Recently
I received a request to sign an online mass memorandum requesting the
authorities concerned to close the mental health centers in Kerala. Being a
down-to-earth practitioner in psychiatry I couldn’t sign the memorandum.
The
hue and cry of psychiatrists for closure of mental health centers started up as a consequential
effect of the murder of a young law student who was in the maniac phase of bipolar
mood disorder. As I pointed out in the last post, in Malayalam, of this
blog the murder of Satnam Singh Mann was the culmination of malicious and murderous
process triggered by the attitudes prevailing in Kerala. He was accused of
being Islamic terrorist attempting to murder Amruthanadamayi, the
internationally known human-god managed by the Rashtreeya Swayam Sevak Sangh.
The last scene of the murderous process occurred in the Government Mental
Health Centre, Trivandrum. He was locked up in a cell of the ‘asylum’ with
other patients and he was found to be unconscious next day. He was transferred
to the Medical College Hospital where he succumbed to the injuries he
sustained.
I
understand from the press reports that the professor of psychiatry, Trivandrum,
certified the ‘patients’ locked up in the cell with Satnam are
‘normal’. It means that these ‘patients’ can be held criminally responsible for
the murder of Satnam!
Asylum culture
prevails
Thirty
years ago I was working as psychiatrist at Kuthiravattom. A young,
good-looking, unmarried lady in good physical health, suffering from
epilepsy and psychosis, under my treatment, was admitted in the female ward.
That was the fourth “incarceration” of the young lady. When the psychosis
remits she is discharged and when it relapses she is brought back.
After
a few days of the fourth admission, one morning one of the nurses informed me 'secretly' that "something brutal" was done to the young lady at night by a male nursing
assistant. I interviewed the patient. She narrated that one nursing assistant
raped her last night. She could not cry or fight because she was heavily
sedated. I reported the matter to both the superintendent and resident medical
officer in writing. They didn’t take any action. Next day I went to the
Medical College Police station and lodged a written complaint. The
Inspector called the superintendent and enquired. The inspector expressed his
helplessness, because the superintendent said that nothing of the sort occurred
in the hospital. I was in an embarrassing situation.
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| Rosewood Campus in UK |
I
had no other option than bringing the matter to the public notice. I contacted
the young lady’s brother, who was a teacher in a government college. I got the
consent from him to ‘leak’ matter to the press without disclosing the identity
of the young lady. I contacted the city bureau chief of the Malayala Manorama
(I still remember his name) and narrated the story. The bureau chief and his
wife, working in the telephone exchange, came to the hospital under the pretext
of the close relatives of the young lady. I gave them permission in the form of
a ‘pass’ to visit the patient and interview her. (An illegal act, perhaps!)
Next day, as I expected, a bomb exploded. Waves of protests by various
political parties thronged the premises of the Mental Hospital. Both the
superintendent and the resident medical officer were kept under suspension
pending departmental enquiry. Criminal case was charged against the culprit and
punished by the court of law.
I
am not repeating the narration of incident of murder of the mental patient Martin Mendes
which I narrated in the last post. It took place in the mental health centre,
Trivandrum, ten year after the Kuthiravattom incident.
Immediately
after the murder of Satnam Singh, another murder took place in the Mental
Health Centre, Kozhikode.
All
these incidents are, in my opinion, the symptoms of serious malady, that is,
the asylum culture still prevailing in our mental health centers. The
psychiatrists working in these institutions are vicariously responsible for it.
Closure of the mental health centers is not the remedy.
What happened in
western world?
Melanie
Mcfadyean wrote on the closure of Tooting
Bec Hospital with 2500 inmates, in 1995 in South London, after its existence almost
100 years, in
The Independent: “Once, they were conveniently locked away in mental hospitals.
Today, the mentally ill are back on the streets, more visible than at any time
in living memory. Have they simply been cast out to save money? Or have their
difficult lives actually been made more tolerable by the modern patchwork of
'community care' schemes?”
She wrote: “June McKerrow of the Mental Health Foundation explains: 'In some
areas community care is working, but in others services are clearly feeling
beleaguered, defensive and dumped on, expected to provide simple solutions to
impossible problems by government and public alike.' The NHS and Community Care
Act of 1990 devolved power away from the NHS and on to the social services. The
result has been to stretch social service professionals and health
professionals beyond their limits.”
If such
is the situation in UK, a developed country with much less population than
ours, what will be condition of the chronic psychotic patients who will be
thrown out of the mental health centers? Decades ago, one of the superintendent
of the MHC Kozhikode discharged a large number of ‘inmates’ on an experimental
basis. After a few weeks I happened to go to Palakkad in connection with organizational
work. After the work I arrived at the Palakkad bus station. One person came to
me and joyously lunged “Doctor! Doctor!” The public gathered around us and
questioned me. I confessed. Yes, I am a doctor. I know this man. He is Mr. Mariyappan, an inmate of MHC
Kozhikode. The people around us told me that Mariyappan has no place in this world to go
other than the Mental Health Centre, Kozhikod! The public collected some money
and tried to give it me to meet the expenditure of taking Mariyappan back to
Kozhikode MHC. I refused to accept the money, but promised them to take the
patient back to the hospital, which I carried out honestly. I had narrated this
incident under the caption, “Mariyappante Thiricuvaravu” in my Malayalam book
on anecdotes, titled Thalam Thettiya Jeevithakathakal. While these
articles were being serialized in the Deshabhimani Weekly, one of my
colleagues in Kozhikode MHC bluntly ridiculed me as populist writer because of
my writings in Malayalam, in the lay press!
The psychiatrist, basically being scientists, should not be
carried away by the sentimentalism propagated by the popular media and the
publicity mongers. They have to consider
the ground reality before taking up the popular slogans like closure of mental
hospitals.
The remedy for the malady is eradication of "asylum culture" still
prevailing in our mental health institutions.
