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In India, as in other parts of the
world, the traditional approach to the care of the mentally ill during
the last 200 years was custodial rather than therapeutic. This approach to
psychiatric care delivery system was transplanted in India from
contemporary Britain. Mental hospitals were constructed in isolated areas
with the aim of segregating those who, by reasons of insanity, were
considered troublesome and dangerous to their neighbors. The overriding
concern was to protect the citizens without regard for appropriate care
and cure of the patients. The inevitable fallout of this system was poor
quality of care in mental hospitals. The inmates were subjected to
indignity and humiliation for an indefinite period. The stigma of mental
illness prevailed and a climate of despondency prevailed.
With the advent of social and political
changes in public life of the country in the first quarter of the 20th
century, there was a growing awareness of the people in the area of health
care, human dignity, individual liberty and plight of the disabled members
of the society. This change was reflected in the society’s concern for the
appropriate management of persons afflicted with mental illness. In the
fifties and sixties the advent of modern psychopharmacological agents
brought new hopes for effective care and better outcome of mental
disorders.
This breakthrough is nothing less than
a revolution in the history of modern psychiatry. It coincided with the
phenomenal growth of general hospital psychiatry in our country. It is
generally agreed that the establishment of psychiatry units in general
hospitals has done more to advance psychiatry than any single diagnostic
or therapeutic discovery could do. These units have become easily
accessible to the general population and was instrumental in reducing the
stigma attached to mental disorders. Teaching and research in psychiatry as
a part of other branches of medical sciences made the specialty more
attractive to the newer generation of medical students.
It is worthwhile to trace the beginning
of general hospital psychiatry in our country:
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The first department of psychiatry with
outpatient facility in a general hospital in India was opened on 1st
May 1933 at the then Carmichael Medical College (now known as R. G. Kar
Medical College). Kolkata. Five years after this event, in 1938, the
outpatient facility of Department of Psychiatry of J.J. Hospital, Mumbai
was opened.
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A department of Neurology and
Psychiatry was established in the Calcutta Medical College in 1939 by an
order of the Government of Bengal.
Now let us elaborate on the process
that culminated in the establishment of the first psychiatric clinic in a
general hospital in India.
During the early decades of the 20th
century a movement was initiated, first in the USA and then in the UK to
improve the quality of care for mental illness and to disseminate
knowledge about mental health amongst the masses. In order to organize
this movement a National Committee for Mental Hygiene was established in
the USA in 1909. This was followed by the formation of a Mental Hygiene
Council in the UK in 1923. The educated and the enlightened people of all
walks of life were enrolled as members of these organizations. The impact
of their activities was felt on the shores of India very soon. On active
encouragement from the Mental Hygiene Council (UK), the Indian Association
for Mental Hygiene came into being at Simla on 23rd August
1928. The membership of the association was open to all who subscribed to
its aims and objectives and participated in all activities towards their
implementation. Lt. Col. Owen Berkeley – Hill, Superintendent of the then
European Lunatic Asylum, Ranchi (now known as Central Institute of
Psychiatry) was elected as its first President. The aims and objectives of
the association, as attributed by its President, were as follows –
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To disseminate the knowledge about
mental hygiene amongst masses
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To organize meetings, seminars and
popular lectures on mental health and mental illnesses
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To establish a library for storing and
distributing books on mental health and allied disciplines
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Publication of a quarterly Bulletin of
the Association
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Establishment of treatment centers for
mental illnesses.
The Calcutta Chapter of the Association
was opened sometime in late 1929. Dr. Girindra Sekhar Bose, who was the
Founder President of Indian Psychoanalytical Society (established in 1922)
and the then head of Department of Psychology, Calcutta University was a
leading member of the Association at Kolkata. The Calcutta Chapter, under
the leadership of Dr. Bose, took an active part in implementing the rather
ambitious plan of the Association. From a small beginning (with five
founder members) this subcommittee of the Association grew in size
rapidly. In course of less than four years, by the beginning of 1933, its
membership rose to 264.
The Calcutta Chapter arranged a monthly
popular lecture on mental health delivered by a leading scholar of the
city. It became so popular and attractive that, on public demand, the
monthly event soon became a weekly event.
Emboldened by this favorable public
response, the Association decide to establish a home for the Mentally
Retarded for their custody, care, and training. Support in the form of
money, land and voluntary expert service came readily and the Home was
established on 24th April, 1932. The name of the Home – BODHANA
NIKETAN – was coined by none other than the Nobel Laureate poet
Rabindranath Tagore.
The next step taken by the Association
was the opening of a psychiatric outpatient clinic in a general hospital.
The far-reaching impact of this act outlived the association itself. The
State Government was approached for assistance in this endeavor. It was
proposed by the Association that adequate room be made available in the
Calcutta Medical College (a state-run institution) for the Clinic. The
initial response was positive, but very soon it was made clear by the
Government that the time was not yet ripe for it. Thereupon, the
Association, under the leadership of Dr. Girindra Sekhar Bose, persuaded
the authority of Carmichael Medical College, Calcutta – then run by a
non-profit-making private organization – to allow it to open a psychiatric
outpatient clinic in the college premises (this private college was taken
over by the State Government in free India). It was agreed that the
Association would pay for the expenses of the clinic. The College
authority, however, lent some furniture and arranged for supply of free
electricity. Dr. Bose made an advance of Rs. 867.50/- to defray the cost
of furnishing the Clinic and purchasing some essential instruments. Thus
the stage was set for opening the doors of the first psychiatric OPD
clinic in a general hospital in India.
Let me add a few interesting details
about this Clinic-
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The working hours of the Clinic was
between 8-00 AM and 10-00 AM on every Tuesday and Thursday. The
MO-in-Charge was Dr. Girindra Sekhar Bose. He had two other M.O.’s to
assist him. They were Dr. Bhupati Mohan Ghosh and Dr. Kamakhya Charan
Mukherjee. All the members of the staff worked on honorary basis. The sole
exception was a part-time bearer who received a monthly pay of Rs. 2/-
(Rupees Two only).
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Though the OPD clinic was opened on 1st
May, 1933 the first patient was registered on the following day i.e. 2nd
May, 1933. The original case record of this patient is still preserved and
displayed on the wall of the chamber of the Head of the Dept. of
Psychiatry of R.G. Kar Medical College.
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It is on record that 174 new cases
attended the clinic during the first year of its existence. It is
gratifying to note that this clinic is not only the first of its kind but
is still one of the most thriving centers of service, teaching and
research in Psychiatry in Kolkata.
REFERENCES
Quarterly Bulletin of the
Indian Association for Mental Hygiene, No.5 (January 1930), pp 31- 37, No.
21 (January, 1934), p – 18, No. 22 (April, 1934), pp – 2-4.
Venkoba Rao A. (1975)
Psychiatry in India, In world History of Psychiatry (ed. J. G. Howells ) p
-647, New York, Brunner / Mazel.
Wig, N. N. (1978)
Psychiatric Units in General Hospitals – Right Time for Evaluation
(editorial), Indian Journal of Psychiatry, Vol. 20, pp – 1-5.
Indian
Journal of Psychology (January, 1929), pp – 52 – 55.
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