This essay revolves around the reformation and sectorization of Swedish psychiatry starting in the 1970’s. Psychiatry was to change from being based in closed asylums to being an institution in the middle of society, finding social solutions to mental illness and working through a dynamic network of various care givers, such as welfare officers, nurses and psychiatrists. This new kind of psychiatry was first tested in Nacka, where psychiatric reformers Johan Cullberg and Bengt Berggren were the heads of a six-year long pioneer project of sectorized psychiatric care. My specific purpose is to analyze the new ideas of mental illness and of psychiatry’s role in society which were introduced in this project and how they were expressed in the official reports presenting it. The reformation was preceded by a public debate concerning psychiatry, which had intensified a few years around 1970. In the debate a new kind of radical critique was voiced which named psychiatry a tool of power and oppression, a kind of rhetoric which found its way into the debate amongst psychiatrists. In it the traditional way of psychiatry, based in mental asylums, was attacked by Cullberg who saw in a recent social psychological trend the possibility of a new psychiatry, which would be decentralized and working with social solutions. It was this kind of psychiatry which was shortly thereafter to be tried in Nacka, as a response not only to critique of the old system but also to economic problems. The social psychological fundament was there put to practice through preventive work, focus on the family as a system and new kinds of therapy. The new psychiatry can be said to have led to what Hydén calls a handicappization of mental illness, and what Björk discusses as a new conception of the patient as unique. Throughout the planning of the new psychiatry and the reports on the Nacka-project questions concerning the role of psychiatry were dealt with, questions which were at first raised in the public debate. The reformist critique of psychiatry which led to the Nacka-project was, I suggest, to some extent inspired by a public more radical critique of psychiatry but the two ways also had inherent differences.

<p>I denna studie analyserar vi handläggares upplevelse av samverkan mellan två stora välfärdsmyndigheter, Försäkringskassan och Arbetsförmedlingen. Genom sju kvalitativa intervjuer undersöker vi möjligheter och hinder med samverkan utifrån den s.k. nya arbetslinjen och rehabiliteringskedjan. Vår teoretiska referensram utgår ifrån gräsrotsbyråkratin, sektoriseringsteorin samt olika idéer om samverkan och domänkonflikter. För att få underlag för studien tar vi också del av aktuell forskning som berör ämnet. Resultatet från vår studie visar att det finns flera gemensamma upplevelser av hinder och möjligheter hos respondenterna. Bland annat lyfter alla respondenter fram att samverkan är någonting positivt som klargör myndigheternas ansvar inför klienten. Resultatet visar även att majoriteten av respondenterna upplever att rehabiliteringskedjan motverkar passivitet som de anser råder inom rehabiliteringssfären.</p> / <p>In this study we analyze handling offices experience of cooperation between two major welfare authorities, the social insurance office and the employment agency. With the help of seven qualitative interviews we investigate the opportunities and the hindrance for cooperation on the base of the new so called workfare and rehabilitation chain. Our theoretical frame takes its starting point in particularly the theory of street level bureaucracy, sectorisation within the public sector and different ideas about cooperation and domain conflict. To build a platform for the study, we also take part of topical science that is relevant for the study. The result showed that there are several common experiences of opportunities and hindrance of cooperation. All of the respondents brought up the fact that cooperation is something positive that, from the client perspective, elucidates the authorities’ responsibility. The majority of the respondents also experienced that the rehabilitation chain counteract passivity, which existed within the rehabilitation sphere.</p>

I denna studie analyserar vi handläggares upplevelse av samverkan mellan två stora välfärdsmyndigheter, Försäkringskassan och Arbetsförmedlingen. Genom sju kvalitativa intervjuer undersöker vi möjligheter och hinder med samverkan utifrån den s.k. nya arbetslinjen och rehabiliteringskedjan. Vår teoretiska referensram utgår ifrån gräsrotsbyråkratin, sektoriseringsteorin samt olika idéer om samverkan och domänkonflikter. För att få underlag för studien tar vi också del av aktuell forskning som berör ämnet. Resultatet från vår studie visar att det finns flera gemensamma upplevelser av hinder och möjligheter hos respondenterna. Bland annat lyfter alla respondenter fram att samverkan är någonting positivt som klargör myndigheternas ansvar inför klienten. Resultatet visar även att majoriteten av respondenterna upplever att rehabiliteringskedjan motverkar passivitet som de anser råder inom rehabiliteringssfären. / In this study we analyze handling offices experience of cooperation between two major welfare authorities, the social insurance office and the employment agency. With the help of seven qualitative interviews we investigate the opportunities and the hindrance for cooperation on the base of the new so called workfare and rehabilitation chain. Our theoretical frame takes its starting point in particularly the theory of street level bureaucracy, sectorisation within the public sector and different ideas about cooperation and domain conflict. To build a platform for the study, we also take part of topical science that is relevant for the study. The result showed that there are several common experiences of opportunities and hindrance of cooperation. All of the respondents brought up the fact that cooperation is something positive that, from the client perspective, elucidates the authorities’ responsibility. The majority of the respondents also experienced that the rehabilitation chain counteract passivity, which existed within the rehabilitation sphere.

Bakgrund. Innan dess att svensk psykiatri genomgick övergripande förändringar genomsyrades mentalhälsovården av olika psykologiska teorier vilka sedermera kom till att utgöra väsentliga beståndsdelar inom den “vårdkulturella revolutionens” fundament. Detta utmynnade därefter i svensk socialpsykiatris tillblivelse varigenom dessa försöksverksamheters väl fungerande praxis och kunskaper till synes har glömts bort genom åren. Metod. När, varför och hur har det gått från att vårdgivare/klient-relationen tidigare har betraktats vara “god” till att i dessa dagar te sig “avhumaniserad”? Hur var denna relation förr, hur är den i dag och hur kan den förslagsvis göras bättre framöver? För att kunna besvara detta tas en närmare blick, genom manifest kvalitativ innehållsanalys med konventionell (induktiv) ansats, på svensk hälso- och sjukvård emellan åren 1960–1980 såväl som en om än konkretiserad djupdykning ned i 1970-talets “nya psykiatri” och socialpsykiatriska försöksverksamheter. Resultat. Vägarna till utformandet av en vårdvärnande relation emellan vårdgivare och klient återfinns inom vårdgivarens bemötande och tillvägagångsätt gentemot klienten. Vad som fordras är en tillitsfull atmosfär och att bådadera parterna upprätthåller kontinuerlig kontakt (Gustafsson, 2010) vari tid bistår med goda förutsättningar i utformningen av funktionella tillika utvecklande allianser (Topor &amp; Denhov, 2012). För att brukarinflytande skall fungera under förebyggande arbete, i led om att i största möjliga mån ta uti klienters problematik, krävs ett krispsykoterapeutiskt förhållningssätt och vetskap om psykisk kris genom vilka genuin närvaro uppnås (Cullberg, 1974). Forskning visar även tydligt att vad som behövs vid vårdbemötande är genuin närvaro, medmänsklig förståelse och rak kommunikation: att inte bara se människan, utan även att förstå vad just denna kris innebär för just denna individ såväl som att klientens beteende sett till sin helhet och vad som inte uttrycks säger så mycket mer än vad ord kan någonsin beskriva. Slutsats. Empirin antyder att aktuell forskning anmärker vad som fungerar bra och mindre bra, om inte alls, i relation till vårdbemötande är för all del bra. Men vad om nordisk socialpsykiatris pionjärer såsom Berggren, Cullberg och Haugsgjerd? Aktuell forskning refererar inte till någondera och deras arv tycks vara bortglömt. Så vad om all den kunskap och insikt som förvärvades och införlivades vid tidigare försöksverksamheter såsom Cullbergs kristeori och krispsykoterapi? Aktuell forskning refererar heller inte till någotdera och alltsammans tycks ha gått i stöpet. Vad som däremot framgår är att deras visioner tillämpades med mycket goda resultat vid bland annat Nackaprojektet tillika att sagda teori och psykoterapi tycks ha runnit ut i sanden efter verksamhetens nedläggning. Psykologin och psykiatrin, till syvende och sist, rör sig i ett gränsland emellan vetenskap och humaniora däri de, i samvaro med etisk kodex om att all behandling skall vila på “vetenskap och beprövad erfarenhet”, samexisterar i led om att med fumliga försök fånga livets komplexiteter. Men vart någonstans bör gränsdragningen gå emellan “vetenskaplig professionalitet” och “personlig inlevelse” när man möter någon med psykisk ohälsa, en medmänniska i psykisk kris? / Background. Prior to the undertaking of radical changes in Swedish psychiatry, various psychological theories permeated mental healthcare that would subsequently become essential components at the very heart of the “care-cultural revolution.” This subsequently resulted in the creation of Swedish social psychiatry through which trial establishments’ well-functioning praxis and knowledge have, so it seems, been forgotten over the years. Method. How, when and why has it gone from the fact that the caregiver/client-relationship has previously been considered as “good” to in these days feel as though it has become “dehumanized”? How was this relationship in the past, how is it as of today, and how can it be made better for the future? In order to answer this, a closer look, through manifest qualitative content analysis with conventional (inductive) approach, is taken on Swedish health care throughout the 1960s–1980s as well as an elaborate deep dive down into the “new psychiatry” of the 1970s and social psychiatric trial establishments. Result. The paths to the formation of a care-ensuring relationship between caregiver and client are found within caregivers’ attitude and approach towards their clients. What is required is a trusting atmosphere and that both parties maintain continuous contact (Gustafsson, 2010) wherein time provides good conditions in the formation of functional and developing alliances (Topor &amp; Denhov, 2012). In order for user influence to function during preventive work, in line with addressing clients’ problems as much as possible, a crisis psychotherapeutic approach and knowledge of mental crisis is required through which genuine presence is achi-eved (Cullberg, 1974). Research also clearly shows that what is needed during care meetings is genuine presence, compassionate understanding, and straightforward communication: not only to see the person, but also to understand what this particular crisis means for this particular individual as well as that his or her behavior in itself and what is not being expressed says so much more than words can ever describe. Conclusion. Empirical data suggests that current research remarks on what works well and less well, if not at all, in relation to care treatment is certainly good. But what about the pioneers of Nordic social psychiatry like Berggren, Cullberg, and Haugsgjerd? Current research refers to neither and their legacies seem to have been forgotten. So, what about all the know-ledge and insight that was acquired and incorporated in previous experimental activities such as Cullberg's crisis theory and crisis psychotherapy? Current research refers, likewise, to neither and everything seems to have gone down the drain. What is clear, however, is that their visions were applied with very good results in, amongst other things, the Nacka Project as well as that said theory and psychotherapy seem to have faded away following the trial establishment’s closure. Psychology and psychiatry, ultimately, move in a borderland between science and the humanities wherein they, in conjunction with the code of ethics that all treatment is to be based on “science and proven experience,” coexist in line with fumble attempts to capture life’s complexities. But where exactly should the line be drawn between “scientific professionalism” and “personal insight” when meeting someone with mental ill-health, a fellow human being in a mental crisis?