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The First Experience

I was channeled into psychiatry in 1961, early in my medical career, more or less by coincidence. It was not my own choice. As a conscientious objector, I was conscripted to work as a physician in an institution for the criminally insane in lieu of military service.
There was practically no treatment in the institution. It rather resembled a labor camp, with various different types of labor, such as landscaping, farming, metalworking, welding, and carpentry. The inmates, who were called patients, slept in cage beds made of mesh wiring. The atmosphere was grim. There was a great deal of inmate hostility. Many spent vast amounts of time in solitary confinement. After a certain period, depending in length on the seriousness of the committed crime, the institution would file a recommendation for conditional release at the Ministry of Justice. 
The director of this particular institution was a woman, most unusual in those days, whereas almost all the other staff members and all the patients were men. She ruled with an iron hand, but occasionally and unexpectedly would grant privileges to a certain patient. This turned her into a distant goddess who performed miracles seemingly by whim or at random. To the staff she was a fickle, unpredictable woman who used her near-absolute power to intimidate and belittle the men over whom she wielded her scepter. Every once in a while a professor would arrive from the capital city, Amsterdam, to dispense advice on treatment. He was willing to discuss such only with the director. Often he would single out certain patients for observation at his clinic, which for these people meant months of waiting, then six weeks of observation, and afterwards again months of waiting for the report. The report would routinely recommend psychotherapy, which I later understood to be futile, as such therapies as a rule failed. Sometimes it was decided that sexual offenders should undergo castration, which was performed after obtaining the consent of the patient. One can wonder just what the value of such consent was: the alternative was reconciling with indefinite detention without hope of returning to society.

In those days professor Pieter Baan* was experimenting in the city of Utrecht with the treatment of detainees ruled criminally insane. I don’t know how successful he was, only that when the treatment failed, the detainees were sent to us. When treatment had not succeeded detention could not be terminated. Sometimes the detainees had been held for experimental treatment for over six years before being transferred to us.

In those days this type of detention was also applied to people who had committed less serious crimes, such as repeated theft of bicycles,**  small-scale fraud, swindling, and exhibitionism. In other words, there was often no reasonable relationship between the severity of their crime and the duration of their detention.

Many of the patients were eccentric and difficult to fathom. They had sometimes committed the strangest acts, and related bizarre stories about themselves. They were reclusive, odd people who often behaved inappropriately or in ways that defied comprehension. At the same time they evoked fascination. They found themselves in a grim world where the wielding of power was the key to events. They, and the way they were treated, led to my specializing in psychiatry. This book is the fruition of my experience with them.

*Today’s Ministry of Justice’s observation clinic in Utrecht is named after him. – translator
**In the Netherlands this is the most common petty crime. – translator

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