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Madmen and specialists: The clientele and the staff of the Lunatic Asylum, Bangalore
Abstract
The history of the asylum has proven to be an invaluable resource for exploring the interface between science, medicine, religion and social and political processes. The definitions of insanity have troubled humans for centuries, as have the methods for treatment. Diverse, and often conflicting, ideological positions are quite common. Documenting the specific histories of the staff and patients of an asylum can thus help us understand the evolution of the physical and the intellectual growth of psychiatry in India. In this endeavour, we have used the records of the Lunatic Asylum, Bangalore (later the All India Institute of Mental Health and subsequently the National Institute of Mental Health and Neurosciences [NIMHANS]) to explore the history of psychiatry in India. The only asylum maintained by a 'Native Kingdom', it exemplifies the dynamics of the growth of mental health services in the country. We trace the changes in administrative control of the Asylum, the changes in medical practice and some aspects of the social history of the region. This article traces the history of psychiatry at one institution, which, at the micro level, is a mirror to the understanding of the historical trends of psychiatric services in India.
... Yet despite this, there are no studies to date that explore how the gender performatives of hospital security officers resist or contribute to the disbursement of power and coercion within the hospital. Since research discovered similarities between the gendered performatives of police and security officers (Rigakos, 2002) and psychiatric institutions have a long history of being theorised as a prisonlike environment (Donald, 2001;Jain & Murthy, 2006;Wright, 1997), I draw primarily on literature that critically explores the construction of masculinity within policing/prison institutions, as well as the "prison" hospital practice of physical/chemical incarceration. This allows us to excavate the links that adjoin how the gendered experiences of security officers exacerbate or hinder coercive intervention within psychiatric facilities. ...
... Once again drawing links to the heroic/dangerous tasks and conquests taken on by public policing agents (Rigakos, 2002;Tracey & Scott, 2006), Jackson demonstrates his belief that one of the guard's key responsibilities is to physically protect the establishment and their fragile female staff from the risky patients. The suggestion that patients are also in need of protection seems ludicrous to him, as the hospital guards characterize and surveil the involuntary patients the same way prison guards interact with and control prisoners -they are never at risk or in need of protection but are othered to the extent that they are utterly feared by hospital staff (Donald, 2001;Jain & Murthy, 2006;Wright, 1997). ...
... Like I mean it...as soon as that kind of sinks in...you feel a threat there alone. Just the fact that...you're in a room or an area where you cannot get out... Hospital patients are captives; often having committed no crime against society besides that of being 'different', they nonetheless experience gendered humiliation, abuse, degradation, confinement and a deprivation of their rights in a frighteningly similar fashion to the experience of prisoners (Donald, 2001;Federman, 2012;Jain & Murthy, 2006;Kilty, 2012;Wright, 1997). ...
... 35 "Financial rather than therapeutic reasoning" guided care, a common theme in the custodial care of those with serious mental illness over time. 35 Here, too, the care needs of the insane were likely forgotten, and harm ensued. ...
Despite medical, technological, and humanitarian advances, the criminalization of those with serious mental illness continues. This is not an isolated phenomenon. The benefits of treatment reform and innovation are difficult to maintain or sometimes outright harmful. Across time and geography, the care of those with serious mental illness tends towards maltreatment, be it criminalization or other forms of harm. We present a social history of serious mental illness, along with the idea that the treatment of serious mental illness is a Sisyphean task-perpetually pushing a boulder up a hill, only for it to roll down and start again. The history is provided as a basis for deeper reflection of treatment, and treatment reform, of those with serious mental illnesses.
... [11] In addition, psychiatrists from Germany who had moved to the UK under the Rockefeller program (W Mayer-Gross, Lieberman) during or before the World War established close links with Indian psychiatrists who were training there, and this would, in turn, have an impact on postgraduate training in India. [12] Things remained in a flux during the war, and the politics of the subcontinent changed dramatically soon after. Col Moore-Taylor, who had been instrumental in steering the reform process, retired when India became independent. ...
Specialists in psychiatry, in the Indian sub-continent, were trained in the UK in the early 20th century. Just before
Independence, an Indian branch of the Royal Medical Psychological Association was established. Many issues of
contemporary concern were discussed, as also plans for the further development of psychiatry in the region. Soon after
the Second World War, and the Independence of India, the association was disbanded. However, a large number of
psychiatrists from south Asia now live and work in the UK, and the Indian Psychiatric society and the Royal College
continue to have close links.
... Finally, the following topics were excluded from this review because they were extensively covered in the International Review of Psychiatry earlier this year, 2006 or 2005: . The historical perspective and its implication for stigmatization of people with mental illness (Jain & Murthy, 2006;Mills, 2006;Ng & Chee, 2006;Pols, 2006). . The Asian Tsunami in December 2004 and its respective aftermaths (Bhugra, 2006;Bhugra & van Ommeren, 2006;Carballo, Heal, & Horbaty, 2006;Chandra, Pandav, & Bhugra, 2006;de Silva, 2006;Ganesan, 2006;Ghodse & Galea, 2006;Math et al., 2006;Nikapota, 2006;Rosati, 2006;Saxena, van Ommeren, & Saraceno, 2006;Sumathipala, Siribaddana, & Perera, 2006;Vijaykumar, Thara, John, & Chellappa, 2006;Visanuyothin, Somchai Chakrabhand, & Bhugra, 2006;World Health Organisation, 2006;Yule, 2006). . ...
There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.
Medline search focusing on English-speaking literature.
Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.
This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.
Movement and mental illness in a settler colony
Objective
Historiography of South Asian mental asylums is generally skewed towards asylums operated by the British. The Lunatic asylum, Bengaluru, later to become NIMHANS, was one of the early asylums and was administered by a princely state (Mysore). This study aims to evaluate socio-demographic and clinical characteristics as well as the treatment outcome of patients admitted to the Lunatic Asylum, Bengaluru in the early 20th century (1903-1911)
Methods
A review of inpatient registers at the Lunatic Asylum, Bengaluru was conducted for the years 1903-1911 and analysed using descriptive statistical methods.
Results
There were 620 admissions during this period and three-fourths were men (n = 465, 75.0%). The mean age of the patients was 32.09 ± 10.29 years at the time of admission. Acute mania (n = 209, 33.7%), chronic mania (n = 125, 20.2%) and dementia (n = 65, 10.5%) were the most frequent diagnoses. At the time of discharge, 35.5% reported being cured and 12.1% improved. The overall death rate of patients at the asylum was 27.2%. Subjects who died had a mean duration of in-patient stay of 11.9 years. The mean age at death was 45.7 years with the comparable life-expectancy of the general population during the period being around 23 years.
Conclusions
In-patients in the Lunatic Asylum, Bengaluru in the pre-antipsychotic era had a good outcome with approximately 50% being cured or showing improvement and longer life expectancy than the general population.
This book focuses on the Ranchi Indian Mental Hospital, the largest public psychiatric facility in colonial India during the 1920s and 1930s. It breaks new ground by offering unique material for a critical engagement with the phenomenon of the ‘indigenisation’ or ‘Indianisation’ of the colonial medical services and the significance of international professional networks. The work also provides a detailed assessment of the role of gender and race in this field, and of Western and culturally specific medical treatments and diagnoses. The volume offers an unprecedented look at both the local and global factors that had a strong bearing on hospital management and psychiatric treatment at this institution.
The National Institute of Mental Health and Neuro-Sciences (NIMHANS) in Bangalore, India began as the lunatic asylum, in 1848, when a separate asylum to care for the mentally ill was approved by Sir Mark Cubbon, Commissioner of Mysore in the Pettah area of Bangalore. After the transfer of power from the British to the Kingdom of Mysore in 1881, it became, for a while, the only asylum to be supported by a native kingdom. A larger mental hospital, in the light of the expanding population of Mysore, was thought essential by the 1920's, when the Maharaja of Mysore approved the decision to build a new asylum. This was finally completed in 1937, and by then had been renamed as the Mysore State Mental Hospital. The hospital, and its staff, was recommended as the first institution to begin training specialists in psychiatry and related mental health fields, after Independence, in 1953, when it was renamed the All-India Institute of Mental Health. It now houses the Department of Psychiatry at NIMHANS. The asylum architecture, horticultural layout, high standards of mental health care and emphasis on scientific training initiated in the early part of the last century continue to date and many of its alumni hold distinguished positions all over the world.
This article is the first comprehensive cultural critique of India's official community mental health policy and program. Data are based on a literature review of published papers, conference proceedings, analyses of official policy and popular media, interviews with key Indian mental health professionals, and fieldwork in Kanpur district, Uttar Pradesh (2004-2006). The authors demonstrate how three influences have shaped community psychiatry in India: a cultural asymmetry between health professionals and the wider society, psychiatry's search for both professional and social legitimacy, and WHO policies that have provided the overall direction to the development of services. Taken together, the consequences are that rural community voices have been edited out. The authors hypothesize that community psychiatry in India is a bureaucratic and culturally incongruent endeavor that increases the divide between psychiatry and local rural communities. Such a claim requires sustained ethnographic fieldwork to reveal the dynamics of the gap between community and professional experiences. The development of culturally sensitive psychiatric theory and clinical services is essential to improve the mental health of rural citizens who place their trust in India's biomedical network.
In the Indian scenario, research in mental health is notably deficient, but available clinical and epidemiological data suggest a significant co-morbidity between mental diseases and cardiovascular diseases. Mental health problems do not have the precision of other biological sciences due to the complex phenotypes. In India the effects of culture and the transition in symptomatology of psychiatric patients are also important. Equally important are the family influences, traditional Indian herbal ethno-pharmacology and the community care perspective. The Indian systems of medicine give a lot of attention to visceral functioning and psychiatric research look into the metabolic substrate.
History is a screen through which the past lightens the present and the present brightens the future. Psychiatry by virtue of its ability to deal with human thoughts and emotions and provide a pathway for healthy minds provides an important platform towards being a mentally sound human being and largely the society. This review takes a sneak peek into the foundations of modern psychiatry in India. The description is largely based on the time frame, which provides a better understanding of the factual information in each period starting from the Vedic era and culminating in the post independence period.
The history of disease contributes to a better understanding of the growth of ideas in medicine. The colonial period was marked by a rapid increase in the variety of diseases that were known to European practitioners. We have studied the diary of Dr Charles Smith who worked in Bangalore in the nineteenth century. We feel that some of his descriptions tally with later accounts of cysticercosis. He also comments on a wide range of behavioural symptoms, and attempts to correlate neuropathological observations to these. This neuropsychiatric perspective was prominent in the nineteenth century. Infective causes of psychiatric disorders are once again considered important; this account highlights the fact that similar ideas were prevalent in British India, even 150 years ago. In addition, Dr Smith's comments describe the social mileu of 'western' medicine in India in the early colonial period.
Synopsis
The case histories of the patients newly admitted to the Retreat Asylum in York between 1880–1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72·9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34·9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31·4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38·1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49·1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31·4% remained in the asylum for five or more years.
The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.
This article presents an introduction to the history of Indian psychiatry. It suggests that this history can be divided into four main periods, 1795 to 1857, 1858 to 1914, 1914 to 1947 and 1947 to the present day. The focus of the piece is on the periods 1858-1914 and 1914-1947, as it traces the main trends and developments of the colonial era and argues that the foundations of modern psychiatry in India were laid down in the period of British rule. A brief consideration of the post-Independence period suggests that the patterns established in the years of British rule have continued to influence the psychiatric system of modern India. Research for these conclusions is based on extensive archival work in Indian mental health institutions and in Indian records offices, as well as work conducted at the National Library of Scotland in Edinburgh and at the India Office Library, the Wellcome Institute Library and the London School of Hygiene and Tropical Medicine.
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