Madhouse: Psychiatry and Politics in Cuban History by Jennifer L. Lambe (review)

In Madhouse, historian Jennifer Lambe explores how Cuba’s Mazorra asylum, and the “social marginalization” that mental illness often engenders, can give us insight into the island’s social, cultural, and political life, as well as popular and medical notions about mental illness. Founded in the mid-nineteenth century during Spanish colonial rule, Mazorra was Cuba’s first institution devoted exclusively to the care of the mentally ill. The hospital’s function as a depository for society’s outcasts, including disabled slaves and destitute free people of color, was notorious in its early years. The first round of serious reform occurred during the U.S. occupation of the island from 1898 to 1902, when Progressives joined forces with Cuban nationalists who had fought to liberate Cuba. The renovated hospital came to symbolize the promise of Cuba’s future as a modern nation just as the decaying asylum it replaced symbolized the failure of Spanish rule.

Like most asylums around the world, Mazorra alternated between brief phases of reform and longer periods of decline. In this respect, Lambe notes a paradox: high points of reform often came during periods of authoritarian rule, including the U.S. occupation of 1898–1902, and the subsequent dictatorships of Machado, Batista, and Castro. Likewise, these moments of reform often involved the new regime, or its supporters, pointing to the decrepit state of the asylum as a mark of the corruption of the outgoing government. This practice was especially noteworthy post-1959. After the revolution, the national hospital was in a state of complete disrepair and its renovation became a symbol of the promise of the new government and its commitment to wide ranging public health initiatives. By 1966, the hospital was listed as one of the “world’s best psychiatric hospitals,” thanks in a large measure to the directorship of Dr. Eduardo Ordaz, who ran the hospital for over four decades (pp. 143–48). The story of Ordaz is especially striking as he remained both distant from the regime and a practicing Roman Catholic.

Tragically, the revolutionary government’s progress was marred by its use of psychiatry and psychology to regulate and control political dissent. Lambe highlights in particular the ways the regime simultaneously medicalized and politicized homosexuality as a marker of political dissent. The post-1959 period also witnessed the blossoming of industrial psychology, and Ernesto “Che” Guevara, a doctor by training, embraced “psychometrics” as a vital tool for revolutionary progress. In her final chapter, Lambe explores the meaning of “madness” as it traveled with exiles from Cuba to Miami and beyond. Most intriguing is her exploration of how popular notions of “nervousness” became further medicalized and emerged as a way to narrate the complex traumas of both the revolutionary reordering on the island and the displacement of migration. Lambe also highlights how revolutionary psychiatry repurposed older practices, especially work therapy, to the government’s ideological imperatives.

This ambitious book, which will serve as a launching pad for future researchers, provides a very thorough examination of Cuban psychiatry but would have benefited from a deeper engagement with various areas of scholarship. First, a more robust comparative framework might have helped readers see more clearly what is unique about Cuba. For example, Lambe discusses the relationship of work therapy to slavery and its enduring legacy on the island (p. 8). But work therapy, which included patients being enlisted to build their own hospitals, was a near universal practice, born of both financial necessity and the belief in work’s therapeutic benefits. Similarly, many other traits of Cuban psychiatry are found everywhere: overcrowding, shortage of care in the provinces, the fascination exerted by hospitals on the press, corruption, and the tension between hospital as place of cure and prison. These rise and fall narratives of hospitals are common in the historiography, so what is specific about the Cuban case? Similarly, Cuban psychiatry’s focus on the...