The Rise of Mental Health Nursing: A History of Psychiatric Care in Dutch Asylums, 1890-1920 (review)

The Rise of Mental Health Nursing brings the reader back to Dickensian times. Geertje Boschma describes the complex forces that led the Dutch mental health care system to evolve at the turn of the century—changes that are, to a large extent, representative of events in most northern European countries as well as in the United States. Boschma's work is predominantly a result of researching the archives of four Dutch asylums. It covers the time when psychiatric patients started being seen as people with mental illnesses, rather than as people with "a loss of reason that supposedly kept the afflicted in a bestial stage and legitimized their enchainment" (p. 31). The author describes heart-wrenching cases of human suffering that resulted from the unscientific psychiatry of the day and a care system that was just starting to evolve. Both patients and staff, predominantly psychiatric nurses, had to endure many hardships. Forces within Dutch society as well as within the mental health institutions led to this situation.

Some of the predominant societal forces on the mental health system were rooted in the belief systems of the Catholic and Protestant churches, both of which were trying to protect and expand their turf and were skeptical of evolving medicine. Political and social movements, changing gender roles, and the existing political and judicial system all played important roles in the development of a new mental heath system, as did the birth of scientific psychiatry, the lack of nursing education, staff with workloads exceeding their capabilities, and limited options for the treatment of patients.

The story of mental health nursing is brought to life by the multiple, powerful, and graphic descriptions of patients and caregivers during this period of change. Using data from patients' hospitalization records and institutional reports written during this period, Boschma makes clear that, in spite of improvements being made, it was still a time with many challenges for the mentally ill and their caregivers. For instance, a patient with delusions "heard voices scolding him, and he beat nurses, behaving aggressively for over a month . . . and often refused food. The nurses regularly force-fed him. He weakened . . . 5 months after his admission he caught pneumonia and died within a week" (p. 136). Another example occurred in "Veldwijk when an otherwise quiet patient impulsively attacked a housefather who came to pick up the patient from the carpentry workshop. The patient stabbed the father in the chest with a chisel, and he died several days later in the hospital" (p. 137).

Boschma emphasizes that changing gender roles were an important factor in the development of mental health nursing. Women were considered the ideal caregivers because of their superior moral capabilities; this was at a time when the value of women to society was beginning to be acknowledged, thanks to the women's movement. During this same time, males began to enter the profession of mental health nursing, yet they were received with much skepticism and were at times marginalized and discriminated against, a fact that is well illustrated in the case of the nurse P. N. Bas. Bas's experiences motivated him to become one of the leaders in organizing mental health nurses—beginning with males, but later extending to all mental health nurses. Boschma's in-depth descriptions of the difficulties that male nurses had in obtaining recognition and a place in nursing is a welcome addition to the body of literature discussing gender equality in medicine and health care.

This book is a great asset for historians of psychiatry, mental health nurses, and people interested in gender issues in health care.