Tag: Alcohol

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Alcohol, Alcoholism and Mental Health in British Guiana, Part 2

By Deborah Toner

At the inaugural meeting of the Caribbean Conference for Mental Health (CCMH) in 1957, delegates described alcoholism as the single biggest mental health issue facing Aruba, where the conference was held, and amongst the biggest problems across the region. As part 1 of this post established, heavy alcohol use had featured prominently in psychiatric explanations of insanity during the late nineteenth-century period of asylum reform led by Dr Robert Grieve at the Public Lunatic Asylum in Berbice, British Guiana. Grieve and other physicians typically used the term ‘alcoholism’ to describe the physiological and neurological effects of alcohol consumption that led to different forms of insanity and used some combination of theories about inherent racial difference, the impact of social dislocation, and environmental factors to explain the varying prevalence of mental illnesses amongst the colony’s ethnically diverse population.

By the time the Caribbean Federation of Mental Health (CFMH) was formed in the 1950s, to spearhead the first cross-Caribbean project to improve mental health at a population level, medical and psychiatric professionals around the world increasingly viewed alcoholism as a mental illness or physiological disease in its own right. As a result of the influence of organisations like Alcoholics Anonymous (AA), the term had also become part of everyday language in discussing problem drinking, defining alcoholism as a particularly destructive, out-of-control pattern of drinking. The early conferences of the CFMH explored these ideas and adapted the AA model of alcoholism to incorporate, as part of alcoholism’s causation, the psychological and social legacies of colonialism and ongoing processes of rapid socio-economic change in the Caribbean.

The Emergence and Spread of the ‘Alcoholism Movement’

From the late nineteenth and up to the middle of the twentieth century, an increasingly global community of researchers, practitioners, temperance advocates and policy makers discussed the social, economic and health impacts of alcohol consumption at major international conferences known as anti-alcohol congresses. By the middle of the twentieth century, the “disease” model of alcoholism dominated medical, psychological, and social work approaches to understanding and treating problem drinking. Organisations like Alcoholics Anonymous, the Research Council on Problems of Alcohol and the Yale Centre for Alcohol Studies, all founded in the United States between 1935 and 1943, helped to popularise the idea that alcoholism was a sickness to which some individuals were more susceptible than others. There was ongoing debate about the aetiology of this susceptibility – as a physiological allergy to ethanol; as a psychosexual disorder; or as more environmentally influenced. But all agreed that alcoholism should be treated as a public health problem (Tracy 2021; Tracy 2005).

            Treating alcoholism as a public health problem, these organisations promoted mass public awareness campaigns, alongside new models for treating and rehabilitating the individual alcoholic. The most influential was the Alcoholics Anonymous Twelve Step programme, “a set of principles for achieving sobriety and personal transformation through self-reflection, mutual aid, good works, and surrender to a higher power” (Tracy 2021). The AA model for treating alcoholism spread around the world quite quickly, with branches opening in Mexico in 1940, Ireland in 1946, Scotland in 1848, France in 1960, and Japan in 1963 (Toner 2021, 18). In the Caribbean, a report commissioned by Aruba’s Department of Social Affairs in 1951, led to the foundation of an Alcoholics Anonymous group and the Aruba Society Against Alcoholism in 1955. Both these organisations fed into the establishment of the Aruba Society for Mental Health that hosted the first Caribbean Conference on Mental Health in 1957 (CCMH Proceedings 1957). While research into a wider range of records is needed to map the spread of AA across the Caribbean more systematically, proceedings of the 1959 Virgin Islands conference suggest that it quickly became established. In discussing tensions between different government departments about who should be involved in improving mental healthcare and how it should be funded, Trinidadian delegates commented that Alcoholics Anonymous ‘could be relied upon to go along’ without public funding, indicating that AA was already an established presence in the Caribbean by the end of the 1950s (CCMH Proceedings 1961). Certainly, delegates at later conferences reported that AA branches had been established in Grenada in 1961 and Antigua in 1962, and joining AA had become a formal part of the treatment programme operating in St Ann’s Hospital, Trinidad by 1963 (CCMH Proceedings 1965).

Alcoholism at the Caribbean Conferences for Mental Health: Definitions and Causation

American speakers were influential in moulding discussions of how to define alcoholism at the Caribbean Conferences for Mental Health. In 1957, Dorothy M. Johnson, Supervisor of Psychiatric Social Work at the State of Florida Alcoholic Rehabilitation Program, followed the Yale Center of Alcohol Studies in defining an alcoholic as a person who drinks ‘alcohol in an uncontrolled and self-destructive manner’, such that their drinking causes serious detrimental impact on their health, personal relationships and/or work. Johnson further highlighted that alcoholism was often linked to difficult transitions or traumas in a person’s life. Another colleague from the Florida Rehab Program implicitly defined alcoholism as a male condition, saying that wives often caused their husbands’ drinking problems by infantilising and emasculating them. The secretary of Aruba’s AA branch, comprised of 150 members at this time, defined an alcoholic as ‘a person who has a physical allergy to alcohol and is at the same time emotionally immature’, echoing the way in which AA as an organisation typically combined a specific physiological predisposition with the influence of social and psychological factors in explaining individuals’ alcoholism (CCMH Proceedings 1957).

However, in applying the AA definition and treatment model to rehabilitation programs in the Caribbean, mental health professionals typically emphasised broader sociological processes, some relatively recent, others with long historical roots, in explaining alcoholism in their communities. A social worker from the Aruba Department of Social Affairs, which had kickstarted sustained investigation into alcoholism in the early 1950s, highlighted as a central cause, the ‘mental tensions’ that had resulted from rapid development of the island’s oil industry, via American investment, in the previous two decades. In the capital port city, the higher wages and social influence of a large influx of ‘unsettled foreigners’ apparently led to increased incidence of alcoholism. In more rural regions, alcoholism was attributed to the longer-term pattern of young men from Aruba migrating to Cuba for work on sugar plantations, where they often developed habits of heavy rum consumption, combined with psychological feelings of inferiority stemming from intergenerational poverty (CCMH Proceedings 1957). The dislocating effects of rapid socio-economic change across the 1950s and 1960s, often as a result of migration and tourism, continued to be important themes in explaining the psychology of alcoholism, and mental health problems more broadly (CCMH Proceedings 1961; CCMH Proceedings 1965).

            Conference delegates often pointed to the psychological and social legacies of colonialism in producing the emotional immaturity, or feelings of emasculation and powerlessness, that organisations like AA posited as being central to the psychology of alcoholism (CCMH Proceedings 1965). Discussion following papers presented by personnel from the Florida Rehabilitation Program in 1957 highlighted that the Caribbean experience of alcoholism was bound to be different from that in the US because of the legacies of colonialism and slavery (of course, the US had its own legacies of slavery and colonialism, but the early alcoholism movement in America, and Alcoholics Anonymous in particular, overwhelmingly catered to white people). Delegates argued that instability of family life in the Caribbean was a source of emotional immaturity and emasculation, rooted in the ‘break up of family patterns among negroes when they were taken from Africa into slavery in the New World’ and that feelings of powerlessness were pervasive because of how colonial governments (still in control of most Caribbean countries at this time) meant that Caribbean people were ‘not master in [their] own home or own country’ (CCMH Proceedings 1957).

            Reports from both St Ann’s Hospital, Trinidad and Fort Canje Hospital, British Guiana in 1963 suggested that alcoholism was more common amongst patients of East Indian heritage. Heather Pinto, Senior Occupational Therapist at St Ann’s Hospital, stressed the psychological and social legacies of colonialism in explaining this. While she followed the AA disease model in stating that some predisposition in the individual was necessary for broader factors to lead to alcoholism, the main causes that explained a higher rate of alcoholism amongst East Indian people were: the psychological legacy of indenture and separation from a distant homeland; the trauma of marginalisation due to ethnic, linguistic and religious difference; and cultural traditions that embedded alcohol in social and family life. By contrast, she stated that Black people were ‘not so inclined to be bogged down by memories of slavery’, but where they did develop alcoholism this was because they used alcohol as a ‘tranquiliser’ for feelings of inferiority compared to Europeans they worked with in the oil and sugar industries. Europeans who developed alcoholism in the Caribbean, meanwhile, were likely to do so because of ‘too much money and lack of suitable activity which constitutes boredom and depression’. While Pinto concluded that alcoholism was fundamentally rooted in emotional immaturity, in line with a core tenet of AA’s definition of alcoholism, this emotional immaturity was understood to be the product of historical and social forces that shaped the experience of different ethnic groups in the Caribbean (CCMH Proceedings 1965).

This conclusion was broadly in line with the wider ethos of improving mental health at population level with which these CFMH conferences were imbued. Specific innovations in institutionalised and outpatient care were implemented to treat individuals, in the context of a broader understanding that it was really major social inequalities arising from Caribbean histories of colonialism that needed to be addressed. You can see our working paper, “Changing Approaches to Mental Healthcare in the Caribbean Conferences on Mental Health” for more on this broader context, and await publication of our article on the relationship between intoxication, insanity, migration and intoxication for more on how these relationships played out in British Guiana across the whole colonial period.

Deborah Toner is an Associate Lecturer in the school of History, Politics and International Relations, University of Leicester.

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Research during Covid: The three Rs (Reflexivity, Resilience and Rum)

By Members of the Research Team

Research never goes to plan. As academics, we all know this. It is also a fact we constantly share with our students as an expected part of academic research. Whether it is a failure to gain access, or find enough people willing to participate, we all face research challenges. Like most things however, Covid has added a new set of challenges to academic research (as well as opening up new opportunities), which our research team recently faced on a trip to collect data in Guyana. This reminded us all about the importance of the three Rs – Reflexivity, Resilience and Rum (rum is used to emphasise the importance of relaxation and researcher self-care as well as the importance of looking after each other when out in the field, something that is to commonly forgotten about in research). Subsequently, this blog outlines how Covid recently impacted upon our data collection plans and how we, the team of three (the three musketeers), responded to the challenges they faced, illustrating the importance not only of the team – its members, relationship, reflexivity, and resilience – but also of building the networks of support that became an invaluable source of help on this trip. Although often over-looked, networks of support – academic as well as practitioner – are invaluable as we travel the globe in person or virtually undertaking research and delivering research papers at conferences.

Covid-19: The Challenges

We have all had to face new challenges arising from the global Covid pandemic, and this includes research. The ever-changing requirements for travel alone can be a minefield especially when multiple destinations are involved. Do you need a PCR test? A lateral flow? A vaccine record? Although the team joked about the possibilities of Covid negatively affecting this research trip as we completed the usual research risk assessment form, we did not for one minute think that this would become our reality. As we navigated the various government requirements for travel to Guyana, and as transit passengers (currently there is no direct flight from London to Georgetown), we quickly became all too familiar with the challenges when these documents expire. Three days prior to travel our connecting flight was cancelled; due primarily to the knock-on effects of Covid the carrier was required to consolidate some of its existing flights. This delay in being able to fly to our final destination meant that our existing Covid PCR tests (taken in the UK before departure) became invalid while we were in transit. As a result, two hours before we were due to leave for the airport, we had to retest, and then found ourselves faced with the unenviable decision of whether to abandon the research trip as one of us tested positive. Despite the UK being only days away from dropping all restrictions the rules of quarantine in our transit destination, as in many areas of the Caribbean, remained in full force. After a frantic hour of rearranging hotel rooms, contacting our colleagues, updating the insurance provider, and ensuring the Covid patient had the basic necessities for a possible ten-day stay in isolation, the remaining two members of the team apprehensively continued on with the trip.

Reflexivity

We reflect on a daily basis in both our personal and professional lives, and the importance of being reflexive when undertaking research is well documented.  It facilitates self-awareness and allows researchers to respond to unexpected challenges and situations in appropriate and ethical ways. It also allows researchers to improve and build on instances of good practice as well as to learn from their mistakes. Thanks to Covid we had to revisit and alter our itinerary for the trip. This was mainly owing to the fact that as a team we were now lacking in the expertise required for certain elements of data collection, namely the interviewing of prisoners and a focus group with their families. The added scrutiny that this placed on our planned activities ensured that we worked together, albeit remotely, to create a workable plan. As a result, two of the most invaluable research tools on this trip quickly became Zoom and WhatsApp, as we adapted to the circumstances to ensure the trip was a success. This technology enabled us to further refine our research questions and aims as we prepared for the interviews with our colleague in isolation. Due to the circumstances, we also made the decision to employ a local researcher with experience of working with prisoners and their families. In addition to helping with the language barrier (many speak a variation of English known as Guyanese Creole) this also had the unexpected benefit of producing more in-depth data as the prisoners connected with the interviewer over their shared experiences of living in the same country. Furthermore, where possible one of our key activities – a session in which we co-created a new tool that will enable the Guyana Prison Service to gauge the experiences of prisoners and officers – was moved to an online session. This had the added benefit of enabling officers, and members of our team, from a wider geographical area to take part. This reflexivity not only ensured we were able to successfully carry out our designated activities, it also strengthened our relationships with our partners, both in Guyana and the UK, as we worked together to overcome difficulties.

Resilience 

Although not a fan of the word resilience – which seems to have become a contemporary buzz word – it best describes the reaction of the team members to the situation they found themselves in during this research trip. Instead of letting it get them down they did their best to make the best out of a bad situation (thanks to being reflective), which actually resulted not only in a very productive data collection trip, but also one that contained some genuine moments of comradery, good humour and bursts of hysterical laughter despite the adverse and at times disappointing situation that faced us. As Charles Darwin exclaimed/outlined: ‘It is not the strongest of the species that survive, not the most intelligent, but the one most responsive to change’. Sentiments that stand true for the recent predicament we, the research team, found themselves in and how we chose to respond to it.

We had always planned for Covid, in that we decided that three persons would go on this trip, so that in the event of sickness and isolation the others could complete the research activities. Despite our pact that if one of us tested positive for Covid then the team would carry on without them, like many plans in life, you never really expect them to happen so, the reality and its accompanying shock was somewhat overwhelming and definitely unexpected. In fact, the first 5 minutes after the initial news of the positive test was spent asking the medical team if they were joking, as is often the way in the Caribbean. It was however no joke. One of us had tested positive and was going to have to stay behind in transit and in quarantine in a different country on their own, while the remaining two went on to Guyana. This is when true teamwork and collegiality really come into play as everyone (bar the infected who had to stay outside) pulled together to rectify/address the situation in the 2-hour window before everyone was due to fly. A team member in the UK liaised with our travel agent. We called and discussed the situation with our partners, and later on the British High Commission in Guyana, with whom we have built excellent working relationship over the past few years.

Once the initial shock of one of us testing positive for Covid had worn off the team revisited their itinerary and data collection plans for the forthcoming week to ensure everyone was still involved where practically possible/needed. Despite the initial disappointment, and the frustration of not being able to go and collect data in Guyana, the Covid patient endeavoured to come up with an exit plan until they heard from the Ministry of Health. The idea was to rest up, clear the virus and follow the team on after 5-days. However, this was not to be. Instead, the Ministry made it quite clear that the minimum isolation period was 10-days, although the patient was given a hotline number to call. After a frustrating day with 7-hours spent just redialling but being unable to get through on the telephone number provided by the Ministry of Health, the Covid patient also explored other avenues of help/support to ascertain the situation. It was at this point that the importance of networks was emphasised: the team was in touch with the High Commission of Guyana, and it was willing to help. Once the Covid patient knew that they were quarantined for 10-days and the research team had created a new itinerary for the trip, it was easy to plan their time and make the best use of the situation both to recover but also to catch up on some of the background project reading, reading the interview transcripts and coding frames as well as numerous other tasks that often get postponed.

The team debriefed every morning and/ or evening where practicably possible not only to catch up on the day’s progress but also to relax, and jolly each other along. The daily debriefs with their colleagues in Guyana, including meetings where the Covid patient Zoomed in, also helped to ensure that they felt part of the project and part of the team. It also kept them busy and helped the time to pass quickly, with some days feeling quite busy despite not leaving the hotel room. We had a job to do, and Covid was not going to stop us. We just had to get on with it.

Rum

Undertaking research in the Caribbean is challenging. Although, Guyana is often seen by many as a desirable research location, many often fail to consider the subject matter of our project, the political/cultural sensitivities, and the fact that despite being a desirable destination, our time is often spent in old colonial prisons – some of which have been deemed to violate the United Nations Minimum Standards for the treatment of prisoners – talking to prisoners, staff, communities and families about often upsetting and traumatic experiences, which the research team then have to process and deal with. It is in this context that the importance of self-care and looking after each other comes into play. Although there are more formal channels of support offered to everyone working on the project, there are also informal support practices that have been an integral part of this research project, which is also reflected in the relationship of the team.

The research team on this project are very close, familial like even – but without much of the negativity associated with families. We all genuinely support each other. There are no egos. There is no competition. Instead, there is clear leadership, collegiality and care. Whether it is coffee and cake or catching up over a meal, regular debriefs, relaxation and humour have always been an important part of the team’s R and R, emphasising the importance of relaxation and researcher self-care as well as the importance of looking after each other when out in the field, something that is to commonly forgotten about in research. It was this which got us through what one of the researchers described as the most difficult situation in their 25-year career. With pride, we returned to the UK together, having completed all our planned activities and with our research team stronger than ever before.

Acknowledgements: The Covid patient would like to thank their two travel/research companions, as well as the team in Guyana, and everyone that looked after them, especially the High Commission in Georgetown in Guyana, and the Chief Medical Officer of the transit country, who went above and beyond in their support.

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Alcohol, Alcoholism and Mental Health in British Guiana, Part 1.

Deborah Toner

As previous posts have highlighted, the use of alcohol, cannabis and other substances form a major part of ongoing discussions about mental health and mental illness in Guyana in the twenty-first century. Concepts relating to the problematic use of substances also shaped historical understandings of mental health issues in British Guiana and the Caribbean. In two linked posts, I aim to explore how alcoholism in particular was understood during two key junctures in the development of mental health infrastructure in the region: the late nineteenth-century period of asylum reform led by Dr Robert Grieve in British Guiana (part I); and the foundational conferences of the Caribbean Federation for Mental Health in the mid-twentieth century (part II).

While the terms alcoholism and alcoholic are still widely used and familiar today, in both lay and therapeutic contexts, clinical diagnoses of problem drinking have long been moving away from these terms. The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994, included alcohol abuse and alcohol dependence as two distinct disorders, while the more recent DSM-V of 2013, integrated the diagnostic criteria for both into one “alcohol use disorder”, with gradations in terms of its severity. Public health bodies such as the WHO have increasingly shifted to the language of harmful drinking and alcohol-related harm instead of alcoholism. There are multiple reasons for these developments; an important one to highlight here is that alcoholism as a concept has, since its inception, been a moveable feast.

The Asylum Journal for 1882. Berbice, British Guiana: printed for the Asylum Press.

By exploring the development and application of the alcoholism concept through the history of mental health in British Guiana, these two linked posts constitute a preliminary attempt to write British Guiana into a major aspect of the global historiography of alcohol in the nineteenth and twentieth centuries. The emergence and spread of medicalized understandings of problem drinking and associated concerns about public health have been a major focus of this historiography (Levine 1985; Sournia 1990; Piccato 1997; Tracy 2005; Toner 2015). Until the nineteenth century, habitual drunkenness was largely understood as a moral failing. Across the nineteenth century, new terms like inebriety, dipsomania, addiction and alcoholism diagnosed certain drinking patterns and practices as medical or psychiatric problems. Moral judgements and social prejudices were still embedded within these new concepts, and they varied in their definitions and applications from place to place. In British Guiana, Robert Grieve devoted many pages of the Asylum Journal (1881-86),produced while he was Medical Superintendent of the Public Lunatic Asylum in Berbice, to analysing the connection between alcoholism and insanity. His interpretation combined analysis of the physiological and neurological effects of alcohol with theories about racial difference, degeneration and the impact of social dislocation. By the 1950s and 1960s, Alcoholics Anonymous, formed in the United States in 1935, had established a significant presence in the Caribbean. The “disease” concept of alcoholism, which Alcoholics Anonymous helped to popularise in lay terms around the world, featured in the early conferences of the Caribbean Federation for Mental Health, alongside broader interpretations of problem drinking that considered the psychological and social legacies of colonialism and ongoing processes of rapid socio-economic change.

Part I: Intemperance, Alcoholism and Insanity in the late Nineteenth Century

Rather than using alcoholism to denote particular patterns of alcohol use, late nineteenth century medical practitioners in Europe, North America and elsewhere typically used the terms alcoholism or chronic alcoholism to describe the range of physiological, neurological and psychological conditions that alcohol consumption could cause. Physicians in British Guiana followed a similar pattern. They made few and only vague attempts to describe an “alcoholic” pattern of drinking behaviour and more consistently employed the terms “drunkards”, with “intemperate” or “vicious” habits in the use of alcohol to convey prolonged or excessive patterns of consumption. In quantifying excess, Robert Grieve ventured some specific observations. In discussing the importance of good diet for general physical and mental health, he stated that the quantity of alcohol consumption “within which safety lies is very limited, not more than a wineglassful of ordinary spirits or its equivalent in the twenty-four hours” (Asylum Journal, 1881). Case histories presented in the journal sometimes described heavy drinking patterns that led to specific symptoms as alcoholism. A 41 year old migrant from Barbados, diagnosed with syphilitic insanity, reported that “he had been drinking freely for some time and he rather proudly declared that he could take a bottle of strong rum without staggering”. Grieve subsequently noted that he had been suffering hallucinations upon his admission to the asylum, “no doubt dependent upon the alcoholism under which he then laboured” (Asylum Journal, 1882). Dr Godfrey, in Georgetown Hospital, was initially stymied in treating a patient suffering from shooting pains and paralysis of the arm, which the doctor suspected had been caused by excessive drinking. The patient, a 39 year old sugar distiller, claimed to drink only “a glass or two of alcohol during the day”, but his wife subsequently informed Godfrey of a “clear and exact history of alcoholism which had been going on for some time”. On giving up drinking altogether, the patient slowly recovered over a period of several months (Transactions of the British Guiana Branch of the British Medical Association, 1891).

Plans for Berbice Lunatic Asylum, The National Archives, CO 116, British Guiana Blue Books.

Medical and psychiatric experts more consistently attributed to intemperance in the use of alcohol, various physiological and neurological imbalances that caused different forms of mental illness. Writing in the Journal of Mental Sciences, James S. Donald described intemperance as “one of the most fertile causes” of “lunacy” in British Guiana, singling out the consumption of high-strength rum, known as “high wine”, for producing “cerebral lesions” over time (1876). Grieve wrote quite extensively in the Asylum Journal about the prevalence of Bright’s disease (an out-of-use term for various kidney diseases) amongst patients of the Berbice asylum, where it was a leading cause of death over several years. He attributed the comparatively high rate of Bright’s disease within the asylum to the long term effects of malaria, poor diet, and intemperance in the use of alcohol, and also argued that drinking alcohol compounded the negative effects of malaria and malnutrition on the kidneys. Further, he postulated a causal link between Bright’s disease and neurological changes that led to insanity and hence, admission to the asylum. For example, in a case history of a 50 year old female patient, “said to be of intemperate” habits, Grieve traced a causal link between her kidney disease and her “cerebral excitement”, which manifested on admission in symptoms such as incoherence, delusions, violent and erotic outbursts, severe head pains and memory loss, and ultimately led to her death via a brain haemorrhage. He concluded the case history: “we have therefore a case of insanity arising directly from Bright’s disease and remotely from intemperance” (Asylum Journal, 1881).

Finally, in exploring the causes of mental illness, Grieve pondered connections between intemperance and theories of racial difference, degeneration and social dislocation. Grieve sometimes attributed an inherited predisposition greater causal weight to mental illness than environmental or lifestyle factors, but all three could be linked through the theory of degeneration. “Proclivity to any disease is influenced by all the previous conditions of life not only of the patient but of his ancestors”, he argued, and that insanity as a disease could often be understood as the last step in the “evolution of degeneration of which too often overindulgence in drink forms the starting point” (Asylum Journal, 1881). Assessing the numbers of patients admitted to the asylum in Berbice up to 1880, Grieve explained that there was a considerably higher proportion of migrants than creoles – a distinction based on being born outside or within British Guiana – likely as a result of having less of a family support network to provide care during periods of mental distress. Within the category of migrants, Grieve further attributed a disproportionate number of African patients in the asylum population to racial difference, in two senses. First, the disorientation of being displaced from a “savage” lifestyle in Africa to the comparatively high “civilisation” of a British colony. And second, as a “race which possesses less of civilisation than any other seen in the Colony”, he argued Africans were unlikely to suffer mental illness because of “mental strain”, a common explanation of insanity in Europe at the time. Instead, the high rate of Africans being admitted to the asylum in British Guiana was taken as evidence that “vice”, especially in the use of alcohol, was a “more active agent in the manufacture of the insane” than “mental strain” (Journal of Mental Sciences, 1880). While so-called ‘moral causes’ of insanity – including anxiety, domestic strife, the strains of modern life – predominated in English cases of insanity, Grieve suggested that in British Guiana such problems weighed little on the minds of people of either African or East Indian descent. Amongst these groups in the colony, alcohol and cannabis (or gange) were respectively considered the leading causes of insanity (Asylum Journal, 1882). The close connection Grieve drew between African asylum patients and alcohol use was also linked to their higher fatality rate as patients compared to other ethnic groups, as a consequence of co-morbidities between cerebral abnormalities, chronic heart disease and Bright’s disease (Asylum Journal, 1883).

By the time the Caribbean Federation of Mental Health was formed in the 1950s, medical and psychiatric professionals around the world increasingly viewed alcoholism as a mental illness or physiological disease in its own right, and the term had become a familiar part of everyday language in discussing problem drinking. Come back to the blog for Part II of this post to find out how such ideas were debated at the Caribbean Conferences for Mental Health in the 1950s and 1960s.

Deborah Toner is an Associate Lecturer in the school of History, Politics and International Relations, University of Leicester.

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History of Substance Use and Control in Guyana

Kellie Moss

The control of psychoactive substances in Guyana was established in the nineteenth and early twentieth centuries through varied national and international drug control initiatives related to opium, cannabis, and the supervision of pharmaceutical products. As in other colonies, early measures were implemented as a means of social control for the economically disadvantaged. Missionaries were amongst the first to draw attention to the use of psychotropic substances by Indigenous peoples (known as Amerindians) in association with spiritual and recreational experiences. The Accaway’s, who inhabited Upper Demerara, Mazaruni, and the Putaro districts, produced a fermented beverage known as piwari for feasts (Bernau, 1847). Traditionally prepared for male consumption, missionaries noted that women would chew cassava bread into a pulp adding water until fermented. The men would then drink until they were in a state of ‘beastly intoxication’, or the trough (generally a canoe used for the purpose of fermentation) was empty (Duff, 1866). In addition to spiritual and recreational purposes, Amerindians also utilised fermented beverages for medicinal purposes, such as reducing fever (quassia bark), stomach ache (mauby bark, also known as a ‘decoction of woods’), and enriching the blood (sorrel plant). To motivate and organise the Indigenous population, colonial agents encouraged, and fostered their dependency on psychotropic substances. This included distilled spirits, such as rum or brandy (Bernau, 1847). This rapid introduction to distilled spirits, in addition to European influence on habits of consumption, resulted in social dependencies that tied the Amerindian labour force to the colonial system. Although informal, the fostering of chemical dependencies played a pivotal role in the political and economic shaping of the colony, as the colonial authorities increasingly used this technique as a means to control those on the fringes of society.  

Piwarry Feast of the Accaway Tribe: Wellcome Library , EPB/B/13446, Bernau, J. H. (John Henry), Missionary Labours in British Guiana (John Farquhar Shaw, London, 1847).

Legislation to criminalise the use of psychoactive substances was first introduced in Guyana in 1838, following the termination of the apprenticeship system, through which the formerly enslaved were tied to their previous owners for a four-year period. To avoid a decline in plantation labour the colonial government introduced numerous measures to restrict African movement, including in 1839 an ordinance for the ‘relief of the destitute poor’ (TNA, CO 113/1).This act granted the Court of Policy (legislative council) the power to ‘set to work’ those unable to support themselves (TNA, CO 113/1). In accordance with the act, anyone caught absconding, drunk, introducing, or attempting to introduce spiritous or fermented liquors into the workhouses could be sentenced to hard labour in prison for one month (TNA, CO 113/1). Despite the introduction of such measures the formerly enslaved continued to leave sugar estates in favour of villages and urban centres. To offset this emerging labour vacuum plantation owners imported indentured contract labourers from Africa, Asia, and Europe (TNA, CO 113/1).

As a result of its introduction to Guyana by indentured immigrants from South Asia (known as East Indians), the cultivation of Indian hemp, more commonly known as cannabis, quickly became a thriving cottage industry. Widely believed to have spiritual and medicinal connotations, the cultivation and use of the plant had long been a part of Hindu tradition (Russo, 2005). Accepted by plantation owners in the Caribbean, the use of cannabis was, to a certain extent, even promoted as a means of enhancing labourers’ productivity (Jankowiak & Bradburd, 2003). As one of the oldest-known plants in Asia cannabis was prepared and used in various forms. Bhang, the dried leaves of the plant, being the cheapest and most widespread, was reported by British medical officers to produce a ‘quiet, pleasant delirium’. The sticky yellow resin of the plant known as charas (hashish), on the other hand, was believed to cause ‘excitement attended with violence’. The drug was also used in the form of a sweetmeat called majun, and smoked as ganja, which was made from the plants dried flower tops. The latter preparation was the one generally chosen among indentured labourers in the colony owing to its low cost (British Medical Journal, 1893).

De historia stirpivm commentarii insignes, L. Fuchs, 1842: Wellcome Collection.

As the nineteenth century progressed official opposition to cannabis first arose in recognition of the drug’s alleged debilitating effects. They were concerned that indentured labourers were spending more time and effort growing cannabis than attending to their work on the estates. Furthermore, colonial authorities also expressed unease regarding the excessive use of cannabis, which some felt had the tendency to increase rather than reduce confrontation, particularly in hostile situations. Concerns regarding the effects of the drug continued to grow as the use of cannabis, which was believed to have been initially confined to Hindu men, spread amongst the different ethnic groups on the estates (British Medical Journal, 1893). Owing to the increased number of incidents being attributed to substance abuse, an ordinance to regulate the sale of opium and bhang was introduced to the colony in 1861 (TNA, CO 113/4). The primary focus of the act was to restrict the access of Indian and Chinese immigrants to the drug (TNA, CO 113/4). The evidence for this legislation, however, was based on little more than the casual observations of plantation owners. Critics used evidence of substance abuse to feed into larger classifications and ideas about race and its connection to moral character (TNA, CO 113/8). Debates regarding the use of psychotropic substances and their control are therefore rooted historically in much wider concerns related to colonial power structures, and the rights and privileges of the labouring population.

With recurrent concerns regarding the use of opium and cannabis in Guyana, namely the link between insanity and substance abuse, rum was rapidly introduced by plantation owners as an alternative (British Medical Journal, 1893). Unlike cannabis, and its indirect benefits as a labour enhancer, the planters directly profited from the production and distribution of rum (TNA, CO 113/8). Interested in creating a captive consumer class, official tolerance in the Caribbean regarding the use of rum was also predominantly favoured by colonial authorities. Simultaneously, the sanctioned access to alcohol for labourers was a powerful incentive for immigrants to engage in plantation work. Unsurprisingly, the consumption of alcohol dramatically increased during this period as indentured immigrants became increasingly reliant on its effects to obscure the misery of plantation life. The consolidation of laws relating to indentured immigrants in 1873, namely those in connection to the penalties for drunk and disorderly conduct, highlight the extent of its escalation as penalties for drunk and disorderly conduct were further outlined (TNA, CO 113/5).By positing a need for such measures, the plantation owners served to justify their exploitative and oppressive actions towards the labourers.

Internationally the drive to control psychoactive substances began in 1912 at the International Opium Convention at the Hague (TNA, CO 113/13). Despite the lack of agreement amongst the delegates a discussion on cannabis had lasting repercussions for Guyana as legislation was introduced to further regulate the importation and sale of Indian Hemp in 1913 (TNA, CO 113/13). Despite the lack of scientific or medical data to support these international debates cannabis was designated from this point as a dangerous drug. The cultivation and importation of cannabis was officially criminalised in Guyana following the introduction of the 1938 Dangerous Drugs Ordinance. Later amendments followed Guyana’s independence with the United Nations Convention against the Illicit Traffic in Narcotic Drugs and Psychotropic Substances in 1988, which required states to adopt measures to establish as a criminal offence any activity related to narcotic drugs (CARICOM Report, 2018). This demand continues to place pressure on Guyana’s overstretched prison system (see Ayres, 2020).

Throughout the history of Guyana, the use of psychotropic substances has been determined therefore, by numerous factors, such as cultural expectations and economic motivations. Drugs became a reward to encourage productivity, but also led to debts and addictions, all of which ensured the economically disadvantaged remained bound to their employers. The stimulating properties of these substances and their ability to establish and solidify bonds, whether economic, cultural or religious, has ensured their enduring and widespread demand from pre-colonisation to the present day.

Kellie Moss is a research associate on the ESRC GCRF project Mental Health, Neurological and Substance Abuse Disorders in Guyana’s Jails, 1825 to the present day.

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An historical perspective on Guyana’s jails

Clare Anderson

In the nineteenth and twentieth centuries, the colonial administration of British Guiana managed over a dozen jails, three of which still stand today. These are: Camp Street (Georgetown), New Amsterdam, and Mazaruni. The history of prison building and incarceration in British Guiana was the focus of a recently completed project, funded by the British Academy and conducted by researchers from the University of Guyana and the University of Leicester. The project asked questions about the role of prisons in the colonial justice system, and about historical patterns and experiences of imprisonment. It sought to find out whether history can offer lessons from the past that might be useful for understanding jails today.

HMPS Mazaruni, 19th century

The project team comprised myself and Dr Kellie Moss (Leicester) and Dr Mellissa Ifill and Estherine Adams (Guyana). Together, we undertook extensive research on colonial-era records held in our respective national archives, where we discovered a rich history of continuity and change. We found that colonial prison administrators kept coming back to the question ‘what is prison for?’ From that stemmed near-continual discussion of the same topics. These included the desirability of the separate treatment of different kinds of offenders (and adults and juveniles); the role of religion in rehabilitation; the deficiencies of prison infrastructure; prison security and escape; the morale of prison officers; and the education and training of inmates.

We presented some of our research to a group of serving prison officers, in autumn 2018, and had the opportunity to visit Mazaruni and New Amsterdam. Three things became immediately apparent. First, a great deal of colonial-era infrastructure survives today. Second, at least some of the daily rhythms of incarceration (including modern prison regulations) date from the British period. Third, there remain many parallels between the past and the present, regarding the active debate of exactly those issues that were discussed in the past.

Estherine Adams and Kellie Moss, project workshop, Georgetown, November 2018

New Amsterdam and Georgetown Prisons are the oldest operating prisons in Guyana. They were built by the Dutch, and extended by the British after they took control of the colony in 1814. Later, in 1843, the British constructed Her Majesty’s Penal Settlement (HMPS) Mazaruni, near Berbice. They also built numerous other district prisons, along with several ‘lock-ups’ in the more remote regions. The government of Guyana built the other two modern institutions, Timehri and Lusignan, following Independence in 1966.

The project found that the history of Guyana’s jails is intertwined with the history of colonialism, notably enslavement, immigration, and population management. During the era of slavery, the owners of enslaved persons punished their human property for what they perceived as labour infractions or ill-discipline, often using extremely brutal measures. After emancipation, the colonial state took on this role, and this was the background to the development of prisons in the 1830s and 1840s. The British imprisoned emancipated slaves and others, including Asian indentured labourers, for a range of offences. These included crimes against property, but also what they called ‘idleness’, and breaches of harsh labour laws, including unauthorised absence from home or work.

Indentured Indian sugar workers, early 20th century

The project also discovered that the architectural design of and daily regimes instituted in Guyana’s prisons were strongly influenced by changing European and American thinking about their ideal form and function. The British adapted and built jails according to ‘modern’ prison design. Ideally, prisoners would occupy individual cells, and they would be punished and rehabilitated through a programme of education, work, training and Christian instruction. One notable feature of nineteenth-century punishment was the use of prisoners in colonial building projects. Inmates built and repaired streets and pavements, and constructed parts of the Sea Wall – in the latter case including through the draft of prisoners from Mazaruni to Georgetown. However, despite Britain’s claim to penal ‘modernity’, prisons could be violent places in which prisoners were chained, flogged or placed on harsh rations. Georgetown prison even had a treadmill, which constituted an extreme form of physical punishment.

Mazaruni Prison, 2017. Photograph: Obrey James.

From the very earliest days, where there were efforts to reform and rehabilitate prisoners, they were often frustrated by a lack of resource and difficulties in recruiting guards and other personnel. In large part, these failures reflected the fact that the British never came to a firm conclusion on the rationale for incarceration. Rather, jails always served a variety of purposes, and these were often incompatible with each other. For example, though the British wanted to use jails for different types of offenders, the pressure of numbers meant that prisoners were often transferred to inappropriate locations, and this put a strain on prisoner training, education and work. Also, guards often left employment, or retired early, due to stress and overwork. There even erupted various scandals where it emerged that guards had violently beaten and mistreated prisoners. This led to the establishment of a Board of Prisons in 1862, and the appointment of an Inspector General of Prisons from 1879. These measures increased government regulation over prisons, and enabled some positive interventions such as the introduction of tickets-of-leave (or what we would now call probation), which helped to rehabilitate and resettle inmates.

Several other themes emerged during our research project, notably regarding the mental health of inmates and guards. For example, we found archives that suggested that historically there was excessive consumption of alcohol (by inmates and guards), and that inmates routinely smoked marijuana. We also discovered that some prisoners hallucinated or had delusions, became suicidal, or were transferred to the ‘lunatic asylum’ in New Amsterdam. This led the research team to develop a more focused project, with the goal of exploring issues around the prevalence of mental, neurological, and substance abuse (MNS) disorders in Guyana’s jails. A collaboration between the universities of Leicester and Guyana, in partnership with the Guyana Prison Service and HMP Leicester, this project is both historical and contemporary. Funded by the Economic and Social Research Council, it will run until the autumn of 2021.

Social scientists know that attention to the relationship between lives and environments, and the production of an evidence base, are vital for successful research impact in a field now known as ‘global mental health’. As well as understanding individual health, we need to be sensitive to history, society and culture. Recently, researchers have argued that western concepts and models of MNS disorders require refinement, so that they do not produce misconceived diagnosis or become neo-colonial in their application of knowledge on a problem defined in the West. Our earlier historical research, against the background of this concern, forms the background to our new project.

The project team, University of Guyana, April 2019 – from left, Di Levine, Queenela Cameron, Deborah Toner, Clare Anderson, Dylan Kerrigan, Martin Halliwell, Estherine Adams, Shammane Joseph Jackson, Kellie Moss, Kristy Warren. Photograph: Mellissa Ifill.

The historians on the team, now including also Shammane Joseph Jackson and Dr Deborah Toner, are returning to the archives. Our team of anthropologists, criminologists, political scientists, and sociologists – Dr Tammy Ayres, Queenela Cameron, Professor Martin Halliwell, Dr Dylan Kerrigan, Di Levine and Dr Kristy Warren – are currently examining modern records and undertaking interviews, and will be running focus group workshops, with prisoners, prison officers, and prisoners’ families. Some of the things we want to find out about are how different communities – and men, women and youths – define/ defined and experience/ experienced MNS disorders; what constitutes/ constituted MNS disorders management and welfare provision; and how Empire and Independence impacted on prevalence, representations and experiences.

We want to see if it is possible to connect present-day challenges associated with MNS disorders to the history and legacies of the British Empire in Guyana. Our hypothesis is that the existence of MNS disorders in jails today can be traced back to the British colonial period. Thus, they cannot be disconnected from the country’s history as a sugar colony that employed and controlled indigenous people (Amerindians), enslaved Africans, and indentured labourers. We hypothesize that Empire created particular forms of trauma, shaped demography and religious practice, and instituted patterns of population control including through the building of jails. We seek to render this history actively part of the process of change today, by connecting new historical work to new research in and around prisons in Guyana today.

Clare Anderson is Principal Investigator of the ESRC GCRF project Mental Health, Neurological and Substance Abuse Disorders in Guyana’s Jails, 1825 to the present day.