This contribution brings together the history of psychiatry and the history of disability in Belgium, for the period stretching from the end of the eighteenth century up till the end of the twentieth century. The chapter starts with enumerating several key reasons why such an approach is not only possible, but also valuable and innovative. On the basis of different case studies related to the history of disability and the history of psychiatry, the specificity of Belgian care and medicine is being discussed. Some of the themes being touched upon are the introduction of Belgian psychiatric legislation, the emergence of educational institutes for blind and/or deaf people, the impact of the First World War on representation of otherness and the well-known tradition of family care for psychiatric patients. On the basis of these and other case studies it is, first of all, argued that the Belgian state played an active role in the problematisation of mental and physical differences, but that it actually was private institutions, mainly religious congregations, who managed these populations on a daily basis. Second, the chapter pleads also to take into consideration the agency of the people who were controlled and disciplined; they were not only able to oppose and reinterpret the categories and norms that were imposed on them; they also used these labels to construct new (positive) identities – bringing them into competition with physicians, experts, bureaucrats, etc. By highlighting the variety of different players involved, this chapter illustrates the general theme of this section, ‘Beyond Physicians’.
The epilogue takes stock of the merit and potential of the ‘new narratives’ presented in this volume. As a whole, the volume intends to do two things: empirically, it presents medical histories on Belgium to the Anglophone world while, conceptually, it does so by using the latest methods and perspectives. While ‘traditional’ medical history mainly represented stories about medical science, the medical profession and the state, these new narratives are (also) about patients, alternative healers, clergymen, women and other historical actors.
With its contributors writing after many ‘turns’ (social, cultural, performative, praxeological, material and somatic), the ambition of the present volume is to move beyond science, the profession and the state. Like medicine, medical history is not owned by physicians, but by all of us. While in the past, medical history was written by male, Western physicians, today’s medical history is (also) written by historians, women and non-Westerners, producing multiperspective and multivocal stories. While some may regret this development because of the fragmentation it entails, much is to be gained by including all historical actors. Moving beyond the great doctors, decentring the big picture and provincialising Europe leads to a diversity of narratives – representing the diversity of today’s world.
In an era of transnational and global historiography, reflecting on the national frames of writing medical history remains a necessary endeavour. On the one hand, it helps historians to interrogate the metanarratives they use in writing about the medical past, many of which still focus on interactions between physicians and the state and stem from an older social historiography of medicine. By widening their gaze to a history of (health) care, historians may bring a broader range of actors and influences into the limelight. On the other hand, questioning national frames of writing history also shows the complex stratification of local practices, international circulation of scientific knowledge and national structures. Medical histories of modern Belgium therefore consist above all of a variety of entanglements taking place both in Belgium and beyond.
In recent years, medical historians have broadened their analyses of hospitals by looking at the materiality of healthcare institutions and how it ties to the complex ideological, social and economic organisation of society. This ‘material turn’ brought new nuances to a history that had been up to then mostly dominated by the master narratives of teleological progress and social control.
This chapter aims to shed light on the material environment of Belgian hospitals and asylums in the nineteenth and twentieth centuries and on the ways that it not only reflected prevailing ideas about cure and care but also responded to evolving moral norms, economic constraints and the slow social levelling of Belgian society. From an ideology of comfortable domesticity to the demands of aseptic cleanliness, from old paternalist charitable ideals to new commercial aspirations, healthcare institutions kept reconfiguring their material forms to match an ever-changing set of scientific and lay expectations. Closely following international trends in hospital design and furnishing, Belgian healthcare institutions were also shaped by national realities such as the stranglehold of Catholic congregations on the healthcare sector. Lastly, by looking at the ways in which objects and material environments were built, used and adapted, this chapter gives us insights into the everyday practices – from dry scrubbing floors with coffee grounds and locking up prostitute patients in closed quarters, to colour-coding elements of the architectural environment – that made up hospital life in the past.
This edited volume offers the first comprehensive historical overview of the Belgian medical field in the nineteenth and twentieth centuries. Its chapters develop narratives that go beyond traditional representations of medicine in national overviews, which have focused mostly on state–profession interactions. Instead, the chapters bring more complex histories of health, care and citizenship. These new histories explore the relation between medicine and a variety of sociopolitical and cultural views and realities, treating themes such as gender, religion, disability, media, colonialism, education and social activism. The novelty of the book lies in its thorough attention to the (too often little studied) second half of the twentieth century and to the multiplicity of actors, places and media involved in the medical field. In assembling a variety of new scholarship, the book also makes a contribution to ‘decentring’ the European historiography of medicine by adding the perspective of a particular country – Belgium – to the literature.
This chapter reviews the history of medicine in what were the Belgian colony of Congo and the administered territories of Ruanda-Urundi (now Rwanda and Burundi). Highlighting both the commonalities and particularities of the Belgian case in the history of colonial medicine, the chapter examines the four main aspects of Western medical endeavours in the Belgian colonies – a state-organised medical service, missionary medicine, industrial medicine and research organisations and activities. While Belgian colonial medicine aligned closely with the activities of other colonial powers, it was exceptional in many ways. Political, economic and church interests vested in the Belgian colonies were in some instances freer to shape the colony as they saw fit, outside the interference of a general metropolitan public. The downside of such disinterest, however, included fewer resources from the metropole and a lack of checks on colonial abuses. Ultimately Belgium, starting a bit 'behind the curve' as a colonial power, had to innovate solutions for health problems in a colony that was poor in resources and political will. Belgian colonial medicine, in the end, left strong traces in the current field of international humanitarian aid.
This chapter offers a varied overview of the historical relation between medicine and religion in Belgium, which was until the 1960s a predominantly Catholic country. Moving beyond a too strong political reading of healthcare debates, in which both fields have been described as opposites (competing with one another or aiming for compromise), this chapter pays attention to intellectual encounters and to the role of religious practices and beliefs in medicine. First, the chapter sketches the evolution of Catholic organisations and institutions, most notably the changing role of religious orders, which in Belgium have held a firm grip on the medical field. It describes evolving Catholic views on ‘care’, along with political conflicts over an expanding welfare state and changing views on the growing role of lay medical personnel. Second, the chapter turns to religious practices, rituals and exceptional phenomena such as miracles, and the medical debates these inspired. From a medical perspective, religion could be a source of health (e.g. ‘moral therapy’ to treat mental illness) or disease (e.g. Christomanie). Third, the chapter goes on to discuss how Catholic doctors and caregivers gave their religious views a place in their professional work and identities. Here the chapter turns to medical ethics and professional codes of conduct, and the ways in which these have been inspired by Catholic thinking. The chapter pays particular attention to questions related to reproductive medicine and the end of life.
This chapter focuses on the ways in which, since the nineteenth century, medicine and medical discourse have legitimised, reinforced or altered gender relations in Belgium. It focuses on three themes: the social division of medical labour, the gendered character of medical knowledge and the role of feminists in claiming and redefining the female body. Addressing the theme of the social division of labour allows us to provide readers with general information about the presence and status of women and men within the main medical structures throughout the period. The chapter presents key social and political debates relevant to the history of medicine, such as discussions on the supposedly limited competences of midwives or women’s access to medical education and the medical profession.
The history of gynaecology enables us to look more closely at the impact of these structures on the treatment of women’s bodies and on discursive practices defining women’s health. Gynaecology emerged at the end of the nineteenth century as a new profession founded on the successes of modern surgery and dedicated to the protection of maternity, femininity and sexual modesty. During the first and in particular the second wave of organised feminism in Belgium, activists involved in political debates about women’s rights had to struggle with stereotypical, often medically legitimised views about women’s moral and physical weaknesses and incapacity to assume various social roles. In women’s political fights centred on themes such as contraception and abortion, feminists developed alternative understandings of women’s bodies, also using medically informed representations.
Medicine has become increasingly professionalised and institutionalised in the modern era. Within this narrative of medicalisation, popularisation has been interpreted as a process directed by the traditional protagonists of medical history: physicians and institutions. Although historians have argued that medical knowledge was ultimately democratised throughout the nineteenth and twentieth centuries, they have mostly portrayed the increasingly large numbers of users of medicine as passive consumers of knowledge that was nominally created by professionals. Over the past two decades, however, historians have paid more attention to the circulation of knowledge, arguing that knowledge is constructed by mutual interactions between the scientific and the public domain. In a similar vein, historians have shown that the sharp antagonism between ‘official’ and ‘alternative’ medical beliefs was not a historical reality, but a cultural construct.
This chapter shows the implications of these new theoretical approaches for the Belgian context – in which ‘popular’ and ‘alternative’ views of medicine have not yet been subject to much historical scrutiny. By focusing on visual media through which medical knowledge was communicated and circulated, concrete models displayed in health exhibitions and public health films, this chapter takes a first step to decentralise the history of ‘popularisation’. By drawing attention to the ways in which medicine circulated, we give lay audiences agency in the historical narrative: they transform from passive recipients into active actors and consumers, who have the agency to interpret, choose from and respond to different views of the body, sickness and health.
This chapter outlines how the organisation of financing of the cost of medicine has evolved since the late eighteenth century. The economic burden of caring and healing has been largely ‘mutualised’ over the past two hundred years. It is no longer individual patients who pay the largest part of medical fees, but society, with – as a consequence of the introduction of a compulsory social security system in 1944 – a key role for the state. However, the state delegated this redistribution to non-profit private health insurance funds – mutual societies – which, since the late nineteenth century, developed into central players in financing of healthcare. However, this narrative does not take into account public welfare at local level in financing the cost of care, nor the middle-class philanthropy and Catholic charity that characterised the field in Belgium as well.
The collectivisation of costs makes the discussion on how to fund the system an ongoing topic in the public space, while also tending to conceal the continued existence of major social differences. At the same time, the medical industry (private hospitals, pharmaceutical companies, etc.) became an important economic factor, both as an employer and as a central player in a knowledge-based economy. These changes had effects on the administration of care, requiring new forms of financial efficiency. As medicine became a business, different norms of management were introduced, which, in turn, were heavily criticised.