Migration, Ethnicity, and Mental Health

International Perspectives, 1840-2010

Angela McCarthy, Catharine Coleborne

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136469015
• Edition: 1
• Topic: History
• Subtopic: Social History
• Index: History

Most investigations of foreign-born migrants emphasize the successful adjustment and settlement of newcomers. Yet suicide, heavy drinking, violence, family separations, and domestic disharmony were but a few of the possible struggles experienced by those who relocated abroad in the nineteenth and twentieth centuries, and were among the chief reasons for committal to an asylum. Significant analysis of this problem, addressing the interconnected issues of migration, ethnicity, and insanity, has to date received little attention from the scholarly community.

This international collection examines the difficulties that migrants faced in adjustment abroad, through a focus on migrants and mobile peoples, issues of ethnicity, and the impact of migration on the mental health of refugees. It further extends the migration paradigm beyond patients to incorporate the international exchange of medical ideas and institutional practices, and the recruitment of a medical workforce. These issues are explored through case studies which utilize different social and cultural historical methods, but with a shared twin purpose: to uncover the related histories of migration, ethnicity, and mental health, and to extend existing scholarly frameworks and findings in this under-developed field of inquiry.

1 Introduction

Mental Health, Migration, and Ethnicity

Angela McCarthy and Catharine Coleborne

Until fairly recently, international scholars working in the field of the histories of mental health have privileged national episodes and sites in the histories of institutions and institutional confinement, particularly through the eighteenth-and nineteenth-century eras, with some work focused on the twentieth century.¹ ‘Mental health’ has been defined largely through institutional confinement because of the large number of accessible archival materials relating to the nineteenth century, with historians focused on studies of single institutions, often plotting demographic patterns of confinement for hospitals, as well as assessing their place in the wider contexts of mental health policy and changes over time. Several volumes of collected essays examine national contexts for mental health, including studies of Canada, Australia, Wales, and Britain more widely.² Another wave of edited volumes locates the study of institutional confinement as a global phenomenon, with studies of international perspectives on the worldwide trends for mental health hospitalisation, studies of European approaches to psychiatric treatment inside institutions, a volume which considers the way psychiatry was bound up with practices of ‘empire’, and most recently, a volume which situates the study of institutional mental health inside the approaches of transnational and comparative histories of psychiatry.³

Yet despite the new and developing attention to looking across sites at similar and divergent practices and at shared knowledges of mental health, the subject of migration has received far less specific attention than these other strands of inquiry outlined above. There have been exceptions, specifically those contributed by American historians and studies. Richard W. Fox, for instance, used a sample of 1,229 case histories in his book So Far Disordered in Mind: Insanity in California, 1870–1930 (1979) to identify, inter alia, the social backgrounds and behaviour of the insane. His methodology and analysis are therefore important to us, particularly his stress on age as a factor in explaining the over-representation of the foreign-born among the insane.⁴ In this sense he reiterates Benjamin Malzberg’s identification of age as an important component when examining asylum admissions.⁵ Gerald N. Grob, meanwhile, made some of the most important critical interventions in the American literature between the 1960s and 1980s. His work in Mental Illness and American Society, 1875–1940 (1983) explores issues of hostility and fear towards new immigrants and minority ethnic groups in the period he investigated. In an earlier work, The State and the Mentally Ill (1966) which focused on a Massachusetts hospital, incorporation of foreign-born inmates, including the Irish, formed part of his analysis of patient populations.⁶ Yet inside existing studies of Britain, and the white settler colonies we include—Canada, Australia, New Zealand, and Fiji, as well as numerous studies of India—immigrants themselves mostly appear in the discussion as subject to colonial economies, or as ‘at risk’ populations because they allegedly lacked familial networks and were often among the very poor. The social and geographical origins of patients at specific institutions also receive some attention, as does their ethnicity, an important aspect of this volume, as we discuss below.

We argue, then, building on the range of ways that the histories of mental health has been represented, that migration ought to be considered as a particular focus of a new generation of inquiries into mental health and institutional confinement. Here, we place special emphasis on a few themes emerging from recent collaborative research, including the relationship between mental health and migration itself; the analytical category of ethnicity inside institutional populations, including questions surrounding ethnicity and institutional confinement; and the significance of the migration of intellectual ideas and trends in psychiatry, as well as personnel. Overall, we elaborate on the ways that contributors to this volume tackle these various themes, as well as others, using a variety of tested and new approaches to the analysis of their sources.

In this way we contribute more broadly to the field of migration studies, in which many analyses focus on successful migrants and their contributions to new societies, or emphasise the discrimination and prejudice migrants encountered. More recent investigations draw on concepts such as transnationalism and networking to highlight the ties between the homeland and the respective diasporas.⁷ A further key aspect of the extant historiography is a focus on individual migrant groups, with explicit comparative investigation rarely undertaken.⁸ Several works encompass diverse ‘types’ of migrants including settlers, entrepreneurs, soldiers, women, juveniles, and appropriate to this volume, medical personnel. Such individuals were among a vast outpouring of around 60 million people leaving central and western Europe for overseas shores during an era of mass migration between 1815 and 1930. Among the largest flows were 11.4 million from Britain, 9.9 million from Italy, 7.3 million from Ireland, and 5.0 million from Austria-Hungary.⁹ In addition, beyond a focus on human mobility, the migration of ideas is also increasingly examined by historians.¹⁰

But what do we know about those who struggled with their relocation abroad? Previous investigations of the relationship between migration and mental health predominantly appear in the work of epidemiologists, transcultural psychiatrists, and social scientists, but with a particular focus on the twentieth century. Malzberg, for instance, examined first admissions to mental hospitals in New York State. He found that although the rates of foreign-born admissions varied according to how long they had been in the country (with the most recent arrivals more likely to be institutionalised), high rates of first admissions among the foreign born compared to native born were skewed by scholars by failing to account for age discrepancies.¹¹ Transcultural psychiatrists Roland Littlewood and Maurice Lipsedge are sceptical about the stresses generated immediately after migration, claiming that strains may be greatest some years after relocation when ‘new life in the adopted country has fallen short of expectations’.¹² In this volume, Angela McCarthy considers this issue among a sample of New Zealand’s foreign-born patients in Dunedin’s public asylums, and similarly finds that migrants were more likely to be admitted several years after settlement.

McCarthy therefore makes an important contribution, for studies of nineteenth-century migration and mental health are somewhat fleeting. From a Canadian perspective, David Wright and colleagues suggest that migration is often downplayed as a factor in asylum committals, despite migrants being suspected of mental illness because of their strange appearance, habits, lack of language skills, and lack of kin resources.¹³ The applicability of these findings to diverse ethnic groups in distinct locations remains to be seen, recent research having demonstrated the movement of Irish migrants, especially, in robust networks of family and friends.¹⁴ Other studies of migration typically focus on internal movement, particularly from rural to urban areas. Andrew Scull and John Walton, for instance, perceive a link between long-distance migration and committal.¹⁵ Still other scholars refute any correlation between long-distance migration and admission to the asylum.¹⁶ More recently, Joseph Melling and Bill Forsythe, in their study of the Devon Asylum, suggest that more settled individuals were increasingly likely to be admitted to asylums than recent migrants or migrants with sustained mobility.¹⁷ In this volume, Jacqueline Leckie points to those indigenous Fijians classified as insane who had been ‘wanderers’ outside their villages and become destitute, not only in a material sense but also in a social sense.¹⁸ Akihito Suzuki also engages with this theme in his study of psychiatric hospitals in Japan. In particular, he focuses on the urban-rural ‘loop’, encompassing young migrants sent back to cities where they became disabled and unable to work and support themselves, before returning again to the households of their parents or relatives in native countryside villages. In this way, he incorporates the striking differences between institutional provision in urban areas and the care provided in rural households.

Yet as McCarthy indicates in this volume, the migration process does not necessarily result in asylum admission, for not all migrants were institutionalised. Nevertheless, examination of case book records and official asylum and immigration documents reveals an acknowledgement by patients, their family and friends, and medical authorities that anxieties relating to the migration process could result in institutionalisation. McCarthy’s work also draws attention to areas of analysis little studied among migration and madness including the role of the voyage and migration pathways. The voyage also appears in Leckie’s study of Indian indentured migrants bound for Fiji in the later nineteenth century. There, she argues, migrants of all backgrounds were displaced due to physical dislocation and ‘profound shifts in their cultural worlds’, resulting in institutional confinement, repatriation, or suicide.

Movement from overseas destinations to new countries is not, however, the only process of migration that scholars of mental health have explored. The subjects of return migration and repatriation are also noteworthy. Littlewood and Lipsedge queried whether mentally ill migrants were encouraged to voluntarily return home ‘in the belief that the illness is caused by the stresses of migration and that the patient will recover back in his original country’.¹⁹ Return migration remains under-examined in this volume and in migration studies as a whole,²⁰ although Leckie points to the repatriation of the insane from Fiji, and McCarthy highlights briefly the critical role of family and friends as instrumental in the relocation of patients from New Zealand.

While some migrants experienced mental health issues in their new homelands, other migrants were employed as psychiatric staff to care for patients.²¹ These psychiatric workers were among a range of medical personnel migrating globally to provide general health care. A particular contingent of workers, 200 ‘suitable girls’ assisted from Britain in 1946, is the focus of Kate Prebble and Gabrielle Fortune’s chapter. Situating their analysis within a framework that incorporates immigration policy, the professionalization of nursing, and domesticity, Prebble and Fortune contend that unqualified women with no previous history of employment in the psychiatric sector were best suited to psychiatric work.

Male superintendents in the nineteenth century feature in Elspeth Knewstubb’s analysis of Ashburn Hall, New Zealand’s only private lunatic asylum. As Knewstubb argues, these men were products of their time both culturally and intellectually, with a range of cultural, social, educational, and employment attitudes and influences at play in their diagnoses, treatment, and general comments about patients. In this sense, Knewstubb’s work focuses on the migration of ideas, arguing that rather than an assumed movement of ideas from England to New Zealand, a range of international influences were present, particularly French and Scottish. The doctors’ intellectual influences are further nuanced by the mobility of ideas in medical circles through publications and correspondence between practitioners. In this way Knewstubb adds to the work on the circulation of medical theory, as evident in Crowther and Dupree’s exploration of the global dissemination of Joseph Lister’s theories and insights about antiseptics.²²

The mobility of ideas is also covered by Maree Dawson in her study of diagnoses made at the Auckland Asylum in New Zealand. Drawing on case books, medical journals, text books, and government reports, she considers whether there was an Empire-wide conception of identifying congenital idiocy and how these ideas were disseminated through the ‘organs’ of the profession. Dawson’s study points to the diagnosis of congenital idiocy which legitimised fears of racial degeneracy and the inherited nature of mental disease across the British Empire, particularly in ‘white settler’ colonies. As Dawson indicates, however, differences in localised social concerns are reflected in diverse ideas about congenital idiocy and various ways of treating the condition, in a medical sense. But concerns about a ‘degenerate residuum’ were part of wider discussions of national efficiency which permeated the British Empire.

ETHNICITY AND MENTAL HEALTH

Indeed, the concept of ‘race’ or biological difference rather than ‘ethnicity’ has featured more readily in studies of asylums to date. This has emerged from a focus on colonial medicine and psychiatry in the past decade of studies of institutional confinement.²³ Slo...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Tables and Charts
• Acknowledgements
• 1. Introduction: Mental Health, Migration, and Ethnicity
• 2. Mental Health and Migration: The Case of the Irish, 1850s–1990s
• 3. Migration, Madness, and the Celtic Fringe: A Comparison of Irish and Scottish Admissions to Four Canadian Mental Hospitals, c. 1841–91
• 4. Migration and Madness in New Zealand's Asylums, 1863–1910
• 5. Locating Ethnicity in the Hospitals for the Insane: Revisiting Case Books as Sites of Knowledge Production about Colonial Identities in Victoria, Australia, 1873–1910
• 6. A Degenerate Residuum?: The Migration of Medical Personnel and Medical Ideas about Congenital Idiocy, Heredity, and Racial Degeneracy between Britain and the Auckland Mental Hospital, c. 1870–1900
• 7. Medical Migration and the Treatment of Insanity in New Zealand: The Doctors of Ashburn Hall, Dunedin, 1882–1910
• 8. ‘Lost Souls’: Madness, Suicide, and Migration in Colonial Fiji until 1920
• 9. Between Two Psychiatric Regimes: Migration and Psychiatry in Early Twentieth-Century Japan
• 10. ‘Suitable Girls’: Recruitment of British Women for New Zealand Mental Hospital Nursing Post–World War II
• 11. The Impact of Migration on the Mental Health of Refugee Women in Contemporary New Zealand
• 12. Afterword: Madness is Migration—Looking Back to Look Forward
• Contributors
• Index