Between Emotional Involvement and Professional Detachment: The Challenges of Nursing in Dutch Mental Institutions (1880-1980).

This article is about the tension and changing balance between emotional involvement and professional detachment in the practice of nursing in Dutch mental institutions between the 1880s and 1990s. We address this issue in relation to institutional and material conditions, power differences between doctors, nurses and patients, different treatments, and the social marginalisation of hospitalised patients. On the basis of various sources (nursing textbooks, chronicles of skills learning by students, personal accounts, questionnaires and interviews), we describe how nurses were supposed to interact with patients and how they dealt with three sensitive issues: the need to use coercion in response to agitated patients, the sexual behaviour of patients and the risk of suicide in psychiatric institutions. We argue that nursing mental patients required a great deal of emotional work and that there was a shift from strict rules of behaviour imposed from above to more flexible self-regulation, guided by self-reflection.

Freud and Albert Moll: how kindred spirits became bitter foes.

This article explores the antagonism between Sigmund Freud and the German neurologist and sexologist Albert Moll. When Moll, in 1908, published a book about the sexuality of children, Freud, without any grounds, accused him of plagiarism. In fact, Moll had reason to suspect Freud of plagiarism since there are many parallels between Freud's Drei Abhandlungen zur Sexualtheorie and Moll's Untersuchungen über die Libido sexualis. Freud had read this book carefully, but hardly paid tribute to Moll's innovative thinking about sexuality. A comparison between the two works casts doubt on Freud's claim that his work was a revolutionary breakthrough. Freud's course of action raises questions about his integrity. The article also critically addresses earlier evaluations of the clash.

Locura, salud mental y ciudadanía: del individualismo posesivo al neoliberalismo / Madness, mental health and citizenship: from possessive individualism to neoliberalism

Desde que apareció como rama de la medicina en la estela de la ilustración y la Revolución Francesa, la psiquiatría ha experimentado importantes transformaciones en el marco de diferentes cambios socioeconómicos y políticos ocurridos en las sociedades occidentales. En este contexto más amplio, puede observarse una tensión recurrente entre el interés del individuo y el del cuerpo social en su conjunto. Esta fricción está íntimamente relacionada con una serie de dinámicas contrapuestas que han marcado el desarrollo de la psiquiatría y la atención a la salud mental: humanización versus disciplina, emancipación versus coerción, inclusión versus exclusión y ciudadanía democrática versus sometimiento político. Este artículo aporta un análisis conceptual y una panorámica histórica de las ambivalentes relaciones entre la psiquiatría y la atención a la salud mental, por un lado, y la política, más en concreto, el desarrollo de la noción moderna de ciudadanía, por otro

Since its emergence as a branch of medicine in the wake of the Enlightenment and French Revolution, psychiatry has experienced significant transformations against the background of different socio-economic and political changes In Western societies. In this wider context we see a recurring tension between the interest of the individual and that of the social body as a whole. This friction is closely related to opposing dynamics in psychiatry and mental health care: humanisation versus disciplining, emancipation versus coercion, inclusion versus exclusion, and democratic citizenship versus political subjection. This article provides a conceptual analysis and an historical overview on the ambivalent relations between on the one hand psychiatry and mental health care and on the other politics, and, more particularly, the development of the modern understanding of citizenship

Mental health, citizenship, and the memory of World War II in the Netherlands (1945-85).

After World War II, Dutch psychiatrists and other mental health care professionals articulated ideals of democratic citizenship. Framed in terms of self-development, citizenship took on a broad meaning, not just in terms of political rights and obligations, but also in the context of material, social, psychological and moral conditions that individuals should meet in order to develop themselves and be able to act according to those rights and obligations in a responsible way. In the post-war period of reconstruction (1945-65), as well as between 1965 and 1985, the link between mental health and ideals of citizenship was coloured by the public memory of World War II and the German occupation, albeit in completely different, even opposite ways. The memory of the war, and especially the public consideration of its victims, changed drastically in the mid-1960s, and the mental health sector played a crucial role in bringing this change about. The widespread attention to the mental effects of the war that surfaced in the late 1960s after a period of 20 years of public silence should be seen against the backdrop of the combination of democratization and the emancipation of emotions.

Treatment as punishment: forensic psychiatry in The Netherlands (1870-2005).

This article provides an overview of the development of forensic psychiatry in the Netherlands from the late nineteenth to the early twenty-first century. The first part addresses the ways forensic psychiatry established itself in the period 1870-1925 and focuses on its interrelatedness with forensic practice, psychiatry's professionalization, the role of the government, the influence of the so-called New Direction in legal thinking and (Italian and French) anthropology of crime, and the debates among physicians as well as between psychiatrists and legal experts on the proper approach of mentally disturbed offenders. From the mid-1920s on the so-called 'psychopaths laws' anchored forensic psychiatry in the Dutch legal system. The second part zooms in on the enactment of these laws, which formalized special measures for mentally disturbed delinquents. These implied a combination of sentencing and forced admission to and treatment in a mental institution or some other form of psychiatric surveillance. The article deals with the meaning, reach and consequences of this legislation, its debate by psychiatrists and legal experts, the number of delinquents affected, the offenses for which they were sentenced and the (therapeutic) regime in forensic institutions. The goal of the Dutch legislation on psychopaths was ambiguous: if it was designed to protect society against assumed dangerous criminals, at the same time they were supposed to receive psychiatric treatment to enable their return to regular social life again. These legal and medical objectives were at odds with each other and as a result discussions about collective versus individual interests as well as about the usefulness and the effects of this legislation kept flaring up. To this day the history of this legislation is characterized by the intrinsic tension between punishment and security on the one hand and treatment and re-socialization on the other. Whether at some point one or the other prevailed was largely tied to the social climate with respect to law, order and authority.

Cadaver brains and excesses in Baccho and Venere: dementia paralytica in Dutch psychiatry (1870-1920).

This article explores the approach of dementia paralytica by psychiatrists in the Netherlands between 1870 and 1920 against the background of international developments. The psychiatric interpretation of this mental and neurological disorder varied depending on the institutional and social context in which it was examined, treated, and discussed by physicians. Psychiatric diagnoses and understandings of this disease had in part a social-cultural basis and can be best explained against the backdrop of the establishment of psychiatry as a medical specialty and the specific efforts of Dutch psychiatrists to expand their professional domain. After addressing dementia paralytica as a disease and why it drew so much attention in the late nineteenth and early twentieth century, this essay discusses how psychiatrists understood dementia paralytica in asylum practice in terms of diagnosis, care, and treatment. Next we consider their pathological-anatomical study of the physical causes of the disease and the public debate on its prevalence and causes.

'Paralysed with fears and worries': neurasthenia as a gender-specific disease of civilization.

Around 1900 neurasthenia received much attention in both the medical world and society at large. Based on professional publications by Dutch psychiatrists and neurologists and on patient records from the Rhijngeest sanatorium near Leiden in the Netherlands, this article addresses the meanings and interpretations of this nervous disorder as put forward by doctors and patients. We argue that their understanding of this disorder was determined not only by medical views, but also by social-cultural factors and prevailing gender norms.

Sexual modernity in the works of Richard von Krafft-Ebing and Albert Moll.

The modern notion of sexuality took shape at the end of the nineteenth century, especially in the works of Richard von Krafft-Ebing and Albert Moll. This modernisation of sexuality was closely linked to the recognition of sexual diversity, as it was articulated in the medical-psychiatric understanding of what, at that time, was labelled as perversion. From around 1870, psychiatrists shifted the focus from immoral acts, a temporary deviation of the norm, to an innate morbid condition. In the late nineteenth century, several psychiatrists, collecting and publishing more and more case histories, classified and explained the wide range of deviant sexual behaviours they traced. The emergence of medical sexology meant that perversions could be diagnosed and discussed. Against this background both Krafft-Ebing and Moll articulated a new perspective, not only on perversion, but also on sexuality in general. Krafft-Ebing initiated and Moll elaborated a shift from a psychiatric perspective in which deviant sexuality was explained as a derived, episodic and more or less singular symptom of a more fundamental mental disorder, to a consideration of perversion as an integral part of a more general, autonomous and continuous sexual instinct. Before Sigmund Freud and others had expressed similar views, it was primarily through the writings of Krafft-Ebing and Moll that a new understanding of human sexuality emerged.

Self-development and civic virtue: mental health and citizenship in The Netherlands (1945-2005).

This article is about the development of mental hygiene and mental health care in the Netherlands from the Second World War to the present, aiming to explore its relation to social and political modernization in general and the changing meanings of citizenship and civic virtue in particular. On the basis of three different ideals of individual self-development, my account is divided into three periods: 1945-1965 (guided self-development), 1965-1985 (spontaneous self-development), and 1985-2005 (autonomous self-development). In the conclusion, I will elaborate some more general characteristics of Dutch mental health care in its sociopolitical context.