In this delightfully original work, Christina Ramos examines the history of the Hospital de San Hipólito, Mexico City, a lunatic asylum founded by a penitent conquistador in 1567. The date here is worth noting; this is two hundred years before the founding of St. Luke’s in London and constitutes, by any measure, the first European institution for the “mad” in the Americas. By highlighting this chronology, Ramos illustrates how San Hipólito drew on the remarkable legacy of mental hospitals established on the Iberian peninsula, often dated to the foundation of the Hospital de los Inocentes, in Valencia, around 1410. These institutions for the mad, historians have hypothesized, were the successors of the Muslim (Moorish) maristans that were founded before the Catholic reconquest.

By examining the Hispanic tradition of lunatic asylums, Ramos challenges what she cleverly refers to as the “origin story” of Western psychiatry, one that has, for too long, prioritized French, German, and Anglo-American institutions. Historians of psychiatry in Europe and North America inevitably anchor their narratives of the rise of modern psychiatry in the biographies of Pinel, Conolly, and Griesinger, ignoring, or only mentioning in passing, their Mediterranean counterparts or antecedents. Even “revisionist” historians who looked critically at the rise of psychiatry have remained firmly within these Anglo-Saxon and French traditions, as exemplified in the work of Michel Foucault, Klaus Doerner, and Andrew Scull. Ramos refers to this historiographical myopia as the “erasure” of the influence of the Hispanic Enlightenment. And yet Spain, through its often-caricatured Inquisition, was forced to confront madness, if only to determine whether heretical utterings and behaviours were rationally intended, or not.

With Spanish imperial exploration and expansion into the Americas in the 1500s, the early colonists of New Spain established a diverse range of hospitals in the century after the fall of Tenochtitlan. As Ramos explains, the colonial functionaries aimed to recreate the tradition of Iberian public welfare, or caridad publica, through diverse institutions most often run by religious orders. Over the course of the seventeenth century, San Hipólito evolved from a general welfare institution for the indigent to an asylum catering exclusively to madmen (an institution for women – the Hospital del Divino Salvador – sadly no longer has extant historical records). Ramos concludes that doctors had only a modest part to play in the process of determining sanity (and thus heresy) during the early modern period. Rather it was religious figures – both in the form of members of charitable religious orders and functionaries of the formal Inquisition -- that sought to understand the “interiority” of the mad. Ramos builds explicitly on the work of the early colonial historian, María Cristina Sacristán, who argued that the Inquisition cases involving madness demonstrated the “surprising leniency” of the Holy Office towards those troubled in mind.

Bedlam in the New World can be divided into two principal parts – the first being a repositioning (discussed above) of the role of the Spanish Enlightenment in the rise of specialist treatment of the mad during the colonial period; the second consists of a micro-history of San Hipolito itself, in which the author examines a much narrower period at the close of the eighteenth century. By the 1770s, the older buildings of the original welfare institution had fallen into disrepair, prompting the construction of a new “modern” hospital, whose patient and institutional records remain available. In these latter chapters, the author charts how the religious order – the hipolitos – continued to exhibit considerable medical knowledge and authority. Nevertheless, in the final decades leading up to the start of the Mexican War of Independence in 1810, there was indeed a growing privileging of formal medical testimony about madness which (in a third of the cases) resulted in hospitalization. By this time, the experience of the lunatic asylum in New Spain was converging with similar trends in Western Europe and Britain.

Overall, this is a splendid monograph, one that opens up the eyes of non-Hispanophones to the rich and complicated world of Spanish colonialism and its religiously-run charitable institutions. It will be of particular interest to medical historians of the French-speaking world, where the central role of the Spanish hipolitos could be fruitfully compared with Catholic orders working in lunatic asylums and other quasi-medical institutions. To this reviewer, the book’s strength lies in its aforementioned geographical reorientation of the historiography of madness and asylums, making it required reading for advanced scholars in this field.