A girl in a long black shirt screams incoherently, banging her head against a wall at a Sufi shrine in the Pakistani city of Thatta. Jamila Ahmed's family says she is possessed by a demon.
Doctors couldn't help so they brought the girl, kicking and screaming, to be exorcised by the spirit of a saint.
Islam in the South Asian nation of 180 million is incredibly diverse.
Many flock to shrines like the one where Jamila'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 Shi'a and Sunnis.
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 Qaeda-linked Taliban, have over the years bombed Sufi shrines that they consider heretical.
During an annual celebration this year at a shrine 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, Karachi, is located.
Sayed Muhammad Rais Yar's 24-year-old son Rahim Yar has been in the shrine in Thatta since 2007. He was brought in by his father after Rahim stopped speaking, grew physically weak and suffered memory loss.
"Our 90 percent problem is solved, about 10 percent remains. Some [demons] have left him but there is one strong Jinn inside him. It [the problem] will be solved in a few days," the father says.
Rahim Yar describes have seen Jinns "literally...from head to toe."
"When these things get inside my body, I can hear their voices just like I am talking to you," Rahim Yar says. "These creatures speak to me like this. I get terrified after that."
Rahim says the Jinn inside him says he needs to take him to India, to a temple where people are sacrificed.
Nearby, some people are chained by their ankles to a wall. Relatives say it is dangerous to release them because they can get violent. The relatives say they want them to be close to the spirit of the saint.
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 in Karachi, Syed Aliuddin -- wearing a white robe and silk cap set with a green stone resembling an emerald -- listens to people lament.
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 e-mail and mobile phone.
He says some of the Jinns possess bodies out of jealousy, others out of love or sexual desire.
"They love women," Aliuddin says. "They torture their husbands when they come to the women. They sit inside the abdomen and have sex with them."
Aliuddin charges between 50 rupees (55 cents) and 250 rupees a session, which lasts up to 30 minutes. The more serious the issue, the more radical the cure.
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, says psychiatrist Najmi Chughtai.
"Actually, these are psychiatric illnesses," Chughtai says. "They don't understand it because the laboratory tests are not positive and there are not any physical symptoms like fever present. This is more about a lack of education and awareness, rather than access to medical facilities. It's a desperate attempt to seek hope and that's why they turn to these exorcists."
Some Islamic clerics caution against the overuse of exorcism, and mistaking psychological and physical symptoms for possession.