki ghar nahin baitha
sakte hain” (cannot keep a young unmarried girl at home).
After marriage, her husband’s home is her home. She should
visit her natal home only as a guest, she should never return
to her parents’ home. Parents cough out their life savings
too/take loans/dispose‑off their property and arrange for
substantial dowry to marry their daughters.
In India, marriage and family dominate the life of women.
The primary duty of the woman is to be subservient/loyal to
the husband/his relatives and her children. After marriage,
husband and relatives control all outside relationships.
There are festivals/rituals such as “teej” and “karva chaut”
in which the woman worships her husband as her God/
Lord (“Patiparmeshwar”) and prays for his long life. The
primary roles for the women are still “marriage” and
“motherhood.” Marriage confers a positive status to the
woman which is greatly enhanced by motherhood. No
wonder non‑solemnization of marriage of young daughters,
separation or divorce is very stressful not only for the
woman, but for the entire family. Marriage brings security
and dignity to Indian women. Unmarried status in India is

stigma especially for females.
The sociologist Susan Wadley after examining the identity
of women in folklore, myths, and legends rooted in
Sunday, July 26, 2015, IP: 122.172.163.228]
January 2013 S245
history, observed that the Indian woman is constantly
made to adopt contradictory roles – the nurturing roles as
daughters, mothers, wives, and as daughter‑in‑laws, and the
stereotyped role of a weak and helpless woman. The latter
is fostered to ensure complete dependence on the male
sex. Consequently, the constant movement from strength
to passivity leads to enormous stress placing the woman’s
mental health under constant threat.[6]
Reforms in Hindu marriage customs
Sati was prevalent in Ancient India. The British succeed
in bringing XVII Prevention of Sati Act which declares sati
illegal and punishable by courts. Raja Ram Mohan Roy,
Ishwar Chandra Vidyasagar and E.V. Ramasamy Periyar paved
the way for social reform. In India, the first movement of
marital rights of women centered on three major problems,
child marriage, enforced widowhood, and property rights
of women. The Dowry Prohibition Act[7] was enacted to
curb the dowry menace. It applies to all people, Hindus,
Muslims, Christians, Parsis and Jews. The law was found to
fail to stall this evil. Dowry Death (304B)[8] was later enacted.

Where the death of the woman occurred in unnatural
circumstances within 7 years of marriage and it is shown
that she was subjected to cruelty or harassment by her
husband or his relatives in connection with any demand for
dowry, it would be presumed to be a dowry death, deemed
to be caused by the husband or his relatives.
MARRIAGE AND MENTAL ILLNESS
Marriage is the greatest event in an individual’s life and
brings with it many responsibilities. Mental disorders can
either result in marital discord or may be caused by marital
disharmony. In predisposed individuals, marriage can cause
mental‑health problems.[1] Divorce seeking couples have
higher psychiatric morbidity than well‑adjusted couples
with more neurotic traits. Besides, studies consistently
show greater distress among widowed/separated/divorced
men and women. Greater distress is seen in among married
women compared to married men and greater distress
in single women as compared to single men.[1] An ICMR
and DST study[9] on severe mental distress also found the
highest common distress was found in housewives, in both
rural and urban samples. The ever married suffered more
than those who were never married.
Indian society has a greater bias against women with mental
illness; many of them are abandoned by their husbands and
in‑laws and are sent back to their parents’ homes. This
causes misery and stigma and further complicates their
problems by making them more susceptible to development
or exacerbation of psychiatric disorders after marriage.[10,11]
Anxiety disorders
Batra and Gautam[12] found a high prevalence of neurotic
disorders among divorce‑seeking couples. The neurotic

problems encountered were either antecedents or
consequences of marital disharmony. In a prospective study
of 107 subjects with obsessive‑compulsive disorder being
married significantly increased the probability of partial
remission.[1]
Depression
There is research evidence to suggest that for men,
marriage confers protection against depression, while it
appears to be associated with higher rates of depression
in women. There is some evidence that within marriage,
the traditional role of the female is limiting, restricting and
even boring, which may lead to depression.[1] Moreover,
in traditional Hindu families there a rigid code of conduct
for women which prevents communication and expression
of emotions, especially negative ones, because of which
there is higher prevalence of internalizing disorders such as
depression in women compared of men.
Suicide
Studies in China and India report that single individuals
are not more vulnerable to suicide than their married
counterparts.[13,14] Cultural attitudes toward the woman’s role
in marriage may also partially explain the comparatively higher
ratio of female to male suicides found in Asian countries as
compared to Europe and the United States of America. In
countries like India, Pakistan, and Sri Lanka, where arranged
marriages are common, the social and familial pressure on a
woman to stay married even in abusive relationships appears
to be one of the factors that increases the risk of suicide in
women.[15] Dowries, which involve a continuing series of gifts
before and after marriage, complicate the problem. When
dowry expectations are not met, young brides can be harassed
to the point where they are driven to suicide.[16] In some
cases families oppose the marriage of young couples, who
face the unsolvable conflict of either living apart or severing

ties with their families; choose suicide – either together or
alone.[17] In a study of women treated in hospital emergency
rooms after a suicide attempt, over 40% were young rural
women 15‑34 years of age; an unhappy marriage (over 60%),
financial problems (over 40%), and having been beaten by a
spouse (almost 40%) were the most frequently cited stressful
events they had experienced.[18]
Alcohol use
Alcohol use in India on social occasions has a long‑history.
Social approval of alcohol use has generally been for men.
Thus, rates for alcohol use are much lower in women.
Alcohol intake by spouse results in marital problems. The
divorce rate among heavy drinkers is high and the wives of
such men are likely to be anxious, depressed and socially
isolated. Besides, women admitted with self‑poisoning
blame the drinking habit of the husband.[16] The home
atmosphere is often detrimental to children because of
quarrelling and violence. Indian studies have shown that
50‑60% of domestic violence is due to alcoholism.[1]
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January 2013S246
MARRIAGE AND SEVERE MENTAL ILLNESS
The WHO data, in which confounding factors such as,
age, pre‑morbid personality traits, and family history
were controlled, married men experienced significant

delay (1‑2 years) in the onset of psychotic symptoms
compared with single men.[19] Patients with schizophrenia
are more likely to remain single and unmarried than patients
in other diagnostic groups, this being particularly true of
male patients.[1]
The extensive review of gender differences in the
epidemiology of schizophrenia has been reviewed by
Picinelle and Homen.[20] It included three studies from India.
The 5‑year follow‑up study[21] of patients attending a teaching
hospital, reported a better clinical and social outcome for
women. The better outcome could be because it was an
out‑patient sample with lesser degree of impairments. At
the end of 10 years, however, there were no significant
difference in the outcome.[22]
A 10‑year follow‑up study of a cohort of 76, first episode
patients with schizophrenia,[23] found that marital outcome
in Indian Patients as good with no gender difference. A high
marital rate (70%) (before the onset of mental illness) was
reported with more men remaining single and more women
facing broken marriages. Being married before the onset of
illness, presence of children, a shorter duration of illness
at inclusion and the presence of auditory hallucinations at
intake were all associated with a good marital outcome.
Being unemployed, experiencing a drop in socioeconomic
level and the presence of flat affect and self‑neglect for
10 years were all associated a poor marital outcome.
A Schizophrenia Research Foundation (SCARF) study[6]
showed that women were brought in for treatment much
later. The ratio of male:female service seekers registered
at SCARF Out Patient Department (OPD) was 2:1. A greater
number of female patients were in the category of patients
who had been untreated for a long‑time. The main reason
attributed for these findings was the low‑priority is given

to the mental‑health of women compared to men. The fact
that women generally are presented at a later age with
schizophrenia raises issues about the losses these women
sustain with regard to established relationships, careers
and children.[24]
In a pilot study of 783 patients with mental illness
registered with SCARF[6] to study the patterns of marriage
and divorce, the salient findings were: More women with
mental illness got married; more women were deserted
and abandoned, separated and divorced by their spouses;
more men continued to be married, with their spouses
taking on the wage earning role; the women abandoned
by their spouses, did not receive any financial support/
maintenance from their spouses, the parents had to bear
the responsibility of looking after them; and most women
complained of ill‑treatment by their in‑laws.
Another study[6] of 75 divorced/separated women in
comparison to 25 married women living with their care
givers provided interesting information. All except eight
lived with their parents. Twenty children were taken care
of by the patients themselves or their parents. Only six
children were cared by the husbands. Lack of awareness
and the widespread belief that marriage is a panacea for
all evils prompted some parents to get their daughters
married even when they were symptomatic. Several needs
were expressed for the separated women including to
simplify the legal measures.
It is noteworthy that women with severe mental illness are
discriminated in a big way. While wives are more tolerant,
husbands are not and many of the marriages women with
the mental illness end sooner or later. The women with
severe mental illness are ostracized on three accounts.

First, the female status, second the psychoses and third,
marital status (divorced/separated). These three together
constitute the “triple tragedy.” Most disturbing is the
observation that they are abandoned more often because
of the negative attitude toward mental illness, rather than
the illness per se. The observations of other workers are in
the same line. The stigma of being separated/divorced was
more often more acutely felt by families and patients than
the stigma of mental illness per se.[6]
The relationship between marriage and mental illness has
been examined by Nambi.[1]
Several studies show low marital rates for schizophrenic
patients compared with controls and other groups of
mentally ill patients; lower rate in women than in men,
a poor clinical course and lower socioeconomic status
among the divorced, and a clear evidence for selection of
schizophrenia among those never married.
From the analysis of records of 272 outpatients of the
Institute of Mental Health at Chennai,[1] it emerged that
majority of treatment seekers were males (3:2); nearly 26%
males and 6% females were single; 30% of males and 23%
females were married and 10% were divorced/separated/
widowed.
Domestic violence and mental illness
Domestic violence means violence that occurs within
the family. Domestic violence is considered as one of
the burning social problem of the present day in India.
The married women with major mental illness form an
extremely vulnerable population at high‑risk for various
forms of abuse. The incidents of wife battering, harassment
by husband and in‑laws, dowry deaths, suicides, kitchen
accidents occur on a large scale. Many cases go unreported.

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January 2013 S247
The victims are unable to raise their voice, nor protect
against violence.[25]
Domestic violence is an age‑old phenomenon. In the past,
it was mainly hidden behind the four walls of the house.
Those within did not wish to speak about it. Those outside
did not want to hear it. Social practices, customs, beliefs,
myths, and patriarchy are the important causative factors
for domestic violence in India.[25]
Harassment by in‑laws on issues related to dowry is
characteristic of the Indian setting. It has emerged as a
risk factor for poor mental health. This age‑old practice
continues to survive and has been a significant factor that
has driven many women to suicide.[26]
In a study on domestic violence, the International Centre
for Research on Women (ICRW)[25] in multiple centers
in India, reported that 85% of men admit that they had
indulged in violent behavior against their wives; physical,
emotional or sexual, at least once in the last 12 months.
57% of men admitted to have committed sexual abuse with
their wives. 32% of men admitted to committing violence
on their pregnant wives.

Risk‑factors for domestic violence include alcoholic
husbands, illiterate or poorly educated couple, poor
socioeconomic status, women with no income of their own,
and dowry problems.[25] Unfortunately, the cycle of domestic
violence continues from one generation to another. An
abused boy/boy witnessing his father beating his mother
grows to be an abusive husband. Likewise, an abused girl/
girl child witnessing her mother being battered grows to be
a battered woman herself.
It is very important to identify and treat domestic violence
in those with mental illness. In half of all murders committed
by domestic partners, serious mental illness contributes to
the risk.
The mental health problems related to domestic violence are
varying in nature. Many women accept it as normal in India
and suffer in silence. A few react with physical aggression.
The psychological symptoms emerge as subsyndromal or
diagnosable disorders.[25]
There are a number of international instruments to
prevent violence against women including the Convention
on Elimination of All forms of Discrimination Against
Women.[27] Several legislations have been enacted with
the same purpose: Dowry Prohibition Act,[7] Section 305
IPC (abetment of suicide of a mentally insane person),
Section 306 IPC (abetment of suicide); Section 304B
IPC (dowry death), Section 498‑A IPC (of cruelty of husbands
or relatives of husband),[8] the Protection of Women from
Domestic Violence Act (PWDVA),[28] etc.
The protection of women from domestic violence act[28]
PWDVA defines the expression “domestic violence” to
include actual abuse or threat of abuse that is physical,

sexual, verbal, emotional, or economic. It provides for more
effective protection of the rights of women in a domestic
relationship, guaranteed under the Constitution who are
victims of violence of any kind. Harassment by way of
unlawful dowry demands to the woman or her relatives is
also covered under this definition. This act has the following
important features:
1. The respondent has to be an adult male.
2. It appreciates that the marital relation is a delicate,
personal and private relationship.
3. It appreciates the fact that victim of domestic violence
is often unprivileged in many ways.
4. It provides various reliefs such as a protection,
residence, maintenance (monetary relief), custody and
compensation orders and emergency help.
5. It provides necessary help in lodging the report.
6. It provides free legal aid to the woman.
7. It assumes that the woman would always safeguard the
relationship.
8. It adopts a reconciliatory approach.
9. It empowers the woman. Criminal proceedings would
be initiated only when the woman requests for the
same.
The PWDVA has been perceived by many as an anti‑male
Act. It is a double‑edged weapon. It should be used to
protect women, not to take revenge on men.
Marriage of women with psychotic illness and Hindu
Marriage Act (HMA):[29] The Indian paradox

There is a wealth of data showing the effect of Indian
culture on marriage of patients with mental illness. This
has been described by Sharma and Tripathi[30] as the “Indian
paradox.”
The Indian paradox can be described under four headings:
1. Despite the presence of severe mental illness parents
are determined to marry their mentally sick daughters.
2. Parents often succeed in marrying daughters with
mental illness/active symptoms. This is possible because
in India arranged marriages and giving/offering dowry
are the norm.
3. Besides, most boys prefer arranged marriages because
they fetch good dowry.
4. The woman with mental illness, who is ill‑treated
and abandoned by her husband and in‑laws, seeks
restitution of conjugal rights rather than divorce.
5. Interesting observations were made in South India.
Many of the separated/divorced women (30 out of 75),
whether or not they wished to rejoin their husbands,
still continued to wear their mangalsutras.[6] The
reason given for this ranged from “I am still married,”
“as long as my husband is alive I must wear it” or “It
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January 2013S248
gives a sense of security and protection.” The women
who did not wear mangalsutra were either Christians
or Muslims. Similar observation was made by Sharma
and Tripathi[31] in Northern India, where the separated
women continued to put vermillion on their heads.
6. The Dowry Prohibition Act[7] sometimes promotes
dowry rather than curbing it.
A handsome dowry glamorizes the marriage proposal, so
as to distract the other party from the deficiencies in the
daughter. After marriage, when marital problems arise
because of mental illness in the woman, gifts are offered
to pacify the husband and his relatives. At other times,
husband themselves might demand money/gifts; the price
for putting with a ‘mad’ woman.
The paradoxical situations cited above can be understood
in light of the prevailing deep rooted social value systems
relating to marriage in India.
The Hindu Marriage Act (HMA)[29] provides the conditions for
a valid Hindu marriage. It also provides for four matrimonial
reliefs: Nullity of marriage, judicial separation, divorce, and
restitution of conjugal rights. The legal provisions are often
violated in the marriages of patients with mental illness
because of the strong impact of Indian culture. They are
mentioned below:
1. Remarriages of husbands and wives, separated because
of mental illness take place without formal divorce.
In a series of 124 marriages of 118 married women with

mental illness from Varanasi at a tertiary care hospital,
it was observed that 91.9% were first marriages of
both patients and their spouses. 10 (9%) were second
marriages (6 of patients, and 4 of spouses). Only one
second marriage of the patient was solemnized after
divorce, the remaining took place without divorce from
previous marriages.[32] Such marriages are void as per
section of HMA. However, because of social approval
they continued. Likewise, in a series of 75 mentally
ill divorced/separated women from Chennai legal
separation occurred only in 16 instances. However, 13
of the husbands were remarried.[6]
2. Women with frank psychotic illness are married.
In the series from Varanasi evidence for mental illness,
in the form of taking psychotropic medication or mild
psychiatric symptoms/side‑effects was present about
half (48%) of the women. In five marriages mental
illness was present in both wives and their husbands at
the time of marriage.[32] It is difficult to say as to how
many of them were fit to give consent at the time of
marriage.
3. Consent to marriage is often by proxy, force or fraud.
In the series from Varanasi[32] proper consent was
present in only 14 marriages. In 110 marriages consent
was by proxy from either of the patient/husband/both
partners. Consent by fraud by concealment of past
history of psychiatric (partially or fully) of the women
with mental illness was present in 87.7% of the cases.
Besides, five wives and two husbands with mental illness
were coerced into marriage.[32] Thus, valid consent to
marriage was not given importance.

4. Dowry Prohibition Act[7] is often abused in the setting of
mental illness.
Very often parents paid a substantial dowry at the
time of marriage.[6] Dowry is usually a non‑issue in
marriages of women with mental illness as the giver
and the receiver are usually in agreement. However,
when marital problems erupt after marriage because of
mental illness, allegations of dowry demand/harassment
are made and complaints are lodged at police stations.
Sometimes these cases landed up in courts, leading to
animosity and worsening the mental disorder. In these
petitions the usual plea from the woman’s side that
she is normal and the husband has rejected the woman
because he is greedy and wants more dowry.[32]
5. No maintenance was given to the women even when
they had children. Only in four cases, a one‑time
meager amount as maintenance was given.[6] Similar
observations were made by Sharma and Tripathi.[32]
Besides, the decision with respect to custody of the
child was made by the husband.[32]
The above observations are reflective of the deep
rooted patriarchal social norms and values relating to
marriage.
6. Concealment of history of mental illness during marriage
is rather common in the Indian community. Often it is
a no‑win situation. When the truth is discovered there
is a lot of animosity, the marriage often breaks or there
are petitions for nullity of marriage under Section 12 of
HMA. The President of the Indian Psychiatric Society,
Dr. S. Nambi, suggested that “an express legislative

provision should be incorporated, which states that a
past history of mental illness will be no bar to marriage;
failure to disclose such past history or the fact of
treatment would not amount to the suppression of a
material fact,” i.e., should not be a ground for nullity of
marriage.[1]
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3. Isaac R, Shah A. Sex roles and marital adjustment in Indian
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Soc Psychiatry 2004;50:129‑41.
4. Basu J, Chakroborty M, Chowdhury S, Ghosh M. Gender
stereotypes,
self‑ideal disparity and neuroticism in Benagali families. Indian
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5. Bharat S. On the periphery: the psychology of gender. In:
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Penal Code (45 of 1860) as amended by the Election Laws
(Amendment)
Act, 2003 (24 of 2003). Delhi: Universal Publishing Co Pvt
Ltd.; 1860.
9. ICMR‑DST. An ICMR DST of severe mental distress, 1987.
10. Behere PB, Tiwari K. Effect of marriage on pre‑existing
psychotic illnesses
in males. Report Submitted to Indian Council of Medical
Research, 1991.
11. Behere PB, Rao ST, Verma K. Effect of marriage on
pre‑existing
psychoses. Indian J Psychiatry 2011;53:287‑8.
12. Batra L, Gautam S. Psychiatric morbidity
and personality profile in divorce

seeking couples. Indian J Psychiatry 1995;37:179‑85.
13. Rao AV. Suicide in the elderly: A report from India. Crisis
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factors for
suicide in China: A national case‑control psychological autopsy
study.
Lancet 2002;360:1728‑36.
15. Gururaj G, Isaac MK, Subbakrishna DK, Ranjani R. Risk
factors for
completed suicides: A case‑control study from Bangalore, India.
Inj
Control Saf Promot 2004;11:183‑91.
16. Kumar V. Poisoning deaths in married women. J Clin
Forensic Med
2004;11:2‑5.
17. Vijayakumar L, Thilothammal N. Suicide pacts. Crisis
1993;14:43‑6.
18. Pearson V, Liu M. Ling’s death: An ethnography of a
Chinese woman’s
suicide. Suicide Life Threat Behav 2002;32:347‑58.
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Cooper JE, et al.
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cultures.
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Monogr
Suppl 1992;20:1‑97.
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epidemiology of affective
disorders and schizophrenia. World Health Organization
[WHO/MSA/
NAM/97.1]; 1997.
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Results of a
follow‑up study from India. Schizophr Res 1992;7:65‑70.
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23. Thara R, Srinivasan TN. Outcome of marriage in
schizophrenia. Soc
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Health care providers’ handbook on Hindu patients14

}2section
Guidelines for health services
Hindu beliefs affecting health
ca
re
Hi
nd
u b
elie
fs a
ffecti
ng
Hindu beliefs affecting health c
are Hindu beliefs
Hindu beliefs affecting
health care
15
Hindu beliefs affecting health
ca
re

Hi
nd
u b
elie
fs a
ffecti
ng
Hindu beliefs affecting health c
are Hindu beliefs
1 . Food beliefs
Hindu dietary practices can vary depending on the
individual’s beliefs and customs.
Most Hindus do not eat beef or pork and many follow a
vegetarian diet. Fasting is common among Hindus, but
there are no set rules and the decision to fast is up to the
individual.
Many Hindus follow Ayurvedic dietary practices. Under
this system certain foods are classified as hot or cold and
can adversely or positively affect health conditions and
emotions12.
The classification of foods as hot or cold is unrelated to
temperature. Hot foods are generally those foods which
are salty, sour or high in animal protein, while cold foods
are generally sweet or bitter4.
Some strict Hindus do not consume garlic or onion as the
properties of these foods disturb spiritual practices such

as meditation.
Refer to section three for a table of foods suitable for
vegetarian Hindus.
2 . Karma
• A central belief of Hinduism is the doctrine of karma,
the law of cause and effect14.
• Hindus believe that every thought, word and action
accumulates karma, which can affect current and
future lives. Hindus believe in reincarnation14.
• Actions from a past life can affect events in the current
life, including health and wellbeing14.
• Health care providers should be aware that a strong
belief in karma can affect decision-making regarding
health care.
3 . Holy days
Hindus do not observe a specific day of worship,
although some days of the week may be associated with
particular deities.
Hindus do observe a number of holy days and festivals
which can have an impact on health care due to
associated fasts.
Most Hindu holy days are based on the lunar calendar
and the dates can vary from year to year. Some festivals
can occur over an extended period with celebrations
lasting for days or weeks.
A religious calendar is published in the Queensland

Health Multicultural Clinical Support Resource.
www.health.qld.gov.au/multicultural/support_tools/
mcsr.asp
4 . Fasting
Fasting is an integral part of Hinduism and is seen as a
means of purifying the body and the soul, encouraging
self-discipline, and gaining emotional balance7.
Fasting may be practiced on specific days of the week,
during festivals or on holy days, or in conjunction with
special prayers.
It is not considered obligatory for a Hindu patient to fast
during hospitalisation. However, some patients may wish
to fast while in hospital.
There is no specified way to fast, but individuals may
choose to abstain completely from all food and drink or
only abstain from certain foods.
5 . Dress
While there is no religious requirement for modest dress,
many Hindus choose to dress modestly and may be
reluctant to be examined by health care providers of the
opposite sex.
Hindu women may wear a sacred thread or gold chain
around their necks and Hindu men and boys may wear
a sacred thread across the chest. These items should
not be removed during examination. If it is necessary to
remove an item, permission should be sought prior to
removal15.
Hare Krishna followers, and some other Hindus, may
wear sacred tulsi beads around the neck. If it is necessary

to remove these beads, they should be retied around the
wrist (preferably right).
In addition, some jewellery worn by Hindus may have a
sacred meaning and patients should be consulted before
removal.
http://www.health.qld.gov.au/multicultural
Health care providers’ handbook on Hindu patients16
6 . Mental health and/or cognitive
dysfunction
Hindus believe that all illnesses, whether physical or
mental, have a biological, psychological and spiritual
element. Treatments which do not address all three
causes may not be considered effective by a Hindu
patient10.
Many Hindus attach a stigma to mental illness and
cognitive dysfunction.
Many Hindus have a strong belief in the concept of the
evil eye and may believe this to be a cause of mental
illness13.
In addition, all illness, including mental illness, may be
seen as the result of karma from this, or a previous life.
Further information about mental health care for
multicultural communities can be accessed through the
Queensland Transcultural Mental Health Centre.
www.health.qld.gov.au/pahospital/qtmhc
7 . Transplants and organ donation

Hinduism supports the donation and transplantation of
organs. The decision to donate or receive organs is left to
the individual.
8 . Sexual and reproductive health
Contraception
There is no official Hindu position on contraception.
Abortion
Beliefs about abortion may vary depending on cultural or
religious interpretations.
Many Hindus believe that the moment of conception
marks the rebirth of an individual, which may make
abortion unacceptable, except in emergencies4.
Assisted reproductive technologies
There is no official Hindu position on assisted
reproductive technologies.
9 . Pain management
Hinduism encourages the acceptance of pain and
suffering as part of the consequences of karma. It is not
seen as a punishment, but as a natural consequence
of past negative behaviour and is often seen as an
opportunity to progress spiritually16.
This may affect triaging or the monitoring of pain levels
as Hindu patients may not be forthcoming about pain
and may prefer to accept it as a means of progressing
spiritually.

However, this behaviour may be less prevalent in
Australia, especially among young people.
10 . Death and dying
Hindus believe that the time of death is determined by
one’s destiny and accept death and illness as part of life.
As a result, treatment is not required to be provided to
a Hindu patient if it merely prolongs the final stages of a
terminal illness.
Under these circumstances, it is permitted to disconnect
life supporting systems. However, suicide and euthanasia
are forbidden in Hinduism.
Guidelines for health services
Additional resources Addition
al
res
ou
rc
es
A
ddi
tion
al res
ources
Additional resources Additional

resources Additional
www.health.qld.gov.au/pahospital/qtmhc 1. Food beliefs2.
Karma3. Holy days4. Fasting5. Dress6. Mental health
and/or cognitive dysfunction7. Transplants and organ donation8.
Sexual and reproductive
healthContraceptionAbortionAssisted reproductive
technologies9. Pain management10. Death and dying
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Culture and Mental Illness
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132 Social Work Practice in Mental Health: Cross-Cultural
Perspectives
Culture and Mental Illness
Chittaranjan Subudhi
ABSTRACT: The global burden of mental illness is high and
opportunities for promoting
mental health care are neglected issues in most parts of the
world. Though many of the
affected people come from the deprived sections of society and
have very limited access
to treatment and care, their concerns have remained grossly
unaddressed (Kermode, Bowen,
Arole, Joag, and Jorm, 2009). Mental illness can be attributed to
genetic, psychological, social
and cultural factors. Advancements in the field of healthcare
and greater awareness about
mental illness notwithstanding, cultural dynamics play an
important role in shaping the
perceptions, beliefs and practices of people towards mental
illness and its treatment
(Satcher, 2001). Attitudes to mental illness vary among cultures
and such cultural influences
not only shape attitudes and perceptions towards the mentally
ill, but also affect patients’
diagnosis, prevention and treatment techniques and so on.

Mental illness is a universal
phenomenon. Cultural relativists mention that the explanation
of mental illness can’t stay
isolated from the individual’s social and cultural context
(Siewert, Takeuchi, and Pagan,
1999). The concepts of mental illness are also changing with the
change of culture and time.
Every culture has its own way of explaining mental illness
which is based on a set of beliefs
and practices. This paper tries to explore, how Indian culture
influence the expression,
prevalence and treatment practices on mental illness.
Keywords: Culture, Perception, Mental Health, Mental Illness,
Beliefs.
INTRODUCTION
India is a culturally diverse country where it is believed that, in
every twenty five miles we
come in contact of people from a diverse culture (Srivastava,
2002, p. 529). Our country is
also associated with more spiritual traditions from primeval
times; and is known as a
home of all religion and culture. Culture plays a vital role in
directing, shaping, and
modeling social behavior at both individual and group levels
(Pandey, 1988).Mental
illnesses are common and a universal phenomenon (Herrman,
Saxena, Moodie, and
Walker, 2005, p. 5). So, a one line definition of mental illness
cannot be accepted in this
complex cultural society (Behere, Das, Yadav, and Behere,
2013, p. 189). The culture
shapes the cause and probable treatment of mental illness. So,
the perspective and

perception of mental illness and treatment practices also vary
with the respective culture
(Wagner, Duveen, Themel, and Verma, 1999, p. 3). The concept
of illness, either mental
or bodily, implies deviation from some clearly defined norms of
the society (Szasz,
1960). That is why, when any human being changes his/her
behavior unexpectedly and
behaves differently from the ‘normal’ (every society has its own
way of life and every
individual should perform the expected roles and
responsibilities assigned to them) way
of life, the public construes these signs as mental illness. These
changing behavioral
Culture and Mental Illness 133
indications are described by Muslims as possessed by ‘Peer’ and
illustrated by Hindus as
possessed by ‘Goddess’ (Behere et al., 2013, p. 187). Due to the
lack of instruments or
devices through which we can measure the exact cause of this
changing behaviour a lots
of causes come into the picture for mental illness. As a result,
culture is playing a major
part in determining the different causes of mental illness and
shape the treatment process
accordingly. So the people sometimes blame demonic sprits or
curse of the past life as the
cause of mental illness (Magnier, 2013).The concept of mental
illness is changeable over
time, but it is specific to a specific culture at a given time in its
history (Foucault, 1965;
Szasz, 1961, p. 115). Culture has a prominent role in the

perception, experience,
response, treatment, and outcome of mental illness (Siewert et
al., 1999). Culture not
only influences the mental health and illness, but also it is an
essential part of it (Sam and
Moreira, 2012). So, it is necessary to give details about the
culture for understanding the
relationship between culture and mental illness.
DEFINING CULTURE, MENTAL HEALTH AND MENTAL
ILLNESS
Culture
Anthropologist Edward Burnett Tylor (1871) has defined culture
as “that complex whole
which includes knowledge, belief, art, morals, law, custom, and
any other capabilities and
habits acquired by man as a member of society” (Loewenthal,
2006, p. 4). Tylorwas the
person who used the word culture in social sciences for the first
time. This definition is
very popular, highly accepted and gives an understandable
depiction about culture. Another
definition given by the United Nations Educational, Scientific
and Cultural Organization
[UNESCO] (2002), “Culture should be regarded as the set of
distinctive, spiritual,
material, intellectual, and emotional features of society or a
social group, and that it
encompasses, in addition to art and literature, lifestyles, ways
of living together, value
systems, traditions, and beliefs”.
In social sciences, culture is something related to human
society, including the social
experiences, ethics, attitudes, values and ways of life which are

transmitted socially, rather
than biologically. Culture passes from generation to generation
through members of the
society. Culture has many dimensions and it includes ethnicity,
race, religion, age, sex, family
values, the region of the country, and many other features
(Eshun and Gurung, 2009).
Social anthropologists place a distinction between ‘culture’ and
‘a culture’; where ‘culture’
signifies the social heritage of mankind and ’a culture’ signifies
social heritage of a
particular person (MacIver and Page, 1974). It is a way of life
of a particular group/people.
As a whole, culture is a learned process which changes over
time and consists of tangible
and intangible behaviors. Cultural traits and norms shape our
normative behaviour practices
and beliefs, influences our thinking process and defines the
everyday activities of a specific
human group. Nowadays culture has been categorised and is
compared between western
versus non-western or modern versus traditional societies in
social sciences (Lefley, 2010).
In cultural anthropology, it is defined that culture may proceed
at three different levels:
(i) learned patterns of behavior (it is a learning process and
defines our behavior); (ii) aspects
Perspectives
of culture that act below the conscious levels (such as a deep

level of grammar and syntax
in language); and (iii) patterns of thoughts and perception,
which are also culturally
determined. Every culture is dynamic and different from another
(Scott and Marshall, 2004).
Mental Health
Nowadays the concept of mental health and mental illness have
become a controversial
debate and discussion (Macklin, 1972) and as such it is
necessary to define both the
concepts. The World Health Organization (WHO) quotes that
“there is no health without
mental health”. So, mental health is a vital component of the
health system and both
mental and physical health are important.
WHO defines mental health as, “a state of well-being in which
every individual realizes
his or her own abilities, can cope with the normal stresses of
life, can work productively
and fruitfully, and is able to make a contribution to her or his
community” (October, 2011).
Thompson has defined mental health as, “the successful
performance of mental functioning,
resulting in productive activities, fulfilling relationship with
other people and the ability
to adapt to change and cope with adversity…. mental health is
the springboard of thinking
and communication skills, learning, emotional growth,
resilience and self-esteem” (2007).
Mental health is a state of normal condition or situation where
every human being is able
to function efficiently towards themselves and in their
respective community; it is the

absence of and freedom from mental illness and
psychopathology (Herrman et al., 2005;
Keyes, 2005). The difference between mental health and illness
is just like the difference
between health and illness, normal and abnormal, healthy and
sick, sane and insane
(Herrman et al., 2005; Keyes, 2005; Scheid and Brown, 2010).
Mental health is something
in a positive sense, and the absence of mental illness, but the
absence of mental illness
does not mean the presence of mental health (Keyes, 2005).
Mental Illness
The concept of mental illness has a variety of meanings in
different discourses (Macklin,
1972). The concept of mental illness is a multi-faceted one and
every discipline has their
ownview points to understand this concept (Aneshensel and
Phelan, 1999). The medical
model of mental illness always focuses on the internal process
of an individual, but the
social model focuses on a socially unacceptable behavior which
is labeled as deviant by
others (Aneshensel and Phelan, 1999). Scott and Marshall
(2009) have mentioned mental
illness is the judgment of the mind where deviance is one of the
behaviors. Dr. Gro
Harlem Brundtland is of the view that mental illness is not a
personal failure, it is just
like any other disease (such as cancer, AIDS) that people do not
want to discuss openly
(WHO, 2001).
The Oxford dictionary of sociology defines, “mental illness is
an illness characterized by
the presence of mental pathology: that is, disturbances, mental

functioning, analogous to
disturbances of bodily functioning” (Scott and Marshall, 2009,
p. 462).
In the medical model, mental illness is a disease, or a disease
like entity, with a psychological,
genetic or chemical base that can be treated through medical
means (Aneshensel and Phelan,
2006). This model also gives you the idea that mental illness is
a chemical imbalance
within our brain, which is a neurotic problem, where the social
model argues that it is a
social dysfunction (Thompson and Bland, 1995). It is the
deviation from the normal life
of the individual and inability to perform the expected and
prescribed social roles. Mental
illnesses are illnesses characterised by the presence of mental
pathology: that is, disturbances
of mental functioning, analogous to disturbances of bodily
functioning (Scott and
Marshall, 2004). Mental ill health comprises mental health
problems and strain, impaired
functioning associated with distress symptoms, and diagnosable
mental health disorders,
such as schizophrenia and depression. The concept and
distinction between mental health
and mental illness and the distinction between physical and
mental illness are highly variable
across cultures. In a broad sense, we can state that where
physical illness is noticeable in
the body, at the same time mental illness is noticeable with the
behavior (Thompson, 2007).

Siewert et al. (1999) have argued that mental illness cannot be
separated from the
individual’s social and cultural context and culture plays an
important role in the
perception of mental illness. Cultural anthropologists have
mentioned that every society
has its own culture and social norms which is distinct from
others and these cultural and
social norms define the person as normal or deviant (Macklin,
1972).
THE CULTURAL PERSPECTIVE ON MENTAL ILLNESS
Mental illness and culture cannot be isolated. Culture plays a
crucial role in the perception
of mental illness. Cultural relativists emphasise that concepts
are socially constructed and
vary across cultures. Mental illness is a social construct. Hence,
different cultures have
their own beliefs to find the etiology of mental illness, as well
as treatment and intervention
processes (Scott and Marshall, 2004; Jimenez, Bartels,
Cardenas, Dhaliwal, and Alegría,
2012). Not only culture, but also time and situation/place have
influenced the determinants
of mental health. Due to those changing determinants, it is very
difficult to define mental
illness. According to the biomedical model, mental illnesses
are, “fundamentally biological
in origin, and, given the common physiology of homo sapiens
worldwide, psychopathology
will be essentially homogeneous, with only superficial
disparities in presentation across
peoples” (Thakker and Ward, 1998, p. 502).The biomedical
model of mental illness brings

attention to the cause of mental illness being a neurotic problem
and considered as a disease
like other physical diseases (Foucault, 1957). The biomedical
model of mental illness is
linked to an individualist ideology where mental illness is
treated and diagnosed as
something purely individual. Opposing this biomedical view,
Marsella and Yamada (2000)
have mentioned that mental illness is closely rooted in one’s
culture, poverty, helplessness,
and backed by powerful socio-political and economic structures.
Thus, most of the time
social construction the oristsargue the validity of the medical
model of mental illness and
claim that mental illness is politically and socially constructed
(Szaz, 1960). Cultural theorists
always place importance on the society in shaping every
individual’s perception and
Perspectives
responses, which are possible through social interaction. These
are formed in the cultural
and sociopolitical context of the society (Siewert et al., 1999).
There are significant variations in the cultural views of mental
illness across cultures
(Mehraby, 2009). Culture influences the epidemiology,
phenomenology, outcome, and
treatment of mental illness (Viswanath and Chaturvedi, 2012).
Culture has multiple roles
to play in the expression of psychopathological disorder (Tseng,
2001) such as:

1. Pathogenic effects: Culture is a direct causative factor in
forming or generating illness
2. Patho-selective effects: Tendency to select culturally
influenced reaction patterns
that result in psychopathology
3. Patho-plastic effects: Culture contributes to modelling or
shaping of symptoms
4. Patho-elaborating effect: Behavioural reactions become
exaggerated through
cultural reinforcements
5. Patho-facilitative effects: Culture factors contributes to
frequent occurrence
6. Patho-reactive effects: Culture influences perception and
reaction.
Castilo (1997) has also mentioned some significant ways that
culture influences mental
health. These are:
1. the individual’s own personal experience of the illness and
associated symptoms;
2. how the individual expresses his or her experience or
symptoms within the context
of their cultural norms;
3. how the symptoms expressed are interpreted and hence
diagnosed;
4. how the mental illness is treated and ultimately the outcome
of this treatment.
From the above analysis, we can summarise the relationship
between culture and mental
illness that “the cultures that patients come from shape their
mental health and affect the
types of mental health services they use” (U.S. Department of

Health and Human Services,
1999). In most cultures, mental illness identifies forms of
negatively valued deviant
behaviors that are differentiated from anti-social behaviors by
their incomprehensibility
within that cultural idiom. Now we have to discuss the
significance of Indian culture to
describe the cause of mental illness as well as the treatment
process.
CAUSES AND HEALING PRACTICES OF MENTAL ILLNESS
Causes of Mental Illness
Every society has its own culture which regulates the
individual’s perception and treatment
procedure of mental illness. Srivastava (2002) has mentioned
three different theories of
causation of mental illness; supernatural theory, shock theory
and biochemical theory. In
supernatural theory, he has mentioned the possession of a
maleficent evil/soul that causes
a change in the psychology of a person. These psychological
changes in the mind mark that
person as mentally ill. Those people believe in supernatural
causation; they will approach
local faith healers or spiritual faith healers to remove these
evils. In shock theory, mention
is made of the sudden changes of the individual’s environments
in which the individual is
unable to cope with the situation, can lead to mental illness. In
situations like loss in

business, failure in examination, death of the partner, or
winning a huge amount on the
lottery can be the cause of mental imbalances or depressions
and may lead to mental illness.
The famous sociologist Emile Durkheim, who had initiated the
concepts of normal and
pathological, has given the four causes of suicide. One of the
four typologies of suicide is
‘anomic’. When the existing norms and the rules suddenly
collapse and the new norms
are not favorable, one commits suicide (Bessa, 2012). The
biochemical theory shows that
chemical imbalances occur in the brain and are causes of mental
illness. But this type of
theory is generally confined within the reflective and literate
people in Indian metropolises
and cities. These people have the knowledge of modern
medicines and they prefer to
consult with the psychiatrists for their treatment (Srivastava,
2002).
In the ancient epoch, mental illness was due to supernatural
power, magical spirit (like
witchcraft or demonic), or possession by evil spirits which
disrupted our mind (Wanger et al.,
1999). This concept is still prevalent in this modern era.
Sometimes it is believed it was a
curse or a result of a previous life’s curse/punishment. In rural
India, people still believe
the cause of mental illness is by the evil spirits angry that the
sick person had killed a cow
during his/her past life (Magnier, 2013). Thara, Islam, and
Padmavati (1998) has identified
some other reasons for mental illness; especially family
conflicts and problems in personal
relationships; financial and role performance problems; and

disturbed relations with the
neighborhood as the predominant causes of violence, self-
destructive behavior, sadness,
insomnia, and alcohol abuse.
Healing Practices of Mental Illness
The different symptoms that arise due to mental illness are
viewed by the people as
spiritual, psychological, or somatic in origin (Lefley, 2010). If
it is believed that the cause
of mental illness is due to supernatural or spiritual reason’ then
most of the people prefer
traditional healing practices to address mental illness. Up to
about 70% to 80% of the
population of mentally ill belong to rural areas and first visit
religious places and consult
with the indigenous practitioner for their treatment (Trivedi and
Sethi, 1979; Thara et al.,
1998). Thara et al. (1998) have also mentioned eight out of ten
mentally ill patients are
seen at religious healing centers. Some rural populations have a
common belief that the
sprit cannot get out because there is no exit point in our body;
so they get sticks and
puncture the eardrums on both sides to remove this spirit
(Magnier, 2013).
Raghuram et al. (2002) have mentioned, both the elite literature
of traditional culture and
the so called higher civilisation of today agree to the same fact;
that the cause of mental
illness depends on evil forces and lack of devotion to the God.
People with mental illness
are following various diagnosis (e.g. Pher, kartab, shaitani aid,
jadu tona, and stars
positioning) and treatment methods (e.g. tabiz, jhaad, phook,

chirag, and jap) to cure
mental illness (Viswanath and Chaturvedi, 2012). Most of the
people follow both
traditional as well as biomedical healing systems in parallel.
But the first choice is to go
Perspectives
to traditional healers and consult with them. Shamansare
performing ritual activities to
remove this illness from our mind. Thompson (2007) has
mentioned in his book ‘Mental
Illnesses’ a unique practice that was practiced to cure mental
illness.In the Stone Age,
they had developed some crude surgery to cure the mental
illness. In this surgery a hole
was drilled through the afflicted person’s skull to release this
evil spirit. These practices,
called trepanning, are evidenced in fossils of human skulls in
South America and Europe.
In folk healing systems, the faith healers believe that the cause
of mental illness is due to
natural and supernatural powers. For treatment and diagnosis of
mental illness, they
generally follow ritualistic and religious obligation processes.
In Tamil Nadu, there are
some temples like Hanumantha puram where a group of young
women used to remain in
a so-called trance state for about 30 minutes around noon
almost every day. Even if
considered a cry for help or attention, this practice gets social
sanction and is not perceived
as a deviant behaviour (reported by Thara, 2010).

In tribal regions, tribal people prefer to go to sorcerers and
other faith healers to cure and
get recovery from mental illness (Kishore, Gupta, Jiloha, and
Bantman, 2011). Theybelieve
that the places of worship can provide an alternative to
psychiatric treatment for people
with mental illness (Nayar and Das, 2012). Marine Carrin has
described that the concept of
evil ‘possession’ is very common among patrilineal tribal
societies and the matrilineal Tulu
society of south Kanara (reported by Thara, 2010).
Ayurdeva practice is an ancient practice in our country to cure
different health problems,
and is still prevalent. The government is also taking the
initiative to promote this Ayurveda
medical practice. The government is offering courses on
Ayurveda as well as posting
practitioners in the health centres. In the mental health field,
people also take services from
Ayurveda. The National Institute of Mental Health and
Neurosciences, Bangalore is a major
center of psychiatric training in our country and is also
promoting Ayurvedic medicine to
cure mental illness.
CONCLUSION
The relationship between culture and mental illness is highly
concrete in our country
from the ancient era. This traditional belief system and practice
to cure mental illness is
still followed in this twenty first century. Mental health
practices are fully dominated by
different cultures in our county. Our county has given no

importance to mental health
services and very few mental health professionals are working
in this field; this creates
another favorable circumstance for culture to dominant mental
health practices. Mental
illness is considered as a shame, taboo or stigma in our county.
It is highly necessary to
bring awareness among people and orient them to follow
modern mental health services.
Research related to the effect of culture on mental health or
illness is also given little
attention in our country. It is also necessary to find out the
merits and demerits of these
traditional and folk methods, and faith healing practices through
different research, and to
share this knowledge from common people to educationalists,
policy planners and policy
analysts to formulate some concrete plans and programmes.
Also, to give importance to
some of the practices like yoga or meditation, which keepour
mind and body healthy.
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Twelve myths of religion and psychiatry: lessons for
training psychiatrists in spiritually sensitive treatments
BRENT R. COYLE
Department of Psychiatry Residence Training, East Tennessee
State University,
Tennessee, USA
AB S T R A C T Our world is Ž lled with renewed interest in
spiritual dimensions. Educators and
clinicians, however, have little practical guidance for these
complex issues. The American Council
on Graduate Medical Education’s Residency Review Committee
Guidelines now require training
of resident physicians in spiritual sensitivity. The current level
of sophistication and rapid expansion
of this powerful and complex dynamic of the profession are a

challenge to psychiatrists. Problems
now facing many training programmes are lack of data, negative
bias and misinformation
surrounding spirituality. This paper focuses on 12 common
myths often associated with the interface
of psychiatry and spirituality.
The Psychiatry Residency Review Committee has made a bold
move with new
requirements, explicitly requiring education of residents on
spiritual sensitivity in
a culturally sensitive context (American Medical Association,
1996).The DSM-IV
statistical manual (Lukoff et al., 1992) likewise has included a
V-code for a “religious
or spiritual problem” (American Psychiatric Association,
1994).These two events
have marked a new beginning in careful thought and study of
religious and spiritual
topics within the field of mental health. Additionally, consumer
consciousness
within health care, in which consumers increasingly play a
greater role in deciding
what type of care the consumer prefers or is willing to purchase,
is an important
factor (Barsky, 1988). Historically the general population has
been more religious
and spiritual than many mental health professionals (Neeleman
& King, 1993). It
appears we have a clear mandate to teach and practice culturally
and spiritually
sensitive psychiatry. But how do we teach a subject area that is
unfamiliar? What
have we been taught? How accurate is the information? How
does one go about
Ž nding answers to these questions? The answers to many of

these questions may
be found in accepting our own limitation and formulating fresh
and proper
questions.
Mental Health, Religion & Culture,Volume 4, Number 2, 2001
Mental Health, Religion & Culture
ISSN 1367-4676 print/ISSN 1469-9737 online © 2001 Taylor &
Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/13674670110059541
Correspondence to: Brent R. Coyle, Director of Psychiatry
Residency Training, Department of
Psychiatry and Behavioral Sciences, P.O. Box 70567, East
Tennessee State University, Johnson
City, TN 37614, USA; e-mail: [email protected]
Myth 1. ‘Psychiatrist’s spiritual/religious beliefs are
representative of
the general population’
Results of 12 Gallup Polls over the last 35 years have been
surprisingly consistent.
Polls have indicated that:
(1) 95% of the general population believes in God;
(2) 84% of those surveyed considered religion important or very
important in their
lives;
(3) 78% pray on a regular basis;

(4) 42% had attended a religious service within the last week
(Gallup, 1985).
Intuitively, many providers are aware of the important role of
religion and
spirituality in the lives of the general population. In many cases
these in uences
form the basis of self-deŽ nition and are important factors in
family tradition and
social support. Religious activities consume a great amount of
some patient’s time
and serve as important coping strategies (Aponte, 1996; Benson,
1996; McEwen,
1998; Pargament, 1997, 1998; Smith, 1994;Waldfogel, 1997).
The term ‘religiosity gap’ has been applied to the difference
that exists between
mental health professionals and the general population
regarding religious beliefs.
The data presented in Figure 1 show relative percentages on a
number of religious
activities. For example, the rate at which various populations
would endorse the
statement ‘my whole approach to life is based on my religion’ is
represented.
Similarly represented are the relative percentages of non-
religiousness. This is
represented in the number of individuals who would label
themselves as agnostic,
atheistic, humanistic or otherwise non-religious and is much
higher among mental
health professionals.There is then what has been described as a
‘gap’ in the religious/
spiritual beliefs of psychiatrists (Larson & Larson, 1994).
There has also long been great diversity of opinions and beliefs

regarding issues
of religiosity and spirituality within psychiatry. Atheistic and
agnostic icons such
as Freud and Ellis are contrasted with others such as Jung,
James and PŽ ster who
espoused the importance of a spiritual nature from the
profession’s inception.
150 Brent R. Coyle
TABL E 1.
Group Religious (endorsement of the Non-religious (identify
selves as
statement ‘my whole approach to atheistic, agnostic, humanistic
or
life is based on my religion’) % otherwise non-religious) %
General population 72 9
Family therapists 62 15
Social workers 46 9
Psychiatrists 39 24
Psychologists 33 31
Psychiatrists holding religious beliefs have perhaps traditionally
been seen as
outliers of the profession. Recent studies have shown however,
that psychiatrists
who are also members of the Christian Medical and Dental
Society are a highly

esteemed group and largely conventional in their use of
psychotropic medication
for major Axis I disorders. These same individuals, however,
advocate the
effectiveness of Bible reading and prayer for suicidal ideation,
grief, sociopathy and
alcohol substance abuse (Galanter et al., 1991).
Finally, researchers have also found that there is a great
disparity between
mental health professional’s beliefs and their clinical practice.
One example of this
disparity is indicated by the fact that 46% would endorse the
statement ‘my whole
approach to life is based on my religion’, yet only 26% would
feel that religious
content was ‘important in the treatment of all or many’ of their
clients (Bergin &
Jensen, 1990).
Conclusion
While psychiatrists represent a broad range of opinions and
clinical practices,
generally, psychiatrists are not representative of the general
population in their
religious/spiritual beliefs.
Myth 2. ‘We know why psychiatrists are different’
Many factors may play into the “religiosity gap” of mental
health professionals.
Selection bias is certainly possible in at least two directions.
First, it may be possible
that people who are less religious are attracted to psychiatry or
other mental health

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