Beng Yeong Ng. Till The Break of Day: A History of Mental Health Services in Singapore, 1841-1993. Second Edition. Singapore: National University of Singapore Press, 2017. 340 pp. $34.00 (paper), ISBN 978-981-4722-40-7.
Reviewed by Shu Wan (University of Iowa)
Published on H-Disability (May, 2018)
Commissioned by Iain C. Hutchison (University of Glasgow)
In recent decades, the interaction between colonialism and mental health has been subjected to increasing historical investigation. Scholarship discloses how colonial authorities pathologized indigenous peoples, stigmatized their vulnerability to mental illness, and institutionalized political dissenters in insane asylums in South Asia and Africa. Nonetheless some former colonial settings have not been scrutinized. The transition of Singapore’s medical health services during colonial occupation, and through decolonization and postcolonialism, is the focus of psychologist Ng Beng Yeong’s new edition of Till the Break of Day: A History of Mental Health Services in Singapore, 1841-1993, originally published in 2001.
This volume emphasizes the evolution of mental health services rather than mental illness or impairment. The book’s encyclopedic scope ranges from the professionalization of mental treatment to the prevalence of physical illness among patients. The study is divided into three parts: the period of British colonization, its temporary interruption by Japanese occupation during World War Two, and the postcolonial period. Although Ng seeks to highlight the consistent stigmatization of mental patients across the three periods, his multi-chapter documentation of the development of psychiatric therapy does not support this argument for continuity.
A clinician, rather than a historian, Ng fails to fulfill his promise of contextualizing mental health-related events. In his otherwise excellent discussion on the political implications of terminological change from “asylum” to “hospital,” Ng neglects the impact of historical contexts, such as postcolonialism and the Cold War, on mental health. Although he sporadically discusses examples in different sections of his book, hinting at the intervention of orientalism and colonialism in shaping the mental health system in the colonial period, he does not make a coherent analysis. For example, in various chapters Ng mentions the ethnic Chinese who constantly make up a high proportion of the insane population. Moreover, some psychiatrists’ testimonies clearly attributed the Chinese vulnerability to mental illness to their ethnic identity. Evidence from both clinicians and patients demonstrates that the stigmatization of mental patients was endowed with orientalist misconceptions of the Chinese race, which is highlighted by historian Catharine Coleborne’s study of mental health in a similar colonialist context in Australia, Insanity, Identity and Empire: Immigrants and Institutional Confinement in Australia and New Zealand, 1873-1910 (2015). However, Ng fails to place Chinese patients within a wider context; he provides no discussion aimed at other ethnic groups in Singapore, such as Malays, Tamils, or Europeans, nor does he reveal the ethnic composition of psychiatrists and other medical carers.
In the second half of the volume, Ng seeks to appraise the postcolonial improvement of mental health services in Singapore from the 1960s, exemplified in the professionalization of nursing and medical education; proliferation of child, adult, and forensic psychiatry; and emergence of multidisciplinary collaboration in mental treatment. Ng features these developments as representing the new dawn of the psychiatric profession in Singapore. Nonetheless, the inheritance of discriminatory legal articles from British common-law culture, intense medical education exchange programs with the British psychiatric profession, and Ng’s emphasis on British physicians’ contributions accumulatively reflect the significant continuity of British colonial legacies for the development of postcolonial Singaporean psychiatry. It is a pity that Ng seems to ignore the colonial features of those developments, simply attributing them to Singaporean clinical diligence and innovation. This presents a considerable weakness to Ng’s conclusion, which points to the positive development of mental health services in the postcolonial period.
Another weakness is the author’s omission of mental patients’ and their families’ voices. Mainly basing his study on medical reports and official archives, Ng presents a government-oriented story of mental health. Preoccupied with the evolution of terminology, treatment innovation, and transition from institutionalization to rehabilitation, Ng presents a Whig interpretation of the history of mental health in Singapore, characterized by ceaseless technological progress from the colonial to postcolonial periods. However, voices advocating for greater understanding of mental disability, and patients and their families who might have been counter-forces to clinical interpretations of “progress,” are silent in Ng’s vision. Indeed, the medical historian Kah Seng Loh’s recent scholarship on mental disability in Singapore has highlighted the consistent tension between patients and the psychiatric profession.[1]
Note
[1]. See Kah Seng Loh, “Mental Illness in Singapore: A History of a Colony, Port City, and Coolie Town,” East Asian Science, Technology and Society 10, no. 2 (2016): 121-140; and Kah Seng Loh, Ee Heok Kua, and Rathi Mahendran, “Mental Health and Psychiatry in Singapore: From Asylum to Community Care,” in Mental Health in Asia and the Pacific: Historical and Cultural Perspectives, ed. Harry Minas and Milton Lewis (New York: Springer, 2017), 183-203.
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Citation:
Shu Wan. Review of Ng, Beng Yeong, Till The Break of Day: A History of Mental Health Services in Singapore, 1841-1993.
H-Disability, H-Net Reviews.
May, 2018.
URL: http://www.h-net.org/reviews/showrev.php?id=52178
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