A healing space

SANJEEV JAIN & PRATIMA MURTHY

The National Institute of Mental Health and Neuro Sciences (NIMHANS), located on the grounds of the erstwhile Mysore State Mental Hospital, was designed as the first modern, open mental hospital in the early 20th century.

The man behind this was Frank Noronha. The hospital’s origins, and its development in the context of the medical and social history of Bangalore (and India), thus offer a glimpse into the influences that shaped mental health services and education in India.

Frank (Francis Xavier) Noronha, born in 1878, studied at the Madras Medical College, joined the Mysore Medical service, and also served in the Army. After the First World War, when efforts were made to improve the care of the mentally ill, Noronha became one of the first doctors to be formally trained in psychiatry at the new Institute of Psychiatry in London.

The building, however, was a successor to a century of work and ideas. Dr Charles Irving Smith was born in Bangalore in 1809. After his education as a doctor in the U.K., he started his career in the same city in 1831 and began treating patients with ‘lunacy and mania’ at the Hospital for Soldiers, Peons and Paupers, which was established in the Bangalore Cantonment area as one of the first civic services provided under the rule of the East India Company. Dr. Smith also contributed immensely to the establishment and improvement of hospitals in Mysore, and later served as the Inspector-General of Hospitals for Madras and Rangoon.

Till the late 19th century, the Mysore Kingdom (which had become independent following the Rendition of 1881 and the Government having reverted to that of the Maharaja) was the only native kingdom that supported a lunatic asylum. It was thus identified as one of the regions of progressive governance, and its commitment to improving medical services was further strengthened by its support for many large hospitals in Bangalore and Mysore. A larger asylum was recommended as the population was likely to grow from the 150,000 that it was at that time!

Dr. F. Noronha was thus sent off to the U.K. in 1922 to train as a professional psychiatrist and also to manage the new asylum being planned. On passing his DPM exam, he became a member of the Royal College in 1924, where he was introduced by Sir Frederick Mott (a famous psychiatrist and geneticist). On his return, he improved the case notes and introduced a formal examination and files for every patient, and many other reforms (including the diet). Equally importantly, by this time, the financial burdens of the First World War were getting over, and the Kingdom finally had enough resources. Though initially a site in Mysore (close to Huikal lake) had been mooted, Dr. Noronha was of the firm opinion that Bangalore was to be preferred as it was close to already established large medical facilities and “ which (while) being fairly away from the main centres of population will still be within easy reach of the principal medical institutions”.

The second highest hillock in Bangalore (the highest having been developed as the Indian Institute of Science) was thus chosen. Sir Mirza Ismail was the Dewan by then and he shared a passion for gardens and well-designed public spaces with Dr. Noronha. Sir Mirza Ismail believed that well looked-after gardens and avenues cost little but yielded much “in the effect (they) had on peoples’ minds”.

Dr Noronha was also a very keen gardener, and many of the trees were chosen by him, in discussion with Gustav Krumbiegel, the eminent botanist from Germany, who designed the gardens at the Bangalore Palace at that time, and the Lal Bagh. More than 75 species of trees, both native and exotic, can be found in the campus of the Hospital. The plans of the garden were prepared in conjunction with those of the building, and Dewan Mirza Ismail was very proud of the fact that they had created parks in the Mental Hospital, which were often used as picnic-grounds for the citizens of Bangalore (and thus by association, the stigma and exclusion of mental illness was reduced).

The new building itself was loosely based on the plans of the Institute of Psychiatry building, then was housed at the Bethlem hospital site in Moorfields. It was constructed by the civil engineering firm, the Mysore Engineering Company (MEC), which was staffed entirely by Indian engineers and was responsible for many public works. It was considered essential that the spaces in an asylum provide an environment conducive for recovery, and this principle lay at the root of asylum design, where “where one could be both mad and safe”.

This careful consideration to a healing environment contrasted sharply with other asylums in India, which were often hand-me-downs from jails or barracks. This building, and the Hospital for Europeans and Indians in Ranchi, were the only two custom-built asylums in British India in the early 20th century, and were designed with the explicit purpose of providing a healing environment, and with all the necessary ‘modern’ attributes. The old asylum on Avenue Road was closed, and the staff and patients moved to this site in 1937.

Prof. E. Mapother, who headed the Institute of Psychiatry in London, while on a visit to India in 1937, was so impressed by the Mental Hospital in Bangalore that he strongly recommended it as the only one fit to impart post-graduate training and also because Bangalore was modern, cosmopolitan and free of communal or anti-Western feelings. His suggestions to the pre-Independence reform process were probably instrumental in the decisions made soon after, and the AIIMH was formally established in 1954 in association with the Mysore State Mental Hospital. Psychiatric services of Mysore, which began in the 1830s, thus, became part of the social life of Bangalore, and India. The Asylum has evolved into an Institute of some renown, and its services are used by more than 1000 persons every day. Almost 1000 psychiatrists, and several hundred other specialists have trained here and it has now become a hub for research into many aspects of the brain and mind.

Institutional histories are not merely an account of the brick and mortar, but also the ideas (and the trees) that are planted and nourished therein. The attention to the needs of the disadvantaged, provision of the best possible care for them, in the best possible environment, and concern for both the physical and mental spaces that surround those with mental illness, indicated a deep concern about the lives of the citizens.

The garden and the building are to be seen as a manifestation of this ideal, and perhaps deserve a heritage status. As we celebrate 75 years of the building, and its gardens, one would do well to remember those ambitions.

(Prof. Sanjeev Jain is Head of Department of Psychiatry, NIMHANS. Prof. Pratima Murthy heads the Centre for Addiction Medicine in the Dept. of Psychiatry, NIMHANS.)

http://www.thehindu.com/todays-paper/tp-features/tp-sundaymagazine/a-healing-space/article4543062.ece