I have always been intrigued by the mysteries of the mind. These tend to crop up in much of what I read, and much of what I write. My first novel was about the unquiet mind. Nine by Nine came out in 2008. It was a quiet story of a young woman, Tara, who slowly loses her sanity. Reviews saw it as a coming-of-age story, a portrayal of life in a university hostel. Few, if any, noticed that Tara was mentally ill. This was a pity, but could not be helped. I moved on to write other books, on other themes. In 2010, I happened to attend a seminar at the Nehru Memorial Museum & Library on the mental health aspects of communal conflict. It was the first of many organised by Dr Alok Sarin, a psychiatrist who was then a senior fellow there. A number of psychiatrists, psychologists, academics, and activists attended these seminars. As a mere writer, I was the least qualified of the lot. Pretty soon, I decided that I must learn all that I could about mental healthcare in India, past and present. Ever since my last book appeared, various people have asked me what the next one would be about. There is an awkward silence after I tell them. Then they ask me why. ‘Because,’ I reply, ‘nobody seems to have written the kind of book that I’ve been looking for.’ Asylum is that book. 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. 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. The first officially recognised – though privately run – asylum was established in Calcutta in the year 1788. Soon enough, public asylums came up across the breadth of British India. Foreign in both concept and design, the asylum became the approved place to confine the insane. By the middle of the 19th century, medical science was thinking differently about insanity. The origin of this affliction was not yet clear. And its antidote was not yet known. But there was reason to believe that it could be corrected through humane and therapeutic treatment. As this view took root in the Western world, asylums began to be refashioned as institutions for the care of the mentally ill. While Britain was quick to attend to its own asylums, it took a while to turn to those in its largest colony. This book is the story of asylum reform in India. It begins in the early 20th century, when the subcontinent was under colonial rule. And it continues through the course taken by an independent, sovereign nation. It is about the force of new ideas and the grip of old ones. About civil servants, doctors, journalists, lawyers, and judges who pushed for change. About the course of political events. And about the weight of international opinion. Fragments of this story are scattered in archival records, official reports, court proceedings, academic journals, and news articles. But nowhere have these been pieced together in a way that speaks to ordinary citizens like me. This is what Asylum tries to do. A Note The names of mental hospitals have changed over the years. They have also tended to get long and unwieldy. To simplify matters – for myself and for the reader – I refer to a hospital by its location. So what is today the Institute of Mental Health and Hospital, Agra, is simply ‘Agra’ in my book. I trust that the reader will figure out when I am referring to an institution, rather than a city. The city of Ranchi presents a peculiar problem. The European Lunatic Asylum, Ranchi, was set up in 1918. Then, the Indian Mental Hospital, Kanke, opened in 1925. Kanke is a suburb of Ranchi, and the two hospitals are practically neighbours. To get around this obstacle, I simply refer to the former as ‘Ranchi’ and the latter as ‘Kanke’. Incidentally, ‘Ranchi’ is now the Central Institute for Psychiatry, Ranchi. And ‘Kanke’ has become the Ranchi Institute of Neuro-Psychiatry and Allied Sciences. The names of a few cities have also changed with time. I have stuck to the first version that occurs in the book. PART ONE ONE Asylum In this country we are hardly ever called to see a patient in the initial stage … In the enormous majority we only see a patient when he is so insane, and has become so troublesome, that he is of necessity placed in an asylum to give security and freedom from annoyance to the sane population; even then, however, much can be done for the amelioration of many, and for the comfort and well-being of all.1 At the dawn of the 20th century, 8,365 men and 950 women were in asylums for the insane across British India. By Western standards, these numbers were absurdly small. There was no reason to believe that Indians were any saner than other people. So the asylums clearly contained only a fraction of all those who were mentally ill. Where were the rest? They were, quite simply, at home, at large, or in jail. A family was likely to overlook the early signs of mental illness in one of its own. If alarmed or anxious, it consulted tantrics and exorcists, pirs and fakirs, hakims and vaids. It tried tantra and mantra or potions and charms. It could also turn to beating, bleeding, and branding. Or to ropes and chains, bolts and locks. When all else failed, it might try its luck at an asylum – if indeed there was one within reach. But for that it would have to get a court order. It was easier to abandon its sick, perhaps at a place of worship. Or to look the other way when he – or she – just happened to wander off. An unknown number of wanderers drifted about the countryside, fending for themselves. Some were seen as a public nuisance, others as a threat to public safety. The police could therefore round up beggars and vagrants. It could also round up those who seemed to be of unsound or deficient mind. The legal system decided whether a person − produced by relatives or by the police − was eligible for admission to an asylum. This decision was taken by the police commissioner in Bombay, Calcutta and Madras city; and by a civil magistrate at other places. The authorities were assisted by a medical officer who was called in to examine the candidate. The doctor’s job was to assess whether the person really was of unsound or deficient mind. And if so, whether he needed to be placed in state care. Someone who seemed to pose a danger to others, or to himself, was most likely to qualify. But other reasons might also play a part. The question called for a medical opinion and the answer was not always obvious. Especially if the doctor – like many doctors – had little experience to go by. After that, it was up to the authorities. They could either order that the person be taken to an asylum. Or they could send him to jail for further observation. His spell in jail was not supposed to stretch more than a fortnight. But for a variety of reasons, it could last quite a while. A harsher spell in jail was in store for those who were in for a crime. Some were convicts. Others had been acquitted on grounds of insanity. And then there were those who were yet to stand trial. All prisoners – sane and insane – had to submit to the discipline demanded in jail. But if a jail doctor certified that an inmate was insane, he was supposed to be transferred to an asylum instead. For a variety of reasons, this could take time. 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 G.F.W. 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 M.R.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 M.R.Ry. Motamarry Sanyasi Chetti Garu were the other benefactors that year. The library in the Madras asylum was stocked with newspapers, periodicals, and books. Patients played football or croquet outdoors, and chess or draughts indoors. From time to time, jugglers, acrobats, bands, and performing bears were brought in to entertain them. Christmas was celebrated with a special treat. A Christmas tree was decorated and small presents were distributed. A gramophone and records of English and Hindustani music were bought at Tezpur. Patients were provided with books, newspapers, musical instruments, and cards. The ‘magic lantern’ – or bioscope – was screened now and then. Sweetmeats and fruits were distributed on festivals. During Durga Puja, select patients were taken for the vashan ceremony at the river ghat. On another occasion, some were even escorted to the race course. The mentally ill were vulnerable to a host of physical ailments. Many had been in a ‘moribund’ state when they arrived, and many would fall sick during their stay. Anaemia, debility, fevers, diarrhoea, dysentery, cholera, tuberculosis, and pneumonia were among the common ailments. Every asylum had an infirmary. Except for the one at Madras – which had trained nurses – all infirmaries were staffed by untrained attendants. As every infirmary did not have an isolation ward, infectious diseases were liable to spread. Sometimes such diseases travelled from the town to the asylum. In the year 1900, only 1 per cent of Ratnagiri’s patients were in the infirmary on an average day. But the number was as high as 16 per cent at Madras. All said and done, it was a fairly healthy year at Cuttack, Dharwar, and Jubbalpore; and a fairly sickly one at Dacca, Dullunda, and Lucknow. Some asylums took special precautions to keep their inmates healthy. For instance, 22 persons were being fed by tube at Madras and 9 were being fed by hand at Calicut. All patients were weighed once a month at Calicut, Dacca, Dullunda, Madras, Patna, Tezpur, and at Vizagapatam. At Vizagapatam, 59 per cent of the patients lost weight during the year. The figure was 47 per cent at Tezpur, 27 per cent at Madras, and 21 per cent at Calicut. Feeble patients were weighed more often and given extra food, tonics, and drugs. Better clothing was provided to convalescent and weak patients at Dacca, and warm clothes were issued well before the cold season set in at Lahore. Preventive doses of quinine were administered at both places. Tezpur dosed its patients with quinine, iron, and dilute sulphuric acid. The Madras infirmary attended to 19 cases of injury that year. The injuries included a femur fracture after a fall from a verandah; bruising caused by an inmate banging his head against the iron bars of his cell; a scalp wound obtained while running; a cut received during an epileptic fit; a sore eye from being punched; and a bite on the back by a fellow inmate. Elsewhere, an elderly person sprained his knee while turning cartwheels. In a fit of excitement, one man fractured his collarbone, and another his ulna. And a woman was bitten by a snake as she tried to catch it. Eleven per cent of the asylum population died in the year 1900. Jubbulpore had the lowest mortality rate of 2 per cent. The highest figure of 27 per cent was reported from Hyderabad in Sind province. Less than 5 per cent of the patients died at Agra, Benares, Calicut, Cuttack, Dharwar, and Ratnagiri. On the other hand, over 20 per cent died at Ahmedabad and at Colaba that year. In death as in life, no two asylums were alike. Britain had an elaborate system to establish and administer its asylums. British India had nothing of the sort. And the flaws in its asylums were more than evident to those who cared to look within. Each asylum had its own peculiar history. Each was shaped by local circumstances. And each depended on how its superintendent chose to interpret his job. Outside of British India, much of the subcontinent was then under assorted Indian rulers. Little is known about the asylums in these territories. Many were simply jails by another name. But a few took their cue from the ones in the colony. In January 1901, the Indian Medical Gazette carried a piece on the progress in the country during the past hundred years. Medical departments had been organised. Medical colleges and schools had come up. Hospitals and dispensaries had been opened. Diseases like small pox, typhus, cholera, and dysentery had ‘lost their greatest terrors’. And research on malaria and typhoid was close to a breakthrough. The article said little about mental illness, except that its treatment was not as ‘crude and rough’ as it used to be. But it did make an important announcement: We have on previous occasions referred to the changes which are about to take place in the management of the asylum in India[;] and with the new century we have every reason to expect that a new era is dawning for the insane in India.2 1 G.F.W. Ewens, Insanity in India: Its Symptoms and Diagnosis; with Reference to the Relation of Crime and Insanity (Calcutta: Thacker, Spink & Co., 1908), 216. 2 Anon., ‘Medical Progress in India during the Past Century’, Indian Medical Gazette, vol. 36, no. 1 (January 1901): 22. TWO The New Era It was a fortunate occurrence that before Lord Curzon left England to assume his duties as Viceroy[,] the requirements of Indian asylums were brought under his notice. He promised to look into the matter immediately on his arrival in India. Through a mutual friend, Dr McDowall was able to bring his presidential address under the notice of Lord Curzon. Whether owing to that fact or not, we now see the beginning of the reforms so urgently required. … [W]e must heartily congratulate Dr McDowall on the achieved results of his labours. It is not often that a reformer commands instant attention.3 Having served in England’s asylums for some thirty years, Dr T.W. McDowall was no stranger to insanity. Intrigued by a brief mention in a medical journal, he decided to find out more about its treatment in India. It was not possible for him to go there to see things for himself. So he relied on official documents and personal correspondence. What he learnt became the subject of his presidential address at the annual meeting of the Medico-Psychological Association of Great Britain and Ireland in July 1897. Though he called the colony ‘a miracle’ of successful governance in many respects, Dr McDowall said it was ‘lamentably behind’ in providing for the mentally ill. An asylum was under a medical officer who had neither specialised knowledge nor practical experience of the subject. He was burdened with exacting duties outside the asylum, and excessively occupied with routine tasks within. As he did not reside at the premises, the asylum was really run by his subordinates – an arrangement that was ‘most vicious’. And after he had served but a brief tenure, a different medical officer would take his place. From this state of affairs, Dr McDowall expected nothing but ‘evil and mismanagement’. According to his sources, asylums were both understaffed as well as underfunded. There were cases of ‘very bare and miserable’ accommodation, of overcrowding, of inadequate infirmaries, and of insanitary conditions. Dr McDowall believed that the system defeated the best intentions and killed the enthusiasm of the best officer. Lord Curzon took over as Viceroy of India in January 1899. It appears that he actually kept his promise. Within a few months, Dr Robert Harvey, the Director-General of the Indian Medical Service, informed Dr McDowall that the government intended to reform the asylums in British India. This was not a miracle. The government had been mulling over the matter for quite some time. In August 1894, A.H.L. Fraser and Dr C.J.H. Warden submitted a confidential note to the government. A civil servant, Fraser was then divisional commissioner of Chhattisgarh. Warden was a professor of chemistry and also the chemical examiner at Calcutta. Both men had been members of the Indian Hemp Drugs Commission. Since hemp drugs were believed to cause insanity, the commission had visited every asylum, scrutinised records, and spoken to witnesses. Its 3,281-page report dealt with a wide range of subjects − including the cultivation of hemp, production and trade of drugs, and the social and moral effects of drug consumption. Of their own accord, Fraser and Warden chose to write a separate report on the asylums in British India. This was bound to create waves, and it did. Declaring themselves to be ‘very unfavourably impressed’, Fraser and Warden wrote of the want of interest, of scientific treatment, and of systematic supervision. In general, superintendents had a ‘superficial’ understanding of mental disease and an ‘imperfect’ view of their duties. Failing to realise the importance of their work, they tended to relegate it to subordinate staff. This was quite evident in the ‘worthless’ statistics of insanity that they produced each year, and the ‘laughable’ case records of asylum patients. The two commissioners went on to make a series of stinging charges. They had seen a patient suffering from acute mania, ‘shouting and singing and raving in wild delirium’ while grinding corn in the glaring light of an open shed. Another patient ‘raving and furious’ in acute mania, was chained to a tree in an open court. There was no attempt to segregate patients according to their mental condition. Convalescents were ‘thrown together’ with the acutely ill. And recovered patients were ‘herded’ with those in all stages of mental disease. This, according to the superintendent concerned, was not ‘either dreadful in itself or possibly disastrous’ for those of sane mind. Fraser and Warden also observed an autopsy being conducted in an open verandah. They pointed out that recent slaughterhouse regulations did not allow an animal to be killed in the presence of other livestock. Yet inmates of the asylum were allowed to watch as the dead body of a fellow patient was dissected. According to Fraser and Warden, such ‘flagrant abuses’ would not be allowed in an asylum managed on scientific lines.