The Psychiatric Maghreb: Colonialism’s Erudition on North African Insanity

“I have found it more difficult to certify sanity than insanity”.

French psychiatry sought to cement its budding authority in the nineteenth century through the development of a variety of emerging theoretical frameworks. Nevertheless, such a field demonstrated a disturbing common thread in its institutional practices notwithstanding its utopian intentions and the supposed sincerity of its practitioners.

North African women were markedly absent as patients, and often the rationale, indistinguishable between primitive normality and insanity. Such patriarchal elucidations relied on the self-image of the French as highly civilised, with some parts of society even being ‘civilised to excess,’ while Muslims were described as almost medievally barbaric and primitive.

This simplistic, binary worldview was fundamentally linked to both settler notions and belief in the authority of expert knowledge, and it is unsurprising that the theory of the ‘primitive mentality’ of Muslims, explaining what had made the detection of insanity difficult for earlier psychiatrists, was proposed by the first generation of psychiatrists teaching, working and living in North Africa.

Additionally, Professor Richard C. Keller highlighted the utilisation of radical somatic treatments such as psychosurgery and convulsive shock therapies becoming more widespread in hospitals in the Maghreb region in the twentieth century. As Keller notes of Blida Psychiatric Hospital in Algeria today, ‘the hospital has become what its founders and caretakers, including Antoine Porot, Frantz Fanon, and Mahfoud Boucebci, had most hoped to avoid: a warehouse of madness that recalls the asylums of the late nineteenth century rather than a vestige of colonial investment and a sign of a progressive outlook on psychopathology.’

What was markedly the pinnace of modern study was instead tarnished by ignorant and patriarchal norms. The difference in social norms, customs, predisposed stereotypes and traditions resulted in insanity labelled as a ‘disease of civilisations’, claiming the Maghreb to be barbaric and the French to exhibit the default norm as a form of standardised comparison. French psychiatrists allowed this to cloud their judgement when carrying out experiments.

With many psychiatrists operating across the Maghreb, notably in Blida Psychiatric Hospital, Algeria and Manouba Psychiatric Hospital, Tunisia, there was a colonial obsession with psychiatry in the region, especially the lack of female North African patients being treated in these prominent institutions.

The scarce numbers of female patients was linked to multiple reasons relating mainly to the inappropriateness of female patients being assessed by male psychiatrists, as this was deemed to go against North Africans traditions and customs. This lead to these patients being labelled as the ‘hidden subjects’.They were hidden in plane sight and ignored in written sources despite the fact that numbers rose after the 1930s and these female patients contributed to various new findings, shaping and deepening psychiatric understanding and advancing methods.

Colonial psychiatry contributed in portraying North Africans as their stereotypes of ‘born slackers, born liars, robbers and criminals’ alongside the imagery of the North African male being the ‘violent, loud and intimidating’ figure whilst the North African female was the ‘passive, quiet and accepting’ figure.

The timid nature of North African women claimed to have been one of the reasons why they were underrepresented, due to their unwillingness to come forward to seek help as this went against social and religious customs. The ‘healthy norm’ was referred to as being the European, with anything that did not fit this category was deemed one way or another to be insane. Very few French colonial psychiatrists published case studies on female Muslim patients, with many who chose to speak about these hidden patients, preferred to remain anonymous.

One psychiatrist who chose to include females in their analysis was Suzanne Taieb who wrote a dissertation regarding superstitions in psychiatric disorders in Algeria, published in 1939. Many case studies were discussed where she emphasised that a female Muslim patient’s illness was the sole cause of their changed behaviour as opposed to the regional stereotypes of character and conduct.

One prominent case she described was of that of a 25-year old Algerian woman who suffered a psychiatric episode lasting for 5 months in which the patient was admitted to Blida Psychiatric Hospital for. The patient claimed to have been possessed and her behaviour was described as being manic and unsettled on admission and then was described as being ‘very calm’ and ‘docile’ as she embarked on her road to recovery. The fact that the patient was described as being able to recover from her psychiatric state and return to normality was unusual and rarely found in female Muslim patients. This was due to various reasons, namely the lack of publications and representation in French colonial psychiatric findings to refer to and the unexpected ability of a female Muslim from a colonial perspective to have the ability to be able to return to their normal state.

Taieb notes the patient herself explained her episode as an “Arab disease” which signifies the impact colonial perception of Maghrebian psychiatry had and how it was embedded in North Africans’ thinking that anything outside the European norm of sanity was deemed to be associated with ethnicity and abnormality to varying degrees. Taieb highlights the lack of mutual understanding between colonial patients and psychiatrists as well as how the miseducation of culture, religion and social customs contributing in labelling a Maghrebian norm to be insane.

This case study exemplifies the perception of colonial psychiatry on female North African ‘normality’ in two main ways; the first is that it highlighted the absence of aggressive behaviour thus lacking any European or male qualities, which included authoritativeness; whilst the second was that North African female psychiatry was centralised around them being more prone to believe superstitions.

With the creation of French psychiatric institutions, as it being the conclusion to the explanation of the initial lack of patients, to tackle psychiatry in the North African region, French psychiatrists were adamant numbers of patients would increase, in which they did in the 1930s. Despite the increase, in female Muslim patients especially, Maghrebian ‘insanity’ was still characterised and represented by Muslim men. Colonialism was even imposed on psychiatry where the severity of madness was organized in different levels of ‘seriousness’ and ‘extremity’ depending on a patient’s origin and background.

The Maghrebi form of insanity was denoted as being far more dangerous and provocative compared to the European form of insanity. Even when diagnosing conditions, it was approached with a sense of hierarchy, comparison and distinction. Female Muslim patients, although few, shaped psychiatric understanding, cemented findings and aided advancements but were greatly misrepresented and excluded in a male dominated field. Even as patients, females were still disregarded, and even mental illness had a hierarchical classification even with regard gender.

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