An analysis of the introduction of mental nursing in asylums reveals the inherent class and gender contradictions of the training ideals. Training provided a metaphor for negotiating a new hierarchical structure, which facilitated the creation of a disciplined, respectable lower middle- and working-class nursing workforce, a process quite similar to changes simultaneously occurring in industry, such as the adherence to regular work routines and stricter time schedules. The process forged new gendered work relationships and new understandings of care shaped according to the cultural and religious context of the various groups involved. Female compassion and a civilized attitude were the antidote to supposed unruly behaviors such as theft, drunkenness, and disobedience among personnel, behaviors generally associated with lower-class morality but considered incompatible with the new somatic routines. Complaints about such lower-class behaviors were not new and had been expressed in similar terms during the era of moral treatment. However, nurse training provided a structure and language through which a definite break with the past could be made. In a manner typical of Dutch culture, this process resulted in a training pattern that differed between the various “pillars” yet adapted to similar social and medical changes. A detailed look at the training system reveals the characteristics and behaviors the “new nurse” was supposed to embrace within the asylum. The domestic ideology fit perfectly the re-creation of a “mistress-servant” relationship within a nurse training hierarchy of head nurse and student nurse. As nurse historian Rafferty identifies, the rhetorical call for “civilization” represented the new values and attributes desirable within a new scientific medical order: enlightenment, rationality, science, Christian purity, innocence, virtue, youth, freshness, gentleness, hygiene, sobriety, gentility, and intelligent obedience.

A Gendered Structure

Women played a crucial role in creating the hierarchy and norms of women's work in which nurses were socialized within asylums. The evolution of the Dutch mental nurse training structure furthers Martha Vicinus’ argument for British nursing that hospital nurses did not create real communities of women that were run and financed by women, as schools, colleges, and settlement houses often were. Complicated struggles with doctors and the traditional structure of nursing, Vicinus argues, prevented nurses from controlling their own situation.