This special issue, which brings together six articles, seeks to explore the question of madness from non-European contexts (Latin America and Africa), taking part in the dynamic renewal of historiography on mental disorder and psychiatry in the ‘Global South’ over the past few years.Footnote 1
We understand the term madness first and foremost as a category within which various beliefs as well as political and clinical forms of knowledge are constructed, and which gives rise to practices of social control. It is important not to restrict our definition to psychiatry alone, but rather to envisage madness as encompassing a wider range of actors and institutions that coexist, cooperate, or enter into tension – patients, staff, police, the judiciary, religious communities, families, and ‘traditional’ healers.
Writing the history of madness implies analysing it not as a rigid or fixed phenomenon, but rather as a label applied to individuals or groups on the basis of particular behaviours or discourses.Footnote 2 Each institution (asylums and hospitals, religious communities, administrations, families, etc.), and more broadly each society confronted with madness, circumscribes its contours according to its values, norms, and concerns. The term ‘madness’ – as well as that of the ‘mad’ – is therefore understood in this special issue as a socially constructed and shifting category.
The six articles bring historians and anthropologists into dialogue through a diversity of sources and methodologies. They highlight the entanglements, continuities, and ruptures in the logics and systems of representation of madness and mental disorder across different periods, actors, institutions, and geographies, and seek to contribute to the history of madness through a double decentring, both historiographical and disciplinary.
A contribution to the Global South historiographies of madness and psychiatry
By bringing together contributions from various countries in Latin America (Peru, Brazil, and Argentina) and Africa (South Africa, Niger, and Nigeria), this special issue proposes a geographical decentring. Its aim is to take into account ongoing research on this theme in non-European contexts and contribute to the renewal of studies in the humanities and social sciences on madness and the history of psychiatry in Europe and North America in recent years.Footnote 3
Historiographies of madness in Latin America
In Latin America, traditional historiography has initially privileged a national scope, highlighting each nation’s process of building psychiatric knowledge and the collective dynamics leading to the acknowledgment of psychiatry as a profession. Often handled by psychiatrists and published in professional journals, this account of the complex process of professionalisation tended to be made in a somewhat triumphant form, embracing and paralleling the narrative of political modernity as a linear trajectory – history being used as a means of legitimation. In this context, other historical journals were created in the early 2000s as a way to offer an alternative as well as a place of collaboration between historians and doctors, and to analyse the sinuosities of knowledge building and of professionalisation. The inaugural paper of Frenia, by Rafael Huertas,Footnote 4 offers an example of that renewed perspective.
Argentina and Mexico have drawn special historiographical attention, insisting on the conditions of asylum confinement. Resorting to the methods of social history allowed scholars to contextualise the demographic variations of various institutions, such as the psychiatric clinic La Castañeda in Mexico.Footnote 5 This approach also uncovered the attempts of doctors to shape society from their perspective. It also highlighted how they built an expertise along the way.Footnote 6 These studies led to a renewed, somehow nuanced approach to the Foucauldian theoretical framework, concluding in the relatively weak power of psychiatric institutions, due to structural overcrowding and overfunding – a tendency which also accepted counterexamples and exceptions, as was the case in the Argentinian psychiatric collaboration with the dictatorial regime.Footnote 7
Psychiatric spaces, institutions, and knowledges have also been examined under the perspective of race and of migration, in particular in the Brazilian,Footnote 8 Cuban,Footnote 9 and BolivianFootnote 10 cases. Though not always quite as concretely effective as psychiatry’s champions might have wanted, research has shown that psychiatric authority have at times been put at the service of degeneration theories and eugenism, which gained a significant audience throughout the twentieth century, for instance in ArgentinaFootnote 11 and Peru.Footnote 12
More recently, a series of studies has begun to insert Latin American psychiatry into a more global perspective, which includes the circulations at work with the Euro-American space and has contributed to questioning the diffusionist approach which presented Europe as the main centre of knowledge and practice production, various peripheries being confined to the role of receiving such propositions without further ado. Yet, these new studies have highlighted doctors’ scientific agency and challenged the chronological framework applicable to southern realities. Andrés Ríos Molina thus offered a diachronic take on the social handling of madness in Peru, challenging the chronological spectrum usually employed by choosing a temporal frame that goes beyond the life and death of Lima’s asylums.Footnote 13 Also arising from an ethical necessity as well as an epistemological attempt, and drawing on the postcolonial and decolonial gazes, a recent collective work casts light on the underlying set of relations between scientists and indigenous populations that made science making possible, yet were invisibilised in the process.Footnote 14 These archival dead-angles call for specific attention, as they allow historians to understand, beyond scientists’ ambitions of clarity, how ‘troubling’ these encounters were.
The present special issue intends to showcase this ongoing endeavour in Latin America: by offering a decentred perspective, in Hernán Scholten’s text; by questioning power relations between crucial actors such as doctors, police, and family, in Elías Amayas’s paper; and by introducing patients’ voice, in Yonissa Wadi’s article.
Historiography of madness and African studies
The main trend in the early historiography of madness on the African continent has focused primarily on the study of the construction of psychiatric knowledge under colonial rule. In this respect, research on British African colonies has been pioneering, largely due to the relatively early implementation of psychiatric institutions in colonial territories following the end of conquest.Footnote 15 By contrast, scholarship on the French empire has remained somewhat delayed, despite a more recent renewal of interest.Footnote 16 Scholars have emphasised how psychiatry in colonial Africa functioned above all as a tool of othering. This ‘constructionist’ approach highlights the ways in which medical science contributed to shaping the ‘African’ as an object of knowledge, elaborating specific classificatory systems and practices intrinsic to the functioning of colonial power.Footnote 17
Although psychiatric wards in the colonies functioned largely as lunatic asylums – prioritising confinement over care – the limited number of patients and the lack of facilities undermine the idea of a ‘great confinement’ myth as theorised by Michel Foucault in his work on madness in Europe.Footnote 18 For instance, according to a report of the Health Department of the French West African Federation (FWA), only 1,804 individuals were admitted to psychiatric hospitals in 1950. By 1954, the figure had risen to just 1,959 for a population of over 25 million inhabitants in the FWA.Footnote 19 Moreover, historiography has moved beyond an analysis of colonial psychiatry and understood solely through its disciplinary dimension. Recent scholarship has thus deconstructed both the myth of a ‘psychiatric power’ in the tropics and Erving Goffman’s concept of the ‘total institution’.Footnote 20
For several years now, following the renewal of the history of psychiatry in Europe and North America – which has paid close attention to the social history of psychiatry and to psychiatric institutions as laboratories of the social and the political – a growing body of literature has emerged on the history of madness across the African continent. This scholarship has opened up new perspectives: for example, through the study of ordinary experiences,Footnote 21 by fostering dialogue across disciplinary boundaries,Footnote 22 by interrogating sources in innovative ways,Footnote 23 by exploring new research terrains,Footnote 24 or by situating madness within broader transnational and global dimensions.Footnote 25
The three articles presented in this special issue, focusing on both the colonial period in Nigeria (Itodo Unekwu) and South Africa (Mishka Wazar), and the postcolonial context in Niger (Gina Aïtmehdi and Camille Evrard), are part of this historiographical renewal. They do so, both through the sources they mobilise – particularly psychiatric archives and patient files – and through the transversal research themes they address: forced labour under colonial rule (Unekwu), the political and social history of colonisation in South Africa (Wazar), and the history of post-independence French cooperation in Niger (Aïtmehdi, Evrard).
Beyond the history and classical sources of psychiatry
We propose in this special issue a disciplinary and methodological decentring by bringing together contributions from both early career and more established historians and anthropologists who offer external perspectives on psychiatric questions. This was, in fact, the starting point for the conception of the special issue, since we, as the two editors, have both been working for several years on questions of madness and psychiatry in our respective fields (Peru for Irène Favier, and Senegal and Burkina Faso for Romain Tiquet), while not originally coming from the history of psychiatry as such.Footnote 26
The aim here is not merely to add internal content to the history of psychiatry, but rather to offer a new approach: through the lenses of social, cultural, and political history by foregrounding the role of diverse actors and institutions, and, in a sense, considering the history of mental illness as a social phenomenon that can also be illuminated from the outside.
All the articles collected in this issue invite the readers also to navigate across different scales, from the micro-level to broader transnational perspectives, in order to highlight the gap between discourses, practices, and individual experiences of mental disorder. Whether by tracing the life trajectories of individuals diagnosed with mental illness or by analysing the governance of the ‘mad’ within psychiatric institutions, the contributions offer an ‘analysis of the conditions of social experience’Footnote 27 in all their complexity. In doing so, the issue seeks to construct wider analytical pathways through which to engage with current debates on global mental health (on methodologies, on unexplored actors, on interdisciplinarity, etc.).Footnote 28
The papers presented here are an additional contribution to this collective effort as well as a sample of sources and voices coming from the Global South, which do not limit themselves to decentring the historiographical narrative but also end up enriching it. The aim here is not to counteract a northern-centred narrative in order to substitute an alternative – following a circular logic which would end up being little productive – but to complexify it and make it finally global.
This special issue also aims to provide a space for reflection for researchers in the humanities by bringing into dialogue different methodologies and sources. Each of the six articles engages, in its own way, with the ‘classic’ sources of the history of psychiatry (medical journals, administrative reports, correspondence, etc.), either by deconstructing them or by turning to alternative materials and new sources: patient files, admission registers, iconography, the press, material culture, judicial and penitentiary archives, private papers (diaries, letters), and interviews.
The question of psychiatric sources particularly – concerning their preservation, classification, and accessibility – is central to two archival projects led by the coordinators and lies at the heart of several contributions to this issue. These include an EAP project dedicated to digitising psychiatric archives from turn-of-the-century Peru, in which Elías Amaya Nuñez has been directly involved,Footnote 29 and an ERC Stg project on the history of madness in West Africa,Footnote 30 which has contributed to the classification and preservation of the psychiatric archives of the Niamey hospital. Some of these archives are also drawn upon in the contribution of Gina Aïtmehdi and Camille Evrard to this special issue.
This diversity of sources allows for an exploration of the relationship to illness as seen by a broader range of actors. The patient is thus no longer considered solely in a face-to-face encounter with the doctor, but rather within a plurality of interactions – inside the hospital with fellow patients and nursing staff, and outside the institution with family members, social networks, and other institutions or care communities.
Three thematic axes make it possible to establish a dialogue between the articles focusing on Latin America and those devoted to Africa.
Decentre the history of psychiatry
The two articles presented here – by Hernán Scholten and Itodo Unekwu – take the theme of mental disorder and psychiatry as their starting point, using it to decentre the perspective and address other topics. Scholten’s contribution engages with intellectual history on an international scale, while Unekwu’s article contributes to the broader history of forced labour and the organisation of work imposed on populations under colonial rule in Africa.
The article by Hernán Scholten offers an example of the deconstruction of northern-centred narratives, by questioning the common interpretative pattern of international (mental) health relations and precisely following the sinuous making of the global movement for mental hygiene from Clifford Beers’ publications. It calls into question the linear frame hitherto accepted by convoking sources from France, the USA, Brazil, and Argentina, and undermines the historiographically still prevalent analytical diffusionist framework, which tends to reduce circulations to a centre–periphery single scheme. Scholten’s tracing of the reception and circulation of Beer’s original proposition contributes to a transnational history still to be written, in a decentred mode for which this paper suggests a methodological track.
Unekwu’s article addresses a theme still too rarely explored in the historiography of madness in Africa: the relationship between lunacy and forced labour. The study examines the exploitation of mentally ill individuals by the British colonial government in Kabba Province, Northern Nigeria, between 1900 and 1947. Drawing on both administrative sources (colonial reports, medical records, and court documents) and oral histories, the article cross-examines and deconstructs the written colonial archive. This research not only sheds light on a neglected aspect of how individuals deemed insane were managed – or instrumentalised – within colonial Nigeria, but also contributes to the broader historiography of forced labour. Ultimately, it illuminates the complex entanglements of mental illness, labour, and power in colonial Nigeria, and more broadly across the African continent.
Emergence of new actors
The second axis focuses on the emergence of new actors, whether through the struggle for the professionalisation of Peruvian psychiatrists (Nunez) or the opening of the first psychiatric service in Niamey, Niger, around the 1970s (Aïtmehdi, Evrard). Through this focus, these two articles examine the relationships that these ‘new actors’ maintain with others – families, local communities, and so on – and explore the changes brought about by their struggle or emergence in the definitions, representations, and management of mental disorders.
Elías Amaya Nuñez, in his paper, focuses on Peruvian psychiatrists’ collective struggle for professionalisation – a non-linear processFootnote 31 which he shows taking place without major scientific breakthroughs occurring. Paradoxically enough, this article allows for a Goffmanian elucidation of the role of family members, a crucial actor on which the historiography has insisted in the last decades.Footnote 32 In addition to this consideration of newly considered major actors of in-and-out processes of internment, Elías Amaya’s paper allows us to qualify another still predominant narrative, that given by a Foucauldian take on the psychiatric institution. Rather than fierce advocates of internment, Peruvian psychiatrists seem to have battled with other institutional counteractors, among whom are the police and families, in order to downsize the flow of internees and make daily professional action within the asylum somehow more manageable. All in all, the use of newly digitised documents allows for a better understanding of the processes of categorisation and of crucial decisions in the life of individuals, in which hierarchical and administrative logics sometimes come to play a significant role, participating in all-but-triumphant process of medicalisation.
The article by Gina Aïtmehdi and Camille Evrard takes as its starting point an archival quest to reconstruct the history of the first psychiatric service in Niger, Pavillon E, established in the early 1970s. The two authors – an anthropologist and a historian – guide the reader through their exploration of a plurality of sources: psychiatric, medical, and administrative records from the service itself, nursing dissertations from the School of Public Health, doctoral theses in medicine, as well as interviews conducted with current and former staff members of Pavillon E.
By examining the history of this pioneering service in the country, the article raises a broader set of interconnected questions. It highlights the need for a monographic history of specific psychiatric institutions to contribute to the still-emerging historiography of madness and psychiatry in post-independence West Africa. It also considers the influence of Fann clinic – the first open psychiatric service in Senegal, established in 1956 and regarded as the cradle of transcultural psychiatry – on the daily operations of the Nigerien service, particularly in training the country’s first psychiatrists, as well as the continuities with the former colonial power, notably through Franco-Nigerien cooperation and the assignment of French psychiatrists to oversee the service. Finally, the article lays the groundwork for a more detailed investigation into the reception of this institution within the broader Nigerien medical landscape, exploring the tensions and interactions it generated with other actors, including families, local communities, and traditional healers.
(In)visible patient
Lastly, this issue proposes a special focus on patients, to whom a well-known paradox applies: although central, they tend to rarely be heard due to a lack of written production on their part. The study of clinical records proposed by Yonissa Waldi and Mishka Wazar offers then an entrance to a complex and in-context world. The use of patient files allows them to construct a personified history of mental disorder, focusing on the ordinary experience of mental disorder, and tends to break up the limited approach, which mainly only sheds light on the discourses of medical staff and political authorities on patients and their families. The use of psychiatric archives and patient files is a sensitive issue. In recent years, the historiography of madness in Europe and North America has developed significantly,Footnote 33 and ongoing research is now addressing this theme in relation to Latin America and the African continent.Footnote 34 The goal, however, is not to remain solely focused on individual trajectories, but rather to situate these biographies within a broader historical context and shed new light on various historical sequences: (colonisation, war episodes, etc.). Looking at these ‘minuscule lives’Footnote 35 offers a version that is certainly more discrete but, above all, takes a genuinely alternative view of the social and political realities which these individuals are navigating.
Yonissa Wadi’s article investigates some of them by historicising forty-two letters written by inmates from São Paulo’s Pinel Sanatorium, addressed to family members and friends, as well as to authorities and doctors. This allows us to see a psychiatric institution functioning in first person, as it were, and to hear voices once again little heard. Confronting these voices within a given context, this approach casts light on how both daily and existential challenges were psychically and socially handled by human beings from such a place and time in history, namely Brazil in the second half of the twentieth century. Yonissa Wadi’s handling of handwritten, epistolary sources also allows for a closer understanding of how doctors would apprehend and use them in the making of their diagnoses and medical decisions – thus highlighting the construction of psychiatric knowledge from the empirical experience of the patient him/herself.
Mishka Wazar’s article focuses on a British soldier-patient, Richard Lea, who was confined in the Valkenberg and Robben Island Asylums in Cape Town during the late nineteenth-century colonial period. The article pays particular attention to the letters written by Lea, a British sergeant serving in the South African War, which he addressed to the colonial administration to complain about his internment and the living conditions in the asylum. These letters of protest shed light on the environment in which he lived – an unstable, turbulent, and unpredictable world – and allow reflection on several scales: the life of this soldier-patient before and during his confinement, and also the broader geographical and national tensions shaping both the asylums and South Africa. More broadly, these letters offer an original perspective from which to explore the political and social histories of South Africa at the turn of the twentieth century, marked by conflict between British and Dutch imperial ambitions.
Each article in this special issue, while historical in nature, resonates in many ways with contemporary challenges in the care of individuals with mental disorders – ranging from the chronic underfunding of psychiatric structures to the tendency towards criminalisation at the expense of treatment. Thus, beyond its contribution to the historiography of madness and mental illness more broadly, this special issue also seeks to place in historical perspective the challenges faced by the countries under consideration in terms of public mental health policy.
