On a scorching summer afternoon in June, Mohammed Ali and his wife, Fathima, sat deep in conversation under one of the several shamianas at the Hazrat Sultan Syed Ibrahim Shaheed Badusha shrine, situated in the village of Erwadi in the coastal city of Ramanathapuram in Tamil Nadu.

Every now and then, the couple would shoot a concerned glance to their left, to check on their 35-year-old son, occupying the mat next to theirs. Mohammad Assan was lying down in a fetal position. He did not have a shirt on, just a pair of black shorts and on his ankles, shackles. He moved his fingers constantly and muttered softly to himself.

The dargah was swarming with people – it was the annual month-long Erwadi Santhankoodu festival, an event in honour of Sulthan Syed Ibrahim Shaheed Badhusha Nayagam, whose grave is at Erwadi. People across different religions participate in the celebrations. Despite the heat, people walked around the premises of the dargah barefoot, on hot sand.

Some patients stared blankly, others shouted relentlessly and angrily at the dargah. A few patients lay on the ground – of these, some scooped up handfuls of sand and threw them on their bodies. Some paced up and down, others walked, some ran around the shrines, talking to themselves.

A relative of one woman who was sitting opposite the shrine and screaming at it said she was “conversing with god”. She added, “The devil that is inside her is talking to god, so we should not disturb her.”

For over 400 years, the dargah has drawn countless people from all faiths. Many visitors to the dargah come in search of a miracle cure from mental illnesses that they believe have been caused by evil spirits, djinns and black magic. They believe the water in the dargah, the oil in its lamps, and even the sand on its grounds, are all imbued with healing powers drawn from the shrines of Hazrat Sultan Syed Ibrahim Shaheed Badusha and other saints who are entombed in the dargah’s premises.

For over 400 years, the Hazrat Sultan Syed Ibrahim Shaheed Badusha dargah in Erwadi has drawn people from all faiths. Devotees believe the saints buried there can help cure mental illnesses. Photos: Johanna Deeksha

One Hindu woman said she had been coming to the dargah for around a decade.

“I came here when I was severely depressed,” she said, “No medicines worked, only ‘baba’ was able to help me.” She was referring to the saints buried at the dargah. “All the people here recover and go back home, just like I did,” she added.

But not everyone who was visiting the dargah in August 2001 went back home. On August 6 that year, a fire broke out at a nearby mental home – one of the many residential houses in the village of Erwadi that offered paid accommodation to the mentally ill and their families. Out of the 43 patients inside the home, 25 patients, who were shackled, died in the immediate aftermath of the fire, while 15 people who were not shackled managed to escape. However, three among them later succumbed to burn injuries, taking the total death toll to 28.

The incident shocked the nation. The Supreme Court took suo motu cognisance of it and issued notices to the Union government and the Tamil Nadu government. All mental homes of this kind in Erwadi, which were operating without a license, functioning in thatched sheds and shackling patients, were closed a week later, and over 500 inmates were placed under the care of the government. While some were sent back home, others were admitted to government hospitals in the state.

Based on the directions of the Supreme Court, a commission headed by N Ramdas, a district judge in Tamil Nadu, was set up to conduct an inquiry into the Erwadi fire incident. The commission’s report was tabled in the state assembly later that year, in November. In consonance with the Supreme Court’s recommendations for homes in Erwadi, the commission recommended the closure of mental homes across India that functioned in thatched sheds, and the “unchaining” of all inmates. The court also directed the central government to identify all faith healing centres across the country and ensure that basic standards were met in these spaces.

But while the commission studied the problem, the patients in Erwadi who had moved into government hospitals began to leave. Syed Ruknudeen Ibrahim, a trustee at the shrine, remembered that about a month after they were admitted to the hospitals, patients began to return to the dargah. “Nobody wanted to be in the hospitals anymore, so they all came back and began to live here again,” said Ibrahim, who is a member of the dargah trust, and is among those members who claim they are descendants of the saints buried there.

After a fire at a home associated with the Erwadi dargah killed 28 people in 2001, patients were sent home or shifted to government hospitals. But in about a month, they began to return to the dargah.

Gradually, the Tamil Nadu government realised that taking patients away from the dargah and admitting them to hospitals would not work as long as the patients themselves believed that they could only be cured by god.

Such beliefs are deep-rooted in traditional societies, not just in India, but around the world.

“Before the advent of modern science, almost all of our lives were governed by faith,” said Sanjeev Jain, a professor from the Department of Psychiatry, National Institute of Mental Health and NeuroSciences in Bengaluru.

Globally, in many cultures, the soul was believed to be “a reflection of the divine presence”, and therefore, people felt that “any problems with the soul could only be solved by divinity”, he said. Jain added that around the ninth century in the Arab world, and much later in Western countries, mental hospitals began to be set up near mosques and churches – the first attempts at organised care of the mentally ill.

In India, too, faith-healing has a long history and continues to have a strong grip on people. In Tamil Nadu itself, people suffering from potentially debilitating mental illnesses like schizophrenia, mania and psychosis not only throng the Erwadi dargah, some visit the Gunaseelam Prasanna Venkatachalapathy temple in Tiruchirappalli, or St Anthony’s Shrine in Thoothukudi, besides other religious spots in the state. Several psychiatrists told me that this wasn’t surprising, since India is largely a religious country, where people turn to prayers even for more mundane problems.

Further, according to the National Mental Health Survey 2016, India faces a “severe shortage of mental health professionals”. While 10% of the country suffers from mental illnesses, the country only has 0.3 psychiatrists for every 1,00,000 people. High-income countries have between one and two psychiatrists for every 1,00,000 people. In India, only Kerala fulfils this requirement.

“Because various parts of the country lack mental health services, these places of worship become shelters for people who are chronically ill,” Jain said.

Given the high burden of mental health disorders, the acute shortage of mental health professionals and the tendency of families in India to seek treatment at religious centres, many psychiatrists have come to believe that instead of seeing faith-healing and modern medical approaches as antagonistic, it is best to see them as complementary. Some argue that in a country where mental health hospitals are often ill-equipped and unsafe, faith-healing centres may offer a more therapeutic setting for recovery for many.

Mental hospitals are often “a way to hide away people with mental illnesses from the rest of society and pretend no problem exists,” said Dr Anubha Sood, from the Department of Psychiatry, University of Texas, who has worked on the subject of faith-healing for six years. “They are not provided the means to reintegrate into society.” She argued that at the very least, faith-based healing centres ensure that patients have family and support systems that make them still feel that they are part of society. “They don’t feel completely abandoned in these places, unlike in mental hospitals, where care is completely delegated to the people working in the hospitals,” she said.

Some mental health experts argue that hospitals leave patients feeling abandoned, and with no way to reintegrate into society, whereas religious centres can allow them to retain family and other support systems.

These views are reflected in efforts in recent years to integrate faith-healing and modern psychiatry. In 2008, the Gujarat government started the “dawa-dua project” at the Hazrat Saiyed Ali Mira Datar dargah in Mehsana district in Gujarat. Through the programme, the government hoped to find a way to provide trained professional help at the dargah. They did so by convincing the traditional faith-healers at the dargah, called “mujavirs”, to encourage patients to seek professional help, along with offering prayers. Funded by the state department of health and family welfare, with guidance and monitoring by the Government Hospital for Mental Health, Ahmedabad, the programme saw some success: in an interview in 2018, a representative of The Alturist, the NGO that manages the programme, said that in eight years, 38,500 patients had benefited from it.

In 2014, the Tamil Nadu government sent a team of psychiatrists and social and health workers to Gujarat to study the “dawa-dua project”. After spending three days in Gujarat and learning about the collaboration, the team, which was led by Dr C Ramasubramanian, the state nodal mental health officer, and included Dr Periyar Lenin, the Ramanathapuram district psychiatrist, as well as other health officials, returned to implement the same model at faith-healing centres in Tamil Nadu, starting from the Erwadi dargah.

Ramasubramanian and Lenin discussed the project with the trustees at the dargah and the priests, locally known as hajarath.

“Initially they were hesitant to cooperate with us. They said it was only because the medicines were failing that patients were coming to the dargah for help,” Ramasubramanian recalled. “I asked them that if I could prove to them that medicines helped patients, would they agree to cooperate?”

Ramasubramanian invited the priests to visit the rehabilitation centre at the Chellamuthu Trust, in Madurai, which was founded in 1992. “When they saw that there were several people who had recovered and were doing very well in their lives, they decided to collaborate with us,” he said.

The same collaboration was extended to the St Anthony’ Shrine Puliampatti, another shrine that the mentally ill would visit in search of a cure. Meanwhile, a similar private initiative was underway at the Gunaseelam temple, started by a private hospital.

Eight years later, the results are mixed – there are no easy answers about whether the model is working, as I found by visiting the three sites. While some patients and their families were happy that they had the option of taking medicines while also offering prayers to god, others felt that prayer was the only way for patients to be “cured”. Many people I spoke to at the dargah said that they did not have faith in medication because they had already tried it and it had failed them. Most families said they had spent months or years going to psychiatrists, but that nothing had come of it.

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Mohammad Ali, born Peter Nyanaprakash, and his wife Fathima, live in Cuddalore, almost 400 km from the dargah. (Other than Ali and his family, who agreed to be named, the names of all other patients and family members have been changed to protect their privacy.) Ali had been coming to the dargah for decades. A retired policeman, he first visited it after he started to have violent outbursts of anger. “I was behaving the same way a mentally ill person would,” he said. “I would not be able to control my anger and would even get violent.” He knew he needed help, and in his search for it, he ended up at the Erwadi dargah.

Ali said that his visits to the dargah eventually helped him recover from his illness. “Baba completely healed me,” he said. Years later, when his son Assan was in Class 10, he started to display the same symptoms as Ali once did.

Fathima recalled one such outburst vividly. “I was cooking in the kitchen one morning, packing the kids’ lunch boxes, and suddenly I felt someone kick my back really hard,” she said. “I turned back and saw Assan.”

That was probably the first episode, the family said. After that, Assan’s angry outbursts became more frequent: he would often refuse to clothe himself, break furniture, and electronic items like the television set and phones, and even beat up Ali, Fathima and his own younger sibling. He barely spoke, except to ask for food and water.

Ali said he took him to different psychiatrists but the scans showed nothing. “He became so thin at one point, it was scary to even look at him,” Ali said. “He would not sleep or eat.”

The doctors gave Assan some medication. “But they were only sleeping tablets and then some additional tablets to improve his overall health,” Ali said. “He would just be sleeping all the time.” The parents were not sure if the doctors arrived at a particular diagnosis, and referred to their son’s ailment just as a “mental illness” when I spoke to them.

After about five years, the family, which had by then converted to Islam, came to the dargah looking for a solution, again. “The first time we visited, we stayed for three months, the next time for 41 days and then once again for about 20 days,” Ali said.

Fathima said that they started seeing improvement in Ali’s behaviour after this – improvement which they attribute to the power of the saints buried at the shrine. “Baba told us that he would begin to wear clothes if we brought him to the dargah and it actually came true,” Fathima said. “Here he keeps his clothes on, otherwise, usually he refuses to wear any clothes at all.”

The couple said they had not seen any signs of any mental illness when their son was younger. But they believed that at some point someone had done “seivanai”, black magic or witchcraft, and cursed their family. “Someone cursed my whole family,” Ali said. “That is why we are suffering so much.”

Patients who are mentally ill visit the dargah and stay anywhere between a few days to several years there. Attenders, almost always their mothers, also stay by their side through this time, to take care of them.

Later, in another part of the dargah’s campus, I sat next to one of the shrines with Vijay Arun, a 38-year-old man. For ten years, he had remained almost entirely within the confines of the dargah’s compound.

When he started college, Arun began to have “attacks,” he said. “I would lose complete control of myself. I would get terrified by everything. I would not be able to move, neither could I eat or sleep.” The attacks would come whenever he had to leave home for his college hostel. Eventually, his family decided that he would become a day scholar and travel to college every day.

Later, when he finished college and started working, the attacks started again. Arun described his fear as “paralysing”, and said they left him unable to do his daily chores or lead a normal life. His family took him to several temples. They had also been told that someone had done “black magic”, and that the family was doomed.

About ten years ago, Arun’s mother brought him to the Erwadi dargah. “After a few days, I was finally able to relax and take control of my mind again,” he said. He arrived at the dargah when he was 28 years old. He spent four years on its premises, through which his mother remained by his side.

He would wake up every morning, go to the shop near the dargah to buy anything his mother needed, and then remain within the dargah’s premises, eating the food that was provided. Occasionally, his friends called him over the phone. Sometimes, he helped out if there was any work that needed to be done around the dargah. He saw scores of people walk in and out each day. Among them, he said, were people who had completely recovered and left.

Lenin, the Ramanathapuram district psychiatrist, cautioned that cases where patients recovered typically involved minor mental illnesses and not severe ones. “Sometimes, it may be a mere coincidence that they recover when they come to the dargah and the illness becomes self-remitting,” he said. “Such patients leave in a few days.” But, he added that “the ones with severe illnesses remain there for years” and that “most patients who are shackled suffer from schizophrenia, and these illnesses can only be managed with medication.”

When he was 32, Arun felt like he was also finally ready to leave the dargah, and return to a “normal” life.

“I went to the railway station and bought a ticket,” he said. “I even got on the train and sat on the upper berth.” But then, he added, “I grew anxious and began hyperventilating. I began to feel like I was losing control of my mind again.”

Arun got off at the next station and returned to the dargah. Three years later, he tried to leave again. “This time, I only made it as far as the station before returning,” he said.

Arun dreams of having a full-time job, a wife and children. But the thought of stepping out of the dargah terrifies him. Some of his friends cannot believe that he is “wasting” away his life at the dargah. “I’ve tried to make them understand my situation,” he said. “Sometimes they do, but most times, they don’t.”

The “dawa-dua” project was started in 2014 with the hope that patients like Assan and Arun would be able to access professional help at the dargah itself. An outpatient psychiatric centre was opened near the entrance of the dargah that year, just inside its gates.

Ibrahim explained that people would walk into the dargah, pray and seek blessings from the priests and then, in many cases, would be directed by the priests to visit the centre. Alternatively, people would go to the centre first, obtain medication and get it blessed by the priests inside. “The belief is that if they receive the medication inside the dargah, then it would have a better effect on them,” Ibrahim said. “Rather than receiving it outside at a regular hospital.”

Patients who visit the dargah may meet priests, who then direct them to the psychiatric care centre. Alternatively, they may procure medicines from the centre, which they then take to the priests to be blessed.

The response to this measure has been mixed. Neither Assan nor Arun, for instance, have availed of the services at the centre. While Assan sought help from psychiatrists near his hometown, claiming that one of the saints buried at the dargah directed him to do so in a dream, Arun did not seek professional help at all. “If I had a physical illness it would make sense for me to take medication but this is happening because of a curse,” he reasoned. “What good will medicine do?”

The members of the dargah claimed that they did encourage most patients to get professional help, but that there were nevertheless some who insisted on only seeking “baba’s” help. However, one priest told me that he didn’t ask people to go to the doctor because he felt that would mean that the priests were shirking responsibility. “They come to us to get help, how can we send them somewhere else?” he said.

According to Ibrahim, enough patients benefited from the outpatient department that the members of the dargah decided to donate a part of its land to the Tamil Nadu government to set up a full-fledged mental hospital. The hospital was opened in 2016, in another part of the dargah’s sprawling campus, and now has an in-patient centre and a rehabilitation centre.

The hospital also shelters people who have been abandoned by their families.

Among them was M Savithri, a 40-year-old woman who had been at the centre for a few months when I met her in June. Savithri, who was handcrafting a garland of seashells as we spoke, said that she had been at the centre for a few months and had recovered significantly. Madasamy, the caretaker at the hospital, showed me pictures of Savithri when she was first rescued from the premises of the dargah. In them, Savithri sat on the ground, looking disoriented, her clothes and hair dishevelled. “She was in a very bad state,” Madasamy said. “Now she is doing very well. But her family has not come to take her back home.” Several other men and women at the hospital were engaged in activities such as making handicrafts that Tuesday afternoon, and nurses said that they had improved appreciably during the period of their stay.

Lenin, who until six months ago was posted at the Erwadi centre, and is currently heading the psychiatric department at the Ramanathapuram Government Hospital, said that the programme had been a success but doesn’t feel that the impact can be measured with data or statistics.

“I think of it like this: something is better than nothing,” he said. “At least now people have more of a chance of getting professional help if they want it.” But, he added, “We do not interfere with the workings of the dargah and people’s belief systems.” Further, he conceded that there was still continued hesitance among people to opt for medication. “There is no way that we can force anyone to take our help,” he said.

Dargah representatives agreed that people did often feel hesitant to try medication. “We ask the people to try both – if it is a disease then the medicine will take care of it and if it is the devil, then god will take care,” Ibrahim said.

These efforts to combine prayer and medicine in Tamil Nadu have received some national attention. The National Mental Health survey report, 2015-’16, described the Erwadi programme as a success and noted that efforts were underway to replicate the model elsewhere in the state. At the national level, the survey noted that until 2016, nearly 376 faith healers had been trained “on the identification of mental health problems and more than 40,000 persons with mental illnesses from 12 states had received treatment with 60% of follow-up rate at 3 months.”

The survey also claimed that chaining of persons with mental illnesses had stopped and “that there was an improved awareness regarding mental health in the communities.”

But on the ground, things are somewhat different.

After spending some time at the main shrine in Erwadi, I visited another patch of land that belongs to the dargah, around two kilometres away.

There, I found that around ten or so men were chained to trees. One patient’s mother swept the area around the tree to which her son was tied, but when we approached her for a conversation, her son went into a rage and began to yell foul abuses at her.

Close by, under a tin-roofed shed, several mats were spread out, next to which were placed bags of clothes, jars of pickles and other personal belongings. This shed was where the attenders of these patients, mostly their mothers, lived – praying and waiting for their sons to be cured so that they could one day leave the dargah and return home.

The mothers were from different parts of Tamil Nadu and Kerala. Some had been in Erwadi for a month, some two, while others had lived there for years. Many had left behind their other children and their husbands and could only visit them occasionally. Their stories all sounded strikingly similar – the son started to have violent episodes, during which he would beat family members. After many psychiatrist visits, the family decided to place their trust in the healing powers of the dargah.

“I thought at first that maybe it was a mental problem, so we took him to the doctor,” one mother said. “But then we realised that this was the devil’s doing, so we brought him here and are waiting for him to recover.”

After the fire accident, the dargah introduced rules forbidding families from tying up patients, but the attenders still shackle them to the trees. “We don’t allow the patients to be tied up, but if the families themselves want to do so, we can’t say anything,” Ibrahim said. “Because sometimes, it is the only way they can have control over them.”

After the Erwadi fire, the Supreme Court forbade the chaining of patients. But some families continue the practice, saying it is the only way to ensure their own safety and prevent the patient from running away.

Some of the mothers showed Scroll.in the scars they had suffered after their children grew violent. “If we don’t tie them, they will run away,” one said. “Do we look like we can go after them and have the strength to bring them back? We have no choice but to keep them tied until the devil leaves them.”

Since the dargah provides food to the patients and their attenders, the mothers don’t have to cook and are completely devoted to their caretaking duties. These duties include feeding the patients, helping them get cleaned, and giving them medication.

Despite their struggles, most cling on to hope. “My younger son was also suffering and we brought him here and he was cured,” one mother said. “Now he has a job and is doing well. So I’m sure my older one will also recover soon.”

Much before the dawa-dua project came into being, and before the Tamil Nadu government sent its doctors to Gujarat, a doctor in Trichy had been visiting the district’s Gunaseelam Prasanna Venkatachalapathy temple to provide care to the mentally ill. The Gunaseelam temple, much like the Erwadi dargah, has for years been known as a destination for families of the mentally ill, seeking some kind of divine intervention. And just like in Erwadi, people would tie up the patients in areas surrounding the temple and believe that they would be cured.

In 1992, when Dr G Gopalakrishnan paid a visit to the temple and found scores of patients living around the temple premises, he felt that he needed to do something to help. He spoke to the members of the temple board and convinced them to allow him access to the patients so he could provide them with professional help. The temple authorities readily agreed, but only under two conditions – “that I should not speak ill about the temple or the priests, and that I cannot dismiss their work,” Gopalakrishnan said. “That did not bother me. I was only there to provide additional care to the patients, and not to interfere in the functioning of the temple.” So Gopalakrishnan began to visit the temple every week and consult with patients.

After the Erwadi fire incident, shackling of patients was forbidden at the temple as well. Every Tuesday and Thursday, the psychiatrist visited the temple to provide treatment to the patients. From the donations that the temple received, a building was constructed beside the temple, where abandoned patients could be rehabilitated. But about a year ago, with the support of Banyan, an NGO based in Chennai, this was converted to a full-fledged care facility. The facility includes an emergency care and rehabilitation centre, with accommodation for abandoned patients, as well as an in-patient facility. It has posts for two psychiatrists, one nurse and several health workers. Gopalkrishnan said that nowadays, the facility typically has patients occupying all its available rooms.

The temple priests usually ask patients and their attenders to stay at the temple for 48 days in order to be “cured”. When the psychiatric facility was set up, it adhered to a similar time frame so as to fall in sync with the temple’s activities – thus, patients are allowed to stay for 48 days, during which doctors strive to first diagnose them and then devise a treatment. At the end of this period, patients are reunited with their families.

“Our staff are made to stand inside the temple and if we notice that some family has a member with a mental illness, we usually make them aware of the professional care that is available to them,” Revathi Manikandan, a nurse, said.

Like in the dargah, here too some patients refuse professional care and want to rely only on “god”, she said. But, she added, there are several patients who are grateful to be able to access professional care that might otherwise have been unavailable to them.

The Gunaseelam Prasanna Venkatachalapathy temple has also for years been a destination for those with mental illnesses. In the 1990s, under a private initiative, a doctor set up a rehabilitation facility next to the temple.

At the temple premises, I met Lakshmi Ramanan, who had been living at the centre for 32 days with her 27-year-old son, Vijay Ramanan, who was diagnosed with schizophrenia by the doctors at the centre.

He began suffering bouts of anxiety and having violent episodes in Class 11, ten years ago. “His father also exhibited similar behavioural patterns but it wasn’t this severe,” Ramanan said. “The doctors prescribed medication, but he would refuse to take it. Even his father would not approve, so I would hide it in his food.”

Vijay was doing fairly well for a while, and then the pandemic hit. “All three of us had Covid, but his father’s symptoms and mine were worse,” Ramanan recalled. “I was taken away to the hospital. So he did everything for his father and took care of him. My husband died in his arms. After that everything changed.”

Vijay began to have violent episodes again. As a last-ditch effort, Ramanan’s daughter suggested visiting the temple. “My husband had also come here when he was suffering. So I remembered that and agreed to bring him here,” Ramanan said. When the family arrived, they were pleasantly surprised to learn about the professional help available at the temple. “We just wanted to come and ask god to help us,” Ramanan said. “But when we were told about this facility, it made us happy.”

She said having a nurse and other staff feed, give medicine and take care of her son had brought her immense relief.

Ramanan added that Vijay’s condition had improved dramatically in the preceding few weeks, but that things had deteriorated after. Earlier that week in July, Vijay had had a job interview. “He knew all the answers but because of the internet connectivity issues here, he couldn’t do the online test properly and became upset,” Ramanan said. “Now his mental state has deteriorated again. We had only a few more days left to leave.”

Ramanan now envisages another extended stay at the temple. As her eyes welled up with tears while recounting her son’s struggles with mental health, the nurses and other health workers at the centre consoled her and assured her that he would start to do better again soon, and offered words of encouragement.

Patients who visit the temple are usually asked to stay for 48 days. To synchronise with the temple's approach, the rehabilitation centre adhered to a similar time frame to diagnose and treat patients,

Another patient, who suffered from schizophrenia, and was staying at the centre with his 75-year-old father as his caretaker, was on his second visit to the centre. When we spoke, he repeated one sentence over and over again: he requested to be euthanised. His father, in tears, said he had had many dreams for his only son and hadn’t thought that he would spend his own last years caring for him. “The first time we came here, it helped him,” the father said. “The doctors and nurses helped us a lot and he was taking all his medication. Then his mother died and we were back to square one. We had to come back.”

All the patients that Scroll.in spoke to at the rehabilitation centre said they did not hesitate to take medication. “We believe we need both god and medicine,” Ramanan said. The patients’ daily routine involves attending prayers at the temple five times a day. “That way, patients feel that god is playing a role in their recovery,” the nurse said.

Around 200 km away, in St Anthony’s Shrine in the town of Puliampatti, in Thoothukudi district, near the border with Tirunelveli, patients can usually be found spread across two large tin-roofed sheds built right outside the church building. According to social workers at the shrine, these usually range from those who have been there for a few months to those who have been there for a few years.

Patients who visit the St Anthony's shrine in Puliampatti, in Thoothukudi district, can usually be found in two sheds near the church building. These include recent arrivals and some visitors who have stayed for years.

The church is situated within a larger walled compound. Towards one side, the main road abuts the compound, across which lies a parking lot used by the church. A psychiatric clinic associated with the church is situated here, a green, single-storey building.

A smaller road abuts the opposite face of the compound wall. Across that road is situated a rehabilitation centre, a cream and brown single-storey building with three rooms.

The clinic opens every Saturday, and provides free consultation and medicines to patients – it usually sees a line of patients throughout the day. “We have a lot of people coming to the church on Saturday,” said Sister Clara, a counsellor at the church. Doctors may prescribe medicines or recommend rehabilitation, and, “if the patient is very violent, we refer them to the government hospital,” said Clara. The rehabilitation center remains open throughout the week for patients to engage in activities like knitting or craft making, or seek counselling from social workers. Clara said that St Anthony was believed to have the power to remove evil spirits from people.

Like at the dargah and the temple, at the church, too, several years ago, families would tie up patients, waiting desperately for a cure. Clara said that after the Erwadi incident, people at the church were also prohibited from tying up patients inside the premises. When Scroll.in visited the church one Friday morning in July, one patient among about 40 or 50 families that had made the church their home had shackles on her legs, but was walking around – her family said they needed the chains to prevent her from wandering away on her own.

The rehabilitation centre attached to St Anthony's shrine remains open throughout the week for patients to engage in activities like knitting or craft making, or seek counselling from social workers.

At around 10.30 am, patients started to trickle into the rehabilitation centre. Among them were Raghav and Neetu, a brother and sister duo from a village in Thanjavur, both suffering from schizophrenia. Once they entered the centre, Neetu sat quietly in a corner, while Raghav tried to knit.

Their father, Senthil Murugan, said that Raghav had first started to display signs of distress as soon as he finished college. He recounted that Raghav began to have violent episodes and would wander off on his own. At the time, Neetu would take her cycle and go looking for him. “About a year later, she also started to behave differently,” the father said. “She did not have violent outbursts, but she just stopped interacting normally.”

When Raghav attempted to take his own life, Murugan decided that both his children needed help – they visited several temples seeking a solution. Murugan believed that someone had cast a curse on the family and that two of his three children were suffering as a result.

Finally, he heard somebody in his village mention St Anthony’s. “We came here and found that they give medicines too,” he said. “So we pray at the church and then come here and take the medication.”

Malar Kumar, a 43-year-old-mother of a 23-year-old schizophrenia patient, had been living at the church for nine months. “She would not make eye contact, would talk to herself and would either not eat at all, or eat nonstop,” Kumar said. “She would often also burst into laughter. Sometimes, her heart would beat so fast, I would be able to hear it.”

The family obtained medication for her for six months from a psychiatrist. But after the outbreak of the Covid-19 pandemic, the family’s finances were hit, and they found themselves unable to pay for more medicines. After her daughter’s condition worsened, Kumar brought her to St Anthony’s.

A psychiatric clinic associated with the church. The clinic opens every Saturday, and provides free consultation and medicines to patients – it usually sees a line of patients throughout the day.

Clara said that since 2014, the church has had a psychiatrist visit its premises. Dr Sivasailam S, at one point, was visiting both the Gunaseelam temple and St Anthony’s Church to provide treatment, he told Scroll.in. In 2018, the state government provided the church funding to set up the rehabilitation centre. “Ever since, the number of patients staying back at the church has come down,” Clara said.

Clara explained that many patients firmly believed that they had been cursed, or that an evil spirit had entered them. Echoing religious leaders at the dargah, she said, “We tell them that if it is a disease, medicine will take care of the illness, and if it is caused by an evil spirit, then god will cure them.”

Several patients have fully recovered and left the church, some current residents told Scroll.in. “We have seen it with our own eyes,” said Angel Rani, the mother of one patient. “So we are sure it will happen to us.”

A 2021 paper delved into the functioning of the dawa-dua concept in Gujarat by accessing case records from the Hazrat Saiyed Ali Mira Datar dargah between July 2008 to March 2018. The authors analysed the socio-demographic profile of patients, their past history of illness, their diagnoses, the mean duration of illness, and the sources from which patients had been referred.

They also interviewed 26 patients who had travelled to the dargah. The 26 patients were from three groups – nine who only relied on prayer, eight who only relied on medicine and nine who relied on a combination of the two. The researchers also interviewed six mental health providers who worked at the facilities attached to the dargah, to assess their perspectives about patients who visited the dargah and the challenges they faced in their endeavour.

The paper concluded that the programme had seen some success. “Despite some implementation challenges, the findings indicate that collaboration of modern psychiatry medicine and faith-based treatment practices certainly benefit patients with otherwise limited access to mental health care,” it noted. This, the paper said, “thereby protects human rights of patients.”

The paper also found a sharp rise in patients who had been referred to psychiatrists through word of mouth referrals, from 33 in 2008 to 630 in 2017. This was even as the number of patients being referred by the dargah’s mujavirs had declined, from 608 in 2008 to 168 in 2017.

But the number of patients who are guided to at least some modern medical care when they seek out faith healers remains limited to a handful of centres across the country.

In many small places of worship, priests continue to believe that evil spirits should be “beaten” out of people, said Dr Kishore Kumar, the director of Banyan, the Chennai NGO, which works in the field of mental health and homelessness. In some areas, Kumar added, people are nailed to trees by their hair in order to get the “spirit” out, while in other places they are tied through the day, in the hope that the spirit will leave them.

Some families resort to putting those who are ill through bizarre tests. Kumar recalled one incident involving a middle-aged Muslim housewife, whose family was convinced that she had been possessed by a djinn.

“Her family believed that if she drank alcohol and did not get intoxicated, then it would be true that she was possessed,” he said. “So they forced her to drink a quarter bottle of rum, and when she didn’t get intoxicated, they decided that it had to be beaten out of her.”

He argued that one crucial way to prevent such cruelties from being perpetrated on people suffering from mental illness would be to educate spiritual leaders, to ensure that they could intervene when they encountered such situations. This, he said, was important given people’s trust in these healers. Further, he said, the government needed to appoint more psychiatrists, even at the level of primary healthcare centres, so that people had easier access to professional mental health care.

Dr Anubha Sood, from the Department of Psychiatry, University of Texas, pointed out that such collaboration with faith healers was particularly crucial because the condition of mental hospitals in the country was also often poor. “In many mental hospitals, patients are tied up and women, especially, are often not safe in these spaces,” Sood said.

Sood argued that there were ways in which faith healing could be effective because the approach often focused on achieving a “holistic balance of family, community and self”.

But on the ground, across the country, patients and their families continue to suffer. “Despite all the advances in medicine and progress as a society,” Jain said, “we still haven’t developed a modern, more humanistic way to provide care to the mentally ill.”

This reporting is made possible with support from Report for the World, an initiative of The GroundTruth Project.