Effects of Extreme Ritual Practices on Psychophysiological Well-Being

Dimitris Xygalatas
Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA (xygalatas@uconn.edu)
Sammyh Khan
School of Psychology, Keele University, Keele, UK
Martin Lang
Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
Radek Kundt
Laboratory for the Experimental Research of Religion (LEVYNA), Faculty of Arts, Masaryk University, Brno, Czech Republic
Eva Kundtová-Klocová
Laboratory for the Experimental Research of Religion (LEVYNA), Faculty of Arts, Masaryk University, Brno, Czech Republic
Jan Krátký
Laboratory for the Experimental Research of Religion (LEVYNA), Faculty of Arts, Masaryk University, Brno, Czech Republic
John Shaver
Religious Studies Program, University of Otago, Dunedin, New Zealand

Extreme ritual practices involving pain and suffering pose risks such as injury, trauma, or infection but are performed by millions as culturally prescribed remedies, particularly for mental health issues.
Study examined one of the world's extreme rituals involving bodily mutilation and prolonged suffering.
Findings suggest participation had no detrimental effects on physiological health and was associated with subjective health improvements, particularly for those engaging in more intense participation.
Individuals facing health issues or low socioeconomic status tended to seek more painful forms of engagement.
Proposed mechanisms include bottom-up neurological responses to pain and top-down processes related to social support and self-enhancement, influencing quality of life.
Emphasizes the importance of traditional practices for coping with adversity where psychiatric or medical interventions are scarce.

Religious beliefs and practices significantly impact personal and public health, such as dietary restrictions and health-related behaviors.
Previous studies suggest that engaging in religious activities, such as prayer, yoga, and collective rituals, positively affects psychological and physiological well-being (Bernardi et al. 2001; Gupta et al. 1997).
Limited understanding exists regarding extreme religious rituals which involve stress, pain, and bodily mutilation, despite their historical and cultural prevalence (Xygalatas 2012).
Such rituals, while posing risks, are undertaken voluntarily and often considered remedies for various ailments, especially in mental health contexts (Jilek 1982).
Investigating these phenomena is pivotal in developing societies where biomedical and folk health interventions coexist, posing the question of compatibility between them.

Focus on Kavadi Attam (burden dance), a ritual performed by Tamil Hindus involving body piercings and pilgrimage to Lord Murugan's temple during festivals such as Thaipusam.
Ritual preparation includes fasting and prayer, followed by piercings and carrying heavy altars (more than 3 m tall, weighing up to 60 kg).
Participants may also walk on shoes with nails or drag chariots attached to their skin.
The festival represents major spiritual significance in the Tamil community, often viewed as a vow of reciprocity to the deity.
Strong communal bonds are formed through collective participation, affecting perceived well-being and providing social recognition.

Enrolled 39 males (mean age 45.21, SD 15.76) for the ritual group (19 underwent piercing and carried a kavadi), and 20 controls from the same community. Two dropped out, resulting in 37 total subjects.
Participants monitored to assess stress levels, sleep efficiency (SE), and physical activity during three phases spanning 2 months: pre-ritual, during the festival, and post-ritual.

Used BodyMedia SenseWear mini armband to record:
- Heart Rate (HR)
- Galvanic Skin Response (GSR) as a stress biomarker
- Sleep Efficiency (SE), reflecting immune system activity
Data consistently recorded for over 22 hours daily with an average adherence rate of 92.2%.
Controls accounted for physical activity and potential confounding factors like age, BMI, and humidity through a heat index.

Administered clinically validated tools:
- Patient Health Questionnaire (PHQ-9) for depression
- Generalized Anxiety Disorder Questionnaire (GAD-7) for anxiety
- EUROHIS-QOL for quality of life assessment
- Single-Item Health Status (SIHS) for self-assessed health

Collected via median split on number of piercings suffered (mean = 63.23, SD = 11.61) distinguishing high versus low pain experiences.
Socioeconomic status (SES) assessed through education, occupational prestige, and material wealth.

Analyzed using R software, incorporating predictors for demographic variables and employing logistic models for pain/stress predictions.
Assessments between conditions (ritual versus control) documented changes from pre to post-ritual levels of health.

Significant decrease in mean HR and GSR from pre to post-ritual, but no significant differences between groups overall.
No substantial differences in depression, anxiety, or quality of life however; a noteworthy interaction noted where the ritual group showed improvement compared to controls.
Increased self-assessed health scores in the ritual group post-ritual exceeded those of control participants.

Participants of lower SES and those suffering from chronic illness reported higher engagement levels in painful practices, implying adaptive coping strategies via extreme rituals.

Although extreme rituals have risks, they paradoxically offer psychological benefits.
Connectedness and cultural beliefs potentially amplify the perceived impacts of extreme rituals on health.
Bottom-up neurological and top-down social mechanisms facilitate these positive outcomes, reinforcing participant well-being.

Challenges in isolating factors due to naturalistic setting constraints necessitated observational methodology.
Sample limitations included recruitment challenges yielding minimal variance in samples prone to anxiety and depression.

Supports the role of traditional cultural practices in improving psychological well-being amidst environmental stressors.
Highlights the necessity to recognize cultural approaches alongside biomedical interventions for health management, especially in underserved communities.