[Narratives on fear within psychiatric care].

The aim of the study is to describe and analyze beliefs and experiences of mental health care workers within Swedish psychiatric care prior to the introduction of neuroleptics in the early 1950s. The sources are narratives taken from interviews with nurses who worked in Swedish psychiatric care prior to 1953, works of fiction, and contemporary professional literature. The narratives are discussed from the perspective of modern literature on fear. A number of themes on fear recur in various permutations. The first encounter with the mentally ill was associated with fear. The physical environment, the regulations and the procedures all sent messages about the potential risks. The choice of psychiatric care as a professional sphere and professional pride alike seem grounded in self-efficacy to overcome fear. Tall tales and professional literature told of irrational and unpredictable violence among the mentally ill, thus inspiring fear. Violence did occur, but the fear seemed out of proportion to the nurses. The narratives give examples of strategies for dealing with fear, including use of restraints and procedures designed to gain control over dangerous objects and situations. The nurses considered it important to be able to rely on co-workers and call for help when necessary. Violence was seen as a consequence of the patient role, where patients lived up to expectations of dangerousness, and nurses tried to develop body language that signalled non-violence, using older colleagues as role models. Psychological strategies, such as denial of fear or attempts to assimilate fear, are also described. The ability to hide one's fear as a prerequisite for warding off violence and the ability to socialize with the mentally ill in a positive manner, are recurring themes in both fiction and contemporary professional literature. The statements are understood as expressions of a normative professional identity in dialogue with the message of fear in psychiatric hospitals. Implicit or unconscious beliefs about fear are discussed. These include socially learned fear about women's helplessness and need for protection. Fear of physical violence may be related to fear of being put in situations that may entail a threat to one's self image and the authority associated with nurses' professional identity.