Monsters in the Mind

“Since wars begin in the minds of men…, it is in the minds of men that the defences of peace must be constructed.” – So begins the loftily worded preamble of UNESCO in defence of its mandate to further the cause of education and culture around the world. And perhaps justifiably so…. any one who has read the latest India Today issue peeping into the minds of terrorists, Zia ur Rehman, Sauquib and Muhammad Shakeel can find it to be quite a terrifying read.

The three are a chilling example indeed of how war or terror – whatever be its ultimate expression does indeed begin in the minds of humans. But the worrying thing is that the armaments necessary for such a battle are not readily available in the country and so this decisive battlefield may be getting conceded by default. If the mind is the decisive battlefield where things happen, then some attention needs to be paid to the mind of the Indian people and its health.

But what has the mnd got to do with rising fanaticism and one of the most visible manifestation of which is terror ? has got to do with the matter of terrorism, you might ask. Well look at this : According to a study on Post-Traumatic Stress Disorder (PTSD) in children and adolescents affected by the communal violence in Gujarat, conducted in February 2006 by mental health professionals belonging to the Psychiatry Department of B J Medical College and Civil Hospital, Ahmedabad, close to five percent of the 255 interviewed showed signs of the disorder even four years after the riots; 9.4 per cent suffered from depression.

The genesis of the study in itself points to a problem that has up till now been more or less ignored. According to Dr G K Vankar, head of the psychiatry department at the Civil Hospital and the principal author of the study, the research was done on the request of the non-government organisation Self Employed Women’s Association (SEWA). The organisation’s staff, who works with the riot-affected, felt that several children had become “rebellious”, says Vankar. “The children were not obeying their mothers, they were not studying,” he adds.

How far of a journey is from the pain and the traumatic scars of the riots to the jihadi uncovered by India Today? Not very long it would seem “We’re all equals in the jihad for Allah, but I was associated longer with the Allah ke bande (men of God). He was happy with the way things were happening. A handful of Allah ke bande were able to paralyse the economic life of such a big country by targeting metros and nothing much could be done about it. We gave back what we were getting from them,” Shakeel says.

Could we have done any thing to retard the spread of hatred and fanaticism ? May be , if you see that a lot of indoctrintation and brain washing happens in a context where the mind is often unble to make discerning judgements and think for itself, allowing one to implant alien ideas and giving them a welcoming home

If we consider that nearly two third of persons with known mental disorders never seek help from health professionals, that is a large number. Most others utilize the services of other agencies and resort to harmful practices and keep on visiting faith healers and delay the treatment till the condition deteriorates which compels them to seek the treatment from established institutions. Stigma, discrimination and neglect prevent care and treatment reaching people.

7 percent of Indians, or around 7 crore people, suffer from mental disorder in one or the other form, but the healthcare facilities are woefully inadequate. Describing the situation as serious rights issue, the National Human Rights Commission (NHRC) has taken up the matter with the Medical Council of India (MCI).

Well with psychiatric conditions and mental illnesses slowly creeping up the statistical ladder, it is good that that the Human Rights Commission is taking cognizance of the fact. One only hopes that it will do more than talk to the generally somnolent Medical Council and find some more active players to take note of this monster in the mind.

The views expressed in this post ar

Kalawati,Government and the NGOs

While channel-surfing after the parliamentary vote, I ran into one channel analyzing the speech of Rahul Gandhi, generally considered well-delivered. The television commentator prefaced his comments by saying that Rahul Gandhi began by making NGO-ish comments like his visit to the house of the Vidharbha widow Kalawati and talking about subjects like women’s welfare. Subsequently the anchor explained, Rahul went on to talk of more substantive things pertinent to the matter at hand. This comment of the anchor made me stop and think. Think quite a bit. Because the anchor seemed to be saying that topics like citizen’s welfare are not matters of critical concern to government and that these subjects can be left to the intervention of NGOs. If this is the thinking, than it is a sad state of affairs. It seems to by default reinforce the thinking that the government’s imagery is that of a militaristic big brother, bothered only about nuclear bombs, a strong army and police and national security and the welfare of its citizens is a second rate agenda that can be out sourced to NGOs.

Actually it could be construed that it is a shame that NGOs have to exist in the manner that do and perform the functions that they are performing – running schools, and orphanages and hospitals and feeding centers and performing other such other services. A lot of these initiatives have their origins in colonial times when church run institutions and others began this work. However it is easy enough to accept and understand that social sector investment would not be a priority for a colonial government unless it furthered their commercial or strategic political interests. That these functions still need to be performed by the voluntary sector sixty years and more after independence is actually a shame. In most developed societies, governments take care of the basics necessities of their citizens through direct provision of services as in the socialist states or through creation of viable social safety nets. NGOs typically act as watch dogs overseeing the implementation and efficacy of programs rather than actually run programs.

That NGOs would usually do in relief situations where systems have broken down and governments often do not function. The fact that government involvement in the sectors of education, health care and other social sectors is at a level that voluntary organizations need to raise resources – often from overseas and deliver services on the ground, should say some thing. From time to time, the government talks of regulating the activities of the voluntary sector and especially of those who get funding from overseas. This is seen as a way of controlling the work and activities of the sector. Well, the fact of the matter is that there is a more effective and sustainable way of controlling the activities of the voluntary sector.

If only the government would take sectors like education, health care and grass root level poverty alleviation and not just macro economic structural reforms as seriously as it deals with say issues like terrorism and national security and invest in them wisely and well- not just in terms of financial allocation though that is important too, but also in terms of the brightest and the best being assigned to administer these schemes. That would pretty well make most NGOs obsolete and out of work and there would be no further need to regulate them. and in the mean time, while the government gets its act together – that is if they wish to do so, there is a need to recognize the many groups – small and big, known and unknown who serve the many Kalavatis of the land.

The State of India's Mind

On a quiet September morning in the criminal ward of the Psychiatric Centre Jaipur, Ramesh caught hold of 70-year-old Muhammad Janaad by his hair, yanked him out of his bed and threw him on the floor. Then he dragged him under one leg of the bed, climbed on to it and kept jumping till Janaad was killed. No patient is supposed to be treated like a prisoner at the Psychiatric Centre Jaipur but those housed in the criminal ward might as well be in jail. Covering the incident, Tehelka informs that in a country of more than a billion people, there are 36 state-run mental hospitals in India and only 500 qualified psychiatrists manning them. This too in an age when mental illnesses and particularly stress related and induced disorders are increasingly blipping on the radar screens. Unlike other areas of health care, our procedures and systems in the area of mental health continue to be governed by antiquated procedures and rules. Though in theory, the mental health scenario in India is governed by the provisions of the Mental Health Act of 1987 which repealed the Indian Lunacy Acts of 1912, many of the procedures have not changed much.

As the term “lunacy” in legal usage itself indicates, the evolution of the mental health law in India has interesting origins. In the early 19th century, experts and administrators believed that the tropical climate was one of the causes of mental disorders among the Europeans living in India. Accordingly European patients, who did not improve within six months after their admission in a mental hospital in India, were sent to England for treatment. The passage money and other expenses were paid by the East India Company as loan to be repaid by the recovered patient. The practice began in 1818. In course of time the cost-effectiveness of this exercise was called into question. In order to regulate the selection of such patients the need for enactment of a law became apparent. In 1851 the “Lunatics Removal Act” was passed. This Act has the dubious distinction of being the first mental health legislation in British India. In pursuance of this Act and the rules framed there under, the flow of patients gradually dwindled, till it came to an end in 1891.

The enactment of India Lunacy Act, 1912 had a far-reaching consequence and impact on the whole system of mental health services and administration in India. Under this new legislation the central supervision of all mental hospitals became a reality. This is a fundamental change in the management of mental hospitals. These hospitals were thus removed from the grip of the Inspector General of Prisons. The next most important change was the recognition of the role of specialists in the treatment of mental patients. Psychiatrists were appointed as full time officers in mental hospitals

However, the mood and climate that faces the mentally ill is that of the eternally doomed. The winds that blow through the mental health ward are not those of concern, love and compassion but of regimentation, confinement and callous indifference. The over all management of many psychiatric institutions is still quasi judicial. The judiciary can order hospitalization of prisoners when it might not be required and in these cases professional psychiatrist expertise is essential. There is little hope for patients in a custodial environment which breeds isolation and exclusion. They are deprived of any skills for daily living and social interaction. There is no counseling to prepare patients for adjustment problems, relapses, re-admission or abandonment.

Less than one per cent of India’s total health budget is spent on mental health, with a large chunk being devoted to communicable diseases. A national mental health programme has been in place since 1982, but its implementation has been hindered by a greater focus on illness rather than on comprehensive mental well being. Even the Mental Health Act of 1987 is narrow in focus relating to severe illnesses and disability and the The Indian experience on institutionalized mental help as well institutionalization of patients itself has not been civilizing.

A report prepared for the National Human Rights Commission (NHRC) in 1999 after an empirical study of mental hospitals in the country made a condemnation of the state of mental health institutions. Clearly in the years gone by since then, not much has changed and a lot of attention and resources is needed to shake the state out of its state of apathetic lethargy