Abstract
This book presents detailed and highly original research about the treatment of the mentally ill in apartheid South Africa, based on archival research, legislation, contemporary official sources and newspapers, and oral interviews. Tiffany Fawn Jones’ study argues that to examine psychiatric institutions in South Africa in the twentieth century is to reveal a ‘disordered state’ and social policies which paradoxically ignored black patients, who formed the majority of those housed in repugnant overcrowded conditions and circumstances. Instead, the professional attention of psychiatrists – at least officially – was trained on white male patients. In this way, Jones’ book adds to the now substantial and impressive field of histories of insanity, colonialism and institutions. The book’s arguments about a repressive white state, its contradictions and its effects on the mentally ill, are powerfully made, with the author drawing on a wealth of interpretive frameworks, theories and evidence to construct a very insightful account of the place and period.
In seven chapters, this work shows how different institutional populations fared during the apartheid regime. The funding context of the mental health system before apartheid is set out in the first chapter, which not only surveys the historical field – studies of places and institutions in the nineteenth century, legislation, fears of white racial degeneration and a renewed focus on white mental health following World War I – but also nicely situates the future of mental health for the country after 1948. The narrative bears some resemblance to the Australian story of institutional care and an increasingly distinct focus on whiteness through institutional practices, official writing and population management. Interestingly, like Australia, South Africa had a mixed provision of institutional care: most institutions housed all ‘races’ and ethnicities, but some were dedicated to separate white or non-white populations, a point that becomes relevant as the book’s overarching argument is drawn out. It is significant that Tara Hospital, the main focus of mental health innovation by 1946, represented the core values of the state mental health care policy. It was, Jones argues, ‘the embodiment of white therapy’ (p. 39). In other words, it mattered less whether there were segregated institutions in this era beyond 1948: mixed-race institutions continued to differentiate mental health care treatment based on racial difference.
To demonstrate her argument about the intrinsically disordered nature of the state’s policies and practices of mental health care, Jones describes the institutional populations across the period 1948 to 1973. The Table of institutions on page 44 tells a story of racialized confinement and care, patterned across geographical sites and politically construed in the context of apartheid. Jones’ use of oral histories here is valuable for shedding additional light on such ‘facts’ and their meanings, and she also suggests that there is no single interpretation of these facts. The chapter also introduces the problems of gender and class as categories, and the ways that these cut across ‘race’/ethnicity to produce identities for patients, which became meaningful in the context of treatment and release, or the potential for recovery and discharge.
Chapter Three focuses on patients’ own accounts of institutionalization. This chapter is very well placed, bridging sections of the book and bringing to life some of the major intellectual concerns the book is grappling with in the course of its narrative of institutional care during apartheid. Jones is absolutely right to suggest that without patients’ accounts of the past and institutions, no history of mental health care is complete (p. 58). The methodological and theoretical discussion here is excellent, and offers much to think about. While a collective view of ‘patients’ views’ is impossible, Jones posits (p. 59), historians can piece together such accounts from available evidence. This becomes critical later when patient communications become structurally important to a patient’s release (p. 85); again, this means that white educated patients benefited from the systemic discrimination of non-whites, the poor and ill-educated institutional populations.
The fact that Jones works under impossible conditions as a historian – given the relative paucity of patient records – and still manages to locate patients’ narratives in the very few sources she can access is testament to the validity of her claims. Not only were patients’ communications such as letters sometimes destroyed, but patients also lacked privacy, had little agency and control over writing, and later archives separated letters from patient records. All of this sounds familiar to me, and the idea to base this chapter on 66 letters by 23 patients is valid: Jones acknowledges the gaps and omissions. The reading and interpretation of these letters offered here is sensitive and telling: a particular politics and culture of South African notions of mental illness and hospitalization was at work. The views of institutional staff are also put forward, showing the tensions between those different institutional personnel and patients and families.
Subsequent chapters examine community and cross-cultural psychiatry, the definition and policing of sexuality in the latter years of the apartheid era, private institutions for black patients in a move to separatist institutionalization and, finally, critiques of the system from the perspective of the Church of Scientology.
This is an important history. The complex delivery and meanings of mental health care services in South Africa, the politics of ‘difference’ at work, including gender, sexuality and class difference, alongside the official ideas about ‘race’, made for an intensely fraught and highly charged context for mental health care. Abuses occurred, and institutional memories held by professional staff interviewed for this study varied; there was resistance, and criticism, at work. This book highlights the way a ‘language of madness and race’ (pp. 16–17) operated in the not-so-distant past, and at the same time constructs a very telling new look at a colonial and postcolonial site for the history of psychiatry. Its conclusion places all the arguments and evidence back inside a reflection made possible by the Truth and Reconciliation Commission. How far psychiatry can and should be read inside this framework is a good question, not only for South Africans, but all of us, as we interrogate poor treatment of the mentally ill.