10

‘A Disgrace to a Civilised Community’:1

Colonial Psychiatry and the Visit of
Edward Mapother to South Asia, 1937–8

James H. Mills and Sanjeev Jain

In 1937, Edward Mapother, Medical Superintendent of the Maudsley

Hospital in London, took a trip around the mental hospitals of Britain’s
dominions in South Asia. The result was a series of documents that
provide a snapshot of psychiatry in India and Ceylon in the twilight years
of the British Empire. This chapter will consider Mapother’s reports from
a number of perspectives in order to assess the politics and the impact
of an expert ‘visitor’ to a colonial medical system.

Professor Edward Mapother, the medical superintendent of the Maudsley

Hospital in London, was the oldest of seven siblings, and the son of an ENT
surgeon. Mapother had his initial training in Dublin, and after the First
World War, he had been entrusted with reforming psychiatric services in
London. He set about pushing through changes in legislation and
developing the wards of the London County Asylum, establishing
neuropsychiatric clinics and placing the emphasis on early treatment. The
result was perceived as a shift from a legalistic and custodial system to a
clinical one that emphasised the latest in psychiatric theory. Chief among his
innovations was the Institute of Psychiatry at the Maudsley Hospital in
London.2 This was designed as a remedy for what Mapother described as the
‘absurd situation that if English-speaking psychiatrists want to specialise they
have to go to Germany or Austria, especially Vienna (since they teach in
English)’ and his vision was of ‘an institute to provide for research and for
the very advanced training of psychiatrists and of most English speaking
psychiatrists on leave from India and from the various British Overseas
Dominions.’3
Mapother was invited to Ceylon by Dr S.T. Gunasekara, who, by 1936,
was the first Ceylonese Medical Director of the island.4 He wrote, in 1937,
that in a meeting:

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[W]ith the minister for health I mentioned your name knowing your
reputation and how keenly you are interested in the subject. I am writing this
demi-officially to enquire whether you could see your way to come out to
Ceylon, and if so, when and for what length of time. I shall be glad if you
would also let me know the terms under which you could come.5
Gunasekara was the recipient of a Rockefeller Foundation scholarship which
he spent in London6, and Mapother enjoyed a long relationship with the
Foundation that stretched from the 1920s until his death in 1941.7 It is
likely that it was this connection which put the Maudsley psychiatrist
uppermost in the mind of the new Medical Director of Ceylon when he
turned his attention to the mental health of the island.
The result of this trip was to be a series of documents that provide a
snapshot of psychiatry in South Asia in the years before the Second World
War and the subsequent end of the British Empire. This chapter will
consider Mapother’s reports from a number of perspectives. Firstly, it looks
at the politics and the impact of an expert ‘visitor’ to a colonial medical
system. It seems clear that his inspections and reports were organised as a
direct challenge to the colonial state, and were intended to force it into
policy decisions it was unlikely or unwilling to take of its own accord.
Secondly, it examines the evidence of psychiatric practices in South Asia in
the period before decolonisation. Psychiatry had often been lauded as one of
the benefits of imperialism and its introduction of modern scientific and
medical techniques. Mapother’s observations allow the historian to assess
how effectively the British had implemented psychiatric practices. Finally,
the chapter considers the significance of this outsider’s glimpse of hospitals
in South Asia for other accounts of the region’s medical systems under
colonial rule.

Psychiatry in South Asia

British colonial administrators had established specialist institutions for
those they considered ‘insane’ in both local and European communities from
the eighteenth century onwards in South Asia. At first, these seemed to be
little more than places of segregation and isolation, but as the nineteenth
century progressed attempts to provide therapy based on European models
became more complex and concerted. By the 1860s, it was common to find
superintendents expressing the opinion that, ‘I hope that we shall be able to
carry out still further improvements, and in time bring the Asylum as near
to the English standard as the circumstances of the country admits’,8 while
those nearer the top of the colonial bureaucracy also recognised that
‘everything that constitutes a remedial institution on the modern European
footing has to be introduced and exercised for the first time’.9 Throughout
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this period, the asylum system was funded by the colonial state and each
hospital was headed by a European doctor working for the Indian Medical
Service, although the staff at the hospitals were usually drawn entirely from
the local community.10
This began to change in the twentieth century. The state-run hospitals of
the colonial system experienced a lack of European medical personnel
during, and in the wake of, the First World War. The effect was the
‘Indianisation’ of the health services so that it was now doctors of local origin
who took control of facilities.11 Outside of these institutions, Christian
Hartnack has shown that modern Western theories of mental health and
therapy were beginning to circulate in society and that even such innovations
as Freudian analysis found a local market.12
The period in which Edward Mapother arrived in South Asia in the
1930s was a particularly complex one that has been relatively neglected in
accounts of colonial medicine. The latter has been accused of simply serving
as a ‘tool of empire’,13 where ‘the history of medicine in empire refers to the...
history of medical regimes as participants in the expansion and consolidation
of political rule.’14 Such an impression usually relies on evidence from the
nineteenth century and the focus here on Mapother’s visit in the decade
before the end of Empire in South Asia provides an insight into the rather
more complicated power relations of medicine in this period.
Mapother in Asia
Edward Mapother provided the following account of the circumstances of
his visit in the official report submitted to the Government of Ceylon in
1938:
The inadequacy of the provision for mental disorder in Ceylon and the
deficiencies of such treatment as has been provided has been a subject of
criticism for a number of years. During a visit to Ceylon in January 1937
some of those who felt strongly about the matter asked me to visit Angoda
Asylum. The impression produced was such that when subsequently I
received from the Government of Ceylon an invitation to give an opinion
upon necessary reorganisation, I was glad of the opportunity.15
While this is the only account of the origins of his trip to Ceylon, other
sources written after the journey provide some other details. Mapother
himself noted in a letter in 1937:
I am venturing to send you another copy of my Ceylon Report in the hopes
that you might get Dr Gregg to look over it at his leisure. It has raised hell
in the Island (vide cuttings from local press) and various parties from the
Ministry of Health downwards are briskly engaged in passing this from one

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to the other. What is more important they seem agog to do something quick.
It seemed to me one of the cases where forcible methods seemed most likely
to be successful.16
Another letter in his correspondence provides more information. In a letter
to Mapother, written in September 1938, John Pye, a member of the
European Association of Ceylon, wrote:
There can be no doubt whatever that your report has done splendid work in
making the Government and the country realise the terrible state into which
the Department dealing with mental cases had fallen. I am afraid that until
your report, which has now been published as a Sessional paper, none except
the one or two of us who had to visit the place, including the Government
themselves, really knew how terrible was the treatment afforded to mental
cases.17
When taken together, these details provide glimpses of a picture of the
circumstances of his involvement in Ceylon. It seems that while visiting the
island, those living locally who felt strongly about the provision of psychiatry
there – probably those involved in some capacity as ‘visitors’ – took the
opportunity to avail themselves of an ‘expert’ to assess what they had
encountered. Mapother thereafter seems to have taken it upon himself to
create a fuss about the facilities, a fuss was reported in the newspapers and
which had pressured the colonial government to act. Whether Dr
Gunasekara was in collusion with those critics of the colonial government is
unclear, but it was certainly the case that his relations with British superiors
had been uneasy in the past.18 He acted by approaching Mapother to return
to the island in a demi-official capacity and to make recommendations as to
how the system might be improved. From the above, at no point does the
impression form that it was the colonial government itself which took the
initiative to have Mapother visit the island in the first place. It seems as if the
government had little interest in the psychiatric facilities under their control,
and were simply responding to criticism in their eventual strategy.19
While the visit of Mapother to Ceylon had forced the colonial
government to act and to appoint him in an official capacity as an ‘expert’
assessor and inspector, it had further unforeseen consequences in unleashing
him on the rest of South Asia. Having been asked back by the island’s
government, he decided that ‘in order to qualify myself for giving advice of
a practical kind, I suggested that I should make a preliminary inquiry into
the mental arrangements of various Provinces of India.’20 As such, he took off
to Ceylon’s neighbour, packing in visits to hospitals as far apart as Bombay,
Madras, Lahore and Ranchi. As well as visiting seven of India’s psychiatric
units, he attended the Indian Science Congress in Calcutta and interviewed
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a number of officers in the Colonial Medical Service, including the Director-

General of the Indian Medical Service himself.
Significantly, however, the Government of India was careful to make it
clear that, while it was happy to help him out in whatever ways it could, his
was not an official visit. Mapother had agreed in a meeting with the
President of the Medical Board at the India Office that ‘the information
which I obtained was not for publication, but for personal use in relation to
the report which I was preparing for the Government of Ceylon as to the
reorganisation of the Island.’21 Indeed, this was emphasised in newspaper
reports, one clipping stating that ‘Dr Edward Mapother in an interview to
The Hindu, stated that he was in India on a holiday tour’.22 It seems that the
Government of India was not about to be caught out as had its equivalent
in Ceylon. While the latter was forced to publish his criticisms and
recommendations, and to commit itself to reforms, the assessment of
Mapother of India’s system remained a private typescript that remains
unpublished in his private papers to this day.
Mapother’s reports
Edward Mapother was unequivocal in his assessment of the psychiatric
facilities of the Government of Ceylon, and in his view of the implications
of this assessment. He made it plain that the ‘inquiry in Ceylon reveals such
a state of affairs that to acquiesce in its continuance would imply callous
indifference to suffering and mortality.’23 His criticisms were wide-ranging.
The buildings had ‘the air of a prison that is neglected and dilapidated,’24
despite the fact that they had only been built in 1926. They had been erected
as an exact replica of the older hospital they replaced, and the only reasoning
behind this was to move the institution out of the capital city, Colombo. The
hospital was dangerously overcrowded, so that 3,000 patients were packed
into buildings designed for only 1,830. This was thought to be behind the
high death rates at the institution, largely accounted for by tuberculosis and
dysentery. In 1936, this had been 137 per thousand inmates, almost double
the average in India. Verandahs had been converted into bed-space, and
patients slept on mats; by day, they crouched there ‘immobile and
unoccupied in two long rows containing 45 apiece’.25 The solitary
confinement cells were condemned as ‘unfit for human habitation’.26 Only
the female side came in for any praise, thanks to the efforts of Miss
Robinson, the matron, but even here Mapother observed that there was no
real attempt at treatment, ‘the sight of nearly 1,000 women sitting in orderly
squares on the ground doing nothing or giggling without reason, hardly
represents an ideal state of affairs.’27
It was not just the hospital itself that came in for his scrutiny. Mapother
argued that there was no reason to suspect that there were differences in
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incidence in mental disorder and mental defect between Asian and Western
societies. As such there was no excuse for the low ratio of psychiatric
accommodation to the local population. He pointed out that in London
there was a bed in a public mental hospital for one in every two hundred of
the capital’s inhabitants, while in Ceylon this figure was about one for every
three thousand – a total of 1,830 beds for all 5.4 million of the island’s
inhabitants. Expenditure was similarly critiqued; Mapother concluding that,
in London, spending on mental health facilities was about twenty-five per
cent of that on hospitals for physical ailments, while in Ceylon it was only
four per cent. This demonstrated to the author that ‘those in authority in the
East have not yet reached a modern standpoint with regard to the relative
importance of mental disorder and its treatment.’28
The outcome of this low expenditure was not simply overcrowding. The
provision for patients was poor quality, largely because allowances per
patient were almost half that of the average in India. The number of doctors
at Angoda had not been increased to take account of the large patient
population, with the effect that the doctor–patient ratio was one-fifth of that
allowed in India. The scene painted by Mapother of his arrival at the hospital
suggests that the outcome of this was very little treatment for the inmates at
all:

The garden was densely packed with a turbulent mob of men, a few of them
entirely nude, the majority naked except for a loin cloth. Many were
shouting remarks at the sky and waving their arms, while others shrieked
insults above the din and shook their fists in each other’s faces. Now and then
when actual violence seemed imminent a couple of male attendants would
dart into the thick of the mob and extricate one of those quarrelling by
dragging on one arm. Their manner of handling patients in the presence of
the Medical Superintendent and myself was not reassuring as to what might
happen in our absence.29
His prescription for improvement was far reaching, and was composed
of thirteen recommendations which tackled the provision of psychiatry in
Ceylon, root-and-branch. In the first instance, legal reform was necessary.
The historical origins of the Lunacy Ordinance of Ceylon were obscure, but
it seemed to hark back to an age when mental illness was a legal rather than
a medical matter. The individual had to be presented to a judicial authority,
who would make the decision as to whether a doctor should be consulted or
not. Once the doctor had been consulted, the judicial authority could order
detention in the asylum; only the magistrate responsible for this order could
authorise the subsequent release of the patient. The regulations seemed to be
concerned mainly with those dangerous to others, and with those who might

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be falsely presented as insane, as part of a plot, and Mapother noted that ‘the
law does not seem to have contemplated treatment as a contingency to be
considered’.30 He suggested that new legislation be modelled on the English
Mental Deficiency and Mental Treatment Acts, and that certification should
be the last resort in a system where the emphasis was on voluntary patients
seeking legally authorised therapy. As a separate note, he urged the
authorities to devise new regulations for dealing with mothers who had
killed their recently born child. He argued that these should not be tried as
murderers, but rather should be admitted to psychiatric hospitals for
treatment as civil rather than as criminal cases.31
He then tackled the institutional aspect of the system. He clearly felt that
the reliance on one institution for the whole island resulted in the muddling
together of different types of patient. In the first instance, he suggested that
those admitted to the facilities through the penal system ought to be
separated out. The custody of those awaiting trial for, or serving sentences
for serious crimes consisted of measures, which Mapother felt were quite
unsuitable in an environment where civil patients were under treatment,
and, as such, he thought a separate hospital needed to be built. He then
suggested that the existing hospital at Angoda could be adapted to house
what he called the ‘chronic insane’. This involved measures such as pulling
down its forbidding walls, painting the wards and other buildings, replacing
bars on windows with ‘armour plate glass’, using impermeable flooring in the
lavatories and building a new recreation hall. Mapother devoted much detail
to the latter:

This hall could be used daily for drill and gymnastic classes, it should be
furnished with newspapers and books, with indoor games, and a
gramophone and wireless set… here there should be given occasional
concerts either organised by the staff of the institution, or provided by
companies from outside if sympathisers could be found to do this. Display
of sound films is usual nowadays in English mental hospitals and at some in
India.32
He was similarly enthusiastic about ‘outdoor games such as cricket and
tennis and football’, picnics and ‘carefully supervised occupation’ in the new
regime he proposed.
With Angoda rescued, Mapother turned his attention to a range of new
institutions. The first was a neuropsychiatric clinic, to treat ‘neurological
cases of the clearly organic type’ such as schizophrenia and ‘general
paralysis’.33 Patients would only be admitted there on a voluntary basis, and
it would have one hundred beds for inpatients and would offer an outpatient
service. Complementing this was the psychopathic hospital, with a capacity

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of 1,500 beds. This would deal with patients likely to recover within two
years, who would benefit from being separated from the chronic cases at
Angoda but who were not suffering from conditions likely to respond to the
treatments on offer at the neurological hospital. The regime would be similar
to that at Angoda, consisting of recreation halls and occupational therapy
opportunities.34 Then there would be an observation home, to deal with
those who may well be perfectly sane but who were, at the time, plunged
into Angoda regardless of condition. This was essentially a clearing house, in
which those in recent contact with the psychiatric system could be assessed,
and then directed to the correct institution from the number above, once it
was clearly established that they were suffering from a mental illness. This
would contain three hundred beds, and patients were to remain there a
maximum of six weeks, by which time a decision could be made about their
ailments. He concluded his plans for this set of hospitals by pointing out
that ‘in order to cope with the future number of unavoidable cases plans will
probably have to be made for another Mental Hospital’.35
While Mapother concerned himself with the institutional system, he did
not neglect the issue of who would run it. He proposed that existing staff be
sent to India to observe best practice there at Bangalore, Madras and Ranchi.
He then suggested a ‘special service of medical officers devoting themselves
to psychiatry as a career’. He observed that only two of the five medical
officers currently serving at Angoda had any sort of psychiatric training, and
was sure that the hospital was seriously understaffed when compared with
India, where the ratio of patients to staff was between five to one and nine
to one, whereas in Ceylon it was sixteen to one. He anticipated a system with
twenty-one doctors at various levels of seniority and argued that:

[T]he necessity to create a permanent and separate service of psychiatrists

must involve the provision of a career with such a rate of pay and chance of
promotion as will render this specialty attractive to the suitable type of
man.36
Alongside these doctors, Mapother saw the need for ‘a service of well
trained mental nurses’ arguing that at present ‘there prevails a complete
ignorance of the standards customary in modern institutions for the care of
the insane.’37 European nurses were to be sent out to Ceylon to supervise the
hospitals and the training of local staff, and the best of the latter were to be
sent to England for specialist training that would qualify them to return to
take up senior positions. Furthermore, he advocated the recruitment of
‘young women of suitable education’ to be trained as social workers to work
with the local community to learn more about the circumstances of
particular patients and to provide a means of ‘aftercare’ for those released

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from hospital. He was also keen to provide ‘occupational therapists’ trained

to the standards that he had seen in India at Ranchi. Finally he urged the
addition of psychiatry to the syllabus of medical students on the island, so
that even those who did not go on to become psychiatrists ‘would profit by
an elementary knowledge of normal and morbid psychiatry’, emphasising
that ‘the relation of psychiatry to neurology should be persistently stressed’.38
Ceylon was not simply to have a new cadre of specialist doctors and nurses
running its mental hospitals, it was to have a network of amateur
psychiatrists spread throughout its clinics and general practices.
The plan was grand and the response, at first, seemed vigorous. His
report was submitted to the Government on 9 May 1938, and, by 25
August, the Executive Committee of Health met to approve a strategy. All of
the suggestions that were cheap were approved. The law was to be
modernised, the syllabus at the Medical College was to be altered to
incorporate instruction on ‘special treatment of mentally defectives’, senior
staff were to be sent abroad to ‘familiarise themselves with recent practice’
and new staff were to be specially trained. However, there were no clear or
definite instructions on the number of new staff to be recruited and the
vague statement that ‘the principle of the creation of a special service of
Medical Officers devoting themselves to psychiatry as a career should be
accepted’ suggests that the Government was in no rush to commit itself to
rapid expansion in the number of specialists. Indeed, when it came to giving
effect to Mapother’s plans for a new institutional network, there was a
considerable downsizing of scale: a neuropsychiatric clinic at the General
Hospital to be staffed by a specially qualified medical officer was provided,
along with a psychopathic hospital at Maharagama for three hundred
patients with a house of observation for one hundred patients attached, and
a separate institution for housing inmates who were committed to detention
at an asylum by order of the courts at Angoda, which was to have three
hundred inmates.39
Mapother had wanted his neuropsychiatric clinic to have five ‘specially
qualified medical officers’, his psychopathic hospital to have 1,500 beds and
the house of observation to have three hundred beds. The Government
made it explicit that ‘it is, however, realised that all his proposals cannot be
undertaken immediately on account of the heavy cost involved in carrying
them out’. Tellingly, there is no mention of giving effect to another of
Mapother’s proposals. He had suggested the ‘establishment of a Visiting
Committee for each institution’ to ‘meet at the hospital, carry out
inspections, and make recommendations’.40 It would appear that the
Government of Ceylon had learned its lesson; allowing visitors into its
asylums and inviting them to report back could be a costly and troublesome
business. Indeed, when news of the Government’s alteration of his scheme
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filtered back, Mapother was furious. He wrote to John Pye at the European
Association as follows:

I have been rather disturbed by the indications in the newspapers that the
fulfilment of my recommendations was likely to be distorted. I had thought
of bringing the whole matter to the notice of the Secretary of State. However,
the international crisis intervened and made the raising of all minor
questions inopportune. The crisis will presumably have subsided shortly and
if it appears that the programme proposed diverges entirely from my
recommendations it may seem advisable that I should ask the Sec. of State to
interest himself in the matter. I think this would be better than that I should
deal with the situation by a comment on inadequate proposals in the Ceylon
newspapers.41
There seems to have been no approach to the Secretary of State, and no
recourse to the newspapers. Mapother was dead within eighteen months of
writing the above letter, and the collection of his correspondence reveals that
his interest in South Asia in that time was limited to trying to persuade the
Rockefeller Foundation to fund fellowships for Indian students to study at
the Maudsley.42 Indeed, the international crisis he mentioned was the
prelude to the 1938 Munich Agreement between Chamberlain and Hitler,
which, of course, did not subside but escalated into the Second World War
– followed by rapid decolonisation by the British in South Asia. Mapother’s
grand plans for psychiatry in Sri Lanka were never realised.

Mapother in India
‘It would be difficult for the most jingoistic to affirm that, in the matter of
provision for mental disorder in India, the British “bearing of the white
man’s burden” has been quite adequate.’ The opening declaration of
Mapother’s report on his travels in India accurately set the tone of what was
to follow, and he made sure that readers did not miss the point by
emphasising that the state of affairs there ‘sets an awkward task for the
holders of the moderate view [that] British rule has been a benefit’.43 The
report was severely critical of the facilities, noted the demoralisation of many
of the staff, and was gloomy about the scale of the problem and the
difficulties of undertaking any attempt at improvement.
Mapother had worked hard to arrive at his conclusion, as he took full
advantage of the freedom given to him by the India Office:
I had a conversation of nearly an hour with Sir John Megaw. He was quite
alive to the deficiencies of psychiatric arrangements in India, but convinced
that other needs must have priority and that economic reasons forbade these

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defects being rectified. He arranged that I should have every possible facility
to meet those whom I wished to see in India, and to visit all institutions.44
As noted earlier, he made visits to hospitals as far apart as Bombay,
Madras, Lahore and Ranchi, in all, seeing for himself seven of India’s
psychiatric units. He also attended the Indian Science Congress in Calcutta
and interviewed a number of officers in the Colonial Medical Service,
including the Director-General of the Indian Medical Service himself. He
compiled a ‘who’s who in relation to psychiatry in India’ in his report that
recorded his observations on those he had met. Of the Surgeon-Generals of
Bengal and Madras he recorded that they were ‘extremely friendly and
expressed appreciation of the situation coupled as usual with an almost
excessive clarity of vision as to the difficulties.’45 Of Lt Col. O. Berkeley Hill,
who had served as Superintendent of the Ranchi Hospital, he wrote that he
‘is by far the ablest man that there has been in psychiatry [but] he is a bitter
controversialist with a dangerous wit who scored so successfully off his
official superiors that they retired him as soon as possible’.46 He was equally
critical of the Indians he encountered. Of Lt Col. L.E. Dunjibhoy in
Calcutta he observed that, ‘his annual reports include reference to his wide
travels and the closeness of his acquaintance with psychiatrists in Europe and
America. But he did not seem to have equal intimacy with psychiatry itself.’47
In Bombay he noted, ‘the young man in charge of the psychiatric out-patient
clinic is a young Parsee whose name I have mislaid. He is a psychotherapist
trained at the Tavistock Clinic with an ingenious and credulous mind and
little knowledge of solid psychiatry.’48 He explained that Dr G. Bose in
Calcutta was ‘devoted to psychoanalysis’ and as such was ‘a danger to
psychiatry in India’.49
Some did not come in for such strong judgement, so that ‘Dr Banarsi
Das was trained at the Maudsley… his hospital is deplorable but it is
probably not his fault.’50 Lt Col. Lodge Patch of the facility in Lahore was
described as ‘with intelligence and keenness nearly equal to that of Berkeley
Hill, he unites stability and balance,’51 and Venkata Subba Rao at Madras
had ‘a real knowledge of psychiatry and its needs [and] an unselfish
enthusiasm’. It was in them that Mapother saw some cause for optimism,
and of the latter he noted that ‘he seemed to me the best Indian in British
India to support if the Rockefeller Foundation were disposed to foster
psychiatry there in any way.’52
Having travelled widely and assessed the key men, his overall judgements
were damning. The asylums of India were ‘a permanent monument of brutal
stupidity and of a refusal to look at the rest of the world with any hope of
learning from it’, and he spoke readily of ‘the wretched provision for the
insane in India.’53 The buildings were shaped by ‘the conception held by the
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Public Works Department as to the nature of lunatics and the

accommodation proper for them, unchecked by any such experience as
could be borrowed from a psychiatrist’, and he described ‘one single ward in
which I saw a female patient [that] was an exact replica of the
accommodation for tigers at the Regents Park Zoo.’54 The availability of
services in British India was compared to that in London, in which there
were ten institutions with 22,000 beds serving a population of 4.4 million,
as compared to nineteen institutions, and 9,608 beds in the whole of British
India, for 276 million people. In London, there was a psychiatric bed for
every two hundred individuals, while in India there was one bed for 30,000.
He identified wide divergences in provision within India; in the Bombay
presidency there was one bed for every 12,000 of the population, as
compared with Bengal, Bihar and Orissa, where there was only one bed for
every 57,000 individuals. While there were five psychiatric beds for every
eight beds for ‘physical disease’ in London, there was only one bed for
psychiatry to every seven for bodily ailments in India. Thus, even allowing
for differences in economics and poverty, it was obvious that the shortage of
beds for mental capacity was four times that of the UK. The London County
Council spent £2.2 million per annum on the mental health services –
twenty-five per cent of the total health budget – while all the mental
hospitals of India accounted for just Rs.3.6 million – £250,000 – or less
than ten per cent of the total medical spending.55
This shortage of provision partly explained the problem he identified of
overcrowding, which in turn emphasised the lack of staff. He noted that
where there was no overcrowding, as in Bengal, this was a result of ‘a
deliberate refusal to fill institutions beyond capacity’.56 The situation in
Bombay was the worst, and he drew out the consequences of overcrowding;
the confinement of both civil and criminal lunatics in the same institutions,
the inability to separate out the chronic from the acute patients, an official
disinclination to admit cases in the early stages of illness who might most
benefit from treatment, and the rapid discharge of those who, while not
cured, had moderated their behaviour. The outcome of all this was
‘the growth of a well founded tradition that the asylum is a place fit only for
the segregation of such dregs, and that it is inhuman to send or keep there
any persons who are not either indifferent or anti-social.’57
Indeed, what provision was available was then analysed in terms of cost.
Mapother discovered that there were enormous disparities within India on
what was spent per patient; in Lahore this was as much as Rs.553 per
patient, while in Agra it was less than half that as Rs.264. The direct result
of this was that ‘the death rate of the mental hospitals is in proportion to
their cheapness’,58 so that at Ranchi, where Rs.116 was spent on diet, the
hospital death rate was about the same as the death rate in the community
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around it, at about twenty-five per thousand per annum. At Agra, where
only Rs.63 was spent on food, the death rate in the hospital was almost five
times greater than that in the local population. The report made the obvious
conclusion that ‘it is futile to expect that any material improvement in the
arrangements for dealing with mental disorder in India can be made without
a very large increase in cost.’59
Blame for the problems lay in the lack of leadership shown in the matter
of medicine in India according to Mapother. The British officers of the
Indian Medical Service (IMS) were settled into what Mapother called ‘a long
tradition that anything but passive acceptance was grousing, and that the
way to acquire merit was to avoid grousing’.60 Indeed, this had been
exacerbated in the 1930s by the peculiarities of the period, and Mapother
thought that ‘the higher officers of the IMS strike one as having a sense that
their whole Service is under notice to quit’, a reference to the Nationalist
campaigns of the 1930s against the British and to the Indianisation of
medical provision in India that had been gathering pace since the end of the
First World War.61 Mapother therefore argued that ‘the whole situation in
India cries aloud for a crusade’,62 and saw the leaders in this to be both
Indians and Americans. The Indians could draw on the example of the
independent state of Mysore. Mapother had visited the mental hospital there
and called it:

[A] monument to the vision and wisdom of all those responsible for the
mental defectives in the East. The Institution is almost unique among mental
Hospitals in India… it is quite evident that modern methods of diagnosis
and treatment are available and freely used.63
Though established in the 1840s, when Mysore was ruled by the British, the
hospital had been extensively and recently improved. A new building, well-
maintained grounds and laboratory facilities had been provided in the 1920s
by the local Maharajah, whose family had ruled Mysore as a state
independent of British India since 1878. It had been modeled on the
Maudsley by its first Superintendent, Frank Noronha, an Indian doctor who
had studied psychiatry in London.
As for the Americans, Mapother was hopeful that ‘the Rockefeller
Foundation could even by the loan of its name and at very little cost give to
such a crusade the influence which no private person could exert.’64 As
already stated, Mapother had a longstanding relationship with the
Foundation, and he took it upon himself to raise the issue of India with its
representatives. He closed a letter to his contact with a paragraph that read:
[S]ome day I hope your Foundation will take a serious interest in psychiatric
arrangements for four hundred million people in India. At present they are

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primitive but I believe the situation is such that great development is

possible.65
In other correspondence, he noted that:
I told the Rockefeller people that… it would be an excellent plan if they
could see their way towards helping with the finance in India of a psychiatric
clinic at which Indians could get the sort of education in their own country
that would enable them to deal with early and minor cases.66
However, it does not seem as if he managed to spark interest in the crusade
that he wanted to inspire in India; ‘I had rather hoped for a beginning of at
least a few fellowships in India, but this and many other hopeful ideas must
now be infinitely postponed’ was the position of his correspondent at the
Foundation by the end of 1939.67
The shape the crusade was to have taken was based on the same
principles as those he proposed in Ceylon. He advocated changes in the law
relating to civil cases so that the power to admit to psychiatric hospitals lay
with patients and doctors rather than magistrates, and a strengthened
Visiting Committee needed to be appointed to each institution. All medical
students were to receive an elementary education in psychiatry, specialist
colleges in north and south India were to be established for the training of
psychiatrists, finance was to be made available to send the best abroad to
study recent developments, and a cadre of mental health nurses and social
workers was to be nurtured. In a note on the syllabus to be studied by this
new generation, he wrote ‘emphasise need for education of medical students
in neuropsychiatry’.68 To pursue these reforms and to oversee their operation
a psychiatrist should be appointed to the Public Health Commission for the
Government of India. Finally, a programme of survey and public
information was to be devised, so that the problems of mental illness in India
could be studied and the benefits of early treatment at the hospitals could be
conveyed to local communities.69 Any attempt to dispute this scheme on
grounds of cost was dismissed in advance in the opening paragraphs of his
introduction, in which Mapother pointed to the grand project of the time,
where the British were erecting an imperial capital at New Delhi. He wryly
noted that ‘it serves only for the work and ceremonial entertainment of the
representatives of the British Raj, its more fortunate officials, and the native
Princes who support it’, before reminding readers that it had cost £18
million to date.
It is unclear that anyone ever saw this plan or read his recommendations.
Mapother wrote in July of 1938 that ‘I am hoping shortly to get together a
note of my impressions on the situation in India’,70 so it is clear that he did
not get round to writing his notes within a year of his visit. In his notes, he
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laid out a plan for the report he was to write and included a list of those to
be contacted about it, including Sir John Megaw, the President of the
Medical Board at the India Office in London, and the Viceroy himself.
There is no evidence that they received the report as no copy remains in the
India Office collection at the British Library. Indeed, it is not clear what they
would have done with it even had it ended up in their offices, because
Mapother had committed himself to the deal that gave him access to India,
but which meant that ‘the information which I obtained was not for
publication’. He had visited India, and been appalled by what he saw of the
psychiatric services of the colonial administration there, but it was that very
administration that prevented him from doing anything about the state of
affairs he had found.
Conclusion
The tale of Mapother’s travels in India points to a number of conclusions.
The first is that many of those involved in the process of his visits seemed
convinced that the psychiatric systems of South Asia needed to be opened up
to the outside world, and that visiting in various forms would be an
important part of the improvement of mental health institutions in the
region. Those who found themselves so concerned about the hospital in
Ceylon that they needed to take action were themselves visitors to the
institution, and they saw the arrival of an expert visitor as central to their
response. When Mapother took on the role, he incorporated visiting into
many aspects of his blueprint for reform. His institutions were each to have
a Visiting Committee, staff were to be sent from the institutions to hospitals
and colleges elsewhere for training and education, and the patients were to
be entertained by companies and films from the outside world. The
insularity and isolation of so much of the psychiatric provision was seen to
be a problem, and the solution was to be provided through various forms of
visit.
A cursory reading of the evidence brings to mind the post-colonial
critiques of medicine in colonial contexts mentioned earlier. It might be
argued that Mapother was simply seeking to re-establish an Orientalist
colonial order in recommending greater engagement between psychiatric
institutions in south Asia and the wider world. After all, this was a period in
which psychiatry was increasingly ‘Indianised’, and his appearance as a
British expert who gave full voice to harsh criticism could be read as an act
of colonial paternalism; the superiority of the European was being asserted
over the incomplete or childlike efforts of the Asian.71 Indeed, the idea that
Indian doctors needed to be sent to London for training seems to emphasise
the colonial relationship, in which those on the imperial periphery are
directed to the metropole to be civilised.72 Such a reading would be
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ahistorical and overly determined by theory. In reality, Mapother was as

critical of the British and European individuals he encountered on his travels
as he was of Indians, and commended as few of the former as he did of the
latter. He used imperial rhetoric only where it could be employed against
British colonial administrators in order to shame them into greater action,
not in order to subject Asians. The sole hospital in South Asia he lauded was
that established and run entirely by Indians in the independent state of
Mysore. He did not recommend training in London per se, but at the
Maudsley, the hospital that was his life’s work and which he regarded as a
model for psychiatric training, treatment and administration in general.
Indeed, the blueprint he exported to South Asia drew heavily on the one he
had already imposed on London, and which he clearly considered to be the
solution to the problems of social psychiatry the world over. If he was empire
building, it was for his institution and his ideas, not his nation.73
The circumstances of Mapother’s visit to South Asia also point to the
value of visitors’ reports to the historian. His observations suggest that
visitors can provide crucial assessments of medical systems, crucial because
they emanate from outside of the internal logics and cultures of those
systems. When working with sources from within the system it may be
difficult for this historian to escape the working of these mechanisms, and as
such when an assessor arrives who has no experience of the logic or the
culture, and who has no material or professional attachment to them, a fresh
and often disruptive perspective is provided. Mapother certainly falls into
this category in this case, as his is a set of documents which throw an
interesting light on the psychiatry of colonial South Asia. The picture he
presents rather undermines the lofty rhetoric of imperial medicine in the
region, which had boasted since the nineteenth century of its benefits to the
subject populations; ‘the establishment of lunatic asylums is indeed a noble
work of charity, and will confer greater honour on the names of our Indian
rulers than the achievement of their proudest victories.’74 Coming towards
the end of British rule in South Asia, Mapother provides a clear sense that
when viewed from outside the region and its corridors of power, the mental
health services of the imperial regime conferred little honour on the
colonisers and brought few benefits to the local population.
The final set of conclusions relates to the broader theme of this volume
about medical visitors. Those who organised his trip to South Asia intended
Mapother to act as an expert witness in a one-off capacity. There was never
any suggestion that he was to become a regular monitor of the system in
South Asia, rather it was hoped that he would stir matters up; his
professional prestige and experience would allow him not only to identify
problems and to offer solutions, but also to demand the attention of the
bureaucrats and politicians whose apathy had stifled action. In Ceylon, he
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succeeded up to a point, as the evidence suggests that he had managed to

force the issue of the mental health services of the colony into public debate
to the extent that the Government was compelled to act. However, the
correspondence also points to the limitations of his achievement, as it seems
that the Government was determined to reform at its own pace and in ways
that fell some way short of Mapother’s recommendations. Indeed, the story
from India only emphasises the ways in which his role as expert visitor could
be circumscribed, as he was limited to observing and noting while
specifically shorn of any power to publicly condemn or report. In short, it
may be the case that historians can find much in the reports of visitors to
medical institutions and systems, as they can provide important perspectives
and information often missing from accounts written from within those
institutions and systems. However, historians need to be alive to the swirling
political circumstances of appointment before considering the career and the
achievements of any expert visitor.
Notes
1. British Library, C.S.B. 24/3. E. Mapother, ‘Report on Present Arrangements
for the Treatment of Mental Disorders in Ceylon and Suggestions for
Reorganization’, in Papers laid before the State Council of Ceylon during the
Year 1938 (hereafter ‘Ceylon Report’), (Colombo: Government of Ceylon
Press, 1939), 1.
2. This summary of his career is based on A. Lewis, ‘Edward Mapother and the
Making of the Maudsley Hospital’, British Journal of Psychiatry, 115, 529
(December 1969), 1349–66.
3. Royal Bethlem Hospital Archive, EM–01, Report on Psychiatry in India File
(hereafter ‘India File’), to The Rockefeller Foundation, March 1931.
4. M. Jones, Health Policy in Britain’s Model Colony: Ceylon 1900–1948
(Hyderabad: Orient Longman, 2004), 76.
5. PRO CO 54/950/4, from S.T. Gunesekara to E. Mapother, 21 July 1937.
6. Jones, op. cit. (note 4), 262.
7. See R. Hayward, ‘Mapother, Edward (1881–1940)’, Oxford Dictionary of
National Biography (Oxford: Oxford University Press, 2004),
http://www.oxforddnb.com/view/article/58394, accessed 3 March 2009.
8. Annual Report on the Lunatic Asylums in the Punjab for the Year 1879, 3.
9. Minute by President of Madras, 29 October 1865, Government of India
(Public) Proceedings, 27 February 1869, 105–107A
10. For more on the nineteenth century see J. Mills, Madness, Cannabis and
Colonialism: The ‘Native-Only’ Lunatic Asylums of British India, 1857–1900
(Basingstoke: Palgrave, 2000); W. Ernst, Mad Tales from the Raj: The
European Insane in British India 1800–1858 (London: Routledge, 1991);

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 James H. Mills and Sanjeev Jain

S. Kapila, ‘The Making of Colonial Psychiatry, Bombay Presidency, 1849–1940’

(unpublished thesis: University of London, 2002).
11. J. Mills, ‘The History of Modern Psychiatry in India: 1795 to 1947’, History
of Psychiatry, 12 (2001), 431–58.
12. C. Hartnack Psychoanalysis in Colonial India (Oxford: Oxford University
Press 2001).
13. A phrase taken from D. Headrick, The Tools of Empire: Technology and
European Imperialism in the Nineteenth Century (Oxford: Oxford University
Press, 1981).
14. R. MacLeod, ‘Introduction’, in R. MacLeod and M. Lewis, Disease, Medicine
and Empire: Perspectives on Western Medicine and the Experience of European
Expansion (London: Routledge, 1988), 2.
15. ‘Ceylon Report’, op. cit. (note 1), 3.
16. Royal Bethlem Hospital Archive, EM–01, Papers of Edward Mapother,
Treatment of Mental Disorders in Ceylon File (hereafter ‘Ceylon File’), to Dr
O’Brien, 26 February 1937.
17. ‘Ceylon File’, ibid., from John Pye, 23 September 1938.
18. In 1931, Ceylon had been granted some limited self-government, but senior
officials such as the Governor remained British and the Colonial Office in
London remained the distant source of authority. The Colonial Office and
the Medical Advisor Dr Stanton had opposed the appointment of
Gunasekara as the first local Medical Director in October 1936. See Jones,
op. cit. (note 4), 76.
19. For a contrast in state approaches see the chapter by Leonard Smith in this
volume.
20. ‘Ceylon Report’, op. cit. (note 1), 3.
21. ‘India File’, op. cit. (note 3), 33.
22. Ibid., ‘Growing Interest in Psychiatry, Dr Mapother Interviewed, Visit to
Madras’ (undated newspaper clipping).
23. ‘Ceylon Report’, op. cit. (note 1), 3.
24. Ibid., 6.
25. Ibid., 7.
26. Ibid., 8.
27. Ibid.
28. Ibid., 4.
29. Ibid., 7
30. Ibid., 12.
31. Ibid., 9.
32. Ibid., 11.
33. Ibid., 17.
34. Ibid., 20.

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35. Ibid., 21.

36. Ibid., 23.
37. Ibid., 25.
38. Ibid., 27.
39. Ibid., 28.
40. Ibid., 16.
41. ‘Ceylon File’, op. cit. (note 16), to John Pye, 4 October 1938.
42. ‘India File’, op. cit. (note 3), to Dr O’Brien, The Rockefeller Foundation, 8
July 1938.
43. ‘India File’, op. cit. (note 3), ‘Report on Psychiatry in India’, 1.
44. Ibid., 33.
45. Ibid., 34.
46. Ibid., 37.
47. Ibid.
48. Ibid., 38.
49. Ibid., 37.
50. Ibid.
51. Ibid., 38.
52. Ibid., 39.
53. Ibid., 1.
54. Ibid., 31.
55. Ibid., 3–4.
56. Ibid., 5.
57. Ibid.
58. Ibid., 9.
59. Ibid.
60. Ibid., 10.
61. For more on this process see M. Harrison, Public Health in British India:
Anglo–Indian Preventive Medicine 1859–1914 (Cambridge: Cambridge
University Press 1994), 233; Mills, op. cit. (note 11), 449–51.
62. ‘India File’, op. cit. (note 3), ‘Report on Psychiatry in India’, 10.
63. Sir Mirza Ismail, My Public Life: Recollections and Reminiscences (London:
George Allen and Unwin, 1950).
64. ‘India File’, op. cit. (note 3), ‘Report on Psychiatry in India’, 10.
65. ‘India File’, op. cit. (note 3), to Dr O’Brien, The Rockefeller Foundation, 8
July 1938.
66. Ibid., to Lieutenant Colonel Owen Berkeley Hill, Ranchi, 23 February 1937.
67. Ibid., from A. Gregg, The Rockefeller Foundation, 3 December 1939.
68. ‘India File’, op. cit. (note 3), ‘Report on Psychiatry in India’, 1.
69. Ibid., (note 43), 18–26.
70. ‘India File’, op. cit. (note 3), to Dr O’Brien, The Rockefeller Foundation, 8
July 1938.
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 James H. Mills and Sanjeev Jain

71. Orientalism is an analytical device that draws heavily on the work of E. Said,
Orientalism (New York: Pantheon, 1978) and idem, Culture and Imperialism
(London: Chatto and Windus, 1993). The paternalistic ideology of British
imperialism in South Asia is mapped in A. Nandy, The Intimate Enemy: Loss
and Recovery of Self under Colonialism (New Delhi: Oxford University Press,
1983).
72. For recent discussions of this relationship see H. Fischer-Tine and M. Mann
(eds), Colonalism as Civilizing Mission: Cultural Ideology in British India
(London: Anthem, 2004).
73. This view seems to be corroborated by Mapother’s DNB entry, which
emphasises that ‘he never abandoned his commitment to the Maudsley
[which] provided the institutional space and intellectual opportunity for
Mapother to realise his own vision of psychiatry’, Hayward, op. cit. (note 7).
74. F. Winslow, ‘Review of “Practical Remarks on Insanity in India”’,
Psychological Medicine and Mental Pathology, 6 (1853), 356–67.

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