MENTAL HOSPITALS AND HEALING PRACTICES IN COLONIAL INDIA
GAURANGA BANERJEE, Ex-Professor & Head, Unit of Psychiatry; NRS Medical College, Kolkata, India.

INTRODUCTION
 

In India, as in other parts of the world, the traditional approach to the care of the mentally ill, during the last two hundred 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 over-riding concern was to protect the citizens without regard for appropriate care and cure of the patient. 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 in a climate of despondency.

Let us explore the backdrop of the construction and maintenance of mental hospitals in colonial India from a social and political perspective.

Though Western Medicine was introduced in India by the Portuguese rulers of Goa, no mental hospital was established by them. To build a chain of mental hospitals and to introduce Western healing practices in them were conceived and executed by the British East India Company. In the early phase of their development, mental hospitals were meant exclusively for the soldiers who fought for the East India Company against the Indian princes and for the “gentlemen,” i.e. the covenanted officers of the company. The rich white settlers in British India, who were, needless to say, solidly behind the Company’s political, diplomatic and military activities had easy access to these hospitals. At a latter stage, as the British empire became a reality, the scale of the trader turned into the scepter of the ruler. The ruler had to open mental hospitals for the natives also. The segregation of the white and native patients was, however, preserved carefully.

On the decline and fall of the Mughal empire after the death of Aurangazeb (1707) a power vacuum developed in India’s political system. Regional powers were no substitute for a strong central authority. The adventurous British traders took advantage of this situation. By fair means or foul, they grabbed power to rule vast territories of the country one by one. Bengal was the first province to come directly under the British rule after the battle of Plassey in 1757. Thereafter, the quest for an empire was spearheaded from Calcutta.

It is said that “from the midday halt of Charnock” (an employee of the East India Company) grew the City of Calcutta on the silt of the river Ganga. The city grew in size and importance as the company’s business and political influence grew across the country. In 1774 Warren Hastings was appointed the Governor of Bengal by the Board of Directors of the East India Company with Calcutta as his headquarters. The pre-eminence of the City in the scheme of things of the East India Company was thereby established firmly. Business activities, administration and war efforts – everything was controlled from Calcutta. It is, therefore, natural that the need for a mental hospital was felt first by the British in this City.

The proceedings of the Calcutta Medical Board dated April 3, 1787 indicate that a mental hospital was in existence at Calcutta at that time. It appears from the deliberations of the Board that the said mental hospital was established by Dr. G. M. Kenderdine, a surgeon of the East India Company. The exact site and date of establishment of this private hospital are not known. It stands to reason to presume that Dr. Kunderdine founded this hospital to augment his depleted income sometime between 1767 and 1774. A representation made by the doctor to his employer shows that he was suspended from service in 1767 for dereliction of duty and reinstalled in 1774. On this very ground the Board rejected his prayer for permission to admit patients sponsored by the government.

In 1787 a government sponsored hospital was established on a plot at a stone’s throw from Presidency General Hospital (IPGMER, Calcutta) under the supervision of Dr. William Dick, a Surgeon of the East India Company, on monthly salary of Rs. 200/-. After the retirement of Dr. Dick (in 1818) this hospital gradually deteriorated in the standard of its service. The Government was forced to close it down in 1821. Mr. Beardsmore, a Headkeeper of this hospital, had already opened a private hospital in 1817 behind the boundary wall of Presidency General Hospital at Bhowanipur, Calcutta. Needless to say, all these three hospitals were meant exclusively for white mental patients.

In Madras a mental hospital was established in 1794 which incidentally is probably the oldest existing hospital of its kind in India today. Till 1857 the number of mental hospitals grew very slowly. But following the takeover of the administration of India by the British Crown in 1858, some important changes occurred in the field of mental health as a part of sweeping changes in other walks of life. The first Lunacy Act enacted in India for the establishment of mental hospitals and their management came into force in 1858 (Act XXXVI of 1858). During the subsequent two decades at least six mental hospitals were in existence in Eastern India alone. They were European Lunatic Asylum at Bhowanipur (established in 1817) one each at Patna, Dacca (i.e. Dhaka, the capital of Bangladesh), Dulanda (Calcutta), Berhampore and Cuttack. The mental hospital at Dacca was shifted to Tezpur in 1876, soon after Assam was separated from Bengal in 1874.

The number of mental hospitals gradually grew in other parts of India as well. By 1865 six mental hospitals were established in Western India- at Colaba, Poona, Dharwar, Ahmedabad, Ratnagir and Hyderabad (Sind, now in Pakistan). In South India, Two hospitals – one each at Waltair and Tiruchirapalli – were established in 1871. In the same year another hospital, meant for both the Europeans and Indians, lodged in separate wards, was established in Madras (Chennai). In the Central Provinces, two hospitals were opened, one each at Jabalpur and Berar (Elichpur) in 1866. In North India, mental hospital was established at Benaras (Varanasi) in 1854, one at Agra in 1858 and another at Bereilly in 1862. Punjab, however, had its mental hospital as early as 1840, during the reign of Maharaja Ranjit Singh, i.e. before the territory was finally taken over by the British East India Company in 1849. With the increase in their number, quality of service and living condition got worse very rapidly, indeed, by the end of the 19^th century the conditions inside the mental hospitals deteriorated to most inhuman level. A pen picture of the living conditions and healing practices of these hospitals follows.

MORAL TREATMENT – THE REMOVAL OF CHAINS

It has been documented that the Arabs established many flourishing medical schools and mental hospitals in Baghdad, Damascus and Cairo between 8^th century and 13^th century. The enlightened treatment received by the patients in those hospitals and the relaxed atmosphere inside them remained unsurpassed in Europe for many centuries. The Renaissance brought little solace for the mental patients till the late eighteenth century. The concepts of humanism and freedom of the individual permeated the social fabric of Europe after the French Revolution. Enlightenment in the form of removal of chains and other mechanical restraints from the mental patients were observed in France, England, Italy and Belgium in the last decade of the 18^th century. Mental hospitals were being built during this period in India and efforts were made to introduce this concept of humane or moral treatment in Indian mental hospitals. Though written records are scarce, it is generally agreed that value of simple interventions and kind treatment was recognized as the rule of the hospitals. Hard data are more easily available from 1821 when government sponsored patients were admitted in private hospitals meant for the Europeans only. For the European patients non-restraint had been established as the rule by the mid-fifties of the 19^th century. Reports of hospital superintendents show that in the hospitals for native patients  restraints were resorted to even in 1870’s, though the same reports concede that native patients were as a rule, quieter than the European ones. This contradiction was explained by the fact that European patients considered it insulting to be restrained by native keepers. If restraint was essential in a given situation, it had to be done by a European Keeper; if European keepers were not available, restraint was not to be done.

FOOD AND DIVISIONS

European patients were divided into class-I and Class-II on the basis of their social status. Patients of Division-I lived in separate rooms and dined together on one table. Disturbed patients were kept in a high security building. They were supervised by European or Anglo-Indian staff only. They were given spicy food. Fish and flow with seasonal fruits, jelly, cheese and pudding were supplied. They had to pay Rs. 100/- per month. Diet for Division-II was also good, but details are not known. They had to pay Rs. 50/- month.

For the native patients the food was poor. One rupee was spent for the daily diet of sixteen patients since 1844. Before that date the allocation of money was 3 paise per patient per day. There was no division between patients on social status. But the kitchens for the Hindus and Muslims were separate. Before 1844, in a day the native patients used to get only one meal  that consisted of rice, pulses and occasional fish or meat. Needless to say, the morbidity and mortality rates were high. Dr. F. P. Strong, the then Civil Surgeon of 24 Parganas, who was in-charge of the native mental hospital, increased the allocation of money, and added fish or meat to their daily diet which was served twice a day. This information is contained in the annual report of the native mental hospital for 1844 which was founded in 1816 at Russa Pagla on the southern outskirts of Calcutta. This is, incidentally, the first mental hospital meant for the native patients. (Bengal Presidency Native Insane Hospital). By 1842 this hospital became “filthy, crowded, defaced and broken”.

OVERCROWDING, SANITATION AND BEDS

The Government built another mental hospital at Dullunda (at the site where the Police Training School now stands). This place is about 300 meters to the south West of IPGMER, Calcutta. In 1847 patients from Russa Pagla Hospital were transferred to the Dullunda Hospital. The accommodation was for 150 patients. But the number of patients swelled to 350 by 1871. NCL’s and Criminal Lunatics were also lodged in this hospital.

The annual report for 1872 shows that wooden platforms were provided for patients of Dacca Asylum so that they need not sleep on the floor. This step was taken to reduce the rates of morbidity and mortality by medical illnesses. After few years separate sleeping arrangement was made in Punjab for the prevention of physical and sexual abuse of mental patients by one another. At the native hospital at Russa Pagla patients were allowed to sleep on bamboo frame constructed by themselves. The floor of the old, damp, dilapidated building was considered by the authority to be unsuitable for the purpose. By implication, patients had to sleep on the floor, physical and sexual abuse by one another was common and death rate high.

REMOVAL OF PATIENTS TO ENGLAND

In the early 19^th century experts and administrators believed that the tropical climate was one of the causes of mental disorders among the Europeans living in India. Accordingly European patients were sent to England for treatment, if they did not improve within six months of their admission in a mental hospital in India. This practice began in 1818 and continued till 1891. The passage money and other expenses were paid by the East India company as a loan to be repaid by the recovered patient. Doubts were expressed about the utility of this practice by Dr. John Macpherson in 1854. But his views were ignored. In 1866 Sir Charles Wood, the then Secretary of State for India (The British Crown took over the administration of India in 1858) expressed strong reservation about the wisdom and cost effectiveness of this practice. A strange incident hastened the pace of events. In the same year five native mental patients were sent to England for treatment at government expenses by mistake. Needless to say, the government took strong exception to this gross violation of rules. Stringent rules and regulations were framed to regulate the selection of patients. Gradually the flow of patients was reduced to trickles till the “Royal India Asylum” at Ealing (Where these patients were used to be lodged from 1870 onwards) was closed down on December 31, 1891.

Thus ended an imperial practice based on a flawed theory.

DRUGS AND OTHER PHYSICAL METHODS

The role of drugs in the management of patients in the mental hospitals of colonial period was insignificant. Little is known about the methods of treatment followed in the mental hospitals of late 18^th century. Reports of early 19^th century suggest that doctors believed that a comfortable meal was the best sedative and exercise the best hypnotic. Around 1855 morphine and other opiates were in use along with a hot bath. Blood-letting as a method of treatment was used sparingly. If ever used, it was done by the use of leech and not by vene section. For chronic patients blisters were created on different parts of the body, especially on the nape of the neck. Doctors knew that blisters had no intrinsic value as a modality of treatment. It diverted the patient’s attention to physical symptoms and thereby helped reduction of mental anguish. Report of Bengal Asylums for 1862 shows that this method of treatment was used for control of excitement and sleep disturbance along with a mustard poultice applied to the stomach. Potassium Bromide was used for epilepsy. (It is noteworthy that Barbiturates were not introduced to clinical Psychiatry till 1903). Dr. Smith of Lahore Asylum considered digitalis to be useful at times.

Dr. A. J. Payne, the Superintendent of both the European Lunatic Asylum and the Dullunda Native Hospital used drugs very rarely. A few pegs of rum was, according to him, good medicine for excited patients (Report of 1873).

In the last quarter of 19^th century “current electricity” was frequently used in the native asylum at Dullunda by Dr. Payne, the then Superintendent of that asylum. He reports (Report of 1873) that the use of electric treatment yields surprising results. This treatment is, however, different from modern method of ECT invented by Cerletti and Bini in 1938. In the older variety (i.e. what was used in the late 19^th century) it was static electricity. The Gadget was touched at different parts of the body. It was a very painful experience. The use of this method was topped subsequently on the ground that the machine was primitive and imperfect. It is noteworthy that Dr. Payne was the Superintendent of nearby European hospital as well. But he never used this method of treatment on his European patients.

OCCUPATIONAL THERAPY

The discussion on management of mental patients will remain incomplete unless we add a few words about occupational therapy as practiced in those days. Labour, as therapeutic modality, was practiced widely in native hospitals with great success. But in the hospitals for Europeans it was not introduced with enthusiasm. Dr. Theodore Cantor, Superintendent of European Asylum at Bhowanipur, Calcutta, was of the view that outdoor work in the tropical sun might be harmful for the Europeans. Moreover, he noted that patients of his hospital spent the whole day doing nothing, still they refused to participate in any work outside their rooms (Report of 1873). Attitude of the Superintendents often was a deciding factor. It was, however, emphasized in government orders that occupational therapy must not be coercive in nature. It is a part of the treatment of each patient and must be tailor-made for his need and aptitude. While knitting, sewing and weaving were taken up easily by the female patients in both European and native hospitals, occupational therapy involving outdoor activity was, as a rule, scorned by the European male patients. In the native asylum at Russa Pagla, till its closure in 1847, and at Dullunda since 1847, on the other hand, inmates usually came from the families of cultivators and laborers. They readily joined the occupational therapy sessions. The nature of the job earmarked for them was cultivation and preparing ropes and other products by jute. The standard of their work was so good that the hospital sole their products in open market with a profit margin of over six thousand rupees in one year (Report on 1873). Clay modeling and dressmaking were also introduced at Dullunda Hospital. Dr. Francis P. Strong of Russa hospital took great pains in encouraging the patients to take up occupational therapy as a mode of their treatment. His work was continued at Dullunda hospital by Dr. Payne, as it brought money to the hospital. Dr. Payne was perceived as ill-disposed to native patients. Dr. Theodore Cantor, his predecessor, proposed that they might learn the 3R’s. But Dr. Payne shot down this proposal on the plea that literature had no place in the life of these natives and that the expenditure on salaries of teachers would be a sheer wastage of money (Report of 1863).

OTHER DEVELOPMENTS

Arrangement for entertainment was made for the patients at times. But shortage of rooms, even in European mental hospitals, stood in the way of its proper and regular use. As per the 1862 Report, Dacca Asylum made arrangement for Indian musical instruments and indoor games after the evening meals. Some patients were allowed to attend local festivals with their keepers. At the native asylum at Russa Pagla patients were allowed to perform dance and music including Indian instrumental music (flute, cymbal). They were given the indulgence to smoke tobacco, chew betel leaf and play cards. The authorities did understand the value of entertainment and harmless habits in the life of the patients. But vagaries of whims of Superintendents and lack of adequate facilities in the hospitals often stood in the way of implementation of their instructions.

In late 1860’s and early 1870’s Dacca Asylum broke new ground when it decided to board out patients to the families of respectable person of the town. The aim was to avoid the ill-effect of overcrowding on the process of recovery and to permit the patients to adjust with family life in a foster home before their discharge. Doctors used to visit them in their foster homes for assessment of their mental state. The head of the family used to receive Rs. 5/- as subsidy per month. This system did not last long as the head of the family was held responsible for escape of the patient. The emphasis on moral treatment in mental hospitals of 19^th century India was a reflection of pious wishes of our rulers. The picture of what was actually realized was different.

During the early part of the 20^th century, with the growing social and political awareness of the educated section of the Community, the plight of the mental patients incarcerated in these hospitals got adverse publicity in the media and ultimately in the British Parliament. Consequently the Government took certain major decisions for the improvement of the management of mental hospitals. In 1906 ideas were afloat for the supervision of these hospitals by a central authority. The Government decided that the mental hospitals which were till then controlled by the inspector General of Prisons, would be under the overall charge of Civil Surgeons (i.e. CMOH of modern times).  This is a fundamental change in the management of mental hospitals. The next most important change was the recognition of the role of specialists in the treatment of mental patients. Psychiatrists were appointed as full-time officers in mental hospitals.   

The enactment of the Indian lunacy Act in 1912 had probably the most far-reaching consequence and impact on the whole system of mental health service and administration in India during the following seventy five years. Under this new legislation the central supervision of all mental hospitals became a reality. The Central lunatic asylum for European patients was established under this Act, only to be closed down after the establishment of the Ranchi asylum in 1918.

As a result of the sustained efforts of Col. Berkeley Hill, the Superintendent of Central European Asylum at Ranchi, the term “Asylum” was removed from the Government records in 1922 and all asylums in India were renamed as Mental Hospital. The stigma of asylums was sought to be reduced by this change in nomenclature. He worked hard to bring about many other changes for the betterment of mental hospitals. How far he succeeded can be assessed from his on statement. In 1924 he wrote these words in a paper published in the Journal of Mental Science (British Journal of Psychiatry of today). “There is a Persian saying that there is no greater anguish known among mankind than to have many thoughts at heart and no power of deed. This particular form of anguish must be well-known to most medical superintendents of mental hospitals”.

The condition of the mental hospitals rapidly deteriorated during the following two decades. The “Bhore Committee” Report (1946) states that there were at least 19 mental hospitals with bed strength of 10,181. the majority of these hospitals were quite out of date and were designed for detention and safe custody without regard for curative treatment. Here was a gross inadequacy in the medical personnel, both numerically and in specialized qualifications. The Report recommended that these hospitals should be modernized. The modernized mental hospitals should meet both the needs of the community and the medical colleges. And these should form part of any scheme for reconstruction or expansion. The inadequacy of nursing staff and attendants did not escape the notice of the Committee. Besides making other recommendations, it observed that the Indian Lunacy Act, 1912 had outlived its utility.

The spadework done by the Bhore Committee for the qualitative and quantitative improvement of mental hospitals was not forgotten. There was a steady rise in the number of mental hospitals in free India, in 1947 there were 31 of such institutions and in 1987 it rose to 45. Efforts were also taken to improve the  conditions existing in those hospitals.

But it must be conceded that the emphasis shifted from the mental hospitals to the creation of psychiatric departments of teaching hospitals. As a result, mental hospitals continued to languish in the backyard of negligence in financing staff pattern, floor space in relation to patient population and the quality of care.

The author has drawn freely from the following publications and expresses his indebtedness to their authors and publishers: