The Hidden Patients

Front matter

Nina Saloua Studer

BAND 8 ZURCHER BEITRAGE ZUR GESCHICHTSWISSENSCHAFT bóhlau

ZURCHER BEITRAGE ZUR GESCHICHTSWISSENSCHAFT BAND 8

Chapter 2

Discovering Deviance: The Criminalisation of Patients -ne 68 2.1. Case Study on Alternative Modes of Admission 68 2.4, Definitions of Criminality in a Colonial Context 72 2.4 French Laws on Placements in Asylums iota 7Á 46 Mechanisms of Admissiofi à sssicasaetr tetto prac 81 xc Crucisms E AGUUSSIONS: suain racc reri ta iua tta arn 100

Chapter 3

The Visible Patient: Categorising Deviance |... 3.1. Case Study on Patient Transit through the Psychiatric System 35i Coinne Musin PAR Er rennes dcum ema ets 23. Diagnoses and Propios aleas

6 Table of Content

Chapter 4 Treating Deviance: The Shock of the New |... 143 4.2 Treating Muslim Patients

5.3. General Paralysis: Alcohol, Syphilis and Civilisation

sue: Puerperal Insanity: The Perfect Mothers: ioannes

$6 "he. Absence of DISEHOSES tuent Conclusion: Visible Psychiatrists aee 220

eiue NEED a nn 226

Imagined Absence of Female Muslim Patients... 240 Appendix A: Mini-Biographies of Colonial Authors on Insanity among North African Muslims |... sss 248 Appendix B: Representation of Colonial Statistics... 264 Bibiliontaphy uomine moa SD Eam M Dr EE 281

Acknowledgements

This book is based on my doctoral dissertation in history, which I was able to write

at the Universities of Zürich and Oxford thanks to a scholarship from the Swiss National Science Foundation (SNF), who also generously supported the publication of this book. I would also like to thank my supervisors, Prof. Dr. Gesine Krüger, from the History Faculty of the University of Zürich, and Dr. habil. Jan-Georg Deutsch, from the History Faculty of the University of Oxford. Both have given me invaluable support during the process of researching and writing this book, and have helped me with their critical questions, their always helpful suggestions and their patience as I developed the tone, structure and framework. I wish to thank them both for having been great professional and personal mentors to me. Additionally, the seminars that both ofthem offered to doctoral students provided me with a vital opportunity to present and discuss preliminary findings to a group of peers. I would also like to express my sincere gratitude to all my friends and colleagues with whom I have discussed my project in Zürich, Oxford andat various conferences, and who have helped shape this book with their suggestions.

There have been so many esteemed researchers from such diverse fields as psychiatry, Islamic sciences, the history of medicine, colonial history and gender studies who patiently discussed my questions and findings with me, that it is impossible to name them all here, but I am most grateful to all of them for the precious assistance that they have given me. I would, however, like to personally thank the eminent Moroccan psychiatrists and psychoanalysts Rhita El-Khayat and Jalil Bennani for giving me the chance to discuss my project with them in summer 2011, and all the participants of my colloquium on colonial psychiatry in the Maghreb (*Madness in North Africa: Gender, Race and Religion in the Writings of French Colonial Psychiatry") at the Historical Institute of the University of Zürich in Spring 2013. The lively, intelligent and critical discussions in this colloquium helped me map out the difficult areas in this field and have demonstrated that there is a broader interest in this topic.

I am intensely grateful to the staff at those archives and libraries that I visited in Oxford, London, Paris, Rabat, Basel, Geneva and Zürich, for their assistance during my research. I must express my special gratitude to the ever-helpful staff at the Zentralbibliothek Zürich, who humoured even my strangest requests and who have been truly phenomenal in helping me find source material based on obscure references, and to the staff at the Bibliothèque Nationale du Royaume du Maroc in Rabat, who were unbelievably accommodating and cooperative.

Thanks are also due to Research Network Reconfigurations at the University of Marburg, and especially Dr. Achim Rhode, who kindly allowed me to work on the final draft of this book during my Visiting Research Fellowship there.

8 Acknowledgements

I would also like to thank all three of my parents, Christoph, Monique and Marc, for their endless loving support, without which this book would never have been possible. This work is inherently influenced by my mother who, as a descendant of French colonisers in Morocco and Algeria and as a midwife, fostered my interest both in the history of medicine and in the colonial Maghreb. I am aware how much I owe all three of them, both as an academic and as a person. I would also like to thank Darren's parents, Margaret and Alan, for their much appreciated support and belief in me, especially during the hardest times while writing this book. Finally, I would like to thank my partner Darren, for putting up with me at these most stressful moments of this project, for his unwavering, invaluable support, and, above all, for tirelessly proofreading the various drafts of this book and always providing insightful comments and highly appreciated suggestions.

Introduction

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

Thus wrote the British psychiatrist John Warnock in 1924, summarising a lifetime of professional experience with colonised patients. Although Warnock was writing about Egypt, where for twenty-eight years he was the main — and, for a long time, only — working psychiatrist, the quotation above also encapsulates the experiences of many French colonial psychiatrists working in the Maghreb and the difficulties they faced, or believed they faced, in their everyday professional lives. Warnock's quote hintsat the significant complications presented by such factors as geography, culture, language and religion in the process of diagnosis; fears concerning an enormous number of “hidden’, potentially dangerous insane that European methodologies were ill-equipped to identify; and, most pertinently for the subject of this book, the difficulties early colonial psychiatrists had in locating insanity within the local populace.

Warnock gave two very specific reasons for his statement. Firstly, he was referring to family members who wanted to be rid of a difficult, housebound patient and therefore alleged “all sorts of insane conduct on the part of the testator”, which made it difficult to "separate the truth from the false" This situation seems to have seldom arisen in the colonial Maghreb, as was shown by concerns and theories about low Muslim patient numbers. His second reason, however, could be directly transposed into the discourse on North African “insanity”, carefully built up by generations of French colonial psychiatrists. Warnock stated: "Often the patient is an old lady who understands very little about business, and of course, cannot read or write, and being in the Hareem knows scarcely anything of what goes on in the outside world, and one has to make the standard of intelligence low in these cases”? According to Warnock, this specific context of being confronted with an uneducated, segregated Muslim woman made the "diagnosis" of sanity extremely difficult. This professional unease when it came to assessing potential female Muslim patients can be found in many of the texts written by French colonial psychiatrists. The seemingly genuine confusion over what constituted "sanity" and "insanity" in Muslim North Africans in general, and the women in particular, and the question of whether Muslim women really were so uneducated as to make authoritative diagnosis almost impossible were two of the main preoccupations of French colonial psychiatry.

1 Warnock, Twenty-Eight Years, 586. 2 Ibid.

The Fascination with Insanity

French colonial psychiatrists were not the only ones fascinated with the question of North African forms of "insanity". Practically from the beginning of the French colonisation of the Maghreb,’ many colonial authors showed an interest in issues which would be interpreted as psychiatric problems today. The scandalous particularities of cases of "insanity" and the possible dangers of *madmen" freely roaming the streets engendered concerns about - largely imaginary - social problems while providing a sensationalist appeal to European observers. As a result of this extensive public interest, "insanity" ended up being discussed in a wide range of French publications: from those with strictly legal or medical content to those which appealed to a broader audience, such as the colonial press, socio-anthropological publications and even literary texts.‘ The colonial psychiatrists writing on their Muslim patients were therefore only one strand in this discursive net on “insanity” among the colonised North Africans. Even though the French colonial psychiatrists often deplored this state of affairs and claimed that they were the only ones who could write authoritatively about the subtleties of the topic, they were influenced by the fears and wishes expressed in publications written outside their profession — especially when it came to the threats posed to settler societies by “madmen”.

Both in the popular discourse and in the psychiatric texts, it was usually “madmen" and almost never “madwomen” who were seen as dangerous and problematic. In the psychiatric theories from the 19th and the early zoth centuries, it was believed that certain groups among the general population had a particular predisposition to madness. It was therefore one of psychiatry's main duties to define the morbid predispositions different groups of society embodied, in metropolitan as well as in colonial contexts.’ During colonial psychiatry' initial contact with North Africans,

3 French control over the Maghreb started with the conquest of the Algerian coast in 1830. However, it took the French army until 1857, the year of the fall of Kabylia, to completely conquer Algeria. See for example: Lorcin, Rome and France, 299. On the conquest of Algeria, see also: Ageron, Histoire de l'Algérie contemporaine. Compared with Algeria, the colonisation of Tunisia and Morocco had been at once more informal - with both countries officially being “protectorates” and not conceived as part of /a Grande Nation — and considerably shorter. Tunisia became a French “protectorate” in 1881 and Morocco in 1912, and both remained under French rule until their independence in 1956.

4 The literary fascination with insanity did not, of course, end with the independence of the Maghreb states. For a discussion on "female insanity" in postcolonial Algerian (and Lebanese) literature, see: Mallem, Folie féminine.

5 Inthe colonies, this morbid predisposition was believed to be influenced by diverse factors, such as the climate, lifestyles, professions, diets, the stages of evolution and the dangers of heredity. Most of these explanations for insanity will be discussed in the following chapters.

The Fascination with Insanity 11

Muslims seemed to be less susceptible to mental problems and Muslim women even appeared to be almost excluded from these risk groups. This is shown by an early quote from the eminent French psychiatrist Louis Delasiauve, who wrote in 1865 that, in Algeria, “we notice that insanity prevails particularly among Europeans and men." With Muslim women being neither predisposed to mental problems by gender’ nor by “race”; many colonial psychiatrists accepted the presence of significantly fewer female Muslim patients in the colonial mental institutions as self-evident.

Other French colonial psychiatrists were convinced that insanity had to exist among Muslims in general and Muslim women in particular, but that it was somehow hidden from colonial perception, with the interned Muslim patients merely being the tip of the iceberg, while the vast bulk of “invisible patients”, far exceeding those treated in the hospitals, lay hidden beneath the surface.’ This led to the conclusion that a dauntingly large number of potential Muslim patients was, for some reason, evading the registration and care of colonial psychiatry. It was felt by many colonial psychiatrists that France, with its ideals of a mission civilisatrice," hada moral duty to find, save, look after and — if possible — cure these neglected patients. In 1908 Louis

6 Delasiauve, Review of Collardot, 118. On the prevalence of male patients in the colonies, see also, for example: Jobert, Projet, 61; Reboul/Régis, Assistance, 199. The French sources have been translated into English, but both the intricacies of the original French, with single sentences being subdivided into complex, interlaced structures with clause after clause, and the complicated terminology of the psychiatric sources made it difficult to produce a translation that is accurate without being too literal, and which conveys the sense of the text without sacrificing too much of the idiom.

7 Not all French psychiatrists agreed with this statement. Many believed that, in the European context, women were more likely to become insane than men. The findings in Algeria therefore pointed to an apparent reversal of the European situation, which was also observed in other colonial contexts. Sally Swartz, for instance, wrote about the situation in the Cape colonies in 1999: “The fact that more men than women were incarcerated in Cape colonial asylums, a pattern which has been sustained throughout the 2oth century, suggests that these asylums may have had a social function somewhat different from those in Europe and America, where more women than men were incarcerated. This is a topic that needs further research.” Swartz, Lost Lives, 153.

8 The theory that less civilised “races” presented fewer cases of insanity, that insanity was, in fact, a “disease of civilisation’, will be discussed in detail in Chapter 1.

9 On the popular analogy of the “iceberg” in the history of psychiatry, see for example: Porter, Wahnsinn, 117.

10 Fora discussion of the concept of a mission civilisatrice, see for example: Conklin, Mission to Civilize, 1-9; Keller, Colonial Madness, 5 f. French colonial doctors and psychiatrists saw themselves and the benefits they brought to North Africa as both components and prototypes of this mission. See for instance: Bouquet, Médecine et colonisation, ii; Piessac, Devoir social, i; Aubin, Bréves réflexions, 8.

Margain, for instance, expressed his perceived humanitarian obligation as a French psychiatrist involved in colonisation projects as saving these “madmen”, which were allegedly ignored by their own societies: “But I felt too heavily the importance of this question and the urgent interest that existed to create a movement of opinion in order to rescue from misery, from vagrancy, from death thousands of abandoned human beings, for me not to consent to courageously start to work"

During this early colonial period, many French psychiatrists believed that thelow numbers of Muslim patients could be partly explained through the lack of opportunity for appropriate care due to a lack of psychiatric institutions, which left them abandoned and at the mercy of - but not cured by - their traditional healing methods.” The most influential French colonial psychiatrist, Antoine Porot, for example, had no doubt in his first official report on North Africans in 1912 that Muslim patients would appear with the creation of French institutions." And indeed, the numbers of both male and female Muslim patients rose after the construction of psychiatric institutions in the Maghreb in the 1930s. Yet despite rising numbers of female Muslim patients, Muslim "insanity" remained chiefly represented by men in the French perception. Photographic reproductions of the lived reality in these new model institutions, like the photograph used on the cover of this book," for example, almost always depicted male and not female Muslim patients.

French colonial psychiatric interest in the Maghreb can be roughly divided into two periods, the dividing point between them being the building of psychiatric

11 Margain, Aliénation mentale, 87. This notion was part of the idea of a “moral conquest”, in which France, the superior country militarily and morally, had an obligation to better the conditions in its colonies. Many doctors and psychiatrists felt that this improvement was best conducted through them. Victor Trenga, for example, wrote in 1913, after having attacked racism in Americans: “We, the French, are far from being of such an odious intransigency. If it pleased us no longer to be the educators of the world, the genius of our race would lose one of its purest characteristics. Our great originality is not to feel superior to other men; it is not wanting to keep our superiority to ourselves." Trenga, Ame arabo-berbère, 179.

12 In the French understanding of North Africa, the only possibilities open to people suffering from mental problems were the traditional Islamic asylums, so-called māristāns, which will be discussed in subsequent chapters. For historical analyses of the development of these märistäns, see: Issa Bey, Histoire; Bay, Islamische Krankenháuser; Dols, Origins of the Islamic Hospital; Chakib et al., Maristane Sidi-Frej; Belkamel/Raouyane, Bimaristanes au Maroc; El Ayadi, Maristanes; Moussaoui/El Otmani, Introduction des hópitaux. Arabic vocabulary that has not been adopted by European languages has been transcribed using the rules of the Deutsche Morgenlandische Gesellschaft. See: Wagner, Regeln. The Arabic terms used in the sources have been compiled in a glossary. See p. 310.

13 Porot, Tunisie, 58.

14 The title page shows a ward for Muslim men at the Manouba Psychiatric Hospital in Tunisia, published by the psychiatrist Raoul Vadon in his 1935 dissertation.

The Psychiatric Maghreb 13 institutions in the Maghreb in the 1930s. From 1845 to the 1930s psychiatric treatment of Muslim patients was mainly a metropolitan affair, with European and Algerian Muslim patients shipped to French asylums where metropolitan psychiatrists looked after these "colonial patients”.” The first French medical experts on mental illness working on North African soil were mostly attached to hospitals as general doctors. Psychiatrists in the French asylums treating patients selected by these general doctors were dismissive of the latter’s medical abilities, often remarking disparagingly upon their diagnoses." The general doctors, by contrast, claimed that the psychiatrists in France could not possibly match their own understanding of the North African mentality." These competing interpretations, this professional rivalry, were part of a broader struggle for authority over the field of mental illness, in which religious, legal and medical experts jostled. The psychiatric profession was not consolidated until the end ofthe roth century," and in the context of North Africa, most general doctors included in their medical treatises paragraphs or even chapters on insanity among the colonised, even after this struggle had been decided in favour ofthe psychiatrists.

The Psychiatric Maghreb — a Unit of the Orientalist Imagination

The earliest French psychiatric investigation of an Arab Muslim population was written by Jacques-Joseph Moreau de Tours in 1843, who travelled, in his capacity as a personal psychiatrist, through the "Orient" with a private patient for a few years.” His psychiatric descriptions of the “Orient”, published in France's foremost psychiatric

15 The term “colonial patients" is used to describe those who were not “metropolitan patients", i.e. Muslim, European and Jewish North Africans.

16 See,for example: Laurens, Contribution, 9; Peyre, Maladies mentales, 195.

17 Many psychiatrists also believed that a deeper understanding of Muslim *minds" or *mentality”, indispensable for psychiatric practice, could only be gained by living in North Africa. The French psychiatrist Levet, for instance, wrote in 1909 that it was impossible to treat “Arab patients” without having experienced life in the Maghreb: “The insanity of Arabs presents special forms, which confuse the clinician; and I believe that to properly penetrate these patients, not only extensive experience of [treating] mad Arabs is needed, but also a perfect knowledge of the life, the normal native milieu, knowledge which doctors in the metropolitan asylums cannot have, who, for the most part, have only had the occasion to know Algeria through a quick pleasure trip.” Levet, Assistance, 239.

18 For the concurrence between the medical and religious professions in the treatment of the insane in 19th century France, see: Dowbiggin, Inheriting Madness, 20 f., 38; Goldstein, Console and Classify, 197 f.

19 See, for example: Fernando, Mental Health, 57.

20 He travelled through Malta, Egypt, the Levant and Asia Minor. Moreau, Recherches, 104 — 15.

journal, the Annales Médico-Psychologiques, were taken up by many later psychiatrists who specialised in the Maghreb.” It was seen as a founding text of French colonial psychiatry on North Africa, despite the fact that it concerned neither French colonies nor North Africa. This extrapolation was possible because, despite its cultural diversity and regional differences, most colonial psychiatrists viewed the Arab-Muslim world as homogeneous enough to permit information on one region to be applied to any other. In North Africa, this meant that most differences — whether ethnic, linguistic or cultural - were eclipsed by the one binding character trait that “all” inhabitants shared: Islam, both in terms ofa religion and, more broadly, a culture.” The geographic focus of this book on Algeria, Tunisia and Morocco is therefore based on the colonial source material itself; which is somewhat contradictory when it comes to the complexities of the relationships between North Africans. While many colonial authors were obsessed with differentiating Algerians from Tunisians and Moroccans (and vice versa), as well as Arabs from Berbers,” it was generally supposed that these differences were negligible in the light of the many similarities they displayed as “North Africans”, “Arabs” or even “Muslims”. A Berber might prove to be very different from an Arab in the professional experiences of the psychiatrists, but as “Muslims”, they were still similar enough to be compared to any other Muslim in the world. While certain distinctions remained present in the descriptions of Muslim men,” Muslim

21 The psychiatrist Jean-Michel Bégué described in 1996 how Moreau de Tours’ findings were used by French psychiatrists as authoritative evidence over fifty years after the publication of his article. Bégué, French Psychiatry in Algeria, 537.

22 Apart from the Jewish populations in North Africa, which formed, in the minds of many colonial doctors and psychiatrists, an intermediate step between civilised European and primitive Muslim. Henry Bouquet, for example, described in 1909 how Tunisian Jews had a conception of insanity which was not based on the supernatural, and was, therefore, much closer to European theories. Bouquet, Aliénés en Tunisie, 27 f.

23 French colonial sources often drew contrasting pictures of the two "distinct races" of Arabs and Berbers, with Berbers being clearly preferable. The French ethnologist Aug. Dilhan, for example, envisaged the following recipe for a functioning Tunisian society in 1873: "Many Berbers, a certain amount of Moors, as few Arabs as possible, 1096 Jews, 1096 Europeans." Dilhan, Ethnographie, 212.

24 The French psychiatrist Victor Trenga, for instance, wrote in 1913: “At present, the five million Muslim natives inhabiting Algeria may be considered as forming a single society, a homogeneous whole, despite the diversity of origins and of language (nearly seven hundred thousand Kabyles speak a separate language, so different from Arabic).” Trenga, Ame arabo-berbère, 12.

25 See for instance the distinction of Arab and Berber men in medical and psychiatric colonial publications: Lafitte, Contribution, 23; Richardot, Pratiques médicales, 6 £.; Sicard, Etude, 65; Gervais, Contribution, 47; Arrii, Impulsivité criminelle, 30; Montaldo, Mortalité infantile, 83; Sutter, Epilepsie mentale, 72. This has been discussed by other historians: Keller, Colonial Madness, 12.

The Psychiatric Maghreb 15 women in the psychiatric source material appeared to be comparable and equatable across all possible geographic and ethnic divides.

This typically Orientalist imagining of a nebulous unity, somehow ingrained in those who were not European, can be found in texts by both psychiatric experts and laymen interested in psychological problems across the whole time period analysed in this book. The French author Raymond Charles, for example, wrote in his 1958 book on the “Muslim Soul” that Islam “presents a psychological and social structure which establishes among its followers a remarkable kinship despite biological or geographical obstacles”* Charles explained these deep-rooted mental similarities between all Muslims by appropriating (and corrupting) the Islamic concept of ‘umma, the idea of a supranational religious unity of all Muslims: “Admittedly, the forms of existence of an Indonesian, a Black African and a North African coincide: but a certain mental uniformity results from their obedience to a rigorous dogmatic and ritual unity.” According to Charles, all of these different colonial subjects not only had similar forms of existence, but their mere adherence to the religion of Islam reinforced these similarities.

This psychiatric unity of the Maghreb was uncritically accepted by most colonial psychiatrists. Etienne-Paul Laurens, for example, offhandedly explained in an article written in 1919 that information collected by his colleague Auguste Marie on psychiatric patients in Cairo could be easily applied to Algeria: “Although these are not, strictly speaking, Arabs from Algeria, we thought it useful to cite this work, which relates to Arabs who, in short, are in all respects similar to our natives of Algeria."* If the perceived similarities between Egyptians and Algerians allowed for such statements in clinical matters, it is not surprising that some psychiatric experts had no problems in formulating generalisations on “this North African race?” “the North African pathology” or “the Muslim North African mentality" based on their professional experiences in one of the three colonies in the Maghreb.

While these generalisations conform to modern stereotypes about Muslims, this assumption of “sameness” was both deeply problematic and inherently racist, as it was based on the Orientalist paradox of even the most sophisticated differences among

“Orientals” disappearing when directly comparing them to allegedly superior Europeans. Somewhat surprisingly, this imaginary, single unit of the Maghreb in psychiatric matters remained unchallenged by many postcolonial psychiatric authors, and

26 Charles, Ame musulmane, 8.

28 Laurens, Contribution, 18.

29 Porot/Arrii, Impulsivité criminelle, 588. 30 Sutter, Épilepsie mentale, 71.

31 Brissot, Propos, 500.

assertions ofthe cultural sameness of the Maghreb can be found in a number of postcolonial psychiatric publications. The French psychiatrist J.-J. Maupomé, for example, described in 1970 the “common denominator" between the different ethnicities in postcolonial Morocco, “[which] unites Morocco: Islam; Islam with its rigours, its ritual, its severity." This same simplistic worldview was even advocated by certain Arab postcolonial psychiatrists.”

It was the popularity of this idea of a deep-rooted Muslim sameness that allowed Moreau de Tours’ 1843 psychiatric article on the “Orient” to turn into one of the founding texts of French colonial psychiatry. Yet despite the importance of Moreau de Tours’ seminal publication, the years following his article only saw infrequent publications touching on the subject of psychiatry in North Africa — which, at that time, meant French Algeria. Only in the 1860s did psychiatry begin its preoccupation with the Algerian insane, and the first — ultimately unsuccessful — plans for constructing an asylum in Algeria were proposed." The 1880s and 1890s saw the first publications of travel accounts written by French psychiatrists who visited Algeria and the newly “protected” Tunisia” and who described, in a quasi-ethnological way, what and whom they encountered on their journeys. In their capacity as psychiatrists, they surveyed existing Muslim asylums and general hospitals in the colonies and described the miserable conditions in both sets of institutions. While some of these psychiatrists were truly shocked by the conditions the Muslim mad endured in the traditional Islamic maristans and deplored the inhumane treatments administered there, these reports must be seen as quintessentially colonial testimonies used to justify the concept of a “civilising colonialism”.”°

32 Maupomé, Quelques aspects, 34.

33 The Iraqi psychiatrist Ihsan al-Issa, for example, declared in a 1989 article that "since the Algerian sociocultural background is similar to that of Morocco and Tunisia, many of the psychiatric findings and information could be generally applied to these countries." Al-Issa, Psychiatry in Algeria, 240.

34 See: Delasiauve, Review of Collardot; Jobert, Projet. These early projects, rejected due to budgetary concerns, were discussed in depth in Sauzay’s 1925 dissertation on the “Assistance of Sane and Insane Psychopaths in Algeria" See also: Porot, Allocution, 29 f.; ibid., Assistance psychiatrique, 86; Desruelles/Bersot, Note sur l'histoire, 311 ff. The titles of French sources have been translated into English in the text — the original French titles can be found in the bibliography.

35 Variot, Visite; L'hôpital arabe de Tunis; Voisin, Souvenirs. The French psychiatric journal Annales Médico-Psychologiques also published a translated account of two visits by British psychiatrists to Egyptian asylums in that same period. Dumesnil/Pons, Deux visites.

36 These reports showed a combination of horror and pity, yet they were too similar in structure, phraseology and details, following an unacknowledged blueprint, to be seen as individual, humanitarian texts, and usually did not add to the already existing “knowledge” of the

Framing the Title 17

Due to World War I and budgetary cuts, general doctors, travelling experts and metropolitan psychiatrists remained responsible for the assessment and treatment of North African mental patients until the 1920s. In 1925 Antoine Porot, founder of what became known as the psychiatric École dAlger, became the first professor of General and Medical Pathology at the Medical Faculty of the University of Algiers." This was to be the starting point of psychiatrists living, working and studying in North Africa. By the 1930s the first psychiatric hospitals for Muslim patients were finally built in the Maghreb, ending patient transfers to France." This allowed colonial psychiatrists to become more vocal and authoritative, and by the 1940s and 1950s the École d'Alger even came to dominate the psychiatric mainstream discourse in France.”

Framing the Title — "The Hidden Patients”

The tide “The Hidden Patients" was chosen for three reasons, the principal one being that female Muslim patients were somehow "hidden in plain sight" — present in the colonial institutions, but ignored in the written sources. Colonial psychiatry’s strong focus on criminal insanity on the one hand and Muslim normality on the other distorted the portrayal of the clinical reality“ and resulted in certain topics being neglected despite the breadth of publications. The physical absence of psychiatric texts concerned with female Muslim patients effectively hid them from the eyes of readers of the academic literature."

A second reason for the title was the colonial obsession with explaining the low number of Muslim female patients by claiming that no respectable Muslim family would allow their women to be brought to a *mixed" hospital, where they would be literally unveiled, examined and treated by men. In the colonial imagination, Muslim families preferred to look after these patients at home, actively hiding "insane" Muslim women from the appropriate colonial psychiatric institutions. This "appropriation" of gender segregation — through a very literal interpretation of Muslim ideals — gave colonised mad. Reports written by British psychiatrists about the máristáns in Cairo are equally analogous. See for example: Urquhart, Two Visits, 47; Tuke, Two Visits, 49. Chapters 3 and presentan analysis ofthese colonial reports on the conditions in these traditional North African asylums.

38 This will be discussed at length in Chapter 3.2.5 "Psychiatric Hospitals in North Africa"