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

When I was growing up in Marianao near Havana in the 1940s and 1950s, Mazorra, the insane asylum, had become part of Cuban folklore as the place where Liborio, the cartoon character of the archetypal white Cuban, would have dispatched every oddball he'd run into during his meandering through the city. That, and the periodic exposés in the Cuban press of the poorly fed, emaciated inmates dressed in rags remained engraved in the memory of my generation.

Jennifer Lambe, a young scholar at Brown University, has written a definitive story of the real Mazorra, from its foundation in the colonial Cuba of 1857 until the present, based on a thorough and magnificent job of mining the archives, periodicals, and documents related to that institution. Through Mazorra, Lambe also explores, as the subtitle of the book suggests, the history of mental health in Cuba and its relation to broad social and political processes before and after the revolution of 1959.

COLONIAL AND REPUBLICAN PERIODS

As Lambe writes, at its mid-nineteenth-century inception, Mazorra was designed as a warehouse for the socially marginalized, and for the emancipated former slaves and other people of color unable to earn a living due to old age or illness. Created by the colonial government as a way to exclude nonpaying inmates from charitable institutions, it featured a long-lasting policy of forced labor by its inmates that continued long after slavery was abolished.

From the end of colonial rule in 1898 to the 1959 Revolution, Mazorra went through recurring cycles of reform and regression. The US military interventions of 1899 and 1906 working jointly with enlightened Cuban administrators, such as Lucas Álvarez Cerice, the superintendent of Mazorra, made significant progress in the respectful treatment of inmates, electrification, the installation of new beds and new toilets, the implementation of work therapy, and the replacement of the nuns attending the patients with trained nurses. Conditions worsened considerably afterward, during the early Republican period leading up to the 1933 Revolution, caused by the scarcity of doctors and reduced budgets that brought about considerable overcrowding. The theories of the Italian criminologist Cesare Lombroso and of American eugenics led to racist notions reflected in the treatment of patients at the institution. For example, criminologists and medical doctors working there argued that white women had more difficulty giving birth because their vulvas occupied a higher location, which "explained" why black women had more children.

The mass revolution that overthrew the dictatorship of Gerardo Machado in 1933 awakened great social and political expectations that were for the most part frustrated but whose reformist thrust continued unabated up to the 1950s. This was reflected in the advances in social legislation enshrined in the socially progressive and democratic Constitution of 1940. In the specific case of Mazorra, President Ramón Grau San Martín (1944–1948), a university professor of physiology who had been one of the principal leaders of the 1933 Revolution, appointed Dr. Esteban Valdés Castillo, a noted forensic psychiatrist and the director of a well-known private clinic, as the institution's new director. Valdes Castillo installed a full medical staff, including ninety-six physicians, of which twenty-five were psychiatrists; developed occupational, art, music, gym, and play therapy programs; acquired modern scientific equipment; and erected a baseball stadium and other sports arenas. Most important, he introduced the medical treatment model of inmates as patients, instead of deviants. Unfortunately, his directorship lasted a little more than a year. He was removed after being accused of irregularities in state credits for the hospital budget, but this accusation has been challenged by accounts that have blamed political maneuvering for his firing. Not too long after Valdés Castillo was fired, Grau named Luis Suárez Fernández, a neurosurgeon and brother of Miguel Suárez Fernández, the head of the Senate, to direct Mazorra. With this appointment began the regression phase of the cycle with the implantation of institutional politicking and...