|
 
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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 11
| Issue : 2 | Page : 91-97 |
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Addressing Intersectionality through Medical Pluralism: Role of Indigenous Healing Systems in Mental Health
Mahi Singh
Department of Psychology, University of Delhi, New Delhi, India
| Date of Submission | 05-Nov-2022 |
| Date of Acceptance | 11-Apr-2023 |
| Date of Web Publication | 29-Aug-2023 |
Correspondence Address:
Ms. Mahi Singh
EC 196, Maya Enclave, Hari Nagar, New Delhi - 110 064
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jacs.jacs_39_22
As the world experiences rapid industrialization and we stray away from deeper aspects of being, there is an alarming increase in problems related to mental health. A paucity of mental health professionals burdens health-care systems worldwide, and this problem has become more evident postpandemic. Such a situation indicates a gap that indigenous healing systems can bridge. This article aims to recognize the role of indigenous healing systems in mental health promotion. We also focus on how alternative medicine addresses cultural differences in mental health. After a brief comparison between conventional and alternative medicine, we explore possibilities for collaboration between the two. Findings suggest that individuals in emerging and low-income countries widely resorted to alternative medicine. It has a comprehensive set of benefits but also has its limitations as it is a loosely regulated field. Alternative practices remain a popular healthcare choice in emerging countries, and combining them with conventional medicine opens up new possibilities for holistic healing and decolonizing narratives in mental health.
Keywords: Alternative medicine, culture, ethnomedicine, folk healing, intersectionality, mental health
How to cite this article:
Singh M. Addressing Intersectionality through Medical Pluralism: Role of Indigenous Healing Systems in Mental Health. J Appl Conscious Stud 2023;11:91-7 |
How to cite this URL:
Singh M. Addressing Intersectionality through Medical Pluralism: Role of Indigenous Healing Systems in Mental Health. J Appl Conscious Stud [serial online] 2023 [cited 2023 Oct 4];11:91-7. Available from: http://www.jacsonline.in/text.asp?2023/11/2/91/384455 |
| Introduction | |  |
Mental illnesses account for 14% of the global disease burden; (APA, 2017) in India, 14.3% of the population suffers from mental illness (Kanwal, 2022). In a globalized world, indigenous healing systems have been used for centuries to treat ailments of the body and the mind. Indigenous healing practices include medical procedures, methods, theories, and practices that use drugs derived from plants, animals, and minerals, as well as spiritual therapies, manual therapies, and exercises. These methods may be used separately or in combination to treat, diagnose, prevent, or maintain health and well-being (Fokunang et al., 2011). These practices are also referred to as folk healing or healing traditions and fall under the scope of alternative medicine. Alternative medicine describes medical treatments outside the purview of conventional (biomedical, standardized, and traditional) therapies. They are also referred to as “integrative” or “complementary” medicine.
People in several developing and underdeveloped nations resort to these indigenous healing practices to deal with their mental concerns due to societal stigma surrounding seeking therapeutic help or systemic issues like a deficit in mental health-care facilities. This paper explores the various aspects of indigenous healing systems, their significance in the Indian context, how folk healing practices address intersectionality in healing, and how they contrast with the Western model of mental health. The article uses the terms indigenous healing practices, healing traditions, and folk healing interchangeably.
| Overview of Healing Traditions in the Indian Context: Benefits and Potential Pitfalls | | |
Even in the 21st century, healing traditions significantly influence India's mental health care setup. Folk healing remains more prevalent in rural areas, where psychiatric care is limited. It is frequently used as the first resort to treat any mental illness before seeking help from a medical practitioner since folk healers are culturally sensitive, easily accessible, and affordable (Shankar et al., 2006). A folk healer is usually an unlicensed person with no formal medical education who uses these healing practices alongside herbal remedies and the power of suggestion to help the people in his cultural context. The proficiency of the healer in their healing practices is usually an outcome of years of study, observation, and imitation. In some cultures, the healer is believed to possess hereditary powers. The folk healer may help by mediating with God or the gods to restore balance (Khosla and Das, 2019). In the case of mental illness, folk, and religious healers constitute the predominant choice for most of the population.
Folk healing methods have a holistic approach to dealing with physical and mental illness; they target the causal factors of the disease, which are often seen as stemming out of problems in social adjustment or are attributed to more parapsychological causes, such as Nazar or evil eye, which is due to ill wishes cast by envious people, or Bhoot or evil spirits which hover around the suffering from the unseen forces or spiritual influences. About 75% of the patients prefer trying folk or sacred healing before resorting to psychiatric services (Lichtenstein et al., 2017). A study by Campion and Bhugra (1997) showed that folk practitioners and home remedies meet the needs of about 60% of patients. Another 20% depend on indigenous medical practitioners, and the rest 20% of patients turn to medical care from qualified practitioners.
The Indian subcontinent has significantly contributed to indigenous healing practices in the form of Ayurveda, yoga, and ritual healing. Ayurveda is proven helpful in cases ranging from depression to even specific symptoms of schizophrenia (Raguram et al., 2002). Ayurveda has been seen as beneficial for the treatment of dementia (Manyam, 1999), Alzheimer's disease (Ringman et al., 2005), and Parkinson's disease (Nagashayana et al., 2000). Recent studies have also highlighted Ayurveda's role in managing migraines without side effects (Soman et al., 2022). Similarly, Yoga which involves performing a combination of a variety of asanas (physical movements), pranayama (breathing exercises), and dhyana (mindfulness), have a host of benefits, sucha as coping, reducing distress, and physical impairment (Park et al., 2015), increased physical and mental well-being, enhanced cognitive performance, decreased stress and re-incarceration rates (Wimberley et al. 2016), and enhanced self-concept (Dubey, 2011; Khosla and Singh 2019). More recently, the role of Yoga in the treatment of neuropsychiatric problems is being recognized in the light of emerging evidence (Varambally et al., 2020. A study by Bhandari (2022) highlighted that an online yoga cum ayurveda intervention reduced psychological comorbidities in COVID-19 survivors. Yoga is also seen to bring minor changes in biomarkers of mental illnesses (Bhargav et al., 2020). Correspondingly, Yoga-based interventions have been shown to positively impact the quality of life and perceived stress (Gard et al., 2012), cognition, and memory of the geriatric population (Hariprasad et al., 2013) and depression (Pilkington et al., 2005).
Ritual healing is a lesser-known but significant indigenous healing practice in India. Rituals are 'patterned and ordered sequences of words indulged repeatedly, appealing to extraordinary beings' (Sax et al., 2010). Ritual healing treats physical and mental illnesses, such as infertility, restlessness, chronic pain, economic difficulties, marital problems, and childhood illnesses (Sax, 2010). In general, help is sought from a healer for any situation or physical trouble, also referred to as pareshani (Khosla and Das, 2019). It is understood as an imbalance between the physical, social, and spiritual worlds, probably in some state of adharma (incongruence with the nature of things). The patient visits an ashram or the shrine of the village goddess to worship.
Ritual healing helps bring about personal transformation (Ranganathan, 2015), a change in the meaning of experience, and their perception of reality. (Csordas, 1994). The discourse between various characters of ancient Indian texts like the Bhagavad Gita or the Ramayana reflects different psychotherapeutic principles. The Gita for instance, encapsulates what could probably have been one of the earliest documented sessions in CBT. For instance, Arjuna believes that “ he will be the cause of the destruction of his family” (”The destruction of a family destroys its rituals of righteousness [Chapter 1, Shloka 40]) and that “he cannot be at peace”. He is triggered by the thought of fighting with his kinsmen, the negative thought that he experiences is “this war is evil” and “I cannot be happy with this war” (”What happiness will we ever enjoy if we kill our kinsmen in this battle?”[Chapter 1, Shlokas 36-27]). Krishna then engages in what is similar to the CBT technique of examining the disadvantages of non-participation (”In death thy glory in heaven, in victory thy glory on Earth [Table 1]. Arise therefore Arjuna with thy soul ready to fight!”[Chapter 2, shloka 37]) (Bhatia et al., 2013)
Similarly, the central theme in Ramayana is the victory of good over evil; it also promotes various principles for positive mental health, such as maintaining serenity in tragedy, finding meaning in one's existence through Dharma, and conflict resolution. These themes are reflected in the dialogues between different characters of Ramayana (Jacob and Krishna, 2003). Understanding these texts and their application to one's life can help navigate through the issues of everyday life.
While healing traditions play a significant role in rural India's mental healthcare, predominantly in rural areas, there have been some pitfalls to the authenticity and impact of folk healing. In some cases, folk healing has perpetuated stigma and stereotypes against those with mental illnesses. In some instances of folk healing, the cause of mental illness is attributed to a wide variety of superstitions like bad karma for a (misdeed) either by the individual or by their ancestor in their present or previous life. Similarly, a study by Basu (2009) highlighted that Muslim and Hindu folk healers share similar beliefs about patients. They see “insanity” as synonymous with “impurity.” They have parallel concepts of “chhut” and “achhut” and “pak” and “napak” (pure and impure) (Magnier, 2013). Likewise, a study by Schoonover et al. (2014) highlighted that subjects were predominantly dissatisfied with their experiences with folk healers and felt better with appropriate medication. There is ample evidence supporting healing systems in Indian society; they play a significant role at home and abroad as holistic treatment modalities for treating various issues when practiced with discretion. These traditions are meaningful in the context of healing and an integral part of Indian culture.
| Indigenous Healing and Acknowledgement of Intersectionality | | |
Health-care activities do not exist in isolation in any society; health behaviors in any community are influenced by social factors like relationships between patient and healer, social norms, individual behavior, and social beliefs around seeking help. Health behaviors and their associated support systems are rooted in the cultural context of the society in which they exist and are sustained. Objectivity is one of the fundamental values of Western medicine, due to which it often fails to acknowledge cultural differences and experiences in treating individuals and overlooks the causation while treating the symptom. For instance, using the same chart for height and weight to monitor children's growth might ignore that children from ethnic minorities have different genetic characteristics and developmental trajectories. We might risk labeling their growth as “inadequate” or “abnormal.” This is one of the reasons why individuals from marginalized communities such as the Aboriginals, people from Sub-Saharan Africa, and other developing countries resort to using indigenous healing practices. Not only are these more accessible, but they also pay attention to cultural differences. An example of this can be the indigenous healing practices among the Aboriginals of Canada, which have a variety of healing methods embedded in religious and spiritual activities, are very community-centric, and provide individuals with systems to make meaning out of suffering and understand them better. Communities like Aboriginals and sub-Saharan tribes have a history of socio-cultural and colonial trauma (Kirmayer, Simpson & Cargo, 2003). On some level, these healing practices also address intergenerational cultural trauma (Durie et al., 2009). Likewise, asylum seekers, refugees, and undocumented immigrants who might be suspicious of resorting to clinical psychotherapy due to the fear of being ousted might also resort to consulting folk healers from their own communities. Low rates of seeking help are also associated with the stigma around mental health in one's community (Sue and Sue, 1999). A study by Leong et al. (1995) showed that People of Color in the United States of America have lower utilization rates of conventional mental health services compared to white people, despite the similarity in the prevalence of mental health disorders. Asian Americans also have inadequate mental health services rates (Lin and Cheung, 1999). An antecedent factor to this low utilization can be a sense of alienation experienced in a therapeutic setup based on a Eurocentric theoretical framework that emphasizes independence, individuality, and assertiveness as opposed to cultural values, which support social interdependence and adjustment (Highlen, 1996). Minute misconceptions in understanding and acknowledging cultural differences in a therapeutic setting can show up as cultural microaggressions toward those already on the margins. For instance, the therapist's inability to understand the client's accent or tone during verbal communication or the counselor's assumption of universal meanings of words can increase the cultural divide between the client and counselor (Myers, 1998). Often, the folk healers that the individuals from these communities confide in have shared cultural values. They understand individuals' behaviors within their sociocultural context and help better social adjustment (Helms and Cook, 1999). The indigenous healing practices the Aboriginals, Latinos, and Asian Americans resort to include but are not limited to massage, acupuncture, meditation, yoga, astrology, burning incense, and aromatherapy. These nonverbal practices, along with the use of culture-based, creative arts practices, may be helpful for those individuals who belong to cultures that de-emphasize verbal expression in managing their mental health, and talking about emotions is not (Constantine et al., 2004). Multicultural awareness in the therapeutic approach is a modern-day necessity to counter problems arising from socio-cultural differences. The cultural experiences of individuals play a significant role in shaping their mental health. They must be taken into account during any form of treatment. Current narratives in healing point towards an increasing need to decolonize therapy and hold space for more indigenous practices rooted in culture.
| Biomedicine and Ethnomedicine: Exploring Possibilities for Collaboration | | |
Globally, medical practices can be categorized into biomedicine and ethnomedicine. Biomedicine refers to a medical system that comprises medical doctors and other staff like nurses, pharmacists, and therapists who treat symptoms using, give diagnoses and conduct procedures like radiation treatment and surgery (NCI, n.d.). It is the traditional medicine system worldwide. This is synonymous with conventional, allopathic, mainstream, and Western medicine. Ethnomedicine is the study of “indigenous medicine” of ethnic communities, their knowledge, and practices that were transmitted orally over centuries and evolved over millennia of human existence (Chattopadhyay and Bhattacharya, 2008).
The medical perspectives in the global North focus on scientific rationality, diagnosis, biological determinism, and evidence-based practice (Stewart, 1968). The biomedical model is generally seen as a picture of reality rather than a representation of societal structures. On the contrary, ethnomedicine focuses on understanding the disease from a socio-cultural perspective and looks at the individual within the larger context of their existence. Folk healers identify that their work is not independent of the larger society. Instead, their healing practices are embedded within the community and nurtured by that society's prevailing culture, politics, and social norms. The method of medicine, and indeed the work of all health-care providers – is not independent of the larger community. Instead, healing practice is embedded within society and nurtured by that society's prevailing culture, politics, and social norms. Ethnomedical beliefs relating to the nature and causes of illness have given rise to alternative theories of sickness, health, and treatment in emerging countries. Expanding on the WHO (2014) health definition mentioned previously, mental health is conceptualized in the West by a psychological framework that considers a person as an individual-oriented phenomenon (Sue et al., 2019). Significance is placed on individuality or self-choice, and there is a strong emphasis on the principle of autonomy in healthcare and medical ethics.
In contrast, Eastern philosophies comprehend mental health mainly from a psychological framework that contextualizes an individual or self as a holistic phenomenon that follows a holistic conceptualization of mental health. The self is conceptualized as a harmonious balance of social relations and an interplay of mind, body, spirituality, and nature (Chan et al., 2001). The strategy document on alternative medicine by World Health Organization (WHO), alongside their mental health action plan (WHO, 2013), acknowledges the need to recognize the diversity in conventional and alternative treatment options. There is increasing advocacy for more research on the quality, effectiveness, and forms of indigenous practices, considering the environmental, social, and spiritual factors that make up these indigenous practices (Complementary and Alternative Medicine (CAM) Overview, 2021). A collaborative approach can provide more holistic care, with biomedicine providing pharmaceutical care. In contrast, indigenous medicine provides extra care along psycho-social and spiritual lines, which are vital for the overall adjustment of an individual.
| Evaluating the Role of Indigenous Healing Systems in Mental Health Promotion | | |
We have explored the socio-cultural aspects associated with the practice and significance of indigenous healing traditions. There are several strengths and shortcomings related to the practice of indigenous healing traditions. The popularization of indigenous healing practices provides representation to multiple communities and cultures. Apart from that, indigenous healing practices reflect a phenomenological perspective toward the treatment and presuppose that there is no “one size fits all” approach when it comes to seeking help. By addressing cultural differences, healing traditions give space to multiple narratives across society, especially those from the margins. Thus, vilifying healing traditions as “pseudoscientific” again leads to the oppression of Eastern cultural values. The hypocrisy of the global North reflects in their paradoxical practices of criticizing these healing modalities while also appropriating them and profiting off them by presenting them in a glamourized way to Western society. In the process of capitalizing on these practices, the West has forgotten to give due recognition to the communities in which these practices originated and have been used for centuries. This is a modern-day example of cultural colonialization. Resistance towards alternative medicine can come from big pharma as these practices are not very profitable and target more significant lifestyle changes that promote health more sustainably than conventional pharmaceutical care and orthodox medicine, a booming industry. However, the considerable impact of specific schools or religious sects on the results of interventions is a crucial concern in yoga and many indigenous practices. As a result, it is challenging to extrapolate the findings to patients from the same area or culture who do not belong to the specific group.
Furthermore, folk healers can sometimes falter in their conceptualization of mental illness by neglecting biological factors and seeing illness as an outcome of moral failures or spiritual disconnect. Questions can also arise around the need for more authority to check the power assumed by folk healers in a society. Often, they see themselves as instruments of spiritual energy. For instance, in most African nations, the folk healer occupies a prominent role in society and sometimes functions as a judge, custodian of cultural norms, and adviser to the ruler and elders. Another challenge to the practice of alternative medicine can be the myths surrounding the various procedures involved in its approach, especially among urban populations. However, despite all its pitfalls, alternative medicine remains a popular choice for those who might not have access to clinical healthcare and has been an integral part of healthcare in non-Western societies. (Green & Colucci, 2020).
| Implications and Direction for Future Research | | |
With the help of existing literature, we have been able to gauge the significance of indigenous healing practices, both in a medical and cultural sense, especially in non-Western societies. There is scope for a cross-cultural comparison between the outcomes of practicing alternative medicine in individualist and collectivist cultures. In aaddition, extensive analyses of ancient and religious texts such as the Bible, the Quran, or the Gita can shed light on more practices that can be inculcated in modern therapeutic settings. Integrating the knowledge and skills of folk healers and using that expertise in combination with a Western scientific approach would provide a host of benefits, like more significant insights into developing an effective health-care program to reduce the stigma and shame associated with seeking help for mental illness and also enhance adjustment and acceptance in the community (Khosla and Goel, 2019). More intensive research is required to develop modules of yogic practice that are less culture-specific and intertwined with the biomedical framework (Kumar et al., 2021). This would make it easier to generalize the benefits of such practices across different socio-cultural contexts.
| Conclusion | | |
No one health-care system caters to all the healthcare needs of one society. The two medical systems mentioned in the paper represent and are influenced by the two significantly distinct cultural environments in which they operate. On the one hand, biomedicine is particularly effective in treating objective and measurable disease conditions, while ethnomedicine effectively manages illness conditions and promotes psycho-social adjustment. Despite differences in disease theories, clients subscribe to medical systems depending on availability, cultural beliefs, and expectations. Indigenous practices may have their set of limitations, but they have assisted millions of people in emerging countries on their path to healing. We cannot replace conventional medicine with alternative healing practices, but we can tap into its vast potential by combining it with more mainstream therapeutic approaches.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1]
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