The history of psychiatry in India since independence is essentially the story of how psychiatry has largely come out of mental hospitals and has gradually become a part of mainstream medicine. This is a remarkable change, and in a way, it is a new beginning of psychiatry in India. It is also noteworthy that India has been in the forefront of this movement, at least in the developing world. Hence, in this chapter, my focus will be mainly on how psychiatry has reached this present position. I may have to clarify right at the beginning that history is a continuous process, and divisions of time are only arbitrary lines to understand the whole process better. The mental hospital movement of the colonial period was a very important phase and has given shape and structure to modern psychiatry. However, mental hospital care, which was developed originally in Europe, when applied to Indian conditions, turned out to be a very expensive and a wasteful method of care for the mentally ill requiring large spaces and buildings with large multi-layered staff. Worse still, this system of care further isolated mentally ill away from society without any significant medical benefit. All over the world, services in such isolated mental hospitals gradually tend to deteriorate and become depersonalised and dehumanised. It was much worse in India and other developing countries with very limited financial resources and trained manpower, and a very different cultural background from Europe. The focus of mental hospitals was always on very serious psychiatric conditions such as psychosis or dementia. This further reinforced the stigma against mental disorders. Persons with lesser forms of psychotic illness and other common psychiatric disorders, which are so widespread in the community, were generally left out of this system of modern medical care.

Mental hospitals have of course, not totally outlived their utility and usefulness. Many of them are still playing a very useful role in the long-term care of disturbed and chronically mentally ill, especially with criminal and legal background. In Indian settings, some of the hospitals have completely transformed themselves into modern academic institutions such as the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, the Central Institute of Psychiatry (CIP), Ranchi, or the Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, and are playing a very significant role in service, training and research. However, the fact remains that in the second decade of twenty-first century, the bulk of psychiatric patient care in government, private or voluntary sectors is now outside mental hospitals, through general hospital psychiatric units (GHPUs), private clinics, primary care centres and non-governmental organisation (NGO) run services. Similarly, while 50 years ago, training of mental health professionals was confined to few mental hospital-based institutes such as the NIMHANS, Bangalore, and the CIP, Ranchi, now the bulk of training programmes has moved to autonomous medical institutes such as the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, the All India Institute of Medical Sciences (AIIMS), New Delhi, and various major medical colleges in Lucknow, Vellore, Mumbai, Kolkata, Chennai and other big cities. It has changed the whole atmosphere of psychiatric training with proximity to, and interaction with other medical disciplines. Psychiatric research has gained equally by this transformation. While the traditional mental hospitals had very little scope or incentive for research, the newer academic departments in medical institutes and medical colleges are producing much more relevant and valuable research, and also winning recognition in many national and international forums.

I do not plan to go into great details of pre-colonial and colonial periods of history of psychiatry in India, mainly because this subject has been amply covered in many previous articles. Nizamie and Goyal (2010) have written a comprehensive article on the ‘History of psychiatry in India’ in the Indian Journal of Psychiatry. (In fact, I have borrowed the terms, ‘Psychiatry in pre-colonial, colonial and independent India’ from that article, which I acknowledge with thanks). There is an equally good article by Parkar, Dawani and Apte in Journal of Postgraduate Medicine in 2001 (Parkar et al. 2001). A very comprehensive article titled ‘The history of modern psychiatry in India 1857–1947’ by James Mills, a chapter in a book ‘History of Psychiatry’ published by Sage in 2001, is an outstanding piece of research and is worth reading by anyone who is interested in this subject (Mills 2001). While the history of psychiatry in colonial period is well covered in all the above references, my own personal favourite is the article (in two parts) ‘History of psychiatry in India and Pakistan’ by Dr. L.P. Varma in the Indian Journal of Psychiatry in 1953, then called Indian Journal of Neurology and Psychiatry (Varma 1953). This is a remarkable article on the history of Indian psychiatry, especially when one keeps in mind that this was being written for the first time by an Indian psychiatrist in an Indian Journal. The article is comprehensive, very well researched (with nearly one hundred references) along with scholarly and insightful comments by late Dr. L.P. Varma who was then First Assistant Superintendent at the Indian Mental Hospital, Kanke, Ranchi and also the Editor of the Journal. The Indian Psychiatric Society from time to time has also covered the subject of history in many of its conferences, souvenirs and journal supplements. One outstanding contribution in recent years has been the issue called ‘Icons of Indian psychiatry’ brought out by Indian Journal of Psychiatry in 2010 under the leadership of its editor, Rao (2010). It is an excellent volume on history of psychiatry in India, highlighting the contributions by various pioneers from different regions who are no more.

The Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi has also brought out an excellent book on ‘Mental Health—An Indian Perspective 1946–2003’ (Agarwal et al. 2003). It contains some very good articles on historical aspects by authors such as D.S. Goel, S.D. Sharma, M. Sarada Menon and others. It has some very interesting appendices, including excerpts from the famous Bhore Committee Report (1946) containing the sections related to mental health. It also has the detailed report by Col. Taylor describing his visits to all the mental hospitals in India at that time, and highly unsatisfactory conditions encountered there (Taylor 1946).

Abnormalities of human behaviour have been known and recognised since the beginning of civilisation all over the world. While it is true that modern science, medicine and psychiatry came to India along with the colonial powers, it does not mean there was no recognition or no methods of treatment and care of the mentally ill in India before that. Both the Ayurveda and Unani systems of medicine, which were widely practiced for hundreds of years in the country, had extensive discourses on signs and symptoms of various types of mental disorders and their management. In the indigenous herbal pharmacopoeia, there were powerful remedies such as opium, cannabis, ‘Sarpgandha’ and Brahmi, which have been relevant even in modern times. However, at that time, the knowledge of modern anatomy, physiology or pathological changes in brain was rudimentary, and humoral theories such as disturbance of ‘Kaph, Pit and Vayu’ were the main basis of diagnosis and management. Apart from herbal medicines, religious rituals and faith healing practices were widely prevalent for the treatment of mentally ill. There was, however, one significant difference between pre-colonial and post-colonial periods. While there were no formal asylums or mental hospitals for the care of seriously mentally ill in pre-colonial India, they sprung up with regular frequency during the British colonial period and became the main feature of psychiatry in colonial days. In fact, there was hardly any other psychiatry outside mental hospitals in the European system of medicine for a long time, while the Ayurveda and Unani systems still continued to offer help for various forms of common psychological conditions. Indian medical systems also recognised variations in personality and temperaments. Religious practices such as meditation and yoga were regularly used for psychological treatment, which is gradually being re-incorporated in the modern psychiatry now.

As is well known, the term ‘psychiatry’ was coined by Johann Christian Reil in Germany in the year 1808. This is to the credit of Reil that he did not see psychiatry as merely a speciality dealing with ‘diagnosis and treatment of mental disorders’, but visualised psychiatry as a broad clinical approach utilising psychological knowledge and methods for all medical disorders. Unfortunately, despite Reil’s broad vision, the term psychiatry remained limited to diagnosis and management of serious mental disorders such as psychosis, dementia or severe mental retardation. This is particularly true of the development of psychiatry during the colonial period of the eighteenth and nineteenth centuries in British India, when asylums or mental hospitals were the main centres for its practice.