How did the British reform mental healthcare in India? This book studies the history

In the year 1900, over a thousand persons were admitted to the asylums in British India. A few were brought in by family. One in four came over from jail. And the rest had been picked up from the streets.

The asylum was headed by an officer of the elite Indian Medical Service. As superintendent, this doctor was responsible for the diagnosis and treatment of those in his care.

Symptoms of mental illness varied a great deal in form as well as degree. For the purpose of diagnosis, a bunch of symptoms was labelled as a certain type of insanity. Three types of insanity were most reported – mania, melancholia, and dementia. Among patients admitted in the year 1900, around 61 per cent were described as manic, 19 per cent as melancholic, and 8 per cent as demented. What did these labels mean?

Outside the covers of medical textbooks, they meant different things to different doctors.

For Dr GFW Ewens, the superintendent of the Lahore asylum, mania was the easiest to recognise. The patient was excited, restless, as easily moved to laughter as to tears. His thoughts flew and his speech was rapid, even incoherent. He was impulsive, defiant, and would not be reasoned with. High on energy, he slept very little. The acutely manic patient was oblivious to social niceties. He was noisy and abusive. He could tear off his clothes and go about naked. Being checked enraged him to the point of injuring himself, or those around him.

Dr Ewens saw the melancholic patient as one who suffered from persistent misery. Solitary and still, he either remained silent or else he wept and wailed. He refused to occupy himself in any way, even to eat his meals. He was indifferent to his appearance and personal hygiene. He had no interest in life and might try to end it.

The demented patient, in Dr Ewen’s opinion, had lost his memory, intellect, and volition. Helpless as a child, he asked for nothing and generally did as he was told. He was very much like a mentally deficient person, except that his condition had come about late in life.

Through the 19th century, medical science was unable to figure out the cause of mental illness. It could not explain how human thought, feelings, and will were impaired. Nor had it come up with a cure for, say, mania, melancholia, or dementia. But this did not mean that mental illness could not be treated. It certainly could, and it was. But the remedies were not strictly medical. And the results could not be predicted.

In a case of acute mania, Dr Ewens believed that regular and ample feeding was essential – if necessary, by force. For a patient who did not take eggs and meat, he suggested plenty of milk, ghee, sago, tapioca, and rice.

If also induced to perform some form of manual labour, certain patients became less violent and began to sleep better. Sedatives and hypnotics were useless in acute mania, but a heavy meal or warm bath might help. Dr Ewens found that the most effective way to deal with chronic cases of restless and violent behaviour was to leave the patient in the open – preferably in a grassy spot in the shade.

If this did not work, the only option was to confine him in a separate room, with a large amount of straw to prevent him from injuring himself. At times he could also be administered a hypnotic such as sulphonal, chloral, potassium bromide, trional or veronal. Such drugs were of no value in a case of melancholia. A melancholic patient might, however, respond to large quantities of nourishing food, and to some form of exercise or occupation.

Dr Ewen’s general prescription for most of his patients was liberal and regular nourishment, careful nursing, rest, exercise, and occupation.

He also recommended that patients be treated with patience, politeness, and honesty. While his methods may have been in vogue at Lahore, they were not necessarily followed at other asylums. It was up to each superintendent to treat his patients in whatever way he thought best.

The asylums at Colaba, Lahore, and Madras were large, and running them was a full-time job. Elsewhere, an asylum was just one of the superintendent’s many duties in the district. Though he visited it from time to time, someone else looked after day-to- day affairs. At Bhawanipur, Dullunda, Jubbulpore, Nagpur, and Tezpur, that someone was a junior doctor. But those who looked after the 15 remaining asylums did not hold a medical degree. Without a doctor at hand, the treatment and care of patients could become even more doubtful.

Nevertheless, every asylum reported that a number of patients recovered every year. Some were sent back to jail. And some were sent back home. But many would remain unclaimed for the rest of their life.

In the year 1900, around 11 per cent of the asylum population recovered. An equal number died.

Each asylum in British India was one of a kind. The one at Bhawanipur was simply a house to which barracks had been added later on. It could only accommodate 42 patients, and was reserved for Europeans and Eurasians. The Berhampore asylum was set up in abandoned military barracks. Dullunda was a circular building with a central courtyard surrounded by small rooms.

The Madras asylum was very different. Dating back to 1871, its cottages and single-roomed blocks were set amidst spacious grounds. With a capacity of 689 patients, it was the largest of all asylums. Lahore was also different. Its construction was completed in the year 1900. And it was built on the lines of a prison.

The capacity of an asylum was decided by its floor space. Most asylums had a norm of 50 square feet per patient. Jubbulpore and Nagpur adopted a slightly higher norm of 54 square feet. Madras lowered the norm to 45 square feet in the section for Indians, and raised it to 60 square feet in the one for Europeans and Eurasians. At 72 square feet per patient, the most liberal norm was that of Lahore.

At times, the population of an asylum might exceed its capacity. In the year 1900, this is what happened in the men’s quarters at Ahmedabad, Bhawanipur, Jubbulpore, Lahore, and Ratnagiri. Women’s quarters at Ahmedabad, Dullunda, Jubbulpore, and Poona were also overcrowded; as were those of the Indian section at Colaba. Various other asylums were almost full for a part of the year.

Overcrowding was a serious problem. Cuttack had to transfer some of its patients to other asylums. And Agra and Benares had to stop accepting patients from jails.

Due to the shortage of space at Poona, juveniles were kept with adult criminals, and recuperating patients stayed with those who were acutely ill. Civil inmates at Dharwar shared quarters with criminal inmates. And well-behaved patients were placed together with violent patients at Tezpur.

Most patients at Calicut and Madras were not considered violent. But a third of Vizagapatam’s patients were reported to be so. Several such patients at Tezpur were confined in cells. Cells were also a common feature at Dharwar. At Dullunda, a patient managed to escape by picking the lock of his cell. Locks of the sort that were used in jails were installed after this incident. Three patients escaped through the bamboo fence at Tezpur. And one committed suicide by hanging himself.

Patients who were found fit to work were expected to make themselves useful at the asylum. A little less than half of Lahore’s patients passed the test. At Agra, on the other hand, all the patients did. Usually, there was plenty of work to be done. This could include helping with cooking, grinding grain, plastering, and sweeping. Ten of the asylums had some amount of land suited to farming or gardening. There was a dairy farm at Bareilly, Dacca, Dullunda, Madras, and Patna. And an oil mill at Bareilly, Berhampore, and Jubbulpore. Some patients at Jubbulpore, Lahore, Madras, and Tezpur were engaged in weaving or tailoring. At Tezpur, women made most of the summer clothing for the patients. At Madras, European and Eurasian women were occupied with needle-work and knitting.

The monotony of asylum life might be broken by a variety of pastimes. Patients at Calicut played cards, chess, and other games. Several were allowed to keep pets.

On one occasion, some of them were taken to watch an acrobatic show. On another occasion, they went boating and had a picnic. A sports gymkhana was organised at the asylum, where the public was admitted for a small fee. The West Coast Spectator, Kerala Patrika, and Kerala Chandrika were delivered to the asylum, free of charge. His Highness the Zamorin of Calicut and MR Ry C.M. Rarichen Mooppen Avargal hosted “treats” for the patients during the year.

Every Saturday afternoon, a Brahmin priest and a barber played music and sang at the Vizagapatam asylum. And troupes of actors, acrobats, and jugglers performed here through the year. The patients amused themselves at cards and chess, or with cymbals and tom-toms. A few of them were taken to the town to watch a play. The annual treat hosted by Sri Maharajah G.N. Gajapati Rao boasted a fireworks show, acrobatics, and gifts of fruit. The Rajah of Kurapam, Babu Nandi Lal Ghosani, and MR Ry. Motamarry Sanyasi Chetti Garu were the other benefactors that year.

Excerpted with permission from Asylum: The Battle for Mental Healthcare in India, Daman Singh, Context Non-Fiction.