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Related Topics
The Rise of Mental Health NursingReview - The Rise of Mental Health Nursing
A History of Psychiatric Care in Dutch Asylums, 1890-1920
by Geertje Boschma
Amsterdam University Press, 2003
Review by Tony O'Brien, M. Phil.
Sep 8th 2004 (Volume 8, Issue 37)

Geertje Boschma's account of the origins of mental health nursing in the Netherlands offers an insightful and scholarly analysis of a period of social history that is otherwise not especially well researched. Boschma's research draws on the archival records of four Netherlands asylums. The rise of mental health nursing situates late nineteenth century psychiatry within the complex and structure unique structure of Dutch society, and provides a careful documentation of the many influences of that period that shaped both psychiatry and the emerging discipline of nursing. The result is a satisfying and rich description.

The turn of the nineteenth century is an especially interesting period in the history of psychiatry. The asylums that had expanded throughout the western world in the previous 100 years had lost much of their legitimacy as places of medical care, and had become, using Scull's phrase 'warehouses of despondency and gloom'. The many histories of psychiatry that have been written about that period concentrate mainly on psychiatry or the social history of patients. Nursing has seldom been studied with the depth that Boschma brings to this task.

The book begins by with a description of the plural nature of Dutch society; the phenomenon of verzuiling, translated as 'pillarization' or 'compartmentalization'. Political reform enabled religious groups such as Roman Catholics and Protestants to develop their own organizations, something denied under the national government with followed the end, in 1815, of French occupation. Understanding this social context, and the increasing industrialization of the Netherlands in the latter half of the nineteenth century is crucial to an appreciation of the development of asylum care and psychiatry. The categories of gender, class, religion and scientific psychiatry reflect the plural nature of the Netherlands at this time. Boschma shows how these related categories were played out in the secularization of the asylums and in the contradictory interests served by the feminization of asylum care and the development of mental nurse training.

Boschma describes the different processes by which moral treatment regimes, to different degrees committed to religious models of insanity, became secularized, and committed to what was regarded as scientific psychiatry. Care of inmates became the business of the emergent discipline of nursing, initially based on the nursing practices of general hospitals, but later incorporating elements of pedagogy. By the early twentieth century something we would recognize today as a therapeutic relationship formed part of the mental health nursing curriculum. The process of change was uneven and contested. Professional groups of psychiatrists and, later, nurses, labor and clerical interests, and womens' groups with differing agendas for change, all played a part in the development of mental health nursing. At times their interests converged, for example when psychiatrists' and nurses' organizations lobbied for the introduction of training. But even this convergence of interests contained contradiction. Psychiatrists' interests in creating a compliant workforce subject to psychiatric rather than religious authority did not extend to supporting nurses' release from domestic duties such as cleaning and housekeeping.

The idea of asylum care as a civilizing enterprise requiring cultured individuals of good moral character and social standing is a prominent theme. The perception that women were more morally suited to the task coincided with the rising expectations of women for participation in the labor market. For many women asylum care offered an opportunity for employment that was otherwise denied. However the reality of asylum work was such that the expectations of women as employees were not met. The long hours, restrictive living conditions and arduous tasks of asylum work led to high attrition rates. To some extent this was exacerbated by the introduction of training programs, as graduates left the asylum for more congenial employment in providing private care, especially to individuals with 'nervous conditions' who, it can be imagined, presented less onerous problems to their nurses.

The everyday work of mental health nurses comes to life in this book. Supervising 'bath treatment' in which patients were restrained, sometimes for days on end, in baths of water and in which they ate, drank, defecated and slept, sleeping in dormitories with the patients whose care they provided, facing fines and disciplinary action in any case of perceived dereliction of duty, especially if it resulted in adverse publicity for the asylum administrators, combining care of patients with domestic tasks were all part of the lot of the mental health nurse at this time. Low rates of staff retention were explained in terms of the nurses' lack of 'civilization'.

One of the intriguing aspects of this book is its analysis of the marginalization of male nurses. As the new gendered model of asylum care developed, male nurses were seen to lack the necessary civilizing moral character necessary for asylum work, to be unreliable as employees, and less easy to discipline by psychiatrists. But Boschma never opts for a one-dimensional analysis. Labor market conditions meant that men has less reason than women to see asylum work as a career opportunity, as there were other employment opportunities available to them that were denied to women. Thus although the gendered stereotype of females as possessing natural caring qualities contributed to the decline of males in mental health nursing over this period, that alone is not a sufficient explanation for their relative exclusion.

Boschma's skill in showing the relationships between the various forces at work in shaping the history of mental health nursing, evident throughout the book, is one of the factors that makes her work rewarding and informative. While there are certainly themes that could be developed further, Boschma's achievement in bringing together an analysis of Dutch society with themes of gender, class and religion is impressive. The work is extensively referenced to other research and published material, and the explanatory footnotes provide a rich source of detail for those interested in the minutiae of historical research. Any student or teacher of the history of psychiatry or mental health nursing will find this book has something to offer in extending their understanding of that history, and of the Dutch context in particular.

 

2004 Tony O'Brien

 

 

Tony O'Brien M Phil., Lecturer, Mental Health Nursing, University of Auckland


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