Jonathan D. Ablard's book is a welcome addition to the burgeoning literature on medicine, science and social control in Argentina. Despite the first part of the title, the book does not duplicate the works that examine the growth of a psychoanalytical culture in Argentina. Rather, Ablard examines government psychiatric hospitals, especially the two main facilities in Buenos Aires (one for females and the other for males). Madness in Buenos Aires is in some ways an institutional history, but to label it that would be unfair, as it also deals with who was admitted, and why.
The picture that Ablard gives the reader is in some ways not surprising, but is nevertheless deeply depressing. Whatever the grand goals of the politicians and psychiatrists, the treatment of the internees was generally abysmal. There were too few beds, too little food and not enough staff. At times people were turned away from the hospitals because there was no room. Legal processes were unclear and slow.
Ablard's goals are quite clear: ‘The experience of psychiatric patients serves as a useful case study of how the Argentine state developed and functioned over the last century and of how Argentines interacted with it. Briefly this study argues that the capacity of the state to provide social services and also in different ways to control the populace was often circumscribed to an extent hitherto not recognized in the scholarly literature’ (p. 5). What becomes quickly very clear is that there was a vast difference between the goals of those who established the institutions and guided them and what actually happened.
The book is based on a wide examination of archives, especially those of the hospitals themselves, and an impressive array of published reports. In addition, an extensive consultation of contemporary published comments on mental illness and treatment is supplemented by an examination of relevant secondary works.
Ablard begins with a brief summary of the history of hospitals and the treatment of madness until 1880. After that date, with the creation of a stronger state, the drive to be more like European countries and a growing fear of the impact of immigrants, much more attention was placed on questions of mental health. For example, the first criminal code, enacted in 1888, called for all accused criminals to be given a medical examination, including a psychological assessment. New psychological institutions were created, and outsiders commented on the modernity of the approaches used, but conditions were often squalid.
Conditions appear to have worsened after Hipólito Yrigoyen came to the presidency in 1916, apparently because of the use of patronage, and to have continued to worsen during the 1930s. For example, the women's institution in Buenos Aires had over 3,000 patients in a hospital built for under 2,000, and in 1933 was given permission to limit new admissions. This trend of limiting new admissions because of lack of space continued, off and on, during both the 1930s and 1940s, and was not limited to the one hospital. The author does suggest that frustration with existing government policies caused doctors to experiment with newer techniques, such as outpatient clinics.
The Perón administration did promise major reforms, pledging to change legal structures and improve facilities, but many of the plans were never completed. There was little consistency in administration, and resistance to change came from doctors and others. One of the most interesting, if shorter elements of the book is the segment which recounts the Onganía regime's display of a significant interest in mental health and toleration of reforms that were clearly products of the 1960s. It makes clear what a complex and contradictory place Argentina was during those years. The military encouragement of a more progressive attitude towards mental health issues did not last long, as the Levingston government rapidly suppressed most of the changes. Real repression came after the military coup of 1976 with the installation of a government that saw psychology as dangerous.
What makes this book of special interest is that it confirms what many have felt for some time: that the relative weakness of the Argentine state has had serious consequences. The treatment of those with supposed mental health problems was frequently abominable, not necessarily because the intended policies were so bad given the state of existing knowledge – though clearly they were frequently far from optimal – but because of the state's failure to provide even minimal services. As Ablard points out, this calls into question the ability of the state to deliver social welfare programmes in a reasonably adequate fashion. Perhaps more importantly, Ablard undermines many of the arguments that a number of recent historians, especially in the English-speaking world, have made about social control. These historians have argued that intellectual elites' discourses and theories have created an authoritarian tradition. Those who set policies for the mental health institutions may have had authoritarian tendencies, but they failed almost completely to carry out their ideals. They were remarkably unsuccessful by any measure, and even constantly bemoaned the fact that the rate of institutionalisation was lower than that of Europe or the United States. On this issue, at least, there was little social control.
Ablard has written a book that traces the history of the Argentine state's response to mental illness. The story is distressing, interesting and in some ways not surprising for those of us who perceive a weak Argentine state. By discussing the state's mental health policies, the author has raised important questions about the Argentine state's ability to impose social control. This is a book worth reading.
