During the first half of the 19th century institutions for the treatment of the insane were established throughout Europe and North America. These institutions 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 remarkable 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 character. 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 (1 795-1 855) became the country's first full-time asylum doctor. Georg Engström 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 principiai 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 intense 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 treatment 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. / <p>Behandlar huvudsakligen Georg Engström och förhållandena vid Vadstena hospital</p> / digitalisering@umu

The early nineteenth century saw the emergence of institutional psychiatry across Europe. Aware that Sweden had fallen behind in this development, Parliament decreed in 1823 that a number of specialised institutions for the care of the insane were to be established. The Vadstena asylum, opened in 1826, was the first such institution in Sweden.   The aim of this study is to examine medical interpretation of and responses to erotic behaviour in psychiatric practice at the Vadstena asylum in the period 1849-1878. The book places the theme of the erotic, a topical subject in nineteenth-century public debate, in the context of psychiatry as an emerging specialty in Sweden. The book explores how erotic behaviour was conceptualised as disease, and the nature of therapeutic intervention in erotic cases, in order to present a more nuanced image of nineteenth-century medical attitudes to sexuality. By highlighting the superintendency of physician Ludvig Magnus Hjertstedt, and linking his account of an 1845 study tour through Europe to medical practice at Vadstena, the study situates responses to erotic patients in a period when psychiatry claims authority over human sexuality.   In methodological terms, the study applies critical questions inspired by revisionist scholarship to a body of empirical source material. Focusing on a single institution, and conducting in-depth readings of case notes – with regard to language, form, and function – allows the study to highlight the everyday practice of the asylum physician in his encounters with male and female erotic patients, including the use, importance and diagnostic integrity of the concepts nymphomania, erotomania and masturbation. Hjertstedt’s travel journal provides insight into the physician’s medical philosophy, informing the analysis of diagnostic and interpretive procedures, while connecting medical practice at Vadstena to its European paragons.     The results indicate that while the use of specific diagnostic terms to describe erotic behaviour was infrequent, therapeutic and managerial intervention shows that sexual acts and expressions of desire were considered disturbing and dangerous symptoms in both male and female patients. The analysis thus makes visible a gap between psychiatric theory and asylum practice, emphasising uncertainties and complexities inherent in the latter. While erotic behaviour could be considered indicative of illness, it might also be interpreted as a lack of character or a result of insufficient moral instruction. The asylum’s regime of work and moral instruction was designed to restore health as well as sound values and appropriate behaviour in its patients, indicating a medical culture at Vadstena which was both curative and normalising.