India Syndrome

 In 1985, Régis Airault arrived in India to work as the resident doctor of psychology at the French consulate in Mumbai.

At the time, travelers from France, upon arriving in India, could visit the consulate to place their passport and return plane ticket into safe-keeping. Airault had the opportunity to speak to those travelers, often in their 20s or early 30s, soon after they landed in India. All were excited about their forthcoming travels.

But soon, Airault began noticing a curious condition in some of the French travelers, particularly among those who had spent longer periods of time in the country: a spectrum of behavioral and psychological changes that later became known as “India syndrome”. The condition has cousins around the world: religious tourists to Jerusalem are struck with a spontaneous psychosis upon visiting the city, certain that they are hearing God or in the presence of saints; visitors to Florence are physically overcome, even hallucinate, upon viewing the beauty of the city’s art.

In India, Airault would be dispatched to examine travelers who had lost their bearings, had become disoriented and confused, or had found themselves in manic and psychotic states. The contrast was shocking. “I would see them perfect when they arrive and after one month, I would see them totally unstable,” he recalls. Initially, what Airault observed was blamed solely on drug use, but many of the travelers were also exhibiting symptoms such as depression and isolation, stemming from a feeling of disorientation in an unfamiliar land or culture.

In rare cases, others were later diagnosed with acute psychosis, delirium and delusion. At its most powerful, India syndrome could be all-consuming, leading to a complete detachment from reality or an overwhelming disconnection from familiarity. Airault came to call that group “the travelers who were lost forever”.

Over the decade that followed, the French psychiatrist traveled back and forth between France and India researching and compiling notes and observations into a thesis, which he adapted into a book, published in 2000, called Fous de l’Inde – Crazy About India – which revolves around a central question: does India itself bring forth these transformations, or do people go there determined to be transformed?

“More than any other country,” he wrote about travelers from the west, “India has a way of stimulating the imagination and stirring intense aesthetic emotions which can at any moment plunge the traveler into utter anxiety. For this reason, our ‘experience’ of India can be somewhat ambivalent.” This depends on each person’s personal history, their ‘impulse to travel’ and past traumas which have been buried deep inside,” he wrote. “The subconscious has a way of bringing us face-to-face with them at certain times of our lives. Because India speaks to the unconscious: it provokes it, makes it boil and, sometimes, overflow. It brings forth, from the deep layers of our psyche, the buried.”

Airault distinguished the symptoms of India syndrome from common culture shock, the experience of travelers either feeling an intense connection to a new and different place or feeling an extreme rejection and disconnection from it. Culture shock often manifests within days of arriving; India syndrome, rather, typically emerges after weeks or months of residing in the country. He noted that many travelers arrive with some deep-rooted idea of what India is, previously held expectations of what India can offer – emotionally, physically or spiritually – and a hardened determination to realize that imagined experience: “The trip to India begins early, with the idea that we have made, conveyed by our culture, its cliches, its legends, its myths, but also by our childhood fed by marvelous tales and stories.”

He included dozens of examples of foreign travelers he observed or treated: one had burned his passport shortly after arriving and spent two months in prison suffering from anxiety attacks; one had been wandering around India, in good health and spirits, for five years even as his parents had presumed him dead; and another had traveled to the holy city of Varanasi and believed that the goddess Kali could hear his dreams and was speaking to him. Many of the cases were more benign: travelers arriving with an emotional or traumatic history that was suddenly brought to the surface and confronted, which resulted in a breakdown.

Much of what psychiatrists have noted as India syndrome, however, is rooted in an exaggerated and sometimes misplaced expectation for what travelers believe India might offer. They leave home expecting enlightenment at the pinnacle of their journey and stop at nothing in their pursuit.

Though India syndrome, like many of its cousins, is not universally recognized or officially accepted as a psychological diagnosis, the symptoms have become enough of a concern that insurance companies selling travel packages to India-bound tourists have been known to include clauses that void the coverage if the traveler has a psychiatric history or if he or she takes drugs.

Several embassies and consulates in India have permanent psychiatrists on staff to address and treat their nationals in distress. If they don’t, they contact a psychiatrist such as Sunil Mittal, who has built a career in part on diagnosing and treating the conditions that arise from India syndrome.

As the senior psychiatrist at the Cosmos Institute of Mental Health and Behavioural Sciences, Mittal sees approximately one foreign tourist every week in his office in New Delhi who would fall under the umbrella of India syndrome. The tourists arrive at the clinic through the recommendation of an embassy, in response to the concerned pleas of a family member, or as the result of an arrest made by police.

Mittal breaks down cases of India syndrome into two categories. The first occurs among those who arrive as simple tourists but bring with them some emotional or psychological issue or trauma relating to their family, their job, their relationships, or their past. “They come with a turmoil and they have a breakdown here,” Mittal explains. At the core of the person, he says, lies a vulnerability, a deep-rooted issue that he or she hopes to resolve.

The second group is made up of those who come to India determined to embark on some form of spiritual journey to seek higher meaning or realization. They visit holy centers and sites and immerse themselves in training and study of meditation or yoga. They often become enamored by yogis or gurus, or the juxtaposition between what is expected and reality, and seek an extreme break from their life back home.

“On the path of a spiritual quest, all the values that have been ingrained in someone are questioned,” Mittal says. “This can lead to a state of emptiness, a state of loss of direction, or a sudden feeling of exaltation – and then not knowing how to handle a situation.”

Though drug use is rarely the only spark, it is often an accelerant. Cannabis has been consumed in India for centuries in three forms. The most common is bhang, prepared with ground-up leaves and seeds that are mixed into a drink like a yogurt-based lassi. Ganja is the flowering buds of the cannabis plant, most often consumed by smoking. And charas, or hash, is produced by rubbing the sticky resin off the leaves and buds of the plant until it forms balls that are smoked in a straight clay pipe. Records of cannabis use in Ayurvedic medicine date back a millennium. But the plant most famously appears in Hindu mythology as a favorite of Shiva.

In 1986, India made the cultivation, consumption and sale of all forms of cannabis illegal, despite its continued use by sadhus and international tourists alike. The convoluted gray area that cannabis occupies – semi-illegal, openly used ceremonially – has tempted many foreign tourists to experiment. The results can be overwhelming. “It’s like a bomb,” Mittal says.

The new lens that the traveler begins to see through can distort even the surest of convictions, replacing hesitation with complete openness, skepticism with blind trust. The lens can undoubtedly offer positive experiences, but also more extreme results. For a 2007 paper on the forces that push international tourists in India to renounce their lives, the Indian anthropologist Meena Khandelwal interviewed three foreigners who had moved permanently to India to pursue a spiritual journey and noted that a US consulate official in New Delhi had told her that “his office may see about 25 Americans each year who have exhausted financial resources and alienated family members in the United States”.

Changes can manifest themselves subtly at first, as strong culture shock. Some begin to wear one of the many forms of Indian sari. They carry walking sticks, wear red threads tied around their wrists denoting blessings and sport long necklaces. Travelers who are not Hindu or Muslim or Buddhist or Jain before arriving become, at least in appearance, a model example of a convert. They stay in ashrams or monasteries, where they study and learn, reform their lifestyle or system of belief, or preach asceticism.

Over his career, Mittal has treated hundreds of cases across a spectrum of severity. There was the American man found wandering near the Taj Majal, disoriented and confused. After noticing the man behaving bizarrely, the owner of a roadside eatery called the police. The US embassy was contacted and the man then sent to Mittal’s clinic.

He determined that the man had arrived in the city of Agra like any other tourist; he had not been on a spiritual journey but simply wanted to see the iconic mausoleum. There, he had tried cannabis, something he had smoked back home with no adverse effects, but this time it had proved overwhelming. He arrived at the clinic unable to answer more than basic questions. “He left everything – his backpack, passport, everything – and just ran away,” Mittal says. Within a month of his return to the United States, he had returned to his normal self.

Then there was the British woman who had been living alone for a year in a small cottage in the mountains of the state of Uttarakhand. Locals had become concerned after she had begun behaving and talking strangely and stopped paying her rent. When police arrived, she claimed she had been captured by spirits. Her family contacted Mittal, who saw that she was on a path to a complete renunciation of her previous life.

And there was the American woman in her 20s who had been traveling in India before withdrawing from contact with home – one of the more severe cases Mittal has seen. After months of searching, she was found living in an ashram in Rishikesh and performing erotic, half-naked dances each night. When confronted by Mittal’s team, she was adamant that she was an apsara, a female mythological spirit who tempts yogis and priests to test their resolve in celibacy. She assured Mittal that she was fine and that this was her path, but she appeared to be in a trancelike state.

For both Airault and Mittal, in most cases, the treatment is simple: a plane ticket home. But in other, more severe cases, the experiences of some individuals in India can leave permanent marks on their behavior even after they return home. In one case, a Japanese tourist had been reported missing and was tracked to Varanasi, where he had had a psychotic episode and been detained by police after trying to board a train without a ticket. When he was brought to the clinic, Mittal found him to be suffering from schizophrenia and sent him home to Japan. Four years later, he reappeared at the clinic, asking to be hospitalized. “He felt he was going to be safe in India,” Mittal says.

“At one end, it could be a true pursuit,” Mittal explains, “and for somebody else it could result in a psychotic state.” At this darker end, some travelers come to believe that they are inhabited by spirits or are a god incarnate. Others place themselves in dangerous situations by pushing themselves to increasingly greater extremes in their search for spiritual fulfillment.