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Patients with intellectual disabilities in the forensic asylums 1915-1982: before admission

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Patients with intellectual disabilities in the forensic asylums 1915-1982: before admission
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  This article was downloaded by: [Universitetbiblioteket I Trondheim NTNU]On: 20 January 2014, At: 02:20Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Scandinavian Journal of DisabilityResearch Publication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/sjdr20 Patients with intellectual disabilitiesin the forensic asylums 1915–1982:before admission Erik Søndenaa ab , Camilla Gudde ac  & Øyvind Thomassen ada  Forensic dep. Brøset, St. Olavs Hospital, Trondheim, Norway b  Department of Social Education, University College Sør-Trøndelag, Trondheim, Norway c  Department of Social Work and Health Sciences, NorwegianUniversity of Science and Technology, Trondheim, Norway d  Department of Historical Studies, Norwegian University of Science and Technology, Trondheim, NorwayPublished online: 16 Jan 2014. To cite this article:  Erik Søndenaa, Camilla Gudde & Øyvind Thomassen , Scandinavian Journal of Disability Research (2014): Patients with intellectual disabilities in the forensic asylums 1915–1982:before admission, Scandinavian Journal of Disability Research, DOI: 10.1080/15017419.2013.868824 To link to this article: http://dx.doi.org/10.1080/15017419.2013.868824 PLEASE SCROLL DOWN FOR ARTICLETaylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &   Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions    D  o  w  n   l  o  a   d  e   d   b  y   [   U  n   i  v  e  r  s   i   t  e   t   b   i   b   l   i  o   t  e   k  e   t   I   T  r  o  n   d   h  e   i  m    N   T   N   U   ]  a   t   0   2  :   2   0   2   0   J  a  n  u  a  r  y   2   0   1   4  Patients with intellectual disabilities in the forensic asylums 1915  –  1982: before admission Erik Søndenaa a,b *, Camilla Gudde a,c and Øyvind Thomassen a,d a  Forensic dep. Brøset, St. Olavs Hospital, Trondheim, Norway;  b  Department of Social Education,University College Sør-Trøndelag, Trondheim, Norway;  c  Department of Social Work and HealthSciences, Norwegian University of Science and Technology, Trondheim, Norway;  d   Department of   Historical Studies, Norwegian University of Science and Technology, Trondheim, Norway (  Received 29 August 2013; accepted 20 November 2013 )Until 1982, a number of patients with intellectual disabilities (ID) in Norway werehospitalized in the country ’ s two forensic mental health hospitals. The aim of thisarticle was to explore the background of these patients based on the characteristics of their life experiences before admission to the hospital. Data from the period 1895 – 1982 were retrieved for 272 patients with ID. All patients ’  records were read and keyinformation from childhood and important life experiences were categorized in termsof both numeric and descriptive variables. Most patients had experienced social andhealth problems in their family during childhood. A minority had completed primaryeducation. A majority of the patients had some work experience. Offences leading toadmission included several types from simple to serious crimes. Three periods werecompared in order to study the changes in relation to the changing social and welfareconditions during the century. One main observation was that in spite of better education the trend during the century was that fewer of these patients experiencedany labour participation. Historically, the diversity in level of functioning and previoustreatment makes patients with ID in the forensic mental health hospitals a more variedgroup than previously described. Keywords:  intellectual disabilities; history; mental health; forensic; institutions Introduction Studies of and interest in offenders with an intellectual disability (ID) have increasedrapidly during the last 20 – 30 years (Holland, Clare, and Mukhopadhyay 2002; Lindsay2002). However, the focus on this relationship dates back to the early 1900s, whendifferential psychology, theories of degeneracy and eugenics evolved (McDonagh 2008;Rafter  1997; Scheerenberger  1983). In the beginning of the twentieth century, the association between ID and offending behaviour was perceived as more absolute andominous than it is at present, against the background of today ’ s welfare-conditioned beliefs. Leading voices such as Walter Fernald and Henry Goddard were pessimisticabout the prospects, with statements such as  ‘ the feeble-minded are a parasitic, predatoryclass, never capable of self-support or of managing their own affairs. They causeunutterable sorrow at home and are a menace and danger to a community ’  (Fernald1912). The idea that people with ID were predisposed to criminal activities made such an *Corresponding author. Email: erik.sondenaa@ntnu.no Scandinavian Journal of Disability Research,  2014http://dx.doi.org/10.1080/15017419.2013.868824 © 2014 Nordic Network on Disability Research    D  o  w  n   l  o  a   d  e   d   b  y   [   U  n   i  v  e  r  s   i   t  e   t   b   i   b   l   i  o   t  e   k  e   t   I   T  r  o  n   d   h  e   i  m    N   T   N   U   ]  a   t   0   2  :   2   0   2   0   J  a  n  u  a  r  y   2   0   1   4  impact on the legislators and policy-makers of the time that special eugenics programmesand legislation were implemented, and special institutions were built to house, protect andtrain people with ID (Rafter  1997). The view that there was an association betweenintelligence and crime was dominant until the second half of the twentieth century(Scheerenberger  1983). This relationship is still recognized as robust (Lindsay, Taylor,and Sturmey 2004). However, the causal relationship has been questioned in the studiesemphasizing socio-economic status, social deprivation, parental disorders and peer influence (Moffitt et al. 1996; West and Farrington 1973). Welfare and policies regarding people with ID changed in some respects during the last century. The eugenic institutionalization during the period 1900 – 1920, as described byScheerenberger (1983), with a large number of institutional beds for people with ID did not take place in Norway. A few small institutions (500 beds in total) were established until1952, when the institutional movement began and the number of beds was increased to5000 in a few years. The neighbouring countries Denmark (in 1911) and Sweden (in 1928)had established forensic hospitals for ID offenders (Kirkebæk  1993). A secure unit for  ‘ restless male patients ’  was established at one of the Norwegian ID institutions (EmmaHjorts pleiehjem) in 1934, but there seemed to be little political interest in this initiative andconsequently insufficient funding to operate this unit (Fjermeros 1998). These nationaldifferences have two possible explanations. First, the Norwegian economy was weak, withthe result that such services were not prioritized. Second, the highly influential enthusiastswho could raise the issue of such special care on a priority level were absent. In Denmark,Christian Keller dedicated his working life to the forensic ID-services (Kirkebæk  1993) andin the USA, Henry Goddard was among the pioneers (Scheerenberger  1983).Kirkebæk (1993) based her studies on the Kellerske institutions in Denmark, where people with ID were separated into two groups: those with intellectual and those withmoral disabilities. The latter group was associated with insanity, but was treatedseparately in the forensic mental health care. The Norwegian historian Svein Skålvåg(2003, 317 – 318) argues that in Norway a different explanation was given for people withID. The differences were mainly that ID was not classified separately but was categorizedunder mental disorders in Norway unlike the situation in Denmark with two scientificclasses as described by Kirkebæk (1993). Skålvåg (2003) argues that different   perspectives and professional positions on ID during the first decades of the twentiethcentury may reflect major conceptual differences in the Nordic countries. Theconsequence was that the ID-services were subordinated to mental health services in Norway, in contrast to several other countries. Offenders with an ID in Norway  Although the Norwegian services were influenced by these international trends, very fewinstitutional places were adapted for people with ID and none was specially adapted for offenders with ID. A significant proportion of the patients in the Norwegian forensicasylum Reitgjerdet (1923 – 1987) and its predecessor Kriminalasylet (1895 – 1963) werehowever characterized as mentally disabled. A large proportion of these patients wereadmitted from prisons or other local asylums because of problematic or dangerous behaviour. A significant number of patients were also admitted directly from their ownhomes, apparently as a consequence of social crisis. The background information on most of the patients was described in the medical journals. Inadequate welfare services seemedto have contributed to the large number of ID patients. A number of comments on this2  E. Søndenaa  et al .    D  o  w  n   l  o  a   d  e   d   b  y   [   U  n   i  v  e  r  s   i   t  e   t   b   i   b   l   i  o   t  e   k  e   t   I   T  r  o  n   d   h  e   i  m    N   T   N   U   ]  a   t   0   2  :   2   0   2   0   J  a  n  u  a  r  y   2   0   1   4  ‘ welfare gap ’ , describing these patients as unfit for treatment in this forensic hospital(Andresen 1926), seemed not to influence the admission policy during the entire century.The Reitgjerdet asylum then had to provide for ID offenders, although the hospital wasintended for other forensic services. The chief physician at Reitgjerdet, Karl Andresen wrotein 1926 that issues of ID were outside the scope and competence of the Norwegian psychiatrists; however, they had to admit such patients in the absence of other options(Andresen 1926). When institutionalization was introduced in 1952, some ID offenders mayhave been placed in such non-forensic services, but the admission of ID offenders toReitgjerdet was continued until the Norwegian parliament decided to phase it out in 1982.  A selected historical scope The number of pupils in special schools for people with ID, introduced by law in 1881,declined significantly from 1900 to the 1930s and the age of entrance to the schoolsincreased from 7 – 8 years to 10 – 12 years. High costs and low priority from thegovernment were the subject of some of the complaints from the special schooladministrators (Grennes 1933). Professionals in the field were disappointed about the political disregard of the needs of people with ID. After Second World War, this social problem seemed to be overdue for inclusion in a developing welfare system. Theintroduction of the modern welfare system was associated with the central financialresponsibility for care of people with ID in 1949 and later with the establishment of thenational health care for people with ID in 1952 (Sandvin 1995).The insufficient services and neglect of the needs of people with ID during the first half of the twentieth century led to placements and care from services and staff in other sectors and professions. One such recipient of these people was the forensic services.  Aims of the study  This study has aimed to explore the characteristics of patients with an ID in the forensicservices in Norway in the period 1895 – 1982, as these patients has previously not beenrecognized. The emphasis was on their family background, school experiences, health,adulthood, offending behaviour and the reason for admission to the forensic hospital. Oneobjective of this study was to question the Norwegian policy of incarceration of peoplewith ID and to compare it with previous and recent international practice. In the searchfor literature, we did not find any other descriptive studies of a comparable sample. Methods  Material  The patient archives of the forensic hospital Reitgjerdet and its predecessor Kriminalasy-let cover 1810 individual patients who were admitted one or several times during the period 1895 – 1982. All patients were admitted with medical reports and diagnoses, andmost of the patients were diagnosed with severe mental disorders such as dementia praecox (schizophrenia). Among the minority of patients, 272 (15%) were diagnosed withID, labelled debility, imbecility or idiocy. Several patients with other diagnoses such asepilepsy,  insania ex constitutione  and  insania degenerativa  also had considerableintellectual problems, but without an ID diagnosis.The background information varied in quality, content and structure, and reflected thetraditions and the formulations of the chief physician. However, the patient informationmade it possible to make useful comparisons and descriptions. Scandinavian Journal of Disability Research  3    D  o  w  n   l  o  a   d  e   d   b  y   [   U  n   i  v  e  r  s   i   t  e   t   b   i   b   l   i  o   t  e   k  e   t   I   T  r  o  n   d   h  e   i  m    N   T   N   U   ]  a   t   0   2  :   2   0   2   0   J  a  n  u  a  r  y   2   0   1   4
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