Insanity and Other Discomforts: A Century of Outpatient Psychiatry and Mental Health Care in the Netherlands 1900-2000

Throughout the nineteenth century, psychiatry in the Netherlands, as in other countries, primarily developed in relation to the care of the insane in asylums. Around 1900, however, it also gained ground in clinics tied to universities, in sanatoria and other facilities for mental and neurotic patients as well as alcohol addicts, and in private practice. After the First World War, psychiatrists began to treat more and more individuals who were not institutionalised. The 1920s and 1930s saw the emergence of the mental health movement and the establishment of Pre- and Aftercare Services for the mentally ill and the mentally retarded as well as counselling centres for problem children. In the Second World War the first public facility for psychotherapy was established, followed by Centres for Family and Marriage problems.
In the nineteenth century psychiatry centred on the notion that the mentally ill could be cured by temporarily removing them from society, but in the twentieth century, the opposite view gradually won ground. It was now thought better to treat those with either serious disorders or minor psychic and behavioural problems in ways that enhanced their social functioning and allowed them to remain in their everyday environments as much as possible. In the last decades of the twentieth century, this approach gained prominence in Dutch mental health care.
In this general overview, I will map all the various extramural organisations, facilities, and practices in the Netherlands in which psychiatrists and other professional groups have played a role during the twentieth century. My discussion is chronologically divided into four periods: (1) before the Second World War, when the first outpatient facilities and the first mental health organisations were established, with specific contradictions coming to the fore from the beginning; (2) the years of the German occupation and post-war reconstruction (1940-1965), when the fairly small-scale mental health care system rapidly expanded and professional expertise was increasingly emphasised; (3) the years between the mid-1960s and early 1980s, marked by a substantial increase in scale of the mental health system as a whole, a growing involvement and funding by the government, and a striving for greater uniformity in the fragmented outpatient care sector; and finally, (4) the 1980s and 1990s, a period in which the limitations of the sector’s unbridled growth became visible and the emphasis shifted from building an independent outpatient sector towards closer collaboration with institutional psychiatry. Moreover, my discussion is organised around four themes: (1) the formal and institutional development of outpatient mental health care, including its funding; (2) the professional groups that shaped it and its various groups of patients and clients; (3) the kinds of approaches and treatments adopted by the mental health facilities; and finally, (4) the larger socio-cultural context.