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Psychiatric patients at work

The world beyond the walls of the asylum in colonial Vietnam
Claire EDINGTON
Cet article est une traduction de :
Des patients au travail

Résumé

In colonial Vietnam, mental asylums were designed as large agricultural colonies, where patients would work the land on the path to healing and eventual liberation. This article discusses the role of labor as a kind of therapy for asylum patients, and how French psychiatric experts were constantly drawn into broader networks of care and economy, thereby shifting attention from the asylum itself to the world beyond its walls.

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Texte intégral

The asylum for the insane: braiding mats, Anonymous, Biên Hòa, 1920‐1929

© MUSÉE DU QUAI BRANLY – JACQUES CHIRAC, N° DE GESTION : PV0006776 https://www.quaibranly.fr/​fr/​explorer-les-collections/​base/​Work/​action/​show/​notice/​584454-asile-des-alienes/​page/​1/​

  • 1 This article is based on research from my book Beyond the Asylum: Mental Illness in French Colonial (...)

1This photograph was taken at the Biên Hòa asylum outside Saigon, sometime in the decade following its opening in 1919. After World War I, Indochina’s health service expanded from campaigns against epidemic disease to include projects geared towards maternal and child health and the organization of a rural assistance program. The inclusion of mental health care resulted in part from local pressures to deal with the increasing visibility of mental illness, especially in rapidly urbanizing centers. Indochina’s psychiatric assistance program would grow to include a network of open psychiatric services in major hospitals and the establishment of a second asylum in the north, outside Hanoi, in 1934. While Algeria has received much more scholarly attention, it was Indochina that in the 1930s earned the praise of international onlookers for having made the most “serious efforts” towards mental health reform in all the French empire.1

2As in France, there were two principal ways into the asylum. Placement could either be requested by the administrative authorities (most were brought in on charges of vagrancy or violent crimes) or be initiated by the patient’s family. For many Vietnamese households weathering the tremendous economic and social dislocations under French colonial rule, the care for a sick and often disruptive family member had become increasingly burdensome. Asylum patients in Indochina – the population remained overwhelmingly Vietnamese and male – were diagnosed with various forms of paranoia, depression, mania, mental confusion, and schizophrenia (démence précoce), as well as nervous disorders like epilepsy and psychopathic illnesses caused by alcohol and opium addiction or the neurological complications of syphilis.

  • 2 Claire Edington & Hans Pols, “Building Psychiatric Expertise across Southeast Asia: Study Trips, Si (...)

3The first asylum to open in Indochina, Biên Hòa, was organized as a large agricultural colony, where patients would work the land on the path to healing and eventual liberation. The use of therapeutic labor for asylum patients was inspired by early French ideals of rural life and social reform as well as Dutch experiments with agricultural colonies in neighboring Java, where French psychiatrists took a series of study trips in the early 20th century.2 For colonial psychiatrists, agricultural colonies promised not only “cerebral hygiene” and discipline through physical labor but also a kind of moral re-education. Even for those with no hope of a cure, psychiatrists believed that approximating the habits of ordinary life would serve a kind of harmonizing function. With the partial exception of Madagascar, Indochina was the only French colony (and the only other colonial territory in Asia) to follow Dutch leads by adopting patient labor as the central organizing principle of care for the insane.

4By simulating the appearance of freedom and normal life, the asylum as agricultural colony projected a vision of an idealized colonial order, one premised on establishing a kind of continuity between the discipline of institutional order and life in the community. This was reflected in the design of the institution itself – including the explicit racial segregation of the patient population within the walls of the asylum – but also the regimes of self-discipline and industry that were taught to Vietnamese patients as an essential aspect of labor therapy. In the name of promoting psychiatric well-being, nearly a third of patients were kept busy performing tasks associated with every aspect of the daily running of the asylum: from the harvesting of rice and vegetables for meals, to the construction and painting of new pavilions, laundry and the sewing of patient clothing, making baskets, husking rice, manufacturing bricks, and the production of latex from rubber trees that were grown on the asylum’s grounds.

  • 3 European patients did not labor, but neither did members of the Vietnamese elite who came to occupy (...)

5Colonial asylums were embedded in local and regional economies that structured the kind of work that patients engaged in (including the tapping of rubber trees and the production of latex on the asylum’s grounds), its integration into daily institutional regimes of care and surveillance, and the reliance on this labor to ensure the financial solvency of the institutions.3 In the photograph above, we see patient-laborers helping with the fashioning of mats out of straw. They were supervised by a Vietnamese asylum guard, most likely a former patient. What we do not see is the use of a range of persuasive and coercive measures employed by asylum directors – from monetary bonuses to packs of cigarettes – to encourage these patients to work. Despite the insistence on the voluntary nature of patient labor, economic productivity played a primary role in the constant promotion of labor as a kind of therapy throughout the interwar period as the colonial budget situation worsened amidst the global economic depression. Patient labor proved vital for keeping these institutions afloat.

  • 4 See “Une révolte à la colonie agricole de Chezal Benoit”, Informateur des alienistes et des neurolo (...)
  • 5 Trung Tâm Lưu Trữ Quốc Gia II (TTLTQG-II) (Vietnam National Archives Centre II), Hồ Chí Minh City, (...)
  • 6 For example, the use of prisoners as a source of plentiful, cheap labor began in Indochina as early (...)

6While acknowledging the financial benefits of the practice, asylum directors routinely insisted that the organization of patient labor was for medical purposes first and foremost and that in no circumstances were patients coerced into working. Much of the energy devoted to avowing a patient’s choice to labor, however, exposed an underlying sensitivity shared by asylum administrators to accusations of mistreatment. They surely knew of the pressures facing psychiatrists in France, who confronted charges of patient labor as inherently exploitative. Sometimes these charges came from the patients themselves. In 1910, reports of a bloody revolt at the agricultural colony of Chezal-Benoît in central France described a group of patients who, misled by the appellation of a colonie, were apparently “disillusioned” to find themselves barricaded in and sent to the fields to labor rather than resting comfortably in the homes of the local peasantry.4 In Indochina, the anticipation of such critiques produced some anxiety in the pages of annual asylum reports. For example, at Biên Hòa in the 1920s, some patients were employed with the banal task of removing rice husks. This incredibly labor-intensive chore also had the lamentable effect of forcing patients to work in what was described as a “very dusty atmosphere.” As compared with those patients exposed to the clean air of the open fields, a fundamental tenet of work therapy, those husking rice were found to be in a “regrettable” situation. In 1927, as a result, the director of Biên Hòa invested in the installation of a more useful (and efficient) Groundhand machine for processing the rice that had been harvested on asylum grounds.5 This sensitivity to charges of exploitation is striking in a colonial context where labor abuse was commonplace, particularly in settings of confinement. 6It also belied the actual use of range of persuasive and coercive measures – from monetary bonuses to packs of cigarettes – to encourage these patients to work.

7At every turn, asylum administrators in interwar Indochina were beset with the challenges of failed surveillance and interpersonal violence produced by patient overcrowding, diminishing budgets, and problems with staff recruitment and retention. Confronted with the pressure to treat more acute cases, French experts also relied on family resources to support temporary or permanent releases for those patients who no longer seemed to benefit from confinement. Once the family agreed to assume responsibility for their care, the patient would be repatriated to their home village, where they were put under a “medical surveillance” of either weekly or monthly visits by the local doctor, who administered medicine, kept track of the patient’s progress, and eventually recommended a permanent release or reintegration back into the asylum. This period, referred to as a “trial leave” (sortie provisoire), was envisioned not as a break with asylum but rather as an extension of it.

  • 7 Vietnamese understandings of mental illness bear the influence of Taoist, Buddhist, and folk tradit (...)

8Vietnamese families, meanwhile, pursued their own strategies in ways that both facilitated and constrained the ambitions of colonial psychiatrists. In some instances, families eagerly solicited the services of state-run institutions, while in others, they attempted to shield family members as much as possible from the outside world. Rather than abandon their relatives to the care of French experts, some families would write to doctors, visit patients, and demand their release or transfer to other institutions. In letters to asylum directors, family members offered their own opinions about the patient’s condition and at times asserted that their loved ones had, in fact, improved enough to come home. These family assessments did not always square with those of experts and, at times, would generate significant conflicts. Debates revolved around the mental health of the patients but also the capacity of the families to assume their care upon release and the asylum itself as the most appropriate site for treatment and rehabilitation.7

9The arrival of asylums may have marked the beginning of psychiatry as a state-sponsored project in Vietnam, but it was inserted into a pre-existing field of knowledge and practice that it never fully succeeded in displacing. By moving the mentally ill out of doors and back into the community, psychiatric experts were continually drawn into broader networks of care and economy. Indeed, colonial asylum directors could not and did not operate in isolation. Their reliance on the Vietnamese public not only to present patients for treatment but also to take care of patients upon their return home meant they were repeatedly forced to negotiate the terms of patient entry and release. It is only by shifting our attention from the asylum itself to the world beyond its walls that we get a sense of the true reach of psychiatric norms into daily life and the range of the different kinds of actors – prosecutors and spirit mediums, parents and neighbors – who all participated in deciding the fate of the mentally ill.

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Notes

1 This article is based on research from my book Beyond the Asylum: Mental Illness in French Colonial Vietnam (New York, Cornell University, 2019). I relied on archives in both France and Vietnam, including hundreds of patient case files from two asylums opened by the French in 1919 and 1934.

2 Claire Edington & Hans Pols, “Building Psychiatric Expertise across Southeast Asia: Study Trips, Site Visits and Therapeutic Labor in French Indochina and the Dutch East Indies, 1898- 1937”, Comparative Studies in Society and History no. 58/3 (2016), pp. 636-663.

3 European patients did not labor, but neither did members of the Vietnamese elite who came to occupy the old European wing when a “paying service” for indigenous populations was inaugurated at Biên Hòa Hoa in 1934. The racial segregation of patients also found concrete expression in the quality of bedding and clothing provided, respective diets, as well as the organization of daily life and leisure activities, including swimming, tennis, and reading.

4 See “Une révolte à la colonie agricole de Chezal Benoit”, Informateur des alienistes et des neurologistes no. 6/25 (June 1911), pp. 140-142.

5 Trung Tâm Lưu Trữ Quốc Gia II (TTLTQG-II) (Vietnam National Archives Centre II), Hồ Chí Minh City, Goucoch, IA.8/2912(3), Rapport annuel de Bienhoa, 1927.

6 For example, the use of prisoners as a source of plentiful, cheap labor began in Indochina as early as 1862. Prisoners were put to work digging irrigation ditches and building roads. The colonial state also farmed them out to private contractors as a revenue-generating measure. Poulo Condore, the notorious prison colony, represented the extreme end of forced labor in Indochina: physically taxing work, long hours, poor diet, and high mortality rates from diseases such as malaria and dysentery. Such punishing working and living conditions provoked prisoner rebellions and public outrage and did much to undermine claims about the rehabilitative goals of punishment. Corvée, the requisitioning of labor for large-scale public works, also drew the ire of the colonized population and resulted in periodic protests as early as 1908 and helped fuel the rise of left-wing activism in the colony from the late 1920s. The practice was eventually outlawed by the French government in 1937 following the arrival of the Popular Front to power and mounting international pressure to sign the International Labour Organization’s forced labor convention of 1930. The careful promotion of patient labor thus unfolded in the context of local protests as well as growing international consensus around the prohibition of “unfree labor.”

7 Vietnamese understandings of mental illness bear the influence of Taoist, Buddhist, and folk traditions, as well as traditional Chinese medicine, particularly in terms of the blurring of psychological and physical health: emotional states are closely tied to physical disturbances and vice versa. For some Vietnamese writers, this environmental framework was not necessarily incompatible with Western (and especially Hippocratic) ideas about disease, and they insisted on points of conceptual overlap. Yet even when French doctors and Vietnamese families broadly agreed about the presence of mental illness that required treatment, important differences emerged when it came to interpreting the origins of the affliction and what should be done about it. For example, a sudden change in character (walking aimlessly, talking nonsense, claiming to be spirits) was for French experts taken as evidence of an underlying psychosis, meriting confinement; for the families of patients, however, it seemed rather to signal a state of being taken over by a supernatural force, which required healing through ritual performance (see Edington, Beyond the Asylum).

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Pour citer cet article

Référence électronique

Claire EDINGTON, « Psychiatric patients at work », Terrain [En ligne], 76 | mars 2022, mis en ligne le 03 mai 2022, consulté le 20 mai 2022. URL : http://journals.openedition.org/terrain/23398 ; DOI : https://doi.org/10.4000/terrain.23398

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Auteur

Claire EDINGTON

Dr. Claire Edington is an Associate Professor of History at the University of California – San Diego. She received her Ph.D. from Columbia University in 2013. She specializes on the history of medicine in colonial and postcolonial Southeast Asia. Her first book, Beyond the Asylum: Mental Illness in French Colonial Vietnam, was published with Cornell University Press in 2019. She is currently working on a new project on the history of drug addiction in Vietnam across the 20th century.

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