Book Review – Anne Roekens (dir.), Des murs et des femmes. Cent ans de psychiatrie et d’espoir au Beau-Vallon (Presses Universitaires de Namur 2014)
The psychiatric institution le Beau-Vallon was founded at the eve of the first World War by the catholic order of les Soeurs de la Charité de Jésus et de Marie. Located on one of the hills surrounding the Belgian city of Namur and dedicated to the exclusive care of women, Beau-Vallon was designed as the first pavilion asylum of Wallonia and rapidly developed into an imposing near-autonomous structure isolated from what was seen at the time as the poisonous influence of the city. On the day of its official inauguration in 1924, it was already comprised of eleven pavilions housing a total of 740 patients.
Today, the institution celebrates a century of existence with the release of a book entitled Des murs et des femmes: Cent ans de psychiatrie et d’espoir au Beau-Vallon. Edited by Anne Roekens, a professor of contemporary history at the University of Namur and also the (co-)author of five out of the book’s seven chapters, Des murs et des femmes showcases the penmanship of seven additional contributors, among whom three psychiatrists (Xavier de Longueville, Benoît Delatte and Jean-Paul Rousseaux, responsible for the seventh chapter), three young historians graduated from the Catholic University of Louvain (Nathalie Collignon, Lisa Lacroix and Mélanie De Brouwer) as well as historian Benoît Majerus who has published extensively on the history of psychiatry in Europe these last few years. The book also incorporated elements from the work of students from the UNamur history department who in 2012 and 2013 were given the opportunity to delve into the records of the institution.
Thematically structured, Des murs et des femmes explores different aspects of the history of the institution, from the context of its foundation to its present state, from its evolving spatial infrastructures and treatment procedures, to the specificities of its personnel and patient population. The book does a great job at revealing the slow processes behind some of the important changes that radically affected 20th-century psychiatry, such as the apparition of psychopharmacology, the professionalization and secularization of the medical personnel, deinstitutionalization, etc. Surprisingly, the history of Beau-Vallon (which would have been considered a second-class country asylum – ou “asile de province” – by the medical authorities of the capital) parallels that of western psychiatry more closely that one might think. In one instance it even seems to have anticipated change when the institution opened several residential facilities outside the hospital a decade before the launch of the 1991national plan to encourage the development of ‘MSP’ (Psychiatric Care Houses) and ‘IHP’ (Protected Homes Initiatives). This last fact the authors are of course eager to point out. But Des murs et des femmes is far from being the simple celebratory narrative that one might expect. Although never overtly critical of this particular institution, the authors do not shy away from sensible topics such as forced confinement, physical coercion, unresponsive physicians, suicide or social segregation inside the asylum, etc. The tone of the book is globally that adopted by most medical historians today who cautiously navigate between the radical anti-institutional acidity of the 60s/70s and the blind optimism of Whiggish medical-historical writing. This middle way is apparent when the authors expose the mutability of the totalitarian psychiatric space, recontextualize the use of mental therapeutics or brush aside the rigid physician-patient antagonism to highlight what Benoit Majerus in his book Parmi les fous (2013) already deemed the central relationship of the everyday institutional psychiatric experience: that of nurses and patients.
Des murs et des femmes, however, will probably prove a frustrating read for historians of psychiatry due to a somehow limited depth of analysis. It propounds no really innovative thesis. The book might be in this regard illustrative of a certain Belgian francophone approach to history: close to its rich source material but lacking in theoretical background and perspective. The two first chapters (Le temps des fondations & Espaces psychiatriques, espaces religieux) appear the strongest and tightest while the four following chapters, dealing respectively with the two world wars, the patient population, treatment and the asylum personnel, seem a bit more factual and loosely problematized. The last chapter, which is concerned with deinstitutionalization and was penned by the three medical authors, confidently recounts the progressive opening of Beau-Vallon and the evolving Belgian legal context in many interesting and necessary details but without never really questioning the process of deinstitutionalization itself. To be fair, the very nature of the project must have imposed some limitations to the contributors’ creativity. When medical historians decide to work on the records of a single medical institution, it is usually to study some or other aspects of medicine or psychiatry, and they are then usually free to narrow their focus as they think best for the relevance of their subject. In The Psychiatric Persuasion, for instance, Elizabeth Lunbeck used the records of the Boston Psychopathic Hospital to write about the psychiatrization of everyday life, just as a few years earlier Nancy Tomes in The Art of Asylum-Keeping dug through the archives of The Pennsylvania Hospital for the Insane only to reflect about the social significance of mid-19th century asylums . But Des murs et des femmes is ultimately the history of the Beau-Vallon asylum itself, an object uneasily unified around a cardinal analytical argument. The study, as a result, covers the major aspects of the institution’s evolution in a thematic overview that still seems to have a lot of unexplored potential.
It is great, however, to see a medical institution collaborate with historians and work such as this being commissioned. And despite its limitations, Des murs et des femmes seems to achieve its purpose successfully. It is a carefully researched and well written effort that is also accessible for the layperson. This accessibility would seem essential for a centennial anniversary publication. The source material used by the different authors is incredibly rich and varied; it includes congregational and hospital archives, legislative texts, medical literature, private archives, oral history (most interviews have been conducted by Anne Roekens), photographs, etc. Moreover, long excerpts from archival documents are showcased in dark grey sidebars, giving the reader direct access to the words of various actors from the period – whether it be catholic nurses or nursing students, psychologists, a priest or a judge. This makes for an engaging read that will similarly please the general, medical and historian public. It is also worth noting that the history of sciences and medicine in Belgium is still in its infancy. In this regard, any contribution to this field is highly valuable, especially when it points out, as is the case here, the specificities of the Belgian situation (for instance the predominantly religious and hospital-centered character of 20th century Belgian psychiatry), possible archive material and new territories to explore while contributing to building the picture of a larger national historical context that no reference work has yet come to illuminate.
1. Elizabeth Lunbeck, The Psychiatric Persuasion : Knowledge, Gender, and Power in Modern America, Princeton: Princeton University Press, 1994; Nancy Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry, Philadelphia: University of Pennsylvania Press, 1994 (origin. ed. 1984)
Valerie Leclercq is a FNRS doctoral Research Fellow at the Free University of Brussels. Her areas of interest include 19th and 20th-century medicine, the history of patients, psychiatry and medical ethics. She is currently writing her dissertation on the therapeutic encounter at the turn of the 20th century.