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’.

During the early part of the nineteenth century, most senior positions in the colonial medical services were occupied by Europeans. Only from 1855 were Indians allowed to occupy higher-level roles. However, public proclamations and official regulations did not always reflect British officials' sentiments and unofficial practices. In his book Race, Sex and Class, Ballhatchet discusses the case of a highly qualified, mixed-race (Eurasian) doctor who had been made assistant surgeon in the mid-nineteenth century. He soon fell foul of European prejudice, becoming the victim of a scandal. Although the allegations against him were eventually shown to have been groundless, if not malicious, the director-general of hospitals recommended that in order to avoid similar occurrences in the future, Indians and Eurasians ought not to be appointed to senior positions, regardless of their qualifications.

This book focuses on the Ranchi Indian Mental Hospital, the largest public psychiatric facility in colonial India during the 1920s and 1930s. Although it does not cover the views of the patients and their families, its scope is wide-ranging in other respects and it breaks new ground in the fields of history of colonial medicine in South Asia and of the history of psychiatry more broadly. The latter has been a mixed blessing on account of the relative dearth of material that would have allowed a comparison of trends at Ranchi to those in other institutions in India and Britain. Historians of Indian colonial medicine as well as of psychiatry have hitherto tended to focus on earlier periods. Only very recently have they begun to investigate institutions during the early twentieth century. To date, the few existing studies on particular mental hospitals in Britain do not consistently and comprehensively deal with the full range of institutional data here examined. In particular, information on the types of mental disorders assigned, variations in classifications and conceptual changes are rarely discussed. Nor do they frame local developments in relation to global and transnational ones. It will be left to subsequent scholarship to assess how the local affairs and transnational connections discussed in the current study on Ranchi compare with a wider range of institutions in, and medical exchanges between, South Asia, Western countries and other parts of the world.

Five themes drive the analysis of the Ranchi material.

The ambition to standardise the classification of different types of mental illness and to develop more sophisticated diagnostic categories during the early twentieth century has been well documented. The traditional nineteenth-century mode of diagnostics, with mania, melancholia, idiocy and dementia at its core, was, as historians of psychiatry have shown, reshaped by the adoption of more refined systems throughout the world during the early twentieth century. This general trend seems well established. What is less clear is how this process towards modern classification systems and standardisation manifested itself on the ground, in diagnostic practice in individual institutions. Historians have traced the varied conceptual developments of the main figures driving this process such as Bleuler, Kraepelin, Meyer and Leonhard. But the ways in which changes in nomenclature induced and mapped on to conceptual changes in less prominent, individual psychiatrists' cognitive mind-sets and diagnostic practices have scarcely been considered.

Even institutional reports and statistics have not been evaluated to any great extent. With the exception of works by Andrews et al. (1997), Cherry (2003) Crammer (1990), Gardner (1999), Gittins (1998) and Michael (2003), the number of institutional histories of Britain with which case-studies from other localities could be compared is indeed restricted.

The rate and pattern of patients' mortality in mental institutions are important parameters in the assessment of clinical outcomes. They provide a way of measuring the effects of mental healthcare provision. The study of death rates has been an important focus of analysis since the first half of the nineteenth century. Mortality is, of course, closely related not only to the care and attention an institution bestows on its inmates, but also its patient intake and their health status on admission. Recent research in Western countries has shown that mortality among psychiatric patients in both institutional and community-based care settings remains high. In Sweden the mortality rate for 12, 103 patients in the late 1990s was three times that of the wider population; a Norwegian study of psychiatric inpatients from 1980 to 1992 concluded that ‘mortality of psychiatric patients is still unsatisfactorily high’; and an assessment of data from seven German hospitals in the mid-1990s revealed that over six times more patients died than expected. Furthermore, an Italian team of epidemiologists concluded in 1997 that: