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 Table of Contents  
PERSPECTIVE
Year : 2021  |  Volume : 37  |  Issue : 4  |  Page : 385-387

Mental hospitals and historical trauma: Stop blaming stigma, address the trauma


School of History, Philosophy, Political Science and International Relations, Victoria University of Wellington, Wellington, New Zealand

Date of Submission10-Jul-2020
Date of Decision18-Aug-2020
Date of Acceptance13-Sep-2020
Date of Web Publication25-Nov-2021

Correspondence Address:
Dr. Sarah Ann Pinto
School of History, Philosophy, Political Science and International Relations, Victoria University of Wellington, Wellington
New Zealand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_198_20

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  Abstract 


Background: India is facing a mental health crisis but to change community stigma, we need to address historical trauma. This article discusses the issue of community stigma toward mental health care in India. Objective: The research aimed to trace the roots of community stigma toward mental health care facilities. Method: This study primarily used the archival method of data collection in constructing its narrative. Primary sources including colonial records, some vernacular newspapers, and a few Indian sources were analysed. The Maharashtra State Archives and the National Archives of India, New Delhi, served as the main repository of primary sources. Additionally, India Office Records at the British Library, London, provided further evidence for this research. Digitized copies of Annual Asylum Reports made available by the National Library of Scotland added to the evidence. The study also involved fieldwork at the Thana, Yerawada, and Ratnagiri mental hospitals in 2014. Results: Community stigma to the use of mental health care facilities is a historical problem. The establishment of lunatic asylums in India (as they were referred to in the 19th century, the nomenclature changed in 1921 to the term mental hospitals) caused disruption to local communities and families and left a legacy of trauma and fear. Conclusions: Acknowledging the trauma will disrupt patterns of coercion and cultures of abuse within mental health institutions and it will enable new narratives in mental health care.

Keywords: Colonial legacy, historical trauma, India, mental health crisis, stigma


How to cite this article:
Pinto SA. Mental hospitals and historical trauma: Stop blaming stigma, address the trauma. Indian J Soc Psychiatry 2021;37:385-7

How to cite this URL:
Pinto SA. Mental hospitals and historical trauma: Stop blaming stigma, address the trauma. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Dec 8];37:385-7. Available from: https://www.indjsp.org/text.asp?2021/37/4/385/331123



India is facing a mental health crisis but to change community stigma, we need to address historical trauma. In India, governments and the media have traditionally blamed the aversion to mental health care facilities on community stigma. Recent articles in the Pioneer and the Al Jazeera described the current mental health care crisis as an epidemic.[1] It emphasized that the stigma associated with mental illness only worsens the crisis. The media made similar allegations after the Erwadi fire incident. In 2001, the government tried to shift mentally ill people from the Erwadi Shrine in Tamil Nadu to government mental hospitals. The shrine's shed that had chained mentally ill people caught fire killing 25 of them. The families of the survivors refused the government's offer.[2]

The incident sparked a discussion around community stigma. The media stereotyped the families as superstitious for using the shrine and refusing to move their relatives. Even government mental health policies and programs follow a similar trend of labeling local communities as superstitious. Mental health programs in India have primarily focused on offering scientific methods of treatment to superstitious families who refuse to have their relatives treated at hospitals and other health care centers.[3]

While undertaking research for my doctorate and book, Lunatic Asylums in Colonial Bombay: Shackled Bodies, Unchained Minds, which is a social history of asylums in the Bombay Presidency (1793–1921), I found that this aversion to the use of mental health care facilities was a historical problem. Examination of archival records from the Maharashtra State Archives, National Archives (Delhi), British Library, and National Library of Scotland formed the basis of the study along with fieldwork at the Yerawada Mental Hospital, Ratnagiri Mental Hospital, and Thana Regional Mental Hospital. In this article, I elaborate some of my findings and accounts of historical trauma as experienced by patients and local communities. The establishment of lunatic asylums in India (as they were referred to in the 19th century, the nomenclature changed in 1921 to the term mental hospitals) caused disruption to local communities and families and left a legacy of trauma and fear. Therefore, local communities rejected the institution as a place of care for mentally ill relatives. The historical trauma experienced by Indian communities is elaborated here is six themes:

First, colonial agencies undermined Indian worldviews, medical practitioners, and caretakers. The interwoven spiritual-somatic Indian perspectives on mental illness and its treatment contested this ideological foundation of the asylum system. The Victorian asylum as a mental institution resulted from a separation of the spiritual and somatic meanings of mental illness.[4] To promote asylum use, colonial agencies portrayed Indian treatment practices and beliefs as stagnant and superstitious. Such a colonial narrative served to normalize the colonial position, based on the supposed superiority of Western medicine. However, it failed to convince local communities to seek treatment at an asylum. Indian society came to perceive the asylum system and European doctors as an intrusion in their socioreligious customs and practices. The establishment of the asylum led to the undermining of the practitioners of Indian medicine. Indian doctors were labeled quacks, and religious mendicants such as sadhus and fakirs, who cared for people suffering from mental illness, were themselves incarcerated in lunatic asylums.[5]

Second, the establishment of such an institution led to colonial interference in close family and community ties. The lunatic asylum as a by-product of individualistic societies in England was irrelevant to Indian society that valued its close family ties. The asylum system failed to assimilate into Indian society because it rejected local collective approaches for the care of mentally ill people. In Indian society, mentally ill people were cared for within their families and communities. The asylum system forced their separation from them. Collectivistic societies are characterized by strong links between the individual and the group or community; the separation of patients because of the asylum caused trauma to both the families involved and the patients. For Indian families, then, the asylum represented a forced and undesirable intervention into their traditional family and community lives.[6]

Third, the colonial asylum project led to the undermining of Indian culture. The asylum was a space for the execution of a “cultural project of control.”[7] Asylum agencies forced patients to conform to colonial perceptions of an Indian patient. Colonial agencies often misunderstood Indian cultural practices; for example, the Hindu practice of ritual fasting became a cause for incarcerating Brahmin Devram. For several months he remained incarcerated while the magistrate and the asylum assistant surgeon bickered about his apparent suicidal tendency. An over-representation of sadhus, fakirs, and beggars in asylum records is another indicator of the misconstruction of mental illness.[8] The asylum, thus, rightly derived its local name Pagal khana, a mere place of confinement for the “mad.”

Fourth, physically and mentally weak patients experienced trauma when they were forced to labor on the pretext on treatment. Colonial asylum doctors treated Indian insanity in a “common-sense” way; their treatment regimen revolved around clothing, feeding, and occupying patients. Superintendents considered this type of treatment as a practical means of managing Indian patients. For example, patients were made to work until they were exhausted to quieten them. On the pretext of treating them, superintendents often lent patients out to the Public Works Department and other government institutions to offer labor. Moreover, laboring of patients helped in alleviating the monetary burden of the state.[9] Such asylum “treatment” practices were a cause for families keeping their relatives who suffered from mental illness homebound rather than admitting them to an asylum. As Superintendent Niven explained in the Asylum Annual Report 1873–1874, the asylum provided patients with “too much treatment and too little care.”[10]

The fifth trauma that patients experienced was the manipulation of their voices. The impairment of a group's ability “to speak and be heard“[11] was a form of epistemic violence that manifested itself in the asylum. Asylum staff manipulated the patients' ability “to speak and be heard” in two ways. Firstly, they physically obstructed patients, preventing them from making complaints to the Visitors (Government-appointed inspectors). Secondly, they used their voices as evidence of their mental illness. Sajan Curim a former patient at the Colaba Lunatic Asylum wrote a complaint letter to government authorities about the condition of the asylum. When the government questioned the superintendent, he used this letter as evidence of Curim's mental illness. Patient silences were also selectively interpreted, sometimes as a symptom of mental illness, and on occasions as a sign of improvement. The asylum violated the rights of its patients by regulating their voices and controlling the extent to which they could speak and be heard.[12]

Finally, patients and families experienced trauma because of the lack of privacy and the linking of the asylum with the criminal justice system. Bombay's colonial superintendents, in their official reports and letters, complained of families refusing to use the asylum because of the stigma associated with it. Numerous petitions letters of families asking for the discharge of their relatives is further evidence of the stigma associated with the asylum. The asylum also instilled a sense of fear. Families feared forceful incarceration and permanent confinement of their relatives. Public certification of those deemed mentally ill only aggravated the shame associated with the asylum's use. The tendency of families to conceal mental illness was an indication that they feared the intervention of the judiciary and penal authorities and the incarceration of their kin, behind asylum walls.[13]


  Mental Hospitals in India Today Top


Government mental hospitals in India continue as places of confinement rather than care. Mental hospital care in India involves the use of “lunatic asylum” buildings. Moreover, their forms of therapy are a continuation of colonial hospital practices. On my visit to the three hospitals in Maharashtra in 2014, the evidence clearly pointed to their custodial character. The colonial government constructed the mental hospital at Ratnagiri in 1886, at Thana, Mumbai in 1902, and Yerawada, Poona in 1913. At Ratnagiri [Figure 1], there was no psychiatrist and subordinate staff managed the hospital. At Ratnagiri and Yerawada, hospital staff employed patients in chores around the asylum. At the Thana Mental Hospital, one method of occupational therapy involved work on a weaving machine installed when the government inaugurated the asylum in 1902. An article in The Indian Express on 25 June 2020 noted that at the Yerawada Mental Hospital patients continue to be engaged in “sewing and paper-making.”[14] In 1904, Superintendent Grayfoot of the Dharwar Lunatic Asylum described such treatment methods as “common-sense treatment.”[15]
Figure 1: The Men's Ward, Ratnagiri Mental Hospital (Author's Photograph, 2014)

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While hospitals continue to use common sense treatment, they also continue to carry a legacy of trauma. A report by the Human Rights Watch in 2014 noted that in government mental hospitals women were treated “worse than animals.”[16] Such historical trauma, patterns of coercion, and cultures of abuse in mental hospitals need to be addressed.

A mere change in policy will not change community attitudes to mental health care facilities. In 2017, the UN Special Rapporteur Dr Dainius Pūras rightly called for a “revolution” in mental health care.[17] If we want to see a revolutionary change, governments, medical practitioners, policymakers, and society need to acknowledge this historical trauma so that, together, new narratives of mental health care can be written that are holistic and rights-based. We need to move beyond educating people about stigma, we need to move toward acknowledging the trauma and healing the fear behind the stigma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
2.
Pinto SA. Lunatic Asylums in Bombay: Shackled Bodies, Unchained Minds. Cham: Palgrave Macmillan; 2018. p. 1.  Back to cited text no. 2
    
3.
Ibid; National Mental Health Programme, India; 1982. Available from: https://main.mohfw.gov.in/sites/default/files/9903463892NMHP%20detail_0_2.pdf. [Last accessed 2020 Jul 07]. Also See.National Mental Health Policy for India; 2014. Available from: https://nhm.gov.in/WriteReadData/l892s/6479141851472451026.pdf. [Last accessed 2020 Jul 09].  Back to cited text no. 3
    
4.
Scull, Andrew. Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton and Oxford: Princeton University Press; 2015. Scull A. From madness to mental illness: Medical men as moral entrepreneurs. Europ J Sociol 1975;16:254.  Back to cited text no. 4
    
5.
Nicholas Dirks. Foreword. In. Bernard Cohn. Colonialism and its Forms of Knowledge: The British in India. New Jersey: Princeton University Press; 1996. p. 9. Pinto. Lunatic Asylums in Bombay. p. 44, 50.  Back to cited text no. 5
    
6.
Pinto. Lunatic Asylums in Bombay. p. 173-4.  Back to cited text no. 6
    
7.
Pinto. Lunatic Asylums in Bombay. p. 94 5.  Back to cited text no. 7
    
8.
Pinto. Lunatic Asylums in Bombay. p. 4, 50.  Back to cited text no. 8
    
9.
Pinto. Lunatic Asylums in Bombay. p. 93, 120 123, 155.  Back to cited text no. 9
    
10.
Annual Administration and Progress Report (Asylums of the Bombay Presidency); National Library of Scotland; 1873-1874. p. 21.  Back to cited text no. 10
    
11.
Dotson K. Tracking epistemic violence, tracking practices of silences. Hypatia 2011;26:236.  Back to cited text no. 11
    
12.
Pinto. Lunatic Asylums in Bombay. p. 145-50.  Back to cited text no. 12
    
13.
See chapter on 'public perceptions of the Pagal khana' in pinto. S. A. Lunatic Asylums in Bombay. p. 153-80.  Back to cited text no. 13
    
14.
15.
Grayfoot BB. Superintendent, Lunatic Asylum, Dharwar, to the Personal Assocition. to the Surgeon General with the Government of Bombay, GoB, GD, 1907/81, MSA, Mumbai; 1904.  Back to cited text no. 15
    
16.
17.
Available from: https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689&LangID=E. [Last accessed 2020 Jul 09].  Back to cited text no. 17
    


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