‘Institutions are supposed to be like homes. A place where the woman can belong, a place which she can call hers. But sadly, more often than not, institutes don’t care.’
Ratnaboli Ray, Anjali Mental Health Rights Organisation
I work at an institution for mentally-ill women. When women start touching each other in sexual ways, the staff increases their medication. Is this ok?
No. In fact, forced medication (especially the use of tranquilizers) is included in the list of practices considered forms of violence. This is often done not because of medical reasons but because of social prejudices against mentally challenged women and a lack of understanding of sexuality. Homophobia may also be part of the equation.
Says Ratnaboli Ray, a mental health worker: ‘Just because they are mentally ill doesn’t mean that they are asexual or void of any feelings. It is also not true that because they are mentally ill, they are sex crazy – it is also another myth. If they are in a space 24/7 where they have nothing to do, how are they going to keep themselves engaged? As literate adults, we also touch our own bodies. So for example, when we talk we may keep our hands inside our sweaters or pockets. It is imperative to understand what sexuality is, and how it is a very normal day-to-day thing. We make an issue out of it because of our own value system. The knowledge of psychiatry is very limiting; it is only about symptoms and alleviations of symptoms. They don’t train doctors to look into the trajectory of the person.
Another thing is that the women don’t have any options in terms of partners. To believe that a person who has been incarcerated for ten years will lead a life of celibacy is also an extreme thing to expect. Even if they are homosexual, there is nothing wrong in it. Not accepting it as “normal” is the fault of the culture and values you are viewing it through. The homophobia present in institutions and in our state leads to the thinking that a woman exploring another woman is mad or diseased.’
Isn’t hysterectomy the best way to preserve menstrual hygiene and to protect our patients from unwanted pregnancies?
These are two separate issues, but in either case, hysterectomy is not the solution.
Some mentally-challenged women do find it hard to manage their menstrual period, specially if they are not taught how to do so. It is the responsibility of the institution to patiently do this and provide the hand-holding and assistance required. Many institutions don’t do this, because they are short of skilled staff, incapable of handling the hygiene issues involved, or wrongly consider menstruation to be shameful or dirty. For their own ‘convenience’, a hysterectomy is projected as ‘good for the patient’. The removal of the uterus and ovaries from the body of a woman who does not have the capacity to make an informed decision about this is a serious violation, and can become extremely controversial. It is akin to the unauthorised removal of any other organ from someone’s body.
Sometimes institutions say that family members themselves request such drastic steps. Families and loved ones of mentally ill patients living in institutions need to similarly examine their motivations. While a hysterectomy will make a woman incapable of becoming pregnant (and protect her from an unwanted pregnancy in case of abuse), it will also hide sexual abuse within the institution from coming to the fore. Sadly, pregnancy may sometimes be the only evidence of sexual abuse in institutional settings. Institutions have sometimes removed the uterus of patients to hide instances of abuse. A hysterectomy can remove the evidence of abuse but does not protect the woman from the abuser or the abuse.
When considering such drastic action, keep the humanity of the woman at the centre: a woman with a mental disability remains a full human being, despite her disability. The rights (bodily integrity, personal autonomy, and sexual and reproductive health) of these women cannot be sacrificed at the altar of convenience.
When the women living in our institutions get pregnant, we either abort the foetus or give the child up for adoption. What other alternative do we have?
This is a difficult issue that people the world over have debated. There is a tendency to see women with disabilities as less than complete persons who are inadequate and incapable of caring for another being. This is not necessarily the case. Says Ratnaboli Ray, mental health worker, Anjali Foundation, ‘One of the main reasons cited by institutions is that the woman (especially with a mental disability) can barely take care of herself. My question is: how are you assuming that a mentally disabled person will not be able to handle a child? You have to remember that the disability is not the same in every context. An intellectually disabled person may have a difficulty in managing accounts or her day-to-day life, but she may have an excellent nurturing skill. You cannot give a blanket statement saying that a person who is disabled is disabled in every context of life. Child-rearing, nurturing, is something that may come automatically to a disabled person. I think this is where all of us make a mistake.
Another excuse often given by institutions is the lack of infrastructure… you don’t have psychologists, you are short of skilled staff, you are short of space, that is not the woman’s problem. It is very important for a child to be with his mother in the initial years of life. Who are we to decide that it is best if the child is taken away?’
We monitor our girls round the clock. When they don’t listen to us we are forced to beat them or punish them to make them understand.
Most institutions are premised on unequal power relations between staff, who also act as custodians, and patients. Problems arise when the limits of these relationships are crossed and ‘acting in the best interests’ of the patient takes on a darker meaning. ‘This is a very common problem across institutions,’ says Ratnaboli Ray, a mental health worker from the Anjali Foundation. ‘This is a part of institutionalisation because institutionalisation is equal to regimentalisation, and regimentalisation heavily relies on aggression, violence, and beating. People who are in charge of institutions are also custodians. Again because they are custodians, there is the whole value of custodianship which allows again this kind of aggression. You know that the patients are vulnerable; you know that they are less powerful. It is the story of domination; it is the story of power.
It is not even so much about actual physical beating. The very act of moving around in an institution with a rod or a cane in hand is a lot. You don’t actually have to hit a person. The whole issue here is how you psychologically dominate. And how you create this fear psychosis. It is a very powerful language. Basically, since they are disabled, you are treating them as less than human. And you very well know that they are powerless, and even if you beat them, they don’t have enough language, or vision, or sound, or whatever to retort. Even if they can, they may not complain, because they have nowhere else to go. So it is not always the act of beating, it is also the act of creating an environment of violence and fear.’
Discipline is a concern in all institutions, be it educational institutions or residential ones. In the past schools used the cane to discipline students. These are now seen as failed models. Schools today try and model themselves around more open, free and democratic principles and an environment not of fear but of curiosity and encouragement. Mental health-related institutions need to similarly course-correct and understand that happy residents make model institutions. Some institutions in India (for example, The Banyan in Chennai have developed alternative models of based on principles of nurture and are worth looking at in this context.