The Most Social of Maladies: Re-Thinking the History of Psychiatry From the Edges of Empire

Abstract

This paper argues that the colonial experience was never just “out there” but was a constitutive feature of the global development of psychiatry and, indeed, of social medicine itself. I show how regional knowledge about psychiatry, produced in scientific exchanges across colonial Southeast Asia over four decades and culminating with the 1937 Bandung Conference, became part of new international approaches to health care in rural areas, and later, in developing nations. In particular, I discuss how the embrace of the agricultural colony as a solution to the problem of asylum overcrowding occurred at the same moment that colonial public health experts and officials were moving away from expensive, technocratic fixes to address indigenous health needs. Yet in the search for alternatives to institutionalized care, including forms of family and community support, colonial psychiatrists were increasingly drawn into unpredictable and unwieldy networks of care and economy. Drawing on research from Vietnam, this paper decenters the asylum so as to recast the history of colonial and postcolonial psychiatry as integral to the history of social medicine and global health. The paper then returns to Bandung in 1955, the site of another famous meeting in the history of Third World solidarity, to consider how the embrace of the “Bandung spirit” may provide new avenues for decolonizing the history of colonial and postcolonial psychiatry.

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“…Identifying with neurasthenia suggests an "appropriation from below" in which some Vietnamese individuals characterized themselves as suffering from an excess of civilization (Monnais 2012). The medicalization of anxiety in Vietnam during the 1920s and '30s was both produced by the desire for evidence of civilized modernity, viewed by many Vietnamese as necessary to national independence, and indicative of a growing medicalization of Vietnamese society (Edington 2021). However, since then, the status of neurasthenia in Vietnam as proof of one's own enlightened-if overburdened-state of mind has changed dramatically.…”

“…During the early colonial period, psychological theories from the West found a receptive audience among the cosmopolitan elites in urban Vietnam, but after World War I, leading Vietnamese intellectuals agitating for national independence favored the political philosophies of Locke, Rousseau, Marx, and Engels (Marr 2000). Meanwhile, French psychiatrists-and, eventually, their Vietnamese counterparts in the colonial asylums-pioneered several therapeutic approaches that became widespread, not just in other colonial holdings in Southeast Asia but in the metropole as well (Edington 2019). For example, bridging the divide between the asylum and its surrounds, racialized notions of labor therapy were designed to prepare patients for life after discharge and instill self-discipline by having them perform agricultural labor.…”

“…In the early twentieth century, Vietnam's academic, popular, and literary press became the site of intense debate over and experimentation with the role of the self in public and family life. For example, citing Émile Durkheim, Vietnamese scholars argued that rising rates of mental illness and suicide were the byproducts of modernization, not a deficiency in traditional culture (Edington 2019). Between World Wars I and II, the Vietnamese intelligentsia resisted colonial rule by drawing on Western scientific knowledge and medicine that the French believed were too advanced for Vietnamese to appreciate (Nguyễn-Võ 2008).…”