Madhouse: Psychiatry and Politics in Cuban History

By Jennifer L. Lambe

On the outskirts of Havana lies Mazorra, an asylum known to--and at times feared by--ordinary Cubans for over a century. Since its founding in 1857, the island's first psychiatric hospital has been an object of persistent political attention. Drawing on hospital documents and government records, as well as the popular press, photographs, and oral histories, Jennifer L. Lambe charts the connections between the inner workings of this notorious institution and the highest echelons of Cuban politics. Across the sweep of modern Cuban history, she finds, Mazorra has served as both laboratory and microcosm of the Cuban state: the asylum is an icon of its ignominious colonial and neocolonial past and a crucible of its republican and revolutionary futures.

From its birth, Cuban psychiatry was politically inflected, drawing partisan contention while sparking debates over race, religion, gender, and sexuality. Psychiatric notions were even invested with revolutionary significance after 1959, as the new government undertook ambitious schemes for social reeducation. But Mazorra was not the exclusive province of government officials and professionalizing psychiatrists. U.S. occupiers, Soviet visitors, and, above all, ordinary Cubans infused the institution, both literal and metaphorical, with their own fears, dreams, and alternative meanings. Together, their voices comprise the madhouse that, as Lambe argues, haunts the revolutionary trajectory of Cuban history.

• Language: English
• Publisher: The University of North Carolina Press
• Release date: Dec 22, 2016
• ISBN: 9781469631035

Jennifer L. Lambe

Jennifer L. Lambe is assistant professor of history at Brown University.

Book preview

Madhouse

ENVISIONING CUBA

Louis A. Pérez Jr., editor

Envisioning Cuba publishes outstanding, innovative works in Cuban studies, drawn from diverse subjects and disciplines in the humanities and social sciences, from the colonial period through the post–Cold War era. Featuring innovative scholarship engaged with theoretical approaches and interpretive frameworks informed by social, cultural, and intellectual perspectives, the series highlights the exploration of historical and cultural circumstances and conditions related to the development of Cuban self-definition and national identity.

JENNIFER L. LAMBE

Madhouse

Psychiatry and Politics in Cuban History

The University of North Carolina Press   Chapel Hill

Publication of the book was assisted by a grant from Brown University.

© 2017 The University of North Carolina Press

All rights reserved

Set in Arno by Westchester Publishing Services

Manufactured in the United States of America

The University of North Carolina Press has been a member of the Green Press Initiative since 2003.

Library of Congress Cataloging-in-Publication Data

Names: Lambe, Jennifer L., author.

Title: Madhouse : psychiatry and politics in Cuban history / Jennifer L. Lambe.

Other titles: Envisioning Cuba.

Description: Chapel Hill : University of North Carolina Press, [2017] | Series: Envisioning Cuba | Includes bibliographical references and index.

Identifiers: LCCN 2016019378 | ISBN 9781469631011 (cloth : alk. paper) | ISBN 9781469631028 (pbk : alk. paper) | ISBN 9781469631035 (ebook)

Subjects: LCSH: Psychiatric hospitals—Cuba—Mazorra—History. | Psychiatry—Cuba—History. | Psychiatry—Political aspects—Cuba.

Classification: LCC RC451.C9 L36 2017 | DDC 362.2/1—dc23 LC record available at https://lccn.loc.gov/2016019378

Cover illustrations: Building is Mazorra—Edificio principal del Hospital de Dementes, from Cuba y América, Revista illustrada, December 11, 1904, and is used courtesy of Widener Library, Harvard University. Hooded figure is M. L. Needleworker of obvious skill, from Breves communicaciones a la Junta Facultativa del Hospital de Mazorra, Revista de neurología y psiquiatría 2 (May–June 1931), and is used courtesy of the New York Academy of Medicine.

For Mazorra

Contents

Acknowledgments

INTRODUCTION

CHAPTER ONE

A Moral Revolution at Mazorra, 1899–1902

CHAPTER TWO

Fragments of a Journey to Mazorra: From a State of Ruin to a Second Occupation, 1902–1909

CHAPTER THREE

The Great Divergence: Psychiatry, Race, and the Age of the Inferno, 1909–1933

CHAPTER FOUR

The Plague of Politiquería: Corruption and the Experts, 1934–1958

CHAPTER FIVE

Banishing the Inferno: From Mazorra to Hospital Psiquiátrico de La Habana

CHAPTER SIX

The World the Revolution Made: Political Process and Mental Transformation

CHAPTER SEVEN

The Repeating Madhouse, from Havana to Miami

EPILOGUE

Notes

Bibliography

Index

Illustrations

Projected reforms for Mazorra, c. 1899   40

Patio in the 2nd Men’s Section and a Group of Inmates   41

Inmates making clothes   59

Mazorra postcard   65

The General and the King   74

Two images of the beheader   86

M. L. Needleworker of obvious skill   106

President Grau addressing Mazorra staff   116

Mazorra’s champion baseball team   117

Electroshock   126

Margot has lipstick applied   134

The Caballero de París   137

Imprisoned patients, 1959   145

Emaciated patient, 1959   146

Communist brainwashing   173

Revolution and popular diagnosis   190

Fulgencio Batista tries to calm his nerves with a cup of té de tilo   223

Statue honoring Eduardo Bernabé Ordaz   232

Mazorra’s archive   235

Acknowledgments

One ordinary summer night, amid the commotion of Cuban music and dancing couples at a restaurant on New York’s Lower East Side, I found myself in the middle of a conversation I have come to know well over the past few years. You’re studying the history of Mazorra? a young Cuban living in New Jersey asked me incredulously. "Well, that is Cuban history!" I nodded and smiled as we headed down a familiar path, straight into Cuba’s notorious madhouse.

Exchanges just like that one—casual, fleeting, and revelatory—have decisively shaped this project. Because I will never have the opportunity to thank the many Cubans who have taken the time to share their feelings, memories, and fears about this place, it only seems right to begin by doing so here. In Havana, Miami, New York, and beyond, perfect strangers have been willing to explain what this place has meant to them and why it matters. Their conviction, in turn, has fed mine. The manicomio can be a lonely place to dwell, but, thanks to them, I have never felt alone there.

Many others have contributed to this book, beginning and especially at Yale University. John Warner was a wonderful reader with a preternatural sense of where the story should go and the patience to help me find my way there. I have benefited from many enlightening discussions with Stuart Schwartz about Cuba and comparative contexts, and his feedback has long helped me sharpen my thinking and writing. Since my first class with Gil Joseph, I have enjoyed poring over his comments, unfailingly thoughtful and incisive. At every crucial moment Gil has managed to nudge me, ever so gently, in the right direction; sometimes he even led me to believe I ended up there on my own. Lillian Guerra forged connections, made contacts, and, in regular two-hour phone conversations, helped me see the way to the end of a chapter tunnel. I am not sure I would ever have made it to Cuba for the first time without her, and I am certain that without her guidance and example I would not have continued to return. I must also thank Mariola Espinosa and the late Patricia Pessar for their thoughtful guidance and mentorship. I am very grateful to Marcy Kaufman, who has contributed to this project in many ways.

My colleagues in the Yale doctoral program played a crucial role on the road to this book. Over the years, I have been fortunate to count on the friendship of Michael Bustamante. Mike’s boundless curiosity, vast pool of knowledge, and dedication to Cuba have helped me push through many stages of the research and writing and encouraged me to trust my instincts. I am grateful for his insightful contributions and his willingness to read and reread paragraphs up through the end. Taylor Jardno has made crucial interventions in every chapter. I must also thank Ingrid Castañeda for being a wonderful friend and colleague since our very first week at Yale. My time in New Haven was made incomparably better by the friendship of Erika Helgen, Nazanin Sullivan, Antonio Córdoba, Marian Schlotterbeck, Maria Clara Carneiro Sampaio, Rob Sierakowski, Christine Mathias, and especially Katherine Mooney and Sigma Colón. I am also grateful to Aaron Potenza, Fredy González, Mary Brazelton, Yenisey Rodríguez, Cecilia Cárdenas-Navia, Adrián Lerner Patrón, Andra Chastain, Drew Konove, Jonathan Graham, Ezer Vierba, Kirsten Weld, Lisa Pinley Covert, Carmen Kordick, Santiago Muñoz, and Tim Lorek. I am fortunate to have had stellar partners in writing; conversations with Robin Scheffler and David Minto enriched this project in immeasurable ways. Participants in the Holmes Workshop in the Program in the History of Science and Medicine twice provided invaluable feedback on my work, and Marco Ramos has offered particularly important interventions. Dean Saveena Dhall and the exceptional Mellon Mays and Bouchet fellows made writing both fun and productive.

Conducting research in Cuba can be challenging on multiple fronts. My trips were made possible by the Tinker Foundation and the MacMillan Center for International and Area Studies at Yale, and I am grateful to Jean Silk and Nancy Ramirez for facilitating those grants. I also received generous support from the American Council of Learned Societies, the Mellon Foundation, and the Coordinating Council for Women in History. The Fundación Antonio Núñez Jiménez provided invaluable sponsorship and assistance during my research trips to Cuba.

My Cuban friends and surrogate family have made every trip to the island memorable. I am especially grateful to Jorge Macle, Reinaldo Funes, Enrique Beldarraín Chaple, and Julio González César Laureiro. Roberto Ordaz generously contributed documents and family memories, and I owe deep gratitude to him and those Cuban psychiatrists and medical professionals who shared their experiences with me. Finally, I would like to thank librarians and archivists at the Archivo Nacional de Cuba, Biblioteca Nacional, and Museo Finlay. All arguments in this book are solely my own, and I am exclusively responsible for any errors or misinterpretations therein.

Serious work on the history of Cuba would be much more difficult without the Cuban Heritage Collection (CHC) in Coral Gables, Florida. I am grateful to the CHC and the Goizueta Foundation for granting me a graduate research fellowship. My time at the CHC was productive and fun thanks to María Estorino, Lesbia Orta Varona, Esperanza de Varona, Annie Sansone Martínez, Gladys Gómez Rossié, Rosa Monzón Álvarez, Meiyolet Mendez, and Brittney Bomnin. I am also fortunate to have received the thoughtful guidance of José Puig. Mercedes Cros Sandoval and Humberto Nagera kindly granted me interviews. I am also grateful to archivists and librarians at the New York Academy of Medicine, New York Public Library, National Archives at College Park (Maryland), National Library of Medicine, Library of Congress, and Peabody Museum.

Many scholars and enthusiasts of Cuba have offered invaluable feedback and guidance on this project. My sincere thanks to Alexandria Pantera, Lou Pérez, Alejandro de la Fuente, María Antonia Cabrera Arús, Devyn Spence Benson, Rachel Hynson, James N. Green, Daniel Rodríguez, Esther Whitfield, Adrián López Denis, Kate Ramsey, Steve Palmer, Jonathan Ablard, Marial Iglesias Utset, Jorge Domínguez, Ricardo Quiza, Ada Ferrer, Walfrido Dorta, Mirta Suquet, Luciano Castillo, María del Pilar Díaz Castañón, Víctor Fowler, Diasmel Gil, Gregorio Delgado García, Manuel Barcia, Michelle Chase, Rafael Rojas, Anne Eller, Marcela Echeverri, Melina Pappademos, Romy Sánchez, Raquel Otheguy, Billy Kelly, Hadar Harel, Octavio Ramos, John Gutiérrez, Eric Barkin, Michel Pérez Céspedes, Jesse Horst, Kelly Urban, Rainer Schultz, Elizabeth Mirabal, Carlos Velazco, Ariana Hernández Reguant, and too many others to count.

In Providence, I have been lucky to find a welcoming and enriching academic community. I am particularly grateful to Deborah Weinstein and Deborah Levine, who offered perceptive commentary and emotional support on late drafts, and to my new colleagues in the Department of History for their thoughtful questions. Lou Pérez and an anonymous reader for the University of North Carolina Press provided invaluable and thorough feedback. I owe enormous thanks to Elaine Maisner and Alison Shay, as well as the UNC editorial staff, for their thoughtful stewardship of this project; to Mylena for her careful reading of an earlier version of it; to Annette Calzone and Vickie West for their copyediting; and to Ellen Lohman and Amy Murphy for their proofreading and indexing, respectively.

I have to close by expressing my gratitude to the two families who have sustained me over the course of this project. My suegros have made many early morning airport trips, packed and repacked suitcases, laughed at all of my Cuba stories, and taught me the best slang any Cubanist might want to know. As for my siblings, though Becky, Danny, and Andy did not always understand why I was still working on this project, they did their best to appear interested. The unconditional support of my parents has never flagged. My father soldiered through one version of this book and made illuminating connections to his own professional experience; my mother offered to scrutinize every page for typos (something I didn’t impose on her). Finally, Alex made me promise that I would refrain from closing with anything sentimental, so I will just offer my last and most heartfelt round of thanks to him.

Madhouse

Introduction

Before the days of shock treatment

and needles, píldoras and juice,

this place in Havana, banana plants

outside its windows, housed

the infirmed of spirit, the politically

incorrect. Everyone abandoned

here in this place, the house

of the incorrigible, lost more than

track of time …

—Virgil Suárez, Mazorra, or House for the Incorrigible (2005)

One December day in 1956, at a hospital just outside the city of Havana, the march of time came suddenly to a halt. The government hastened to cover it up, draping artificial lights in the sky to substitute for the sun and stars. The pretense appeared to work, at least for a while. Not until 1966 was the end of time recorded by a psychiatrist at the Hospital Psiquiátrico de La Habana, the mental hospital popularly known as Mazorra. The event was disclosed to him by a patient who had already declared herself responsible for several scientific innovations, including the atomic bomb and propulsion planes. Perhaps for that very reason, the Communists had begun to pursue her; the Russians, she was sure, had infiltrated her television and radio in order to steal her thoughts.

Just before time was brought to a halt, and a few months after she had first arrived at that hospital, the same patient had reported the existence of five dimensions, several of which were her exclusive domain among mortals. The fifth was a zone of particular interest: the terrain of indifference, useful for everything. There she was at once Saint Barbara and all of the saints of the church; all of the virgins; Mary Magdalene, but unrepentant. In the fifth dimension, she explained, we have no life, we have nothing, and nothing, she proposed enigmatically, means everything.¹

In the borderlands of indifference and on the margins of meaning lies Mazorra, primordial laboratory of the fifth dimension. Founded in 1857 in the twilight of the colonial period, Cuba’s largest psychiatric institution would become an icon of negligence and transcendence, a crucible of political struggles and popular fears. As a mental asylum established before a robust class of psychiatrists existed in Cuba, its ambiguously medical character became a persistent facet of its existence. Residents of the island quickly learned that Mazorra was a place where one was sent to languish. With the knowledge of this place, Virgil Suárez writes, mothers threatened their children.² There were high-profile cases of political intrigue that converged on the institution throughout its history, as in the case of the wealthy Mesa brothers, one of whom committed the other to Mazorra in order to acquire his fortune.³ More commonly, however, and in grimmer circumstances, families reluctantly drew on its existence to resolve personal circumstances. As one character in Reinaldo Arenas’s Before Night Falls relates of a new acquaintance, I found out that in order to have one mouth less to feed, his family had taken him to that insane asylum, the worst in Havana.⁴

It is little surprise, then, that Mazorra served as home to more than one reincarnation of Saint Barbara, the virgin imprisoned by her father and martyred for her faith. Only years before the aforementioned apocalypse, another avatar of the saint acquired a significant following among patients and employees alike. Sporting a pile of old magazines and an empty jar to collect coins, she dispensed miracles and divided the faithful into the lucky few destined for grace, and the rest condemned to hell. They, in turn, offered their devotion, and reportedly welcomed her in their dreams.⁵

IN ITS LITERAL and symbolic distance from civilization, Mazorra may well have been the place where many inmates lost track of time. Nevertheless, as a state institution and the only one of its kind until the 1959 Revolution, it was also firmly embedded in the march of historical change. At Mazorra, Cubans witnessed the promise and inevitable disappointment of national yearnings for modernity, scientific and otherwise, and the efforts of the state—colonial, neocolonial, and revolutionary—to grapple with the problem of social marginalization.

But Mazorra’s existence also touched a more primal nerve. During its long history under Spanish, U.S., and Cuban stewardship, Mazorra was rocked by multiple cycles of revolutionary agitation and exorcism. Those efforts yielded ghastly, archetypal images, which left an indelible stamp on popular consciousness. The repeated unveiling of what Cubans would refer to as Dante’s Inferno provoked national and international outrage, but also personal grief. As generation after generation traipsed to the outskirts of Havana to see the notorious hospital for themselves, it was as much the reflected madness of the outside world as that of the individual patients that impressed itself on guests.

Mazorra’s place in the Cuban imaginary also fueled the development of multiple counternarratives to the Inferno. If the hospital often seemed to plumb the depths of degradation, it was a repository of uncanny possibility, too, and even a subject ripe for comedy. On occasion, such humor reached to the highest echelons of political power. Mirta Suquet recalls a joke that once made its way through Havana skewering none other than Fidel Castro himself. It begins with an apocryphal trip to the hospital by the revolutionary leader. When Fidel arrives, it continues, "they explain that there was a loco [madman or patient] imitating him and that, moreover, he greatly resembled him physically: in his madness he had achieved a magisterial likeness. Fidel requests to meet him and, when they are face to face, the patient lunges forward and begins to hit him. They fall to the floor forming an indistinguishable pair, until the bodyguard decides to shoot at one of the two without being exactly sure which was which. What follows—and herein lies the power of the joke—is that no one knows whom he killed."⁶ And so Fidel joins the universal tradition of mad kings: a sheep in wolf’s clothing, or the emperor’s tropical robes.

The carnivalesque face of madness offered material for political and social commentary of all kinds, much as popular locos colonized memories and experiences of the Havana cityscape. Mazorra visions of a world upside-down could be poignant and even cathartic: capping a decade of political violence in the 1940s, what Cuban would not respond to the image of a young patient, an accomplished performer of peasant music, willingly submitting himself to a haircut and a shave at the hands of another patient who had murdered his own wife?⁷ The delicate equilibrium of the carnivalesque is equally apparent in the story of a patient-barber several decades later, who, in a moment of remarkable clarity, would ask the physician who had come to him for a shave why he was willing to put his life in his hands.⁸ Occasionally, comedic implications arose from the very juxtaposition of antagonisms, as in the cohabitation throughout the early 1960s of two patients, one who believed himself to have been at Fidel Castro’s side at the storming of the Moncada barracks and another who regarded himself as an imprisoned [Fulgencio] Batista general and [wore] the medals to prove it.⁹

Inversion and humor offered subversive fodder to hospital observers, but they could also point to the fragility of compassion. Emotional investment in the institution has waxed and waned over the course of Mazorra’s long history. Public engagement (or the lack thereof) often fed, in turn, on political events outside the hospital. Revolutionary interventions in 1899 and 1933 produced a veritable, if short-lived, consensus on the need for reform, but the resonance of those exorcisms could outlast their institutional impact. A later reconstruction at the hands of Eduardo Bernabé Ordaz, personally selected to lead the hospital by Fidel Castro after the 1959 Revolution, would prove more enduring than any other in Mazorra’s past. But the constant return of scandal could also produce apathy and disengagement; popular empathy, provoked in moments of outrage, often proved difficult to sustain in its aftermath. The redundancy of abjection throughout Mazorra’s long history endowed its cycles of rebuilding with a sort of restless amnesia.

In The Circular Ruins (1940), Jorge Luis Borges writes of a wizard condemned in his very existence to oblivion. The story opens on a vision of the man, nameless and somehow remote, stepping off his canoe into the circle of an abandoned temple. There, he is overcome by a sense of inevitability: the imperative to dream a man into existence. As he begins his work, he is driven by the spirit of the past, which lingers in the ruins and promises to give life to his future progeny. But the son’s birth proves strangely bitter, a harbinger of death that cannot be ignored. The father erases the son’s memories of his recent creation and sends him down the river, where another set of circular ruins awaits him. Yet the wizard’s own memories cannot be erased, and one day the force of inevitability again asserts itself. The circular ruins catch fire, and the wizard gradually succumbs to his immolation, accepting that he too is a mere illusion, the product of another wizard’s imagination.

More than a few wizards—reformers, politicians, and memorable directors—have come face to face with Mazorra’s circular ruins over the course of its history, now a century and a half long. Often unknowingly, they have set out, like Borges’s everyman, to recapitulate the labors of those who preceded them, rechristening hospital wards in honor of their newest heroes and resurrecting mental patients as exemplary victims. As reformers marshaled history to make moral claims on the present, however, they also froze it to clear a path to the future. They, too, found that moving forward required them to bracket an ambiguous past. History might serve as ethical fuel, but only in its broadest strokes.¹⁰

Over the course of the hospital’s life span, Cubans have repeatedly drawn purpose from this counterpoint of remembering and memorialization as well as disavowal and forgetting. In his study of Freud’s collectibles, John Forrester has described the psychoanalytic process thus: Freud, he writes, offered his patients two different models of remembering and forgetting: remembering as a means of disinterring the past so as to destroy it and finally release it into oblivion, and remembering as a means of preservation, a lucky chance amidst the processes through which the past inexorably vanishes.¹¹ Psychoanalysis, then, is nothing less than a cure through the kind of remembering that makes forgetting possible.¹² In this regard, Mazorra represents an exemplarily psychoanalytic site, host to dramatic acts of historical catharsis—and erasure.¹³

In fact, the hospital maintains its own clearinghouse of collectibles, a museum filled to the brink with newspaper articles, trinkets, and patient artwork. But the focus, above all, is on photographs, a snapshot of the past that ratified what had been.¹⁴ A visitor wanders first through a procession of pre-1959 indignities—images of naked and emaciated wretches—only to reach confirmation of revolutionary triumph: patients who dance, work, write poetry, and paint. We are meant to understand, as one sign proclaims, that with the triumph of the Revolution a new life [began] for those who were forgotten for so many years.

There are, nonetheless, multiple ways to forget. We might reasonably ask what is obscured in a focus on the visual immediacy of abjection—a sort of historical phrenology in its own right, which reads proximate surfaces as equivalent to a continuous past. In Mazorra’s museum, these images (unmarked, undated, menacing, but also elusive) are marshaled toward a historical vision in which there is, simply, no history: Throughout the years of the colony and the mediated republic the subhuman conditions in which the patients of this hospital lived led our Commander in Chief to declare that the Hospital de Dementes de Mazorra was Dante’s Inferno. A vision of lost—or, per Marial Iglesias, omitted¹⁵—time, drolly expressed in the appeal to be brief, we’ve lost 50 years,¹⁶ thus seizes on Mazorra as an icon of tragic immutability, brought back to life by the invasion of revolutionary humanism.

In contrast, this book departs from a simple but contrary proposition: that it is not only possible but necessary to chronicle the history of Mazorra and Cuba over the 1959 divide. Scholars of the island have long adhered to the idea that its history can be parceled out into disparate historical eras (colony, neocolony, and revolutionary state) with sharp breaks of radical upheaval separating one from the other. Historical and political teleologies have certainly been drawn across those periods: one thinks, for example, of Fidel Castro’s 1968 declaration of one hundred years of struggle connecting the outbreak of the independence fight to his own revolution. But long arcs of this kind have remained resistant to less heroic implications.

Recently, this has begun to change, with new studies of continuity and persistence in Cuban history.¹⁷ This book builds on that work, while also questioning a paradigm that insists on binary opposition: rupture or continuity. The sheer fact of chronological juxtaposition—the telling of long stories—requires us to relinquish historiographical truisms, including the fact of heroic disjuncture itself. Indeed, as I have argued elsewhere, Mazorra’s history follows neither a linear nor a circular course but rather runs along a sort of Möbius strip, with historical memory a fragile product of its twists and turns.¹⁸

Madhouse thus engages mental healing and illness to explore histories of Cuba that have remained absent from traditional narratives. Though built on the margins of Havana for the most marginal of Cuba’s citizens, Mazorra’s liminality has paradoxically rendered it an acute barometer of political and social tides. As generations of Cubans have claimed, the hospital incarnates the glories and the failures of the Cuban state, even as direct vectors of political authority have passed through it. That politicization dates to the institution’s founding in the throes of sugar and slavery, but it was greatly magnified in the final independence war of 1898.

The first U.S. occupation of Cuba following independence (1899–1902) ushered in a decade of political intervention at the hands of Cuban war heroes and U.S. occupiers. The decision made during the occupation to turn Mazorra into a facility entirely subsidized by the national government in turn set the stage for the following century of politicization. And the relationship between the hospital and state politics was not static but dynamic, and often dizzyingly so. In an inescapable trope of republican and revolutionary Cuba, observers painted Mazorra as a mirror of the state (sometimes flattering, but more often not). Just as often, however, Mazorra served as the state’s measure: drawing attention, from the margins, to the state’s central contradictions, inequalities, and perversities. Like many icons in Cuban history, the hospital has been haunted by an enduring gap: between the promise of heroic reform on one hand, and the persistence of social marginalization on the other.

Slavery’s Specter: The Problem of the Margins

Throughout Mazorra’s early history, the asylum’s most tenacious ghost was slavery itself. That specter was even encoded, symbolically, into the hospital’s founding. In 1854, Spanish colonial officials purchased the land for the asylum from prominent slave trader José Mazorra. His name—Mazorra—would soon be used to refer to the hospital, a constant though unremarked vestige of the link between scientific progress and forced labor.¹⁹ But there was no more palpable sign of this primordial pact than the early mobilization of future patients sent to the plantation to build their own asylum. The urgency of reform at Mazorra would thereafter justify the often unthinking recourse to uncompensated patient labor.²⁰

By the time the hospital opened as the Casa General de Dementes in 1857, the condition of Cuba’s mentally ill represented a pressing issue indeed. Three decades earlier, a bishop had arranged for the insane who wandered the streets to be interned at the Hospital de San Lázaro, and then finally in a department of their own at the Hospital de Paula. Mentally ill women, together with beggar women, would soon be attended by an order of nuns at the Casa de Beneficencia. In September 1828, the Hospicio de San Dionisio, built on the grounds of the leprosarium, received a group of insane Cubans previously confined in Havana’s jails. But San Dionisio was vulnerable to cholera outbreaks, and the Marquis of Havana, the governor, and the captain general thus acquired Mazorra’s plantation to build a full-fledged asylum.²¹

Yet the commitment to better care for Cuba’s insane was not fenced off from other concerns. Both in theory and in practice, custodial imperatives would also penetrate its walls, as the asylum became known as a warehouse for socially marginalized populations.²² Several decades before formal abolition was decreed, the facility was founded as a place of refuge both for the insane and for those "emancipados [or freed slaves] and other gentes de color, who, as a result of their age or ailments, were not able to earn a living.²³ Vagrants, too, would make an early appearance as inmates.²⁴ As Rachel Hynson has argued, the founding of Mazorra thereby built on the campaign of José Gutiérrez de la Concha, three-time captain general of Cuba, to purge nonpaying inmates, especially inmates of color, from existing charitable institutions. Racial and social separation, he believed, would allow officials to more fully dedicate all of their resources to the privileged, favored class on the Island."²⁵ The movement to provide adequate care for the wealthy and white thus depended on a parallel effort for those who were neither.

In this context, the Casa General de Dementes was envisioned as a uniquely hybrid institution, bridging scientific advancement and social exclusion. But the asylum’s connection to slavery ran deeper still. Some of its funding came from the government’s Fondo de Emancipados, amassed from the amount charged to individuals who wished to hire the Africans freed on slave ships by British or Spanish officials combating the illegal trade.²⁶ Meanwhile, former slaves and people of color who could no longer work were sent there as a point of last resort. Many asylums in postemancipation societies functioned as de facto warehouses for the formerly enslaved, but at Mazorra that condition was explicitly embedded in its statutes and structure.

The forced cohabitation of the formerly slave and the formerly sane impacted the treatment of both groups. The frequency with which allegations of patient abuse appear in the colonial record is itself a testament to this fact. Equally telling is the implementation of productive labor for hospital inmates long after slavery was abolished. Doctors and administrators would constantly return to patient work as both a therapeutic device and a vehicle of social reintegration. Their logic thereby mirrored the discourse of postabolition apprenticeship programs, designed to prepare slaves for the ostensible burdens of freedom. Uncompensated and undercompensated patient labor would thus become one of the most ambivalent legacies of the asylum’s umbilical connection to African slavery.²⁷

A Clinical Difference: Race, Religion, and Cuban Psychiatry

Mazorra’s origins in sugar and slavery would also shape the evolution of Cuban psychiatry, which found a claim for clinical novelty, not to mention its most challenging professional competition, in the racial and religious difference of the Cuban population. In Cuba, a racially diverse patient population emerged alongside medical efforts to understand, theorize, and even diagnose it. Beginning in the asylum’s earliest years, Cuban doctors puzzled over the high representation of people of color within that population.²⁸ At the time, psychiatrists throughout the Americas tended to present mental illness as rare among African-descendent slaves, thereby adhering to paternalistic discourses about bonded labor. The social arrangement of slavery, doctors and apologists argued, protected simple-minded slaves from the distressing world around them. Soon emancipation itself would be cast as one such disruption and a potentially maddening force.²⁹

Across postabolition contexts, observers were thus little surprised to see growing populations of people of color in mental asylums. Yet they dedicated limited clinical attention to these patients.³⁰ Part of the explanation for this silence returns us to the problem of the marginal: patients of color were rarely regarded as worthy of therapeutic interest or study.³¹ Even when their numbers remained high—often exceeding their comparative representation in the population—their preferential admission to public rather than private psychiatric facilities fated them at best for the benign indifference of doctors, and at worst for outright abuse.

But Cuban psychiatrists were far less reticent on the question of race. Well beyond the end of slavery, the significant presence of people of color at Mazorra proved an unavoidable reality for the doctors who staffed it. That overrepresentation was even fortified by the arrival of Jamaican and Haitian sugar laborers to Cuba in the 1910s and 1920s, some of whom ended up in Mazorra as a point of last resort. Admittedly, many psychiatrists were unmoved by this fact. Others, however, became invested in the clinical possibilities of racial difference. From the colonial period all the way through the present, enterprising Cuban psychiatrists have sought to project their discipline onto an international stage by exploring its most outstanding feature: racial diversity and a unique heritage of transculturation—both linked to a history of African slavery. Like their colleagues in other postcolonial contexts, experts framed racial dynamics as central to the nation’s capacity for sovereign development, as both a state project and a psychological process.³²

Yet race also held serious implications for the enterprise of scientific development. Cuban diversity forced psychiatrists to reckon with the cultural specificity of their own tools. This was particularly evident in the area of popular religion. Cuban psychiatrists had long looked outside the island—to Europe, the United States, and other parts of Latin America—to locate themselves intellectually. Their barometer for professional development was often set to the pace and trajectory of their foreign colleagues. But the Cuban populace manifested little investment in the international models prized by psychiatrists, and many remained wedded to other approaches to mental distress. Religious models were invariably the most prominent, ranging from Catholicism to religions of African descent (Spiritism and santería) as well as other forms of popular healing. Throughout the early decades of the twentieth century, psychiatrists had many opportunities to interact with noninstitutional providers of mental health care, and at certain points they responded by explicitly pathologizing their popular healer others. Later on, however, they would seek to appropriate that difference, both for its ostensible novelty and (eventually) the access it offered to disciplinary relevance.

Sexuality, Expertise, and the State

The obstacles to professional ascendance were not limited to the religious realm. Cuban psychiatrists have long fought to extend their expertise beyond Mazorra, especially to social questions in the public sphere. The tense counterpoint between Cuba’s notorious mental hospital and the diverse professionals who staffed it—psychiatrists, but also psychologists, general physicians, and other employees—thus represents a key axis of this book’s narrative. Psychiatrists in particular struggled and often failed to establish professional autonomy from the institution that seemed to define them against their wishes and design.

Cuba’s Revolution of 1933 represents an important turning point in these efforts. Before then, psychiatrists fought largely defensive battles, fending off popular healers, hypnotists, Spiritists, and other competitors in the medical marketplace. The psychiatric discipline remained a fundamentally weak one, challenged not only by the appeal of other solutions to mental distress but even more so by incipient psychiatric organization within Cuba and the ongoing fight to improve Mazorra. After 1933, however, an energized cohort of middle-class professionals began to infiltrate public debates, inspired by the achievement of the socially progressive Constitution (1940) as well as new legal paradigms oriented to prophylaxis rather than punishment.

Even in Cuba’s Second Republic (1933–59), however, the reach of psychiatric authority remained curtailed. On one hand, state corruption rendered many legal innovations dead letter, enlivening in principle but effectively irrelevant in practice. Equally frustrating, however, was the essential codependence of the psychiatric exercise, which ultimately relied on popular adherence and interest. The success of outpatient care for the normal and neurotic—as opposed to institutional care at Mazorra—demanded that individuals identify themselves as potential patients. Cuban psychiatrists lacked both the manpower and the ideological appeal to achieve that interpellation.

On a most basic level, numbers remained a serious problem. Though the ranks of the profession continued to grow in these decades—and even diversify, with newly minted psychologists, social workers, and educators—psychiatric practice beyond Havana remained virtually nonexistent, with only a few clinics dotting the landscape of large provincial towns. In their absence, other figures, many religiously oriented, continued to dominate the landscape of mental healing.³³ By this time, a number of lucrative private facilities had already sprung up in Havana, but even there the reach of private practice was largely restricted to those patients both willing and able to pay.

Meanwhile, outside of Cuba, this was a period defined by the expanding bounds of psychiatric engagement, particularly in the post–World War II context. Both world wars had afforded a psychiatric laboratory of sorts, producing new pathologies (shell shock, battle fatigue) and new therapeutic technologies. If innovation began on the battlefield, it nonetheless found a broader terrain for implementation in the wars’ aftermath. The dissemination and popularization of psychoanalysis was an important aspect of this opening, with the flight of European émigrés from the Nazi advance. Psychoanalysis spread quickly throughout the Americas, particularly in the United States but also in Brazil, Peru, and notably Argentina, where it would eventually coalesce into a full-fledged psy culture.³⁴

Though access to analysis remained class specific in many contexts, Freudianism, psychology, and psychotherapy in general thus became something more pervasive: a social and cultural language, and a vehicle for mental health professionals to establish their cultural authority.³⁵ The case of the United States was perhaps unique in this regard, but it held an outsized importance for Cuban psychiatrists, many of whom maintained close relationships with North American colleagues. Mazorra itself had long offered a stage for the testing out of foreign ideas on domestic soil, and psychoanalysis eventually joined the theoretical and therapeutic arsenal of Cuban psychiatrists.³⁶

Sexuality represented a crucial vector of this expansion. Since its emergence, psychoanalysis had been criticized for its unilateral focus on sex, particularly Freud’s argument that frustrated sexual instincts usually lurked behind adult neurosis. Though his own position on the issue had begun to evolve in the post–World War I period, analysis nonetheless helped to position sexuality at the frontlines of psychiatric engagement.³⁷ In the 1930s and 1940s, sexuality assumed a position of prominence in disciplinary conversations and social reform, abetting the rise of psychiatrists as experts and propelling the language of psychiatry into public debates. In Cuba, doctors and reformers also aimed to draw public attention to the question of sexuality, and to do so using psychiatric understandings and medical management.

We might designate these diverse efforts across national contexts—often led by but not limited to psychiatrists—as paradigmatically biopolitical in their efforts to forge governable and, importantly, self-governed subjects of a rational liberal state.³⁸ But Cuba’s Second Republic, marked by rampant corruption and politicking, fell far short of this designation. For their part, Cuban psychiatrists sometimes presented contradictory and pathologizing arguments about sexuality, which gained little popular traction. We should not be surprised that upper-class Cubans, with their gaze set on U.S. trends,