Startlingly, the prime minister seemed unaware that the Chinese had declared a unilateral ceasefire and retreated from the Bomdila pass overnight. His address unleashed chaos in Tezpur. People grabbed whatever came to hand and began leaving town. Infamously, panic-stricken government officials and high-living members of the planter community were the first to evacuate. Currency notes in the local branch of the State Bank of India were set on fire. Since coins could not be burned, they were flung into the Padum Pukhuri lake, only to be recovered by grateful divers later. ^[1]

One civil servant remained unruffled by the commotion. Dr. Nani Bordoloi, the Superintendent of the Tezpur mental hospital, dispatched his staff and patients’ families to Guwahati (180km away) and Shillong (250km away). He then commandeered the local radio station and reassured listeners that there was no sign of an invasion, ^[2] in sharp contrast to the doom and gloom of the ‘official’ news. For this act of fortitude, and for keeping his mind when everybody around was losing theirs, he was awarded the Padma Shri, the first psychiatrist to be so honoured.

But what happened to those under his charge? According to eyewitness accounts and oral histories, patients wandered the deserted streets of Tezpur after the doors of the mental hospital were thrown open that day. According to one apocryphal anecdote, some of the patients wandered about shouting “China Zindabad” in honour of their ostensible liberator. ^[3] It is the kind of story that echoes Sadat Hasan Manto, writing about another border, in the opposite cardinal direction, in another time. ^[4]

It is also one of many surreal associations in the history of the Tezpur mental asylum. It began life on a picturesque bend of the Brahmaputra river, at the very edge of the British Empire. It survived the churn of epidemics and two world wars, and exists today as the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH). Boundaries were made and unmade around it. The river itself changed course over its lifetime. Through all this, its patients remained largely unheard, no more alive than their cut-dry medical histories in annual reports and administrative memos. This is not their story. But through this brief impressionistic biography of the Tezpur asylum, told largely through its annual reports and case notes, we hope to convey something about “madness” and its management.

Hospitals, dispensaries, medical colleges and asylums were an integral part of the British colonial government. For the ill, nothing like a common public space or healthcare services had existed in India before then, and these were welcomed by people. They were also meant to emphasise the permanence of the ruler and provide a justification for its ‘civilising’ mission. The ways in which Indian society came to view medical care in subsequent decades continued to be shaped by this logic.

It was a logic also grounded in commercial interest. British botanists and doctors had ‘discovered’ tea in Assam in the early nineteenth century. (The Chinese and Assam tea plant species had diverged from each other about 2 million years earlier.) Chinese tea had been introduced to Europe half a century ago, and had already influenced politics and quarrels from Boston to Bombay. ^[5] Scientists and businessmen in London and America were busy calculating the amount of land to be brought under cultivation in the shadow of the Himalayan slopes to ensure a regular supply of tea to their populations, while also circumventing payments to the Chinese. ^[6] Oil, too, had been struck in Digboi, east of Tezpur, in 1867. Digging began in the following decade, and India’s first refinery was established there in 1901.

Encouraged by these prospects, the British had moved eastwards, in a slow and protracted campaign that lasted almost 75 years. Burma was connected to the Indian possession. In 1874, the North-East Frontier non-regulation province was carved out of the Bengal Presidency, and Richard Harte Keatinge was appointed its first Chief Commissioner. The town of Tezpur became a hub for the tea estates. Workers and staff were imported from all over India through a complex system of bondage, slavery and migrations. The Tezpur Station Club was established in 1875 for the benefit of planters and officers, and the asylum followed the next year.

Located on a bend in the Brahmaputra and the Mora Bharali river, ^[8] the asylum began its life with some 60 odd patients, a third of whom were recorded to have been transferred from the asylum in Dacca. ^[9] Many of the first patients had been ill for long durations and were perhaps the ‘wandering mentally ill,’ a common sight even in the present day. Some were from as far south as Madras, and had landed up in Assam as tea garden ‘coolies.’ There were also vagrants and soldiers. The records tell us that almost half the patients died within a few months. By the end of the year, just 24 survived.

This appalling death rate was attributed to unclean water, severe anaemia, and even a possibility that staff were filching food (seen to have happened in many other asylums, though it was stoutly denied in Tezpur). Undoubtedly, those already in indifferent health were more likely to succumb. Two of the deaths come across as particularly intriguing. Two young women, aged 20 and 29, had been admitted in good health.

They had been diagnosed with hysteria and nymphomania, concepts that were quite new in the 1870s, and considered a degeneracy of morals or the brain. ^[10] One can only wonder about the circumstances that prompted these rare diagnoses.It is possible that the encounter between Victorian morality and Indian culture, or indeed any society at the edge of ‘civilization,’ ^[11] influenced diagnosis and classification. Then, as now, psychiatry remains the one discipline of medicine most influenced by cultural and societal narratives.

The annual report of 1878 described the site of the asylum as an excellent one: “on a high plateau, well raised above the Brahmaputra, and admit(ting) of perfect drainage in all states of the river.” Its proximity to the river, however, meant that it was prone to seepage. Extensive drains had to be cut to ensure that the buildings remained dry. A padded cell ^[12] was the only masonry building on campus, and the patients lived in “mere bamboo huts.”

Despite the patients’ “indescribably filthy habits,” the report gushingly noted that “nothing could be more perfect than the cleanliness maintained in the huts.” Having been modified for improved security after a few patients had escaped, the huts ended up having reduced ventilation, so a “pucca” building was proposed immediately.

As an early attempt to make the asylum financially productive (“self-sustaining” in today’s management-speak), the mostly well-behaved inmates were encouraged to cultivate cotton and tea. The first annual report noted that the “orderly life, absence of excitement, good food and kind treatment have a most marked benefit in this respect, so marked as occasionally to be delusive.”

This overrepresentation of migrant workers was also reflected in the asylums of a frontier society on the other side of the globe: California. In that American state, the foreign-born––Chinese, Germans, and even a few South Asians––accounted for more than half of the admissions. ^[13] The gold-rush and boomtown life in California had resulted in a rapid growth of population and a very skewed gender ratio. Both these things, according to contemporary opinion, induced madness. Most of the patients were men, and had no family to support them after their recovery.

Some Chinese patients did express a desire to return home, but “the disturbed state of China” in those years, and the fact that “there is not a single asylum in the Chinese empire” ^[14] prevented their repatriation. No psychiatric services existed in the northern hemisphere between California and Assam, which now represented the limits of Anglophone influence in medical services.

At the end of the nineteenth century, California’s first psychiatric facility in Stockton was, in this sense, contemporaneous with Tezpur. The California asylum report of 1876 approvingly quoted the observations made by Dr. TA Wise in Dacca in 1853: “insanity is less frequent in East Indians than among the civilized nations.” The sudden onset of “civilization” was thought to be a factor in producing insanity, as was rapid migration and a loss of social moorings.

Historical references aside, it is clear that there was soon a world of difference in approaches in California and Tezpur. For instance, it is instructive to read the recorded causes of insanity in California: these include inherited conditions, masturbation, study and experiment in spiritualism, sheep herding, excessive cigarette smoking and tobacco swallowing, drinking California wine, bad business, loneliness, want of proper food, (getting) struck by trains, Christian science and hypnotism, hystero-erotocism in women, and over studying. The causes of insanity recorded in Tezpur were ganja, spirits, opium, fever, epilepsy, grief, anger and jealousy. The paucity of psychological causes in Tezpur is an early reminder of the neglect of the ‘psyche’ of patients in non-Western settings. Moreover, by 1900, California had five mental hospitals with 5000 residents, while Tezpur, serving an area as large and complex, still had less than 200.

At this time, the asylum was the only recourse for a person suffering from any sort of mental derangement. The criteria for admission were the severity of behavioural change and the degree of social disruption. Little attention was paid to the nature of the disorder. Systems have since changed and there is a temptation to contextualise those diagnoses within so-called modern concepts. While it may seem that people were being hospitalised for what may now be categorised as severe anxiety or emotional reactions, readers should keep in mind that the medical and sociological narratives of the era were very different.

They came from far and wide: one compounder came all the way from the licentiate medical school in Nagpur; while the doctors were invariably graduates of the Calcutta Medical College. As a consequence of bureaucratic rivalries and, inevitably, racism, Indian doctors were only awarded short tenures in senior positions. Dr. Bose was in-charge for two months in 1900; Dr. Sikdar at the helm for four months in 1912, and Dr. Bhattacharjee for two. GC Das was made Deputy Superintendent in 1910 and Rai Sahib ^[15] in 1914. This only changed after the First World War.

Gradually, and in spite of these flaws, Tezpur acquired all the appurtenances of a ‘developed’ asylum. Patients were offered books and amusements, attended horse races and were taken to the Brahmaputra ghats for Durga Puja. A gramophone with Hindustani and English music records was made available in 1896. The timing is remarkable; the gramophone had been invented only a few years ago in New York City, and the first records cut in Calcutta only started appearing sometime in the late 1890s. This hints at progressive attempts to ensure life in the asylum was not too different from the world outside.

The psychiatrist's gaze had also moved out of the asylum and to society at large. The health authorities were concerned about the widespread use of opium, hemp, and alcohol. Opium addiction had already become a particular menace in Assam. Now, a substantial proportion of admissions to the asylum were for cannabis-related psychosis or what the literature came to call “hemp insanity.” It was first alluded to in the Indian Hemp Drugs Commission Report in 1893-4, though the first scientific communication came from Ewens in 1904. ^[16]

Dr. Robert McNamara, the Superintendent of the asylum from 1888-99, submitted colourful case notes describing ganja use in those admitted to the asylum. These included the accounts of a Vaishnavite beggar who had cut off his penis, one who spouted religious ideas, and another who had cut off his wife’s head. Despite these observations, in his final submission to the Indian Hemp Drugs Commission, Dr. McNamara wrote that he was “unsure whether the ganja had a direct correlation with the insanity.” ^[17]

Nevertheless, in 1903, the annual reports of these two facilities were merged, and savings were made on paper at least. This was a prelude to the 1905 partition of Bengal, ^[19] when the eastern sector of Bengal and parts of the Northeast regions were merged into a single administrative entity that would now contain both Tezpur and Dacca. The partition was revoked soon after, but not without creating societal and religious tensions, ripples of which are felt even today. The mentally ill, as is often the case, became the test population for a political machination.

Personal details and anecdotes were now dropped from the reports, which became succinct to the point of absurdity, comprising mainly tables and costs. The overcrowding also prompted the suggestion that “non-criminal lunatics” could be discharged to the care of their families. By now, even the Naga tribes and other communities which had long resisted British rule were sending patients for admission to the asylum.

Doctors and soldiers from the Northeast participated in the Great War of 1914. Post the war, there was an impetus to improve the nature and extent of psychiatric services in the Empire. Specialist training for psychiatrists of the colonies started in London. Asylums were renamed “mental hospitals” as part of the drive to mainstream and medicalise psychiatric care. Many Indian medical officers who had assumed command in the war had come good and won British trust. As a result, one begins to see more Indian names as mental hospital superintendents.

On the ground, change was gradual. In spite of sending patients home, overcrowding had only increased. The old buildings of the asylum had outlived their utility, and were now decrepit, but it was noted regretfully that since piecemeal repairs to the buildings were not sensible, the “present distressing conditions must still continue.”

It was also evident that the asylum needed a full-time, trained psychiatrist as superintendent. In 1932, an assistant surgeon was selected and sent to the European Mental Hospital in Ranchi for the necessary experience. The Ranchi hospital had been established after the war for treating only those of ‘European’ ancestry. It had the best facilities, and also a reputation for encouraging a detailed and systematic study of patients’ symptoms.

These improvements seem to have passed Tezpur by, because the notes seldom reflect the complexity of clinical conditions. Even while research papers from the mental hospitals of Madras, Ranchi and Lahore went out to the world, Tezpur got along unobtrusively and inexpensively. In the 1930s, the poor state of the economy caused by the Great Depression nudged the authorities to toy with the idea of mandating fees for the use of the medical facilities. The medical officers resisted this strongly: they felt that it was unfair to “impose a fresh burden” on the population.

All this placid bureaucratic plodding was then rudely interrupted by the Second World War. The Japanese had advanced to the north-eastern frontier of the subcontinent.

On the other hand, the region was now open to much wider engagement. The Americans were flying in with their mammoth B17 bombers and freighters. They were supported by an array of doctors, nurses and orderlies. There were soon field hospitals: one set up in Ledo ^[20] by the University of Pennsylvania had 289 buildings, 162 tents and treated 50,000 patients, with a mortality rate of 0.4%. ^[21] The massive 14th Army, commanded by Field Marshal Slim, had its own medical corps. Back then, Chinese troops actually marched through Assam, but on the same side as British India and supported by American planes. ^[22]

The mental hospital continued its work, helped along occasionally by professionals from abroad. The Silesian nurses, from central Europe, came in for particular praise. Their involvement may be linked to the earlier establishment of Protestant churches in the region, the presence of Allied forces, and the wartime displacement of Polish and central European clergy.

The Japanese were driven back and the Axis powers were defeated. In the euphoria of victory, new sterilising equipment was ordered, buildings were added, and more staff was sanctioned. Annual reports resumed, and the 1945 edition recorded 34 deaths, substantially fewer than 154 in the previous year. This number is the only hint of the terrible privations the patients must have experienced in the war years.

The British would soon be leaving, but not before drawing incisive lines across lands and souls. Around this time, plans for improving the conditions in mental hospitals found a mention in a comprehensive blueprint for healthcare reform. It was hoped that soon-to-be independent India would have something like the freshly-minted National Health Service (NHS), a pillar of the post-war rebuilding effort in the United Kingdom.

In the first detailed post-War report of 1946, Lt. Col SL Bhatia, commented that the Tezpur Mental Hospital was still in a “mixed state of a Prison, Asylum, and Mental Hospital.” Perhaps his most telling set of observations was of psychiatry being a kind of “morbid curiosity” for most medical men, and the “very crude” attitude of the public towards the mentally ill. Unfortunately, the impressions of Lt. Col Bhatia are reflected in twenty-first century attitudes: psychiatry remains the Cinderella service of medical care.

In any case, all talk of health reform was quickly abandoned in the face of Partition and its aftermath. In the first annual report after independence, ^[23] Col AN Chopra noted that a new temporary post of office assistant had been sanctioned in October 1948 “to deal with matters relating to the repatriation of patients belonging to Pakistan dominion.” The details of who these patients were and on what grounds they were being repatriated remain, as with so much else, shrouded by the mists of time. The fact of the matter is that East Pakistan did not have a mental hospital in 1947. The asylum in Dacca had been shut down in 1925, when most of the patients in Bengal had been moved to the big facility in Ranchi. ^[24] All of Pakistan’s three mental hospitals were in its Western wing.

The appointment of separate office staff—and not a doctor—to deal with matters related to the repatriation had echoes in an exercise conducted in 1940s Nazi Germany. In that regime too, office staff were appointed to identify the mentally ill for transfer to concentration camps as doctors were often thought to be less reliable when it came to complying with the rulers’ orders.

After independence, the Indian Medical Service, whose writ once ran from Suez to Singapore, was disbanded. The opinions of military medical men like Lt. Col Bhatia and Col Chopra were no longer thought relevant or necessary. In 1949, Dr. Nani Bordoloi, who had also been in the Army, moved to the Assam civilian service. He took charge of the hospital and remained its Superintendent right through to the Indo-China war, and the exodus from Tezpur.

As an aside on the subject of evacuations, there exists a delightful correspondence in the Trivandrum State Archives. It is between the Resident for the Madras Presidency and the Dewan of Travancore. ^[25] Between June 1942 and April 1943, the two exchanged a series of letters on the protocol regarding evacuation of prisoners and inmates of lunatic asylums in case of an anticipated invasion. After a detailed discussion, there is a ‘Most Secret’ Express letter from the Resident, which says that “... when there are serious cases, the medical officers would be failing in their duty as members of the medical profession if they left them unattended, and the existence of this professional obligation differentiates doctors from the generality of members of public service.”

In the ebb and flow of political and social change, how the marginalised fare is the only real measure of whether the changes are worthwhile or not.

These were initially created to house Partition refugees whose nationality was yet to be decided. In a bureaucratic twist reminiscent of Toba Tek Singh, ^[27] some of these now house the destitute and chronic mentally ill. In the Permanent Liability Homes in Bamunigaon, ^[28] for instance, a project called Navchetna has set up a rehabilitation facility for mentally ill people who are homeless.

At the administrative level, the lives of those with mental illness continue to be moved across files, budgets and targets. They themselves remain unreached—stigmatised by the public, and often seen as a liability by those in charge of running state affairs. Yet, their lives carry on, both “crazy” and cruel.

Alok Sarin is a practicing clinical psychiatrist in New Delhi, with an active interest in psychiatry, medicine, history, ethics, society, and literature with their many intervening spaces and conversations. He has been in active clinical practice for the last three decades and is currently an Honorary Consultant to the Sitaram Bhartia Institute of Science and Research, New Delhi.

Sanjeev Jain is at the Dept. of Psychiatry at NIMHANS, Bengaluru, where he has been studying historical and social responses to mental health issues using institutional and individual histories. His work explores the development of psychiatric care and health policy in South Asia, during the colonial and post-colonial period. He also heads the Molecular Genetics Laboratory, where he researches the genetic and genomic correlations of psychiatric and neurological disease.