Asian Journal of Psychiatry 5 (2012) 339–343

Sikhism, spirituality and psychiatry

Gurvinder Kalra a, Kamaldeep S. Bhui b, Dinesh Bhugra c,*a Department of Psychiatry, Lokmanya Tilak Medical College & Sion Hospital, Sion, Mumbai 400022, Indiab Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UKc Health Service & Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK

A R T I C L E I N F O

Article history:

Received 12 April 2012

Received in revised form 10 August 2012

Accepted 13 August 2012

Keywords:

Depression

Spirituality

Sikhism

Sikh

Psychiatry

A B S T R A C T

Sikhism has millions of followers in India and among the Indian diaspora. As a religion it is relatively

young but carries with it unique perspectives which are often not well known. The holy book of Sikhism,

Guru Granth Sahib, is not only the last Guru, but also remained a key text for this religion. Using

descriptions of the religion and its followers we attempt to understand the context of spirituality within

this religion and attempt to apply it to clinical settings. We explored various texts to understand the

notions of spirituality and ethics and directions for living one’s life. We studied both the Gurumukhi

version as well as the English translation of the Sikh holy text. In the context of history of the Sikhs,

various descriptions related to mental well being were identified. In this paper we describe the history,

development and the core values of the religion and we also review their role on psychiatric and mental

health settings for managing Sikh patients. Guru Granth Sahib offers a very useful insight into what is

understood by the term equivalent to depression and its phenomenology. The notions of dukh (loosely

translated as pain, but can also mean sadness or suffering) and maya (illusion) and their role in daily

living are also discussed. In this paper these descriptions are explored further and their importance

explained.

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1. Introduction

Sikhism originated in the Punjab province of India whichremains the homeland of the religion, though the Sikh diaspora isvery prominent in many countries, including the UK and Canada.The current geographical state of Punjab is smaller than it used tobe centuries ago. Guru Nanak – first of the Sikh gurus – was born in1469 in Talwandi (now Nankana Sahib), 55 miles west of Lahore. Atthat time, the indigenous population of the region was largelyHindu. His personal experiences inevitably led Guru Nanak toestablish the Sikh religion. He had a mystical experience which ledhim to challenge the existing religious orthodoxies. After thisexperience, his first poetic experience is described as Mool Mantra,which encapsulates his concept of divinity.

The term guru is applied to someone who dispels ignorance ordarkness (gu) and who proclaims enlightenment (ru) (Cole andSambhi, 1989). Following a series of journeys and events, he beganto express his thinking, and individuals started to follow him andhis teaching. Many of these teachings, writings and pronounce-ments from that time form the core of Sikhism. Guru Nanak thensettled down with his family at the age of 50 and continued todevelop the philosophy of Sikhism through creating a community.

* Corresponding author. Tel.: +44 20 7848 0500; fax: +44 20 7848 0333.

E-mail address: dinesh.bhugra@kcl.ac.uk (D. Bhugra).

1876-2018/$ – see front matter � 2012 Elsevier B.V. All rights reserved.

http://dx.doi.org/10.1016/j.ajp.2012.08.011

A few days before his death, Guru Nanak chose a successor to carryon with his work by presenting him with a book of his own hymns(a pothi) and a woollen string (a seli) indicating renunciation of theworld and devotion to God. The growth of the religion continuedapace over the next three centuries with Guru Gobind Singh beingthe last guru. Born in 1666, he was a significant leader, a poet aswell as a major warrior. He introduced rites how people were to beinitiated into the religion. He also developed a code of disciplinewhich prohibited certain diets and activities. Initiated men tookthe name of Singh (the lion) and members of the new communitywere called Khalsa (the Pure Ones). Guru Gobind Singh emphasizedequality by inviting men and women from all castes to join thecommunity. On his deathbed, he pronounced that Guru Granth

Sahib becomes the last guru of Sikhs.We studied both the Gurumukhi and the English translation of

this Sikh holy text and identified various descriptions related tomental well being. In this paper we describe the history,development and the core values of the religion briefly and wealso review their role on psychiatric and mental health settings formanaging Sikh patients.

2. Core concepts

Guru Granth Sahib has contributions from all the gurus alongwith many others from Sufi tradition as well as other significantpoets and scholars of the time. The scripture is subdivided

1 The first number in parenthesis indicates page numbers from the Guru Granth

Sahib while the second number indicates the line number on that page.

G. Kalra et al. / Asian Journal of Psychiatry 5 (2012) 339–343340

according to musical settings; the names of the sections beingthose of Indian musical arrangements. Each section has a uniformorganization with hymns of Guru Nanak appearing first, followedby the third, fourth, fifth and ninth gurus and then those of otherSufi ascetics. The scripture is unique, as it has contributions fromSufis, Hindus and Muslims as well. It also makes references to thegreat Indian epics Ramayana and Mahabharata.

The language used is called Gurmukhi; the form is poetry andthe aim is to provide a sense of essential unity with God to thelistener or the reader. God is seen as supreme, but also as a friendand a lover and living is the key to a proper relationship with God.

As Guru Gobind Singh, the last Sikh Guru, declared that after himthere will be no Guru and the diktat of Granth Sahib shall be final,the Shri Guru Granth Sahib (Granth – book; Sahib – Supreme) thus isthe final Guru of Sikhism. It is a voluminous religious text of 1430pages, compiled and composed by the Sikh Gurus from 1469 to1708 (Rahi, 1999). It consists of a collection of hymns whichdescribe the qualities of God and the various reasons on why oneshould meditate on God’s name. The text was first compiled by thefifth Sikh guru, Guru Arjan Dev, from the hymns of the first five Sikhgurus. The holy book has been a source of emotional andpsychological support, through the means of prayers in Sikhism.It is revered and worshipped by the Sikhs as their spiritual guide.

Cole and Sambhi (1989) emphasize that Guru Granth Sahib is thevisible focal point for Sikh devotions. It dominates the Sikh ritualand theology as well as has a significant role in daily living,ceremonies, festivals etc. Thus a notion of spirituality is at the coreof functioning of Sikh individuals. Gurudwaras, their religioustemples are at the centre of practice of religion, though Guru Granth

Sahib will be present in most Sikh households. The functions of thegurudwara, apart from reading the scriptures, include providing acommon kitchen, sharing food and offering shelter and support tothose who need it.

Sikh theology relies on a monotheistic approach. Ultimatereality is a unity with God, and as God is without qualities, truthbecomes an inadequate description (Cole and Sambhi, 1989). TheGod is one, only one in this context which, according to Cole andSambhi (1989), raises the question of whether it really is amonotheistic religion or monistic. These authors argue thatSikhism has no difficulty in coming to terms with scientifictheories of evolution and that of an expanding universe. Withinthe religious writings there is an opposition to materialism.Interestingly, another key factor is the belief that God is residingat home, so every individual must do the duty at home. Man isnot only the latest or highest product of an evolutionary processbut is the result of God’s intention. The exact reasons of why Godmade man are not clear; man’s condition is of interest and notthe reasons for birth. Like many philosophers and thinkers,ignorance on man’s part is the problem. Man is intelligent, isaware of the notions of right and wrong, but may still miss thechance to meet the Lord. The reasons for this vary from birth,environment, karma (the notions of cause and effect), maya (amaterialistic view of the world) and self-dependence rather thanan acknowledgement that God also has a role. This dependenceupon God and obedience to his will (hukam) is at the heart ofbeing liberated (Cole and Sambhi, 1989). This interactionbetween birth, environment, etc. is not dissimilar to the bio-psychosocial models of understanding an individual. Cole andSambhi (1989) argue that according to Sikhism the world existsin reality and is not to be rejected. Liberation is different fromrebirth and is a release from the round of death with man unitingwith God resulting from the soul reaching the stage of sack khand

(the realm of truth, the ultimate stage in the development of thesoul). Liberation is obtained by meeting the guru through naam

simran (remembering the name). The name in this context is thatof God, but can apply to anything. It has certain rituals attached

to it and the practice is that of transforming personality throughpractice.

As noted above, the guru in this context must be an enlightenedmessenger of God and this approach has been used in psychother-apy in the Indian context (Neki, 1973). As writings of other authorswere included in the scriptures, it is clear that the gurus saw thatthere are many paths to God and they themselves did not haveexclusive access to the truth or there was not a single way offinding the salvation which is an intriguing show of open-ness.

Rituals related to Sikhism are clearly described with emphasison clean physical appearances and saying prayers regularly. Work,worship and charity form the core of Sikh ethics. Self-conceit is notto be encouraged, as it will lead to lust, anger, greed andmaterialism. Sikh charitable work is critical in supporting thosewho are vulnerable. Thus there is a clear direction away from anindividualistic and ego-centric development and view.

Spiritual aspects rely on the core notion of good deeds andconcepts of heaven (suarg) (182-11) and hell (narak) (91-1). Theemphasis on home responsibilities and duties are highlighted bythe advice that one should not wish for a home in the heavens, andshould not be afraid to live in hell (337-10) even though someyearn for paradise (bhisat) and others long for heaven (surgindoo)(885-11) thereby reflecting human nature. However, heavencannot be attained without the karma of good actions (p. 952);thus there is a system of reward for good deed and a clearencouragement to do so.

In the developmental context like Hindu beliefs there are fourstages of life but unlike Hinduism where these stages are ofcelibacy, householder, societal obligations and giving up of worldlythings the four stages in Sikhism are different (p. 113; p. 687). Thefirst is that of creation of life, second is the sense of duality(dubidha), third is the three-phased maya, and the fourth stage, thehighest is that of mukti where one attains a state of bliss andultimate happiness. The process of creation, i.e. being in theintrauterine life has been described as a terrible hell (narak ghor)(706-7), wherein the fetus has to rest head downwards. Thus therelationship with the world starts in an upside down manner. Thethree-phase maya is said to affect almost every human being in theworld (129-6; 297-3) and keep them in spiritual darkness (agyaan)(509-14). Maya is illusion but can also mean mirage especiallywhen used to describe material things. Attachment to maya hasbeen compared to a treacherous wilderness (maha-sankat) (220-2)and mirage (mrig-trisna) which is chased by individuals eventhough they know it is false (219-9); it has been compared to awitch (daainn) (868-3) and sweet wine (madu-meetha) which theintoxicated mind (muhn-matwala) continues to drink (350-7). Onecan break the bonds of the three-phase maya only by the guru’sshabad (words or teachings), after which one moves to the state ofliberation (mukti) (127-12). This approach thus starts to makesense in the context of psychotherapy where the guru is able toteach the pupil to detach from maya and achieve mukti. Maya isalso understood as having (undue) emotional attachment toanything apart from the Lord and described as having a pale color(sooha) while Lord’s love at the fourth level, a beautiful deepcrimson color (laal) (221-3). With maya, the spiritual conscious-ness (soorat) is lost (p. 989); one is emancipated only after freeingoneself from maya. Pages 76–77 in the text specifically describe theprocess of birth, and the way in which emotional attachmentsdevelop between the child and the parents, through hugging andembracing the child. However, all this has been described asemotional and worldly attachments which is only transitional andmortal, leading one into grief. Attachment to the Lord on the otherhand is immortal. The Lord himself has created maya and moh

Table 1Metaphors for dukh and sukh in Guru Granth Sahib.

Dukh (sadness) Sukh (happiness)

Agani (fire) (21-15) Anad (190-10) or Annand or

Anado or Annant (joy)

Andesa (anxiety) Binod (joy) (547-2)

Andh-gubbara (pitch darkness)

(116-10) or Andh-andhara (125-7)

Dheera or dheeraj (patience) (206-2)

Antar-maeill (inner filth) (22-10) Kalyan (welfare, happiness,

blessedness)

Baavra (madman) (235-10) Khem (well being) (295-6)

Bairaag (renunciation) (247-7) Kusal (well, happy, healthy) (256-2)

Baurani (insanity; 424-6) Mangal (well, happy) (191-1)

Bhau-jal (terrifying world-ocean)

(22-6)

Nidhana (treatment) (186-1)

Birha (1379) or Birtha (separation)

(p.860)

Nihaal (rapture; 200-5)

Chint (anxiety; 191-10) or Chind

(anxiety; 299-18)

Paramanand (supreme

bliss; 194-15)

Chint-rog (disease of anxiety) (188-13) Ras (joy) (680-11)

Duhel (conflict, disturbance) (379-1) Saanti (peace) (516-2)

Dukh (sadness) (21-12) Seetal (content) (191-12)

Jhoor (grieve, sulk, lament) (263-12) Suhaila or suhel (soothing) (379-1)

Kal-saagar (ocean of pain; 324-11) Sukh (contentment) (191-1)

Klesh (anguish) Thand (peace)

Maeill (pollution or filth) (p. 18) Ulaas (rapture) (677-13)

Peerh (pain) (861-19)

Rog (disease) (195-15)

Sansaa (anxiety) (p. 1218)

Sar saagar (world ocean) (p. 17)

Sog (grief) (63-1)

Sootak (pollution) (229-12)

Udaas (sad) (71-8)

Unmaad (madness) (867-4)

Vaaeinn (cries of distress) (136-18)

Vad-taap (deadly fever) (199-12)

Table 2Characteristics of two types of individuals as per the Guru Granth Sahib.

GurmukhCarefree (nichand) (29-13).

Have shed their egos (29-11).

Sleep and wake in peace (p. 646).

Enlightened, blessed and undefeatable and a virtuous being, who practices

truth, self-discipline (sanyyam) and good deeds (26-15), and has radiant

faces (mukh ujley-590-13).

Never suffer bodily pain (125-3) and are always happy (131-10) to the

point of never suffering in dukh (424-15; p. 1032).

ManmukhSelf willed (29-11).

Egoistic (haumai) (29-16).

Filled with wickedness (vikar) and desire (trishna) (29-7) and anger.

Ignorant (agyan), evil-minded (durmat) and egotistical (ahankaari) (314-14).

Filled with anxiety and cannot sleep (p. 646).

Usually gamble (juuaa).

Suffer in dukh (sadness) (131-10) because of their love of duality (128-1).

They are born in dukh and die in dukh (p. 947).

G. Kalra et al. / Asian Journal of Psychiatry 5 (2012) 339–343 341

(emotional attachment) (125-16). The enticing desire for maya

leads people to become emotionally attached to their children,relatives, households and spouses (61-9). Only emotional attach-ment and love to god is considered pure and peaceful and full ofcontentment (p. 61). Key concepts in understanding the compo-nents of psyche are related to worldly attachment and also to thenotions of mukti as described above. These are not only emotionsbut also experiences which form the core of one’s being. Thesewords cannot be translated suitably as they mean much more thanliteral translation.

3. Dukh and sukh in Guru Granth Sahib

Not surprisingly human beings live with emotions and undergoexperiences—some of which are painful and others pleasurable.Some emotions and experiences may well be rather neutral. Likereligious texts from other religions, notions of jealousy, pride,greed etc. are described in the text. Emotions of hatred/vengeance(vaeir), anger, and greed (lobh) have been looked down upon as bad(p. 108) for the living and for human experiences. The text alsoexplicitly discusses sadness (dukh) and happiness (sukh) usingmany metaphors (Table 1). These terms and their descriptionshighlight the intrinsic unhappiness in the world especially if one isdetached from the God. The world whether it is at large or anindividual one is unhappy (dukhiya) (413-2) and, overflowing withpain and suffering (767-6); where in only a few are happy (sukhiya)(413-2). This does not mean nihilistic interpretation but a realisticone where individuals perhaps expect too much and feel let down.The only way this unhappiness can be overcome is by devoting oneto God.

As both the experiences and emotions of dukh and sukh arecreated by the Lord (125-13; 787-12), he is the one who relieves itand is thus both Dukh-bhanjan (destroyer of dukh) (99-6) andSukhsaagar (ocean of peace and happiness) (927-12). Happinesshas been referred to as a jewel (ratan) which lies within the self, butwe receive it only if the Lord wants us to get it (117-2). Thus thisconcept becomes incredibly important in our understanding ofmodels of illness, pain and emotions that individuals carry withthem. Throughout the text, Lord has been equated to peace andhappiness and looking for him outside oneself leads to terrible pain(maha-dukh) (p. 124). This may refer to people searching forhappiness outside themselves, whereas the emotions are internal.Thus, the external search can lead to sorrow. The text makes it clearthat happiness is a state of mind and a choice we make. Thiscognitive reframing enables individuals to carry their emotions inthe context of their functioning.

The mind (muhn) is considered prone to get diseased withdoubt (bharam), superstition (bhed) and duality (dooja) (416-7), allof which ultimately keep the person in dukh. Bharam is also a termused for delusions and overvalued ideas in clinical assessments butdoes not mean psychopathology in the spiritual context and doesso as a philosophical argument and development. Interestingly it isnoted that melancholy can affect anyone whether they are the richor the poor and can affect them equally (182-1) indicating thatunhappiness or depression in a broader context can have nospecific targets but any one can be prone to it. The state of a personafflicted with melancholy has been symbolically referred to a treewith dried leaves and branches, which become green in an instantwith the ambrosial name of the Lord (amrit naam) (191-8). Thus aritual and cognitive approach is indicated to come out of themelancholic experience.

Sukh comes when one remembers God (813-9); this clearlyindicates how important it is to remember God if one wants to behappy. This feeling of being content and happy is critical to goodfunctioning as an individual. Those who do not take his name,suffer in agony even after death (36-8) indicating that there is

happiness in the ritual itself. Those who sing his praises stay inecstasy forever (sadaa anand) (36-12). Love for Lord is thusconsidered the prime achievement and ambition, and any othertype of love has been referred to as the love of duality which leadsto conflict (p. 111) and thence to dukh, distraction, distress anddeath (113-9); this is a characteristic of individuals who aredescribed as self-willed manmukhs (113-18) as opposed to thosewho are described as gurmukhs (Table 2).

Karma has been etiologically related to dukh; bad karmic deedsmaking one sit and weep (15-11). Those with good karma on theother hand, never get affected by dukh (pain), rogue (disease), andbhau (fear) (184-3,4). By the good fortune of good deeds done in thepast, one can perform actions to determine one’s future (75-13).Thus good deeds are critical as the rewards can move across births.

G. Kalra et al. / Asian Journal of Psychiatry 5 (2012) 339–343342

The collective unconscious thus may play a role here in ourunderstanding.

Grief related to death of the loved one may make the survivor’slife a worthless one (83-15) and the loss of the husband may leavethe widow in sadness and dissatisfaction (226-2) therebyconfirming that loss itself can lead to grief and sadness whichmay be compared with modern notions of depression. Othercauses which may contribute to grief and misery include harshwords (fika-bol) (15-14) indicating a sense of alienation and hurt,hypocrisy (pakhand) (28-17) related to falsehood and pretensions,loss of wealth (dhan) (p. 59-14). Interestingly drinking wine resultsin madness (baral) (554-14) as does slandering the saints (sant ki

ninda). These actions can cause sadness, hopelessness (niraasa),pollution of the intellect, restlessness, misery and thereby lead toall sorts of diseases (rogue) (p. 279 and 280). The notion thatenvironment also plays a role in human functioning anddysfunction is illustrated by the observation that sadness can becaused by kaam—excessive and unfulfilled sexual desire, krodha—anger and ahankaar—egotism (p. 51). These demons (pareit) (513-13) and wounds of the soul (jeeah mei chot) (152-11) are prevalentin the environment thus indicating that individual responses tospecific provocateurs can cause problems.

4. Therapeutic context

The text describes five ways to achieve salvation: listening(suniyai) to the spiritual hymns (Bani), obeying (mannai) thesehymns, reciting the name of the Lord (Naam), meditating andsubjective experience of the name, and with the company of saints(Rahi, 1999). A lot of this is therefore cognitive reframing.Intuitive balance is described as the perfect state of mind whereunderstanding, peace and tranquility are produced, and a truedevotion to God is seen leading to the final state of happiness:Samadhi (p. 68) and a connection to the Lord. This state of intuitivebalance cannot be produced in a manmukh since he is alwaysengrossed in maya. In various verses, the spiritually inclinedperson (Giyani) is considered a balanced individual (351-9). Non-spiritual people have been symbolically compared to an emptyhusk (p. 192). Spiritually, people live either in total spiritualdarkness (andhiyaara) (128-4) or in light (chaanun) (129-3) ofspiritual energy where the light of the lord may illuminate theheart, dispelling all ignorance (368-13). God is ubiquitous (p.1226), pervading through water, land and the sky (89–15) andbeing the mind (muhn), body (tunn) and the breath (prana) (94-9),existing in each human’s heart (130-1). He is not limited to eitherthe temple (dehura) or the mosque (maseete) (875-3). In manypages of the text, Lord has been mostly referred to as a male, ahusband (p. 112; p. 127), lover (saajan), companion (sangi-261-17;saathi-375-4), friend (meet-108-5; sakha-375-6), darling (pyara),beloved (preetam), mother and father (maat, peeta-268-2), child(soot-780-4), brother (bhraata) (407-6), and relative (bandhap-780-4). The Lord is described as formless, shapeless and colorless(130-1; 578-7) supporting (tek) and anchoring (aadhaar) mankind(212-10). This nirakaat (formless) description is in contrast withsaakar (formed) God. The lord acts as a puppeteer (khilavanhaar),who dresses the puppets (kath ki puothi) and plays them around (p.206). The world has been called the garden being looked after theLord, the gardener (maali) (118-7), who himself plants all thesaplings (humans), irrigates them and in the end, devours themleading to their death (554-11). The mind (muhn) has beenvariously described as an inscription or message (parwaana)written on the body (kaya) which is a paper (kaagad) (662-10) or asthe priest (maulana) in the body which is a mosque (mahjeed) (p.1167). The mind has been compared to an intoxicated elephant,which can be bridled by the guru who has a controlling rod or canbe a rod himself (159-7). A mind-body connection has been clearly

stated to exist in some verses in the text, as on p.55 – man juthaey

tan juth hai jihva jooth hoe – if the mind is polluted, then the body ispolluted as well, and the tongue is polluted too (55-19). This isclearly in agreement with other great traditions of medicine (suchas Chinese or Ayurvedic medicine) which talk of a similarconnection and do not distinguish between ‘mental’ and the‘physical’ (Kirmayer and Young, 1998); while it contrasts with theWestern biomedical (especially Cartesian) concept of mind-bodydualism (Chaturvedi and Desai, 2007).

5. Therapy: the role of Lord and the Granth

The text thus not only describes the causes of dukh but alsoplays an important role in helping people deal with dukh at anindividual level. After cure from depression, i.e. when peace andtranquility come to the mind, the state has been referred to asSamadhi (p. 327), wherein the mind is restored to its originalbalanced state (sanaatan), and does not suffer from any illness.

The Lord is described as the true healer and physician (vaeid) (p.962) providing counseling (maslat) after conversation (gallaan)with the dukhi (592-5). Diagnosing dukh in the mind by thephysician (vaeid) is crucial (p. 1279). The name of the Lord issimilar to medicine (aukhad) (259-14; 675-6), which can cure dukh

(sorrow) and darad (pain) in an instant (288-8) providinghappiness that cannot be described in words (431-19) and makingthe mind, immaculate and impeccable (nirmal) (p. 1299) withoutmalice and abnormal emotions. The taking of the name of the Lordin itself is cooling and soothing for the mind (seetal) (p. 1142).Suffering (santaap), sorrow (dukh) and anxiety (chinta) do nottouch those who are regular with the name of the Lord (p. 44; p. 45;189-17; p. 201), thus making the gurmukhs resistant to depression.

The darshan (glimpse) of Lord also brings happiness (p. 460)which can last for a long time (26-11). It has been recommendedthat one should renounce all maya and meditate only on the nameof God. When the Lord dwells in mind, there is peace (18-7). If yousing of the Lord, your pain shall be sent far away and peace shallcome to your home (2-8; 11-4; 11-19; 20-19), and the diseases ofthe ego (haumaey) and doubt (bhrama) are cast out (47-18).This peace has been symbolized with gems, jewels and rubiesin the mind (2-12) (muhn wich rattan, jawahar, manak, je ik gur ki

sikh suni).In planning any therapeutic interventions it is critical that the

clinicians are aware of how these religious beliefs affect attitudesand help-seeking. These are formed not only as a result of beingborn into the religion but also due to developmental factors andcultural values. McMullen (1989) studied 500 Sikhs from sixvillages in the Punjab focusing on beliefs, practices and attitudes ofthe religious communities. The normative beliefs and practice ofreligion are distinct from its operative aspects. While studyingthese individuals, McMullen (1989) noted that over one-third hadno education and 40% of the sample consisted of students andhousewives, though it is not clear whether these students werefemale. One-third of the respondents regarded Guru Granth Sahib

as the source of religious authority and one-fifth saw tradition asthe source. Attending the gurudwara (38%), prayers (36%) andmeditation (87%) were three key components of religious activity.Over three-quarters of respondents attended the gurudwara fortheological and religious reasons. The five symbols of Sikh identitywere considered extremely important by a majority of respon-dents. Over one-third (37%) felt the presence of God all the timeand 16% did not. McMullen (1989) concludes that there did notappear to be a great deal of variation in the normative andoperative beliefs of Sikhs.

The notion of religious values and spirituality is thus inherent inthe community, and feelings of unhappiness, sadness anddifficulties are dispelled using prescribed rituals and religious

G. Kalra et al. / Asian Journal of Psychiatry 5 (2012) 339–343 343

practices. It is critical that clinicians take into account spiritualvalues and religious practices of Sikh patients. Five Ks – kirpan

(sword), kesh (long hair), kara (steel bangle), kach (breeches) andkangha (comb) are symbols of Sikh identity. Managing their valuesin the context of treatment and therapeutic engagement may bechallenging in some clinical settings, but need to be taken onboard. The strength of the family and religious values can be apositive advantage in forming therapeutic alliances. It should bepossible to use the scriptures as part of the treatment.

6. Conclusion

The Sikh religion constitutes social, cultural, political andterritorial identities and the role of spiritual values in dailyfunctioning is widely accepted and crucial. It is significant that anindividual’s cultural values and their slant on religious andspiritual values is taken into account and formulated in anytherapeutic management. Sikhism is a product of its culture andtime, but the values are applicable even today and are important to

individual patients and their families. Notions of sadness andunhappiness need to be understood and managed in such acontext.

Conflict of interest

The authors have no conflict of interests to report.

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