Abstract
Elegantly written and a product of an impressive range of archival research, Lambe’s history of the psychiatric institution of Mazorra and its turbulent relationship with politics and the state in modern Cuba is a valuable addition to scholarship across multiple fields. Lambe weaves a tapestry that includes themes familiar to historians of psychiatry in post-colonial contexts, notably the legacies of colonialism and slavery, the disciplinary boundaries of sex, and professional efforts to create distinction out of diversity. Uniting these themes is a close analysis of the fraught relationship between macro-politics, both physical and conceptual, and the professional practice of psychiatry in one of the most infamous psychiatric institutions of the Caribbean. Mazorra becomes a mirror of the state, reflecting and refracting its fault lines, social and political preoccupations, and creating popular fodder for satire of the ‘sane’ and expert alike. The result is relevant not merely to the historiography of psychiatry, medicine, and public health, but also to the history of Latin America more generally.
Mazorra’s consolidation as a nationalist icon began even before the brutal independence wars and US occupation(s) from 1898 to 1909. Cuban revolutionaries saw in Mazorra the embodiment of Spanish neglect, and US colonizers imbued with the spirit of 1890s’ Progressivism saw a laboratory with which to realize dreams of social regeneration through centralized planning. Through the early years of the Cuban republic, Mazorra thus represented a joint political and moral project of national renewal and redemption from a sordid colonial past. Its iconic national status was more than metaphorical: it was physical (early decrees physically relocated the provincial ‘insane’ to the hospital), financial and therapeutic in its approach to reform. The unlikely collaborative project, rife with contradictions in an environment of impaired sovereignty, Spanish legal legacies, and the conflicting visions of a nation born of a compromised independence, crashed multiple times throughout the early republican period. In its budgetary controversies, widespread fears of ‘degeneration’ that attended the rise of Mazorra’s patient population, and contestation of individual liberties and power relations by patients themselves, Lambe presents the institution as a microcosm and a mirror of a compromised Cuban nation.
Mazorra was transformed into a vehicle for both popular and professional pessimism soon after the US occupiers left the island in 1909, born in part of a sensationalist press and the widening racial, class and ethnic disparities that distanced Mazorra from the Cuban population and inclusive visions of ‘nation’. Psychiatry experienced significant limitations in this institutional setting, where administrators were political appointees; access to psychiatry was limited to the elite, and popular understandings of psychosocial pathology and treatment often bypassed the psychiatric profession altogether. These professional weaknesses became particularly acute when they were attended by corruption, political violence, severe budgetary restriction and popular apathy.
Professional psychiatrists overcame some of the aforementioned limitations during the 1959 Revolution, where the themes of revolutionary exorcism, mimesis between nation and ‘madhouse’, and the politicization of mental illness re-emerged with familiar but distinct valences. With the well-publicized reforms within Mazorra, the expansion of acute psychiatric care outside Havana and the leadership’s dedication to rectifying social deviance of ghosts past, the profession seemed on the cusp of an unprecedented popular relevance. Where it existed, however, this professional opening was largely filled by the Revolution’s emerging psychological professionals, who dedicated themselves to politically charged, psychological assessments of work and the measurement of political integration. Perceived as a vestige of bourgeois culture, psychiatry was left on the sidelines of intervention in long-standing and trans-revolutionary concerns, from the ‘problem’ of homosexuality to the relationship between mental illness and criminality. Conflict over political and judicial oversight of psychiatric professional terrain was nothing new, but under the Revolution it was magnified and transformed. The state not only took over the massive project of social engineering that communist revolution entailed, but it also utilized a heterodox appropriation of psychiatric terms and concepts that prescribed political rather than medical cures.
The result of what Lambe refers to as an organic psychiatrization is a fascinating, transnational study of the subsequent reach and limitations of Foucauldian biopower among the Cuban population which had settled in the USA. As hundreds of thousands of exiles made their way out of Cuba during the Mariel boatlift of the 1980s, Mazorra and ‘madness’ became identified in art and literature with the feelings of alienation, dislocation and homelessness (both literal and figurative) that attended exile and physical spaces of suffering in Miami and throughout the USA. Both on the island and in mainland USA, a psychiatric language of ‘nerves’ was popularly adopted and redefined outside the bounds of professional, psychiatric diagnosis. Cubans facing repressive political scrutiny, familial dislocation and basic shortages of material goods on the island adopted the psychiatric language and tranquillizers for treatment. Exiles took ‘nerviosismo’ (and disproportionately high tranquillizer use) with them across the Florida Straits to manage emotional and socio-economic stresses that attended exile. Psychiatry was popularized, but its professional input and impact were limited and reinvented by populations who expanded and transformed the emotional and physical definitions of madness. In all cases, Mazorra became a symbol that defined the triumphalist and the extremist politics of the Cold War, and a vehicle for telling the actual life stories that defied normative histories.
It is in the permeable boundaries before and after 1959 that Lambe makes a vital historiographical contribution to the history of psychiatry and politics in modern Cuba. Cuban archives are notoriously difficult to access, particularly those closest to the present. Historians who have managed to access sources and to bridge the revolutionary divide have traditionally portrayed history as one of complete rupture or, as recent revisionists have argued, one of marked continuity. Lambe contributes to recent revisionism, likening the history of psychiatry and politics across the revolutionary divide to a Möbius strip, with Mazorra as mimesis and each revolutionary disruption both familiar and distinct. Lambe’s work thus unites historiographical fields, neatly linking the historiography of psychiatry and medicine in the periphery to nation-building in Latin America and providing a valuable piece of scholarship for future generations.