Читать книгу Rainforest Asylum - Sara Ashencaen Crabtree - Страница 23

Sashidharan and Francis (1993) note that the eighteenth century Enlightenment saw not only the development of the new profession of psychiatry but also of theories about race and morbidity. These informed early views of psychiatry and continue, so it is argued, to preoccupy the profession today. The authors assert that while theories of race were traditionally divided into hierarchical relationships, wherein European superiority was contrasted with the inferior, colonised races, these were now recast as theories of deviance revolving around the descendants of former colonised subjects (Sashidharan and Francis, 1993).

In relation to difference and diversity, European observers have long entertained an anthropological interest in regional phenomena and their effects on local Third-World populations. Sadowsky (2003), however, identifies that anthropology as a discipline is itself a product of colonial encounters with new cultures; and that arising from these the concept of cultural relativism has developed.

Cleary and Eaton (1992) and Ong (1995) argue that in Borneo and Malaya anthropology served to aid the efforts of the colonialists in enforcing social control through the categorisation of races. In Sarawak, this led to the eventual segregation of ethnic groups (Cleary and Eaton, 1992). Racial categorisation was also a feature of mainland Malaya under colonial rule; however, the sinister overtone of a eugenics-style agenda at play is questionable. The colonial objectives, articulated in the negotiations for Independence, were to afford ‘inalienable genealogical and geographical right to the land and its fruits to the bumiputera’ to protect their interest from the entrepreunial successes of the tenacious migrants from China and the Indian subcontinent, for example (Baba et al., 2010; Chua, 2007: 271). Despite the ironies of such migration having been encouraged by the colonial authorities in the first place, in order to assist in the development of the economic infrastructure, and to more effectively exploit the resources of the Malayan archipelago, these protective policies were summarily adopted by the new postcolonial government.

The fruitful alliance between anthropology and psychiatry continues, as evidenced, for example, by the renowned work of psychiatrist anthropologist Arthur Kleinman. Emile Kraepelin, for instance, carried out extensive travels in Java and Malaya, noting regional manifestations of mental disorder (McCulloch, 2001). In Sarawak by the mid-twentieth century the position of the ‘Government specialist alienist’ and director of the Sarawak Mental Hospital was filled by Dr. K.E. Schmidt who brought with him from Europe many of the experimental advances in psychiatric therapies prevalent in that period. In addition, throughout most of his career in the region, Schmidt, infected, it would seem, with the true zeal of the stereotypical colonial psychiatrist, was busily engaged in the study of the ethnic and cultural peculiarities amongst patient populations and published widely on that topic (Chiu et al., 1972; Nissom and Schmidt, 1961; Schmidt, 1964; Schmidt, 1967).

In addition, the psychoanalytic tradition drew inspiration from the colonial enterprise where a bi-directional influence of psychological interpretations can be detected. Although Khanna (2003) rightly insists on parochialising the psychoanalytic tradition as located within a specific historical-cultural moment, the penetrating and appropriating objective of colonialism offered, appropriately, a rich source of symbolic terrain to probe. The alien and unknowable quality of Africa was symbolically used by Freud in describing women’s strange sexuality as the ‘dark continent’ in reference to phraseology by the nineteenth century explorer, Henry Morton Stanley (Khanna, 2003: 49). Psychoanalysis was typically preoccupied with the irrational fixations and neuroses of the immature mind, those of children and potentially women and primitive people as well (Khanna, 2003). Transported from Europe, psychoanalysis rooted tentatively in India and there evolved to reproduce a new indigenised interpretation of Freudian analysis, such as in relation to the Oedipal Complex, where it is the father, rather than the son that is castrated; allowing Keller (2001: 303) to make a pointed political commentary on the patriarchy of the British Raj and attitudes towards it. Pathological conditions exerted a fascination for Europeans abroad, but where madness, unlike in Europe, does not appear to have been viewed as a particularly feminised condition, especially if based on the numbers of admitted women to asylum across ethnic boundaries. Accordingly, Laura Stoler, in reference to Edward Said’s analysis of Orientalism, indicates that Asian women preoccupied the fantasies of ‘the imperial voyeur’ in a different context from that which tended to animate the amateur anthropologist of this period (Stoler, 1991: 54). However, as Keller (2001) elucidates, Ernst (2010) explains this anomaly as the constructed notion of the symbolic feminisation of the subject nation yielding inevitably to the masculine authority of the imperial powers. (2010). Instead, the conditions of indigenous women in relation to mental disorders were subsumed under those of generic male conditions, with rare exceptions, such as that shown towards the phenomenon of latah in the Malayan regions, defined as a nervous affliction characterised by involuntary verbal and bodily repetitions, frequently obscene in nature (Winzeler, 1995).

Latah, in its passive, imitative, non-voluntary and mechanical manifestations, was seen primarily as a disorder of Malay and eventually Dayak women (Spores, 1988; Winzeler, 1995). Ronald Simons (1996) by contrast, argues that latah is not a condition confined to a specific culture or region solely, but is far from being unknown as a startle response in the West as well. Culture merely dictates the form and degree of the reaction, as well as conferring whatever benefits (or otherwise) may be conferred upon the ‘sufferer’. If correspondingly downplayed in the West, latah appears to have a distinct social role to play in Southeast Asia (Simons, 1996). In this vein, Aihwa Ong (1990) describes how latah, once traditionally associated with older Malay women, has become a common feature amongst young Malay, female industrial workers caught between conflicting, cultural gender norms. Here latah appears to act both as a generalised indicator of tension as well as a possibly that of resistance to these political and cultural contradictions.

Colonial enthusiasts, both contemporary and historical, have long expressed curiosity about such local phenomena as koro: an hysterical anxiety that the sufferer’s genitals or nipples are fatally receding, and the phenomenon of amok as well. These were being increasingly viewed as simply bizarre local manifestations of known European disorders, albeit demonstrated at a more basic, primitive level (Littlewood, 2001; Mo et al., 1995); although one serious outbreak of koro in Singapore was noted as late as 1967 (Ng and Chee, 2006). Winzeler (1995) goes on to argue that this perceived tenuous commonality with Europeans and their mental disorders would not suspend European value judgements concerning Malayan people and their propensities towards mental illness.

In Malayanist versions of Orientalism, sensuality and femininity … were seldom raised, but instability was given great emphasis. It was axiomatic that Malays, Javanese and other Malayan peoples were by nature ‘sensitive to the slightest insult,’ ‘volatile,’ preoccupied with maintaining balance and composure and so forth. Such psychological tendencies were held to be in part a matter of inherent character and in part a consequence of despotic political rule and a rigidly hierarchical social order that was to be changed through the creation of a new way of life under European guidance (Winzeler, 1995: 4).

In this analysis, therefore, colonial rule could be seen as imposing a fundamentally civilising and benevolent power on territorial possessions that would sweep away regional and traditional tyranny, and bring order and medical help to local populations, a view which Ernst (2010) dismisses as mere mythology. The issue of amok demonstrates this point in its description, as attributed to an English physician in 1891, as being a ‘blind furious homicidal mania’ that was ‘peculiar to the Malay race’ (J Teoh, 1971: 20).

Amok was considered not only a disorder of the Malay (as well as the Javanese) individual but one that was peculiar to men and dishonoured men at that.

When the Malay feels that a slight or insult has been put upon him … He broods over his trouble, till, in a fit of madness, he suddenly seizes a weapon and strikes out blindly at everyone he sees - man, woman or child, often beginning with his own family (Swettenham, 1906: 143).

Murphy states, however, that incidents of amok increased in parallel with the colonisation of settlements by Europeans in the eighteenth and early nineteenth century (1973). Although in rural areas amok was still considered an honourable response to intolerable triggers, in the Europeanised urban areas, the social factors were ignored in favour of explanations pointing towards insanity or perhaps somatised physiological conditions. By the 1930s a general diagnosis of schizophrenia was applied to the condition, which by this time had become comparatively rare (Murphy, 1973). The marked decline of cases of amok, standing in comparison with its former and rising prevalence, conforms with Golberg’s observation that the medicalisation of madness could usefully be employed to support State policy, in this case that of colonialism (Goldberg, 1999).

Western responses to amok were divided, with opinions varying between whether this sort of indiscriminate slaughter could be classified as plain crime or insanity; medical opinion eventually veering towards the latter (Hatta, 1996; Spores, 1988). Commensurate with Murphy and Winzeler’s arguments, for Spores the gradual demise of amok was related to the enormous social changes taking place in feudal Malaya through the imposition of colonial law and order. This, combined with the medicalisation of amok, resulted in colonial authorities branding the amok runner a lunatic rather than a notorious anti-hero, with all the associated stigma that this conjured up for Europeans and imparted to colonial subjects (McCulloch, 2001).

The colonial psychiatrist therefore found himself in the powerful position of becoming the undisputed ‘arbiter of deviance’, redefining behaviours previously thought of as little more than local oddities towards classifications of mental disorders, from mild neuroses and hysterias, to the seriously deviant and criminally insane (Romanucci-Ross, 1997a: 18).

Psychiatry, with its function of defining, maintaining and ‘treating’ psychological disorder, often identified in the context of social disorder, provides the scientific basis and the legislative and therapeutic justification for a particular approach in dealing with madness. Furthermore, by asserting its expertise in dealing with madness, psychology provides the glue that binds the individually deviant behaviour in the socially sanctioned procedures for incarceration (Sashidharan and Francis, 1993: 98).

Psychiatric opinions could therefore be seen as a useful tool, one that aided and empowered colonial authorities to apply methods of control towards labelled deviant individuals on the grounds of civil order.

The anthropological and medical curiosity towards regional behaviours reframed as ‘mental disorders’ have continued to excite psychiatric interest for Western and Western-trained psychiatrists. In the mid to late twentieth century interest in the so-called ‘cultural-bound syndromes’ generated large-scale research intent on establishing classifications that were strongly reminiscent of the endeavours of colonial psychiatry:

The extent to which such patterns could be fitted into a universal schema depended on how far the medical observer was prepared to stretch a known psychiatric category (Littlewood, 2001: 4).

Consequently, the interest in culture-bound syndromes can be read as providing continuing examples of perceived ‘otherness’ for Western observers, which become dislocated from the meaning associated with their manifestations. Culture-bound syndromes are viewed as strange exotica and reinterpreted within a framework of classification to make them more intelligible to unfamiliar audiences. According to Naomi Selig (1988: 96) the spate of cross-cultural psychiatric studies looking at the incidence of schizophrenia globally in the 1960s continued to exemplify the modern day ‘colonial stance’.

The attempt to identify universals in mental illness formed the basis of the World Health Organization (WHO) International Pilot Study of Schizophrenia in 1966. A significant finding to come out of this report was that, contrary to expectations, diagnosed schizophrenics in some developing countries had a better prognosis of recovery than those in the developed countries of the West. A follow-up study two years later supported this finding (Sartorius et al., 1977). Other psychiatric studies in cross-cultural variables have specifically attempted to focus on the connection between psychiatric disorders and the ‘sociocultural’ environment using very large statistical samples of ‘different groups of people’ (Leighton and Murphy, 1966: 3). Both the WHO report of 1966 and cross-cultural psychiatry have been subjected to sharp criticisms, largely on methodological grounds. Kleinman (1988: 14-15) points out how disease has been schematised into professional taxonomies, which when applied cross-culturally have fallen methodologically foul of what he describes as the ‘category fallacy’: that of applying cultural specific diagnostic nosologies onto culturally diverse samples. This unwarranted application of nosologies persistently ignores the underlying point that biomedicine itself is merely another form of ethno-medicine but is nonetheless ‘treated as a universal construct’ (Nichler, 1992: xii; Crandon-Malamud, 1997). This underlying assumption is clearly conveyed by descriptions of cross-cultural psychiatry:

As an underlying principle [my italics] we take an attitude of inclusiveness in these regards just as we do in dealing with the range of psychiatric phenomena as defined by Western thought…it seems unnecessary to waver in the face of cultural relativism as though we completely lacked valid standards of functioning’ (Leighton and Murphy, 1966:12-13).

Dawn Terrell (1994) consequently highlights the basic assumption of the study: that there is a universal identification of abnormality, this provides both the baseline for the study, and effectively begs the question by so doing.

In connection with these points and in reference to contemporary Black dissent regarding psychiatric practices and assumptions in the West, Chakraborty argues that for the most part modern psychiatry has failed to grasp the implications of ethnicity, and continues to interpret cultures from a Western ethnocentric viewpoint only.

For most psychiatrists culture has meant odd happenings in distant places that did not apply to them. The difference that they found in other cultures was ascribed to childlike behaviour, magical thinking, or inferior social or psychological development. Old healing traditions were thought to be unscientific; healers were judged to be abnormal or psychotic; and handbooks were written on how to study psychiatric symptoms among ‘natives’ (Chakraborty, 1991: 12).

Fernando et al. (1998) argue that contemporary as well as historical psychiatry continues to be a powerful instrument of social control of perceived and labelled deviants in society and go on to take issue with the racial bias that is built into psychiatric diagnosis. This, the authors contend, adopts stereotypic assumptions concerning the inherent alien nature, inferiority and dangerousness of black people leading to custodial care (Fernando et al., 2005). In this way racist assumptions from the past inform the present and duly resonate with Littlewood and Lipsedge’s point that the primitive being is already ‘in a sense ill’, or in other words, infantile and maladjusted and therefore less prone to mental illness (Littlewood and Lipsedge, 1989: 34). Accordingly, Kleinman (1988: 37) recounts that depression has been seen by ‘paternalistic and racialist’ psychiatrists as uncommon in India and Africa due, we are led to infer, to assumptions concerning the primitive and non-introspective cast of mind of non-Westerners (Fernando, 1995). Such views tally with the observation of Dr Schmidt in describing ‘Land Dayaks’ (the Bidayuh) as fundamentally superstitious, fearful and ‘ignorant’ (Schmidt, 1964: 142; Schmidt, 1967: 357).

The racist overtones of such views are transparently obvious to modern-day scholars, but the cultural presumptions inherent in contemporary generic biomedicine, embodied in every-day medical practice and malpractice with minority groups, are being increasingly testified to in medical journals (Bhugra, 1997; Bose, 1997; Cohen, 1999; McLaughlin and Braun, 1998; Murphy, 1978; Vanchieri, 1998).

Furthermore, through historical associations and contemporary training, the racism of ethnocentricity is not confined to the West but is duly exported to other countries. Acharyya, for instance, identifies psychiatric care with modern-day colonialism: whereby ‘Third-World psychiatrists’ trained in Britain incorporate the dominant paradigm so completely that they find difficulties in evolving new methods of dealing with mental illness within their own culture (Acharyya, 1996: 339). Contemporary critiques of racist assumptions and values in psychiatry form a useful prism to view modern-day practices in both the West and in former colonies such as Malaysia.