Psychiatry is often described as a site of care. For me, it has more often been a site of control. My time at NIMHANS - the so-called apex centre for mental health in India - was marked not by healing but by surveillance, restraint, and forced treatment. The system called it “protocol.” I call it punishment.

Carceral psychiatry is what happens when treatment begins to mirror incarceration. When survival is reduced to compliance. When a patient’s pain is treated as a liability to be managed rather than a voice to be heard. I entered the hospital searching for safety, but what I found was a structure where my trauma was ignored and my consent erased.

This essay is not an academic abstraction. It is a survivor’s account of how psychiatric care collapses into coercion, and why the line between care and control is not only political but deeply personal.

I was admitted to NIMHANS in October 2024 after a deadly suicide attempt. By then, I carried the labels of Borderline Personality Disorder and Bipolar Affective Disorder. I was still profoundly suicidal, and so the psychiatry team proposed Electroconvulsive Therapy (ECT). I resisted with everything I had. I was terrified of losing my memory. My refusal, however, counted for nothing. They declared me “incapacitated,” even though the Mental Healthcare Act is clear: a person has capacity if they can understand the relevant information, appreciate the consequences of their decision, and communicate it in some form. I met all those conditions. I was capacitated. Yet my voice was erased, and I was coerced through ten sessions of ECT.

My second admission came after another attempt- this time, the admission was involuntary. Again, I was suicidal. Again, my self-harm urges surged. Let me be clear: I do not see self-harm as maladaptive. It is the only coping mechanism that grounds me, whether I am buried in a suffocating depressive low or consumed by a chaotic panic attack.

Inside the ward, everything sharp was taken from me. But one day, in a frenzy, I smashed the glass of a fire alarm. Within seconds, nurses, attendants, and security guards swarmed me. They threw a blanket over my head, pinned me down, and strapped me into restraints. I screamed that it reminded me of my childhood sexual abuse, that it was retraumatizing. No one listened. No one loosened the straps.

The next morning, during rounds, my doctor didn’t ask if I was safe or if I could endure another day. Her first question was: “What do you think about breaking the glass?” She wanted guilt. I gave her pain. I told her it was retraumatizing, that it echoed the abuse I had survived. Her response was flat: “Standard Operating Procedure.”

What happened to me was not an accident. It was not the cruelty of one nurse with a blanket, or one doctor who chose to dismiss my voice. It was systemic. In that sense, it was ordinary. And that ordinariness is exactly the problem.

Psychiatry, as it is practiced in India and elsewhere, often mirrors the logic of carceral institutions. Surveillance replaces trust. Confinement replaces safety. Punishment replaces care. The moment I broke the glass, my act was not read as an expression of unbearable distress but as a threat to order. The response was not to ask what I needed, but to subdue me as quickly and efficiently as possible. My pain became property damage. My trauma became SOP.

This logic has a history. The earliest psychiatric asylums were built not as spaces of healing but of containment. Michel Foucault traced how madness was locked away alongside poverty and criminality in Europe’s “great confinement.” In India, too, colonial psychiatry grew within prison walls. Mental illness was managed less through care and more through segregation, surveillance, and control. What I experienced is simply the continuation of that lineage: the asylum reborn as the modern hospital, still carrying the imprint of carceral violence.

And yet, psychiatry continues to defend these practices in the name of safety. “Restraint” is treated as a neutral medical term, as though being tied down does not rip open old wounds for survivors of violence. “SOP” disguises the absence of empathy. Forced ECT is framed as life-saving, even when it tramples on consent. These practices persist not because they are the most effective forms of care, but because they preserve order—for the institution, not the patient.

Survivor movements worldwide have shown that alternatives are not only possible but already exist. Community-based care, trauma-informed approaches, and peer support systems shift the emphasis from control to collaboration, from silencing to listening. In such spaces, patients are not reduced to risks that must be managed but recognised as human beings in pain who deserve dignity, agency, and safety.

When I think back to NIMHANS, what haunts me most is not only the violence itself but the routine way it unfolded. Nobody flinched when I screamed. Nobody questioned the blanket, the straps, the force. That routineness is what makes carceral psychiatry so dangerous: it is violence hiding in plain sight, legitimized by protocol, justified by authority. Until we confront that logic, healing will remain indistinguishable from punishment.

I do not deny that psychiatry can save lives. I have felt medications pull me back from the edge of death, and I know people who have found stability and safety because of psychiatric care. To dismiss all of it would be dishonest. Some doctors and nurses act with compassion, and there are moments when medical intervention is not only useful but essential.

But care is not the same as control. The fact that medication can help does not justify coercion. The fact that some benefit from hospitalization does not erase the violence of forced confinement. Healing requires trust, and trust cannot be built on the fear of restraint or the looming threat of being silenced. Psychiatry has the tools to heal, but too often it chooses the logic of punishment. To recognize its potential without naming its failures is to mistake survival for dignity.

My time at NIMHANS reveals more than individual negligence; it exposes a structural problem. Psychiatry, when organized around coercion, reproduces the same carceral logic as prisons: surveillance, confinement, punishment disguised as treatment. If the goal is healing, then care must look radically different.

We need to shift from carceral psychiatry to emancipatory care. That means moving away from the assumption that control equals safety, and building systems that centre trauma, agency, and dignity as the foundation of recovery. Community-based and trauma-informed models are already here: survivor-run crisis lines, peer respite centres, de-escalation practices rooted in trust instead of force. These are not fantasies. They save lives without stripping people of humanity.

True healing cannot happen in a place where every cry is treated as a threat, every act of resistance as a disorder, every patient as a problem to be subdued. Healing begins where freedom is possible—when people are met not with restraints but with compassion, not with coercion but with choice.

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