One of the first English-language historical analyses of African psychiatry, this book discusses mental and social disorder in the west African country of Sierra Leone from the late 18th century to the present. Much of the study compares trends in mental health care in the colonial era with treatment in the period since 1961, when Sierra Leone gained independence. Putting the historical evidence in a social context, Bell's analysis shows that the increasing number of institutionalized mental patients results from social problems rather than mental illness.

Using unique primary sources, including the case records of patients at Kissy Lunatic Asylum and archival records, Bell traces the history of that African mental institution. The narrative shows major social, economic, administrative and international factors affected the hospital and details the changing characteristics of the patients. Initially, Colonial authorities needed a place to house persons disturbing the public, and the hospital received patients with psychiatric illnesses from Sierra Leone and other British West African territories. After World War II, more of the patients were socially disordered, a transformation that reflected a basic demographic change. As the country became more urban, Kissy became a place for those suffering from such social maladies as drug addiction, alcoholism, social alienation, and homelessness. The work also considers beliefs about mental illness in an African society and changing attitudes toward psychiatry and stresses the importance of traditional healers. The book will be of interest to scholars specializing in the history of psychiatry and medicine and in African Studies.