Western responses to amok were divided, with opinions varying between whether this sort of indiscriminate slaughter could be classified as plain crime or insanity; medical opinion eventually veering towards the latter (Hatta, 1996; Spores, 1988). Commensurate with Murphy and Winzeler’s arguments, for Spores the gradual demise of amok was related to the enormous social changes taking place in feudal Malaya through the imposition of colonial law and order. This, combined with the medicalisation of amok, resulted in colonial authorities branding the amok runner a lunatic rather than a notorious anti-hero, with all the associated stigma that this conjured up for Europeans and imparted to colonial subjects (McCulloch, 2001).
The colonial psychiatrist therefore found himself in the powerful position of becoming the undisputed ‘arbiter of deviance’, redefining behaviours previously thought of as little more than local oddities towards classifications of mental disorders, from mild neuroses and hysterias, to the seriously deviant and criminally insane (Romanucci-Ross, 1997a: 18).
Psychiatry, with its function of defining, maintaining and ‘treating’ psychological disorder, often identified in the context of social disorder, provides the scientific basis and the legislative and therapeutic justification for a particular approach in dealing with madness. Furthermore, by asserting its expertise in dealing with madness, psychology provides the glue that binds the individually deviant behaviour in the socially sanctioned procedures for incarceration (Sashidharan and Francis, 1993: 98).
Psychiatric opinions could therefore be seen as a useful tool, one that aided and empowered colonial authorities to apply methods of control towards labelled deviant individuals on the grounds of civil order.
The anthropological and medical curiosity towards regional behaviours reframed as ‘mental disorders’ have continued to excite psychiatric interest for Western and Western-trained psychiatrists. In the mid to late twentieth century interest in the so-called ‘cultural-bound syndromes’ generated large-scale research intent on establishing classifications that were strongly reminiscent of the endeavours of colonial psychiatry:
The extent to which such patterns could be fitted into a universal schema depended on how far the medical observer was prepared to stretch a known psychiatric category (Littlewood, 2001: 4).
Consequently, the interest in culture-bound syndromes can be read as providing continuing examples of perceived ‘otherness’ for Western observers, which become dislocated from the meaning associated with their manifestations. Culture-bound syndromes are viewed as strange exotica and reinterpreted within a framework of classification to make them more intelligible to unfamiliar audiences. According to Naomi Selig (1988: 96) the spate of cross-cultural psychiatric studies looking at the incidence of schizophrenia globally in the 1960s continued to exemplify the modern day ‘colonial stance’.
The attempt to identify universals in mental illness formed the basis of the World Health Organization (WHO) International Pilot Study of Schizophrenia in 1966. A significant finding to come out of this report was that, contrary to expectations, diagnosed schizophrenics in some developing countries had a better prognosis of recovery than those in the developed countries of the West. A follow-up study two years later supported this finding (Sartorius et al., 1977). Other psychiatric studies in cross-cultural variables have specifically attempted to focus on the connection between psychiatric disorders and the ‘sociocultural’ environment using very large statistical samples of ‘different groups of people’ (Leighton and Murphy, 1966: 3). Both the WHO report of 1966 and cross-cultural psychiatry have been subjected to sharp criticisms, largely on methodological grounds. Kleinman (1988: 14-15) points out how disease has been schematised into professional taxonomies, which when applied cross-culturally have fallen methodologically foul of what he describes as the ‘category fallacy’: that of applying cultural specific diagnostic nosologies onto culturally diverse samples. This unwarranted application of nosologies persistently ignores the underlying point that biomedicine itself is merely another form of ethno-medicine but is nonetheless ‘treated as a universal construct’ (Nichler, 1992: xii; Crandon-Malamud, 1997). This underlying assumption is clearly conveyed by descriptions of cross-cultural psychiatry:
As an underlying principle [my italics] we take an attitude of inclusiveness in these regards just as we do in dealing with the range of psychiatric phenomena as defined by Western thought…it seems unnecessary to waver in the face of cultural relativism as though we completely lacked valid standards of functioning’ (Leighton and Murphy, 1966:12-13).
Dawn Terrell (1994) consequently highlights the basic assumption of the study: that there is a universal identification of abnormality, this provides both the baseline for the study, and effectively begs the question by so doing.
In connection with these points and in reference to contemporary Black dissent regarding psychiatric practices and assumptions in the West, Chakraborty argues that for the most part modern psychiatry has failed to grasp the implications of ethnicity, and continues to interpret cultures from a Western ethnocentric viewpoint only.
For most psychiatrists culture has meant odd happenings in distant places that did not apply to them. The difference that they found in other cultures was ascribed to childlike behaviour, magical thinking, or inferior social or psychological development. Old healing traditions were thought to be unscientific; healers were judged to be abnormal or psychotic; and handbooks were written on how to study psychiatric symptoms among ‘natives’ (Chakraborty, 1991: 12).
Fernando et al. (1998) argue that contemporary as well as historical psychiatry continues to be a powerful instrument of social control of perceived and labelled deviants in society and go on to take issue with the racial bias that is built into psychiatric diagnosis. This, the authors contend, adopts stereotypic assumptions concerning the inherent alien nature, inferiority and dangerousness of black people leading to custodial care (Fernando et al., 2005). In this way racist assumptions from the past inform the present and duly resonate with Littlewood and Lipsedge’s point that the primitive being is already ‘in a sense ill’, or in other words, infantile and maladjusted and therefore less prone to mental illness (Littlewood and Lipsedge, 1989: 34). Accordingly, Kleinman (1988: 37) recounts that depression has been seen by ‘paternalistic and racialist’ psychiatrists as uncommon in India and Africa due, we are led to infer, to assumptions concerning the primitive and non-introspective cast of mind of non-Westerners (Fernando, 1995). Such views tally with the observation of Dr Schmidt in describing ‘Land Dayaks’ (the Bidayuh) as fundamentally superstitious, fearful and ‘ignorant’ (Schmidt, 1964: 142; Schmidt, 1967: 357).
The racist overtones of such views are transparently obvious to modern-day scholars, but the cultural presumptions inherent in contemporary generic biomedicine, embodied in every-day medical practice and malpractice with minority groups, are being increasingly testified to in medical journals (Bhugra, 1997; Bose, 1997; Cohen, 1999; McLaughlin and Braun, 1998; Murphy, 1978; Vanchieri, 1998).
Furthermore, through historical associations and contemporary training, the racism of ethnocentricity is not confined to the West but is duly exported to other countries. Acharyya, for instance, identifies psychiatric care with modern-day colonialism: whereby ‘Third-World psychiatrists’ trained in Britain incorporate the dominant paradigm so completely that they find difficulties in evolving new methods of dealing with mental illness within their own culture (Acharyya, 1996: 339). Contemporary critiques of racist assumptions and values in psychiatry form a useful prism to view modern-day practices in both the West and in former colonies such as Malaysia.
Madness and gender in multicultural Malaya
The rise of the modern psychiatric movement in Malaysia derives its origins from its colonial heritage. Britain, as well as the Dutch in what is now Indonesian Borneo (Kalimantan), were busily exporting European concepts of illness and contemporary