Harry Oosterhuis

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

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.

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.

Between institutional psychiatry and mental health care: social psychiatry in The Netherlands, 1916-2000.

The term “social psychiatry” became current in the Netherlands from the late 1920s. Its meaning was imprecise. In a general way, the term referred to psychiatric approaches of mental illness that focused on its social origins and backgrounds. In this broad interpretation social psychiatry was connected to the psycho-hygienic goal of preventing mental disorders, but also to epidemiological research on the distribution of mental illness among the population at large. The treatment called “active therapy”, introduced in Dutch mental asylums in the 1920s and geared towards the social rehabilitation of the mentally ill (especially through work), was also linked with social psychiatry. In a more narrow sense social psychiatry indicated what before the 1960s was usually called “after-care” and “pre-care”: forms of medical and social assistance for patients who had been discharged from the mental asylum or who had not yet been institutionalized. This article focuses on the twentieth-century development of Dutch social psychiatry in this more narrow sense, without, however, losing sight of its wider context: on the one hand institutional psychiatry for the insane and on the other the mental hygiene movement and several outpatient mental health facilities, which targeted a variety of groups with psychosocial and behavioural problems. In fact, the vacillating position of pre- and after-care services was again and again determined by developments in these adjacent psychiatric and mental health care domains. This overview is chronologically divided into three periods: the period between and during the two world wars, when psychiatric pre- and aftercare came into being; the post-Second World War era until 1982, when the Social-Psychiatric Services expanded and professionalized; and the 1980s and 1990s, when they became integrated in community mental health centres.

Psychotherapy in The Netherlands after the Second World War

The early history of psychotherapy in the Netherlands hardly differs from that of the surrounding countries. Somewhat later than in France and Germany, psychotherapy appeared during the last decades of the nineteenth century,1 with general practitioners who started to treat their patients (mainly for all kinds of somatic complaints) by psychological means.2 In the early decades of the twentieth century, psychotherapy was narrowed down to mainly psychoanalytic treatment. The patient population consisted of a small elite group of people who belonged to the upper social classes. The practice of psychotherapy was restricted to some “enlightened” psychoanalysts.3 However, the more recent history of Dutch psychotherapy is much more unusual. The increase in ambulatory mental health care services as well as psychotherapy was higher than elsewhere in Europe.4 Psychotherapy grew so fast that by the 1980s it was considered the best form of treatment in ambulatory mental health care.5 Even more exceptional was the establishment of a separate profession for psychotherapists, so that as well as being registered as a psychiatrist, general doctor, psychologist or even social worker, it was possible to be registered as a psychotherapist. This phenomenon has been characterized as “le phenomene hollandais”.6 This article deals with this recent history of psychotherapy in the Netherlands. The main focus is on the developing institutions as well as on the establishment of the psychotherapeutic profession. The first section describes the period between the foundation of the first psychotherapeutic institute in Amsterdam in 1940 and the emergence of the regional ambulatory centres for mental health care (RIAGG) in 1982. In this period the number of patients benefiting from psychotherapy grew rapidly; shifts in the attitude of society towards psychology in general and the individualization of people supported the emancipation of the patient. At the same time, as will be shown in the second section, the history of psychotherapy partly covers the process of the professionalization of the psychotherapist. In 1930 only a few psychoanalysts regarded themselves as psychotherapists, whereas in 2000 almost 5,000 psychotherapists were officially registered as such. The formal and multidisciplinary character of the profession is typically Dutch: it has a legal status and, apart from general doctors and psychiatrists, the vast majority of psychotherapists are also psychologists. In the third section, we will briefly describe recent developments. Firstly, the effects of the rise in popularity of biological psychiatry are depicted and secondly, the efforts being made to dismantle the profession. We will argue that these events could reveal another transformation in the way in which mental health problems are considered.

Falling Between Two Stools. The Difficult Emancipation of Bisexuality in the Netherlands

Over the last decade, media attention for bisexuality has increased in the Netherlands. Especially among younger people, there appears to be more openness and tolerance for bisexual feelings and behavior. Also, a growing number of individuals seem to identify themselves as bisexual. Has there indeed been a change in attitudes and behaviors involving bisexuality? In order to answer this question, the authors rely on a combination of historical and sociological approaches. First, they offer a historical overview of the sexological conceptualization of bisexuality. Second, they analyze the questions and the results of a number of sociological surveys on sexual attitudes and behavior. Third, the authors present a case study of how bisexual feelings and behavior were interpreted by readers and editors of a Dutch magazine popular among a young female readership.

Cycling, modernity and national culture.

Abstract This historiographical essay provides an overview of extensive recent work on the history of cycling to show the diverse ways in which the bicycle was adopted and experienced across western societies. Two key aspects are explored. First, it discusses the complex relationship between cycling and modernity, including tensions between ideas about cycling as liberating and as a vehicle of social conformity (in relation to gender as well as social class and status). Second, it highlights distinct differences in cycling levels, patterns of use and cycling cultures between nations. It is argued that these differences, which have been historically constituted, explain present-day cycling trends as well as the success or failure of policy initiatives across western countries.

Madness and crime: historical perspectives on forensic psychiatry.

The human sciences have been profoundly significant in the development of modern society and our current understanding of individuals and groups within them. The human sciences have a fascinating history – emerging first as products of the bourgeois society that arose in the era of the Enlightenment and the French Revolution, the human sciences developed in a dialectical relationship between humanization and disciplining, emancipation and coercion, assimilation and marginalization, and democratic rights and political control. In this article, we sketch the general historical background of forensic psychiatry and we discuss the main themes, points of interest and questions that emerge in the jurisdiction-specific contributions to the special edition of International Journal of Law and Psychiatry for which this article serves as Introduction. Recurring themes include: forensic psychiatry’s relation to legal traditions and schools; the relation between legal and medical ideals, theories, discourses and practices, including in particular differing and changing meanings of criminal insanity and non-responsibility.

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.

Mental Health as Civic Virtue: Psychological Definitions of Citizenship in the Netherlands (1900-1985).

This chapter discusses how, in the Netherlands from around 1900 until the mid-1980s, the idea of ‘citizenship’ acquired new definitions in the context of developing ‘mental hygiene’ and outpatient mental health care. Formulating views about the position of individuals in modern society and their potential for self-development, psychiatrists and other mental health workers linked mental health with ideals of democratic citizenship. Thus, they were involved in the liberal-democratic project of promoting not only productive, responsible, and adaptive citizens, but also autonomous, self-conscious, and emancipated members of an open society.

Carlton Reid, Bike Boom: The Unexpected Resurgence of CyclingReidCarlton, Bike Boom: The Unexpected Resurgence of Cycling, London, Island Press, 2017; 246 pp., US

is about much more than cars. Moreover, the book also does not encompass everything that could be said about automobilism: some important motor vehicles and themes are missing, such as the motorcycle and the development of French roads which since the 1950s have been crucial for promoting the wine industry to tourists. To sum up, this book is a solid historical work based on a wide range of source materials and is mainly iconographic (around three images by page). It shows clearly and concisely how French society was transformed by the motor vehicle during the Thirty Glorious, and can be read by specialists of mobility or not. Finally, it allows readers to understand the place of automobilism in French society and to consider the context of the third automobile revolution that we can see today in France.