Madmen and Specialists

Anthony Appiah

  • Colonial Psychiatry and the ‘African Mind’ by Jock McCulloch
    Cambridge, 185 pp, £35.00, January 1995, ISBN 0 521 45330 5

If you’ve ever spent some time in a Ghanaian town, such as Kumasi, in Asante region, you will occasionally have seen people half-clothed in filthy rags, hair matted with the red-brown dust thrown up from the laterite earth, wandering the streets largely unmolested; talking, perhaps, to themselves; begging sometimes; or scratching through rubbish heaps looking for something to eat. When I was a child in Kumasi we were taught to fear these madmen and women, whom we called bodamfoo. When we were naughty we would be threatened with a visit from them. Indeed, there is an Asante proverb which runs: Obodamfoo se ne dam ko a, na nye ode hunahuna mmofra. (If the madman says his madness has gone, that doesn’t mean the thing he uses to frighten children.) Among adults, I think, it would be more accurate to describe the attitude to bodamfoo as one of mild contempt. The only other people I can think of who are regularly treated with a similar contempt are what we would call alcoholics (though these even children will mock). But (to quote another of our proverbs) Odehyee bo dam a, yefre no asaboro – if a royal goes mad, we call him a drunkard – because, obviously, it is worse to be a drunk than a lunatic.

Many of the bodamfoo die early as a result of their unsanitary lives; a few are locked up from time to time because they have threatened or hurt someone; others live permanently in asylums, where they are fed what the local branch of the Social Welfare Department has the money to pay for. I never heard of any receiving medical attention and certainly not psychiatric treatment. There is a fair amount of financial support in Kumasi these days for the very few mentally-ill children who get to be in the children’s home; but they are there because their families will not have them, not because they are being treated, and they depend on the charity of a few rich people, some of whom have had children with these problems themselves.

As for the less spectacular forms of mental distress – depression, anxiety – there are, perhaps, a few doctors and a few drugs, but these are available only to a small number of professional families. Most people would be more likely to go to a traditional or Christian priest or a Muslim malaam and seek solutions from the other world. There is, in short, plenty of psychiatric work going a-begging; and, what with all the other things we have to worry about, as the Ghanaian economy struggles along and life gets more expensive every day, improving mental health provision is not, it is fair to say, even a tiny blip on the radar of Ghanaian national political consciousness. This is surely true in most of post-colonial Africa.

The mental health of the native populations was not a central priority of British or French colonial governments in Africa, either. Psychiatry and Africans were each, in their own way, marginal to the preoccupations of the metropolitan bureaucracies: psychiatry was low-status medicine and Africans ... well. Put the two together and you had a recipe for neglect. As psychiatry was developing its modern therapeutic aspirations in Europe, the function of colonial asylums remained largely custodial. There was, for example, a mental asylum at Victoriaborg in the Gold Coast as early as 1888, but ‘with the exception of a brief period in 1929, when a specialist worked for a time at the Accra asylum, there was no psychiatrist in the Gold Coast until 1951.’ The first mental health clinic in Senegal – perhaps the most Westernised region of French West Africa – was not built until 1956. And in any of these colonies there were places for hundreds, at most, of the mentally-ill in populations of many millions. Only where there were significant European settler populations – in Algeria, Southern Rhodesia, Kenya and South Africa – did any very extensive mental health provision exist before the Second World War, and even in these places it was woefully inadequate. But the low status of psychiatry in Western medical practice generally suggests that the lack of human and material resources was not simply a colonial phenomenon: the same situation prevailed even in the Fifties in ‘any mental hospital in Birmingham, Lyon, Melbourne or Toronto’.

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