My inmate days | Life inside two mental health institutions

A young man who wrote intense love poetry turned out to be a killer, and an elderly man was bent on self-harm… Novelist Rithwik Aryan spent 18 months inside two of India’s biggest psychiatric care facilities and met a diverse mix of people

Few people are aware of what goes on inside a mental health institution. They are limited access, highly guarded establishments with tall fences and barbed wires designed to keep patients from escaping. Staunch gunmen stand guard all day long with their double barrelled shotguns to protect the inhabitants from each other.

In the course of writing my recent psychological thriller-dark comedy novel, ‘Out of Madness’, I spent 18 months living inside two such institutions — The Central Institute of Psychiatry (CIP) in Ranchi and the Institute of Mental Health and Hospital, Agra. Most of what I describe here happened during my time at these institutes.

The main facilities at both places are surrounded by a sprawling forest with trees of pine and juniper. Tall and dominating, these trees sometimes reach a height of over 200 feet. There was a white church down a gravel path at CIP, where a few inmates would play badminton and volleyball in the evenings, and a small library designated for the patients’ recreation.

From a literary standpoint, I was in heaven. From a layperson’s perspective, I was in far deeper trouble than I realised.

Most of our perception of mental health institutions is influenced by popular psychological thrillers like ‘Shutter Island’, ‘Silence of the Lambs’, and ‘Cure for Wellness’. Mainstream Hollywood has made millions capitalising on what could potentially go wrong within such a place. Serial killers. People on death row. Cannibals. However, the most appropriate and accurate depiction can be found in the eight Oscar-winning film ‘One Flew Over the Cuckoo’s Nest’ or Angelina Jolie’s ‘Girl Interrupted’.

In therapy

As a child, I came to the conclusion that I was going to become a bestselling author. And I wanted to achieve that through an uninhibited creative process, where the ambitions of success were not first and foremost in my mind. So, once I was done writing and confident that my story was truly the stuff of bestselling novels, I was welcomed into the world of rejection. It took a toll on me and drove me to insanity.

Suddenly, I was on six pills a day and two therapies a week. 

The early symptoms occurred because my reality and my ambitions were not overlapping. Put simply, I was not a great writer. The more I chased perfection, the farther it got from me. I grew anxious. I would wash my hands 200-250 times a day. Then I would moisturise it the same number of times. My mind would get exhausted even before I could write a single word. Because I was perpetually tired, I could not work. This made my anxiety worse. 

I was chasing the perfect start, not realising that it’s the journey that is important. They were the initial signs of Obsessive Compulsive Disorder. And then, when I began isolating myself more, my troubles doubled. Within a month I was diagnosed with Obsessive Compulsive Disorder, Major Depressive Disorder and Generalised Anxiety Disorder. And to top it off — Bipolar Affective Disorder. 

With these diagnoses began my routine trips to the psychiatrist’s chamber. My father and I visited almost all the good psychiatrists in the city. He would drive me from one chamber to another. One clinic to another. His demeanour — soft and empathetic. I would sit in the passenger seat staring out of the window and trying to figure out how I managed to get here.  

I spent a few years in isolation. I moved into a secluded building on the outskirts of Bengaluru. This was during high school. I convinced my family that it was a good idea to let me stay away from home. I wanted to enrol in an expensive international school because I wanted to pursue literature or psychology abroad.

I managed to get into Harvard University in the US. The institution is so grand that people usually turn all stern and serious when I say the name out loud. But I was barely three months into my extension course when I dropped out. When people ask me why I dropped out, my only explanation is that my classes were interrupting my writing schedule. Back then, I thought I was in trouble. When I look back, I figure that I dropped out because after a long time, a story was brewing inside me, for which I was ready to pay the price.

Boston to Bihar

Boston left me empty and hopeless. With nothing much to do, I decided to return home. My next pitstop was Bihar — a place notorious for its many gangsters, old gang wars and corrupt politicians. It is here that I began finding ideas that would become the basis of my first story, ‘Out of Madness’.

I spent a solid five years in Bihar developing probably one of the funniest and wittiest stories I thought I would ever write. Gangsters, orchestra dancers, sex workers, corrupt politicians, unruly bureaucrats. It was cathartic.

While in Boston, I was still in therapy. Through my university course, I became familiar with the McLean Psychiatric Hospital — a vast facility used in multiple Hollywood films (including ‘Girl Interrupted’). I decided to set my novel in a mental health facility because I was fascinated by McLean and then later with artist Vincent Van Gogh (who had spent the last years of his life inside an psychiatric institute before killing himself).

So when the Bihar chapter was over, it was time to step into a psychiatric hospital.

Having been a patient myself and having studied a reasonable amount of psychology, I had a basic understanding of mental illness. I met the director at CIP, Ranchi — a very kind gentleman named Dr Basudeb. 

My very first impressions of the place were of the tall and endless barbed fences with guarded watch posts. The doctor’s chamber was outside the wall of the asylum.

First impressions

Apart from CIP, there are two adjoining mental hospitals in Kanke, Ranchi — the state-run Ranchi Institute of Neuro-Psychiatry & Allied Sciences (RINPAS) and a private mental hospital, Davis Institute of Neuropsychiatry. Close by is the Kanke dam and unexplored jungles. Every now and then, I would hear distant gunshots being fired to keep the stray birds away from one of the facilities.

Once inside, I saw that CIP was luminous. This was a regal mental asylum — a lush green 220-acre campus entirely built in 1857. Patients roamed in blue or yellow robes. Each patient was living in a private world of his own. Their conversations were as private as their thoughts. Every now and then, someone would raise their head and say the most incomprehensible of things. Nasty and gory things. Things that can’t be written in a newspaper column. Though I’ve taken all the liberty to write them in my novel.

Some would spend their time totally dazed by the gifts of nature. Some would stand and stare endlessly at a giant peepal tree occupied by singing parakeets and hummingbirds. Some would collect leaves that had fallen to the ground. It was like they were in a treasure hunt. I was quite scared to walk in the gardens unaccompanied. 

I was asked to report at the Academic Library (which is right at the heart of the campus). Some patients stared at me as I walked. Others went about their business as if I didn’t exist. I was scared and self-conscious but fascinated at the same time. A few steps ahead, I came across a Dutch church dating back to 1857. It was covered in ivy and made for a beautiful sight.

Encounters with patients

During the first few days, I went about writing in a haphazard manner. There was no structure, no discipline. Most of the time was spent in soaking up the surroundings. And it was quite an unpredictable place. The patients could roam freely. You couldn’t stop them. It was their territory, not mine. Initially, I stayed in the vicinity of a guard who would sit near the Dutch church with a stick. The patients did not loiter near him. So for a few days, I sat and wrote there, having surrendered my chances of survival to the hands of a guard with a wooden stick. I would write for hours, from early morning to late at night. At night, I had a separate accommodation in the guest house (it’s inside the premises of CIP, but away from the wards).

Shortly afterwards, I developed a hack for writing amazing and out-of-the-box scenes. I began using flashcards. This is how Nabokov had written ‘Lolita’ while on a cross country tour of the US with his wife. He would write meditatively on flashcards. Random scenes taken from random bursts of inspiration. And then he would connect them all and he would have a story built out of the virtue of true creativity. How else are you supposed to translate your inspiration into something tangible?

With time passing by, I grew accustomed to the ways of living inside the institute. From the fourth floor of the library (I was generously offered a writing space there), I would watch and absorb the world that was developing outside of the story as well as inside. In the evenings, the patients would line up at the back of their wards against the backdrop of a depressing red sunset. And there would be absolute calmness. First they would eat their food, then they would be administered medicines.

In the night, quite often, there would be commotion in the wards. One time, a patient declared his undying love for a nurse. He stood on his bed and demanded she be sent to the ward immediately! Another
time, a tortured maniac was locked inside a room for punishment. He banged the door and screamed for hours, the noise echoing through the whole campus.

Creating connections

Around Deepavali, I made friends with a patient, Shehdab. He was there, he told me, because he was addicted to marijuana. His parents had gotten so tired of his weed habit that they had sent him down here. Shehdab had a knack for writing the most epic and emotional poetry for his beloved. He would write hundreds and hundreds of poems for the girl from his village of Samastipur. He loved and missed her dearly. 

Every time he saw me, he would race towards me, jumping across the overgrowth of bushes, his robe flying as if he were a superhero. He would recite the dramatic poetry he had written. On the weekends, he would send those poems in the form of a letter to his girlfriend back home. 

On Deepavali, Shehdab came to me and asked me to request his doctor to set him free. I didn’t see any harm in his demand. I was sure he was not smoking weed anymore. 

It was only when I went to see the kind doctor, having carried Shehdab’s demand with me, that I was told that Shehdab was not there for his marijuana addiction. He was there because he had axed his girlfriend and her entire family one night after they had refused to let her marry him. His mind didn’t accept what he had done. I’m still friends with Shehdab though.

Death interrupted

Apart from him, I met a patient who had tried killing himself seven times by hanging from a ceiling fan. He had been caught all seven times by his family. He was an elderly guy, and very hostile. People told me that he might try killing or flashing me — based on the mood he was in. Initially scared, I approached the gentleman with kindness and love. The next day, he came to see me and gifted me a rose. This was right before he attempted suicide again, by hanging himself from the ceiling with a bedsheet. He was caught this time as well.

Inside the asylum, the line between one’s vulnerability and one’s reality doesn’t exist. People can be whoever they wish to. One claimed to be the first cousin of the prime minister, another was ‘inventing the next cutting edge fighter plane’, another believed a large tree at the back of the campus was a time machine. 

Nobody is aware they have a disease. The ones who do are docile and loving. They would touch my feet or greet me sweetly. After spending time with them, you realise they are just human beings with an illness. 

In the institute, the inhabitants don’t judge others. They live, love, play, eat, heal and fight together. The facility taught me that life is far bigger than our problems.

I believe the ones who found their way into the institute are fortunate. For they will survive. They have people who are paid to talk to them and treat them. What really makes me concerned for our society are tragedies like that of Atul Subhash, the techie who killed himself because he allegedly could not bear the harassment from his wife and her family. 

Men’s mental health has since become a talking point. Men are expected to be brave in the face of adversity, they are considered weak if they show their emotions. But at the same time, men are raised to mock other men who dare to express their vulnerabilities. 

Undetected mental illnesses are very common. Maladaptive practices to cope with grief, loss or any inconvenience are rampant. 

My biggest takeaway from the institutes is that mental health should be prioritised by everyone, regardless of gender or age.