Recently, I had the opportunity of coordinating a course on ‘Mental Health, Poverty and Marginalisation”. And a component of the course involved a visit to The Banyan, an organization that worked for poor and destitute mentally ill women. Ofcourse, I have compiled many a report as part of my job, but there are some observations I want to make that are perhaps irrelevant to my institution and, therefore, will never make it to the reports.
But before I begin, a brief introduction to the Banyan. Located in Chennai, The Banyan is devoted to rescuing, treating and rehabilitating destitute and poor mentally ill women. Apparently, families who find such women a burden either economic, social or political, put them in express trains that terminate at Kanyakumari (the southern-most tip of the country). Express trains have fewer stops in between so these women are unlikely to be dislodged anywhere near their home. Many of these women, somehow, find their way to Chennai, the nearest metropolitan city. What is remarkable is that these women hail from various parts of the country and speak different languages and often have no idea where they are or what they are expected to do. Banyan is concerned with rescuing such women, providing treatment during which time they are sheltered in their transit home and then ( more recently) they have even started repatriation. The last part is a difficult process and, often times, unsuccessful.
The Banyan’s work in the field of care and support for the mentally ill has been a first of its kind, atleast in India. And what is most admirable about their work is that they have understood the need for rehabilitating clients with their families. They make a proactive effort at doing so. This is important not only for the clients but also for the families and society. To that extent, the approach is radical and shows an interest in changing not only attitudes but also increasing levels of acceptability.
However, there were a couple of issues I thought needed some further consideration. And much of it stemmed from what workers said or did.
As part of their Community mental health programme at Kovalam, Banyan told us they would ask people who walked into the health centre if they knew of anybody who was mentally ill or who required treatment. Once people identified other people, Banyan would take over and approach the individual and his/her family and take the process further. This was Banyan’s idea of involving the community and civil society in the process.
This, to me, is a dangerous approach. How are people supposed to know who is mentally ill and who is not? There are scores and scores of literature and movies that speak about how misfits, misanthropes, rebels and people of different thought have been identified time and again by society as people with mental problems. That society does not like a person who thinks differently and would only be too happy to institutionalize him/her is obvious when you see movies like One Flew Over the Cuckoo’s Nest. Indeed, feminist literature, especially in India, is replete with how only too often the medical model is eager to diagnose rebellious women with mental illness. Moreover, there is a chance that prejudices play a role in such approaches. People are prejudiced against communities, castes, genders and it would only be a question of time before a McCarthian witch hunt ensues. It might well be that I am exaggerating greatly the ills of such an approach. But the point is that communities are heterogeneous and there are different groups within communities. What’s more, Banyan doesn’t even seem to be aware of this danger. Community participation is crucial in any kind of social problem solving, but, a thorough consideration of the heterogeneity of society and the delicate nature of mental illness ( taboos etc) must be made before an intervention.
A second concern that I had was triggered off by an exchange between one of the workers and one of the clients at Kovalam. The clients were sharing with us ( students and outsiders) their stories and answering questions that the students would ask. The worker intervened once and asked one of the clients, “ what about marriage? What about settling down now that you have some control over your illness?” The question was rather matter of fact and was ok as far as it went. The client replied, “ I don’t want to get married. I am happy now.” At which the worker retorted, “ Why ever not? You are so pretty. I am sure you will get a husband in a jiffy.” What is most disturbing in this exchange is not that the girl was asked about marriage but that she was told that there should be no hurdles in the event she wanted to marry BECAUSE she was pretty. And this from a credible, top ranking worker in the organization. The credibility attached to such a person is huge. And for her to make such a comment is doubly harmful.
The larger question, however, is what exactly does a treatment towards ‘normalcy’ entail? Is normalcy about making the mentally ill accept and internalize the values of society. Values that are arguably skewed. Values that are being debated, discarded, reformulated all the time. Or is normalcy about helping people gain greater control over their lives? And do what they want to do, regardless of what others might believe to be normal.