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REVIEWS
Jonathan D. Ablard, Madness in Buenos Aires:
Patients, Psychiatrists, and the Argentine State, 1880–1983
In Madness in Buenos Aires, Jonathan Ablard convincingly demonstrates that Argentine psychiatric institutions
were not the agents of social control that Foucauldian scholars have maintained they were in Europe and the
United States. While Argentina had the most developed system of mental hospitals in Latin America, according
to Ablard a weak state limited these institutions’ policing and coercive functions. Buenos Aires’s two main hospitals,
the Hospital Nacional de Alienadas (for women) and the Hospicio de las Mercedes (for men) attempted to replicate
European psychiatric practice, including even having an equal percentage of the national population interned.
Nonetheless, lack of funds, ineffective administration, chronic overcrowding, bureaucratic incompetence and the
absence of proper legal controls made Buenos Aires’s hospitals places where patients were more often neglected
than captured by a ‘clinical gaze’.
The book is based on meticulous use of primary and secondary sources and is divided into five chapters plus an
introduction and conclusion. Chapters 2 to 5 cover the period between 1900 and 1946 and are a comprehensive
history of the development and misfortunes of Buenos Aires’s two hospitals. These chapters are made compelling
by Ablard’s skilful use of case histories to illustrate diagnosis, treatment and legal problems of the patients. The last
chapter of the book deals with the changes in psychiatry from the time of Pero´n until the end of the military
dictatorship in 1983. Argentina prided itself on its modernity and large European population, yet the conditions that
existed in the two Buenos Aires hospitals were similar to those in other Latin American manicomios. In the first decades
of the twentieth century, patients often lacked adequate food, clothing and even beds, to say nothing of medical attention.
In the early 1930s, the women’s hospital had over 3,000 patients in facilities designed for 1,900 and in 1935 the men’s
asylum had a population of 2,580, more than twice its capacity.
An overwhelmed legal system meant that, although there were laws to protect people from unjust incarceration,
judicial review often came months after patients were committed. Because of court delays, and a law stipulating
that only the authority that requested commitment could rescind it, people were often held in unhygienic and dangerous
conditions for long periods after they had been medically cleared for release. Although patients were often trapped in
the system it seems to have more often been due to bureaucratic incompetence than intention. Furthermore, although
most patients had little recourse once committed, patient law suits and conflict among patients, doctors and administrators
indicate that the control exercised by the institutions was often quite fragile.
Diagnoses of those admitted tended to correspond to international psychiatric and intellectual trends. In the early
twentieth century, ‘degeneration’ (which was often judged by physical traits such as facial asymmetry) was often said
to cause or confirm an inmate’s insanity. Immigrants, especially political radicals, were considered particularly likely to
be degenerate and at least part of the psychiatric profession believed it was their duty to incarcerate these dangerous
insane for the good of society. As psychoanalytic theory gained authority, illness was more often attributed to psycho-sexual
conflicts. In the case of women these often had to do with reproduction or menstruation or with deviating from acceptable
feminine roles. Treatment in the hospital relied on cardiazol, insulin and electro-shock therapies, as well as medical cures
for syphilis. Doctors also at least occasionally practised surgical interventions, including lobotomy. Albard indicates that,
despite significant overcrowding, there may have been some use of psychoanalysis or psychotherapy in the hospitals.
The last chapter deals with the changing fortunes of the psychiatric profession under Peronism and succeeding
(mostly military) regimes. Ablard contends that one reason that hospital administration and patient care did not improve
during the period of Peronist populism was because Pero´n kept public institutions weak by making patronage and
clientelism the means of remedying social and political problems. The chapter also examines new trends in treatment
developed by progressive mental health professionals: small hospitals, more out-patient treatment, egalitarian therapeutic
communities. Eventually the profession divided into two antagonistic camps: one that favoured social justice and political
change and another that served as accomplices for the post-1976 military government in its interrogation and torture of
prisoners. Many of the psychologists and psychiatrists who advocated more innovative and humane treatment for their
patients eventually became targets of the military and at least 13 psychiatrists were disappeared. This is a very interesting
but somewhat rushed chapter. It would benefit from more discussion of the importance of psychoanalysis in Argentinian
life, the new types of therapy that developed from the 1950s onwards, and the roles of mental health professionals during
and after the dictatorship.
Overall, this is a well written, carefully researched contribution to the history of medicine in Latin America and a
refreshing revision to the now accepted wisdom that these institutions served as instruments of political policing
and social control. It will be welcomed by those interested in the history of public health, state formation and Latin
American history in general.
Ann Zulawski
Smith College
doi:10.1093/shm/hkn116
Advance Access published 12 March 2009
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Ablard uses the history of psychiatry in Argentina as a prism through which to examine not simply the provision
(or more often the lack) of mental health care, but also the nature and structure of the state, social change, modernity
and the formation of a cultural identity. He is not a mental health professional, but rather a historian and it is this
perspective that he brings, inter-weaving personal accounts, documentary records, sociological theorizing and archival
research to place the history of psychiatry in Argentina firmly in a socio-cultural-political context.
Although the book appears to be based on his doctoral dissertation, it is to his credit that it does not read like it. Even
the opening of the first chapter in which he speaks of the great 1986 film, Man Facing South-East, directed by Eliseo Subiela,
sets a tone that is broad-ranging, inclusive and engaging. He is concerned as much with the place of psychiatry within a
culture as the culture of psychiatry. There is a thoughtful and sometimes moving mix of social documentary and social
comment. Throughout the book Ablard's concern and feelings for those who may have suffered from and were certainly
confined within the psychiatric system is evident and the substantial number of personal accounts and archival photographs
underscores the point.
In some respects the history of psychiatry in Argentina is depressingly familiar. It is a catalogue of neglect, misunderstanding,
if not misanthropy and cruelty, of terrible conditions of deprivation and persistent and debilitating stigma. You have to look
hard for redeeming factors or experiences, but they can be found. Ablard cites the use of radio broadcasts by patients as
early as the 1930s and of the brief flowering of the ideas of therapeutic communities in the 1960s as examples of creativity
in the face of repression. He is also generous to the many staff who showed genuine care for those confined and recognizes
that very often the relationship with the staff, many of whom received little training and almost all of whom received little pay
and less kudos, was on the better side of paternal; it could be caring and intimate as well as brutal and repressive. Individual
acts of kindness and compassion are mixed with callous abuse and appalling conditions.
There are chapters that detail tragedy and abuse in ways other than those familiar to the West. The use of psychiatric
facilities by the military juntas is particularly bleak reading. The chronic lack of funding and a developed infrastructure
are constant themes.
It becomes clear that there are certain cultural and social factors that distinguish the history of psychiatry in Argentina
from that of North America or Western Europe and the English-speaking West. The intensity and pervasiveness of political
awareness made psychiatry as much a political issue as a medical one, in a way perhaps unmatched in the West apart
from the Italian psichiatria democratica or the use of hospitalization by the Soviet Union. And it is in drawing out and
contrasting and comparing these aspects that Ablard is able to shed more light and illumination on our current practices.
The final chapter is some ways the most surprising. In it Ablard makes the case that historically the Argentine state has,
despite despotism and a militarized government, not been strong and therefore its social control has been very limited,
and that the development, and practice of public psychiatry is both symptomatic and revealing in its "chaos, neglect and
diffuse social control". This makes a very important point about the place of psychiatry in social and cultural affairs.
Like the very best historical and cultural documents, Ablard's book tells us as much about ourselves as it does about its
putative subject matter. It brings to our attention the inter-relationship of class, poverty, social stigma and social division.
It is rich in detail (there are 60 pages of notes and another 20 of references), and he skillfully uses both personal research
and archival material, but the books remains accessible and absorbing. Ablard uses photographs of people and institutions
to poignant effect, and there seems to be a sad connection with the faces that peer out at us. And they will be one of the
longest legacies of the text.
The book will be of interest to scholars and general readers alike. It will appeal to those with an interest in Argentine social
history and those more taken by the historical and cultural aspects of psychiatry. It is a fine addition to a relatively neglected area.
Review by Mark Welch, Ph.D.
Apr 21st 2009 (Volume 13, Issue 17)
© 2009 Mark Welch
Mark Welch, British Columbia, 2009
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