Mandatory Madness: Colonial Psychiatry and Mental Illness in British Mandate Palestine 1009430378, 9781009430371

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Mandatory Madness

Mandatory Madness offers a fresh new perspective on a pivotal period in the history of modern Palestine, by putting mental illness and the psychiatric encounters it engendered at the heart of the story. Through a careful and creative reading of a wide range of archival and published material in English, Arabic, and Hebrew, Chris SandalWilson reveals how a range of actors responded to mental illness in the decades before 1948. Rather than a concern of European Jewish psychiatric experts alone, questions around the causes, nature, and treatment of mental illness were negotiated across diverse and sometimes surprising sites in mandate Palestine. Bringing together histories of medicine, colonialism, and the modern Middle East, Mandatory Madness highlights how the seemingly personal and private matter of mental illness generated distinctive forms of entanglement: between colonial state and society, Arabs and Jews, and Palestine and the wider region. Chris Sandal-Wilson is a lecturer in the history of medicine at the University of Exeter. He earned his PhD from the Faculty of History at the University of Cambridge. He researches and teaches the histories of medicine and psychiatry, British colonialism, and the modern Middle East. His work has been published in Culture, Medicine, and Psychiatry, The Historical Journal, and other journals and edited volumes.

The Global Middle East General Editors Arshin Adib-Moghaddam, SOAS, University of London Ali Mirsepassi, New York University Editorial Advisory Board Faisal Devji, University of Oxford John Hobson, University of Sheffield Firoozeh Kashani-Sabet, University of Pennsylvania Madawi Al-Rasheed, London School of Economics and Political Science David Ryan, University College Cork, Ireland The Global Middle East series seeks to broaden and deconstruct the geographical boundaries of the ‘Middle East’ as a concept to include North Africa, Central and South Asia, and diaspora communities in Western Europe and North America. The series features fresh scholarship that employs theoretically rigorous and innovative methodological frameworks resonating across relevant disciplines in the humanities and the social sciences. In particular, the general editors welcome approaches that focus on mobility, the erosion of nationstate structures, travelling ideas and theories, transcendental technopolitics, the decentralization of grand narratives, and the dislocation of ideologies inspired by popular movements. The series will also consider translations of works by authors in these regions whose ideas are salient to global scholarly trends but have yet to be introduced to the Anglophone academy.

Other books in the series: 1. Transnationalism in Iranian Political Thought: The Life and Times of Ahmad Fardid, Ali Mirsepassi 2. Psycho-Nationalism: Global Thought, Iranian Imaginations, Arshin Adib-Moghaddam 3. Iranian Cosmopolitanism: A Cinematic History, Golbarg Rekabtalaei 4. Money, Markets, and Monarchies: The Gulf Cooperation Council and the Political Economy of the Contemporary Middle East, Adam Hanieh 5. Iran’s Troubled Modernity: Debating Ahmad Fardid’s Legacy, Ali Mirsepassi 6. Foreign Policy as Nation Making: Turkey and Egypt in the Cold War, Reem Abou-El-Fadl

7. Revolution and Its Discontents: Political Thought and Reform in Iran, Eskandar Sadeghi-Boroujerdi 8. Creating the Modern Iranian Woman: Popular Culture between Two Revolutions, Liora Hendelman-Baavur 9. Iran’s Quiet Revolution: The Downfall of the Pahlavi State, Ali Mirsepassi 10. Reversing the Colonial Gaze: Persian Travelers Abroad, Hamid Dabashi 11. Israel’s Jewish Identity Crisis: State and Politics in the Middle East, Yaacov Yadgar 12. Temporary Marriage in Iran: Gender and Body Politics in Modern Persian Film and Literature, Claudia Yaghoobi 13. Cosmopolitan Radicalism: The Visual Politics of Beirut’s Global Sixties, Zeina Maasri 14. Anticolonial Afterlives in Egypt: The Politics of Hegemony, Sara Salem 15. What is Iran? Domestic Politics and International Relations, Arshin Adib-Moghaddam 16. Art and the Arab Spring: Aesthetics of Revolution and Resistance in Tunisia and Beyond, Siobhán Shilton 17. Tunisia’s Modern Woman: Nation-Building and State Feminism in the Global 1960s, Amy Aisen Kallander 18. Global 1979: Geographies and Histories of the Iranian Revolution, Arang Keshavarzian and Ali Mirsepassi 19. Fixing Stories: Local Newsmaking and International Media in Turkey and Syria, Noah Amir Arjomand 20. Schooling the Nation: Education and Everyday Politics in Egypt, Hania Sobhy 21. Violence and Representation in the Arab Uprisings, Benoît Challand 22. A Social History of Modern Tehran: Space, Power, and the City, Ashkan Rezvani Naraghi 23. An Iranian Childhood: Rethinking History and Memory, Hamid Dabashi 24. Heroes to Hostages: America and Iran, 1800–1988, Firoozeh Kashani-Sabet 25. The Making of Persianate Modernity: Language and Literary History between Iran and India, Alexander Jabbari

Mandatory Madness Colonial Psychiatry and Mental Illness in British Mandate Palestine Chris Sandal-Wilson University of Exeter

Shaftesbury Road, Cambridge CB2 8EA, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 103 Penang Road, #05-06/07, Visioncrest Commercial, Singapore 238467 Cambridge University Press is part of Cambridge University Press & Assessment, a department of the University of Cambridge. We share the University’s mission to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781009430371 DOI: 10.1017/9781009430395 © Chris Sandal-Wilson 2024 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press & Assessment. First published 2024 A catalogue record for this publication is available from the British Library. Library of Congress Cataloging-in-Publication Data Names: Sandal-Wilson, Chris, 1992- author. Title: Mandatory madness : colonial psychiatry and mental illness in British mandate Palestine / Chris Sandal-Wilson. Description: Cambridge, United Kingdom; New York, NY: Cambridge University Press, 2024. | Series: The global Middle East ; 26 | Includes bibliographical references. Identifiers: LCCN 2023023079 (print) | LCCN 2023023080 (ebook) | ISBN 9781009430371 (hardback) | ISBN 9781009430388 (paperback) | ISBN 9781009430395 (epub) Subjects: LCSH: Psychiatry–Palestine–History–20th century. | Mental illness– Palestine–History–20th century. | Mental health laws–Palestine–History–20th century. | Psychoanalysis and colonialism–Palestine–History–20th century. | Palestine–History–1917-1948. | Great Britain–Colonies–Asia– Administration–History–20th century. Classification: LCC RC465.8.P35 S36 2024 (print) | LCC RC465.8.P35 (ebook) | DDC 362.196890095694–dc23/eng/20230703 LC record available at https://lccn.loc.gov/2023023079 LC ebook record available at https://lccn.loc.gov/2023023080 ISBN 978-1-009-43037-1 Hardback Cambridge University Press & Assessment has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Contents

List of Illustrations Acknowledgements Introduction

page viii ix 2

Part I

33

1 Psychiatry in Palestine between the Ottomans and the British

35

2 Enumerating Insanity: Pathologies, Translations, and the Census

81

Part II

117

3 Petitions, Families, and Pathways to the Asylum

119

4 Insanity before the Courts: Defining Abnormality, Punishing Normalcy

158

5 Getting In and Getting Out of the Criminal Lunatic Section

194

Part III

231

6 Investing in Psychiatric Institutions and Expertise into the 1940s

233

7 Treating the Mentally Ill: Work, Drugs, and Electricity

272

Epilogue: Partitions and Afterlives

305

Bibliography Index

315 338

vii

Illustrations

FIGURES

1.1 Photograph of the Convent of St Vincent de Paul in Jerusalem page 47 1.2 Changing admission patterns at the Ezrath Nashim hospital, 1895–1922 51 1.3 Photograph of the building of the first government mental hospital 62 1.4 Photograph of Bethlehem, showing site of the first government mental hospital 63 2.1 Number of insane per hundred thousand of the population in 1931 census of Palestine 93 2.2 Photograph of the building of the second government mental hospital 115 3.1 Palestinians admitted to the Lebanon Hospital for Mental Diseases, 1920–48 141 6.1 Photograph of the British demolition of old Jaffa in 1936 247 MAPS

0.1 Map of government and major private mental institutions in mandate Palestine 3.1 Residence of the 174 patients from Palestine admitted to the Lebanon Hospital for Mental Diseases between 1901 and 1935

viii

1

140

Acknowledgements

This book would not have been possible without the support, given in so many different forms, of a humbling number of people. It is a privilege to be able to acknowledge, however inadequately, that support here. This book began life as a doctoral dissertation at the University of Cambridge, which was funded by a Wolfson Foundation Postgraduate Scholarship in the Humanities. This scholarship, together with subsequent awards from Trinity Hall, the History Faculty, and the Joint Centre for History and Economics at Cambridge, as well as the Centre for British Research in the Levant and the Palestine Exploration Fund, allowed me to undertake the archival work and language training necessary for this book. Since completing my doctorate, I am very lucky to have found myself in a series of teaching and research positions at Birkbeck, University of London, the University of East Anglia, and the University of Exeter, which afforded me the time I needed to continue to research and ultimately write this book. I am grateful to colleagues and friends at all three institutions, who have supported and encouraged me in countless ways over the years. I am also profoundly grateful to my students: the questions they pose and perspectives they offer have sharpened my own thinking on this and so many other subjects, and their perseverance even in the midst of a global pandemic has been a lesson and an inspiration to me. I am deeply indebted to the many archivists and librarians without whose labour, expertise, and patience my own work would have been impossible. Most of the archival material which this book uses is held in the Israel State Archives today. At the very start of this project, the Israel State Archives began a process of full digitisation. Though this has not been without issues, I am grateful to all those responsible for speedily digitising the many hundreds of files I requested over the years. At the Middle East Centre Archive at St Antony’s, Oxford, Debbie Usher has been tirelessly efficient and helpful, while at the American University of Beirut, I owe a debt of gratitude to the entire archives and special collections team, in particular Shaden Dada, Yasmine Younes, and ix

x

Acknowledgements

Iman Abdallah. I also wish to thank archivists, librarians, and all staff at the British National Archives, the British Library, the Archives and Special Collections at the School of Oriental and African Studies, the Central Zionist Archives, municipal archives at Haifa, Jerusalem, and Tel Aviv, the Library of Congress, and the Hallwyl Collection. My ability to work with this archival material was a result not only of support from archivists and librarians, but all those whose language training over the years at Cambridge, Jerusalem, and Amman meant I was able to use Hebrew- and Arabic-language sources in this book. I wish particularly to thank Hagar Ben-Zion and Lameese Ahmad, both for their expertise and patience, and for their friendship. It would be impossible to thank by name all those who have challenged and extended my thinking at conferences, seminars, workshops, and chance encounters since the beginnings of this project nearly a decade ago. I can only single out here some of those who created supportive and much valued spaces for conversation and reflection over the years: Ana Anti´c, Lauren Banko, Edna Bonhomme, Rohan Deb Roy, Chris Dole, Omnia El Shakry, Maziyar Ghiabi, Monica Ronchi, Sherene Seikaly, Sara Scalenghe, Yasmin Shafei, and Hande Yalnızoğlu. Among those who helped shape this project in its earliest years, I thank Seth Archer, Mériam Belli, Elise Burton, Catherine Evans, Tim Harper, Ruth Harris, and Tanya Lawrence. Leigh Denault, Emma Hunter, and Rosamond McKitterick all made me, in different ways, a better historian. Jake Norris and Megan Vaughan offered encouragement and insightful feedback as the examiners of the doctoral dissertation out of which this book grew. For their expert insight into key details, I am grateful to Nadi Abusaada, Issam Bannoura, Emily Jacir, George Hanna Malouf, Anne Mansour, Adnan Musallam, and Inger Marie Okkenhaug. Friends and colleagues at Cambridge, Birkbeck, UEA, and Exeter, including Semih Çelik, Gemma Clark, Shinjini Das, Jennie Davey, Eliza Hartrich, Sarah Marks, Louise Moschetta, Jana Mokrišová, Yael Navaro, Ay¸se Polat, Mezna Qato, Luna Sabastian, Hilary Sapire, Hana Sleiman, Peter Waldron, and Gloria Young, have all supported and encouraged this project – and me – in innumerable ways over the years. I wish particularly to thank those who read and provided feedback on parts of the book at various stages: Hannah-Louise Clark, Amanda Dillon, Merve Fejzula, Jayne Gifford, Joel Halcomb, Stacey Hynd, Sarah Irving, Sam Knapton, Lamia Moghnieh, and Martin Moore. The book has been immeasurably strengthened by careful, generative feedback during the peer review process, which even managed to rekindle excitement as the finishing line came into sight. It was a pleasure to work with the indefatigable and inventive Kate Blackmer, who designed and created the maps for the

Acknowledgements

xi

book, and with Carolyn M. Jones, whose sharp editorial eye and goodhumoured efficiency were a godsend at a late stage in the publication process. Thanks are also due to Maria Marsh and the rest of the team at Cambridge University Press. Finally, I owe my greatest debt of gratitude to Andrew Arsan, who has been over many years an unfailingly generous and encouraging supervisor, mentor, and friend: thank you for everything. My family has been a constant source of love and support, and I can only begin to express my gratitude to them here. Canâ, Aslan, Nukhet, and Mike, thank you for welcoming me into your family with open arms and hearts: hepinizi çok seviyorum. My aunt and uncle, Pauline and William, have always been like a second set of parents to me. It has been my greatest privilege to have two remarkable women as my grandmothers: Nanny Maud, deeply missed and much loved; and Nanny Norma, whose love and support has been unwavering. My brother Thomas, and his husband Michael, have created a happiness together which brings joy to all those around them. With Hakan I have found my companion, my love, my adventure, my home; without him this book and so much else would have been impossible. (Bramble has helped too, of course.) This book is dedicated with thanks and love to the memory of my dad – and to my mum, in the anticipation of many more happy memories together, still to come.

Map 0.1 Map of government and major private mental institutions in mandate Palestine

Introduction

In the year 1931, I was married to Nassif D., a shoe maker from Jaffa, and had from him six children, four girls and two boys. During 1944–1945, my husband became ill and then lost his mind; Your Excellency may allow me to state that apart from our being in a complete state of distress, my husband beats me and the children practically every night and has on many occasions tried to burn the hut in which we live. I have in vain approached the Public Health Department and the Police Authorities in Jaffa to send him to a Lunatic Asylum but they have failed to do so. I therefore have been advised to refer the matter to Your Excellency and respectfully trust that Your Excellency will order the department concerned to act as soon as possible before it is too late, as I am sure that one of these days, my children and myself will be the victims of a lunatic man.1

In December 1945, Zmurud D. wrote in desperation to the High Commissioner of Palestine, the highest-ranking official in the British mandate government that had, by then, governed Palestine for over two decades. Experiencing violence at the hands of a husband who had ‘lost his mind’, she had already sought help from the department of health as well as the police in Jaffa, but to no avail; petitioning the High Commissioner directly was her last resort. Zmurud’s gambit yielded results, though not in a form she had anticipated. Rather than admit her husband, the department of health arranged for him to be offered a course of electro-convulsive therapy at the government mental hospital near Jaffa as an outpatient. While this meant the overcrowded hospital could treat him without filling one of their precious beds, these ‘inoculations’ – as Zmurud erroneously called them a few months later – made her husband ‘very furious’. Every time he returned home from the hospital, he beat her and the children, and poured kerosene over their mattresses in his attempts to burn down the house. Faced with this

1

2

Zmurud D., Jaffa, to High Commissioner, 1 December 1945, Israel State Archives [ISA] M 6628/6.

Introduction

3

unbearable situation, Zmurud wrote once again to the High Commissioner to demand that her husband be sent to a mental institution before it was too late.2 This time, she was assured that her husband would be admitted when a vacancy became available3 – though there is no record in the colonial archive of when, if at all, this may have come to pass. The story of Zmurud’s encounter with mental illness is just one of the many I have come across in the archive of the British colonial government that ruled Palestine from the end of the First World War until 1948, though that does not diminish the poignancy of her calls for help under harrowing circumstances. These stories unfolded against the backdrop of a pivotal period in the history of modern Palestine. Across three short decades, former Ottoman territories in the Levant were partitioned and parcelled out as British and French mandates under the auspices of the newly created League of Nations; a British administration formally committed to the creation of a Jewish national home in Palestine was imposed against the expressed wishes of the indigenous Arab population; and a Palestinian national movement emerged which, by the late 1930s, was capable of sustaining an unprecedented general strike and years-long revolt against both the British and Zionism. Stories like Zmurud’s are easy to overlook, against the backdrop of these momentous developments and in the knowledge that the mandate period would come to a sudden and dramatic end in 1948 with the establishment of the State of Israel and the Palestinian nakba, or catastrophe, of displacement and dispossession. Yet these stories – of how people living in mandate Palestine negotiated both mental illness and the colonial state at the same time – are at the heart of this book. They matter in their own right and on their own terms: Zmurud’s petitions, which speak powerfully to the way her and her family’s life had been turned upside down by mental illness, make this plain. These stories also, however, hold out challenges to and possibilities for the study of mandate Palestine, the history of psychiatry, and our understanding of how Palestine connects up to wider regional, imperial, and global histories. By centring the social and cultural history of mental illness in mandate Palestine, Mandatory Madness makes an intervention in each of these three areas. First, it provides a distinctive new account of how mandate officials, European Jews, and Palestinians – Muslim, Christian, and Jewish – interrelated. Stories like Zmurud’s can reveal the intimate ways in which the big political transformations of the 2 3

Zmurud D., Jaffa, to High Commissioner, 2 May 1946, ISA M 6628/6. A/Director of Medical Services to Zmurud D., Jaffa, 17 May 1946, ISA M 6628/6.

4

Introduction

period were felt by ordinary Palestinians. But more than this, focussing on these stories brings into view a rich seam of encounters, negotiations, and contestations stretching across colonial state and society, at a register overlooked by the political histories that dominate the scholarship. Second, the book makes the case for shifting the centre of gravity within histories of psychiatry – particularly colonial psychiatry – away from institutions or experts and towards a fuller apprehension of the myriad spaces, actors, and issues which mental illness entangled. Tracing the varied encounters which mental illness engendered requires a rethinking of the archive of the history of psychiatry, too. Third, by locating Palestine firmly in relation to wider regional, imperial, and global contexts, Mandatory Madness challenges the methodological nationalism, the stubbornly national framing of analysis, which still characterises much scholarship on both Palestine and colonial psychiatry. But it also uses the history of psychiatry in Palestine, including its specificities and incommensurabilities, to engage critically in debates around mobility, translation, and globalisation across these distinct fields and to underscore that blockages, and not just connections, structured Palestine’s relationships with wider worlds. Zmurud’s story gives a sense of what is gained by embracing this more expansive approach to the history of mandate Palestine and psychiatry. Her petitions open up our understanding of where the history of psychiatry unfolds and who its principal characters are, and offer a powerful example of the sustained, consequential negotiations Palestinians undertook with the colonial state around mental illness; her story also provides an oblique avenue of approach to understanding the encounter between Palestine and developments in psychiatric practice globally, by showing how the introduction into the mandate’s mental institutions of new techniques like electro-convulsive treatment was understood and experienced by families like Zmurud’s. To start with this first point about spaces and actors, Zmurud’s husband Nassif was not, after all, confined for long periods of time behind the walls of a mental hospital but spent most of his time at home, even once admitted for outpatient treatment. Nassif’s condition, moreover, was far from a private matter, concerning patient and psychiatrist alone; in one sense intensely personal, it was at the same time highly social, involving his family as well as a range of officials and other actors. Central though psychiatry and mental illness were to Zmurud and Nassif’s story, theirs is one that might easily slip from view if we keep our sight trained too closely on a single psychiatric institution, or the research and practice of a particular psychiatrist or school. Institutional and intellectual histories of colonial psychiatry have been important in revealing the often uneven integration of psychiatric

Introduction

5

expertise and practice within the wider panoply of colonial rule.4 But stepping outside the institution and de-centring the experts makes possible a rich social history of how colonial subjects navigated mental illness, and how the colonial state, in turn, responded. Zmurud’s story also demonstrates how mental illness prised open a crucial if unstable space for Palestinians to negotiate in meaningful ways with the colonial state. Her husband’s illness profoundly disrupted her family’s life, but she was neither the passive victim of circumstances beyond her control, nor did she meekly defer to the diagnoses and prescriptions of medical experts. When mental illness made its shocking appearance, Zmurud took action. Across the mandate period, mental illness was understood both as an issue affecting an individual’s health and as a potential, if not actual, threat to the safety of families, neighbours, and wider communities. Zmurud made use of this, and sought out any government agencies she believed might hold the power to help her and her children, turning not just to doctors and health authorities but to the police as well. Rebuffed by one set of officials, she tried another, and rather than accept what experts determined, she put forward her own account of her husband’s condition and proposal for his treatment. Zmurud mobilised her community, too, adding their voices to her own to strengthen her calls for help. Her first petition to the High Commissioner was attested by representatives from Jaffa’s Orthodox Christian community, who urged the government to step in and help with the difficult matter of ‘her mad husband’.5 Her negotiations with doctors and officials took place on a markedly uneven playing field, and her grasp of the treatment which her husband was receiving seems partial, but her persistence yielded at least some concessions from the mandate government. This was no mean feat. In the wake of war and with the future of Palestine hanging in the balance, it would not have been difficult to overlook the story of a shoe-maker who had ‘lost his 4

5

For an overview of the historiography, see Richard Keller, ‘Madness and Colonization: Psychiatry in the British and French Empires, 1800–1962’, Journal of Social History 35, 2 (2001), pp. 295–326; and Megan Vaughan, ‘Introduction’, in S. Mahone and M. Vaughan, eds., Psychiatry and Empire (Basingstoke: Palgrave Macmillan, 2007), pp. 1–16. Key points of reference in this now substantial body of scholarship include: Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Palo Alto, CA: Stanford University Press, 1991); Jock McCulloch, Colonial Psychiatry and ‘the African Mind’ (Cambridge: Cambridge University Press, 1995); Jonathan Sadowsky, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria (Berkeley: University of California Press, 1999); Richard Keller, Colonial Madness: Psychiatry in French North Africa (Chicago: University of Chicago Press, 2007); and, albeit focussed on psychology rather than psychiatry, Erik Linstrum, Ruling Minds: Psychology in the British Empire (Cambridge, MA: Harvard University Press, 2016). Zmurud D., Jaffa, to High Commissioner, 1 December 1945, ISA M 6628/6.

6

Introduction

mind’ and beat and threatened his wife and children at home. Zmurud worked hard to make sure this could not be ignored, could not be overlooked, either by her community or by the colonial government. Striking though her story may be, Zmurud was not alone in being moved by mental illness to enter into such critical negotiations across state and society. Over nearly three decades of British rule, mental illness engendered and sustained complex, consequential interactions within Palestine. Stories of these encounters often reach us in their most compelling form through petitions like Zmurud’s, and with good reason: for all the raw emotion of the human tragedies they convey, these were highly crafted pieces of writing, carefully calibrated to move the state to action. But encounters with mental illness are woven through a dizzying array of archival material: sometimes sensationalised, as in newspaper reportage of criminal insanity trials; at other times, buried beneath the deadening prose and statistics of the department of health’s annual reports. These archival traces reveal that encounters around mental illness played out across a range of spaces and involved a wide cast of actors; they took hugely varied forms. Some, as in the case of Zmurud and her husband, were unspectacular, unequal, often unrewarding negotiations about the care of the mentally ill, initiated and kept going by families who, in their desperation, demanded that the colonial government reach into their homes and take over responsibility for their relatives. If these negotiations offer an insight into what Claire Edington has called the colonial micropolitics of psychiatric care,6 and telegraph wider contestations over the nature of mental illness and efficacy of particular therapeutic responses, not all encounters around mental illness played out at such an everyday register. Others unfolded more publicly: in the mandate’s courts, for instance, where judges, lawyers, and witnesses – expert and lay – debated the mental responsibility and legal culpability of defendants in full view of the press and public, and where what was at stake was not simply the fate of the accused individual but the relationship between the law and other forms of psychiatric and social knowledge. At a different level again, the British authorities found themselves grappling with the specificities of mental illness and psychiatry in Palestine. Some of the dynamics of this encounter find parallels across the colonised world, as colonial states and their medical experts struggled with the question of how cultural difference might affect the expression and treatment of mental illness. In Palestine, unusually, the most 6

Claire Edington, Beyond the Asylum: Mental Illness in French Colonial Vietnam (Ithaca, NY: Cornell University Press, 2019), pp. 6–7.

Introduction

7

systematic attempt to come to terms with this was not through any specialist research but rather through the enumeration of the ‘insane’ population in the 1931 census. Other dynamics were unique to Palestine, most obviously the immigration of hundreds of thousands of European Jews across this period and the concomitant development of voluntary provision for the mentally ill, provision which often outstripped the government’s own. Another peculiarity, no less important, was a set of institutions, understandings, and laws inherited from Palestine’s former rulers, the Ottomans, an inheritance the British more often retained and adapted than uprooted and replaced. A growing body of scholarship highlights the continuities which suture together the histories of Ottoman and British Palestine.7 Extending this into the realm of psychiatric encounters furnishes us with not only a fuller appreciation of Ottoman legacies, but also a distinctive angle of approach to global histories of science and medicine, where a commitment to transcending national or even imperial boundaries has not always entailed reflection, as Anna Tsing puts it, on ‘struggles over the terrain of circulation and the privileging of certain kinds of people as players’.8 Rather than locate global connectivity in networks of European experts alone,9 from the vantage point of mandate Palestine inter-imperial exchange entangled a non-European empire and its European successor, and regional connections established in the late Ottoman period were sustained as much by patients and their families travelling for treatment as by Arab medical doctors and nurses seeking training and professional development. Encounters around mental illness in mandate Palestine rippled up and down these multiple registers of experience, a testimony to both the polyvalency of mental illness itself as a term always open to negotiation 7

8

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Roberto Mazza, Jerusalem: From the Ottomans to the British (London: I. B. Tauris, 2009); Salim Tamari, ‘City of Riffraff: Crowds, Public Space, and New Urban Sensibilities in War-Time Jerusalem, 1917–1921’, in K. A. Ali and M. Rieker, eds., Comparing Cities: The Middle East and South Asia (Oxford: Oxford University Press, 2010), pp. 302–11; Abigail Jacobson, From Empire to Empire: Jerusalem between Ottoman and British Rule (Syracuse, NY: Syracuse University Press, 2011); Jacob Norris, Land of Progress: Palestine in the Age of Colonial Development, 1905–1948 (Oxford: Oxford University Press, 2013). Anna Tsing, ‘The Global Situation’, in Jonathan Xavier Inda and Renato Rosaldo, eds., The Anthropology of Globalization: A Reader (Oxford: Blackwell, 2002), p. 463. For these critiques, see Sarah Hodges, ‘The Global Menace’, Social History of Medicine 25, 3 (2011), pp. 719–28; and Warwick Anderson, ‘Making Global Health History: The Postcolonial Worldliness of Biomedicine’, Social History of Medicine 27, 2 (2014), pp. 372–84. There are important exceptions, including Abena Dove Osseo-Asare, Bitter Roots: The Search for Healing Plants in Africa (Chicago: University of Chicago Press, 2014); and Elise Burton, Genetic Crossroads: The Middle East and the Science of Human Heredity (Stanford, CA: Stanford University Press, 2021).

8

Introduction

and contestation, and its productive versatility as a lens of analysis which can carry us across the thresholds of social, cultural, or political history. Tracking psychiatric encounters through these layers provides a strikingly different perspective on this crucial period in Palestine’s history. It de-centres and re-contextualises the land purchases, political manoeuvrings, and insurgencies and counter-insurgencies that have served in more teleological political histories as milestones on the road to the end of British rule, the partition of Palestine and establishment of the State of Israel, and the displacement of hundreds of thousands of Palestinians in the nakba.10 If a focus on psychiatric encounters opens up vital space for social and cultural history and makes it possible to take the mandate period on its own terms rather than as merely a prelude to 1948, it also reimagines the sites, actors, and indeed sources of the history of psychiatry. Finally, following patients, as well as psychiatric ideas and practices, as they travelled not just within but beyond the borders of the mandate reveals both the connections and the disjunctures which structured Palestine’s position relative to wider regional, imperial, and global contexts. Stories like Zmurud’s, in other words, form a rich tapestry of interactions around mental illness within which state and society are knitted together in sometimes unexpected ways, layers of history and registers of experience often held apart are instead crosshatched into connection, and the threads of certain stories stretch out towards Lebanon, Egypt, and India – or hang loose, trailing off into unknown, uncertain outcomes.

Re-Entangling the Histories of Mandate Palestine While there is now a growing body of scholarship on the history of psychiatry and the sciences of the mind in the Middle East,11 its 10

11

For a useful recent review of the historiography of the mandate: Lauren Banko, ‘Historiography and Approaches to the British Mandate in Palestine: New Questions and Frameworks’, Contemporary Levant 4, 1 (2019), pp. 1–7. There is a growing list of important works which break with this focus, including: Salim Tamari, Mountain against the Sea: Essays on Palestinian Society and Culture (Berkeley: University of California Press, 2008); Ela Greenberg, Preparing the Mothers of Tomorrow: Education and Islam in Mandate Palestine (Austin: University of Texas Press, 2010); Norris, Land of Progress; Andrea Stanton, ‘This Is Jerusalem Calling’: State Radio in Mandate Palestine (Austin: University of Texas Press, 2013); Sherene Seikaly, Men of Capital: Scarcity and Economy in Mandate Palestine (Stanford, CA: Stanford University Press, 2015); and Fredrik Meiton, Electrical Palestine: Capital and Technology from Empire to Nation (Oakland: University of California Press, 2019). For an incomplete list, see Eugene Rogan, ‘Madness and Marginality: The Advent of the Psychiatric Asylum in Egypt and Lebanon’, in E. Rogan, ed., Outside In: Marginality in the Modern Middle East (London: I. B. Tauris, 2002), pp. 104–25; Fatih Artvinli, ‘“Pinel

Re-Entangling the Histories of Mandate Palestine

9

geographic coverage has been uneven. To date, to the extent that scholars have alighted on the history of mental illness in mandate Palestine at all, they have largely approached it as the story of the struggle of a group of European Jewish psychiatrists to establish their own private clinics, professional organisations, and ultimately the foundations of the future Israeli mental health service after 1948.12 Within this scholarship, the history of the mandate’s engagements with mental illness is given little attention, except insofar as the colonial government’s provision is represented as a kind of foil, as forming a parallel if inferior system to that being evolved by and for the Yishuv, Palestine’s Jewish community.13 And the history of Palestinian encounters with mental illness and psychiatry is afforded even less weight. In part, this is a result of the privileging of particular kinds of sources as constituting the archive for writing a history of psychiatry in Palestine, above all the publications – whether research articles in medical journals, conference proceedings, or reports by professional societies – of psychiatric experts. In part, it also follows from the adoption of a teleological framing that works backwards from the establishment of the State of Israel and an Israeli mental health service, and thus approaches the history of psychiatry in the mandate period not on its own terms but rather as subsumed within this bigger national story.

12

13

of Istanbul”: Dr Luigi Mongeri (1815–82) and the Birth of Modern Psychiatry in the Ottoman Empire’, History of Psychiatry 29, 4 (2018), pp. 424–5; Joelle Abi-Rached, ʿAsfūriyyeh: A History of Madness, Modernity, and War in the Middle East (Cambridge, _ MIT Press, 2020); Beverly A. Tsacoyianis, Disturbing Spirits: Mental Health, MA: Trauma, and Treatment in Modern Syria and Lebanon (Notre Dame: Notre Dame Press, 2021); Lamia Moghnieh, ‘The Broken Promise of Institutional Psychiatry: Sexuality, Women and Mental Illness in 1950s Lebanon’, Culture, Medicine, and Psychiatry 47, 1 (2023), pp. 82–98. The history of psychoanalysis has received much attention in its own right: Cyrus Schayegh, Who Is Knowledgeable Is Strong: Science, Class, and the Formation of Modern Iranian Society, 1900–1950 (Oakland: University of California Press, 2009); Omnia El Shakry, The Arabic Freud: Psychoanalysis and Islam in Modern Egypt (Princeton, NJ: Princeton University Press, 2017); Kutluğhan Soyubol, ‘Turkey Psychoanalyzed, Psychoanalysis Turkified: The Case of İzzettin Şadan’, Comparative Studies of South Asia, Africa and the Middle East 38, 1 (2018), pp. 57–72. The work of Rakefet Zalashik is exemplary in this respect. See, in particular, Rakefet Zalashik, Ad Nefesh: Immigrants, Olim, Refugees, and the Psychiatric Establishment in Israel (Tel Aviv: Ha-Kibbutz ha-Me’uhad, 2008) [in Hebrew]; Rakefet Zalashik, Das Unselige Erbe: Die Geschichte der Psychiatrie in Palästina und Israel (Frankfurt am Main: Campus Verlag, 2012) [in German]; Rakefet Zalashik and Nadav Davidovitch, ‘Professional Identity across the Borders: Refugee Psychiatrists in Palestine, 1933–1945’, Social History of Medicine 22, 3 (2009), pp. 569–87. Marcella Simoni, ‘A Dangerous Legacy: Welfare in British Palestine, 1930–1939’, Jewish History 13, 2 (1999), pp. 81–109; Marcella Simoni, ‘At the Roots of Division: A New Perspective on Arabs and Jews, 1930–39’, Middle Eastern Studies 36, 3 (2000), pp. 52–92.

10

Introduction

Mandatory Madness does not seek to underplay the significance of private Jewish provision: it is an undeniably important dimension of this history and indeed distinguishes Palestine from other colonial contexts. For most of the mandate period, private Jewish provision not merely rivalled but outstripped government provision both in terms of its bedstrength and the kinds of treatment available. Across Palestine’s major cities with significant Jewish populations – cities like Jerusalem, Jaffa, Tel Aviv, and Haifa – private psychiatric institutions proliferated, especially after 1933, when the Nazis came to power in Germany and precipitated the flight of large numbers of European Jewish psychiatrists to, among other destinations, Palestine. Private Jewish provision predated the mandate’s own efforts in this field, too: the earliest institution to tend to the ‘insane’, the Ezrath Nashim home in Jerusalem, opened its doors for the first time in the 1890s, when the Ottomans still ruled. Ignoring this history to focus exclusively on the mandate’s provision, or on Palestinian engagements with mental illness, would not only be impossible, but produce an equally partial understanding of the period. By adopting a more capacious approach to what the history of psychiatry entails, focussed less on psychiatric institutions and experts than interactions, Mandatory Madness brings the mandate government, the Yishuv, and Palestinians together into a single analytic frame instead. The last two terms appear – like the better-known pairing of Arab and Jew – to denote two mutually exclusive groupings. Yet while their use may be unavoidable, not least as categories adopted by actors at the time, it is important to clarify that these are not neutral or unproblematic descriptions. The position of Palestine’s Sephardi or Mizrachi (‘eastern’) Jews brings this sharply into focus. Former Ottoman subjects, they spoke Arabic with their Muslim and Christian neighbours and were deeply divided on the subject of Zionism, with some joining anti-Zionist protests in the early years of British rule. For their part, European Jewish émigrés were also ambivalent about their ‘backwards’, ‘native’ co-religionists. Yet over time, both as a result of the evolution of a set of Zionist parastatal institutions that claimed, with the mandate’s blessing, responsibility for all of Palestine’s Jewish population, and as a consequence of the failure of Arab nationalists to maintain a clear distinction between Zionism and Jews more generally, these categories did come to form an oppositionary binary. As Ella Shohat puts it, ‘[f]or the first time in Sephardi history, Arabness and Jewishness were posed as antonyms’.14 Rather than 14

Ella Shohat, ‘Sephardim in Israel: Zionism from the Standpoint of Its Jewish Victims’, Social Text 19/20 (1988), p. 11. See also Michelle U. Campos, ‘Between “Beloved Ottomania” and “The Land of Israel”: The Struggle over Ottomanism and Zionism

Re-Entangling the Histories of Mandate Palestine

11

straightforward descriptions, the terms Arab and Jew, Yishuv and Palestinians, should be treated as denoting protean, contested, and at times overlapping groupings, though in this book I have tried, either through context or through additional qualifiers, to clarify my own usage as far as possible, and, more than this, to highlight how encounters around mental illness at times worked to reinforce and at others served to undermine the hardening boundaries between these categories. Attending to how mandate officials, European Jewish émigrés, and Palestinian Arabs – Muslim, Christian, and Jewish – engaged with the question of mental illness challenges existing accounts on two key points. In the first place, a shared lens of analysis reveals that government and private provision for the mentally ill, rather than forming separate and parallel systems, were inextricably entangled; the history of one simply cannot be understood in isolation from the other. European Jewish psychiatrists, including those who ran their own private clinics, appeared before the mandate’s courts, testifying to the mental capacity of defendants; they were appointed to inspect and report on criminal lunatic wards; they offered an interpretation of the returns of the ‘insane’ population in the 1931 census. In turn, the mandate government – while attempting in general to avoid assuming responsibility for private institutions – stepped in when these institutions stumbled and their patient populations threatened to spill out onto the streets, either with an offer of subsidies and a demand for reform, or by expanding their own provision. This dynamic, indeed, can be seen as driving the history of the mandate government’s provision. In 1922, when the first government mental hospital opened outside Bethlehem, it did so in part to relieve the beleaguered Ezrath Nashim institution; in 1932, a second government mental hospital was established, again outside Bethlehem, for much the same reason; and in 1944, a third and final such government hospital, this time near Jaffa, opened and immediately took in all the patients at a nearby private mental institution teetering on the brink of collapse. Knitting these systems together at another level still, patients continuously circulated between private and government hospitals, especially as the costs of private treatment mounted and families turned to government institutions for financial respite. From the vantage point offered by psychiatric provision, colonial and Zionist state-building projects in Palestine appear among Palestine’s Sephardi Jews, 1908–13’, International Journal of Middle East Studies 37 (2005), pp. 461–83; Dafna Hirsch, ‘“We Are Here to Bring the West, Not Only to Ourselves”: Zionist Occidentalism and the Discourse of Hygiene in Mandate Palestine’, International Journal of Middle East Studies 41, 4 (2009), pp. 577–94; Salim Tamari, ‘Ishaq al-Shami and the Predicament of the Arab Jew in Palestine’, Jerusalem Quarterly 21 (2004), pp. 10–26.

12

Introduction

as enmeshed and often mutually reinforcing, rather than wholly distinct, enterprises.15 A second way in which Mandatory Madness departs from existing framings of the history of psychiatry in mandate Palestine is by moving beyond an exclusive focus on the mandate and the Yishuv, above all by writing Palestinians back into this story. Like Zmurud, who mobilised both her community and the government when mental illness intruded on her family’s life, Palestinians – Muslim, Christian, and Jewish – participated actively in the making of this history in myriad ways. They acted as petitioners seeking succour for their relatives, and as plaintiffs, defendants, and witnesses in criminal insanity trials. They were also the doctors, nurses, and hospital attendants whose labour allowed government mental institutions to function and who worked – frequently in the face of indifference on the part of their employer, the mandate’s department of health – to cultivate psychiatric expertise. But writing Palestinians back into this history also dramatically refigures its parameters, by provincialising psychiatry and its medicalised offerings of cure or confinement. The therapeutic trajectories Palestinian families charted for their relatives exceeded both the psychiatric hospital and the colonial archive, as they pursued – often simultaneously – medical and nonmedical options alike, in ways which trouble any sharp distinction between the modern and the premodern or the secular and the sacred. And even within the walls of the mental hospital, Palestinian patients might carry with them contrapuntal understandings of their experiences, transforming this site into a space animated, fractured, even haunted by dissonant registers: the psychiatric, the otherworldly, the somatic, the political. As well as recovering the agency of Palestinians, zooming out from the mandate and the Yishuv reveals the importance of both regional connections and Ottoman legacies to this history. Palestine is often represented as exceptional, not least as the only case in which the League of Nations’ Permanent Mandates Commission endorsed settler colonialism by incorporating the Balfour Declaration, with its commitment of British support for ‘a national home for the Jewish people’, into the mandate text.16 Without eliding all of Palestine’s stubborn specificities, widening the camera lens can bring into view how the history of mandatory

15 16

For similar dynamics in other areas, see Norris, Land of Progress, and Meiton, Electrical Palestine. See below. Susan Pedersen, ‘Settler Colonialism at the Bar of the League of Nations’, in Caroline Elkins and Susan Pedersen, eds., Settler Colonialism in the Twentieth Century: Projects, Practices, Legacies (London: Routledge, 2005), pp. 124–9.

Re-Entangling the Histories of Mandate Palestine

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psychiatry was embedded in the larger regional context. Palestinians travelled for treatment at the Lebanon Hospital for Mental Diseases at Beirut before and after the post-war partition of the region, and the vast majority of aspiring doctors in mandate Palestine had little choice but to make similar journeys north for medical training at the American University of Beirut, as their late Ottoman predecessors had done. And it was not only European Jewish émigrés who pipped the British to the post by transplanting psychiatry to Palestine before the First World War; knowledge of the psy-sciences was already independently circulating across Ottoman Arab territories through scientific journals like alMuqtataf from the last decades of the nineteenth century onwards.17 Their expectations primed by a long visual and literary tradition of representing Palestine as a timeless, biblical ‘Holy Land’,18 the British may have arrived imagining that in Palestine, as elsewhere in the colonised world, they would discover a population for whom psychiatry was a novelty and mental illness – commonly understood as an unfortunate byproduct of industrial modernity19 – a rarity. As it turned out, however, many of their newly acquired subjects were less psychiatrically naı¨ve than the British had fantasised, and came to demand more from their new rulers than the miserly sum set aside for health in the mandate’s budgets allowed. Taken together, recognition of the interdependency of government and private provision, on the one hand, and of Palestinian psychiatric agency, on the other, warns against assuming too sharp a break between the histories of Arabs and Jews in this period. Far from remaining within the closed circuit of government provision, at least some Palestinians sought treatment for relatives in private Jewish institutions, as well as beyond the borders of the mandate. And large numbers of European Jewish patients were admitted to government mental hospitals, to be treated by Arab doctors and nurses alongside Arab patients. By the end of the mandate period, certainly, the history of psychiatry had been partitioned, along with historic Palestine, as psychiatric patient populations were reordered down ethno-religious lines and government mental institutions were parcelled out between Israel and Jordan. But across the preceding decades, entanglement rather than separation characterised 17 18

19

Abi-Rached, ʿAsfuriyyeh, pp. 39–46. For the history of English representations of Palestine as a ‘Holy Land’, see Eitan BarYosef, The Holy Land in English Culture, 1799–1917: Palestine and the Question of Orientalism (Oxford: Clarendon Press, 2005). A link asserted internationally by the late nineteenth and early twentieth centuries: see for instance Andrea Killen, Berlin Electropolis: Shock, Nerves and German Modernity (Berkeley: University of California Press, 2006).

14

Introduction

this history, and even after 1948, not all these ties were immediately or fully shredded. In the 1990s, in an attempt to break out of a pattern within the historiography of attending exclusively to either the Arab or Jewish ‘side’ of this story, labour historians pioneered a ‘relational’ approach to the period, which emphasised the mutually constitutive nature of these histories, and put the interactions between them front and centre.20 But it is not only in the field of labour history that such an approach is possible. Reconstructing and tracking the interactions generated by mental illness uncovers a new relational history of Palestine, in which Arabs, Jews, and indeed the British mandate seldom negotiated the question of mental illness in isolation from one another.

A History of Psychiatry without Case Files In Emile Habibi’s satirical classic The Secret Life of Saeed: The Pessoptimist, the narrator is sent ‘strange letters’ which relate the surreal life of the eponymous anti-hero, a Palestinian refugee who ends up acting as an Israeli informant after 1948. Towards the end of the novel, the narrator tracks down the author of these letters first to Acre, and then to the mental hospital housed in the same building that had served as a notorious prison during the mandate period. After expressing astonishment to the hospital’s staff that a shrine to those executed by the British on the site commemorates only members of a Jewish paramilitary organisation, and not the Arabs whom they hanged as well, the unnamed narrator attempts to discover who the mysterious Saeed might really be. Together, they search the hospital’s records, trying to discover Saeed in among all the patients admitted since the founding of the state, but are unable to find anyone with that name. They then look for similar names, and ‘find one that looked suspicious’: Saadi. But that is all the hospital’s records yield; the only additional information the narrator is able to glean from the hospital staff about his elusive correspondent is that a woman had recently visited the hospital from Beirut to ask after him – and that he had died the year earlier.21 The archival trail has gone cold. 20

21

Gershon Shafir, Land, Labour, and the Origins of the Israeli-Palestinian Conflict, 1882–1914 (Cambridge: Cambridge University Press, 1989); Zachary Lockman, ‘Railway Workers and Relational History: Arabs and Jews in British-Ruled Palestine’, Comparative Studies in Society and History 35, 3 (1993), pp. 601–27; Zachary Lockman, Comrades and Enemies: Arab and Jewish Workers in Palestine, 1906–1948 (Berkeley: University of California Press, 1996); Deborah Bernstein, Constructing Boundaries: Jewish and Arab Workers in Mandatory Palestine (Albany: SUNY Press, 2000). Emile Habibi, The Secret Life of Saeed: The Pessoptimist [1974], trans. Salma Jayyusi and Trevor Le Gassick (London: Arabia Books, 2010), pp. 161–2.

A History of Psychiatry without Case Files

15

For historians, as for Habibi’s narrator, the search for patients among the records of the mandate period can be a frustrating one. Zmurud’s story is a case in point. Although she had been reassured by the mandate government that her husband Nassif would be admitted as soon as a bed in the mental hospital at Jaffa became available, I have been unable to find any document in the colonial archive which would allow us to ascertain when – or if – this ultimately took place, let alone a case file with which to continue this story. In this respect, Nassif’s case is typical. With the notable exception of files relating to criminal lunatics, patient case files do not appear to have survived. They are not to be found among the many other records of the mandate’s department of health held by the Israel State Archives today. Nor are any records on site in Bethlehem at what was at the time the first government mental hospital, and which has continued since 1948 to operate as a psychiatric hospital under first Jordanian rule and, after 1967, Israeli occupation.22 Alongside the limited survival of patient case files in the archive, historians must contend with a decidedly uneven body of published material. While European Jewish psychiatrists and other experts published research based on their clinical experiences in private institutions in Palestine, no parallel set of publications about mental illness was produced in this period by the Arab doctors who made up the majority of the staff of the mandate’s department of health. These lacunae and imbalances in the kinds of sources which have been the anchors of most institutional and intellectual histories of psychiatry are in part responsible for the existing scholarship’s portrayal of this history, as one in which European Jewish psychiatrists are the principal actors, the mandate government a bit player, and Palestinians off-stage entirely. In the absence of these conventional sources, historians appear to have concluded that the history of psychiatry in mandate Palestine is itself non-existent and have focussed their attention on the Yishuv instead. Just as historians of decolonisation in the region have innovated methodologically when faced with inaccessible or absent archives,23 so too does Mandatory Madness contend that embracing a less conventional, more eclectic body of sources – even from within the colonial archive – can uncover an expansive, ultimately richer history of psychiatry in mandate Palestine. Rather than treat the limited survival of case files and the uneven publication of psychiatric research simply as an obstacle to recovering 22 23

Private correspondence with Dr Issam Bannoura, director of the Bethlehem psychiatric hospital, 21 December 2017. Omnia El Shakry, ‘History without Documents: The Vexed Archives of Decolonization in the Middle East’, American Historical Review 120, 3 (2015), pp. 920–34.

16

Introduction

this history, or as evidence of its absence, accounting for this archival state of affairs can also be itself revealing. The asymmetry in research publications, for instance, is an important reminder that bringing the mandate, the Yishuv, and Palestinians into the same frame of analysis should not obscure their stark differences, or imply an equivalency. The first was a colonial state, sanctified in international law under the cover of a different name but able to marshal troops and resources from across the British empire in moments of need. The second was welded across this period into a state-in-waiting, complete with its own self-governing institutions, by a highly organised political nationalist movement and with the recognition and practical support of the mandate. Meanwhile the third was an indigenous population who had been colonised in the wake of profound wartime political and social dislocation and whose political rights were never, in spite of their tireless efforts to organise, afforded international recognition. These and other differences crucially shaped the conditions within which psychiatric and medical expertise was cultivated and validated. Put simply, while European Jewish psychiatrists and other specialists working in private institutions had the freedom to select clinically interesting patients, trial new methods of treatment, and publish their findings, the department of health – the most important though not the sole employer for Palestinian Arab doctors across the period – invested little in developing Palestinian psychiatric expertise, instead abetting conditions of work at government mental institutions that restricted opportunities for research or any other kind of specialist development. The lack of psychiatric research published by those employed in the mandate’s department of health marks Palestine out from other colonial contexts. While ambitious French and, to a lesser extent, British psychiatrists often found in the colonies a laboratory that they could use to push the limits of the field, establish their reputations, and ultimately return to the metropolitan medical stage feted as pioneers,24 Palestine was different. It sat in contrast to medical services elsewhere in the British empire, where western-trained doctors drawn from the colonised population only gradually replaced Europeans in the interwar decades in India, or the post–Second World War decades across much of subSaharan Africa.25 Instead, from the start the majority of the employees 24

25

McCulloch, Colonial Psychiatry; Keller, Colonial Madness. For colonies as laboratories of modernity generally, see: Paul Rabinow, French Modern: Norms and Forms of the Social Environment (Cambridge, MA: MIT Press, 1989); Gwendolyn Wright, The Politics of Design in French Colonial Urbanism (Chicago: University of Chicago Press, 1991). Waltraud Ernst, ‘The Indianization of Colonial Medicine: The Case of Psychiatry in Early-Twentieth-Century British India’, NTM Zeitschrift für Geschichte der Wissenschaften, Technik und Medizin 20 (2012), pp. 61–89; Yolana Pringle, Psychiatry and Decolonisation in Uganda (Basingstoke: Palgrave Macmillan, 2018), pp. 59–92.

A History of Psychiatry without Case Files

17

of the department of health were former Ottoman subjects who had received medical training in Beirut, Istanbul, Damascus, and Cairo26 – though across this period the highest ranks in the department were filled exclusively by Europeans. Allocated a paltry 4 per cent of government expenditure most years, the health department prioritised tackling infectious diseases – above all malaria – over providing hospital care,27 and certainly over nurturing psychiatric expertise. This is made clearest by the career of the doctor who was in charge of the government’s only mental hospitals for most of the period, Dr Mikhail Shedid Malouf. Malouf – a central, albeit elusive, character in this book – started out working as an ophthalmologist, before being given responsibility for the first government mental hospital in 1925. Rather than receiving support from the government to develop his expertise by, for instance, taking specialist training abroad, he appears to have had to learn on the job. Whether as a result of a lack of formal qualifications or simply time, he never drew on his extensive clinical experience to publish, and so, besides a handful of reports produced for the government and the occasional interview, frustratingly little exists by way of his writing. This situation did not change even in the 1940s, when Palestinian Arab doctors working in the department of health, voluntary clinics, and mission hospitals came together to form the Palestine Arab Medical Association and launched their own Arabic-language medical journal in 1945. In spite of their enthusiastic support for the cultivation of specialist knowledge, psychiatry was not on their radar. It never featured, for instance, among the articles published by Palestinian doctors in the association’s journal, where the focus – as for the health department – was on either infectious diseases like malaria or infant and maternal health.28 26

27

28

Liat Kozma and Yoni Furas, ‘Palestinian Doctors under the British Mandate: The Formation of a Profession’, International Journal of Middle East Studies 52 (2020), pp. 87–108. In this respect, there were parallels with British mandate Iraq, though this formally ended in 1932. See Omar Dewachi, Ungovernable Life: Mandatory Medicine and Statecraft in Iraq (Stanford, CA: Stanford University Press, 2017), pp. 48–53. See Sandy Sufian, ‘Arab Health Care during the British Mandate, 1920–1947’, in T. Barnea and R. Husseini, eds., Separate and Cooperate, Cooperate and Separate: The Disengagement of the Palestine Health Care Service from Israel and Its Emergence as an Independent System (London: Praeger, 2002), p. 14. Miserly health budgets were not unique to mandate Palestine, with colonial states generally budgeting little for health and husbanding those scant resources for use in ‘colonial enclaves’ and in combating epidemic disease. For two classic studies, see Vaughan, Curing Their Ills; and David Arnold, Colonizing the Body: State, Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: University of California Press, 1993). In part, the attention to malaria was also in order to refute Zionist claims about their own efforts in this area. See Sandra Sufian, Healing the Land and the Nation: Malaria and the Zionist Project in Palestine, 1920–1947 (Chicago: University of Chicago Press, 2007), pp. 319–27.

18

Introduction

The picture was very different for European Jewish psychiatrists and other medical doctors in Palestine. While some were employed by the department of health, the large number of doctors arriving from Europe to Palestine from 1933 onwards meant that out of both necessity and desire, many more practised privately – if they were lucky, that is, and were not forced into other forms of work entirely.29 Already by 1920, the growing community of European Jewish doctors in Palestine had established a Hebrew-language medical journal, Harefuah, which did – by contrast to the journal of the Palestine Arab Medical Association – publish a number of articles on psychiatry, particularly in the 1940s as new forms of treatment like electro-convulsive therapy were introduced in private Jewish mental institutions. In this respect, European Jewish psychiatrists resemble settler colonial scientists elsewhere, who took advantage of what Richard Keller has called the ‘unique opportunities for experimentation and innovation’ offered by settler colonies like French Algeria.30 A well-established body of scholarship approaches Zionism as a settler colonial movement,31 but this framing can obscure as well as illuminate. Harefuah, as Sandra Sufian has noted, was one strand in the larger project of evolving a distinctively Hebrew medicine, complete with its own Hebrew medical dictionary.32 This knowledge production was thus less aimed at international audiences, with a view to securing glittering careers elsewhere, than at a national constituency, itself under construction at the time – marking a point of distinction between psychiatric research in Palestine and in other settler colonial contexts in the same period. If reflecting on the unevenness of published research can reveal something about expertise and the conditions under which it was enabled or constrained, patient case files – the other archival mainstay of histories of psychiatry – raise different issues. Except in relation to ‘criminal lunatics’, who were institutionalised in prison lunatic wards and who were 29 30 31

32

As Rakefet Zalashik notes, this had become the subject of popular jokes in Tel Aviv by the second half of the 1930s. See Zalashik, Das Unselige Erbe, pp. 64–5. Keller, Colonial Madness, p. 6. For an important collection on Zionism as a settler colonial project, see the 2012 special issue of Settler Colonial Studies, introduced in Omar Jabary Salamanca, Mezna Qato, Kareem Rabie, and Sobhi Samour, ‘Past Is Present: Settler Colonialism in Palestine’, Settler Colonial Studies 2, 1 (2012), pp. 1–8. Analysis of Zionism as a settler colonial movement stretches back at least to the 1980s: see Baruch Kimmerling, Zionism and Territory: The Socio-territorial Dimensions of Zionist Politics (Berkeley: University of California Press, 1983); and Shafir, Land, Labor, and the Origins. See Sandra Sufian, ‘Defining National Medical Borders: Medical Terminology and the Making of Hebrew Medicine’, in S. Sufian and M. LeVine, eds., Reapproaching Borders: New Perspectives on the Study of Israel-Palestine (Lanham, MD: Rowman & Littlefield, 2007), pp. 97–120.

A History of Psychiatry without Case Files

19

necessarily the subjects of scrutiny and correspondence by multiple government branches, patient case files do not survive, whether destroyed as a result of routine bureaucratic practices or any number of upheavals across the past century. But even those case files which do survive, for so-called criminal lunatics, can frustrate as well as illuminate, and their use requires careful methodological as well as ethical deliberation. An example that illustrates some of these issues is the relatively chunky file relating to Abraham P. Although judged a criminal lunatic by the courts, Abraham had been admitted to the government mental hospital at Bethlehem in 1926, rather than one of the mandate’s prisons, where the majority of criminal lunatics were detained. Most documents in his file are short summaries of the findings of a medical board which convened each year to examine his health and chart any improvement in his condition. Interlaced with these, albeit with decreasing frequency as the years dragged on, is correspondence from his wife, Haya, communicating through a lawyer. In 1929, for instance, she wrote to request that her husband be examined, in the hope he would be deemed fit for discharge. But the examining board found him to be ‘dull, apathetic, slow in speech, slightly negativistic’; he ‘[s]till believes that at times the hospital food is either adulterated or poisoned’; and, when asked why he went to the toilet up to twenty times a day, he told them, ‘I don’t know but I was forced by certain internal ideas or impulses to go there.’33 He was not recommended for release. Haya visited the hospital, and in another letter through her lawyer in February 1930, claimed she had been told that her husband would be released in the next few months.34 But this turned out not to be accurate. The medical officer in charge of the hospital, Dr Malouf, reported that, far from improving, Abraham’s condition ‘is tending to deteriorate and that it is unlikely to improve in the near future’.35 Over the next fourteen years, a medical board was convened annually to examine Abraham; each time, they found him to be not fit for discharge from the hospital, having failed to improve. When he arrived in the government mental hospital in 1926, he was around thirty years old; by the time of the final entry in his file, when he was examined in February 1944, he would have been nearly fifty.36 Abraham’s file is in many ways rich in the kinds of details that historians of psychiatry have productively used in their research. We learn 33 34 35 36

Record of Proceedings of Medical Board, 21 May 1929, ISA M 337/29. Abraham Weinshall, Haifa, to Chief Secretary, 3 February 1930, ISA M 337/29. Director of Health to Chief Secretary, 1 March 1930, ISA M 337/29. Director of Medical Services to Chief Secretary, 16 February 1944, ISA M 337/29.

20

Introduction

about his particular fear of being poisoned; we get a sense of his wife Haya’s struggle to have him released, in a striking counterpoint to Zmurud’s equally determined efforts to have her husband admitted; we are even tantalised with the prospect of hearing him speak, as his explanation for his behaviour is given in quotes in the report. But his file is also riddled with issues. It only starts in 1929, but we know he was in the hospital from 1926; it ends in 1944, but we do not learn whether he was released or died, if indeed this represents the end of his time in the institution at all rather than an accident of record-keeping or archival survival. Like so many similar files in the archive, his file is bookended by mysteries. Reading his file, we never learn why or on what charge Abraham had been detained as a criminal lunatic in the first place; indeed, in spite of the length of the file – over fifty pages – we learn remarkably little about Abraham at all across the two decades he spent within the government mental hospital, beyond whether his condition was judged to have improved or not on a year-by-year basis, a stark reminder that these files were produced through set processes for a particular purpose. But Abraham’s file also raises questions around contemporary archival practice and the ethics of doing this historical research, too. At least when I first accessed his file, his full name was left unredacted. While this is not in itself unusual or problematic, the Israel State Archives – which holds the vast majority of records produced by the mandate government37 – also did not ask researchers accessing this file to sign the kind of agreement promising to respect patient anonymity which other archives holding sensitive medical records make a requirement for access; instead, this and many other medical and health files were made freely available to all online in an unredacted form. It is my decision, then, informed by reflections on the ethical as well as methodological challenges of working with such sources,38 particularly where unfettered access to these sensitive patient records might perpetuate the extreme vulnerability of the subjects of colonial psychiatry into the present,39 to give only Abraham’s first name and an initial – a practice I repeat for every patient encountered in Mandatory Madness, as well as for close family members like Zmurud – in order to preserve a degree of anonymity. 37 38

39

For the background to this, see Lauren Banko, ‘Occupational Hazards, Revisited: Palestinian Historiography’, Middle East Journal 66, 3 (2012), pp. 448–50. For a useful review of practice, see David Wright and Renée Saucier, ‘Madness in the Archives: Anonymity, Ethics, and Mental Health History Research’, Journal of the Canadian Historical Association 23, 2 (2012), pp. 65–90. Claire Edington, ‘Beyond the Asylum: Colonial Psychiatry in French Indochina, 1880–1940’ (PhD diss., University of Columbia, 2013), p. 27.

Psychiatry and Politics in Mandate Palestine

21

Rather than approach the absence of patient case files and the uneven corpus of published research as an obstacle, then, Mandatory Madness reads these lacunae and asymmetries for what they can reveal of the history of mental illness in mandate Palestine. But it does not remain fixated on these sources as the sole foundations of any history of psychiatry. Instead, it turns to a range of archival and published sources, from census reports, court records, and folklore research, to English-, Hebrew-, and Arabic-language newspapers, memoirs by police officers, and petitions from Palestinian families. While a careful reading of these and other sources – including budgets, disciplinary proceedings, and architectural plans – can shine a light on the inner workings of mental institutions otherwise left dark by a dearth of patient case files, drawing on this more eclectic mix of sources is generative rather than only substitutionary. These sources embody and make possible the more expansive social history of psychiatry in Palestine which is at this book’s core. They take us outside the walls of the institution and delineate a history of mental illness that takes place across encounters in the courtroom, the prison, the home, and the street as much as the hospital. They take us beyond the mandate’s borders, too, to those sites outside Palestine that nonetheless played key roles in this history, whether as alternative options for psychiatric treatment, centres for training, or models to be emulated: the Lebanon Hospital for Mental Diseases outside Beirut is the most important example of all three. In recent decades, historians of colonial psychiatry have produced rich, compelling portraits of particular institutions and colonial contexts, but – with notable exceptions40 – have paused at the hospital’s boundaries or the colony’s limits. Broadening out what counts as the archive of colonial psychiatry and mental illness not only makes it clear that mandate Palestine most certainly has a story to be told, but it also shifts the centre of gravity within this story, placing interactions and entanglements across as well as within borders at the heart of the action. Psychiatry and Politics in Mandate Palestine Since the early 2000s, Palestinian researchers, practitioners, and activists have been at the forefront of critiques of the potentially depoliticising 40

Claire Edington and Hans Pols, ‘Building Psychiatric Expertise across Southeast Asia: Study Trips, Site Visits, and Therapeutic Labour in French Indochina and the Dutch East Indies, 1898–1937’, Comparative Studies in Society and History 58, 3 (2016), pp. 636–63; and Matthew Heaton, Black Skin, White Coats: Nigerian Psychiatrists, Decolonization, and the Globalization of Psychiatry (Athens: Ohio University Press, 2013), pp. 79–103.

22

Introduction

effects of psychiatric diagnoses like post-traumatic stress disorder, which threaten to reduce pain and suffering to an individual pathology by ignoring the political as well as social determinants of health.41 While this body of work makes a powerful argument for the need to reckon with the impact of political events and structures on mental and emotional health, and reframe responses to trauma to include demands for justice, linking together politics and mental health remains a difficult undertaking for historians.42 This is not least because it raises a thorny issue of retrospective diagnosis, which most are loath to stretch their source base to attempt. One approach historians have found more comfortable as well as productive has been attending to the political commitments and effects of psychiatrists producing knowledge within colonial contexts. At one end, much attention has been given to figures like the ethnopsychiatrist J. C. Carothers, commissioned by the Kenyan government during its brutal suppression of the anti-colonial Mau Mau revolt in the 1950s to provide a psychological explanation of the uprising, an explanation which placed more emphasis on the mal-adaptation of the colonised subject than on dispossession and political disenfranchisement.43 At the other end of the political spectrum, Frantz Fanon famously laid the blame for mental disorders in Algeria’s war of independence squarely at the feet of the French: it was colonialism, ‘a fertile purveyor for psychiatric hospitals’, which drove the colonised subject mad.44 Mandate Palestine produced neither a Carothers nor a Fanon. As we have seen, those working within the mandate’s mental institutions did not publish much at all, whether for specialists or wider audiences. They did not, by contrast to Palestinian mental health practitioners today, draw on their expertise or clinical experience to diagnose the pathologies of occupation.45 And even among those European Jewish psychiatrists who published both internationally as well as in Harefuah, any engagement with political questions took place at a different register. Rather 41

42

43 44

45

For a review of this literature by one of its most prolific contributors, see Rita Giacaman, ‘Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside”’, Journal of Palestine Studies 47, 2 (2018), pp. 9–27. For an exceptional case, see Ruba Salih, ‘Scars of the Mind: Trauma, Gender, and Counter-Memories of the Nakba’, in Diana Allan, ed., Voices of the Nakba: A Living History of Palestine (London: Pluto Press, 2021), pp. 255–75. J. C. Carothers, Psychology of Mau Mau (Nairobi: Government Printer, 1954). For Carothers, see McCulloch, Colonial Psychiatry, pp. 64–76. Frantz Fanon, The Wretched of the Earth [1961] (London: Penguin Classics, 2001), p. 200. For the ‘unstable’ political valency of the psy-sciences, see in particular Linstrum, Ruling Minds. The work of psychiatrist and psychotherapist Dr Samah Jabr, head of Palestine’s Mental Health Unit, is exemplary. See Samah Jabr, ‘Palestinian Barriers to Healing Traumatic Wounds’, Middle East Monitor (20 August 2019).

Psychiatry and Politics in Mandate Palestine

23

than deploy the psy-sciences to legitimise or critique British rule, a more pressing political question for this group, as Sandra Sufian has demonstrated, was understanding what high rates of mental illness among Jews in Palestine meant for the Zionist promise that aliya or immigration to Palestine would redeem the mentally, as well as physically, ‘degenerate’ Diaspora Jew.46 The relationship between psychiatry and politics in mandate Palestine, then, might appear to be less direct than in other contexts. But it is nonetheless important. In the first place, although psychiatric experts themselves were not mobilised either for or against the mandate, psychiatric modes of thinking were taken up into politics anyway. As Sloan Mahone highlights, it was not only medical experts who understood and sought to realise the political possibilities offered by the psy-sciences in the early twentieth-century colonial world.47 In Palestine, too, ideas of irresponsibility drawn from the social sciences as well as the sciences of the mind seeded themselves in the prose of counter-insurgency produced by officials assigned the task of explaining ‘disturbances’ over the mandate’s three-decade span. And the single most significant example of mental illness being put to work to reinforce the logic of colonial rule came from the pen not of a psychiatrist nor even a medical doctor, but rather a mathematician: the superintendent of the 1931 census. In the census, enumerators were tasked with recording rates of ‘insanity’ alongside other kinds of infirmity in the population. Yet another kind of psychiatric encounter ensued, this time between enumerator and enumerated, at the doorway of the home. The census superintendent mobilised the returns of the ‘insane’ population produced through these encounters to argue that Palestine’s three putative communities perched on distinct rungs in the ascent to modernity: the Muslim population farthest from modernity, the Christian population somewhere in the middle, and the Jewish population the closest and thus the best qualified to support British developmentalist ambitions in the country.48

46

47 48

Sandy Sufian, ‘Mental Hygiene and Disability in the Zionist Project’, Disability Studies Quarterly 27, 4 (2007); and Tammy Razi, ‘Immigration and Its Discontents: Treating Children in the Psycho-Hygiene Clinic in Mandate Tel Aviv’, Journal of Modern Jewish Studies 11, 3 (2012), pp. 339–56. For an overview of ‘degeneration’ in relation to the Jewish diaspora, see Todd Samuel Presner, ‘Generation, Degeneration, and Regeneration: Health, Disease, and the Jewish Body’, in Mitchell B. Hart and Tony Michels, eds., The Cambridge History of Judaism (Cambridge: Cambridge University Press, 2017), pp. 559–88. Sloan Mahone, ‘The Psychology of Rebellion: Colonial Medical Responses to Dissent in British East Africa’, Journal of African History 47, 2 (2006), pp. 241–58. Norris, Land of Progress, p. 66.

24

Introduction

Psychiatric encounters speak to the political history of the period in other, sometimes surprising ways, too. During the great Palestinian revolt that rocked the foundations of British rule across the late 1930s, for instance, petitions reveal that even as relations between the mandate and its Palestinian subjects reached a nadir, families continued to write to the government to request that it step in and relieve them of responsibility for caring for mentally ill relatives. At the same time, against a backdrop of the criminalisation of nationalism and the targeting of the conditions of everyday life as part of British counter-insurgency strategy,49 courts struggled to determine what was pathological in criminal insanity cases: was it defendants’ behaviour, or the wider context of violence in which they found themselves? Precisely because the intersections between psychiatry and politics were often indirect, the rest of this section provides an outline of the political history of this period by way of orientation. Before the First World War, Palestine was ruled by the Ottomans for centuries, though not as a single administrative unit: Acre and Nablus in the north were incorporated into a province centred on Beirut, and – as admissions data from the Lebanon Hospital for Mental Diseases suggest – not a few Palestinians continued to look to Beirut when seeking out treatment for relatives in the decades after the British and French partitioned the Levant. Palestine shared in many of the broader transformations of the late nineteenth- and early twentieth-century Ottoman empire.50 But there were also specificities at play here. The particular attention commanded by Palestine as a ‘Holy Land’, for one thing, made it – and Jerusalem above all – the site of notable investment by missionaries, resulting in a proliferation of schools, hospitals, and other institutions.51 The mandate owed multiple debts to these mission foundations: not only were many of the staff of the health department educated at mission schools, but the buildings which housed the first two government mental hospitals at Bethlehem had originally been constructed by mission organisations. 49

50 51

Matthew K. Kelly, The Crime of Nationalism: Britain, Palestine, and the Nation-Building on the Fringe of Empire (Berkeley: University of California Press, 2017); Charles Anderson, ‘The Suppression of the Great Revolt and the Destruction of Everyday Life in Palestine’, Jerusalem Quarterly 79 (2019), pp. 9–27. Salim Tamari, The Great War and the Remaking of Palestine (Berkeley: University of California Press, 2017). For an overview of medical activities, see Yaron Perry and Efraim Lev, Modern Medicine in the Holy Land: Pioneering British Medical Services in Late Ottoman Palestine (London: Tauris Academic Studies, 2007). See also Helen Murre-van den Berg, ed., New Faith in Ancient Lands: Western Missions in the Middle East in the Nineteenth and Early Twentieth Centuries (Leiden: Brill, 2006).

Psychiatry and Politics in Mandate Palestine

25

Alongside missionary efforts, of course, what also marked out Palestine as distinctive was its centrality to the Zionist movement. Zionism, a political movement cohering by the end of the nineteenth century around the idea of securing self-determination and escaping antiSemitism in Europe through the creation of a Jewish national home in Palestine, found concrete expression in these decades in the first two aliyot, that is, waves of migration by European Jews to Palestine.52 Beginning in the 1880s, and continuing up to the end of the mandate in 1948, aliyot profoundly reshaped Palestine’s demographics. In 1922, around a tenth of the total recorded population was Jewish;53 towards the end of the mandate, that proportion had risen to a third, from 84,000 to 554,000, a change driven largely by migration.54 Even before the dramatic leap in numbers across the 1930s and 1940s, European Jewish migrants were reshaping Ottoman Palestine in other ways: it was in the late Ottoman period that Tel Aviv, a new city to the north of historic Jaffa, started life. This was also a foundational period for the emergence of consciousness around a specifically Palestinian form of national identity, though this did not, as Michelle Campos has shown, preclude the simultaneous investment by Palestine’s Muslims, Christians, and Jews in other forms of identification, including as Ottoman citizens.55 With the Ottoman entry into the First World War, events were set in motion that would result in the British occupation of Jerusalem by the end of 1917 and the north of Palestine the year after; the establishment of an interim civil administration in 1920; and finally the confirmation of British rule in the novel configuration of a mandate of the League of Nations in 1922. The mandate system appeared to break with pre-war European imperialism by recognising only a mandatory power’s administrative control, rather than sovereignty, over territories seized during the war, and by specifying the intended outcome of this arrangement: selfrule, once a period of ‘tutelage’ had elapsed. Like other territories of the dismembered Ottoman empire shared out between the British and 52 53 54

55

For an account of Zionism’s development, see Shlomo Avineri, The Making of Modern Zionism: The Intellectual Origins of the Jewish State (New York: Basic Books, 1982). J. B. Barron, Palestine: Report and General Abstracts of the Census of 1922 (Jerusalem: Government of Palestine, 1923). Figures from A Survey of Palestine: Prepared in December 1945 and January 1946 for the Information of the Anglo-American Committee of Inquiry (Jerusalem: Government Printing, 1946). Michelle Campos, Ottoman Brothers: Muslims, Christians, and Jews in Early TwentiethCentury Palestine (Stanford, CA: Stanford University Press, 2011). For this period as pivotal in the formation of Palestinian identity, see Rashid Khalidi, Palestinian Identity: The Construction of Modern National Consciousness (New York: Columbia University Press, 1997).

26

Introduction

French, Palestine was classed as an ‘A’ mandate, that is, understood as having ‘reached a stage of development’ which warranted provisional recognition of its existence as an independent state, and which – it was envisaged – would mean a relatively short period of ‘advice and assistance’ by the mandatory power before it was judged ‘able to stand alone’.56 That Palestine was a mandate mattered. This was less to do with the generic architecture of the mandates system, which required mandatory powers to submit regular reports to representatives of different member states sitting on the Permanent Mandates Commission in Geneva, and which allowed mandatory subjects to petition the Commission over the head of the mandatory power – though a number of historians have shown that Palestinians made inventive use of these mechanisms.57 Nor, as Mandatory Madness demonstrates, was the mandate particularly consequential for the management of mental illness: more often than not, the mandate government took its cues from other points of reference – from other British colonies, particularly India and Egypt, and Ottoman legacies – rather than Geneva, and conformed to an empire-wide pattern of underinvestment in psychiatric provision. Where the mandate did, however, matter was in its incorporation of the text of the 1917 Balfour Declaration. This wartime declaration committed Britain to supporting the creation ‘in Palestine of a national home for the Jewish people’, on the condition that this should not ‘prejudice the civil and religious rights of existing non-Jewish communities’. In reducing the majority of Palestine’s population to ‘non-Jewish communities’ with civil and religious but not, crucially, political rights, it inaugurated a process of reordering as a result of which Palestinian Jews were split off from their Muslim and Christian neighbours, and ‘Arab’ and ‘Jew’ emerged as the ascendant and antagonistic categories into which the population of Palestine could ultimately be partitioned.58 With the text of the mandate committing the British state to facilitating Jewish immigration and settlement on the land,59 even before it was 56 57

58 59

§22 of the Covenant of the League of Nations (1920). See avalon.law.yale.edu/20th_ century/leagcov.asp. Natasha Wheatley, ‘Mandatory Interpretation: Legal Hermeneutics and the New International Order in Arab and Jewish Petitions to the League of Nations’, Past and Present 227, 1 (2015), pp. 205–48; Lauren Banko, ‘Claiming Identities in Palestine: Migration and Nationality under the Mandate’, Journal of Palestine Studies 46, 2 (2017), pp. 26–43; Nadim Bawalsa, ‘Legislating Exclusion: Palestinian Migrants and Interwar Citizenship’, Journal of Palestine Studies 46, 2 (2017), pp. 44–59. Seikaly, Men of Capital, pp. 4–6. §6 of the Mandate for Palestine (1922). See avalon.law.yale.edu/20th_century/palmanda .asp.

Psychiatry and Politics in Mandate Palestine

27

confirmed it had become a lightning rod for Palestinian opposition: riots against Zionism and British rule broke out in 1920 in Jerusalem, and the following year in Jaffa, too. The mandate also gave official recognition to the Zionist Organisation, founded at the end of the nineteenth century, as a public body that would advise and co-operate with the administration in the creation of a Jewish national home. Under the coordinating leadership of the Jewish Agency, as it became towards the end of the 1920s, a set of parastatal institutions evolved that went on to form the sinews of the State of Israel after 1948. This included the Vaad Leumi, the Jewish National Council, which organised its own health committee to coordinate the activities of two of the most important Zionist medical agencies: the Hadassah Medical Organisation, which was established in the United States on the eve of the First World War to promote health initiatives in Palestine, and the Kupat Holim, which provided medical insurance to workers in the Histadrut, the federation of Jewish workers in Palestine.60 In addition to this role, the Vaad Leumi’s health department – led across this period by Dr Avraham Katznelson – advised, berated, and negotiated with the mandate department of health, including around provision for the mentally ill. The colonial archive bulges with his correspondence, alternately excoriating the government’s failure to provide enough beds for psychiatric cases and intervening on behalf of Jewish families to request that their relatives be urgently admitted to government institutions for treatment. Denied similar recognition of their political rights, and boycotting elections for legislative institutions which the government tried to set up on the grounds that participation would require an acceptance of the terms of the mandate, Palestinian Arabs by contrast faced a much more challenging road to organising. By the 1930s, however, Palestinian nationalist politics had entered a new phase, with the formation of the Istiqlal (‘independence’) party, and the adoption of new strategies to mobilise workers and peasants to exert pressure on the British, including through strikes.61 Rumbling beneath these developments were profound socio-economic dislocations, as a crisis of Palestinian landlessness and impoverishment deepened, driven by Zionist land purchasing on the one hand, and the failure of the British to address agrarian taxation and indebtedness on the

60 61

For further detail, see Marcella Simoni, A Healthy Nation: Zionist Health Policies in British Palestine (1930–1939) (Venice: Libreria Editrice Cafoscarina, 2010), pp. 65–79. Weldon Matthews, Confronting an Empire, Constructing a Nation: Arab Nationalists and Popular Politics in Mandate Palestine (London: I. B. Tauris, 2006); Charles Anderson, ‘Other Laboratories: The Great Revolt, Civil Resistance, and the Social History of Palestine’, Journal of Palestine Studies 50, 3 (2021), pp. 47–51.

28

Introduction

other.62 With ever-increasing numbers of Palestinians pushed to precarious existence at the urban margins by deteriorating conditions in the countryside, an incident involving the holy places in Jerusalem in 1929 sparked the first serious revolt since the establishment of the mandate, and led to bloody communal violence in Jerusalem’s Old City, Safad, and Hebron. Less than a decade later, an even more significant episode of anti-colonial rebellion unfolded. Starting in April 1936 with a general strike that was sustained for an unparalleled six months, the great revolt evolved into a countrywide armed uprising which was only suppressed in the second half of 1939 as a result of a British counter-insurgency effort entailing, at its height, the deployment of tens of thousands of British soldiers to Palestine on the eve of the Second World War. The great revolt and its suppression left few areas of life untouched, including the provision of healthcare. In 1938, armed men broke into the government mental hospital at Bethlehem and murdered a Jewish member of the hospital’s staff. Iron shutters and iron doors were subsequently installed to secure the staff dormitories,63 and two British police officers billeted at the hospital at night.64 While a striking number of Palestinians continued to approach the mandate on behalf of mentally ill relatives even across these fraught years of insurgency and counter-insurgency, some at least were not reassured by the security measures put in place at government hospitals: admissions to the Lebanon Hospital for Mental Diseases from Palestine spiked in this period. During the great revolt, the British had moved beyond tinkering with immigration quotas to propose a more radical solution to the Palestine question: partition.65 Recommended in the first place by the Peel Royal Commission in 1937, it was dropped in favour of restrictions on Jewish immigration in 1939 that aimed to ensure a degree of political quiescence in Palestine during the Second World War. The majority of Zionists were willing to put on hold their opposition to this policy in order to concentrate on the war effort against the Nazis, and so the years of the war marked a period of relative quiet in Palestine and indeed saw the

62 63 64 65

Charles Anderson, ‘The British Mandate and the Crisis of Palestinian Landlessness, 1919–1936’, Middle Eastern Studies 54, 2 (2018), pp. 171–215. Director of Medical Services to District Commissioner, Jerusalem, 20 December 1938, ISA M 4087/9. District Commissioner, Jerusalem, to Director of Medical Services, 6 January 1939, ISA M 4087/9. For the history of the partition as a ‘solution’, see Penny Sinanoglou, Partitioning Palestine: British Policymaking at the End of Empire (Chicago: University of Chicago Press, 2019).

Psychiatry and Politics in Mandate Palestine

29

expansion, in important if uneven ways, of psychiatric provision and expertise. It was against the backdrop of one of these developments, the opening of a new mental hospital near Jaffa in 1944, that Zmurud dared to hope that her husband might be admitted as a patient; conversely, it was following the piloting of new kinds of treatment during the war years that the government responded in a quite different way to how she imagined, offering electro-convulsive therapy to him as an outpatient. With the war’s end, opposition to the continued restriction of Jewish immigration escalated into a Zionist paramilitary campaign aimed at dislodging the British by force. Exhausted by the war, and under international pressure to allow unrestricted Jewish immigration to Palestine as the horrors of the Holocaust became more fully known, in 1947 Britain passed the question of Palestine on to the new United Nations to resolve. In November 1947, the UN voted in favour of partitioning Palestine into two states: a Jewish state comprising much of the coastal plains including Jaffa, Tel Aviv, and Haifa, as well as stretches of territory in the interior to the north and south; and an Arab state, comprising the hilly interior of the country including Nablus, Hebron, and Ramallah – but not an internationalised Jerusalem – as well as stretches of the coast around Acre in the north and Gaza in the south. But events on the ground quickly overtook this plan: first, as civil war between the Yishuv and the Palestinians broke out even in advance of the British withdrawal in May 1948; and then as the newly established State of Israel defeated the armies of neighbouring Arab states and seized a much greater portion of territory than envisaged in any previous partition proposal. Across both phases of the war for Palestine, 750,000 Palestinians were displaced in what became known in Arabic as the nakba, or catastrophe, while those parts of Palestine which remained in Arab hands were divided between Jordan in the West Bank and East Jerusalem, and Egypt in the Gaza Strip.66 While 1948 marked the moment at which the State of Israel was able to bring together and transform a patchwork of voluntary and government mental institutions into the foundations of a national mental health service, the opposite was true for the Palestinians. Though Jordan inherited a government mental hospital in Bethlehem, the history of provision for Palestinian mental health fragmented after 1948. Across the 1950s and 1960s, the World Health Organization assumed some responsibility for arranging and funding medical training regionally, while the United Nations Relief and Works Agency footed the bill for 66

For a collection on the 1948 war, see Eugene L. Rogan and Avi Shlaim, eds., The War for Palestine: Rewriting the History of 1948 (Cambridge: Cambridge University Press, 2007).

30

Introduction

Palestinian patients who, like generations before them, found their way to the Lebanon Hospital for Mental Diseases for treatment. The psychiatric partition of Israelis and Palestinians was shadowed, in other words, by a fragmentation in responsibility for Palestinian mental health. Entanglement as a thread which had knitted the history of psychiatry together across the mandate period snagged and unravelled. To track these diverging histories past 1948 would require different frameworks, different archives, and engagement with a different set of questions about psychiatry’s transformation in an unevenly decolonising world67 – in short, another book.

Encounters around Mental Illness in Mandate Palestine Mandatory Madness unfolds across three loosely chronological parts; each chapter within these parts focusses on a particular kind of encounter around mental illness. Part I covers the opening years of British rule in Palestine, from wartime occupation to the census of 1931, and tracks the early efforts of Palestine’s new rulers to understand and manage mental illness. Both chapters in this part reveal the extent to which British actions and knowledge around mental illness were shaped by the legacies of the Ottoman past; subject to debate and critique among a wide range of actors; and driven by developments and pressures on the ground. The first chapter reconstructs the dynamics of the initial encounter between the British and the question of mental illness in Palestine. Far from recapitulating a familiar narrative about the colonial introduction of psychiatry, it instead offers a multi-layered account of the opening of the first government mental hospital at Bethlehem, in order to highlight how the British were in fact latecomers to an ongoing history of psychiatry in Palestine. Well before the British occupation of 1917, Palestinians had recourse to a range of medical and non-medical options for the management of the mentally ill, and those existing understandings, experiences, and institutions crucially shaped how the British responded to mental illness across these formative years. The second chapter takes us to the start of the 1930s, to explore the colonial production of knowledge on mental illness. It does so not through the writings of any psychiatric expert, but rather through the report of the 1931 census and its extensive analysis of the return of the ‘insane’ population. Rooted in a very particular encounter around mental illness – between 67

See Ana Anti´c, ‘Transcultural Psychiatry: Cultural Difference, Universalism and Social Psychiatry in the Age of Decolonisation’, Culture, Medicine, and Psychiatry 45 (2021), pp. 359–84.

Encounters around Mental Illness in Mandate Palestine

31

enumerator and enumerated – the census report’s analysis and the debates surrounding it reveal how the question of mental illness could be used to locate both Palestine and its different communities in relation to empire, development, and modernity. Part II, which centres on the 1930s and 1940s, is threaded together by a focus on a set of negotiations around mental illness between the mandate government and Palestinian – Arab and Jewish – families. Taken together, these chapters reveal families to have exercised a considerable degree of agency in relation to the management of their mentally ill relatives. The third chapter takes as its subject the petitions which flooded the mandate government from the 1930s onwards, seeking the admission of relatives to the government’s mental institutions. These petitions are read both for what they reveal about the often complex therapeutic strategies pursued by families and as carefully crafted arguments about mental illness and the state’s obligations to its subjects. The fourth chapter turns to the encounters around mental illness which played out in the colonial courtroom. Criminal insanity defences forced mandate judges, medical experts, and lay witnesses alike to engage in debate about what forms of behaviour and thought were evidence of mental illness and what should, by contrast, be considered normal, ‘rational’, and therefore punishable for a given defendant. Neither ‘insanity’ nor – as the fifth chapter demonstrates – ‘criminality’ were stable categories in 1930s and 1940s Palestine. Particularly in the 1940s, mandate officials worried that the families of the mentally ill were staging criminal offences in order to have their relatives smuggled into institutional care through the back door as criminal lunatics. By working closely with case files from the rich archive of the criminal lunatic section at Acre, this chapter delves into the more complex dynamics which sometimes surrounded individuals’ routes in and out of this institution, and attempts to recover their experiences of this space. Part III focusses on the final decade of the mandate period, and shifts the emphasis away from encounters between state and society towards understanding how novel forms of psychiatric expertise and practice were negotiated by different groups within Palestine across the 1940s. The sixth chapter traces two major developments in this transformative decade: the opening of the third and final government mental hospital at Jaffa in 1944; and the cultivation of expertise around wartime trauma and mental nursing. In both instances, investment was driven as much by colonial subjects and crisis as by British design, and built figuratively as well as literally on the foundations of the past. The seventh and final chapter brings us, at the end, to the encounter between patient and psychiatrist, and between Palestine and new methods of psychiatric

32

Introduction

treatment developing globally. Across the 1930s and 1940s, a set of therapies that used work, drugs, and electricity to intervene on the body to cure the mind were introduced into private and government mental institutions in Palestine. Though these techniques tantalised with the promise of transcending context through their universal applicability, this chapter highlights instead how they travelled to and were deployed within Palestine in a highly uneven way. The book closes with an epilogue, focussed squarely on 1948. By reconstructing a series of psychiatric encounters that attended the end of the mandate period, the epilogue draws out the profound rupture both of this moment and the processes of partition, erasure, and pathologisation which surrounded it. This rupture radically diminishes the possibilities for continuing any unitary, entangled history of psychiatry within the territory of what had once been mandate Palestine.

Part I

1

Psychiatry in Palestine between the Ottomans and the British

In December 1924, the Austrian-born psychoanalyst Dr Dorian Feigenbaum reflected on the care of the mentally ill in Palestine. Writing from New York for an American audience, he drew on his experience as the medical director of a private Jewish asylum in Jerusalem, a position he had held from the end of 1920 to early 1923. It had not been a happy stint in office: the committee of the asylum, he recounted, ‘resisted every attempt to modernise the institution’, and were particularly alarmed by his attempts to introduce psychoanalytic methods. The picture he painted of the state of treatment for the mentally ill in Palestine was far from a happy one, either. But it was improving, in his view, thanks to the entry of the British into Palestine in 1917. Until that point, Feigenbaum wrote: the insane were, because of religious and traditional prejudices, still prevalent in the Orient, either given no treatment whatever, or were put in the hands of sheikhs or magicians – when they were not confined in cloisters where, chained to the walls, they were put on a diet of bread and water and frequently were given whippings ‘to drive out the demons’.1

Feigenbaum noted that this ‘very sad though psychologically interesting chapter of cultural history’ was now coming to an end, thanks to the efforts of the newly created department of health, which had closed many of these old disreputable sites and established its own mental institution at Bethlehem. While underfunded and lacking specialists, it nonetheless represented an improvement on the private asylum in Jerusalem at which Feigenbaum had once been employed, and which he now – ties with his former employers severed – dismissed as being worse than useless, writing of the ‘hopelessness of a situation where the insane had to be treated in an old building, equipped with unsuitable and defective apparatus’.2

1 2

Dorian Feigenbaum, ‘Palestine Must Have Sound Nerves’, The Jewish Ledger (19 December 1924), ISA M 6628/15. Ibid.

35

36

Psychiatry in Palestine between the Ottomans and the British

In Feigenbaum’s telling, the British occupation of Palestine marked a dramatic rupture in the history of mental illness and its treatment. Both the British administration and a new generation of central European Jewish émigrés sought to introduce modern understandings and methods of treatment into Palestine, in the face of tight budgets, local superstition, and – in Feigenbaum’s case – outright opposition by an older generation of Jewish immigrants. A wealth of scholarship on late Ottoman Palestine and the British mandate throws this framing of the transition between empires into question, however. Rather than a slumbering backwater awaiting awakening by Europeans, historians have shown how Palestine and the Ottoman Levant were already being transformed by processes traditionally associated with modernisation across the late nineteenth and early twentieth centuries.3 The First World War caused profound dislocation within the region. But in important respects the British and French mandates that emerged when the dust had settled were built on Ottoman foundations: not only were there continuities in terms of the social bases of colonial rule, and its developmentalist thrust, but even opposition to it was organised down the lines instantiated by the late Ottoman education and military system.4 While the establishment by the British of a mental institution at Bethlehem in 1922 marked an important moment in the history of mental illness and its treatment, Feigenbaum – both playing to the presumed Orientalist hankerings of his audience and perhaps seeking revenge against his former employers – misrepresented the situation in Palestine before the 1920s. Certainly, the kind of treatment described by Feigenbaum was meted out by men of religion to the mentally ill. But it was far from the only option open to the families of the mentally ill before the arrival of the British. Both understandings of mental illness and methods of treatment underwent transformation such that by the eve of the First World War, Palestinians had recourse to Ottoman, colonial, and mission asylums across the region, as well as – closer at hand – hospices and hospitals within the territorial bounds of what became 3

4

For Palestine specifically, see Beshara Doumani, Rediscovering Palestine: Merchants and Peasants in Jabal Nablus, 1700–1900 (Berkeley: University of California Press, 1995); Mahmoud Yazbak, Haifa in the Late Ottoman Period, 1864–1914: A Muslim Town in Transition (Leiden: Brill, 1998); Tamari, The Great War; Vincent Lemire, Jerusalem 1900: The Holy City in the Age of Possibilities, trans. C. Tihanyi and L. A. Weiss (Chicago: University of Chicago Press, 2017). David Fieldhouse, Western Imperialism in the Middle East, 1914–1958 (Oxford: Oxford University Press, 2006); Mazza, Jerusalem; Jacobson, From Empire to Empire; Norris, Land of Progress; Cyrus Schayegh and Andrew Arsan, eds., Routledge Handbook of the History of the Middle East Mandates (Abingdon: Routledge, 2015); Michael Provence, The Last Ottoman Generation and the Making of the Modern Middle East (Cambridge: Cambridge University Press, 2017).

Psychiatric Encounters in the Late Ottoman Empire

37

mandate Palestine itself. These institutions were not rendered obsolete by the arrival of the British; Palestinians continued to seek out relief and treatment at these institutions into the mandate period, while the new British administration, in turn, found its own approach to mental illness shaped in multiple crucial ways by the legacies of its Ottoman forebear. In this key respect, then, Palestine is distinctive within the history of colonial psychiatry, which has generally narrated the introduction of asylums, mental hospitals, and psychiatry itself as following the arrival of European colonialism; here, not least as a result of the fact that British rule in Palestine began so late, in the wake of the First World War, the colonial administration had to negotiate with both existing institutions and a population that was already familiar to a degree with psychiatry. This chapter, then, does not seek to offer a history of the birth of psychiatry in the Middle East, nor of Palestine’s first encounter with modern methods of understanding and treating mental illness. Instead, at the heart of this chapter lies a messier set of encounters and negotiations that surrounded the establishment of the first government mental hospital at Bethlehem in 1922. What Feigenbaum represented as the breach of modern psychiatry into an antique land was, these encounters reveal, a more complex phenomenon. It grew out of a fraught relationship with existing institutions for the management of the mentally ill, and was as much a response to perceived crisis as the unfolding of any systematic plan for mental healthcare by the British. It was deeply contested, and by a surprising range of actors, from other branches of government to perhaps the most significant international humanitarian organisation operating in the region at the time. And rather than displacing that ‘very sad though psychologically interesting chapter of cultural history’, which Feigenbaum characterised as scarred by lurid stories of brutal abuse at the hands of men of religion, alternatives persisted, both because the British showed little interest in evangelising for psychiatry and because their provision never in any case kept pace with demand. This chapter ends by sketching the development of the first government mental hospital across the 1920s, with a focus on its staffing and on recovering a sense of the everyday lives of the patients who found themselves confined within it in this period. But to begin, we turn to the period before the British mandate, to explore what possibilities were open to Palestinians with mentally ill relatives in the last decades of the Ottoman empire. Palestinian Encounters with Psychiatry in the Late Ottoman Empire The government mental hospital established at Bethlehem in 1922 was a late addition to an already existing, complex landscape of therapeutic

38

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options open to Palestinians; one, moreover, that had been undergoing dramatic transformation in the decades before the First World War. In Istanbul and Cairo, vast asylums with histories stretching back centuries were reorganised and reformed under the Ottomans and, after 1882, the British in Egypt, while in Jerusalem and Beirut, new mission hospitals and private homes for the mentally ill were established. In spite of the stress placed by Feigenbaum and other European and North American observers on the abuse suffered by the mentally ill at the hands of men of religion, hospitals and doctors as well as monasteries and shaykhs played a role in the management of mental illness for at least some Palestinians in the late Ottoman period. Many of these institutions, including those that fell outside the borders of Palestine after the First World War, continued to receive Palestinian patients into the interwar years and beyond and, more than this, shaped the development of the mandate government’s own provision for the mentally ill in ways both obvious and subtle. As in so many other areas of life, the last decades of Ottoman rule saw changes both in understandings of mental illness and in its treatment. For centuries, and in contrast to the emphasis placed by Feigenbaum and others on supernatural explanations of mental disturbances, humoral understandings of mental illness would have been familiar to physicians and at least some non-physicians too. Like its English counterpart, the Arabic term for melancholia (malikhuliya) – that is, depression – is derived from the Greek, meaning ‘black bile’.5 This informed treatment, which would have centred on bleeding, bathing, and other interventions designed to rebalance the body’s humours. These treatments would generally have been undertaken within the setting of a bimaristan, which we might gloss as a hospital or a place of healing, which admitted those suffering from mental disturbances as well as bodily diseases such as leprosy, rather than within an asylum given over exclusively to the management of the mentally ill.6 In addition to being sites of medical treatment, these institutions integrated gardens, fountains, and even music into their therapeutic regimens, as at the Bimaristan alArghun in Aleppo, which had been established on the site of a former palace in the fourteenth century.7

5 6

7

Sara Scalenghe, Disability in the Ottoman Arab World, 1500–1800 (Cambridge: Cambridge University Press, 2014), pp. 92–4. Michael Dols, Majnun: The Madman in Medieval Islamic Society (Oxford: Oxford University Press, 1992), pp. 112–35. See also Miri Shefer-Mossensohn, Ottoman Medicine: Healing and Medical Institutions, 1500–1700 (Albany: State University of New York, 2009), p. 135; Scalenghe, Disability in the Ottoman Arab World, pp. 98–9. Rosanna Gorini, ‘Attention and Care to the Madness during the Islamic Middle Age in Syria: The Example of the Bimaristan al-Arghun, from Princely Palace to Bimaristan’, Journal of the International Society for the History of Islamic Medicine 2 (2002), pp. 40–2.

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While bimaristanat continued to operate well into the nineteenth century, they were judged to be in urgent need of reform by the late Ottoman period, especially as understandings of mental illness, its causes, and its treatment underwent change.8 As Joelle Abi-Rached has traced, Arabiclanguage medical and scientific journals such as al-Muqtataf (The Digest) introduced and elaborated naturalistic accounts of mental disease to audiences in Palestine, as well as the rest of the Levant and Egypt, across the late nineteenth and early twentieth centuries.9 In one article from 1905, for instance, al-Muqtataf described insanity in firmly bodily terms, as a disease of the brain, which could be due to weakened physical conditions resulting from a lack of nutrition or a lack of sleep, as well as a disease which might be inherited.10 The journal introduced terms such as ‘psychology’ (bsikolojia) to Arabic-speaking audiences,11 but its focus tended to be less on mental disease and its treatment and more on putting this science to work to strengthen the mind. This was in line with the journal’s well-documented advocacy of Darwinian theories of evolution, and its wider emphasis on the need to ‘evolve’ in order to prevail in the struggle for survival with European states.12 Thus in a 1891 article on the prevention of diseases, the editors of al-Muqtataf included a warning – alongside cautionary notes about hypnosis, alcohol, opium, and other drugs – against overstraining the minds of students (ijhad quwa al-tilmidh al-ʿaqliyya) and neglecting their physical education (ihmal al-tarbiyya aljasadiyya).13 8

9

10 11

12

13

Artvinli, ‘“Pinel of Istanbul”’, pp. 424–5. For an account stressing the urgent need for reform, see Pliny Earle II, ‘A Visit to Thirteen Asylums for the Insane in Europe with Statistics’, American Journal of the Medical Sciences 25, 49 (1839), p. 99. Abi-Rached, ʿAsfūriyyeh, pp. 38–43. For the Palestinian readership of al-Muqtataf and similar journals,_ see Ami Ayalon, ‘Modern Texts and Their Readers in Late Ottoman Palestine’, Middle Eastern Studies 38, 4 (2002), pp. 21–2. ‘Intishar al-junun’, al-Muqtataf 30, 6 (1905), pp. 498–9. ‘Al-‘ulum al-‘aqliyya’, al-Muqtataf 11, 4 (1886), pp. 211–14. It defined ‘bsikolojia’ as being ‘a science which investigates the nature of the mind, its structure, and the basic laws that act on it’. Marwa Elshakry, Reading Darwin in Arabic, 1860–1950 (Chicago: University of Chicago Press, 2014); See also Nadia Farag, ‘The Lewis Affair and the Fortunes of al-Muqtataf’, Middle Eastern Studies 8, 1 (1972), pp. 73–83. ‘Wiqaya al-Amrad’, al-Muqtataf 15, 2 (1891), p. 810. This was resonant with the emphasis on a rational, scientific mode of education (tarbiya) put forward by the journal’s editors and other Arab intellectuals in this period. See Elshakry, Reading Darwin, pp. 133, 82–3. For more on physical education, see Wilson Chacko Jacob, Working Out Egypt: Effendi Masculinity and Subject Formation in Colonial Modernity, 1870–1940 (Durham, NC: Duke University Press, 2011), pp. 76–9. For the diasporic dimensions to this emphasis on physical education from the interwar period, see Stacy Fahrenthold, ‘Sound Minds in Sound Bodies: Transnational Philanthropy and Patriotic Masculinity in al-Nadi al-Homsi and Syrian Brazil, 1920–32’, International Journal of Middle East Studies 46, 2 (2014), pp. 259–83.

40

Psychiatry in Palestine between the Ottomans and the British

If the sciences of the mind were always about more than mental illness and its treatment, changing understandings were nonetheless accompanied by changing modes of treatment. Moral treatment – that is, a rejection of the use of physical restraint in favour of a more ‘humane’ strategy of encouraging reason and self-control – was introduced in asylums in Istanbul in the second half of the nineteenth century by an Italian physician appointed by the Ottoman state,14 while British colonial doctors credited themselves with abolishing mechanical restraint and instituting reforms in the vast asylum at ʿAbbasiyya just outside Cairo in the years that followed the 1882 occupation of Egypt.15 These asylums in Istanbul and Cairo would have represented treatment options to a small number of Palestinians in the late nineteenth and early twentieth centuries. In spite of the expansion of rail networks knitting together the empire, and the circulation of soldiers, students, and parliamentary delegates between Palestine and Istanbul, few Palestinians appear to have been admitted to Topta¸sı asylum in Istanbul, the ‘official’ asylum of the Ottoman empire.16 Across the 1880s, it was instead overcrowded Greek and Armenian asylums which provided many of the patients at Topta¸sı.17 A decade later, in 1897–8, just four patients from Syria and thirteen described as ‘Arabs’ were admitted to Topta¸sı, of a total of four hundred admissions that year; it is not clear how many, if any, were Palestinian.18 Cairo seems to have been as, if not slightly more, significant as an option for mentally ill Palestinians in the late Ottoman period. In the three decades following 1895, over four hundred Syrians were admitted to ʿAbbasiyya;19 it would not be a stretch to imagine that at least some Palestinians were included in that figure.

14

15

16 17 18

19

Artvinli, ‘“Pinel of Istanbul”’, pp. 424–37. See also Fatih Artvinli, ‘Insanity, Belonging, and Citizenship: Mentally Ill People Who Went to and/or Returned from Europe in the Late Ottoman Era’, History of Psychiatry 27, 3 (2016), pp. 268–77; Burçak Özlüdil Altın, ‘Psychiatry, Space, and Time: Case of an Ottoman Asylum’, Journal of the Ottoman and Turkish Studies Association 5, 1 (2018), pp. 67–89. For an overview, see Rogan, ‘Madness and Marginality’, pp. 110–14. For a contemporary account, see F. M. Sandwith, ‘The Cairo Lunatic Asylum, 1888’, Journal of Mental Science 34, 148 (1889), pp. 473–90. Fatih Artvinli, Delilik, Siyaset ve Toplum: Topta¸sı Bimarhanesi (1873–1927) (Istanbul: Boğaziçi Üniversitesi Yayınevi, 2013), p. 67. Altın, ‘Psychiatry, Space, and Time’, p. 78. ‘Statistique de l’asile des aliénés de Top-Tachi de l’année 1313 (1897–98)’, Gazette Médicale d’Orient 43, 13 (1898), p. 189. As Palestine was not a distinct Ottoman administrative unit, those admitted to the asylum from what became mandate Palestine may well have been admitted under either the ‘Syria’ or ‘Arab’ categories. John Warnock, ‘Twenty-eight Years’ Lunacy Experience in Egypt (1895–1923): Part II’, Journal of Mental Science 70, 290 (1924), p. 397.

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If a trickle of mentally ill patients from across the Ottoman Levant made their way to Istanbul and Cairo over the late nineteenth century, in 1900, an alternative, much closer at hand, opened up to Palestinians with the establishment of the Lebanon Hospital for the Insane at ʿAsfuriyyeh, on the foothills of Mount Lebanon a few kilometres south-east of Beirut.20 The Lebanon Hospital for the Insane – renamed the Lebanon Hospital for Mental Diseases on the eve of the First World War – differed from the asylums at Topta¸sı and ʿAbbasiyya in that it was not under the control of the Ottoman or British governments, but rather had been founded in the wake of a vigorous fundraising campaign throughout Europe and the United States by a sexagenarian Swiss Quaker missionary, Theophilus Waldmeier, and his wife, Fareedy Saleem. It was thus one of a number of educational and medical institutions established by European and North American missionaries from the mid-nineteenth century onwards as part of an inter-imperial and inter-denominational competition for influence and converts in the region,21 though it is important, as Abi-Rached argues, to note the crucial support that Ottoman authorities and local elites extended to this project, too.22 Marketed for many years as the only modern asylum between Istanbul and Cairo,23 the ‘humane care’ shown to patients at ʿAsfuriyyeh was represented as desperately needed to combat the prevailing superstitious, cruel treatment of the insane in the Levant.24 In a report issued soon after the hospital opened, Fareedy Saleem wrote about an exchange she had had with one of the patients, after he asked about the letters she was writing to subscribers: He was so touched, and, with tears in his eyes, said, ‘God bless these dear friends: tell them I am so grateful that I was brought to ʿAsfuriyyeh, otherwise they would have brought me to the devil’s cave, and the priests would have killed me in order to cast the devil out of me, or I would have lost my whole reason and become incurable.’25

20 21

22 23 24

25

For this institution’s history from foundation to closure, see Abi-Rached, ʿAsfūriyyeh. _ See Inger Marie Okkenhaug and Karène Sanchez Summerer, eds., Christian Missions and Humanitarianism in the Middle East, 1850–1950: Ideologies, Rhetoric, and Practices (Leiden: Brill, 2020). Abi-Rached, ʿAsfūriyyeh, pp. 58–70. _ for the Insane’, British Medical Journal 2, 2534 (1909), p. 229. ‘Lebanon Hospital See, for instance, Theophilus Waldmeier, Appeal for the First Home for the Insane on Mount Lebanon (London: Headley Brothers, 1897), p. 7. See also Annual Report, Lebanon Hospital for the Insane, 1908, pp. 24–7. Waldmeier’s appeal and all of the annual reports of the hospital cited throughout the book are available in digital form through the Archives and Special Collections, Saab Medical Library, American University of Beirut [AUB]. Annual Report, Lebanon Hospital for the Insane, 1901, pp. 8–9.

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As well as serving to showcase the hospital’s therapeutic success, Fareedy’s interlocutor also neatly captures a central dynamic in histories of psychiatry in the Middle East: the attempt by European missionaries and physicians from the late nineteenth century on to wrestle control of the mentally ill and responsibility for their treatment out of the hands of ‘men of religion’, and into the hands of ‘men of science’, as Eugene Rogan has put it.26 Two decades later, Feigenbaum reproduced a similar narrative of transition, this time to describe the impact of British rule in Palestine. But there is reason to be sceptical of this framing. At ʿAsfuriyyeh, for instance, successive medical directors found themselves locked in battle with the Waldmeiers, who – up to and beyond Theophilus’ death in 1915 – fought a determined rearguard action on behalf of the therapeutic value of religion in the hospital against these secular medical authorities.27 Rather than an accurate description, then, the transposition of madness from the domain of religion to the domain of science ought to be taken as a mission statement. ʿAsfuriyyeh’s supporters certainly represented the institution’s goal in this way, as being not only medical but educational. In 1909, the British Medical Journal hailed the hospital’s success in disseminating ‘the ameliorating influences of modern medical science and humanitarian zeal, not only among those dwelling in its neighbourhood, but to far-distant countries by travellers along the trade routes to Damascus and Baghdad, and even along the hajj road from Damascus to Mecca’.28 This had an apparently demonstrable impact on how mental illness was treated in Palestine: Dr David Watt Torrance, a Scottish doctor who had opened a missionary hospital in Tiberias in northern Palestine in 1885, reported how ‘[t]he members of certain Moslem families are the chief exorcists, but thanks to the ʿAsfuriyyeh, faith in them is dying out’, so that ‘[o]ne such practitioner was begging from me lately in Safad, saying he had nothing to do’.29 Indeed, Palestinians made their way to ʿAsfuriyyeh almost as soon as the mental institution opened its doors. In 1901, a Muslim merchant from Nablus and a Greek Orthodox blacksmith from Jaffa arrived at the hospital; both were discharged a few months later, without any improvement. A third admitted in the same year, a Jewish gardener from Jaffa, remained a patient for much longer; he was eventually discharged, apparently cured, in 1919.30 Over the next decade and a half, the hospital regularly admitted patients from other towns that would be incorporated 26 28 29 30

27 Rogan, ‘Madness and Marginality’, p. 104. Abi-Rached, ʿAsfūriyyeh, pp. 65–8. _ ‘Lebanon Hospital for the Insane’, p. 229. Annual Report, Lebanon Hospital for the Insane, 1908, p. 26. See entries 75, 86, and 88, List of Patients at the Lebanon Hospital for the Insane, Asfuriyeh, 1 August 1900 to 31 March 1936, Archives and Special Collections, Jafet Library, AUB.

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into mandate Palestine, including Jerusalem, Haifa, Acre, Nazareth, and Bethlehem.31 While the number of Palestinian patients admitted was not large, never exceeding twenty in any given year, they nonetheless represented a significant proportion of total admissions to the hospital across these years: in 1908, for instance, when seventeen patients from Palestine were admitted, the total number of admissions was just under seventy. Palestinians, then, made up a consistently significant proportion of cases at ʿAsfuriyyeh across the early twentieth century. This is perhaps unsurprising: towns in northern Palestine such as Haifa, Nablus, Acre, and Nazareth were administratively split off from Jerusalem and belonged instead to an Ottoman administrative unit centred on Beirut, a booming port city to which students, litigants, and merchants alike increasingly gravitated in the late Ottoman period.32 And Jerusalem, the Ottoman provincial seat for southern Palestine, was itself only eleven hours by motor car from Beirut, according to one early post-war estimate.33 On the eve of the First World War, then, and in contrast to Feigenbaum’s exclusive focus on prevailing ‘religious and traditional prejudices’, decades of developments involving Ottoman, colonial, and missionary medical institutions meant that at least some Palestinians had recourse to asylums at Istanbul, Cairo, and – above all – Beirut. These changes in provision were paralleled, if not always directly undergirded, by the circulation of knowledge about the sciences of the mind in Arabic-language medical and scientific publications like al-Muqtataf. If Palestinians were embedded within these regional circuits of knowledge and therapeutic practice, there were also in the decades before the First World War options for treatment available even more locally, within the territorial limits of what became mandate Palestine. To round off this survey, then, let us consider three of the most significant of these institutions, all of which survived the cataclysm of the First World War and endured across the mandate years: the Ezrath Nashim home in Jerusalem; the hospice of the Sisters of St Vincent de Paul, also in Jerusalem; and the municipal general hospitals. While none of these institutions specialised in the treatment of the mentally ill, unlike ʿAsfuriyyeh and the other asylums at Istanbul and Cairo, they nonetheless admitted and cared for the mentally ill over the last decades of the Ottoman period, and so represented important localised options to the mentally ill and their families.

31 32

33

These figures can be derived from the hospital’s annual reports between 1902 and 1917. For merchants, see Doumani, Rediscovering Palestine, pp. 68–73; for students and litigants, see Jens Hanssen, Fin De Siècle Beirut: The Making of an Ottoman Provincial Capital (Oxford: Oxford University Press, 2005), pp. 60, 166–80. ‘Medical News’, British Medical Journal 1, 3312 (1924), p. 1118.

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The Ezrath Nashim home, which Feigenbaum derided as ‘hopeless’ after his brief ill-fated stint as its medical director in the 1920s, had been founded in 1895 by a Jewish women’s charitable organisation. Established to provide succour to the growing number of European Jews arriving in Ottoman Palestine since the 1880s, the institution had started out life as the ‘Ezrath Nashim Home for the Insane and Incurable’ – at that time a single rented room within the Old City of Jerusalem – before it moved to a new site on Jaffa Road outside the city walls that had been acquired for the society by Baroness Rothschild. Initially it admitted mostly women, but a second building was added for male patients in 1910.34 By the end of the First World War, the hospital was accommodating an average of nearly fifty patients; by 1921, this number crept to over sixty.35 Though later publicity material emphasised the home’s mission of alleviating the suffering of the mentally ill, who ‘were left without any assistance and wandered around in a terrible neglected state uncared for, without food or clothing or any means of sustenance’,36 admissions statistics reveal that up until 1910, the home – true to its original, full name – consistently admitted more ‘incurable’ than ‘insane’ cases, that is, patients suffering not from mental illness but other chronic conditions.37 This ratio changed in the 1910s, as the home admitted larger numbers of insane patients, and indeed engaged ‘a specialist in psychical diseases’ to care for them.38 Though there were a handful of non-Jewish patients at the home in the early 1920s, shortly before the opening of the first government mental hospital at Bethlehem,39 it is not clear whether the home admitted many – if any – non-Jewish patients in the late Ottoman period. A second institution that made provision for the mentally ill in late Ottoman Palestine was the hospice of the Sisters of St Vincent de Paul, or the Sisters of Charity, also in Jerusalem. In Palestine and especially Jerusalem, even more so than at Mount Lebanon, the nineteenth century was a period of ever more intense European diplomatic and religious competition for influence.40 While some missions appear to have 34 35 36 37 38 39 40

Ezrath Nashim Information Booklet, c. 1929, ISA P 4270/11, p. 19. For some of this story, see Zalashik, Das Unselige Erbe, pp. 26–8. A/Treasurer to Director of Health, 22 September 1921, ISA 6627/21. Ezrath Nashim Information Booklet, c. 1929, ISA P 4270/11, p. 20. Bulletin No. 20, for 1922, of the Home for Insane and Incurable founded by Esrath Nashim Society, Jerusalem (1923), ISA M 6627/33. Ibid. Director of Health to Medical Director, Ezrath Nashim Asylum, 25 September 1922, ISA M 6627/24. For this dynamic, see Laura Robson, Colonialism and Christianity in Mandate Palestine (Austin: University of Texas Press, 2011), pp. 20–4. For an account focussed on Anglican missions specifically, see Inger Marie Okkenhaug, The Quality of Heroic

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embraced – with mixed success – medical work and founded hospitals as a means to legitimise their presence in the Holy Land and facilitate conversion,41 it was central to the work of the French Society of St Vincent de Paul in Jerusalem, which was established in the midnineteenth century to administer relief to the sick and other cases of distress.42 Though they were far from the only French order to provide charitable medical care in Jerusalem, the Sisters of St Vincent de Paul were, according to one early twentieth-century observer, unique among Christian societies in the city for their care for ‘the mentally afflicted’ at their convent outside Jaffa Gate: Surely never was such varied misery relieved under one roof! Their buildings, though vast, are quite inadequate to their purpose. The Sisters themselves have no separate cells, but are housed, like their patients, in dormitories. Their chapel is almost bare; all that can be spared from the merest necessities of life is spent upon others. Under that kindly roof we find orphanages for boys and girls, an asylum for the aged and bedridden, for the blind, the crippled, the deformed, the mentally afflicted (neglected by all other Christian societies in Jerusalem, cared for by Jews and Moslems only, and by the latter with no appliances of science, barely of civilisation). Here, too, we find a crèche, a refuge for foundlings, children often literally cast out, some of whom have been found mangled by pariah-dogs. All creeds, all nationalities, both sexes, are welcomed, the only condition being that of misery too great for admission elsewhere.43

As with many mission institutions, then, the hospice of the Sisters of St Vincent de Paul admitted patients from a range of backgrounds, not only Christians. The Ezrath Nashim home and hospice of the Sisters of St Vincent de Paul reflect two very different external influences shaping healthcare in late Ottoman Palestine. But external actors were not the sole drivers of change, as is now well established in the historiography,44 and developments in healthcare need to be understood against the backdrop of wider reforms and initiatives by both the Ottoman central government and more local actors. From the 1870s, the Ottoman state tasked

41

42

43 44

Living, of High Endeavour and Adventure: Anglican Mission, Women and Education in Palestine (1888–1948) (Leiden: Brill, 2002). Philippe Bourmaud, ‘Public Space and Private Spheres: The Foundation of St Luke’s Hospital of Nablus by the CMS (1891–1901)’, in H. Murre-van den Berg, ed., New Faith in Ancient Lands: Western Missions in the Middle East in the Nineteenth and Early Twentieth Centuries (Leiden: Brill, 2006), pp. 133–50. W. H. Bartlett, Jerusalem Revisited (London: T. Nelson & Sons, 1867), p. 93. For a list of their activities, see Seth J. Frantzman and Ruth Kark, ‘The Catholic Church in Palestine/ Israel: Real Estate in Terra Sancta’, Middle Eastern Studies 50, 3 (2014), p. 387. Ada Goodrich-Freer, Inner Jerusalem (New York: Dutton, 1904), pp. 159–60. For a photograph of the convent, see Figure 1.1. For a starting point, see Beshara Doumani, ‘Rediscovering Ottoman Palestine: Writing Palestinians into History’, Journal of Palestine Studies 21, 2 (1992), pp. 5–28.

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Psychiatry in Palestine between the Ottomans and the British

municipalities across the empire with a range of responsibilities, including security, infrastructure, justice, and education, as well as health and sanitation.45 In Palestine, the municipalities of three of the most important towns – Jerusalem, Jaffa, and Nablus – came to establish and run hospitals as a result. While these were generally funded out of municipal tax receipts, the Watan or ‘National’ hospital in Nablus was built in 1888 using donations from local residents instead,46 suggesting that investment in healthcare was not solely a concern of central government in late Ottoman Palestine; indeed, this hospital predated the municipal hospital at Jerusalem by several years. At Jerusalem, a city crowded with missionary hospitals, the municipality funded a municipal doctor, a municipal pharmacy, and – in 1891 – a municipal hospital, all of which served the whole population of the city.47 The municipal hospital recruited its staff from a range of backgrounds, too, hiring Greeks and Jews as physicians and drawing on Catholic women’s orders – including the Sisters of St Vincent de Paul – for its nursing staff.48 Though these municipal hospitals did not make specific provision for mental illness, the mentally ill nevertheless ended up being treated within them and in other general hospitals across Palestine in the interwar years;49 it would be remarkable if municipal hospitals, like the hospice run by the Sisters of St Vincent de Paul, had not occasionally taken in and cared for the mentally ill in the late Ottoman period too. While the birth of the asylum, or the introduction of psychiatry, have been focal points in histories of colonial psychiatry, in the case of Palestine, both the modern sciences of the mind and institutions that provided care – if not always medical treatment – for the mentally ill predated British rule by decades. This is not to say that the founding of the first government mental hospital at Bethlehem in 1922 was unimportant: provision for the mentally ill within the territorial bounds of what became mandate Palestine was undeniably limited in the late

45 46 47 48

49

Johann Büssow, Hamidian Palestine: Politics and Society in the District of Jerusalem, 1872–1908 (Leiden: Brill, 2011), p. 80. Tawfiq Canaan, An Autobiography, ed. Mitri Raheb (Bethlehem: Diyar Publisher, 2020), p. 66. Lemire, Jerusalem 1900, pp. 120–2. Philippe Bourmaud, ‘Epidemiology and the City: Communal vs Intercommunal Health Policy-Making in Jerusalem from the Ottomans to the Mandate, 1908–1925’, in A. Dalachanis and V. Lemire, eds., Ordinary Jerusalem, 1840–1940: Opening New Archives, Revisiting a Global City (Leiden: Brill, 2018), p. 445. For the Sisters of St Vincent de Paul, see Goodrich-Freer, Inner Jerusalem, pp. 91, 244. Annual Report, Department of Health, Government of Palestine, 1928, p. 57. The department of health’s annual reports were accessed at the British National Archives and the Israel State Archives.

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Ottoman period, and access to more specialised institutions at Istanbul, Cairo, and even Beirut would have been beyond the reach of many. But rather than representing a brand new start for the care of the mentally ill in Palestine, as Feigenbaum suggested, the first government mental hospital needs to be set within a longer and more complex history of the expansion of therapeutic options available to the mentally ill and their families from the middle of the nineteenth century onwards. External actors, including the British in Egypt, Christian missions throughout the Levant, and European Jewish charitable societies, as well as the Ottoman central state, municipal governments, and local society, shaped this history. And far from being simply the historical backdrop to the story of psychiatric provision by the mandate, many of the institutions founded in the decades before the mandate continued to admit and treat Palestinians right across the mandate period and indeed beyond it, too. Indeed, as we will now see, those therapeutic options available to late Ottoman Palestinians did not simply continue into the mandate period and coexist alongside new government institutions, but crucially shaped the British mandate’s approach to the question of mental illness across the 1920s and beyond.

Figure 1.1 Photograph of the Convent of the French Sisters of St Vincent de Paul, outside Jaffa Gate in Jerusalem, dated 1920. From the Eric and Edith Matson Photograph Collection, Library of Congress.

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Psychiatry in Palestine between the Ottomans and the British

The Devolution of Health and the Post-war Crisis in Provision for the Mentally III The government mental hospital at Bethlehem first opened its doors to patients late in 1922. While this might appear precocious, given that the British mandate for Palestine was only confirmed that same year, in a sense it fits a broader pattern in the history of British colonial psychiatry. Over the nineteenth century, colonial lunatic asylums had been slow to emerge in British India, with Burma, for instance, provided with a lunatic asylum only in 1870.50 But by the start of the twentieth century, and in the context of British colonialism in sub-Saharan Africa, frequently a gap of only a few years separated the formal establishment of British protectorates and the opening of lunatic asylums – or, more often, a lunatic ward appended to colonial prisons.51 Even set against this wider shift in the history of colonial psychiatry, however, it is remarkable that expenditure for a government mental hospital had been approved for Palestine in July 1918, before the British had even secured the northern half of the country.52 Why, with the war still raging, was the establishment of some kind of mental institution even on the agenda of the interim occupying administration? In part, the sense of urgency that surrounded the establishment of a government mental hospital emerged out of the fraught relationship between the new British administration and those institutions that predated their arrival. The drive to take responsibility for mental illness derived less from any systematic plan for healthcare and more from a sense that the existing arrangements for the management of the mentally ill were breaking down and could not be relied upon. In that respect, the seemingly precocious British attention to this question turns out to have been, as in so many other instances from across the history of colonial psychiatry, a form of crisis management.53 In the first years of British rule in Palestine, responsibility for the mentally ill was delegated to existing institutions. This was in line with the administration’s wider policy of decentralisation when it came to healthcare. While the British committed their resources to anti-malaria measures, as ‘an essential preliminary to all other steps for the moral and 50 51

52 53

Jonathan Saha, ‘Madness and the Making of a Colonial Order in Burma’, Modern Asian Studies 47, 2 (2013), p. 411. Nigeria and Nyasaland (present-day Malawi) are good examples. Megan Vaughan, ‘Idioms of Madness: Zomba Lunatic Asylum, Nyasaland, in the Colonial Period’, Journal of Southern African Studies 9, 2 (1983), pp. 218–38; Sadowsky, Imperial Bedlam, p.10. A/Director of Health to Treasurer, 19 August 1922, ISA M 6627/24. Saha, ‘Madness and the Making of a Colonial Order’; Christienna Fryar, ‘Imperfect Models: The Kingston Lunatic Asylum Scandal and the Problem of Postemancipation Imperialism’, Journal of British Studies 55 (2016), pp. 709–27.

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material improvement of the country’,54 general public health and the provision of hospital accommodation were left to others: general public health measures like sanitation and inspections to municipal and rural councils; and hospitalisation initially to an assortment of international organisations, notably the American Red Cross and Zionist organisations.55 The post-war withdrawal of the American Red Cross, and a fall in funding from Zionist organisations, meant that the burden of providing hospital care passed on to other voluntary and charitable institutions, in particular mission hospitals. Rather than making up any shortfall in provision, the government’s policy of devolution only deepened in the early 1920s, with general hospitals established or taken over by the government during the war at Gaza, Nablus, Jaffa, Beersheba, and Acre handed over to their respective municipal authorities by 1925.56 In keeping with this wider policy of devolution, then, the government relied on the Ezrath Nashim home in Jerusalem to provide accommodation for the mentally ill in the immediate post-war years. But – in striking contrast to its approach in other areas of health – the government very quickly began to make plans to relieve itself of dependence on this private institution. In part, this was a question of finance. The cost of subsidising the Ezrath Nashim home spiralled in the immediate post-war years. While in 1919 the government had subsidised the asylum to the tune of £600, this figure rose rapidly; the subsidy was more than double this initial amount for the first half of 1921 alone.57 George W. Heron, director of the new department of health established in 1920, expressed alarm at the sums of money being handed over to this institution, which had – in spite of the ever-growing subsidy – nevertheless managed to rack up a significant debt. In part, this was a result of a failure to re-capture the private donors who had supported the Ezrath Nashim society before the war disrupted this arrangement. But in part the debt was also a result, Heron complained, of ‘reconstructions and alterations of the building effected this year which, under the circumstances, were hardly justified though no doubt desirable’.58 His characterisation of this work as excessive was disputed on behalf of the society by Margalit Meyuchas. Far from unnecessary, this work had been precipitated by the government’s recognition of the asylum as a ‘necessary institution’. It was, after all, she argued, ‘by virtue of the government having sent its own 54

55 56 57 58

Estimates for the Occupied Enemy Territory Administration South, 1919, ISA M 6564/ 17, p. 10. For the history of anti-malaria measures in mandate Palestine, see Sufian, Healing the Land. Estimates for the Occupied Enemy Territory Administration South, 1919, ISA M 6564/ 17, p. 10. Ibid., p. 21. Audits of Ezrath Nashim asylum by Assistant Treasurer, Jerusalem, 22 September 1921, ISA M 6627/21. Director of Health to Civil Secretary, 17 October 1921, ISA M 6627/21.

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patients there that the asylum was obliged to widen the sphere of its activities’.59 This had included not only the extension of the home’s physical fabric, but the hiring of a specialist from Europe to direct the institution in 1920: Dorian Feigenbaum, still in post late in 1921 when this dispute was ongoing. From their perspective, it was not mismanagement but rather the failure of the government to properly subsidise this ‘necessary institution’ which had left the Ezrath Nashim home in debt. What Heron and Meyuchas agreed on was that the Ezrath Nashim home had undergone significant changes in the post-war years. Some of this, as Meyuchas reminded Heron, was a direct result of government intervention. While the balance between ‘insane’ and ‘incurable’ residents at the home had been shifting in favour of the former already by the 1910s, in 1921 the government used an Ottoman-era law regulating asylums to forbid the admission of any other patients besides those who were mentally ill into the home.60 The institution ceased to be a home for the incurable and insane and became instead a home for the insane only. This, as the society noted, had a knock-on effect on discharge figures: as the number of ‘incurable’ cases in the home declined, the number discharged dramatically increased. In 1921, for instance, eighty-two ‘insane’ patients were admitted, and sixty-three discharged.61 The increasingly rapid turnover in patients fed into a second major trend in terms of admissions in the post-war years: the skyrocketing number of mentally ill patients admitted on a yearly basis to the home, from an average of just twenty during the war, to quadruple that figure by the early 1920s. While this was offset to a degree by the higher discharge rates, it is clear that the home had become seriously overcrowded. In March 1922, pressure on the home was so severe that the society wrote to Heron to ask whether a barracks could be put at its disposal to accommodate patients, as ‘all beds are permanently occupied (including the reserve-beds)’.62 A final change in admissions can also be linked directly to the government’s policy of delegating responsibility: while a majority of patients in the home continued to be Jewish, by the early 1920s around a third of patients at the home were Christian or Muslim.63 Their costs were directly met by the government, though Heron appears to have been uneasy about the prospect of Jewish and Muslim patients, in particular, being accommodated together.64 59 60 61 62 63 64

Ezrath Nashim Society to Director of Health, 25 November 1921, ISA M 6627/21. Bulletin No. 20, for 1922, of the Home for Insane and Incurable founded by Esrath Nashim Society, Jerusalem (1923), ISA M 6627/33. See Figure 1.2. President, Ezrath Nashim, to Director of Health, 29 March 1922, ISA M 6627/23. Figures taken from Note on Inmates of Ezrath Nashim Asylum, August 1921 and August 1922, ISA M 6627/23. Director of Health to Treasurer, 1 May 1923, ISA M 6627/21.

90

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60

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0 1895 1896 1897 18981899 1900 1901 1902 1903 19041905 1906 1907 19081909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922

‘Incurable’ cases admitted

‘Insane’ cases admitted

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Figure 1.2 Changing admission patterns at the Ezrath Nashim hospital, 1895–1922. Figures taken from Bulletin No. 20, for 1922, of the Home for the Insane and Incurable founded by the Ezrath Nashim Society, Jerusalem (1923), ISA M 6627/33.

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More than just the patient demographics or the physical fabric of the Ezrath Nashim home was undergoing transformation in the early 1920s. In keeping with its new government-enforced focus on the mentally ill alone, the society hired a specialist in mental diseases from Europe: Dorian Feigenbaum, who was appointed medical director of the home in 1920. Feigenbaum, looking back with some bitterness after his time at the home was brought to an abrupt end, complained he had been blocked from enacting much-needed changes by the society’s conservative governing committee. But it is clear that things did change in this period. Feigenbaum himself travelled widely over the course of his short stint in Jerusalem in order to learn from other institutions in the region and gather examples of best practice that he could introduce at the Ezrath Nashim home: in the autumn of 1921, he went to Beirut, presumably to visit ʿAsfuriyyeh;65 in January 1922, he departed on a tour of mental institutions in Egypt and Europe.66 By 1922, hydrotherapy was in use at the Ezrath Nashim home, suggesting that rather than simply providing hospice care, it was attempting to actually treat the mentally ill.67 And Feigenbaum sought to shape government policies too. He offered to give a course of lectures for ‘both Jewish and Arabic policemen’, with demonstrations, to ensure mentally ill patients were handled properly by policemen when they fell into their charge.68 Indeed, in June 1921, midway through Feigenbaum’s time in post, the Bishop in Jerusalem visited the Ezrath Nashim home and lavished praise on ‘the order, the cleanliness, and the freshness of these rooms’, the ‘unceasing care and effort on the part of the doctor and his staff’, and even ‘how wonderfully cheerful and happy most of the patients were’.69 If this account is a stark contrast to Feigenbaum’s later critical assessment of the institution, in the end Feigenbaum’s innovations led to his downfall: after a series of lectures on the unconscious, dreams, and the Freudian theory of neurosis, he was dismissed from his post. As Eran Rolnik puts it, this marked the ‘abrupt and early end to the first attempt … at a practical application of psychoanalytic theory’ in Palestine.70 More than this, it can hardly 65 66 67 68 69 70

President, Ezrath Nashim, to Director of Health, 19 October 1921, ISA M 6627/23. Dorian Feigenbaum, Ezrath Nashim, to Dr Briercliffe, Public Health Office, 13 January 1922, ISA M 6627/23. Director of Health to Director of the Public Works Department, 4 July 1922, ISA M 6627/23. Medical Director, Ezrath Nashim, to Principal Medical Officer, Jerusalem, 23 October 1922, ISA M 6627/23. Bulletin No. 20, for 1922, of the Home for Insane and Incurable founded by Esrath Nashim Society, Jerusalem (1923), ISA M 6627/23, p. 18. Eran Rolnik, ‘Between Ideology and Identity: Psychoanalysis in Jewish Palestine’, Psychoanalysis and History 4 (2002), p. 211.

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have inspired confidence that the government’s money was being put to good use by this private institution. While the Ezrath Nashim home clearly had problems, financial and otherwise, by the early 1920s, it seems to have been less hopeless than either Feigenbaum or George Heron, the director of health, represented. Feigenbaum’s motive in exaggerating the failings of his former employer is clear, but Heron’s criticism of the institution for its unjustifiable expenses too can be related to his career and worldview. Heron – who was to remain director of health for almost the entirety of the period – had been a physician in London before taking up a post with the government of British-ruled Egypt in 1908. That he came to Palestine in 1920 through the colonial service in Egypt was, as Marcella Simoni argues, not incidental to his attitude in his new role as director of health: rather than treating Palestine as a special case because of either the mandate or Zionism, he believed that the same standards and practices should be applied in Palestine as across the rest of the British empire.71 It is through that lens that the ‘excesses’ of this private Jewish mental institution, with its spiralling subsidies, renovations, and psychoanalytic flirtations, may have come to represent a good enough reason in Heron’s mind to sever the government’s connection with it. As we will see, his background in the colonial medical service may also explain his anxiety about ‘mixing’ Jewish and Muslim patients in this institution. Whatever lay at the root of Heron’s views, the perceived mismanagement of the Ezrath Nashim home posed a dilemma. Other institutions were allowed to simply fail: the general hospital at Tulkarm closed its doors in February 1925, when the municipality proved unable to contribute to its continued upkeep.72 But madness was different, not least because it always represented a potential threat to public order as well as a question of health, as Heron himself emphasised repeatedly in the early 1920s. It was a matter of ‘great urgency’ that ‘lunatics at large or confined in prisons … be properly accommodated’, as he put it, conjuring a calculatedly alarming vision of lunatics roaming the streets unchecked, threatening public safety.73 Given the rising cost of subsidies and the perceived mismanagement of the Ezrath Nashim home, the only option left was for the department of health to assume direct responsibility for the mentally ill by pushing ahead with the establishment of a government mental hospital, for which expenditure had already, after all, been approved. Rather than a result of any comprehensive plan for 71 72 73

Simoni, A Healthy Nation, pp. 200–1. Annual Report, Department of Health, 1925, p. 21. Director of Health to Financial Secretary, 17 October 1921, ISA M 6627/21.

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healthcare in Palestine, it was to save the government from ever more costly reliance on the Ezrath Nashim home that the first government mental hospital was established. This is a stark contrast with the existing scholarship on healthcare in mandate Palestine, which often offers a very different narrative: that it was the failings of the government’s provision that in part meant private Jewish provision expanded so dramatically over the 1930s and 1940s, in order to pick up the slack.74 In the 1920s, at least, it might be argued the reverse was true: it was the perceived shortcomings of private Jewish provision that prompted the entry of the government into this field. But what the department of health’s earliest interactions with the Ezrath Nashim home help illustrate is the extent to which the histories of private Jewish provision and colonial governmental provision for the mentally ill were intertwined. While a focus in the scholarship has been the gap in quality and indeed scale which opened up, especially over the course of the 1930s, between the more sophisticated private provision made by European Jewish psychiatrists and the always substandard, underfunded provision made by the mandate, for the 1920s at least a different story emerges. The two spurred one another on: by thrusting responsibility on the Ezrath Nashim home and enforcing Ottoman-era asylum regulations, the British drove the transformation of that private institution; in turn, attempts at reform within the Ezrath Nashim set alarm bells ringing within the department of health such that they moved to establish their own mental hospital, in a striking departure from their commitment to a policy of devolution in healthcare more widely. The Ezrath Nashim home was not the only institution to admit and care for the mentally ill in Palestine before the arrival of the British, nor was it the only one of those institutions to find itself in a closer relationship with the new government after the end of the war. While the British sought to devolve as much responsibility for health as possible to other actors, in the immediate aftermath of the war municipal hospitals were run as government hospitals and only gradually handed over to the municipalities across the early 1920s. Mission hospitals too found themselves under scrutiny. Late in 1925, for instance, the department of health stepped in when it emerged that the Sisters of St Vincent de Paul were treating patients at the convent’s clinic in Jerusalem with ‘poisonous drugs’ which, it was feared, the Sisters were ‘likely to misapply … with very disastrous consequences to the patient’.75 But although 74 75

See, for instance, Zalashik, Das Unselige Erbe, pp. 66–7. R. Briercliffe, Department of Health, to Senior Medical Officer, Jerusalem, 23 October 1925, ISA M 6588/17.

Orphans, Lunatics, and the Bethlehem Mental Hospital

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these other institutions had also played a role in managing the mentally ill in the late Ottoman period, it was to the Ezrath Nashim home alone that the British turned for a solution to the problem of the mentally ill, at least initially. In a sense, this is consistent with what Jacob Norris has identified as the key shift between development under the Ottomans and the British: whereas the world of Ottoman development was a mixed, multifarious one, the British focussed more exclusively on European Jews as agents of development in Palestine.76 But as the department of health’s attempts to end its dependence on the Ezrath Nashim home suggest, the story of health does not map neatly onto the story of development, and within the history of health, mental illness generated particular anxieties and specific responses. If inheritances from the late Ottoman period helped shape many aspects of British rule in Palestine, they mattered in different ways. In terms of mental illness, the endurance of institutions which had cared for the mentally ill before the war made it possible for the government to delegate responsibility initially, but ultimately it was the perceived breakdown in those arrangements that mattered, as a spur to the establishment of a government mental institution. The speed and sense of urgency with which the first government mental hospital was established can be seen, at least in part, as a result of this perception of crisis, but this was not the only dimension to this story. Nor was the Ezrath Nashim society the only actor with which the department of health had to negotiate in these early years. The question of where this new mental hospital was to be located also proved contentious and threw the department of health into a confrontation not just with other branches of the civil administration but international humanitarian organisations – as we shall now see. Orphans, Lunatics, and the Struggle over a Mental Hospital in Bethlehem One of the reasons the department of health was forced to tolerate the continued devolution of responsibility for the mentally ill to the Ezrath Nashim home, even as the cost of subsidies to the home spiralled, was the difficulty in identifying a suitable site for the proposed government mental hospital.77 But by 1922, the department of health had settled on an orphanage on the outskirts of Bethlehem and had made arrangements to lease it from the German missionary society which had built and run the institution and which still owned the site. The decision to convert 76 77

Norris, Land of Progress, p. 66. A/Director of Health to Treasurer, 19 August 1922, ISA M 6627/24.

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this orphanage into a mental hospital aroused fierce opposition from a strikingly broad coalition, including local society, branches of the British civil administration, and international humanitarian organisations. In the face of this opposition, and in particular calls for the orphanage to take in Armenian children displaced in the Ottoman wartime genocide, the department of health was pressed to articulate an ambitious vision of the nature of this mental hospital – and more than this, to counter perceptions of the mentally ill as ‘useless’ members of society. These confrontations, then, offer a window into the conceptualisation of mental illness in the early years of British rule in Palestine, a theme that will be developed further in the second chapter. The orphanage eyed up by the department of health in the early 1920s had been built by a German mission organisation, the Berliner Evangelische Jerusalem Verein, in 1896 to look after dozens of Armenian children orphaned and displaced in the massacres of that decade.78 Over the years, as the Armenian orphans aged out of the institution, the orphanage came to take in Syrian orphan children;79 in the immediate aftermath of the British occupation, it appears to have continued to operate as an orphanage for boys.80 The site itself is worth describing, not least because the contestation over its future and the department of health’s determination to make use of it cannot be understood without a sense of this location and its buildings. Hailed as ‘one of the best and most favourably situated buildings’ in Bethlehem,81 the orphanage was located just to the south-west of the town, on the road between Bethlehem and the nearby village of Artas, and consisted of a three-storey main building flanked by symmetrical wings and set in grounds of 20 dunums, or around 5 acres, of land. Photographs of the time make clear both its distance from the town of Bethlehem and its handsome construction, built using pale limestone.82 It was this stone – 78

79 80

81 82

Axel Meißner, Martin Rades ‘Christliche Welt’ und Armenien: Bausteine für eine internationale Ethik des Protestantismus (Münster: LIT Verlag, 2010), p. 308, f. 108. For the Hamidian massacres, see Stephan H. Astourian, ‘The Silence of the Land: Agrarian Relations, Ethnicity, and Power’, in Ronald Grigor Suny, Fatma Müge Göçek, and Norman M. Naimark, eds., A Question of Genocide: Armenians and Turks at the End of the Ottoman Empire (Oxford: Oxford University Press, 2011), pp. 55–81. Meißner, Martin Rades ‘Christliche Welt’, p. 143. Director of Health to Civil Secretary, 12 June 1922, ISA M 6617/15. The pastor of a nearby Lutheran church offered a slightly different account of the site’s history: see Judgment of the Land Court of Jerusalem, in case of Attorney General v. Deutsche Evangelische Verein, Land Case No. 35/44, 1948, ISA GL 16648/9. Minutes of Government Weekly Meeting, Jerusalem, 25 August 1922, ISA M 6617/15. See Figures 1.3 and 1.4. For a rich account of the types of stone used in Palestinian buildings in this area, see Tawfiq Canaan, ‘The Palestinian Arab House: Its Architecture and Folklore’, Journal of the Palestine Oriental Society 12 (1932), pp. 232–3. See also

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‘Jerusalem stone’ – that Ronald Storrs, the governor of Jerusalem in the immediate post-war years, mandated should be the face of all new buildings in the city in an edict of 1918, making local limestone the only material allowed on external walls within the vicinity of Jerusalem.83 Storrs also happened to be one of the most vociferous opponents of the orphanage plan. In April 1922, Storrs wrote furiously to the chief secretary of the government with a formal protest against the conversion of the orphanage into a lunatic asylum, in particular, and the placing of a lunatic asylum anywhere in Bethlehem, in general. The move was one he considered ‘unsuitable and prejudicial to the interests of one of the most important towns in my district and indeed of Palestine’.84 As well as the proprietorial manner in which Storrs wrote about Bethlehem, what is notable about this protest is its echo of the purpose of the Pro-Jerusalem Society, which Storrs had founded in autumn 1918: that is, ‘the preservation and advancement of the interests of Jerusalem, its district and inhabitants’.85 The contention that the use of this site as an asylum would not serve the interests of Bethlehem was not unique to Storrs, but there was a clear aesthetic as well as practical dimension to his protest. Storrs’ efforts to ‘preserve’ Jerusalem’s character led to aggressive interventions into the physical fabric of the city, reversing late Ottoman developments, in order to rework it to fit romanticised British notions of what the city should look like.86 It is hard not to see his rejection of the siting of an asylum in the vicinity of Jerusalem and Bethlehem as stemming from his circumscribed views about what was appropriate to the character of ‘his’ district, especially given that the building itself, no matter how recent in provenance it was, could otherwise be held up as a superb example of the stone-clad aesthetic he had made mandatory for all buildings in the vicinity of Jerusalem. The idea that mental illness might be a symptom of industrial modernity was a well-established one from the nineteenth century on; here, however, there is a sense that a site for the treatment of mental disease might also

83

84 85 86

Andrew Ross, Stone Men: The Palestinians Who Built Israel (London: Verso, 2019), p. 156. Yair Wallach, A City in Fragments: Urban Text in Modern Jerusalem (Stanford, CA: Stanford University Press, 2020), pp. 146–7; Eyal Weizman, Hollow Land: Israel’s Architecture of Occupation (London: Verso, 2007), pp. 28–9; Roberto Mazza, ‘“The Preservation and Safeguarding of the Amenities of the Holy City without Favour or Prejudice to Race or Creed”: The Pro-Jerusalem Society and Ronald Storrs, 1917–1926’, in A. Dalachanis and V. Lemire, eds., Ordinary Jerusalem, 1840–1940: Opening New Archives, Revisiting a Global City (Leiden: Brill, 2018), pp. 403–22. R. Storrs to Civil Secretary, 20 April 1922, ISA M 6627/24. Ronald Storrs, Orientations (London: Ivor Nicholson & Watson Limited, 1937), p. 265. Wallach, A City in Fragments, pp. 134–6.

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constitute something of a loss of innocence, an unwelcome breach by modernity into a supposedly biblical environment. Storrs was not the only opponent of the orphanage plan, nor its most dogged critic. Shortly after Storrs registered his own formal protest, Harold McAfee, the Beirut director of the American humanitarian organisation Near East Relief, approached the government in Palestine for permission to take charge of the site to accommodate some of the 100,000 orphans which the organisation found in its care after the First World War.87 Given that many of these orphans were Armenian, McAfee presented Near East Relief’s proposed takeover of the Bethlehem site, ‘built by benevolent contributions contributed specifically for the erection of an Armenian orphanage’, as a fitting return to its original purpose.88 He was deeply dismayed to learn the government planned to convert it into a mental hospital, and across the rest of the year McAfee sought to reverse this decision. He argued, in a meeting with the chief secretary in the summer of 1922, that ‘alienating a building, the original purpose of which was to support and educate orphans to be useful members of society in order to house forty individuals who were incapable of being useful citizens, was not a policy in keeping with the interests of the country’.89 McAfee’s insistence was one born in part of desperation. In 1922, Near East Relief was urgently seeking a new place of refuge for Armenians who had already been repatriated in the immediate aftermath of the First World War to French Cilicia in southern Anatolia, but who had been displaced once again in 1920 when Turkish forces under Mustafa Kemal drove out the French, captured Marash, and massacred thousands of Armenians in the city.90 But his insistence on the value of supporting and educating orphans also spoke to a wider shift in the aims of Near East Relief. Originally founded to provide immediate relief in the form of food during the war, after 1918, as Keith Watenpaugh has argued, the organisation developed a more far-reaching vision of humanitarianism, which went beyond fixing immediate suffering to reforming social and political systems across the region.

87

88 89 90

This was typical of the approach of Near East Relief: by 1920, Near East Relief had already been granted the use – for free – of another former German orphanage, this time in Jerusalem. See James L. Barton, Story of Near East Relief (1915–1930): An Interpretation (New York: Macmillan, 1930), p. 214. H. B. McAfee, Managing Director, Near East Relief Committee at Beirut, to Civil Secretary, 5 May 1922, ISA M 6617/15. Minutes of Government Weekly Meeting, Jerusalem, 25 August 1922, ISA M 6617/15. Keith Watenpaugh, Bread from Stones: The Middle East and the Making of Modern Humanitarianism (Berkeley: University of California Press, 2015), p. 113.

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And at the heart of this more expansive project was the rearing, by Americans, of a transformational new generation of orphans.91 While Near East Relief had a particular stake in the question of the support and education of orphans, their strategy of contrasting ‘useless lunatics’ with orphans who could go on to make valuable contributions to society resonated within the government of Palestine. This was not least because, as Emily Baughan notes, this was a transitional moment in British imperial politics, within which humanitarian work on behalf of children was folded into a post-war reconceptualisation of empire as a moral force.92 No such moral cachet was attached to supporting lunatics, a term left undefined but which here was nonetheless clearly understood as denoting those suffering severe and untreatable afflictions of the mind. At a meeting of high-ranking British officials convened in Jerusalem in August 1922, then, when McAfee’s criticisms were relayed, they found support among a number of those present. Norman Bentwich, attorney general, agreed ‘[i]t seemed a pity that the orphans should suffer for the advantage of lunatics, who could be accommodated anywhere’. While the chief secretary distanced himself from McAfee’s description of lunatics as ‘useless’, he nevertheless was sympathetic to the use of ‘the expression to contrast the lunatics with the orphans as the two were at opposite ends of the social scale’. Moreover, he noted this was a position shared by the people of Bethlehem, whom he described as ‘averse to an asylum being installed in what was perhaps one of the best and most favourably situated buildings in their town and this in place of a useful institution such as the orphanage’.93 This was the only time local opinion was raised in relation to the proposed conversion of the orphanage; much more attention was given to critiques from other branches of the government and from Near East Relief than Bethlehemites themselves. As these comments make clear, the conversion of the Bethlehem orphanage into a mental hospital revealed not only a fault line in the relative valuation of orphans and lunatics, but deeply divergent understandings of the mental hospital itself. It was not only orphans but the orphanage which were figured as useful, and it was not only lunatics but the mental hospital – or asylum, the older term deployed by many of these 91

92

93

In practice, Watenpaugh notes, most of the care and education of Armenian orphans was done almost exclusively by Armenian professional teachers and administrators, rather than Americans (Ibid., pp. 116–17). Emily Baughan, ‘“Every Citizen of Empire Implored to Save the Children!” Empire, Internationalism, and the Save the Children Fund in Inter-war Britain’, Historical Research 86, 231 (2013), pp. 119, 130. All quotes from Minutes of Government Weekly Meeting, Jerusalem, 25 August 1922, ISA M 6617/15.

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officials – which were dismissed as useless. This dismal view was not atypical: it reflected wider pessimism by the early twentieth century about the curability of the mentally ill and the therapeutic value of institutions which had become silted up with incurable cases across the preceding century.94 But J. W. P. Harkness, standing in for the director of health at this meeting, offered a forceful counterargument. Far from patients at the hospital being ‘useless members of society’, he contended that ‘it was expected, with the facilities afforded by adequate accommodation, to have a reasonable percentage of cures’. Indeed, even while still patients in the institution, he noted, they would be employed in different forms of work which would in turn help support the running of the hospital and reduce the cost to government. And far from accepting Bentwich’s argument that lunatics could be accommodated anywhere, he argued that ‘the modern principles of treatment required that if insane people were to be treated with any hope of cure they must be accommodated and treated under the best conditions possible’. Bentwich’s response was revealing: ‘this was all right in a civilised country’ – the implication being that for a country like Palestine, it was an unaffordable extravagance. It was not simply divergent understandings of the mental hospital at stake here. This was also a debate, at a formative moment for British rule in Palestine, over the nature of that rule. Was the purpose of British rule in Palestine to ‘preserve’, as Storrs would have it, and adapt and indeed lower expectations to fit the perceived requirements of the country, as Bentwich was suggesting? Or was British rule to strive to reproduce standards imported from Britain itself, as Harkness contended in outlining his vision of a modern mental hospital, and as the mandate itself, formalised just a month earlier by the League of Nations, with its injunction to progress under European ‘tutelage’ might have been taken to mean? In the end, and in the face of such opposition, the department of health had to marry this argument about the recoverability of the mentally ill if given proper treatment to a warning about the danger posed by lunatics left at large, suggesting their inability to force any consensus on the nature of British rule in Palestine. Citing an incident from 1921, in which several people had been killed, and others wounded, ‘through the action of a person of unsound mind’,95 Harkness sought to alarm the government into supporting the department of health’s plan. Yet, his appeal to security concerns sat uneasily with his emphasis on treatment and recovery, rather

94

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Andrew Scull, Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine (Princeton, NJ: Princeton University Press, 2015), pp. 224–67. All quotes from Minutes of Government Weekly Meeting, Jerusalem, 25 August 1922, ISA M 6617/15.

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than restraint and criminality, a contrast that serves to underline what was distinctive about mandate Palestine. Across other British colonies in the early twentieth century, provision for the mentally ill grew out of the prison system, with the first asylums little more than prison annexes instituted to separate out the insane from the sane.96 By contrast, in Palestine the government approached the question of provision for the mentally ill as a matter for the department of health from the beginning, with provision for ‘criminal lunatics’ only developed years later.97 This was an attitude shaped at least in part by advice from colonial medical authorities in Egypt, whom the early department of health in Palestine consulted extensively on the establishment of the first government mental hospital. Their guidance was very clear: asylums should be attached to hospitals, rather than prisons, to eliminate the stigma associated with being certified as a lunatic. De-stigmatising admission to asylums would encourage people to come forward sooner for treatment, allowing for earlier, and possibly more effective, interventions.98 The invocation, then, of the mentally ill who committed acts of violence – the kind of ‘lunatic’ that McAfee, Bentwich, and others had in their minds when they used the term – should be understood as strategic, a move made by the department of health to outmanoeuvre opposition, but one that sat uncomfortably with its wider effort to treat mental illness firmly as a health, rather than criminal, issue. The department of health ultimately carried the debate, securing the site for a government mental hospital. The opposition generated by this plan may have failed to derail the conversion of the site, but it was not entirely without effect: it forced the department of health to articulate, more explicitly than might otherwise have been the case, a vision of the government mental hospital as a place of cure rather than mere confinement, and thus as requiring not just any old site – as both McAfee and Bentwich proposed – but a spacious, open, attractive site in which patients had a hope of recovery. While Feigenbaum presented the British as straightforwardly bringing modern psychiatry with them to Palestine, the controversy which surrounded the first government mental hospital suggests that even at the highest rungs of the new government, there were divergent views about quite what a mental hospital was, and whether one was, in fact, suitable for Palestine.99 96

97 98 99

Vaughan, ‘Idioms of Madness’, p. 219; Lynette A. Jackson, Surfacing Up: Psychiatry and Social Order in Colonial Zimbabwe, 1908–1968 (Ithaca, NY: Cornell University Press, 2005), pp. 53–4. See Chapter 5. ‘A Scheme for Lunacy in Egypt’, forwarded by Dr Warnock, Lunacy Division, Government of Egypt, to Director of Health, 8 December 1921, ISA M 6627/24. Similar debates took place within colonial psychiatry in other contexts. See for instance Fryar, ‘Imperfect Models’.

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The department of health, in spite of the urgency of the need to find an alternative to the Ezrath Nashim home by 1922, was determined that the right site be acquired for a proper mental hospital, even if it meant confronting a coalition of actors within and beyond the government who opposed their plan. In one sense, this commitment to an ambitious vision of a mental hospital in Palestine, while clearly deeply held enough to ensure the department fought off opponents, seems at odds with the highly critical attitude Heron had adopted towards the – in his view – unwarranted, excessive undertakings of the Ezrath Nashim home the previous year. Was the department’s own scheme, as government officials like Bentwich had suggested, not also open to the same criticism, as inappropriate, excessive? In another sense, however, both the department’s frustration with the Ezrath Nashim home, and their determination to acquire this site, can be seen as consistent: it was precisely the fundamental issue of siting which made, on the one hand, the

Figure 1.3 Photograph of the ‘German’ [Jerusalem Verein] orphanage at Bethlehem, before the First World War. From the Hallwyl Museum Collection, Inventory Number LXVI: N.78.

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Figure 1.4 Photograph of Bethlehem from the west, with the buildings of the Jerusalem Verein’s Armenian Orphanage visible on the left of the image, dated 1898. From the Eric and Edith Matson Photograph Collection, Library of Congress.

Ezrath Nashim home, located in the most important and busiest extramural area of Jerusalem, an unfit site for expansion and, on the other hand, the German orphanage outside Bethlehem a suitable site for investment. The department’s aspirational vision of this mental hospital should be taken seriously – no matter how short of that ideal the reality subsequently fell, as we shall see later in this chapter.

From Monastery to Mental Hospital All places that had been ‘adapted’ for the habitation of the insane were closed, and endeavours were made to treat the patients by modern methods. Among the asylums that were closed, the most noteworthy was perhaps the el Khadar cloister, dedicated to Elijah, and located near the Ponds of Solomon, not far from Jerusalem.100 100

Feigenbaum, ‘Palestine Must Have Sound Nerves’.

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Before we turn to explore the early years of its life, there is a third and final dimension to the story of the founding of the first government mental hospital, one that returns us to the question of non-medical ‘alternative’ modes of understanding and treating mental disease which Feigenbaum, Waldmeier, and others emphasised in their writings for western audiences. In Feigenbaum’s telling, it was not just the inadequate Ezrath Nashim home that was eclipsed by the British arrival into Palestine. The new government also moved to close down those abusive, ‘superstitious’ methods of treatment meted out by priests, shaykhs, and others in the region. But as with much of Feigenbaum’s account, this narrative of transition – in which mental illness was displaced from the domain of religion to the domain of science – does not quite capture what happened to non-medical methods of treatment in the first years of British rule in Palestine. The first government mental hospital, with its suggestive proximity to a monastery of St George that had previously received and treated the mentally ill, here acts as a point of departure for thinking differently about the relationship between these purportedly oppositionary traditions, as blurring into rather than always competing with one another. While Palestinians had recourse to a number of medical institutions – general or specialist, governmental or missionary, in Palestine or further afield – when mental illness appeared in their midst in the decades before the First World War, their options also included non-medical, as well as medical, remedies. Feigenbaum’s myopic focus on superstition prior to the arrival of the British is misleading, but much of what he has to say about the non-medical treatment of the mentally ill finds corroboration in other accounts from the time itself. As the Arabic aphorism has it, aljunun funun: madness takes many forms. Thus alongside both an older humoral understanding of forms of mental illness like melancholia, and the naturalistic account of mental disease elaborated in the pages of journals like al-Muqtataf in the late nineteenth century, the idea that supernatural agents – above all the jinn – might be responsible for madness continued to hold purchase. The line between different states was not always clearly demarcated, as Sara Scalenghe highlights: while one might be recognised as a ‘holy fool’ (majdhub) – a saintly individual with a special connection to the divine and the capacity in some cases even to perform miracles – it was equally possible to be dismissed as insane, or denounced as a heretic; the boundaries between these states were blurred in practice.101 And far from these beliefs being confined to

101

Scalenghe, Disability in the Ottoman Arab World, p. 123.

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the ‘ignorant’ peasantry, James Grehan notes that spirits were judged real enough for jurists to debate and make rulings against the legality of marriages with jinn.102 Just as humoral or naturalistic understandings of mental disease shaped medical treatment, so too did these beliefs in the supernatural origins of some mental illnesses, documented in folklore research by European and North American visitors as well as by Palestinian ethnographers in the interwar years, shape treatment. The American Ada Goodrich-Freer, who arrived in Jerusalem in 1901 and was herself a psychical researcher, elaborated on this. The Muslims of Palestine, she wrote, ‘assume (who knows with what justice?) that insanity is due to the presence of an evil spirit’, and that as a result ‘their treatment is based on the theory of exorcism, of making his tenement unpleasant’. She described how the insane were ‘sometimes shut up under the Haram area, or chained to a pillar in the church at al-Khader, or sent to the cave of Elijah’. At these sites across Palestine, she wrote, the ‘awful sacredness of the place’ might well shock them out of their insanity.103 While we might expect Goodrich-Freer – spiritual medium and psychical researcher – to be less sceptical of a form of treatment that relied on supernatural agency, Thomas Chaplin, trained as a medical doctor, reached a similar conclusion: he suggested that this treatment worked in the same way any sudden fright might, ‘producing a kind of shock to the nervous system which proves beneficial’.104 Chaplin was not alone in giving a medical rationalisation of this treatment. Writing for a psychiatric medical journal in the 1880s, the French psychiatrist JacquesJoseph Moreau described the treatment of the insane at the monastery at al-Khader, to the south-west of Bethlehem, a site noted by GoodrichFreer too. Moreau emphasised the similarities between the treatment meted out by the Orthodox monks at al-Khader, and the ‘moral treatment’ advocated by the psychiatrist François Leuret, who had died in 1851. Both, in Moreau’s view, relied on a similar agent to prompt change and healing: fear.105

102 103 104

105

James Grehan, Twilight of the Saints: Everyday Religion in Ottoman Syria and Palestine (Oxford: Oxford University Press, 2014), p. 147. Goodrich-Freer, Inner Jerusalem, p. 243. Thomas Chaplin, cited in P. J. Baldensperger, ‘Orders of Holy Men in Jerusalem (Answers to Questions)’, Quarterly Statement of the Palestine Exploration Fund 26, 1 (1894), p. 36, fn. 1. For Chaplin, see Perry and Lev, Modern Medicine in the Holy Land, p. 72. Edward M. Brown, ‘François Leuret: The Last Moral Therapist’, History of Psychiatry 29, 1 (2018), pp. 44–7.

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Three or four times a day a Greek monk armed with a stout cudgel presents himself to the lunatic and interrogates him. If the responses are sensible, then the monk withdraws and the lunatic has not long to wait to regain his liberty, but if the responses are not sensible, and as many times as they are repeated, the unfortunate lunatic receives a strong blow from the therapeutic stick [du bâton thérapeutique]. Quickly the lunatics become fearful of this treatment; fear being the beginnings of wisdom, their responses become sensible. After about fifteen days, he is most often cured.106

Leuret was widely discredited within French psychiatry, and so Moreau’s reference appears to have been a joke at his expense, pointing out the proximity between Leuret’s ‘moral treatment’ and the methods employed by monks in the Levant, rather than an attempt to take the latter more seriously by pointing out its resonances with respected French psychiatric practices. But taken together, this odd trio of commentators – Goodrich-Freer, Chaplin, and Moreau – blurs the boundaries between the medical and the non-medical treatment of the mentally ill. Two of the sites noted by Goodrich-Freer appear to have been especially important to the miraculous treatment of the mentally ill in late Ottoman Palestine, both of them linked to al-Khidr, the ‘evergreen one’, a figure particularly revered by Sufis and identified with the Prophet Elijah by Jews and Muslims and with St George by Christians.107 The cave referenced by Goodrich-Freer is Elijah’s cave on Mount Carmel, Haifa, which she elsewhere described as being ‘resorted to by all classes, sects, and nationalities’ for its power.108 The other, as we have seen, was the monastery of St George in the village of al-Khader near Bethlehem. While far from the only important site for the healing of the insane in Palestine, the monastery at al-Khader attracted much comment, both before and after the First World War. In the 1920s, the Palestinian medical doctor and folklore researcher Tawfiq Canaan wrote about the monastery in his magnum opus, Mohammedan Saints and Sanctuaries in Palestine, and before that, in a series of articles for the journal of the Palestine Oriental Society, established in 1920 to promote archaeological, historical, and anthropological research in Palestine. Drawing on notes taken by his father about the monastery, Canaan described how the insane were restrained with chains in the belief that, once cured, St George himself would release them. While recounting the story told to his father by a priest, in which St George appeared to one of the sick as a

106 107 108

Jacques-Joseph Moreau (de Tours), ‘Notes sur les asiles d’aliénés en Orient’, Annales Médico-Psychologiques 5 (1887), p. 310. See Grehan, Twilight of the Saints, p. 158. Ada Goodrich-Freer, ‘The Powers of Evil in Jerusalem’, Folklore 18, 1 (1907), p. 69.

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gentle-looking man riding a horse and carrying a spear, Canaan himself gave a more sceptical account of how this ‘miraculous’ cure worked: The patients received no medical treatment at all, but had to be cured by the miraculous intervention of St George. The head of the church found it very often necessary to hasten the cure by driving out the devil. This was done by thorough beating and prayers. No wonder that these poor creatures were furious when the priest fell into their clutches. Whenever a patient’s condition got somewhat normal the priest secretly unfastened the chain from the church, and told the patient that the saint declared him cured. Only a simple straw mattress was given them. The two who were bound in front of the church had not the least protection from the frightful summer heat or the cold of the winter. Their food consisted of bread – sometimes very hard – and water. Both were given to a very limited extent. The odour of their evacuations used to make the place unsupportable.109

But the monastery, Canaan continued, had been renovated shortly before the outbreak of the war, and the treatment of the insane had improved significantly. A sanatorium had been built a short distance from the church, comprised of ‘good rooms’ with hygiene ‘in every respect better’, though the method of treatment remained fundamentally the same: each room came equipped with a chain that connected, either physically or symbolically, the ‘patient’ to the saint’s sanctuary so that miraculous cures could continue to be worked. In spite of these changes, Canaan confirmed what Feigenbaum also reported: that ‘[t]he present government has forbidden the acceptance of [the] insane in this place’.110 Stephan Hanna Stephan, a civil servant in the new mandate government as well as an archaeologist, curator, and folklore researcher, also wrote about the monastery, reporting that under usual conditions an individual would be ‘healed’ in just a matter of weeks. But now, he noted, ‘this practice has ceased and the government has a lunatic asylum near Bethlehem which employs modern methods’.111 The termination of this practice was noted almost in passing in both Canaan and Stephan’s writings; indeed, reduced to a footnote in the former’s. It is difficult, moreover, to find references to the forbidding of this practice in the colonial archive either. Douglas Duff, stationed in Palestine from 1922, recounted in his memoirs that he had seen ‘some extraordinary cases where cures were effected’ at the monastery of St George near Bethlehem, so it may be that the ban on receiving the insane at al-Khader was not put in place until the middle of the 1920s, 109 110 111

Tawfiq Canaan, ‘Mohammedan Saints and Sanctuaries in Palestine (Continued)’, Journal of the Palestine Oriental Society, 5 (1925), pp. 201–2. Ibid., pp. 200–2. Stephan Hanna Stephan, ‘Lunacy in Palestinian Folklore’, Journal of the Palestine Oriental Society 5 (1924), p. 9.

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rather than immediately – or that it only gradually became effective.112 But it is not clear. While the case of the monastery at al-Khader would seem to follow the contours of the story outlined by Eugene Rogan, which we encountered earlier, of a European attempt since the late nineteenth century to wrest control over the mentally ill in the Levant from the hands of ‘men of religion’ to ‘men of science’,113 the lacunae in the colonial archive around this story suggest a lack of real or sustained interest in this endeavour on the part of the mandate government. The government’s investment in psychiatry in Palestine was uneven: in spite of the department of health’s ambitious vision of the mental hospital as a site of cure rather than merely confinement, they were markedly less interested in drawing attention to their closure of alternatives or indeed evangelising about psychiatry to the population of Palestine. The picture we are left with, then, is not of a decisive or deliberate break with the past, but instead a period in which different modes of treatment appear to have coexisted, if uncertainly. This sense of ambiguity comes across most clearly in a list put together by Canaan in the mid-1920s of sanctuaries associated with al-Khidr: one site in Nablus was clearly no longer in use (‘Mentally diseased persons used to be fastened here with iron chains’); a second site in Nablus seems to have been still in use (‘The ill take a bath in this basin on Friday, believing that this will cure them’); and in a third, it was left unclear (‘There is a chain for the majanin’).114 This sense of ambiguity only deepens when we shift our focus from sites to people. The mandate government certainly intervened to clamp down on those offering more alarming forms of non-medical treatment for mental illness. When a Lebanese man, Salim Abdu Harb, appeared in Jerusalem in the middle of the 1930s promising to cure the insane by branding a cross on their foreheads, he was arrested for practising as a doctor without a licence.115 Yet exorcisms continued to be performed by other methods in the mandate period. The Dominican priest Antonin Jaussen wrote about one famed performer of such exorcisms, the Nabulsi shaykh Sa’ad al-Din, in 1923.116 Jaussen had interviewed Sa’ad al-Din a number of times over the course of the year, and the shaykh explained how he healed the sick,

112 113 114 115 116

Douglas V. Duff, Bailing with a Teaspoon (London: John Long, 1953), p. 144. Rogan, ‘Madness and Marginality’, p. 104. Canaan, ‘Mohammedan Saints and Sanctuaries’, pp. 199–200. See Palestine Post [PP], 17 March 1935, p. 5 and PP, 25 March 1935, p. 5. For Jaussen, see G. Chatelard and M. Tarawneh, eds., Antonin Jaussen: sciences sociales occidentales et patrimoine arabe (Beirut: Centre d’études et de recherches sur le moyenorient contemporain, 1999); Roberto Mazza and Idir Ouhes, ‘For God and La Patrie: Antonin Jaussen, Dominican Priest and French Intelligence Agent in the Middle East, 1914–1940’, First World War Studies 3, 2 (2012), pp. 145–64.

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particularly those whose sickness was a result of possession by jinn, by writing the names of Allah on paper as well as on the body of the possessed. While many came to him at Nablus, he also travelled to treat the sick: from Jaffa, where he cured one woman who had been sick for over three years, to the other bank of the Jordan, where he cured six people in and around Amman and Salt. His renown was such that before the war, the Ottoman authorities had reportedly brought the mentally ill to him to be treated. ‘The current government does not allow him the same liberty’, Jaussen noted dryly, but this did not seem to have dented his business. As he continued: ‘I met at his house a madman originally from a neighbouring village: he had been sent by the president of the municipality.’ Even as Jaussen sat with the shaykh, numerous people – men and women – approached him for help with various problems.117 That the arrival of the mandate government did not mark a sharp break with ‘alternative’ approaches to the question of mental illness is clear; given the state’s limited resources and, indeed, apparent interest in this question, the enduring popularity of these forms of treatment into at least the interwar years should hardly come as a surprise. While it is possible to frame this as a failed or incomplete transposition of the question of mental illness from the domain of religion to science, it is not clear these terms would have necessarily been meaningful, or the line between them sharp, to those who actually sought help with mental illness in the late Ottoman and early mandate years. Just as some medical doctors attempted to rationalise the working of treatments at sacred sites, so too do the families of the mentally ill appear to have blurred the lines between medical and non-medical treatments across the region. Early reports from ʿAsfuriyyeh, for instance, emphasise how many of the patients arriving at the hospital bore signs of having suffered abusive treatment at the hands of men of religion before their admission.118 But the reverse also happened. Just as many came to ʿAsfuriyyeh after failing to find relief at the hands of men of religion, those who consulted Sa’ad al-Din, for instance, sometimes turned to the shaykh after doctors failed them. Jaussen relates the story of one woman, Farizah, gravely ill for seven months, who had consulted all the doctors of Nablus before 117

118

J. A. Jaussen, ‘Le cheikh Sa’ad ad-din et les djinn, à Naplouse’, Journal of the Palestine Oriental Society 3, 4 (1923), pp. 145–57. For more, see Chris Sandal-Wilson, ‘Ethnographies of Madness: Père Antonin Jaussen, Shaykh Sa’ad al-Din, and the Management of Mental Illness in Mandate-Era Nablus’, in Sarah Irving, ed., The Social and Cultural History of Palestine: Essays in Honour of Salim Tamari (Edinburgh: Edinburgh University Press, 2023), pp. 142–72. Elihu Grant, The Peasantry of Palestine: The Life, Manners and Customs of the Village (Boston: Pilgrim Press, 1907), p. 98.

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being brought to Sa’ad al-Din; the shaykh immediately recognised the work of the jinn and drove them out, healing her.119 For the families of the sick, even if they distinguished between the methods used by mental hospitals and monasteries, doctors and shaykhs, this did not prevent them from shopping around for a cure for their relative’s mental ailments. Their options were seldom plotted out by a medicalised model of cure or confinement alone. Even the ban imposed on accepting the insane at the monastery at alKhader, which might look like a clear-cut case of state-sanctioned medical science supplanting popular religious practice, can be given a different reading when set alongside the government’s decision to establish the first government mental hospital near Bethlehem, within walking distance of the monastery. In many ways, the site made sense practically: the town was centrally located, just a twenty-minute journey by motor car from Jerusalem; it enjoyed a good water supply; the climate of Palestine’s hilly interior was judged superior to that of the coastal plain; and a handsome, spacious site was available.120 But it was certainly not the path of least resistance, as we saw. While part of the department of health’s determination to use this site in spite of opposition can be related to these practical considerations, and their ambitious vision of what this mental hospital should be like, it is nonetheless intriguing that the first government mental hospital was established just a mile or so from a site to which the insane had long been brought for treatment by Palestinians, a site that had – according to Canaan and others – just itself undergone a dramatic transformation to better accommodate the mentally ill. Was the department of health’s fixation on this site in part an attempt to feed off more established strategies for managing the mentally ill, to cannibalise rather than simply displace? This overlap in the geography of the medical and the sacred is not unique to Bethlehem or Palestine: in Lebanon, for instance, the Psychiatric Hospital of the Cross was established in 1937 on a hill outside Beirut known locally as ‘the possessed mount’, and already the home of a Capuchin convent.121 While there is no explicit reflection on this overlap in the colonial archive, such striking proximity would have been difficult to overlook by those – 119 120

121

Jaussen, ‘Le cheikh Sa’ad ad-din’, pp. 151–2. All these criteria would be repeated in discussions about building a new mental hospital at the end of the 1920s. See Memorandum on Mental Hospital Construction by Director of Public Works and Acting Director of Health, 4 October 1928, British National Archives [BNA] CO 733/155/13. Elias Aboujaoude, ‘The Psychiatric Hospital of the Cross: A Sane Asylum in the Middle East’, American Journal of Psychiatry 159, 12 (2002), p. 1982. I am grateful to an anonymous reviewer of the Jerusalem Quarterly for bringing this parallel to my attention.

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patients as well as families – who made the journey to and from the hospital after 1922, as they retraced many of the same well-known steps that had been taken for generations by pilgrims seeking cure from al-Khidr. But in addition to geographic proximity, and routes to the hospital layered with other meanings and memories, there is a further way we might think of the overlap between the world of psychiatry and alternative worlds in which jinn are agentive and exorcisms effective, this time within the space of the hospital itself. As we have seen, to go to a mental hospital or consult a doctor did not necessarily require a disavowal of the supernatural; patients and their families might cycle between doctors and shaykhs, hospitals and shrines, all the while carrying their own understandings of their condition with them. Just as sacred caves were given medical rationalisations, so too should we consider how the space of the mental hospital could be invested with otherworldly meaning by those who occupied it. At the government mental hospital, like other contexts examined by medical anthropologists, patients who suspected their condition could be a result of the work of jinn, might ‘experience spectrality in medical encounters, as well as ambiguous cohabitations with human and jinni others’. Rather than a break with a superstitious past, as Feigenbaum and others might have it, we may think of mental hospitals as a haunted space; ‘not as rational, modern, and futureoriented institutions, but as multidimensional and multi-temporal spaces in which other worlds and neglected histories push through and demand attention’.122 Patients whose bonds to the jinn had, as anthropologist Stefania Pandolfo evocatively puts it, ‘encysted’ – forming ‘an otherness that has become an unrescindable part of [the] self’123 – transformed the space of the hospital. But this commingling of the medical and the otherworldly may have drawn strength from other, more surprising sources: in particular, the use made by doctors, nurses, and other hospital staff of the term majnun,124 a term for the mad etymologically inseparable from its connection to the jinn. The establishment of the first government mental hospital in 1922, far from being the first encounter between Palestine and modern psychiatry, sat instead at the interstices of a much more complex set of interactions: between the new British regime and its multiple Ottoman inheritances; between the department of health, other branches of government, and 122 123 124

Emma Varley and Saiba Varma, ‘Spectral Ties: Hospital Hauntings across the Line of Control’, Medical Anthropology 37, 8 (2018), p. 631. Stefania Pandolfo, Knot of the Soul: Madness, Psychoanalysis, Islam (Chicago: University of Chicago Press, 2018), p. 98. Certainly, the medical officer in charge of the government mental hospitals at Bethlehem, Dr Malouf, used this term and its derivatives. See ‘Dr Malouf Speaks with Us about the Mad’, Filastin, 29 October 1932, p. 2.

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international humanitarian organisations; and between psychiatric modes of treatment and alternatives, diversely understood. These shaped the government mental hospital and the approach of the department of health more broadly, in numerous ways, from the urgency that surrounded the hospital’s opening, to its siting and how its purpose was defined and articulated. In the final part of this chapter, we turn our focus inwards, for a sense of what this institution would have been like across its first decade of operation, and for the start of a sense too of the staff and patients whose lives hinged, in one way or another, on the first government mental hospital at Bethlehem.

Staff and Patients at the First Government Mental Hospital What would it have been like to live and work at the first government mental hospital in the 1920s? Over the first year or so, and indeed at intervals beyond that, it would have felt like a construction site: the amount of work needed to convert it was substantial and ongoing when the first patients were admitted towards the end of 1922, and across the decade further work and extensions would have meant more disruption. Indeed such was the unfinished state of the hospital when it opened that initially only male patients could be admitted, with work finished on a separate wing for female patients only in July 1923.125 In the meantime, patients remained at the Ezrath Nashim home, with the subsidy to the institution even increased in April 1923.126 It was not only the physical fabric of the hospital, from security to sanitation, being refigured in these early years. Both the staffing and the patient population of the hospital were in flux across these years, with two major developments: the appointment, in 1925, of Dr Mikhail Shedid Malouf as medical officer in charge of the hospital; and a gradual shift in patient demographics as increasing numbers of Jewish patients were admitted to the hospital. When the government mental hospital first opened, it was run by a British matron, heading a staff that consisted of six nurses, six tamurgis – that is, medical orderlies – and ten servants.127 But the staff appeared to struggle, with the matron described as ‘having a very difficult task with the semi-trained staff at her disposal’128 in these years. In the face of 125 126 127 128

Director of Health to President, Ezrath Nashim, 9 June 1923, ISA M 6627/21. Director of Health to Treasurer, 20 April 1923, M 6627/21. Director of Health to Quartermaster, Medical Stores, 21 September 1921, ISA M 6606/18. J. W. P. Harkness, Department of Health, to H. W. Dudgeon, Khanka Asylum, sent as enclosure on 19 October 1922, ISA M 6627/24.

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these teething problems, the department of health looked to the colonial medical service in Egypt, and in particular the director of the Khanka asylum, Dr H. W. Dudgeon, for guidance. This is unsurprising: George Heron, the director of health, had served in the public health department of Egypt for nearly a decade before joining the Egyptian expeditionary force in the First World War and making his way to Palestine. As well as being asked for advice about the lock-and-key system to be used in the new mental hospital,129 colonial medical authorities in Egypt were approached in the hope of bringing experienced staff from the asylums at ʿAbbasiyya and Khanka to work in Palestine;130 when this plan fell through, staff at Bethlehem were sent to Egypt to receive training as mental hospital attendants.131 But there was a particular problem finding suitable senior staff for the hospital, either from Palestine or Egypt. The issue, at least as Dudgeon saw it, was the fact the hospital was headed by a matron: ‘none of my men have been trained to petticoat government and the East resents it’.132 The Palestine department of health appears to have accepted this assessment, and appointed a medical officer to take charge of the government mental hospital, with the British matron subordinated to him. Initially, this position was occupied by the Armenian physician Dr Khatcher H. Kesheshian, but he was moved into schools and prisons by 1925,133 and in November 1925, Dr Mikhail Shedid Malouf was placed in charge of the hospital.134 He would remain in post right up until the very eve of the end of the mandate. Malouf is thus a central figure in the history of psychiatry in British mandate Palestine, and indeed this book, and a brief detour is more than justified for his biography. Malouf had not been born in what became mandate Palestine, but rather in Kfar ʿAqab in Mount Lebanon in 1894. This seems to have mattered: early reports on the department of health within the Arabic-language press in Palestine referred to him as being Syrian, by contradistinction to European and Palestinian employees, in a breakdown of the department’s demographics in 1924.135 And when he took leave, it seems he returned to Lebanon.136 But it is important to remember that Malouf and his Palestinian colleagues would nonetheless

129 130 131 132 133 134 135 136

John Warnock, ʿAbbasiyya, to Director of Health, 8 December 1921, ISA M 6627/24. H. W. Dudgeon, Khanka Asylum, to Director of Health, 1 May 1922, ISA M 6627/24. Palestine Agent in Cairo to Director of Health, 15 August 1922, ISA M 6627/24. H. W. Dudgeon, Khanka Asylum, to J. W. P. Harkness, Department of Health, 24 October 1922, ISA M 6627/24. Khatcher H. Kesheshian, Annual Confidential Report, 1931, ISA M 5131/20. Annual Report, Department of Health, 1925, p. 1. Mir’at al-Sharq, 27 September 1924, p. 1. As reported, for instance, in Sawt al-Sha’ab, 10 July 1929, p. 3.

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have had much in common, not least their education. Malouf studied medicine at the Syrian Protestant College – as the American University of Beirut was then known – graduating in 1916 and continuing on to the Imperial Medical School in Istanbul.137 This was a typical itinerary for university-trained Palestinian medical doctors too.138 While Michael Provence has noted how shared education, experiences, and social worlds knitted together a last Ottoman generation of military and political leaders across the fragmented region in the mandate era,139 many of the doctors employed by the health department in British mandate Palestine represented another layer to the last Ottoman generation – one which shared not only an education and profession but, as members of an emergent late Ottoman middle class, consumption habits, aesthetic preferences, and social mores too.140 Though it is difficult to get much sense of Malouf’s social or personal life,141 the magazine of the American University of Beirut’s alumni association, al-Kulliyah, reveals that at least until the mid-1930s he was assiduous in keeping up links with his alma mater, informing them of career developments like his appointment to the Bethlehem mental hospital, regularly returning to visit and attend commencement exercises while spending his annual leave in Lebanon, and making the occasional financial contribution too.142 These links, forged in the late Ottoman period, appear to have mattered more to him than any sense of solidarity with colleagues in Palestine; it is notable, for instance, that he seems to have remained aloof from attempts to organise professionally which culminated in the establishment of the Palestine Arab Medical Association in the 1940s. In spite of his appointment to take charge of the Bethlehem mental hospital, before 1925 Malouf does not appear to have had any special training or indeed interest in psychiatry. While by the early 1920s, medical students at the American University of Beirut could take a course of lectures and clinical demonstrations on mental diseases at ʿAsfuriyyeh as part of their final year of studies,143 the same opportunity 137 138 139 140 141

142 143

PP, 30 December 1947, p. 1. Kozma and Furas, ‘Palestinian Doctors under the British Mandate’, pp. 93–4. Provence, The Last Ottoman Generation. For this, see Toufoul Abou-Hodeib, A Taste for Home: The Modern Middle Class in Ottoman Beirut (Stanford, CA: Stanford University Press, 2017). A rare glimpse into his life, based on interviews with his wife Berthe, is given in Larry Collins and Dominique Lapierre, O Jerusalem! (New York: Simon Schuster, 1972), pp. 122–3. This is also reproduced in George Hanna Malouf, Maloof: The Ghassani Legacy (Hereford: Maloof Publications International, 1992), p. 305. See Epilogue. See, for examples, al-Kulliyah, vol. 11 (1924–5), p. 134; vol. 13 (1926–7), p. 34; vol. 16 (1929–30), pp. 222, 251. Annual Report, Lebanon Hospital for Mental Diseases, 1923–4, p. 29.

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would not have been available to Malouf in the previous decade. When he was first employed by the newly created department of health in 1920,144 his focus seems to have been quite different. In those early years, he was assigned to Hebron as the medical officer at a travelling ophthalmic hospital; he even went to Egypt for a special course on ophthalmology.145 His appointment to the government mental hospital in 1925, then, marked a dramatic change of direction in his career. While he was no specialist, reports made on Malouf’s work leave no doubt about his competence: he was routinely described as capable, efficient, and good at organisation.146 And he appears to have learnt on the job: the director of health described him as having special aptitude in the field of mental disease in 1931, with ‘a fair knowledge of psychopathic medicine’.147 He would continue, as we will see in later chapters, to cultivate this expertise, particularly in the 1940s around war-related trauma and new psychiatric treatments.148 Malouf’s appointment did not resolve all staffing issues at the hospital, however. While an early area of concern had been training male attendants, recruiting female nursing staff proved to be a more persistent problem. Twelve training centres for nurses had been established in Palestine in the 1920s,149 and in 1928, the department of health boasted that Palestinian Arab women were considered to ‘make capable and reliable nurses and a demand for them has arisen in neighbouring countries’, such that ‘Palestine has supplied nurses to Egypt, Syria, Transjordan, Turkey, and Iraq’. But at the same time, the department conceded there was ‘difficulty in inducing Moslem women of good family to enter the nursing profession’.150 Decades later, this remained a problem: a 1946 report noted the ‘[r]ecruitment of Arab girls to the nursing profession is most inadequate, and the staffing of hospitals in wholly Arab areas is always a difficult problem’.151 The government mental hospital in particular had a reputational problem as a result of certain scandals that occurred in the 1920s: in 1926, the British matron 144 145 146 147 148 149

150 151

Staff List of the Government of Palestine, Showing Appointments and Stations on the 30th June 1941, Middle East Centre Archives [MECA] GC/5. The American University of Beirut Directory of Alumni, 1870–1952 (Beirut: Alumni Association, 1953), p. 110. Annual confidential reports, M. S. Malouf, 1936, 1937, and 1938, ISA M 5131/12. Annual confidential report, M. S. Malouf, 25 November 1931, ISA M 5131/20. See Chapters 6 and 7. For the history of nursing in mandate Palestine, see Julia Shatz, ‘A Politics of Care: Local Nurses in Mandate Palestine’, International Journal of Middle Eastern Studies 50 (2018), pp. 669–89. Annual Report, Department of Health, 1928, p. 43. Annual Report, Department of Health, 1946, p. 16.

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of the hospital, Miss D. L. Whitaker, locked an Arab nurse in an isolation cell reserved for maniacal patients after an argument. Whitaker was swiftly fired,152 but Heron lamented that ‘[t]he incident at the Bethlehem mental hospital is known throughout the hospitals of the country and has already severely shaken the confidence of the Palestinian nurses of the service in the attitude of the British members of the department of health towards them’.153 Not only the staffing but the patient population underwent changes over the course of the 1920s. Initially, the department of health planned to admit only non-Jewish patients to the mental hospital at Bethlehem. The Jewish mentally ill would continue to be treated at the Ezrath Nashim home, and the government would provide a reduced subsidy to cover the upkeep of ten indigent, non-paying patients at this institution. The rationale given for this policy is striking. ‘It is not possible to provide separated accommodation at the government asylum for the insane for Jews’, Heron explained in May 1923, ‘and the Moslem and Jewish lunatics cannot be mixed.’154 If the case of the Ezrath Nashim’s treatment of Muslim, Christian, and Jewish patients earlier in the 1920s might not have represented, to Heron, a compelling counterexample of ‘Moslem and Jewish lunatics’ being successfully mixed, Heron’s view was also at odds with the avowedly non-sectarian attitude adopted at ʿAsfuriyyeh, an institution which was widely admired by British officials across the region. Heron here may have been guided by the example of colonial India, where religion had come to displace caste as the organising category of colonial rule in the early twentieth century; he would not have been the only mandate official to look to colonial India for a template of British rule in Palestine.155 But although religion became increasingly important in Indian mental hospitals in the interwar years,156 Heron’s declaration that ‘Moslem and Jewish lunatics’ could not be mixed would not have found direct parallels even in India. Heron’s conviction was an unusual one, and one that began to break down quickly. Rather than subsidise the Ezrath Nashim home to accommodate indigent non-paying Jewish patients, just a few months later Heron had reconsidered. ‘As an economy’, he proposed to transfer those ten indigent patients to the government mental hospital at Bethlehem. While this would entail hiring additional staff, including ‘a Jewish 152 153 154 155 156

Annual Report, Department of Health, 1926, p. 1. This story is related in Simoni, ‘A Dangerous Legacy’, pp. 94–5. Director of Health to Treasurer, 1 May 1923, ISA M 6627/21. Matthews, Confronting an Empire, Constructing a Nation, p. 22. Waltraud Ernst, Colonialism and Transnational Psychiatry: The Development of an Indian Mental Hospital in British India, c.1925–1940 (London: Anthem Press, 2013), pp. 192–3.

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cook’ – that is, a cook who could prepare food for observant Jewish patients – Heron estimated that this would ultimately result in savings to the government.157 In November 1923, plans were in motion for the establishment of a kosher kitchen, complete with specially marked cutlery and other utensils.158 Indeed, if Heron’s position that Muslim and Jewish patients could only be mixed with difficulty had any basis in pragmatics, it may have been the need to make separate arrangements for food that made him hesitate. But whatever the case, by 1925 the government mental hospital was admitting equal numbers of Muslim, Christian, and Jewish patients.159 The department of health’s annual report from the following year made clear the scale of the shift: ‘[t]he original arrangement by which Jewish lunatics were to be treated in the Ezrath Nashim home and other patients in the Government Mental Hospital, could not be maintained and about one third of the patients under treatment at Bethlehem were Jewish cases’.160 As patient demographics underwent this dramatic shift over the course of the 1920s, what would it have been like to be admitted to this institution? What can we recover of the routines and sensations of everyday life in the government mental hospital? To begin to develop a sense of this, it is necessary to weave together fragmentary but often evocative references in the colonial archive. The journey to the hospital would have been a bumpy, uncomfortable one, we know, as a starting point for imagining patient experiences of this institution. In 1931, and presumably before as well, the approach road to the hospital was described as being ‘in an extremely bad state of disrepair’; there were ‘large rocks sticking up in the middle of the road’, and ‘numerous and deep potholes, which in the winter, when full of water, will make it really dangerous for anyone using the road with a motor car’.161 Once they were off this bumpy road and in the hospital itself, a patient was supposed to be photographed. In practice, because this involved hiring a private photographer, and the photographer refused to make the journey unless there were more than six patients to be photographed, it may have been a while before any photograph could be taken and attached to a patient’s case file.162 A patient would also be administered a Wassermann test on 157 158 159 160 161 162

Director of Health to Treasurer, 26 October 1923; Director of Health to President, Ezrath Nashim, 28 October 1923, ISA M 6627/21. Director of Health to Quartermaster, Jerusalem, 30 November 1923, ISA 6555/8. In 1925, the government mental hospital admitted 12 Muslim, 14 Christian, and 13 Jewish patients. Annual Report, Department of Health, 1925, p. 28. Annual Report, Department of Health, 1926, p. 35. Director of Health to Director of Public Works, 16 August 1931, ISA M 4087/7. M. S. Malouf to Senior Medical Officer, Jerusalem, 5 March 1936, ISA M 6602/18.

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arrival, to check for syphilis; patients from Jaffa and its surroundings were additionally examined for bilharzia, a parasitic infection thought common to the area.163 Subjected to these tests and greeted by nurses wearing blue cotton uniforms emblazoned with the letters G.H.S. – Government Hospital Service – a patient’s first impression of this institution may well have been dominated by the sense of this as a medicalised, professionalised space.164 After admission, how would patients – assuming they were not seriously ill, or confined to one of the multiple isolation cells165 – have passed their days in the government mental hospital? Although unsurprising in view of the fact that the hospital was set in a site of 5 acres, it is still striking that patients were reported to ‘spend practically the whole day in the hospital grounds except during the four winter months’, when snow could blanket Bethlehem and its surroundings. Outdoors, they were employed in a range of activities: ‘gardening, vegetable growing, poultry and rabbit-keeping, carpentry and building’.166 This had been envisaged even as early as the planning of the initial repairs to the site. When repairs were ordered on the cistern which supplied the hospital building itself, for instance, an unfinished cistern was discovered in the garden; orders were given ‘to repair [it] and fix pump to store water for gardening purposes’.167 A shelter to protect male patients from the elements, particularly the sun, while out of doors was also one of the early improvements ordered;168 later on, better garden seats were requested for the patients’ enjoyment of the hospital grounds, as was a gramophone ‘for the patients’.169 In addition to gardening, efforts were made to instruct patients in other forms of employment. In November 1924, Heron proposed installing two looms at the hospital, and asked for the instructor from the government prison at Jerusalem to be sent to the hospital to teach certain selected patients how to use them.170 Employment, particularly gardening, was understood as having

163 164 165 166 167 168 169 170

Public Medical Officer, Jerusalem, to Medical Officer, Bethlehem, 21 February 1925, ISA M 6555/8. Store Regulations of the Department of Health, Appendix 7, 19 September 1921, Revised October 1933, ISA M 6607/15. See Enclosure detailing Minor Works in A/Director of Health to A/Chief Secretary, 27 May 1926, ISA M 4087/7. Annual Report, Department of Health, 1925, p. 28. Estimate No. ZN. 1199, 27 October 1923, ISA M 4087/6. Director of Public Works to District Engineer, Jerusalem, 5 April 1923, ISA M 4087/6. Senior Medical Officer, Jerusalem, to Medical Officer, Bethlehem, 29 April 1929, ISA M 6627/22. Director of Health to Deputy Inspector General Police and Prisons, 8 November 1924, ISA M 6627/22.

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therapeutic value, but it shaped how patients sensorily experienced the hospital too. Those vegetables, egg-laying chickens, and rabbits tended within the hospital grounds ‘make a useful supplement to the patients’ ordinary diet’, as the department’s annual report put it in 1929.171 The noises of the animals, and the sound of work in the gardens and elsewhere, would also have contributed to the hospital’s soundscape, competing with the music playing on the gramophone. But the fact the patients spent so much of the year outside had the additional benefit of easing the sense of overcrowding at an institution, which was, already within a few years of opening, desperately full. Even in 1925, lack of space at the hospital meant ‘many insane persons have had to be detained in police lock-ups and other unsuitable places while awaiting admission’.172 By 1926, the strain on the institution was such that a dining room had to be converted into a dormitory to accommodate ten additional patients, and Dr Malouf was urgently requesting the construction of two pavilions to make up for the loss of dining and other recreational spaces within the hospital. While the loss of these spaces was not, in summer, a particularly serious issue, ‘[i]t is getting dark early these days’, Malouf wrote in September, ‘and very soon the patients will not be able to have their suppers outside, nor can they have it inside’.173 By 1929, the average number of patients at the hospital – which had had a bedstrength of fifty in 1925 – surpassed sixty;174 by 1930, more than eighty acute cases were awaiting admission.175 The pavilions requested by Malouf as an urgency in 1926 were only constructed in summer 1931, however.176 In the intervening years, the department of health had committed itself to a plan to construct a new government mental hospital from scratch, with a site secured and further work to the first government mental hospital – which was still, after all, only leased from the Jerusalem Verein rather than owned outright by the government – put on hold.177 But this plan to construct a new mental hospital was torpedoed by the onset of the global depression, and the swingeing cuts inflicted on the mandate’s budgets across the board in

171 172 173 174 175 176 177

Annual Report, Department of Health, 1929, p. 56. Annual Report, Department of Health, 1925, p. 28. M. S. Malouf to Senior Medical Officer, Jerusalem, 21 September 1926, ISA M 4087/7. Annual Report, Department of Health, 1929, p. 56. Annual Report, Department of Health, 1930, p. 59. High Commissioner to Secretary of State for the Colonies, 16 April 1931, ISA M 4087/ 7; Annual Report, Department of Health, 1931, p. 49. High Commissioner to Secretary of State for the Colonies, 30 March 1928, BNA CO 733/155/13.

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1931.178 Failure to deliver on this proposed institution left the government open to criticism from the Jewish Agency, the new quasi-governing organisation representing all Jews in Palestine, which lamented that in abandoning their plan the government had ‘done away with the hopes of a radical solution of the problem of the insane’.179 But it also meant that the lease of the existing government mental hospital site could be renewed, securing the site for a further five years, and much-needed work finally done to improve it.180 Against this backdrop of severe overcrowding and seemingly endless delays to renovation and extension work, it is unsurprising Palestinians continued to seek out many of the same options for the treatment of mentally ill relatives as they had done in the late Ottoman period. In 1930, to give a representative snapshot, twenty patients were admitted to the government mental hospital; thirty-two were admitted to the Ezrath Nashim home, and six to ʿAsfuriyyeh, that same year.181 At the start of the 1920s, the department of health had articulated an ambitious vision of the proposed mental hospital at Bethlehem in response to critics and sceptics both within and outside the new British administration. Feigenbaum, for one, bought into this as marking a sea-change in beliefs and practices around mental illness in Palestine. Not only, as we have seen across this chapter, was the reality more complex, as the department of health negotiated with late Ottoman institutions, a range of critics, and non-medical alternatives, but within a decade, the veneer of ambition that characterised the department’s initial foray into this area of healthcare had been worn down – even as the urgency of dealing with a scandalous lack of provision for the mentally ill continued to grow unabated. Long-delayed pavilions on a leased site: this was increasingly recognised as an inadequate solution to the problem of overcrowding by the early 1930s. And the scale of that overcrowding, the scale of the government’s failure to make adequate provision for the mentally ill, was about to become known in a more systematic way than it ever had been before, or indeed would be again, when in November 1931, a census was taken of the population of Palestine – and a return of the ‘insane’ population made. It is to that enumeration of the insane that we now turn.

178 179 180 181

Secretary of State for the Colonies to High Commissioner, 29 August 1931, ISA M 4088/7. Memorandum by Jewish Agency on Proposed Measures of Government Assistance to Jewish Health Services, 7 October 1932, BNA CO 733/223/4. Director of Health to Director of Public Works, 16 August 1931, ISA M 4087/7. Figures from Annual Report, Department of Health, 1930, p. 60; and Annual Report, Lebanon Hospital for the Insane, 1929–30, table VIII.

2

Enumerating Insanity Pathologies, Translations, and the Census

If any person is insane enter ‘Insane’. If any person is blind of one eye enter ‘Blind, one’. If any person is totally blind enter ‘Blind, two’. If any person is totally deaf enter ‘Deaf’. If any person is both deaf and dumb enter ‘Deaf and dumb’. If any affliction dates from birth so state, e.g. ‘Blind, two, birth’.1

Picture the encounter. Not between psychoanalyst and analysand, nor even psychiatrist and patient, but enumerator and enumerated. This encounter takes place one night in November 1931, repeated up and down the length of mandate Palestine. The enumerator comes to the door of the house and makes a return of the household, jotting down the number of residents, recording their relation to one another, their religion, sex, occupation, infirmities. The enumerator asks if any members of the household are blind (‘and if so, sir, in one eye or two?’), deaf (‘and dumb, too, sir?’), or insane. The enumerated responds; the enumerator translates what they say into one or two words, and with the return of the household complete, moves on to the next door. There are many to count, and not long to count them. And so the questions are repeated and the surely messy answers made into neat data until the whole of the allocated block of houses has been enumerated and the exhausted enumerator can retire at last, task accomplished. The census inquiry returned a mere 809 individuals as ‘insane’ out of a total population of 1,035,821, making ‘insanity’ the second-least-common infirmity after deaf-mutism and of virtually negligible importance relative to the number suffering eye diseases.2 Yet in his report on the census, published in 1933, the superintendent of the census, Eric Mills, worked through the returns of this inquiry with a painstaking attention to detail; the result was the most systematic analysis of mental illness in Palestine produced by any 1 2

Palestine Gazette, 16 September 1931, BNA CO 733/206/5A. The census returned 19,076 suffering blindness of one eye and 8,172 suffering total blindness. For eye diseases, see Anat Mooreville, ‘Oculists in the Orient: A History of Trachoma, Zionism and Global Health, 1882–1973’ (PhD diss., UCLA, 2015).

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mandate official or expert across this period. The report thus highlights a paradox that recurs again and again in the history of colonial psychiatry: the apparent disconnect between the small recorded number of the mentally ill in absolute as well as relative terms, on the one hand, and the urgency and complexity of discussions around these cases, on the other. But it also embodies what is distinctive about the history of colonial psychiatry in Palestine. Penned by a mathematician rather than psychiatrist or even medical doctor, the report nonetheless serves as a more productive point of departure for understanding how mental illness and its causes were conceived in Palestine than the patient case files or research publications that more typically anchor histories of psychiatry. If the census report inadvertently captures both what was exemplary and exceptional about the history of psychiatry in this context, it is also remarkable for consciously reflecting on Palestine’s place in relation to wider worlds. The challenge of enumerating the insane and analysing these returns drove debates about which models were suitable for emulation, debates that concerned Palestine’s proximity to regional neighbours, other British colonies, and Europe even as they erased its Ottoman past. At the same time, Palestine itself came to be presented in the report as possessing a kind of archetypal quality. Results generated here gained global significance, as potentially holding the key to settling once and for all arguments about the relationship between mental illness and modernity. The census report was not only the most systematic effort to come to terms with the question of mental illness in Palestine; it was the most overt attempt to locate Palestine in the world through mental illness. Only one author’s name was emblazoned on the report’s cover, and the idiosyncrasies and myopias of that author are evident throughout the analysis of the returns of the insane population. In one sense, these peculiarities should be treated seriously: Mills occupied a string of key positions within the mandate government in the 1930s, including as acting chief secretary and commissioner for immigration, and on this basis alone, his views – whether representative or not – warrant some consideration. His analysis of the census returns, while seldom overtly political, nonetheless speaks in important ways to the relationship between psychiatric knowledge and colonial governance. Yet in another sense, the report’s attribution to a single author is deceptive. At every stage, the census inquiry into insanity unfolded as a series of encounters: negotiations about its design and purpose with Arab and Jewish advisory committees; the conversation between enumerator and enumerated repeated throughout Palestine that night in November 1931; and the dissenting words of experts that were included in the pages of the published report. To keep these varied encounters in sight, this chapter eschews the usual focus on identity adopted in the extensive scholarship on the colonial

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census. This focus has been fertile, enabling the scholarship to explore how certain categories of identity were developed and deployed within colonial contexts, and with what implications for enumerated and enumerator alike.3 While there is much to be said about the formation of the particular category of ‘insanity’ used in the census, this chapter explores this and other questions not through the lens of identity, but other analytics, above all translation. Translation is an analytic which helps tie together the census and the history of psychiatry in mandate Palestine across these multiple levels of encounter: first, and most obviously, from myriad Arabic-, Hebrew-, and English-language terms into the single term – ‘insanity’ – deployed throughout the report by Mills; second, from the testimony of the enumerated into the record of the enumerator, as ambiguous and complex statements about ‘insanity’ were forged into fixed and legible statistical facts; and finally, from encounter into theory. This chapter proceeds by tracing the life story of the census inquiry into insanity. Its middle two sections engage in detail with the report itself, exploring first how Mills situated the returns of Palestine’s insane population in relation to broader debates about insanity and modernity, and then examining some of the specific causes of mental illness that the report flagged up as significant. The final section turns to the question of the report’s afterlife, narrating this alongside the story of the founding of the second government mental hospital in 1932. To begin, however, this chapter returns us to the encounter between enumerator and enumerated that lay at the foundation of Mills’ analysis, and works upwards.

Enumerating Insanity The unusual attention given to the question of insanity in Mills’ census report has not gone wholly unremarked in the historiography. While interest in the census in general has been more often than not a result of the snapshot it offers of the rapidly changing demographics of this formative period, for historians of psychiatry, the census has been approached as a resource to be mined for numbers, in mandate Palestine as elsewhere.4 This chapter works from a different starting 3

4

See, for examples, Benedict Anderson, Imagined Communities: Reflections on the Origin and Spread of Nationalism (London: Verso, 2006), pp. 164–70; Norbert Peabody, ‘Cents, Sense, Census: Human Inventories in Late Precolonial and Early Colonial India’, Society for Comparative Study of Society and History 43, 4 (2001), pp. 819–50; Sumit Guha, ‘The Politics of Identity and Enumeration in India, c. 1600–1990’, Comparative Studies in Society and History 45, 1 (2003), pp. 148–67. For instance, Sufian, ‘Mental Hygiene and Disability’; Zalashik, Das Unselige Erbe, pp. 41–2.

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point and poses a more basic question: why include an inquiry into insanity within the remit of the census in the first place? And, relatedly and perhaps more pressingly, why trust the results? The census of 1931 was the second census taken since the occupation of Palestine by the British in 1917, but the first, in 1922, had been much more limited in scope. Like the French census of Lebanon taken the previous year, the first census of Palestine had followed a logic of sectarian enumeration and was almost entirely concerned with the ratio of Muslims, Christians, and Jews in this newly acquired territory.5 Thus, as one contemporary observer put it, the census of 1931 offered ‘for the first time a real conspectus of the population of Palestine’.6 As it turned out, it was also the last, as plans for a third in 1936 were shelved following the outbreak of the Arab revolt.7 The decision to include an inquiry into insanity in 1931, then, cannot simply be explained in terms of immediate precedents or institutional memory. Nor can the inclusion of this inquiry be explained as standard practice: in Britain itself, the census had dropped the inquiry into infirmities altogether since 1921. Including this line of inquiry, then, was not a foregone conclusion, but one of many decisions made by the census superintendent, Eric Mills, in the wider process of setting up the census. Though Mills was described by contemporaries as a ‘first-class mathematician’,8 and his papers reveal him grappling with complex mathematical problems,9 he admitted the difficulty of the task assigned to him. ‘Anyone contemplating for the first time the complicated and highly delicate mechanism of census operations’, he wrote, ‘is bound to be afflicted with a sense of timidity in setting up and controlling the necessary machinery in a country completely lacking in experience of this kind.’10 With Ottoman precedents erased in this way,11 it is hardly surprising that Mills looked outside Palestine for models that could assist with both 5

6 7 8 9 10 11

Barron, Palestine: Report and General Abstracts. For the French censuses of Lebanon, see Rania Maktabi, ‘The Lebanese Census of 1932 Revisited: Who Are the Lebanese?’, British Journal of Middle Eastern Studies 26, 2 (1999), pp. 219–41. A. Zaiman, ‘Census of Palestine, 1931’, Journal of the Royal Statistical Society 96, 4 (1933), p. 660. High Commissioner to Secretary of State for the Colonies, 30 April 1936, BNA CO 733/ 309/9. Edwin Samuel, A Lifetime in Jerusalem: The Memoirs of the Second Viscount Samuel (London: Vallentine, Mitchell, 1970), p. 148. See notes by Mills, undated, among his personal papers in ISA P 655/63. Eric Mills, Census of Palestine, 1931: Volume I (Alexandria: Whitehead Morris Ltd, 1933), p. 6. For Ottoman-era population counts, see Beshara Doumani, ‘The Political Economy of Population Counts in Ottoman Palestine: Nablus, circa 1850’, International Journal of Middle East Studies 26, 1 (1994), pp. 1–17.

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the collection and interpretation of data. For Mills, the most important model was the census of India, in particular the one taken in 1911 under the supervision of E. A. Gait, to whom he acknowledged his indebtedness in the introduction to his report on the census.12 Mills not only followed Gait in his inclusion of this line of inquiry, but lifted his definition of insanity straight out of Gait’s 1911 census as well. In 1911, Gait explained ‘[t]he statistics of the insane are intended to include only those who suffer from the more active forms of mental derangement, or insanity properly so called’, and so distinguished between ‘the insane in the strict sense of the term and the weakminded’.13 Mills reproduced this distinction in his own census. The purpose of the inquiry into insanity, Mills wrote, was to make a return of those afflicted by ‘insanity in an active form as opposed to idiocy or feeble-mindedness’.14 Although this ‘active’ form of insanity was never explicitly defined, Mills made clear at various points throughout the census report that it was characterised by strong emotions, violence, and dangerousness, and was distinct from the degrees of what we might today call intellectual disability conveyed at the time by the terms ‘idiocy’ and ‘feeble-mindedness’.15 Mills’ definition of insanity and his assumption that colonial India and mandate Palestine were fundamentally commensurable did not go unchallenged. Dr Heinz Hermann, medical director since 1924 of the Ezrath Nashim private mental hospital in Jerusalem, was consulted in the writing of the census report. He criticised Mills’ distinction between ‘insanity in an active form’ and ‘idiocy or feeble-mindedness’. In remarks which were ultimately incorporated into the census report itself, Hermann argued ‘one of the radical mistakes which permeate statistics is the constant attempt … to distinguish between these two forms, although, from the clinical point of view, idiocy or feeblemindedness is quite capable of producing a condition of violent excitement’.16 Against this, Mills insisted that ‘in ordinary life plain men detect some difference’ between the two, and the returns were thus reliably ‘of persons who display the most violent forms of emotional

12 13 14 15

16

Mills, Census of Palestine, p. 6. E. A. Gait, Census of India, 1911: Volume I (Calcutta: Government Printing, 1913), p. 345. Mills, Census of Palestine, p. 224. For an authoritative account of the history of the terms idiocy, imbecility, and feeblemindedness, see Mark Jackson, The Borderland of Imbecility: Medicine, Society, and the Fabrication of the Feeble Mind in Late Victorian and Edwardian England (Manchester: Manchester University Press, 2000). Mills, Census of Palestine, p. 224, fn. 2.

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excitement and not of merely passive subnormal victims of mental instability’.17 This rejection of medical expertise in favour of his own common-sense definition of insanity, obvious to the layperson, points to the vulnerable position of the psychiatric specialist more widely, whose claim to expertise had long been ‘predicated on convincing laypeople that they could not trust their eyes and ears’; on the idea that there was, in fact, ‘something rather more to madness than acting like a madman’.18 But these comments also speak to a deeper question, on the translation from encounter into theory. Why, in short, did Mills think the census encounter could legitimately serve as the foundation for his extensive theorising? Part of the answer stems from the definition of insanity used, and its implications for the accuracy of the returns. By rejecting a more nuanced definition of insanity in favour of a common-sense definition, Mills helped shore up the legitimacy of the encounter that underpinned his theorising. Although the enumerators were laypeople, not trained medical experts, and had to trust the enumerated themselves to admit to the insanity of relatives, they could nonetheless be relied upon to provide accurate information because the information sought was recognisable to all, not experts alone. This question of accuracy had been raised in meetings with the Arab and Jewish census advisory committees, convened separately to assist with preparations. In a meeting with the Jewish census advisory committee on 1 July 1931, Dr Reuben Katznelson – representing the Vaad Leumi, the Jewish National Council – argued the inquiry into infirmities should be excluded from the census precisely because the results would be inaccurate. Statisticians in Britain since the late nineteenth century had expressed doubt over the reliability of this method of gathering information on infirmities; by 1921, the inquiry had been dropped from the census in Britain, following advice from the Royal Statistical Society that ‘the results obtained from this column are inaccurate and misleading, and that information relating to infirmities is in fact better obtained from other sources than that of the general census’.19 Katznelson drew attention to the divergence in census practice between Palestine and Britain – but Palestine was not Britain, argued the director of health, George Heron, who also attended these meetings. 17 18

19

Ibid. Joel Peter Eigen, ‘Lesions of the Will: Medical Resolve and Criminal Responsibility in Victorian Insanity Trials’, Law and Society Review 33, 2 (1999), pp. 426–7. For the struggles of medical professionals to lay claim to exclusive authority over madness in the face of legal, religious, and lay competitors, see Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (New Haven, CT: Yale University Press, 1993), pp. 232–66. ‘Report on the Census’, Journal of the Royal Statistical Society 83, 1 (1920), p. 137.

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What was appropriate for metropolitan Britain, with its shift away from reliance on the general census towards more specialised inquiries led by medical experts, was not necessarily so in Palestine. More specialised inquiries in England were required ‘as people did not want to admit the fact’ of insanity, whereas it was ‘not the same in Palestine amongst the Arab population’; ‘they had no objection to announcing the fact’, Heron continued.20 Katznelson may not have been satisfied with this, but the Arab census advisory committee, which met with Mills later the same day, seemed to concur. Awni Abd al-Hadi, representing the Arab Executive, agreed that: As regards the insane it would be useless to attempt a classification by lay enumerators or members of the family. The record should be of persons totally insane for which the Arabic term majnun should be used. This was a degree of real insanity and was an infirmity known and likely to be admitted by the relatives of the person affected.21

So long as the census confined itself to ‘persons totally insane’, rather than push either enumerator or enumerated to make finer distinctions between schizophrenia, depression, and so on, Abd al-Hadi was satisfied that the returns of this inquiry were likely to be largely accurate. Abd alHadi’s comments help us understand Mills’ conviction that it was possible to translate from the encounter between lay enumerator and enumerated into theories and analysis of mental illness; his comments also engaged the question of translation at another level, by drawing attention to the specific term to be used in Arabic by the lay enumerators. While this point was not developed in the meeting, his advice about the term to be used – majnun – was reflected in Mills’ later discussion in the census report, and so it seems likely that it was the term adopted by the enumerators. If so, it would have been a notable departure from the standard terminology of the department of health, which used ghayr salim al-ʿaql as the Arabic translation of ‘a person of unsound mind’ in its standardised forms relating to the mentally ill across this period.22 Just as he had dismissed the more precise terms that Hermann had urged in place of a crude distinction between active insanity and feeblemindedness, here too Mills was concerned only that ‘to the uneducated it is possible that the word may include within its meaning imbecile or

20

21 22

For this meeting, from which subsequent quotations are also taken, see Minutes of a Meeting with the Jewish Census Advisory Committee, 1 July 1931, BNA CO 733/ 206/5A. Minutes of a Meeting with the Arab Census Advisory Committee, 1 July 1931, BNA CO 733/206/5A. For an example, see schedule for a petition for the reception of a patient to an asylum in Palestine, ISA M 6628/5.

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half-witted’.23 In this connection, Abd al-Hadi’s description of majnun as indicating ‘real insanity and … an infirmity known and likely to be admitted by the relatives of the person affected’ reassured him that the Arabic translation of the term ‘insanity’ both accorded with his interest in recording only ‘insanity in an active form’, and would encourage the enumerated to volunteer this information to enumerators. The discussion of the Hebrew term – likely holeh ruah – to be used was shorter, but similar in thrust; Mills was content that the translation ‘is generally understood to connote only active insanity’. The abruptness with which this question of translation was dealt may in part be attributed to Mills’ own linguistic shortcomings: his private papers reveal that he certainly did not understand Hebrew, and there is little evidence he had much competency in Arabic either.24 But this is only a partial explanation. Mills was listed as one of the founding members of the Palestine Oriental Society,25 which – among other things – published an article on ‘Lunacy in Palestinian Folklore’ in 1924 listing no less than thirty-one different terms in Arabic, and their particular inflections of meaning.26 Resources were available, even in English, for him to pursue this question further. That he did not may well have been a by-product of his insistence on a common-sense approach to defining and identifying mental illness. But it may also have been a result of a wider process of semantic restriction, which saw the rich, expansive vocabulary recorded by folklorists pared back in practice to one or two terms – a narrowing evident not only here and in the terminology adopted by the department of health, but in petitions sent by the families of the mentally ill as well. It is worth dwelling on these multiple questions of translation because they serve to throw into sharper relief some of the contrasts and overlaps between the census report and other, more conventional forms of knowledge production on mental illness. The issue of translation, above all from clinical encounter to theory, has been an important one in the history of the psy-sciences. For Omnia El Shakry, attending more critically to this act of translation helps us think through the co-production of psychoanalytic knowledge and conceive of analysands not ‘as merely objects of knowledge but as co-creators of psychoanalytic theory within the clinical encounter itself’.27 Even beyond the psychoanalytic encounter, historians of colonial psychiatry have noted the fascination 23 24 25 26 27

Mills, Census of Palestine, p. 227. Undated personal papers by Eric Mills from the 1930s, ISA P 655/63. ‘Members of the Palestine Oriental Society’, Journal of the Palestine Oriental Society 1 (1921), p. 225. Stephan, ‘Lunacy in Palestinian Folklore’, pp. 2–3. Omnia El Shakry, ‘Psychoanalysis and the Imaginary: Translating Freud in Postcolonial Egypt’, Psychoanalysis and History 20, 3 (2018), pp. 313, 323.

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psychiatrists could display in their encounters with the mentally disturbed, especially those whose delusions appropriated the symbols of European modernity and so ‘flung back at the conquerors their own images of superiority in disturbingly distorted forms’.28 This almost excessive interest could be demonstrated by others within the colonial context: coroners assigned suicide cases who pursued witnesses in quests for understanding that went well beyond what was required by the law, for instance.29 In spite of the wealth of material that these investigations could produce, of course, the conclusions were often reductive – ‘acute mania’; a verdict of suicide, without further comment30 – aimed at fulfilling certain functions in the workings of the colonial state, not at doing justice to the stories of the individual humans caught up in its cogs. Psychoanalysts too could show a similar insistence on reading their subjects through ‘the primal structuring of incest fantasies’, as in the Egyptian psychoanalyst Sami-Ali’s study of prostitutes in postrevolutionary Egypt.31 But in showing their workings, as it were – the testimonies of relatives, the drawings of prostitutes – these oftenreductive conclusions nevertheless hold open the possibility of being read against the grain, and of allowing sometimes breathtaking glimpses of the intimate details of the human lives at the foundation of theories. Mills certainly displayed an interest in the question of mental illness beyond what would seem to be justified by the relative significance of the returns of the insane population. But if Mills resembles coroners in other contexts who worked through questions around mental illness to understand these to their own satisfaction, the form his attempt to solve these questions took resulted in a very different relationship between encounter and theory. Rather than integrating and preserving records of these encounters, and thereby offering a way to open up and re-read the history of mental illness, here there is a flattening without hope of complication. We are two steps removed from recovering these encounters: first by the act of translation performed by the enumerators in the original making of the returns, as a rich discordant symphony of pathologies, symptoms, and understandings of madness were compressed into a flat note or two (‘Insane’); and second by the deliberate destruction of the original records of the census by the government in November 1932, to make it impossible ‘to identify any person with the details recorded about him at the enumeration’.32 28 29 30 31 32

Vaughan, ‘Idioms of Madness’, p. 219. Megan Vaughan, ‘Suicide in Late Colonial Africa: The Evidence of Inquests from Nyasaland’, American Historical Review 115, 2 (2010), pp. 396–7. Ibid., p. 397; Jonathan Sadowsky, ‘The Confinements of Isaac O.: A Case of “Acute Mania” in Colonial Nigeria’, History of Psychiatry 7 (1996), pp. 91–112. El Shakry, ‘Psychoanalysis and the Imaginary’, pp. 324–5. Palestine Bulletin, 25 November 1932, p. 4.

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We are left to speculate about the dynamics and details of these encounters, alongside contemporaries. Quidnunc, a satirical columnist for the Jewish-owned English-language Palestine Bulletin popular among mandate officials like Mills,33 captures something – albeit in exaggerated form – of the dynamics at play here, when he described it as: an amazing fact … that many hunchbacks told the enumerators that they had humps, while husbands, although not too anxious to point out imperfections in their wives, in many cases admitted that their better halves were one-eyed. Lame men said they were lame and blind men admitted they were blind. Nor was madness hidden.34

One of the most vivid insights, indeed, into the experience of the night of the census comes from an individual who actually went unenumerated. Writing to Mills the day after the census took place, this Jerusalemite described how, ‘although I have waited the whole night, no enumerator came to my house, so that I and my family have been excluded from last night’s census’.35 With the original records destroyed, this is what we are left with, rather than glimpses of households across Palestine attempting to rationalise to enumerators the ‘insanity’ – whether in Arabic, Hebrew, English, or other languages – of relatives. Though the nature of the encounter and its translations forecloses possibilities for a reading against the grain, for many of the same reasons – their tidying away of any messiness into numerical data, their unrelenting focus on a single, ‘common-sense’ conceptualisation of ‘insanity’ – these encounters were judged by Mills to provide a solid enough foundation for the most extensive reflections on the question of mental illness ever produced by a government official in mandate Palestine. It is to these reflections that we now turn.

Insanity and Modernity In October 1932, with the census report yet to be published, Dr Mikhail Shedid Malouf was interviewed by the Jaffa-based daily Filastin about mental illness and its treatment in Palestine. Asked about the number of majanin – lunatics – in Palestine, Malouf argued that even as they waited on the official figures, it was possible to give an approximation. Taking the rate in Europe and America as his point of reference, Malouf reasoned that ‘among us here and in the east in general it is a lot less than in the west, because madness grows with modern civilisation 33 34 35

Mills’ undated personal papers reveal he started his mornings each day with the Palestine Bulletin and its successor, the Palestine Post. See ISA P 655/63. PB, 29 February 1932, p. 3. S. Hashimshoni, Jerusalem, to Superintendent of the Census, 19 November 1931, ISA M 5066/2.

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[madaniyya]’.36 His hypothesis was in part borne out the following year, when the census report concluded that ‘Palestine compares very favourably with European countries’ in terms of the rate of insanity: while in England, for instance, there were 449 ‘insane’ people per 100,000 of the population, in Palestine, there were a mere 83.37 But rather than focus on how Palestine compared internationally, Mills took his analysis of the census returns in a radically different direction to how Malouf had approached this question. Disaggregating the results by religion, Mills argued that the census returns showed a clear correlation between the rate of mental illness and level of development of the three putatively distinct communities of Palestine: Muslim, Christian, and Jewish. In foregrounding this breakdown of the results, Mills – like Malouf – drew on wider theories about the relationship between madness and modernity, but connected them up to a set of troubling questions around migration, development, and state-building that were specific to Palestine. His presentation of the returns, in other words, had complex political implications – implications which he himself, however, shied away from unpacking fully or spelling out clearly. Though both social theorists and colonial psychiatrists had expounded a connection between madness and modernity by the early twentieth century,38 it was not to these but to the model of the Indian census that Mills once again turned in his analysis of the returns. As early as 1891, census superintendent E. A. Gait had offered an explanation for the strikingly lower rates of insanity recorded for Assam than for Europe that emphasised the deleterious effects of modernity. ‘The life of an Indian peasant’, he wrote, ‘is as a rule calm and placid, and there is little to cause him worry or anxiety.’ By contrast, he continued, ‘in Europe the mental wear and tear is yearly becoming greater’.39 This was a line of argument he reprised and developed ten years later, as census superintendent for Bengal. ‘In Europe the competition between man and man is severe’, he wrote, ‘and the strain on the nervous system deranges many feeble intellects which in the calm

36

37 38

39

‘Dr Malouf Speaks with Us about the Mad’, Filastin, 29 October 1932, p. 2. For more on the freighting of madaniyya, see Wael Abu-ʿUksa, ‘Imagining Modernity: The Language and Genealogy of Modernity in Nineteenth-Century Arabic’, Middle Eastern Studies 55, 5 (2019), pp. 671–82. Mills, Census of Palestine, p. 229. For colonial psychiatry, see Vaughan, ‘Introduction’, pp. 1–2. For the wider link between madness and civilisation in nineteenth- and twentieth-century thought, see Charles Rosenberg, ‘Pathologies of Progress: The Idea of Civilization as Risk’, Bulletin of the History of Medicine 72, 4 (1998), pp. 714–30; and Roy Porter, ‘Diseases of Civilization’, in W. F. Bynum and Roy Porter, eds., Companion Encyclopedia of the History of Medicine (London: Routledge, 1993), vol. 1, pp. 584–600. E. A. Gait, Census of India, 1891: Assam: Volume I (Shillong: Assam Secretariat Printing Office, 1892), p. 131.

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and placid East would escape the storms to which they succumb.’40 Mills very directly lifted from this model, closely echoing Gait’s bucolic representation of the tranquillity of peasant life and his forbidding account of modern urban existence in his own report, for instance. But he did much more than simply reproduce these conclusions from India. Rather, in translating this framing across to Palestine, Mills the mathematician seems to have latched onto the idea that the specific conditions of Palestine meant this case study could provide the raw data needed to prove or disprove the link between madness and modernity once and for all. If ‘mental disorder is a disease of modern civilisation’, as Mills put it plainly at the head of his analysis, then this ‘leads naturally to a consideration of the statistics bearing on the structure of the population of Palestine, composed as it is of strata of differing traditions and standards of life’. And it was in this respect that Palestine emerged as a model laboratory for testing global sociological theory, because the proportion of insane for each of the main religious communities appeared to index quite clearly their differing ‘standards of life’.41 Presented in this way, the returns of the census appeared to suggest that the rate of insanity rose with the presumed modernity of the three putative communities of Palestine. Mills made this correlation explicit in his analysis. Taking each community in turn, the figures were lowest for the Muslim population, who ‘practically in entirety … live a life of comparative tranquillity engaged in agricultural pursuits which, while not entirely dissociated from anxiety in times of drought or natural phenomena of destructive character, have none of those disturbing factors present in the life of industrial countries’. Next in order of frequency of insanity was the Christian population, ‘not, on the whole, followers of the tranquil life of the fields’. Mills posited that ‘their gradual withdrawal from agricultural occupations and their increasing participation in civilisation with its variety of toxic influences are partly responsible for the higher proportion of insanity among the Christians’. Finally, with the highest rates of insanity, came the Jewish population of Palestine. Here, the question was complicated by the idea that Jews had ‘for long years, been subject to special disturbing influences of social origin’, a popular topic of investigation in psychiatry from the midnineteenth century.42 If this was thought common to Jews everywhere, 40 41 42

E. A. Gait, Census of India, 1901: Bengal: Part I (Calcutta: Bengal Secretariat Press, 1902), p. 281. Mills, Census of Palestine, p. 230. See Figure 2.1. See Sander Gilman, ‘Jews and Mental Illness: Medical Metaphor, Anti-Semitism, and the Jewish Response’, Journal of the History of Behavioral Science 20 (1984), pp. 150–9. For a review of this literature, see Robert Kohn, Itzhak Levav, Stacey Zolondek, and

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160 140 120 100 80 60 40 20 0

Muslim

Christian All

Jewish

Total

Male Female

Figure 2.1 Number of insane per hundred thousand of the population in 1931 census of Palestine. Figures taken from Mills, Census, p. 261.

the Jewish population who had migrated from Europe to Palestine also suffered those ‘distortions in personal life which arise from the conditions of modern civilisation and are common to all who live in those countries whether they be Jews or not’.43 Disaggregating the returns of the insane, here as elsewhere,44 could be put to work to serve multiple political purposes. Mills himself sought to present the census and his report as apolitical in the public speeches, interviews, and press releases which he undertook in the months leading up to November 1931.45 But regardless of how he himself saw the report, or wished for it to be seen, his analysis of the census returns spoke to some of the most contentious and important political issues of the day. Before delving into some of the more obviously political implications of Mills’ analysis in relation to development and migration, there are two more basic points worth drawing out about the way in which he

43 44 45

Michaele Richter, ‘Affective Disorders among Jews: A Historical Review and MetaAnalysis’, History of Psychiatry 10, 38 (1999), pp. 245–67. All citations from Mills, Census of Palestine, p. 230. Melissa Nobles, Shades of Citizenship: Race and the Census in Modern Politics (Stanford, CA: Stanford University Press, 2000), pp. 32–5. See letter to the editor by Eric Mills, in PB, 16 October 1931, p. 2. For more information on the publicity arranged in advance of the census, see ISA M 5066/3.

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organised and represented these figures. In the first place, in analysing the returns in relation to religion, Mills’ report naturalised the grouping of Arab and European Jews as a distinct community with its own psychiatric profile, contributing to a process of partitioning off Arab Jews from their Muslim and Christian neighbours that had been ongoing since the start of British rule. Strikingly, this was done in opposition to expert advice to the contrary. In a comment given in full in the report, Hermann argued that some distinction needed to be drawn ‘between Sephardicoriental Jews and such Ashkenazim as come from Europe’. This was so that the rate of mental illness among the latter could be more accurately identified, as the rate among Ashkenazim was ‘undoubtedly much greater than that of indigenous Jews’.46 This advice went unheeded, though was – as we will see – picked up later in the decade. Second, Mills’ representation of the census returns actively participated in the process of annexing modernity to Palestine’s Jewish population while relegating its Muslim and, to a lesser extent, its Christian populations to a lower stage of development. That is, there was a compelling circularity to Mills’ analysis. Taking as his starting point that madness grew with civilisation and that Palestine’s three ‘communities’ were at distinct points on the road to modernity, Mills produced statistics isolating each community’s rates of insanity, which could, in turn, be used to evidence that community’s stage of development, closing the loop.47 Stadial understandings of development were omnipresent in the interwar years: the mandate system had enshrined it within international law by recognising territories seized from the defeated empires of the First World War as being at distinct stages of development and therefore requiring more or less ‘tutelage’ before they were deemed able to stand on their own feet in the modern world.48 Mills’ representation of the returns extended this stadial framing into a psychiatric register to

46 47

48

Mills, Census of Palestine, p. 231. That statistical data might be represented in such a way as to confirm prior convictions is an idea articulated most famously by Stephen Jay Gould, first in ‘Morton’s Ranking of Races by Cranial Capacity: Unconscious Manipulation of Data May Be a Scientific Norm’, Science 200 (1978), pp. 503–9, and The Mismeasure of Man (New York: W. W. Norton, 1981). For an example of how differences in status between ‘A’, ‘B’, and ‘C’ mandates mattered, see Philippe Bourmaud, ‘Exporting Obligations: Evolutionism, Normalization, and Mandatory Anti-Alcoholism from Africa to the Middle East (1918–1939)’, in Schayegh and Arsan, eds., History of the Middle East Mandates, pp. 76–87. For differentiating the ‘civilised’ from the ‘uncivilised’ in international law, see Antony Anghie, Imperialism, Sovereignty, and the Making of International Law (Cambridge: Cambridge University Press, 2004); Umut Özsu, Formalizing Displacement: International Law and Population Transfers (Oxford: Oxford University Press, 2015).

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distinguish between the populations within a given territory rather than just between nations, and in so doing produced neatly stepped statistics that added further support for this way of arranging and valuating the populations of the world. While these two effects followed quite directly from how Mills set up his analysis of the returns, interpreting these figures led him to more complex political territory, territory he himself muddled through. The first of these was in relation to development and state-building in Palestine. In assigning modernity – and insanity – to Palestine’s Jewish community, the report at one level lent support to the prevailing British strategy for developing Palestine. As Jacob Norris has shown, for a number of reasons the British saw European Jewish migrants as ‘useful auxiliaries in colonial development’, as a group whose proximity to modernity meant they could be entrusted with much of the work of increasing Palestine’s productivity.49 As a result of this cultural schema, the mandate awarded development contracts overwhelmingly to Zionist enterprises, thereby disempowering and frustrating a Palestinian Arab population that, already by the late Ottoman period, had become invested in working towards these goals alongside the state.50 If at one level the census report affirmed this understanding of European Jewish migrants as the most suitable agents of development in Palestine, at another level, it complicated the picture, precisely by linking modernity and insanity. It was not only development which these migrants were bringing, the report reminded its readers, but madness too. As Mills warned, ‘since insanity is a disease associated with civilisation, it is probable that the introduction into Palestine of standards and habits of life, evolved in Europe, may be accompanied by an increase in the prevalence of serious mental disorder’.51 Not everyone in the British administration had embraced the adoption of European Jews as agents of development in Palestine; some worried that they would corrode the supposedly pristine pastoral world of the Arab Middle East, much as they were believed to have done in Britain itself.52 And – the commitment made by the mandate text to support mandated territories along the road to self-government notwithstanding – these more specifically formulated concerns connected up to a wider anxiety about the dangers of 49 50

51 52

Norris, Land of Progress, p. 66. Ibid., pp. 22–3. See also Seikaly, Men of Capital; and Fredrik Meiton, ‘Electrifying Jaffa: Boundary-Work and the Origins of the Arab–Israeli Conflict’, Past and Present 231 (2016), pp. 201–36. Mills, Census of Palestine, p. 241. Assaf Likhovski, Law and Identity in Mandate Palestine (Chapel Hill: University of North Carolina Press, 2006), pp. 48–51.

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an overly interventionist form of colonial rule, which stretched back to the middle of the nineteenth century.53 While this longstanding discourse turned on the threat of revolt if social, cultural, and religious reforms were made too quickly or too invasively, Mills’ analysis raised another troubling possibility: ever-increasing rates of mental illness and, with them, the need to dramatically expand funding for psychiatric provision to keep up. Mills’ prediction of an increase in serious mental disorders carried with it a warning about relaxing the limits imposed on European Jewish immigration to Palestine: on the one hand, to help insulate the Arab population from this potentially deranging influence; on the other, to avoid overburdening the mandate’s already-stretched mental institutions by growing a population with significantly higher rates of mental illness. While hardly the most immediate consideration later in the decade when Mills, as commissioner of migration, was tasked with setting the quotas for Jewish immigration into Palestine, his later involvement in this question is a reminder that these returns, and his analysis of them – no matter how idiosyncratic – were far from abstract exercises. But the impact of European Jewish immigration on Palestine’s development, its rates of insanity, and the resourcing of its psychiatric provision was only one way to look at the issue. Turning the statistics around gave rise to a very different question: not whether Jews were good for Palestine, but rather whether Palestine was good for Jews. This question also took Mills into highly charged waters and would be picked up later in the decade in debates within Zionism about migration too. As well as comparing the rate of insanity in Palestine generally to rates found in European countries, Mills also set the rate of insanity among the Jewish population in Palestine against those for Jews in Prussia, Baden, and Hungary. Doing so revealed that rates in Palestine were ‘well below’ rates elsewhere. This was in part a consequence of the exclusionary immigration procedures in place in Palestine, Mills was quick to point out; since 1925, entry to Palestine had been denied to any lunatic, idiot, or mentally deficient person, artificially reducing the rate of insanity among the migrant population.54 But Mills also drew another 53

54

Karuna Mantena, Alibis of Empire: Henry Maine and the Ends of Liberal Imperialism (Princeton, NJ: Princeton University Press, 2010). These ideas around ‘indirect rule’ would go on to be taken up into the mandates system: see Susan Pedersen, The Guardians: The League of Nations and the Crisis of Empire (Oxford: Oxford University Press, 2015), pp. 107–11. In spite of Mills’ assumption, these restrictions did not only affect European Jewish migrants: see Lauren Banko, ‘The “Invention” of Palestinian Citizenship: Discourses and Practices, 1918–1937’ (PhD diss., SOAS, 2013), p. 237. For a wider discussion of

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conclusion, if not without hesitation: ‘the statistics may indicate that the conditions of life in Palestine give to Jews a greater sense of personal harmony than has been their experience elsewhere’.55 Mills did not linger on this point, perhaps unsurprisingly; both Edwin Samuel and Isaiah Berlin described him as far from sympathetic to Zionism.56 If anything, he sought to dilute it. Not only, he noted, was it the case that exclusionary immigration laws would reduce the percentage of the insane arriving in Palestine, but it was also a fact – he declared – that ‘immigrants into most countries come from among the healthier people and the stronger stocks’, such that they were naturally less likely to suffer mental illness. If the rates of insanity were lower among Jews in Palestine than in Europe, this was as much a result of the demographics of migration as conditions within Palestine itself.57 If Mills himself struggled to work through the complexities of this question, Dr Hermann offered a very different interpretation. Rather than see these immigrants as representing healthier stocks, Hermann drew attention to their average age: in their early twenties, the age ‘at which, according to experience, the most serious and commonest mental disease usually breaks out’ – schizophrenia.58 At no point in the report did Mills use the term schizophrenia,59 or indeed any term more specific than ‘insanity’. We can see Hermann here drawing on his status as a medical expert, both through his use of language and invocation of ‘experience’, to invert Mills’ reading of the relationship between migration and mental illness. Hermann did not have the space to develop this line of argument about age, migration, and schizophrenia. But it was taken forward later in the 1930s by Jewish psychiatrists as they sought to present insanity not as a result of a higher stage of development among European Jewish migrants but as a result of the stresses of migration on mind and body.60 This analysis was also far from politically disinterested, because it suggested the burden placed on public health and public order

55 56 57 59

60

immigration restrictions based on mental illness, see Alison Bashford, ‘Insanity and Immigration Restriction’, in C. Cox and H. Marland, eds., Migration, Health, and Ethnicity in the Modern World (Basingstoke: Palgrave Macmillan, 2013), pp. 14–35. Mills, Census of Palestine, p. 231. Isaiah Berlin, Letters: Volume I, 1928–1946 (Cambridge: Cambridge University Press, 2004), p. 101; Samuel, Lifetime in Jerusalem, p. 149. 58 Mills, Census of Palestine, p. 231. Ibid. Or its antecedent, dementia praecox, still in use in this period. For the reception of the term schizophrenia, and its long struggle to replace dementia praecox in the context of British psychiatry, see Thomas Dalzell, ‘The Reception of Eugen Bleuler in British Psychiatry, 1892–1954’, History of Psychiatry 21 (2010), pp. 325–39. Lipman Halpern, ‘Mental Diseases amongst the Jews of Eretz Israel’, Harefuah 7 (1937), p. 214; and Kurt Blumenthal, ‘Mental Diseases among Newcomers’, Harefuah 13 (1938), pp. 251–7. For discussion, see Zalashik, Das Unselige Erbe, pp. 89–93.

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by the high rate of insanity among European Jews in Palestine was not rooted in anything inherent or permanent about that population, such as their stage of development. Instead, it was simply an immediate response to the challenging experience of migration at a particularly delicate age that, over time, would be resolved. While this in part addressed the mandate’s concerns about immigration quotas, it was also – as Sandra Sufian has shown – an intervention into debates within the Zionist movement.61 From the 1920s, the Jewish Agency had, on the one hand, been selecting for migration to Palestine those it believed would be most useful in building up the country’s economic absorptive capacity, and so enable further immigration; on the other hand, it had also sought to expel the mentally ill, especially chronic cases, on the grounds of the financial burden they imposed on the wider Yishuv.62 To do so, they worked with the department of health. In their annual report from 1928, for instance, the department acknowledged how it had been possible, ‘with the help of the Zionist Executive, to repatriate a few of these persons [i.e. mentally ill people without Palestinian citizenship] to their countries of origin’.63 While exclusionary immigration laws and the repatriation of the mentally ill were hardly unique to interwar Palestine, some expressed concern that this eugenic approach to mental illness carried with it an implicit acknowledgement of the limits of the central Zionist promise that return to the land of Israel would redeem the mentally – as well as physically – ‘degenerate’ Diaspora Jew.64 As tensions continued to rise over the question of immigration quotas in the 1930s, this way of framing the rate of insanity among European Jews thus helped make the case that, at least in terms of the strain such migration put on medical services, the problem would be only temporary. Working exclusively with aggregate data rather than clinical experience or even anecdotes, the census report does not allow for the kinds of readings against the grain which we might crave for a social history of mental illness and the census in mandate Palestine. It is bereft, notably, of Palestinian voices. Yet the census report was not monolithic. While the overarching thrust of Mills’ analysis, with its close attention to and apparent confirmation of the relationship between insanity and modernity, was clear, his habit of citing at length the often-contradictory

61 62 63 64

Sufian, ‘Mental Hygiene and Disability’. Rakefet Zalashik, ‘Psychiatry, Ethnicity, and Migration: The Case of Palestine, 1920–1948’, Dynamis 25 (2005), pp. 408–10. Annual Report, Department of Health, 1928, p. 57. Sufian, ‘Mental Hygiene and Disability’.

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interpretations and interjections of Dr Hermann made the deep fractures running throughout the report sharply visible. Even without introducing a second voice into his analysis, Mills struggled to work through and reconcile competing interpretations of his data. This was especially clear as he began to explore more specific causes of insanity that he believed the census data could help illuminate, like the relationship of migration to mental illness. The following section takes Mills’ discussion of other, more specific causal factors of insanity as a springboard for exploring the various pathologies thought to be at work in mandate Palestine, juxtaposing Mills’ Olympian perspective as census superintendent with those more fragmentary and pragmatic attempts to understand the causes of mental illness that emerged out of encounters with the mentally ill on the ground. Sex, Drugs, and Loud Noises Apart from the external shocks incidental to industrial life the principal immediate causes of male insanity in Europe and elsewhere have been, at various times, thought to be gross alcoholic intemperance, addiction to harmful drugs, and excesses in sexual intercourse.65

Mills was relatively uninterested in the causes of mental illness among women. As his census report made clear, he viewed a pathology of insanity rooted in the conditions of modern industrial life as peculiar to men; the insanity of women was to be understood quite differently, not in relation to external but rather biological causes. Among women, Mills declared, ‘insanity … is partly associated with childbirth and the climacteric or, more generally, with the development and degeneration of the reproductive system in the critical ages of life’.66 Mills’ comments return us to a well-established line of argument in the feminist scholarship on the history of psychiatry, inaugurated by Elaine Showalter. With his identification of childbirth and the ‘climacteric’ – menopause – as the main cause of insanity among women, Mills echoed the Victorian psychiatrists who figured woman ‘as the victim of periodicity; her life is one perpetual change’.67 Mills supported this conclusion by plotting the rate of insanity among women and men against firstly 65 67

66 Mills, Census of Palestine, p. 233. Ibid., p. 235. Elaine Showalter, ‘Victorian Women and Insanity’, Victorian Studies 23, 2 (1980), p. 169. For some examples from the wider literature on gender and madness, see Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (Basingstoke: Palgrave Macmillan, 2004); Lisa Appignanesi, Mad, Bad, and Sad: Women and the Mind Doctors (London: W. W. Norton, 2008); Louise Hide, Gender and Class in English Asylums, 1890–1914 (Basingstoke: Palgrave Macmillan, 2014).

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their age, and secondly their conjugal condition. Graphs of the former appeared to show that while the incidence of insanity among men was most concentrated in the crucial decade between 25 and 35, insanity was more evenly spread across women’s lives. The proportion of male to female insane actually appeared to reverse in the later decades of life as the number of female insane began to outweigh – for the first time – the male insane, as a result of the onset of menopause. A table setting out the link between conjugal status and insanity for men and women, meanwhile, was marshalled as evidence for a distinctively biological pathology of insanity among women in another way. While the rate of insanity among men was dramatically lower among those who were married than unmarried, for women – at least among Muslims and Jews – marriage had a less markedly positive effect. For Mills, the explanation for this was obvious: for women, marriage brought with it the mentally destabilising potential of childbirth.68 Mills was not alone in thinking of female insanity in these terms. Climacteric and puerperal insanity – that is, insanity following childbirth – were being used to classify new psychiatric patients by the department of health up until the end of the 1930s at least. Takuhee K. was one such woman given this kind of diagnosis in the 1930s. Her story conveys both a sense of the human life history behind the diagnostic category and the uneven attention these patients were afforded. In May 1935, Takuhee came to the attention of the mandate’s medical authorities. She had recently given birth and, following the delivery, had attempted suicide. She fractured her arm instead and was taken to the government hospital in Jerusalem to recover. While there, Dr T. B. Haddad – a medical doctor but not a psychiatric specialist – diagnosed her as suffering from ‘a sub-acute puerperal insanity’, and although he discharged her from the hospital as having recovered from her fracture near the end of April, he made inquiries with the director of medical services about admitting her to the government mental hospital at Bethlehem. He followed this up a week later, a sign of the urgency with which he viewed the case; her ‘mental depression’, he wrote, ‘is increasing from day to day’.69 It is not recorded if his attempts to have her admitted were ultimately successful. The number of cases actually admitted to the

68

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Mills, Census of Palestine, pp. 235, 238. He explained the apparently anomalous results for Christian women by reference to the distorting effect of the fact that a proportion of that population lived in convents. T. B. Haddad to Director of Medical Service, 5 May 1935; and Director of Medical Services to Senior Medical Officer, Jerusalem, 9 May 1935, ISA M 6627/27.

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government mental hospitals on the grounds of puerperal insanity was extremely low across this period, so it seems unlikely.70 As Takuhee’s story suggests was the case in practice, and as the census appeared to show was also true in theory, women’s insanity was considered to be of secondary importance when set alongside that of men. Although the rate of insanity among women overtook that among men in the last decades of life, the overall rate of insanity among women was lower than that among men. This ratio held for patients in government mental institutions, as well as those awaiting admission. In 1933, for instance, there were 130 beds available in government mental hospitals, of which 80 were for men and 50 for women; the ratio was similar among the 142 awaiting admission, of whom 80 were male and 62 female.71 But more than statistics explain the level of interest shown by Mills and others in investigating male pathologies of insanity over female insanity. The kind of biologised pathology of insanity asserted for women did not lend itself to investigation by the non-specialist, whereas a pathology rooted in the ‘toxic influences’ of modernity was not only accessible to non-specialists but positively invited ‘lay’ attempts at understanding and – more than this – amelioration. Although not of particular interest to Mills, where this biologised conceptualisation of the pathology of female insanity had arguably more concrete consequences was in relation to the law, as we shall see in a later chapter.72 For now, however, we remain with Mills, and take the toxic influences he identified as the main causes of insanity among men as our points of departure in exploring how the roots of male insanity were understood in mandate Palestine. In his report, Mills began with ‘the principal immediate causes of male insanity in Europe’, which he identified as alcohol, drugs, and sexual excess, along with the more ambiguous category of ‘external shocks incidental to industrial life’. But this way of thinking about mental illness could not straightforwardly be applied to Palestine. As the differential rates of insanity found among the three putative communities of Palestine were taken to suggest, these factors were not believed to operate evenly on the population; these toxic influences of modernity were thought to pose a more direct threat to European Jews than Palestinian Muslims. And some factors were dismissed almost entirely as having an effect in Palestine. Mills described alcoholic intemperance as unknown among Muslims and Jews, and only slightly more common among 70

71

Two cases of puerperal insanity figure in the Annual Report, Department of Health, 1929, while one of climacteric insanity appears in the Annual Report, Department of Health, 1938. 72 Annual Report, Department of Health, 1933, p. 63. See Chapter 4.

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Christians. But even among Christians, alcoholism accounted for a much lower proportion of cases of mental illness than in Europe, where up to a fifth of cases admitted to mental homes could be traced back to alcohol abuse.73 The number of those admitted to mental institutions in Palestine as a result of alcoholism supported Mills’ conclusion: between 1929 and 1946, only three cases of alcoholism in total were admitted to any of the major government and private mental hospitals;74 in a report on the lunatic section of Acre central prison in 1946, Dr Kurt Blumenthal underlined this pattern, noting that ‘no alcohol-addicted case was found’.75 Drugs, too, appeared relatively minor in this context. This was by contrast not only to the European ‘norm’ invoked by Mills but to a situation much closer at hand: Egypt. By the 1920s, there was already a long-standing association between Egypt, hashish, and insanity. F. M. Sandwith, who became director of the ʿAbbasiyya asylum outside Cairo two years after the British occupation in 1882, wrote extensively on hashish as a cause of insanity in Egypt, describing its addicts as weakminded, chronic demented cases who inevitably returned to the drug after discharge and so were always being readmitted.76 Palestine was perceived as very different right from the start of British rule as neither a major producer nor consumer of drugs, but rather a route for traffickers between neighbouring Egypt, Syria, and Turkey. In the first report made on drug trafficking in 1923, it was declared ‘[t]he drug habit is not prevalent in Palestine’.77 But the continued importance of Palestine as a trafficking route meant this question was revisited almost annually. In 1928, the acting director of health observed: I am not aware that any section of the population of Palestine is addicted to the taking of hashish. It is, however, possibly taken in very small quantities by some fellahin. Very occasionally patients suffering from the effects of hashish have been admitted to the government mental or general hospital but such patients have invariably been Egyptians.78

This was a conclusion which Mills echoed in the census report. Here, in a departure from his usual focus on Muslim, Christian, and Jewish, the 73 74 75 76 77 78

Mills, Census of Palestine, p. 239. See annual reports of the department of health for the years 1929, 1934, and 1945. Dr Kurt Blumenthal, Report on the Lunatic Section of Acre Prison, 1 February 1946, ISA M 351/41, p. 2. Sandwith, ‘The Cairo Lunatic Asylum’, pp. 481–3. Report by the Government of Palestine for the Calendar Year 1923 on the Traffic in Opium and Other Dangerous Drugs, ISA M 6621/7, p. 3. Acting Director of Health to the Chief Secretary of the Government of Palestine, 21 September 1928, ISA M 6621/6.

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key distinction to draw was between Palestinians and Egyptians. ‘[T]he very great majority of patients in hospitals in Palestine suffering from the effects of this drug [i.e. hashish] are Egyptians living in the country,’ he wrote, adding, ‘not Palestinian Arabs.’ Indeed, he emphasised, ‘there are … practically no cases of Palestinian Muslims who are addicted to hashish’, making its significance as a cause of insanity in that community negligible.79 The picture had changed a decade later; in 1942, the newly formed Palestine Narcotics Intelligence Bureau reported that ‘addiction to narcotics in Palestine is greater than was at one time supposed’.80 But addiction did not translate directly into mental illness, much less grounds for admission to a mental institution; there were just two cases of hashish insanity awaiting admission to government mental hospitals in 1945, and a solitary one the following year.81 Alcohol and drugs, then, were seldom invoked as causes of mental illness in Palestine; nor did they serve to underline differences between the Muslim, Christian, and Jewish populations. By contrast, sex and ‘shocks incidental to industrial life’ were invoked as causal factors, albeit in highly specific ways, with Mills latching onto the former as the key to understanding mental illness among Palestinian Muslims in particular, and the latter as the key to understanding mental illness among European Jews. Of course, neither was held up as the sole explanation for mental illness: as we have already seen, the effect of migration on mental health was a subject of discussion in relation to European Jewish migration to Palestine, while Mills raised – though avoided probing – the question of how far ‘special disturbing influences of social origin’ were at work on Jews as Jews.82 But in the context of the report, sex and industrial shocks helped make concrete the link between modernity and mental illness that Mills had introduced in abstraction earlier. Although we might expect the most direct link between sex and mental illness to come through syphilis, as it progressed to attack the brain as neurosyphilis or – as it was known at the time – general paralysis of the insane, it was actually the weakness of this link which required some kind of explanation. Here again, the relative lack of cases of general paralysis of the insane marked Palestine out as distinctive, at least by comparison to the British colony that was closest at hand, Egypt. Just as hashish insanity comprised a substantial proportion of admissions to the

79 80 81 82

Mills, Census of Palestine, p. 233. Report by the Inspector General of the Palestine Police for the Calendar Year 1942, on the Traffic in Dangerous Drugs, 15 April 1943, ISA M 6622/4. Annual Report, Department of Health, 1946, table 8. Mills, Census of Palestine, p. 232.

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ʿAbbasiyya asylum at Cairo, around the turn of the century 6 per cent of all admissions to this asylum were cases of general paralysis of the insane.83 Syphilis was certainly a major concern in Palestine: 3,663 cases of syphilis were treated between 1924 and 1932 at Hebron alone, a testimony to the scale of this issue. But this was predominantly syphilis in an endemic, non-venereal form.84 Venereal syphilis was still a concern: the government welfare inspector tried to draw attention to the problem of ‘[l]ax sex behaviour resulting in the prevalence of venereal disease’ in 1933,85 and Wasserman tests were performed as a standard procedure on all patients admitted to the government mental hospitals in order to detect syphilis.86 But the number of cases of general paralysis of the insane admitted to mental institutions was low across the period, just one or two a year. This situation demanded explanation. Mills linked the low number of cases of general paralysis to the prevalence of malaria in Palestine, suggesting – in line with medical thinking of the time – that ‘malaria may be preventive of paralysis’. Hermann, for once, concurred: The late syphilitic forms in the East have certainly different characteristics from those in the West. This is explained, apart from the question of influence by the sun and the frequent suffering from malarial infection, by the fact that among natives cases of general paralysis are very rarely seen. This is also my experience. The cases of paralysis which have occurred more frequently recently are almost invariably found among people who have immigrated here from Europe, America, and the Russian district bordering on Asia, or who have spent many years in those countries.87

If syphilis, one of the ‘toxic influences’ of modernity, was presented as disproportionately affecting Jews newly arrived from Europe – a proposition supported by the higher frequency of admissions with this diagnosis to private Jewish institutions than government hospitals – the very low numbers involved, usually just one or two a year, ultimately made this a relatively insignificant point of differentiation.88 But sex mattered in other ways. Mills showed a kind of fixation on the sex lives of Muslim men, in particular, as the key to understanding 83 84 85 86

87 88

Ibid., p. 240. Report on Palestine Submitted to Arthur Wauchope, by Mrs Neville Rolfe and Miss Nixon, Copied 19 May 1933, MECA GB 165-0161 58/2, pp. 14–15. Ibid., p. 27. District Medical Board Report, No. 314, Acre, 14 December 1945, ISA M 6640/26; District Medical Board Report, No. 312, Acre, 14 December 1945, ISA M 6640/26; Record of Examination, No. 104, Acre, 27 March 1945, ISA M 344/35. Mills, Census of Palestine, p. 240. The number of cases of general paralysis of the insane being admitted to government and private institutions can be derived from the annual reports of the department of health between 1929 and 1939.

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mental illness among this population. Noting the large proportion of men who were unmarried between the ages of twenty and twenty-five, and the obstacles within a society governed by strict notions of ‘family honour’ that confronted men in search of pre-marital sex, Mills argued ‘the opportunities for marriage among men are few in the years during which the satisfaction of sex needs is a powerful influence in mental and nervous equipoise’.89 But his attention to sexuality was unusual. Though there were certainly some instances in which sexual behaviour was cited as evidence of mental illness by medical experts, this was not common; across the period, it was more likely to draw the attention of the law than psychiatry.90 If Mills’ attention to the frustrated development of a ‘normal’ sex life among young, largely unmarried men was not shared by medical experts, he approached the issue of Palestinian Muslim marriage practices from another angle which found wider resonances: heredity. In particular, he identified the practice of cousin-marriage as ‘a predisposing cause of insanity’ in the children of these matches.91 For Mills, consanguineous marriage as a cause of mental illness helped explain the somewhat puzzling results found when the proportion of mental illness was mapped for each sub-district of Palestine. Jaffa subdistrict was largely urban in character, while Hebron and Jenin subdistricts were largely rural and ‘neither … so subjected to the emphatic changes manifest in the sub-districts in the plain regions’. Yet the proportion of insane in each was the reverse of what Mills anticipated. That is, in Jaffa, the proportion of Muslim insane per 100,000 was only 35, while that in Hebron was 67, and that in Jenin was 81. Flying in the face of Mills’ assumptions about the tranquil nature of rural existence, this surprising difference had to be located in the lower likelihood of cousinmarriage in the towns relative to the countryside instead.92

89 90

91

92

Mills, Census of Palestine, pp. 234–5. See Orna Alyagon Darr, ‘Narratives of “Sodomy” and “Unnatural Offences” in the Courts of Mandate Palestine (1918–48)’, Law and History Review 35, 1 (2017), pp. 235–60, and Plausible Crime Stories: The Legal History of Sexual Offences in Mandate Palestine (Cambridge: Cambridge University Press, 2018). That homosexuality was lodged in the domain of the law in mandate Palestine is hardly surprising; it had only been made a legitimate subject of medical rather than legal discourse in England in the 1910s. See I. D. Crozier, ‘The Medical Construction of Homosexuality and Its Relation to the Law in Nineteenth-Century England’, Medical History 45 (2001), pp. 61–82. A line of inquiry which continues to be pursued today in research on a link between consanguineous marriage and schizophrenia: see Abdulbari Bener, Elnour Dafeeah, and Nancy Samson, ‘Does Consanguinity Increase the Risk of Schizophrenia? Study Based on Primary Health Care Centre Visits’, Mental Health Family Medicine 9, 4 (2012), pp. 241–8. Mills, Census of Palestine, p. 235.

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Hermann was unconvinced such a clear distinction could be drawn between urban and rural marriage practices. But he agreed that cousinmarriage would certainly serve to distinguish the Palestinian Muslim population from the European Jewish population, given that the ‘chances of consanguineous marriage in a population largely composed of immigrants are small’.93 Marriage practices, then, went a long way to explain mental illness among the Palestinian Muslim population, in Mills’ view. In resorting to this explanation for mental illness, which identified heredity rather than environment or participation in any of the toxic influences of modernity as the key causal factor, Mills tapped into a wider anxiety about the degeneration of national populations in Europe, an anxiety which turned in part on a conviction that insanity as well as criminality were hereditable and therefore, many psychiatrists feared, incurable.94 What was rendered invisible in this framing of sex and marriage, of course, was any acknowledgement of their affective dimensions, affective dimensions to which the long-standing link between love and madness in Arabic poetry, for instance, might well have drawn attention. Most famously expressed in the romance of doomed lovers Majnun and Layla,95 this connection was also taken as the subject of folklore research in interwar Palestine.96 Yet Mills’ approach to the influence of sex and marriage on the mind left no space for love, and kept his analysis strictly disconnected from these alternative discourses. With sex and marriage presented as the principal causes of mental illness among the Arab rural population, and alcohol and drugs held to be relatively insignificant in Palestine, this meant responsibility for mental illness among the European Jewish population had to fall under that final, capacious category set out by Mills: ‘external shocks incidental to industrial life’. While this formulation, especially coming as it did in the wake of the First World War, might naturally prompt us to think of shell shock and other traumatic pathologies of insanity, what Mills seems to have had in mind was not so much spectacular one-off shocks but rather the kind of grinding disorientations attendant on modern urban life. Mills was hardly unaware of the importance of the First World War

93 94 95

96

Ibid., p. 237. See Daniel Pick, Faces of Degeneration: A European Disorder, c.1848–1918 (Cambridge: Cambridge University Press, 1989), and Jackson, The Borderland of Imbecility. For this, and other connections between love and madness in medieval Islamic society and culture, see Dols, Majnun, pp. 313–48; and Geert Jan van Gelder, ‘Foul Whisperings: Madness and Poetry in Arabic Literary History’, in Joseph E. Lowry and Shawkat M. Toorawa, eds., Arabic Humanities, Islamic Thought: Essays in Honour of Everett K. Rowson (Leiden: Brill, 2017), pp. 150–75. Stephan, ‘Lunacy in Palestinian Folklore’, p. 7.

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and its potentially devastating impact on health. During the war he had initially served in France, before being transferred to Egypt for ‘light duty’ after being gassed; he continued to suffer the effects of this event into the 1930s, being described by observers as a sick man ‘subject to blinding headaches’.97 Yet shell shock does not appear in his analysis, nor do alternatives like traumatic anxiety neuroses. In part this is a question of the timing of the census, predating the violence of the years around the Second World War that brought the question of trauma into the spotlight in Palestine.98 But in 1931, what Mills focussed on was not the spectacular but the mundane – above all, noise: The noise of industrial countries, the general struggle not only for a better condition of life but for bare existence, all play their parts in destroying the balance of the nervous and hence of the mental system … It has been said that if a dog, endowed as it is with the most acute hearing, were also endowed with the mental equipment of a man it would be dead in a fortnight in an ordinary European city.99

Although he may have had personal reasons to dwell on noise in this way – his wife was ‘very deaf’100 – his emphasis on noise was far from unique in this period. As James Mansell has argued, industrial modernity brought with it a host of noises thought to carry the potential to disturb the mind.101 By the late 1920s, the British Medical Association was warning that ‘the present increase in unnecessary noise is a factor in creating neuroses’, such that ‘much neurosis of the inhabitants in our big cities may be regarded as analogous to the shell shock that followed deafening bombardments during the war’.102 This way of thinking was not simply applied wholesale, without modification, to Palestine, however. As was the case with drugs, alcohol, and sex, it underwent a revealing translation, one which reinforced the representation of Palestine’s population as both unevenly modern and unevenly insane. While medical experts had asserted a link in general terms between the noise of industrial modernity and mental derangement by the interwar

97 98 100 101 102

Samuel, A Lifetime in Jerusalem, p. 148. Mills’ personal correspondence confirms this: see ISA P 655/63. 99 See Chapter 6. Mills, Census of Palestine, p. 230. Samuel, A Lifetime in Jerusalem, p. 148. James Mansell, The Age of Noise in Britain: Hearing Modernity (Urbana: University of Illinois Press, 2016). ‘Noise and the Public Health: Memorandum of Evidence Submitted by the British Medical Association to the Minister of Health’, British Medical Journal 2, 3540 (1928), p. 210.

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decades, in Palestine, sensitivity to noise was used to distinguish European Jews from Palestinian Arabs. Complaints about ‘nervewracking’ or ‘nerve-shattering’ sounds – car horns, radios, repair work – recurred with great frequency in both editorials and letters published in the pages of the Palestine Post across the 1930s and 1940s.103 They also gave rise to an anti-noise league in Tel Aviv in the 1930s, founded by Joseph Broadhurst, the former head of the government’s Criminal Investigation Department.104 These complaints about noise by European Jews and British officials found many targets, but an important element that runs through them is the conviction that sensitivity to noise correlated to what one editorial in the Post called ‘a high standard of culture’.105 This self-representation was sometimes elaborated further through explicit contrast with the Arab population, as another piece in the Post about hawking in the old cities of Palestine demonstrates: People of the Orient have been used to noise as an adjunct to business from times immemorial, and relief can only be brought about by the slow process of educating the people, making them realise that it is unnecessary to shout at the top of your voice to sell your goods.106

Here was an orientalism which operated not at the level of a visual but rather auditory stereotype. It made clear the identity of its opposite: more educated Europeans were not only more vulnerable to nerve-wracking noises but were, as a result, themselves quieter, more self-contained, orderly. Within this representational schema, any concern about noise shared by middle-class Arab families was erased, and the position of Europeans as the sole bearers and drivers of modernity in Palestine reinscribed. This representation of Arabs and Jews as sensitive to noise to different degrees could have quite concrete consequences, as discussions about conditions in the prisons at Acre and Jerusalem reveal. In 1940, the district commissioner of Jerusalem, Edward Keith-Roach, argued that while overcrowding was an issue in the prisons, it was mitigated to a degree by the ‘fact’ that the prisoners were averse to solitude and unconcerned with privacy. ‘To an Arab’, Keith-Roach wrote, ‘segregation is an unending torture’. He added, ‘Many Jews feel the same.’ Echoing the Post, Keith-Roach held this to be a result of their shared lack of education: ‘Human companionship at work, play, or rest is an essential to

103 104 105

PP, 24 January 1934, p. 4; PP, 12 March 1935, p. 6; PP, 21 October 1946, p. 4. Joseph Broadhurst, From Vine Street to Jerusalem (London: Stanley Paul, 1936), p. 229. 106 PP, 16 February 1941, p. 6. PP, 18 September 1934, p. 7.

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illiterates.’ For Keith-Roach, there was not much of a distinction between Arabs and Jews; they both, he wrote, ‘love to hear their own voices’.107 This representation was hotly contested by the Vaad Leumi, the Jewish National Council. They protested that while ‘existing conditions fit the Arab standard of living’, it was necessary to create ‘a separate prison in a Jewish area for Jews, containing all improvements in existence in a civilised country’.108 This argument around prison conditions serves as a reminder that these representations around sensitivity and civilisation had a life beyond the psychiatric, and that they were deeply contested. Both these points help bring what was remarkable about Mills’ analysis in the census report more sharply into focus, as the attempt of a non-specialist to interpret data generated out of a flattening encounter between lay enumerator and enumerated, and marked as much by the idiosyncrasies of its author as by its resonances with wider currents of thinking, psychiatric and otherwise. As such, while some of the ways of conceptualising the causes of mental illness in Palestine will resurface in later chapters, others will not – more a product of one man’s attempt to make order out of chaos at an Olympian distance, than revealing of more widely held or closely grounded beliefs about mental illness.

Afterlives of the Census Although Mills had satisfied himself that the encounter between enumerator and enumerated that night in November 1931 provided a solid foundation for his analysis of the prevalence and causes of ‘insanity’ in Palestine, others were less convinced. Writing a few years later, Dr Lipman Halpern, a German Jewish neurologist who arrived in Palestine in the wake of 1933,109 drew attention to the unreliability of the statistics at the foundation of Mills’ report. Given that the figures were obtained in a general census of the population, he wrote, ‘they cannot be taken as complete or exhaustive for any of the religious groups because of the tendency of the Arab as well as the Jew to regard mental disease as an affliction shameful to the entire family and to conceal its

107 108 109

Report of an Investigation into the Central Prison, Jerusalem, submitted by E. Keith Roach, District Commissioner, Jerusalem, 15 August 1940, ISA M 351/17. Memorandum submitted by the Executive of the Vaad Leumi and Chief Rabbinate to the High Commissioner, 27 December 1944, ISA M 351/17. For Halpern’s background, see Zalashik, Das Unselige Erbe, p. 64.

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occurrence for that reason’.110 Halpern thus directly contradicted the director of health’s argument at the 1931 census advisory committee that, by contrast to England, in Palestine people had no objection to admitting ‘insanity’. But however inaccurate the results of Mills’ census in absolute terms, Halpern conceded that in terms of revealing the relative significance of insanity across the three putative communities of Palestine, the results were reliable. And indeed, Halpern’s explanation largely echoed Mills’ own, casting the difference in rates of insanity as a result of what he called ‘the civilisation factor’. Coming from ‘occidental’ countries, he explained, Jews suffered the most from ‘the social and individual difficulties inherent in civilisation or brought about by it’, followed by ‘the civilised Arab Christians, who by their education and occupation stand on a higher social level than the Arab Muslims’.111 Halpern, who conducted his own census into the Jewish insane in 1936, even extended – as Hermann had suggested in 1931 – this line of thinking to account for the different rates of insanity found among groups within the Jewish population, with rates of insanity highest among Ashkenazim, followed by Sephardim, and finally Mizrachim.112 Halpern’s critical engagement marked a high point in the afterlife of Mills’ report; it would never receive as much attention from any other quarter. Certainly Mills won praise from metropolitan commentators for his report,113 and was elected a fellow of the Royal Statistical Society in 1934.114 Various consuls, societies, and professors requested either copies of the census report or specific information within it.115 The census even had an impact in medical circles – but for its inquiry into blindness, not insanity, as it revealed that Palestine suffered the world’s highest rate of blindness in the 1930s.116 Regardless of the praise the

110 111 112

113 114 115 116

Lipman Halpern, ‘Some Data of the Psychic Morbidity of Jews and Arabs in Palestine’, American Journal of Psychiatry 94 (1938), p. 1216. Ibid., p. 1217. Halpern defined the Mizrachi community as including ‘the Yemenis, the Persians, the Orientals, the Aleppans, the Babylonians, and so on’. Having accounted for their proportion within the total Jewish population in Palestine, he calculated that the index of the incidence of mental illness in each was 1.12 for Ashkenazim, 0.79 for Sephardim, and 0.49 for Mizrachim. Halpern, ‘Mental Diseases’, pp. 208–9. For the place of Mizrachim in Zionist hygienic projects, see Hirsch, ‘“We Are Here to Bring the West, Not Only to Ourselves”’. Zaiman, ‘Census of Palestine, 1931’, p. 660. See G. U. Yule, ‘On Some Points Relating to Vital Statistics’, Journal of the Royal Statistical Society 97, 1 (1934), p. 84. See ISA M 320/15. Arnold Sorsby, ‘The Incidence and Causes of Blindness in the British Commonwealth’, British Medical Journal 2, 4425 (1945), p. 558.

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report garnered, demand was hardly overwhelming: by April 1936, it was reported that 960 of the 1,500 copies of the report that had originally been produced remained untouched.117 As for Mills himself, in spite of the recognition his work on the census earned him, he was not able to capitalise on it in the way others did. Unlike his exact contemporary, J. H. Hutton, who used his background as census commissioner of India to secure an academic career at Cambridge,118 Mills found himself trapped by his success. Edwin Samuel recounted how he was ‘so useful in Palestine that no High Commissioner was willing to release him, not even when he had a chance of becoming the secretary in London of an eminent scientific body’.119 Small wonder, then, that when Isaiah Berlin met Mills late in 1934, he found him a ‘disgruntled, melancholy, bitter, clever failure’.120 Mills had argued that the census ‘will be found to give a direct and unmistakable indication of the importance of the respective infirmities in the life of the people’ and would therefore allow government to be rooted not in speculation but in fact. Prior to these statistics becoming available, it had been impossible for public authorities or private institutions ‘fairly to assess the importance of their work in relation to the satisfaction of the requirements of the people’.121 Yet Mills’ hope that the census would provide a reference point for government departments as they made crucial decisions appears to have gone largely unfulfilled. Some heads of departments did request copies of the census,122 but its impact was muted in the department of health, in spite of the direct role that the director of health, George Heron, had played in its formulation. This is not to say the department did not use the census at all: it cited its returns in some of its annual reports, for instance.123 But it is clear that the figures gathered over the course of the general census were of limited value to the department in guiding its activities, when it could rely instead on numbers gathered by its own medical officers on a more finely tuned range of issues than this one-off enumeration of the ‘insane’. The annual reports alone contained statistics relating to psychiatric admissions, deaths, discharges, and waiting lists as well as a breakdown of patients by gender, community, and diagnosis. When Heron had

117 118 119 121 123

Government Statistician, Jerusalem, to Chief Secretary, 23 April 1936, ISA M 524/31. See Nicholas Dirks, Castes of Mind: Colonialism and the Making of Modern India (Princeton, NJ: Princeton University Press, 2011), p. 345, fn. 88. 120 Samuel, Lifetime in Jerusalem, pp. 148–9. Berlin, Letters, p. 106. 122 Mills, Census of Palestine, p. 226. See ISA M 320/15. See, for instance, Annual Report, Department of Health, 1946, p. 13.

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remarked, back at the meeting of the Jewish census advisory committee in 1931, that the government had not yet thought to ask the population about their infirmities and that the census thus represented a valuable opportunity to do so, he clearly did not mean the state lacked any information on infirmities whatsoever. Instead this comment highlighted how the census inquiry could go beyond what was already known of the population, by – at least in theory – enumerating all those with infirmities and not simply those who had already come to the attention of the department of health as patients. This more comprehensive enumeration of the insane was revealing – and alarming. Once set alongside the admissions figures from both government and private institutions, it allowed Mills to declare that ‘less than 22 per cent of the actually insane in the country are under restraint in the only public and the only private asylums in the country’.124 While the department of health recorded the number of those on the waiting lists for the government mental hospitals, this turned out to be only a fraction of the number who required admission according to the census. In 1931, the department of health listed 116 individuals as awaiting admission to mental institutions, with 151 already under treatment; the census found that there were 809 insane individuals in Palestine, which meant the department of health was only aware of slightly over a quarter of all enumerated cases of insanity that year.125 Yet even in terms of highlighting the mismatch between supply and demand, the census only had a limited impact. Anxieties about the failure of the government to expand provision for the mentally ill to keep up with ever-rising demand were already widely expressed by the late 1920s, with the first government mental hospital overcrowded and plans to establish an urgently needed new mental hospital repeatedly deferred. The pressure of numbers on the mental institutions of Palestine was clear well before the census results were made public. Indeed, by the time the census report was finally published in 1933, this pressure had already resulted in action. In December 1932, the government finally expanded its provision for the mentally ill by opening a second mental hospital at Bethlehem for male patients. In the spring of that year, with long-delayed plans for the construction of a new government mental hospital built from scratch put on hold indefinitely in the wake of the great depression, approval had been given for the leasing of a second site – the so-called Swedish hospital, on the road to Bayt Jala from Bethlehem – to be used for the accommodation of patients. The hospital 124 125

Mills, Census of Palestine, p. 232. Annual Report, Department of Health, 1933, p. 49.

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had been built by the Swedish Jerusalem society in 1913, but closed in 1925 as a result of financial difficulties.126 The decision to acquire this site was made against the backdrop of financial pressure not only on the government but on private Jewish institutions too. The depression – like the First World War before it – precipitated a drastic decline in contributions from subscribers to the Ezrath Nashim mental hospital, leaving the institution in serious financial difficulties. As we saw in the previous chapter, the government had subsidised this hospital in the earliest years of the British occupation of Palestine. But once the first government mental hospital at Bethlehem opened, it withdrew this funding, in the face of protests from the institution that this would mean its collapse. As Heron dryly noted in 1926, these predictions seem to have been rather exaggerated; not only had the institution survived, it had actually expanded, with new buildings constructed and more and more patients admitted for treatment.127 In the wake of the depression, however, the hospital found itself in real financial difficulties. The staff went on strike over withheld pay,128 and the number of patients had to be reduced.129 It was the threat of this institution closing and casting its patients out onto the streets that forced the government to take action: in the short term, by providing subsidies to the institution on the condition that it reorganised and made certain economies; in the longer term, by finally taking steps to expand its own provision for the mentally ill in order to reduce its continued dependency on this private institution.130 Thus, when the second government mental hospital opened its doors late in 1932, it immediately admitted thirty cases from the Ezrath Nashim mental hospital, whose costs the government had been subsidising in the interim.131 Far from representing the realisation of a careful plan for the expansion of government provision for the mentally ill, guided by the figures dispassionately tabulated and analysed by Mills, the second government mental hospital was opened under circumstances of great 126

127 128 129 130 131

Inger Marie Okkenhaug, ‘Scandinavian Missionaries in Palestine: The Swedish Jerusalem Society, Welfare, and Education in Jerusalem and Bethlehem, 1900–1948’, in Ragnhild J. Zorgati, ed., Tracing the Jerusalem Code: Christian Cultures in Scandinavia, vol. 3 (Berlin: DeGruyter, 2021), pp. 518–40. I am grateful to Inger Marie Okkenhaug for sharing this chapter with me in advance of publication. Director of Medical Services to District Commissioner, Jerusalem, 19 March 1926, ISA M 6552/32. H. Hermann, Ezrath Nashim Hospital, to Senior Medical Officer, Jerusalem, 23 October 1931, ISA M 6552/32. H. Hermann, Ezrath Nashim Hospital, to Senior Medical Officer, Jerusalem, 10 November 1931, ISA M 6552/32. Director of Health to District Commissioner, Jerusalem, 12 May 1934, ISA M 6552/32. Director of Health to H. Hermann, Ezrath Nashim Hospital, 18 May 1932, ISA M 6552/32.

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haste and urgent necessity – and in advance of the publication of the census report. This sense is reinforced by the partial nature of the renovation undertaken of the site prior to the opening of the hospital. The site, which included the three-storey stone building previously used as a hospital, required restoration after being left unoccupied for the last seven years. It was described as being in a state of disrepair; even access to the site was difficult, with the steep road leading to the site in a bad condition.132 Approval had only been given for the leasing of the site in April 1932, and the hospital received its first patients in December that year, perhaps prematurely. As Dr Malouf – who took charge of this new mental hospital, alongside the first – reported in August 1933, the garden walls and fences which surrounded the hospital were not high enough to prevent patients from escaping. ‘This is a subject causing constant worry to us’, he warned, ‘and notwithstanding the vigilant attitude of the staff and the severe warnings issued to them, there had been a few escapes and many attempts to run away.’133 Even leaving aside the issue of the walls, the site seemed much less suitable for the accommodation of the mentally ill than the first government mental hospital. The ground south of the main building was described as being very rough, with stones strewn all over. Although there were fruit trees in the garden, opportunities for the agricultural occupation of patients seemed limited indeed; extensive work would be needed to transform this situation, with proper terraces with ramps or steps recommended.134 Landscaping on this scale does not appear to have been attempted, however. The efforts of the government in this area were instead much more limited: in November 1937, five years after the opening of the hospital, Malouf requested that crushed stones be purchased to cover the patients’ playground, preventing them from dirtying the floor of the hospital with their muddy feet when they went outside after it rained.135 It is difficult, reading early correspondence and reports about the hospital, to shake the sense that the urgency of the circumstances surrounding its establishment led to shortcuts being taken, with long-term consequences for the experience of patients. 132

133 134 135

Report on Condition of Swedish Hospital, Bethlehem, in May 1932, enclosed in letter from Engineer in Charge, Jerusalem District, to Director of Public Works, 8 June 1932, ISA M 4087/7. M. S. Malouf, Bethlehem, to Senior Medical Officer, Jerusalem, 25 August 1933, ISA M 6543/16. Report on Condition of Swedish Hospital, Bethlehem, May 1932, ISA M 4087/7. M. S. Malouf, Bethlehem, to Senior Medical Officer, Jerusalem, 22 November 1937, ISA M 6543/16.

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Figure 2.2 Photograph of the Swedish hospital, Bethlehem, taken before the First World War. From the Eric and Edith Matson Photograph Collection, Library of Congress.

Conclusion Mills’ reflections on insanity in Palestine never had the practical value he hoped. As far as mental illness was concerned, rather than work from the figures and analysis Mills had carefully provided, the mandate government continued to lurch from crisis to crisis, acting only when pressure to do so became irresistible. But the census report warrants attention nonetheless. The most systematic attempt to come to terms with the question of mental illness in mandate Palestine, Mills’ analysis – produced by someone who lacked a medical or psychiatric background – underlines the value of looking beyond the usual suspects of case file and research article when it comes to assembling the history of psychiatry’s archive. In centring the meeting between enumerator and enumerated that took place on the threshold of the home one night in November 1931, it also highlights the unexpected forms psychiatric encounters might take – and the particular challenges posed by this

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encounter, which was tidied up through a series of acts of translation and the deliberate destruction of records. This chapter has highlighted the multiple acts of translation through which the inquiry and report proceeded, not least because doing so exposes the fiction that this was a single-authored work. Though bearing the traces of its author’s idiosyncrasies, the census report is best understood as emerging out of a striking range of encounters and as itself deeply concerned with the question of connection. It is in conversation with a range of influences: some of these are made explicit, as in the case of Mills’ debt to the Indian census or in the case of Dr Hermann, whose words regularly punctuate the text; others are left implicit or indeed deliberately made invisible, like the Ottoman population counts erased in Mills’ claim to be undertaking for the first time a census in Palestine. These influences ensured that Mills’ analysis, particularly his explanation for the different rates of insanity recorded among the communities of Palestine, resonated with wider currents of thought. But in weighing up which models to emulate and which to discard, and in drawing out what was exemplary and exceptional about Palestine’s results, Mills and the others involved at various stages of the census inquiry and report also used the question of mental illness to locate Palestine in the wider world – an often politically charged endeavour. If the census report offers the most sustained and conscious reflection on how psychiatry in Palestine might be placed in the world, it is able to do so at least in part because of Mills’ own Olympian remove, as census superintendent, from the ‘insane’ he sought to account for. The clarity and neatness of explanations at this abstracted level, which meant they were able to connect up so directly to bigger questions and wider currents of thoughts, was what was truly idiosyncratic about the report. As we will now see, on the ground – in the home, the street, the courtroom, the prison – madness was messier.

Part II

3

Petitions, Families, and Pathways to the Asylum

In March 1933, Joseph F. scribbled a long, desperate letter to the director of the mandate’s health department about his wife. Writing in French, Joseph explained how his wife, Amineh, had been diagnosed with neurasthenia – a kind of nervous exhaustion – in 1928, and how he had ruined his health and spent all his money taking her to France to be treated at an asylum there. She had appeared to recover and had returned to Jerusalem, but in September 1931 her mental troubles (troubles mentaux) had reappeared. Joseph had approached the health department, but they informed him that the government mental hospital at Bethlehem was overcrowded, and there was no room for his wife. When pressed, they told him that the department was in the process of leasing the site of the old Swedish hospital for use as a new mental hospital, and that once it was open, his wife would be accepted there. Joseph waited, and waited. After months, he reached out to the health department once again, only to be informed – to his astonishment – that although the old Swedish hospital had now been converted into a second government mental hospital, there was no room in it for his wife. His hopes dashed, he composed an anguished letter to the director of the health department, describing how his wife suffered from the most unbearable sickness, and had to be kept almost locked up, receiving no sunlight and no air, passing each day without laughter or hope of improvement. He had accepted the task of caring for his wife from a sense of resignation inculcated by his Christian education, he declared, but he nevertheless wrote angrily of the government’s failure to help. He accused them of being more concerned with the fate and welfare of animals than of humans. More sharply still, he criticised the failure of the government to make space for his wife in their new mental hospital, as promised. He had waited sixteen months only for the health department to tell him that there was no room for his wife, but ‘the department found enough places to accept forty-seven sick Jews who were taken from the Jewish asylum to here, less sick and suffering less than the atrocious suffering of my wife’. He continued: ‘I 119

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thought that if I said that my wife was Jewish, would she have been admitted with the forty-seven Jews? I do not want to believe it.’1 George Heron, the director of health, penned a short reply a few days later, expressing his sympathy, but declaring it impossible to admit Amineh given the current lack of room at the mental hospitals at Bethlehem.2 Joseph’s loudly declared resignation to the task of caring for his mentally ill wife notwithstanding, Amineh appeared as the subject of a second petition half a year later, this time written in English by the Latin Patriarch of Jerusalem. The Patriarch described her as a ‘very pitiful mental case’ who had been suffering ‘very violent periods of insanity for the past two years’, and noted that she was now living ‘with her poor mother, her husband, Joseph F., having deserted her’.3 Once again, the response to the request to admit her for institutional care was negative, on account of the lack of any vacancies.4 After this, Amineh slips out of sight in the colonial archive, leaving us to wonder at her eventual fate. Did she remain with her beleaguered mother? Did her condition ever improve? Joseph F.’s petition on behalf of his wife was unusual in several respects: it was in French, not Arabic, Hebrew, or English like the vast majority of similar petitions; it was long, running to five full sheets of scribbled pleading. Also unusual is the appearance of Amineh in a second, independently composed petition, though the frustration that seems to have driven Joseph to abandon his wife and so propel her into the orbit of another petitioner was far from unique. In spite of these peculiarities, Joseph’s petition was one of over a hundred to swamp the mandate’s health department from the early 1930s until the end of the period on the subject of the mentally ill, and in other respects it was quite typical. While most petitions were less evocative, its basic purpose – the admission of a relative to a government mental hospital – was standard, as was the short letter of regret from the government that it elicited. What was also typical is the sense that both petitions give of Amineh’s wider journey through a number of different contexts of care or – to put it perhaps more neutrally – management. From Joseph’s petition, for example, we learn that she had previously been treated at an asylum in France, before spending many months confined at home in Jerusalem; from the Latin Patriarch’s petition, we learn how this changed again sometime over the course of 1933, so that she was now with her mother. 1 2 3 4

Joseph F., Jerusalem, to Director of Health, 1 March 1933, ISA M 6627/26. Director of Health to Joseph F., Jerusalem, 3 March 1933, ISA M 6627/26. Latin Patriarch, Jerusalem, to Director of Health, 3 October 1933, ISA M 6627/26. Director of Health to Latin Patriarch, Jerusalem, 10 October 1933, ISA M 6627/26.

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Of course, this information was imparted in the hope of moving the mandate to action, rather than an objective itinerary: Joseph used Amineh’s long stay in an asylum in France as the explanation for his inability to afford further private treatment, and his need to fall back on the state’s provision. This was just one strategy by which Joseph sought to prod the mandate into action in his petition: his framing of the department of health as cheating his wife out of her place, and of himself, guided by a Christian sense of compassion, as a deserving recipient of aid, another. While an extreme example, Joseph’s letter underlines that these petitions were often highly crafted pieces. Reading petitions in this way, as carefully constructed arguments, throws light on how Palestinians attempted to negotiate with the mandate state at a very different register to that of high politics and constitutional questions usually taken to be the natural haunt of petitions in this context,5 and suggests Palestine had more in common with other colonial contexts, where petitions also played an important role in accessing healthcare,6 than is often acknowledged. This does not mean that petitions should be read only as arguments; they allow us to reconstruct better than any other source the strategies by which Palestinians sought to manage the mentally ill, strategies within which government mental hospitals were often only a part. It would be a mistake, moreover, to dismiss everything expressed in petitions as rhetoric, totally unmoored from how petitioners understood both the condition of their relatives and the options available to them for treatment. Joseph’s petition, for instance, gives us an extraordinary insight into how the establishment of the second government mental hospital might have been viewed by Palestinians, as catering disproportionately to the Jewish mentally ill and aimed primarily at relieving pressure on private Jewish mental institutions. To a degree, this was not an unfair reading of events. As we saw, part of the impetus behind the establishment of the second government mental hospital was to relieve overcrowding at the Ezrath Nashim mental home, whose finances had been thrown into disarray in the wake of the global depression. But the sense of marginalisation and frustration clear in Joseph’s hypothetical wondering – ‘if I said my wife was Jewish’ – is remarkable 5 6

Wheatley, ‘Mandatory Interpretation’; Banko, ‘Claiming Identities in Palestine’; Bawalsa, ‘Legislating Exclusion’. See Hannah-Louise Clark, ‘Expressing Entitlement in Colonial Algeria: Villagers, Medical Doctors, and the State in the Early 20th Century’, International Journal of Middle East Studies 48 (2016), pp. 445–72. Petitions had similarly diverse concerns in earlier periods of Palestine’s history, too: see Yuval Ben-Bassat, Petitioning the Sultan: Protests and Justice in Late Ottoman Palestine, 1865–1908 (London: I. B. Tauris, 2013).

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for how it recasts the dynamics of Palestinians’ engagements with psychiatry, too. Both at the time, and in scholarship since, Palestinian Arabs have largely been presented as passive in the face of mental illness, reluctant to think beyond the home as a space in which the mentally ill could be managed. Joseph, with the wealth and social capital to have his wife admitted to a French asylum, is clearly atypical in his resources, if not – as this chapter shows – in his decision to look outside the borders of mandate Palestine for a solution to his situation. Yet his story and the many others at the heart of this chapter upend the prevailing representation of Palestinian Arabs in terms of psychiatric fatalism, by firmly locating the ‘problem’ of family members being kept at home at the supply end of the equation: with the government’s provision for the mentally ill and access to it, rather than with demand among Palestinians. More than this, the failure of Joseph’s petition to achieve its desired ends suggests that how Palestinians imagined that the government’s provision for the mentally ill ought to function – dispassionately calculating individual medical needs without regard for their religious background – was not always matched by its messier, less rationalised operation in reality. These petitions, then, can reveal much about the operation of the mandate state, as well as how families perceived and approached it. This chapter offers a dual reading of petitions, both as rhetorical devices and for what they reveal of the experiences of the mentally ill and their families. Both readings require care: petitions are complex historical sources, riddled with contradictions and caesuras. If the elaborate accounts they sometimes provide of the background to a particular crisis in a family’s life could be shrewdly partial, their outcomes too are more often than not left uncertain, in the absence of corresponding patient case files with which to follow their stories through. These uncertainties are compounded further by questions of archival survival and provenance. While the first petitions about mental illness start to appear in the colonial archive from the early 1930s, it is possible that similar petitions were written earlier, but have simply not survived, destroyed through routine bureaucratic practices or as a result of the chaos in and around 1948.7 And in spite of their intensely personal contents, whether petitions were written by their signatories, or professional petition-writers or other actors, is often an open question. Joseph F. almost certainly wrote his own. But crude estimates of literacy rates across the 1930s and 1940s make it clear that significant proportions of the population would

7

Ilana Feldman, Governing Gaza: Bureaucracy, Authority, and the Work of Rule, 1917–1967 (Durham, NC: Duke University Press, 2008), pp. 31–61.

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have struggled to write these letters themselves.8 Petition-writers had been ubiquitous in the late Ottoman period;9 it would not be surprising if third parties of one kind or other continued to play a major but unquantifiable role in composing these petitions across the mandate decades. Whether analysed as rhetorical devices or for what they reveal of the experiences of the mentally ill and their families, petitions reinforce the picture painted by Joseph F., of Palestinian Arabs as much more actively engaged with questions of psychiatric care and management than has hitherto been represented. Petitions lay bare the complex ways in which the mandate’s processes, institutions, and indeed anxieties were incorporated into the strategies of Palestinian families and communities as they sought to manage the mentally ill. A central argument across this book is that a focus on mental illness is productive, bringing to the surface an important if overlooked set of interactions between state and society around the mentally ill. Mental illness, in that sense, returns us to a field marked for investigation in the late 1990s by Ann Laura Stoler and Frederick Cooper, but left fallow in histories of Palestine: that stretch ‘between the public institutions of the colonial state and the intimate reaches of people’s lives’.10 Petitions help reframe interactions between state and society in mandate Palestine, but they also depart from the focus of scholarship on colonial concerns about the intimate, which has tended to centre on poor whites, somatic contacts in settler homes, and the like – to put it another way, on Europeans slipping out of their proper place.11 The petitions examined here do not share this emphasis, and uncover a different register of anxieties. These petitions, which urged the mandate government to take charge of the minds and bodies of petitioners’ relatives, instead reveal a state overwhelmed by the scale of its responsibilities in the most intimate realm of all.

8

9 10 11

Calculating literacy rates is notoriously tricky, but for estimates, see Ami Ayalon, Reading Palestine: Printing and Literacy, 1900–1948 (Austin: University of Texas Press, 2004), pp. 16–17. Ben-Bassat, Petitioning the Sultan, pp. 50–8. Ann Laura Stoler and Frederick Cooper, Tensions of Empire: Colonial Cultures in a Bourgeois World (Berkeley: University of California Press, 1997), pp. vii–viii. For instance, David Arnold, ‘Orphans and Vagrants in India in the Nineteenth Century’, Journal of Imperial and Commonwealth History 7, 2 (1979), pp. 104–27; Julia ClancySmith and Frances Gouda, eds., Race, Gender, and Family Life in French and Dutch Colonialism (Charlottesville: University Press of Virginia, 1992); Ann Laura Stoler, Carnal Knowledge and Imperial Power: Race and the Intimate in Colonial Rule (Berkeley: University of California Press, 2002).

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Pathways to the Asylum Even as they looked to the future with the hope of relief, petitioners often also looked back, recounting not just how a relative’s condition had begun or worsened, but their own efforts to care for and manage them. This information was not imparted neutrally: it could, as in Joseph F.’s letter, be woven into the petitioner’s wider strategy for securing help from the government; key details, too, might be withheld. But the backgrounds that petitioners sketched out offer a rare window into understanding how families responded to the appearance of mental illness in their midst, and under what circumstances they might turn to the mandate government and institutionalisation. Read carefully, these petitions challenge the picture of distinction that was and continues to be drawn between how Arab and Jewish families managed the mentally ill. While Jewish families are presented, within this picture, as actively seeking out institutional treatment – whether government or private – for their mentally ill relatives, Arab families are held to have settled for managing their relatives at home, a strategy represented variously in terms of passivity, reluctance, and ignorance. One historian of the mandate period, for instance, argues that the Arab mentally ill ‘were … kept at home and cared for by their relatives’ because – in contrast to the Jewish population – there was never the same drive among Arabs to establish private institutions for their care.12 Other versions of this argument were expressed by some medical professionals at the time. Dr Abraham Rosenthal, who had arrived in Palestine from Russia in 1924, described in the early 1930s how ‘the rural population, owing to its primitive Oriental psychology, usually keeps their mental sick at home, especially in the case of women’.13 A senior official in the health department, Dr J. W. P. Harkness, meanwhile offered a somewhat more sympathetic – and self-aware – explanation: Arab patients ‘who cannot be admitted to the government hospitals are looked after by their relatives at home or, where they can afford the expense, are transferred to hospitals in neighbouring countries’.14 As Harkness tacitly accepted, underlying the decision to care for relatives at home was not a ‘primitive Oriental psychology’ but rather the failure of the government’s provision for the mentally ill to keep pace with demand. The returns of the 1931 census appeared to show that only 12 13 14

Simoni, ‘A Dangerous Legacy’, p. 95. Abraham Rosenthal to Senior Medical Officer, Jerusalem, 20 October 1931, ISA M 6552/17. Acting Director of Medical Services to Chief Secretary, 6 August 1938, ISA M 1752/20.

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a fifth of the ‘actually insane’ in Palestine were being accommodated in institutions, with eight hundred ‘insane’ individuals enumerated in Palestine and yet just a hundred and fifty of them under treatment.15 The establishment of the second government hospital in 1932 did not solve this problem; by 1941, the number waiting for admission to a government institution had passed three hundred.16 It was this context of chronic overcrowding which lay at the root of many cases in which the mentally ill were kept at home, rather than fatalism or preference; indeed, as we saw with Joseph F., petitions were often desperate attempts to find a way around this obstacle and access an alternative to caring for relatives at home. But even if undesired by petitioners, maintaining relatives at home might not always have been as backward and detached from professional medical care as Rosenthal’s comments suggested. Petitions from Palestinian Arabs and Jews reveal – sometimes inadvertently – that families could and did hire medical doctors to attend to relatives while at home. Esther F. of Mahane Yehuda in Jerusalem, for instance, disclosed in a petition to the High Commissioner that her young son, Shlomo, had been receiving treatment at home from one Dr Blumaz for a number of years, after suffering a fall which had left him ‘ruined mentally’.17 Khader D.’s wife, too, was attended by doctors while at home, though this was not something he himself divulged. Khader had written to the department of health in January 1937 to request that his wife, Yamineh, be admitted to the ‘Bethlehem women hospital for foolpersons for treatment’, as he described it.18 He wrote to the High Commissioner just a few days later with the same request, explaining how his wife had been ‘very dangerously and seriously insane’ for the past year and a half.19 A medical examination was arranged for the end of February, but the examining doctors found her ‘quiet’, and reported that she answered all questions put to her ‘in a normal way’. This led to her being declared ‘not dangerous to herself or to others’, and a low priority for admission. Easing concerns further, the examining medical officer reported that ‘she was under treatment by several doctors, among whom was Dr Hermann’, of the nearby Ezrath Nashim hospital.20 Remaining at 15 16 17 18 19 20

Mills, Census of Palestine, p. 232. Director of Medical Services to Chief Secretary, 5 April 1941, ISA GL 16648/10. Esther F., Jerusalem, to High Commissioner, 18 April 1937, ISA M 6627/28. Khader D., Bayt Hanina, to Inspector General, Public Health, 16 January 1937, ISA M 6627/28. Khader D., Bayt Hanina, to High Commissioner, 23 January 1937, ISA M 6627/28. Medical Officer, Villages, to Senior Medical Officer, Jerusalem, 4 March 1937, ISA M 6627/28.

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home, then, did not always indicate passivity or a reluctance to engage with medical doctors – though petitioners did, as Khader’s case suggests, have an incentive not to disclose that their relatives were currently receiving some kind of medical attention at home, if they wanted them to be accorded priority for admission. In other ways, too, petitioners may have been more active in seeking out relief for their relatives than they revealed. As Antonin Jaussen had observed in relation to the Nabulsi shaykh Sa’ad al-Din in the early 1920s, families might well pursue medical and non-medical modes of treatment simultaneously or in sequence, as in the case of one woman who was brought to the shaykh for an exorcism after being failed by doctors.21 Not everyone, of course, embraced such therapeutic pluralism: Fadwa Tuqan’s memoirs, for instance, make it quite clear that ‘superstition’ – including resorting to amulets or incantations for cure – had no place in her family home when she was growing up in interwar Nablus. But even within Tuqan’s own family, and in spite of disapproval from her grandmother and mother, her paternal aunt – al-Shaykha – performed healing rituals, reciting Qur’anic verses and breathing over water to cure sick children.22 Nor – more crudely drawn distinctions between superstitious Palestinian Arabs and their disenchanted Jewish counterparts notwithstanding – was the pursuit of multiple possible means of relief limited to Christian and Muslim families alone, as W. P. H. Lightbody discovered in 1935 while acting director of medical services. In April, the department had been approached by Avraham Katznelson, head of the Vaad Leumi – the Jewish National Council’s – health section, with a list of seven ‘severe mental cases’ in Jerusalem alone, and a request to admit the two most serious to the government mental hospital in Bethlehem. Although the hospital was, as usual, already overcrowded, Lightbody managed to create two vacancies. But when the district medical officer was duly dispatched to the homes of the two families to tell them the good news, he found that one had already been admitted to a private Jewish institution, and the other – nineteen-year-old Amram K. – was not at home, but had gone north to Tiberias.23 When Lightbody complained, Katznelson wrote back to express his regret that ‘circumstances of an accidental nature, which I could not have foreseen, interfered with the

21 22 23

Jaussen, ‘Le cheikh Sa’ad ad-din’, pp. 151–2. See Chapter 1. Fadwa Tuqan, A Mountainous Journey: An Autobiography, trans. Olive Kenny (Saint Paul, MN: Graywolf Press, 2013), pp. 31–42. W. P. H. Lightbody, Acting Director of Medical Services, to Avraham Katznelson, Vaad Leumi, 23 May 1935, ISA M 6627/27.

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settlement of these two deplorable cases’. He explained that a wealthy individual had paid out of his own pocket for the first case to be temporarily accommodated in a private institution, but that since this was only temporary, she would still require admission to the government mental hospital in the near future. As for Amram, the explanation was a little more complicated: As you may have heard, there is a belief common in certain circles of very orthodox Jews that a visit to the Holy City of Meron during the Lag B’Omer holiday has a curative effect on sick persons. Accordingly, Amram K.’s family took him to Meron during the recent holiday in the hope that the visit would bring about a cure. As I need not tell you, the hoped-for cure was not effected, and the man is back in Jerusalem.24

Furnished with this explanation, Lightbody again dispatched the medical officer to visit Amram’s home, where he found the young man alone, lying quietly in bed. Amram had worked for a time at a printing press in Jerusalem, he told the medical officer, but then – as he put it – ‘was not feeling well’. His neighbours were able to add some detail: though mostly quiet, Amram at times would get excited, shouting and trying to get out of the house. But he had never attacked anyone and was not dangerous – ‘at present’, the medical officer editorialised. With the government mental hospital already overcrowded, the medical officer concluded he was not an urgent case for admission. He added a final detail, having obviously asked about the recent trip: ‘His mother took him to Safad and Tiberias for a change of air.’25 Amram’s story – and in particular, the competing narratives about his journey north, for miraculous cure or change of air – underlines more than just the point that Palestinian Arabs were not alone in pursuing nonmedical relief alongside medical forms of treatment in this period. It also has something to say about the contingency – if not the deliberate partiality – of the mandate’s knowledge about ‘alternative’ treatments. The pilgrimage for Lag B’Omer was a popular one, drawing thousands of Jews – particularly Mizrachim – to the grave of Rabbi Shimon Bar Yochai outside Safad across the 1930s.26 It would not have been at all difficult for the medical officer to make a connection between Amram’s recent trip and Lag B’Omer. Yet in the explanation offered to the medical

24 25 26

Avraham Katznelson, Vaad Leumi, to W. P. H. Lightbody, Acting Director of Medical Services, 6 June 1935, ISA M 6627/27. Medical Officer, Villages, to Senior Medical Officer, Jerusalem, 1 July 1935, ISA M 6627/27. See: PB, 24 May 1932, p. 1; PP, 15 May 1933, p. 5; PP, 22 May 1935, p. 7; and PP, 30 April 1937, p. 9.

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officer on his visit to Amram’s house, and the summary communicated back to the department of health subsequently, reference to any possible religious dimension to his journey north was elided. Only Katznelson’s alternative explanation, prompted by the need to account for the inconvenience caused to the department of health, explicitly alerted mandate authorities to another possible reading of Amram’s journey as a pilgrimage aimed at securing a miraculous cure for mental malady. Without the unforeseeable coincidence of medical and miraculous treatment for Amram’s condition, the story of his pilgrimage would never have made it into the colonial archive: ‘change of air’ is all that would have been recorded, contingent on a medical officer bothering to inquire in the first place. This reflects a wider and partially wilful myopia on the part of the mandate, which conserved its energies for what it viewed as the most serious cases of mental illness. But it is also a cautionary reminder of the selectivity of information given by families to the mandate about the treatment histories of mentally ill relatives; these were not objective histories, but revealed or concealed for a particular purpose – securing admission to the mandate’s mental institutions. Far from being fatalistically resigned to keeping the mentally ill at home, petitions reveal Palestinian Arabs as well as Jews to have been active in pursuing multiple means of relief and treatment for relatives while at home, even as they also sought admission to the government’s mental institutions. Of course, these petitions by their nature do not simply highlight but themselves embody instances in which families asserted themselves vis-à-vis the state. But even stepping back from them for a moment, if we were to think of barriers to Palestinian use of the government’s psychiatric provision, a much more obvious one would be political rather than ‘cultural’, as Rosenthal presented it at the time. As well as the period in which petitions begin to appear in the colonial archive, the 1930s also represent the decade in which an increasingly organised and ambitious Palestinian national movement collided with the British mandate regime. By the early 1930s, a deepening crisis of landlessness among the peasantry, and the continued frustration of demands for self-determination and an end to the British policy of support for Zionism, had given rise to new forms of Palestinian social and political mobilisation.27 Novel patterns of collective organising and

27

Charles Anderson, ‘State Formation from Below and the Great Revolt in Palestine’, Journal of Palestine Studies 4, 1 (2017), p. 41. For the most comprehensive account of this process, see Charles Anderson, ‘From Petition to Confrontation: The Palestinian National Movement and the Rise of Mass Politics, 1929–1939’ (PhD diss., New York University, 2013).

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non-violent action – including strikes, boycotts, hunger strikes, and civil disobedience – emerged that took increasingly direct aim at dislodging the mandate itself.28 By 1936, these developments culminated in an anticolonial rebellion – the great revolt – which began as an unprecedented general strike and morphed into a country-wide armed uprising that would only be suppressed in the second half of 1939.29 Not all Palestinian Arabs threw their support behind the great revolt, but under the circumstances, too close an association with the mandate government or indeed an approach of business as usual carried risks.30 Against this backdrop, it is striking that Palestinian Arabs were petitioning the mandate government at all across the 1930s, and in particular in the second half of the decade.31 For what reasons, then, did Palestinians decide to turn to the state to take charge of their mentally ill relatives in this decade and beyond? A close reading of the petitions suggests two broad factors at play, around expectations and knowledge on the one hand, and economic need on the other. In the first place, petitions appeared to respond to the expansion – however slow and inadequate – of government provision for the mentally ill. In a sense, Joseph F.’s letter highlighted this, with his fixation on the promise held out by the opening of a new government mental hospital in 1932. That an expansion of government services might correspondingly enlarge the expectations of subjects is a phenomenon that has been noted in relation to other areas of life in mandate Palestine. Ilana Feldman, analysing a petition by residents of Gaza about water services, has similarly argued that the expansion of provision of services created new expectations of government, and opened up new spaces and styles of interaction and challenge by subjects.32 But petitions around mental illness suggest that expanding provision of these services on its own was not sufficient to engender novel forms of interaction between state and subject. Knowledge was also crucial. The case of Ahmed A., from Khan Younis – also in Gaza – offers an 28 29 30

31

32

Anderson, ‘Other Laboratories’. For an important recent account of the development of the revolt, see Kelly, The Crime of Nationalism. W. F. Abboushi, ‘The Road to Rebellion: Arab Palestine in the 1930s’, Journal of Palestine Studies 6, 3 (1977), pp. 42–3; Noah Haiduc-Dale, Arab Christians in British Mandate Palestine: Communalism and Nationalism 1917–1948 (Edinburgh: Edinburgh University Press, 2013), pp. 130–62; Seikaly, Men of Capital, pp. 29–30. Palestinians were certainly not unique in this, however: as Hannah-Louise Clark highlights, Algerian villagers and elders reached out to the authorities for medical help even as French soldiers were harassing them and ravaging their villages. See Clark, ‘Expressing Entitlement in Colonial Algeria’, p. 446. Feldman, Governing Gaza, pp. 167–8.

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illustration of this. He had been brought to the government’s attention not through a petition by his relatives, but rather a letter from one Shalom Volovelsky of Tel Aviv, who had happened to stumble upon him while passing through the village one day in December 1935. Volovelsky wrote to the director of medical services about spotting ‘a man about 40–45 years old, apparently a lunatic, tied with chains to a fence, exposed and where the automobile traffic passes by’. He had asked residents about the case, and had been informed that ‘this man has been kept in this state for eight years (perhaps this is an exaggeration), day and night, winter and summer’.33 The medical officer for Gaza was sent to investigate, and reported that Ahmed – whose age, contrary to appearance, was just twenty-seven – had suffered some kind of change in character seven years earlier. He had stopped speaking except for the phrase biddi ashrab (‘I want to drink’), and had begun chasing motor cars and destroying hedges, trees, and vegetables. It was to stop him from doing damage to the latter that he had been tied up. ‘His relatives’, the medical officer continued, ‘will be exceedingly obliged if he could be admitted to the asylum’, and had pointed out that there were, he continued, ‘two other idiots at Khan Younis who are also not directly dangerous to others’.34 The health department had never embarked on the same kind of programme of public education for mental illness as they had for hygiene, which was the subject of lectures in schools in towns and villages across Palestine.35 Once Ahmed’s relatives at Khan Younis were interviewed by the medical officer, and made aware of their options, they seized upon the chance to have him admitted to a mental institution – and, it seems, even drew attention to two other cases who might be similarly handed over to the authorities. While the government might boast of their water services and other public works, they were much quieter in advertising their always overburdened psychiatric provision; knowledge of any expansion in provision was far from guaranteed in this context. If expectations and knowledge were important implicitly, it is financial need which is most explicitly and poignantly expressed in many of the petitions in the archive. Ishac W. from Deir Abu Tor near Jerusalem 33 34 35

Shalom Volovelsky, Tel Aviv, to Director of Medical Services, 8 December 1935, ISA M 6628/4. Medical Officer, Gaza, to Senior Medical Officer, Jaffa, 28 December 1935, ISA M 668/4. Medical officers gave a total of 48 hygiene lectures to 321 teachers in town and village schools in 1930 alone; no similar effort was made for mental illness. See Annual Report, Department of Health, 1930, p. 62. Communicating health and hygiene was also seen as a possible role of the Palestine Broadcasting Service in the mid-1930s: see Stanton, ‘This Is Jerusalem Calling’, pp. 82–3.

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wrote to the director of medical services in these terms in May 1938 about his sister, whom he described as having been ‘insane’ for the past five months. She had been treated by several doctors while living with him and his family, in yet another example of how the home might be a site for medical care rather than a separate domain. But she had shown no improvement, and finances were tight. ‘As I am the only supporter of her and of a large family’, Ishac explained, he could no longer afford this private treatment, and requested that she be admitted to a government institution.36 His plea was rejected. It would be possible to read these protestations of poverty as being made cynically, in the hope of escaping entirely – or at least reducing – the fees charged by the government mental hospitals. Certainly, some went to extraordinary lengths to avoid becoming liable for hospital fees, which were waived for indigent families but charged for patients with families of means: one woman did not visit her sister once during her four years in the government mental hospital out of a fear that she would be held liable for settling her account.37 But perhaps precisely to pre-empt such suspicions or objections, these petitions were often accompanied by supporting evidence. In June 1933, Raiseh S., from Jaffa, wrote to the director of health about her brother, Mahmoud, who had been divorced from his wife by a qadi or religious judge ‘because he became insane’. He had come to live at her home instead, where he beat her, and attacked passers-by and neighbours too. Raiseh, who described herself as having ‘no man to support me’ and as ‘a poor woman’, was unable to endure this situation and pleaded with the government to admit him to a mental hospital ‘as a mercy for me and for humanity’. Alongside her petition, she attached not only proof of her brother’s divorce, but also a mazbata or official document attesting to her poverty given by the mukhtars, the community leaders.38 The outcome of her petition is unknown, but armoured in authenticating documentation as it is, hers is one of the most robust petitions citing poverty extant in the archive today. It is unsurprising that financial distress appeared so often in these petitions, nor was poverty as a motor driving petitioners into the arms of the state a phenomenon exclusive to Palestine in the 1930s and 1940s. Claire Edington, for instance, has noted growing concern on the part of the colonial state over the inability or unwillingness of families to take care of mentally ill relatives in the wake of the global depression in 36 37 38

Ishac W., Jerusalem, to Director of Medical Services, 18 May 1938, ISA M 6627/29. Letter intercepted by the Jerusalem Postal Censors to S. Cassis, Bolivia, on 24 September 1939, ISA M 6627/29. Raiseh S., Jaffa, to Director of Health, 9 June 1933, ISA M 6628/3.

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French Indochina.39 But some of the causes and indeed timings of economic distress in Palestine were irreducibly specific. Palestine’s economy was, in the first place, largely counter-cyclical in relation to the global economy, slowing in the late 1920s but picking up in the early 1930s as a result of the infusion of capital that accompanied increasing European Jewish immigration.40 While the expansion of Palestine’s cities and industries like construction had meant employment for the large numbers of Palestinians pushed out of the countryside by a deepening crisis of landlessness and agrarian taxation, their existence at the urban margins was precarious. By the middle of the 1930s, they were shut out of ever larger portions of the urban labour market as a result of the consolidation of a ‘Hebrew labour’ programme among Zionist employers.41 The subsequent economic dislocations attendant on the great revolt were followed in turn by the Second World War, which on paper represented a period of economic growth, but on the ground saw rampant inflation and strict austerity, such that for most Palestinians ‘[d]aily bread became an all-encompassing concern’.42 Small wonder, in this context, that so many petitioners pleaded poverty. Situating these petitions in the wider economic travails of the period can also help make sense of their uneven geographical distribution. Petitions were overwhelmingly urban rather than rural in their point of origin. Nearly half were sent from Jerusalem alone, unsurprisingly given it was the most heavily populated city in mandate Palestine, home to around 100,000 already in 1931 – almost a tenth of the total population. The next two most common points of origin were Tel Aviv and Jaffa, respectively, which together accounted for over a fifth of all petitions. Hebron was the fourth largest single source, though at this point it is important to note we are talking about only half a dozen petitions, while Haifa and Petah Tikva were next, tied for fifth place with three petitions each; Bayt Jala and Lifta followed with two each, and then a dozen other locations with just a single petition. These included smaller towns in the centre of Palestine with populations of a thousand or so, like Abu Dis and 39

40 41

42

Claire Edington, ‘Going In and Getting Out of the Colonial Asylum: Families and Psychiatric Care in French Indochina’, Comparative Studies in Society and History 55, 3 (2013), pp. 751–2. Roger Owen and Şevket Pamuk, A History of Middle East Economies in the Twentieth Century (Cambridge, MA: Harvard University Press, 1998), p. 60. Mahmoud Yazbak, ‘From Poverty to Revolt: Economic Factors in the Outbreak of the 1936 Rebellion in Palestine’, Middle Eastern Studies 36, 3 (2000), pp. 107–8. For the most comprehensive study of the peasant economy, see Amos Nadan, The Palestinian Peasant Economy under the Mandate: A Story of Colonial Bungling (Cambridge, MA: Harvard Centre for Middle Eastern Studies, 2006). Seikaly, Men of Capital, p. 104.

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Bayt Hanina, as well as larger towns further from the centre, like Khan Younis in Gaza – where Ahmed A. had been discovered by a passer-by – and Acre. Jewish settlements of varying sizes like Rishon LeZion, Hadera, and Nahariya rounded out the list. Although petitions were sent from a range of different locations across the length and breadth of Palestine, they did come disproportionately from major urban centres, above all Jerusalem. Cities were not uniquely hit by the economic stresses of the period; but a possible explanation, drawn from a sociological perspective, is that families newly arrived in Palestine’s towns and cities were unable to turn to extended kinship and community networks to care for the mentally ill at home, and so found themselves forced to turn to the state instead.43 The example of Raiseh S., who presented herself as on her own, with no one to support either her or her brother, offers a stark example of how this dynamic might play out. But it was not just, as we have seen, financial need which mattered: expectations and knowledge did too. The countryside, after all, was affected just as profoundly by economic difficulties across the period. But if, as the example of Ahmed A. suggests, inadequate or non-existent knowledge of the government’s provision was common even in more remote towns, then in the countryside this was very likely to be a key barrier to access. To pull all this together, it may be tempting to conclude that financial distress outweighed political conviction when petitioners decided to approach the mandate government about mentally ill relatives in the 1930s and 1940s. But to frame their behaviour as a choice between economics and politics is perhaps misleading. As Natasha Wheatley has argued at a very different register, the use made of mandatory structures and norms by Palestinian petitioners did not necessarily indicate their acceptance of these as legitimate.44 Many of the petitioners we have encountered here were no less inventive, no less virtuosic, than the political leaders and legal thinkers examined by Wheatley: withholding information, shopping around, cladding their petitions with proofs. Petitions about mental illness reveal Palestinians to have entered into close negotiations with the mandate government even at those moments at which its authority was most under strain, and speak to the expectations which the state itself had let loose and which Palestinians were now driving home. But relief from the burden of managing their mentally ill relatives was the principal concern of petitioners – not the legitimacy of 43 44

For an important historical sociological account along these lines, see Scull, Most Solitary of Afflictions. Wheatley, ‘Mandatory Interpretation’, p. 236.

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the mandate, a subject on which petitioners might, characteristically, have decided to strategically hold back.

Boundary-Crossing Patients While petitioners were focussed on securing admission to government mental institutions, their petitions nonetheless – in providing a background to their current predicament – offer an insight into how private mental institutions were integrated into families’ strategies for managing the mentally ill. Shopping around was not unique to Palestine; in other colonial contexts too, families pursued medical and non-medical forms of treatment simultaneously.45 What was, however, distinctive was the availability of non-governmental psychiatric provision, in the form of both the ever-growing number of private Jewish institutions within Palestine and, over the border, the Lebanon Hospital for Mental Diseases near Beirut. Just as Palestinian Arabs have been associated most closely with the home as the principal site of care for the mentally ill, so conversely have these private institutions been linked to the Jewish mentally ill. Though it is certainly true that within the borders of Palestine private mental institutions catered primarily to Jewish patients, the picture changes if we widen the camera lens to capture Palestine’s place in the wider region. Doing so reveals how Palestinians – Arabs and Jews – came to incorporate institutions beyond the borders of the mandate into their responses to mental illness, and affirms the value of stepping beyond the national framing that characterises so much scholarship on Palestine and colonial psychiatry alike. As well as crossing the literal border between Palestine and Lebanon, Palestinian Arabs and Jews also crossed the boundaries between government and private provision within the mandate, as their petitions show. This was certainly common among Jewish patients. While most petitions from Palestinian Arabs requested the admission of relatives to a government mental hospital from the home, many Jewish petitioners – responsible for two-fifths of extant petitions – wrote not to request institutionalisation per se but rather the transfer of a relative from a private mental hospital to a government one. The reasons for this are clearly illustrated by the example of Joseph T. His father, an elementary school teacher at the Jewish settlement of Herzliya, explained to the government in June 1945 that although his son was currently being treated at the Ezrath Nashim mental hospital in Jerusalem, the family 45

Edington, ‘Going In and Getting Out’, p. 741.

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was unable to bear the cost any longer; it was taking all his salary just to meet the hospital’s expenses, and his other sons had families of their own to support and could not help. He pleaded with the government to admit Joseph to the government mental hospital near Jaffa, and so relieve the family of this weighty financial burden.46 The fees charged by private mental hospitals meant that for many families these could only be a temporary expedient in, rather than the end goal of, the longer-term management of mentally ill relatives. As well as cost, another reason why Jewish families might have to look to government provision in place of a private institution was the nature of their relative’s condition. Private institutions were reluctant to admit or retain violent patients, forcing their families or wider community to look elsewhere for care. This was the case for Zahava L., who was brought to the attention of the mandate government in 1942. Zahava did not appear to have any family to claim responsibility for her, so in this instance it is through the petitions of Dr Fritz Noack, from the Vaad Leumi’s health section, that we learn of her movement in and out of multiple institutional contexts. Zahava had initially been admitted to a private home at Givat Shaul in Jerusalem, ‘but had to be removed due to her noisiness and aggressiveness’, Noack explained. She had then been moved to a second private institution in Jerusalem, the Har Hazofim mental hospital; she was discharged after only a few days ‘for the same reasons’. With no vacancies at the government mental hospitals, the management at the Har Hazofim hospital had turned to the police, asking them to keep her in prison until a bed became free in a government institution. They had refused. Noack, speaking on behalf of the Vaad Leumi, also disclaimed responsibility by framing the question as one of ‘public security’, not health. The institution in which she was currently a patient was unable to restrain or continue to keep her, he warned, and so, unless government took her into one of its hospitals – or prisons – there would soon be a ‘public scandal’.47 As we shall see shortly, the idea that mentally ill women ‘at large’ embodied both a scandal and a threat to public order was a common and potent representational strategy among petitioners. In this instance, however, it did not convince the government. In March, Noack informed the director of health that Zahava had been discharged from the private home and left to wander the streets. Eventually, a social worker from the Vaad Leumi managed to place her temporarily with a family at Givat Shaul, but it was clear this was a temporary solution, and 46 47

P. L. T., Herzliya, to Settlement Medical Officer, Jerusalem, 17 June 1945, ISA M 6628/6. F. Noack, Health Section, Vaad Leumi, to Director of Health, 22 February 1942, ISA M 6627/30.

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an unsuitable one at that.48 After this, she slips out of the purview of the state and its archive. For reasons of both cost and the unavailability of alternatives, then, Jewish families might look to send their relatives to be treated in government mental institutions, alongside Arab patients and by Arab doctors and nurses. Some Arab families did the reverse, and arranged to have relatives admitted to private Jewish institutions. The numbers were never great. But again, considering the political backdrop of the period, that families did this at all is remarkable – and at odds with how government and private provision are usually represented, as segregated institutional and experiential worlds for Arabs and Jews.49 We can find examples of this even into the late 1940s, when the mandate was beginning to come undone at its seams. In November 1946, for instance, the Supreme Muslim Council wrote to the director of health about the sister of a sharia judge at Beersheba, who ‘had a mental disease and was admitted to the hospital of nervous diseases in Haifa’, that is, the private hospital of Dr Kurt Blumenthal on Mount Carmel. The council was writing to request that she be transferred to the government mental hospital at Bethlehem – but only, they claimed, because the fees at Haifa were too high to be sustainable any longer.50 This was not a unique case,51 nor is it surprising that Blumenthal’s institution was popular: it was the first in Palestine to administer new treatments for mental diseases, including electro-shock treatment.52 The mandate government even received applications for visas from outside Palestine from individuals seeking admission to his hospital.53 But other Jewish private institutions attracted Arab patients, too. As late as August 1947, there were Arab patients at the Ezrath Nashim mental home in Jerusalem. Amina K., for instance, had been admitted to the government mental hospital at Bethlehem, and had been discharged after a number of years of treatment there near the end of 1941.54 But she suffered a relapse sometime around the end of the Second World War, 48 49 50

51 52 54

F. Noack, Health Section, Vaad Leumi, to Director of Health, 5 March 1942, ISA M 6627/30. See Simoni, ‘A Dangerous Legacy’. Supreme Muslim Council to Director of Medical Services, 17 November 1946, ISA M 6627/31. Blumenthal’s hospital is described as ‘the most expensive private institution in the country’ in Sylva M. Gelber, No Balm in Gilead: A Personal Retrospective of Mandate Days in Palestine (Ontario: Carleton University Press, 1989), p. 62. Medical Report on Mental State of Yacoub M., Bethlehem, 16 November 1946, ISA M 6627/31. 53 See Chapter 7. See ISA M 4342/42. Senior Medical Officer, Jerusalem, to Director of Medical Services, 8 December 1941, ISA M 6627/29.

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and her relatives had asked, without success, for her to be re-admitted for further treatment. As an interim measure, they arranged for her to be treated at the Ezrath Nashim home, but they insisted this could only be temporary, and continued to seek her admission to a government institution.55 The high cost of treatment, for Arab as for Jewish families, meant that those patients who did find their way into private institutions often did so in the context of a more complex history of admissions, discharges, and transfers. Treatment at a private Jewish institution within Palestine was an option for those who could afford it, even temporarily, but as the admission statistics for the Ezrath Nashim show, the number of Arab patients admitted was always low – an average of just one or two every few years.56 Focussing on Palestine alone to get a sense of how far Palestinian Arabs in particular made use of private institutions, however, is misleading, because families were more than capable of plotting therapeutic trajectories for their relatives which traversed the borders of the mandate state. Joseph F., who took his wife abroad to receive treatment, was not atypical in that respect – though he was in his decision to go to France. By far the most important option for private treatment for Palestinian families was the Lebanon Hospital for Mental Diseases at ʿAsfuriyyeh, just south-east of Beirut.57 It had admitted patients from across the Arab provinces of the Ottoman empire, including cities which would later come to form part of mandate Palestine, almost from the moment it opened its doors in 1900,58 and Palestinians continued to look to ʿAsfuriyyeh right across the first half of the twentieth century. Though the number of patients admitted from Palestine was hardly overwhelming, rarely breaking out of single digits in a given year, it is important to put this in context: the government mental hospital at Bethlehem had a bedstrength of just forty when it was first established. Even with the expansion of the first government mental hospital and the opening of two additional hospitals, the number of patients travelling for treatment was still statistically significant into the 1940s.

55 56

57

58

H. F. K., Jerusalem, to Acting Director of Medical Services, 21 August 1947, ISA M 6627/31. Figures drawn from the annual reports of the mandate department of health, which provide a breakdown by religion of patients admitted to the Ezrath Nashim home as well as government mental hospitals. There is some evidence Palestinians were also treated in institutions in Egypt. For the case of an Italian woman, Palestinian by marriage, who was admitted to the ʿAbbasiyya mental hospital in the 1940s, see ISA M 4986/38. For more on this early history, see Chapter 1.

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What led families to continue to look north to ʿAsfuriyyeh throughout the mandate period? Some explained the decision to send relatives across the border to Lebanon simply in terms of ‘the lack of accommodation … in the Bethlehem lunatic asylum’.59 This was how senior officials in the department of health understood things: recall Harkness’ explanation that Arab patients ‘who cannot be admitted to the government hospitals are looked after by their relatives at home or, where they can afford the expense, are transferred to hospitals in neighbouring countries’.60 Yet it was not only Arab patients, as Harkness suggested, who were admitted to ʿAsfuriyyeh across this period; a closer reading of patient lists from the Lebanon Hospital for Mental Diseases reveals that European Jewish patients also found their way here for treatment.61 Beyond Palestine, as well as within it, the strategies by which Arab and Jewish families – particularly those with resources – managed their mentally ill relatives had more in common than represented at the time or since. There were other factors, beyond the unavailability of government provision, that led families to turn to ʿAsfuriyyeh. In the first place, for some families ʿAsfuriyyeh may simply have appeared to be a more local option than the government institutions at Bethlehem, in ways which reflect not only geography but longer histories of responding to mental illness within the region. From the opening of the hospital in 1900 to the middle of the 1930s, when the hospital’s annual reports cease noting the place of residence of patients in such detail, admission statistics reveal that ʿAsfuriyyeh regularly admitted patients from across the north of Palestine: from Haifa and Acre in particular, but also from Nazareth, Safad, Tiberias, and the Jewish colony of Zikhron Ya’acov, and further south, Nablus too. Although the most populous cities in Palestine, Jerusalem as well as Jaffa and Tel Aviv, sent the single largest numbers of patients, taken together admissions from across the north of Palestine outweighed these two cities individually: Jerusalem and Jaffa-Tel Aviv each sent forty-five patients, while admissions from across northern Palestine surpassed fifty. Cities like Haifa, Acre, and Nablus had been part of the same administrative unit as Beirut in the late Ottoman period, and this sense of connection and proximity appears to have persisted. 59 60 61

District Commissioner, Jerusalem, to Chief Secretary, 9 September 1942, ISA M 551/19. Acting Director of Medical Services to Chief Secretary, 6 August 1938, ISA M 1752/20. List of Patients at the Lebanon Hospital for the Insane, Asfuriyeh, 1 August 1900 to 31 March 1936, Archives and Special Collections, Jafet Library AUB. It is only possible to determine the religious background of patients from Palestine up until 1936; after this point, records which would allow this do not survive, making it impossible to come to concrete conclusions about the proportion of patients from Palestine from different backgrounds.

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Even after the post-war partition of the region, inhabitants of the region along the newly drawn border between Palestine and Lebanon were permitted a degree of latitude in crossing from one side to the other by the British and French authorities, making, in Cyrus Schayegh’s words, ‘crossing the border … an everyday occurrence’.62 The itineraries of psychiatric patients, as much as pilgrims and other mobile subjects, confirm that the colonial border did not completely sever the ties between parts of the former Ottoman province of Beirut.63 If a sense of proximity, informed by longer histories stretching back to Ottoman-era practices of managing the mentally ill, helped to shape family decision-making, ongoing political histories also played a role. This is suggested by plotting admissions not over space but over time. While the number of patients admitted most years hovers in the single digits, there are two striking exceptions: across 1937–9, when over sixty Palestinians were admitted; and in 1948, when nearly thirty were admitted in a single year (Figure 3.1). Both of these spikes coincided with key moments in the political history of mandate Palestine – the great revolt, and the nakba respectively – and reaffirm that families did not reach these decisions about how to manage mentally ill relatives in a vacuum cut off from politics. On the one hand, these events pushed Palestinians to look outside the mandate. During the great revolt, the circumstances of political and economic instability meant that many Palestinian Arab families with means left the country anyway.64 But the great revolt also impacted specifically on the workings of the already overburdened government mental institutions. Armed men stormed the first government mental hospital in Bethlehem towards the end of 1938 and murdered a member of the hospital staff.65 Although protective measures were put in place, it would hardly be surprising if Palestinians – even among those who chose to remain in the country – came to consider sending their relatives away for treatment as a safer option.

62

63

64 65

Cyrus Schayegh, ‘The Many Worlds of ‘Abud Yasin: Or, What Narcotics Trafficking in the Interwar Middle East Can Tell Us about Territorialization’, American Historical Review 116, 2 (2011), p. 278. Toufoul Abou-Hodeib, ‘Sanctity across the Border: Pilgrimage Routes and State Control in Mandate Lebanon and Palestine’, in Schayegh and Arsan, eds., History of the Middle East Mandates, p. 386. Abboushi, ‘The Road to Rebellion’, pp. 42–3; Seikaly, Men of Capital, pp. 29–30. Director of Medical Services to District Commissioner, Jerusalem, 20 December 1938, ISA M 4087/9. For other ways in which violence, particularly by British counterinsurgents, intruded on the space of the clinic during the great revolt, see Chris Sandal-Wilson, ‘The Colonial Clinic in Conflict: Towards a Medical History of the Palestinian Great Revolt, 1936–1939’, Culture, Medicine, and Psychiatry 47, 1 (2023), pp. 12–36.

Map 3.1 Distribution by recorded place of residence for the 174 patients from Palestine admitted to the Lebanon Hospital for Mental Diseases between 1901 and 1935

Figure 3.1 Palestinians admitted to the Lebanon Hospital for Mental Diseases, 1920–48. 141

Figures drawn from the annual reports of the Lebanon Hospital for Mental Diseases.

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The increase in the number of Palestinian patients at ʿAsfuriyyeh can be related at least in part to the changing possibilities for managing the mentally ill within Palestine itself. But on the other hand, it is also worth considering if this was driven by a rise in the actual incidence of mental illness in these years, too – however impossible it is to reach any concrete conclusion on this point on the basis of extant archival evidence. Contemporary research on mental illness under the Israeli occupation, at least, suggests severe political stress and mental health are causally linked in complex ways.66 And while it would be ill-advised to straightforwardly apply this to our understanding of the impact of any historical event, some of the cases admitted to ʿAsfuriyyeh in the late 1930s were very directly linked to political violence by psychiatrists at the time. The tragic story of Shafika M. is a case in point: she was admitted to ʿAsfuriyyeh after a psychiatric specialist in Palestine concluded she was suffering from paranoia and delusions of persecution as a result of the death of her seven-year-old son in an explosion in Jerusalem in 1936.67 If Palestinians sent relatives to ʿAsfuriyyeh for treatment in part because of its perceived proximity, and in part because unrest pushed families to consider options farther afield, a third reason was the perceived difference in quality between this hospital and those within Palestine. The quality of treatment at ʿAsfuriyyeh was most clearly articulated in relation to European patients who found themselves in need of psychiatric attention while in Palestine. In one case, for instance, the senior medical officer at Jaffa noted how the relative of a young English lady ‘who showed signs of mental disease when she was on a visit to Jaffa’ expressed horror at the idea of having her admitted to the government mental hospital at Bethlehem, and whisked her away to Beirut instead. The medical officer agreed with the decision, opining with respect to Palestine: ‘I know of no place in which patients of a high standard of life can be accommodated.’68 In 1947, Dr Pridie of the British Middle East Office – the post-war successor to the Middle East Supply Centre – echoed this: ʿAsfuriyyeh was ‘the only mental diseases hospital I have seen in the Middle East which is suitable in every way for British patients’.69 Those who chose to send their relatives

66

67 68 69

See Jabr, ‘Palestinian Barriers to Healing Traumatic Wounds’; Megan Giovannetti, ‘“Maybe the Devil Got into My Mind”: Tackling Depression in Palestine’, Middle East Eye (4 January 2019). For a review of this work, see Giacaman, ‘Reframing Public Health in Wartime’. District Commissioner, Jerusalem, to Chief Secretary, 9 September 1942, ISA M 551/19. Senior Medical Officer, Jaffa, to Director of Medical Services, 6 February 1939, ISA M 6628/15. Beirut Consular Section to Secretariat of the Palestine Government, 22 April 1947, ISA M 327/41.

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to ʿAsfuriyyeh were not always doing so as a result of a lack of options within Palestine; they were sometimes paying hefty fees in order to have relatives admitted as first-class patients, so that they could be accommodated at a standard thought suitable for their socio-economic class. In the late 1930s, to give an example, Tewfik A. of Jaffa was being charged £270 a year to meet his wife’s expenses as a first-class patient in the hospital.70 Yet Tewfik, and a number of other families whose relatives were being treated at ʿAsfuriyyeh, failed to keep up with the hospital’s fees, particularly after the outbreak of the war in 1939. In desperation, the Lebanon Hospital for Mental Diseases turned to the mandate government for help in recovering what was owed to them, and so across the early 1940s mandate officials found themselves chasing a number of Palestinian families – Arab and Jewish – for the payment of their debts to this institution.71 While the decision to send relatives across the border to a private institution seemed to take these individuals and their families firmly beyond the control or concern of the mandate government, in reality these patients had the same potential to be foisted back on the mandate as a responsibility of government as did patients in private institutions within the borders of Palestine when things went wrong. And just as families could be strategic in the information they gave to mandate officials about relatives within Palestine, so too did the families of patients at ʿAsfuriyyeh utilise the delays in communication and uncertainties introduced by the Palestine–Lebanon border to their advantage, claiming to have sent fees, reached separate agreements with the hospital, and even themselves crossed the border, when they had in fact not.72 These manoeuvres suggest that although resources loomed large in shaping the decision of families to turn to private institutions or not, these constraints might be temporarily evaded, under the right circumstances: Tewfik’s wife, for instance, remained at ʿAsfuriyyeh for years in spite of his failure to pay for her upkeep. Across the 1930s and 1940s, families plotted courses for their mentally ill relatives which crossed multiple boundaries: between government and private institutions, purportedly separate Arab and Jewish health systems, and Palestine and Lebanon. Their stories highlight the importance both of avoiding a teleological framing which projects segregation backwards from 1948, and a too narrowly national frame of analysis. But these 70

71 72

British Consul, Beirut, to High Commissioner, 31 October 1939, ISA M 551/19. To put this in context, the average gross annual income of a fellah near Ramallah in 1930 was £40; after taxes and production costs, this was reduced to £9–11. See Yazbak, ‘From Poverty to Revolt’. See ISA M 551/19. British Consul, Beirut, to High Commissioner, 7 January 1940, ISA M 551/19.

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circulations across different institutional contexts within and beyond Palestine also suggest something about how families had come to apprehend psychiatry and mental illness down universal lines by the 1930s and 1940s. In shopping around, families appear to have perceived these institutions as interchangeable, bound together as a result of their shared commitment to a medicalised response to mental illness that was valid everywhere. And mental illness, too, emerges through these stories of movement as recognisable, unmistakable, even as it travelled across borders. These were not effortless circulations: resources, politics, and the willingness of private institutions to take on violent cases all made this terrain uneven. But for canny relatives like Tewfik A., those interruptions and blockages might represent not an obstacle but rather a resource to be exploited in their strategies for managing the mentally ill.

Activating Mandatory Anxieties When Joseph F. wrote to the department of health in the 1930s, his letter carried a clear sense of how he expected the government to behave – dispassionately calculating medical need and distributing resources accordingly – and an even clearer sense of disappointment that it had not lived up to this expectation. His expectations were not entirely unfounded. At various points across these decades, the department of health set out the logic by which decisions about admissions to its mental institutions were to be made, a logic with which petitioners often sought to engage in order to secure treatment for their relatives. But here as elsewhere, taking the state at its word might well be a mistake; just as Lori Allen has argued in relation to the investigative commissions which have probed Palestine since the First World War, petitioners like Joseph F. could end up stumbling on the ‘gap between the explicit and implicit rules of the game’.73 Not all petitioners were as naı¨ve, however. In this section, we turn our attention to the range of representational strategies petitioners deployed in their dealings with the mandate government, and examine both how these strategies suggest that petitioners imagined the state as functioning, and how accurate and efficacious these readings turned out to be. 73

Lori Allen, ‘Determining Emotions and the Burden of Proof in Investigative Commissions to Palestine’, Comparative Studies in Society and History 59, 2 (2017), p. 387. In other ways, too, trust in ‘the promise of bureaucratic claim making’ could play out with tragic results, as poignantly shown in Sherene Seikaly, ‘How I Met My Great-Grandfather: Archives and the Writing of History’, Comparative Studies of South Asia, Africa and the Middle East 38, 1 (2018), pp. 6–20.

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The twin logics governing admission decisions were articulated most clearly in April 1946 by the director of medical services: ‘we have to select cases for admission on the grounds of (a) likelihood of responding to treatment and (b) public safety.’74 While petitioners engaged more frequently and explicitly with the latter, petitioners’ more uneven engagement with the former also warrants attention. This criterion had changed over time in line with developments in psychiatric practice, and above all as a result of the introduction of electro-shock therapy into government mental hospitals in 1945.75 This not only held out the promise of curing or relieving patients, but it also opened up new ways of managing the mentally ill. It now became possible for the department to admit patients for a definite period of time only – usually six months or so – to complete a course of treatment, after which they would be discharged, recovered or not.76 If this seemed to hold the key to reducing overcrowding, care had to be taken in selecting patients for admission in order to maximise this opportunity: not all were thought to benefit equally, with electro-shock therapy thought to be particularly effective in cases of acute schizophrenia. This evolving rationale did not go unnoticed by petitioners. Around the same time electro-shock therapy was introduced into government institutions, a number of petitioners began to deploy new arguments and strategies of representation in their approaches to the government: in December 1945, Rahamim S. of Tel Aviv asked for his daughter Hanna to be admitted so that ‘she might eventually be cured under proper medical treatment’;77 in February 1946, Shlomo Z. and Itzhak S. of Petah Tikva made a similar argument about their ward when they claimed that, on account of her youth, ‘she will probably benefit by treatment’.78 In neither case did the examining medical officer agree: both were chronic schizophrenics and so ‘unsuitable for shock treatment’.79 But precisely because they were suffering from schizophrenia, their admission was judged urgent on the grounds of ‘public safety’, the second rationale outlined by the department of health; although unlikely 74 75 76 77 78 79

Director of Medical Services to Ethel Harris, Nahariya, 11 April 1946, ISA M 6628/8. Clinical Assistant, Government Mental Hospitals Bethlehem, to Superintendent, Mental Hospital Jaffa, 27 August 1945, ISA M 6602/17. For instance, Medical Report on Ribhi F., District Health Office, Bethlehem, 14 November 1946, ISA M 6627/31. Rahamim S., Tel Aviv, to Director of Medical Services, 16 December 1945, ISA M 6628/6. Shlomo Z. and Itzhak S., Petah Tikva, to Director of Medical Services, 2 February 1946, ISA M 6628/6. Senior Medical Officer, Jaffa, to Director of Medical Services, 1 January 1946, ISA M 6628/6; and Senior Medical Officer, Jaffa, to Director of Medical Services, 28 January 1946, ISA M 6628/6.

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to recover, they were too dangerous to be left with their families. Rather than relying on this language of danger in the first place, however, these petitioners had instead sought to engage with the shift in representations of the hospital as a place of treatment rather than merely confinement – an unsuccessful strategy, as it turned out. That these petitioners were Jewish might be taken to indicate that Jews coming from Europe, where some of these treatments were already established, had greater familiarity with new therapeutic practices than their Palestinian Arab counterparts. Psychiatric knowledge was certainly unevenly distributed across the population of mandate Palestine. But it was not only European Jews who had exposure to developments elsewhere in the world, as a growing body of scholarship on the importance of Palestinian return migration attests.80 Just as these return migrants could go on to mediate social and cultural developments for their communities back in Palestine, so too do they appear to have introduced new understandings and expectations around mental illness, drawn from experiences at the Lebanon Hospital for Mental Diseases but also further afield. Some had received insulin and electro-shock treatment while in the United States, for example, years before these were available in Palestine itself, and returned with knowledge of these treatments. In cases of relapse, they demanded them once again.81 But if petitions evidence awareness on the part of at least some petitioners of the latest developments in the field of psychiatric treatment, this did not always translate straightforwardly into a petition’s success. More important than understanding the latest developments in psychiatric practice was the ability to read the mandate correctly, and play off its anxieties effectively. Of the two sets of criteria outlined by the department of health, concerns about public safety outweighed the question of therapeutic potential right across the period, even after the introduction of new 80

81

Jacob Norris, ‘Return Migration and the Rise of the Palestinian Nouveaux Riches, 1870–1925’, Journal of Palestine Studies 46, 2 (2017), pp. 61–75; Saleh Abdel Jawad, ‘Landed Property, Palestinian Migration to America and the Emergence of a New Local Leadership: al-Bireh 1919–1947’, Jerusalem Quarterly 36 (2009), pp. 13–33; Nadim Bawalsa, ‘Trouble with the In-Laws: Family Letters between Palestine and the Americas (1925–1939)’, Jerusalem Quarterly 47 (2011), pp. 6–27. Much of this is inspired by work on the Lebanese context, above all Akram Fouad Khater, Inventing Home: Emigration, Gender, and the Middle Class in Lebanon, 1870–1920 (Berkeley: University of California Press, 2001). For the importance of investment in health provision among the Syrian-Lebanese diaspora in Latin America, see Lily Balloffet, ‘Syrian Refugees in Latin America: Diaspora Communities as Interlocutors’, LASA Forum 47, 1 (2016), pp. 11–12. Medical Superintendent, Bethlehem, to Director of Medical Services, 8 March 1947, ISA M 6627/31. Electro-shock therapy was in use at ʿAsfuriyyeh by the Second World War: Annual Report, Lebanon Hospital for Mental Diseases, 1942, p. 15.

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treatment methods. This was the key lens through which government officials in and beyond the health department viewed the question of mental illness: whether in the census’s focus on the ‘actively insane’;82 police concern about the ‘menace’ posed by lunatics ‘at large’;83 or in the department of health’s policy in the context of overcrowding in the 1930s of admitting ‘violent cases only, who are considered dangerous to themselves and others’.84 Families were alert to this prioritisation of violent cases, not only in their petitions but in relation – as we will see in a later chapter – to the government’s separate provision for ‘criminal lunatics’. They accordingly developed a range of strategies to represent their relatives in terms of the threat they posed. But before we turn to these, it is important to register that their efforts to present their relatives in line with concerns about public safety were complicated by the question of translation. Just as testimonies had to be translated for British judges in the courtroom,85 petitions which arrived in Arabic and Hebrew were translated into English for the health department. It is difficult to follow this process of translation in detail; indeed, it is difficult even to give precise figures for the number of petitions received in the different languages, on account of the vagaries of archival survival. Sometimes translations were only summaries, rather than word-for-word renderings; in some cases, the translations do not survive; in other cases, originals do not survive. Complicating matters further is the possibility that in some instances, professional petition-writers may have performed this translation for clients who were perhaps literate in Arabic, Hebrew, or another language, but not English. But amidst these many uncertainties, what is clear is that the choice of term used in translation will have mattered, here as much as in the courtroom, the census, and other contexts. While the number of Arabic and Hebrew petitions is not large, making firm conclusions difficult, there are some patterns. In both, we find a variety of ways of describing the mentally ill, with some avoiding the question of terms altogether by simply calling them ill, with no reference made to the nature of this illness; in these instances, the nature of their condition has to be inferred from the fact that they are requesting admission to a mental hospital. In Arabic, we find individuals being called majnun,86 and many other descriptions derive from this root, as 82 83 84 85 86

See Chapter 2. District Superintendent, Southern District, to President, Jaffa District Court, 1 September 1930, BNA CO 733/201/2. Senior Medical Officer, Jerusalem, to District Commissioner, Jerusalem, 16 June 1936, ISA M 6627/28. Likhovski, Law and Identity in Mandate Palestine, pp. 29–30. M. Ibrahim Kamal, Advocate, to Director of Health, 27 November 1933, ISA M 6627/26.

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in the case of a man – Raiseh’s brother, whom we met earlier – described as having been divorced from his wife on account of his insanity (min aljunun).87 But just as common are descriptions which derive from the word for reason – ʿaql – with individuals described in petitions as suffering from mental diseases (al-amrad al-ʿaqliyya).88 While majnun and its derivatives were often translated in stronger terms, as referring to the ‘insane’ or ‘lunatics’, derivatives of ʿaql were translated more carefully: we read, for example, of individuals suffering a ‘deterioration of her mental abilities’,89 or the more generic ‘mental disease’.90 In translations from the Hebrew, there was less distinction made between terms. Hebrew-language petitions commonly refer to individuals who were holeh ruah and, relatedly, holeh b’machalat ruah; less commonly, we have those whose condition is described using a different root, which gives us meshuga (crazy) in Hebrew. Thus we read of a man described as shega,91 or another, described as having ‘gone insane’ using a reflexive verb (hishtagea).92 But in translation, both sets of terms are almost always rendered ‘insane’ or ‘lunatic’. While the low sample size and the specificity of each of these complex cases make it difficult to do more than speculate on this point, we might well wonder whether this difference in the translation of Arabic and Hebrew petitions had repercussions for how urgent these cases were believed to be by the department of health. Though families may have had little control over the weighting given to their words as a result of translation, their petitions were carefully crafted to activate mandatory anxieties around public order. At a very obvious level, some petitioners sought to frame cases in relation to political tensions. At the start of the great revolt in 1936, for instance, Zipporah Bloch of the Vaad Leumi’s social services section wrote to the senior medical officer in Jerusalem about the particularly concerning case of a mentally ill woman ‘inciting disorder … by calling upon the Jews to kill the Arabs’. ‘We feel that at a moment such as this’, she warned, ‘much harm can be done by just such insane ravings’, and called on the department of health to intervene. If not, ‘the government must accept the responsibility for the outcome of her rantings as long as she is left at

87 88 89 90 91 92

Raiseh S., Menshieh, Jaffa, to Director of Health, 9 June 1933, ISA M 6628/3. Muslim Society of Haifa to Senior Medical Officer, 9 April 1946, ISA M 6628/8; and in ISA M 6627/31. Petition by mukhtars and inhabitants of Jerusalem about Labibeh F. to Director of Medical Services, received 13 April 1948, ISA M 6627/31. Supreme Muslim Council, Jerusalem, to Director of Medical Services, 16 November 1946, ISA M 6627/31. Jacob R., Jerusalem, to Chief Secretary, 3 August 1942, ISA M 6627/30. Z. Bloch, Vaad Leumi, to R. Katznelson, Vaad Leumi, 8 May 1933, ISA M 6627/26.

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large’.93 Another way to frame the potential of these cases to generate outrage was in terms of religious sentiment. This was clearest in the case of a man who was reported as going naked around Mea Shearim, an ultra-orthodox neighbourhood in Jerusalem. The local committee petitioned the department of health in January 1933, declaring his nudity to be ‘against morals and religion’, and urging the department to remove him, ‘whereby the honour of man and religious feelings will be saved’.94 The chief rabbi raised this case, too.95 But the director of health was not swayed.96 Petitioners appeared to overestimate the mandate’s concern about religious sensitivities at a time of relative quiet. While some petitioners sought to activate mandatory anxieties around politics and religion, by far the most common and potent representational strategy deployed across petitions was through linking public safety to questions of gender, sexuality, and motherhood. With nearly half of all petitions relating to female relatives, this turn to gender was not, however, automatic. Instead, it was in part tailored to match the increasing attention the mandate government paid to women’s welfare from the 1930s onwards, from commissioning investigations into the condition of female prisoners,97 to the establishment of a department of social welfare in 1944.98 This mirrored a wider turn in the 1930s, evident at the League of Nations, towards women’s welfare.99 Petitioners also, in part, were responding to long-standing as well as ongoing processes of reworking domesticity, femininity, and maternity across the region.100 In Palestine as elsewhere, being a mother was recast in this period, from a set of practices and dispositions picked up naturally from experience and the example of older generations, to instead requiring a specific kind of education in schools, infant welfare centres, the press, and other public

93 94 95 96 97 98 99

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Z. Bloch, Social Services, Vaad Leumi, to Senior Medical Officer, Jerusalem, 30 April 1936, ISA M 6627/28. Mea Shearim Committee to Director of Health, 24 January 1933, ISA M 6627/26. Chief Rabbi Kook to Chief Secretary, 28 June 1933, ISA M 6627/26. Director of Health to Chief Secretary, 19 July 1933, ISA M 6627/26. Report by Margaret Nixon, Government Welfare Inspector, 1 July 1931, ISA M 6628/9. Department of Social Welfare Annual Report, 1944, in ISA M 130/66, pp. 4–5. Barbara Metzger, ‘Towards an International Human Rights Regime during the InterWar Years: The League of Nations’ Combat of Traffic in Women and Children’, in K. Grant, P. Levine, and F. Trentmann, eds., Beyond Sovereignty: Britain, Empire and Transnationalism, c. 1880–1950 (Basingstoke: Palgrave Macmillan, 2007), pp. 71–3. See Khater, Inventing Home; Beth Baron, Egypt as a Woman: Nationalism, Gender, and Politics (Berkeley: University of California, 2005); Lisa Pollard, Nurturing the Nation: The Family Politics of Modernising, Colonising, and Liberating Egypt, 1805–1923 (Berkeley: University of California, 2005); Marilyn Booth, Classes of Ladies of Cloistered Spaces: Writing Feminist History through Biography in fin-de-siècle Egypt (Edinburgh: Edinburgh University Press, 2015).

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arenas.101 But as well as tapping into these more explicit concerns about women expressed by state and society, what emerges from across these petitions and their deployment of gendered representations is how families apprehended and approached the mandate state as a paternalistic entity at a more fundamental level. While this term paternalistic has been used to characterise the mandate system in general, with its language of trusteeship,102 it has tended to be applied more to the French than British mandates.103 These petitions suggest that, in this respect as in others, differences between the two have been overstated.104 Petitions could represent the sexuality of mentally ill women both in relation to the danger their condition posed to their own safety, and in relation to the danger posed to wider public order by their being ‘at large’. The first is evident in the following, harrowing story. In August 1944, Dr Mousa Yacob of Bayt Jala near Bethlehem petitioned the department of health about a mentally ill woman, Rebecca C. She had been examined by Dr Malouf, but he had dismissed the case as not an urgent one; she suffered chronic epilepsy and some ‘weak-mindedness’.105 Yacob disagreed: he argued that Malouf had seen her when she had been in a quiet spell, ‘for she is a subject of circular insanity’. As well as describing her violence during the fits of insanity which regularly afflicted her, he related a recent distressing incident. Rebecca’s mother and friends usually chained her up or locked her in a room during these fits, but if she was not restrained, ‘then she goes to the street naked, roaming about here and there’. ‘It has happened lately that while thus going about’, Yacob continued, ‘two policemen … seized her and took her to a lonely place and used her illicitly at night and left her in a ditch,

101

102

103

104

105

See Ellen Fleischmann, The Nation and Its ‘New’ Women: The Palestinian Women’s Movement, 1920–1948 (Berkeley: University of California, 2003); Sheila H. Katz, Women and Gender in Early Jewish and Palestinian Nationalism (Gainesville: University Press of Florida, 2003); Greenberg, Preparing the Mothers of Tomorrow. For a reflection on both potential meanings of the label ‘paternalist’ in relation to the mandates system, see Susan Pedersen, ‘Metaphors of the Schoolroom: Women Working the Mandates System of the League of Nations’, History Workshop Journal 66, 1 (2008), pp. 188–207. Above all in Elizabeth Thompson, Colonial Citizens: Republican Rights, Paternal Privilege, and Gender in French Syria and Lebanon (New York: Columbia University Press, 2000). Scholarship on colonial Iraq has, however, revealed the highly gendered working of British rule too: see Noga Efrati, ‘Colonial Gender Discourse in Iraq: Constructing Noncitizens’, in Schayegh and Arsan, eds., History of the Middle East Mandates, pp. 157–69. For two important collections emphasising comparison, see Peter Sluglett and Nadine Méouchy, eds., The British and French Mandates in Comparative Perspective (Leiden: Brill, 2004); and Schayegh and Arsan, eds., History of the Middle East Mandates. M. S. Malouf to Senior Medical Officer, Jerusalem, 10 August 1944, ISA M 6627/30.

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where she was found on the following day after long and careful search by her poor mother.’106 The response of the director of medical services was cool in tone, but Yacob’s words seem to have had an effect. ‘Although specially urgent grounds for admission are not present’, he wrote, ‘her name has been placed on the waiting list and will be considered when a vacancy occurs.’107 A second petition highlights how these anxieties around the sexuality of mentally ill women could be framed as a question of public order, not just personal safety. The mukhtars of Lifta village, just outside Jerusalem, wrote to the director of medical services in May 1946 on the subject of a woman of twenty-five who was ‘in a serious condition and has become dangerous to public safety in view of her repeated molestations’. ‘Her aged father’, they continued, ‘is unable and unfit to control her’; this heightened their fears that ‘she may be assaulted or even raped’, an event which they warned would precipitate ‘a serious breach of the peace’.108 In this instance, the failure of the aged father to control his young female relative had potentially disastrous public consequences, and the mukhtars turned to the colonial state as the ultimate guarantor of paternal authority. As well as these efforts to frame mentally ill women’s sexuality as threatening themselves or public order, another powerful strategy was in terms of their threat to children. While there were certainly instances in which men were represented as threatening their children,109 the majority of cases involved mothers. In 1935, Zipporah Bloch wrote to alert Dr Katznelson of the Vaad Leumi’s health section to a pregnant woman, who had been abandoned by her husband and was living with her widowed mother and young child in Givat Shaul. Bloch described her as ‘very violent’; among other things, she beat her mother, and ‘frequently attempts to strangle her child’.110 This was clearly the most shocking detail of the case, and was picked up and amplified by Katznelson in his petition to the director of medical services. ‘This lunatic attempted to strangulate her one-and-a-half-year-old child’, he wrote, ‘and there seems to be imminent danger to the life of the child if

106 107 108 109 110

M. Yacob, Beit Jala, to Chief Medical Officer, 31 August 1944, ISA M 6627/30. Acting Director of Medical Services to M. Yacob, Beit Jala, September 1944, ISA M 6627/30. Mukhtars of Lifta Village to Director of Medical Services, 24 May 1946, ISA M 6627/31. Z. Bloch, Social Services, Vaad Leumi, to District Commissioner, Jerusalem, 12 May 1933, ISA M 6627/26. Z. Bloch, Social Services, Vaad Leumi, to Avraham Katznelson, Health Section, Vaad Leumi, 24 January 1935, ISA M 6627/27.

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she is not separated immediately.’111 This was not an isolated occurrence. In April 1948, for instance, a petition signed by several mukhtars and residents of Jerusalem also stressed this element of another case, reporting that a woman had tried several times to suffocate members of her family, including her children.112 Doctors from the mandate’s health department shared these concerns. Dr Malouf, for instance, examined a case in 1937, and recommended her urgent admission, ‘as she is a dangerous and violent lunatic who, on several occasions, attempted to kill her own child’.113 At a time when the government, Zionist organisations, and Palestinian nationalists alike viewed the production of particular kinds of mothers as critical to realising wider political and social projects, mentally ill women who tried to kill their children represented a deeply shocking subversion of the model of the hygienic, responsible, and nurturing mother. Both in relation to motherhood and women’s welfare, petitioners responded to the explicit and expanding attention given to these issues by state and society. But in representing these cases as posing a gendered threat to society and public safety, these petitions figured and approached the mandate as invested in upholding a paternalistic social order and regulating women’s appearance ‘at large’ in public space. In her usage of the term paternalistic in the context of mandate Syria and Lebanon, Elizabeth Thompson highlights how the French authorities strategically reinforced male authority and gendered hierarchies in the wake of a wartime ‘crisis of paternity’, in ways which find resonance here. But there is a second meaning to the term, in her use: it also conveys the ability of mediating elites to broker services to their clientele.114 In this respect as well, petitioners in Palestine appeared to apprehend the mandate as paternalistic. Rather than relying solely on the contents of their petitions to secure the admission of relatives to mental institutions, petitioners across the period turned to a range of important individuals or bodies to intercede on their behalf with the state, too – intercessors who were themselves almost invariably male: mukhtars, bishops, bureaucrats. We have already seen a number of instances in which local mukhtars or the Vaad Leumi’s health or social services sections intervened on behalf of the mentally ill and their families. But families turned to two other 111 112 113 114

Avraham Katznelson, Health Section, Vaad Leumi, to Director of Medical Services, 25 January 1935, ISA M 6627/27. Note on a Petition to Director of Medical Services, received 13 April 1948, ISA M 6627/31. Senior Medical Officer, Jerusalem, to Director of Medical Services, 9 February 1937, ISA M 6627/28. Thompson, Colonial Citizens, pp. 66–7.

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important groups of intercessors as well, groups who served as intermediaries in mandate Syria and Lebanon, too.115 The first of these were religious figures: the Latin Patriarch, the Anglican Bishop in Jerusalem, and others took the cases of their co-religionists to the government on a number of occasions.116 The importance of religious – particularly Christian – figures in this connection is unsurprising. As Laura Robson argues, the British, drawing on experiences in India, sought to apply a rigidly communal vision of society to Palestine, in a way which disempowered the Arab Christian community in the long term even as it strengthened the hand of Arab Christian leaders in the short term to negotiate with the mandate government.117 The second group of intercessors were bureaucrats, government officials and employers who took up the cases of their Palestinian subordinates or acquaintances. The director of education intervened in a number of cases in the 1940s,118 as did the postmaster general.119 While intercession by these figures did not always work, it was sometimes successful, in revealing ways. In September 1932, the postmaster general was asked to intercede on behalf of a former employee of the department of posts and telegraphs, who had suffered a ‘mental disturbance’ while stationed in Jerusalem in 1929.120 What is striking about this case is that although his condition was explicitly described as ‘uncurable’, which would usually disqualify the mentally ill from admission unless they were violent, the acting director of health proposed to give the case precedence once new beds became available in the second government mental hospital at Bethlehem, then nearing completion.121 This example brings the gap between the explicit and implicit rules of the game most clearly into view. Petitioners who took the introduction of new psychiatric treatments and the therapeutic rationales articulated by the department of health seriously, and framed their petitions in terms of curability, found themselves disappointed; families who turned to 115 116

117 118

119 120 121

Ibid., pp. 42–3, 59–65. For examples, see Latin Patriarch to Director of Health, 3 October 1933, ISA M 6627/ 26; Reverend J. Khadder, St George’s Cathedral, Jerusalem, to Director of Medical Services, 12 February 1936, ISA M 6627/28; and Anglican Bishop in Jerusalem to Acting Director of Medical Services, 29 July 1944, ISA M 6627/30. Robson, Colonialism and Christianity. See Director of Education to Director of Medical Services, 24 February 1941, ISA M 6627/29; Director of Education to Director of Medical Services, 30 June 1944, ISA M 6627/30; Director of Education to R. S. F. Hennessey, Department of Public Health, 22 February 1947, ISA M 6627/31. Acting Postmaster General to Director of Medical Services, 4 July 1947, ISA M 6627/31. Rae Behrman, Emergency Relief Fund for Palestine, to Postmaster General, Jerusalem, 14 September 1932, ISA M 6627/26. Acting Director of Health to Senior Medical Officer, Jerusalem, 24 September 1932, ISA M 6627/26.

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intercessors, who approached the mandate not as a rational, bureaucratic entity but as a paternalistic one, were rewarded with a coveted bed at a government institution for even ‘uncurable’ relatives. In Palestine, as in the French mandates, a paternalistic mode of operation appears to have persisted and indeed expanded even as the state committed itself to a more direct, more rationalised responsibility for the welfare of its subjects in the 1930s and 1940s.122 While this psychiatric paternalism found its strongest expression in anxiety over the gendered threat posed by the female mentally ill and in the privileging of male intercessors over standardised criteria, it also created opportunity for female petitioners. As a final story demonstrates, women could leverage this paternalism to their advantage. In April 1935, Zehra A.’s son, Sudki, was examined by the medical officer at Jaffa, and recommended for admission to a mental institution when a bed became available.123 In June, Zehra refused to wait any longer, and wrote to the director of health to plead for her son’s immediate admission: his condition was so wild and unmanageable that ‘he must be fettered with chains’, and the situation at home was ‘unbearable’.124 After receiving a noncommittal reply to this first letter, she wrote again in July, framing her plight in the following terms: Please answer my demands and save the life of my family, my son who is living a very miserable and unhealthy life, my little children who are becoming disappointed with their lives, and at last my own life. I am a woman, very weak, unable to give help to my beloved lunatic son, nor a power to exert in looking after my little children. Please be merciful!125

This time, she was successful: that month, the director of health made arrangements for her son’s admission to the government mental hospital.126 As Kenda Mutongi has argued in a very different context, Zehra, like the Kenyan widows at the heart of Mutongi’s argument, ‘by invoking the very gender roles that were designed to control them, by … turning the language of patriarchy into one of entitlement, were able to get what they needed and at the same time enforce gender roles upon men’.127

122

123 124 125 126 127

Andrew K. Arsan, ‘Failing to Stem the Tide: Lebanese Migration to West Africa and the Competing Prerogatives of the Imperial State’, Comparative Studies in Society and History 53, 3 (2011), p. 455. Senior Medical Officer, Jaffa, to Director of Medical Services, 16 April 1935, ISA M 6628/4. Zehra A., Jaffa, to Director of Public Health, 8 June 1935, ISA M 6628/4. Zehra A., Jaffa, to Director of Medical Services, 18 July 1935, ISA M 6628/4. Senior Medical Officer, Jaffa, to Medical Officer, Government Mental Hospital Bethlehem, 24 July 1935, ISA M 6628/4. Kenda Mutongi, Worries of the Heart: Widows, Family, and Community in Kenya (Chicago: University of Chicago Press, 2007), pp. 7–8. Women in French mandate

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Mandatory paternalism could be put to work to serve multiple ends. Petitioners like Zehra were not unique in mirroring the discourses of the state back at it: as Ted Swedenburg has shown, it was not just mandatory rule but also opposition to it that was couched in gendered terms, with the great revolt cast in peasant memories in terms of the violation of their honour and the rape of their land.128 The petitions examined here demonstrate that this gendered rendering of the mandate also played out at a psychiatric register, as Palestinians sought succour from the state on the basis of its paternalism. That their attempts to negotiate with the government on these terms were met with no small degree of success might be taken as evidence of the astuteness of this reading.

Conclusion For Natasha Wheatley, the importance of petitions sent to the Permanent Mandates Commission by Palestinians does not lie in the fact that they won for petitioners tangible redress, since very few accomplished this. They matter instead because they ‘forced painstaking rebuttals from mandatory authorities and long discussions at the Permanent Mandates Commission’s meetings’, contributing to the creation of norms.129 The reverse is true of the petitions examined here. A significant number of petitions about the mentally ill did, in fact, meet with concrete action, even if ‘only’ a medical examination or the addition of a person’s name to a waiting list. It is in the realm of ‘talk’, and the generation of norms, that the impact of these petitions seems more muted. Confronted with reasoning it had itself articulated, the state often succeeded in shaking off those obligations by which petitioners imagined it to be bound, subverting rather than contributing to the creation of norms. If out of these complex interactions an impersonal, rationalised state failed to emerge, this was a productive failing, creating opportunities for exception that suited – albeit in different ways, and to different degrees – state and subject alike. Some petitioners were less adept than others in navigating this game: Joseph F., with his bitter complaints about the mandate

128

129

Syria and Lebanon could also invert colonial paternalism to their advantage: see Thompson, Colonial Citizens, p. 187. Ted Swedenburg, Memories of Revolt: The 1936–1939 Rebellion and the Palestinian National Past (Fayetteville: University of Arkansas Press, 2003). See also Frances Hasso, ‘Modernity and Gender in Arab Accounts of the 1948 and 1967 Defeats’, International Journal of Middle East Studies 32, 4 (2000), pp. 491–510. Natasha Wheatley, ‘The Mandate System as a Style of Reasoning: International Jurisdiction and the Parceling of Imperial Sovereignty in Petitions from Palestine’, in Schayegh and Arsan, eds., History of the Middle East Mandates, p. 107.

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not playing fair, had misread the rules. But few were truly naı¨ve in their dealings with the mandate government. As we have seen throughout this chapter, petitioners stirred up mandatory anxieties, appealed to intercessors, withheld information, shopped around, and made use of the institutions of the state without necessarily accepting that state as legitimate. In any colonial context but perhaps especially Palestine, it is tempting to valorise the agency and virtuosity of these petitioners, to celebrate those Palestinian families who defied the post-war partition of the region by sending relatives across the Palestine–Lebanon border for treatment, or who played off the anxieties of a violent colonial state for their own ends. Yet it is also worth remembering that when historians of psychiatry first called in the 1980s for more attention to be given to the role played by families in shaping the experiences and therapeutic trajectories of the mentally ill, they did so – as Mark Finnane puts it – in order to critique the notion of the ‘innocent’ family forced to give up the care of relatives by circumstances outside their control.130 If we might hesitate to think in terms of ‘innocence’ or ‘complicity’, it is nonetheless clear that the temptation to valorise agency and indeed mobility in a colonial context must be tempered with a recognition of the unequal power dynamics which existed within families around those deemed mentally ill, and which often intersected with other axes of oppression, notably gender. These dynamics are necessarily difficult to determine in the petitions used here, which were – as we have seen – highly crafted works of persuasion, withholding and disclosing for particular purposes. We cannot know the precise combination of motives, for instance, that drove Tewfik A. to send his wife to ʿAsfuriyyeh for treatment as a firstclass patient – and then to stop paying for her treatment; or the degree to which petitions that represented women’s sexuality as posing a threat to the social order did so cynically, in order to secure them care; or the exact circumstances which led Joseph F., even as he expressed his Christian resignation to a life of caring for his wife Amineh, to seek institutional treatment for her – and then abandon her with her aged mother when that failed. But an acknowledgement of the agency of the men in these

130

Mark Finnane, ‘Asylums, Families, and the State’, History Workshop 20, 1 (1985), p. 137. See also David Wright, ‘Getting out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Social History of Medicine 10, 1 (1997), pp. 137–55; Patricia Prestwich, ‘Family Strategies and Medical Power: “Voluntary” Committal in a Parisian Asylum, 1876–1914’, in R. Porter and D. Wright, eds., The Confinement of the Insane: International Perspectives, 1800–1965 (Cambridge: Cambridge University Press, 2003), pp. 79–99; and Catharine Coleborne, ‘Families, Insanity, and the Psychiatric Institution in Australia and New Zealand, 1860–1914’, Health and History 11, 1 (2009), pp. 65–82.

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women’s lives must also be a recognition of the control they wielded over them; these petitioners were not innocent of that, even if their demands were not always met, even if they were themselves the weaker party in an acutely asymmetrical relationship with the mandate state. The following pair of chapters turns to two contexts in which these power dynamics were laid barer still: the criminal courtroom, and the criminal lunatic sections of the mandate’s prisons.

4

Insanity before the Courts Defining Abnormality, Punishing Normalcy

In September 1943, Joseph Denishensky1 murdered his wife, Zipora, while she slept at their Tel Aviv home. The story was a shocking one, not least because it was reported that ‘they were a devoted couple and had always lived on the best of terms’, and because they had an eight-year-old daughter, who was presumably in the house on the night of the murder. With no clear motive for the crime, nor evidence of ill will or any quarrel, when the case came before the court of criminal assize in Tel Aviv in January 1944, questions were raised about Joseph Denishensky’s mental state. The court called on Dr Malouf, as medical officer in charge of the government’s mental hospitals, to examine Denishensky. He reported that Denishensky ‘was at the time [of the murder] suffering from obsessional neurosis, a disease of the mind’, a condition from which he had been suffering for some years, and for which he had ‘been receiving treatment but not, unfortunately, from a mental specialist’.2 Frederick Gordon Smith, who was presiding over the court as the chief justice of Palestine, questioned Malouf further on Denishensky’s mental state. He did so in a very specific way, focussing on the defendant’s cognitive and intellectual faculties; Malouf replied in an equally specific way. In response to the chief justice’s questioning, ‘Dr Malouf with his expert knowledge said that by reason of that disease the accused did not know the nature and quality of what he was doing or he would not know that what he was doing was wrong’. This met the legal definition of insanity as set out in the Palestine Criminal Code, and so the chief justice returned a special verdict of ‘guilty but insane’, sentencing Denishensky to be detained at the pleasure of the High Commissioner.3 1

2

3

In this chapter, where the full names of individuals were reported in the press at the time, these are also given in full here. For those who appear only in archival material, just a first name and initial are used. Chief Justice to High Commissioner, 7 January 1944, ISA M 349/56. It was not made clear who exactly had been providing treatment in this case, but presumably a nonspecialist physician. Judgment by Chief Justice, F. Gordon Smith, in Court of Criminal Assize in Tel Aviv, Criminal Assize Case No. 49/43, 5 January 1944, ISA M 349/56.

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The tragic case of Joseph and Zipora Denishensky offers a point of departure for thinking about the relationship between the law and mental illness in mandate Palestine. In the first place, it introduces some of the key features of the legal system within which questions around the responsibility of the ‘insane’ were addressed: the central role played by British judges, for instance; the importance of expert medical testimony; and the particular definition of insanity set out by the law. Other details of the case are notable, too, and help frame the wider concerns of this chapter. The violence and senselessness of the case drew the attention of the press, which did not focus on the question of whether Denishensky was aware of the nature and quality of what he was doing, but showed a morbid fascination instead with the peculiarities of his obsessional neurosis. ‘It was phobia of the number 27’, reported the Palestine Post, the Englishlanguage Zionist daily newspaper, ‘which drove a 27-year-old night watchman, Joseph Denishensky, to axe his 27-year-old wife in bed on the night of September 27.’4 The sensational features of this and other cases in which insanity defences were raised meant that these trials drew interest out of all proportion to their statistical significance. The number of ‘criminal lunatics’ in Palestine at any one time across the 1930s stood at under thirty.5 While that number increased sharply across the 1940s – with over a hundred criminal lunatics detained in 1943, the year Denishensky murdered his wife6 – insanity defences nevertheless were raised in only a very small fraction of cases which came before the mandate’s courts. However disproportionate, press interest means that this chapter can draw on newspapers, as well as archival sources, in exploring the encounter between the law and insanity in mandate Palestine. But this reportage was skewed in other ways beyond its sensationalising bent: while cases involving Palestinian Arabs certainly received some attention, by far the most sustained coverage in the English- and Hebrew-language press was afforded to European Jews who entered insanity defences.7 This is in spite of the fact that the number of Jewish criminal lunatics equalled that of Muslim and Christian criminal

4

5 6 7

PP, 6 January 1944, p. 3. The fact that the murder appears to have actually taken place on the 28 September did not seem to get in the way of the paper’s commitment to a ‘good’ story. Director of Health to Chief Secretary, 25 February 1932, ISA M 6627/10. Director of Medical Services to Chief Secretary, 23 March 1945, ISA M 4087/5. While they bitterly protested British ‘justice’ during the great revolt (see Rana Barakat, ‘Criminals or Martyrs? Let the Courts Decide! British Colonial Legacy in Palestine and the Criminalisation of Resistance’, al-Muntaqa 1, 1 (2018), pp. 84–97), the Arabic-language press did not afford as much attention to non-political courtroom reportage as their Englishand Hebrew-language counterparts. See also Darr, Plausible Crime Stories, pp. 76–7.

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lunatics.8 Reading along the grain of this imbalance in the archival record brings into focus what is specific to the encounter between the law and insanity in mandate Palestine. Historians of colonial psychiatry have long highlighted that medical and legal authorities struggled to identify madness among colonised populations, as a result of a perception of cultural difference. In order to recognise those who were by virtue of their madness exceptional, colonial authorities needed first to determine what was ‘normal’ – no straightforward endeavour, as Megan Vaughan notes. Was it ‘normal’, these authorities had to wonder, for Africans to have visions, for instance, or for Malays to suffer group hysteria?9 In spite of their relative rarity, then, each trial in which an insanity defence was raised forced medical and legal authorities to tackle wider questions about the nature of cultural difference. In mandate Palestine, insanity defences certainly prompted reflection on the dividing line between the normal and the pathological. But the cultural proximity perceived to exist between European Jewish defendants and the British judges who presided over most appeals cases meant that ‘normative uncertainty’ in this context was often less ‘transcultural’ in nature, and hinged instead on other interconnected axes of identity like age, class, or gender. They were treated, in other words, like settler populations elsewhere in the early twentieth-century world.10 The absence of any explicit reflection on the question of normativity in the case of Joseph Denishensky illustrates this point; in this instance, the British judge took for granted the norms against which Denishensky – a European Jewish man, living in Tel Aviv with his wife and daughter – ought to be judged. If cases involving European Jews largely sidestepped those questions of cultural difference that preoccupied colonial law’s encounter with insanity elsewhere and in relation to Palestinian Arab defendants, determining criminal-legal responsibility in mandate Palestine was complicated in a further way. Across the mandate period, but particularly from 1936 when Palestinians rose up against British rule and its commitment to a Jewish national home, the criminal responsibility and indeed mental capacity of the Arab population was understood by colonial authorities as always already attenuated. This view – expressed most clearly in official reports commissioned after ‘disturbances’ in 1921, 1929, and 1936 – went

8 9 10

Dr Kurt Blumenthal, Report on the Lunatic Section of Acre Prison, 1 February 1946, ISA M 351/41, p. 1. Vaughan, ‘Introduction’, p. 2. For the importance of the resemblance between defendants and their judges in shaping determination of responsibility, see Catherine Evans, Unsound Empire: Civilization and Madness in Late-Victorian Law (New Haven, CT: Yale University Press, 2021), p. 4.

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hand-in-hand with a ‘criminological framing’ of Palestinian nationalism,11 and the pursuit of a counter-insurgency strategy that had collective punishment at its heart.12 In this context, in which responsibility was perceived as both collectively diminished and individually irrelevant, judging specific attenuations that were the result of mental disease – while not completely out of the question – was hardly a priority for the courts, which were in any case often superseded across the period of the revolt by military courts passing swift, unsparing judgement on defendants. While both historians of colonial psychiatry and transcultural psychiatrists have long highlighted the protean nature of ‘insanity’, in mandate Palestine it was not only the bounds of insanity which were fickle and blurred, but the category of criminality which was deeply unstable – and seemingly ever expanding – too. The first part of the chapter lays out the legal architecture within which these terms – responsibility, insanity, and criminality – were elaborated and contested. In the second, the focus shifts to two exemplary cases which reveal how different bodies of knowledge – psychiatric, social, folkloric – were put to work within the courtroom to determine when the limits of normal behaviour had been breached. The final part of the chapter focusses more squarely on the question of criminal-legal responsibility in a context of generalised disorder and criminality.

Determining Responsibility in a Hybrid Legal System When the British chief justice questioned Dr Malouf during the Denishensky trial in January 1944, the questions he posed were consciously crafted to establish whether the defendant met the legal definition of insanity as set out in the Palestine Criminal Code; Malouf’s answers were also carefully calibrated, allowing the judge to return a clear verdict of ‘guilty but insane’. In this way, the Denishensky case – tragic though it was – unfolded smoothly, in line with the letter of the law. Few of the other cases which this chapter considers proceeded so straightforwardly. But in all, the legal architecture inherited and modified by the British over the course of the mandate played an important role in shaping deliberations over legal responsibility, and their outcome. This 11 12

Kelly, The Crime of Nationalism, p. 6. Jacob Norris, ‘Repression and Rebellion: Britain’s Response to the Arab Revolt in Palestine of 1936–39’, Journal of Imperial and Commonwealth History 36, 1 (2008), pp. 25–45; Matthew Hughes, ‘The Banality of Brutality: British Armed Forces and the Repression of the Arab Revolt in Palestine, 1936–39’, English Historical Review 124, 507 (2009), pp. 313–54; Laleh Khalili, ‘The Location of Palestine in Global Counterinsurgencies’, International Journal of Middle East Studies 42, 3 (2010), pp. 413–33.

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included not only cases which focussed on criminal-legal responsibility, but cases conducted according to commercial or land law and cases which came before religious courts, too. The claim to have brought rule of law was a key legitimating idiom deployed by the British in Palestine, as elsewhere.13 But the reality was more complex than this rhetoric. In the first place, the British preserved much of its Ottoman legal inheritance. This included the operation of a hybrid legal system. Parallel to the civil courts, across the mandate period religious courts had jurisdiction over matters of personal status, and were empowered to make decisions about marriage, divorce, and inheritance as these concerned members of their own ‘communities’. Ottoman law in force in Palestine on 1 November 1914 was, moreover, taken as the benchmark for the legal status quo, as set out in the Palestine Order-in-Council of 1922. While successive attorney generals – plans for an elected legislative council having been aborted in 1923 – introduced procedural and substantive reforms across the decades, this process of ‘Anglicisation’ was uneven and, particularly in the first decade of mandate rule, piecemeal. As the Peel Commission of 1937 put it, the development of the law in Palestine had been ‘to a considerable extent one of improvisation carried out, until later years, without expert advice … by complete amateurs, led by amateurs’.14 And in terms of the basic organisation of the courts, the mandate preserved in modified form a four-tier arrangement that had been instituted by the Ottomans: petty civil and criminal cases were dealt with by magistrates’ courts in major towns; district courts in Jerusalem, Jaffa, Haifa, Nablus and – after 1937 – Tel Aviv heard appeals from the lower courts and judged more serious civil and criminal cases; a supreme court in Jerusalem was empowered to hear appeals from lower courts and decide questions of constitutional or administrative law; finally, under special circumstances, appeal could be made to the Privy Council in London.15 In none of these courts did a jury system operate.16 Magistrates, sitting alone, handed down judgments in their courts, while in the district 13 14

15 16

See for instance Martin Bunton, ‘Inventing the Status Quo: Ottoman Land-Law during the Palestine Mandate, 1917–1936’, International History Review 21, 1 (1999), p. 32. Palestine Royal Commission Report Presented by the Secretary of State for the Colonies to Parliament, July 1937 [Peel Report] (London: HMSO, 1937), p. 160. The first attorney general, Norman Bentwich, was thought particularly amateurish; see Simon Davis, ‘“Irish & Roman Catholic Which Upsets All the People Here”: Michael McDonnell and British Colonial Justice in Mandatory Palestine, 1927–1936’, Twentieth Century British History 29, 4 (2018), pp. 497–521. Likhovski, Law and Identity in Mandate Palestine, pp. 27–30. One explanation was that, ‘in view of the state of communal feeling in Palestine, it might not be an instrument of justice’. See Norman Bentwich, ‘The Legal System of Palestine’, Middle East Journal 2, 1 (1948), p. 35. Another account cited the ubiquity of bribery and

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courts cases were decided by a panel of three judges: one British, and two drawn from the Muslim, Christian, and Jewish population of Palestine. In capital cases, a special court of criminal assize was assembled in which a British judge from the supreme court sat with the judges of the relevant district court; an even larger panel, headed by a British president, heard cases in the supreme court. The absence of juries sets insanity defences in Palestine apart from other contexts researched by historians. Ruth Harris has, for instance, highlighted the significance of the self-presentation in court of women who committed crimes of passion in fin-de-siècle France for their chances of acquittal by the jury, but in Palestine there was no jury of peers who could be won over by performances that evoked shared cultural scripts.17 While magistrates or judges drawn from the population of Palestine may have been able to recognise and sympathise with at least some of the cultural scripts evoked by defendants, it was British judges who played a key role in determining the outcome of cases, especially as appeals made on the grounds of insanity moved these cases up the rungs of the court system. Some cultural scripts may have been more familiar to British judges than others, but there were frequently also linguistic as well as cultural barriers at work in the court: as many British judges knew neither Arabic nor Hebrew, translators mediated the testimonies of those who did not themselves speak English.18 The self-presentation of defendants, then, was rarely recorded, though in some instances the behaviour of a defendant did appear to influence the court’s decision. In May 1937, Abraham Mishalov murdered his mother and brother, and seriously wounded two other family members, at their home in Tel Aviv. It was the most gruesome of any case to come before the mandate’s courts in which a plea of insanity was made. Among the many forms of evidence cited in support of this plea was his behaviour while in court. Brought before a judge immediately after the murders took place, Mishalov’s behaviour was described as ‘confused and stupid’ and ‘strengthens the hypothesis that he is not sane’.19 At his trial in June, his behaviour continued to attract comment. The Hebrew-language daily Davar, which reported extensively on the case, described how Mishalov ‘periodically attempted to talk’, but ‘it was hard to understand what he was saying because he was stuttering’; ultimately the counsel for the defence made him keep quiet.20 When his turn came to testify, he

17 18 20

corruption which ‘would mean the complete downfall of the ethics of British justice’ (Broadhurst, From Vine Street to Jerusalem, p. 203). Ruth Harris, Murders and Madness: Medicine, Law, and Society in the Fin de Siècle (Oxford: Clarendon Press, 1989), pp. 208–42. 19 Likhovski, Law and Identity in Mandate Palestine, p. 30. Davar, 27 May 1937, p. 7. Davar, 21 June 1937, p. 7.

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‘testified haltingly, and in a way that was hard to understand’.21 In the end, it was the testimony of psychiatric specialists called on as expert witnesses by the defence that was credited with securing a verdict of guilty but insane for Mishalov,22 but it is not difficult to imagine that his behaviour in court also played a part. In another, less serious case, behaviour alone could secure a ‘guilty but insane’ verdict from the court. Jacob Algour was brought before a magistrate’s court in Tel Aviv after assaulting the employees and guests of the Excelsior Hotel in July 1946. In court, ‘he called the magistrate a madman, and insisted that his name was Schnaps and not Algour’, in spite of the fact that he had changed his name from Schnaps to Algour a number of years earlier while doing active service in Palestine.23 He was sent to the criminal lunatic section of Acre prison by the court, in spite of the fact that ‘[n]o medical evidence was given during the trial’.24 The behaviour of defendants could also be scrutinised for evidence of duplicity, however. Already in the 1920s, government officials expressed concerns about ‘prisoners feigning insanity in order to escape the punishment which the offence with which they are charged would entail’25 – a further challenge complicating the task of determining criminal-legal responsibility. While the testimony of medical experts and families in the courts raised different, thorny issues about cultural difference and the relationship between psychiatry and the law, the behaviour of defendants could sometimes convince judges they were simply malingering. Consider the following case, in which a man found himself in court for insulting a tax collector who had visited his village: The prisoner came to court, laughed, made strange grimaces and finally said that he was mad and could not be held guilty for anything he had ever said. The prisoner was then told to go and see a doctor. The prisoner had thought of this, and there proved to be a doctor standing outside the court. The doctor entered, took the oath, and swore that the prisoner had something wrong with his head, and that he might at times be so insane as to insult a tax collector without knowing it. The court took a long time to consider its verdict. After careful consideration, the judges decided to send the man to prison for eight days.26

In this instance, the too-easy fit between the man’s behaviour and crude stereotypes about mental illness – as well as the helpful medical witness 21 23 24 25 26

22 Davar, 29 June 1937, p. 6. PP, 2 December 1937, p. 3. District Commissioner, Samaria, to Commissioner of Prisons, 23 September 1946, ISA M 349/4. Medical Report, No. 178, Acre, 22 August 1946, ISA M 349/4. Memorandum on criminal lunatics, attached by Acting Chief Secretary to Commandant of Police, 22 December 1929, ISA M 6628/9. PB, 14 July 1930, p. 4.

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conveniently close at hand – appears to have aroused suspicion, rather than sympathy. The behaviour of defendants in the courtroom, however, was normally only of secondary importance in determining mental and therefore legal responsibility. Almost from the start of the mandate, the emphasis in these cases was on the testimony of medical experts. In 1924, the process to be followed was established, at least in its bare bones, by the Trial Upon Information Ordinance: if it appeared that a defendant was ‘insane’, ‘the court may direct such enquiry as it thinks fit to be made with a view to ascertaining whether he is sane or not, and if upon such enquiry the court is of the opinion that he is insane, the court shall direct him to be detained during the pleasure of the High Commissioner’.27 While left vague in the ordinance, this was typically interpreted to mean that the court should order the examination of the defendant by specialists, who would then report their findings to the court. Often the responsibility for examining the defendant was given over to Dr Malouf, but other doctors were called on to testify to the mental state of defendants, especially when examination was arranged not by the court but rather the defendant’s lawyer. In the case of Abraham Mishalov, for instance, the counsel for the defence requested that he be examined by Professor Martin Pappenheim, a psychiatrist and specialist in alcoholism, epilepsy, and aphasia in Tel Aviv.28 In 1937, the law was sharpened when the long-awaited Palestine Criminal Code came into force. Recommended as early as 1929, a draft was published in 1933, but sustained criticism meant it was republished in heavily revised form before finally coming into force on 1 January 1937.29 The new code, among other things, addressed the question of criminal-legal responsibility more precisely than hitherto had been the case: §14. A person is not criminally responsible for an act or omission if at the time of doing the act or making the omission he is through any disease affecting his mind incapable of understanding what he is doing, or of knowing that he ought not to do the act or make the omission.30

27 28 29

30

Official Gazette of the Government of Palestine, 15 January 1924, p. 457. Entry for Pappenheim, Martin, in the Österreichisches Biographisches Lexikon 1815–1950, vol. vii (Vienna: Verlag der Österreichischen Akademie der Wissenschaften, 1978). For the Criminal Code’s tortuous journey into force, see Norman Bentwich, ‘The New Criminal Code for Palestine’, Journal of Comparative Legislation and International Law 20, 1 (1938), pp. 71–9. Criminal Code Bill, 1936, published in the Palestine Gazette, 28 September 1936.

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The new criminal code finally replaced the old Ottoman criminal code in a systematic way, rather than just amending or adding to it by the piecemeal enactment of ordinances, as had been the case over the course of the previous decade with the Trial Upon Information Ordinance of 1924, for instance. And it was this definition which the chief justice, in the case of Joseph Denishensky, had cleaved to closely, describing it as repeating ‘in substance … what is the law in England and has been the law of England for the last one hundred years’.31 But this more precise stipulation of what state of mind would constitute criminal-legal responsibility was not universally welcomed. When it appeared in the initial draft of the criminal code in 1933, it was found wanting by the Palestine Post’s legal correspondent, an anonymous practising lawyer.32 While he praised the new code’s attempt ‘to lay down what mens rea, what guilty mind, a man must have before the law can affect him’, he criticised its understanding of criminal responsibility, calling it ‘a primitive one’, ‘quite inadequate in the light of modern knowledge’. The new code’s emphasis on a madman being incapable ‘of knowing that he ought not to do the act’ was misplaced, in his view. ‘Unhappily’, he observed, ‘many a madman knows that he “ought” not to do an act but his diseased mind prevents any control over his acts and the demon within him forces him to do what he knows he “ought” not to do.’33 This criticism of the code’s handling of the question of criminal-legal responsibility as out of step with ‘modern knowledge’ was not without justification. As the chief justice himself noted, it was modelled on what had been established practice in English criminal law since the middle of the nineteenth century. While the chief justice regarded this antiquity as positive, in England itself this approach had come under stress in the wake of the First World War from psychiatrists who claimed that its conception of insanity as a disorder of the intellectual or cognitive faculties (‘understanding’ or ‘knowing’ the nature of a particular act or omission) was outdated. It might suit a lawyerly need to establish mens rea, but did not allow for consideration of ‘uncontrolled impulses’.34 The legal correspondent of the Palestine Post was thus articulating a more

31 32 33 34

Judgment by Chief Justice, F. Gordon Smith, in Court of Criminal Assize in Tel Aviv, Criminal Assize Case No. 49/43, 5 January 1944, ISA M 349/56. For the original 1933 draft of the Criminal Code, see Palestine Gazette, 6 June 1933, p. 644. PP, 28 June 1933, p. 7. Tony Ward, ‘A Terrible Responsibility: Murder and the Insanity Defence in England, 1908–1939’, International Journal of Law and Psychiatry 25, 4 (2002), pp. 370–2. The law in England would only change in the 1950s, with the introduction of the concept of diminished responsibility.

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widely held critique of this approach to criminal-legal responsibility. In practice, the strict focus set down by the law on the intellectual and cognitive faculties of the defendant was not always followed in the mandate’s courts as closely as in the Denishensky case, and medical experts volunteered or found themselves pressed to give their view on whether a defendant had been at the mercy of impulses they could not control. In reality, these cases were messy, both in this respect and others. By contrast to the attempts at neat theorising in the colonial census, when we come to consider encounters between the mandate and the mentally ill in the courtroom, they are stubbornly specific, irreducible even to something as fundamental as the application of the criminal code. While the focus of this chapter is on criminal-legal responsibility, the question of insanity was not raised and debated in the criminal courts alone. Mental and legal responsibility was also judged in civil as well as religious courts. In the field of civil law, the process of Anglicisation was more uneven than in criminal law, which was systematically replaced by a new code in 1937; some areas, like commercial law, saw significant changes as early as the 1920s, while other areas, like tort and labour law, were given little attention across the mandate period.35 The Ottoman Mejelle – or body of civil law – thus continued to shape the civil courts’ handling of questions of insanity, even in commercial cases, well into the mandate period. As Michael Dols has noted, the criteria given in the Mejelle for determining whether a minor had reached the age of ‘discernment’ give some indication of what it meant to be considered mentally, and therefore legally, competent: a minor deemed to be lacking in discernment was defined as ‘one who does not understand the difference between buying and selling, who does not know that selling means giving up property and that buying means acquiring it, and who does not distinguish between an excessive injury and a slight one’.36 If the Mejelle established a broad connection between an individual’s mental competency and their legal capacity to enter into business transactions, its more specific rulings were being cited in judgments in 1920s Palestine. In a case from 1926 involving a European Jewish businessman, J. Novovolsky, who had been taken to court for refusing to pay a company from whom he had ordered goods on the grounds that he was insane at the time of making the order, the court rejected his argument by citing the Mejelle’s ruling that ‘acts done during convalescence are valid’. The court concluded that the ‘[d]efendant had been discharged 35 36

Likhovski, Law and Identity in Mandate Palestine, p. 58. §943 of the Mejelle. See Dols, Majnun, p. 439.

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from the hospital, he was allowed to go about, to visit his shop, and he cannot now be allowed to raise this plea’.37 If courts turned to the Mejelle to judge legal responsibility in commercial cases, the British decision to preserve the Ottoman hybrid legal system also had sometimes complex consequences for how insanity was worked through in law. A case in point, which criss-crossed the legal landscape of late 1920s Palestine, was that of Hilaneh Farah, a Palestinian widow. In 1925, Farah made a gift of land to her relative Ibrahim Khoury Farah, who then sold the land to Michael Shraga Harris. A sense of the nature of this transaction can be gleaned from the fact that, in the same year, Harris was one of the principal shareholders of the newly registered Hityashvuth Company Ltd, the aim of which was ‘[t]o assist in every way the settlement of Jews whether individually or in groups on lands in Palestine and by promoting immigration, establishing and building towns, villages, etc.’38 But at the time of Hilaneh’s gift, it was alleged she was insane and that both the initial gift and subsequent sale were therefore invalid. The case came before an ecclesiastical court in the first instance, as both Hilaneh and Ibrahim belonged to the same Christian denomination, and the court found in favour of annulling the contract between Hilaneh and Ibrahim. But Ibrahim appealed, and the supreme court, sitting in November 1928, judged that the ecclesiastical court could not have jurisdiction in this case because, with regard to matters of personal status besides marriage, divorce, alimony, and wills, all parties to an action had to consent to the jurisdiction of the ecclesiastical court;39 if Hilaneh was insane, as had been argued in that court, then it could not simultaneously be held that she was capable of giving her consent to the court’s jurisdiction. The case was remitted to the district court instead,40 where in April 1930 it was judged that Hilaneh was weak-minded and had been at the time of the gift, five years earlier. But this verdict upset the subsequent sale of the land by Ibrahim to Michael Shraga Harris, and necessitated another hearing, this time in the land court of Jerusalem, to determine ownership. The land court agreed

37

38 39 40

Phoenix Co. v. J. Novovolsky, District Court of Jaffa, 22 November 1926, in Max Friedman and Leon Rotenberg, eds., Collection of Judgements of the Courts of Palestine, 1919–1933 (Tel Aviv: L. M. Rotenberg, 1938), pp. 1629–30. The reference was to §980 of the Mejelle. PB, 22 July 1925, p. 3. As established in §54(ii) of the Palestine Order in Council of 1922. Ibrahim Khoury Farah v. Elias Mitry Iskafy and Hilaneh Farah, Supreme Court in Jerusalem, 1 November 1928, in Friedman and Rotenberg, Collection of Judgements, p. 1004.

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with the district court, and annulled the initial gift of land by Hilaneh to Ibrahim and thus Harris’ claim to ownership, in December 1931. This time both Ibrahim and Harris appealed to the supreme court, arguing the land court was not competent to determine the question of insanity and that in any case the evidence heard by the court had not proven insanity. The supreme court rejected the first grounds of appeal, but decided, with regard to the second, ‘the land court did not go into the question of whether the evidence is compatible with the provisions of the Mejelle and the dicta of the learned jurists as to the nature of insanity’. The land court had concluded ‘it was highly probable that in the year 1925 the donor was insane’, but the supreme court held that ‘[s]uch a probability cannot form a basis for judgement’. The case was remitted to the land court once more,41 and here drops out of sight in the historical record, its outcome unclear. Regardless of its ending, there is something tragicomic in the tangled saga of this allegedly mentally ill widow, whose condition was leveraged by a series of guardians to frustrate at court the ambitions of both a male relative and a major Zionist land purchaser over the course of several years. The persistence with which all parties sought to turn every point of jurisdictional minutiae to their advantage speaks to the very real implications which followed from the British continuation of multiple aspects – procedural and substantive – of its Ottoman legal inheritance. If the complex battle over Hilaneh Farah’s gift of land makes clear that Palestinians were adept at ‘forum shopping’,42 darting between civil and religious courts in search of advantage, other cases – in which insanity raised questions about divorce, guardianship, and inheritance – fell more squarely under the umbrella of personal status law and so were settled within the religious courts. Having carved out this domain for the religious courts at the start of the period, colonial authorities were exceedingly reluctant to regulate or even monitor the workings of these courts, sometimes in spite of repeated entreaties to do so.43 In this context, it might be easy to assume that the religious courts worked with very different understandings of insanity and evaluated such claims differently from the civil courts, especially given assertions of the incommensurability between the psy-sciences and religion in general, and Islam in particular. Yet as Omnia El Shakry has argued, a rendition of this 41

42 43

Ibrahim Khoury Farah and Michael Shraga Harris v. Dr Jacoub Nazha as guardian for Hilaneh Farah, Supreme Court in Jerusalem, July 1932, in Friedman and Rotenberg, Collection of Judgements, pp. 1010–12. Lauren Benton, Law and Colonial Cultures: Legal Regimes in World History, 1400–1900 (Cambridge: Cambridge University Press, 2002), p. 106. Robson, Colonialism and Christianity, pp. 72–4; Likhovski, Law and Identity in Mandate Palestine, p. 96.

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relationship as one of mutual ignorance ignores the resonances, connections, and indeed cross-fertilisations between these two traditions in the twentieth-century Arab world.44 One case, which came before the sharia court of Hebron in the early 1930s, suggests there may not necessarily have been a radical difference between how religious and civil courts adjudicated insanity in mandate Palestine. In the summer of 1932, Shafic Asal, an advocate practising in Hebron, wrote to the director of health on behalf of his client, Abdul S. Abdul had been ‘appointed recently as the guardian of his brother Abdullah S. of Hebron in accordance with a judgement emanating from the sharia court, Hebron’. The sharia court, which had convened in July 1932, had arrived at this judgment ‘because it has been proved that the said Abdullah is insane’. It had done so ‘based on very strong evidence, the principal part of which is that given by Dr Abdul Aal, the medical officer of the health department at Hebron’. As his brother’s guardian, Abdul S. was writing to the department of health to arrange his admission to the ‘hospital for the insane’ at Bethlehem.45 In reaching a verdict on mental incapacity, sharia courts in mandate Palestine could draw on a long-standing, extensive body of judicial rulings or fatwas, especially in relation to the validity of divorce pronouncements made by a husband whose sanity was under doubt.46 Khayr al-Din alRamli, a mufti in seventeenth-century Ramleh, issued guidance to judges on this question. If a man pronounced a divorce but was either majnun (‘his speech and actions are not proper except in rare moments, and … he hits and curses’) or ma’tuh (‘dim-witted and confused, and unable to manage but does not hit or curse’), then the divorce was invalid; similarly, if he had a history of madness, and claimed under oath that he had been seized by the madness again at the time of pronouncing the divorce, then the divorce was also invalid. If he had neither a history of madness, nor appeared to still be majnun or ma’tuh, then evidence would be required before the divorce could be pronounced invalid by the court, like the testimony of two witnesses.47 These witnesses, it is clear, did not have to be medical experts. Indeed, as Michael Dols noted, ‘medicine is virtually ignored in the Muslim legal discussions’ of insanity, with ‘doctors … never mentioned as specialists in the determination of insanity’.48 44 45 46 47 48

El Shakry, The Arabic Freud, p. 11. Shafic Asal, Advocate, Hebron, to Director of Health, 9 August 1932, ISA M 6627/26. Scalenghe, Disability in the Ottoman Arab World, p. 118. Judith Tucker, In the House of the Law: Gender and Islamic Law in Ottoman Syria and Palestine (Berkeley: University of California Press, 2000), pp. 88–90. Dols, Majnun, pp. 451–2. This was in spite of the fact that there were many other instances in which classical fiqh, or Islamic jurisprudence, allowed medical expertise to be called upon to resolve disputes in sharia courts. See Khaled Fahmy, In Quest of Justice:

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The importance accorded to the testimony of a government medical officer in the sharia court of Hebron in the 1930s paints a very different picture of how these courts were integrating medical expertise into their handling of this question by the mandate period. There was something stubbornly irreducible about this case, however, making generalisation difficult. Dr Abdul Aal, who testified in the sharia court in Hebron, appears to have been able to form a particularly strong relationship with the community he was supposed to serve. This is clear from a petition that the ulama, mukhtars, and natives of Hebron – as they styled themselves – submitted to the High Commissioner in December 1942, asking him to block the proposed transfer of Dr Aal. He had been stationed in Hebron for twenty-five years, during which time the sanitary conditions in the town, they noted, had improved dramatically. But they placed much more stress on how Dr Aal’s character made him a good fit for the people of Hebron, than on specific health or sanitary measures undertaken. The petitioners emphasised Dr Aal’s ‘tact and wisdom and integrity in serving both government and the public’, and praised him as ‘the best example of a government officer representing the government as a higher body to patronise the public affairs for the public welfare and the love of the people in accordance with the wishes of the Almighty’.49 The value placed on Dr Aal’s testimony in the local sharia court, then, may have been less a reflection of any broader rapprochement between medicine and religious law, and more a result of his deep involvement in the community and their trust in his judgement. The department of health’s response to Abdul S.’s request that they admit his brother to a mental hospital is also notable, as it reinforces this sense that Dr Aal’s appearance before the sharia court was on an ad hoc basis. The department asked that Abdul S. register his brother with the senior medical officer of the district, so he could be added to the waiting list for the government mental hospital.50 Though a government medical officer had testified to his insanity at a sharia court, this information had not been shared with or sought out by the health department – a failure of communication consistent with a wider pattern of often willed ignorance on the part of the mandate government. These cases are stubbornly specific. But if they do suggest any broader pattern, it is less of a tale of mutual ignorance between medicine and religion, and more of willed ignorance on the part of mandate authorities about the workings of the religious courts

49 50

Islamic Law and Forensic Medicine in Modern Egypt (Berkeley: University of California Press, 2018), pp. 252–7. Petition by ulama, mukhtars, and natives of Hebron to High Commissioner, December 1942, ISA M 853/10. A/Director of Health to Shafic Asal, Advocate, Hebron, 17 August 1932, ISA M 6627/ 26.

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that they had decided to maintain as part of the hybrid legal system inherited from their Ottoman predecessors. Maintaining this system, as we have seen, had multiple, complex, and very concrete consequences for determining mental and legal responsibility in mandate Palestine.

Deploying Knowledge, Defining Normalcy Although criminal-legal responsibility was debated and determined within a legal system inherited from the Ottomans and subsequently modified in procedural and substantive terms by the British, it was not in relation to the law alone that insanity defences were advanced, critiqued, and judged. Informally, but not insignificantly, the behaviour of defendants in the courtroom might influence the outcome of trials. More formally, criminal law was not intended to operate in a vacuum, but acknowledged and enshrined the importance of expert medical witnesses. Other kinds of knowledge, too, played a role in shaping what was considered ‘normal’ or ‘abnormal’ for different groups, including – in a context of colonial anxiety over cultural difference – folklore research. In the Denishensky case with which this chapter began, psychiatric expertise worked in lockstep with the law, as the chief justice put precisely formulated questions to Dr Malouf and received definitive answers about the defendant’s cognitive and intellectual faculties in return. Yet different forms of expertise did not always come together so straightforwardly, as the cases which are our focus in this part of the chapter make clear. Not only this, but these cases highlight the considerable debates which raged within the fields of law and psychiatry, internal debates which left participants in trials much room for manoeuvre. The following story opens up these key issues. On 19 July 1934, Sima Meskin, the wife of a famous actor at the Habimah theatre, opened the door of her Tel Aviv home to find a sixteen-year-old girl, Naomi Schmidt, outside, flowers in hand. Schmidt, whose father worked with Meskin’s husband, asked for Mr Meskin, but he was at work. Mrs Meskin invited her inside, offered her a glass of water, and – after the girl admired the Michelangelo reproductions around the house – turned to the cabinet to show others to her. With Meskin’s back turned, Schmidt drew a knife concealed in the bouquet of flowers, and stabbed her. Mrs Meskin lived to recount this tale at Naomi Schmidt’s trial at the end of October 1934. Schmidt, for her part, confessed that she had bought the knife in order to stab Mrs Meskin and that she had done so out of love for Mr Meskin.51 The 51

Doar Hayom [DH], 29 October 1934, p. 6.

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magistrate found her guilty of premeditated attempted murder, and the case moved up to the district court in Jaffa. Public and press interest in this case – involving a famous actor, with a theatrical quality of its own – ran high: a photographer for one of Palestine’s newspapers had his camera seized after taking a photograph of the defendant in the courtroom, and large crowds gathered outside the Jaffa court house to watch the start of Schmidt’s trial.52 It was at this point, the first day of the trial, that the lawyer for Schmidt – who had already been characterised as ‘insanely jealous’ in the press – declared he was bringing medical evidence which proved the mental state of the defendant would not allow her to be prosecuted under a charge of premeditated attempted murder.53 Two medical experts, who had been supervising Schmidt since the incident, were called upon to testify to the court. The first, Dr Wall, introduced himself as a psychiatrist who had been practising for nearly three decades and specialised in social cases and the young. He testified that Schmidt’s attack took place in a moment of madness, and was the result of an impulse that it had not been in her power to resist. The second medical expert who gave evidence to the court was Professor Pappenheim. He told the court how he had gradually won Schmidt’s trust after visiting her in prison, and she had begun to open up to him. What she told him made it clear she was ‘in a condition of passing madness’, which hinged on a delusional, obsessive, and unrequited love for Mr Meskin. He explained: ‘When she looked at Mr Meskin, she created for herself illusions, and it seemed to her that he loved her. And it was in line with this illusion that she acted.’54 It was an almost textbook case of a condition which Pappenheim termed erotomania, or ‘raving love’. Both medical experts, and the counsel for the defence, recommended that Naomi Schmidt be found guilty but insane and allowed to go abroad to recover. But the judge, Randolph Copland, ultimately sentenced Schmidt to six months’ imprisonment, the mildest sentence possible, rather than finding her guilty but insane. Before turning to the judge’s reasoning, it is worth dwelling on the testimonies offered by Wall and Pappenheim. Both, in different ways, offered accounts which sat uneasily with the requirements of the law. Wall did not offer an evaluation of the cognitive faculties of the defendant – her ability to understand the nature of her actions – but spoke instead of the uncontrollable impulse which compelled her. It was precisely this issue which had been a focal point of

52 53

DH, 31 October 1934, p. 6; DH, 27 November 1934, p. 4. 54 PP, 20 August 1934, p. 5. DH, 27 November 1934, p. 4.

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criticism of the revised criminal code’s treatment of insanity in the press just a year earlier. If Wall’s definition of insanity did not coincide with that set out in the criminal code, Pappenheim’s testimony raised other difficulties. Pappenheim presented Schmidt as a textbook case of the condition he called ‘erotomania’. But defining erotomania was not as straightforward as he gave reason to believe. In the nineteenth century, the influential French psychiatrist Esquirol had – controversially – defined erotomania as a kind of monomania, that is, an obsessive delusional condition, on a par with religious forms of monomania. While the category of monomania did not survive the nineteenth century, the idea of erotomania as a kind of delusion did, and psychiatrists like Krafft-Ebing and Kraepelin identified hallucinations, including pseudomemories, as features of erotomania in the early twentieth century. By this point, the erotomaniac was understood as suffering the delusion not of being in love, but of being loved, above all by someone of a higher rank.55 In that respect, Schmidt’s belief that the popular, six-foot-tall actor Mr Meskin was in love with her made her a seemingly perfect fit for this diagnosis. Yet this was not the only understanding of the condition in play in Palestine in the 1930s, and just a year after Schmidt’s trial concluded, Dr Abraham Litwak gave a lecture on the subject of erotomania in Tel Aviv. His conclusion, based on work with a patient, was that the expression of erotomania depended more on the character of the individual affected, rather than the disease itself; in the case of his recent patient, the condition expressed itself not in delusions but rather a set of behaviours including masturbation, nakedness, and sexual dissatisfaction with her husband.56 Pappenheim’s definition of erotomania scrupulously avoided discussion of any of these behaviours, and focussed exclusively on Schmidt’s delusions. But if this allowed him to conceal the lack of consensus among psychiatrists about this condition, his focus on delusions created an opening for the judge to dismiss Schmidt’s plea of insanity and find her guilty. In view of the fact she had confessed to both the attack and to premeditation, the only point of discussion – as the judge, Randolph Copland, put it – was Schmidt’s mental responsibility at the time of the act. Here, rather than accepting or rejecting the testimony of the medical experts that Schmidt had been suffering from delusions, the judge chose to render it irrelevant: 55 56

See G. E. Berrios and N. Kennedy, ‘Erotomania: A Conceptual History’, History of Psychiatry 13 (2002), pp. 389–94. Abraham Litwak, ‘On the Research of Erotomania’, Harefuah 9 (1936), pp. 359–62.

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Suppose the state of affairs were true as imagined by the girl; would that have provided an excuse? The answer is, of course, no. Therefore, the fact that there was this delusion has no bearing at all. Maybe one day every crime will be treated as a pathological case. That, however, is not the law at the moment and I must confine myself to the limits of the law in this land.57

The judge’s decision to assess the guilt of a deluded defendant as if their delusions were true was not wholly unprecedented. A court of criminal appeal in England had arrived at a similar decision a few years earlier, in a case involving a man who killed his wife while allegedly under the influence of an delusional jealousy. The court in that case had dismissed this defence, arguing that ‘assuming the dead woman to have done all that the appellant insanely believed her to have done … that did not justify a husband, or any man, in putting an end to her life’. But this approach was unusual, as Tony Ward notes: far from setting a precedent, it was quickly forgotten and ignored in practice.58 This was thus both an unusual and recent verdict to echo in Palestine, an echo made all the more striking by the fact that it was a decision reached by Copland, one of the more conservative English judges in Palestine – that is, reluctant to turn to English law where local law remained available, or to recognise colonial subjects’ claims to English rights where possible.59 Pappenheim’s definition of erotomania, and Copland’s decision to judge Schmidt’s guilt as though her delusions were true, both underline the uncertainty and debate which existed within psychiatry and law about insanity and responsibility. But the case also brings into sharp focus how fractious the relationship between these two fields could be. Unusual though Copland’s approach may have been, his greater purpose in sidelining the testimony of the two medical witnesses was representative of a much bigger issue in criminal law, as his summation remarks make clear. With his baleful picture of a possible future, in which ‘every crime will be treated as a pathological case’, Copland was tapping into a deep vein of anxiety among legal experts about the expansion of the dominion of psychiatric experts since the nineteenth century to include far more than just the care of the obviously ‘mad’. Indeed, his remarks echoed – perhaps unintentionally – those of the French sociologist Gabriel Tarde, who had already warned at the end of the nineteenth century that ‘[a] violent, irresistible current drives science to its usurpations and to its conquests’, such that ‘the field of irresponsibility has grown out of all proportion’.60 57 59 60

58 PP, 28 November 1934, pp. 1, 8. Ward, ‘A Terrible Responsibility’, pp. 374–5. Likhovski, Law and Identity in Mandate Palestine, p. 73. Gabriel Tarde, Penal Philosophy [1890], trans. R. Howell (Boston: Little, Brown, 1912), p. 154.

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These ‘usurpations’ did not go uncontested by legal experts, who understood that these assaults on the notion of free will, and of criminal responsibility attendant on it, threated the very foundations of their profession’s decision-making capacity. When an insanity plea was made and psychiatrists became involved, the potential existed for these cases to – as Catherine Evans has put it – ‘erupt into dramatic controversies in which the entire criminal law system, rather than only the defendant’s life, seemed to hang in the balance’.61 This apocalyptic reading of the threat posed by psychiatry’s incursion into the courtroom was one with which Copland clearly sympathised. In view of these stakes, his decision to judge Schmidt as though her delusions were real becomes more comprehensible, as an unusual step taken to defend the integrity of the wider criminallegal system. There is a final layer to this trial worth excavating. While the judge rendered the testimonies of the medical witnesses irrelevant, the counsel for the defence, Mr Henigman, offered his own plea for leniency. The defendant, he noted, was very young, just sixteen years of age. At this impressionable and tender young age, she had become used to visiting the Habimah theatre, where her father worked, a ‘strange’ place – as the defence put it – and one where her proximity to adults had affected her badly, he claimed.62 Copland, in his summation, put more weight on Schmidt’s lawyer’s words than on the testimonies of the expert witnesses: Henigman had, he noted, ‘painted a very moving picture of the child’s position, that of a young girl without proper parental control and unbalanced’. While ‘far from … insensible’ to this appeal for Schmidt to be sent away to heal, Copland declared that he had to consider ‘the other side of the picture’: If I say she is not insane and yet let her go free, this would offer encouragement to every hysterical boy and girl. I am guided not only by the interest of the prisoner but also by public interest. This is something which cannot be done.63

In a sense, then, it was not the expert medical witnesses who touched on the question of normative uncertainty which has been identified as 61

62

Catherine Evans, ‘At Her Majesty’s Pleasure: Criminal Insanity in 19th-Century Britain’, History Compass 14, 10 (2016), p. 471. For the wider history of this issue, see Charles Rosenberg, The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age (Chicago: University of Chicago Press, 1968); Roger Smith, Trial By Medicine: Insanity and Responsibility in Victorian Trials (Edinburgh: Edinburgh University Press, 1981); Joel Eigen, Witnessing Insanity: Madness and Mad-doctors in the English Court (New Haven, CT: Yale University Press, 1995); Arlie Loughnan, Manifest Madness: Mental Incapacity in the Criminal Law (Oxford: Oxford University Press, 2012); and Harris, Murders and Madness. 63 DH, 27 November 1934, p. 4. PP, 28 November 1934, p. 1, 8.

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central to histories of colonial psychiatry in other contexts, but rather Schmidt’s lawyer and, in response to him, the judge. Yet unlike in other contexts – in Africa, for instance, where colonial officials had to work out if visions were, in fact, ‘normal’ – the problem of normative uncertainty in this case was not principally transcultural in nature. Instead, as Copland suggested, the issue was more specific: if Schmidt did not face consequences for her actions, then the floodgates would be opened for ‘every hysterical boy and girl’ to escape penalties for their actions too. Rather than going beyond the bounds of the normal, Schmidt’s circumstances – living in Tel Aviv with relaxed parental supervision and access to ‘strange’ spaces as well as adults – seemed worryingly unexceptional, at least to the British judge presiding at her trial. In the late 1990s, Shula Marks suggested that in focussing attention so closely on race and gender, historians of colonial medicine were in danger of overlooking the operation of other categories of identity, like class.64 In the case of Naomi Schmidt, age and class, rather than culture – or indeed gender – were foregrounded in the judge’s analysis; indeed, it is notable that Copland went so far as to speak of ‘every hysterical boy and girl’, downplaying the importance of Schmidt’s gender in delimiting the boundary between normal and pathological behaviour. Instead ‘youth’ – an object of concern in Britain itself at this time, though more pressingly when prefixed with ‘working-class’65 – appeared in this case to be the more relevant category; such anxiety about the volatility of youth was nothing new to Palestine in the 1930s, nor unique to Palestine in the region either.66

64

65

66

Shula Marks, ‘What Is Colonial about Colonial Medicine? And What Has Happened to Imperialism and Health?’, Social History of Medicine 10, 2 (1997), p. 216. For a piece which responds to this call in the history of colonial psychiatry in the Gold Coast, see Matthew Heaton, ‘Aliens in the Asylum: Immigration and Madness in Gold Coast’, Journal of African History 54, 3 (2013), pp. 373–91. While the literature is more developed for the post-war years, see Harry Hendrick, Images of Youth: Age, Class, and the Male Youth Problem, 1880–1920 (Oxford: Oxford University Press, 1993); Andrew Davies, ‘Youth Gangs, Masculinity, and Violence in Late Victorian Manchester and Salford’, Journal of Social History 32, 2 (1998), pp. 349–69; Penny Tinkler, ‘Cause for Concern: Young Women and Leisure, 1930–50’, Women’s History Review 12, 2 (2003), pp. 233–62. Jonathan Büssow traces concerns to 1908, in ‘Children of the Revolution: Youth in Palestinian Public Life, 1908–1914’, in Y. Ben-Bassat and E. Ginio, eds., Late Ottoman Palestine: the Period of Young Turk Rule (London: Bloomsbury, 2011), pp. 55–78. Youth emerged as a category of political mobilisation and peril across the region in this period: Oz Almog, The Sabra: The Creation of the New Jew [1997], trans. Haim Watzman (Berkeley: University of California Press, 2000); Omnia El Shakry, ‘Youth as Peril and Promise: The Emergence of Adolescent Psychology in Postwar Egypt’, International Journal of Middle East Studies 43, 4 (2011), pp. 591–610; Sara Pursley, ‘The Stage of

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Schmidt’s case has been worth giving so much attention because it highlights how just a single case in which an insanity defence was raised could be ‘the thin edge of a very big wedge’.67 Schmidt’s case was not ‘typical’, exemplary of other trials in this period, but it did force a reckoning with weighty questions around the relationship between psychiatric expertise and criminal law, and saw different forms of knowledge – legal, social, psychiatric – put to work to define and demarcate the normal and the pathological. A second case, which went to trial in the same year, further draws out some of these points, while also offering a direct contrast to both the Schmidt case and indeed the Denishensky case with which this chapter began, as it concerns a Palestinian ‘peasant woman’ rather than European Jewish defendants. In January 1934, Fatima bint Issa Shalbak appeared before the supreme court in Jerusalem sitting as a court of appeal. Described as ‘a middle-aged peasant woman of the village of Ana, in the Jaffa district’, she had been sentenced to death by the court of criminal assize for the premeditated murder of her blind husband with an axe. Shalbak had, in a statement to the police, confessed to the murder, a statement she repeated before the court: I was deceived by the devil. The accursed Satan deceived me. That demon struck68 me to kill my husband. Therefore did I take an axe and gave him two blows upon the head. Then I took his body and flung it in the well.69

She had been unrepresented at the court of criminal assize and had pleaded guilty to the charge of premeditated murder initially, a plea the court itself advised her to withdraw. At the court of appeal, however, she was represented by Henry Cattan, who contended that she could not have been in her right mind at the time of the murder. He asked for the medical examination of the defendant, which the court granted, directing that she be examined by Dr Malouf. In April, she was brought back before the court, having been kept under observation for a month at the

67 68

69

Adolescence: Anticolonial Time, Youth Insurgency, and the Marriage Crisis in Hashimite Iraq’, History of the Present 3, 2 (2013), pp. 160–97. Evans, ‘At Her Majesty’s Pleasure’, p. 471. The translation here (‘struck’) might appear to suggest Shalbak was presenting herself as having been ‘struck’ by a jinn (madrub), as opposed to inhabited or possessed. But being ‘struck’ by a jinn was ordinarily linked to paralysis or physical injury, not action outside the control of the individual: see Dols, Majnun, pp. 294–5. Unfortunately the original Arabic is not recorded, so it is not clear what term she used. PP, 25 January 1934, p. 1. See also Michael McDonnell, The Law Reports of Palestine, 1920–1933 (London: Crown Agents for the Colonies, 1934–5), p. 77. These cases rarely made their way into the law reports; clearly they were not seen as particularly interesting cases from a legal perspective, at least.

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women’s prison, Bethlehem, near the government mental hospital where Malouf worked. Malouf’s testimony before the court was striking. He ‘certified that during this period no indication of mental deficiency or of lunacy could be observed and that her mentality was the normal average mentality of a woman of her class in Palestine’. Shalbak was not, in other words, a case that could be found guilty but insane, in his view.70 In the end, the court overturned the death sentence imposed on Shalbak by the lower court, but on technical grounds: the sole witness who could provide evidence for premeditation was her daughter, whose evidence was inadmissible. What is striking is that the court, even as it handed down this reprieve, made clear that it, like Malouf, believed the woman was responsible for her actions; the judgment declared the court had taken no account of the counsel’s plea in mitigation. On the contrary, they expressed their feeling that the crime had been ‘committed in circumstances of great brutality’, and in line with this, they sentenced Shalbak to fifteen years in penal servitude.71 Historians researching insanity defences in a range of other contexts have noted that the number of women found guilty but insane by criminal courts tends to be lower than that of men. In these analyses, women were less likely to be found guilty but insane because acts presented in court as evidence of female criminal insanity were normalised as typical of a female mentality that was always already divergent from the default, responsible male subject of law. To put it another way, in order to be found both ‘mad’ and ‘bad’, rather than just ‘bad’, women had to commit spectacular acts of violence – usually against their children or husbands – to be transported beyond available understandings of women’s so-called ‘normal’ deviance.72 Yet in this case, the court found Shalbak legally responsible, in spite of the fact she had committed the kind of spectacular violence that historians suggest would likely have secured a ‘guilty but insane’ verdict in another context. Shalbak’s actions, however, were not simply judged against what might be considered ‘normal’ for women, but a more specific normal: that of ‘the normal average mentality of a woman of her class in Palestine’, as Malouf put it.

70 71 72

PP, 22 May 1934, p. 2. Judgment in Court of Appeals, Jerusalem, 19 April 1934, ISA P 187/7. Robert Menzies and Dorothy Chunn, ‘The Gender Politics of Criminal Insanity: “Order-in-Council” Women in British Columbia, 1888–1950’, Histoire sociale/Social History 31, 62 (1998), pp. 249–50. See also Bronwen Labrum, ‘Looking Beyond the Asylum: Gender and the Process of Committal in Auckland, 1870–1910’, New Zealand Journal of History 26 (1992), pp. 125–44; Catherine Evans, ‘Persons Dwelling in the Borderland: Responsibility and Criminal Law in the Late Nineteenth-Century British Empire’ (PhD diss., Princeton University, 2016), pp. 20–1.

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In the absence of a jury, it has been argued Palestinian judges filled the role of informants who could help British judges understand local context.73 In this case, however, it was Malouf who took on the dual role of cultural interpreter as well as medical expert, helping the mandate’s judges determine not just whether the defendant might meet medical and legal definitions of insanity, but what kinds of behaviour or thought should be expected of someone of her background. This was not a unique position, but neither was it an easy one to fill. Concern about British overdependence on Palestinian intermediaries was expressed by a number of colonial officials at the time: Joseph Broadhurst, of the Palestine police, worried that the prosecution of crime was left almost entirely in the hands of the Palestinian officer, ‘who knows both the language and the mentality of the people’;74 Edward Keith-Roach, district commissioner, similarly lamented that British officers were ‘in the hands of translators, mostly Arab Christians’75 – like Malouf. Malouf was performing interpretive work of a somewhat different order: not the translation of Arabic into English but rather the identification of the ‘normal average mentality’ of a woman like Shalbak. In spite of anxieties around interpreters, in this case Malouf’s representation of Shalbak as belonging to a different mental and moral universe was seized on by the court as chiming with their own horror at the ‘brutality’ of the crime committed – and, critically for the defendant’s chances of a reprieve, the world from which it was thought to have sprung. Deemed normal for a woman of her background, Shalbak’s account – in spite of its invocation of Satan – did not seem to the court to be sufficiently unusual to call into question her sanity and therefore her legal responsibility. Shalbak’s attempt at explanation and absolution through a turn to the supernatural was unsuccessful; the result was that she was sent to prison. In a way, the court’s logic was clear and consistent: just as the youth of Tel Aviv had to be deterred from evolving theatrical delusions about romance, so too did Arab peasant women need to face the consequences of acting on seemingly commonplace beliefs in possession and demons, lest the courts concede that ‘every crime will be treated as a pathological case’. Although it was Malouf, a medical doctor, who had been called upon to interpret Fatima bint Issa Shalbak to the court, uncovering the ‘normal’ among the Palestinian peasantry was a task more properly within the domain of folklore researchers, both European and 73 74 75

Likhovski, Law and Identity in Mandate Palestine, p. 30. Broadhurst, From Vine Street to Jerusalem, p. 203. Edward Keith-Roach, Pasha of Jerusalem: Memoirs of a District Commissioner under the British Mandate (London: Radcliffe Press, 1994), p. 75.

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Palestinian. It was as a result of their work that Malouf’s analysis would have chimed true in the courtroom, highlighting yet another field of knowledge that could shape the course and outcome of insanity defence trials in mandate Palestine, this time more indirectly. One of the most significant vehicles for this kind of research was the Palestine Oriental Society, which met for the first time in March 1920 and amassed an influential list of patrons and subscribers – including census superintendent Eric Mills – over the course of its existence. While the society published on a range of intellectual subjects, and included European biblical scholars as well as Palestinian Arab and European Jewish researchers, as far as folklore research was concerned, it was a group of Palestinian Arab – largely Jerusalemite – ethnographers who predominated. Loosely headed by Dr Tawfiq Canaan, who had been trained as a medical doctor, this group contributed an eclectic array of essays on Palestinian folklore,76 some of which were encountered in the first chapter. They wrote to record for posterity the customs of a peasantry whose way of life they perceived as rapidly disappearing, and their work has been read for its proto-nationalist assertion of the depth and authenticity of Palestinian roots in the land.77 Written in English and aimed at a European audience, including those closely affiliated with the mandate, this aspect of their folklore research, as a strategic riposte to Zionist narratives, is undeniably important. Yet their work – which contains, among other things, a rich set of writings on folk beliefs and practices around mental illness – can be approached through the lens not just of political history, but the history of medicine, and relatedly the law, too. In 1924, Stephan Hanna Stephan – among many other things, a civil servant, archaeologist, and curator – published an article on lunacy in Palestinian folklore in the society’s journal.78 It was one of the most substantial investigations of the subject published in the journal or 76

77 78

For this circle, see Salim Tamari, ‘Lepers, Lunatics, and Saints: The Nativist Ethnography of Tawfiq Canaan and His Jerusalem Circle’, Journal of Palestine Studies 20 (2004), pp. 24–43. For Canaan himself, see Khaled Nashef, ‘Tawfiq Canaan: His Life and Works’, Jerusalem Quarterly 16 (2002), pp. 12–26; Brigit Mershen and Ulrich Hübner, ‘Tawfiq Canaan and His Contribution to the Ethnography of Palestine’, in U. Hübner, ed., Palaestina Exploranda: Studien zur Erforschung Palästinas im 19. und 20. Jahrhundert anlässlich des 125 jährigen Bestehens des Deutschen Vereins zur Erforschung Palästinas (Wiesbaden: Harrassowitz, 2006), pp. 250–64; and Philippe Bourmaud, ‘“A Son of the Country”: Dr. Tawfiq Canaan, Modernist Physician and Palestinian Ethnographer’, in M. LeVine and G. Shafir, eds., Struggle and Survival in Palestine/ Israel (Berkeley: University of California Press, 2012), pp. 104–24. Tamari, ‘Lepers, Lunatics, and Saints’, pp. 38–40. For more on Stephan, see Sarah Irving, ‘“A Young Man of Promise”: Finding a Place for Stephan Hanna Stephan in the History of Mandate Palestine’, Jerusalem Quarterly 73 (2018), pp. 42–62.

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elsewhere, and had much to say about beliefs around the causes of mental illness. The article, taking as its starting point the idea that madness manifests in many different forms, began by listing thirty-one terms used to capture these different shades of lunacy: mahbul, glossed as ‘disordered in brain (by grief or love)’; majdub, referring to someone suffering ‘imbecility, idiocy, “furor sanctus” because caused by a “good spirit”’; and munaffid, from the same root as intifada, colourfully defined as ‘having dusted (his brains and thus lost them)’.79 Of all these, majnun was the most common. Its significance, Stephan explained, lay in the fact that even in terms of its etymology it conveyed the extent to which folk understandings of mental illness were closely tied to a belief in the action of jinn. While there were certainly other causes, the majority of cases of lunacy were blamed on jinn: they were credited with inflicting insanity as punishment for a range of actions, from transgressing universal moral laws to more specific, seemingly innocent offences, like shouting in a cave or well and disturbing its resident spirit.80 While Stephan’s article was the most comprehensive exploration of the subject, the link between the term majnun and belief in possession by spirits had long been clear to English-speaking audiences; it was even highlighted in the British Medical Journal before the First World War.81 And in 1934, the same year that Shalbak was put on trial for murder, Tawfiq Canaan published his own piece on Palestinian folk practices and beliefs in which he reaffirmed that, as a result of ignorance about modern medicine, there was a ‘deeply-rooted belief that sickness is attributable to the action of evil spirits’.82 A central goal for ethnographers of the Palestine Oriental Society may have been to make the case for a long-standing Palestinian connection to the land. But their work had other effects, too; it – as much as psychiatric expertise – could serve as one of those bodies of knowledge which allowed officials to negotiate the normative uncertainty thought inherent in a colonial context. By emphasising the ubiquity of belief in the power of jinn in Palestinian folklore, their work helped inform mandate officials’ understandings of what should be deemed normal among the Palestinian peasantry. When Malouf argued before the court that Shalbak had ‘the normal average mentality of a woman of her class in Palestine’, British judges could draw deep from this reservoir of folklore research in support of his contention, and so sentence her to fifteen years

79 81 82

80 Stephan, ‘Lunacy in Palestinian Folklore’, pp. 2–3. Ibid., pp. 4–7. ‘Lebanon Hospital for the Insane, Asfuriyeh’, British Medical Journal 2, 2607 (1910), p. 1937. Tawfiq Canaan, ‘Modern Palestinian Beliefs and Practices Relating to God,’ Journal of the Palestine Oriental Society 14 (1934), p. 90.

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in prison. In the case of Naomi Schmidt, multiple branches of expert knowledge – legal, psychiatric, and social – offered competing explanations of her crime. But there was not necessarily a tension between different bodies of knowledge: as the case of Fatima bint Issa Shalbak suggests, they could also be mutually reinforcing, as law, psychiatry, and folklore all lined up to condemn her as criminal – not insane. Criminal Insanity in a State of Exception In the courtroom, it was the blurred boundaries of the category of insanity which preoccupied the judges, medical experts, and other participants in insanity defence trials. In debates over the limits of mental irresponsibility, a set of different kinds of knowledge – legal, psychiatric, social, folkloric – were put to work either explicitly or more subtly, as reference points in the background. Yet it was not just the category of insanity that was unstable. Both terms in the formulation ‘criminally insane’, or ‘criminal lunatic’ – the label given to those found ‘guilty but insane’ by the courts – were shifting and treacherous in mandate Palestine. But in order to understand the mutability of the category of ‘criminality’ in this context, it is necessary to zoom out from the courtroom, and examine how Palestinian Arab responsibility was represented more widely, and particularly in what Ranajit Guha has called the prose of counter-insurgency. Writing about the colonial response to peasant uprisings in British India, Guha has drawn attention to the way in which colonial states frequently deployed a language of irresponsibility to delegitimise anti-colonial insurgency and justify its violent suppression. In British India, this was baked into the prose of counter-insurgency through the use of metaphors which stripped the peasantry of will and reason and assimilated them to natural phenomena like earthquakes or wildfires.83 Extending this line of analysis, Matthew K. Kelly has more recently argued that the colonial authorities responded to the great revolt that rocked Palestine between 1936 and 1939 with a criminological framing of Palestinian nationalism, representing the revolt as a wave of crime, lawlessness, and disorder.84 This criminological framing was married to and built on an understanding of Palestinian village life as oriented towards mutual protection, rather than justice, an understanding which legitimised a policy of imposing collective rather than always individual punishment. Enshrined in law as early as the mid-1920s, this 83 84

Ranajit Guha, ‘The Prose of Counter-Insurgency’, in R. Guha and G. Spivak, eds., Selected Subaltern Studies (Oxford: Oxford University Press, 1983), pp. 45–86. Kelly, The Crime of Nationalism.

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principle was extended over the great revolt, as British counterinsurgents demolished Palestinian property, imposed heavy collective fines, demanded forced labour, and installed punitive village occupations between 1936 and 1939.85 With collective criminality expanded in this way, latitude for individual responsibility to be of significance was correspondingly diminished. In these same years, the main challenge to the law came not from psychiatry’s expansionist ambitions, but rather the military courts and the threatened suspension of the normal operation of the courts through the imposition of martial law.86 This was the critical context in which questions of criminal insanity were raised in the late 1930s. Historians of colonial psychiatry have long considered the relationship between moments of political upheaval and the psy-disciplines. But their focus has tended to be on the way the psy-disciplines provided colonial states with useful theories about the minds of colonised subjects and insurgency, theories which pathologised and delegitimised dissent.87 Although the psychiatrist J. C. Carothers’ account of Mau Mau in 1950s Kenya, commissioned by the Kenyan government, is the best known example of this, the use of the psy-sciences to pathologise anticolonial revolt predated Mau Mau by decades, as Sloan Mahone has shown, and did not always require the involvement of psychiatric experts. ‘Disturbances’ in 1911 were already characterised as an ‘outbreak of mania’ by colonial authorities in East Africa, transforming the behaviour of these dissenters into evidence that British rule and the imposition of ‘civilisation’ that came with it was resulting in outbreaks of collective psychological instability.88 Palestine conforms more to this example than the later marshalling of psychiatric experts evident in Mau Mau. No psychiatric or medical expert was called upon to diagnose resistance in mandate Palestine, nor did they volunteer to do so. But non-specialists nonetheless took up a psychological language to explain and discount Palestinian discontent, as is clearest in the reports produced by British investigative commissions in the wake of ‘disturbances’ in 1921 and 1929, and the great revolt which began in 1936. While the framing of resistance in mandate Palestine, both in the great revolt and before, worked as in other contexts to delegitimise political action, it had indirect 85 86 87

88

Hughes, ‘The Banality of Brutality’. For the debate over imposing martial law in Palestine in 1936, see Kelly, The Crime of Nationalism, pp. 78–85. McCulloch, Colonial Psychiatry; Robert Edgar and Hilary Sapire, African Apocalypse: The Story of Nontetha Nkwenkwe, a Twentieth-Century South African Prophet (Athens: Ohio University Press, 1999); Mahone, ‘The Psychology of Rebellion’. Mahone, ‘The Psychology of Rebellion’, p. 243.

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consequences too: seemingly generalised senseless violence shaped the handling of specific cases of criminal insanity. One of the earliest extended reflections on collective responsibility came in 1921 in the aftermath of rioting, which particularly affected Jaffa, in May of that year. Alongside descriptions of the Arab population of Jaffa as being ‘credulous’ and ‘excitable’,89 stirred up by rumours without evidence, the report deployed a language of contagion to explain the failure of the police to maintain order. In this account, the police had been unable to keep order during the rioting ‘either because they felt themselves unable to cope with the tumult, or because racial passion had become infectious and they were unwilling to make an effort to stem the rage of their own people’.90 This language of contagion was recapitulated at the end of the report: ‘racial considerations influenced their conduct’, it concluded, such that ‘they became infected with partisanship’. Indeed, ‘it would have been surprising if this half-trained body of men had been able, in the interest of public duty, to stand out against the flood of racial passion which had been let loose’.91 For the commissioners, the responsibility of individual Palestinians – whether in the crowd, excited by rumours spreading like wildfires, or in the police, swept up in a ‘flood of racial passion’ – appeared to have been compromised; having located responsibility at the level of the crowd, the imposition of collective punishments logically followed. While the Shaw Commission that was sent out to investigate the ‘disturbance’ of 1929 split into a majority and dissenting minority report, the minority report – the report ultimately approved by London – similarly placed emphasis on the credulity and excitability of the Arab population, and blamed the Arab leadership and papers for artificially inflaming these passions.92 By 1936, though there was similar condemnation of the inflammatory role of the press, the Peel Commission report concluded that the fundamental causes of Arab anger were political.93 There was movement, then, across the interwar decades away from presenting the disturbances in pathological terms, as irrational or pre-political, and towards recognising the political roots of such events. This did not, however, translate into a move away from collective punishment; indeed, the late 1930s saw British counter-insurgents adopt collective punishment as the central plank in their strategy for the repression of the great revolt. 89 90 92

93

Reports of the Commission of Inquiry into Disturbances in May, 1921 [Haycraft Report] (London: HMSO, 1921), p. 18. 91 Ibid., p. 25. Ibid., p. 49. Report of the Commission on the Palestine Disturbances of August, 1929 [Shaw Report] (London: HMSO, 1930). For the politics of the majority and minority reports, see Anderson, ‘The British Mandate’, p. 177. Peel Report, pp. 193, 106–10.

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If the use of a psychological register by non-specialists to delegitimise anti-colonial revolt in Palestine parallels cases from elsewhere across the British empire, the kinds of questions that this raised about individual responsibility had been more directly tackled not by colonial psychiatry but rather a sociological literature stretching back to late nineteenthcentury Europe. This literature troubled itself with the issue of the responsibility of individual members of a crowd. For Gustave Le Bon, the most influential contemporary theorist of this phenomenon, becoming part of a crowd resulted in a kind of suspension of the individual’s conscious personality, such that they resembled the ‘hypnotised subject’; more evocatively still, he wrote that ‘[a]n individual in a crowd is a grain of sand amid other grains of sand which the wind stirs up at will’.94 From the turn of the century, Le Bon’s ideas, as Timothy Mitchell has shown, found a receptive audience in Egypt among British officials as well as – with his translation into Arabic in 1909 – among the emergent bourgeoisie.95 Others connected this phenomenon directly to the question of legal responsibility, like sociologist and sometime magistrate Gabriel Tarde; in 1890, he argued that ‘in an excited crowd … imitation is absolutely unconscious and blind and contrary to the habitual character of the person who is subjected to it; it is a phenomenon of momentary insanity which lessens responsibility or eliminates it’.96 Against the backdrop of representations of individual responsibility as having been submerged amid the collective insensibility of the crowd, how were courts to single out, assess, and judge cases in which individual responsibility was held to have been attenuated in another way, as a result of ‘insanity’? It is notable, then, that such cases were reported at all. In June 1921, for instance, a Palestinian man was reported by the official commission of inquiry to have ‘ran amok in a Jewish shop in Menshieh, killing two Jews and wounding others’. He was arrested and later ‘found by a medical board to be insane’.97 The use of the word ‘amok’ in this connection is striking, as a term which was originally coined to refer to a specific ‘state of furious homicidal passion’ found, it was thought, exclusively among the Malays.98 Given its homicidal bent, questions of legal responsibility naturally arose in relation to it. At the end of the nineteenth century, one 94 95 96 98

Gustave Le Bon, The Crowd: A Study of the Popular Mind (London: T. Fisher Unwin, trans. 1896), pp. 34–5, 36. Timothy Mitchell, Colonising Egypt (Berkeley: University of California Press, 1991), pp. 122–5. 97 Tarde, Penal Philosophy, p. 302. Haycraft Report, pp. 35–6. See W. G. Ellis, ‘The Amok of the Malays’, Journal of Mental Science 39, 166 (1893), pp. 325–9. For the term’s usage, see Thomas Williamson, ‘Communicating Amok in Malaysia’, Identities 14, 3 (2007), pp. 341–65.

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asylum superintendent in Singapore wrote that ‘the man who runs amok … undoubtedly suffers from some form of impulsive insanity, generally of a most transient character’, which was ‘in the majority of instances … sudden and uncontrollable’. But individuals could nonetheless bear some responsibility for their actions while in this state, he wrote: anyone who sought to provoke such a state should be held responsible for their actions, just ‘[a]s a man who of his own free will makes himself drunk, and in a blind drunken rage, more or less unconscious of his actions, commits a crime, is responsible’.99 In 1920s Palestine, amok may have been used imprecisely. But there was nonetheless a specific body of expertise on this condition, one which could be drawn upon to spotlight an individual’s mental condition and parse responsibility from irresponsibility even in these circumstances of generalised disorder. A second case, this time from the peak of the great revolt, brings the dynamics of determining responsibility in a context of generalised irresponsibility more sharply into focus, while underlining the range of actors who helped define and determine responsibility, criminality, and insanity in the courtrooms of mandate Palestine. It concerns Jewish defendants, and highlights that while a prose of counter-insurgency that diminished Palestinian Arab responsibility did not directly affect the court’s adjudication of their culpability or prevent detailed discussion of their individual mental states, the generalised circumstances of violence did nonetheless play a role in shaping their trial’s outcome. In April 1938, three Jewish youths – Abraham Sheen, Shlomo ben Yusseff, and Shalom Zurabin – were arrested after firing on an Arab bus near Rosh Pinah in northern Palestine. The following month, they were brought before the Haifa military court, where the aged father of Zurabin gave evidence in Yiddish as to the mental state of his son. He testified that his son, a carpenter by trade, ‘had been without regular employment for two years’, and that ‘[i]dling about, he had become melancholy and moody, and neighbours remarked that he was on the verge of insanity’. At this point, it was reported, the defence asked for Shalom Zurabin to be taken out of the courtroom. While in some cases, as we saw, the defendant’s behaviour in the courtroom – strange grimaces, aggression – was recorded as evidencing their mental incapacity, in this case, the defence sought to limit a defendant’s exposure in the court. With Zurabin removed from the courtroom, the father went on to describe the ‘abnormal actions of his son, his treatments at hands of mental specialists, and his reactions to the course of treatments prescribed’. None of these

99

Ellis, ‘Amok’, pp. 337–8.

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worked, and ‘he had finally come to the conclusion that it was lack of work which drove his son to frequent fits’; he thus gave Zurabin his permission to join friends and enter a kibbutz at Rosh Pinah. It was from this kibbutz that he and his co-defendants launched their attack in April 1938. The father ended his testimony by recounting the family’s unhappy history of mental illness: his mother-in-law was ‘a confined lunatic, as was his brother-in-law who became so after a sudden attack during a train journey’; his sister-in-law ‘had been abnormal for over twenty years’; he himself had been admitted to a mental home in Poland.100 If the testimony given by Zurabin’s father highlights the role families might play in giving evidence for mental incapacity in these trials, on the fifth day of the trial, expert medical witnesses were summoned to testify before the court too. Dr Heinz Hermann, superintendent of the Ezrath Nashim mental home, testified that Zurabin, who had been under his supervision for a time a few years earlier, in 1936, suffered from schizophrenia – or, as the Palestine Post put it, in terms which would have been more familiar to its Anglophone audience, dementia praecox. Hermann gave a brief explanation of this condition to the court. ‘The disease’, he explained, ‘was a lack of coordination between the feelings and expressions of the patient.’ Hermann had visited Zurabin in Acre prison earlier in May, together with his colleague Professor Mayer, and ‘found his condition to be one of latent insanity’, a term which Hermann did not elaborate directly. Asked to explain his behaviour, Zurabin told them ‘he had a special mission to fulfil’. In the court, Hermann gave his opinion that ‘at the time of the commission of the crime the accused did not know the difference between right and wrong’, a direct nod to the criminal code’s definition of insanity. While Malouf and others gave similarly precise testimonies to criminal courts in this period, what is notable in this case is that both medical witnesses were cross-examined by the prosecution – Captain J. K. A. Robertson – and that an account of this cross-examination exists in newspaper accounts of the trial. Among other things, Robertson pressed Hermann on the delusions suffered by Zurabin: ‘If the supposed act took place under a delusion’, asked the prosecutor, ‘would you say that this delusion went so far as to supposing that there was no bus on the scene at the time of firing?’ The witness answered, ‘Not necessarily’, and added that if a person thus afflicted was under the delusion of an enemy being present or some person intending to do him injury, he would be able to recognise the presence of a

100

PP, 29 May 1938, p. 2.

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bus; or, as a result of some futile idea of some imaginary mission, he would be prompted to perform ‘a symbolic act’.101

Professor Mayer, the second expert witness summoned to testify in court, agreed with Hermann. He too was ‘of the opinion that [Zurabin] was not mentally responsible for his actions which resulted from hallucinations and a diseased mind’. Robertson pressed him on this point in a short back-and-forth: ‘Do you consider’, asked the prosecutor, ‘that this boy who acted in such a way did so out of an uncontrollable impulse?’ ‘It was not an uncontrollable impulse, rather a delusion.’ ‘Was this delusion such that he was convinced that his mission was to shoot Arabs?’ ‘Yes, to shoot, but not necessarily Arabs.’102

In his closing speech, the defence submitted that Robertson had failed to challenge the testimonies of the two expert witnesses, which in spite of his efforts to draw them into discussion of impulses rather than delusions, remained carefully calibrated to fit the requirements of the criminal code. In his own summation, however, Robertson adopted a different angle of attack. As well as pressing Hermann on the nature of Zurabin’s delusions, he had also asked about the nature of his condition more generally. Was it hereditary? Was it incurable? Hermann had answered that while hereditary, the condition was not necessarily incurable, and that ‘[a] change from city life to a healthy outdoor environment would improve such a patient’s condition’. In his closing argument, Robertson took aim at both this and Zurabin’s father’s testimony ‘that the cause of the insanity was his son’s being out of work’. ‘That cause’, Robertson contended, ‘was removed with the son’s work at Rosh Pinah’; he went on to cite ‘letters of the accused to his father in which he mentioned his satisfaction at being in the colony with friends and in a pleasant environment’.103 In spite of his best efforts, however, Robertson failed to convince the court, and Zurabin was found insane and detained as a criminal lunatic. Shortly after the verdict was handed down, it was reported that he had suffered fits while in Acre prison, and had been removed to the hospital ward for care.104 His insanity defence had been supported by the breakdown in his health over the course of the trial, the testimony of his father, a family history of mental illness, and the precise

101

PP, 31 May 1938, p. 2.

102

Ibid.

103

PP, 6 June 1938, p. 7.

104

Ibid.

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testimony of two expert witnesses – a mutually reinforcing and ultimately incontestable set of evidence, even at this time of emergency. While the focus of the trial was Zurabin’s mental condition, he was not the only defendant. His co-defendants, Abraham Sheen and Shlomo ben Yusseff, were found guilty by the court, and sentenced to death. Before a packed courtroom, the counsel for the defence entered a final plea in mitigation on the grounds of the impressionability of the two defendants as little more than young boys. ‘He referred to the acts of terrorism, the brutal attacks and assaults, and the damage to life and property’, and was quoted as saying: ‘Small wonder that these boys could not maintain their equilibrium of mind. Whatever they did may be described as a manifestation or childish prank of unbalanced minds.’ He went on to refer to the testimony of expert witnesses ‘who stated that Zurabin could influence young and other people within his circle, by suggesting that it was right to do what was wrong’.105 Similar arguments were repeated the next day by the Orthodox chief rabbi of Jerusalem, Yosef Tzvi Dushinsky, in an appeal to military authorities. He too emphasised both the young age of the defendants, and ‘[t]he pressure of the two years’ continued disorder and attacks on Jews on the psychology of youths and light-minded ones’, and urged the authorities to ‘take special account of the events which took place on the spot of the crime just a few days prior to the event of the crime’, such as an incident where a bomb was thrown at the home of a Jewish farmer in Rosh Pinah. Dushinsky pleaded for the authorities to commute the capital sentence, on the grounds that these ‘extraordinary psychological causes must have undermined Jewish morality of these light-minded youths’.106 While one of the defendants was ultimately given a reprieve on the grounds of his youth, the other was executed. The pleas that they were impressionable and susceptible to bad influences echoed a wellestablished framing of disturbances in terms of the excitable Arab crowd, whipped up by the press and elites. But neither served exculpatory ends. Just as a criminological framing of disturbance had gone hand-in-hand with the imposition of collective punishments rather than individual reprieves, so too did pleas about the susceptibility of these defendants fail to dislodge their sentences. One had applied exclusively to Palestinian Arabs; the other concerned European Jews, whose supporters indeed explicitly distinguished them from the Arab culprits responsible for the violence engulfing Palestine. Yet they were ultimately similar in 105 106

Ibid. Chief Rabbi Dushinsky to Military Commandant of Palestine, Jerusalem, 7 June 1938, MECA JEM 61/3.

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their results: susceptibility did not in the end amount to much in the courtroom, because to concede that the violence afflicting Palestine constituted grounds for attenuated legal responsibility would have eroded the functioning of the courts almost entirely. As a result of the efforts of the defence and others, the Rosh Pinah case brings this logic to the surface. The argument that the ‘exceptional’ levels of violence which plagued Palestine and made it impossible for boys like Zurabin’s peers to grow up ‘normally’ – that is, with balanced minds or a clear idea of right and wrong – came undone by the fact that this ‘exceptional’ violence was, in fact, commonplace: it was the ‘normal’. To decide and define the exception in this way would have been to set vast tracts of behaviour out of reach of the mandate’s courts, just as the chief justice in Naomi Schmidt’s trial a few years earlier had feared, and at a time when the court’s jurisdiction had already been sharply curtailed by the operation of military courts. In cases like that of the Rosh Pinah shooters, the court decided that the law had to deter individuals from acting on impulses which were illegal but in some way normalised given the circumstances of their lives. Moments of ‘disturbance’, anti-colonial revolt, and colonial counter-insurgency were more than simply opportunities for colonial psychiatrists and non-specialists alike to pathologise dissent. These circumstances also pressed in on the space of the courtroom and the law, and shaped the determination and definition of responsibility, criminality, and insanity – with sometimes life-or-death consequences for defendants.

Conclusion The number of trials in which insanity defences were successfully made was small across most of the mandate period. For most of the 1930s, the number of criminal lunatics – those found guilty but insane by the courts – hovered below thirty at any one time. These figures rose dramatically in the 1940s as the result of a deceptively minor change to the law: in 1940, a new ordinance was passed that handed magistrates presiding over the lowest rung of the court system the power to intern criminal lunatics. This led to the number of criminal lunatics surpassing one hundred by 1943.107 Yet even with this rise, and bearing in mind those cases in which insanity defences were ultimately rejected by the courts – think of Naomi Schmidt and Fatima bint Issa Shalbak – the question of criminal insanity was not, in quantitative terms, particularly 107

Director of Medical Services to Chief Secretary, 23 March 1945, ISA M 4087/5.

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significant. In focussing on just a small number of exemplary trials in which insanity defences were raised, this chapter has sought to underline the point that the importance of these trials is not captured by the frequency of their occurrence. Even a single case raised weighty questions about responsibility, criminality, and insanity. Sometimes the stakes were made explicit, as in the trial of Naomi Schmidt, when the integrity of the judicial system as a whole appeared to be at risk. In other cases, what was at stake – a particular representation of the Palestinian peasantry, in the case of Fatima bint Issa Shalbak, or of the nature of ‘disturbance’ itself, in the case of Shalom Zurabin and his codefendants – was more submerged, and entangled with other bodies of knowledge, including folklore research and official investigative commissions. And these cases, but particularly those involving European Jewish defendants, drew attention from the press and public – sometimes of a scurrilous or voyeuristic nature, as is particularly notable in the case of Joseph Denishensky with which this chapter began. Having examined these trials – the legal framework in which they took place, the arguments made and bodies of knowledge press-ganged into their service, their embeddedness in wider legal, psychiatric, and political contexts – a significant question remains: what happened after these trials were concluded, and defendants found guilty but insane? These socalled criminal lunatics were to be detained at the pleasure of the High Commissioner, according to the law, but the law did not set out where or how this detention should take place. Even in the Denishensky case – an exemplary case in the sense that it proceeded remarkably straightforwardly – this was an open question. Shortly after his trial was concluded, then, the chief justice wrote to the High Commissioner to recommend that Denishensky be detained not at the criminal lunatic section of Acre central prison, but rather at a private Jewish mental institution, where Dr Malouf had suggested that he might, with proper care and attention, recover.108 Denishensky’s brother agreed to cover the fees for his treatment at the Ezrath Nashim mental home in Jerusalem, and he was admitted shortly afterwards, with no further issue.109 Just as in the trial itself, legal official, psychiatric expert, and family were in agreement and played their respective roles without fault or fuss. Yet here too, the straightforwardness with which the Denishensky case was resolved is exceptional: very rarely were families willing to cough up the money necessary to secure criminally insane relatives a place in private mental hospitals rather than the criminal lunatic section of the mandate’s prison 108 109

Chief Justice to High Commissioner, 7 January 1944, ISA M 349/56. A. Denishansky to Inspector-General, 10 May 1944, ISA M 349/56.

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system; more commonly, the question of who should be responsible for criminal lunatics provoked bitter arguments between different branches of the mandate government and families. Releasing criminal lunatics was even more fraught. While this chapter, then, explored one question of responsibility – namely, in the courts, of the insane – the next chapter takes us out of the courtroom to open up a second question of responsibility, and the fractures it engendered across state and society alike – that is, the question of responsibility for the criminally insane.

5

Getting In and Getting Out of the Criminal Lunatic Section

In April 1941, John Macqueen – deputising for the director of medical services while he served as wartime controller of supplies – drew attention to an alarming, albeit anticipated, development. At the start of 1940, there had been fewer than thirty criminal lunatics in mandate Palestine. Many of them, as we saw in the last chapter, had been brought before the mandate’s higher-level courts on serious charges like murder and attempted murder, and had been found guilty but insane and thus detained at the pleasure of the High Commissioner at the lunatic sections set aside for men at Acre central prison and for women at the Bethlehem women’s prison. The number of criminal lunatics had hovered around this point for years, but in 1940, the situation changed dramatically. Twenty new cases had been detained in just eleven months, leading to serious overcrowding in the criminal lunatic wards; a further twelve followed between November 1940 and April 1941, when Macqueen raised the alarm. Macqueen had no doubt about the cause of this unprecedented and unwelcome increase in the number of criminal lunatics: the culprit was an ordinance amending the jurisdiction of magistrates’ courts in 1939, which had empowered magistrates presiding over the lowest courts in Palestine’s legal system, and dealing largely with petty civil and criminal disputes, to order the detention of criminal lunatics.1 To illustrate just how directly this amendment had affected criminal lunatic numbers, he observed that nineteen of the twenty new cases from 1940 had been sentenced by magistrates making use of their newly expanded powers. The amendment’s impact went beyond simply increasing numbers. It was also, Macqueen continued, driving a transformation in who the criminal lunatic was, and why they were detained. Closer examination of these nineteen new cases had revealed that ‘they had been detained for offences which any mentally unbalanced person would commit on the 1

For these provisions, see Article 19 of the Draft Ordinance regarding the Jurisdiction of Magistrates’ Courts, published for information in the Palestine Gazette (20 July 1939), pp. 743–51.

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mildest provocation’ – offences such as trespass, theft, and assault – and that while many were judged fit to return home, ‘in almost no case has it been possible to induce their relatives to take them back’.2 Taken together, these details raised a disturbing possibility: that families were deliberately arranging for their mentally ill relatives to be brought before these newly empowered magistrates’ courts in order to relieve themselves of responsibility for caring for them. Macqueen could provide anecdotal evidence taken from his own experience in support of this. A former patient from one of the government mental hospitals had suffered a relapse, but had been refused readmission – not an uncommon outcome at a time when the waiting list for a bed in a mental hospital surpassed three hundred.3 Her relatives had come to speak with Macqueen, hoping to reach an agreement, but ‘indicated that if I could not find a bed for her they would deal with the matter in their own way and that that would not be by paying for her in a private institution’. ‘Three weeks later’, Macqueen continued, ‘she was in the female criminal lunatic prison at Bethlehem.’ If no change to the law were enacted, he feared that ‘all of the three hundred odd mental patients on my waiting list will become inmates of our prisons at no very distant date.’4 His warning was prescient: by 1943, the number of criminal lunatics had already surpassed one hundred.5 While those serious cases examined in the previous chapter raised concerns in the colonial courtroom about insanity being used to enable criminals to escape the law, the more minor cases which came to flood the system after 1940 activated a very different set of anxieties: officials from across the mandate’s health department, prison service, and increasingly established social welfare department worried that in these cases criminality was being exploited by families to allow lunatics to bypass long waiting lists and access institutional provision. The inadequacies of this provision, which were sharply exposed in a report on the Acre criminal lunatic section in 1946, might naturally bring to mind historical sociologist Andrew Scull’s famous description of the Victorian asylum as a ‘convenient place to get rid of inconvenient people’.6 Rather than viewing these individuals as simply falling between

2 3 4 5 6

John Macqueen for Director of Medical Services to Chief Secretary, 5 April 1941, ISA GL 16648/10. Annual Report, Department of Health, 1939, p. 73. John Macqueen for Director of Medical Services to Chief Secretary, 5 April 1941, ISA GL 16648/10. Director of Medical Services to Chief Secretary, 23 March 1945, ISA M 4087/5. Andrew Scull, ‘A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum’, in A. D. King, ed., Buildings and Society: Essays on the Social Development of the Built Environment (London: Routledge, 1980), pp. 37–60.

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the gaps in provision, this chapter foregrounds instead how social abandonment was – to borrow the resonant words of anthropologist João Biehl – ‘forged in the unaccounted-for interactions of family, psychiatry, and other public services’.7 Zooming out from the colonial courtroom, this chapter traces the trajectory of the criminal lunatic, from the circumstances that surrounded their initial detention, through their experiences of institutionalisation, to the difficult process of being discharged. At each stage, a range of actors from across colonial state and society attempted to shape these trajectories, entering into complex, sometimes contentious negotiations in order to do so. While in many instances entry into the criminal lunatic section certainly marked a kind of ‘terminal exclusion’,8 attending closely to the interactions which surrounded these cases also reveals the limits of abandonment as a framing for this history, with some families attempting to make use of institutionalisation for quite different reasons. As well as examining the manoeuvring of families and officials around the figure of the criminal lunatic, this chapter also seeks to recover some sense of how these individuals themselves understood and experienced institutionalisation as criminal lunatics, in particular through a careful reading of their ‘delusions’. This is possible thanks to the remarkable survival of case files relating to criminal lunatics, a survival which might itself be understood as an artefact of the way in which these cases fell within the purview of multiple branches of the mandate government and generated as a result a voluminous as well as durable paper trail within the colonial archive. These files, which include examination reports made by prison and medical officers as well as correspondence from patients’ families, provide an invaluable window into the criminal lunatic section for men at Acre in particular; much less survives about the criminal lunatic section for women at Bethlehem. Richly individual in spite of the standardising impulses of their genre, these files – set alongside the more impersonal reports and government correspondence about the workings of criminal lunatic sections and their processes of admission and discharge – offer often striking insights: into the family dynamics which first brought these cases to the notice of the criminallegal system; into the experiences and sometimes self-understandings of the people institutionalised as criminal lunatics, and contestations over the nature of their condition and the possibility of ‘cure’; and finally into

7 8

João Biehl, Vita: Life in a Zone of Social Abandonment (Berkeley: University of California Press, 2005), p. 18. Ibid., p. 14.

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the fraught, improvised quality of the negotiations which surrounded their release.

Criminality in Question Concerns about families exploiting the criminal-legal system to relieve themselves of responsibility for mentally ill relatives predated the 1939 ordinance empowering magistrates’ courts to order the detention of criminal lunatics. These concerns had circled the criminal lunatic section almost since its creation. The first criminal lunatic section for men had been established as a wing of the central prison at Acre in 1929,9 following a long, bitter dispute across the 1920s between the department of health and the department of police and prisons about whether those found ‘guilty but insane’ by the courts should be detained in a prison or in the government mental hospital at Bethlehem. Resisting calls for these cases to be admitted to Bethlehem, the director of health, George Heron, had argued the admission of criminal lunatics – necessitating, among other things, the stationing of prison wardens to ensure they did not escape – would lead to the institution ‘developing on the lines of a gaol and not of a hospital’, so militating ‘against the proper evolution of the hospital as a place for the treatment of disease’.10 In the early 1930s, a second criminal lunatic section, this time for women, was established as a separate wing of the Bethlehem women’s prison,11 after the plight of female criminal lunatics – and female prisoners more generally – was taken up and championed by the government welfare inspector, Margaret Nixon. Starting in January 1931, Nixon submitted a series of shocking reports evidencing the unsuitability of prison accommodation for the relatively small number of female criminal lunatics at the Bethlehem women’s prison. Not only was prison the wrong place for these women, who had been charged with offences like ‘disturbances of the peace’, ‘indecency’, and so on ‘simply because the poor women do not know what they are doing’, but the behaviour of the women within the prison was extremely disturbing, too.12 Nixon described how one woman in particular, Sarwi S. of Nazareth, who was awaiting trial for 9

10 11 12

The plan was approved in 1928: see Eric Mills, Acting Chief Secretary, to Director of Public Works, 7 May 1928, ISA M 6628/9. But alterations were ongoing well into 1929, preventing admission until late that year: Medical Officer, Haifa, to Director of Health, 17 September 1929, ISA M 6628/9. Director of Health to Chief Secretary, 13 November 1931, ISA M 6628/9. Chief Secretary to Commandant of Police and Prisons, 28 January 1932, ISA M 6628/10. Margaret Nixon, Government Welfare Inspector, to Chief Secretary, 4 March 1931, ISA M 6628/9.

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theft, was in urgent need of transfer to a mental hospital for proper treatment: she was ‘raving mad, tears her clothes and her bedding to pieces, breaks everything she can get hold of, shouts all day and all night, so that the other prisoners get no peace’.13 The impact on other prisoners was so severe that in March 1931, the women prisoners at Bethlehem penned a remarkable petition to the government urging them to remove a particularly loud lunatic from the prison, and begging them ‘not to convert the prison into a home for the insane’.14 Almost as soon as these criminal lunatic wards opened, families were reported to put them to unforeseen – and in the view of the mandate government inappropriate – use. As early as 1932, the commandant of police and prisons warned that a severe shortage of beds in mental hospitals and long waiting lists were leading the families of the mentally ill to ‘turn them out into the streets or trump up charges against them in order to get rid of the responsibility of looking after them’.15 By 1936, the director of health too was concerned about the way families appeared to use criminal charges to relieve themselves of responsibility for difficult relatives, and engineer their admission into government institutions through the back door. Writing to one senior medical officer about a seemingly urgent case, in which a woman’s transfer from prison to a government mental hospital had been requested, he urged caution: ‘relatives and persons responsible for the care of mentally unsound persons frequently attempt to get those persons admitted to the mental hospital by having them committed to prison in the first instance’.16 At issue was not the authenticity or indeed acuteness of her condition; in this instance, it so happened that the woman under discussion had previously been admitted to the government mental hospital and diagnosed with acute mania. Rather, it was her criminality which was in question, not least because the charge against her was minor – giving false evidence.17 If at least some families appeared to contrive the institutionalisation of relatives on minor charges before 1940, it is clear this was a far from

13 14

15 16 17

Margaret Nixon, Government Welfare Inspector, to Commandant of Police, 15 January 1931, ISA M 6628/9. Petition from ‘The Political Women Prisoners in the Bethlehem Prison’ to Commandant of Police and Prisons, enclosed with letter from the Commandant to Chief Secretary, 23 March 1931, ISA M 6628/9. Commandant of Police and Prisons to Chief Secretary, 13 August 1932, ISA M 6628/10. Director of Medical Services to Senior Medical Officer, Jerusalem, 20 February 1936, ISA M 6627/28. Medical Officer, Government Mental Hospital, Bethlehem, to Senior Medical Officer, Jerusalem, 8 February 1936, ISA M 6627/28.

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certain route to the asylum, hinging on the hope that once imprisoned their relative’s condition would be detected and deemed significant enough to warrant transfer to a mental hospital. Once the 1939 ordinance empowered magistrates to order the detention of criminal lunatics even on the most minor charges, this path to a mental institution was made considerably more straightforward and predictable. As a result, as Macqueen observed, the number of families apparently availing themselves of this option rose dramatically. From just thirty-one at the start of 1940 to over a hundred by 1943, the number of criminal lunatics detained at Acre and Bethlehem’s lunatic sections more than doubled in a few years, necessitating the expansion of both sections: at Acre, a former police station attached to the central prison had to be converted to accommodate the many new detainees, while at Bethlehem, a large extension of the government mental hospital set aside for female criminal lunatics was completed around the end of the Second World War.18 The number of criminal lunatics, and the route by which many reached the criminal lunatic sections, came under particularly strong criticism in the most extensive report produced about this issue during the mandate period. In May 1945, Dr Kurt Blumenthal, a German Jewish psychiatrist who had arrived in Palestine in 1933 and set up a popular private clinic on Mount Carmel in Haifa, began making weekly visits to Acre criminal lunatic section at the request of the government. Over the course of a year, Blumenthal examined over a hundred patients and took notes on conditions in the section, submitting his observations to the department of health in a lengthy report early in 1946. While his report can be understood within a long-established tradition of prison inspection, stretching back to at least the 1920s in Palestine,19 it is unique in providing such a detailed account of the functioning – or, as Blumenthal presented it, dysfunction – of a mental institution in mandate Palestine. No similar report, for instance, was ever produced for the female criminal lunatic section at Bethlehem. One of the areas which came under particular criticism in the report was admissions. Blumenthal was appalled by the number of criminal lunatics in Palestine, a point he underlined by means of a comparison: in Britain, there were 1,000 criminal lunatics in a population of 40 million; in Palestine, there were 142 criminal lunatics in a population

18

19

Memorandum relating to the disposal of criminal lunatics prepared by the Inspector General, A/Director of Medical Services, and Adviser on Social Welfare, for Chief Secretary, 24 June 1944, ISA M 320/13. Orna Alyagon Darr and Rachela Er’el, ‘The Conflicting Uses of Prison Visitation in Mandate Palestine’, Law and Social Inquiry 47, 3 (2022), pp. 920–45.

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of just 1.5 million. ‘[R]eception in the lunatic section in Palestine’, he wrote, ‘takes place in a much wider degree than in Great Britain.’20 This was a consequence, he argued, of the failure of the mandate to provide adequate accommodation for the mentally ill, which led to the following ‘special peculiarities’: A mental defective interferes or threatens his surroundings. The neighbours report the occurrence to the police. The police reply that one should refer to the health department. The police can only take action when a crime exists. The health department declines to transfer the patient to an asylum owing to lack of accommodation. A crime is thereupon arranged for. Furniture is destroyed; damage to property. Or a mother or sister are attacked; assault. In this way the patient obtains a bed in the lunatic section without waiting on the health department’s list. A large number of such arranged cases are familiar to me.21

As evidence of this practice, Blumenthal observed that by far the most common charge brought against the 118 individuals he had examined during his investigation was some form of assault; 52 of them had been detained on these grounds. ‘It may be pointed out’, Blumenthal continued, ‘that the principal group of assaults is often directed at members of the family and have no serious nature.’ The second most common group was damage to property, with 14 cases, and again Blumenthal noted ‘the relative harmlessness and triflingness of the criminal deeds … which is confined to throwing of stones at cars or damaging of furniture etc’.22 There were only, in his estimation, 18 ‘really serious cases’; that is, of murder, manslaughter, attempted murder, and arson. A similar pattern emerges across the files of nearly 70 criminal lunatics that survive in the colonial archive from the 1940s. Some had appeared in court on serious charges, including murder or attempted murder. But by far the majority had been charged with more minor offences: over 20 had been charged with assault, typically – just as Blumenthal observed – against family members; another 10 had been charged with disturbances of the peace of various kinds; and half a dozen with theft and trespass apiece. These patterns – both in the cases examined by Blumenthal and those extant in the colonial archive – do not, of course, give a direct indication of how far these crimes were being purposefully arranged by relatives and others in order to draw first criminal-legal and then medical attention. But digging deeper into the detail of individual cases, and stepping back to consider the broader context in which families made decisions about the management of difficult relatives, can provide further insight into the 20 21

Dr Kurt Blumenthal, Report on the Lunatic Section of Acre Prison, 1 February 1946, ISA M 351/41, pp. 9–10. 22 Ibid., p. 10. Ibid., pp. 2–3.

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dynamics at work. One of the most striking patterns which emerges out of a closer reading of individual case files relates to how these individuals’ trials unfolded. In a number of trials that took place before magistrates in both Jerusalem and Tel Aviv across the middle of the 1940s, the prosecution – rather than the defence – raised the question of a defendant’s mental capacity and, more than this, provided the evidence which resulted in a ‘guilty but insane’ verdict. Menahem G., detained as a criminal lunatic after breaking a window in Tel Aviv in early 1946, is a case in point. His lawyer appealed against the magistrate’s initial decision to detain him as a criminal lunatic on the grounds that in the magistrate’s court, it was the prosecution that had introduced evidence about the mental state of the defendant; the lawyer contended that ‘[i]nsanity is a defence and does not form part of the case for the prosecution’.23 If this case neatly captures how insanity ‘defences’ were weaponised by the prosecution in the magistrates’ courts, two further cases enable us to begin to excavate some of the motives behind such a seemingly irregular legal manoeuvre. Aron T. had been arrested for throwing stones at the windows of a house occupied by his wife in Jerusalem in August 1944. At his trial, Dr Heinz Hermann, director of the Ezrath Nashim private mental hospital, testified as an expert witness for the prosecution that Aron suffered from attacks of recurrent mania and could not be held responsible for his actions. His wife, Katherina, was also listed as a witness for the prosecution. Aron was found ‘guilty but insane’ by the magistrate and detained. But a month later, Katherina instructed her lawyer to petition the government to transfer her husband from prison to the Ezrath Nashim hospital in Jerusalem, where the family had already made arrangements for his reception with Dr Hermann.24 When the government failed to arrange for his transfer within a month, Katherina’s lawyer wrote again, this time on her behalf as well as her husband’s. In a dramatic escalation of their effort to secure Aron’s transfer out of the criminal lunatic section, the lawyer sought to have the verdict of ‘guilty but insane’ overturned on the grounds that the trial before the magistrate had been irregular in at least three ways: Aron’s wife was not competent to give evidence against him; the charge as laid was not an offence because the property damaged had been his own, rather than another’s; and finally, ‘[t]he insanity of an accused is not an offence but a defence, and can never be part of the case

23 24

I. Adereth, Advocate, Tel Aviv, to High Commissioner, 9 April 1946, ISA M 347/22. Herman Cohn, Advocate, Jerusalem, to Officer Administering the Government, 7 September 1944, ISA M 338/41.

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of the prosecution’, and therefore ‘[n]o evidence of insanity should have been adduced by the prosecution at all’.25 A plausible reading of this odd case is that Katherina, who had been willing to testify for the prosecution alongside Dr Hermann in the magistrate’s court, had sought to use the criminal charge of damage to property to leverage her elderly, unwell husband – who, as one medical report put it, ‘mistrusts all the members of his family, mainly his wife’26 – into a mental institution against his wishes. If she had hoped that it would be relatively straightforward to arrange for her husband’s transfer into Dr Hermann’s care at the Ezrath Nashim hospital once he was detained, however, she was swiftly disabused of this belief. In the face of difficulties in arranging his transfer, and in view of the conditions her husband endured at Acre in the meantime – where, in spite of his age and poor health, ‘he is not even given a bed to sleep on and is not allowed to wear his own clothes’27 – she seems to have come to regret her strategy and, panicking, fought to have the initial judgment overturned as irregular. Ultimately, however, her plan appears to have worked; it just took slightly longer than anticipated. In December, months after Aron was first detained for throwing some stones at his own property, he was finally transferred out of the criminal lunatic section, having ‘promised of his own free will to undergo detention at the Ezrath Nashim mental hospital, Jerusalem, for the purpose of recovery’.28 Mandate officials worried that families were exploiting the expanded powers of magistrates to rid themselves of responsibility for mentally ill relatives. Certainly, the failure of the government to provide adequate accommodation for the mentally ill in hospitals pushed some to this desperate but rational stratagem, at a time when wartime inflation and scarcity made it less and less viable to continue to care for relatives at home.29 But these cases were not always straightforwardly, if at all, about abdicating responsibility; they do not all fit a model of abandonment. In some instances at least, criminal charges were an attempt to gain leverage over relatives by harnessing the power of the courts within the context of complex family struggles. While this is a plausible reading of the case of Katherina, who seems to have seen in the courts a chance to pressure her suspicious husband into treatment, these dynamics are explicit in another case.

25 26 27 28

Ibid. Record of Medical Examination, No. 214, Acre, 10 October 1944, ISA M 338/41. Herman Cohn, Advocate, Jerusalem, to Officer Administering the Government, 7 September 1944, ISA M 338/41. 29 Ibid. For scarcity, see Seikaly, Men of Capital, pp. 127–54.

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In May 1945, Muhyi al-Din I. of Jaffa wrote to the High Commissioner to request the release of his brother, Sa’ad al-Din, from the criminal lunatic section at Acre. Muhyi al-Din explained that he had quarrelled with his brother in February 1945, and when his brother ‘insulted’ him – other reports suggest he had actually ‘assaulted’ him – Muhyi al-Din reported him to the police station at Jaffa. ‘I have raised this case against him’, Muhyi al-Din wrote, ‘in order to have him more polite and lest he tries to commit such mistakes in future.’30 A report drawn up at Acre criminal lunatic section makes the context of this incident clearer. Sa’ad al-Din had taken a job as a porter during the war, but low pay, difficult work, and the prospect of finding a more lucrative job with which to help his brother in providing for the needs of their large family, which included a widowed sister with five children, all led him to resign from his post. His brother had objected, however, resulting in ‘a very bitter quarrel’.31 But when Sa’ad al-Din was sent to Acre criminal lunatic section and months elapsed without him being discharged, Muhyi al-Din appears to have regretted involving the criminal courts in this family conflict. Having visited his brother in the criminal lunatic section, and spoken with the medical doctor, he wrote to request his brother’s discharge. He was of sound mind, he explained, so ‘no benefit could be acquired by keeping him at that place’. More than this – and, it seems, more importantly from Muhyi al-Din’s point of view – ‘I have excused him’, he wrote.32 Months later, Sa’ad al-Din was recommended for discharge.33 Katherina and Muhyi al-Din may have been atypical in that they appeared to come to regret their decision to involve the courts in family disputes. There were plenty of families whose lack of action might be taken to suggest that they stood by their decision to bring criminal charges against mentally ill relatives; as we will see, there were also many who refused to resume any responsibility for relatives when approached about arrangements for their discharge. But these cases, atypical in some respects though they may have been, reveal something of the way in which families by the 1940s had come to apprehend the colonial court system – and in particular the lowest court within that system, the magistrate’s court – as a resource which might be tapped to resolve problems and assert control within the family itself. On the surface, it may seem extraordinary that Palestinians – Jewish and Arab – made such 30 31 32 33

Muhyi al-Din I., Jaffa, to High Commissioner, 11 May 1945, ISA M 344/35. Record of Examination, No. 104, Acre, 27 March 1945, ISA M 344/35. Muhyi al-Din I., Jaffa, to High Commissioner, 11 May 1945, ISA M 344/35. Inspector General of Police and Prisons to Chief Secretary, 1 August 1945, ISA M 344/35.

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use of the criminal courts in the 1940s: Palestinian Arabs during the great revolt and Jews following the 1939 White Paper restricting immigration to Palestine had both borne the brunt of laws they perceived as illegitimate. But zooming out from a focus on criminal lunatics to consider other ways in which the law could be leveraged within the family suggests that such a use of the courts may have been less exceptional than it first appears, particularly where generational tensions were involved. Though generational dynamics were apparent in neither the case of elderly husband-and-wife Aron and Katherina, nor the brothers Muhyi and Sa’ad al-Din, the statistics which Blumenthal compiled as part of his report are suggestive in this regard. Of the 118 cases at Acre criminal lunatic section which Blumenthal examined, almost half were under the age of thirty. The single most populous age bracket was between twenty and twenty-five, with 27 patients; this was followed closely by those between twenty-six and thirty, at 24.34 And Blumenthal was only recording patients’ ages in 1946, rather than their age at admission. Given that more than two-thirds had been at the hospital for over a year by the time he examined them, the age at which many were admitted would have been lower still, something that is evident in the case files. Khadder K., for instance, had been just fifteen years old when he was charged with the assault of two female relatives as well as damage to property, and sentenced to detention as a criminal lunatic by the Jerusalem magistrate’s court in May 1947.35 In one sense, the youthfulness of the population of the criminal lunatic section should not be surprising: well over half the cases examined by Blumenthal were diagnosed with schizophrenia, a condition which typically presents during the period of late adolescence and early adulthood.36 But a purely epidemiological perspective does not help us understand how these young men came to be institutionalised in a criminal lunatic section specifically, or the wider context in which their families weighed up different options for managing ‘difficult’ younger members. The youthfulness of the criminal lunatic section should also, then, be approached in relation to the growing sense of crisis surrounding ‘youth’ more widely in the interwar decades. As in semi-colonial Egypt around the same time, this sense – of youth as both possibility and peril, to borrow Omnia El Shakry’s redolent framing – was fuelled in part by 34 35 36

Blumenthal, Report on the Lunatic Section of Acre Prison, pp. 3–4. He also recorded two cases under the age of twenty. Ahmad K., Jerusalem, to High Commissioner, 9 July 1947, ISA M 351/24. This was an association well established at the time: Hermann, in the 1931 census report, had identified individuals between eighteen and twenty-five as most at risk of schizophrenia. See Mills, Census of Palestine, p. 231.

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the dramatic arrival of an educated younger generation onto the stage of politics by the early 1930s.37 And these anxieties around youth found expression in the elaboration of both a discourse of ‘juvenile delinquency’, and a set of criminal-legal and social welfare practices for managing this problem. To begin to more fully contextualise criminal insanity against the generational dynamics of the 1930s and 1940s, a return to fifteen-year-old Khadder is instructive. According to a medical report from July 1947, he had been receiving treatment from a series of mental specialists including Dr Malouf, Dr Hermann, and others across the four years prior to the incident which saw him brought before the court. But he had also reportedly spent two weeks in a government reformatory school, and when it came to making a recommendation on his case, the medical board examining him suggested that on account of his age he should either be admitted to a reformatory school or mental hospital, and only failing that, the criminal lunatic section at Acre.38 Khadder was unusually young, and the reformatory – for juvenile offenders, defined as aged between nine and eighteen39 – would not have been an option in the vast majority of criminal lunatic cases. But the very direct reference made to it in Khadder’s case nonetheless serves to draw attention to the more subtle ways juvenile delinquency may have shaped the context in which families ultimately came to use criminal insanity defences to manage unruly younger relatives. Across the mandate period, ever increasing numbers of juvenile offenders were sent to the government’s reformatory institutions, and these institutions in turn multiplied and evolved. From 1919, the department of police and prisons operated a reformatory school at Tulkarm, the Howard Home, for boys charged with criminal offences. In the early 1920s, this reformatory took in around 20 juvenile offenders;40 a decade later, over 80 boys were being admitted over the course of a year.41 By the early 1940s, there were four different institutions, which were now run by the department of education, tracking a broader shift in approach towards juvenile offenders from punishment to rehabilitation.42 And the number of 37

38 39

40 41 42

El Shakry, ‘Youth as Peril and Promise’. For an account of the emergence of the youth and particularly students as political actors in 1930s Palestine, see Matthews, Confronting an Empire, Constructing a Nation. Record of Examination, No. 55, Acre, 3 July 1947, ISA M 351/24. For the construction of the ‘juvenile delinquent’ in law, see Julia Shatz, ‘Governing Global Children: Child Welfare in Palestine, 1917–1950’ (PhD diss., University of California, Berkeley, 2018), p. 92. See also Razi, ‘Immigration and Its Discontents’. Report on the Palestine Administration, 1923 (London: HMSO, 1924), p. 32. Annual Report of the Probation Officer for Palestine for 1934, ISA M 272/19, p. 3. Report of the Committee on Development and Welfare Services, 1940, ISA P 4187/10, p. 126.

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institutionalised juveniles had risen dramatically. At the end of 1943, 135 Arab boys under the age of fourteen were at a reformatory school at Bethlehem; 67 older Arab boys were at a special camp at the government stock farm near Acre; 41 Jewish boys of all ages were at a reformatory at Rishon LeZion; and 11 girls ‘of both races’ were at a separate reformatory at Bethlehem.43 Elsewhere in the British empire, one of the reasons behind comparable increases in the number of institutionalised juvenile offenders was uptake of these systems among families. Case records from colonial Ghana from around this period, for instance, reveal how parents petitioned for their children to be institutionalised when other strategies for managing their unruly behaviour failed.44 But in mandate Palestine, it is hard to identify a parallel turn to reformatories by desperate parents. Instead, those petitions which do survive among juvenile offender files in the archive are typically calls for clemency, pleading for children’s release rather than admission. The case of Saleh K. illustrates this. In early 1946, Saleh was caught trying to steal bananas from a truck in Jaffa. He had three previous convictions for similar offences, and had been placed on probation each time; so when he appeared before the court this time, the magistrate sentenced him to three years in the Bethlehem reformatory.45 In the following months, his father repeatedly wrote to the government, petitioning them to release him. ‘I became an old man’, he explained, ‘unable to support my family which count ten persons and nobody is helping them except me’. It was on these grounds that he urged the government to ‘[free] my son from the prison for he can assist me that we can both of us meet the high expenses of living’.46 The argument made by Saleh’s father suggests one reason why there was no direct parallel between how families acted in juvenile delinquency cases and how they behaved in criminal insanity cases: while criminal lunatics were presented as a burden on the family’s resources at a time of scarcity and economic difficulty in the 1940s, juveniles were seen as potentially contributing to the family – even through acts of petty theft, as in the case of Saleh and his bananas. Another reason for this difference is suggested by the detail of Saleh’s account. Saleh had been brought before a court three times on separate charges before he was finally sent to the reformatory. Even if a family did wish to relieve themselves of 43 44

45 46

Annual Report, Social Welfare Department, 1944, ISA M 130/66, pp. 7–8. Stacey Hynd, ‘Pickpockets, Pilot Boys, and Prostitutes: The Construction of Juvenile Delinquency in the Gold Coast [Colonial Ghana], c. 1929–57’, Journal of West African History 4, 2 (2018), p. 64. A/Director of Social Welfare to Chief Secretary, 12 August 1946, ISA M 348/27. Toma K., Jaffa, to High Commissioner, Jerusalem, 29 June 1946, ISA M 348/27.

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responsibility for a difficult younger member by having them sent to a reformatory, the route to institutionalisation was much less sure for juvenile delinquents – who were more likely to be placed on probation – than it was in cases where a criminal insanity defence was raised. Both economic rationality, then, and the unpredictability of this course of action meant that the law never represented the same kind of resource for parents of delinquent children as it did for the families of mentally ill youth. Although it did not form a direct parallel or alternative, juvenile delinquency mattered at another level, crucially shaping the context in which the generational dynamics of criminal insanity cases played out. As we saw in relation to families petitioning the government to admit relatives to mental hospitals in the 1930s and 1940s, the options that families were able and willing to pursue hinged on the knowledge available to them. This was true in cases of return migrants demanding what they had come to expect abroad, for instance, as in cases of more isolated communities which embraced institutionalisation once this was advertised to them.47 Arguably something similar was at work in this context, too. Over the 1930s and 1940s, ever greater numbers of Palestinian children – and, more particularly, boys – appeared before the courts charged with minor offences. Between 1932 and 1935, 2,190 boys were arrested by the police; this figure rose to 5,592 between 1936 and 1939; and 11,201 between 1940 and 1944.48 While relatively few arrests led to institutionalisation, they nonetheless will have served to normalise to a degree the incursion of criminal law into the home and, more particularly, its interposition within generational relationships. These cases will also have made families familiar with the idea that, under the right circumstances, a government institution could be leveraged into taking responsibility for their more troublesome members.49 While it might appear extraordinary, then, that families were turning to the courts to manage their mentally ill relatives across the 1940s, set against this backdrop there was in fact a kind of normality to it. The 1939 amendment empowering magistrates’ courts to detain criminal lunatics may have been put to unforeseen and unwelcome use by families. Yet in a sense 47 48 49

See Chapter 3. Annual Report, Social Welfare Department, 1944, M 130/66, p. 30. The suppression of the great revolt, which saw an estimated 264,000 detained by security forces between 1936 and 1939, will certainly have brought even more families face-toface with these processes of criminalisation, though not along generational lines in the same way. See Matthew Hughes, Britain’s Pacification of Palestine: The British Army, the Colonial State, and the Arab Revolt, 1936–1939 (Cambridge: Cambridge University Press, 2019), p. 247.

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the problem was doubly one of the government’s own making: most obviously in not providing sufficient beds in mental hospitals, which forced families to devise alternative strategies; and in engineering the relentless, remorseless encroachment of criminality into families and generational relationships throughout the preceding decade, which familiarised Palestinians with the possibilities as well as perils of engaging with the mandate’s criminal-legal system.

Diagnosis, Daily Life, and Delusions in the Criminal Lunatic Section The decision to accommodate male criminal lunatics at a special ward at Acre central prison, rather than at a government mental hospital, had been shaped by the director of health’s insistence that their admission would make the hospital resemble a gaol, and so blur the lines between the medical and the carceral. Yet accommodating the mentally ill in prisons was hardly uncontroversial. Across the 1930s and 1940s, there was concern that while this arrangement may have been protecting the medical space of the mental hospital from being contaminated by the more overt trappings of the carceral, it was also working in the opposite direction, and insulating the prison lunatic ward from medical influence. This anxiety is clear in a flurry of government correspondence from 1930, when the Secretary of State for the Colonies issued a circular stipulating that criminal lunatics ‘should be sent to a lunatic asylum’, and ‘should not be imprisoned with hard labour’.50 While criminal lunatics at Acre were not given hard labour to perform, they were also not sent to a ‘lunatic asylum’. There was a clear sense of nervous uncertainty in the reasoning offered by the government chief secretary in response to this circular that ‘if the accommodation so provided is separate from the prison proper it would not appear that objection would be taken to the arrangement but that it could be contended that the persons so accommodated were being detained in a lunatic section and not in a prison’.51 Turning as it did on a rather technical distinction, this reasoning did little to dampen criticism of the criminal lunatic section as an under-medicalised space across the rest of the mandate period – criticism that was particularly pronounced in Blumenthal’s report of 1946. Setting Blumenthal’s report alongside individual case files provides some support for this picture of inadequate medicalisation in 50 51

Circular from Lord Passfield, Secretary of State for the Colonies, 22 November 1930, ISA M 6628/9. Chief Secretary to Director of Health, 26 December 1930, ISA M 6628/9.

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relation to admission processes and the day-to-day lives of patients. But a careful reading of ‘delusions’ and other instances of patients’ voices being recorded in case files suggests that for some patients, at least, the problem was the opposite: over-medicalisation or medicalisation of the wrong kind, not under-medicalisation. Differences between the criminal lunatic section at Acre and government mental hospitals would have been evident in terms of practice and conditions from the moment of admission, and starkly so for patients who might themselves have had prior experience of the latter. Unlike at the government mental hospitals, where patients were preceded by their medical reports, examined once again on arrival, and even photographed for the purpose of record-keeping, individuals were often transferred to the criminal lunatic section without any accompanying papers, so that it sometimes took weeks ‘before any information is available about the patient’.52 This situation was aggravated further by a lack of cooperation on the part of the families of many criminal lunatics. Families, Blumenthal noted in his 1946 report, were key to understanding and treating psychiatric cases; they provided vital personal and family histories that could help shed light on the nature of a patient’s condition. Yet in many cases, it was difficult if not impossible to even make contact with patients’ families, resulting in frustrating gaps in knowledge. Blumenthal recalled one case, a man who had been found ‘guilty but insane’ after assaulting his mother and another person in December 1945 and transferred to the criminal lunatic section. He had been found insane on the basis of his behaviour in the courtroom alone, not the evidence of a medical expert or even family. When Blumenthal tried to follow up with the patient’s family in order to fill in these gaps, he found it impossible. The prison had no record of his family’s address, and a letter sent to an address provided by the patient was returned, undelivered. In the end, the family themselves took the initiative and made contact, but not until February – more than two months after his admission.53 This was far from exceptional. As Blumenthal explained, ‘[a] large proportion of the cases either do not receive any family visits or are destitute’,54 with families steering clear of visits out of fear that relatives might be discharged back into their care. While this complicated diagnosis and discharge, it also compounded the wider sense of isolation which engulfed the section. Without visits, and in the absence of newspapers or a wireless set, there were patients at Acre, Blumenthal noted, who only ‘learned of the end of the [Second World] war from the ringing of bells, 52 54

Blumenthal, Report on the Lunatic Section of Acre Prison, p. 11. Ibid., p. 3.

53

Ibid., pp. 5–6.

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but from lack of newspapers knew nothing of the details’.55 While Blumenthal was critical of these families for their failure to visit, it is worth setting his judgement alongside patient case files from the archive. Correspondence from families not only reveals a perhaps surprising number of visits to the lunatic section to check on relatives – indeed, we might here recall Muhyi al-Din’s trip to Acre to visit his brother, before he petitioned for his release – but also some of the obstacles which might prevent families from visiting, even if they wanted to. Mary O., for instance, a resident of Tel Aviv, wrote to the High Commissioner to ask that her son be transferred to the mental hospital near Jaffa in May 1945. She was, she wrote, ‘an old woman … without any means … and cannot afford to pay the transport nor can I travel at my age’.56 Further complicating the picture of neglect presented by Blumenthal, a number of patients simply had no family in Palestine. This was most obviously the case for many of the Jewish concentration camp survivors who arrived in Palestine across the 1940s; one such case, a refugee who had survived a concentration camp in Italian-controlled Libya but whose wife and sons had remained behind, was noted by Blumenthal.57 But there were others, too, whose families were not, for whatever reason, in Palestine itself.58 With or without cooperation from families, all patients in the criminal lunatic section were given a diagnosis. Well over half of the 118 cases which Blumenthal had seen were diagnosed with schizophrenia – though the prison records often used the older term, dementia praecox; a further 20 were judged to be ‘idiots’ or ‘imbeciles’, terms which at the time conveyed different degrees of intellectual impairment; there were also 9 patients with epilepsy.59 Though the proportion of cases diagnosed with schizophrenia might appear unusually high when set alongside figures drawn from elsewhere in the British empire in roughly the same period,60 it is in line with the breakdown of psychiatric cases generally in Palestine: in 1946, the same year as Blumenthal’s report, over half of all cases admitted to government mental hospitals, the Ezrath Nashim hospital, and Acre criminal lunatic section received this diagnosis.61

55 56 57 58 59 60

61

Ibid., p. 15. Mary O., Tel Aviv, to High Commissioner, 15 May 1945, ISA M 341/13. Blumenthal, Report on the Lunatic Section of Acre Prison, pp. 7–8. For example, see Yusuf M., ISA M 346/40, whose family were in Iran. Blumenthal, Report on the Lunatic Section of Acre Prison, pp. 1–2. For instance, at Zomba lunatic asylum in colonial Nyasaland in the mid-1930s, 35.7 per cent of inmates were given a schizophrenia diagnosis. See Vaughan, ‘Idioms of Madness’, pp. 229–30. Annual Report, Department of Health, 1946, table 8.

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More notable than the diagnoses reached by the prison medical authorities is the way in which these diagnoses were contested by families, as well as patients themselves. Subhi M. of Hebron, detained as a criminal lunatic after his arrest on charges of attempted sodomy in October 1943, offers an example of the former. He was diagnosed as suffering from schizophrenia ‘coupled with severe attacks of excitement and impulsiveness’,62 but his family offered a quite different reading of his condition. In a letter sent to the district officer of Hebron in September 1945, two years after Subhi was first detained, his father explained that while his son was ‘alleged to be insane, in fact he is suffering from epileptic fits due to his desire to see his family’; if he were to be released into the care of his family, he continued, this would undoubtedly ‘cure him from his epileptic fits caused by his absence’.63 This was how the translator of this petition rendered it, at least; in the original Arabic, the word epilepsy (al-sarʿ) was not used; instead, Subhi’s father wrote of nervous outbursts or fits (naubat ʿasabiyya).64 Though the rationale behind this translation is unclear, it seems significant that the translator chose to substitute epileptic for nervous: while the latter had clear associations with a new language of nerves and nervous systems, a language elaborated in the pages of scientific journals like al-Muqtataf since the late nineteenth century, the former was less clearly modern, and indeed closely associated with a folk belief in possession by jinn.65 The family offered their own interpretation of Subhi’s condition, perhaps hoping that in doing so they would be able to represent not just their son’s condition but themselves in a favourable way, as knowledgeable, suitable guardians who could be trusted with his care. But they had little control over the way in which this was mediated by government translators, and given new emphases. Not only families but patients put forward interpretations of their own conditions. In the medical examination reports attached to patient case files, their views are not infrequently recorded. Elicited under particular circumstances, and reaching us only as understood and crudely summarised by prison medical authorities, these nonetheless reveal something of how patients interpreted their circumstances. Some of the patients recorded in this way claimed to experience their illnesses not as mental but physical conditions. Salim S. expressed that ‘he feels depression of

62 63 64 65

Record of Examination, No. 285, Acre, 6 December 1946, ISA M 345/2. Translation of Sabbah M., Hebron, to District Officer, Hebron, 2 September 1945, ISA M 345/2. Sabbah M., Hebron, to District Officer, Hebron, 2 September 1945, ISA M 345/2. See, for instance, Stephan, ‘Lunacy in Palestinian Folklore’, p. 7.

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his chest, throat, abdomen, etc.’, ‘thinks to be physically ill, but of good mental condition’, and had ‘no insight to have been insane’;66 Solomon S. repeatedly asked to be transferred to a hospital in Jerusalem ‘so as to get cured from his imaginary chest disease’;67 Elhanan W. was described as labouring under ‘the effect of neurasthenic delusions that he suffers from heart disease which is not true’.68 In these cases, patient descriptions of physical ailments were treated as delusional. But these reports of physical pain are strikingly similar to what historians, medical anthropologists, and others have noted in relation to the expression of mental distress elsewhere. In the decades after the Second World War, Nigerian psychiatrist Thomas Lambo argued that colonial-era psychiatrists failed to diagnose many cases of depression because they had been unable to recognise its primary symptoms among Nigerians; rather than feelings of guilt, sadness, or shame, Lambo suggested Nigerians were more likely to present somatic complaints like burning and tingling sensations, pressure in the chest, or pain in the extremities.69 While the medical doctors at the criminal lunatic section did register and record these complaints of physical pain, they understood them as evidence of delusional insanity. A comparative perspective leads us to read these complaints differently, as offering insight into how mental distress was experienced and expressed by some individuals in mandate Palestine. Once admitted and assessed, what was daily life in the criminal lunatic section like for these patients? This question is particularly pertinent in light of one finding of Blumenthal’s report: that a majority of individuals remained in the criminal lunatic section at Acre for more than a year. Of 118 cases, just 17 had been in the section for less than a year. Many had been there for much longer: 34 had been in the section for more than five years, while 4 had been there for sixteen years – since its opening.70 Understanding conditions in the lunatic section assumes sharper significance still when we recall that many were young, with a majority under the age of thirty-five, and that dozens of Palestinians thus spent long years of their youth behind its walls – and behind the barbed wire which surrounded the section’s small exercise yard. As the barbed wire

66 67 68 69

70

Record of Examination, P/44, Acre, 3 May 1947, ISA M 334/25. District Medical Board Report, Acre, 14 December 1945, ISA M 6640/26. Record of Medical Examination, Acre, 16 March 1946, ISA M 334/27. Matthew Heaton, ‘The Politics and Practice of Thomas Adeoye Lambo: Towards a Post-colonial History of Transcultural Psychiatry’, History of Psychiatry 29 (2018), pp. 318–19. Something similar has been observed in contemporary Kashmir: see Saiba Varma, The Occupied Clinic: Militarism and Care in Kashmir (Durham, NC: Duke University Press, 2020), pp. 94–5. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 4.

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suggests, the physical environment of the section, as much as its staffing and the forms of treatment undertaken within it, warrants attention. There were four wards in the section: two for quiet patients, and two for ‘dirty’ and ‘excitable’ patients as well as ‘newcomers’. Though accommodating up to 25 patients at a time, they were nonetheless described by Blumenthal as ‘roomy and well ventilated’. Quiet and excitable patients were kept separate at night, but during the day they were mingled together in the single, shared hall which doubled as a dining and living area as well as in the section’s small exercise yard. This was ‘a state of affairs which … urgently needs altering’, Blumenthal wrote, ‘as it leads to the disturbance of the manageable patients’. There were two isolation rooms, but neither was suitable for use: one was a dark cell, without light or ventilation; the other contained electrical fittings. There were thus no opportunities for isolating patients in a more excited state. The effect of these conditions on quieter patients was keenly felt. Blumenthal reported interviewing a patient who was in remission and had been transferred to the main prison, and who surprised him by telling him that he preferred being in prison. ‘It was true that food and beds in the lunatic section were better’, the patient informed him, ‘but continual company with the noisy insane was so unendurable that he preferred prison.’71 If the built environment of Acre lunatic section fell short of Blumenthal’s expectations for a modern mental institution, the staffing, too, was judged to be wanting. A consulting psychiatrist visited the section once a week, and overall, the medical supervision of patients was a responsibility of the prison doctor. But on a day-to-day basis, the patients were in the hands of a staff of thirteen attendants, led by a senior medical orderly, and sixteen police officers, led by a British sergeant. The senior medical orderly had received special training, and in Blumenthal’s view had ‘a good comprehension of his duties’, but the other dozen Palestinian attendants had only attended short courses at the government mental hospital at Bethlehem, and had been given no opportunity for further training. Blumenthal was sharply critical of the shortcomings of the staffing arrangements at the lunatic section, remarking of the attendants that: Their work is confined simply to pure guard duties. They have been working for years in the lunatic section only and could therefore not gain any experience in knowledge and treatment of mental diseases. It would be desirable if, by changing the attendants between institutions they were given an opportunity of increasing

71

Ibid., pp. 11–13.

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their knowledge. The attendants speak Arabic, a few English, and only one or two of them a few words of Hebrew. They consequently are not able to communicate properly with those patients who speak nothing but Hebrew. But even with those who speak Arabic, no human contact exists on account of lack of interest for the fate and illness of the individual patient, due to deficient training. In addition the presence of uniformed policemen leaves the attendants in doubt as to whether they are dealing with prisoners or with patients.72

Giving further weight to his argument that the presence and power of the police within the section corroded the atmosphere of the institution, Blumenthal reported how he had found in an epileptic patient’s record the following ‘inadmissible’ decision, ordered by the British sergeant: ‘Three days dark room as punishment’.73 The sense that emerges across Blumenthal’s report, then, is that the criminal lunatic section was much less clearly demarcated from the prison proper, and much more distinct from the government’s mental hospitals, than government officials – including the director of health – had insisted across previous decades. With the work of the attendants confined largely to ‘guard duties’, there was little attempt to organise the entertainment or occupation of patients, let alone any form of treatment. Therapy, Blumenthal noted, was confined to the administration of narcotics like scopolamine and morphine, and luminal for patients with epilepsy.74 Beyond this, patients had to be temporarily transferred out of the section in order to receive treatment elsewhere: those with general paralysis of the insane – neurosyphilis – were sent to the government hospital at Haifa to receive malarial treatment;75 while some appear to have received electro-shock therapy at the government mental hospitals in the final years of the mandate.76 It was not only these medical treatments that were largely absent in the criminal lunatic section; the occupation of patients ‘hitherto has been totally neglected’ too, Blumenthal lamented. While a large proportion of the patients were employed in cleaning work in the section, and a very small proportion in the prison workshops, this occupied only ‘the smallest part of the day’, such that patients ‘spend the greatest part of the day sitting idly around’.77 And Blumenthal was alarmed by the level of supervision given to patients in performing these tasks. Patients set to work in the kitchen did so alone, without supervision, while the kitchen itself seemed to be open to patients throughout

72 75 76 77

73 74 Ibid., p. 14. Ibid. Ibid. See for example District Medical Board Report, No. 314, Acre, 14 December 1945, ISA M 6640/26. Record of Examination, No. 252, Acre, 19 October 1946, ISA M 334/25. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 5.

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the day. Blumenthal recalled watching in horror ‘a patient fetch a big knife from the kitchen in order to cut an orange’,78 again unsupervised. Though Blumenthal criticised the lack of occupation for patients, there had been attempts earlier in the 1940s to expand opportunities for patients to keep themselves occupied. In 1942, the government had made plans to enlarge the section’s exercise yard by expropriating nearby land – including the property of the nearby historic al-Jazzar mosque. This plan came under fierce and sustained criticism, however, starting with a petition by ‘The Moslems of Acre’ which condemned the expropriation of the waqf property as ‘inconsistent with the Moslem Sharia Law’. ‘It would not’, they continued, ‘befit the famous al-Jazzar mosque to have a garden for the insane in its neighbourhood.’79 While the petition did not articulate what specifically was thought objectionable about this plan for a ‘garden for the insane’ near the mosque, the government pored over the visual and auditory impact of the scheme in response. The director of land settlement noted that the land marked for expropriation was ‘at present occupied by a block of unsightly shops and a number of hideous, ramshackle, temporary buildings used as garages’; in his view, pulling all this down and constructing a stone wall around the site ‘could only add to the dignity of the surroundings of the mosque’.80 The chief secretary added that he had been advised the proposed exercise yard ‘would be repugnant to Moslem sentiment only if worshippers were likely to be disturbed at prayer by noises from the yard’;81 this, he had been reassured, was highly unlikely given the distance between the mosque and proposed yard, and plans to build a high wall around the latter.82 Yet the proposal had still not been realised by 1947, as the mandate began to unravel, suggesting the unwillingness of the government to push ahead with this scheme to expand opportunities for exercise among Acre’s criminal lunatics in the face of sustained local opposition. The picture Blumenthal painted of life at Acre criminal lunatic section is one of unrelenting boredom, distressing chaos, and inadequate medicalisation. But once again patient case files offer a way to deepen and nuance Blumenthal’s account. As we saw, these case files often recorded what examining medical doctors took to be ‘delusions’, like patient 78 79 80 81 82

Ibid., p. 13. Telegram from the ‘The Moslems of Acre’ to High Commissioner, 20 August 1942, ISA M 297/5. Director of Land Settlement to Chief Secretary, 21 September 1942, ISA M 297/5. Chief Secretary to District Commissioner of Galilee District, 23 November 1942, ISA M 297/5. District Commissioner of Galilee District to Chief Secretary, 9 December 1942, ISA M 297/5.

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complaints of physical pain. Here, these accounts of patient delusions are read for what they might suggest of patient understandings and experiences of life in the criminal lunatic section. Whether ‘delusions’ or not, the contents of these delusions should be taken seriously as a historical source. As Jonathan Sadowsky has argued, in his own reading of colonial accounts of one individual’s delusions, ‘[d]elusions are not formed at random’ but must be ‘put … in the context of colonial domination’.83 In the absence of interviews or memoirs by former patients, these delusions – recorded as evidence of continued mental illness within medical reports – are in most cases as close as we can come to patients’ perspectives on life in the criminal lunatic ward, and significantly enrich our understanding of how this institution was experienced and understood by those who resided, often for many long years, within it. They also offer a rare window onto the dynamics of the relationship between patient and attendants, a relationship often – as Nana Osei Quarshie notes – either overlooked or flattened out in histories of colonial psychiatry.84 As a starting point for thinking with these accounts of delusions, let us consider one crucial aspect of daily life in the criminal lunatic section: food. As Blumenthal noted, patients had access to the kitchens, and often worked there unsupervised; Blumenthal also wrote separately about the diet of patients and their physical well-being, noting that ‘[a]s a general rule I found the patients well nourished’, with weights ‘checked twice monthly and when necessary supplements made to the diet-sheets’.85 A significant number of the patients whose case files we have were described as underweight, and put on an extra diet with tonics, in line with Blumenthal’s observations.86 But these case files also reveal a deep anxiety around food in the lunatic sections at both Acre and Bethlehem. Frida S. was sent to the criminal lunatic section of the Bethlehem women’s prison in June 1933, after appearing in court on the charge of attempted arson. She was described by Dr Malouf, the section’s consulting psychiatrist, as suffering delusions and ideas of persecution, which manifested in relation to food. As well as being sleepless and noisy 83

84 85 86

Sadowsky, ‘The Confinements of Isaac O.’, p. 106. I am also here inspired by the work of Luise White, who takes stories of vampires told by Africans about European firefighters and police ‘at face value, as everyday descriptions of extraordinary occurrences’, as ‘a way to see the world the way the storytellers did’. See Luise White, Speaking with Vampires: Rumor and History in Colonial Africa (Berkeley: University of California Press, 2000), p. 5. Nana Osei Quarshie, ‘Contracted Intimacies: Psychiatry Nursing Conspiracies in the Gold Coast’, Politique africaine 157 (2020/1), pp. 91–110. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 13. These case files can be found in ISA M 339/20, M 344/31, M 344/37, M 346/54, and M 351/19.

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at nights, ‘[s]he refuses prison food for fear of its being poisoned’, Malouf noted.87 Frida was not the only one to refuse food in the Bethlehem criminal lunatic ward: around the same time, Simha J. also did so. Yet her behaviour was given a very different interpretation by Margaret Nixon, the government’s welfare inspector. Nixon had discovered Simha while inspecting the women’s prison in the early 1930s, and made representations to the chief secretary about her case in summer 1933. Like Frida, Simha had been charged with arson and found ‘guilty but insane’; unlike Frida, however, Simha’s refusal of food was not attributed to any delusions of persecution. Instead, Nixon understood and represented this as a deliberate, motivated act, reporting how ‘[f]or the last four days she has been on hunger strike which I consider a real danger to one of her frail physique’.88 While Nixon does not explicitly set out the goal of this ‘hunger strike’, it might be inferred that it was in protest at being held in the prison from the solutions Nixon proposed to end it: transferring her to the Bethlehem mental hospital proper, or discharging her into the care of her family.89 The contrast between how Frida’s ‘paranoid’ refusal of food and Simha’s ‘hunger strike’ were perceived underlines the dense web of meanings which could be spun out around food and eating practices in the lunatic section. It also points us towards a more coercive dimension of the treatment of these patients: it is clear that at least some of those who refused to eat were ‘fed by force’, as one report puts it.90 Fears around food were repeated in another patient’s delusions, though here they were only one of a number of elements. Rafiq B. had been admitted to Acre criminal lunatic section in September 1942 after stabbing one Dr Mughrabi near Damascus Gate in Jerusalem and being found ‘guilty but insane’ by the courts. Medical reports made during his time in the criminal lunatic section testify to a fear of poisoning similar to that of Frida a decade earlier. A report from May 1944 noted he was ‘very suspicious of all human contacts’: If two persons are whispering or talking nearby they are conspiring against him and if a mate offers him food he gets suspicious of being poisoned, and if a new warder or a new mate comes to the section it is to be a spy on him. [More] than once he reported cases where warders are trying to seduce him. He refuses to have any person share the bath with him or to assist him in this bath.91 87 88 89 90 91

M. S. Malouf to Senior Medical Officer Jerusalem, 23 August 1933, M 6627/26. Margaret Nixon, Government Welfare Inspector, to Chief Secretary, 23 June 1933, ISA M 6628/10. Director of Medical Services to Chief Secretary, 8 July 1933, ISA M 6628/10. Record of Examination, No. 284, Acre, 22 November 1945, ISA M 348/19. Record of Medical Examination, Acre, May 1944, ISA M 344/31.

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Here, then, suspicion around food prepared by others was recorded as one manifestation among many of his delusional paranoia. This paranoia was evident prior to his admission to the criminal lunatic section; indeed, it was at the root of his stabbing of Dr Mughrabi, as an earlier medical report made clear: Rafiq is still having the delusions that he should not have been detained and that Dr Mughrabi sent him to the Jewish Hospital where he was given injections to make him unconscious, and during his unconsciousness, the hospital people used to get young men to seduce him by acts of sodomy, and what he did was revenge. When he was told that at present he is going to have such injections he was enraged and refused, afraid of being seduced. He is still under delusions to suspect that any medical treatment given is never for his good.92

There is a lot in this knot of fears to be untangled. In the first place, we might note the suspicions which attached to the ‘Jewish Hospital’ recommended by the unfortunate Dr Mughrabi. This may have been the Ezrath Nashim private mental hospital, which admitted a few Muslim and Christian patients over the years, but it could equally have been one of the more dubious unregulated private institutions which cropped up in Jerusalem across the 1930s, where sedatives were heavily used to keep patients amenable in the absence of more effective means of treatment. Rafiq’s reports of being sodomised while unconscious at the encouragement of the Jewish hospital staff tie together a twinned fear of penetration – both injection and seduction – with communal suspicions. These fears also, clearly, had implications for how he experienced the criminal lunatic section, which, as Blumenthal reported, also relied on the administration of narcotics like scopolamine and morphine by injection.93 Indeed, the staff reported that ‘when he was asked if he agrees now to have similar treatment (to get hypnotics injections and in his unconsciousness he claims he is seduced) he obstinately refused’.94 While these fears clearly shaped his experience of the criminal lunatic section, they appear to have affected how attendants treated him, too. In a report from September 1944, more than a year into Rafiq’s time in the criminal lunatic section, it is difficult to shake the sense that the staff in the institution were – if not playing with him – at least ‘testing’ him. ‘[H]e is struggling hard to appear normal but there is lots of acting underneath it’, the report observed, continuing: ‘[h]is fears are buried but existing, possibly with the same influence on his brain.’ He remained suspicious and mistrustful, a point which the attendants helped illustrate 92 93 94

Record of Medical Examination, Acre, 2 April 1943, ISA M 344/31. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 14. Record of Medical Examination, Acre, September 1944, ISA M 344/31.

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by provoking him with their own actions. ‘It is just enough to stand nearby’, the report explained, ‘and to talk in a low voice with another, at the same time to point at him, to keep him nervous and irritated for a day’.95 Here, we may recall not only Blumenthal’s verdict that the lunatic section was hopelessly overcrowded, with no separation between the noisy and quiet, but also his criticism of the staff’s lack of training and indeed human sympathy. These ‘tests’ were used to justify Rafiq’s further detention. This was in spite of the repeated petitions of his father, who wrote plaintively to the High Commissioner in August 1945 to request his son’s release. The family had visited him and ‘saw that he was much better’, but they continued to be told that ‘although he had improved yet he was not fit for release’.96 At a medical examination which took place after this petition was sent, it was reported that Rafiq now ‘maintains that if [he] would see the doctor he attempted to stab, he would apologise [to] him’. Yet in spite of this, and the fact he was described as being clean in habits, sleeping and eating regularly, and not aggressive, the report made on him was paranoid about the possibility of relapse. ‘Although the patient is not hallucinated or deluded’, it read, ‘he seems to be intelligent enough and preserve enough of his personality to be able to hide some of his paranoid delusions.’97 He was not recommended for release. As well as revealing how difficult it was to prove sanity, even with family support, once it had been called into question – a point to which we will return – this case also speaks to the fears that patients attached to specific medical practices. For Blumenthal, the criminal lunatic section was inadequately medicalised; for patients, those medical practices which were in place might be overwhelming. The delusions recorded for Yaacov P. echo some of the same themes that we saw in Rafiq B.’s story. In February 1946, Yaacov had attacked his wife at night with a bottle; a few days later, he entered the flat of a female neighbour with a hammer and threatened her. Sent to the criminal lunatic section at Acre charged with assault and criminal trespass, he was diagnosed as suffering from schizophrenia with delusions of persecution. He told the medical authorities a story riddled with anxieties about treatment, injections, and disease, their summary of which is worth quoting at length: … one day while asleep, a neighbour passed by his room, opened it and frightened him for no apparent cause; subsequently a doctor and some police constables were called, he was then given an injection, conducted to a police 95 96 97

Ibid. Hajj Darwish B. to the High Commissioner, 18 August 1945, ISA M 344/31. Record of Medical Examination, Acre, 7 September 1945, ISA M 344/31.

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station, arrested, tried, and brought here … He goes on telling that neighbours living in the flat as well as the foreman, under whom he was working, for three consecutive nights called to his apartment, looking at him through the door and whispering and watching what he was doing inside … He prefers seclusion, as a protest against his detention with mental patients stating that he is a sound mind. He does not do any work attributing to his being ill, suffering from heart trouble. He is under the influence of persecutionary delusions, that somebody calls at his bed room at night with a tubing to blow and introduce diseases into his body. He is looking about [in] deep attention afraid that any mates do any harm to him … his sleep is more or less disturbed, has to be induced by drugs.98

An injection by a doctor and police officers at his own home, which brought him to the criminal lunatic section, a place where he did not belong and could not get the heart treatment he required; continuous intrusions at night by neighbours, workers, and now the attendants in the ward, which had left his sleep profoundly disturbed and necessitated the administration of sleeping drugs; his nightmarish account of terrifying nocturnal visits by an unknown person who came to blow diseases into his body with tubing – all these entangled elements in Yaacov’s account support the contention that ‘delusions’ cannot be taken as formed at random, but might be read productively, creatively, and carefully as historical sources. In this instance, the weaving of medicalised menaces throughout his account might be read in at least two ways. In the first place, it underlines the point that patients may have judged the criminal lunatic section using very different criteria to those used by medical authorities like Heron or Blumenthal. Yaacov’s fears did not turn on the presence of prison guards, or insufficient differentiation from the prison, as did Heron and Blumenthal’s, but rather the threat of injection and infection. For Yaacov, Rafiq, and others, the problem was not that the criminal lunatic section was insufficiently medical, but the opposite. A second way to read Yaacov’s account develops this point about medicalisation in a different way, bringing to the fore contestations over the nature of his illness and the efficacy of the therapeutic response. Far from being a place to receive treatment and recover, the lunatic section was unable to tackle the real issue afflicting Yaacov: his heart trouble. Yaacov, as we saw, was not alone in reporting somatic pains which medical authorities subsequently labelled delusions. In these cases, the concern was not the availability of psychiatric treatment, as it was for Blumenthal; instead, the problem was the kind of treatment offered – for the mind – when what patients insisted was required was instead treatment for heart issues, chest diseases, and other physical ailments. 98

Record of Medical Examination, Acre, 6 April 1946, ISA M 346/68.

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Getting Out of the Criminal Lunatic Section On 4 May 1947, the fortress housing Acre central prison and its criminal lunatic section was rocked by a series of explosions that blasted a hole in the outer walls and blew out the prison gates. The charges had been set by the Zionist paramilitary group Irgun, which had the previous year bombed the King David Hotel in Jerusalem as part of an escalating campaign to bring British rule in Palestine, and its restrictions on Jewish immigration, to an end. In the ensuing chaos at Acre, more than two dozen members of Zionist paramilitaries held in the prison were able to escape, along with hundreds of other prisoners. In J. Bowyer Bell’s dramatised account of the prison break, the explosions, fire, and shooting ‘set off those locked in the lunatic cells’, and ‘their wild howls created further panic’.99 Patient case files reveal that the impact of the prison break on the criminal lunatic section went well beyond inducing ‘wild howls’. Some were injured: one young man, Muhammad W., described in medical reports as being confused about why he was in prison, sustained shrapnel wounds to his thigh and chest during the attack, and had to be sent to the government hospital at Haifa for treatment.100 But others joined the exodus from the prison. Iskandar N. of Bethlehem, who had been sent to Acre after stealing a neckerchief from a shop in December 1946, escaped in the chaos – but returned within a fortnight. He and his family, to whom he had fled, were both interrogated about his escape. Iskandar explained ‘he escaped because he was afraid of the panic occurring in the prison’. His family, meanwhile, testified to his ‘good conduct and behaviour while at home’. Ironically, his escape became evidence of what the medical board examining him called ‘partial remission’, resulting in him being recommended for discharge into family care.101 Not all returned of their own accord. Fawzi H. had also escaped in the chaos, but he was caught and returned by the police two weeks later. During his escape, he reported that he had crossed the frontier into Lebanon before returning to Safad – his hometown – in order to find work. The medical board which examined him after he returned in June 1947 noted that he too appeared to be in a state of partial remission and recommended his discharge; again, his behaviour and ability to provide a coherent, detailed account of his time ‘at large’ seemed to count in his favour.102

99 100 101 102

J. Bowyer Bell, Terror Out of Zion: Irgun Zvai Leumi, LEHI, and the Palestine Underground, 1929–1949 (New York: Avon Books, 1977), p. 265. Record of Examination, No. 72, Acre, 16 August 1947, ISA M 351/72. Record of Examination, No. P/70, Acre, 4 August 1947, ISA M 352/31. Record of Examination, No. P/50, Acre, 14 June 1947, ISA M 351/57.

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While Iskandar and Fawzi were not the only patients at Acre criminal lunatic section to try and escape over the years,103 they were hardly typical. In fact, leaving the criminal lunatic section at all was relatively uncommon. Between May 1945 and January 1946, just 12 patients – out of a total of 118 seen by Blumenthal – were discharged from the section; a further 3 were transferred to hospitals; and 1 died.104 The likelihood of discharge plummeted as the duration of a person’s stay in the section increased: while 4 patients were discharged in the first six months since admission, and a further 3 in their first year, not a single person who had been in the section for more than three years was discharged in all the months observed by Blumenthal.105 This low turnover in patients was in part a result of the chronic nature of the condition of many of those in the section, which meant that they were never judged to have recovered enough to be discharged. But even among those who were deemed to have made an improvement, getting out of the criminal lunatic section was a difficult, complex process. This was in no small part because discharge required a degree of consensus between psychiatric, criminallegal, and social welfare experts, as well as the families of the patients. That release from the criminal lunatic section was always negotiated rather than a unilateral decision was made painfully clear to those who sought a solely legal route out across the 1940s. In January 1945, Yeshuea L. entered the Royal Air Force Officers’ mess on King George Avenue in Jerusalem and – according to eyewitnesses – picked up and destroyed a box sitting on the table, ‘[a]ll the time … speaking to himself’. Brought before the magistrate’s court in Jerusalem charged with unlawful destruction of property, he was judged to be ‘in a mentally deranged state’ at the time of the crime, on the grounds of the evidence of the medical officer observing him while in the central prison in Jerusalem at the request of the police. He was sent to Acre.106 A month later, Yeshuea himself wrote an extraordinary letter to the court of appeal in Jerusalem, protesting this ‘tragic misunderstanding’ and pleading for release from the criminal lunatic section at Acre ‘[a]s a matter of greatest urgency’. He described himself as being ‘in the most difficult conditions, between men mentally sick, which puts an extraordinary strain on my health’.107 The district court convened in Jerusalem in March to hear his appeal – but quickly ran into an insuperable obstacle. In his review of the

103 104 106 107

For example, see Record of Examination, No. 117, Acre, 13 June 1944, ISA M 341/66. 105 Blumenthal, Report on the Lunatic Section of Acre Prison, pp. 1, 4. Ibid., p. 4. Criminal Case No. 615/45, Certified True Copy 20 March 1945, ISA M 704/4. Yeshuea L., Jerusalem, through the Officer-in-Charge, Central Prison Acre, to Court of Appeal, Jerusalem, 1 February 1945, ISA M 704/4.

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proceedings in the magistrate’s court, the president of the court of appeals, Paget Bourke, was scathing in his criticism, describing the circumstances of the case as ‘really monstrous’. ‘Guilty but insane’ was a special verdict which could be reached when a defendant was successful in raising an insanity defence, but in this case, the defendant – representing himself in the absence of a lawyer – had not made this argument at all. Instead, it was the prosecution who had called on the medical officer to testify to the defendant’s mental state, and it was on this basis that the magistrate ordered Yeshuea to be detained as a criminal lunatic. It was the second such case in recent months, Bourke noted, in which a magistrate appeared to have ‘abused’ his power to order detention for the ‘guilty but insane’ and thereby ‘interfere with the liberty of a member of the public’. But what made the case truly ‘monstrous’ was that because the verdict of ‘guilty but insane’ was considered an acquittal in the eyes of the law, there could be no appeal – and so the court of appeal had to dismiss the case.108 In the absence of a legal route to redress, whether a patient could be discharged from the criminal lunatic section depended, at its most basic, on satisfactorily answering three questions: to what extent their mental state had improved; whether they were judged to be harmless or not; and in what circumstances they would likely find themselves if discharged. These questions required consensus between quite different bodies of expertise. The first question, whether a patient had recovered, was one which was primarily but not exclusively addressed by the section’s medical experts. For these experts, the key difficulty was that they had to convince the government ‘there is a reasonable probability that the state of mind in which the crime was committed will not recur’.109 This was far from simple. As the acting solicitor general noted in November 1947, ‘it is difficult for a medical officer to state categorically that a man was sane’.110 In an extension of the confusion in the colonial courtroom over what was ‘abnormal’ behaviour, and therefore evidence of insanity, the ‘normative uncertainty’ surrounding these cases made it unclear what recovery and a return to ‘normal’ might look like in individual cases. To give an almost facile example of this, one man from a village in Tiberias sub-district was examined in January 1947, and described as ‘making queer gestures by his face, giving the impression that he is

108 109 110

Judgment given by R/President, Bourke, in District Court of Jerusalem in its Appellate Capacity, Criminal Appeal No. 30/45, 19 March 1945, ISA M 347/22. Memorandum enclosed with letter from Eric Mills, Acting Chief Secretary, to Commandant of Police, 22 December 1929, ISA M 6628/9. Acting Solicitor General to Chief Secretary, 11 November 1947, ISA M 352/18.

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witless’. In addition, it was reported he ‘cannot solve the simplest problem laid to him’, which may have helped determine his state of mind except for the fact it was equally plausible, the examination report continued, that it ‘might be due to his simple school education’.111 In view of these complications, he was recommended for release only in September 1947.112 Similar concerns were raised about the young Khadder K., whom we met earlier, on the grounds that ‘[h]is knowledge of the world is poor’, he ‘solves little arithmetical problems’, and ‘[h]e does not know the kind of government existing in Palestine’, thinking that ‘the High Commissioner is a Muslim’. Khadder was just fifteen when admitted to Acre for assaulting his mother and grandmother, and his father begged the High Commissioner to release him on the grounds that ‘[h]is being amongst lunatics in the Acre mental detention place, amongst full aged men, will no doubt influence on his physical and mental powers awfully’.113 Faced with the challenge of evidencing ‘normality’, examining doctors reached for social rather than strictly medical markers of recovery. In particular, they sought to build up a case for the sanity of a given individual by reference to both their capacity for, and attitude towards, work. Being judged capable of work, and having a positive attitude towards it, were taken as evidence of the recovery and normalcy of criminal lunatics. Participating in work allowed criminal lunatics to behave like, and be around, the ‘normal’ inmates of the prison. Zion N. of Nathanya, arrested for causing a disturbance of the peace, was examined in October 1945. In the report, it was noted that ‘[h]e is at present working like a normal prisoner (tailoring)’.114 In April 1945, Zion had been recommended for employment at the tailor shop in the central prison with ‘ordinary prisoners’; in the months since, it was observed that ‘[h]is work and conduct so far proved satisfactory and no complaints from prison authority received’.115 He was recommended for discharge. Attitude as well as competence mattered. Moshe G. was examined in June 1945. The medical board found him to be ‘[o]bedient, cooperative, and carries out any work he is assigned’. More than this, he was ‘anxious and persistently begging for his discharge so as to earn his living normally’. He too was recommended for discharge.116

111 112 113 114 115 116

Record of Examination, No. P/5, Acre, 23 January 1947, ISA M 350/5. Warrant for Release, 12 August 1947, ISA M 350/5. Ahmad K., Jerusalem, to High Commissioner, 9 July 1947, ISA M 351/24. Report on a Prisoner, Zion N., Nathanya, 29 October 1945, ISA M 334/20. Record of Examination, No. 194, Acre, 30 July 1945, ISA M 334/20. Record of Examination, No. 160, Acre, 18 June 1945, ISA M 344/64.

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Of course, it was possible to be recommended for discharge even without demonstrating much interest in work. Yet in the criminal lunatic section, a lack of interest in work or refusal to engage in unpaid work could be construed as a failure to recover. Given the difficulty of testifying to the sanity of individuals once it had been put in doubt by medical experts and courts, every scrap of evidence for or against recovery mattered. If insanity defences in the courtroom presented an opportunity to define the ‘normal’ negatively, by identifying its violation, the discharge of criminal lunatics posed a different challenge: to define the ‘normal’ positively, by establishing – indeed valorising – the characteristics which patients would need to demonstrate in order to be released. Equating normality with economic productivity, in that respect, was a self-interested move, both in the immediate sense of legitimising the use of prisoners’ unremunerated labour as therapy, and in the broader sense of elevating and instilling a particular kind of work discipline into the population of Palestine – of forging obedient, economically productive colonial subjects. Yet this turn to work as evidencing sanity should also be understood against the broader backdrop of calls right across the British empire in the post-war period for a more reformative penal programme, one which would rehabilitate prisoners into productive and quiet workers.117 Securing release from the criminal lunatic ward required consensus between different bodies of expertise, but these fields themselves were undergoing transformation across the 1930s and 1940s, giving rise to changing standards, opportunities, and obstacles. If evidencing sanity was a challenge, complicating matters further is the fact – as we have seen – that families as well as patients themselves also came to their own conclusions on this point and sometimes forcefully represented these views to the government. We might return here to Rafiq B., whose father petitioned the High Commissioner repeatedly to request his son’s release from Acre. ‘After visiting my son several times in his prison’, he wrote, ‘I saw that he was much better’;118 successive medical reports on Rafiq disagreed, however, and he remained in the section for years. Part of the problem was that while ‘[h]is behaviour is quite normal on the surface’, the examining medical doctors believed ‘[h]is fears are buried but existing, possibly with the same influence on his brain’, and that ‘[a]ny time these fears will dominate him where he

117

118

Stacey Hynd, ‘Law, Violence, and Penal Reform: State Responses to Crime and Disorder in Colonial Malawi, c. 1900–1959’, Journal of Southern African Studies 37, 3 (2011), pp. 441–2. Haj Darwish B., Jerusalem, to High Commissioner, 6 March 1943, ISA M 344/31.

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becomes dangerous again’.119 As well as assessing recovery, then, medical examinations assessed whether an individual was harmless or not. Here, as elsewhere, the threat an individual posed to public safety carried more weight than a strictly medical assessment of their condition. Rafiq’s apparent recovery was more than counterbalanced by his potential for violent relapse, condemning him to continued detention; in other cases, conversely, a lack of improvement in a patient’s mental state was no barrier to discharge if they were judged to be ‘harmless to himself and to others’.120 Yet even where a patient was reported to have made a partial recovery, or judged harmless, medical opinion alone was not enough to guarantee discharge. The police also played a crucial role in the decision-making process. In addition to a medical report, the police submitted their own report on each case, which assessed the patient’s probable position and circumstances if discharged. This included their prospects for work, whether friends or family were able and willing to receive them, their own wishes, and whether they were likely to reoffend.121 Sometimes the police got it wrong, reporting that no friends or relatives could be found, only for them to turn up later, leading Blumenthal to caution that ‘police inquiries into family and local communities must be carried out more carefully’.122 But such mistakes notwithstanding, the police were extremely active in this area, locating and interviewing the relatives of criminal lunatics, receiving assurances from them about their upkeep, even putting pressure on reluctant families to accept their relatives so that they could be discharged safely. Their usefulness in this regard can be seen in the fact that medical authorities sometimes approached the police to play the same role in facilitating the discharge of non-criminal patients from government mental hospitals, too. In 1942, for instance, the senior medical officer at Jerusalem had asked the police ‘to bring pressure to bear on’ a number of relatives to accept patients on their discharge from hospital.123 Social welfare workers sometimes were called upon to assess a patient’s likely circumstances on discharge, too,124 but as we will see, the social welfare department invested their energies less in developing

119 120 121 122 123 124

Record of Examination, No. 186, Acre, 9 September 1944, ISA M 344/31. Record of Examination, No. 160, Acre, 18 June 1945, ISA M 344/64. All this information was given in Form P.329, filled out by the Palestine Prisons Service. For an example, see ISA M 334/28. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 16. Senior Medical Officer, Jerusalem, to Director of Medical Services, 15 January 1942, ISA M 6627/30. Inspector-General of Police and Prisons to Chief Secretary, 9 April 1945, ISA M 338/13.

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these individual arrangements and more in establishing a systematic solution to the problem of discharging criminal lunatics. Of course, in significant measure the police’s assessment of the probable circumstances of criminal lunatics on discharge depended on the attitude of families and communities, and whether they were willing and judged able to take responsibility for patients who had very often made only seemingly partial recoveries. Family attitudes varied dramatically, from those who were willing to pay to have relatives admitted to private institutions to those who avoided even visiting out of fear that they would find themselves saddled once more with responsibility for these relatives. Yet not only family attitudes but means were assessed by the police and social welfare department, a sharp reminder that abandonment was produced by a constellation of forces rather than traceable to a single intention.125 In one case, for instance, it proved impossible to release an otherwise ‘quiet and harmless’ patient because of his family circumstances. His family consisted only of elderly parents and a sister, and his father and sister worked, ‘leaving only the mother who is old and sick at home’ to look after him during the day. Compounding matters, their accommodation was on the roof of a building.126 It is a mark of how desperate the government had become to discharge criminal lunatics by 1947 that, against the advice of medical officers and social welfare workers, the government under-secretary pushed to have him discharged nonetheless: ‘[i]t seems to me that even on a roof he would be better off than in jail’.127 In other cases, the dangers of releasing patients into inappropriate circumstances were even more acute: Botros K.’s wife had remarried – illegally, it was noted – after he had been detained for stoning her on the street, causing her grievous injury. The local district commissioner worried that if he was released and learnt that she had not only remarried but was now pregnant, ‘there is a risk of his again becoming dangerously insane’.128 In view of the many difficulties that attended attempts to discharge patients into the care of families, a range of other potential solutions to this problem were pursued. Officials approached the Prisoner’s Aid Society of Tel Aviv, which provided services and support for European Jewish prisoners and their families in Palestine, to ask if they could fund the stay of criminal lunatics at private mental hospitals. But the society 125 126 127 128

Biehl, Vita, p. 14. District Commissioner, Jerusalem, to A/Commissioner of Prisons, Jerusalem, 30 April 1947, ISA M 334/27. Minute by Under-Secretary of Government of Palestine, 23 May 1947, ISA M 334/27. District Commissioner, Galilee, to Inspector General of Police and Prisons, 11 March 1944, ISA M 338/13.

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was unwilling to use its limited funds in this way; as the secretary explained, ‘lunatic prisoners lie really on the extreme borderline of our activities because, as a rule such prisoners are not offenders but medical or social welfare cases’,129 a comment that offers a fairly direct insight into how these cases were perceived by at least one group in mandate Palestine. A more ambitious proposal, put together by the inspector general, director of medical services, and adviser on social welfare, was a boarding out scheme which drew on practice in England. ‘[P]roperly selected types’ of cases, that is, those who were chronic but judged harmless, ‘could be boarded out with families in villages or settlements at government expense’ and under ‘expert medical and social control and supervision’, the arrangements for which could be set up by the departments of health and social welfare.130 Although this proposal received government support, it was slow in being implemented; even with credits approved, in May 1945 the director of medical services warned it would still take some time before the boarding out scheme could be implemented.131 By 1947, at least, it seems the scheme had been implemented.132 Blumenthal, for his part, supported the boarding out scheme but wanted it taken in a different direction: rather than sending patients to live with families, he argued that a ‘considerable proportion’ of the ‘inmates’ – and here his usual language of ‘patients’ slipped – of the section ‘could perform certain duties in a work house’, relieving pressure on mental institutions while also taking ‘harmless wandering mental cases off the streets’.133 In spite of these belated attempts at a systematic solution to the multiple challenges posed by the discharge of criminal lunatics, it is clear that this process was highly contingent, drawing a range of actors with distinct agendas into complex negotiations which were rarely straightforwardly resolved. The improvisational nature of many discharges is underlined by a final example. Eftim D. had been detained after assaulting his sister in July 1943. At Acre, he was diagnosed as suffering from dementia praecox, the older term the prison medical doctors used instead of schizophrenia. He had been, and two of his brothers remained,

129 130

131 132 133

Honorary Secretary, Prisoner’s Aid Society, Tel Aviv, to Deputy District Commissioner, Tel Aviv, 9 February 1944, ISA M 338/11. Memorandum relating to the disposal of criminal lunatics prepared by the Inspector General, A/Director of Medical Services, and Adviser on Social Welfare, for Chief Secretary, 24 June 1944, ISA M 320/13. Director of Medical Services, to Chief Secretary, 10 May 1945, ISA M 4087/5. A/Director of Medical Services to Director of Social Welfare, 1 September 1947, ISA M 6627/31. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 17.

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employees of the department of health, with one brother a medical doctor and the other a pharmacist at Nablus. In spite of his apparent recovery by the end of the year, neither brother was willing to take on responsibility for him if discharged. Instead, one suggested an unusual way out of this impasse to the government social welfare adviser: that ‘it might be possible that his brother be employed in a mental hospital as a clerk, in which case he would be prepared to pay the full cost of maintenance’. Approached by the social welfare adviser with this proposal, the department of health agreed to this ‘experiment’. Eftim was discharged from Acre criminal lunatic section in March 1944, and sent to the government mental hospital at Bethlehem, where he undertook clerical duties in return for board and lodging.134 If the family’s solution to this impasse was inventive and apparently unique, Eftim’s discharge underlines a broader point: that while the approval of psychiatric, criminallegal, and social welfare experts was needed, at least in some combination, before a patient at the criminal lunatic section could be recommended for discharge, their families held the power to veto or otherwise derail the best laid plans of these experts.

Conclusion It is easy to mistake criminal lunatics as a marginal group: a few hundred people, mostly men, with the vast majority of them appearing in the 1940s as an unforeseen consequence of an amendment which affected the lowest-ranking courts of the land. Indeed, they were perceived at the time as cut off from wider currents and concerns, so isolated they barely knew the Second World War had ended. This chapter has contended otherwise: not only was the criminal lunatic section far from cut off from the outside world, but it was a central site – and the criminal lunatic a key figure – in a set of important debates in mandate Palestine: about the nature of criminality and insanity, in a context in which both were protean and highly political categories; about the often uneasy and occasionally downright hostile relationship between psychiatric, criminallegal, and social welfare expertise; and between the mandate government and the population of Palestine. But those detained as criminal lunatics were more than simply the object of negotiations conducted by others. Both Blumenthal’s report, and the dozens of patient case files that 134

Minute by Adviser on Social Welfare to Chief Secretary, 1 March 1944, ISA M 335/18. It appears he took a bed that had been recently vacated by one of two Jewish patients at the hospital who had been transferred to Jaffa. See Director of Medical Services, to Medical Officer, Bethlehem, 12 March 1945, ISA M 6627/30.

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survive in the colonial archive, reveal patients to have been actors within these negotiations too: asserting their preference for the conditions of the prison proper, over those of the lunatic section; instructing lawyers and making arrangements with visiting family members; articulating their own understandings of their condition, as physical rather than psychiatric; even taking matters into their own hands and attempting to break out, sometimes successfully. The colonial criminal lunatic section, a site shaped by the intersection of colonial government, penal regimes, and psychiatric expertise, might well at first glance appear to be a space in which the room for manoeuvre on the part of families, let alone those detained as criminal lunatics, was crushed nearly out of existence. Looking a little closer, what we see instead is a remarkable capacity to identify – to borrow from Michel de Certeau – those ‘cracks that particular conjunctions open in the surveillance of the proprietary powers’;135 to identify those cracks – and to put them to use.

135

Michel de Certeau, The Practice of Everyday Life [1980], trans. S. Rendall (Berkeley: University of California Press, 1984), p. 37.

Part III

6

Investing in Psychiatric Institutions and Expertise into the 1940s

The Second World War is often figured as a pause in histories of Palestine, as Palestinian nationalist politics reeled from the blows inflicted by a devastating British counter-insurgency over the course of the great revolt, and the Zionist movement put its opposition to British immigration policy as expressed in the 1939 White Paper on hold to focus on the war against Nazi Germany. Yet in the history of colonial psychiatry, at least, the final decade of the mandate period – both the war and the chaotic years bookending it – might be reckoned as transformative. This decade witnessed the single most important expansion in government provision for the mentally ill of the mandate years, with the opening late in 1944 of a third and final government mental hospital south of Jaffa. While falling short of the 240-bed, purpose-built mental hospital that had long been the fantasy of the department of health, the opening of the new hospital, with 175 beds, meant that the bedstrength of government mental institutions almost doubled overnight. This marked a turning point in the relationship between government and voluntary institutions, too, as government provision for the mentally ill exceeded provision in private Jewish institutions for the first time. The opening of the third government mental hospital was certainly the single most visible development of the decade, but the 1940s also saw the cultivation of particular forms of psychiatric expertise within the health department. Against the backdrop of wider efforts among the Palestinian Arab medical community to organise professionally, mobilise politically, and invest in expertise, this chapter focusses on two distinct branches of specialist psychiatric knowledge nurtured in this period. In the Second World War and its wake, Dr Mikhail Shedid Malouf, medical officer in charge of the Bethlehem mental hospitals, seized the opportunity to examine veterans discharged with psychiatric disabilities and develop specialist understanding of traumatic conditions. And from 1944, doctors, matrons, and nurses at government mental hospitals set out to design and implement the curriculum of a mental nursing course – as it was known at the time – which would provide students with both the 233

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specialist knowledge needed to care effectively for patients, and the promise of professional recognition attendant on the achievement of a certificate. The final decade of the mandate, then, was marked by an investment in both psychiatric institutions and expertise which, while never huge, might nevertheless seem surprising, given the wider context of dislocation and crisis. As the committee set up in 1940 to review and recommend reforms to development and welfare services in Palestine observed, as a result of the ‘disturbances’ of the great revolt, government departments – health included – had ‘been reduced in strength to such an extent that, far from being in a position to expand, they are unable to discharge … even those day-to-day duties which now fall to their lot’.1 More than this, the report continued, the war, which had closed the Mediterranean for exports and imports, and the continued high cost of police and security within Palestine, made the availability of sufficient resources to finance a recovery, let alone expansion, of services doubtful in the foreseeable future.2 If the committee on development and welfare appeared cautiously resigned to the deferral of most of its programme to the post-war period, the end of the Second World War ushered in further dislocations, as Zionist paramilitaries waged war on the mandate government and its continued restrictions on Jewish immigration to Palestine in the wake of the Holocaust. By February 1947, the British had referred the question of Palestine to the newly established United Nations for resolution. With the United Nations voting in favour of partition into separate Jewish and Arab states, civil war ensued, months before the termination of the mandate and the final, formal withdrawal of the British in May 1948. The 1940 report’s gloomy prognosis about the future of development and welfare services turned out to be, if anything, not pessimistic enough. With the end of the mandate in 1948, Palestine appeared to miss a shift to investment in development and welfare that elsewhere in the British empire has led historians to argue that the immediate post-war period represented nothing less than a second colonial occupation.3 Indeed, rather than prompting a change in approach, the Second World War seemed instead to underline the continued value of big infrastructural 1 2 3

Report of the Committee on Development and Welfare Services, 1940, ISA P 4187/10, p. 1. Ibid., p. 148. D. A. Low and J. M. Lonsdale, ‘Introduction: Towards the New Order, 1945–1963’, in D. A. Low and A. Smith, eds., The History of East Africa, vol. 3 (Oxford: Clarendon Press, 1976), pp. 1–63. See also P. J. Cain and A. G. Hopkins, British Imperialism: 1688–2015 (3rd ed., Abingdon: Routledge, 2016), pp. 669–72.

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projects which had characterised the first age of colonial development; the war had confirmed, for instance, the importance of industrial development in the Dead Sea by catapulting Palestine into the ranks of the top five chemical exporters to Britain.4 These priorities are reflected in relative government spending. Expenditure on health and welfare never came close to the sums invested in industry or infrastructure, and in fact the proportion of the budget directed to the health department actually fell between 1939 and 1940, from a paltry 3.9 per cent to just 3 per cent.5 The seeds of a more expansive vision of colonial development may have been evident in Palestine, as elsewhere,6 by the late 1930s, not least in the calls of the committee on development and welfare for investment in health and other welfare services in 1940. But the abrupt termination of the mandate meant these seeds never bore fruit; Palestine never entered fully into the second age of colonial development. A new government mental hospital; the cultivation of expertise around trauma; the rolling out of a new mental nursing course – though seemingly minor developments, when set against the backdrop of all else that was happening across the final decade of the mandate it is surprising that they occurred at all. One way to narrate these developments would be as a story of progress made against all odds by the beleaguered mandate government, a result of what Roza El-Eini has argued was the mandate’s genuine commitment to welfare services following the suppression of the great revolt.7 This chapter offers a different interpretation. Drilling down into these three areas, it locates the impulses driving developments not with any major shift on the part of the mandate’s approach, as following any systematic plan for investment in institutions and expertise, but rather in messier processes of reaction and interaction. These involved a range of actors: senior officials in the department of health, certainly, but also the managing committees of private Jewish institutions, the army and the consulting psychiatrists attached to it during the war, and those doctors, matrons, nurses, and attendants who staffed the government mental hospitals. This is clear even in relation to the third government mental hospital, identified as a priority by the 1940 report; the institution that opened its doors in 1944 was quite different to what the report had 4 5

6 7

Norris, Land of Progress, pp. 164–6. Annual Report, Department of Health, 1940, p. 2. For a table which very starkly reveals the proportion of funding allocated to health relative to security and public works, see Norris, Land of Progress, p. 14. Frederick Cooper, Decolonization and African Society: The Labour Question in French and British Africa (Cambridge: Cambridge University Press, 1996), pp. 57–8, 68–70, 119–20. Roza El-Eini, Mandated Landscape: British Imperial Rule in Palestine, 1992–1948 (Abingdon: Routledge, 2005), pp. 85–7, 452.

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envisaged, emerging as an emergency response to crisis in the voluntary sector and on a site haunted by history. Rather than knit these three developments – a new mental hospital, wartime psychiatry, and mental nursing – tightly together, then, as elements in an overarching plan by the mandate government, this chapter pulls them apart to highlight that these investments – of time, energy, care, resources – were made by a multiplicity of actors. Even if we might trace in these haphazard, discrete developments the stirrings of a new pattern in the knot of relationships entangling state and subject, welfare services and expertise – the dawn of a kind of second mandatory occupation – not only was this driven as much by colonial subjects and crisis as by British design, but there is something strikingly recursive to this history. In its final decade, as in its first, the mandate found itself buffeted by the demands and deeds of its subjects and building both figuratively and literally on the foundations of the past in response. And, as in the first age of colonial development, Palestinians who sought to take part in and shape these processes, who invested in building expertise or professionalisation, often did so in spite of, not thanks to, the mandate. These echoes of the past, not any coherent mandatory vision of the future, are what ultimately undergird the three stories of investment in institutions and expertise brought together here. From Voluntary to Government Provision for Mental Illness In 1940, the committee charged with preparing a coordinated scheme for development and welfare services in Palestine put the establishment of a new government mental hospital high on its list of priorities for health services, second only to its call for a tuberculosis sanatorium. The need for a new mental hospital was keenly felt, the committee noted. The government maintained two mental hospitals in rented buildings in Bethlehem, with a total bedstrength of 157, while the Ezrath Nashim private hospital in Jerusalem – the only other officially recognised institution in Palestine – had accommodation for a further 60 cases. This was ‘totally inadequate’ to the needs of the country, they observed, with the result that hundreds of ‘serious mental cases’ remained ‘at large’. Worse, this acute shortage of accommodation left the government unable to demand the closure of unsuitable, officially unrecognised institutions – like a large private mental home at Bnei Braq, singled out as a particularly offensive example ‘owing to the unsuitability of the accommodation afforded and the inadequacy of the staff employed’. In spite of this institution’s shortcomings, it could not be closed as it ‘at least performs the

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valuable service of keeping dangerous and possibly homicidal lunatics off the streets of Tel Aviv’. In view of this unacceptable situation, the committee proposed the closure of the second government mental hospital at Bethlehem, the smaller of the two institutions at just 52 beds, and the construction of a new mental hospital with 240 beds ‘on modern lines’ in its place. This was not a bold or even original suggestion, they took pains to point out: rather, it was a return to a proposal made over a decade earlier, abandoned in the wake of the global depression in favour of the less costly conversion of the old Swedish hospital into a small second mental hospital.8 However long overdue and modest, the committee’s proposal suffered a similar fate to its predecessor. Instead of constructing a new mental hospital as part of a wider plan for development and welfare, the government resorted once again to converting an existing site into a smaller mental hospital, this time at Jaffa. This section reconstructs the story of the founding of this institution, revealing the extent to which it was interactions between government and private Jewish provision for the mentally ill, rather than initiative or particular energy from either one individually, that drove institutional developments in the last decade of the mandate. This is a pattern which should be familiar to us by now. In the 1920s, the mandate had established the first government mental hospital in order to staunch the flow of subsidies to the Ezrath Nashim private hospital; in the 1930s, the travails of that same institution forced the mandate to open the second government mental hospital; in the 1940s, the opening of the third and final such hospital was rushed through in response to a crisis in the private Bnei Braq mental hospital. However familiar, that it was interactions between the mandate government and the Yishuv – Palestine’s European Jewish community – at the heart of this story should still not be taken entirely for granted. A note by the mandate’s director of health offers a tantalising glimpse from the archive of one alternative. Lamenting the unaffordability of a new, desperately needed mental hospital in November 1937, he reported talk ‘from Arab sources that public subscriptions could be obtained towards the building fund for the new government mental hospital’. If there were, he continued, ‘no objection to the formation of local voluntary committees to obtain subscriptions towards the building fund for a government institution, the department would be prepared to encourage and assist such committees in their work’.9 But this is the only document on the 8 9

Report of the Committee on Development and Welfare Services, 1940, ISA P 4187/ 10, pp. 65–6. Director of Medical Services to Chief Secretary, 17 November 1937, ISA M 6629/13.

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subject in the archive; it appears the idea was never taken further. The timing was certainly unpropitious, against the backdrop of the Arab revolt and discussions of partition. Yet it was not a unique occurrence: there were other instances in which Palestinian Arabs offered to support the expansion of government medical services financially.10 Having eschewed these potential partnerships with Palestinians in the field of health and welfare, as in development more broadly,11 the mandate government ensured that it would be their interactions with private Jewish institutions that drove developments in provision for the mentally ill. At the start of the British occupation of Palestine, the government had hoped the majority of the everyday healthcare needs of the population could be met not by the state but by voluntary or municipal hospitals, with the limited health budget reserved for public health priorities like malaria prevention.12 Over time, this ambition had been frustrated. Across the economic difficulties of the 1930s, the department of health had taken over struggling municipal hospitals, while the outbreak of the Second World War and the closure of German and Italian hospitals – particularly important in serving the Arab population of Jerusalem, Jaffa, and Haifa – resulted in a further increase in the share of responsibility for health assumed by government.13 In one sense, the story of the third government mental hospital fits this trend, marking the point at which government provision for the mentally ill overtook private provision for the first time. Yet the case of provision for the mentally ill is also distinctive. Rather than municipal or mission hospitals, the mandate stepped in here to relieve faltering private Jewish institutions. Reconstructing the circumstances leading to the opening of the third government mental hospital foregrounds the complex and ongoing interaction between government and private provision – dynamics at odds with portrayals of these as parallel health systems largely sealed off from one another.14 The seeds of the scandal which by 1944 had pushed the mandate into establishing a third governmental mental hospital at Jaffa were sown

10

11 12 13 14

In the 1940s, Jaffa municipality offered to provide funds to the government for the construction of a maternity hospital, while two elderly ladies from the Abu Khadra family offered to donate funds and land for the construction of a hospital in Gaza. Acting Director of Public Works to Chief Secretary, 25 January 1946, ISA M 325/38. Norris, Land of Progress, pp. 22–3. See also Seikaly, Men of Capital; and Meiton, Electrical Palestine. Annual Report, Department of Health, 1925, p. 6. Annual Report, Department of Health, 1940, p. 3. See Simoni, ‘At the Roots of Division’ and Simoni, ‘A Dangerous Legacy’.

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across the previous decade. Though the mandate had increased its provision to take pressure off the Ezrath Nashim hospital in 1932, it subsequently failed to keep up with rising demand for admission to mental institutions. Private institutions thus came to provide for an ever larger proportion of patients in Palestine. The Ezrath Nashim hospital continued to play a role, not least as the only private institution officially recognised by the mandate government, but other institutions, officially unrecognised, proliferated across this period. Already by 1929, two smaller institutions – including the nucleus of the Bnei Braq hospital – were operating in the vicinity of Tel Aviv, under the aegis of a charitable society that had been set up to meet the growing needs of the city.15 This process accelerated after 1933 with the arrival of hundreds of thousands of European Jewish immigrants into Palestine, including a large number of German-trained psychiatrists. At the end of 1933, Dr Kurt Blumenthal founded the first mental institution in the north of Palestine, on Mount Carmel in Haifa; the following year, a group of German Jewish psychiatrists founded another institution, the Har Hazofim home on Mount Scopus in Jerusalem.16 Two further institutions, unlicensed and run for profit near Tel Aviv, came to the attention of the department of health towards the end of the 1930s: one at Bat Yam, run by a Mr Shmuel Geffen; the other, Bitan’s Mental Home, on the Petah Tikva road.17 By 1942, it was estimated that although the government could accommodate just over 150 patients at the two Bethlehem mental hospitals, private institutions were capable of accommodating 340: 60 at Ezrath Nashim, 120 at Bnei Braq and another 160 beds across private, officially unrecognised institutions throughout Palestine.18 The mandate’s engagement with these proliferating private institutions was uneven. As the only officially recognised such institution in Palestine, the Ezrath Nashim hospital was also the only one to be subject to sustained government scrutiny and regulation, as well as support. During the hospital’s financial difficulties in the early 1930s, the mandate department of health demanded its reorganisation before any further

15

16 17 18

Mills, Census of Palestine, p. 231. For the Society of Mental Rehabilitation at Tel Aviv, see Dvora Kahanovitz, President of the Society for Mental Rehabilitation, Bnei Braq, to the Department of Health, Tel Aviv, 22 April 1941, Tel Aviv Municipal Archive [TAMA] 4-4737. See Zalashik, Das Unselige Erbe, pp. 65–7. Senior Medical Officer, Jaffa, to Director of Medical Services, 6 February 1939, ISA M 6628/15. High Commissioner to Secretary of State for the Colonies, 17 October 1942, BNA CO 733/449/6.

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subsidies were granted: this included capping the number of patients at 60; restricting admission to paying patients, or those for whom guarantees of payment had been received; and even bringing its record-keeping into line with that utilised in government mental hospitals.19 Given that these reforms were designed to ensure the hospital was ultimately able to wean itself off government subsidies and fund itself through patient fees, it is unsurprising that later in the 1930s, Ita Yellin, president of the charitable society administering the hospital, complained about the questionable benefits derived from official recognition: ‘our asylum has only the disadvantages of a recognised institution but none of the advantages which it should enjoy in view of its legal status’.20 Except in moments of crisis, similar scrutiny did not fall on other private institutions, which remained officially unrecognised. The sheer number of patients in these private homes worked against the government’s ability or willingness to examine them too closely or hold them to account. These dynamics were spelled out in an annual report by the health department: ‘[s]ome of them are disgraceful places, but the present lack of accommodation for insane persons prevents the proper application of the lunacy laws of the country’.21 Across the 1930s and 1940s, as a result, the government consistently failed to take action in response to complaints about these institutions. In 1931, for instance, the local council of Ramat Gan, a Jewish settlement to the east of Tel Aviv, wrote to the department of health to raise concerns about a home which had been set up in the vicinity of a local school. With ‘lunatics … wandering in the streets’, parents had stopped sending children to school, and the local council was receiving complaints every day about ‘the unruly state of affairs which has been created in the colony’.22 But in the absence of alternative accommodation, the department of health concluded it could not take action and close the home.23 In the 1940s, the neighbours of another institution, the Har Hazofim home in Jerusalem, complained repeatedly about ‘the terrible screaming that comes from this place notably at night’.24 But again, government officials 19 20 21 22 23 24

Annual Report, Department of Health, 1933, pp. 62–3; Medical Director, Ezrath Nashim, to Director of Health, 16 January 1930, ISA M 6628/13. Ita Yellin to District Commissioner, Jerusalem, 12 December 1937, ISA M 6552/32. Annual Report, Department of Health, 1933, p. 63. P. Krinitzi, President of Local Council, Ramat Gan, to Medical Officer of Health, Tel Aviv, 15 March 1931, ISA M 6629/16. Director of Medical Services to Chief Secretary, 7 April 1931, ISA M 6629/16. John D. Whiting, Secretary of the American Colony, Jerusalem, to Colonel Heron, Director of Public Health, 20 February 1942, ISA M 6553/15; and again, a year later, John D. Whiting, Secretary, American Colony Hostel, to District Commissioner, Jerusalem, 23 October 1943, ISA M 6553/15.

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concluded, on inspection, that this was ‘the best of its kind’ – faint praise indeed – and in any case it was ‘serving a very good purpose as otherwise the inmates would be on the streets in view of the lack of accommodation in government asylums’.25 It was not so much the shortcomings of private institutions in terms of their location, their bookkeeping, or even indeed their treatment of patients, as the possibility of their collapse which alarmed the mandate government and forced them into action. The institution at the heart of the crisis which developed across the early 1940s was the Bnei Braq mental hospital outside Tel Aviv, which had started small with just a few dozen patients in the late 1920s but within a decade was the single largest mental hospital in Palestine, accommodating over a hundred patients. Never officially recognised, the hospital was forced onto the government’s radar by the end of the 1930s by financial difficulties and the threat of imminent collapse. For the committee running the hospital, the cause of these financial difficulties was its charitable spirit, which led it to care for patients for free. As Dvora Kahanovitz, president of the society in charge of the hospital, explained, most patients were ‘of the poorest classes, whose families find it difficult at times to pay even … minimal charges’.26 As a result, the hospital struggled – even with subsidies from the municipality – to offset the costs of treatment and pay staff. In July 1938, the situation had reached such a critical point that staff went on strike in protest against the non-payment of their wages.27 It was one of a number of strikes that took place in the hospital in its final years. Though the strikers had arranged for at least one nurse or attendant to continue to safeguard patients across the hospital’s different wards, and some of the patients themselves took responsibility for maintaining sanitary conditions, a government inspection – discovering patients unwashed and undressed, and beds left unchanged even after patients had defecated in them – raised alarm about the threat of epidemic disease ravaging the hospital.28 With the day-to-day operation of the institution disrupted, and at the request of the mayor of Tel Aviv, the department of health intervened, deploying the local medical officer ‘to explore the possibilities of putting the Bnei Braq mental hospital on a proper working basis’. While a one-off 25 26 27 28

A/Senior Medical Officer to District Commissioner, Jerusalem, 12 November 1943, ISA M 6553/15. Dvora Kahanovitch, President of the Society for Mental Rehabilitation, Bnei Braq, to the Department of Health, 22 April 1941, TAMA 4-4737. PP, 21 July 1938, p. 2. Medical Officer of Health Settlements to Senior Medical Officer, Jaffa, 21 July 1939, ISA M 1752/20.

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contribution from government was raised as a possibility, the thrust of his recommendations was that the institution needed to be streamlined, both in terms of the number of its patients and staff, to ensure it could meet its running costs in future. In particular, following examinations by a specially convened committee of medical experts, the hospital was urged to discharge more than two dozen patients who ‘are neither homicidal nor suicidal nor have to be fed artificially’.29 The committee in charge of the hospital, and the mayor of Tel Aviv, protested this vehemently, but it seems that the hospital did ultimately make efforts in this respect. In November 1940, for instance, Abraham G., writing to the High Commissioner to plead for the admission of his wife into a government mental hospital, told of how his wife had been a patient at the Bnei Braq hospital for the past five years free of charge, until they had begun demanding money for her treatment and ultimately put her out on the streets – in his telling – when he was unable to pay.30 Far from forming separate and parallel health systems, here is a case of not simply close but also highly consequential interaction between the mandate department of health and a private Jewish mental hospital. These measures, though clearly carrying significant repercussions for patients and their families, did not succeed in resolving the institution’s financial troubles. In fact, the original issue – the proportion of patients who were unable to pay for treatment – worsened over time. In April 1941, a sixth of patients were being maintained entirely free of charge.31 On the eve of the institution’s collapse late in 1944, this proportion had risen to more than half: of 120 patients, only 16 had relatives who paid their fees; the social welfare department of the Tel Aviv municipality covered the costs of 19 more; other welfare bodies and local councils met the costs of 20 patients between them; the remaining 62 were ‘free patients’, and described as being ‘destitute’.32 As a result, further strikes by the hospital’s staff over non-payment of salaries broke out in January 1939 and later too.33 While the government offered emergency subsidies to the institution to prevent it from collapsing immediately and simply dumping its patients onto the streets, the deterioration of the hospital’s financial situation meant the government found itself at risk of funding it 29 30 31 32 33

Senior Medical Officer, Jaffa, to District Commissioner, Southern District, Jaffa, 31 December 1938, TAMA 4-4737. Abraham G., Tel Aviv, to High Commissioner, 21 November 1940, ISA M 6628/5. Medical Officer of Health, Settlements, to Senior Medical Officer, Jaffa, forwarded to Director of Medical Services, 2 June 1941, ISA M 6629/16. Medical Superintendent, Government Mental Hospital Jaffa, to Senior Medical Officer Jaffa, 7 October 1945, ISA M 6569/14. PP, 18 January 1939, p. 2.

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on a permanent basis.34 This was an unacceptable outcome for the department of health, and in particular George Heron, then in his final years as director of health and staunchly opposed – in the 1940s as in the 1930s, when the Ezrath Nashim hospital was in similar difficulties – to funding private institutions using government money. The institution, he argued, was organised in a deeply unsuitable way: its accommodation, stretched over a ‘dilapidated group of eight small houses’, was not fit for purpose, and made the running of the institution both more costly and difficult than it should have been.35 Faced with the prospect of pouring a potentially indefinite amount of money into propping up an unsatisfactory institution that had struggled to reform itself over the previous three years, Heron convinced the government to adopt his proposed solution: to convert another site, outside Jaffa, into a new government mental hospital, and to transfer patients at the Bnei Braq institution to this new hospital before closing it permanently. Even before the scheme had received approval from the Secretary of State for the Colonies in April 1943, preliminary work had begun on the site.36 In December 1944, the troubled Bnei Braq institution shut its doors for the last time. In one sense, this detailed reconstruction of the circumstances leading to the opening of the third government mental hospital and closure of the Bnei Braq hospital reinforces what has already been argued about the mandate and indeed colonial welfare more broadly: that investment in raising living standards and building up welfare services in the 1940s was not disinterested but rather a response to crisis and critique.37 In particular, the story of the establishment of the third government mental hospital chimes with Sherene Seikaly’s account of the mandate’s last decade. For Seikaly, it was the threat of wartime economic disaster which pushed the mandate to develop and deploy new institutions and technologies to weather unprecedented pressures. In her reading, the calorie – a new technology underpinning the ambitious rationing scheme introduced in Palestine in 1941 – was an innovation born not of managerial initiative nor any detached drive to rationalise, but rather as a response to the exigencies of war and political discontent.38

34 35 36 37

38

Statement forwarded by High Commissioner to Secretary of State for the Colonies, 12 January 1944, ISA M 323/30. Director of Medical Services to Chief Secretary, 5 May 1942, ISA M 323/30. Secretary of State for the Colonies to High Commissioner, 4 April 1943, ISA M 323/30. Michael Havinden and David Meredith, Colonialism and Development: Britain and Its Tropical Colonies, 1850–1960 (Abingdon: Routledge, 1993); Cooper, Decolonization and African Society; Norris, Land of Progress. Seikaly, Men of Capital, pp. 78–81.

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If this account of the mandate as buffeted into action by crisis resonates, in one key respect the history of psychiatric institutions is distinctive. The challenge of shaping a nutritional economy in wartime Palestine laid sharply bare how the expertise and capital of the Yishuv far outstripped the colonial government in the field of social welfare and nutrition.39 Rather than reveal Palestine’s European Jewish community as being straightforwardly more expert and better equipped than the mandate, however, a different picture emerges out of a reconstruction of the story of the third government mental hospital. Here, the immediate spark for action on the part of the mandate is the stumbling of a voluntary Jewish institution; far from revealing the mandate as lagging behind the Yishuv, the mandate had to step in to prop up the Yishuv when it stumbled. That the mandate fell into a pattern of intervening when private Jewish institutions like the Ezrath Nashim hospital in the 1930s or the Bnei Braq hospital in the 1940s encountered difficulties should be taken as a caution against exaggerating both the degree of separation between government and private Jewish health systems, and the strength of the Yishuv’s parastatal institutions before 1948. If, as Rakefet Zalashik has argued, the foundations of the Israeli mental health system were laid in the period before 1948,40 the cement which went into the making of that foundation was mixed in no small part with the mandate government’s help.

The Former Lives of a Mental Hospital Udi Aloni’s 2006 film Forgiveness takes place in an Israeli mental hospital established on the site of the Palestinian village of Deir Yassin. Depopulated in an infamous massacre perpetrated by Jewish militias in April 1948, in Aloni’s film the Holocaust survivors brought to the Kfar Shaul (‘borrowed village’) mental hospital commune with the ghosts of murdered villagers. ‘They can tell the ghosts of Deir Yassin how they are maintaining their sheikh’s tomb and horrors they experienced in Europe’, Aloni writes, and ‘[t]he ghosts of the villagers, in turn, can tell the Holocaust survivors of the olive trees, of the numerous wells that had to be dug because of water shortages, of the budding village industry, and of neighbourly cooperation with the Jews who were living nearby’.41 While the story of Deir Yassin and Kfar Shaul is certainly a striking example of this, it was far from uncommon for sites to be repurposed following 1948: as Eyal Weizman notes, evacuated British military 39 41

40 Ibid., pp. 95–6. Zalashik, Das Unselige Erbe, p. 17. Udi Aloni, What Does a Jew Want? On Binationalism and Other Specters (New York: Columbia University Press, 2011), p. 76.

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infrastructure in the West Bank and Gaza became the ‘nuclei’ for newly necessary refugee camps in the wake of the nakba, with Balata refugee camp near Nablus and Rafah in the south of the Gaza Strip two examples.42 Yet as we have seen already with the first two government mental hospitals, there was nothing new in this repurposing of older sites after 1948. Private institutions, too, cycled through multiple uses. Just a few hours after the final patients were transferred out of the Bnei Braq mental hospital, new residents moved in: over fifty refugees from eastern Europe, who were allowed to stay on the site rent-free by the proprietors, and who were greeted on arrival by neighbours with pots of food they had prepared for their own Sabbath meals. The new residents even inherited, thanks to the committee of the now defunct Bnei Braq hospital, the furniture and bedding left on site.43 The previous section used the story of the third government mental hospital to probe the dynamics of the relationship between voluntary and government provision for the mentally ill. This section shifts focus, attending instead to the history of the site which the hospital came to occupy, a layered history which speaks not just to the limits of the mandate’s investment in the question of mental illness but reveals the unusual range of actors who left their mark on the built environment that housed psychiatric patients after 1944. The first two government mental hospitals had been established on sites created as part of a boom in European missionary welfare work around Bethlehem in the late nineteenth and early twentieth centuries: the orphanage of the German Jerusalem Verein and the short-lived hospital of the Swedish Jerusalem society. The third mental hospital was different: it repurposed a site founded not by missionaries but established and used previously by the government itself. This site, located in the sand dunes to the south of Jaffa, was a harsh and seemingly unpromising one. And its uses before coming to host a government mental hospital were indelibly linked to politics, violence, and war. The site was originally intended for Palestinians displaced in the demolition of parts of the old city of Jaffa by British counter-insurgents in 1936; later, it was used as a detention camp for Italian prisoners of war during the early years of the Second World War. That psychiatric patients were the next group to inhabit this site is suggestive both of the way patients were viewed – as subjects along a continuum of confinements, in which lines between inmate and patient were blurred – and of the way this unhomely site itself came to be coded as suitable for particular inhabitants.

42

Weizman, Hollow Land, pp. 232–3.

43

PP, 31 December 1944, p. 3.

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The origins of this site are partly captured by the name sometimes given to it in discussions by the government: al-qarya al-ʿarabiyya (‘the Arab village’). This naturalised what was in fact a highly artificial site linked quite directly to British counter-insurgency during the great revolt. In June 1936, in the single most destructive example of the use of demolitions to facilitate military access to and control over urban space, the British army destroyed a large swathe of old Jaffa, displacing up to 6,000 residents of the city.44 With some of those displaced only given enough warning to evacuate with the clothes they were wearing and nothing more,45 it is unsurprising that no thought was given in advance to the question of where the displaced might be re-homed. A committee convened in August by the chief secretary to discuss the demolitions expressed its confidence that the displaced unable to find alternative accommodation on their own would be ‘few or none’, a confidence which rested on the assumption that ‘Arabs’ all had extended families to fall back on. For the few unable to find somewhere else to live, it was suggested they could ‘be accommodated on government land in hutments like those which had been erected in the detention camp at Sarafand’.46 The model of a detention camp in mind, a plot of land in the sand dunes several kilometres to the south of the old city was chosen, but by the end of the year little had been done to develop this site. With winter closing in, many of the families displaced by the Jaffa demolitions complained to the government welfare inspector, Margaret Nixon, that they had been unable to find somewhere else to live and were now suffering from the severe weather. Emergency accommodation in the form of hutments transported down from the detention camp at Sarafand was finally set up later that winter, but ‘the refugees declined to move into the new accommodation which had been provided for them and preferred to remain in their semi-demolished rooms or crowd into undamaged houses, rather than move their effects to more comfortable quarters’.47 By what measure the government determined these hutments ‘more comfortable’ was left unelaborated, but this was only the first in a series of setbacks in the government’s struggle to populate its ill-chosen site. The announcement of the Peel Commission’s partition plan in July 1937 complicated matters further, as the ‘Jaffa housing scheme’ was placed 44 45 46 47

See Figure 6.1. For this and other examples of demolitions as a strategy of British counter-insurgency, see Hughes, Britain’s Pacification of Palestine, pp. 177–93. Ibid., p. 180. Minutes of a meeting held in the Chief Secretary’s Office, Tuesday, 11 August 1936, ISA M 4141/4. High Commissioner to Secretary of State for the Colonies, 8 July 1937, ISA M 4141/6.

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Figure 6.1 ‘Cutting a new road through old Jaffa’, photograph by John D. Whiting, November 1936. From the John D. Whiting Photograph Collection, Library of Congress.

within the boundaries of the proposed Jewish state. Amid such uncertainty, only two Arab families had applied to rent houses on the site, with little sign that more would be forthcoming.48 While the government had built a hundred one-roomed houses on the site, uptake remained slow, and not simply because of political uncertainties: the high rent, and the location of the site – nearly 4 kilometres from the market centre of Jaffa on which many of the families depended for work and household 48

District Commissioner, Southern District, to Chief Secretary, 21 July 1937, ISA M 4141/6.

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supplies, and poorly connected by ‘roads’ which were often no better than sandy tracks – both made it deeply unattractive.49 Across 1938, improvements, including the planting of tamarisk cuttings along the boundaries of the site to combat encroachment by sand from surrounding dunes, led to a gradual uptick in applications;50 by the end of the year, 73 of the 104 houses were leased.51 But problems persisted: the tamarisk cuttings planted to try and staunch the drift of sand were threatened both by children and animals,52 and proved useless in high winds, when residents were forced to remove sand from the streets and buildings themselves.53 And though the site had been set up to re-home those displaced by British counter-insurgency violence, it certainly offered no shelter from further invasive actions by the British army: in December 1938, soldiers carried out a search operation, forcing open doors and causing damage to property;54 the same happened again in July 1939, leading one district engineer to protest – about damage to state property.55 In a final, tragically ironic twist, in September 1940 the government decided to convert the site into an internment camp for Italian families in Palestine, and the Palestinian residents were evicted, losing their homes yet again, within a month.56 The site thus entered the second phase of its life, as a detention camp. Extensive alterations were undertaken to make it suitable for this purpose: the erection of a 3-metre-high barbed-wire fence around the site, complete with raised sentry boxes; the conversion of some of the hundred or so one-roomed dwellings into communal kitchens, showers, and a sick bay and clinic; and the installation of hot water and electric light points.57 By November 1940, Italian internees had been transferred to 49 50

51 52 53 54 55 56 57

Acting District Commissioner, Southern District, to Chief Secretary, 1 October 1937, ISA M 4141/6. District Commissioner, Southern District, to Chief Secretary, 1 April 1938, ISA M 4141/6; Assistant District Engineer, Jaffa District, to Director of Public Works, 2 July 1938, ISA M 4141/6; Assistant Conservator of Forests to Director of Public Works, 29 August 1938, ISA M 4141/6. District Commissioner, Southern District, to District Engineer, Jaffa, 31 December 1938, ISA M 4141/6. Assistant Conservator of Forests, Southern District, to District Engineer, Jaffa District, 24 May 1939, ISA M 4141/6. Mukhtar of ‘the Arab Village’, to District Officer, Jaffa, 4 July 1940, ISA M 4141/6. District Engineer, Jaffa District, to Officer Commanding Bedfordshire and Hertfordshire Regiment, Jaffa, 7 January 1939, ISA M 4141/6. District Engineer, Jaffa District, to District Superintendent of Police, Jaffa, 16 July 1939, ISA M 4141/6. District Engineer, Jaffa District, to Director of Public Works, 1 October 1940, ISA M 4141/6. Inspector General of Police to Director of Public Works, 20 September 1940, ISA M 4141/6.

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the camp,58 and incorporated into the process of maintaining and altering its physical fabric. Four of them helped construct a large brick oven in February 1941, though their pay was delayed by months, to their frustration; they wanted the money to buy cigarettes.59 But problems continued to afflict the site. In January 1942, of the seventy-two rooms occupied by internees and police personnel, fourteen had leaked badly, as poor plasterwork and cracks in the walls and roofs failed to keep the winter rain out.60 In August that year it was reported that the sand had piled up to such an extent on the southwestern corner of the camp that it would now be an easy matter for someone to simply step over the barbed wire and escape.61 In spite of these issues, when the department of health settled on the site as their alternative to continuing to fund the Bnei Braq hospital, the proposal was met with resistance from the police. The inspector-general of police protested that the site was ‘admirably suited for the purpose for which it is now used’, and that it would be difficult, if not impossible, to find somewhere else that could accommodate over 200 internees, including 56 children.62 Across the summer of 1942, he even submitted alternatives to the health department for consideration: the Scots College at Safad, until recently used as a British police billet but no longer required for that purpose; the Jacir Palace in Bethlehem – a proposal swiftly dismissed on the grounds that there was a first-floor balcony which wrapped around the whole building, making it dangerously unsuitable for patients.63 But Heron, as director of health, continued to argue that no other site was as advantageous as that currently occupied by the detention camp: isolated, yet also – to the south of Jaffa and east of the Jewish settlement at Bat Yam – in an area both Arab and Jewish patients would feel able to access; already set up with key facilities, including roads, water supply, electrical lighting, kitchens, baths, latrines, and even a small hospital block; and big enough to accommodate up to 150 patients and 40 staff.64 No other site offered anything comparable,

58 59 60 61 62 63 64

Director of Public Works to District Engineer, Jaffa District, 27 November 1940, ISA M 4141/6. Assistant Inspector Commandant of Camp No. 13, Jaffa, to A.S.P. and J.S.P., Jaffa, 20 June 1941, ISA M 4141/6. Superintendent of Police, Lydda District, to District Engineer, Jaffa, 17 January 1942, ISA M 4141/6. Assistant Superintendent of Police, Jewish Settlements, Lydda District, to Superintendent of Police, Lydda District, 14 August 1942, ISA M 4141/6. Inspector General of Police to Chief Secretary, 23 May 1942, ISA M 323/30. Director of Medical Services to Chief Secretary, 23 July 1942, ISA M 323/30. Director of Medical Services to Chief Secretary, 5 May 1942, ISA M 323/30.

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and in February 1943, the camp’s Italian inhabitants were evacuated, apparently over the course of just a single day. The department thus acquired a site which had been designed for, occupied by, and even maintained with the labour of refugees and internees; a site bounded by tamarisk plants threatened by displaced Jaffan children and furnished with an oven built by Italian detainees in exchange for cigarettes. Only slowly were some of the most obviously inappropriate traces of these former uses of the site erased. The barbedwire fence, identified as dangerous in initial assessments of the site’s suitability,65 was a case in point. While the raised sentry boxes of the detention camp were removed by August 1943,66 replacing the barbedwire fences with corrugated iron sheets proved an arduous process: the wind ‘works like a snow-plough’, one inspection report lamented, and in just one night enough sand could be blown away that the sheets were left standing in the air, with space beneath them.67 Even after patients were admitted to the site late in 1944, the fencing remained a problem: some of the corrugated iron had been toppled by the sand and wind, while the barbed wire which had remained to secure the site from unwanted visitors had fallen into ‘such a state of disrepair that it can no longer be considered a protection of the premises’, the superintendent in charge of the hospital complained. The failure to devise a solution to the problem of fencing at the site, a problem which had plagued it even as a detention camp, had serious ramifications for the patients in a period of growing tensions, as the medical superintendent explained: Access to the hospital compound has thus become an easy matter and on more than one occasion, numbers of men and boys from the neighbouring village have been found looking into the windows of the single rooms, where excited female patients are. When asked to leave the premises they were extremely rude and refused to go away. Furthermore, seventeen cypress trees have recently been stolen from the compound. It is also impossible to keep a check on the resident nursing staff, who can come and go as they wish by day or night, a most undesirable practice under present conditions of insecurity.68

Proposals to replace this broken-down fencing made as late as September 1947 despaired over the continued presence of barbed wire, ‘[o]riginally erected for a detention camp’ and ‘hardly suitable for a

65 66 67 68

Ibid. District Engineer, Jaffa District, to Acting Director of Public Works, 25 August 1943, ISA M 4141/7. Inspection Notes by A.D.E., 11 January 1944, ISA M 4141/7. Medical Superintendent, Government Mental Hospital, Jaffa, to Senior Medical Officer, Jaffa, 10 July 1947, ISA M 4141/8.

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hospital for mental patients’.69 Given the lengths to which the department of health had gone in previous decades to ensure that mental hospitals did not look or feel like prisons, the persistence of the barbedwire fencing at the third government mental hospital underlines the sense that this was a short-sighted, emergency response to a crisis, one from which the ghosts of past uses proved difficult to exorcise. There were other, more innocuous forms that these legacies took: at some point in its past life, a tennis court had been built on the site, which the department of health continued to maintain once taking over; whether it was for use by patients or staff is unclear.70 But the built environment was only one element shaping patients’ experiences of the third government mental hospital. The staffing was another. Heron had argued that one of the advantages of the site was that it was ‘midway’ between Jewish and Arab areas; more than this, he had hoped Jewish administrative and nursing staff would be tempted to take up posts in the hospital so they could live by the sea at neighbouring Bat Yam.71 His hopes appear to have been realised: nearly half the staff were Christian, over a third Jewish, and the remainder Muslim. This was a marked departure from the first government mental hospital, where the staff were mostly Christian, and gave rise to a distinct pattern in rank and role: all administrative and medical staff were Jewish; the nursing staff were almost evenly split between Christian women and Jewish men, with a small number of Jewish women too; and the majority of the domestic staff were either Christian women or Muslim men.72 Alongside proximity to Bat Yam, what else seems to have shaped the staff demographics was the hospital’s assumption of responsibility for patients previously treated at Bnei Braq. The transfer of patients from Bnei Braq to the new mental hospital meant that an overwhelming majority of patients were Jewish: in March 1947, there were 183 Jewish patients at the hospital, and just 14 Muslim and 5 Christian patients.73 While it is not clear if the Jewish staff at Bnei Braq followed their patients to new jobs – lured perhaps by the promise of a more reliable salary than that irregularly provided by their struggling former employer – at the

69 70 71 72 73

District Engineer, Jaffa to Acting Director of Public Works, 10 September 1947, ISA M 4141/8. District Engineer, Jaffa District, to Acting Director of Public Works, 25 November 1945, ISA M 4141/8. A/Senior Medical Officer, Jaffa, to Director of Medical Services, 18 October 1945, ISA M 6573/7. Quarterly Financial and Progress Report in respect of the Government Mental Hospital, Jaffa, 17 January 1947, ISA M 323/30. Ibid.

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highest levels there was certainly continuity. The medical superintendent in charge of the hospital was Dr S. Heinsheimer, whose involvement with many of these patients predated this appointment; he had been a member of the board responsible for examining patients at the Bnei Braq hospital in the late 1930s as part of the department of health’s short-lived attempt to bring patient numbers and expenses under control.74 He was assisted by Dr Abraham Rabinowitz, whose connection with these patients was closer still; he had treated patients at the Bnei Braq hospital almost since it opened in the late 1920s.75 Neither of the first two government mental hospitals had been built from scratch for the purpose of treating the mentally ill, and both, in different ways, were shaped by the existence and travails of private Jewish institutions. Yet the third government mental hospital nonetheless stands out for the degree to which it bore the imprint both of its site’s past lives and of the institution it had superseded. For patients transferred here from the Bnei Braq hospital, the impact of the site’s inherited physical fabric would have been felt not only in the incongruity of carceral architecture like the barbed-wire fencing, but also in how it impinged on daily routines. Patients, like detainees and refugees before them, found themselves roped into the never-ending struggle against the sand; the archive affords a glimpse of this when in December 1946, a garden hoe was reported missing by the hospital, ‘lost in the sand by patients while working in the sand dunes’.76 Yet overlayered on top of these echoes of the site’s past lives, patients would have found much else about the mental hospital familiar: the doctors, at least some of the rest of the staff, and the majority of other patients too. Recovering patient experiences of this mental hospital from the archive is difficult, even more so than for its counterparts at Bethlehem. From what can be pieced together, however, it is evident that in a very real sense, the third government mental hospital at Jaffa would have felt as much the successor to the maligned Bnei Braq institution as it was the successor to the ‘Arab village’ for displaced Palestinians and wartime detention camp for Italian families. Little wonder, as we shall see in the Epilogue, that the families of some Jewish patients requested the transfer of their relatives from Bethlehem to this new hospital near Jaffa in the final, fraught years

74 75 76

V. L. Ferguson, Senior Medical Officer, Jaffa, to District Commissioner, Southern District, Jaffa, 31 December 1938, TAMA 4-4737. Dvora Kahanovitch, President of the Society for Mental Rehabilitation, Bnei Braq, to Department of Health, Tel Aviv, 22 April 1941, TAMA 4-4737. Schedule of Discrepancies at Government Mental Hospital Jaffa at Kiriat Arabieh, 20 December 1946, ISA M 6573/7.

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of the mandate; or that the State of Israel took over the running of this institution with such ease after 1948.77

Trauma, War, and Psychiatric Expertise in the 1940s The establishment of the third government mental hospital was not the only notable development of this period. The final decade of the British mandate also witnessed efforts to cultivate expertise across a dispersed set of areas within psychiatry. While the following chapter takes as its focus the introduction of new treatments like occupational and electro-convulsive therapy into government mental hospitals, the second half of this chapter attends to two less obvious areas in which psychiatric expertise was developed across the 1940s: trauma, above all in relation to the Second World War; and the construction of a curriculum for mental nursing. Just as the mandate’s investment in institutional provision for the mentally ill was not the result of careful planning but was rather forced by crisis and scandal, so too was its investment in building up psychiatric expertise – and indeed medical expertise more generally – halting, limited, and more often than not driven by pressure from elsewhere. While the expansion of government provision for the mentally ill was precipitated by the impending collapse of a private Jewish mental hospital, however, the impetus when it came to cultivating expertise in the department of health came from other sources: in the case of trauma, from the military; in the case of the new mental nursing curriculum, from those doctors, matrons, and indeed nurses who staffed the government mental hospitals. In the historiography of Palestine, the Second World War has been overshadowed by the events which bookended it: the great revolt, and the Palestinian nakba. Although the Second World War did not lead to heavy fighting within Palestine itself, the mandate – already militarised as a result of the British counter-insurgency over the late 1930s – became a strategically significant base during the war. As well as hosting troops drawn from across the British empire, during the war up to 30,000 Jews and 12,000 Arabs from Palestine volunteered to serve in the British army.78 Until 1944, when a separate Jewish Brigade was formed, volunteers served largely in mixed units in a range of capacities and indeed theatres of the war, including France, North Africa, and Greece.79 Many 77 78 79

Zalashik, Das Unselige Erbe, pp. 115–17. Ashley Jackson, The British Empire and the Second World War (London: Hambledon Continuum, 2006), pp. 141–2. Mustafa Abbasi, ‘Palestinians Fighting against Nazis: The Story of Palestinian Volunteers in the Second World War’, War in History 26, 2 (2019), p. 241.

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of these volunteers were trained at Sarafand, a military base to the southeast of Jaffa which had been used to hold detainees during the revolt and which grew rapidly with the outbreak of war into one of the main nerve centres of the British military in Palestine.80 Alongside a hygiene school, responsible for educating officers about good food, clean water, and dangerous insects,81 a psychoneurotic hospital was set up at Sarafand under the command of Major J. B. Lloyd, assisted by Brigadier R. F. Barbour, consultant psychiatrist to the Middle East Force.82 It was to this unit that psychiatric cases among service personnel were sent for treatment, though as we will see, this was far from a self-contained system for Palestinian volunteers – Jewish or Arab – identified as suffering from psychiatric disorders. Not only the remit – military cases – but also the approach of the psychoneurotic hospital was distinctive within the history of psychiatry in mandate Palestine. While government and private mental institutions were not totally uninterested in the question of the causes of mental illness, the cases which came before the psychoneurotic unit at Sarafand brought questions of causation front and centre. If a case could be attributed to military service, this carried significant implications in terms of the government’s responsibility for their maintenance, including after being discharged from military service. Discussions of these psychiatric cases, then, scrupulously avoided a language of trauma – which, even before the sanctification of post-traumatic stress disorder as a diagnostic category in the wake of the Vietnam War, directed attention towards the traumatising event as the culprit83 – and reached for a more ambiguous set of terms in order to delimit responsibility. This is made clear in discussions from a committee set up in the summer of 1943 to tackle the issue of pensions for ex-servicemen with disabilities. The committee, chaired by Dr John Macqueen of the department of health, divided the psychiatric cases into two types: psychotic and neurotic. ‘Psychotics’ were ‘truly mentally unbalanced persons’, whose permanent, full recovery was deemed highly unlikely, and who, it was argued, ‘would have developed their disease in civil life’; that being so, they were

80 81 82

83

Hughes, Britain’s Pacification of Palestine, pp. 240–1. H. S. Gear, ‘Hygiene, the Medical Officer, and the Middle East Campaign’, South African Medical Journal 19 (1945), p. 182. Interim report of committee appointed to consider assistance for Palestinian soldiers discharged from the army on medical grounds, enclosed by Department of Labour to Acting Director of Medical Services, 29 November 1943, ISA M 6618/17. There is a vast scholarship on the history (and politics) of trauma: for an introduction, see Mark S. Micale and Paul Lerner, eds., Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930 (Cambridge: Cambridge University Press, 2001).

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not eligible for pensions. ‘Neurotics’, by contrast, were those deemed to ‘have broken down under the unusual strain of war’. While this would appear to make their illness attributable to their military service, the committee argued that they too ‘would have broken down in any case under unusual strain at intervals during their lives whether in the forces or not, and if properly treated they recover’.84 What constituted ‘proper treatment’ was modelled by Major Lloyd’s handling of neurotic cases at Sarafand, an example approvingly cited at length by Macqueen: He said that, not only would it be wrong for the state to support even temporarily the neurotics from the administrative point of view, but also from the aspect of their own good. The worst treatment, he assured me, was to nurse these people. He spoke of 600 of them following El Alamein who, after two days rest were, in most cases, quite fit and ready to go back to the line, and recovered as they did so. If you let them slip into a convalescent camp where they find life easy and where they do not have to battle with their weaknesses, in three weeks they are parasites and you never get them out.85

While distinctive within the history of psychiatry in mandate Palestine, Lloyd’s approach – which proved so influential to the government officers charged with handling the issue of responsibility for ex-servicemen – was typical in relation to how such cases were understood and managed more broadly within the British army in the Second World War. Stung by the cost of pensions given out for psychiatric injuries following the First World War, and convinced this had been in part a result of ‘suggestion’, the British government had made it clear from the start of the war that there would be no compensation for those discharged for mental disabilities in order to ensure there could be no unconscious motives for developing psychoneuroses.86 This translated into what was styled a ‘no-nonsense’ approach to such cases on the ground. Like his counterparts at Sarafand, another consultant psychiatrist attached to the Middle East Force, G. W. B. James, explained high rates of recovery as a result of treating these patients as nothing more serious than cases of fatigue, labelling them as ‘exhaustion’, prescribing simple remedies – sleep and 84 85 86

Chief Secretary to Director of Medical Services, 15 July 1943, ISA M 6618/16. Minutes of the Second Meeting of the Committee on Palestinian Ex-Soldiers with Disabilities, 9 November 1943, ISA M 6618/16. See Ben Shephard, ‘“Pitiless Psychology”: The Role of Prevention in British Military Psychiatry in the Second World War’, History of Psychiatry 10 (1999), pp. 491–524; Mark Harrison, Medicine and Victory: British Military Medicine in the Second World War (Oxford: Oxford University Press, 2004), pp. 120–6, 170–83; and Edgar Jones and Stephen Ironside, ‘Battle Exhaustion: The Dilemma of Psychiatric Casualties in Normandy, June–August 1944’, Historical Journal 53, 1 (2010), pp. 109–28.

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rest – and ensuring ‘an atmosphere of active treatment’ in hospitals, where ‘the expectation of cure and return to duty should be adopted by therapist and patient as a matter of course’.87 While this treatment was to be delivered as near to the front as possible (‘forward psychiatry’), cases which proved unresponsive were sent on to one of the psychoneurotic centres in the region, like Sarafand.88 If the history of health and welfare in Palestine has been framed in terms of a dual model, the psychoneurotic unit at Sarafand would seem to constitute a third, parallel system, with its own distinct patient demographics and an approach underpinned by the needs and anxieties of military psychiatry. Yet here, as always, there were leakages across these systems, not least because – as the committee appointed by the mandate to discuss this question recognised – the ‘psychotic’ cases, whether their military service was deemed to have caused their breakdowns or not, would always eventually become the responsibility of the government to maintain in mental institutions. It was, after all, ‘the normal function of the state to provide for the insane’, the committee concluded, and over time, these cases would thus all ‘be absorbed into the mental institutions of the government’.89 In view of the ‘no-nonsense’ approach of the psychoneurotic unit at Sarafand, responsibility for these serious cases could quite quickly land on the government. As early as July 1940, the British general hospital in Jerusalem found itself grappling with this challenge: a locally enlisted Palestinian diagnosed with schizophrenia had been admitted to the hospital, and his family had failed to come and take charge of him when asked to do so; the hospital authorities wrote to the director of health to ask if they could transfer him to a government mental hospital as a discharged soldier instead.90 More cases followed. Between the summers of 1941 and 1943, forty-two were discharged from the army on the grounds of psychiatric disability. But they faced the same problem their civilian counterparts did: a shortage of beds in government mental hospitals.91 Reviews undertaken by the department of health near the end of the war reveal how Arab and Jewish cases, even those cases which were awarded financial support from the government, were set on different trajectories as a result. Of the twenty-eight ex87 88 89 90 91

G. W. B. James, ‘Psychiatric Lessons from Active Service’, The Lancet 246, 6382 (1945), pp. 804–5. Harrison, Medicine and Victory, pp. 122–4. Minutes of the Second Meeting of the Committee on Palestinian Ex-Soldiers with Disabilities, 9 November 1943, ISA M 6618/16. Precis of correspondence, OC No. 62 General Hospital to Director of Medical Services, 5 July 1940, ISA M 6618/16. Minutes of a meeting at the department of health, 13 August 1943, ISA M 6618/16.

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soldiers awarded financial support in 1944, for instance, more than half of Jewish cases were patients at a private mental institution near Bat Yam run by Shmuel Geffen, with the government subsidising their fees; the majority of the Arab cases, by contrast, were recorded as being cared for at home by relatives, who were also – exceptionally – given financial support by the government.92 Although the war had led to the establishment of the psychoneurotic unit at Sarafand, and the implementation of a distinctive approach to psychiatric cases among Palestinian volunteers, it was after the emergency circumstances of the war had actually passed and the mandate government took steps to review and finalise its obligations towards these cases that greater opportunity arose for Palestinian doctors to develop expertise around the question of trauma. Starting in late 1946, the government ordered medical experts from the department of health to examine and report on the current and probable future position of disabled volunteers. The first review was submitted in November 1946, and covered all Arab cases, including those with non-psychiatric disabilities.93 In February 1947, a review of Jewish psychiatric cases took place, led by Dr Malouf, as medical officer in charge of the Bethlehem mental hospitals, and Dr Rabinowitz, from the government mental hospital at Jaffa.94 Each reported separately on these cases; only Malouf’s reports appear to have survived. Strikingly, while Malouf agreed that these were all serious cases – the majority of the twenty-four cases were diagnosed with schizophrenia – in only one instance did he conclude that military service could reasonably be held responsible for their psychiatric condition: that of Joseph A. Malouf’s report on Joseph A. offers a clue as to why he did not return a similar verdict for any of the others, and introduces some of the considerations that he found himself weighing up as he cultivated expertise in an unfamiliar area of work. Joseph had joined the British army in 1943 and then the Jewish Brigade upon its formation in 1944, serving in Palestine, Egypt, and Italy. Crucially, Malouf reported ‘it is stated that he joined battle while in Italy’, and indeed was treated at one of the army’s psychiatric centres in Italy before being transferred to Palestine.95 In no other case did Malouf report that they had been actively involved in 92 93 94 95

List of soldiers discharged on medical grounds, enclosed to A/Director of Medical Services, 31 July 1944, ISA M 6618/9. Director of Medical Services, to Secretary, Government Committee for Disabled ExServicemen, 7 November 1946, ISA M 6618/14. For individual reports on these cases, see M. S. Malouf, Government Mental Hospital Bethlehem, to Director of Medical Services, 16 April 1947, ISA M 6618/14. Examination of Joseph A., 21 March 1947, ISA M 6618/14.

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combat. Indeed in some cases, the very opposite was emphasised: he argued that, for instance, one man’s ‘service in the army as a musician could not be reasonably said to have precipitated his mental condition’;96 another’s ‘service as a fitter in the RAF’ was similarly dismissed as a cause of his schizophrenia diagnosis.97 In these cases and others, alternative causes were proposed. The three women among these cases give a sense of the range of explanations Malouf offered in place of military service. In relation to the first, who volunteered in 1942 and had served as a nurse in Palestine and Egypt before her discharge in 1944 with a diagnosis of schizophrenia, Malouf turned to her family history: her father, he noted, ‘is said to be eccentric and of incestuous propensities’.98 The troubles of the second, who had served in some unspecified capacity within Palestine, were judged to predate the war: ‘[e]ven before joining the army she was unable’, Malouf commented, ‘to adjust herself well to the environment’.99 In the case of the third woman, who had served in Egypt in an army electrical mechanical store, Malouf delved even more deeply into her personal history. She was, he wrote, ‘nervous in her childhood’, and indeed – he continued, as if in explanation – ‘was divorced four years after her first marriage’.100 Family or personal histories could be similarly cited for the male cases, even where Malouf was able to offer a more detailed account of their military service. A particularly striking example of this is his report on Moshe L. Moshe, Malouf recorded, ‘showed signs of lack of adaptation even previous to joining the army in 1941’, a judgement made in relation to a number of other cases too. Yet it is Malouf’s detailed account of Moshe’s service which stands out; it is possible that Moshe, in a state of remission, was better able to recount and share his story than most. He had served in Palestine and Syria before being sent to Italy in 1943, ‘where he served mainly in detecting land mines and their removal’. ‘After the armistice’, Malouf’s report continued, ‘he went to Germany to look for his people and in May 1946 returned to transit camp No. 158 in Egypt where his first mental symptoms became apparent’. He went on to be admitted to a general hospital ‘in a state of confusion’, discharged from service on medical grounds, and subsequently admitted to the Geffen private mental institution at Bat Yam which treated so many of his peers.101 It is this detailed report that drives 96 97 98 99 100 101

Examination of Israel G., 12 February 1947, ISA M 6618/14. Examination of Arthur W., 21 March 1947, ISA M 6618/14. Examination of Lucy W., 12 February 1947, ISA M 6618/14. Examination of Charlotte B., 21 March 1947, ISA M 6618/14. Examination of Shifra M., 12 February 1947, ISA M 6618/14. Examination of Moshe L., 28 March 1948, ISA M 6618/14.

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home what was extraordinary about the wider process of review: here was a Palestinian psychiatrist evaluating the impact of the Second World War and, indeed, Holocaust on the mental state of a Jewish ex-serviceman on behalf of the British mandate government. And as in almost all other cases, Malouf came to the conclusion that military service had not precipitated mental illness and that the government’s liability was thus limited. Charged with reviewing government support for wartime psychiatric cases, Malouf worked both from his clinical experience of examining these individuals and ‘prevailing opinion amongst psychiatrists the world over’ to justify his recommendations. In an extended report submitted to the government in April 1947, we see Malouf thinking through the problem of psychiatric disability among veterans. Malouf’s starting point was the principle that ‘war and military service should not precipitate insanity in persons who have normal healthy, hereditary predispositions’; it was for this reason ‘millions of soldiers and civilians experienced all sorts of military service and war conditions and came out as fit as expected to be whereas a few soldiers broke down with insanity’.102 This was, as we have seen, the position adopted by military psychiatrists during the war: indeed, Malouf echoed Major Lloyd of the Sarafand psychoneurotic unit quite directly when he wrote that ‘many of these insane soldiers would have become insane had they lived a civilian life all through’.103 But it was also clear, Malouf continued, that at least in some cases military service was the precipitating factor in the development of ‘insanity’; it was important, therefore, to weigh up the role played by wartime experience on a case-by-case basis. One way of doing this was by identifying exactly what kind of duties an individual had undertaken since, as he put it, military service ‘ranges from clerical duties to actual combatant duties of modern warfare’. But here Malouf had run into two problems. In the first place, he had often been unable to obtain a full picture of an individual’s military service. And second, there was no general agreement about or official recognition of the particular forms of military service which precipitated breakdowns, so the decision came to ‘centre round the personal opinion of the doctors dealing with the cases’. In the absence of any standard point of reference, Malouf put together his own list of ‘war conditions’ which might qualify: ‘severe action, severe bombardment, severe discipline, overwork’.104 There were overlaps here with some of the conclusions reached by military 102 103 104

M. S. Malouf to Director of Medical Services, 16 April 1947, ISA M 6618/14. See above, and Shephard, ‘“Pitiless Psychiatry”’, pp. 498–9. M. S. Malouf to Director of Medical Services, 16 April 1947, ISA M 6618/14.

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psychiatrists attached to the Middle East Force, who suggested, for instance, that the single most important precipitating factor was the experience of dive-bombing or machine-gunning from the air.105 But it is clear that Malouf, although working with inadequate personal, family, and indeed service histories, reached these conclusions on the basis of his own work with disabled veterans; charged by the government to examine these cases, Malouf had seized the opportunity to develop more specialist knowledge of what was to become, in subsequent decades, labelled trauma. Although the Holocaust and nakba were to raise the stakes of understanding trauma in this context in different ways, even as Malouf was writing about the relationship between shocks and psychiatric disorders in the immediate post-war years this was far from solely a historic question. With the end of the Second Word War, Jewish paramilitaries stepped up their attacks on British personnel and infrastructure in Palestine. The department of social welfare reflected on the effects of this campaign: ‘[e]ach act of terrorism naturally leaves behind it a trail of social problems – not merely problems arising out of loss and bereavement but also the minor disasters … of nervous shock, loss of employment, and damage to property’.106 Medical reports on those injured in these attacks are refreshingly direct in acknowledging their traumatising potential, and indeed in using the language of trauma at all. The reports reveal attacks targeting Palestine’s railway network as particularly significant – perhaps unsurprisingly, given this was one of the largest employers of the period.107 Those affected were examined by medical boards, often made up of non-specialists, who interpreted the symptoms of insomnia, anorexia, trembling, depression, irritability, and neuralgia shown by affected individuals as signs of ‘traumatic anxiety neuroses’, and made recommendations about sick leave and their ability to return to work. An illustrative case, which underlines what was lost as well as gained in the development of a particular kind of psychiatric expertise around trauma in this period, is that of Mousa T., the driver of a train bombed in November 1946. He had suffered a concussion and physical injuries in the attack, and ‘a nervous breakdown with a state of anxiety’ ever since. Examined by a medical board in September 1947, nearly a year later, he was reportedly ‘apathetic and melancholic’, ‘very emotional’, and – exceptionally, among these cases – he claimed ‘that after his accident 105 106 107

H. B. Craigie, ‘Two Years of Military Psychiatry in the Middle East’, British Medical Journal 2, 4359 (1944), pp. 106–7. Annual Report, Department of Social Welfare, 1945–6, ISA M 5163/19, p. 9. For some of these reports, see ISA M 6640/22, ISA M 6640/22, and ISA M 6640/24. For the significance of the railways, from a labour history angle, see Lockman, Comrades and Enemies, p. 12.

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he became sexually impotent’. An unnamed specialist in nervous diseases was enlisted to help diagnose this unusually long-lasting case; they ‘did not find any organic neurological signs and found that the patient was suffering from a traumatic anxiety neuroses’.108 In the absence of any sign of lesions to the brain or spine, the kinds of signs medical doctors had sought out since the late nineteenth century,109 Mousa was nonetheless given a diagnosis denied to the ex-military cases being examined by Malouf at almost exactly the same time. As a result he was invalided from service and referred to the assessment board which would determine his government pension. The Second World War may have offered Malouf the opportunity to develop a specialist knowledge of wartime psychiatric cases, extending the expertise he had largely acquired on the job across the past two decades. But this specialist knowledge, acquired by immersing himself in the work of military psychiatrists who prided themselves on a ‘no-nonsense’ approach to psychiatric disabilities and whose priority was to prevent the emergence of a cohort of costly ‘parasites’, may have come at a price for those who found their wartime service dismissed, and their family and personal histories probed, in the hunt for an inexpensive culprit to hold liable for their condition.

Professionalising Mental Nursing The Second World War provided an important impetus to the development of specific forms of psychiatric expertise around wartime trauma. But the last decade of the mandate was also notable as the period in which Palestine’s medical community underwent a process of professionalisation and organisation, marked above all by the formation of the Palestine Arab Medical Association in 1944.110 Emerging out of more local medical societies at Jerusalem, Jaffa, Haifa, and Nablus, some of whose origins stretched back to the last Ottoman years,111 the association organised meetings, published its own medical journal, and sought to influence government policy. As Liat Kozma and Yoni Furas argue, this 108 109

110 111

District Medical Board Report on Mousa T., Haifa District, 10 September 1947, ISA M 6640/23. Ralph Harrington, ‘The Railway Accident: Trains, Trauma, and Technological Crises in Nineteenth-Century Britain’, in Micale and Lerner, eds., Traumatic Pasts, pp. 31–56. For the hunt for lesions in the First World War, see Tracey Loughran, Shell-Shock and Medical Culture in First World War Britain (Cambridge: Cambridge University Press, 2017), pp. 93–100. PP, 24 September 1944, p. 3. Kozma and Furas, ‘Palestinian Doctors under the British Mandate’, p. 104.

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move by Palestinian doctors to organise themselves independently of the department of health was a continuation of a pattern across the period: far from receiving support and encouragement from the mandate government, the expansion and professionalisation of the Palestinian medical community was despite or even in opposition to, rather than because of, British rule.112 A meeting of the medical superintendents of government hospitals in July 1947 makes clear how little the government had done to cultivate expertise, even by the eve of the end of the mandate. The kinds of improvements demanded at this meeting reveal the absence of even some of the basic infrastructures which might support the development of specialist medical knowledge in the department of health. They urged the creation of a central library, with ‘all modern standard books, health reports, and statistics as well as the collected volumes of medical journals’; that all hospitals be provided with reference texts; that medical journals, for which subscriptions were in fact already being paid, be made properly available; and that a bulletin of the clinical activities of hospitals across Palestine be compiled and circulated monthly.113 This neglect was typical of a wider pattern. Across the mandate decades, no medical school was established within Palestine. Yet the number of Palestinian university-trained medical doctors grew across this period. In 1914, there were twenty Arabic-speaking universitytrained doctors in Palestine; by the end of the mandate this figure had increased more than tenfold.114 Many of those who took up positions within the department of health owed their medical qualifications to the American University of Beirut, and their earlier education to missionary schools.115 Just as the mandate government took advantage of buildings constructed by missionaries for use as government mental hospitals, so too did it benefit from the education many of its medical officers had received before or after the First World War at mission schools. It was in the face of this persistent underinvestment that the Palestine Arab Medical Association, under the presidency of Dr Tawfiq Canaan – an alumnus, like so many of his colleagues, of the American University of Beirut – sent its own list of proposals to the health department following a

112 113

114 115

Ibid., p. 88. For the anti-colonial politics of Tawfiq Canaan, a key figure in the Palestine Arab Medical Association, see Nashef, ‘Tawfik Canaan’. It was also suggested monthly clinical demonstrations of important cases be held with discussions, and symposia put on across the year devoted to particular subjects for the entire health service, with lecturers invited from outside Palestine. See H. Lehrs, Medical Superintendent of the Hospital for Infectious Diseases at Bayt Safafa, to Director of Medical Services, 8 July 1947, ISA M 6576/28. Kozma and Furas, ‘Palestinian Doctors under the British Mandate’, p. 87. Ibid., pp. 96–8.

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conference in July 1945, in the hope of prompting change. These included the proposal that ‘one or more Arab doctors should be sent yearly to British universities for specialisation’, since ‘[n]o real scientific work and no real service can be ever done to the country without a backbone of specialists’.116 The idea that expertise might serve or even save Palestine was by no means unique or particularly pronounced in the field of medicine: as Sherene Seikaly has shown, from the onset of the Second World War in particular a set of ‘men of capital’ in Palestinian society had come to place their hopes for the future of the nation in the discipline of economics.117 The attention paid to psychiatry specifically in this wider project of the cultivation of medical expertise was minimal, however. Launched in 1944, the journal of the Palestine Arab Medical Association did not contain a single article on psychiatry or psychology.118 Instead, it published on malaria, tuberculosis, fertility, and childbirth, as well as on the importance of medieval Arab doctors to the history of medicine.119 In that respect, its interests reproduced those of the health department, which had long prioritised infectious diseases – above all malaria – as a public health objective.120 In overlooking psychiatry, the association mirrored the long-standing neglect which characterised the government’s approach to psychiatric expertise, too. This neglect is most evident in Dr Malouf’s career. In spite of being responsible for the only mental hospitals operated by the mandate government until 1944, Malouf routinely reported in his annual reviews that he had not taken any special courses of instruction; we might suspect he was simply too busy to be released for specialist training.121 The opportunity he was afforded during the Second World War to cultivate expertise on trauma is the exception that proves the rule: in this instance, his research was encouraged by the government in order to minimise their financial obligations to wartime psychiatric casualties. Only in the late 1930s was there a serious attempt to train up an assistant for Malouf, when Dr F. I. Haddad, 116 117 118 119 120

121

General Secretary and President of the Palestine Arab Medical Association, to Director of Medical Services, 15 July 1945, ISA M 325/19. Seikaly, Men of Capital, pp. 32–5, 106–9. Though the absence of the latter is hardly surprising, given its emergent status across the region in this period: see El Shakry, The Arabic Freud. For this latter, see I. B. George, ‘Foreword’, al-Majalla al-Tibbiyya al-‘Arabiyya alFilastiniyya 1, 1 (1945), pp. 1–4. For Sufian, this is consistent with a wider colonial prioritising of infectious diseases to protect the health of imperial armies, administrators, and settlers. Sufian, ‘Arab Health Care during the British Mandate’, p. 14. See, for example, annual confidential report, M. S. Malouf, 25 November 1931, ISA M 5131/20.

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a medical officer at Haifa, secured a scholarship to undertake a course of training in medical psychology at the Maudsley Hospital and the Institute of Medical Psychology, London, and attend psycho-therapeutic clinics at the West End Hospital for Nervous Diseases.122 But Haddad died in 1939, and this plan of providing Malouf with expert support never came to fruition.123 Though cultivating psychiatric expertise among Palestinian medical doctors was a priority for neither the department of health nor for the Palestine Arab Medical Association, it would be a mistake to think that expertise and professionalisation were concerns in relation to doctors alone. These were also live considerations for psychiatric nurses and attendants, too often overlooked or dismissed within the historiography of colonial psychiatry.124 The 1940s saw important efforts to develop a specialist mental nursing qualification – mental nursing being the only term used at the time and so adopted here, too. Regulations for the training of nurses had first been issued in 1919,125 reissued in 1923,126 and a full syllabus prepared in 1925,127 though as Julia Shatz has noted, until 1930, only a quarter of nurses who qualified were trained at government hospitals; here as elsewhere the mandate outsourced to voluntary institutions, in this case mission hospitals.128 As part of their general training, nursing students received only a cursory introduction to the subject of mental illness (‘insanity’) in their third and final year of study.129 With little opportunity for specialist training embedded in the general nursing syllabus, in 1929, John Macqueen – at the time senior medical officer at Jerusalem – proposed a training course for mental nurses. Rather than a full nursing course, he envisaged a tightly focussed sixmonth series of weekly lectures, evidently intended to allow nurses who had completed or nearly completed general training to develop specialist knowledge under the supervision of the department of health’s most experienced practitioners. Students on the proposed course would have been lectured by the matron of the first government mental hospital on 122 123 124

125 126 127 128 129

Annual Report, Department of Health, 1937, p. 4. Annual Report, Department of Health, 1939, p. 1. For two important exceptions, see Shula Marks, ‘The Microphysics of Power: Mental Nursing in South Africa in the First Half of the Twentieth Century’, in Mahone and Vaughan, eds., Psychiatry and Empire, pp. 67–98; and Quarshie, ‘Contracted Intimacies’. Annual Report, Department of Health, 1925, p. 23. Circular No. 127, Director of Health, 26 February 1923, ISA M 6579/23. Director of Medical Services to Medical Officers, 15 January 1941, ISA M 6579/23. Shatz, ‘A Politics of Care’, p. 673. Regulations for training of nurses in Palestine, 26 February 1923, ISA M 6579/23.

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the nature of mental disorder, the duties and responsibilities of nurses towards patients, and various specific states like hysteria, mania, delusion, alcohol and drug addictions, and general paralysis of the insane, and by Dr Malouf on anatomy, sensation, memory, the will, and the causes as well as symptoms (examples given included ‘eccentricity; collecting rubbish; degraded habits; sexual depravity’) of mental disorders.130 The idea of a mental nursing course appears to have fallen by the wayside, however, across the 1930s. In the early 1940s, following the reform of nursing training in general,131 it was revived, when Macqueen – now the director of medical services – rediscovered and sent copies of his old proposal to Malouf and the matrons at the two mental hospitals at Bethlehem for feedback.132 The responses were critical. Annie Muir Hunter, matron at the second mental hospital, rejected the syllabus as ‘not comprehensive enough for the training of mental nurses’. Instead of the six-month course proposed by Macqueen, Hunter argued a three-year course with the award of a certificate at completion would bring the standards of training of mental nursing in Palestine in line with those of Britain, and moreover ‘encourage girls of better education to enter the mental hospitals’.133 Malouf agreed, though he allowed that nurses who had already graduated from training at a general hospital might take a shorter, two-year version of the course.134 In this instance, the department of health’s attempt to commit the minimum of resources needed to invest in developing expertise in mental nursing was rejected as inadequate; the mandate’s muddling through was overturned by the collective opposition of the medical and nursing practitioners responsible for the mental hospitals. In July 1944, as a result, a committee was set up with a remit to develop the syllabus of the fuller, three-year certificate course. Made up of Malouf, Hunter, and one of the nurses – Miss O. Jupp – and the clinical assistant – Dr Joseph Klemperer – from the Bethlehem mental hospitals,135 it met three times

130 131 132 133 134 135

Draft syllabus attached by Senior Medical Officer, Jerusalem, to Medical Officer and Matron, Government Mental Hospital Bethlehem, 26 September 1929, ISA M 6579/23. Circular No. 35/42, by Director of Medical Services, 3 July 1942, ISA M 6579/23. A/Director of Medical Services to Senior Medical Officer, Jerusalem, 9 June 1944, ISA M 6579/23. Matron, Government Mental Hospital No. 2 Bethlehem, to Senior Medical Officer, Jerusalem, 29 June 1944, ISA M 6579/23. Medical Officer, Bethlehem, to Director of Medical Services, 30 June 1944, ISA M 6579/23. A/Director of Medical Services to Malouf, Klemperer, Hunter, and Jupp, 17 July 1944, ISA M 6579/23.

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over the summer of 1944. By the end of the year their proposed syllabus for training in mental nursing had been approved, and the course advertised to start in October 1945.136 The committee’s report offers a rare insight into what those most closely involved in the running of the government mental hospitals thought mental nursing students should learn. In part, this was – as Hunter had urged in her response to the initial six-month proposal – about bringing standards in line with those in Britain; the committee, for instance, recommended the government acquire copies of the so-called ‘Red Handbook for Mental Nurses’, published under the authority of the Royal Medico-Psychological Association in England.137 And indeed the organisation of the syllabus mirrored, in important ways, the training given to mental nurses in Britain since the late nineteenth century, which had aimed, fundamentally, to equip asylum attendants with a sufficient understanding to administer first aid, particularly in response to the kinds of accidents and injuries that were thought common to the asylum context.138 Thus in their first year, students in Palestine were given lectures on anatomy and physiology, first aid, hygiene, and elementary nursing, the last of which introduced subjects like ‘the special care of homicidal, suicidal, escapee, and patients with self-injury tendencies’.139 The importance of this was reflected in the examinations for the course, which asked, for instance, students in 1947 to identify ‘the duties of a nurse in regard to a) suicidal patients and b) homicidal patients’.140 The second year – when nurses with general certificates could join – built on this foundation through lecture courses on general principles and practices of nursing, on infectious diseases and the spread of infection, on the anatomy and physiology of the brain and nervous system, and on materia medica. This final course placed heavy emphasis on explaining the use of ‘sedatives in common use in mental hospitals’: sulphonal, paraldehyde, veronal, luminal, and bromides.141 In the third year, training became more specialised still, with courses on psychology, on nervous and mental diseases and their special nursing 136 137

138 139 140

141

Circular No. 101/44 by A/Director of Medical Services, 19 December 1944, ISA M 6579/23. Medical Officer, Bethlehem Mental Hospitals, to Director of Medical Services, 22 November 1944, ISA M 6579/23. For the ‘Red Handbook’, see Peter Nolan, A History of Mental Health Nursing (Cheltenham: Nelson Thornes, 1993), p. 64. Nolan, History of Mental Health Nursing, p. 66. Syllabus of the Lectures on Mental Nursing, 6 December 1944, ISA M 6579/23. Examination questions, included in Director of Medical Services to Medical Superintendents of Government Mental Hospitals, Bethlehem and Jaffa, 18 December 1947, ISA M 6579/21. Syllabus of the Lectures on Mental Nursing, 6 December 1944, ISA M 6579/23.

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requirements, and a one-off lecture on mental deficiency, covering ‘idiots, feeblemindedness, imbeciles, amentia’ – all terms used at the time to convey differing degrees of intellectual disability. The inclusion of just one lecture on the latter underlines the prioritisation of the ‘actively insane’ – to borrow the crude but revealing terminology of the 1931 census – within mental institutions; the home and family, not the mental hospital and mental nurse, were envisaged as the appropriate sites and agents of care for these groups. Of the remaining two, the psychology course opened with lectures on the brain, consciousness, and indeed the sub-conscious, before moving on to mental illnesses, their causes, and symptoms. The focus here was clearly on equipping nurses to judge a patient’s mental condition by recognising the symptoms of the various groups of mental disorder. The other course for finalists, on nervous and mental diseases and their special nursing requirements, was even more practically oriented: in the first lecture, for instance, nurses were taught how to care for, feed, and protect patients with epilepsy and Huntingdon’s chorea; in the third lecture, they were given special rules for the protection of melancholics; in the fifth, methods of restraining violent patients were discussed, including manual, chemical, and mechanical restraints; while the final three lectures in the series dealt with the importance of occupation and recreation, the so-called ‘modern therapies’ – electric shock, cardiazol shock, and insulin therapy – and the removal and transfer of patients.142 Composed of intensive lecture courses, summer exams, and year-round practical training, the mental nursing syllabus was demanding – perhaps too demanding, Malouf conceded in October 1947. ‘It was found out from practical experience during the last two years’, he reflected, ‘that the syllabus of lectures in mental nursing for the second-year nurses is more than could be assimilated by the pupils’. With the end of the mandate on the horizon, Malouf was still mulling a reorganisation of the syllabus, with lectures on the anatomy and physiology of the nervous system as well as on the mind in health pushed back into the third year.143 There were other teething issues too, beyond the course’s content. The language of instruction and examination was English, rather than Arabic or Hebrew.144 This quickly proved an obstacle to recruitment. In January 1945, it was reported that none of the male nurses already working at the second

142 143 144

Ibid. Medical Superintendent, Government Mental Hospitals Bethlehem, to the Director of Medical Services, 7 October 1947, ISA M 6579/21. A/Director of Medical Services to Senior Medical Officer, Jerusalem, 13 October 1944, ISA M 6579/23.

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government mental hospital wanted to take the mental nursing training or examinations ‘mostly due to the fact that the examinations are to be in English’ and ‘[t]he majority of the staff know nothing whatsoever of this language’.145 The expert committee, comprising medical doctors and British nurses, had devised a demanding syllabus and called for an increase in pay for mental nurses in the hope these measures could raise the ‘quality’ of nursing recruits, and draw ‘girls of better education’, as Hunter put it. But these requirements threatened to exclude those already employed at the government mental hospitals from the opportunity to formally develop their specialist knowledge. In the end, the development of the new training course appears to have failed to widen the pool of recruits for mental nursing: the vast majority of those registering for the course were already working at one of the government’s mental institutions. Everyone who registered for the training in its first year running was already working at the first government mental hospital; indeed they had been selected by the matron ‘as suitable for training’.146 By contrast, none of the nursing staff at other institutions, whether the government hospital in Jerusalem or the infectious diseases hospital at Bayt Safafa, were reportedly interested in this training.147 In view of the importance of ensuring existing employees of the department of health could access this training, then, by March 1946 reforms to the syllabus were proposed, including ‘some system of training for Arab girls who cannot read and write English’.148 If the organisers of the course appeared to give up their hopes of recruiting ‘girls of better education’, able to learn and pass exams in English, the course also seems to have failed to encourage enrolment among the other key demographic long identified by the department of health as a target for recruitment: Muslim women. Of the six nurses registered to begin training at the start of 1948, only one was Muslim – a man from Bethlehem, Tewfic Khalil Shahin. The rest were Christian; some, like Nasrat G. Nassar, had been employed at the Bethlehem government mental hospital since 1931 and indeed occupied a relatively senior role in the hospital’s staff as a bash tamurgi, or head attendant.149 Where the 145 146 147 148 149

Government Mental Hospital No. 2, Bethlehem, to Director of Medical Services, 10 January 1945, ISA M 6579/23. Sisters, Government Mental Hospital Bethlehem, to Senior Medical Officer, Jerusalem, 17 February 1945, ISA M 6579/23. Government Mental Hospital No. 2, Bethlehem, to Director of Medical Services, 10 January 1945, ISA M 6579/23. Suggestions by W. Farrer, Matron, Government Hospital, Jerusalem, 3 March 1946, ISA M 6579/22. Applications for Registration or Notification of Registration etc of Nurses Under Training, ISA M 6579/21.

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mental nursing course did, in fact, succeed in widening the pool of nursing recruits was not in relation to Muslim women but Italian nuns. With the assistance of the Latin Patriarch of Jerusalem, the department of health reported in 1946, it had been possible to obtain the services of the Sisters of the Order of St Dorothy for nursing work at the first government mental hospital. Alongside this work, some of the sisters registered for training in mental nursing:150 in 1947, three nuns sat the first-year examinations; a fourth, Sister Pia Rosaria Montagna, was meanwhile enrolled for the second-year examinations.151 Why – with notable exceptions like the Sisters of St Dorothy – such long-serving members of staff at these institutions registered for training might well be explained in terms of seizing the opportunity, hitherto unavailable, to develop their knowledge of mental nursing further, in a more theoretical rather than hands-on way. But it is also important to recognise the practical advantages that attached to the mental nursing certificate. In February 1945, two senior nurses at the second government mental hospital – Afifeh Yacoub and Wadad Shami – were denied promotion on the grounds that ‘they are not trained’.152 We find an Afifeh Y. Abu Daya – almost certainly the same woman as Afifeh Yacoub – among those registered for the course later that year.153 As Julia Shatz has argued, nurses in mandate Palestine conceived of themselves not only in terms of relationships of care, but as employees of the department of health, for whom issues like working conditions, benefits, and pay also mattered;154 the same conclusions should be extended to mental nurses, too. Afifeh’s enrolment in the mental nursing course appears an economically rational move intended to enable her to secure promotion, with all the benefits that came with it. But digging deeper into Afifeh’s story reveals there was more than just economic rationality at work here; this was also a question of dignity and respect for nurses as employees, professionals, experts. In the summer of 1947, as Afifeh completed her second year of studies for the mental nursing certificate, an incident occurred at the government mental hospital at Jaffa, where she was then working, involving the excessive destruction of linen by patients. Furious, the medical officer in 150 151 152 153 154

Annual Report, Department of Health, 1946, p. 16. List of successful candidates for Palestine Mental Nursing Examinations, November 1947, M 6579/21. Senior Medical Officer, Jerusalem, to Director of Medical Services, 16 February 1945, ISA M 6543/12. Matron, Government Mental Hospital Bethlehem, to Senior Medical Officer, Jerusalem, 30 January 1945, ISA M 6579/23. Shatz, ‘A Politics of Care’, pp. 681–4.

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charge of the hospital, Dr Heinsheimer, launched a formal investigation. Afifeh found herself caught up in this investigation, and was one of the nurses interrogated by a board of enquiry about how it was that the patients apparently under their supervision had managed to do so much damage. Afifeh’s testimony offers us a rare glimpse into the perspective of a mental nurse: I am for eighteen years in service of mental patients. When patients are excited they exert their energies in tearing up sheets and clothing. I have seen many such instances. At times it occurs in our presence and we try to prevent them, most of the time we are successful. Damage is reported to matron. At times, very excited patients are placed in a second room without clothes.155

Afifeh’s testimony and the testimony of other nurses made it clear that the fundamental problem was a shortage of staff, which made it impossible to keep patients under observation at all times. What also shines through in her testimony is her sense of professional pride (‘most of the time we are successful’), even in the face of such challenges. But Heinsheimer, ignoring the fact that nurses like Afifeh had nearly two decades of experience in mental nursing, and had explicitly drawn upon that experience (‘I have seen many such instances’) to explain the situation to the board, cited ‘their lack of experience in mental treatment’ as in part explaining the incident. He continued: ‘They are still in the initial stage for the care of mental cases, and it is only with hard experience that they could be of any help.’156 One can well imagine how the weight of this and similar experiences over decades, crosshatched with hierarchies of profession, gender, and race, had led Afifeh and others like her to hope that the highly legible form of expertise conferred by the mental nursing certificate might safeguard her professional dignity and enable the expertise she had built through hard-won experience to be recognised at last. Conclusion The final decade of the mandate was a seemingly unpropitious period to invest in either psychiatric institutions or expertise. Beginning with the Arab revolt and its brutal suppression, bisected by the Second World War, and concluding with a paramilitary campaign waged against the British and a civil war between the Yishuv and the Palestinians, these 155

156

Proceeding of Board of Enquiry Held to Enquire into the Cause of Excessive Destruction of Linen at Government Mental Hospital Jaffa, 1 and 4 September 1947, ISA M 6573/7. Ibid.

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years were nonetheless marked by a series of developments in the history of psychiatry in Palestine. This chapter has focussed on three of these: the opening of a third government mental hospital, tipping the balance between government and voluntary provision in favour of the former for the first time; the cultivation, through a reading of the relevant scholarly literature and clinical experience, of specialist knowledge in war-related traumas by the department of health’s foremost psychiatric expert; and the crafting of an ambitious new mental nursing course that would impart specialist training and professional recognition to those responsible for the day-to-day care of the mentally ill in government institutions. Taken separately, these do not, perhaps, amount to much; taken together, they give a sense of gathering momentum, of a growing commitment to developing knowledge and practice in one branch at least of Palestine’s welfare services, even possibly of the stirrings of a new phase in the history of development ultimately cut short with the termination of British rule in May 1948. This impression of gathering momentum is developed further in the next chapter, which explores the introduction of new forms of treatment for the mentally ill into mental institutions in Palestine across this same decade. Yet what is clear from the three distinct episodes examined here is that these commitments and investments seldom followed any systematic blueprint, whether that laid out by the committee on development and welfare services in 1940 or any other. Instead, investments in psychiatry were haphazard and reactive. This was true even when they were demanded or approved by the nerve centre of the mandate government in Jerusalem, as the case of the improvised third government mental hospital reveals. Its story proved irremediably entangled with that of two other institutions: a struggling private Jewish hospital at Bnei Braq and a site variously used as a resettlement and detention camp. And frequently, these investments were made independently of or even in spite of, rather than because of, the mandate government: driven by the exigencies of war and the wider logic of military psychiatry and compensation in the Second World War, or founded on the refusal of staff at the Bethlehem mental hospitals to accept a skeletal six-month mental nursing course proposed by the director of health. Whether in the bids of doctors like Malouf and his colleagues in the Palestine Arab Medical Association to seize and create opportunities for acquiring expertise, or in the struggles for dignity at work by nurses like Afifeh Yacoub, attempts to build psychiatric expertise on the eve of the end of empire were deepened, if not driven, by Palestinians – more so than by any British plan to set in motion a second age of colonial development, a second mandatory occupation.

7

Treating the Mentally Ill Work, Drugs, and Electricity

In August 1925, the British medical journal The Lancet published a letter from one Jamil F. Tutunji, who signed himself off as a medical doctor from Palestine. Tutunji wrote to raise ‘questions as regards the WagnerJauregg treatment of dementia paralytica’. In 1917, the Viennese psychiatrist Julius Wagner-Jauregg had treated neurosyphilis – general paralysis of the insane or, as Tutunji put it, dementia paralytica – by inducing malarial fever in patients; in 1921, he publicised the success of this method.1 His announcement triggered a period of frenetic experimentation with therapeutic methods that targeted the body to heal the mind, in Palestine as elsewhere.2 Tutunji, drawing on the results of his own preliminary experiments, suggested in his letter to The Lancet that the key to this method’s effectiveness lay not in anything specific to malaria but rather in the changes in body temperature which it eventuated. He hypothesised similar symptoms could be induced by intramuscular injections of colloidal sulphur – but he had not yet, across eight years of practice as a medical doctor, encountered a single case of general paralysis of the insane on which to test this theory. ‘This may be due’, he wrote, ‘to the fact that malaria is endemic in this country and syphilis comparatively rare.’ In the absence of any opportunity to test this himself, he was writing to bring his hypothesis to the attention of the journal’s readers in the hope that they might be able to trial it on his behalf and report back.3 Six years later, Tutunji wrote once more to the editor of The Lancet, this time angrily. Since his letter, two papers had been published in the

1

2

3

For an account of the development of this treatment, see Edward Brown, ‘Why WagnerJauregg Won the Nobel Prize for Discovering Malaria Therapy for General Paresis of the Insane’, History of Psychiatry 11 (2000), pp. 371–82. Edward Shorter and David Healy, Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness (New Brunswick: Rutgers University Press, 2007), p. 5; Joel Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley: University of California Press, 1997), pp. 71–94. Djamil F. Tutunji, ‘Subcutaneous Injection of Colloidal Sulphur in Neuritis’, Lancet 206, 5321 (1925), p. 408.

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journal which appeared to prove his hypothesis correct. Neither, however, had acknowledged him in any way. With this method of treatment being embraced enthusiastically in psychiatric institutions around the world,4 Tutunji demanded recognition as ‘the first physician to suggest the treatment of G.P.I. by injection of sulphur’.5 At least one report published subsequently in the journal did take care to credit him with the initial suggestion – albeit in its penultimate sentence.6 Elsewhere, his contribution continued to go unacknowledged. A moment of deep professional frustration for Tutunji, in a sense this episode represented a dead end in the history of psychiatry in Palestine too, for precisely a reason Tutunji had identified: few cases of general paralysis of the insane were ever admitted to mental institutions in Palestine, and so fever treatment – however induced – was rarely used.7 Yet in another sense, this story marks a beginning, not an end; other techniques that worked on the body to produce therapeutic results pick up where the history of fever treatment leaves off, and were increasingly implemented across mental institutions in Palestine in the final decade of the mandate period. This chapter focusses on three of these methods of treatment: patient work; drugs, in particular insulin and cardiazol; and electro-convulsive therapy. While these techniques shared a common focus on the body as the site of their intervention, each worked on the body in a distinct way: encouraging it to perform work; penetrating it with injections of drugs; or stimulating it through the application of an electrical current. And they followed starkly divergent trajectories within government mental institutions in Palestine, with patient work implemented to little acclaim across the period, insulin- and cardiazol-shock therapy shunned in favour of the use of sedatives, and electro-convulsive treatment enthusiastically and recklessly embraced following its apparently successful introduction in private Jewish mental hospitals years earlier. Taking these three methods of treatment together, this chapter

4

5 6 7

Waltraud Ernst, ‘Practising “Colonial” or “Modern” Psychiatry in British India? Treatments at the Indian Mental Hospital at Ranchi, 1925–1940’, in Thomas Mueller and Waltraud Ernst, eds., Transnational Psychiatries: Social and Cultural Histories of Psychiatry in Comparative Perspective, c. 1800–2000 (Newcastle: Cambridge Scholars Publishing, 2010), pp. 92–4. Djamil F. Tutunji, ‘Treatment of G.P.I. by Injection of Sulphur’, Lancet 215, 5574 (1930), p. 1434. Noel G. Harris and J. A. Braxton Hicks, ‘The Treatment of General Paralysis of the Insane by Malaria and Sulphur’, Lancet 220, 5686 (1932), pp. 384–7. Some individuals with syphilis were treated with fever therapy at Haifa government hospital (see District Medical Board Report, No. 1465, Jerusalem, 9 June 1947, ISA M 6578/16), but it was seemingly never used in government mental institutions. For malaria in Palestine, see Sufian, Healing the Land.

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uses them to engage a set of questions posed by Tutunji’s story, about how psychiatric knowledge and practices travel, and the tension between the universalising claims of somatic treatments and the stubborn specificities and inequalities that adhere to place. In the first instance, Tutunji’s story speaks to the encounter between mandate Palestine and developments in psychiatric knowledge and practice globally. His experimental engagement with fever therapy makes clear that these developments did not simply diffuse outwards from their European points of origin, with the rest of the world passive beneficiaries. Yet this is how one of the few attempts at a comprehensive history of shock therapies renders the story. In that account of how each treatment ‘spread worldwide from its origins in the European heartlands’, the movement of ideas and practices appears both inevitable and selfpropelled: ‘[i]n time, hospitals from Palestine to Argentina would embrace them all, as the powerful logic of modern medicine spun the world from regional collections of medical folklore to an international scientific unity’.8 Tutunji’s story disrupts this frictionless rendering by directing our attention to questions of agency, as well as inequality. Tutunji and others in mandate Palestine worked to inform themselves about, choose between, and innovatively adapt these ideas and practices, but as his story also reveals, the playing field on which they did so was not a level one that allowed all to participate alike. Tutunji had his finger on the pulse of early twentieth-century psychiatry. But his contribution went unacknowledged, a situation that even his sharp protestations only partially alleviated. If Tutunji’s story foregrounds the ‘lumpiness’ of the global space in which psychiatric developments took place,9 this chapter attends also to the unevenness of the terrain through which ideas and practices moved within Palestine itself. All three of the somatic therapies pioneered in the 1930s – insulin-, cardiazol-, and electro-shock – were first administered in private Jewish institutions, and adopted only much later, if at all, in the government mental institutions that employed largely Palestinian Arab doctors and nurses; though more difficult to track, occupational therapy appears to have followed a similarly jagged trajectory, even within government institutions. The history of the adoption and implementation of these treatments, then, would seem to draw a sharp line between private and government institutions, and the terms on which they were able to engage with psychiatric developments elsewhere. In the existing 8 9

Shorter and Healy, Shock Therapy, p. 60. Frederick Cooper, Colonialism in Question: Theory, Knowledge, History (Berkeley: University of California Press, 2005), pp. 91–112.

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scholarship on psychiatry in mandate Palestine, historians have sought to explain this difference, and account for the early adoption of cuttingedge treatments by European Jewish psychiatrists, in terms of their immersion in the central European medical tradition out of which these developments emerged.10 As we will see, there was indeed a clear point of contrast here with Dr Mikhail Shedid Malouf, who worked hard across the 1940s to develop expertise around these new methods of treatment, particularly electro-convulsive therapy, but did so with little support or recognition from the mandate government and in the face of obstacles posed by conditions at the government mental hospitals. There were undeniably important differences in how these methods of treatment were implemented in institutions across Palestine. But rather than conclude that therapeutically Palestine was home to two parallel health systems, this chapter argues that in some instances, these divergences themselves became the grounds for entanglement between these systems. When the government mental hospitals were perceived to have fallen behind their private counterparts, for instance, health officials – rather than invest in training existing employees – looked instead to import expertise from private institutions, fuelling cross-fertilisation between government and private hospitals. As well as drawing our attention to questions of agency and inequality in tracking how psychiatric ideas and practices travel, Tutunji’s story frames this chapter in a further way. One reason somatic treatments like fever therapy were so keenly pursued and adopted around the world was related to how these treatments were thought to work. In targeting the body to cure the mind, they appeared to be ‘blind methods’, as Megan Vaughan puts it: their appeal was that ‘the context in which they were applied mattered little’.11 Attractive everywhere, in a colonial context the universalising claims of these somatic methods had a particular allure, because they held out the possibility of sidestepping a question that – as we have seen – confronted psychiatrists and others at every turn: were certain patterns of behaviour and thought symptoms of mental illness, or were they ‘normal’ by the standards of the culture to which the individual belonged? If these methods appeared to transcend the trappings of culture by working on the body below, that they were embraced across the final decade of the mandate period is particularly striking: in the very 10 11

Rakefet Zalashik and Nadav Davidovitch, ‘Last Resort? Lobotomy Operations in Israel, 1946–1960’, History of Psychiatry 17 (2006), p. 94. Megan Vaughan, ‘Breath of Unreason’, London Review of Books 30, 15 (2008), pp. 29–30. For a similar argument on the tension between the promise of ‘portable’ rather than ‘place-based’ expertise in the sciences of the mind in this period, see Linstrum, Ruling Minds, p. 4.

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years mandate Palestine appeared to be fragmenting down the lines of political, religious, and cultural difference, and partition loomed, psychiatrists were implementing forms of treatment seemingly ‘blind’ to these differences. Yet as Tutunji’s story cautions, psychiatrists’ hopes for a form of treatment which could be deployed without thought for context were always to be frustrated. In his case, the idiosyncrasies of place meant both that cases of general paralysis of the insane were out of his reach for experimental purposes and that no matter his contribution to its development, fever therapy would always be of limited use therapeutically in this context. While historians of occupational therapy have been particularly alert to the ways in which its allocation was inflected by race, class, and gender, across all three of the methods of treatment – work, drugs, and electricity – examined here, the identity of the patient and the specificities of place continued to matter, puncturing psychiatrists’ hopes of escaping the gravitational pull of context.

Work Unlike the various somatic treatments pioneered in the wake of WagnerJauregg’s experimentation with malaria, patient work had a much longer history. Keeping patients occupied had been a preoccupation in nineteenth-century asylums across Britain and its empire,12 both as an element within the so-called moral treatment of patients and as a costsaving measure for asylums. By the early twentieth century, however, ‘occupational therapy’ had emerged as a self-consciously clean break with the often dubiously motivated employment of patients in the past, in which it was feared economic motives had predominated. With its emphasis on engaging individuals in work that had the potential to restore their spirits, give them a sense of purpose, and allow them to find a useful place in society after treatment, occupational therapy systematised and repackaged patient work as a way to facilitate the social rehabilitation, if not medical recovery, of psychiatric patients.13 Across the first half of the twentieth century, this resulted in a subtle but 12

13

Waltraud Ernst, ‘“Useful Both to the Patient as well as to the State”: Patient Work in Colonial Mental Hospitals in South Asia, c. 1818–1948’, in W. Ernst, ed., Work, Psychiatry, and Society, c. 1750–2015 (Manchester: Manchester University Press, 2016), pp. 117–41; and Sarah Chaney, ‘Useful Members of Society or Motiveless Malingerers? Occupation and Malingering in British Asylum Psychiatry, 1870–1914’, in Ernst, ed., Work, Psychiatry, and Society, pp. 276–97. John Hall, ‘From Work and Occupation to Occupational Therapy: The Policies of Professionalisation in English Mental Hospitals from 1919 to 1959’, in Ernst, ed., Work, Psychiatry, and Society, pp. 319–20.

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perceptible shift away from assigning patients forms of work that emerged organically out of the needs and functioning of the mental institution – like laundry, cleaning, or cooking – towards forms of occupation ever more artificially divorced from the ‘real’ world of work.14 In Palestine as elsewhere, this older, more ‘holistic’ approach to patient work, and the newer, more professionalised model of occupational therapy, coexisted – albeit only briefly. The former was by far the more significant and enduring, though because it was less heavily theorised and consciously deployed, its implementation proves difficult to trace in the archive. The latter was introduced into government mental institutions in the 1940s, but abortively; the story of its abrupt termination is a sharp reminder that developments in psychiatric practice might not easily transplant from one context to another. In this instance, the health department’s priorities and presumptions meant that occupational therapy struggled to appear viable in this context. Patient work had been important in government mental institutions since the opening of the first mental hospital at Bethlehem in 1922. Early reports about the hospital make this clear: except in the winter months patients spent much of their time outdoors, where they could tend to the vegetables growing in the hospital’s gardens, or look after the poultry and rabbits kept in the enclosures on the grounds.15 These forms of patient work occupied existing niches in the everyday functioning of the institution and brought more than simply therapeutic benefits, producing vegetables, eggs, and meat, which were all integrated into patients’ diets. But alongside these more ‘organic’ forms of work, in these early years the hospital also ran a workshop in which carpentry and other trades were taught to patients. In 1924, for instance, we find the director of health asking to borrow the instructor at the Jerusalem prison, in order to teach selected patients at Bethlehem the use of the loom. He explained: ‘We are endeavouring to give instruction in various trades to the insane at the Bethlehem hospital for the insane.’16 Here, the emphasis was more clearly on rehabilitating patients socially, and ensuring that they could find employment after discharge. Decades before the attempt to introduce occupational therapy on a more professional basis in Palestine, patient work at the government mental hospitals took a range of forms, from tasks that needed to be fulfilled for the institution to continue

14 15 16

Jennifer Laws, ‘Crackpots and Basket-Cases: A History of Therapeutic Work and Occupation’, History of the Human Sciences 24, 2 (2011), pp. 5–8. Annual Report, Department of Health, 1925, p. 27. Director of Health to Deputy Inspector-General, 8 November 1924, ISA M 6606/18.

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functioning to training that was very intentionally arranged for the sake of securing patients’ futures after discharge. Both the variety of work, and the way this was distributed among the patient population, is brought most clearly into view in an interview which Dr Malouf, as medical officer in charge of the Bethlehem mental hospital, gave to the popular daily Filastin in 1932. As well as speaking about the hospital’s activities and the situation of the mentally ill in Palestine, Malouf had also invited the interviewer to visit the hospital and see it with his own eyes. This article thus offers a rare eyewitness account of how patients were kept occupied, as well as Malouf’s perspective on the meaning of work in this context. As the visitor stressed, seemingly everywhere he looked, he found patients engaged in different forms of work, indoors as well as outdoors. The whole atmosphere of the institution, he noted, was more like a school than a hospital. Malouf explained: Do not be surprised by this: this is the first thing that interests us, to improve the physical condition of the patient, because in lots of cases their physical condition is in no small measure a cause of their insanity. Work is the best occupation for the insane, and he who works in the day will sleep at night. Encouragement to work is a type of medicine.17

Alongside work, which could strengthen the body, weaken the causes of disease, and ensure that patients – and staff – got a good night’s sleep, patients were also kept occupied with recreational activities: the Filastin reporter spotted patients dancing to songs being played on the gramophone, and others playing checkers. These forms of occupation served important functions, too, and were encouraged. Recreation of this kind, Malouf explains, ‘is what helps them to respect themselves, and believe that they are still good human beings’.18 Work and play, as Malouf’s comments suggest, were understood as supporting patients’ physical, social, and even moral rehabilitation. If work was a powerful ‘type of medicine’, however, it is also clear from what the reporter observed that it was not one that was prescribed to all patients interchangeably. There was a clear division of labour along gendered lines at the government mental hospital. It was men, the reporter noted, who worked outdoors. He saw them tending to the plants, or to the chickens and rabbits; constructing the huts that housed the animals; washing the doors and windows of the hospital; operating the water pump; and engaged in different trades. Female patients, by contrast, were allocated other kinds of work, mostly indoors: working in 17

‘Dr Malouf Speaks with Us about the Mad’, Filastin, 29 October 1932, p. 2.

18

Ibid.

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the kitchen; helping with laundry and ironing; and receiving instruction in sewing and embroidery so that they could work for a wage in future. As the reporter’s observations suggest, not only were the forms that patient work took shaped by the existing needs and functioning of the institution, but the distribution of that work was tailored to understandings of appropriate gender roles in society. In order to support patients’ social rehabilitation, it was imperative that they were being equipped with the skills – like carpentry for men, or embroidery for women – which would best enable them to find employment and so resume their proper place in society after discharge. This mirrors what historians have noted for other contexts, in which the allocation of patient work was gendered – with women, for instance, assigned domestic work, and men labour outdoors – as well as racialised – with Chinese patients in British Columbia assigned laundry work,19 African patients assigned farm labour in colonial Zimbabwe,20 and Bengali men assigned lighter tasks in colonial India in an extension of their wider representation as effeminate.21 Far from sidestepping the question of difference that dogged colonial psychiatry generally, then, patient work as it was implemented in the Bethlehem mental hospital took the presumption of difference as its starting point, as its organising principle, albeit in a way that was never explicitly rationalised or theorised. In the decade that followed the rare snapshot provided by Malouf’s interview for Filastin, patient work at the government mental hospital slips out of sight. Certainly patients continued to work in institutions, evident from brief glimpses in the archive. Late in 1938, for instance, the hospital was requisitioning rings to fasten to the legs of chickens, suggesting that patients were still looking after poultry late into the decade.22 And in the years immediately after the Second World War, Malouf was purchasing seeds to plant a wide range of vegetables – cauliflower, cabbage, aubergine, tomato, green pepper, carrot, radish, marrow, green bean, and lettuce – in the gardens of the two Bethlehem mental hospitals.23 But these hints are far and few between, underlining a wider point about patient work: that in spite of its widespread use right across this period, it seldom attracted the same enthusiasm or even recognition as did, for instance, electro-convulsive therapy. Across the 1930s and 19

20 22 23

Kathryn McKay, ‘From Blasting Powder to Tomato Pickles: Patient Work at the Provincial Mental Hospitals in British Columbia, Canada, 1885–1920’, in Ernst, ed. Work, Psychiatry, and Society, pp. 99–116. 21 Jackson, Surfacing Up, p. 5. Ernst, ‘“Useful Both to the Patients”’, p. 128. Requisition No. 604762, 15 November 1938, ISA M 6602/18. M. S. Malouf to Senior Medical Officer, Jerusalem, 19 January 1946, ISA M 6541/26; M. S. Malouf to Senior Medical Officer, Jerusalem, 12 April 1946, ISA M 6541/26.

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1940s, work was never held up in the department of health’s annual reports, for instance, as an example of how the government mental hospitals were facilitating the rehabilitation of patients. In part, this silence might be related to an enduring anxiety around the very different and sometimes highly negative meanings that could be projected onto patient work, at odds with its representation as therapeutic or rehabilitative. Early in the twentieth century, the employment of patients in various forms of work had been met with a decidedly mixed reception among patients’ families at the Lebanon Hospital for Mental Diseases at ʿAsfuriyyeh – to which the department of health, as much as Palestinian patients and their families, looked across this period. Some families were reportedly furious on discovering the hard, dirty hands and feet of relatives who had been put to work outdoors picking olives and chopping firewood for the hospital, and demanded an explanation.24 If this sounded an early cautionary note about the potential dangers of publicising patient work, scandals closer at hand reiterated these warnings right up until the end of the mandate period. In 1947, for instance, health officials were alarmed to discover that the proprietor of a private mental home at Givat Shaul in Jerusalem had been putting patients to work in his own home, 15 metres down the road from the institution, after neighbours complained.25 A senior medical officer investigated, and discovered, as he noted in a sharply worded letter to the proprietor, ‘three inmates of your … institution working in your house independently without any escort or supervision’. ‘[N]o lunatic patient is allowed to leave the door of your institution without being certified cured’, otherwise the institution, he threatened, would be liable to closure.26 In his response, the proprietor – Zisha Wilner – made no attempt to justify the employment of patients on the grounds that it served any kind of function of social rehabilitation; instead, he attacked the complaints of his neighbours as ‘vexatious and malicious in character’, and assured the department that the patients worked ‘under my personal supervision’.27 Scandals like this one suggest how patient work’s value – its ability to serve therapeutic, social, and economic purposes all at once – could also open it up to critique and disapprobation.

24 25 26 27

Annual Report, Lebanon Hospital for the Insane, 1907, pp. 32–3. Translation of Complaint of Hillel Magsumoff, Givat Shaul, Jerusalem, to the Public Health Department, Jerusalem, 23 July 1947, ISA M 6553/8. Senior Medical Officer, Jerusalem, to Zisha Wilner, Givat Shaul, Jerusalem, 13 March 1947, ISA M 6553/8. Zisha Wilner, Givat Shaul, Jerusalem, to the Department of Health, 25 September 1947, ISA M 6553/8.

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If – for reasons of embarrassment or otherwise – there was little explicit reflection on the goals of patient work in government mental institutions, an episode from the end of the mandate period suggests where the balance in emphasis between fulfilling these multiple functions lay. One of the advantages of engaging patients in gardening and tending to animals was, as we noted, the way it tangibly benefited the hospital, enriching diets without requiring the purchase of additional food. Malouf’s requests and reports from the years immediately after the Second World War reveal the scale of activity in this area: in addition to the many different vegetable seeds he had asked for, over two hundred chickens, forty ducks, almost the same number of pigeons, eight turkeys, and an unspecified number of rabbits were kept at the first government mental hospital.28 It would be easy to assume that patient work, undertaken to this degree, brought benefits to the institution at a commensurate scale. But the opposite was true: in May 1947, the accounts for the poultry farm and vegetable garden at the government mental hospital reported a loss of £306 over the previous year. Undertheorised though it was, the subsequent discussion around the finances of this form of patient work reveals the relative weighting of its therapeutic and economic functions. Responding to these figures, the senior medical officer at Jerusalem reasoned that ‘[a]s the farm and garden are a form of vocational therapy for the patients, the loss is not perhaps very serious’. ‘On the other hand’, he continued, ‘the loss is considered high to justify their continuance.’29 Ultimately, it seems, the therapeutic value of the work outweighed its financial costs; the poultry farm and vegetable garden continued into the final months of the mandate. We find Malouf, for instance, purchasing more seeds for the garden at the end of the year, in November 1947 – seeds, poignantly, he would not himself survive to see sprout into life.30 However therapeutic and rehabilitative in orientation, patient work – as the reporter from Filastin observed – was not distributed at random. Within the Bethlehem mental hospital, this had been most apparent in relation to gender, with men and women allocated different kinds of labour. When the third government mental hospital opened its doors near Jaffa in 1944, another way of dividing up patient work became more visible. At Jaffa, as at Bethlehem, patients were offered a range of forms of 28

29 30

Poultry Return, 1945, at Government Mental Hospital Bethlehem No. 1, 30 April 1946, ISA M 6541/26; and Senior Medical Officer to Director of Medical Services, 29 July 1946, ISA M 6541/26. Senior Medical Officer Jerusalem to Director of Medical Services 6 May 1947, ISA M 6541/26. M. S. Malouf to Senior Medical Officer, Jerusalem, 14 November 1947, ISA M 6541/26.

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occupation. A 1947 report on the hospital listed these alongside other methods of treatment, including electro-convulsive therapy – explicitly framing patient occupation in terms of treatment in a way without parallel for the Bethlehem mental hospitals. The report noted that half of all patients were engaged ‘in work in the garden, wards, laundry, kitchen, sewing room etc.’, but that they were also offered a good range of recreational activities, including games, radio, cinema, trips to the nearby seashore, and bathing in the sea.31 Though patients at this site certainly found themselves corralled of necessity into fighting back the encroaching sand from surrounding dunes, the emphasis here appears to have been much less on the physically demanding forms of labour that the poultry farm and vegetable garden at Bethlehem entailed, and much more on recreational forms of occupation. Given that European Jewish patients made up the vast majority of the patient population at Jaffa,32 the different forms of occupational activity stressed across the government mental hospitals would appear to map onto their distinct demographics, along lines which historians have identified for other contexts, too. In colonial India, for instance, European patients were not given physical labour but rather leisure activities to keep them occupied; Indian patients, by contrast, were expected to work.33 Far from a form of treatment which could be imported wholesale from elsewhere and applied blindly, keeping patients occupied always involved a reckoning with context and an adaptation to the perceived needs – social as well as medical – of different groups of patients. Patient work was important across government mental institutions throughout the mandate period, even if it seldom attracted much attention and went undertheorised. In the 1940s, however, there was an abortive attempt to introduce occupational therapy – of the kind that had been promoted in Britain, for instance, since the 1920s34 – into Palestine. In April 1946, the department of health engaged a professional occupational therapist, Mrs E. M. Allen, to introduce and supervise occupational therapy at the mental hospitals at Bethlehem, as well as among hospitalised ex-servicemen at Bayt Safafa and patients at the British section of the government hospital in Jerusalem. As part of this new programme, patients were to be encouraged to make a range of articles that could then be used by the department: these included waste 31 32 33 34

Quarterly Financial and Progress Report in respect of the Government Mental Hospital, Jaffa, 17 January 1947, ISA M 323/30. In its first year, the Jaffa mental hospital admitted 170 Jewish patients, 6 Muslim patients, and 1 Christian patient. Annual Report, Department of Health, 1945, p. 11. Ernst, Work, Psychiatry, and Society, pp. 9, 14–16. Laws, ‘Crackpots and Basket-Cases’, p. 5.

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paper baskets, tray cloths, table napkins, raffia table sets, and bread baskets.35 But occupational therapy on these lines proved short-lived indeed in mandate Palestine. Just a few months into Allen’s appointment, she resigned and was never replaced; instead, the matrons at the various hospitals were instructed to revert to ‘occupational therapy as prior to the appointment of Mrs Allen’.36 Part of the reason for occupational therapy’s swift fall from grace seems to have been the sharply critical response with which it was met at the government hospital in Jerusalem. Just a month after its introduction, the matron of the British section at the hospital was writing to ask whether the supplies that had been bought for occupational therapy could be taken away to clear up some much-needed space in the hallway, as ‘the patients are not at all interested’. They much preferred playing bridge and whist, she reported, and ‘do not want to be troubled with any kind of work’.37 Her request was granted, and occupational therapy discontinued at the hospital; it would continue at the government mental hospitals and Bayt Safafa for only a few weeks longer before Mrs Allen resigned. That a programme of therapy, which was supposed to have been implemented across four different hospitals, could be torpedoed by its failure at just one of them suggests that these were not all accorded equal priority. To put it another way, the lack of interest shown by British military and civilian officials at the government hospital at Jerusalem appears to have weighed more heavily in the department’s decisionmaking than the therapeutic needs of Palestinian psychiatric patients. This would be in line with experience in other colonial contexts: in French Algeria, for instance, keeping European patients occupied was given priority, while Arab patients were left idle – a situation Fanon rebelled against in the 1950s.38 But the low importance assigned to occupational therapy’s working at the government mental hospitals is also suggested by an odd coda to this story, from early 1947. When the matron at the first government mental hospital at Bethlehem sent two tray cloths and a cosy cover which patients had made to the health department’s central medical stores in 35 36 37 38

Director of Medical Services to Senior Medical Officer, Jerusalem, 30 April 1946, ISA M 6593/15. Director of Medical Services to Senior Medical Officer, Jerusalem District, 3 July 1946, ISA M 6593/15. Matron of Government Hospital, British Section, Jerusalem, to Senior Medical Officer, Jerusalem, 8 May 1946, ISA M 6593/15. One of Fanon’s innovations, when he took over Blida in 1953, was to expand the provision of occupational therapy from European settlers only, to Muslim patients. See Hugh Butts, ‘Frantz Fanon’s Contribution to Psychiatry: The Psychology of Racism and Colonialism’, Journal of the National Medical Association 71, 10 (1979), p. 1016.

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Jerusalem, the director of medical services was baffled. ‘Are they samples of goods in hand for disposal, or what?’, he asked.39 He may or may not have forgotten that occupational therapy supplies remained at the government mental hospitals and that patients there were engaged in a range of occupational activities. But he certainly had forgotten the department’s directive, as the matron of the hospital reminded him, ‘that anything of a useful nature made by this material should be forwarded on to medical stores when finished’.40 Occupational therapy in the government mental hospitals was not simply a low priority, but the idea that it might produce anything ‘of a useful nature’ – rather than ‘samples … for disposal’ – appeared doubtful to the health officials who ultimately made the decision to start, and withdraw, this new form of treatment. A final episode suggests that others, outside the mandate government, shared in this sense of doubt about the value and possibilities of patient work. In 1945, a siting board marked a large area of land near the government mental hospital at Bethlehem for expropriation, as part of plans to extend the hospital’s grounds. The area consisted ‘partly of a terraced cultivated slope and of a steeper uncultivated western portion’, complete with an ‘agreeable’ view.41 The terraces had not magically appeared, however. In June 1946, Anton Khoury of Bethlehem, who described himself as a farmer and dairy farmer, wrote a blistering letter to the chief secretary protesting the planned expropriation of 85 dunums of his land.42 He had leased this land in the early 1920s from the Jerusalem Verein – just as the government had done, nearby – in order to set up a dairy farm. The land had been rocky and overgrown with thistles and brushwood, and he detailed the investment of labour and fertiliser needed to turn ‘[t]hat erstwhile seeming uncultivable rocky mountain … into a fertile plot which in its surroundings looks very much like an oasis in a desert’. The government planned to expropriate precisely the most fertile areas, Khoury noted, even at a time of predicted food shortage when ‘the Palestine food controller [has] been urging the population to 39 40 41 42

Director of Medical Services to Medical Superintendent, Government Mental Hospital Bethlehem, 14 February 1947, ISA M 6602/17. Matron of Government Mental Hospital No. 1, Bethlehem, to Medical Superintendent, Bethlehem, 18 February 1947, ISA M 6602/17. Report of a Siting Board on Land Required for a Government Sanatorium-Hospital, 16 June 1945, ISA M 326/61. The British introduced a metric dunum equivalent to a quarter of an acre in 1928; prior to this, an older Ottoman definition of the dunum had been in use, which was slightly smaller, equivalent to 0.9133 metric dunum. It is not clear which Khoury is using. For this conversion, see Amos Nadan, The Palestinian Peasant Economy under the Mandate: A Story of Colonial Bungling (Cambridge, MA: Harvard University Press, 2006), p. xix.

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cultivate almost every square metre of land in order to relieve the expected shortage’. ‘If expropriation is carried through’, Khoury warned, ‘85 dunums of the best land, reclaimed at a very high cost, will go out of cultivation at a moment when almost every metre counts.’ He urged the government to reconsider and purchase undeveloped land nearby, which – besides preserving his own farm intact – would come ‘at a smaller cost of the taxpayer’. His letter concluded by outlining his reason for hopefulness in asking this: ‘I am convinced that government has at heart the encouragement and the promotion of agriculture among the Arabs on modern and efficient lines.’43 Khoury’s letter is worth citing at length because it casts the question of patient work in a very different light. It evinces a clear belief in the importance of hard work not just to the individual but, linking it up to the predicted difficulties in food supply, the survival of the nation; in the letter, moreover, Khoury presumes to advise the government on the economic rationality of its decisions. But it is also noteworthy because it gives an insight into how the place of patient work in these hospitals was understood. We have seen the scale of agricultural work that patients at the Bethlehem mental hospitals undertook, on the vegetable gardens and poultry farm. But if work was meant to reform patients not only mentally but socially, transforming them into productive members of society on release, Khoury does not seem to have been convinced; acquiring more land for this use would, as he saw it, imperil the nation, not secure its future. It is not made explicit what he thought the patients should have been doing; he does not suggest they should be resting, for instance. But what is clear in his lament about hard-won land being taken out of cultivation is the sense that attempts to occupy patients outdoors were, fundamentally, a waste of space. Drugs While occupational therapy encouraged patients to work their own bodies in the hope of achieving a form of rehabilitation, the somatic methods introduced into Palestine over the 1930s and 1940s promised relief or cure by working more directly on the body. The remainder of this chapter focusses on three of these somatic therapies in particular: insulin-, cardiazol-, and electro-shock treatment. These belonged firmly to the period of frenzied experimentation set off by Wagner-Jauregg’s malaria therapy, though they all differed from this method in that they relied on 43

Anton Khoury, Farmer and Dairy Farmer, Bethlehem, to Chief Secretary, 5 June 1946, ISA M 326/61.

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inducing convulsions rather than fever.44 The first, developed in the early 1930s by the Austrian psychiatrist Manfred Sakel, sought to treat schizophrenia by inducing hypoglycaemic comas through injections of insulin.45 The second, developed around the same time by the Hungarian neuropsychiatrist Ladislaus Meduna, similarly targeted schizophrenia, this time by inducing epileptic fits in patients. This was achieved initially through injections of camphor, but later by a drug with a similar effect, known as cardiazol in Europe and metrazol in the United States.46 The third, and the focus of the final part of this chapter, was developed slightly later in the 1930s by the Italian neurologist Ugo Cerletti, who – in a modification of the methods developed by Sakel and Meduna – innovated by inducing seizures using electricity, not drugs.47 Each of these somatic methods took particular aim at schizophrenia, ‘the great dragon of mental disorder’48 of its day, as Niall McCrae puts it. With well over half of all cases admitted to government mental hospitals in 1946 given a diagnosis of schizophrenia,49 the possibility that somatic treatments held out of curing or at least alleviating this condition should have proved irresistible in mandate Palestine. Yet while electroconvulsive treatment was adopted in government mental institutions in the mid-1940s, neither insulin- nor cardiazol-shock therapy was ever introduced in this setting. Instead, drugs were used in government institutions largely for the purposes of sedation and ‘chemical restraint’, not treatment, right up until the end of the period. This was in spite of the fact that both insulin and cardiazol treatments had been introduced in private institutions in the late 1930s. These therapies, then, travelled very unevenly to Palestine, rather than flowing smoothly outwards from their points of origin. As well as exploring some of the reasons that these therapies were not implemented in government mental institutions, this section also highlights how the perception of a ‘lag’ between practice at government and private institutions itself became politicised and was used to press for greater financial support for private Jewish institutions. Insulin and cardiazol treatments were first administered in Palestine in 1937, at the private hospital of Dr Kurt Blumenthal on Mount Carmel in Haifa. Blumenthal, who migrated to Palestine from Germany after 1933, had, together with his wife Erna, set up a private clinic in Haifa shortly 44 45 47 48 49

Andrew Scull, ‘Somatic Treatments and the Historiography of Psychiatry’, History of Psychiatry 5 (1994), pp. 7–8. 46 Shorter and Healy, Shock Therapy, pp. 14–16. Ibid., pp. 23–8. Ibid., pp. 31–45. Niall McCrae, ‘“A Violent Thunderstorm”: Cardiazol Treatment in British Mental Hospitals’, History of Psychiatry 17 (2006), p. 67. Annual Report, Department of Health, 1946, table 8.

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after their arrival. By 1936, it had outgrown its early makeshift accommodation and moved into a new building, with seventeen rooms. As well as patient fees, it had also managed to attract funding from the Haifa Jewish community council.50 This institution became one of the most important private mental hospitals in Palestine, and indeed beyond: the mandate government even received visa applications from individuals elsewhere in the region who sought admission to Blumenthal’s hospital.51 And, as we saw earlier, the department of health put much faith in Blumenthal’s expertise, too, appointing him to investigate conditions in the lunatic section at Acre central prison in the 1940s. Both his professional reputation, and the reputation of his hospital, owed much to his early and indeed innovative implementation of somatic treatments, which he took care to record and publicise in the pages of the Hebrewlanguage medical journal Harefuah as well as elsewhere. In 1937, Blumenthal began introducing insulin and cardiazol treatments in his hospital. His approach was decidedly experimental. After administering the treatments separately, he innovated – like other psychiatrists in Europe at the time – by attempting to combine them, by first inducing a hypoglycaemic coma in the patient using insulin, and only then injecting them with cardiazol, so that the patient had a seizure while comatose. Once the seizure subsided, the patient was brought out of the coma using a sugar solution.52 In 1938, he reported his experiences in Harefuah. In his view, there were two major advantages to this combined method. First, a much lower dosage of cardiazol could be used to induce a seizure – which, given the high cost of the drug, brought no small benefit.53 Second, this combined method made a profound difference in terms of the attitude and experience of patients. Patients had been terrified of cardiazol therapy, and the violent seizures it involved, and this had posed all sorts of issues not only around safety but also around convincing patients to cooperate and continue with a course of treatment. In this combined method, patients were unconscious during the seizure and so could not remember it at all. With no reason to resist treatment, it became much easier to convince patients to see these courses through to completion. This had led to a happy change in atmosphere in the institution, too: Blumenthal reported receiving letters of thanks from cured patients, even flowers. One patient, whose words

50 51 52 53

See Zalashik, Das Unselige Erbe, pp. 65–6. See ISA M 4342/42 for a visa application by a prospective patient from Damascus. Kurt Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, Harefuah 15 (1938), p. 174, 179. Ernst, Colonialism and Transnational Psychiatry, p. 183.

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Blumenthal quoted in Harefuah, had related his wonderment that ‘[t]he clinic is a modern and humane place of shelter’, a place where patients ‘are treated by doctors dressed in white coats, and by means of injections, without the patient even feeling it’.54 Blumenthal’s use of both insulin and cardiazol treatments anticipated their adoption, either separately or in this combined method, in other private mental institutions in Palestine. Dr Heinz Hermann introduced insulin coma therapy into the Ezrath Nashim private mental home in Jerusalem a few years later in 1943, for instance.55 Yet, neither treatment was ever introduced into a government mental institution before the end of the mandate period. For Rakefet Zalashik and Nadav Davidovitch, the early introduction of somatic treatments into Palestine by European Jewish psychiatrists can be understood in terms of their familiarity with the medical context out of which these developments emerged, if not even more directly through their prior experience of using these treatments in institutions in central Europe.56 Certainly this is evident in, for instance, how Blumenthal showed awareness of recent work by Sakel and Meduna.57 But an explanation on these lines runs the risk of overemphasising the importance of being rooted in a central European psychiatric tradition. In the same year that insulin and cardiazol treatments were being introduced into Blumenthal’s hospital, after all, they were also being administered for the first time at the Lebanon Hospital for Mental Diseases at ʿAsfuriyyeh, after the medical director of the hospital – Dr R. Stewart Miller – observed their use first-hand during a trip to Vienna.58 The non-implementation of these methods at the government mental hospitals must be explained on its own terms, not solely in relation to the precocity of psychiatrists in private institutions. There were three main obstacles to the introduction of insulin and cardiazol treatments in government institutions. In the first place, neither insulin nor cardiazol was inexpensive. Given that the vast majority of patients at the government mental hospitals were non-paying patients, on the grounds of poverty,59 there was little hope that high treatment costs could be recouped from patient fees. A second problem was timing: the

54 55 56 57 58 59

Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, p. 177. Heinz Hermann to Senior Medical Officer, Jerusalem, 28 February 1944, ISA M 6552/32. Zalashik and Davidovitch, ‘Last Resort?’, p. 94. Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, p. 179. Annual Report, Lebanon Hospital for Mental Diseases, 1937, p. 7, 9. Statistics showing the proportion of paying and non-paying patients at the mental hospitals are difficult to find, but in 1928, for instance, out of sixty patients at Bethlehem, only ten were paying patients – though they were charged a range of rates. Senior Medical Officer Jerusalem to Director of Health, 27 July 1928, ISA M 6628/15.

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outbreak of the Second World War caused serious problems in the supply of insulin across the region such that at ʿAsfuriyyeh, for instance, insulin therapy had to be discontinued over the war years.60 These problems afflicted Palestine too: there were deaths resulting from a lack of insulin for diabetics in Palestine during the war.61 The shortage was so severe that in the early years of the war the government refused to release insulin requested for the private treatment of the mentally ill, even in cases in which families offered to cover the costs.62 Once it became possible to produce insulin locally,63 private institutions like Blumenthal’s began to reinstate treatment, so long as families covered the costs of the insulin.64 But problems were not limited to the supply of insulin. Sugar was also required, to revive patients from their hypoglycaemic comas, and its wartime rationing caused complications. Hermann, for instance, had to write to request an additional allowance of sugar be allocated to his institution each month for this purpose.65 Under these circumstances, it is hardly surprising that the government mental hospitals did not rush to introduce insulin treatment. A third obstacle was staffing. Both insulin and cardiazol were challenging to administer, and placed heavy demands on an institution’s medical staff. Blumenthal gives a sense of this in his initial report on these methods. In insulin therapy, for instance, the exact dosage required to bring a patient to a hypoglycaemic coma had to be worked out through a painstaking process of gradually increasing the dose administered each day, over the course of days or even weeks. Once the dosage had been determined, and comas began to be induced, constant supervision was needed in case of emergencies, over periods lasting hours on a daily basis.66 The medical director of the Lebanon Hospital for Mental Diseases echoed this in his own report, a year after introducing the treatment into the hospital: ‘[M]any emergencies arise during insulin treatment’, he warned, such that ‘[n]othing but unremitting care can prevent untoward results.’67 Cardiazol was shorter and simpler, Blumenthal noted. A seizure could be induced relatively easily with an injection, and lasted around a minute, with the patient recovering 60 61 62 63 64 65 66 67

Annual Report, Lebanon Hospital for Mental Diseases, 1940, p. 9. PP, 20 February 1942, p. 3. Director of Medical Services to Senior Medical Officer, Jerusalem, 20 March 1942, ISA M 6627/30. PP, 7 March 1941, p. 5. W. K. Bigger, Acting Director of Medical Services, to Senior Medical Officer, Nablus, August 1944, ISA M 6627/30. H. Hermann to Senior Medical Officer, Jerusalem, 28 February 1944, ISA M 6552/32. Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, pp. 173–4. Annual Report, Lebanon Hospital for Mental Diseases, 1938, pp. 9–10.

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consciousness ten minutes or so afterwards. But it was also highly dangerous. The seizures were extremely violent, and precautions had to be taken to prevent the patient biting, for instance, their tongue. Even so, patients could – and did – end up with broken bones.68 Given the reluctance of the government to invest in specialist training for mental nurses until the end of the mandate period, and the disdain with which those nurses and attendants were viewed in general, it is again unsurprising that these highly demanding forms of treatment were not introduced into the government’s mental hospitals. Introducing insulin and cardiazol treatments would have made the running of government mental hospitals costlier and more difficult, requiring more supervision and expertise, and entailing greater risk. But as a gap opened up between the treatments available in government mental hospitals and their private Jewish counterparts, the Jewish National Council’s health section began to apply pressure to the government to either catch up – or cough up. The head of the health section, Dr Fritz Noack, wrote to the director of medical services in 1942 along these lines: Government might consider the introduction into the mental hospital at Bethlehem of the treatment of insulin shock, cardiazol shock, and electro shock. There is a number of psychiatrists in Palestine at present who could carry out this treatment, and government might invite a consultant psychiatrist to the Bethlehem hospital for this purpose. This would be of great value, particularly in increasing the turnover of patients, thus utilising the few beds to the best advantage.69

Drawing attention to the failure of government to provide these new treatments offered the Jewish National Council a means of applying pressure to extract particular concessions, whether the hiring of more of the many European Jewish psychiatrists in Palestine without suitable work, or – failing that – the provision of greater financial support for private Jewish institutions which did offer these treatments. Noack continued his letter by noting that ‘only the private Jewish institutions use the modern methods of treatment by shock’, which, ‘calling as it does for special supervision and expensive drugs, adds to the financial burden falling on the shoulders of the Jewish institutions’.70 In the absence of greater government investment in its own institutions, Noack argued it should offer more financial support to those private Jewish institutions 68 69 70

Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, pp. 174, 178. F. Noack, Health Section, Vaad Leumi, to Director of Medical Services, 24 April 1942, ISA M 6628/15. Ibid.

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where this treatment was already available. Scholars have been rightly critical of framing global histories of medicine in terms of a ‘lag’ between, for instance, metropolitan and colonial ideas and practices.71 But the unevenness in how these new treatments were implemented across Palestine, the gap between practice in private and government provision, was observed, critiqued, and politicised at the time. Strikingly, rather than separating them out or drawing them further apart, divergence of practice across private and government provision was instead used to call for cross-fertilisation between them, for them to be bound together more tightly through either the exchange of expertise or resources. Although government institutions never introduced insulin or cardiazol treatment, this is not to say that they did not employ any drugs at all in the management of patients. Sedatives like scopolamine were used in both the government mental hospitals and in the criminal lunatic section at Acre.72 At the government mental hospital at Jaffa, for instance, the medical superintendent described sedatives as a sometimes necessary form of ‘chemical restraint for mental patients’, particularly ‘excited, impulsive, and aggressive patients’. But in general, he was reluctant to rely too heavily on these methods, on the grounds that ‘the necessity arises to always increase the dosage which results in drug addiction and in the physical and mental deterioration of the patients’.73 In Acre, too, sedatives were given to calm criminal lunatics when agitated.74 But Blumenthal’s report on the criminal lunatic section at Acre suggests that sedatives were being used in a therapeutic way, too. He discussed scopolamine and other unspecified ‘narcotica’ alongside occupational therapy and electro-convulsive treatment, under the heading ‘therapy’, and not just as a form of restraint.75 Case files from the section provide further evidence of the therapeutic use of drugs, revealing that sedatives were being administered to help those who struggled to sleep.76 While 71

72

73 74

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For a review of the historiography in relation to the British empire, see Mark Harrison, ‘Science and the British Empire’, Isis 96, 1 (2005), pp. 56–63. For the dangers of taking this too far and not attending to difference within global histories of medicine, see Hodges, ‘The Global Menace’. For a longer history of the use of opiates like scopolamine, see David Healy, ‘Some Continuities and Discontinuities in the Pharmacotherapy of Nervous Conditions before and after Chlorpromazine and Imipramine’, History of Psychiatry 11 (2000), pp. 393–412. Proceedings of Board of Enquiry into Cause of Excessive Destruction of Linen at Government Mental Hospital, Jaffa, 1 and 4 September 1947, ISA M 6573/7. District Medical Board Report, No. 311, Acre, 14 December 1945, ISA M 6640/26; Record of Examination, No. P/51, Acre, 14 June 1947, ISA M 350/49; Record of Examination, No. P/122, Acre, 24 October 1947, ISA M 352/7. Dr Kurt Blumenthal, Report on the Lunatic Section of Acre Prison, 1 February 1946, ISA M 351/41, p. 14. Record of Examination, No. 75, Acre, 6 April 1946, ISA M 346/68.

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Joel Braslow, in particular, has argued that the shift to thinking about drugs as a potential cure for mental illness in the 1950s marked a significant departure from their earlier use as chemical restraints, the evidence from Palestine blurs this distinction.77 Sedatives were being prescribed to help with the recovery of the victims of train sabotage, those drivers and guards caught up in the bombing of trains in the last years of the mandate. In these cases, the specialists who examined them recommended rest and prescribed sedatives for treating their anxiety neuroses.78 While sedatives were the primary drug administered to these shock victims, there were some unusual exceptions. In one instance, that of a senior clerk at Haifa who appears to have suffered some kind of traumatic event that induced a depressive state such that he could not concentrate on work or cope with the noises of the city, it was not a sedative but testosterone that the nervous diseases specialist decided to use in his treatment.79 Even as private mental hospitals were pursuing insulin and cardiazol treatments, then, in government mental hospitals other drugs were being used both as chemical restraints and, in some cases, as a form of treatment. Insulin and cardiazol treatments tantalised psychiatrists with the possibility, as Blumenthal put it in his early report, of dealing with schizophrenia as an organic disease that could be alleviated or even cured by acting on – by shocking – the body.80 Yet here, as much as with patient work, context continued to assert itself: the universalising claims which enveloped insulin and cardiazol treatments did not guarantee their embrace in government mental institutions in Palestine, once weighed against more specific considerations of cost, supply, and staffing, and found wanting. Sedatives, in this context, appeared the more useful drug by far. These sedatives were also put to use outside government mental hospitals, in some of the less regulated private institutions that cropped up in Jerusalem over the period, and it is from this context that we get a 77

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For the shift in thinking on the place of drugs in psychiatry, see Braslow, Mental Ills and Bodily Cures, p. 37; Joanna Moncrieff, ‘Magic Bullets for Mental Disorders: The Emergence of the Concept of an “Antipsychotic” Drug’, History of the Neurosciences 22 (2013), pp. 30–46. For chlorpromazine, see Judith Swazey, Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation (Cambridge, MA: MIT Press, 1974). For example, District Medical Board Report, Haifa District, 29 August 1947, ISA M 6640/22; and District Medical Board Report No. 2586, Haifa District, 25 September 1947, ISA M 6640/24. District Medical Board Report, No. 3428, Haifa, 21 December 1945, ISA M 6640/26. This is the only case I have been able to find of testosterone in particular, or hormones other than insulin, being used in psychiatric treatment. Blumenthal, ‘Treatment of Schizophrenia with Insulin and Cardiazol’, p. 173.

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rare glimpse of a patient’s perspective on their use as ‘chemical restraints’. In May 1941, complaints were made against Isaac Samuel Rosenblatt, who was alleged to have turned his premises in a residential neighbourhood in Jerusalem into a private mental home. One of the complaints concerned the kind of treatment meted out to the patients of this and other such private institutions. Patients were – in the evocative words of the complainant, who himself seems to have spent some time at this or a similar institution – ‘buried alive, because every resistance is declared a sickness of mental disease’. The letter continued: ‘[t]he consequence of any resistance [is] further injections with narcotic remedies a little stronger than before, to prove [to] … the visitors that the patient is still very sick’.81 If Blumenthal offered a cautiously optimistic account of the use of drugs in mental institutions in Palestine, as changing the atmosphere of the clinic for the better, this letter offers a very different, much bleaker perspective on that story. Together, they gesture to the wide spectrum of responses to chemical interventions in the 1930s and 1940s – from flowers of thanks, to the sense of being buried alive.

Electricity Like insulin and cardiazol treatments, electro-convulsive therapy was first introduced into mandate Palestine by Dr Kurt Blumenthal at his Haifa hospital. In a report published a few years later in Harefuah, he claimed to have been so impressed by reports about this treatment coming out of Münsingen asylum in Switzerland in 1940 that he decided to acquire a machine with which to try out this treatment himself. With the Second World War raging, this proved easier said than done; in the end, Blumenthal had to give the machine’s technical specifications to an electrical engineer at Tel Aviv to build locally. In spite of this setback, Blumenthal administered electro-shock treatment for the first time in December 1940 – remarkably soon after the publication of the report from Münsingen asylum which had galvanised him initially. He went on to treat nearly eighty patients using electro-convulsive therapy over the following six months, inducing nearly a thousand shocks in total.82 Though he was not uncritical of this new method, he judged it to be superior to cardiazol treatment in a number of important ways – not least 81

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M. Loewenberg to E. Keith Roach, District Commissioner, Jerusalem, May 1941, ISA M 6553/23. It is unclear but it appears Loewenberg himself may have spent some time in an institution; he wrote ‘also I was in such a pension in Lifta for seventeen days five years ago’. Kurt Blumenthal, ‘Electro-shock Therapeutics in Psychiatry’, Harefuah 22 (1942), pp. 4–6.

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of which that its seizures tended to result in fewer broken bones and other serious injuries – and began replacing cardiazol treatment in many cases with electro-convulsive therapy.83 The apparent success rate, too, was impressive: in 1943, Blumenthal reported that half of the cases of schizophrenia he had treated with electro-convulsive therapy had gone into total remission, and a third into partial remission.84 Of all the treatments examined in this chapter, electro-convulsive therapy generated by far the most enthusiastic response in mandate Palestine, across government mental hospitals – where it was introduced in 1945 – as well as private Jewish institutions. Not only did it appear to achieve remarkable therapeutic results, but its ease of application opened up new possibilities for treating patients and alleviating the conditions of overcrowding that had for so long plagued psychiatric provision in Palestine. Implemented in both government and private institutions alike and on patients from a wide range of backgrounds, here was a method of treatment that truly seemed capable of transcending context. But even in the few short years between its introduction and the end of the mandate in May 1948, some of the wilder optimism that surrounded this treatment began to break down, and both doubts about its results and confusion about its operability in Palestine surfaced. And although applied to patients from all backgrounds across government mental hospitals, criminal lunatic sections, and private Jewish institutions, it – as much as patient work – does not appear to have been distributed ‘blindly’, wholly without regard for the identity of the patient. Astonishment characterised early responses to the effects of electroconvulsive treatment, and not just among psychiatrists. Blumenthal had recorded high rates of remission among patients treated with electroshock, but success stories were so striking that they found their way into memoirs from the period, too. In her memoirs, for instance, Sylva Gelber – briefly employed at the Vaad Leumi’s social welfare section – recounts taking Ruth Polanski,85 a young woman who had suffered a serious mental breakdown, for treatment at Blumenthal’s hospital. Blumenthal’s fees had been stupendous, but the results, to Gelber at least, seemed to have justified the cost:

83 84

85

Ibid., pp. 4–6. Kurt Blumenthal, ‘Methods of Psychiatric Treatment by Shock Therapy’, Harefuah 24 (1943), pp. 131–3. See also Kurt Blumenthal, ‘Insulin, Cardiazol, and Electroshock Treatment in Palestine during the Last Five Years’, Journal of Nervous and Mental Diseases 101, 4 (1945), pp. 332–46. This is already a pseudonym in Gelber’s account.

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About four weeks later I was sitting at my desk when a young woman whom I did not recognise entered the office. She was dignified and quiet, and she was obviously not in a disturbed state. When I realised that it was Ruth I could hardly believe my eyes. She told me that at the hospital in Haifa she had undergone some strange-sounding medical procedures about which, not surprisingly, I had never heard. It was shock therapy. This form of treatment had then just been introduced by two Italian psychiatrists, in search of some cure for schizophrenia. Whatever its long-term value, the immediate effects of the procedure, which had made it possible for a patient like Ruth to walk out of a mental institution so quickly and so apparently well, seemed to me and to my Kehillah colleagues to be nothing short of a miracle.86

With reported results like this, it is little wonder that electro-shock therapy was quickly introduced into other private Jewish mental hospitals in Palestine. In July 1941, Dr Heinz Hermann and his colleague Dr H. J. Kleinschmidt deployed the treatment for the first time at the Ezrath Nashim home in Jerusalem. While not implementing it on the same scale as Blumenthal, they too embraced the new treatment enthusiastically, administering it to over fifty patients across six hundred sittings in the first two years or so. Like Blumenthal, they reported compelling results: a third of all cases who underwent electro-shock treatment left the hospital cured fully or in part.87 Yet in spite of reporting these results, all three psychiatrists expressed unease about this treatment, and uncertainty about how – and indeed whether – it really worked. The ‘miraculous’ – as Gelber put it – rapidity of patient recoveries seemed simply too good to be true. Blumenthal recounted the case of a woman diagnosed with schizophrenia who had not responded at all to insulin coma therapy. After just three sessions of electro-convulsive therapy, however, she was speaking with the other patients and taking an active interest in their conditions and recoveries. Her husband visited and described her as having returned to her old self, prior to the onset of the illness. But Blumenthal was sceptical. Writing in Harefuah, he expressed his concern that electro-shock therapy had only covered up the outward signs of schizophrenia while leaving the underlying condition intact. His patient had made a social recovery, certainly, but not, in his view, a medical one – a comment that, in disaggregating the notion of recovery, highlights the shared ground between somatic treatments and occupational therapy. Blumenthal in no way disparaged this symptomatic relief. Many patients had previously languished in mental institutions for years on account of these psychoses. Even to treat 86 87

Gelber, No Balm in Gilead, p. 68. H. Hermann and H. J. Kleinschmidt, ‘The Electro-shock Therapy of Schizophrenia’, Harefuah 25 (1943), pp. 84–6.

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only their symptoms, so they could be sent home after just a few months was, he wrote, a beautiful thing.88 But his doubts persisted. In a later reflection from 1943, he again suggested shock treatments only jolted patients out of the immediate grasp of their psychosis, rather than ending the disease’s hold over them completely.89 Hermann and Kleinschmidt were similarly sceptical that electro-shock treatment really tackled the underlying disease, warning it was more likely that it merely removed the symptoms of schizophrenia, rather than its actuality.90 They thus joined a global chorus of sceptics who were increasingly unconvinced by the 1940s and 1950s of electro-shock therapy’s efficacy, in particular for cases of schizophrenia rather than affective disorders like depression.91 In the early 1950s, for instance, Frantz Fanon and François Tosquelles wrote and presented a series of papers in which they argued that electroshock was never therapeutic in itself. Instead, it only had value insofar as it cleared the ground for ‘psychotherapeutic work proper’, by dislodging those pathological reconstructions of the personality which had formed in response to an initial disturbance.92 ‘Outside the possibility of such therapeutic linkages’, they wrote, ‘the Bini cure appears to us a complete nonsense.’93 This theoretical disquiet had concrete consequences, which are particularly pronounced in relation to criminal lunatics. Once electro-shock treatment began to be offered at the government mental hospital at Jaffa, criminal lunatics at Acre central prison were increasingly sent to Jaffa for a course of treatment. Salim S. of Nazareth, who had been found guilty but insane after attempting to set fire to a customs office and detained at Acre criminal lunatic section in May 1945, was one of those sent to receive a course of electro-shock treatment at Jaffa. Diagnosed with schizophrenia, he appeared to be a perfect candidate for treatment and indeed was judged to have made a good recovery by the medical board examining him, which recommended his release in October 1946.94

88 89 90 91

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Blumenthal, ‘Electro-shock Therapeutics’, p. 6. Kurt Blumenthal, ‘Shock Therapy in Psychiatry’, Harefuah 24 (1943), p. 147. Hermann and Kleinschmidt, ‘Electro-shock Therapy’, pp. 84–6. Jonathan Sadowsky, Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy (Abingdon: Routledge, 2017), pp. 47–51; Lara Rzesnitzek and Sascha Lang, ‘“Electroshock Therapy” in the Third Reich’, Medical History 61, 1 (2017), pp. 66–88. Jean Khalfa, ‘Fanon, Revolutionary Psychiatrist’, in Jean Khalfa and Robert J. C. Young, eds., Alienation and Freedom (London: Bloomsbury, 2018), pp. 185–6. François Tosquelles and Frantz Fanon, ‘Indications of Electroconvulsive Therapy within Institutional Therapies’ (1953), in Khalfa and Young, Alienation and Freedom, p. 295. Record of Examination, No. 252, Acre, 19 October 1946, ISA M 334/25.

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Blumenthal – in his capacity as the section’s psychiatrist – urged caution, however, and explained that Salim still showed clear signs of schizophrenia, complaining ‘constantly about his physical sensations with lack of initiative’, and that he was therefore in a state of partial, not full, remission.95 He was only released and handed over to his family in July 1947.96 His experience of a long delay between apparent recovery under treatment and discharge was not unique.97 Caution about discharging patients from the criminal lunatic section at Acre can be understood as linked – very directly, through Blumenthal – to uncertainty and scepticism about how, and if, electro-shock treatment worked. Yet, paralleling their embrace of this treatment in practice, if not theory, in their own private mental institutions, these psychiatrists nevertheless recommended that electro-shock treatment be made available in the criminal lunatic section at Acre. In his report on the section from February 1946, Blumenthal declared himself ‘of the opinion that the experience of the last few years justifies the introduction of the electroshock treatment, in order to shorten the periods of excitement’ and on the grounds that ‘the length of institutional sojourn is reduced by the use of convulsive therapy’. He proposed a machine be acquired for use in the section. With this machine in place, patients could receive treatment in the institution itself, as electro-shock treatment – in addition to its other advantages – could be carried out by the existing staff.98 Given Blumenthal’s sharply critical comments about the training of this staff elsewhere in the report, and how the expertise of mental nursing staff was dismissed more generally,99 this underlines one of the key contrasts between electro-shock treatment, and insulin-coma and cardiazol-shock treatments: electro-shock treatment made much less of a demand on the staff of the institution, in terms of both time and expertise, than the others. Electro-convulsive therapy was not, in spite of Blumenthal’s recommendation, introduced into the criminal lunatic section at Acre central prison. But it was introduced into the government mental hospitals. On 26 March 1945, almost four years after its introduction in private institutions, the first patient underwent electro-shock therapy at the government mental hospital at Bethlehem. In the five months that followed, over fifty patients underwent treatment; only one patient was 95 96 97 98 99

This is the original language of the report. Record of Examination, P/44, Acre, 3 May 1947, ISA M 334/25. Commissioner of Prisons to Chief Secretary, 4 August 1947, ISA M 334/25. Director of Medical Services to Chief Secretary, 1 March 1946, ISA M 346/40. Blumenthal, Report on the Lunatic Section of Acre Prison, p. 15. See Chapter 6.

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discharged as cured, but many other long-standing cases were described as changed for the better ‘in a most striking way’.100 As well as holding out the prospect of improving the condition of those patients already within the hospital, the introduction of electro-shock treatment also had a notable impact on admission patterns. It became possible to admit individuals for a definite period of time – usually six months – as they underwent a course of electro-shock treatment, after which they were to be discharged, whether recovered or not.101 And it also, for the first time, became possible to treat the mentally ill as outpatients.102 In terms of both temporality and spatiality, then, electro-shock treatment was highly attractive, offering the government the means to finally make inroads into tackling the conditions of overcrowding that had plagued its provision for the mentally ill right across this period. Yet it was not Dr Malouf, medical officer in charge of the hospital, who administered this treatment; rather, it was initially administered by one Dr Joseph Klemperer, a clinical assistant at the hospital. Indeed, when the Solus electrical head clamps required for the treatment arrived in Palestine, they had been issued to the government mental hospitals only after the director of medical services was assured that Klemperer had prior experience with electro-shock therapy.103 It is plausible that he gained this experience working at Blumenthal’s hospital in Haifa, where he appears to have settled upon arriving in Palestine after 1933, before he moved to Bethlehem in the 1940s.104 Regardless of where exactly he gained this experience, the use of Klemperer’s existing expertise to introduce a new treatment into government mental hospitals neatly illustrates the way in which the mandate government operated more generally: its reluctance to invest in training its Palestinian Arab employees when it could simply draw on the large number of European Jewish specialists present in Palestine instead – as indeed the Jewish National Council encouraged. Far from parallel health systems, the movement of 100

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J. Klemperer, Government Mental Hospitals, Bethlehem, to Superintendent, Government Mental Hospital, Jaffa, 27 August 1945, ISA M 6602/17. The lower rate of recovery might be linked to the demographics of the government mental hospital: there were more older chronic cases in the government mental hospital than in private homes, where psychiatrists reported their greatest successes as occurring among adolescent cases. For an example, see Medical Report on the Mental State of Ribhi F., District Health Office, Bethlehem, 14 November 1946, ISA M 6627/31. For an example, see District Medical Board Report, No. 45076, Jerusalem, 26 August 1947, ISA M 6578/16. Director of Medical Services to Senior Medical Officers, Jerusalem and Jaffa, 12 March 1945, ISA M 6006/17; Sister, Government Mental Hospital, Bethlehem, to Senior Medical Officer, Jerusalem, 17 March 1945, ISA M 6602/18. For his naturalisation file, see ISA M 6282/21.

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figures like Klemperer and Blumenthal between private and government contexts highlights the degree to which these histories cannot be narrated in isolation from one another but are instead tightly intertwined. It is against this backdrop, too, that we should view Malouf’s efforts to come to terms with this new treatment method and the technology behind it after 1945. Although largely sidelined in the initial implementation of electro-shock treatment, by January 1946 Malouf was writing to the director of medical services about acquiring a different electro-shock machine. Weighing up the advantages and disadvantages of various models, he recommended a Strauss-MacPhail machine be acquired for use in the government mental hospitals; this recommendation was, in part, made on the basis of the pre-existing expertise of the hospital’s clinical assistant – no longer Klemperer, but one Dr Schneider, described as having experience with a Strauss-MacPhail model in England. But this was not the only reason given for recommending the Strauss-MacPhail; Malouf made his case on the basis of the machine’s superior electrodes and more precise timing mechanisms, too.105 And when he had to justify his recommendation later in the year, he added that the head electrodes of the Strauss-MacPhail ‘are simpler and do not have the same horrifying effect on the patient as the Solus electrodes’,106 in use up until this point. In spite of the mandate government’s failure to invest in specialist training, Malouf worked to keep himself abreast of developments in the treatment of patients, became intimately knowledgeable about the details of electro-shock therapy, and sought to take advantage of the broader post-war turn towards colonial investment in welfare and development in order to put his hospitals on a more ‘modern’ footing. In addition to the new models of electro-shock machine, for instance, we also find Malouf writing around the same time to request blood pressure monitors for the mental hospitals at Bethlehem and Jaffa so that patient blood pressure could be measured as they underwent electro-shock treatment.107 There were sharp limits to his ability to make this vision of the mental hospital a reality, however: in the end, only two Strauss-MacPhail machines – not the four Malouf requested – were ordered by the government;108 these only arrived in January 1947.109 Even then problems continued to plague the implementation of a new therapeutic regime in government mental 105 106 107 108 109

M. S. Malouf to Director of Medical Services, 12 January 1946, ISA M 6602/17. M. S. Malouf to Director of Medical Services, 7 September 1946, ISA M 6602/17. M. S. Malouf to Senior Medical Officer, Jerusalem, 22 January 1946, ISA M 6602/17. Tender for supply of Electrical Convulsion Therapy Unit, received 24 May 1946, ISA M 6614/13. Monthly Report, January 1947, Jerusalem District, ISA M 6589/43.

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hospitals, as alterations had to be made to the electrical installations to make these new machines useable.110 Eventually, the new machines were put to use, and Malouf could describe them as being ‘superior to the [old] Solus machine’;111 but the length of this saga, stretched out over more than a year, indicates the obstacles that Malouf had to overcome in order first to acquire expertise and then to put this knowledge into practice in the government’s mental hospitals. In both government and private mental hospitals in mandate Palestine, electro-shock treatment was enthusiastically embraced. In colonial North Africa, Richard Keller has argued that the enthusiasm with which French psychiatrists took up electro-shock therapy was contingent on race; they were much more likely to use experimental and potentially dangerous forms of treatment on Muslim patients than on white settlers.112 Yet this does not seem to translate straightforwardly into the context of mandate Palestine. Electro-shock was first used in private mental hospitals, with largely Jewish patient populations; it was used in the Bethlehem government mental hospitals, with largely Arab patient populations; and it was also introduced in 1945 to the government mental hospital at Jaffa, with its largely Jewish patient population, but – as we have seen – where Arab and Jewish criminal lunatics detained at Acre central prison could also be treated as outpatients.113 In this respect, as a treatment applied to Jewish and Arab patients alike, electro-shock therapy does seem to have been a ‘blind’ method, deployed without thought for those questions of cultural and normative difference over which officials and experts obsessed in other contexts, like the colonial courtroom. Taking place against the wider backdrop of the final, fraught years of the mandate, and with partition and war looming on the horizon, the embrace of this method of treatment without thought for whether patients were Arab or Jewish is striking. But looking beyond the number of patients treated, we can see ways in which psychiatrists’ hopes for a treatment that could be deployed like a magic bullet, without thought for context, were dashed in reality. In the first place, psychiatrists found that these treatments could not simply be imported unmodified into Palestine. In their report in Harefuah, Hermann and Kleinschmidt noted that they had found it impossible to induce a seizure in a patient when the machine was set at 60 or even 70 110 111 112 113

Acting Director of Medical Services to Director of the Public Works, 4 June 1946, ISA M 6549/32. Monthly Report, February 1947, Jerusalem District, ISA M 6589/43. Keller, Colonial Madness, pp. 104–6. Quarterly Financial and Progress Report in respect of the Government Mental Hospital, Jaffa, 17 January 1947, ISA M 323/30.

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volts, the voltage recommended by European and American psychiatrists; neither even caused loss of consciousness. Instead, they started electro-shock treatment with a voltage of 90. The length of the shock, too, had to be increased from that recommended by other psychiatrists.114 The situation in the government mental hospitals was no better. Set at the same voltage and timing, and applied to the same patient under the same conditions of resistance, the electro-shock machine gave readings of wildly varying current passing through the patient’s head. Klemperer was baffled: ‘The figures shown by the machine are not in accordance with the physical laws.’115 In these very practical ways, it quickly became apparent that electroshock treatment could not offer access to the bodily truth of mental illness unmediated by the specific local context of its application. And, although enthusiastically applied to Arab and Jewish patients alike, it did appear to matter who the patients were in other ways. At the government mental hospital at Jaffa, for instance, of the 525 patients who were administered electro-shock therapy between 1945 and 1947, 351 of those treated were women, compared with 174 men. There were more female patients than male in the hospital, but not by enough to explain this ratio: there were 74 male to 98 female patients in January 1947.116 And there seems to have been a recklessness in the application of electro-shock treatment among the predominantly Arab patient population of the mental hospitals at Bethlehem which found no parallel in reports from either private institutions or the mental hospital at Jaffa: as Klemperer noted in his initial report on the treatment, electro-shock had been administered to long-standing elderly patients of the hospital, ‘violent patients in the strong jacket, and even pregnant women’.117 It is in moments like this one in the writings of psychiatrists – which, of necessity, ground this chapter – that we might most lament the limited survival of patient accounts. It is difficult, beyond the instances we have already seen – the reported speech of the grateful patient or the letter relating the sensation of being buried alive by sedatives – to recover how patients would have understood or experienced these methods of treatment. Yet, if we are willing to take a more speculative approach, one story may suggest the profound effects electro-convulsive therapy could 114 115 116 117

Hermann and Kleinschmidt, ‘Electro-shock Therapy’, p. 84. J. Klemperer, Clinical Assistant, Government Mental Hospital, Bethlehem, to Superintendent, Mental Hospital Jaffa, 27 August 1945, ISA M 6602/17. Quarterly Financial and Progress Report in respect of the Government Mental Hospital, Jaffa, 17 January 1947, ISA M 323/30. J. Klemperer, Government Mental Hospitals, Bethlehem, to Superintendent, Government Mental Hospital, Jaffa, 27 August 1945, ISA M 6602/17.

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have on those who underwent it. At the age of twenty-two, Mohammad Z. of Haifa began acting oddly. Leaving the house for days and months at a time to wander aimlessly around the country, he became incoherent and unable to work. In 1945, now aged twenty-eight, he was admitted to Dr Blumenthal’s mental hospital, where he underwent a course of electro-shock treatment for four months and was discharged. A year later, he was examined by a medical officer, who concluded he had been suffering from schizophrenia for the past seven or eight years, and continued to do so. He had not benefited by his treatment at Blumenthal’s hospital, clearly, and indeed was not considered a case that was curable; as a result, his admission to a government mental hospital was not recommended. It is not clear what happened to him, but it seems very likely that the failure of his stay at Blumenthal’s hospital to cure him precluded his subsequent treatment in a government institution. But this may not have been the only impact of that experience. Just as we saw in an earlier chapter how medicalised processes could be taken up into and form elements within the reported delusions of patients, Mohammad’s case file might be read creatively, as reflecting another level at which he had been affected by his experience of electro-convulsive treatment. Noting his symptoms, the medical officer recorded that Mohammad suffered hallucinations; he was described as deluded. He saw visions; he heard voices; and – strikingly, tantalisingly – he felt himself to be electrified.118

Conclusion: Partitions and Splittings Jamil Tutunji’s attempt to pioneer a new form of fever therapy in the middle of the interwar years may have marked a dead end for that particular treatment in mandate Palestine. But it represented the beginning of a period of experimentation with other therapies that targeted the body to heal the mind, whether with work, drugs, or electricity. His effort to participate in this period of experimentation globally, frustrated though it may have been, did not even mark the end of his own encounters with psychiatry. Having been appointed to a series of important positions within Transjordan, including personal physician to King Abdullah and director of health by the 1940s, in 1951 Tutunji examined the king’s son, Talal, and recommended that he be sent to the Lebanon Hospital for Nervous and Mental Disorders for further assessment and treatment.119 When 118 119

Medical Report on the Mental State of Mohammad Z., Bethlehem, 17 June 1946, ISA M 6628/8. Alec Kirkbride, From the Wings: Amman Memoirs, 1947–1951 (London: F. Cass, 1976), p. 124.

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Talal succeeded his father in July 1951, Tutunji was swiftly fired,120 before being reappointed when Talal was forced to abdicate the following year. The news of his reappointment was greeted with ‘special pleasure’ at the Lebanon Hospital for Mental and Nervous Disorders, where it was hoped that he would play an active role in helping with the hospital’s recruitment of student mental nurses from Jordan.121 By the 1950s, this pool of potential recruits would have included Palestinians, both those displaced in the nakba of 1948 and those living in the areas of historic Palestine that were now controlled by Jordan. In 1925, Tutunji had written to The Lancet describing himself as a medical doctor in Palestine; by the 1950s, as Jordanian minister for health, he not only had a role to play in facilitating the training of Palestinian and Jordanian student mental nurses at ʿAsfuriyyeh, but was ultimately responsible for the first government mental hospital at Bethlehem, which continued to operate under Jordanian control after 1948. The scale of the political changes in the intervening decades is laid starkly bare in these two encounters with psychiatry at different ends of Tutunji’s career. But as we have seen across this chapter, and indeed across this book, politics stalked psychiatry and Palestinians’ engagements with mental illness in ways both obvious and subtle throughout the mandate period. In 1937, the same year Blumenthal introduced insulin- and cardiazol-shock treatment into his private hospital on Mount Carmel, the Peel Royal Commission concluded its inquiry into the great revolt, and recommended the creation of a separate Arab and Jewish state in Palestine. Partition was first officially mooted at precisely the same moment that new somatic treatments were being introduced which looked – at first glance, at least – as though they could be applied to all, regardless of differences in culture or environment. Ten years later, as Malouf struggled to acquire his new electro-shock machines at Bethlehem, the newly established United Nations arrived at the same conclusion as the Peel Commission: that partition was the only solution to the Palestine question. Somatic treatments had held out the promise that mental disease was rooted in the body and that treatment which targeted the biological roots of mental disease could therefore be applied without thought for the identity of the patient or the specificities of the place. But, as we have

120 121

Robert B. Satloff, From Abdullah to Hussein: Jordan in Transition (Oxford: Oxford University Press, 1994), pp. 18, 50. Hilda Fox to Dr Ford Robertson, Medical Director of the Lebanon Hospital for Mental and Nervous Disorders, 3 November 1952, in Honorary Secretary’s File, July 1952 to January 1953, C3D2B9, Archives and Special Collections, Jafet Library AUB.

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seen, somatic treatments succumbed in a sense to the logic of partition too, in practice if not in theory: the kind of work assigned for therapeutic purposes depended on the patient’s gender, class, and nationality; the new somatic therapies that relied on careful administration of drugs foundered in part on a suspicion that the Palestinian staff of government institutions were not equal to this challenge; and electro-convulsive treatment was both adapted technically to function in Palestinian space and deployed on different patient groups with varied levels of restraint and recklessness. The distinction between the new somatic treatments introduced in the late 1930s and 1940s and patient work was not so great, after all; each contended in their own way with the question of difference and context. The years leading up to 1948 had seen the implementation of a remarkable range of new methods of treatment, many of which took aim at schizophrenia – a term that gradually, in these years, supplanted the older category of dementia praecox so long favoured by the department of health. The triumph of schizophrenia, with its enthronement of the notion of Spaltung or the splitting of psychic functions,122 was uncannily paralleled in the conclusion to the political history of mandate Palestine, as Arabs and Jews too were to be split apart in partitioned states. In the Epilogue, we turn our attention to that process of partition, and to the end of the mandate period’s entangled psychiatric history.

122

G. Berrios, R. Luque, and J. Villagrán, ‘Schizophrenia: A Conceptual History’, International Journal of Psychology and Psychological Therapy 3, 2 (2003), pp. 116–17; Dalzell, ‘The Reception of Eugen Bleuler’, pp. 331–2.

Epilogue Partitions and Afterlives

Late in January 1949, just a few weeks after a UN-decreed ceasefire brought the first Arab–Israeli war to an end, an extraordinary episode unfolded in the history of psychiatry in what had been, up until May 1948, British mandate Palestine. Under the supervision of UN personnel, Arab Legion guards, and qualified medical attendants, sixtyseven Jewish psychiatric patients – six of them confined to stretchers – were transported in a convoy of buses, ambulances, and army jeeps from the Bethlehem mental hospital, through Jerusalem’s Old City, to the Mandelbaum Gate, the checkpoint marking the end of the Jordaniancontrolled city and the start of the Israeli-controlled city. There, they were transferred into a second convoy of buses and ambulances organised by the newly established Israeli Ministry of Health, and taken to five different institutions around the city – a list of by-now familiar names, including the Convent of the Sisters of St Vincent de Paul and the Ezrath Nashim private hospital. At the same time, unspecified Arab authorities were reported to have agreed to the simultaneous transfer out of Israelicontrolled territory of forty-eight Arab psychiatric patients, the majority of them from the criminal lunatic section at Acre.1 This meticulously planned and executed transfer of psychiatric patients across no-man’s land one cold winter’s morning in 1949 appeared to draw a line under a decades-old pattern of treating Muslim, Christian, and Jewish patients together, in the same institutions and at the hands of the same doctors and nurses. As recently as 1942, the mandate’s director of medical services, George Heron, had proudly declared that ‘[w]e mix Arabs and Jews at Bethlehem mental hospital without any trouble’, and indeed argued for the siting of the third

1

Administrative Order by Neil Hansen, Captain USMC, Jerusalem, 18 January 1949, ISA G 152/22; Dr S. Zaiman, Chief Physician of Ministry of Health, State of Israel, to Ministry of Health, 30 January 1949, ISA G 152/22; Army Liaison Officer to the International Red Cross, to the International Red Cross Committee, Tel Aviv, 29 December 1948, ISA G 152/22.

305

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government mental hospital near Jaffa, ‘midway between Arab and Jewish areas’, so that this practice could continue.2 The partitioning of patient populations in January 1949 marked a clear break, then, with the operation of colonial psychiatry under the British mandate. It was not, however, unprecedented or without parallels. Just a year before the British mandate for Palestine was terminated, the end of British colonialism in South Asia set similar dynamics in motion there, as the newly independent governments of India and Pakistan embarked on a process of exchanging Muslim and non-Muslim psychiatric patients across partition lines – a dimension to the tragedy of Partition that has found immortalisation in Saadat Hasan Manto’s surreal short story Toba Tek Singh.3 Decolonisation and partition played out at a psychiatric register around the globe in the middle of the twentieth century. While the exchange of Arab and Jewish patients certainly represents a dramatic episode in this history, the partitioning of psychiatric populations in what had been mandate Palestine neither began nor concluded in January 1949. The roots of this partition stretched back years before 1948. In January 1949, the key actors responsible for arranging the exchange of patient populations were the Israeli, Palestinian, and Jordanian medical and political authorities, and the representatives of international organisations including the Red Cross and UN agencies. But in the years leading up to the end of the mandate, separation was driven from below, not simply organised from on high. The families of patients in the government mental hospitals had played a role in setting this process of segregation in train, as they petitioned the government to transfer their relatives to institutions where they would be in the ‘majority’. The story of Mariam B., from Bir Nabala – a village north-east of Jerusalem – is a case in point. Diagnosed with an organic form of psychosis, in November 1945 Mariam had been admitted to the new government mental hospital at Jaffa. Half a year later, her father, Hussein, wrote to the director of medical services to request that she be transferred to the mental hospital at Bethlehem instead, because at Jaffa ‘[h]er nationality [jinsiyya] is making her suffer a great deal’. He explained: ‘As my daughter was the only Arab patient between the Jews, she suffered many injuries on the head inflicted by the Jewish patients.’4 The director of medical services, now Dr R. S. F. Hennessey, 2 3 4

Director of Medical Services to Chief Secretary, 5 May 1942, ISA M 323/30. For more details, see Anirudh Kala and Alok Sarin, eds., The Psychological Impact of the Partition of India: The Partitioning of Madness (New Delhi: SAGE, 2018). Hussein B., Bir Nabala, to Director of Medical Services, 15 July 1946, ISA M 6628/6. His petition was translated from Arabic to English; the quotes are taken from the English translation with the original Arabic in brackets.

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moved quickly to fulfil this request. The speed and indeed the manner in which he did so suggest that – in spite of his predecessor’s conviction, expressed just a few years earlier, that ‘mixing’ was unproblematic – he shared Hussein’s view that Arab and Jewish patients could no longer share the space of the mental hospital: just a week after receiving this petition, he had arranged to exchange a Jewish female patient at Bethlehem for Mariam B. at Jaffa.5 Mariam was not the only patient to be exchanged in the years leading up to the end of the mandate at the request of her family. The following year, in February 1947, Avigdor K. wrote to request that his son, who had been at the Bethlehem mental hospital for a number of years already, be transferred to Jaffa. ‘I have the impression’, he explained, ‘that it would do him good in respect of his feelings if he would live in another surrounding i.e. between Jewish patients for this reason’.6 His was but the most explicit in a series of requests by Jewish families for the transfer of relatives from Bethlehem to Jaffa in these years, requests that otherwise were more discreetly framed in terms of a desire to be closer to relatives and so visit them more easily, for instance.7 The response by the department of health underlined the communal logic to these transfers, however explicitly framed by families, as each Jewish patient was exchanged for a Muslim or Christian one.8 As the British declared their intention to withdraw, and the United Nations looked to partition Palestine, even the patient population of the government mental hospitals had begun to ‘unmix’, as a result of pressure from families and with British acquiescence. The psychiatric partition of Palestine was a process, not an event; if its roots predated the formal termination of the mandate, it continued to be worked through long after 1949’s exchange of patient populations and armistice agreements. This was something Nazmi Ju’beh discovered as late as the 1980s, when a chance encounter led his mother-in-law to realise that her husband’s brother, long thought dead, was in fact still alive – and a patient in Givat Shaul mental hospital in Jerusalem.9 Her brother-in-law, Shaykh Hassan al-Labadi, had been the imam at Abu Dis 5 6 7

8 9

Director of Medical Services to Medical Superintendent, Government Mental Hospital Bethlehem, 23 July 1946, ISA M 6628/6. Avigdor K., Jerusalem, to Director of Medical Services, 1 February 1947, ISA M 6627/31. Joseph L., Rishon LeZion, to Director of Medical Services, 29 August 1947, ISA M 6627/31; Channah W., Tel Aviv, to Director of Medical Services, 20 December 1945, ISA M 6628/6. Director of Medical Services to Medical Superintendent, Government Mental Hospital Jaffa, 10 February 1947, ISA M 6627/31. Nazmi Ju’beh, ‘Sheikh Hassan al-Labadi and Seven Acts of Lost Memory’, Jerusalem Quarterly 30 (2007), pp. 10–25.

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until an incident at al-Aqsa mosque near the start of the Second World War, in which he had fatally stabbed a British soldier. As a result, he had been sentenced to death, a sentence commuted to detention for life at Acre prison. His family had continued to visit him in prison until May 1948, when Acre fell to the Israelis in the days following the end of the mandate; after that, and in spite of their efforts to reach him through the Red Cross, the family lost all contact with him. Nearly forty years later, they learnt from someone working at the Givat Shaul mental hospital that he was alive. While Israeli urban legends hold that Holocaust survivors hospitalised at Givat Shaul communed with the spirits of the Palestinian inhabitants of Deir Yassin massacred in 1948,10 living ghosts haunted this institution too; it is precisely that otherworldly language – ‘a ghost, a tall, angelic, unassuming figure’ – which Ju’beh reaches for in order to describe the rediscovered shaykh. In the absence of any records in the Israeli prison or health systems explaining what had happened, besides some transfer memos which revealed that he had moved between a number of hospitals before finally arriving at Givat Shaul, Ju’beh could only guess at how Shaykh Hassan had lost his memory and been institutionalised. Released into his family’s care, the shaykh was taken by his son to Amman, where he had long ago moved for work: But the shaykh lived his last days beset by perplexity. He used to go out to the Amman heights looking for something that we couldn’t fathom, followed by one of his grandchildren. He did not live long; he died two months after his ‘liberation’. Was it freedom that killed him? Had we committed a mistake in freeing him from his prison?11

The history of psychiatry in Israel after 1948 has received more scholarly attention than its Palestinian counterpart, but this historiography has adopted a resolutely national frame.12 The story of Shaykh Hassan alLabadi gestures to the continued interconnection between these histories long after 1948, the incompleteness of partition. But it also raises questions about archives. Ju’beh’s hunt for records that might shed light on Shaykh Hassan’s past, and the failure of this search to provide answers and closure, should not feel unfamiliar to us; like Ju’beh, and indeed like Emile

10 11 12

Aloni, What Does a Jew Want?, p. 76. Nazmi Ju’beh, ‘Sheikh Hassan al-Labadi’, Palestine-Israel Journal of Politics, Economics, and Culture 5, 2 (1998). Zalashik, Das Unselige Erbe; Nadav Davidovitch and Rakefet Zalashik, ‘Recalling the Survivors: Between Memory and Forgetfulness of Hospitalised Holocaust Survivors in Israel’, Israel Studies 12, 2 (2007), pp. 145–63; Oded Heilbronner, ‘The Mentally Ill and How They Were Perceived in Young Israel’, History of Psychiatry 32 (2021), pp. 20–36.

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Habibi’s narrator at the end of The Secret Life of Saeed: The Pessoptimist, throughout this book we have come across many archival trails that run cold, stories that are cut short, for the mandate period too. Yet there is something distinctive about the turn to urban legends, to rumour, to imagination after 1948, evident not only in Ju’beh’s speculation about the shaykh, or in the stories about Givat Shaul and Deir Yassin, but even in histories related in more stolidly national frames: Nadav Davidovitch and Rakefet Zalashik, for instance, retell the Israeli urban legend of a ship that brought hundreds of mentally ill Holocaust survivors to Israel in the first years of the state’s existence and how these survivors were immediately incarcerated in the government psychiatric institution at Acre, on the site of the old mandate-era prison, a place notorious for its harsh conditions. Whether true or not, the story came to capture how hospitalised survivors had been treated by the early state within the Israeli public sphere.13 Though there are parallels and connections to be marked, it would be misleading, however, to draw false equivalences between the archives and histories of Palestinian and Israeli psychiatry. If historians of the latter struggle to escape the pull of the nation-state, there is no unitary archive or straightforward national story for the former. Instead, a history of Palestinian psychiatry after 1948 must reckon with – among other things – the expansive role played by various international agencies in the management of the mentally ill, training of doctors and nurses, and funding and organisation of hospitals, and the task of painstakingly piecing this history together using multiple archives on different continents as a result. Nor is it possible to tell a story of evolution, as can be done in the case of the Israeli mental health system, which emerged after 1948 on foundations laid across previous decades in the form of private institutions and professional associations. In the first place, these foundations were never as solidly constructed for Palestinians, as a result of a lack of investment in the department of health by the mandate government. In spite of this, Palestinian doctors and nurses – as we have seen – worked to cultivate specialist knowledge, implement and refine new therapeutic practices, and establish psychiatric care on a more professional basis. Yet many of the fruits of their efforts were doomed to wither on the vine, amidst the wrenching dislocations of the nakba. Beyond simple adaptation, in a different context Camille Robcis has shown how even the most shattering political crises might be generative of lasting therapeutic insights.14 This stakes out an important direction 13 14

Davidovitch and Zalashik, ‘Recalling the Survivors’, pp. 145–6. Camille Robcis, Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France (Chicago: University of Chicago Press, 2021), pp. 15–47.

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for future research, on psychiatry after the nakba. But for now, this epilogue lingers on rupture. Right on the eve of 1948, one of the most important threads in this history, which might have provided continuity between these two eras, was snapped in the most shocking way, as this announcement on the front page of the Palestine Post from December 1947 reveals: Bethlehem, Monday – A government medical officer, Dr M.S. Malouf, was shot and killed near the men’s medical asylum here about 11.30 this morning. According to witnesses, four men, described as Jews, came to the hospital and asked if Dr Malouf was in. When told that he had not arrived, the men left. A few minutes later, Dr Malouf approached the hospital and was shot dead a few yards from the main entrance. Some witnesses said the murderers were in Arab dress and escaped in a car. Dr Malouf, who was fifty-three, leaves a wife and three children.15

The Arab National Committee met the following morning and condemned the attack on a man on his way to the hospital to do his humane work.16 Dr Avraham Katznelson of the Vaad Leumi’s health section similarly held a press conference in Jerusalem, deploring the murder, and linking it to the earlier murder of another government medical officer, Dr Hugo Lehrs, while on duty at the government hospital at Bayt Safafa. Malouf’s murder was ‘apparently in retaliation’ to that of Lehrs. With the possibility of further retaliation obvious, Katznelson urged the two dozen Jewish nurses at the government hospitals in Jerusalem to abandon their work ‘since all the assurances given by the government to the Jewish authorities regarding the safety of its Jewish personnel had proved vain’.17 The separating out of patient populations was accompanied by calls for staff, too, to segregate in advance of partition proper. Dr Malouf’s funeral was a huge affair, with thousands of mourners flocking to Bethlehem, including representatives from the Orthodox and other Christian communities, the Arab Higher Executive and Supreme Muslim Council, consuls and doctors from other Arab states, and the medical profession in Palestine, with Drs Tawfiq Canaan and Mahmud Taher Dajani representing the medical associations of Jerusalem and of Palestine respectively.18 But in the following weeks, a heated debate was staged in the pages of the Palestine Post, when the newspaper published a report which suggested that Malouf had been murdered not by Jewish assailants in retaliation but because he had ‘refused to contribute several thousand pounds to Arab national funds’, just as it was alleged he had 15 17

PP, 30 December 1947, p. 1. PP, 30 December 1947, p. 3.

16 18

Filastin, 31 December 1947, p. 2. Filastin, 1 January 1948, p. 4.

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refused during the Arab revolt.19 This resulted in a furious letter to the editor from Dr Izzat Tannous, Malouf’s almost exact contemporary – Malouf graduated from the American University of Beirut School of Medicine in 1916, just two years ahead of Tannous – who had become much more heavily involved in politics, having headed the Arab Office in London in 1936. Tannous poured scorn on the idea that Malouf had ever been pressured to contribute, and fulminated that ‘such news is being invented by the real perpetrators of this abominable outrage against a doctor who served Palestinians irrespective of race and creed to cover their murderous act’.20 A response was published in the paper at the end of the month, with the name and address of the author withheld by the editor. This anonymised letter disputed Tannous’ account: ‘I knew Dr Malouf well, and in the course of a conversation I had with him in August 1945, much was revealed to me of his relations with the Husseinis and the dangers to which he was exposed during the 1936–1939 disturbances because of his friendship with Jews and because his home was open to his British friends.’ The author went on to point the finger of blame at the Husseinis, noting: ‘His tragic death is regretted first of all by those Jews who knew him and this not because of his political attitude towards the Jewish question, as he, also, was an anti-Zionist, but because of his human qualities and his courage to face the threats of the aggressors.’21 As these allegations and ripostes about his politics make clear, Malouf – one of the central figures, in many ways, in Mandatory Madness – was and remains an elusive character in the archive.22 His entry in the American University of Beirut alumni directory, compiled after his death, underlines this: in spite of the connections he had maintained with his alma mater into the 1930s, not only was the entry brief, but it was out of date by some decades, both in relation to his career – he had been a travelling medical officer specialising in ophthalmology in Hebron, the directory wrongly maintained – and personal life – he was recorded as unmarried.23 He had done his job well, to judge both by annual reviews of his performance and what we know of his cultivation of expertise on wartime trauma and electro-convulsive therapy. But by showing no apparent interest in publishing his work, failing to step up to any substantive role in organisations like the Palestine Arab Medical Association, and even allowing existing networks like the alumni network 19 21 22

23

20 PP, 13 January 1948, p. 3. PP, 19 January 1948, p. 4. PP, 29 January 1948, p. 4. At a late stage in the preparation of this book for publication, a chance email to Emily Jacir opened up new possibilities for understanding Dr Malouf’s life beyond the archive, but it was not possible to adapt the manuscript to reflect this in a more substantive way. American University of Beirut Directory of Alumni, p. 110.

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to atrophy, Malouf rendered himself a caesura in the archive. As a result, he became most visible at the moment of his death, as his murder stirred up rumour and counter-rumour about his politics and his social circles, and even uncovered a wife and children for the man whom we otherwise know only through his work. His wife’s name, not given in these newspaper accounts more interested in disputing the identity of his murderers and enumerating his mourners, was Berthe,24 which we learn from another, unexpected source: a quasi-fictional account of the final years of the mandate period, published in the early 1970s and based in part on interviews. This offers a very different perspective on Malouf’s final few days. The following excerpt, worth quoting at length for the way it poignantly if imaginatively humanises a figure so central to this book, comes from interviews with Berthe Malouf herself, and opens with the ringing of the bells of the Church of the Nativity to mark Christmas Eve, 1947: Hearing the bells in his home a few streets away, Dr Mikhail Malouf, the Arab head of Palestine’s psychiatric hospitals, stood up. Normally, Christmas eve was a joyful feast in the Malouf home. Dozens of their friends dropped in to celebrate around the dishes of the Arabic mezze that Berthe Malouf spread over every table in her house. As they feasted, they would listen to the distant carolling rising from Shepherds Fields. And at the sound of Bethlehem’s bells they too would walk singing up to Basilica Square. This year there was no mezze and no feasting in the Malouf home. It had not seemed appropriate. The only sound drifting up to their home had been that of a few British soldiers on pass singing loudly off in the distance. Now, with the chimes of the Church of the Nativity ringing through his living room, Dr Malouf solemnly wished his wife a traditional Arabic greeting, ‘May all your feasts find you in good health.’ Then he kissed her. Arm in arm they stood at their living room window peering into the darkness through the lightly falling snow. From the centre of Bethlehem they heard again the shouts and singing of the British soldiers, a little drunker now, ringing through the night. ‘But in the houses’, Berthe Malouf thought, listening to them, ‘there is only sadness.’25

A few days later, Malouf heard the news of the murder of a colleague in the department of health, Dr Hugo Lehrs, announced on the radio: And he lamented to his wife, ‘This should never have happened.’

24

25

We learn a little about Berthe – though never her name – elsewhere in the paper: that she was involved in fundraising for the Palestine Society for Crippled Children, for instance. See PP, 22 July 1945, p. 2. Collins and Lapierre, O Jerusalem!, pp. 122–3. This section is based on interviews with Berthe Malouf, among others: see ibid., p. 579.

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At high noon the next day, the Biblical ration of vengeance, an eye for an eye, a tooth for a tooth, was exacted on the Arab medical community. On his way to visit the inmates of a little insane asylum outside Bethlehem, Mikhail Malouf was murdered, wrapping in a new sadness the home in which a few nights before he and his wife had celebrated their melancholy Christmas together.26

In emphasising the interconnectedness of the social and cultural histories of psychiatry for Muslims, Christians, and Jews in British mandate Palestine, in using their many encounters around mental illness to tell a new relational history of this period, Mandatory Madness has sought to resist the idea that the separation, division, and partition we see in and around 1948 was inevitable or immanent. Patients drawn from across Palestine’s communities were treated in government mental hospitals by the same doctors, matrons, and nurses; their insanity defences were tried in the same courts, and their detentions as criminal lunatics served out in the same wards; their relatives wrote the same pleas to government officials. This was certainly no even playing field, whether in terms of access to private Jewish mental homes, the standards by which criminal insanity cases were judged, or the application of new, experimental treatments in government institutions. But these were connected histories nonetheless. And, to return to Mariam, whose father had asked in 1946 for her transfer from Jaffa to Bethlehem on the grounds of her ‘nationality’, these connections, shared spaces, entanglements mattered. While her father argued she was at risk because of her nationality, as the only Arab patient in the hospital, a medical officer with knowledge of her case privately informed the director of medical services that the situation was more complex than perhaps the father knew: During her stay in the mental hospital, Jaffa, and as a result of the pathological feature of her character (organic psychosis, encephalitis), she could not be prevented from developing a special affection for a particular Jewish patient (Malca G.) whose company she sought from time to time. It is regretted that Miss Mariam B. has become a victim to her affection to this particular Jewish patient and I emphatically state that the injuries which she sustained must in no way be related to her nationality.27

Glimpses of the kinds of relationships that could emerge within the walls of the institution are few and far between in the archive. Almost by their nature, interactions between patients, taking place behind the closed doors of shared rooms, beyond the surveillance of overworked nurses 26 27

Ibid., p. 127. A/Senior Medical Officer, Jaffa, to Director of Medical Services, 10 August 1946, ISA M 6628/6.

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and attendants, elude the institutional archive, except where the consequences of these contacts spill out into violence that could not be overlooked, as seems to have been the case here with Mariam. If Mariam’s story is a final reminder of the limits and lacunae of the archive, the crucial blind spots in the history assembled here, it also speaks profoundly to the process of partition and separation which had already taken root by 1946 and which would only gather pace across the coming years. By this point, Mariam’s ‘special affection’ for a Jewish patient – her desire to spend time with her, to seek out her company – required a medical explanation, a diagnosis, to understand. In advance of partition proper, the entanglement that defined the history of psychiatry in mandate Palestine had already become pathologised.

Bibliography

Archival Collections British National Archives, London. Central Zionist Archives, Jerusalem. Haifa Municipal Archives. Israel State Archives, Jerusalem. Jafet Library, Archives and Special Collections, American University of Beirut. Jerusalem Municipal Archives. Middle East Centre Archives, St Antony’s College, Oxford. Saab Medical Library, American University of Beirut. School of Oriental and African Studies, University of London. Tel Aviv Municipal Archives.

Newspapers, Magazines, and Journals English British Medical Journal. Journal of the Palestine Oriental Society. The Lancet. Palestine Bulletin. Palestine Gazette. Palestine Post.

Arabic Filastin. Al-Kulliyah. Al-Majalla al-Tibbiyya al-ʿArabiyya al-Filastiniyya. Mir’at al-Sharq. Al-Muqtataf. Sawt al-Sha’ab.

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Index

‘Abbasiyya asylum, Egypt, 40, 73, 102, 104 Abd al-Hadi, Awni, 87–8 ‘Asfuriyyeh. See Lebanon Hospital for Mental Diseases Aal, Dr Abdul, 170–2 Abdullah, king of Transjordan, 302 Abu Dis, 132, 307 Acre, 24, 29, 43, 49, 133, 138 Acre central prison conditions and overcrowding, 108–9 and detention of Shaykh Hassan alLabadi, 308 medical observation during trial, 188, 189 prison break, 1947, 221–2 in Secret Life of Saeed The Pessoptimist, 14, 309 Acre criminal lunatic section admission without medical evidence, 164 agency of criminal lunatics, 229–30 alcoholic cases, 102 alternatives to, 192 anxiety about carceral atmosphere, 208 challenges of diagnosis, 209 demographics, 204–5, 210–11 as destination for criminal lunatics, 194 discharge from, 222–9 escape of patients in 1947, 221–2 establishment of, 197 everyday life within, 212–15 family attitudes towards discharge, 227, 228–9 importance of work for discharge, 224–5 isolation of patients, 209–10 length of stays, 212 need for expansion, 199 patients sent to Haifa for treatment, 221 patients sent to Jaffa for electroconvulsive treatment, 296 petitions for release from relatives, 201–3, 211, 219, 225

338

plan to expand exercise yard, 215 proportion of patients diagnosed with schizophrenia, 210 proposed boarding out scheme, 228 proposed introduction of electroconvulsive treatment, 297 role of police in discharge, 226–7 use of sedatives, 291 acute mania, 89, 198 addiction, 99, 102–3, 265, 291 alcohol, 39, 99, 101–2, 165, 187, 265 Aleppo, 38 Algeria, 18, 22, 283, 300 aliya/aliyot. See European Jewish immigration al-Jazzar mosque, Acre, 215 al-Khidr, the evergreen one, 63–72 al-Kulliyah, 74 Allen, Mrs E. M., 282–3 al-Muqtataf, 39–40, 43, 64, 211 Aloni, Udi, 244 amentia, 267 American University of Beirut, 13, 17, 74–5, 262, 311 Amman, 69, 308 Amok, 186–7 Anglican Bishop in Jerusalem, 52, 153 anonymity, preserving patient, 20 anorexia, 260 Arab Higher Executive, 310 Arab Jews, 10–11 Arab Legion, 305 Arabic terms for mental illness, 88, 147–8, 181–2 Artas, 56 Asal, Shafic, 170 auditory orientalism, 108 Balfour Declaration, 12, 26 Barbour, Brigadier R. F., 254 Bayt Hanina, 133 Bayt Jala, 112, 132, 150

Index Bayt Safafa government hospital, 268, 282–3, 310 Beirut, 14, 41, 43, 47, 58, 70 Bentwich, Norman, 59–60 Berlin, Isaiah, 97, 111 Berliner Evangelische Jerusalem Verein. See Jerusalem Verein Bethlehem agriculture around, 284 attitudes towards asylum, 59 British attitudes towards, 57 criminal lunatics from, 221 funeral of Dr Malouf, 310–13 missionary interest in, 245 patients at ‘Asfuriyyeh from, 43 reformatory, 206 staffing of mental hospitals, 268 weather, 78 bilharzia, 78 bimaristan, 38–9 Bir Nabala, 306 blindness, 45, 81, 90, 110, 178 Bloch, Zipporah, 148, 151 blood pressure monitors, 299 Blumenthal, Dr Kurt on admission patterns at Acre, 199–200 on alcoholic cases at Acre, 102 analysis of demographics at Acre, 204–5, 210 criticism of Acre built environment, 213 criticism of staffing at Acre, 213–14 dangers of insulin and cardiazol treatment, 289–90 electro-convulsive treatment at Acre, 297 failed treatment of Mohammad Z., 301–2 food at Acre, 216 founding of hospital in Haifa, 239, 286–7 high fees for treatment, 294 inspection of Acre criminal lunatic section, 199 introduction of electro-convulsive treatment, 293–4 introduction of insulin and cardiazol treatments, 287–8 Muslim patients at hospital, 136 popularity of hospital beyond Palestine, 136 scepticism about electro-convulsive treatment, 294–7 under-medicalisation and neglect at Acre, 208–10, 214–15, 220 value of insulin and cardiazol treatment, 292 Bnei Braq private mental hospital, 236–7, 239, 241–5, 249, 251–3, 271 strikes by staff, 241–2

339 border between Palestine and Lebanon, 134, 137–9, 143–4, 156 Bourke, Paget, 223 Broadhurst, Joseph, 108, 180 Cairo, 38, 40–1, 43, 47, 102, 104 camphor, 286 Canaan, Tawfiq, 66–8, 181–2, 262, 310 cardiazol shock therapy in nursing curriculum, 267 origins of treatment, 286 use in Palestine, 285–93 Carothers, J. C., 22, 184 Cattan, Henry, 178 Census advisory committees, 82, 86–8, 110, 112 Census of India, 1911, 85 Census of Lebanon, 1921, 84 Census of Palestine, 1922, 84 Census of Palestine, 1931, background and influences, 84–6 commentary and correspondence around, 90 destruction of original records, 89 differences with British census, 86 enumeration process, 81, 86 European Jews as agents of development, 95–6 organising society by religion, 94 question of identity, 82 rates of insanity by sub-district, 105–6 rates of insanity internationally, 91 reception, 110–11 returns of infirm population, 81 returns of insane population by gender, 101 returns of insane population by religion, 92 census of the Jewish insane, 1936, 110 Cerletti, Ugo, 286 Chaplin, Thomas, 65 climacteric, 99–100 collective punishment, 161, 183, 185–6 Committee on Development and Welfare, 1940, 234–7, 271 consanguineous marriages, 105–6 Copland, Randolph, 173–7 cousin marriage. See Consanguineous marriages criminal insanity in civil and religious courts, 167–72 concern about malingering, 164–5 dramatic increase in 1940s, 194 and medical expertise, 165–7 normative uncertainty, 24, 31, 160, 176

340

Index

criminal insanity (cont.) press coverage of, 6, 158–9, 173 rates and numbers, 159, 191 relationship between law and psychiatry, 174–6 self-presentation in courts, 163–5 in a state of exception, 183–91 weaponisation by prosecution, 201 Dajani, Dr Mahmud Taher, 310 Damascus, 17, 42 Darwinian evolution, 39 Davar, 163 deaf-mutism. See Deafness Deafness, 81, 107 Deir Abu Tor, 130 Deir Yassin, 244, 308–9 delusions distorting European modernity, 89 around electricity, 302 around food, 216–19 as historical source, 196, 215–21, 301–2 in the law, 173–5, 188–9 around medicalisation, 218–20 in the nursing curriculum, 265 of persecution, 142 around somatic complaints, 211–12 dementia paralytica. See Syphilis dementia praecox, 188, 210, 228, 304 Denishensky trial, 158–61, 166–7, 172, 178, 192 department of education, 205 department of health aborted plan for new mental hospital, 79–80, 233 admissions criteria, 145 annual reports, 6, 111 budget and priorities, 12, 17, 130, 235, 283 dispute with police and prisons, 197 engagement with 1931 census, 86–7, 111–12 Palestinian organising independently of, 262 policy of devolution, 48–9, 238 relationship with private mental institutions, 239–41 relationship with Vaad Leumi, 27 role in assessing wartime psychiatric casualties, 257 staffing, 15–17, 73–4 struggle to establish first government mental hospital, 55–63 department of social welfare, 149, 226, 227, 228, 260

detention camp, for Italian wartime detainees, 248–51 diabetes, 289 diffusionism in global history, 274, 286 Dudgeon, Dr H. W., 73 Duff, Douglas, 67 Dushinsky, Yosef Tzvi, 190 electro-convulsive therapy adaptation to Palestine, 300–1 for criminal lunatics, 214, 296–7 impact on petition patterns, 145 origins of treatment, 286 for outpatients, 2 as part of nursing curriculum, 267 patient perspective on, 301–2 scepticism about, 295–7 uneven introduction into Palestine, 18, 273–5 use at Blumenthal’s hospital, 136 use in government mental hospitals, 297–300 use in private Jewish hospitals, 293–6 Elijah, Prophet, 63–72 epilepsy, 150, 165, 210–11, 214, 267, 286 erotomania, 173–5 Esquirol, Jean-Étienne Dominique, 174 eugenics, 98 European Jewish immigration in the census, 96–8 impact on Palestine, 25, 132 redemption of Diaspora, 23 restrictions on, 28–9, 221 selection and repatriation, 98 eye diseases. See Blindness Ezrath Nashim mental hospital Arab patients, 136 bedstrength in 1940, 236 changing patient demographics, 50–1 continued subsidies after 1922, 72 cost of treatment, 135, 137 destination for patients exchanged in 1949, 305 financial position in 1920s, 49–50 impact of 1929 economic depression, 113–14 introduction of electro-convulsive therapy, 295 introduction of insulin therapy, 288 official recognition and regulation, 239–40 Ottoman history, 10, 44 perceived excesses of, 53 problem of siting, 63 proportion of patients diagnosed with schizophrenia, 210

Index strike by staff, 113 therapeutic innovation and resistance, 52–3 threat of closure, 53–4 withdrawal of subsidy after 1922, 76–7 Fanon, Frantz, 22, 283, 296 Farah legal case, 168–9 feeble-mindedness, 85, 87, 267 Feigenbaum, Dr Dorian British arrival as rupture, 36, 42, 47, 61, 67, 71, 80 criticism of the Ezrath Nashim home, 44 as director of the Ezrath Nashim hospital, 50, 52–3 emphasis on pre-mandate superstition, 35–9, 43, 64 fever therapy, 214, 272–6, 285, 302 Filastin, 90–1, 278, 281 first government mental hospital at Bethlehem agriculture and animals at, 78–9, 281 appointment of Malouf as medical officer in charge, 17 archives and activities after 1948, 15, 29, 303 changing patient demographics, 76–7 comparatively early establishment in 1922, 48 established to relieve Ezrath Nashim hospital, 11, 54, 55 influenced by Egyptian model, 61, 73 murder of Jewish member of staff in 1938, 28, 139 need to situate in longer history, 37, 46, 71 occupational therapy samples, 283 overcrowding and need for expansion in 1920s, 79–80, 112 patient experiences of admissions and everyday life, 77–9 physical renovations, 72 proximity to monastery of St George, 64, 70 registration by nurses for mental nursing certificate, 268 service of Sisters of Order of St Dorothy, 269 staffing, 72–3, 75–6, 251 unmixing of patient populations, 306–7 unusual destination for criminal lunatics, 19 First World War, 25, 36, 43, 58, 73, 106, 255 forward psychiatry, 256 France, treatment in, 119–22

341 Gait, E. A., 85, 91 Geffen private mental hospital, 239, 257, 258 Gelber, Sylva, 294–5 general paralysis of the insane. See Syphilis Givat Shaul, Jerusalem, 135, 151, 280, 307–9 Goodrich-Freer, Ada, 65–6 Gordon Smith, Frederick, 158, 166 gramophone, 78–9, 278 Greek Orthodox, 5, 42, 65–8, 310 Habibi, Emile, 14, 309 Hadassah Medical Organisation, 27 Haddad, Dr F. I., 263 Haddad, Dr T. B., 100 Hadera, 133 Haifa courts, 162, 187 Elijah’s cave, 66 government hospital, 214, 221 medical society, 261 patients at ‘Asfuriyyeh from, 43, 138 petitioners from, 132 as site of Blumenthal’s hospital, 286 Halpern, Dr Lipman, 109 Hamidian massacres, 56 Har Hazofim private mental hospital, 135, 239, 240 Harefuah establishment and focus, 18 politics within, 22 publication of research on electroconvulsive treatment, 293–6, 300 publication of research on insulin and cardiazol treatments, 287–8 Harkness, Dr J. W. P., 60–1, 124, 138 Hashish, 102–3 Hassan al-Labadi, Shaykh, 307–9 Hebrew terms for mental illness, 88, 148 Hebron, 28, 75, 104, 105, 132, 170–1, 211, 311 Heinsheimer, Dr S., 252, 269–70 Hennessey, Dr R. S. F., 306 Hermann, Dr Heinz critique of insanity in census, 85 and electro-convulsive therapy, 295–6, 300 expert testimony in Zurabin case, 188–90 and insulin therapy, 288, 289 on marriage practices, 105 on migration and mental illness, 97–8 need to distinguish Sephardim and Ashkenazim, 94, 110 role in Aron T.’s case, 201–2

342

Index

Hermann, Dr Heinz (cont.) as second voice in census report, 99, 116 on syphilis, 104 treatment of Khadder K., 205 visiting patients at home, 125 Heron, Colonel George W. and the 1931 census, 86–7, 111–12 attitude to mixing patient populations, 76–7, 305 background, 53 on criminal lunatics, 197, 220 criticism of the Ezrath Nashim hospital into 1930s, 113 influenced by Egypt, 73 insistence on site of third government mental hospital, 249, 251 instruction at Bethlehem mental hospital, 78 mental illness as a threat, 53 and petitions about mental illness, 120 recruitment of nurses, 76 reluctance to fund Ezrath Nashim hospital, 49–51, 53 reluctance to subsidise Bnei Braq hospital, 243 Herzliya, 134 High Commissioner of Palestine addressee of petitions, 2–3, 5, 125, 171, 203, 210, 219, 224–5, 242 delusions about, 224 detention at the pleasure of, 158, 165, 192, 194 reluctance to release Eric Mills, 111 Histadrut, 27 holy fool, 64 Howard Home, Tulkarm. See Reformatory schools humoral theory, 38–9, 64–5 hunger strike by prisoner, 217 Hunter, Annie Muir, 265–6, 268 Huntingdon’s chorea, 267 hybrid legal system, 162, 168, 172 hydrotherapy, 52 hypnosis, 39, 186, 218 idiocy, 85, 96, 130, 182, 210, 267 imbecility, 87, 182, 210, 267 immigration restrictions, 96 Imperial Medical School, Istanbul, 74 impotence, sexual, 261 infant and maternal health, 17 insomnia, 260 insulin therapy in nursing curriculum, 267 use in Palestine, 285–93

Irgun, 221 Israel State Archives, 15, 20 Israeli mental health system, 9, 29, 244, 309 Istanbul as destination for psychiatric treatment, 40, 43, 47 education in Ottoman era, 17, 74 Ottoman-era asylums, 38, 40 Istiqlal party, 27 Jacir Palace, Bethlehem, 249 Jaffa demolition by British counter-insurgents, 245–6 district court, 173 medical society, 261 municipal hospital, 46, 49 patients at ‘Asfuriyyeh from, 42, 138, 143 petitioners from, 2, 131, 132, 203 rates of insanity in census, 105 riots of 1921, 184–7 Jaffa Gate, Jerusalem, 45, 47 James, G. W. B., 255 Jaussen, Antonin, 68–70, 126 Jenin, 105 Jerusalem beginnings of revolt in 1929, 28 British ‘preservation’ of, 56–8 British occupation in 1917, 25 census in, 90 central prison, 78, 108, 277 courts, 162, 168, 178, 204, 222 criminal insanity cases from, 201, 217, 222 distance of Bethlehem from, 70 government hospital, 100, 212, 256, 268, 282–3, 310 in great revolt, 142, 148 medical society, 261, 310 missionary investment in, 24, 44 municipal hospital, 46 number of mental cases in, 126 patients at ‘Asfuriyyeh from, 43, 138 petitioners from, 119, 125, 127, 130, 132, 152 and private mental hospitals, 218, 240, 292 riots in 1920, 27 Jerusalem stone, 57 Jerusalem Verein, 56, 62–3, 79, 245, 284 Jewish Brigade, 253, 257 Jewish National Council. See Vaad Leumi jinn, 64–5, 69–70, 71, 182, 211 Journal of the Palestine Arab Medical Association, 17–18, 263

Index Ju’beh, Nazmi, 307–9 Jupp, Miss O., 265 jury system, absence of, 162–3, 180 Juvenile delinquency, 205–7 Kahanovitz, Dvora, 241 Katznelson, Dr Avraham, 27, 126–7, 151, 310 Katznelson, Dr Reuben, 86–7 Keith-Roach, Edward, 108, 180 Kemal, Mustafa, 58 Kesheshian, Dr Khatcher H., 73 Kfar Shaul mental hospital, 244 Khan Younis, 129–30, 133 Khanka asylum, Egypt, 73 Khayr al-Din al-Ramli, 170 Khoury, Anton, 284–5 King David Hotel, Jerusalem, 221 Kleinschmidt, Dr H. J., 295–6, 300 Klemperer, Dr Joseph, 265, 298–9, 301 Kosher, provision of food in mental hospital, 77 Kraepelin, Emil, 174 Krafft-Ebing, Richard von, 174 Kupat Holim, 27 Lag B’Omer, 127–8 Lambo, Thomas, 212 The Lancet, 272–3 landlessness, crisis of Palestinian, 27, 128, 132 Latin Patriarch of Jerusalem, 120, 153, 269 Le Bon, Gustave, 186 Lebanon Hospital for Mental Diseases after 1948, 30, 303 as destination for Palestinian patients, 13, 24, 80, 137–44, 146 establishment of, 40–4 and the great revolt, 28 high standards at, 142 links to Palestine, 21 model offered by, 52, 76 and non-medical treatments, 69–70 and patient work, 280 and shock therapies, 288, 289 and teaching at AUB, 74 Lehrs, Dr Hugo, 310, 312 lesions, to brain or spine, 261 library, proposal for medical, 262 Lifta, 132 Lightbody, Dr W. P. H., 126–7 literacy rates, 122 Litwak, Dr Abraham, 174 Lloyd, Major J. B., 254–5, 259 luminal, 214, 266 lumpiness in global history, 274

343 Macqueen, Dr John, 194–5, 199, 254–5, 264–5 Mahane Yehuda, Jerusalem, 125 majdhub. See Holy fool majnun, 71, 87–8, 147–8, 170, 182 Majnun and Layla, romance of, 106 malaria, 17, 48, 104, 238, 263 malaria therapy. See Fever therapy Malouf, Berthe, 312 Malouf, Dr Mikhail Shedid and agricultural occupation of patients, 279, 281 appointment to Bethlehem mental hospital, 72 background and specialist expertise, 17 biography and education, 73–5 complaints and requests about second government mental hospital, 114 as consulting psychiatrist in women’s prison, Bethlehem, 216 cultivation of expertise on electroconvulsive treatment, 298–300 examining doctor in petition cases, 150, 152 as expert witness in criminal insanity trials, 158, 161, 178–81 initial sidelining in delivery of electroconvulsive treatment, 298 interview with Filastin, 90–1, 278 lack of support for specialisation, 263–4, 275 murder and funeral of, 310–13 on rates of insanity in Palestine, 90–1 recommendation in Denishensky case, 192 report on veterans with psychiatric disabilities, 233, 257–61 requests for expansion of Bethlehem mental hospital, 79 response to discharge request, 19 responsibility for nursing curriculum, 265–7 responsible for examining defendants, 165 treatment of Khadder K., 205 Manto, Saadat Hasan, 306 masturbation, 174 Maudsley Hospital, 264 mazbata, 131 McAfee, Harold, 58–9 Mea Shearim, Jerusalem, 149 Medieval Arab medicine, 263 Meduna, Ladislaus, 286, 288 melancholia, 38, 64, 260, 267 menopause. See Climacteric

344

Index

mens rea, 166 Menshieh, Jaffa, 186 mental nursing course, 264–70 Meron, 127 Metrazol. See Cardiazol Meyuchas, Margalit, 49–50 Middle East Force, 254–5, 260 Mills, Eric background and career, 81–2 career after census, 111 causes of insanity among men, 101–9 causes of insanity among women, 99–101 as commissioner of migration, 96 commonsense definition of insanity, 85–8 correlation between insanity and modernity, 91–9 depoliticising census, 93 erasure of Ottoman precedents, 84, 116 influenced by India, 84–5, 91–2 long-term illness, 107 and Palestine Oriental Society, 181 purpose of the census, 111 views on Zionism, 97 minor criminal charges use within family disputes, 201–3 Mishalov trial, 163–5 Mongeri, Dr Luigi, 40 moral treatment, 40 Moreau, Jacques-Joseph, 65 morphine, 214, 218 motherhood, 149, 151–2 Nablus Balata refugee camp, 245 and Beirut, 24, 42–3 courts, 162 department of health at, 229 medical society, 261 municipal hospital, 46, 49 nonmedical treatments, 68–9, 126 patients at ‘Asfuriyyeh from, 138 Nahariya, 133 nakba, 29, 139, 245, 253, 260, 303, 310 narcotics, 103, 214, 218, 291, 293 Nazareth, 43, 138, 197, 296 Near East Relief, 58–9 Nigeria, 48, 212 Nixon, Margaret, 197–8, 217, 246 Noack, Dr Fritz, 135, 290 noise, as cause of insanity, 107–9 normative uncertainty, 182, 223 nutrition, 39, 244 Nyasaland (Malawi), 48

ophthalmology, 17, 75, 311 opium, 39 Ordinance regarding the Jurisdiction of Magistrates’ Courts, 1939, 191, 194, 197, 199 orphans Armenian, 56, 58–9 Bethlehem orphanage, 55–9, 62–3, 245 at St Vincent de Paul, 45 Syrian, 56 Ottoman approaches to development, 55, 95 Armenian genocide, 56 education under, 73–4 law, 50, 162, 166, 167–8, 169 legacies, 7, 12–13, 36–7 non-medical approaches to madness, 64–9 Palestine, 24–6, 36 petition-writers, 123 population counts, 84 province of Beirut, 43, 137–9 psychiatry and institutions, 37–47 Palestine Arab Medical Association, 17, 74, 261–4, 271, 310, 311 Palestine Bulletin, 90 Palestine Criminal Code, 158, 161, 165–7 Palestine narcotics intelligence bureau, 103 Palestine Order-in-Council, 1922, 162 Palestine Oriental Society, 66, 88, 181–2 Palestine Post, 108, 159, 166, 188, 310 Palestinian return migration, 146, 207 Pappenheim, Professor Martin, 165, 173–4 paternalism, mandatory, 150, 152–5 patient case files methodological and ethical considerations, 18–21 survival of criminal lunatic records, 196–7 Peel Commission, 1937, 28, 162, 185, 246, 303 Permanent Mandates Commission, 12, 26, 155 Petah Tikva, 132, 145, 239 petitions chronology and survival, 122 in context of great revolt, 128–9 gender and sexuality within, 149–55 geographical distribution, 132–3 languages written in, 120 in other colonial contexts, 121 to Permanent Mandates Commission, 26 petition-writers, 122–3 pleas of poverty, 130–2

Index political and religious tensions, 148–9 proportion of Jewish petitioners, 134 supporting attestations, 5 terms used for mental illness, 88, 147–8 by women prisoners at Bethlehem, 198 photography in court, 173 in government mental hospitals, 77, 209 police during 1921 riots, 185 at Acre criminal lunatic section, 213–14 delusions about, 219 in the government mental hospital, 28 lock-ups, 79 role in securing discharge of patients, 226–7 sexual assault by, 150 training for, 52 turned to by families, 2, 200, 203 turned to by private institutions, 135 post-traumatic stress disorder, 22, 254 prison lunatic sections exceptional survival of case files, 18 in other colonial contexts, 48, 61 prisons as backdoor to institutionalisation, 195, 198 borrowing instructors from, 78, 277 investigations into condition of female prisoners, 149 medical observation during trial, 173, 179, 188, 189 not appropriate for mentally ill, 53, 61 as option for mentally ill, 135 petitions for release by family, 206 tradition of inspections, 199 prose of counter-insurgency, 23, 183, 187 Psychiatric Hospital of the Cross, Beirut, 70 psychoanalysis, 52–3, 88 public subscription, Arab proposal for health, 237–8 puerperal insanity, 100–1 Quidnunc, 90 Rabinowitz, Dr Abraham, 252, 257 railway, attacks on, 260–1, 292 Ramallah, 29 Ramat Gan, 240 Red Cross, 49, 306, 308 reformatory schools, 205–7 restraints chemical, 267, 286, 291–3 physical and mechanical, 40, 267 Rishon LeZion, 133, 206

345 Robertson, Captain J. K. A., 188–9 Rosenthal, Dr Abraham, 124 Rosh Pinah, 187–91 Sa’ad al-Din, Shaykh, 68–70, 126 Safad, 28, 42, 127–8, 138, 221, 249 Sakel, Manfred, 286, 288 Saleem, Fareedy, 41–2 Salt, Transjordan, 69 Sami-Ali, Egyptian psychoanalyst, 89 Samuel, Edwin, 97, 111 Sarafand detention camp, 246 Sarafand psychoneurotic unit, 253–7, 259 schizophrenia in the 1931 census, 87, 97–8 within army, 256–8 in court, 188 in petitions, 145–6 prevalence in criminal lunatic section, 204, 210–11, 219, 228 as splitting of psychic functions, 304 as target of somatic treatment, 286, 292, 294–7, 302 Schmidt trial, 172–8, 183, 191–2 scopolamine, 214, 218, 291 Scots College, Safad, 249 second government mental hospital, Bethlehem condition of physical site, 114 establishment in 1932, 11, 112–14 language competency of nurses, 268 opportunities for occupation of patients, 114 perception of, 119–21 promotion prospects of nurses, 269 proposed closure in 1940s, 237 second mandatory occupation, 236, 271 Second World War, 28–9, 107, 132, 229, 233–5, 238, 245, 253–61, 263, 270–1, 289, 293 Secretary of State for the Colonies, 208, 243 sedatives, 218, 266, 273, 291–3, 301 sexual assault, 150–1 sexuality, 99, 104–5, 149–51, 156 Shalbak case, 178–83, 191–2 sharia court, Hebron, 170–1 Shaw Commission, 185 shell shock, 106–7 Sisters of St Vincent de Paul, 43–7, 54, 305 Sisters of the Order of St Dorothy, 269 social abandonment, 196 sodomy, 211, 218 Solus electro-shock apparatus, 298–300

346

Index

St George, monastery at al-Khader, 63–72 Stephan, Stephan Hanna, 67, 181–2 Stewart Miller, Dr R., 288 Storrs, Ronald, 56–8 Strauss-MacPhail electro-shock apparatus, 299–300 strike, as Palestinian political strategy, 3, 27–8, 129 sugar, 287, 289 suicide, 89, 100, 242, 266 sulphur, use in fever therapy, 272–3 Supreme Muslim Council, 136, 310 Swedish hospital, Bethlehem, 112, 115, 119, 237 Swedish Jerusalem society, 113, 245 syphilis, 78, 103–4, 214, 265, 272–3 Syrian Protestant College. See American University of Beirut

Tiberias, 42, 126–7, 138 Topta¸sı asylum, 40 Torrance, Dr David Watt, 42 Tosquelles, François, 296 train sabotage. See Railway, attacks on translation in the census, 83, 87–9 in court, 163, 180 of Le Bon, 186 of petitions, 147–8, 211 Trial Upon Information Ordinance, 1942, 165–6 tuberculosis, 236, 263 Tulkarm, 53, 205 Tuqan, Fadwa, 126 Tutelage, within mandate system, 25, 60, 94 Tutunji, Dr Jamil F., 272–6, 302–3 United Nations Relief and Works Agency, 29

Talal, king of Transjordan, 302–3 Tannous, Dr Izzat, 311 Tarde, Gabriel, 175, 186 Tel Aviv anti-noise league, 108 criminal insanity cases from, 158, 163, 172, 201 founding of, 25 municipal support for Bnei Braq home, 241–2 patients at ‘Asfuriyyeh from, 138 petitioners from, 132, 145, 210 Prisoner’s Aid Society, 227 private mental hospitals at, 239 testosterone, 292 third government mental hospital at Jaffa built environment, 250–1 destruction of linen, 269–70 doubling government bedstrength, 233 earlier uses of site, 245–9 electro-convulsive treatment at, 2 established to relieve Bnei Braq hospital, 31, 238–44 as an important development of the 1940s, 29, 31 pathologisation of patient interaction, 313–14 petitions to transfer relatives to, 210 recreation and occupation at, 281–2 siting of, 306 staffing, 251–3 treatment of criminal lunatics at, 296 unmixing of patient populations, 306–7 use of electro-convulsive treatment at, 300–1 use of sedatives at, 291

Vaad Leumi condemnation of Malouf’s murder, 310 as coordinating body, 27 efforts to find accommodation for patients, 126, 135–6, 151 interventions on behalf of families, 152 involvement in 1931 census, 86 pressure on government around treatment, 290, 298 protests over prison conditions, 109 social services section, 148, 294 Wagner-Jauregg, Julius, 272, 276, 285 Waldmeier, Theophilus, 41–2 Wassermann test, 77 Watan Hospital, Nablus, 46 Whitaker, D. L., 76 White Paper, 1939, 204, 233 women’s prison, Bethlehem as backdoor to institutional treatment, 195 as destination for female criminal lunatics, 194 establishment of criminal lunatic section, 197–8 food in the criminal lunatic section, 216–17 medical observation during trial, 179 need for expansion of criminal lunatic section, 199 World Health Organisation, 29 Yacob, Dr Mousa, 150–1 Yacoub, Afifeh, 269–70, 271 Yellin, Ita, 240 Youth, concerns about, 177–8, 180, 190, 204–5

Index Zikhron Ya’acov, 138 Zionism adoption of Hebrew Labour policy, 132 as agent of development, 95 and Arab Jews, 10 debates within, 98 emergence of movement, 25

347 funding for health, 49 opposition to, 27, 311 parastatal institutions in mandate Palestine, 27 during and after Second World War, 28–9 as settler colonial, 18 Zurabin trial, 187–91