Houses of Madness is an intriguing analysis of the history of mental asylums in nineteenth-century Bengal. It explores these institutions through several phases of their development, which involved changed not only in medical treatment and its interpretation of the mentally challenged, but also in the social composition of and the spatial distribution within mental institution. By locating the asylums both socially and geographically, it explains how mental illness was defined within these confines.
The book compares the medical practices in India and England and shows changing definitions of ‘insanity’ led to changes in the social composition of asylum inmates. Through a narration of the inmates’ daily life inside the asylums of colonial Bengal, Debjani labour in asylums and how male and female insanity were defined differently. These questions were directly related to and also resulted in the development of mental illness, Which ranged from the medical and moral to physical and mechanical restraints.
Debjani Das is Assistant Professor, Department of History, Vidyasagar University, West Bengal, India. She work on the social history of medicine in colonial India.
THIS ADVERTISEMENT IN A NEWSPAPER was published by the Government of India along with a week-long schedule of mental illness awareness campaigns. Its various activities included painting competitions, poster exhibitions, and street plays highlighting issues surrounding mental illness and discussions on 'identification and management of common mental diseases'. This showed the government's initiative to address mental illness and also to make its citizens aware of the malady, which is curable. Also, by publicizing the event, the government made an effort to break the taboo associated with mental illnesses in India. It reached out to the maximum number of people through several programmes based on community engagements. It assured the public that mental illness was curable like any other disease. Such an awareness campaign, therefore, highlighted the beneficial measures adopted by the government to address issues of mental health. It also showed the need to control and curb problems related to it. In the present day, mental illness is a cause of alarm as many people, both in developed and developing countries, are increasingly being diagnosed with the problem. In post-Independence India, issues of mental health were addressed not only in mental hospitals or psychiatric institutions, but also through several non-governmental organizations; for instance, in recent years, two very significant non- governmental organizations working on community mental health problems are The Banyan Tree in Chennai and Iswar Sankalpa in Kolkata. In the treatment of mental illness, the difference between the functioning of a government-run institution and a non-governmental organization is that while the former particularly limits itself to the treatment of patients once they are admitted, the latter engages itself more with the community at large. In doing so, these organizations try to reach out to the community, take initiatives to locate homeless persons suffering from mental illnesses, admit them at their treatment shelters, and at the end of the treatment regime, not only take steps to return the patients to their families but also very effectively continue with their post-treatment care. Mental patients are admitted into such homes or shelters either by their family members or by the police. The government's engagement with the issue and the gradual involvement of non-governmental organizations emphasize the relevance and need for awareness of mental illness even in the present day.
While the Indian government of the twenty-first century attempted to bring mental illness to public attention by putting an advertisement in a local newspaper, the authorities in the nineteenth century kept it a private affair within the closed walls of asylums. Though the present-day government makes an effort not to associate mental illness with any taboo or shame, but to recognize it as a disease that is curable if treated on time, the colonial government tried to cover up the subject as it not only conceived mental illness as a matter of pity and hopelessness but also did not recognize it as a curable disease until the end of the nineteenth century.
'Insane hospitals' or 'lunatic asylums' were terms used in medical records of the nineteenth century to define institutions where mentally ill individuals were confined. Patients were admitted into those institutions either by their family members, friends, acquaintances, or by the police, but always under the supervision of the Magistrate of the state. A look into the period reveals various attempts by medical officers of both the East India Company and the colonial government to understand mental illness. The nineteenth century witnessed the evolution of several definitions of insanity and the insane, including experiments on asylum construction. This also led to the proliferation of asylums in India.
In particular, this book studies the reasons for the environmental and geographical locations of the asylums of Bengal. It further analyses how that determined the architecture of asylums and the method of treatment within them. During the nineteenth century, the definition of insanity was constantly revised and reframed. Within this context, gender issues played a key role: it became difficult for the medical practitioners to situate 'mad' women. Even though medical officials found it problematic to define them, possibly because of the relatively small number of women admitted into asylums, they still constructed an image of insane women that needs to be questioned.
In Europe and America, a whole body of scholarly work exists and is still being produced on insanity and mental asylums. These address a range of issues from treatises on insanity and its definitions to the condition of patients in the asylums and the acts and policies implemented. Medical literature written by physicians in England and America during the early nineteenth century is also extensive. In India, the issue of insanity in the nineteenth century has not been extensively dealt with, other than very important contributions made to the field by Waltraud Ernst and James Mills.! The present work is a new contribution to the already expanding historiography of colonial psychiatry, as it takes up the case of the Bengal Presidency, which was very important with Calcutta being the capital of British India during the nineteenth century. It was here that the first European Lunatic Asylum was established along with several other 'native' asylums, much before they were constructed in any other part of India. Although there is an extensive literature on the issue in general, there is a particular dearth of historiography on the area in the case of Bengal; hence, much of this work is based on primary sources and their interpretations. Since English and European physicians were in charge of the asylums in Bengal, the medical literature and references drawn in this work are also based on their observations on what was happening in England and how they tried to translate their knowledge into practice in Bengal.
This work concentrates on the nineteenth century as it was the period when various definitions of insanity evolved, asylums were built in India, rules and regulations were made, and acts on lunacy were also passed to govern the mentally ill. In England, the beginning of parliamentary enquiries on madhouses began in 1807, followed by an act to set up public asylums in 1808. Porter has pointed out that there has been 'no attempt to create an interpretative synthesis of English madness before institutionalization became the dynamo of change in the nineteenth century'. Another reason why this study is confined to the nineteenth century is because it marked the consolidation of British rule in India. Therefore, it is also necessary to know whether the transfer of power from the Company to the Crown caused any shift in the understanding of insanity and its treatment as well as in the laws implemented to control those who were mentally unfit.
Michel Foucault's work Madness and Civilization is a significant contribution to the field. He argued that Western European culture actually lost some of its reasons or homogeneity by silencing the voices of madness in its midst. Foucault drew his examples from the 'classical age', written about by observers such as Thomas Willis, Robert Whytt, Philippe Pinel, and Samuel Tuke. He explained how asylums and prisons became sites of disciplining and punishing of the self and for 'surveillance and judgement'. Discussing the methods of treatment practised in the asylum, he pointed out that the underlying principle was that 'madness will be punished in the asylum'. The primary concern of the mental hospital was to sever and to 'correct'; therefore, according to him, therapeutics did not function in the infirmary. Methods of treatment such as 'consolidation', 'purification', 'ablution', and 'regulation of movement' were efforts towards disciplining the inmate. Another significant aspect of treatment in the asylum was labour, which, according to Foucault, was enforced to regulate patients into a disciplined workforce. Work in an asylum, according to him, This work differs from Foucault's views on insanity by arguing that asylums were not only places to 'discipline and punish', but also to understand insanity as a disease and implement various treatments for its remedy. The treatments practised in the asylums were undoubtedly harsh, although the physicians of the time were not skilled enough to put through the precise practice, or to understand what insanity was. This study also shows how labour in the asylums of Bengal had a profit value added to it. Labour in the asylum was considered as both a part of moral treatment and a source of profit for the maintenance of its inmates.
The history of 'colonial psychiatry' has opened up a broad spectrum of subject areas of study in mental illness and asylum practices. Richard Keller has pointed out that the 'European doctors monopolized the medical profession, allowing Indians to initially occupy only the most menial positions in the asylums'i'' He further stated how 'asylum physicians in Britain advocated work as a means of "moral management" of mental illness'. However, British physicians in India 'found hard labour impracticable, if not injurious to Europeans because of the harsh tropical climate'. 5 This was why Europeans at the European Lunatic Asylum of Bengal were not allowed to do any physical labour, while on the contrary labour was crucial at the 'native' asylums. Thus, issues of race and class were significant aspects in the understanding of insanity in the nineteenth century. Ernst's work on the European asylums of India focused on issues of race and class divisions in the asylum, providing a different dimension to the understanding of insanity. According to her, asylums were places of 'refuge' or 'temporary receptacles', and 'madness unlike destitution crossed barriers of social class'.6The definitions and discourse of mental illness in nineteenth-century British India could not be isolated from the 'social context' in which they existed. She further states that the medical practitioners and the 'administrators utilized social discriminations based on race and class to uphold white supremacy'. Hence, first-class patients were diagnosed as suffering from 'temporary weakness' while patients of other classes were termed as 'idiots' and 'maniacs’. As most patients belonged to the latter group, asylums operated as last resorts for those European soldiers and poor Whites who did not respond to societal discrimination or military discipline. Europeans were sent back home for further treatment after their temporary stay in asylums in India. This 'repatriation of deranged colonial servants to Britain', according to her, 'brings back home the fact that colonial rule also took its toll on the British'. It also illustrated the Company's 'swift measures to make "invisible" those who might otherwise tarnish the image and self perception of the British as a mentally and physically superior person'.
Gender is an important issue that cannot be ignored in understanding the dynamics within the asylums. Louise Hide's recent work, Gender and Class in English Asylums, 1890-1914,10 deals with the issue of gender and class as it shows how there was a sudden increase in asylum admissions during the Victorian period in England as the result of socio-economic changes that affected people's lives in England during the time. The book also addresses another very important aspect of studying insanity, showing how towards the end of the nineteenth century, certain nomenclatures and the functioning of the asylum changed, as Victorian psychiatry took a 'clinical turn' away from asylums. to mental hospitals, and from attendants to nurses. Hide's work further addresses the relationships between doctors, patients, and attendants inside England's asylums through the notions of masculinity and femininity as understood during the time.
Appignanesi in her work Mad, Bad and Sad has also provided further insight into the issue of gender, as she has shown how a 'particular period's definitions of femininity or masculinity were closely linked to definitions of madness.' She has demonstrated how diagnoses and explanations of mental illnesses are shaped by different transitions in history; hence, the understanding of mental illness varies from one period to the other. Similarly, Indrani Sen's work on the mental illnesses of the 'white woman' in the colonies established the link between the 'conditions of gendered life in the colony and the problem of mental disorder'. Instead of dealing with the question of 'insanity alone', she concluded that the 'mental disorders' of European women in India was a result of social, economic, and cultural conditions. Sen studied the mental disorders of European women within the context of the distinctions made by present health experts among 'severe' and 'common' mental illness.
Phyllis Chesler in her work Women and Madness focuses on the construction of madness within Western patriarchal societies. There was a 'double standard of mental health' which defined female psychiatric symptoms such as depression or frigidity as different from male psychiatric symptoms such as alcoholism and drug addiction or sociopathic personality. Chesler shows how psychology and psychiatry defined the gender bias within power relations inside the psychiatric institutions. Almost in a similar tone and within the context of psychiatry in England during 1830 to 1980, Elaine Showalter wrote The Female Malady. She pointed out that since women outnumbered men in asylums, insanity was necessarily understood as a female malady. Although this view does not stand in case of the asylums of Bengal during the period, her argument that 'proper establishment of the menstrual function was viewed as essential to female mental health' holds true in defining female insanity in the asylums of Bengal.
Nineteenth-century medical texts and reports on women's reproductive health in India often referred to frequent occurrences of puerperal mania and puerperal fever causing physical debility and puerperal insanity among women. It was associated with a diverse form of mental illnesses linked to childbirth, which could affect women of any 'class'. In her work Dangerous Motherhood, Hilary Marland argued that 'puerperal insanity was very much a disorder that "belonged" to the nineteenth century in terms of its medical and social setting'. There are several instances of this disorder listed in the nineteenth-century medical records of India. As physicians could not diagnose its causes precisely, they often referred to violent mania and severe melancholia among women, either during pregnancy, during childbirth, or within months of her delivery, as its symptoms. The asylum records do not contain any mention of puerperal insanity, although there were clear hints of symptoms similar to this disorder in the case histories written about the insane women in Bengal whenever the asylum doctors diagnosed any prenatal or postnatal woman's madness. Puerperal insanity was prevalent among patients admitted to asylums, but the absence of the term in nineteenth-century asylum records, despite its presence in reports on reproductive health, is debatable.
James Mills suggested that colonial asylums in India were meant to manipulate and regulate vagabonds and dangerous Indians and that in reality, asylums became areas of controversy and resistance to colonial rule. He pointed out that there were instances of lunatics who even within the confines of the asylums could make decisions and resist the regimes of discipline. Through a study of the intentions of the British behind establishing mental asylums in India, the way in which local people interacted with these establishments, and also from the records left behind by these institutions, he argued that his study does not 'accept the diagnosis of any of the convicts of the asylums of British India as sane'. 17 Mills pointed out that inmates often looked at mental hospitals as a place that they could use for their own ends. Therefore, these were not only places where families could put up the troublesome members of the household, but also, for the patients themselves, a place of shelter, work opportunities, and a refuge in times of personal crisis, in addition to viewing it as a place where they might escape the rough discipline of prison regimes. He studied psychiatry within the broader project of the colonial 'civilizing mission'. But his argument that the institutions of 'modern psychiatry' in India were beginning to be established in the period after 1858 is debatable as its line of descent could be drawn back from the early decades of the nineteenth century.
Houses of Madness analyses how definitions of insanity and various methods of treatment gradually developed even before the transfer of power from the East India Company to the Crown took place. It was in the asylums that definitions of insanity were forged, expanded, modified, corrected, and extended through experiments on the inmates of the asylum, both 'natives' and Europeans, and which finally paved the way for the emergence of psychiatry as a discipline in the late nineteenth century. Although there were certain restrictions on such practices for the patients at the European asylum, this study shows that as long as they were in the colonies they were not completely exempt from experiments at the hands of European physicians.
There have been several works by historians on the social history of medicine in colonial Bengal over the last few decades. Waltraud Ernst's work is an important contribution in the field; her recent study on the 'lunatic asylums' of Bengal is very relevant to this work. Nevertheless, areas like madness and mental asylums in colonial Bengal seem to have eluded most scholars.
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