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Ablard uses the history of psychiatry in Argentina as a prism through which to examine not simply the provision (or more often the lack) of mental health care, but also the nature and structure of the state, social change, modernity and the formation of a cultural identity. He is not a mental health professional, but rather a historian and it is this perspective that he brings, inter-weaving personal accounts, documentary records, sociological theorizing and archival research to place the history of psychiatry in Argentina firmly in a socio-cultural-political context.
Although the book appears to be based on his doctoral dissertation, it is to his credit that it does not read like it. Even the opening of the first chapter in which he speaks of the great 1986 film, Man Facing South-East, directed by Eliseo Subiela, sets a tone that is broad-ranging, inclusive and engaging. He is concerned as much with the place of psychiatry within a culture as the culture of psychiatry. There is a thoughtful and sometimes moving mix of social documentary and social comment. Throughout the book Ablard's concern and feelings for those who may have suffered from and were certainly confined within the psychiatric system is evident and the substantial number of personal accounts and archival photographs underscores the point.
In some respects the history of psychiatry in Argentina is depressingly familiar. It is a catalogue of neglect, misunderstanding, if not misanthropy and cruelty, of terrible conditions of deprivation and persistent and debilitating stigma. You have to look hard for redeeming factors or experiences, but they can be found. Ablard cites the use of radio broadcasts by patients as early as the 1930s and of the brief flowering of the ideas of therapeutic communities in the 1960s as examples of creativity in the face of repression. He is also generous to the many staff who showed genuine care for those confined and recognizes that very often the relationship with the staff, many of whom received little training and almost all of whom received little pay and less kudos, was on the better side of paternal; it could be caring and intimate as well as brutal and repressive. Individual acts of kindness and compassion are mixed with callous abuse and appalling conditions.
There are chapters that detail tragedy and abuse in ways other than those familiar to the West. The use of psychiatric facilities by the military juntas is particularly bleak reading. The chronic lack of funding and a developed infrastructure are constant themes.
It becomes clear that there are certain cultural and social factors that distinguish the history of psychiatry in Argentina from that of North America or Western Europe and the English-speaking West. The intensity and pervasiveness of political awareness made psychiatry as much a political issue as a medical one, in a way perhaps unmatched in the West apart from the Italian psichiatria democratica or the use of hospitalization by the Soviet Union. And it is in drawing out and contrasting and comparing these aspects that Ablard is able to shed more light and illumination on our current practices.
The final chapter is some ways the most surprising. In it Ablard makes the case that historically the Argentine state has, despite despotism and a militarized government, not been strong and therefore its social control has been very limited, and that the development, and practice of public psychiatry is both symptomatic and revealing in its "chaos, neglect and diffuse social control". This makes a very important point about the place of psychiatry in social and cultural affairs.
Like the very best historical and cultural documents, Ablard's book tells us as much about ourselves as it does about its putative subject matter. It brings to our attention the inter-relationship of class, poverty, social stigma and social division. It is rich in detail (there are 60 pages of notes and another 20 of references), and he skillfully uses both personal research and archival material, but the books remains accessible and absorbing. Ablard uses photographs of people and institutions to poignant effect, and there seems to be a sad connection with the faces that peer out at us. And they will be one of the longest legacies of the text.
The book will be of interest to scholars and general readers alike. It will appeal to those with an interest in Argentine social history and those more taken by the historical and cultural aspects of psychiatry. It is a fine addition to a relatively neglected area.
© 2009 Mark Welch
Mark Welch, British Columbia, 2009