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Madness and Colonization: Psychiatry in the British and French empires, 1800-1962.

A recent intersection of two historiographical strains points to a promising new direction for social and cultural history. Given the pervasive influence of Michel Foucault and Edward Said on much historical research since the 1970s, it is no surprise that several historians have drawn their attention to a topic that brings some of Foucault's and Said's most provocative contributions together: the problem of madness and its treatment in European colonies. (1) Scholars in British and French colonial history have in the last decade produced important works that revise our understanding of both colonialism and the social history of medicine through their interrogations of colonial psychiatry--that is, the establishment, administration, and practice of mental health care for both European and indigenous populations in Asian and African possessions from the early nineteenth century to decolonization. This literature responds not only to Foucault and Said, but also connects to influential works in post-colonial stu dies that investigate the psychology of colonial domination and complicate the racial divide that informed colonial contact.

Studies of colonial psychiatry have the capacity to engage with at least four distinct historiographies. First, this research decenters the history of Western psychiatry, a field that has grown substantially since the 1961 publication of Foucault's groundbreaking thesis, Histoire de la folie a l'age classique. Scholars have grappled with this dimension of medical history by examining social, political, technological, and professional aspects of psychiatry since the early modern era, encouraging a polemical debate over questions of progress, power, and professional interest. Foucault's contentions that psychiatric power responded to a wider scientific episteme in the modern era by delineating artificial barriers between reason and madness to protect the former from the latter's incipient threats has sparked wide-ranging criticism. Some argue that Foucault ignores historical truth when he describes a "Great Confinement" beginning in the mid-seventeenth century, as only a tiny fraction of the French population e ver experienced psychiatric incarceration. (2) Others agree that Foucault plays fast and loose with the historical record, but agree with his emphasis on the social implications of psychiatric confinement and treatment. (3) Regardless of the positions that post-Foucauldian historians have taken, however, the result is a spate of correctives that alternately test and complement Foucault's analysis through interrogations of psychiatric professionalization, the connections between psychiatry and politics, the importance of gender and race for mental health discourses, and the ways that medical technologies have combined with social policies to enhance psychiatry's coercive power in the twentieth century. (4) But as good as many of these works are, they focus exclusively on Western developments, and present a narrative of reform, professionalization, and technological innovation relevant to Europe and America. Studies in ethnopsychiatry offset the discourse of Western psychiatry to some extent, but like their Eur ocentric counterparts, they ignore the role of contact between Western and alternative psychiatric medicine. By their very nature histories of colonial psychiatry disrupt these accounts, elucidating the ways in which Western medicine's alliance to colonial authority encouraged a return to traditional practices in Asian and African colonies. (5)

As Foucault describes madness as an imperative discourse in an age of reason, Edward Said labels the "Orient" a topos of the Western academic imagination. Just as Foucault has come to represent the trend toward a constructivist approach in the history of psychiatry, then, Said's work encapsulates a move under way in the 1970s toward a scholarly preoccupation with the relationship between knowledge and colonial power. Orientalism excoriated the academic study of an undefinable "Orient" that encouraged the reification of stereotypes in existence since classical antiquity--stereotypes that in turn marked the conception of the Islamic world in an equally ill-defined "Occident" and played into political machinations for colonial expansion. Since the appearance of Orientalism studies of the social and human sciences and their colonial connections have mushroomed. Works on the history of anthropology have revealed troubling relationships between efforts to know "others" and ineluctable "predicaments of culture" that hinder understanding and encourage the unbalanced exercise of power in the colonial context, (6) while other studies connect academic disciplines to "investigative modalities" that facilitated colonial administration. (7) Historians have uncovered some of the ways in which social scientists established false racial divisions that assisted "collaborationist" mechanisms of domination in African and Asian contexts, (8) and scholars have described diverse urban planning programs in which an architectural aesthetics that insisted upon modernization while claiming to preserve tradition were instrumental for "civilizing" strategies in Morocco, Indochina, Madagascar, and Egypt. (9)

If social scientists defended colonial abuses by reference to the civilizing mission, engineers and other applied scientists argued that their work assisted in the "mise en valeur" of colonial possessions: major projects brought colonial backwaters into the modern age. But recent histories of science and technology indicate an important relationship between scientific knowledge and colonial domination. Technological mastery informed ideas of racial superiority in European imperial expansion, and connected scientific innovation to civilizing ideology after the seventeenth century. According to one study, the mere presence of French astronomers, meteorologists, and geophysicists in Algeria, Tunisia, Madagascar, Latin America, and China rendered them cultural ambassadors who reinforced notions of French cultural superiority. And in certain cases, a colonizing power's insistence on exclusive rights to scientific knowledge encouraged indigenous scientists to elaborate local traditions of scientific innovation. (10 ) Finally, scholars have begun to investigate the close connections between colonial medicine and power--a relationship Frantz Fanon described in A Dying Colonialism in 1959. Historians have been somewhat reluctant to lambaste the medical oeuvre of European imperialism, but recent works have elucidated the importance of medical knowledge for colonial conquest. (11)

As psychiatry occupies a unique space between the social and natural sciences, the discipline constitutes a crucial locus for study of the relationship between knowledge and power in colonial domination. The asylum in any context functions as both hospital and prison, and psychiatry's medical applications render the mental institution the ultimate "correctional facility." Under colonialism, where the ruling state is in almost constant tension with the population, the position of psychiatric knowledge becomes even more complex. The French conqueror of Morocco Hubert Lyautey admitted in 1933 that "[t]he physician, if he understands his role, is the primary and the most effective of our agents of penetration and pacification." (12) The fact that Lyautey offered this dictum to a psychiatric congress in Rabat is significant. As the authors of the works examined here make clear, colonial psychiatry allied itself closely to civilizing missions as it assembled knowledge about "indigenous psychologies" that facilitate d rule.

This point bears reflection, as it indicates a third literature that the study of colonial mental health care expands. Much of the recent scholarship in postcolonial studies focuses intently on the specific psychological problems of the colonial predicament. Unlike Frantz Fanon, however, who argued that colonialism breeds psychopathology and necessitates liberatory violence, and Octave Mannoni, who asserted that colonialism relies on internalized and pathological notions of dependency on the part of the colonized, a more recent wave of studies in colonial psychology examines subtler mechanisms of domination. Freudian, Eriksonian, and object relations theories provide the tools for examining the meanings of ambivalence for colonial psychology, for example. According to one interpretation, a mythology of British heroism in the face of native criticism shielded late Victorian military men and civil servants from the seductions of a "magical Orient." (13) Another critic reveals the duplicity of British promises t o colonial subjects. Official policies encouraged the "Anglicization" of Indians, but in practice many British colonials found any attempt by Indians to emulate them profoundly threatening: imitation was the sincerest form of mockery. Lacanian theories that claim recognition as a constitutive factor in human subjectivity, and therefore in authority, may also provide clues about colonialism. One scholar has argued that in the context of British India, where power was based in racial difference, authority's demand for recognition opened a space of resistance: the Indian's vexing failure to recognize British authority had the capacity to alienate the colonizer from his position of power. (14) Scholarship about gender and imperialism also focuses on psychological problems in colonial contact. Colonialism's emphasis on "those parts of the British political culture which were least tender and humane" rearticulated masculinity according to "new forms of institutionalized violence and ruthless social Darwinism" that extolled competition, athleticism, and militant domination. This reconceptualization of British masculinity as colonial masculinity, which effectively elevated a Kshatriyan model of masculinity over Brahmanic ones, alienated long-standing political and cultural arbiters by removing the chief legitimating sources of traditional authority. (15) And recent studies of British imperialism in sub-Saharan Africa have applied psychoanalytic concepts of fetishism and displacement to colonial rule. Colonialists displaced onto Africans "the contradictions that [they could not] resolve at a personal level." Colonial administrators therefore discredited local rituals as "fetishistic," but only as they ignored their own fetishistic investment in the power of commodities as critical tools for "civilizing" Africans. (16)

This scholarship is intriguing, but much of it remains highly speculative. Although laying a psychoanalytic grid over historical evidence can be informative, this methodology often proves limiting, and reveals far less about the psychology of the colonial predicament than it obscures. Scholarship on colonial psychiatry opens a new window into this important historical problem, and offers significant if ambiguous evidence about "colonial psychology." Sources in the history of colonial psychiatry reveal a great deal about what psychiatric practitioners, judges, police, families, and neighbors considered "pathological" in the colonial context, thereby shedding light on the "normal" as well. As the works discussed here show, definitions of mental normality and pathology preoccupied medical and lay colonizers. While colonial psychiatric work may reveal little scientific truth" about psychology, the practice of colonial mental health care provided a venue for discussing colonial psychology explicitly, and therefore constitutes an essential location for scholars grappling with this important historiographical problem. Even though many British and French psychiatrists ignored the role played by colonialism in psychological relationships between colonizer and colonized, their writings remain historically important because of the ways they did address psychology: through accounts of dysfunction that they localized in "the indigenous mind," and almost never in a culture of political and racial oppression.

The historiography of colonial psychiatry has thus opened up fascinating new directions for studying the history of psychiatry and medicine, the history of science and technology under colonialism, and the ramifications of colonial social structures for human psychology. And finally, studies of colonial psychiatry provide significant insight into the functions of race for colonialism. Whereas historians of Europe and the United States have noted the importance of gender and class as locations for examining the social implications of psychiatry, in the colonial context race is the paramount category for social analysis. Certainly race figures in European and American psychiatry as well: American psychosurgeon Walter Freeman singled out African-Americans and Jews as particularly good subjects for lobotomy, and Freud focused intently on race and mentality in Totem arid Taboo, to note just two examples. But colonialism raises different questions. Psychiatrists provided scientific justifications for racist policy. French-Algerian psychiatrists Antoine Porot and Don Come Arrii, for example, argued in a 1932 article that Algerians' tendencies toward violence meant that the French mission in North Africa required stronger policing than elsewhere, as "it is above all through ... sanctions that we teach these thwarted and overly instinctive beings that human life must be respected ... a thankless, but necessary task in the general work of civilization." (17) In addition to lobbying for colonial policy, such positions offered scientific definitions of race based on psychological predispositions as much as biological factors, and forged hierarchies of race and class that included settler populations in their scope. Colonial psychiatry thus refers not only to the colonized but also to diverse settler populations. As the historians discussed below suggest, colonial psychiatric discourse about the European insane expands our understanding of the permeability of racial boundaries in the colonial context. If, as some scholars hav e suggested, poor, criminal, and "marginal" whites compromised European hegemony, where did psychopaths figure in debates about citizenship and power? (18) The rule of "the autonomous European"--as much of a constructed figure as "the dependent African or Asian"--relied above all on the power of European reason, raising important complications in the case of the insane.

The authors of the works considered here write from a number of disciplinary backgrounds. Some are historians, while others are sociologists, anthropologists, or practicing therapists. Although disciplinary prejudices inform many of these works, collectively they bring important historical problems to light, while indicating promising directions for further inquiry into the social, cultural, medical, and political dimensions of colonial psychiatry. The resulting studies are extremely diverse, but taken as an ensemble a fascinating synthesis emerges that illustrates striking similarities and shows intriguing anomalies in very different British and French colonial contexts.

At its inception in late eighteenth-century India, British colonial psychiatry was preoccupied with Europeans' psychological capacity to live "under Oriental light," as Waltraud Ernst demonstrates in Mad Tales from the Raj: The European Insane in British India, 1800-1858. (19) The development of psychiatric infrastructure in India paralleled British imperial advancement. Begun as private businesses for interning the mad, asylums were gradually taken over by the state as the English administrative presence became stronger in the early nineteenth century. Asylums had existed with the East India Company's approval (and at times, sponsorship) in the major colonial centers of Madras, Bombay, and Calcutta almost since the arrival of significant numbers of soldiers and civilian colonists. But these small private madhouses had only become large public institutions around the 1850s. At the outset, mental health care was in some ways identical to other private ventures: investors with no medical training built houses o f confinement that they managed as businesses, ensuring profitability through a lack of competition and by tapping a concern for public order within the European community. Psychiatry in India also mirrored practices in England, where the government's use of privately operated madhouses to preserve public order was commonplace until Parliament mandated the establishment of public lunatic asylums in 1845.

Yet important particularities marked psychiatric care in India. Large asylums located in the city centers of Calcutta, Bombay, and Madras served mostly European patients, while a network of dozens of other smaller institutions confined the Indian insane. Based on extensive research in India Office records, Mad Tales focuses on the first group, illustrating the peculiarities of confinement for "doo-lally" ("dangerous or crazy") soldiers and civilians from the late eighteenth century to the Sepoy Mutiny. (20) Following Foucault, Ernst goes beyond the "myopic medical gaze" in order to seek the wider "socio-cultural and economic context" for confinement in India. British institutions in India reflected European humanitarian concerns for disciplining (rather than punishing) madness and maintaining conditions superior to those in jails and workhouses, because "madness unlike destitution crossed barriers of social class." However, racial tension and the imperative to maintain the prestige of the ruling race also lef t their mark on the architecture, therapy, and administration of asylums in India. (21)

Racial difference was crucial to day-to-day practices of confinement and treatment. European doctors monopolized the medical profession, allowing Indians to occupy only the most menial positions in asylums. Authorities also usually confined European and Indian patients in separate institutions. In the few instances when Europeans and Indians were interned together, segregation left the relatively few Europeans with distinctly better living conditions. In Bombay's asylum at mid-century, doctors dedicated half the institution's space to twentyone Europeans, while seventy-two Indians were packed into the remaining half. Despite constant official complaints regarding the abominable conditions that resulted from the classificatory imperative to segregate patients, authorities never contemplated altering such practices. Therapeutic tendencies manifested racism in more insidious ways. Whereas psychiatrists in Britain advocated work as a means of "moral management" of mental illness, British psychiatrists in India fo und hard labor "impracticable, if not injurious to Europeans" because of the harsh climate. Crucially, this view "cut across lines of class." Physicians argued that even soldiers and working-class Europeans should not work in asylums, while in the same institutions Indian patients were forced into intensive labor as part of their therapy. Finally, psychiatrists in Britain and India diverged on the issue of restraining violent patients. British psychiatrists viewed manacles and leg irons as barbaric symbols of the asylum's dubious past. But European psychiatrists in India dissented. As public institutions employed only Indian orderlies and nurses, "natives" were largely responsible for controlling recalcitrant patients. European racism made mechanical restraint an absolute necessity: for British patients, their "shame of being laid hands upon by natives" outweighed their contempt for restraining devices. Before the development of psychoactive drugs for calming patients, mechanical restraints were the only mean s for avoiding Europeans' ultimate humiliation: physical domination by native orderlies. (22)

Conditions of confinement and therapy thus provide key locations for studying the intersection of race and psychiatric practices in India. But Ernst's major preoccupations are the intersection of class and race in the Raj and the manner in which psychiatrists and administrators employed social discrimination to maintain white supremacy in India. Ernst devotes much of her study to complicating the idea of a monolithic ruling race in British India. As the presence of poor whites in India and other colonies became increasingly problematic over the course of the nineteenth century, the East India Company and later Parliament restricted immigration of poor Europeans into the colony. The "ruling class's concern to preserve the image of British character" manifested itself in policies toward social misfits like prostitutes, vagabonds, alcoholics, and the insane that were designed to avoid "lowering the European Character in the eyes of the Natives." Discriminatory categories divided patients into two groups--first-a nd second-class--and physicians' diagnoses and descriptions of insanity in case histories varied accordingly. Doctors described first-class patients as suffering from "temporary weakness" or affected intellect, while they characterized workers as "perfect Idiots" and "maniacs." As most patients belonged to the latter group, asylums operated as last resorts for soldiers and poor whites who did not respond to social discrimination or military discipline. If these patients had not recovered their senses within a year of their initial confinement, Company officials ordered them repatriated to England. There they were admitted into the Company's asylum at Pembroke House or, less frequently, simply set loose at the first port, only to wind up in the care of British public institutions. (23)

The fact that punitive policies like internment and repatriation were aimed most specifically at poor whites indicates that psychiatric practice in India served as a measure of social control. Yet as Ernst notes, the numbers of patients passing through the asylum system in British India were too insignificant to have curbed social deviance in any meaningful way. In the 1850s, there were only a hundred patients in Calcutta's asylum, and Bombay and Madras each held ten Europeans on average. Repatriation of chronic patients accounts only minimally for these small numbers: a mere five hundred cases originating in India passed through Pembroke House from 1818 to 1858. These institutions could only have preserved order through their potential for social control: their very presence threatened the possibility of confinement for wayward souls. The asylums therefore functioned as key symbols of the civilizing mission. As markers of European medical superiority, institutions propagated the myth of medicine as an import ant means of colonization despite their limitations in actually confining and treating patients. Though the number of patients confined and treated was tiny, it "contributed to the maintenance of the self-image of the British as a superior people whose charitable humanitarianism and rational, scientific achievements made colonial rule appear morally beneficial and legitimate." (24)

Mad Tales is most effective at describing the ways class informed diagnoses of insanity, and the ways these diagnoses worked toward the end of preserving white prestige in India. Mildly "nervous" or "fatigued" officers might remain in India after a brief convalescence in a first-class ward, but working-class insanity threatened the myth of white superiority too profoundly to be tolerated. Deranged subalterns met with swift internment, and often with forced repatriation. Therefore while Ernst says little about the effects of colonial psychiatry on Indians (who, she acknowledges, constituted the majority of patients), Mad Tales deepens our understanding of race in the Indian colonial context by demonstrating the lengths to which Company and later Government officials went to preserve the illusion of white psychological autonomy. Ernst's 1996 article on "European Madness and Gender in Nineteenth-Century British India" expands her scope by examining the intersection of sex and madness in the colonial setting. (25 ) Here Ernst takes issue with literary critic Elaine Showalter's assertion that madness had become a "female malady" during the nineteenth century in Britain, (26) and argues that this notion is entirely invalid for British India. Ernst agrees that one could find in the history of insanity in India "evidence of... men's domination of women, set within the wider context of the oppression of the colonized by the colonizers." But she argues that viewing this interpretation as dominant obscures the subtleties of nineteenth-century psychiatry both in India and in the Metropole. Moreover, Ernst notes, a careful consideration of the evidence suggests that this interpretation is largely implausible. (27)

Psychiatric nosology in nineteenth-century India certainly took gender into account. For example, case histories often place the etiology of women's madness in a failure to fulfill the social roles of the memsahib, and psychiatrists often found that men went mad when they failed to meet military standards for discipline. But, Ernst argues, psychiatrists never considered madness the province of any particular sex. Even if they often described men's symptoms as coextensive with nineteenth-century understandings of femininity, there is no proof that psychiatrists or public opinion ever considered male insanity as a manifestation of femininity. The male insane were therefore no more "feminized" than women alcoholics were "masculinized" for their behavior. Even therapy paid less attention to gender than to factors like class and educational background. And although Ernst concludes that historians must account for gender, it is "myopic" to employ gender to the exclusion of other factors in the history of insanity, in Britain or in India. (28)

Ernst is right to criticize those who ignore crucial factors like race, class, and ethnicity in examining gender as the sole social category relevant to the history of madness. Yet there are significant problems with Ernst's argument. She often conflates gender with sex: at times she discusses femininity and masculinity, while at others she discusses asylum statistics on the numbers of male and female patients. Ernst asserts that according to statistics, insanity could not possibly have been a female malady in British India, because the only "face of European madness during the raj [was] the physiognomy of a stereotypically male mad-person." This argument is overly facile. Certainly, numbers in a society as statistically skewed as the British community in India privilege the male population. But this does not mean that images of mad Englishwomen--which Ernst argues belong to "accounts of Romantic exoticism" rather than the historical record--remain historically unimportant. (29) Instead, just as Ernst has not ed that discourses about insanity reached far beyond statistical "truth" in discussions of class and race in colonial India, she needs to consider that discourses about gender might have done the same. Cases of insane women were few and far between, but statistically speaking so were cases of insane European men in India. A relative statistical unimportance does not mean that "mad tales" of deranged English roses in the Raj had no cultural significance in nineteenth-century British India.

Ernst offers an intriguing reason why Europeans in India never considered madness within their community to be a "female" malady. This could have been "an implicit imperialist strategy" that aimed "towards conceptual homogenization and the creation of 'imagined communities'" that contrasted "gentlemanly colonial power" to a "feminine Orient." Following this hypothesis, gender profoundly informed ideas about racial difference in colonial India, and safeguarding imperial power meant maintaining the integrity of that gendered difference. To employ gendered terminology to describe differences of psychological health or illness in such a context--ostensibly to label male psychopaths "feminine"--could erode a system of political inequality that relied on a gendered division of power that preserved authority for "manly Englishmen" and disenfranchised "effeminate" natives. Here Ernst suggests strong parallels with extra-medical spheres of imperial rule. Her analysis echoes Mrinalini Sinha's argument that British auth orities responded to middle-class Bengalis' threats of political subversion by portraying them as effeminate--and therefore politically marginal--figures. (30) Yet the problem with Ernst's suggestion is that she never follows through on her argument. By ignoring some of the broader contexts of British psychiatry in India, Ernst never addresses the crucial political developments where the gendering of authority became paramount, and where psychiatry might have offered significant contributions to a project of political disenfranchisement.

The result is that Ernst's works leave crucial questions unanswered. Was the British psychiatric network in India really a fait accompli by 1858? Did the shock of the Mutiny, which precipitated so many drastic shifts in colonial policy, also encourage the study of "indigenous mentalities"? How did developments like the foundation of the Indian National Congress alter colonial psychiatrists' perspective, if any? Despite the overall very high quality of her research, the fact that Ernst limits her scope to European psychopaths is regrettable. In any colonial situation, the interaction between colonizer and colonized defines the fundamental social context, and psychiatry is no exception. But aside from a few notes about early British ethnopsychiatry, Ernst unfortunately relates little detail here. She tells us that psychiatrists thought that Europeans could never overcome the climatic difficulties of life in the Raj, and that Indians were intellectually inferior and developmentally arrested compared to Europeans . She also emphasizes the inherent contradictions in British theory about Indian psychology. According to mid-nineteenth-century psychiatric discourse, pathology marched in step with civilization, but at the same time "primitive Orientals"--who accordingly should have been protected from madness--were a fundamentally insane race. But unfortunately for her readers, Ernst never addresses the ways this politically expedient discourse may have changed along with an advancing independence movement.

Readers are forced to turn to other sources for clues about psychiatric developments in this period. Although they address psychoanalysis rather than psychiatry, Christiane Hartnack and Ashis Nandy have produced important works that examine the political implications of the psycho-sciences in the context of the independence struggle. Both authors concentrate on the first Indian psychoanalyst, Girindrasekhar Bose, who founded the Indian Psychoanalytical Society in 1922. Hartnack argues in her article "Vishnu on Freud's Desk: Psychoanalysis in Colonial India" that in contrast to Freudian assertions of the universality of psychoanalysis, "Indian psychoanalysts affirmed their cultural particularity" in response to the psychological conditions of colonial politics and society. Psychoanalysts merged Freudian theory with Hindu conceptualizations to forge an alternative to the prescribed identity of the middle-class educated Babu. Hartnack outlines the radical revisions Bose and his colleagues brought to key Freudian concepts and ties them to the context of civil disobedience against British rule. For example, Bose reversed the Oedipal complex to have the son castrate the father rather than submit to his authority. This revision is startling given the rigidly patriarchal structure of much of Indian society. Yet Bose's inversion of Oedipus makes sense given its political context, as it suggests an unconscious desire to lash out against the continued paternalism of British rule. According to Hartnack, the colonial predicament explains why Indian psychoanalysis differed so much from Freudian orthodoxy. Although Indian practitioners diverged in their psychological portraits of colonizer and colonized, they clung to their religious identities and embraced the social differences forced on them by colonialism, upsetting Freud's efforts to found a universal science liberated from cultural prejudices. (31)

Ashis Nandy's essay on "The Savage Freud: The First Non-Western Psychoanalyst and the Politics of Secret Selves in Colonial India" expands Harrnack's investigation. (32) Nandy begins by questioning why psychoanalysis has suffered such an ambiguous fate in twentieth-century India. He responds with a careful examination of psychoanalytic culture in India at the moment of its inception. Focusing on a close reading of Bose in the context of Freud, Jung, and classical Hindu texts, his intellectual history of psychoanalysis in India confirms Hartnack's argument that Indian analysts sought to merge Freudian and traditional Hindu philosophies to open a new path to social criticism as well as treatment of the mentally ill. But, Nandy goes on to argue, the circumstances that led to such an easy acceptance of psychoanalysis in India--a lack of controversy over its concern with sexuality, the strength of Bose's personality, and the embracing of the discipline by a small minority of educated Bengali Hindus--effectively ha ndicapped the discipline after its initial wave of success. Bose published in both Bengali and English, but it was in his Bengali writings that he "used Indian cultural categories to domesticate psychoanalysis for Indians." Nandy revises Hartnack's thesis by asserting that although these latter papers were successful in influencing a cultural tradition in Bengal, Bose's generally apolitical stance kept psychoanalysis confined to the level of intellectual (and not political) criticism of Indian tradition and colonialism. (33)

Both Nandy and Hartnack refer to the psychiatric culture in which figures like Bose operated, and therefore provide clues about the trajectory of British psychiatry in India after the Mutiny. Hartnack, for example, notes that British psychoanalyst Owen Berkeley-Hill treated European patients almost exclusively, although in his publications he "made Indians the object of [his] psychoanalytical reflections." (34) And Nandy demonstrates how racism informed psychiatrists' perspectives on Indians. Berkeley-Hill's work, for example, contrasts British character traits like "individualism, determination, land] persistence" with Hindu attributes like an "incapacity for happiness," "irritability and bad temper," "slowmindedness," and a "bent for tyrannising and dictating and obstinacy." (35) But neither author engages with British psychiatry in India directly. As a result, Nandy and Hartnack ignore the social consequences of ideas, as they never address the effects of a discourse about an "Indian mind" that emerged fro m a psychiatric tradition or the realities of psychiatric practice in early twentieth-century India. In the Indian context, then, the few available studies suggest that in the late nineteenth and early twentieth centuries colonial psycho-sciences turned toward the "indigenous mind." Indian practitioners like Bose presaged Fanon by examining the psychological pressures of colonialism, and British doctors turned from distinguishing among Europeans to producing psychological distinctions between Europeans and Indians. Bose's history of contesting Freud, and earlier clinicians' diversions from European practices disrupt Eurocentric narratives of the history of the psycho-sciences. And these histories show that by the twentieth century British psychiatrists who worked in the state's service had begun to correlate knowledge and power in a new context--that of colonial domination. But scholarship on British psychiatry in twentieth-century India is so limited as to rule out definitive claims. The situation is differe nt for diverse African contexts, where an expanding historical literature develops each of these points by demonstrating how ethnopsychiatric knowledge changed along with the dynamics of colonialism in the twentieth century.

The British and French colonization of North and sub-Saharan Africa follows several temporal trajectories. But there is a consistency in the development of networks for psychiatric assistance. Across the continent--and unlike the Indian case--the establishment of psychiatric institutions followed colonization by a long interval. The Abbasieh asylum neat Cairo opened at the turn of the twentieth century, the first British institutions in sub-Saharan Africa appeared in the 1910s, the French hospitals in North Africa broke ground only in the 1920s, and the Fann Psychiatric Clinic in Dakar scarcely preceded decolonization. Many factors account for these delays. In sub-Saharan Africa, tropical diseases represented a much more immediate threat than mental illness, and therefore colonial authorities found epidemic health care and vaccinations more pressing than psychotherapy. Economic considerations also played an important role. No equivalent of the British East India Company provided private financing for hospital s, and beleaguered administrations often followed a laissez-faire policy for both indigenous and European populations. In indigenous communities throughout Africa, harmless fous were left to their own devices (usually under family or communal care), and authorities often confined dangerous alienes in prisons. As for Europeans, the wealthy sought private care either in the colonies or in the Metropole, and poor whites usually suffered the same neglect as natives. In extreme cases, French authorities transported violent European and indigenous patients to asylums in southern France. (36)

A European psychiatric presence was therefore largely absent in most of Africa during the nineteenth century. But when British and French colonial authorities finally dedicated resources to the establishment of local institutions for mental health care in the early twentieth century, the resulting facilities differed considerably from nineteenth-century Indian asylums. Even considering that the majority of Indian asylums confined Indian patients, the existence of facilities for the exclusive confinement of Europeans suggests that psychiatrists were preoccupied with studying British psychopathology in India. Recent scholarship suggests drastic differences for the African cases. From Algiers to Lagos, from Mombasa to Cape Town, psychiatrists, colonial administrators, and settlers focused their concerns about madness on indigenous rather than European populations. Officials fretted about how to define insanity in an alien culture, and psychiatrists from both British and French schools published widely on "indige nous psychopathology" and the political and social implications of "the African mind." These doctors also cared for European patients, but their preoccupation was the identification and classification of madness in Africans. Although the first studies of African mentalities date from the mid-nineteenth century, then, the inauguration of psychiatric institutions that functioned as virtual laboratories for documenting madness across cultures began a period of officially sanctioned ethnopsychiatric inquiry. Geographic and cultural differences between Africans and Indians, significant administrative variations, and developments in biological psychology and anthropology account for this shift. But historians also suggest that political developments were paramount. Increasingly voluble independence movements that called attention to inconsistencies in colonial rule provoked investigations into indigenous psychology. Studies of African colonial psychiatry therefore open a window on the psychology of colonialism by p ointing to incongruities between the realities of colonialism and medical imperatives.

Historians Megan Vaughan, Jock McCulloch, and Jonathan Sadowsky emphasize common themes in the history of British psychiatry in sub-Saharan Africa. Defining a specifically "African" insanity fascinated psychiatrists in Nyasaland, Nigeria, Rhodesia, and British East Africa. But the problem of defining insanity across radically different cultures beset public officials as well as physicians. Judges and police, among others, struggled to distinguish madness from merely aberrant or criminal behavior as a means of administering colonial societies. These historians also suggest that psychiatric knowledge found a political outlet in a number of important cases throughout the twentieth century. Doctors and administrators often described acts of political defiance as manifestations of mass insanity. Finally, these scholars emphasize the failure of European methods to cure local mental illnesses. Whereas psychiatrists in India treated their European patients somewhat effectively by importing European methods, subsequen t efforts to transfer a technology for managing insanity to Africa met with miserable failure, as insufficient resources and cultural misunderstanding impeded any program for healing African patients.

As Foucault argues, the transition to modernity brought the dialogue between sanity and madness to a standstill, and the power of reason thereafter identified, categorized, and dominated the irrational "other" within European society. Megan Vaughan finds significant contextual differences for this dialogue in Nyasaland in Curing Their Ills: Colonial Power and African Illness. European medicine may have "played an important part in constructing 'the African' as an object of knowledge, and elaborated classification systems and practices which have to be seen as intrinsic to the operation of colonial power." At the same time, colonial administrations operated through direct subjugation and active domination rather than through the "productive power" that Foucault dissected in modern European societies. While liberal democracies rely on individual self-policing inscribed through educational, medical, and judicial discourses, colonial societies actively police their subjects through direct repression of political, criminal, and antisocial behavior. A medical definition of the "other" thus mattered far less to the operation of colonial regimes than it did to modern European states, as racial difference provided a clear social fault line. Finally, as colonial administrators were more concerned with group identities than individuals, medical knowledge emphasized the definition of "normal" rather than pathological Africans. (37)

This was especially the case with psychiatric investigations of "the African mind," where linguistic and cultural differences accounted for profound misunderstandings. An issue like witchcraft confounded distinctions between normality and pathology, with important legal implications. How could British authorities effectively distinguish "alien" habits from true insanity? Were those who accused others of casting spells criminals who perpetuated superstitions in defiance of the law? Or were they mad, deserving psychiatric treatment rather than judicial punishment? (38) In practice, the distinction made little difference: those deemed insane were unlikely to be confined in an institution unless they were criminally violent. One of Vaughan's most intriguing points is that the British understanding of the etiology of madness led officials to consider the insane of lesser importance than "normal" Africans. Most theorists about African madness felt that civilization itself brought psychic disturbances to "deculturat ed" Africans who were unprepared for rapid progress. The highest proportion of psychiatric patients belonged to the intelligentsia (who had the closest contact with Europeans), and sexual dysfunction followed the introduction of clothing to certain tribes. In contrast, those who remained in traditional situations showed a low incidence of insanity, according to physicians like J. C. Carothers, who founded an East African psychiatric "School" in the 1930s. Carothers found that traditional cultures "relieved individuals of responsibility," but that depressive patients tended to be wracked by guilt: clear evidence that civilization facilitated madness.

Vaughan's crucial point is that the "deculturated" mad (as opposed to those suffering from witchcraft delusions) were not "Other," in the traditional sense of reason's perspective on insanity. Instead, they were "insufficiently 'Other'": deculturation made pathological Africans not different, but rather not different enough to warrant attention. Instead, British authorities and psychiatrists concerned themselves with "normal" African mentalities, the defining "Other" of the colonial situation. Even though these "normal" African subjects exhibited "symptoms" that suggested parallels with the European insane--superstition, primitive beliefs, an incapacity for abstract rational thought--they did not fit a European concept that considered only those alienated from their own culture legitimately insane. Those who were alienated--the "deculturated"--were studied carefully and used to support arguments against bringing the benefits to civilization to Africans. But these "deculturated" figures did not fit into a soci al composition in the same way as the European insane did in the classical era. As a consequence, psychiatric treatment amounted to little more than confinement in brutal institutions, administered as prison annexes. (39)

Vaughan's brief account outlines some of the major issues at stake in psychiatric theory and practice not only in Nyasaland, but throughout British sub-Saharan Africa. Jock McCulloch's Colonial Psychiatry and "the African Mind" explores many of the same personalities and concerns introduced in Vaughan's analysis. Like Vaughan, McCulloch makes British discourse about the normal African mind his central focus, he laments the silence of African voices about the topic, and he draws on archival sources in addition to medical publications to support his account. But the luxury of space allows McCulloch expand his analysis to include psychiatric ventures throughout the continent, and to account for the specific ways European mental medicine changed scientific parameters to produce an inferior African through the mind, rather than the body. Where he falters is in his attempt to provide a comprehensive account of both British and French efforts to capture the "African mind" through scientific investigation, and in the problematic parallels he consequently draws between fundamentally different contexts.

The best elements of McCulloch's analysis are his detailed examinations of the British asylums at Ingutsheni in Southern Rhodesia and Mathari in British East Africa. McCulloch's arguments correspond to Ernst's about the limitations of asylums as institutions of social control. As these institutions confined relatively few people, McCulloch asserts that their purpose was less to preserve social order than it was to serve three political functions. First, like their metropolitan counterparts, colonial asylums empowered physicians by giving medicine free and exclusive reign over madness. Second, these institutions provided settler communities with a location for "dumping" their own insane relatives as well as for "disposing of dangerous African employees." Finally, they offered "evidence of the civic virtue of settler societies," proving the ultimately philanthropic nature of colonialism through their symbolic value. (40)

Reports conserved in the Kenyan and Zimbabwean National Archives indicate that British African asylums were extremely basic institutions, with no specialist facilities, and little or no capacity for treating patients' physical illnesses. This did not slow their operation, however, and staff carried out psychosurgeries and electro-convulsive therapies routinely in abysmally septic conditions. European patients in these institutions tended to be alcoholics--a scourge of settler communities--whom conventional hospitals were unwilling to handle. But the majority of patients treated in asylums were Africans who found the psychological transition from a rural agricultural tradition to urban wage labor insurmountable. McCulloch argues that the British ethnopsychiatrists (who were themselves largely drawn from settler society) "were watching a world being born," where uprooted (or "deculturated") subjects were set loose from a grounding tradition into an advancing civilization. Although doctors like Carothers and Rob ert Cunynham Brown noted in their surveys of Nigerian institutions that proximity to the colonial administration--more than any natural predisposition to insanity--accounted for the social makeup of asylum populations, this awareness did not hinder these same individuals from developing theories about African insanity based on this limited population sample.

Because of the political importance of his prolific writings on "the African mind," Carothers rapidly became the most important authority in Anglophone circles on the topic. His work is emblematic of an entire generation of ethnopsychiatric thought. Both his WHO treatise on The African Mind in Health and Disease of 1953 and his 1954 report for the British East African government on The Psychology of Mau Mau referred to biological and cultural factors that determined normal African psychology. Carothers noted similarities between published accounts of leucotomized Europeans and his own observations of African patients at Mathari, and this led him to conclude that inferior development (or at least employment) of the brain's frontal lobes was common in Africans. He also proffered cultural theories for African inferiority that modernized obsolete physiological determinants by demonstrating how African cultural phenomena reinforced racial inferiority. "[I]ntellectual and social impoverishment" stunted the African child's development, and a poor capacity for individuation preserved "the African's" mind in a childlike state. And while education could change some environmental stimuli for Africans, African culture, according to Carothers, remained nearly as fixed as race: this culture was tied so closely "physical setting and genetic disposition" that it trapped cognitive development effectively enough to render British civilizing efforts futile. Theories like these justified settlers' projections of their own violent tendencies onto Africans (one of McCulloch's more controversial points), and pointed to the unsuitability of the African temperament for political leadership. (Expensive) education was harmful for Africans, psychiatrists argued, and democratic institutions would be impossible given the African "inability to accept responsibility ... [and] predisposition to mental illness." (41)

McCulloch's most important conclusion is that ethnopsychiatrists, governments, and settler societies alike attributed indigenous political protests more to psychological impulsiveness than to any legitimate claim for enfranchisement. Strong archival and published sources support such claims about British psychiatric endeavors in Africa and McCulloch's assertions about British theories of an "African mind." His extension of these claims to the French colonial domain, however, is far more problematic. A penchant for sweeping assertions based on limited evidence is the greatest weakness of McCulloch's study; (42) consequently, McCulloch's strongest claims about colonial and metropolitan psychiatry often miss the mark. McCulloch argues, for example, that Fanon was the first psychiatrist to be familiar with both Francophone and Anglophone literatures on "the African mind," although French psychiatrists cited English-language publications extensively in articles as early as 1912. Asserting the isolation of African ethnopsychiatrists, McCulloch disregards the importance of publications like Maroc Medical, Turnisie Medicale, and Algerie Medicale, where French practitioners published widely, and also neglects the fact that the French psychiatric establishment chose North African locations for its annual congresses of 1912, 1933, and 1938. He argues that ethnopsychiatrists "ignored the ways in which colonial contact had reshaped African societies," which defies his earlier arguments that figures like Carothers and J.F. Ritchie were deeply concerned about the impact of European civilizing efforts on "primitive" cultures (138). He tells us that "Black wage laborers and urban dwellers formed the majority of the inmates at Blida" (144), but earlier discusses the "landless peasants who formed the bulk of [Fanon's] patients at Blida" (135). Finally, his chapter on "contemporary reviews of colonial mental health systems" ultimately reads as an apologia for colonial psychiatry's abuses, arguing that although patients received no e ffective treatment, they were never subjected to "brutal or arbitrary violence," and those admitted to colonial asylums "received food and shelter" (37). Yet here again McCulloch ignores his own evidence: he indicates earlier that psychiatric inmates were fed and housed in institutions where they served as test subjects for experimental therapies. Is there any more "brutal or arbitrary violence" than the use of electro-convulsive therapy for tubercular or tertiary syphilitic patients, which he describes as commonplace? (38) For all his emphasis on medical racism, McCulloch apparently refuses to engage with other crucial ethical issues at hand.

McCulloch's tendency towards oversimplification also obscures important distinctions between the British and French psychiatric traditions. In Britain, for example, psychiatry may have been the "backwater" he calls it; but in France, psychiatry was at the forefront of the medical profession from the nineteenth century onward. (43) McCulloch also never accounts for important postwar developments in French West Africa, where Henri Collomb founded the journal Psychopathologie Africaine, and the ethnographers Marie-Cecile and Edmond Ortigues produced their 1966 study Oedipe Africaine. (44) Beyond these issues, McCulloch's failure to examine the French secondary literature leads to far more dangerous oversights. His most interesting observations about Fanon's attacks on theories of African inferiority and Eurocentric psychotherapy are not as original as they appear to Anglophone readers, as Robert Berthelier's L'Homme maghrebin dans la Litterature psychiatrique -- published a year before McCulloch's book -- discus ses the same subject through an examination of the same sources. (45) Readers seeking an original and more accurate treatment of French psychiatry in Africa would therefore do well to seek other accounts that illustrate the differences between British and French contexts.

Jonathan Sadowsky's Imperial Bedlam: Insitutions of Madness in Colonial Southwest Nigeria is much stronger than McCulloch's study for several reasons. Sadowsky limits his scope to one region, allowing him to explore the functioning of just two institutions--the Yaba and Aro asylums in Nigeria--in detail. Sadowsky's sources also distinguish his work. Sadowsky relies largely on British and African archival documents, but his investigation probes more deeply than the others because he gained valuable access to patient case files, allowing him to conduct a social history of madness in colonial Nigeria. Where other historians lament the silence of indigenous voices, Sadowsky cites them, and focuses on the content of madness in the colonial context--that is, the political implications of specific manifestations of mental illness in colonized patients. Finally, his familiarity with the crucial issues at stake in contemporary cross-cultural psychiatry enrich his accounts of postcolonial psychiatric reforms in Nigeria . (46)

By the end of the nineteenth century, the British colonial press lamented the problem of mad Nigerians roaming the streets of Lagos, and called upon authorities simultaneously to preserve public order and to take pity on deranged Africans. A lunatic ward at the Lagos prison became quickly overcrowded, and as public madness became more visible by the early twentieth century (with an increasing British presence in the colony), officials passed a lunacy ordinance in 1906 stipulating the construction of specialized institutions for confining the insane. As Sadowsky argues, however, these institutions that were "[c]reated in response to the scandal of untreated lunatics on the streets... themselves became enduring scandals of the colonial period." (47) Until the 1950s, Nigeria's colonial prisons and asylums were "functionally equivalent." Sadowsky focuses on the Yaba asylum in Lagos, where psychiatric patients received no treatment and lived in dank cells with only rudimentary facilities for hygiene and medical ca re--indeed, in worse conditions than convicts. Rampant overcrowding and restricted public health budgets limited institutional efficacy, and for most of the colonial period there was no psychiatrist on the state payroll.

Sadowsky ascribes these poor conditions to a paradox of Britain's "Indirect Rule" in Nigeria, which promised the exploitation of economic resources by the British, and the civilizing of Nigerians with minimal intervention in local traditions. Like other scholars, Sadowsky notes that despite egregious conditions asylums symbolized the civilizing mission. But just as "[t]he expense of a truly modern asylum... was incompatible with the economic goals of colonialism," a policy of "financial restraint was justified by the goal of preserving the African way of life." Before the 1930s, officials argued that to reform the rudimentary system of confining dangerous lunatics would impose European standards on native customs. Additionally, official rhetoric about cultural differences was conveniently ambiguous. Although administrators admitted that they could recognize madness--and therefore social danger--in Africans, they felt that racial and cultural difference made it impossible for them to cure these patients, so th ey urged cost-effective confinement over expensive treatment. By the 1930s, when colonial officials realized the necessity of improving conditions at Yaba, such reforms had become fiscally impossible. (48)

Sadowsky's emphasis on the social history of the Yaba asylum is the most novel aspect of his study. In attempting to understand how British colonials defined madness among Nigerians, Sadowsky pays close attention to those whom they confined. Most patients at Yaba were Africans, and these patients tended to be urban wage laborers rather than peasants. Contrary to the British officials who constructed theories based on such statistics, Sadowsky is careful to note that inmates' occupations "tell us more about the institutions and which lunatics they housed than they do about lunatics generally." He makes the same observation about sex-statistics. Men outnumbered women three to one in British colonial asylums, but again this is more "an artifact of treatment patterns ... than a reflection of the 'true' prevalence of mental illness." Asylums like Yaba housed "unambiguous cases"--those whose clearly erratic behavior made them potential public dangers--and they also confined those who came into closest contact with authorities. Therefore male, urban, insane criminals comprised the majority of patients. Patients admitted to Yaba found it difficult to be released from the asylum, where the staff aimed at reducing patients to harmlessness rather than nursing them to mental health. (49)

Sadowsky's concern with the content of colonial madness marks another new direction for the historiography of colonial psychiatry. He notes that the British appear to have confined patients not because their behavior was "anomalous or deviant" but instead "because they drew attention to structures of power in ways which denaturalized those structures." These patients' disorders allowed them to speak what other Nigerians only thought. Many patients confined at Yaba, for example, suffered from what psychiatrists called "persecutory delusions," a diagnosis that Sadowsky notes "was overdetermined by the persecutory nature of colonialism itself." Sadowsky cites a number of cases to support this point, including those of patients who "refuse[d] food ... provided by the British government" and who claimed that local officials had authorized murders. The most intriguing of these is the case of Isaac O., to which Sadowsky devotes an entire chapter. A nineteen-year-old missionary student at the time of his first confin ement in 1932, Isaac claimed "that he would kill all the Europeans in Nigeria," posed as a colonial official in order to solicit help from villagers while he carried loads on a highway, and claimed that he had "purchased a motor car for a million pounds." Isaac's delusions drew attention to his position between cultures. His violent sentiments toward Europeans demonstrated his resentment at the hollow promises of a colonial education, while his other claims "appropriated" symbols of British dominance: military power, automotive technology, and capital. (50)

Of course, Sadowsky admits, it would be a mistake to conflate madness with anticolonial resistance. But the "content" of madness "demands attention; without it the patient is decontextualized, and the social dimension of affliction is obscured." Even if we cannot interpret delusions and confinement as manifestations of resistance and oppression, they "have significance as a gauge and representation of social pressures and contradictions" in a moment when Nigerians increasingly realized just how limited their opportunities under colonialism were. Sadowsky follows Fanon, concluding that "as inchoate articulations of the stresses of colonial society" the "'symptoms' of Nigeria's lunatics and the psychiatric labels that were affixed" deepen our understanding of the psychology of colonialism. And the psychiatric literature that medical theorists produced about indigenous madness informs us about the psychological predicaments of colonialism for the colonizers as well as the colonized. Sadowsky argues in his conclu ding chapter that although the Nigerian psychiatric literature is generally more liberal than other colonial literature on madness, knowledge produced in the colonial context could not escape the prejudices of that milieu. Practitioners in Nigeria "viewed Africans as representatives of a race, rather than as individual patients," with the result that they described Africans' "innate character" without examining British policies that provoked trauma by transforming the social landscape. (51)

Sadowsky's close readings of case files and his account of Nigerian psychiatry's transition to independence are Imperial Bedlam's greatest strengths. His innovative interpretations of insanity's content demonstrate the usefulness of psychiatric history for understanding colonialism's hold over emotional as well as material domains, and his examination of the Nigerian psychiatrist T. A. Lambo's reform programs in the 1950s draw surprising parallels between postcolonial theories of liberation and psychiatric developments. For Sadowsky, Lambo's rapprochement of psychiatry and local traditions brought to mental patients a liberation concomitant with Nigeria's independence. The British-trained Lambo rejected notions of European superiority by hiring regional traditional healers at the Aro hospital to assist in treatment and interpretation of mental illness. Lambo also established a community outreach program that installed recuperable patients with local families on a work exchange program. This innovative service reduced the hospital's heavy case load, helped patients adapt to extrainstitutional environments, and gave villagers access to hospital financing for housing and infrastructure. The programs were so successful that the UN produced a film about Aro, and the hospital served as a model for other African mental health systems. Sadowsky notes the inappropriateness of a Whiggish narrative of progress in both postcolonial and psychiatric history, given the persistence of authoritarianism and poverty in much of Africa and the revelations of antipsychiatric literature. But ignoring the political origins of individual cases of progress is also a grave mistake: the "Nigerianization of psychiatric institutions provides an example of the creative energy for which independence provided greater scope.... [I]t provided more opportunity for Nigerian physicians to use their expertise publicly [and] represented ... a collapse in the basic logic of colonialism itself." (52)

The many strengths of Sadowsky's study incompletely conceal the very few weaknesses. The book is perhaps too concise. Readers may long for more detail about the political origins of British asylums and debates over patient care before the 1950s, and Sadowsky's assertion that anticolonial activists protested "double standards in the colonial medical services" remains undeveloped. More seriously, some of Sadowsky's assumptions about colonial psychopathology--like Vaughan's and McCulloch's--are questionable. By asserting that "colonial policies were generating the social changes which were altering epidemiological patterns" among Nigerians, Sadowsky grants a certain truth to psychiatrists' theories about deculturation, where he could problematize them. Certainly the colonial environment, where "civilizing" rhetoric raised expectations that realities failed to meet, and where individuals seeking opportunity found themselves alienated from both local and British communities, provoked significant trauma. But even t hough patients' utterances reflected colonial dynamics, these dynamics may not be the root of madness. This is also inconsistent with Sadowsky's argument that it is "crude to say that colonialism caused madness," although "it brought about specifically colonial pathologies." (53) But these few issues should not detract from a work that serves as a model for scholars of colonial psychiatry through the richness of its narrative, its balanced treatment of its historical problem, and the innovations that Sadowsky brings to both the history of psychiatry and colonial studies.

Although they vary widely in scope and quality, Vaughan's, McCulloch's, and Sadowsky's studies point to important shared factors in the history of colonial psychiatry. The importance of racial difference to colonial psychiatric theory and practice means that the dominant accounts of psychiatric history fail to explain African developments. There was no "Great Confinement" in British Africa, despite the obviously political abuses of psychiatric internment, and psychiatry's capacity for social control across cultures was greatly limited by cultural misunderstandings. Each of these authors argues that despite psychiatrists' investment in the idea of an "African mind," and the currency of this idea among settler populations, such sterile notions hindered the production of knowledge instead of facilitating it. And debates over deculturation in Nyasaland, East Africa, Rhodesia, and Nigeria encouraged colonizers and colonized alike to question the merits of a civilizing mission that appeared to produce pathology, a central notion for Fanon. But Fanon emerged from an entirely different context. How can studies on French North Africa--whose specific problems produced one of the twentieth century's most important revolutionary and psychiatric theorists--contribute to debates about psychiatry's role in colonialism, and to our understanding of how colonialism affected modern psychiatry?

The French conquered Algiers in 1830. In 1838, France passed a law mandating the internment of lunatics at public expense in every French department. But it was only in 1938 that the Algerian government officially inaugurated the Hopital Psychiatrique de Blida, which served both the European and indigenous communities in the Algerian departments of Algiers, Constantine, and Oran. The French established other colonial institutions--in Tunisia, Morocco, Madagascar, and Indochina--but Blida, if only through its association with Antoine Porot and Frantz Fanon, remains paradigmatic. Histories of French colonial psychiatry have therefore focused on Algeria almost to the exclusion of other locations. Interestingly, the political currency of therapeutic issues in transcultural psychiatry means that most of these histories have been written by practicing psychiatrists, with the result that while they present much important information, some crucial issues of interest to historians remain unclear in these accounts.

French psychiatry's preoccupation with Algerians and Algeria's privileged position within the French colonial order are the chief reasons Algerian-born Jean-Michel Begue offers for Blida's importance in his thesis on "Un siecle de psychiatrie francaise en Algerie (1830-1939)." (54) Focusing on papers published between 1843 and the Second World War by both metropolitan and colonial psychiatrists, Begue's study sets the French mission in Algeria apart from its British counterparts in Africa and Asia. Whereas authorities in British India repatriated the European insane both to cure and to preserve the image of white superiority, the French went a step further. A lack of local facilities, combined with the civilizing imperative inherent in French colonialism, forced French authorities to transport both European and indigenous lunatics to French asylums. Algerian departmental prefects therefore signed contracts with asylums in southern France for their patients' treatment at Algerian expense. But changes in food, climate, clothing, language, and culture, combined with isolation and distance from loved ones made metropolitan internment extremely hostile for Algerian patients. In his report on "L'Assistance des alienes aux colonies" at the 1912 Congress of French and Francophone Alienists and Neurologists in Tunis, French psychiatrist Emmanuel Regis condemned the political obstacles to meaningful assistance for the Algerian insane, and argued that continued transportation of lunatics itself constituted a pathogen. The cure rate for North African Muslims hovered around five percent, compared to thirty percent for French patients, and in 1873, a psychiatrist from the Aix asylum had reported that the average annual mortality rate for Muslim patients was forty-nine percent, compared to thirteen to fourteen percent for Europeans. (55) Algerian officials responded by commissioning studies, but the outbreak of war in 1914 delayed construction and Blida only opened two pavilions in 1933, when metropolitan institutions categoric ally refused admission to North African patients.

After sketching the development of a psychiatric assistance network in Algeria, Begue moves on to his central preoccupation, "comparative Algerian psychiatry." He divides the century from French conquest to the outbreak of the Second World War into two distinct periods for Algerian psychiatry: 1830-1912, when mostly metropolitan psychiatrists described the "Muslim mentality," and the period from the Tunis Congress to 1939, which witnessed the development of the Ecole d'Alger under the direction of Antoine Porot at the Faculty of Medicine in Algiers. Theorists in the first period included travelers, military physicians, and alienists who examined Algerian lunatics and collectively found them less prone to madness than civilized Europeans. More content with his place in life, the male North African Muslim only went mad through an excess of religious fervor or the influence of hashish. The Oriental mentality was the obverse of the Occidental mentality: a lack of ambition and initiative among natives protected th em from civilization's threats of madness. And the relative rarity of female Muslim psychopaths--which resulted from the selective internment of violent males and many North Africans' reluctance to submit women to medical authorities--encouraged these theories. Women's seclusion from education and intoxicants, psychiatrists argued, sheltered them from the psychological burdens of civilization. Importantly, some prewar observers also noted other interesting commonplaces among Maghrebi patients--especially a tendency toward violence.

These observations set the tone for the development of Porot's Algiers School of psychiatry. Like other ethnopsychiatrists, Porot's obligation to treat the indigenous insane led him to question the mentality of "normal" Algerians, resulting in standard racist and paternalistic conclusions. Based on his observations of Algerian tirailleurs in the French army, Porot noted that the Algerian had no concern for the future and was intellectually childish, but with none of the child's natural curiosity or other good traits. Moreover, the Muslim lunatic showed none of the "mobile and polymorphous, at times rich psychoplasticity of the civilized man and the European." Porot reflects the tendencies of the British ethnopsychiatrists in Vaughan's analysis who concluded that the native was "normally abnormal." Despite Porot's efforts to present clear definitions of normal and pathological mentalities, Begue notes (emphatically) that Porot produced an "even greater confusion between the normal and pathological stares of th e indigene, as the normal indigene appears to have a pathological mentality!" (56)

After the Algiers faculte instituted psychiatric instruction in 1925, Porot's observations defined his teachings, and his students produced theses and articles that clearly articulated theories about Algerian mentalities. Algerians were not only ordinarily pathological, but were also born criminals, according to Don Come Arrii, who argued that the civilizing mission needed to preserve public order from indigenous criminality. Another Porot student, Jean Sutter, focused on primitivism. Algerians were more evolved than Central Africans, he argued, but primitive tendencies accounted for Muslims' fatalism, inactivity, and ineptitude. Like Carothers, Sutter, Arrii, and Porot considered both cultural and racial factors in the production of the Algerian mentality, and their conclusions tended toward an irrevocable rift between the mental systems of the North African and the European. Constant references to Lucien Levy-Bruhl and Charles Blondel underscored their pronouncement of the Algerian as "psychically entirely other." (57)

Despite the efforts of figures like the Arabic-speaking Suzanne Taieb, who combined fieldwork among Tunisian women in hammams with psychiatric observations to argue that North Africans were "different" rather than "inferior," (58) the Algiers School remained hegemonic. Begue therefore describes "ethnopsychiatric knowledge" as a discipline that is "like ethnology, the daughter of colonization." Yet Begue's ultimate goal is to apply the lessons of history to present-day therapeutic ends. Begue warns that the Algiers School's emphasis on physical racial differences could manifest itself in new biological typologies. Could we be so far off, he asks, from notions of "indigenous serotonin?" Modern transcultural psychiatry, he concludes, must "interrogate ... metaphors that, in principle, refer to the same issues that upheld Algerian psychiatry a century ago." (59)

Begue's thesis is ultimately more important as a warning about the dangers of racism for contemporary therapeutic practice than as a historical study. As the first sustained investigation of French psychiatry in Algeria, his work has strong historiographical value, but a reliance on published medical sources and an absence of political or social context compromises his account. The same problems are evident in Robert Berthelier's L'Homme maghrebin dans la litterature psychiatrique. Berthelier addresses the same sources as Begue in an effort to "try to sketch ... a history of received ideas" rather than to document "the gaze of the other and the mysteries of institutional origins." (60) The result is a book that in many ways merely replicates Begue's study of Algerian comparative psychiatry and expands its chronological scope. Yet Berthelier also introduces thoughtful questions relating to psychiatric discourse during the Algerian war and its aftermath that make L'Homme maghrebin valuable for historians despit e its limitations.

Berthelier writes that only by knowing the psychiatric history of the Maghreb can we understand the "origins of stereotypes that we more or less collectively continue to live." (61) He documents a continuous thread in psychiatric discourse about the North African male across what he calls a "grand curve" from conquest to the present, focusing on the cultural ignorance of the Algiers School. Only a "blindness born from the conjunction of status as a psychiatrist, a prior denial of all non-ideologically oriented information, and ignorance of a culture kept at a distance" could account for the Algiers School's misinterpretations about Muslim communities. Despite isolated resistance, the Algiers School's "monologue" about Algerians remained dominant until the war forced a "dialogue." (62) In a fascinating twist, Berthelier describes the ways that psychoanalytic and anthropological influences combined with an increasingly outspoken indigenous population to transform the nature of psychiatric discourse after the 19 30s. Evidence that patients in metropolitan asylums had died from hunger and cold during the German Occupation forced French psychiatrists to confront their ethical responsibilities to patients, and opened the discipline to alternative opinions. The third generation of the Algiers School, best represented by Maurice Porot (Antoine's son) and Yves Pelicier, brought a cultural dimension to their work, and they "reintegrated [Muslims] into the human community" by shedding their predecessors' primitivist assumptions and accepting indigenous culture as a "real culture." (63)

Trends in psychiatry were important, but the Algerian war was the crucial factor in the revision of French colonial psychiatry, the final arc in the "grand curve." The sheer force of the FLN's message, Berthelier argues, made the European community acknowledge the vitality of the Muslim population and the fragility of its own existence. But during the war, two generations of French psychiatrists were at work: Porot's followers like Sutter and Charles Bardenat, and the culturally influenced third generation. Caught in the middle was Frantz Fanon, and Berthelier's reflections here form one of the more interesting sections of the book. Fanon's education at the Lyon Faculte de Medecine emphasized the worst elements of the Algiers School's teachings about Muslims; Berthelier, himself a Lyon graduate of the 1960s, supports Fanon's claims about the racism he encountered there. At Blida in the 1950s, Fanon agreed that Algerians were fundamentally different from Europeans, but contested the Algiers School's conclusion s. Ethnocentric diagnostic criteria misinformed European psychiatrists, and Fanon argued that the colonial predicament accounted for phenomena like the Algerian's "penchant" for lying. Berthelier therefore portrays Fanon as a complement to Porot. Like Porot's "debilitated hysteric," Fanon's "individual alienated from an oppressive society" is "an abstraction.... In both cases, the patient is in reality an object and not a subject." Fanon's "revolutionary messianism" is thus "the mirror-image of the colonialism and the ethnocentrism of the other." (64)

Fanon certainly denounced the teachings of the Algiers School; indeed, most would place him at the end of the "grand curve." But Berthelier insists that by the very nature of his polemics Fanon needs to be considered within the context of the Algiers School--if only as its most vehement detractor. At the end of the curve, Berthelier places Maghrebi psychiatrists like Bachir Ridouh, who have erased the Algiers School's foundations by illustrating the political content of the School's "objective" knowledge. Fanon attempted the same attack, but Ridouh's work lacks Fanon's polemical tone, and is based (Berthelier argues) not in a political but in a therapeutic context. This assumption is questionable, as is much of Berthelier's scholarship. L'Homme maghrebin contributes little that is new, and many sources are quoted directly from Begue. But regardless of the book's shortfalls, Berthelier provides an innovative reading of Fanon, and his acknowledgment that ethnopsychiatric ink about North African Muslims now flow s from Maghrebi pens and not French ones is incontestable.

As evidence supporting this point, a recent examination of French psychiatry in North Africa comes from Jalil Bennani, a psychiatrist and psychoanalyst in Rabat. Bennani brings a transcultural perspective to the way we understand French psychiatry and colonialism, and he presents a subtlety in La Psychanalyse au pays des saints: Les Debuts de la psychiatrie et de la psychanalyse au Maroc that is lacking in other accounts. This results from his field of inquiry as much as his cultural perspective: psychiatry, like colonization itself, developed differently in Morocco than it did in Algeria. Bennani therefore urges a reconsideration of French colonial history: if we want to "open an intercultural field of thought," we have to stop putting the past "on trial." Moroccan analysts must realize that their discipline has colonial origins, but also that this past should not necessarily invalidate psychoanalysis as a means for treating Muslims. Bennani argues that through his training in France, he "discovered the univ ersality of unconscious drives, beyond cultural specificities" by reconciling psychoanalytic theory and "non-Western cultural data." (65)

Bennani's unquestioned faith in psychoanalysis may render his study suspect in many historians' eyes, but it is precisely his capacity to bridge two cultures through psychoanalysis that brings such novelty to his work. Unlike many of his more nationalist colleagues, who would deny the legitimacy of any vestiges of French colonial rule in North Africa, Bennani cautions against reactionary tendencies. To be sure, the works of the Ecole d'Alger show clearly the school's "dependency on the social context"; and in Morocco, where the psychiatric presence was "more subtle and more nuanced," practitioners perpetuated "the prejudices of the era and consciously or unconsciously participated in the 'civilizing project'." (66) Even the psychoanalysis that Rene Laforgue, a founder of the Parisian Psychoanalytic Society and suspected Nazi collaborator, brought to Casablanca in the postwar era bought into Levy-Bruhl's ideas of a "primitive mentality." But Bennani argues that despite its darker side, psychoanalysis "opened a breach" in the "normative attitudes" of psychiatric discourse, allowing practitioners to see past "magical beliefs" and "to recognize an individual without denying his belonging to a group." (67)

Hubert Lyautey's commitment to medicine as a key means of pacification created an environment in which the establishment of psychiatric institutions provoked fewer political and financial disputes than it had in Algeria or Tunisia, As a result, the Berrechid Psychiatric Hospital opened early in the 1920s, and by 1949 Morocco had five other institutions of various sizes in addition to Berrechid for treatment of Europeans and indigenous populations in Casablanca, Rabat, Marrakech, and Ben Ahmed. The relative absence of political debate over the issue of psychiatric welfare meant that no powerful professional lobby formed to come to the defense of public health initiatives: unlike the Algerian case, there was no "Ecole de Rabat." Bennani argues that a relative openness within the psychiatric community made Morocco the one location in the French Maghreb where the implantation of psychoanalysis was possible, and psychoanalysis's renewal of mental health care in the metropole--where it replaced a "sterile" nosologi cal preoccupation with a dynamic understanding of human consciousness--made this implantation "inevitable." (68)

Psychoanalysis altered perspectives on mental health and illness in Morocco by admitting heterodox views. Because state support of institutions requires clear lines of demarcation, psychiatry emphasizes hard distinctions between normality and pathology, with invariably harsh consequences in encounters with other cultures. By contrast, psychoanalysis emphasizes the permeability of normality and pathology. Even though Laforgue embraced outdated primitivist views of Arabs, then, the presence of his analysands in Moroccan institutions opened psychiatry to new views that broke with the past. Under Laforgue's student Louis Clement, at Berrechid in the late 1950s "institutional structures liberalized and softened: the act of listening to patients modified [these structures] and opened them to other dimensions." The psychoanalytic community centered around Laforgue's group in Casablanca closed its ranks nearly as tightly as had orthodox psychiatry--only three Moroccan psychoanalysts practiced under colonial rule, and only in the last years of the protectorate--but Bennani argues that the political implications of this institutional "softening" should encourage Moroccans to examine the history of psychoanalysis with "reasoned critique" rather than reactionary polemics.

Like Begue's and Berthelier's works, La psychanalyse au pays des saints relies too heavily on limited sources. Published articles and interviews with members of Laforgue's group constitute the bulk of Bennani's evidence. And the priority of present-day therapeutic concerns over a more complete engagement with the past make his study disappointing for historians seeking information about the politics of psychotherapy under the protectorate. But a diversification of sources and a historical preoccupation are of course no guarantees of better scholarly work. Rene Collignon, for example, begins an article on French psychiatry in colonial Senegal with a promising historical contextualization. (69) Citing diverse sources from French and Senegalese archives, Collignon establishes the complexity of France's contradictory policies on assimilation and "association." While the French Revolutionary legacy motivated civilizing efforts in French West Africa, an "associationist" faction cited evolutionary theory to argue th at the assimilation of the majority of Africans into French culture was neither necessary nor possible. This administrative rift resulted in bureaucratic entanglements over exactly which Africans could claim French citizenship. After deftly exploring these contradictions within the same administrative system, Collignon goes on to synthesize others' research--including Vaughan's--to argue that "miscommunication between the administrator and the colonial subject" produced "enormous obstacles to the establishment of an open space for listening to psychic suffering." This is undoubtedly true, but the links Collignon draws between the politics of assimilation and psychiatric practices are tenuous at best, and the resulting study amounts to little more than another account of "deculturation" and psychiatric racism. Collignon never brings the delicate analysis to his project that Bennani incorporates despite the latter's overwhelming concern for the present, unabashedly political goals, and limited sources. Moreover , Collignon never accounts for how a progressive institution like Henri Collomb's Dakar School of transcultural psychiatry could have emerged prior to decolonization, and he never addresses figures like the Surrealists, who found an "antidote to civilization" in so-called primitive mentalities. (70) The question of assimilation was certainly crucial to the practice of French and British colonial psychiatry, but a strong analysis needs to connect these problems explicitly, rather than simply assert their relationship.

Studies of colonial psychiatry must go beyond the racism formula. Race was, of course, a central element in the colonial psychiatric encounter. But illustrating that metropolitan and settler psychiatrists were bound by their cultural roots shows only the most obvious aspects of the discipline. Moreover, putting historical personalities and disciplines "on trial" is not the only way to elucidate the ways that race operated as an organizing category in colonial psychiatry. Colonial psychiatry as a location for historical inquiry can tell us about a good deal more than science gone astray. As several of these authors have shown, psychiatry gives us a new lens through which we can interpret the civilizing mission. European psychiatry may have brought measurable progress to certain regions. But rather than using technological advances as apologias for psychiatry's darker side, we can look at the ways colonial politics used the establishment of medical institutions and assistance networks to perpetuate the illusion of Western munificence. By extension, a careful examination of non-medical sources could enhance our understanding of how medical administrations functioned within colonial political systems on an everyday basis--something none of these authors has explored. The knowledge produced in the psychiatric encounter with the colonized often reinforced the mandates of the civilizing mission, but in other ways it called European superiority into question. Yet the existing scholarship has neglected the tension between psychiatrists' expectations and the unexpected results turned up in their research. French psychiatrists in North Africa, for example, defended the axiom that Muslims rarely exhibited depression, anxiety, or suicidal tendencies: Muslims' "carelessness" about the future protected them from these manifestations. And yet some of the same practitioners' works are full of references to depressed, anxious, and suicidal natives. (71) How did psychiatrists explain this contradiction and other similar ones?

In addition to general trends like a preoccupation with racism and the civilizing mission, other patterns specific to national historiographies are apparent. The British accounts, written mostly by historians, tend to be based on traditional historical evidence, while French histories penned by therapists emphasize the medical literature. But a more striking difference is the presence of whites in British histories, each of which refers to settler populations. Ernst, of course, focuses on the European population, while Vaughn, McCulloch, and Sadowsky are careful to specify that not only indigenous populations constituted a "problem" for British colonial psychiatrists. This may have more to do with recent historiographical trends than with the historical problems themselves. Since Said's Orientalism, Anglophone critics have demanded more responsible documentation of white colonial communities. (72) Refuting persistent images of a white, bourgeois colonial monolith, this scholarship is careful to draw attention to poor whites in the British colonies and the ways social prejudices reinforced their place in the colonial social order.

This begs the question of Europeans in the history of French colonial psychiatry, a group that none of the French historians mentions. French institutions confined Europeans as well as local populations: why, then, are they entirely absent from these histories? Historian Francoise Jacob offers a possible solution. She argues in a brief article that trepidation about Europeans' psychological ability to live in colonial environments preoccupied psychiatrists in the early nineteenth century. (73) These thinkers determined that common manifestations like homesickness, reversal of fortune, and halted ambition contributed to early colonists' mental instability. Yet increases in settler populations in the second half of the nineteenth century proved these theories wrong, and Jacob argues that the influences of social anthropology, Darwinian thinking, and the armchair ethnopsychology of Freud and Lucien Levy-Bruhl shifted psychiatrists' focus from European to indigenous populations by the 1920s. But the asylums that opened in the 1930s treated many Europeans, and doctors continued to publish studies about the psychopathology of colons. While Jacob's thesis is intriguing, then, the solution may rest elsewhere. The authors' concerns about the importance of contemporary politics for therapy also accounts significantly for the absence of Europeans in these studies. The inflammatory rhetoric of anti-immigration groups in France in recent years has targeted North African Muslims as the source of a host of social problems, and although Britain has witnessed similar developments, the radical right there has attained nowhere near the virulence (or the popular support) of the French National Front. The Ecole d'Alger's rhetoric about North Africans as primitives ruled by criminal impulses--or, in Fanon's words, "born slackers, born liars, born robbers, and born criminals" (74)--has therefore manifested itself anew in the context of immigration. Begue, Berthelier, and Bennani are practitioners who see North Africans in consultations every day. Many of their patients have developed psychological disorders that the authors argue result from lingering colonial racism, and which demand a re-examination of discourses about a "Muslim mentality." Political and practical exigencies have thus pushed European settlers aside in these studies, and encouraged a concentration on a more insistent historical legacy.

Questions about French settlers' psychological capacity to live "under the Oriental sun" demand attention, then, as does the relationship between psychiatry and politics in the context of decolonization. Berthelier argues that the Algerian war brought an awareness of Islamic culture's vitality and legitimacy to Europeans, while it demonstrated the weakness of a continuing settler presence. But did psychiatrists respond to the FLN like Carothers responded to the Mau Mau--by labeling revolution pathological? Earlier reactions by French psychiatrists to indigenous liberation movements indicate that this was a probable response that merits considerable attention. Finally, a major strength of Sadowsky's Imperial Bedlam is his careful consideration of Nigerian understandings of madness as well as British interpretations. By contrast, none of the French scholars has examined how European psychiatry interacted with Muslim perceptions of mental illness. Yet anthropological and ethnopsychological literatures suggest th at rich therapeutic and explanatory traditions about madness have existed in the Maghreb for centuries. The implications of these traditions for colonial contact in the psychiatric hospital merits historians' attention. (75)

Despite the considerable information these studies have uncovered, the existing scholarship has only scratched the surface of the rich stores contained in the history of colonial psychiatry. These works are primarily histories of psychiatric discourse, while the social history of these institutions remains largely unexplored. Only Ernst engages gender as an analytical category: the others limit their discussions to sex, addressing male-female ratios without delving into the significance of gender in colonial madness. Historians must problematize this issue, especially considering the importance of gender in recent colonial studies and works on the history of psychiatry. (76) And with the exceptions of Ernst and Sadowsky, scholars have ignored the detailed investigations into patients' backgrounds and the medical regimens of specific institutions that marked patients' experiences of confinement--methods that characterize the best social histories of psychiatry in Europe and the United States. (77) Psychiatric regimes in other colonies remain undocumented: historians have yet to explore British psychiatry in Egypt, Dutch institutions in Sumatra and Java, and French asylums in Indochina and Madagascar. Finally, none of these histories details the postcolonial fate of colonial psychiatry. Yet as one critic has shown, the attitudes encouraged by colonial psychiatric discourse have persisted in the post-colonial era, stigmatizing not only African and Asian immigrants into Europe, but also the Creole populations of France's extant overseas territories. (78) Historians have also overlooked ethnopsychiatry's turn toward European populations. What is the significance of psychiatric interrogations of "primitive mentalities" French peasant populations in the 1960s and 1970s, which cite major works of the Algiers School?79 These areas await scholarly documentation. The works addressed here suggest intriguing possibilities for how colonial psychiatry can revise existing understandings of medical and colonial history. They demo nstrate psychiatry's significant role in the production of knowledge about colonized populations, and shed new light on the psychological dimensions of diverse colonial societies. But like many important studies, these histories raise more questions than they answer, and in so doing indicate new directions for both the social history of medicine and the history of colonialism.

Richard Keller, "Madness and Colonization: Psychiatry in the British and French Empires, 1800-1962"

Cultural, social, and intellectual historians have begun to examine the intersecting histories of European colonialism and psychiatry. At their best, these studies engage with at least four distinct historiographies. First, they revise the history of European medicine by illustrating the importance of the colonies to metropolitan scientific developments. Second, they explore the relationship between knowledge and power in the colonial context that the pre-occupied scholars since the publication of Edward Said's Orientalism in 1978. Third, they explicitly address the psychology of colonialism, a phenomenon at the heart of many intriguing yet speculative works in postcolonial studies. Finally, they open a new methodological window into the history of race by exploring institutional psychiatry's contributions to definitions of race and citizenship under colonialism. This essay reveals the potential implications of such research by highlighting recent studies of British and French colonial psychiatry in Africa an d Asia, while also addressing possible future directions for the study of colonial psychiatry.


This essay was written in the course of a fellowship at the Rutgers Center for Historical Analysis. I am grateful to Michael Adas, Bonnie Smith, and Peter Stearns for their comments on previous drafts. I also thank Elisabeth Roudinesco and Francoise Verges.

(1.) I refer here specifically to Michel Foucault, Histoire de la folie a l'age classique (Paris, 1972 [1961]); and to Edward W. Said, Orientalism (New York, 1978).

(2.) Edward Shorter, A History of Psychiatry, From the Era of the Asylum to the Age of Prozac (New York, 1997), 6.

(3.) Roy Porter, A Social History of Madness: The World Through the Eyes of the Insane (New York, 1988), 16.

(4.) Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (New York, 1987). For other accounts of the professionalization of French psychiatry, see Jacques Postel, Genese de la psychiatrie: Les premiers ecrits de Philippe Pinel (Paris, 1998), and Ian Dowbiggin, inheriting Madness: Professionalization and Psychiatric Knowledge in Nineteenth-Century France (Berkeley, 1991). On gender and ethnicity, see Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830-1980 (New York, 1985); and Sander L. Gilman, Difference and Pathology: Stereotypes of Sexuality, Race, and Madness (Ithaca, 1985), 150-62. On somatic treatments, see Shorter, A History of Psychiatry; Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," History of Psychiatry 5 (1994): 1-12; Jack D. Pressman, Last Resort: Psychosurgery and the Limits of Medicine (New York, 1997); and Joel Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the T wentieth Century (Berkeley, 1997), among others. Two very strong histories of psychiatry's relationship to the state in two very different political environments are Jean-Bernard Wojciechowski, Hygiene mentale et hygiene sociale (2 vols.; Paris, 1997), and Michael Burleigh, Death and Deliverance: "Euthanasia" in Germany, c. 1900-1945 (New York, 1997).

(5.) Vincent Crapanzano, The Hamadsha: A Study in Moroccan Ethnopsychiatry (Berkeley, 1973); Atwood D. Gaines, ed., Ethnopsychiatry: The Cultural Construction of Professional and Folk Psychiatries (Albany, 1992); and Susantha Goonarilake, Toward a Global Science: Mining Civilizational Knowledge (Bloomington, 1999).

(6.) James Clifford, The Predicament of Culture: Twentieth Century Ethnography, Literature, and Art (Cambridge, 1988); Helena Kuklick, The Savage Within: The Social History of British Anthropology, 1885-1945 (New York, 1991).

(7.) Bernard Cohn, Colonialism and Its Forms of Knowledge: The British in India (Princeton, 1996).

(8.) Patricia Lorcin, Imperial Identities: Stereotyping, Prejudice, and Race in Colonial Algeria (London, 1995), provides the best example. On collaborationist theories of imperialism, see Ronald Robinson, "Non-European Foundations of European Imperialism: Sketch for a Theory of Collaboration," in Studies in the Theory of Imperialism, ed. Roger Owen and Bob Sutcliffe (London, 1972): 117-42.

(9.) Paul Rabinow, "Techno-Cosmopolitanism: Governing Morocco," in French Modern: Norms and Forms of the Social Environment (Chicago, 1995): 277-319; Gwendolyn Wright, The Politics of Design in French Colonial Urbanism (Chicago, 1991); and Timothy Mitchell, Colonising Egypt (Berkeley, 1991).

(10.) Michael Adas, Machines as the Measure of Men: Science, Technology, and Ideologies of Western Dominance (Ithaca, 1989); Lewis Pyenson, Civilizing Mission: Exact Sciences and French Overseas Expansion (Baltimore, 1993); and Gyan Prakash, Another Reason: Science and the Imagination of Modern India (Princeton, 1999).

(11.) See Megan Vaughn, Curing Their Ills: Colonial Power and African Illness (Stanford, 1991); David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley, 1993), and his more recent collection of essays, Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900 (Amsterdam, 1996); Leonore Manderson, Sickness and the State: Health and Illness in Colonial Malaya, 1870-1940 (New York, 1996); and Philip Curtin, Disease and Empire: The Health of European Troops in the Conquest of Africa (New York, 1998). See also Roy MacLeod, ed., Nature and Empire: Science and the Colonial Enterprise, a special issue of Osiris 15 (2000); and Nicolaas A. Rupke, ed., Medical Geography in Historical Perspective (Medical History, Supplement 20; London, 2000). For the French context, see M. C. Micouleau-Sicault, Medecins francais au Maroc: Combats en urgence, 1912-1956 (Paris, 2000).

(12.) Proceedings of the Congres des medecins alienistes et neurologistes de France et des pays de langue francaise, XXXVIIe Session--Rabat (Paris, 1933), 73-4.

(13.) Lewis Wurgaft, The Imperial Imagination: Magic and Myth in Kipling's India (Middletown, Conn., 1983).

(14.) Homi Bhabha, "Of Mimicry and Man: The Ambivalence of Colonial Discourse," and "Signs Taken for Wonders: Questions of Ambivalence and Authority under a Tree outside Delhi, May 1817," in The Location of Culture (New York, 1994), 85-92 and 102-22.

(15.) Ashis Nandy, The Intimate Enemy: Loss and Recovery of Self under Colonialism (Delhi, 1983), 32.

(16.) Anne McClintock, Imperial Leather: Race, Gender, and Sexuality in the Colonial Contest (New York, 1995), 181-9 and 219-31.

(17.) Porot and Don Come Arrii, "L'impulsivite criminelle chez l'indigene algerien--Ses facteurs," Annales Medico-Psychologiques II(1932): 588-611.

(18.) Anne Stoler, "Rethinking Colonial Categories: European Communities and the Boundaries of Rule," Comparative Studies in Society and History 31 (1989).

(19.) Waltraud Ernst, Mad Tales from the Raj: The European Insane in British India, 1800-1858 (New York, 1991).

(20.) Michael A. Launer traces the origins of the term "doo-lally" to the Deolali dust bowl "one hundred miles North East of Bombay," where some mentally ill soldiers were effectively abandoned by British authorities, and where heat, heavy drinking, and sexual promiscuity were thought to contribute to madness, according to popular legend. See "Doolali-Tap," History of Psychiatry 5 (1994): 533-7.

(21.) Ernst, Mad Tales, 10.

(22.) Ibid., 78, 82-3. See also Ernst's "Idioms of Madness and Colonial Boundaries: The Case of the European and 'Native' Mentally Ill in Early Nineteenth-Century British India," Comparative Studies in Society and History (1997): 153-81, especially 158-60.

(23.) Ernst, Mad Tales, 13-15, 115-20.

(24.) Ibid., 56, 65.

(25.) Ernst, "European Madness and Gender in Nineteenth-Century British India," Social History of Medicine 9, no. 3 (1996): 357-82.

(26.) See Showalter, The Female Malady.

(27.) Ernst, "European Madness and Gender," 360.

(28.) Ibid., 366, 382.

(29.) Ibid., 373, 380.

(30.) Mrinalini Sinha, Colonial Masculinity: The 'Manly Englishman' and the 'Effeminate Bengali' in the Late Nineteenth Century (New York, 1995), 9. Sinha also makes an important distinction between the labels "effeminate" and "feminine," implying that the former operates within a sliding scale of masculinity, while the latter diametrically opposes the masculine.

(31.) Christiane Hartnack, "Vishnu on Freud's Desk: Psychoanalysis in Colonial India," Social Research 57 (1990): 921-949; 922,931-32,945. James H. Mills, Madness, Cannabis, and Colonialism: The "Native Only" Lunatic Asylums of British India, 1857-1900 (London, 2000), released too late to be included in this review, also helps to fill this gap in the historiography."

(32.) Ashis Nandy, "The Savage Freud: The First Non-Western Psychoanalyst and the Politics of Secret Selves in Colonial India," in The Savage Freud and Other Essays on Possible and Retrievable Selves (Princeton, 1995): 81-144.

(33.) Ibid., 122.

(34.) Hartnack, "Vishnu on Freud's Desk," 936.

(35.) Nandy, "The Savage Freud," 98.

(36.) This was most often the case for North Africans, although some West Africans were also transported. See Paul Borreil, "Considerations sur l'internement des alienes senegalais en France" (Med. thesis; Montpellier, 1908).

(37.) Vaughan, Curing Their Ills, ix-x, 8-11.

(38.) Ibid., 106.

(39.) The Zomba lunatic asylum in Nyasaland only became a "mental hospital" administered by the Medical Department in 1951, and even this reform was superficial: with no resident psychiatrist, an untrained staff employed psychosurgery, electroshock therapy, and psychoactive drugs more for purposes of control than for treatment.

(40.) Jock McCulloch, Colonial Psychiatry and "the African Mind" (New York, 1995), 43-5.

(41.) Ibid., 58-63, 120.

(42.) Of over two hundred sources in his bibliography, only twenty-six relate to French colonialism; of these, nine are books and articles by Frantz Fanon, and McCulloch cites none of the French secondary literature on colonial psychiatry.

(43.) See Jan Goldstein's Console and Classify for the best treatment of French psychiatric history. Moreover, in France, insanity had enormous "economic significance," contrary to McCulloch's assertions (41). In the interwar period the French Ministry of Labor contributed significant funds in order to fight the toll mental illness exacted on the French postwar economy. See Richard Keller, "Technologies and Economics of Mental Hygiene in Interwar France," paper presented at the Western Society for French History, Pacific Grove, California, November 1999.

(44.) Collomb and his colleagues founded Psychopathologie Africaine in 1965; M. C. and E. Ortigues, Oedipe Africaine (Paris, 1966).

(45.) See Robert Berthelier, L'Homme maghrebin dans la litterature psychiatrique (Paris, 1994), 111-122.

(46.) Jonathan Sadowsky, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria (Berkeley, 1999).

(47.) Ibid., 25.

(48.) Ibid., 35-7.

(49.) Ibid., 52-3, 57.

(50.) Ibid., 67-73, 85, 90.

(51.) Ibid., 75-7, 98.

(52.) Ibid., 40-45.

(53.) Ibid., 98, 117.

(54.) Jean-Michel Begue, "Un siecle de psychiatrie francaise en Algerie, 1830-1939" (CES Memoire, Universite Pierre et Marie Curie, Paris, 1989). I cite the version located at the Bibliotheque Medicale Henry-Ey, Centre Hospitalier Sainte-Anne, Paris. Readers may find a summary of the thesis in Jean-Michel Begue, "French Psychiatry in Algeria (1830-1962): From Colonial to Transcultural," History of Psychiatry 7, no. 28 (1996): 533-48.

(55.) See "Les alienes en Algerie," Annales Medico-Psychologiques (1873, vol. I): 492.

(56.) Begue, "Un siecle," 145, 153.

(57.) Ibid., 211.

(58.) Suzanne Taieb, "Les idees d'influence dans la pathologie mentale de l'Indigene Nord-Africain. Le role des superstitions" (Med. thesis: Algiers, 1939).

(59.) Begue, "Un siecle," 242-3.

(60.) Berthelier, L'Homme maghrebin, 12.

(61.) Ibid., 167.

(62.) Ibid., 81, 84, 44.

(63.) Ibid., 107, 124, 145.

(64.) Ibid., 121.

(65.) Bennani, La Psychanalyse au pays des saints. Les debuts de la psychiatrie et de la psychanalyse au Maroc (Casablanca, 1996), 239, 244.

(66.) Ibid., 16.

(67.) Ibid., 242.

(68.) Ibid., 124-28.

(69.) Rene Collignon, "La construction du sujet colonial: le cas particulier des malades mentaux. Difficultes d'une psychiatrie en terre africaine," in La psychologie des peuples et ses derives, ed. by Michel Kail and Genevieve Vermes (Paris, 1999), 165-81.

(70.) See especially Minotaure 2 (1933), a special issue of this Surrealist journal edited by Marcel Griaule, and dedicated to the ethnographic Mission Dakar-Djibouti of 1931-1933. See also James Clifford, "On Ethnographic Surrealism," in The Predicament of Culture, 117-51.

(71.) See, for example, A. Donnadieu, "Psychose de civilisation," Annales Medico-psychologiques 97, no. 1 (January 1939): 30-37.

(72.) Ann Stoler provides two prominent examples in her article "Rethinking Colonial Categories" (cited above) and her more recent book Race and the Education of Desire: Foucault's History of Sexuality and the Colonial Order of Things (Durham, N. C,, 1995).

(73.) Francoise Jacob, "La psychiatrie francaise face au monde colonial au xixe siecle," in Decouvertes et explorateurs: Actes du Colloque International, Bordeaux 1 2-14 Juin 1992. VIIe Colloque d'Histoire au Present (Paris, 1994): 365-73.

(74.) Frantz Fanon, The Wretched of the Earth, trans. by Constance Farrington (New York, 1963), 296.

(75.) See Michael W. Dols, Majnun: The Madman in the Medieval Islamic World (New York, 1992), and Francoise Cloarec, Bimaristans, lieux de folie et de sagesse. La folie et ses traitements dans les hopitaux medievaux au Moyen-Orient (Paris, 1998). An early example dealing with the Maghreb is Edmond Doutte, Magie et religion en Afrique du Nord (Paris, 1984 [1908]). Among more recent works are Sleim Ammar, "L'assistance psychiatrique en Tunisie: Apercu historique," L'Information psychiatrique 48, no. 7 (1972): 647-657; Riadh Ben Rejeb, "A propos de la transe psychotherapeutique de Sidi Da"as: Note sur la place du djinn dans les psychotherapies traditionnelles," Institut de belles lettres arabes 54, no. 168 (1991): 215-21; and Ghita el-Khayat, Une psychiatrie moderne pour le Maghreb (Paris, 1994).

(76.) Much historical work has focused on the importance of gender for colonialism. See the review essay by Malia Formes, "Beyond Complicity versus Resistance: Recent Work on Gender and European Imperialism," Journal of Social History (1995): 629-41. Many works have appeared since her review among them Sinha's Colonial Masculinity and McClintock's Imperial Leather (both cited above). For a diverse perspective, see also the following collections of essays: Julia Clancy-Smith and Frances Gouda, eds., Domesticating the Empire: Race, Gender, and Family Life in French and Dutch Colonialism (Charlottesville, 1998); Ruth Roach Pierson and Nupur Chaudhuri, eds., Nation, Empire, Colony: Historicizing Gender and Race (Bloomington, 1998); and Sara Friedrichsmeyer, Sara Lennox, and Susanne Zantop, eds., The Imperialist Imagination: German Colonialism and Its Legacy (Ann Arbor, 1998). The literature on gender and psychiatry is far too vast to list here. A few important examples include Elizabeth Lunbeck, The Psychiatric P ersuasion: Knowledge, Gender, and Power in Modem America (Princeton, 1994); Ann Goldberg, Sex, Religion, and the Making of Modem Madness: The Eberbach Asylum and German Society, 18 15-1849 (New York, 1999); and of course Showalter's The Female Malady (cited above).

(77.) See especially Roy Porter's A Social History of Madness, which employs the voices of the (mostly famous) insane to describe their experiences, and Joel Braslow's Mental Ills and Bodily Cures, which provides important indications about the relationships between doctors and patients in its horrifying descriptions of the "somatic turn" in American public institutions in the first half of the twentieth century.

(78.) See Francoise Verges, Monsters and Revolutionaries: Colonial Family Romance and Metissage (Durham, N.C., 1999), 185-245, in which the author argues that the "assumptions of colonial psychology and its critique" inform the contemporary judicial systems assessments of crimes committed by Creoles in the French overseas department of La Reunion.

(79.) See, for example, G. Jacquel and J. Morel, "Sorcellerie et troubles mentaux: Etude faite dans le department de l'Orne," L'Encephale 54 (1965): 5-35; and Leger, Peron, and Vallat, "Aspects actuels de la sorcellerie dans ses rapports avec la psychiatrie. Peut-on parler de delire de sorcellerie?" Annales Medico-psychologiques 129, Vol. II (1972): 559-75.
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Author:Keller, Richard
Publication:Journal of Social History
Geographic Code:4EUUK
Date:Dec 22, 2001
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