“Both of us were silent for a while as we sat there companionably, contemplating the limits of our respective healing traditions.” They are both Indians: Baba, a Muslim pir (wise man), in a dusty room by the mosque piled with phials and mortars; Dr. Kakar, a psychoanalyst trained in the United States, Europe, and India. Baba has been consulted by an unhappy husband whose sexually unsatisfied wife is being unfaithful, and though he has given the couple a talisman, some holy water, and a lecture on clean living, neither doctor is very hopeful about the outcome.
With extraordinary sympathy, openmindedness, and insight Sudhir Kakar has drawn from both his Eastern and his Western backgrounds to show how the gulf that divides native healer from Western psychiatrist can be spanned. To write his book he visited a temple famous for exorcism of spirits, a huge Sikh ashram, a Dravidian shaman, a Tibetan lama, a matriarchal guru-ess, and an Ayurvedic doctor, as well as the pir—all specialists in the cure of mental illness. Physical medicine is outside his chosen field—he is under no obligation to compare the effect of holy water with that of penicillin—so he is free to acknowledge, implicitly at least, that the indigenous soul doctors’ rate of cure probably runs just about level with that of Westerners. Important questions are involved, therefore, about what mental healing really is. Do Western psychiatrists, unwittingly, use methods taken for granted by the “superstitious” East? Do Western therapies in fact succeed—if and when they do—for the reasons generally assumed by their practitioners?
At the outset it is certainly hard to see anything in common between healing Western-style and Eastern-style. Baba is a specialist in exorcism, via incantation and talisman: his work as he sees it has nothing to do with inner, personal conflict but is a straight fight with a possessing demon. These balas—very Freudian spirits, for they specialize in entering women’s dreams and enticing them to “bad acts”—are around everywhere and may possess anyone more or less at random. It is not hard for Kakar to translate the balas as forbidden fantasies which have been externalized. But his next visit has sensational elements which might seem harder to assimilate to Western ideas.
Among his other gifts Kakar has a fine ability to evoke the Indian scene. When he arrives at Balaji temple, which he had imagined as isolated and austere, it turns out to be all peeling green paint, piles of refuse, hawkers of cheap images. Inside the temple is a hell by Hieronymus Bosch. Young girls, in the persona of the possessing devil, shriek obscenities; old women are turning somersaults or hanging upside down to dislodge the fiend; others are in chains, or heaped over with stones; and dogs scavenge in the smoke of burning offerings. But there is a closer parallel than the world of Bosch. It was only a century ago that Freud, among others, was visiting Charcot’s clinic at the Salpêtrière in Paris. Contemporary accounts of Charcot’s wards, and his sensational Friday demonstrations, a venue for letout Paris, describe scenes not unlike Balaji temple; swoons and crises, convulsions, shrieks, and somnambulisms. (After Charcot’s death, however, when there was no one to orchestrate the scenes, they declined drastically.)
In Freud and Breuer’s Studies in Hysteria of 1895, Freud’s intelligent and aristocratic patient Emmy von N. is described as crippled by grimaces and spasms—every so often she would shriek, “Don’t speak, don’t touch me!” before placidly continuing her conversation. Frau Emmy dreamed of witches; but, lacking cultural backing for the existence of spirits, did not “believe in” them. Otherwise, though, she was not acting very differently from the patients at Balaji: mental suffering was being translated into boldily spasms for which she had no conscious responsibility. Had she been Indian she would have been shouting at (or as) a demon, not a doctor; and had she lived a few hundred years earlier in Europe, she would have seen the demon or witch instead of dreaming about them.
Kakar carefully unravels the factors that he believes to be healing in the temple setting and in the pir’s practice. The healers give the patient’s illness a meaning, and an important one—he is the battleground for forces of absolute good and evil. He is absolved from any personal shame for his bizarre afflictions; and he is reconnected to traditional sources of strength and comfort by ritual and symbol. At the temple there is also an effective form of that newly discovered Western specialty, family therapy: the patient’s accompanying family is drawn into the cure, while at the same time there is solidarity and support among the whole temple community so that isolation and fear are lessened. Thus, in Kakar’s Western version of the process, “the unconscious content of the psyche is considered neither fixed and immutable nor malignant and threatening, as in the notion of the psychoanalytic id, but as fundamentally capable of a benign transformation.” Western psychotherapy, aimed at freeing the patient for independence and choice, looks rather a lonely, hermetic, and risky business in comparison.
Kakar goes on to study the shaman of a forest tribe in eastern India, and a Tibetan lama in exile. Both, again, work with the notion of possessing spirits (though it should be said that all these healers show a lot of horse sense about excluding simple physical illness). There are of course differences in each group’s cluster of beliefs about the spirits, who are not all ghosts of the dead; but, to generalize roughly, they come back to haunt either because they are angry ancestors, or because they had lives that were cut short or frustrated, or because they are being used by the malice (conscious or not) of envious neighbors. And this, we might say, is what the therapist works with still: envy, frustration, the reproachful voice from the past.
Again, these two healers, like the pir and the temple exorcists, work with dissociative trance in the patient; as Kakar says, this is probably the single most widespread psychotherapeutic technique used in the world. There is no doubt that it is a state that the brain craves from time to time, and wherever a culture does not provide it in approved, ritualized form it is looked for in drugs, alcohol, fast driving, dancing. The “magnetic sleep” of the early days of hypnotism, electroconvulsive therapy, Primal Scream therapy, probably all had or have something of the dissociation experience in them. Why it “works” is not known; Kakar quotes the psychiatrist William Sargeant on neurophysiological changes resulting from high sensory stimulation, and Freud on the therapeutic effect of shattering an overrigid ego, and perhaps the two mean the same thing. Curiously, most of the Western forms of psychotherapy using dissociation—LSD therapy, drug abreaction, sleep therapy, sensory deprivation—seem to have been only briefly tried and dropped, no doubt because they are less restful options for the therapist than sitting behind a couch.
The intrepid author’s further adventures—with tantric practice, with two popular cults—provide experiences ranging from the ludicrous to the mystical. He is obliged to repeat a mantra against Freud (with silent apologies to his colleagues), joins happily in the communal chanting of a crowd of fifty thousand, pursues the grotesqueries of tantric symbolism (“like a script by Freud in collaboration with Céline”). lies at the feet of an imperious lady guru. In his Indianness he is never unmoved by beauty or devotion when he finds it; but he keeps his feet on Western ground, and when he wants to explain the meaning of mantra he quotes Rilke. He is aware that the mystic and the analyst scarcely have a common language for what is most important to them; spiritual experience, he sees, does not necessarily bring virtue or knowledge with it, while on the other hand psychoanalytical training provides no place whatever for the spiritual. Yet from his own professional experience he is able to see parallels: that the nearest thing to the extended training of the tantric is the “long meditative discipline” of the training analysis; and that there is a similarity between the concentrated passivity of meditation and the “free-floating attention” with which the analyst ideally listens to his patient. From his experiences with the two popular sects he learns about the gurudisciple relationship as compared to the psychoanalytic transference; and in the tantra he finds a vast ready-made stock of expressive and healing symbols.
Kakar’s greatest asset—he puts it down to being Indian—is that he actually believes in psychological reality, believes that what feels “true” is in fact true at that moment for the experiencer. He comments on the scarcity of Western psychiatrists who pay more than lip service to this, and quotes Jung—“Only an insignificant minority regards the psychic phenomenon as a category of existence per se.” R.D. Laing in fact in his early books was one of the few who has done so. When Laing writes about a patient who said, “This is the first cup of tea anyone has ever given me,” and one who said, “I was born under a black sun,” he is concerned with the phenomenological truth of what they said rather than with its literal consensual truth. The Indian patient says, “The god told me” without needing to add “…in a dream” to prove his sanity; the dream’s psychological reality is taken for granted. Kakar’s foreignness frees him from the hampering obsession with literalness, with distinctions between “primary-process” and “secondary-process” thinking, which was bequeathed to psychoanalysis by Freud and which makes it unfit to confront works of imagination and art generously.
In looking at differences between Western and Eastern therapy Kakar is not particularly concerned, then, with what most Westerners would consider the main one—that Western therapy is concerned with “getting at the truth.” (Which is more real, a demon or “the id”?) He takes up a point from a more sophisticated comparison made by Lévi-Strauss, in an analysis of a shamanic ritual. Both the shaman and the psychoanalyst provide meaning and structure for their patients’ suffering, says Lévi-Strauss, and both enable conflict to emerge and be resolved; but while the shaman provides a ready-made myth for his patient to use, the analyst’s role is to facilitate the patient’s own private myth:
Many psychoanalysts would refuse to admit that the psychic constellations which reappear in the patient’s conscious could constitute a myth. These represent, they say, real events….We do not question these facts. But we should ask ourselves whether the therapeutic value of the cure depends on the actual character of remembered situations, or whether the traumatizing power of those situations stems from the fact that at the moment when they appear, the subject experiences them immediately as living myth…[that is,] an emotional crystallization which is moulded by a pre-existing structure.
Both kinds of myth, presumably, must be directed by the healer toward a victorious resolution.
The Easterner’s trauma can be dealt with from a common stock of symbols because Hinduism, says Kakar, has them in such profusion: “What in the West is repressed and relegated to the unconscious finds a cultic home in India, where it can be consciously engaged with and ritually acted out.” The Western patient must cut his private path through the jungly unconscious rather than take one of a multitude of age-old beaten tracks. (The analyst, of course, contributes to the form the private Western myth takes; and it is a curiously neglected question what miniculture an analyst and a patient divided by age, sex, and education manage to draw on.)
The interdependence of private and social myth in the East has been discussed by Gananath Obeyesekere in his fascinating study of Sri Lankan cults, Medusa’s Hair.* Private dreams and visions are molded by cultural expectations, he demonstrates, but at the same time myth can be revitalized by the individual’s dream; so for the person suffering a mental illness, “a cultural idiom is used to objectify personal drives and motives,” but also “the patient recreates the symbol in her own consciousness and thereby lends vitality to the cultural image.” Inner and outer experience give value to each other, so that “it is possible for a person to dream a myth rather than a dream, though the latter is the model for the former.” In the performance-minded West, however, anything to do with such florid fantasy has connotations of childishness or craziness (that people still have an appetite for it is suggested by the popularity of Tolkien’s books, for instance, or science fiction films); and the mental patient’s aberration remains private, for he has no role that he can step into.
There are other differences suggested by Kakar that are less convincing. The Indian patient’s treatment is always social, he says, and concerned with a web of relationships; but the same is surely true for the patient in the West, even if the core of the therapy concerns family relationships which are past—mythical ones, in Lévi-Strauss’s sense. Kakar also contrasts the ideals of freedom of East and West; for the former, inner richness and freedom but outer conformity; for the latter, liberty to act, but rationalistic conformity within. It is doubtful, though, whether this goal of Western therapy—liberating the patient for a new freedom—is not honored more in the breach than in the observance. No doubt there is some adaptation to circumstance, a little newly acquired freedom, and a tremendous ingestion of the therapist’s values. (Can years of “interpretations” be any more free of suggestion than the shaman or guru’s scenario?)
As for the psychoanalytic transference, this differs by being a temporary discipleship, says Kakar, as compared to the chela’s adoration of the guru, his affirmation that “I am small and you are great but I am part of you.” Yet for Western patients, the question of “resolving the transference” remains somewhat mysterious. “Aaron Green,” the analyst interviewed by Janet Malcolm for Psychoanalysis: The Impossible Profession, admits to her in that book that after years in the profession he has no real experience of it; and in the recently published interviews with Freud’s patient Pankeyev, The Wolf-Man Sixty Years Later, by Karin Obholzer, the old man reveals himself still tangled in compulsive dependencies after a lifetime of therapy.
In many ways, then, psychoanalysis may be much less radically different from “magical” therapies than has been admitted. If it is, what place do “healing illusions” have in it? Is it they, and not insight, that contribute more to betterment? “Aaron Green” suggests to Janet Malcolm that at the end of his treatment the patient should feel like one of the characters waking up at the end of A Midsummer Night’s Dream, that something strange and benign has happened but he can scarcely say what—surely even more of a mystification than the Indian feels after darshan with the guru or exorcism by the priest. Is the psychiatric stand-off, the analyst’s “blank screen” attitude, chiefly of value because it lends a useful aura of mystery and force to the doctor’s spare remarks? And is it appropriate for Westerners to be put under a spell—a valuable borrowing of ancient techniques, or an unwise attack on the patient’s sense of reality?
Perhaps the Western patient is on a borderline between the hysterias of a century ago and a new, consciously aware kind of mental suffering, so that there is no very clear answer yet. Or perhaps the very leap forward in Western self-consciousness to which Freud contributed has made the bemusement of the patient in therapy less appropriate. At least 150 years of this growing objectification of the idea of self preceded him (a period when the number of nouns beginning with “self-” grew by about a hundredfold). This is where the real difference between the Western and Eastern patients and their therapies lies: as Kakar points out, introspection scarcely has a place in Indian culture, and the “Know thyself” (atmanamvidhi) of Indian philosophy refers to a self that is pure and characterless essence rather than to a personal set of foibles. In the West, where the former is ignored, the individual’s moral task has concerned the latter: exploring, accepting personal character and its history, neutralizing the demons by bringing them home rather than by expelling them.
If Western psychotherapy has a semireligious ethic, it is this cleansing by self-scrutiny, which has no place in the rituals described by Kakar. But possibly, nevertheless, the healing in Western therapy draws on the same sources as they do: on a surrender to communication, both with another human being, and with that level of imaginative reality which Kakar describes, in relation to the tantra, as “akin to artistic creativity, and [which] may well have its source in that particular human capacity and propensity which creates metaphors in the waking state and dream images in sleep.”
February 17, 1983