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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Doing HarmDouble Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow CreaturesFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting RealGluttonyGood WorkGoodness & AdviceGreedGroups in ConflictGrowing Up GirlGut FeminismHabilitation, Health, and AgencyHandbook for Health Care Ethics CommitteesHandbook of BioethicsHandbook of Children's RightsHandbook of PsychopathyHappinessHappiness and the Good LifeHappiness Is OverratedHard FeelingsHard LuckHardwired BehaviorHarmful ThoughtsHeal & ForgiveHealing PsychiatryHealth Care Ethics for PsychologistsHeterosyncraciesHistorical and Philosophical Perspectives on Biomedical EthicsHoly WarHookedHookedHow Can I Be Trusted?How Fascism WorksHow Propaganda WorksHow to Do Things with Pornography How to Make Opportunity EqualHow Universities Can Help Create a Wiser WorldHow We HopeHow We Think About DementiaHuman BondingHuman Dignity and Assisted DeathHuman Dignity and Assisted DeathHuman EnhancementHuman GoodnessHuman Identity and 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About School ViolenceLearning from Baby PLeaving YouLectures on the History of Political PhilosophyLegal and Ethical Aspects of HealthcareLegal Aspects of Mental CapacityLegal ConceptionsLegal InsanityLegalizing ProstitutionLet Them Eat ProzacLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberal EugenicsLife After FaithLife at the BottomLife, Sex, and IdeasListening to the WhispersLiving ProfessionalismLosing Matt ShepardLostLuckyMad in AmericaMad PrideMadhouseMaking Another World PossibleMaking Babies, Making FamiliesMaking Genes, Making WavesMaking Sense of Freedom and ResponsibilityMalignantMasculinity Studies and Feminist TheoryMeaning and Moral OrderMeaning in LifeMeaning in Life and Why It MattersMeans, Ends, and PersonsMeans, Ends, and PersonsMedical Enhancement and PosthumanityMedical Research for HireMedicalized MasculinitiesMedically Assisted DeathMeditations for the HumanistMelancholia and MoralismMental Health Professionals, Minorities and the 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RightnessMovies and the Moral Adventure of LifeMurder in the InnMy Body PoliticMy Brain Made Me Do ItMy Sister's KeeperMy Sister's KeeperMy WayNakedNano-Bio-EthicsNarrative MedicineNarrative ProsthesisNatural Ethical FactsNatural-Born CybogsNaturalized BioethicsNeither Bad nor MadNeoconservatismNeonatal BioethicsNeurobiology and the Development of Human MoralityNeuroethicsNeuroethicsNeuroethicsNew Takes in Film-PhilosophyNew Waves in EthicsNew Waves in MetaethicsNietzsche on Ethics and PoliticsNo Child Left DifferentNo Impact ManNormative EthicsNormativityNothing about us, without us!Oath BetrayedOf War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Studies in Normative EthicsOxford Studies in Normative Ethics, Volume 7Oxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections on Ethics and ResponsibilityReflections On How We LiveReframing Disease 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CulpabilityThe Age of CulpabilityThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Character GapThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Cow with Ear Tag #1389The Creation of PsychopharmacologyThe Criminal BrainThe Decency 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with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, 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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Psychiatry and Empire is part of the Cambridge Imperial and Post-Colonial Studies Series, covering modern imperial history and contemporary issues in the former colonies. According editor Megan Vaughan's introduction, psychiatry has long been considered to more or less unproblematically have functioned as an instrument of colonization, adding scientific and medical authority to the subjugation of colonized peoples. The story is a familiar one. Early settlers paved the way with guns and occupation; the resulting crises of legitimation being addressed by the newly emerging social and medical sciences. Psychiatry is a prime candidate as a tool of colonization, having as it does, the mandate to manage unruly and disruptive members of the community. In this publication the various authors consider the relationship between psychiatry and the colonial enterprise, arriving at differing conclusions, although all broadly in support of the central argument that psychiatry helped provide a rationale, under the guise of science, for existing practices of social control. However as many of the contributions show, this was by no means an uncontested or straightforward process. Distance from the center, Paris, London or Amsterdam, meant that the effectiveness of psychiatry was limited. In some cases it also created opportunities for innovation and critique although the viability of any alternative discourses and practice were, in the end, subject to the fate of the colonial governments.
The book contains nine separate, individually authored chapters, covering colonial experiences in East Africa, South Africa, Indonesia, Fiji, India and the Caribbean. Although there is no overall theory advanced, the chapters each contribute to a counter-argument to any simplistic view of colonial dominance. Colonial policies in various institutions were played out differently, influenced by local conditions. In addition, indigenous authorities, with or without the support of colonial theorists and officials, appropriated the instruments of colonization, in this case psychiatric science and practice, to challenge racism and oppression. If colonization is never complete, the opportunities for resistance are many, and the authors of Psychiatry and Empire provide some superb examples of oppressed group agency.
Perhaps one of the more spectacular cases is that of Algeria, in which Atoine Porot developed forward-looking community psychiatric services which were too advanced to be repatriated to Paris. Ultimately sidelined by decolonization, the Algiers School was far ahead of the carcereal models practiced in Europe. This development, however, was not a matter of colonial benevolence. Along with it went development of theories of 'the Islamic mind' which merit close attention in relation to current discussion of the West's relationship to Islam. Porot was able to theorize Algerian resistance in a way that made sense to French colonial authorities, and so remained an agent of colonization. In an interesting footnote Ropert Keller notes that the original observations of compound 4560 RP (later chlorpromazine) were made in Tunisia. The implications for the advancement of Parisian psychiatry were far reaching.
Unusually in a collection of this nature there is a chapter on mental health nursing. Historical studies tend to be influenced by available documentation, and by views of what voices merit attention in writing history. On both counts nursing is often excluded in accounts of early psychiatry, as there is a paucity of the sorts records that can help in writing that history, and because doctors, not least because they left behind a large volume of written records, are assumed to speak about the practice of psychiatry. Shula Marks' study of mental nursing at Valkenberg makes for harrowing reading. This is not simply a theoretical discussion; it is also a first hand account of the micropractices of abuse. The racism of early South Africa adds an extra dimension to the systematic cruelty of Valkenberg. In concluding, Marks comments on the fusion of disciplinary and sovereign power in the lives of nurses and asylum inmates, illustrating that their separation in many analyses is somewhat misleading.
Another interesting contribution is that of Jacqueline Leckie who writes about St Giles asylum in Fiji. Leckie argues that imported notions of madness became localized in Fiji, with existing views of normal behavior serving as benchmarks. In this chapter Leckie shows that it was not necessary to have the overt accoutrements of colonial institutions in order for psychiatry to become established, although that most powerful of symbols the asylum was constructed in 1886. The language of psychiatry came to infuse everyday medical and popular discourse, providing an efficient means of disseminating psychiatric control. Leckie gives numerous examples of the gendered construction of madness in Fiji. It is not clear, however, how madness is to be constructed if not according to accepted social norms. A woman, for example, whose conversation departs from her own community's accepted social norms and becomes fixated on sexual themes is likely manifesting some form of distress. Given that many women were referred to asylums by family members, psychiatry did not act alone in defining their behavior as 'abnormal' although it may well have lent considerable authority to family perceptions of madness. The use of family, cultural and social norms to define madness continues to be problematic today. If we must give due weight, for example, to cultural norms, that surely means accepting at times that cultural norms have been breached. The same can be said for gender. As Ian Hacking has pointed out, it is one thing to say something is socially constructed, but quite another to say what, if anything, there is beyond the construction.
Perhaps the best example of appropriation of western ideas is seen in Shruti Kapila's analysis of psychoanalysis in India. This is a truly fascinating chapter in which Freudian ideas are shown to be taken on their own terms, with local practitioners building a distinctive and indigenous discipline of psychoanalysis. Kapila shows how some of Freud's ideas were presaged by earlier Indian thinkers, and how Freud's theory of the subjective found fertile ground. The development of psychoanalysis was contemporaneous with critique of colonial rule, and it was of some advantage to the Indian psychoanalytic body, under Bose, to be at some remove from mainstream psychiatry. Nehru also took a close interest in psychoanalysis, but the two men reached opposite conclusions as to the relationship of the discipline to religion. For Bose, psychoanalysis gave religion the possibility of rational explanation; for Nehru psychoanalysis served the purpose of separating religion from politics. What they had in common was active engagement with psychoanalysis, illustrating one of the themes of Psychiatry and Empire; the role of agency in responding to the intellectual and political challenge of western ideas.
Psychiatry and Empire offers a diverse range of readings of interest to both history and to theory of transcultural psychiatry. They illustrate the larger debates about the historical and contemporary relationship between the West and its former colonies must be situated in local contexts if they are to be properly understood. Not only are there local factors that are unique to each setting, but in all the cases presented here, there is the question of how agency is enacted in specific times and places. Psychiatry and Empire is a valuable contribution to the history of psychiatry and to understanding current issues of cultural difference in mental health care.
© 2009 Tony O'Brien
Tony O'Brien, RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, [email protected]