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A History of Indian Psychiatry

In this article, S. Haque Nizamie and Nishant Goyal detail the ways the discipline of psychiatry has developed over centuries in India starting from the Vedic period to the present day.

A number of ancient Indian texts, as it turns out, provide mention and even detailed descriptions of psychological disorders, such as schizophrenia - in fact Nizamie and Goyal state that Indian texts contain the earliest mentions of mental illness. This is quite ironic considering the lack of awareness regarding mental health and illness in the country today.

Of course, some of these mentions were apparently colored by superstition - for instance, the Atharva Veda suggests that mental illness could be a result of divine curses, a belief that was also paralleled in Ancient Rome. However, it seems that for the most part, the ancient Indian outlook on mental illness was rational, with texts such as the Unani describing types and subtypes of disorders.

Centuries later, under the rule of the legendary Emperor Ashoka, after whom this university as named, there is evidence of the existence of hospitals dedicated to treating the mentally ill. Similarly, there also appear to have been asylums under Mohammed Khilji, although there was little development in the field of psychiatry itself during the Mughal reign.

The British Empire, on the other hand, witnessed a great deal of growth. The 1700s brought with them the beginnings of the East India Company, and with it, political instability. It was around this time that mental asylums began to develop in the three Presidencies.  These are perhaps the more overlooked byproducts of colonialism in the country.

These facilities mirrored in many ways the British model and practices, with supervision from . They employed a number of treatment and therapy methods, including opium and, in some cases, music therapy. However, it must be noted that the earliest of these facilities were intended for and accessible to only Englishmen and sepoys, and the rest of the population was left to . The discrepancy is telling, but not surprising in the least.

Asylums continued to develop over the mid-colonial period. One of the most important events that took place during this time was the Lunacy Act, passed in 1845, which - among other things - elevated the status of mentally ill people to 'patients'. This is an important provision, because in giving these people a clinical, objective label relatively (if not entirely) free of negative connotations, the Act undoubtedly reflected and propagated a reduction in the stigma associated with mental illness, instead legitimizing them as medical disorders. The Act also made it mandatory for asylums to be legally registered and for plans for asylums to be inspected by 'Commissioners with Lunacy'.
In addition to the Act, this period also saw the introduction of new treatments (again imported from the West) such as moral management and the use of new drugs, like chloral hydrate. However, the focus was still not so much on curing the patients as on controlling them.

The Central Institute for Psychiatry, headed by Colonel Owen A. R. Berkeley-Hill, can be seen as a pioneer in psychiatry for the number and range of initiatives taken by them, particularly circa 1914 onwards. Berkeley-Hill persuaded authorities to change the term from 'asylum' to 'hospital' in 1920, further legitimizing and de-stigmatizing mental illness. The CIP also launched Occupational Therapy Unit and innovative service programs, raised public interest in the mental hygiene movement, and pioneered hydrotherapy in 1923 - in fact Berkeley-Hill also co-founded the Indian Association for Mental Hygiene in Ranchi. This was where the focus shifted to include preventative measures in psychiatry.

Higher education in psychiatry started to gain more currency, starting once again by the CIP, who initiated a University of London-affiliated diploma course in Psychological Medicine in 1922. The CIP had also started a library dedicated to mental health in 1918. In the years that followed, an Indian became a psychology professor, a child guidance clinic was established, the first psychiatric outpatient service was started, and much more.

The Health and Development Committee, or the Bhore Committee, reported in 1946 a number of inadequacies and suggested several measures, including a greater focus on training of personnel and modernization of hospitals as well as their attachment to medical colleges. This is a landmark report, for it set in place many of the most fundamental aspects of modern psychiatric medicine. One of the most well known psychiatric institutions, the National Institute on Mental Health and Neurosciences in Bangalore, was created (starting as the All India Institute of Mental Health) in 1974 because of its recommendations.

With Independence dawned a period of unprecedented growth in psychiatry.

Initially, independent India focused more on improving existing hospitals, promoting outpatient care, and on creating General Hospital Psychiatric Units than on creating new ones, although a few new hospitals were also started. A large number of developments in these institutes occurred post-1950, particularly in the growth and development of GHPUs.  In the 1960s, day hospitals were conceived of, and institutions began offering a range of specialized services, such as adolescent clinics and geriatric OPDs. In 1949, CIP founded the nation's first Clinical Psychology Laboratory as part of its Department of Clinical Psychology.
But there's more: the founding of the All India Institute of Mental Health (the future NIMHANS) in 1954.
But there's more: the first training program for Primary Health Care, and various other training programs all over India. A project on severe mental morbidity conducted at multiple locations throughout the country, from Bangalore to Calcutta. There were even attempts to integrate more traditional Indian elements into healthcare, such as yoga.
And there's more. The first drafts of the National Mental Health program. The Mental Health Act of India (which was recently revised).

Even when this spate of development was broken, briefly, by the Erawadi tragedy, in which 26 patients of a hospital in Tamil Nadu were killed in a fire, the people rallied and ushered in more reforms, and mental health services were 'revamped' throughout the country. Indian research and literature in the fields psychology, psychiatry, and neuroscience all boomed from 1949 and into the 1960s, with a resurgence in the 1980s in diverse areas, although some areas like biological psychology remain "woefully neglected".

It cannot be denied that India still faces issues when it comes to mental healthcare, awareness and research regarding it. But it is worth noting that the rate of growth and development of psychiatry has been increasing exponentially right from its first seeds in ancient India. One can only hope that the same will continue into our future. 

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