The demands of societies in miniature: about mental health institutions

The history of psychiatry includes dimensions beyond the health and medical history perspective, says author and researcher Mikael Eivergård in his book Frösö Sjukhus [Frösö Hospital], published by the Jämtland County Museum. He is referring to the fact that the large mental health institutions have something to tell us about their time and society. He asks whether it is perhaps within the closed walls of the mental hospital that society’s view of humans, values and morals of have been allowed to be expressed in their most pure form?

The growth of large institutions in which the mentally ill were isolated from the surrounding world took place under specific historical conditions, he argues (Eivergård & Elfström, 1992:7).

I would like to continue to dwell on the situation of health care professionals in mental health care. They were also, in some sense, incarcerated into the miniature societies of the mental hospitals.

Nurses were the group of employees at the large mental hospitals who were, more than any others, present in the everyday lives of those with mental illness. According to Eidegård, this meant they saw what measures could help life for the patients (ibid, 88). But their ideas and suggests were rarely supported, because, they claim, that doctors and ultimately Medical Boards usually opposed any kind of change. “Can’t be done”, was the standard response. In an interview, one states “Even so, we kept trying.  Small steps at a time.” For example, metal dishes were replaced by porcelain plates. It was trialled for a while and it turned out well.

The same interviewee states that “Progress came from the floor – never from above” (ibid).

Eivegård points out that the strict regulations under which the staff worked were responsible for making the hospital into a workplace that was partly out of step with its time.

“The closed world of the hospital made it possible to hold on to regulations that were outdated in relation to the surrounding community for a long time. A regulatory framework that significantly encroached on the private lives of the employees.” (ibid)

The staff at mental hospitals whose task was to monitor and care for patients were themselves strictly monitored under the rules that governed the job. For example, healthcare staff had to live in the hospital grounds in special housing units. Unmarried employees at Frösö Hospital were referred to staff accommodation located in the attics of the hospital buildings, explains Eivegård.  Two people shared a room, single rooms hardly existed.

In the book “Sjukvården i Göteborg 200 år: 1782-1982” [Two hundred years of health care in Gothenburg: 1782-1982], I read an interview with Gertrude Böös who started work at Lillhagen in 1932. She notes that there was not much concern about personal freedom. For example, all nurses had to leave the job when they married.

I remember what a sensation it was when the first married nurse was allowed to keep her job. She was one of my friends and she went up to Hospital Director Höglund, old Hugo Höglund, and told him that she was going to get married.  And she went shakily down on her trembling knees and begged to keep her job. He almost had a fit at first, but she was actually allowed to keep her job.” (Carlson, 1982:117).

An interview with a nurse who wanted to remain anonymous and who worked both at Gibraltar, ‘The hut’, and Lillhagen are also included in the book.  He tells us that he worked from half past six in the morning to half past eight in the evening. Until 1926 there were no days off except every other Sunday.

For two years he was on duty at night. During that time, he did not have a single day off during the entire time. When he and those with they same job were awake, they had to mark on the time clock every ten minutes so that the supervisors could subsequently check that they had not slept during working hours.

He notes that there was not much concern about personal freedom at that time.  You weren’t allowed to think freely, he summed up. Trade unions, for example, were unheard of. It was only after they had moved out to Lillhagen that they joined a trade union. But initially they did not dare to say that they had joined. For example, socialists were completely banned.

When they were given a day off once a week, the healthcare staff could hardly believe it was true. The nurse explains that they didn’t dare stay at home because they could not believe relief staff would come.

“Finally, one of the more daring ones declared: ‘Tomorrow I will stay home.’ A relief worker did actually show up.” (ibid)

Another psychiatric nurse, Carl Larsson, started in Gibraltar’s mental health department in 1926. At that time he was 23 years old.  He emphasises that he had joined an old-fashioned institution. When the psychiatrist Nils Anton Nilsson arrived as a new doctor in the same year, he closed all the wards in the basement. He also ended use of straitjackets and much more. Carl Larsson emphasises that Nils Anton Nilsson shook up the hospital in every sense.  However, the long hot baths that bipolar patients were prescribed remained. They were made to lie in these baths for up to eight hours.

Mental health nurse Karl-Erik Sterner worked at Lillhagen and says that there were high levels of unemployment when he applied for the job. There were 10,000 unemployed in Gothenburg, which then had about 244,000 residents[1], but Sterner had been lucky and had had a holiday job at Gibraltar the previous summer. His parents didn’t really want him to work as a mental health nurse, but he wanted to try it give it a try.

He began working at the asylums and describes terrible sights, such as patients who stood banging their heads against the wall, while others were locked into strange positions. But when Sterner recovered from the first shock, he saw something else.

“When I got over the first shock, I began to take an interest in the patients and discovered that the illness was a shell; it was possible to penetrate this shell and make contact with the human being behind or below it.”

He also tells us that after working for a year he was accepted as a student and was allowed to start studying and learn about the illnesses he had seen. Until then, he had probably only stayed at the job since he needed the work. When he started studying a little, the work began to mean something, he points out.

“From around the turn of the century, there was plenty of evidence about the conditions for healthcare workers,” says Gösta Carlson. He compares them with hand labourers who also lived with their employers.  For example, staff who lived in the hospital grounds had to request permission if they wanted to stay out past 9 pm when the doors were locked.

Undoubtedly, these voices are part of the heritage of psychiatry, and it is good that there are, and have been, people who interview, listen to and collect their stories. More voices are needed from the miniature societies of the mental hospitals. These interviews, to which Eivergård refers, are also historic documents that reflect what it looked like in the society of the time. For example, such as the conditions for labour unions. To some extent, it was also about what could be said and what could not be said. We are witnessing a ‘workplace discourse’ which can still be seen today, albeit partly under other titles. Concepts of power are[2] at the core; where influence can be wielded and where it cannot, etc. There is a continuum.  And it is a type of collective memory[3] that healthcare professionals can return to. The above voices also highlight, not least, the fight for rights that many people have benefited from. And, in turn, it makes up a large cultural heritage to be protected and passed on: The democratic heritage. (Eivergård & Furumark, 2017).

In her book  “Uses of Heritage“, researcher Laurajane Smith has included a warning about the risk of sentimentalising the past. A “staged” or in some other way sentimentalised past obscure or depoliticise class, gender or labour organisation. (Smith, 2006:201). Without delving too deeply into the discussion, the risk should be significantly less thanks to the work of highlighting authentic voices (first-hand memories).

/Helena Lindbom


Carlson, G.1982. Sjukvården i Göteborg 200 år: [1782-1982]. Göteborgs sjukvårdsstyrelse.
Eivergård, M. & Elfström, B.1991. Frösö sjukhus: 75 år ur sinnessjukvårdens historia. Östersund. Jämtlands läns museum.
Eivergård, M. & Furumark, A. 2017. 100 procent kamp. Mänskliga rättigheter & kulturarv. Danmark. Boréa Förlag AB.
Smith, L. 2006. Uses of Heritage. Routledge.

Collective memory


[1] Kä stad/goteborg/befolkning
[2]  Makt inom samhällsvetenskapen är enligt NE antingen handling, dvs. maktutövning, eller förmåga, dvs. maktresurser.
[3]  Enligt ”de föreställningar och kunskaper som en grupp, organisation eller befolkning har om sitt gemensamma förflutna.