The State and Mental Health in Sindh

Between 1795 and 1806, the East India Company began establishing lunatic asylums for the care of British soldiers in Colaba, Madras, Monghyr and Bombay. It was decided that some among the Company’s significant number of British as well as Indian soldiers, needed custodial care.

However, a history of mental illness and its treatment in Sindh is divided into two parts.

One part falls into British Sindh, and like other areas of colonial India, it can be further divided into four phases. The first phase lasted from 1784 to 1857; the second from 1858 to the early 1900s; the third between 1900s and 1920; and the last from 1920 to 1947.

The second part of the institutional history of mental illnessstarted when Pakistan came into being. At least two distinct phases here can be identified: the first phase started in 1947 and it continued till the passing of the 18th Amendment on the 8th of April, 2010. Afterwards, we can say that a second phase started and is continuing at the moment.

These phases have witnessed the establishment of lunatic asylums, their transformation from asylums to hospitals; and the transformation of mental health patients’ image from harmful individuals to unwell people.

The present article is an attempt to gather diversified bits and pieces of the history of mental illness in Sindh. However, it tries to fit the fragments into the context of the Sir Cowasji Jehangir Institute of Psychiatry, Hyderabad.

The British conquest of Sindh took place in 1843. Later, SIndh was made part of the Bombay Presidency. The government after 18 years opened the first custodial asylum in at Larkana in 1861 at an old fort belonging to the Kalhora dynasty. However, the story of lunatic asylums in Sindh goes like this: in 1862, Larkana was under discussion as the proposed site to construct the asylum. But, Superintendent Niven objected on the grounds that it is an isolated place. Later, Sir Alexander Grant (1826-1884), the Director of Public Instruction in the Bombay Presidency, pointed out the urgency of a lunatic asylum in Sindh. Thus, land measuring 27.3 acres near the left bank of Indus River, and adjacent to the river port named Seth Giddu Mal, was marked. In 1865, the lunatic asylum came into being through a trust deed, and in the same year Sir Cowasji Jehangir resolved to donate Rs. 50,000 for the construction of the building and garden. A. H. Hughes’ Gazetteer of the Province of Sindh (1876) stated that lunatic asylum was completed in July 1871, with Sir Cowasji Jehangir’s donation of Rs. 50,000, and the government’s grant of Rs. 8,000. The same gazetteer stated that lunatic asylum was made open for the patients on the 3rd of September 1871. Interestingly, the announcement of its opening didn’t refer to it as Sir Cowasji Jehangir Lunatic Asylum. In fact, Sir Cowasji noted this and made a complaint. However, it became the first asylum of India where a public donation was used.

The superintendent at Hyderabad, instead of administering drugs, offered “curd, tobacco and snuff” to tempt patients into work

Interestingly, the asylum’s location, Giddu, become synonymous with its proper name of the Sir Cowasji Jehangir Lunatic Asylum. The word “Giddu” from a proper noun became an adjective and carried the attributive usage for the fool, insane or naive. However, one of the earlier names of the asylum was “Sodayn Jo Ashram”. Meanwhile the Sindh Revenue Board’s records mentioned it as Charin Ji Ispatal (Mental Hospital).

The location had many disadvantages. Chief amongst these was its closeness to the Indus River, in order to provide water for crops and garden. Such use of the  patients’ labour became the decisive factor for its selection. At that time, in India , “lunatic labour” was employed for generating financial resources. So, the superintendent at Hyderabad, like his Indian counterparts, instead of administering drugs, offered “curd, tobacco and snuff” to tempt them into work.

The Indian Medical Department’s “Annual Administration and Progress Report of the Insane Asylums in the Bombay Presidency” (1873-74) stated that the number of patients in Sir Cowasji Jehangir Asylum, Hyderabad, was 98 – of which 60 were Muslims and 38 Hindus

The asylum was located at Giddu Bander road, where bullock-carts’ noises, peddlers, porters, and common peoples’ conversations were easily heard in the wards, especially in the female ward. So, the patients were frightened and cried during day. The solution came in the shape of constructing an 11-feet-high wall. The idea worked. The wall provided some privacy and had a positive effect on the atmosphere in the female ward to some extent.

In almost all Indian “lunatic asylums”, shocks and other measures along with medicine blended the physical labour and entertainment. Women at the Sir Cowasji Jehangir Asylum at Hyderabad, the Superintendent reported in 1873, were more difficult to manage than the men. After he introduced women to grain grinding, he noticed a significant change in them. They became “orderly”. On the other hand, male patients laboured in the asylum’s agriculture fields. Surgeon Holmstead, Superintendent of the Asylum, stated that there were no drugs to equal bodily labour for the patients. However, at Hyderabad, drums, banjos and other native  singing and playing instruments were also used from 1871. Later, in 1876, Sir Cowasji Jehangir also donated a musical box to the asylum. The musical instruments served two purposes: they managed to reduce the level of outside sound, and secondly, they helped soothe the nerves of patients.

Some types of mental illnesses in Sindh mentioned in the Indian Medical Departments’ reports from 1873 to 1914 were mania, melancholia, idiocy, mental stupour, dementia, delusion insanity and epileptic cases. Those reports reveal that causes were excessive use of charas, bhang, chario dhatoro, spirts, and cannabis indica. Some reports mentioned that opium-eating and habits of debauchery also caused lunacy. However, other factors cited were mental stress, abuse of intoxication and mental instability.

The Indian Medical Department’s “Annual Administration and Progress Report of the Insane Asylums in the Bombay Presidency” (1873-74) stated that the number of patients in Sir Cowasji Jehangir Asylum, Hyderabad, was 98 – of which 60 were Muslims and 38 Hindus. The per-patient cost was 95 rupees, 4 annas and 4 paisas. Likewise, the 1878 report mentioned that 11 patients died in 1877, and in 1878 the number of dead was 12. The cost per patient in 1878 was reported to be 108 rupees, 0 annas and 6 paisas. In the previous year (1877) the cost per patient was Rs. 100, 10 annas and 11 paisas. Gradually, per patient costs decreased as it was reported to be Rs. 69 and 10 paisas and Rs. 77, 3 annas and 8 paisas per patient in 1890 and 1891 respectively.

The cost of drugs and expenditure on patient care has a directly proportional link with the type of drug, its advancement and its application. Some of the drugs used at Sir Cowasji Jehangir Asylum included digitalis, hypodermic injections of morphia, hydrocyanic acid for mania and atropine, bromide and sodium dilantin for epileptic seizures. In the 1930s and 1940s chemical treatments - cardiazol “convulsion” and insulin “shock” or “coma” therapy - became popular. Later, the Electric Convulsion Therapy became a cheaper replacement for cardiazol convulsion therapy.

Legislation also changed the status of the mental patients in British India. An earlier law was the Lunatic Removal Act 1851 (which ceased in 1891). It regulated the shifting of British patients back to home. While in 1858 the British Crown took over Indian administration, newer laws were enacted. Some of them were the Lunacy (Supreme Courts) Act 1858, the Lunacy (District Courts) Act 1858, the Indian Lunatic Asylum Act 1858 (with amendments passed in 1886 and 1889) and the Military Lunatic Act 1877. These acts enabled the authorities to detain  patients for an indefinite period in facilities where living conditions were poor, with an assumption of rare recovery. Consequently, it led to the bill (1911) that merged the prevailed legislation and paved the way for the Indian Lunacy Act (ILA) 1912. The ILA 1912 became the first law that governed mental illness in British India. At the time of Partition, both India and Pakistan administered their asylums under the ILA 1912.

It is still vague as to how at the time of Partition in 1947, the Hindus and Muslims confined in Sir Cowasji Jehangir Asylum were divided between the two new countries. None of the statistics available have a clear understanding of it. But the picture might be nearer to Saadat Hasan Manto’s short story Toba Tek Singh, where one character, named Bishan Singh, refused to leave Pakistan because he was told that his hometown Toba Tek Singh is on the Pakistani side of the new border.

Perhaps some Hyderabadi Sindhi inmate of Sir Cowasji Jehangir Asylum like Bishan Singh refused to leave, too. The reasons for doing so might be different. No one knows!

(to be continued)