This post is written by Muskan Soni, Research Author, Department of Sociology, Monk Prayogshala, Mumbai, India.
It is not uncommon to find praise prefaced with paranoia in Indian households; compliments are often followed by the perfunctory: “nazar na lage” (may you be spared of the evil eye).
For a disorder that looks for comfort in routines, the arsenal of remedies available in India could only be a delight for the obsessive-compulsive brain. Different subcultures offer their own snack bar of options to soothe the anxious mind: salt, chillies, lemons, camphor, alum. The evil eye is hardly unique to the subcontinent, but it deeply permeates Indian social culture: black dots behind ears, a string of chillies at the door, saying “mashallah” at the end of compliments, and the list goes on. These are routines, practised daily to ward off bad luck. But what really happens when a disorder looks curiously like someone following cultural norms?
Can culture camouflage compulsions?
A 2024 study on cultural variations in how obsessive-compulsive disorder (OCD) manifests found that compulsions take different forms across cultures: religious and ritual compulsions in Middle Eastern countries, symmetry and order in East Asia, checking and counting in the West, and contamination and cleaning, most prominently, in the Indian subcontinent. This is not to say culture can cause OCD, but it is worth asking how a disorder in search of compulsions could borrow from a cultural framework like the evil eye that already offers locally endorsed practices. In a clinical screening, such compulsions can lose their ego-dystonic labels, and the disorder itself might become invisible.
This invisibility also presents in numbers: While older epidemiological estimates put OCD prevalence in India at 0.6 percent against global averages of 2 and 3 percent, the National Mental Health Survey of India (2015–16) updated this to a lifetime prevalence of 0.76 percent. Read uncritically, this might suggest that India has less OCD, but anyone who has spent time in an Indian household knows how profoundly ritual repetitions make up everyday life. This, perhaps, raises a tougher question: How do you distinguish practices that are culturally ingrained, absurd, and outdated, such as caste purity-based discrimination, from contamination-based OCD? Caste-based hierarchies offer a seemingly incontestable hiding place for contamination compulsions, the same way the evil eye borrows from rituals that were already socially sanctioned. For an observer, the actions may look identical internally, even when they are driven by distress.
Cross-cultural treatment
Cross-cultural discussions often focus on scrupulosity or religious OCD. Even a quick search on Reddit, the largest ledger of human anxieties, turns up more results for religious OCD than threads about the evil eye. Warding off nazar rarely registers as a subject of its own. For a disorder shaped by thought-action-fusion, or the belief that thoughts can equate to actions, this is perhaps not all that surprising: if posting about it might invite more of the same, then it follows that the rare few who voice these anxieties also confess that even typing it is scary.
I once asked an American friend who had spent a few months in India what had stuck with her the longest. Touching her head every time her foot brushed a book wasn’t on my roster of guesses, since she was neither religious nor did she believe a book could be disrespected by a foot. Still, a few months around people who wholeheartedly believed it and the reflex stuck. This behavioural contagion thus begs the question: If a brief encounter with these protective routines could be absorbed so quickly, what happens after years of conditioning in a brain predisposed to OCD?
Such examples of behavioural realities within India reveal some of the blind spots of individualistic therapy. Exposure and Response Prevention (ERP), often considered the gold standard for OCD treatment, requires resisting compulsions. However, many compulsions sit within the thresholds of culture and escape pathologising, as they can be hard to resist within a model that validates them as protective routines.
In socially bound communities, resisting certain rituals could also be looked at as social transgressions, and therapy as a sort of cultural or religious violation. Treatment within such cultures could also get complicated as individuals seek out faith healers instead of licensed professionals to assuage their anxiety related to supernatural causes such as the evil eye.
The burden of resistance
Living in a communal society, a person with OCD has to negotiate their disorder while balancing social expectations that are both encouraged and demanded. Belief in the evil eye is not as personal as one’s compulsions might be; nazar is often warded off on behalf of others; priests, faith healers, and well-meaning grandmothers have all been found with black threads and burning chillies to “protect” children, houses, cars, and even exam results. Therefore, treatment plans designed for individual discomfort might struggle with compulsions that never belonged to the individual in the first place. This, in turn, calls into sharper focus everything that this piece has been asking: When someone with OCD reaches for the same ritual their culture offers, are they managing their own anxiety or a social one?
