The Crusader of Mental Health

Joining NIMHANS

CRC was introduced to Dr H S Narayanan, a psychiatrist in the Mental Hospital by Dr. Pundalika. It was Dr. Narayanan who inspired young CRC to study psychiatry. Dr. Narayanan used to consult on Wednesdays in the evening at Victoria hospital.

He invited CRC to come to Victoria to learn psychiatry. “Young doctors like you should study in psychiatry; it is an interesting field” he would say. CRC had been fascinated by the Kannada novels of Triveni (the pen name of Anasuya Shankar), particularly ‘The Closed Door’, which were based on real life psychiatric case studies. She had graduated in psychology; the case studies were given to her a clinical psychologist who worked in Bangalore Mental Hospital.

The books “Manonandana” and “Manamanthara” by Dr. M Shivram (‘ Raashi’), which analyzed causes of mental disturbances and treatment methods, had made a deep impression on CRC. Dr. Shivram was a well known physician and founder of Bangalore Medical College, who linked diseases to the state of the mind in a gentle, humorous way. He was the first to write in Kannada on mental disorders. CRC aspired to become a popular doctor and writer like Shivaram.

Just as a detective penetrates the mind of a criminal and decodes its working, CRC felt that a good psychiatrist should be able to analyze the mind of a patient, match her behavior to the working of her subconscious mind, arrive at the root cause of the illness, and then treat it. The doctor unravels a person’s inner conflicts from her abnormal behavior. This challenge attracted CRC and he decided to learn under Dr. Narayanan. CRC started attending Dr. Narayanan’s clinic in Victoria Hospital as an observer from 1973 till 1974.

One day a father brought his son, who was around 30 years old. The son had stopped doing all work. He would sit quietly all day, not speaking to anyone. He refused to bathe, change his clothes and would be furious if he was compelled to do so. He was the only son of his parents, and they despaired of him. “I am getting old, and cannot work anymore. If he acts like a silent god, and sits like a stone statue, what will become of us?” the father asked, tears in his eyes.

CRC addressed the son. “Prabhakar, you have heard your father speak. What is your problem, why are you refusing to work, what is troubling you – speak up without any worry.”
The man sat silently. Dr. Narayanan too urged him to talk, “Can’t you hear the doctor asking you? Why are you silent?”

At last Prabhakar opened his mouth. “I studied for 15 years, then I worked for 2 years. I feel weak and tired. Now I am resting. My parents keep nagging me to work, giving me tasks and asking me to go on errands. They don’t allow me to rest in peace.”

Dr. Narayanan diagnosed it as a case of schizophrenia. What was schizophrenia, CRC wondered. He asked if all people who were lazy and stop physical activities were schizophrenic. Narayan replied, “No, not all of such people; but among people who withdraw from the world, like sadhus, sanyasis who retreat to Himalayas, people living in monasteries, those who take up studying religious or philosophical texts, some are indeed schizophrenic.”
One day, Geeta, a young woman, was brought to Dr. Narayanan. She used to faint often. The doctors at the government hospital had decided that she was not epileptic, and probably suffered from hysterical attacks. They referred her to Narayanan. CRC examined her first. When she was brought to the clinic, she had had as many as 8 to 10 fainting spells in a day during the week.

“Even today, she has already had 6 attacks”, her mother said. During the spell, her limbs jerk, her mouth drools, but she has never fallen and injured herself. After she recovers, she does not recall having fainted. We are trying to arrange her marriage. Next week, the boy’s family is coming to see her. Please cure her fast, or misfortune will befall us. If they discover that she has this condition, they will reject her”, pleaded her mother.
When he narrated the case to Dr. Narayanan, he asked him if he had ever tried inducing an attack. CRC asked how could an attack be induced.

“ I’ll show you now”, said Narayanan. He asked the girl to sit on a stool. “Geeta, is it true that you get some kind of attacks?”

“Yes Sir. They say I get such spells, but I am not aware what happens to me during the attack.”

“Start thinking of an attack. Imagine what happens in your body and mind just before an attack. We will observe the process and will then be able to decide the appropriate course of treatment. Don’t you want to get better?”
Gita sat without replying, gazing at the doctor.

“Look, now I will press a nerve in your forehead. This will induce an attack in you. Now close your eyes”. Saying so, he pressed a spot in her forehead.
Gita’s breath quickened. Strange sounds started issuing from her mouth. Tears flowed from her eyes. She started whimpering. Her head hung limply on one side.
Her mother cried out in alarm as she rushed forward. “She is going to fall!”
Narayanan motioned her to stop. “Do not worry she will not fall,” he assured her. Just as he had promised, Gita did not fall, though she swayed and bent her body from side to side. Her nostrils quivered, her face was working. Soon, she slowly slid forward from the stool and lay down on the floor motionlessly.
Narayanan pressed her forehead again and said, “Gita, we have seen your fainting attack. You may open your eyes now.”

Gita came to slowly, and spoke in a slurred voice, “O Mother! Where am I?”

With help from the doctor, she arose and sat on the stool. All this amazed CRC; it seemed like a miracle. Narayanan sent out the parents.

Placing his hand on her arm, he said, “See child, you seem to be troubled by something. We are concerned for you. You are unable to resolve your problem; this is agitating your mind. You must confide in me without fear. They are trying to get you married. Are you against this marriage or are they forcing you to marry? I will speak to your parents about what you really want.”

Narayanan’s face showed his concern and sympathy. Tears rolled down Gita’s face.

“I love a boy in our neighborhood. He is a good person and he too loves me. But he failed in his PUC exams and he works as sales boy in a shop. His family is poor and he the only bread winner. My parents say that starvation and a hard life will be my lot if I marry him. ‘We will marry you to a boy who earns well and who belongs to a wealthy family,’ they tell me. I have promised the boy that I will marry only him. If my parents try to force me to marry someone else, I will take my life or run away from home. Please talk to my parents and make them accept my choice.”
Narayanan called in her mother and talked to her. Her mother corroborated what Gita had said. She wanted the doctor to convince Gita to give up her infatuation with boy, who was not bright and worked in a small shop.
Narayanan said that Gita should get better first, before anything was done. He asked the parents to cancel the visit of the prospective groom, and to come again the next week. He wrote out a prescription for a placebo tablet for Gita.

When they came to the clinic again, Gita had improved dramatically. The hysterical fits had stopped. The parents had postponed the visit of the groom, and Gita too had agreed to defer marrying her lover.
“I will study further and get a job. If I am employed my parents will let me marry him as their objection would no longer hold true.”

CRC was deeply impressed by the treatment of the disease and the resolution of the marriage issue. CRC’s experiences in Victoria hospital – the stream of patients with varied problems, the way Dr. Narayanan examined and treated each patient, the rather dramatic mode of treatment of some cases – strengthened his interest in psychiatry. People who had been suffering from symptoms like chronic headache, and had consulted physicians in other specialities, but found no relief, came to the mental health clinic and were cured. Some patients had stopped speaking, some suffered from paralysis of limbs, some claimed to be possessed of a demon and raved. All such patients suffering from psychological symptoms who came here became better within days or weeks of starting treatment. CRC decided to do his post graduation in psychiatry.

Narayanan encouraged him to specialize in psychiatry. “What will you achieve after internal medicine – you will be one among ten doctors. Our country has a shortage of psychiatrists. Youngsters like you should take up mental health.”

One day he asked CRC to meet him next day early morning at the Mental Hospital. He said he would introduce CRC to

Dr. G N Narayana Reddy, Medical Superintendent, and ask that CRC be appointed as Senior House Surgeon. On first January the diploma course in psychiatry would start; if he applied as a senior house surgeon from that department, his chances of getting selected would be high. September 9, 1974 was to be an important date in CRC’s life.
Narayan told Dr Reddy that CRC had been working in his clinic in Victoria Hospital for the past six months, and could handle patients independently in his absence. He suggested that CRC be appointed as Honorary Senior House Surgeon in Mental Hospital the same day and that CRC could start working with him in family ward.
Dr. Reddy was delighted to hear this. He asked CRC to start working from that day itself and to collect appointment order later. CRC was touched by Dr Reddy simplicity and humility. Dr Reddy later became director of NIMHANS.
CRC joined NIMHANS in September 1974; he was to work there till his retirement on 30 June 2013. CRC believes that Dr. Reddy’s blessings made him what he is today.

He was impressed by Reddy’s work and was moved by his compassion for poor patients and his dedication to work. One incident stood out in particular. One day at 9 pm, when Dr. Reddy was doing his rounds in the hospital, he found many people camping at the entrance steps of OPD. He enquired of them and found that they had come from out of town, and had reached too late for consultation that day. They could not afford to stay in a hotel, and intended to camp overnight there and get examined the next day and leave for their homes. Reddy had the OPD opened and got them accommodated in a hall. Later he set up a permanent place for out of town patients and relatives to stay during their treatment. It became popular and donors came forward and a new wing was constructed next to OPD. This was named ‘Relatives Rest Home’. For a nominal charge, relatives of patients could stay in rooms or the dormitory.
Dr.Narayan Reddy was instrumental in helping CRC in another instance. In 1985, CRC completed his twenty fifth book, Mind and Mental Illness (Manasu Mathu Manasika Aswasthate), in Kannada, which was a compilation of his 48 articles. Reddy got it published by NIMHANS and organized its launch event. The book was launched by Jeevaraja Alva, the minister in the Government of Karnataka. The book described the progress made in treatment of mental illnesses and how to prevent them. CRC gave back the consideration he received for the book to NIMHANS to be used for publishing books in Kannada.

CRC applied for the DPM course, which was of 24 months duration.. He passed the interview for DPM; there was no entrance exam for DPM at that time. The DPM course started on January 1, 1975. He was posted to Dr Narayanan’s unit. He reported to the second pavilion’s fourth ward, which was a ‘closed’ ward. In a ward which could accommodate 20, he found 60 patients. Some had to share a bed, others had to sleep on floor. He saw the file of a patient suffering from fever for 3 days. He examined and found that the patient had become dehydrated. CRC ordered glucose drips to be administered. Over the next two years, he worked in various departments – neurology, neuro-surgery and psychiatry as part of his training.

His dissertation in DPM was on the level of anxiety in under-trial prisoners in Central Jail. He got Dr D. L. N. Murthy Rao award for being the ‘the best outgoing student’ in the batch. This helped him later in getting a seat in MD. After DPM he worked for 6 months as research assistant; he could not have got a job in NIMHANS as an MD degree was a requirement.

In March 1977 he was appointed as research assistant in ICMR project on ‘Collaborative Study on Severe Mental Morbidity’ under Dr R L Kapur, Professor of Community Psychiatry, for a period of one year; this was a temporary post with a consolidated salary of one thousand rupees per month. The study involved the training of the primary health care personnel for identification and management of severe mental illnesses and epilepsy in rural areas, and the evaluation of the intervention by a final field survey. This study showed that primary health centre personnel could be successfully trained to identify and treat psychotics and epileptics.
As part of the project, the team carried out a study to examine the validity of social dysfunction as a measure of severity of mental illness. The tool for measuring social dysfunction was Form R2 of KAS Behavioral Inventories. The study was carried out by measuring the social functioning of 200 patients attending the psychiatric outpatient department of NIMHANS and 200 normal people (control group), who were matched with the patients on age, sex, education and rural/ urban background. It was found that the scores on social dysfunction were higher amongst the mentally ill compared to subjects in normal group, higher in psychotics compared to neurotics and higher in those assessed by the psychiatrist to be more severely ill than those judged as less severely ill. Thus the hypothesis of the study was established.

Dr. H S Narayanan, his teacher in DPM, had only a DPM qualification, not an MD degree; consequently, he had been appointed as an assistant surgeon in the hospital. Narayanan was working in NIMHANS on deputation from the state government. To get promoted as professor, he joined the MD course along with CRC, when he was around 50 years old. He interacted with his fellow-students without any ego issues.

CRC applied for the MD course and was selected. He did his MD from July 1977 to June 1979. His thesis subject was the mental health of post graduate students of Indian Institute of Science (IISc.). He interviewed 1200 students. He contacted half of them after classes; he tracked the rest of them down to their rooms in the evenings. The study found that 16% had emotional issues like depression, loneliness, stress, feeling harassed by teachers. Subsequently, NIMHANS recommended to IISc to offer counseling services to students, as academic performance of these students had been impaired. Later NIMHANS conducted a two week training program in counseling for volunteer teachers of IISc.