Joost Vijselaar, Het gesticht, enkele reis of retour (Amsterdam 2010; Uitgeverij Boom); The asylum, single fare or return

Based on an extensive qualitative analysis of patient records, this book studies in great detail the social patterns of admission, stay, treatment, care, and discharge in three Dutch psychiatric hospitals in the period 1890-1950. In line with other recent research, it demonstrates that families did in fact cope and care for their disturbed relatives, sometimes for extended periods of time and even in cases of serious mental illness. In general, two major factors contributed to the referral of a patient to an institution: first, escalating, disruptive behavior that threatened the patient’s social integration; and second, the weakening of the capacity of the family to cope with and care for the patient. The intensity of treatment in these hospitals was conspicuously low, the emphasis laying on care rather than cure, and on the regulation of disturbing behavior, with internal transfer between wards for the quiet and the (half)disturbed being the most important social tool. Labour and bed rest constituted the backbone of the regime in Dutch asylums during the entire period, covering the functions of cure, care, and the management of unrest. Therapeutic innovations, such as the famous somatic cures (e.g. ECT), did not characterize the regime in a significant way, but were rather adopted in only a quarter of all cases. Patterns of discharge mirrored the process of admission: with a psychiatrist assessing improvement by social criteria (such as the measure of social integration), and families exerting a clear influence on the discharge of their relatives, the probationary discharge being the instrument of choice for doctors to test the adaptive power of both family and (former) patient. Families did exert a significant ‘pull’ on the asylum, benefiting those with a social network in society. In all, the asylum was less high-walled than its general image would have us believe, and its population had a more dynamic character than is often assumed. Admission to an asylum did amount to a ‘return fare’ for a considerable number of patients suffering from manic-depressive or psychotic disorders.