Academic journal article Indian Journal of Psychiatry

Tracing the Development of Psychosocial Rehabilitation from Its Origin to the Current with Emphasis on the Indian Context

Academic journal article Indian Journal of Psychiatry

Tracing the Development of Psychosocial Rehabilitation from Its Origin to the Current with Emphasis on the Indian Context

Article excerpt

Byline: S. Sundaram, Sneha. Kumar

Mental illness and mental health are concepts that have existed from time immemorial. In India, the Atharvaveda and Vedic texts and traditional medical systems such as Siddha, Unani, and Ayurveda have described mental health and disorders, in detail. The advent of the mental hospital brought in the 'chemical revolution' in psychiatric management. The early nineties witnessed the birth of psychiatric rehabilitation in India. These developments saw a shift from a biological to a biopsychosocial model. It embraced the individual, family, community and society into the treatment process. The present rehabilitation process is geared towards providing quality of life, community living, accessible and suitable care.

' High high in the hills, high in a pine tree bed.

She's tracing the wind with that old hand, counting the clouds with that old chant,

Three geese in a flock

one flew east

one flew west

one flew over the cuckoo's nest '

-Ken Kesey, One Flew Over the Cuckoo's Nest

Mental illness and mental health are concepts that have been existent from time immemorial. The history of mental illness and the trajectory of psychiatric care have been through the dark and despondent, superstitious, and stigmatized, radical and resourceful, experimental, and empirical. The first stirrings of the mental health movement began in Greece, Jerusalem, and the Islamic world in the 4th century AD, slowly spreading to the rest of the world. India, a land of diverse cultures, was no stranger to the concepts of mental illness and more importantly, mental health. The Atharvaveda talked about divine curses, and mental disorders were described in the Vedic texts. Traditional medical systems such as Siddha, Unani, and Ayurveda also described mental health in detail.[1]

By the 18th century, 'lunatic' asylums were set up across continents. This was an era of institutionalization where people with mental illness were kept in asylums for psychiatric treatment and kept away from family and society. The underlying assumption was that they posed a danger to self and others. The concept though started with the sentiment of modernizing psychiatric care had several drawbacks, namely, use of restraints, abuse, unhygienic conditions, poor nutrition, and overcrowding. The prevailing condition of the time led to the development of the humane care approach toward the late 19th and early 20th century with influential and leading names in psychiatry paving the way for better care.[1]

The British Raj saw the setting up of several mental asylums across India. These asylums cropped up in major cities such as Calcutta, Madras, and Bombay.[1] Some of them, like their Western counterparts, also saw a period of chaining, unscientific procedures, inhumane treatment, and overcrowding while others had started implementing rehabilitation practices involving psychotherapeutic inputs and involvement of local communities in psychiatric care.

The advent of the 'mental hospital' began with the establishment of the Government Mental Hospital, Kilpauk, Madras whose ancestry traces back to more than 200 years. The 1950s was considered a landmark for the hospital wherein it saw a revolution in the treatment of the mentally ill. It was a 'chemical revolution' in psychiatric management, with the introduction of antidepressants and anxiolytics. The practice of psychiatry became more humane and modern.[2]

In the year 1922, it was recognized as a 'Government Mental Hospital' in keeping with the developments being made in the field of psychiatry. The hospital made great strides in achieving an ideal 'doctor-patient' relationship and brought in 'voluntary board admissions' that modified the application of the Indian Lunacy Act, 1912, setting a precedent for others to follow. The 'open hospital' system was introduced which facilitated the removal of physical restraints; psychiatric outpatient clinics were introduced in two general hospitals of Madras, thus, promoting referrals and reducing overcrowding in the mental hospital. …

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