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Psychiatric Cultures Compared

Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century: Comparisons and Approaches

Marijke Gijswijt-Hofstra
Harry Oosterhuis
Joost Vijselaar
Hugh Freeman
Copyright Date: 2005
Pages: 456
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  • Book Info
    Psychiatric Cultures Compared
    Book Description:

    The history of mental health care in the twentieth century is a relatively uncharted territory. Exemplifying a new emphasis on the comparative approach, this volume offers overviews of various national psychiatric cultures and explores new research subjects. By confronting Dutch psychiatry with developments abroad, this collection highlights interesting contrasts and analogies. Some articles focus on the interaction between asylums and the family, others address issues such as psychiatric nursing, psychotropic drugs, the organisation and policies in the field of psychiatry, the role of various professions, the development of the inand outpatient mental health sectors, anti-psychiatry and de-institutionalisation. Several authors bring in the broader social and cultural context, such as the two World Wars, the welfare state, gender and class relations, the protest movement of the 1960s, democratisation, and totalitarian regimes. Two broad reflective reviews, one historiographic and the other contextual and comparative, conclude the volume.

    eISBN: 978-90-485-0391-9
    Subjects: Health Sciences, History

Table of Contents

  1. Front Matter
    (pp. 1-4)
  2. Table of Contents
    (pp. 5-6)
  3. Acknowledgements
    (pp. 7-8)
    The Dutch editors
  4. Introduction: Comparing National Cultures of Psychiatry
    (pp. 9-34)
    Marijke Gijswijt-Hofstra and Harry Oosterhuis

    When in 1905 the Budapest asylum doctor Kárlmán Pándy published his ‘comparative study’ of the care for the insane in Europe, he was by no means the first one to do so, nor would he be the last.¹ The history of psychiatry and mental health care offers numerous examples of cross-national inquiries by doctors and others who wished to learn about psychiatry in other parts of the Western world, and perhaps seek models to adopt in their home country. International study trips were – and still are – a favourite way to collect information firsthand.² Correspondence with foreign colleagues and...

  5. Overviews Psychiatry and Mental Health Care

    • CHAPTER 1 Within and Outside the Walls of the Asylum: Caring for the Dutch Mentally Ill, 1884-2000
      (pp. 35-72)
      Marijke Gijswijt-Hofstra

      The first Dutch insanity law of 1841 marked a break with the past. After an earlier effort to reform the asylums had largely failed, the insanity law ordained that asylums should treat and cure the insane medically rather than just provide shelter and care. Asylums which did not come up to standard had to be closed or could be assigned the status of shelter (bewaarplaats). A state inspectorate was instituted to monitor the standards, while the provinces were responsible from then on for providing sufficient asylum capacity for their own poor insane, if not by building their own asylums then...

    • CHAPTER 2 Insanity and Other Discomforts: A Century of Outpatient Psychiatry and Mental Health Care in the Netherlands 1900-2000
      (pp. 73-102)
      Harry Oosterhuis

      Throughout the nineteenth century, psychiatry in the Netherlands, as in other countries, primarily developed in relation to the care of the insane in asylums. Around 1900, however, it also gained ground in clinics tied to universities, in sanatoria and other facilities for mental and neurotic patients as well as alcohol addicts, and in private practice. After the First World War, psychiatrists began to treat more and more individuals who were not institutionalised. The 1920s and 1930s saw the emergence of the mental health movement and the establishment of Pre- and Aftercare Services for the mentally ill and the mentally retarded...

    • CHAPTER 3 Madness and Autonomy: The Moral Agenda of Anti-psychiatry in the Netherlands
      (pp. 103-115)
      Gemma Blok

      In 1974, a young man called Piet was admitted to Conolly – a closed ward for acute admissions of the psychiatric hospital Brinkgreven in the Dutch town of Deventer. Piet was admitted because of restlessness and derailed behaviour, and was diagnosed as suffering from ‘problems in breaking away from his parents’. Family therapy (the preferred method of treatment at Conolly) was tried, but Piet’s parents did not want to participate. Next, the Conolly staff tried to provoke Piet into making personal ‘change’. ‘Piet’s way of dealing with people’, one of them wrote in his patient file, ‘is such that they...

    • CHAPTER 4 Psychiatry and the State in Britain
      (pp. 116-140)
      Hugh Freeman

      The focus of this paper is on the relationship between the British state and the mentally ill, primarily in the second half of the twentieth century. To a large extent, this is the story of the National Health Service – the nhs. This relationship with the state has inevitably involved politics – but generally not party politics, along the usual left-right dimension.

      Until the 1940s, the British state did not acknowledge responsibility for providing general health care to the population. In the early modern period, the functions of the national government, embodied in the Sovereign, were very few. Everything else...

    • CHAPTER 5 The Transformation of Mental Health Policy in Twentieth-Century America
      (pp. 141-161)
      Gerald N. Grob

      In mid-nineteenth century America, the asylum was widely regarded as the symbol of an enlightened and progressive nation that no longer ignored or mistreated its insane citizens. The justification for asylums appeared self-evident: they benefited the community, the family and the individual by offering effective medical treatment for acute cases and humane custodial care for chronic cases. In providing for the mentally ill, the state met its ethical and moral responsibilities and, at the same time, contributed to the general welfare by limiting, if not eliminating, the spread of disease and dependency.

      After the Second World War, by way of...

    • CHAPTER 6 Continuities or Ruptures? Concepts, Institutions and Contexts of Twentieth-Century German Psychiatry and Mental Health Care
      (pp. 162-182)
      Volker Roelcke

      Twentieth-century German psychiatry is conventionally subdivided into three fairly distinct stages, parallel to German political history. On this basis, the first decades after 1900 were characterised by the success of academic psychiatrists (such as Emil Kraepelin or Alois Alzheimer) in the realms of nosology, classification and neuropathology, and the presence of a rationally structured system of mental health care built on the pillars of university departments and state asylums. The advent of Nazi rule marked the beginning of the second phase, which lasted from 1933 until 1945. Following this traditional perspective, Nazi mental health policies were guided by racial ideologies,...

    • CHAPTER 7 Care and Control in a Communist State: The Place of Politics in East German Psychiatry
      (pp. 183-199)
      Greg Eghigian

      No sooner had the Berlin Wall come down in 1989 than questions began to be asked about the role psychiatry, clinical psychology and psychotherapy had played in East Germany’s authoritarian regime. Since its founding in 1949, the German Democratic Republic (gdr) and its governing communist party (theSozialistische Einheitspartei Deutschlandsor sed) had been among the ussr’s most stalwart allies. With the reunification of Germany, western German policymakers, eastern German reformers and international observers, well aware of the Soviet practice of committing dissidents to psychiatric institutions, wondered aloud whether the same kind of systematic abuse of psychiatry had taken place...

    • CHAPTER 8 Between the National Socialist ‘Euthanasia Programme’ and Reform: Asylum Psychiatry in West Germany, 1940-1975
      (pp. 200-224)
      Franz-Werner Kersting

      We have to catch up with regard to asylum psychiatry – just like all other countries… PresidentKennedyhas expressed this insight, and it would be desirable for other governments also to identify with his message. But psychiatry in Germany faces yet otherspecial, historically determined ‘remains’. One of the medical problems of psychiatry is to discuss the question of‘restitution’… Restitution is possible and necessary [in psychiatry as well]: First with regard to the surviving victims, then – as a substitute so to speak – with regard to the ill and those in need of care now living in...

    • CHAPTER 9 ‘Misery’ and ‘Revolution’: The Organisation of French Psychiatry, 1900-1980
      (pp. 225-247)
      Jean-Christophe Coffin

      This paper will focus on the debates which have orientated the transformation of the framework of psychiatric care in the public sector throughout the twentieth century in France. It will give a general overview of the French public psychiatric sector between 1910 and 1980. One may say that this sector has dominated the scene over that period but was not the sole generator of this history. Though university and private sectors have not been included here, these should not be forgotten.³ The analysis will focus on a group of psychiatrists who were particularly active in the care of patients after...

    • CHAPTER 10 Outpatient Psychiatry and Mental Health Care in the Twentieth Century: International Perspectives
      (pp. 248-274)
      Harry Oosterhuis

      This article is about the main similarities and differences between the twentiethcentury history of extramural psychiatry and mental health care in the countries that are central in this volume: France, the Federal Republic of Germany, Italy, the Netherlands, the uk and the usa. My comparative analysis does more than switch back and forth between relevant general trends and specific national developments. It also has a double focus: the development of outpatient services and other facilities in society, also known as ‘community care’ in the Anglo-Saxon countries, and ‘de-institutionalisation’, the demise of the public system of mental institutions, or at least...

  6. Psychiatric Patients

    • CHAPTER 11 Out and In: The Family and the Asylum. Patterns of Admission and Discharge in Three Dutch Psychiatric Hospitals 1890-1950
      (pp. 277-294)
      Joost Vijselaar

      In March 1917, a 22-year-old Dutch serviceman was sent from his barracks to a psychiatric hospital by a medical officer, with the rare diagnosis of insania moralis. The young man already had a history of alcoholism, vagabondage, stealing, blackmail and promiscuous behaviour. Being forced by his father to enter the army as a way to quell this irresponsible behaviour, he turned out to be a sergeant’s nightmare, a lazy, undisciplined man, insubordinate, drinking, laughing at his superiors, etc. Since he was unresponsive to punishment or imprisonment, it was decided to refer him to an asylum. Within a month’s time, during...

    • CHAPTER 12 Were Asylums Men’s Places? Male Excess in the Asylum Population in Japan in the Early Twentieth Century
      (pp. 295-311)
      Akihito Suzuki

      The subject of psychiatry and gender has attracted considerable scholarly attention in the last two decades.¹ From the late 1980s, the cultural history of women’s madness has become an established sub-genre within the history of psychiatry and madness, through path-breaking works by Elaine Showalter and Mark Micale, to name just two.² More recently, the gender history of insanity has incorporated various approaches and historiographies, such as men’s history and colonial history.³ This chapter attempts to further expand the subject by bringing in the perspective of international comparison. Although it discusses mainly Japanese material, I have tried to go beyond a...

    • CHAPTER 13 Madness in the Home: Family Care and Welfare Policies in Italy before Fascism
      (pp. 312-328)
      Patrizia Guarnieri

      Institutions for the insane existed already in the fifteenth and sixteenth centuries, and historians of the early modern age have stressed that even then a notion existed of care, not just of confinement or segregation. But the numbers of inmates were very small. In the very long tradition of Italy,¹ Florence had 15 beds in the Pazzeria for the poor insane, founded in 1688 in S. Maria Nuova Hospital, and about 30 beds for the paying insane in S. Dorotea, opened in 1643. In the early twentieth century, there were about 1400 inmates in the two Florentine asylums.

      By comparing...

  7. Psychiatric Nursing

    • CHAPTER 14 Changing Attitudes towards ‘Non-Restraint’ in Dutch Psychiatric Nursing, 1897-1994
      (pp. 331-358)
      Cecile aan de Stegge

      In 1907, Jacob van Deventer, founder of the Dutch teaching programme in psychiatric nursing, gave a lecture for an international audience.¹ His lecture was based on 25 years of experience with asylum reform: from 1883 until 1891, he had been chief medical officer of the Buitengasthuis in Amsterdam, and from 1892 until 1904, of the Meerenberg asylum in Bloemendaal.² From 1905, he was Inspector at the State Inspectorate for the Insane and the Asylums.³ Van Deventer accentuated the great progress in psychiatry he had witnessed. Psychiatrists had – standing on the threshold of the twentieth century – finally come to...

    • CHAPTER 15 Nurses in Swedish Psychiatric Care
      (pp. 359-378)
      Gunnel Svedberg

      The history of psychiatric nursing in different European countries varies, although there are of course also conspicuous similarities. From the middle of the nineteenth century and throughout the twentieth, staff within Swedish psychiatric care have looked towards Germany, the Netherlands and the uk for inspiration. In spite of this, the Swedish model of nursing has in some important respects come to differ from that in these countries. One of the most obvious differences is that in some countries, psychiatric nursing was established as a separate branche with its own staff systems and separate recruitment and training of students, in close...

  8. Psychotropic Drugs

    • CHAPTER 16 Mental Ills and the ‘Hidden History’ of Drug Treatment Practices
      (pp. 381-402)
      Toine Pieters and Stephen Snelders

      There can be no history of psychiatry without a history of psychopharmacology. Whether on medical prescription or as self-medication, whether to sedate or to cure, whether promoted by pharmaceutical companies or clamoured for by an anxious population, the consumption of psychoactive drugs has been an integral part of the politics of mental health.

      Psychotropic drugs have been and still are important, although recurrently controversial, intervention tools in the treatment of mental ills. The administration of psychoactive substances has remained an underlying variation in mental health care, regardless of changes in therapeutic fashion. Psychiatrists, as trained doctors, have continued to prescribe...

  9. Reflections

    • CHAPTER 17 From Exploration to Synthesis Making New Sense of Psychiatry and Mental Health Care in the Twentieth Century
      (pp. 405-423)
      Frank Huisman

      The essays in this volume are part of a major effort: rethinking and rewriting the history of psychiatry and mental health care in the twentieth century. It has often been reiterated that traditionally, the history of psychiatry was written by psychiatrists and for institutions. Hence, most publications were about psychiatric theory or were placing the asylum in the centre of attention. During the last two decades, however, there have been many calls to change the focus from theory to therapy, from blueprints to actual practice, and from doctors to patients. After having gone through a mild version of the Science...

    • CHAPTER 18 Progress, Patients, Professionals and the Psyche. Comments on Cultures of Psychiatry and Mental Health Care in the Twentieth Century
      (pp. 424-437)
      Ido de Haan and James Kennedy

      There is no set standard for evaluating historical developments in psychiatric care, Marijke Gijswijt-Hofstra seems to conclude in her chapter in this volume. Not only is it difficult to find any consensus on the relative weight of criteria by which we should judge ‘progress’ (the presence of strong professional expertise, caring communities of solidarity, robust patients’ rights, etc.), as she notes, ‘it makes a significant difference whether the quality of care is judged by past or present standards’. At the same time, it is acknowledged that the history of psychiatry has been full of reformers and reform movements which have...

  10. About the Contributors
    (pp. 438-441)
  11. Index
    (pp. 442-456)
    Anne Hilde van Baal