Black Skin, White Coats: Nigerian Psychiatrists, Decolonization, and the Globalization of Psychiatry by Matthew M. Heaton (review)

The past two decades has seen a rich literature on colonial asylums in Kenya, Malawi, Nigeria, South Africa, Zimbabwe, and Algeria.¹ Historians have used those institutions and their supporting science to gain insight into the construction and gendering of colonial states, and to identify the similarities and differences between governance in imperial centers and peripheries. In contrast, Matthew Heaton’s innovative Black Skin, White Coats is the first full-length history of a national mental health system focusing on the transition between the colonial and postcolonial periods. Heaton has conducted archival work in Nigeria, London, and Geneva, interviewed specialists in the field, and read the secondary literature. The only obvious omission is the standard psychiatric texts, and in particular Henderson and Gillespie and Martin Roth, to which Nigerian psychiatrists such as T. A. Lambo and his generation were exposed. Those texts present both the disease categories and the racially based assumptions about personality and character on which colonial psychiatry was based.

Black Skin, White Coats is built around three governing arguments. First, the transformation of psychiatric practice and theory in Nigeria was part of the decolonization project. That transformation fed into a postcolonial modernity that was global rather than national in character. In this process, Western science was adapted to local settings. Finally, in adopting a cross cultural focus, Western psychiatry was changed fundamentally—and part of that change originated in Nigeria. If Heaton’s thesis is correct, such profound changes must be reflected in the established disease categories.

The book begins with the colonial asylums and their place within the science of ethno-psychiatry, and then traces the decolonization of medical servicing and the establishment of global networks. An innovative chapter then looks at mental illness among Nigerian immigrants in the United Kingdom. Chapter 4 examines schizophrenia, depression, and the culture-bound syndrome of brain fag. Heaton then turns to the story of traditional healers and biomedicine, an important and hitherto neglected subject. Chapter 6 examines the introduction of psychoactive drugs and the impact of illicit drug use. The text ends with an essay on Nigerian psychiatry and globalization. Much of the concluding argument revolves around T. A. Lambo and the Aro village experiment in community care. In summary, Black Skin, White Coats explores the shift from colonial subjects to citizens.

The major change in the period under review (1950s–1970s) was the revolution in psychotropic drugs that saw the shutting down of asylums in the OECD states and their replacement by outreach programs. In the 1970s, Nigeria’s health infrastructure developed rapidly. However, it was not until the 1980s, when the health sector was seriously underfunded and understaffed, that some Nigerian specialists begun to question Western disease models and to reassess the value of traditional healers.

While Heaton’s study makes a number of interesting and valuable contributions to the literature, his main thesis remains unconvincing. There were, as he acknowledges, ample precedents for the Aro Village scheme founded by T. A. Lambo. More broadly, to sustain the claim that Nigerian psychiatry made a major contribution to a global science, there would need to be evidence that it influenced the North Atlantic psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders. There should also be—but are not—references to the influence of Nigerian psychiatry on the massive public health systems in India, China, and Russia.

For all its virtues, Black Skin, White Coats also provides little detailed insight into the social dynamics of Nigeria itself. For example, passing references to the social and economic history of Nigeria make it difficult to identify what led men and women through the asylum gates. We know from Blida (Algeria), Mathari (Kenya), and Ingutsheni (Zimbabwe) that violence, poverty, drink, or an organic brain disorder were the most common reasons for admission. We also know that elsewhere in Africa admissions...