Edmund McMahon

Psychiatry at the Frontier: Surveying Aboriginal Mental Health in the Era of Assimilation

'Aboriginal mental health' is a discursive formation which first emerged in the postwar heyday of Australian assimilationism, as the governmental problem of Indigenous difference was recast in normalising, psychological terms. Psychiatric interest in Aborigines grew from the 1950s onward, as a number of researchers–led by John Cawte of the University of New South Wales–conducted surveys of perceived behavioural maladjustment in Indigenous communities. This work claimed to illuminate, not just the neglected burden of Indigenous mental illness, but also the broader predicament of the Aboriginal mind at the frontier between a primitive past and a fully assimilated future. This paper critically analyses psychiatric constructions of the assimilating subject and prescriptions for Indigenous government in the name of mental health.

Australian Aborigines, ten years ago thought to be a dying people, are having a population bulge, if not an explosion ... The general picture of outback Australia shows a rising full-blooded Aboriginal population. Thus, the Aborigines are assuming a new social and medical significance, and no problem they present needs attention more urgently than the psychiatric one.¹

These words, published in the Medical Journal of Australia in 1964, sounded the first call for psychiatric engagement with the needs of Indigenous Australians. They prefaced a survey report by John Ewart Cawte on the typology and prevalence of psychiatric morbidity in a remote Aboriginal community. Cawte was a former mental hospital superintendent embarking on what would be a distinguished academic career in the newly founded School of Psychiatry at the University of New South Wales. Over the next three decades, Cawte, along with a loose group of collaborators and emulators, pioneered the use of sociopsychiatric survey techniques in ongoing research that monitored 'psychological adjustment to cultural change' in remote Indigenous communities.² His work, and that of his colleagues, provided the bulk of published data on Indigenous mental health before about 1990.³ Many workers directly trained by Cawte or inspired by his example went on to later prominence in the fields of Indigenous health and welfare. For these reasons, Cawte is commonly recognised—though perhaps only ambivalently honoured—as the founder of 'Aboriginal mental health' as a discrete field of systematic medical research and practical intervention in Australia.⁴

This paper traces the emergence of this field, analyses its ideological and institutional conditions, and evaluates critically the discourse on Aboriginal psychiatry that it produced. It questions the nature of the psychiatric 'problem' that Aborigines 'presented' in the years around Cawte's 1964 proclamation, and seeks to understand the psychiatric solutions he proposed. It investigates the origins of Cawte's sociopsychiatric project in the mental hospital, the extension of this project to remote communities, and its ultimate transformation at the hands of Indigenous health workers.

Cawte's texts are read here, not as empirical descriptions of reality, but as texts for a cultural history. Broadly, this is the history of assimilationism, a doctrine of national consensus articulating both a desire for social progress and a fear of social and cultural disintegration. More narrowly, it is the history of social experts such as Cawte, who promulgated 'human technologies' for the management of social change at the psychological level. This history is offered, not in order to arraign psychiatry for its 'collaboration' with an (officially) discredited policy, but with the aim of exploring complexities and ambivalences within assimilationist discourse.⁵ The aim is also to highlight continuities with our present, not-yet-postcolonial, predicaments in the field of Indigenous health, and in all the diverse social locations where 'mainstream' Australia struggles to come to terms with Indigenous people's needs and rights.

Hapless wanderers

Some time during the late 1950s, an eighteen-year-old 'part-Aboriginal' man was transferred, under police escort, from Darwin Hospital in the Northern Territory to a psychiatric hospital in Adelaide, South Australia, and admitted with a diagnosis of 'prison psychosis.'⁶ Serving time at Darwin's Fannie Bay Gaol for supplying liquor to 'a native ward,' he had been observed talking to himself and otherwise behaving strangely. Placed under psychiatric observation, his condition deteriorated rapidly. Given tranquillising injections, he 'had developed ideas that the staff were persecuting him' and 'repeatedly struck his head against the wall.' An attempted course of electro-convulsive therapy (ECT) further worsened the situation, necessitating additional tranquillising injections to 'quiet his noisy outbursts.'⁷ As a return to gaol seemed impossible, and given that the Northern Territory had no facilities for inpatient psychiatry, the prisoner was transferred, by the standard inter-governmental agreement, to Enfield Receiving House, South Australia's admission centre for all those with acute mental illnesses, for ongoing treatment.⁸

'Restraint in hospital,' according to subsequent case notes, 'made him very anxious.'

He claimed he had been put in hospital as an attempt to drive him insane. To the patients, he boasted that he was the man they couldn't send mad. He said that they had given him needles in Darwin to send him mad ...⁹

Clinical interviews were unrevealing, punctuated by constant denials of illness and requests for discharge. The patient's fragmentary life history was, however, more instructive. Born in outback New South Wales, he had been removed from his family at an early age and raised in rural orphanages. Although he dreamed of working outdoors with horses, he was placed as a bellboy in a Sydney hotel at the age of fifteen. He soon ran away, but was intercepted by police as he got off the train in Queensland. More congenial work on a sheep station was then arranged, from which he eventually drifted into an itinerant lifestyle as a stock worker and rodeo rider in the 'Top End.'

This 'hapless wanderer's' aggressive response to the hospital regime therefore appeared to the interviewing psychiatrist as the culmination of a life in 'progressive retreat from authority and institutions.' In confinement, the patient's 'distinctly grandiose and autistic defences' had apparently decompensated; forced to give an account of himself, he had broken down. Gradually, under heavy tranquillisation, the patient's restlessness subsided and his 'constant, rather disorganised protests' became dulled. His sentence having expired, he was discharged to freedom with little hope that his 'personal inadequacies' had been redeemed or that his wanderings would cease.¹⁰

John Cawte, the chronicler of this unhappy story, saw many such lost souls during his twelve years as Enfield's superintendent, from 1951 to 1963. A small, but apparently increasing, number of disturbed and disruptive Aborigines flowing into Enfield Receiving House from its vast catchment in the remote north and centre of Australia, posed unique challenges to the practice of psychiatry as it struggled towards postwar reforms. Even where the black patient's language and culture were not entirely exotic to the examining psychiatrist, geographical and social distance impeded a properly nuanced and psychodynamic diagnosis and made rehabilitation and aftercare all but impossible. Too often, as Cawte was to argue for many years to come, Aboriginal patients slipped through the gaps of psychiatric understanding and provision into the 'back wards' of mental institutions.

Cawte's concern for Aborigines was conditioned by a rural childhood in the shadow of the local 'blacks' camp,' and by a precocious career as a medical undergraduate at the University of Adelaide under the tutelage of such prominent Aboriginalists as J. B. Cleland, Norman Tindale and A. A. Abbie.¹¹ After graduating in 1949, at the tender age of twenty-one, Cawte was led into psychiatry by an almost literary fascination with human frailty.¹² In a field long regarded as Australian medicine's stagnant backwater, Cawte represented a new breed of doctor more interested in psychology and treatment than in institutional accounting. Two early experiences helped to set Cawte apart from his more senior colleagues. The first was three years of psychoanalytic training in the early 1950s.¹³ The second was a period of professional development in the United States of America during 1955 and 1956 where Cawte, on a scholarship from the Commonwealth Fund of New York, had the opportunity to observe at first hand the radical transformations overtaking psychiatric thinking. This American training, unprecedented for an Australian psychiatrist at the time, proved formative for Cawte's later career.¹⁴ Mentored at Harvard University by the pioneering social psychiatrist and anthropologist Alexander Leighton, Cawte became interested in 'culture and personality.' Seconded to the navy, he was persuaded of the preventive value of 'forward treatment' and, consulting with an influential group of psychiatric thinkers clustered around Gerald Caplan and Eric Lindeman at Harvard, he quickly became excited by the possibilities of the emerging 'community psychiatry.'¹⁵ All of these ingredients would later contribute to his own work with Aborigines, work which he initially characterised as 'Australian ethnopsychiatry'.

Cawte's unusual professional development and progressive inclinations placed him at the Australian vanguard of the global reform movement that stormed the custodial asylum in the postwar years.¹⁶ Given day-to-day charge of Enfield Hospital in 1951, Cawte soon found himself, as one colleague recalled it, locked in a 'running battle' with parsimonious superiors whose perspective on mental illness had been shaped in an era of therapeutic pessimism and degenerationist theories of mental illness.¹⁷ Cawte ran Enfield on the principles of combat psychiatry, trying anything that might keep patients out of chronic care.¹⁸ Convinced that 'social interaction' was the basic 'principle of therapy,' Cawte had reorganised the Receiving House as a 'therapeutic community,' with desegregated wards, regular group therapy and even a degree of patient government.¹⁹ These developments were aimed, not at curing the sick brain, but at 're-"acculturation" of the social being, enlisting deviants as agents in their own 'emotional and cultural education.'²⁰ Community within the hospital was to be linked with community without. Public visiting, after care, psychiatric social work, and voluntary organisations for mental health were all promoted by Cawte as sources of therapeutic intelligence and avenues of rehabilitation.²¹

Against this dawning institutional enlightenment, patients such as the 'hapless wanderer' stood out for the first time as 'abnormal' cases within the broader hospital population. As the psychiatric subject began to be construed and treated as an active psychological agent, located in interpersonal space, Aboriginal patients, whose ways of life and thinking were often radically foreign to white metropolitan experience, were newly problematised. Thousands of miles from home, often with little English, sometimes feeling surrounded by the 'paraphernalia of a powerful magic,' many of these patients could scarcely be addressed as subjects of a healing 'community.' Their 'profound ambivalence' to the 'hospital and its medicine,' as Cawte later wrote, left them refractory to the new sociotherapeutic regimes that were supposed to usher in an era of humane and effective mental health.²² 'Rapport and trust were meagre, intervention largely unhelpful,' Cawte wrote of one Enfield inmate:

Most of the time he sat morosely in corners. With encouragement he took part in group meetings and once spoke with animation when asked to describe hunting; he described spearing kangaroos and rabbits, using a throwing stick.²³

Such contributions, though heartening, were ultimately opaque to psychiatric understanding. It was impossible, as Cawte noted, for the staff to decide whether this patient's behaviour was delusional and paranoid or merely brought on by homesickness and bewilderment.²⁴ The problem was never solved: one night this patient fled the hospital and was never seen again.

Similar problems frustrated any attempts at communication between the hospital and the patient's community. It was not unusual for Aboriginal patients to be admitted with little, or misleading, information on the social background of their case, making accurate diagnosis difficult. Usually, they were discharged into an unknown environment that had often changed radically in their absence. Tradition-oriented patients, who returned to claim redistributed wives, or to seek redress for sorcery, encountered stresses that often saw a rapid relapse.²⁵

Those seeking to diagnose mental illness in Aborigines struggled to decode unfamiliar cultural manifestations which sometimes seemed to cloak Indigenous people's symptoms. Cawte often recalled one striking case, admitted to Enfield in 1958, as the victim of 'Kurdaitcha men'—tribal assassins of the Desert peoples who killed by magic with a pointed bone. Refusing food and water, the patient first complained of the pains caused by the bone in his body and then became entirely 'bereft of speech and response.' These symptoms, apparently combining paranoid 'delusions of reference' with hysterical and depressive features, presented a serious challenge to classification. As tube-feeding continued, and the patient showed no sign of recovery, 'desperation' set in among the treating medical staff. Cawte, setting aside his psychodynamic principles for the moment, administered a brief course of ECT and was astounded to see 'a dramatic and complete recovery.' Within weeks the resurrected patient 'flew home happily.'²⁶

This denouement was not merely a relief, but also a revelation. ECT's known effectiveness in cases of endogenous depression permitted a differential diagnosis. Behind the 'pointed bone' of which this patient complained was a psychological disorder equivalent, or alternative, to 'involutional melancholia,' the depression of the climacteric. The complaint's occult content was not the product of private psychosis, but of cultural conditioning, which caused the 'ensorcelled' Aborigine to exhibit fear and blame where his Western counterpart would voice gloom and self-reproach.²⁷ The underlying distress was commensurate, only its idiom was different. ECT, for all its crudity, had served as a translation device cutting through cultural difference to the illness's biological substrate, permitting a blurred recognition of curable suffering behind what had seemed an inscrutable drama of the primitive bizarre. As an underlying similarity was revealed, Aboriginal culture itself became the problem which psychiatric understanding must resolve.

When Cawte left Enfield for academia in 1963, he was already persuaded that this work of translation must be continued beyond the walls of the hospital. Psychiatrists, he was persuaded, must quit their 'narrowly clinical, consulting room outlook' to understand and treat the Aboriginal mind in its 'native habitat', ideally through the establishment of psychiatric field services.²⁸

'A sick society'?

This vision began to be realised from the mid-1960s, through a research project established after Cawte's appointment to the School of Psychiatry at the University of New South Wales. This became known as the 'Human Ecology of the Arid Zone Project.'²⁹ Although work under this rubric took a variety of forms, the core of the enterprise remained Cawte's Australian ethnopsychiatry: the study of the quantity and nature of mental illness among remote Indigenous communities in the throes of 'acculturative change,' using intensive survey methods during short periods 'in the field.'

The 'urgent question' that this program sought to answer, for the sake of Australia's national health and 'racial harmony,' was 'to what extent should Australian Aborigines, tribal and transitional, be regarded as a "sick society"?'³⁰ The 'sick society' was a concept with considerable currency among epidemiological thinkers at this time. As defined by the influential Scottish social psychiatrist J. F. Halliday, 'sick societies' were populations undergoing a breakdown in social functioning resulting in a generalised maladaptive syndrome.³¹ Symptoms included demographic abnormalities, industrial inefficiency, and, above all, elevated rates of psychiatric and psychosomatic illness. Australian ethnopsychiatry's avowed agenda was, therefore, to evaluate people's 'psychological adjustment to cultural change by measuring psychiatric morbidity.'³² The survey gaze fell not only on the narrow field of the floridly insane, but on what Cawte called the 'broader field of organism/habitat.' This 'ecological' perspective did not problematise sickness as such, but rather 'adaptation' or 'coping'—the competence of the individual and the collective in preserving and promoting their own, always precarious, health.³³ Psychiatric morbidity, in this perspective, was itself symptomatic of 'risk factors' that were seen to be general within the social structure of Indigenous communities.

Underpinning this program was the conviction that the challenges posed by the Aboriginal patient for reformist psychiatry in the 1950s and 1960s was just one facet of the larger 'Aboriginal problem' confronting a self-consciously progressive postwar nation. In 1951, as the twenty-three-year-old Cawte took up his first post at Enfield, Australian governments had met to confirm cultural assimilation as the shared goal of a new Indigenous policy. The formal target of the new 'positive policy' was not so much a particular race as a social psychology, 'a different way of thinking,' a matter of outlook and habit. Just as the mentally ill were being 'deracialised,' so too were the racially different discovered to be 'rational beings,' with an educable potential for citizenship and survival in the modern world.³⁴ The 'social techniques' that psychiatry had developed in the normalisation of asylum populations might also, Cawte proposed, be employed in the 'deinstitutionalisation' of formerly 'protected' Aborigines. Furthermore, in tracing the evolution of mental illness from 'traditional,' through 'transitional' and, finally, to 'modern' patterns, psychiatry could actually chart the inward transformations of Indigenous identity, 'scanning the troubled emergence of this people and providing an influence in the direction of mental health and social efficiency.'³⁵

Ethnopsychiatry, in this context, was no mere academic enterprise, but a discourse for the management of changing identity. In its emerging roles of political consultation, inter-professional liaison, crisis intervention and primary prevention through community building, psychiatry took its place as a developmental technology marrying progress and order, 'part of the "human engineering" necessary for the modern frontier.'³⁶ 'Aborigines, and those concerned with their welfare,' as Cawte urged in 1965, 'await the guidance that could come from psychiatry.'³⁷

Kalumburu: Persistence, paranoia and pauperism

Surveys in ethnopsychiatry, usually conducted by a small interdisciplinary team of academic workers during university vacation periods, were necessarily brief. During the few short weeks available, multidisciplinary survey teams would travel to isolated missions and settlements, pitch camp among the locals, and attempt to amass as much case data as they could. Survey tasks were systematically apportioned among the team members.³⁸ This 'blitz epidemiology'³⁹ could not afford to be doctrinaire in its methods. Likely cases, past and present, were initially identified at second hand, either through discussions with white authorities or perusals of court, school and hospital records. These accounts were then usually cross-referenced against those of informants eminent in the Indigenous community so as to mitigate somewhat the inevitable biases of selection and interpretation. Finally, if the identified case was available to the researchers, clinical contact was made—sometimes through an interpreter—to verify the nature of the complaint and to provide psychiatric 'first aid' in the form of drug treatment.⁴⁰

Cawte's first field survey of Indigenous psychiatric morbidity, setting the methodological and theoretical template for later researchers, was conducted in August and September 1964 at Kalumburu, an isolated Benedictine mission community on the northern coast of Western Australia. The local West Kimberley clans had recently undergone a demographic resurrection, after many years in which deaths heavily outnumbered births. This demographic transition recommended the Kalumburu population as a specimen for the study of social sickness, since it was assumed that traditional mechanisms of community integration, already weakened by the trauma of colonialism and depopulation, would now be subject to the destabilising strains of rapid population growth. Family structure, economic life and the gender order were all in a state of flux.

At Kalumburu, Cawte attempted to establish the normal profile of Indigenous illness in a 'full-blood' community, and to assess any changes occurring in the contact situation. He drew on contemporary observations as well as the missionaries' recollections dating back almost to the settlement's foundation in 1908. Cawte later recorded that there was little trace of psychopathology in the calm surface of mission life. Certainly, neither the missionaries nor the local Aborigines identified more than a handful of cases of overtly 'mental' behaviour over the past fifty years.

To the expert eye, however, a considerable load of covert and unrecognised morbidity quickly became evident. Although Cawte agreed that the incidence of severe and fatal mental illness was not excessive, he estimated the occurrence of minor mental disorder to be 'at least double that in an Australian white rural population.'⁴¹ Much neurosis, Cawte wrote, tended to be missed because of its exotic cultural idiom. Hysteria, for example, was clearly discernible in a number of cases of spirit possession, while phobias, rather surprisingly, appeared to be widespread among women and children who feared demon animals.

Obsessive-compulsive tendencies were, in Cawte's judgement, also widespread at Kalumburu. The symptom most obvious to the trained eye was, again, unusual: a near-universal addiction to dancing. Corroborees were held most evenings at Kalumburu, often leaving their participants 'too tired' to help tend the mission farm the next day. Whatever superficial benefit these dances had in conserving social solidarity was somewhat undermined, in Cawte's judgment, by the fact that they were devoid of authentic cultural meaning.

Significant and ritual dances are not held any more—only 'play' dances. Bystanders who are asked during the performance what the dancer is dancing may reply: 'that's George.' Repeating the question and clarifying the meaning still produces little but the dancer's name: 'just George.' George himself is imperfectly aware of what the dance originally represented, its symbolic significance and the part it plays in the scheme of things.⁴²

Although Cawte remarked elsewhere on the etiquette of conversational indirection observed at Kalumburu, he did not, in this case seem to consider the possibility that 'just George' might have been a polite response to an inappropriate inquiry.⁴³ Rather, in his view these empty corroborees summed up the 'existential problem' confronting the Kalumburu natives. To him, the dancers at Kalumburu were alienated in a Durkheimian sense, rehearsing defunct steps to ward off their angst, clinging to outmoded rituals so they did not have to face a disenchanted world. No longer a dying race in physical terms, the West Kimberley peoples were evidently not yet fully alive to the opportunities and obligations of modernity.

Cawte also perceived a failure of adjustment and adaptation in an almost ubiquitous 'passive-aggressive' and 'passive-dependent' 'personality disorder.' These defects of character and motivation, so unexpected in the 'friendly' and 'dignified' mission blacks, according to Cawte soon became painfully apparent in a notable lack of foresight, resourcefulness, industry and independent initiative. It was 'very tempting' to relate these Aboriginal 'shortcomings' to the failings of the Aboriginal family. The stunning impact of contact and settlement, the psychiatrist proposed, had produced a 'lost generation,' utterly bereft of purpose in life, who now failed to inculcate any form of industry—hunter-gathering or agrarian—in their children. As the white residents detailed with frustration, Indigenous parents would not submit their children to injections at the clinic, nor compel them to complete their homework, nor wean them before the age of four or five. This 'indulgent absence of childhood training,' and the general lack of constraints upon 'pleasure and idleness,' seemed implicated in the 'defective motivation' of Kalumburu's sons and daughters.

Fear, Cawte wrote, preponderated over guilt at Kalumburu. Self-castigating and suicidal depressions were, as far as Cawte's inquiries could determine, quite rare at the mission, while a 'paranoid trend' was evident in the universal fear of sorcery. Cawte considered that, against the background of such projective thinking, cases of schizophrenia appeared less as aberrations from consensual reality than as exemplars of 'all that is wrong with a culture.'⁴⁴ In this generalising judgment, it is notable that Cawte relied heavily on one of two identified cases of 'functional psychosis'—that of a man whose agitation about sorcery attacks had seen him excommunicated by his fellows as wambaba or mad. The other case, of a man who 'ran off into the bush preaching the gospel, catechising the natives,' was not seen as so typical.

Here again, patterns of childhood socialisation were speculatively implicated. Fondly handled and nurtured, not only by their parents but also by the extended kin group, children in the camp grew up with continuous warm human contact. What little discipline was meted out generally took the form of group teasing and ridicule, which Cawte believed inculcated narcissistic dynamics of fear and shame rather than 'a constructive sense of guilt.'⁴⁵ Logically, therefore, a sharp contrast between a warm and nurturing 'inside' and a suddenly hostile 'outside' might be supposed to be deeply entrenched in the natives' emotional makeup. Intriguingly, Cawte makes no mention of the fact that the mission had, until recently, employed a 'dormitory system' to separate children from their parents, a fact which might have cast a more complex light on the observed defects of parenting at Kalumburu.

In such analyses, we see how easily a culturally informed psychiatry flips over into a psychiatric diagnosis of culture. The normal 'Kalumburu personality,' profiled by the pattern of its disorders, seemed intrinsically lacking in a capacity for delayed gratification and an intropunitive conscience, essential ingredients for the development of a modern capitalist ethos.

There was little new in this diagnosis. Cawte's analysis of 'personality disorder' largely transcribed censorious pronouncements on the fecklessness of the 'primitives' and their children that his Benedictine informants had often voiced elsewhere.⁴⁶ More broadly, it echoed the conventional white Australian decrial of Indigenous 'pauperism,' the phase of arrested development that was commonly supposed to ensue as the fabric of the Dreamtime inevitably dissolved. 'Pauperism', as Tim Rowse has argued, was a label invoked wherever Aborigines refused to enter the charitable contract, and white interventions failed to find 'purchase on the Indigenous "soul".' ⁴⁷ For a settler society, 'pauperism'—where individuals were no longer 'properly' Aboriginal, but stubbornly refused to conform to white expectations—could only prefigure elimination. The 'hybrid Aborigine,' whether genetically or culturally defined, was understood, in Ian Anderson's words, as 'both (self-)destructive and sterile.'⁴⁸ The improvident dancers of Kalumburu, apparently failing to accept the rights and responsibilities of assimilation were seen as a case in point.

The pauper, as representative of the 'undeserving poor,' was also an archetype of the illegitimately sick. In Cawte's theory, the apparent stasis of Indigenous communities, such as Kalumburu, reflected cultural attitudes that saw anxiety projected outside of the individual's 'locus of control.' Sickness and misfortune, concretised as fear of sorcery, disrupted individual organisation and motivation, enforced the sick person's reliance on the collective and frustrated white medical care. The novel stresses of contact had, therefore, caused a disproportionate collapse in the health of a people unconditioned to government from within. It was this inadequacy of psychocultural defences, Cawte implied, that linked the problem of Indigenous inertia under assimilation with the older pattern of the dying race. If Aborigines were to survive civilisation, they would need to be converted to mental health from their collective representations, endowed with an understanding of themselves as subjects and guardians of a remediable private consciousness. In the interim, he suggested, all whites working with Aborigines should receive training in the elements of mental hygiene, and psychiatric services should be extended to all parts of the frontier.

Lake Nash: 'Disorders expressing hostility to whites'

In 1965, Cawte set out to investigate reports of a 'localized instability'⁴⁹ among the 'Yowera' people living on cattle stations around Lake Nash near the border of Queensland and the Northern Territory. 'Well-informed persons,' he wrote, 'welfare officers, nursing sisters ... [a] "flying doctor" and cattle station managers—are all firmly of the opinion that these Aborigines show an undue amount of instability and frank mental illness.'⁵⁰ Here, Cawte reviewed the prevalence of mental illness over the previous five years. This preliminary survey yielded a remarkable rate of observable mental illness: twelve cases in a total population of 120.

The pattern of illness that Cawte observed at Lake Nash had important differences to that which he had described at Kalumburu two years earlier, where general inactivity was seen to represent people's 'loss of purpose in life.' Aboriginal pastoral workers, unlike the recipients of government welfare or mission charity, were compelled to work. Station managers, Cawte noted, would not tolerate 'conservatism or regression' among the people they habitually called 'their blacks.' This toll on Aboriginal sweat, although 'by no means excessive' in Cawte's judgment, was seen to give rise to mental disorder among those unbalanced individuals 'unable or unwilling to make their contribution.' Psychological conflicts around the issue of work were, in Cawte's analysis, both cause and content of the 'transitional illnesses' among the 'Yowera.'⁵¹

Several case vignettes illustrated the point.⁵² Mick D., twenty-eight years old, was 'over-active and rebellious.' He used Western equipment in 'a clownish way' and mimicked the habits of the station whites. Keith D., eighteen, resembled his brother 'in his failure to establish a co-operative or even a working relationship with white people ... He is completely unoccupied.' Musselly, twenty-five, had worked well until his tribal initiation at about twelve years of age, when he became prone to violent outbursts and was admitted to Alice Springs Hospital. 'Upon his return he would not work, was morose and resentful of authority ... Said he would kill the station manager ... who was at a loss to understand the change.' Toby, twenty-eight, after a 'normal' childhood, 'became actively opposed to authority without ever making clear his reason.' 'He is somewhat helped by Largactil [Chlorpromazine], but is on the whole morose and vacant, especially towards white people.' Mick, forty-five, 'says he is sick—strained himself in the guts through hard work, still able to move around but not to work.'

He worked too hard as a young man ... now he claims that if he works hard he takes a fit ... On the station he is regarded as aggressive in a concealed way; he is a subversive influence on the younger working men and discourages the women from attending the sick bay with their babies.

At first grouped simply as 'transitional illnesses,' Cawte later defined these cases as representatives of a syndrome 'expressing hostility to whites' whether aggressive or passive.⁵³

The 'localized instability' at Lake Nash was one of many signs that marked the end of an era of pastoral quiet in Central Australia. In 1949—around the time that Toby and Musselly reached manhood and developed their 'transitional illnesses'—stockmen from Lake Nash became the first Aboriginal workers in the Northern Territory to strike for wages. They eventually won £2 per month and 'free tucker,' a fragment of European wages but a welcome improvement.⁵⁴ However, according to Lyon and Parsons' historical account of the Alyawarre struggle, the workers remained dissatisfied with the poor quality of the food and clothing supplied by the station, and continued to enact strategic, small-scale protests as part of a larger struggle that had land, as much as economic advantage, as its primary object.⁵⁵

To simplistically identify the 'symptoms' of Cawte's 'patients' as instances of such protest would court the charge of 'cultural ventriloquism.' Triply separated from the historian by time, culture and imputed insanity, these 'subalterns' cannot 'speak' to us directly.⁵⁶ Leaving questions of consciousness and intention to one side, however, we can note that the content of these putative mental illnesses had intrinsic political resonances in their particular time and place. If, as Ranajit Guha suggests, 'discrimination,' 'symbolic transference' and 'symbolic inversion' are basic modalities of 'peasant insurgency,' then 'delusions' that held all whites as enemies, that transferred antipathy from the cattle boss to the clinic, and that carnivalised and subverted the insignia of European prestige, can be seen as fundamentally unsettling to the pastoral peace.⁵⁷ Mick D.'s tendency to 'steal all the keys he could find,' like Musselly's habit of sitting unoccupied on the woodheap, alarmed white observers, not because they exemplified expectations of 'the Aboriginal' but because they defied them: not because they were incomprehensible, but because their meanings could not be acknowledged in this colonial setting. As Patrick Wolfe has written, 'the further from the pole of mythic authenticity that Aboriginal identities can be asserted or reclaimed, the greater the ideological threat that they pose.'⁵⁸ Cawte's psychocultural definition of Lake Nash as a hotbed of 'transitional illnesses'—crises of primitive identity lost, not assertions of modern identity found—aimed to neutralise this ideological threat.

Questions of power are also at stake in the psychiatric labels which, given to a few, delegitimised the actions of the many. The developing industrial unrest in Central Australia was characterised by the psychiatrist as an attempt, 'inspired from outside,' to create further unrest among Aborigines by manipulating their 'aggressive attitudes.'⁵⁹ Within the ideological horizons of the time, a non-traditional political movement founded in an assertive and historical Indigenous identity was virtually unthinkable. Blinkered by assimilationist binarisms—adjustment or annihilation, subordination or citizenship, same or different—a psychiatry that problematised Aboriginal 'adaptation' remained blind to the adaptations that Aborigines were making on their own terms.

Mornington Island: Casualties of change?

During 1966–67, Cawte assembled a multidisciplinary team of researchers to conduct the most comprehensive study yet. The chosen survey population was Mornington Island, a mission settlement in Queensland's Gulf of Carpentaria. Life on Mornington seemed to share many of the features that Cawte had identified elsewhere as an accumulation of 'social dynamite' at the nation's borders: high birth rate, uneasy ethnic coexistence, institutionalised dependency, shifting authority structures and changing family dynamics. The island's relatively small, well-defined population made it a useful case study for the close analysis of these generalised risk factors.

Moreover, this population was itself divided into three ethnic groups: the Lardil people, a mission-bred but relatively cohesive and still substantially traditional group; a diffuse population of 'detribalised' mainland Aborigines with whom the Lardil had intermarried; and, alongside these groups but substantially separate from them, a small band of traumatised Kaiadilt refugees. These refugees had been rescued from nearby Bentinck Island in 1948 when, after years of famine and internecine clan warfare, a catastrophic flood made their traditional subsistence impossible. These three peoples, the surveyors suggested, might therefore be taken as typical of three distinct varieties of the Aboriginal experience: 'intelligent parasitism,' detribalised drift, and contact shock. This representative diversity made Mornington Island an ideal 'natural laboratory' for the study of various 're-enculturation reactions,' and for the formulation of strategies allowing for the 'enlightened administration' of the Indigenous 'emergence'.⁶⁰

This survey repeated the methods of previous studies, but incorporated a significant innovation. The peoples of Mornington Island were invited to 'survey themselves'. Over repeated visits to the island, 294 persons, or ninety-one per cent of the adult population, were given a simplified symptom checklist questionnaire. Through an interpreter where necessary, the subjects answered 'yes' or 'no' to questions that included:

7. Do you have pains in the heart or chest?

19. Do you suffer badly from frequent severe headaches?

35. Do you wear yourself out worrying about your health?

46. Do you wish you always had someone at your side to advise you?

60. Do people often annoy or irritate you?

Participants in the morbidity survey were given four brief questionnaires aimed at measuring dimensions of personal belief and behaviour: 'acquisition' and 'emulation' of Western culture and 'retention' of 'traditional beliefs' and 'traditional activities.'⁶¹ These measures of 'disculturation and re-enculturation,' which were taken to be measures of 'an individual's identity during culture contact,' were then statistically correlated with the morbidity data to test hypotheses relating cultural change to mental disorder.

This study had implications for the most consistently contested issue within the broad assimilationist consensus: was Indigenous culture a necessary vehicle for development to modernity and citizenship, or an impediment to it? Should Aborigines be drawn in as atomised, rights-bearing individuals, as traditional liberals such as Paul Hasluck insisted, or 'move up in groups,' as Durkheimian social scientists such as A.P. Elkin urged? If a correlation between traditionalism and psychological disorder could be shown, the survey team proposed, 'then minority groups searching for their own identity and values may be doomed to further psychological discomfort.'⁶² If this correlation did not hold true, then 'either retention or reaffirmation of traditional ways (and the acceptance of this by the dominant group) may yet provide a path to satisfying personal and inter-group relations in plural societies.'⁶³

The findings of this investigation were striking and unexpected: none of the parameters of cultural identity were 'importantly associated with symptom levels.'⁶⁴ Nor did these parameters necessarily relate consistently to each other: 'neither acquisition nor emulation of Western ways has interfered with the old beliefs.'⁶⁵ It was possible, if the questionnaire responses were to be believed, to be fluent in English, to attend the cinema and to express a desire for a 'house with several rooms,' and yet to 'think the old native beliefs can help you' and that 'when you die ... you will go to the Spirit Home in the East.'⁶⁶ And it was possible to be all these things and feel healthy. Despite these findings, the rhetoric of the surveyors continued to position Aborigines as 'casualties of change' or damaged identities, and to problematise the 'retention of traditional belief' as a symptom of neurosis. Although a particular hypothesis might be refuted, broader assimilationist assumptions were harder to displace.

'By and for Aborigines'

Cawte generally saw Aboriginal recalcitrance—to medicine, to employment, to citizenship—through a psychotherapeutic prism. Arrested 'development,' in his paradigm, could be assimilated to transference resistance: the failure of that psychologically primitive attainment, which Erikson called 'basic trust,' necessary to all positive relationships and especially to that between doctor and patient. Contemporary Aborigines, raised without consistent rewards or punishments, had a 'withered faith' and, therefore, lacked the capacity for therapeutic trust.

'They build up,' Cawte wrote in 1971:

a phantasy that we are slippery, aloof, exploiting, hostile; so they do not take our medicine or advice, or if they do, develop reactions unconsciously designed to thwart us and make us feel guilty. Such extremists die young, or become our sickest patients.⁶⁷

Here we see the psychiatrist, even while attempting to highlight the profound impacts of settler colonialism upon the psyche of the Indigenous population, slipping once more into the insidious terms of colonialist discourse. 'Healing' is identified with white authority, 'resistance' relegated to the realm of the primitive unconscious, and death understood as the consequence of some fundamental defect in the Indigenous subject. As one of Cawte's students was later to detail, the Aboriginal mistrust of white medicine often had more solid foundations than infantile 'phantasy.'⁶⁸

The 'withered faith' of Aborigines was also presumed to impair the effectiveness of the traditional doctors or 'medicine men,' whose work had once 'immunize[d] against anomy.' Nevertheless, as Cawte and Kidson wrote of the 'Walbiri doctor':

The people will turn to them in times of stress. This is a predictable pattern, one that Western medicine must anticipate ... There is a definite move to recapture at least some of the social and spiritual elements of the Aboriginal past. Professor Elkin notes that he has been watching this movement since 1936.⁶⁹

The question for Western psychiatry, therefore, as it struggled to understand and combat the 'illnesses of transition' was how to respond to this underground medical revivalism. Should Western medicine ignore the native doctor, 'trusting time to make them obsolete,' actively oppose their 'regressive or dangerous' activities or seek a productive rapprochement for the '30 or 60 years of transition' that were presumed to remain before the final extinction of the old ways?⁷⁰

At least initially, Cawte was strongly drawn to the latter possibility. In his surveys of Central Australia, the psychiatrist found many traditional doctors to be friendly and altruistic individuals, with a collegial esteem for those white healers who did not condemn them as charlatans. By establishing a rapport 'at the bedside' with traditional practitioners, Cawte hoped it might be possible to exert a stabilising influence upon a 'potentially regressive people.'⁷¹ In particular, he envisaged the possibility of enlisting these customary agents of authority as part of the modern community health system. As case finders and counsellors, the medicine men might otherwise bring refractory individuals to effective clinical treatment, while retaining their all-important status as guardians of group conscience and collective morale. Progress could thus be married with order. As David Thomas has pointed out, this vision of mobilising Indigenous agency, like Cawte's portrayal of Indigenous healers as colleagues rather than curiosities, was well ahead of its time.⁷²

Upon further reflection, however, this vision of engaging individual minds through existing systems of what Pat O'Malley calls 'Indigenous governance' did not seem feasible.⁷³ 'Sadly,' as Cawte wrote looking back:

the intuitions of the native doctors about sickness diverged so far from those of the clinic that it seemed unlikely that they could be recruited as case-finders. Much of their response to illness lay in cursing or harming effigies, and in revenge (payback) against the presumed culprit.⁷⁴

Such practices, even though they countered the governmental problem of social disintegration, seemed to run counter to the liberal aims of individual autonomy and secular rationality. Ultimately, the goal of a liberal 'translation' of psychiatric expertise—bringing Indigenous people freely to new and more acceptable forms of psychological subjectivity and social conduct—foundered on basic incompatibilities of outlook. In the final analysis, not all the problems of assimilation could be reduced to questions of therapeutic communication.

'Deeply impressed' by the incommensurabilities of Western and Indigenous medical perspectives, Cawte sought new ways of overcoming black 'resistance' to white 'healing.' In 1975, persuaded that Indigenous peoples must 'organize their own psychiatric services, adapted to their special traumas,' he set up a training program for Aboriginal 'behavioural health technicians' in Townsville, North Queensland.⁷⁵ Trainees, primarily from urban Indigenous communities, were given instruction in clinical interviewing, case finding, crisis intervention, and family and alcohol counselling. They also learnt methods of liaison with local statutory and voluntary agencies and attended lectures and films on the assumptions and practices of traditional medicine. The final two months of training involved field trips to communities and areas where Indigenous mental health and alcohol problems seemed most acute—a new elaboration of the old ethnopsychiatry with Indigenous staff. This work empowered many Indigenous people to define and combat the needs of their own community, and gave them status long denied by white institutions.⁷⁶

In 1976, in order to further the impetus of this work and to provide a structure for communication between those Indigenous health workers toiling in isolation, Cawte founded the Aboriginal Health Worker Journal (subsequently the Aboriginal and Islander Health Worker Journal).⁷⁷ Initially published at Cawte's personal expense, the journal offered simply worded articles—by Cawte, his survey collaborators and colleagues, and a growing number of Indigenous health workers and service users—on aspects of Indigenous behavioural and physical health. However, the journal soon evolved into more than just a vehicle for the dissemination of medical intelligence from centre to periphery, as writings began to be circulated 'from health worker to health worker.' Under Cawte's editorship, a variety of Indigenous self-representations began to appear alongside simplified versions of ethnopsychiatric articles on how to 'understand' the 'problems' and 'differences' of mental illness in Aborigines. Clinical anecdotes, poems, artworks, recipes for low-cost and bush foods, diaries of newfound sobriety, health worker anecdotes and traditional legends from across the continent were circulated to forge a new collective consciousness on the meanings of, and obstacles to, Aboriginal wellbeing. Especially into the 1980s, many of these representations drew pointed attention to the historical and political dimensions of Indigenous distress, including the 'cultural genocide' undertaken in the name of assimilation.⁷⁸The Aboriginal Health Worker Journal—and the Aboriginal mental health movement that developed from it—was, therefore, simultaneously a fulfilment of Cawte's psychiatric integrationism and a forum for its critique. Indigenous people, in short, were no longer simply objects of mental health discourse but were becoming its formulators and arbiters.

Thus, the development of a new era of 'self-determination' in Indigenous policy brought about a change in the role of the psychiatrist, from detached social pathologist in the 1960s to engaged community development worker in the 1970s. Cawte's own engagement with Aboriginal needs continued to evolve. After many years of annual visits to 'study the consciousness of the Elders' in Arnhem Land, Cawte was enlisted as a sort of intercultural emissary by the Warramirri clan of the Yolngu people, tasked with recording and interpreting their traditions to metropolitan Australia, and subjected to clan rules of knowledge and disclosure—a far cry from the detached social pathologist of old.⁷⁹

Conclusion: Assimilation and mental health

Early writings on the mental health of Indigenous Australians reveal much about the ways that medical perceptions and concerns are 'framed' by institutional practices, unexamined political allegiances and broader cultural concerns. 'Australian ethnopsychiatry' was, ultimately, a discourse that problematised the will of an unfree people. Assuming that Aboriginal identity was fatally compromised by contact, it paradoxically pathologised assertions of a vital Aboriginality as symptomatic of cultural loss, and so translated the living history of colonialism into the fixed and immaterial case history of the patient. Ultimately, however, this psychiatric discourse, like assimilationism itself, foundered on its own inherent contradictions. Psychiatry's repertoire of unconscious motivations, pathological defences and transference resistance went some way towards containing the inherent paradoxes of a doctrine that coerced the people it claimed to liberate and enforced the change it claimed was inevitable—but it could not heal a culture by denying it. Aboriginal mental health, as Cawte came to recognise, was something that would have to be discovered through negotiation, not imposed by medical fiat. Australia's frontiers could not be closed by therapy.

University of New South Wales

Notes

^1. John E. Cawte, "Australian Ethnopsychiatry in the Field: A sampling in north Kimberley," Medical Journal of Australia, vol. 1, no. 13 (28 March 1964): 467.

^2. John E. Cawte, Medicine Is the Law: Studies in Psychiatric Anthropology of Australian Tribal Societies (Sydney, NSW: Rigby, 1974), xxi.

^3. Ohn Kyaw, "Aboriginal Psychiatry in the Making" (FRANZCP thesis, 1992), 16–25.

^4. See Ernest Hunter, "'Double Talk': Changing and Conflicting Constructions of Indigenous Mental Health," Australian and New Zealand Journal of Psychiatry, vol. 31 (1997): 822; David Piers Thomas, Reading Doctors' Writing: Race, Politics and Power in Indigenous Health Research 1870–1969 (Canberra, ACT: Australian Institute of Aboriginal and Torres Strait Islander Studies, 2004), 107–110; a more critical evaluation of Cawte's legacy is given in Joseph P. Reser, "Aboriginal Mental Health: Conflicting cultural perspectives," in The Health of Aboriginal Australia, edited by Janice Reid and Peggy Trompf (Sydney, NSW: Harcourt Brace Jovanovich, 1991), 236–49.

^5. Tim Rowse (ed.) Contesting Assimilation (Perth, WA: API Network, 2005) offers a kaleidoscopic perspective on these issues.

^6. John E. Cawte, "Australian Aborigines in Mental Hospitals, Part II: Patterns of Transitional Psychosis," Oceania, vol. 36 (1966): 278.

^7.Ibid.

^8. John E. Cawte, "A Psychiatric Service in the North?," Australian Journal of Social Issues (June 1964): 21.

^9. Cawte, "Aborigines in Mental Hospitals II": 279.

^10.Ibid., 279–80.

^11. John E. Cawte, personal communication (typescript manuscript) dated 16 December 2004, "Norman Tindale," in Box: Tools of the Doctors, Cawte Papers, School of Psychiatry, University of New South Wales (hereafter Cawte Papers), 231.

^12. John E. Cawte, Last of the Lunatics (Melbourne, Vic: Melbourne University Press, 1998).

^13. For a discussion of Cawte's training within the broader context of Australian psychoanalysis, see Joy Damousi, Freud in the Antipodes: A Cultural History of Psychoanalysis in Australia (Sydney, NSW: University of New South Wales Press, 2005), 266–9.

^14. Raymond Prince, "Pioneers of Transcultural Psychiatry: John Cawte," Transcultural Psychiatry, vol. 36, no. 3 (1999): 349–50.

^15. John E. Cawte, "Community Care of Mental Illness in North America: Some Observations and Recommendations," Medical Journal of Australia, vol. 2, no. 26 (1957): 709–15; Prince, 349–50.

^16. For this movement in Australia, the United States of America and Britain respectively, see Milton Lewis, Managing Madness (Canberra, ACT: Australian Institute of Health, 1988), especially chapter 4; Gerald N. Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton, NJ: Princeton University Press, 1991); and David Armstrong, Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century (Cambridge: Cambridge University Press, 1983) especially chapters 3 and 7.

^17. Bill Cramond, quoted in W. A. Dibden, "A Biography of Psychiatry," (manuscript at Adelaide University Library, 2001). Accessed on 24 April 2007 at <http://www.adelaide.edu.au/library/guide/med/menthealth/dibden.html>.

^18. Dibden, "A Biography of Psychiatry," 13–14.

^19. John E. Cawte, "The British Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, 1954–1957," Medical Journal of Australia, vol. 44, no. 13 (1957): 480–1.

^20. Cawte, "British Royal Commission," 481.

^21. Maureen Bell, "From the 1870s to the 1970s: The Changing Face of Psychiatry in South Australia," Australasian Psychiatry, vol. 11, no. 1 (2003): 79–86.

^22. Cawte, "Aborigines in Mental Hospitals II," 274.

^23.Ibid., 277.

^24.Ibid.

^25. Cawte, "A Psychiatric Service," 23–7.

^26. "Kurdaitcha Shoes," in Box: Tools of the Doctors, Cawte Papers.

^27. Personal communication from John Cawte to the author, 16 December 2004.

^28. John E. Cawte, "Australian Ethnopsychiatry and Frontier Psychiatry" (Ph.D. Thesis, University of New South Wales, 1968): 1.

^29. David Maddison, "Current Research: Projects Underway," Social Science and Medicine, vol. 3 (1969): 83.

^30. John E. Cawte, "Australian Aborigines in Mental Hospitals Part I: Available Statistics, 1954–1963," Oceania, vol. 36, no. (1966): 265.

^31. See James L. Halliday, Psychosocial Medicine: A Study of the Sick Society (London: Heinemann, 1949).

^32. Cawte, Medicine is the Law, xxi.

^33. For an insightful analysis of the sociomedical survey, see David Armstrong, "The Rise of Surveillance Medicine," Sociology of Health and Illness, vol. 17, no. 3 (1995): 393–404.

^34. Adolphus P. Elkin, Citizenship for the Aborigines: A National Aboriginal Policy (Sydney, NSW: Australasian Publishing Company, 1944), 28.

^35. Cawte, "Australian Ethnopsychiatry," 467–8.

^36. John E. Cawte, "Flight into the Wilderness as a Psychiatric Syndrome. Some Aspects of the Human Ecology of the Arid Zone," Psychiatry, vol. 30, no. 2 (1967): 160; see also John E. Cawte, Cruel, Poor, and Brutal Nations: The Assessment of Mental Health in an Australian Aboriginal Community by Short-stay Psychiatric Field Team Methods (Honolulu, HI: University of Hawaii Press, 1972), 142–59.

^37.Ibid., 280–1.

^38. Cawte, Cruel, Poor, and Brutal Nations, 1–8; see also Cawte, Medicine Is the Law, 232–8.

^39. John E. Cawte, "Editorial Review: The Human Ecology of the Arid Zone," Australian and New Zealand Journal of Psychiatry, vol. 2 (March1968): 5, footnote 2.

^40. See Leslie G. Kiloh, "Psychiatry amongst the Australian Aborigines," British Journal of Psychiatry, vol. 126, no.11 (1975) 1–10; M.A. Kidson, "Psychiatric Disorders in the Walbiri, Central Australia," Australian and New Zealand Journal of Psychiatry, vol. 1 (1967) 14–22.

^41. Cawte, "Australian Ethnopsychiatry," 467.

^42.Ibid.

^43. John E. Cawte, "Tjimi and Tjagolo: Ethnopsychiatry in the Kalumburu People of North-western Australia," Oceania, vol. 34, no. 3 (1964): 186.

^44. Jules Henry, Culture against Man (New York: Random House, 1963), cited in Cawte, Medicine Is the Law, 54.

^45. Cawte, "Tjimi and Tjagolo," 175–8.

^46. See Theodore Hernández, "Children among the Drysdale Rivers Tribes," Oceania, vol. 12 (1941/42): 129–30; Eugene Perez, Kalumburu: The Benedictine Mission and the Aborigines, 1908–1975 (Wyndham, WA: Kalumburu Benedictine Mission, 1977), cited in Colin Tatz, "Genocide in Australia," Australian Institute of Aboriginal and Torres Strait Islander Studies Research Discussion Papers, no. 8, 19.

^47. Tim Rowse, White Flour, White Power: From Rations to Citizenship in Central Australia (Melbourne, VIC: Cambridge University Press, 1998), 40–1.

^48. Ian Anderson, "I, the Hybrid Aborigine: Film and Representation," Australian Aboriginal Studies, vol. 1 (1997): 7–8.

^49. John E. Cawte, "Ethnopsychiatry in Central Australia: I. 'Traditional' Illnesses in the Eastern Aranda People," British Journal of Psychiatry, vol. 111 (1965): 1069.

^50.Ibid.

^51.Ibid.

^52. All cases from ibid., 1074–5.

^53. John E. Cawte, "A Sick Society," in The Psychology of Aboriginal Australians, edited by G. E. Kearney, P. R. Lacey and G. R. Davidson (Sydney, NSW: John Wiley and Sons, 1973) 365–79.

^54. Pamela Lyon and Michael Parsons (for the Central Land Council), We are Staying: the Alyawarre Struggle for Land at Lake Nash (Alice Springs, NT: IAD Press, 1989).

^55.Ibid.

^56. Gayatri C. Spivak, "Can the Subaltern Speak?," in The Postcolonial Studies Reader, edited by Bill Ashton, Gareth Griffiths and Helen Tiffin (London: Routledge, 1995), 24–8.

^57. Ranajit Guha, Elementary Structures of Peasant Insurgency in Colonial India (Oxford: Oxford University Press, 1983), 18–75.

^58. Patrick Wolfe, "Nation and MiscegeNation: Discursive continuity in the post-Mabo era," Social Analysis, vol. 36 (1994): 117.

^59. Cawte, "Traditional Illnesses in the Eastern Aranda," 1077.

^60. Geoffrey N. Bianchi, John E. Cawte and L. G. Kiloh, "Cultural Identity and the Mental Health of Australian Aborigines," Social Science and Medicine, vol. 3, no. 3 (1970): 371–87.

^61.Ibid., 375–83.

^62. Cawte, Cruel, Poor, and Brutal Nations, 95.

^63.Ibid.

^64. Bianchi, 386.

^65.Ibid., 383.

^66.Ibid., 376–7.

^67. John E. Cawte, "Australia, 10,000 Years B.P.: Mental Health in Primitive Societies," Mental Health in Australia, vol. 4, no. 2 (1971): 60–7.

^68. Ernest Hunter, "Stains on the Caring Mantle: Doctors in Aboriginal Australia have a history," Medical Journal of Australia, vol. 174, no. 9 (2001): 479.

^69. John E. Cawte and Malcolm A. Kidson, "Australian Ethnopsychiatry: The Walbiri Doctor," Medical Journal of Australia, vol. 11 (19 October 1964): 977–83.

^70.Ibid. p. 982.

^71. John E. Cawte, "Medicine Man–Medical Man: A Note on Faith in the Doctor as Exemplified by Australian Aborigines," vol. 2, no. 3 (17 July 1965): 134.

^72. Thomas, Reading Doctors' Writing, 108.

^73. Pat O'Malley, "Indigenous Governance," in Indigenous Governance, edited by Mitchell Dean and Barry Hindess (Cambridge: Cambridge University Press, 1998), 156–71.

^74. Paul S. C. Tacon and John E. Cawte, "Traditional Doctors of Australia: Their Tools and Intuitions, March 1998," Folder: Letters UNSW Press to John Cawte, Cawte Papers.

^75. John E. Cawte, "The Psychiatry of the First Pacific Peoples," Australian and New Zealand Journal of Psychiatry, vol. 11 (1977): 27–8.

^76. Marvin W. Kahn, Joseph Henry and John E. Cawte, "Mental Health Services by and for Australian Aborigines," Australian and New Zealand Journal of Psychiatry, vol. 10 (1976): 221–8; see also Marvin W. Kahn and John E. Cawte, "Training for Indigenous Behavioural Health Technicians: An American Indian Mental Health Program Adopted and Adapted by Aboriginal Australians," (manuscript held at the School of Psychiatry, University of New South Wales, 1976).

^77. Anon. "Healing and Health," The Aboriginal and Islander Health Worker Journal, vol. 20, no. 3 (1996): 24–8.

^78. See, for example, Pat Swan, "200 Years of Unfinished Business," Aboriginal and Islander Health Worker, vol. 12, no. 4 (1988): 29–41.

^79. John E. Cawte, The Universe of the Warramirri (Sydney, NSW: UNSW Press, 1993).

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