Psychiatrists and psychiatry in late colonial India

Introduction

In 1893–94, the Indian Hemp Drug Commission (hereafter IHDC) delineated the physical, moral and mental effects of hemp on the people of India. It was prepared by a seven-member team which included W. Mackworth Young (Financial Commissioner of Punjab) H.T. Ommanney (Collector, Bombay), A.H.L. Fraser (District Commissioner, Central Provinces), C.J.H. Warden, (Professor of Chemistry in Calcutta University), Raja Soshi Sikhareswar Roy (a well-known zamindar from Rajshahi), Lala Nihal Chand (prominent lawyer from Punjab), Kanwar Harman Singh (youngest son of the Raja of Kapurthala) and H.J. McIntosh (Under Secretary of the Government of Bengal). ¹ One of the primary objectives of the commission was to investigate hemp and its links to insanity. Asylum statistics time and again had reiterated links between insanity and hemp. The IHDC made a scathing critique of the asylum system in India, exposing maladministration and recommending reforms. In response, the colonial state initiated a process that led to the so-called ‘modernisation’ of psychiatry in India. Modernisation meant professionalisation to bring treatment of the insane in line with English psychiatry. Psychiatry had become highly medicalised in the West by the beginning of the twentieth century. From an art of management of the ‘insane’, it had become a science of the brain. ² This article examines the hitherto unexplored process of professionalisation of psychiatry in the early twentieth-century India. Most of the research on the history of psychiatry in India has focused on the nineteenth century. ³ Waltraud Ernst’s research on the Ranchi Mental Hospital ⁴ is the only existing published work that has looked at the trajectory of psychiatry in the first half of the twentieth century, and it focuses on the Ranchi Hospital; therefore, it cannot be generalised. This study attempts to fill the lacuna and is, therefore, the first to establish a theme-based chronological analysis of events that unfolded in the history of psychiatry in the first half of twentieth-century India.

The first section of this article details the links between the IHDC and the bureaucratic, legislative and medical reforms that were initiated at the beginning of the twentieth century with the passing of Act XXXVI of 1858, and how both together played a crucial role in the emergence of the psychiatric knowledge. The events at the turn of the century can be regarded as a turning point since they had a long-term impact on the professionalisation of psychiatry. Smaller asylums were amalgamated into larger ones and some of these larger asylums were declared ‘central’ for the purpose of training. For the first time, full-time superintendents were appointed who took charge of the asylums.

The second section discusses the role played by these full-time psychiatrists in ‘modernising’ psychiatry in the first half of the twentieth century by focusing on the negotiations psychiatrists made with the colonial state. Psychiatrists’ voices can be heard in forms of appeals, memorandums, books and articles. These ‘mad-doctors’ had started to gain a reified identity by the first decade of the twentieth century as they became psychiatrists. From the mid-nineteenth century in England, psychiatrists had been granted special authority to declare someone insane; this power had its antecedents in the legal field. Their expertise was called upon in courts of law to declare anyone non compos mentis. ⁵ Contrastingly, in India, the professionalisation of psychiatry was triggered due to ill-conceived plans of the colonial state. The article argues that the consequence of such amateurish schemes were that the growth and development of psychiatry remained restricted even as late as the eve of independence in 1947.

The final section further delves into the processes that led to professionalisation, modernisation and Indianisation of psychiatry in the last three decades before independence. The nationalist movement pushed for an Indianisation of psychiatry even as international movements such as those pushing for ‘mental hygiene’ and psychoanalysis significantly changed the course of psychiatric understanding both in India and abroad. It demonstrates links between modernisation and professionalisation of psychiatry at the national level and connects it to the international scenario. Concomitant changes in the field of epistemology also fostered the processes of professionalisation and medicalisation. However, India being a colony witnessed modernisation that was faulty and uneven. While some mental hospitals in India witnessed modernisation, others remained as mere receptacles for interning the ‘insane’.

This article focuses on the salient features of psychiatry in the first half of the twentieth century and answers the following questions: Did the change of terminology from the lunatic asylums to mental hospitals have a deeper significance or was it superficial in nature? What role did the state play and how sincere were these attempts to revamp and reorganise the establishment? What influence did this so-called ‘medicalisation’ and ‘professionalisation’ have on the patients and the personnel of these institutions? To what extent was the psychiatric infrastructure altered by ongoing political developments?

Investigation, Reform and Reorganisation

The IHDC aimed to ascertain the extent of hemp cultivation, the procedures by which the hemp plant was made into a drug, the classes that were prone to the use of drug, and the forms of its consumption. One of the primary objectives of the commission was to investigate hemp’s links to insanity since asylum statistics had time and again reiterated connections between the two. ⁶ Hemp was a common recreational drug used by Indians. James H. Mills argued that

in the first half of the nineteenth century, British observers were vaguely aware of hemp as a substance that Indians used but by the end of nineteenth century the drug was increasingly viewed both as a cause and symptom of insanity. By the nineteenth century cannabis was being linked in India to sexual immorality, chronic indolence, violence and disorderly behavior. ⁷

It was with the IHDC that hemp and its relationship with insanity came under close scrutiny. The commissioners studied data of the asylums and in this process collected information by examining histories of the patients. They drew attention to the haphazard ways in which the inmates were categorised and the causes attributed for their alleged insanity. The magistrate, police and the medical personnel were under tremendous pressure to fill up the medical certificates. Ganja as a cause was internalised by the staff to the extent that at times the cause ‘unknown’ was replaced with ‘ganja’. ⁸ Faulty processes were unmasked at several levels. In spite of the wide scale enquiry, the IHDC concluded that ‘there was no trustworthy basis for a satisfactory and reasonably accurate opinion on the connection between hemp drugs and insanity in the asylum statistics appended to the annual report’. ⁹ It was argued that hemp was a part of Indian social customs and cultural traditions. Amar Farooqui asserts that the report of the Royal Commission on Opium’s ‘reinforced the idea that opium if taken in moderation was not harmful and, when administered regularly in small doses, was actually beneficial’. ¹⁰ It would be difficult to estimate the extent to which the conclusions of the IHDC reinforced the use of hemp, but the colonial state wanted uninterrupted flow of revenue from hemp cultivation and therefore denied any possibility of a relationship between the drug and insanity. ¹¹

It is important to explore here how hemp got associated with insanity. What consequences did this link have on Indians? Hemp was a common recreational drug used by Indians. It has been used in different forms. It is difficult to pinpoint the date when this process of linking hemp with insanity began. The James Clark Enquiry noted that by 1868 hemp was considered to be ‘the most frequent cause of insanity’. ¹² Thus by the 1860s the link had been established. Mills has pointed out that

there were two stages by which cannabis use and cannabis users became categorized as a social problem in the asylums of colonial India. First, medical officers at the asylums came to believe that cannabis use was linked to insanity in Indians. Second, the officers used the asylum as a site where they could observe cannabis users and establish the distinguishing signs which marked them of as a distinct human type and to be watched out for because of their dangerous potential. ¹³

The typification of ganja smoker was at work. He was typified as young, reckless and poor, and he lived on poor diet taken irregularly. A ganja smoker was generally ‘nervous, feeble, pale’ and had ‘irregular’ and ‘debauched’ habits. Ganja kindled the imagination while reinvigorating sexual power.

J.C. Penny, the civil surgeon of the Delhi asylum declared that

Old bhang drinkers, charas and ganja smokers and majoom-eaters are, as a rule, emaciated; they lose vital energy, become impotent, forgetful or are weak minded and melancholy … he has hard corn like thickening of the ball of the right thumb from the constant habit of rubbing up the charas. ¹⁴

Ganja smoking was tied to certain marginalised groups such as dhobis, faqirs (mendicants), labourers, ‘kahars’, ‘halalkhors’ and palki bearers. ¹⁵ For almost two decades knowledge was produced in the asylums and it was at the end of the nineteenth century that out of the asylum knowledge, a political discourse was formulated. Clearly, the IHDC was the result of knowledge production at the local level.

Historians working on psychiatry in the colonial context have shown that psychiatry practised in colonies differed dramatically from a colony to another. The invention of psychotropic drugs changed the nature of psychiatry in the twentieth century, making it more goal oriented. This is not to deny that racial undertones of the discipline as racism and colonial power continued to reflect in the newly emerged modern psychiatric regimes. Psychiatrists were not mere medical professionals but also played a role of being critical political actors. Megan Vaughan has argued

if the voices of the ‘alleged lunatic’ are unclear, the records nevertheless often tell us an interesting story. In particular, they reflect on the process by which the magistrate sought to define ‘mad’ behaviour in a group of subjects whose normal behaviour he [magistrate] usually regarded as ‘alien’, to say the least. ¹⁶

In other words, the ‘normal’ behaviour of ‘natives’ was often considered ‘abnormal’. Richard Keller similarly analyses that ‘colonial psychiatrists found even “ostensibly normal” North African to exhibit a range of pathological behaviours that rendered the general population inherently dangerous the social order’. ¹⁷ Jock McCulloch has pointed out that

the old racism was concerned with measuring the native’s body: the literature from the nineteenth and early twentieth centuries is filled with attempts to discover a key to the African’s backwardness in the size or structure of his brain…modern theories about race have tended to concentrate upon the mentality and sociability of colonial peoples, presuming to have found the reason for their backwardness in their personality or culture. ¹⁸

Keller has argued that

by the turn of the twentieth century, thinking about ‘mind’ in an increasingly biological fashion intersected with a new infatuation with comparative psychology. Social anthropologists, philosophers and psychiatrists began a nearly obsessive documentation of the functions of what they called ‘civilized’ or European and ‘primitive’ mentalities. ¹⁹

The association of hemp with insanity should be understood in the context of this desperate need to situate ‘normal’ behaviour as ‘abnormal’ characteristics of the colonised subject resulted in an entrenchment of the colonial psychiatric power. The use of hemp for addiction was bizarre in English eyes, as in England hemp was never used for recreational purposes. Scholars who have researched the relationship between drugs and colonialism asserted that ‘drugs remained at the heart of empire’. ²⁰ Mills and Barton for example regard

the need to find products to sell to Africans and Asians in exchange of prized commodities such as slaves and tea led Europeans to become merchants of drugs and drink, and their success in this role saw societies across the world become markets of intoxicants that have endured to this day and which changed the habits and tastes forever. ²¹

Imperialism, ‘by encouraging this trade of drugs undermined their “civilizing” nature consequently giving way to liberals and missionaries who projected drugs users as victims that were in the need of salvation’. ²² The colonial drug policy first established links between hemp and insanity but later denied any such associations. A critical assessment of the hemp drug policy permits us to understand this urgent need to initiate asylum reforms. The asylum system was much easier to modify than the hemp drug policy and the asylum reform was possible without creating any massive financial deficit.

The colonial state directed attention and energies towards the restructuring of the asylum system. The critique offered by the IHDC became the basis for a separate report, wherein two IHDC Commissioners, A.H.L. Fraser (Commissioner, Chhattisgarh division) and C.J.H. Warden (Professor of Chemistry, Calcutta), reflected upon the limitations of the asylum system in India. They criticised the management and organisation of asylums and demanded professionalisation of psychiatry. For the commissioners, the asylum work was a professional matter and in India the systematic treatment of the insane was non-existent. Having some knowledge about asylum management in England, they regarded asylums in India as disordered. They revealed the miserable state of affairs by illustrating instances of maladministration and also pointed out that ‘the superintendents held asylum work as an additional charge since they had other duties to perform’. ²³ The asylum work fell in the hands of untrained subordinates. The commissioners believed that the superintendents of asylums lacked special experience and skill in the treatment of mental diseases and were often largely disinterested. ²⁴ It was recommended that ‘whole-time superintendents should be appointed because under the prevalent system, the civil-surgeons did not have sufficient time for asylum work’. ²⁵

Andrew Scull has demonstrated that the reification of the professional identity of psychiatrists in England was a complex process. By 1845, the medical profession had secured powerful support for the proposition that insanity was a disease and thus naturally something which doctors alone were qualified to treat. ²⁶ By the mid-nineteenth century, professional psychiatric organisations had come up to secure a separate identity for the profession. The earliest of these was the Association of Medical Officers of Asylums and Hospitals for the Insane. In 1853, the Association launched its own periodical, The Asylum Journal. The professionalisation of psychiatry was further catalysed by skill and specialty. The second half of the nineteenth century witnessed several waves of legislation related to insanity in England. The Lunacy Act of 1845 made it compulsory for every county and borough to have its own lunatic asylum for interning the mad, and a Lunacy Commission was set up in order to inspect the workings of asylums all over the country. The 1853 Act furthered the provisions of the 1845 Act. Also significant was the Act of 1890, which was enacted to prevent wrongful certification and confinement. These acts led to the concretisation of psychiatry as a discipline. Psychiatrist or ‘mad-doctors’ were now seen as those people who knew how to manage, identify and certify insanity, on account of their medico-legal training. The key to understanding and curing madness was its proper management. Jan Goldstein in her classic work Console and Classify looks into the making of French psychiatry as a profession in the nineteenth century. She points out:

Among the many ‘human sciences’ thrown up by this far-reaching development was psychiatry, the medical study and treatment of disorders of the mind. It arose almost simultaneously in France, Britain, America and the German Lands and despite considerable mutual borrowing, soon bore in each setting the mark of a distinctive national tradition. From the closing decade of the eighteenth century, when they pledged to outdistance their English rivals, to the closing decade of the nineteenth century, when they began to be overtaken by the Germans, French physicians played the singular most vigorous role in constituting and legitimising a psychiatric science. ²⁷

In India, this process of legitimising and professionalising of psychiatry was slow and uneven. The insane asylums were first built during the beginning of the nineteenth century for incarcerating European soldiers but were later on extended to the ‘natives’. Rules and regulations regarding the working of the asylums were formulated during the early half of the nineteenth century. These loosely defined principles were tailored for functioning of the asylums during the beginning of the nineteenth century and became outdated by the beginning of the twentieth century since the asylums grew in number and size.

The professionalisation of the Indian Medical Service (IMS) also occurred during the first half of the twentieth century. The imperatives for the so-called ‘professionalisation’ of the IMS occurred in wake of several epidemics that severely affected the Indian population at the turn of century. David Arnold pointed out that the Western medicine reached its apogee in the 1890s. ²⁸ Medicine was its zenith during the last decades of the nineteenth century. Biswamoy Pati and Mark Harrison argued that ‘[t]he establishment of port health trusts in cities such as Bombay and Calcutta was one direct result of … the flurry of activity that resulted from the importation of plague into Bombay in 1896’. ²⁹ The entrenchment of Western medicine accentuated the zeal for ‘reforming’ the psychiatric infrastructure. However, in the later decades of the twentieth century the focus was only narrowed down to epidemics and other medical necessities that were considered exigent for the long-term survival of the colonial state. This as a result marred the long-term growth of the psychiatric discipline giving it a marginal status.

The Lunatic Asylums Act of 1858 (Act XXXVI of 1858) was a stepping stone that provided formally guaranteed provisions for the maintenance and care of insane persons in colonial India. This Act is significant because it delineated the procedure by which ‘dangerous’ and ‘harmless’ neglected insane persons could be incarcerated. ³⁰ The procedure gave the police, the magistrate and the medical officer authority to declare any person ‘insane’. The word ‘lunatic’ as used in this Act, ‘meant and included every person of unsound mind and incapable of managing his affairs, and every person being an idiot’. ³¹ The definition of ‘lunacy’ remained vague in this period. The police was to interpret alleged ‘lunacy’ according to the given situation. The act indirectly made a distinction between psychiatry for the rich and that of the poor. The superintendent-in-charge at the Cuttack asylum wrote ‘lunatics are be found by the police disturbing the peace; and unable to take care of themselves, they are at once taken up and brought before the nearest magistrate’. ³² The ‘wandering’ and ‘dangerous’ lunatics were first sent to a magistrate who performed his medical-executive role, with the help of the civil surgeon. He identified and certified insanity. After examination, the magistrate issued orders of dispatch to the nearest jail or asylum. The discourses of legalism were given upper hand over medicalism which consequently decelerated the processes of modernisation.

The 1858 Act, the subsequent amendments, and the 1912 Act ³³ remained silent regarding training, role and status of the superintendent-in-charge of the asylums. Scull points out that ‘as the asylums grew in number, the assistants became, in effect, apprentices, superintendents in training, and it was from this pool of experienced men that most senior positions were filled’. ³⁴ England had mammoth asylums; by contrast, there existed in India, small asylums covering different regions. An important suggestion made by the IHDC Commissioners was the amalgamation of small asylums in order to create bigger ones. Judging against the English asylums, they felt that the asylum staff had no skills and was not provided with any special training. The commissioners argued that the lack of training was a predicament produced due to lack of scientific study of insanity in India. Training in medical schools consisted of a few lectures on medical jurisprudence. These lectures were generally delivered by men who ‘have no special experience of insanity’. ³⁵ The superintendent, the ‘native’ doctor and the subordinate staff needed training and specialisation in the mental illnesses although none of this was available. Debjani Das has although pointed out that ‘in case the individual was departing to join as a physician in one of the asylums in India, then additional training from Bethlem, St. Luke Hospital, or other hospital of a similar measure in England was considered all the more necessary’. ³⁶ The training helped them to understand the disease, but there is little evidence to support that all underwent the prescribed training. While certain superintendents-in-charge were keen to know about the disease and kept themselves updated with the new developments at home and abroad, others performed their duties as keepers. ³⁷

The commissioners urged the state to initiate a proper study of insanity in India. They felt that the government was wasting resources on the small asylums and argued that asylums should be centralised in order to secure maximum efficiency while minimising costs. ³⁸ They believed that centralisation of asylums would lead to special training in the mental diseases, as central asylums would become training grounds for subordinate staff. Reform was possible only if the government devoted special attention to the study of mental diseases in India. These solutions offered by the IHDC Commissioners were not welcomed by the government as reform and reorganisation would require expenditure. A full-length report was prepared by Dr Rice (Surgeon-General) offering resolutions to the problems. There was a lengthy discussion on the English precedents, first in the report of Warden and Fraser and then in Rice’s suggestions. From the very beginning, however, it was made clear that it was impossible for the colonial state to have the same psychiatric infrastructure as existing in England. Rice remarked:

If these are contrasted with the expensive, specially designed lunatic asylums in European countries, and specially trained whole time medical officers, sumptuously paid and housed on the premises, with assistants quite as well trained but of only less standing and experience … with the already fully occupied Civil Surgeons [in Indian lunatic asylums] who have no previous training at all, and who have to do all the professional work themselves, I shall be surprised if it is not admitted that it cannot in reason be expected that an insane asylum can be run on the same lines in the country as at home. ³⁹

Historians of medicine have spoken about the limited nature of colonial medicine. ⁴⁰ Rice attempted to defend the constraints of the existing establishment. He recommended reorganising the ‘native’ asylums into various classes and suggested that the first-class asylums would hold 700–1,000 inmates and a whole-time superintendent, and they would be established in Bombay, Bengal and the northwestern provinces. The second class asylums would hold 400–700 inmates and were to be established in Madras and Punjab. The latter would have a civil surgeon as the superintendent. ⁴¹ He also suggested the amalgamation of existing small asylums with these first and the second class asylums. Another significant recommendation was that rigorous screening of lunatics be undertaken at the time of admission. This was to prevent the admission into asylums of persons suffering from a temporary result, of sickness, intemperance or debauchery, and those whom their friends ought to support. ⁴²

The government renounced the plan of centralising all the asylums as local government objected to the measure. Several small asylums were nevertheless shut down. The Delhi asylum was permanently closed after 1899 as a new asylum was established at Lahore early in 1900 and all the patients—103 male patients and 35 female patients—of the Delhi asylum were transferred to it. ⁴³ Thereafter, Punjab had only a central lunatic asylum at Lahore. In Bengal, the Cuttack asylum was closed, but the asylum in Tezpur continued to function due to the objections of the local government. In the northwest provinces, the Lucknow asylum was merged with the Agra asylum. The Agra asylum was declared central asylum for the purpose of training. Although centralisation was meant to initiate a process of specialisation, this goal was never fully archived. Despite chidings of members of the IHDC, the study of insanity was not introduced in a full-fledged manner. The central government sought views of provincial governments about the introduction of psychiatry in the medical curriculum. The chief commissioner of Burma stated ‘that there are many subjects of far more practical use than the study of insanity …’ ⁴⁴ The Bengal government argued that ‘it would not be worthwhile to add a new subject to the course for the sake of training one man’. ⁴⁵ Shruti Kapila has also pointed out ‘… while specialisation was desirable and vital for the reform of colonial psychiatry, its realisation was at odds with the general objectives of the Indian Medical Service’. ⁴⁶

In areas where there were several asylums, one asylum was selected for the purpose of lecturing. The full-time officers were specially appointed as superintendents for these newly amalgamated asylums. Attempts were made to appoint as superintendents, those who had gained some knowledge of mental diseases in the United Kingdom. The full-time superintendent-in-charge was given an additional payment for lecturing in the medical schools. The Lahore asylum was the first to be centralised and developed as a ‘modern’ asylum. J.T.W. Leslie, the Director General of Medicine wrote in an unofficial memorandum:

In India up to now the asylums have been built on prison lines, and though the underground dungeons at Bhowanipore have not been used for many years … I have today visited the old, and the site for the new, asylum at Lahore. The old one is a serai adapted for the purposes of the safe keeping of lunatics on strict prison lines… The new asylum, though it will be a great improvement on the old one, is planned on the same lines and will be nothing more than a somewhat glorified prison … (emphasis added). ⁴⁷

He advocated the development of psychiatry along the lines of modern European asylums. He felt that restraint should be dispensed with and that all walls and bars should be abolished. ⁴⁸

The turn of the twentieth century witnessed changes, but in many ways, old methods and practices continued. The so-called ‘reforms’ and ‘reorganisation’ had inherent limitations for which reasons these had become ineffective in a decade or two. The obsolete patterns were quite visible in the ways reform was structured. In fact, it would not be wrong to argue that the reform was a manoeuvre on the part of the government to direct the attention from hemp to asylums. It was an intelligently devised mechanism to ensure the incessant flow of revenue. The reform and amalgamation of asylums were in fact seen as a cost saving measure. The mammoth asylums soon became unmanageable in the absence of modern facilities and trained staff. C.J. Lodge Patch, the superintendent-in-charge of the Lahore Asylum described his first visit to the Lahore asylum in 1922 in the following words:

Nearly all the male patients were allowed to go about stark naked without even a loincloth; handcuffs and fetters are applied on the slightest provocation or without apparent provocation by any attendant who cared to use mechanical restraint, and universal seclusion was the part of the daily routine … my first action was to collect two hundredweight of handcuffs and other instruments of torture and send them in a bullock-cart to the Central jail. ⁴⁹

The government wished to devise reforms that were financially viable. Every attempt made to reform and reorganise had latent intent of economising. Similar attempts of economising also took place in England during the same period. Scull argues that ‘the practice of cheeseparing worked through overcrowding of pauper lunatics and increase in intake of paying patients’. ⁵⁰ Nonetheless, the process of closing down of the small asylums and opening of centralised ones was peculiar to India. Economising through centralisation impeded all possibility of further developments. Mammoth asylums were common in Europe, but facilities that enabled their management there were entirely absent in India. It can be argued that modernisation along the lines of English psychiatry was only a cover up that the colonial state used occasionally as a rhetoric to demonstrate liberality and advancement.

Anouska Bhattacharyya has looked at the emergence of psychiatric knowledge in the latter half of the nineteenth century. She locates the emergence of the specialised knowledge in ‘macro-administrative change, attempts to converge or delineate medical and judicial spheres and publication of the new genre of the lunacy text’. ⁵¹ She also takes cognizance of the professionalisation of psychiatry in the West and the drive it gave to India to hasten the processes. Her work covers the period from 1858 to 1912 and therefore is limited to the beginning of the twentieth century. She fails to situate the significant role the reform cycle played during the turn of century. Shruti Kapila in her thesis was able to establish the interesting links between the IHDC and the asylum reorganisation. She argues that

Questions of ‘reform’ of the working of the colonial psychiatry, at the beginning of the twentieth century were in the language of ‘professionalism’, ‘specialism’ and ‘scientific’ culture. The agenda of government more than fifty years on, in relation to the disciplinary agendas of psychiatry was then, to recast them along the ‘improved lines of modern practice’. ⁵²

Kapila aptly points out that the ‘Questions of economy overrode any considerations of efficacy of the reform and professionalisation of the institutional identity of colonial psychiatry’. ⁵³ In other words, the reform cycle that was initiated during the beginning of the twentieth century was devised to maintain financial stringency. Samiksha Sehrawat has tried to shed light on the need of budgeting the medical expenditure in case of hospitals. She points out that

private philanthropic effort was considered the proper motor for the construction and maintenance of voluntary hospitals in nineteenth century Britain … the colonial state’s initiative to found dispensaries in India did not indicate the abandoning of these principles but rather the launching of an improving project for Indian society. Thus, the colonial state’s participation in medical philanthropy was meant to ‘stimulate’ its colonial subject to emulation of British ideals of voluntary associational culture and utilitarian philosophy. ⁵⁴

The asylum system during the nineteenth century was an integral part of the punitive order. Philanthropy on the large scale was not much an option since asylums throughout the nineteenth century were peopled by the poor, since the rich and the middle classes looked down upon these incarceral institutions. The state initiative to reform had its latent intent of privatising the psychiatric care over the period. According to the 1912 Act, the reception of a petition had to be submitted by the husband or wife or the nearest relative of the patient, ⁵⁵ since it was believed that this would prevent the illegal detention of the sane. The new requirements made it impossible for the poor to admit their relatives as submitting the application was a costly and time-consuming process. The only way the poor could avail of the facility was by leaving their relatives on the streets. The poor who were regarded as ‘troubled’ could be picked up by the police whereas the rich had to submit an application and pay for their stay. The division between the psychiatry for the rich and for the poor was therefore complete.

‘Lunatic’ Asylums or ‘Mental’ Hospitals

The twentieth century was a period of flux in the history of psychiatry in India. The state made attempts to revamp the psychiatric infrastructure in the period. The 1912 Act was a significant attempt to consolidate lunacy laws. This period also witnessed changes due to individual efforts. These individuals were usually (although not always) superintendents-in-charge of the central asylums. Individuals for the first time loomed large on the screen of the history of psychiatry of India. The IHDC’s condemnation of the asylum system in India had led to the centralisation of the institutions in Calcutta, Poona, Madras, Agra, Lahore and Rangoon. These institutions had full-time superintendents to manage the central asylums. The notion that the central asylums would become centres for the study of insanity paved the way for specialisation. The scientific study of insanity never took off on a larger scale. Nonetheless, the concept of a specialist emerged during this period. Some of these specialists dedicated their lives to the cause of studying insanity and some of the central asylums became hubs for psychiatric deliberations. These deliberations were often among these specialists and the colonial state. These negotiations were sometimes successful but at other times failures. What should be kept in mind is that innovation and interest depended entirely on the zeal of the superintendents-in-charge. His motivation was his own as the government did not have much stake in the process. The change also included bringing psychiatry in India in line with international developments in the field. These changes however should not be understood in terms of teleological growth.

The changes that were triggered due to IHDC criticism began making a visible difference in altering the psychiatric infrastructure. Kapila also pointed out that ‘criticism and rhetoric of reform nevertheless resulted in the recognition of the realm of colonial psychiatry as distinct from both penology and other medical disciplines’. ⁵⁶ During this period the question of alteration in nomenclature became palpable. The question of the change of name from ‘lunatic asylum’ to ‘mental hospital’ was interlinked with the question of curative treatment. Curative treatment was scarce in the lunatic asylums. Asylum as a term meant literally and also physically a place that was ‘refuge’ or ‘safe haven’ for lunatics. These ‘safe havens’ were built to keep the public safe from the ‘dangerous’ insane. According to Michel Foucault,

‘Dangerousness’ meant that the individual ‘must be considered at the level of his potentialities (ses virtualites) and not the level of his acts’, not as someone who had actually violated the law but as someone whose potential behaviour had to be subject to control and correction. ⁵⁷

Over the period of the nineteenth century, the lunatic asylums became the places where insanity was managed. The basic principles of moral management were observation and control. This control would enable lunatics to develop their will power and allow them to differentiate between right and wrong. By the end of the century, pessimism related to the cure rates of insanity had heightened. The asylums in the West were filled with ‘incurables’ as the number of ‘cured’ patients had dropped. Moral therapy came to be regarded as redundant as psychiatry took a biological turn.

By the end of the century, the term ‘lunatic’ was considered offensive and the word ‘asylum’ had also become outmoded. In England, the term ‘lunatic asylum’ was replaced with the word ‘mental hospital’. The change in the terminology should be understood in terms of shift in the knowledge systems regarding the disease and its cure. The Government of India was neither interested in any further reorganisation of psychiatry nor in the change of nomenclature. It can be seen from the fact that the Government of India took more than 10 years to resolve the issue whether the nomenclature ‘lunatic asylum’ ought to be changed to ‘mental hospital’ or not. Discussions regarding the change of the terminology reveal covert attitudes of the state and bureaucracy. P. Hefferman, the superintendent of the Madras Lunatic Asylum, was the first one to suggest that ‘the term “lunatic” is a relic of a barbarous age …’. ⁵⁸ He further pointed out:

A gentleman who was treated in this institution in the present year, and made a good recovery, a clergy man wrote to me a short time ago and suggested that I should petition government to change the name of the institution to that of the ‘MADRAS MENTAL INFIRMARY’. I cordially agreed with him and seize the present occasion to carry his suggestion into effect. ⁵⁹

In 1917, the governments of Madras, Bengal, Punjab, Burma, the Central Provinces, Assam and Coorg accepted the proposal to change the designation ‘lunatic asylum’ to ‘mental hospital’. The proposal was opposed by the government of United Provinces. S.P.O. Donnell, the secretary to government of the United Province wrote to the secretary to the Government of India:

… the term ‘lunatic asylum’ is a much more accurate description of the institution referred to than ‘Mental Hospital’ would be. Curative treatment is not at present the primary object of the existence of the asylum in the United Province. The aim and the purpose of these institution is rather to provide accommodation where lunatics are dangerous to themselves or to others who are a nuisance to the community and can be kept in safe custody under reasonable, comfortable and healthy conditions; it would be impossible to convert them into hospitals designed primarily for the treatment without the introduction of changes which would be extremely costly…the change of designation would be misleading… ⁶⁰

The perspective of Donnell reflects the nature of colonial psychiatry. The aim was largely to incarcerate the mad and the delinquent whereas ‘cure’ as a notion was sidelined in general. W.M. Hailey, the chief commissioner of Delhi, argued that ‘whatever name we give to the institution it will still be the “Pagal Khana” for Indians, and disinclination to commit a friend or relative to its care will not be affected by a change in its official designation’. ⁶¹ Sarah Ann Pinto has argued that ‘the elite eluded the asylum because it lacked scientific methods of treatment … the middle class and the poor also avoided the use of the asylum because of the stigma associated with the process of admission and incarceration. Most patients in the asylum were persons ‘‘found committing mischief in the public streets and [were] caught and conveyed [to the asylum] by the police’’’. ⁶²

The Indian Lunacy Act of 1912 was amended in the year 1922. The amending act allowed for the much desired change in the designation of ‘lunatic asylum’ as ‘mental hospital’. The bill for the act stated that ‘it is, however, necessary to retain the word “asylum” in the act, because of its use in other legislation’. ⁶³ After much debate the ‘lunatic asylums’ were now designated as ‘mental hospitals’. This change in nomenclature called for reform at least in theory, if not in practice. In a discussion over the passing of the bill, it was stated:

It has also been pointed out though medical treatment is actually given in some asylums still the present designation deters people from availing themselves to it. The government of India appreciate the purpose of the proposed change in designation and they recognise the importance of emphasising the curative treatment which should be available in these institutions. ⁶⁴

The Government of India was aware of the situation as it stated clearly that ‘medical treatment is actually given in some [emphasis added] asylums’. ⁶⁵ The Act IV of 1922 added to Section 84 of the 1912 Lunacy Act, the qualification ‘if it is satisfied that provision has been or will be made for the curative treatment therein of persons suffering from mental diseases’. ⁶⁶ The amendment stated that

if in any licensed asylum no provision for curative treatment has been made, or the Local Government may consider that the provision made is insufficient, the Local Government may require the person in charge of the asylum to take such measures for making or supplementing such provision …. ⁶⁷

No licensed asylums existed in this period. Curative treatment at least officially had become the norm.

Some serious efforts were made to organise the psychiatric services in the period by these emerging specialists. The waves of change were experienced, articulated and demanded by a small group of individuals. The term professionalisation has been described by Thomas Broman as a set of criteria, which usually included ‘(1) specialized and advanced education; (2) a code of conduct or ethics; (3) competency tests leading to licensing; (4) high social prestige in comparison to manual labour; (5) monopolization of the market in services; and (6) considerable autonomy in conduct of professional affairs’. ⁶⁸ The want for professional body and specialised training was articulated by the psychiatrists. England had a professional body called the Board of Commissioners from the mid-nineteenth century. In India, this need for the professional body and special education to train psychiatrists was expressed by W.S.J. Shaw, the Superintendent of the Yeravda Central Asylum, Pune. He clamoured for the need to reorganise lunacy administration in India. For a whole decade, Shaw made several appeals to the Government of India that an alienist ⁶⁹ department was essential for the proper functioning of asylums. He remarked that ‘the government has been considering the formation of an organised department since 1906 but nothing was been done so far’. ⁷⁰ He noted that such an organised department would include all grades of asylum officials: superintendents, assistant medical officers (in various grades), nurses, attendants, stewards, clerks, etc. He was convinced that no advancement in the administration of psychiatry in India was likely to occur until an organised ‘Department of Psychiatry’ was established. These individual psychiatrists had self-interests at stake but were also interested in the greater change.

Shaw contended that ‘the cost of organizing the department would be modest and an organized department would amend the overall administration of lunacy in India’. ⁷¹ Berkley Hill, the Superintendent of the Ranchi European Lunatic asylum, concurred with Shaw’s proposal regarding the formation of an organised alienist department. He wrote to the inspector generals of civil hospitals, Bihar and Orissa, that the ‘time has arrived for the introduction of radical changes in the organisation, equipment and administration of lunatic asylums in India’. ⁷² Hill felt that ‘the most urgent motive, in India as well as elsewhere, for the institutions of this type is to serve as teaching centres for psychiatric training’. ⁷³ He appealed for the establishment of specialised hospitals for observation, treatment, research and training. Hill suggested that the men of the same class as those who were lecturers on mental diseases in the medical schools in England and the USA should be recruited. These alienists were expected to train Indians with superior medical qualifications locally for working in the alienist department. ⁷⁴ He also added to the debate on the issue that the central asylums should be styled as mental hospitals as ‘the word asylum frightens them [the people] and keeps them away’ and that there was serious stigma attached to this term. ⁷⁵

Shaw had similar concerns and he mentioned that ‘there is at present practically no proper system of education in psychiatry’. ⁷⁶ He wrote a ‘Memorandum on Lunacy Administration in India’. ⁷⁷ In this memorandum he commented that ‘there is no committee or central body in India similar to the Board of Commissioners in England to supervise the administration of the Indian Lunacy Act’. ⁷⁸ He reiterated the urgent need for trained staff and the difficulties faced in securing specialists. He urged the government to create a department for alienists. His appeals regarding the creation of a specialist department were rejected. It was stated that ‘this cannot be done, and no further action seems to be necessary’. ⁷⁹ Shaw raised the matter again after gap of two years. He recalled that at the time of his appointment ‘in 1906 the alienist department was supposed to have been initiated by the instance of the Secretary of State, and medical officers interested in psychiatry were attracted to the department as the “pucca” one’. ⁸⁰ He remarked ‘as I have represented, no real effort has since been made to carry out the idea, and now it is admitted that the “Department” does not exist’. ⁸¹ He urged ‘in the name of humanity and efficiency, to recommend a reconsideration of the disposal of my “memorandum”’. ⁸² Shaw requested that his suggestion be forwarded to the secretary of state. His request was declined, and it was pointed out that ‘the administration of the mental hospital is a provincial matter transferred over, on which the secretary of state can exercise superintendence, direction and control only for a very limited purposes, which are here irrelevant’. ⁸³ The local governments had argued against the proposal on grounds of financial stringency. L.S. White, deputy secretary to the government of the United Provinces, Judicial Department, wrote to the secretary to the Government of India, Home Department that ‘under the present circumstances, it has been found impossible to provide the necessary funds and the proposal must inevitably be deferred till the financial condition of these is more satisfactory’. ⁸⁴

The refusal on the part of government to provide adequate medical facilities for the mentally ill reflects the colonial state’s latent objective to allocate burden of mental illness on ‘natives’ themselves and especially those who did not pose any danger to the state. In other words, the colonial state continued to run on the principle that ‘dangerous’ insane should be incarcerated since they pose danger to themselves, others and above all the state. These notions challenged the ‘modern’ ideals that the mental hospitals were centres where ‘cure’ was offered and new methods of treatments evolved. By the turn of century, the mental hospitals in England, the USA and Europe had become pinnacles of innovation, and new therapies emerged. The Government of India did not take any concrete steps to medicalise psychiatry and a host of other indigenous therapies continued to flourish alongside Western medicine. In India, the mental illness was regarded no less than a crime.

The period from 1905 to 1922 witnessed the rise of nationalism as a movement in India. The devolution of powers to local governments was a result of this intensified struggle. The unrest began with the partition of Bengal in 1905 and the surge of the Swadeshi Movement. Sumit Sarkar argues that ‘there was first what may be termed “constructive swadeshi”—the rejection of futile and self-demeaning “mendicant” politics in favor of self-help through Swadeshi industries, national schools and attempts at village improvements and organisation’. ⁸⁵ The Indian Councils Act of 1909 allowed Indians to contest elections for the legislative council. It allowed greater powers for budget discussion, raising questions and sponsoring resolutions to members of legislative councils, who were to be elected on the basis of a highly restrictive and divisive franchise for the first time. These measures were not acceptable to many sections of Indian nationalists, and were the most short-lived of all early constitutional ‘reforms’. They had to be revised in 10 years. ⁸⁶ The devolution of power was further made possible with the Government of India Act of 1919. The act laid the basis for ‘dyarchy’ which meant that certain functions were ‘transferred’ to the provincial governments, while others were kept ‘reserved’. Health, education and agriculture were transferred to the provincial governments. ⁸⁷

Although health was a subject that was ‘transferred’ to provincial governments under the 1919 Act, this did not bring changes in the overall system. The entry of Indians into the upper echelons of the administration was slow. The mere idea that Indians could be now admitted into the IMS made colonial officials anxious. In 1921, W.B. Brander, secretary to the Government of Bombay wrote to the secretary to the Government of India:

Services under the government of India has [have] not now those attractions which it once had. Variations of exchange, the limitations imposed by the government system, the increasing feeling that posts, even in the specialized departments, should be filled entirely by Indians, contribute to a sense of unsettlement amongst Europeans Government servants and detract from those merits which services in India previously possessed. ⁸⁸

This perception can be understood in the context of the fact that Indians were now entering government services in comparatively larger numbers. Roger Jeffery points out that ‘after the 1919 Act there were long discussions on how many IMS men the provinces had to employ, and in which posts, and each round of discussions concluded with fewer posts remaining closed to outside competition’. ⁸⁹ There was a growing need for trained staff that could work under the specialist European. Lunacy administration fell under the transferred list, but this did not change the scenario. Very few Indians were allowed to fill higher posts such as that of the superintendent-in-charge of the central lunatic asylums. Indians were denied access to higher posts because they supposedly lacked the necessary training.

Waltraud Ernst is able to show that by the mid-twentieth century an Indian superintendent-in-charge of the Ranchi Indian Mental Hospital was extremely successful in running it. Jal Edulji Dhunjibhoy, the said medical official, travelled widely in Europe. He familiarised himself with the latest methods of treatment and applied them to the patients of the hospital. Ernst noted:

When the building work at the new institution in Ranchi was completed, Dhunjibhoy was appointed as its first superintendent. An appointment such as that at Ranchi was highly coveted among doctors. Not only did it entail taking over a large, brand-new purpose-built institution, but well-paid vacancies at senior-management level were few and far between, especially at a time of financial retrenchment such as the decades following the First World War. What is more, Dhunjibhoy was among the first few ‘native’ medical officers to head a major medical institution. ⁹⁰

‘Indianisation’ was a slow process, and Indians who succeeded in entering higher positions invariably faced racial discrimination. Ernst argued that the structural inequalities continued to persist even in terms of salaries, allowance and status. She remarks

the Indianization of the colonial service was certainly an important official step towards equality—but it was an ‘equality’ that recognised the services of lower-grade Indians on the basis of their closeness to European employers and maintained de facto discrimination against the higher sections of Indian society by means of special allowances. ⁹¹

Dhunjibhoy was paid less and faced discrimination and derision from his European colleagues.

Indians were never given the status of citizens. They were regarded as subjects of the British colonial state. Indians entered into the higher echelons of the government service during the twentieth century because of the intensifying nationalist struggle. Dhunjibhoy was among the fortunate few who were given the charge of the mental hospitals so early on. The rest had to wait up till the late 1930s to climb up the hierarchies because of their skin colour.

Racial discrimination not only created obstructions in the process of Indianisation but also delayed the progress of specialisation and professionalisation of Indian psychiatrists and psychiatry. Indian psychiatrists only surfaced as a hand-full of names such as Sharma, Das, Vaidya, Ahmad and Rizvi, a decade before independence. It is difficult to single out their achievements. The nature of Western medicine had transformed by the beginning of the twentieth century. There was a conscious attempt to focus only on exigent needs of the empire. Epidemics and the rising nationalist movements were regarded as impediments in furthering the progress of medicine. Indianisation of psychiatry should be contextualised within the broader framework of a marginal science. Psychiatry remained a surrogate child of colonial medicine. By the 1930s, the government had decided to withdraw investments, and the phase of asylum building had petered-out. The professionalisation of psychiatry was carried out by a bunch of psychiatrists. These psychiatrists were mostly Europeans, since widespread racism along with lack of training slowed down the Indianisation of psychiatric services. Nonetheless, by the last decade many of the Indian psychiatrists were working hand in hand with their European counterparts to advance the course of psychiatry.

Shaw was frustrated, but he did not give up. He wrote an article ‘The Alienist Department of India’ in 1932 in the Journal of Mental Sciences. Here he critiqued the existing system of psychiatric services. He stressed that the creation of an alienist department had been impeded again and again. He pointed out that the classification of insanity in India was obsolete. Shaw felt that the asylums and prisons were alike in India, and remarked, ‘the architecture and fittings of asylums were as a rule gaol-like and difficult to associate with anything of the nature of a hospital, and the “keeper” staff organisation is unsatisfactory type, being modelled on that of the Prison Department’. ⁹² He concluded that ‘we must continue to depend on the influence and energy of few and scattered provincial specialists for the enlightening of the politicians in the methods of civilization, during the continued absence of the central supervision contemplated in 1906’. ⁹³ Shaw’s efforts are laudable as he made several attempts to reorganise lunacy administration in India. However, being part and parcel of the empire he was not able to critique imperialism. He blamed Indians, ‘since no Indian outside the IMS has materially assisted in that progress’. ⁹⁴ Shaw further remarked that ‘the noisy section of the population led by M.K. Gandhi prefer the ayurvedic and other indigenous systems to modern methods of treatment. These so-called “systems” are based on very primitive ideas of anatomy and physiology, and are even more out-of-date than that of Galen’. ⁹⁵ He also believed that ‘Europeans, and person of European habits, should not as a rule be treated in the same mental hospitals as Indians’. ⁹⁶ Shaw’s views were a product of his culture and time. Shaw once wrote that ‘many Indians appear to be interested in psychology, but curiously yet I have to hear of one who has taken up the subject from its pathological aspect’. ⁹⁷ This fact can be understood since psychology grew outside the control and confines of the colonial state.

Professionalisation and Internationalism

The international movements had become significant factors that determined the course of psychiatry’s development in the last three decades before India’s independence. The international health movements interconnected the metropole, the colonies and the globe. The political climate had changed and the metropoles reluctantly and slowly were forced to introduce recent developments in the field of science and medicine. Volker Roelcke, Paul J. Weindling and Louis Westwood argued that by the late nineteenth and early twentieth century psychiatry had become one of ‘the most contested and influential modern sciences’. ⁹⁸ The international relations and transfers of concepts, practices, personnel, as well as funds in a context of rising internationalism and nationalism became significant factors in shaping the psychiatric development at the local and the global levels. ⁹⁹

Berkley Hill published an article in the journal, Indian Medical Gazette, in which he appealed for initiating the mental hygiene movement in India. ¹⁰⁰ He pointed out that the year 1922 marked a watershed in the history of psychiatry since the Indian government changed the nomenclature of ‘lunatic’ asylums to ‘mental’ hospitals. This, he declared, meant a lot to those who had demanded such a change. Hill however felt that this change would mean nothing if the larger structure failed to alter. He complained that ‘in many of the largest towns in this country there is not a single specially qualified physician to whom a mental case can be referred for advice and treatment’. ¹⁰¹ Hill remarked in this context that in 1916 the National Committee of Mental Hygiene (NCMH) had been founded in the USA. The committee worked for the conservation of mental health. He felt that the committee was doing great service by disseminating knowledge regarding mental diseases. England and France had followed the lead of the USA by encouraging the mental hygiene movement in their respective countries. ¹⁰² Something of a similar nature ought to be initiated in India. Psychiatric knowledge should be spread by medical students among the intelligent residents of the large towns. Hill argued that the money spent on the pursuit of spreading awareness would help in the prevention of mental disorder and the state would then spend less on the insane and their treatment. ¹⁰³

The term ‘mental hygiene’ dates back to the mid-nineteenth century. In 1893, Isaac Ray, founder of the American Psychiatric Association, defined it as ‘the art of preserving the mind against all incidents and influences’. Adolph Meyer and Clifford Beers were two significant advocates of the mental hygiene movement in the context of the USA. ¹⁰⁴ Adolf Meyer was a psychiatrist who believed that besides being a medical problem, mental hygiene was a civic responsibility. ¹⁰⁵ Beers was a patient who after his recovery wrote his autobiography titled, A Mind That Found Itself. His autobiography brought him immediate recognition and fame. He became an exponent of the mental hygiene movement. Norman Dain, in his biography of Clifford W. Beers remarks that ‘the mental health movement was for Beers an extension of himself, a creative responsive to his experiences and needs’. ¹⁰⁶ Meyers and Beers believed that processes of industrialisation and urbanisation were undermining the mental health of Americans. ¹⁰⁷ Beers founded the NCMH in 1908. The main objective of the NCMH was to encourage the institutional growth of the movement, to change public attitudes towards the insane, and ultimately to educate the public to enable them to lead mentally healthy lives. ¹⁰⁸ Nick Crossley asserts that mental disorder was believed to be linked to moral decline, particularly among the working class. ¹⁰⁹ By the 1920s, the mental hygiene movement had become an international movement. ¹¹⁰

Berkley Hill was an exponent on the mental hygiene movement in India. In 1928, he started the Indian Association of Mental Hygiene, for which the British Association of Mental Hygiene was the model. ¹¹¹ India was invited to the First International Hygiene Conference which was to be held at Washington in May 1930. Since Berkeley Hill had attended the International Conference on Psychology a year earlier, it was decided that Major J.E. Dhunjibhoy, the Superintendent of Ranchi Indian Mental Hospital, would be the delegate of the Government of India. ¹¹² Hill was the first president of the Indian Association of Mental Hygiene. He is a significant figure in the history of modern psychiatry in India. Ashis Nandy avowed that ‘Berkeley-Hill name is inextricably linked to modern psychiatry and psychoanalysis in India …’ ¹¹³ The Calcutta section of the Association opened a psychiatric outpatient clinic on 1 May 1933 in a general hospital. Girindrasekhar Bose played an important role in running this outpatient clinic. This may be regarded as the first outpatient clinic in India for the treatment of mental disorders. ¹¹⁴ Berkley Hill worked hard to run the association. He argued that mental hygiene ought to be integrated with the general medicine and education. He believed that ‘if the public know more about the danger signals of approaching mental breakdown, and psychiatric assistance was not delayed in such cases, what tragedies might be avoided!’ ¹¹⁵ Hans Pols pointed out that

mental hygienists considered mental health as an essential condition to meet the demands of citizenship (and mental disorder as one of the main causes of social disorder). Because mental hygienists explicitly connected the mental health of individuals to national and, later, international concerns, mental hygiene activities appeared to be relevant to broader social and political goals. ¹¹⁶

The mental hygiene movement was the precursor to the mental health movement. India’s participation in the mental hygiene movement is significant as it gave India an edge in this field.

The dissemination of psychology and psychoanalysis in India is one of the hallmarks of development of psychiatry and its related disciplines. Ashis Nandy remarked that ‘perhaps in no other country was psychoanalysis to register such easy dominance as in India’. ¹¹⁷ The department of psychology was established in 1915 in the Calcutta University. Psychology initially grew under the auspices of Narendra Nath, but it was Girindrasekhar Bose who played a significant role in popularising psychology and psychoanalysis. Bose was the first person to receive a doctorate in psychology from Calcutta University. ¹¹⁸ Bose published several articles on psychology and psychoanalysis. His contributions towards the development of psychology in India are enormous. Bose was not interested in the plain application of Western psychological concepts and techniques. He felt that more research should be done on traditional Indian psychology. ¹¹⁹ Bose was the founder of the Indian Psychoanalytical Society established in 1922. He interacted with Sigmund Freud, Ernest Jones and William A. White. His work was appreciated by these three men. Psychoanalysis was systematically pursued by some British officials as well. Berkeley Hill applied psychoanalytic theories on to Indian patients. He published several papers analysing Indians habits, culture and society. ¹²⁰ Hartnack argues that Hill utilised psychoanalysis to criticise elements of Indian society and culture as this allowed Hill to justify British rule in India. Bose on the other hand criticised Western concepts of psychoanalysis and regarded them as inadequate to unravel the Indian psyche. Psychoanalysis was used by Indians and Europeans to both critique and justify British rule. ¹²¹ Ernst has recently observed that

historians too have been much more fascinated by the development of psychoanalysis in India than by mainstream psychiatry … all of which is far less exotic in appeal for social and cultural historians than engagement with the role of sexuality, the unconscious mind and mechanisms of repression in regard to individual, cultural and political processes. ¹²²

Historians have so far focused on psychoanalysis, while psychiatry remains a relatively unexplored area. But it should be kept in mind that psychology and psychoanalysis witnessed growth and institutionalisation because they developed outside the control of the colonial state. Indians contributed to the growth and the development of these disciplines thereby benefitting Indians. Psychiatry on the other hand witnessed restricted growth due to constraints of colonial control.

Peter Conrad and Joseph W. Schnieder pointed out that ‘a unitary, popular and finally dominant concept of mental illness developed only in the late eighteenth century. It was not an overnight revolution, but rather a gradual development over more than two centuries’. ¹²³ By the twentieth century, they argued that the process of medicalisation was complete. Dominance over the conception and treatment of madness had been achieved. ¹²⁴ In other words, medicalisation meant reification of the medical machinery, that is, science and technology were used to pathologise and prescribe the suitable cure for particular diseases. This process led to objectification of humans by declaring them patients, giving complete control to doctors. Medicalisation of psychiatry in India was much different than its Western counterpart. Psychiatry was the by-product of colonialism. There existed no direct antecedents from which one can draw any direct relationship between ‘indigenous’ and ‘Western’ understanding of insanity and its cure. The psychiatric power and its claim to a superior cure of insanity drew authority from colonialism. The process of medicalisation of psychiatry in colonial India should not be seen in unitary terms. The paraphernalia of psychiatric infrastructure had fully emerged by the twentieth century, but the state refused to take responsibility of the mentally ill. The national movement was seen as an impediment. The government spent energy to meet the immediate medical needs of the Indian population. It would not be inappropriate to argue that psychiatry remained at the margins of the medicinal interventions. Shruti Kapila argued that ‘government prerogatives of both financial stringency and medical priorities overrode any comprehensive conception of a profession’. ¹²⁵

India still lacked a professional body of psychiatrists. There was no institution that could unite the psychiatrists as a group of individuals. Roger Jeffery argues that ‘after 1922 a limit of one Indian to every two European recruits was set’ for the IMS. ¹²⁶ This indeed hastened the process of ‘Indianisation’. After this period one does witness Indians being appointed to high posts such as that of the superintendent of asylums. The first Indian superintendent of the Agra Mental Hospital, Banarsi Das, played an important role in the establishment of a professional body. The Royal Medico-Psychological Association was the main organisation of psychiatry in Britain. Its origin dated back to 1841, when An Association of Medical Officers of Asylums and Hospitals was formed. From 1866 to 1925, this body was known as the Medico-Psychological Association, and between 1926 and 1971, it was called the Royal Medico-Psychological Association. In 1971, a new charter was granted to the association whereby it was constituted as the Royal College of Psychiatrists. ¹²⁷ Initially the association met annually, but after 1866, its meetings took place once in every quarter. The body had a professional journal in which its members published their research. After almost a 100 years of the founding of the Royal Medico-Psychological Association, an Indian Division came up in 1936, called the Royal Indian Medical Psychological Association.

Banarsi Das, wrote letters requesting the director general of Indian Medical Service to facilitate the functioning of the association. He pointed out that ‘an Association could only function if local governments would provide leave and travelling allowance to its members for the annual meetings’. ¹²⁸ After the formation of the Royal Indian Medical Psychological Association, the government conceded his demand and requested provincial governments to assist the members. J.A. Thorne, joint secretary to the Government of India stated in the context that

the object of the Indian division is to encourage the study of mental diseases by means of periodical meetings at some central Mental Hospital which will provide an opportunity for alienists in India to pool their experiences and to exchange ideas on problems of psychiatry and administration of mental hospitals. ¹²⁹

The first meeting was held in 1939 at the Punjab Mental Hospital, and it was attended by 24 members. Dr C.J. Thomas, member of the Royal Medico-Psychological Association, attended the meeting. ¹³⁰

In 1922, the Ranchi European Mental Hospital got affiliation from the University of London to start a Diploma course in Psychological Medicine. ¹³¹ A similar attempt was made in 1932, when mental nursing in India got recognition from St. Andrew’s Hospital, Northampton. ¹³² These attempts were rather rare, and they failed to alter the overall situation. A handful of Indians were sent abroad to study psychiatry. Banarsi Das was a civil surgeon at Hardoi but later on became the superintendent-in-charge of the Agra Mental Hospital, and he published an article in 1931 about his psychiatric tour to Europe in that year. He wrote that ‘through the generosity of the United Provinces Government, I undertook a tour of visits to some of the important mental institutions of Europe’. ¹³³ He visited the Bethlem Royal Hospital at London, Craig House at Edinburgh (a private hospital), and psychiatric clinic at Hague in Holland, and psychiatric hospitals and clinics in Germany, Austria and France, observing and learning about the advances made in psychiatry in these countries. Even on the eve of decolonisation, therefore, Indians continued to travel to England, the USA, and Europe to gain experience and training, given that psychiatric education in India lagged behind the West.

Professor Edward Mapother of the Maudsley Hospital, London, visited Srilanka (then Ceylon) and India in 1937. He made a damning critique of the overall psychiatric infrastructure while claiming that the British were ‘bearing the white man’s burden’. ¹³⁴ Mapother regarded the psychiatric infrastructure as ‘the white man’s burden’ because he believed that the British were doing the best that was possible under the circumstances. He argued that ‘it is probable that the situation would have been as bad under the rule of any European nation, and worse under the Indians themselves, but one cannot expect Indians to accept this argument as finality’. ¹³⁵ He wrote that ‘the wretched provision for the insane in India is apt to be excused in particular by reference to the cost of other medical purposes’. ¹³⁶ He attributed these pathetic conditions to overcrowding and lack of infrastructure. James H. Mills and Sanjeev Jain have analysed the Mapother Report and they pointed out that ‘Mapother’s visit in the decade before the end of Empire in South Asia provides an insight into the rather more complicated power relations of medicine in the period’. This period was marked by Indianisation which resulted in an intense struggle between Indians and Europeans. ¹³⁷ Mapother noted that

it is clear that in the future as never in the past, the progress of psychiatry in India will depend almost wholly upon those educated in India. The creation of an effective service of psychiatrists and the improvement of undergraduate and postgraduate training necessary for this seems bound to become business hereafter of the separate governments of each province or presidency. ¹³⁸

On the one hand, he was aware of the necessity of the change, but on the other hand, he remained doubtful about such transformation being achieved.

Mapother visited all the major psychiatric institutions of India. His Report was not published, and it was decided that the information obtained was for personal use and for preparing a report for the Government of Ceylon. For obvious reasons the report was suppressed as it would invite widespread criticism. Mapother held consultations with the president of the medical board and the director general of medical service. Both were aware of the conspicuous lack of the psychiatric structure, but it was clear that the government was not prepared for massive modifications. The rising national movement and lack of funds were regarded as major impediments. It is evident that the colonial state was washing its hands off from the responsibilities as these liabilities had to be eventually borne by Indians. Mapother’s assessments were confirmed by the Health Survey and Development Committee (1946), also known as the Bhore Committee after its chairperson Joseph Bhore. ¹³⁹ The Committee highlighted the appalling conditions of health services in India. Mental hospitals were surveyed by Colonel M. Taylor, Medical Superintendent of the Ranchi European Mental Hospital. He pointed out that

the majority of the mental hospitals in India are quite out of date, and are designed for detention and safe custody without regard to curative treatment. The worst of them were the Punjab mental hospital, the Thana mental hospital, the Nagpur Mental hospital—savour of the workhouse and the prison and should be rebuilt. ¹⁴⁰

He further argued that the superintendents of six of these hospitals ‘have little or no postgraduate experience or training in psychological medicine’. ¹⁴¹

The Bhore Committee started surveying health services in 1943, and its final report was submitted in 1946. The committee had envisaged reform based on its recommendations after World War II ended. By then, however, the political turmoil was at its peak. Many of the recommendations of the Bhore Committee laid the basis of health reform in independent India. Nevertheless, according to the report the total accommodation available in 1946 for treatment of mental illness was 10,189 beds. It was noted that ‘the functioning of existing mental institutions, in most cases, [was] far from satisfactory’. ¹⁴² After the death of Banarsi Das in 1943, Lt Col. Moore Taylor, the Superintendent of the European Mental Hospital at Ranchi, took over the presidentship of the Indian Division of the Royal Medico-Psychological Association. By this time of the War, the nationalist upsurge was already underway. In 1946, moves were initiated which were made to establish a separate Indian psychiatric society. In April 1947, Taylor resigned as he felt that the Indian division was being allowed to die. ¹⁴³ The new body was named as the Indian Psychiatric Society. Today it is the chief professional body of psychiatrists in India. The state often supported such initiatives because India did not have specialist facilities for training and education. Until the late 1950s, majority of psychiatrists were sent abroad. The Bhore Committee recommended the creation of the All India Institute of Mental Health which was established in Bangalore with the aim of providing postgraduate training in psychiatry, clinical psychology and for conducting research in mental health. Later in 1962, the institute was renamed as the National Institute of Mental Health and Neurosciences. ¹⁴⁴ E.A. Bennet, the senior physician in psychotherapy in Maudsley Hospital and consulting psychiatrist, India, remarked,

Mechanical restraint was routine in some of provincial civil mental hospitals as recently as 1945 and even shackles, chains and hand cuffs, while unusual, were by no means unknown. The Punjab Mental Hospital in Lahore (800 bed) contains some well design modern wards. The two hospitals at Ranchi and the Mysore state hospital, near Bangalore stand out as two examples of what may be achieved elsewhere. ¹⁴⁵

Conclusion

The article has demonstrated that by the mid-twentieth century, some individuals were performing important roles in transforming the nature of psychiatry in India. Wider exposure to international trends was an important feature of the twentieth-century psychiatry in India since enthusiastic practitioners not only travelled widely but also experimented with new methods of treatment, as we saw in the case of psychoanalysis and the mental hygiene movement. These efforts were frequently confined to individuals and cannot be generalised. The state maintained an apathetic attitude towards the mentally ill and the mental illness.

The reform cycle triggered as a direct consequence of the IHDC’s report has been examined. The reorganisation was initiated not because of the colonial state’s intention to reform, but instead in an attempt to redirect the energies and attention of critics of colonial drug policies at both the national and international levels towards something more palpable. The colonial state also ensured the continuous supply of revenue from hemp cultivation. The result was shoddy reorganisation that had short-term gains. The restructuring of asylum management had become redundant in a decade or two since the IHDC reforms. India had mammoth asylums but lacked the facilities and infrastructure required for their management. An unintended consequence of reform was the emergence of the figure of a ‘psychiatrist’. This consolidation of the psychiatrist’s identity was a result of multiple processes that included administrative reforms, legislative changes, epistemological shifts, and political alterations at both national and international levels. Psychiatrists such as Charles Lodge Patch, W.S.J. Shaw, Berkeley Hill and Banarsi Das, to name a few, began to play a crucial role in the professionalisation and modernisation of their profession. In fact, it can be argued that the second wave of reform that started from the second decade of the twentieth century was more a result of individual efforts. These changes were neither unilinear nor inevitably productive but instead reflected a tumultuous path of modernisation. Psychiatrists felt the need of modernisation more than any other group and their contributions were noticeable at national and international levels.

Legislative reform and medical advancement at least theoretically made ‘curative treatment’ an essential part of the mental hospitals. The 1912 Act furthered the class-based treatment since it made the admission process lengthy and expensive. The mental hospitals no longer remained abode for the poor as they used to be in the nineteenth century. Indians were given treatment in some of these hospitals according to their economic status. Wealthy Indians had access to first class treatment in some of the mental hospitals by the twentieth century. Bhattacharyya has erroneously argued that ‘With the rise of the psychiatric expert and the increasingly significant role of medical education in India, the asylum was transformed into a singularly colonial and homogeneous space’. ¹⁴⁶ This article, on the other hand, has shown that while some of the mental hospitals witnessed advancement, others continued to exist as mere receptacles of the mentally ill. The zeal of the respective superintendents was an important factor that determined whether those were to be a lunatic asylums or mental hospitals. It has also demonstrated how colonial modernity with its ambiguities attempted to allocate the burden on the ‘natives’ by only attempting to provide [in]adequate psychiatric infrastructure, without actually delivering on the promise. The result of this superficial modernisation was that India never had facilities for those who wanted to become specialists, and even after several reforms, anyone who desired to specialise in psychiatry had to go to Britain. This sort of dependency fettered the development of modern psychiatry in India.