Jarl Jørstad

Jarl Jørstad

1923-2006

(Biography written at time of nomination.)

Jarl Jørstad's development as psychiatrist and psychoanalyst was influenced by three months confinement in a solitary cell, and later 18 months as a prisoner in Germany during the war, when many hundreds of Norwegian students were arrested.  His experiences in the concentration camps Pölitz, Buchenwald and Neuengamme contributed to his growing curiosity about the forces in human minds which create such cruelty and holocaust. He luckily survived and started the medical school in Oslo in 1945, and graduated as MD in 1950, psychiatrist in 1958 and psychoanalyst in 1972.

His interest in the treatment of schizophrenic patients developed during his work in two periods at Dikemark mental hospital, treating severely disturbed and schizophrenic patients from Oslo.  During the last 12 years period, when he was head of the department 5 (Lien), together with a dedicated staff, he managed to develop a pioneering institution, trying to combine a therapeutic community with individual psychotherapy, including many young schizophrenic patients.  The experiences they had during this period were published in many papers and on Norwegian TV.

This was one background for the ISPS Symposium in Oslo in 1975.  Another important background was also his stay in the USA in 1968 – 69, when his main goal was to study the teaching of psychotherapy, at Harvard (Beth Israel Hospital, John Nemiah, Peter Sifneos), Yale (Theodore Lidz), New York ,(a.o.Montefiore, Hillside, Jacoby, - Alberta Szalita), and NIMH , Washington D.C. (Helm Stierlin).  This created important networks of top professionals in psychotherapy, family therapy and social treatment of schizophrenic patients in USA.  The following years many of them came to Norway and gave seminars and taught in many places in Norway.  Well known psychotherapists from United Kingdom, Switzerland and Germany (M..Jackson,  D.Malan, G.Benedetti, H. Stierlin and many others) also had important seminars.

The successful ISPS Symposium in Oslo in 1975, contributed to this process of increased interest in psychodynamic understanding and treatment of schizophrenic and other psychotic patients all over Norway.

In 1976 Jarl Jørstad was appointed as medical director of the psychiatric university clinic 6 B in Oslo City Hospital Ullevål.  This was also a pioneer institution in developing a therapeutic community which included a mixture of neurotic and psychotic patients, and had many groups.  A basic condition for their treatment program was that they could select the patients they admitted into the ward, and they favoured more resourceful neurotic patients.

During his leadership he recruited many excellent clinicians and researchers, which developed a good and open research team together with the clinicians, and were setting the main point in clinical research and the results of institutional treatment.  When the department in the late 1970s developed a crisis, caused by new obligations to admit immediately all psychotic and suicidal patients as emergency cases from the catchment area in the city, the number of psychotic inpatients increased rapidly, and the more neurotic patients were treated in the out patient clinics.  Many of the nurses working in the acute unit developed signs of burn-out syndrome, their organization of the therapeutic community did not work any longer. The research which included patients, staff and the ward atmosphere, showed clearly that the milieu and the groups were now harmful for many of the psychotic patients. 

In 1981 the whole treatment program was then radically changed to an individually oriented therapeutic milieu, where the psychotic patients were separated from the more acting–out borderline patients, who got a special organized, group oriented day unit. The nurses were now taking more care of the psychotic patients and took more responsibility and leadership. After one and two years the researchers found that the ward atmosphere showed reduced aggression and was warmer, the patients said they had a much better ward milieu, and the burn out syndrome in the staff was resolved.  These results were published in a book and in several Scandinavian and international journals, and resulted in a couple of doctorate degrees.      

The engagement and enthusiasm of Jarl Jørstad in promoting psychodynamic understanding, modified psychotherapy and optimal milieu therapy for psychotic patients, influenced many professional workers in psychiatry, both in Norway, Sweden and Denmark.  He was asked to give many seminars in these countries, and delegations came from them to learn from the experiences at Dikemark and Ullevål hospitals. He was also asked for to be a consultant for institutions in crisis, which was a result of his interest and study of irrational group processes which influence teamwork and leadership in all organizations (Tavistock), and which gave him many tasks in Scandinavian countries and Switzerland.                                

Together with a large group of young psychiatrists he also contributed to a radical change in the teaching and training of psychiatric residents in the 1970s in Norway.  In spite of resistance from most of the professors in psychiatry, they managed to introduce obligatory supervision in the therapist-patient relationship, and the basic principles of psychodynamic psychotherapy, once a week in one year, later extended to two years.  As leader of the psychotherapy committee in Norwegian Psychiatric Association he also formulated the qualifications of the supervisors: they should be experienced psychotherapists, and should have had their own personal psychotherapy or psychoanalysis.  Later special courses in supervision were also developed.

In his books and many papers he focused more and more on the early mother-child relationship as a background for vulnerability in later life, the unconscious forces in human mind, and the transference/countertransference interaction in therapeutic relationships of severely disturbed patients.  His popular psychiatric books were published in a couple of editions both in Norway, Sweden and Denmark, the first also in Poland, and the last in the UK.

Since 1990 until the time of his death, he still had his private psychotherapeutic and psychoanalytic practice at his home in Sandvika outside Oslo, but now for only a few hours a week.

Svein Haugsgjerd

 

 

 

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