health of colonial settlers (Piddock, 2004). Apart from the Straits Settlements (Penang and Singapore), cases were referred from the States of Johore, Malacca and Selangor; the quality of early psychiatric services in Malaya at this time was evidently by no means deficient in comparison with other nations (Teoh, 1971). Even at the original Singapore asylum the number of psychiatric beds per capita was roughly equivalent to that of Britain and ahead of America, with conditions for patients considerably preferable compared to the community and institutional abuses of the insane in North America (Geller and Harris, 1994; Murphy, 1971). A fact perhaps not so surprising when put in the context of asylums in the British Raj, which were often superior to those in Britain and supported by comparatively enlightened policies and rapid responses to reform (Keller, 2001; Ernst 2010). This, notwithstanding a revisionist critique of the colonial authorities neglect of the vagrant mentally ill Indian beyond the walls of the asylum, and the overcrowding and racially-based differences in treatment within them (Ernst, 2010)
To return to historical Singapore, the types of admission to the new asylum were varied, with the first case of neurosyphilis in the Asian local population noted in 1906. By comparison in England, Shorter (1997) argues that neurosyphilis rose to epidemic proportions swelling the numbers of nineteenth-century asylums and resulting in mania, paralysis, dementia and death, with further cases of morbidity due to a rise in alcohol abuse. Accordingly, from the beginnings of the twentieth century the socio-economics of the period dictated that 20% of all admissions to the Sepoy Lines asylum were suffering from signs of neurosyphilis. Whilst equally by 1906 in grim comparison it was noted that similarly alcoholic psychosis was beginning to replace illnesses caused by opium consumption (Teoh, 1971).
Prior to Gilmore Ellis’ supervision of the new Singapore asylum the original hospital in Stamford Raffles’ Singapore had an enviable discharge rate of 89% with most cases admitted suffering from acute psychotic attacks after the use of opium and other narcotics; this situation was not to last however (Murphy, 1971). Madness and ethnicity were already viewed by medical authorities of the time as following certain racially determined lines, and consequently Chinese migrant workers were perceived as suffering from their own distinct forms of insanity and increasingly so, as Victor Purcell states:
Insanity among the Chinese was attributed to drinking, opium-smoking and gambling, and in some measure to speculation … Chinese lunatics suffered from dementia mostly, whereas the other races had mania, the former being due to gambling and opium-smoking (Purcell, 1948: 65).
Gambling, use of opium and more notoriously venereal diseases were a feature of life for nineteenth-century colonial Malaya where migrant labour was overwhelmingly made up of male Asian workers from China and the Indian subcontinent. These men were largely brought to work in tin mines, on estates and railways, and in small private enterprises, although in Sarawak Chinese farming skills were sought (Chew, 1990). By contrast, immigrant women were largely brought to work in brothels serving Asian migrant and white expatriate masculine needs (Manderson, 1996). Prostitution however, carried its own penalties in the form of syphilis, which was initially a rare occurrence amongst non-Europeans.
General Paralysis of the Insane, a syphilitic infection of the brain which causes insanity, was never seen among Asiatics. Practically all cases were among those of European stock and it was then considered that the disease was peculiar to Europeans only and was a disease of civilised life running at high pressure (Teoh, 1971: 20).
The inference here being that the pressures that the white expatriate community suffered from were similar to those of the Asian expatriate community, whereby socially sanctioned conjugal relationships were unlikely in a social environment characterised by a lack of eligible females. British civil servants in Malaya, in common with other colonial regions, required permission to marry from their employers and this only after many years of service, which consequently gave rise to the institution of concubinage of local women (Stoler, 1991). This, Stoler argues, was an expedient policy that preserved the health of expatriate males and helped to secure their continued employment and contentment in foreign regions.
In relation to this point, Teoh notes that the majority of admissions to the Singapore asylum at this time were in an appalling state of health; with women admissions, few though they may have been, in the worst physical condition of all (1971). A plausible inference may be drawn under the circumstances that these were due to the ravages of a life of prostitution and its concomitant hazards, as much as from any other form of disease and hardship.
The low admission rates in Singapore at the turn of the nineteenth century have been in part attributed to the low percentage of women admissions, and this in turn due to very few numbers of women per capita in the community at this time, where the first case of puerperal insanity was admitted to the asylum as late as 1888 (Teoh, 1971; Ng and Chee, 2006). This has been estimated as standing in the region of three women to every 10 men, and as such represents a comparable situation to that of other conurbations of British influence in colonial Malaya during this general period (Tan and Wagner, 1971; Teoh, 1971). Nonetheless, this was not an isolated national anomaly, for in colonial Nigeria, there were three times as many male patients in psychiatric care as females, and where originally in the Ingutsheni Lunatic Asylum, no provision had been made for women at all (Sadowsky, 1999, Jackson, 2005).
These therefore, as Keller (2001) observes, create some significantly interesting anomalies when correlated with feminist studies of admission rates of women in England during the era, whereby according to Kromm (1994: 507), it denoted ‘a clear shift in the understanding of madness as a gendered disorder’. She goes on to argue that theatrical and pictorial representations increasingly depicted woman as the embodiment of madness in various postures of melancholia as opposed to mania (Kromm, 1994). Furthermore, Showalter (1985) argues that the over-representation of madness amongst women was far from being merely a nineteenth-century and twentieth-century phenomenon, but existed from the seventeenth century onwards.
To rehearse the analysis of these feminist studies of the feminisation of madness Denise Russell (1995: 18), in support of Kromm’s assertion that there existed a preponderance of women in British public mental hospitals in the nineteenth century, considers the late eighteenth-century interest in ‘specifically female problems’ as an origin of perceiving insanity as a gendered condition. It is argued that these forms of feminine pathology were dominated by the medical preoccupation with female sexuality and moral purity. In turn, this continues as a dominant discourse in relation to the labelling of women as suffering from mental illness (Barnes and Bowl, 2001; Ussher, 1991).
Joan Busfield (1994), however, contests the assertion of overwhelming numbers of nineteenth-century women in asylum care, and instead asserts that at least in relation to that century the empirical evidence pointing to proportional differences between male and female admission data is quite small. Statistical evidence notwithstanding, diagnosed insanity and high admission rates in the asylum system related to gender depended heavily on the institutionalised perception of woman as essentially associated with the likelihood of insanity.
Yet the Victorian era marked an important change in the discursive regimes that confined and controlled women, because it was in this period that the close association between femininity and pathology became firmly established with the scientific, literary and popular discourse: madness became synonymous with womanhood (Ussher, 1991: 64).
While the debate concerning the precise numbers of women in asylum care in previous centuries will no doubt continue, there has been little dissent concerning the claim that there has been a universal predominance of women diagnosed with mental illness in the twentieth century (Miles, 1988; Ramon, 1996; Ussher, 1991). Phyllis Chesler (1996: 46) baldly states that more women are being hospitalised with a diagnosis of mental illness than ‘at any other time in history’. These diagnoses are, she argues, predominantly affective depressive disorders in keeping with women’s subdued and passive presence in society, a topic also explored by Redfield Jamison (1996) in her personal account of bipolar depression. Chesler goes on to allude to the continuing dichotomised perceptions
