In the early hours of August 2001, the village of Erwadi in Tamil Nadu woke up to shrieks and wails. A freak fire had broken out at a shed on the precincts of the village shrine. The fire trapped 43 mentally ill people whom the shrine committee had chained there. Within minutes, the fire gutted the entire enclosure made of coconut palm branches. The fire killed 25 of the 43 people, including 11 women, that day.1 After the accident, the government made an investigation into similar shrines that looked after mentally ill people in the State of Tamil Nadu. The government offered families that kept their relatives at such shrines places in mental hospitals. However, these families refused to have their relatives moved, choosing instead to keep them in âsheds and chainsâ.2 Even today, the shrine at Erwadi continues to house mentally ill people. A government-appointed psychiatrist has been visiting since May 2015, to provide medical intervention three times a week to those who were willing to avail of it. The medicines offered are a means to calm patients and to stop the shrine from using chains to restrain them.3
The incident at Erwadi drew a considerable amount of public attention; the media labelled the local community as âsuperstitiousâ because of its blind faith. The trend of labelling local communities as âsuperstitiousâ is evident even in government mental health policies and programmes. Mental health programmes in India have primarily focused on offering âscientificâ methods of treatment to âsuperstitiousâ families who refuse to have their relatives treated at hospitals and other health care centres.4 The government and the media have conveniently blamed Indian societyâs superstitious beliefs for its poor response to mental hospitals; however, post-independence governments have paid little attention to providing effective mental health care to generate peopleâs trust in it. In fact, India launched its first Mental Health Policy only in 2014.5 Mental health care has remained peripheral to government health care policies and provisions.
The mental health care system and its clientele face several challenges in India. First, Indiaâs psychiatrist/patient ratio stands only at 0.3:100,000.6 Second, government mental hospitals have frequently made headlines for the abuse of patients. The State of Maharashtra7 has four government mental hospitals at Thana, Yerawada, Nagpur, and Ratnagiri. The paucity of psychiatrists has left these institutions chiefly under the management of untrained subordinate staff. The only educational qualification required of them is a primary education, and their posts are permanent.8 In the hospitals at Thana and Yerawada, the media has reported several cases of abuse by subordinate staff. Patients sweep floors and even clean toilets, complying with orders from the staff to avoid abuse.9 In 2007, a report by the Chief Judicial Magistrate exposed the poor conditions of the four hospitals regarding basic facilities like food, drainage, and water. The Indian government in the past has recognized the deplorable conditions within mental institutions. Recognizing that their nature was âcustodialâ, the government decided to bring them under âcomprehensive managementâ.10
Keeping in line with this vision, the government launched national and district mental health programmes in 1982. However, shortage of staff and resources greatly limited the success of the National Mental Health Programme (NMHP) and District Mental Health Programme (DMHP).11 Shortage of resources and staff was only part of the problem. NMHP and DMHP aimed to âmoderniseâ psychiatric practices and create âawarenessâ among Indian communities. Modernization implied implementation of western models of psychiatry, and âawarenessâ meant making Indian communities accept âmodernâ methods of treatment.12
Dr. Eduardo Duran , the Director of Health and Wellness for the United Auburn Indian Community in Northern California, has argued that such mental health policies and programmes that undermine indigenous spiritual beliefs, facilitate the continuation of âneo-colonizationâ of indigenous peoples.13 Exclusive western models have been largely unsuccessful in the mental healing process of American Indian communities. In fact, the continuance of such models has only served those in the existing system whose power positions it reinforces. Furthermore, these institutions become avenues for jobs only for those who agree with the continued colonization of indigenous peoples.14 An examination of the history of these institutions brings to light continuing patterns of abuse within such institutions.
Psychiatric care in government mental institutions in India still bases itself on a colonial model. On my visit to the three hospitals in Maharashtra, the evidence clearly pointed to their custodial character. The colonial government constructed three of the four mental hospitals at Thana, Yerawada, and Ratnagiri. At Ratnagiri, a general physician from the government hospital oversaw the mental hospital. He held additional charge of the hospital, much like in the nineteenth century. The Ratnagiri Mental Hospital had no therapists. The former occupational therapy centre was now an empty locked room. 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. Such conditions provide some obvious explanations why local communities avoid mental hospitals. The situation indicates that the Indian communityâs aversion to mental hospitals has some historical roots.
Dr. Duran, in his book Healing the Soul Wounds, postulated that colonial institutions left indigenous communities in America with historical traumas or âsoul woundsâ. In the American Indian worldview, there is a holistic understanding of mental health: the mind, body, and spirit are interlinked. Therefore, colonial institutions, in the experiences of American Indians, affected their physical and psycho-spiritual wellbeing. Moreover, such trauma is intergenerational and has had an increasing negative implication for each subsequent generation.15 Concerning colonial asylums in Bombay, such âsoul woundingâ is evident in examples of the incarceration of Indians because of differences in colonial and Indian worldviews. In 1849, a magistrate in Ahmedabad sent Brahmin Devram to the asylum because he went on a religious fast. The magistrate concluded that the Brahminâs fast was an attempt at suicide and he admitted Devram to the Ahmedabad Asylum.16 Such a misconstruction was just one example of a âsoul woundâ. In addition, colonial asylums were in an appalling condition adding to the trauma of those who experienced life within them.
In 1904, Superintendent J.P. Barry described lunacy administration in India as the âveritable Cinderellaâ in the family of colonial institutions.17 He complained about meagre government funding for asylums. He also petitioned the government to stop the practice of charging fees for first-class paying patients, because: âThe entire building [was] more like a godown or a dilapidated barrack than an asylum. It [was] a shock to oneâs sense of justice to demand Rs. 4 a day for housing mentally sick people in so unsuitable a placeâ.18 While superintendents complained of lack of amenities and poor funding, they ironically criticized the reluctance of Indian communities to admit relatives to an asylum. Startling similarities are evident in situations regarding mental health treatment and Indian communities during colonial times and today, both in terms of government neglect and community aversion. There is therefore a need for a ânew narrativeâ of mental health treatment. Dr. Duran argued dealing with such historical issues was imperative to the writing of new narratives in mental health treatment.19
This book, then, is an attempt to deal with the historical issues associated with mental hospitals by bringing to light historical traumas or âsoul woundsâ experienced by local communities as they encountered the colonial asylum system in the Bombay Presidency. The use of the term âsoul woundâ is intentional. It does not imply a common conception of the âsoulâ among communities in India. Rather, the study uses it to be inclusive of the âsacredâ beliefs integral to the understanding of the mind and mental health across various Indian communities.20 In the experience of Indians, the lunatic asylum had implications on their physical, psychological, and spiritual wellbeing.
While violence and abuse within the asylum was a source of trauma to patients, the undermining of Indian worldviews, cultures, and beliefs further added to their wounding. âEpistemic violenceâ21 was common both within and outside the asylum, as local knowledge concerning mental health and treatment was designated as superstitiousâas opposed to colonial knowledge that was deemed modern and scientific. These unresolved historical traumas are intergenerational.22 Aversion to gover...