A small village in one of India’s southern states woke up to a tragic fire twenty three years ago. Little did it know that this incident would alter the course of the nation’s approach to mental health care.

Erwadi in Tamil Nadu was no ordinary place. After all, this village housed the revered dargah (shrine) of Hazrat Sultan Syed Ibrahim Shaheed Badusha, along with other saints who are buried in the dargah’s premises.

For centuries, this dargah had attracted pilgrims from diverse faiths, all drawn by the belief in the shrine’s miraculous powers to cure mental ailments brought on by evil spirits, djinns and black magic.

Its very essence – the water, the oil from the sacred lamps, even the sand beneath one's feet – was believed to hold healing powers.

However, on August 6, 2001 a fire tore through a makeshift faith-based mental home — a type of paid accommodation prevalent in Erwadi — where families could stay with their mentally ill relatives.

At just 28 months old, Rebecca Riley was diagnosed with ADHD by psychiatrist Kayoko Kifuji at Tufts-New England Medical Center in Boston.

Rebecca’s mother had told the psychiatrist that she had difficulty sleeping, seemed hyperactive, and was “constantly getting into things, running around, not being able to settle down.” Dr Kifuji prescribed clonidine, a potent sedative typically used for hypertension.

By age three, Dr Kifuji added another diagnosis to the child's medical chart: pediatric bipolar disorder. With it came a cocktail of powerful drugs - Seroquel, an antipsychotic, and Depakote, an anticonvulsant.

Rebecca died at age four. The autopsy revealed that she had died from an overdose of psychiatric drugs, primarily clonidine intoxication.

The American Psychiatric Association (APA), the largest psychiatric organization in the world, decides what conditions are considered "mental illnesses" by voting on them. It then goes on to list them in a guide called the DSM (Diagnostic and Statistical Manual of Mental Disorders.)

Unlike physical health, mental health lacks clear biological signs, or biomarkers, to confirm a diagnosis.

For example, a blood test can indicate if a patient had a heart attack by looking for a specific biomarker. But in mental health, there's no such test.

Symptoms like agitation and disrupted sleep could point to depression, anxiety, or early schizophrenia, and diagnosis relies on detailed conversations and questionnaires.

Decades of research into blood and other markers have failed. Mental health disorders are diverse and often overlap. Two patients with depression might share only one symptom, and anxiety frequently coexists with depression.

Allen Frances, a prominent American psychiatrist who led the team for the fourth edition of the DSM, has sounded alarm bells about the broadening of diagnostic criteria in the latest version of the manual (DSM-V).

He believes that the DSM-V is leading to too many people being diagnosed with mental health conditions.

"If anything can be misused, it will be misused, especially if there's a financial incentive," Frances has cautioned.

“And pharma, the big drug companies, have a tremendous financial incentive in making sure that every DSM decision is misused by expansion, so that people who are basically checked well are treated as if they're sick. They become the best customers for pills,” he has said.

He is particularly worried about how this affects children, pointing out that normal behaviors often seen in kids are being labeled as medical conditions.

"We have wild overdiagnosis in attention deficit disorder and autism," he has pointed out.

According to Frances, “their immaturity is being turned into a disease, and kids are being treated with medication for basically just their immaturity.”

The answer to this, perhaps, lies in people’s lived experiences.

Take Sharada’s case, a 35-year-old woman from India, who has been visiting a Mahanubhav temple regularly for the past decade. She told Dr Shubha Ranganathan that she first turned to the temple seeking relief from persistent physical symptoms like pain, fever, and vomiting that conventional medical treatment could not resolve.

The Mahanubhav sect in India offers a unique approach to healing. Their temples, scattered across Maharashtra, provide a refuge for those seeking relief from mental and spiritual afflictions. Emphasizing direct devotional worship to one God, Parameshwar, the sect practices strict monotheism, vegetarianism, and teetotalism.

At the temple, Sharada would enter into trances, and afterwards, she continued to visit regularly. Over time, she began to interpret more of her problems as ‘possession.’ On days when family friction overwhelmed her, she would flee to the temple, knowing she would find refuge there.

For her, the temple was a sanctuary – a space that allowed her to navigate the intersections of physical, emotional, and spiritual well-being.

In another faith healing site in India – Rajasthan’s Balaji Temple – visitors deprive themselves of sleep, eat tasteless or bitter food, restrain themselves in chains, hit their bodies against the walls or move their head in repeated, circular motion for long periods of time to heal.

The evolution of modern psychiatric care is fraught with power, control and dominance. The way we think about ‘madness’, ‘insanity’ and their treatment has a lot to do with the worldwide colonial project.

Historian Michel Foucault’s work tells us that in the past, madness was simply seen as irrational behavior, no different from physical ailments. The mind and body were viewed as deeply intertwined, with no clear separation.

But by the late 1700s in Europe, perspectives started to shift. Madness became more of a psychological issue, linked to one's moral and mental state rather than just physical health. This change reflected deeper social transformations, as communities prioritized control over treatment.

Institutions like the Hôpital Général in Paris were established not to heal the mentally ill, but to isolate them from society. Foucault suggests this was more about maintaining social order than advancing medical understanding.

In India, traditional texts long before colonial rule described mental illness in terms of spiritual and emotional disturbances. However, British colonial rule introduced a different approach.

Under British rule, behaviors previously seen as part of an ascetic lifestyle in Indian culture, like wandering, were reinterpreted as symptoms of mental illness.

The first lunatic asylum in Mumbai was set up in the 1740s. By the 1800s, the British had established similar facilities across their Indian territories. The Lunacy Act of 1858 legally reinforced the confinement of the mentally ill, intertwining mental health care with colonial control.

“Since the APA's inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of "scientific evidence," along with racialized theories that attempted to confirm their deficit status,” the apology reads.

The body has also said that there are still significant disparities in how mental health conditions like schizophrenia are diagnosed, particularly between white patients and those from Black, Indigenous, and People of Color (BIPOC) communities.

Like I pointed out in one of the previous sections, there are no clear-cut tests to diagnose mental illnesses. Several experts and critics of the field have said that it then becomes about the patient’s own experience.

What this means is, people suffering from mental distress understand their own experience better than anyone else. They have the capacity and intelligence to know what helps them and what harms them.

So, if someone's dealing with deep, debilitating sadness and they say antidepressants helped them feel better, we have to trust that. On the flip side, if another person finds healing through visiting an indigenous healer, their story is just as valid.

What we must be open to understanding is that the story of mental health is not linear. It certainly isn't a case of we once mistreated the mentally ill and are now enlightened and compassionate because of Science.

Jarrod Clyne's story is a chilling reminder of the coercive practices of modern psychiatric care."I was held down, tied up, forcibly medicated, and placed in a seclusion cell," he writes here.

The disturbing story of Willowbrook, a Staten Island psychiatric facility, tells us that children were deliberately exposed to hepatitis through contaminated drinking water and feces.

Here, here and here, you’ll find more personal accounts of people in psychiatric care, who’ve had harrowing experiences – with medicines, abuse, and neglect.

So, psychiatry is definitely not the infallible savior it often pretends to be. We must confront the uncomfortable truth: Countless individuals have found healing outside its rigid confines, tapping into diverse cultural, spiritual, and personal reservoirs.

In this four-part series, we’ll be telling stories of human distress and the ways people in parts of India chose to deal with it. As someone who has spent countless hours interviewing, listening, and making sense of these stories, I have only one thing to ask of you:

Please be open – to views, experiences, and perspectives that might appear alien, unbelievable, or even problematic at first glance. It might just offer you a perspective on psychiatry, psychology and human suffering that you’ve never encountered before.

(This is the first part of a four-part series on faith healing in India. To read parts two, three and four click here, here and here.)

(With inputs from Dr Ayurdhi Dhar)