In 1833, Bergen Mental Hospital – popularly referred to as «Mentalen» – came into operation. As its name clearly suggests, it was meant to be, and in Bergen was also considered to be, a real therapeutic institution for people with mental illnesses. This notwithstanding, in the history of Norwegian psychiatry Mentalen has been virtually ignored. Or more correctly, it has been placed in the category of «bedlam» or «madhouse», meaning a pre-medical confinement facility and thus the opposite of an asylum. This shift in category happened already in the late 1840s and has since formed the basis for how Mentalen has been perceived in the history of Norwegian psychiatry. Why and how did Mentalen suffer such a demotion?
In March 1845, the Christiania-based Morgenbladet daily printed a caustic description of the country’s institutions for the insane (1). Its author was Herman Wedel Major (1814 – 1854), a young doctor who had recently returned to Christiania from an extensive tour of Europe, where he had studied the leading contemporary institutions in the emerging field of psychiatry. Not a single institution in any Norwegian city deserved to be mentioned in the same breath as those therapeutic institutions that he had visited.
The agony suffered by the unfortunate in these «madhouses», these «filthy holes» as he called them, was a disgrace to the Norwegian nation (1). The madhouses served purely as confinement facilities that were unable to bring even a single one of these unfortunate souls back to their senses. What the country needed was a «lunatic asylum», a place where the ill could be cured, but such places were found only abroad, he claimed.
In Bergen this provoked reactions, not of an apologetic, but rather of an arrogant and condescending kind. The Bergen Stiftstidende newspaper phrased it thus:
Some time back, Cand. Med. Major, who has travelled abroad using public funds to study the arrangements that are in place there to counter illnesses of the mind, published an article in the Morgenbladet concerning the same subject in our own Fatherland. It was thus brought to our attention that he might well be unaware of our local mental hospital, and we thus assume that the same hospital, although inferior to more costly arrangements of a similar kind in other countries, in light of our limited resources nevertheless satisfies all reasonable requirements and deserves to be recognised as such (2).
Young cand.med. Major was obviously speaking against his better knowledge, the newspaper maintained. He could not have claimed that the country had no curative institutions for the mentally ill had he been aware of the facilities available in Bergen. In ten years, nearly 400 people had been treated at Mentalen, and close to 250 of them had been discharged as cured. With poorly concealed pride, the newspaper pontificated to the experts in the capital city that there was an exception to the picture of misery drawn by Major and Morgenbladet.
The message to the capital was clear: look to Bergen! The following year, this was precisely what Major did; he travelled around to the country’s mental institutions to see for himself. However, although his verdict of Mentalen was milder than those he gave for institutions in other cities, his visit to Bergen caused a change of tune. In a few short years, Mentalen changed from being the pride of the local authorities to become a stain on their reputation.
The original madhouse in Bergen, or «home for the feeble-minded» [«daarehus»] to use the founders’ own term, was built in 1762. At the time, it was hailed as a huge advance in the name of altruism and humanism (3). Around sixty years later, in 1824, it was given the following disheartening report: «The current organisation of the home appears to succeed in depriving those unfortunate souls who are committed thereto of what little reason they might have left, rather than to restore to them what they have lost» (4).
In this respect, the situation in Bergen was indistinguishable from developments in the two other major cities of the realm, Trondheim and Christiania. Here too, new madhouses had been built in the second half of the 18th century, and received similar testimonials for their poor conditions during the first couple of decades of the 19th century (5). The only difference was that the madhouse in Bergen was directly linked to the somatic hospital – it was located in its back garden – while in Trondheim and Christiania the madhouses had been physically and administratively subordinated to these cities’ general hospitals, meaning combined poorhouses and retirement homes (6).
This difference did not reflect any disparities in the ideas about or approaches to madness – it was not the case that a medical view of such conditions was more prevalent in Bergen. The solution chosen in the 1760s was exclusively based on practicality, but the affiliation with the hospital would attain major importance in the 1820s. In addition, a mere coincidence caused the psychiatric institutions in Bergen to be out of step with the country as a whole.
Mentalen in Bergen was planned and built throughout the 1820s and 1830s with the aim of being a curative institution, consistent with the principles of the contemporary European asylum movement. With some justice, the institution may thus lay claim to being Norway’s first real psychiatric asylum. Photo: Marcus Selmer, year unknown. From the archives of Neevengaarden, Bergen City Archives
A decisive journey abroad and a death
In June 1823, two young doctors from Bergen set out on a 14-month educational tour of the Continent. They were Christen Heiberg (1799 – 1872) and Christian Wisbech (1801 – 1869), and they were 25 and 23 years old respectively when they returned home the following year (7). Shortly after their return, Laurents Hallager (1777 – 1825), chief physician at Bergen Hospital, died. Christen Heiberg was immediately appointed new chief physician at the hospital as well as the madhouse.
A few months before his death, Hallager had submitted a proposal for a new institution for the mentally ill. Owing to his new position, the 25-year-old Heiberg received the plans for review. He profoundly disagreed with the late chief physician’s plans for a new building.
Hallager’s plan conformed to previous practices for constructing madhouses in Norway. The building was designed for the exclusive purpose of confining the sufferers. The windows were small and placed high up on the wall, and the rooms were furnished as prison cells to keep the patients completely secured for the benefit of themselves, the interior and society.
Heiberg totally rejected Hallager’s plan. Over the course of twelve days in February 1825 he made a new sketch of the planned institution, which was based on a radically new principle. To Heiberg, it was an unalterable requirement that:
it is not the exclusive intention of [the new madhouse] to confine the insane and separate them from the remaining community of burghers, thus to prevent them from committing violent acts or otherwise [imposing] harm, but that one also will take pains to contribute in every possible way to alleviate, improve and above all cure their condition, and [therefore] the plan appears overall totally insufficient in my opinion (8).
The purpose of building a new institution for the insane would have to be to cure them. This is the key feature of what is considered the watershed in the history of care for the insane. The moment when the first attempts were made to cure the mentally ill marks the beginning of the history of psychiatry and the asylum. Heiberg thus declared that the city of Bergen should erect an institution that in itself should restore the insane to reason, i.e. what posterity in practice would refer to as an asylum – a curative institution.
By the 1820s, the so-called asylum movement had spurred the establishment of a number of different institutions whose aim was to cure madness, and Heiberg and Wisbech visited several of them in Germany and Bohemia, as well as Sct. Hans Hospital near Roskilde in Denmark. The introduction that Heiberg had received to what he referred to as «the mental science of medicine» had convinced him that the material environment as such could form a basis for the troubled minds of «the insane» to be calmed. The building itself embodied a therapeutic regime and a curative instrument (9).
Heiberg reviewed Hallager’s plan item by item, criticising and proposing new solutions that he considered to be in line with the purpose of cure and «the mental science of medicine». To the greatest extent possible, the building should be similar to a normal civilian home, not a prison. Sufficient space and air, enough light, heat and cleanliness would provide opportunities for the patient’s mind to recover. Heiberg sketched far larger rooms than Hallager had done, he meticulously described a new central heating system with an associated ventilation system, and he described in detail how the toilets ought to be designed. In particular, he devoted much space to vistas and windows. Rather than peepholes high up on the wall, Mentalen should be provided with large windows, thus to «enliven the mind», as Heiberg put it (8).
Specific therapeutic interventions were scarce, however. As described above, the building itself should provide healing. It was not until questions were raised concerning the location of the new mental hospital that Heiberg found it necessary to describe what should be the patients’ activities in the institution. The meadow behind the hospital where Mentalen was to be located was waterlogged. This was not a disadvantage, quite the opposite, Heiberg explained to the city authorities – the insane could help drain the ground. Manual labour in the open air was excellent therapy. In general, a disciplined daily life in the institution would help bring the patients back to their right mind. Fixed mealtimes, meaningful manual labour, well-directed social interaction – all these constituted therapy.
Mentalen was built in the back garden of the city hospital at Engen and was thus surrounded by a dense housing mass. The photo was taken in the 1880s from the Dragefjellet peak towards Nøstet. In the distance Fredriksberg fortress, the fortification on the Nordnes promontory. Photo: Axel Lindahl. Property of the Norwegian Museum of Cultural History
Bergen goes its own way
Heiberg and Wisbech were not the only ones to have visited the new curative institutions on the Continent. Some years earlier, Fredrik Holst (1799 – 1871), city medical officer in Christiania and later professor, had investigated how «care for the insane» was arranged abroad. After his return home, he succeeded in persuading the government in 1825 to appoint a commission to investigate the conditions for the insane nationwide.
Holst and Heiberg generally shared the new view on the phenomenon of madness and claimed that many of the insane could be cured in new institutions. They were both imbued with the same optimism regarding what could be achieved by medically managed efforts, and they had seen the same innovations during their travels abroad. Their positions differed, however: Heiberg was medically responsible for a local project in what was still the country’s largest city, Bergen, while Holst was a member of a government-appointed commission in the capital aiming to establish a new national network of curative institutions.
Frederik Holst earned his exalted role in the history of Norwegian psychiatry as Major’s precursor – as the man who prepared the ground for the great achievements that Major later would complete (10 – 12). Recent literature points out major differences in their reform projects, but this is not the crucial issue in our context (13). The report and grandly designed plan of the Holst Commission, to build four curative institutions under the auspices of the government, was available in 1827, but the matter was never deliberated by the Storting. The work of the commission did not produce any immediate result, and not a single building was erected.
The development in Bergen contrasts sharply with the collapse of Holst’s nationwide project. On the penultimate day of 1826, without even waiting for the Storting’s deliberation of Holst’s plan, the Bergen hospital committee unanimously decided to build a new curative institution in the city (6).
How could Bergen Hospital find the means to build a new institution for the treatment and cure of the insane when Holst and the government-appointed commission could not even succeed in having the substance of their proposal deliberated by the Storting? How could a provincial city assume responsibility for such a project when the government found itself unable to build even a single institution? The answer is as simple as it is surprising: In Bergen, there were funds to spare in the hospital’s budgets.
The reason for the relative wealth at the hospital in Bergen lay in a scheme particular to the city. The hospital had been established as a separate foundation. To fund its operations, it had received a proportion of the so-called «dredging money». All ships that docked in Bergen had to pay a fee to the city’s dredging services. This was a highly lucrative deal – in 1825, the hospital was owed nearly 10 000 «spesidaler» [old silver coins] by the city’s coffers. The hospital was thus enabled alone to finance the construction of a new institution for the city’s mentally ill. This task fell to the hospital, because the madhouse had been placed administratively under the hospital in 1762.
As noted above, the plan was to build a new, but not qualitatively different, madhouse – and if Hallager had not met an early death, this would have been the likely outcome. However, with the appointment of the recently returned Heiberg and his recently imported knowledge about and enthusiasm for the «mental science of medicine» and the European asylum movement, the project was fundamentally altered. As a result, a dedicated curative psychiatric institution, called Bergen Mental Hospital, could open on 1 August 1833.
This totally fails to fit into the established narrative about the development of Norwegian psychiatry and the emergence of the asylums. It has been assumed that the European asylum movement obtained a real and concrete presence in Norway only with Major, the Insanity Act and Gaustad Hospital – so we have been told repeatedly by historians, psychiatrists and others (5, 10 – 12). In such a narrative, Mentalen is an anomaly. It was planned and constructed with the explicit objective of being a curative building, i.e. the key ambition of the emerging psychiatric discipline – the very characteristic of having moved from the dark past to the brightness of the future. Thus, in a certain sense and in principle, we could have elevated Mentalen, not Gaustad Hospital, to the status of being Norway’s first real psychiatric asylum.
However, neither historians nor contemporary reformers in Christiania such as Major have regarded Mentalen as an asylum. Nor would the people of Bergen retain their conviction when it was challenged.
After remaining almost static in the first half of the 1800s, the population of Bergen grew rapidly, especially from the 1870s onwards. A new asylum, the Neevengaarden, was completed in 1891. Here we can see the city’s central area from the fish market towards Torgalmenningen square on a postcard from 1890. All the buildings portrayed were lost in the great fire of 1916. Photographer unknown. From the postcard collection of Bergen University Library
Major’s verdict of Mentalen
When Major visited Bergen in 1846, thirteen years after Mentalen opened and one year after the arrogant article in Bergen Stiftstidende, he could see for himself what had been initiated by Heiberg. Heiberg himself had moved away from the city many years earlier. He had left his home town for the benefit of a career in the capital city that led him to a professorship in surgery at the university.
According to Major, Mentalen appeared to be the country’s best institution by far for treatment of the insane. The «large, light and airy» rooms contrasted with «the country’s other» institutions, which had taken «the repulsive and unhealthy madhouses of the Medieval age as their example» (14). But all was not well.
According to Major, Mentalen had two reprehensible aspects. First, it was an abomination that it was located within a city and not out in the country. In addition, a real asylum needed to be a separate administrative unit under the management of a separate, specialised chief physician, since only this could provide the patients with the attention needed to cure them. Major therefore concluded that Bergen had the country’s best madhouse – a pre-scientific confinement institution – and not an asylum. In this way, Mentalen was placed on the opposite side of the qualitative distinction represented by the asylum.
The criticism voiced by Major caused renewed reactions in Bergen, but the haughty pontifications from 1845 were gone. Now, Mentalen needed to stand up to a comparison with the idealistic demands on which Major founded the forthcoming Insanity Act and the planned model institution at Gaustad, and this comparison left much to be desired. Rather than ignoring the ministry and expertise in the capital, as the city authorities had done when deciding to build Mentalen in 1826, they adapted. After Major’s visit, nobody in Bergen ever again claimed that Mentalen was a curative institution that could serve as an example to others, and the institution instead came under harsh criticism.
Bergen takes a new perspective on Mentalen
The critical perspective that the people in Bergen now adopted with regard to Mentalen provides some interesting information on the activities there (6). It transpired that chief physician Wisbech had hardly dealt with the patients at all, since all his time had been devoted to the management of the somatic hospital, as he noted in his defence. Chief Municipal Officer Bonnevie, who was a member of the hospital committee, declared that on his numerous inspections he had never encountered a single doctor.
The institution’s regulations, which had been directly copied from the famous Berlin Charité, were excellent as such, but they were in no way adhered to. According to the regulations, the patients should engage in extensive and organised social interaction. Music and games should be played, but when Bonnevie had demanded that the skittles set be taken out, the patients were clearly unfamiliar with the game. Moreover, he had found a number of dust-covered wooden rifles in the attic. The original plan to let the patients exercise marching and drill, and thus foster discipline, had been abandoned. The same kind of inattention and neglect featured in the work performed by the patients. It was pleasurable rather than organised and disciplined, and thus regarded as worthless in terms of its therapeutic value.
All these reprehensible factors were widely reported in the local newspapers. The people of Bergen quickly abandoned the view that Mentalen was the country’s first curative institution for the insane, in the sense of a real asylum consistent with the definitions of psychiatry, and adopted Major’s view, according to which the institution in practice was demoted to the country’s best madhouse or bedlam. The people of Bergen were no longer able to define their institution themselves; they had to relate to a higher standard handed down to them by the capital city.
Moreover, this applied not only to the area of psychiatry or health. Over a few decades, the construction of the new capital had caused the population of Christiania to outstrip that of Bergen. In the mid-century, the newspapers in the capital referred to Bergen as «the city of stagnation» and as a town characterised by hidebound conservatism with few signs of dynamic development (6). Mentalen was no longer a jewel that demonstrated the city’s capacity for progress, science and humanity to the outside world; it had rather become a sad testimony to how Bergen was being surpassed by Christiania in all areas.
The local authorities in Bergen realised that in order to measure up against the capital city’s model institution at Gaustad, a new asylum had to be built out in the countryside. Without any government funding this was illusory. Instead, they tried to comply with the requirements of the Insanity Act.
Mentalen was supplied with a separate chief physician and established as a separate administrative unit, thus to permit authorisation as an asylum in conformity with the law. In addition, some small symbolic changes were made – a board fence was erected between the hospital and Mentalen, and the institution was provided with a separate entrance. Like the other madhouses, Mentalen was duly approved as an asylum (institution for the insane) in 1850/51 (13). This status was a purely formal affair, but ensured that the activities could continue under the new legislation. In effect, posterity has upheld Major’s verdict of Mentalen as a «madhouse».
Bergen falls out of step
The decision made in 1826 to defy Holst and the ministry was to have long-term repercussions in Bergen. The construction of Mentalen brought the city effectively out of step with the national and governmentally directed development of Norwegian psychiatry.
Although Major failed to gain acceptance for the idea that the government should build asylums to replace all of the country’s madhouses, a network of state asylums was in practice built during the second half of the 1800s. One might perhaps believe that the country’s second largest city would be first in line once Gaustad Hospital had opened in 1855, but that was not to be. Thanks to Mentalen, the situation in Bergen was far less precarious than in the two other regional capitals, Trondheim and Kristiansand. The next state asylum, Rotvold, was built in Trondheim in 1872, and Eg asylum in Kristiansand was completed ten years later (10).
The authorities of Bergen constantly pleaded with the government for funding to build a new asylum, but repeatedly met with rejection (6). Bergen and its environs could in no way live with a psychiatric institution that only had a capacity for fifty patients, and the numerous private asylums that emerged in the city after the mid-century were regarded as emergency solutions. Finally and for the second time, a decision was made to build independently and at the city’s own cost.
Despite the major protestations of the magistrate – he was concerned about the city’s finances – the city council decided to build what was to become the Neevengaarden after its completion in 1891, and what today is Sandviken Hospital. Western Norway was the only one of the country’s regions never to receive a government-funded asylum, but where an equivalent institution ended up by being built at municipal cost. In the political process, constant references were made to the city’s pioneering role in building Mentalen. The example of the past represented an obligation, and when the government refused, the local council chose to go ahead with construction on its own. The pace of Bergen never coincided with that of the government, and the city therefore danced to its own tune.