Drowning in Enchanted Waters: The Role of Practiced Islam in Mental Health Nosology and Treatment Seeking Behaviors Demonstrated in Urban Bangladesh

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Abstract

In Bangladesh, there are two parallel mental health paradigms. The biomedical psychiatric system is under-funded, under-staffed and often the final form of care accessed by patients when other treatments have been unsucessful. The traditional religious approaches to mental health are based on Islamic doctrine and heavily influenced by cultural and socio-historical contexts. These two perspectives often find themselves at odds with each other: The former is perceived as curative only of symptoms and entirely devoted to science; the latter is socially obligatory and only recognizes two causes of mental illness: jinn-e dhora (possession) or ban mara (religious cursing). Mental illness symptoms in Bangladesh are overwhelmingly manifested somatically or as behavior deviant from the culturally acceptable, both of which are externalizations of illness. This Islamic model of mental health leads to the construction of culture-bound symptoms not found in Western diagnostic schemes and succeeds in providing an explanatory model for abnormal conduct and inexplicable physical sensations not recognized by the DSM-IV. Detailing three-months of field research in urban Dhaka, this thesis includes background information on the Qur'anic attitude towards mental health, an introduction to Bangladeshi culture, symptomotologic and diagnostic psychiatric data gathered at the Dhaka Monorog Clinic, and a description of traditional Bangladeshi religious healters, detailing their diagnostic and treatment modalities. My research demonstrates a tendency toward pluralistic care seeking strategies by mental health patients and their families. However, there is no referral system in place in Bangladesh that integrates biomedical and cultural Islamic approaches and the psychiatric community fails to recognize traditional, "unscientific" healing or to consider amalgamative care. This report utilizes case studies and personal anecdotes to provide insight into the parallel mental health treatment systems in Bangladesh and serve as a springboard for future research.