The Foundation Of Sanity

The past and present of psychiatric care in one building

One of the most iconic scenes in Icelandic cinematic history plays out in the 2000 film Englar Alheimsins (Angels of the Universe). It depicts three three main characters enjoying a lavish night at Reykjavík’s most luxurious restaurant, gorging themselves on expensive food and wine before being presented with a bill they have no hope of paying. Instead, the trio informs the waiter, “we are patients at Kleppur, please be so kind as to call the police.” No further explanation was required.

For over a century, Kleppur has been synonymous with mental illness. At the turn of the 20th century, authorities felt the nation’s psychiatric problems were so severe that something drastic had to be done. Thus, in 1907 and for the first time in the country’s history, the state financed the construction of a healthcare facility. In that way, Kleppur became the building block of the Icelandic welfare state. It is where Iceland’s mentally ill are treated to this day.

“Before Kleppur, the mentally ill were kept in cages or boxes, or on a leash.”

Slaves in cages

“Before Kleppur, the mentally ill were kept in cages or boxes, or on a leash,” says psychiatrist Óttar Guðmundsson, who has published a book on the history of Kleppur. “They would be auctioned off by the state to the farmer who was willing to take them in for the least amount of money. These people would often be forced to slave away for their guardian.”

Neighbouring countries had established facilities for the mentally ill two centuries earlier, but, as with so many things, Iceland remained far behind cultural and technological progress.

“Kleppur represented incredible progress in the care of the mentally ill,” says Óttar. “Patients would now be treated humanely and have a place to stay. However, as there was no medicine to treat patients at the time, people would often be stuck there for years — they had nowhere else to go.”

Water treatment

Quack medicine and authoritarianism dominated much of 20th century mental health care. Until 1930, when Kleppur’s current main building was opened, the hospital was run by Þórður Sveinsson. He had studied psychiatry in Munich, but was more New Age shaman than scientist. In fact, he shunned medicine and believed in the power of water treatment, administering 55 degree celsius water, hot baths and even exorcisms.

“I don’t think Þórður ever wanted to be a doctor, he was much more interested in politics, Greek and latin,” says Óttar. “His water treatments weren’t used in any big European psychiatric hospitals. He also employed psychics and believed that ‘beings on a lower plane of existence’ caused psychiatric problems.”

It was a watershed moment in Icelandic psychiatric treatment when Helgi Tómasson was appointed chief physician in 1930. That didn’t mean superstitious Þórður was out of the picture. He was popular, a published poet with a Danish wife and, most importantly, an influential member of the Independence Party. Instead, the hospital was split in two. Þórður continued to administer water and employ mediums in the older building, while in the new building Helgi introduced the latest methodology in psychiatric treatment.

“It wasn’t just prejudices that contributed to Kleppur’s poor reputation, but also the stories of harsh methods that dominated psychiatric treatments of the 20th century.”

Not long after Helgi’s appointment, however, the biggest political firestorm of the 20th century would damage his reputation and, by proxy, that of Kleppur.

The big bomb

For much of the 20th century, Icelandic society was dominated by the Independence Party and the Progressive Party. In 1930, Progressive Party Chairman and Minister of Justice Jónas frá Hriflu was one of Iceland’s most influential and controversial people. Among his responsibilities was the appointment of doctors and he had become deeply embroiled in a fierce debate with the Independence Party-dominated doctor’s association.

Curiously, Helgi, a lifelong member of the Independence Party, decided to dive head first into the debate, and attempted to use his authority as a psychiatrist to diagnose the minister as insane.

“One night Helgi decides to visit Jónas at his home. There, he declares that Jónas is insane and needs to come with him to Kleppur,” says Óttar. “It’s an unbelievable lack of judgement, a doctor can’t just decide someone is mentally ill without examination.”

In retaliation, Jónas publicised Helgi’s housecall in a scathing critique of the healthcare system entitled “Stóra bomban” (“The Big Bomb”). Helgi then pointed to Jónas’ over-the-top reaction as further proof he was unwell. Still, Helgi was fired and replaced as chief physician of Kleppur by a man who was both a subpar doctor and a terrible drunk. This completely paralyzed Kleppur until Jónas stepped down as minister of justice a few years later and Helgi was reappointed chief physician.

In the years that followed, Kleppur became a polarising and highly politicised institution — much to the detriment of the nation’s mental health. The Independence Party came to view the hospital as its own, while members of other political parties viewed it with suspicion.

Dictionary prejudices

Over the years, Kleppur became a physical manifestation of prevailing prejudices. A lexicon of slang formed around public perception of Kleppur, with the terms used to such an extent that they were entered into the dictionary; kleppsmatur, klepptækur, kleppsvinna and kleppari are used, respectively, to describe inedible food, someone who needs to be locked up, meaningless work and a crazy person.

But it wasn’t just prejudices that contributed to Kleppur’s poor reputation — stories of the harsh methods that dominated 20th century psychiatric care didn’t help. People who were committed also tended to disappear into the institution for years without any connection to the outside world. There are even stories of the coffee being spiked with sedatives to keep patients docile.

“I first came here in 1975,” a patient at the closed psychiatric ward tells me while watching a live broadcast from parliament. “There have been many sadists who have worked here, but the culture has changed drastically and now it’s better to be here.”

Society’s attitudes regarding mental illness have also changed in recent decades, in turn helping to create a more positive image of Kleppur.

“I started working here 30 years ago and the attitudes in society have changed a lot since then,” says Eyrún Thorstensen, head of the department for addiction and security. “Back then patients would feel stigmatised if they were to be treated at Kleppur. But the prejudices are not nearly at the same level today.”

Psychosis yellow

Much has changed for the better at Kleppur in recent decades, but the work of its staff is often hindered by an edifice purpose built to house patients rather than treat them. Narrow, windowless corridors, shared rooms and a low ceiling painted an acidic shade that one former department head called “psychosis yellow,” all feel counterproductive to fostering good mental health.

“This house is cramped and does not meet the requirements of a modern psychiatric ward,” says Díana Liz Franksdóttir, department head of the mental rehabilitation ward. “We have often felt that our patients don’t receive the same level of service as many others. Much of the amenities here are worn and old — we’ve even had to purchase furniture from flea markets.”

Construction is currently underway on a new multi-billion króna high-tech national hospital. Curiously, a new psychiatric ward is missing from the blueprints.

“You could say that the omission of a psychiatric ward in the new hospital’s design is a reflection of the government’s attitude towards mental health services,” says Díana. “The biggest challenge we are faced with today is the building itself.”

When Kleppur was constructed, it was far from Reykjavík and surrounded by farmland. Today, it is flanked by an industrial estate and the country’s biggest harbour. Remarkably, its grounds have been spared the urbanisation that claimed surrounding farms. However, Kleppur’s design means just going outside is complicated and requires staff escort through labyrinthian corridors.

“There is a lot we can’t do as well as we otherwise could because of the building,” says Eyrún. “It can be quite frustrating working here, because of how sadly lacking the facilities are for our patients. A good environment and a well designed building are vital to the improved mental health of patients. I think many patients find it hard to stay here for long, because of how lacking the building is.”

Speaking to staff and patients in those narrow corridors with their “psychosis yellow” ceilings, you get the sense that the sentiment is shared by everyone who spends their days at Kleppur.

A symbol of a nation’s mental health

It’s easy to read into the fact that the first medical institution funded by the Icelandic state was a psychiatric hospital. “It is definitely possible to philosophise about that,” says Óttar. Perhaps the constant oscillation between endless summer sunshine and eternal winter darkness is conducive to a manic national character, or maybe only a Norse madman would choose to settle in 9th century Iceland.

It seems equally indicative of government priorities today that the biggest healthcare investment in Icelandic history makes no space for the mentally ill.