These enclosed institutions in pastoral settings, to which Prior (1993) refers, historically included not only the mentally ill, but a miscellaneous population comprising the mentally retarded, the sick, vagrants and criminals (Shorter, 1997). The concept of the self-enclosed community offers a chilling description that is immediately recognisable as conforming precisely to Erving Goffman’s definition of the ‘total institution’ (Goffman, 1968: 296; Goffman, 1991).
The humane and rational treatment of the insane could be delivered reasonably well in England and the Empire, with only a limited number of individuals accommodated in asylums. Unfortunately, the early nineteenth century saw a massive rise in admissions – a phenomenon that also occurred in Europe, the American colonies and, as will be seen, at a later date in colonial Malaya as well as in several other colonial psychiatric institutions (Ernst, 2010; Jackson, 2005; Sadowsky, 2003). The late nineteenth-century asylum would of necessity abandon much of the rehabilitative content of care and more importantly would become an increasingly closed community, heavily custodial and characterised by locked wards. Duly these responses to overcrowding would be re-enacted in asylums in the Malayan, Indian subcontinent and African regions (Clark, 1966; Ernst, 2010; Fernando, 2010; Jackson, 2005).
Shorter (1997) states that within the first decade of the nineteenth century there were sixteen new asylums built in the London area alone, including Colney Hatch, which held 2,200 beds and the Hanwell Asylum, West London with 2,600 beds.
What were intended by early Victorian reformers as small country houses to provide refuge for not much more than one hundred inmates had been transformed by the end of the century into sprawling ‘stately homes’ that behind their elegant facades reproduced the worst conditions of urban overcrowding (Barham, 1992: xi).
The reason for this enormous increase in the number of detainees in asylums is a highly contested area: for Sutton, asylums in England appear to have been used for a large scale exercise in socio-behavioural control, where they became a ‘dumping ground’ for the physical and mental wrecks of industrial capitalism (Sutton, 1997: 52). Shorter responds by ascribing the increase to three main factors. Firstly, the enormous rise in neurosyphilis and secondly to a significant increase in alcohol abuse. Finally, Shorter, following Scull, points to a radical change in the structure of the family, which would no longer accommodate the disruptive presence of the insane in its midst (Shorter, 1997; Scull, 1979). Furthermore, Lis and Soly (1996) suggest that upper-class families initiated the search for custodial care for unruly, violent and immoral relatives, followed eventually by proletarian families, and this largely on economic grounds, so that asylum admission would represent only a temporary suspension of labour, particularly in the case of men.
Complicit psychiatry
Historical overviews of the birth of psychiatry have inevitably expanded to include these developments in the colonies; and the transported evolution of asylums from concentrated sites of colonial activity to macro-scale national assimilation and adaptation. Comparisons often depend upon the numbers of psychiatric institutions, trained staff and budget allocation prior to the postcolonial period, with the exponential growth in these areas since, which is constructed as an unqualified good. Accordingly, we learn that while there were only four, albeit very large, psychiatric hospitals in the Dutch East Indies, by the 1970s this number had doubled in Indonesia (Pols, 2006). Likewise, in Pakistan, since Independence the numbers of psychiatric institutions has grown exponentially (Gilani et al., 2005). Deva (2004) in turn reports similar developments that have taken place in Malaysia, of which more will be said.
Goldberg et al. (2000) provide a useful context by which to measure these apparent improvements, by pointing out that the overwhelming majority of the world’s population live in the developing world and many of these countries have experienced colonialism. Thus, the historiographies of biomedicine have intersected with those of colonial rule; and the latter, as Keller (2001) points out, has been duly strengthened by a Foucauldian analysis of power. Accordingly, the projected mission of British colonialism, for example, that was perceived at the time as fundamentally benevolent and civilising, as well as undeniably profitable, have since been subject to powerful, iconoclastic accusations that have served to sharply refute many of the more benign associations imperialism once boasted of. Thus, the irredeemable evils of empire building have become a guilt-laden, culturally embedded, assumed fact in the contemporary consciousness. Yet such analyses are as captured within a specific socio-historical context, equally as much as that phenomena under study. It is timely to recall then to what extent the greatest admiration, as well as the opprobrium of historians and the informed public, is compelled by sheer fascination when contemplating the mightiest example of administrative, military and cultural hegemony of all: that of the Roman Empire. It is not inconceivable therefore, that emerging revisionist analyses in the ‘post’ postcolonial future may offer new shades of meaning and alternative interpretations for further consideration in our understanding of colonialism and its influences. Thus, as Keller (2001) advises, the more modest study of colonial psychiatry needs to move beyond over-simplistic accounts of racist oppression by colonials, towards a more nuanced and historically situated analysis in order to do this important topic justice.
A valuable corpus of literature on colonial psychiatry has begun to be consolidated over the past few decades, which provides important insights into formalised psychiatric services offered by the British, French and Dutch colonial authorities across Asia and Africa. Such a wide socio-historical-geographical span inevitably leads to rich, multilayered, diverse and textualised accounts that elicit our critical understanding of the processes, practices and principles underlying the establishment of services and their impact upon local communities. These historiographic studies in turn serve to illuminate ethnographic accounts of psychiatric service users, such as this study, where indigenisation has reshaped service provision to fit a postcolonial landscape, and where the historical thread is less distinct but still visible for tracing back to a beginning, if not the beginning.
Colonialism has been credited, albeit with much ambivalence, qualification and reservation, with the establishment of modern psychiatric services in its once occupied territories. Pan-Asia and Africa both saw numerous incidents of industry in the introduction of European psychiatry, albeit unevenly and with markedly different standards of care applied across communities. A necessarily brief tour through the literature reveals the extent of this enterprise to bring modern psychiatric care to the indigenous masses.
The imperial machinery, it is argued, was run through the careful coalition of its essential parts, in which psychiatry and medicine in general had a vital role to play in the consolidation of the Empire, along with bureaucratic administration and the militia (Bhugra, 2001).
Accordingly, Roland Littlewood questions how colonial administrations were served by the rising profession of psychiatry developing in parallel in colonised regions.
We might note, for instance, some affinities between the scientific objectification of illness experienced as disease and the objectification of people as chattel slaves or a colonial manpower, or the topological parallels between the nervous system and imperial order. Both argued for an absence of higher ‘function’ or sense of personal responsibility among patients and non-Europeans (Littlewood, 2001: 9).
In this analysis colonial authorities viewed subject people as being greatly in need of the new science of psychiatry due to their pathologically morbid tendencies, and generally benighted and ignorant condition.