The Mathari National Teaching and Referral Hospital was established in 1910 and, over a century later, it remains Kenya’s only national mental referral hospital. Tracing back the history of the hospital reveals a dark and disturbing tale, one filled with societal stigma and the systemic marginalisation of some of our country’s most vulnerable citizens.
Why the need for a psychiatric hospital?
Before British colonisers arrived in Kenya in the early 19th century, indigenous communities used traditional medicines and systems of knowledge to treat those that lived with various mental health conditions and neurological disorders, such as epilepsy. The Abagusii community were also experts in performing neurosurgical procedures such as craniotomies. However, with the enforcement of colonial laws and policies, traditional medical systems were gradually stigmatised and outlawed, and the indigenous population became dependent on Western forms of medicine.
Colonisation had not only reshaped the medical landscape of Eastern Africa, the country was also subject to colonial rules and an economic system that oppressed its indigenous population. This, and other factors, such as the coercive enlistment of African corps in the First World War, led to issues of depression and anxiety, for the enlisted warriors, as well as their loved ones back home.
It was in this climate that a psychiatric hospital was established. Before its existence, most citizens with mental health disorders were housed within prisons. The building was redesigned from a smallpox isolation centre that had been in use during the late 19th century and it was called the Nairobi Lunatic Asylum. This name was changed to Mathari Mental Hospital in 1924 and later shortened to Mathari Hospital from 1964 onwards.
The Structure of Mathari Hospital
Despite being a separate institution, Mathari continued to be supervised by the operating prison medical officer for the next two decades. The present-day hospital has three distinct divisions: the civil wing, which is used for general psychiatry, the rehabilitation centre which houses those who struggle with addiction, and the maximum-security ward which holds mentally ill criminals.
As was the case with many medical institutions in Kenya at the time, the best facilities were reserved for the few Europeans. Kenyan Indians were then prioritised over Black Kenyans, who were the majority, yet were confined to the worst facilities and given the worst care.
The majority of the European colonisers who developed mental health disorders were normally taken to South Africa for treatment as the settler population did not want to share treatment facilities with Africans and Asians. However, during the First World War, their demand for psychiatric treatment within the country also increased. The main ailment amongst European settlers was alcoholism and their admission numbers to Mathari had spiked to 68 by 1948, from the initial two patients at the advent of the treatment facility.
Psychiatric Racism
The deplorable conditions for Africans at Mathari Hospital were caused by the European staff who were supervising the centre – many of whom were unqualified for their roles and exercised racial prejudice in the treatment of their African patients. These staff members subjected the Africans under their care to Western forms of treatment and therapy, without any consideration for their local culture and context, thereby making the treatment ineffective.
One such individual was Dr. James Cobb who was appointed senior medical officer in 1937. Like his patients, Cobb suffered from severe mental health issues including alcoholism and was known to disrespectfully exhibit his patients to guests of his. He also kept lions at the facility and was suspected of abusing the animals. For a time, Cobb was protected due to his connections with the British crown, but he was forced to retire in August 1938.
Another of the psychiatrists at the institution was Dr. John Colin Carothers, a South African coloniser who settled in Kenya in 1938 and was soon after appointed as Cobb’s replacement. Dr. Carothers wrote several papers on mental health in Africa and exhibited psychiatric racism in most of them. His academia revealed his prejudiced views towards Africans, as he referred to the Mau Mau as ‘psychopathic criminals’ due to their quest for independence and his work deemed the African mind inferior to the European mind.
In line with these sentiments, Mathari Hospital was used to lock up several Kenyan activists, in a bid to curb their anti-colonial efforts, one of them being the radical Elijah Masinde. This racial prejudice is reflected in the hospital’s medical records from that time which extensively detail the lives of European patients, but share almost nothing about the African patients.
Despite being built upon institutional racism propagated by colonial officials, there were African nurses who did their part to care for the mentally distressed patients at the centre. Post-independence, Africans also joined the ranks of psychiatrists at Mathari, and the hospital was established as the main teaching psychiatric hospital for the University of Nairobi’s Department of Psychiatry.
As the years go by, society is becoming more accepting and understanding of mental health issues. Several activist groups also continue to agitate for the proper care of mentally ill patients, thus treatment facilities such as Mathari Hospital have a strong capacity for improvement.