[AI] The Outlook Cover story of the week: Why is the ‘mentally ill’ label so safe for abuse in India?

avinash shahi shahi88avinash at gmail.com
Sat Jul 11 05:29:57 PDT 2015


http://www.outlookindia.com/article/the-grey-side-of-the-moon/294819
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



-- 
Avinash Shahi
Doctoral student at Centre for Law and Governance JNU



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