1 INDIGENOUS HEALING AMONG INDIAN SOUTH AFRICANS L.R. NAIDOO Paper presented at the Cross-Cultural Symposium of the Department of Psychiatry, Medical School, University of Natal, 1985 1. INTRODUCTION It is necessary to know and understand a community and its values to appreciate its practices. To analyse its practices using your own frame of reference is a futile exercise. What may be construed as self indulgence by one culture may be therapy to another culture. Alternatively, what maybe construed as repression by one culture maybe therapy to another culture. Hence in the presentation this morning, I will dwell on the Indian Culture, an overview of its curative and preventative health systems, the use of traditional healing methods, and some implications for the practice of psychiatry among Indian South African. 2. THE INDIAN CULTURE Largely as a result of a political system of separate development which to date actively prevents an integration of the four races of this country, the Indian South African is not very different from Indian of India in culture. The culture of the Indian South African is however limited by the culture of his fore-fathers. The forefathers of the two majority language groups viz Tamil and Hindi people (85%) were labourers brought from India to work in the sugar plantations of Natal. The minority groups of Gujerati Hindus and Muslims (Gujerati, Urdu) were mostly business men and artisans who came to South Africa as Free Passenger Indians between 1880 and 1913. in 1913 Indian immigration was banned. As a result of this type of cultural heritage the majority of the Indians at present follow cultural practices taught by their labourer forefathers. However, although cultural input has been politically frustrated since 1913 by the exclusion of immigration rights for Indians, this community has maintained it links with the people of Indian through visits to India and sponsoring of visits by learned Indians from India. 2 Hence, while literary and philosophical knowledge characteristic of Indians culture is limited among Indian South Africans, their practices are fairly similar. What values characterize the Indian? The Indian has a value system which is diametrically opposite to that of American and English cultures. This community values mutual dependence, exertion of rational control over emotion and impulse and living in harmony with others and with nature. It is a deeply religious community which accepts that God is constantly directing the course of people and the task of each individual is to worship God, practice Divine behaviours, and constantly seek union with Him. Life is a constant battle between the forces of good and evil. In its ultimate sense evil is the tendency to remain trapped with desires, attachments, and ignorance of one’s true nature. Folklore portrays evil in the more concrete form of evil influences and evil spirits. Hence while the sophisticated individual will say that sickness is due to a life characterized by desires, attachments and ignorance of one’s true self – the less sophisticated will say that sickness is due to the possession of evil spirits. While the immediate prescriptions for healing differ between the sophisticated and unsophisticated the ultimate prescriptions (i.e. preventative strategies) are the same for the sophisticated and the unsophisticated. With this background I will now do an overview of the Indian curative and preventative healing systems. The Indian traditional curative healing system is characterized by religious, magical, mystical and natural concepts of causation. The traditional preventative healing system is characterized by well-defined physical and mental exercises. The aim of these exercise is to keep the individual in peak physical mental balance in his striving for God-realization. These exercises are purported to incidentally fortify the individual against physical and mental disorders. We will return to the description of these timehonoured exercises later. 3 3. THE INDIGENOUS CURATIVE SYSTEM The traditional healer used by the Indian South African is any person who possesses the power to heal. They use a variety of healers viz. the Hindu faith healer, the Temple priest, the Herbalist, a Muslim priest who practices healing, a Zanzibar healer, Christian priests, prayer groups and a Swami or Guru. These individuals vary in their healing modes from placing a blessing hand on the head of the sick person to elaborate rituals designed to drive out the offending spirit. The Hindu Faith-healer acquires the art of healing through instruction, modeling, or via a special calling. The calling to heal may occur via a dream, a spontaneous demonstration of the power to heal while in a trance state at a prayer gathering or after a development of a deep faith in God shortly after the recovery from severe personal illness or illness of a family member. The art of healing can be acquired by both young and old and both men and women. These individuals heal both in a normal conscious state and in a state of trance. Some bless the sick while invoking the spirit of a particular deity, while others bless and prescribe certain rituals such as an abstinence from meat or salt on certain days of the week for a prescribed period of time, the offering of a prayer to a certain deity, the eating of fruit that have been blessed and the drinking of Vibbuthi (healing ash) in water. Some healers conduct a ritual such as flicking a piece of clove in front of a prayer alter. The direction in which the clove lands is indicative of whether an evil “wind” or evil spirit has possessed the sick individual. Subsequent to the diagnostic ritual a prescription is given to ward off the negative element in the individual. In the trance state the healer is either possessed by the spirit of a deity or he communicates with the deity. The deity may display anger towards an entire family or some members and may exhort them to be more fervent in their worshipping. Sometimes explanations of possession by an evil spirit, possession by an evil spell cast by an envious neighbour, and possession 4 as a result of tramping the treatment of another healer may be given. These explanations are given followed by certain ritualistic prescriptions. The healer does not necessarily use special clothing when healing. Some men use Dothis (traditional Indian Loin cloth dress). Most healers use either an ash dot, or a trident of three lines of ash across the forehead on the letter V. All go into a period of prayer before healing. Some healers have the ability to take on the pain of the sick by inhaling deeply at the point of affliction. He repeatedly inhales deeply and exhales forcefully. These pain removing sessions may continue for several visits. He may couple this technique with certain ritualistic prescriptions. The casting of an envious or evil eye is a widely accepted belief. Whenever children and adults receive many praises a ritual is performed by an elder or a healer to remove the negative influence. The temple priest has an ascribed power to bless the sick. He makes offerings of fruit and milk to a certain deity on behalf of the family of the sick. He blesses the entire family and places healing ash dots on their foreheads. Sometimes he may offer an explanation for the condition very much like the faith-healer and he may give certain prescriptions. He usually offers a packet of healing ash to be used after the prayer. The Muslim priest acquires the power to heal through a natural calling which may take the form of an awareness of healing potential. He many also acquire this power as a child. As a child he may demonstrate clairvoyant abilities and he may be advised to become a priest. Sometimes healing powers are transferred from a senior Moulana to an understudy. Muslim priests or Moulanas are usually male. Upon presentation for help the Moulana may listen to the problem, go to a private place for prayer, to a private place for communication with the agents of God by 5 gazing into water or a wall. He may return with a blessed object referred to as a Tarweez. The Tarweez may take the form of a string or necklace for the neck or affected part of the body and a piece of paper or wood with a special inscription from the Holy Koran written in Saffron Ink. The inscriptions may be attached to the string necklace. The inscribed object is required to be dipped in water which should be drunk or sprinkled in the yard of the patient. Sometimes before the Tarweez is made the Moulana may reveal to the patient the nature of his ailment. Upon acknowledgement of these utterances the Moulana goes to a private place to make the Tarqeez. Sometimes the Moulana may offer an explanation or insinuation of cause. The explanation would be one of a negative influence emanating from an envious neighbour, possession by a Ginn (or evil spirit) or the tramping of a treatment of another healer. Insinuations are given by asking questions which pertain to these causes. Usually explanations are not given. Sometimes the Moulana may request a certain number of plates on which he makes an inscription of an extract from the Holy Koran. The sick are requested to eat only from these plates and to drink the water used to wash these plates. Herbalist may or may not combine faith-healing with herbal medication. Herbal medication is derived from the roots of plants and are sometimes mixed with preparations from chemists. Knowledge of which plants to use is acquired though self-instruction and sometimes through Divine communication. Some herbalists attempt to combine western medical knowledge with their herbal knowledge. The Zanzibar healer is renowned for removal of evil objects placed in the house or yard of the sick individual by some envious neighbour who envies his success in an important life activity. He often makes the claim that the sick are “doped”. He prescribed emetics to vomit the “dope”. This healer possesses the ability to cast an evil spell and counteract an evil spell. He is also capable of exercising the evil spirit referred to as a “tokoloshe”. The tokoloshe is sometimes reported to take the form of a short person who threateningly follows the sick around and 6 gives instructions to behave in a specific ways. The Zanzibar Healer often dons exotic garments to perform his work. Prayer groups are conducted at the bedside of the afflicted, or in the house of the sick or at a prayer centre. In these groups prayers are recited and holy hymns referred as Bhajans or Kirtans are sung for several hours or a short period of time. The Swami or Guru is a religious leader. He usually blesses the sick and recites mantras or holy versus to invoke the assistance of God. He may prescribe the singing of holy hymns and recitation of mantras. He may also prescribe meditation and yoga. He attributes all afflictions to disharmony in the individuals physical and mental systems. This is an appropriate point to describe the traditional preventative healing systems since it is directed at maintaining harmony in the physical and mental systems. 4.INDIGENOUS PREVENTATIVE HEALING SYSTEMS In relation to preventative healing the most central concept to be aware of is that of Yoga. Yoga is the science of achieving union with God. It is purported to incidentally fortify the mind and body against afflictions. Hatha Yoga is a system of exercising that is designed to realize the union of the individual soul with the Universal Soul. A product of these sophisticated exercises is optimal physical fitness. The more complex exercises are taught by Yogis or individuals who have mastered these exercises. Dhyana yoga, Japa yoga and Pranayama are yogas that give rise to highly peaceful states of mind. These two are meditative procedures. There are several other types of yoga that incidentally produce physical and mental harmony viz. Kundalini yoga, Karma yoga, Bhakti yoga, Raja yoga and so on. The methods and experiences that occur in these practices are subject matter for a series of papers. 7 Hatha yoga and Dhyana yoga are gradually increasing in popularity among Indians in South Africa. 5. USE OF INDIGENOUS HEALING Watts (1980) found that 25% of a random sample of individuals who were in receipt of treatment Rx in Chatsworth consulted an indigenous healer for either a physical or mental problem. A survey, by the author of 80 consecutive Indian psychiatric outpatients at King Edward VIII Hospital revealed that 65% consulted a healer. Another survey by the author, of medical students in 1985 revealed that 75% knew of a relative or friend who visited a healer for either physical or mental problems. It is evident from the above figures and the author’s experience as clinician that indigenous healing is widely utilized among Indian South Africans. 6. IMPLICATIONS FOR THE PRACTICE OF PSYCHIATRY AMONG INDIAN SOUTH AFRICANS From clinical experience it is common knowledge that the majority of Indian South African psychiatric patients are considered unsuitable for re-educative and reconstructive psychotherapy because of their low educational levels and their negative motivations to cathart. We view this as lack of sophistication and resistance. Hence these patients are doomed to prolonged use of medication with or without supportive psychotherapy. It is evident that psychiatric practitioners fail to recognize the value system of this community to contain emotional release and conceive of problems as a result of negative external influences and good fortune is the result of positive external forces. The psychiatrist and psychologist cannot replace the indigenous healer. However, they can complement the activities of healer by: 8 1. Showing a positive interest in his diagnosis and treatment. 2. Empathizing with the patient’s beliefs. 3. Prescribing indigenous preventative strategies. The third suggestion has been practiced by psychiatrists in India for over a decade. A successful system of therapy referred to as Yoga therapy has been devised. Generally treatment takes two months with daily sessions of half-hour to one hour duration. The system utilizes the techniques of the Hatha Yoga, Pranayama, and Dhyana Yoga. To summarize, it is evident that the Indian Community has a variety of curative and preventative indigenous healing systems. The curative systems are widely used. Practical implications for the practice of psychiatry among Indian South African’s are feasible especially with regard to incorporation of indigenous preventative healing strategies. In view of the fact that our country has a wide variety of cultures it is my fervent hope that this symposium heralds the advent of culturally relevant therapies in our country.