The Rise of Mental Health Nursing
Geertje Boschma
The Rise of Mental Health Nursing

Examining the relations between the rise of scientific psychiatry and the emergence of mental health nursing in Dutch asylums, this study analyses the social relationships of class, gender and religion that structured asylum care in the Netherlands around 1900. Drawing on archival collections of four Dutch asylums, the book highlights the gendered nature of mental health nursing politics. Seeking to model the asylum after the forceful example of the general hospital, psychiatrists introduced new somatic treatments and designed mental nurse training which aimed at creating a nursing staff skilled in somatic care. The training system, based on the projected image of the civilized, middle-class female nurse, bringing competence and compassion to the care of the mentally ill, created new opportunities for women, while at the same time restricting the role of men in nursing. Capturing the contradictory realities of hospital-oriented asylum care, the book illustrates the social complexity of the care of the mentally ill and forms an important addition to the historiography on European psychiatry.

The Rise of Mental Health Nursing onderzoekt de tegenstrijdigheden in de op het ziekenhuis georiënteerde inrichtingszorg, die rond 1900 opkwam. Bovendien illustreert het boek de sociale complexiteit van de psychiatrische zorg. Op basis van archiefmateriaal uit vier Nederlandse psychiatrische inrichtingen onderzocht Geertje Boschma de sociale verbanden die de psychiatrische verpleging rond 1900 kenmerkten. De introductie van nieuwe somatische behandelingsmethoden door psychiaters creëerde destijds een vraag naar verplegend personeel dat geschoold was in somatische zorg. Het opleidingsmodel, dat (overwegend mannelijke) psychiaters ontwikkelden, was gebaseerd op het beeld van de beschaafde vrouwelijke verpleegster uit de middenklasse die competentie en compassie in de zorg verenigden. De nieuwe kansen die hiermee gecreëerd werden voor vrouwen legden tegelijkertijd een beperking op aan de rol van mannen binnen de verpleging.

Care of the Mentally Ill
Asylum Attendants and Mental Nurses
The Historiography of Mental Health Nursing
Four Asylums as Case Studies
The Chapters in Brief
Chapter I • Asylum Reform Ideals: Personnel Matters
The Appeal of Institutional Care and Moral Treatment
A Legal Basis for Asylum Reform
Increased Medical Influence
Liberal Views, Reform Rhetoric, and the Problem of Personnel
Lower-Class Institutions
The Position of Attendants and Patients in the Asylum Hierarchy
Different Responses and Different Solutions: Roman Catholic Initiatives
Reform Ideals Frustrated: Asylum Growth and a New Law
A Second Law on the Insane
Awakening of Protestant Duty
Chapter II • The Ideal of a Mental Hospital
New Medical Opinions: Scientific Psychiatry
Medical Views in Veldwijk: A Christian Psychiatry
Bed Rest
Architectural Changes and the Increased Application of Bed Rest
Hydrotherapy and Bath Treatment
Work Remained
The Inspiring Example of the General Hospital: A New Demand for Skilled Nursing
Chapter III • Female Compassion: Mental Nurse Training Gendered Female
Religious Roots
Female Compassion, Domestic Ideology and the Women’s Movement
Growing Demand
A New Educational Structure for Nurses
A Respectable Salaried Occupation
Female Influence
Hospital Hierarchy
Raising the Status of Psychiatry: The Introduction of Mental Nurse Training
Gendered Ideals: Raising the Morality of Asylum Personnel
Het Wilhelminahuis (The Wilhelmina Home)
Chapter IV • The Burdensome Task of Nurses
The Invisible Role of Nurses
The Nurse as Object and Agent of a Disciplined Asylum Routine
Threat, Repression, and Abuse: The Division of Wards as a Control Mechanism
An Analysis of Patient Records
Responding to Dependency
Growing Old and Demented
Sick since Youth
Suffering from Mania, Acutely or Periodically
The Care of Paralyzed and Handicapped Syphilis Patients
They Wished to Be Dead: The Risk of Suicide
Overcome by Delusions: The Risk of Refusing Food, Self-Mutilation, Violence and Escape
Nervous Afflictions and Brain Trauma: Rare Cases in the Turn-of-the-Century Asylum
Chapter V • Negotiating Class and Culture
A Gendered Structure
A New Discipline and Morale
Culture Shock
The Orthodox Protestant Perception of Mental Nurse Training: A Family Ideology
Gendered Nursing Leadership in Veldwijk
Implementing an Educational Structure
Mental Nurse Training at Veldwijk
Debate over The Boschhoek
The Boschhoek Revisited
Roman Catholic “Resistance”
Chapter VI • The Marginalization of Male Nurses
Nursing, a Respected Occupation – but not for Men
Squeezed out
Nurse Artisans
The Home of a Married Nurse: A Place of Family Care?
Growing Class Consciousness
Male Nurse Activism and the Career of P.N. Bras
Gendered Politics versus Expertise
Chapter VII • Controversy and Conflict over the Social Position
An Ambiguous Social Position
Growing Social Awareness among Asylum Nursing Personnel
Activism among the VCV Nurses
Seeking Legal Protection from the State
Controversy over Training
Ambivalence over Morality and Class Background
The Threat of Private Duty
Tension over the NVP Exam Criteria
Controversy over the Somatic Approach and Biomedical Footing of Psychiatric Care
Conclusion • The Politics of Mental Health Nursing
The Disappointment of Somatic Explanations in Turn-of-the-Century Psychiatry
A Gendered Notion of Civilized Care
The Educational versus the Social Value of Mental Nurse Training
Economic Problems, Growing Costs
Ideals and Limitations
List of Illustrations
List of Abbreviations
List of Archives
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