On "standing alongside the patient in his difficulties" or the privileging of the historical.

Abstract

Byline: Alok. Sarin, Sanjeev. Jain It is the year 1936. The city of Ranchi, in the Eastern part of India, blessed with a salubrious climate, had the rather unique distinction of having not one, but two rather large mental hospitals which actually pretty much faced each other across a common road. Both the hospitals had been established a few years apart, but the one for Europeans was administered by the Imperial government, while the other, for Indian citizens, by the Bengal Presidency. This is a particularly fascinating period. The European mental hospital is run by (naturally) a Britisher, Lieutenant Colonel Owen Berkeley-Hill, and the Indian hospital by Major Jal Dhunjibhoy, both officers of the Indian Military Service. To confound matters, however, Colonel Berkeley-Hill has committed the cardinal sin of marrying an Indian, a lady called Karimbil Kunhimanny from the Southern city of Cannanore. [sup][1] He is, therefore, somewhat of a "pariah" in the inner circles of Ranchi society. Major Dhunjibhoy, on the other hand, being a Parsi and a member of the IMS to boot, enjoys a slightly different and elevated status. [sup][2] What is interesting is that both men are prolific writers, travel widely, have large circles of influence, and have left footprints on history. Much of what we know about the thoughts of these men is from the rather detailed annual reports that each wrote about their respective hospitals. These form lovingly detailed reports of the year, with a "Trienniale" report giving a 3 year overview. [sup][3] The annual reports gave to the individual scope and potential to talk about the nitty-gritty of statistics, of how many people got admitted to, or were discharged from, or died in, the hospitals. Both men, however, also talk about what they thought characterized mental illness, what caused it, and the ways that it was different, if at all, in different parts of the world. There are other ways that we can get glimpses of their lives and thoughts. Apart from the annual reports, Berkeley-Hill has also written a most interesting manuscript titled All Too Human; An Unconventional Autobigraphy. [sup][1] Both men have published in the medical literature, Dhunjibhoy, perhaps more widely. There also exist Governmental files that document their views, and there is some personal correspondence available of conversations with Dhunjibhoy's daughter Roshan. [sup][2] Dhunjibhoy, interestingly, was also the first President of the Indian Psychiatric Society, and stayed on in Karachi after the partition of India. The reason that we talk about these available materials is that what started as an exploration purely from interest, of the history of Ranchi in the early 20 [sup]th century, reveals some rather interesting facts. The first among these is that quite contrary to the popular perception of the mental hospital as repositories of both squalor and brutality, the institutions that are being described here are places where a fair amount of thought is going into how a person with mental illness should be treated, how symptoms should be dealt with, and what the role of the professional should be. In a rather moving passage in the annual report of the Indian Mental Hospital, at Kanke in Ranchi, of the year 1934, [sup][3] Dhunjibhoy writes. "In the mental disorder, it is the patient himself who is being treated and not so much other parts of the body, and that is why the personal factor is so important. It is essential to try and see the world as the patient sees it, to accept for the time being the reality of his abnormal experiences and to stand alongside him in his difficulties." This compelling paragraph seems to capture in a few words much of the essence of the principles of caring and compassion that bio-medicine has frequently been accused of having lost sight of. It must certainly be said that in a dispassionate recounting of history, many of the allegations of neglect, abuse or even general uncaring that have been leveled against medicine, or specifically psychiatry, have often been more than appropriate. …