Ravings of a Madwoman

Corrie van Eijk-Osterholt and Kurt Bökenkamp
(published in Dutch only)

reviewed by Mira de Vries

Van Eijk-Osterholt is known to the Dutch public for her 1972 book about her 25-year running battle with mental health services on behalf of her twin sister. Although never officially committed, the sister spent her entire adult life locked up, battered, and later poisoned. The author took meticulous notes of all her many contacts with the authorities, who responded with impotence, indifference, incompetence, and deceit. The problem was never solved, and the sister died in the system several years after the book was published.

Bökenkamp was among other things involved in establishing runaway houses in the Netherlands. 

These two authors’ names became well-known in the heyday of social psychiatry in the Netherlands. Therefore, when someone found brochures about psychiatric injustices in the previous century, it was brought to their attention. They republished the brochures after retouching the Dutch for the benefit of the modern reader, and adding some commentary.
The brochures were written by what today we would call a “user” of the mental health system, Mrs. Johanna Stuten-te Gempt. Practically nothing is known about who she was, although her literacy suggests that she must have come from a well-to-do family.

Johanna didn't express doubt about her need for hospitalization. What exactly ailed her she never stated. The authors were able to uncover in the public records that her husband passed away in 1889, apparently before her first admission, so perhaps she was depressed. In her brochure she asserted to have been released from her first admission while she was unrecovered and still confused, contrary to her second admission, when she was for years refused her freedom even though she was recovered. It’s a bit doubtful that she was ever truly all that confused, considering her articulate testimony of the enormous injustice done to her and her fellow patients.

The similarity of what Johanna experienced in the late nineteenth century to conditions when her brochures were republished in 1983, and for that matter, to today, is striking. Few of us who have contacts with such institutions will have trouble identifying with Johanna’s descriptions of abuse of power by her carers, physician, and family. The name of the book is borrowed from Johanna’s bitter complaint that whenever she told her family about what was happening to her and the other inmates, the staff dismissed her accusations as the “ravings of a madwoman.”

There are a few differences between then and now. It is arguable who is/was better off. Today’s solitary confinement cells, which are used so much in the Netherlands, are not plagued by rain, frost, or rodents. On the other hand, Johanna and her contemporaries were not held naked under the eye of a constantly rolling hidden camera. They probably also did not have to suffer the indignity of the ritual to check bodily orifices for smuggled illicit drugs.

There does not seem to have been compulsory medication in her day. Neuroleptics had not been invented yet, so there were no tardives (t. dyskinesia, t. akathisia, t. dystonia, t. hypersensitivity, t. psychosis, t. dementia). On the contrary, people who managed to be freed were often recovered, not due to any medical treatment --  there wasn’t any -- but because time is a great healer, when the patient has not meanwhile been poisoned with so-called medications. 

Another interesting detail we learn from Johanna is that people with terminal somatic illness were also admitted to the same institutions. In those days any illness that doesn’t heal spontaneously was terminal. These people did receive some rudimentary treatment, namely morphine, to this day still the most effect form of pain relief. When the staff wanted to take a day off, they would for the sake of convenience administer a double dose. Johanna observed how cruel this was, as at the time of withdrawal the pain would return doubled. This 19th century lay writer understood the rebound effect of narcotics better than most highly trained 21st century psychiatrists.

Johanna felt that she had at times needed care, and believed that there was a sanatorium in Belgium where she could have received care properly. This was probably wishful thinking on her part. The importance of this book is precisely that it illustrates how injustice and abuse of power are not incidental, but intrinsic to every system of care for powerless people, in every point in time and every place. If there are psychiatric institutions on other galaxies, these same abuses of power no doubt occur there too.

The only antidote to abuse of power is to make sure that no innocent person is ever held anywhere against his will.

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