The 22-year-old woman was scared. She whimpered and whined and if she looked frightened her father seemed anxious. Worry was written all over his face.

She has been trying to run away from home, he said, and had been trying to bite people.

She has had a headache for years but it has got worse ever since she had a baby three months ago.

The Hakim

The father had brought his daughter to a traditional doctor or Hakim in the heart of rural Punjab. He had heard that the Hakim might be able to help.

The Hakim made an immediate diagnosis. Too much blood in the head he said. The pregnancy has disturbed her menstrual cycle and the blood has not been able to leave her body. It has gone to her brain instead, he said. I will have to drain it out.

However bizarre, this analysis was proclaimed with reassuring confidence but then the Hakim has had plenty of practice. His register shows that over the last 30 years he has treated no fewer than 160,000 people.

The bloodletting

The girl resisted. Plainly disturbed, she did not really seem to understand what was happening but she did realise something was up when she saw the Hakim's blade.

She was dragged to the centre of a dusty courtyard, made to kneel down and then restrained by her father and some of the Hakim's assistants.

The Hakim removed the purple veil which covered the woman's head and placed it around her neck. He twisted it tighter and tighter so that her blood flow was constricted.

Her veins throbbed and then with a deft flick of a finger, the Hakim sliced open her forehead.

Blood poured out filling a metal bowl which lay on the ground between her legs. Her whimpering got louder.

The blood kept on flowing. It was over within three or four minutes. The woman, visibly shaken and weakened, was helped to her feet by her father who led her to a chair.

Effects of the cure

The Hakim watched with a satisfied smile. "She will be back to normal in no time at all" he said.

Perhaps not surprisingly, as she left the clinic, the woman did try to bite the Hakim's arm.

He gave her a friendly cuff on the head in response and he said that if she was not cured yet that was simply because she needed follow-up treatment.

He said he had put her on a three-month course of herbal medicine.

"I could eliminate mental illness in all Pakistan," he said. "Blood letting has a 90% success record."

The history of bloodletting

The theory is centuries old, dating back to the ancient Greeks. The Hakim said his family has been carrying out the procedure for seven generations and the eighth generation is already getting ready to take over.

The Hakim's son, who watched the proceedings, has already been to Lahore to study Greek medical theory and he has been trained to carry out the blood letting himself.

Spiritual solutions

But while some put their faith in the Hakim and his methods, others prefer traditional healers who offer spiritual solutions for the mentally ill.

Healers like Pir Pinjar in Rawalpindi. Some Pirs beat patients in order to get evil spirits from their bodies.

They justify this on the grounds that they are not beating the person but rather the spirit.

But Pir Pinjar says he does not agree with such techniques - he prefers gentler methods. I attended one of his twice-weekly clinics.

His devotees gathered in a small room decorated with tinsel and squatting on the floor they rhythmically chanted verses from the Koran.

Awaiting the spirit

The Pir, who was lying on a bed covered in red cloth, convulsed, his toes sticking out at right angles. Someone lowered the lights and in the gloom the Pir started alternately groaning and speaking in a high pitched voice.

The spirit has come one of his followers whispered.

Another brought in bowls of fruit and other food as an offering to the spirit. Pir Pinjar claims that the spirit which enters his body is keen to help those in need and that it has the power to coax evil spirits from the bodies of people who are suffering from mental and physical illness.

Capturing the spirit

There is no-one I cannot treat, he says. When people ask for his help, he places a mirror on their head, holds it there for a few minutes and then examines it.

To me, he said, the mirror is like a doctor's x-ray, I can read a spirit's intentions.

And should he decide that someone needs a spirit to be removed then Pir Pinjar lays on a theatrical flourish.

He produces a large round metal pot, takes off the top, pops in the spirit, replaces the lid and then binds the pot with yellow rope so that the spirit can't escape.

On the face of it, the blood letters and faith healers are exploitatively playing on people's fears and ignorance. But at least some of them do seem to be genuine in believing that they do have answers which Western medicine has long forgotten.

Faith in traditions

And perhaps more importantly, many of the people who visit traditional healers do believe that the methods work. But then most Pakistanis who need treatment have no one else to turn to.