(35 2) (Journal of Social History) Richard Keller - Madness and Colonization Psychiatry in The British and French Empires, 1800-1962-Peter N. Stearns (2001)

MADNESS AND COLONIZATION: PSYCHIATRY IN THE
BRITISH AND FRENCH EMPIRES, 1800-1962
By Richard Keller 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 prob-
lem 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 indige?
nous 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 inves-
tigate 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 lafolie a Vage classique. Scholars
have grappled with this dimension of medical history by examining social, polit?
ical, technological, and professional aspects of psychiatry since the early modern
era, encouraging a polemical debate over questions of progress, power, and pro?
fessional 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 ofthe posi-
tions 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 psy?
chiatry and politics, the importance of gender and race for mental health dis-
courses, and the ways that medical technologies have combined with social
policies to enhance psychiatry's coercive power in the twentieth century. But
as good as many of these works are, they focus exclusively on Western develop-
ments, 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
296 journal of social history winter 2001
counterparts, they ignore the role of contact between Western and alternative
psychiatric medicine. By their very nature histories of colonial psychiatry dis-
rupt these accounts, elucidating the ways in which Western medicine *salliance
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 politi-
cal 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 pro-
grams 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 mis-
sion, engineers and other applied scientists argued that their work assisted in the
"mise en valeur" of colonial possessions: major projects brought colonial backwa-
ters into the modern age. But recent histories of science and technology indicate
an important relationship between scientific knowledge and colonial domina?
tion. Technological mastery informed ideas of racial superiority in European im-
perial 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, schol?
ars 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 reiuctant 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 func-
MADNESS AND COLONIZATION 297
tions 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 ofthe 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 colonial?
ism breeds psychopathology and necessitates liberatory violence, and Octave
Mannoni, who asserted that colonialism relies on internalized and pathological
notions of dependency on the part ofthe 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 alien-
ate the colonizer from his position of power.14 Scholarship about gender and
imperialism also focuses on psychological problems in colonial contact. Colo-
nialism's emphasis on "those parts ofthe British political culture which were least
tender and humane" rearticulated masculinity according to "new forms of insti-
tutionalized violence and ruthless social Darwinism" that extolled competition,
athleticism, and militant domination. This reconceptualization of British mas?
culinity 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. Colo-
nialists 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. Al-
though 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 signifi-
cant 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 historiograph-
ical 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 poiitical 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 so?
cial 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 psychosur-
geon 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-
Aigerian 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 in-
stinctive 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 psychologi?
cal 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
African or Asian"?relied above all on the power of European reason, raising

important complications in the case of the insane.
The authors ofthe 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 indi-
cating promising directions for further inquiry into the social, cultural, medical,
and political dimensions of colonial psychiatry. The resulting studies are ex-
tremely 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 Europeans1 psychological capacity to live "under Oriental
light," as Waltraud Ernst demonstrates in Mad Talesfrom the Raj: The European In?
sane in British India, 1800-1858 }9 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 En?
glish 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 con?
finement 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 Euro?
pean patients, while a network of dozens of other smaller institutions confined
the Indian insane, Based on extensive research in India Office records, Mad
Taks 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 "my-
opic medical gaze" in order to seek the wider "socio-cultural and economic
context" for confinement in India. British institutions in India reflected Euro?
pean 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 ten-
sion and the imperative to maintain the prestige ofthe 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 treat?
ment. 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 in-
stances 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 or-
derlies and nurses, "natives" were largely responsible for controlling recalcitrant
patients. European racism made mechanical restraint an absoiute 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 avoid-
ing Europeans' ultimate humiliation: physical domination by native orderlies.22
Conditions of confinement and therapy thus provide key locations for study -
ing 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 main-
tain 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 poiicies
toward social misfits iike 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 his?
tories 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 recov-
ered their senses within a year of their initial confinement, Company officials
ordered them repatriated to England. There they were admitted into the Com?
pany'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 pass-
ing 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 min-
imally 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 asy?
lums 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 iimitations in actually confin-
ing 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. 4
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 in?
sanity threatened the myth of white superiority too profoundly to be tolerated.
Deranged subalterns met with swift internment, and often with forced repatri?
ation. 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 demon-
strating 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 mad?
ness in a failure to fulfill the social roles ofthe memsahib, and psychiatrists often
found that men went mad when they failed to meet military standards for disci-
pline. 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 at-
tention 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
Emst 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 of-
ten 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 Euro?
pean 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 popu-
lation. 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 noted 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 gen?
der 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 rela-
tive 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 homogeniza-
tion and the creation of Umagined communities'" that contrasted "gentlemanly
colonial power" to a "feminine Orient." Following this hypothesis, gender pro-
foundly 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 "ef-
feminate" natives. Here Ernst suggests strong parallels with extra-medical spheres
of imperial rule. Her analysis echoes Mrinalini Sinha's argument that British au?
thorities 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 gen-
dering 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 ieave crucial questions unanswered. Was the
British psychiatric network in India really a/ait 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 ofthe Indian National Congress alter colonial psychiatrists' perspec-
tive, if any? Despite the overail very high quality of her research, the fact that
Ernst limits her scope to European psychopaths is regrettable. In any colonial sit-
uation, 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 infe-
rior and developmentally arrested compared to Europeans. She also emphasizes
the inherent contradictions in British theory about Indian psychology. Accord?
ing 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 devel?
opments in this period. Although they address psychoanalysis rather than psy?
chiatry, 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 psycho-
analyst, 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. Psycho?
analysts merged Freudian theory with Hindu conceptualizations to forge an al-
ternative to the prescribed identity ofthe 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 p^ternalism of British rule. Accord?
ing to Hartnack, the colonial predicament explains why Indian psychoanalysis
differed so much from Freudian orthodoxy. Although Indian practitioners di-
verged 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 Psycho-
analyst and the Politics of Secret Selves in Colonial India" expands Hartnack'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 Hart-

nack'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
handicapped 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) crit?
icism 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] psychoanalyti-
cal reflections."34 And Nandy demonstrates how racism informed psychiatrists'
perspectives on Indians. Berkeley-HilPs work, for example, contrasts British char?
acter traits like "individualism, determination, [and] persistence" with Hindu at-
tributes like an "incapacity for happiness," "irritability and bad temper," "slow-
mindedness," 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 from 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 doc?
tors 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 different 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 In?
dian case?the establishment of psychiatric institutions followed colonization
by a long interval. The Abbasieh asylum near 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 hospitals, and beleaguered administrations often followed a laissez-faire pol-
icy 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 na~
tives. 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 author?
ities finally dedicated resources to the establishment of local institutions for
mental health care in the early twentieth century, the resulting facilities dif-
fered 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 psychia?
trists 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 Eu?
ropean populations. Officials fretted about how to define insanity in an alien
culture, and psychiatrists from both British and French schools published widely
on "indigenous 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 differ?
ences 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. Increas-
ingly 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 colo?
nialism by pointing to incongruities between the realities of colonialism and
medical imperatives.
Historians Megan Vaughan, Jock McCulloch, and Jonathan Sadowsky empha-
size 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 insan?
ity 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 Euro?
pean patients somewhat effectively by importing European methods, subsequent
efforts to transfer a technology for managing insanity to Africa met with mis-
erable failure, as insufficient resources and cultural misunderstanding impeded
any program for healing African patients.
As Foucault argues, the transition to modemity brought the dialogue be?
tween 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 llls: Cobnial Power and African lllness. 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 iiberal democracies rely on individual
self-policing inscribed through educational, medical, and judicial discourses,
colonial societies actively police their subjects through direct repression of po?
litical, 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 concemed with group identities than indi-
viduals, 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 mis-
understandings. An issue like witchcraft confounded distinctions between nor-
mality 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 in?
sane of lesser importance than "normal" Africans. Most theorists about African
madness felt that civilization itself brought psychic disturbances to "decultur-
ated" 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 con-
cerned 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 cul?
ture 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 social
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 psychi?
atric 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 anal?
ysis to include psychiatric ventures throughout the continent, and to account
for the specific ways European mental medicinechanged 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 ofthe
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 indi-
cate that British African asylums were extremely basic institutions, with no spe-
cialist facilities, and little or no capacity for treating patients' physical illnesses.
This did not slow their operation, however, and staff carried out psychosurg-
eries 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 la?
bor 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 ground-
ing tradition into an advancing civilization. Although doctors like Carothers
and Robert Cunynham Brown noted in their surveys of Nigerian institutions
that proximity to the colonial administration?more than any natural predis-
position 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
circies on the topic. His work is emblematic of an entire generation of ethnopsy-
chiatric 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 de-
termined normal African psychology. Carothers noted similarities between pub?
lished 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 pre-
served "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] predis-
position to mental illness."41
McCulloch's most important conclusion is that ethnopsychiatrists, govern-
ments, 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 psychi?
atric 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 of?
ten 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 publica?
tions like Maroc Medical, Tunisie Medicale, and Algerie Medicale, where French
practitioners published widely, and also neglects the fact that the French psy?
chiatric 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
ofthe 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 re-
ceived no effective 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 dis-
tinctions 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 de?
velopments 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.^ Beyond these issues, Mc?
Culloch'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?discusses the same subject through an examination ofthe same sources.4
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 Cobnial South-
west Nigeria is much stronger than McCulloch's study for several reasons. Sad-
owsky 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. Sad?
owsky'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 famil-
iarity 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 ... themseives
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
care?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 condi?
tions asylums symbolized the civilizing mission. But just as "[t]he expense of
a truly modern asylum ... was incompatible with the economic goals of colo?
nialism," 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 dif?
ferences 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 they 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 gov-
ernment" 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 confine?
ment 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; with?
out it the patient is decontextualized, and the social dimension of affliction
is obscured." Even if we cannot interpret delusions and confinement as mani-
festations of resistance and oppression, they "have significance as a gauge and
representation of social pressures and contradictions" in a moment when Nigeri?
ans increasingly reaiized just how limited their opportunities under colonialism
were. Sadowsky follows Fanon, concluding that "as inchoate articulations ofthe
stresses of colonial society" the "'symptoms' of Nigeria's lunatics and the psy?
chiatric 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
concluding 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 individ-
ual 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 psychi-
atry'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 postcolo-
nial theories of liberation and psychiatric developments. For Sadowsky, Lambo's
rapprochement of psychiatry and local traditions brought to mental patients a
liberation concomitant withNigeria'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 recuper-
able patients with local families on a work exchange program. This innovative
service reduced the hospital's heavy case load, helped patients adapt to extra-
institutional environments, and gave villagers access to hospital financing for
housing and infrastructure. The programs were so successful that the UN pro?
duced 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 per-
sistence 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 de-
tail 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 epidemiologi-
cal 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 reali-
ties failed to meet, and where individuals seeking opportunity found themselves
alienated from both local and British communities, provoked significant trauma.
But even though patients' utterances reflected colonial dynamics, these dynam-
ics 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 prob-
lem, 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 misun-
derstandings. 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 cen-
tral 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 mandat-
ing 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 in?
digenous communities in the Algerian departments of Algiers, Constantine,
and Oran. The French established other colonial institutions?in Tunisia, Mo-
rocco, 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
314 j ournal of social history winter 2001
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 asy?
lums. 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 per?
cent, 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 categorically refused admission to North African patients.
After sketching the development of a psychiatric assistance network in Al-
geria, 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 develop?
ment 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, mili-
tary 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 them 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 indige?
nous insane led him to question the mentality of "normal" Algerians, resulting in
standard racist and paternalistic conclusions. Based on his observations of Alge?
rian 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 ofthe 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 states of the indigene, as the
normal indigene appears to have a pathological mentality!"56
After the Algiers facuite instituted psychiatric instruction in 1925, Porot's
observations defined his teachings, and his students produced theses and arti-
cles 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 or?
der 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 fac-
tors 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 Blon-
del 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 ob?
servations to argue that North Africans were "different" rather than "inferior,"58
the Algiers School remained hegemonic. Begue therefore describes "ethno-
psychiatric 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 LHomme 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 VHomme maghrebin valuable for historians despite
its limitations.
Berthelier writes that only by knowing the psychiatric history ofthe Maghreb
can we understand the "origins of stereotypes that we more or less collectively
316 j ournal of social history winter 2001
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 Mus?
lim 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 anthro-
pological influences combined with an increasingly outspoken indigenous popu-
lation to transform the nature of psychiatric discourse after the 1930s. 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 are in the "grand
curve." The sheer force of the FLN's message, Berthelier argues, made the Eu?
ropean 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 sec-
tions 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 con-
clusions. 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 mes-
sianism" 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. VHomme 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
flows 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 etdela 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 universality 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 'civ?
ilizing 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 "primi-
tive mentality." But Bennani argues that despite its darker side, psychoanalysis
"opened a breach" in the "normative attitudes" of psychiatric discourse, allow-
ing 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 cre-
ated an environment in which the establishment of psychiatric institutions pro-
voked 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, Mar-
rakech, 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 psychi?
atric 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" nosological
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 normal-
ity and pathology, with invariably harsh consequences in encounters with other
cultures. By contrast, psychoanalysis emphasizes the permeability of normal-
ity 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 polit?
ical 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 mem-
bers 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 psychi?
atry 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 effbrts in French
West Africa, an "associationist" faction cited evolutionary theory to argue that
the assimilation of the majority of Africans into French culture was neither
necessary nor possible. This administrative rift resulted in bureaucratic entan-
glements over exactiy 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 ar?
gue that "miscommunication between the administrator and the colonial sub-
ject" 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 overwhelm-
ing 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 colo?
nial 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 histor?
ical personalities and disciplines "on trial" is not the only way to elucidate the
ways that race operated as an organizing category in colonial psychiatry. Colo?
nial 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, psychi?
atry 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 med?
ical 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 ex?
ample, 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 civi?
lizing mission, other patterns specific to national historiographies are apparent.
The British accounts, written mostly by historians, tend to be based on tradi?
tional 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 "prob-
lem" 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 doc-
umentation 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 psychi?
atry, 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 arm-
chair 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 in-
triguing, 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 immi-
gration. 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 Ori-
ental 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 Euro?
peans, 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 anthropologicai and ethnopsychological literatures suggest that rich thera-
peutic 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 ex-
isting scholarship has only scratched the surface of the rich stores contained
in the history of colonial psychiatry. These works are primarily histories of psy?
chiatric 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 stud?
ies 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 pa?
tients' 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 asy?
lums 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 ofthe Al?
giers School?79 These areas await scholarly documentation. The works addressed
here suggest intriguing possibilities for how colonial psychiatry can revise exist-
ing understandings of medical and colonial history. They demonstrate psychia?
try'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.
Program in Social Thought and Analysis

Campus Box 1112
St.Louis,MO 63130
ENDNOTES
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 lafolie a I'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
(NewYork, 1988), 16.
4. Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nine?
teenth Century (New York, 1987). For other accounts of the professionalization of French
psychiatry, see Jacques Postel, Genese de la psychiatric 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-J980
(New York, 1985); and Sander L. Gilman, Difference and Pathology: Stereotypes ofSexu-
ality, Race, and Madness (Ithaca, 1985), 150-62. On somatic treatments, see Shorter, A
History of Psychiatry; Andrew Scull, "Somatic Treatments and the Historiography of Psy?
chiatry," 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 llls and Bodily Cures:
Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, 1997), among
others. Two very strong histories of psychiatry's relationship to the state in two very differ?
ent political environments are Jean-Bernard Wojciechowski, Hygiene mentale et hygiene
socide (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 Goonatilake, Toward a Global Science:
Mining Civilizational Knowledge (Bloomington, 1999).
6. James Clifford, The Predicamentof Culture: TwentiethCentury 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 Britishin India (Princeton,
1996).
8. Patricia Lorcin, ImperialIdentities: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
BobSutcliffe (London, 1972): 117-42.
9. Paul Rabinow, "Techno-Cosmopolitanism: Governing Morocco," in French Modern:

Norms and Forms ofthe Social Environment (Chicago, 1995): 277-319; Gwendolyn Wright,
The Politics ofDesign in French Colonial Urbanism (Chicago, 1991); and Timothy Mitchell,
Colonising Egypt (Berkeley, 1991).
10. Michael Adas, Machines as the Measure ofMen: Science, Technology, and Ideologiesof
Western Dominance (Ithaca, 1989); Lewis Pyenson, Civilizing Mission: Exact Sciences and
French Gverseas Expansion (Baltimore, 1993); and Gyan Prakash, Another Reason: Science
and the Imagination of Modern India (Princeton, 1999).
11. See Megan Vaughn, Curing Their llls: Colonial Power and African lllness (Stan-
ford, 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 ofTropical Medicine, 1500-1900 (Ams?
terdam, 1996); Leonore Manderson, Sickness and the State: Health and lllness in Colonial
Malaya, 1870-1940 (New York, 1996); and Philip Curtin, Disease and Empire: The Health
of European Troopsin the Conquest of Africa (New York, 1998). See also Roy MacLeod, ed.,
Nature and Empire: Science and the Colonial Enterprise, a special issue ofOsiris 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 neurologistesde France et des pays
de languefranqaise, XXXVlle Session?Rabat (Paris, 1933), 73-4.
13. Lewis Wurgaft, The Imperial Imagmation: Magie and Myth in Kipling'sIndia (Middie-
town, 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 ofSelf under Colonialism (Delhi,
1983), 32.
16. Anne McClintock, ImperialLeather: Race, Gender, and Sexuality in the Colonial Con*
test (New York, 1995), 181-9 and 219-31.
17. Porot and Don Come Arrii, "Uimpuisivite criminelle chez Pindigene algerien?Ses
facteurs," Annales Medico-PsychologiquesII (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 Taks 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 Taks ,10.
22. Ibid., 78, 82-3. See also Ernst's "Idioms of Madness and Colonial Boundaries: The
Case of the European and 'Native' Mentally 111in Early Nineteenth-Century British
India," Comparative Studies in Society and History (1997): 153-81, especially 158-60.
23. Ernst, Mad Taks, 13-15, 115-20.
24. Ibid., 56,65.
25. Ernst, "European Madness and Gender in Nineteenth-Century British India," Social
History ofMedicine 9, no. 3 (1996): 357-82.
26. See Showalter, The Femak 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," impiying 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 BritishIndia, 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 Seives in Colonial India," in The Savage Freud and Other Essays on
Possibk and Retrievabk Seives (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 I'internement des alienes
senegalais en France" (Med. thesis; Montpellier, 1908).
37. Vaughan, Curing Their llh, ix-x, 8-11.
38. Ibid., 106.
39. The Zomba lunatic asylum in Nyasaland only became a "mental hospital" adminis-
tered 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 Psychiatryand "theAfrican 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 Goidstein's Consok 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 toli 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 coileagues founded PsychopathologieAfricaine 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 Aigeria
(1830-1962): From Colonial to Transcuiturai," 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 I'Indigene Nord-
Africain. Le role des superstitions" (Med. thesis: Algiers, 1939).
59. Begue, "Un siecle," 242-3.
60. Berthelier, LHomme 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 etdela psych*
analyse 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. Difflcultes 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 ClirYord,"On Ethnographic Surrealism," in The Predicament of Culture,
117-51.
71. See, for example, A. Donnadieu, "Psychose de civilisation," Annaks Medico-psycholo-

giques 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 ofThings (Durham, N. C, 1995).
73. Francoise Jacob, "La psychiatrie francaise face au monde colonial au xixe siecle,"
in Decouvertes et explorateurs:Actes du Colkque International, Bordeaux 12-14 Juin 1992.
Vlle Colloque d'Histoire au Present (Paris, 1994): 365-73.
74. Frantz Fanon, The Wretchedofthe 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. Lafolie et ses
traitements dans ks 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," Ulnformation 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," lnstitut de belks kttres arabes 54,
no. 168 (1991): 215-21; and Ghita el-Khayat, Une psychiatrie moderne pour k Maghreb
(Paris, 1994).
76. Much historical work has focused on the importance of gender for colonialism.
See the review essay by Malia Formes, "Beyond Compiicity 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 McCHntock's Imperial Leather (both cited above). For a diverse perspective, see
also the following collections of essays: Juiia 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 ImperialistImagination: 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 Eiizabeth Lunbeck, The Psychiatric
Persuasion: Knowkdge, Gender, and Power in Modern America (Princeton, 1994); Ann
Goidberg, Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and
German Society, 1815-1849 (New York, 1999); and of course Showalter's The Femak
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 llls
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 ofthe 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 "assump-
tions of colonial psychology and its critique" inform the contemporary judicial system's
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 departement de l'Orne," UEncephak 54 (1965): 5-35; and Leger, Peron, and
Vallat, "Aspects actuels de la sorcellerie dans ses rapports avec la psychiatrie. Peut-on
parlerdedeiiredesorcellerieV% AnnaksMedico*psychologjiques129, Vol. II (1972): 559-75.

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MADNESS AND COLONIZATION: PSYCHIATRY IN THE

BRITISH AND FRENCH EMPIRES, 1800-1962

By Richard Keller Washington University in St. Louis

A recent intersection of two historiographical strains points to a promising new

African or Asian"?relied above all on the power of European reason, raising

At its inception in late eighteenth-century India, British colonial psychiatry

Hindu texts, his intellectual history of psychoanalysis in India confirms Hart-

with Europeans), and sexual dysfunction followed the introduction of clothing to

for "disposing of dangerous African employees." Finally, they offered "evidence of

psychological impulsiveness than to any legitimate claim for enfranchisement.

aspect of his study. In attempting to understand how British colonials defined

continue to live."61 He documents a continuous thread in psychiatric discourse

political but in a therapeutic context. This assumption is questionable, as is

the implantation of psychoanalysis was possible, and psychoanalysis's renewal of

Collomb's Dakar School of transcultural psychiatry could have emerged prior

Program in Social Thought and Analysis

5. Vincent Crapanzano, The Hamadsha: A Study in Moroccan Ethnopsychiatry(Berkeley,

6. James Clifford, The Predicamentof Culture: TwentiethCentury Ethnography,Literature,

8. Patricia Lorcin, ImperialIdentities:Stereotyping, Prejudice,and Race in Colonial Algeria

9. Paul Rabinow, "Techno-Cosmopolitanism: Governing Morocco," in French Modern:

21. Ernst, Mad Taks ,10.

23. Ernst, Mad Taks, 13-15, 115-20.

24. Ibid., 56,65.

26. See Showalter, The Femak Malady.

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

28. Ibid., 366, 382.

29. Ibid., 373, 380.

31. Christiane Hartnack, "Vishnu on Freud's Desk: Psychoanalysis in Colonial India,"

33. Ibid., 122.

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

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

37. Vaughan, Curing Their llh, ix-x, 8-11.

38. Ibid., 106.

41. Ibid., 58-63,120.

44. Collomb and his coileagues founded PsychopathologieAfricaine in 1965; M. C. and

46. Jonathan Sadowsky, Imperial Bedlam: Institutions of Madness in Colonial Southwest

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"

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

57. Ibid., 211.

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

60. Berthelier, LHomme maghrebin, 12.

61. Ibid., 167.

62. Ibid., 81,84,44.

63. Ibid., 107,124,145.

64. Ibid., 121.

66. Ibid., 16.

67. Ibid., 242.

68. Ibid., 124-28.

71. See, for example, A. Donnadieu, "Psychose de civilisation," Annaks Medico-psycholo-

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