tiistai 30. heinäkuuta 2013

From insane to mental patients: the mental hospital of Seili

The insane
In 1619 the king Gustavus II Adolfius gave a decree on that the lepers, crippled and mentally ill which were kept in the St George's hospital and The Room of the Holy Ghost, should be moved to a suitable island, some tens of kilometers outside Turku. The lepers lived on a smaller island, where the church today stands, and the rest on the main island. In time only lepers and mentally afflicted people were taken to Seili. In 1755 lepra was so little occuring, that it was decided not to bring any more lepers to Seili. The last leper died in 1785, after which there only was the mental patients left. In addition, there also lived common people on the island since the 16th century, and some staff of the hospital.

The first mentioning of a madhouse (dårhus) on Seili is from 1689. It stood about 80 meters from the main building from the 19th century, which can be seen today. The madhouse had four rooms and three locks on the front door. Documents show that the hospital bought chains, locks and files to open the chains with for the mental patients, and it was common to chain restless patients to the walls. This was not anything odd in a Finnish or European context, since the restless or violent mentally afflicted people were chained, locked in rooms or kept in holes in the ground. People acting weird, but not violent could more often be kept free at home, and these were seldom patients of the mental hospitals.

File:Philippe Pinel.jpg
Philippe Pinel. Picture from Wikipedia Commons.
During the Enlightment the attitudes towards mental patients changed. In Seili it can be seen for example in that these people no more were refered to as inmates, but as patients. In Europe, mental patients were reliesed from their chains in many mental hospitals. Often the French psysichian Philippe Pinel is mention in this context, as one of the first to unchain his inmates. It cannot be left out, that instead for example straitjackets came in use, so it was not a total reliesement of the inmates that happened.
After the Finnish war, in 1809, a control commission was sent to Seili. Their repport concludes that the mental patients had enough of food, but that all other points of living conditions were on an unacceptable level. The patients lived in small, stinky rooms,which were never aired, they slept on wooden bunks and their clothes were allmost nonexisting. The report stated that changes must be done.

The mental hospital
Soon after plans on building a new hospital was made, and the architect Per Johan Gylich was asked to do the blueprints. In 1851 the construction work of the main building begun. During the end of the 18th century and beginning of the 19th century, Seili had the biggest mental hospital in Finland, with 50 patients. After the new main building was ready, 67 patients could be kept there. The patients lived in rooms of size 1,80 x 2 meter, with a bed, a window and a small table in each. The rooms were heated by space heaters, which were warmed from the aisle side. The walls of the paitents were painted in brown colours, with large squares, which were thought to calm down patients. If patients were violent or restless, they could be isolated in their rooms, all from one hour to severeal months. In the new main building also a day room for working and a canteen were built.
The patient room.

In 1840 a new and modern mental hospital was built in Lapinlahti in Helsinki. A decision was made by the medical counsil that the mental hospital of Seili should be an asylum for mental patients with no hope for covering. All patients who could be healed, should be sent to Lapinlahti. This is in a time, when psychiatry becoms a more independent part of studies in medicin, and splitting mental illnesses into uncurable and curable becomes a rather common view in Europe.

In 1889 the Medical council decided that all male patiets of Seili were to be moved to Käkisalmi in South-Eastern Finland, and the hospital of Seili became a mental hospital for women only. This continued until 1962, when the hospital no longer was in use.

The patients and the treatments
In the hospital of Seili, the diagnoses of the patients were rather much the same as in most other Finnish mental hospitals until the division into curable and uncurable illnesses. The most common diagnoses in the 18th and 19th centuries were mania and melancholia. Also, many women were diagnosed with hysteria, which was seen as a common illness until the end of the 19th century. The mental hospital of Seili was a state hospital, and patients were sent there from all of Finland. Some patients were also from Russia, some from the areas with many people speaking Finnish or Finnish-related languages such as Karelia and Ingria, and some ethnic Russians.

In 1911 Paul Eugen Bleuler described the illness schizophrenia, after which it soon became one of the most common diagnoses of mental patients. During the last decades of the history of the mental hospital of Seili, one third of all patients were diagnosed with schizophrenia.

Also retards were taken to Seili. Today, many of them would probably be called mentally deficient, but what in the 19th century and early 20th century was described as retarded, does not necesserely correspond to today's views. Often the poor people wiht little or no education, got bad results in the tests made by highly educated middle class men. In the 1920's intelligence was commonly measured also to the patients of Seili with Simon-Binet -tests, which gave a little less class- and education bound results, but which still did not necesserely give accurate results on today's opinion.

The mentally deficient were divided into three groups: idiots, imbecills and debils. The intelligence was measured in intelligence age (idiot < 6 years, imbecill 7-14 years and debils >14 years).

Some of the patients were criminal patients. These could be i.e. Infanticides and arsonists, who were non compos mentis to the crime they committed.

The treatments in Seili were mostly ways of calming down restless patients. This was mostly done by baths, medicine, isolation and binding. There has never been a psychiatrist in Seilin, which ment that few medicins were used and no surgeons, such as lobotomia, shock-therapy or other related operations were made in Seili. Since most patients came to Seili from an other mental hospital, they might have gone through some of these treatments elsewhere.

Calm, trustable patients were allowed to walk around on the island and work for the people living on the island. Some were even sent to the nearby town of Nauvo for work.
Outside the hospital there was a garden where patients could get some fresh air.

According to Jutta Ahlbäck-Rehn, who has written her doctoral thesis on the diagnoses of the female patients in Seili, some of the women would have been uncorrectly diagnosed when sent to Seili. These could later be sent home as ”cured”, but these were exeptions. Few of the women with more uncertain or wage diagnoses would be sent home or to other mental hospitals.

In 1962 most patients were sent to other mental hospitals or to mental units of local healt-care centres or hospitals. Some of the patients were also sent to nursing homes.

Sources:

Achté, Kalle ja Turunen, Sakari, ”Seilin hospitaali 1619 – 1962” Käytännön lääkäri 1:1971.
Ahlbäck-Rehn, Jutta, Diagnostisering och disciplinering Medicinsk diskurs och kvinnligt vansinne på Själö hospital 1889 – 1944 (Åbo 2006).
Shorter, Edward, Psykiatrian historia (Hoboken/Helsinki 2005).
Burton, Neil, A Brief History of Schizofrenia, http://www.psychologytoday.com/blog/hide-and-seek/201209/brief-history-schizophrenia, 17.7.2013.

Wiki Commons,  http://en.wikipedia.org/wiki/File:Philippe_Pinel.jpg, 19.7.2013.

Lisa Svanfeldt-Winter

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