European efforts to establish psychiatric institutions in India date back to the eighteenth century. Provision for the confinement of the mentally ill was first made in Calcutta some time prior to 1787. In 1794, the 'Madras Lunatic Asylum' was opened to afford 'security against the perpetration of those acts of violence which had been so frequently committed by unrestrained lunatics'. Each of the presidency towns of Calcutta, Bombay and Madras could boast its own 'asylum for the European insane'. Despite its relative insignificance in quantitative terms, psychiatric provision for Europeans in India was an integral part of European social relief measures. The repatriation of asylum inmates thus conveniently removed the problem of European vagrancy from India and limited the expense of maintaining pauper patients in costly psychiatric institutions in India. In the early nineteenth century, psychiatry had become an integral part of the colonial system of social welfare and control.

This chapter discusses the conceptual and methodological concerns connected with the central themes of the book. It reflects on varied definitions of human activity as labour, work and action, from the Ancients to Adam Smith, Karl Marx, and Hannah Arendt, contrasting these with NAZI ideas on forced labour and its supposedly liberating effects. The ways in which work and activity have been integral to medical ideas and practices in both Western and non-Western healing traditions and psychiatric regimes are explored, and the different themes covered by the contributors to the book are presented.

This chapter focuses on the organisation of patient work in the mental institutions established by the British for both Europeans and Indians in South Asia. It explores the changing and plural meanings of work in relation to prevalent medical ideas and practices in different institutional settings in British-held territories from the early nineteenth to the middle of the twentieth centuries. Different aspects of work will be discussed, such as work as therapy; means to combat idleness; patients’ empowerment; institutional profit; and forced labour. The incentives used by staff to induce patients to engage in physical labour and the punishments employed in cases of non-compliance will be scrutinised. It will be shown that gender, social and caste prejudices and sentiments affected the types of activity patients were expected to engage in, and how, with the emergence of professionalised occupational therapy from the early twentieth-century, patient work became increasingly acceptable also with regard to European patients. The link between intensive work regimes and the concomitant decreased use of other treatment methods such as sedation, prolonged rest and hydrotherapy from the 1920s onwards will be explored.

In 1932, Dhunjibhoy proclaimed: ‘We introduce all the latest approved Western methods of treatment with due regard to Eastern conditions.’ It is clear from the records that he did just that. Finances permitting, he experimented with new treatments as soon as they became publicised in the academic literature, exposing patients at Ranchi to the same benefits and horrors that were bestowed on their counterparts in Europe and North America. From today's perspective, shock therapies and prolonged sedation constitute a woeful chapter in the history of psychiatry. At the time they seemed to provide a glimpse of hope among Western-trained practitioners around the globe, nurturing the belief that modern science and medical technology could effect improvement in some, if not all, types of mental illness. However, despite the emphasis on drug and shock treatments in the official report forms, the ‘sheet anchor’ at Ranchi was the more mundane, tried and tested hydrotherapy, together with an intense regime of work therapy. These methods, too, could be seen as means to subjugate and exploit patients. Towards the late 1930s in particular there are traces of this. Yet, there is also ample evidence of care and attention being paid to the welfare of patients. The well-established links with the upper echelons of the public, the frequent outings, feasts and nutritious food, and entertainment by external performers, leisure opportunities and the parole procedure for recovering patients indicate that Ranchi's institutional boundaries were permeable, albeit surrounded by a four-metre-high wall.

Ranchi was, Dhunjibhoy liked to claim, a ‘modern mental hospital’ that benefited from the introduction of ‘all the latest approved Western methods of treatment’. The evidence provided in his regular reports and publications fully substantiates this claim. When he was not travelling to ‘keep abreast with the rapid advancement of the science’, Dhunjibhoy read profusely. His library books and journals at the Ranchi Indian Mental Hospital have been well preserved and are testimony to his profound and wide-ranging knowledge of hospital management and therapeutics. There are books that he might have acquired well before the institution's inauguration and which would have helped him to set up the institution from scratch, and complete sets of some of the most authoritative journals, considered vital reading by Western-trained psychiatrists around the world. These included, American Journal of Psychiatry (from 1923), British Medical Journal (from 1927), Journal of Mental Science (from 1921), the Lancet (from 1927), the Practitioner (from c. 1929), Psychoanalytic Review (1921–42), Psychological Bulletin (1927), Psychiatry – Journal of the Biology and the Pathology of Interpersonal Relations (1938, 1939), International Journal of Psychoanalysis (1920), Brain.

One of the most pertinent questions in relation to any mental hospital is: who were the people who ended up in it? Who were they prior to becoming ‘patients’ with a particular diagnosis attached to them? Were they ‘village idiots’ and ‘half wits’, as is often assumed; ‘the morally disreputable, the poor, and the impotent, […] vagrants, minor criminals, and the physically handicapped’, as the sociologist Andrew Scull suggested in 1979 for the period prior to the mid-nineteenth century in England?1 Or were they dangerous psychopaths, religious fanatics and ‘mad axmen’, as many fear when they hastily walk past a mental institution? Were the inmates merely somewhat strange ‘eccentrics’ who had developed the Indian version of the British colonials’ ‘doolally tap’ syndrome where they went ‘pagal’ (‘mad’)? Were they just a mixed bag of inconvenient family members and depressed women, political rebels, uncooperative Indian princes or intractable tribals who were locked away?

Evidence for each of these characterisations can be found in hospital records and medical, official and patient accounts all over the world. Sociohistorical analyses that set themselves apart from previously preferred ‘Whig’ narratives that celebrated the progress of biomedicine in Western science-based psychiatry have tended to focus on mental institutions as means of social, political and gender control, where formerly autonomous people were forced into the role of the ‘passive patient’.