About the collection
Official asylum records in the Medical History of British India Mental Health collection highlight the colonial context of psychiatry in British India and colonial ideas about the native body.
The rise of the asylum
In Britain, legislature for the building of asylums began in the 19th century:
- Lunacy Act 1808
- County Asylums Act 1828
- Lunacy Act 1845.
The rise of capitalism, urbanisation, and the power and prestige of the medical community assisted the development of the asylum. Before the 19th century, those deemed ‘lunatics’ were not usually institutionalised, but were cared for by family, friends, or parishes. In other cases they were housed with the poor and the criminals.
Changes after the Indian Rebellion
While there existed houses for the detention of mentally ill sepoys in India, the situation was much the same, and did not change significantly after the 1857 Indian rebellion.
The rebellion prompted Britain to take a more direct role in India and its institutions. This included medicine, and by extension psychiatry, a field that was gaining respectability in the west.
The first Lunacy Act in India was enforced in 1858 and throughout the latter half of the 19th century asylums for both Europeans and natives were established throughout British India.
The Mental Health collection depicts this expansion, allowing evaluation of the quality of asylum care and conditions from 1867 to 1948. Colonial doctors' explanations for the improvement or deterioration of asylum conditions are also offered in the reports.
Labelling mental illness
The epidemiology of mental illness during the British rule of India can be mapped in the statistical tables which identify and categorise mental illness.
The regular addition to physical causes of insanity such as small-pox, venereal disease and typhoid up to the early 1900s demonstrates that, as some historians have argued, there was more focus on physical conditions than mental. The inclusion of masturbation, syphilis and witchcraft as causes of insanity in the Bengal reports uncovers some of the British cultural and social perceptions of madness and of their colonial subjects.
From the 1860s until 1912, types of insanity appear as various forms of mania and dementia, melancholia and imbecility. From 1912 types and causes were merged, but retained many physical categories, and still listed alcohol and cannabis as causes of mental illness.
The role of asylums in India
Reports offer the user the opportunity to view and explore colonial rhetoric concerning the role of the asylum and reveal that it served both as a mechanism for social control and as a therapeutic place.
Colonial personnel wished to civilise or constrain the indigenous population, frequently admitting members of wandering gangs and those accused of 'mischief'. The testing of new therapies on patients by staff can be viewed as exploitative and motivated by the desire for professional recognition.
Yet the reports reveal that asylums actively encouraged improvement and many emphasise the intention to alleviate and understand patients' suffering whether native or European. Notably, disparaging descriptions of the local population evident in other collections of the Medical History of British India are missing from references to asylum patients and their behaviour.
British efforts and motivation to provide asylum care based on the increasingly popular, more humane 'moral management' system can be examined in the Mental Health collection reports.
Authors of reports emphasise the need to treat patients kindly, to maintain cleanliness and to provide a good diet alongside occupational therapy. Treatment within the asylums represented the norms and values of 19th and early 20th-century Britain and the desire to transplant these into colonial India.
Occupational therapy introduced a ‘normal’ working routine to the patients and was the primary method of trying to improve the patients' wellbeing.
The reports describe patients working in the asylum grounds and producing goods such as matting, coir and oil. Statistical tables show the revenue from 'lunatic labour'. The British idea of a sane, healthy, functioning person was one that involved submissiveness, obedience, self-regulation, and productivity.
Notably, there was a gendered division of the work in the asylums – female patients performed gardening tasks while buildings were maintained by men. The reports allow us to explore the extent to which British, western capitalist values were communicated through the treatment of the patients and how these values were subsequently categorised as normal.
Restraints and rewards
The abuse of patients by staff is deemed intolerable, with staff being dismissed for such offences. Mechanical restraint of 'excited' and unruly patients, such as belts, sheets, bags and hand cuffs were used in some asylums – for example, Dullunda and Patna – but in others it was fervently discouraged.
'Moral treatment' – including sedation with drugs – which aimed at keeping patients docile and disciplined reduced the need for mechanical restraint, although the reports show that there were debates about the appropriateness of both.
Parties, lantern slides, outings and fireworks were also deemed good for the patients' wellbeing and mood, particularly those who were usually seen as 'apathetic'. In some institutions patients made pets from local wildlife and were rewarded with outings.
Drug treatment included digitalis, hypodermic injections of morphia, hydrocyanic acid for mania and atropine, bromide and sodium dilantin for epileptic seizures. In the 1930s chemical treatments such as cardiazol 'convulsion' and insulin 'shock' or 'coma' therapy gained popularity in treating schizophrenia. Colonial doctors travelled to other countries and corresponded with others, trialling drugs and sharing results, as documented in Ranchi Indian Mental Hospital, Bihar.
Descriptions of 'nitrogen gas inhalation' and 'prolonged continuous sleep treatment', which were in vogue in Canada and America respectively, allow analysis of the spread and success of emerging therapies. By 1939 Electric Convulsion Therapy (ECT) from Italy was viewed as a cheaper replacement for cardiazol convulsion therapy in India, around the same time as it was in Britain.
Health link to asylum conditions
Morbidity and mortality rates within the asylums can be tracked from tabular data, providing a view of patient health over time and relating to changing conditions in the asylums. Government medical personnel consider how best to maintain a sanitary environment and tackle the problem of overcrowding – for example, dry-earthing and building extensions.
Patients and staff
Asylum patients were primarily from a poor social background, and of a low caste. Statistics and returns in the reports show gender, race, class, occupation and ethnicity of those admitted. Most asylums housed natives only, although some asylums were built exclusively to shelter Europeans, such as Bhowinapore in Bengal.
Reports up to the late 1870s list asylum patients by name, providing information on native and European ancestors for genealogists.
Europeans deemed mentally ill, including 'military insanes', were quickly despatched to Britain and the reports show that they were invalided or sent to private or public asylums.
Historians have argued that this measure was taken to preserve the image of the colonial rulers as healthy, elite, and superior. Housing Europeans in the asylums of India could risk revealing weakness to the natives, compromising the perception of the British as a superior race, thus threatening the colonial order.
European and native staff
The Indian asylums were staffed by both Europeans and natives. As in Britain, asylum work was unpopular. Despite the difficulty in finding people willing to work in the asylums, Indians were excluded from all but the lowest of posts.
The records contain praise for the native staffs, as well as complaints, most often about the inefficiency of the wards – accompanied, however, by recognition that the pay for these already undesirable positions was so low as to provide no motivation for a good work ethic.
The staff as a whole had little formal training in psychiatry, and psychiatry itself was still in the early stages of understanding mental illness.
It was common practice, for example, to incarcerate those with epilepsy as insane. However, following the Indian Lunacy Act of 1912 the emphasis is placed, for example, in Agra and Oudh, on offering advice and treatment.
From 'lunatics' to 'patients'
From 1920s when the term 'lunatic asylum' is replaced with 'mental hospital' the reports reflect the changes in psychiatry occurring in Britain where the purpose of the asylum shifted from refuge to hospital. More specialist staff are employed and 'lunatics' become 'patients'.
Yet, as late as 1945, the Assam Mental Hospital in Tezpur is described as in 'a mixed state of a prison, an asylum and a mental home'.
Cannabis and insanity
Diagnosis of the insane, as seen in the Mental Health collection, reflects early and incomplete understandings of mental illness. The asylum records distinguish between moral and physical causes of insanity.
The most frequently listed physical cause was the abuse of intoxicating drugs – specifically hemp, as J C Penny, Superintendent of the Delhi lunatic asylum, stated in 1872: 'Insanity or permanent disorder of the mind is a result of the evil habit of over-indulgence in this narcotic.'
However, the tendency to pinpoint cannabis as the main cause of insanity in Indian asylums was later revealed as flawed. The Indian Hemp Drugs Commission 1893/1894 ruled that asylums statistics were unreliable, with drug abuse being used as the default cause of insanity by persons – usually policemen – unqualified in psychiatry.
It was also during this period that ideas of addiction developed and became medicalised – for example, 'Cannabis Indica Psychosis' is listed as a mental disease from the late 1920s until 1951.
While excessive use of cannabis was considered dangerous, the idea that moderate use caused insanity was increasingly refuted. Furthermore, the asylum reports show that cannabis and opium were actually used on occasion in the asylums for the purpose of calming patients.