NEW DELHI: In the trenches of the Western Front during the World War I, with artillery shells bursting all around them, and enemy machineguns wiping out almost entire battalions in a day, the Indian soldiers thought “the world was ending”. Shell shock was hitting the Indian rank and file. For them, a support mechanism had to be created back home.
And the Indian Army rose to the occasion.
A hundred years ago, it was the Indian Army that was instrumental in the expansion of modern psychiatry in India.
“It was the army that introduced the concept of psychiatry to India. Before the war, there were ‘lunatic asylums’ in India for Indians that had a terrible reputation of being centres of incarceration and torture. During and after the war, the army had to grapple with an uncounted number of Indian combat stress casualties (CSCs). For their care and rehabilitation, the Indian Army had to ensure that a proper support mechanism was created in India. Many civilian mental healthcare institutions of today resulted from the Indian Army’s campaign for better care for our troops. It also resulted in the Indianization of the Indian Medical Service, later the Army Medical Corps,” said Brigadier MSVK Raju (Retd), formerly the head of psychiatry, AFMC Pune.
As early as November 1914, the horrors of trench warfare, coupled with the wet and cold European climate and the industrial nature of the casualties, were having a telling effect on the Indian Expeditionary Force, which had joined the British Expeditionary Force on the Western Front from September 1914 onwards. The chief censor of Indian military correspondence in France, Evelyn Berkeley Howell, was among the first to spot signs of ‘mental disquietude’ among the Indian troops in their letters.
In his January 1915 report, Howell wrote: “… Many of the men show a tendency to break into poetry which I am inclined to regard as a rather ominous sign of mental disquietude. The number of letters written by men who have obviously given way to despair has also increased both absolutely and relatively….What is more significant still is the proportion of letters which though they show no sign of giving way to despair or of any faltering devotion to duty yet give a melancholy impression of fatalistic resignation to a fate that is regarded as speedy and inevitable …”
It’s very difficult to ascertain how many Indians actually suffered from shell shock or mental neuroses in those early stages of the war. But some letters did indicate that their authors had experienced extreme trauma and could slip deeper into depression if not supported well.
One such letter was written by a certain Rajwali Khan from Kitchener’s Indian Hospital, Brighton, on September 4 1915 to Ghulam Hussain of 59th Scinde Rifles (Frontier Force) in France: “If only I could see you once, then I should have nothing to regret. If God grants life, then I shall see you again. But it is difficult, for we are plunged in great and grievous calamity. Whenever I write to you, I am filled with anxiety. But nothing can be done. Alas! Alas! What am I to say about myself, that would be fit to write? There is nothing but my corpse left. They have cut off the whole of one leg, and one hand too is useless. What is the use of my going to India thus? I am always in distress on your account. Please write soon …They have given me a leg, but it is made of wood, and vile. I cannot walk. I shall start for India in a few days. You must write at once … I am taking nothing but a picture back to India. There is nothing left of me. I have lost a hand and a leg. What am I to do?”
This letter, sadly, was never sent as it had “depressing details of wound and trauma”.
By 1918, the need for opening hospitals for cases of shell-shock was acutely felt as “mental cases” started coming in their hundreds to Bombay and the existing facilities in that presidency proved inadequate to support them. James Mills in his 2001 book “The History of Modern Psychiatry in India, 1858-1947″ lists a letter written by the assistant director of medical service, Bombay, to the surgeon general of India on January 28, 1918.
“95 Indian mental cases arrived in Bombay from overseas from 1st January to date and in view of the large number of Labour Corps personnel in Mesopotamia and the increasing strain from climactic and other conditions, there is every reason to anticipate that the number will increase rather than decrease as the hot weather approaches,” he wrote.
The Indian Army acted swiftly. It lobbied hard with the government of Bombay and government of India to systematically expand psychiatric treatment in the country for the soldiers. There was friction between the Army and the bureaucracy over this, but the Army didn’t give up and eventually prevailed. More and more facilities were opened up and more beds were reserved in psychiatric wards for treatment of Indian soldiers.
All of this happened much quicker than in Britain, where things started only after a formal inquiry into war neuroses in the British Army was conducted in the 1920s (but while the British Army dealt with over 80,000 cases of shell shock after the war, the corresponding figure for the Indian Army is not known).
In fact, the term “lunatic asylum” was changed to “mental hospital” at the insistence of a few Indian Army medical officers (like Lieutenant Colonel Owen AR Berkeley-Hill who headed the European Mental Hospital at Ranchi, now the Central Institute of Psychiatry). One of the largest among these was the Indian Mental Hospital at Ranchi (known as RINPAS today), which came up in 1925, and had Captain JE Dhunjibhoy of the Indian Medical Service as medical superintendent. In fact, the shabby treatment meted out to civilian patients, pejoratively called “insanes”, stopped once military patients started coming in.
The Indian Army Act of 1911 was also amended in 1923 for the benefit of soldiers who had mental illnesses. The provision for continuation of service after treatment or honourable discharge with full retirement benefits was introduced for such soldiers. Military courts were also instructed to pass ‘not guilty’ verdicts whenever the defendant was a soldier of “unsound mind incapable of defending himself”.
By the 1930s, Indian Army’s lobbying had ensured that psychiatry was integrated as a full course in the syllabi of medical colleges across the country. Investments in new institutions and reforms in the existing ones were all pushed by the Army.
But the Indian attitude towards mental patients didn’t change much.
Dr Jitendra Nagpal, a senior consultant psychiatrist at VIMHANS and Moolchand Hospital, Delhi, said, “Indian psychiatry got a tremendous head-start during WWI. Just before the war, the Indian Lunacy Act came up in 1912. From then until 1987, it remained the single piece of legislation for mental healthcare in India. But mental health, till today, is a taboo topic here. There’s so much social stigma attached to it that families that have such patients either try to hide it or try to dissociate themselves from the individual.”
By the time the Second World War broke out, there were four full-time psychiatrists with the Indian Army.
Brigadier Raju says by this time, the lessons learnt in WWI had been forgotten. But by the end of the war, the number of military psychiatrists had gone up to 45 and the number of mental hospitals in the country stood at 31.
Independent India, it seems, only added 12 more mental hospitals in the last 68 years. According to a study by NIMHANS, Bangalore, in India about two crore people need help for serious mental disorders and about five crore suffer from mental illnesses not deemed serious.
NIMHANS also estimates that at least 35 lakh such Indians need hospitalization but there are only 40 institutions that can treat such cases. A 2012 note by the Union health ministry says there’s less than one psychiatrist for four lakh people. That same year, India had 2.6 lakh suicides — the highest in the world — as revealed by a WHO report released two weeks ago.
Many ended their lives due to lack of access to mental healthcare facilities or stigma attached to such diseases, the report added.
For India, it’s WWI advantage lost.