Self-development and Civic Virtue: Mental Health and Citizenship in the Netherlands, 1945-2005

In the nineteenth and early twentieth centuries, the relationship between institutional psychiatry and citizenship was "negative" or "exclusive" in the sense that hospitalization in a mental asylum generally implied legal certification and therefore the loss of and potential serious infringement on basic civil rights. In the course of the twentieth century, however, in two ways a more "positive" or "inclusive" connection between psychiatry and liberal-democratic citizenship was established. Firstly, the last three decades of the last century saw a growing attention for and recognition of the civil rights of the mentally ill. In many Western countries the legislation on insanity was amended, reflecting a shift from values associated with maintaining law and order to values associated with mental patients' autonomy, responsibility, and consent, as well as their right to adequate care and treatment. Secondly, from the early twentieth century on, in psychiatry as well as in the broader field of mental hygiene and mental health care, psychological definitions of citizenship were advanced. Expressing views about the position of individuals in modern society and their possibilities for self-development, psychiatrists, psycho-hygienists, and other mental health workers connected mental health to ideals of democratic citizenship and civic virtue. Thus, they were clearly involved in the modern liberal-democratic project of promoting not only virtuous, productive, responsible and adaptive citizens, but also autonomous, self-conscious, assertive, and emancipated individuals as members of an open society.
This article is about the development of mental hygiene and mental health care in the Netherlands after the Second World War in order to explore its relation to the social and political modernization in general and the changing meanings of citizenship and civic virtue in particular. In the course of the previous century, citizenship in the Netherlands took on a broad meaning, not just in terms of political rights and duties, but also in the context of material, social, psychological, and moral conditions that individuals should meet in order to develop themselves and be able to act according to those rights and duties in a responsible way. Notions such as fairness, social justice, social responsibility, tolerance, emancipation and personal development became elements of the definition of good citizenship. On the basis of the three different ideals of individual self-development that I identify, my account is divided into three periods: 1945-1965 (guided self-development), 1965-1985 (spontaneous self-development), and 1985-2005 (autonomous self-development). Before turning to the post-war period, I will briefly sketch the rise of the mental movement in the Netherlands and its socio-political background during the first half of the twentieth century. In the conclusion I will elaborate some more general characteristics of Dutch mental health care in its sociopolitical context.