Having a mentally ill person in a family becomes a matter of shame and embarrassment in our ‘civil society’. Let me clarify here that I am talking primarily of our middle class with a heavy load of morals and values on its shoulder. The energy of the entire family gets focused on ‘covering it up’ as much as they can and till they can. The ill person is often smuggled out of the house to some faraway destination where acquaintances are far and few. Spiritual cures, exorcism and other methods are tried before finally contemplating to take the person to a mental hospital – the last resort for most.
By this time usually months (if not years) would have passed. The family itself had undergone extreme stress in coping with this person’s strange behavior besides working on the continuous cover up for the numerous inquisitive relatives and neighbors. More than physical, it takes a toll on their mental make up - the mind working all the time to hide the truth, creating stories matching the previous ones and feeling ashamed. Also add to this, the pain of ‘losing’ a family member, who may show no sign of getting back to normal and the economic burden of managing a non-functional family member.
So, when they reach with this person to a hospital with psychiatric facilities (which people still refer to as ‘asylum’) they have almost washed their hands off him or her… more so if it is ‘her’ being managed by her husband and in-laws. At this point the prime concern of the care takers is that the person should be kept in the ‘asylum’ for they cannot hide her / him from others any longer. Beside the issue of ‘managing’ such a person at home, the embarrassment that she / he causes to the family becomes a major factor in the giving up attitude. And this ‘embarrassment’ comes most likely from the stigma the society has attached to people with mental illnesses.
Where does this stigma come from? What or who created it in the first place? Like most other colleagues working in psychiatry, these questions have bothered me no ends. ‘Fighting the stigma’ remains a major challenge that most mental health professionals often discuss while people continue to face it… atleast in India
Recently I visited a Community Based Rehabilitation program for the mentally ill persons, being run by Ashagram Trust in a tribal area near Barwani (MP). The undulating landscape is spaced with small hillocks where people still live in hamlets. Most huts, mud walls with a thatched roof, are separated from another by atleast a distance 100 meters, if not more. The crop, mostly maize & chilly, though cotton is also creeping in as a major cash crop now, either surrounded the hut or starting from it, spread over a huge area in front or behind.
Most of these people work in their fields and when the crop time is over, often go to the near by cities in search of some odd jobs. Life remains simple except for the extreme poverty, drought (which hounded them for the last 3 or 4 years continuously) and the moneylenders who charge exorbitant interest for the money they lend out in ‘times of need’ and there seems to be no dearth of such times.
Anyways at one household, I noticed a woman feed her child while we were there. She was wearing a blouse, which she simply pulled up, exposing both her breasts and then put the child to one… the other remaining exposed. ‘Exposed’? It triggered a little thought process. What if a middle class woman does the same in her house say in Delhi or Kanpur or Bangalore or Trivandrum or Calcutta or any other ‘civilized’ city? Would it not set everyone thinking she’s mad? Would it not embarrass her family as well as the guests? But why should it… its just a breast… just another breast. And this woman was surely not unwell… just that in this society no one cares. Or should I ‘infer’ that they are uncivilized.
Anyway we moved on to other houses because we were looking for something else… the breast was just a distraction… but strong enough to send me looking for more – not the breasts but on the trail of acceptance and non-acceptance of things in different cultures.
So we landed up at Anjar Singh’s house, a man in his 40s who is still ‘mentally ill’ – perhaps suffering from chronic schizophrenia. He was thin. His bones showed from malnutrition. And we found him sitting on the mud floor engrossed within him. He is not a tribal. His father, an old man with grey hair, greeted us warmly and we sat on a cot laid out for us. Anjar Singh just looked at us - no communication - and then went back to his work – caressing the floor with his fingers which moved almost aimlessly as he kept talking to himself very softly. He has been suffering from his mental illness for some 20 years or so. His father showed us the cage they built in one part of the hut where Anjar was caged for almost 15 years so that he does not harm anyone. He used to be violent then. The Ashagram team searched him out and then treated him with medicines. His father is a happy man, for he can now leave his son in the open. “He is not violent or troublesome anymore”, he says happily.
For my eye, it was strange. The man is still psychotic. Surely he isn’t violent – but is not being violent a good enough reason to be happy and contended with? What about personal hygiene? Does he not dirty the house or pee and crap around?
“Of course he does. But so do the other children… Anjar Singh’s own children. His children’s children”, came the reply. Someone or the other cleans it off when one finds the time.
At other times, Anjar Singh goes out to his field and stays there for days. Either ways the concept of ‘dirtying’ the place just doesn’t seem to exist. The house has a mud floor. Most area is open unlike a city flat. No tiles or mosaic or lovely sofas or other furniture which may get spoiled, no cramped spaces, no over bearing stench accumulating in a closed room, not even the feeling of awe and overbearing emotions of vomiting at the sight of ‘shit’- for shit is a common sight and smell out here.
Anjar Singh’s wife still stays with him. His children help his father on the field. Everyone in the village knows that he was ‘pagal’ (mad) “but”, as a child put it for me, “he doesn’t throw stones or hit anyone now so he’s ok”. “…So he’s ok…”. This ‘so’ is perhaps grounded in the simplicity of a village that is yet to climb up the ladder of ‘development’ (not necessarily human development though). So should I term them ‘underdeveloped idiots’? Or wonder at the concepts we have built around ourselves to be able to live in the cities and hate and cringe at the sight of our own shit – an important byproduct of all the junk we eat and that has to be thrown out of the body… if we are to live.
In yet another village stays Narayan, a tailor who shut his shop about 15 years ago. His sewing machine lies in one corner of his house. He himself lies outside the house in a small thatched shelter built for him. If it rains, there is a room outside which is then unlocked for him. His wife has left him along with his children. Parents died some time ago. Of his two brothers, both younger to him, one works in a city and comes home once in a few weeks to meet his wife, an anganwadi worker, who stays here. The other brother teaches at the village school while his wife also does some work.
Narayan was called into the house to meet us. His dirty shirt, unmatched socks without a shoe, an unshaved beard and uncombed hair, immediately shone against the small but neat household. He exhibited signs of psychotic behavior, at times getting distracted by his hallucinations. But he was not violent at all. It was his thought process that was derailed and he was not aware of his own position in life. He talked to us in his own style, often almost like a mystic. I also sensed his younger brother’s discomfort. And he soon expressed it. He was concerned about narayan’s un-cleanliness and the impression on us.
Each time he returns from the city, he takes Narayan to the barber for a shave and gives him clean cloths. But Narayan doesn’t take much time to dirty them again. As the younger brother talked, his embarrassment over his elder brother’s uncouth appearance became more and more obvious. It was not a ‘disgust or hate’ but simply an overpowering feeling that Narayan should be cleaner. And where was it coming from? The city? The cleanliness that the house exhibited?
Perhaps that is where the seeds of stigma arise. This family surely is moving towards ‘development’ – not mental though – but economic and perhaps also social. The brahminical (or should I call it elitist) concept of cleanliness is catching up with them. Hence the concern is shifting from the ‘functionality’ of the mentally ill person to cleanliness… and it is not necessarily the same as hygiene.
The spaces in this village will perhaps shrink soon. If this is an indicator of ‘development’ then soon there will be more concrete buildings and maybe even a school that will teach… yes ‘teach’...maybe English and the importance of cleanliness, hygiene and development. And then someone, somewhere will one day chase out a Narayan for the ‘nuisance’ that he / she would have become by then.
Mental health professionals in the cities will continue to debate and discuss their ‘fight against stigma’ over coffees and snacks.
For Narayan, unfortunately this village is too close to the highway that took us back to the city.