Madness and politics

Madhouse: Psychiatry and Politics in Cuban History
Jennifer L Lambe
2017, University of North Carolina Press
325 pages, plates, paperback

WHAT better vantage to explore political history in Latin America than from the wards of a psychiatric hospital?

After all, sanity is not the condition that comes to mind immediately when exploring the region’s occasionally over-emotional, and often irrational, development.

That is not to trivialise the underlying dynamics of class and imperialism that have shaped social relations in this part of the world, but it is to recognise as author Jennifer Lambe does so eloquently that the way we conceptualise madness clearly has a political dimension.

The political abuse of psychiatry allowing regimes to silence and often incarcerate opponents by declaring them mentally ill has been an important theme of historical debate. Most readily associated in the West with systematic state practices in the Soviet Union and its eastern European sphere of influence during the Cold War, the phenomenon has in fact been widespread – from Canada to Norway and Japan.

In the United States, there are many examples of the confinement on the grounds of mental illness – both temporary and long-term – of individuals considered to be a threat to the political order or mainstream values.

Indeed, it is no surprise that current debates about the suitability of Donald Trump to hold the country’s highest office have focused on his mental health, especially in relation to his terrifying right to press the nuclear button without congressional oversight.

Lambe has concentrated on Cuba and, in particular, Mazorra hospital on the outskirts of Havana, to paint a highly original portrait of the connections between the notorious institution’s work and Cuba’s political elite in different periods of the country’s modern history.

The outcome offers a fascinating insight into the role psychiatry plays within the political imaginary, providing yardsticks against which acceptable and unacceptable ideas, hopes and aspirations can be measured. As a result, the author argues that Mazorra has served both as a laboratory and as a microcosm of the Cuban state.

Founded in 1857 in the twilight of Spanish colonial rule, Cuba’s largest psychiatric institution – and one of the most important in the Americas – was from its creation something that existed at the ambiguous edge of science. Yet, given the country’s history, it has also survived and reflected the many cycles of “revolutionary agitation and exorcism” that Cuba has undergone since then. As the author notes, it provides a case study for the emphasis on continuity in Cuban history that refuses to compartmentalise this into discrete periods.

Lambe writes: “Madhouse thus engages mental healing and illness to explore histories of Cuba that have remained absent from traditional narratives. Though built on the margins of Havana for the most marginal of Cuba’s citizens, Mazorra’s liminality has paradoxically rendered it an acute barometer of political and social tides.” [p 6]

The author has used this barometer – and in particular its calibration in terms of such themes as slavery, race, sexuality and the state – to examine Cuba’s mind itself. The state and politics, she says, have been pivotal to the hospital’s evolution, making psychiatry an issue of national political significance at key moments, particular leading up to and in the aftermath of the 1959 Revolution.

“In a place like Cuba – poised on the divide between Western and non-Western, sovereign and colonial, national and diasporic – psychiatry was uniquely politicized and even radicalized on occasion … If physicians living under Spanish rule once found their primary interlocutors in Spain and France, the shift to postcoloniality reoriented their attention to US colleagues. Similarly, after 1959, Soviet and Eastern Bloc psychiatrists came to exercise a significant influence, along with lateral relations within Latin America.” [p 13]

Lambe traces the development of Mazorra from the period following the Spanish–American war ending European control, in which US influence seeking to revolutionise asylum management departed from then current practice in America itself, thereby reflecting the role that Cuba could play as an imperial laboratory, while setting the scene for Cuba’s own nationalistic designs for medical care. The author notes that this created a patriotic icon and reference point for future struggles over the contours of the republic.

Fast forward to the revolutionary era after 1959, and we find in the ambitions of Dr Eduardo Ordaz, appointed by Fidel Castro to run the hospital, an effort to spearhead “the transformation of Mazorra into a crowning, nearly utopian, symbol of the revolutionary project” [p 140] that inaugurated a new era for Cuban psychiatry through which revolutionary leaders could fulfil their commitment to redeem the most marginalised members of society.

The debates that would follow over the “treatment” and criminalisation of homosexuality by the revolutionary regime offer one insight into the profoundly political dimension of this enterprise, as Cuban leaders embarked on a frustrated quest to build the “new man” of Che Guevara’s longing. But while we can clearly find cause to condemn aspects of this process, we must not forget the transformation of Mazorra in this period, and how this also reflected much wider reforms in the country.

As Lambe writes, the revolutionary reconstruction of Mazorra was popular, not least because it brought access to psychiatric care for the first time within reach of the poor, and by the late 1970s psychiatric treatment encompassed not only patient and physician, but also family, neighbours and local representatives of the Committees for the Defence of the Revolution.

This is a mesmerizing book in which the author identifies how the history of Mazorra and madness in Cuba can offer a unique stage on which to witness the evolution of the country’s state, by focusing attention on those whose reality diverged from that decreed from above.

As such, the study of madness draws attention to something that we often fail to recognise, highlighted in this case by Cuba but clearly applicable everywhere, which is that political standards in themselves can so often be absurd. Indeed, perhaps politicians are drawn to the control of psychiatric care because they recognise in it syndromes that could so easily apply to themselves as they hurry to engineer their visions of reality.

“Perhaps there was something a little mad about revolution, driven by sentiments both quixotic and alienating,” Lambe reminds us pointedly. “As Fidel Castro noted on more than one occasion, the wagers of righteous revolution, beginning with Maceo and Martí and running all the way through his present, were all crazy in their way. The madness of the state is, in turn, a trope that trails Cuba’s disappointed revolutions, with Mazorra as their inescapable shadow.” [p 233]