When did human civilisation actually begin? Did it begin with humans making artefacts, pots and weapons, or with the advent of agriculture and animal husbandry or with the creation of settlements, which later became city-states?
The famous anthropologist Margaret Mead is believed to have said that human civilisation began with a healed femur, which had been discovered at a site containing ancient human remains.
Dr. Sanjeev Jain | Photo Credit: SPECIAL ARRAGEMENT
“Usually, in animals, if you break your leg bone, you are left to die,” says Dr Sanjeev Jain, Professor, Department of Psychiatry, NIMHANS, at a recent talk organised by the Rohini Nilekani Centre for Brain and Mind (CBM), NIMHANS as part of their Brain Awareness Week Program
The fact that the bone had healed indicates that someone had actually helped rehabilitate this person, he says, concluding that this was also, in some ways, the beginning of medicine. “Medical care has been the driving principle of all human civilisation,” states the Bengaluru-based psychiatrist and teacher at the talk held at the Atta Galatta bookstore in Indiranagar and supported by the International Brain Research Organisation (IBRO) and Dana Foundation, in collaboration with the Department of Mental Health Education, NIMHANS and the CBM at the National Centre for Biological Sciences (NCBS).
Dr. Jain, author of the book Mindscape and Landscape: An Illustrated History of NIMHANS, went on to trace the larger history of mental healthcare before zeroing in on the genesis and evolution of Bengaluru’s National Institute of Mental Health and Science, better known as NIMHANS. “Ever since we have written records of human cultural history to go back to, madness has always been recognised,” he says. According to him, accounts of madness have cropped up in diverse texts, including the Ramayana, the Old Testament and ancient Greek myths. “The Greeks thought that madness was due to intoxications or passion—alcohol, love or opium,” he says, adding that Ayurveda, too, contains information about it. “Understanding how and why people go mad has been a critical aspect of human society,” he says.
A view of Brain Bank (Museum) of NIMHANS (National Institute of Mental Health and Neuro Sciences). | Photo Credit: SREENIVASA MURTHY V
Looking after the mentally ill
The idea of creating spaces to nurture the mentally ill emerged only in 800 C.E. with the advent of Islam, says Dr. Jain. “Many mosques started looking after the mentally ill, and the first mental hospital was set up in Baghdad,” he says. This also meant that the idea of the asylum spread with Islam. “It went to Cairo, Libya and Spain,” he says.
Islamic culture dictated that the mentally ill should be looked after in a place that closely resembled heaven, replete with running water, music, fruit trees, and flowers. So, this became the general design of asylums all over the Arab world, he adds. Over the next 400-500 years, the idea of having designated spaces for the mentally ill spread to Europe when it came in contact with Islamic cultures. “They started building these asylums,” says Dr. Jain.
The oldest running mental hospital is the Bethlem Royal Hospital, founded in 1247 C.E. in Bishopsgate, London, relocating multiple times over the centuries. “It started for 7-10 people in the inner part of London and gradually moved further and further away,” he says, adding that spaces like this began being built all over Europe.
Madness back then was seen as the work of God or the devil, stemming from the idea that human consciousness is supposed to be of divine origin, says Dr. Jain. This is perhaps why the responsibility of looking after the mentally ill often fell on religious institutions like churches and mosques. “Between 1200 and 1300, the idea that the mentally ill needed to be looked after by the church or charity became popular.”
Changing times
Then, as the Renaissance and, later, the Enlightenment altered people’s ideas about religious beliefs, personal freedoms and governance in Europe and eventually North America, things began to change. “By 1500 or so, the so-called scientific Renaissance started. That changed our notion of the world,” he says. The human being was no longer the centre of the universe; the sun did not revolve around the earth; laws of physics were very clear; microscopes helped us see inside a cell, and so on, he says. “This awareness changed the nature of healing from being the profession of priests to doctors.”
The reduced role of divine providence in the natural world fundamentally changed the way mental health was addressed, a change that was also influenced by other significant moments in history, including the Industrial Revolution and the Age of Exploration, which also led to colonisation. “It opened up a whole scope of human thinking,” he says. As the way of looking at the human mind changed, the profession of psychiatry started changing too, albeit slowly, with the notion of a mental hospital becoming formalised in the early 18th century. Also, since this period coincided with the expansion of colonial endeavours, these radical ideas about how to treat mental health spread to European colonies, including India.
British hospitals
Using illustrations from his book, Dr. Jain also discusses the series of events that led to the formation of NIMHANS. When the British defeated and killed Tipu Sultan in 1799 in the Fourth Anglo-Mysore War and then established their cantonment in Bengaluru a few years later, it influenced the city’s medical infrastructure. “The cantonment moved from Srirangapatna to Bangalore for the simple reason that Bangalore was at 3000 ft high and had fewer mosquitoes,” he says, with a laugh.
The British began establishing their cantonment, constructing many churches, clubs, bungalows and shops in the area. They also built hospitals, with the first general hospital established being the Hospital for Peons, Paupers and Soldiers (today, Bowring Hospital). “The British decided that one thing that did not exist in India was medical services for the poor,” says Dr. Jain, pointing out that there was no proper institutional facility back then. “The import of the British Hospital became a very defining moment for Indian society.”
National Institute Of Mental Health & Neuro Sciences (NIMHANS) | Photo Credit: Handouat E Mail
A brief history of NIMHANS
Dr. Charles Irving Smith, a doctor at this general hospital who was born in the Bengaluru cantonment, played a crucial role in establishing the Bangalore Lunatic Asylum in 1847. Smith, who had studied in England and returned to India as a doctor in 1831, was keenly invested in mental health and went on to found this asylum as a separate ward for the mentally ill inside the Hospital for Peons, Paupers and Soldiers in 1847.
Dr. Jain, in his address, goes on to detail the evolution of this ward into the well-known NIMHANS. Some of the key highlights of this journey include the renaming of the asylum to the Mysore Government Mental Hospital, its move to a new location in Lakkasandra, which is today the State Bank of Mysore, the impact of events like the Great Famine of 1876–1878 and the two World Wars.
He also highlights the contributions of people such as Dr. M.V. Govindaswamy and Dr. Frank Xavier Noronha to the institute. NIMHANS was created in 1974 by amalgamating the Mysore Government Mental Hospital and the All India Institute of Mental Health, which was established by the Government of India in 1954. “All these changes have made NIMHANS what it is,” he says, adding that the institute played a tremendous role in shaping Indian psychiatry.
Challenges ahead
Today, NIMHANS has evolved into a cutting-edge institution, boasting a neuropathology museum and research centre, a blood bank, family wards, a central animal research centre, an electron microscope lab, a human brain bank, and so much more. “Anything biological to be done with the body or brain can be done at NIMHANS today,” states Dr. Jain. The challenge, he believes, lies more in the psychological aspect of mental health that continues to be obscure. “Psychology in India is very difficult because of the linguistic and cultural diversity. A unified psychology is really difficult to emerge from the ground up.”
