Madness in Buenos Aires: Patients, Psychiatrists, and the Argentine State, 1880–1983 (review)

It has become a truism that of all the societies of Latin America, Argentina is the most psychoanalyzed: at any given moment half the population are analysts and half patients, and then they switch sides. But parallel to this mid-twentieth-century psychoanalytic culture (treated in recent years in interesting works by historians, among them Mariano Plotkin’s Argentina on the Couch [2003] and Freud on the Pampas [2001]), there has long been a public psychiatric establishment, mostly supported by the state and not especially given to the application of psychoanalytic theory in dealing with the mentally ill. Argentina’s self-conscious program of modernization has embraced the psychiatric hospital in particular as both site and emblem of medical progress. Focusing for the most part on Buenos Aires, Jonathan Ablard has given us a robust institutional history of the country’s psychiatric regime, stretching from its pre-history in the mid-nineteenth century to the end of the military dictatorship in 1983 (although he cites no clinical cases after 1955 out of respect for people who might still be alive today). Ablard himself strongly suggests that the book uses psychiatric institutions as a case study to examine the history of the Argentine state rather than the history of psychiatry itself, and the emphasis certainly tilts his study in that direction, although at no time does he lose sight of the peculiarities of dealing medically and legally with the mentally ill. Despite the waxing and waning of government interest in supporting public psychiatry, the leitmotif running through the study is the failure of state means to achieve state goals in this regard. Hospitals were always overcrowded and underfunded, their support dependent upon state capacity, the vagaries of the political regime, and the health of the country’s export sector. Where Ablard does deal with mental disturbance, it is from the point of view of social constructivism rather than psychiatric realism. The writing is crisp, and the text is replete with striking photographs of the mad, mad-doctors, and madhouses.

The early sections of the book look at nineteenth-century institutional psychiatry, telling a relatively familiar story with an Argentine twist. Primitive psychiatric establishments proliferated under the liberal regime of Bernardino Rivadavia and declined under the conservative dictatorship of Juan Manuel de Rosas. The post-Rosista period saw the introduction of ideas about moral therapy for the treatment of the mentally disturbed rather than the application of harsh confinement and other methods. By the time waves of European immigrants hit the Argentine shore from 1880 or so, immigration began to be seen as the locus of psychopathology, linked to ideas about hereditary degeneration, and became a major public health consideration because of the numbers of newcomers and fears of social contagion. The Argentine fin de siécle saw the opening of a monumental new female psychiatric hospital in Buenos Aires in 1898, by which time biological and criminological theories of psychopathology had become the dominant paradigms. Somatic markers were used to identify forms of mental illness, while nosology and therapeutic regimens were also strongly influenced by heavily gendered notions of normal behavior. Despite continuing problems of underfunding and overcrowding, by the early twentieth century the Argentine psychiatric regime was touted as the most advanced in Latin America.

By the 1920s, when the physician and social thinker José Ingenieros was writing on psychology and criminality, the innovative treatment of the mad was seen as a leading indicator of Atlantic modernity. The period of the 1930s through the 1950s saw the introduction into Argentine institutional psychiatry of surgical-medical interventions adopted from Europe and the United States, including electroconvulsive and insulin shock therapies, lobotomy, and neurosurgery, but the chronic failure on the part of the Argentine state to support its modernizing program with resources undermined the reforms and advances yet again, a story that was to repeat itself for...