När psykiatrin vände sig åt samhället : Om psykiatridebatt, sektoriseringsplaner och Nackaprojektet 1968-81

This essay revolves around the reformation and sectorization of Swedish psychiatry starting in the 1970’s. Psychiatry was to change from being based in closed asylums to being an institution in the middle of society, finding social solutions to mental illness and working through a dynamic network of various care givers, such as welfare officers, nurses and psychiatrists. This new kind of psychiatry was first tested in Nacka, where psychiatric reformers Johan Cullberg and Bengt Berggren were the heads of a six-year long pioneer project of sectorized psychiatric care. My specific purpose is to analyze the new ideas of mental illness and of psychiatry’s role in society which were introduced in this project and how they were expressed in the official reports presenting it. The reformation was preceded by a public debate concerning psychiatry, which had intensified a few years around 1970. In the debate a new kind of radical critique was voiced which named psychiatry a tool of power and oppression, a kind of rhetoric which found its way into the debate amongst psychiatrists. In it the traditional way of psychiatry, based in mental asylums, was attacked by Cullberg who saw in a recent social psychological trend the possibility of a new psychiatry, which would be decentralized and working with social solutions. It was this kind of psychiatry which was shortly thereafter to be tried in Nacka, as a response not only to critique of the old system but also to economic problems. The social psychological fundament was there put to practice through preventive work, focus on the family as a system and new kinds of therapy. The new psychiatry can be said to have led to what Hydén calls a handicappization of mental illness, and what Björk discusses as a new conception of the patient as unique. Throughout the planning of the new psychiatry and the reports on the Nacka-project questions concerning the role of psychiatry were dealt with, questions which were at first raised in the public debate. The reformist critique of psychiatry which led to the Nacka-project was, I suggest, to some extent inspired by a public more radical critique of psychiatry but the two ways also had inherent differences