Goal and Means
(thesis, in Dutch, includes English summary)
M.A.J. Romme, MD PhD
Reviewed by Mira de Vries
After reading Sandra Escher’s thesis, which is based on her work with Marius Romme, I became curious about Romme’s own thesis, (self?-)published in 1967. The unimaginative title does injustice to the content, a thorough and scholarly study of the selection of patients for psychiatric hospitalization in Amsterdam. The study looks at:
Even with this important factor missing, it would be interesting to see Romme’s work repeated in the present day, and the findings compared to Romme’s of nearly forty years ago.
Most fascinating for me is the first chapter. In it Romme provides a glimpse of the history of psychiatry in Amsterdam. The first mention of a madhouse was in 1549, predating the “Golden Age” of vast prosperity that international trade was to bring to Amsterdam in late medieval times. Thirteen years later an apparently wealthy citizen donated money for the building of a madhouse, in gratitude for his wife’s safely giving birth. She had been “attacked and assaulted by a madwoman during her pregnancy.” At the address Romme names for this madhouse, there is today a fish market. One thing will have changed, though it's hard to say for better or worse: the smell.
The same time period marks the introduction of that insufferable scourge of the Dutch health system: the waiting list. For lack of capacity in the madhouse, its target population spilled over into poorhouses and plague hostels. Yet, Romme speculates, quoting the work of his thesis advisor, probably most mad people remained free and neglected. It was in 1841, smack in the middle of the Netherlands’ liberal era when state power was viewed with suspicion, that a complex “Mad Law” was legislated. Among other things, it bestowed medical status on the existing madhouses.
Other bureaucratic aspects seem to be rooted deeply in our history as well. City subsidies, top jobs created to provide employment for favored fellows, and investigative committees, all flourished already in the nineteenth century. And then, like now, in spite of all the investigations, money, doctors, and intrusion into the lives of mad people, nobody ever recovered. The mad population (Romme uses the wonderfully descriptive term: social unsuitables) increased many times more rapidly than the general population.
Bureaucracy continued to snowball as liberal ideals were lost and the Dutch state invaded the private domains of its citizens more and more. Now – meaning when Romme wrote this nearly four decades ago, though it is more true today than ever – one of psychiatry’s major functions is to facilitate access to income and housing. Throughout four and a half centuries, psychiatric institutions have mainly been poorhouses in disguise.
Romme wrote his thesis during a period when little was yet known about what went on in neighboring Germany during WWII, and even less was said about it. Before the war (as well as after when Romme was writing) there were no secular madhouses in Amsterdam, only Protestant and Jewish ones, according to his thesis. Although Romme does not mention it, the nazis wiped out the people in the Jewish institutions along with the rest of the country’s Jewish population. However, they seem to have left the non-Jewish institutions in the Netherlands unmolested, contrary to what they did in Germany, Austria, France, and Poland. Why this is so I do not know. It would be an interesting subject for someone to research.
Romme never mentions the whole sordid holocaust, in spite of the fact that his thesis advisor was Dr. A. Querido, who, judging by his name, was born into the community of Jews who sought haven in Holland after eviction from Spain during the inquisition. Querido was one of the 10% of Amsterdam’s Jews who survived the holocaust. With formidable understatement, Romme but says in a footnote, “The period in which Dr. A. Querido directed the department of Mental and Nervous Diseases was interrupted by the war years, during which he was replaced by” so-and-so.
By the way, in 1956, Querido was a founding member of the Society for Social Medicine.
Is there any clue in Romme’s thesis that he was to become a hero of our movement by rejecting psychiatric labeling of voice-hearers and pioneering real solutions to their problems? Not that I could find, except for two of the conclusions listed not in the book itself but on the insert, for the benefit of the graduation ceremony: