The mentally ill were not ‘fit’ for national news until ’80s except for wrong reasons

In the book 'Asylum', Daman Singh provides an account of the history of mental healthcare and asylums in India since the early 20th century.

Illustration by ThePrint Team

The mentally ill did not make it to the national news very often. When they did, it was for all the wrong reasons.

Before independence, the Indian Mental Hospital, Kanke, was regarded as a modern institution, a fine example for others to follow. It is not clear when exactly this stopped being true. But by the early 1980s, there were plenty of reasons for it to be in the news.

In June 1982, India Today carried an article on the hospital, which by then was called the Ranchi Mansik Arogyashala. The grim account by Chaitanya Kalbag described it as ‘crawling with decay and despair’. Everything assailed the senses, from the sight of men and women living in conditions ‘that make the word squalid sound respectable’, to the smell of ‘uncared-for bodies’ that inhabited ‘shockingly maintained’ wards. Many patients had to ‘rot for years’ after being certified as sane, because their relatives would not take them back. Women were more likely than men to be abandoned in this fashion.

The accompanying photographs by Raghu Rai left little to the imagination. One was of newly arrived patients tied to iron bed-frames, unclothed. Dogs and patients were seen eating from the same plates in the women’s section. A scene from the 107 kitchen showed chapatis being rolled out on a filthy floor. And in another, a patient was being held down by four men, while a fifth held out a primitive pincer-like contraption in the ‘shock shop’.

Understaffed and underfunded, the hospital authorities were apparently trying to make the best of an impossible situation. Yet the medical superintendent had candidly admitted that his patients were worse off than the inmates of a concentration camp.

Two years later, the hospital was in the news again. On 4 September 1984, the lower staff had gone on strike to protest a pay cut. This left the patients unfed as well as unguarded. The next morning, 276 of them wandered out of the hospital gates. The strike was called off the following day, and order was restored. But before that had happened, a young reporter named Uttam Sengupta managed to sneak inside with a photographer. The Telegraph carried the story on the 8th of September, and tracked it over the coming weeks. Digging into the past, the paper printed charges of negligence, malpractice, and corruption that the Bihar government had allegedly chosen to ignore.

A week after the ‘escape’, 188 patients had been ‘captured’, while 88 remained ‘at large’. But the bigger story was the eyewitness account of ‘disgraceful living conditions’ at the hospital. A few wards on the ground floor were ‘showpieces’ for the benefit of visiting dignitaries. Unlike these, the wards on the first floor were usually kept locked. They were badly maintained, poorly ventilated, and ill-lit. And they had neither cots nor mattresses. Sengupta also learnt that the hospital did not have a morgue. Corpses were seen ‘carelessly dumped’ in a corner of a ward. The fate of the dead, he pointed out, was hardly surprising when one witnessed the treatment meted out to the living. 

A sprinkling of disturbing articles had appeared in the press during the 1980s and 1990s. Kanke was not the only mental hospital to be singled out. The reportage included stories from Agra, Ahmedabad, Amritsar, Bangalore, Calicut, Gwalior, Nagpur, Ranchi, Ratnagiri, Thane, and Yeravda. Were all mental hospitals in the same situation? And did all patients get a raw deal? That was not the case. The stories of those who were treated well, whose condition improved, and who returned to their home would remain untold.

In October 1981, Sreedhar Pillai reported that two male attendants at the Calicut mental hospital allegedly got drunk and climbed the outer wall of the women’s ward. One of them then unlocked the heavy iron door of a cell, and assaulted its inmate 26-year-old Premaja. The other attendant happened to drop thebunch of keys as he tried to enter the next cell. The noise woke up its two inmates. They raised an alarm and the culprits fled.

After keeping quiet for the next three days, Premaja confided in the head nurse. The hospital, however, hushed things up. When a group of its employees leaked the story, the police registered a case. There was a public uproar, protests were held outside the hospital, and local organisations came forward to champion Premaja’s cause. Her father, a retired school teacher, wrote to the prime minister and the chief minister, demanding action against the criminal negligence of the authorities. According to him, his daughter suffered from depressive psychosis. Except for the occasional violent outburst, she was well-behaved. She had been in the hospital for the past 12 years.

It was not unheard of for a magistrate to send a mentally ill person to jail until he could be admitted to a mental hospital.This was the practice in Madhya Pradesh, as also in various other states.

In June 1982, Sreekant Khandekar found that there were 34 such ‘non-criminal lunatics’ at Gwalior’s central jail. The jail authorities said that the Gwalior mental hospital would not take them. And the hospital authorities said that the jail had not sent them over. As a result, these patients remained in jail. At least four of them had been waiting there for more than eight years. While they waited, these men were living in a long, narrow hall, which they shared with mentally ill convicts and undertrials. Raised cement slabs served as beds for the inmates. A psychiatrist from the Gwalior mental hospital visited the jail, but these visits were neither frequent nor regular. Patients could be taken to the mental hospital for consultation, as it was just 200 yards away from the jail. But, like all prisoners, they could only be moved under police escort. And it was not always possible to arrange for this facility.

In a complaint to the Bombay High Court in July 1988, H.A. Shukri alleged that his mother had died of negligence at Yeravda. The court then appointed a commission to look into all four mental hospitals in Maharashtra. The commissioner’s report led the court to observe that patients in these hospitals were ‘treated like animals’. It ordered the state government to carry out several improvements. Six months later, The Times of India reported that not much had changed.

Yeravda’s buildings were still dilapidated, with leaking ceilings, torn netting, broken doors, ripped electrical fittings, damaged compound walls, and a ‘terrible shortage of water and toilets’. A journalist who had been recently admitted for de-addiction claimed that the attendants were cruel to patients. They would, for instance, take an ‘excited’ patient to the ‘oonch ward’, where criminal patients were locked up. One such patient had returned with a broken leg. The journalist had also seen other patients brought back battered and bleeding to the infirmary. At times, an attendant would beat up a patient just ‘for the fun of it’. During Holi celebrations that year, drunk attendants had tied two patients to a tree and whipped them with leather belts. On another occasion, a patient with high fever was given a hot bath and left to dry in the sun, after which he developed complications and died.

Most of the patients at the overcrowded Nagpur hospital were chronic cases. One of them had been there since 1929. The Times of India correspondent came across three alcoholics ‘bunched together’ with 60 epileptic patients. Among them was a child.The isolation cells at Nagpur were 8’x6’ cages with rusty iron grills. They were smaller than enclosures for animals in a zoo.

Like Nagpur, Thane too was overcrowded. The hospital had only 300 beds for its 1,756 patients. These beds were reserved for those who had recovered. No bedding was given to any patient, not even in winter. After meals, patients drank water, tea, or milk from their thali, as neither glasses nor mugs were provided. Most of them bathed in the open.

The smallest of the four mental hospitals, Ratnagiri was also overcrowded. It was short of trained staff, and faced delays in medical supplies. In very many cases, relatives did not take back patients who had recovered. Under the law, a person cannot be tried for a crime unless he is of sound mind. So when a mentally ill person is charged with an offence, his trial may have to be postponed till he is declared capable of defending himself in court. All this while, he is supposed to be treated for his condition – in jail or at a mental hospital. Also, his mental state is supposed to be periodically assessed. Under the law, a mentally ill undertrial may remain in jail or a mental hospital indefinitely.

In May 1992, Ramesh Vinayak reported that there were 22 undertrials at the Amritsar mental hospital. Some had been accused of murder. Others were charged with trivial crimes.

Gattu, for instance, had been arrested for stealing cigarettes 15 years ago. And Bawa Singh was picked up for trespassing at the age of 26. He was now 53. If tried, and if convicted, these persons would have been handed a jail sentence that was far shorter than the time they had spent at the hospital. But most of them were unlikely to ever appear in court.

One such person was Raksha Devi, who had been accused of killing her husband ten years ago. Her daughter, Meenu, was born at the Amritsar mental hospital. Bright and quick-witted, the child lived with her mother in a hospital ward.

Writing for the Indian Express in June 1994, Siraj Qureshi revealed that a number of patients at the Agra mental hospital were actually ‘quite normal’. But their relatives were not willing to take them home. This was not particularly surprising, for they had been ‘packed off’ to the hospital for ‘piquant reasons’ that had nothing to do with their state of mind. According to Qureshi, the hospital was using electroconvulsive therapy as ‘first aid’, and fellow-patients were made to assist in the procedure. A female patient had a fractured hand from being beaten by an attendant. And hooligans had entered the women’s ward through the broken boundary wall. Qureshi’s article was based on an official inquiry by assistant district magistrate Hardev Singh, who had been tipped off about a racket in fake medical certificates.

Qureshi’s article was followed by three more. Usha Rai, who made a trip to the hospital, saw for herself its decrepit buildings, leaking roofs, and broken walls. Many patients in the male wards were stark naked, some lay in their own faeces and urine. Attendants who wished to ‘play hookey’ gathered patients into one ward and locked them in. There would be two or three persons to a bed, while others were on the floor. Several of the iron beds had no mattress. Women were not provided sanitary napkins when they menstruated. Instead, they were simply locked in a cell for a few days. Some patients who were infested with lice had gouged out holes in their scalp. The procedure for electroconvulsive therapy reminded Rai of an abbatoir. After a cloth bag was placed over the patients’ heads, they would be ‘dragged off kicking and screaming like goats for slaughter’. And while the shock was being administered, they were held down by ‘other terrified patients’.

Thanks to Hardev Singh’s inquiry, a committee of doctors at the hospital reviewed a large number of cases, and declared that 180 patients were mentally sound. Around 80 of them were quickly released. The rest were held back for a second opinion. In the meantime, Hardev Singh was transferred. Usha Rai had raised a pertinent point at the time – ‘If a government which has come to power on the votes of the marginalised, cannot run efficiently one mental hospital with a little over 400 patients, can it run a whole state?’ India Today published a piece by Farzand Ahmed and Avirook Sen in September 1996. The photo-feature was about persons who had been abandoned by their relatives at one mental hospital or another.

This excerpt from ‘Asylum: The Battle for Better Mental Healthcare in India’ by Daman Singh has been published with permission from Westland Non-Fiction.