Physical restraint of people with mental illness has a long and inglorious history. Philippe Pinel is credited with having released the mentally ill from their chains at the Bicêtre and the Salpêtrière hospitals in Paris at the end of the 18th century. Yet physical restraint has continued in mental hospitals, in religious shrines and healing sanctuaries around the world. Such restraint, including shackles, rope, stocks, cages, and being locked in confined spaces, is applied to men, women and children. The practice seems to have aroused little human rights concern, except when mentally ill people in chains have died.
Most shrines in Muslim countries represent the Sufi tradition in Islam where followers seek healing and fulfilment of their wishes using Sufi saints as intermediaries. Shrines provides a significant resource where people engage in religious rituals, community living and healing rituals to address physical, emotional, and social ailments. Not underestimating the hand of misfortune, gender, poverty, availability of formal health services, and social support seem to play a significant role in emphasising the position of the Sufi shrine in a Muslim setting.
The held strong beliefs that misfortunes in the form of ill health, conflicting relationships, or failures show a weakened relationship or connection with Allah. Seeking protection from the holy saint or requesting the saint to be an intermediary between them and Allah is aimed for relief. For them, coming to a sacred venue and using the holy saint as an intermediary to obtain mercy from Allah is one way to improve their situation.
Thousands of people visit shrines every monthwhile seeking healing for their problems. Symptoms, illness perceptions, and sickness behaviour are, in part, given meaning and shaped by local traditions and cultural beliefs.
Stories about supernatural causes of illness are accepted without question; they are reassured and advised by others to recite certain prayers, words, or verses to bring about healing. The shrine provides a platform for many women to be ‘accepted’’ and ‘‘respected’’ for dealing with their unfortunate fate and hardships, and still holding on to their faith and religion. It gives them an opportunity for catharsis and a public display of their grief and distress in the form of crying, wailing, and pleading to the Sufis to grant them mercy.
Some corners of the shrine compounds are designated for those who were acutely disturbed and in need of physical restraint. This is generally for disrobing and inappropriate behaviours in public. Such people are bound by their feet or wrists in metal restraints and tied to the metal grill encased with the grave of their following Saint.
The chains allowed movement within a diameter of about six feet. A family member remains within close proximity so that they could help if the attendee was hungry or thirsty. Family members who help restrain these individuals feel distressed at their plight. The chains are released slowly as a person became more able to contain their behaviour and act in public. Culturally employed coping strategies to deal with such mental distress includes talking to others, praying and pleading for forgiveness. Range of symptoms and behaviours commonly associated with a diagnosis of schizophrenia such as visual or auditory hallucinations are commonly believed to be a result of possession by supernatural forces.People visiting shrines consider complete surrender to religious healing to be crucial since they have little understanding about mental illnesses. Living with the belief in fate is their ultimate spiritual opium. The tradition of shrines in certain regions is linked with Sufism. Sufi pirs played a role in helping the common people acquire closeness with Allah and acted as intermediaries.
In Pakistan, people perceive and use religious venues as major sources of help when dealing with their problems. As a physical symbol, the shrine represents a space that can be used as respite for those suffering from ailments of differing natures and it satisfies the need to be contained safely while healing takes place. At a deeper level, the shrine symbolises safety, acceptance, faith, a non-blaming attitude from, and sense of belonging to, a wider religious and social community. Treatment and care of mentally ill patients is in shackles. This blatant abuse of human rights is not a simply a product of the callousness or ignorance of families and communities, or by refusal to accept psychiatric treatment, but may more correctly be attributed to neglect by governments of their responsibility to provide basic mental health services for people with severe mental illness. Only effective and sustainable strategy for eradicating the deeply offensive practice to keep mentally ill patients restrained and enchained can help to ensure that families and communities have affordable and equitable access to basic mental health services. There is a need to clarify the relevance of beliefs about mental illness and psychiatric treatment, and the deep connections between availability and cost of psychiatric treatment and care.
The writer is a professor of psychiatry and consultant forensic psychiatrist in the UK. He can be contacted at [email protected]