Point to a science capable of studying persons as wholes.
Validate the incorporation of medical anthropology into the methodology.
Stimulate ordinary people to involve themselves in clinical research using this case study methods.
lead to an improved model for writing case studies.
lead more people to study and use holistic health healing therapies.

We are at the fringe of a new era of healing. We see how we can incorporate all aspects of a person's life into the healing process. We see the need for mind exercises to strengthen the immune system so that we are protected from disease. We see how to use our psyche positively to keep us healthy.
This case study method forces us to look beyond pathological tissues to examine the many facets of psychology, theology, medical anthropology, ecology, and physiology and determine the cause and cure of disease. We see how our thoughts, attitudes, feelings, beliefs, and values effect our health.
We see the marvelous interplay between the mind, the brain, and the immune system. We can hope from these case studies that they will change the way approach which incorporates all methods and aspects into the healing process. This process will include body, mind, emotions, spirit, and environment. In the first case study of Savithri, the chronological structure method is followed. In the second case study of Kiran, the theory building structure is followed. Names have been changed to maintain privacy.

CASE STUDY OF SAVITHRI

Basically human beings have power within themselves to transform their own lives as well as that of society. This case study is reflection of Savithri's search in her healing process. You will see her struggle in accepting the illness -- the rejection of allopathic treatment and the frustrations she went through during the first stage of her illness. Then you see her accepting the treatment of Ayurveda and massage, getting better, but again the urge to serve the poor forced her to go back to the village where she had started her illness, against the advice of the doctor. The hardship and stressful situations made her sick again. She came to the reality that something had to be done. She bends her heal to the orthopedic doctor and gets treated with medicines and injections. She felt ashamed of herself. She accepted that she was sick, and it is not curable, she has to live with the limitations.
She went for a course to Indian Institute, Bangalore, for three months. There she learned a lot about social issues and she planned to work in the future with her limitations. She planned to be out of the village for some time, as she saw that she must take care of herself. She was told to come to Pune for healing. At first she was reluctant and upset, so she kept ways from the Holistic Health Centre.
Then she gradually recognised and took full responsibility for her own healing. Now she is a changed person and proclaims everywhere about her fullness of health. It was an adventure for her. She narrates her own story. Art work was an important part of her healing so some of the pictures are included.

Phase 1 : Genesis of life
I am one of the eleven children of my parents. We were seven boys and four girls. I was a very active and outgoing child. My mother had to see to all of us. She didn't get much love and affection from any one of us, nor from my father. My father was like a stranger to us. He came home every 15 to 20 days and did not stay for very long at home. We treated him as a guest. We did not close to him. I used to watch him. He was a social worker. He was very busy helping people around us. It was a new place, where people came from far off places, like us, to settle there. So he was busy measuring land, surveying the land for someone else, solving the disputes among them, etc. We did not include him in our family. He had entrusted all his responsibility of home to his order sons.
They took responsibility for us. But my parents had no time for us. We were notorious and did all kinds of mischief.
I remember one incident very clearly. I was only three years old. I had a friend who used to come every day to play with me and I was very fond of him. I use to wait for him. He was ten years old and deaf and dumb. I did anything he wanted, as I really experienced his love. My parents did not want me to play with him because he was dirty and of a low caste, but I did not care. one day he took me far away. After walking about ten km., I got tired and sleepy, so we stopped under a tree and I went to sleep. My father could not find me at home and were terrified. At last my sister found me sleeping under the tree with my friend sitting near me. my sister tied the boy to a tree and beat him with a stick, and left him there. I was very angry with my sister. At home they all teased me about it. This incident was much alive in me and brought me very close to the poor and oppressed. I decided that when I grew big, I'd fight for justice and right. This was a strong power in me from then onwards in my life.

Between age 4-6 years
As my father was away much of the time, my mother had added jobs and couldn't give much attention to us. I remember at that age we fought for justice and equality. My younger sister was epileptic and got fits. Mother over protected her, also other at home. Three of my brothers and myself decided to stand together to fight against her whenever we saw that she got something special. We used to gang up and irritate her trying to take it away, or teasing her. When she got something she never shared it with us, but used to eat it in front of us. When we fought with her she used to cry and my mother used to beat us. Often we ran away and escaped from her. We refused to include her in any activities like games, going to the forest for wood, looking after the animals, going to the fields to pick berries, etc. The four of us shared whatever we got and enjoyed our games and play, always leaving her out of our fun.

My Experience at School
I was smart at many things at home, but dull at school from fear of the teacher. He was a magician and I thought he could put a spell on me. He was very strict can beat the children, so I couldn't learn. I thought that I was stupid and compared myself with my brothers who were clever at studies. Their teasing also put me down. Sometimes I told them, " I know how to live and you know books". I used to absent myself from school frequently playing hookie. I would to school without brushing my teeth so they'd send me home, but I would roam and play. See Pictures 3 and 4. Because of all this I finished my S.S.L.C. three years later than my classmates.
When I was thirteen years old I suddenly realised that I was a woman, I did not want to be one. Up till then I had been completely like my brothers. My mother's instructions were very strict, I had to stay at home, learn things around the house, and not move around with boys. I hated the restrictions as a woman, suffered an identity crisis and became very depressed. See Picture 5. After matric I stayed at home for two years and helped my mother run the house. I was good at it. It was hard for my family financially. After two years I went to college and did my B.A. My friendship with my brothers changed considerably. I become a consultant to them when they asked my opinion. Our bonds of friendship and support deepend.
We grew up in a mixed culture and never knew such things as caste, creed and religion existed. We all played together and treated each other as equals. I had a few hobbies; I loved games, liked to sit and watch people, enjoyed reading and discussions and I loved watching nature. I did not like any kind of a structured life with laws -- unless the laws were made in consultation with those who are involved in keeping them. I had a disciplined life as my father had give the charge of the family to my elder brothers. They did it in a very nice way . Even though we were notorious and active children, they helped us to become responsible and accountable for our actions. Every week we had a meeting among us, eight boys, four girls, and mother.
In Malabar we did not have a church close by,but we did pray meaningfully. For example, we had our daily prayers, every week we had a reconciliation ceremony among ourselves, and open sharing. At this prayer everything was dealt with. We evaluated the work of each one during the week, clarified and confronted. Corrections were given in a very caring and loving way. If any wanted to do something new it was bought out and discussed.
We had weekly at which mother used to give accounts of running the house -- whether the money was enough, or she needed more, and what were the areas where she needed help. Each one of us were given jobs according to our capacity and we had to give an account of it in our own way. At these meetings, if my brothers found that any of us were hurt during this process, they would spend time helping the person understand. Because of this I become assertive when I grew up, and could talk in any group without fear. In my family I saw that justice was done to each one. They valued my opinion. for example, one of my brothers wanted to marry a girl and came to me with this problem. I told him that if he really loves her and thinks he would be happy in his life I would support him, and he married the girl he wanted.
I was good in managing the house and helped in the marriage of my sisters and brothers, but I never wanted to marry. I was open and free with everyone. I always talked to boys freely. When my favourite brother married, his marriage was arranged by me, with one of my friends. When his first child was born I was with her in the hospital. My sister in-law was concerned about me and told my brother I'm too free with boys and he'd better find a boy for me and get me married. When I heard this I was very angry. I refused to speak to them. Meanwhile I decide to join the convent. My decision made this brother of mine very angry and guilty -- he kept away from me for seven years. It was painful for both of us. He thought that I joined the convent because of them and I will not be happy. When I brought up the topic in the meetings about my call for religious life, this brother objected very strongly. At last my father intervened and gave me permission.

Phase 2 : Life and Mission/Illness

Life and Mission
I joined the convent at the age of 25. The poverty and misery of the poor people touched me and changed my attitude and motives. It urged me to be with them and search life together. Therefore I took the first step towards this movement, by being with women and children who were the victims of social evils.I could understand them better being a woman. I felt the need of some skills which would equip me for my work. I went to Ambilikkai in Tamil Nadu, for a two year course on community health guides. The topics covered were basic nursing and midwifery, and community organisation and development.
During this course I went to a village called Maner in Patna, Bihar State, for my field experience. I chose two villages, and with their permission I did a socio-health survey. It was done efficiently, but this project was purely accomplishing my need to complete my studies, not the left need of the people. It was my first experience in the village.
After my studies I joined a team of three others who were involved in the village work. We extended our work to a few more village where Harijans were a majority. We trained Harijan women as health workers, but people didn't accept them. In one village of 100 families, eleven children died in two months. These tragic deaths opened my eyes. I saw that I must do something to improve the situation. It was in 1982 that my enthusiasm and great desire to serve people met with the realisation of the depth of the problem they faced.
I plunged into many things, We started motivation training which helped them to excess themselves. We got help from Integrated Rural Development Programme (IRDP) to improve the economic conditions and formed co-operative societies. We felt, as social workers, we had a great role to play to bring hope into hopless situations. We started many schemes under IRDP.
In 1983 I attended on Organizational Development workshop in Pune. The theme was Contemplation in Action. The participants were involved with people in difference degrees as social activists. It was an enriching experience for me and also a turning point in my life. All the time I was working for people. This made me to work with people. With hard work they were able to express their needs. We also discovered their talents and abilities. Some key issues. There were a lot of problems from the landlords. The people were afraid even though they knew the law. Those who tried to get their right had to suffer a lot of threats and even one young man of 26 was murdered and thrown in the Ganges.
To be with people and motivate them, two of us stayed in the village. The living conditions and food were very bad. But I was not that bothered. We were able to achieve many things. The law released the bonded laborers from the obligations to the landlords, the women stood up for their rights, the children received scholarship, etc. I learned a lot from the people. Linkage with social action group was one way we got empowered to go in our involvement and develop a clarity of vision. Even though the work increased, to fulfill the obligations, we were about eleven voluntary groups sharing the work. We used to meet every month for sharing, supporting, and planning for future. We started a federation of all the small organization in 1984. We formed a common goal for all. This group opened a new door for me in my life. I felt completely at home with the group. They were ever ready to help us. So we did lot of group activities I was also a member of PUCL (people's Union For Civil Liberties). I was so involved in various activities I id not care for my comforts.

History of Illness
My general health weakened. I felt my internal organs were all out of order. I suffered from indigestion, amoebiasis, diarrhoea, ulcer, muscle weakness, sinus trouble tonsillitis, ear problem headache, etc. This was due to improper and untimely food, tension, extremes of weather, lack of clean drinking water, etc. These troubles did not bear the pain, and the weakness of my hands and legs increased until I was unable to walk. I felt a kind of tingling sensation at the tips of my toes and fingers. See Picture 6.

Hospital Experience
At last I saw the doctor in the hospital and he admitted me immediately. All kinds of investigations were done. I was put on traction. Lying in bed I felt helpless and hopeless and very angry inside. See picture 7. I was resistant to the treatment and thought of all the negative comments made by other about me. I was in the hospital in this condition for three weeks. I couldn't accept the illness. I felt that I am young and have to work, I can't get sick. I was annoyed with the doctors who kept the sickness as a secret from the patients. My mind was divided between sickness and my work. I reacted negatively to each medicine. I was afraid of becoming paralyzed and thus becoming a burden for others. I had prided myself on being an independent person and now I was completely dependent on others. These factors made me more sick and drained me emotionally. I couldn't trust anyone and also questioned God, friendship,and community, which and previously been of great value to me.
I thought of my family and felt very close to them. My inner struggle was worse than my physical pain. When the conflict was too much, see Picture 8 which depicts my feelings, and I was so full of questions, questions everything, caught in a darkened image of the world, and experienced being imprisoned behind bars, only my inner will kept me alive, I could only run to the security of my own family. I shared my feeling and instructions with my mother. I reacted to everything and grew impatient. See picture 9. I felt my thinking power diminished. I withdrew from everything. This experience was more painful for me than my physical pain. I was completely broken down and could not sort it out. I had lost my way. Tension was eating me up. My hormones were all out of balance. This picture shows my defensive reaction : blowing off at everything.
Together with my mother, we planned that try Ayurvedic treatment a I was disillusioned with allopathy and I believed in other systems of medicine. So I went for Ayurvedic treatment for three months at home they promised they would cure me and I did get better. During those months I tried to find out what was going on inside me, but could not in depth. After three months they told me I need more rest, but I resisted and came back to the village to save the people. Even at this stage my goal to go to the poor made me get up an ignore the mesages of my body which begged for rest.
After working for six months, my wholebody was swollen, hands weak, and I was worse then before. I was unable to walk, I felt helpless, only my inner will kept me up. Everything was in darkness. Those who had supported me, left me.
I was taken to an orthopaedic specialist, I kept quiet, I thought I failed. I did not believe in allopathic medicine, yet here I was on complete berets for 21 days. I had X-rays, injections, but I did not rest. In my head I was doing my future plans -- deciding to take up some studies to get out of the village. On discharge from the hospital, I went to the Indian Social Institute, Bangalore, for three month course on Social analysis.
There I realised that I was not realistic, I must see what is within my capacity. After finishing this course I was asked by my Superior to come to Pune for healing. I had my reservations. See Picture 11. It was a moment of great confusion for me. It was not my choice. I felt that I can manage if I was more careful, why waste more time. I know my capacity now and I will accept my inabilities an live accordingly, and I was O.K. with it. I was a bit angry with the suggestion that I go to Pune and so I arrived with a chip on my shoulder, thinking let me see how they will cure me!
It took me two months to look into the Holistic Health approach. I stayed away from the cetre but watched what happened there. I noticed that I was not forced to do anything. I was left free. Then I attended a workshop on Basic Holistic Health during which I kept an open mind, and forgot my village and my mission. I realised that there are some facts and common sense in what was said. This workshop really opened my eyes -- one thing was clear to me that healing can be done only by my efforts. A  glimmer of hope and brightness came into my life.

Phase 3 : New Life

Symptoms
When I arrived in Pune I had weakness of the left side, I could not write with my right hand, couldn't bring my hands close to my body, had back pain, neck pain, and tingling of hands and legs.

Treatment
During the Basic Holistic Health workshop, I realised that I am responsible for my health. This was something new for me. The community was very supportive to me. The Holistic Health team were understanding and never forced me. As I watched their functioning with other clients, both in the house and in the centre, I felt confident that I can take charge of my healing and can get their help.
This was shift in my belief system away from thinking that I was condemned to invalidism for life, toward using the healing power within me to be well. The team explained to me the way to function in my healing process. They said to patients with myself as it would be a long slow process. I liked the weaving of knowledge with treatment, and I felt I was treated as an equal. My whole person was involved in the diagnosis, selection, and implementation of the treatment regime. I found the team firm but compassionate. I attended many workshops.

Basic Holistic Health : which gave mean understanding of taking a sick person as a whole, not in part. I saw the importance of the five dimensions of Holistic Health : Self responsibility, Nutritional awareness, Stress management, Social and Environmental sensitivity, and Physical fitness -- and through these integration of body, mind, spirit, and emotions. This was the turning point for me to look into the holistic health approach. I was a bit shy to approach the team. It took me two weeks to step into the clinic. My back was hurting very badly, finally I dropped into the clinic one morning. I was not questioned -- instead the team welcome to me warmly. They attended to my back and gave me a realignment therapy. I felt much better. That gave me confidence that I can be treated in the centre. As I was going on with the physical healing, I had a chance to attend the next workshop.

Stress Management Workshop : Here I connected my physical pains to the stressful situations. The inputs were rally good. It was scientific and I had to say "aha" as the connections were unfolding. I realized that the whole sickness did not start two years ago -- it had been storing up in my mind for long time and the body symptoms were a result of my inability to cope with my mental struggle. The workshop helped me to look into my stressful situations and deal with them rather than putting them on my life, I got the chance to attend the next workshop.

Psychosynthesis and Assertiveness Training : I was happy to attend this workshop as I knew it will help me to look further into my being. I was much more relaxed. This was another approach to unfold other aspects of me. As I was dealing with my subpersonalities, I realized my weakness and strengths and how I could integrate them in my life and work.
One of the scenes which came out during this workshop (mentioned earlier in this case), was the injustice done to my 10 years old deaf and dumb friend, when I was a three year old child--standing and crying, angry, and helpless. I integrated this crying child in me, by dealing with my sister. The drawings were really revealing, I enjoyed doing it, even though I am not an artist. As I was working on these aspects, another workshop was scheduled which I attended.

Getting the Meaning of Dreams : I was more and more interested to unfold myself. I had many dreams. An important area that was revealed to me was about my father. I was afraid of dead people : My father died a few years ago. He came many times in my dreams, but I was afraid to relate to him. During the dream workshop again he came in my dream. I shared the dream in the group and the team helped me to look into myself. I realized that I was angry with my father as I felt he never cared for us. I couldn't  forgive him. I realized how far I had kept him from my life and even when he died, I did not feel much. I was helped to begin a new relationship with my father through dialogue and healing of memories. Now I experience him very close to me as a strong resource person. He is a spiritual energy for me. During this workshop many other treasures were revealed to me and I experienced the depth of life and healed many memories.

All through my stay in Pune I had inputs through seminars, personal counselling, and I read many beautiful books on healing and applied them to myself. I am a person who has many questions and these were answered through the above approaches.

• I learned that sickness does not happen overnight. There are many reason to make and unhealthy environment. It takes a long time to get sick and a long time to be healed.
• I changed my diet from non-vegetarian t vegetarian and I felt better. I followed hydrotherapy and took a lot of salad with plenty of sprouts, especially wheat. I look meals at regular times.
• I received acupressure for neck and back pains on alternate days for three weeks.
• I received realignment therapy twice a week for four weeks.
• I was taught, and continue to follow yoga exercises for the back and neck.
• I followed acupressure points for eyes and nose and remedial exercises for sinus trouble and to improve vision.
• I took ten days of magneto therapy.
• I followed relaxation exercises with guided imagery for 15 minutes three times a day, drawing the images once a week to note progress.
• I spent 45 minutes twice a day at meditation.

After one to two months, I could experience gradual healing -- I had confidence, was open and responsible. I did not feel anxious. I spent time for myself. at age two. It was so surprising all I had kept in my head.
I gradually integrated all the unresolved parts of me and accepted my shadow.
In short, the books, treatment, and seminars and workshops helped me to find out the root cause of my illness. I looked at my illness with a bodymind approach. I took full responsibility an looked into myself objectively. I saw that many events and tensions build up until finally the body breaks down at its weakest point. A complete denial of myself was the beginning and when the body is sick, the mind also is affected. The holistic health way of dealing with the sick with a compassionate understanding attitude helped me to deal with my sickness quite smoothly. This healing was a long, painful, gradual process which I faced and worked through. I am in touch with my body now and will never again ignore it or allow it to break down. I know how to keep myself in balance and harmony and how to react harmoneously with the environment. I also realised that life is an integrated whole and it has to be approached with compassion and understanding. It is a very difficult phenomena to realize that the human body is a masterpiece in the total creation.
For me health is harmony with God, oneself, others, and with nature. See Picture 14. Imbalance of this harmony is sickness for me. All putting back into harmony is cure. All human beings need this harmony. My experience of healing has become teaching material for me to help especially the chronically ill. I communicate the importance of this integrate not only to the sick, but to the public at large.
This healing process has brought me closer to God. Now I am able to integrate my work in my life. I spend 45 minutes in the morning and in the evening in quiet meditation, alone with God. Also whenever I feel tense, I take some time to meditate and it helps me a lot. I have become a reflective person. Before these experiences, Mass was a ritual for me and I missed it many times. But now it is a cherished experience for me.
I feet that I have made Jesus a part of the Mass is the culmination of all that I do. I feel now that the spiritual self, God, is my director. See Pictures 15 and 16 (Picture 15 on page 82)

Staff Comment
I met Savithri about year ago when she came for a meeting. It was after her treatment with Vaidya. She complained of weakness in her left hand. I gave her acupressure release - she could not bear the pain.
Acupressure gave her a little relief. But I could see she did not believe in it. When she came to Pune, I had my apprehensions and as she said, she was skeptical and wanted to challenge us.
During the basic Holistic Health Workshop I saw her getting interested and when she come to the clinic, I was cautious -- I only attended to her back. Slowly our relationship warmed up and then I saw she was committed to a holistic healing process. She was enthusiastic, honest and open. She had many questions to ask, as she was growing in learning by unfolding herself. She became a beautiful person. Her whole personality and relationship with others were different. She could be healed not by the doctors, but by herself. She was ready to take up job when she was well.
Now she is doing a very difficult job with plenty of travelling and taking responsibility. It is now one year that she is working there and last week she wrote : "I had to go to many places and do so many programmes, but I'm happy to tell you my health is fine." I am really proud of her. (Comment by Celine Payyappilly, Co-ordinator Holistic Health Centre )

Lesson Plan on Savithri's Case Study

Objectives

• To have others profit by her experience.
• To get others to open themselves to change and healing.
• To get in touch with their own experiences.
• To bring hope to others.
• To touch sympathy, empathy and eagerness to help others, you reach out to others to heal themselves, and then to heal the world.
• To reach self-responsibility.

Knowledge
At the end of lesson a student of holistic health should be able to:

1. Know about the importance of self-responsibility.
2. Believe that knowledge can change beliefs and attitudes.
3. See the importance of balancing personal needs and goals with working with others.
4. Know that we are human beings and we will get sick, but we should take responsibility for healing ourselves ( healing is within).
5. See how childhood experiences lead to formation of attitudes. Experiences help to change attitudes.
6. See how physical sickness does not make a person a cripple, but the mental and psychological aspects are more involved in the illness.
7. See that social workers are regarded as morally good people so they shouldn't get sick. Sickness is regarded as something not good. So when one is doing good how can a bad thing such as sickness happen to them. Social workers need to take care of their own health so they can take care of others.
8. See the importance of harmony with God, self, others, and the whole universe.
9. Understand that books, and workshops can enhance knowledge, which is healing.

Attitudes

1. Identify your attitude towards sickness and health.
2. Identify you attitude towards different systems to medicine.
3. Identify your attitude towards the healer/healee relationship.

Content
The following points can be considered :

Phase 1 : Early life

1. How childhood hurts are carried with us until healing of memories is complete.
2. The family structure and its impact -- in large families the difficulty of giving sufficient love and attention to each child - especially when father's work takes him away from home.
3. How teachers and interactions and comparisons at school effect the lives of children.
4. The frustration felt by children at unjust punishment.
5. How decisions taken at these early experiences mold and shape our whole life.

Phase 2 : Life and Mission/Illness

6. The importance of meaning in life.
7. The need to integrate care of self with mission in life.

Phase 3 : New Life

8. The benefit of illness.
9. The importance of support groups.

Teaching Methods
Discussion and question - answer. The discussion could focus on :

1. The group's attitude towards allopathic treatment.
2. Their response to her story - their emotional response especially when she was so sick and yet wanting to be involved in her work.
3. The relationship between healer and healee.
4. The relationship between Savithri and doctors in the hospital.
5. The relationship between Savithri and orthopedic surgeon.
6. The relationship between Savithri and the Ayurvedic doctor.
7. The relationship between Savithri and her family.
8. The relationship between Savithri and her colleagues.
9. The relationship to herself.
10. How she balanced the spiritual, emotional, psychological and physical aspects in her life.
11. The support groups reaction.
12. Identifying the turning point when she took full responsibility of herself .
13. Listing the positive and negative factors in the environment which effected her in this situation.
14. Listing her innate strengths.
15. The impact her illness had on her personality.

Role play her behavior when she first felt sick.
Use psychodrama on any scene from the case study.
Invite individuals to tell their own story of sickness and return to health.

Study Her Beliefs Before Healing

• That her illness was for life.
• That laws are to be broken, unless you're involved in making them.
• I should be unstructured, not tied to an institution.
• Work is more important than bodily health.
• I can only work in small teams, where we have participative decision making.
• If people are compassionate, I can be okay.
• Work, life's mission is more important than listening to my needs and wants.

CASE STUDY OF KIRAN

In this case study of Kiran, the theory building structure is followed. After the introduction, Kiran's story is unfold focusing on the following theories in this order:

• Personality
• Cultural Beliefs and Customs
• Stress Components
• Biology of Hope
• Family Support System
• Love

Introduction
Kiran is a 56 year old lady who is still getting help from our Holistic Health Centre. She is a special case. She had a cerebral hemorrhage in 1958. She was eight months pregnant at that time and had some swelling of the feet. She was in bed for 30 years after this with the left side paralysed. A month ago, Kiran was walking with the help of her husband when whey happened to meet one of the staff nurses from our Holistic Health Centre. They exchanged greetings and casual talk led to interest in health and healing. Our staff explained the working of our centre and all that we were doing to help people who can be healed of their ailments with various methods of treatment and participation in self cure.
After this meeting Kiran started to come to the centre for treatment. I was curious to know what made her get up from her bed after 30 years. The first visit to the clinic was very encouraging to her. After the third visit, she said she was 50 percent improved. She said previously it took her one hour to walk to the centre, now she can do it 20 minutes. Because of this remarkable improvement, I decided to write up her case.
Kiran talks a lot. Her husband is very quiet. Kiran looks healthy, physically well-built, warm and cheerful, willing to talk about herself, her illness, and past history. We observed her warm relationship with her husband, children and the youngest daughter-in-law, who was at home with her children. Kiran seems to neglect dental care, her teeth are badly discoloured, brown with some teeth missing. She talked about her paralysed left leg which kept her from walking for many years.

THEORY 1 : PERSONALITY

Emotional stability is a very important factor during illness. It is a time when all of us. regardless of other temperamental requirements, share the need for self-esteem. To confront a crisis without self esteem is to be hopelessly adrift and to experience oneself as naked and defenceless. The presence or absence of self-esteem has a great impact on our experience of life, our behaviour and even on our perceptions of the world. A woman who esteem herself, feels warmth and gratitude when another expresses affection for her. A woman with little self-esteem doubts the authenticity of affection offered.
A person's self-esteem is often wounded by the discovery that she is seriously ill, and the feeling of vulnerability that accompanies this loss of self-esteem. Those with reliant temperaments differ conspicuously from those with autonomous temperament in how they hope to reestablish that besieged sense of self-worth. Each of us silently judges whether or not we are worthy of life. The origins and standards of this value judgement can be different for each person. Although both subjective assessments (worthiness and competence) are important parts of self-esteem, those with dominant tendencies toward autonomy are more preoccupied with their sense of competence. A crisis often forces us to experience the core of our personal competence.

Childhood
Originally Kiran's family came from a village called Warmbori near Ahmednagar, Maharashtra State. Her grandparents were Marathas. They came to Pune in search of a job. It was during the British rule. The British converted them into Christians during the famine. She was born and brought up in Pune. She lost her mother when she was only five months old. Her father found it very hard to look after her. He took her to the orphanage at Panchhowd run by the Anglican Sisters. Her father used to visit her. He married three times. She had one sister, four step-sisters, and two stepbrothers. Her father's main work was carpentry, but he also was a teacher of embroidery. He used to teach anyone this trade. Many girls were his students and Kiran also learned the trade.
When she was five years old, she was sent to a boarding school, run by the same sisters, called St. Gabriel's. Kiran was a very active and spunky child. The Sisters liked her very much. She was good in her studies and in sports. She was a leader and often was the monitor of her class. She used to be the spokesman for anything. she was open and frank and told the truth straight to the person. She was not afraid of anyone. She liked one girl in the class. She would do any thing for her, but many others were afraid of her. Her father was very fond of her. He was a hot-tempered man and used to get angry with others. He always did things his own way. When she was 10 years old he came to the boarding school and told the Sister he wanted to take her home. The Sisters had nothing to say as they knew what kind of a person he was. She came home and still continued her studies. She is very grateful to the Sisters who did so much for her.
Her illness was a confrontation with self-esteem. She felt hopelessly adrift to experience the nakedness of herself. She started to doubt the authenticity of affection offered. She felt she was a burden to her husband, and once she told him to leave her and go somewhere else and live happily. She realized that she would not be able to get up and walk. This was her own judgement. She was a more dominant person and was more concerned with feeling worthy. We could see the crisis of illness in her. She antagonised everyone at home. The one who took it badly was her eldest daughter-in -law. Shailaja. She felt that Kiran did not like her and only liked her own daughters. Shailaja could not see any good points in her mother-in-law, who was very impatient. Kiran could not wait two seconds to get an answer or to get something. Even if she saw that they were doing something. Kiran would not wait. She was very hot tempered. She did not give any consideration to what others did. Shailaja said that her husband did not earn much money. After staying six month with the in-laws they moved out and stayed close by, but Shailaja did not come to see her mother-in-law, though her children liked the grandparents. Shailaja agreed that she also is a hot tempered person like her mother-in-law and she could not tolerate her anger.

THEORY 2 : CULTURAL BELIEFS AND CUSTOMS

 Religious Beliefs
Religious beliefs play an important role in health. For many in India their work is based on the belief that God rules things, whether they use the word God or not. If I am good or have enough faith. "I will not get sick". This belief may lead the person into self condemnation when they fall ill. The perspective and authority of religious belief offers a pathway toward self-affirmation. A belief in God includes she confronting belief in universal order. It is a system of belief in which every occurance has meaning wherther fully understood or not. The belief that God knows, acknowledges and understands our suffering provides a satisfying feeling of recognition. A dynamic life contains both the inner force of heroic resistance and the inner force of heroic resistance and the inner force of acceptance and surrender. There can be no doubt that the idea of God provides enormous comfort and meaning belief is capable of furnishing a sustaining strength and providing deeply meaningful experience during illness. In India, as a whole, people believe in God. This helps us to work with them whatever religion they follow.

Marriage Beliefs
Marriage beliefs in India are different according to the religion and the areas. Generally, marriage are arranged by the parents for their children. In tribal areas they have gatherings of boys and girls for celebrations. After the boy asks the parents to the girl to give her in marriage. Child marriage has been very common, but now it has reduced through education, government law, and custom. According to religious customs also the marriage pattern differs. Usually a man has only one wife. But among Muslims, they can have more than one wife. After the death of the thousand the widow ordinarily stays single. They suffer a lot because of this. The in-laws do not treat them well. But if a man loses his wife, he can marry again. Women are dominated by men. The wife has to serve her husband as God. This is the way a girl is taught before marriage and it hold true even among many well educated people.
Divorce is not that common, but within their civil code, it take place especially among Muslims. Among Christians it was forbidden, but now there are certain policies which allow it. It is not that easy as people still feel and believe that once God unites them, men have no power to separate. In hardship and in joy they stand together. If they divorce, they feel guilty. They suffer a lot due to this belief.

Marriagge Patterns in General
There are different patterns of relationship between husband and wife common to many parts of the world.

Parent-Child Pattern
Parent-Child patterns are characterised by well-defined roles. These marriages are oftern stable and outwardly successful, for the roles that each willingly and confronting enacts satisy the majority of their respective needs. Husband and wifeare able to anticipate and support each other. They experience a familar identify and each knows what is expected. They are secure in each other. But when problems arise, their well-defined roles prove insufficient to some new circumstance or crisis. Then the underdeveloped and negected aspects of each partner's personality are exposed and each may become confused and vulnerable. The areas of vulnerability are correspondingly magnified when either the wife or the husband is threatened with the loss of marriage partner.

1. Mother- Son Relationship
   In this pattern usually the wife takes the dominant role as mother and treats the husband as son. The wife is capable of managing the house and the husband depends upon her. He fails to take responsibility for the family. In such a situtation, when the wife gets sick, the husband is at a loss and  find it hard to act as a responsible father. This pattern can provide an enormous amount to strength for a family as long as mother remains strong enough to stay in change of their lives.
2. Father-Daughter Relationship
   In this pattern the husband assumes the role of "benevolent big daddy" to his wife whom he treats as a daughter. He has many of his most pressing needs satisfied. He is respected, praised and depended upon, he rarely experiences uncertainly or personal vulnerability. But his sense of confidence and control depend upon his wife's admiration: it is her adoring glance and needful requests that help maintain his sense of himself as exclusively wise, kind, strong and lovable. The husband in a father role rarely get angry and more often he is a gentle lecturer.
   None of these patterns are healthy as they neglect the right one party. Cultural prohibitions in India, prevent expression of emotions. Cultural and religious faith and acts of human services are encouraged, they are validated and rewarded. Do not stroke yourself, do not indulge yourself, cover your feeling up. We want to accept our feelings and yet each, although secretly desirous, deprives themself the right to do so. To feel anything intensely is to be intensely alive. We long for permission to accept grief as valid, we seek external justification for feeling intensely.
   What is healthy is a legitimisation of feeling and emotions which are expressed appropriately. Wholeness demands expression of feelings.
   A marriage pattern that is more common in the West, and is emerging gradually in India is a complementary one in which both parties are equal and interdependent in their relationship. This includes appropriate expression of feelings. This pattern is slowly gaining ground against the strong cultural custom of oppressing women.
   Whatever the marriage patterns are, they can be changed by the individual for the good or bad according to situation. The responsibility for change depends upon each person. The ultimate value of these patterns can be no greater than the new goals and behaviours which they encourage. But once they are on the road to change, a hopeless and embittered family environment can be changed into one of closeness, warmth, and exiting growth.

Birth Control
In India the Government spends a lot of time and money to control the population. Many believe the cause of poverty in India is due to over-population. India has the wealth to feed its millions but the inequality in the distribution of wealth is the major cause of increasing the gap between rich and poor. We see a major portion of wealth is in the hands of privileged few.
Many of the poor in India are not worried about the number of children. They believe that the more they have the merrier. For them children are a blessing from God and any interference will be punished by God. They believe if God gives them children, He will also help them find a way to bring them up. Most people believe in God. Religious beliefs are very strong. Muslims and Christians usually are not for family planning. Now educated people see the need and keep the family small. If a person goes for sterilisation operation and if any tragedy such as serious illness or death of their children occurs, they will say that it is a punishment from God.

Religious Belief
For Kiran, health means happiness, that is being able to work and cope with life. She is a Christian and has great faith in Jesus. She belongs to the Free Church. Having a strong faith in Christ, she believes that whatever happens to her is for her good. She makes many sweets for Christmas and shares with her neighbours. She fasts every Friday. She always keeps flowers in front of a picture of Jesus. If her  husband does not bring flowers she get angry and grumbles till she gets them. This is very important for  her. She brought up all her children in this faith. She said that Christ suffered for others and we should  also love and serve others. She has read the whole Bible five times. God the all powerful and compassionate father loves her and He looks after her and her family. She said that she was unconscious for four days, and God restored her to life. She prays every day that the Lord may give her strength like Samson and she will preach His name like Samson as her spiritual healing symbol. She follows the ten commandments very strictly and praises God every day. In her life we can see one of the reason for her survival and her happiness is due to her religious faith.

Marriage
Kiran started her periods at the age of eleven. Even though she was only eleven, she looked as if she was 15 years old. Her father looked for a boy from that time onwards and she was married at the age of 13 in 1945. Her husband, Sumant, was 20 years old. He is a wireman. They stayed in an one room house in Pune. He is a quiet man and did not get angry or fight back with anyone. Her father used to get angry with her husband, but he would never say anything. Kiran did not allow her father to get angry with her husband. Instead of Sumant responding, she used to stand up for him. Sumant also lost his mother when he was little boy. His father died about six years ago. He had two brothers and two sisters: One brother was drunkard and died two years ago in their house. Her husband is the third child for his parents. Sumant loved his family. His father did not earn enough. They suffered much from poverty. Her husband was a very sensitive child and started working from the age of ten. Her father-in-law was a pastor. Due to difficulties in the family her husband had only the minimum education, but he took a lot of responsibility for the family.
Kiran can read and write Marathi well. She studies till the seventh standard. She can speak Hindi satisfactorily. Her husband also can read and write Marathi and can speak Hindi. Their first child, a baby girl, was born one year after their marriage. Kiran was still a girl. She did not know anything about managing a house. She was in a boarding school and when her father brought her home, her stepmother took care of the house, and Kiran still continued as a spoiled child and did whatever pleased her. She did not know how to cook, clean, or do housework. When she was expecting the child, she did not know what it was all about. Her husband was very caring and loving to her. He married her to have someone to manage the house. Soon he found out that she was not good at any of these things, but the understood her. He taught her everything. She really loved her husband. Their love was mutual. He was a support and encouragement to her. Gradually she learned all the housework and managed it well. She was aware that her husband was struggling to manage financially. He never showed his tension externally. But being a sensitive person, she picked it up, and wanted to help him very much.
She had babies every eighteen months. During pregnancy she did not have and special diet. She had morning sickness during every pregnancy for three to five months. She suffered a lot, but did not go to a doctor as she considered it a normal phenomena. She used to eat a lot of sour things like tamarind and green mangoes. She also like to eat chillies and mud. She loved the smell of the wet mud during early pregnancy. All her babies were born in Sasson Hospital. After the delivery, she was well taken care of . She had a lady helping her at home for cooking, cleaning, giving bath, and caring of her. Kiran was given a lot of Methi bhaji ( curry prepared with tender Fenugreek plants) as it helps in builing up the blood. She took other green leafy vegetables, roti made of wheat as well as jowari. Soup was prepared of head of the goat, and legs as it is believed to give for general health. Lots of dry fish was given for production of mill. Panova (Ajuan) leaves were given with meals for the production of milk and for digestion. They have three sons an two daughter. Kiran had one a abortion and a premature stillbirth.

Socioeconomic and Political Milieu
Kiran lives in Bibwewadi village. The majority of people are Hindu Marathas. The standard of living is how. Most of them belong to lower middle class families. Many of them, like her have come from far places and live in one-room houses rented from mainly three families. The living conditions are poor.
There are only a few bathrooms and toilets which are not sufficient for all the people. People have little health awareness. They use the road, lanes, and drains for toilets. The drains are open. There is municipality water supply. Very few of them have a water tap in the house. Children are taught the habit of using the road or pathways for a toilet. Even ladies do the same. Kiran does not like this. She keeps her house clean.
They have been staying in an one-room house all these years. After her youngest son got married, he made a room on top of the existing room. One can imagine husband and wife (she an invalid) and five children having to cook, eat, study, play, and sleep all in one room. They have municipal water supply and latrine with open drainage system. They have gas stove. They are non-vegetarian and eat mutton and eggs. they keep a few chickens. Her youngest son owns a scooter. He also has made a two bedroom house with all the facilities, and has given it on rent for one year. He bought a plot of land, but there is no water supply nor road. He is waiting for these facilities to come and then will build or sell it for a profit. They do not like to move out of Bibwewadi.
The main religious practised are Hinduism, Islam and Christianity by people living in her area. Many people work in different offices or as rickshaw drivers, bus conductors, State transport bus drivers. Some work as coolies, labourers, business men, and farmers. Many women work in the farm according to the season. Some of them go to the marketyard to carry loads. Many women do not have any work except household work.
Kiran likes to listen to music and watch TV. She enjoys embroidery and stitching, but now she is not able to do it. She reads the Bible and prays daily. She likes people who do good for others and behave well with all. She likes the children to be calm and quiet and clean. She is quite fashionable, she likes to dress up well. You can see her hair style with colourful ribbons and bobbypins. She likes peace. She does not like proud people, or those who tell lies. She does not give more importance to sons than to daughters. She keep away from people who are not trustworthy. One of her goals in life has been to