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MURPHY HALLIBURTON
THE IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT:

LESSONS ON HEALING FROM SOUTH INDIA
ABSTRACT. This paper considers the significance of the positive and negative aesthetic
qualities of different therapies—in other words, how “pleasant” (a term that is elaborated
in the paper) it is to undergo various treatments. Interviews were conducted with patients
undergoing three forms of healing for mental illness and related problems in the state
of Kerala in southern India—ayurvedic (indigenous) psychiatry, allopathic (biomedical)
psychiatry, and religious healing. Informants revealed concerns about the aesthetic process
of therapy, reporting adverse reactions to allopathic treatments and in some cases asserting
that they enjoyed ayurvedic procedures. Some informants with long-term illnesses had
chosen to live in the process of therapy and reside indefinitely in the aesthetically engaging
environment of a mosque, temple, or church after pursuing medical therapies for years.
Thus considerations of the quality of the process of therapy also call for an examination of
the limitations of the concept of “cure” for describing what is accomplished in healing in
some therapeutic settings.
KEY WORDS: aesthetics of healing, ayurveda, cure, ethnopsychiatry, India
This paper focuses on process in healing, and reconsiders the allopathic (biomed-
ical) way of looking at what is accomplished in therapy. Despite recent emphasis
in anthropology on the aesthetic and embodied experience of healing, there has
been little scrutiny of how aesthetically pleasant or painful it is to undergo various
therapies. Research conducted among psychiatric patients in Kerala in southern
India indicates that some people suffering psychopathology and related problems
had positive aesthetic reactions to ayurvedic psychiatric treatments and some com-
plained about the abrasive effects of allopathic medications and electroconvulsive
therapy (ECT). In certain cases, this led patients to discontinue allopathic therapy
and pursue other forms of treatment.1 Additionally, some people with intractable
mental suffering have found a solution to their problems by living within an aes-
thetically engaging process of therapy at religious healing centers.
This attention to the process of healing leads to a scrutiny of the concept of
cure. The cultural contingency of the idea of cure is highlighted by informants’
descriptions of the variety of states that are attained through healing, such as
improvement, living in the process of therapy and achieving a better-than-normal
state. It is also suggested here that an overemphasis on cure in allopathic psychiatry
may obscure attention to the aesthetic quality of a therapy.
This paper is based on fieldwork conducted in Kerala in 1994, 1997, and 1999
among patients and healers of three different psychiatric and related therapies:
Culture, Medicine and Psychiatry 27: 161–186, 2003.
°
C 2003 Kluwer Academic Publishers.
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162 MURPHY HALLIBURTON
allopathic (biomedical) psychiatry, ayurvedic psychiatry (part of the South Asian

medical system called ayurveda), and religious healing (at places of worship that
are also healing centers).
This paper revolves around a concept I call “pleasant process.” Considering the
pleasantness of the process of treatment reworks anthropological and allopathic
assumptions about healing in two major ways. First, it is important to consider
how pleasant or painful it is to undergo therapy. Patients appreciate a pleasant
or nonviolent method of therapy, and the pleasantness of the therapeutic process
affects patients’ choice of therapy and their decision to continue treatment.
Second, the fact that some people who are suffering distress in Kerala have found
a way to manage their problems by continuing to live with an intractable illness in
a pleasant environment, and that others feel they have achieved a state that is better
or “higher” than their normal, healthy state, suggests that medical anthropology
should reframe its understanding of what is accomplished in the treatment of
illness. Medical anthropologists should examine their use of the concept of cure
and consider a wider realm of therapeutic engagements, including less teleological
possibilities.
This scrutiny of the concept of cure in connection with attention to the process of
healing was also inspired by the realization that the word “cure” has no equivalent
in Malayalam, the language of Kerala. In English, “cure” refers to the eradication
of a problem and/or a return to a normal state of health. Malayalis talk of bringing
“change” (mā _ruka/māt tam . ), finding “improvement” (bhēdam . ), or even reaching a
state of “prosperity” (abhivr+ ddhi), to express what is accomplished through healing.
“Pleasant” is the most appropriate word I could find to encompass patients’ re-
ported experiences in undergoing treatment, experiences that are at times pleasant
and at least nontraumatic. This word is in some ways inadequate to cover the range
of issues discussed in this paper, but since I do not want to invent a new term, I will
define here the various meanings I am attributing to the word “pleasant.” Often
“pleasant” describes a person’s positive sensory reaction to a method of treatment.
For example, “cooling” (tan. uppȧ, kul. irmma) is a common local idiom for ex-
pressing the positively valued aesthetic experience some people had in undergoing
therapy in Kerala.
There are some instances, however, where the usual sense of pleasant is too
positive a description for therapies that are simply not traumatic or painful to
undergo. Ayurveda, for example, can be uncomfortable, irritating or demanding,
requiring one to undergo an austere vegetarian diet, digest a large quantity of ghee
(clarified butter), or take medicine to induce vomiting. And, as will be discussed
later, there is evidence that in the past, ayurveda used invasive and violent therapies,
and allopathy was more focused on giving care and relief.
Finally, the idea of a pleasant process also includes instances where the usual
meaning of pleasant is too mundane to describe the transformative experiences
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IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 163

some people have in healing. The demanding nature of ayurveda can be considered
part of cultivating self-discipline or development of the self. This is similar to a
spiritual benefit reported by patrons of religious healing in Kerala. Healing in these
cases is not just pleasant in the visceral or aesthetic sense, but exalted—a raising
of the self or spirit to what is conceived as a higher level, a transformation to
an auspcious state as opposed to a simple removal of a problem or a return to
normalcy.
THE AESTHETICS OF HEALING
Inspired by the focus on embodied and phenomenological experience in anthropol-

ogy in the 1980s and 1990s, some anthropologists in recent years have examined
the aesthetic, visceral, and sensual experience of healing (e.g., Desjarlais 1992;
Laderman and Roseman 1996; Roseman 1991). These researchers assert that ill-
ness and healing are not something one merely thinks about, as earlier anthropol-
ogists had assumed; rather, these phenomena are felt.
This paper supports Laderman and Roseman’s position that “if healing is to
be effective or successful, the senses must be engaged” (Laderman and Roseman
1996: 4), but expands upon this insight. Those who have analyzed the aesthetics
of healing have neither compared the aesthetics of different medical systems nor
examined the aesthetics of biomedicine. Thus these studies do not explicitly reveal
that the sensory engagements they analyze are often positive experiences and
perhaps do not fully take account of the benefits of these experiences. Put more
simply, it seems to have been overlooked that a therapy that feels good might
have benefits over a therapy that feels bad, especially for a problem which is
psychological or spiritual.
Roseman (1991) took on the issue of the engagement of sensory experience
in examining Temiar healing practices in Malaysia, though her work looked at
aesthetic elements as symbols and examined how they are interpreted intellectually
rather than how they are experienced in the body. Regarding Temiar music, for
example, Roseman claims that “[t]he evocative power of these sounds, however,
lies in the way they are imbued swith meaning and interpreted by participants”
(1991: 172, emphasis added). Robert Desjarlais makes the link between aesthetics
and embodied experience in his analysis of healing in Nepal. Desjarlais explains
that Sherpa shamans make an ill person’s body feel better by engaging the ill
person/body aesthetically.
Meme [the shaman] changes how a body feels by altering what it feels. His cacophony of
music, taste, sight, touch, and kinesthesia activates a patient’s senses. This activation has
the potential to “wake” a person, alter the sensory grounds of a spiritless body, and change
how a body feels. (Desjarlais 1992: 206)
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Desjarlais’ analysis alerts us to the visceral experience of this kind of shamanic

healing, but it would be intriguing to learn how this experience compares to the
visceral experience of a biomedical hospital. Desjarlais explains that there is an
allopathic medical facility available in the area where he did his research, but it
is a general clinic which treats “physical illnesses (a headache, broken bones, and
bruises),” not a psychiatric hospital (Desjarlais 1992: 163). People experiencing
“soul loss” who were treated by a shaman were not tempted to attend this clinic
for their problem. But if there were allopathic psychiatric facilities available, as
there are in Kerala, they would likely claim to heal things like soul loss (which
they would call by another name) and would constitute an alternative therapy.
Having had the chance to compare the aesthetic experiences of patients in
multiple therapies, this paper focuses on the positive and negative values pa-
tients attribute to some aesthetic experiences of healing and the importance of
considering the quality of the process of therapy. In addition, this study provides
a supplement to the work of Nichter (1980), Nichter and Nordstrom (1989), and
Nunley (1996), who have observed that people in India and Sri Lanka see allopathy
as a powerful and “heating” medicine that can give quick relief but can also cause
serious side effects. Nichter describes some of the differences people in South
India perceive between allopathic and ayurvedic medicine.
While English medicine [allopathy] is praised for fast action, it is almost always spoken
about as having “uncontrolled” side effects. Ayurvedic medicine, on the other hand, is
referred to as a controlled medicine, aimed at balance. (Nichter 1980: 228)
Nichter and Nordstrom make a similar observation regarding Sri Lanka.
Allopathic medicines are spoken of as “shocking” the body and causing side effects which
may prove as troublesome as those symptoms originally prompting one to seek treatment.
(Nichter and Nordstrom 1989: 374)
This paper explores patient reports on how a powerful and “shocking” therapy
feels and the implications of that experience.
DECONSTRUCTING THE CONCEPT OF CURE
Little attention is currently devoted to the concept of cure in medical anthropol-

ogy. Although some researchers have highlighted the cultural contingency of this
concept, few have followed up on this insight. Cure is applied in many medical
contexts by anthropologists, and the biomedical emphasis on eradication and final
results inherent in the term is usually taken for granted as what one tries to do
for an ill person in any context. Various works of medical anthropology feature
the word cure prominently in their titles but fail to examine the term itself. For
example, none of the articles in a volume called Culture and Curing (Morley and
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Wallis 1979) examine the concept of cure—it seems to be taken for granted as
what the various healing systems discussed in the volume try to do in all con-
texts. In another example, an article called “Closure as Cure” (1986), Herzfeld
explains that narrative closure in stories told by Greek healers helps effect cure
in the sense of getting rid of a problem and returning the sick person to an orig-
inal state of health. The term is also regularly and casually used in many works
of medical anthropology, including several sources cited in other sections of this
paper.2
One exception to the tendency to take the concept of cure for granted can
be seen in Crapanzano’s study of the Moroccan Hamadsha healing cult (1973).
Crapanzano advocated that the particular cultural meaning of cure, which may not
always involve returning the sufferer to his/her original state, should be considered.
He explained that
the Hamadsha effect their cures by incorporating their patients into a cult which provides
them with both a new role—one which is probably more in keeping with their individual
needs—and an interpretation of their illness and cure. (Crapanzano 1973: 6)
Kleinman and Sung (1979) similarly revealed the cultural contingency of cure
by focusing on healing and suggesting that medical efficacy depends on cultural
context. (Kleinman and Sung represent a Chinese tâng-ki healer as considering
several patients as “cured” (14, 15), but it would have been interesting if they had
also examined the Chinese term(s) that were translated this way.) Csordas (1983),
citing Crapanzano’s study (Crapanzano 1973), also briefly engaged the cultural
contingency of the idea of cure.
Anthropologists who have studied chronic illnesses have occasionally reflected
on the issue of cure and the goals of therapy. Estroff (1981) engaged the meaning
of cure in her ethnography of people suffering psychological distress while trying
to cope with daily life in noninstitutional, community settings.
I had expected that people in the treatment program would be cured or would get better. I
did not know that the process and progress would be so slow, so painful, and so laden with
failure and setbacks. (Estroff 1981: 18)
The situation of the people Estroff describes is reminiscent of the informants I met
in Kerala who have chosen to live with an intractable problem at a temple, mosque,
or church, though the latter environments are more aesthetically engaging than the
community psychiatry program Estroff examined. Kleinman similarly reflected on
the issue of the goals of therapy, proposing a program for emphasizing care rather
than cure among people with chronic illnesses, asserting that “chronic illness by
definition cannot be cured, that indeed the quest for cure is a dangerous myth that
serves patient and practitioner poorly” (1988: 229). Estroff and Kleinman did not
elaborate on how the concept of cure is itself constructed, but their recognition
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of its significance to those seeking therapy foreshadows this paper’s concern with
examining its cross-cultural implications.
Finally, Hoskins (1996) presented a case from Indonesia in which a healing
ceremony was performed not to cure a terminal cancer patient but to mend a
social disharmony related to this illness. This ceremony was performed after the
patient sought biomedical and indigenous medical treatment and was deemed
incurable.
Expanding on the possibilities suggested by these studies, this study shows a
variety of additional outcomes and considerations of the process of therapy, and
examines the indigenous terminology for what is accomplished through healing.
These different outcomes and considerations problematize the concept of cure in
several ways: care and attention to the quality of the process of therapy, living
in a pleasant, aesthetically engaging environment, and achieving a state that is
better or “higher” than one’s original state are all discussed as alternatives to
the eradication of the problem and the return to normality implied by the term
cure.
The concept of cure and the degree of emphasis on this goal may explain what
appears to be a lesser attention to the process of therapy in allopathic psychi-
atry in Kerala. However, this analysis of the utilization of the concept of cure
in biomedicine is only preliminary, and there are issues that require additional
investigation. For example, there are differences between biomedical ideals and
practices, and the diversity of biomedicine makes it difficult to consider as a single
entity (e.g., Good and Good 1993; Hahn and Gaines 1985; specifically regarding
psychiatry, Rhodes 1991). What would be required is ethnographic analysis of the
nuances of the meanings of cure and the relationship between the ideals of this
concept and the practice(s) of biomedicine. Although biomedicine in Kerala is
strongly guided by international research and ideologies, further investigation of
these issues should also consider regional variation in biomedical practice (Good
1991; Payer 1988).
I also wish to emphasize that I am not suggesting biomedicine is at all times
exclusively focused on curing. As discussed later, some diseases are considered
chronic or incurable, and some physicians work only on palliating suffering. I
suggest that it is the degree of emphasis on cure and how this ideal shapes practice
that leads to a lesser attention to the pleasantness of the process of treatment.
Furthermore, it is not simply the concept behind a single word, cure, that requires
investigation, but the practices and the wider set of goals associated with this term,
such as the willingness to use invasive techniques and the emphasis on eradication
of a pathology as an optimal, even if not always realizable, outcome.
Let us now turn to an analysis of the biomedical and history of medicine lit-
eratures to understand the origins, historical trajectories and emphasis on cure
in biomedicine. Biomedical literature reveals little discussion about the concept
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of cure. Cure is not defined in Black’s Medical Dictionary, or in most medical
dictionaries, reference books, or textbooks. One medical dictionary that did define
it did so as follows:
1. restoration of health of a person afflicted with a disease or other disorder. 2. the favorable
outcome of the treatment of a disease or other disorder. 3. a course of therapy, a medication,
a therapeutic measure, or another remedy used in treatment of a medical problem. (Mosby’s
Medical, Nursing and Allied Health Dictionary 1998: 427)
The Oxford English Dictionary’s (1972) fifth definition for cure, “[t]o heal (a
disease or wound); fig. to remedy, rectify, remove (an evil of any kind),” contains
the notion of removing, which is a characteristic of allopathic practice that is
not covered in the medical dictionary definition above. Also, the Oxford English
Dictionary in its first entry for “cure” gives the definition “To take care of; to care
for, regard,”3 which is intriguingly similar to the overlap between process and
final disposition, or care and cure, I observed in Kerala.
This original meaning of cure is invoked by historians of biomedicine who claim
there was a division at some point in the past between efforts to take care of the
ill (make the sick person feel better) and cure the patient (remove the disease
entity). Medical historians Kothari and Mehta (1988) warn about the tendency
in biomedicine to utilize invasive procedures to remove any abnormality (even
those that are benign) and other instances of what they see as violence in medical
practice. They then suggest that healers should focus on easing dis-ease (i.e., pain,
suffering) and thereby return medicine to the original meaning of cure, which was
“to take care.”
The idea that the chief role of a medical system is to take care of the dis-eased gives the
system only a palliative role. This is as it should be. Oliver Wendell Holmes has described
his teacher, Dr. Jackson, as one who never talked of curing his patients “except in its true
etymological sense of taking care of him.” Holmes goes to the extent of generalizing that
“the doctor who talks of curing his patients belongs to that class of practitioners known in
our common speech as ‘quacks.’ ”
Modern medicine is in need of humility; it must give back to “cure” its etymological
meaning. It must recognize that with a concerned physician around, no disease, no death,
is incurable. A drug to ease, a procedure to palliate, a word of cheer, the graceful stoicism
to hold the dying patient’s hand—all this and more falls within the curative competence of
a compassionate clinician. (Kothari and Mehta 1988: 197)
This proposal differs from the present status of palliative care in allopathic
medicine. “Palliative” is defined as “a term applied to the treatment of incurable
diseases, in which the aim is to mitigate the sufferings of the patient, not to effect
a cure” (Black’s Medical Dictionary 1992: 434), and palliative care focuses on
terminally ill patients and hospice care (Doyle et al. 1998). Palliative medicine in
contemporary allopathy refers to attempts to relieve suffering after the possibility
of cure has passed.
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There are, however, cases in contemporary biomedicine in which definitions of

cure are more nuanced. Examples of this can be seen in the treatment of cancer.
Knowing that complete eradication is hard to determine, success in cancer treat-
ment is measured in 5-year survival rates. Also, in advanced cases of cancer, doctors
try to weigh the benefits of abrasive therapies against the patient’s “quality of life,”
the degree of mental and psychological suffering they are undergoing (Hanks and
Hoskin 1995; Redmond 1998). More pertinent to this study, schizophrenia is often
considered to be a chronic problem featuring “exacerbations and relative remis-
sions,” and a variety of outcomes, such as “social recovery,” are considered (Kaplan
and Sadock 1989: 767, 768). Still, some researchers in biomedicine have recently
questioned the emphasis on curing and would like to see palliative care extended to
a wider variety of problems, not only illnesses that are deemed incurable (Carney
and Meier 2000; Meier and Cassel in Owen 2000). They critique an emphasis on
cure that obscures other goals of treatment and consideration of how painful it is to
undergo a course of therapy (Callahan 1990; Cassel 1982; Morrison et al. 1996).
Medical historians Jecker and Self (1991) suggest that in the past there was
greater attention to care and palliation, which changed with biomedicine’s attempts
to gain prestige and develop as a profession. A division between care and cure re-
sulted in part from a gendered division of labor and competition with homeopathic
healers and lay people, often relatives, who took care of the ill, work which was
considered women’s duty and thus devalued. Jecker and Self conclude that such
competition “put physicians at odds with activities, such as patient empathy and
care, that call upon abilities of engagement and identification with others” (1991:
293). I would add that the issues Jecker and Self discuss are more acute when the
dis-ease involved is psychological or related to a psychological condition, such as
the forms of suffering in Kerala examined in this study.
INFORMANTS AND INTERVIEWS
Research for this study consisted of interviewing 100 patient-informants about

their illness histories and speaking to more than 20 healers about their methods of
treatment. The principal sites for this study were two allopathic psychiatric hos-
pitals, an ayurvedic mental hospital, an ayurvedic psychiatric outpatient practice,
a Hindu temple, a Muslim mosque, and a Christian church. The temple, mosque
and church are known specifically for healing spirit-possessed or psychologically-
suffering persons.4 Of the 100 patient-informants interviewed, 32 were using
ayurvedic therapy, 35 were using allopathic therapy, and 33 were undergoing re-
ligious therapies at the time of interview. Seventy-two were interviewed using
semistructured questionnaires, which focused on illness symptoms and history,
history of therapy-seeking, experiences with different therapies, plans and prog-
nosis for the future, financial situation, education, employment, and other issues.
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Twenty-eight informants were given formal, unstructured interviews in which they
were asked about their illness experience but were allowed to depart from inter-
viewers’ questions to explore in greater depth areas they felt were significant.5
All but one of the unstructured interviews and 11 semistructured interviews were
recorded on tape (a total of 38 taped interviews). My research assistants—Kavitha,
Benny, and Biju—and I selected candidates so that the various features of our pa-
tient sample were represented in both styles of interview.
Informants were approached and interviews requested at healing centers by
myself and my research assistants. We obtained interviews from people of a variety
of class, age, gender, and religious backgrounds. Informants were both inpatients
and outpatients (ayurvedic, allopathic, and religious centers had both inpatients
and outpatients, which they classified according to degree of severity, such as the
potential for violence). We attempted to—and to a significant degree did—obtain
a stratified random sample of the total clinical population at each research site. We
aimed to pick every nth person of particular demographic features (for example,
male, female, Muslim, Hindu, middle class), and most informants responded to
our request for an interview. Logistics sometimes necessitated that we choose
according to factors such as whoever was nearest to us when they were leaving their
therapy sessions, whether they seemed they would be good informants (talkative,
eager to be interviewed), or whether they were willing to have their interview taped.
However, if after a while we found we had too many people of a certain identity
or inpatient/outpatient status, we would explicitly choose patients to balance the
sample. A few features of the sample are not ideally balanced, however. With
two male assistants and one female assistant—and the cultural inappropriateness
of myself, a male, traveling with a female assistant to distant research sites—we
interviewed more male than female subjects.
In all, we interviewed 61 men and 39 women (22 males and 10 females in
ayurvedic care; 21 males and 14 females at allopathic centers; and 18 males
and 15 females at religious healing facilities). Informants ranged in age from
17 to 73 years and the average age was 34 (32 among allopathic patients, 33
among ayurvedic patients, and 37 among patients of religious healing). In terms
of religious affiliation, an important feature of social identity in Kerala, we inter-
viewed 55 Hindus, 26 Muslims, and 19 Christians (19 Hindus, 11 Muslims, and
2 Christians using ayurveda; 22 Hindus, 5 Muslims, and 8 Christians undergo-
ing allopathic treatment; and 14 Hindus, 10 Muslims, and 9 Christians at religious
healing centers), a distribution that reflects closely that of Kerala’s total population,
which is approximately 55% Hindu, 25% Muslim, and 20% Christian.
We interviewed people from a variety of class and educational backgrounds, but
detailed quantitative information on these features is difficult to convey, and all of
the factors that go into determining class would require a lengthy explanation for
each subject. The vast majority of interviewees are of middle- and working-class
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status. Patients ranged in employment from the unemployed to manual laborers

to school teachers to engineering students to classical dancers to businesspeople.
The one socioeconomic group that is underrepresented in this study is the elite
upper class. Approximately 90% of informants are literate, which is just below
the average (approximately 95%) for Kerala state. We interviewed a variety of
inpatients (53) and outpatients (47) at each healing center, and thus a range of
severity of illness problems are included. Wishing to avoid privileging the nosology
of any one healing system, we did not try to determine allopathic diagnoses.
Instead patients’ and their families’ reported symptoms were used as the “standard”
descriptions of illness, and these symptoms are listed for specific patients presented
later.
Most informants have tried different forms of therapy, and the most common
reason for changing therapies was that the ill person did not experience a “change”
(mā_ruka/māt tam. ) in their condition. Some left allopathy or ayurveda because they
could not afford to pay for medications, and some left allopathy because of the
unpleasantness of treatment.
Although this paper features informants from all forms of healing, it provides
more examples from patients who were undergoing ayurvedic therapy at the time
of the interview and had previously tried allopathic therapy. Patients who were
undergoing allopathic therapy and those who were undergoing religious therapies
and had previously used allopathy also had negative comments about how allo-
pathic therapy felt, but they had fewer negative comments than ayurvedic patients
who had tried allopathy. It is possible that ayurvedic patients who complained
about former allopathic treatments are a self-selecting group of individuals who
react more strongly to the aesthetics of allopathic procedures and may have been
attracted to ayurveda because of its reputation for providing gentler treatment.
Note that many of the excerpts of interviews that follow feature the comments
of a bystander, such as a spouse or parent, who is accompanying the patient-
informant during treatment. This is a characteristic of healing systems in Kerala.
Relatives or friends usually accompany patients to healing centers and usually
speak for these patients during consultations with doctors. Likewise, patients and
their accompanying relatives and friends were usually interviewed together by me
and my research assistants. In many contexts in Kerala culture, the self appeared to
be embedded in family and social connections. Much has been written about this
sociocentric or relational self in South Asia (e.g., Marriott 1976; Shweder 1991;
Vaidyanathan 1989), yet it should not be assumed that there is a strict dichotomy
between the sociocentric South Asian and the individualistic westerner, or that the
South Asian person is wholly sociocentric—there are realms of autonomy in South
Asian societies (see Ewing 1991; Mines 1988) as well as ways in which Americans
are sociocentric (Kusserow 1999). While acknowledging that there are spaces of
autonomy in Kerala culture and that intrafamilial conflict may be concealed by this
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method of interviewing, I decided to go along with the local form of presentation for
interviews and in most cases spoke to the person suffering illness along with his/her
accompanying relative or friend. There were also occasions when my assistants
and I spoke to patient-informants alone.
REACTIONS TO AYURVEDA AND ALLOPATHY
A statement by Ajit,6 a young man who was seeing an ayurvedic psychiatrist

and had formerly been treated by allopathic psychiatrists, embodied many com-
mon adverse reactions to allopathic psychiatric treatments. Ajit’s problems started
four years before the interview. He was aggressive, he hit his father and he was
accused of burning down the family business (which he said he did not do). Like
all inpatients of ayurvedic psychiatry we interviewed, Ajit was first taken to an
allopathic hospital, the medicine of first resort in Kerala,7 but his reactions to the
process of allopathic treatment were not positive. (This and all other quotations
from patient-informants are translated from Malayalam, although words in italics
occurred in English in the original.8 )
I came to [name of allopathic hospital], took injections and was given a new medicine.
Later I was forced to stop it. The reason was that I had started shivering. [ . . . ] 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 electric shocks . After going there [to the
allopathic hospital] and coming here [to the ayurvedic hospital], I feel this is better.
One sees in this excerpt frequently heard complaints about unpleasant effects of
medications and ECT in allopathic psychiatry. Ajit says injections of medications
caused him to start shivering, and he describes electric shocks as a “painful method”
of treatment. This passage also contains a positive evaluation of ayurvedic care.
Some patients undergoing treatment that involved what I call a pleasant process
also enthusiastically described their treatment not only as a way of getting rid of
a problem but also as a means of transformation or, as Ajit put it, bringing one to
“another level.”
After reviewing all interviews with current and former ayurvedic and allopathic
patients for aesthetic evaluations of treatment, the following trends were revealed:
95 of the patients were currently using or had previously tried allopathy. A total of
14 of these informants offered, without our asking, some complaint about the effect
of psychiatric medications or ECT during their allopathic treatment. This group
included 35 patients currently using allopathy (three complaints), 30 patients of
ayurveda who had formerly used allopathy (nine complaints), and 30 patients of
religious therapies who had formerly used allopathy (two complaints). Forty-two
patients interviewed were currently using or had previously tried ayurveda, and
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none of these informants complained of abrasive effects of ayurvedic therapy. This

group included 32 informants who were currently using ayurveda, four who were
currently using allopathy and had previously used ayurveda, and six who were
currently using religious therapies having previously tried ayurveda.
The following are examples of the kinds of evaluations of treatment presented (in
addition to that of Ajit, above). Varghese, an 18-year-old Christian, was receiving
treatment at an allopathic facility because of eccentric behavior at school and
anxiety and depression around exam time. During our interview, he recalled the
treatment he received at another allopathic facility
I was taken to [name of hospital]. There I was given three shocks. I felt numbness in
my head when I got the first shock. [ . . . ] There I completed six months of treatment, I
broke my lips [he later explained that this was because of ECT], was totally tired mentally,
and came home. I could not write my examination in maths. [ . . . ] I was given an injec-
tion. Terrible pain. When I requested to do counseling, I was called in and examined for
swelling.
Varghese’s way of avoiding these uncomfortable effects of therapy was to seek

treatment at the allopathic facility he was currently utilizing but from a clinical
psychologist who relied on fewer medications.
The wife of Hanifa, a 30-year-old Muslim man who was seeking relief for
his tension, agitation, and sleeplessness at Beemapalli mosque, was concerned
about problems her husband experienced when taking allopathic psychiatric
medications
Kavitha: Are you taking allopathic medicine now?

Wife of Hanifa: No, no.
Kavitha: Now he is not taking any medicine.
Murphy: Now it is finished.
Wife of Hanifa: Now that he is not taking medicine, there is a lot of improvement. When
he was taking medicine, he had memory problems. [ . . . ]
Kavitha: Was it because of memory problems that you stopped, or . . . ?
Wife of Hanifa: Yeah, because of memory problems and a lot of tension, too
much thinking—he was like this. So we changed. Now there is relief after com-
ing here [Beemapalli mosque]. After he came here, he sleeps without taking
medicine.
Kuttappan is a 64-year-old Hindu man who was undergoing the 45-day pan-
chakarma inpatient treatment at the Government Ayurveda Mental Hospital
(GAMH), having previously tried allopathy for problems that included crying
and talking too much, showing too much anger and talking nonsensically. These
problems started a few days after his son’s wife killed her son and then herself.
Kuttappan’s wife, who was taking care of him at the GAMH, explained that they
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decided not to return to an allopathic hospital because of fear of the effect of ECT
on her somewhat elderly husband.
They told us we should take him to [name of allopathic hospital]. He is old now. If we take
him there, they’ ll give him a shock or something. He is 64 years old. Here they give only
native medicine and will get ‘change’ [mā_t_tam. ]. They [some relatives] told us there was
‘improvement’ [bhēdam . ] with this medicine for their son so we took him here. He has a
cough and asthma now, but he will get over it. This treatment can do all this.
When Kuttappan previously sought treatment at this same allopathic hospital, he

ran away from the hospital claiming the staff was doing black magic on him.
In Kuttappan’s wife’s statement, there is in addition to her worries about allo-
pathic treatment a degree of enthusiasm in describing ayurvedic care. One often
heard enthusiastic descriptions among other ayurvedic patients and persons us-
ing religious therapies, but such descriptions were rare among allopathic patients
I interviewed. Finally, it should be noted that Kuttappan’s wife uses the terms
mā_t_tam
. , which is best translated as ‘change,’ and bhēdam . , or ‘improvement,’ to
describe what is sought when one goes for treatment. No Malayalam term for
the dispensation of an illness used by my informants has the same meaning as
cure.9
Sreedevi is a 22-year-old Hindu woman who was seeking outpatient therapy
from an ayurvedic psychiatrist for problems that included stomach pains, episodes
of bahal.am . (agitation, tumult, fits), loss of energy, and a decline of interest in her
studies. When Sreedevi’s mother told us they originally tried allopathic treatment
for these problems, we asked why they changed therapies.
Biju: Why did you change treatments? Why did you change to ayurveda?
Mother of Sreedevi: Well, it was a few days ago that we discontinued. After that . . . then
finally we didn’ t see the [allopathic] doctor for a few days. Then it’s ayurveda. This
ayurveda is a good treatment. Ayurveda has this way of treating, but if it’s the other one
[allopathy] there are some side effects. And since this is a mental problem, we have been
coming here.
Bindu, a 36-year-old Hindu woman who was receiving inpatient treatment at the
GAMH, had similar concerns about allopathic medications. Bindu had been de-
pressed and had attacked her brother’s wife and son. She was sent to an allopathic
psychiatrist, but she discontinued that therapy because allopathic medicines made
her too tired and made her feel like there was a weight on her head, effects that
she says disappeared after she changed to ayurveda.
While there were complaints about allopathic medications and ECT, some pa-
tients reported positive reactions to undergoing ayurvedic therapies. Abdul Aziz
is a 27-year-old Muslim man who was receiving treatment at the GAMH. He was
accompanied by his father, who told us that he had been talking incoherently and
had been violent. Abdul Aziz also had itching and pain in his body which he said
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were caused by a spirit. During three years of allopathic psychiatric treatment, he

received ECT nine times and took as many as 16 pills a day. Abdul Aziz’s father
also explained that the “head treatment,” a treatment at the GAMH, made Abdul
Aziz feel “cool and calm.” In my meetings with him, Abdul Aziz was pleasant,
upbeat, and eccentric, and was often wearing the mud pack and banana leaf of
talapodichil treatment.
Talapodichil is a well-known and high profile inpatient psychiatric procedure
in ayurveda. What is said later about talapodichil is generally true of the other
ayurvedic treatments I investigated at GAMH in the sense that they are reported
by informants to cause little discomfort and are sometimes aesthetically pleasing.
Patients describe the process of undergoing these therapies in positive or humorous
terms. What Abdul Aziz’s father refers to as “head treatment” is most likely ta-
lapodichil, although he could be referring to pichu, which is similar to talapodichil
and, according to patients, an equally “cooling” therapy. “Cooling,” a term which
will be discussed in more detail later, is an idiom for a pleasant effect based on lay
South Asian concepts of health and aesthetics.
I will always associate Abdul Aziz with talapodichil. On one of my first vis-
its to the GAMH, he was one of the first people I encountered. With the top
of his head wrapped in mud and a banana leaf he ran up to me, pumped my
hand enthusiastically, smiled, and welcomed me. In subsequent visits, Abdul
Aziz would enthusiastically greet me, and I would often see him literally march-
ing around the hospital with the banana leaf on his head singing “la illaha
il allah,” an Arabic phrase all Muslims know, meaning “there is no god but
Allah.”
After completing four weeks of panchakarma treatment,10 which includes tak-
ing purgatives, enemas, and nasally administered medicines while on a special
vegetarian diet, the patient at the GAMH receives talapodichil. Talapodichil is
performed, along with other ayurvedic procedures, at 3 o’clock in the afternoon,
outdoors on the verandah of the GAMH.11 The patient who is to receive ta-
lapodichil sits on the short wall surrounding the verandah of the building. A nurse
unwraps a ball of medicated mud containing nellikka (gooseberry) and puts aside
a small portion. The nurse then rubs oil on the patient’s head (which, if the patient
is male, has been shaved), and molds the large portion of the gooseberry mud
onto the patient’s head from the top of the skull down to the top of the forehead
and about as far down on the back and sides. A banana leaf is then tied over the
mud-pack to keep it in place, and the patient is allowed to walk around the hospital
compound or relax as he or she wishes. After 45 minutes, the patient returns to
the treatment area and a portion of mud is removed from an area known as the
marma, a region between the forehead and the top of the skull that is considered
the center of many mental activities. The mud removed from this area is replaced
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with the small portion of mud that was reserved at the beginning of the procedure.
After another 45 minutes, the mud and banana leaf are completely removed and
the patient wanders off to socialize or relax.
Informants I spoke with, who were undergoing talapodichil, said it had a cooling
effect on their head and body. One patient joked that it was like having an “AC” (air
conditioned) hat. Ajit, the former patient of the GAMH who was introduced earlier,
reflecting on his treatment there recalled: “I got some more energy, especially a little
improvement in memory. My head got cooled.” “Cooling” (tan. uppȧ, kul. irmma,
and other terms) is a cultural idiom for a pleasant physical, visceral state, or effect.
In many parts of South Asia, there is a lay system of classification of foods, weather,
times of day, emotion, and many other things as heating or cooling (Bhattacharyya
1986: 67; Daniel 1984; Nichter 1987). Mental imbalance is most often—though
not always—considered to be due to excess heat that affects the head and can be
countered by substances and circumstances that create cooling effects. However,
cooling has many meanings beyond issues of mental disorder. It has the general,
pragmatic meaning of a pleasant aesthetic effect and can be applied in many
contexts. People in Kerala—friends, research assistants, and others—were often
telling me what would give one a cooling effect: drinking salt with one’s lime juice,
building one’s home a certain way, or visiting certain parts of a temple. Ajit also
used the word kul. irmma to describe what one can attain from ayurveda. Kul. irmma
translates as “coolness,” “freshness,” “satisfaction,” or “delight,” indicating a wider
meaning than just physical pleasure or comfort.
Another inpatient procedure that patients said was cooling is pichu, which in-
volves tying two layers of cloth around the top of a patient’s head and pouring
medicated oil into a hole in the cloth at the top of the head. The patient then sits on
the verandah or walks about the hospital grounds while the oil, which is replen-
ished three to four times every 10 minutes, soaks in. Some patients are also given
nasya treatment, in which nurses wave steaming towels around the patient’s head
in order to increase blood circulation and warm the head. Then the patient lies on
a table, and a medicine is poured into the patient’s nose while a nurse rubs the
patient’s head. When I observed this procedure, a patient was laughing because
of a tickling sensation from the treatment and because the nurse was teasing the
patient about his reaction.
Joking and humor were sometimes part of the aesthetic environment during
these ayurvedic treatments. On one occasion while undergoing talapodichil, a
patient joked about his “AC hat,” and during another treatment session a patient
made others laugh by pretending to be a police inspector, since the mudpack and
banana leaf reminded him of a policeman’s hat. In interviews about their healing
techniques, ayurvedic psychiatrists also emphasized the importance of using humor
in their counseling sessions with patients.
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Interviews with allopathic patients did not reveal any positive aesthetic reactions
to allopathic treatments. For example, no allopathic treatment was described as
cooling. When patients said something good about allopathy, it was usually that
they experienced improvement in their condition (such comments were also heard
about religious therapies and ayurveda). An engineering student we interviewed
at an allopathic hospital was the most enthusiastic supporter of allopathy, which
he praised for being “more logical, more methodical.”
These descriptions of ayurvedic therapeutic measures and patient reactions
should be qualified with the observation that the use of gentle, sometimes plea-
surable, therapies was not always a marked characteristic of ayurvedic medicine.
In the past, treatments were used in ayurveda that were more analogous to ECT.
Dr. Rajendra Varma, whom I interviewed at his workplace, the Vaidyarathnam
Oushadhasala ayurvedic clinic, explained that
in the olden days, instead of this psychiatric treatment—shock treatment—we used to take
the patient to [what they pretended was] the “execution room” and we would bring in an
elephant and ask the elephant just to show its leg as if to squeeze the head, to press the head
of the patient.
The elephant would raise its leg over the patient’s head as if to crush it. The
patient would become frightened, and then the elephant’s leg would be removed.
Alternately, Dr. Varma said, uniformed men would drag the patient before the
king, who would accuse the patient of a crime and demand that he be executed.
Then the trial would be revealed as a hoax. These procedures are also described,
along with suggestions to beat patients with certain kinds of mental illnesses, in
the classical ayurvedic medical text Caraka Samhita (Sharma and Dash 1998:
436–437 [Cikitsāsthānam Ch. IX, Verses 79–84]).
Although he does not mention any of these ayurvedic “shock” therapies,
Francis Zimmermann, in writing about the “flower power of ayurveda,” claims
that abrasive therapies have been discontinued in modern ayurvedic practice
(1992). Classical ayurveda, Zimmermann explains, contained some more
violent and cathartic procedures, but now in the context of competition with
allopathy—recognizing that allopathy has essentially cornered the market on
invasive procedures such as surgery—ayurveda emphasizes the balanced, gentle,
and nonviolent aspects of its practice.
Regardless of whether the emphasis on gentleness is a modern innovation, it
is something that clients of ayurveda appreciate. This is perhaps a case of effec-
tive maneuvering around the hegemony (in terms of funding, government sup-
port, and patronage) of allopathic medicine in India: ayurveda emphasized non-
violent approaches to health and illness and attracted some patrons away from
allopathy.
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POSITIVE EVALUATIONS OF TREATMENT
Another aspect of the significance of the aesthetic quality of the process of ther-
apy is revealed by the positive evaluations of healing experiences by informants.
Some informants recalled their process of healing with enthusiasm and described
a movement to a state that was more auspicious, somehow better or higher than
the state of health that existed before their illness.
Rajan is young man who was formerly possessed at Chottanikkara temple, a
Hindu temple in central Kerala that is renowned for its healing powers. Rajan was
so strongly affected by his experience at Chottanikkara that he decided to live at
the temple and work at the temple lodge. His description of his possession-healing
experience was spirited, recounted with a you-have-to-try-it-for-yourself tone. The
following excerpt shows Rajan’s enthusiasm and also gives an impression of the
daily routine, the environment, and some of the color and variety of the procedures
possessed/ill people engage in at Chottanikkara (though his excited description in
Malayalam, laced with English terms and Sanskritic Hindu religious terminology,
does not translate smoothly).
The first bhajan [singing worship] starts at three thirty a.m. Then the temple will be open
at four. Then there are the remaining demi-gods: Ayappan, Sivan, Murugan, Ganapathy,
Sarppan. It will open completely, then we will walk around the temple. Then there are
pūjas [worships] and consecrations. There will be dhāra [a sprinkling of water ritual] at
the Siva shrine. Then almost at the same time, it will start. We will start shaking like this
[the possessing spirit will become active]. It will start at 5 o’clock in the morning. Then
at eight we have ghee. After that, we will have fruit or something. We are not allowed to
eat any food prepared outside. Naivēd’am. [food offered to the deities before being eaten
by worshippers] will be done at noon. That food will be the meal we eat in the afternoon.
Have you seen kuruti [a worship invoking the goddess Kali]? You will see kuruti pūja
tonight.
Notice that Rajan is excited that my assistant Biju and I should see what is essen-
tially part of the healing process, the kuruti ceremony. After this mention of kuruti,
Rajan’s description moves right into the beginning of the next day.
Then we are ready to go again at four a.m. We will bathe again, become fresh, and will
go to the temple. After bathing, we will walk around the temple. There are four pūjas:
at six o’clock is dı̄parādhana [waving lamps in front of an idol], śı̄vēli [an elephant-led
procession around the temple] is at seven o’clock. At eight thirty at night, kuruti begins again.
It will be over at nine thirty. Thus full time we are in this temple or under its treatment. We
will not know anything about what is going on outside. Full concentration, full prayer.
We will be fully praying. [ . . . ] [W]e chant the mantras of Saraswatham [pertaining to the
goddess Saraswati] and Garudarudam [for Vishnu] and the Garuda pañcakāra [a hymn].
We enter while chanting these mantras. These mantras have a good relationship with nature.
They will make us pure automatically.
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In addition to a good degree of enthusiasm, even bravado, in this narrative, one

gets a sense of the aesthetic environment at Chottanikkara temple. The temple
is a beautiful setting. It is a large complex of shrines and several acres of open
grounds surrounded by hills. All of the temple complex is beautifully decorated
and painted. A great variety of pūjas (worships) are carried out over the course
of the day at the temple’s various shrines with music playing and incense burning.
The environment emphatically engages the senses. This is an important part of
the process of healing according to Desjarlais (1992), Laderman and Roseman
(1996), and others who have written on the aesthetics of healing. In addition to
a sensory experience, some people at Chottanikkara report undergoing a spiritual
change or a positive reorientation, also conceived as a movement to a higher level.
Consider, for example, how Jayasree, a woman who previously tried allopathy for
her chronic fever, headache, and tiredness, relates her healing/worship experience
at Chottanikkara.
I have been coming to Chottanikkara for the last six years now. I came here because
of the caitan’am . [‘power/consciousness’] and blessing of the Devi [the goddess] at
Chottanikkara. I started sitting for worship. From then until now, I haven’t been to the
hospital. I have no problem at all. I came here, and Devi cured everything in me. So I have
been getting aiśvar’m
. [‘wealth/glory’] and abhivr+
ddhi [‘prosperity’] continuously. Because
of that blessing, I will be here forever.
While most patrons of ayurveda and allopathy talk about getting “relief” or “re-
ducing” their problems—an absence or reduction of the negative—Jayasree talks
about things like prosperity and blessing—the presence of a positive experience.
Jayasree did not find a cure, a ridding of her problem. Rather, she went through
a positive transformation. Ajit, the young man quoted earlier who was formerly
treated at the GAMH, recalled that he had a positive experience there. At first, it
was difficult for him to change to a vegetarian diet, stop smoking, and get used
to the idea that he would have to remain at the hospital for 45 days, but he said
he grew to like the treatment. In the passage from Ajit that was cited earlier, he
mentioned that ayurveda wants to take the patient to “another level.” Shortly after
this statement, Ajit elaborated on what he saw as the different goals of allopathy
and ayurveda.
There might be some good aspects in allopathy when one looks at its research and other
things, but if we want to get good kul. irmma [‘coolness/satisfaction’], if we want to reach
a nalla laks. ’m. [‘good goal’]. . . . Right now, speaking about our life, what is it? If I have a
fever, I must get better [ma_ran. am. , lit. ‘must get changed’] For what? To go for work the
next day. Get a cold, get ‘changed’ [ma_ran. am. ] in order to go to school the next day. This
is the level at which we maintain our health. But if we have a supreme aim in life, ayurveda
will help us attain it.
According to Ajit, ayurveda helps one to attain a supreme aim. Again, this involves
a transformation rather than a simple removal of a problem. Ajit also says here
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that a patient pursues “change,” a goal that differs from the sense of eradication or
return to normalcy in the allopathic concept cure.
PLEASANT PROCESS AS RESOLUTION
What does one do if one has been pursuing treatment for psychospiritual prob-
lems for years, going in and out of psychiatric hospitals, having tried homeopathic
medicine, mantravādam. (magic), and other measures? At what point does con-
stant treatment become a burden? Some people experiencing suffering whom my
research assistants and I interviewed had been living at a temple, mosque, or church
for years, having previously tried more medically oriented treatments for several
years. These informants had reached a point where a pleasant process, living in
the pleasant or spiritually engaging environment of a temple, mosque, or church,
became a way of managing their problems.
Sasi is a 27-year-old Hindu man who is possessed and has been living at
Beemapalli mosque with his mother for years after spending a good portion of
his life trying other treatments. Eight and a half years before our interview, when
his problem started, Sasi’s family went to see a mantravādan, a specialist in magic,
to counter the sorcery that they thought might have been the cause of his afflic-
tion. Sasi then spent a year seeking treatment from a private allopathic psychiatric
hospital in Trivandrum and two years in the state allopathic psychiatric hospital
in Trivandrum. For the last five years, he has been at Beemapalli mosque, and his
mother says that it is only at Beemapalli that he gets relief. During a follow-up in-
terview seven months after our original interview, Sasi’s mother told us that Sasi’s
condition has been “up and down.” She said she believes one gets relief by going
through ups and downs, and affirmed that she and her son “have complete faith in
Beemapalli.”
The younger brother of Mustapha, a 44-year-old Muslim fisherman who
had been seeking relief for his problems at Beemapalli mosque, recounted the
following.
Brother of Mustapha: This is the fifth time it has come. The problem has been coming
and going for the past eight to ten years. We don’t go anywhere else now. We took him
everywhere and lost a lot of money and he didn’t get better [sukhamāvilla, lit. ‘didn’t
become healthy’]. When we take him here, he becomes healthy [sukhamāvunnun. t. ȧ].
This time we came here three months ago. [ . . . ]
We are giving him no medicine other than that. Now there is some relief [ku_ravȧ, lit.
“lessening”]. He will get some relief during these months. We are sure about it.
Kavitha: When he is sick, how long do you have to stay here?
Brother of Mustapha: Until he gets relief. Now it won’t take more than two months.
Mustapha had been hitting and swearing at anyone who came near him and talking
strangely, among other things, for many years. He had been treated at a state-run
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allopathic psychiatric hospital, where he received ECT, and his family had tried
mantravādam. (magic, in this case to counter sorcery). While Mustapha and his
family have not decided to live at Beemapalli mosque, his brother’s statement
shows that they are resigned to live with this problem and seek relief from it in
regular intervals at the mosque.
Mariyamma is a 65-year-old woman who lives at Vettucaud Church, a Catholic
church which is famous as a healing center, in Trivandrum. Mariyamma has been
taking allopathic medicines for the last six years for sleeping and breathing prob-
lems related to family tensions. She also prays at Vettucaud Church to find relief
from her problems. This should not be taken to mean that Mariyamma is pray-
ing to find some future relief for her problems, though that may happen. Her
prayers are her relief at present. When asked what plans she has to get over her
difficulties, Mariyamma explained, “I want to remain here until the end of my
life.”
IMPLICATIONS AND CONCLUSION
Having examined the significance of positive and negative aesthetic experiences—

that is, the relative “pleasantness”—of treatment, it could be suggested that this
issue is not of great importance to many or most people undergoing treatment. It
was, after all, only a minority of present and former allopathic patients who offered
complaints about allopathic treatments, and most of these were patients presently
using ayurveda, which may represent a group of individuals who are particularly
sensitive to allopathic treatments. It is possible that the majority of patients in al-
lopathic care who did not complain about the aesthetic process of treatment easily
tolerated these therapies. As we did not specifically ask for complaints or evalu-
ations of how particular therapies felt—these were usually offered in the course
of interviews about illness history and the experiences in different therapies—it
is possible that some unpleasant experiences were not revealed. It is also possible
that patients tolerate uncomfortable procedures for a period of time and change to
a new form of treatment only when and if they decide that the unpleasant effects
of therapy are not worth bearing. Thus some informants may not have reached the
point where they might complain or change therapies.
However, if it is true that only a small group of individuals are significantly
bothered by the aesthetics of allopathic treatment, we can at least say that the
pleasantness of the process of therapy is important to some patients, and it is
important enough to some that they will choose an alternate therapy hoping to
avoid abrasive treatments. Meanwhile, the patients with intractable problems who
have decided to live at a mosque, temple, or church draw attention to the impor-
tance of the aesthetic environment of healing that is experienced for an extended
time.
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The degree of the importance of a pleasant process of treatment could be fur-
ther ascertained by conducting additional interviews to see if the number of com-
plaints about allopathic therapy becomes more evenly distributed between patients
currently using allopathy, ayurveda, and religious healing or if these complaints
continue to be more prevalent among people who changed to ayurveda. Further
interviews could also address more explicitly the reactions of patients to specific
procedures and examine patients who are about to change or have just changed
therapies due to aesthetic concerns. It would also be useful to explore possible con-
nections between ideologies of therapy, methods of therapy, and patients’ reported
experiences. Some researchers have examined biomedicine’s use of war metaphors,
revealing that healing is often conceived of as “fighting” an illness or “destroying”
a pathogen (Bastos 1999, Martin 1994). Does this ideological/discursive stance
have some role in obscuring attention to how it feels to undergo therapies? Does an
ayurvedic orientation to treating patient discomforts and restoring balance rather
than destroying a pathogen lead to practices that are more palliative?
It should also be pointed out that, related to the suggestion presented earlier
that overemphasis on the goal of cure could lead to a de-emphasis on process,
allopathic medicine does cure, or complete treatment, more quickly than the other
therapies presented here. For this reason, many people feeling time pressure from
work and other obligations (as Ajit pointed out above) prefer allopathy. And while
pleasantness is important to some, it seems that a certain amount of abrasiveness
can be tolerated to accommodate time pressure. Whether such pressure could
be considered “modern,” or part of changing work conditions, is another issue
for future consideration. In order to interpret such trends, and more broadly, in
order to comprehend the concerns and the experience of people suffering distress,
anthropologists should attend to the quality of the process of therapy and widen
our understanding of the variety of ways of coping with an illness to include care,
living with a problem, curing, and attaining a higher state.
ACKNOWLEDGMENTS
I thank Dr. K. Gireesh and the staff at Abhaya Gramam psychological counsel-
ing center in Kerala, where a preliminary version of this paper was presented.
For their comments on earlier versions of this paper, I am particularly indebted to
Robert Desjarlais, Vincent Crapanzano, Setha Low, Shirley Lindenbaum, and Joan
Mencher. I also thank the three anonymous reviewers of the original manuscript
of this article, who provided valuable suggestions and challenges for rethinking
the arguments I present. Research for this study was made possible by a predoc-
toral grant from the Wenner-Gren Foundation for Anthropological Research and
a Doctoral Dissertation Research Improvement Grant from the National Science
Foundation.
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NOTES
1. In this paper, “allopathy” is the term most often used to refer to the medical system
that is also known as “biomedicine,” “western medicine,” “cosmopolitan medicine,” or
“modern medicine.” As allopathy is one of the most common terms used to designate this
medicine in Kerala, it is appropriate for discussing the ethnographic context in this paper.
In addition, allopathy best describes how biomedicine is characterized in this study. The
term refers to the treatment of illness by opposites (e.g., toxic substances that will kill a
disease pathogen), which can involve attacking an illness and using abrasive techniques.
Finally, the term biomedicine would be misleading, since ayurvedic medicine, which is a
major focus of this study, is also based on biological knowledge.
2. These should not be seen as especially problematic uses of this concept, but rather
as random examples of a common feature of medical anthropological writing. Examples
include Bhattacharyya (1986: 47–49), Nichter and Nordstrom (1989: 384), and Roseman
(1991: 9, 17, 129).
3. The literary examples from the Oxford dictionary for the first meaning of cure range
from 1382 to 1623, while examples of the fifth definition range from 1526 to 1872, perhaps
indicative of a range of time when the meaning of cure began to shift.
4. Whether spirit possession and psychopathology are comparable problems is an is-
sue that has been debated in anthropology (e.g., Bourguignon 1991; Kehoe and Giletti
1981; Lewis 1983, 1989) and remains unresolved. Without implying that these states are
completely equivalent, I consider these “idioms of distress,” to use Nichter’s term (Nichter
1981), to be comparable for the purposes of this paper, because the people in this study
considered them different manifestations of a single problem that is treatable by various
therapies. For example, several informants described the same problem/illness as both pos-
session and mental illness and pursued therapy through worship at a temple and allopathic
psychiatric healing.
5. For further explanation of how unstructured interviews provide a complement to
semistructured interviews in anthropological research see Bernard (2002: 204–210).
6. The real names of patient-informants are not used in this article. The actual names
of healers and research assistants, however, are used.
7. The vast majority of informants I interviewed consulted allopathic doctors for
their first treatment. This pattern of selecting therapy is not characteristic of other soci-
eties where medical choice has been studied (e.g., Janzen 1978; Romanucci-Ross 1969;
Young 1981). The difference may relate to high literacy, widespread immersion in secu-
lar education, and the relatively widespread availability of allopathic health care, which
have been projects of the Communist government of Kerala. The highly literate pop-
ulation of Kerala (around 90 percent) also has opportunities to read about allopathic
medicine, which receives a lot of coverage in the press. Although some informants first
visited astrologers or mantravādans (sorcerers), these often simply made some prediction
about the cause and chances of curing the problem and referred the client to a doctor or
hospital.
8. Throughout this paper, Malayalam words are transcribed using American Library
Association – Library of Congress-defined characters and diacritical marks for translit-
erating Malayalam into the Roman script (American Library Association – Library of
Congress 1997). Sanskrit-derived ayurvedic medical terms (e.g., talapodichil, nasya)
are transcribed according to conventions in texts published in English on ayurvedic
medicine.
9. English–Malayalam dictionaries offer a variety of terms for the English “cure.” How-
ever, these entries are usually long Sanskritic neologisms, which translate into something
like “to cause peace to come to an illness,” and I did not observe these terms being used by
any informants (M.P. Pillai 1995; T.R. Pillai 1996).
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10. Some Americans pay significant sums of money to receive this same pan-
chakarma treatment at centers in Connecticut and New Mexico for health maintenance and
relaxation.
11. Most of the examples in this paper come from 12 months of fieldwork that was
conducted in 1997. At that time, the GAMH was in a large, old, dilapidated house. On
returning to Kerala in 1999, I learned that the GAMH had moved to a larger, modern
facility that looked a lot like an allopathic hospital. I did not spend enough time at the new
facility to sufficiently evaluate how it compared as an environment for healing. There was
a lot more space inside the new facility, yet treatments at this facility were administered
indoors rather than outdoors. I could not help wondering to what degree modernizing this
facility also meant imitating the architecture of biomedicine and perhaps losing a more
aesthetically engaging environment.
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Department of Anthropology
Queens College
City University of New York
Flushing, NY 11367-1597, USA
e-mail: murphy halliburton@qc.edu
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pp871-medi-464952 MEDI.cls June 14, 2003 10:48

THE IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT:

KEY WORDS: aesthetics of healing, ayurveda, cure, ethnopsychiatry, India

162 MURPHY HALLIBURTON

allopathic (biomedical) psychiatry, ayurvedic psychiatry (part of the South Asian

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 163

THE AESTHETICS OF HEALING

Inspired by the focus on embodied and phenomenological experience in anthropol-

164 MURPHY HALLIBURTON

Desjarlais’ analysis alerts us to the visceral experience of this kind of shamanic

Nichter and Nordstrom make a similar observation regarding Sri Lanka.

DECONSTRUCTING THE CONCEPT OF CURE

Little attention is currently devoted to the concept of cure in medical anthropol-

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 165

166 MURPHY HALLIBURTON

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 167

168 MURPHY HALLIBURTON

There are, however, cases in contemporary biomedicine in which definitions of

INFORMANTS AND INTERVIEWS

Research for this study consisted of interviewing 100 patient-informants about

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 169

170 MURPHY HALLIBURTON

status. Patients ranged in employment from the unemployed to manual laborers

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 171

REACTIONS TO AYURVEDA AND ALLOPATHY

A statement by Ajit,6 a young man who was seeing an ayurvedic psychiatrist

172 MURPHY HALLIBURTON

none of these informants complained of abrasive effects of ayurvedic therapy. This

Varghese’s way of avoiding these uncomfortable effects of therapy was to seek

Kavitha: Are you taking allopathic medicine now?

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 173

When Kuttappan previously sought treatment at this same allopathic hospital, he

174 MURPHY HALLIBURTON

were caused by a spirit. During three years of allopathic psychiatric treatment, he

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 175

176 MURPHY HALLIBURTON

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 177

178 MURPHY HALLIBURTON

In addition to a good degree of enthusiasm, even bravado, in this narrative, one

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 179

PLEASANT PROCESS AS RESOLUTION

180 MURPHY HALLIBURTON

IMPLICATIONS AND CONCLUSION

Having examined the significance of positive and negative aesthetic experiences—

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 181

182 MURPHY HALLIBURTON

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 183

American Library Association – Library of Congress

184 MURPHY HALLIBURTON

Doyle, Derek, Geoffrey Hanks, and Neil MacDonald

IMPORTANCE OF A PLEASANT PROCESS OF TREATMENT 185

186 MURPHY HALLIBURTON

Pillai, Mekkolla Parameswaran

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