Franz Fanon has shown how ideas of mental health and illness reflect historical and political constructs, especially for racialized and colonial subjects and their subjugators. “Confronted with a world configured by the colonizer, the colonized subject is always presumed guilty.”. Drawing on Fanon and other post-colonial scholars, my research asks the question: what influence did colonial ideas about race and mental illness have on mental health care practices in East Africa during British colonialism? I explore this question by examining primary source materials from Zanzibari archives of the British Superintendent-directed “lunatic asylum” in Zanzibar, Tanzania, from 1914 to 1947. In particular, I conducted a close reading and analysis of the diagnostic labels used during this time, how they were variously applied to African patients (colonial subjects) as compared to patients in British mental hospitals in the same time period. My research reveals the colonial motives of the British Protectorate in both the diagnosis and the treatment of patients, and considers the broader political purpose these diagnoses may have served. My research also contributes an historical perspective to the broader field of Global Mental Health, as I examine how shifts in psychiatric diagnoses reflect social interests, political power, and racialized ideas.
The reports date back to Colonial era, when Zanzibar was under the control of the British Protectorate. During this period slavery was no longer legal, however Zanzibari citizens were still treated as second class in their own town and had limited rights or freedoms. Greater emphasis in the research is on the report dating 1934 and 1935 the section of the Annual Medical and Sanitary report openly stated that diagnoses given were merely a best guess. That not only were the staff in charge inadequate to make such diagnoses, but also it was a commonly held belief that the native populations admitted to the asylum were mentally incapable of having the same diagnoses as their English counterpart. This commonly held belief was fueled by the work of J.C. Carothers, who, during the colonial era was considered the expert in psychiatric care in all of Africa and the “foremost Authority in the African mind.”
Introduction
In my research, I have attempted to dissect the chronology of the mental illness diagnoses and the shift in terminology that occurred in East Africa, Specifically in Zanzibar, Tanzania between the years 1914- 1947. This was done through a close examination of material attained from the archives in Zanzibar, Tanzania; as well as a thorough examination of secondary sources. The reports that I have access to, date back to Colonial era, when Zanzibar was under the control of the British Protectorate. During this period slavery was no longer legal, however Zanzibari citizens were still treated as second class in their own town and had limited rights or freedoms. The question that begs to be answered is why the asylum was opened in the first place. What population did the hospital serve? What effect, if any, did the hospital’s existence have on the future of mental health care in Zanzibar. As I moved through the Archival material I began to focus more specifically on the motives of the British Protectorate in diagnosing patients and the greater purpose these diagnoses might serve.
It is the aim of this paper to examine the archival material and roughly define the purpose and limits of diagnoses delivered by the British Protectorate led lunatic asylum in Zanzibar, Tanzania through the years 1914 to 1947.
Background: On Tanganyika
Modern day Tanzania is comprised of the mainland, which was from 1919 until 1963 known as Tanganyika, and the Islands Pemba and Zanzibar. Tanzania is part of a group of nations that are known as the Swahili coast. Swahili culture and society has been described as slippery, in that each person you speak to has a personal and very passionate definition as to what exactly it is and means to be “Swahili.” The Swahili coast of east Africa is comprised of several ethnic groups, including Africans, Arabs, and Indians, because of this, Swahili people consider themselves a culturally defined entity and not an ethnic one. Your “Swahiliness” is defined by divisions based on area of origin, length of settlement in Zanzibar, and other factors, and that ethnic differences were affirmed and emphasized both by the British and by the Omani Sultanate. However the influence of the powers that controlled the Island of Zanzibar enveloped in local traditions with a fluid synchronicity, becoming less of an outside influence and something altogether new.
Before 1919 Tanganyika was a German colony and was known as German East Africa. The British took over its administration after the defeat of Germany in World War I. Until 1890 when Zanzibar became a British protectorate it was a sovereign state under the rule of Oman Arabs. Tanganyika received its independence in December 1961 and Zanzibar in December 1963. Tanganyika and Zanzibar were joined together in April 1964 and formed the United Republic of Tanzania. Nineteenth century British imperialism was driven by the demands of industrialization, the need to obtain and secure new sources for raw materials, to gain new markets for their manufactured goods and lastly, to create global outlets for capital investments. Though it could be said that the real drive was the curiosity with “others” and the need to conquer lessor civilizations. “…it was the presumption of British racial, cultural and moral superiority that bolstered Britain’s justification for colonial rule. “ Similar to the pursuits of neighboring European countries, nineteenth century felt they had a moral duty “to civilize” their African colonial subjects. “
Background: The Asylum
The asylum is located in Kilimani which is about a mile south of the historic district of Stone Town. Initially it was built as a space to confine “lunatics,” but quickly it was decided that the space was better served as a prison in the new Protectorate. However, the demand for a space to confine mentally ill became just as apparent and space for the criminally and non-criminally insane was temporarily made at the Mnazi Mmoja Hospital.
Another building was to be added at the Kilimani site for accommodating mad persons. The Principal Medical Officer of the Protectorate in 1915 Dr. H. Curwen, he was asked to calculate the cost of providing a space for an asylum at the prison. He replied that, before he could come up with either a plan or an estimate, the Protectorate must decide exactly whom it intended to confine. Discussion ensued that demonstrates how such planning was complicated by the British obsession with racial stratification and by the conflicting agendas of medical and civil authorities.”
In the spring of 1923 the Principal Medical Officer of the Protectorate was Dr. J. A. Taylor, advocate for “a real mental hospital surrounded by sufficient land suitable for cultivation.” In describing Kilimani’s deficiencies he claimed that expanding the hospital would be at little cost to the protectorate. It became obvious in England, by 1925, that Taylor’s assertions about potential cures and minimal expense to the public were false. This may have given colonial authorities pause, but did not ultimately deter them from expanding the asylum. Time would show that a larger stand-alone hospital in Zanzibar would suffer the same fate as those in England: a cycle of overcrowding, building expansion, and filling beyond capacity. Already the little asylum at the prison was growing. What social processes accounted for this?
In much of Europe, the rise of the great asylum as social institutions paralleled the growth of industrial mechanization and capitalism. “The alienation of labor, and its meaning, from human workers has been portrayed as inexorably linked to the rise of hegemonic capitalism and as an inevitable outcome of commoditization.” Now without the uses of free slave labor to fuel the industrial beast, it was an easy turn to the labor of criminals and “mentally deficient.”
“Classification of madness had been an early passion of the newly-created psychiatric profession in its bid, in 19th century Britain, for control over madhouses But over the course of the century, as that control was established and asylum populations grew, elaborate classification schemes fell into disfavor, with simpler distinctions–“acute, chronic, imbecilic”–prevailing Unlike their colleagues at home, Zanzibar authorities had more overriding classification concerns than differentiating among mania, melancholia and dementia . Policies governing confinement in the Zanzibar Protectorate were patently and unapologetically racist. The Old Barracks was used only to house “Africans,” by which term the British meant both locally born and mainlanders–essentially anyone not of European, Arab or Indian descent. Separate accommodations would be needed for “Asiatics” in any new asylum space. “British Indians” and Europeans who went mad were to be repatriated. Arabs accommodated in the system would be asked to pay if they had the means (AB2/363). ”
J C Carothers, a district medical officer who became superintendent at Mathari Mental Hospital in Nairobi, was the most prolific and influential of the ethnopsychiatrists. He was of those mental health practitioners who, between 1900 and 1960, regarded themselves as authorities on the psychology and behavior of African people. In addition to Carothers, they included the white South Africans D J F Laubscher and Wulf Sachs, and the French-Algerian Frantz Fanon. Most psychiatrists working in Africa during the colonial period held to the absurd belief that Africans did not suffer from depression. This theory was based on the belief that Africans lacked the ability to be self-reflective or self-critical and thus depression was impossible. Of course later research during the 1950s showed that this view was absolute nonsense. “Africans, along with people throughout the world, suffer from certain universal mental disorders. What differs is the nature of their symptoms, the way these disorders are expressed.”
Research Questions and Objectives
Were standards of care and housing for patients in the Zanzibar asylum consistent with practices in British facilities?
Were known treatments and therapies used on patients in the Zanzibari asylum? The Mental Treatment Act of 1930 paved the way for asylums to be treated as hospitals and the care provided to be considered therapeutic. It also introduced “voluntary status” of patients which became a point of pride for superintendents as well as a notable change in the perception of treatment and diagnosis. In western asylum institutions, the 30’s were marked by a period that was focused on rehabilitation as opposed to simply locking away those you suffered from mental illness. (ibid) Asylums celebrated holidays provided educational course, even art therapy and dance lessons. While this model was short lived, it was a period of a gentler treatment of those were inhabited asylums. The transition into the 40’s and on saw a huge decline in the care provided within the asylum. Overcrowding and economically demanding structures—Victorian buildings were a financial drain and unsuitable to the changing psychiatric practice. It might also be valuable to discuss the British asylums in India during the same period? I plan to research on British lunatic laws and facilities. (ibid)
Were diagnoses given to patients in the Zanzibari asylum consistent with description and definition of said diagnosis? In the Annual Medical Report of 1934 the superintendent plainly states that he is unqualified to diagnose or treat patients and believes the patients to be too primitive to suffer the intricate mental illness of British patients. I have found similar accounts of similar attitudes in secondary information about such situations/circumstances in Nigeria, Kenya and India.
I feel that the outcome of researching these questions will help answer the larger question of the motives and implications of psychiatric diagnoses given to Zanzibari patients and how they reflect political and social interests.
Materials
I was given access to archival documents from a professor/mentor of mine here at the University of Oregon. The documents that I was given access to are the Blue Book Statistical Reports for Zanzibar, Tanzania between the years 1914-1956. The Blue book statistical reports are manuals that meticulously detail a range of information created by British parliament that account for the activities of the British government. The material that I looked at is a section of the report that in its entirety pertained to the Zanzibar protectorate. The full report would include reports in hospitals, education, army prisons as well as any imports or exports that they were in control of.
[more information on the reports @ History and visual images ]
Methods and Limitations
As I moved through the data and the literature, I realized trying to define diagnostic labels or comparing them to contemporary definitions of mental illness would lead me astray and not draw any deeper meaning. It is not my goal to interpret these labels by merit of definition, but to define the social and political implications of being admitted to the asylum. As such, I am limited by the content of my primary sources. There is very little beyond raw data in these sources and much else had to be inferred from other sources and read between the lines. Even with the limited purview that I am given, the hypothesis I acquired is supported by similar theory and writings of various other authors on the subject.
For this project, there were particular avenues that could not be fully explored due to scope and access to material. I felt a deep urge to compare the data from these archival documents to that of similar populations in England, India and other colonies on the African continent to further prove that the diagnoses given to patients were not only racially biased but also used as means as social control. I hypothesize that with this data we would be able to see the prevalence of Zanzibari men diagnosed with mania is greater than that of their English counterparts.
Literature
Prior to Protectorate governance, Zanzibaris produced transportable food surpluses, made saleable craft items, engaged in small trade and desired imported foodstuffs and cloth. Arabs and Indians carried on more global trade relations. Cloth from the United States and rifles from Europe, mostly traveling first to through Zanzibar, were found to have reached the lakes region of East Africa well before the turn of the century.
“Commoditization seemed to have little to do with madness. Slave labor was forcibly alienated and yet few slave lunatics were admitted to the asylum.” A change in the mode of production that radically altered social relations was necessary to criminalize resistance to waged labor and to stimulate Zanzibari families to give up their mad kin in greater numbers. “Reification of a social hierarchy based on race, a rigid system of property rights, insistence on a cash economy, and the availability of social institutions to take over from families and patrons–these aspects of British colonialism built the asylum and helped it grow.”
In all forms of health care there is a power dynamic that is created by the person giving care that asserts dominance over the person receiving care. There is an assumption that the doctor or professional has a greater knowledge and can advise on a number of health issues. This relationship is entered willingly, but the power differential has been established and thus boundaries have been fixed. Foucault refers this dynamic in his discourse as ‘bio-power’. This can be seen as the ways in which physical bodies have been relegated to behave in a certain context, as a microcosm of social control in a wider population. The focus on power is through a series of micro-relations and while the dynamic may not be fully understood within the context of the relationship, it is so deeply embedded that it is more or less accepted. Within the confines of the lunatic asylum in Zanzibar there is no accepted relationship. The colonial power established is ultimate and without mutual understanding; the dynamic of this bio-power is established through a one-sided, culturally-exclusive view of mental health. Furthermore, the body of knowledge that the power-dynamic is built on is based on the social-interpretations of what is considered normal, deviant or acceptable by European standards, not on the local, culturally-accepted norms.
This power dynamic is one of the reasons I was drawn to this project. I could not wrap my head around why space was diverted from the prison to create more space to confine people in an asylum. Jonathan Sadowsky speaks of similar curiosity in colonial governed Nigerian asylum patient populations. He lists 2 factors that challenge the psychiatric system that developed. For one thing, it was found that cultural differences effected the ability of diagnosis causing a great challenge for the asylum superintendents. Since this was the case, therapy and treatment seemed a burden of cost and even “extravagant.” Sadowsky also stresses that “madness” cannot simply be defined as “universally human,” or absolutely “relative to culture,” but is both. While culture can be used as a tool, or
Franz Fanon, an Algerian ethnopsychiatrist defines the relationship of the colonizer and the colonized as fixed within a “an image of inferiority that the colonized internalize.” Colonial power and diagnoses seeks to reshape and redefine the Individual understanding of personhood. Fanon writes: “Confronted with a world configured by the colonizer, the colonized subject is always presumed guilty.” Fanon goes on to say that though this dynamic is created, and the power is asserted over the colonized, recognition of authority is not simply given and thus the power dynamic is imperfect and perpetually at odds.
“The native may not accept the authority of the colonizer, but his complex and contradictory fate—where rejected guilt begins to feel like shame—hangs over him like a Damoclean sword; it threatens him with an imminent disaster that may collapse both the internal life and the external world.” Because of this, the relationship between the colonist and the colonized becomes one of “physical mass.” However, at a certain point violence becomes a redundant, destructive force and does not lead to a desired outcome for the colonizer.
As Fanon states, the treatment and diagnoses of mental health issues within the colonial power dynamic were employed as a means of social-control. a lever in treatment, it should neither be obsessed upon in analysis or treatment of patients. “… psychiatry whether caring or coercive, exists for the purpose of controlling anomalous behavior and emotion.” The notion of social control has been a controversial one over the last few decades. Academics such as Waltraud Ernest believe that the term is overdone and feel that “complex phenomena” cannot be defined with a simple catch phrase. It seems that there is still room to dissect the many ways that vulnerable populations are have been abused and what reason was there to allow it to continue. While the notion of “social control” may out of fashion, this issue is still a prevalent one in prisons and hospitals around the world. Until abuse and exploitation of said populations for the means of labor has become as unpopular as the discussion, we should continue have meaningful conversations about the subject and find ways to undermine the powers that allow for this atrocity to continue.
The manipulation and distortion of the sense of self over time through the power dynamic of the colonial forces can be seen in various temporal and physical spaces. During the Algerian revolution, Fanon had the experience of treating French soldiers who had engaged in torturing anti-colonial resistance as well as the torture victims. In this space, he clarified his position that the doctor patient relationship is always defined by the system. In the narrative of the medical officer explaining why diagnoses of the African patient are inadequate we can see similarities in power dynamic of the colonizer and colonized comparable to the narratives of Fanon. The Medical Officer states: “Very little in the way of psychological treatment is possible when dealing with the African lunatic. Good food, pleasant surroundings, medical treatment for bodily ills, and adequate amusements are the only useful methods of which can be employed. At the moment the provisions of pleasant surroundings is impossible but the prison authorities programme so that every lunatic spends five hours daily in the open air.” The report in the next year extends the previous year’s struggles to treat and diagnose the African and elaborates on this based on what he defines as primitive mentality and “unusual tongues.”
The mentality of the “weak African mind” was developed by J.C. Carothers. …Carothers, who saw Africans not as thinking individuals but as a “series of reactions” and compared them to leuctomized Europeans”
“Given the historical role of the African continent in the west’s philosophical construction of “otherness,” the logic of “Barbaric primitivism” is exceptionally transparent when applied to Africa. The undifferentiated African self with communal identity, low ego-boundaries and animistic beliefs prone to the disruptions of bounded consciousness and identity labeled as psychosis. Yet when such derangements do occur, they are described as less rich and detiled than a European madness. More “educated” (white) patients having differentiated forms of schizophrenia while less educated patients present with “amorphous” forms of the same disease represents a variation on the Barbaric perspective applied to epidemiological findings in An early World Health Organization monograph on psychopathology in Africa was certainly marked by this same perspective.
Findings
One of the major finds in the reports was the addendum sanitation report that outlined the fact that the asylum is situated in buildings are that are attached to the prison and both are run but the same superintendent. The superintendent stated that the hospital was not staffed by a trained psychologist, and the any diagnoses given were merely the best guess possible. It was also made clear that the asylum itself was an extension of the island prison and not well equipped to run as an asylum. Medical officer writing the report also stated that the diagnoses couldn’t be accurate since the “simple African mind” was not capable if the intricate mental health issues of the Englishman. Again, this echoes the work of Fanon; “The Algerian criminality, his impulsivity, and the violence of the organization of his nervous system or of charactorial originality, but the direct product of the colonial situation.” When a native person was acting out, but was unable to be charged with any criminal behavior defined by British standards of conduct; the native was labeled a lunatic and committed to the asylum. In this way, the colonial power dynamic set the stage for persons existing outside of the ‘normal,’ socially-defined accepted set of behaviors to be characterized as crazy.
[“In 1939, the disaproval that the Chief of Prisons had feared arrived from the Downing Street Office of the Colonial Advisory Committee on Penal Administration. It was very mildly worded and it accepted the notion that conditions in the colonies may not permit adherence to European standards. Moreover, it noted the reciprocal nature of family and institutional care:
In advanced countries the usual course is to provide institutional treatment for such cases, though the alternative of arranging for non-violent lunatics to be looked after by their own families is adopted wherever possible. In Colonial conditions institutional treatment is likely to be more difficult and care by the family less difficult…(E)very endeavor should be made to arrange for the care of lunatics in one or the other of these ways. (AB2/157) ]
By December of 1939, mad persons–some with neurosyphillis–were being turned away from Kilimani because of overcrowding.
During this time-period, more men being diagnosed (discus metzl)
Conclusion
The transition into the 40’s there is a shift in how patients are being treated, still, the paternalistic air of superiority prohibits proper care and acknowledgement. In one source the medical officer spoke about how the patients were provided beds but could not or would not use them. Metzl reading- protest psychosis “[African American] men required psychiatric treatment because their symptoms threatened not only their own sanity but the social order of white American.”