“Patients were conveniently dumped there by their families. They feared to take them back, since managing them at home was difficult when they turned violent”

Your exemplary services in psychiatry spans more than 75 years. Looking back, how do you view your journey?
It has been very exciting and rewarding. I am very happy that I chose psychiatry as my subject of specialisation, at a time when it was not even heard of. The mentally ill who suffer severely are easily misunderstood due to their lack of communication skills and unusual body language. Treating and rehabilitating them is no small challenge, and for me accepting the challenge has been a gratifying experience.

You were born in Kerala, but brought up and educated in Chennai. Tell us about your early days and schooling?
My father served as a Judge under the Madras Presidency. As Chennai was part of the province, it was but natural that my education happened here.

After my admission to Class 2, I was asked to recite a poem. I said I did not know any. With a serious face my class teacher joked, “Come on dearie, I will kill you if you do not recite one tomorrow!” Frightened to death, I vanished in no time and took refuge in class 1! There I continued hiding for nearly 6 months until our Mother Superior, who very sweetly, but with great difficulty convinced me about the joke, and brought me back to class 2! My higher classes were done in Good Sheperds School, and my Senior Cambridge at Church park .

What prompted you to take up medicine in college?
The seed was sown during my first visit to the Egmore Hospital as part of a sightseeing spree with my mother and her friends, who had come to Chennai. I was only 13 at that time. What I saw in the crowded hospital was deeply imprinted on my mind. That eventually led me to the medical profession. I had to spend an extra year to learn science in order to be eligible to do Zoology prior to my medical studies.

How did your family react to your decision?
My family strongly opposed, including my father’s close friends, who themselves were doctors. They were worried about the struggle of five and a half years of college, and the stress and strain of the practice. According to them, a teaching job after some basic graduation was the ideal occupation for women!

But I stood firm. Luckily, my brother sided with me and helped me to get into Madras Medical College (MMC). Medical education was free for women at MMC those days. Yet, very few women came to study. After my residency at Moulana Azad Hospital in Delhi, during 1947, my first placement was at Pithapuram in Andhra Pradesh. There I had to learn Telugu, to converse with the patients. Soon I got back to MMC and did my MD in general medicine here.

Again, in an era when few women went to medical colleges and almost none ventured to study psychiatry, you dared to specialise in mental illness. How did it happen?
During a ward visit as part of my studies, I happened to meet a girl who was shabbily dressed and behaved strangely. She also had turned violent. I saw her being given a very strong injection. It was an extremely painful one, but, the only available remedy of that time. Her pathetic plight was terribly disturbing. I guessed that something was seriously wrong with her mind. I was inquisitive to know more about this comparatively lesser known area of diseases. The subject of my further specialisation was decided, then and there.

Psychiatry was least popular those days. Good learning centers were not many. Fortunately, I got admission for a two-year specialisation course at NIMHANS, Bengaluru. I joined their third batch and graduated as the first woman psychiatrist from there .On completion, I was posted as the first woman Assistant Surgeon at the Mental Hospital in Chennai. Soon I was promoted as the first woman Superintendent of the Mental Hospital.

What was the state of the hospital, when you took over?
It was terribly overcrowded and understaffed. There were about 2800 inmates, a 1000 more than the official records. It was more like an asylum. The atmosphere inside was suffocating and miserable. Food and medical supplies were limited to 1800 patients only.

Patients were conveniently dumped there by their families. They feared to take them back, since managing them at home was difficult when they turned violent.

What were the reforms and changes that you introduced?
My first decision was to increase the number of the working staff. Around 25 social workers were appointed, and an out-patient ward was also opened, where documenting the case histories was made compulsory.

Reducing the number of admissions was my next challenge. We contacted the families, advised and encouraged them to bring the patients in the morning and take them back in the evening, assuring them of good day care. They were half-hearted in the initial trials. Later, convinced of the working pattern and the improved conditions of the patients, they gradually agreed. Patients who turned violent had to be sedated, before they were sent home.

We further reduced the number of visits with medication and counselling, to once a week, for the follow-ups, reviews and medicines. Social workers were the connecting links between doctors, patients and their families. They documented the patients’ particulars, listened to those who were eager to talk, and contacted the families for timely follow up and review. This way doctors could focus more on the diagnosis and treatment.

New buildings, better amenities, vocational training centres and recreational facilities were also introduced. More number of trained occupational therapists, recreational therapists, and psychologists were placed. Rehabilitation and social acceptability were given priority.

How was the rehabilitation planned?
Without effective rehabilitation, I felt that no treatment was complete. Our occupational therapists were trained to encourage the patients to bring out their talents and abilities, whatever may it be. Over small talk and simple exercises of self introduction and light refreshments, many of them opened up. Patients were helped to do what they were good at, mainly to engage them productively.

Amazingly, with constant support and guidance, patients produced various things, depending on their ability, interest and mood, which included detergents, paper covers, and other handcrafted objects. The products were sold outside. I remember, those days, I personally approached the customers to get them sold. We supplied paper covers even to the temples of Thiruthani and Tirupati. Incentives were paid to the patients for their labour, which they took home. Baking was also a huge success after our old hospital flour mill, was made to function.

Patients at some stages only eat and sleep, having no motivation, and families often accused them of being lazy. Trained staff on such occasions made the families understand, that it was only due to the illness. The families then realised the need to assist the patients in their daily chores like brushing teeth, grooming and so on.

Difficulty in communicating is seen as a major problem with the patients. I remember a patient, an expert weaver who sat helplessly staring at the loom for hours unable to express the problem, until his trainer at the therapy division came to his rescue.

Do you think the stigma on mental illness still persists?
Yes, the stigma continues, even in these modern times.
Stigma is confined not only to the patients or the families, but it extends also to the subject of psychiatry. It is an ignored subject even in our MBBS syllabus. Psychiatry is not taught from the first year as other streams of medicine. Since there is no separate exam for it, most of the students attach no importance to it. It is a very sad state. I feel strongly about the need for more psychiatrists in service, and have recommended posting one each, at least, in all the women’s hospitals. It is disappointing, that till date nothing has been done. Around 50% of the women’s illness could be attributed to their emotional problems, due to the stress and pressure they undergo at home. Under such circumstances, psychiatric services would be a great boon to them. Frankly speaking, even psychiatrists are treated sceptically. Families of the patients visit them discreetly. Many avoid appearing with them publicly fearing the society’s branding. I remember many occasions where the wedding invitations came with an apologetic request from the guardians, as, “You need not bother to come, hope you will understand, doctor. Your blessings are all that we seek”.

Lack of understanding of the illness, and the reluctance of acceptance are the major stumbling blocks to be dealt with. People should understand that mental illness is neither a sin, nor a punishment given by God for your previous birth’s bad deeds. Just as any physical problem that cripples or disables the affected part of the body, the illness here affects the mind, and that is all.

However, people are a little more open than before about consulting, thanks to the growing awareness, which is very vital, in early detection and treatment. With the advancement of science, many effective drugs are also available for better results and cure.

SCARF has been your brain child…tell us more about it?
I felt a need for promoting rehabilitation outside government services also. Many like-minded joined me. Thus SCARF (Schizophrenia Care and Research Centre) was founded in 1984. Currently it also acts as a collaborating centre of the World Health Organization (WHO). Several philanthropists and mental health professionals like psychiatrists, psychologists, social workers, rehabilitation experts, and administrative and support staff, pool in their services there.

You have been tirelessly battling all your life for the betterment of the mentally ill. What are your ways of relaxation?
Till a couple of years ago, I was busy visiting hospitals and practising daily at home. But, now I do take breaks. Consultation at home is confined to two days a week. My nephew, who is a psychiatrist, takes over the rest of the days. I find time to read, socialise and watch movies. But my best relaxation always has been my work and improving on it, which I consider a pleasure even today.