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 Table of Contents    
GUEST EDITORIAL  
Year : 2014  |  Volume : 56  |  Issue : 3  |  Page : 213-214
On "standing alongside the patient in his difficulties" or the privileging of the historical


1 Department of Psychiatry, Sitaram Bhartia Institute of Science and Research, New Delhi, India
2 Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

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Date of Web Publication12-Sep-2014
 

How to cite this article:
Sarin A, Jain S. On "standing alongside the patient in his difficulties" or the privileging of the historical. Indian J Psychiatry 2014;56:213-4

How to cite this URL:
Sarin A, Jain S. On "standing alongside the patient in his difficulties" or the privileging of the historical. Indian J Psychiatry [serial online] 2014 [cited 2019 Aug 26];56:213-4. Available from: http://www.indianjpsychiatry.org/text.asp?2014/56/3/213/140614


It is the year 1936. The city of Ranchi, in the Eastern part of India, blessed with a salubrious climate, had the rather unique distinction of having not one, but two rather large mental hospitals which actually pretty much faced each other across a common road. Both the hospitals had been established a few years apart, but the one for Europeans was administered by the Imperial government, while the other, for Indian citizens, by the Bengal Presidency. This is a particularly fascinating period. The European mental hospital is run by (naturally) a Britisher, Lieutenant Colonel Owen Berkeley-Hill, and the Indian hospital by Major Jal Dhunjibhoy, both officers of the Indian Military Service. To confound matters, however, Colonel Berkeley-Hill has committed the cardinal sin of marrying an Indian, a lady called Karimbil Kunhimanny from the Southern city of Cannanore. [1] He is, therefore, somewhat of a "pariah" in the inner circles of Ranchi society. Major Dhunjibhoy, on the other hand, being a Parsi and a member of the IMS to boot, enjoys a slightly different and elevated status. [2] What is interesting is that both men are prolific writers, travel widely, have large circles of influence, and have left footprints on history.

Much of what we know about the thoughts of these men is from the rather detailed annual reports that each wrote about their respective hospitals. These form lovingly detailed reports of the year, with a "Trienniale" report giving a 3 year overview. [3] The annual reports gave to the individual scope and potential to talk about the nitty-gritty of statistics, of how many people got admitted to, or were discharged from, or died in, the hospitals. Both men, however, also talk about what they thought characterized mental illness, what caused it, and the ways that it was different, if at all, in different parts of the world. There are other ways that we can get glimpses of their lives and thoughts. Apart from the annual reports, Berkeley-Hill has also written a most interesting manuscript titled All Too Human; An Unconventional Autobigraphy. [1] Both men have published in the medical literature, Dhunjibhoy, perhaps more widely. There also exist Governmental files that document their views, and there is some personal correspondence available of conversations with Dhunjibhoy's daughter Roshan. [2] Dhunjibhoy, interestingly, was also the first President of the Indian Psychiatric Society, and stayed on in Karachi after the partition of India.

The reason that we talk about these available materials is that what started as an exploration purely from interest, of the history of Ranchi in the early 20 th century, reveals some rather interesting facts.

The first among these is that quite contrary to the popular perception of the mental hospital as repositories of both squalor and brutality, the institutions that are being described here are places where a fair amount of thought is going into how a person with mental illness should be treated, how symptoms should be dealt with, and what the role of the professional should be.

In a rather moving passage in the annual report of the Indian Mental Hospital, at Kanke in Ranchi, of the year 1934, [3] Dhunjibhoy writes.
"In the mental disorder, it is the patient himself who is being treated and not so much other parts of the body, and that is why the personal factor is so important. It is essential to try and see the world as the patient sees it, to accept for the time being the reality of his abnormal experiences and to stand alongside him in his difficulties."

This compelling paragraph seems to capture in a few words much of the essence of the principles of caring and compassion that bio-medicine has frequently been accused of having lost sight of.

It must certainly be said that in a dispassionate recounting of history, many of the allegations of neglect, abuse or even general uncaring that have been leveled against medicine, or specifically psychiatry, have often been more than appropriate. [4],[5] Enough and more evidence exists in the form of rather chilling stories of poor services, the abuse of human rights, and large-scale neglect in terrible conditions of people with mental illness in institutions that were actually entrusted with the responsibility of caring for them.

In tracing the history of psychiatry in the sub-continent, it is worth remembering that until 1947 the history of psychiatry is the history of the mental hospital, as most mental health interventions were undertaken in the mental hospitals.

The rather staggering amount of neglect and abuse, often leading to public outrage, regarding the state of affairs in mental hospitals is far too well known to bear recounting here. What remains interesting is the journey of these establishments from places of "asylum" for people with mental illness to institutions that became such a byword for all that is undesirable in the annals of caring, that the only conceivable option that seemed to remain was to shut them down, a road that the Western world has traveled down. This road to de-institutionalization has also been widely written about and critiqued. As Oliver Sacks writes, "The hospital if nothing else, offered protection and safety - offered, in a word, asylum." [6] So the debate is not merely historical, but has contemporary ramifications.

While this debate on the validity of choice continues across the world as well as that of the possible outcomes of this choice, the question before us is where we, as a society, would like to go. So the question really is, which story is real? Is it the "caring" asylum that Dhunjibhoy describes, or the cesspool of maltreatment that it was later to become? The answer is that both stories are probably true.

As people interested in "making sense" of history, it seems to us that turning our gaze on the past to see what it has to teach us may be appropriate. This certainly is not to bathe everything remote, or what is being imagined for the future, in rose-colored hues, but more to see what it is that we may have lost sight of in historical journeys. Why is it that we have stopped "standing alongside the patient in his difficulties" as Dhunjibhoy exhorted us to do? And, how is it that the process of understanding the patient, or from the point of view of the patient, can inform our present position?

With that end in sight, we plan to start in the Indian Journal of Psychiatry a section on the history of psychiatry in India titled "From the Archives," where we would share with the readership of the IJP notes, passages, files, and extracts of historical interest. In this section we plan to present brief notes from the voluminous mental hospital reports, case descriptions, and musings on mental health and mental illness from the pages of history.

We would also be delighted to invite participation from the readers of the IJP in this on-going endeavour, so if there is something of historical interest that any reader would like to share, we would be delighted to include it in this section.

 
   References Top

1.Berkeley Hill O. All Too Human: An Unconventional Autobiography. London: Peter Davies; 1939.  Back to cited text no. 1
    
2.Sarin A. Roshan Dhunjibhoy is dead: The India International Centre Quarterly, Issue of Autumn 2013. p. 105-112.  Back to cited text no. 2
    
3.Annual and Triennial Reports on the Working of the Ranchi Indian Mental Hospital, Kanke, in Bihar and Orissa for the years 1930-1940.  Back to cited text no. 3
    
4.National Human Rights Commission: Quality Assurance in Mental Health. New Delhi, 1999.  Back to cited text no. 4
    
5.Nagaraja D, Murthy P, editors. Mental Health Care and Human Rights. New Delhi: National Human Rights Commission (NHRC) and the National Institute of Mental Health and Neuro-Sciences (NIMHANS); 2008.  Back to cited text no. 5
    
6.Payne C and Sacks O: Asylum: Inside the Closed World of State Mental Hospitals. Photographs by Payne C, Essay by Sacks O. Cambridge, Massachusetts: The MIT Press; 2009.  Back to cited text no. 6
    

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Correspondence Address:
Dr. Alok Sarin
Consultant Psychiatrist, Department of Psychiatry, Sitaram Bhartia Institute of Science and Research, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.140614

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