According to a World Health Organisation report (2017), almost 7.5% of Indians suffer from major or minor mental disorders that require expert intervention. In reality, this number could be much higher as suggested by the findings of a study by India’s National Institute of Mental Health & Neurosciences (NIMHANS), which revealed that nearly 150 million Indians needed active intervention while fewer than 30 million were getting it.
WHO describes mental health as "a state of well-being in which an individual realizes his/her/their abilities, can cope with the normal stresses of life, can work productively, and can make a contribution to his/her/their community.” It is more than merely the absence of mental disorders or disabilities.
In India, mental illness is considered to be taboo and people afflicted with any mental health-related disorder are thought to be 'mad'.
Societal attitudes and fear of stigma lead to people remaining undiagnosed and unable to get proper treatment. Adding to that, poor awareness about these issues results in people dismissing the symptoms as a part of life.
The situation gets more severe because there is a lack of professional doctors who can take care of the patients. India has just three psychiatrists per million people, 95% fewer than the commonwealth norm of 5.6 psychiatrists per 100,000 people. (WHO Mental Health Atlas 2017)
In 2015, the suicide rate was 15.7 per 100,000, which is higher than the global average of 10.6 per 100,000 (Srivastava, Chatterjee & Bhat, 2016). The recent suicide of actor Sushant Singh Rajput informs us that mental health care is a major challenge in India, which doesn’t spare even the wealthy and famous. Even though it permeates all levels of society, it is more widespread for people who are marginalized and suppressed.
There is a complete lack of awareness in rural areas, even more so for women. Rural women bear through a lot of problems and difficulties throughout their lives. They are often subjugated and don’t have a say in family matters, with the decision of the family patriarch taking precedence over everything else.
Rural women in India are less literate (56%) than rural men (72%), which further entrenches the inequalities (NSS 71st Round Report). Also, an overwhelming majority of rural Indian women do not have the right to choose their partners, with the decisions often made by the family elders. They suffer not only from economic poverty but also from ‘information poverty’ i.e. they do not have the required skills or means to access adequate information, understand it, and apply it appropriately.
Moreover, they are not perceived as productive workers even though women work for longer hours than men. This is because women provide labor on family farms and complete household duties without receiving income. If the imputed value of her work is ascertained, it would be more than the men’s salary in their family.
These factors lead to the deteriorating mental health of women in rural households. Depression in women presents itself with physical symptoms rather than emotional. Consequently, when they attend primary care services, the diagnosis of their conditions is often overlooked and families incur unnecessary costs for ineffective healthcare treatments, as a result of which, psychosocial interventions are not initiated.
Another cause of mental illnesses is domestic violence. A household survey of 500 women in rural Maharashtra reported 23% had been beaten in the last six months. (Jain D, Sanon S, Sadowski L, Hunter W)
Rural women are controlled most of their lives... they are told what to wear, what to do, where to go, etc. Many a time, the pressure that they are subjected to becomes so high that it drives them to take their own lives. According to a Lancet study, nearly two in every five women in the world who take their own lives are Indian.
And sometimes, this suppression has a different result.
Spirit Possession – Real Or Fake?
You may have heard of stories about people, mainly women being possessed by demonic presences in villages. Often an Ojha or ‘Tantrik’ is called to cure the patients by warding off the evil spirits. This phenomenon of spirit possession is prevalent in many places in India.
There are two ways in which a particular 'episode of possession' is perceived in rural society. Often the woman is taken to be possessed by a supernatural being (ghost, demon, good, etc). In this case, this phenomenon is viewed as a case of supernatural intervention, rather than the onset of mental illness. It can also be recognized as an episode brought about by a mental illness when the secondary consciousness manifests itself as a human personality. For this, psychiatric treatment should be sought.
Due to cultural beliefs and the lack of awareness around mental illnesses in India, most of the time such episodes are seen as paranormal interventions, and the 'possessed' woman is sought to be ‘cured’ by approaching a shaman who then performs an exorcism.
This phenomenon can be understood by referring to various examples available in anthropological studies that have been conducted around similar cases from the past few decades.
The case study of Somavati by Obeyesekere’s in 1977 illustrated the traditional perception of the people towards such episodes.
Somavati was a 29-year-old woman in South Asia who was 'possessed' by several spirits. In the initial years of her childhood, Somavati was brought up by her maternal grandmother. However, at the age of seven, her father brought her back home. This forced separation from her grandmother was traumatic for Somavati, and her grandmother was not in favor of the decision either.
The years that followed were full of problems. She was regularly beaten up if she did not execute the duties properly, and to get away from her abusive family, she married a man who showed interest in her. The man turned out to be an alcoholic who used to beat her severely. Somavati’s parents found out about her abusive husband and forced her to divorce him, against her wishes.
Obeyesekere comments, "The return to her parents likely reactivated the trauma that resulted from an earlier event - her forceful removal from her grandmother' s home."
Even after twenty months of living with her parents, her parents had no intention of getting her remarried. It was during this time that she had her first episode of spirit possession.
She described it as follows: "My hands and feet grow cold; it is as if I don't control them. Then my body shivers-shivers and the inside of my body seems to shake... This goes on and on ... and if I hear someone talk I get angry. My rage is such that I can even hit my father and mother in those moments."
Interestingly, all the 'spirits' that possess her seem to be hostile towards her family.
According to Richard J. Castillo (Professor of Psychology), this cultural concept of 'possession' episodes can be accommodated by dissociation theory, through which Somavati’s illness and similar cases can be classified as 'possession disorder'.
He presented that the various spirits which manifested in the body of Somavati are similar to various kinds of “protector” personalities most commonly observed in American Multiple Personality Disorder (MPD) patients.
Dissociative theory suggests a behavior of trance in life-threatening situations or extreme stress, and Somavati's possession episodes were the results of the spontaneous trance she employed to cope with the physical abuse and mental trauma afflicted on her since childhood. Through this, she enabled her primary personality to psychologically escape from her oppressors. Simultaneously, she developed alternate conscious identities to deal with rage and aggression. These identities surfaced later in her life in the form of alter personalities.
This is just one of the cases where Dissociative Identity Disorder is alleged to be a demonic spirit possession, which leads to the mental health problems remaining untreated.
This problem is widespread in India and was also depicted in the movie Bhool Bhulaiya. In the movie, the protagonist Avni unconsciously develops abnormal behavior, leading her family members to believe that she is possessed by the ghost of Manjulika, a dancer who had a tragic life and had once resided in their Haveli. However, she had an identity disorder. As a child, Avni was forcibly taken away from her grandparents and as a result, she had anxiety and repressed emotions. When Avni heard the story of Manjulika, she sympathized with her as Manjulika was also forced apart from her loved one, and this caused Avni to unconsciously create an identity associated with Manjulika.
These occurrences are relatively common in the context of Rural India as the idea that spirits can come in and out of a person is consistent with the view that the soul is immortal and never ceases to exist.
Spirit possession has two causes:
1. The basic condition due to the individual’s intrapsychic (internal) tension (Eg: Somavati’s childhood abuse and Avni’s sudden detachment from her grandparents).
2. A precipitating condition due to a situation involving unusual stress or emotion. (Somavati is forced to divorce and Avni’s arrival at the haveli.)
The only primary gain that comes off these incidents is the relieving of an individual’s internal tension, while the secondary benefits include increased attention, influence over relatives, and sympathy.
The frequency of these possessions is drastically more in rural women because they are often subjugated and oppressed their entire lives. As they are vulnerable and have emotional or physical problems, these episodes enable them to express their suppressed emotions, and sometimes even lead to their families helping and treating them better after they are “cured”, to avoid the need for more costly rituals. For these women, it is a way of adapting to different types of traumatic events and abuse.
There are multiple cases where women from far off places come to specific locations of supernatural importance to remove the ‘unworldly spirit’ from their bodies. Every year in Malajpur Village (Madhya Pradesh), a “Bhoot Mela” is observed in the temple of Guru Deoji, where thousands of women come to the temple to submit to a guru and his disciples who perform exorcisms to drive off demons and restore sanity. The process of exorcism may involve violence against the possessed by pulling the hair, beating with a broom or a stick. These are the women who grew up in a culture where spirits were parts of folk stories and have felt invisible and unimportant for most of their lives.
These episodes eventually lead to a change in their social status, as even when people are afraid of them, it is still better than being neglected. For them, anything is better than being in their oppressed household setups.
These kinds of incidents can be used against women, consequently, a woman can easily be declared as a witch.
The Dark Side – Witch-Hunting
This form of oppression that rural women have to suffer is ‘witch Hunting’. In some states like Rajasthan, women are accused of practicing witchcraft. The accusations can be made solely on the premise that something seems to be wrong in the society like the death of a child, a disease outbreak, spirit possession, or a bad harvest.
For the people, witchcraft is an easy explanation when there is no easy answer and it also gives men the leeway to do whatever they want by asserting their dominance. The people finally get someone to blame when an unfortunate situation arises over which they have no control.
After identifying a witch, they are tortured and most likely murdered. Throughout India thousands of witch hunts take place. According to India’s National Crime Records Bureau, more than 2500 people in India have been tortured and killed in these hunts between 2000 to 2016. The actual number may be much higher because most states don’t list witchcraft as a motive for the murder.
To prevent this, in 2015, Rajasthan and Assam passed laws banning witch-hunting. But even with these laws, these activities are not reduced to a large extent as the people who perform these hunts are illiterate and don't care about the laws and the consequences of their actions.
Solutions
If we want to combat the problem of mental health care for people in general and rural women in particular, the Government has to take drastic steps.
Community-led intervention can be of use as observed by the Comprehensive Rural Health Project (CRHP) undertaken in western Maharashtra. Its interventions include income generation; agricultural and environmental programs; education; PHC, hospital and referral services; and rehabilitation for disabilities. All these services lead to women's empowerment which enables them to be self-confident and promotes them to contribute to the community.
Awareness campaigns to foster knowledge and to provide information in rural areas should be held to enable people to understand the importance of mental health and help them comprehend the severity of mental health problems. The government should integrate mental health services in India’s basic healthcare system to improve its affordability and accessibility. Moreover, a committee should be established to survey rural areas and actively check people for disorders.
By Samyak Garg
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