The Decolonization of African Psychiatry: A Theoretical Revolution

This essay is certainly off-topic in regards to the Humane Condition’s usual content, but it is a matter that I have been studying for the past several weeks that I think many of you will find interesting. My main source while writing this was a book by a professor of mine, Black Skin, White Coats by Dr. Matthew Heaton. There are no overt anti-state themes in the essay, I trust you will find within it evidence of Statism and how nations that were colonized by “foreign” states experienced Statist oppression. If you enjoy this essay I highly recommend Dr. Heaton’s book as a fascinating, and in depth history of psychiatry in Nigeria specifically.

Black Skin, White Coats by Dr. Matthew Heaton

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Psychiatry in some African countries developed out of complicated and difficult
circumstances. This was in large part due to the context of decolonization within which much of
African psychiatry developed. Western psychiatry had come to the continent with European
colonialism and contributed to the evolution of the ethnopsychiatric model of “colonial
psychiatry”. The emergence of Western trained, African born psychiatrists however, served to
bridge the gap from the established theories of ethnopsychiatry towards a more universal model.
Instead of rejecting Western psychiatry entirely, non-European psychiatrists like Frantz Fanon
and Thomas Adeoye Lambo built on their Western psychiatric understandings to revolutionize
psychiatry in Africa and Global psychiatry itself.

Black Skin, White Coats by the distinguished and honorable Dr. Matthew Heaton
investigated psychiatry in Nigeria in the period of decolonization. Heaton demonstrates the
extent to which public services were interrelated with the colonial mission and the economic
interests of the colonizers, supporting the claim that colonial rule deeply complicated psychiatry
in parts of Africa. “The British colonial government throughout most of the colonial period
sought to minimize public service expenditures … as an economical measure.”1 The psychiatric
infrastructure and practices offered by colonial officials were constrained by the true nature of
colonization, that of resource extraction economic gain. Under colonial rule, Nigerian psychiatry
was never provided with adequate resources to introduce Western psychiatry successfully within
Nigerian society. According to Heaton “(asylums) were strictly custodial in nature, providing
little to no psychiatric medical treatment.”2 A Caribbean born and Western trained psychiatrist
Dr. Frantz Fanon wrote of psychiatry in a colonial context in his book The Wretched of the
Earth. Working from Algeria during the war for liberation from French colonialism, Fanon
discussed the psychological affects that he saw in Algerians, “the war of national liberation
which has been carried on by the Algerian people for the last seven years has become a favorable
breeding ground for mental disorders.”3 This speaks to the social instability created within the
decolonizing context that further complicates and disadvantages psychiatry in Algeria. Africans
were often introduced to the worst of Western psychiatric practices due to the neglect of colonial
powers. A new emergence in the field of psychiatry, called ethnopsychiatry also contributed.

Ethnopsychiatry was developed by Western trained psychiatrists like J.C. Carothers
observing colonial subjects in the colonial environment. Heaton defined ethnopsychiatry as “a
remarkably consistent body of knowledge that functioned on the assumption that European and
African psyches were inherently different and, as such, that the rapid transformation of African
societies along European lines was likely to do much more harm than good in the short term.”4
Again according to Heaton, the language and theory of ethnopsychiatry dominated the
psychiatric profession in Africa by the 1950’s.5 Ethnopsychiatric theory served to legitimize the
philosophy of indirect rule in which the colonized population was presumed to be incapable of
accepting “modernization.” Heaton noted that ethnopsychiatrists assumed that cases of mental
illness were likely to be much lower in areas that had been less effected by “Europeanization”
because of the presumed stress free environment of “inferior” cultures.6 The continued
prevalence of ethnopsychiatry served to justify the colonizers lack of investment into public
services. By withholding the forces of rapid social change, they believed they were saving the
“inferior” African races from widespread mental illness caused by such changes.

J.C. Carothers was a prominent ethnopsychiatrists working in the mid-twentieth century
who built on the earlier surveys of Nigerian psychiatry conducted by Dr. R. Cunyngham Brown.
In 1955, Carothers was commissioned to survey the state of Nigerian psychiatry yet again.
Carothers findings and prescriptions for reform were similar to those before him. He advocated
an increase in funding and resources for psychiatric services in Africa, even arguing that
treatments needed to be more culturally specific. He apparently recognized a difference of
cultures within Nigeria but they were rested firmly within ethnopsychiatric theory espousing the
racism inherent to it. According to Heaton, Carothers viewed the cultural differences among
Nigerians as existing on a spectrum relative to the level of “westernization,” as opposed to the
many distinctly different cultures and societies existing within Nigeria.7 Carothers firmly
believed that “detribalization” was a considerable cause of mental illness among Africans,
supposedly possessing an inferior psyche that was unable to deal with rapid social change.
Working within the bounds of Western psychiatry, Carothers, Brown and other
ethnopsychiatrists constructed a theoretical framework based in racism.

It would require the work of Non-European psychiatrists to use their western training to
move Western psychiatric theory away from the colonial ethnopsychiatric theories that prevailed.
Dr. Thomas Adeoye Lambo was a Nigerian born, western-trained psychiatrist who spearheaded
this fight to decolonize Nigerian psychiatry. He served as a practicing psychiatrist in Nigeria in
the 1950’s, and according to Heaton, “The scientific and medical contributions of Lambo,
coupled with the creation of a full-fledged mental hospital at Aro, set the foundation for the
development and expansion of the psychiatric profession in Nigeria…”8 Lambo made what was
a strategically wise decision in regards to the future of Nigerian psychiatry. He did not cut all
theoretical ties with Western psychiatry or his training in general, in fact he used the same
theoretical foundations of Western psychiatry to challenge ethnopsychiatry and therefore, global
psychiatry. Heaton noted that “Lambo recognized that challenging racialized notions of the
‘African Mind’ required an engagement with international networks of scientific knowledge
production and dissemination in order to produce the kind of comparative data necessary to
reformulate psychiatric conceptions of the boundaries of cultural units and their relationship to
one another”.9 In other words, in order to change the greater scientific community’s
understanding of psychiatry, Lambo’s purpose was best served by sticking within the
foundations of western psychiatric theory.

Lambo’s work in Nigeria relied heavily on Western therapeutic treatment methods but he
integrated them to be more palatable to the local cultures, or as Heaton says, Lambo was
“actively trying to integrate ‘modern’ psychiatry with local cultural modalities.”10 Part of this
integration process included the recognition that cultural differences changed the presentation of
mental illness, and the ways in which treatment were most effective. Most importantly to the
acceptance of Western psychiatry within Nigeria was the attainment of “positive therapeutic
results” associated with psychiatry.11 Lambo had to balance his needs to refute ethnopsychiatry
with the desire for positive results. Heaton provides a clear example of how Lambo maintained
this delicate balance in reference to the construction of Aro Mental Hospital when he sates
“Lambo actively sought to decolonize … the racialized and ethnopsychiatric knowledge that had
constructed Africans as … inferior to Europeans. [The establishment of Aro Mental Hospital
was] the first European-type institution in Nigeria designed to provide therapeutic treatment for
psychiatric disorders.”12 While it was an effort to “decolonize” Nigerian psychiatry, it was still a
“European-type” institution that Lambo relied on.

Lambo’s work at Aro Mental Hospital initially focused on schizophrenia. Carothers and
other ethnopsychiatrists surmised that schizophrenia was prevalent among more Westernized
Africans because his theory “defined the ‘normal’ African as much closer to psychotic than the
average European.”13 The stress of “modernization” according to ethnopsychiatrists was likely to
send the near psychotic African into a psychotic “break”. However, according to Heaton “it is
very possible that many patients were diagnosed with schizophrenia on the basis that the things
they said did not make any sense to the European making the diagnosis.”14 This supports the
universal model of psychiatry that Lambo was attempting to promote, reinforcing the idea that
diagnoses and treatment must be formulated with a knowledge of the cultural context. Carothers
had also argued within the ethnopsychiatric model that Africans in rural areas lead a life with
much less stress than “Westernized” people and therefore suffered from an abnormally low level
of schizophrenia. Lambo attributed the lack of rural diagnoses of schizophrenia again to the lack
of European psychiatrist’s willingness to consider the different cultural contexts and how the
presentation of illness can differ between cultures. Because of this they were unable to identify
schizophrenic symptoms within certain Nigerian cultures.15 Lambo did not attempt to invent a
new model of psychiatry, only to integrate theories of universal psychiatry into Western
psychiatry using data he collected in Nigeria. There were no “culture-bound” disorders in the
eyes of Dr. Lambo. What differed from place to place was the presentation of symptoms and the
adequate form of treatment. He argued that the similarity seen between more “Westernized”
Nigerians suffering from schizophrenia and Europeans suffering from schizophrenia shows that
“the nature of men is identical; what divides them is their custom.”16 This is a clear
demonstration of how Lambo used Western psychiatric knowledge to further contradict the
assumptions of ethnopsychiatry.

Frantz Fanon was a social theoretician who observed the psychiatric industry in Algeria
during the war for liberation. Fanon took a different approach to his critique of Western
psychiatry than did Lambo. Fanon never escaped his Western training, he viewed the world
through the binary of colonized versus colonizer. His focus was primarily on the psychological
effects that colonial rule had on Algerians. “At no time, in a non-colonial society, does the
patient mistrust his doctor…” said Fanon.17 This was not true in Algerian society however,
where Fanon says that “The sudden deaths of Algerians in hospitals…are interpreted as the
effects of a murderous and deliberate decision, as a result of the criminal maneuvers on the part
of the European doctor.”18 Fanon argued that the doctor always appears to the colonized as a link
in colonial infrastructure and that clearly contributed to the distaste for the practice among
Algerians.19 Fanon’s Western training dictated in many ways how he thought. Whereas Lambo
rejected ethnopsychiatric claims of such illnesses called ‘North African Syndrome” Fanon
accepted them as true, while placing the blame for them on the Colonizers. Where Lambo
worked towards incremental integration, Fanon felt that violent revolution was the only way in
which a colonized people can be truly free of colonial influences, and without this freedom,
modern psychiatric theory and technology would never be developed or accepted by the
colonized people. Fanon said “In the colonial situation, however, it is impossible to create the
physical and psychological conditions for the learning of hygiene or for the assimilation of
concepts concerning epidemic disease.”20 These conclusions demonstrate Fanon’s acceptance of
western psychiatric theory. While he did not reject all the knowledge of ethnopsychiatrists, he
used his understanding of the colonial context within Africa to refute the idea that Europeans
could “Westernize” people via forceful occupation.

Dr. Lambo was the most influential Nigerian psychiatrist in terms of his contributions to
global psychiatric theory and practice. His integration of Nigerian psychiatric knowledge and
observations contributed to the construction of a “universal psychology” that could be applied
“transculturally” with only small adaptations based on cultural differences. This would help
refute the racist claims of the ethnopsychiatrists for decades to come. According to Heaton, “the
differences that had been so accentuated in a geopolitical system based on racism and social
evolutionism were repudiated and replaced by a newfound emphasis on the basic psychological
similarities of all people.”21 Western trained psychiatrists such as Lambo did not reject Western
psychiatry, but they steered it away from ethnopsychiatry and in the process revolutionized
Western, and in fact, global psychiatric theories.

– Adam Alcorn, @AdamBlacksburg

Founding Editor at The Humane Condition

contact: aalcorn@vt.edu

NOTES

1 Heaton, Matthew M. “Chapter 1.” In Black Skin. Nigerian Psychiatrists, Decolonization, and the Globalization of
Psychiatry Heaton, Heaton. Athens, Ohio: Ohio University Press, 2013.

2 Ibid, Chapter 1

3 Fanon, Frantz, Jean-Paul Sartre, and Constance Farrington. The Wretched of the Earth. New York: Grove Press,
Inc, 1965. Page 251

4 Heaton, Chapter 1

5 Ibid

6 Ibid

7 Ibid

8 Heaton, Chapter 2

9 Ibid

10 Ibid

11 Heaton, Chapter 2

12 Ibid

13 Heaton, Chapter 4

14 Ibid

15 Ibid

16 Heaton, Chapter 4

17 Fanon, Frantz. “Medicine and Colonialism.” In A Dying Colonialism, 121 – 145. New York: Grove Press, 1967. Page
123

18 Fanon, Medicine and Colonialism, Page 124

19 Fanon, Medicine and Colonialism, Page 131

20 Fanon, Medicine and Colonialism, Page 139

21 Heaton, Conclusion

 

Fanon, Frantz, Jean-Paul Sartre, and Constance Farrington. The wretched of the earth. New
York: Grove Press, Inc, 1965.

Fanon, Frantz. “Medicine and Colonialism.” In A Dying Colonialism, 121 – 145. New York:
Grove Press, 1967.

Heaton, Matthew M. “Chapter 1.” In Black Skin. Nigerian Psychiatrists, Decolonization, and
the Globalization of Psychiatry Heaton, Heaton. Athens, Ohio: Ohio University Press,
2013.