Studies of the Weatherhead East Asian Institute, Columbia University. Ithaca; London: Cornell University Press, 2019. xiii, 291 pp. (Table, graph, maps, B&W photos.) US$45.00, cloth. ISBN 978-1-5017-3393-2.
Claire Edington’s Beyond the Asylum is a social history of psychiatry and mental illness in colonial Vietnam. Studies of colonial psychiatry often focus on its role in the racialized biopolitics of colonial rule. While race and biopolitics certainly have their role, Edington’s account is distinguished by the way she escapes the confines of the asylum—and a certain kind of postcolonial scholarship—and instead uses the history of psychiatry and mental illness as a means to explore the wider dynamics of colonial rule. In so doing, she engages with important debates across a range of fields, most notably the history of medicine, the history of imperialism, and Vietnamese studies.
The book is organized to take readers from the notional inside to the outside of mental health in colonial Vietnam. It begins with the discourse around and definition of mental illness, moves to the operation of the asylum, and ends in the social world beyond its walls. This spatial organization is also roughly chronological, making it clear that developments in the colony were part of dramatic shifts in psychiatric theory and practice worldwide in the early twentieth century.
Chapter 1 traces the evolving definitions of mental illness in colonial Vietnam between 1883 and 1930 and how they reflected French, Vietnamese, and Chinese legislation, Indigenous medicine, popular understandings of mental illness and its treatment, and debates about the role of the colonial state. Chapter 2 takes readers inside the asylums of Bien Hoa (completed in 1919) and Voi (1934) to explore the everyday challenges, negotiations, resistances, and accommodations that allowed them to function. Chapter 3 focuses on a particular type of accommodation: the transformation of the asylum into an agricultural colony and its patients into workers. Patient labour was framed as a form of treatment and rehabilitation, but it was also a pragmatic response to perennial budget shortfalls, and, Edington argues, intimately related to the larger development of the plantation economy in Vietnam.
Chapter 4 traces the journeys of patients in and out of asylums. Moving patients from overcrowded asylums back into the community compelled French experts to negotiate with the Vietnamese families and communities who would be responsible for their care, and contributed to the emergence of a new, more diffuse kind of psychiatric power. Chapter 5 explores representations of mental illness and treatment in the flourishing Vietnamese popular press of the 1920s and 1930s. In columns, serialized stories, and novels, ideas of mental illness were central to the working out of new ideas of personhood, self-control, social norms, and modernity. Finally, chapter 6 details how in the 1930s, psychiatrists sought to expand their role beyond the asylum by redefining their role as experts in the field of crime and criminality, and in particular what came to be understood as juvenile delinquency.
Much of the originality of Edington’s account stems from the way she approaches the topic from the vantage point of the history of medicine—she trained in the history and ethics of public health at Columbia—rather than postcolonial or Vietnamese studies. In particular, her perspective is informed by histories of psychiatry in North America and Britain that situate the asylum and mental health care within broader networks of caregivers and communities. This is a novel approach to sources that might easily have lent themselves either to an account of a hegemonic colonial biopolitics, or to one of resistance and contestation. Instead, Edington paints a picture of a hybrid and contingent psychiatric practice that reflected metropolitan theory, local exigencies, and Indigenous concepts in equal measure. She shows how tens of thousands participated in the creation of this important institution: patients in and out of the asylums, French and Vietnamese psychiatric and medical professionals, asylum guards, court prosecutors, and the families of the mentally ill.
Perhaps the most exciting result of Edington’s approach is the way she engages with her topic in ways that are fine-grained yet attuned to the wider world. At its base, Beyond the Asylum is a social history: “the story of society’s transformation as told through the experiences of those at the margins” (3). We meet characters like Nam, an epileptic preparing a meal for her family when she’s struck by a seizure; Cac, a simple-minded temple guardian and father of three, revered by villagers as a healer; Mai, petitioning for the release of her husband so he can contribute to the support of their eight children; or Sam, released into the care of his brother, an employee at a Saigon printing press. By recovering their voices, their aspirations, their successes and disappointments, Edington constructs a vision of ordinary life missing from accounts of the period in Vietnam that tend to focus on elite experiences and the overtly political.
At the same time, she reminds us how these experiences, which seem so rooted in a particular place, can only be understood in relation to the global transformation of science and medicine, economy, society, culture, and politics that—with apologies to Bruno Latour—we might call modernity. Psychiatry in Vietnam and France existed in a dialectic, and as legislation and practice around mental illness evolved across the early twentieth century, the colony might just as easily lead as follow the metropole. The use of patient labour, common in asylums in Europe and the Americas, was as much related to global capitalist development as to Vietnam’s rubber plantations. The enduring credence of Vietnamese in faith healers and mystics had its analog in the craze for seances and hypnosis in Victorian England and Belle Epoque France. And the experiences of the poor, the marginalized, and the sick, when confronted by a modern state and its medical system, can share commonalities that transcend space and time.
Gerard Sasges
National University of Singapore, Singapore