Surfacing Up: Psychiatry and Social Order in Colonial Zimbabwe, 1908–1968 (review)

This study emerges as part of a growing subfield within the history of medicine, namely that of "colonial psychiatry," spearheaded by Megan Vaughan's work on the Zomba Lunatic Asylum in Malawi and her subsequent book, Curing Their Ills: Colonial Power and African Illness (1991). Lynette Jackson takes her title, Surfacing Up, from her conversations with Zimbabwe's first black psychiatric nurse, who described the process by which those who were presumed to be mad "surfaced" into view and most importantly, according to Jackson, became a potential source of trouble within the colonial social order (pp. 11–12). Like the histories of colonial psychiatry that have preceded it, this study of Ingutsheni Mental Hospital near Bulawayo in the former Southern Rhodesia proposes to read the tensions, conflicts, and "madnesses" of the colonial system through the prism of the mental hospital and those deemed mad—listening hard for African subjects' individual voices where the regime that governed them heard only "noise."

Surfacing Up begins and ends with a postcolonial moment, highlighting the revolutionary reform tactics of independent Zimbabwe's first black minister of health, who personally led the movement to expose and then dismantle the appalling race-based system of mental health care employed by Ingutsheni Hospital since its establishment in 1908. The priority placed upon the need to reclaim sites like Ingutsheni, says Jackson, not only connotes the acute awareness of the "psychic violence of colonialism," but also illustrates "the ways in which postcolonial mental health care reforms were resonant of postcolonial expectations" (p. 2). Indeed, Zimbabwe triumphed in this regard for a time, putting into place the most inclusive and effective health-care system in sub-Saharan Africa until structural adjustment programs prompted a rethink about the economics of free health care for the poor (p. 190). Somewhat unfortunately, although not surprisingly in a study of colonialism (the study ends in 1968), it is during the transition to independence that Jackson allows the African patient voice to retreat once again into the background. It would have been an added strength to pursue in detail the ways in which a nascent African government set out to restore the dignity and hope of some of society's most disenfranchised people.

The majority of the book details the institutional history of Ingutsheni, from its unheralded origins as a minor place of confinement to its later pretensions, however misguided, as a model hospital for psychiatric treatment and recovery, based dubiously upon one physician's dedication to "shock" therapies. However, most interestingly, in back-to-back chapters (3 and 4) Jackson traces the gendered nature of African routes to the colonial asylum. These acts of surfacing up were "linked to a suspect's mobility and location on the European colonizer's spatial, social, and economic map" (p. 102). The hospital's African male patients were first observed and then found to be diagnosable as a result of their proximity to, and incorporation into, the colonial economy. Mass migration and urbanization are the main culprits here, and Jackson relies heavily on the well-developed literature on the political economy of mining in southern Africa to buttress case studies of migrants, "criminals," and prophets.

If African men were sometimes found to be mad due to the ways in which the colonial authorities presumed to know them, African women experienced just the opposite. Their journeys to Ingutsheni were a result of the peripheral nature of their identities under colonialism: that they occasionally emerged at all—and were perceived to be "stray" or "wandering"—was reason enough for the authorities to presume pathology (p. 109). While it is no surprise that the racist ideologies of colonial occupations should re-create themselves within the confines of colonial institutions, histories of psychiatry still provide unique insights into the manner in which the colonizer and...