Compassion is a choice. Always. “Nothing happens without the permission of the brain,” Dr. Sarada Menon says twice to ascertain I heard it right. “As a child, I had always wanted to know why people behave the way they do. It's the mind that decides every action. Showing love and affection is done consciously, never without the mind's consent.”
Her clinic has no name-board as most schizophrenia patients being brought for the first time respond violently to the word “psychiatrist”; it is they who, after weeks and months of treatment, come back healed to thank her for what they have become — “normal” to the world, most importantly to themselves.
Long before she founded the Schizophrenia Research Foundation (SCARF) in Chennai, Dr. Sarada knew her life and career would be built on this premise of compassion and trust. From a faint moment of decision in 1947, when as a student of psychiatry she was convinced of what she wanted to become, her strength of character has remained steadfast. Sixty-five years on, she is still seen nudging patients on their path to recovery, teaching them to view life the way she does — in positive spirit.
“My parents were disappointed when I was born. I was the eighth child and their seventh girl! After six girls, my brother was born. So they expected another boy, but I arrived to their dismay. Most of my growing up years were spent in my sister's home,” she recounts of her independence that early on in life.
Subsequently, her admission to school turned out to be as interesting as her nature. When they approached Presentation Convent, Dr. Sarada was old enough for Std.II since she could recite a poem by-heart. A nun, who was her class teacher, was famous for saying “I will kill you.” It turned out one day that the nun used her favourite words to Dr. Sarada. The petrified child didn't go to Std.II the next day but instead walked into the Std.I classroom and sat there. This continued for many days. By the time the principal saw her and asked, “What are you doing here, dear?” Dr. Sarada had lost six months of that year. To this Dr. Sarada says, “I wanted to solve my own problems.”
Dr. Sarada was keen on pursuing a career in medicine. For that she had to first get a degree in Science. Her parents, however, saw the five-and-a-half years of medical studies as an unnecessary ordeal. But a persistent Dr. Sarada got into Women's Christian College, Chennai, and completed three years of under-graduation in two years! Her next stop was at Madras Medical College. Women candidates got a fee waiver those days, yet another reason for Dr. Sarada to stay the way she wished — motivated and independent.
After one year residency in Irwin Hospital, New Delhi, Dr. Sarada's first appointment was at Pittapuram Mission Hospital in Andhra Pradesh. “I didn't know a word of Telugu. The missionaries who ran the hospital were very strict. They expected me to converse in Telugu. Soon I had a master teaching me to read and write the language. In two months, I surprised everyone by taking lessons in Bacteriology, in Telugu!”
In all of the places where she was subsequently posted, Dr. Sarada saw crude reality to its face. The general condition of the mentally ill, the ignorance prevailing among even the educated, lack of awareness initiatives and the stigma that haunted the affected propelled her to aggressively reach out.
“Every medical college should have a full-fledged psychiatry department as per medical rules, but it was not to be,” says Dr. Sarada, who made remarkable changes to the functioning of the Institute of Mental Health, Chennai, after taking charge as its first woman superintendent in 1961. Lab facilities and infrastructure improved under her leadership, the occupational therapy unit underwent a makeover to provide interesting vocational activities for the patients; sports day and exhibitions were conducted when artwork and handicrafts done by patients would go on display and funds raised. Still, there was much to be desired.
“The institute was overcrowded. There were 2,800 inpatients against the sanctioned strength of 1,800. People who brought the mentally ill for treatment would often never come back to take them home as per schedule. The address given to us would be wrong, and so the patients continued to stay at the hospital. That's when I realised an outpatient department would solve the issue. A full-fledged outpatient department was soon started. I was particular that no one residing within a radius of five miles be admitted as an inpatient. Instead the patients could come every day and go back home the same day after medication and counselling. A day-care centre that was started around that time was a boon for the families of the mentally ill. The patient was left in our care through the day and picked up in the evening by the family member. This won a lot of appreciation as those attending to the mentally ill at home were relieved of stress — physically and emotionally — at least through the day,” says Dr. Sarada.
A significant responsibility in this entire process of treating the mentally ill and getting them to lead a dignified life rested on social workers. Dr. Sarada introduced many of them into the mainstream of operations — so they could serve as a link between the doctor and home, and also between the patient and home. Such interaction proved to be very effective. A smiling Dr. Sarada says, “When I retired in 1978, the number of inpatients had come down to 1,800!”
Aasha, an Association of Families of Schizophrenia, was started by her in 1985 to deal with the trauma family members of the mentally ill go through.
SCARF was her dream. Her three petitions to the then Tamil Nadu Chief Minister Jayalalithaa, who had assumed power for the first time, were accepted. In due course, the land was sanctioned, the government grant of three lakhs was increased to 10 lakhs, and the mentally ill were “officially” placed on a par with the differently abled. SCARF was born in 1984. Today it offers a temporary residential facility, advanced tele-psychiatry methods of treatment, vocational training and employment opportunities; even a mobile clinic operates for the benefit of the mentally ill, besides research projects and awareness programmes being conducted round the year.
“Communication, care and constant review are essential to help the affected at every stage. There was this woman I was supposed to treat. She seemed alright to me. Her relatives, however, kept saying she doesn't remember anything of what had happened over a 13-year period. They refused to take her back from the centre she was in. When I asked what it was that she couldn't recall, they said it was her son's marriage, and her daughter having a baby. This woman had not gone home in years, had never been there for any of the occasions they were talking about… how was she to remember something she does not know? “Truckloads of mentally ill people are brought from all over India and left to wander in places they do not know. We bring those we manage to rescue to our shelter and when they get well enough to talk clearly, they would have forgotten where they have come from. Our challenge is to trace them back to their homes,” Dr. Sarada's face reflects the concern in her voice. “These people can be made whole. Mental illness is like any other illness. Response to treatment should not be sidelined from the mainstream of medicine. If treatment is not given properly, relapses occur. About 20 per cent recover well fully, 60 per cent need rehabilitation to come back to original state, 20 per cent do not recover. Even with this 20 per cent one can work on their residual ability and tap their resources to a constructive goal. When we can tolerate a drunkard, why not a schizophrenic? Give affection. Be considerate.”
True. A lot can happen over the choices we make. Compassion is definitely a choice.