Murphy on Lambe, 'Madhouse: Psychiatry and Politics in Cuban History'


Jennifer L. Lambe. Madhouse: Psychiatry and Politics in Cuban History. Envisioning Cuba Series. Chapel Hill: University of North Carolina Press, 2017. 344 pp. $32.95 (paper), ISBN 978-1-4696-3102-8; $90.00 (cloth), ISBN 978-1-4696-3101-1.

Reviewed by Michael Murphy (Mississippi State University)
Published on H-Disability (October, 2018)
Commissioned by Iain C. Hutchison (University of Glasgow)

Printable Version: http://www.h-net.org/reviews/showpdf.php?id=51910

In recent years, probably linked to the realities and stories concerning psychiatric and psychological disorders in today’s society, examinations of the history of mental health and illness have come from the historical profession at a rate not seen since the mid-1990s. Jennifer L. Lambe’s Madhouse: Psychiatry and Politics in Cuban History joins this renewed examination of this history, which reevaluates the place of mental health and illness in relation to society and the state while also weaving the agency of patients into the narrative. Mental health and illness and their institutions are no longer merely historicized. Works such as Lambe’s skillfully examine this topic in relation to society and the state over time. She details the history of Hospital Psiquiátrico de La Habana, Cuba’s most well-known state hospital, throughout the twentieth century. More specifically, Lambe shows how the hospital, commonly known as Mazorra, developed over time from the late nineteenth century, when Cuba was a colony, through to the end of the Cold War. Over seven crisply defined chapters, Lambe ultimately argues that “the history of Mazorra and madness in Cuba offers a unique stage to witness the evolution of the Cuban state” and “provides a window onto those populations, both Cuban or not, who remained maddeningly but also stubbornly outside it” (p. 15).

After a succinct introduction, which includes an overview covering methodology and terminology, and chapter breakdowns, Lambe delves into Mazorra’s place in the unstable and unsure years of the Cuban War of Independence and the immediately preceding decades. During Spanish colonialism, the poor conditions at Mazorra became synonymous with the overall health of colonial Cuba; these conditions became worse with the start of war. Lambe details the inhumane conditions of Mazorra, concurrent with reports of suffering across Cuba during the late 1890s. At the end of 1896, the hospital housed 1,052 patients. By the beginning of 1899, nearly four years into the war, its population had plummeted to 393 patients due to “hunger, malnutrition, and gastrointestinal illness” (p. 19). With the United States’ occupation of Cuba by the early days of 1899, the promise of change and improvement came to Mazorra.

At the time of the American occupation during the early twentieth century, a correlation existed between the newly liberated hospital and the establishment of the Cuban state. Lambe explains, “The hospital’s political import, forged at the nexus of colonial abjection, patriotic euphoria, and imperialist conceit, would become an enduring legacy of independence” (p. 21). She goes on to detail how the progressive movement in the United States influenced Cuba’s admission practices to the hospital. In the wake of Civil Order No. 57, initiated by the occupation government at the insistence of local native leaders, Mazorra opened its doors to a vast number of individuals with mental illness from across the island. Also during this time, standardization, dating back to the US reformist period of the mid-nineteenth century, known for uniformity and regularity under the Kirkbride Plan, came to the state hospital in the form of more civil orders. In both socially scientific and political senses, US progressivism played a major role in Mazorra’s transformation. This led to an embracement of the moral treatment theory in the treatment of the mentally ill, a practice that fell out of favor in the United States in the late nineteenth century. However, the condition of state-sponsored care for the mentally ill in Cuba held parallels to those in the United States in the early republic and early Age of Jackson.

During and after the second US occupation, sanctioned under the Platt Amendment, Mazorra went through a period of uncertainty, and sharp shifts in policy, funding, and support. The second occupation brought paternalistic patronage to the people of Cuba and to the patients of the hospital, but faltered in the decades after the occupying forces left. Lambe explains that after the second occupation, the strategy of moral treatment was labeled a failure and it lost support. She notes that Cuban leaders who still supported moral treatment argued that Álvarez Cerice’s moral revolution for the hospital, linked to the revolutionary spirit of 1898, fell out of favor and became labeled a failure due to unsettling chaos and sharp changes in policy brought on by the occupations.

Through the hard times in the decades after the second occupation, some began to push to criminalize blackness and Afro-Caribbean culture. Madness came to be linked to such classification and culture into the 1930s. Mazorra, known as the Inferno during this period, became what Lambe refers to as a cultural contact zone, “where new wealth met abject poverty, psychiatrists encountered mental healers of a religious bent, and nearly all national life met its shadow: the most marginalized constituents of the new Cuba” (p. 78). In the decades leading up to the Cuban Revolution of 1959, the hospital transformed into a catchall for political dissenters and became a model of the cronyism and nepotism associated with Cuba’s government under the rule of Fulgencio Batista. Much like the Cuban state during the last years of Spanish colonialism, Mazorra became synonymous with bedlam. Much like the ending and immediate outcome of the Cuban War of Independence, the Revolution of 1959 “would inherit” a failing Mazorra (p. 139).

After the Cuban Revolution of 1959, the theme of revolution returned to Mazorra. The new government named Mazorra “the Hospital Psiquiátrico de La Habana,” and attempted to create an institution that represented the success of the revolution that it could show to the world. She goes on to note that “leftist and anti-imperialist visitors to the island were invariably ushered to the institution” to laude its equivalence to facilities in non-Communist nations (p. 141). However, the cronyism that occurred during the Batista years continued into the Fidel Castro years. The first administrator of the Hospital Psiquiátrico under the new government, Celia Sánchez, came to this position not because of his qualifications in psychiatry but because Castro deemed him “the chosen one” (p. 143).

Much as with the occupations of Cuba in the early twentieth century, the influences of the Soviet Union and United States on the treatment and classification of mental illness had lingering negative effects. Beginning in the 1960s, the treatment of mental illness became politicized. This became apparent with the criminalization and assumed treatment of homosexuality. At the Hospital Psiquiátrico, medical experts’ views fell into two camps that resembled party lines. Child psychologists drew on “socioeconomic factors and family dynamics” and anti-psychoanalysts favored Pavlovian conditioning (p. 156). Lambe explains that while a campaign known as the Lavender Scare successfully led to the firing of numerous reported gay government employees in the United States and Nikita Khrushchev’s continuation of Joseph Stalin’s criminalization of homosexuality, Cuba sent purported homosexuals to labor camps. This politicization of the Hospital Psiquiátrico continued into the last decades of the Cold War. Lambe notes that under the banner of revolution, “it was the state rather than the mental health professionals” who would guide Cuba’s politicized treatment of mental illness (p. 157). By the last decade of the Cold War, Cuba began to experience worsening economic conditions that were linked to the economic downfall of the Soviet Union. Because of this, Cubans, with the blessing of Castro, began leaving the country for the United States on a dangerous trek across the Straits of Florida on what became colloquially known as the Mariel Boatlift. Upon their arrival in Florida, the refugees became the target of white nationalism and racism by citizens and sections of the press in the United States. Matters were made worse when it was revealed that a number of those sent on the boatlift were former prison inmates and state hospital patients in Cuba. This realization, as Lambe explains, “highlighted the shortcomings of deinstitutionalization” in the United States (p. 203). Beginning in the late 1960s, state hospitals in the United States began to release patients and cut rolls in the name of economic conservatism. By 1980, when the boatlift began, institutional psychiatric care in the United States could not wholly assist refugees who came from the Hospital Psiquiátrico.

In the last pages of Madhouse, Lambe explains that “the madhouse has long served as a metaphor for the Cuban state,” especially after the Revolution of 1959, which she further explains in detail in the book’s epilogue (p. 230). In 2010, twenty-six patients at the Hospital Psiquiátrico passed away on a cold night. In response, the Cuban government swiftly placed the hospital’s director on trial and ultimately sentenced him to fifteen years in prison for “misappropriation” and “dereliction of duty” (p. 231). It is in this story that Lambe reminds the reader of the lasting power of revolution and its role in psychiatry in Cuba.

Citation: Michael Murphy. Review of Lambe, Jennifer L., Madhouse: Psychiatry and Politics in Cuban History. H-Disability, H-Net Reviews. October, 2018.
URL: http://www.h-net.org/reviews/showrev.php?id=51910

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

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