Mudpacks and Prozac

Experiencing Ayurvedic, Biomedical, and Religious Healing

Murphy Halliburton

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781598743999
• eBook ISBN: 9781315424279
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

People seeking psychiatric healing choose from an almost dizzying array of therapies—from the medicated mud packs of Ayurveda, to the pharmacopeia of Western biomedicine, to the spiritual pathways of the world's religions. How do we choose, what do the treatments offer, and how do they cure? In Mudpacks and Prozac, Murphy Halliburton investigates the very different ways in which Ayurvedic, Western, and religious (Christian, Muslim, and Hindu) healing systems define psychiatric problems and cures. He describes people's embodied experiences of therapies that range from soothing to frightening, and explores how enduring pleasure or pain affects healing. And through evocative portraits of patients in Kerala, India—a place of incredible cultural diversity that has become a Mecca for alternative medicine—Halliburton shows how sociopolitical changes around the globe may be limiting the ways in which people seek and experience health care, with negative effects on our quality of health and quality of life.

1

INTRODUCTION

When I met “Ajit” in an ayurvedic hospital in Kerala, India, he had already tried two of the most popular therapies for mental illness. Seeking relief from emotional distress, sleeplessness and violent outbursts, he underwent the medicated mudpack treatments of ayurvedic psychiatry, which is based on the South Asian system of medical practices known as ayurveda. He had also used the psychoactive pharmaceuticals of Western biomedical psychiatry, which is known in India as “allopathy” or, in a phrase evocative of allopathy’s colonial origins, “English medicine.” Ajit had not visited any of the religious sites that are also reputed as healing centers for people with mental health problems, but the young man had recently participated in a pilgrimage, which he feels helped him achieve some mental peace.

During our first encounter Ajit offered an impassioned discourse on the ideals and practices of ayurvedic and allopathic medicine in the changing context of health in “modern society”:¹

In the case of allopathic doctors, after asking two or three questions, they will know which medicine to prescribe. But ayurvedic doctors, they want to take the patient to another level. At that level, things are very different. Right now I am taking treatment for mental illness. For this illness, there is a painful method. It is giving “shocks.” After going there and coming here [referring to allopathy and ayurveda], I feel this is better. But now everyone “prefers modern medicine.” It is because of “modern society” that some are reluctant to come to ayurveda.²

There might be some good aspects in allopathy when one looks at its research and other things, but if we want to get good coolness [kulirmma], if we want to reach a good goal [nalla lakshyam] … Right now, speaking about our life, what is it? If I have a fever, I must get better [literally, must get changed—māranam]. For what? To go to work the next day. Get a cold, get changed [māranam] in order to go to school the next day. This is the level at which we maintain our health. If we have a supreme aim in life, ayurveda will help us attain it.

These brief but insightful comments, like those of many other patients I met, delve directly into phenomenology and the nature of embodiment, issues that captivate me as a medical anthropologist. Most notably, the aesthetic experience of medical treatment is a central concern for the patients I interviewed. Ajit specifically comments here on the visceral experience of different therapies. Giving “shocks,” or electroconvulsive therapy, he considers painful, whereas he reports that his “head got cooled” from ayurvedic therapy, evoking a local idiom for a pleasant aesthetic effect. I found that similar experiences were recounted by other people suffering mental afflictions in Kerala, many of whom abandoned allopathic psychiatric treatment to pursue a different form of healing because of what they experienced as uncomfortable or abrasive methods of treatment. Whereas allopathy may involve an occasionally painful healing process, patients report that ayurveda usually provides less abrasive and, at times, aesthetically pleasant therapeutic experiences. Ajit employs the Malayalam term kulirmma, which translates roughly as “coolness” and “satisfaction,” to describe the aesthetic experience he obtained through ayurvedic treatment.

On one level, it seems perfectly obvious that patients would be concerned with the pain or pleasure they experience. And yet, the ways in which the aesthetic pleasantness of treatments differ between medical systems have been overlooked in studies of mental healing. Scholars tend not to take aesthetic pleasantness seriously either as a source of insight about concepts such as embodiment, healing and curing, or as a source of insight into critical public health issues such as how and why patients seek treatments, make decisions about treatments, and navigate multiple medical systems. The seemingly mundane fact that patients tend to prefer a therapy that feels good—or is “cooling,” as they say in South India—over one that is more abrasive or painful is actually a rich point of departure for medical anthropological inquiry.

In investigating aesthetics, I am also concerned with experiences that run much deeper than simple pleasure or pain. In the preceding quote, Ajit also claims that ayurvedic doctors attempt to bring the patient to “another level,” a positive transformation he alleges can occur through ayurvedic therapy. This also evokes the experience of people who seek religious therapies at temples, mosques and churches, where they undergo aesthetically rich healing processes that engage the senses through music, smells and a scenic environment. Although many report only moderate improvement after therapy, some recount undergoing a transformative process that brought them to a state similar to what Ajit describes, a level of well-being that is more vibrant than the normal “healthy” state they experienced before their illness. Here health does not signify merely an absence of illness—it is not merely “remedial,” to borrow Alter’s (1999) label for contemporary biomedical and social science assumptions about health. Rather, it is something that can be continually improved upon or “changed,” as they say in Kerala when describing what is accomplished in healing.

An awareness of the pleasantness of the process of healing thus leads to a recognition of the contingency of time in healing and the limitations of the concept of curing for understanding what is accomplished in therapy. There is no word in Malayalam, the primary language of Kerala, that has quite the same meaning as the English term “cure” or that depicts the allopathic orientation to treatment. Curing implies an eradication of a pathogen or a return to a state of normalcy, or a “baseline,” that existed prior to an illness. “Cure” is in some contexts more ideal or ambitious than the verb māruka, meaning “change” (or, more loosely, “improve,” “get better”), which is used in Kerala to describe the improvement one attains through therapy. The concept of “curing,” or even “healing,” meanwhile, falls short of capturing the sense of moving to a higher level or the auspicious transformation reported by some who were using religious therapies.

Since people in Kerala have several, mainstream therapeutic options, many patients discontinue unpleasant treatments to pursue less abrasive forms of healing. Some people with intractable mental illnesses that have persisted for years have found a “solution” to their problems, not in achieving a cure, but in resolving to live with their problems in the aesthetically and spiritually engaging environment of a religious healing center. In other words, they have decided to live in a process of therapy that is “pleasant” in the sense of being positively aesthetically engaging and where the contingency of time is deemphasized. The concern about the aesthetic quality of the process of therapy in ayurveda and the actions of those who choose to live with their problems in a religious center suggest an orientation to the process and goals of therapy that is less teleological, less oriented to absolute endings than the orientation in allopathic medical practice. Both approaches involve working toward goals, but the ayurvedic and religious orientations attend to the quality of the present—the process—while moving forward, whereas allopathic therapy proceeds with a more emphatic focus on the future and with a concern that results should come quickly. Recall that Ajit described allopathic psychiatric treatment as having a “sudden effect.” Although allopathic treatment does not attend as much to the quality of the present—that is, the process of therapy—the speed of allopathic therapy appeals to people who feel they do not have time to engage in gentler but slower ayurvedic treatment.

Ajit calls our attention to another aspect of the aesthetic and phenomenological experience of illness when he describes his problem as a “mental” (manasika) illness. “Mental” is one of several idioms, including bōdham (“consciousness”) and ōrmma (“consciousness/memory”), which people in Kerala use to describe their experiences of illness. These idioms, and the modes of experience they represent, form part of a local phenomenological orientation, a set of relations between mind, body, consciousness and other parts of the person through which one mediates one’s experience of the world. I describe this as a “local” phenomenological orientation because I am suggesting that these orientations are culturally and historically constructed. “Local” phenomenologies are, of course, informed by larger discourses and philosophies, but as opposed to a universal phenomenology, which philosophers have long attempted to define, people suffering “mental” distress in south India reveal that people experience the world through a variety of phenomenologies. People in various settings make sense of their personhood and their way of being in the world in terms of a range of modes of experience and perception—mind, manas, body, ōrmma, soi, dasein, among others—that cannot be reduced to mind-body dualism or embodiment.

In anthropology, cultural studies, philosophy, gender studies and other fields, much attention has been paid to the paradigm of embodiment and to intriguing critiques of the limitations of Western mind-body dualism. For a long period, perhaps since the development of modern research universities, academic enquiry focused almost exclusively on thought and mental representation, overlooking how people feel and experience the world viscerally or through the body. To correct this representationalist bias, researchers over the last two decades have examined how our embodied experience shapes our engagement with the world and have questioned what they see as the limitations of mind-body dualism. Ethnographers claimed to have found peoples who transcend the dichotomies of western mind-body dualism and ground experience more firmly in the body, a discovery that actually continues a long-term trend in Western academia to find in the East or the cultural Other the fulfillment of what is lacking in modernity and the West. The search for the embodied Other, in which research on the body appears to be caught, has led us to overlook what may be a great diversity of phenomenological experience that cultures construct differently in various settings. Living neither in the realm of Descartes and Heidegger nor in a grounded, embodied alternative, people in Kerala distinguish between body, mind, buddhi (“intellect”), bōdham (“consciousness”), ōrmma (“consciousness/memory”), and ātman (“the true, essential self”), idioms that are found in Indian philosophical and religious texts and that are used by people whom I spoke with in Kerala. These particular idioms constitute a continuum of increasingly intangible modes of experience—from the highly tangible body to the completely intangible ātman—in which the more intangible realms are more highly valued.

The nature of the aesthetic quality of healing and the phenomenological orientation reflected in the experience of people suffering illness in Kerala are historically contingent to a certain degree, and they continually encounter and counter various influences. There is evidence that in the past, more invasive and painful procedures existed in ayurveda along with gentler methods of treatment, but ayurvedic practitioners now place greater emphasis on less invasive, nonviolent methods to distinguish their practice from allopathic medicine (Zimmermann 1992). Meanwhile, people in Kerala are reporting increasing time pressure due to contemporary work regimens with the consequence that they say they have less time to undergo these lengthier, nonabrasive therapies. While Ajit says that ayurvedic doctors want to take people to a higher level, he also explains that today when one is ill one must get over it quickly in order to get back to work or school. Ayurvedic therapy can take weeks, but, as Ajit observes, an allopathic doctor prescribes a pill after asking two or three questions. In addition, the proliferation of allopathic psychiatric and psychological discourses in the media and in popular culture corresponds to alterations in “idioms of distress” in Kerala.³ More people are complaining of problems like “tension” or “depression” and using these English terms to describe their afflictions. These Western, embodied depictions of mental states may be modifying the phenomenological orientations people engage with in South India.

Embodiment and Phenomenology

Interpretations that seek explicitly to collapse mind/body dualities, or that are essentially dialectical or montage-like in form, are now privileged. The body is no longer portrayed simply as a template for social organization, nor as a biological black box cut off from “mind,” and nature/culture and mind/body dualities are self-consciously interrogated (Lock 1993: 136).

This observation by Margaret Lock in 1993 describes a turn to the body in the 1980s and 1990s in fields ranging from anthropology to comparative literature. This transition provided a profound corrective to studies that looked at human experience in cognitive or mentalistic terms and through the assumptions of Western mind-body dualism. Until the late twentieth century, researchers and scholars overemphasized the realm of the mind, focusing on concepts, ideas and representations of human experience while paying little attention to visceral experience, the world of the senses, or the fact that our perception is shaped by our condition of being in a body.⁴

The discovery of the body and embodied experience profoundly affects social and cultural analyses of health and illness. Illness is a powerfully embodied experience that was previously approached by medical anthropologists and other social scientists in terms of peoples’ concepts and beliefs.⁵ While different people, or cultures, may have different “understandings” of the body or “concepts” about healing and the “meaning” of illness, illness and healing are highly embodied experiences. They are not just conceived: they are felt, lived, and experienced, affecting the person bodily, aesthetically and emotionally as well as mentally and existentially. In examining experiences of illness and healing in India, I am both embracing and refining this turn to the body. I consider the importance of the aesthetic-experiential realm for comprehending the process of healing while going beyond the depiction of non-Western subjects as people who are somehow more in touch with their bodies to depict a greater variety of aesthetic and phenomenological orientations than we previously imagined.

While drawing our attention to the body, researchers have created a picture of the world wherein peoples who are labeled “non-Western” or “traditional” are either more grounded in their bodies or they experience the world with a more subtle awareness of mind-body interconnection.⁶ Meanwhile we are led to imagine that the Western subject is naively unaware of the embodied nature of his own experience (I say “his” intentionally; the Western woman is frequently seen as akin to the non-Western subject in her awareness of her body). “Mental” patients and spirit-possessed people in Kerala, however, express their suffering explicitly in terms of the mind and other intangible parts of the person, which I suggest actually represents a greater degree of rarification away from the body, or a more fine-tuned parsing of the intangible from the material, than is contained in Western mind-body phenomenology.

Attempting to discern and map out local phenomenologies, orientations to experience, which are not simply about the body but about the condition in which a person lives as a combination of mind, body and other locally construed modes of experience, should provide richer insights into the nature of human experience than our tendency to look for transcendence of Western mind-body dualism in the world outside the modern, middle-class West.

Having leaned on the term “phenomenology” at several points already, I should explain that this term has multiple and ambiguous meanings, and I should clarify how I am using it. There is no succinct or consensus definition of “phenomenology.” The term is associated with the philosophy of Husserl, Hegel, Heidegger and Merleau-Ponty, among other Western thinkers. Also, diverse movements within Buddhist, Japanese, Indian and other cultures and philosophies have been considered phenomenological. Phenomenology is concerned with the nature of experience and knowledge and the relation between these. It involves an attempt to understand the condition of being in and experiencing the world while also addressing our awareness and interpretations of this condition. The concept of phenomenology has been imported into anthropology to refer to feeling and perceiving the world and to indicate a focus on sensate experience and the existential condition of being in a body.⁷ Some use phenomenology to describe an effort to represent experience-in-itself in ethnography, prioritizing direct, subjective (though not necessarily embodied) experience over theory and interpretation.⁸ I use the term here to refer to how one experiences—at the levels of consciousness, mind, body and other media—being in and living in the world, yet I also assert that there is not a single, universal phenomenology but rather multiple phenomenologies, multiple culturally and historically shaped ways of assembling and prioritizing the modes of experience ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• CONTENTS
• Acknowledgments
• 1 Introduction
• 2 Three Therapies of South India
• 3 Lives and Problems
• 4 Experiencing the World From Body to Ātman
• 5 Cooling Mudpacks: The Aesthetic Quality of Therapy
• 6 Conclusion: Pleasure, Health and Speed
• appendix A: Semi-Structured Interview Questions
• References
• Index
• About the Author