 So, good morning and thank you all for the wonderful introduction. My name is Divya and I'm truly happy to be here with you all today. I would like to thank the organizers of this event for this unique opportunity and the chance to try on a new avatar in Second Life. Before I begin my presentation, I would like to briefly, sorry Alice. Excuse me, remember to keep clicking. Yeah, I think this, I can't see, okay, this is a slide. I can't see the teleprompter information though. Can you look up the green chat at the bottom? Yeah. And you should see it in green print. Yes, now I can see that. Okay, so let me just try once more. Okay, you'll be coached on entering Second Life. No, sorry. That's obviously not the right one. Yeah, I found the right one. Okay, I would like to briefly introduce myself. Yes, so I'm a researcher, a teacher who's passionate about mental health, disability rights and advocacy. I'm a teaching assistant at the Department of Social Work and Social Administration at the University of Hong Kong where I assist in teaching two courses on disability. One of the reasons that initially drew me into this area of work was my early childhood experience of being sidelined or being called weird for not getting well with my peers. As I grew older, I began to question the concepts of normality. What is normal after all and does this normal change? This led me to pursue my higher education in humanities with a focus on understanding how people think about themselves and the world around them. Uh, slide change, please? Yeah, my questions on why people think the way they do led me to ask, what does an illness experience mean? But hidden in this question is a tacit acceptance of a particular behaviour or condition as an illness experience. What if the experience were to not be considered as an illness at all? For instance, what if say depression was not classified as a mental illness? How else would it be understood? My presentation today will explore one such condition known as spirit possession, which in the DSM PHY, that is, the Diagnostic and Statistical Manual of Mental Disorders, Version 5, is seen as a type of mental disorder. However, in many parts of the world, possession is not seen as a mental illness. In this case then, how is possession understood and what are the reasons for not seeing it as a mental illness? Possession broadly refers to the alleged presence of an external being within an individual, which also has the power to control or affect the individual. In other words, it could be seen as a sign of distress or discomfort. Uh, slide change, please? Yeah. Through engaging with this category, I would like to point out that the distinction between illness and distress becomes even more murky in the case of mental illnesses, which in most cases have no biomarkers despite psychiatry's quest for finding an organic cause of mental illness. Further, the term spirit possession is at best an underrepresentation for is used as an umbrella term for a host of conditions. Slide change, please? The background to the debate on spirit possession. So, as just mentioned before, spirit possession is a widely resourced subject in both anthropology and psychiatry. In the DSM PHY, possession by harmful spirits is placed under the dissociative identity disorder commonly known as the DID. The DSM broadly suggests that the spirit possession can be seen as negative only if they disturb the functioning of the individual, thereby suggesting that possession per se is not pathological. This seems to be like a reasonable distinction. The problem, however, is that possession states are often not clear cut and demarcated from one another, making it difficult to apply the psychiatric classification, I'm sorry, on the experiences of possession. Let me find the sentence. Yeah, if we were to consider the anthropological literature on possession, we find that it looks at it as an enabling condition that either provides core for marginalized sections of society to temporarily change the status quo. For example, if a woman from a lower strata of society gets possessed and screams at men of a higher strata, it is permissible as it is not seen as an act done by the woman herself but by a spirit that has taken over her. Or as a symbol of the real struggles of an individual. For example, the woman in the above case can be seen to struggle symbolically with her own identity. Recent anthropological studies have also drawn reference from post-colonial theory critiques of a global approach to mental health. In non-Western countries, should be understood in realities, I'm sorry, someone popped up, okay, should be understood in terms of their own cultural realities. In other words, the WTO emphasis on stepping up mental health services in non-Western and especially developing countries of the world would be effective only if it takes into consideration the cultural differences in these regions. Thus in some, we see that the understanding of possession is seen to be static and enabling by academic writings. But a common point that unites these two approaches is a stress on quote unquote culture. We hence need to ask what does a cultural perspective or a critique mean. But before that, it is essential to briefly mention the limitation of the psychiatric approach and understanding position and the basic assumptions of the psychiatric approach. Slide six, please. Yeah, the DSL-5 states that the disruption of identity characterized by two or more distinct personality states or an experience of possession is a characteristic of the DIT. The second characteristic is recurrent amnesia. The third is significant distress. The fourth is the disturbance is not a normal part of a broadly accepted religious or cultural practice. The fifth is the symptoms are not attributable to the direct physiological effects of a substance. Let's examine quickly a few of the problems that emerge from this factorization based on my own PhD fieldwork and some other studies as well. Slide seven, please. Yeah, the second criteria which I just spoke about is recurrent amnesia in the DSM. Now in reality, while individuals may have amnesia in a state of possession, there may be periods when individuals recall the entire episode. This is especially true in cases where individuals have experienced possession for a long time. The third criteria in the DSM is significant distress. Some of the individuals who visit religious places to get healing from possession may not know that they are possessed and may only find out through experiencing an episode of possession. They may not necessarily be in distress. Fourth one is disturbance is not part of a broadly accepted cultural or religious practice. This is perhaps the most contested one as both negative and positive possession are accepted within a religious space. Thus, there are significant limitations with the DSM understanding of possession which can be summarized by its tendency to make possession a singular, fixed and an universal experience. Hence, if the DSM understanding of possession is limited to say the least, then how can possession be understood? Are there any perspectives that view possession outside these categories? And if so, what are they? Further, how do they engage with spread possession which lies at the crossroads of religion, culture and psychiatry or medicine? Slide 8 please. The remaining part of this presentation will engage with the question of how can possession be constituted outside the medical perspective. What are the considerations and bases for such an understanding? In other words, how do different societies and cultures understand possession, given the predicaments with a singular, universal, generalized and medicalized understanding of possession? Possession from a cultural take. The following information is based on an ethnographic study of possession at a temple in South India. In other words, it is an attempt to engage with the question of how people at a temple understand possession. This includes those who are considered possessed, their families and other devotees who visit the temple. The temple is dedicated to a main deity, the goddess who is said to have special powers to remove possession. As this information is well known locally, many devotees seek the blessings of the deity to get rid of their possession. This process is long, daunting and as often many uncertainties. Slide 9 There are also many points during the healing journey which are ambiguous for the individual and may be said to be possessed as well as having a mental illness. Some also mention that possession, for say, is not a mental illness. They do not think that a medical center or a psychiatric institution is the best place to address their problems. What then does a cultural understanding of possession mean given that we are looking at possession within a temple? Before delving into the specificities of the debate, perhaps it is useful to point out two categories. Firstly, that there are many understandings of possession and therefore there is no single cultural perspective. And secondly, that these cultural understandings change over time and are hence open to many interpretations. Given these two broad points, I would now like to discuss an alternative reading of possession which is outside the realm of a medicalized model. I will be discussing two main aspects. Firstly, a narrative of possession which is not pathological and secondly, an understanding of the body which is different from the Western biomedical understanding. Through these two points, I will then indicate why the DSM classification is incongruent with non-Western perspectives. Slide nine, please. Position in the plural. So as stated earlier, possession is common place at the temple where I conducted my PhD fieldwork. However, there were many terms that were used to indicate possession which were not merely reflective of the rich local vocabulary but also to indicate that there were different treatments to be pursued. This depended on the nature of the possessing spirit. For instance, being possessed by a ghost of an elderly man was different from being possessed by a snake or by one's ancestors. Therefore, treating possession meant treating the specific kind of possession which one was suspected to be afflicted with. In addition, the words meant for possession used locally meant obstruction or a distress. It was used in other contexts as well which were completely non-beligious but when used inside the context of the temple refer to what we call as possession in academic writings. This wide variety of possession types thus meant that various methods of diagnosis, treatment and checking the spirit as truly left the body was long and time consuming. To complicate things further, one may be possessed by more than one spirit. One may be possessed with a malevolent spirit as well as a spirit of a deity. As said earlier, the very assumption of the DSM that pathological possession can be distinguished from culturally acceptable possession is therefore problematic. As in this case, possession by spirits is considered to be a sign of distress whereas possession by a deity is seen as a blessing. The temple as a site of healing is a site where both these type of possession take place thereby reducing the distinction between good and bad possession. A possession episode then could be indication of any of these forms manifesting themselves. It could be a deity or one of the many evil spirits that reside within an individual. The task of identifying which spirit is manifesting itself was the purpose of its existence becomes a central part of healing at the temple. Again, this varies from the categorization of the DID in the DSM which does not consider multiple ambiguous or ambivalent possession states. Next slide please. Yeah, different understandings of the body. One may be led to ask the reason behind these differential understandings of possession. In other words, what's the basis for these understandings of the same phenomenon? One of the primary differences in the biomedical or the western model and the case of possession in the temple is that of different conceptions of the body and its relation to the external world. Western medicine is based on a clear understanding of the body as a corporeal entity in that it is a fixed static entity. On comparison, the body at a possession site is considered to be fluid in that external forces can enter the body and affect an individual. Thus, in the case of possession, it is not an internal conflict of an individual or a dissociation within an individual but an attack by an external agent which enters the body of an individual. The latter is possible only because the body is seen as porous which is open to outside influences. Thus, evil spirits, ancestors and other elements can enter an individual and cause distress. Similarly, the relationship of the individual to the forces of nature, time, tight date, date can influence an individual's ability and invulnerability to possession. That is, two individuals who may be exposed in the same spirit at the same time may be affected differently. Once an individual is possessed and seeks relief from the possession of the temple, he or she is influenced by the partner deity. The struggle to be free from possession thus involves a triadic relationship between ghosts, men and gods. It is a geometry, the way tree of gods over the ghosts that leads to a successful recovery from possession. Next slide please. The images shown in this slide indicate one of the possible ways to re-conceptualize the body. On the left, we can see a person surrounded by many layers or sheets, with each layer having a name and a purpose. Hence, rather than a clear mind-body distinction, we have the whole person consisting of many layers. On the right is a modern image of an MRI, again in this section, to demonstrate the different layers. If you could think of the lines in this picture as a layer, similar to the first picture. Through these pictures, it is clear that alternative ways of understanding the body do not negate a concept of the mind, but may perceive it differently. One may wonder how these two points mentioned above have a relationship with the deism and thereby to the theme of this conference. Based on the information above, let's consider a case. Next slide please. X is a young woman, approximately 20 years of age. She mentioned to me that she has been residing in the temple for nearly a year. While she was, sorry, when she was in the late teens, she had sudden mood swings. These swings became more intense with time and ultimately, she visited a psychiatric clinic and was given a diagnosis. She took the prescribed pills but stated that they did not reuse the mood swings. She came with a family to the temple to seek the blessings of the deity, having no prior knowledge of being possessed. Once in the temple, she began to have regular position episodes. At the time of conversation, she mentioned that she had two spirits that were troubling her. She seemed to remember some of the events that took place during the position episode. She also felt that she was being watched over by the deity as she survived a major fall. The above case demonstrates the challenges in applying the DSM criteria of position states. With that, there may be variations in everyday pattern, behavior and manifestation of position. Further, that amnesia may not be constant and Ms. X had some memory of the events. In addition, she mentioned being possessed by more than one spirit which makes it difficult to separate positive versus negative position. It is significant to also mention that the treatment for relieving Ms. X from position would also change depending on the nature of the spirit within her, the demands of the spirit, the strength of the spirit and the strength of Ms. X as well as her own insight into the healing journey. And so, no two journeys of recovery are the same as they keep changing and are customized to individual cases. It's also possible that if Ms. X were to be possessed again, then her experience may be completely different from a previous experience. The recovery journey similar to that of recovering from mental illness is nonlinear and may include many types of treatments or combinations before a person is able to completely recover from position. As the condition is seen as an attack from an external agent, the individual is seen to be not mentally sick. At the same time, prolonged suffering from position could also lead to physical or mental illnesses. A final point about the case is that Ms. X went to a temple not due to the lack of medical facilities, but despite it, for it was not a cure to find solution to a disease. This is significant because many writings on possession, both academic and otherwise, tend to see lack of medical facilities as a reason for visiting healing shrines to cure position. Slide 13, please, beyond the temple as a cultural equivalent. It is easy to assume that the temple resolves what are essentially psychiatric conditions in ways that may be suitable and acceptable to people. However, such an assumption would be erroneous for accepting position also means accepting the different conceptions of the mind body or the spirit world and one's vulnerability to them. Hence, the temple is far from a cultural equivalent of a psychiatric setup as suggested by few recent writings. In other words, healing from position at the temple means accepting a perspective that is different from psychiatry and hence a different take towards the world and the afterward. One may agree or choose to disagree with the alternative worldview presenting. However, may further examine this narrative with a perspective which is western and psychiatric or use other alternative perspectives. The position in opposition is also significant for it often has policy implications. I'm sorry. For instance, religious place which includes ones where position takes place are often under the scanner of the stage. I'm sorry. Hello. Just can you give me a minute? I can't speak. I can't hear. I can't speak anymore. I can't speak anymore. I'm not here to speak. Thank you. You can go again. Sorry. Yeah. Yeah. So I forgot where I was. I need to go up a bit. Sorry. However, such an assumption. Sorry. Give me a minute. I have to scroll up. One second. Where was I? Yeah. One may further examine this narrative with a perspective which is western and psychiatric or use other alternative perspectives. The positioning of possession is also significant for it often has policy implications. For instance, religious places which include ones where position takes place are often under the scanner of the state or organizations that are against unscientific dangerous practices. Yeah. Sorry. I can no longer manage my teleprompter. I'll just give me a second. Yeah. Slide 14 please. Yeah. Beyond these approaches, it is significant to know the different starting points and different trajectories that lead to a reading of possession from a non-psychiatric lens. Through this brief presentation, I hope I've managed to introduce a glimpse of another perspective and the possibility that it entails. For challenging the dominant psychiatric take of mental illnesses, it is essential to see what are the alternative, perhaps subhalter narratives and where do they take us. This exploration should be a quest if we would like to bring on multiple voices on board independent of our own personal stances, academic perspectives and biases. Slide 15 please. These are some interesting readings on the topic. And with this, I would like to end my presentation and I would highly appreciate comments and feedback. Thank you. Yeah, I'm done. I can't hear any applause though, but okay. Thank you, Divya. No problem. Reminding us that we need to take cultural beliefs into account in thinking about mental illness is really important. And I have a question. Your research was done in India. You now in Hong Kong, is possession also important in understanding mental illness in Chinese culture? Yes, thank you for your question. And yes, I think it is important, but when I say Chinese, it's also a very broad, I would say a broad term. So it's very, I mean, there's a lot of variations within China itself and based on what people consider to be locally important, for example, say the monkey king or whatever are culturally relevant and significant, they turn to take it as a reason for being possessed. I'm sorry, I'm getting distracted with the chat box. I think I shouldn't look at the chat box. Yeah, so I was saying that, yes, so they do get significant importance to possession, though the kinds of possession and the nature of the spirit attack might vary culturally as well. But it's also interesting to note that in Hong Kong as well, we see a lot of ancestor worship. And if I'm correct, then there's also a month which is, I mean, meant for worshipping your ancestors or your ghosts. So it is very prominent and very significant. Though in Hong Kong, we do not see possession in temples or in churches or something like that, but there is still an acceptance of ghosts and afterlife, which is very significant. Yes. I'm sorry, I was a bit distracted with the first question because I kept looking at the transcription as well. Yeah. It's a question from Moog. Interesting. Yes. Shall I answer that? Are you answering Kittiarra? I'm sorry. No, the thing is I'm seeing a lot of things on my chat box and I just happened to catch Moog's question. Okay, so you can answer Moog's question, then we'll get to Kittiarra. Okay. Okay. Because I, when I was looking and speaking, I was getting distracted. So I stopped looking at the chat box and I think I missed a couple of questions from the chat box. Okay. Yeah. So Moog's question was, do these also happen outside religious places or outside temples? Yes, they do. But when they happen, immediately those people are brought to the temple, which is known for healing spirits. So they can happen outside non-religious questions, but they do have to take them to the religious place and try and get them healed within a religious setting. So it's very interesting as to why they see it as a case of position, but not say like a fit or some other kind of an attack. So I've asked them many times that why would you say a person is frothing from the mouth or is trembling? Why would you see it as a case of position and not necessarily like say a fit or something else. And they have their own reasons and they try and explain to me as to why this is not a medical condition, but a spirit attack. I think the most significant thing is they say that in a case of position, in a non-religious setting, this person starts speaking in a different voice. And it's an episode of position and then the person returns to being normal. So this is a fundamental marker for them to distinguish say a fit versus say a position condition. I've just posted Katara's question. She asks, I'm a Reiki master and healer. Do you think an individual can live in a healthy life with spirits as part of their universe or self? Interesting. So thank you for the question because this also opens up a lot of debate about how people come to terms with their own condition or distress. And in certain cases, people who have been living for position for a long time, say a decade or so, will say that we have come to terms with it and though we are not living the life we lived before, we're still able to live a functioning life and we are able to contribute in the way we wish to. And so they say they're not healthy, but they're managed to come to terms with it and they're able to function. So their entire focus is of course on a functioning self. And so to answer your question, as long as they are possessed, especially by an evil spirit, no, they cannot live an healthy life, but they can try and manage to live a functioning life. We have a question from Sister and she, I'm wondering if it is actually possible to research and truly understand realities that are beyond one's personal worldview or if we are always limited by our own worldview and must accept that we can never really know reality as others experience it. Thank you, Sister, for this question. I think that we can probably never understand completely somebody else's worldview in the terms of what they experience or what a particular event or an experience means to them. We can probably never understand it completely, but what we can try and do is to try and see how the world looks from their eyes. So we may not understand it, but we can try and document it and try and understand their reasoning behind why they believe or disbelieve. So I would say that ultimately we are all limited by our own perspectives and our own worldview. For instance, if you ask me if I would take my friend or family to a temple to be healed, I'm not very sure. I might still take them to a psychiatric ward despite knowing that somebody else can have a worldview where possession is acceptable. But for me, since I may not believe in it, I would still probably take the person to a psychiatric ward. So I think it is a limitation. And by acknowledging this limitation, we also accept the fact that people can think differently and that it's possible that the same experience or the same condition can be seen from various perspectives. And I think Abaluna has the last question. She asks, has temp type healing been introduced to patients and institutions that do not particularly believe in possessions? It would be interesting to see the effects if applied in such conditions. Thank you for the question. I'm just trying to understand the first part. If temple type healing has been introduced to patients and institutions that do not particularly believe in possession? Yes, partly yes, because we have experiments where position has been introduced to institutions, but not necessarily to people. For example, so there's this initiative in India, which is called prayer and medicine. So it is a kind of an initiative which is set up in a mosque of the Muslim place of worship, where people were said to believe in spirits and ghosts. And they would try and say that, okay, you can believe in ghosts, but also have this medication because both the medication and the prayer work hand in hand. So they will try and encourage the patients to not only believe in possession, but also to consume medications. So this is one part of the story. But we haven't seen any attempt to take a local healer or a priest to a psychiatric ward. So it's always been a one-way journey of trying to introduce medication and medicines within a religious space, but the vice versa, which is taking religion to a medical institution or a hospital or a psychiatric ward has never happened. So we quite do not know if that would work. But my ability, my suggestion is that maybe before we do that, we need to figure out if that would also lead to other kinds of complications, especially legal or other kind of political complications as well. Because now under the rubric of scientificity and rationality, a lot of these temple shrines and a lot of these healing places are being shut down. So there's a lot of politics and other kinds of perspectives which influence religious treatment not be censored. Well, I want to thank you very much, Dr. Padmanabhan. This was a fascinating eye-opening presentation. Virtuality is an immersive movie and we always need to think carefully about each other's beliefs about disability. Thank you so much. Thank you so much to everyone for your wonderful questions. And I found them very intriguing and it has given me more thought on my own topic. And I hope I can develop this further. And thank you so much for being here and listening to me. And I apologize for the gaps. And I was trying to read the teleprompter and my PowerPoint at the same time. So it was a bit tough, but I hope you manage to get the gist of my presentation. And thank you so much to the organizers and all of you there.