As less people with psychiatric problems are kept behind locked doors, old mental hospitals are being converted into luxury accommodations. What do psychiatric facilities look like in a future increasingly dependent on pharmaceuticals? We take a look at old asylums and new clinics. Text: BJÖRN HEDLUND Photo: PATRIK ENGSTRÖM
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S채ter was designed by architect Ture Stenberg and opened in 1912. When the hospital was open, the area had 37 buildings, 20 of which were high-security.
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hen I worked in social psychiatry in Sollentuna, a suburb north of Stockholm, I met a woman who was diagnosed with borderline personality disorder. She was experiencing severe panic attacks and for weeks had been saying she needed help. Finally, she told me she felt like she was going crazy and that she wanted to kill herself. I contacted the team at the Stockholm county council responsible for dealing with acute cases, but they were unable to help because the woman was also intoxicated. We called a taxi to take her to a clinic in central Stockholm. It rushed past traffic jams on the outskirts of the city while she clutched the door handle with a terrified expression on her face. After a few days of detox, she was transferred to Danderyd Hospital’s psychiatric ward.
Långbro hospital, near Fruängen south of Stockholm, was more focused on the temporary treatment of the mentally ill. It was located in a beautiful park area, and patients were to spend a shorter period at Långbro before they were transferred to other establishments. Hermann Göring was a celebrity guest who spent time there in 1925, the result of the psychological fallout of morphine abuse. At its height in the 1970s, Långbro housed 1,350 patients. The following decades were a period of de-institutionalisation, and in 1995 the hospital shut its doors. Today new residential buildings have been built along Långbro, but the park still looks as it originally did. The buildings are still intact and give the grounds a rather gruesome feeling. The architecture and choice of location for both Beckomberga and
“In a time where a major political issue is whether or not terrorist Anders Behring Breivik should receive psychiatric care, we are very far removed from Svante Nycander’s 1969 battle cry - Abolish forensic psychiatric care!”
his is the face of Swedish psychiatric care today: Those with acute psychiatric distress have fewer options. They’re rushed to the emergency room, but what happens next has changed radically in the last few decades. The massive mental hospitals of yesteryear have been replaced by less consolidated services that are integrated into the community. One example is in-home support, which allows patents a degree of independence. The end of the 1980s was the beginning of de-institutionalisation and a movement away from the long-term lockdown of the mentally ill. In the middle of the 1960s, around 35,000 people were confined to inpatient psychiatric care, primarily at mental hospitals. Thirty years later, in the 1990s, this number had been reduced to 15,000. In Stockholm, Beckomberga and Långbro were places where people with mental illnesses spent a lot of time. In its heyday, Beckomberga in Bromma, north of Stockholm, was one of Europe’s largest facilities of its type. Beckomberga opened in 1952 and was closed in 1995. The exterior is sober. A courtyard rises in the centre of the massive facility, surrounded by a low brick building that once functioned as an auditorium and church. In its heyday, Beckomberga employed 800 attendants and was home to around 2,000 patients.
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Långbro emphasised nature as an important part of the patients’ recovery. The area around Långbro hospital is today full of private residences, restaurants, schools and day-care facilities for children. In the middle of the area is a pond filled with goldfish.
nother of Sweden’s most wellknown facilities, Säter, is waiting to hear its own fate. Designed by architect Ture Stenberg, this secure facility opened in 1912. It was intended to house patients who were considered high-risk. The walls were thick and patients were moved from one part of the facility to another through a series of locked doors. The entire building was lit from a central switch. A guard was always on duty in an inaccessible room where he could control the opening and closing of the outer gate. The architecture was pompous and was intended to “radiate
the power and strength of society”. Sociologist Erving Goffman’s 1961 book Asylums: Essays on the Social Situation of Mental Patients and Other Inmates is a seminal work that lead to the movement towards deinstitutionalization. Goffman showed how the boundaries between caretaker and inmate are reinforced through institutional rituals. This plays an important role in confinement and discipline of pathological patients. Goffman was interested in how identity, self-perception, social roles and integrity is produced and transformed in social interactions. Another famous work of Goffman’s was Stigma, wherein he discusses how, as a result of their deviation from social normative behaviour, the mentally ill are often ostracized from the community.
Sweden sends its criminally insane to one of five forensic psychiatry facilities. In a time when a major political issue is whether or not terrorist Anders Behring Breivik should receive psychiatric care, we are very far removed from Svante Nycander’s 1969 battle cry – and book title – Abolish forensic psychiatry! (Avskaffa rättspsykiatrin!). At the beginning of next year, Helix will be opened as a new forensic psychiatric clinic in Huddinge, south of Stockholm. The secure facility will house ninety mentally ill patients. Anna Espling Rolf at BSK Arkitekter, which designed the building, is enthusiastic about the project. In the middle of the building is a square she says is “medical Sweden’s coolest space”. She describes the square and the entire Helix facility as a place that should be “safe, light and pleasant”. She wants to stay far away from words associated with prisons or the prevailing image of secure mental
hospitals. “Coercion and seclusion” are negative concepts. Communication and openness are, on the other hand, oftrepeated terms. The overarching goal for the facility’s design is the well-being of staff, and Espling emphasizes just how dedicated everyone involved in the project has been. There is also a focus on security – which is related to involuntary confinement – but this fact is often omitted when representatives of the architecture firm introduce themselves. As we’ve heard elsewhere, she talks about security in terms of how dynamic it is. This means the “right people should be in the right place”. Another reoccurring theme is predictability. It’s about streamlining the facility, because it’s difficult to maintain security if doing so is too cumbersome. “Doors that should be open aren’t, and so on,” she explains. “People shouldn’t feel monitored. Predictability is important.” Just as in the design at Beckomberga, nature here is seen as a healing force. Helix reflects an entirely different epoch, with other values and ideologies, but it’s clear Beckomberga has similar ambitions. Nature should have a curative effect, and it’s important to create pleasant places for the employees and patients to meet. With strong anti-psychiatry organisations as their advocates, caregivers for people with special needs once played a much different role than they do today. It is telling that Anna Odell’s 2009 graduation project at Konstfack (University College of Arts, Crafts and Design), which involved a staged psychiatric breakdown, was so controversial. Today caregivers’ associations articulate requirements for recognition and rights connected to biological identity in cases of what is often referred to as “neuropsychiatric disability”. These groups are often sponsored by the pharmaceutical industry. Just as you can talk about a militaryindustrial or border security industrial complex, you can say the same about psychiatric treatment and pharmaceuticals. Privatisation of the pharmaceutical market in Sweden or health centres in Stockholm are examples of what happens when markets for new types of products open up. The selection of products increases, while less marketable, but still valuable, products become scarcer. At the same time, in the city, the availability in urban areas shifts where wealthier neigh-
bourhoods benefit at the expense of suburbs and rural areas. Mental illness and anxiety are aggravated by a society that is becoming increasingly unequal. Living environments that are designed specifically for people with serious forms of psychiatric illnesses say a lot about the times in which we live. As was in the case in other places, Beckomberga and Långbro both used hydrotherapy to cure their patients. Today spa treatments fulfil the same function. There are major differences between these two wet treatments and the latter is both more widespread and more socially acceptable. It demonstrates how what anthropologists Carlos Novas and Nikolas Rose refer to as a global tendency towards “biological citizenship” is reinforced. They also write about how the connection between caregivers’ associations and the pharmaceutical industry is an expression of biological citizenship. To a certain extent, it replaces political citizenship. Envisioning yourself as a product of your own biology is a new kind of self-perception and identity. New ways of being where the contradiction between the collective and the individual is erased in favour of new shared affiliations and perspectives. The appropriation of normality and the fact that more individuals are defined, and define themselves, with acronyms or according to neuropsychiatric disabilities doesn’t mean, however, that stigma and forced institutionalisation have gone away like magic. The medicalisation of society and human beings continues, but mental illness has been redefined.
wentieth century mental hospitals were filled with mentally ill patients who were perceived to be a risk. The old facilities were organised around a central surveillance room and a strict power structure. The contemporary focus on risk-assessments and security architecture has also extended to psychiatric treatment environments. Modern forms of treatment have a more decentralised structure: in-home support, special schools and assisted living are an expression of how the psychiatric space has grown to encompass other parts of society. At the same time, the conversion of old mental hospitals to luxury flats heralds the emergence of a new outlook on mental illness.
HELIX FORENSIC PSYCHIATRIC CENTRE ARCHITECT: BSK Arkitekter COMPLETED: October 2012 SIZE: 1 700 sq m NUMBER OF PATIENTS: 90
The architects at Stockholm-based BSK wanted to combine a light and modern healthcare environment with stringent security requirements. The structure of the facility in Flemingsberg, outside of Stockholm, resembles a broken comb that rests on a mountaintop. There is also a focus on nature. Helix is located in an isolated park where patients can take walks.
BRINKÅSEN FORENSIC PSYCHIATRIC CENTRE ARCHITECT: Sjögren Arkitekter COMPLETED: September 2011 SIZE: 17 000 sq m NUMBER OF PATIENTS: 80 The intent of the design of the Brinkåsen clinic was to create a facility that would resemble society’s separation of activities: work, home and leisure. The staff at Sjögren Arkitekter divided the various activities by situating 14 buildings around a circular park. The living quarters are located on the ground floor so that patients can live in direct contact with nature.
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Helix, a new forensic psychiatric centre in Huddinge near Stockholm, will open at the beginning of next year. This secure facility will house ninety mentally ill patients.
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The former mental hospital S채ter in Dalarna is in a state of disrepair. There has been talk of using the premises to exhibit outsider art, but there is no funding to renovate and operate the buildings.
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BSK Arkitekter designed the new Helix facility in Stockholm. Nature is thought to have a curative effect, and itâ€™s important to create pleasant places for the employees and patients to meet.
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