Matthew Heaton's Black Skin, White Coats: Nigerian Psychiatrists and the Globalization of Psychiatry, focusing on the extraordinary work of the Nigerian-born Dr T. Adeoye Lambo in decolonizing psychiatric practice, deals elegantly with the ideological divides between ethnopsychiatry, transcultural psychiatry, and the ‘new cross-cultural psychiatry’ of the 1980s. It presents boldly the implications for both historians and mental health practitioners of positing a universal human psyche (however ambivalently and with whatever complications of context), as the point of departure for psychiatric theorizing. This is not, therefore, simply an addition to accumulating scholarship on the history of the treatment of mental illness in Africa.

This monograph provides a deeply satisfying history of psychiatry in postcolonial Nigeria, but more importantly, it challenges the colonizing tendency of histories that have for decades rehearsed and therefore underwritten three assumptions: that medical science and ‘enlightened’ psychiatric practice was created in the northern hemisphere and exported to the ‘primitive’ south; that colonialism disrupted ‘enlightened’ indigenous healing practices; and, that colonial psychiatry (a term sometimes extended to refer to the colonizing effects of postcolonial psychiatry) was used by governments in Africa as a means of social control, robbing ‘unruly’ African subjects of both physical and emotional freedom. These well-worn paths have been reproduced with minor variations for three decades, and need now to be firmly set aside – Heaton is showing the way.

There certainly was a flow of medical knowledge and practice from north to south as a direct result of the colonization of Africa. However, the penetration of this knowledge into African settings was highly variable and always subject to interrogations and twists. There were local colonial players, generators of knowledge themselves, who used Africa as an exotic laboratory, a continent to be mined. Largely unarchived and uncurated, indigenous Africans actively and creatively interacted with invading European systems of knowledge, appropriating what was useful and discarding the rest. In the postcolonial period that is the focus of Heaton's monograph, the untold histories of Africa's complex interaction with so-called Western medicine began to be inscribed in scholarly literature. This was not the point in which ‘liberated’ or ‘educated’ Africans entered the stage – it was is simply the point at which the written text intervenes. As Heaton evocatively describes, the text here demonstrates a negotiation, not between ‘European’ and ‘African’, or ‘modern’ and ‘traditional’, but rather within complex local contexts, amid new understandings of racialized subjectivities, and surrounded by tensions between globalisation and context sensitivity.

There are many versions of the discourse in which Western psychiatry is positioned as importing alien and alienating diagnoses, physical and chemical incarceration, and perhaps most dangerously stigma, to societies in which the mentally ill had previously been accommodated and cared for in local communities. The archive is relatively silent on precolonial and colonial treatments of those with mental illness, especially in rural communities beyond colonial centres. However, there is evidence that the treatment of the mentally ill in African communities without ‘modern’ psychiatric facilities included fretful families, cruelty, banishment, ambivalence and negotiation, various forms of medicine, and moments of heroic compassion, all of which are both familiar and universal. Heaton's account of this territory, both in the description of Nigeria's colonial psychiatric history and of Aro Mental Hospital under the directorship of Dr T. Adeoye Lambo does ample justice to these complexities. It is precisely in the representation of persons and families in struggle that a version of the suffering subject is allowed to emerge from under the cloak of invisibility thrown by denigration on the one hand (a version of which is of course encapsulated in the assumption that Black Africans had nervous systems too primitive to suffer depression), and idealisation on the other (before colonialism and Western psychiatry, harmonious communities generated little mental illness, and were able to normalise their manifestations through tolerance and incorporation).

Heaton's book underscores a picture of unreliable and inadequate government responses to acute and severe mental illness that characterize both colonial and postcolonial Africa. It wrestles with the ways in which the racialized psychiatric knowledge of colonialism appropriated and rendered inferior African subjectivity; this is indeed a means of social control. At the same time it makes clear that psychiatry during both colonial and postcolonial periods had a faltering reach into the apparatus of post-independent Nigeria. It is to be hoped that this monograph is widely read, and consolidates fresh approaches to mental illness in Africa.