A case formulation from (for) a trauma-informed psychologist and a survivor of domestic violence about the state of care for women with severe mental illness in India 

Presenting Concerns 

My body is an eclipse. Everybody wants to stare at it. It provokes dogma, lines up ominous myths; yet most people will never fully understand what it undergoes. 

 The first time I saw a woman chained to a bed, I was perhaps nine. My parents’ parting had left my small body adrift in a sea of adult sorrow. I was struggling to keep my head afloat after their bitter separation volleyed me between countries like a tennis ball in a prolonged, energy-depleted game. Back at my grandparent’s home, I had no real friends except the daughter of a cleaning woman who worked for the family that lived next door. While her mother polished brass plates and scrubbed dirt off someone else’s courtyard, we’d vanish into alleyways like wind—two girls stealing time at the edge of someone else’s threshold. She wasn’t allowed inside the house where her mother worked because she belonged to the “Musahar” village. Musahar are a part of the Mahadalit community in Northern India where caste encrypts all social exchanges. The literal translation of their name is “rat-eaters.” It stems from the fact that caste-coded segregating practices shunted them far away from villages. Food scarcity would force the community members to catch and eat rats for sustenance, particularly during periods of famine and exacerbating poverty. 

It is an exercise in irony how the purity politics of caste malforms perception. In the 90s, the professor who hired a Musahar woman as a maid is considered progressive even as her little daughter is left unchaperoned in the sweltering heat.  

The girl’s name is Munni. Theirs is a village full of Munnis. Some days she brings marbles to play. Other days, it is a kitten or a kid—a soft mewling or braying while still negotiating with the physics between gravity and ground. Munni and I plucked pilaghanti (yellow bell) flowers and made garlands which we wore around our necks mimicking characters from a popular religious epic on TV. I sneak her into our home and watch the show together when I have minimal adult supervision. Other days, we chase after stray pups in the vicinity. My grandmother was an animal whisperer of sorts. She had no qualms about warring neighbours over the odd street dog and their offspring. Bhuri (The Brown One) had recently given birth to five little nuggets, and we had made a shelter on the frayed edges of a dilapidated garage, three houses away. On one rainy day, when we went to feed them, we found two missing.   

Triggered by urgency, we traced the skeleton of the colony nook by nook, looking for signs of the disappeared. Two small bodies bending and breaking into houses desperately trying to locate two other, smaller bodies. Fuelled by the trance of our quest and without realisation, we arrived at the haunches of that housing unit. The adults had muscled in these tectonic fears in us about that house. The last home on the block, the fount of several urban legends about witches with arms longer than banyan branches and minatory crowing.  

The outside of the house looked like a scream snared in stone. The rickety gate was ajar, and we were now inside the weed-maddened excuse of a garden. Munni paused and begged me to turn back. My brain too overpowered by curiosity ignored her pleas and ventured forth. The door had a gigantic lock dangling from it like a monkey in meditation. Lichen wallpapered the trunks of trees drooping over the roof. I suddenly heard whimpering emerging from the back of the house. In these moments, fear often magnetises action. I was scared for myself, but I felt even more scared for the pups. I sprinted while Munni strategically placed herself on a slope in the verandah.  

That's when I saw her—a breathing corpse, her eyes fixed on the ceiling, her body restricted to a single bed in that hermetic room.  

I was frozen at the mouth of that half-opened window. She didn’t see me. Or maybe she did. She didn’t move her head. But she rubbed her legs like a cricket and then I heard the jangle of the chain around her ankle that tethered to the foot of the bed. There were a stainless-steel glass and a quarter plate on a small stool next to her bedside. The fan over her seemed mired in its own desultory guilt.  

I was locked in that spot for what seemed like years. Then a hand grabbed me by the arm. My uncle’s face hovered over me as a contorted mask of grimace and worry. 

That evening, back at home, I was reprimanded for my little misadventure.  

As punishment, I was put to bed early. In my pretend state of sleep, I could hear the adults chatter outside the room as they wrapped up dinner.  

“Why doesn’t he take her for treatment?” 

“Because he doesn’t want her to live anymore.”  

The woman I saw was named Sri. She had come to that house as a bride. An endogamous marriage that takes into consideration every constellatory nuance of the birth chart fails to accommodate the fragility that tugs at our psychological seams.  

Her husband beat her. When he died, her son continued the grim tradition.   

It was much later—as an adult far removed from the warped materiality of that town—that I learned she had paranoid schizophrenia. The damage she endured was supposed to be a drug for her malady. Her husband deemed it fit to beat her “possessed” body till it was too broken for any haunting. He was enraged by betrayal of omission about her condition when their match was arranged. Her parents didn’t fully comprehend the illness that was slowly inundating her consciousness. After he died, the son took over the mantle. She was tied to that bed so she wouldn’t wander off as she had done several times before. There was a servant who intermittently attended to her. 

Before she started being chained to that bed, the only loving relationship she was able to build was one with stray dogs and cats she secretly fed in her husband’s absence. There were no clandestine séances being conducted in that saltbox. Just the desperate cries of wounded animals she sheltered from time to time when she had some free will to wander.  

I don’t know how the puppies landed in her backyard.   

My grandmother kept feeding Bhuri and her kids till one morning they all disappeared without a trace. Some speculated that the dogs were displaced by bribing the municipality workers. Someone said they were run over by a truck driver who subsequently threw them into a canal. Our subsequent searches bore no outcomes.  

I don’t know what happened to Sri either. She too disappeared like a cry swallowed by a screeching vehicle in the dead of the night.  

History/Intake 

Indian psychologist and activist, Ratanaboli Roy, is an ​​indefatigable defender of a rights-based approach to mental healthcare. She has documented the atrocities women face in this country due to iatrogenic harm emerging from draconian psychiatric and medical structures. From medication by proxy to involuntary institutionalization to forced ECT—it is a long list of indignities that should ignite our collective conscience but somehow doesn’t. More often than not, the women subjected to this ruthless misconduct are also survivors of domestic violence.  

Her testimonials find resonance in my practice as a practitioner specialising in treating cases related to intimate partner violence and complex trauma. 

Aditi is an engineer by education. She experienced epileptic seizures accompanied by severe depressive spirals. She tried every therapeutic measure, every totem, trick and tablet she could find. One Sunday, as she scrambled to make herself some lunch a few months after leaving her husband and moving into a small one-bedroom apartment, a knock on the door put her to pause. Her in-laws and her estranged husband arrived with medical staff from a psychiatric facility. Her husband had signed her off as a threat to herself and they were there to place her on suicide watch.  

She was institutionalised without consent. Folded into the clinical rituals of an asylum under the guise of protection, no one paused to ask how she wanted to be saved. 

When Tara was “found” outside a movie theatre with her boyfriend who didn’t share her religion, her brothers dragged her home by her hair and choked her till her face turned blue. They used her own dupatta in attempts to smother life out of her. Her sister-in-law intervened and she too was slapped in return. Tara continued to share the same two-bedroom house with those brothers for another 10 years. There was no apology, no sanctuary.  

When popular culture narratives from the film industry glorify abuse against women as accidents of masculine intensity as opposed to acts of outright terror, people like Aditi and Tara are betrayed all over again.  

In a paper titled “Experiences of Cis-Women & Girls in Mental Health Institutions in India,” researchers describe segregation based on disabilities, acts of aggressive restraint, violation of privacy and lack of knowledge about redressal mechanisms as significant deterrents for women who are in need of long term psychiatric and therapeutic interventions in India. 

There are no comforting shelters for women who are caught in the ink-thick weather of trauma arising from gendered violence in this country.  

In recent months, some of my female therapy clients have alerted me to a new-fangled and disturbing trend where AI is summoned to gaslight. A young woman received a five paragraph long, ChatGPT-aided dehumanising takedown from her fiancée. Her insecurities were labelled “deficits” and highlighted with bullet points. An essay with neatly footnoted manipulation was constructed to highlight every insecurity she had. Cruelty disguised as commentary. All of it was packaged as an analysis by an “unbiased” source: a machine parroting the same misogyny as men. 

At the boiling core of gender-based violence against women is a thirst for ownership. A woman’s defiance is rooted in her rejection of becoming a possession. When she exerts free will, it affords her personhood. She is no longer an object. When psychiatric institutions thread fear through the spines of mentally ill women, they regress them back to an object. Their insanity would vanish if they could just evacuate their personhood. This kind of oppressive “treatment” is another form of objectification. Hands pinned forcibly as pills are shoved down the throat. Hosing down “unclean” individuals from a distance. Your essence is redacted. Your marrow splinters. Your stratum of remembering is rendered permanently infertile. Numbness is such a scheming doppelganger of calm.  

Grief freezes my ankles and bends my body into a meat hook when my auto-immune illness brings me to my knees. This neuropathy reached its crescendo during the most brutal months of my abuse.  

My work expects me to offer safety to my therapy clients, but my own body can’t differentiate between shutdown and safety.   

Systemic Contributors  

In the tender dissection that precedes any kind of trauma repair for survivors of gender-based violence, therapeutic neutrality feels like an act of betrayal. An uncomfortable collusion.  

During our internship, we sit in the musty, paint-shorn rooms of public health clinics, a modest clipboard in hand, trying to minute the stories that leak beyond the impassivity of our intake forms. Stentorian judgements of doctors ricochet off the beige walls around us, where fee-paying waiting rooms sit. The mezzanine is for those dangled from the lowest rung of the pecking order—staff and patients alike. Free is the most prominent four-lettered slur in this place. The women who enter these dated strongholds are usually not there out of their own volition—some inescapable deadlock has dragged them into this confinement.  

The first woman whispers her name—Shabana. She has the eyes of a fish held above the tanks of local seafood restaurants, ready for customers to inspect. Her sister waits in the halls with the kin of other patients. The staff ignores them as if they are some fugitive congregation. The sisters sew saree blouses in the walled hush of a hutment where they both live with their mother and two children. Her needle-limned devotion to the work is barely enough for three square meals for each family member. Her husband is addicted to hard drugs. After she got tired of being treated like a punching bag, she left him and came back home, young daughter in tow. In a fit of rage, he barged in and snatched the teenage girl from her. He now refuses her any meeting with the daughter.  

“He is punishing me by hurting her, madame. If I can’t save her, do I deserve to be called a mother?” 

A case is filed against the husband. There are pending reports, rounds to and fro from the local police station, overworked and underpaid social workers who sometimes diligently, sometimes carelessly refer her from one corridor to another. On the daily, hours fragment waiting in the shadows of standard bureaucratic foot-dragging that shames the pace of glacial decomposition in Antarctica.  

She has attempted suicide twice. The battered women’s outreach through which she has arrived here is run by an NGO and is underfunded. There is no other anchor or compass for Shabana if it falls through.  

The daughter remains with the husband. 

My ears turn flame-red even as my wet palms leave leaf-shaped imprints on the blank printer paper as the scribbling spills over.  

In March of 2025, The Supreme Court of India took suo moto cognisance and halted a particularly egregious ruling by a lower court that “grabbing [the] breasts of a girl and breaking off the drawstrings of her lower garment could not be considered an attempt to rape.” 

The girl was a minor and her assaulters were two men who had attempted to kidnap her. The judge who passed the original decree declared that one must differentiate between “preparation” and the actual “attempt” to commit an offense. As per his ludicrous reasoning, the perpetrators hadn’t yet shown sufficient intensity of determination to rape.  

Fifteen years ago, prior to this verdict, while coming home after hearing about a half dozen cases like Shabana, I felt an icky sensation from the side slit of my bus seat. I was drowsy from exhaustion and the window seat of a crowded municipal bus in Mumbai is a prized spot. The breeze comforted me even as the stench overpowered my senses. Suddenly I jumped as I felt fingers trying to pinch the fabric of my kurta. I confronted the sorry sack who appears to be in his late 50s. He started yelling about immoral girls “roaming around” late at night and looking for attention as he hastily descended at the next bus stop. The bus conductor tried to console me by saying: “What can you do? These old men are senile!” 

I disembarked and immediately sank into the asphalt. Two of the street dogs I fed regularly—Rani and Mili—surrounded me as I tried to shrug off this intrusive thought that engulfed my brain: My body is a dirty ditch in which mosquitoes breed disease. I ran my nails across the length of my arm trying to dissociate. Scars leapt forth from skin like zippers on a circus tent.  

Cause on Onset 

The first time he slammed me into the wall, I was cradling a plate of cookies. One dropped. Then another. Crumbs scattered across the carpet. My shoulder throbbed where the drywall caught me, but it was the absurdity of the incident that seeped past the bone, into the nerve—I was offering this nourishment with one hand while bracing for wounding with the other. My allegiance to that plate was so unyielding that I didn’t even think of using my other hand as a shield when the second slap landed.  

Everything was drained into an expanding vacuum within me. The deadening quiet of this space kept growing—mute, cavernous, aimless—like the silence left after an emergency alarm stops. No cry, no outrage. Just the sterile hum of nothing. I sank to the floor. At terminal velocity, falling and flying are not disparate. I ran up the stairs and out into the yard. I forgot I was in the middle of an American winter. My toes touched snow. Its sting sharp. It felt more like a collapse without a conclusion. A hall of mirrors where the loss multiplies endlessly.   

Then, I assumed I was scared of losing him. 

Now I know that I had begun to grieve losing myself. 

Violence is irreversible. Whoever I was before I had my face flattened against that cold concrete disappeared into the floorboards of the room that night.  

Months of verbal abuse had preceded the first attempt at physical violation.  

Diurnal cycles of alcohol-fuelled profanities on Skype followed by texts teeming with paragraphs of apologies and threats of self-harm.  

I was making him angry.  

I was causing him sadness which in turn was coiling into rage. 

If only I understood how much it hurt him to hit me.  

How was this happening to me?  

I am a trauma-informed psychologist. 

I had been tutored in the precision of the map and the medicine.  

I had rote-learned the acronyms for my quizzes. 

This is an example of DARVO—deny, attack, reverse victim and offender. 

I can explain to you with utmost clarity what happens during an amygdala hijack. I have written about how intermittent reinforcement is weaponised as the point of access in cases of narcissistic abuse.  

Yet, I am sitting and grilling chicken for him while a series of apologies cloud my mind.  

I was trauma-informed when he shoved me after telling me my skin was the colour of shit. I was trauma-informed when he giggled while speculating if I would end up as a statistic of suicidal depression like my father. I was trauma-informed when my mother’s husband flung my baby sister’s asthma medicine from the kitchen window of our coffin-sized apartment in Mumbai. I was trauma-informed when my uncle, to whom the house belonged, told my ailing grandmother to consider leaving her body instead of clinging to her life while making his so uncomfortable. Flying down from America to India is expensive, he surmised. I was trauma-informed when I repeatedly requested a family to rescue their daughter from her marital home after multiple group counselling sessions only to learn a few weeks later that she was hospitalised with a shattered spine. 

The one time I made up my mind about leaving him after a long road-trip spanning half of the American west coast, we were at a stoplight. A van stopped next to us. Its body was tattooed with the quote: “White genocide is a crime.” 

My brownness suddenly felt very naked, very discernible. 

The signal cleared and we drove off. One hand on the steering wheel and another on my thigh, he kept staring into the distance. 

“You think I am the worst of my kind out there?” 

Recommended Interventions 

गुलमिया अब हम नाही बजइबो, अजदिया हमरा के भावेले । 

(I won’t play your slave; I adore freedom now) 

Chamki and I are sitting on a bench. I call her Chamki because her fur shines from a distance. She sniffs inside my plastic jar of mutton mince dog treats. She likes this particular flavour. I rescued her after a drunk man drove over her sleeping puppies. She is a pariah dog. No one wants to readily adopt a stray dog here. Least of all a brown female like Chamki.  

Chamki thrives on peppy music; she musters immaculate patience and sits through entire playlists I curate for her, head bopping like a committed fangirl. I play her a song I found on Instagram. I have been humming it under my breath as I do my nightly feeding rounds for her and other strays.  

Written by prolific Hindi and Bhojpuri poet Gorakh Pandey, whose life and work are a testament to the peasant revolts of Northern India, this revolutionary anthem has been reimagined in the voice of working women from Bihar. Bihar is where my family traces its roots. It is one of India’s most impoverished states where gender-based violence is so rampant that nearly 40% of women between the ages of 15-49 claimed to have experienced some form of physical, psychological and/or sexual abuse or other violences from a spouse or partner in the previous state. The song is a reclamation. An unspooling midnight hymn that imagines and augurs resistance through and with the community. 

This is the place where our great-grandmothers as “lower caste” midwives refused to commit female feticide despite threats from patriarchal architects of caste supremacy.  

This is the place where my grandmother sheltered battered women and maimed dogs in her cowshed. Away from the eyes and hands of those who wanted to end them.  

This is the place where my mother and her coterie helped a college friend escape at the break of dawn before she was beaten into submission for a marriage she didn't want.  

June Jordan wrote: We are the ones we have been waiting for. 

Chamki places her paw in my lap. I replay Ghulamiya.