In Madness in Buenos Aires, Jonathan Ablard convincingly demonstrates that Argentine
psychiatric institutions were not the agents of social control that Foucauldian scholars
have maintained they were in Europe and the United States. While Argentina had the
most developed system of mental hospitals in Latin America, according to Ablard a
weak state limited these institutions' policing and coercive functions. Buenos Aires's
two main hospitals, the Hospital Nacional de Alienadas (for women) and the Hospicio
de las Mercedes (for men) attempted to replicate European psychiatric practice, including
even having an equal percentage of the national population interned. Nonetheless, lack
of funds, ineffective administration, chronic overcrowding, bureaucratic incompetence
and the absence of proper legal controls made Buenos Aires's hospitals places where
patients were more often neglected than captured by a 'clinical gaze'.

The book is based on meticulous use of primary and secondary sources and is divided
into five chapters plus an introduction and conclusion. Chapters 2 to 5 cover the period
between 1900 and 1946 and are a comprehensive history of the development and misfortunes
of Buenos Aires's two hospitals. These chapters are made compelling by Ablard's
skilful use of case histories to illustrate diagnosis, treatment and legal problems of the
patients. The last chapter of the book deals with the changes in psychiatry from the
time of Peron until the end of the military dictatorship in 1983. Argentina prided itself
on its modernity and large European population, yet the conditions that existed in the
two Buenos Aires hospitals were similar to those in other Latin American manicomios.
In the first decades of the twentieth century, patients often lacked adequate food, clothing
and even beds, to say nothing of medical attention. In the early 1930s, the women's
hospital had over 3,000 patients in facilities designed for 1,900 and in 1935 the men's
asylum had a population of 2,580, more than twice its capacity.

An overwhelmed legal system meant that, although there were laws to protect people
from unjust incarceration, judicial review often came months after patients were committed.
Because of court delays, and a law stipulating that only the authority that
requested commitment could rescind it, people were often held in unhygienic and
dangerous conditions for long periods after they had been medically cleared for
release. Although patients were often trapped in the system it seems to have more
often been due to bureaucratic incompetence than intention. Furthermore, although
most patients had little recourse once committed, patient law suits and conflict among
patients, doctors and administrators indicate that the control exercised by the institutions
was often quite fragile.

Diagnoses of those admitted tended to correspond to international psychiatric and
intellectual trends. In the early twentieth century, 'degeneration' (which was often
judged by physical traits such as facial asymmetry) was often said to cause or confirm
an inmate's insanity. Immigrants, especially political radicals, were considered particularly
likely to be degenerate and at least part of the psychiatric profession believed it was their
duty to incarcerate these dangerous insane for the good of society. As psychoanalytic
theory gained authority, illness was more often attributed to psycho-sexual conflicts. In
the case of women these often had to do with reproduction or menstruation or with
deviating from acceptable feminine roles. Treatment in the hospital relied on cardiazol,
insulin and electro-shock therapies, as well as medical cures for syphilis. Doctors also at
least occasionally practised surgical interventions, including lobotomy. Albard indicates
that, despite significant overcrowding, there may have been some use of psychoanalysis
or psychotherapy in the hospitals.

The last chapter deals with the changing fortunes of the psychiatric profession under
Peronism and succeeding (mostly military) regimes. Ablard contends that one reason that
hospital administration and patient care did not improve during the period of Peronist
populism was because Pero'n kept public institutions weak by making patronage and clientelism
the means of remedying social and political problems. The chapter also examines
new trends in treatment developed by progressive mental health professionals: small hospitals,
more out-patient treatment, egalitarian therapeutic communities. Eventually the
profession divided into two antagonistic camps: one that favoured social justice and political
change and another that served as accomplices for the post-1976 military government
in its interrogation and torture of prisoners. Many of the psychologists and
psychiatrists who advocated more innovative and humane treatment for their patients
eventually became targets of the military and at least 13 psychiatrists were disappeared.
This is a very interesting but somewhat rushed chapter. It would benefit from more discussion
of the importance of psychoanalysis in Argentinian life, the new types of therapy
that developed from the 1950s onwards, and the roles of mental health professionals
during and after the dictatorship.

Overall, this is a well written, carefully researched contribution to the history of
medicine in Latin America and a refreshing revision to the now accepted wisdom that
these institutions served as instruments of political policing and social control. It will be
welcomed by those interested in the history of public health, state formation and Latin
American history in general.

Ann Zulawski
Smith College
From: Social History of Medicine, March 2009

A particular strength of Madness in Buenos Aires are the multiple perspectives that emerge from the at-times heart wrenching narratives from inside the asylums, in which not only patients and their families but well-meaning doctors suffered tragic setbacks. Thus Ablard's book adds important new dimensions to our understanding of the acceleration of modernity in turn-of-the-century Argentina and its concomitant social effects, a subject of great interest to scholars who study this South American nation. 

—Julia Rodriguez, Journal of Social History