Madhouse

The volume under review proposes to rethink Cuban history from the vantage point of the Havana psychiatric hospital known as Mazorra. According to the author, the hospital “incarnates the glories and failures of the Cuban state” (p. 6). Inaugurated as the Casa General de Dementes in 1857, when the island was still a Spanish colony, Mazorra has occupied since then a central place in the Cuban political and social imagination.Madhouse is an ambitious book. It offers an institutional history of the hospital, an exploration of the process of professionalization of psychiatry in Cuba, and, in more general terms, a discussion of the history of the Cuban state and politics over a period of almost one century. The history of the hospital, like the history of Cuba in general, has been deeply influenced by US politics. Lambe's historical narrative thus starts in 1899 with the first US military intervention in Cuba. By the turn of the twentieth century, members of the Cuban political and intellectual elite considered Mazorra's modernization and improvement to be a patriotic imperative, but, paradoxically, Cubans relied on the impulse (and the funding) provided by the US occupation to carry it out.Lambe shows that the history of Mazorra converged with the development of psychiatry as an autonomous specialty. Psychiatrists claimed for themselves the monopoly on deciding on people's institutionalization as well as determining criminals' legal responsibility. The struggle for the medicalization of madness and marginality also invaded the walls of the hospital. Thus, Mazorra became the first hospital in Cuba to dismiss the Sisters of Charity, who were replaced by professional nurses trained at the hospital.The problems that plagued Mazorra were—at least until 1959—similar to those endured by most psychiatric hospitals in Latin America: high levels of corruption among the staff, nepotism, overcrowding of patients, budgetary restrictions, and the coexistence of modern therapeutic techniques with openly repressive measures. A case in point is the emphasis on labor therapy. While it was considered a means of therapy, at the same time it served as a source of funding for the hospital as well as for certain unscrupulous members of the staff who literally rented patients out to work at sugarcane plantations without any compensation for the patients themselves.The second half of Madhouse gradually shifts the focus from Mazorra itself to more general topics such as the debates over sexuality taking place in Cuba before and after the revolution of 1959, exploring Cubans' perceptions of homosexuality and masturbation. Homosexuality has occupied a central place among the preoccupations of the revolutionary government. In order to cure it, the post-1959 government applied a great variety of measures, ranging from Pavlovian therapies to openly repressive methods, including forced internment.The revolution had a profound impact on Mazorra, as it did on all other aspects of Cuban social, political, and cultural life. Material conditions improved considerably and the rate of patient mortality diminished dramatically during the early years of the Fidel Castro government. Work therapy was reintroduced at the hospital, but in a deeply reformed format. Thus, Mazorra became a community of working patients who participated, alongside other Cubans, in different forms of voluntary (and remunerated) collective labor.The last two chapters of Madhouse go beyond the confines of Mazorra and concentrate on topics such as the nature of the sociopsychological research carried out under Castro's government, the emergence of new debates about the place of psychiatry within the Cuban universe of psy practices, and the exportation to the United States of Cuban perceptions on mental diseases via the post-1959 wave of emigration. Lambe pays particular attention to the episode from 1980 known as the Mariel boatlift, when the Castro regime was accused of emptying mental hospitals and prisons and encouraging the migration to the United States of people interned there.Madhouse is a fine piece of scholarship. However, it has some weaknesses. As happened in other countries with a large population of African origin, in Cuba the rituals and forms of religiosity of the black population were pathologized and criminalized. It is unfortunate that such issues related to ethnicity are not dealt with in depth throughout the book. The volume would have also benefited from the introduction of some comparison with other countries such as Brazil, where there is an extensive secondary literature on these topics.In summary, Madhouse is the result of an ambitious project. Its strength and weaknesses are, in part, the result of its broad scope. As the author herself acknowledges at the end of the volume, in many cases the sources necessary for the research were difficult to access or simply not there. The reader will probably miss an analysis of clinical histories, which were not to be found. However, the book constitutes a very solid text that reflects the author's enormous effort. Madhouse is destined to become mandatory reading for all of those interested in the history of psychiatry in Latin America and also, more broadly, for the general public interested in Cuban history

Art · Elite · Institutionalisation · Literature · Medicalization · Modernization theory · Narrative · Narrative history · Political history · Political science · Politics · Professionalization · Psychiatry · Social science · Sociology · State (computer science) · Cuban History and Society · Historical Psychiatry and Medical Practices · History · Law · Medicine

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