Colonial Psychiatry

What it is

Carothers had been a colonial medical officer in Kenya and then spent twelve years in medical charge of a mental hospital and a penal institution in Nairobi. He was given a nine-month appointment as medical consultant to the World Health Organization and wrote The African Mind in Health and Disease, published as Monograph Series number 17 in Geneva in 1953. Its central claim was that the peculiarities it catalogued could be explained by underuse of the frontal lobes, and it likened the African mind to that of a European patient after leucotomy. Those conclusions are reproduced here in summary as the object of criticism and never as a finding.

Fanon was born in Martinique, trained in Paris and posted to Algeria. He used clinical material to argue that the alienation of his black patients was a product of colonialism rather than of any natural inferiority. His reply to Carothers is that Carothers had missed the point, because African culture at that stage was the struggle to be free.

This publication holds the full text of the monograph, read from the World Health Organization's open repository, and three corrections follow from it. The often-quoted comparison is at pp. 157 and 161, at the end of the psychiatry chapter rather than in its conclusions; it runs from the European patient to the African rather than the other way round, and it carries two stated exceptions. The claim is not original to the monograph but comes from Carothers's own 1951 paper in the Journal of Mental Science, which the monograph quotes in the third person among everyone else's work and then adopts in the author's own voice four pages later. And the date is settled: the monograph is 1953 in two impressions, and the paper behind it is 1951.

In effect

The primary document is not the simple hereditarian tract the second-hand version suggests, and the difference is not exculpatory. It is the opposite.

It states its confounds, at length. Two full pages on why a colonial asylum population is not a sample. Malnutrition and endemic infection as factors that must often stultify investigations of adults. An acknowledgement that the European electroencephalography controls were of a considerably higher educational standard. A statement that most studies involving age have been vitiated because ages were not known.

It dismantles most of its own physical evidence in public. The brain case rests entirely on one Nairobi autopsy series whose comparability the author questions himself. The electroencephalography did not replicate: he commissioned A. C. Mundy-Castle, who found no significant difference against European controls, and the book prints the null result. The intelligence testing he sets aside, stating that there is no present possibility of assessing comparative general intelligence in that setting.

And its stated conclusion is culturalist rather than genetic. It rejects the view that Africans are fundamentally incapable of mature development, says the pattern is common to most preliterate groups and probably to early Europeans, and ends by noting a striking lack of evidence that adaptation had influenced the genetic basis of mentation.

So the shape to carry is a document that disclaimed the genetic argument, published the failures of its own evidence, stated its confounds better than many contemporaries, and arrived at the racial conclusion anyway by a developmental route, keeping frontal idleness as the physiological description of a state it had just attributed to upbringing. What replaced the evidence was a catalogue of European stereotype assembled from colonial and metropolitan writers, introduced with the assertion that such classical conceptions are largely true. The stereotypes were the data. The catalogue is recorded in this publication's hub as existing and is reproduced nowhere.

The object of study was also declared unexaminable on page eight. The preface restricts the subject to the untouched rural African, concedes that this is a somewhat hypothetical abstraction, and states that those who are untouched are not amenable to scrutiny, before excluding the urban, the Christian, the Muslim and the educated African by definition. That is why Fanon's substantive objection is borne out by the primary: the population Fanon was treating is the population the monograph excluded from its subject.

One institutional fact is worth holding. The same numbered series carried John Bowlby's Maternal Care and Mental Health as monograph number two, which Carothers cites approvingly. The imprint that carried Bowlby carried this, which is the clearest demonstration in this library that an imprint is not an evidence grade.

What it does not say

It does not say the World Health Organization endorsed the conclusions. The series disclaimer, that authors alone are responsible for views expressed, is the whole of the Organization's distance from the text, and that distance is thin. What the monograph was subsequently used to justify administratively is not in the document, is not asserted here, and is the first item for external verification.

It does not treat Fanon's clinical material as a controlled study. He published vignettes from his own practice documenting psychiatric harm he attributed to the colonial war and to torture. They are evidence of what he saw and recorded. Whether that published material supports the causal claims later relayed from it is an open question and is flagged as one.

It does not accept the secondary account this vault first met the subject through. Peter Watson dates the commission to the mid-1950s, when the monograph is 1953. He dates Fanon's Black Skin, White Masks to 1960, when the French original is 1952. And he assimilates Fanon to R. D. Laing without argument, on the ground that both were showing mental illness to be a rational response to an intolerable situation. Those are not the same position: Laing's claim is about the family as cause, and Fanon's is about a colonial state as cause, made by a clinician who also took the organic basis of illness seriously.

It does not treat the two sides as symmetrical. Carothers's conclusions are rejected. Fanon's critique stands.

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