Article
Dutch institutional psychiatry
1827 to 1950.
Paper presented at the First European Congress “Psychomotor Activity and Human Development” Marburg, Germany,1996.
Drs. J. de Lange, psychomotor therapist,
Psychiatric Hospital “Duin en Bosch”, Castricum, Netherlands.
email: jdelange@knoware.nl
I
What research is available to us for a history of the therapy of movement in psychiatric institutions? Not very much, I’m afraid. In the field of the history of psychiatry no systematic study of the subject seems to have appeared so far. Unless we make an exception for the work of Michel Foucault. In his noted, or should I say, notorious work ‘L’histoire de la folie...” he devoted as much as a whole paragraph to the therapy of movement.
If the history of the therapy of movement deserves more than a single paragraph, it does so not in the last place because of its significance for the field of movement therapy itself. But, of course, a history of the therapy of movement does not coincide with the history of the group of professionals whose occupation it is nowadays. For example, long before there was an organised professional group of movement-therapists, the therapeutic value of movement was praised by nineteenth-century lunacy-doctors. But neither does the history of the therapy of movement coincide with a medical theory that explains its effects on mental illness. At the end of the nineteenth-century, for instance, there were sufficient theoretical arguments to prescribe a therapy of movement rather than the treatment in bed. But in practice this hardly ever happened. Therefore, we shall not try to find the history of the therapy of movement among those who made it their profession, nor within the contours of a psychopathology. Rather we shall write this history against the background of a certain space: the space-for-movement in psychiatric institutions. The origin of this space coincides with the birth of the asylum.
In the Netherlands it was an Utrecht physician, Dr. Schroeder van der Kolk (1797-1862) , who played an important role in Dutch lunacy reforms in the first half of the nineteenth-century. By a few simple renovations and alterations to the mad-house in Utrecht, he managed to improve the conditions of the insane to such a degree that the authorities as well as asylum-doctors elsewhere in the country took note.
View on the Utrecht asylum “Willem Arntsz Huis” in 1859
At last it would be possible to actually cure mad people. In 1818 this had already been declared, by Royal Decree, the purpose of the care of the insane. But the deplorable conditions in which most madhouses found themselves made this a goal beyond anyone’s reach. Improvement of these houses of confinement was one of the main tasks to be settled by the first Dutch Mental Health Bill of 1841. From then on, the insane were to be housed in special medical institutions.
This meant that new spaces had been created for the mentally ill. And in contrast to the old habit of confinement, where separation, locking up and chaining down of the insane were important features, this new space could only be seen as a “space filled with movement”, a space for free movement even.
And as such it has often been typified, both by nineteenth-century asylum-doctors and by later historians who studied the history of psychiatry. The history of this space, however, is not easily written on the basis of any single text. Because not one complete text has ever been devoted to this space. Its history can only be found scattered over many texts, buried in subclauses, hidden under various headings. For the time being, this history will prove to be not much more than the vague picture of the ground-plan of such areas for movement.
II
For a start, the insane were free to roam the gardens and courtyards of the renovated mad-houses. They could go for a stroll, or if it was raining they could walk along the galleries. If possible, they were taken for walks outside the asylum, preferably out in the open, outside the town. Also different types of swings were tried out, such as a chair which was suspended from ropes in a tree. Walking and swinging offered distraction to the insane, it took their minds off their delusions and put them in touch again with the order of the world around them. Walking had the added advantage over swinging that it made the mad-men tired. This made them sleep better, which generally improved the necessary peace and quiet in the institutions. Again for reasons of peace and quiet, physical labour, the kind of work that involved movement, was often thought to be a solution. This could be working on the land or in gardens; but also sawing wood, carpentry and pushing wheel-barrows are mentioned. Gaining exercise by physical labour was thought to be valuable not only because of its bodily effects, but also because of the moral values of work.In fact a kind of barter took place between labour and movement: labour made movement meaningful, while movement in turn provided labour with health. Unfortunately it was not easy to involve all patients in this kind of therapeutic activity. It turned out to be very difficult to get the deranged from the upper classes or townspeople to cooperate. And, anyway, in the Netherlands, where until the late nineteenth century almost all mad-houses were located in the cities, working the land was more often a case of wishful thinking than a real possibility. In that respect, gymnastics were thought of as a proper alternative. Around 1848 the well-known German gymnastics teacher Carl Euler (1809-1885) offered his services to the Utrecht asylum. He had gained experience with gymnastics for the insane in Illenau, one of Germany’s modern institutions. Though Schroeder van der Kolk was in favour, the Board of Governors turned down Euler’s request. A number of years later, Euler applied for a post at the newly built asylum Meerenberg in Santpoort, - for a long time the only new location in the Netherlands. The Board of Governors of this modern institution decided to offer Euler the desired post. The Dutch National Inspectorate of the Insane and Asylums was highly satisfied with the developments in question. In their reports they urge the other medical institutions to appoint gymnastics teachers as well. This happened - for instance- in Utrecht and - for a short while - in Rotterdam. And so real gymnastics were taught in Dutch asylums, be it on a very limited scale. Apart from proper gymnastic exercises taught in these lessons, a more liberal form of movement was also supported. This could be climbing ropes, for instance, or jumping on a board. It was not unusual for these lessons to be brightened up by musical instruments. Several folk-games are mentioned, such as skipping for women and of course, since we are speaking of Holland, ice-skating. We could even mention the drill exercises that were practised in some institutions. A drummer made sure no one marched out of step.
Drilling exercises at the asylum in Dordrecht 1882
III
Nineteenth-century literature on managing the mad thus provides us invariably with the same story: It tells us, that, compared to the daily practice of the previous period there was a change in the way movement was valued. Up until the nineteenth century, movement of the insane was mainly something to be feared, something that should be curbed and restrained. Movement implied danger, in the form of running away, hitting and kicking, or even just by its oddity. Thus, movement was kept in check by many forms of physical restraint. But from the nineteenth century onwards, so the story continues, a new approach came into existence. Physical restraint was to be despised, and within the walls of the renovated asylums, the old danger was to be controlled in a new way. Remarkably enough by prescribing the very movement that was first feared.
The history of early institutional psychiatry, and indeed of almost all literature it gave birth to, can thus be characterised by a dialectic of physical restraint and freedom of movement. In this way, movement provided the asylum with an almost mythical value, for movement meant liberation.
Although in Germany and in England many of the new asylums were built in the country during the nineteenth century, it was to take a long time before the Netherlands followed suit. The real new psychiatric architecture started as late as 1886, when the Protestant mental hospital Veldwijk was opened. Though Veldwijk was praised for its possibilities for walking in the surrounding woods, bed-treatment was of prime importance, as was common in those days. It does not seem strange then, that gymnastics was hardly ever mentioned anymore. But this does not mean, as some historians suggest, that the therapy of movement disappeared. Rather a new space for movement was created, for a whole architecture of bed-constructions appeared on the scene, developed to regulate the mad-men’s compulsion to move . A therapy of movement came into being, which took shape in activities that could be carried out in bed, such as swinging, knitting and writing.
IV
At the time of this new psychiatric architecture, we also see a rise in the number of institutions for the treatment of neurasthenia. Movement, and especially gymnastics, was often prescribed by the physician. In the Christian Sanatorium in Zeist for instance.
Gymnasium at the Christian Sanatorium for treatment of neurasthenia in Zeist; 1904.
On the whole, the therapy of movement in treating neurasthenia patients was along the same lines as in the field of lunacy care. Except on one point. Whereas in the lunatic asylums movement was intended to tire and exhaust the inmates, and thus promote peace and quiet in the asylum, in sanatoriums al tiredness was to be avoided. There was to be cycling, but not against a headwind and also the ascent of hillsides was to be avoided. For patients still to weak to be allowed out-door activities, there was even the possibility of cycling inside of the gymnasium, on one of the first home-trainers ever. In the mental hospital in Deventer this same home trainer was found. Its use was part of the new approach towards psychiatric patients, which became popular in the nineteen twenties. This ‘more active therapy’, developed by the German alienist Herman Simon (1868-1948), was copied by W.M. van der Scheer (1882-1957) in Santpoort, and J.L.C. LeRütte (1864-1944) in Deventer. Once again, gymnastics were mentioned in mental hospitals and even gymnastics teachers were appointed. Optimistically LeRütte used the phrase ‘movement therapy’. It was not only in the daily practice of psychiatric hospitals that the contours of the area for movement were more finely drawn. In psychopathology, too, space for movement was created, for instance, in the work of Ludwig Binswanger (1881-1961).
From then on, it was no longer space that gave room to movement, but rather the other way around. It was now said, that movement itself created space, not a mathematical space, but “Einer patischer Raum”, as Erwin Straus (1891-1975) called it. In the fifties, the Dutch psychiatrist H. Van der Drift applied these insights to a new profession: the profession of movement-therapy. A profession which speaks its own language,which is not only a body-language, as we usually understand it, but also the language of a particular space. A language which belongs to the space for movement in psychiatric institutions.
This paper was based on a thesis by the author, published in 1998. Lange, J. de, (1998) Van Lijfsdwang tot Lichaamswerk. Geschiedenis van de bewegingsruimte in de Nederlandse Inrichtingspsychiatrie 1827-1975. Bewegen en Hulpverlening, 15,1, pp. 3-104.
Illustrations: Willem Arntsz Huis and asylum Dordrecht: museum GGZ, Trimbos Instituut, Utrecht. Gymnasium: De Lange, 1998.
