Mental health nursing emerged as a new occupational field in the late nineteenth century in the context of the rise of scientific psychiatry. Based on new understandings of mental illness and new forms of psychiatric treatment, asylum physicians legitimized and initiated the introduction of mental nursing in asylums, which restructured a field of work that had hitherto been the domain of lay attendants. In light of the new significance that skilled nursing care had acquired in the context of general hospital reform, psychiatrists, themselves a rising professional group, argued that more refined and better trained personnel would greatly improve psychiatric care. Shifting social and gender relationships, particularly the changing social position of middleclass women, constructed and shaped mental nursing. The emergence of mental nursing mirrored larger social changes for lower middle- and working- class men and women and their work illustrates the social complexity of the care of the mentally ill.

In both nursing and psychiatric historiography, little attention has been paid to the gendered nature of the asylums’ mental health nursing politics. The introduction of mental nurse training was based on the projected image of the well-educated, middle-class female nurse who would bring competence and female compassion to the care of the mentally ill. The aim of establishing a nursing staff skilled in somatic care in the asylums created new opportunities for women, while at the same time restricting the role of men in nursing. This study explicitly discusses the gendered restructuring of asylum care that the new training scheme for mental nurses implied. Reform profoundly changed the work relationships of the new male and female mental nurses. The explicit attention paid to male and female nurses’ gendered experiences illustrates how concepts of femininity and masculinity were formed in relation to each other. Moreover, it paints a more nuanced picture of nursing as a gendered field of both men's and women's work.

In addition to gender, class is another important category for analysis. This study argues that the introduction of mental nurse training was an attempt to uplift the morality and class of asylum personnel. In their effort to place asylum care on the same footing as the work of their counterparts in general medicine, middle-class psychiatrists sought the assistance of middle-class women skilled in somatic care.