‘How are we able to discern madness in any history or archive?’ asks Nancy Rose Hunt at the start of her introduction to this arresting collection of essays. It is a beguilingly straightforward question: to even begin to imagine where its answers might lie leads scholars into highly complex interpretive, interdisciplinary terrain. The book builds on a well-established body of scholarship on the history of colonial psychiatry in Africa but takes it into new theoretical directions. Madness, as Hunt argues, cannot be either reduced to the psychiatric or positioned in opposition to it. There are no closed or easy definitions here. How can we contemplate madness without also contemplating dreams (and nightmares), affective traces, phantasms, and deliria? How to plot psychiatry, psychoanalysis, and psychopolitics together – and apart? And how to grasp, conceptually and historically, the vernacular in worlds where the power of the state was attenuated both by shifting global understandings of health and sickness and by local idioms of distress? In manifold ways, the book recasts conventions. It unsettles the chronology of colonialism and its end: most chapters focus on the late colonial and early postcolonial years but all speak powerfully to the present as well as much deeper pasts (Hunt’s own chapter offers two milieux in counter-point: the transatlantic slave ships of the eighteenth century and the lorries of the 1950s Gold Coast). It puts histories of health and healing in dialogue with a distinctive tradition of Africanist anthropology. And it works across a dizzying array of perspectives and scales – from close-up, person-centred micro-histories to accounts of diagnostic categories to forays into unseen archives and overlooked sources. One essay uses a psychiatrist’s photographs, another the artwork of hospital patients. All are sensitive to the discord, the polyvalence – the opacity – of their sources.

Psychiatric Countours comprises ten substantive chapters, the first four of which work with patient histories and biographical frames. Nana Osei Quarshie explores the writings of Akla-Osu, a Ghanaian confined to the Accra Psychiatric Hospital four times between 1969 and 1976. Historians have long wrestled with the meanings to be gleaned from delusions: what Quarshie explains is the value that Akla-Osu’s delusions have not just for medical but for intellectual histories of Africa. Akla-Osu ‘dared to invent the future’, in Quarshie’s words, and his writings demand a new approach, ‘one that engages the creative conceptual work of patients’. Richard Hölzl traces the life of an African missionary priest – ‘Father John’ – in colonial Tanzania. African priests were liminal figures, Hölzl explains, valued as local experts but, as embodiments of African culture, generating deep disquiet amongst the European missionaries. The deeper they penetrated the mission itself, the more anxious the mission became at the reach, ‘the unfathomable depth’, of African ‘tradition’. At independence, Father John called for a liberation of the church as well as the state. For that, he was marked out as a problem – ‘a psychological case’. The rector of the seminary where he trained called him a megalomaniac and a psychopath. As with several of these essays, the single life story illuminates ‘much larger political and psychopathological processes’.

Raphaël Gallien has studied over 1,000 patient case files from the Anjanamasina hospital in Madagascar, from 1906 to the turn of the twenty-first century. Here, he works with just four, all from the 1920s. All ‘fell into madness’, Gallien writes, when faced with the ‘impossibility of reaching the social status to which they aspired’. All were situated ‘on the border between the world of the colonized and that of the colonizers’. Their madness was a response to the ‘social and racial immobilities’ that colonialism, and its attendant racial hierarchies, laid down. Hubertus Büschel offers a biographical account of Benedict Nta Tanka, a Cameroonian clerk who began hearing voices in 1968. In 1969, Tanka travelled to Nigeria where he met the German psychiatrist and World Health Organization (WHO) visiting professor Alexander Boroffka. Before setting off, Tanka began to write – a first draft of an autobiography, a play, eighty short statements, and thirty-eight ‘dream-protocols’. In writing, and through his relationship with Boroffka, Tanka ‘empowered himself, away from being a passive patient to being an active agent of global knowledge production’. Büschel’s essay is simultaneously a patient-centred ‘history from below’, a vernacular history of psychiatry in postcolonial Africa, and a critical account of one particular diagnostic category: schizophrenia.

Jonathan Sadowsky’s essay is also centred on the 1960s, its analytical focus ‘the problem of depression in African studies’. Through the colonial period, depression was assumed to be a ‘disease of civilisation’: Europeans were deemed susceptible due to their being supposedly more advanced. In 1967, the Canadian psychiatrist Raymond Prince reviewed fourteen reports on insanity from different parts of colonial Africa. All found depression to be rare or non-existent. The exception was a study by anthropologist Margaret Field, who worked at a healing shrine in Ghana in the 1950s. For Field, ‘Africa had just as much depression as anywhere else’: the people she described as depressed were mostly women, self-accused witches. Contemplating Field’s conclusions leads Sadowsky to consider how guilt was deemed a cultural capacity. Matthew Heaton’s essay on psychic stress disorder also features Raymond Prince and reveals how psychiatrists pegged culture to particular constellations of symptoms. That Africans moving from ‘tradition’ to modernity suffered particular social and psychic stresses was a colonial trope. Prince wanted to know if Nigerian students, detached from their ‘traditional’ social worlds, suffered mental fatigue as they laboured over their studies. This he labelled as ‘brain fag’: to advance his theory, he circulated a questionnaire to five prestigious secondary schools in the spring of 1959. Heaton uses their responses to formulate his own account of the widely felt ‘nervousness’ associated with (late) colonial settings like Nigeria – ‘not necessarily pathological in a medical sense,’ he writes, ‘but characterised by precarity, uncertainty, danger and varying degrees of violence.’ By plotting his interpretation of students’ responses against his critique of Prince, Heaton works deftly along and against the archival grain. So does Romain Tiquet, who analyses letters sent to the governor of Cape-Verde peninsula in Senegal in the 1960s by people seeking to have their relatives committed to a psychiatric clinic. Tiquet uses Senegal’s regional archives to explore what motivated families to have their relatives admitted and how they understood madness themselves, beyond the confines of ‘medical vocabulary and diagnostics’. Richard Keller’s essay is distinctive for the deeper narrative he gives of psychiatry in France and North Africa, taking the reader with remarkable writerly skill from the eighteenth century to the present day. The tensions between universalist and particularist ways of understanding madness and their implications for citizenship is the analytical focus, illuminated superbly via his account of psychiatrists Frantz Fanon and Suzanne Taïeb.

Psychiatric Contours is not just a valuable addition to the existing scholarly literature but a volume that presages new ways of conceptualising what madness in Africa might involve and how scholars might articulate its lived experience, cultural expression, and archival forms. All of the writers have thought deeply about madness, psychopolitics, and the vernacular – the three organising concepts that Hunt sets out in her introduction. Some essays are more accessible than others. Hunt’s own contributions are theoretically rich and doubtless intellectually brilliant but may prove challenging to those unversed in the kind of allusive, provocative writing in which she obviously excels.