The Grey Side Of The Moon

A young Mexican music hall performer’s car breaks down in the Monegros desert on a rainy spring afternoon. She’s driving to Barcelona to keep an appointment with her magician husband. Desperate to reach him by phone, she accepts a lift in a bus that winds its way to the cobbled courtyard of an enormous building. It’s like an old convent in a forest of colossal trees, laden with signs she doesn’t see in the dim light of the lamp in the courtyard: cardboard tags stitched to the bodices of the new arrivals, sweetness that’s too patent to be real, heavily sedated women walking as though through the bottom of an aquarium. Once led inside, M, in Gabriel Garcia Marquez’s hair-raising short story, I Only Came to Use the Phone, realises that the shadowy place with frozen stairways and stone walls is a hospital for the mentally ill. Everyday life becomes a blur as her attempts to break free are suppressed by matrons who with saccharine surety or with terror silence all at the sanatorium. No one believes M. Even her husband is taken in by the doctor’s ‘spin’.

Several thousand miles from northeastern Spain, Meena­k­shi*, a 33-year-old schoolteacher in Delhi, found herself in a similar situation one warm September evening in 2013. Wit­h­out any warning, uniformed attendants barged into her house and forced her to accompany them somewhere. “No questions were taken. I was led to a hospital van, taken to a private facility and sedated,” says Meenakshi in a matter-of-fact tone, obviou­sly veiling inner tremors. Later, she realised that her husband had cold-bloodedly planned it all, as she’d resisted his attempts to molest their son. “I was hospitalised without any documents. They said my husband had the last word in the matter.” Her relatives rescued her after two months when they found out she was in a mental hospital, all worn-out and terrorised. “Even now, my husband accuses me of being over-suspicious. He says ‘it’ could happen again. There’s no way to escape this fear.”

Photograph by Amit Haralkar

“Everything was planned. My husband was having an affair, he wanted to take our sons, get a divorce on grounds of mental instability.”

Jessica Paul, 46, Mumbai, naturopath
Reason: Husband’s extramarital affair

Jessica was alone at home one night in ’04 when three people knocked on the door. Posing as state health workers conducting vaccinations in the area, they held her down, sedated her, and took her away. The next morning, she found herself in a private mental hospital where she was forced to stay against her will for a month with virtually no contact with her family and medicated against her will. Without her consent or kno­wledge, she was also forced to endure electro-conv­uls­ive therapy. “I was like a vegetable,” she says. Jessica later discovered that her husband had her admitted to the mental hospital without a court order. She claims that her husband wanted her certified “insane” so that he could get a divorce without paying alimony.

Does the testimony of a person who’s labelled “mad” have any consequence? If anything, assertions that they are normal and not in need of treatment would be held against them as further evidence of being in denial. If they tell the doctor that the rest of the family is plotting against them to seize property, the doctor would put that down as a symptom of obsessive comp­ulsive personality disorder. If she accuses her husband of having an extramarital affair, she could be seen as paranoid and delusional. In the hands of unscrupulous professionals and perfidious family, the “insanity” label becomes a powerful wea­­pon used against women or the weakest members. Bhargavi Davar of the Bapu Trust for Research on Mind and Discourse, Pune, says, “The practice of locking up someone just because a family member or friend alleges that he/she is mentally uns­o­und, without checking, is criminal. A lot of people abuse the mental health laws to get access to property, abandon their spouses, have extramarital affairs, gain custody of the kids etc.”

In our midst, there are psychiatrists who swindle families into handing them large amounts of money to “treat” their loved ones in an illegal manner, sometimes even for minor symptoms like stress. In some cases, family members connive with the doctor to have the so-called patient locked away in a mental hospital. The Mental Health Act in India says that two psychiatrists and a reception order from a magistrate must prove that someone has a psychosocial disability and therefore needs to be in a mental health institution. “But if someone wants to abandon a family member, they just need to get a fake certificate from a psychiatrist to prove that he or she is insane. That’s where you see a nexus between the family and a medical officer,” says Ratnaboli Ray, founder of Anjali, a mental health rights organisation in Calcutta. Private facilities add to the problem as the magistrate is often unaware if the doctor is authorised to issue a certificate.

Photograph by K. Bhaskar Rao

Aarti says, “He was called to the CO’s where Sunil’s mobile was snatched away.... He was locked up and later referred to a naval hospital in Kochi.”

Sunil Sahu, 28, Visakhapatnam, naval officer
Reason: Reported Corruption

Sunil was posted in Karwar in Karnataka as a shipwright artificer in 2012-13 when he noticed and reported corruption in the naval facility. Charges were framed against him and Sunil was transferred to other naval bases, till the CO at the INS Kattabom­man in Tirunelveli ordered his immediate transfer to the psychiatric ward of a medical college for mental abnormalities. Wife Aarti then filed a petition with the Kerala HC, and an examination by a government psychiatrist revealed that he had, prima facie, no mental abnormalities as alleged by the navy. Still, the ordeal dragged on for months till Sahu was admitted to a private facility in Bangalore where psychometric tests finally confirmed he was “normal”.

People who are labelled “mental” and have gone through the harrowing experience of such incarceration are too traumatised to talk, or complain. Every quirk of theirs is pigeonholed, everyone looks at them through tinted glasses. It’s a stigma that stays forever. Outlook spoke to a cross-section of individuals from diverse backgrounds, religions and age groups who’ve been confined at mental hospitals, allegedly because of vested interests. They’ve all lived through it, but only a few agreed to relate their trauma. Father Peter Manuel is one of the few who did agree.

The 30-year-old Catholic priest from Kerala fell in love with a Muslim woman who had converted to Christianity in 2010 and wanted to marry her. But this angered the clergy and he was forcibly admitted to a mental hospital in August last year for “deviating from the faith and odd behaviour”. His family members, in connivance with the church, thought it imperative to have him undergo a psychiatric evaluation. Peter was suspe­nded from the order, locked up in his cousin’s house, and then taken to a mental hospital run by Catholic nuns in Panaikulam, Thrissur. “The doctor said it would be just a reg­u­lar diagnosis, but instead they sedated me. When I woke up, I was told that they would keep me under observation. Even the local parish priest issued a letter that I had deviated from my faith.” Wife Marina (they had married in 2013) had no idea about Peter’s whereabouts for days until the police informed her that he had been taken to a mental hospital. “They wanted to put him in for good, but I put a lot of pressure on the hospital authorities to free him,” she says. Marina says there was more to it than just what the church called blasphemy—she suspects the congregation was afraid Peter would block its funds by sho­wing how the church was doing business in the name of charity.

“I have been labelled mentally ill, my kids have been taken away from me, relations with my parents are ruined...how much worse can it get?”

Mrinalini Jaiswal, 47, Delhi (Presently lives in London)
Reason: Marital stress

An IAS officer’s daughter, Mrinalini started her own management consultancy with her husband in Delhi after they got married in 1992. It was all smooth sailing till marital stress, sexual abuse by her husband and the toll of having too many children (she has four sons, aged 9 to 19) extra­cted its pound of flesh. In September ’07, when her husband was hospitalised for dengue, Mrinalini had a panic attack and was unexpectedly shifted to a reputed private facility in Delhi. She was put on strong medication for 46 days. Later, Mrinalini found out her husband and father were behind it. In April 2012, she was hospitalised again despite carrying papers from a psychiatrist saying she was perfectly alright. Mrinalini was released after lawyers and mental health activists lobbied for her release. Meanwhile, her husband filed for divorce and custody of their four sons on the ground that she was mentally unstable.

Inter-caste/religion affairs seem to be particularly vulnerable to such collusions. Mekhla Roy, a 28-year-old former sales agent in Calcutta, saw this happening to her when she decided to marry a Muslim man in 2011. “My father had died a couple of years ago and my uncles were suspicious of my defiant attitude. They started brainwashing my mother, saying that I wanted to take over the family property.” Mekhla is quite articulate as she narrates the ordeal of how the police came to her house in December 2013, dragged her out and admitted her to a state-run mental hospital. “My uncles told the cops that I’m neurotic, abusive and need critical treatment.” Mekhla was confined for a year, put into seclusion cells, and forcefully administered psychotropic drugs. “Hospitalisation will remain a dark scar in my life, but I’m strong-willed and will go back to work soon,” she says.

But not everyone’s so hopeful of the future. A frightening situation arises when people are diagnosed as ‘delusional’ just because they hold contrary religious, political or cultural beliefs. And this isn’t just an Indian phenomenon. Internationally, some famous cases include that of Wang Wanxing, one of China’s longest-serving dissident prisoners, who spent 13 years in a psychiatric hospital after he staged a one-man protest in Tiananmen Square in 1992 on the third anniversary of the massacre. The government claimed he was paranoid and delusional, but Dutch psychiatrists released a report recently showing that he was “comple­tely mentally sound”. More recently, the South African author of Indian origin, Zainub Priya Dala, was violently attacked in Durban for expressing her admiration for Salman Rushdie, and then admitted to a mental health institution, allegedly under pressure from the local Islamic community. Kranti, an advocate at the Human Rights Law Network in Mumbai, says, “Mental illness is seen as a reason for legal exclusion. This has led to the loss of liberty for many people.” Amita Dhanda, professor and head at the Centre for Disability Studies, NALSAR University of Law, Hyderabad, concurs: “People lose control over their everyday lives—when and what you eat, wear or sleep. Others decide what is good for you.” A recent Human Rights Watch report on the plight of the mentally ill shows that women are often forcefully committed, even if they are only perceived as having a mental illness. Kriti Sharma, a researcher in the disability rights division at Human Rights Watch, points out, “Even when there is no medical emergency, in India decisions are typically taken by a family, caregiver or judge. So doctors and nurses don’t bother to get the patient’s consent, or even explain procedures. This leads to rampant abuse.”

Being labelled “mental” and living with that taboo is hard enough, but what makes things worse are the loopholes in our mental healthcare system which permits illegal confinement. Aparna Sanyal, whose documentary film A Drop of Sunshine is about a girl coping with schizophrenia, believes diagnosis is often based solely on perception than scientific data. “The doctor typically relies on five minutes of conversation with family members or the patient herself and gives a diagnosis by comparing the so-called symptoms with, say, the Diagnostic and Statistical Manual of Mental Disorders.” Avinash Mokashi, a former deputy superintendent of police in Maharashtra, says that in some family disputes, nominal mental disorders are highlighted and the person is subjected to forceful medical treatment which may not be warranted. Pushpa Tolani, an activist from Mumbai, points out that the “mental health department licensing authorities often don’t conduct proper monthly checks on psychiatric nursing homes for involuntary admissions”. Meanwhile, most mental health professionals contend that treatment is in the “patient’s best interest”, as they are just not in a condition to give informed consent.

“I just followed him because I really thought he cared... but landed up in a government mental hospital in Calcutta.”

Abhijit Guha, 60, Calcutta, former electrician
Reason: Family dispute

Abhijit used to work as an electrician in Jalpaiguri district of north Bengal. The only earning member in his family of two other brothers and an ailing mother, he worked hard. His brothers were apparently envious, there were squabbles over the little property they had. It made Abhijit anxious. So, some time in August 2005, his elder brother told him that he would take him to a reputed doctor to treat his anxiety and sleep deprivation. “I just followed him because I thought he cared, but landed up in a government mental hospital in Calcutta,” he says calmly. This hospital has been his home for the last 10 years. Abhijit counts the days and waits for his brother to take him back, but no one’s ever come since he was admitted here. He says it’s a violation of human rights to admit someone without their knowledge or consent, but still longs to see his family and the girl he had fallen in love with years ago.

But mental illness is not one entity, there are situations with varying degrees of complexity; and boundaries get blurred. Ideally, if intervention is needed in the case of a mentally distressed person, there should be more choices at hand and legal safeguards for people to meet psychiatrists in a state of freedom. Besides plugging the legal loopholes, it should be asked whether institutions could be radically reimagined even for real cases, where the focus is on individual attention, security and creative expression. Facilities like smaller and more personalised institutions, group living or community-based services may help. But this would require the government to devote res­ources, since it would mean more facilities of a different kind. Institutions may be more open to public scrutiny, and families given a wider spectrum of choices.

Sadly for decades, India has ignored mental health (the government spends a meagre 0.06 per cent of its health budget on it). For a million people, there are three psychiatrists and roughly 0.5 psychologists. Last October, the Men­tal Health Care bill came into being finally, which decriminalises attempted suicide, bans electro-convulsive therapy without anaesthesia and gives importance to community-based care. There is also a call for other changes—like briefer hospital care for crisis situations and the possibility of long-term care for a few. “All of this needs to be ethically regulated, so that the rights of a person are kept sight of,” says Dr Alok Sarin, consultant psychiatrist at the Sitaram Bhartia Institute of Science and Research in Delhi. He feels that the new mental health legislation is an attempt to have adequate safeguards for those rare situations when involuntary or ‘supported’ admission becomes necessary. “At present, there exists many poorly regulated centres where people are too easily admitted, and that will need consideration,” he says. Dr Sanjeev Jain, psychiatrist and former head of the department of psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, believes that private ‘half-way homes’ are under a welter of different rules and supervision with no timely audits. “Involuntary or illegal long-term stay needs to be corrected through civic oversight and due medical and legal processes,” he says. But others like Dr Yusuf Matcheswalla, a psychiatrist at Masina Hospital in Mumbai, are worried about certain provisions in the new bill like the advanced directive (a mandate that specifies a person’s preferences for treatment should he or she lose the capacity to make treatment decisions in the future), or seeking permission for treatment every week from the family or mental health authorities. Dr Matcheswalla believes in electro-convulsive therapy. “We are an acute treatment ward and admit only serious cases. So, 7-8 cases out of 10 in this chronic category are administered electro-convulsive therapy,” he says.

It seems that the government has finally taken note. Earlier this year, women and child development minister Maneka Gandhi told the Rajya Sabha: “A lot of women are put there (in asylums) because they are widows, have property and the rest of the family conspires to remove them (from their homes). A survey has also been initiated to determine the condition of women across mental health institutions in India.” Lalitha Kumaramangalam, chairperson of the National Commission for Women, thinks this is a contentious issue, but lots of women are speaking out and asserting themselves. “More research needs to be done to corroborate the evidence,” she says.

But in this dystopian world of barbwires, psychotropic drugs and surgically controlled moods, people who are lab­elled “mad” aren’t just illegally confined. It becomes a morbid everyday reality that scars them forever, ruins car­eers, shatters families. Still somewhere they yearn to pick up the broken pieces and reclaim their lives. It’s like the Ken Kesey line from One Flew Over the Cuckoo’s Nest: “He knows that you have to laugh at the things that hurt you just to keep yourself in balance, just to keep the world from running you plumb crazy.”

(*Some names have been changed)

By Priyadarshini Sen in Delhi and Calcutta