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e -(ux Architecture
Dreaming Nurses
Magaly Tornay
Roland Kuhn and nursing staK, +LM+, from a private photo album of a nurse at Münsterlingen.
Treatment
September )*)+
The strange story of the dreaming nurses of Münsterlingen came to me by a chance <nd in
the archives. While researching the extensive experiments with new drugs that psychiatrist
Roland Kuhn had conducted in this rural psychiatric clinic in Eastern Switzerland on often
unwitting patients, I came across the collected dreams of female caregivers. Embedded in
patient <les, the dreams formed the core of psychotherapy protocols. Some nurses, I began
to uncover, were asked to attend psychotherapy with their boss, Kuhn, while continuing
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their care work, thus being transformed into patients of sorts. Their dreams were an entry
point for the talking cure, and a token of their collaboration.
Dreams are rare sources for historians. They belong to the subjective, ephemeral realm,
even though they still bear witness to a particular time, place, and life. They are Reeting,
tangible only indirectly, as a memory, narrative, note, or story; and each time they are
remembered and retold, their contours change a little. This is why the writer Jorge Luis
Borges categorized them as a “work of <ction,” for their un<xed, intrinsically narrative
quality.+ In the beginning there must have been a word in this psychotherapeutic setting, a
dream retold. In the evenings, Kuhn would sit down and speak into his voice recorder. Later,
his secretary would type up what had been dictated, as a silent ally, and insert the copies
into medical <les. At Kuhn’s encouragement, some nurses would bring handwritten, dated
notes with their dreams of the week to the sessions, while others kept a dream diary, at
times showing increasing poetic verbosity over the course of the treatment. The archived
dreams are thus polyphonic, authored by Kuhn, his secretary, and the dreaming nurses,
and they tell us as much about this dense, hierarchical setting as about the nurses
themselves.
Years later, in search of entirely diKerent <les, I would open those archive boxes and come
across protocols, dreams, and conversations. I copied them, typed them up, a wrote them
down once again, adding another layer to the increasingly spiraling observation of
observers. Take, for example this dream, which itself is already layered:
Dreams: The patient dreamt that another nurse had to go to another
psychotherapist. He told her that he needed a squirrel to help her, and
that she should look for one. She looked for the squirrel and eventually
found it. It was very small, so she was able to hold it in her hand.
Somehow, without her noticing, it gave birth to six young squirrels.
These were very small. The squirrel died in the process and the cubs
were now always looking for milk.,
Kuhn’s dream interpretation, however, seems disappointingly meager in the records. In the
squirrel dream, he mainly saw a reference to an old fairy tale revolving around people
transforming into animals. As he was oriented towards Daseinsanalyse, a Heideggerinspired psychoanalytical strand that considers dreams a “way of being-in-the-world,” he
favored manifest dream content over an interpretation of latent or symbolic elements. Thus,
dreams were read quite literally in Münsterlingen, providing just another trace of a life’s
trajectory.
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Nurses at Lake Constance, +LM*, from a private photo album of a nurse at Münsterlingen.
Located near the Austrian and German borders and overlooking picturesque Lake
Constance, the rural psychiatric clinic of Münsterlingen became famous for Kuhn’s
discovery of the <rst antidepressant, Tofranil, in +L`a. Kuhn had been a senior physician
there since +LbL, becoming the director of the clinic in +Lc+ and remaining there until his
retirement in +La*. More recently, he has become the focus of a media scandal and a
historical investigation, since former patients have come forward to recount their
experiences of being involved in clinical trials without their consent or knowledge.- His
psychotherapies with nurses raise, in retrospect, similar questions about the ethics of
therapy in a strictly hierarchical, densely interwoven social microcosm.
As was common at the time, unmarried staK lived on the premise of the clinic as well as the
Kuhn family and other personnel. Until +Lcb, the nursing staK even lived on the wards, door
to door with the patients. To leave the premises, a gatekeeper guarding an iron gate had to
be passed; the curfew was set at ++ p.m. Female nurses had a diKerent status than their
male counterparts. On average, they were younger and often in concomitant training. Kuhn
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once described female nurses as “socially disadvantaged” compared to male ones
because they often did not yet have their own families, making them more dependent on
the “family” of the psychiatric clinic. For this reason, a “nurses’ Christmas” had been
introduced, so that caregivers could celebrate with their “institutional family.”.
Since the +L`*s, psychiatric care increasingly became a female profession, a change
usually associated with the advent of modern psychotropic drugs. With modern
antipsychotic drugs, such as the neuroleptic chlorpromazine introduced in +L`b, wards
became quieter. Patients appeared more subdued and calmer, thus requiring less physical
strength in nursing than before. Tellingly, the designation for the nursing profession also
gradually changed from “warden” to “nurse” around that time.
Kuhn’s psychotherapies with staK mainly aKected female caregivers. One reason for this
was that female behavior was more readily framed as depressive or “ill” than male, and
narratives of melancholic, crying or simply “dihcult” women came into play rather quickly
in the consulted sources from Münsterlingen. For Kuhn there was no question, for
example, that a nurse who “always walked around stiiy with a reproachful face” and found
“a Ry in the ointment everywhere” was not simply unhappy at her job but showed
symptoms that he interpreted as “typically depressed.”/
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StaK bedroom, ca. +LM+, from a private photo album of a nurse at Münsterlingen.
Psychotherapy protocols from the +L`*s to the +Lc*s bear witness to how an unequal
psychotherapeutic relationship and a similarly hierarchical work structure overlapped.
Unconventional sexual behavior, problems at work, and even gossip from the wards were
all translated into a psychoanalytic language, thereby narrowing the gaze and locating the
source of all dihculties within the nurses. Fittingly, the decisive factor for Kuhn initiating a
psychotherapy was in most cases work-related, like when a nurse performed too slowly,
inadequately, complained, cried in her room, or had quarrels with others. When he got
word of such incidents, he ordered the nurse to his ohce for a talking cure. These sessions
could last from an hour to over three and happened once a week, biweekly, or more
intensely, always during working hours. The therapies could last a few weeks or, in most
cases, many years or even decades.
What motives lay behind this unusual practice? The dreams Kuhn hat set out to collect
certainly provided him with rich material for his interest in Daseinsanalyse, for the nurses
were apt dreamers, versed in the language of psychiatry and often more eloquent than
many of the patients. The microcosm of the clinic ensured close observation. But even
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more crucially, the nurses’ talking cures provided him a versatile instrument to regulate and
maintain the clinical order.
Indeed, the clinic might have caused malaise for the nurses in another sense, since
structural problems were not tackled at an organizational level, but transferred into their
psyches. The immense burden of care work, at times amounting to <fty-eight hours of
“heaviest work” per week, was transformed into individual dihculties, mainly depressions.
Kuhn himself admitted in +LMM that there was an “actual circle of doom” at his clinic: a
chronic lack of staK, particularly on the women’s wards, led to “nervousness and
dissatisfaction” among the nurses, inciting more of them to quit their jobs, in turn
increasing the workload for the remaining staK.0 In order to address this, he chose the
strategy of attempting to retain their ability to work with the help of dream analysis,
psychotherapy and psychopharmaceuticals.
For the caregivers, the line between health and illness was narrow and seems to have been
moderated primarily by the will to maintain the clinical order. Spatially speaking, they were
always in between the couch, the ward, and their bedroom. They had to occupy the role of
the patient, private citizen, and staK all at once. These three strands became entangled into
a dense bundle in Kuhn’s talking cure, with the registers of labor and the personal overlaid
by psychotherapeutic language. Roles were blurred and many borders transgressed.
Nobody put this more pointedly than one of the caregivers aKected by Kuhn’s therapy, who
claimed it was as if she “had to live three lives at once, one in psychotherapy, one on the
ward, and another one outside the fence of the clinic.” Living three lives at once was, to her,
excessively exhausting, and she eventually chose to quit her job.1
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Roland Kuhn in his ohce, +Lcb, SRF TV archives.
Since dreams are ephemeral, it is impossible to assess the veracity of their recollection,
which at least potentially opened up some space for agency for the dreaming nurses of
Münsterlingen. Some of the archived dreams seem to have something subversive about
them, for instance when a nurse repeatedly dreamed of a dead Kuhn lying in a cohn.
Another nurse went week after week to therapy only to report that she had not dreamt
anything at all. This drove Kuhn into growing desperation and helplessness. He interpreted
her silence and lack of dreams as a clear sign of the classical resistance that is part of the
psychoanalytic process. In some ways, it was: once she started talking, the nurse
addressed the setting, which she found humiliating because it made her feel as if she was
“forced to speak.”2
Refusing to dream, to recount dreams, or on the contrary inventing particularly interesting,
beautiful dreams may have been among the few strategies of resistance against these
involuntary talking cures available to the caregivers. The close proximity on the clinic
premises where they repeatedly encountered Kuhn by chance—who routinely assessed
and commented on their state—as well as his dual role – boss and psychoanalyst – must
have made for a coercive, constricting setting. Another, much more dihcult option was to
leave the clinic and <nd another job, a strategy to which many of the nurses under
treatment eventually resorted.
The nurses often dreamed of the clinic in all its particularities, which featured mountains of
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pills, syringes, gangster-doctors, or patients and colleagues. Kuhn <gured prominently as
an object of transference. The doctor in his white coat, as one dream goes, was living in the
childhood home of a nurse and started opening cupboards with her old stuKed animals,
quite literally entering her childhood memories and taking a seat at the family table. In
another example, Kuhn operated on people’s souls, with the risk of heart failure, infection,
and bleeding, ordering the nurse to “nurse well, nurse them healthy.”3
It seems like a poignant comment on this setting that a caregiver had scribbled “Daddy
Longleg” in English under a photograph in her photo album showing Kuhn surrounded by
staK. The nickname circulated in the clinic, designating a spider with long, thin legs, as well
as a popular +L`` Fred Astaire-movie with a Pygmalion plot, in which an anonymous, rich
older man pays for the education of an orphan, whom he later marries.+4 For the
Münsterlingen talking cures, the nickname is particularly revealing, since Kuhn was
roughly a generation older than most of the nurses he treated. It may also point to a certain
type of familialism, which was common in therapeutic quasi-families. As criticized by
Deleuze and Guattari, the therapist in this case assumes a “doctor-daddy-judge” role, thus
at once enforcing social power structures and reproducing the triple hierarchies of the
family, the law, and psychiatry.++
Daddy Longleg had spun a wide web over the Münsterlingen clinic. Yet it wasn’t until the
+Lc*s that external criticism was voiced, and politicians questioned the many roles he had
amassed, perhaps unwittingly employing a spider metaphor again: “There isn’t a single
thread in this psychiatric clinic that doesn’t end with him,” said one political note. At that
point, Kuhn was in charge of selecting staK, teaching nursing classes, overseeing the
nursing education, as well as being responsible for over b,*** patients.+, Kuhn, however,
managed to dodge the accusations, as he often did, by pointing to the strained budget of
the clinic.
Even though the blurring of roles that happened in Münsterlingen—the dreaming
nurses/patients, the therapist/boss—initially may seem reminiscent of reformist
approaches to psychiatry, such as the French clinic La Borde where institutional roles were
interchangeable and all participants were cooking, doing therapy, and living and working
together, this parallel ultimately falls short.+- Although people lived in a clinical microcosm,
Münsterlingen in no way corresponded to a therapeutic community, as has been
implemented elsewhere. The hierarchies remained unchanged, and the disciplinary
dispositive in force. In contrast to reformist approaches, Kuhn’s way of thinking was free of
social critique.
Thus, the treatment of nurses and the collection of their dreams was primarily a tool to
regulate life on the wards, discipline perceived transgressions, and maintain workRow. In
addition, the dreams and conversations provided a rich stream of inside information and
raw material for existential analysis. However, there was also criticism, resistance,
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competing interpretations, and humor from the nurses themselves. Since dreams are
subjective and elusive, they ultimately generate a surplus of images and imaginations that
escaped the Münsterlingen setting and were not exhausted in Kuhn’s dream interpretation.
Treatment is a collaboration between e-Rux Architecture and the Institute for the History
and Theory of Architecture (gta), ETH Zürich.
Notes
+ Jorge Luis Borges, lecture at the Teatro Coliseo, Buenos Aires, +Lcc.
, For sources and a more detailed history of the dreaming nurses, see Magaly Tornay, Träumende Schwestern:
Eine Randgeschichte der Psychoanalyse (Vienna: Verlag Turia + Kant, )*)*), L, L+. All pictures are also taken
from the book.
- For a comprehensive history of these trials see Marietta Meier, Mario König, and Magaly Tornay, Testfall
Münsterlingen: Klinische Versuche in der Psychiatrie, CDEF–CDHF (Zürich: Chronos Verlag, )*+L).
. State Archive of Thurgau, L’t*, +.*.b/*, Diary Kuhn, Vol. +, +c.+).+Lc+.
/ Tornay, Träumende Schwestern, `+.
0 Ibid., `b.
1 Ibid., cL f.
2 Ibid., c` f.
3 Ibid., +*` f.
+4 The <lm was based on the +L)+ novel by Jean Webster. Thanks to Rainer Gross for this reference.
++ Gilles Deleuze and Félix Guattari, Antioedipus: Kapitalismus und Schizophrenie (Frankfurt am Main: Suhrkamp,
)*+L (+Lcc)), +)).
+, State Archive of Thurgau, t’a*)’+`+/tc`, Interpellation betreKend Abklärung der Verhältnisse in der
Psychiatrischen Klinik Münsterlingen (February +Lcb), L.
+- See Camille Robcis, Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France (Chicago:
University of Chicago Press, )*)+.
Category
Labor & Work, Psychology & Psychoanalysis,
Surveillance & Privacy
Subject
Sleep & Dreams, Care, Health & Disease
Return to Treatment
Author
is co-leader of the project “Governing by Values? On the history of medical and bioethics in Switzerland” at the
University of Bern Institute for Medical History.
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