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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, 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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@example.com