Atlas›Domain XVI · Historical, discredited & harmful›Guide 015
Guide XVI-015

Relic and shrine veneration

300Western Europe
A 33 · L 54 · M 1320 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: veneration of relics and healing shrines as historians describe it for late antique and medieval Latin Christianity (Brown, The Cult of the Saints, enlarged edition 2014; Finucane 1977 as discussed by Trenery 2016; Trenery 2016 on English miracle collections 1090-1234), the shrine of St Dymphna at Geel and the family care that grew from it (Goldstein and Godemont 2003; Boeckx for OPZ Geel, c. 2007; Belga News Agency), the Lourdes Medical Bureau procedure as the Sanctuary publishes it, and present-day healing shrines where people with mental health conditions are taken (Human Rights Watch 2020; NHRC India; Scroll.in on Mira Datar and Erwadi). This is a historical religious practice, not a therapy: the guide covers the psychotherapist's own work with clients and families for whom it matters.

What it is. From late antiquity, Christians across Western Europe sought healing, justice and protection at the tombs and relics of saints. Brown argues that relics were experienced as a link between heaven and earth, and that this devotion was shared across social classes rather than being a practice of superstitious masses set against an elite religion [source: University of Chicago Press description of Brown 2014]. People whose reason was judged impaired (Latin terms in miracle texts include insania and amentia, alongside demonic terms) were brought to shrines by relatives and neighbours; the miracle collections recorded by monks and canons almost always end the story with a cure [source: Trenery 2016]. The same pattern appears at shrines in other traditions today, including Sufi dargahs in South Asia and shrines in North Africa [source: HRW 2020; Scroll.in].

Core idea of change, as its participants understood it. Healing was attributed to the saint's presence and intercession, sought through pilgrimage, prayer and time spent in or near the holy place [source: Brown 2014 publisher description; Trenery 2016]. Historians do not treat the records as clinical evidence: Trenery cautions against reading modern diagnoses back into the texts, and criticises Finucane's survey of over 3,000 English miracle accounts for doing so [source: Trenery 2016]. The Lourdes Medical Bureau, under its own criteria, does not recognise psychological, psychiatric, functional or nervous conditions as miraculous cures [source: Sanctuary of Lourdes, "The miracles of Lourdes"].

Why it matters to a psychotherapist. Three legacies reach clients: (1) living pilgrimage and shrine devotion, which can carry hope, community and meaning; (2) the Geel tradition, where the overflow of pilgrims to St Dymphna's shrine became a family-care system for people with mental illness that continues under a public psychiatric centre [source: Boeckx/OPZ Geel; Belga News Agency]; and (3) the harmful survival of chaining, confinement and forced fasting at some shrines and healing centres, documented in about 60 countries [source: HRW 2020]. Cross-refer: chaining and shackling (Domain XVI 104), prayer camps (XI 069), ziyara (XIII 260), pilgrimage (XIII 307), mazar (XI 030).

2. Framework

Session number and length follow the client's needs and the setting; the phases below are the psychotherapist's own sequence [synthesis].

Historical phases of the practice (outline only)

  • Late antiquity (c. 4th-6th centuries): the rise of devotion to the "very special dead" and their relics in Latin Christianity; Brown's chapters frame this around presence (praesentia) and power (potentia) [source: University of Chicago Press table of contents; the content of those chapters is [uncertain: not verified]].
  • High medieval England (c. 1066-1300): large shrines such as Canterbury collected miracle records. In one Canterbury account a man from Fordwich, bound and brought to the saint, raved all day, spent the night in the church and was recorded as sane the next morning; within about fifty years the cure was shown in the cathedral's stained glass [source: Trenery 2016]. Mad pilgrims were often bound on the way to and at shrines, sometimes because of earlier violence; beating also appears in some records [source: Trenery 2016, citing Laharie for beating of the possessed].
  • Geel, 13th century to the present: the legend of Dymphna, an Irish king's daughter said to have fled her father and been killed near Geel [source: Goldstein, "The Legend of St. Dymphna"; Boeckx]. From the 13th century people with mental illness were brought to pray for her intercession; a pilgrims' guest house is dated 1286 and a sickroom beside the church 1480 [source: Goldstein, Legend page]. Pilgrims made a nine-day stay of prayer (novena) at the church, extended if no cure followed; cures were entered in a register with mainly a legal function [source: Boeckx]. The sickroom held few beds, so from the 15th century clergy placed pilgrims with local households for payment, and this became family care [source: Boeckx; Goldstein, Legend page]. Local rules before 1800 included requirements to chain patients judged dangerous [source: Boeckx]. Belgium's 1850 law on the insane recognised the model and an 1851 regulation created the State Colony for free family care [source: Boeckx]. The 1930s peak is given as about 3,700 boarders in a town of about 15,000 [source: Boeckx] or about 3,500 in a town of about 20,000 [source: Belga News Agency] [uncertain: sources differ]. Today Geel has about 135 adult foster guests and about 12 foster children and adolescents, organised by the Public Psychiatric Care Centre (OPZ) Geel [source: Belga News Agency]. Goldstein's page dates Dymphna's recognition as patron to 1247 [uncertain: not verified in a second source].
  • Lourdes, 1858 onwards: cures reported since the apparitions of 1858; a Medical Bureau founded in 1883; over 7,000 healings reported and 70 recognised by the Church as miraculous; a case passes from the Bureau's permanent doctor to the International Medical Committee of Lourdes (CMIL), which votes on whether a cure is "unexplained in the present state of our knowledge", and then to the bishop of the person's home diocese [source: Sanctuary of Lourdes].
  • Present-day healing shrines: HRW documented shackling at shrines, including the release in 2015 of over 700 people chained at one shrine near Marrakesh, and the BBC's report of hundreds of people chained to trees at a Sufi shrine near Burewala, Punjab [source: HRW 2020]. In India, 28 people died in a 2001 fire at a private asylum in Erwadi, Tamil Nadu, mainly because they were chained; the National Human Rights Commission then directed every state to certify that no mentally ill person was kept in chains [source: NHRC press release]. At Mira Datar dargah, Gujarat, the state's Dawa-Dua programme (from 2008) has worked with shrine attendants to encourage psychiatric care alongside prayer [source: Scroll.in].

Phases of the psychotherapist's work [synthesis]

  1. Orientation and historical literacy. Goal: enough knowledge to hear a client's shrine, relic or pilgrimage story without dismissal or romanticism. Move on when you can place the client's tradition and its current form.
  2. Recognition and assessment. Goal: learn what the practice means to the client, what they hope for, whether it runs alongside or in place of care, and whether anyone was confined, chained, beaten or deprived. Move on when meaning, hopes and risks are mapped.
  3. Safety and safeguarding. Goal: act on any current confinement, abuse, untreated physical illness or suicide risk. Takes priority over every other phase whenever risk appears.
  4. Meaning-making, processing and repair. Goal: work with hope, disappointment, religious struggle, trauma from shrine confinement, family guilt, and family history (including Geel boarding). Move on when the client can hold their experience in a coherent, self-chosen account.
  5. Advocacy and follow-up. Goal: connect the client and family with rights-based, community-based support; contribute to reporting and reform where appropriate; review periodically.

3. Guiding principles

  • Respect devotion, refuse harm. Pilgrimage and prayer are legitimate religious practice; chaining, forced fasting, beating and detention are not. In practice: affirm the client's faith while naming harm plainly [source: HRW 2020 recommendations; synthesis].
  • The psychotherapist never provides, supervises or refers to a harmful practice. In practice: you never recommend a shrine stay as treatment, never facilitate confinement at one, and never present a shrine as a substitute for medical or psychiatric care [synthesis].
  • Historical humility. Medieval categories of madness do not map onto modern diagnoses. In practice: avoid telling a client what a medieval pilgrim "really had" [source: Trenery 2016].
  • Popular and learned belief are not two tiers. In practice: do not treat a client's devotion as a sign of low education or as inferior to institutional religion [source: Brown 2014 publisher description].
  • Care alongside, not instead of. In practice: support clients who want prayer and psychiatric or medical care together; integration programmes such as Dawa-Dua take this route [source: Scroll.in; synthesis].
  • Medicines are not yours to change. In practice: never advise starting, stopping or changing a medicine; if a client plans to stop one because of a pilgrimage or a hoped-for cure, ask them to talk with their prescriber first and, with consent, inform the prescriber [synthesis].
  • No practice is presented as treating cancer or any physical disease. In practice: when a client hopes a shrine will cure a physical illness, keep their medical care in view without arguing theology [synthesis].
  • Confinement is a rights issue. In practice: treat chaining, locking up or forced fasting at any healing site as a safeguarding and human-rights matter, never as a cultural detail [source: HRW 2020; NHRC].
  • Family love and harm can coexist. In practice: families who took a relative to a shrine usually acted from love and desperation; explore without blame while still naming harm [synthesis].
  • Community inclusion is the lesson the field draws from Geel. In practice: Geel is cited as a unique example of integrating patients into the community, and American programmes were modelled on it [source: Tuntiya 2006; Goldstein and Godemont 2003].
  • Cultural humility and spiritual competence. In practice: use the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions; draw on the spiritual and religious competencies of Vieten et al. 2013 [synthesis; DSM-5-TR wording [uncertain: not verified]].
  • Name a religious difficulty accurately. In practice: where the clinical focus is a religious or spiritual problem (for example loss of faith after a failed pilgrimage), the DSM-5-TR category Religious or Spiritual Problem may be used, code Z65.8 [source: ICD-10-CM Z65.8 "Other specified problems related to psychosocial circumstances", which lists religious or spiritual problem under Includes].
  • Boundaries in shared communities. In practice: if you share a parish, mosque or pilgrimage group with a client, consider APA Ethics Code Standard 3.05 (Multiple Relationships) before taking on or continuing the work [source: APA Ethics Code].
  • Never name those harmed. In practice: in notes, teaching and advocacy, describe people by role, never by name [synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Building your own historical literacy

  • Purpose / when: before or early in work with any client for whom saints, relics, shrines or pilgrimage matter.
  • Steps: (1) Read a scholarly overview of how relic veneration arose (Brown 2014) and how miracle collections recorded madness (Trenery 2016). (2) Learn the Geel story from Goldstein and Godemont 2003 and OPZ Geel's own account, and the Lourdes procedure from the Sanctuary's site. (3) Learn the client's own tradition's shrines (for example, dargahs in South Asia) from the client and from reliable sources. (4) Read HRW 2020 so you can recognise current abuses. (5) Note where sources disagree (for example, Geel's 1930s figures) [synthesis].
  • Example language (illustrative): "I know a little about the history of healing shrines, but I'd like to hear what this one means in your family."
  • Watch for: romanticising the past or dismissing it as ignorance; both distort what the client brings. It is working when you can ask informed questions and the client corrects you comfortably.

4.2 Opening a conversation about shrines, relics or pilgrimage

  • Purpose / when: a client mentions a pilgrimage, a relic, holy water, a saint's medal, a vow, or a family member taken to a shrine.
  • Steps: (1) Ask open questions about the practice and its importance. (2) Ask who in the family takes part and who decides. (3) Ask what has happened in the past at the shrine. (4) Reflect meaning before offering any view. (5) Record the client's own words for their tradition [synthesis].
  • Example language (illustrative): "You mentioned the shrine your grandmother visits. What happens there, and what does it mean to you?"
  • Watch for: guarded answers that suggest the client expects ridicule; slow down and state respect. Working signs: the client volunteers detail and links it to their difficulties.

4.3 Cultural Formulation Interview with the spirituality module

  • Purpose / when: at assessment where religion shapes how the client understands their distress or its cure.
  • Steps: (1) Use the DSM-5-TR Cultural Formulation Interview, and its supplementary module on spirituality, religion and moral traditions, in your own words rather than reading items aloud. (2) Cover the client's explanation of the problem, sources of help, and what they expect from treatment. (3) Note the role of saints, shrines or relics as a source of help. (4) Feed the findings into a shared formulation [synthesis; DSM-5-TR module content [uncertain: not verified]].
  • Example language (illustrative): "Some people understand their difficulties in religious terms, some in medical terms, some in both. How do you see what's been happening?"
  • Watch for: imposing a medical frame too early. Working signs: a formulation the client recognises as theirs.

4.4 Mapping hopes and expectations before a pilgrimage

  • Purpose / when: a client or relative plans to visit a healing shrine (for example Lourdes, Geel's church, a dargah) hoping for relief.
  • Steps: (1) Ask what they hope will change and how they will know. (2) Ask what they will do if nothing changes. (3) Ask how ongoing care (therapy, medical care, any prescribed medicines) fits with the trip; if they mention stopping a medicine, ask them to speak with their prescriber before doing so, without advising either way. (4) Plan for crisis support while travelling. (5) Agree to review afterwards [synthesis].
  • Example language (illustrative): "It sounds like this pilgrimage carries a lot of hope. Can we also think together about how you'll look after yourself if it doesn't bring the change you're praying for?"
  • Watch for: plans to abandon all other care, or a family plan to leave a relative at a shrine; move to 4.8 and 4.9. Working signs: the client holds hope and a back-up plan together.

4.5 Psychoeducation on how historians read shrine cures

  • Purpose / when: a client interested in history, or a client distressed by miracle stories, asks what happened at shrines.
  • Steps: (1) Offer historians' accounts, attributed: miracle collections were written by monks and canons and almost always end in a cure; records served purposes of the shrine; medieval categories of madness differ from ours (Trenery 2016). (2) Note that Lourdes itself does not recognise psychiatric or functional conditions as miracles (Sanctuary of Lourdes). (3) Stay neutral on faith questions; offer history, not theology [synthesis].
  • Example language (illustrative): "Historians point out that the people writing down these cures were the shrine's own clergy, and that they recorded the stories that ended well. That doesn't answer questions of faith, but it may help explain why every story you read ends in healing."
  • Watch for: the client hearing this as an attack on their faith; check how it lands. Working signs: less self-blame for not being cured.

4.6 Working with disappointment, religious struggle and Z65.8

  • Purpose / when: after a pilgrimage, vow or relic devotion that did not bring the hoped-for cure, the client feels abandoned by God, unworthy, or ashamed.
  • Steps: (1) Validate the grief of a lost hope. (2) Explore the meanings the client gives the outcome (punishment, lack of faith, God's will). (3) Gently test self-blaming meanings against the client's own tradition's teaching, with the client's consent to involve a trusted religious adviser. (4) Where the religious problem is the clinical focus, record it as Religious or Spiritual Problem, Z65.8 [source: ICD-10-CM Z65.8]. (5) Screen for depression and suicidal thinking (see 4.15) [synthesis].
  • Example language (illustrative): "You went with so much faith, and you've come back feeling that you failed. I wonder whether your tradition really says that the people who weren't healed were the ones who didn't believe enough."
  • Watch for: hopelessness, withdrawal from community, suicidal statements. Working signs: the client can hold faith and disappointment without self-condemnation.

4.7 Working with a client's devotional objects

  • Purpose / when: a client carries a relic, medal, holy water or other blessed object and draws comfort from it.
  • Steps: (1) Ask what the object means and when they turn to it. (2) Treat it as a legitimate source of comfort and connection. (3) Check that it is not being used in place of needed medical care for a physical illness, or as a reason to stop prescribed treatment; if so, encourage contact with the treating doctor. (4) Never handle the object without the client's invitation [synthesis].
  • Example language (illustrative): "When the panic rises, you hold the medal your mother gave you. Tell me what happens for you when you do that."
  • Watch for: distress if the object is lost; magical certainty that replaces care. Working signs: the object supports, rather than replaces, other coping.

4.8 Screening for confinement, chaining and deprivation at healing sites

  • Purpose / when: a client, or a relative, has stayed at a shrine, prayer camp or traditional healing centre, here or abroad.
  • Steps: (1) Ask neutrally whether they were free to leave. (2) Ask whether anyone was tied, chained, locked in, beaten, or kept without food. (3) Ask about sleep, toileting and shelter conditions, and any sexual or physical violence. (4) Ask whether any of this is still happening to anyone they know. (5) Record facts, not interpretations. HRW documents chaining at shrines, forced fasting, beatings, physical and sexual violence and arbitrary detention across about 60 countries [source: HRW 2020; steps synthesis].
  • Example language (illustrative): "Some places of healing keep people there against their will, or tie them up. Did anything like that happen while you were there?"
  • Watch for: shame or loyalty to family that leads to minimising; ask again later. Working signs: a clear account and readiness to plan safety.

4.9 Safeguarding and reporting

  • Purpose / when: a current risk to an adult or child: confinement, chaining, beating, forced fasting, or withdrawal of medical care.
  • Steps: (1) Follow your service's safeguarding procedure for adults at risk; for any child, use child-protection routes and your mandatory reporting duties. (2) If the risk is abroad, consult your safeguarding lead about routes such as national human-rights bodies (for example India's National Human Rights Commission, which has directed states to certify that no one is kept in chains) and organisations documenting abuses (HRW). (3) For forced fasting or physical injury, arrange medical assessment. (4) Explain to the client what you will share and why; keep them informed. (5) Document. [source: NHRC press release; HRW 2020; steps synthesis].
  • Example language (illustrative): "What you've told me means your cousin may be in danger right now. I need to talk with our safeguarding lead about how to help; I'll tell you what I share."
  • Watch for: fear of family or community retaliation; plan for the client's safety too. Working signs: the person at risk is reached and the client stays engaged.

4.10 Working with families who took a relative to a shrine

  • Purpose / when: a family member feels guilt, or a family remains divided, over a relative taken to a shrine or healing centre.
  • Steps: (1) Hear the family's reasons: often love, fear and lack of services; HRW documents shackling by families in private homes and calls for voluntary community-based services [source: HRW 2020; motives synthesis]. (2) Distinguish devotion (prayer, visits) from harm (chaining, detention, withheld care). (3) Help the family name what happened without blame or denial. (4) Where repair is wanted, support acknowledgement and apology between family members. (5) Link the family to community mental health support [synthesis].
  • Example language (illustrative): "You took your brother there because you didn't know where else to turn. And you also saw him chained, and that has stayed with you. Both can be true."
  • Watch for: scapegoating one relative; defensive denial. Working signs: the family can talk about what happened together.

4.11 Trauma-informed work with survivors of shrine confinement

  • Purpose / when: a client who was chained, confined, beaten or deprived at a shrine or healing centre.
  • Steps: (1) Establish physical and emotional safety first; arrange medical review for lasting physical effects (HRW records infections, nerve damage, muscle wasting and malnutrition from forced fasting). (2) If disordered eating followed forced fasting, involve medical care and an eating-disorder service; for support, the National Alliance for Eating Disorders. (3) Offer an evidence-based trauma-focused therapy if post-traumatic stress is present, at the client's pace. (4) Separate the client's faith from the abuse done in its name, if the client wishes. (5) Address any coexisting mental health condition through mainstream care [source: HRW 2020 for harms; steps synthesis].
  • Example language (illustrative): "What was done to you there was not treatment, and it was not your fault. We can go at whatever pace feels manageable."
  • Watch for: dissociation, overwhelm, anger at family or faith, and shame. Working signs: fewer intrusive memories and a sense of choice about faith.

4.12 Family-history work: an ancestor at a shrine or in Geel family care

  • Purpose / when: a client discovers that an ancestor was taken to a shrine, boarded with a Geel family, or lived in a state colony or asylum.
  • Steps: (1) Explore what the client knows and how the story was told in the family (silence, shame, pride). (2) Point to legitimate archives and heritage bodies (for Geel, OPZ Geel and Belgian heritage publications) rather than speculation. (3) Help the client place the ancestor in historical context: Geel boarders lived in ordinary households, often for decades [source: Belga News Agency; Boeckx]. (4) Explore what the story means for the client's own sense of risk, identity or inheritance. (5) Support rituals of remembrance the client chooses [synthesis].
  • Example language (illustrative): "You've found out your great-grandmother lived with a farming family in Geel for thirty years. What do you make of that, and what would you like to know?"
  • Watch for: fear of inherited illness; offer accurate information or referral for genetic counselling where relevant. Working signs: a story the client can hold with compassion.

4.13 Using the Geel model as heritage and psychoeducation

  • Purpose / when: clients, families or teams exploring community inclusion, family placement or recovery-oriented care.
  • Steps: (1) Describe Geel, attributed: a shrine-based pilgrimage that grew into family care, later run by the state and now by OPZ Geel, where some guests stay for decades and others for months as preparation for independent living [source: Belga News Agency; Boeckx]. (2) Note its influence: variants in Germany, France and Italy; US family-care programmes modelled on it in the 19th and 20th centuries [source: Belga News Agency; Tuntiya 2006]. (3) Note the decline in host families and the reasons given (other housing options, newer treatments) [source: Belga News Agency]. (4) Use it to discuss inclusion, stigma and belonging; do not present it as a religious cure [synthesis].
  • Example language (illustrative): "In one Belgian town, people with mental illness have lived with ordinary families for centuries. What would belonging look like for you?"
  • Watch for: idealising Geel; its own history includes chaining rules before 1800 [source: Boeckx]. Working signs: practical discussion of the client's own community connections.

4.14 Supporting a client who wants prayer and psychiatric care together

  • Purpose / when: a client or family wants to keep visiting a shrine while also receiving mental health care.
  • Steps: (1) Affirm that both can go together. (2) Describe, attributed, an integration model: Gujarat's Dawa-Dua programme at Mira Datar dargah, where shrine attendants encourage psychiatric help alongside prayer, with a 2021 evaluation reporting some success despite implementation problems [source: Scroll.in]. (3) Agree a plan that keeps clinical appointments and any prescribed treatment under the prescriber's direction. (4) With consent, coordinate with a trusted religious adviser [synthesis].
  • Example language (illustrative): "You don't have to choose between your prayers and your treatment. Let's make a plan that keeps both going."
  • Watch for: reports that chaining or beating persists despite rules, as journalists found near Erwadi [source: Scroll.in]; if so, return to 4.8 and 4.9. Working signs: steady attendance and the client's sense that their faith is respected.

4.15 Suicide-risk assessment after lost hope

  • Purpose / when: despair after a failed cure, after shrine abuse, or after family rejection.
  • Steps: (1) Ask directly about suicidal thoughts, plans and intent, using your service's standard risk assessment. (2) Build a safety plan with reasons for living, which may include the client's faith and community. (3) Where needed, lethal-means counselling about safe storage and removal. (4) Give crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland). (5) Arrange follow-up [synthesis].
  • Example language (illustrative): "When hope falls away like this, some people think about ending their lives. Have you had thoughts like that?"
  • Watch for: religious prohibitions that make disclosure harder; reassure the client that you will not judge. Working signs: an agreed safety plan and contact maintained.

4.16 Collaborating with religious leaders and chaplains

  • Purpose / when: the client wants a faith leader involved, or a faith community runs or promotes a shrine.
  • Steps: (1) Obtain explicit consent and agree what will be shared. (2) Approach the leader as a partner in the client's wellbeing. (3) Where harm is present, share HRW's recommendation that healing centres end chaining, non-consensual fasting and detention and let people leave at will [source: HRW 2020]. (4) Keep clinical decisions with the clinical team [synthesis].
  • Example language (illustrative): "Your imam matters a great deal to you. Would it help if I spoke with him, with your permission, about how we can both support you?"
  • Watch for: pressure on the client from either side. Working signs: aligned messages from faith and care.

4.17 Self-reflection on your own beliefs

  • Purpose / when: throughout; especially when you notice scepticism, reverence, or irritation about shrines or relics.
  • Steps: (1) Notice your reactions to the client's account. (2) Take them to supervision. (3) Check whether you are steering the client toward or away from faith. (4) Use the competencies of Vieten et al. 2013 as a self-check [synthesis].
  • Example language (illustrative, to yourself or a supervisor): "I felt dismissive when she described the holy water; I want to understand that before our next session."
  • Watch for: proselytising or debunking. Working signs: the client feels free to disagree with you.

4.18 Duties when a colleague or institution endorses a harmful shrine practice

  • Purpose / when: a colleague advises a family to leave a relative chained or confined at a healing site, or a service sends people there in place of care.
  • Steps: (1) Raise the concern directly where safe. (2) Escalate to your manager, safeguarding lead and, where needed, your professional regulator or licensing board, following its published route. (3) Do not take part in, supervise or refer to the practice. (4) Document your actions [synthesis].
  • Example language (illustrative): "I can't support advising the family to leave him there in chains. I need to take this to our safeguarding lead."
  • Watch for: pressure to defer to cultural authority; respect for culture does not extend to detention or violence. Working signs: the person at risk receives care.

4.19 Advocacy for rights-based community care

  • Purpose / when: a client or community wants to act on abuses at shrines, or you work in or with affected regions.
  • Steps: (1) Share HRW's recommendations: ban shackling, monitor institutions, develop voluntary community-based services, engage faith leaders [source: HRW 2020]. (2) Point to WHO QualityRights as a good-practice example HRW cites [source: HRW 2020]. (3) Support the client's chosen level of involvement, protecting their safety and privacy [synthesis].
  • Example language (illustrative): "If you want to do something about what happened there, there are organisations working on exactly this. We can look at what feels safe for you."
  • Watch for: re-traumatisation through public testimony. Working signs: the client feels agency rather than exposure.

4.20 Teaching the profession's lessons

  • Purpose / when: supervision, team training or teaching about the history of care.
  • Steps: (1) Present shrine healing, attributed to historians, without ridicule (Brown; Trenery). (2) Present Geel as the field's long-cited example of community integration (Goldstein and Godemont 2003; Tuntiya 2006). (3) Present current abuses at shrines as human-rights failures (HRW 2020; NHRC). (4) Draw out the lesson that hope, belonging and community can coexist with rights-based care [synthesis].
  • Example language (illustrative): "Geel shows what community can offer; Erwadi shows what happens when people are chained instead of cared for."
  • Watch for: naming people harmed; use role descriptions only. Working signs: trainees can discuss shrine devotion respectfully and recognise abuse.

5. Handling problems

The problems below are the psychotherapist's own synthesis [synthesis]; a source tag marks any point drawn from a cited source.

  • Client feels the therapist is hostile to their faith. Name the respect explicitly; return to the client's meanings (4.2); avoid historical critique unless asked.
  • Client stuck in self-blame after no cure. Explore the theology the client holds, with consent involve a trusted adviser (4.6, 4.16); screen for depression and suicide risk (4.15).
  • Client plans to stop medication because of an expected cure. Do not advise for or against; ask the client to speak with the prescriber first and, with consent, inform the prescriber.
  • Client hopes a shrine will cure cancer or another physical illness. Do not argue theology; keep medical care in view and encourage the client to stay with their doctors.
  • Family minimises chaining as "how it is done". Name the harm calmly; cite HRW's documentation and India's NHRC directive [source: HRW 2020; NHRC]; follow safeguarding (4.9).
  • Overwhelm when a survivor recounts confinement. Slow down, ground, shift to stabilisation; resume only with consent (4.11).
  • Non-adherence because of pilgrimages or long stays abroad. Plan care around travel; agree remote contact and crisis resources (4.4).
  • Rupture after the therapist reports a risk. Acknowledge the client's feelings, explain the duty, repair; keep the door open (4.9).
  • A child is involved. Child-protection routes and mandatory reporting take priority; seek assent and parental consent for therapy where appropriate; never name the child in notes shared outside the record.
  • Shared religious community. Assess multiple-relationship risks under APA Ethics Code Standard 3.05; refer on if objectivity is compromised [source: APA Ethics Code].
  • Idealising Geel or medieval healing. Offer the fuller picture: chaining rules in Geel before 1800 [source: Boeckx]; binding and beating in medieval records [source: Trenery 2016].
  • Physical touch requested in a religious or comforting gesture. Touch only with consent before and during, a right to stop, and never sexual; restraint is never used.
  • Client asks you to recommend a shrine. Decline to recommend any religious practice as treatment; explore what the client is seeking and support their own decision.

Sources

Pages and documents

Books and articles cited

  • Brown, P. (2014). The Cult of the Saints: Its Rise and Function in Latin Christianity, enlarged edition. University of Chicago Press (original edition 1981 [uncertain: not verified]).
  • Finucane, R. (1977). Miracles and Pilgrims, as cited and discussed in Trenery 2016.
  • Goldstein, J., and Godemont, M. (2003). The legend and lessons of Geel, Belgium: A 1500-year-old legend, a 21st century model. Community Mental Health Journal 39(5), 441-458 (details as listed on the first author's faculty page).
  • Laharie, as cited in Trenery 2016 [uncertain: not verified].
  • Vieten, C., et al. (2013). Spiritual and religious competencies for psychologists [uncertain: not verified].
  • American Psychiatric Association. DSM-5-TR Cultural Formulation Interview and supplementary modules [uncertain: not verified].
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