Morning begins with a 1.5 hour journey via two buses from the Brahmin heart of Madras to the small fishing village of Kovalam. You know you are nearing when you forget the trickle of sweat down your back and the college boys sandwiched against you who blast syrupy Tamil songs from mobile phones at 8 a.m. You only see blue, blue sea and sky, the ebony of water buffalo against ochre beach. You feel the salty sea breeze dry your face.
And you know you have reached when all you can see are ivory minarets and the cupcake-shaped tower of the dargah[i] rising above miles of fluttering green flags bearing the Islamic white crescent and star. The mothers and grandmothers, dressed head to toe in black hijab or in sequin-studded saris, descend down the bus stairs with children in tow or tucked in their arms. They float between the flower and food vendors towards the feather-shaped door of the dargah.
Here is the heart of Kovalam. The scene of sea, sky, and dargah fills me every day, and then I turn right and walk down the wide dirt road to The Banyan Holistic Health Centre, a community mental health awareness and treatment program[ii].
But this is just place.
***
Manu rests on his bed of wooden plank and weakly raises his arm, twisted and quivering from a stroke of four years past. A community worker from The Banyan and I sit on the floor of his home—a room half the size of my kitchen—and listen to Manu’s wife, Lakshmi, explain why she did not bring him to the Health Centre’s psychiatric out-patient clinic for the last month.
Because he has lost the ability of his hand, Manu is unemployed and Lakshmi has toiled to support their family. She spends her days making and selling pine oil and soaps, cooking, and caring for Manu. Their daughter aspires to be a computer scientist and studies for exams in the evenings. She does not help. Lakshmi says she needs to work constantly to pay her daughter’s private school fees, give the monthly rent, feed the family, and pay for Manu’s various medicines. She has no time to bring him to the Banyan.
The community worker asks her what medicines she has paid for, as Manu came to the Banyan months before and received free medication. A quack told the family he could cure Manu with an injection that would cost 15,000 rupees. The family paid. Lakshmi shows us a case of large, white pills and smaller, yellow ones. She has mixed the remaining Banyan-prescribed medication with those given by the quack, and cannot remember when she began to do this. With tears in her eyes, she says that Manu has not improved during the last four years.
In soft, rounded Tamil, the community worker urges Lakshmi to take a few hours off the next Tuesday and visit the psychiatric outpatient clinic. We get up to leave. Manu mutters that he is better and gripping the wall, shakily hoists himself up and walks, step by step to his house’s entrance. His warm eyes follow us as we walk down the path, carrying a shadow of his story.
These same eyes first meet mine, and then the psychiatrist’s, at the next outpatient clinic. During the clinical interview, the psychiatrist unearths more of Manu’s story. Following his stroke, Manu lost the ability to hold anything with his right hand. He could no longer hold the threshing tools and scythe that he used to plant and harvest rice. But his youngest daughter devoted herself to his care. She would bathe, clothe, and feed him. Two years ago, this daughter passed away due to an illness. The psychiatrist rests his pen and looks tired. “I can give him medicine to alleviate the pain in his hand and to stop his talking to the voices he hears. But that only goes so far.” A physical therapist is needed to train Manu to use his hand. An occupational therapist could perhaps design an agricultural tool for Manu to use, or perhaps give him training in another vocation.
The community worker suggests that Lakshmi come to the Banyan and train other long-term patients and women in the Kovalam community in the preparation of pine-oils and soaps, as another source of income. She also informs them of the Tamil Nadu Disability Allowance, a government-provided monthly stipend given to patients with mental illness and other disabilities.
Manu’s eyes tug at a place in me that I did not know existed.
And he is just one voice.
***
At the end of the AIF Service Corps orientation in Delhi, I wondered if mental health was worth devoting oneself to when poverty, lack of education, and the pressures of marriage and dowry still exist—all potential causes of mental illness that I have witnessed during the last two months. Why work to alleviate a symptom of these problems?
Manu is more than a patient, a voice. His mental and physical breakdown have grown out of a mesh of economic, social, and biological problems. Medicines will treat mental illness, but will not heal a broken mind. But what the Banyan is doing and still dreaming of—reaching into the realms of education, vocation, family, and religious structure to promote mental health—is what may ultimately heal and prevent the unraveling of the mind.
*Names have been changed to preserve anonymity.
Posted by Aditi Ramakrishnan
[i] Dargah: a Sufi shrine built over the remains of a Sufi saint. While it is often confused with a mosque, some would argue that a dargah is quite un-Islamic. Muslims, Hindus, and Christians flock to dargahs to pray to the saint himself or to seek a path to God through his blessing. Strict Muslims may not go to dargahs for this very reason of praying to a being other than Allah. In Tamil Nadu, many with mental illness go to the dargah for faith-healing and spiritual treatment.
[ii] The Banyan: a Chennai-based NGO and mental health rehabilitation center primarily for homeless women with mental illness. The Banyan now consists of Adaikalam, a large rehabilitation center in Chennai, BALM (a research unit on mental health), and The Holistic Health Center and Community Mental Health Programme in Kovalam, Tamil Nadu. The Kovalam facilities include a general and psychiatric outpatient clinic, an inpatient unit, and a community for long-term rehabilitation for women with acute mental illness. As a Yale and AIF fellow, I am documenting the Banyan’s community mental health model in Kovalam and writing about perceptions and treatment of mental illness in Tamil Nadu.
