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MUSINGS IN PSYCHIATRY  
Year : 2018  |  Volume : 60  |  Issue : 6  |  Page : 288-294
Central Institute of Psychiatry: A fictional journey to past in a time machine


1 Department of Psychiatry, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
2 Department of Child Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
3 Consultant Psychiatrist, Sullia, Karnataka, India

Click here for correspondence address and email

Date of Web Publication5-Feb-2018
 

   Abstract 


A fictional journey was planned and carried out in a time machine, to know and understand the glorious past of Central Institute of Psychiatry (CIP), Ranchi. As Dr. Anand, the protagonist, went through different periods in the history of CIP, he narrated his experiences while meeting different peoples in different clinical settings. In this journey, he met Lt. Col Berkeley-Hill at European Mental Hospital, as it was in the 1930s. He tried to understand the relevance of Professor Mapother's report and its essence in relation to European and Indian psychiatric scenario during inter-war period, the significance of Moore-Taylor's report, and the direction of psychiatric training and teaching during postindependence era under Major RB Davis as the superintendent of Hospital for Mental Diseases (HMD). Here, Dr. Anand met the great rebel poet of Bengal (and the national poet of Bangladesh later), Kazi Nazrul Islam, who was here for a short period, before being shifted to Europe for further treatment. Dr. Anand also met other superintendents/directors of CIP during postindependence period and tried to understand the significance of those periods in the total journey of CIP till today. The journey started in the present and went back in time. Finally, a brief comparative analysis has been made regarding the status of CIP vis-à -vis other important psychiatric institutes/hospitals in the past and present.

Keywords: Central Institute of Psychiatry, European Mental Asylum, Fictional journey, Hospital for Mental Diseases

How to cite this article:
Aich TK, Das B, Bhat T S. Central Institute of Psychiatry: A fictional journey to past in a time machine. Indian J Psychiatry 2018;60, Suppl S1:288-94

How to cite this URL:
Aich TK, Das B, Bhat T S. Central Institute of Psychiatry: A fictional journey to past in a time machine. Indian J Psychiatry [serial online] 2018 [cited 2021 Apr 19];60, Suppl S1:288-94. Available from: https://www.indianjpsychiatry.org/text.asp?2018/60/6/288/224668




“I am the rebel eternal,

I raise my head beyond this world,

High, ever erect and alone!”

– Kazi Nazrul Islam


   Scene 1: December 2015; Farewell to Dr. S. Haque Top


Dr. Anand is a bright young 2nd year resident in psychiatry department at the Central Institute of Psychiatry (CIP), Ranchi. Today is 29th December 2015, the D-day for which Anand was waiting eagerly! Dr. S. Haque, Professor of Excellence, will be officially given farewell on behalf of the institute. Anand is very much excited over the prospect of meeting many other past CIP alumni, who have decided to grace the occasion. He knows Dr. Haque for the last 1½ years and he is awestruck at Dr. Haque's personality and achievements gathered over the years! Anand came to know that Dr. Haque is the longest serving CIPian at CIP, stayed in CIP from 1981, when he joined DPM, continued his MD, and after passing, he joined the institute as assistant professor. Dr. Haque became director in the year 2000 and after retirement in 2012 he continued till date as the professor of excellence. It is 34 years in total that Dr. Haque spent in CIP!

Farewell has been arranged in the Berkeley-Hill conference hall. It is 10 a.m. in the morning. Students of psychiatry, psychology, social work, and psychiatric nursing have already gathered in the hall. Old alumni started pouring in. Director Dr. D. Ram, Professor CRJ Khess, Professor Basudeb Das, and other teaching faculties took their seat. They are all waiting for Dr. Haque to arrive anytime! Professor Vinod Kumar Sinha, a contemporary of Dr. Haque and a close friend of him, in fact took the initiative for this farewell function. Text, audio, and video messages of old alumni, who could not make it to the occasion, have already reached. All these text messages have been compiled and are ready for release in a booklet form.

It is 2-h intense and memorable interaction and presentations. Dr. Anand came to know few humane aspects to Dr. Haque's personality, which were hitherto unknown to him. Speakers after speakers shower praise to Dr. Haque and it is quite evident that professor saab was relishing the occasion!

At the end of the gala farewell, a tour to CIP was arranged, to showcase the developments done in the new millennium. There has been face-lift of old wards named after eminent European psychiatrists of the bygone era: Maudsley, Kraepelin, Conolly, Freud, Tuke, Bleuler, Pinel, etc., and there are renaming of some old wards and Centers[1].

Team started the tour from Ibn Sina Central library. For all CIPians, its library is dear to their heart. But, old alumni did not know that currently “it has a collection of nearly 55,000 books, bound volumes of journals, and WHO publications. Nearly 2000 books from different world wide publishers have been added every year to make the library collection richer. The library currently subscribes 318 printed journals and has access to almost more than 2000 journals by using different platforms such as ScienceDirect, Wiley's Online Library, Ovid SP, Cambridge Online, and Springer Link. The library is also a member of the ERMED– India consortia–which is run by National Medical Library, New Delhi. ERMED provides full-text access of almost 1800 journals on its platform.” Old alumni remained awestruck to this new modern library building.

Visit proceeded to K. S. Mani Centre for Cognitive Neurosciences and Girindra Shekhar Bose Centre for Neuroimaging and Radiological Sciences. Subsequently, the present and past alumni strolled through the big CIP campus leisurely, sat and gossiped at the patients' canteen, till lunch break. Old alumni recalled those days when the patient named “Maggi” used to serve tea to them every morning here, before they would start their day in the institute. Lunch is arranged and served at the new look “CIP Guest House.”

Dinner is an informal one, upon request from all old alumni who attended the function, and it has been arranged at boys' hostel premises. Alumni visited new married resident hostel, a beautiful multistoried building with all modern amenities available. The entire institute is now having a Wi-Fi connection including hostel premises. They realized that CIP has come up age and functioning with all modern facilities available to a modern medical institute. It is a moment of pride for them also! So much change has occurred that many alumni could not recognize their own hostel premises, where they spent a significant part of their life as a budding mental health professional!

As the evening sets-in banquet started and old alumni gradually become informal, ideas flowed more freely, and intimate moments are unearthed and shared. This hostel campus has witnessed many love and romances being flourished, some of them have even ended in marriage! Even some of those bitter moments seem to be a sweeter one today!

At the end of the day, Dr. Anand has an intense desire to know more about the glorious past of CIP. Anand believes that a man's contribution to the institute and the society at large cannot be judged singularly; a lot depends on the prevailing sociocultural and political scenario of the state and country at large. He decided that he would go to the library next day and study about the history of making of CIP over the decades during the last one century! With this thought, after a hectic and satisfying day, he went into deep sleep. After sometime, Anand suddenly got up from bed hearing some strange sound overhead. He came out and went to rooftop. He saw a balloon-shaped spaceship waiting for him to board. As if in a trance, he went in and then he realized that it is a “time machine.” Anand expressed the desire to take him 20 years back in time in CIP!


   Scene 2: May 1995; Central Institute of Psychiatry Day Top


Residents and students of psychology, social work, and psychiatric nursing are excited today over the prospect of a terrific case conference. Dr. S. S. Raju has joined the institute as the director on January 9, 1993. Since his joining, he has expressed big ideas on reviving the institute from its current slump. He expressed many times that his vision is to make this institute the best one in Asia! He has planned to celebrate CIP day this year in a big way. A 2-day seminar has been arranged on the current advances in depressive disorder with multiple eminent speakers from different parts of the country, which include Professor K. Kuruvilla, Professor Venkoba Rao, and Professor O. Somasundaram, among others. An ideal case conference is a part of this celebration. Conference started at 2 p.m. sharp. A resident doctor presented the case in the usual manner, a student of psychology presented her psycho-diagnostic findings, a student of social work presented psycho-social perspective of a patient, and a student of psychiatric nursing presented her nursing observation report. Finally, a psychiatry resident compiled all findings and a diagnosis is put forth. Chairperson Dr. V. K. Sinha opened the case for discussion. Senior residents took over the discussion. Diagnostic confusion continued. Finally, consultants and guest professors contributed to the discussion. At the end of the day, no consensus could be reached in diagnosis. Dr. Anand gets astonished that even such eminent professors differ in diagnosis. Even in the era of Diagnostic and Statistical Manual of Mental Disorders-IV and International Classification of Diseases-10, we are unable to reach a consensus in psychiatric diagnosis!

Dr. Anand heard from his seniors that Professor S.S. Raju was a simple man with high ideals and had a visionary zeal. It was a different story that Professor Raju's life was cut short abruptly on the eve of Saraswati Puja in the year 1998. Thus, his dream of making CIP the best institute in Asia also remained unfulfilled!


   Scene 3: “wednesday Afternoon Clinic” and Dr. Sashi K Pande: Central Institute of Psychiatry in 1970s and 1980s! Top


Dr. Anand decided to board the time machine again and requested the pilot to take him to a summer of 1981[2],[3].

Though it is a summer afternoon at 2 p.m., weather is still a pleasant one. A group of young psychiatry trainee including Dr. S. Haque and Dr. Vinod Kumar Sinha and few other medical officers are waiting for Dr. Sashi K Pande to arrive for his clinic to start. His “Wednesday afternoon clinic,” with his hallmark walking stick and a waft of “More” cigarette smoke, has become popular among students and patients as well. Not infrequently, these clinics would run up to late evening hours! Dr. Haque is scheduled to present a case of catatonia today, apparently, a simple case for presentation for a new trainee in psychiatry. The only problem is that the patient is completely mute since his admission yesterday! “So, what is your impression about the case Dr. Haque?” asked Dr. Pande in his characteristic demeanor. “Catatonic schizophrenia, Sir” Dr. Haque said emphatically. “OK, let us see, what it comes out to be” said Dr. Pande. Dr. Pande lit his cigarette and turned toward students, “I have no problem, if any of you also wish to smoke, it may become a long interview session!” Mute patient remain seated before him, so also Dr. Pande. Minutes passed. 15 min over… 30 min over… still no reaction from either the patient or the interviewer! Some of the trainees showed restlessness and finally gathered courage to follow their director and lit a cigarette and cherish the leisure summer afternoon. It is after about 40 min the patient broke the silence, “may I go sir!”[2]

CIP in the 1970s and 1980s was still of a sleeping beauty. Work used to start on a slow pace, with all the medical staffs used to assemble in a small structure (which functioned as the patients' canteen later). Doctors used to go through the “hospital order book” and night reports, exchange pleasantries, and after an hour everybody used to go to their respective wards. Patients to be reviewed were selected by the ward sisters. In fact, CIP was known to be a hospital run by nursing sisters! There were fixed routines for managing patients like reviewing patients by rotation, changing the phenothiazine tablets once in every 3 months, at random![3]

Many of the old-world British traditions were still continuing such as serving breakfast, lunch and dinner with specific manners and styles, and serving a glass of water on a tray covered in white napkins! Lunch break was a long one, from 1 p.m. to 3.30 p.m., with every one used to have a lengthy siesta after lunch. Attendance in the afternoon was a formality. The outpatients were seen only in the morning sessions, usually one or two, sometimes up to five, with three to four new patients in a week [3].

Dr. Sashi K Pande left CIP by October 1981 and the change of guard was by another great CIPian, Dr. Sridhar Sharma. He ushered the residency scheme in CIP and was responsible for conducting several academic conferences. He was, also, the architect behind the creation of several new posts and departments like the department of neurology.


   Scene 4: “insulin Coma Therapy” Session and Dr. K. Bhaskaran Top


Dr. Anand decided to board the time machine again and ordered the pilot to take him back to the year 1965[4],[5],[6].

It is 7 a.m. in the morning. There has been some brisk activity among sisters and few junior doctors. “Insulin Coma therapy” is planned in a new patient. It is a quiet room and the patient is encouraged to relax. Today is the first session. The patient, an Indo-Pak war veteran, has been given a diagnosis of “war neurosis.” Marked weight loss was complained with associated stress and anxiety symptom. Doctors and nurses waited for the superintendent to come in anytime. And, here he comes…. Dr. K. Bhaskaran, a very good teacher and a very compassionate person as well. All the staff and students of the institute have high regards and love for him. He looked toward the treating doctor, “I hope you screened the patient properly,” “Yes Sir” was the prompt answer. “Good, let's go ahead with the procedure sister,” said Dr. Bhaskaran. Doctor took the syringe from the nurse and checked whether exact 10 ml soluble insulin is loaded. He slowly pushed the medicine subcutaneously over the patient's forearm. Dr. Bhaskaran asked the resident doctor, “Dear, I hope, you have understood the method and application of Insulin Coma Therapy”? “Yes sir,” he said, “I have to increase the dose of Insulin daily by 5–10 units, to be given each morning. Patient will be kept under constant nursing observation. I will record the appearance of symptoms of hypoglycaemia like feeling of weakness, emptiness, shakiness, faintness and hunger. I will also record pulse, appearance of sweating and tremor, if any, in regular intervals”. “Good” again said Dr. Bhaskaran, “Instead of becoming drowsy your patient may become restless, disinhibited, laughing, or crying. Any doubt please do not hesitate to ask the sister who is assisting you. She is very experienced and an expert in carrying out Insulin Coma Therapy.” “Yes sir” said the resident doctor. With these words, Dr. Bhaskaran left for other works. Doctor continued to monitor the patient closely. He looked for appearance of any muscular twitching, any signs that the patient might be drifting into coma. In that case, oral as well as intravenous glucose and 0.5 ml of 1:1000 solution of adrenaline is kept ready for subcutaneous injection. But, no untoward happened and at 10 am the patient was aroused. A breakfast of about 1000 calories is served containing 20–25 g of protein. Breakfast was appetizing and the patient ate all of it. Doctor was happy for completing the therapy session smoothly. He instructed the patient to go back to his bed. “Do not forget to take routine lunch and other meals” said the doctor. “OK sir” was the response from the patient.[4]

Dr. K. Bhaskaran had joined the Hospital for Mental Diseases (HMD) in 1961 as deputy medical superintendent and promoted to medical superintendent and professor of psychiatry in 1963 and stayed here till August 20, 1973. He did his Diploma in Psychiatry from McGill University, Canada, in 1954 and later MD in Psychiatry from Patna University. In the years 1960 and 1961, Dr. Bhaskaran was the secretary of Indian Psychiatric Society (IPS) and in 1970 he was the elected president of IPS. During his stewardship at CIP, Rural Mental Health Clinic (Mandar), Rehabilitation Center, and Sheltered Workshop started functioning. DPM was started in the year 1962 with four students, only to get discontinued till 1969, when it was stated again. Two of our future directors Dr. S. D. Sharma and Dr. L. N. Sharma were from this 1962 batch. Regular MD in Psychiatry was started from 1971 onward. Dr. Bhaskaran was the director and professor at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, for a very brief period in 1969.[5],[6]

Dr. Bhaskaran used to take time to open up with his colleagues and students. Some of the staffs of CIP still fondly remember his generosity. He used to interact with staffs' family members on festival days and loved to play Housie and table tennis.


   Scene 5: “narcoanalysis” Session and Dr. D. Satyanand Top


After meeting Dr. Bhaskaran, Anand now have a desire to go back few more years in history. So, he decided to board the time machine again, this time for a brief journey back to a sunny warm morning in 1962.[4],[7],[8]

Dr. S. D. Sharma and Dr. L. N. Sharma had joined DPM few months back. Dr. Satyanand decided to demonstrate them the technique of narcoanalysis. A young lady with hysterical conversion reaction is earmarked for the procedure. Dr. Satyanand reached the room and took his seat. He asked, “So, young psychiatrists, have you read the theory behind Narcoanalysis”? “Yes sir” promptly said Dr. Sridhar, “In Narcoanalysis we give intravenous injection of sedative drugs to produce a disinhibited state of mind, so that the patient becomes more communicative and has less emotional control.” “Very good, Dr. Sridhar” said Dr. Satyanand, “It is more certain to work than hypnosis and so, it gives more confidence to the clinician. Probably, you can obtain a better result with persuasion, without either hypnosis or drugs. And, like many other procedures, it is the treating doctor's level of confidence that is extremely important in successfully carrying out the procedure.” With these statements, Dr. Satyanand took a 0.5 g of amylobarbitone sodium and dissolved it in 5 ml of distilled water and started pushing it slowly intravenously. “How much slowly, Sir” asked Dr. Sridhar. “It should be at the rate of about 1 ml solution per minute.” And he instructed the patient to count backward from 20 to 0. “You must watch for appearance of drowsiness and disinhibition, you must stop pushing drug before there is serious disturbance in articulation” said Dr. Satyanand. As the desired state of mind reached, Dr. Satyanand started interviewing the patient with a low and polite voice and soon the desired information is obtained! He pointed to the students that “If the narcosis is pushed beyond this, rapport with the patient is lost and the desired objective cannot be achieved!”[4]

Dr. D. Satyanand was the superintendent of the HMD from 1957 to 1963. To understand the contribution of Dr. Satyanand, one has to understand little bit of history of psychoanalytic movement in India. In Calcutta, Girendra Shekhar Bose started Indian Psychoanalytical Society in the year 1922. Soon, it got affiliated to the International Psycho-analytical Association and with it the society came under full Freudian influence. Later, due to the influence of Lt. Col Owen Berkeley-Hill, British School of Psychoanalysis also began to have its influence in India. Dr. Satyanand initially received his analysis from Col Berkeley-Hill, and later came under the direct influence of Melanie Klein. “He started with orthodox Freudian views leavened by the British School and grafted on it concepts derived from Indian Mythology and Hindu philosophy, particularly the Bhagavad Gita.” His “Total Psychoanalysis” or “Soul Analysis” involved “analysis of contents and processes of all dimensions of personality”.[7],[8]

Dr. Satyanand expressed his views in a series of publications which, “on account of stylish opacity and semantic parataxis, are difficult reading. Hence, in spite of his prolific productivity, his influence on psychotherapy in India is not visible.”[7]


   Scene 6: Reception of Kazi Nazrul Islam, the Rebel Poet (“bidrohi Kobi”) of Bengal and Dr. R. B. Davis Top


Anand's next stoppage was to move back in time one more decade. Anand had an intense desire to meet Kazi Nazrul Islam. Anand remembered after he joined this institute, he searched for a memorabilia of Kazi Nazrul, but he did not found one![9],[10]

It is a sunny morning in the month of February in the year 1952. Superintendent of HMD Major RB Davis along with other staffs are eagerly waiting to receive a special guest as an inmate of this hospital. He is none other than the great Kazi Nazrul Islam, a Bengali poet, writer, musician, and revolutionary. He is ill for more than 10 years now. Some mysterious illness has taken away his power to speak, his power of expression, and his basic existence as a poet!

Nazrul stayed 4 months in CIP. There was no change in his clinical status and the mysterious disease remained as mysterious as ever. He was rumored to have neurosyphilis, slow poisoning by British regime, and so on. “Nazrul Treatment Society” sent the poet to London in 1953 and from there to Vienna. Cerebral angiography was done and a final diagnosis of “Pick's Disease” was given to him!

After the creation of Bangladesh, he was given the status of “National Poet” there. “His combined devotional music from Hinduism and Islam gave rise to a beautiful amalgam. He synchronized Bengali music with folk, classical, Islamic devotional songs, Persian lyrics, Bhajans and Kirtans, and gave rise to a melodious symphony which struck the chord of every Bengali's heart”.[9]

Besides Kazi Nazrul, CIP in its long-checkered career had seen many illustrious persons as its inmates. Noted among them was Dr. Vashishtha Narayan Singh, a NASA-returned mathematical genius. He taught in ISI Kolkata, IIT Kanpur, and TIFR Mumbai in early and mid-seventies before became a victim of schizophrenic illness. He received inpatient treatment during the major part of the 1980s at CIP. He absconded from home, while on a parole, to attend the last rites of his deceased father. Years later, he was retraced and brought back to his native village in Ara. In 2014, Bhupendra Narayan Mandal University in Madhepura, Bihar, acknowledged and honored his contribution in the field of mathematics by appointing him as a visiting guest faculty.

When Major R B Davis joined as superintendent of European Mental Hospital in the year 1946, he was a young man of only 35 years! Nobody, probably, had seen more changes to European Mental Hospital, than that happened during the tenure of Dr. Davis. India got independence from British on August 15, 1947. The hospital changed its name twice during his tenure: As “Inter-Provincial Hospital” in 1948 and subsequently to “HMD” in 1952. He was the founder secretary of IPS in 1946 and continued with the post till 1954. In 1955, he became the president of IPS. In the same year, he resigned from his job in HMD and started his private psychiatric hospital “Davis Institute of Neuropsychiatry.” He was only 44 years old then![10]

Dr. Davis was responsible for making the hospital a leading center for psychiatry in India at that time. He introduced the first electroencephalography in India, and he conducted the first neurosurgery in Ranchi along with army surgeons from the military hospital. He started modified electroconvulsive therapy and insulin coma treatment. He conducted trials of new drugs as soon as they were available. He started a pathology and radiology department. Patients and staffs had picnics and outings together and played games together. He was interested in teaching and many of the leading psychiatrists in the country were trained under him.[10]

Besides his interests in psychiatry, Dr. Davis was interested in gardening, farming, English literature, and Western Classical Music. He could speak English, French, Hindi, Bengali, and Urdu. He opted to become an Indian citizen in 1948 and was a great admirer of Gandhi.[10]

Before Dr. Satyanand took over the baton of CIP, Dr. L. P. Varma became the superintendent of HMD for a period of 2 years (March 1955 to April 1957). He was the first MD in Psychiatry passed out from an Indian University (Patna) in 1943. Official journal of IPS was started in 1949 (as Indian Journal of Neurology and Psychiatry). Dr. L. P. Varma edited three volumes of the journal from 1951 to 1954. It stopped publication after 1954 and was reborn in 1958 as the “Indian Journal of Psychiatry” under the editorship of Dr. L. P. Varma. He was the president of IPS in the year 1964.


   Scene 7: Report of Professor Mapother and Lt. Col Moore Taylor Top


Premier status of European Mental Hospital was, probably, for the first time questioned by none other than another Englishman, Professor E Mapother, who was instrumental in establishing Institute of Psychiatry in Maudsley Hospital in London, UK. In 1937, he visited few selected mental hospitals in India and submitted his report in 1938.[11]

“Professor Mapother rated the asylums in India on a grade of 'badness,' with only the European Mental Hospital in Ranchi and a native Mental Hospital in Bangalore had anything commendable. However, he wondered at the waste of money on the hospital for Europeans, established by Berkeley-Hill with much triumph, based on a concept of race that in practice is unreal, and does not correspond to education, mode of life, or any valid claim”.[11]

On the other hand, Professor Mapother commented that the mental hospital in Bangalore was a “monument to the vision and wisdom of all those responsible for the mental defectives in the East. The institution is almost unique among mental hospitals in India. It is quite evident that here modern methods of diagnosis and treatment are available and freely used”.[11]

Thus, the claim of Dr. Berkeley-Hill that “the miserable bear-garden I had taken charge of in October, 1919, had become the finest mental hospital in Asia, and a great deal finer than many mental hospitals in Europe” has been put to question within few years of his retirement, by one of his own countrymen!

We can only speculate the reasons behind such report by Professor Mapother. Understanding European and Indian psychiatry during that period, probably, will give us some hint regarding the reason behind such report. Two parallel schools of thought were prevailing in European psychiatry during the period between the 1st and 2nd World War: psychiatrists who practised “mainstream psychiatry” – standard teaching, training, and treatment in clinical psychiatry available then and psychiatrists who follow and practice “psychoanalysis” in addition to clinical psychiatry! Psychoanalysis was highly fashionable during those inter-war period, attracting much attention on the part of elite European and Indian societies.[8],[11]

European Mental Hospital was an important center in India where psychoanalysis was being practiced. Whereas, centers at Native Mental Hospital at Bangalore and Indian Mental Hospital at Ranchi were focusing more on medical treatment. Professor Mapother had more faith in “mainstream psychiatry” than “psychoanalytic treatment.” Probably, this was the reason why Mapother's report tilted in favor of Native Mental Hospital, Bangalore. One could only speculate what would have been the report of Professor Mapother, had he got the opportunity to visit the “Indian Mental Hospital,” Ranchi![8],[11]

Lt. Col Moore Taylor was the superintendent of European Hospital till 1946 after retirement of Col Berkeley-Hill. Moore Taylor was involved in another important event in Indian psychiatry-drafting “mental health report,” part of now famous “Bhore Committee Report” in 1946, which outlined the future course of action in relation to Mental Health policy in India.


   Scene 8: “hydrotherapy” Session and Lt. Col Owen Ar Berkeley-Hill Top


Anand boarded the time machine again and instructed the pilot to go to his final destination to meet Major Berkeley-Hill in his earlier days in European Mental Hospital.

It is a winter morning in the year 1925! A tall European doctor in an army uniform was standing and supervising a “Hydrotherapy” session. Yesterday only, a young patient was admitted in an acute excited state. He did not sleep the entire night and created a lot of disturbances for other inmates and ward staffs as well. After proper clinical assessment, doctor ordered for “Hydrotherapy” sessions. All necessary arrangements have, already, been done. Two ward boys, who are placed in charge of the patient, have already heated the water to an agreeable temperature and poured it into the specially designed bathtub meant for hydrotherapy. Doctor himself checked the temperature of the water and looked satisfied. He instructed the patient to be put into the bath and ordered to cover the entire body except the patient's head with a lid. Satisfied, as he is leaving the spot, he gave the instruction to check the warmth of water intermittently and change of water as and when necessary and to keep the patient in that state entire day. He ordered, “do not talk amongst yourselves and speak, only when the patient speaks first.” “Yes sir,” is the response from both the ward boys. A strict silence is, thus, maintained around the “hydrotherapy” site.[1],[8]

Army Major was none other than Lt. Col Owen AR Barkley-Hill, in his initial days as Major, who joined the European Lunatic Asylum as the new hospital superintendent on October 19, 1919, and continued till October 11, 1934. Major had an attractive personality, was witty, and talkative among friends and colleagues.[12]

His first reaction after coming to European Lunatic Asylum was that “it was not an asylum but a bear garden.” He went into a state of “impotent despair” following repeated failed attempts to improve the state of affairs of the asylum. Provincial Government of Bihar, under whose administration the asylum was running then, did not heed to his repeated request to improve the ground condition of the asylum. Exasperated Major managed a write-up in the influential newspaper “Statesman” from Calcutta.[1],[12]

Statesman published a leading article describing the asylum as “worse than a Kaffir's Krall.” The intended uproar led to investigations and finally to changes that Berkeley-Hill advocated. With financial support from Provincial Government and Central Government, he employed a large number of Indians to care for the patients.

By 1921, the staff consisted of 73 Indians, 13 Europeans, and one Anglo-Indian for 186 patients. Male:female ratio was 106:80. Among them, 73 (39.2%) had syphilis. Eighty-six 46.2% patients were diagnosed to have dementia precox.[13]

Treatment in Ranchi was designed primarily to induce feelings of comfort and relaxation. To achieve this, Col. Berkeley-Hill prepared a resort-like program offering rest (for at least 1 week initially), prolonged bathing (for patients who suffer from acute excitement), nutrition (with loss of weight corrected by special diet), occupational therapy, and exercise with outdoor games. Male and female patients were allowed to dine together at small tables. After about 8 months of residence, the patient consented to undergo psychoanalysis.[12],[13]

During his tenure, European Mental hospital was recognized by University of London as the first psychiatric teaching institute in India in 1922. Much has been written about Lt. Col Berkeley-Hill as a psychoanalyst. Ernst Jones considered Berkeley-Hill essays, “The anal-erotic factor in religion, philosophy and character of the Hindus,” “A short study of life and character of Mohammad,” and “Hind-Moslem unity” to be among the most significant.[12],[13]

Epilog

After meeting Lt. Col Berkely-Hill in his period, Dr. Anand decided to come back to the present. He got into the time machine and pressed the button to take him back….he got up from bed and realized that he was dreaming!

Anand wanted to have an impartial assessment on the importance of CIP in Indian psychiatric scenario and the contributions from its superintendents/directors vis-a-vis other eminent psychiatrists of those periods. An institute cannot be assessed in isolation, it can only be done in association with neighboring institutes and other institutes of prominence during those periods. He decided to study the history of neighboring Indian Mental Asylum (currently known as RINPAS) and Native Mental Hospital in Bangalore (currently known as NIMHANS).[14],[15],[16],[17],[18]

During Col Berkeley-Hill's time, Captain JE Dhunjibhoy, an Indian psychiatrist, was the superintendent of Indian Mental Asylum (RINPAS). He was in charge of the largest mental hospital in India (confining, on an average, 1300 patients). It was sad but true that Captain Dhunjibhoy and his Indian Mental Hospital always remained under the shadow of Col. Berkeley-Hill and his “European Mental Hospital.” The enduring marginalization of the Indian Mental Hospital and Dr. Dhunjibhoy was a legacy of colonial rule in India![14]

If it was a clear advantage “European Mental Hospital” prior to Indian independence, it was advantage “Native Mental Hospital, Bangalore,” during postindependence period!

Bangalore had the advantage of having Professor Mapother's report in its favor, being a capital city, Government of India's decision to make one premier institute in various fields and off-course long period of leadership of Professor M.V. Govindswamy as the Director of new All India Institute of Mental Health (NIMHANS). Decision of Dr. R. B. Davis to leave HMD by 1954 probably halted the desired progress of CIP in the early 1950s.

In an article on “History of psychiatry in India and Pakistan” in 1953, Dr. L. P. Varma wrote, “Berkeley-Hill was a pioneer in psychiatry and he has made the hospital (European) as one of the best in the world. It is a pride of our country and the British administration in India”.[18] But, postindependence period, Ranchi was no more a capital city and no more a choice location in the eyes of political and bureaucratic power brokers and decision-makers in Delhi. Probably, these were the prime reasons that CIP gradually lost its eminence in Indian psychiatric scenario, over last few decades, even though it had the services of some excellent psychiatrists/administrators as its superintendent/director.

With the arrival of new millennium, Dr. Anand believes, the wheel of fortune is again turning in favor of this institute. Creation of state of Jharkhand has led to Ranchi becoming a state capital, and there is extensive all-round growth of the city. Ranchi has been connected extensively by rail, road, and air to Delhi and other state capitals. Of late, more funds have been pumped into CIP, and there is a spurt of developmental activities as evidenced by the erection of many new buildings and commissioning of many new and advanced machines. But with every change, there comes some skepticism also. Anand recalled reading an article by Dr. Sayeed Akhtar, another great alumnus of CIP, where he beautifully summarizes some of the dilemma faced by an old alumnus. “There is abundance of manpower engaged in clinical and research work, sophisticated gadgets and computers are aplenty, nursing personnel have increased to almost 200, the CIP life is beaming. But there appears to be something missing, is it the lack of basic human values, empathy or lack of basic trust or something else, is difficult to pin-point”.[2]

Dr. Anand believes the need of the hour is to convert CIP into an autonomous institute in line with NIMHANS. At the end of this fictional journey, he is convinced that we are standing at another crossroad in the history of CIP and the day is not far off when CIP will enter into another “golden era” in its checkered history.

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Conflicts of interest

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Correspondence Address:
Dr. Tapas Kumar Aich
Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh
India
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DOI: 10.4103/psychiatry.IndianJPsychiatry_443_17

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