Bangkok Post

Thailand's first psychiatric hospital turns 250

As Thon Buri - Thailand’s first mental health hospital - celebrates its 250th anniversary this year, Pichaya Svasti charts the historical footprints of Thailand’s “red roof”

PUBLISHED : Monday, 06 March, 2017, 4:34pm
UPDATED : Monday, 06 March, 2017, 5:07pm

By Pichaya Svasti

For over a century, Thais have been familiar with the slang term “langkha daeng”, meaning “red roof”. If someone says, “go to langkha daeng”, it mockingly or cruelly means, “you’re crazy, just go to an insane asylum”, because Thailand’s first psychiatric hospital had its roof painted red. This colloquial phrase is used so widely that a Thai movie about the lives of the mentally disturbed was named Langkha Daeng and became a big hit in 1987.

However, first-time visitors to “Langkha Daeng” -- officially Somdet Chaopraya Institute of Psychiatry in Klong San district, Thon Buri -- are often surprised by its peaceful ambience and shade offered by big trees. Instead of gloom, it’s a site of beauty and tranquillity. Its buildings and compound also tell the history and development of psychiatric care in Thailand.

Somdet Chaopraya Institute of Psychiatry was the first psychiatric hospital in the Kingdom, founded by King Rama V on Nov 1, 1889, under the name “Insane Asylum” (Rong Payabal Khon Sia Jarit). Its birth was inspired by King Rama V’s visit to a lunatic asylum in Singapore during his royal visits to Java and Singapore in 1870. Located at Pak Klong San, the asylum provided medical treatment for patients by physicians and Thai traditional physicians.

“It was one of the first four hospitals in Thailand: Siriraj Hospital, established in 1888; a hospital in front of Burapha Palace; one beside Wat Debsirin; and the asylum which was originally located across the street where the residence of Chinese tycoon Keng Sua had been,” Dr Sanjai Saengwichian, a retired Siriraj Hospital physician and historian, said during a tour organised as part of the celebration of Thon Buri’s 250th anniversary.

According to Dr Sanjai, there were at least two reasons for authorities to select this area as the location for a mental health hospital. First, its proximity to Siriraj Hospital made it convenient to transfer mentally ill patients from Siriraj. Second, the Thon Buri quarters, on the west bank of the river, ranging from Klong San to Bangkok Noi, were old-time communities and also the home of one of Siam’s most powerful clans, the Bunnag family. This neighbourhood was then a business district full of Thai, Chinese, Muslim and Hindu traders and was easily accessible by boat and, thus, patients were able to visit this hospital and see doctors.

“Prince Damrong Rajanuphap [former interior minister] wrote a memo that the newly-opened hospitals were not popular because people were accustomed to being treated by home-visiting doctors and consulting fortune-tellers first to forecast whether or not they would recover,” Dr Weerapon Unaharassamee, deputy director of Somdet Chaopraya Institute of Psychiatry, said.

The asylum had 30 patients in its first year. However, the number increased to 1,120 in 1904, but the space remained limited. Therefore, Dr H. Campbell Highet, the Metropolitan Ministry’s chief sanitary doctor and the first director of the hospital, proposed the government buy the land and house belonging to Chao Phraya Surawongwaiwat (Vorn Bunnag), or Chao Khun Thahan, as well as the land owned by Pia Rachanupraphat and nearby land totalling 44.5 rai to build a new hospital, which is the current location of the institute. The new location is at the western edge of Klong San, about 600m away from the original site.

Today, Somdet Chaopraya Institute of Psychiatry has 500 beds and receives approximately 543 in-patients per day, according to the institute. Statistics from the Department of Mental Health show that Thailand has 19 mental health hospitals under the department and there were over 45,000 in-patients in 2016.

Back in the early 1900s, the construction of the first psychiatric hospital was under the supervision of Phraya Ayuravejvichak, originally Dr Modern Carthew, the assistant of the Sanitation Department and later the second hospital director. He was well-known for building the true foundation of a Westernised psychiatric hospital by providing treatment according to modern knowledge as well as patient care, with compassion and humanitarian principles. The compound of the hospital had large shady trees with colourful flowers and leaves.

The hospital buildings had red tin roofs and the patient rooms had steel bars in the lotus stem shape.

“The tin roofs and fences were painted in red auto paint, so the hospital has been widely known as Langkha Daeng,” the doctor noted.

Later, the hospital was run by modern physicians. Professor Luang Wichian Phaetthayakhom (Dr Thian Tuwichian) was appointed the first Thai director after his two years of studies in psychiatry in the United States. He realised the importance of psychiatric care and shared his knowledge through articles, lectures and speeches in order to better people’s understanding and bring an end to the great fear towards psychiatric patients. He granted the hospital the new name, “Thonburi Psychiatric Hospital”, instead of “Insane Asylum”, in 1932 to ease stigma against those with mental illnesses.

“Later, certain Thai psychiatrists attended conferences in Vienna and ordered hydrotherapy tubs for patients here to soak in water and then calm down [during 1934-1942], as well as straitjackets which would be used until World War II. Straitjackets were made of raw cotton fabric that shrank when wet,” Dr Weerapon said.

“The hospital continued to improve patient treatment procedures. For example, earlier some doctors had believed patients would get better after having seizures, so they had tried to induce seizures under various methods.

“At early stages, intentional malaria infection caused convulsions and relief to some patients but death to some others.

Later approaches included the use of insulin and later metrazol as a convulsive agent. Later, electroshock therapy, also known as electroconvulsive therapy [ECT], was used starting from 1937.”

Treatment at Somdet Chaopraya Hospital was continually developed to ensure patients’ well-being. For instance, occupational therapy has been promoted for those recuperating from mental illness in order to promote rehabilitation through activities in daily life. Patients there have been encouraged to make handicrafts and gifts for sale. In the past, their handicrafts sold like hot cakes and gradually brought huge incomes which were shared between the patients and hospital. The hospital spent the money buying more than 1,000 rai of land in Muang Nonthaburi where another psychiatric hospital, Srithanya, has been open since 1941.

After that, Dr Fon Sangsingkaew, the hospital director from 1942-1959, was regarded as the “Father of Psychiatry” in Thailand. He renovated the hospital by removing all steel bars, installing screens, changing the name of the wards to those of flowers for pleasant meanings, employing love in patient care, and treating patients the way parents would their children. In an academic aspect, he laid the foundations of pre- and post-graduation in psychiatry and mental health. He renamed the hospital “Somdet Chaopraya Hospital” in 1956 according to the name of Somdet Chaopraya Road in front of the hospital with the aim to mitigate patient humiliation.

Some of the hospital’s old medical equipment and kits are on view in the Somdet Chaopraya Institute of Psychiatry Museum together with models of patients in order to demonstrate old treatment approaches for mental health patents there.

Currently, the hospital offers treatment and care for psychiatric, neurological, neurosurgical and neuropsychiatric patients. The hospital is a training institute for psychiatry, mental health and health-related of pre- and postgraduate levels in order to develop academic activities in mental health, neurology, neurosurgery, psychiatry and neuropsychiatry. It was renamed Somdet Chaopraya Institute of Psychiatry in 2002.

“At present, psychiatric treatment here is modern. You may not be able to differentiate between passers-by and parents as they walk around you in this hospital compound,” Dr Weerapon said during the recent “Western-Style Hospitals in Thon Buri” lecture as part of the first series of the “In Remembrance of Krung Thon Buri” fair throughout the year.

This year, Thon Buri celebrates its 250th anniversary as the old capital of Thailand. Of all the commemorative events organised by the public, private and independent sectors in Thon Buri, the first series in February involved “Khlong San”, the second one in April “Bangkok Yai and Bangkok Noi”, the third in June “The Sampeng-born Chinese in Thon Buri”, the fourth in August “3 Mosques, 3 Periods of Time”, the fifth in October “The People of the Venice of the East”, and the last one in December “King Taksin, The Monarch of Krung Thon Buri”.

Under the red roof