Jainism - Its relevance to psychiatric practice; with special reference to the practice of Sallekhana.

The short version

This paper examines Sallekhana (also called Santhara), a Jain religious practice of ritually fasting to death, and explains why understanding it matters for psychiatrists and mental health professionals. Jainism is one of India's oldest religions, and Sallekhana has been documented since at least the 4th–3rd century BCE. The authors' core argument is that Sallekhana is philosophically and legally distinct from suicide, and that clinicians unfamiliar with its religious context risk misreading a practice that some of their Jain patients or patients' families may encounter or discuss. Rather than a clinical trial, this is a historical and textual analysis. The authors draw on Jain scripture, secular Tamil literature from the Sangam era (roughly the first centuries BCE/CE), scholarly legal commentary, Indian census data, and 2015 Indian court rulings to trace Sallekhana's history, criteria, and modern legal status. Sallekhana is permitted only for specific reasons — intolerable suffering, old age, or incurable illness — and traditionally requires a person to be examined by learned Jain teachers who confirm the motive is spiritual liberation, not despair, before the practice is sanctioned. The paper distinguishes Sallekhana from vadakirutthal, a similar-looking but genuinely suicidal fasting-death practice recorded in secular (non-Jain) Tamil literature of the same era. It also recounts a real 2015 legal controversy: India's Rajasthan High Court ruled Sallekhana illegal and equated it with suicide, but the Supreme Court stayed that ruling within a month as unconstitutional, after which at least two elderly Jain women in Tamil Nadu reportedly undertook the practice. The authors summarize Jainism's five core ethical vows (nonviolence, truthfulness, non-stealing, chastity, and non-possessiveness) and its three-part path to liberation (right knowledge, faith, and action) as the philosophical backdrop that gives Sallekhana its meaning within the tradition. The authors argue Sallekhana should not be automatically classified as suicide by clinicians or courts, and that this topic deserves more attention in psychiatric training, especially for professionals working with Jain communities. Because this is a historical and ethical review rather than a clinical study, it offers no patient outcomes, treatment data, or statistics — its value is in cultural context for mental health practice, not in evidence of a therapeutic intervention.

Key findings

• Sallekhana (also called Santhara) is a Jain religious practice of ritually fasting to death, traditionally permitted only for intolerable suffering, old age, or incurable illness, and only after community examination of the person's spiritual motive.
• The paper argues Sallekhana is philosophically and procedurally distinct from suicide, distinguishing it from vadakirutthal, a similar-looking but genuinely suicidal fasting-death practice recorded in secular Tamil literature.
• In 2015, an Indian court ruled Sallekhana illegal and equivalent to suicide, but the Supreme Court stayed that ruling within a month as unconstitutional; at least two elderly Jain women in Tamil Nadu are reported to have undertaken the practice since.
• Jainism's philosophy rests on five core ethical vows — nonviolence (ahimsa), truthfulness, non-stealing, chastity, and non-possessiveness — and a threefold path of right knowledge, faith, and action.
• The authors recommend that psychiatrists and mental health professionals learn about Sallekhana's religious context so they can avoid misclassifying it as suicide in clinical or legal settings involving Jain patients.

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