Professional Documents
Culture Documents
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Roy Porter
The closing decades of the twentieth century brought a rising and sustained
critique of the welfare institutions of the modern state one largely left-wing
in origins but increasingly taken over and voiced by the radical right. Profes-
sions which professed to be enabling were, claimed a rising chorus of critics,
disabling.1 Social services which presented themselves as benign were, in
reality, insidious, serving the interests of providers not consumers, promoting
professional dominance, policing deviance and intensifying the social control
required to ensure the smooth running of multinational capitalist corporations
or, in the right-wing version, such institutions were wasting tax-payers money
on scroungers and so encouraging malingering.2
Unsurprisingly, such political critiques of welfarism (in its widest sense)
spawned histories of their own. Replacing various kinds of Fabian, Whig or
celebratory historical interpretations which had treated the emergence of the
caring professions and social-security institutions as benecial and progres-
sive as shifts from neglect to administrative attention, from cruelty to care,
and from ignorance to expertise a new brand of studies took altogether a more
negative or jaundiced view of such social institutions and policies, and sought
to blow their benevolent ideological cover.3
In no eld were the new and critical histories more critical, indeed more in-
dignantly impassioned, than the history of psychiatry. Traditional in-house
and Whig histories of the care of the insane had never been particularly
triumphalist after all, psychiatry had always been a house divided against
itself, uneasy in its stance towards both the public and the medical profession at
1 I. Illich, Limits to Medicine: The Expropriation of Health (Harmondsworth, 1977) and Disabling
Professions (London, 1977).
2 The literature here is so vast, it would be impossible to begin citing it. Of great importance,
however, in clarifying the issues has been S. Cohen and A. Scull (eds.), Social Control and the
State (New York, 1981).
3 Once again, humanitarianism or control is a topic on which the survey literature is too vast even
to begin to cite, but see M. Micale and R. Porter (eds.), Discovering the History of Psychiatry
(New York and Oxford, 1994), especially N. Dain, Psychiatry and Anti-Psychiatry in the United
States, 41544; G. Grob, The History of the Asylum Revisited: Personal Reections, 26081,
and the substantial introduction.
1
2 Roy Porter
large, and aware of its embarrassing want of magic bullets.4 But from the six-
ties, psychiatry and social policy towards the mad became subjected to intense
historical analysis.
Perhaps most radically, and certainly most doggedly, the American (anti-
psychiatrist) Thomas Szasz deemed mental illness a mythic and monstrous
beast, and proclaimed that mental illness was a ction. Insanity, he has contin-
ued ever since to claim, is not a real disease, whose nature has been progressively
scientically unveiled; mental illness is rather a myth, forged by psychiatrists
for their own greater glory. Over the centuries, medical men and their supporters
have been involved, argues Szasz, in a self-serving manufacture of madness.
In this he indicts both the pretensions of organic psychiatry and the psychody-
namic followers of Freud, whose notion of the unconscious in effect breathed
new life into the obsolete metaphysical Cartesian dualism. For Szasz, any ex-
pectation of nding the aetiology of mental illness in body or mind above
all in some mental underworld must be a lost cause, a dead-end, a linguistic
error, and even an exercise in bad faith. Mental illness or the unconscious are
not realities but at best metaphors. In promoting such ideas psychiatrists have
either been involved in improper cognitive imperialism or have rather naively
pictorialized the psyche reifying the ctive substance behind the substantive.
Properly speaking, contends Szasz, insanity is not a disease with origins to be
excavated, but a behaviour with meanings to be decoded. Social existence is a
rule-governed game-playing ritual in which the mad person bends the rules and
exploits the loopholes. Since the mad person is engaged in social performances
that obey certain expectations so as to defy others, the pertinent questions are
not about the origins, but about the conventions, of insanity. In this light, Szasz
dismisses traditional approaches to the history of madness as questions mal
poses, and aims to reformulate them.5
In some ways reinforcing and complementing Szaszs critique of the episte-
mological status of insanity, Michel Foucaults Madness and Civilization, rst
published in French in 1961, argued that mental illness must be understood
not within the domain of positivist science but as inscribed within discursive
formations. To be precise, madness was a voice that, from Classical through
Medieval times, spoke its truth and was listened to, within a Platonic philosophy
4 J. G. Howells (ed.), World History of Psychiatry (New York, 1968). An important attempt at
European comparative history is L. de Goei and J. Viselaar (eds.), Proceedings: First European
Congress on the History of Psychiatry and Mental Health Care (Rotterdam, 1992). R. Porter,
Madness and its Institutions, in A. Wear (ed.), Medicine in Society (Cambridge, 1992), 277301,
is a brief comparative study of institutions.
5 T. S. Szasz, The Myth of Mental Illness (New York, 1961; London, 1972; revised edn, New York,
1974); and The Manufacture of Madness (New York, 1970; London, 1972). For discussion see R.
E. Vatz and L. S. Weinberg, The Rhetorical Paradigm in Psychiatric History: Thomas Szasz and
the Myth of Mental Illness, in Micale and Porter (eds.), Discovering the History of Psychiatry,
31130.
Introduction 3
6 M. Foucault, La Folie et la Deraison: Histoire de la Folie a lAge Classique (Paris, 1961); trans.
and abridged as Madness and Civilization: A History of Insanity in the Age of Reason, by R.
Howard (New York, 1965; London, 1967). C. Gordon, Histoire de la Folie: An Unknown Book
by Michel Foucault and Rewriting the History of Misreading, in A. Still and I. Velody (eds.),
Rewriting the History of Madness: Studies in Foucaults Histoire de la Folie (London and New
York, 1992), 1943, 16784.
7 D. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic
(Boston, Mass., 1971); A. Scull, Museums of Madness: The Social Organization of Insanity in
Nineteenth-Century England (London and New York, 1979) a much-revised version of this
later appeared as The Most Solitary of Afictions: Madness and Society in Britain, 17001900
(New Haven, Conn., and London, 1993). The Castels pioneering studies of France should also be
mentioned: R. Castel, LOrdre Psychiatrique: LAge dOr dAlienisme (Paris, 1973; and 1976);
English trans. by W. D. Halls, The Regulation of Madness: Origins of Incarceration in France
(Berkeley and Cambridge, 1988); F. and R. Castel and A. Lovell, The Psychiatric Society (New
York, 1981).
8 For instance M. Roth and J. Kroll, The Reality of Mental Illness (Cambridge, 1986).
9 K. Jones: Mental Health and Social Policy, 18451959 (London, 1960); A History of the Mental
Health Services (London, 1972); and Asylums and After: A Revised History of the Mental Health
Services from the Early Eighteenth Century to the 1990s (London, 1993).
4 Roy Porter
10 Micale and Porter (eds.), Discovering the History of Psychiatry; Still and Velody (eds.), Rewriting
the History of Madness.
11 S. L. Gilman: Difference and Pathology (Ithaca and London, 1985); Jewish Self-Hatred, Anti-
Semitism and the Hidden Language of the Jews (Baltimore, 1986); Sexuality: An Illustrated
History (New York, 1989); Inscribing the Other (Lincoln, NE, 1991); The Jews Body (New
York and London, 1991); and Health and Illness: Images of Difference (London, 1995). See
also related themes J. Hubert (ed.), Madness, Disability and Social Exclusion: The Archaeology
and Anthropology of Difference (London, 2000).
12 For polemics see for instance J. L. Crammer, English Asylums and English Doctors: Where
Scull is Wrong, History of Psychiatry 5 (1994), 10315; K. Jones, Sculls Dilemma, British
Journal of Psychiatry 141 (1982), 2216. Scull has not been slow to hit back: Humanitarianism
or Control? Some Observations on the Historiography of Anglo-American Psychiatry, Rice
University Studies 67 (1981), 357; Psychiatry and its Historians, History of Psychiatry 2
(1991), 23950; Psychiatrists and Historical Facts. Part one: The Historiography of Somatic
Treatments, History of Psychiatry 6 (1995), 22542; and Psychiatrists and Historical Facts.
Part two: Re-Writing the History of Asylumdom, History of Psychiatry 6 (1995), 38794.
13 A. Scull, A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum,
in A. D. King (ed.), Buildings and Society (London, 1980), 3760.
Introduction 5
14 For one contribution amongst many see C. Jones and R. Porter (eds.), Reassessing Foucault:
Power, Medicine and the Body (London, 1994).
15 P. Bartlett, The Poor Law of Lunacy: Administration of Pauper Lunatics in Nineteenth-Century
England (London, 1998); J. Moran, Committed to the State Asylum: Madness and Society in
Nineteenth-Century Ontario and Quebec (Montreal, 2000). See also the studies in P. Bartlett
and D. Wright (eds.), Outside the Walls of the Asylum: The History of Care in the Community
17502000 (London and New Brunswick, NJ, 1999).
16 L. D. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-
Century England (London, 1999); E. Murphy, The Administration of Insanity in East London
18001870, PhD thesis, University of London (2000). Pioneering was W. Llewellyn Parry-
Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and
Nineteenth Centuries (London, 1971).
17 A. Suzuki, Lunacy in Seventeenth- and Eighteenth-Century England: Analysis of Quarter Ses-
sions Records. Part one, History of Psychiatry 2 (1991), 43756. Part two, History of Psychiatry
3 (1992), 2944; and see his Closing and Disclosing Lunatics within the Family Walls: Domes-
tic Psychiatric Regime and the Public Sphere in Early Nineteenth-Century England, in Bartlett
and Wright (eds.), Outside the Walls of the Asylum, 11531; Framing Psychiatric Subjectiv-
ity: Doctor, Patient and Record-keeping at Bethlem in the Nineteenth Century, in B. Forsythe
and J. Melling (eds.), New Research in the Social History of Madness (London, 1999); and
his forthcoming book on family psychiatry in nineteenth-century Britain, provisionally entitled
Insanity at our Own Doors: Family, Patient and Psychiatry in Early Victorian London. See also
B. Forsythe and J. Melling (eds.), Insanity, Institutions and Society: New Research in the Social
History of Madness, 18001914 (London, 1999); Bartlett and Wright (eds.), Outside the Walls
of the Asylum.
6 Roy Porter
20 The major studies suggesting women were disproportionately conned in asylums are: P.
Chesler, Women and Madness (New York, 1973); E. Showalter, The Female Malady: Women,
Madness and English Culture, 18301980 (New York, 1985); Y. Ripa, Women and Madness:
The Incarceration of Women In Nineteenth-Century France (Minnesota, 1990). For excellent
summaries of feminist critiques of psychiatry and the history of psychiatry, see J. Buseld,
10 Roy Porter
Sexism and Psychiatry, Sociology 23 (1989), 34364 and N. Tomes, Feminist Histories of
Psychiatry, in Micale and Porter (eds.), Discovering the History of Psychiatry, 34883. For a
more recent discussion of the role gender played in the history of psychiatry, see the collected
papers in J. Andrews and A. Digby (eds.), Sex and Seclusion, Class and Custody: Perspectives
on Gender and Class in the History of British and Irish Psychiatry (Amsterdam, 2002).
Introduction 11
all classes, and for several decades its ofcers struggled to achieve this goal.
Before the 1860s, the number of patients remained small, never exceeding 200,
and the total of paying patients (some from the wealthy planter elite) nearly
equalled the number of pauper patients, whose care was funded largely by local
governments. The patients were nearly all white in a state which had a black
majority population. Although the asylum could legally accept blacks after
1849, only ve were resident when the Civil War ended in 1865.
After the Civil War, McCandless goes on to show, the nature of the asylum
changed radically. Without explicitly abandoning its curative goals indeed
in 1895 it was renamed the South Carolina State Hospital for the Insane it
insensibly accepted a custodial function, handling large numbers of patients now
deemed primarily chronic and incurable. The patient headcount grew rapidly,
reaching 2,200 by 1920, and the social and racial nature of the patient population
also changed markedly, as a result of signicant changes in the situation of the
state. One of the richest states in the 1820s, by the late nineteenth century South
Carolina descended to become one of the poorest. Paying patients virtually
disappeared, and the institution was inundated by impoverished beneciary
patients whose costs were now paid by the state.
Emancipation fully opened the asylum to the black majority and the number
of black patients skyrocketed to over 1,000 in 1920, ironically creating a biracial
institution in a state increasingly devoted to rigid segregation. The changes in
the institutions role and patient population accompanied a marked deterioration
in its internal conditions, the result of grossly inadequate funding. To a large
extent this development resulted from the states steep economic decline and
internecine political struggles. But inadequate funding also reected changes
in the institutions clientele. As a result, its ofcers were unable to provide even
basic custodial care to patients increasingly marginalized by chronic disease,
poverty and race.
The question of gender is central to Jonathan Ablards examination of
connement in Argentina. As Ablard shows, by the early twentieth century
Argentina had one of the most extensive and modern systems of public psy-
chiatric care in Latin America. Despite the promise of these institutions and of
plans to build new asylums in the interior of the country, however, by the 1930s
all of Argentinas public facilities were in crisis, plagued by overcrowding,
physical breakdown, legal irregularities, and impossible doctor-and-staff-to-
patient ratios. Addressing one hospital in the city of Buenos Aires, the Hospital
Nacional de Alienadas (National Hospital for the Female Insane), Ablard ex-
plores the decline of that hospital from two viewpoints. First he considers how
the structural and ideological contradictions of public health policy condemned
the National Hospital to overcrowding. From the 1870s to the 1930s, Argentina
was a major destination for European immigrants. Argentine elites viewed those
newcomers with ambivalence, believing that their presence disrupted the social
12 Roy Porter
and political order and that many were defective, and hence likely to require
help from the state. Accordingly, public health, and particularly psychiatric
hospitals, received paltry state subsidies.
As a further cost-saving device, hospitals for women such as the National
Hospital were entrusted to charitable and religious organizations which per-
formed the work for little or no recompense. The National Hospital was further
burdened by the fact that it was Argentinas only psychiatric facility dedicated
entirely to female patients. As a result, it received patients from all over the
country. Many arrived with no identication, and often without the proper legal
paperwork. Ablard also examines the hospitals relationship to everyday citizens
and to public authorities. Despite conditions which were often harsh, families
were the principal source of commitments until 1933. Thereafter the adminis-
tration of the National Hospital, forced by overcrowding to refuse additional
patients, established new admissions rules which led to a sharp increase in pub-
lic authority commitments. This shift further undermined what many doctors
had hoped was a trend towards a growing public condence in the hospital.
The National Hospital, however, viewed its relationship to the general public
with great ambivalence. On one hand, throughout the rst half of the century,
doctors continued to hope that commitments by family members would even-
tually lead to a growth in voluntary self-admissions. On the other hand, the
hospital was constantly trying to restrict frivolous, inappropriate and medically
unnecessary admissions. Yet its attempt to become a strictly medical institution
was further impeded by socially grounded medical concepts that called for the
protection and attentive control over women at large. As a result, doctors were
ultra-vigilant for signs of mental illness in women who violated social norms,
and also tended to be reluctant to release such women from the hospitals care.
The historiography of psychiatry in Argentina had relied hitherto almost
exclusively on published medical literature. Ablard breaks new ground by ex-
amining previously untapped sources, including insanity proceedings, hospital
annual reports, and the archive of the elite womens Society of Benecence
which ran the hospital from the 1850s until 1947. Much of the earlier literature
assumed that Argentina followed European, and particularly French, models of
hospital care. A careful study of primary documents reveals, however, that the
Argentine psychiatric network reected the peculiarities of national social and
economic development, and particularly the relative weakness of the national
state when it came to the implementation of health and social control policies.
Another Latin American nation here investigated in a parallel study is Mexico.
Cristina Rivera-Garza traces the history of the General Insane Asylum, inau-
gurated in 1910 by General Porrio Diaz the agship welfare institution
devoted to the care of the mentally ill in early twentieth-century Mexico. One
of the largest and most monumental projects of the modernizing agenda of
the Porrian regime, the asylum soon faced serious nancial limitations as a
Introduction 13
result of the Mexican revolution, whose armed phase commenced just three
months after the asylums opening. Plagued by overcrowding, poor stafng
and physical deterioration, the asylum authorities nevertheless kept detailed
patient records. Using admission registers and medical les from 1910 through
to 1930 a year after the institution underwent medical and administrative
reform Rivera-Garza explores the continuities and discontinuities between
the Porrian strategies of connement as set out in asylum regulations, and the
actual procedures through which men and women became asylum inmates. In
examining the social and demographic proles of inmates, Rivera-Garza ad-
dresses the various ways in which both police and families used concepts of
gender and class to detect mental illness in a rapidly changing social milieu. It
is a kind of analysis especially important in an institution which, while serving
a range of social classes, admitted great numbers of patients as free and indigent
(100 per cent of women and 86 per cent of men in 1910) and on the strength of
a government order (86 per cent of women and 68 per cent of men).
Drawing upon institutional reports and patient testimonies, she then exam-
ines the dynamic of life within the asylum grounds, paying special attention
to the ways in which the layout and routine of the institution replicated and
reinforced distinctive class and gender understandings of mental illness. In be-
coming mad, Rivera-Garza concludes, asylum inmate characterizations shed
light on the negotiation through which state agents and family members distin-
guished mental illness, something of growing relevance in the context of the
emergent revolutionary regimes concerned with the reconstruction of the nation.
This social history of connement in revolutionary Mexico City shows the con-
tested origin of public health policies, variously interpreted as either a vertical
imposition of an increasingly centralized state or the success of revolutionary
welfare policies.21
In a welcome contribution to the history of colonial policy towards the mad
in British Africa, Jonathan Sadowsky illustrates how the history of that colonys
asylums re-enacted developments common in the comparative history of psy-
chiatric institutions, while also illustrating themes peculiar to the politics and
priorities of colonialism. Initially the institutions were, like many colonial im-
ports, already obsolete by metropolitan standards, replicating virtually all the
shortcomings British psychiatry had come to pride itself in overcoming. For
most of the early twentieth century, administrators of the Nigerian colonial state
ventilated a rhetoric of scandal and the need for reform, but when reform was
at last achieved in the late 1950s and early 1960s, it was contemporary with
Nigerias gradual shift to independence, and the reform was largely accom-
plished through the initiatives of Nigerians.
21 C. Rivera-Garza, Mad Encounters: Psychiatrists and Inmates Debate Gender, Class, and the
Nation in Mexico, 19101930 (Lincoln, NE, forthcoming).
14 Roy Porter
the factors which shaped Japanese psychiatric provision into a system that was
distinctively mixed and varied.
As will be evident, individually and collectively these studies address major
questions in the history of psychiatry. Several seek to uncover the impulses
behind the mighty movement accelerating in the nineteenth century and con-
tinuing in the twentieth to certify and incarcerate large populations of people
(as Malcolm observes, a stunning one-in-a-hundred of the whole population in
Ireland!). In some cases Germany for instance the movement seems to have
been, as Scull classically argued, in part a response to capitalism, industrial-
ism and urbanization.22 But elsewhere the asylum grew in nations or regions
(Ireland for instance, but also South Carolina) which were not only primarily
rural but actually undergoing economic retrogression.
What were the forces behind the drive to conne the insane and to consolidate
the procedures of incarceration? How important were doctors? Alternatively,
were high-level political decisions and changing proles of ofcial public pol-
icy preponderant? This seems to have been the case in Mexico and Argentina.
Elsewhere, the practice of street-sweeping, as described in Colebornes study,
indicates the prime role of the police in the committal of the insane in Victorian
Australia. Or was the push to conne largely family-driven a desire to get
difcult relatives out of the domestic sphere? Malcolm intriguingly suggests
that, although a nineteenth-century Foucauldian model of the great conne-
ment might seem attractive to some, in the early comprehensive system of state
asylums which developed in Ireland, the urge to put people away actually came
in large measure not from the agents of the state but from families and commu-
nities who were glad to have economic burdens shifted off domestic shoulders
in circumstances of drastic economic crisis.23 Prestwich for her part underlines
the role of the bourgeois family in securing connements in nineteenth-century
Paris.
None of the authors in this book subscribes to the Foucauldian great con-
nement model tout court. But that does not mean that they renounce the
notion that institutionalization and the asylum served the ends of social control,
of disciplining and punishing, however dened. Indeed several of the essays
emphasize how the asylum particularly targeted certain groups. In Australia,
Coleborne nds, women were disproportionately likely to be the victims of
psychiatric labelling, stigmatization and asylumdom.24 Moran and Wrights
22 A. Scull, The Most Solitary of Afictions. See also C.-R. Prull, City and Country in German
Psychiatry in the Nineteenth and Twentieth Centuries, History of Psychiatry 10 (1999), 43974.
23 M. Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981).
24 See also C. Siobhan Coleborne, Reading Madness: Bodily Difference and the Female Lunatic
Patient in the History of the Asylum in Colonial Victoria 18481888, PhD thesis, La Trobe
University, Melbourne (1997); for women as victims in Britain, Showalter, The Female Malady;
and see also N. Tomes, Feminist Histories of Psychiatry, in Micale and Porter (eds.), Discov-
ering the History of Psychiatry, 34883.
Introduction 17
study of lunatic asylums in Ontario by contrast nds that there it was the
large oating population of young unmarried men who were often scooped
up by the asylum. In antebellum South Carolina, lunatic slaves remained the
problem of their masters, but after the Civil War, the asylums in that state in-
creasingly were reduced to serving as custodial institutions for free blacks.25
Conditions for black patients were worse in every way than for whites. Similar
racial discrimination may be seen in Deacons analysis of institutionalization
in South Africa. Blacks formed the chief population of the Robben Island insti-
tution, while white South Africans were largely cared for in private facilities.26
What all these studies point to is the need to specify, in their unique historical
context, the distinctive range of factors which gave the psychiatry establish-
ment its point; nor must we forget that these may have changed dramatically
over time.
The new history of psychiatry which emerged form the 1960s was, not
surprisingly, centred on North America and western Europe.27 Studies of other
nations, regions and continents have followed, promoting the same or similar
inquiries. We now know, for instance, much more about the development of
psychiatry in Greece after its independence, in Central and South America, and
in Russia.28 This academic development inevitably led to the formulation of
the question: what power role did psychiatry and the institutionalization of the
insane play in colonial and quasi-imperial contexts? This is a matter particu-
larly important in the light of the commonly held view that medicine and
by implication, psychiatry are intrinsically colonial pursuits: they colonize
the body, colonize the patient. If that is the nature of medicine, then must not
psychiatry itself have served to promote the imperial mission? Indeed Megan
Vaughan and other scholars have shown beyond doubt how the importation of
western psychiatry into imperial contexts did not merely provide rationales for
locking up troublesome indigenous individuals but supplied supposed psycho-
logical proles of the native at large, construed, for instance, as savage, or
backward or childlike, thereby rationalizing colonial rule.29
25 See also P. McCandless, Moonlight, Magnolias and Madness: Insanity in South Carolina from
the Colonial Period to the Progressive Era (Chapel Hill, NC, 1995).
26 See also H. Jane Deacon, Madness, Race and Moral Treatment: Robben Island Lunatic Asylum,
Cape Colony, 18461890, History of Psychiatry 7 (1996), 28798; S. Swartz, Changing Di-
agnoses in Valkenberg Asylum, Cape Colony, 18911920: A Longitudinal View, History of
Psychiatry 6 (1995), 43152.
27 Mention should also be made here of the comparative study: K. Doerner, Madmen and the
Bourgeoisie: A Social History of Insanity and Psychiatry (Oxford, 1981).
28 D. Ploumpidis, An Outline of the Development of Psychiatry in Greece, History of Psychiatry
4 (1992), 23944; J. Brown, Heroes and Non-Heroes: Recurring Themes in the History of
Russian-Soviet Psychiatry, in Micale and Porter (eds.), Discovering the History of Psychiatry,
297307;
29 See notably M. Vaughan, Curing Their Ills: Colonial Power and African Illness (Stanford, Calif.,
1991).
18 Roy Porter
These are lines of inquiry further explored in this book. What seems clear,
however, is the sheer complexity of the colonial structures themselves. As is
evident from the examples of Australia and South Africa, there was some
bad feeling from settler groups in the colonies towards the mother country.
Australians were never allowed to forget their convict origins and, partly for
that reason, the handling of the insane in that colonial milieu was never di-
vorced from police business. In both places, the heavy arm of psychiatry fell
disproportionately upon the disadvantaged native population.30
But once again the story proves more complex than it might seem. At rst
sight it might be expected that West Africa would provide a case in which
psychiatrization would serve as an instrument of the rule of White over Black.
But in fact Britain invested little faith or money in asylums in the biggest
West African colony, Nigeria. Sadowsky shows why: Britain paradoxically,
hypocritically but characteristically wanted to have its imperial cake and eat it
it wanted colonial rule, but chose to improve the colonized as little as possible.31
As is so often the case, the empire can offer a mirror for what was going on
in the metropolitan domains. How far were the mad poor and other disadvan-
taged groups in London, Paris or New York being treated as colonized people?
Certainly, as studies have shown, there was a very different psychiatry for the
poor than the psychiatry for the rich.32
The case of Nigeria suggests that institutionalization and psychiatrization
were less the bold and clear instruments of policy than the foci of uncertainties,
muddles, conicts and indecisions. As is revealed by the studies of European
and American psychiatry contained in this book, much might be hoped and
expected of the psychiatric enterprise, but in practice neither the bricks-and-
mortar, nor the diagnostics, nor the therapeutics ever delivered the goods, and
psychiatry never won the unambiguous respect of the politicians, the press, the
pundits or the people.
Till recently, the history of psychiatry has had various obvious weaknesses.
One relates to evidence. In many cases, important archives have been inacces-
sible to historians, or their astonishing richness of case material and documen-
tation has overwhelmed the scholar. As the article below by Andrea Dorries
in particular suggests, computer software is making it possible to overcome
30 See also S. Garton, Medicine and Madness: A Social History of Insanity in New South Wales,
18801940 (Kensington, Australia, 1988); M. James Lewis, Managing Madness: Psychiatry
and Society in Australia 17881980 (Canberra, 1988).
31 See also J. Sadowsky: The Connements of Isaac O.: A Case of Acute Mania in Colonial
Nigeria, History of Psychiatry 7 (1996), 91112; Psychiatry and Colonial Ideology in Nigeria,
Bulletin of the History of Medicine 71 (1997), 94111; and Imperial Bedlam: Institutions of
Madness in Colonial Southwest Nigeria (Berkeley, 1999).
32 R. Hunter and I. Macalpine, Psychiatry for the Poor, 1851. Colney Hatch Asylum, Friern Hospital
1973: A Medical and Social History (London, 1974); C. MacKenzie, Psychiatry for the Rich:
A History of Ticehurst Private Asylum, 17921917 (London and New York, 1993).
Introduction 19