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Mental Health Legislation in India- a mockery of Human Rights? By: Hemal Shringla was born and brought up in Mumbai. She is a freelance writer and language and literature teacher based in New Delhi. She has lived, studied and worked in several countries such as France, Israel, U.S.A. and South Africa.

 “Are you Jhilmil?”, a policeman asked me… I was walking

down a road near Claridges Hotel, around noon one

day in September 2007. I was exhausted, hungry and

sleepy, and I almost felt a palpable relief as I nodded

yes. What happened next was something no woman should have to

experience. To me, it was worse than torture, rape and was dehumanizing

in the extreme. Ten police men and women surrounded

me, in broad daylight, and manhandled me, I was in pain, and the women restrained me from much movement by

stepping on my feet, in chappals, with their heavy police boots. They laughed at me and said they were taking me

to my sasural. I begged them to let me call my family because I truly did not understand who was behind this,

but they just refused, saying I had no rights. I kept praying and hoping for a miracle, trying to wave to people in

other cars at traffic lights, but who in their right minds would stop a PCR van?? The van pulled into a private

mental institution called VIMHANS and I was handed over by the police to

a group of psychiatrists and nurses.

 

 Jhilmil Breckenridge, 45 years, is a beautiful and intelligent yoga teacher cum corporate consultant. This is an account of what happenedto her about six years ago. Jhilmil is the daughter of a former bureaucrat. Her husband is Douglas Breckenridge and they are the parents of four sons from ages 16 to 7. Douglas Breckenridge lives in Michigan, U.S.A. now with the four boys. He left India, taking the boys with him behind Jhilmil’s back, without court permission, which legally amounts to kidnapping, with the complicity of her parents. They have been in a divorce battle for over two years now. Her parents today live in the Friends Colony house she jointly owns with her husband while she lives in a single rented room in Gautam Nagar, an overcrowded urban village. Hers is not an isolated case.

 

The Mental Health Act of India 1987 permits involuntary institutionalization. If a family member testifies before a

magistrate that his/her relative suffers from any labeled mental illness and is resisting treatment, he is able to

forcibly admit him or her to a mental institution indefinitely and even for life. The government plans to replace the

Mental Health Act 1987 of India with the Mental Health Care Bill 2012 which still needs to be passed by Parliament. It is considered by Ministry of Health and Family Welfare and few to be a progressive piece of legislation drafted by a private psychiatrist named Somitra Pathare and it recognizes the right of the patient to determine how s/he is to be treated. The new bill retains the possibility for involuntary institutionalization in cases where the patient’s mental capacity is deemed by psychiatrists to be severely impaired.

For Abdul Mabood, Founder-Director of Snehi, a mental health NGO, and also one of India’s handful of mental

health activists, the fact that such a decision depends on the discretion of psychiatrists is very dangerous. According

to him, psychiatry does not have any scientific, medical and rational parameters to establish illness and functions on the basis of assumptions, i.e., ‘Assumed Chemical Imbalances’. “Mental health policy in India is in the hands of psychiatrists which is not a good thing as they have vested interests,” he says. For him, drafting of mental health policies should be a consultative process in which survivors of psychiatry, various mental health professionals, educationists, activists of mental health rights, woman rights, child rights, disability rights, health rights and labour rights must have a major say. He rues the fact that the government simply “outsources the job to private psychiatrists again.”

For Mabood, till date psychiatry is not a science. It functions within the framework of two biased models – social

and chemical - which impact women negatively most. “Mental illness is viewed as an individual pathology.

The cause is located within the brain rather than in society,” he says citing the example of Jhilmil to illustrate his

point. “Jhilmil was incarcerated a second time with help of police in 2012 but a few of us mental health activists

were able to obtain her release within a week or so. When I asked the attending psychiatrist why he had been treating her with such strong medication he replied that he found her behavior to be impulsive which is totally ridiculous,” he said. “Tell me,” he continued, “Wouldn’t the behavior of any of us be impulsive if we were dragged to a mental institution with the help of police despite being in our full senses? In the same way, take the case of a married

woman who is routinely abused by her husband and his family. It will hardly be surprising if she becomes mentally

disturbed. The problem is that she will be the one to undergo antidepressant.

 

treatment which will not necessarily make her better.” The words ‘mental illness’ themselves are objectionable for Mabood given that there are no medical or scientific tests to establish the objective existence of chemical imbalance or any other psychopathological condition. People are diagnosed with bipolar disorder or schizophrenia or whatever on the basis of symptoms only. This is why he prefers the term ‘mental or behavioural disturbance’ or ‘disorder’.

India has one of the highest suicide rates in the world. Each suicide speaks more about the pathology of his/her society, not the pathology of the individual committing suicide only.

 

A majority of those who not only commit suicide, but also manifest symptoms of mental distress are young adults and women. Women sufferers far outnumber men. These statistics buttress Mabood’s views linking mental health to social factors rather than individual pathology. Reducing emotional distress to a set of symptoms

caused by brain abnormalities is dehumanizing to say the least. Indian women are routinely dehumanized in

any case, in their homes, their workplace and on the streets. They face both overt and covert abuse all the

time – they suffer flagrant and unacceptably high levels of human rights violations such as severe attitudinal

and verbal abuse, battering and rape. And there are subtler forms of abuse too such as not being able to follow careers of their choice, limited freedom of expression in both their matrimonial and marital homes, inhibition of

sexual desire and curtailment of freedom of movement. In such a case how can their brains be held responsible

if they experience distress? According to Mabood, very often the abusers are psychiatrists themselves who do

not hesitate to take advantage of the vulnerability of their women patients. If they complain, he stated, their testimony

will most likely not be considered valid and will be not admissible in the court of law because person labeled ‘unsound mind’ is no citizen! “The day these women victims obtain rights on par with other so called normal

people, many, many psychiatrists will find themselves behind bars,” he said with obvious relish. Most psychiatrists will certainly concede that environmental factors contribute to mental disorders but the problem is that the current medical

model, on which they base their treatment, does not translate into an integrated approach and the worst

impacted are women, children and other sections vulnerable to stress such as the poor or those belonging

to minorities. One of the drawbacks of the bill is that it doesn’t stress psychotherapy, for example, or community

based methods as it should, which is evidence once again of the massive medical bias on which psychiatry

in its every aspect is based, from psychiatrists, psychiatric diagnose, psychiatric medication and the multi-billion dollar pharmaceutical industry. The proposed bill opens door to opening unregulated private institutions to incarcerate people one wants to get rid of.

 Distress is a human response; it does not take place in a vacuum orspontaneously by itself in the brain. Patterns of emotional distress, who suffers from it and under what circumstances are indicators of what is wrong in society and where. The Mental Health Care bill 2012 is an improvement on the 1987 legislation, but it still

has a long way to go before the human rights and legal capacity of incarcerated people are addressed adequately.

 

Mental health legislation in India should provide:

„1.  better access to various kinds of therapy individual, group, marital and child and adolescent therapy.

„2.It should also be more actively engaged with promoting positive mental health within communities rather than only dealing with mental ill health.

„3. Mental health policy making should be integrated with policy making in other domains such as social welfare, education and law, for example.