Sunday, August 9, 2015

Manasa: Finding Reason in Insanity

Friedrich Nietzsche wrote about love, madness, and the meaning (or absence thereof) of life and death. He wrote so many things in so many ways. He was derided as a lunatic, cast away, and isolated, and in the end he died a broken and paralysed man.

Thus Spoke Zarathustra, his masterpiece and in many ways a Bible for thinkers throughout the ages, has this to say on what he was to go through: "There is always some madness in love. But there is also always some reason in madness." Nietzsche never loved, but that didn't stop him from going mad.

The point here is that there are reasons for insanity. Many reasons. How we assess them is a different matter. Diagnosis depends on context and history, after all. So it's natural that no one size fits all and that "madmen" are treated differently from place to place.

Dr Saman Hettige, who heads the Manasa Ayurveda Hospital in Neelammahara, offers one diagnosis. One among many, true, but there's innovation, an in-your-face way of looking at the mind, in what he's doing and what he's propagating, around the country and around the world.

Neelammahara is in Boralesgamuwa, 20 miles from Colombo city and bordering on Piliyandala (which in turn gives way to Kalutara District) on one side. Manasa is run from here.

He explains its history. He explains his family's history. "The two are connected," he smiles.

Hettige's ancestry goes back to the 19th century. Rajadi Rajasinghe's royal physician, "Shailindrasinghe Padithuma", had after the British annexation of 1815 gone to Dickwella, where one of his sons (Dickwelle Sudhakshi) continued the family line. "I'm from the seventh generation," Dr Hettige says.

So how did Manasa begin? Dickwella Sudhakshi had come to Neelammahara, where under him a temple was built and several descendants committed themselves to medicine. "After him came Werahera Sobitha, Erawwala Seelalankara, and Dehiwela Dhammaloka in that order. Dhammaloka's golaya was my father."

Hettige's father had envisioned a mental hospital in Neelammahara. "We originally began giving over our patients to villagers, for them to look after under our orders. As time went by however, and as the economy began changing, these villagers found it difficult to keep up with what we wanted. Naturally enough, we built a place of our own in the 1950s. Right here."

Manasa is not your typical hospital. In fact it would be wrong to say it's a hospital, because the word brings to mind things which do not capture the essence of the place. "This is the world's oldest deshiya mental hospital. That's rarely to be found in other countries, which isn't to say that such places can't be found at all. I remember the late Dr Harischandra, for instance, mentioning that he'd come across African tribes treating mental patients. But those are exceptions."

35 patients are a lot. What commendable is how they're treated. Unlike those much used (and abused) techniques of straitjacketing, lobotomy, and everything else you read about in One Flew Over the Cuckoo's Nest, Manasa runs on a principle: no one method fits everyone. "We go for prevention, not merely cure," Hettige tells me, "and for that we try to not involve our patients with drugs. We treat them normally."

Moving on, he mentions that the Buddha himself observed that everyone, at some point, suffers mentally (summed up in his saying "Sabbe Pruthugjana Ummaththaka" from the Moola Pariyaya Sutta of the Majjima Nikaya). "We can't pinpoint a specific reason for someone's insanity. We can't tabulate diseases easily either. On the other hand, you find parallels between the way our ancestors classified them and the way the West did. 'Pitta Unmada', for instance, is melancholia, while 'Kama Unmada' is nymphomania."

When asked about the kind of patients Manasa takes in, Hettige pauses. "We treat everyone," he says, "and by everyone I don't just mean Sri Lankans. We've treated foreigners and even courted royalty. For example, we treated the daughter of the Maharaja of Mysore. She'd been to other countries, both in the West and East. But we were the ones who treated her well. As a token of appreciation, we were invited to Mysore, where at the end of our 'trip' we were gifted with two elephants. One of them was Raja, who carried the daathu karanduwa in Kandy for many, many years." Small world.

Next he talks about how his patients are treated. "We rarely if at all isolate them. True, sometimes they get aggressive. But we group them together as frequently as it is possible. Especially when they get suicidal tendencies, that helps. The end result? We've achieved a 60 to 70 percent success rate, even factoring the dropouts who are in need of money and have dependents outside to support in the remaining 30 percent."

In the end, he adds, how we "cope up" matters. "Each of us handles pressure differently. That's normal and inevitable. Unfortunately, the world around us isn't like that. Whether we keep up or whether we take time to adapt ourselves, it keeps going. Factors like work, peer pressure, and exam pressure are frequently cited by those who can't handle that. So how we manage life is crucial."

By way of summing up, Hettige says moreover that while we were "taught" how to accept and affirm life in the past, our education system is woefully lagging in that area. "We were taught Jathaka stories in our childhood. They weren't just moralistic. They contained both good and evil, and it was this dualism which shaped our outlook on the world. That prepared us for what we had to face later on. Not anymore."

That's for another time, though. Another story.

Hettige's philosophy (and that of all those who've preceded him) stands out. Remarkably. No, this isn't only because he empathises with patients without isolating them. This is because Hettige, like all doctors who privilege reason over rhetoric and care over time, ensures that patients are treated not as patients, but as human beings. This is what you can see. What the patients themselves can see.

We should be grateful, we believe. And we are.

Written for: The Nation INSIGHT, August 8 2015