Traditional healing practices and perspectives of mental health in Nagaland Thesis submitted to Martin Luther Christian University, Shillong For the Degree of Doctor of Philosophy By Ningsangrenla Longkumer Regn. No: PhD14-026 Under the supervision of Dr. PSS Sundar Rao 1 Declaration I hereby declare that this thesis entitled Traditional healing practices and perspectives of mental health in Nagaland submitted to Martin Luther Christian University, Shillong for the degree of Doctor of Philosophy is a bonafide effort made on my part under the supervision of Dr PSS Sundar Rao. This work has not been submitted to this or any other university for the award of any degree or diploma. Any other source of information utilized in the study has been duly acknowledged by me. Ningsangrenla Longkumer Research Scholar Martin Luther Christian University 2 3 Acknowledgment I acknowledge my deep gratitude and thanks to the administration of Martin Luther Christian University for facilitating the Doctoral Programme at the University in particular Dr. Glenn Kharkongor, Chancellor for his continued encouragement, guidance and support, Dr. Maribon Viray, former head of the Department of Counselling Psychology and Dr. Sairabell Kurbah, Doctoral Secretary. I am indebted to my Supervisor Dr. PSS Sundar Rao, adjunct professor at Martin Luther Christian University, for his expert guidance at all stages of my research project and for encouraging me to present parts of the results at two National Conferences. My sincere thanks to all the community leaders of the selected study areas in rural and urban areas, to all the heads of households and family members, to all the traditional healers included in the study, the key informants, members of the focus groups as well as the administration of the State Mental Health Institute in Kohima. I appreciate all the valuable help from the volunteers and village guides to identify and facilitate all the interviews. I thank all my hosts in various places who enabled me to carry out the fieldwork successfully. I acknowledge all the love, patience and prayers of my family and friends during my extensive fieldwork and enabling me to complete my research on time. Finally, I thank God for all His blessings that enabled me to accomplish all the rigorous tasks needed on this significant research for the benefit of the people of Nagaland. 4 Table of Contents Page No. Title Page …...………….…………………………………………………………….............. 1 Declaration ……………………………...……………………………………………............ 2 Certificate ……………………………………………………………………………………. 3 Acknowledgement …….…………………………………………………………………....... 4 Table of Contents …………………………………………………………………………..... 5 Index for Tables ………………………………………………………………………..…..... 9 Index for Figures …………….………………………………………………………........... 13 Abstract …………………...………………………………………………………............... 15 CHAPTER 1: INTRODUCTION ……………………………………………...................... 22 1.1. Mental Health and Quality of Life- Problems in Indigenous populations …….….….... 22 1.2 Traditional Healing practices for mental health: Preventive, Curative, Promotional…... 24 1.3 Healing, Health & Wholeness: Role of Traditional methods …………………………... 26 1.4 Need for the Study …………………………………………………………………….... 28 1.5 Problem Statement ………………………………………………………………......…. 30 1.6 Research Questions……………………………………………………………….....….. 32 1.7 Research Objectives ……………………………………………………………….…… 32 1.8 Research Hypotheses …………………………………………………………….…….. 33 1.9 Scope and Significance of the Research ……………………………………..…...……. 33 1.10 Conceptual and Theoretical Frameworks …………………………………….……….. 35 1.11 Operational Definitions ……………………………………………………..………… 38 CHAPTER 2: REVIEW OF LITERATURE ………………………………….…………… 39 2.1 Introduction ……………………………………………………………..…...…………. 39 5 2.2 International Studies …………………………………………………..……...………… 43 2.3 Studies from India………………………………………………………..…...………… 83 2.4 Studies from North-East India ……………………………………………...……...…… 89 2.5 Other Studies …………………………..……………………………………………..… 98 CHAPTER 3: METHODOLOGY ……………………………………………………..…. 108 3.1 Introduction ………………………………………………….………………………... 108 3.2 Quantitative Sampling of Nagaland State …………………….…………………...….. 108 3.3 Quantitative Data Collection Methods ……………………………………………...… 112 3.3.1 Description of Tools Used ……………………………………………................. 115 3.3.2 Pilot Study ………………………………………………………………………. 117 3.3.3 Validity of the Tools ……………………………………………………………. 117 3.4 Quantitative Data Management …………………………….…………………………. 118 3.5 Quantitative Data Analysis ………………………………….………………………… 118 3.6 Qualitative Research Methodology ……………………………….…………………... 119 3.7 Ethical considerations ………………………………………………………………… 122 CHAPTER 4: MATERIALS ………………………………………………….………...… 123 4.1 Introduction ……………………………………………………………….…………... 123 4.2 Quantitative Household Survey …………………………………………….………… 123 4.3 Quantitative Traditional Healers Survey ………………………………………….…... 129 4.4 Qualitative Focus Group Discussions ……………………………………..………….. 133 4.5 Qualitative Key Informant In-depth Interviews ……...…………………….…………. 133 4.6 Qualitative Selected Patients’ Case Reports ………………………………………….. 133 4.7 Qualitative Ethnographic study: State Mental Health Institute, Kohima ….…………. 134 CHAPTER 5: FINDINGS ……………………………………………………….………... 135 5.1 Introduction …………………………………………………………………….……... 135 6 5.2. Quantitative surveys ………………….………………………………………………. 135 5.2.1 Household Interview Survey ……………………...………………………….… 135 5.2.2 Traditional healer Interview Survey ………………………………………….… 178 5.3 Qualitative Surveys ……………………………...……………………………….…… 224 5.3.1 Focus Group Discussions ………………..…………………………………….. 224 5.3.2 Key Informant In-depth Interviews ………..………………………………...… 238 5.3.3 State Mental Health Institute Kohima, profile ……...………………………….. 243 5.3.4 Selected Mental Disorders Patients’ Case Reports……………...……...…...….. 245 CHAPTER 6: DISCUSSION …………………………………………………………..…. 249 6.1 Introduction …………………………………………………………………………… 249 6.2 Burden of Mental Illness in Nagaland ………………………………………………… 249 6.3 Popularity of traditional healing for mental health in Nagaland ……………………… 251 6.4 Traditional healing practices for mental health ……………………………………….. 254 6.5 Integrated Mental health care …………………………………………………….…… 265 6.6 Role of Community Based Participatory Approaches (CBPA) in future linkages between traditional healing and modern psychiatric care …………………………………………. 271 6.7 Limitations of present research and future research needs …………………………… 272 CHAPTER 7: CONCLUSIONS AND RECOMMENDATIONS ………………………... 275 7.1 Introduction ………………………………………………………………………….... 275 7.2 Conclusions from household interview survey ……………………...…………...…… 275 7.3 Conclusions from Traditional Healer Survey………………………………………….. 277 7.4 Recommendations …………………………………………………………………….. 277 REFERENCES ……………………………………………………………………………. 279 ANNEXURE …………………………………………………………………………...…. 314 Annexure 1: Ethics Approval ………………………………………………………….….. 314 7 Annexure 2: Traditional healer In-depth Interview Schedule …………………………..… 315 Annexure 3: Household In-depth Interview Schedule………………………….…………. 321 Annexure 4: Consent Form …………………………………………………….…………. 328 8 Index for Tables Table 4.1 Distribution of respondents by age and area Table 4.2 Distribution of respondents by gender and area Table 4.3 Distribution of respondents by tribe and area Table 4.4 Distribution of respondents by religion and area Table 4.5 Distribution of respondents by educational level and area Table 4.6 Distribution of respondents by occupation and area Table 4.7 Distribution of respondents by marital status and area Table 4.8 Distribution of respondents by type of family and area Table 4.9 Gender of traditional healers Table 4.10 Age of traditional healers Table 4.11 Tribe of the traditional healers Table 4.12 Educational level of the traditional healers Table 4.13 Occupation besides being a local practitioner Table 4.14 No. of years of practice of traditional healers Table 4.15 Traditional healing as a family practice Table 5.1 Common ethno-botanical (herbal) treatments Table 5.2 Common ethno-zoological (animal product-based) treatments Table 5.3 Manual treatments Table 5.4 Psycho-spiritual treatments Table 5.5 Mental disorders reported in rural and urban households Table 5.6 No. of households who consulted a traditional healer in rural and urban samples Table 5.7 Traditional treatment given for each mental disorder combining both rural and urban samples 9 Table 5.8 Traditional treatment given for each mental disorder in rural samples Table 5.9 Traditional treatment given for each mental disorder in urban samples Table 5.10 Reported outcome of traditional healing of mental disorders Table 5.11 Overall satisfaction of traditional healing for mental disorders Table 5.12 Recommendation of traditional healing for mental health in rural and urban samples. Table 5.13 Reasons for recommendation of traditional healing for mental health Table 5.14 Reasons for not recommending traditional healing for mental health Table 5.15 Popularity of traditional healing for mental health in rural and urban samples Table 5.16 Reasons for popularity of traditional healing for mental health Table 5.17 Reasons for decline of popularity of traditional healing for mental health Table 5.18 Perceived requirement of additional training of traditional healers Table 5.19 Consultation of traditional healer by mental disorder Table 5.20 Consultation of traditional healer by age Table 5.21 Consultation of traditional healer by gender Table 5.22 Consultation of traditional healer by tribe Table 5.23 Analysis of consultation of traditional