January, 2012; Chennai, India: I got an opportunity to attend the psychiatric outpatient clinic in C.S.I. Rainy Multi Speciality Hospital in Chennai (formerly ‘Madras’), India. This hospital has an interesting history relating to its establishment. It was founded in 1888 by the Church of Scotland as a Medical Dispensary and due to the efforts of Miss. Christina Rainy the hospital buildings came into being⁵. The medical work was pioneered by Dr Alexandrina Mcphail, between 1888 and 1928, who established an institution primarily to provide medical care to women and children. Both these pioneers were Missionaries from the Church of Scotland. Over the years, the institution has grown under the leadership of Overseas and Indian Doctors. The department of psychiatry has been growing over the years.

On the first day of my first visit, outside this psychiatric clinic, there stood a large crowd of patients and their relatives waiting their turn to meet the psychiatric team. Among them was a young girl restrained by three or four people. She suddenly screamed and rolled on the floor and squirmed and shouted ‘It’s coming’ (later, I came to know that she was referring to the demons coming into her body). Her hair was untied and her sari tied up shabbily; poor self care was apparent. She was surrounded by a group of onlookers. At this point, the nurse came out of the clinic and called that particular patient and her five (!) carers followed her inside the clinic room.

They also try alternative medicines and keep visiting the religious gurus. Finally, they arrive at the out-patient clinic when all their alternate avenues have closed down.

In this scenario, this patient presented with dissociative disorders (trance and possession disorder). She was brought in with the help of five carers. When she was asked to sit down, she sat down calmly. Her screaming had gone. She pulled away the hair from her face. She was quiet for a moment or two. When I asked her what had happened to her, she said the devil was torturing her. She said ‘It’ sometimes comes into her body and then she wouldn’t remember what was happening. At this time, she screamed again saying ‘It’s coming again’… she made a loud noise and tried to get up and run but was restrained by her relatives.  She then started to behave as if she were ‘controlled by the demons’. Her relatives reported the appearance of these symptoms immediately following the death of her father. They said that these attacks lasted for a few minutes only and she got several of such attacks in a day. Such presentations are very common at this clinic.

I will update this blog with few more interesting cases shortly.