Psychiatry in India and Pakistan
- Reference type:
Journal Article
- Record-number:
18331
- Author:
Bennet, E. A.
- Year:
1948
- Title:
Psychiatry in India and Pakistan
- Journal:
Ment Health (Lond)
- Volume:
8
- Issue:
1
- Pages:
2-5
- Epub-Date:
1948/08/01
- Date:
Aug
- Short-title:
Psychiatry in India and Pakistan
- ISSN:
0025-9632 (Print) 0025-9632
- PMCID:
PMC5078316
- Accession-number:
18885356
- Keywords:
Humans, India, Pakistan, Psychiatry, PSYCHIATRY/India and Pakistan
- Notes:
Bennet, e a Journal Article Ment Health (Lond). 1948 Aug;8(1):2-5.
- URL:
- Language:
eng
The partition of India has thrown upon the Governments of the 2 Dominions responsibilities of such urgency that time must elapse before plans for the health of the population can take shape. When these plans come to be formulated the question of priorities is sure to arise. Mental illness did not arouse much medical enthusiasm in India in days gone by; and there (as elsewhere) other forms of sickness were (and still are) thought to be of more importance. Tuberculosis and leprosy, eg, present special problems. The provision of hospital accommodation for patients with these complaints is inadequate.
Expert calculation revealed that in 1941 there were 20?000?000 persons in India ” so blind as to be unable to perform any work for which eyesight is essential The general hospitals are few and even in the large towns there is a shortage of beds. It would be rash, therefore, to expect any rapid change in the conditions for the mentally afflicted. There are, however, indications that in each Dominion the needs of psychiatric patients have not been overlooked. The proposal to build a mental hospital near Calcutta will fill a long-felt need. The Government of Pakistan has laid considerable emphasis upon the teaching of psychiatry in the reorganization of the medical services. An ambitious suggestion to establish Chairs in Psychiatry at the medical teaching centres in Lahore, Karachi and Dacca (in Eastern Pakistan) has been considered. Through the Sind Public Service Commission a notice was issued inviting applications for the Professorship of Psychiatry in Karachi. An appointment to this post was about to be made when financial considerations caused a postponement. Psychiatric outpatient clinics are being opened at some general hospitals in which there will be psychiatric wards. This policy is in accordance with modern trends and reflects credit upon those directing the medical arrangements in Pakistan.
The purpose of this brief article is to sketch the position of psychiatry in India before the recent war, to indicate the impetus given to psychiatry under the pressure of war conditions and to point out some present-day needs and possibilities. I
Hospital accommodation in India and in Pakistan for psychiatric patients requiring institutional care and treatment has been considerably below requirements for many years. On a rough computation there is one bed for every 30,000 people. Most of the hospitals are old fashioned and were intended merely for custodial purposes. In certain places a portion of the jail has been adapted for the reception of patients and several other hospitals are
distinctly jail-like. Mechanical restraint was routine practice in some provincial civil mental hospitals as recently as 1945 and even shackles, chains and handcuffs, while unusual, were by no means unknown. A few hospitals are well appointed and fairly adequately staffed. The Punjab Mental Hospital in Lahore (800 beds) contains some well-designed modern wards. The 2 hospitals at Ranchi and the Mysore State Hospital, near Bangalore, stand out as examples of what may yet be achieved elsewhere. The Ranchi European Mental Hospital?now to be called the InterProvincial Mental Hospital?provides accommodation and treatment facilities similar to those found in many hospitals in Europe.
The standard of nursing care in the 3 hospitals just mentioned is good. Elsewhere in the 2 Dominions it is very far from satisfactory. For the most part trained nurses are unobtainable so that untrained male and female attendants must be used and often there are not enough of them. The nursing conditions in the usually overcrowded wards are consequently poor. The work is arduous and unsatisfying, so younger men and women are not drawn to it.
Taking all these matters into consideration it is understandable that young Indian doctors were not attracted to the study of psychiatry. Then again the fear of mental illness is more conscious among Indians than among Europeans.
This is a somewhat grim picture. In prewar India, life moved slowly and the administrative machinery, central and provincial, was anything but dynamic?at any rate in medical matters. In 1912 the Indian Lunacy Act became law and it is still the statute under which the mental hospitals work. During the intervening 44 years, psychiatry has advanced to a remarkable extent. The Mental Deficiency Act of 1913 and the amending Act of 1927 are the chief statutes under which mental defectives may be dealt with in Britain. There is nothing corresponding to these Acts in India and Pakistan. Consequently mental defectives may only be detained in institutions under the provisions of the now outmoded Act of 1912. Before the partition of India psychiatrists in that country were well aware of the need for an Act under which mental defectives could be treated in special colonies. At least 2 suggested Mental Deficiency Acts were drafted by experienced psychiatrists, but sad to relate, they did not receive official sanction or commendation.
II The outbreak of the Second World War led in due course to an expansion of the Indian Army and the Royal Indian Air Force, while the British units already in India were supplemented by a continuous flow of fresh units of the Army and RAF Everywhere hospital accommodation had to be expanded by new construction. In many places the old Indian Military Hospitals and British Military Hospitals were almost submerged in the new buildings which sprang up around them; and dozens of entirely new hospital centres were created. Some idea of the vastness of the medical services in India during the war will be gained when we recall that in one area alone (Poona) there were more medical officers than in the prewar RAMC
The development of the medical services was at first gradual and it was not till 1942 that it became evident that the psychiatric needs of the Army were not being met. At that time there were 6 psychiatrists in the Army in India and some of them were doing general duty as well as psychiatry. By 1945 the number of whole-time psychiatrists had risen to almost one hundred. This rapid development was accompanied by the provision of over 3 thousand beds for psychiatric patients. The policy was to link the treatment of these patients with that of the general hospitals. A ” standard psychiatric ward” of twenty-five beds was designed and one or more of these units was added to the smaller general hospitals according to local needs. In addition large psychiatric centres were formed in base areas with accommodation for several hundred patients. These proved insufficient and in 1945 a psychiatric hospital of 1,200 beds was opened. Toward the end of the war there were between forty and fifty psychiatric centres in India, Burma and Ceylon. The supply of psychiatrists was always less than the demand. It was easier to build wards than to obtain trained staff to run them. Scattered throughout the Army were many younger medical officers with varying civil experience in psychiatry. Some were appointed graded specialists while others required further experience. Training courses were arranged and systematic teaching was given. No claim is made that the training produced fully competent psychiatrists. But it did provide a fairly adequate background for carrying out specific tasks in the relatively homogeneous group of Service patients. The training of these officers was the responsibility of experienced psychiatrists who?with 2 or 3 exceptions ?came from the U.K. The trainees were Indian and British and they worked together with the greatest goodwill.
The geographical formation of the country on the borders of India, Assam and Burma led to Divisions operating alone, so it became necessary to have Divisional Psychiatrists. This indeed was the only theatre of war in which each Division had its own psychiatrist. Several of these officers were Indians who had ” graduated ” in the training centres in India. Before the war there were no Indian Mental Nursing Orderlies. Five training centres were established and a large number of nursing orderlies, trained by Indian Psychiatrists, were eventually graded as M.N.Os. The method of selecting candidates for commissions in the Army in India was changed in 1943.
Previously the responsibility of selection lay with an Interviewing Board. In February 1943 the first batch of aspirants to commissions, thirty-six in number, arrived in Dehra Dun to be tested by the method of selection which had come into use in the British Isles. The new machinery for selection was at first rather cumbersome, being the joint effort of the previous Central Interviewing Board and a new Selection Board framed on the pattern of the War Office Selection Boards. A few months later a highly trained team from England took over this work and expanded it. Psychological tests designed for Europeans were of little value with Indians and some entirely new tests, appropriate to the concepts of Indian soldiers, were introduced. Selection methods were also used in the Women’s Services with satisfactory results. The advance made by the use of these methods was striking and in due course a Directorate for the Selection of Personnel was set up. Later the ICS adopted an analogous method for selecting candidates for the civil service?a tribute to those responsible for building up the intricate machinery of Selection. Ill
The facts just mentioned are of more than historical interest. They have relevance to psychiatry in India and Pakistan today. The staffing of the psychiatric centres and of the Selection Boards was shared by Indian and British psychiatrists and psychologists. Some of these, officers of the old IMS and the IAMC, are still in the armies of India and Pakistan, while others have returned to civilian practice. Throughout the 2 Dominions, therefore, are many psychiatrists with experience in the use of modern methods?a much larger number than ever before*. The majority are younger men well able to accept responsibility. Not all are now practising as psychiatrists. Although the need for psychiatrists was great, the opportunities for clinical work were restricted and a few have taken up general practice. The period of political transition slowed up the plans for development of the psychiatric services. But let us hope this is temporary and that development has not been halted. Indeed several ex-army and present army psychiatrists have been sent at the expense of their respective Governments to pursue postgraduate studies in England. The Indian Psychiatric Society was started in January 1947 with a membership of forty-two practising psychiatrists. The Council of the Society met in October 1947?that is after the partition of India?and resolved that the political division of the country should not interfere with the integrity of the Society and that psychiatrists from both Dominions should be eligible for membership. This decision is in keeping with the best traditions. Hitherto psychiatrists in civil practice have worked in relative isolation. Now it will be possible to share the administrative and clinical experience of others; and to lay down standards of training for psychiatrists and mental nurses. The Council of the Society has expressed its willingness to co-operate in the drafting of new legislation with provision for mental defectives and delinquents and to maintain the status of psychiatry at a high level. A lack of vision in the past has resulted in such anomalies as the admission of criminal patients to the wards of mental hospitals and the classification of ordinary patients as ” non-criminal On this and other related matters the Council of the Indian Psychiatric Society has already made recommendations.
During the war the Government of India set up a Commission to report upon the civil mental hospitals and upon the psychiatric needs of the community. The findings of this Commission (The Bhore Report) is an important document containing, as it does, comments upon present conditions and recommendations for improvement. Psychiatrists in India and Pakistan would do well to study the Report of Postwar Educational Development in India, issued in 1944 by the Bureau of Education, India. In it will be found a mass of carefully sifted facts which have a direct bearing upon the future of mental health in the 2 Dominions. The first paragraph in this Report reads as follows:
” In every civilized country in the world, whether occidental or oriental, which aspires to be regarded as civilized, with the exception of India, the need for a national system of education for both boys and girls which will provide the minimum preparation for citizenship has now been accepted. In India the need for similar provision has been under discussion for many years, but that no substantial progress has yet been made is obvious from the fact that over 85%, of her population is still illiterate.”
The preventive aspects of psychiatry must be linked with a comprehensive educational policy. In 1944 there were only 2 institutions in India for the education of mentally handicapped children. The establishment of many special schools for these children is essential.
“Apart from the provision of special schools, it will be necessary to take the assistance of specialist medical officers including psychiatrists, educational psychologists and social workers experienced in mental welfare, in dealing with these cases. For this purpose specialist doctors may be associated with the school medical service at least for parttime work. Social workers will be able to seek and remedy environmental causes which contribute to the condition of the child, both at home and outside it.”?Report on Postwar Education in India, p. 56.
A Child Guidance Clinic was opened in Bombay several years ago and might well be taken as a modeL Possibly other Child Guidance units have been established since. There is certainly a need for them.
No one will underestimate the magnitude and importance of the task presented in building up a satisfactory mental health service in India and Pakistan. Frustrations will be many and at times the burden will seem almost too heavy. A difficult but necessary step will be to educate public and official opinion. The relationship between mental disability and the religious, social, economic and educational environment of children and adolescents is at present unknown. Fortified with information on such matters it would be possible to discuss the principles of health with conviction. To cure and to alleviate mental ailment is commendable. To observe and to change the conditions in which it multiplies is a demanding and rewarding obligation which will provide our colleagues in India and Pakistan with an objective worthy of their zeal.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.