Colonialism and Transnational Psychiatry: The Development of an Indian Mental Hospital in British India, c. 1925-1940

by Waltraud Ernst

Overview

This book focuses on the Ranchi Indian Mental Hospital, the largest public psychiatric facility in colonial India during the 1920s and 1930s. It breaks new ground by offering unique material for a critical engagement with the phenomenon of the ‘indigenisation’ or ‘Indianisation’ of the colonial medical services and the significance of international professional networks. The work also provides a detailed assessment of the role of gender and race in this field, and of Western and culturally specific medical treatments and diagnoses. The volume offers an unprecedented look at both the local and global factors that had a strong bearing on hospital management and psychiatric treatment at this institution.

Product Details

ISBN-13:	9780857280190
Publisher:	Anthem Press
Publication date:	10/15/2013
Series:	Anthem South Asian Studies
Pages:	294
Product dimensions:	6.20(w) x 9.10(h) x 1.00(d)

About the Author

Waltraud Ernst is Professor in the History of Medicine in the Department of History, Philosophy and Religion at Oxford Brookes University, UK.

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Colonialism and Transnational Psychiatry

The Development of an Indian Mental Hospital in British India, c. 1925â"1940

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By Waltraud Ernst

Wimbledon Publishing Company

Copyright © 2013 Waltraud Ernst
All rights reserved.
ISBN: 978-0-85728-019-0

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CHAPTER 1

INDIANISATION AND ITS DISCONTENTS

The Indian gentleman, with all self-respect to himself, should not enter into a compartment reserved for Europeans, any more than he should enter a carriage set apart for ladies. Although you may have acquired the habits and manners of the European, have the courage to show that you are not ashamed of being an Indian, and in all such cases, identify yourself with the race to which you belong.

— H. Hardless, The Indian Gentleman's Guide to Etiquette, 1919

During the early part of the nineteenth century, most senior positions in the colonial medical services were occupied by Europeans. Only from 1855 were Indians allowed to occupy higher-level roles. However, public proclamations and official regulations did not always reflect British officials' sentiments and unofficial practices. In his book Race, Sex and Class, Ballhatchet discusses the case of a highly qualified, mixed-race (Eurasian) doctor who had been made assistant surgeon in the mid-nineteenth century. He soon fell foul of European prejudice, becoming the victim of a scandal. Although the allegations against him were eventually shown to have been groundless, if not malicious, the director-general of hospitals recommended that in order to avoid similar occurrences in the future, Indians and Eurasians ought not to be appointed to senior positions, regardless of their qualifications. Instead of being given a commission they should be made warrant officers, as:

this course would not [withdraw] them from their own class, or [place] them in a false position, one in which though equals in virtue of holding Her Majesty's Commission, they are, nevertheless, not looked upon by the other Officers of the service as on an equality in a social sense.

The career of S. G. Chuckerbutty, an Indian from Bengal, highlights similar issues. He sat and excelled at the first competitive exams organised in London in 1855, and had converted to Christianity. He has been celebrated as the first, and one of only a few in the late nineteenth century, who had managed to 'remove from his race, the stigma of a proscription which denied them a career of honourable ambition in their own land'. However, his dire experiences prior to his eventual senior appointment as professor of materia medica at Calcutta Medical College, and even afterwards, attest to the many structural obstacles he had to contend with, and the considerable social prejudice and outright hostility he experienced from Europeans.

The practical and social obstacles that stood in the way of Indians and Eurasians aspiring to positions in the colonial service led to them being present almost exclusively in the subordinate uncovenanted service (at the level of 'subassistant surgeon') during the nineteenth century. This dovetailed with the contemporary need for employment opportunities for British professionals. The Raj constituted an attractive career outlet for the British middle classes, offering not only secure employment (as long as colonialism prevailed) but also a far more luxurious lifestyle than that available to them in their motherland. This phenomenon is well documented. British civil servants and the upper strata of the military were aptly described as belonging to a distinct social category: a kind of 'middle-class aristocracy'. Much of the imagery of Raj lore reflects this. India is depicted as an exotic playground for Britons, presenting its own environmental tribulations (the 'heat and dust'), attractions (hunting, sports, club life) and displaying a distinctive social etiquette (calling cards and seating orders) that governed relationships between the various strata among the 'Anglo-Indians' (that is, the British in India), and the official rules of social engagement between them and Indians.

As long as Europeans were allocated senior positions, with Indians relegated to subservient, even menial, activities, the imperial social pecking order remained largely circumscribed in terms of European seniority and supremacy on the one hand and Indian subalternity on the other – even though both sides were highly heterogeneous, with their own social hierarchies based on social class, ethnic origin, caste and religious affiliation. The decades around the turn of the nineteenth to the twentieth century could be considered the ideological heyday of this formal constellation. The announcement of Delhi as the new imperial capital in 1911, 'undertaken in large part to enable the government to escape the uncomfortable political atmosphere of Calcutta, marked by continued and often violent demonstrations of nationalist sentiment', could be, as Metcalf put it, considered as 'the beginning of the end'. Following increased anti-British political agitation from the late nineteenth century and the formation of the Indian National Congress in 1885, Indians (and some Europeans) gradually began to challenge the prevalent imperial, political and social order. From 1892 Indian medical degrees were finally recognised, removing the requirement to sit exams in Britain. The formal rules of engagement between Europeans and Indians of the middle and upper echelons of colonial society began to change. This was particularly pronounced from the second decade of the twentieth century, when the number of Western-trained Indian medical practitioners increased noticeably, leading to what the authorities termed the Indianisation of the Indian medical services.

Indianisation, alongside the decentralisation of some of the colonial services in 1919 (via the devolution of medical administration to individual provinces) and the establishment of local self-government in the various provinces in 1935 changed the administration of the colonial state considerably. These developments bring into relief a number of important issues and questions. Foremost among these is whether members of the gradually emerging group of Indians in senior positions should be most appropriately pigeonholed as mere collaborators with the colonial project, who fulfilled Macaulay's earlier nineteenth-century vision of the British colonial state and its educational institutions of raising an Indian middle class that could interpret 'between us and the millions whom we govern – a class of persons Indian in colour and blood, but English in tastes, in opinions, in morals, and in intellect'. The eexperiences of colonia subjects and mediators between the indigenous uneducated 'masses' and the rulers were, in the context of French North Africa, described by Fanon in 1952 in his Black Skin, White Masks. Being a psychoanalyst by training, Fanon focused on the 'psychopathology of colonisation', namely the feelings of dependency and inadequacy that he considered to be the consequence of 'black subjects' embracing the culture of the colonial power. Fanon's work developed from earlier debates on negritude, which had also grappled with the social and psychological consequences of French colonialism during the 1920s and 1930s. This is, significantly, also the main period with which this book is concerned.

The role of, and the psychological impact on, Macaulay's indigenous mediators – or members of what Marxist and dependency-theory scholars in the 1970s and 1980s have termed the 'comprador bourgeoisie' – has received considerable critical attention throughout the twentieth century among historians of colonialism and those involved in colonial liberation and postcolonial movements. More recently there has been a conceptual shift towards questions of 'identity' and in particular 'multiple identities', allowing for a more comprehensive and nuanced assessment of the condition of the colonised. However, in the history of colonial psychiatry, the issue of how to conceptualise the gradual incorporation of Western-trained indigenous practitioners into the senior ranks of the colonial medical service has rarely arisen. This is partly due to the fact that only very recently have historians of psychiatry begun to shift their focus from the nineteenth to the twentieth century, with 'no narrative in sight which can explain the psychiatry of the 20th century, comparable to the authoritative coherence achieved for the 19th century'. The history of psychiatry in British India has been written mainly by reference to nineteenth-century colonial culture. On the other hand, existing work by medical historians on the important role of 'intermediaries', 'middles' or 'subalterns' within colonial settings has concerned itself mainly with those appointed to positions at the intermediate, subordinate or auxiliary level, or with the development of medical research and science.

Towards Indianisation

Dhunjibhoy had been trained at Bombay Medical College, graduating with a fully recognised MBBS (Bachelor of Medicine and Surgery). He was also a fellow of the College of Physicians and Surgeons (FCPS), a distinction considered highly prestigious among medical practitioners. Dhunjibhoy was made a member of the Indian Medical Service, the supreme medical service on account of its strong link with the British Medical Association (BMA). As was common practice at the time, the appointment was both military and civilian; Dhunjibhoy was therefore given a military commission on joining the IMS. No suitable vacancy being available at the time in Bombay, his services were 'placed temporarily at the disposal of the Government of Bengal', some sixteen hundred kilometres across the subcontinent, where a position needed to be filled at the mental hospital in Berhampore, almost two hundred kilometres northwest of Calcutta (Kolkata). When the building work at the new institution in Ranchi was completed, Dhunjibhoy was appointed as its first superintendent.

An appointment such as that at Ranchi was highly coveted among doctors. Not only did it entail taking over a large, brand-new purpose-built institution, but well-paid vacancies at senior-management level were few and far between, especially at a time of financial retrenchment such as the decades following the First World War. What is more, Dhunjibhoy was among the first few 'native' medical officers to head a major medical institution. At the three old mental hospitals from which Ranchi got its first intake of patients, high-ranking Europeans had been in charge: Lt. Col. H. R. Dutton at Patna, Lt. F. E. Knight (following Dhunjibhoy's reposting) at Berhampore, and Lt. Col. M. Mackelvie at Dacca (Dhaka). Dhunjibhoy's appointment promised to put an end to European pre-eminence in senior IMS positions. His practical achievements were acknowledged locally and in Britain. H. Ainsworth, the most senior medical officer in the province and the inspector-general of civil hospitals, Bihar and Orissa, announced in relation to the successful transfer to Ranchi of 1,226 patients in 1925: 'I think Captain Dhunjibhoy and his staff deserve much credit for the success which has attended the opening of the hospital.' This view was echoed in the Journal of Mental Science (JMS):

The organization necessary to safely effect the transport of such large numbers can be better imagined when it is stated that the distance, for instance, from Dacca is some 300 miles, and involves a journey of 51 hours by steamer and rail and road. ... Great credit is due to Capt. Dhunjibhoy and those who assisted him, in that the transport of this large number of patients was carried out without hitch or mishap.

The colonial government facilitated Dhunjibhoy's further training and specialisation. He was sent to Europe and North America on a number of occasions prior and subsequent to his appointment at Ranchi. He was put in charge of the training of students from Patna Medical College and the Department of Psychology at the universities of Calcutta and Dacca. When the mental hospital was recognised in 1936 for postgraduate study by the universities of London and Edinburgh, he was responsible for students working for 'diplomas in Psychological Medicine'. In regard to his formal career development, Dhunjibhoy had the official support of the colonial government at the highest level. This was in line with the Indianisation of government services pursued during this period – enforced, not least, to appease increased anticolonial strife.

There is however evidence that Dhunjibhoy's lot was not an easy one and that his achievements were not acknowledged by all of his European colleagues. Although the colonial government actively facilitated Dhunjibhoy's career at the highest level proportionate to his training and experience, he became the target of criticism and discrimination – not so much despite his elevation to a senior position but because of it. The new government policy of Indianisation within the colonial service did not instantly do away with discriminatory practices and ingrained adverse attitudes among European practitioners. New terms of reference were supposed to govern working relationships between European and Indian practitioners but, as will be shown, notwithstanding the official requirement for equity between European and Indian senior officers, issues of race, class and professional competition for scarce jobs were rife. Structural inequalities that had affected staff in earlier decades persisted, ensuring the continuation of an employment hierarchy favouring European staff.

Structural Inequities

The IMS pay scales for Europeans and Indians were seemingly on a par, being based, as before, on formal qualification and length of service. Dhunjibhoy, for example, was paid Rs. 1,350 per month in 1925, when he started at Ranchi as a captain. On reaching, in due course, the rank of major in 1928, he earned Rs. 1,500 per month, and then Rs. 1,650 from 1931. This was apparently in line with what his European counterpart, Owen Berkeley-Hill, superintendent at the neighbouring mental hospital for Europeans and higher-class Eurasians, who was paid as a major (that is, Rs. 1,200 per month in 1920 and Rs. 1,350 in 1921). However, Dhunjibhoy was in charge of the largest mental hospital in India (confining, on average, 1,400 patients). His European counterpart was responsible for a much smaller number of Europeans and higher-class Eurasians (a maximum of 102 men and 96 women). Berkeley-Hill also had the benefit of working in an institution that provided care on a superior scale, commensurate with the higher social standing of its patients (the institution's admission restrictions clearly specified that only Europeans and higher-class Eurasians were eligible for treatment). A range of discretionary payments and special allowances were common. Dhunjibhoy himself seems to have been acutely aware of the pay differential. One of his daughters noted, T know my father complained from time to time about racism. He received about Rs. 1000 less than his British counterparts.'

Another problematic structural issue concerns the extent to which Indians of the lower ranks, such as Dhunjibhoy's attendants and subordinate staff, did not appear to profit from the Indianisation of the medical service. They remained, as before, subservient, being graded according to the proximity of their position to European structures of management and command. Hence, attendants who looked after Indian patients at the Ranchi Indian Mental Hospital received a lower remuneration than those caring for Europeans and Eurasians at the Ranchi European Mental Hospital. In 1921, European male attendants (later to become psychiatric nurses) were paid Rs. 150 or Rs. 160 per month in the former, and at the latter, Indian male attendants received Rs.24, Rs.21 or Rs. 18. At Madras (Chennai), Indian attendants received between Rs. 15 and Rs.27 (with eight salary points for males, and four for females), while 'Attendants, Superior Grade', employed in the adjoining but separate premises reserved for European patients, earned considerably more, namely between Rs.84 and Rs. 100 (with five salary points).

Pay scales also varied between different provinces, some qualifications were considered less deserving than others, and members of the IMS were generally paid more. The fairness of this system was contentious. For example, in the province of Madras, another non-European, of Sri Lankan Tamil heritage, Dr H. S. Hensman, started as superintendent at the Madras Mental Hospital in 1924 on only Rs.900. He had obtained his licentiate in medicine and surgery in Madras (LMS). This was a lesser certificate awarded after a shorter course than Dhunjibhoy's MBBS from Bombay. However, Hensman also held the LRCD and the MRCS (Diploma or licentiate of the Royal College of Physicians and of the Royal College of Surgeons in Britain, a conjoint initial qualification in medicine). The government had also posted him to England for one year for specialist training in the treatment of mental diseases (in 1922–23). His starting salary was low in contrast to his immediate predecessor at Madras, W. R. J. Scroggie, a European who had trained in London some ten years earlier, who was paid over double Hensman's rate for doing the same job (Rs.2,000 in 1923). Scroggie was then a lieutenant colonel and a member of the IMS. Hensman, in contrast, despite his additional diploma from a British institution, was not made a member of the IMS.

(Continues...)

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Table of Contents

Acknowledgements; Abbreviations; Tables and Figures; Introduction; Chapter 1: Indianisation and its Discontents; Chapter 2: The Patients: The Demographics of Gender and Age, Locality, Occupation, Caste and Religion; Chapter 3: Institutional Trends and Standardisation: Deaths, Diseases and Cures; Chapter 4: Classifications, Types of Disorder and Aetiology; Chapter 5: Treatments; Conclusion; Notes; Bibliography; Index 

What People are Saying About This

From the Publisher

‘Ernst paints a fascinating picture of a mental hospital in India where doctors and patients struggle with the problems and paradoxes of modernity during an era of dramatic political change and medical innovation on a global scale.’ —Joseph Alter, Pittsburgh University

‘A very important and original contribution to the growing literature on psychiatry and colonialism, notable for its tight focus on a single mental hospital for Indians rather than the imperial ruling class.’ —Andrew Scull, University of California, San Diego

‘An in-depth account wherein individual and institutional histories coalesce, a work of honest scholarship which will be useful for medical historians, sociologists and lay readers alike.’ —Deepak Kumar, Jawaharlal Nehru University

Editorial Reviews

‘Waltraud Ernst offers us a major new contribution [and] by far the most detailed and insightful account of a mental hospital for Indians produced to date. […] [Ernst is] a leading light in this field.’ —Christopher Harding, ‘Social History of Medicine’

From the Publisher