The mental dynamic

Asylum: The Battle for Mental Healthcare in India

Author: Daman Singh

Publisher: Westland

Pages: 184

Price: Rs 499

How did mental illness become a public health priority in India? Who was responsible for initiating reforms in mental hospitals, formerly known as lunatic asylums? To what extent were these shifts catalysed by the decline of British rule in India? If these questions interest you, read Daman Singh’s new book Asylum: The Battle for Mental Healthcare in India.

Ms Singh, who has made a sincere attempt to tell “the story of asylum reform in India” with this work of non-fiction, writes, “When it comes to maladies of the mind, there is an enduring culture in the Indian subcontinent of turning to the occult, to faith, and to traditional methods of healing. In the 18th century, another option was added to this list — the lunatic asylum.”

India’s first asylum — officially recognised but privately run — was established in Calcutta in 1788. Ms Singh writes, “The asylum was meant to protect society from the disturbing, disruptive and possibly dangerous influence of the insane. It was a primitive form of captivity in cruel and barbaric conditions.” Many of these asylums had more inmates than they were able to support. Due to shortage of space, recuperating patients were kept with the acutely ill.

In 1900, the asylums in British India had over a thousand inmates. Some were brought to these institutions by family members who had given up on them after consulting tantrics, exorcists, pirs, fakirs, hakims and vaids.  Some were transferred to asylums from prisons. All the others had been picked up by the police from the streets. It was their job to round up not only beggars and vagrants but also people who “seemed to be of unsound or deficient mind.”

This book captures the changes that took place in these institutions over the course of the 18th and 19th centuries. Inmates in the Calicut asylum were allowed to keep pets. The Madras asylum had a library; it also hosted performances by jugglers, acrobats, bands and bears to entertain inmates. The asylum in Tezpur had a gramophone and records of English and Hindustani music. Inmates were given books to read, and musical instruments to play.

These humane interventions were not visible in asylums all over British India. Based on her research, Ms Singh clarifies that the life of inmates in each asylum was shaped by local circumstances. The superintendents of these asylums decided how to run them. The practices that they introduced depended on how they interpreted their job. British India— unlike England — had no standardised protocols regarding asylum administration, for a long time.

“It would take more than bricks and mortar to modernize the treatment of mental illness,” writes Ms Singh. Her book documents the contributions of policymakers, administrators, lawyers, journalists, social workers, media people and concerned citizens who wanted to ensure that patients would no longer be chained to trees and beds, or kept in solitary confinement; they would have access to occupational therapy, exercise, and recreation. Some hospitals took patients on shopping expeditions; others had projectors, so they screened films.

Ms Singh looks briefly at the impact of the Partition, which “left hundreds of Indian patients stranded for years in mental hospitals in Pakistan.” Pakistani historian Fakir Aijazuddin helped her source annual reports of the Lahore mental hospital from 1947 to 1950. They filled in “many of the blanks in what we know about the disturbing events of the time.”

Saadat Hasan Manto’s famous short story titled “Toba Tek Singh” (1955) is set in a context wherein the governments of India and Pakistan have decided to exchange the inmates of their asylums. Muslim inmates from Indian asylums are to be sent over to Pakistan; Hindu and Sikh inmates from Pakistani asylums are to be handed over to India.

Outside the literary world of Manto, in real life, India and Pakistan exchanged their mentally ill patients on December 6, 1950. Ms Singh writes, “Why did the transfer of mentally ill patients take so long? After all, the two governments were able to evacuate over a quarter million of their citizens in a matter of months. Why then did it take them more than three years to reclaim a few hundred who were in mental hospitals?”

With these critical questions, she holds both states accountable for protecting the interests of these patients who were treated “no better than second-class citizens.” Her work also builds on Sanjeev Jain and Alok Sarin’s edited volume The Psychological Impact of the Partition of India (2019), which examines the collapse of medical services during the violence of 1947, and what this meant for people living with psychological distress and mental illness.

Ms Singh’s book makes it clear that India’s Mental Healthcare Act, 2017, builds on a long legacy of efforts to advocate for rights-based institutional care. The journey, however, is far from complete because mental hospitals are “increasingly reluctant to retain patients merely because they have nowhere else to go.” Some of them are accommodated by “shelters for beggars and the destitute.” Others have to fend for themselves on streets.