Icke som en annan människa. Psykisk sjukdom i mötet mellan psykiatrin och lokalsamhället under 1800-talets andra hälft

Sammanfattning: The purpose of this thesis is to study conceptions of mental illness in Sweden during the second half of the 19th century. The central aim has been to analyze how mental illness was understood and interpreted in what was a continual interaction between medical professionals and lay people. The relationship between the local community and the asylum influenced the admittance and discharge of patients as well as the explanation and treatment of patients’ symptoms. The analysis has been based on the assumption that psychiatric practice and theory developed through contact between people in the community and the asylum doctors. It appears likely that the development of psychiatry during the second half of the 19th century, both in the asylums and the universities, was shaped by this relationship. The interaction between psychiatry and the local community has been investigated primarily through patient records from asylums in Vadstena, Malmö and Lund. Admission records and patient files have been read in parallel in order to assess both doctors’ and laymen’s perspectives on an immediate and direct level. The first part of the thesis deals with psychiatry as a medical discipline and examines, first, doctors’ striving for reliable scientific knowledge and professional recognition and, second, professional attitudes towards care in the community. The second part of the thesis homes in on conceptions of mental illness in the local community, acknowledging many different aspects of the everyday treatment of deviant behaviour. The last part focuses explicitly on the interaction between psychiatry and the local community, aiming to uncover how this interaction affected the mutual roles of doctors and laymen, the practical handling of the mentally ill and, not least, understandings of mental illness and the development of clinical practice in the asylum. A central conclusion of this thesis is that the assessment and treatment of mental illness grew out of a dynamic relationship between social and medical models of interpretation, on both a theoretical and a practical level. On a pragmatic level, asylum care was a medically based activity but at the same time it attended to social problems in the local community. On a theoretical level, one can see that doctors’ conceptions of illness were grounded in a medical perspective but at the same time originated from interpretations of social behaviour. Lay people were dependant on the doctor not only as a medical expert but also as a social benefactor. The doctor was dependant on lay people not only for pathological material but also for illness narratives that could be transformed into medical knowledge. The social and the medical were intertwined.