by Dr Iqra Rashid Shah
Her popularity with patients was such that she once suffered a bruised rib when an old shepherdess hugged her too tightly.
On a dreary Friday in 2009, while searching for the property records of my hospital, crucial for the completion of project NMHP, I stumbled upon a locker in the ashes and clinkers of the burnt asylum. Veteran employees believed this locker to be the only remnant that might contain the documents we needed. I forced open the dust-ridden, rusty box and rummaged through its contents until I found a few old, begrimed files.
Inside one of them was a handwritten letter:
To,
The horticulture officer,
Srinagar.
Sir,
While taking my patients to the right almond garden, I found a broken twig. I went near the tree only to find that it was diseased. Please come and inspect.
Yours sincerely,
Erna Hoch.
The discovery left me in awe. I had heard stories from my seniors about “Meem”, our first Head of Department, but this letter imprinted itself indelibly on my mind. Alongside it was a large translucent sheet, drawn with trees and plants, still aligned with their actual placements in the burnt asylum. Across it ran scribblings in the same hand as the letter, like a fragile graffiti on paper.
Dr Hoch’s involvement in this place, far from her homeland, was beyond imagination. Her devotion to the hospital, then derided as Pagal Khana, testified to her love and commitment. Witnessing her efforts, even belatedly through these remnants, altered my outlook and rekindled my own dedication. Two decades after her departure, I found myself falling in love with the same place. It gave me the impetus to rebuild the ruins into what stands today as the Institute of Mental Health and Neurosciences (IMHANS), Kashmir, now a premier psychiatry facility that rose from wreckage to recognition.
The Making of a Pioneer
Dr Erna Hoch, born in 1919, grew up in Basel, a city in northwest Switzerland. After serving in England in a women’s army corps assignment during the Second World War, she studied medicine at the University of Basel and trained as a psychiatrist. Between 1957 and 1988, she lived in India, working in a range of clinical, academic, and administrative posts.
From 1969 to 1980, she was professor of psychiatry at the Medical College in Srinagar and headed Kashmir’s only psychiatric institute. She is remembered for transforming the “backwards madhouse” and “insane asylum” into a hospital that stood at the forefront of psychiatric practice. Before arriving in Srinagar, she had been deputy head of psychiatry at the All-India Institute of Medical Sciences, New Delhi. Yet she yearned for a role that would allow her to build something anew. A chance visit to Srinagar gave her that opportunity.
On arrival, she was asked to take immediate charge of the mental hospital. Appointed professor and head of psychiatry, as well as director and medical superintendent, she embarked on the arduous task of creating a proper psychiatric facility in a place where none existed. Locally, people called it Pagal Khana, meaning “house of the insane”. To many, she became Pagal Mem, the lady from the lunatic asylum.
The Lotus Lake
In her book The Mad House at the Lotus Lake, Dr Hoch describes the part of Srinagar where she lived and worked. She wrote of the almond trees in bloom, the nearby temples, the fort, and the meandering corners of the hospital grounds. The challenges she faced were daunting: teaching the local population, retraining her staff, working with meagre budgets, and confronting resistance from both her employees and the administration.
Over time, her perseverance earned trust. The number of patients increased dramatically. Seventy per cent of new arrivals came through word of mouth from those already under treatment or cured. Even stigma did not deter people from seeking care. They preferred the mental hospital over the general hospital because, as she observed, here they found humdardi, human compassion. This trust was a milestone, one that sustained her mission and spurred expansion.
Her leadership was marked by the ability to get things done and by her insistence on training staff with genuine skill. The obstacles, however formidable, never broke her resolve.
Changing Attitudes
One of her greatest achievements was altering the behaviour of staff towards long-term patients, many of whom had been treated as outcasts. She believed these so-called chronic patients could live well in a benevolent and protective environment outside, had their families not abandoned them. She therefore focused on rehabilitation, restoring dignity to those who had been warehoused for years.
The spring almond blossom festival revealed the cruelty of society. Revellers often climbed the walls of the hospital, mocking and pelting stones at inmates for amusement. Horrified by this spectacle, she demanded police protection. She also responded with imagination. She organised a picnic in the orchard, giving her patients their first outing in years. Later, she hired buses for annual trips around the lakes to the Mughal Gardens, where patients shared refreshments. The joy on their faces, their animated recollections, offered her deep satisfaction.
Her efforts in rehabilitation and outreach were mocked by sceptics, who accused her of pandering to authorities for contract extensions. Yet she ignored the malice and continued her work.
An Ethic of Care
She recalled how American visitors expressed astonishment at the hospital’s atmosphere. They had never seen psychiatric patients embrace doctors or greet them warmly. In Western institutions, she explained, patients fled from doctors. Despite being poorly resourced, the hospital had something that Western counterparts had lost: warmth and humanity.
Her popularity with patients was such that she once suffered a bruised rib when an old shepherdess hugged her too tightly. She immersed herself in Kashmiri culture, its traditions, and its demographics. She encouraged patients to stroll in the garden, ensuring it remained tended and alive. Small gestures created a sense of normality and stability for patients who otherwise felt abandoned.
Her vision extended to policy and infrastructure. She studied the traditional Kashmiri hamam to solve heating problems. The project was arduous, requiring years of persistence to secure funds and firewood. Yet she saw it through.
Dr Hoch also pioneered child psychiatry in India. In the 1950s, she developed a children’s service at the Methodist Hospital in Lucknow. She documented her observations of Indian children with meticulous care, always mindful of the role of religion and culture. Between 1956 and 1961, she treated and studied children at the Nur Manzil psychiatric centre, publishing her findings in Indian Children on a Psychiatrist’s Playground. Scholars now recognise her work as pioneering, though it went largely unnoticed at the time, perhaps because she was ahead of her era.
Her contributions remain unparalleled. She was an administrator of rare ability, an empathetic doctor, a teacher, a leader, and a reformer. She thought ahead of her time and remained unwavering in her mission to establish psychiatric care in Kashmir. To capture her essence, one can only turn to the words of Allama Iqbal:
Hazaron saal nargis apni be-noori pe roti hai,
Badi mushkil se hota hai chaman mein didaavar paida.
(The writer is a registrar in the Department of Psychiatry. Ideas are personal.)