| Abstract|| |
The history of the mental hospital in Delhi is a fascinating story. Set up in colonial times, the asylum in Delhi seems to reflect the tumultuous and chaotic history of the city itself. It was perhaps established in the early 19th century, and functions till 1857, when it is ransacked in the Mutiny. It is subsequently merged with the asylum at Lahore in 1861, set up again, and incredibly, closed again at the turn of the century. Subject to the whims of administrators and policy makers, the asylum then ceases to exist till the 1960s when a new avatar appears. In it's non continuity is the story of the neglect of mental illness.
Keywords: The Great Indian Mutiny, mental hospitals, history of psychiatry, history of Delhi
|How to cite this article:|
Jain S, Sarin A. The fractured history of the mental hospital in Delhi. Indian J Psychiatry 2018;60, Suppl S1:212-7
| Introduction|| |
Asylums in India followed the boundaries an overview of the British colonial rule, first by the East India Company and later the Crown. The asylum at Delhi was no exception. As the British influence crept up to Delhi, through the annexations of Oudh and the consolidation of the United Provinces, hospitals, dispensaries, and asylums were established. Although there are hints of some institutional care by the Mughals too, these are ambiguous. The Punjab was annexed only by mid-19th century, and the Empire extended to the north-west, reaching Peshawar. By then, Hoenigberger, a doctor from Saxony, had already established a small asylum in Lahore under the rule of Ranjit Singh, and when the British annexed the Punjab, they took over the administration of that. Thus, for the first half of the 19th century, the asylums of Delhi, Bareilly, and Benares were grouped together, while in the second half of the 19th century (after the annexation of Punjab), it is Delhi and Lahore that are conflated. The Delhi asylum thus leads a very precarious existence, threatened to be merged with Bareilly, or moved to Meerut, destroyed in the events of 1857, resurrected, moved to Lahore, and then back again to Delhi in 1861. It exists here till 1899, when it is finally merged with Lahore, which in turn is broken up following the partition in 1947. The new Mental Hospital in Delhi is reopened in the mid-1960s.
| Physicality|| |
While the origins of the Lunatic asylum in Delhi are not known to the authors with precision, it seems that the asylum was in existence by the early 19th century. It finds specific mention in the records of the 19th century, where the Delhi, Bareilly, and Benares asylums are often commented upon and referred together. A new asylum was considered necessary for Delhi, and the comments of the civil surgeon are sought in 1845, but the plans are finally not approved. It was rather suggested that as Dr. Balfour had initiated considerable reforms at Bareilly, with an overall improvement; all the other asylums in the region follow his example. Even this was not without quibbling about its financial implications. A disused building at Fatehgarh (halfway between Bareilly and Delhi and thus enough for both sites) could be refurbished for Rs. 30,000 while a new building would cost Rs. 81,457. However, there are some hints of laborers being employed to clear land for an asylum in Delhi, and by mid-19th century separate returns for the Delhi and Bareilly asylums are reported. It is recommended in 1850 that the two asylums be merged, but whether this actually happens is not quite clear. Things are not too good at Delhi, and one enquiry reports that 1852 finds that it was “noisy and filthy”, with “stocks and chains in full operation”. There is some concern that the data being presented and the impressions drawn could be faulty. It is also hinted that no further patients be transferred to Delhi, as it was too small to accommodate more people.
By mid-1852, it was pointed out that the predecessor of Dr. Paton had “flagrantly neglected” his duties; and now “better officers who entertain correct and enlightened views as to the proper mode of managing them (asylums) had been appointed”, as it had been noted with “regret the sorry state that the Delhi asylum had fallen to”. Reports of 1853 record that 176 patients were treated here, of which 44 were cured and 29 died. The proportion improved somewhat in 1854, reflecting a general improvement. By 1855, the reports for the asylums suggest that the asylums “have received the zealous attention of the medical officers in charge...... many improvements have been made,” but details were still not properly filed and comparisons with other asylums were not possible.
As Waltraud Ernst, the historian of Indian psychiatry, notes, in the early 1850s, Surgeon G. Paton initiated some “fatal reforms.” Paton had studied the treatment of the insane in France, and started by reorganization of the administration of the asylum in “what he called gentle bit firm means.” He dismissed the Indian doctor, his predecessor, and the diet was reorganized at allowing less food for those who were “idle, unwilling, or unable to work.” The same was done for tobacco, “which was given as a reward for good behavior only.” While these innovations were perhaps intended for benefit, as Ernst notes, “In the long run Surgeon Paton's approach of enforcing discipline and industriousness by punishment through food restriction and economic incentives was reflected in not altogether favourable cure and death rates, his rigid regimen was consequently again to be followed by a more liberal one when a new surgeon took over the Civil Surgeoncy the Delhi area.” It is of course interesting that the administrative noting is highly appreciative of Dr. Paton in the initial years, as he ensured a reduction in costs.
On May 11, 1857, the asylum in Delhi was ransacked and the inmates “escaped or were set free.” The First War of Independence of India, or the Great Indian Mutiny, broke out in Meerut on the May 10, 1857; so clearly one of the first acts of rebellion in Delhi is perhaps the ransacking and “liberation” of the Delhi asylum, a rather unappreciated fact. The fate of the “liberated” inmates of the asylum remains unclear, but as Lodge-Patch says, “In all probability the greater number of these perished miserably in the subsequent siege of Delhi or the fighting before and within the walls of the city.”
Available details point to the asylum being a “large building outside the walls of the city on the road from Delhi Gate to Muttra (now known as Mathura), about 600 yards from the river Jumna (now known as the Yamuna).” It also seems to have been a well-managed and flourishing institution, administered as far as circumstances permitted on humanitarian principles.” Other sources also refer to the existence of the hospital at the time of the Mutiny. Mahmood Farooqui, looking at letters of the time, notes a number of references to the asylum. So, there are reports of a baker at the asylum who absconds from his post, and is forcibly sent back. There is also the following report: “…the prisoners Saheb Singh and Jadunath had been arrested on the charges of spying and are imprisoned at the kotwali; further that these people are insane and always stay at the lunatic asylum, and create a nuisance and cause difficulties for the other prisoners … In accordance with your order, Saheb Singh and Jadunath, lunatics under imprisonment, have been dispatched to your lordship.” What his lordship did with the unfortunates remains a matter of speculation. There is also an interesting snippet of “an imposter pretending to be insane arrested for spying,” and sent to the kotwali.
After the situation had settled down, the hospital was reestablished. The former asylum then became a jail and was never to house mentally unwell people again. The civil surgeon, Dr. Balfour, found accommodation for the few “lunatics” that were sent to him in a “house between Chandneechauk and the Queen's Gardens, near the site of the Delhi Institute,” but this could hold only a couple of dozen patients at best. Soon, this was exchanged for another building near the Jumma Masjid, which could accommodate about fifty.
At this time, the official discussions as to whether a large central facility is better than multiple smaller ones begins, and soon, in the interests of economy 61 patents were transferred from the Delhi hospital, which was closed, to the asylum at Lahore, then situated then at the Anarkali bazaar. The Delhi jail was subsequently modified to function as an asylum (as a result of the “barabarous practice of confining lunatics”), which had become commonly done. The asylum was reestablished in the mid-1860s (perhaps 1866) at the insistence of Dr JC Penny, the civil surgeon of Delhi. By 1871, the hospital was well on its way to recovery. There had been some budgetary constraints the previous 2 years, which had led to a situation where “cases had to be refused admission, or either transferred to the poorhouse, if paupers; or left to the tender mercy of friends”. However, after “admonition, and an additional grant” things got better. New buildings were added, and it now provided accommodations for almost a 100 patients and included modifications to the juvenile ward, a separate “hospital” (presumably for the medically ill), and single rooms. The average space for each person (in the wards was calculated as 100 cubic feet [10' × 10'× 10.5']) and this was independent of verandah and other covered spaces. Attempts were being made to fabricate revolving panes on the roof, so that ventilation could be improved. Help with gardens, and avenues of trees have been planted, and among the pets “we have two monkeys, a cat, a dog and a fair show of pigeons.” Over time, to this were added sitars, “tom-toms” (dholaks and tablas, one presumes), various musical instruments and encouragements to sing (including one blind man who has an abusive turn of phrase, and keeps the beat on an (including one blind man who has an abusive turn of phrase, and keeps the beat on an “old tin dish”). In addition to work in the gardens being paid and credited to the patients, innovative options were sought. Innovative occupations were sought. In 1874, an ice-pit was created and the sale of ice to the Delhi jail earned the patients 6 paise/day (!). Why the jail required ice is of course a matter for speculation! The ice-pans of Delhi had been quite famous, but suffered in 1857, and the idea of employing the lunatics to help making the ice for the drinks must have appealed to some officials! The mortality dropped from 28% to 10% in 3 years, and the administration was congratulated for this rapid improvement. Interestingly, the expenses of the asylum came to around Rs. 6000/year, but the inmates contributed more than Rs. 1000 worth of labor. It was gradually expanded and extended into trenching a piece of waste ground around the asylum, where the foundations of old buildings had to be blasted, as they were too strong. What buildings of historical antiquity were blasted away is of course veiled from our gaze now! The asylum, now designed to accommodate 150 persons, seldom reached its full capacity, and accommodated 151 patients in 1885 (the highest number ever).
In 1874, Mr. and Mrs. Gilson, who were the overseer and matron of the asylum, moved to the asylum at Agra, and another couple, Mr. and Mrs. Cousins, helped by an Indian staff, Martha, took over, but were not very effective over the years. Mr. Cousins eventually became Deputy Superintendent, but was suspended on account of laxity in discipline and accounts, was reinstated later, but his ultimate departure was thought to be very fortunate. He was replaced by Mr. Bernard, who was thought be much better, but a few years later, he too proved disobedient and was fined. It was often noted that the nonmedical staff (barkandazees and keepers) were often found to be “indolent and troublesome;” some were dismissed for stealing the lunatics' food, or for carelessness and harsh treatment. Gradually, a native doctor from the jail helped in looking after the medically ill, helped by the Jemadar. By 1875, the asylum at Lahore was overcrowded, and patients from the Punjab were admitted to Delhi in greater numbers, leading to an overcrowding, and an increase in the staff. Some restrictions on new admissions (ordered by the Government of India as part of an earlier austerity drive, one can guess) and a pro-active effort at discharges were recommended to reduce the numbers in the asylum. A native doctor NathuLal was employed, at a salary of Rs. 20/pm, which was a fraction of that of the British doctors (Medical Superintendent Rs. 150/pm and Deputy Medical Superintendent at Rs. 50/pm; both positions were reserved from European doctors). Costs and comparisons were a constant refrain. In 1878–1879 epidemics caused a marked increase in mortality. Dr. NathuLal also died, and was considered a great loss as he was noted to have been “peculiarly adapted for looking after the welfare of the lunatics.” Dr. Nathu Lal can thus presumably be considered the first official Indian “psychiatrist” in northern India. Dr. Saadat Ali joined the asylum staff the following year, to be followed by Gopal Das, who is described as taking an “intelligent interest in his duties and a careful supervision over expenditure.” The salary for the hospital attendant was raised to Rs. 35 subsequently, without any further increase in the Med Supdt's salary.
A weaver, who supervised the blanket-weaving, was killed by a patient in 1883, and a gratuity and pension requested for the family. By the end of the century, by 1890s, the reports are quite perfunctory, and monotonous, with an emphasis on financial matters, collecting dues from paying patients, ensuring savings and debates about why average costs in Delhi are always higher than Lahore. Presumably as part of this, the cook, gardener, bishti and barber were dismissed from the Delhi asylum, their duties being taken over by the patients themselves (if one were charitable, could one call it an early attempt at a therapeutic community!). One problem, the Superintendent at Delhi pointed out, was the impossibility of getting wardens at salaries between Rs. 5 and 8/pm, at which “coolies of the worst character can only be procured…their project is plunder and the lunatics suffer.” This constant preoccupation with the costs ultimately leads to its logical consequence, of shutting down the asylum altogether. Similarities with the present are, of course, unintended.
| Clinical Aspects of the Asylum at Delhi|| |
Admissions in 1870 were few, and treatment consisted mainly of gainful occupation. The mortality rate (four deaths (epilepsy, starvation (despite tube feedings) and two by fever on top of chronic myocardial infarction) was quite low by now, but still too high for the administration. Dr. Fairweather, who instituted significant reforms, opined that “I am a decided advocate for the disciplined value of treatment by occupation of mind and body for the insane.” Recovered and discharged patients were above 40%, and a number of wandering insanes who were otherwise “faqueers” were admitted. Violent crimes (slicing off partners' nose out of jealousy, assaults with swords, drowning her grandchild) were some of the reasons for being admitted as a criminal mentally ill. It was commented (an issue that has contemporary feel to it) that the “insane are not slow in sagacity and the power of comprehending what is done for their good, and thus will appreciate kindness. It is refreshing that the care of the insane received so much attention....” as compared to the neglect that had been the case earlier.
Causes of insanity were quite often listed as physical (mainly ganja and addictions), or moral. Ganja use was seen to be particularly pernicious, and the doctors commented that various parts of Delhi (the Eidgah maidan or the banks of Yamuna) were popular places of congregation for young men who sat in small groups, every evening, to share a chillum of ganja. Excessive use, especially of the more potent variety, was listed as one of the most common causes of insanity. Acute mania was seen to have the best outcomes, with “almost all the recoveries” being in this group.
One Mr. Ashraff Khan, who had once been diagnosed as “apparently sane” became very violent, and assaulted several people. It was commented that he “does not appear insane, but is a man of ungovernable temper.” This is a rare instance of someone who was difficult to call clinically “insane” being in the asylum. Over time, he becomes fixated that the Jemadar was against him, and cheating him of his fair potion of food. He complains that the bread and dhal were below the requisite weight and insisted that the superintendent weigh them in front of him. This was done, and the material found to be rather in excess. By then, Ashraff Khan had been promoted to be a kind of assistant-keeper, who helped to “keep order.” A young girl of 8 years was admitted by a man who found her as he was ploughing his field, and believed by him to be a wolf-child. She gradually recovered, and became lively and playful, and though she would play ball with a matron, would not socialize with other children. A particularly interesting case was an Irishman, who converted to Islam, and took the name Ahmed Din. He claimed to the Duke of Normandy, Lancaster, and said he was on his way to Kabul to help the Amir. He was arrested by the police and sent to the asylum, but his Mussulmen friends “were annoyed at being thus deprived of their proselyte” and intended to memorialize the government for the “iniquity of making out a man to be insane” on grounds of religious conversion. He was sent to Colaba, to the great relief of the superintendent. In these 2 months, he had continued to send newspaper cuttings from the newspapers supplied to the asylum, and exaggerated accounts of the Russians progress in central Asia, which could have caused some problems with the “excitable population” of Delhi. However, it is noted that most of his letters fell into the hands of the police. Of course, the idea of an intelligence service that occupies, and informs, itself by reading letters from the inmates of an asylum may have some interesting contemporary corollaries.
Politics continues to reflect in the lives of patients of the asylum, as one patient found sitting on a bridge complains that he has written to the Queen (Victoria) that the present government was incapable of ruling Kabul and Khyber, and that he should be given the charge, when he would “settle matters to her satisfaction,” while another imagines himself the Alamgir (the Mughal emperor) come to life again. A schoolmaster who suddenly assumes the role of a ticket collector (new technologies and new positions rapidly incorporated into cultural content of delusions!) and is sent to the asylum for this; while persons with recurrent insanity who are fond of music and putting on performances, and recover rapidly suggest similarities with symptoms of mania. A person caught eating a child was discharged as not insane, as he was of a “respectable and venerable” presence, but identified himself as a Sirbhangi. Imrit, a darzy, who claims he is a descendant of the Sen dynasty; Habib Shah who claims to the last of Mughals and anointed by Nizam-ud-Din Aulia (was discovered sitting on the throne in the Red Fort, which was then a military camp!) and his story “spread very far” though he was discharged quite sane; and also Juma, from Peshawar, who thought himself the son of Col Mackeson [who had been assassinated by religious fanatic from Swat in 1853] are the subject of some of the more colourful case notes. Both Imrit and Juma were later discharged as cured.
The asylum in Delhi, by all accounts, seems to have functioned fairly reasonably till the end of the 19th century, when, incredibly, after another policy discussion, opinion seems to have veered again toward the establishment of a large central facility. On March 23, 1900, 103 male and 35 female patients were again transferred from Delhi to the newly furbished asylum at Lahore, as the asylum was finally shutdown. It would, amazingly, take six decades for Delhi to have a dedicated facility again.
| The Early Modern History|| |
In a series of ironic twists, the entire 19th century history was played out again in the late 20th century. Since the major asylum of northern India was now in Pakistan, new facilities had to be built. A portion of the Tihar jail (which was built in 1957) served for a while as a mental hospital. Plans for a new building, on a site in Shahdara, which had been earmarked half a century earlier, were slow to execute. Mired in ministerial prerogatives, the buildings and services oscillated between the social welfare and health ministries. When ready, they were found to be prone to flooding, and lacked electric supplies. Overcoming all these obstacles, the Mental Hospital of Delhi, though initially planned for 100 patients (to replicate the 100-bedded hospital of a century ago), was ultimately opened in 1966 with 400 sanctioned beds, and would soon house several times more.
The history of the Delhi asylum, as indeed all histories of Delhi, continues to be endlessly fascinating because the asylum does not have a linear or continuous history, subject as it is to the ebb and flow flow of empires. At the beginning of the 19th century, Lucknow is the bigger city, and Delhi is a landscape of ruins, with a population confined within its walls. The population, however, is quite cosmopolitan, with Europeans and Indians developing the beginnings of a new ethos (Nayi Taleem) that tried to syncretize the older Sanskrit and Persian traditions of science and literature, with the new European ideas. This also included medical care, as European doctors had been part of Delhi life from the time of Jahangir. The asylum is established just outside its ramparts, to the south of the walled city, while the British Resident and officers lived on the ridge to the north. As described above, it leads a chequered existence, as the East India Company is constantly aware of financial prudence and parsimony. Despite this, attempts are made to improve the conditions by regular improvements, and the events of 1857 throw it into chaos. The administration is now passed to the Crown, and thus the Indian Medical Service. The asylum is reestablished, but then moved to Lahore. The North-West frontier is going to preoccupy the British for quite a few decades, and the edifice of civilian administration, and governance in the Punjab is thus critical to this effort. The asylum at Lahore is expanded, and though whether it is sensible clinical practice to send patients from Delhi all the way to Lahore is often questioned, and the asylum at Delhi reestablished, the administration is steadfast and finally shuts down the Delhi asylum. Interestingly, and perhaps tellingly, the grand plans for imperial New Delhi do not seem to include a medical service for the population at all, to match the imposing buildings being built for the new rulers. By this time, the Mughal gardens of Shahdara, once gifted to Dara Shikoh, and lovingly restored by Bahadur Shah Zafar had fallen into decay, and parts of it even used as a municipal waste site. However, even in the early 20th century, Shahdara had been identified as a possible site for the new mental hospital, whenever it is to be built. Whether it the desire to locate it in the gardens of the Mughals (continuing the centuries old tradition of asylums and gardens), or merely fortuitous coincidence as the asylum at Lahore (at independence, the only asylum in the Punjab) is also located in the suburb of Shahdara, is not known. Thus, and in many ways, by its name, location and early history, the asylum at Delhi provides a fitting background to the experience of the care of the mentally ill during the Mughal and British imperial rule.
The work was supported by a grant from the Wellcome Trust (Turning the Pages 096493/Z/11/Z). We would also like to acknowledge the help of Dr. Pradipto Roy and Ms. Sarah Ghani.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Jain S, Murthy P, Sarin A. Madness and sanity at the time of Indian independence. Indian J Psychiatry 2016;58:342-4.
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Report Delhi Asylum/Annual Report of the Lunatic Asylums in the Punjab. 1884.
Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None