Meet The Psychiatrist Who Works Inside South Asia’s Largest Prison Complex

India’s Tihar Prison Complex, otherwise known as Tihar Jail, sprawls over 400 acres in Tihar Village, New Delhi. The nondescript road leading up to it is dotted on either side by neon pharmacy signage, temporary tea stalls, and eateries that serve saccharine cupcakes. 

It’s hard not to be intimidated by the presence of the largest prison complex in South Asia that houses nine central prisons that come under the aegis of the Department of Delhi Prisons. The Rohini Prison Complex in northwest Delhi and the Mandoli Prison Complex in Shahdara district in northeast Delhi are the other two prisons that are overseen by the same department. As of July this year, the prison population across the 16 prisons is approximately 19,500 – well over the sanctioned capacity of 10,026. Since opening in 1957, Tihar Jail’s high-profile inmates have included actors, millionaires, social rights activists, and a former Prime Minister’s son. 

For 43-year-old psychiatrist Vivek Rustagi, who heads Tihar’s mental health services unit, the jail has been his second home for the last six years. After completing a postgraduate course in psychiatry in 2004, in Delhi, Rustagi worked at the Institute of Human Behaviour & Allied Sciences (IHBAS) – a referral centre for Tihar Jail inmates. His experience at IHBAS, prior to joining Tihar Jail full-time, helped expose him to inmates from diverse backgrounds. 

Rustagi begins his workday at 10 AM after a gruelling almost 90-minute commute in mind-numbing Delhi traffic. He hands over his mobile phone and other electronic devices at the security checkpoint. Once inside, he figures out the tasks that need to be attended to on a priority basis before setting out on his daily rounds to each of the critical wards, accompanied by junior staff. 

“Jail work is not predictable as there are many medical and administrative issues that keep cropping up, and one needs to prioritise them accordingly,” he told VICE. “There have been times when I’ve reached home at three or four in the night because of emergencies. I hardly get time to step out, except for the occasional coffee or smoke break.”

Rustagi’s job profile is diverse and includes counselling prisoners as well as assessing the validity of their claims of mental illness. The likelihood of being manipulated by some of the toughest psychopaths and cold-blooded criminals is writ large. Socio-political pressures trickle into the job, too. Many prisoners claim to be schizophrenic or to suffer from other serious mental illnesses with the hope that the court will commute their death sentences. 

“The rationale behind [giving] the death sentence is for the convict to become conscious of the crime,” explained Rustagi. “But if they are mentally unstable, they won’t know what’s happening and justice will be incomplete.”

Even though Rustagi comes across such cases on a daily basis, it was his interaction with the convicts of the 2012 Delhi gang-rape and murder case — in which a 22-year-old physiotherapy intern was brutally beaten and gang-raped in a moving bus, and then dumped on the side of the road along with her male friend, and left to die — that most unsettled him. The case made national and international headlines and helped amend rape laws in the country, though not necessarily with great results. 

The case resulted in the execution of four of the five adult convicts, except one, who allegedly died by suicide in prison. The sixth convict, who was a juvenile at the time of committing the crime, was sent to a juvenile correction home after being convicted of rape and murder. He was given the maximum sentence of three years for juveniles. Except for him, the other five were in Tihar Jail for months before being executed. 

“I was meeting each of them twice a day, every day, for three months. It was really unsettling,” said Rustagi. “One of them claimed to be a schizophrenic, [hoping] his death sentence would be commuted. I had to assess his mental state by setting aside any biases and public pressure.”

During the intensive, month-long conversations with the rapists, Rustagi also got an insight into their twisted philosophies. One of them told Rustagi that the victim needed to be taught a lesson for being out late at night with a man.

Rustagi presented an exhaustive report before the courts that stated that none of the five adult convicts had any debilitating mental health issues. He explained that there are certain objective parameters that such claims need to be tested against, regardless of how smart the criminal might be. Also, he added, someone faking their mental health condition will have inconsistencies in how they present themselves, including behaving differently depending on who they are interacting with — prison staff or lawyers, for instance, and acting “normal” when they think they are not being watched or observed on camera. There will also likely be loopholes in their testimonies. 

“You have to understand that most of these criminals don’t genuinely believe they have done anything wrong, as they are devoid of any guilt mechanism,” he said. “They have been raised with poor development of consciousness and become sociopaths. In that sense, “abnormal” things seem perfectly normal to them.”

The way he sees it, prisons are places where complex power plays take place, and prisoners are extremely cautious about what they want to reveal about themselves, including their childhood trauma, vulnerabilities, as well as details of the crime itself. “They might not necessarily be inarticulate, but they don’t want to be vulnerable because they might seem weak, which affects their hierarchy among the other prisoners,” said Rustagi. “The idea is to create a conducive environment, a safe space for prisoners to share their fears, assuring them that these private conversations will not be leaked to anyone else [inside].”

Recently, Rustagi came across a case in which a man murdered his two children after losing a property case because he feared being homeless and wished to save them from a future of poverty. 

“He didn’t talk for months but he was clearly extremely traumatised,” he said. “We made him understand that his actions were not so abnormal that they couldn’t be addressed. It’s all about creating that safe space and making them believe that no one is beyond reform.”

In another case, a man who had killed his wife was not ready to leave his children in the care of his relatives while he was in jail. After several counselling sessions it was learnt that the man was sexually abused as a child. He refused to trust anyone to take care of his children because of fear stemming from his own childhood experience and unresolved trauma. 

Rustagi clarified that these cases do not involve “hardened criminals” because they still have that guilt mechanism and are self-aware. Whereas in the 2012 gang-rape and murder case, the convicts had started to believe in their own lies. They kept repeating that they were being used as scapegoats and that there was a conspiracy against them by the media and the government, according to Rustagi. 

Rustagi, however, does believe that some convicts are too far gone, particularly the sociopaths and psychopaths who have an absence of any guilt mechanism. With such criminals, the approach is not reformation but prevention, said Rustagi, adding that these men have to be stopped from committing other crimes, including drug trafficking, running illegal businesses from prison, and accessing weapons like blades or pocket knives that they can use to inflict harm on themselves and others inside the prison.

“Some criminals are kept in high-security cells. When they become agitated and there is the potential for self-harm, we control their agitation, without necessarily focusing on reformation,” said Rustagi. “That’s the best one can do.”

One such criminal is the infamous “Butcher of Delhi,” who mutilated his victims, and threw their torsos in bags outside the Tihar Jail. However, the serial killer, whose name is Chandrakant Jha, has thus far displayed impeccable behaviour in prison, according to Rustagi. 

“Interestingly, he is not someone who is traditionally anti-social because all the other aspects of his life were pretty normal and routine. For him, killing people had to be methodical, so that it did not impact his daily routine,” said Rustagi. “Also, he openly acknowledges his crimes, so he derives a sadistic [pleasure] and ego boost from [confessing].”

Being in prison can and often is a traumatic experience in itself. Containing an inmate’s trauma can become extremely difficult, especially when they face continuous attacks from other inmates due to the heinous nature of their crime(s). Rustagi said in the prison world, people who are convicted of harming women and children are often tortured by other inmates. 

“A few years ago, there was the case of a man who was convicted for morphing pictures of women and children and selling them online,” Rustagi said. “He was beaten black and blue by the other inmates and developed a condition known as catatonia. He couldn’t blink due to the severe trauma and would get extremely jittery and nervous after every court hearing.” 

The problem of overcrowded Indian prisons certainly doesn’t help in counselling prisoners and providing them with a safe space to understand themselves better and the opportunity to reform. Every single prison, Rustagi said, is woefully understaffed, particularly in the mental health department. 

“Apart from psychiatrists, mental health [departments] are supposed to include psychotherapists who specialise in specific therapies, social workers who are trained to liaise between convicts and their families, as well as between courts and the administration, and psychiatric nurses. Unfortunately, there is hardly any Indian prison that is [well staffed].”

He added that there also needs to be an attitudinal change from the administration who must understand that inmates with mental health issues will only further complicate and stress the prison apparatus if they are not tended to by qualified and well-paid staff. 

“[Monetarily] incentivising mental health workers is crucial not simply because it’s a taxing and draining job, but if they are not [adequately paid], it opens [avenues for] corruption. Entire death sentences can be changed by a “neutral” report.”

After counselling murderers, innocent and traumatised undertrials, gang rapists, hardened criminals who rape four-year-olds and feel no remorse, terrorists and more, do things get to him when he goes back home every night? Rustagi said that while things seem impossibly overwhelming, especially when one first enters the prison system, there is only so much one can do — there is simply no time to ruminate and let them get to you. 

Just recently, Rustagi said, a junior doctor in his team got triggered while handling the case of a man whose girlfriend had died of suicide because it reminded him of his own girlfriend’s suicide. At any given time, Rustagi has a team of around six to seven doctors assisting him. 

“Often, when a particular case really affects us, we talk things over a tea or take a cigarette break and move on to the next case. We validate each other’s experiences. Prison is unforgiving and things [do] stay with you.”

If you or someone you know is considering suicide, help is available. Call 1-800-273-8255 to speak with someone now or text START to 741741 to message with the Crisis Text Line.

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