Jain samayika, pratikramana, preksha and sallekhana

1. Introduction

Version followed: samayika, pratikramana and Paryushana as described by Y. K. Malaiya's Jain educational pages (Shvetambara and Digambara forms named separately); Preksha Dhyana as set out by Acharya Mahaprajna (Mahapragya) in Preksa Dhyana: Theory and Practice, published by Jain Vishva Bharati (Ladnun, Terapanth Shvetambara order); sallekhana as Jain sources describe it, following Samantabhadra's Ratnakarandaka Shravakachara as cited by J. M. Koller; the legal position as the Rajasthan High Court and Supreme Court of India stated it in 2015.

These are not therapies. They are religious observances and a contemplative method of a living tradition, each with its own scriptures, ascetics and institutions. Jain teaching holds that karma binds the soul (jiva), and that non-violence (ahimsa), self-restraint and equanimity loosen that binding on the path to liberation (moksha). These are the tradition's beliefs, recorded here as Jains hold them. [source: Koller; Malaiya]

• Samayika is described as staying in equanimity by withdrawing into the self. In Digambara usage, pratikramana itself is sometimes called samayika. [source: Malaiya, Paryushana]
• Pratikramana literally means "turning back". Malaiya calls it a renewal meditation. It includes samayika, prayers to the Five Supremes and the Jinas, reflection on vows (vratas) and their transgressions, kayotsarga (detachment from the body) and pratyakhyan (resolutions for the coming period). It ends with a request for forgiveness (Michchhami Dukkadam: "may my wrongdoing be rendered fruitless"). [source: Malaiya] Kayotsarga and the lay vows (anuvrata) are covered in 270.
• Paryushana is the annual rainy-season observance. Shvetambaras observe eight days ending in Samvatsari (the annual pratikramana), with recitation of the Kalpa Sutra. Digambaras observe ten days of Dashalakshana, with recitation of Umaswati's Tattvartha Sutra. Both close with mutual forgiveness. Fasting is widely undertaken in this season [uncertain: not verified in an institutional source]. This guide gives no fasting lengths. [source: Malaiya]
• Preksha Dhyana (preksha means "perception") was systematised by Acharya Mahaprajna and is taught through Jain Vishva Bharati. Its stated aim is to "see yourself": perceiving the self rather than suppressing mental activity. [source: Mahaprajna, JVB]
• Sallekhana (santhara) is a vow to face death by gradually giving up food and then drink. Jain sources permit it only near the end of life, when normal life is no longer possible because of extreme calamity, famine, very old age or incurable disease. It is taken after subduing the passions, and Jain teaching insists it is not suicide. [source: Koller; The Week 2025] It is covered in the Harm account below.

How change happens, in the tradition's terms: repeated self-examination, confession, forgiveness and equanimity reduce the passions (kashayas) and the karmic influx. [source: Malaiya; Koller] In the therapist's terms [synthesis]: these observances give structure for moral reflection, repair in relationships and community belonging. The therapist's task is to understand them in the client's life, support the client's own use of them, and watch for points where health, scrupulosity, coercion or suicidal crisis come in.

2. Framework

No source gives a session count or protocol for psychotherapy alongside these observances. The phases below are [synthesis], built around the observance cycle.

[source for Module 5 content: APA, CFI Supplementary Modules]

3. Guiding principles

• Client-led. The client decides whether and how their practice enters therapy. In practice: ask before you bring up samayika or preksha, and use the client's own words. [synthesis]
• Attribute, don't adjudicate. Present karma, moksha and the merit of austerities as Jain teaching, neither affirming nor dismissing them. In practice: say "in your tradition…". [synthesis]
• The therapist is not a religious authority. Rulings on vows, atonement or fitness for sallekhana belong to the client's ascetic teachers. In practice: refer doctrinal questions to them, and don't take on a confessor's role. [synthesis]
• Know the sect. Practice differs between Shvetambara and Digambara, and between subsects (for example, how long Paryushana lasts and which texts are read). In practice: never generalise from one Jain client to another. [source: Malaiya]
• Values-driven or fear-driven. IOCDF separates practice that comes from fear, guilt or shame (a sign of OCD) from practice that brings meaning or peace. In practice: listen for this tone whenever pratikramana or vows come up. [source: IOCDF, For Faith Leaders]
• Health questions go to the doctor. Fasting, medicines and illness are medical matters. In practice: with consent, write to or call the GP or physician, and send medication questions to the prescriber. [synthesis]
• No austerity targets. The therapist never suggests, endorses or measures fasting length or other austerity. In practice: talk about meaning and safety, never about amounts. [synthesis]
• Assess suicide risk as a person, not a score. Current UK guidance (NICE NG225, as summarised in a 2023 British Journal of Psychiatry editorial by Mughal et al.) advises against risk tools and low/medium/high stratification. Use a compassionate psychosocial assessment, a risk formulation and collaborative safety planning. In practice: this applies whenever end-of-life fasting or wishes to die come up. [source: Mughal et al. 2023, BJPsych editorial on NICE NG225]
• Vow is not automatically pathology, and religion is not automatically protection. In practice: assess capacity, coercion, mood and the clinical context case by case. [synthesis]
• Children cannot give the consent the tradition itself requires. In practice: when a minor fasts long or is put forward for a death vow, that is a safeguarding matter. [synthesis; see Harm account]
• Collaborate with clergy when the client wishes. In practice: get explicit consent for any contact with a sadhu, sadhvi, samani or community leader, and agree its scope. [synthesis]
• Competence and boundaries. In practice: seek consultation if you don't know Jain practice; avoid dual roles within a small community; disclose your own faith only if it helps the client. Professional ethics codes and spiritual-competency frameworks (for example, Vieten et al. 2013) apply [uncertain: not verified]. [synthesis]

4. Intervention inventory

The observances themselves are led by Jain ascetics (sadhus, sadhvis and, in the Terapanth order, samanis) and by community institutions. Preksha is taught by Jain Vishva Bharati and its trained instructors. Everything below is the psychotherapist's own work alongside them. [source: Malaiya; Mahaprajna, JVB] Interventions without a source tag are [synthesis].

4.1 Respectful enquiry into the client's practice

• Purpose: learn which observances the client keeps (daily samayika, regular or annual pratikramana, Paryushana or Dashalakshana, preksha) and what each means to them. Use this at intake, and whenever a practice comes up.
• Steps:
  1. Ask about sect and community first. Shvetambara and Digambara calendars and texts differ. [source: Malaiya]
  2. Ask what the client does, how often, with whom (a temple, upashraya, home or JVB centre) and who guides them.
  3. Ask what the practice gives them (calm, a clear conscience, connection, identity) and what it costs them (time, conflict, guilt, physical strain).
  4. Write the client's own terms down and use them afterwards.
  5. Keep curiosity separate from evaluation, and save clinical concerns for later questions.
• Example language (illustrative): "You mentioned pratikramana. Would you tell me what it's like for you, and what it means in your life?" / "Which tradition are you part of? I know practices differ between communities."
• Watch for: the client explaining their faith defensively, which suggests they expect judgement; a gap between how important the client says a practice is and how they sound talking about it. It's working when the client corrects your understanding freely and brings practice material without being asked.

4.2 Cultural Formulation Interview with the spirituality module

• Purpose: a structured assessment of how culture and religion shape the problem, coping and help-seeking. [source: APA, CFI Supplementary Modules]
• Steps:
  1. Give the core CFI early in assessment.
  2. Add Supplementary Module 5 (Spirituality, Religion and Moral Traditions). It covers which traditions the person identifies with, and their community and family background; the role of those traditions in daily, family and community life; how leaders, texts and practices have helped the person cope; and whether the traditions have added to the problem, caused distress or discrimination, or led to conflict with others. Paraphrase the questions; don't read them out mechanically. [source: APA, CFI Supplementary Modules]
  3. Add the Older Adults module or the Caregivers module where end of life or family care is involved. [source: APA, CFI Supplementary Modules (module list)]
  4. Summarise the formulation back to the client and check it with them.
• Example language (illustrative): "Has your faith helped you through this? Has any part of it made things harder, or caused friction with family?"
• Watch for: clients from a minority community playing down any conflict with the tradition; family members present during the interview. Offer part of it alone. It's working when the formulation names both the supports and the strains that come from the tradition.

4.3 Accommodation in scheduling and treatment

• Purpose: keep therapy going around the religious calendar without asking the client to choose between the two.
• Steps:
  1. Ask for the client's dates for Paryushana or Dashalakshana and Samvatsari or Kshamavani; they vary by sect and year. [source: Malaiya]
  2. Offer reduced, shorter or paused sessions, as the client prefers, during intensive observance. A detailed pratikramana can take hours. [source: Malaiya]
  3. If the client is fasting, plan homework and exposure work that doesn't add physical load. Avoid scheduling demanding sessions when the client says they are depleted.
  4. Check whether dietary practice (for example, not eating after sunset, or avoiding root vegetables) matters for inpatient, group or residential settings, and ask the client to state their own requirements. [uncertain: specific food rules not verified]
• Example language (illustrative): "Paryushana is coming up. Shall we change our schedule for those days?"
• Watch for: the client going along with your schedule out of deference. It's working when attendance holds steady across the observance.

4.4 Client-led integration of samayika and preksha

• Purpose: when the client wants it, draw on their own contemplative practice for self-regulation and self-observation, used as they were taught it.
• Steps:
  1. Ask what the client already practises and who taught them. Preksha's named constituents are kayotsarga (total relaxation with self-awareness), antaryatra (internal trip), svasa-preksha (perception of breathing), sarira-preksha (perception of the body), caitanya-kendra-preksha (perception of psychic centres), lesya dhyana (perception of psychic colours), bhavana (auto-suggestion) and anupreksha (contemplation). [source: Mahaprajna, JVB] Supporting components (asana, pranayama, mudra, sound) and advanced components (present-moment perception, thought perception and fixed gazing) are listed on an unattributed Jain page. [uncertain: page unattributed]
  2. Let the client lead in their own words. The therapist doesn't teach preksha. For instruction, refer to a Jain Vishva Bharati instructor or the client's own teacher. Give no breath-regulation, psychic-centre or gazing instructions.
  3. Agree a specific use. For example, a brief kayotsarga-style relaxation the client already knows, used as grounding before difficult material; or the preksha stance of perceiving without suppressing, linked to observing thoughts. [source for the stance: Mahaprajna, JVB; application: synthesis]
  4. For trauma survivors, offer choice: eyes open, short practice, an external anchor, and permission to stop. Published trauma-sensitive adaptations (Treleaven 2018) and the secular cousins in Domain II (MBSR, MBCT) apply [uncertain: not verified].
  5. Screen before the client attends an intensive preksha camp: recent psychosis, mania, severe dissociation or trauma, and current crisis. [synthesis]
  6. Review the effects afterwards.
• Example language (illustrative): "You said kayotsarga helps you settle. Would you like to use it at the start of our sessions, the way you were taught?"
• Watch for: adverse meditation experiences such as anxiety, depersonalisation, intrusive memories, perceptual changes or sleep disruption. Research describes these in other meditation traditions (Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica) [uncertain: not verified]. If they arise: cut the dose, ground with eyes open and attention on the room, and coordinate with the teacher if the client wishes. Separate a spiritual experience from psychosis, mania or dissociation by function, distress, insight and wider symptoms. Neither pathologise the experience nor miss illness; DSM-5-TR has a code for a religious or spiritual problem (Z65.8). It's working when the practice gives the client steadiness they can use in and out of session.

4.5 Fasting health review and coordination with the doctor

• Purpose: keep fasting during Paryushana, Chaturmas or other penance safe for clients who are ill, pregnant, taking medicines, older, young, or have a history of eating disorder.
• Steps:
  1. Ask whether the client intends to fast and what kind of fast it is. Record what they tell you; don't set or comment on lengths or targets.
  2. Ask about diabetes, kidney, heart or other conditions; pregnancy; medicines; and any history of restrictive eating.
  3. With consent, involve the GP or physician before the observance. All medication questions go to the prescriber.
  4. Ask the client whether their ascetic teachers allow lighter observance for illness or age. [uncertain: Jain exemption rules not verified]
  5. Agree warning signs that mean stopping and seeking medical care (for example, fainting, confusion, or reduced urine). Have the doctor confirm the list. [synthesis]
  6. For clients with a history of eating disorder, look at whether the religious motive is being taken over by weight or control motives, and involve the eating-disorder team.
• Example language (illustrative): "I won't advise on how to fast; that's for you, your teachers and your doctor. But could we check with your doctor before Paryushana, given your diabetes?"
• Watch for: pride or secrecy around fasting that looks like eating-disorder cognition; fasting as self-punishment for perceived sins (this overlaps with 4.6); family or peer competition over austerities. It's working when the client fasts, or modifies the fast, with medical oversight and no medical emergency.

4.6 Scrupulosity in pratikramana and vows

• Purpose: tell the confessional self-examination of pratikramana and vow-keeping apart from religious OCD (scrupulosity), and treat scrupulosity when it is present.
• Steps:
  1. Assess the pattern. Scrupulosity involves fears of having sinned or broken doctrine. People may avoid practice altogether or fixate on minor details, and practice is driven by fear, guilt or shame rather than meaning. [source: IOCDF]
  2. Look for compulsions: repeating confession, repeated Michchhami Dukkadam, re-reciting, checking for harm to tiny beings (an ahimsa-related theme [synthesis]), and seeking reassurance from ascetics or family.
  3. Formulate together with the client what belongs to OCD and what belongs to their faith.
  4. Give exposure and response prevention, adapted to the faith. With consent, consult a faith leader the client trusts, so the leader supplies tradition-specific guidance and supports the plan rather than offering accommodation. [source: IOCDF]
  5. Reduce reassurance and accommodation gradually and by plan. Examples IOCDF gives: one designated confessor, a scheduled reduction in confession, and small steps toward feared settings. Validation replaces reassurance. [source: IOCDF]
  6. Don't lower religious standards below the tradition's normal standard as a treatment goal. IOCDF lists that as a form of accommodation unless the person can meet the normal standard. Aim for the ordinary practice of the client's community. [source: IOCDF]
• Example language (illustrative): "Your pratikramana used to leave you feeling lighter. Now it sounds like it leaves you more afraid. Can we look at which part is your faith and which part might be OCD?"
• Watch for: the therapist being drawn into giving religious rulings; leaders who unknowingly reassure the client. It's working when practice returns to its ordinary form and the client says it brings meaning again.

4.7 Forgiveness and moral repair around Samvatsari and Kshamavani

• Purpose: use the tradition's annual exchange of forgiveness as a resource for repairing relationships, and help when it brings up guilt, conflict or moral injury.
• Steps:
  1. Before the season, ask whose forgiveness the client means to seek and whom they mean to forgive. Shvetambaras exchange forgiveness at the end of Paryushana; Digambaras do so on the day after Dashalakshana. [source: Malaiya]
  2. Explore what Michchhami Dukkadam means to the client: a formula, or a real reckoning. [source for meaning: Malaiya]
  3. Where there has been abuse or serious harm, separate the client's religious forgiveness from any obligation to reconcile with, or keep in contact with, someone unsafe. [synthesis]
  4. Where guilt is about actions the client believes broke their deepest values (moral injury), work on responsibility, repair and self-compassion, alongside the client's own pratikramana and atonement. [synthesis]
  5. Review afterwards: what changed, and what was left unresolved.
• Example language (illustrative): "Kshamavani is about asking for and giving forgiveness. Is there anyone you're dreading saying it to, or anyone you're hoping will say it to you?"
• Watch for: forgiveness pressed on the client by family; resentment that goes underground. It's working when the client takes part on their own terms and reports relationships clearer or safer.

4.8 Grief, ritual and community support

• Purpose: support Jain clients through bereavement, including families whose relative took sallekhana, using the community's rituals and support.
• Steps:
  1. Ask which rites and gatherings the family is observing, and what they mean to them.
  2. Make room for mixed feelings. A death the community honours as religious may still bring grief, doubt, anger or guilt in family members. [synthesis]
  3. Don't take sides between family members with different views of a relative's fast.
  4. Encourage connection with the client's sangha (community) where it helps, and look for isolation where it doesn't.
• Example language (illustrative): "Your community saw your father's death as a spiritual achievement. How are you carrying it?"
• Watch for: complicated grief, or guilt over not having stopped, or not having supported, the vow; social pressure to show only pride. It's working when the client can hold their own feelings alongside their community's framing.

4.9 Collaboration with ascetics and community leaders

• Purpose: coordinate with the client's sadhu, sadhvi, samani, acharya's representative, temple or JVB centre when the client wishes it, so religious and clinical care point the same way.
• Steps:
  1. Get written consent that names who, what may be shared, and why.
  2. Agree the purpose: for example, the leader's guidance on lighter observance during illness, support for a scrupulosity plan, or (in end-of-life care) the guiding ascetic's view on whether the tradition's conditions for sallekhana are met. [synthesis]
  3. Respect monastic rules of conduct. Ask the client how ascetics can be contacted, since some don't use phones or travel by vehicle. [uncertain: not verified]
  4. Keep clinical decisions clinical and religious decisions religious, and write down the boundaries.
• Example language (illustrative): "Would it help if I spoke with the sadhvi who guides you, so we're not pulling in different directions? You decide what I share."
• Watch for: the client feeling that the therapist and the leader are allied against them; leaders who give reassurance that feeds OCD (see 4.6). It's working when the client experiences joined-up support.

4.10 When sallekhana or end-of-life fasting comes up (high-risk area)

• Purpose: respond competently when a client, or a client's relative, speaks of taking or planning the sallekhana vow, or of stopping food to die.
• Steps: follow "What to do instead and how to help those harmed" in the Harm account. In brief: respectful enquiry; capacity and coercion assessment; telling a religious vow apart from a suicidal crisis; a compassionate psychosocial risk assessment and risk formulation, with no risk scores; collaborative safety planning; and urgent involvement of the medical and palliative-care team. [source: NICE NG225 as summarised by Mughal et al. 2023, BJPsych editorial; synthesis]
• Example language (illustrative): "You've told me you're thinking of taking santhara. I'd like to understand what it means to you, and also how you're feeling in yourself right now. Can we talk about both?"
• Watch for: the absence of the conditions Jain sources name (very old age, incurable disease, calamity or famine) [source: Koller]; hopelessness, feeling a burden, untreated pain or depression; family or community pressure; minors. Never discuss method.

4.11 Safeguarding where children fast or are put forward for vows

• Purpose: protect minors who undertake prolonged religious fasts or are put forward for a death vow.
• Steps:
  1. Treat a minor on a prolonged fast, or put forward for santhara, as a safeguarding concern, whatever the family's intentions. Reported cases include a young adolescent who died after a long penance fast, where police brought charges after alleged coercion (the family denied it), and a very young terminally ill child for whom the parents took the vow after consulting a monk. [source: The Peninsula 2016; The Week 2025]
  2. Follow local child-protection procedures and involve the child's doctor urgently.
  3. Assess the child's understanding and assent, and the family's support needs, without demeaning the faith.
• Example language (illustrative): "I can see how much your faith means to your family. Because your daughter is still a child, my job is to make sure she's medically safe. I need to involve her doctor today."
• Watch for: public celebration or record-listing that creates momentum; a child repeating adult religious language with no sense of what it means. It's working when the child is medically assessed and protected, and the family stays engaged.

5. Handling problems

Guidance in this section is [synthesis] unless tagged.

• The client fears you will judge their faith, or see their austerities as pathology. Name your role ("I'm here to understand, not to judge your practice"), lead with the CFI, and ask before raising concerns.
• The client expects you to give religious answers (whether a lapse breaks a vow, what penance to do). Decline warmly, refer to their teacher, and explore the anxiety behind the question. If the questions recur, assess for scrupulosity. [source for the pattern: IOCDF]
• Stuck in repetitive confession or self-accounting. Formulate with the client as OCD rather than piety, and bring in a trusted leader to back the ERP plan. [source: IOCDF]
• Non-adherence because of the observance (missed sessions, homework dropped during Paryushana). Plan ahead (4.3) and set reduced goals for the season.
• Overwhelm or adverse effects at a preksha camp or in intensive samayika. Reduce practice, ground the client, screen before the next retreat, coordinate with the instructor, and assess for psychosis, mania or dissociation without pathologising spiritual experience (4.4).
• A fasting client becomes medically unwell. Stop the session's agenda, direct them to urgent medical care, and inform the GP with consent, or without it where life is at risk under local law.
• The fast becomes eating-disorder behaviour. Name the shift gently, involve the eating-disorder team, and invite the client's teacher to affirm that the tradition doesn't require self-harm. [uncertain: tradition's own statement not verified]
• Ruptures. If the client feels you've disrespected their tradition, acknowledge it, ask what landed badly, and repair. Consult a colleague or community adviser if you lack cultural knowledge.
• Family conflict over observance (for example, an elder's wish for sallekhana that younger family members oppose, or the reverse). Hold neutrality; use the CFI Caregivers and Older Adults modules [source: APA module list]; offer a family meeting with the medical team.
• Leaving or loosening practice. Clients may feel guilt or community loss. Explore it without steering them either way.
• Dual relationships in small communities. Agree how you will handle meeting at community events, and refer on where confidentiality can't be protected.
• Therapist's own reaction to sallekhana (alarm, or romanticising it). Take it to supervision; use structured capacity and risk processes rather than personal views.

Harm account

This account covers sallekhana (santhara) and related fasting controversies. It is written at professional level. It gives only the qualitative description the sources give and no method detail. No person who died is named.

What was actually done

The vow as Jain sources describe it. Sallekhana is a voluntary vow to face death at the end of life. Samantabhadra's Ratnakarandaka Shravakachara allows it only when normal life is no longer possible because of extreme calamity, famine, very old age or incurable disease. [source: Koller] The person:

• first subdues the passions and gives up worldly attachments;
• asks relatives for forgiveness and forgives them;
• repents past wrongs;
• meditates on the nature of the self.

Two states of mind count as transgressions of the vow: wishing to go on living, and wishing for a speedy death. Fear is also to be avoided. [source: Koller] The vow involves gradually giving up food and then drink. [source: The Week 2025] It is taken under the guidance of Jain gurus, and the person may retract it. [source: Sharma, ILI Law Review 2016] Jain teaching forbids suicide as an act of violence. It holds that sallekhana is different in kind: it is not driven by passion, and its aim is to stop new karmic bondage. [source: Koller; The Week 2025] One community organisation has claimed that about 100 people a year observe santhara. [source: BBC 2006 via Pluralism Project]

Documented events and controversies (as major news reports them).

• Rajasthan, 2006: the BBC reported the deaths of two older Jains within about a week after santhara fasts, one of them a man who had been ill for some time. Campaigners called for a ban, arguing the practice is akin to suicide. A writ petition was then pending before the Rajasthan High Court. [source: BBC 2006 via Pluralism Project] A community publication reported a terminally ill woman's santhara as sanctioned by a Jain cleric and her family, and quoted a sadhvi who said it was "not an act of suicide". [source: HereNow4U 2011]
• Nikhil Soni v Union of India (Civil Writ Petition No. 7414/2006, Rajasthan High Court, Jaipur Bench; Sunil Ambwani CJ and Veerender Singh Siradhana J; decided 10 August 2015, as Sharma (ILI Law Review 2016) and LiveLaw (2015) report). According to these sources, this was a public interest litigation filed by an advocate. The court held that santhara is not an essential religious practice protected by Articles 25, 26 or 29. It held the practice amounts to suicide under s.309 of the Indian Penal Code, with abetment punishable under s.306. It directed state authorities to stop the practice and treat it accordingly. [source: Sharma, ILI Law Review 2016; LiveLaw 2015]
• Supreme Court stay. LiveLaw (2015) reports that on 31 August 2015, on an appeal by members of the Jain community, who argued sallekhana is "very distinct from 'Suicide'", a bench of Chief Justice H. L. Dattu and Justice Amitava Roy granted leave and stayed the High Court judgment. [source: LiveLaw 2015] The final outcome of the appeal, and how the change from the IPC to India's newer criminal code bears on it, are [uncertain: not verified].
• Hyderabad, 2016 (a penance fast, not sallekhana): a 13-year-old died after a prolonged religious fast during Chaturmas. Police charged family members with culpable homicide not amounting to murder after advocacy groups alleged she had been coerced. The family said she fasted of her own free will. [source: The Peninsula / AFP 2016]
• Indore, 2025: the parents of a 3-year-old with a terminal brain tumour took the santhara vow for her after consulting a Jain monk. A records organisation then listed her as the youngest person to take it. The report does not address whether a child could understand or consent. [source: The Week 2025]

How it caused harm

• Consent and capacity. Critics' central concern is that a fast to death may not be freely and capably chosen. This is most acute for people who are very old, ill, dependent on family, or cognitively impaired. Defenders stress voluntariness, guidance and the right to retract, contrasting santhara with sati. [source: Sharma, ILI Law Review 2016; BBC 2006] Clinically, impaired capacity from delirium, dementia or depression can undermine a voluntary choice that looks valid. [synthesis]
• Coercion and social momentum. Family sanction, community celebration and public recognition can make it hard to retract a vow that tradition says may be retracted. [synthesis, based on the reports above] In the Hyderabad case, coercion was alleged and denied; the outcome is [uncertain: not verified]. [source: The Peninsula 2016]
• Minors. The Jain conditions presuppose an adult who has subdued the passions and who chooses. A young child cannot meet them. Both reported child cases drew public concern, and one led to criminal charges. [source: Koller; The Peninsula 2016; The Week 2025]
• Untreated suffering. Depression, hopelessness, feeling a burden, or poorly controlled pain can be mistaken for spiritual readiness. The result can be a death that better palliative and psychiatric care might have changed. [synthesis]
• Bereavement. Relatives may carry guilt, conflict or legal fear, particularly after the 2015 ruling. [synthesis]
• Physical course. Starvation and dehydration at the end of life carry medical suffering that needs medical management. This guide gives no clinical detail on it [uncertain: not verified].
• Most at risk: very old and frail people, those with terminal or painful illness, people with cognitive impairment or depression, people who depend on family for care, and children.

Recognising it today

• Terms: santhara, sallekhana, and the phrases "taking the vow" and "peaceful death". It may come up as a relative's plan rather than the client's.
• Features of the tradition's own account (to compare against): the person is at the end of life with a condition the tradition names; the passions are subdued; forgiveness has been exchanged; the vow is taken under a guru's guidance and can be retracted; and there is no wish for a speedy death. [source: Koller; Sharma 2016]
• Red flags [synthesis]:
  • a minor, or anyone lacking decision-making capacity;
  • no terminal illness or extreme old age;
  • motives voiced as hopelessness, being a burden, shame, conflict or untreated pain;
  • a recent loss or depressive episode;
  • pressure, deadlines or public promotion by family or others;
  • medical and palliative care refused on the person's behalf;
  • any suggestion that retracting the vow would bring disgrace;
  • acute suicidal thinking in which the vow is just the method.
• In a colleague or service: treating the vow as automatically suicidal and responding with coercion and no cultural understanding, or treating it as automatically religious and doing no capacity or risk assessment. Both are errors. [synthesis]
• How it differs from legitimate observance: ordinary Paryushana fasting, samayika and pratikramana are life-affirming disciplines. They are not end-of-life vows.

What to do instead and how to help those harmed

1. Respectful enquiry. Ask what santhara means to the person and their family, who is guiding them, and how the decision was reached. Use the CFI Module 5, plus the Older Adults or Caregivers modules. [source: APA CFI modules]
2. Capacity. Assess decision-specific capacity under local law: can the person understand, retain and weigh the information, and communicate a choice? Include medical review for delirium, dementia and depression. Reassess as their condition changes. [synthesis; local legal framework applies]
3. Coercion. See the person alone. Ask whether they feel free to change their mind and what would happen if they did. Ask about financial or care dependency. [synthesis]
4. Vow or suicidal crisis. Compare the person's account with the tradition's own conditions [source: Koller], and assess for depression, hopelessness, burden, acute distress and any intent to die outside the vow's framework. A request to die driven by crisis is treated as a suicidal crisis. A considered end-of-life religious choice by a capable adult calls for palliative and spiritual support, not coercion. [synthesis]
5. Risk assessment to current standards. As the 2023 BJPsych editorial by Mughal et al. summarises NICE NG225: do not use risk tools or scales, or low/medium/high categories, to predict suicide or to decide who gets care. Make a compassionate, collaborative psychosocial assessment focused on the person's needs and strengths. Build a risk formulation from their narrative. Consider a collaborative safety plan, with family or carers involved where appropriate, and review it as circumstances change. [source: Mughal et al. 2023, summarising NICE NG225] No information about means goes beyond what lethal-means counselling requires.
6. Palliative care. Refer urgently to palliative care for symptom control, hydration and comfort decisions, and advance care planning within the law. Invite the person's guru or community into care planning if the person wishes. [synthesis]
7. Children. Follow child-protection procedures and get urgent medical care. A minor cannot give the consent the tradition itself requires. [synthesis; source for cases: The Peninsula 2016; The Week 2025]
8. Legal and ethical duties. Document the assessment. Know your jurisdiction's law on suicide, assisted dying, capacity and safeguarding. In India, note that the 2015 High Court ruling was stayed by the Supreme Court [source: LiveLaw 2015]; current status beyond that is [uncertain: not verified]. Follow your professional ethics code and seek supervision. [synthesis]
9. Helping those affected. Offer bereaved relatives grief work that allows for honour and doubt together (4.8). Help clients who felt pressured, or who retracted a vow, with shame and community rupture. Treat any depression or trauma with standard evidence-based care, adapted to faith with consent.

Sources

• Paryushana Parva (Y. K. Malaiya)
• Preksa Dhyana: Theory and Practice, Basic Principles (Acharya Mahaprajna, Jain Vishva Bharati), via HereNow4U
• Basic Principles of Preksha Meditation (unattributed page), HereNow4U
• Koller, J. M. Sallekhana (essay; cited as the work) [uncertain: publication details not verified]
• Sharma U. R. (2016) Nikhil Soni v Union of India: case comment, ILI Law Review
• Supreme Court stays Rajasthan HC ban on Santhara (LiveLaw, 2015)
• Jain Indian fasts to death: controversial practice (BBC News 2006, via Pluralism Project)
• Santhara: an established Jain practice to attain salvation (HereNow4U, 2011)
• India family hit with homicide charges after fasting death (The Peninsula / AFP, 2016)
• 3-year-old girl fasts unto death; all about Santhara (The Week, 2025)
• DSM-5 Cultural Formulation Interview: Supplementary Modules (American Psychiatric Association)
• For Faith Leaders (International OCD Foundation)
• Mughal F. et al. (2023) New guidance for self-harm: an opportunity not to be missed. British Journal of Psychiatry 223(5), 501–503
• Books: Mahaprajna, Acharya. Preksa Dhyana: Theory and Practice. Jain Vishva Bharati.
• Also cited [uncertain: not verified]: Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica; Treleaven 2018; Vieten et al. 2013; NICE NG225 full text (cited here through Mughal et al. 2023); DSM-5-TR religious or spiritual problem code (Z65.8).
• ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances