Catálogo de publicaciones - libros

This chapter introduces the broader African and global contexts in which the arguments made about psychiatry in Uganda need to be understood. It introduces key themes in the history of psychiatry and decolonisation in Africa, including the use of psychiatric and psychological knowledge in the wars of decolonisation, and critiques of ethnopsychiatry and African psychiatrists. It also traces the development of psychiatry as a transnational and global phenomenon, considering explanations for tendencies towards universalism and standardisation.

This chapter traces the development of institutional psychiatry under colonial rule in order to set up the institutions, practices and attitudes towards psychiatry that were inherited by a newly independent Uganda in 1962. It explains the low priority accorded to psychiatry, expressed through minimal financial resources and specialist personnel, and the largely reactive nature of psychiatric policy. It explores reasons for admission to Hoima Lunatic Asylum and Mulago Mental Hospital, highlighting the recurrence of violence as a reason for committal, as well as the ways patients and their families contested the processes of confinement. It also looks at psychiatric practices within Mulago Mental Hospital, including treatment, communication problems and what the glimpses of patients in the archival record can tell us about the ways patients shaped institutional life.

This chapter examines the experiences of early Ugandan doctors as they took over responsibility for psychiatry at the end of empire. It explains how Uganda saw itself as uniquely placed to lead psychiatric education within Eastern and Southern Africa, culminating in the opening of a Department of Psychiatry at Makerere University College in 1966. It also explores the place of Ugandan doctors within the institutions and structures governing psychiatry during colonial rule, hierarchies of power at Butabika Mental Hospital in the early 1960s and the relationship between psychiatry and late colonial politics. The ambiguous position of doctors during the political dissent that erupted in Buganda in the 1940s, as well as the practical difficulties facing the first two psychiatrists—Stephen B. Bosa and Benjamin H. Kagwa—reveals not only an uneasy relationship between psychiatry and colonial politics, but also the challenges facing Ugandan psychiatrists at the end of empire.

This chapter uses epidemics of ‘mass hysteria’ in East Africa in the early 1960s as a lens through which to explore the place of psychiatry in the context of political instability. It situates ‘mass madness’ in the areas around Mbale, eastern Uganda, in its wider social and political context, linking it to anxieties of decolonisation, including an upsurge of violence and forced circumcisions. Juxtaposing an investigation by psychiatrist Benjamin H. Kagwa with oral history interviews with Gisu elders, it aims not only to explore how broader anxieties may have found expression in spirit possession, but also to highlight the difficulties facing the first generation of Ugandan psychiatrists as they took over responsibility for psychiatry. It makes clear that Kagwa was unable to bridge the social and cultural gap between psychiatry and those affected by mass hysteria. Not only did his education, class and language skills set him apart from his patients, but there remained fundamental differences between understandings of mental illness and the types of treatment deemed to be effective.

This chapter explores the ways that psychiatry in Uganda flourished in a period of experimentation and innovation during the late 1960s and early 1970s. During this period of relative political stability in Uganda’s history since 1962, psychiatrists looked to reorient the relationship between psychiatry and the mentally ill, as well as to highlight the relevance of psychiatry to the priorities of development and nation building. This was framed as a ‘psychiatry of poverty’, in which plans for the development of psychiatry shifted from the already overstretched psychiatric institutions towards the training of non-psychiatrists, or psychiatric auxiliaries, who could be trained to take on responsibility for mental health care at minimal cost. It explores how psychiatrists launched new training courses for police officers, lawyers and social workers, established Africa’s first National Association for Mental Health, and started mental health education. It also questions the ‘success’ of attempts at reform, highlighting not only the gap between intentions and ‘on the ground’ change, but also disconnects with the needs and priorities of the patients themselves.

This chapter situates Uganda in transnational and international discussions on the organisation of mental health care in developing countries during the 1960s and 1970s. It highlights the power of collective experience during a moment of increased mobility and attention on developing countries. Tracing the formation of the Association of Psychiatrists in Africa, it shows how psychiatrists saw common professional challenges that created unity and spurred innovation. It traces the roots of the World Health Organization (WHO)’s policy of mental health in primary care, showing how Uganda’s model of delegating responsibility for mental health care attracted WHO interest. It also highlights the limits of engagement with international mental health due to political and economic turmoil, and the contributions of psychiatrists in the diaspora.

This chapter explores psychiatry and mental health under Idi Amin, and in the wars and violence that continued into the 1980s and 1990s. It shows how, despite the decline and irrelevance of psychiatry for those coping with violence, psychiatric and psychologised language came to provide a useful way of defining and describing ‘traumatised’ populations. Uganda and Ugandan refugees became subjects of the first research on ‘trauma’ and the psychological effects of war and violence in Africa. In doing so, the chapter highlights the ways in which the decolonisation of psychiatry remained incomplete. While psychiatric institutions continued to stagnate, psychosocial activities and research, driven primarily by international agencies and specialists, attracted increasingly significant amounts of attention and money.

This chapter highlights how psychiatry today is regarded as unchanging, characterised by outdated legislation and facilities, all of them relics of the colonial period. It traces the difficulties faced in attempting to rebuild psychiatry and its ongoing marginal status within medicine. It ends by discussing the mental health landscape in Uganda today. In the absence of a large body of Ugandan psychiatrists, and in the context of low government investment, the global mental health movement has entered, creating new alliances and shaping perceptions of rights and how to claim them. By exploring peer support, the chapter highlights how people with lived experience of mental illness are not only offering new forms of mental health care but are actively renegotiating traditional spaces of psychiatry.