In 1953, Frantz Fanon took over as director of the Hôpital Psychiatrique de Blida-Joinville in Algeria. It is said that Fanon’s first act on taking charge of this overcrowded colonial hospital, in which electroconvulsive therapy was liberally dispensed and lobotomies regularly performed, was to unchain the patients. The story echoes that of Philippe Pinel breaking open the doors of the Bicêtre asylum in Paris during the Revolution and unshackling the inmates. Whether Fanon really did unchain the Algerian patients is doubtful. While in his writings he railed against the racism and violence of psychiatry, and medicine more generally, in the North African colonies, what he did as a professional psychiatrist was quieter and more prosaic. His institutional reforms at Blida were aimed at humanising the hospital and in the process mimicked the colonial city. European patients participated in ‘town meetings’, women attended dress-making sessions, and Muslim men socialised in a ‘Moorish café’.
In his account of the history of psychiatry in French colonial North Africa, Richard Keller argues that the psychiatric profession was particularly influential in discussions about the ‘civilising’ mission of French colonialism and the meaning of difference for Republican citizenship. He is at pains to demonstrate that psychiatry in this particular colonial setting was innovative, ambitious, experimental and, in its own way, progressive. But as the story descends into violence, it appears more and more that the lasting legacy of colonial psychiatry was to bring ‘a new degree of sophistication to colonial racism’. Keller wants to complicate an account which too often reiterates a ‘black legend’ of racism and confinement, but some readers might conclude that Fanon was right: there was a dehumanising logic to colonialism, or to settler colonialism at least, and the sciences of the mind played an important role in legitimating it.
The figure of the madman haunts the writings of imperialists and anti-colonial revolutionaries alike. Both Fanon in Black Skins, White Masks, published in 1952, and Albert Memmi in The Coloniser and The Colonised, which appeared five years later, come close to arguing that colonialism as practised in French North Africa was itself ‘mad’ and drove its subjects mad. Early French advocates of assimilation believed that North African peasants could be moulded into Frenchmen, but this argument never went far in Algeria, conquered over a lengthy period by means of appalling violence and dominated by a fragile minority of European settlers. As a result, a language and theory of innate and near ineradicable difference evolved alongside one of assimilation and universalism, and eventually overwhelmed it. According to Fanon, the contradiction created something more extreme than fragmentation and breakdown for the colonised: it made subjectivity altogether impossible. But the trope of madness has a longer history in this region, as Keller shows. In the late 19th century the North African insane were a stock feature of Orientalist texts, evoking the degradation of a civilisation in decline. In 1887, Guy de Maupassant produced a florid account of his visit to the Sadiki hospice for the insane in Tunis (an institution founded in 1663). There he was met by the ‘breath of unreason’, by ‘continuous laughter with a menacing air’. Maupassant was both horrified and fascinated, leaving the hospital ‘full of pity, perhaps desire, for some of these hallucinating men’.
The guiding myth of the French colonisers of North Africa was that they were engaged in the renewal and regeneration of the Roman imperial legacy, a lost Latin civilisation that had been under attack from a conquering Islam since the early Middle Ages. The maristans, houses for the sick and insane like the one Maupassant visited in Tunis, came to be seen as emblematic of Muslim barbarity, and the French psychiatric profession, invoking the theme of the ‘suffering native’, saw a chance to regenerate itself. The North African colonies became an experimental space in which psychiatrists could put their ideas into practice, uninhibited by metropolitan constraints. At the heart of this story is Antoine Porot, whom Fanon would accuse of being the ‘father of psychiatric racism’ in Algeria, though he was seen by his contemporaries as a progressive innovator, committed to reforming his profession.
Trained in Lyon, Porot moved in 1907 to Tunis, where he established an open psychiatric clinic for the European population, emphasising cure rather than confinement. But it was in Algeria, where he was posted in 1916, that Porot made his real mark. In the aftermath of the First World War, France was more determined than ever to make productive use of its colonies. The concept of mise en valeur extended well beyond the economic realm to include the idea that the ‘primitive’ world of the colonies could be elevated through the rigorous application of the sciences, including, crucially, the medical sciences. A primitive colonial subject could become a virtuous Republican citizen only if his body and mind had been transformed. Porot seized the opportunity, not simply to participate in this project, but to drive it forwards, for a period making psychiatry a key part of the colonial development of North Africa.
Not only would Porot create, in Algeria, a state-of-the-art institution for psychiatric care, designed for prevention and cure rather than confinement; he would also, through his research and publications, place the colony at the centre of the study of the relationship between psychology and ethnology. If ‘primitive’ minds were to be cured of their pathologies, they first had to be understood. The result was not only the creation of the vast Blida hospital outside Algiers, built at great expense, with its pavilions and gardens, but also the Algiers School of psychiatry, which was to produce a large body of influential publications.
The hospital opened with a fanfare in 1938. New drugs and therapies were enthusiastically taken up: in 1943 Porot proudly reported that ‘therapeutic activity’ at Blida was ‘very extensive’, with ‘4510 insulin shocks, 2483 cardiazolic shocks, 383 lumbar punctures and 5805 laboratory examinations’ administered in 1940 alone. While French doctors generally proceeded with caution when it came to the application of new therapies in metropolitan hospitals, their colonial counterparts seem to have been less careful. When doctors in France were still testing electroconvulsive therapy on animals, in North Africa it had become a standard treatment. Porot experimented on tubercular patients, pregnant women and cardiac patients, although the use of ECT in these cases was strongly contraindicated. Then he moved on to lobotomies: in 1947 he published a major paper on the subject, and over the next seven years performed more than two hundred operations – roughly the number performed in American hospitals over the same period, although they had three times as many patients. One journalist visiting Blida in 1948 reported that while it looked like ‘paradise’ it was ‘stalked by wandering, soulless bodies’.
Porot and his colleagues were drawn to psychosurgery and other procedures in part because they were ‘blind methods’ with rapid results: the context in which they were applied mattered little. However, in other aspects of their work context and culture were more important. During the First World War, Porot had conducted psychological research on North African military recruits from various communities and had concluded that, while soldiers of ‘French stock’ proved ‘remarkable in their moral robustness and tonicity’, Jews were a little wobbly, and Muslims exhibited a variety of racially specific pathologies, ranging from ‘inertia’ and ‘nonchalance’ to hysteria. Responding to these results and to a much wider interest in the ‘primitive mentality’, Porot began to formulate a theory of ‘ethno-psychopathology’. In 1925 his student Don Côme Arrii produced a thesis based on the study of 20 cases heard in the French-Algerian courts and entitled ‘The Criminal Impulsivity of the Indigenous Algerian’. The ‘childish Arab,’ he concluded, was a ‘monster of amorality’. His thesis, like others from the Algiers School, linked Islam and ‘race’. The Arab mentality, he claimed, displayed ‘numerous hereditary defects’ which were common to all Muslims. Islamic customs were not simply a symptom of this pathology, they were also a cause. Religion was as immutable as biology: the Islamic mentality was an inherited trait.
In a now infamous article published in 1939, Porot and his student Jean Sutter took the argument in a slightly different direction, though the conclusions were the same. On the basis of studies of their institutionalised patients, they found that the fatalism and primitivism of the North African mind had their roots in the nerve centres of the brain. While Islamic culture shaped character in unfortunate ways, a ‘deviant’ brain structure rendered these characteristics ineradicable. The consequences of this notion were far-reaching, and far removed from the utopianism of the colonial policy of the early part of the century. If the brains of North African Muslims were fundamentally different from those of Europeans, any attempt to assimilate them was bound to fail. Those educated subjects who appeared to have successfully made the transition to civilisation – the so-called évolués – were simply engaged in mimicry and were therefore prone to ‘civilisation psychosis’. If Islam didn’t turn your mind, turning away from Islam would.
Similar arguments were made by psychiatrists elsewhere in the colonial world at this time. What they had in common were an insistence that the results of clinical studies of psychiatric patients could be read as profiling a ‘normal’ native psychology, and a habit of pathologising the ‘hybridised’ educated native. But the Algiers School stood out for the extent of its influence. Its members published on subjects that ostensibly had little to do with the colonial context (on somatic therapies especially), and in doing so reached a wide audience; in 1952, the Presses Universitaires de France published a general manual of psychiatry, written by Porot and his colleagues, which was enthusiastically received by the French psychiatric establishment. The school’s influence was further increased by concern in France over North African immigrants’ apparent tendency to suffer from mental disorders, and by the outbreak of the Algerian war in 1954. The Algiers School had theories that explained violence and revolutionary fervour in terms of religious fanaticism and mental instability, and it could (and did) offer a range of psychological warfare techniques to counter the strategies of the FLN.
At one point, Keller argues that ‘French colonial psychiatry – especially its incarnation in Algiers – deployed an intellectual violence that was in every sense the equal of colonialism’s dehumanising legal and social structure, a savagery concomitant with the brutality required to police Algeria’s Manichean world.’ But he presents his larger argument as a paradox: how could a ‘nuanced, detailed, responsive and even progressive scientific circle with utopian ambitions’ be ‘simultaneously an uncomprehending, violent entity driven by militant racism’? Many will need to be convinced that this paradox is as striking as Keller thinks it is. It’s true that colonial psychiatry wasn’t merely a racist instrument of confinement. These were sophisticated scientists at the top of their profession, and some of them cared about their patients. As Keller points out, the attitude of North African communities to colonial psychiatric institutions was not uniformly negative: families often sought help for their relatives, though usually when other therapeutic options had failed. But the combination of utopianism, technical innovation, scientific sophistication and racism is not so surprising in the history of 20th-century science.
The Muslim world of North Africa was, for 19th-century Frenchmen, a ‘space of madness’. But, as Keller shows in his final chapter, that madness is now more likely to be found on the housing estates of the postcolonial European city. The madness of empire has come home. Just as the Algiers School took part in larger debates on French colonialism and its civilising project, psychiatrists in present-day France deal with the political and philosophical implications of mental health problems among beurs, French-born North Africans. The violence of colonialism, and of the Algerian war in particular, continues even now to take a psychological toll. But thanks to Porot, it is difficult to disentangle any discussion of the role of culture or religion in mental illness and its treatment from the legacy of colonial racial theory. Those, like the French clinical psychologist Tobie Nathan, who have developed clinics which practise a culturally sensitive psychiatry (in which, for example, possession by djinns or spirits might be taken seriously), are accused of reifying culture rather than dealing with the poverty, dehumanisation and violence of life in the banlieues. These arguments go to the heart of discussions of French Republicanism and its future, and to the larger question of what it means to live in a postcolonial world.