From the middle of the 19th century, “les miserables” worked with the most unfortunate, with the idiots. It was not until the end of the 19th century that care in the mental hospitals began to take on a health-care mission.

The expression ‘les miserables’ is well known, as it is the title of Victor Hugo’s novel that was published in 1862. The novel ‘Les Miserables’ was critical of the way in which France at the time treated its most deprived, vulnerable and marginalised citizens. Through the protagonist, the former convict Jean Valjean, we meet that society and the opinion of humanity that Hugo criticizes. Jean Valjean, who was first convicted for stealing food for his sister’s children, is changed after a meeting with the bishop of Digne; not immediately, however, but only after robbing little Gervais of the little he had. This led to such regret and reassessment by the main character that he transformed himself from hardness to love and compassion. Subsequently, Valjean treated people with love and generosity, encompassing a great deal of insight into the human condition – not entirely unlike the bishop of Digne, his benefactor.

The factory worker Fantine is one of those he helps after his transformation. But when it is discovered that he has been a convict, everything fades away. Hugo wrote: “Unfortunately, we have to say that the words: “He has been a galley slave” made almost everyone leave him. Within a couple of hours, everyone had forgotten all the good things he had done because of these two words: ‘galley slave’. (Hugo, 1990:165)

Valjean is again stapled to his old identity and is forced to flee and live in hiding. He does so together with Cosette, the daughter of Fantine, whom he adopted after Fantine’s death. They live in hiding, because the policeman, Javert, is hard on their heels. The purpose of this article is to show how close the cultural heritage of the ‘patients’ is to those who have nursed them; that caregivers are also part of ‘mad heritage’.

How did it come about that those at the bottom of society were the first to care for the mentally ill? To be honest, it must be added, that it was not about care. It was about ‘custody’.

On January 8, 1852, the City of Gothenburg decided to set up an institution on a piece of land at Drottningtorget, writes Britta Magnusson (1982). This is the same place where the Clarion hotel is now located following the renovation of the building that was previously the main post office.
An institution that was open to the poor and the sick, to the incapacitated and most deprived members of society. A department for the mentally ill was also set up in the institution. It consisted of a number of large and small rooms that lacked both ventilation and light, explains Magnusson. The two larger rooms were 1.75 x 1.25 metres. These booths were reserved for the most agitated patients. Modernisation was carried out in 1878, when the cells were made larger. But ventilation was still lacking and all the booths were not lit. Some of these were reserved for people who had difficulty keeping clean and, according to an eye witness quoted in the book, the floors were made up of ‘straw beds’ and ‘the stench of these holes was indescribable’.

It was the others, the poor, who were held in the institution who had to take care of the mentally ill and their department. Even as late as the 1890s, the institutionalised poor were used as caregivers for the mentally ill.

On April 26, 1883, the City Council decided to build a new institution, to be called Gibraltar. This led to the start of a new era in the history of mental health care in Gothenburg.
Five years later, Gibraltar was ready to receive ‘les miserables’. From the beginning, the authorities realised that the premises were too small for the needs of the city. The population of Gothenburg was growing considerably. And to remedy the lack of space, isolation rooms had to be built in the basement and they were not much better than the old cells at Drottningtorget. New wings were also added in 1893 with room for 158 more patients.

In 1897, the resident doctor at Gibraltar, Dr Ågren, wrote a letter to the Social Welfare Board, in which he pointed out the inappropriateness of the poor caring for the sick and, above all, the mentally ill. He saw many of the poor as morally and deeply flawed and generally considered them to be irresponsible and unreliable. His presentation led to a reduction in the number of poor caregivers from fifteen to around 6 and to an increase in the number of outside staff who were not members of “les miserables”. (In this case, it is probably also relevant that at the end of the 18th century there was an increased interest in psychiatry among doctors.)

Due to the increase in the sick and poor, and not least the mentally ill, the institution was forced to move out of Gibraltar to make space for the growing mental health department. But this was not enough, people who could not be admitted were placed in care centres around Gothenburg.
Nor was any treatment in the modern sense offered in Gibraltar: “What was offered were the bare necessities of food and accommodation and supervised custody. And because the mentally ill were dangerous, it was also felt that they should be kept properly locked up under constant supervision.”

The male and female staff at the mental hospitals were called the ‘lunatic guards’, ‘boys’, ‘hospital girls’ or ‘lunatic guardesses’, and now I understand why. (Carlson, 1982 p. 186). They did not consider their work to be health care. They were more or less appointed as jailers. Their task was to keep the mentally ill calm, to prevent them from escaping and to protect ‘healthy’ citizens from the mentally ill. Because of the low status of these employees, no one was concerned that, through their work, they were themselves vulnerable. The general view of mental illness as something shameful spread to the staff and continue to do so for a long time. In the name of fairness, it should be said that it was not only those who cared for the mentally ill that were looked down on or were characterised by their duties, which I will come back to. At the bottom of the hierarchy were the patients. In his book, “Berättelser från insidan. En essai om personliga erfarenheter i psykiatrins historia” [Stories from the inside. An essay on personal experiences in the history of psychiatry], ethnologist and author Lars-Eric Jönsson states: “Few things have been more stigmatising in modern society than being admitted to mental hospitals.”

When the first Sahlgrenska Hospital opened at Sillgatan (currently Postgatan in Gothenburg) 238 years ago, only three professional groups were considered to need training in a modern sense. These were the doctors, field surgeons and midwives. Those who were involved in washing, making beds, dressing, cleaning, airing and heating were considered to need only practical instructions in their duties. Those who were nurses, maids or hospital boys were hardly counted as a professional group. It was long-held that the profession was learned by working in the case of hospital staff. Only the nurses, whose job included reading to the patients from a prayer book and catechism, needed any qualifications for the job.

I read this to mean that hospital staff did not have a good reputation in society. “On the contrary”. I cannot help but wonder why, even if I can vaguely sketch out a few explanations. I put my questions aside for the time being and read on.

“In its 1916 report, the state inquiry into the ‘training and working conditions of female staff’, personnel who carry out the simplest tasks in hospitals were destitute, criminal and doubtful people, that no one else would want to have in their service and if they were not to perish, health care was their last possibility of existence.’ (ibid:178–179)

My impression is that this is “cultural heritage from below.” Robertson argues that it is important to understand “the lives that once animated places and spaces” (Robertson, 2013:8) Remembering, collecting knowledge about and bringing to life people from the bottom strata of society contributes to democratisation and to cultural heritage being something we create and value together. If they/we are pushed aside or treaded on as in the old days, the door to hegemonic ideas and totalitarianism is opened, to top-down bureaucracy (Robertsson, 2013:8).

In addition, and here I lean on Punzi for support (2019): If a cultural heritage is not even regarded as such, it is difficult to illustrate the cultural heritage of the marginalised (249).

/Helena Lindbom