Sunday, January 15, 2017

Manasa treats insanity with reason

About a decade or two ago, the entire area spanning from Boralesgamuwa to Piliyandala was a virtual wasteland. It looked, all in all, more a village situated on the outskirts of Colombo than the historically and culturally significant region it was. Then the roads opened up, people moved in, and the inevitable drives at urbanisation followed. The road from Boralesgamuwa to Piliyandala and beyond was connected to Panadura (hitherto accessible through either the paalam paruwa or a longer route via Moratuwa) and, probably because of that, the region elicited more and more interest from outsiders.

Boralesgamuwa is now developed, with nice, shiny walkways and jogging paths flowing by temples and shrines. Restaurants have opened up, as have reception halls, and a part of the country that had earlier been regarded as sleepy, inactive, and only historically significant has gained a new lease of life. That, however, hasn’t been at the cost of forgetting and rubbishing the past. There is still a history attached to the area extending from Rattanapitiya to Kesbewa. This is a story about a hospital that has acquired a considerable portion of that history.

Neelammahara is a little of-sorts hamlet located in Boralesgamuwa, about five kilometres from Colombo on one side and bordering on Piliyandala on the other. In Neelammahara, you come across a temple that dates back over 200 years and was founded by a family that traces its lineage to the 19th century. Dr Saman Hettige, who heads one of the first mental hospitals based entirely on Ayurveda, hails from this family. That hospital, aptly named Manasa, has a way of treating its patients, which makes it almost unparalleled by modern standards.

I spoke with Dr Saman some time back. He had a story to tell. He reflected. I listened.

Hettige’s ancestry, as I mentioned earlier, goes back to the 19th century. Rajadi Rajasingha’s royal physician, Shailindrisinghe Padithuma, had left Kandy after its annexation in 1815 and had arrived in Dickwella. There, one of his sons (Dickwella Sudakshi) had vowed to continue the family line, and soon enough left the South for a hitherto barren village in Neelammahara. In Neelammahara, Sudakshi had commissioned and built a temple (the Neelammahara Purana Viharaya, which stands to this day), and under its watchful gaze had taught generations of physicians and doctors, who all came up one by one thereafter: Werahera Sobitha, Arawwala Seelalankara, and Dehiwela Dhammaloka.

The latter of these had taught Ayurveda to D. S. Hettige, Dr Saman’s father. D. S. Hettige, in later years, had envisioned a mental hospital, one which would revolve around the village community. While the Hospital as such had been “established” in 1890, it was extended to include that community by the time of the Second World War.

Dr Saman explained it well: “We originally began handing our patients over to villagers, to be looked after under our orders. Back then there was a veritable sense of belonging and camaraderie, which explains how the idea caught on and how my father was able to treat his patients with the help of those around him.”

Times change and with changing times so do people. After the Second World War, the villagers began moving out. “They were looking for jobs in the city. With the onset of industrialisation and a changing economy, they had less time to look after our patients. Predictably, we had to rethink our strategy here, and reformed this place into a conventional Hospital where people would be admitted.” Needless to say, their project caught on with both villagers and outsiders, and soon enough it went down as one of the first deshiya establishments dedicated to mental patients, not just in Asia but in the world as well.

Despite this though, I’m wary of describing Manasa as a hospital. The term does not capture the essence of the place. Dr Saman agrees as much, with a caveat: “While this can be considered in theory as the world’s first deshiya mental hospital, I personally doubt it. I remember the late Dr Harischandra, for instance, mentioning that he’d come across African tribes treating those relegated as madmen and lunatics by their societies. But those are, for the most, exceptions.”

As for Manasa itself, suffice it to say that up to now the place has grown enough to warrant treatment and continuous service for 35 patients. What’s even more commendable than quantity, however, is the way these 35 will be treated. Unlike those much used and abused techniques of lobotomy, conformity, and straitjacketing you come across in horror stories from the West, Manasa operates from the premise that no one method fits everyone. In other words, each patient is taken on his or her own merits, which makes it an ideal spot for those derided as incurable elsewhere. And this folks, is done not through drugs and other methods aimed at prevention, but through a cohesive, gradual routine that ends in cure.

Dr Saman credited Buddhism with helping his father making all this discernible to the lay Sri Lankan. He argued that no less a figure than Siddhartha Gautama observed that everyone, at some point, suffers from a mental ailment. He says as much in his “Sabbe Pruthugjana Ummaththaka”, from the Moola Pariyaya Sutta of the Majjima Nikaya, which in a way is reflected in the way our ancestors viewed such ailments.

“The problem is, we can't pinpoint a specific reason for someone's insanity. We can't tabulate diseases. On the other hand, you find parallels between the way our people classified them and the way the West did. 'Pitta Unmada', for instance, is melancholia, while 'Kama Unmada' is nymphomania." All that goes to show that far from being the uneducated bumpkins they’re touted as by our own people, our ancestors actually understood the intricacies of the human mind well even before Western psychology, Freud, and Jung.

Speaking of the West, Manasa doesn’t treat locals only: throughout its long and enviable history it’s catered to foreigners as well. “We basically treat everyone and anyone,” Dr Saman told me, “Once we took in the daughter of the Maharaja of Mysore. She'd been to other countries, 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, Raja, carried the daathu karanduwa in the Kandy perahera for many, many years."

No institution can boast of a 100 percent success rate and Manasa is no exception. Dr Saman isn’t wont to inflate and blow out of proportion, so he told me quite candidly, “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.”

At the end of the day however, success can’t be measured by dropout or retention rates but by the methods used and indulged in. “What differentiates us,” he told me by way of explaining this, “"is that we rarely if at all isolate our patients. Sure, sometimes they get aggressive. But we group them together as frequently as possible. That helps above everything else when it comes to those who harbour suicidal tendencies.”

Given all this, how would he compare the present with the past in terms of how we deal with mental illness? Dr Saman is not exactly chummy with optimism, but that doesn’t make him a cynic either. “It all depends on how we are conditioned from a young age to react to stress and pressure,” he argued, “Today we have inculcated an exam-centred culture in our children. We pressurise them in Grade Five for the scholarship exam and we pressurise them again and again for the Ordinary and Advanced Levels. We basically neglect their well-being.”

According to him, we are all temperamentally (dis)inclined to handle stress differently: “"Each of us handles pressure in our own special way. Unfortunately, the world around us isn't like that. Whether we keep up or whether we take time to adapt ourselves, it keeps on going. Factors like work, peer pressure, and exam pressure are frequently cited by those who can't handle it.” He believes moreover, as do I, that in his day there was a culture of affirming and celebrating life.

I asked him whether religion figured in this, and he agreed at once. “We have a rich literature that springs from Buddhism. Take our Jathaka stories. They didn’t just preach morals. They affirmed life. You didn’t come across heroes and villains, but human beings, flawed and multifaceted. It was this dualism that shaped our way of looking at the world and conditioned us to live with our environment. With today’s focus on achieving results at whatever cost, I fear that we have forgotten all that.” Words to ponder and reflect on, no doubt, though I personally doubt that today’s generation can or will take stock of them.

When we think of mental hospitals we think of lunatic asylums. The image of such asylums being run by rigid doctors and nurses is probably a legacy of that inimitable book and film, One Flew over the Cuckoo’s Nest.

At Manasa however, you will not find Nurse Ratched, nor for that matter Randle McMurphy. You will find, nested away from the hustle and bustle of city life (which admittedly has invaded the region), a resort, a getaway spot, for those who prefer a less noisy, and more wholesome, treatment for insanity. In the final reckoning, I believe we owe Dr Saman Hettige and his ancestors more than a token of appreciation. They have earned eternal thanks. As they should.

Written for: Ceylon Today LITE, January 15 2017