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Walk down the memory lane!!!

2018; Medknow; Volume: 60; Issue: 6 Linguagem: Inglês

10.4103/0019-5545.224322

1998-3794

TS Sathyanarayana Rao,

History is not just the past. It gives us an insight into our culture thereby increasing awareness and understanding. Mental Health has always been a part of Indian culture. The Vedic India has literature mentioning the theory of unity of body and soul. It also emphasizes on how to deal with health and mental health problems in a psychosomatic way.[1] All religions have mentioned about their concern about the mentally ill and their families. In the early 8th century, the medieval Islamic world rulers built the first psychiatric hospital in Baghdad (705 AD) followed by hospitals built at Fes and Cairo.[2] The Indian epics, the Ramayana and the Mahabharata made several quotes and descriptions about the disturbed states of mind and means of coping with them at times of distress. Lord Krishna who advised Arjuna in the Bhagavad Gita is a classical example of crisis intervention psychotherapy.[34] The history of psychiatry in India has witnessed a vast and rapid growth over the centuries. Mental illness was believed to be a consequence of sin and witchcraft and the mentally ill were chained in jails and asylums. In the due course with the study of psychoanalysis, etiology of psychiatric disorders was explained. The development of community psychiatry also paved the way for an orderly approach to the mentally ill.[5] Historical evidence from the pre-colonial literature says that modern medicine and modern psychiatric hospitals were first brought to India by Portuguese during the seventeenth century in Goa. The documentary evidences are not strong enough to substantiate the claims.[6] The need to establish lunatic asylums became more acute for the British Crown, first to treat and manage Englishmen who became "insane" during the war and Indian 'sepoyees' employed by the British East India Company.[7] In 1784, Warren Hastings, who was the first Governor General introduced the 'Pitts India Bill.' According to this the activities of the Government of the East India Company came under the direction of a "Board of Control." Systematic reforms and actions for the welfare were taken during Lord Cornwallis (1786-93) rule.[8] During his rule the first mental hospital was established at Calcutta. This is recorded in the proceedings of Calcutta Medical Board on April 3, 1787, which became the reference point of inception of colonial influence on development of psychiatric care in India.[9] Mental hospitals (or asylums as they were called) in India were greatly influenced by British psychiatry and catered mostly to European soldiers posted in India at that time. It was the efforts of Surgeon Vallentine Conolly who laid the foundation for the first mental hospital in South India at Kilpauk, Madras in 1794. 1858-1918 known as the mid colonial period witnessed a steady growth in the development of mental asylums. This period was significant for the enactment of the first Lunacy Act (also called Act No. 36) in the year 1858.[10] New asylums saw light at Patna, Dacca, Calcutta, Waltair, Trichinapally, Colaba, Poona, Dharwar, Ahmedabad, Ratnagiri, Hyderabad (Sind), Jabalpur, Banaras, Agra and Bareilly.[11] It was Col Owen Berkeley hill and his farsightedness and persistence, that made the institution at Ranchi (now known as the Central Institute of Psychiatry), a unique centre in India at that time. Innovative service programs were initiated at the Central Institute of Psychiatry (CIP) in 1922. This included psychiatric rehabilitation programs for the betterment of the patients. CIP was one of the first centers outside Europe to start Cardiazol-induced seizure treatment in 1938, Electroconvulsive Therapy (ECT) in 1943 and Psychosurgery in 1947. There was a surge in the use of medications with the advent of Rauwolfia extracts in the form of Santina, Serpasil and Meralfen. These were also used for treating psychotic conditions in late 1940s. In the year 1922, CIP got affiliation from the University of London to start Diploma in Psychological Medicine.[12] Till 1933, the patients with mental illness were given treatment only on an inpatient basis. As a precursor to the present-day general hospital units, it was the efforts of Ghirinder Shekhar Bose in 1933 at R G Kar Medical College, Calcutta where psychiatric patients were seen on an outpatient basis.[13] Thus, there was a surge of such units with Masani opening one at JJ Hospital, Bombay in 1938 and Dhunjibhoy opening one day weekly clinic at Prince of Wales Medical College (now Patna Medical College) in 1939.[14] With the suggestion of The Bhore Committee modernization and improvisation of mental health units were carried out extensively in India. The formative years in the independent India laid emphasis upon improving conditions in existing hospitals. At the same time, it encouraged doctors to deliver more of outpatient care through these units. New mental hospitals, notably at Delhi, Jaipur, Kottayam and Bengal, were added. Mid-1950 witnessed rapid development in the spread of GHPUs in India. Dutta Ray started a psychiatric outpatient service by 1957 at Irwin Hospital (now G.B. Pant Hospital), in New Delhi. In 1958, N.N. Wig started the first GHPU at Medical College, Lucknow, with both in-patient and out-patient psychiatric services and a teaching program as part of the Department of Medicine. A similar unit was started by Neki at Medical College, Amritsar a few months later. Over the next 25 years most of the teaching hospitals and major general hospitals in the private or government sector had GHPUs which were managed by emerging mental health professionals joining services after completion of their post graduation in psychiatry[15] The Bhore committee sanctioned to set up the All India Institute of Mental Health in 1954, which became the National Institute of Mental Health and Neurosciences (NIMHANS) in 1974 at Bangalore. The first training program for Primary Health Care was started in 1978-79. It was the aim of the health care facilities to battle the stigma and widen the social network of patients. This was regarded as the vital element of a successful rehabilitation programme. During the last 50 years mental health activities have moved from care of the mentally ill to include prevention and promotion of mental health. Keeping with the reforms in community psychiatry, the first psychiatric mental health camp in India was organized in 1972, at Bagalkot, a taluk of Mysore. With the collaboration of mental health, primary health care has led to a major shift from the concept of custodial care to one that focuses on care and treatment. There is still a huge gap between the rhetoric of this new policy and its implementation. Mental hospitals, with all their inherent flaws and drawbacks, are powerful institutions for the proper care of a subset of mentally ill persons, especially those with severe forms of illness and poor familial/social supports.[1] This special supplement of IJP on Mental Hospitals in India takes a sneak peek into the ups and downs faced over time to establish the modern powerful institutes of psychiatry in India. IJP and the Editorial team is grateful to the guest editors for this accomplishment and the meticulous job done.