which when applied cross-culturally have fallen methodologically foul of what he describes as the ‘category fallacy’: that of applying cultural specific diagnostic nosologies onto culturally diverse samples. This unwarranted application of nosologies persistently ignores the underlying point that biomedicine itself is merely another form of ethno-medicine but is nonetheless ‘treated as a universal construct’ (Nichler, 1992: xii; Crandon-Malamud, 1997). This underlying assumption is clearly conveyed by descriptions of cross-cultural psychiatry:
As an underlying principle [my italics] we take an attitude of inclusiveness in these regards just as we do in dealing with the range of psychiatric phenomena as defined by Western thought…it seems unnecessary to waver in the face of cultural relativism as though we completely lacked valid standards of functioning’ (Leighton and Murphy, 1966:12-13).
Dawn Terrell (1994) consequently highlights the basic assumption of the study: that there is a universal identification of abnormality, this provides both the baseline for the study, and effectively begs the question by so doing.
In connection with these points and in reference to contemporary Black dissent regarding psychiatric practices and assumptions in the West, Chakraborty argues that for the most part modern psychiatry has failed to grasp the implications of ethnicity, and continues to interpret cultures from a Western ethnocentric viewpoint only.
For most psychiatrists culture has meant odd happenings in distant places that did not apply to them. The difference that they found in other cultures was ascribed to childlike behaviour, magical thinking, or inferior social or psychological development. Old healing traditions were thought to be unscientific; healers were judged to be abnormal or psychotic; and handbooks were written on how to study psychiatric symptoms among ‘natives’ (Chakraborty, 1991: 12).
Fernando et al. (1998) argue that contemporary as well as historical psychiatry continues to be a powerful instrument of social control of perceived and labelled deviants in society and go on to take issue with the racial bias that is built into psychiatric diagnosis. This, the authors contend, adopts stereotypic assumptions concerning the inherent alien nature, inferiority and dangerousness of black people leading to custodial care (Fernando et al., 2005). In this way racist assumptions from the past inform the present and duly resonate with Littlewood and Lipsedge’s point that the primitive being is already ‘in a sense ill’, or in other words, infantile and maladjusted and therefore less prone to mental illness (Littlewood and Lipsedge, 1989: 34). Accordingly, Kleinman (1988: 37) recounts that depression has been seen by ‘paternalistic and racialist’ psychiatrists as uncommon in India and Africa due, we are led to infer, to assumptions concerning the primitive and non-introspective cast of mind of non-Westerners (Fernando, 1995). Such views tally with the observation of Dr Schmidt in describing ‘Land Dayaks’ (the Bidayuh) as fundamentally superstitious, fearful and ‘ignorant’ (Schmidt, 1964: 142; Schmidt, 1967: 357).
The racist overtones of such views are transparently obvious to modern-day scholars, but the cultural presumptions inherent in contemporary generic biomedicine, embodied in every-day medical practice and malpractice with minority groups, are being increasingly testified to in medical journals (Bhugra, 1997; Bose, 1997; Cohen, 1999; McLaughlin and Braun, 1998; Murphy, 1978; Vanchieri, 1998).
Furthermore, through historical associations and contemporary training, the racism of ethnocentricity is not confined to the West but is duly exported to other countries. Acharyya, for instance, identifies psychiatric care with modern-day colonialism: whereby ‘Third-World psychiatrists’ trained in Britain incorporate the dominant paradigm so completely that they find difficulties in evolving new methods of dealing with mental illness within their own culture (Acharyya, 1996: 339). Contemporary critiques of racist assumptions and values in psychiatry form a useful prism to view modern-day practices in both the West and in former colonies such as Malaysia.
Madness and gender in multicultural Malaya
The rise of the modern psychiatric movement in Malaysia derives its origins from its colonial heritage. Britain, as well as the Dutch in what is now Indonesian Borneo (Kalimantan), were busily exporting European concepts of illness and contemporary methods of care to their colonies. It should be noted from the outset that, as discussed in Chapter One, the developments in colonial Malaya were not greatly influential in East Malaysia. The position of Sarawak under the Brooke rule, for instance, can be seen to be an historical anomaly that was not specifically connected to British imperialism in Malaya, but that at the time the settlement of Singapore was counted as part of Crown territories in the Malayan region. The accession of Sarawak to the new Federation of Malaysia in 1963 tied its future firmly to that of the Peninsula, and eventually Singapore claimed independence from the Federation of Malaysia. All this lay in the future however, and prior to this period Sarawak evolved at a quite different pace, and under a very different system, in which the development of psychiatry appears to have played a very minor role in comparison to colonial Malaya.
European health care in Malaya was first introduced into urban areas and only progressed to remote rural locations with the expansion of colonial authority (Manderson, 1996). This is in keeping with general colonial policy that health care should primarily serve the expatriate population, whether civilian or military; and in this respect care of insanity was treated in the same spirit, with the siting of asylums in areas of British influence (Bhugra, 2001; McCulloch, 2001). Consequently, the first recorded lunatic asylum in Malaya was built near the regimental hospital under the auspices of the colonial authorities in Penang, a Crown possession for some decades since 1786, to cater, it is claimed, for primarily syphilitic European sailors (Baba, 1992; Deva, 1992). By 1829 however, there were a mere 25 inmates in the Penang asylum, 23 men and two women, almost all being Chinese and Indian (Tan and Wagner, 1971).
Commensurate with the rapid expansion of the asylum system earlier in nineteenth-century England, the rapidly growing colonial settlement of Singapore saw the sequential building of several asylums, commencing with a comparatively small ‘Insane Hospital’ in 1841, where previously the insane were abandoned to the indifferent care of the local gaol (Ng and Chee, 2006, Tan and Wagner, 1971; Shorter, 1997). Eventually this situation culminated in the establishment of the large ‘New Mental Hospital’ in 1928 (Ng and Chee, 2006). However, in the nineteenth and early twentieth century, despite colonial concerns that asylums were required in Singapore, this does not imply that the perceived prevalence of insanity was comparable with that of England in 1900, where it was almost 30% higher than in the Singaporean community (Teoh, 1971).
By 1887, however, an English psychiatrist by the name of William Gilmore Ellis was appointed to take charge of a newly built asylum in the recently established colonial settlement of Singapore (Ng and Chee, 2006). This building, constructed in 1885 on the Sepoy Lines, replaced the original asylum of 1862, which, it seems, had been built to cater for predominantly Asian migrant labour following a murder at the local gaol. Due to overcrowding of the asylum, however, apparently a policy of repatriation of chronically ill Chinese and Indian inmates commenced, duly resonating with the accounts of Ernst and Jackson in this regard.
A further institution was opened in Penang in 1860 but this did not remain for long, with the Sepoy Lines asylum at Singapore being subsequently obliged to absorb their internee population following closure (Murphy, 1971). The next institution on Peninsular Malaya was not established until circa 1910 when the Central Mental Hospital was built in Tanjong Rambutan, a few miles from the tin-mining town of Ipoh in Perak (Tan and Wagner, 1971). Its name was changed to Hospital Bahagia in 1971.
Returning to Gilmore Ellis’ Singapore asylum, admissions in the late nineteenth century were noted to come from as far afield as Bangkok and Australia, where, in the latter case at least, psychiatric services were considered to be far more rudimentary (Teoh, 1971). Although in South Australia, at least, there had been an attempt to model them on British counterparts as a need for asylum care was recognised due to the repercussions of
