Changing diagnoses in Valkenberg Asylum, Cape Colony, 1891-1920: a longitudinal view.

This paper will examine changes made to diagnoses of patients admitted to Valkenberg Asylum, Cape Colony, during the period 1891-1920, in order to illustrate the ambiguous and shifting relationship between psychiatric theory and practice, in this colonial setting. The diagnostic profiles of Valkenberg patients make clear that the distinction between manic-depression and dementia praecox, established in theory by the end of the first decade of this century, was by no means clearly perceived by asylum practitioners. Racial attitudes affected diagnostic practice; these will be outlined. Valkenberg's case records will be used to illustrate interactions between the patient's history, race and gender, classificatory changes, and ambiguous presentation of symptoms. These records add an important diachronic perspective to the synchronic perspective contained in annual reports and lunacy registers. The implications of diagnostic changes for research which attempts retrospective diagnosis will be explored.