Science and Tradition Aid India's Mentally Ill
By BARBARA CROSSETTE, Special to The New York Times
Published: March 13, 1991
MADRAS, India— Sukhanya remembers how it all began almost 13 years ago. Her sister Rama, then 22 years old, suddenly stopped going to college. She turned down offers of marriage. She refused to get a job.
As her behavior became more and more erratic and antisocial, she took to hiding in her room. Finally she locked herself away, refusing to bathe or go out in the sun, for five years.
Rama is a schizophrenic. But for more than a decade, no one around her knew what to do, or even what was wrong with her. Her ultimate salvation was a loving family, especially Sukhanya, who eventually took her troubled sister to a small center in a residential neighborhood of Madras run by the Schizophrenia Research Foundation of India.
Rama was lucky. The small center, established in 1984 to treat schizophrenics, train them for jobs and give them an environment rich in sympathy and support, is the only one of its kind in India.
By the most conservative estimates, India has 50 million mentally ill people. But there is only one qualified psychiatrist for every million of India's 850 million people. The mental hospitals in the country have a total of 20,000 beds.
In India, as in most of the third world, mental illness and other handicaps are a family affair, says R. Thara, joint secretary of the Schizophrenia Foundation and a psychiatrist at the Madras center. Ninety-five percent of mental illness is treated, if at all, at home, with some professional help.
"Plenty of people were doing work on retardation, but nobody was helping schizophrenics," she said. "We were the pioneers." Treatment here is free; the center relies on private donations.
The center sees 70 to 80 people a day, providing transportation for some and helping others find residential accommodations nearby, particularly if the family cannot cope with the illness. Dr. Thara said a major part of the center's work was to take pressure off families with inadequate economic, psychological or cultural resources to deal with the afflicted relatives.
"In the Indian family, the first thing that happens when schizophrenia occurs is denial," Dr. Thara said. "They say, 'This could not happen to my son.' They don't think of it as an illness. They don't look for medical help, and wouldn't think of going to a psychiatrist. They take him to a traditional healer, to a temple, a priest or a mosque."
The religious milieu of India has to be considered when diagnosing and treating schizophrenia, Dr. Thara said.
She said hysterics were often "cured" by a priest shaking a leafy branch in front of them."All they need is a strong suggestion from a person of influence," she said, adding that the clinic was trying to reach faith healers to tell them how they might deal with something worse than simple depression or hysteria. Yoga and Music Aid in Therapy
Sarda Menon, the founder and director of the center and former head of the Institute of Mental Health in Madras, said yoga was used to restore functions of patients. Traditional music is also used.
"We are trying to bring an awareness to the neighborhood," Dr. Menon said. Patients at the center run a cafeteria at the nearby Indian Institute of Technology; others are placed in jobs around the community. In the center, there are courses in screen printing, the making of incense and chalk, and the fabrication of paper packing cases for medicine bottles.
The center in Madras gets help from Oxfam and was recently awarded a grant from the Canadian Government. Dr. Thara has been named a fellow of the Washington-based Ashoka Society, which makes grants to individuals working in developing countries.
William Drayton, the American founder of Ashoka, says that with the major diseases coming under some control in the third world, it is time to turn to the neglected millions of handicapped people in poor nations, and their families.
"Both in terms of public health and human rights, you can see this challenge coming," Mr. Drayton said in an interview in Calcutta in January. "The public is beginning to sense there is something wrong."