UCSF

Using twentieth century Hawaii as a case study, this study examines how place concepts were used in thinking about mental health. Psychoanalysis, the dominant model of American clinical psychiatry after World War II, neglected place in favor of a more universal theory of early childhood events. In Hawaii, however, the establishment of the public mental health system contrasted with this psychoanalytic worldview. Instead of psychoanalysts, sociologists at the University of Hawaii had an unusual amount of influence in theories about mental illness and public health measures. From the 1920s to the 1950s sociology in Hawaii was heavily oriented towards a mental health of human relationships with specific places and the immediate external environment. In addition, sociologists envisioned Hawaii as an exotic "laboratory" -- a unique menagerie of stunning geographical features and polyglot inhabitants fit for scientific apprehension. Place ideas colored conceptions of public mental health problems such as juvenile delinquency, child abandonment, and conflicts within the family. Moreover, particular relationships with place and the environment were investigated in Hawaii's ethnic sub-populations, such as native Hawaiians, and immigrant Japanese, among others.

By the 1950s, however, Hawaiian mental health experts migrated to newer theories, which weakened the importance of specific place, and challenged the notion of Hawaiian uniqueness. Modernization theory, for example, argued that societies around the world progressed on a universal continuum of organization and development. In addition, Hawaii became a staging ground for Cold War integrationism, which highlighted common ground between American and foreign cultures. Finally, Hawaii's statehood was accepted in 1959 on the premise that its multi-racial population revealed the optimal path for assimilating foreign (particularly Asian) people. These ideological shifts weakened the claim for expectionalism in Hawaiian mental health.

This work clarifies recent debate in the history of medicine about the role of medicine in colonial domination. It argues that while aspects of psychiatry were used as a local tool of statecraft, particular power considerations embedded in medicine and psychiatry favor universalist domination in the field of ideas, a form of intellectual colonialism.