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Traditional Healing Practices Sought by Muslim Psychiatric Patients in

Lahore, PakistanYasmin Nilofer Farooqia

a University of the Punjab, Pakistan

To cite this Article Farooqi, Yasmin Nilofer(2006) 'Traditional Healing Practices Sought by Muslim Psychiatric Patients inLahore, Pakistan', International Journal of Disability, Development and Education, 53: 4, 401 — 415

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International Journal of Disability, Development and Education

Vol. 53, No. 4, December 2006, pp. 401–415

ISSN 1034-912X (print)/ISSN 1465-346X (online)/06/040401–15

© 2006 Taylor & Francis

DOI: 10.1080/10349120601008530

Traditional Healing Practices Sought

by Muslim Psychiatric Patients in

Lahore, Pakistan

Yasmin Nilofer Farooqi*University of the Punjab, PakistanTaylorandFrancis Ltd CIJD_A_200748.sgm10.1080/10349120601008530InternationalJournalof Disability,DevelopmentandEducation1034-912X (print)/1465-346X (online)OriginalArticle2006Taylor&Francis534000000December 2006YasminLaho [email protected]

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 Homeopa-

thy, 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: somato-

form (73%); personality/conduct disorders (73%); schizophrenia (70%); affective disorders

(68%); and anxiety disorders (55%). Proportionately more male than female patients used multi-

ple 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]



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 thetraditional 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 religio-

cultural 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 submis-

sion 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, tradi-

tions, 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; witch-craft; and pilgrimage (Ahmed, 1981; Akhtar, 1987; Eliade, 1964; Majid, 2001;



Pakistani Traditional Healing Practices 403

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 inani-

mate 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, politi-

cal 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 makepilgrimages 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 tothe 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, inter-

personal 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 psychia-

trists 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, psycho-

logical, or psychiatric help from the licensed mental health professionals. The costly

services available at private clinics and hospitals are beyond the capacity of the aver-

age 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 flourishingbusiness 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 ratio-nale 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 under-standing, catharsis, and insight into one’s intrapsychic and interpersonal conflicts.




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 symp-

toms 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 thatthey 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 underpriv-

ileged, 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 associa-tion 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 satisfacto-

rily 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 nowhave 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 depres-

sion. 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 depressivesymptoms.



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 homeopa-

thy, 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 researchercategorizes 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 psychi-

atric 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, treat-

ment 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.




All of the patients had been diagnosed for affective disorders, schizophrenia, anxi-

ety, somatoform, or personality/conduct disorders by their treating psychiatrists.

However, at the time of interview the patients’ psychiatric symptoms were in remis-

sion. 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

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 trans-

lation 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 demo-

graphic 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. Descriptive characteristics of the sample ( N = 87)

Characteristic Frequency Percentage

Gender

Male 33 38

Female 54 62

Diagnosis

Affective disorders 35 40

Schizophrenia 17 19

Anxiety disorders 13 15

Somatoform disorders 11 13

personality/conduct disorders 11 13

Age Range = 18–70 years

Income (monthly) (Pakistani Rupees) Range = Rs. 300–10,000

Years of schooling/education Range = 0–14Socio-Economic Status Low and low-middle class



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 Inter-

view 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, andNone). The nominal values of 1, 2, 3, 4, and 5 were used to dummy code Homeop-

athy, Tibb, Islamic Faith Healing, Sorcery, and Multiple Traditional Healing Prac-

tices. 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 inter-

esting 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. Thefindings suggest that 73% of both those with Somatoform and Personality/Conduct




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-diag-

nosed 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.Figure1. Genderdifferenceintraditionalhealingtreatmentchoices

Discussion

This study explored type of traditional healing practices sought by Muslim psychi-

atric 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 2. Gender differences in type of traditional healing practices

Type of traditional healing practices (%)

Gender ( N = 87) Homeopathy Tibb

Islamic Faith

Healing Sorcery

Multiple Healing

Practices

Male patients ( N = 33) 5 1 2 1 25

Female patients ( N = 54) 2 6 6 9 32

Table 3. Type of traditional healing practices by diagnosis

Type of traditional healing practices (%)

Gender ( N = 87) Homeopathy Tibb

Islamic Faith

Healing Sorcery

Multiple Healing

Practices

Affective disorders ( N = 35) 9 3 9 11 68

Schizophrenia ( N = 17) 0 0 18 12 70

Anxiety disorders ( N = 13) 15 15 0 15 55

Somatoform disorders ( N = 11) 0 0 18 9 73

Personality/conduct disorders( N = 11) 9 9 0 9 73



410 Y. N. Farooqi

methods were utilised more frequently by the female patients who are the most

under-privileged, uneducated, vulnerable, and suggestible group in Pakistan, proba-

bly 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 comparedwith 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 tradi-

tional 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, embarrass-ment, 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

Figure 1. Gender differences in traditional healing treatment choices




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 soci-ety 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, phys-

ical, 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 schizophre-

nia, somatoform, and personality/conduct disorders, the course of these illnesses is

usually more chronic and the level of impairment in terms of the global functioningis 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. Interestinglyenough, most Pakistani traditional healers treat their patients tactfully in their reli-

gio-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 tradi-

tional healers, especially from spiritual healers and sorcerers, for the treatment of

their mental disorders

Some questions remain regarding how Pakistani traditional healing practiceswould 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 medi-

cine and psychiatry. Perhaps, in an age of information technology, there is a need for

cooperation between spiritual healers and westernised health care workers. A posi-tive interaction between the two health care systems could improve the mental

health and well-being of people in the East and the West.

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414 Y. N. Farooqi

Appendix. Case History Interview Schedule (English translation)

Name: Age:

Education: Occupation:

Monthly Income: Any other Income:

Marital Status: Dependents in Family:

Hospital: Diagnosis given:

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.




Q7. How frequently have you visited the healer/s per week during the last one

year?

a. 0–1 visits

b. 2–4 visits

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!

y f virginia tech

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