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Erwadi and I : Meetings And Memories

Erwadi is a prosperous town in Tamil Nadu. Al Qutbul Hamid ul Gausul Majid Badshah  Hazrat  Sultan Syed Ibrahim Shaheed  Radiyala Ta’ala Anhu was the eighteenth descendant of the Prophet Muhammad.  He renounced the throne of Madina in the 12th century and decided to travel and preach Islam. He travelled to several places, where he preached his religion, and finally reached Bouthiramanikapattinam, which is now known as Erwadi.

Sultan Syed Ibrahim built a shrine in Erwadi. The shrine contains sacred soil from Madina and also houses the graves of many important members of the royal family. Along with the royal family, there are three other people here who have left their mark on this place and its history. In fact, these three other people are the reason why this story is taking shape.

The martyrs, Abdul Kadir Mujahid and Gazanfar Muhaideen, were commandants in Sultan Syed Ibrahim’s army. They were both martyred and their graves are in the main shrine or dargah in Erwadi. Abdul Kadir was killed in battle – he is revered because he continued fighting even after a serious injury. The main shrine of Erwadi is renowned because of these two men. People believe that illnesses caused by death spells, black magic or by the Devil, especially diseases of the mind, can be cured by appeals to this shrine.

Rabiya Amma’s shrine is right next to the main shrine. Syeda Rabiya Radiyala Ta’ala Anhu was the sister of Sultan Syed Ibrahim. Men are not allowed to enter Rabiya Amma’s shrine and this place too, is famous for curing maladies of the mind.

And so, persons with mental illness began to find their way to Erwadi. They still go there. The shrines could not accommodate all the people who came, and so many institutions or ‘homes’ for people with mental illnesses were built. The treatment was conducted at the shrine – patients would be massaged with sacred water from the shrine or with oil from the lamps, and they would be kept tied up all day. They were tied to trees in the compound of the shrine, and at night, they would be in rooms – but chained to their beds.

In the very early hours of the morning on August 6, 2001, twenty eight residents of such a mental home were burnt alive. There was a fire in the building but the residents   could not run away because they were bound to their beds with chains. This incident led to much sound and fury all across the country. Needless to say, however, beyond the noise there wasn’t very much else. People with mental illness still continue to flock to Erwadi and the practice of keeping the patients chained to their beds also continues.

Erwadi Day is observed in many places in India.

No, none of my patients has ever been burnt to death. Also, as far as I know, none of them is tied up all through the night.

*****

Although this story is not about Anjali, let me , anyway, tell you a few things about the organisation.  Anjali is one of the leading organisations working for the rights of persons with mental illness. It is probably the first organisation in India that began working, alongside the government, to support patients in government mental hospitals. However, it is a fact that not every government official was willing to walk, hand in hand, with Anjali.

Every year,  for some years now, on August 6, Anjali has been bringing together many people in front of the Academy of  Fine Arts in Kolkata, to commemorate Erwadi Day. A public meeting would be held with speeches, plays and songs. This year, in 2015, Anjali organised its Erwadi Day observations at the Pavlov Mental Hospital. A debate was organised and participants argued whether ‘Forced admission is beneficial for persons with mental illness.’ I was there, listening to the speakers, because Anjali had invited me to the programme.

As I heard the well thought out, sensitive arguments both for and against the motion, I realised that everyone was speaking out against government hospitals. Speakers bemoaned the fact that once someone was inside such a hospital there was no guarantee that s/he would leave. There was condemnation of how men admitted to such institutions were forced, by their brothers, to give up claims to their share of the family property. And, of course, much was said about the complete disarray of systems and procedures within the hospitals.

As the speakers talked, I kept going back to the days when I had worked in government hospitals. I was remembering that there were several patients who didn’t have any appreciation or understanding of the problems they were causing at home or in their neighbourhoods. They would break things, and also assault and abuse people around them, and even after such mayhem, would believe that other people were to blame for all that had happened. However, even those who knew that they had problems would resist admission to hospital and had to be forcibly put there. They were unwilling to be in hospital because they believed that once they were inside , it was a point of no return and they would be doomed to stay there forever.

It is indeed true  that many never returned home.

*****

Sunaina had been admitted to the Central Institute of Psychiatry in Ranchi. She came from a village in either Purulia or Bankura, where her father was a schoolteacher. She had also had several hospital stays before – four times in all. She had not been in my care those earlier times. She was a lively young woman of twenty five or so, who had a college degree but was unable to join a post graduate course because her father couldn’t  afford it.

“But I won’t even be able to get married,” she would say. “My father has three daughters and I am the eldest. And to add to everything else, I am mad. Who will marry me?”

“Why don’t you carry on with your medicines?” I asked her one day.

“I find that you are alright if you take this medicine everyday,” I persisted. “If you take medicine, you won’t keep falling ill. On the other hand, if you keep falling ill, there will come a time when the disease can’t be cured.”

“My parents say that if I take medicines for my madness, people will ridicule them and say that their daughter is mad,” she said with a bowed head.

I am often unable to understand how people think. How can people possibly say your daughter is mad if you ensure that she continues with her treatment and is well? And will they be quiet if you let your daughter fall ill and make a spectacle of her ‘madness’ and then pack her off to a ‘lunatic asylum’?

It was then that I learnt that no one had ever discussed Sunaina’s illness with her father because he had never come to the hospital – either to admit her or to take her away. She had always been escorted by some relative or the other.

As expected, Sunaina was well fairly soon. The hospital procedure was that the family would pay for three months when they admitted their patient to the hospital. The family is informed once the patient gets well or after the three months are over. The doctor is expected to let the family know once the patient gets well.  However, it is the clerk’s job to write to the family once the three month period runs out.

In this case, the patient had recovered and so, it was my responsibility to write to her family.

“Shall I write to the address we have in our records?” I asked Sunaina.

“Yes. Are you writing to my family?”

“Please, don’t stop taking your medicines once you’re home,” I said.

“If I go home,” she said, with a pale smile.

“What do you mean?”

“This time, when I was leaving home, my parents made it quite clear that they were not going to take me back home.”

My heart missed a beat. There were many, many people in the Central Institute of Psychiatry or CIP, who had been abandoned by their families. But would it happen to this young woman, too?

“Oh no,” I tried to reassure her. “Parents often say such things in anger. They’ll surely come to take you back, you’ll see.”

“No, they won’t come,” said Sunaina, shaking her head.

However, after two or three days, it was quite evident that inspite of what she had said, Sunaina hadn’t lost hope.

“Doctor, has my father replied?” she would ask, running up to me, as soon as I entered her ward.

“Wait, a bit,” I would say. “We’ve just sent the letter.”

We had this exchange everyday.

The  patients who had been admitted several times to the hospital, knew the rules and procedures very well. They also kept track  of  time more meticulously  than the doctors.

“Doctor, isn’t it time to send another letter?” she asked after some time.

So, I looked through her file. Yes, it was time. I sent the second letter. These letters had a printed format. The doctor merely needed to fill in the patient’s name and address,  and then sign the letter. The tone of the second letter was sterner than that of the first. And Sunaina was back with her questions.

“Has he replied yet?”

“Sorry, no.”

Her eyes no longer sparkled like before. And the questions she asked were different..

“No reply yet, isn’t it? I knew it.” And then she would walk away.

So, I sent the third letter. The contents were now more aggressive, bordering on ‘we’ve told you the patient is better, so, why aren’t you coming to take her home’.

Sunaina no longer ran up to me. She came slowly,  walking, , but never forgot her question. But she began walking away without waiting for an answer.

Days went by and weeks. Months too passed.

“Doctor, last time, no one came after the printed letters were sent. There was no response to any of the three letters. The doctor then sent a letter in longhand. And my cousin came after that,” said Sunaina.

The hospital did have such a rule. If there were no responses to the printed notices, the doctor could write another letter. I went through her papers, and yes, the attending doctor had indeed written such a letter a year ago, and Sunaina had gone home after two weeks.

“Will you write such a letter, please?” asked Sunaina.

A junior doctor was not entitled to sign such a letter. My supervisor would have to sign it.

“Shall I write the letter?” I asked my boss.

“Yes, immediately,” said Dr Lakshman.

I looked at the earlier letter and prepared a draft. Lakshman made a few changes and asked me to get the letter typed.

I sent off the letter and spoke to Sunaina in the ward. She stood there with her head bowed.

“We’ve sent a letter,” I told her.

“Won’t help,” she said. “No one will come.”

*****

Despite everything, she was hopeful again.

“Doctor, any news?” she asked everyday.

There was something else that was bothering her.

“You’ll stop coming to this ward after sometime,” she said. “You’ll be somewhere else. What then?”

“There’ll always be a doctor. People will do whatever necessary to send you home.”

Soon after, even before two weeks were up, a hospital orderly came to our ward.

“The Director’s calling you,” he informed me.

I wondered what was up. Why had the Big Boss summoned me? We were usually called to meet him only if we’d made some terrible mistake.

I ran into Dr. Lakshman as I made my way to the Director’s office.

“You too?” he asked. “What’s up?”

It was clear that neither of us had any idea why we had been sent for. Since Dr Lakshman was the senior doctor, he went in to the Director’s office. I was just about settling down on the sofas, in the waiting area, when Lakshman came back and asked me to join him.

The Director was holding a piece of paper.

“Is Sunaina your patient?” he asked, glancing at that piece of paper.

“Yes, sir,” I replied.

“And how is she?”

“She’s well and waiting to be discharged. We’ve written ….”

“No need to write anything more,” said the Director, interrupting me, and he handed the piece of paper  to Dr. Lakshman.

Lakshman read what was written and silently handed the paper to me. It was some kind of a government missive. The sheet of paper had the Ashoka pillar embossed on it. It was a letter from an MP, addressed to the Director and said:

“Mr ___,   is a respected, elderly teacher of a well known school in our district.  He has three daughters – and Sunaina is one of them. She is mentally unbalanced,  actually  a lunatic. She has been admitted to the lunatic asylum in Ranchi several times but has not been cured. She is a raving lunatic and at present too, she is  in  the asylum.

Two doctors of   the lunatic asylum, namely, Aniruddha Deb and Lakshman, have been repeatedly writing letters and lying to Sunaina’s father. They insist that   Sunaina is now well and must be taken home. The tone of every new letter is stronger than the one that came before and all of this is almost amounting to harassment.

Kindly treat this letter as an order from an MP to the Director of the Central Institute of Psychiatry asking for an end to the harassment of Sunaina’s father, who is a  good man. He is a teacher and very poor, and also has two other daughters. He cannot possibly keep his mad daughter at home and look after her forever.

The Director must immediately put an end to this harassment. Otherwise, as an  MP, I will be forced to  take  legal action against the Director, and Dr Lakshman and Dr Aniruddha Deb. I may also recommend that the Ministry of Health suspends all three of them.”

 

 

As I finished reading the letter, I saw that the Director and Dr. Lakshman were looking away.

“I think….”

“How many more letters have you sent?” said the Director, stopping me mid-sentence.

“We’ve sent four letters in all,” I said. “Three according to our printed format and I drafted the fourth one.”

“Dr. Lakshman signed the fourth letter,” I added swiftly.

“I’ve done everything by the rule book,” was Dr Lakshman’s quick rejoinder.

“They’ve sent me copies of all the four letters,” said the Director. “I am not saying that you did anything outside the protocol. However, I am now telling you that you are not to send anymore letters. There is absolutely no need to communicate with the family, again.”

“Sir, she’s a young woman of twenty six or twenty seven,” I pleaded. “She has a college degree. She has bipolar disorder. All she needs to do is take a tablet everyday – it’ll cost ten rupees a day. She’ll also need to come here four or five times a year to consult with her doctors. There won’t be any charges for the consultations.

“She can get a job and contribute financially to her family. Her father simply needs to understand that they can’t stop treatment. Despite that, if the disease comes back….”

“We’ll have to explain things to the MP before we talk to her father,” said the Director. “Who’ll speak to the MP? You or I?”

I didn’t know what to say.

“Alright, Dr. Deb, you may go now,” said the Director.

“Oh yes, please don’t tell the patient anything,” he admonished` , as I walked away.

I went back to the ward. I was lucky because I didn’t come face to face with  Sunaina right then. She had gone to eat.

*****

My luck held. . My time in Sunaina’s ward was over. The next day, as I was handing over responsibilities, Sunaina came into the room.

“Doctor, you’re leaving?”

“My time is up,” I said, nodding in assent.

“Who will write to my family?” she asked.

I was about to point to Dr. Bhosle but was unable to move my hands or even say a word.

“Nobody’s going to come, right?” said Sunaina, after waiting for sometime.      “I know no one’s going to come. I had told you, hadn’t I?”

And then she left. Neither Dr Bhosle, nor I, could say anything.

“You’d better write a warning in her file,” advised Dr. Bhosle. “Best to label her a suicide risk. You see, if, after all that has happened, she kills herself in this ward, her father’s going to tear us to little bits.”

He was right. We may thoughtlessly cast off our flesh and blood, like a pair of torn slippers, yet, we are unable to stomach the fact that others too may neglect them, even if very slightly.

I didn’t stay on much longer in Ranchi. I had finished my studies and thought it was time to work elsewhere. I was also no longer working in Sunaina’s ward. But our paths did cross– as I walked from one part of the hospital to another, or was on night duty, or in the emergency.

“Doctor, none of the other doctors have written to my family,” she would tell me. “Do you know why?”

“Why do you ask me?” I said one day, in exasperation. “The  doctors, who look after you now,  should be able to tell you. You know that I’m no longer your doctor.”

“They don’t tell me anything,” she said. “I’m sure my father’s told them that they’re not going to come to take me home.

“But these doctors don’t tell me anything. So, I ask you. Won’t you tell me the truth?”

“I have no idea,” I told her and simply bolted from there.

 

*****

They were debating whether forcible admission was good for patients and I was remembering all this. Some people in the audience thought that I was not impressed by what the speakers were saying and was losing concentration.

I don’t remember Sunaina’s name but  her eyes remain with me. Those  eyes would seek me out everytime I was near  the ‘female section’ of the hospital.

Those eyes would be looking at me, through the wires that covered the gate. “Sunaina, pack your things,  your father is here. You are going home.” I knew those were the words she wanted me to say.

I would get on my scooter, look around furtively and ride away as fast as I could, as far as possible. I needed to escape.

And no one can explain why, even today, twenty five years later, I often wake up at night feeling those eyes stare at me. I look fixedly at the dark wall before me. It is tough to go back to sleep. This is my private hell, my very own Erwadi.

 

 

This article originally appeared in Bengali titled “Amar Erwadi” by Aniruddha Deb. He is a practising psychiatrist in Kolkata and writes for both adults and children.
The article was translated to English by Anchita Ghatak. She is a women’s rights activist, and also translates literary works from Bengali to English.

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