With its rich cultural diversity, Manipur is home to at least 34 distinct communities, often earning it the moniker of “mini-India.” As such, the state reflects many of the challenges faced by the broader Indian subcontinent. Being a landlocked region with limited connectivity, Manipur has also historically struggled with prolonged armed conflict. This ongoing unrest has perpetuated systemic oppression and deepened socio-economic disparities, contributing to increased mental health vulnerability among its residents. This article offers a brief exploration of Manipur’s mental health landscape.
The PARAM framework explores pathways towards resilience against and vulnerability to mental illness. It can offer insights into protective factors in the face of chronic and multifactorial adversity, as exists in Manipur. To understand how PARAM could enable a deeper understanding, we must first examine the scope and nature of the challenges in Manipur.
Mental Health Challenges in Manipur
Manipur’s mental health landscape is both severe and under-addressed. According to the National Mental Health Survey (NMHS) 2015-2016, Manipur had the highest lifetime prevalence (19.9%) of Mental Health disorders among surveyed NMHS states. Yet, it ranks among the lowest in prioritising mental health programmes as well as developing mental health action plans. Barriers to care are compounded by inadequate access to mental health resources and trained service providers. The situation is further complicated by the fact that the mental health landscape is shaped by strong cultural beliefs and a deeply rooted stigma surrounding mental illness. The NMHS (2015-2016) also highlighted a significant treatment gap of 86% for mental health disorders. This combination creates significant barriers to care, leaving many individuals without the necessary support. To further understand these barriers, we need to consider the cultural context that influences perceptions and treatments for mental health in the state.
Culturally Bound Syndrome
The customs and traditions of different communities in Manipur influence their health belief practices. Mental health in Manipur needs to be studied within the context of culturally bound syndromes, which are deeply rooted in the indigenous religion, Sanamahism, and long-standing traditional medicinal practices. One notable aspect of Sanamahism is the phenomenon of spirit possessions, which manifests in different forms throughout Manipur. In Manipur, the understanding of spirit possession diverges from the typical perception of illness. Not all possessions are perceived as pathological. Some possessed individuals experiencing Lai Tongba are often regarded as the chosen ones to be mediums who connect the spirit world and the human realm, thereby attaining a revered status within society (Singh, 2020). Consequently, treatment for any other possessions aligns more with traditional healing methods rather than biomedical approaches. The community also has an array of healers who specialise in various aspects of traditional healing practices (Singh & Singh, 2019; Mangang, 2012).
Conflict-Related Trauma
Years of insurgency, counterinsurgency operations, and ethnic strife have also caused widespread trauma. These armed conflicts worsen public health and hinder healthcare delivery, especially among marginalised groups (Yumnam & Dasgupta, 2017). Studies consistently show that exposure to armed conflict increases the risk of mental health disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety (Mesa-Vieira et al., 2022). This underscores the urgent need for comprehensive mental health care for those most affected in conflict zones (Amsalem et al., 2025). Recent data suggest that trauma can be biologically embedded across generations (El-Khalil et al., 2025), with epigenetic changes influencing individual vulnerability and playing a role in the transgenerational transmission of trauma effects (Addissouky et al., 2025). While conflict-related trauma poses a significant challenge, Manipur’s geographical location presents an equally critical issue.
Substance Abuse and Addiction Due to Proximity to Trade Centres
The high rate of substance use disorder in Manipur is affected by its 367.5 km international border with Myanmar, much of which remains unfenced. This, along with the proximity to the Golden Triangle, ongoing political instability, ethnic conflicts, illegal poppy cultivation, and weak government regulations, has dramatically increased drug trafficking and substance misuse in the region (Haorungbam, 2024; UNODC, 2006). This supports findings from the National Mental Health Survey (NMHS) (2015-2016), which reports that about 23.7% of Manipur’s population, or roughly 6,67,000 people, are affected by substance use disorders.
The interconnected challenges, from cultural factors to trauma and substance abuse, in Manipur warrant evidence-based and ground realities-driven revamping of mental healthcare systems.
Relevance of the PARAM Framework in Manipur
The mental health challenges of Manipur are shaped by its culture, history, geography, and ongoing political conflict. The PARAM project offers a timely and context-sensitive model for understanding and addressing these complexities. A primary objective of PARAM is to trace neurodevelopmental trajectories that underlie resilience and vulnerability, and to explore the interactions between genetic programming and exposure to environmental insults (Benegal et al., 2024).
PARAM collects a wide range of information, including genetics, brain development, personality, nutrition, and various illnesses. This helps in understanding the unique vulnerabilities while recognising existing sources of resilience. Several of these assessment tools are particularly relevant to the state’s conflict-affected context.
Exposure evaluations like the WHO’s Adverse Childhood Experiences International Questionnaire (ACE-IQ) measure the impact of violence and trauma at home, in the community, and in society, and are expected to help capture the effects of collective violence exposure in Manipur. This, combined with diagnostic tools including WHO – ASSIST to identify and manage substance use and related problems, DSM-PHQ-9 for measuring depression, Kessler Psychological Distress Scale (K10) for measuring psychological distress, and WHO FLII-11, which can capture the diagnostic evaluation of a range of mental health and substance use disorders for lifetime, past year, or current prevalence, will provide a comprehensive picture of the mental health scene. Additionally, tools like the Alabama Parenting Questionnaire (APQ), which collects data on parenting functioning, as well as family history from the pedigree, will shed light on parental psychiatric and migration history. In addition to psychosocial and clinical data, PARAM also investigates biological markers, offering insight into how prolonged exposure to conflict-related stress and trauma may become biologically embedded in the body and even be passed down through generations.
The holistic integration of genetic and phenotypic characterization of individual in their physical and psychosocial environments, through culturally and regionally relevant measurements being undertaken in PARAM, presents an unprecedented opportunity. These could well shape pathways to resilience for entire communities in the region.
About the Author – Sapam Kiran Dolly
I’m from Manipur. I love exploring how digital technology shapes mental health, and how we can use it in healthier, more meaningful ways. I’m also deeply interested in the generational impact of trauma. Outside of research, I enjoy catching up on my reading and the slow craft of knitting socks.
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