Black Skin, White Coats

Nigerian Psychiatrists, Decolonization, and the Globalization of Psychiatry

Matthew M. Heaton

• Publisher: Ohio University Press
• Year: 2013
• Print ISBN: 9780821420706
• eBook ISBN: 9780821444733
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

Black Skin, White Coats is a history of psychiatry in Nigeria from the 1950s to the 1980s. Working in the contexts of decolonization and anticolonial nationalism, Nigerian psychiatrists sought to replace racist colonial psychiatric theories about the psychological inferiority of Africans with a universal and egalitarian model focusing on broad psychological similarities across cultural and racial boundaries. Particular emphasis is placed on Dr. T. Adeoye Lambo, the first indigenous Nigerian to earn a specialty degree in psychiatry in the United Kingdom in 1954. Lambo returned to Nigeria to become the medical superintendent of the newly founded Aro Mental Hospital in Abeokuta, Nigeria's first "modern" mental hospital. At Aro, Lambo began to revolutionize psychiatric research and clinical practice in Nigeria, working to integrate "modern" western medical theory and technologies with "traditional" cultural understandings of mental illness. Lambo's research focused on deracializing psychiatric thinking and redefining mental illness in terms of a model of universal human similarities that crossed racial and cultural divides.

Black Skin, White Coats is the first work to focus primarily on black Africans as producers of psychiatric knowledge and as definers of mental illness in their own right. By examining the ways that Nigerian psychiatrists worked to integrate their psychiatric training with their indigenous backgrounds and cultural and civic nationalisms, Black Skin, White Coats provides a foil to Frantz Fanon's widely publicized reactionary articulations of the relationship between colonialism and psychiatry. Black Skin, White Coats is also on the cutting edge of histories of psychiatry that are increasingly drawing connections between local and national developments in late-colonial and postcolonial settings and international scientific networks. Heaton argues that Nigerian psychiatrists were intimately aware of the need to engage in international discourses as part and parcel of the transformation of psychiatry at home.

1

Colonial Institutions and Networks of Ethnopsychiatry

African mentality—East, West and South—is, for certain reasons, more uniform than that of literate cultures, such as that of Europe.

—J. C. Carothers, 1953

The position of lunatics in prisons is considerably worse than it would be if they were left to wander the streets.

—C. E. Marlow, Acting Secretary of Health, Nigeria, 1957

While this book is not centrally concerned with colonial psychiatry, it is important to provide some early background on psychiatry in colonial Nigeria in order to establish the professional context that Nigerian psychiatrists encountered in their efforts to transform psychiatric institutions from the 1950s. This chapter makes three arguments about the nature of psychiatric theory and practice in colonial Nigeria that will continue to resonate through the remainder of the book. First, the ways that psychiatric institutions developed in colonial Nigeria were intimately bound up with the philosophy and ideology of European power. The British colonial government throughout most of the colonial period sought to minimize public service expenditures both as an economical measure and because it had little desire to actively transform indigenous communities through heavy-handed policy initiatives. As such, colonial mental asylums were purely institutions of social control designed to house only the most dangerous and criminal “lunatics.” They were strictly custodial in nature, providing little to no psychiatric medical treatment. And because the colonial government was not willing to make psychiatric service allocation an administrative priority, colonial asylums remained chronically underfunded, understaffed, and overcrowded throughout the colonial period. The state of psychiatry in colonial Nigeria was therefore a perpetual embarrassment to the colonial government and a source of alienation for Nigerian subjects who had no reason to consider psychiatry a legitimate healing system prior to T. Adeoye Lambo’s intervention at Aro Hospital beginning in 1954.

Second, the minimalist approach to psychiatric service provision was at least partly justified by a body of knowledge called “ethnopsychiatry” that sought to understand the psychological functioning of non-Western peoples, particularly in comparison to what were considered to be European “norms.” Ethnopsychiatric studies in Africa were generally conducted in colonial settings and, as such, inherited many of the racially hierarchical assumptions that formed the basis of social relations in colonial environments. Ethnopsychiatry became a remarkably consistent body of knowledge that functioned on the assumption that European and African psyches were inherently different and, as such, that the rapid transformation of African societies along European lines was likely to do much more harm than good in the short term. In these psychological constructions, African psyches, lumped together on the basis of racial affinity, were imperiled by the social and cultural transformations of colonial rule, which they were considered psychologically ill-equipped to negotiate. Mental illness in Nigeria, as in other parts of the continent, was primarily seen as a problem for colonial subjects who deviated from constructions of “normal” African psychology. In the colonial context, the most easily recognizable deviation from the African “norm” was the “detribalized” African whose “traditional” worldview was being assailed by the attempt to assimilate European “civilization.” The psychologically disturbed and the “detribalized” came to be indistinguishable in many colonial settings, linked by virtue of being “insufficiently ‘Other,’ ” as Megan Vaughan has put it.¹

Third, and most important for the overall focus of this book, constructions of and policy approaches to mental illness in colonial Nigeria were the product of both local and international forces. The colonial government of Nigeria thrice brought in international experts to examine its psychiatric infrastructure and provide advice on how to improve it. While these experts suggested the extension of European-styled psychiatric facilities, they also reinforced notions of racial difference and the concern that culture clash between the races was likely to result in more, not less, mental illness among African populations. These experts were part of an international community of psychiatrists who were reaching similar conclusions. Local attitudes toward mental illness among colonial officials in Nigeria were conveniently reinforced by scientific knowledge that was international, more or less unanimous in its assumptions, and therefore unequivocal in its application. The broader body of knowledge about the nature of the African psyche contributed to the entrenchment of a basket of binary oppositions: between white and black, between European and African, between “civilization” and “primitivity,” and between “modern” and “traditional” at the level of international science. This coherent body of ethnopsychiatric literature on the nature of the “African mind” had clearly established the terms, language, and debates in professional psychiatry in relation to Africa by the 1950s.

INDIRECT RULE AND COLONIAL ASYLUMS

The history of colonial mental health services in Nigeria is for the most part one of neglect and inertia. The first large-scale asylums for the confinement of the insane opened in 1906 in Yaba, a suburb of Lagos in the southwest; and Calabar, in the southeast. Although chronically overcrowded and underfunded, these two remained the only centrally run asylums in Nigeria until the opening at Lantoro in 1946 of a third asylum, which was designed specifically as a place to send mentally disturbed soldiers returning from overseas deployments in World War II. Prior to the opening of Aro Mental Hospital in Abeokuta in 1954, mental institutions were strictly custodial in nature, designed to protect the general population from violent offenders whom the courts deemed too dangerous to be placed in the general prison population or to be remanded to the custody of relatives. The asylum system in Nigeria offered no curative or therapeutic treatment for its “patients”; indeed, other than the brief tenure of Matthew Cameron Blair in the early 1920s, Nigeria did not boast a single qualified European-trained psychiatrist until the arrival of Dr. Donald Cameron in 1949.² Even the most violent and dangerous “lunatics,” to use the parlance of the times, could not be housed in the two overcrowded government-run asylums, and instead were placed in segregated sections of local prisons or in native administration asylums, most of which lacked trained medical staff qualified to look after the needs of the mentally ill. Conditions in asylums were often dilapidated, unsanitary, and cruel, with inconsolable inmates sometimes chained to walls or rings anchored in the ground. Those mentally disturbed individuals who were neither dangerous nor criminal tended to remain in the care of friends, relatives, and communities to be treated by indigenous medical practitioners as deemed appropriate by their caretakers.³

The overcrowded, unsanitary asylum system that could not claim to offer curative care to any of its patients was a continual embarrassment to the colonial government. The general opinion among government officials throughout the colonial period was that the existing conditions in Nigeria’s asylums were unacceptable, but at no point was a suitable plan of reform implemented. This was to a great extent because the issue of mental health policy was intricately tied to one of the key debates regarding the philosophy of the colonial project in Nigeria, namely whether the emphasis of the colonial regime should be on providing stability to the subject population or on undertaking grand projects of social transformation. In other words, should colonial rule be based more on the philosophy and practice of indirect rule or on the idea of modernization? “Indirect rule” implied a general desire for the preservation of indigenous political structures and cultural traditions. “Modernization” implied the deliberate erosion of traditional ways and their replacement with European models. This dialectic is, of course, overly simplistic. The history of colonial Nigeria is redolent with stories of individuals, institutions, and policies that sought to negotiate some middle ground between these ideological positions. However, in the case of mental health policy, colonial administrations tended to favor a reliance on the indirect rule approach, with the result that the embarrassment of the existing asylum system was determined to be less damaging than the economic and social costs associated with expanding facilities and services to meet approximated need.

The conflict between “indirect rule” and “modernization” and efforts to reconcile them date back to the onset of British colonial occupation in the second half of the nineteenth century. British colonial rule spread in fits and spurts over the course of roughly forty years, beginning with the annexation of Lagos in 1861 and culminating with the defeat of the Sultan of Sokoto in 1903 and the incorporation of his remaining territories into the Northern Protectorate under the governorship of Lord Frederick Lugard. Colonial administrations that developed throughout Nigeria all relied on some variation of indirect rule, whereby British colonial officers ruled through indigenous authorities, whether they were Yoruba obas,⁴ Fulani emirs,⁵ or the infamous “warrant chiefs” of southeastern Nigeria.⁶ However, colonial officials in different parts of Nigeria had different agendas regarding the levels of economic and social transformation that should accompany British colonialism. Particularly in the early years of British rule, many colonial officials in the southern territories of Nigeria believed in the construction and expansion of European-styled institutions and infrastructure. For example, Lagos quickly became a locus for the creation of British-inspired institutions. By 1898, the colonial government in Lagos had established a medical department, which employed eleven European and three African doctors; a police service; and a public works department charged with the maintenance of public buildings and roads and the extension of electric lighting, telegraphs, piers, and public transport.⁷ Progressive-minded British colonial administrators in the south heavily promoted the extension of European education, among other things.⁸ From 1906, the Yaba and Calabar asylums served partly as a symbol of the colonial government’s power to intern the mentally ill, but also as a symbol of the nascent commitment of British colonial rule in the south to a colonial policy bent on the “modernization” of public institutions.

In the northern territories, however, indirect rule conformed to a different set of circumstances and took on an ideological mission very different from what had developed in the south. Lugard believed that the rapid and widespread extension of European ideas and institutions was likely to serve as a destabilizing force for colonial subjects, particularly in the north, where the overwhelmingly Muslim population had very little precolonial experience with Europeans. Lugard explained the form of indirect rule he developed in the north in terms of a “Dual Mandate” to run the colonies to the economic benefit of Britain, while at the same time promoting a tempered notion of progress toward Europeanization for colonial subjects. However, unlike the colonial administrators in the south, Lugard believed that the purpose of colonial rule was theoretically to alter only those customs, traditions, and institutions that the British deemed harmful to Nigerian progress, leaving existing cultures intact to the greatest degree possible. Unlike what was occurring in the south, the development of social services under Lugard’s indirect rule was to be undertaken only by local native administrations, not the colonial government, at their own expense and more or less on their own terms. Lugard believed that for the British colonial government to embark on such activities was a direct violation of the Dual Mandate, in that it constituted unnecessary colonial expenditure and purposelessly brought about the erosion of traditional social structures.⁹ In 1914, Lugard oversaw the amalgamation of northern and southern Nigeria into a single administrative unit. As the first governor-general of a unified Nigeria, Lugard decided that his form of indirect rule should be extended throughout Nigeria. As a result, the development of colonially funded education services and health-care systems ceased to be an administrative priority.

The entrenchment of an indirect rule philosophy based on the concept of budgetary parsimony and justified in terms of cultural unobtrusiveness had a strong effect on the development of psychiatric services in Nigeria. Some officials, particularly those associated with the Department of Medical and Sanitary Services (DMSS), repeatedly argued in the interventionist spirit that the colonial government had a responsibility to expand its facilities to meet the needs of Nigerians deemed mentally ill. However, colonial officials dedicated to the philosophy of Lugardian indirect rule believed that mental health was a cultural issue and, as such, should be left to the care of indigenous communities. Such cultural arguments were generally secondary and used circumstantially to justify the primary consideration: cost. Mental hospitals of the European style were expensive to build, maintain, and staff. They required a lot of land, access to large amounts of water, and had to be prepared to maintain patients for possibly many years at a time. European-styled mental health services were far beyond the budgetary means of the colonial government for most of the colonial period.

An examination of the specific debates surrounding the building of additional government-run asylums in Nigeria clearly illustrates the extent to which the philosophical undercurrents of indirect rule were influencing decisions to keep psychiatric facilities underdeveloped. By the mid-1920s, officials in the Department of Medical and Sanitary Services had begun to push for the erection of a new mental hospital in Abeokuta to reduce the number of “lunatics” who had to be housed in local jails.¹⁰ As of January 1926, the Yaba asylum was at 200 percent capacity, housing 48 patients in space designed to accommodate 24.¹¹ The DMSS proposed that given such conditions, there was a need to develop a new lunatic asylum and to appoint an official, qualified alienist to oversee it.¹²

While the DMSS pushed for the expansion of mental health facilities in both size and scope, other officials saw such proposals as beyond the responsibilities of the colonial government. Rather than expand facilities at the expense of the colonial government itself, many officials saw the establishment of native administration asylums as the ideal solution to accommodate mental patients. In fact, in the Northern Provinces, native administration asylums were the most common institution for the confinement of the mentally ill. By 1925, native administration asylums had been established in Bauchi, Bida, Maiduguri, Ilorin, Kano, Katsina, Keffi, Kontagora, Makurdi, Ibi, Sokoto, Yola, and Zaria.¹³ In 1926, the acting secretary of the Northern Provinces justified the use of native administration asylums in true indirect rule style, arguing to the director of Medical and Sanitary Services in Lagos that there was no “urgent need for Government intervention in such parts of Nigeria where native laws and customs exist as opposed to administration on European lines.”¹⁴ Such comments reflect the constant struggle of colonial officials to reconcile the fact that the existing asylum system was inadequate with the belief that direct intervention to improve the system would be both costly and culturally intrusive.

Seeking practical solutions to the debate between the DMSS and the secretariat described above, the Colonial Office commissioned an independent third party to report on the forms of mental illness in Nigeria and make recommendations for future care of the mentally ill. In 1928, Bruce Home toured twenty-five regions of Nigeria and compiled data from questionnaires sent to colonial residents and medical officers. Home’s conclusions came down strictly on the side of the DMSS. He declared Nigeria’s asylums woefully inadequate for the treatment of mental patients. He noted that asylum facilities were overcrowded, unsanitary, and at times inhumane, particularly in the use of chains to restrain the more restive patients. He compared the government-run asylums at Yaba and Calabar to prisons in their focus on containment rather than treatment, and urged the government to remodel Nigeria’s asylum system based on the design and methods of European mental hospitals. In addition to offering more therapeutic and curative treatment for mental patients, Home also urged the government to expand the size of its existing facilities to be able to accommodate at least four thousand patients on the intuition that demand for mental health services am...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgments
• Introduction Colonizing, Decolonizing, and Globalizing the History of Psychiatry
• Chapter 1 Colonial Institutions and Networks of Ethnopsychiatry
• Chapter 2 Decolonizing Psychiatric Institutions and Networks
• Chapter 3 Mentally Ill Nigerian Immigrants in the United Kingdom: The International Dimensions of Decolonizing Psychiatry
• Chapter 4 Schizophrenia, Depression, and “Brain-Fag Syndrome”: Diagnosis and the Boundaries of Culture
• Chapter 5 Gatekeepers of the Mind: Psychotherapy and “Traditional” Healers
• Chapter 6 The Paradoxes of Psychoactive Drugs
• Conclusion Nigerian Psychiatrists and the Globalization of Psychiatry
• Notes
• Bibliography
• Index