“You can judge a society by how well it treats its prisoners.” — Fyodor Dostoevsky
While I concur with this aphorism, I have often wondered whether the great Dostoevsky ever attempted to assess the compassion of a society by the treatment that is meted out to its mentally ill members. And whether he would consider this test just as valid as assessing the prisoners.
Prisoners undoubtedly have had a very rough deal if we, as it is so often claimed, believe that the primary function behind the goals is reformatory rather than custodial. But my own view is that the mentally ill have had an infinitely worse deal all through history the world over.
As a long-term student of history of medicine, I have always been distressed learning about the tribulations the mentally ill have had to endure historically! They still continue to do so.
There have been visionaries like Philippe Pinel in France and John Connolly in England who have taken up cudgels on behalf of the mentally ill but the impact they have had can be assessed by the fact that straight jackets and padded cells were common place in mental hospitals more than a 100 years after their innovative measures. And all this was happening when it had been accepted that these unfortunate individuals were suffering from an infirmity that not just needed medical attention but societal understanding. The saddest part is that although many of the European mental hospitals have abandoned forcible involuntary restraint, there are several countries where these outdated modalities are still being enforced; I have myself worked in some of those countries. And despite the passage of the path breaking resolution by the United Nations Human Rights Council on the 1st of July 2016 fully recognizing the rights of the mentally ill, there is no public outrage over denial of human rights to the mentally ill; rather there is almost a tacit acceptance of their condition.
And that is a very sad commentary on the society! We in India sadly have more reason than most to feel guilty. After all the very first description of psychosis anywhere in the world appears in the ayurveda where ‘unmada’ is graphically described. I think it would be an excellent idea go through the classic book Alien and Alienists authored by my former London colleague Roland Littlewood which graphically adumbrates the plight of the mentally ill in different parts of the world through different historical times to gain an insight of the magnitude of the problem and its dimensions.
Any section of the society that has been collectively placed at a disadvantage through no fault of its own deserves to have committed advocates to explain its plight. Those who suffered from institutionalized racism have had their advocates; and it is largely through their efforts that racism was brought into contemporary discourse and measures taken which had a positive effect. Similarly, there have been lobbies, which have and continue to campaign on behalf of women. It is perhaps the mentally ill who do not find effective advocates on their behalf. And there is no better evidence of this than the fact that it was only a few weeks ago that the United Nations formally recognized that these people had rights.
I have already penned several columns on this issue, some in this very portal. We in India have always been shamefully insensitive to the plight of the mentally ill. Our neighbours have done no better.
A few days ago I expounded on the case of Mr Imdaad Ali who is suffering from paranoid schizophrenia in Lahore. He was sentenced to death for a crime clearly committed when he was psychotic and the worst part was the absurd assertion by the Pakistan Supreme Court that schizophrenia was not a mental illness as it was a ‘recoverable’ condition. More significant was the fact that there has been no international outcry at such a heinous instance of injustice either from the international human rights organizations or the medical profession; it was clearly warranted! I just cannot imagine similar inertia had Mr Ali been a victim of racial or religious discrimination!
I can update on the issue here. Several Pakistani senators took up this matter and appealed to President Mamnoon Hussain to condone the death penalty. More significantly the Chief Justice of the Pakistan Supreme Court took cognizance of the matter and asked the government to present its position while suspending the execution of the death sentence. I am confident that international and national pressure played a part in this temporary reprieve, which I would like to believe would result in justice for the unfortunate sufferer.
It would not be erroneous to state that there is not a single one of us who has not witnessed psychotic patients loitering on the street eking out a living through foraging. The interrogatory that I would like to pose here is how many of us have made any effort to play our part in elimination of this injustice. I have myself noticed on occasions the sadistically perverse pleasure that many derive from ridiculing the unfortunate sufferers. How many of us have even paused to wonder that behind every mentally ill who has been rejected so cruelly by the society lies a story of a fellow human being, which we must try to understand. Most of them have had families, which rejected them so cruelly. And any attempt to ridicule an ill person is complete abomination.
Part of this apathy can perhaps be understood by the negative perceptions of the prognosis of mental illnesses. This, of course, is a myth and it befuddles me why it has not been challenged so far. I have myself known hundreds of mentally ill who have recovered and with proper treatment and follow up are holding very responsible positions. Having worked in Philadelphia, we were all aware of a mentally ill patient from New Jersey who after having recovered from mental illness went on to do seminal work in mathematics, which fetched him a Nobel Memorial Prize in Economics. He went on to assist in the publication of his biography, which graphically describes his battles with psychosis.
We may not be able to reproduce a John Nash through humanizing the mental health care in our country. But we can offer hope to countless sufferers if we commit ourselves to our ethical obligations not just in letter but also in spirit. Call me a dreamer but I would like to witness that transformation in my lifetime!
by Dr Ashoka Jahnavi Prasad