Academic journal article Indian Journal of Psychiatry

The Census of India and the Mentally Ill

Academic journal article Indian Journal of Psychiatry

The Census of India and the Mentally Ill

Article excerpt

Byline: Alok. Sarin, Sanjeev. Jain

Context/Background: Epidemiological data have long been considered essential for documenting incidence of disability and planning services. India has been conducting census operations for a long time, and this information may be relevant in the current context. Aims: To document the prevalence of insanity, and discussions about treatment and disability arising out of mental illness in India (1850-1950). Settings and Design: The material used was located at the British Library and the Wellcome Library, London; the Teen Murti Library, Delhi, and web-based archives. Materials and Methods: We have retrieved and summarized the coverage of psychiatric illness in previous census reports from the 19 [sup]th and 20 [sup]th century. Statistical Analysis: None, this relies upon historical archives and documents. Results and Conclusions: Differences in incidence and prevalence of insanity, as well as biological and psycho-social factors in the causation, and outcomes, of mental illness are all discussed in these census reports. Comparisons are often drawn to other countries and cultures, and impressions drawn about these differences and similarities. Similar concerns persist to this day. Disabilities and mental illness were not enumerated since the census of 1941 and have been restored only recently, and this lacuna has hampered planning in the post-Independence era. As we debate policy and plan interventions using contemporary census data, it may be useful to remind ourselves of the issues, then and now.

Introduction

As we wait for the report of the census of 2011 and its partial inclusion of disability (that caused by mental illness being only partially covered) in the enumeration, it may be worthwhile to examine some aspects of the coverage of the mentally ill in previous census operations. This inclusion in the current and future census operations is meant to help plan services for the disabled and the disadvantaged. Census reports of the past, and the analysis and interpretations they offer, would help us understand how services were envisaged, and compare those efforts to what are being conceived now.

1871

The very first attempt to estimate the number of mentally ill in India and the differences in rates of insanity was made in the census of 1871. [sup][1] The census of 1871 was also the first time that estimation of the number of "imbecile, idiot or lunatic" was attempted in the UK itself, and the India data thus offered a useful counterpoise. The number of insane and idiots in India was estimated at 67,000 (1 in 2700), a proportion which was one-eighth that of England and Wales (where the total number of lunatics was estimated as 39,567 of whom 35,790 were in Asylums, in a population of 22.7 million). [sup][2] Absence of over work, over excitement, and low rates of intoxication in India were thought to be one reason for these low rates, while it was also suggested that a chronic starvation perhaps did not supply enough nutrition to the brain (to allow the furor of insanity to occur). Differences between Europe and India were also being observed clinically by then. Commenting on the trends in outcomes for admissions into the Bengal asylums (1848-1870), in the Indian Medical Gazette, [sup][3] it was noted that the proportion of admissions who recovered (55-63%) was higher than in England (34%) and Victoria, Australia (49%). It was suggested that the better outcome was a reflection of the fact that most admissions were for those who were recently ill and the numbers of chronic residual ill were rather small. Death rates were also high, so the outcome for patients was either recovery or death (30-36%, as compared to 20-30% in England and Australia). The census thus detected lower incidence and a background of better recovery for mental illness in India. Within India, Mysore region was reported to have a higher rate of insanity than the adjoining Madras. …

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