Year : 2019 | Volume
: 20 | Issue : 2 | Page : 61--63
Western colonial wave in Indian psychiatry - An overview
Vel V Prashanth1, Pranjal Dey2,
1 Resident Doctor, Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Assistant Professor, Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
Dr. Pranjal Dey
Qtr No. 02, New Type 4 Quarters, CIP, Kanke, Ranchi - 834 006, Jharkhand
British colonialism brought a western impact in Indian psychiatry. Starting from the early colonial times when mental asylums were set up in major cities of India to cater the British and Indian soldiers. Then in late colonial period there was a discernible growth in the number of mental asylums away from major cities to cater the local population. Also during this period First Lunacy Act was enacted by the British Parliament which brought many changes in the administration and healthcare system of mental asylums in a more humanistic approach. In pre independence period there was a major change in treatment standard of mental hospitals with introduction of different modes of therapy, medication, rehabilitation technique. Also efforts to train medical and nursing personnel in Psychiatry were started during this period. General hospital psychiatry care was introduced during this period. Thus current practice and training in Psychiatry in India functions courtesy of the moulds constructed during the colonial times.
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Prashanth VV, Dey P. Western colonial wave in Indian psychiatry - An overview.Arch Ment Health 2019;20:61-63
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Prashanth VV, Dey P. Western colonial wave in Indian psychiatry - An overview. Arch Ment Health [serial online] 2019 [cited 2020 Sep 20 ];20:61-63
Available from: http://www.amhonline.org/text.asp?2019/20/2/61/275201
History of psychiatry has been known to be consisting of various cultural and scientific traditions and distributed heterogeneously around the whole globe. British colonialism brought British flavor to Indian psychiatry which at best we proved ourselves good followers. Here, we review the western impact in the development of psychiatric service in India in different colonial periods till independence.
Early Colonial Times (1745–1857)
Until the early part of the nineteenth century, mental asylums were located only at the major cities of India. They were primarily custodial in nature and mostly catered to the British and the Indian soldiers employed by them.
During the rule of Governor Warren Hasting in 1784, the “Pitt's India Bill” was introduced and its welfare activities were undertaken under Lord Cornwallis from 1786 to 1793. During his rule, the first mental hospital at Kolkata was recorded in the Proceedings of the Calcutta Medical Board on April 3, 1787, by Surgeon George M. Kenderline. This was the beginning of western impact on the development of psychiatric care in India.
One of the earliest mental hospitals in India was set up in Bombay in 1745, and a beginning was made to construct a small lunatic asylum in Colaba in 1806. During that period, patients were treated with morphine and opium and were given hot baths; even leeches were applied to their body in controlling their periodic excitement.
In 1855, in Dacca, another lunatic asylum was opened in Murli Bazar. The music therapy and cannabis were used to treat excited patients. In Bihar, two hospitals were opened: one in 1795 at Monghyr for insane soldiers and another in 1821 at Lower Road, Patna. At Kizhpakkam in Madras, the first mental hospital was started in 1794 for 20 patients by Surgeon General Valentine Conolly. In 1799, the government obtained the lease of premises, and another surgeon, Morris Fitzgerald, was appointed as the medical superintendent. Later, in 1807, the hospital was expanded and under the charge of Surgeon James Dalton.
Late Colonial Period (1858–1918)
Growth of mental asylums (1858–1904)
Asylums originally built in India were primarily to protect the society from the mentally unsound people. Therefore, the asylums constructed at that time were simply the places of detention. After Lord Cornwallis' rule, there was no further development in the growth of lunatic asylums until 1857. First Lunacy Act was enacted by the British Parliament during December 1858. This act laid down guidelines for the establishment of mental asylums and procedures for admitting mental patients, which was later modified by a committee from Bengal in 1888.
After 1858, there were many changes in the administration and healthcare system, which later resulted in the establishment of more lunatic asylums during the next 20 years in the eastern part of India. By 1874, there were at least six such asylums in Calcutta (Bhowanipore), Patna, Dacca, Berhampur, Dulanda (in Calcutta), and Cuttack (Orissa). In 1876, a new asylum was opened at Tezpur, Assam.
In the South, new hospitals were opened at Waltair, Trichinopoly, and Madras in 1871. In the Western part of India by 1865, five such institutions were opened at Colaba, Poona, Dharwar, Ahmedabad, and Ratnagiri. Similarly, new asylums were established in 1866 at Jabalpur and Ellichpur in Berar. Mental hospitals were started in Banaras (1854), Agra (1858), and Bareilly (1862).
The Delhi Asylum lead an unstable existence. With initial move to Bareily and later Meerut and eventually being sabotaged by events of 1857. Only that it was resurrected again in Lahore. And yet again, it was reinstated back to Delhi in 1861 where it survived till 1899 when it was once again merged with Lahore. But the partition of 1947, put a final nail in its coffin. It existed till 1899 when it was finally merged with Lahore, which in turn was broken up following the partition in 1947.
In this phase, there was a discernible growth in the number of mental asylums, located away from the major metropolitan cities, and local population was also permitted to avail these facilities. However, most of these asylums were set up primarily near cantonments, where the British army units were stationed.
Humanistic approach and early legislation (1905–1918)
The third phase of development of mental hospitals in India started in the early part of the twentieth century. This was the result of adverse publicity in the press, both in Britain and in India, about the conditions of the hospitals and then the need felt for a more humanistic approach. In 1905, with the initiative of Lord Morley, the control of mental hospitals was transferred from the Inspector General of Prisons to the Directorate of Health Services and to the Civil Surgeons at the local level. It was also acknowledged that specialists in psychiatry and medical doctors should be appointed as full-time officers there when available. Another significant development was the intent of the government in 1906 to have a central supervision of all the lunatic asylums. This resulted in the Indian Lunacy Act 1912 under which a central mental asylum was established in Berhampur for European patients, which later closed down after the establishment of the Central European Hospital at Ranchi in 1918. Superintendent of the European Hospital Col (Dr.) Owen Berkeley Hill had made the institution at Ranchi the foremost in India at that time and attracted many European patients for treatment.
The developments of this phase were characterized by a more humane handling of mental health issues with significant legislative, administrative, and clinical modifications. In spite of these changes, mental health services were confined to mental hospitals with a lack of formally trained workforce.
Pre-Independence Period (1919–1946)
The sustained efforts of Dr. Berkeley Hill and his colleagues helped to raise the standard of treatment and care at the mental hospital at Ranchi. They persuaded the government to change the term “asylum” to “hospital” in 1920. At that time, occupational therapy was started there. The service of psychologists in the diagnosis and management of psychiatric patients was started for the first time in 1920 at Ranchi. Mental health services until then did not have formally trained workforce, and most of the qualified psychiatrists were British living in India. The first efforts to train psychiatrists and psychiatric nursing personnel were made during this period. In 1922, the Ranchi European Hospital, place known today as CIP, got affiliation from the University of London to begin Diploma in Psychological Medicine. In 1939, Department of Neurology and Psychiatry was established at the Calcutta Medical College by order of the Government of Bengal in 1939. Psychology was first introduced as a subject in the Philosophy Department at Calcutta University during this period. In 1922, the Indian Psychoanalytical Association was founded in Calcutta by Dr. Girindra Sekhar Bose, and with the help of Ernst Jones, got its affiliation with International Psychoanalytic Association. In the British undergraduate teaching curriculum, psychiatry was introduced in the mid-forties of the last century. In India, the Bhore Committee in 1946 and several other committees and taskforces subsequently emphasized the importance of undergraduate medical teaching. Furthermore, preventive psychiatry was introduced in the curriculum following the British guidelines. Again, the clinical aspect of psychosomatic medicine, that is, consultation liaison psychiatry, made a beginning in the early part of the twentieth century to bring mental health professionals into proximity with other specialists in medicine for training and providing psychiatric care.
Initial attempts to establish direct links with the patient's family were made in the form of family units. In 1930, an Association of the Medical Superintendents of Mental Hospitals was established. In 1923, hydrotherapy was started and free social intercourse was allowed between the male and female patients during that time.
The first psychiatric outpatient service was set up at the R. G. Kar Medical College, Calcutta, in 1933 by Dr. G. S. Bose. The second such unit was organized by Dr. K. R. Masani at the J. J. Hospital, Bombay, in 1938. In 1939, the Department of Neurology and Psychiatry was established at the Calcutta Medical College in 1939.
The use of Rauwolfia extracts was started for psychotic conditions in the late 1940s. Systematic efforts for using physical treatment methods such as electroconvulsive therapy, insulin coma treatment, and psychosurgery began in the late thirties. Electroencephalography was introduced for diagnosis. Thus, emphasis shifted from custodial care to a curative approach. This progressive trend, however, remained confined to the two major metropolitan centers and mental hospitals.
In 1946, a high-level Health Survey and Development Committee, headed by Sir Joseph Bhore, reviewed the entire public health sector including 19 mental hospitals and prepared Bhore Committee Report which became indispensable for health planners in independent India and merits attention even today. Bhore Committee report had recommendation for the prevention of mental illness and promotion of mental health. The proposal for mental health program and the creation of mental health organization were stated in the report. One of the important recommendations of the Bhore Committee was imperative to develop workforce in the field of mental health which resulted in establishment of All India Institute of Mental Health in 1954 at Bangalore (later known as NIMHANS); here, postgraduate training in psychiatry, clinical psychology, and psychiatric nursing was started. In addition, to set up a general hospital, psychiatry unit was also recommended in the report.
Thus, the current Indian mental health system largely runs on the foundations constructed during the colonial times and continues to show predominant western influence in the basic training and practice of psychiatry.
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Conflicts of interest
There are no conflicts of interest.
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