|Madness and Colonization: Psychiatry in the British and French Empires, 1800-1962
Washington University in St. Louis
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 studies 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 à l'âge 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 ever 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 Eurocentric [End Page 295] 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 [End Page 296] 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 facilitated 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 post-colonial 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 to 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, [End Page 297] 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 and 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 Côme 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 have 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 [End Page 298] 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 of 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 left 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 [End Page 299] 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 twenty-one 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 found 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 means 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- and 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 [End Page 300]
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 important 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