1

“Surrounded with mystery and enshrouded in a thick fog is the amazing revelation of an unusual incident alleged to have occurred in the Colonial Asylum, Accra. A female lunatic patient of the Asylum, it is alleged, has contracted an intimacy with someone and her condition which gives cause for alarm had revealed something startling which has kept the Alienist Officer on his heels. Examined Pregnant. Medical experts, according to the story, have disclosed, after a detailed medical examination, that she is pregnant but as to who was the cause of her condition is still a question mark [1].”

2Adjoa Denta [2] was sent to the Accra Asylum as a convicted criminal lunatic on 14 January 1936 [3]. As far as Dr. MacLagan, the British Alienist and medical officer in charge of the asylum, was aware, Denta had not left the Female Ward since 1937 [4], and yet on 9 January 1939, after three years of confinement, after she had complained of abdominal discomfort in previous months, it was determined that she was pregnant [5]. The Alienist wrote to the patient’s husband, Nsutahene [6] Nana O.Y. Akoto, to ask him to send someone to collect the baby, but unfortunately, it died of malnutrition before the Nsutahene responded [7]. The colonial police were also called in to investigate Denta’s pregnancy [8]. By this stage, Denta had accused four different Accra Asylum employees of fathering her child [9], but with the baby dead, and in view of Denta’s conflicting accusations, the police concluded their perfunctory one-day investigation without filing charges [10]. Despite the brevity of the police’s enquiries, Denta’s case stirred a good deal of public debate in the newspapers. Responding to the newspaper article quoted above, a former Asylum nurse sent an anonymous whistleblowing letter to the Colonial Secretary of the Gold Coast [11] describing a scandalous conspiracy among the nurses and attendants at the Accra Asylum to cover up the truth about the pregnancy.

3The Alienist and the Superintendent of Police dismissed the whistleblower’s claims as being motivated by hostility towards the Head Attendant, who was one of the men Denta had accused of fathering her child. With the rejection of these claims, Denta’s case lost all legal traction and became one of the many forgotten scandals that litter the psychiatric archives of colonial Africa. This paper returns to the letter written by the anonymous whistleblower to look at the unusually rich reflections it offers on life, work, and patient-nurse relationships inside a colonial mental asylum. My goal is not to assess the truthfulness of the conspiracy exposed by the letter, which would in all likelihood be an impossible task; rather, I analyze the letter – one of the few handwritten pieces of expository writing by an asylum nurse in the Gold Coast – as a window into the largely underexplored experiences of psychiatric nurses and attendants in colonial Africa.

4With few exceptions, the history of colonial psychiatry in Africa has focused on top-down perspectives of state policy and medical discourses [12]. The African attendants, nurses, and warders who worked most closely with patients are often relegated to peripheral roles in historical narratives. This trend has been shaped in part by an over-representation of European colonial doctors and politicians in the archival records of colonial medical institutions in Africa [13]; however, this relegation of nurses to the conceptual sidelines is not just a function of limited archival resources: it also has interpretive roots. Historians of psychiatry in Africa have long subsumed the operations of confinement to asylums and interactions between nurses and patients in African colonial asylums into the category of “custodial care [14]”. The earliest scholarship on the topic even suggested that in order to understand the relationship between nurses and patients in African colonial asylums, one only needs to look at custodial care relationships in contemporaneous British asylums [15], thus assuming that a static structural relationship was at play, one in which interactions between nurses and patients were the same everywhere, the only difference being the relative degrees of material austerity. By concentrating on the work of European medical officers and simultaneously reading the work of African nurses through the prism of custodial care, the early scholarship on African colonial asylums effectively obscured the ways that African nursing staff adapted their institutional hierarchies to meet their personal and professional needs.

5In contrast, Shula Marks’ brief historical survey of the experiences of nurses in Southern African colonial asylums – the only one of its kind – goes beyond the abstracted image of absentee doctors and government policy [16] and reveals how nurses working on the ground breached the custodian-ward boundary in ways that, perhaps unsurprisingly, shaped the experience of asylum patients. Marks’ analysis does not represent a complete departure from the established conceptions of African colonial psychiatry, however, as she retains the historiographic tendency to view the African asylum as a space where patient abuse was built upon practices and discourses that flattened their identities. Her express aim is to discover how nurses contributed towards “stripping the inmates of their identity”, be it one of class, race, or gender. This is an understandable goal, of course [17], because it is an undeniable fact that colonial asylums were spaces of cruelty in which patients were often dehumanized. It is not clear, however, that patient mistreatment was necessarily a function of practices that subsumed the individual subject-position of patients into the broad categories of “patient” or African “Other”. Recent scholarship in feminist philosophy [18] and sociology [19] has questioned the need to associate discourses and dehumanization practices with political and medical experiences of injustice. These scholars caution against the humanist fallacy, which is the false belief that since oppression or abuse necessarily entail dehumanization, recognition of the humanity of the oppressed will end injustice. This belief ignores historical moments in which oppressive acts were built upon affirmations of the humanity of the oppressed.

6This article builds on Marks’ scholarship on psychiatric nursing in colonial Africa by taking it in a new direction, towards a reconsideration of the role African nurses played in the dehumanization of mental patients in colonial Africa. It argues that dehumanization discourses, which demarcate who is excluded from one’s circle of moral concern [20], may have facilitated the abuse of some patients by some nurses, but were not necessarily underlying conditions of violence. Although nurses did flatten the identity of patients in many circumstances, medical contraventions in colonial Africa were often born out of intimate relations that recognized the legal and sexual personhood of confined psychiatric patients [21]. This article takes one such violation as its point of departure – the case of Adjoa Denta, the female lunatic who became pregnant or “contracted an intimacy” inside the Accra Asylum. It centers particularly on the anonymous letter that claimed to reveal a conspiracy to cover up the truth behind Adjoa Denta’s pregnancy – a rare example of a document providing insight into the concerns of a psychiatric nurse in colonial Ghana. One reason there is little work on patient-nurse relationships in African asylums is that there are so few archival sources that give us direct access to the voices and concerns of nurses. It is even rarer to find a document of this genre within a larger file containing all the correspondence between the medical authorities and the police generated by the letter [22].

7Taking its methodological cues from micro-historical approaches in African history – which rely on capacious readings of scanty data, minor events and settings, and little-known individuals to unravel the mysteries of larger but underexplored social worlds – the article triangulates Adjoa Denta’s case within a wider repertoire of “contracted intimacies [23]”. I have borrowed this term from the colonial library of the Accra Asylum [24] so that I can transform it from its journalistic function as a euphemistic description of a single pregnancy into an analytical concept that demarcates a broader field of action consisting of clandestine, conspiratorial, or negotiated arrangements and intimate violations among nurses and between nurses and patients. Traces of these “contracted intimacies” appear in the few archival materials that document the daily operations of psychiatric nursing in the Gold Coast. They include several of the remaining fragments of the Accra Asylum’s lost nurse personnel files – which contain statements made by nurses in their letters applying for promotions – and the testimonies of psychiatric nurses as dictated in police reports on criminal investigations into asylum abuse [25]. I triangulate the former nurse’s anonymous letter with these other files, which constitute the only known available materials that contain both the reported speech and written testimony of psychiatric nurses in Ghana’s National Archive and the archives of the Accra Asylum. Together, these documents offer insights into concerns about gendered hierarchies within the hospital and dependencies of nurses on patients, and rapidly disaggregate any static or ahistorical notion of nurse-patient relationships as simply “custodial care”. At the same time, these archival documents reveal several ways in which the social status of patients outside hospital shaped their relationship with nurses inside colonial asylums.

8I place Adjoa Denta’s pregnancy alongside two other “contracted intimacies” between nurses and patients. First, there are the multiple accusations of abuse of power and scapegoating of subordinates made by junior nurses against Mr. Adams, the Accra Asylum’s Head Attendant and most senior African nursing staff member in the 1930s. Adams was one of the four men Adjoa Denta accused of fathering her child. Second, the article considers another realm in which the “custodial” relationship broke down in the archival records: the advent of clandestine debt relationships. Here, I read Mr. Adams’s alleged attempts to conceal his involvement in the pregnancy case by bribing Adjoa Denta through the lens of historical concerns surrounding debt restitution for adultery (ayefaadee) in Akan-speaking contexts in what later became colonial Ghana. I also examine a related, but more common, occurrence: in the Accra colonial Asylum, indebted nurses often borrowed money from patients, who therefore became their creditors.

9Historians of psychiatry in Africa have highlighted the role nurses played in stripping asylum patients of their identities; however, the issue of nurses entering into patron-client relationships with patients, which contemporary readers would rightfully view as abusive, did not merely reproduce European hierarchies of custodial care in colonial asylums in Africa. By borrowing money from patients, African nurses rejected the European legal concept of lunatics as being incapable of financial and legal personhood, both of which were qualities attributed to a creditor. Indebted nurses implicitly affirmed the patient-turned-creditors’ socio-economic or class status beyond the walls of the asylum. As creditors, patients could theoretically foreclose on debts and, under the laws of colonial Ghana, have the nurses imprisoned. Similarly, if he had been found to be responsible for Adjoa Denta’s pregnancy, Mr. Adams would have owed “adultery fees” to Denta’s husband, the chief of Nsuta. As the wife of a chief, the fees for Denta would have been hefty, and if he had been unable to pay, Mr. Adams would have been sent to a debtor’s prison. These secret financial undertakings – borrowing money from patients and bribing them with goods to avoid criminal and debt-related terms of imprisonment – both risked a reversal of the polarity in the asylum’s hierarchy whereby nurses became structurally reliant on patients. Broadly speaking, the existence of situations in which a nurse allegedly impregnated a patient and nurses interacted with patients as their creditors suggests that patients’ multifaceted identities were not simply flattened under a custodial care regime. In these cases, the patients were also objects of sexual desire and agents of financial transactions. As this article argues, contracted intimacies blurred the lines between custodians and patients, between the ordinary and madness.

From “warders” to “nurses”: asylum nursing in the colonial Gold Coast

10Before turning to the case of Adjoa Denta, this section briefly introduces the reader to the history of psychiatric nursing in colonial Ghana and the complex hierarchies of labor and social interaction that were produced within, and just outside, the walls of colonial asylums in Africa.

11It is somewhat ironic that the history of mental health nursing should have been largely overlooked by historians of Africa if one considers that generations of Africans served in asylum care before they were even allowed to work as nurses in medical hospitals in colonial Africa. The first British colonial hospital was established in Accra in 1882, eight years after the official establishment of the Gold Coast Colony [26]. At the time, people of African descent were excluded from the newly established Gold Coast Medical Service [27]. Nurses and doctors were imported from the United Kingdom, which was one reflection of hardening racism in British Africa that also manifested itself in the segregationist policies implemented by European medical bodies in Africa in the late 1800s [28]. In practice, however, British slavers had relied heavily on so-called “castle slaves”, some of whom served as “doctor servants”, to ensure the health of European traders and Africans engaged in the transatlantic slave trade as early as the 18^th century [29]. Similarly, Swiss and German missionaries evangelizing in the Gold Coast in the 19^th century were known to frequent African healers [30]. It was only with the rise of the germ theory of disease, which coincided with the British colonial service excluding African workers from their medical corps, that missionaries came to disparage the use of African healers [31].

12While people of African descent were largely excluded from working as doctors and nurses at the colonial hospital, the colonial Lunatic Asylum in Accra was staffed almost exclusively by Africans from the outset [32]. Established in 1887 to relieve colonial prisons of the burden of holding so-called “lunatics”, the Accra Asylum straddled penal confinement and medical care. Between 1887 and 1930, there were no “nurses” in the true sense of the word working at the Accra Asylum. Rather, much like in colonial prisons, the asylum was staffed by mostly male African “warders” and “attendants [33]”. Warders worked under the supervision of the Head Male and Female Attendants, who worked directly for the Medical Officer in charge of the asylum. Treatment at the Asylum initially focused on moral therapy, whereby male patients farmed the shared land between the colonial hospital and the asylum and female patients cleaned the linen for both institutions [34]. The most violent patients were put in chains or locked in cells [35]. Escape was common, as there was no fence around the institution for decades [36]. The earliest recorded escapes from the Asylum date from the 1890s and coincide with the first dismissals of warders and attendants for patient abuse – an unsurprising correlation [37]. Warders and attendants also had the primary duty of hunting down escaped patients for reconfinement, with the aid of the police [38].

13Medical services expanded rapidly in the Gold Coast in the early 1900s, due in part to the colonial government’s attempts to eradicate epidemics through sanitary controls [39]. Psychiatry, which did not fit neatly into these concerns regarding epidemic diseases, remained neglected. Overcrowding and death are the topics that dominate the archival records of the experience of psychiatric confinement in the Gold Coast [40]. Most importantly, there was no mental health specialist working in the Accra Asylum until the arrival of Dr. MacLagan, an Alienist, in 1929. MacLagan accepted this position in the colonial service because he was promised full support in reshaping asylum care in the Gold Coast. In 1930, the Governor of the Gold Coast asked him to submit a report of proposed changes to be made to the Asylum. Among his suggestions including relocating the hospital, expanding the kitchen, and adding new wards, MacLagan asked to change the title of Accra Asylum staff “warders” to “nurses”. He argued:

14

“As [the] mentally sick are not to be looked upon with horror and repulsion but as individuals afflicted with a sickness allied to physical sickness, I propose that they should no longer be treated in an ‘Asylum’ but in a ‘Mental Hospital’ and cared for by ‘Male and Female Nurses’ in place of ‘Warders’ and ‘Attendants’ [41].”

15MacLagan’s request reflected shifts in nomenclature within the United Kingdom, where psychiatric care was becoming increasingly professionalized and medicalized, and was moving away from its associations with penal confinement [42]. At the time of MacLagan’s arrival in Ghana, the Medical Service had been training African nurses to work in colonial hospitals for nearly a decade [43], and although many of MacLagan’s requests were ignored, the Accra Asylum’s African “warders” almost immediately became “nurses”, at least in name [44]. There was, however, some resistance to MacLagan’s request for nurses instead of warders. A note appended to his letter to the Governor expresses skepticism about his final request, arguing that lunatics did not care where they were treated or by whom. By 1936, the year Adjoa Denta entered the Accra Asylum as a so-called “criminal lunatic”, the nursing profession in Gold Coast was in flux, and nursing (in hospitals and asylums) was increasingly gendered as a female occupation. But psychiatric nurses remained marginalized compared to medical nurses [45].

16For much of the colonial period, psychiatric nurses in colonial Accra worked under conditions of material austerity and far greater social stigma. This goes a long way towards explaining how, and through what discursive registers, former Asylum nurses engaged in the controversy of the “contracted intimacy” of a female patient in 1937, on the one hand, and why they engaged in monetary exchanges and debt relationships with confined patients, on the other.

“Female lunatic in certain condition: but who is responsible?”

17On 16 January 1939, four days after the police had completed their perfunctory investigation into Adjoa Denta’s pregnancy, which produced no suspects, a twelve-year veteran of the Accra Asylum’s nursing staff read an article in the Spectator Daily newspaper entitled “Female Lunatic in Certain Condition: But Who is Responsible?” [46]. The article had a profound effect on the former nurse, who felt compelled to write an anonymous four-page letter to the Colonial Secretary. Handwritten in blue ink, this long, detailed letter began by drawing the Colonial Secretary’s attention to the Spectator Daily’s article on the case. The former nurse called the female lunatic’s pregnancy during confinement an “odious crime” and an affront to the Gold Coast’s newly acquired membership of so-called “Western Civilization [47]”. Thanks to the article, the former nurse explained, word about the female lunatic’s pregnancy was spreading like “wildfire [48]”. The nurse’s outrage resonated with the confusion and shock of residents of Accra, as reported by a staff writer in the Spectator daily:

18

“[If] the male and female lunatics patients in the Asylum are housed in different blocks in one compound and attended by male and female nurses respectively. The question then arises. Who did this? Who is responsible for the Lunatic Patient’s condition? Has there been an occasion either by day or night on which there was no female nurse on duty? Is there anybody who is in the habit of visiting the Asylum’s female lunatics block and who is that person [49]?”

19At the time of Adjoa Denta’s pregnancy, the Alienist, Dr. MacLagan, was at the top of the Accra Asylum’s organizational hierarchy. Operating below him were the Head Attendant, Mr. Adams, and an Assistant Attendant. Beneath the two attendants were four Senior Mental Nurses, and below them there were several male and female Mental Nurses. The anonymous letter to the Colonial Secretary caused a scandal because it linked Adjoa Denta’s pregnancy to the highest-ranking African staff member at the Accra Asylum, Mr. Adams. The former nurse revealed a suspicion that the Mr. Adams was responsible for the pregnancy. In their words,

20

“When the said female lunatic was interviewed by the alienist officer, she mentioned the names of two mental nurses, i.e. J.A. Adams, the head attendant and E.A. Amamoo, a mental nurse, who she said strongly that they have had sexual intercourse with her. According to my so many years’ experience in the Asylum Mr. Adams the head attendant is the only African officer who is liable to visit the female block either night or day without any body to challenge him. He is the head attendant who is responsible for recommending his junior officer before he or she gets increment or promotion and so he can easily arrange with any of these female nurses and cause this awful crime. The authorities should judge this point well. The Hon. Colonial Secretary must urge upon the alienist to dig the culprits or culprit out [50].”

21The author of the letter leveraged the accusation of Mr. Adams’ responsibility for the pregnancy in order to comment on the larger institutional problems facing junior nurses at the Accra Asylum. These concerns centered on controversies over promotions and salary increases among the asylum staff. Like many senior officers at colonial psychiatric institutions in Africa, Dr. McLagan was far less involved in the daily operations of the Accra Asylum than his leading African employees [51]. Mr. Adams, the Head Attendant, was the de facto authority figure. He was responsible for collecting data on the performance of other staff members and reporting the results to the Alienist. These data were then used by the Director of Medical Services to calculate salary increases for nurses who were performing well, salary decreases for underperforming nurses, and promotions to higher positions. According to the ex-nurse’s anonymous letter, the ability to determine the success of the nurses under his command both led Mr. Adams into a life of corruption and reduced the likelihood that his subordinates would challenge these abuses of power.

22It is difficult to gauge the extent of the Head Attendant’s power over junior nurses at the Accra Asylum or his alleged corruption. The available evidence suggests that Mr. Adams had the full confidence of the Alienist, Dr. MacLagan. In the case of the pregnancy, both the Alienist and the Superintendent of Police dismissed the ex-nurse’s letter because they interpreted it as an uncorroborated attack on the Head Attendant’s character. They noted that Adjoa Denta had also accused the gatekeeper and two other staff members of fathering her child. But certain aspects of the letter, as well as the previous accusations made against Mr. Adams, suggest that the information it provided should have been given a more thorough review. Specifically, the letter writer revealed the fact that the anonymous “female lunatic in certain condition” was named “Adjoa Denta”, information that had not been made public in the newspaper article. As the Asylum authorities would later discover, Denta was a wife of the Asante Chief of Nsuta. The letter writer claimed to have learned the patient’s name and other details of the case from Nurse Amamoo, a “fervent friend” and one of the accused staff members, during a chance encounter at the local train station. Amamoo was no stranger to controversy in the asylum. He was a person of interest in a criminal investigation into patient abuse that had occurred three years previously. It appears, however, that due to a coordinated effort among the nursing staff to obscure the origins of the murder weapon, the case was ruled an accidental death [52]. The anonymous letter writer revealed that Mr. Amamoo, who was keenly aware of the power structure in the Asylum, was unwilling to cooperate with that authorities because he believed that Mr. Adams, the Head Attendant, was seeking to “make him a culprit of the case”. When the Alienist later questioned Nurse Amamoo, he denied ever having been at the train station.

23This case was not the first time that Mr. Adams’ alleged abuses of power had been linked to his power to manipulate the career outcomes of his subordinates or to place the blame on them for patient abuse. Just one year earlier, on 10 October 1938, Nurse E.K. Barnor was recommended for dismissal for “making serious accusations against the staff”, but it was not approved by the Director of Medical Services [53]. Similarly, on 20 September 1935, four years before Adjoa Denta’s pregnancy was discovered, Mr. C.Q. Solomon, a mental nurse, wrote a letter to the Director of Medical Services regarding Mr. Adams’ involvement in the death of a patient. Solomon began with an acknowledgment of his impending dismissal from the Accra Asylum, but, he argued, he had not been afforded the chance to see what statements had been made against him by his immediate supervisors so that he could defend himself properly. According to Solomon, he only became involved in order to help Nurse Smith, who had taken the patient over from Nurse Sarbah, because the patient was acting violently. With the help of two other patients, Solomon and Smith had put the violent patient into a holding cell. Solomon had dropped his hat in the room, however, and when he went back in to pick it up, a struggle ensued with the patient. Solomon claimed that he had kept the Head Attendant abreast of the situation and neither mistreated the patient nor allowed other patients to do so. He explained that he knew the consequences of mistreatment and in the past when a patient had been tied and beaten it was he and Smith who had saved the person. In his view, the Head Attendant (Mr. Adams) must have colluded with others to put the blame on him and have him dismissed. This was possible, he noted, because junior officers had no say at the asylum “of whatever opinions their seniors may have to make be they fair or foul, true or false [54]”.

24As suggested by the cases of Barnor and Solomon, deference to the authority of the Head Attendant played an important role in the career outcomes of psychiatric nurses. More importantly, these earlier cases – which were from 1935 and 1938 respectively – reveal that the Adjoa Denta case of 1939 was not an isolated event. Mr. Adams had been accused more than once of organizing a conspiracy at the Accra Asylum in order to hide his involvement in a case of patient abuse. Both Nurse Solomon and the ex-nurse who wrote the anonymous letter recognized that the mechanisms for promotion in the Asylum enabled the Head Attendant to manipulate its rigid organizational hierarchy for his benefit. Of note here are the ways in which African staff adapted the institutional hierarchies of the Asylum to meet their professional and social goals – a point that historians of psychiatry in colonial Africa have missed by placing emphasis on the work of European medical officers in discourses and practices of custodial care.

“Tobacco and all sorts of luxuries”

25Following the revelation that the Head Attendant was the only person with the means and opportunity to impregnate Adjoa Denta, the anonymous letter from the former nurse went on to highlight how nurses working in the female ward had acted as his accomplices. As the nurse wrote:

26

“I have learned that since this female lunatic patient’s condition was made known to the authorities and she mentioned the names of Messrs Adams and Amamoo, there are some three female nurses i.e. Sarah Mensah, Christiana Alfred, and Blagodgi who always presenting the alleged lunatic with tobacco and all sorts of luxuries and advising her to keep the secret and not to mention the name of Adams anymore. Mr. Adams can easily cause this crime especially when these three female nurses are on night duty. They are his closest friends and before anything could be traced out unless they have been suspended together with Messrs Adams and Amamoo [55].”

27On the one hand, the letter writer’s accusation against Mr. Adams reveals how the internal hierarchies of the hospital shaped the experience of junior nurses in the Asylum, while on the other, the subsequent discussion of his female nurse accomplices suggests how social hierarchies beyond the confines of the Accra Asylum might disrupt labor hierarchies within it. Specifically, the alleged gifting of “tobacco and all sorts of luxuries” to Adjoa Denta as bribes signals a broader history of secret debt relationships between nurses and patients that appear in other sources in the psychiatric archive, including disciplinary reports of Asylum nurses.

28The financial status of nurses in the Accra Asylum emerges in the colonial archive because nurses – like many African members of Accra’s colonial society – could be imprisoned or fined for being in debt. The Alienist punished nurses for a variety of reasons, such as being late for work, speaking to him disrespectfully, reading newspapers on duty, not knowing when patients escaped, harming patients, and allowing them to harm one another [56]. But nurses could also be punished for violations beyond the confines of the hospital, including for accumulating personal debt. This was the case with Nurse S.M.A. Yartey, who received a written warning about indebtedness from the Alienist in 1935 and on two subsequent occasions, and E.K. Barnor, who was censured in 1937 [57]. Despite their status as functionaries of the colonial state, asylum nurses were not exempt from imprisonment for debt. African nurses in the Gold Coast, who accumulated debt, were subjected to confinement in the so-called “native prisons”. For example, Nurse E.K. Barnor was “warned in writing… on 8^th March 1939 for debt. He was arrested for debt and imprisoned from 7^th March 1939 to 8^th March 1939 inclusive [58]”. Because imprisonment for debt might force asylum staff to miss work, their employers issued stern warnings for improper financial practices.

29It should be noted that the regulations covering debtor-creditor relationships in the Gold Coast in the early 20^th century emerged from earlier systems of bondage, particularly pawning and panyarring, which developed alongside the transatlantic slave trade. Panyarring, which comes from the Portuguese noun penhor – “pawn” and the verb penhorar – “to seize”, was a debt foreclosure and grievance resolution method that became increasingly widespread in the Gold Coast in the course of the 17^th century with the transition to the sale of humans. It was a form of policing, not of individuals but of communities, that involved capturing and holding one or more persons hostage until their family or kin group repaid the debt or remedied the criminal offence or violation [59]. This practice is not be confused with arbitrary kidnappings for ransom, as panyarring required the provision of criminal, civil, or economic evidence by the claimant. The implicit threat underlying panyarring was that captives might be sold into slavery if the debt for which they were captured was not repaid in full or on time. It is likely that the complex system of pawning that flourished in West Africa during the 19^th and early 20^th century was a response to the socially destructive effects of panyarring [60]. Pawning was the practice of handing one’s kin over to a creditor as security until a debt had been fully repaid. The person who was pawned would live with the creditor’s family and work for them to cover the cost of the interest on the debt, but not the principal, which had to paid to reconstitute the pawn. While panyarring facilitated the foreclosure of unsecured debts and provided a supply of humans for the transatlantic slave trade, pawning allowed people to secure their debts without the use of force. The abolition of the British slave trade in 1807 led to a rearrangement of servitude practices in the Gold Coast, which had the distinction of being one of three colonies where the African political and merchant elites operated their own prisons [61]. It is likely that these so-called “native prisons” first developed in the early 19^th century, at a time when the effectiveness of the threat of being sold into transatlantic slavery was waning as a means of enforcing the foreclosure of debts through panyarring. Imprisonment, which brought great collective shame on families, became the new threat [62]. However, native prisons continued to operate as centers of debt restitution into the 1940s with very little regulation from the colonial state [63].

30The risk of imprisonment for debt developed outside the hospital and the possibility of family shame it led to appears to have induced nurses to breach the boundaries of the custodian-ward divide by engaging in covert debtor-creditor relationships with their patients. For example, Nurse E.A. Ankrah was “severely reprimanded and warned by His Excellency the Governor in 1939 for improperly receiving a loan from a lunatic patient and his salary was reduced one year’s increment [64]”. Similarly, in 1942, Nurse J.K. Essien “was severely censured in writing” by the Director of Medical Services’ office “for borrowing and appropriating for his own use money belonging to a patient [65]”. Nurses, who were tasked with maintaining the confinement of the asylum patients, were simultaneously entering into debt relationships with them. These debt relationships risked the replacement of the asylum system of confinement, which governed patient-nurse interactions, with the debt foreclosure system of imprisonment. Simply put, patients-turned-creditors could in theory foreclose on debts and trigger the imprisonment of the nurses-turned-debtors. By entering into these covert debt relationships, nurses effectively became their patients’ clients, thereby inverting the expected pathway of dependency between these two figures.

31It is important to note first of all that not all patients were in a position to be creditors. Recognition that a patient was able to serve as a creditor was implicit acknowledgment of the patient’s socio-economic status outside the Asylum. Secondly, the mental capacity of the patient-as-creditor in the above cases is by no means clear. The British authorities did not believe that mental patients could serve in positions of authority in financial and political matters [66]. It is clear that this “borrowing” of money from patients was a predatory act on the part of the nurses. At the same time, the social act of becoming a debtor to patients-turned-creditors was an explicit rejection of the British policy of prohibiting lunatics from being creditors. It was a recognition of the individuality of a particular patient as a person who was creditworthy, usually due to their relatively high socio-economic status, regardless of the circumstances that had confined them to the Asylum.

32As with these cases of borrowing money from patients, the claim in the anonymous letter that Mr. Adams induced female nurses to bribe Adjoa Denta with “tobacco and all sorts of luxuries” in order to hide his role in her pregnancy reflects a recognition of the social status of nurses and patients beyond the walls of the Accra Asylum. First, female nurses would have been the ideal medium for delivering these gifts because they were allowed into the female ward without suspicion being cast on them, and they also held the most precarious professional positions in the institution. Most female asylum nurses were confronted with a glass ceiling during the colonial period and were never able to rise to the level of a “Senior Mental Nurse”. The favor of the Head Attendant, or the lack thereof, was therefore a significant factor in the careers of female nurses. This was the case when Sarah Mensah, one of Mr. Adams’ alleged accomplices, applied for the position of Senior Mental Nurse in 1945 following the retirement of the Head Attendant. The only female applicant for the position, Mensah was also the only person the Medical Officer in charge of the asylum explicitly warned the Director of Medical Services against hiring [67].

33Adjoa Denta’s pregnancy can also be read in the context of the longer history of debt relationships in the Gold Coast. In the 17^th and 18^th centuries, Akwamu and Akyem kings would hire various women from the surrounding villages who became wives of the king in name only. The Kings would visit these villages yearly and ask the women to “drink fetish” – to swear an oath on an object enchanted by a local deity – to prove their enduring fidelity. Reportedly, the consequence for lying was madness or death. Any man they admitted to sleeping with would be panyarred, and his kin group would have to pay for his release, or he would be sold to Europeans [68]. Like Adjoa Denta’s husband, Asante Chiefs in the 19^th and early 20^th centuries still expected payment of ayefadee (adultery fees) from any man who slept with their wives [69]. Those who could not pay them were thrown into prison as debtors until their kin could. As a result, what was at stake for Mr. Adams and all the accused staff members was not just the risk of dismissal from the colonial service but also imprisonment for the adultery debt, a fee that would be likely to have been exacerbated by the difference in class between the royal patient and the commoner nurses [70].

34We must proceed with caution, however, when comparing Adjoa Denta’s pregnancy with the extortions typical of historical “woman palaver” situations. From the evidence at hand, it is highly unlikely that Adjoa Denta was a willing participant in a scheme to extract money from the workers at the Accra Asylum. Every commentator on this case unequivocally treated her as the victim of a crime, but this belies the underlying tension that exists between contemporary and contemporaneous interpretations of Adjoa Denta’s mental capacity. Although contemporary thinkers would be likely to mobilize Adjoa Denta’s mental capacity when discussing medical and sexual consent and to query her desires, contemporaneous actors debated her mental state in order to justify their interpretation of her testimony against the various members of the Accra Asylum staff. The Alienist, who later defended Mr. Adams against the former nurse’s accusations, wrote: “I am unable to verify this woman’s statements and her mental condition is such that she cannot be believed. I interviewed the Police, however, on 10 January 1939, and have asked them to investigate [71].” As I noted above, a perfunctory police investigation concluded that due to lack of evidence “there was very little likelihood of the offender being traced [72]”. In contrast to the Alienist, the anonymous letter from the former nurse reported that “whether the alleged lunatic was suffering from dementia praecox or whether the Alienist found her a victim of paranoia intellectualis when she was admitted into the Asylum, I can say truly that she is now sane, physically strong, mentally sound, and she can easily make out the man with whom she has contracted intimacy which causes her pregnant [73]”. While the Alienist argued that Denta’s mental condition meant that her testimony had to be excluded from evidence, the former nurse declared her to be of sound mind, and able to provide proof of the validity of the accusations against the Head Attendant and his female nurse accomplices. These divergences reveal the methodological and historiographical significance of the nurse’s letter: without it we would be left with only a sanitized official version of Adjoa Denta’s story – as authorized by the Alienist and the police – affirming the sanctity of the Asylum’s custodial care regime despite the obvious violation. This suggests that turning to testimonies like those of the former nurse instead of the dominant historiographical emphasis on medical officers and government officials can illuminate underexplored perspectives for narrating the history of colonial psychiatry in Africa.

35This article has examined “contracted intimacies” in the Accra colonial Asylum during the 1930s: the clandestine, conspiratorial, or negotiated arrangements and intimate violations among nurses and between nurses and their patients in colonial Ghana. Incorporating these arrangements, which scholars have largely left unexamined, into the history of psychiatric nursing in Africa demands a reassessment of long-established methodological and historiographical premises.

36Taking the case of Adjoa Denta as a window into the world of nursing in the Gold Coast, this article has examined two contracted intimacies. First, it has looked at the multiple accusations of collusion and scapegoating made by junior nurses against Mr. Adams, the Accra Asylum’s Head Attendant in the 1930s. Historians of psychiatry in Africa have previously uncovered how European ideas of custodial care shaped the operations of asylum confinement in Africa. By placing their emphasis on the work of European medical officers and political actors, however, they have missed the ways that African nursing staff like Mr. Adams used the institutional hierarchies of the Asylum to achieve personal and professional desires. These ambitions, in turn, shaped gendered hierarchies of labor and the career trajectories of dozens of lower-ranking nurses, most of whom were women. Second, the article has considered secret financial relationships within the Asylum in which indebted nurses borrowed money from patients, who therefore became their creditors. Historians of psychiatry in Africa have highlighted the role that nurses played in stripping asylum patients of their identities, but nurses engaging in patron-client relationships with patients did not simply reproduce the Europeans’ imposed hierarchies of custodial care in African colonial asylums; by borrowing money from patients, African nurses rejected the British colonial legal conception of the lunatic as incapable of acting as a financial subject, a creditor. Indebted nurses implicitly affirmed the patient creditor’s socio-economic or class status beyond the walls of the asylum. In their capacity as creditors, patients could theoretically foreclose on debts and have the nurses imprisoned. These secret financial engagements risked reversing the supposed polarity in the asylum’s hierarchy, making nurses reliant on patients.

37A focus on contracted intimacies uncovers the power dynamics shot through the conspiratorial arrangements between nurses and patients in one African psychiatric setting: the Accra Asylum of British-controlled Gold Coast. It reveals hitherto unexplored tensions, and offers ripe avenues for future scholarship, in the demarcation of the ordinary and madness in asylums in colonial Africa