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C:\Documents and Settings\lproctor\Local SettingsYTemporary Internet Files\OLK8\Copyright - thesis (2).doc Mental Illness, Medical Pluralism and Islamism in Sylhet, Bangladesh Alyson Fleur Callan 2005 A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Anthropolgy, University College London 1 UMI Number: U592660 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U592660 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract This thesis examines the health seeking practices of the mentally ill in Sylhet, Bangladesh. Previous work has suggested that in the Islamic world local traditional healing is being undermined by the encroaching global forces of biomedicine and orthodox Islam. However, in Sylhet, traditional healing is thriving. Traditional healing may survive for different reasons. For local women, traditional healers may offer a space for ventilating complaints which is not available elsewhere; for affluent ex-pats the opportunity to reassert their Bengali identity. Western biomedicine poses less of a threat to traditional healing as it has become incorporated as a Bangladeshi product and perceived as inefficacious, corrupt and harmful. Conversely, the endurance of traditional healing may lie in its ability to adapt and incorporate Western biomedicine. Muslims do not see anything inconsistent in visiting Hindu healers as any healer is simply the medium through which Allah works. 2 Contents Abstract 2 Table o f contents 3 List of illustrations 6 Acknowledgements 7 List of key informants 8 Glossary 10 Chapter 1 Introduction: Islam, modernity and healing 17 1. Islam and modernity 17 l.(i) Islam and religious fundamentalism 17 l.(ii) Islamism as a modem phenomenon 19 1.(iii) Islam: the local and the global 21 l .(iv) Islam, politics and the state in Bangladesh 23 2. Globalization, mental illness and healing 29 3. Islam and healing 30 4. Medical pluralism 33 Chapter 2 Setting and Methodology 40 1. Fieldwork setting 40 l.(i) Sylhet 40 l.(ii) Village life 43 1. (iii) Town and country 47 1 (iv) Sylheti as a distinct identity 48 1.(v) Is Sylhet modem? 50 1 .(vi) Status of women and the virilocal rule of residence 52 2. Methodology 54 3. A note on the Sylheti language and the transliterations 63 4. Chapter outline 65 Table 1 67 Chapter 3 An outline ethnopsychiatry of Sylhet 71 1. Healers 71 2. Goingfagol 75 3. Explanations of goingfagol 78 4. The spirit world 81 5. At the psychiatrist’s 83 6. Emotions 88 7. Selfhood 91 Chapter 4 Sorcery: ‘ What else do we Bengalis do?’ 100 1. Theoretical issues 100 2. Local sorcery concepts and practices 102 3. Shanti Afa 107 4. Do healers create tensions? 113 5. Patients prefer a sorcery diagnosis 117 6. Why is there a lot of ingshal Sources of conflict in Sylhet 119 3 Chapter 5 Spirit possession, agency and the law of Allah 128 1. Sandni’s spirit sickness 128 2. The mother in symbolic opposition to Allah 147 3. Personal agency versus Allah’s command 149 Chapter 6 Female saints 155 1. Can women be saints in Islam? 157 2. Legitimacy of saintly authority within Islam 160 3. Legitimacy of the firanis 161 4. Spirit possession: a gendered domain of religious practice? 164 5. Firanis: a women’s space? 167 5. (i) Nadira Frirani 167 5. (ii) ShuliFirani 171 5. (iii) A counter-hegemonic practice? 182 Chapter 7 Going ‘mad’ as resistance? A case of multiple spirit possession 188 1. Gramsci and resistance 188 2. Medical anthropology and power and resistance 190 3. Tanya goesfagol 192 4. Going ‘mad’ after marriage: an act of resistance? 203 4. (i) Challenges the naturalness of the social order 203 4. (ii) Madness as social critique 204 5. Multiple spirits as compensation for loss 214 6. Spirit possession as heightened self-awareness 217 7. Conclusion 221 Chapter 8 The relationship between religiosity and madness 223 1. Illness and morality 223 2. Going fagol as punishment for violating sacred space 225 2. (i) Samad offends the spirits at prayer 225 2. (ii) Chonchol steps on the saint’s shrine 228 3. Zinn disturb those who are pious 234 4. Being close to Allah can send youfagol 235 4. (i) Divine madness 235 4. (ii) The Lengta Fir of Shingogong 236 5. Diagnostic labelling is historically and socially contingent 240 6. Diagnosis is contested within a given culture 242 7. Diagnosis changes across time: the case of Mohi Uddin 246 8. Suffering and Islam 252 Chapter 9 Medical pluralism 254 1. Traditional healing as resistance 255 2. ’Traditional’ healing is not traditional 258 3. Traditional healing is not perceived as oppositional to Islamic 270 orthodoxy 4. Bangladeshi biomedicine perceived to be inferior vis-a-vis other 276 biomedicines 5. Allah has the most power; the doctor is the usila (intermediary) 278 6. Post-hoc rationalizations? 279 7. Pragmatic versus symbolic methods of healing 283 4 Conclusion Appendix 1 Bibliography Illustrations 1. Jamaat-i-Islami postcards 38 2. Saddam Hussein poster 38 3. A fir ’s residence 39 4. Shah Faron gate 39 5. Men with meat carcasses at Qurbanir Eid 68 6. Women cutting meat up 68 7. A saint’s shrine 69 8. Shah Jalal shrine 69 9. Mud and thatch village house 70 10. Slum dwelling 70 11. Pharmacist’s shop 98 12. Psychiatrist’s private chamber 98 13. Woman wearingtabiz 99 14. Londoni house 127 15. Showcase 127 16. ‘M a’ sampler 153 17. ‘M a’ handwritten decoration 153 18. ‘Ma’ commemorative plaque 154 19. Mufti Huzur’s ashon 185 20. Shuli Firani’s mukam - exterior 185 21. Shuli’s goibi flower 186 22. Shuli Firani’s mukam - interior 186 23. The mukam in 2003 187 24. Shuli and husband 187 25. The arrival of the groom 222 26. Groom returns with bride 222 27. Hindu temple 287 28. A female Hindu kobiraj’s residence 287 29. Ashon Fir’s assistant givingzara 288 30. Ashon Fir’s chamber 288 6 Acknowledgements I am grateful to the Economic and Social Research Council for funding the research with a PhD studentship award. Bangladesh is an easy place to do research because the people are so hospitable and friendly. More often than not, my visits to healers and other informants would be greeted with refreshments and invitations to stay for a meal, and they were extremely generous with their time and ideas. Obviously, without their kindness this thesis would not have been possible. As well as my key informants, special thanks goes to Imran Chowdhury for giving up his bedroom for me in Sylhet and help with finding a village base; to Zebunessa Hoq and her husband for introducing me to my village host, Malik, and for introducing me to Shoaib Chowdhury who introduced me to Shoma, my research assistant; to Sultana Farodusi (Shugom) and Shahin for introducing me to key informants; to Debashish Bhowmik for help in finding me a second research assistant; to Steve Plattner for advice on learning the Sylheti language; to Umme Hasina (Joni) for help in preparing language aids; to Jim Wilce for his supportive correspondence during the fieldwork period; to Roland Littlewood and Mukulika Baneijee at UCL for supervising the project; to Roseanna Pollen for comments on an earlier draft. Farid Uddin Ahamed introduced me to contacts in London and Bangladesh and helped with ideas at the planning stage.