Roger Qvarsell 

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Ordning och behandling

I "ORDNING OCH behandling: Psykiatri och sinnessjukvård i Sverige under 1800-talets första hälft" utforskar Roger Qvarsell en betydelsefull och ofta förbisedd epok inom svensk psykiatri. Boken ger en djupgående analys av hur institutioner för behandling av psykiskt sjuka etablerades, och hur dessa förändringar speglade de rådande sociala och filosofiska strömningarna i Europa och Nordamerika.

Under denna tid präglades psykiatrin av en kamp mellan olika teoretiska skolor, men trots dessa konflikter fanns det en gemensam grund för behandlingsmetoderna som hämtade inspiration från upplysningstidens filosofi. Qvarsell belyser hur synen på människans natur och uppfostran påverkade uppfattningen om psykisk ohälsa och dess behandling, vilket ger läsaren en insikt i de tidiga psykiatriska teoriernas utveckling.

Boken tar också upp den svenska Riksdagens beslut 1823 att inrätta behandlingssjukhus, där man trodde att kostnaderna för vård av fattiga skulle kunna minska genom att behandla psykisk sjukdom. Qvarsell beskriver hur dessa sjukhus, med Vadstena som det första, blev viktiga institutioner i den svenska vården av psykiskt sjuka och hur Georg Engström, den första heltidsanställda asylläkaren, bidrog till utvecklingen av vårdmetoder.

Genom att granska Engströms arbete och hans syn på mental ohälsa, framhäver Qvarsell vikten av livsstil och inre känslor i behandlingen av patienter. Boken ger en tydlig bild av hur behandlingens filosofi och optimism bidrog till att reformera det gamla asylsystemet och hur dessa förändringar påverkade samhället i stort.

"Ordning och behandling" är en viktig resurs för den som är intresserad av psykiatrins historia och dess utveckling i Sverige. Qvarsells grundliga forskning och insikter ger läsaren en djupare förståelse för de faktorer som formade psykiatrin under en kritisk period. Boken är ett värdefullt tillskott för studenter och forskare inom humaniora, psykologi och psykiatri.

Abstract

During the first half of the 19th century institutions for the treatment of the insane were established throughout Europe and North America. These institu tions were generally the result of government initiative and were founded on a belief that existed in the new psychiatric theories of treatment.

Psychiatry was, at this time, an embryonic science, in which great conflict existed between different theoretical schools of thought, but in which a remark able concensus existed regarding methods of treatment. Treatment was based on a view of the nature of man inspired by the philosophy of the Enlightenment, in which up-bringing was considered to be able to affect a person's entire charac ter.

In 1823, the Swedish Riksdag voted in favour of the etablishment of treatment hospitals. The background to this decision was the belief that it should be possible to diminish the costs of caring for the poor if mental illness could be treated. However, fears of a general increase in social unrest and philanthropic motives seem also to have been important factors. Sweden's first hospital for the treatment of the insane was established in Vadstena in 1826. Georg Engström (1795-1855) became the country's first full-time asylum doctor.

Georg Engstrom was well-read in German, French and English psychiatric literature, but never himself formulated any psychiatric theory, neither did he write any articles of a principial nature. His psychiatric activities may, however, be followed in his comprehensive medical journals and regular official reports. Engström saw the roots of mental illness in the existence of a surplus, a shortage, or an inbalance in the energy of the psyche. The cause of illness lay in the patients manner of living and, Engström stressed, in the importance of inteme feelings and passions. The essence of treatment lay in the patient's being kept occupied and in his manner of living. Most of the recommendations for methods of treatment contained in the literature were tried out, a number of which for example, being spun in a revolving chair were quickly abandoned.

The development of psychiatry and of the care and treatment of the mentally ill during the first half of the 19th century can be seen as a sign of the fact that science itself was developing and becoming paradigmatic. However, it is also possible the view developments from the perspective of the ideology of treat ment and to focus on the way in which the philosophy of treatment and its concomitent optimism spread and reformed the old asylum system. Finally. it is also possible to observe developments from a pedagogical perspective, stressing the state's desire for control and order in a situation in which there were fears of an increasing social unrest.

Keywords: The history of psychiatry, the history of the mental hospital, 19th century Sweden, Vadstena, Georg Engström (1795-1855)