Studies of the Weatherhead East Asian Institute, Columbia University

Mental Illness in French Colonial Vietnam

Claire E. Edington

• Publisher: Cornell University Press
• Year: 2019
• ISBN:
  9781501733956
• Topic: History
• Subtopic: Asian History
• Index: History

This book is a must-read for any specialist in the history of colonial and post-colonial psychiatry, as well as a fantastic case study for those interested in the social history of European colonialism more generally. ? Choice

Claire Edington's fascinating look at psychiatric care in French colonial Vietnam challenges our notion of the colonial asylum as a closed setting, run by experts with unchallenged authority, from which patients rarely left. She shows instead a society in which Vietnamese communities and families actively participated in psychiatric decision-making in ways that strengthened the power of the colonial state, even as they also forced French experts to engage with local understandings of, and practices around, insanity. Beyond the Asylum reveals how psychiatrists, colonial authorities, and the Vietnamese public debated both what it meant to be abnormal, as well as normal enough to return to social life, throughout the early twentieth century.

Straddling the fields of colonial history, Southeast Asian studies and the history of medicine, Beyond the Asylum shifts our perspective from the institution itself to its relationship with the world beyond its walls. This world included not only psychiatrists and their patients, but also prosecutors and parents, neighbors and spirit mediums, as well as the police and local press. How each group interacted with the mentally ill, with each other, and sometimes in opposition to each other, helped decide the fate of those both in and outside the colonial asylum.

CHAPTER 1

A Background to Confinement

The Legal Category of the “Insane” Person in French Indochina

By the early 1880s, doctors at Chợ Quán Hospital had their hands full. Patients suffering from syphilis, tuberculosis, and dysentery showed up at the hospital’s doors without entry tickets while a number of criminals and vagrants in varying states of mental distress arrived by police escort. They included Nhut, arrested for attacking a European police agent with a saber in the throes of a nervous breakdown. There was also Bich, later diagnosed with epilepsy, who had threatened the life of both his sister and his brother’s father-in-law, succeeding only in cutting off three of his fingers. Some patients clearly seemed disturbed but did not present a dangerous threat. With no prospect of recovery, they were eventually returned to their families, who promised to provide vigilant oversight. One woman, Nhuan, arrived at the behest of her husband following an excited outburst that had since faded into a quiet sadness after her hospitalization. Others seemed to have no family connections. One Chinese patient, blind in one eye, deaf and mute, entered the hospital in the summer of 1879 after he was found wandering in the streets. His doctor noted a diagnosis of “idiocy” in his case file and deemed him “incurable.” With no home to return to, the patient became an employee at the hospital, where he was kept out of trouble by preparing meals for other patients.¹ Louis Lorion, a young French naval doctor who briefly worked at Chợ Quán, later noted that the hospital’s facilities, especially those for violent mentally ill patients, left “a lot to be desired, at least during the time when I was in service at that establishment.”²

Chợ Quán Hospital first opened in 1864 in the growing colonial capital of Saigon. Intended as the centerpiece of French efforts to highlight the benefits of modern medicine, it was also the first hospital created for the exclusive treatment of indigenous patients (hôpital indigène). Despite early enthusiasm, the hospital quickly fell into disrepair due to shaky construction and the damage caused by periodic flooding. By the time Lorion arrived, it had undergone some significant reforms initiated by the French navy, which had assumed control over the hospital’s operations. It now occupied two main buildings, and its staff consisted of two military physicians on loan from the navy, including Lorion, two French civilian nurses, and a group of Indochinese nurses, whose inclusion represented an innovation at the time.³ The hospital nevertheless continued to suffer from a chronic lack of funding due to the absence of any official health care policy in the colony. By the spring of 1882, amid a flurry of requests for admittances, the hospital’s director announced that he would no longer accept any new patients suspected of mental illness, the cabins dedicated to their care “now being completely occupied.”⁴

Upon his return home to France and civilian life, Lorion published a study in 1887 entitled Criminalité et médecine judiciaire en Cochinchine in which he insisted on the remarkable rarity of mental illness in the colony. This was not a surprise, Lorion explained, given the state of development of indigenous society as well as the moral characteristics of its people, whom he described as “fickle, occasionally hardworking, very patient, easygoing.”⁵ Hundreds of years of rule under arbitrary and ancient governments had left the local population (or “Annamites,” Lorion’s preferred term) with only a “mediocre” taste for politics, and the kinds of “big problems which impassion the Occidentals” left them “completely indifferent.” While not “fatalist like the Arabs,” Lorion wrote, the Annamites nevertheless approached life with an extreme stoicism, accepting good fortune with the bad. This insight applied even more strongly to the Cambodians, a “degenerate people whose apathy has become proverbial in Indochina” and who, alongside the ethnic Moi people, occupied “the lowest rung in the ladder of civilization.”⁶ These observations helped to explain the idiosyncratic nature of crime in the colony, distinguished by few violent episodes or crimes of passion. In Lorion’s estimation, because of fundamental differences driving “yellow” and “white” forms of criminality, importing modern penal methods from France to Cochinchina would be of little use. Unfamiliar with the violent passions of European life, the local population proved “more vegetative than intellectual” and therefore seemed at little risk for mental illness. The notion that the Annamite was too patient and apathetic to be truly susceptible to mental illness not only contributed to racist justifications for colonial rule but also informed the expectations and judgments of colonial administrators, who insisted for years that there was no need for an asylum. These conclusions increasingly contradicted those of doctors and hospital directors, who made it clear in their official communications that things looked more dire from the front lines. While Lorion insisted he had met only a small handful of mentally ill individuals during his time in the colony, hospital records hint at a different picture that had slowly started to emerge before the turn of the century.⁷

In the thirty years following the publication of Lorion’s study, French colonial rule in the region further consolidated with the introduction of a racially stratified legal and taxation system, the expansion of the plantation economy, and the development of new networks of hospitals and prisons. This chapter follows the birth of the colony’s first asylum set against this backdrop of the increasing penetration of French institutions into Vietnamese society. Specifically, it traces the emergence of the “insane” person—or, to use the French term, aliéné—as an official category of personhood deserving of legal protections and entitled to state-provided services. In just a few decades, colonial officials moved from claiming there was very little legal basis or practical need for an asylum in Indochina to achieving one of the more comprehensive mental health care systems in the French empire. Here I use the debates over extending France’s famous 1838 asylum law to Indochina as a way of tracking shifting understandings about the pervasiveness of mental illness in the colony, among indigenous and European populations alike, and what should be done about it. A combination of local developments and international pressures would eventually transform perceptions about the problem of the mentally ill into a problem of colonial governance for the first time.

Debates over whether to extend the French asylum law of 1838 reveal how initial attempts to square Vietnamese with French styles of jurisprudence eventually gave way to more pressing questions about the nature of mental illness in the colony and the subsequent need for an asylum. By the turn of the century, the notion that the colonial state would bear the burden of providing care for the sick and indigent who, abandoned by their families, poured into the colony’s rapidly growing cities, began to come into view. The networks of caregiving and policing that developed to target this floating population in the 1910s and 1920s served as a kind of “surface of emergence” for mental illness as a visible, largely urban, social problem.⁸ Whether or not a person legally qualified as insane, his or her social and medical designation as someone who was mentally ill nevertheless taxed colonial resources in ways that could no longer be ignored. The opening of the colony’s first asylum in 1919 inaugurated a new phase, which witnessed attempts to translate the French legal concept of insanity to a vastly different social and institutional context. The promulgation of comprehensive asylum legislation in 1930, which drew on the principles of the 1838 French asylum law but updated and adapted them in important ways, signaled just how dramatically the conversation about mental illness in the colony had changed. This chapter therefore examines the colonial career of the legal concept of the aliéné and how it channeled broader debates about the role and responsibility of the colonial state, the need for new kinds of knowledge and new mechanisms of social control, and ideas about Indochina as a distinctive kind of place.

Chinese Borrowings and Local Medicines

In the late nineteenth century, the popular belief among colonial administrators like Lorion that local populations did not in fact suffer from violent forms of mental illness, therefore failing to meet the French legal definition of insanity that required state intervention, took hold. Instead, the colonial government relied on local forms of care in the community that predated French occupation but that would nevertheless play an important role in the eventual establishment of the formal asylum system. These therapeutic practices reflect the deep, yet uneven, penetration of Chinese culture in Vietnamese society over several centuries.⁹ For instance, the Vietnamese word for “crazy,” điên, takes its root from the Chinese word dian, which translates as “upside down.” Like Chinese physicians, the Vietnamese tended to attribute madness to either external disruptions (such as wind or ghosts) or internal imbalances (produced by somatic or mental processes or both) that produced abnormal states of qi, or vital energy. In writings dating from the fourteenth century, Lê Hữu Trác (or Lãn Ông as he is more commonly known), warned of the pathological effects of uncontrolled emotions, noting for instance, “A joy too lively [agitation, overstimulation] leads to a dispersion of wind (khí).”¹⁰ Just like wind in nature, wind in the body was thought to accelerate and disrupt normal functioning. He also cautioned that overwork and stress might lead to a weakening of the liver and of the lungs, prompting the “three spirits (hồn)” and “seven vital fluids (phách)” to vacate the body and allow “nightmares and sensory hallucinations” to enter.¹¹ In this analysis, which borrowed heavily from Chinese models, strong emotions produce both mental and physical effects and may themselves result from physical changes emanating from both within and outside the body.

Southern Medicine

Discussion of treatments for “frights,” “obsessive” thoughts, anger, jealousy, and anxiety in traditional Vietnamese medical texts reflects not only Chinese influence but also the prized use of indigenous herbal remedies. Tuệ Tĩnh, one of the two titans of traditional Vietnamese medicine alongside Lãn Ông, described the uses and modes of preparation for over six hundred species of flora in his famous “Miraculous Drugs of the South” (“Nam Du’ợc Thần Hiệu”).¹² For Tuệ Tĩnh, whose Buddhist philosophy assumed a close relationship between humans and their physical environment, the key to good health lay in the use of locally derived cures—hence the now famous adage “Use southern medicine to treat southern people.” Although originally written for a Chinese audience, the text was eventually published in Vietnam in 1761 where it became an indispensable guide for how to treat common ailments, including conditions that resembled madness. These remedies, typically of a yin, or cool, thermal nature, promised to address the yang symptoms associated with madness by “dissipating heat, draining fire and extinguishing wind.” They included Job’s tears (otherwise known as coix seed or Chinese pearl barley), described as a “little sweet” and used for the elimination of “wind, humidity and heat.” “Spicy, sour and bitter” chives were thought to “lower qi, relieve pain in the region of the heart, staunch bleeding, support men’s sexual energy and dissipate heat.” Because of the close ties between physical and mental health, it made sense that the same remedies could cure different kinds of ailments. Remedies derived from “animals with scales” had a salty flavor and promised not only to promote the circulation of blood and prevent allergic reactions but also to “ward off evil spirits” and “stop convulsions, forest fevers and children’s frights.” Tuệ Tĩnh recommended roasting them “until golden” in order to use them.¹³

Remedies with calming powers for reducing mental agitation included the dried flowers of ích mẫu thảo (honeyweed or Siberian motherwort, used in Europe since at least the seventeenth century), nghề chàm (Japanese indigo, which held therapeutic powers beyond dyeing clothes), and mạch môn đông, a sweet, slightly bitter herb that promised to clear heat and soothe irr...

Table of contents

• List of Illustrations
• Acknowledgments
• Introduction: Writing the Social History of Psychiatry in French Colonial Vietnam
• 1. A Background to Confinement: The Legal Category of the “Insane” Person in French Indochina
• 2. Patients, Staff, and the Everyday Challenges of Asylum Administration
• 3. Labor as Therapy: Agricultural Colonies, Study Trips, and the Psychiatric Reeducation of the Insane
• 4. Going In and Getting Out of the Colonial Asylum: Families and the Politics of Caregiving
• 5. Mental illness and Treatment Advice in the Vietnamese Popular Press
• 6. Psychiatric Expertise and Indochina’s Crime Problem
• Conclusion: Continuities and Change in Postcolonial Vietnam
• Notes
• Bibliography
• Index