Psychiatric services in Jaipur: Past and present

Byline: Shiv. Gautam Era of Asylums (1856-1944) To view the changing perspective of Psychiatry in Rajasthan, we must begin with the story of establishment of lunatic asylums in Rajputana states. It was after the treaty of alliance signed between the native states of Rajputana and the East India Company (1803-1818) that each native state created/established an asylum for detention and care of the lunatics. Initially the lunatics were seen in dispensaries and detained in jails tied with chains. An asylum outside the jail was first established in 1881 in Jaipur state. Ajmer had an asylum inside jail in 1865 (Hendley 1900). Forty unfortunate lunatics were incarcerated inside 'cells' in this asylum, which was situated near Ghatgate (Jaipur). In year 1894, another enclosure in a walled garden near Central Telegraph Office, Jaipur in the southern part of the city was used as asylum by Jaipur state. Here the lunatics were left to enjoy the Open Court Yard and a 'Baradaree', no cots were provided but the atmosphere was more humane and sympathetic towards the unfortunate lunatics who were confined in this asylum. Food and protection were provided by the jail department till 1922, when this asylum was shifted to a Dharamshala situated near Chandpole Gate opposite the present Janana Hospital. Here the lunatics were again put in cells. The medical supervision was provided by the part-time doctors from the jail department. Administration, watch and ward of asylum remained under the jail department till year 1943 (Annual Administrative Reports of Jaipur State, 1894-1943). In 1943, Jaipur state enacted Jaipur Lunacy Act for detention and treatment of lunatics; the criminal procedure code 1926. Jaipur State was amended for the detention and care of the criminal lunatics 1943 (C.P.U. 1943). From the year 1944, the Mental Hospital Jaipur (Lunatic Asylum) started running as an independent hospital under Medical Department of Jaipur State. Till 1922, the control of lunatic asylum was placed under the Rajputana Agency, but after 1922 the administration of lunatic asylum was transferred to Jaipur Durbar. The annual returns from these asylums show a high mortality of lunatics admitted there in, on account of diarrhea, dysentery and fever. Under orders from Jaipur Durbar, the lunatics could be released from asylums for the care of relatives and friends if assured for kind sympathetic care and protection from doing harm to others. All lunatics were admitted under court orders. The discipline of psychiatry is rather a new specialty of medical science. Though understanding of human mind has existed from times immemorial in different philosophical and religious schools, in the middle ages, due to lack of knowledge, superstitions like evil spirits dominated the explanation for various mental disorders. It is only in the late 19[sup] th century that psychoanalytic explanations came in and the last four decades have seen tremendous scientific advancements in understanding of human behavior through biopsychosocial research. The treatment of mental disorders has also been revolutionized in the last four decades and as a result to this the specialty is now a very fast growing subject. As a result of research in mental health, now intricate complexities of the human mind have been understood in terms of neuroelectrical and neurochemical changes occurring in the brain. Specific change occurring with different mood states has been identified and an intervention to bring desired changes in human behavior is now possible. Mental illnesses once thought incurable are now treatable. Mental illness is now considered like any other illness and there is no reason that it should be concealed, and like patients with physical disorder the mentally ill after treatment can be rehabilitated and made useful citizens. Psychiatric Center, Jaipur Psychiatric Centre, Jaipur is the premier institute of the state for treatment and care of mentally ill. …

The discipline of psychiatry is rather a new specialty of medical science. Though understanding of human mind has existed from times immemorial in different philosophical and religious schools, in the middle ages, due to lack of knowledge, superstitions like evil spirits dominated the explanation for various mental disorders. It is only in the late 19 th century that psychoanalytic explanations came in and the last four decades have seen tremendous scientific advancements in understanding of human behavior through biopsychosocial research. The treatment of mental disorders has also been revolutionized in the last four decades and as a result to this the specialty is now a very fast growing subject.
As a result of research in mental health, now intricate complexities of the human mind have been understood in terms of neuroelectrical and neurochemical changes occurring in the brain. Specific change occurring with different mood states has been identified and an intervention to bring desired changes in human behavior is now possible. Mental illnesses once thought incurable are now treatable. Mental illness is now considered like any other illness and there is no reason that it should be concealed, and like patients with physical disorder the mentally ill after treatment can be rehabilitated and made useful citizens.

PSYCHIATRIC CENTER, JAIPUR
Psychiatric Centre, Jaipur is the premier institute of the state for treatment and care of mentally ill. Founded in 1952, the institution has completed 53 years of its

ERA OF ASYLUMS (1856-1944)
To view the changing perspective of Psychiatry in Rajasthan, we must begin with the story of establishment of lunatic asylums in Rajputana states. It was after the treaty of alliance signed between the native states of Rajputana and the East India Company (1803-1818) that each native state created/established an asylum for detention and care of the lunatics. Initially the lunatics were seen in dispensaries and detained in jails tied with chains. An asylum outside the jail was first established in 1881 in Jaipur state. Ajmer had an asylum inside jail in 1865 (Hendley 1900). Forty unfortunate lunatics were incarcerated inside 'cells' in this asylum, which was situated near Ghatgate (Jaipur). In year 1894, another enclosure in a walled garden near Central Telegraph Office, Jaipur in the southern part of the city was used as asylum by Jaipur state. Here the lunatics were left to enjoy the Open Court Yard and a 'Baradaree', no cots were provided but the atmosphere was more humane and sympathetic towards the unfortunate lunatics who were confined in this asylum. Food and protection were provided by the jail department till 1922, when this asylum was shifted to a Dharamshala situated near Chandpole Gate opposite the present Janana Hospital. Here the lunatics were again put in cells. The medical supervision was provided by the part-time doctors from the jail department. Administration, watch and ward of asylum remained under the jail department till year 1943 (Annual Administrative Reports of Jaipur State, 1894-1943).
In 1943, Jaipur state enacted Jaipur Lunacy Act for detention and treatment of lunatics; the criminal procedure code 1926. Jaipur State was amended for the detention and care of the criminal lunatics 1943 (C.P.U. 1943). From the year 1944, the Mental Hospital Jaipur (Lunatic Asylum) started running as an independent hospital under Medical existence. Like the discipline of Psychiatry, the initial development was rather slow. But after its recognition as a postgraduate teaching department of the medical college in the year 1980, development has been seen in certain areas of its growth. A 20-bedded emergency ward was started in the year 1981 for the patients requiring urgent care and management. The admission facility in the emergency ward is available round the clock. A separate 12-bedded de-addiction ward was also started in the year 1986 to meet the special needs of the drug-addicts.
The outpatients department of the Center is run by consultants, civil assistant surgeons and postgraduate students. At present there are three Associate Professors, six Assistant Professors, five CAS and nine postgraduate students. There are posts for two clinical psychologists and two psychiatric social workers, who collaborate with the professionals for the psychological testing and psychosocial therapies.
The Center has facilities for routine biochemical and pathological testing. Special investigations like EEG, ECG, X-ray, serum lithium estimation and CAT SCAN etc. are either available at the Center or at SMS Hospital. A Bio-feedback apparatus has been added to the department in the year 1996-1997.
There is a separate rehabilitation center for occupational therapy, where patients are given opportunity to work and learn some skills according to their aptitude and therapeutic needs, patients are being involved in the work of carpentry, canning, gardening, painting, in kitchen work, making paper bags for the distribution of medicines in the outpatients department. The rehabilitation therapy department needs to be better equipped to be helpful in the long-term rehabilitation of patients.
A regular General Hospital Psychiatric Clinic is being run at S.M.S. Hospital by the consultants and senior postgraduate students from the department. A 20-bedded de-addiction ward has been started at SMS Hospital. It meets the needs of those drug-addicts who do not want to get admitted at the Psychiatric Center. The need for such a facility was long felt.

TEACHING AND RESEARCH ACTIVITIES
The The department also organizes de-addiction camps in the community with the co-operations of voluntary organization. The center was also given the responsibility of training of doctors from PHC's in de-addiction management.
School Mental Health Program has also been initiated by the department and an awareness building program for mental illnesses and drug abuse prevention in school going children has been initiated. A training program for the school teachers was also organized for their orientation and role as counselors in emotional and behavioral problems of school children.

DEPARTMENTAL RESEARCH
There are ample opportunities for research in Psychiatry and related disciplines in behavioral sciences at the center. The postgraduate students through their work on the dissertations are also taught the basic principle of research methodology.
The center has been actively involved in psychiatric research. Two projects supported by Indian Council of Medical Research (ICMR), one projects supported by Mental Health Foundation, United Kingdom (Jaipur-London project) apart from the regular departmental research have been completed. The center has also participated in the World Health Organization (WHO) field trials for International Classification of Diseases, putting this department on the world map of Mental Health.
Apart from this many other research activities are going on in the center. Nearly 200 scientific research papers have been published and presented by the members of the faculty in National and International journals and conferences. Author has received various prestigious awards namely Bhagwat Award, Marfatia Award, Tilak Venkoba Rao Oration Award, Poona Psychiatric Association Award at National Level and International New Horizon Award for work in de-addiction and drug awareness.