Rainforest Asylum. Sara Ashencaen Crabtree

first year he abolished strait jackets, got 87% of the patients occupied in one way or another, usually at rope-making or weaving in the workshops, instituted a new and better system of record keeping, prosecuted an attendant for ill treating a patient, and arranged for a Chinese Wayang to come and give entertainment (Murphy, 1971: 16).

      In Penang, it would seem that such rehabilitative therapies had equally been introduced to patients there. A fascinating insight from a nineteenth century British superintendent who had served at asylums in both Penang and Calcutta stated that the ethnically diverse patients in Penang were far more amenable to ‘voluntary manual work’ than were the Bengalese patients or their Eurasian counterparts, in his experience (Ernst, 2010: 63).

      In nineteenth century Singapore even the rudimentary after-care of discharged patients was not neglected; however, despite all these therapeutic improvements, Gilmore Ellis could not prevent a very high death rate from cholera and beri-beri amongst inmates. Acute cases with a rapid discharge rate were not typical admissions, as had been seen in the earlier Singapore institution. Now psychiatric chronicity and physical morbidity were the main characteristics of patients at the new asylum, a situation that would be replicated in the later running of psychiatric hospitals of colonial Kenya in the 1920s (McCulloch, 2001; Murphy, 1971). The high mortality rate caused by cholera and beri-beri epidemics ravaged the internee population. They were brought under control only to be subsequently replaced by syphilis and tuberculosis, so that the death rate was never below 20% and on occasions rose to 50% of admissions. Gilmore Ellis’s response was not complacent, where his own scientific investigations failed, saltwater baths and the curative effects of visits to the seaside succeeded in reducing the mortality rates quite considerably (Murphy, 1971).

      In subsequent eras, these fairly benevolent regimes would be overtaken by new forms of treatment such as insulin coma therapy and lobotomy that, as Tai-Kwang Woon dryly notes, ‘did not bring any transient hope to the patients or stirred the enthusiasm of the staff’ (1971: 31). He goes on to note that medication was used to subdue and control patients, and where this failed, restraints in the form of strait jackets were applied. In the case of Hospital Tranquillity treatment included liberal uses of electro-convulsive therapy (ECT), supplemented by sessions of psychotherapy, under the therapeutic regime of the resident colonial alienist of the period.

      Gilmore Ellis’s contribution to psychiatric care in Malaya can be seen to have been very much based in the tradition of moral treatment, whereby humane treatment and structured activities were seen to be a highly necessary component in achieving a ‘cure’. Unfortunately these early improvements were not sustained and deterioration in care in association with larger admissions began to take place (Teoh, 1971). In the West the loss of the earlier optimism towards effecting a cure for mental illness caused demoralisation amongst pioneering psychiatric professionals by the end of the nineteenth century (Shorter, 1997). This loss of vision could also be seen to be taking its toll on the standards of care even in the new Singapore asylum during this period. By 1909 Ellis had left to take up a new post as Chief Medical Officer in the settlement and a new chapter was opened in psychiatric care in colonial Malaya (Teoh, 1971).

       Borneo: Disease, disasters, colonial rule and colonial medicine

      Our best accounts of the development of Western medicine per se can be found amongst accounts of Dutch imperialism in Borneo; and these are very largely concerned with predominant diseases and their impact on local populations, rather than the more esoteric area of mental disorders, which are referred to solely in passing. This is not to suggest that there existed a dearth of alternative treatment in the region during this period of Dutch imperial expansion. On the contrary, the literature indicates that there was already a wide variety of healing traditions in Borneo and likewise in Malaya (Gullick, 1987; Humholtz, 1991).