Bengaluru's National Institute of Mental Health and Neurosciences (NIMHANS) is considered to be the apex centre for mental health and neuroscience education in India. The journey towards establishing the institution, a pioneer in the field of mental health in the country, has been a long and eventful one.
“One night, when he was sleeping, a devil came at midnight and troubled him very much. Since that time, he was not behaving properly. He used to beat people at home. Hence, people thought him a lunatic.”
“He is morbidly elated in mood, exalted in his ideas, incoherent in speech and violent without sufficient provocation.”
These were the case notes written by Dr Francis Xavier Noronha in 1929, a leading doctor in Psychiatry in Bengaluru, who was responsible for the beginning of progressive change in the way mental health was perceived in the early 18th century. It set the ball rolling for what NIMHANS is today.
Dr Francis Noronha
His extensive work and introduction of the concept of documenting detailed case histories, both personal and psychological, can be seen as the beginning of the idea of establishing an institute to study mental health.
Although Dr Noronha’s studies contributed heavily to the formation of NIMHANS, one has to go back to the 1800s, to trace the history of institutions which treated mental illnesses in Bengaluru.
The beginning
In the year 1839, Dr Charles Irving Smith, who had been a part of the battle of Srirangapattanam fought between the British and Tipu Sultan’s army, pushed for the provision of a hospital to treat mental illness.
In that very year, a ward for treating mental illness was opened at the Hospital for Soldiers, Peons and Paupers in Bengaluru. This hospital was located where the Bowring Hospital currently stands.
A diary maintained by Dr Irving Smith records the setting up of this ward and the daily records of “insanity and mania”.
Dr Charles Irving Smith's diary detailing patients' behaviour
“The most ordinary of early symptoms is morosity, irritability of temper and suspicion of all around them; want of memory and competing with ideas is often a prelude to idiocy. One of the most dangerous delusions is that of a patient under supernatural influence, for a patient will commit any crime or perform any act of delusion that he is divinely directed,” Dr Irving Smith had noted.
According to a book co-authored by Dr Sanjeev Jain, Dr Pratima Murthy and P Radhika, Mindscape and Landscape: An Illustrated History of NIMHANS, Dr Irving Smith may have been the first in Bengaluru to document a case, although as a part of his personal journal.
“One patient became suspicious of European and Indian officials and shot dead an Indian in order to force attention up on himself. He describes patients who showed depressive symptoms, progress to dementia and after death are discovered to have inflammatory changes in the brain. These constitute the first description of what later came to be known as neurocysticercosis,” the book states.
The need for a separate facility
It was Dr Irving Smith’s detailed studies of the patients which led him to push for the establishment of a separate facility to treat people with mental heath issues. In 1850, the Lunatic Asylum of Bangalore was established.
The Lunatic Asylum of Bangalore
The new building was constructed in what was then known as the Pete area (from KR Market surrounding Avenue Road), where the State Bank of Mysore currently stands. Annual reports of the administration of the Mysore and Coorg districts documented the hospital as being “simple but airy, located close to a lake with adequate water supply”.
The patients, unlike most mental health institutes across the world, were not confined to one room. They were let out in open spaces and engaged in activities like gardening and rope making.
“Nearly half of the cases of mental derangement are attributed to the abuse of bhang, opium and intoxicating drugs,” Dr Irving Smith had recorded. Within a few years, the number of patients grew from 60 to nearly 200.
The beginning of progressive change in the idea of mental health
In 1921, Dr Noronha petitioned the then Senior Surgeon of Mysore to rename the Lunatic Asylum as Mental Hospital, with the intention of removing the stigma surrounding the use of the terms ‘lunatic’ and ‘asylum’.
“A lot of prison-like terms were utilised when many of these “asylums” were functional. The people were treated more like prisoners than patients. They had a warden, they had roll-call and they even had to wear uniforms. So naturally all of this became somewhat of a symbol to shame these people,” said Dr Prathima Murthy, Professor from NIMHANS.
Records obtained from NIMHANS’ Department of Publications include a letter written by Dr Noronha to the Senior Surgeon.
“The expression is certainly old fashioned and I venture to add has a stigma. With hope Sir under your regime, you will be pleased to free this institution of this reproachful appellation and raise it to the status and dignity of a mental hospital. The public will undoubtedly appreciate the change,” Dr Noronha had written.
“The National Human Rights Commission played a large part in helping improve institutional care. The Supreme Court had directed people to improve institutional care. Efforts like these helped build a better national health care policy,” Dr Prathima told TNM.
Dr Prathima also stated that once the human rights commission got involved, it allowed people in institutes to get better care without impinging on their rights, but added that this didn’t occur until much later.
Hence, in 1926, the Lunatic Asylum of Bangalore was renamed Mysore Government Mental Hospital. In 1929, Gustav Krumbeigel, the Chief Consulting Architect and designer of Lalbagh Botanical Gardens, was commissioned to design a new building for the hospital.
One of the last remaining photographs of the Mysore Government Mental Hospital
Gustav Krubeigel and others supervising the work for the new building
A site was surveyed in Mysuru’s Hulikal, but progress of work was slow. In 1930, Bengaluru witnessed a huge outbreak of dysentery. It was during this time that Dr Noronha proposed that the hospital be located somewhere between Lalbagh and Basavanagudi as the structure would then be close to the Minto Hospital, Victoria Hospital and Vanivilas Hospital. By 1937, the entire operation was shifted to the new building.
The then ruler of Mysore, Maharaja Krishnaraja Wadiyar IV laying the foundation stone for the new building
Beginning of construction of the new building
The structure was broadly based on the blueprint of the Bethlem Mental Hospital in London. However, Krumbeigel added the gardens and lawns surrounding the hospital. This structure is the current OPD Department of NIMHANS.
The new building after construction
Emergency Department
Patients playing Table Tennis
An institute to study issues related to mental health and how it grew
In 1935, Dr MV Govindaswamy joined as the Medical Superintendent of the Hospital and is till date credited with establishing an “open, model mental health care institution”.
In 1946, the Health Survey and Development Committee, or the Bhore Committee reviewed the state of mental health in India and recommended the need for educated medical staff, who were lacking in most institutions.
The State Government Mental Hospital, Bangalore, which had already built up a great reputation by then, became the centre for training of under-graduate and post graduate students by the government of India in 1963; it became the first postgraduate training institute in psychiatry for the country.
Dr MV Govindaswamy, was the founder of what was in 1954 known as the All India Institute of Mental Health. Academic activities and courses in Psychiatry, Clinical Psychology and Psychiatry were introduced.
Gardening as a form of therapy
First leucotomy lab
In 1974, AIIMH and the State Government Mental Hospital were merged and it came to be known as the National Institute of Mental Health and Neuro Sciences (NIMHANS). Now, the institute has a wide range of courses, an Occupational Therapy and Rehabilitation Centre, the Central Animal Research Facility, Advanced Study for Ayurveda, the Neurobiology Research Centre and the NIMHANS Centre for Well Being.
Psychological testing of patients
Children's centre
Going forward
While NIMHANS has definitely built quite a reputation for itself, and is considered one of the best in the country, Dr Prathima says that there’s still a lot of work to be done.
“Sure, we’ve crossed a lot of barriers, but as far as stigma is concerned, there’s still a long way to go,” she said.
Pictures for the story were obtained from the Department of Publication, NIMHANS. Content regarding the history was referred from the book Mindscape and Landscape: An Illustrated History of Nimhans