Recently, Members and Fellows of the Indian Psychiatric Society went to Bodh Gaya of Bihar, the place of enlightenment of Sree Buddha, to participate in the National C.M.E. Ironically’ a month earlier Satnam Singh, a twenty year old student of Law, hailing from Bodh Gaya, reached Kerala in pursuit of spiritual Enlightenment, the latter, though, marred by his psychotic illness, that was treated intermittently and inadequately. Attending a prayer session in a renowned ashram, in an ill-fated moment, he dashed to save the Guru, whom he visualized was being surrounded by a sinister luminescent halo. Apprehending he was an aggressor/terrorist, out to attack the Guru, the disciples and devotees apprehended him and handed over to the police. Noting the oddities of his behavior, the police produced him before a magistrate with a medical certificate of mental illness and got him admitted into the forensic ward of the Mental Health Centre, Trivandrum on Reception Order. Barely twenty four hours later, he was found grievously hurt and breathed his last. The news was received with shock and anguish by the society. As it usually happens in Kerala, a debate and controversy broke out as to whether the serial beatings which killed Satnam, started in the Ashram, continued in police custody and completed in Mental Health Centre or, whether the whole lot of seventy seven blows thundered on his frail body was all delivered in the Mental Health Centre itself, during the last few hours of his life. The police investigation that is going on may discover the facts and resolve the controversy, or it may not do either.
Whether the culpability in this heinous act should be shared by the persons who apprehended him in the ashram, policemen and the hospital staff, or solely to be borne by one of these, is legally important. However, for me, as a mental health care professional, (and many of us, I am sure) what is hurting and painful is that such a brutal inhuman act has happened at the present times, when therapeutic potential in psychiatry has reached such a height and human right concerns about psychiatric patients float very much in the air, we breathe in and out.
Three or four decades back, or earlier when many of us, elders in the profession started psychiatric practice, Mental Health Centres, called mental hospitals then, had deplorable conditions. Our therapeutic armamentarium was much more modest and inadequate, and the general public was less informed on and had more prejudices and superstitions about mental patients. The latter also included a notion that physical punishment exerts a corrective effect on aggressive psychiatric patients and a few practiced it also-in the society, in the hospitals too.
Notwithstanding our advances in therapeutics and the enhanced awareness of human right of our patients, still there are situations where an aggressive or destructive patient will have to be overpowered by force and need to be kept in physical restraint to save him and others from harm. A psychiatric patient gets aggressive, destructive and dangerous when he gets haunted by frightening delusions, threatening or misleading hallucinations, powerful passivity or overpowering automatisms. Being victims of such bizarre experiences, he attacks others including his family members or caregivers, often misidentifying them or misinterpreting their actions. He can then be truly dangerous. Once he is overpowered and restrained, however, he is no longer unsafe and dangerous to any, and all that is needed is expeditious and judicious administration of appropriate treatment. There is no understandable rationale or justification for retaliatory counter aggression on such a patient, except a carryover of a punitive vengeful subhuman mind set, drawn from a superstitious past.
The anguish I felt as a mental health professional in the cruel butchery of this ill-fated psychiatric patient, does not wither away as time passes, but rather gets denser day by day. Along with this, I feel ignited with a spark of commitment to initiate some effective action in this regard. Moving towards the fag end of my professional career, and with scant resources and operational systems and networks in my command, I thought, I would appeal to the present leaders and young active members of Indian Psychiatric Society, many of whom, I feel would have felt the same anguish and stirred by the same commitment; had they been impacted by information of this dismal incident. An important task we can take up is to organize effective training programs for staff in our psychiatric institutions on the guidelines for using physical force and applying physical restraint, when it is imperative, with least damage to the patient (and themselves). The retaliatory counter aggression on the patient should be done away with in our institutions. I feel we should take it up as our professional mandate and challenge to evolve and carry out such training programmes for our institutional staff as it is vital for quality up gradation of mental health care. The mind set of retaliatory counter aggression towards psychiatric patients in the public mind also should be mitigated through effective psycho-educational programs carried out in collaboration with committed voluntary organizations (N.G.O) and Mass Media. The therapeutic empowerment accorded to us by psychopharmacological advances of past several decades, and the Human Rights awareness imparted to us by ethical echelons in medical care and education, should be complemented by our commitment to combat and discard the retaliatory counter aggression towards our patients with in our institutions, and the society at large.