In September 1933, A. F. was discharged from the lunatic asylum in Accra, Gold Coast, where he had spent ‘the last few years'.Footnote 1 Colonial officials had determined that he had ‘recovered his sanity sufficiently to enable him to be discharged’ and therefore they had no medical reason to confine him behind walls designed to separate the ‘sane’ from the ‘insane’. A. F., however, was not free to return to the life he had before his incarceration. A native of the Mopti region in what is now southern Mali, A. F. was technically a French colonial subject, with no legal right of residence in Gold Coast. Simultaneous with his release from the asylum, colonial authorities drafted a deportation order for him. He was driven to Navrongo, on the northern border between Gold Coast and French West Africa, given thirty shillings, and sent across the border to make his own way the roughly 800 km to his native home.Footnote 2
This article examines the plight of internal African immigrants like A. F. in Gold Coast with regard to their experience with the social control mechanisms of colonial psychiatry and the colonial asylum. In so doing, it adds a new dimension to the historiography of psychiatry in colonial Africa. Historians of Europe and the United States have long noted that immigrants have played a pronounced role both in the physical and discursive processes of psychiatric diagnosis and containment because their cultural difference frequently disrupted the delimitation of ‘normality’ on the one hand and because their very presence as carriers of alien cultures branded them an innate threat to established social orders on the other.Footnote 3 In the history of Africa, however, the development of psychiatric medicine and its social control mechanisms was an inversion of the European and American cases. The power of indigenous systems of belief regarding mental illness was to a certain extent displaced in the twentieth century by a ‘Western’ psychiatry that was itself alien, attuned to the cultural beliefs and values of European colonialists who defined the majority indigenous populations as racially and culturally different from and inferior to European ‘normality’.Footnote 4 As Megan Vaughan has argued, ‘to put it simply, whilst the history of insanity in Europe is the history of the definition of the mad as “Other”, in colonial Africa the “Other” already existed in the form of the colonial subject’.Footnote 5 Vaughan and others have made clear that for the most part only the most violent or otherwise uncontrollable criminal ‘lunatics’ found their ways into colonial asylums.Footnote 6 Colonial ideology, medical discourse, and administrative practicalities of alien rule rarely coincided, prompting Vaughan to argue that at a general level ‘the lunatic asylum cannot then be regarded as a major instrument of colonial social or political control’.Footnote 7
Some groups, however, experienced the social control mechanisms of the colonial asylum more significantly than others. This article argues that internal black migrants, like non-white and immigrant demographics in Europe and the US, were one such group. Existing studies on the social control mechanisms of health systems in African history have focused overwhelmingly on the construction of racial and gendered categories in colonial medical discourses. Such works frequently recognize the intensified effects of colonial social order on internal African migrants in the colonial era, including the health consequences of sustained population movement and the dangerous work that migrants frequently did.Footnote 8 Along these lines, historians of colonial psychiatry have frequently mentioned migrants in their analyses. In his history of Kissy Lunatic Asylum in Sierra Leone, Leland V. Bell has noted that young male immigrants from Liberia and Nigeria ‘were a dominant group in prison and in the mental asylum’.Footnote 9 Jonathan Sadowsky has noted the extent to which colonial officials in Nigeria recognized that their own asylums held a ‘large percentage of lunatics from remote localities’.Footnote 10 Lynette Jackson found migrant labor to be a common route to the Ingutsheni asylum in Southern Rhodesia.Footnote 11 However, following Vaughan's cue, these works tend to treat migrants as part of the larger body of African ‘others’ objectified by colonial medical systems, not as a group with its own peculiar relationship to psychological definition and marginalization. The contention of this article, however, is that this emphasis on the racial and, to a certain extent, gendered ‘othering’ of African subjects has obscured the different experiences of intra-African migrants by situating them firmly within the boundaries of their race and gender rather than treating them as the social, political, and regulatory border crossers that in many ways they were well-recognized to be.
As the current historiography shows, the existence of migrant lunatics can be subsumed into the analysis of colonial constructions of race and gender, but racial and gendered perspectives have the tendency to marginalize the contingencies of the immigrant experience. Blackness was an attribute shared by most immigrants and non-immigrants alike in colonial Gold Coast, so focusing on racial discourses obscures in important ways the different experiences that black immigrants may have had from locals. Simultaneously, the vast majority of immigrants in the Accra asylum were male, which serves more as a reflection of the gendered nature of colonial immigration policies and practices in Gold Coast generally than of any particularly gendered approach to policing mental illness in immigrant communities. While gender histories of colonial Africa have well-documented the extent to which African women experienced multiple forms of marginalization, the lack of gender differentiation in the immigrant lunatic population examined in this article has meant that gender plays a very minimal role in the story that follows. The inability of racial and gendered analysis to explain how immigrants got into or out of the Accra asylum suggests that these two categories are not all-encompassing units of analysis for understanding the power dynamics of defining and controlling colonial populations, whether in psychiatric settings or otherwise.
Focusing on contingencies within racialized and gendered constructions is useful because it reveals ways that colonial categories could and did break down, creating conflicts that exposed the ‘tensions of empire’ with which we have become so familiar in other contexts.Footnote 12 As recent works on African immigrants in Europe have begun to argue, the diagnosis and treatment of mental illness often reveals significant fissures in medico-legal frameworks. Richard Keller and Didier Fassin, in particular, have deftly shown how the legacies of colonial psychiatry in postcolonial France have brought to the fore tensions about whether or how to address the role that cultural difference plays in the diagnosis and treatment of mental illness amongst black and Arab immigrants within a supposedly egalitarian legal system.Footnote 13 In the British imperial context, I have indicated elsewhere that the presence of mentally ill Nigerian immigrants in the UK prompted debates in the 1950s and 1960s over whether it was more appropriate for medical and legal authorities to emphasize sociocultural particularities or cross-cultural similarities when deciding how to balance the rights and needs of British subjects who were simultaneously categorized as black, mad, and alien(ated).Footnote 14
The problem with mentally ill immigrants, therefore, is not simply that they cross physical borders, but that they disrupt bureaucratic categories. In the case of Gold Coast discussed here, colonial officials recognized that they had other ‘others’ in the mental asylum. They sought to isolate and neutralize what they saw as a distinct black, mentally ill, immigrant population as a means of reducing overcrowding. However, officials quickly learned that it was administratively impossible to treat an individual simultaneously as black, mad, and immigrant. This created a situation in which the proliferation of ‘others’ did not create a compounding of otherness – as Keller, Fassin, and I have found in the context of immigrants to Europe – so much as incommensurable forms of alterity in which one could be black and mad, black and immigrant, or immigrant and mad, but, in legal terms, not all three. By focusing on the experiences of foreign and non-native immigrants in the Accra Asylum between 1900 and 1945, we can see the colonial asylum and the administration that governed it as an institution significantly at odds with itself over how to address a recognized crisis brought about by a desire to target explicitly these physical and bureaucratic border crossers, thereby revealing how complex and unresolved colonial categories frequently were.
IMMIGRATION AND MENTAL ILLNESS IN GOLD COAST
The first institution for the sole confinement of the mentally ill in colonial Gold Coast came into existence in 1888 with the establishment of a lunatic asylum in Accra. The asylum was commissioned to relieve the pressures of overcrowding on local prisons, which up to that point had been responsible for housing those mentally ill who had become so unruly as to attract the attention of colonial authorities. In 1906, the Lunatic Asylum was renamed Accra Psychiatric Hospital, although in practice it offered little more than custodial care for patients, and colonial officials continued to refer to it as the asylum.Footnote 15 Originally designed to house 200 patients, the Accra asylum quickly became overcrowded. By the early 1930s, more than 350 patients called the asylum home. Of these 350 patients, over 100 were natives of French territories and 39 were Nigerian. This made for a situation in which roughly 40 per cent of all ‘lunatics’ in custody were immigrants at a time when the Gold Coast census estimated that only 6·3 per cent of the total population was foreign born.Footnote 16 Immigrants from other African colonies were six times more prevalent in the asylum than in the general population.
The discrepancy suggests that immigrants had a very different relationship with the colonial asylum than native-born Gold Coast subjects. There are a number of reasons that migrants – and particularly immigrants – might be disproportionately represented in colonial asylums. In Gold Coast, as in other colonial settings, migration was intimately linked with the development of capitalist economic structures associated with urbanization and raw material extraction. In the 1890s, many migrants from French territories began travelling to Gold Coast to make money to pay French taxes. By the 1920s, as many as 80,000 Mossi laborers migrated to Gold Coast each year.Footnote 17 The numbers were large enough that French authorities referred to the mass migrations as a ‘crisis’.Footnote 18 These immigrants from French lands were joined by laborers from Nigeria and large numbers of internal migrants from the Northern Territories of Gold Coast.Footnote 19 Most of these migrants traveled to southern Gold Coast to work in the cacao plantations and mining operations, some returning home in an annual migration cycle. Many, however, remained in Gold Coast permanently. Their status as immigrants made them economically vulnerable, culturally alienated, socially dislocated, and exposed to a variety of stressors that non-migrant individuals did not necessarily face.
There is a great deal of debate in cross-cultural psychiatry over the issue of diagnosing mental illness in immigrants. On the one hand, immigrants frequently live under stressful circumstances that make them susceptible to psychological breakdown. Some literature has suggested that psychologically unstable people or individuals predisposed to the development of severe mental illness might be more likely to migrate than the psychologically healthy.Footnote 20 Nevertheless, it is difficult to diagnose mental illness across cultural boundaries, as definitions of ‘normal’ behavior vary from culture to culture, and if doctor and patient do not speak the same cultural language, miscommunication can easily lead to pathologization.Footnote 21 Doubtless, immigrants to Gold Coast in the early twentieth century encountered these problems. However, they do not entirely explain why immigrants made up such a high percentage of the asylum population. Being diagnosed and labeled as ‘mentally ill’ in Gold Coast, as in other African colonies, did not usually result in incarceration in the asylum. Asylum space was typically reserved only for those whose mental illness posed a serious threat to themselves or others – that is, those with the capacity to disrupt the colonial social order. In Gold Coast, as in other African colonies, most mentally ill individuals were maintained in their local communities, by family, friends, and local authorities.Footnote 22 So, while it is possible, although unknowable, that immigrants experienced higher than average rates of mental breakdown than non-migrants, presence of mental illness per se cannot explain why immigrants would make up such a disproportionate percentage of the asylum population.
Secondly, while immigrants were culturally alien, for the purposes of colonial medical officers, they were most likely lumped together as part of an indistinguishable ‘other’ whose cultural ‘norms’ were inherently pathological relative to Europeans.Footnote 23 By the 1940s, colonial psychiatrists like J. C. Carothers and others were beginning to make connections between migration and mental illness, noting that the ‘deculturation’ or ‘detribalization’ that African migrants experienced left them in an existential quandary that their ‘primitive’ psyches could not reconcile. However, the ‘detribalization’ thesis applied to a variety of sociocultural patterns that natives of a colony experienced no less than immigrants.Footnote 24 Rural-urban drift, engagement with Christianity and European education systems, and changing marriage patterns, all contributed to the psychic turmoil of ‘detribalization’ in colonial psychiatric discourse, and these phenomena applied to local as well as immigrant groups. Therefore, it is unlikely that medical authorities in charge of the Accra asylum would have diagnosed mental illness in African immigrants any differently than in local populations.
Confinement, rather, was not so much a reflection of their supposed psychological state as of their immigrant status, for two reasons. First, since the colonial government preferred to believe that most mental illness could be treated in local communities and did not require institutionalization, the relative lack of social incorporation that immigrants experienced in their adopted environments became a problem. By 1928, some administrative structures had been put in place to provide local representation for immigrant populations in Gold Coast. For example, by this time the Mossi population had become so large that authorities created a local ‘chief’ for the Mossi drawn from the elder migrant population.Footnote 25 However, before this point immigrants did not have family or – frequently – organized community sufficiently stable to take care of them when they suffered a psychological breakdown. As a result, they were probably much more likely to end up in an asylum because there was no one else to take care of them and, as a result, their continued existence outside posed a potential threat to themselves or others and reflected poorly on the colonial migrant labor system in general.
Second, while immigrants were probably much more likely than Gold Coast subjects to be committed to the asylum, they were also less likely ever to be released from the asylum. As historians have pointed out in other colonial contexts, colonial officials were usually fairly accommodating to requests for release of patients made by family members or local native authorities. If the patient was quiescent enough to be looked after by kin, colonial officials were usually happy to arrange a discharge.Footnote 26 However, immigrants rarely had family or native authorities lobbying for their release. Their incarceration far from home made it likely that their families did not even know that they were in an asylum at all and only in rare circumstances would they have had the means to petition for their family member's release and return. Colonial officials were unlikely to release a patient back onto the streets of Accra, even in a calm state, without anyone willing to help him reincorporate into society and prevent remission that could result in a return to the asylum. Evidence does suggest that once confined, immigrants tended to stay in the Accra asylum for a long time. A chart of Nigerian patients slated for repatriation in 1933 shows that each individual patient had been in the asylum for at least seven years, with the longest tenures exceeding twenty years.Footnote 27 One man named S. L. had been awaiting repatriation for 17 years.Footnote 28
It is clear that as a result of these two factors the resources of the Accra asylum were disproportionately spent on the control of immigrants. The dynamics of the colonial social order created a scenario in which immigrants were more likely than locals to be placed in the Accra asylum regardless of the relative severity of their psychological disturbance. Once in the asylum, it was much more difficult for immigrants to achieve release than local patients because of their distance from a home where they could be looked after. Over the years, the one-way doors of the Accra asylum had resulted in the accrual of immigrants at a higher and more sustained rate than non-migrants, which in itself is an illustration of the extent to which the social control mechanisms of the colonial asylum were unevenly felt.
IMMIGRANTS AND THE POLITICS OF THE ASYLUM
Inside the asylum, immigrants became a group of particular interest to colonial authorities. The overcrowding of the Accra asylum had become a significant political liability for the Gold Coast government by the early 1930s. Patterson has noted that in Gold Coast, colonial medical officers frequently refused to commit patients to the Accra asylum out of fear that incarceration there would make their conditions worse.Footnote 29 In 1933, the asylum suffered public embarrassment when the Supreme Court of Gold Coast Colony chastised asylum staff over the violent death of one of its inmates at the hands of another inmate. The court found that the death of the patient ‘was caused … by shock and haemorrhage from fractured ribs and lacerated right lung, caused by an act of violence by one D., a lunatic, not criminally responsible for his actions'. The Court instead found fault with the asylum system itself:
The night attendants A. and K. seem to have had no conception of the duties of night nurses in an Infirmary. In the infirmary, no treatment seems to be attempted by night, even in extremes. The supervision of the Asylum by night is inadequate, where violent patients are in open wards with other patients. The structure of the asylum is unsatisfactory and accommodation inadequate. In these respects conditions in the Colonial Lunatic Asylum, fall far short of the standards required in public mental institutions.Footnote 30
Perhaps more problematic for the colonial government, K. David Patterson has noted that the asylum was located close enough to a European residential area that ‘whites were sometimes disturbed by the nocturnal clamorings of the inmates’.Footnote 31 Something had to be done, not only for the good of the patients, but also for the image of the government itself. Although the problems of the Accra asylum were in many ways systemic, the disproportionate immigrant population soon became the focus of the administration's reform plans.
The colonial administration had multiple options to ameliorate conditions in the asylum and, in so doing, alleviate the overcrowding that contributed so greatly to its degradation. The first and most obvious option was to increase the custodial capacity of Gold Coast's asylum system. As early as 1926, efforts had been undertaken to find and develop sites suitable for the building of a new lunatic asylum in the Kumasi area. However, due to the financial outlay necessary, the process was tabled in 1931.Footnote 32 The Accra asylum would remain the only psychiatric institution in Gold Coast/Ghana until the opening of the Ankaful hospital near Cape Coast in 1965.Footnote 33
With the financial impossibility of expanding institutions during the depression of the 1930s, the next most expedient solution was to reduce the demands made on existing facilities to serviceable levels. This meant reducing the existing asylum population, particularly by removing as many of the immigrants in the asylum as possible. Originally, authorities hoped to achieve this simply by repatriating or deporting all asylum inmates who were not natives of Gold Coast. A government report from 1932 bemoaning the ‘chronic embarrassment’ that the Accra asylum typically housed ‘one hundred persons in excess of the maximum capacity’ also noted the interesting coincidence that of 368 inmates of the asylum about 100 were believed to be subjects of neighboring French West African colonies. The memo then posed the question ‘whether anything should, or can, be done to induce or compel the French Authorities to accept the responsibility for these unfortunate persons thereby relieving the Gold Coast taxpayer from the obligation to house, maintain and nurse them’.Footnote 34 Among the non-native lunatics in the asylum were also several dozen patients identified as originating from the nearby British territory of Nigeria.Footnote 35 If these foreign and non-native patients could be removed from the asylum, Gold Coast authorities realized, the asylum population could be nearly halved, resolving the overcrowding problem and unburdening the ‘Gold Coast taxpayer’ of the cost of maintaining persons who were ultimately the subjects of other territories.Footnote 36 As far as records indicate, all of the immigrants proposed for repatriation were black Africans. Typically, whites who became mentally ill in the colony were repatriated to their European homes expeditiously for both medical and sociopolitical reasons.Footnote 37 Similar arrangements appear never to have been contemplated for black immigrants deemed to be lunatic, however.
The focus on immigrants as the bane of the colonial asylum by the 1930s illustrates the extent to which colonial officials made an active attempt to delimit other ‘others’ within their subject populations, this time for immediate instrumentalist purposes. However, as it turned out, colonial law made it nearly impossible for Gold Coast authorities to divest themselves of immigrant lunatics even when they had a desire to do so. Once diagnosed a ‘lunatic’ and a ‘proper subject for confinement’ in legal terms, the immigrant became a medical case whether or not he or she was actually receiving medical treatment in the asylum. As such, according to the English Lunacy Act of 1890 upon which Gold Coast law regarding lunatics was based, all decisions about the living conditions of immigrant lunatics had to be made primarily in the interests of patient health, not government convenience. This was very different from the situation of ‘healthy’ immigrants, who could be removed and deported as undesirable. The diagnostic status of ‘lunatic’ therefore severely limited the mobility of those to whom it was applied. This situation became something of a paradox for colonial officials as they sought to remove black immigrants from the Accra asylum for the purpose of returning them to their countries of origin.
In August 1932, Gold Coast authorities made their first effort to remove the immigrant population from the asylum by attempting to repatriate the 39 Nigerians that resided there. The Nigerian government's initial reaction to Gold Coast's request that it accept back those lunatics ‘as are fit to be moved’ was to search for any Gold Coast natives in its asylums, with the hope of essentially trading bodies.Footnote 38 Unfortunately, the director of medical and sanitary services (DMSS) for Nigeria indicated that there was only one native of Gold Coast in Nigeria's asylums and expressed ‘doubt as to whether any ship would take him in his present condition’.Footnote 39 The DMSS went on to say that ‘it would be quite impossible for the Medical Department to accommodate 39 lunatics at present. All the Asylums and Prisons with accommodation for lunatics are overcrowded now.’Footnote 40 Nigeria therefore declined to accept all 39, but did agree to the repatriation of five females, citing available space in the female ward of the asylum at Lokoja.Footnote 41 The Gold Coast government, interestingly, did not take Nigeria up on this offer on the basis that removing only five patients did not make a material difference in the situation at the Accra asylum, as it was the ‘male, not the female, wards’ that were seriously overcrowded.Footnote 42 Indeed, this response implies that none of the 39 lunatics whose repatriations Gold Coast requested were women, although available records do not indicate the names or genders of all 39 of the Nigerians in this case. However, this demographic disparity within the asylum is likely a reflection of the extent to which the immigrant community, which accounted for so much of the overcrowding of the asylum in official eyes, was itself overwhelmingly male.
The repatriation of Nigerian lunatics failed primarily because the Nigerian government could not guarantee that conditions for the repatriates would be any better in Nigeria than they were in Gold Coast. Existing colonial law made no allowances for the forcible repatriation of lunatics. When asked to advise the colonial secretary of Gold Coast about the possibility of instituting legislation allowing for forced removal of lunatics, the attorney general noted that, as far as he knew, no such legislation existed in any other country, and, in general, ‘that countries seem to agree that lunatics remain where they are found to be insane’.Footnote 43 Existing law on repatriations in Gold Coast applied only to non-Africans and to healthy, sane individuals, not to those certified as mentally ill. Furthermore, the attorney general pointed out that British and, by extension, Gold Coast law did not allow lunatics to be moved simply for the convenience of Government, but only for ‘the welfare of the lunatic’.Footnote 44 While the benefits of repatriating European lunatics to their home countries with temperate climates where they could receive ‘modern’ medical care was clear to authorities in most cases, the same benefits would almost never apply to Africans being repatriated from one colonial asylum to another. Beyond this, as British subjects Nigerians had right of residence in British territories, including Gold Coast. The government of Nigeria's refusal to accept the lunatics was perfectly legal under the laws of the United Kingdom and British West Africa. Gold Coast therefore could not force Nigeria to accept repatriation of its lunatics.
Although the French West Africans in the Accra asylum did not have the same rights, it was equally difficult for Gold Coast to compel their removal. Seeking to determine if legislation existed that allowed the colonial government to deport the French lunatics, the colonial secretary came up against strong resistance from the attorney general, who argued that no such legislation existed and that it would be undesirable to create such legislation strictly for the purpose of alleviating a government burden. The same lunacy legislation that required patients' interests, not government convenience, to be the impetus for moving lunatics applied to foreigners as well as British subjects. The attorney general was not entirely opposed to the introduction of new legislation, but he argued that it should not be in the form of a forcible deportation of French subjects, but rather through cooperation and agreement with French authorities. In order to be in accordance with existing law, the Gold Coast government needed to be assured that the interests of the patient were not harmed by the removal. According to the attorney general:
If the convenience of the Gold Coast is the primary objective then it will obviously not be adequate, and we must consider whether we can justifiably amplify it so as to make it apply to every case where the other Government is willing to receive the lunatic and to see that he is properly cared for.Footnote 45
But beyond this, ‘if a country is willing receive [sic] its mental unfortunates and our humane principles are satisfied by the assurance that proper care will be taken of them that seems to be enough’.Footnote 46 Even though no other country apparently had similar legislation, the attorney general believed that ‘an economy campaign and appreciation of the deplorably unsatisfactory state of the asylum accommodation’ merited approaching the French about a voluntary transfer of lunatics.Footnote 47
In the end, it was decided not to consult with French authorities along the lines that the attorney general suggested. When asked directly about the possibility in late 1932, the DMSS of Gold Coast declared that he was ‘against the proposal at the present moment’ on the grounds that ‘once it was found out that we had discharged these patients there would be an influx of our own people who are now only certified as a final measure, and the last state might very possibly be worse than the first’.Footnote 48 There was an underlying fear amongst some in the colonial administration that ‘if we enquired of the French authorities we might well discover that the balance of insanity was against the Gold Coast’,Footnote 49 meaning that the French authorities would feel compelled to retaliate by deporting all of their alien lunatics back to British territories. The benefits would be offset at best. Furthermore, the DMSS worried about the expense to be entailed in transporting one hundred lunatics from Accra to the borders with French territories.Footnote 50
Ultimately, if the strategy to be employed was negotiation rather than forcible deportation, the outcome of parley with the French was unlikely to be any more fruitful than it had been with Nigeria, which had denied repatriation on the grounds that patients' welfare would not be served by such a removal. The immigrant status of these individuals rendered them demographically distinct as targets for removal, but their other forms of alterity prevented the government from actually removing them. Their ascribed ‘lunatic’ identity prevented them from being treated like other black immigrants, while their blackness – or at least the social realities that obtained from their blackness in a colonial context – prevented them from being treated in the same manner as European lunatics. Under such circumstances, Gold Coast authorities had to find a way of jettisoning one of the bureaucratic categories of identification for patients in order to remove them.
DECERTIFICATION AND REPATRIATION OF IMMIGRANT LUNATICS
By the end of 1932, Gold Coast authorities had recognized that the primary problem that prevented the removal of black immigrants from the Accra asylum was their legal status as ‘lunatics’. From this point on, Gold Coast authorities worked diligently to decertify immigrant lunatics and remove them from the asylum. The goal of embarking upon a systematic re-evaluation of patients' mental states was primarily to circumvent the law requiring that treatment of certified lunatics be in their own best interests. Once immigrants were released from the asylum they were no longer subject to the same protections that had prevented repatriation and deportation in the interests of their needs as patients. As we will see, removing immigrants from the asylum had as much to do with the political and economic problems of the colonial government as it did the mental state of the patient in question. As a result, efforts to decertify black immigrant lunatics reveal tensions and conflicts within the colonial administration about its goals and its responsibilities towards other ‘others’.
In March 1933, the colonial government in Gold Coast began reevaluating patients in the Accra asylum in an attempt to discharge as many as possible. The attorney general of Gold Coast advised the colonial secretary on a reinterpretation of the existing confinement law, pointing out that ‘the law … provides that any person adjudged a lunatic and a proper subject of confinement shall be confined in an asylum by order of the District Commissioner’.Footnote 51 Through a reinterpretation of the law, Gold Coast authorities could argue that many of their patients were not, in fact, ‘proper subjects of confinement’. As the attorney general rationalized it, ‘“Sanity”… is a matter of degree. Plenty of persons are of unsound mind, but the security of the community does not require their confinement.’Footnote 52 In the case of black immigrants in the asylum, apparently the security of the community did require their confinement at the time of their certification as lunatics; however, if the purpose of decertifying them was to repatriate them, then presumably Gold Coast communities would not experience any security threat as a result of their medical discharge.
In order to discharge a patient from the asylum, the attorney general continued, the DMSS ‘has not to satisfy himself that the person discharged is of sound mind, but merely that he has sufficiently recovered his sanity so as to be a proper person to be discharged’.Footnote 53 Once an immigrant patient was deemed sufficiently recovered the government could apply repatriation and deportation laws normally, and other governments could say little about it. Other governments could no longer refuse the return of these individuals on the grounds of their medical well being because they would (presumably) no longer need to be confined in an overcrowded asylum once back in their homeland. Assuming relatives of the immigrant or the Gold Coast government were willing to pay for the cost of repatriation in the case of Nigerians, or deportation in the case of French subjects, the receiving governments had no grounds for interference.
The DMSS of Gold Coast was thus ordered to conduct an investigation into how many inmates of the Accra asylum could be considered ‘“sufficiently recovered” and discharged to the care of their families'. The document declaring this agenda specifically singled out ‘a number of the persons [who] are either of Nigerian or foreign birth’ as targets of the investigation.Footnote 54 Under this reinterpretation of existing law, 44 inmates of the Accra asylum were re-evaluated as fit for discharge and return to the custody of their family and friends.Footnote 55 Nineteen of these inmates were actually Gold Coast natives, but the majority – 16 from French territories and nine Nigerians – were immigrants.Footnote 56 In this case, records explicitly indicate that all lunatics proposed for discharge were male.Footnote 57
While no detailed case histories are available, circumstantial evidence suggests that the list compiled by the DMSS of Gold Coast was motivated by the short-term political need to reduce overcrowding in the Accra asylum and not by the best available medical knowledge of the individual cases. In fact, the medical staff of the Accra asylum actively resisted the approach being taken by their superiors, arguing that many of the cases proposed by the DMSS had not recovered enough to be fit for discharge whether for purposes of repatriation or not. The Medical Officer in charge of the Accra asylum quickly whittled down the list of inmates declared ‘sufficiently recovered’ from 44 to 26. Perhaps the most startling and potentially scandalous recommendations for discharge on the DMSS's list concerned several natives of Gold Coast who apparently continued to exhibit violent tendencies. The Medical Officer stated:
I consider it to be inadvisable to discharge E. T., Y. B. and J. A. at present. E. T. is not much improved, and is liable to injure himself if he gets hold of a knife. Y. B. has fixed delusions of persecution against three people in Kintampo, and has threatened to kill them. Though he has been quiet since admission, I think there is definite danger of his relapsing and attempting to carry out his threat if released. J. A. assaulted several women before admission in 1931. Though he is now quiet, I do not feel satisfied that he will remain harmless if released.Footnote 58
Three of the patients that even the asylum considered fit for release in April 1933 had relapsed by October and the asylum staff refused to discharge them.Footnote 59
Several of the immigrants proposed for discharge and repatriation had lived in Gold Coast for more than twenty years, and some of them had been in the Accra asylum nearly all this time. Of the nine Nigerians proposed for discharge, the medical officer in charge of the Accra asylum cleared only seven for repatriation. One of the Nigerians refused to be repatriated, as was his right as a British subject, and another could not ‘be induced to give an answer’ about his background, indicating either that he continued to suffer from his mental illness to a significant degree or that he was not willing to be repatriated. The same kinds of problems were found with many of the French West Africans proposed for repatriation. The medical officer declared two of the five Moshi ‘unfit to be discharged at present’. One of the two Fulani ‘can give no account of himself and his home cannot be traced’. As for the rest, the native homes of two could not be traced, ‘and though the homes of the rest are known, none of them are capable of looking after themselves until they reach their villages’.Footnote 60 This posed a significant problem for government officials, since without verification of the native homes of patients they could not be effectively deported or repatriated. They would have to be released into Gold Coast as potential future threats to order, something the government was keen on avoiding. Those who could not see themselves to their villages would likely cause chaos en route, embarrassing the government that claimed them fit for discharge and possibly resulting in their readmission to asylum before the voyage was even completed. Ultimately, if they could not make their way home, hospital officials were left to wonder whether these patients were really in a fit state for discharge at all. Such complications in implementing the discharge and repatriate policy indicate that while higher-ups in the colonial administration were clearly interested in playing down the lunatic otherness of these individuals in order to focus on their immigrant status, it is clear that the medical officers in the asylum itself were more concerned with looking past their immigrant otherness to assess the nature or severity of their psychological otherness.
Only two of the nine French West Africans, A. F. discussed at the outset of this article, and another named A. B., were considered capable of looking after themselves until they reached home. But this did not mean that Gold Coast officials thought these patients were in any way mentally stable. A. B.'s case illustrates quite starkly the extent to which the redefinition of ‘sanity’ was designed primarily to privilege asylum inmates' immigrant otherness over their purported psychological otherness. The Moshi Chief in Accra had actually submitted an application requesting A. B.'s release into his jurisdiction. This left Gold Coast authorities with the question of whether to continue with deportation of A. B. to French territory or to release him at once into the care of the Moshi community in Accra.Footnote 61 While the DMSS recognized that the latter option was cheaper, he recommended the deportation as a more permanent solution because A. B. still suffered from ‘nervous instability’, which the DMSS admitted was ‘common in all these recovered cases’.Footnote 62 As a result, ‘the strain of life often causes relapse’, and, for the government's purposes, it would be better if that relapse occurred in French territory than in Accra.Footnote 63 On 19 September 1933, government authorities escorted A. B. to the border with French Togoland at Aflao. Like A. F., the other French subject, he was given 30 shillings to see himself across the frontier. Although French officials had been notified of the deportation order, Gold Coast officials noted that ‘no formal handing over was ever contemplated’.Footnote 64 A. B. was on his own, not quite ‘sane’ but at least no longer Gold Coast's responsibility.
The discharged Nigerians did not fare much better with their repatriations. Nigerian officials expressed consternation at the repatriation request, declaring in an internal memo that ‘these “restored” lunatics should be identified as natives of Nigeria before we take them over’.Footnote 65 The use of scare quotes around ‘restored’ indicated this official's skepticism about how truly recovered these patients were and underscored the need to verify that the government of Nigeria was actually responsible for these individuals before taking on such a potential liability. These were, ultimately, the same individuals that just a few months previously Gold Coast had wanted to repatriate into the custody of Nigeria's lunatic asylums, but who were now all miraculously recovered enough to return to Nigeria as healthy subjects. Nigerian authorities were cooperative with Gold Coast efforts, but ultimately were unable to trace the relatives of six out of the seven Nigerians. Most of them had been in the asylum in Accra between seven and twenty years, and as one Nigerian official put it ‘can probably give us little account of themselves’.Footnote 66 Of the seven cleared by the medical officer of the Accra asylum to return to Nigeria, only one was eventually repatriated.Footnote 67 Unlike in the case of A. B., when the sole Nigerian returned home he received an escort to his native Katsina, again indicating that Nigerian authorities did not necessarily trust that this man was recovered enough to take care of himself.Footnote 68
The skepticism about the extent of recovery of repatriated mental patients proved to be well founded in later years. Gold Coast maintained its policy of discharge and repatriation for ‘harmless’ immigrant lunatics for the remainder of its colonial existence. And, as in the past, while the threshold of sanity was blurry, the boundaries of immigrant status were clear and exploitable. In 1945, the Gold Coast government informed the government of Nigeria that a man named L. L., a native of Obatiwejeye village near Offa in Nigeria, ‘has recently been discharged from the Accra lunatic asylum as completely recovered’.Footnote 69 Nigeria agreed to L. L.'s repatriation so long as Gold Coast paid for it. Unfortunately for Nigerian authorities, it soon became clear that L. L. was not completely recovered. On the journey back to Nigeria, he had been erratic and violent. In a warning to the secretary of the Northern Provinces, the chief secretary, Lagos, declared that although he had been ‘discharged from a lunatic asylum in the Gold Coast as being cured’,Footnote 70 nevertheless ‘his behaviour en route to Lagos suggests, however, that he is still liable to fits and is of a violent nature’.Footnote 71 As evidence of the instability of L. L., the chief secretary noted that ‘at one stage in the journey he had to be bound to prevent him throwing himself out of the lorry’.Footnote 72 Because L. L. had been discharged and repatriated as a mentally sound person, no accommodation had been guaranteed for him in an asylum in Nigeria. As such, despite his ‘fits’ on the return journey, the government of Nigeria decided to send him back to his home village. The only precaution taken by the government was a notice to the secretary of the Northern Provinces ‘that he should be watched’.Footnote 73 It is unclear whether L. L. ever had to be readmitted to an asylum in Nigeria. His repatriation file ends with his return to his home town. However, the case of L. L. serves as another example in which it appears that Gold Coast's government was willing to manipulate the diagnosis of mental patients in order to effect their repatriation, or at the very least did not do a particularly thorough job of vetting his case before reaching the desired decision to remove him, since the ultimate goal was to expunge the ‘lunatic’ from L. L.'s bureaucratic identity so that he could be treated like a regular black immigrant.
In yet another case, Gold Coast released a man named I. T. from the Accra asylum in 1946 to return to his home in Zaria, in northern Nigeria. Unlike in other cases in which repatriated mental patients traveled with one or more custodians, I. T. was considered sound enough to travel on his own. The labor officer of Gold Coast informed the labor officer, Lagos, of the impending repatriation, stating: ‘I. T., who has been recently discharged from the Mental Hospital here, is being repatriated … He has been provided with transport to Lagos and subsistence en route at the expense of this Government. May he please be assisted forward.’Footnote 74 I. T. did not reach Zaria, however, at least not through the arranged channels. He never arrived at Minna, one of the rail stops in Nigeria on the way to Zaria. It is not clear what prevented him from reaching Minna. He could have decided not to return to Zaria. He could have taken a different route. He may have suffered a relapse and been incapable of completing his journey. Regardless of the reason, the decision to send I. T. back to Nigeria unaccompanied presented the image to the government of Nigeria that the man was completely recovered and capable of looking after himself, therefore making repatriation uncontestable. At the same time, however, the decision to have I. T. travel alone put a man with a history of mental instability in the stressful position of having to find his own way back to his family and friends in Nigeria, if indeed he had any. This approach was uncommon, as most former asylum residents repatriated to Nigeria (but not French West Africa) were escorted to their homes either in the care of qualified mental nurses, paid escorts, or family members. Since we do not know the outcome of I. T.'s case, it cannot be considered a tragic miscalculation on the part of Gold Coast authorities. Nevertheless it is yet another example of the difficulties that immigrant mental patients faced in a colonial encounter that was unable, or at least did not want, to accommodate I. T.'s particular combination of othernesses.
However scandalous these cases may seem, it is also important to emphasize that the decision to discharge and deport/repatriate immigrants from the Accra asylum did not materially improve the problem of overcrowding. By the end of 1933, two French West Africans had been unceremoniously deported and one Nigerian had returned to Katsina.Footnote 75 In the same period, only seven Gold Coast natives had been discharged to the care of their families as a result of the reinterpretation of confinement policy.Footnote 76 The effort designed to clear immigrants out of the asylum had actually resulted in the discharge of more Gold Coast natives than immigrants. An official in the colonial secretary's office lamented in early 1934 that since efforts began to significantly deinstitutionalize patients from the Accra asylum, ‘some few persons – not more than a dozen all told – have been discharged’.Footnote 77 In the meantime, the asylum population had actually grown from 373 to 383.Footnote 78 The result was that the discharge and repatriation of patients had amounted to little more than the maintenance of the situation of overcrowding that had been deemed unacceptable to begin with. Gold Coast's hopes of reducing congestion through discharge and repatriation ultimately failed, but in so failing revealed the extent to which black immigrants were particularly vulnerable to marginalization and manipulation even amongst an already highly marginalized and manipulated asylum population. This stemmed from tensions and conflicts surrounding the incommensurable othernesses that black, immigrant lunatics represented in the colonial bureaucracy and legal system. The incommensurability of these multiple forms of alterity ultimately prevented Gold Coast authorities from arriving at a resolution to the perceived problem of immigrant overcrowding in the Accra asylum.
CONCLUSION
Some years ago, Shula Marks asked what, if anything, makes colonial medicine distinct from the practice of medicine in non-colonized spaces.Footnote 79 Although colonial environments shone a particularly bright light on the coercive possibilities of medical knowledge for purposes of social control, this was by no means unique to colonial settings; Western biomedicine has effectively engaged in a ‘colonization’ of discourse on health and healing in both peripheral and metropolitan spaces. To the extent that histories of colonial medicine have contributed significantly to the understanding of the history of medicine more broadly, Marks has suggested it has been by illustrating how European conceptions of race and gender have contributed to the social construction of disease in the nineteenth and twentieth centuries.Footnote 80 However, Marks's concession is also a lamentation, as she argues that the preoccupation with race and gender has prevented historians of colonial medicine from examining other social cleavages, most notably class, in colonial environments.
The purpose of this article has been to further complicate these racial and gendered analytical constructs of colonial medicine in the history of psychiatry in Africa. In focusing on how immigrants got into and out of the Accra asylum in Gold Coast, I hope to have articulated two points regarding the nature of colonial psychiatry. First, it is clear from the above discussion that while the Accra asylum certainly functioned within a racialized colonial state, it disproportionately affected black immigrants, suggesting that the social structures of colonial Gold Coast did have the capacity to single out immigrants as especially ‘proper subjects for confinement’. Subsequently, colonial officials then singled out the immigrant population in the asylum as particular targets for removal. Even within a colonial social order that defined the black majority as ‘other’, black immigrants were a discernable other ‘other’.
Secondly, and somewhat paradoxically, this article has illustrated the limitations of the ‘othering’ gestures within the medico-legal framework of the British Empire. Although colonial officials in Gold Coast identified immigrants as targets for removal from the asylum, they ultimately found it impossible to force the repatriation or deportation of immigrants from their asylums because of legal and administrative structures that could not simultaneously incorporate all the various forms of alterity that black, immigrant lunatics embodied. The Gold Coast government could not treat Africans in the Accra asylum as it did European immigrant lunatics because they were black; it could not treat them like black immigrants because they were lunatics; and it could not (or rather did not want to) treat them like local lunatics because they were immigrants. Rather than compounding each other, the black ‘otherness’, the immigrant ‘otherness’ and the lunatic ‘otherness’ were incommensurable and momentarily neutralized each other.
This neutralization meant that relatively few immigrants were ultimately repatriated or deported through the processes discussed above; nevertheless, an examination of the contradictory fissures of colonial society in the context of psychiatric institutions, fissures that went beyond racial and gendered binaries, allows a more complicated picture of colonial social, political, and bureaucratic categories to emerge. Between the African collective and the individual subject lie a variety of different layers of social organization and subject formation, of which immigrant is just one. We see here how psychiatric knowledge and administrative practicalities collided as well as how colonial constructions of health and disease formed, adapted, or conflicted across a variety of social and political boundaries. Certainly race and gender are important categories for analyzing colonial constructions of madness, but as this article has shown, these constructions were complicated by the extent to which they were contradicted by other forms of alterity.
