A girl in a long black shirt screams incoherently, banging her head against a wall at a Sufi shrine in the Pakistani city of Karachi. Sania Haneef's family says she is possessed by a demon.
Doctors could not help, so they brought the college student, kicking and screaming, to be exorcised by the spirit of a saint.
The West often associates Pakistan with Taliban militants who force women to cover from head to toe, blow up girls' schools and carry out suicide bombings. But Islam in the South Asian nation of 180 million is diverse.
Many flock to shrines like the one where Haneef's relatives seek solace in the Sufi strand of Islam abhorred by militants and considered more liberal in its philosophy than other branches followed by Shiites and Sunnis.
"Sania has been possessed since she was six years old," her brother, Mohammed, said, describing how an evil spirit, known as a jinn, would speak through her in a man's voice.
"The shrine has captured the spirit. Sania will be cured soon. None of us is leaving until that happens."
Pakistanis are beset by problems — violence, crippling power cuts, poverty and dilapidated hospitals are but a few.
The government, seen as inept and corrupt, offers little relief.
Many people think their suffering is inflicted by evil spirits intent on destroying marriage prospects, businesses and health, and that only Sufi saints can help.
But that's a risky belief in Pakistan. Militants, including the al-Qaida-linked Taliban, have over the years bombed Sufi shrines which they consider heretical.
During an annual celebration this year at one in the central Pakistani town of Dera Ghazi Khan, the Taliban dispatched suicide bombers who killed 41 people.
A double suicide bombing in 2010 at Pakistan's most important Sufi shrine, in the city of Lahore, killed about 42 people.
But fears of possession, and life's many challenges, keep driving people back to the shrines.
Sufism is a mystical form of Islam which adheres closely to the traditions of Islam but also reflects secularism and universalism in spiritual matters.
It is especially strong in Sindh province, where Pakistan's biggest city and commercial hub of Karachi is located.
'Jinns have sex with us'
"The whole concept of jinns [spirits], which previously would have been a belief in some other kind of spirit, has been converted into Islamic parlance," said Ali Khan, an anthropologist at the Lahore University of Management Sciences.
Self-proclaimed exorcists thrive on these beliefs. They claim special powers from God which enable them to help people cope with everything, from domestic disturbances to infertility and impotence. Some even say they can help people find love.
In a dimly lit shack just outside a shrine, Syed Aliuddin, wearing a white robe and silk cap set with a green stone resembling an emerald, listens to people lament.
One man, an electrician, complains his wife is disobedient. In a carefully rehearsed ritual, the exorcist with a white beard writes prayers on strips of paper and douses them in water.
Customers then drink it, believing his promise that it only takes 10 minutes to take effect.
Aliuddin says he can fight 18,000 types of evil spirits made from fire. Like others in his trade, he is keeping pace with the information age, running his own website and offering consultations by email and mobile phone.
"Some possess bodies out of jealousy, others out of love, some have other motives," said Aliuddin, who charges between 50 rupees (55 cents) and 250 rupees a session, which last up to 30 minutes.
"Jinns swim inside us when they possess us, feed on us, have sex with each other and with us."
The more serious the issue, the more radical the cure.
Jamila Bibi turned to the Abdullah Shah Ashabi shrine in the ancient, dusty town of Thatta in Sindh province.
Her son, Muhammed, began having violent fits four months ago. The 18-year-old is chained by his ankle to a wall. He sits silently, staring at others who are chained or are praying.
"We want him to be close to the spirit of the saint. We have had to chain him so he doesn't hit other people," she said.
In a country where a heavy stigma is attached to mental illness, and the state spends little on health, many see spiritual healing as the only option.
"This is more about a lack of education and awareness, rather than access to medical facilities. It's a desperate attempt to seek hope," said psychologist Rizwan Taj.
Nearby, Rahim Yar, who suffers from memory loss and extreme physical weakness, starts screaming.
He has been at the shrine, which has marble floors and surrounds a domed tomb of a Sufi saint, for four years.
"The jinn inside me says he needs to take me to India, to a temple where people are sacrificed," Rahim said.
"He says he will not leave me and I must be sacrificed."