The expansion of medical education in the Dutch East Indies and the formation of the Indonesian medical profession.

In 1851, the colonial administration of the Dutch East Indies established a two-year program to educate young Javanese men to become vaccinators in Batavia (today's Jakarta). During the following sixty years, the medical curriculum was expanded several times; in 1913, it consisted of a ten-year program. In 1927, the Batavia Medical School, granting degrees equivalent to those of Dutch university-affiliated medical schools, commenced operations. Consequently, a steadily increasing number of Indonesian physicians with various credentials were employed by the colonial health service, plantations, sugar factories and mines, or established private practices. They became a social group that occupied an ambiguous and even paradoxical position somewhere between Europeans and the indigenous population. During the 1910s, this inspired these physicians to obtain credentials and professional recognition equal to those of their European colleagues. Several of them became active in journalism, politics and social movements. During the 1920s, several became radicalised and criticised the nature of colonial society. In the 1930s, following the increasingly repressive nature of colonial society, most of them remained active in the public sphere while a small group dedicated itself to improving medical research and health care. After the transfer of sovereignty from the Netherlands to Indonesia on 27 December 1949, this small cadre reestablished medical education and health care, and built the Indonesian medical profession.

Mental health literacy of Indonesian health practitioners and implications for mental health system development.

Compared to other countries in the South-East Asian region, Indonesia's mental health system remains underdeveloped from significant treatment gaps, which subsequently contribute to human rights violations of mental health patients who do not receive adequate medical care. In line with the introduction of universal health coverage in 2014, the Indonesian government plans to redress this by delegating detection and early intervention of mental health services to health practitioners without specialist training in mental health, however, there is limited evidence that they can perform this role effectively. This study aims to evaluate current workforce capacity by assessing differences in mental health literacy between Indonesian mental health and non-mental health practitioners. Compared to non-mental health practitioners, mental health practitioners are significantly less likely to hold stigmatising views towards individuals with mental illness. They are also significantly more likely to correctly recognise symptoms of depression and schizophrenia and recommend and implement evidence-based interventions for these conditions. These findings suggest that task-shifting is unlikely to be an effective solution to reduce the mental health treatment gap, and it is recommended that mental health system reform in Indonesia should initially focus on expansion and retention of the specialist mental health workforce.

Psychology and psychiatry in the global world: Historical perspectives.

Introduces articles in the special issue of History of Psychology, Psychology and Psychiatry in the Global World Part I. The special issue seeks to consolidate and extend the historical analysis of psychology and psychiatry in the global world by bringing together seven articles detailing how theories, techniques, and practices have been translated, adapted, and appropriated in the colonial and postcolonial eras. The contributions demonstrate that it is fruitful to conduct research in the history of psychiatry and psychology together as broader ideational frameworks such as social Darwinism, eugenics, degeneration, and mental hygiene have inspired the development of psychological and psychiatric insights as well as the adoption of their intervention strategies worldwide. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Physician-assisted dying and psychiatry: recent developments in The Netherlands.

The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.

The psychiatrist as administrator: the career of W.F. Theunissen in the Dutch East Indies.

W. F. Theunissen (1882-1961) was a leading psychiatrist in the Dutch East Indies. He was the medical director of several large mental hospitals after which he became director of the Dutch East Indies Public Health Service. Theunissen was not known for his research into the causes of mental illness. Instead, he made his mark as an administrator greatly reducing the expenses of the Lawang mental hospital by expanding occupational therapy in new and innovative ways. His accomplishments earned him the position of director of the Indies Public Health Department, where he oversaw the decentralisation of health services and the development of public health initiatives.

Notes from Batavia, the Europeans' graveyard: the nineteenth-century debate on acclimatization in the Dutch East Indies.

Since the advent of European colonial expansion, medical theories of acclimatization have been inextricably related to convictions about the possibility and desirability of white settlement in the colonies, and political ideas of colonial governance. Before 1800, acclimatization theories emphasized the inherent flexibility of the human constitution and its ability to adapt to new environments. During the first half of the nineteenth century, European theorists came to highlight the vulnerability of white Europeans in the tropics to disease, degeneration, and death instead. They consequently argued that white settlement in the tropics was impossible and inadvisable. European physicians in the British and French colonies presented similar views. By contrast, their colleagues in the Dutch East Indies remained optimistic. They associated themselves with the colonial European settler community and shared their grievances against autocratic colonial rule. They presented medical theories which related acclimatization to prudent behavior, morality, and proper management of the environment, thereby downplaying the significance of climate and high temperatures. During the following decades, their views on acclimatization were transferred to the Netherlands, where they were deployed as an argument against the cultivation system, the then-current approach of colonial governance, which emphasized the trade of cash crops grown by the indigenous population, severely limited European settlement, and curtailed the rights of Europeans living in the Indies. Throughout the nineteenth century, the influence of climate and the possibility of acclimatization became recurring themes in debates about colonial governance in both the Dutch East Indies and the Netherlands.

The impact of an emergency motorcycle response vehicle on prehospital care in an urban area.

INTRODUCTION: Faster emergency response times are generally considered to have a positive effect on life expectancy of patients with a life-threatening event, leading many communities to determine response time intervals. However, worldwide, increasing urbanization and traffic congestion threatens ambulance response times. An emergency motorcycle response vehicle (MRV) can overcome these hurdles more easily than a larger ambulance. It also offers dispatch flexibility in responding to calls estimated to have a low likelihood of a patient who needs transport. The first aim of this study was to determine whether an MRV can shorten response times and impact on resuscitation outcomes in a heavily urbanized and densely populated region in the Netherlands. The second aim was to evaluate differences in dispatch and transport between MRV and ambulance. METHODS: This was a nonrandomized, prospective cohort study comparing an MRV unit with regular ambulances in a Dutch city of 265 000 people. Included were all 'urgent patient' cases within operating time of the MRV between January 2003 and August 2003. RESULTS: A total of 1664 patients was evaluated, including 468 motorcycle and 1196 ambulance responses. Use of MRVs led to a decrease in response time of 54 s (P≤0.01). We could not show a decrease in mortality risk in cases of resuscitation [relative risk (RR): 2.50, confidence interval (CI): 0.17-36.21]. There was a slightly improved 1-year survival in other life-threatening cases (RR: 1.13, CI: 1.03-1.24). However, this is most likely because of differences in dispatch decisions (the MRV is sent to 'lighter' cases) and not because of faster assistance. The MRV paramedic was more likely to treat and release the patient (RR: 2.21, CI: 1.80-2.73) or refer them to a general practitioner (RR: 2.11, CI: 1.73-2.58) and much less likely to refer them to the hospital emergency department (41.2 vs. 72.6%). Referrals to the hospital by the MRV were mostly by the patient's own means of transportation (RR: 13.14, CI: 5.89-29.32) rather than by ambulance. CONCLUSION: Using motorcycles in a Dutch setting lead to better emergency medical service response times. The MRV serves a different population. Resulting in a higher treat and release rate and less transportation to hospital.

Chapter 27: a history of cerebrovascular disease.

Stroke is central to the history of cerebrovascular disease. References to this condition already appear in the Hippocratic corpus, referred to as apoplexy, which was defined by the clinical presentation: a sudden collapse, a loss of consciousness, a lack of movement, and included a variety of pathologies. A humoral imbalance was seen as the causation. In the 17th century, Johannes Wepfer, a Swiss physician, first demonstrated that apoplexy was caused by an intracranial hemorrhage; Thomas Willis, an English anatomist, explored the role of the cerebral arteries. Stroke became a cerebrovascular disease. By the 19th century, based on extensive clinico-pathological correlates initiated at the Paris Medical School, a vascular basis was firmly established and a range of pathologies determined. Apoplexy was considered too imprecise, and the term abandoned in favor of the term "cerebro-vascular accident" and latterly stroke. Although physicians of the 19th century utilized a wide variety of therapies in the treatment of stroke, with particular emphasis on blood letting, therapeutic nihilism dominated stroke management well into the 20th century. Following the mid 20th century work by C. Miller Fisher, with the recognition of the importance and the therapeutic implication of the carotid artery in stroke, the specialty of stroke medicine came into being. Therapeutic nihilism was replaced by an increasing armamentarium of therapeutic interventions.

War & military mental health: the US psychiatric response in the 20th century.

Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future.

Psychological knowledge in a colonial context: theories on the nature of the "native mind" in the former Dutch East Indies.

This article analyzes the views of 3 Dutch physicians working in the former Dutch East Indies during the first part of the 20th century. These physicians based ideas about the nature of the normal indigenous psyche on both their analysis of Indonesian individuals suffering from mental illness and on casual observations that represented widely shared cultural stereotypes. On that basis, they advocated a psychological colonial policy, which was to be based on a scientific understanding of the psyche of the Indonesian people. Using these ideas, they advocated political repression, justified inequality and racism, and limited educational opportunities for Indonesians. Representatives of the Indonesian nationalist movement vigorously protested against these ideas.

War neurosis, adjustment problems in veterans, and an ill nation: The disciplinary project of American psychiatry during and after World War II.

After World War II, the confidence of American psychiatrists was at an all-time high as a result of their successful participation in the war. When the incidence of mental breakdown in the American armed forces rose to unprecedented heights, new and effective psychotherapeutic methods were developed to treat the traumatic effects of the extraordinary stresses of warfare. At the same time, social scientists concluded that breakdown incidence was inversely related to morale, which led to the development of preventive measures aimed at specific groups. Both initiatives stimulated a number of psychiatrists to plan projects of social engineering after the war. They first focused on aiding the reintegration of returning veterans. Later, they addressed the poor mental health of the American population as a whole, which they considered to be the consequence of faulty child-rearing methods.

Waking up to shell shock: psychiatry in the US military during World War II.

During World War I, military officers encountered a new and puzzling phenomenon: soldiers emerged from the trenches stuttering, crying, trembling and at times were even paralysed and blind. Those in charge were convinced these soldiers were cowards or malingerers who deserved stern discipline or to be court-martialled. A number of physicians, by contrast, initially assumed that these alarming symptoms resulted from close exposure to explosions and called it shell shock. Later, they realized that it was a psychological reaction and came up with psychotherapeutic treatments. But it was only in World War II that military psychiatrists, particularly those in the USA, began to implement treatment methods for this phenomenon in a systematic way. Their thinking and the treatments they devised had significant consequences for the future of American psychiatry, which in turn influenced the development of psychiatry and military psychiatry world-wide.

Anomie in the metropolis: the city of American sociology and psychiatry.

American sociologists and psychiatrists have often characterized cities as sites of social disintegration conducive to insanity. Small-town rural life, by contrast, has been presented as ideally suited for fostering mental health. Early research in psychiatric epidemiology confirmed these views. After World War II, psychiatrists and sociologists collaborated in influential research projects on mental illness in the community. Although these studies were guided by theories of social stratification, which ignores location, cities remained problematic for psychiatrists because they contained high concentrations of poverty and social problems and, consequently, mental health problems.

Between the laboratory and life: child development research in Toronto, 1919-1965.

Between 1919 and 1956, psychologists at the University of Toronto built a research program in developmental psychology on a functionalist, holistic, and ecological basis. They conducted longitudinal studies on mental health in growing children in educational settings instead of in laboratories and formed strong alliances with the local educational system in order to do so. They initially defined mental health as adjustment and considered conditions within schools to be conducive to its attainment. After developing a psychological theory of personality development, they came to view educational conditions as discouraging the development of mental health. The alliance between the educational system and psychology consequently unraveled, and the program declined.