2 - Sufi Shrines as an Alternative to Western Rehabilitation
Dr Ashique Selim, ST5 Academic Clinical Psychiatry
Dr Adrian Phillipson, ST6 Adult Psychiatry
Introduction
The role of faith in the process of healing is gradually becoming integrated into main stream
psychiatric practices. The emphasis of the ‘recovery model’ in psychiatry has made it necessary to
integrate a person’s faith into the overall care planning. In the narrative by Morley et al, in 2006 the
authors discuss this history of the relationship between religion and psychiatry and highlight the
importance of the consideration of the role of religion in psychiatric care (1).
A study of psychiatric inpatients in Orissa, India (2) showed that the majority of patients attributed
their psychiatric symptoms to ‘supernatural causation’. The study also showed that the majority of
patients accessed faith healers prior to entering main stream psychiatric services. The authors
commented that this early access of alternate healing delays medical intervention and in turn the
prognosis of the patient. The authors also commented that some of the alternate practices could be
traumatising for the patients and this could have a negative impact on their mental health.
In the USA Arcury et al, in 2000, demonstrated that the majority of elderly persons routinely used
religious practises as a method of self-management of their health (3). They also found that there
was very little gender or ethnic difference in the use of faith for health management. They did
however propose that the participants in the study did not see themselves as ‘using’ religious
practice to heal themselves, but in contrast they saw the practices as a part of their normal lives and
it was difficult to distinguish between the two.
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The bio-psycho-social approach to health care makes it imperative to include spirituality as an
element of the holistic approach to patient care. Active collaboration between the psychiatric
services and the Pakistani Muslim Centre in Sheffield has helped to reduce the number of inpatient
admissions and the length of stay on psychiatric inpatient units for members of the Pakistani
Community (4).
Sufism
Sufism is described as an aspect or dimension of Islam that is concerned with mysticism. It is
thought that Islam was brought to and spread across South Eastern Asia by Sufi saints. Shah Jalal is
the saint who is reported to have travelled to Bangladesh with 360 followers to aid the spread of
Islam in the region. Today there are a large number of Sufi shrines spread across Bangladesh, with
the highest concentration being in the Sylhet District. These shrines are thought to be the resting
places of the Sufi saint and his followers.
It has been suggested that Sufi philosophy is tolerant of people with mental health problems, and
hence the shrines tend to attract people with schizophrenia (5). It is also reported from Pakistan that
‘Sufis’ are providing religiously sanctioned interventions to people with mental health problems (6).
A scoping exercise was conducted by the authors on the psychiatric services of the Sylhet region of
Bangladesh (7). As part of this scoping exercise one of the larger Sufi shrines was visited.
Findings
The authors visited a Sufi shrine located in the outskirts of Sylhet City. The access to the shrine
was lined with shops selling various items for pilgrims to buy. There were numerous vendors
selling colourful threads or amulets to be blessed at the shrine. The shrine itself was on top of a
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small hill with access via a set of stairs. At the foot of the hill was a large pond with traditional
healers selling their wares and giving advice to those who sought it. A number of individuals with
physical disabilities were seen in the grounds asking for donations from the pilgrims.
A total of four individuals who appeared to have a psychotic disorder of some form were seen in
and around the shrine. They were all male and middle aged. The first was a dishevelled man
dressed in rags, with long hair and beard. He was seen walking up and down the stairs without
clear purpose and was talking to himself. He appeared to be actively responding to external, absent
stimuli. He seemed to be restless, did not remain seated in one place for long, and was seen
walking up the stairs and lying down on the floor. The visitors and the other people working at the
shrine were tolerant of his behaviour and when offered food he would accept it. Some local
merchants were of the opinion that this man was from a local family who had taken him to various
traditional healers and doctors but found no improvement. As a last resort they brought him to the
shrine and left him there as they believed he would be safe.
Inside the shrine, there were two other men who had a similar appearance to the first, but were
calmer in their demeanour. One of the men was seen walking around the shrine, picking up small
pieces of plastic thread that he tied together into bundles. He would then tie some of these to his
garments. He was seen engaging in this activity for prolonged periods of time. The other man was
intermittently seen picking up a broom like instrument and sweeping the floor surrounding the
shrine only to return to his perch in the corner of the shrine, where he accepted money from
pilgrims. Both of these men appeared quite withdrawn and apathetic, potentially displaying both
positive and negative symptoms of a psychotic illness.
A final man was seen walking between the pond and the foot of the hill. He had covered his torso
in chains and had dishevelled long hair and beard. He was agitated, and would intermittently pick
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up two metal bars and hit himself across the chest. He approached the authors and was clearly
thought disordered. He demanded money and when offered a small amount he refused to take it
and became more agitated. He sat at the base of a tree and continued to chant and hit himself
intermittently.
Despite the dishevelled and unkempt appearance of all of the individuals, their nutritional state
seemed to be adequate.
Discussion
The Bangladesh Government provides a statutory psychiatric service, but this is insufficient to meet
the needs of a large proportion of the psychiatric patients in the country (8). There is no statutory
rehabilitation service provided for individuals with mental health problems. It has been suggested
that this void is filled by the availability of a robust family support system (5). However, if this
support system fails, or if the presentation of the patient becomes unmanageable, then there are few
options for the family to consider.
From the visit to the Sufi shrine it appears that these places of worship have become a place of
safety for people with physical and mental disabilities, where basic needs, such as nutrition and
shelter, are met. People are more tolerant and charitable while visiting these places and the persons
seeking refuge benefit from this.
What was quite unexpected was to see some of the people engaging in meaningful tasks, such as
sweeping the floors, or collecting plastic strings to be re-used. This model of engagement fits in
well with the ideas of rehabilitation and recovery that have been adopted by western psychiatry.
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It was also interesting to see that the one person who was clearly experiencing severe active illness
was left to his own accord, but was supported in receiving adequate nutrition and shelter.
All of the above did not seem to be organised in a coordinated or intentional manner, but seemed to
be as an inadvertent consequence of being at a place of worship. There has been an interesting
piece of research done in the Western Ghats of India (9) where the benefits of people visiting a
place of worship for mental health problems was looked at. They found that there was a significant
drop in the Brief Psychiatric Rating Scale scores of individuals with psychotic illnesses completing
a period of stay at the temple.
There is a scope for a similar research project to be undertaken in some of the larger Sufi shrines in
Bangladesh. This would enable a better understanding of the impact that staying at a shrine has on
individuals with psychotic illnesses. It could also lead us to understanding potential mechanisms
for any change. There may also be a scope for discussion with the administrators of the shrines, to
look at providing a more formalised, culturally acceptable service for individuals with severe
mental illness.
References:
1)
Morley, J. Taking Religious Experiences Seriously. Philosophy, Psychiatry, &
Psychology, September 2006, vol./is. 13/3(201-203), 1071-6076;1086-3303 (Sep 2006)
2)
Kar, N. Resort to faith-healing practises in the pathway to care for mental illness: a study
on psychiatric inpatients in Orissa. Mental Health, Religion and Culture, November
2008, 729 -740
3)
Thomas A. Arcury, Sara A. Quandt, Juliana McDonald and Ronny A. Bell. Faith and
health self-management of rural older adults. Journal of Cross-Cultural Gerontology 15:
55–74, 2000
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4)
Hackett R, Nicholson J, Mullins S, Farrington T, Ward S, Pritchard G, Miller E,
Mahmood N. Enhancing Pathways Into Care (EPIC): Community development working
with the Pakistani community to improve patient pathways within a crisis resolution and
home treatment service. International Review of Psychiatry, October 2009; 21(5): 465–
471
5)
Islam R, Howard R. Psychiatry in Bangladesh. Psychiatric Bulletin 1993 17:492-494
6)
Amin A, Muhammad G. Psychiatry in Pakistan: 1947-2006: A New Balance Sheet.
Journal of Medical and Biological Sciences 2007 1:2
7)
Phillipson A, Selim A Mental Health care in Sylhet, Bangladesh: A Scoping Exercise
2010
8)
World Health Organisation - AIMS Report on Mental Health system in Bangladesh –
2007 http://www.searo.who.int/
9)
Raguram R, Venkateswaran A, Ramakrishna J, Weiss M. Traditional community
resources for mental health: a report of temple healing from India. British Medical
Journal 2002;325:38
Authors:
Dr Ashique Selim, MB BS, MRCPsych is an ST5 in Academic Clinical Psychiatry at Sheffield
Health and Social Care NHS Foundation Trust, UK.
Dr Adrian Phillipson MBCHB, MRCPsych is an ST6 in General Adult Psychiatry at Sheffield
Health and Social Care NHS Foundation Trust, UK
Contact:
drashiqueselim@googlemail.com
adrianphillipson@yahoo.co.uk
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Conflict of Interests:
The authors received a travel bursary of £800 to cover the cost of flights from the NHS Tower
Hamlets Bangladesh Programme.
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