Colonialism and Psychiatry (review)

Although still small compared to the general historiography of psychiatry, the study of colonial psychiatry has progressed to the point where we might begin some systematic comparisons. The pioneer writer on the subject, Frantz Fanon, generalized very widely from the Algerian context he knew firsthand, and it is becoming clear that despite his considerable discernment, colonial contexts have differed, and so have their psychiatric problems and services. This volume is therefore a welcome contribution. Like many edited volumes, it is uneven, but the best chapters are worth reading, and overall it is an important addition to the field.

Roland Littlewood, the coauthor of an excellent earlier book on ethnic minorities and psychiatry, provides Colonialism and Psychiatry with a smart introduction that outlines basic problems in cross-cultural psychiatry. Often, these problems are discussed as simply issues of cultural difference, and one of the strengths of Littlewood's introduction is that he places political questions at the foreground, without minimizing the significance of culture. He ends the introduction by asking, "Did colonization do anything more than re-label local deviances; can we say that in itself it was pathogenic in any empirical sense?" (p. 14). This is a good question, and one that Fanon thought could be answered affirmatively.

Certainly Jock McCulloch's chapter on colonial psychiatry in Africa, and Joop de Jong's sweeping and sharp overview of psychiatric differences between developed and developing countries, provide evidence for the relabeling of local deviances. Other areas covered in Colonialism and Psychiatry include Australia, India, and Latvia; Milton Lewis's chapter on Australia is especially helpful in outlining the ways the Australian case followed or diverged from the trends of European psychiatry. A chapter about differential access to psychiatric treatment by the Welsh is so cluttered with broad truisms about the social construction of reality that it never makes a really significant argument about any empirical material.

A number of the chapters make the common assertion that folk psychiatries and agrarian cultures provide more "meaning" for those afflicted with illness, compared with the arid, depersonalized medical culture of the West. This claim has become hackneyed, and more-effective comparison will pay attention to the kinds of meaning and explanation offered by different medical cultures, rather than making pseudo-quantitative claims about which culture offers more meaning.

The chapters in this volume leave one unable, in the end, to answer Littlewood's question as to whether colonization was itself pathogenic. A more modest generalization may be suggested, though: colonial psychiatry has provided a rich discourse for describing and theorizing psychiatric problems in the colonized world, but a relatively poor concrete clinical apparatus for treating those problems.