Found no detrimental effects on physiological health, & saw subjective health improvements (greater for those who engaged in more intense forms) in kavadi attam, a high-risk extreme ritual practice

Effects of Extreme Ritual Practices on Psychophysiological Well-Being. Dimitris Xygalatas, Sammyh Khan, Martin Lang, Radek Kundt, Eva Kundtová-Klocová, Jan Krátký, and John Shaver. Current Anthropology, Aug 30, 2019. https://www.journals.uchicago.edu/doi/abs/10.1086/705665

Abstract: Extreme ritual practices involving pain and suffering pose significant risks such as injury, trauma, or infection. Nonetheless, they are performed by millions of people around the world and are often culturally prescribed remedies for a variety of maladies, and especially those related to mental health. What is the actual impact of these practices on health? Combining ethnographic observations and psychophysiological monitoring, we investigated outcomes of participation in one of the world’s most extreme rituals, involving bodily mutilation and prolonged suffering. Performance of this physically demanding ordeal had no detrimental effects on physiological health and was associated with subjective health improvements, and these improvements were greater for those who engaged in more intense forms of participation. Moreover, individuals who experienced health problems and/or were of low socioeconomic status sought more painful levels of engagement. We suggest two potential mechanisms for these effects: a bottom-up process triggered by neurological responses to pain and a top-down process related to increased social support and self-enhancement. These mechanisms may buffer stress-induced pressures and positively affect quality of life. Our results stress the importance of traditional cultural practices for coping with adversity, especially in contexts where psychiatric or other medical interventions are not widely available.

Video of those ritual practices: https://www.youtube.com/watch?v=8aa2YLKxOkw

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Despite their potential risks, extreme rituals in many contexts are paradoxically associated with health and healing (Jilek 1982; Ward 1984). Our findings suggest that within those contexts, such rituals may indeed convey certain psychological benefits to their performers. Our physiological measurements show that the kavadi is very stressful and high in energetic demands (fig. 2C, 2D). But the ostensibly dangerous ordeal had no detectable persistent harmful effects on participants, who in fact showed signs of improvement in their perceived health and quality of life. We suggest that the effects of ritual participation on psychological well-being occur through two distinct but mutually compatible pathways: a bottom-up process triggered by neurological responses to the ordeal and a top-down process that relies on communicative elements of ritual performance (Hobson et al. 2017).

Specifically, the bottom-up pathway involves physical aspects of ritual performance related to emotional regulation. Ritual is a common behavioral response to stress (Lang et al. 2015; Sosis 2007), and anthropological evidence shows that in many cultures dysphoric rituals involving intense and prolonged exertion and/or altered states of consciousness are considered as efficient ways of dealing with various illnesses (Jilek 1982). In our study, those who suffered from chronic illnesses engaged in more painful forms of participation by enduring more piercings. Notably, higher levels of pain during the ritual were associated with improvements in self-assessed health post-ritual. Although the pain was relatively short-lived, there is evidence that the social and individual effects of participation can be long-lasting (Tewari et al. 2012; Whitehouse and Lanman 2014).

The sensory, physiological, and emotional hyperarousal involved in strenuous ordeals can produce feelings of euphoria and alleviation from pain and anxiety (Fischer et al. 2014; Xygalatas 2008), and there is evidence of a neurochemical basis for these effects via endocrine alterations in neurotransmitters such as endorphins (Boecker et al. 2008; Lang et al. 2017) or endocannabinoids (Fuss et al. 2015). These endocrine effects are amplified when performed collectively, as shown by studies of communal chanting, dancing, and other common aspects of ritual (Tarr et al. 2015). While it is uncertain how long-lasting these effects are, such euphoric experiences may become self-referential for future well-being assessment.

At the same time, a top-down pathway involves social-symbolic aspects of ritual. Cultural expectations and beliefs in the healing power of the ritual may act as a placebo (McClenon 1997), buffering stress-induced pressures on the immune system (Rabin 1999). In addition, social factors can interact with and amplify the low-level effects of physiological arousal (Konvalinka et al. 2011). Performed collectively, these rituals can provide additional comfort through forging communal bonds, providing a sense of community and belonging, and building social networks of support (Dunbar and Shultz 2010; Xygalatas et al. 2013). The Thaipusam is the most important collective event in the life of this community, and higher investments in this ritual are ostensibly perceived by other members as signs of allegiance to the group, consequently enhancing participants’ reputation (Watson-Jones and Legare 2016) and elevating their social status (Bulbulia 2004; Power 2017a). Multiple lines of research suggest that individuals are strongly motivated to engage in status-seeking efforts (Cheng, Tracy, and Henrich 2010; Willard and Legare 2017) and that there is a strong positive relationship between social rank and subjective well-being (Anderson et al. 2012; Barkow et al. 1975). Indeed, we found that individuals of lower socioeconomic status were more motivated to invest in the painful activities that can function as costly signals of commitment. Recent evidence from a field study in India shows that those who partake in these rituals indeed reap the cooperative benefits that result from increased status (Power 2017b).

In addition, the cost of participation can have important self-signaling functions. On the one hand, it can boost performers’ perceived fitness and self-esteem, which positively affects mental health (Barkow et al. 1975). On the other hand, through a process of effort justification, such costs can strengthen one’s attachment to the group and sense of belonging (Festinger 1962; Sosis 2003). This role of costly rituals in generating positive subjective states (Bastian et al. 2014b; Fischer et al. 2014; Wood 2016) and facilitating social bonding (Bastian, Jetten, and Ferris 2014a; Whitehouse and Lanman 2014) may offer insights into the functions of painful religious practices.