Madness in culture: is mental disorder universal?
This paper will look at the issue of madness in culture, looking at the issue of whether mental disorders are a universal concept, with particular reference to the Nigerian culture. As Sadowsky (2003) argues, the crude maxim “what is mad in one culture might be considered sane in another” described the approach to ‘cultural psychiatry’ research regarding mental illness for many years; that psychiatric disorders were viewed relatively suggested that these disorders were no more than cultural constructions and thus not ‘real’ diseases (see Sadowsky, 2003; p. 210). In his book, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria, Sadowsky focuses on madness, insanity, as a social process. Whilst not denying the reality of madness as an illness, Sadowksy (1999) argues that madness and normalcy must be viewed at all times, and especially in the context of a Nigerian colonial setting, as part of a continuum: as Sadowsky states, “the insane occupy a position on the spectrum containing the normal and the pathological” (1999; p. 51), and are products of specific social and political circumstances, which must be fully understood in order to understand the label ‘insane’ within a colonial Nigerian setting.
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Thus, this essay looks at how madness in Nigeria evolved in the colonial period, and beyond, and how madness was understood within a colonial framework. The essay then moves on to look at cultural treatments of madness in Nigeria, and genetic and physiological accounts vs. cultural and historical differences in understanding madness within a colonial context, using examples from Nigeria. Finally, syndromes that come and go, such as hysteria and delusions, will be discussed, using the example of persecution delusions from studies of two mental asylums in Nigeria, as discussed in the work of Sadowsky (1999).
The history of madness in Nigeria
Focusing on two mental asylums in Nigeria, the Yaba ‘lunatic asylum’ and the Aro Mental Hospital in Abeokuta, Sadowsky (1999) provides a review of madness in Nigeria, from colonial times to independence. Sadowsky’s argument in his 1999 book, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria, is that through developing an understanding of these institutions, it is possible to come to understand “the struggles within the colonial state over the use of asylums, negotiations in colonial society about the definitions of insanity, the processes which led to confinement and release and the formation of specific psychiatric discourse (p. 9). The book provides an examination of how, when and, most importantly, why Africans were defined as insane and the ways in which definitions of insanity were related to the political context pf colonialism (Stilwell, 2000). Sadowsky (1999) does not argue that colonialism caused insanity but, rather, argues that the content and expression of madness reflected the pressures, stressed and strains brought on by colonial rule, thus providing a social history of insanity in a colonial setting.
As Sadowsky (1999) argues, the debate surrounding psychiatric labeling theory must be centered on the ways in which mental illness is a construct of “the particular historical formations” (p. 112); colonial asylums could be placed on a spectrum from ‘custodial and coercive’ to ‘supportive and therapeutic’, although the vast majority of mental asylums in colonial Nigeria were crudely coercive, due to the cross-cultural barriers and the different perceptions of social relations as held by African patients and colonial medical staff and authorities. It was only well in to post-colonial times that subtler forms of social control and therapeutic practice evolved.
Cultural treatments of madness in Nigeria
As has been seen, Sadowksy (1999) argues that madness and normalcy must be viewed at all times, and especially in the context of a Nigerian colonial setting, as part of a continuum: as Sadowsky states, “the insane occupy a position on the spectrum containing the normal and the pathological” (1999; p. 51), and are products of specific social and political circumstances, which must be fully understood in order to understand the label ‘insane’ within a colonial Nigerian setting. Thus, the cultural context of madness, in terms of understanding madness from a culturally relativistic viewpoint, and from the viewpoint of colonialism, is fundamental in understanding the cultural treatments of madness in Nigeria. Accounts of madness and understanding the responses to madness in a colonial Nigerian setting cannot be understood, interpreted, without also fully understanding the historical, social and political setting at that time.
In general, however, it can be seen, from Sadowsky’s work, that madness was treated, in a blanket manner, as a response to colonialism, as a manifestation that the ‘primitive’ Nigerians could not cope with modernization and that, as such, delusions, deliria and hysteria were almost to be expected, as a reaction against colonialism. Responding to these outbreaks of madness with force, by opening asylums and confining ‘the mad’ to these asylums, with little actual medical care, was a way in which to ‘silence’ the ‘mad’ and to be able to continue on with the aims and practices of colonialism.
The genetic and physiological accounts vs. cultural/historical difference
Mental illness is currently well understood, and treated, as that: an illness. However, as has been shown by Sadowsky (1997; 1999; 2003), within a colonial context in Nigeria, mental illness was often only understood in the context of colonialism i.e., mental illness was understood as a reaction to the modernization brought about by the colonizers, which, it was hypothesized, the ‘primitive’ Nigerians could not cope with, leading them to madness. However, as Sadowsky (2003) points out, “even within colonial governments, there were some who believed, in some degree, in cultural relativism….I discovered many administrators who believed that building asylums was a bad idea because Europeans could not know what madness was to Africans, and that, therefore Europeans should not be imposing alien cultural forms” (p. 211). Thus, at least within the context of colonial Nigeria, madness was not understood, or treated, as an illness, rather as a response to colonialism, and the debate surrounding madness and its genetic and physiological bases, and the different cultural or historical manifestations of madness were not entered in to during colonial rule.
Syndromes that come and go – hysteria
Focusing on two mental asylums in Nigeria, the Yaba ‘lunatic asylum’ and the Aro Mental Hospital in Abeokuta, Sadowsky argues in his book, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria, which uses first hand accounts of delusions of the mentally ill, as gathered from actual case histories of these two mental asylums, the ‘ravings’ of patients are important historical documents in that they can be used for social analyses, showing that the social context of colonization fostered the development of certain kinds of delusions, especially delusions of persecution. Such madness, Sadowsky argues, threatened the colonial worldview, and, to some extent, colonial power, drawing attention, as they did, to the structures and inherent contradictions of colonial power, and, as such, the psychiatric environment tended to class any actions that threatened colonial ideology as ‘madness’, such that, as Sadowsky argues, the ideologies of colonial medical staff reflected the anxieties and insecurities of the colonizers themselves (Sadowsky, 1999). As Sadowsky states, “the content [of delusions] repeatedly referred to specifics of Nigerian colonial history: religious conversion, foreign domination, the changing justice system…and the struggle for independence” (1999; p.115).
According to Sadowsky (1997; 1999; 2003), historically, madness in Nigeria seems to have been understood entirely in terms of colonial power, in terms of madness being understood as a reaction against colonial rule, not as an illness per se, and, as such, madness was not treated objectively, but as one more manifestation of dissatisfaction against colonial rule. The ‘mad’ were thus treated almost as dissenters rather than being treated correctly, as ‘ill’ individuals. No more is this highlighted than when accounts of treatments for delusions are given in Sadowsky (1999) as taken from individual case histories. As shown in these histories, medical staff often played a purely custodial role, not a medical role, with only modest therapeutic programs being offered, if any at all (Sadowsky, 2003; p. 211). It was with some trepidation, and opposition, that mental asylums were set up at all, in a colonial Nigerian context, with little medical help being offered, and these asylums quickly becoming overcrowded, with squalid living conditions (Sadowsky, 2003).
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Thus, as has been seen throughout this essay, based on the work of Sadowsky (1997; 1999; 2003), which looks at madness in colonial times in Nigeria, the understanding of madness in culture is an extremely relative matter, perfectly illustrated through the study of this time period and in this place, which explained madness as a product of colonial rule. Madness, as we understand it now, is obviously not culturally relative and is a universal concept: it is an illness, which needs correct treatment in order to overcome the illness. If this had been understood during the period of colonial rule in Nigeria, the many years of suffering for many thousands of insane individuals would not have had to have been endured: they would have received correct, timely, treatment and would not have whiled away their lives being little more than captives in colonial asylums.
Sadowsky Jonathan, ‘Psychiatry and colonial ideology in Nigeria’, Bulletin of the History of Medicine,71 (1997):94-111.
Sadowsky, Jonathan, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria, Berkeley: University of California Press, 1999.
Sadowsky Jonathan, The social world and the reality of mental illness: lessons from colonial psychiatry’, Harvard Review of Psychiatry 2003, 11(4):210-4.
Stilwell, S., ‘Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria by Jonathan Sadowsky’, Journal of Interdisciplinary History, 31(2) (2000): 322-323.
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