Though histories of madness often point to the European experience, Christina Ramos turns our attention to San Hipólito in Mexico City, the earliest hospital in the New World dedicated to the institutional management of the mentally disturbed. Bedlam in the New World: A Mexican Madhouse in the Age of Enlightenment reconstructs the legacy of this convalescent hospital that focused exclusively on the mad during a time of imperial realignment and intellectual change. It was at this juncture that Enlightenment ideals “fueled renewed attention to states of unreason” (8) and placed the religious at the forefront of the medicalization of madness. This development, Ramos argues, rendered San Hipólito both “a microcosm and a colonial laboratory of the Hispanic Enlightenment” (8).
The book presents a dynamic sketch of San Hipólito’s trajectory. Chapter 1 traces the hospital’s charitable 16th-century origins and, while covering much ground, charts its challenging evolution up to the 18th century. Though chapter 2 depicts a reformed San Hipólito within the new Bourbon order, the following two sections form the core of the book. Here, Ramos pivots to a host of actors and interactions that advanced the medicalization of madness. Chapter 5 follows San Hipólito’s increased penal character that came by way of sweeping Bourbon efforts designed to combat crime in the city. Finally, the book concludes with San Hipólito’s 20th-century closing and the simultaneous inauguration of its modern replacement, La Castañeda.
Ramos successfully deconstructs the process of discerning madness from heresy. Several cases highlight the “inquisitor’s quandary”—the task of uncovering whether “heretical assertions stemmed from a defective brain or a deceitful and spiritual sullied conscience” (91). Ramos introduces the notion of the quandary through the trial of Felipe Antonio Alvarez, a deviant Franciscan friar who made a series of heretical statements. After mocking the Pope and questioning Christian doctrine, among other offenses, Alvarez refused to recant and thereby gave inquisitors cause to question his sanity. The case lingered before inquisitors and the acting physician reached a “different but complementary” diagnosis of the heretical friar’s “partial” insanity (92). Through such cases, readers gain insight into the uncertainty and confusion associated with the authentication of alleged madness. Diagnosing a patient’s mental faculties traversed both moral and medical grounds and consequently presented authorities with varying degrees of mental illness, as shown in the lengthy case of the melancholic Antonio de la Cruz (127–131). By tracing methods of discernment, Ramos captures the complementary, albeit complicated, association between theology and medicine.
While the medicalization of madness was a collective effort, Ramos demonstrates how the religious, not physicians or intellectuals, stood at the forefront of this process. San Hipólito’s patient intake increased after 1700, a pattern that coincided with the consolidation of the medical profession and emergent scientific models. As agents of medicalization, inquisitors balanced their religious mandates with increased efforts to understand the mental states of the accused. The book does not downplay the contributions of physicians. Yet, given the principal role inquisitors played in the medicalization of madness, physicians ultimately “equipped inquisitors with a more refined set of tools for gauging interiority, such as empiricism and a rational theoretical framework for understanding mental disorder” (116). To that end, the book illustrates how medical experts lent legitimacy to inquisitorial judgements that called for the medical custody of the mad. Likewise, by showing that the Inquisition did not merely confine out of convenience, Ramos offsets assumptions about the institution’s perceived anti-Enlightenment approach.
Bedlam in the New World is a welcome addition to the literature on colonial medicine in Spanish America. It builds on the work of María Cristina Sacristán while uncovering the institutional transformation of a unique site. From a broad perspective, the book engages with its imperial context by “using the ‘micro’ to rethink the ‘meta’” (17). Its micro-history framework does not overlook the larger temporal backdrop; however, those expecting a history on the Habsburg-Bourbon shift may want to look elsewhere. In all, the book is concise, clearly written, and well researched. Students of madness and institutional history will want to read this work for its balanced treatment of religion and medicine and its fresh interpretation of early psychiatry in the New World.
Alejandro Renteria is a PhD candidate in the Department of History at the University of California, Davis
Alejandro Renteria
Date Of Review:
February 10, 2023
