Oslo Hospital – 300 years of mental care
Some reflections on the site of Norway’s first psychiatric in-patient facility and the place for small personalized institutions.
In the year 1291, a Franciscan chapel was erected right outside the small town of Oslo, which at the time was not yet the capital of Norway. This was a great nuisance to the Dominicans in St Olav monastery, founded 50 years earlier, not least because they became competitors on the beggars’ market. The chapel was torn down, but with the pope’s help, the Franciscan monastery was established.
After the reformation in the combined kingdom of Norway and Denmark in 1538, the monastery was taken by the king and given to the citizens of Oslo as a foundation for the “poor, sick and sore” under the name of Oslo Hospital – the word hospital meaning a caring institution, not the modern meaning of the word. One could buy a place for one’s old days, but very poor inhabitants were taken in for free.
Oslo Hospital ca 1800. The low white building, parallel with and to the left of the church is the Dollhus. The city of Christiania in the rear. Courtesy: Digitaltmuseum.no.
Then something happened in the year 1736: A maid, Birte Jonsdatter, had “laid to death” her master’s child, and she had been sentenced to decapitation. However, on review of the case, the theological faculty at the University of Copenhagen found her to be “raving mad”. She could not be executed, but was to be put in one of the country’s hospitals. In this way, she ended up in Oslo Hospital as Norway’s first psychiatric in-patient. Birte was not pleased, and lamented that she would prefer to commit another crime and have her execution fulfilled rather than languish in this hospital.
The king, however, did not listen to Birte, and decided that all of the main hospitals in the country were to reserve 1 or 2 rooms for people who were “out of their mind”. But the need was greater than this, and the foundation built a “Dollhus” in 1779. (NB: Not to be confused with Henrik Ibsen’s “A Doll’s House”; this word has its roots in the German Toll-Haus, a madhouse). It could accommodate 16 people of both sexes in cells of 6 square meters, but the opening was delayed because of the smith’s works with the iron bars and chains. Yet this was considered a better option than being locked up in basements, barns and sheds.
The house was built with a slight slope downwards from east to west, with water running down a canal in the middle corridor. In summer, it stank; in the winter, it was frozen.
The cleaner patients has their rooms in the east at the top and the less clean patients in the west at the bottom.
There was a medical doctor looking after their health, but only the somatic side of it. The WPA slogan “No health without mental health” was not yet conceived. The local vicar took care of their spiritual matters. Furthermore, straightjackets were used in order to save expenses to keepers.
Outdoor space. Dollhus to the right, ca 1870. Courtesy: Oslo Museum.
In 1806, the inmates were 11 women and 6 men, mainly because of “amour affaires” or having killed babies born out of wedlock – as had Birte. But the city medical officer’s assessment was that “Oslo Dollhus is, in its present shape and with its preferred method of treatment, more likely to produce insanity and prevent it’s cure than to treat the same”.
So, in 1845, Herman Wedel Major, “the father of Norwegian psychiatry”, became the doctor at Oslo Hospital. He approached his work with the view that mental disorder was caused by an organic disease, either in the brain or in other organs, especially the genital organs or the circulatory system – as opposed to moral explanations. Disease instead of defect! And therefore: One could be cured by the correct treatment. No coercion, but distance to the disease-producing conditions of home. Work is correcting and curing.
The protocol kept in the consultant’s office during the author’s time in the 1990s display the diagnoses used by Major: Melancholia, Mania, Stupidité, Delirium tremens, Dementia, Idiotismus congenitus or acquisitus, Epilepsia and Paralysis generalis. And his treatments were: Hot or cold baths, phlebotomy, digitalis, leeches in the temporalis region, strengthening diets with red wine & mixtures, spicy baths, emetics, quinine and ointments.
During his time at Oslo Hospital, Major wrote the proposal for the first Norwegian Mental Health Act, which was adopted nearly word by word in 1848. His demands to the government were: 1) Guarantee for the personal freedom of the insane and care for their interests if this freedom had to be restricted 2) The goal had to be cure or improvement of the disease 3) Only suitable locations should be used 4) A new asylum had to be built. We may assume that this reflected his negative experiences at our place.
As a result of his work Gaustad Asylum was established under his direction, opening in 1855.
After Major’s time, Oslo Hospital came to function more like a psychiatric nursing home, where many notable psychiatrists practiced, among them the prolific writer (“influencer”) and teetotaller, forensic psychiatrist and anti-Nazi propagandist Johan Scharffenberg during 20 years until he retired in 1941.
Then, in 1983, the Sleeping Beauty woke up: A young psychiatrist, Pål Abrahamsen, became medical director and brought with him a dozen of psychiatric nurses from his former department. He introduced psychologists and social workers, banned all coercive treatment, took in patients from all age groups, also male, and even propagated the “medicine-free hospital”. This last goal was impossible to reach, but there was a spirit of unchaining great powers from all the employees. Family therapy and systems thinking, cooperation with the community around, taking in difficult cases that were refused intake elsewhere, in many ways according to the Soteria principles of Loren Mosher from California.
Dr. Abrahamsen stayed on for 7 years, but the hospital developed further until the new economic regimen in Norwegian hospital services determined that it was too expensive: Oslo Hospital lost their bid to deliver in-patient services in 2011 and was swallowed up by another hospital, also running on a diaconal basis, until it was finally closed down in 2018.
So we can see a parallel between the physical conflict 700 years before and the bureaucratic silent closing during our days. The wards were moved from the blooming apple orchard to a modern concrete structure between a parking lot and one of Oslo’s main ring roads. Now the Norwegian church is moving in, so one can say that the circle is really closed.
Herman Wedel Major and Gaustad Hospital were presented in The Nordic Psychiatrist issue 2019-2. □