British Psychiatric Perception of Africans With Psychosis, 1862-1972.
Background: Sustained British contact with Africans began in the late 19th century when the colonial presence in sub-Saharan Africa intensified. British ethnopsychiatry arose in this context to study the psychology and behavior of African peoples, but disappeared as a discipline in the 1960's with the collapse of overseas colonies. In its place, new disciplines, such as transcultural psychiatry and psychiatric epidemiology, continued to study psychosis in African patients, but the setting of these investigations shifted away from the former colonies and to the UK itself. Aim: To chronicle British psychiatric perception of Africans with psychosis during the colonial period and to draw links from the past to inform current psychiatric theory and practice.
Methods: To trace these developments and their implications, the first author searched the Online British Journal of Psychiatry (BJP) from 1855 using key words such as African, African mind, African praecox, African insanity, Coloured, Black, Negro, and Caribbean. The first author reviewed relevant articles and gleaned additional sources from reference lists. Materials gathered by this process were analyzed using a Critical Discourse Analysis (CDA) approach on a macro-level, meaning that texts were analyzed in sociocultural context, with a view to the historical tension between medical and racial discourse in the United Kingdom since the mid-19th century.
Results: This procedure yielded 41 historical sources from 1862 to 1972. Most (31) were articles from the BJP and were written by British authors (22). One influential British physician, J.C. Carothers, wrote five of the sources, including a WHO monograph (1953) and a book on the African mind (1972). Eight principal racialized themes emerged from the data: (1) Africans are prone to psychosis (Psychosis), (2) are inferior to Europeans (Inferior), (3) have exotic symptoms when psychotic (Exotic), (4) are prone to manic or excited states (Mania), (5) are prone to aggression when psychotic (Aggression), (6) are prone to develop mental disorder when coming into contact with European civilization (Contact), (7) are relatively unaffected by depression and suicide (Less Depression), and (8) have better prognosis in traditional settings (Better Prognosis). The most frequently mentioned themes were Inferior, Exotic, and Contact, but all were well represented through time and across the available sources. Seven of the sources critiqued or opposed racist discourse at various points, but all of these went on to endorse racialized themes elsewhere in the same document. Inferior was the most pervasive theme and referred to African nutrition, temperament, intelligence, work ethic, and quality of psychotic symptoms. Exotic, as a theme, referred mostly to repeated observations of confusional and amorphous manifestations of psychosis in African patients. Contact referred to the oft-repeated notion that Africans became mentally ill when adapting to the more demanding European way of life.
Implications: The British psychiatric legacy is one of profound historical racism. A small number of influential psychiatric publications heavily stereotyped Africans with psychosis through the end of the time period studied (1972). These findings will be discussed in terms of recent trends in British psychiatry that may unwittingly reinvent or perpetuate these perceptions.