John Court: Mental Health at Earlier Margins – An Historical Perspective
 
John Court: Some background

        Some years ago, for a special exhibit on the Queen Street and Mimico Asylums at the City’s Market Gallery, Geoffrey Reaume (a Disability History prof at Ryerson and now York) and I crafted the enclosed text panel on the therapeutic history at those two institutions, sub-headed by general eras as you’ll note.  Most of the material for that came from Geoffrey’s late-1990s thesis research using the original patient records’ files in the province’s Archives of Ontario from his sample of about 428 patients between 1870 and 1940. I think that text, reproduced below provides some background information to my presentation on October26, 2018.

Queen Street Site History

vis-à-vis 

Therapeutic Treatment Approaches 

by
Geoffrey Reaume
School of Disability Studies, Ryerson University

John Court
Centre for Addiction and Mental Health Archives and
Department of Psychiatry, University of Toronto

Before 1850

        By the 1830s, mad people, called during much of the 19^th century by the long-since discredited term, "lunatics," were the object of increasing attention in Upper Canada.  Regulating their lives, along with those of other marginalized groups such as criminals, paupers and prostitutes, was advocated by segments of the establishment.  While madness affected every segment of society, the situation of the poorest mad people was of particular concern.  Upper Canada's emerging middle class became increasingly prominent in promoting measures to confine mad people whom they regarded as unproductive citizens in an emerging capitalist society.  Small groups of poor mad people were recorded languishing in wretched conditions in county jails during the 1830s, some others were boarded out to people who bid lowest to be paid by county officials to confine a mad person, while still others were expelled from the county and left for someone else to deal with.  Only the most relatively fortunate were cared for by family members at home. 

        In order to try to get some semblance of order into this chaotic situation, several attempts were made to set up an asylum in York County in the early to mid 1830s.  These efforts, however, failed to take hold until an Act was passed in 1839 providing for the establishment of the first insane asylum in Upper Canada.  It took another two years before the first “Temporary Provincial Lunatic Asylum" opened in 1841 Toronto.  Over the next nine years various places were used to house this early group of inmates, as they were known, including a disused jail near King and Yonge Streets.  In January 1850, the first inmates were moved from the temporary asylum in downtown Toronto into the newly opened facility, which had been built in what was then the pastoral setting of the Garrison Reserve on today's Queen Street West.

1850 to 1905

Non - interventionist Period and Moral Therapy

        The first half-century of medical therapeutics at Queen Street was a time of less physical intervention, particularly emphasized during the long superintendence of Drs. Joseph Workman (1853-75) and Daniel Clark (1875-1905).  Physically invasive procedures on asylum inmates, which would become very common in the 20th century, were specifically avoided at Queen Street.  In contrast, at some provincial asylums such as London, Ontario, women experienced horrific gynaecological operations in the late 1800s performed by Dr. R.M. Bucke.  Toronto’s Asylum Superintendent, Daniel Clark opposed this practice and did not permit such operations at Queen Street.  Among the most common treatments at the Toronto Asylum during this period was moral therapy, from the “Moral Treatment Movement” of Thomas Kirkbride in the US, which emphasized work and recreation among patients, intended as a way of instilling regular work habits among inmates.  This was, however, also a controversial practice as patients were put to work for no pay as a source of inexpensive labour.  Patients' labour saved the Provincial Government, which mandated this practice, many thousands of dollars in expenses in numerous categories, such as clothing, made by women inmates, and construction work, done by men patients. 

        The results of this can still be seen, as the boundary walls along the east, west and south perimeters of the present-day Centre for Addiction and Mental Health attest to the skills of the nineteenth century patients who built or re-assembled these walls.  In addition to work and recreation, other practices including physical restraints were used on patients officially until 1883 and then unofficially afterwards.  Chemical restraints were also used on patients, such as alcohol, which was used as a sedative, though opposition to this practice from temperance advocates in the community was well known.  While a clearly defined ward system was intended to classify different kinds of patients, the sheer volume of admissions made a ward classification system impractical.  Generally speaking, when it came to treatment during this period, fresh air and exercise were considered more beneficial to a person's mental health among doctors at Queen Street than invasive physical procedures or an over-reliance on chemicals.

1905 to 1924

Classification Period

        The emphasis on proper classification of psychiatric patients' diagnoses, something that Daniel Clark in 1898 said was "impossible," was a major change introduced by his successor at Queen Street, Superintendent (1905-1911) C. K. Clarke.  Classification systems were carried on by his successors in later decades.  Influenced by the practice of the German psychiatrist, Emil Kraepelin, whom he visited on a 1907 European tour, Dr. Clarke stressed more organized medical terminology.  He also initiated more rigorous training for nurses in 1906 and, in 1907, medical conferences began to be held three times per week.  Whereas diagnostic classification in the province was previously wildly chaotic, during this period standard diagnostic classification schemes were introduced.  Over his last thirty years, however, C.K. Clarke aggressively advocated for racially and ethnically specific immigration policies, while supporting the emerging eugenics movement.  Some patients were deported back to their home countries as a result of this approach, including Lee F. who in 1907 was deported back to China, even though he was still very depressed at the time of his expulsion.  Classification in such cases could be anything but beneficial for some patients.

1924 to 1960s

Physical Interventionist Period

        Believing that physically intervening in a person's body could "relieve" symptoms of mental anguish led to some of the most notorious physical interventions in psychiatric history during this period.  At Queen Street, treatments at this time included intramuscular injections of salvarsan for syphilis from 1924-31, malarial treatments, injections of manganese chloride for many syphilis patients, as well as novarsam and tryparsamide treatments, and spinal drainages between 1931-33.  By the late 1930s, Metrazol shock treatments began at Queen Street, to be followed in the next decade by electro-convulsive therapy (ECT).  Insulin shock convulsions were administered extensively at Mimico and Toronto Psychiatric Hospital (TPH), although not at Queen Street.  From 1941, and especially between 1945-1955, the most radical interventionist treatment – lobotomy – was initially carried out on patients from Queen Street at TPH and other local general hospitals, expanding into Mimico, Queen Street and other Provincial Psychiatric Hospitals in the 1950s.  These treatments were usually done without the consent of the patients, only being stopped if a family learned about it beforehand and strongly objected to such procedures.  While physical intervention was by no means at an end, by the late 1950s notorious treatments like lobotomy were superseded by another change – a new era of psychopharmacology.

1950s to 2004 

Medications and De-institutionalization

        The modern uses of pharmaceuticals in psychiatric treatment, and the process of de-institutionalization, are two closely intertwined issues that have come to dominate the history of this topic over the past 40 years.  The first anti-psychotic medication made its initial appearance in Toronto in 1953, one year after its discovery in France.  These new drugs have become the most commonly used medical treatments since the 1960s.  Some patients and mental health professionals feel these drugs were beneficial, while others feel their over-use has had negative side effects such as trembling limbs, as well as leading to too much influence from drug companies. 

        At Queen Street, as elsewhere in the western world, this period witnessed a reduction in the number of in-patients in mental institutions.  This was partly due to the desire to end segregation and to promote community integration of people who receive psychiatric services.  By the mid-1970s, these changing policies led to the demolition of most of the old Queen Street hospital structures dating from the 19th century.  In 1979, the old designation "999" Queen Street West was officially changed to "1001," as the re-built Queen Street Mental Health Centre was officially opened after a decade of construction.  In 1998, the name changed to the Centre for Addiction and Mental Health, as four specialty health care institutions were merged.    The last quarter–century has seen the greatest impact of more patients treated in the community than ever before.  Newer client-centred and evidence-based treatment modalities such as cognitive behaviour therapy (CBT), along with wide-ranging research and educational programs, are re-defining today's CAMH mission.  As well, through the current site redevelopment proposals the Centre is striving to preserve historic vestiges of the institutional setting, notably the surviving boundary walls and two 1891 workshop buildings, while providing a more normalized or conventional urban living environment for those now receiving its services.  Many challenges remain that affected the lives of current and former psychiatric patients in earlier decades, including find a job, housing and acceptance by the wider community.  There has also been greater participation by people who receive psychiatric services in their treatment than in earlier eras.

March 28, 2019