Remembrance of Patients Past: Life at the Toronto Hospital for the Insane, 1870-1940 9781442628069

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Remembrance of Patients Past

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Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870 –1940

Geoffrey Reaume

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

Originally published by Oxford University Press Canada 2000 © University of Toronto Press 2009 Toronto Buffalo London www.utppublishing com Printed in the U.S.A. Reprinted 2010, 2012 ISBN 978-1-4426-1075-0 Printed on acid-free paper Library and Archives Canada Cataloguing in Publication Reaume, Geoffrey    Remembrance of patients past : patient life at the Toronto Hospital for the Insane, 1870-1940 / Geoffrey Reaume. (Canadian social history series) Includes bibliographical references and index. ISBN 978–1–4426–1075-0 1. Mentally ill – Institutional Care – Ontario – Toronto – History. 2. Toronto Hospital for the Insane – History. I. Title.   II. Series: Canadian social history series RC448.O53T67 2009      362.2'109713541      C2009-903809-9 University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council. University of Toronto Press acknowledges the financial support for its publishing activities of the Government of Canada through the Book Publishing Industry Development Program (BPIDP).

For my Mother and Father Josephine Reaume and Nelson Reaume with love and gratitude

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Toronto Hospital for the Insane, 999 Queen Street West, early twentieth century (RG 10-20-B-7-6, Archives of Ontario 4612, Queen Street Mental Health Centre).

‘Oh that I had wings I would fly like a dove and be at rest I would fly out of this asylum. . . . There is nothing impossible with our Heavenly Father all powerful He could give me wings as easy as He’ Ralph M. 1841–1911 Husband, Father, Farmer A patient at 999 Queen Street West from 1898 until his death in 1911

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Contents

Acknowledgements / xi 1 Introduction: The Physical and Medical Setting / 1 2 Diagnosis and Admission / 23 3 Daily Routine and Daily Relationships / 54 4 Patients’ Leisure and Personal Space / 101 5 Patients’ Labour / 133 6 Family and Community Responses to Mental Hospital Patients / 181 7 Discharge and Death / 209 8 Conclusion / 244 Notes / 258 Bibliography / 323 Index / 352

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Acknowledgements

Since this book is about the lives of people who were psychiatric patients long ago, it is especially appropriate to begin by acknowledging the importance to this work of people who have lived in mental institutions in my own lifetime. The seeds for this book were originally planted when I was a psychiatric in-patient at Regional Children’s Centre in Windsor, Ontario, from 18 June to 1 October 1976 and at St Thomas Psychiatric Hospital in St Thomas, Ontario, from 30 January to 12 April 1979, as well as during seven years as an out-patient in my hometown of Windsor. Shortly after I dropped out of grade 9 I was diagnosed with schizophrenia at the age of 14 and paranoid schizo­ phrenia when I was 16. I have known many other people with this and other diagnoses, some of whom have become my best friends. Compared to most of the people described in this book, and many people I knew in these two facilities and have come to know in the years since then, my period of hospitalization was relatively brief. This was largely because I was extremely lucky to have a supportive family to return to, unlike many others in a similar situation. However brief this period may have been, the six months I spent as a psychiatric in-patient and the periods right after these hospitalizations were the most influential times of my life and have led directly to the existence of this book. Working as an out-patient at Goodwill Industries, Contract Division, from April 1980 to June 1981 in Windsor was also very influential, along with the brief period I worked at industrial therapy in St Thomas. These experiences helped to inform my views on patients’ labour and friendships between people with mental health problems. As I did more reading on the history of psychiatry, it was obvious very little was written by academic historians about the perspectives and experiences of psychiatric patients. Too much of what did exist seemed to be based xi

xii   remembrance of patients past

on a stereotype of people in mental institutions as either incapable or violent, devoid of any sort of complexity in personal relationships with one another, a monolithic group of people without much of a life beyond a diagnostic label. Knowing that there is a lot more to this story about a very diverse group of people, I thought, why not try something different? After all, current and former psychiatric patients also have a history that we can write. So that is how this book came about. The entire idea for it came from people I met who happened also to be psychiatric patients, inside and outside of mental health facilities, the greatest teachers any historian of psychiatry could ever have. It is their stories, their lives, that have inspired this book. This book originated as a Ph.D. thesis in the Department of History at the University of Toronto. I would like to thank the three original members of my thesis committee. Professor Michael Bliss, my thesis supervisor, has been very helpful with criticisms and advice over many years, for which I am grateful. Professor Pauline Mazumdar has given me numerous valuable scholarly suggestions as well as constant encouragement throughout the development of this work, which will always be greatly appreciated. I also wish to thank Professor Edward Shorter for his comments. In addition to Professor Bliss and Professor Mazumdar, I would like to thank the other members of my thesis examination committee for their supportive comments and criticism: Professor Wendy Mitchinson, who was the external examiner, Professor Ian Radforth, Professor Carolyn Strange, and Professor Sylvia Van Kirk. I would also like to thank Professor Mazumdar and the Institute for the History and Philosophy of Science and Technology, University of Toronto, and Associated Medical Services, Hannah Institute for the History of Medicine, for supporting me in my post-doctoral research into the history of psychiatric patients’ labour in Ontario. I have benefited from the criticism, encouragement, and suggestions of people who have taken the time to read and comment on earlier versions of portions of this work. These have included Lykke de la Cour, Velma Demerson, Lilith Finkler, Shirani George, Danny Goldstick, Elsbeth Heaman, Ken Innes, Youngran Jo, Susanne Klausen, David Leadbeater, Alison Li, James Moran, Peggy Pasternak, Josephine Reaume, Nelson Reaume, Ruth Ruth, Mel Starkman, ­Marianne Ueberschar, Don Weitz, and Joanne Woiak. I would also like to thank people at Oxford University Press Canada for their enthusiastic interest in seeing this book to press, including Laura Macleod and Phyllis Wilson, as well as an anonymous reader and copy editor Richard Tallman, who provided very helpful and supportive comments on how to improve the manuscript, and Valerie Ahwee for technical assistance. All errors and omissions in this study are mine.

ACKNOW LE D G E ME N T S    x i i i

Portions of this book were originally published in the following: Canadian Bulletin of Medical History 11, 2 (1994) and 14, 1 (1997); Lori Chambers and Edgar-André Montigny, eds, Family Matters: Papers in Post-Confederation Canadian Family History (Toronto: Canadian Scholars’ Press, 1998); and, with Lykke de la Cour, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explo rations in Social History (Toronto: University of Toronto Press, 1998). I thank Cheryl Krasnick Warsh, editor of CBMH, and the publisher of both books for permission to republish material that appeared first in these publications. Jim Connor, during his tenure as executive director of the Hannah Institute for the History of Medicine, and Sheila Snelgrove, former executive assistant of the Hannah Institute, were helpful both with encouragement and in finding me jobs at different times. I would like to thank Cyril Greenland for suggesting in the summer of 1991 that I take a look at the Queen Street patient files to see what they contain. Thanks are due to Dr Ken Reed and the Queen Street Mental Health Centre Research Committee, who granted me access to the records of this institution, which is the focus of the present study. I also appreciate the assistance of the reference staff at the Archives of Ontario, in particular Carolyn Heald and Jim Lewis for their help in obtaining access to material, as well as Bill Hughey and Judith Emery for assisting with publication of photographs for this book. I would like to express my gratitude to the many people whom I  have known in the psychiatric consumer and psychiatric survivor community in Toronto since 1990 whose support, encouragement, and example have helped me in so many ways. In particular, friendships that developed from involvement in West End Psychiatric ­Survivors during the years of its existence, 1992–5, will always be treasured. Marianne Ueberschar has an intellectual curiosity that equals that of anyone I have ever known and is always very generous with sharing her ever-expanding resources. Don Weitz is always ready to tell me, and anyone else, what he thinks and has shared his thoughts on psychiatric survivors’ history on many occasions, a subject about which he has a true passion and commitment. Lilith Finkler has been a source of constant support and advice in all manner of ways, both academic and personal, and is a very dear friend. I would especially like to remember Shirani George, a beautiful spring flower who has gone to a better life. The memory of Shirani’s compassion for people in need, her warm, gentle personality, and her sterling integrity will inspire me for as long as I live. Ruth Ruth, Ken Innes, and the Puzzle Factory Friendly Spike Acting Troupe are true workers of wonders through their artistry and

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determination. I am immensely grateful to them for giving me the opportunity to take this work from the thesis to the theatre in ‘Angels of 999’. This play was written by myself, with an enormous amount of help from Ruth, Ken, and all of the members of the threatre collective who improved and added to the original script. Together, we adapted the words and experiences of some of the people in this book for a stage production by and about people who have been psychiatric patients—history for people who have lived it. I would also like to thank Ron Wilson and Ted Isnor for their friendship, as well as Melanie, Christine, Barbara, Frank, Milano, Anna, Violet, Mark, Doreen, Suzie, and Allan for thoughts left unwritten but always to be remembered in other ways. A fellow patient at St Thomas Psychiatric Hospital in 1979, whom it would only be appropriate to identify as Barbara, more than any other single person, provided the original vision for this entire book. Barbara’s friendship and thoughtful concern for other patients who lived at St Thomas Psychiatric Hospital are cherished memories that resonate throughout the following pages. The quotation from Ralph M., in the epigraph to this book, speaks eloquently to later generations about the hopes, dreams, and sorrow of people who have been in mental hospitals. His words, and the lives of many other psychiatric patients, like Barbara and Shirani, offer the greatest inspiration for this work. It is my hope that this study will have contributed in a small way to remembering their lives and the lives of so many other people who have been patients in mental health facilities, past and present. Finally, I would like to express appreciation to my closest relatives, including my two brothers and four sisters, Ron Reaume, Anne Dupuis, Carole Delisle, Dan Reaume, Brenda Verkoeyen, and Laura Reaume, as well as their families, for all of their support. I would like to remember my maternal grandfather, Francis Udall, who died in 1974 at the age of 81. A veteran of World War I, he suffered shellshock and was a psychiatric patient at various times during his life. I also wish to remember my maternal grandmother, Anne (Halowski) Udall, who died in 1976 at the age of 71. She supported her husband, inside and outside of hospitals, whenever he experienced mental health problems during their 47-year marriage. Their example lives on in my mother, Josephine Reaume, and my father, Nelson Reaume. They know what it is like to see a loved one, both a parent and a child, experience mental health problems and become a patient in a psychiatric facility. For always being there, this book is dedicated to them with love and gratitude. Geoffrey Reaume Toronto,November 1999

1

Introduction: The Physical and Medical Setting O! Visitor to Toronto ‘La Belle’ standing by the City Hall, Walk due west ’long Queen street, ’till you come to a high     stone wall; Within the walls is a palace, extending right and left, This dear visitor is the home, for people of sense bereft. There are illusions and delusions, around you by the score, But on this point, I’ll not say much, being sensitive and sore; This, you must remember, that patients here within, Are here, because we all were born into a world of sin. . . . Now come inside the building, and enter into the halls, You will see many patients, whose sorrows for pity calls. But pray pay no attention, to what might be said to you, Some of them had fine intellects ’fore trouble their minds     o’erthrew . . . Graeme L.1 When 49-year-old Graeme L. wrote these words in 1907, he was a patient at the Toronto Hospital for the Insane, where he remained for six months until he was discharged. A year before Graeme’s admission, another man was admitted to the same institution from the ­London, Ontario, insane asylum. At the time of his transferral to Toronto in 1906, Tom M. had already been a patient in London for 28  years, since 1878 when he was 17 years old. He would remain confined at the Queen Street hospital until his death in 1941, having spent all of his final 63 years in two different asylums. A few months 1

2   REM EM BRANCE OF PATI ENTS PAST

Tom M. in 1935 at the age of 74. Confined at the age of 17 in London ­Asylum, he was transferred to Toronto in 1906 where he remained until his death in 1941, having spent the last 63 years of his life in two mental institutions (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

before he died it was recorded that this old man ‘eats garbage . . . and wanders about making a noise like an animal.’2 The stark contrast between these two people reveals much about both the diversity and desperation of patients in this institution: Graeme was a relatively short-term patient who wrote poetry about the asylum; Tom was a lifelong inmate whose file revealed that he lived a degraded existence behind the bleak walls of 999 Queen Street West for years prior to his death, long since forgotten by family members. This difference among patients’ lives, briefly encapsulated by the institutional lives of these two people, is the focus of this book, this effort to offer a remembrance of patients past. During the 70-year period 1870–1940, 18,819 men, women, and, in some cases, children were admitted or readmitted to 999 Queen Street West.3 Given such massive numbers of people, no study could dissect each and every file, not least because not all files have survived, especially those dating from before the late nineteenth century.

INTRODUCTION: THE PHYSI CAL AND M EDI C A L S E T T I N G    3

As a result, this book starts in 1870 when documentation for a few patients’ lives is still available, with most of the material for the earlier decades being very scarce, beyond a few dozen admission records out of the 3,656 people who had already been confined between 1841 and 1870 at the Toronto Asylum.4 For these people little record exists of their life in the asylum as patients over a long period of time, unlike the extant documentation for those admitted towards the end of the nineteenth century and especially in the early twentieth century. Thus, this book does not claim to be representative of all, or even a majority, of the thousands of people who went in and out of the Toronto Hospital for the Insane. Rather, the purpose is to try to understand the lives of 197 people, most of whom were admitted between 1870 and 1907 and whose interrelated stories lasted until around 1940. In other words, this is an effort to understand them as people first rather than as a diagnostic label. In so doing, this book, like a number of recent studies in the field of patients’ perspectives, is intended to be a contribution to the history of mental institutions and their occupants by giving voice to those people who have been considered ‘silent’.5 Chapter divisions reflect the general themes that illustrate the lives of mental patients, from the admission and diagnosis of a person as mentally disturbed to their daily relationships and leisure and labour activities, which they engaged in either on their own or under the direction of hospital officials. Family relationships will be discussed throughout, with a chapter devoted to the families’ perspectives on the institutional experience, followed by a discussion about the last part of an inmate’s institutional life, discharge or death. Throughout these varied themes, patients’ views and experiences form the core of each chapter, save in the chapter on family and community perspectives, though here, too, patients’ perspectives are included. The main sources have been documentary materials from the clinical files of 431 people admitted to the Toronto Hospital for the Insane between 1870 and 1907, most of whom had died or had been discharged by 1940. Of these 431 psychiatric patients, 197 have made their way into this book, some only in fleeting references, others through detailed portraits. Much more material is available even on this relatively small group of people than was possible to put into this book. All records for the people discussed here are stored at the Archives of Ontario, Toronto, rg 10, Series 20-B-2, Queen Street Mental Health Centre Records. Every patient record in boxes Q1 to Q11 was methodically examined and there were also some files selected from box Q12 and one file of a readmitted patient in box Q51

4   REM EM BRANCE OF PATI ENTS PAST

followed up from an earlier box file. Those documents selected were chosen on the basis of what their files reveal about an individual patient’s experiences. Therefore, this was not a random selection. If one document in a file had a statement, or more than a statement such as a transcript of an interview, that expressed the point of view of a patient through a third party, this file was chosen. All files that contained patient writing(s) or, in a few instances, drawings were selected without exception. The methodology used, therefore, was based entirely on uncovering everything and anything about the experiences of psychiatric patients that was available in each person’s records; it was not based on a numerical quota or on quantity of data on patients created by medical and nursing staff. When a file was selected, material that provided an overall understanding about an individual’s life was included. As much information as possible was selected on a patient as existed in a file, beyond the document or ­docu­ments that shed light on a given patient’s perspective. This approach led to the selection of predominantly chronic patients, people who stayed for at least several years, if not decades, in contrast to individuals who resided at 999 for several months. Long-term patients were more likely to have a larger accumulation of documents than short-term patients, though this was not always the case. These documents include administrative correspondence between hospital officials and families and friends of inmates, as well as letters to and from government inspectors. There are also clinical records and charts in files, primarily dating from after 1907, providing information on the mental and physical state of patients, as well as about relationships within the institution. Without any doubt, the most treasured resources uncovered for this book are writings from the patients themselves, written either while they were still confined or after they were released. These invaluable documents provide the most important insights into life in a mental hospital from the patients’ perspectives. To adhere to the Freedom of Information and Protection of Privacy Act of the province of Ontario, all patient files have been recoded. Patients admitted less than 100 years ago, after 1899, have had their names and the names of their relatives made anonymous, using their actual first and last initials but changing ­Francis to Fred, for example. Some patients admitted prior to 1899 have had their names anonymized as well. In and of themselves, these case files, and thousands more from this institution, contain a rich mine of material that has already been delved into by historians in the recent past and can contribute to many more projects in the future.6 There is a wide variation in the amount of

INTRODUCTION: THE PHYSI CAL AND M EDI C A L S E T T I N G    5

material in patient files, with some containing hundreds of documents accumulated over decades of a patient’s life and others having very little material. This lack of material in some files includes those of long-term patients who were among the most isolated inmates and who had no outsiders inquiring about them. To provide as wide a range as possible on patients’ experiences, including those of isolated inmates, information from files has been used on the basis of themes set out in this study. This has included material from the slimmest to the largest folders. A small amount of material in a file does not mean lack of value, just as a large number of documents does not mean an automatic treasure trove about a patient’s views. For example, there are files with only a few documents that nonetheless include invaluable insights into a particular patient’s perspective, while other files have an enormous amount of material but contain little or nothing about an inmate’s views. The primary motive for writing this book is to present inmates in mental institutions as individual human beings who deserve to be understood on their own terms as people, rather than labels, free from the clutter of medical terminology and diagnostic categories that has too often served to obscure just who those people were who filled the rows of columns in annual reports. In short, this is not a clinical history of patients’ lives but a personal history. Research was based on finding stories about patients and not on statistical representation, so much more time was spent looking for qualitative details in each document than in compiling quantitative information. There was no sophisticated methodology behind this book other than a desire to uncover ­stories about people who were patients at the Toronto Hospital for the Insane and to take their views and experiences seriously as the lives of individual human beings who lived in a large mental institution. Where statistics have been used, these have been gleaned from the annual reports of the inspectors and superintendents rather than from clinical records. While statistics can provide details on certain general trends, such as deaths or numbers of patients who worked during certain years, this material cannot provide the information that is essential to understanding what patients thought about what was happening to them, as is contained either in their own writings or in thirdparty observations. A qualitative approach may only provide a ‘snapshot’ of an inmate’s views or experiences at a given moment in time. Nevertheless, such a snapshot can provide a far more concrete indication of a patient’s perception on experience, especially institutional experience, than can be provided by statistics in which an individual is subsumed under a mass of aggregate data. Just as a picture

6   REM EM BRANCE OF PATI ENTS PAST

can be worth a thousand words, so, too, a snapshot of a patient’s life can be worth a thousand statistics. This desire to understand the individual experiences of the people who make up this book, within the overall context of institutional practices and relationships, is the overriding purpose of Remembrance of Patients Past. A good place to start painting a picture of this overall context is by providing a brief historical survey of the physical and medical setting at the Toronto Hospital for the Insane during the 1870–1940 period.

The Physical Setting The first Provincial Lunatic Asylum opened with 17 patients in 1841, was originally situated in the county gaol on Toronto Street. There was not enough space, however, so branch facilities were set up in a house at the corner of Front and Bathurst Streets and in the east wing of the colonial legislative buildings. In January 1850 a new insane asylum located three miles west of downtown Toronto, at 999 Queen Street West, received its first patients.7 This new facility was about one mile north of the shores of Lake Ontario and was placed on unoccupied farm land, away from the bustling core of the nearby city. However, this rural tranquillity was not to last. By the late 1880s the institution’s grounds had been reduced from over 100 acres to 26 acres, and by 1940 the total land mass for 999 was only 20 acres.8 The asylum’s designers had wanted to move away from the city, following the example of William Tuke’s famous retreat in York, England, where it was believed that people considered to be insane could recuperate in peace and quiet in the clean air of the country.9 However, the urbanization of Toronto and the birth of the local community of Parkdale in the 1870s, just west of the institution, led to the reabsorption of this mental hospital back into the city. In the 40-year period after 1851, Toronto’s population had grown by five times, from 30,000 to 150,000, and by the mid-twentieth century, the core city alone was teeming with 675,000 people, while the suburbs had another 360,000 inhabitants.10 Though there was talk of closing down this location entirely, especially during the first two decades of the twentieth ­century, this never happened—to this day a mental health facility remains on the grounds that were opened in 1850.11 During the period studied here, the name of this facility changed four times: Provincial Lunatic Asylum, 1841–71; Asylum for the Insane, Toronto, 1871–1907; Hospital for the Insane, Toronto, 1907–19; Ontario Hospital, Toronto, 1919–66.12 To provide consistency, the standard full reference used here is Toronto Hospital for the

INTRODUCTION: THE PHYSI CAL AND M EDI C A L S E T T I N G    7

Insane, while the terms ‘asylum’ and ‘hospital’ will be used in short forms, as both these words were used by patients even after name changes. The chronic-care background of the patient population at the Toronto facility was reflected in annual reports throughout this period. In 1876 it was estimated that seven-eighths of the asylum population were chronic and at the turn of the century it was estimated that 81.5 per cent of all admissions to 999 were in this category. By 1940, over 85 per cent of patients at the Toronto Hospital for the Insane were not considered fit for discharge, indicating that chronic care was the primary feature of the patient population over the 70 years considered here.13 What kind of a building did these patients live in? By 1870 the central administrative building and the attached east and west wings had been built, structures that remained until their demolition in the mid-1970s.14 This structure was 584 feet in length, ranging from four to five storeys high. The front of the building was 120 feet long and 90 feet in depth, with the extreme height of the dome tower being 120 feet from the ground and 40 feet in diameter. During the early years of its existence, this dome tower was the tallest structure in Toronto, a modest precursor of the cn Tower and as famous in its day to the local inhabitants. The two oldest wings where patients lived during this entire period faced north and each was 210 feet in length, excluding verandahs, which were 50 feet in diameter, 30 feet by 20 feet. These wings were 60 feet wide and 45 feet in height. Two more wings for patients were opened in the early 1870s and remained in place for a century. These wings were attached to the main building and faced south. They were 215 feet long, 60 feet wide, and four storeys high, like the older wings, and also had similar verandahs. The basement was four feet below ground level and included stores, workshops, and dormitories for some working patients. Corridors throughout the above-ground buildings were 14 feet wide, at the end of which were the semicircular verandahs on each ward, as noted above.15 Non-resistant patients could be domiciled in so-called cottages, which were massive three-storey houses on the grounds. There were three such facilities at 999, two for over 100 females and one for about 50 males; these were in use from the 1880s on.16 From 1906 to 1917, when it was condemned as unsanitary, the nearby ‘King Street branch’, or Mercer Reformatory, was used to house approximately 125 female patients from the free or public wards to relieve chronic overcrowding.17 When it was closed to asylum inmates, additions were made to one of the cottages and to an industrial building to house patients. This overcrowding, which C.K. Clarke publicly

8   REM EM BRANCE OF PATI ENTS PAST

referred to as ‘embarrassing’ in 1909, frequently led to administrative offices being turned into dormitories, as well as to other structural adjustments. Indeed, some patients even had to sleep on sofas in corridors. Staff residences also changed, from being in separate housing on the grounds to nurses being domiciled on wards with patients by the 1920s and sleeping in the upper floor of the main building during the 1930s.18 The physical awkwardness of certain aspects of these facilities was commented upon by Superintendent Daniel Clark in 1904, a year before he retired, in an illuminating critique of the original architectural style: The church, so called, was in a dingy garret, under the dome. The pulpit was built ten feet in height and a stair was made so that entrance was procured by it from the outside corridor. The preacher was supposed to be in danger when addressing the patients so in order to secure his safety he could not be reached from the pit in which they were gathered below. Small windows were put in near the ceiling to be beyond the patient’s reach. This shows the erroneous opinion architects and boards had in respect to lunatics.19 As will be discussed in Chapter 5, a more accessible and less foreboding chapel was built with patient labour during the early 1890s. In total, there were 16 wards, eight for males, eight for females. Six of the wards were for paying patients, who were charged from two to six dollars per week. The largest number of beds, to be sure, were on the public wards, which had up to 18 people sleeping in each dormitory, while the most privileged patients could purchase their own private rooms. Each ward had dining and sitting rooms, toilets and washing amenities, dust and clothes shafts. Not surprisingly, more attention was paid to providing comfortable furnishings on the most expensive paying wards than on the free wards. There were also two infirmaries separated from the main structure, one for men and one for women. In addition, there were: a central kitchen building, opened in 1890; a laundry building (122 feet by 52 feet); cowsheds (closed in 1912); a mortuary; and a farm that had dwindled to only several acres by the late 1880s. There were also a small garden, trees, and a large fountain facing Queen Street to the north, and two smaller fountains in the back of the grounds.20 While the buildings were completely refurbished in the 1920s and a new laundry was built at that time, the physical dimensions remained essentially the same throughout this period as the old structures remained in place.21 There was not too much room to manoeuvre

INTRODUCTION: THE PHYSI CAL AND M EDI C A L S E T T I N G    9

for patients or staff, a point that officials complained about over the years as neighbourhoods and nearby industries, notably the railroad yards to the south, overtook the once quiet countryside.22 Out of all this, all that remains of these various structures at the beginning of the twenty-first century are the brick walls on the east, west, and south sides of the present-day Centre for Addiction and Mental Health, Queen Street Division. The old brick wall facing north, which completed the physical circumvention of the grounds, was torn down along with the rest of the old buildings in the mid-1970s.23 As will be discussed in Chapter 5, these walls were constructed primarily by male patient labourers in the late nineteenth century and average 16 feet in height, an enduring testament to the skills of the patients who built them. What was it like inside the wards that existed behind these walls? The rise or decline in the quality of the living environment for patients depended on which ward an individual was on and how much was paid, or not paid, for room and board. Conditions for even wellto-do people could be unpleasant, but accommodations for the poor were miserable, overcrowded, smelly, and dirty. Rats were seen on wards, with Anita B. recorded as stating in 1909 that she did not want to ‘stay in bed for the rats to eat’. That very same year another female patient, Connie D., was known to chase after rats on her ward with the aim of petting them. Whether she ever succeeded in petting one of the ward rats is not recorded. Rats were still roaming around in 1923 when Superintendent Harvey Clare reported that they lived beneath the basement.24 The conditions of poor hygiene that brought rats from the bowels of the building to wander the halls of 999 Queen Street West were evident in the washroom facilities. In 1906, Superintendent C.K. Clarke declared that the ‘closets [i.e., toilets, known as water-closets] and bath-rooms are a menace to the health of the inmates.’25 In addition to at least the one woman’s fear of rats in bed, bugs were reported crawling around in patient Grace B.’s bed by her father in 1882, a complaint that Superintendent Daniel Clark dismissed.26 Flies and other winged insects also buzzed about the wards, so much so that the family of Maude B. was advised to take back her fur coat as it is ‘apt to be spoilt by moths in a place such as this’. Maude’s mother, Mary, wrote in 1895 about her firsthand view of the $4-a-week middle-class ward as being made up of ‘distressing and comfortless surroundings’—and this was one of the better wards in the building, though not as good as the $6-a-week ward where Maude originally resided.27 This removal from one ward to another—from one physical setting to another—was a stark reminder of the decline

10   REM EM BRANC E OF PATI ENTS PAST

in income and class status for some patients when financial support dwindled or ran out, as it did for Beatrice M. Initially confined in 1893 on the $4-a-week ward, her financial support ended five years after admission so that she spent the rest of her life on the free wards until her death in 1912 at the age of 76.28 The physical location of a patient within the hospital told all about the individual’s class location, a position that could change over time. The lower down on the weekly rate scale a patient went the more spartan and bare were the ward accommodations. The physical ­environment became aesthetically if not physically colder, as comfortable furnishings vanished with less money, replaced by hard benches and bare walls. For example, in 1907, a move from the $4-aweek ward to the $3-a-week ward meant a change from a ward with carpets to one with hardwood floors, as it did for Ann P. Further down the line, a few years earlier Superintendent Clark wrote that the $2.75-a-week ward was ‘somewhat plainer’ than the $3-a-week ward.29 For a patient on a public ward the amenities were cruder than even the lowest-standard paying wards. Katerina G., the sister of inmate Reginald C. wrote in two separate letters, in 1917 and 1918, about the uncomfortable ‘backless benches’ that inmates sat on.30 Wards were also very hot in the summer and cold during the fall and winter. Heat prostration was noted as a contributing cause of death on at least two occasions, as occurred to elderly patients John Y. in June 1911 at a time of ‘extreme heat’ and to Hanna M. in July 1921, several days after she was scalded in the bathtub. At the other end of the seasonal barometer, temperatures inside could be anything but comfortable. In November 1910, Alicia F., the wife of wealthy patient Reginald F., wrote that her husband complained of ‘being so cold all the time’, even though he was in the most expensive male ward.31 Reginald’s contemporary, Ralph M., a farmer who was confined for the last 13 years of his life, 1898–1911, wrote in an undated letter: ‘This assylum [sic] is very cold.’32 Whatever the season, each ward had what at first glance seems to have been a nice built-in spot to look outside while still on the ward— a verandah. The idea of ward verandahs suggests a pleasant airing court—in fact, they were used for decades, well into the late 1930s, as dormitories for sick patients, as was experienced by Margery A. in 1918 and Albert A. in 1939.33 The verandahs were used not only for physically ill people but also for patients considered by staff to be ‘too active’, like Mary D., who was sent there from another ward when she ‘persisted in undressing herself’, indicating that verandahs were also used as restraining rooms, as were single isolation rooms.

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One former patient left behind writing that clearly indicates the grim purpose these hospital verandahs could serve. Elaine O. angrily wrote after her discharge in 1910, ‘I was not a verandah slave or a sitting room slave.’34 Thus, a trip to a ward verandah was not always for the relaxing purpose of rest and viewing scenery that the name implies. While having a private room afforded a degree of privacy that was absent in dormitories, some patients in individual rooms were not much better off than their peers in dormitories on public wards. In 1915, May K., the sister of patient Anne D., wrote that on a previous visit two years before her sister was ‘in a room not fit for an animal to be confined in—a cot bed with a mattress on it not fit for any human being to sleep on, the sole furniture in it without even a change of clothing’.35 As will be seen in discussions about a few upper-class patients, conditions were better for them, but most patients were not in this privileged category. In the late nineteenth century 63 per cent of patients at 999 Queen Street West were kept on public wards, while 37 per cent were on paying wards.36 For most of those on the better wards, hospital life was not one of comfort even by the standards of their own time, and there were significant variations in the environment of paying wards, as the above citations point out. For the majority of inmates who had no money to improve their surroundings—the men and women on the public wards—their physical environment at 999 Queen Street West was cold, crude, and harsh.

The Medical Setting A general outline of medical practices at this massive institution during the 1870–1940 period is necessary to provide a medical context for the lives of the people who make up this study. Table 1 provides an overview of the different approaches to medical treatment employed at 999 Queen Street West between 1870 and 1940 and reflects broader developments within the international field of mental health care. As will be discussed in Chapters 4 and 5, during the second half of the nineteenth century Canadian officials who were responsible for insane asylum inmates implemented moral treatment as a form of institutional therapy.37 While medical practices would change over the seven decades studied here, perhaps the one continuity was that elements of moral treatment remained in place during the entire period. Moral therapy originated with the work of Philippe Pinel in France and William Tuke in England in the late eighteenth and early nineteenth centuries. They initiated the movement away from the most physically coercive forms of confinement and emphasized instead

Years

Therapeutic Approach

Method and Highlights

1870–1905 Non-Interventionist Moral therapy, begun under Joseph Workman (1853–75) with work and Period recreation, continued by Daniel Clark (1875–1905). 1877 Emphasis by Clark on natural healing. He prefers ‘fresh air, generous diet, and cleanliness’ to drugs. 1878–9 Clark defends use of alcohol as sedative for ‘excited’ patients. He says it is safer than opium and chloral hydrate, which are also used. 1883 Official end of the use of physical restraints. 1890s Opposition by Clark to any sexual surgery on patients at 999. He denounces this practice by other doctors. 1898 Introduction of dental treatment, which Clark links to patients’ mental health: better teeth, easier to eat, improved physiological condition. ­Con­tin­ued into the 1940s. ‘Correct classification [of the insane] is impossible’, says Clark. 1905–24 Classification Period C.K. Clarke (1905–11) stresses scientific methods, adopts Kraepelin’s diagnostics. This approach is continued by J.M. Forster (1911–20) and Harvey Clare (1920–5). 1906 Hydrotherapy introduced. 1906 Training school for nurses is instituted. 1907 Medical conferences three times a week are started.

12   REM EM BRANC E OF PATI ENTS PAST

Table 1 The Course of Medical Therapeutics at 999 Queen Street West, Toronto, 1870–1940

Years

Therapeutic Approach

Method and Highlights

1908–09 Standardized provincial classification system. 1909 Out-patient service begins. 1911 Diagnostic updating of files of chronic patients who had been at 999 from five to 50 years. 1924–40 Interventionist Period Rise of so-called ‘heroic’ treatment for mental illness, which reached its height in the period after 1940 with lobotomies (primarily 1945–55). 1924–31 Intramuscular injections of salvarsan for syphilis. 1929 Province encourages more use of biochemistry in preventive treatments. 1931 Part-time dentists placed on staff at all provincial mental hospitals for ­reasons mentioned by Daniel Clark in 1898. 1931–3 Malarial treatments and thousands of injections of manganese chloride for syphilis patients, as well as novarsam and tryparsamide treatments. Spinal drainages reported. 1937 First insulin shock treatment in Ontario at New Toronto (Mimico). 1938–9 Introduction of metrazol shock treatment at Toronto and five other provincial mental hospitals. Used on patients with depression and schizophrenia. 1940 Use of ‘fever cabinets’ to treat patients with syphilis. source: Annual

Reports, 1870–1940; ao, rg 10-B-20, Queen Street Mental Health Centre Records, Clinical Files.

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Table 1  (continued)

14   REM EM BRANC E OF PATI ENTS PAST

trying to instil self-discipline and a firm ‘guidance’ over the behaviour of their charges through moral suasion.38 This effort to promote essentially middle-class standards of conduct on people in mental institutions, such as ideas about respectability and a regular daily routine, influenced asylum keepers throughout the Western world, where larger and increasing numbers of mental institutions were being established. As with their British and American counterparts who had earlier used the ideas of Tuke and Pinel to try to move away from physical coercion, Joseph Workman, Superintendent from 1853 to 1875, and Daniel Clark (1875–1905) both saw this approach as more humane.39 Part of this non-coercive policy was to declare the end of using physical restraints at 999 Queen Street West in 1883, an approach that reflected the then ongoing debate among authorities at Anglo-American institutions about the usefulness of restraint.40 In theory, what this meant for the day-to-day existence of patients was that they were no longer to be threatened with being confined in crib-beds, restraining muffs, waistcoats, and chairs.41 It also meant that most able-bodied patients were expected to engage in some work and entertainment as part of their therapy. However, as will be shown, the reality fell far short of these ideals. Patients continued to experience restraint and abuses that the elimination of physical coercion was supposed to eradicate. Similarly, leisure and work could also be experienced by patients in ways that were quite different from how this treatment was promoted by its practitioners. While John S. Hughes argues that moral treatment was more ‘feminine’ than later ‘heroic’ approaches, the large volume of work undertaken by both male and female patients indicates that this therapy did not produce a ‘soft’ or gentle life, as will be shown in Chapter 5.42 Both Workman and Clark advocated what can best be described as a ‘non-interventionist’ approach to treatment (Table 1). While somatic or direct physical intervention, such as removing an appendix, was practised for physical ailments, neither physician believed in the large-scale use of medication to treat mental disorders. Drugs such as chloral hydrate, opium, and bromides were used as sedatives, but Workman suggested that their use had been ‘overdone’ outside the asylum, while Clark insisted that ‘fresh air, generous diet, and cleanliness’ were better than drugs in treatments for insanity. Clark advocated the use of alcohol as a way to make ‘excited’ patients more manageable, which he said was safer than medications. However, he did this over the opposition of other superintendents in the province and Ontario’s Inspector of Asylums, Joseph Langmuir, as

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well as the opposition of provincial politicians, who, influenced by the temperance movement, reduced expenditures for this provision in 1878. Thus the hospital’s daily routine consisted of a small amount of alcohol consumption, usually whisky, among disturbed inmates. Patients who refused to eat could also be fed with a stomach tube, as occurred 558 times to an unnamed woman in the late 1870s, twice a day with food mixed at times with whisky and cod-liver oil, a revolting mix of force-fed liquids. However, Clark’s publicly stated conservatism in physical treatments most certainly saved some of his patients from further anguish in one important respect for he was opposed to operating on the sexual organs of inmates, primarily females, to ‘cure’ their mental distress (see Chapter 2).43 Clark also started a non-coercive program of medical treatment, in the form of teeth and gum care, that was undoubtedly of benefit to patients. In 1898, Clark began employing a dentist for paying patients, though he also asked that money be set aside for the treatment of free inmates. Clark pointed out that proper dental care would lead to better chewing habits and an improved diet, which would have a positive physiological impact on a person’s physical and mental health. Within a few years, money had been set aside to treat a minority of free patients, and by 1931 this program of dental hygiene was adopted across the province when dentists were employed part-time in mental hospitals to examine all patients.44 It is interesting to note that Josephine Wells, one of Canada’s first female dentists, was employed by Clark during the early years after this treatment began at 999.45 In 1898, Daniel Clark wrote that, where mental disorders were concerned, ‘correct classification is impossible.’46 This view is striking when contrasted with the medical approach that followed his retirement and the appointment of Charles Kirk Clarke as Superintendent in 1905. Daniel Clark’s views were similar to those of other asylum administrators during the late nineteenth century, who believed that people considered insane were to be managed within the walls of an institution where an active medical cure was unlikely for a condition believed to be degenerative.47 However, by the turn of the century, with an increasing number of disputes between therapeutically conservative asylum superintendents and more interventionist-oriented neurologists, there was a greater emphasis among mental hospital administrators to demonstrate the relevance of their work in the relief and interpretation of mental illness.48 In an effort to do this, North American alienists began to look to German and Swiss doctors like Emil Kraepelin and Eugen Bleuler, who claimed to have developed more serious scientific standards in the study of mental disorders.49

16   REM EM BRANC E OF PATI ENTS PAST

The acceptance of the German classification system for psychiatric patients by doctors at Toronto is reflected in their published writings and in clinical records beginning in 1906–7. This brief period is significant, for it marks the early years of C.K. Clarke’s superintendency, a post he held from 1905 to 1911, when he was succeeded by J.M. Forster, who was in charge until 1920 and was in turn succeeded by Harvey Clare, who was Superintendent from 1920 to 1925. Forster, Clare, and those who came after them up to the mid-twentieth century, such as F.S. Vrooman and W.C. Herriman, were all trained in this classification system, which became the accepted diagnostic approach at Ontario mental hospitals well into the 1930s and 1940s. However, this later era became much more interventionist, with some of the most notorious forms of ‘treatment’ practised at 999 Queen Street West during the last years of the period under study.50 As Thomas E. Brown has written of the early years of the twentieth century, ‘psychiatrists insisted that the first priority was the proper classification of the insane.’51 This desire to come up with a more definitive and standard code of diagnoses was seen as important largely because of psychiatrists’ desire to be taken more seriously by other members of the medical profession. One of 999’s physicians, Dr Ezra H. Stafford, chided his colleagues in 1897 for the ‘consummate awkwardness’ of their terminology, observing: ‘This intolerable evil of many names makes psychiatry the ridicule of the outside profession.’52 Nearly a decade later, Dr C.K. Clarke told a meeting of the British Medical Association that Kraepelin’s practice of conducting systematic clinical investigations of patients over a number of years would put the psychiatric profession ‘on a more solid basis than has yet been the case’. Like Kraepelin, Clarke believed that there was an organic basis for mental disorders such as dementia praecox, now known as schizophrenia.53 After Clarke visited Europe and met Emil Kraepelin and Eugen Bleuler, medical conferences were instituted three times a week in 1907 at the Toronto facility to discuss diagnoses and to develop ‘true standards’ about which psychiatrists could agree.54 Thus, the adoption of Kraepelin’s methods of systematic investigation and classification by Clarke and other prominent Ontario officials was done in part because of a desire to bring some order to the chaotic world of early twentieth-century psychiatric diagnoses. This approach was also accepted in the hope that systematizing would improve the reputation and prestige of a profession that practitioners felt was badly in need of greater legitimacy. By 1908, Clarke noted that 55 per cent of all patients at the Toronto facility had dementia praecox. This desire for more professionalization was also reflected

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in the introduction of a training school for nurses at the Toronto mental hospital in 1906, the first such school in Canada. By the time he left 999 Queen Street West in 1911, Clarke’s model of nursing schools had spread to other parts of Ontario.55 Closely connected to these professional pressures and changes was the modernization of hospital bureaucracy. As Barbara Craig has shown in her work on hospital records and record-keeping in Ontario and London, England, between 1850 and 1950, the expansion of the medical bureaucracy after 1890, and especially the use of typewriters by the early twentieth century, had a significant impact on the scope and extent of records kept on individual patients.56 Again, the influence of the new classification scheme can be seen in these developments. Clarke believed, along with Kraepelin, that tracing the heredity of a person was crucial in determining the outcome and thus the diagnosis of mental patients.57 In order to do this a more extensive mode of record-keeping was introduced; indeed, a large portion of the present work uses the records established during these years. Classifying patients included not only new arrivals but also long-term patients who had been admitted prior to 1906. More than 200 patients admitted between 1861 and 1906 had official medical conference reports included in their files from November 1911, all of which have the initials of Assistant Superintendent Harvey Clare. One-hundred eighty of these patients were given the most prevalent diagnosis, one of three forms of dementia praecox, or what came to be categorized in provincial reports as schizophrenia by the early 1930s.58 In an article published in 1916, Harvey Clare noted that the largest percentage of patients in provincial hospitals were those with dementia praecox, making up 25 per cent of all people admitted. The fact that there was such a significant discrepancy between Clarke’s 55 per cent figure and Clare’s 25 per cent estimation for the province suggests that other asylum superintendents did not apply this diagnosis as often as did Clarke when he was at Toronto, even though dementia praecox remained the dominant diagnosis in Ontario’s mental hospitals. Fifteen per cent of the remaining patients were diagnosed with manic depression, followed by 10 per cent each for people with diagnoses of senility, involutional melancholia, general paresis, and exhaustion and 5 per cent each for epilepsy, ‘imbeciles’, alcoholism, and other drug and toxic problems.59 The view that dementia praecox was ‘the most frequent form of mental disease’ was widely accepted among asylum doctors within a few years of the introduction of this classification system to Ontario, as is made clear by Dr J.P. Harrison in an article published in 1910. Harrison wrote about the numerous

18   REM EM BRANC E OF PATI ENTS PAST

psychoses grouped under this term and stated: ‘There is consequently little to be gained by efforts to differentiate too sharply between the various subdivisions, for many symptoms are common to all.’60 While mental hospital doctors placed most of their emphasis on proper classification, it would be inaccurate to portray the 1905–24 period as being without some form of active treatment. For example, in 1906 hydrotherapy was introduced at 999. Patients were placed in specially made bathtubs for at least several hours, sometimes longer, with the water regulated to keep it at a certain temperature. This treatment was continued well into the 1930s, when more continuous baths were added.61 Water therapy was intended to calm the nerves of ‘excited’ patients and soothe depressed people.62 Emphasis on individual treatment was also encouraged during the classification period, and included a new out-patient service for low-income patients, opened in 1909. Ernest Jones was placed in charge of this clinic, though none of these patients were admitted to the asylum.63 By the mid-1920s, however, efforts to categorize mental patients and their disorders were increasingly influenced by a desire to be more active than before in finding some way of lessening, if not ‘curing’, the symptoms of mental anguish. Again, the need to prove professional ‘relevance’ to other members of the medical profession and to a wider public asserted itself. This led to the era of ‘heroic’ treatments, so called because of the impact of these direct physical interventions upon patients, with practitioners trying to show how a ‘dramatic’ attempt to relieve a person of his or her affliction was in itself a sign of the ‘valour’ of this approach. While there was a continuation of classifying patients along the lines first established in the years after 1905, the later years covered by this study are characterized by the rise of interventionist treatments, which continued past the period looked at in this book. As with the other medical developments outlined above, these treatments occurred within the context of approaches first developed in Europe and the United States. At the Toronto institution, the first signs of this more active approach occurred in 1924, when sulfoxyl salvarsan was administered through intramuscular injections to patients who had syphilis. These treatments continued for at least seven years. By 1931, 1,700 injections of manganese chloride were given annually to over 100 patients to treat syphilis, and patients with this disorder were also given malaria during the early 1930s in an effort to relieve their illness through an induced fever.64 Salvarsan was considered ­relatively effective in the treatment of infections found in advanced cases of syphilis, but it was ineffective in relieving firmly embedded

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brain damage caused by the disease. This was a widely promoted treatment by the Austrian psychiatrist Julius Wagner von Jauregg, who developed the method of inducing fever in patients.65 Doctors at Toronto, as elsewhere, concentrated most of their interventionist treatments on syphilitic patients up until the mid-1930s. The organic nature of this condition was viewed as the basis for mental illness, and conclusively to arrest this disorder would be considered an essential breakthrough. However, towards the end of the period studied here, there was greater interest in expanding ‘heroic’ treatments beyond patients with syphilis—‘therapeutic and theoretical vacuum’ had developed within psychiatry, as Elliot S. Valenstein has observed.66 This led to somatic treatments being directed at larger numbers of patients who were diagnosed with chronic disorders and who were thus considered ‘hopeless’. If it could be shown that there was hope for people in this category who had been written off by the standards of psychiatric prognosis then in existence, the laurels would go to the physicians who carried out this practice, as well as to the profession overall. On the other hand, if no such remedy proved effective, the patients operated upon would be the ones to suffer the most long-lasting and devastating consequences. By the end of the 1930s, interventionist treatments had increased significantly. The first insulin shock treatments in Ontario occurred in May 1937 at the mental hospital in New Toronto (or Mimico), four years after the first shock treatment was reported in Europe. Due to its relative ‘simplicity’ to administer, metrazol shock therapy, instead of insulin shock, was introduced at Toronto, Whitby, Hamilton, London, Kingston, and Brockville mental hospitals in 1938–9. Out of 443 patients treated during this first period, 74 per cent were men and women diagnosed with schizophrenia, 21 per cent were diagnosed with manic depression, and 5 per cent had involutional melancholia. It was claimed that insulin shock gave better remission rates with schizophrenia and metrazol shock worked better with people in the other two categories. It was also noted that ‘More severe complications follow metrazol therapy’, which most likely referred to fractures.67 By the end of the period studied here, Superintendent J.R. Howitt recorded the introduction of an artificial fever therapy unit at 999. Established to treat patients with syphilis, these ‘fever cabinets’ were said by Howitt to have been ‘very satisfactory’ for this purpose.68 Shock treatments and fever cabinets continued to be used into the 1940s. The interventionist period that had begun in the mid-1920s reached a crescendo throughout the province, as elsewhere in North America, especially between 1945 and 1955 when the most notorious

20   REM EM BRANC E OF PATI ENTS PAST

of all interventionist procedures—lobotomies—were performed. The first lobotomy done in Ontario was on an unnamed 58-year-old woman in July 1941 at the Toronto Psychiatric Hospital. She was the first of an estimated 1,000 people who were to have this cruel and irreversible operation performed on them in the province by the mid1960s.69 It was well after the period studied here that some of these interventionist treatments were largely superseded by the introduction of neuroleptic drugs. While psychosurgery continued to be performed after the 1960s, it was far more limited in scope than before, and by the late 1970s the legal restrictions on its application in the province considerably diminished its previous widespread use.70 Shock treatment, or electro-convulsive therapy, continues to be used, though with a great deal of controversy from people on both sides of the issue.71 With the introduction of neuroleptic drugs such as chlorpromazine in the mid-1950s, another new era in the history of psychiatric treatments was ushered in, which remains immensely influential in medical practice to this day.72 These latter developments are, of course, beyond the story about to unfold in the following pages. By covering the years 1870–1940, this book is attempting to offer some insight into the lives of primarily long-term patients in huge mental institutions, many of which no longer exist. Where they do still exist, as with the Queen Street facility in Toronto, they usually do not function as they once did—massive structures, filled with thousands of people, that dominated the history of psychiatry up to the middle of the twentieth century in North America. The diversity of the patient population during the period studied here, from wealthy to very poor patients, is in contrast to the institution that exists on this spot at the dawn of the twenty-first century, where people from the bottom of the socio-economic ladder make up the patient population and wards do not separate wealthy or middle-class paying patients from poor patients, as was the case in this earlier era. It is important to remember that institutions like 999 Queen Street West served an essential function in a period before the development of welfare state provisions for the elderly, the infirm, and people on the lowest rungs of society who had no other means of support. During the 1870–1940 period, places like the Toronto Hospital for the Insane acted as shelter for some men and women, for people who had no families or whose families were unable to care for them in the community. Yet, even when acting as shelter for those individuals who had nowhere else to go, it was a strictly defined shelter where one’s class position determined the type of space a person occupied—a crowded dormitory for the poor, a private room for the

INTRODUCTION : THE PHYSI CAL AND M EDI C A L S E T T I N G    2 1

rich. Before universal health insurance, years of asylum confinement could result for some people because there were no other sources of support for them.73 In the lives of these men and women, the power of the state was central to enforcing the power of psychiatry in restraining, confining, and defining their existence inside and outside the hospital. As will be discussed throughout this book, the legal authority that medical officials wielded in being able to involuntarily incarcerate, treat, and even censor the correspondence of people certified as insane was employed with the full co-operation of the state—the legal, political, and bureaucratic authorities who passed and administered laws supporting the coercive structure that grew up around the lives of those who found themselves in places like 999 Queen Street West. While agency, or the ability of patients to influence their own lives, is an essential part of this book, the medical setting in which they lived, supported as it was by the power of the state, very much constrained and limited their options, as did class, gender, race, ethnicity, and disability. While patients were not merely passive actors in this historical drama, they were not able to direct the scenes either, as the managers behind stage wielded omnipresent power should they get out of line, and they enforced their power over patients time and time again. One further point that will become evident is the lack of change in treatment of specific individuals. Since the people whom this book focuses on are primarily chronic, long-term patients who were admitted up to 1907, they were not subjects of the interventionist, so-called ‘heroic’ treatments that were so important beginning in the 1920s. All chronic, long-term patients admitted up to 1906 were reassessed from a diagnostic perspective in 1911, as was pointed out earlier. The clinical files of this same group of people and of those who entered the asylum the following year, 1907, indicate that of these people, those who were still in the hospital after the 1920s were not subjected to the interventionist treatments that later patients received. There were some changes in procedure, such as the boarding out of a small minority of long-term patients in residential homes set up specifically for psychiatric patients beginning in the 1930s, as will be discussed in Chapter 7. However, for the most part, the men and women discussed in this book spent the years of their institutional lives with little in the way of change in treatment or their surroundings, even while the world outside and the psychiatric profession were undergoing colossal changes. As will be discussed, some patients were very aware of the changing world and tried in their own way to keep up with wider events beyond 999 Queen Street West. For others, however, change

22   REM EM BRANC E OF PATI ENTS PAST

outside went unremarked upon, if not unnoticed. Thus, this is primarily a history of those men and women who became long-term patients, that is, longer than two years, in some cases stretching into decades, during a period when custodial confinement, or warehousing of psychiatric patients, was a common feature of asylum life.74 In bringing to light these stories of people who were confined at the Toronto Hospital for the Insane, this book owes a great deal to the many people who have been in mental institutions and have written about their experiences, a rich source of material that can tell us much more about those who made up the population of these facilities than any diagnostic labels can begin to do.75 Psychiatric patients as individual human beings, rather than a collection of labels and anonymous numbers, is what this book is about. The 70-year time frame, 1870–1940, also covers much of the life span of many of the people who will be discussed in these pages, as was the case for Tom M., mentioned at the beginning of this chapter. It is the lives of people like him and his contemporaries to which this book is devoted, this remembrance of patients past.

2

Diagnosis and Admission

The Admission Process The prospect of admission to an asylum could be a terrifying experience. In June 1907 Madeleine B. had been a patient for several days on the Nervous Ward of the Toronto General Hospital when she was told that she was to be transferred to the nearby Hospital for the Insane on Queen Street. Distressed after the recent birth of her child, this 28-year-old woman had been diagnosed with puerperal insanity while at the tgh. In an effort to prevent her transferral, Madeleine informed the medical staff that she no longer heard voices. Instead, she said she preferred the tgh because ‘the sight of the building [at 999 Queen Street West] is enough.’1 Her husband refused to give consent to her transferral and he took her back home. Madeleine’s comments on the asylum structure highlight the fear this facility provoked in some of those who were admitted there. As Andrew Scull has shown, the specialized architecture of nineteenth-century British asylums was specifically designed to intimidate the inhabitants.2 Thus, the actual sight of the building for new arrivals could be a frightening experience in itself, as it was for Madeleine B. This fear of the building was no doubt compounded for many people who were admitted before 1890, as they had to enter, like everyone else, through the basement door until a proper first-floor entrance was constructed. According to Superintendent Daniel Clark, a ‘more dismal and forbidding entrance to this asylum could not have been devised.’3 This was the dismal entrance that thousands of new patients had to go through during the first 40 years of the institution’s existence. Once patients went beyond the front entrance they were brought to the admission ward, where they were assessed before being sent to 23

24   REM EM BRANC E OF PATI ENTS PAST

another ward. This could last from a few days to a few weeks. On the day of arrival, new patients were given a bath and a gown for sleeping in and put to bed. Then, their temperature was taken along with their pulse and respiration.4 Only after observation by medical staff was it determined where in the hospital a patient would go. The circumstances of committal and patients’ views of this process need to be examined. In short, there were as many circumstances leading to confinement as there were patients. The asylum itself was viewed with genuine fear and loathing by some, while for others who felt they had nowhere else to turn it was perceived as a last refuge. This diversity of views as expressed by people about to be committed is evident from the following two people. Elizabeth W. was about to be sent to the asylum for the second time when an examining physician found her to be ‘very nervous and much distressed at the thought of returning to the Asylum’. Indeed she had threatened to commit suicide if returned to the hospital.5 Confined in 1893 at the age of 42, Elizabeth remained locked up until her death in 1920. Seventeen-year-old Henry N., on the other hand, told the committing physician that he ‘Wants to go to a Lunatic Asylum for a rest.’6 Confined in 1906, he was discharged six months later. While most admission papers do not contain many specific responses to the prospect of confinement, these two examples highlight important points: previous experience and the need for shelter. Elizabeth already had been in the asylum and it is obvious from her comments that this had been a traumatic experience. Henry had no such previous experience of being a patient in an asylum. However, his admission papers state his utter terror of returning home, thus illustrating that for someone experiencing domestic problems, being confined appeared one of the few options available for getting away from the place of torment, while also ensuring that one’s basic needs were met. Before uncovering what brought about this process, it is essential to set out the general medico-legal context of the committal process. Patients had to have their diagnosis of insanity certified by registered physicians who conducted examinations prior to recommending that an individual be sent on to the asylum. Patients admitted up to the summer of 1882 were required to be examined by three physicians, after which time examinations conducted by two doctors were sufficient, a practice that was maintained for the remainder of the period under consideration. These documents took the form of official printed sheets, called Form K, and after 1882 Form A, providing two sections on one side of a foolscap page: one space was for the doctor’s observations and why he (there were no female doctors) believed a

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patient was insane; the second section listed details provided by ­others, such as relatives or neighbours. For inmates confined in prison who were transferred to the asylum, physicians or legal authorities wrote or typed statements attesting to a prisoner’s insanity, which could be supplemented with a deposition in support of the doctors’ statements from a family member or acquaintance. Along with the official statements that certified a person, one of the admitting doctors was required to fill out a Form of History of a Patient explaining in more specific detail the personal circumstances, as well as physical and emotional state, of an inmate. This document went from two pages for the earliest patients being examined in this study during the 1870s to four pages in 1907, when most of the latest admissions examined for this book occurred. The increased amount of space for information was created because the Ontario government decided that a more detailed form would help with the scientific study of insanity.7 It is important to note that these Form of History documents were filled out only for those patients who were admitted from the community, whether resident in a private home, public hospital, or charitable boarding house. For those patients admitted from prison, there was instead a document referred to as Schedule 2, which was a more concise one to two pages. This form asked similar questions about an inmate’s personal life and family background, albeit with less space provided for answers than in the more expansive Form of History. Prisoners were also required to have a transfer warrant to allow the police to transport them from prison to the asylum. Once there, they could only be released on the express authority of the LieutenantGovernor of Ontario, who usually took the advice of the Inspector of Public Charities, the direct superior of asylum superintendents in the provincial bureaucracy. In other words, two types of documents had to be filled out before someone could be admitted to an asylum: statements from two physicians (or three physicians before mid-1882) explaining why someone was considered insane, and a more in-depth form describing the personal background and condition of a person believed to be of unsound mind. There was also a certain protocol to be observed among doctors when engaged in the committal process. Practitioners from outside would sometimes send patients without notifying medical superintendents that a new inmate was arriving and would at times neglect to fill out the necessary papers. This could create problems, not the least of which was providing space for an unexpected arrival. To prevent such occurrences, physicians were urged to telegraph or correspond with the relevant institution in their district to have the proper documents

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sent to them for certification, and also were expected to give prior notice to asylum authorities about the arrival of a new patient.8 Yet, even when things went relatively smoothly, asylum officials did not always accept whatever was written on the admission forms by medical colleagues. When 26-year-old Samantha C. was admitted in 1895, Daniel Clark wrote a letter to one of the two physicians who certified her to tell him of his scepticism: You state that you believe Miss C__ is insane from the following facts, ‘taciturnity and an indisposition to exercise and a general appearance of mental aberration.’ You will see on second thought that all of this might be said of a sane person and are not in themselves facts that would prove insanity.9 There was no response to this letter and Samantha remained confined until her death in 1921. The reliability of information from another medical institution could also be called into question by an asylum official. Dr C.K. Clarke, in referring to 40-year-old Gene B., noted in 1906 that ‘we do not always get the exact truth’ about patients transferred from the Toronto General Hospital. This man remained confined until his death in 1908. Clarke’s consternation was such that he informed the Inspector of Asylums that, after the new psychiatric ward was fully operational at the tgh, ‘we shall hesitate long about admitting any patient from that hospital.’10 The fact that Samantha and Gene remained locked up, even after asylum officials cast doubt on information from the doctors who certified them, indicates how difficult it was to reverse the admission process once a person had been admitted when there was no one who offered to be responsible for them outside the hospital, as was required by law. Perhaps one of the more revealing examples of conflicting medical interpretations between those who committed patients and those who received them is provided in the file of Jed R. After receiving the admission papers about this 48-year-old man from Newmarket, Superintendent Daniel Clark wrote to one of the examining doctors to inform him that since the information indicated intellectual ‘weakness’ since childhood, it would be better to send this man to the­ Orillia Asylum for ‘idiots’ and ‘imbeciles’.11 Dr Widdifield, the examining physician, wrote back that the Orillia Asylum was not ‘the proper place for him at all’, for not only could Jed cut 50 cords of wood on his own, he also had good judgement: ‘I might add that politically he is a strong party man and always casts his vote without making a mistake. It is not even necessary for the party committee to look after him. This is very far from being an idiot.’12

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Admitted a few weeks later in 1884, Jed R. was confined until his death in 1919. When we consider his overall conduct in the community prior to confinement (which is discussed in more detail below), it is clear that this man was violent and a physical threat to others in the community, including children. However, if we consider the above remarks in isolation, as a way of trying to determine a diagnosis, it is apparent that this was a very tenuous process with all kinds of personal biases influencing the certification process. Like anyone else, physicians were influenced by a host of factors, including class, ­gender, race, even political affiliation, which in the case of Jed R. merely redirected him from one asylum to another. In this instance, the bias did not determine whether he was going to be locked up, but only where he was to be sent. Another man’s political beliefs became a part of his medical history. James D. was a patient for several months in 1907, eventually being discharged as recovered from manic depression. In remarks recorded in his clinical record, his wife Georgette said that she thought he had been acting strangely ever since he began studying socialism three or four years earlier.13 There is no comment in the record about the absurdity or irrelevance of this remark from a clinical point of view. Indeed, the fact that it was recorded at all suggests the doctor felt that there might have been something to it. In another instance, the confused and forgetful state of an elderly inmate about world news was recast as part of her insanity. Esther B. spent nine months in prison in 1905 prior to being transferred to the asylum the following year, when she was 65. She was imprisoned at the instigation of some of her seven children several months after her husband died. It was recorded that she talked of setting the house on fire, threatened others, and believed she heard the voice of her recently deceased husband.14 Her madness was also ascribed to confusion about her name and children, as well as the fact that Esther ‘became confused about events of which all sane persons in the city must know the leading features. Thought there had been a war between the Russians and Boers; had never heard of the Japanese.’15 Thus, mixing up the Russo-Japanese War of 1904–5 with the Boer War of 1899–1902 was recorded as part of her insanity, rather than as simple confusion over recent news. Esther died in the asylum in 1908 with senility being included as one of the causes of death. Documents in the files of Jed, James, and Esther indicate that they were experiencing serious emotional problems at the time of admission. Yet, passages in each file also reveal the willingness of medical officials to ascribe ordinary non-medical influences, such as personal political views or knowledge about world events, as somehow helping

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Esther B. in a photo from 1908, two months before her death at the age of 67. She spent the last two-and-a-half years of her life confined, first in prison, then in the mental hospital where she died (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

to indicate the extent of a person’s mental problems. This line between the world of psychic disturbances and the personal biases of recording physicians was a very thin one indeed, and the doctors’ tendency to cross this line most certainly had an influence on the admission process. As some of the following stories illustrate, certifying someone as insane raises questions about the social and political influences on this process, from both inside and outside the medical profession.

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Gender and Sexuality The relationship between female sexuality and admission to an asylum is evident through what Wendy Mitchinson describes as the ‘three mysteries’—puberty, menstruation, and menopause. In her study of Toronto Asylum records prior to 1900, Mitchinson notes that nearly one-quarter of women sent to this institution had their diagnosis linked to ‘female-related causes: childbirth, lactation, miscarriage, menstrual disorders, uterine disorders’, and other similar ailments for those patients whose predisposing cause of insanity was recorded.16 This connection made by physicians between a woman’s emotional condition and her physical state was very much tied in with the somatic theories of the time. It was standard teaching by the end of the nineteenth century among American and English medical authorities to relate problems in the area of a female’s pelvis to her brain, which they claimed led to emotional disturbances.17 Thus, it was in such a context that a patient like Frances C. found herself confined in 1880 at the age of 31. Never before having experienced any attack of madness, Frances’s mental collapse was directly related to her having recently given birth. Sixteen days before admission she had experienced ‘protracted and severe labor’, after which she became violent towards herself and others, including threatening her newborn baby and believing others were attempting to poison her.18 Considered a case of ‘puerperal insanity’, Frances would remain confined for the rest of her life until she died in 1931. Stories like that of Frances C. indicate how uniquely feminine physiological experiences, in this case childbirth and post-partum depression, came to be diagnosed as part of ‘women’s madness’. The uterus was seen as the central locus of such instability, commonly referred to as ‘hysteria’, with the ‘wandering womb’, in the words of Jane Ussher, ‘acting as an enormous sponge which sucked the lifeenergy or intellect from vulnerable women’.19 For a woman like Frances to reject her responsibilities as a mother was especially shocking to people in late nineteenth-century Victorian society, where it was expected that a female’s central responsibility was to marry, reproduce, and care for her children.20 At the other end of the diagnostic spectrum were menopausal women whose reproductive years were over, but whose emotional state continued to be tied in with their feminine biological timetable. Sarah S., for example, a 48-year-old widow with four children, was admitted to the asylum in 1894. She would remain in 999 until her death almost 30 years later. Terrified that certain unnamed people were going to take her children away and

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were abusing her, she had barricaded herself in a bedroom with all of her children inside.21 Similarly, 52-year-old Ellen M. was admitted in 1903 after having attacked her daughter, and became very upset about being examined for insanity. The cause of her madness was recorded as having been due to ‘menopause + grief + worry’, though it was also noted that Ellen was reported to have been emotionally distressed, with ‘lucid intervals’, for 13 years prior to the onset of menopause.22 She would remain confined until her death in 1928. The emotional turmoil these women were experiencing is obvious to anyone who reads their files, as is the influence of gender and biology in helping to arrive at a diagnosis that, in cases like these, was ascribed to ‘change of life’. In some cases, surgical intervention was tried in an effort to alleviate an individual’s emotional difficulties. Cynthia H. was a 49-yearold childless widow at the time of her admission in 1904. Prior to her admission to the Toronto facility she was a patient at the Homewood Sanitarium in Guelph for four years, where she was reported to have been restless, terrified of being deserted by everybody, and ‘in constant dread’ about not being provided with food. Cynthia was originally from Montreal, and it was while she was living there shortly before being admitted to Homewood that a local physician, Dr Gardner, surgically removed Cynthia’s womb, fallopian tubes, and one ovary. This hysterectomy was undertaken on Cynthia because she was at the menopausal stage, or the ‘climacteric condition’, as Dr Hobbs wrote. For his part, Superintendent Clark denounced an operation ‘which did no good to the patient as far as her mental condition is concerned’, though he agreed with the admitting physicians that menopause was the correct diagnosis, ‘largely because of lower vitality than in the earlier stages of life’. Clark thought a better approach to finding a remedy to Cynthia’s distress was to ‘see what nature can do’.23 As it turned out, she would be an inmate at 999 Queen Street West until her death in 1909. This particular patient’s experiences prior to admission to the Toronto institution highlight the increasing attention, and controversy, created by the practice of gynecological surgery on women in insane asylums in the late nineteenth century. Superintendents like Daniel Clark of Toronto and James Russell of Hamilton were vocal opponents of such operations practised by, among others, Dr Richard Bucke of the asylum in London, Ontario.24 Clark’s opposition also tells us something about his diagnostic outlook and his attempts to treat patients. While he had no control over what happened to people before they arrived at the asylum, he made sure that one gender-based

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intervention was not attempted on female patients after their admission. In 1897 Clark wrote to the admitting doctor of Lizzie C., who had inquired about the possibility of removing her ovaries ‘to restore her mental faculties’: I may say that I have made several examinations of Lizzie C__ and find nothing wrong with the organs to which you refer. My experience here is that these matters are very much magnified as the cause of insanity and I have a number here who have been operated upon and unsexed by practitioners with the result that matters were worse instead of better afterwards. If any disease is found it is of course necessary to ameliorate that condition as far as possible but as a cause of insanity it is much overrated. An epidemic of utero mania has broken out among some members of the profession which has done more harm than good in many ways; morally as well as physically. The unsexing of a large number of them has been done of late years in the hope of improving their mental ­condition and has not been a success either among the public or in Institutions.25 Thus, even in the context of the period in which this operation was undertaken, the damage such a procedure could do and did do to the well-being of female patients was observed and debated among leading figures of the medical profession. Clark’s opposition was in itself at least partly gender-based, as he viewed gynecological surgery as an attack on a ‘woman’s innate sense of modesty’.26 His comments also indicate that he did not believe there was any notable progress for a patient after such procedures. The views of women who experienced this operation, such as Cynthia, will have to go undetected as the records are silent on this point. Gender and sexuality also influenced diagnosis and admission to an insane asylum in another respect. The observance of promiscuous behaviour among females belonging to the lowest classes of society often led to a diagnosis of mental deficiency and, consequently, to institutionalization. It is essential to place this aspect of the committal process in the context of the emerging eugenics movement at the turn of the century. Harvey Simmons, Angus McLaren, Pauline Mazumdar, James W. Trent, and Ian Dowbiggin have all written about the desire among middle-class social reformers in Canada, the United States, and Britain to ‘cleanse’ society of those who were deemed ‘feeble-minded’.27 Feeble-mindedness was meant to encompass those individuals who were considered in terms that are now seen as offensive: ‘half-wits’, ‘idiots’, people believed to be of below-average

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intelligence for their age and thus devalued as members of society. This category also included people with epilepsy and ‘wayward females’. What brought all of these institutionalized groups together, as far as medical and legal authorities were concerned, was the assumption that ‘chronic insanity was highly related to membership in the lower classes.’28 This in turn led to the myth of the menace of the feeble-minded, which prompted proposals in Canada by such activists as Dr Helen MacMurchy and the National Council of Women to segregate those who were seen as contributing to social problems. As Angus McLaren has noted: ‘For the middle class, of course, it was a comforting notion to think that poverty and criminality were best attributed to individual weaknesses rather than to the structural flaws of the economy.’29 An integral part of the campaign to confine people who came under this all-encompassing social sweep was the emphasis placed on preventing the proliferation of feeble-minded citizens from ‘overwhelming’ society. Thus, by locking up such people, the reasoning went, social order and a healthy ‘race’ would be preserved from ‘contamination’ by an unhealthy gene pool.30 It was this sort of repressive social and political environment that led to the incarceration of women like 38-year-old Madge M., a domestic servant. She had been imprisoned for a year in the York County Gaol before transferral to the Toronto Asylum in 1904. Madge was a single mother of two children, fathered by different men. William Oldright, one of the doctors who examined her in prison, also reflected his own religious bigotry when he wrote in the medical certificate that Madge wanted ‘to have another Roman Catholic after her parents refused to let her marry the father of her first child’. It was noted that she no longer could see one of her children, a son, as he had been adopted. Madge had no control over this matter either, as she was informed of this decision by the superintendent of the charity house where she was residing. What became of her other child is not revealed. Dr Oldright went on to write that it was necessary for Madge to be locked up to prevent her from giving birth ‘to more unfortunates of her own kind to be a burden to themselves and the State’. Her parents had left town, so Madge had ‘for many years’ lived in charitable institutions for the poor—The House of Providence, a Catholic-run general hospital operating since the late 1850s, and The Haven, a shelter for destitute women in Toronto that had opened in 1878.31 It was also recorded that Madge was epileptic, the condition listed as the cause of death when she died in 1916,­ ­having been incarcerated for the last 13 years of her life. She was described as ‘feeble-minded’ by one of her two admitting physicians,

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and this raises the only mystery surrounding her confinement: why was she sent to the Toronto facility, which was explicitly not for those labeled ‘feeble minded’? The answer may be related to her dual diagnosis of also having epilepsy, which may have been the reason why she was not sent to the institution at Orillia, where many who were given the ‘feeble minded’ label were locked up at this time.32 This story also illustrates how 999 Queen Street West received those who, in theory, were not supposed to have been sent there. As the above indicates, a woman’s sexuality and presumed mental competence were a potent mix when arriving at a medical determination. Yet nowhere is the behaviour of the men in the lives of these same women open to the sort of moral censure that could land them in an asylum. This attitude is even more glaringly apparent in the following story of a woman who was clearly used by a man for his own sexual purposes, a point that was instead made to reflect upon the victim rather than the perpetrator. Eve S. was 25 years old when she was imprisoned in the York County Gaol in 1903, thereafter was placed in the Hamilton Asylum, and then was transferred to Toronto in 1906, where she remained until her death in 1910. Eve had epilepsy, was reported to have no known relatives, and had been jailed as a vagrant after living at The Haven. Prior to taking up residence at The Haven, Eve was reported to have lived with a man who told her that if she lived with him and they had a child together she would be cured of her epileptic seizures. How this relationship ended is not stated, but it is clear that she did not like men, as she was reported to have hidden with a club and threatened to kill two male servants while employed as a domestic worker at a doctor’s house.33 Having been used by at least one man by this time, Eve’s anger towards the male servants may have been prompted by anger towards men in general. Sexual harassment that domestic workers like Eve endured may have also pushed her to the breaking point, though there is no reference to this last point in the records.34 Eve was also reported to have been suicidal, as well as violent in her relations with other inmates while confined in jail and at The Haven.35 While her sexual relationships were not emphasized so overwhelmingly, as was the case with a number of other women discussed here, the fact that her ‘cohabitation’ with a man is given such prominence in one of two medical certificates indicates how the private behaviour of women was pathologized in a way that was not done for the men who did the same thing. The confinement of lower-class females who engaged in sexual relations outside of marriage could begin as soon as the local authorities became aware of such behaviour. It is possible to trace the history

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of one woman confined repeatedly over a 30-year period for her sexual lifestyle. Marcia F. was a 45-year-old single woman at the time of her arrest in Cobourg in July 1906, where she had been for less than a week. The admission papers state, and an exchange of letters two decades later documents, how Marcia was repeatedly confined since the age of 15 for the sole ‘reason’ that she frequently engaged in sexual relations with males. From her first incarceration in 1876 until her final discharge in 1907, she spent more than 12 years in the Toronto Hospital for the Insane and an unspecified number in the Hamilton Asylum, with one reference stating she had been confined for a total of 19 years, which suggests seven years were spent in this latter institution. Marcia spoke ‘freely’ about her sex life, ‘does not detect her error’, was ‘lacking in the usual womanly modesty and sense of shame’, ‘is not repentant’, and since a child ‘was always crazy after men’. In reference to her previous admissions, her father stated that this was ‘Always for full illegitimate intercourse with men.’ Other than Marcia, only men were interviewed about her life history, one of whom stated that ‘her acts are of the most immoral kind.’ Living on the margins of society, Marcia was listed as a domestic servant, though she had no money or property at the time of confinement. It was also noted that her memory was good, she could read and write, did not drink or smoke, and was not viewed as dangerous to herself or anyone else. Her primary delusion was that she believed certain men wanted to marry her. In effect, she was seen as insane because of her sexual promiscuity and nothing else. No violence or any other secondary factor was recorded. The fact that she was living in poverty would also have counted against her, as she had no financial resources or influential social network to look to for support. Marcia eventually made her way back to Cobourg after discharge from Toronto in 1907. She died in the Cobourg House of Refuge in 1918.36 The records of the Toronto Hospital for the Insane also show that sexual promiscuity, combined with homosexual behaviour, could lead to incarceration. Mathilda M. was a single woman, ‘about 29’ when she was confined in 1903, after spending two months in the Toronto Gaol. This was her third confinement and she would be discharged in 1907 as ‘Manic Depressive Recovered’. The medical certificates attesting to her insanity state that she was in love with another woman, with whom she had engaged in sexual activity, and had ‘continually impure desires towards her’. Mathilda also talked ‘unblushingly’ about her sexual relations with males, as well as with other females. Prison doctor James Richardson wrote: ‘She has evidently no control over her sexual desires.’ Other than the brief observation

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that she laughs, ‘talks sillily’, sings, and will not work, all of the comments emphasize Mathilda’s sex life when framing the reasons for her committal as a madwoman. She described her unnamed female lover as an ‘angel from heaven’ who could not possibly enter the jail.37 The stories of Marcia and Mathilda point to what Elizabeth Lunbeck refers to as ‘woman as hypersexual’, whereby ‘the sexually assertive woman, the woman endowed with passion equal to that of a man, was by her own account real, and psychiatrists . . . were alone in recognizing her passion as dangerous.’38 However, this point has to be tempered with the realization that physicians were not the only ones engaged in casting a wary eye on sexual promiscuity. For as Cheryl Krasnick Warsh has written, both laymen and medical men shared this desire to control sexual promiscuity among women, something that these admission papers reflect.39 Indeed, as the tribulations of Marcia F. prove, it was the disapproving gaze of non-medical males in her personal life that brought her sexual conduct to the attention of physicians. Thus, the emerging eugenics agenda, along with notions about uncontrolled forms of sexuality, contributed to the admission of women to the Toronto Hospital for the Insane. In her discussion of middle-class ‘manly nerves’ in Victorian Britain, Janet Oppenheim has written about how most medical officials in the late nineteenth century saw masturbation as contributing to ­emotional collapse among those who engaged in this self-centred, uncontrolled ‘vice’: ‘it curtailed and eventually destroyed a man’s productivity; it sapped his vitality and at length rendered him idiotic.’40 Warsh has found that masturbation was linked nearly fivefold more to male committals to the Homewood Retreat in Guelph in the late nineteenth century than to female committals.41 Since contemporary moralizing strictures against ‘self-pollution’ emphasized how much this practice was a dangerous waste of emotional and physical energy, it is not surprising that the more masculine of the two sexes would become the prime focus of this diagnosis, since according to the predominant perspective among both physicians and lay people alike, society had most to lose if males could not control their sexual impulses.42 This emphasis on males as being particularly prone to a sexual practice that could lead to madness is evident in 13 admission records of people confined at 999 between 1880 to 1900. These individuals were between the ages of 16 and 44, and 10 of them were male.43 Like his colleagues elsewhere in the English-speaking world, Superintendent Daniel Clark shared the prevailing medical/moral interpretation of masturbation. That his diagnosis was socially constructed on the basis of prevailing middle-class attitudes is made clear in the following story.

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William P., a 30-year-old farmer and elder in the Presbyterian church in Markham, was sent to the asylum in April 1890. A few days before his admission, William’s brother David, a medical doctor and former student of Superintendent Daniel Clark, wrote a letter from Minnesota to his former professor. David explained that his brother’s condition was ‘The same old story of Youth + Masturbation’. He recounted how, since the age of 14, William had masturbated on a fairly regular basis, so far as could be detected. Even the purchase of a book ‘picturing the fearful consequences of such a life’ was only able to put a temporary curb to his sexual practices, as his observant brother believed William was ‘more or less a slave to the habit’. While visiting the farm David was able to get William to admit that he ‘had no control over himself’ when it came to masturbation.44 This one comment, brief as it is, suggests that this supposedly oversexed man saw his sexual activities as in need of correction, at least if his brother’s account is to be believed. Given the prevailing moral creed of this period, which stressed moderation, temperance, and restraint to the point of sexual repression, there is good reason to believe that William did express this view and probably had to endure more than his share of guilty feelings as a result.45 His brother obviously shared such sentiments, with a strong secular emphasis, reflecting a heavy dose of medical training under prominent figures like Daniel Clark who usually offered an ‘unfavorable’ prognosis ‘under such circumstances’.46 Clark concurred with his former student’s assessment, and it is important to note how William’s sexual habits were seen as the primary reason for his madness, labelled delusional insanity with melancholy.47 This view prevailed in spite of detailed references in David’s letter and on one of two Certificates of Insanity to William’s severe financial difficulties on the farm, which had brought him to the brink of suicide on a number of occasions. William’s comments in this regard include a reference to fears that creditors were after his property and a desire to hang a neighbour whom he regarded as a villain.48 Since his views stress business problems on the homestead as his primary concern, it is likely that William did not share the fixation on masturbation that David and Dr Clark did as the cause of his emotional turmoil. It was a sexual practice that he regretted, but only reluctantly acknowledged to his persistently inquisitive brother. Nowhere in the medical records does William voluntarily ascribe his upset to anything of a sexual nature. That William was emotionally distraught and in need of help is obvious from these documents, which recount his fear of all those around him, hiding in the woods and even in the outhouse from those he believed were out to do him

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harm. It is also evident that, for William, masturbation was less of a cause of emotional distress than were matters relating to how he was going to keep up the farming business and his personal relations. Yet, the medical opinion of three out of four doctors, including that of his brother, shows that they believed William was driven mad by his ‘private vice’. All of this demonstrates how wide a gulf could exist between the perspectives of those who gave the diagnosis and the person who was the focus of medical attention. William spent the next 19 years at 999 Queen Street West before he was discharged. Unlike most of the other people whose insanity was believed to have been caused by masturbation, there is a fairly detailed account of how a 24-year-old male patient responded to medical treatment for this sexual practice and how this influenced his admission. On 20 April 1900, Dr John Stenhouse operated on Edward M.’s penis, ‘splitting the prepuce under cocaine . . . in order if possible to aid in a cure of his masturbating practices’. After lying quietly during this procedure, Edward ‘suddenly got up, in spite of all remonstrances’ put his pants on, and escaped, barefooted, in a ‘frenzy’ down a back lane, only to be later brought back exhausted.49 The next day he showed up at the office of Dr Charles Rea Dickson, who had presumably referred Edward to Dr Stenhouse, since it was Dr Dickson who had had Edward ‘under my professional care for the effects of masturbation for some time past’. While at Dr Dickson’s office Edward was reported to have been very upset, ‘suspicious of my motives and refused treatment’ in which he had previously expressed confidence.50 He was also suspicious of everyone around him, particularly family members, and hit his mother before being confined on 2 May 1900, less that two weeks after the traumatic events at the office of Dr Stenhouse. Edward would remain confined for the rest of his life until he died in 1925 at the age of 49. What these documents reveal is how a sexually mutilating ‘treatment’ proved to be so physically and emotionally upsetting that Edward ran away from the place where this operation was taking place, yet this reaction was recorded as having been the response of an insane person. Similarly, his visit to Dr Dickson’s office a day later was also seen as evidence of his madness. Thus, to resist the doctor’s treatment and then deliberately to denounce the physician whom the patient felt had betrayed his trust when seeking help about presumed sexual problems were seen as a clear indication of his insanity, rather than as a comment about the appropriateness of what the doctor had done to this man. It is interesting to note that any discussion of whether or not Dr Stenhouse’s operation was considered ‘effective’ or

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in any way beneficial to the patient is entirely absent from the medical certificates. Instead, Edward’s responses are the primary focus. His physical and emotional attacks at home are also important factors that contributed to his confinement and indicate his distraught frame of mind and the hurt he inflicted on those with whom he lived. His violent conduct, when combined with his anger at both doctors, would have convinced those around him that Edward M. had lost control. His story and that of William P. a decade earlier illustrate how wider societal attitudes towards a natural sexual practice had a direct bearing on the diagnosis and admission of some men. While both William and Edward had serious personal problems, the emphasis in their admission papers on the pathologizing of masturbation provides clear evidence of how widespread biases about ‘appropriate’ private behaviour were medicalized in an effort to stop conduct seen as unacceptable during this time of sexual repression.

Abuse and Violence Implied or actual violent behaviour towards oneself or others for both men and women could lead to confinement, though this conduct in itself was not the only reason for incarceration as it was usually expressed in conjunction with experiences indicating mental disorder, such as delusions. As well, domestic violence in the home brought about emotional collapse for women in particular. Whether initiated by or inflicted on the person who was soon to be a patient, violence could be a very important aspect of the committal process, as the following examples illustrate. Ellen G. was a 40-year-old mother of seven children when she was confined in 1878 for what would be the remainder of her life, until she died in 1918. Her admission papers state she feared being poisoned, was violent around the house, and that ‘her husband is the source of all her sickness.’51 This comment raises the issue of domestic conflict in the committal process. Clearly, Ellen understood that she was experiencing serious problems. Yet, her comments about her husband are grouped together with other delusions as an indication of her madness, rather than as a possible reason as to why she was so upset. This difference of interpretation is made even more obvious in the following account. Marion H. was a single 27-year-old woman who lived with her family in Toronto when she was confined in 1880. She stated that the other members of her family were lewd, salacious, and vicious towards her and that she wished to leave ‘their polluting company’.52 Dr David J. Oliphant noted on a statement certifying her insanity that ‘she expresses unjust charges of attempted [crossed out

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in original] intended sexual violence towards herself on the part of her brother; + makes endeavor to escape from home at unusual hours, by night especially.’ Marion’s delusions were said to have been ‘all connected with sexuality’.53 There are no references in the admission papers to any other females at this house, only her father, brothers, and Marion. The repeated pathologizing of her comments about sexual abuse and trying to escape from the men around her clearly indicated that Marion’s charges about sexual attack were given no credence by the doctors who sent her to the asylum. Indeed, the hesitancy on the part of Dr Oliphant, crossing out ‘attempted’ in favour of ‘intended’ sexual violence, suggests an effort to lessen the severity of Marion’s accusations against her brother. The fact that her allegations were dismissed as ‘unjust’ raises the point of how the doctor could have known this for sure, unless he accepted the word of the men in the house over that of this extremely isolated woman. Marion would never be released from the asylum. She spent 35 years at Queen Street until her death in 1915. In one instance, a woman’s fear of men was seen as sufficient proof of her insanity. Anita C. was a 35-year-old woman who worked as a domestic when she was confined in 1896 for what would be the rest of her life, until her death in 1920. Destitute, she lived at The Haven, where she said she heard ‘men talking between the walls about killing her’. She also stated that men continually harassed her. No other reason for her insanity was given and it was recorded that she was not considered dangerous to herself or to others.54 Anita heard men’s voices coming from unusual places, not only walls, but also a musical instrument that walked alongside and taunted her.55 It is important not to dismiss such comments as meaningless delusions, for it is essential to place these remarks in the context of this woman’s fear of men. The metaphorical imagery of such comments should be taken seriously as reflecting Anita’s experiences of sexual harassment, which were so emotionally traumatic that she was unable to escape her tormentors no matter where she went. Thus, talking walls or a taunting musical instrument were symbols of ever-present danger represented in seemingly ordinary objects, just as being abused was, for Anita, a horribly ‘ordinary’ part of her life. That women were driven to emotional breakdown by abuse in the home is made clear in second-hand observations of relatives. Anne D., a 42-year-old mother of seven, was admitted in 1906. She had been abandoned by her husband and was unsure about how many of her children were alive, though two of her daughters were reported living at the Alexandra Industrial School.56 Anne was arrested on the basis of a complaint by a citizen that she was dangerous to be at large

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and was placed in prison before transferral to the asylum.57 Prior to this she had been living at the Salvation Army and Bellamy homes in Toronto. Her admission papers state she was not considered a threat to herself or anyone else and emphasize her utterly despondent condition. Anne was reported to sit for hours with a ‘vacant expression’, had an impaired memory, and was hesitant in her answers. In other instances she stared blankly without responding to queries, and at one point was physically startled ‘as if she had been frightened’.58 Her withdrawal indicates someone in the midst of a severe depression, while Anne’s physical reaction shows how fearful she was. A letter written by her sister, May, several years after Anne was confined provides valuable evidence that adds to an understanding of what caused her to become so distraught. Fed up with her irresponsible brother-in-law who had abandoned Anne, moved to Calgary, remarried, and apparently lied about providing Anne with financial support, May wrote, ‘She was driven insane by the brutality of her husband and his dis-loyalty to her.’59 The efforts over the years of May and other family members to get support for their sister from this man are evident in the often tumultuous correspondence in this file and clearly support the above assertions of spousal maliciousness. (Chapter 6 has a more detailed discussion on Anne D. and her relatives.) The effects of this cruelty lasted for the rest of her life, as Anne remained confined until her death in 1944. What these accounts show is that women’s responses to abusive behaviour by men were pathologized, rather than being recognized as having had a concrete basis in their life experiences. Since the most emotionally disturbed person in each of these instances was the woman, by medicalizing accounts of domestic abuse the doctors were able to ignore systemic problems in the community and instead put responsibility on the woman experiencing a breakdown. However, where there were sufficient complaints from people of both sexes about men who engaged in abusive behaviour, physicians were more likely to focus on the need to incarcerate the perpetrator of violence rather than the victims. Men who were confined for reasons relating to violence had usually so isolated themselves from the community to which they belonged that their restraint was seen as an urgent necessity for the benefit of everyone involved. John H. was a 23-year-old single man whose occupation was listed as student and schoolteacher when he was confined in 1883. He was reported to have exposed ‘his body indecently’, was violent towards children, which included threatening to burn a child with hot coals, was going ‘to [w]ring its head off’, and

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was also said to have ‘strung the child up by the neck’.60 Since he worked as a teacher, John’s brutality would have been especially alarming to the wider community because he was in an obvious position of power over children on a daily basis. He remained in the asylum until his discharge in 1909. When confined in 1884, Jed R. was a 48-year-old single farmer who was observed to have been suicidal, experienced ‘religious mania’, threatened to kill other members of his family, and had been ‘caught chasing little girls’.61 He remained at the asylum until his death in 1919. While there were other factors contributing to his being sent to the asylum besides sexual harassment, there was a clear realization that this man was a threat to girls. Thus, the confinement of both of these men was seen as protecting the most vulnerable members of society from further potential abuse. Walter G. was an unemployed 23-year-old when he was arrested in 1898 and transferred from prison to the asylum, where he was admitted for the second time in as many years.62 In this case, his sexual advances towards his mother and younger sisters led to his incarceration. One of the two recording doctors, William Oldright, noted ‘He seemed to have no sense of the [illegible] of such vile and unbrotherly conduct.’ Oldright went on to note his association with both parents and believed this man would be a threat both to the wider community and at home and so should be confined. Walter remained institutionalized until he was sent to a boarding residence in 1950. Unlike the charges by Marion H. of sexual abuse and the ‘polluting company’ of male relatives, Walter’s conduct was corroborated by both of his parents and by the abuser himself.63 The home environment, in this instance, was one in which others sought to offer protection from harassment, and so the violator could be isolated and removed as a threat. For Marion, there was no such protection, as the abusers protected one another and isolated the victim, whose efforts to get away from them made her too much of a threat for them to control. So she was confined. Thus, the dynamics of support around a sexually abusive home environment were crucial to determining whose views were taken most seriously. Women who were emotionally as well as physically traumatized by abuse found themselves candidates for the asylum in large part because of their isolation from support. Men who were confined as having physically assaulted women and others were locked up after their violent behaviour had spread beyond the domestic sphere and into the nearby community for others to see and substantiate. Wilfred S. was 28 when he was brought to Toronto from Reach, Ontario, in 1897, where he would remain until he was transferred to

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the Orillia Hospital for the Feeble Minded in 1911. Wandering about the farm with a lantern at night, he was reported to be ‘the terror of his family + of the neighborhood + they had to handcuff him to bring him to the Asylum.’64 At the time of his admission in 1901, Christopher B., a 45-year-old farmer and father of four children, had beaten his wife after blaming her for casting a spell on him and the farm ­animals. He also went out with a gun at night and had threatened to shoot some neighbours.65 Christopher remained confined until his death in 1912. By far the most extensive documentation of an abusive male to be certified insane pertains to Harold T. Originally arrested and then sent by court order to the Hamilton Asylum in 1903 at the age of 53, he was transferred to 999 three years later, where he died in 1909.66 A farmer who lived in Haliburton County, Harold was married and the father of nine children between the ages of eight and 29 in 1903.67 His brutality is detailed not only in regular admission documents, but also in nine legal affidavits from physicians, friends of the family, and family members themselves, all of which accompanied the usual papers. Worried that members of his family were plotting with an English colonization company to steal his farm, and with neighbours who were destroying the property, Harold committed numerous physical assaults on his wife, Sandra, and their children. His daughter Agatha testified that he: frequently abuses my mother by throwing her down, kicking her and otherwise mal-treating her, and frequently illuses the children. .  .  . On one occasion he went so far as to threaten to shoot the whole family. . . . because my deaf brother, Anthony, did not hear him he picked up the axe to slay him but was prevented by my oldest brother taking the axe from him. . . . he threatened to shoot my brother John. . . . he ran for my youngest brother, Samuel, (a boy about 11 years of age) with a pitch fork and if he had caught him, I believe, he would have thrust him through with it, but when he could not catch him, he threw stones at him putting the whole family in a terrible panic. . . . 68 Similar conduct was recorded by others, including Harold’s throwing an axe at one of his daughters, who was seriously wounded in the leg, throwing crockery at one of his sons, refusing to let his wife leave the farm or allow his children to get an education, and allowing the farm land and house to collapse into ruin. His children tried to help their mother with farm work even though Harold had forbidden building repairs, threshing of crops, or clipped sheep wool

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to be used, in spite of the fact that all of this was needed for the survival of the family.69 Harold had also piled up mounds of stones around the 74-acre farm from which he watched for his enemies. When a family friend told him to move if his neighbours were bothering him so much, Harold replied ‘What is the use, they are ever [sic] where and where ever I go they would be troubling me.’70 Perhaps what is most revealing in this episode is how male violence was part of everyday life and was stopped only after repeated assaults in which murder seemed imminent if nothing was done. Harold’s abuses had been going on for a long time before decisive action was finally taken. Two local doctors noted that they had visited the farm in December 1902 and January 1903 out of concern for the inhabitants, 10 months before his arrest, while his daughter stated her father’s physical abuse had been taking place for three or four years.71 Since Harold refused to do any work and the farm was almost in ruins, his arrest became not only a social necessity but also an economic one. Thus, as these cases document, the incarceration of physically abusive men was very much a community ‘event’ in which people from the immediate family, as well as from nearby households or farms, took action to protect others whom they felt were in danger if nothing was done to confine the disturbed offender. Verbal violence, or uttering threats, when combined with delusions also led to being placed in an asylum. Stephen E. was a married 44-year-old farmer with four children when he was sent to the asylum for the third time in 1894, where he would remain until discharge in 1907. He had threatened to injure acquaintances, while denouncing Queen Victoria as ‘the mother of the abomination of the earth’ and declaring himself King of Scotland and of the whole world.72 One man threatened violence against Governor-General Aberdeen, which led to his arrest in late 1897 and subsequent transferral to the asylum in early 1898. Frank I. was a 28-year-old single, unemployed man from a farm near London, Ontario. He recounted being harassed at school because of his last name (which was German) and having windows at his parents’ house broken by stone throwers. He came to Toronto several years before his arrest and survived by working at ‘odd jobs’ and begging. He believed himself to be descended from royalty and that Queen Victoria was about to ennoble him and other family members but was prevented from doing so by the GovernorGeneral.73 When Lord Aberdeen and his wife visited Toronto (which included a tour of the asylum), Frank was convinced the Queen’s representative was aware of his presence and should have ‘recognized his Royal status by an Invitation’ to one of the balls and dinners being

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held. Frank had even ‘walked up and down in front of Government House here in the hopes that [Aberdeen] might call him in’. When this did not happen he wrote Aberdeen a threatening letter.74 In correspondence with Dr Clark, the Governor-General wrote that his secretary read the ‘objectionable letter (which contained threats of violence)’, showed it to the Chief of Police, then to ‘myself, so that the matter of dealing with the young man was out of my hands from the first’. Noting a recent assassination in the British capital, Aberdeen went on to write that ‘it was probably just as well to take precautions.’75 Shortly after his arrest, Frank wrote the following lines to the man he had earlier threatened: .  .  .  I am exceedingly sorroy I have written you that cruel letter I humbly apoligse. . . . Will you forgive me my heart is breaking[.] you know how many have been cruel to me. . . . I am sorroye forgive me. . . .’ 76 This letter was sent to Ottawa by two friends of Frank, after which it was sent back by Aberdeen to Dr Clark. Aberdeen wrote that he thought that sending Frank to the asylum ‘would be the best thing that could happen’ and told the Superintendent to tell Frank that he did not bear him any resentment.77 Frank was described by Clark as a man who liked to play the piano, ‘the poor fellow . . . gentle by nature . . . says he is now more comfortable than he has been for several years.’78 He remained confined until his death in 1907. To threaten the most socially prestigious figure in the country brought about immediate incarceration for this young man, who obviously craved respectability and social status, neither of which he had, being on the margins of society. Perhaps what is most evident in the story of Frank I., when contrasted with the accounts of some of the other people mentioned here, is that when it came to actual violence directed at ordinary citizens, even when it was well known, as with the reign of terror by Harold T., the authorities took much longer to act than when a few lines were penned threatening a member of the ruling élite. Violent behaviour or threats were not sufficient on their own to warrant confinement since, after all, this sort of conduct could just as easily be viewed as criminal behaviour for the courts to decide. That these cases were ultimately left up to medical officials to certify as cases of insanity indicates the importance of extenuating circumstances in which the patient found him or herself, usually relating to the expression of delusional comments, indicating madness. When such comments were accompanied by the worrisome possibility of continued or potential violence, lay people acted in conjunction with

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medical figures to restrain the person in question. On the other hand, victims of violence could also be confined, as happened to women who were victims of domestic abuse who had been so traumatized by their experiences that they had an emotional breakdown. This last point raises the importance of social support networks in the committal process. The extent of one’s friendship or kinship contacts could dramatically influence the timing and location of confinement.

Social Support Networks People who were socially isolated could be at a severe disadvantage in terms of both when they were admitted and where they were initially sent from the community. Depending on one’s class and personal relations, or lack thereof, it was possible to speed up, delay, or change the place of confinement, as reference to the following people indicates. As was mentioned at the beginning of this chapter, patients could be admitted from jail by warrant or transferred from the community through regular medical channels. The ability to influence this process depended on access to a personal advocate and friends outside the asylum. For some family members, such as the husband of Millie O., the thought of sending their relation to prison to await confinement was unbearable. In 1900, Jason O. refused to let doctors send his 47-yearold wife to the county gaol even though ‘it is practically impossible for him to keep her at home.’79 His insistence led to Millie being spared the ordeal of jail—she was admitted as a regular patient six days later, where she would remain until her death in 1913. The reputation of the prison in such a case was enough to force such action, and indicates the vast difference in reception accorded to someone with a personal advocate, such as Millie had, in contrast to a much less fortunate person like Jim C., an elderly tailor who had been living in a charitable house before becoming violent after drinking too much. After certification, he languished forgotten behind bars for almost four years in the county prison as insane before he was finally transferred to the asylum in 1902, where he died five years later. This problem was recognized at the time by physicians, who lamented that patients from the most poverty-stricken backgrounds were often confined for years in jail, awaiting an asylum opening.80 The unhealthy state of this facility is indicated by that fact that when 74-year-old Jim C. was finally admitted from jail, it was noted that he had vermin in his hair.81 It is also important to note that even these most isolated of inmates could receive some outside support if the horrible conditions in which they existed attracted the attention of a concerned citizen, as occurred

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to two teenage females who had been locked up in the county jail since late 1902. Three months after the arrest of Evelyn F., a woman who regularly visited the jail and who is referred to in documents as Mrs Troman initiated contact with authorities about conditions in the prison. This prompted the following letter, forwarded to Dr Clark, from the Jail Governor to the city Sheriff: I beg leave to draw your attention to the crowded State of the Rooms in this Gaol Set apart for the accommodation of the Insane, there are at the present time 20 fully certified female lunatics confined here in two small rooms. I would especially draw your attention to the urgent need of the speedy removal to an asylum of two very young girls committed as lunatics. . . . Evelyn F__ aged 17 years . . . and Madge C__ aged 15 years. . . . [T]he two named are the most urgent.82 Within three days Evelyn was transferred to the asylum, where she died six years later. There is no indication of what happened to Madge. Expediting the transfer of a patient from jail to the asylum could also be based on class ‘shame’, as was expressed by Henry A., the husband of Mary A. Three days after his wife was sent to prison in early 1894 to await transfer to the asylum after exhibiting ‘such violent symptoms’ that he said it was no longer possible to keep her at home, Henry wrote a letter to Superintendent Clark making his distress clear: ‘She has been a well educated women + my children and myself feel keenly the fact of her being where she is when we would willingly pay for her.’83 Three weeks later Mary was transferred to the asylum, where she remained until her discharge 17 years later. Thus, some patients avoided going to jail only because of the action taken by a spouse, or else were transferred more quickly to the asylum than may have otherwise occurred because of outside intervention, while the ‘lowest’ class of people, neglected paupers without influential friends, had no such chance. They simply had to wait their turn. Elderly men and women were also sent to the asylum, though as Edgar-André Montigny has argued, their confinement in Ontario’s institutions had less to do with uncaring relatives than with an exhaustion of resources to care for them. Indeed, Montigny shows that the often stated claim by provincial authorities that the elderly were being ‘dumped’ in institutions was exaggerated, and had more to do with the inability of officials to realize the financial difficulties faced by low-income and middle-income families in caring for their relatives at home. This committal process was also related to the desire of politicians to cut back on social expenditures.84

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The care of the elderly in nineteenth-century Ontario remained stable during this period, though it is instructive to look at one such case where family supports broke down, leading to the confinement of an elderly woman. Gloria D. was a 69-year-old widow with two children. She believed herself to be very wealthy, talked to people who were not present, charged others with trying to swindle her, and threatened her daughter-in-law.85 Her son initiated the admission process, the circumstances of which aroused the ire of Medical Superintendent Daniel Clark in a letter to the Inspector of Asylums: the statement of Dr. Machell’s is not that she is excited and unmanageable but that she is quiet and harmless and has been left alone for days and days. This is another illustration of the attempt to make this a place for incurables to save the friends the trouble of looking after them. . . . It always seems to me a great pity that an elderly person should be sent to the asylum for insane to die, especially when such are quiet and manageable as this woman seems to be. This woman . . . never attempted to injure herself nor others. . . . [T]he only delusion she has is that she has an immense amount of money at her disposal. Even if we had room for a patient of this kind I would resist the admission of a person who seems to be only in the dotage of old age.86 In spite of Dr Clark’s opposition, Gloria was admitted to the asylum in 1899, where she remained until her death in 1907. The man who sent his mother to the asylum was a salesman who travelled frequently, which may explain why Gloria was ‘left alone for days and days’. While the precise motives for her confinement by her son are not spelled out, it may have been a way to see that his mother was consistently cared for while he was out of town, but this is impossible to know for sure. People were admitted to the asylum in some cases as a result of their poverty. When combined with no one to care for them, or their becoming unmanageable among destitute acquaintances, confinement appeared to be a necessary alternative. James D. was a 56-year-old, single Irish immigrant who had no property and no known relatives in Canada at the time of his admission from the York County Gaol in 1896. He was recorded as having been ‘a poor uneducated laboring man’. James was well known to the prison staff, for he had been a ‘regular frequenter’ of the jail for seven years on charges of theft and vagrancy and had twice before been admitted to 999 Queen Street West after his arrest. Over the years he gradually became argumentative and difficult to manage by shouting, singing, and jumping, while also showing a confused memory. His principal thoughts were centred

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on the prison bookkeeper: ‘He says that I am his God and follows me around wanting to embrace me.’87 Transferred to the asylum, James remained confined until his death in 1914. The widowed mother of Carl G. testified about the violence of her 28-year-old bachelor son upon his arrest in 1897. A brick maker from a working-class family, he was no longer at home and slept in a vacant house ‘without bedclothes or fire, going over to his house to get food’ during the week prior to his incarceration. Like James, Carl’s memory and observation were said to be impaired, as he did not know the occupation of the person who took him from the vacant house, ‘although he says the man had a blue suit and helmet.’88 He was transferred to the asylum and died there in 1925. Audrey B. was a 39-year-old mother of three children, whose husband had died four years before her arrest in 1905, after which she was transferred to the asylum. Though she had been left $2,000 at the time of her husband’s death, it was not known what had happened to this inheritance. Some time before her incarceration she abused and rejected her children, who had been turned out of the house, after which they were split up and sent to other residences. Previously committed two years earlier, Audrey was released ‘to run the streets ever since with no person to care for or treat her’. Unlike her previous demeanour, she began to drink moderately, would not work, and was reported to turn up at the dwellings of acquaintances and refuse to leave.89 Audrey said all of her problems were due to losing her job as a caretaker at the Masonic Hall. When she realized she was coming to the asylum Audrey ‘guessed this to be a place where they put things right, yet did not know what was wrong—nothing wrong with her.’90 She remained at 999 Queen Street West until her death in 1946. Carl and Audrey, through abusive conduct, had both isolated themselves from people with whom they had lived. Yet there was also a significant difference in their respective committals. After being released for the first time, Audrey was known to have lived on the streets for two years before being permanently institutionalized, whereas Carl had left home, or been made to leave home after becoming violent, only a week before his arrest. Since Audrey, unlike Carl, had a network of acquaintances from whom she tried to obtain support, it is possible this lifeline kept her away from immediate reincarceration, though ultimately this was not sustainable. Family and friends who initiated the committal processes could be in as desperate straits as the soon-to-be patient. The statement of Carl’s illiterate, widowed mother, Mabel G., is evidence enough of how, for some, locking up a relative could be the only way to remedy a traumatic situation: ‘I am a widow. I have four children now in

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Canada. These children keep me. I am unable to support or contribute to my son’s support in an asylum. I know of no one who will support him.’91 Thus, working-class and homeless patients and their families had few options to pursue when it came to looking for support during a domestic crisis. Carl’s incarceration was as much an act of desperation as anything else by his mother, while Audrey’s confinement was the response of neighbours who did not know what to do any more when she came knocking on their doors for shelter. As Gerald N. Grob has argued in regard to the United States, in an age when any sort of social support for unemployed working-class and homeless citizens was virtually unknown beyond charity, the asylum could be a source of refuge in an otherwise hostile world.92 Many of the people who became patients at the Toronto facility were from the United States, or had lived there and then come back to Canada. The close proximity of this part of Ontario to the border encouraged this crossborder migration, not only, among the lower and middle classes, to look for work, but also, at least among the wealthy, to look for medical treatment, as the following story of Jerold M. indicates. Patients who went in and out of asylums would have had to deal with the need for support during the readjustment process back in the community. However, if this support could not be maintained, especially when recurring bouts of emotional collapse made it difficult for family members to know what to do, social support could be redirected to having a relative returned to the asylum. This is what occurred to Jerold M., a 47-year-old married lawyer and father of four children when he was admitted to the Toronto Asylum in 1904.93 He had a breakdown at the age of 22 but recovered without being hospitalized and set up an ‘extensive law practice’ in Barrie when he was 25. After being injured falling off a horse and then losing an election campaign in 1894, Jerold had another breakdown, but again he recovered after a few months’ rest. However, more emotional distress occurred in 1899, and he spent several months in Homewood Sanatorium in 1900 and six months in McLean Hospital in Waverly, Massachusetts, in 1900–1.94 Papers from both the Toronto and Waverly institutions show how Jerold became even more withdrawn, worrying to the point of crying about his finances and future prospects, and then became excited and ‘self-laudatory’ just before committal in 1904.95 One of the two committing physicians from Barrie noted how Jerold’s insanity was ‘generally known and talked of’ in the community in which he had lived and worked for 20 years.96 His despair is indicated in his Waverly records, such as when he lamented, ‘I am off

50   REM EM BRANC E OF PATI ENTS PAST

the track and cannot get back. There is no ray of hope.’97 According to Jerold, his attempt to restart his law practice in Barrie after leaving McLean Hospital in 1901 was unsuccessful, because: ‘I carried the asylum thought with me always.’98 The prejudice he faced among his peers would only have intensified his emotional distress, for he undoubtedly had lost both business contacts and friends. Five years after admission to 999, a comment Jerold made provides further evidence about his experiences in between periods of confinement: He says that any person that get into an asylum is always looked down on by the outside world and never can do any business again he says it would be a blessing if the walls of this building would fall and kill all inside it.99 His wife, Isabel, whom the file clearly shows loved and cared for her husband, could no longer handle the emotional trauma of their married life. She noted that Jerold was on the verge of an ‘explosion’ and she feared for herself and others, as well as for her husband, if he was not confined. He had, she explained, changed drastically during the previous four years, particularly during the few weeks before being confined to the Toronto Hospital for the Insane. Referring to the angry opposition of Jerold’s brothers and sister-in-law to his incarceration, Isabel wrote: ‘anyone who knows what my husband was to me in the days of his sanity, will acquit me of any desire to deny him any thing, that by any chance I could think was for his good.’100 Thus, this formerly well-respected lawyer found himself fighting recurring bouts of emotional breakdown up to 1904, which led to increased social and professional isolation and in turn brought about the ruin of his law practice and nearly destroyed his marriage. Jerold would remain confined, in a private room in the asylum’s most comfortable ward for men, until his death in 1912. People less fortunate than Jerold, not only from a class position but also due to language barriers, were particularly vulnerable to social isolation, as they were unable to communicate their thoughts to physicians or to those around them without the aid of an interpreter, when one was available. Lee F. was a Chinese labourer who had arrived in Toronto from Vancouver only a few weeks before his arrest and subsequent transferral to the asylum in 1905. His age was not recorded, though it is obvious that he lived in poverty. Lee did receive some assistance from others who spoke his language, but he was eventually deported to China in 1907.101 In instances like this, the total lack of personal family supports, combined with the obvious

DI AGNOSI S AND A D MI S S I O N    5 1

l­anguage barrier, would have made a distraught person’s emotional confusion all that more difficult to bear. Lee would also have had to deal with the cruel impact of officially sanctioned state racism, which deliberately sought to prevent large numbers of Chinese immigrants from coming to or staying in Canada.102 Poverty, racism, and mental collapse were all intertwined. An example of the link between poverty, disability, and the lack of social supports leading to confinement can be found in the file of 44year-old Richard W., a blind man whose occupation was listed as brushmaker when he was arrested in 1899. Since he was also recorded as having been able to read and write, it is obvious that his disability had occurred sometime during adulthood, though no history of this is indicated.103 Various reasons are given for his confinement, including testimony from his sister that he exposed himself and would chase and sometimes assault women. It was also noted that he had deteriorated mentally since the death of his mother, who was described as ‘an inebriate’ and whom Richard had taken care of in her final days. He also talked to people who were not present, whom he accused of trying to beat him. This man was said to have been insane ‘from infancy’ and was ‘now serving a term for vagrancy at his own request [.] he has no home’.104 How much his disability affected his class position is not indicated, as the reference to Richard’s blindness is fleeting and is not emphasized to any extent. However, it is very likely that lack of sight would have prevented him from gaining employment other than as a brushmaker, a trade frequently taught to people with visual impairment during this period. Thus, his job prospects were extremely limited. A letter five years after his incarceration is the only other reference to this condition. Dr Clark mentions Richard’s failing eyesight: ‘He can scarcely distinguish any­­thing clearly now.’105 This evidence indicates that his visual impairment was gradual and was not total at the time of admission. Being a physical danger to women also indicates that this disability was in the developing stages upon confinement. Richard’s verbal and physical harassment of females could still have taken place with limited sight, such as when he became aware of the presence of women, even if he could not clearly see them. His request to be jailed as a vagrant is especially telling, clear evidence that being locked up was a source of shelter where food and clothing were available. Whether he felt this way about the asylum—where he remained until his death in 1913—will have to remain unknown. However, these records do indicate that for a man who was becoming increasingly disabled and impoverished, confinement was considered a valid option in a world

52   REM EM BRANC E OF PATI ENTS PAST

where blind working-class people had virtually no choices or assistance if they had no family or friends. Connections between disability, confinement, and the social welfare of new immigrants are also important. Such was the case with Vincent J., a single, 20-year-old labourer who said his relatives were well-to-do citizens back in Britain, with his late father having been a jeweller.106 Dazed and confused, he was arrested in 1904 as a vagrant and told one of the examining physicians that he had lost all of his clothes.107 In a lengthy deposition from the Toronto Jail, Vincent wrote about his predicament: I have lost my papers and money, also my trunk and overcoat so I don’t know what to do. I have come out to a strange country without no friends and am stranded, so help me God. I have an affliction in my speech so therefor[e] have been unable to get on in the world. . . . I believe I came out here on the 2nd of February from Liverpool, having come from London: arrived on the 14th of February. . . . I have done nothing wrong but having been sent away to a strange country I have been disheartened and the consequence is I’m stranded and lost everything. I hope God will be good and restore me to my sisters and brothers once more in England.108 He was eventually sent back to England in 1907. His speech impediment, along with a lack of resources, indicates a barrier that existed for a person unable to communicate in a verbal manner that the majority could understand, even when belonging to the same language group. Whether his being sent out to Canada had anything to do with his disability is not stated. However, it is clear that Vincent’s impoverishment and isolation could only have been made worse by not being able to talk with people, at least in a clear manner, which probably also led to his being laughed at and scorned by others. Fortunately for him, he was an eloquent writer and so was able to explain his situation. Together, these varied stories of people who experienced widely different levels of personal support, from genuine concern to complete isolation prior to confinement, illustrate the central role in the committal process of social support networks for people going through a period of emotional collapse.

Conclusion A diagnosis of insanity usually occurred after an individual was brought to the attention of medical authorities by family or unrelated

DI AGNOSI S AND A D MI S S I O N    5 3

acquaintances, and then usually after distraught behaviour was ­evident, from violent conduct or threats to emotional collapse or behaving in a manner viewed as socially unacceptable, such as promiscuous sexual activity. In many cases, observations also included comments that the subjects were delusional or expressing feelings indicating a severely depressed state of mind, all of which would have convinced contemporary observers that these people were in need of restraint or care, depending on the way they expressed themselves. Thus, confinement was partially related to an inability of lay people to know what else to do when someone they knew was experiencing a bout of madness, whether it was of an outward form that threatened those around them or of a more introverted type that saw a friend or acquaintance withdraw from others into a fog of emotional turmoil. This emotional turmoil was not some biologically induced state for most of the people considered here. Distress had to do with the depredations brought on by poverty, social isolation, loss of status and income, and abuse from people in positions of power. Sending someone to 999 Queen Street West could be a desperate attempt to try to remedy a difficult situation and find help for people who appeared to have lost the ability to cope with the world. However, social control was also a factor in confining people whose conduct was seen as too far outside of socially acceptable standards by figures in authority. Repressive attitudes related to sexuality, gender, and class exerted a decisive influence in the committal process of people who were on the margins of society. As will be seen in the chapters that follow, this class and gender division among the people who were committed to the asylum was as much a part of the world inside the Toronto Hospital for the Insane as it was on the outside.

3

Daily Routine and Daily Relationships Daily Routine The daily routine of the asylum was set down in the late 1870s, and over the next 60 years clinical records indicate that the basic schedule remained the same. Employees who resided in the building, as well as working patients, rose at the sound of the morning bell at 4:30 a.m. from May to August, at 5:00 a.m. during March, April, September, and October, and at 6:00 a.m. from November to February. Patients who were ill or otherwise incapacitated, either on their ward or in male and female infirmaries, were allowed to stay in bed. All ablebodied inmates, whether employed or not, were expected to be up by the time breakfast was served. This first meal of the day was at 6:30 a.m. in the summer, at 7:00 a.m. in the spring and fall, and at 7:30 a.m. during the winter. Dinner (or lunch as it is now called), the most substantial meal of the day, was served at noon year-round, and tea was at 6 p.m. all year long.1 As Table 3 shows, tea became supper by 1917. In comparison with other asylums during this period, such as the Pennsylvania Hospital for the Insane, there was nothing unusual about this daily regimen, though British Columbia’s Provincial Hospital for the Insane had a slightly shorter day than at Toronto, lasting from approximately 7:00 a.m. to 7:00 p.m. during the early twentieth century.2 Inmates who were employed did their work between these daily meals, though the hours of work were not uniform and depended on the task and time of year, as will be discussed in Chapter 5. As well, those patients fortunate enough to go to administrative-organized entertainments did so after tea (or supper), with everyone expected 54

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back in the ward or cottage by 9:00 p.m., when the building was locked and lights were turned out year-round.3 The administration of medication and, in the late nineteenth century, alcohol was given to able-bodied inmates on wards during the day as warranted, though it was most often provided during or right after meals, since administering medicine with food and drink was part of the routine. Ward staff performed this function and had specific instructions to provide exact quantities in a measured glass.4 Daily hygiene included the washing of hands and face of each patient every morning and during the day when necessary, either on their own or with the help of staff or other patients. All patients were to have a bath or, after its limited introduction in 1898, a shower at least twice a week, which was not untypical practice during the late nineteenth and early twentieth centuries, and male patients were supposed to have a shave twice a week as well.5 Male and female patients and nursing staff were strictly ­segregated on their own wards, although female staff began being introduced to male wards in 1912.6 Contact between the sexes could occur under supervised conditions, such as at social events, or among patients with access to the grounds. Since the day was structured around mealtimes, more details about this routine are important. Dining facilities after the late 1870s were in small dormitories attached to each ward, and each dining room had a separate table for suicidal patients who were not given knives or forks but were fed by attendants.7 Patients on the one male and one female refractory wards initially had to eat with their fingers or a spoon, but this changed after 1887 when dull knives and tin forks were introduced without incident.8 There was an average of eight people at meal tables in the Toronto mental hospital, which was lower than Hamilton with 10, or Kingston and London with 12 at a table.9 Complaints during the late nineteenth century from officials about the uncomfortably cold temperature of wards during the winter also included the dining rooms, which were not properly heated until 1903.10 The types of food eaten by patients are set out in tables 2 and 3 for 1878 and 1917. The contrast between public and private patients in 1878 indicates how much better food was on the latter wards. Inspector Langmuir noted in 1881 that some patients received small cuts of meat, while others on public wards received only fat. He also mentioned that water needed to be supplied on tables at mealtimes, though, by contrast, he reported that the superior wards had very good meal service.11 Officers also received more abundant meals than did free patients, though Table 2 indicates that in the late nineteenth century attendants’ food was closer to that of their least privileged charges. Leftover food

Patients’ Breakfast

Pay Wards

Free Wards

Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:

tea, coffee, toast, porridge, cold meat tea, coffee, bread, butter, salt herrings, porridge tea, coffee, bread, butter, beef-steak, porridge tea, coffee, bread, butter, ham, porridge tea, coffee, bread, butter, fresh fish, porridge tea, coffee, toast, porridge, cold meat tea, coffee, bread, b utter, beef-steak, porridge

tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge tea, coffee, bread, butter, porridge

Patients’ Dinner

Pay Wards

Free Wards

Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:

corned beef, cabbage, pickles, rice pudding, potatoes or beans roast beef, potatoes, beets or parsnips, apple pudding, pickles or sauce Irish stew, potatoes, sago pudding, pickles or sauce meat pie, potatoes, beets, jam pudding, pickles or sauce fish, meat, soup, potatoes, bread pudding, pickles or sauce roast meat, potatoes, cabbage, rice pudding, pickles or sauce roast meat, potatoes, beets or parsnips, plum pudding, pickles or sauce

corned beef, cabbage, boiled rice, beans boiled meat, soup, potatoes, boiled rice Irish stew, potatoes, boiled rice boiled meat, soup, potatoes, boiled rice meat pie, fish, potatoes, beets, boiled rice meat soup, potatoes, boiled rice boiled meat, soup, potatoes, boiled rice, plum pudding every third Sunday

56   REM EM BRANC E OF PATI ENTS PAST

Table 2 Patients’ and Attendants’ Diet Roll, Toronto Insane Asylum, 1878

Table 2  (continued) Patients’ Tea Pay Wards

Free Wards

Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:

tea, coffee, bread, butter, fruit or pies tea, coffee, bread, butter, cakes tea, coffee, bread, butter, fruit or pies tea, coffee, bread, butter, fruit or pies tea, coffee, bread, butter, cakes tea, coffee, bread, butter, fruit or pies tea, coffee, bread, butter, fruit or pies

tea, coffee, bread, butter tea, coffee, bread, butter, syrup tea, coffee, bread, butter tea, coffee, bread, butter tea, coffee, bread, butter, roast or stewed apples tea, coffee, bread, butter tea, coffee, bread, butter, fruit, cheese or pies

Attendants’ Meals

Breakfast

Monday: coffee, bread, butter, porridge Tuesday: coffee, bread, butter, porridge Wednesday: coffee, bread, butter, cold meat, porridge Thursday: coffee, bread, butter, porridge Friday: coffee, bread, butter, cold meat, porridge Saturday: coffee, bread, butter, porridge Sunday: coffee, bread, butter, porridge source: Annual

Report, 1878, 273–4.

Dinner

Tea

boiled meat, soup, potatoes, rice pudding, bread roast meat, potatoes, apple pudding, buns meat pie, potatoes, beets, bread

tea, bread, butter, syrup tea, bread, butter tea, bread, butter, cheese

roast meat, potatoes, boiled cabbage, boiled pudding, bread fish, meat, potatoes, sago pudding, bread

tea, bread, butter, apple pies tea, bread, butter, syrup

roast meat, potatoes and other vegetables, bread meat pie, potatoes, beets, bread

tea, bread, butter, fruit tea, bread, butter, pies

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58   REM EM BRANC E OF PATI ENTS PAST

from employees’ tables was returned to the kitchen and then re-served to patients on wards until at least 1892. However, since a good diet was seen as a crucial part of treatment Commissioner James Noxon suggested that henceforth all asylum populations, including workers and patients, should eat the same types of food for reasons of economy.12 The 1917 dietary guidelines in Table 3 indicate that both patients and staff had the same type of breakfast, though there was more variety of food available at staff suppers. By this time, the therapeutic purpose of a balanced diet was stressed to such an extent that Inspector Rogers had written in 1906 that food was second in importance only to medicine in treatment.13 The clinical records show that some patients had their own routine to suit their own culinary tastes, while still others found the food unpalatable. Willard C. was said to have been very fastidious about his personal health, was noted for his attention to hygiene, washed his dishes before eating, refused to let anyone else serve him, and was a strict vegetarian who would not touch eggs. It was reported that this 73-year-old man, during his thirty-fourth year of confinement in 1911, had ‘not eaten meat for twenty years and has never been sick; eats vegetables.’14 Within a year of this observation, Willard was discharged into the care of his sister, who took him home to die of tuberculosis. A fellow patient of Willard, Gene P., became ‘very sick’ and vomited after the ward supervisor reported Gene had consumed ‘too many tomatoes’. He recovered, but five months later died at the age of 47 of a gastric hemorrhage a day after becoming seriously ill ‘immediately after taking a little milk’.15 Ralph M., who lived as a free patient at the same time as both Willard and Gene, wrote a letter to his wife about the impact of food on patients: It has been proved lately that the food we get here is not fit for man at all, we have the proof here before us we cannot help but see it if we open our eyes. the people who are obliged to eat it sick of getting sick and they all say it is that miserable food. They all have to eat of it three times a day or get stuffed [.] it not plasent. It is not so easy many thanks when we know it is makeing our fellows sick and a lot of them die.16 Confined in 1898, Ralph M. died at the age of 70 in 1911 at 999 Queen Street of cystitis, inflammation of the urinary bladder.17 ­ Negative sentiment about food was not restricted to the free wards. Reginald F., one of the wealthiest patients in the asylum during his confinement from 1906 to 1914, complained to his wife, Alicia, that he ‘cannot eat’ what was given to him, even though he was on the most

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Table 3 Patients’ and Employees’ Diet, 1917 Breakfast, Employees and Patients



corn meal wheat flakes hominy farina rolled oats rice one egg for unemployed patients one egg for employed patients Dinner, Patients Only

barley rice hominy (for pudding) crackers green peas tapioca split peas corn starch fresh vegetable

roast beef roast mutton boiling beef corned beef salt fish roast pork salt pork fresh fish beef stew

mutton stew frankfurters hamburger roast sauerkraut farina beans beans (lima) potatoes canned vegetable

Supper, Patients Only

corn meal hominy rice crackers macaroni

beans cheese prunes dates figs

apricots peaches (dried) apples oysters or clams salt fish

One Meal, Workers Only, Patients



beef pickled meat canned salmon cold meat salty codfish

salt fish (various) corned beef (hash meat) beef stew (meat) fresh beef hash (meat) frankfurters

60   REM EM BRANC E OF PATI ENTS PAST

Table 3  (continued) Supper, Employees Only

gelatine macaroni beans cheese green peas split peas peaches prunes eggs bacon eggs bacon liver frankfurters

ham eggs corned beef hash (meat) fresh beef hash (meat) canned salmon roast beef roast mutton fresh fish (dressed, heads off) hamburger roast hamburger steak (meat) beef stew (meat)

mutton stew salt fish liver cold meat beef steak mutton chops pork chops ham potatoes (peeled) rice tapioca sago apples pork sausage

Bread and Beverages, Patients and Employees Only



coffee tea

sugar butter bread

note: Every item listed here was not served at every meal. Rather, this list represents various foods served over an extended period of time at different meals. The meal for patient workers included items not listed in the general list for patients, such as pickled meat, canned salmon, cold meat, and salty codfish, and cooked meats were more varied as well. This meal, along with the regular fare given to the general patient population (which would have included working patients), indicates that additional food was given to working patients that was not available to other inmates who did not or could not work. source: ao, rg 63, Subseries A-8, Inspector of Asylums, File: Standard Basic Dietary Ration for Use in Provincial Hospitals, 1917.

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privileged male ward.18 While some inmates clearly did not enjoy hospital food, others were able to supplement their daily fare. Receipts in patient files for ‘dainties’ indicate that patients could get treats from family and friends. A wealthy patient, Elaine K., was sent a roast chicken by a relative, though this was unusual, as more often food such as oranges, chocolates, and chestnuts was sent for patients who were fortunate enough to have outside support.19 Thus, there could be more to an inmate’s daily diet than is found in the official meal lists. These contrasting perspectives about patients’ experiences of daily life in the hospital provide the basis for the rest of this chapter. In approaching this topic from the direction of what went on in the daily lives of inmates at the Toronto Hospital for the Insane, the purpose is to show how troubled people coped with one another and with themselves in their efforts to find friends or deal with traumatic relationships among patients and staff.

Daily Relationships among Patients and Staff Just as it would be inaccurate to portray all inmates as contented with their lot, so, too, would it be a misrepresentation to claim that inmates and staff were constantly in conflict. Hospital employees were as diverse in their attitudes and practices as patients. Some ward staff and physicians, such as Dr F.S. Vrooman, whose clinical entries provide some of the most poignant portraits of patients to be found in records of the Toronto Hospital for the Insane, were compassionate and understanding towards asylum inmates. Other hospital employees were abusive and uncaring and made life miserable for patients who already had enough troubles to cope with. These divergent experiences and attitudes can be gleaned not only from records written by staff but from the comments left by both patients and their relatives that are cited throughout this book. There most certainly were patients and staff who formed close bonds, this being most likely among nurses, attendants, and their charges. Peter Nolan has recounted how an attendant at a British institution in the mid-twentieth century formed close friendships with inmates, and there is evidence from both sides that this also occurred in Toronto.20 This is especially important to note among those inmates who had no external source of support beyond the asylum. May F. had been confined for over 40 years when it was noted: ‘This patient has no relatives alive. Her only friends are the staff of this hospital.’21 Another inmate, who strongly resented her 17-year confinement, nevertheless had kind thoughts about those she left behind. After her discharge in 1911, Mary A.

62   REM EM BRANC E OF PATI ENTS PAST

wrote to Dr Clare: ‘I do miss you all so very much that I want to see you again [.] remember me kindly to every one that I knew.’22 Anna N. was confined in 1898 until her death in 1915. Several years before she died Anna wrote a letter to Dr C.K. Clarke, expressing her gratitude: I am thankful for the care I receieve from the Staff of Officers with the Nurses in Training. . . . The attention I receive is excedently good under God it is all right[.] I wish I could return some payment. But that is out of my power[.]23 Since most of the entries and official correspondence were written by physicians, there is not as much about relations between patients and nurses and attendants. Most references to relationships between ward employees and their charges are inferred rather than explicit. For example, Albert L. spent more than the last three decades of his life in the asylum. A few years before his death, it was observed that he ‘gets along well on the ward and is easily managed by those who understand him’,24 most likely referring to ward attendants. An implication of this passage was that those employees who knew him well and who were familiar with and accepting of Albert’s reclusive habits had a good relationship with this man. The constant presence of ward employees was much more significant in the daily routine of inmates than were the occasional visits by hospital doctors, as Ellen Dwyer and John S. Hughes have observed in regard to American asylums during the late nineteenth century, and as James Moran has shown for the Toronto facility in the 1875–1905 period.25 As will be seen, this constant presence could also lead to friction as well as to friendship. Minnie B. was 43 years old when she was sent to the infirmary in 1928. Her comments reveal how a patient viewed relationships between medical staff while in the infirmary and the varied perspectives one could have towards treatment. Minnie offered a number of sharp observations about labour relations from a patient’s vantage point: January 23, 1928—Drs. are no good only sit in an easy chair and draw a big salary + make the nurses do all the dirty work + get nothing. . . . January 31, 1928—I will get hold of my chart + destroy it. Dr. Morphy sits at the table at night + plans all devilment + makes the nurses do all the dirty work. I know he does.26 These remarks were recorded by a nurse who may have shared such sentiments about male doctors’ relations with women workers in the hospital. That these very critical words were even recorded

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s­ uggests a degree of sympathy on the part of the recorder who wrote into the record a positive view of her own role in contrast to that of her boss. However much the nurse and Minnie B. did or did not agree on labour relations, it is clear there was a divergence of views about one medical treatment in particular. For over a week Minnie was given hydrotherapy, also known as a ‘continuous bath’, in which patients were confined in a tub with regulated temperatures as a way of trying to calm their nerves. Immersed in these tubs for anywhere from four hours to six hours, Minnie’s comments indicate how therapeutic she felt this treatment was. An hour after being placed in the bath the first time she proclaimed, ‘This is great treatment.’ However, shortly after this she asked to be removed from the bath, and the following day, after more than two hours of hydrotherapy, Minnie ‘says she cannot bear it any longer’ and called for other patients to take her out of the tub.27 An hour and a half after making these comments, Minnie was removed from the bath after four hours. Though Minnie was also reported to have been quiet and even slept in the tub, her feelings of hostility to this treatment illustrate that this medical therapy was considered less than beneficial for a patient on the receiving end. Strained relations with the staff are revealed in another instance when staff interfered with socializing between the sexes. Ettie M. was confined from 1900 until she died at the age of 84 in 1918. Known for her sarcastic wit, it was recorded in 1912 that Ettie ‘has appropriated the privilege of mixing with the men patients on the grounds and when interfered with becomes very irate and stirs up a great deal of trouble.’28 Thus the gender segregation rules were not accepted by all patients who wanted to make friends with one another, as Ettie tried to do. Relationships between inmates of an insane asylum could run the whole spectrum of possibilities, just as in the outside world. Some of these relationships help to reveal the internal dynamics and volatility of social life within the asylum, and prove the emotional richness of patients’ lives. Audrey B. was confined for the last 41 years of her life at 999, until her death in 1946 at the age of 80. After nearly two decades of confinement, Audrey was described as ‘fairly well flattened’, which suggests a rather dull, uninvolved existence among her peers. However, it is also obvious that Audrey led an active life in which she showed a particular desire to be friends with specific inmates. It was noted that ‘her interest in other patients is quite marked, especially toward Ada T___.’ Several years later, Dr Winston noted that Audrey’s ‘interest is confined usually to just one patient. At the present time it is Mrs. L. H__ and she is constantly brin[g]ing her extra food and assisting her in many ways.’ While her aloofness from

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other patients was observed, it was also clear that Audrey reached out to those around her, as she was said to have been ‘kind to the other patients and will comb their hair for them and straighten their beds.’29 However, Audrey’s attention was not always so welcome, such as when she upset other women who were trying to sleep by repeatedly lifting up their bed sheets ‘to find out who they were’. During the last few years before she died, Audrey said many times that she saw her late husband wandering about the hospital grounds, at times coming up to a window and taunting her, prompting her to pull down the blinds. She also thought ‘that other patients are her husband’. Isolated and never visited by her three children, something she ‘cannot understand’, Audrey found an important source of support among those patients she reached out to during her years of incarceration.30 While she apparently had only a few friends, the intensity of at least two of these relationships suggests the importance that companionship had for an inmate who was regarded as emotionally ‘flat’. The death of an inmate could provide an opportunity for reflection, on the part of administrators, when informing their relatives. Such comments can help to give an insight into the status of relationships within the asylum that would otherwise remain lost to posterity. Annette F. spent the last 39 years of her life in the Queen Street Asylum. During this time her relatives maintained a regular correspondence with hospital authorities. When Annette died in 1918 at the age of 83, Medical Superintendent Forster wrote, ‘she had special friends among some of the other patients who looked after her very kindly and took a deep interest in her welfare. She was one of the old landmarks about our Hospital, which are gradually passing away. She has been missed greatly from the dances this year.’31 Thus patients looked out for one another, much as members of a supportive family do, especially when it came to assisting those who were increasingly vulnerable through the effects of old age and infirmity. The physical appearance of some inmates could affect their relationships with others in the institution, both inmates and staff. For example, Winslow H. was written up in the clinical record as ‘without doubt the silliest looking man on the ward. . . . He says he is six years old and as far as his mentality is concerned I believe he is about right.’ This insulting characterization was based on the fact that he was untidy in his dress, and in particular his tendency to exhibit ‘a very foolish grin’, which is mentioned several times. He was referred to as a ‘happy imbecile’, and it was recorded that ‘his diagnosis is readily available in his face at any time.’ On account of Winslow’s ‘manneristic performances’ he occasionally got into fights with other patients.

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In spite of the negative impression his appearance made on hospital doctors, this man was also said to enjoy the patients’ weekly dances.32 Thus, he apparently was able to make friends with some of the other inmates, who accepted Winslow as he was rather than stigmatizing him further because of his physical appearance; otherwise, these social events would not have been so eagerly anticipated. The physical appearance of another man so challenged gender conventions around ‘proper’ masculine attire that he became the object of harassment from both inmates and staff. Warren S. was a cross-dresser who ‘wears a womans switch on the back of his head, and wears womens skirts.’ Two separate entries note that he would complain about someone ‘nearly every day’ and said that attendants and other patients, including those he worked with in the laundry, ‘try to do him harm’. Perhaps because of the distressing taunting by other men who mocked his dress, Warren eventually changed from wearing women’s skirts, ‘although he still wears a truss outside of his clothing entirely for ornament.’33 This sort of taunting affected relations between inmates in other areas of social discourse. Jerold M., a wealthy lawyer whom we met in the previous chapter, made ‘fun’ of other patients. Shortly after his admission in 1904, it was noted that Jerold ‘keeps the whole ward in turmoil by teasing the other patients’, about which he was warned to stop lest he be assaulted. Five years later he was still up to mischief when he was observed to be ‘Poking fun at V__ at times about his delusions’, and was also noticed to be cross-examining this same man on his ‘telegraphy powers’, which Jerold found ‘wanting’.34 Some patients took Jerold’s comments very seriously. A wealthy stock­ broker took the advice of his rich fellow inmate as to when to escape. Reginald F. outran a walking party on the hospital grounds and made it all the way to Hamilton before being returned. Reginald’s wife Alicia wrote to Dr C.K. Clarke, ‘you can blame a man by the name of M__ for his going, as Mr. F. has often told me of his telling him to make a dash for liberty, + urging him to do so.’ This comment was corroborated by Dr Clarke, who wrote that Jerold M. ‘keeps influencing the other patients’ to elope.35 Both of these privileged middle-aged inmates would be dead within a few years: Jerold due to heart problems, Reginald, after his release, by committing suicide. Yet while they were incarcerated together, their relationship was hinted at and suggests how one inmate could plot with another to plan an escape. This mixture of taunting and prodding by a patient could be based on mental instability as well as insecurities about life in the asylum. Patients sometimes expressed anger based on the fear that their

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belongings were in danger of being stolen. The extent of theft is not clear, but the incidence of patients missing articles suggests that it was not unknown, especially in the large public wards where there was very little privacy.36 Such fears would have had an obvious impact on relationships. When this was combined with memories brought into the asylum from pre-admission experiences, or delusions, the mixture could be quite tumultuous within the institution. Avis S. spent the last 14 years of her life at 999, from the age of 71. During this period her relations with both patients and staff were repeatedly influenced by her thoughts, which were based, at least in part, on her past life as a worker on a farm, a widow, and a mother of seven children. Her temperance and religious background also came to the fore in her admonishments to those around her.37 Known for her ‘splendid’ sewing work, Avis liked to bring items from the sewing room back to her room. If anyone went into her room to retrieve these items she would get upset and tell them these were her things, and would accuse others of stealing her money and clothes as well as killing her cows.38 Fed up with the immorality that she felt was rampant on the ward, Avis claimed that the nurses had men around at night and denounced both staff and patients by stating that ‘if people in here would drink less brandy and pray more it would be much better.’39 An avid Bible reader, she became angry when anyone interrupted her study, frequently scolded others for drunkenness, and constantly mentioned horrific images of murder and violence. No one, inmate or staff, escaped the wrath of this ‘striking character’, as the following clinical entry, from when she was 82, makes clear: During the ward rounds she always wants to be noticed, shakes hands every morning and asks if your conscience is clear. She frequently tells me that I should be ashamed of myself for being the ring-leader of a certain murder that took place last night that there will be no place for me in Heaven. It is impossible to convince this patient of the fallacy of her sayings. Recently she accused me of murdering her daughter. She was very angry and did a great deal of swearing. The next morning her daughter called to see her, and she apologized to me every day for a week for accusing me of such a thing. She has peculiar ideas about wrong doing and many sexual ideas.40 The difficulty that both patients and staff would have had in forming a relationship with Avis can be imagined, for she was usually noted as making unpleasant remarks about those around her. These notations also suggest that she did not mean any harm, but, rather,

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was becoming senile and trying to ward off all the terrible thoughts that occurred to her by admonishing everyone. These distressing thoughts would have been most upsetting for her since she was unable to escape from them. Thus, relationships could become extremely difficult for an inmate who was unable to find peace of mind due to mental instability. Even as she lay dying at the age of 85, Avis S. claimed that her final illness was ‘due to the Black Art’, rather than having been brought on by a fall that injured her leg.41 Daily lives of inmates, as certainly was the case with Avis S., were very often taken up with the most tumultuous thoughts, which limited their relationships and, in some cases, ended any desire to continue living. Alex C., confined from 1897 until 1935, was tormented for much of his incarceration with the most cataclysmic ideas about persecution and plots. He offered a poetic rendering of his troubles in a letter not addressed to anyone, though it was likely intended for Superintendent Clarke, considering its content: Stop the Talking-Machine hurting my head by electricity during the night time. Stop, causing deafness in my ears or hearing, Stop, paining my eyes and weakening my eyesight. Stop, hurting and disturbing the waters in the physical body. Stop, making soreness and aching in the hips during the night time. Stop, causing toothaches. Stop, causing cramps in the feet and limbs. And stop all electrical violence to my physical system and mental sphere. These are some of the violences practised on me for many years, and I tabulate them for clearness of comprehension, in order that you shall command the talking-machine woman to stop hurting and injuring me by electricity.42 Another patient, Abbie G., spent her last 19 years in the mental hospital until she died in 1921 at the age of 43. Her severely disturbed state was repeatedly noted in her clinical file, particularly her frequent biting of her hands and arms ‘until they are a mass of sores’.43 She did this for years and covered herself with scars in what is now called self-inflicted violence, the intentional harming of oneself that is not suicidal. Totally withdrawn from other inmates, Alex and Abbie highlight the utter despair some patients experienced day in and day

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out. For such unhappy souls, the routine of daily existence could be lost in a shroud of mental misery that institutional life could do little or nothing to alleviate. For still others, emotional despair was turned to desperate resistance.

Resistance Cheryl Krasnick Warsh has noted how turnover in staff, and thus the lack of consistent supervision and familiarity with patients, could lead to situations that made it easier for a person to escape from the Homewood Sanitarium in Guelph in the late nineteenth and early twentieth centuries.44 This sort of unstable employee population also occurred at Toronto and enabled more inmates to exercise various forms of resistance.45 By the early 1900s it was estimated that an average of five patients ‘eloped’ every year.46 Staff members had a particular incentive to be careful not to let an inmate escape on their watch, for if it was found that someone was responsible, the employee could be forced to pay the cost to the asylum of retrieving a runaway patient. One of the best-documented cases of persistent escape attempts is that of Arlene S. Confined in 1903 at the age of 30, this woman was ‘kept under strict watch’ because she was ‘continually and always watching for means of escape’. The desperation of her efforts is revealed in Arlene’s frantic activities, which were regularly entered into her clinical record from 1909 to 1918. She would break windows, ‘praying and beseeching’ unseen friends to take her out, and would even make her way to the reception room of her locked ward ‘where the visitors are admitted and speak to them under the door to take an interest in her and try to help’. Arlene also would not wear any brightly coloured clothes for fear that should she escape ‘these clothes would look remarkable on the street and cause her arrest.’ Her plan of escape included tearing sheets and pillowcases to be refashioned into ropes to lower her from a window. She also took springs out of her mattress to pick the locks of ward doors. On one occasion, Arlene was caught picking the lock at three in the morning. Undeterred by this failure, she was found a month later with her bedclothes made into a rope to get outside.47 On at least three occasions she did temporarily succeed in her escape plans. The earliest evidence is from 1906, but it simply consists of a receipt for two dollars paid by the hospital to a person who lived nearby for ‘recapture of escaped patient’, with no further explanation.48 In the other two known instances there is more detail. Around nine o’clock one evening, Arlene secreted herself among a group of patients

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who went from her ward to the church building, then slipped away out the front staircase of the facility. Upon reaching Queen Street, she ‘put on a hat made of a handkerchief and a pair of nurses cuffs’ and boarded a streetcar going east. Her description and name were even placed in a newspaper, supposedly to ‘alert’ readers in the vicinity, which noted her conservative dress of a ‘light waste and blue skirt’, just as Arlene said would be the case so as not to draw unwanted attention. She was returned after a phone call from an informer, who wished to be anonymous (though this person was nevertheless identified). Authorities found Arlene a day after her ‘elopement’ at her aunt’s house. Undaunted, she tried to escape from a walking party on the asylum grounds just two days after being recaptured. A little over a year later, Arlene made her way out once more, this time under cover of doing work around the ward while the supervisor was eating breakfast. After opening a door with a key, she made her way east again. That evening she was found about four miles east of 999 by a former nurse, who turned her over to the police. However, Arlene was released by police for unexplained reasons. She set off yet again and this time eluded her asylum pursuers, who ‘followed her all day’ until she was recaptured by a policeman in a downtown railway yard.49 Several years later, Arlene was still noted to be ‘always’ trying to escape, and was described as one who ‘runs at every chance, can pick a lock with a piece of wire and open the door’. Arlene said she had no idea about where she would go if she escaped. In 1918, a year after making this comment, Arlene committed suicide at the age of 45. During this last period of her life, she was recorded as being less talkative about escaping. Rather than this reserve counting in her favour from the staff’s point of view, it was instead cause to be even more wary, as it was observed ‘for that reason [she] is very deceptive and requires a great deal of watching.’ Even though it was mentioned that Arlene was very industrious about writing for help, even using torn pillowcases and aprons for writing material, none of these documents survive. Nor is there any evidence that this single seamstress ever had any visitors, as her file contains no references to outside support, though her remains were removed to a funeral parlour with the permission of Arlene’s mother. The only direct remark attributed to her speaks volumes about the tormented thoughts of this resistant inmate. Arlene was recorded as having stated after years of being locked up that she was ‘pretty near out of her mind and ready for the asylum’.50 Reports indicate that escapes also occurred among those patients who were the most trusted. After five years’ confinement, Leonard G.

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was allowed out of his ward unsupervised to sweep the stairs of an outside corridor and ran off, never to be heard from again.51 Another inmate, Henry S., escaped from the barnyard in the northwest corner of the hospital grounds but was recaptured by the police in Barrie and returned several days later. Two years later, in 1910, Henry ran away while working with the ‘milking gang’ at the same farm. After the standard 30-day period had elapsed and no trace of him was found, Henry was written off as escaped. His clinical record noted, ‘It is doubtful whether he has enough intelligence to provide for his own wants.’52 Walter B. also made good on his trusted position by escaping from the horse stables where he worked. He was never apprehended.53 These escapes were made easier by outmoded security equipment. Joseph G. was able to leave unnoticed shortly before breakfast, thanks to a key he made to open and close the ward door. It was noted that ‘locks can be opened by almost any key.’54 Though he was arrested in Niagara Falls, New York, Joseph was let go and disappeared, presumably making his way into the United States. Patients who were not trusted and under closer watch nevertheless had opportunities to run away, such as when they bolted from a staff-escorted walking party out on the grounds. Nancy D., 32 years old, escaped in this manner in 1883, made her way to the nearby railway tracks, hopped a train, and ‘was carried to Guelph’.55 She was arrested there and returned to 999, where she remained until her death 50 years later. Her escape is notable in that she and Arlene were among the minority of women who were reported to have escaped, as most references are to men. The fact that males had far greater access to the grounds, as will be discussed in Chapters 4 and 5, indicates that women had fewer opportunities to run away since they found themselves locked inside much more than men. Also, the long heavy dresses that women wore would have made it more difficult for them to run through fields and scale fences or walls.56 The motive for escape appears obvious—these inmates wished to be free. In one case, however, where the pre-escape circumstances of a long-term inmate who was recaptured are noted, there is a suggestion that there could be other motives than simply a desire for freedom. Daniel K. had been an inmate for 45 years when he walked away from the hospital late one stormy night in February 1924. It was observed that he was never known to have done this before, and there was concern that he may be ‘lying helpless some where in the cold’. For years this man had worked faithfully with the ‘dairy maid Miss Denty’, carrying the milk cans back and forth between buildings after

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supper. However, it was thought that Daniel may have become upset when Miss Denty left a year earlier, plus his duties were altered and his living quarters were changed from a private basement room to a large ward. The day after he was reported missing, Daniel was found to have returned to his old home in Markham. He told hospital authorities ‘that he is entitled to a visit home’, where he once taught school, and ‘seemed to think we should not have returned him to the hospital.’ Several years later, Daniel was sent to an old person’s home in Newmarket, after nearly 50 years in the asylum.57 The observations contained in his file suggest that the emotional and physical disruption that occurred in the life of this quiet old man during the months preceding his escape may have prompted him to leave a world that was no longer as stable or ‘safe’ as it had once been. Thus, to run away from the asylum and return to the world of his youth could have been a way for Daniel to recapture some of the security that had disappeared when his trusted workmate departed and his familiar living and working patterns in the asylum had changed after so many years of reassuring routine. Superintendent Clark, many years earlier, had noted that some patients who escaped, sometimes to hundreds of miles from Toronto, returned on their own to live out their lives at the institution they decided was their home after decades of knowing no other environment.58 Most of the recorded acts of resistance were by individuals acting on their own. Of course, resistance took forms other than escapes. The most frequently documented examples were inmates talking back to staff or refusing to co-operate in ward routine. Yet, one should be careful not to read into all such examples a deliberate effort to subvert authority. Refusing to work, for example, could just as easily have been the action of a tired or lethargic individual. This option may have been chosen on the spur of the moment rather than deliberately strategized to upset the prevailing status quo. On the other hand, the comments or actions of some patients leave little room for doubt that flouting authority was intended. Elaine M., a married mother of three, spent the last quarter-century of her life in the asylum after her admission in 1903 at the age of 52. During her final years, this elderly woman would not tolerate intrusions into her privacy. When an asylum physician tried to interview her, she ‘would give no information . . . told me to put my nose in the corner and leave her alone. She also expressed the desire that I should go to hell.’ She continued in this manner by refusing to talk to medical personnel and ‘resisted all attention and treatment’ right to the end.59

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Arnold S., a patient from 1890 until his death at the age of 57 in 1910, in an undated photo. He was the ‘leading spirit of a mutiny against attendants on his ward’ (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

In one case, resistance was collectively organized to challenge the authorities by a patient whom the staff considered to be quite notorious. Arnold S., a bachelor farmer, spent the last 20 years of his life in the asylum until his death in 1910 at the age of 57. This man was moved about once every year to a new ward because he was considered a manipulator who physically assaulted other inmates.60 In spite of this reputation, or perhaps because of it, a hospital physician wrote: [Arnold] was the leading spirit of a mutiny, some years ago, against the attendants on his ward, and had it not been that one of the attendants, who was supposed to have left the ward had not done so, it probably would have resulted very seriously.61 Organizing such a revolt is an intriguing example of the extent to which some patients would go in resisting institutional pressure. Arnold’s conduct towards others in the asylum also highlights the abuse that occurred behind asylum walls, as is detailed in the next section.

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Abuse and Censorship of Patients’ Letters The extent to which inmates were physically and verbally abused by one another or by staff can only be recounted to a limited extent. Writings from former inmates during the nineteenth and early twentieth centuries in the United States and Europe reveal the widespread existence of abuse in mental institutions. The compilation of accounts by Dale Peterson, Jeffrey Geller, and Maxine Harris provide a clear record of how some inmates experienced terrible trauma while confined.62 In his critique of the social control view of nineteenth-century American asylums, Gerald N. Grob argues that the abusive nature of institutions has been overemphasized to the neglect of pointing out how such places acted as a refuge for indigent members of society.63 Yet this point cannot excuse or rationalize abuses that did happen in institutions that were, supposedly, places of refuge for troubled souls. If an asylum was a place where abuse should be underplayed, excused, or even dismissed by later researchers, then the whole notion of just how much a shelter these places really were for people with nowhere else to turn is called into question. Simply because there were few or no alternatives available for the most vulnerable members of society can hardly diminish the impact of abuse on those people who found themselves behind the walls of places like 999 Queen Street West. The accounts of some inmates make it clear that these were places of horror and cruelty, not of relief or shelter from the troubles they experienced outside the walls. Such accounts deserve to be taken seriously in their own right, not explained away as unrepresentative or isolated viewpoints. It is essential to point out that there can never be a quantitative assessment of the abuse hypothesis either way. No contemporaries systematically compiled statistics on the number of altercations or types of abuse between inmates and staff or between particular patients during the nineteenth and early twentieth centuries, though Ellen Dwyer was able to uncover some data on this topic from ward injury books for the Utica and Willard asylums in New York state during the 1880s.64 However, not all types of abuse, such as verbal and sexual misconduct, would have shown up on such registers. This lack of statistical data is hardly surprising, as formal hospital bureaucracies were in their immature stage at this time, with such a category as ‘Types and Frequency of Abuse’ not being established as an area in which to compile statistics.65 Furthermore, staff were less likely to record abuses considered to be a ‘normal’ part of their work or simply sought to protect one another from charges by covering up their abuse

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of those they were supposed to be helping. Some staff, as at the Kingston asylum, could close ranks and respond with silence when confronted with allegations of abuse, indicating that a form of ‘solidarity’ with fellow abusers was more important to some employees than taking care of patients, who were in a far more vulnerable position.66 With this culture of acceptance for abusiveness among ward staff, it is unlikely that someone would write in a clinical record, ‘I (or my friend) punched and kicked a patient today.’ Thus, the historical sources are inherently slanted to provide a favourable view of the staff, or at least one that gives far more credence to their side of the story than to that of the patients. It does not advance understanding of this topic to make blanket statements that patients were ‘violent, abusive’, and ‘disruptive’, as Ellen Dwyer and Gerald Grob do, to explain away staff brutality.67 The very same charges, after all, can be made about staff when considering the points of view left by some patients. The living conditions and lack of choices for patients need to be contextualized, rather than our focusing solely on the working conditions of staff. The important point here is to start off by placing the working conditions of staff into the context of the daily ward life experienced by patients. The difficult working conditions of employees—low pay, long hours, overcrowded wards—were in no way the responsibility of the patients, even though they were the ones who had to endure the worst conditions for the longest period of time each day. Patients did not get a break from the ward environment at the end of a work-shift, and those patients who did work outside the ward received no pay whatsoever for their labour, as is discussed in Chapter 5, a stark indication of the great inequities between ward staff and inmates. Inmates did not set the employees’ hours of work, nor did they set their wage rates, nor did they ask to be placed on overcrowded wards. Short of escape, patients could not remove themselves from an abusive situation they found themselves in on a ward without some form of outside support, such as a family member willing to take them back home, and that was only possible if they had a caring family to turn to in the first place. Prejudice towards people on the basis of class or ethnicity went both ways, as is mentioned elsewhere in this book, not only against staff, which Dwyer mentions, but also against patients. Patients also had to deal with prejudice towards them on the basis of their physical and mental disabilities. Whatever frustrations the staff had to deal with need to be contrasted with the frustration of patients, most of whom were kept on locked, overcrowded, and unsanitary wards, unable to avoid a staff member who harassed or abused them. Patients

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who were unable to communicate their needs to staff because of their mental disturbance, lack of verbal skills, or ‘incoherence’ to those around them would have been far more disadvantaged and frustrated in relations with staff, even to the point of being terrified, as they were truly alone in trying to make themselves understood. People who were physically disabled or incontinent would also have been extremely vulnerable to abusive treatment from impatient or tired staff upon whom they were dependent. Historians of the asylum experience would do well to avoid perpetuating scarcely concealed stereotypes of patients as an abusive population, as when Dwyer writes that ‘Not infrequently, delusional patients saw attendants as demons and attacked them.’68 Just how frequent was this? What are the sources for this claim, assuming that there must be more than one source? Staff were hired to take care of patients, and if they could not do this without physical assaults, why should excuses be made for them? Historians need to consider just why it is that when patients are recorded as abusive no excuses for them are offered, but when staff members are accused of abuse, researchers such as Dwyer and Grob go out of their way to qualify and rationalize their conduct. The right of an abusive staff member to hold his or her job should never have been more important than the right of a patient to be protected from abuse. Analysing ward violence from the presumption that it is the fault of a monolithic group of violence-prone psychiatric patients is both inaccurate and stereotypical, as if these episodes were only initiated by patients against hapless employees, who were merely responding to ‘disruptive’ inmates, and as if all people with mental disorders are potentially violent. Neither presumption is correct. Evidence from the Toronto Hospital for the Insane clearly shows the fallacy of this blame-the-patients approach to abuse in mental institutions. Patients were and are as diverse as any other population group—some patients, like some staff, were abusers, both of other inmates and of employees. However, no historical or contemporary evidence supports any broad brush stroke tarring all or even a majority of psychiatric patients as abusers. None of the historians cited above have provided any evidence to support the idea that psychiatric patients were or are, as a group, any more abusive than people who have no history of serious mental health problems. Recent studies that seek to counter the myth of the ‘violent mental patient’ need to be incorporated more fully into historical discussions of this topic, as the perpetuation of this myth, including, unfortunately, by some academic historians, has caused much harm and misunderstanding for people—past and present—who have mental health problems.69

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Doctors were the primary recorders of patient life through their entries in the clinical records. Yet, they were least likely to witness abuse happening, as their visits were brief and relied on information from the very people who, in some cases, were accused of abuse by patients or their families. All that researchers have to go on is the occasional report in clinical files, letters from family members, and, when especially fortunate, writings from the inmates themselves. Taken together these documents show that abuse did occur at the Queen Street facility, though it is also clear that reports of abuse were extremely contentious.70 Grob’s point about the way in which asylums acted as refuge for some people does not obscure the fact that abuses in mental institutions did occur and was devastating to those who suffered acts of cruelty. For them, the asylum was no shelter. In 1883 Katerina D., the sister of patient Nancy D., wrote a letter about the treatment this 32-year-old woman was reported to have received at the hands of staff. As the following excerpt shows, her information was conveyed by another patient who said she was trying to help: . . . during my last visit to the Asylum on Wednesday when in the ward with my Sister one of the patients, Miss D__, told me that she felt pained sometimes when the nurses were ‘punishing’ my Sister. I then said what do they do + she replied ‘pull her hair and thump her.’ Miss D__ must have remonstrated with them as she said that they told her it was to make my Sister ‘better’ + that they would do the same to her if she needed it. Dr Daniel Clark responded by declaring that the charges made by this patient had ‘no foundation’, as she was endeavouring to turn people against the staff.71 Nancy D. died in the Queen Street asylum 50 years later. This conflict between the point of view of a patient and that of hospital staff around the issue of abuse is also documented in another episode. Jim W. was a blind 66-year-old inmate at Toronto who claimed to be regularly humiliated by both patients and staff. The abuse he recounted highlights the vulnerability experienced by people with disabilities at the hands of able-bodied individuals. He said attendants ‘were always pulling his nose and throwing water on his head.’ In one incident, after he was told to get out of the way of the floor polisher, he stated that the attendants had ‘thrown him down on the floor’.72 With a bruise observed on his hip, it was obvious to both the doctor and Jim’s sister that he was in pain, and his sister made inquiries about the incident. The attendants denied all knowledge of

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the origin of Jim’s injury, views that were accepted without doubt by the physician. Instead, other patients were blamed for this injury. It is clear from his clinical record that this man was repeatedly harassed by other inmates, from whom he had to be separated at the dinner table. Yet it is also clear from his comments that, unlike staff, Jim had no doubt about who had caused this particular injury—hospital attendants and not other patients. Jim was discharged four years later into the care of his sister. These two episodes illustrate the difficulty of retrieving the patient point of view. On the one hand, there are two documented references about the physical abuse of inmates, while on the other hand staff comments refute these claims, at least insofar as the blame being placed on hospital employees. In both instances, it is important to note, the recorded observations were prompted by relatives, the inquiries being made by the sisters of Nancy and Jim. Other references from patients themselves to abusive conduct in the asylum suggest the everyday tension that existed in the lives of inmates and the insulting taunts they were forced to endure. Ralph M. was confined in the Queen Street facility at the age of 57 in 1898, where he remained until his death 13 years later. In an undated letter to ‘My Dear Wife’, Ralph wrote: I have been called a son of a bich I believe one hundred thousand times since I came to this place, If I had heard any one call my mother a bitch when I was young I would have knocked him down with a club and thought I was doing Gods service like Saul I would have been kicking against the pricks.73 A contemporary inmate of Ralph, Elsa P., wrote a letter about what she had witnessed on her ward. She was admitted in 1903 at the age of 50 and was discharged in 1915. This 12-page letter, which does not have the year recorded but is addressed ‘To The Superintendent’, is worth quoting at considerable length. It was written while Elsa was out on probation at her daughter’s residence on Centre Island in Toronto harbour. Sir for several years I have been tempted to write to the Superintendent. . . . I do firmly believe it is the right thing to do. . . . I certainly should never have done it while there because there are so many watching to get each other in some trouble that seems to be the nature of insanity. I have too much sympathy for my fellow sufferers to resent that. . . . Sir I am very sorry to say that could you know and see what I have in the Toronto Asylum you would at

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Ralph M. was a patient from 1898 until his death at the age of 70 in 1911. His outgoing letters, such as this letter from 9 December addressed to ‘My very Dear Wife’, were routinely confiscated by staff (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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least pity those poor unfortunates especially those who are without kith or kin. its a deep grief to me to do this and I dont wish to mention any names or cause any woman to lose her position but some of those women ought to blush to take the money they are supposed to work hard for. . . . if they only went about things differently it would be a blessing to us who are afflicted[.] I must mention a few things in confidence no one even knows that I am doing this altho many times I resolved the next time I came to my daughters I would do so—I have suffered at their hands and altho I forgive them I feel sure it will be measured back to them some day. . . . I want if possible to help those who are at their mercy[.] I dont know how some of them dare to put on the beautifull uniform also partake of your goodness and treat those poor creatures in the manner they do sometimes[.] I have watched until I could have thrashed some of the nurses myself. . . . is the milk sent up to the wards to be skimmed for the nurses benefit also the best of everything kept back in their cupboard for their extra meals[?] we were allowed perhaps ten minutes from the time we went in the dining room X until we returned [illegible] out called sometimes before our meal was half eaten, then the poor verandah patients pulled & knocked about like dogs, dogs sir[.] I would not treat a cur so, then the poor things scarsly ever got a kind look, I have been so crushed there no wonder at what I had either said or done, I say the nurses have a splendid time and the poor insane patients are at the mercy of a lot of inhuman giddy girls[.] I am very sorry indeed to speak like this[.] I shall say nothing of what I had to endure at their hands[.] God help us all but it seems so different when they are expecting the doctors or Matron that I feel sure you do not know and we are ordered about by the worst patients and they to[o] get privileges, are allowed to deceive and steal our food for the Nurses. I know it so because I made it my business to help in the dining room to see for myself—& the food that those who are sick and need it is given to the favourites. Yes, when my appetite was entirely gone they would give me things to eat but when I might have had a relish for something they would just be mean, I did not mind at all because when I am well I can eat dry bread for that matter[.] excuse me being so plain but I am just relieving my mind, this will do me good. I do not wish to be any detriment to a living soul, but I [illegible] believe in some way they are bribed to be kind to a few, God help the others. . . . my sympathy is with them all, and I do assure you sir I could write a volume of the treatment I myself have seen there, but at present this is sufficient—trusting

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you will forgive my intrusion and that you will in some measure be led to see these things, I remain Yours sincerely . . .74 There is no response to this letter in Elsa’s file. Her comments about patients abusing other patients adds a further dimension and suggests how some inmates had power over weaker patients. Physical abuse is frequently cited in records, and when this occurred an inmate who was being assaulted by another inmate would most likely have welcomed the intervention of staff members. Patient-on-patient verbal abuse is also sporadically mentioned in hospital files, with class, ethnic, racial, and religious prejudices directed at patients by other inmates. Bigotry came from all segments of the asylum population, including the most well educated and privileged people. In these instances there are seldom doubts raised about who was engaged in abusive conduct. Elsa’s letter provides an important insight into how employees could get around abuse accusations. Discounting the views of people who were considered ‘insane’ was another important factor that counted against asylum inmates who made complaints, and was understood by people like Elsa. This left them in an especially vulnerable situation among staff, who could take vengeance on them once the doctor was gone. Patients’ rights advocates were all but unknown outside of family and friends for those people fortunate enough to have them, and they, too, had obstacles to being taken seriously, including medical superintendents who supported the staff when accusations were made. Patients without ‘kith or kin’ were completely on there own, as Elsa’s letter makes plain. The contentious nature of abuse reports is also indicated in her comments about how ward nurses changed their behaviour when they expected doctors or the matron to appear. This highlights how abuse could be hidden or obscured from the official recorders, who were primarily hospital physicians. The maltreatment Elsa referred to happened out of sight of officials making their rounds, something this former patient implies was a deliberate tactic. Thus, one can infer that doctors found some reports of abuse unbelievable because they did not encounter such behaviour while visiting wards. Elsa’s letter was an attempt to say there is another side of the story, one that needs to be taken seriously and addressed. What comes through in Elsa’s letter is that physical and emotional cruelties were inflicted on patients by some staff members, aided by their ‘favourites’ among the inmate population, and this sort of conduct reverberated around the ward in an atmosphere of intimidation. Whether anything was ever done in response to Elsa’s plea for help is unknown.

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In 1917, two years after Elsa left the hospital, there was a formal investigation of allegations of the physical abuse of two male patients by two male attendants after complaints by the wife of one patient, Wesley W., who died of syphilis prior to the inquiry. The accused staff were exonerated during this hearing. The complainant, Hazel W., was blamed for being ‘vindictive’ and for giving credence to the charges of a patient ‘declared to be insane’ who was confined on the same ward as her husband.75 A patient’s complaints against the staff were pathologized in this case by the Inspector, rather than taken seriously with anything other than the most perfunctory of hearings. The hearing was devoid of any cross-examination of the accused, and was held at all only after it became public that one of the alleged victims was a soldier, a point that upset the local veterans’ association. Thus, this hearing, which satisfied the veterans’ representative, was more of a public relations exercise than a genuine effort to get to the heart of what had actually transpired. The problem of getting at just what was going on in each of these episodes needs always to take into account the colossal power imbalances between patients and staff, as Dick Sobsey has shown in his study on abusive conduct towards people who have been institutionalized.76 While there was agency within the asylum, as is reiterated throughout this book, it is essential to remember that this was not based ‘on a level playing field’, as Thomas Brown notes, for the vast majority of patients.77 This is most evident when considering reports of sexual abuse within institutions, a topic that has gained increased attention from researchers in recent years.78 Thomas Brown has uncovered a sexual assault that occurred at the Queen Street Facility in 1886 when a former male employee was charged with rape after he had sexual intercourse with a female patient. However, the victim was blamed when it was charged that she suffered from ‘erotomania’, thus leading to the acquittal of the defendant.79 The comments of two other female patients provide ­further glimpses of this topic. Agatha H. spent the last 44 years of her life in the asylum after being admitted in 1903 at the age of 31. During the 1930s, two clinical entries four years apart allude to her sexual fears, with one observation noting her refusal to sleep on a mattress. The other reference is more detailed and relates the significance of this practice: ‘She is unapproachable and runs away. She sleeps on the floor all night, because she has many sexual ideas and believes she is abused during the night.’80 While later generations do not know what happened to Agatha to make her so fearful, her expression of such thoughts points to the unseen, traumatic side of institutionalization in which some inmates could be vulnerable to sexual abuse. On the

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other hand, she may have experienced flashbacks of sexual assaults prior to confinement. By far the most voluminous comments uncovered about allegations of sexual abuse at 999 are from the writings of Elaine O. Confined in 1905 at the age of ‘about’ 35, this single domestic worker wrote almost three dozen letters and postcards to asylum officials after her release in 1910.81 In two letters written shortly after her release, Elaine’s anger at asylum authorities is evident: the idea of having men like Carson and others to play with a woman as they have with me and you laugh[.] I have a good memory of what it ment to me to be locked up in that Prison house of Satan for 5 years for nothing. . . . you had no Business to take me into that Prison or touch my head or Body to do dispite to me. . . . what you have done and allowed done to me. . . .82 You all aught to be ashamed of your selves such obscene practice. . . . I was no man’s wife nor was I running after men or keeping company with any man[.] to be Kept in that filthy Prison as tho I was a Polygamy or Bigamy conuBine the indecent assault a lot of men up there wrongly imployed the wicked ungodly Villains. I was not your servant the cheek of you or them. . . . You would not dare to do and be so free to any other Toronto woman.83 Medical Superintendent Clarke received another letter from Elaine O. around the same time: that Brutal crowd of men you call cooks. You needn’t think every one insane that gets into that cruel inhospital uncharitable Asylum get such a claw and paw on me. What right or licence have they. I cant see why you allow what you do. . . . I never did any-thing so insane or as bad in all my life as the Asylum attendants did any way. . . . She compared her treatment in local jails to what she had experienced in the hospital: the Asylums physicians attendants and employees have no more right or Authority to do what they have done to me and what I seen them do to patients than the Toronto Jail Guards Governors or physicians nor the Central Prison Officers do to their prisoners[.] they do not punish or allow them to do more than the magistrate or judge committs them for[.] Toronto Asylum goes beyond any thing I ever seen or heard tell of.84

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Elaine’s hostility towards men is made clear in an undated, unaddressed note: ‘I am no admirer of men and I am very particular what Kind of Girls I associate with go out with.’85 In these letters, Elaine referred to men who ‘play with women’ or ‘touch my head or body’, or who commit ‘indecent assault’ or ‘get such a claw and paw on me’. There is no response in Elaine’s file from hospital officials to her about any of her writings. In 1913 she contacted lawyers about initiating proceedings against the hospital, but there is no evidence that this went anywhere; her accusations were collapsed back into her diagnosis by the Medical Superintendent in his communication with the lawyers.86 What happened to Elaine O. after this date is not known. The issue of verification arises for an historian who comes across this material. Since no comments by a third-party observer in Elaine’s file allege any sexual misconduct, does this mean that these documents, and those alleging physical and verbal abuse cited earlier, should not be taken seriously? Clearly, these letters by patients deserve to be considered as legitimate perspectives on the asylum experience. The emotional turmoil Elaine experienced while writing these letters in no way lessens her credibility, as she was venting her anger at those who had abused her or who allowed this abuse to take place. Mary Elene Wood has written about how patients ‘who reported abuses to authorities after their release were seen as vengeful, bitter trouble-makers who probably had not fully recovered from their illnesses.’87 Carolyn Strange has shown that in Toronto during this period a working-class woman like Elaine O. had very little chance of being taken seriously by officials when it came to charges of sexual misconduct; indeed, men were seldom prosecuted, let alone convicted, of rape in Canada during this period.88 This context of the obstacles faced by disadvantaged groups, especially female patients, those with physical disabilities, and individuals who belonged to a racial, religious, or ethnic minority, needs to be kept in mind when considering this evidence. Nancy Tomes has written about the difficulty of determining the accuracy of a patient’s complaints due to lack of corroboration, but she also notes that a superintendent’s dismissiveness towards such complaints was not reliable because of his self-interest.89 This serves as a reminder that the superintendents at 999 Queen Street West had a similar position when they dismissed patient complaints. If patients’ perspectives were questioned in this regard, so, too, must questions be asked about the denials of administrators, especially since they were not present when some alleged incidents occurred. Furthermore, evidence cited above suggests that asylum physicians tended to give

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the staff the benefit of the doubt or even accepted a certain level of casual brutality meted out to resistant patients. Sixty-seven-year-old Elaine M. was known to fight with the nurses when they tried to comb her hair or give her a bath. Dr McClenahan wrote in her clinical record that ‘once or twice [she] has had a black eye as a result of this.’90 This notation from 1918 is recorded in a matter-of-fact style without any hint that staff members should not punch an elderly patient or anyone else they were supposed to be helping. Clearly, medical authorities knew about and accepted some obvious types of abuse by ward staff as part of daily life at 999. Class differences between medical officials and ward staff did not prevent a collusion of interests or views when covering up or ignoring abuse of the most disadvantaged occupants of the institution. This acceptance of abusiveness towards patients was ingrained to such an extent that daily degradations experienced by patients were part of routine operating procedure to staff at all levels of the asylum. There are references in clinical records to ‘bench patients’, a tag that indicates those who were forced to stay seated on a bench in a room on their ward where staff kept a constant eye on them.91 The purpose was to make the job of the staff easier. The mental distress experienced by a patient who had to remain in a fixed position during the day was written about by Angela B., a woman in her early forties when she was confined at Queen Street from 1904 to 1907. She was eventually deported to the United States, where her family planned to place her in an institution in Michigan. During the early part of her confinement in Toronto, Angela was noted to be constantly walking about and so was forced to sit or lie down, and was also force-fed when she refused to eat.92 An undated letter from Angela to her husband mentions what it was like for a patient to have to remain in one position, in this case to remain in a sitting position, for long periods: I beg + implore them to let me lie down. . . . For the love of God [Norman] come to see me or take me away. They have changed all the nurses here and they wont let me lie down. I am nearly dead from it all day so weak I can hardly stand. . . . [Norman] I suffer hell sitting up all day. My hands are crippled [Norman] and they put splints on and they hurt me horribly. . . . I want the splints off and to lie down and not to be locked up, only at night. May God help me . . . why I cant sit up straight even . . . after I have lain down for months to sit up now. [Norman] some of us here must lie down, some sit + some stand or walk all the while, we poor miserable wretches, + they should leave us alone.93

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An undated confiscated letter from Angela B. to her husband about forced sitting. Admitted in 1904 when she was 40, Angela was deported to an institution in her home state of Michigan in 1907 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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Why Angela had splints on is not clear, though it may have been due to rheumatism. The coercion involved in forcing a person to remain stationary was experienced as a form of abuse by Angela, even though administrative reports do not show any hint that they considered the treatment of bench patients to be anything other than part of an unremarkable ward routine. Official policies in place were supposed to protect patients from abuse, or at least abuse as was determined by the hospital authorities. At the Toronto institution, Daniel Clark made it clear during his long tenure (1875–1905) that any staff member found guilty of abusing an inmate would be immediately dismissed, a point also made by his successor, C.K. Clarke.94 However, as James Moran has written, ‘there appeared to be a fine line between clearly unacceptable, outright physical abuse (which, when discovered, resulted in dismissal) and a kind of “rough handling” of patients which was tolerated by Clark.’95 Reflecting the influence of ongoing debate among officials at Anglo-American institutions, Daniel Clark officially abolished physical restraints at Toronto in 1883. However, documents indicate that restraining patients continued well past this period. In 1903, 33-yearold Mary M. was recorded to have been put in a specially made moleskin waistcoat with arm cuffs that prevented her from grasping anything, so that she had to be spoonfed at meals. Dr Clark defended this treatment to the Inspector of Asylums after protests from Mary’s brother, Timothy, stating that she had been destructive to people and property. Up until 1916, when violent conduct by Mary was recorded she was frequently restrained by being isolated in a single room, though there are no further references to a strait-jacket. She died at 999 in 1934.96 During the 1917 investigation of abuse allegations, Superintendent Forster stated that it was ‘an ordinary thing’ for an employee to give ‘a little shove’ to a patient’s feet when literally tossing a restrained inmate into an isolation room; Forster claimed ‘it would not be rough.’97 The rhetoric and the reality in regard to abolishing physical restraints after 1883 were two different things. The form of restraint changed—there were no more crib beds or cages in which a patient would be locked, for example. But physical restraints carried on well past 1883 at 999 Queen Street West, whatever the official stance was. Evidence from the clinical records indicates that coercive treatment of inmates was not a thing of the past, but stayed very much alive well into the twentieth century. While protection of patients was officially proclaimed by superintendents at Queen Street, this ‘protection’ could be as thin as the paper it was written on. Examinations of abuse complaints were

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based on the interest and prejudices of those overseeing the administration of the institution and their willingness to pursue, or more likely, dismiss charges of abuse made against employees. How an abusive employee’s guilt was established is unclear. The burden of proof would have been difficult for an inmate to demonstrate, not only because patients were in a subordinate position within the institution, but also because it was an inmate’s word against that of a staff member, who could dismiss the charge as part of a complainant’s mental illness if the charge was not corroborated by another nonpatient. Fear of punishment, which Elsa P. noted in her letter to the Superintendent, was another factor in regard to making such charges, as Elaine O.’s and Elsa’s letters were only written after they had left the institution. Other factors also weighed against patients’ complaints. Peter McCandless has highlighted an administrative rationale for not wanting to dismiss an abusive employee, which was divulged by an official investigation into conditions at the South Carolina State Hospital in 1909: very few replacements were available.98 Toronto’s superintendents repeatedly complained about lack of staff, particularly during and just after World War I, and Dr Forster raised this point during the 1917 investigation.99 Internal efforts by ward staff to hide abuse from their superiors, about which Elsa P. wrote, are another significant factor, a point that has gained greater recognition in recent years in investigations into abuse at long-term care facilities.100 At both the Willard Insane Asylum during the late nineteenth century and at the Boston Psychopathic Hospital during the early decades of the twentieth century, physicians believed accusations that attendants had committed abusive acts against patients unless the accused could prove otherwise, though Elizabeth Lunbeck shows that this was very much due to class prejudices towards employees.101 Steven Noll has shown how male staff were warned about any consorting with female patients at the Florida Farm Colony in the early twentieth century.102 Warsh found that at the Homewood Retreat in Guelph an employee had to be caught in the act of ill-treatment by a doctor to face the consequences.103 Yet Warsh also notes that because of their distance from constant supervision by administrators, attendants had a great deal of independence from their superiors. This is especially important when considering the ratio of inmates to ward staff. In the late nineteenth century, there were 16 inmates for every attendant at Toronto,104 but this varied so much over time and on different wards that on one of the female back wards at Toronto in 1918 the ratio was 41:1.105 With such widely diverse population ratios,

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it is conceivable that some staff-initiated abuse would be difficult to spot by other employees who were on the ward at the same time, as they may have been busily occupied elsewhere with other patients. Depending on the time and place, doctors, if they wanted to pursue the matter at all, could have had fewer employees to ask to corroborate an inmate’s accusations when such incidents were reported.106 Evidence indicates that at 999 Queen Street West it was more convenient simply to dismiss abuse complaints, and that administrators did not take seriously the views of other patients who stated they witnessed the abuse of a patient by staff. Yet, the experiences of abuse recounted by people like Ralph M., Elsa P., and Elaine O. are serious views left by people who were ignored in their own lifetime. What they described were, for them, traumatic episodes that were significant in their lives regardless of how such incidents register on a graph or on the basis of a ‘competition’ between asylums about which place was considered more oppressive. These accounts of abuse help to reveal how relatives and patients at 999 Queen Street West faced much greater obstacles to being taken seriously when they complained of maltreatment of inmates by staff than when patients were reported to have been responsible for abuse. One further aspect of abuse—the censorship of patients’ letters by hospital authorities— needs to be considered. In this instance there is no difficulty in corroborating that such censorship took place. Almost all of the letters quoted in this book were intercepted by officials and placed in files, except for those specifically addressed to physicians. Letters to spouses, children, parents, siblings, friends, and others were routinely confiscated by superintendents during the late nineteenth and early twentieth centuries. While patients’ rights activists, such as Elizabeth Packard, actively fought against this intrusion on personal privacy in the United States, asylum doctors in North America were quite open about their rationale for this practice.107 In 1875, members of the Association of Medical Superintendents of American Institutions for the Insane passed a resolution stating that ‘valuable information’ about the thoughts of inmates can be obtained from patients’ letters, and that letters from women patients in particular needed to be confiscated ‘for their own good’, to prevent them from getting upset about their contents upon recovery. This resolution stated that it would be ‘an outrage on common decency and common humanity’ if they were to be legally forced to send the letters of asylum inmates.108 A few years later, Daniel Clark stated that no patients’ letters were to be mailed by attendants.109 In 1902, when referring to patient Enid W.’s letter that ‘escaped’ the asylum, Clark wrote to a correspondent: ‘I do

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not know how the letter got away as all patient’s [sic] letters are supposed to pass through my hands. The patients, however, are very ­cunning and sometimes overreach us in that matter.’110 Patients knew what was happening and objected. Alex C. complained in two different letters about the censorship of his letters to friends who never received them because they were confiscated.111 Elsa W., confined for 17 years until her discharge in 1915, complained to Provincial Secretary Hanna in 1909 about this practice: ‘[S]urely a wife can write her honest thoughts to her own husband + sons without being censured by those who regarded it their duty to criticize my letters.’112 As will be seen in Chapter 4, one patient responded quite strongly to this intrusion. This policy was also known to family members, and at least one relative, Alicia F., specifically asked that upsetting letters written by her husband, Reginald F., be confiscated.113 Hospital authorities complied with this request, though Reginald was still able to get some letters out. Anna C., the wife of another inmate, Wendell C., had quite a different response to her husband’s letter, as she wrote to Dr Clark, ‘thank you very much for letting it be mailed to us.’114 May K., the ­sister of inmate Anne D., expressed her anger at this policy in a 1913 letter to Superintendent Forster: Will you kindly let me know why my Sister Mrs J.W. D__’s letters to her brother and myself are always destroyed and not mailed to us. . . . I have no other means of hearing of her except through her letters. My brother addressed and stamped envelopes and gave [them] to her and told her to write him. . . . he did not hear from her and went to the asylum to see her[.] she told him she had written three letters and had also written me [and] that the letters had to be given to her nurse unsealed and had been destroyed[.] I was not aware that a hospital was a prison and its inmates had to be cut off entirely from all help and friends. Though May had asked for a reply allowing Anne to send letters unimpeded, there is no response to this request on file. Instead, Superintendent Forster wrote to her brother Paul, who lived in Toronto, that he did not understand why Anne’s letters went missing.115 While Forster appeared surprised, he actively censored inmate mail, as had his predecessors. This practice was openly acknowledged by his colleague, assistant physician John Webster of the nearby Hamilton mental hospital. In 1916, Webster wrote about a long-term male patient who wrote hundreds of remarkable documents of a legal nature, ‘carefully written with a special ink made by

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One of many outgoing letters by Alex C. from 1908 that were confiscated by staff. He wrote about the censorship of his mail to this correspondent, who never received this letter (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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himself. . . . beautifully bound and enclosed in an envelope of his own manufacture.’116 One of these documents composed by ‘T.L.’ was published in the Bulletin of the Ontario Hospitals for the Insane. This man was diagnosed as having ‘Litigious or Querulous Paranoia’. What is perhaps most striking about the letters found in case files is their lack of compliance, quite in contrast to many of the letters sent to Superintendent Kirkbride of the Pennsylvania Hospital for the Insane in the mid-nineteenth century.117 While gratitude and deference were expressed by some inmates, the critical perspectives of many other patients suggest why so many letters were confiscated. Ironically, this may be one of the reasons why more positive patient perspectives are not preserved—officials may have allowed them to be mailed and thus they were not placed in case files as often. While this type of abuse was not as immediately devastating as physical, verbal, and sexual misconduct, the fact that inmates’ mail was so openly censored indicates that mental patients were subjected to other personal violations in their daily existence at 999 Queen Street West.

Affection and Family Relations within the Hospital While relationships among patients were strained and abusive at times, it is also important to note that there was genuine physical affection in relationships among some inmates. Rhonda D., 46, was observed to be ‘very kind to other patients, kissing and caressing them’.118 Whether such relationships ever developed into homosexual affairs is not recorded in the documents examined for this book. Sexual relationships of any kind among patients, whether consensual or coercive, are seldom referred to in Queen Street patient files during this period. One of the few comments from a patient about this topic was from 36-year-old Jack P. In a letter to his wife he alludes to what appears to be the rebuffing of the sexual advances of another inmate: ‘Another little incident occurred the previous evening and I regret very much I struck one of my poor fellow patients. He, poor soul, was quite inoffensive, only I was not in the state of mind to allow myself to be the plaything of a fellow patient.’119 Even though he hit his ward-mate, Jack expressed a certain degree of affection for this person, suggesting the man’s advance was not aggressive, quite unlike Jack’s response. Heterosexual relationships between inmates would have been possible among those patients who had the freedom to leave locked wards and roam the grounds, and at isolated places of work, such as the farm, well removed from the main buildings. Indeed, James Moran has uncovered one such episode that occurred in 1881, when

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an asylum fireman witnessed two inmates engaged ‘in an improper manner together’ at the blacksmith shop: ‘Clifford admitted to [Medical Superintendent] Clark “that he stood and watched them for a time and made no effort to separate them until it was evident that sexual connection would take place, and then he separated them.” ’ What happened to these two inmates is not known, but fireman Clifford was fired for not promptly informing authorities about this incident.120 Several things can be inferred from this reference. One is the omission of the gender of the two people having sex. The mention of ‘sexual connection’ likely refers to heterosexual intercourse. It is impossible to know whether this was consensual or coercive sex. However, since a hospital employee lost his job for failing to report the episode right away, it is clear that staff were required to report sexual activity between inmates. This, in turn, indicates the lack of privacy that existed for patients who wanted to engage in heterosexual or homosexual activity. Pregnancy of female patients who had been confined for longer than nine months indicates sexual contact within the institution and was reported elsewhere, as Wendy Mitchinson has noted for the Gladesville Asylum in Australia.121 At Toronto there was a report in 1918 of a patient, Alice M., who was ‘assisting in preparing for the arrival of an infant’ to be born by another female inmate.122 While it is not clear whether this unnamed fellow patient had become pregnant inside or outside the hospital, Alice’s work helping her friend shows how affection between inmates did lead to practical day-today support. Attraction to others in the asylum, when reported in an inmate’s file, is nearly always asexual, with only enough information for the researcher to gain a general, usually quite vague impression about the intensity of such relationships. Fifty-year-old Mildred O. was considered by hospital officials to be ‘perfectly oriented regarding both time and place’ and so was likely trusted enough to wander about on her own.123 C.K. Clarke also reported a year earlier, in 1907, that she had ‘a little habit of falling in love with nearly every man she meets’, after three (of five) years at 999. This outpouring of affection may have been in response to her marital problems. In the one surviving letter of Mildred’s, written the same month as Clarke’s observation, she wrote to an acquaintance, ‘My Husband doesn’t want me, that is very evident.’ This view is corroborated by a family doctor, who wrote to Clarke about the husband deserting Mildred.124 Thus, this abandoned wife may have hoped to find a new mate among the male asylum population to replace her negligent husband, though there is no evidence

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that Mildred O. ever succeeded in this quest. Another inmate, 51year-old Evelyn T., had a decidedly maternalistic relationship with other inmates, all of whom she claimed were her children. However, five years later, she claimed that her offspring had all been ‘abolished’ since the death of her husband. This changed attitude may explain why Evelyn no longer talked with other inmates at this time, whereas previously she was noted to be very talkative.125 What is perhaps most striking in the comments about patient relationships is the dearth of references to male expressions of affection towards one another or towards females. If anything, the vast majority of relationships noted in men’s case files depict men in physical and verbal conflicts with one another. While this friction is certainly recorded for women inmates, too, a much broader range of kindness and nurturing is observed among females. Whether this is due simply to fewer observations of bonding between men, or to a masculine desire to avoid such outward expressions of friendship, or to the biases of the observers will have to remain unknown. One of the few references about a male patient taking care of other male inmates was in the context of work duties rather than social relationships. Gregory F. was reported to be friendly and enjoyed his job helping out in the male infirmary, where he assisted the attendants in taking care of bedridden patients.126 That Gregory was known to like this work, rather than his simply doing it unenthusiastically as part of daily routine, indicates that a male inmate was also capable of being active in nurturing activities, even though this was seldom recorded in case files. Relations between family members confined in the asylum at the same time provide a unique opportunity to glimpse the transferral of care from home to institution among close relatives. These relationships can also illustrate the broader themes of daily interaction among inmates and staff. Beginning in 1906, a mother and daughter were confined at 999 Queen Street West until their transferral to Cobourg in 1914. Sometime during the next three years, both mother and daughter were transferred to the new mental hospital in Whitby. It was from this institution that they were returned to Toronto in 1917 upon the request of family members in the United States, following the wishes of the mother.127 During this initial period at the Queen Street institution, Ellen S. and Sandra S. were on separate wards. Described as ‘thin . . . very filthy and neglected’ upon their admission in 1906, the mutual dependency of Ellen and her unmarried daughter Sandra is indicated in a number of letters from inside and outside the asylum.128 The support each provided the other is suggested in correspondence between hospital officials and Margaret B., a married

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daughter and sister of these two inmates. Sandra had been confined first in 1904, but was reluctantly released on six months’ probation in August 1905 after her mother ‘torments me to allow her daughter to go away with her’, in the words of Dr Daniel Clark.129 In February 1906, shortly after Sandra was readmitted, Margaret B. wrote to Assistant Superintendent Ross that the mental condition of her mother ‘is almost as bad as that of my sister’, so confinement at the Queen Street facility was viewed as urgent. Margaret continued, ‘I am sure she would be perfectly happy there, so long as she knows she is under the same roof with her daughter, and I think you would have no difficulty in getting her there, as she would willingly accompany Miss S__.’ They were housed in separate rooms, with the younger woman on the $4.00 a week ward while her mother was on the $3.00 ward, as was instructed by Margaret B.130 How this separation affected them is not known, but it is evident that the mother continued to be supportive of her daughter. A letter from Assistant Superintendent Ross to Margaret B. made reference to an inmate outing to the Canadian National Exhibition over six months later. He observed that, though provision had been made for her to go, Ellen S. refused to visit the cne because her daughter was not allowed to go with her.131 This relationship was so strong that Ellen said she would accept her married daughter’s offer in 1907 to come and live with her on Long Island only on the condition that Margaret’s sister Sandra would be allowed to join them. As a result of this condition, Margaret wrote that she was ‘compelled to relinquish the idea as being altogether unwise’.132 The closeness of this incarcerated mother and daughter was such that Ellen ‘fully believes’ the statements of her daughter that a group of conspirators were out to kill Sandra, though it is evident from the writings of Margaret B. that she did not share these views of her mother and sister.133 Some of the surviving letters by Sandra and Ellen provide valuable insights into institutional life and relationships that extend beyond parent and child. A year before the admission of her mother, Sandra wrote Ellen a detailed letter in which she confided her views about dealings with others in the hospital. This letter provides a rare glimpse of the daily social life in the Toronto Hospital for the Insane from an inmate’s perspective. The two of them exchanged letters on a regular basis, as Sandra acknowledged ‘your very welcome letter’ when writing to her mother, and there are other references to mutual correspondence in the period prior to their joint confinement.134 In one long letter to ‘My Dear Mother’, Sandra wrote about how she sang in the church choir earlier that Sunday with ‘Mrs. H__ “the musical

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attendant” ’, who was an employee of the asylum. When this woman insisted that Sandra was to come up to her room that same afternoon, Sandra wrote to her mother what she felt about this idea, and what she did about it: I had such a terrible repugnance come over me that I could not say I would so she said she would call for me anyway so I said if some of the other patients went up perhaps I would. But I had made up my mind that I would tell Dr. Ross to tell her I could’ent go. So I saw Dr. Ross this morning after church and I told him to tell Mrs. H__ I had a letter to write this afternoon and that I must post it in the morning and I could not go up to her room at 3 O’clock. Dr Ross said he would tell her. . . . I can get rid of Mrs. H__ without any trouble. Though she feared certain people were plotting to harm her, Sandra was equally sure that she had good friends among the other inmates, of whom she wrote, ‘They are so fond of me that they would not let the wind blow on me if they could help it.’ She went on to note that the nurses were trying to prevent her from speaking with Assistant Superintendent Ross, but she claimed other patients supported her efforts to get through to him: I . . . speak to him as much as I like and I was very glad to talk to him about my cold and some of the patients came up and talked to him too + one of the ladies thinks so much of me that she has talked to him too + coaxed him very hard to give me some medicine + look after my cold for I had such a bad cough much to Dr. Ross’s amusement + he was also very much pleased to have her take so much interest in me as she would not bother herself to do it for anyone else but me. I have been so successful in frustrating the nurses that they have had to stop all their efforts, much to the delight of the patients as they all think Dr. Ross should take notice of me + take care of me when I am sick. Sandra claimed she was not vindictive towards those nurses whom she said were against her: ‘I do not feel mad and I never allow any one to know what I think or feel about anything if I had I would not be alive today.’ Furthermore, to spend energy on getting angry at the nurses, Sandra wrote to her mother, ‘would take my mind off the more important business of taking care of my life and yours’. Continuing on with a recounting of tensions with the nurses and friendship with inmates, Sandra wrote about another incident involving Dr Ross, of whom she was obviously quite enamoured:

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Wed Mar 15th Miss Strachan took her proper place as head nurse + Miss Weir kept after her + they both kept after the Dr. Ross + both kept the poor man so busy that he could’ent get a chance to speak to me. . . . he held up his hand as a hint and so in spite of the nurses he took me by the arm + took me off to the Transit + said ‘course we will go together to this transit + I will look at your throat.’ So we went off together to the transit and one of the patients was there + she was awfully pleased to see him look at my throat. . . . So the nurse[s] were frustrated a second time + did not like it much. The patients have been trotting after the Dr. Ross too ever since + they are getting hold of him by the arm + helping me right loyally so the nurses are getting quite sick of their job + Dr. Ross is encouraging his admirers so that I can say good morning to him all I like + he can take as much notice of me as he pleases. . . . I cannot lose Dr. Ross for if I do I will lose all my protection here. . . . xxxxxxxxx Kisses for my dear Mother + please write soon.135 These observations by Sandra illustrate how competing with nurses for the attention of a doctor could lead to friction between inmates and staff. Regardless of whether or not the nurses were conspiring in the manner that Sandra claimed, her charges that they were doing so would have been enough to increase tensions between this inmate and female staff. Interestingly, rather than worrying about competition from other women inmates for the attention of the assistant superintendent, Sandra seems delighted with their help, which suggests the close bonds that could develop between similarly situated patients. Since the nurses were the only women who had clearly defined authority over her on the ward, Sandra saw them as competitors, unlike other patients, with whom she was on equal terms. It is also interesting to observe that her affection for Dr Ross went so far as to see him as her protector; in this sense, Sandra viewed institutional life as preferable to the world outside. As Diana Gittins observed about women patients at Severalls Hospital in Britain, some women saw female-only wards as an escape from male violence and also as a place to develop relationships with other women.136 For Sandra, this feeling of protection from the world outside was extended to one of the few men who was allowed on the ward because of his professional duties. Superintendent Daniel Clark wrote that Sandra believed she was ‘about to be married to Dr Ross. . . . and that she is safe here’, but that she would be harmed by plotters on the outside if released.137 It is also

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significant to note that of all the people she alluded to in this letter, Dr Ross was the only non-patient towards whom she had positive feelings. There is no doubt that her hoped-for marriage with Ross did not occur and that her feelings for him were not reciprocated. Dr Ross wrote to Ellen nine months prior to her own confinement that her daughter’s ideas about himself and the nurses were ‘a lot of foolish delusions’.138 Yet Sandra’s feelings for this man, even though unrequited, show how an inmate could develop a strong emotional attachment to an authority figure in the asylum as a way of giving her hope that someone powerful was looking out for her interests. Of course, what comes through clearly is how much Sandra trusted and loved her mother. A letter from 1912, from Ellen to Chief Inspector Archibald of the Toronto police, provides a hint of how mother and daughter continued to look out for one another, from inside the same ward, six years after the elder woman’s admission. In this letter she told of how a certain man, from outside 999 Queen Street, ‘and his agents’ were using the nurses’ housecleaning duties to harass her and her daughter Sandra: Please kindly tell [Medical Superintendent] Doctor Forster to order Miss Hodgson head nurse in Ward 5 not to have my Bureau drawers meddled with and please tell Doctor Forster to order her not to have my daughter’s Bureau drawers meddled with. I wish to tell you that my daughter has thoroughly washed our Bureau drawers and washed the frames of the Bureaus both outside and inside most thoroughly and everything is tidy in the drawers.139 While nothing came of this complaint, which evidently was never mailed, Ellen’s letter illustrates how Sandra took care of her mother by doing such household chores as cleaning the furniture. Ellen would also have seen herself as protecting her daughter, as well as herself, against the outside forces she believed were invading their privacy. Other letters contain similar concerns from Ellen about outside interferences, including a maternal effort to stop her daughter’s name from being used on a ‘mock marriage agreement’ that was to be so bizarre in nature as to convince ‘old Dr. Forster’ that Sandra was insane.140 This particular letter, in Ellen’s handwriting, indicates the close relationship between mother and daughter, as it was signed by both women. There is no evidence in the Queen Street files of their lives at the Cobourg and Whitby hospitals between 1914 and 1917. Unfortunately, the file for Ellen is missing from the period after mother and daughter returned to the Toronto Hospital for the Insane in February

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1917, though Sandra’s file for this later period still exists. One letter from this period reveals their continuing mutual support. Written by Ellen and signed by both mother and daughter in July 1917, this letter to ‘Deputy Chief Archibald’ was never mailed. In it, Ellen and ­Sandra write: We request you to kindly prevent W.P. (Cohoe?) and F.W.F. McLean and their Agents from trying to make false statements concerning us to the Doctors here. Please prevent them from trying to interfere with any of the Doctors regarding our Privileges in the Asylum. At the present time we would like to go out for several hours some Afternoon and enjoy an outing to the Island and back. We want to go out some times to do our shopping the same as usual. Please kindly attend to our requests for us with our friend the Superintendent Dr. Forster.141 The fact that they enjoyed certain privileges they were anxious to preserve did not exempt them from having their mail censored, as the existence of this letter in Sandra’s file attests. Supported by family members in the United States who sent money orders and living on one of the better paying wards, the two women had ‘a very pleasant Christmas’ in 1917 behind the walls of 999. This would be their last Christmas together. On 1 July 1918, Sandra died of tuberculosis. Dr Forster wrote that Sandra’s ‘mother was with her and withstood her affliction very well considering her great age. She was buried in St. Jame’s [sic] Cemetery on July 3rd. Her mother was able to have the minister and a very nice little funeral.’142 What happened to Ellen after she attended her daughter’s graveyard service is unknown. Ellen and Sandra had remained very close during more than 12 years of institutional life together, and their relationship was sustained through three transferrals in as many years, from Toronto to Cobourg, then to Whitby and back again to Toronto. The relationship between Ellen and Sandra reveals how institutional life reinforced their affection and caring for one another, with the mother in particular acting as an advocate and protector of her child, staying by her daughter’s side literally to the end. The confinement of a parent and child at the same time in the same institution was not unique to Ellen S. and Sandra S. As will be discussed in Chapter 4, Ellen K. and her single daughter, Coreen K., were also confined at the same time for 12 years in the Queen Street facility. A father and son also were fellow patients in this institution. Gilbert D. had been an inmate in the Toronto Asylum since 1861,

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when his son Allen, a 48-year-old farmer and widower, was admitted in 1903. Both men would be confined together for six years until Allen was discharged in 1909 and eventually returned to the family farm.143 Gilbert remained confined until his death in 1914 at the age of 88, having spent the last 53 years of his life at 999. Unfortunately, unlike the previously mentioned parent-child inmates, there is virtually nothing to document how this father and son related to one another during their years together. The one surviving scrap of information about the two of them together shows that even though Gilbert and Allen had been separated for over 40 years by the time the younger man was confined, a caring relationship did exist. Shortly after Allen’s discharge, C.K. Clarke wrote that ‘while here [he] received but few clothes and those he shared with his father, who is a patient here.’144 For a few years at least, some of the needs of this elderly father were looked after by his son. The fact that such family relationships took place in the asylum suggests that the impersonal nature of a large mental institution was not a constant factor in the lives of people like Ellen and Sandra, Gilbert and Allen, when they were able to look out for each other, or among the lives of non-related inmates who ‘adopted’ other inmates as informal family. At the same time, just as occurred elsewhere outside this facility, blood relationships did not always provide a natural bond to bring people closer together, as Ellen K. and her daughter Coreen were known not to get along and so were kept separated.

Conclusion The routine and relationships discussed in this chapter show later generations that the inmate population of this institution during the late nineteenth and early twentieth centuries was very active in trying to formulate ways of coping with their lives as mental patients. They were not simply being controlled from within the institution, plodding along according to the official schedule, incapable of responding to larger forces beyond their influence. For some inmates, securing close personal friendships among hospital staff and especially with fellow patients was an important way to build the support networks that people need to survive traumatic experiences, such as confinement and mental disturbance. At the same time, documents also show that incarceration could lead to more anguish, as abuse at the hands of staff or other patients only served further to distress some inmates who were already distraught enough to begin with. These conflicting

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perspectives and experiences reflect on the unstable patient culture, which was constantly in flux as inmates and employees sought to understand and live with one another in the midst of so much mental suffering. These experiences also lead into the next chapter, on patient leisure. Frequently, the therapeutic aims of administrators were taken further by inmates who created their own innovative ways of living in a mental hospital.

4

Patients’ Leisure and Personal Space It is curious that in the literature on patient lives so little has been written about leisure and personal space, and where it has been mentioned it is usually only in passing and in the context of moral therapy.1 Discussions on this topic have therefore concentrated on entertainments organized by the administration, without any serious attention having been devoted to what patients did to amuse themselves. The purpose here is to offer a wider and more comprehensive picture of leisure by including both recreational activities sponsored by medical officials and entertainments initiated by inmates for one another. Ellen Dwyer, in Homes for the Mad, offers the most organized analysis of various forms of entertainment for both patients and staff. Her research on Willard Asylum in New York state revealed much about the pathetic hopelessness in which many patients existed, where enjoying amusements was exceptional for people locked away for years on end.2 Peter McCandless has been among the few historians to highlight how patients created their own amusements, such as by making checkers sets and initiating a short-lived baseball team for white male patients at the South Carolina State Hospital.3 Such activity, in fact, was not peripheral but a central aspect of the daily existence of inmates at the Toronto Asylum. Indeed, the ability of patients to enjoy diversions from the daily monotony of ward routine could be crucial to their emotional survival in a large institution where years of confinement produced emotional flattening and lethargy among bored inmates. How asylum inmates entertained themselves, or were entertained by others, reveals a good deal about social interaction among patients, staff, and in some cases with outsiders, notably relatives or 101

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friends. Understanding the casual side of their daily lives by studying what patients did with their free time can also illustrate some of the inner workings of the asylum, its social structure, and a wider variety of leisure activities. As will be revealed, patients who had greater access to financial resources and external support were more likely to be able to pursue a wider variety of activities, though lack of opportunities certainly did not stop less fortunate inmates from enjoying various forms of relaxation. In approaching this topic, the discussion will proceed from the general to the specific. The former will provide an overall view of what types of leisure there were at the Toronto Hospital for the Insane and who enjoyed them, while the latter will give detailed accounts of how some patients went about creating this world that was both private and public, depending on the needs, ­circumstances, and personalities of particular inmates. The concept of leisure is given the widest scope here, ranging from large-scale organized events to private ways of coping with institutionalization. As such, the efforts of people to create a ‘personal space’ for themselves is an important part of this theme of understanding patient culture, since carving out ‘safe’ areas could be crucial to instilling a sense of ease and relaxation in a place where privacy was difficult to maintain. Thus, creating a culture of leisure takes on a dimension that goes beyond pleasant diversions and shows how some people tried to come to terms with their environment by making it more bearable and easier to cope with as the years went by. It is essential, as well, to understand how administrators viewed the recreational activities of inmates. In the late 1890s Daniel Clark offered a clear, if cautious, link between leisure and the treatment of mental disorders: It is difficult to estimate the benefit accruing to patients from moral treatment such as entertainments of all kinds. The lifting of the mind for even a couple of hours at a time from out of a pit of despondency and often despair may be the means of tilting the mental balance towards health or recovery. . . . [Entertainments] are factors to produce health in many minds, but the extent of their efficiency is an unknown quantity.4 [A]musements are often of more value to tilt the mind into healthful channels than even our most valued medicines are.5 To provide as much of this ‘medicine’ as possible, staff-organized activities were promoted among the patient population. Beginning in the late 1870s, volunteers from community and church groups were

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invited to come to the asylum, primarily between November and April, to give concerts, readings, and ‘dramatic performances’ on Monday evenings. This was done to relieve the monotony on the wards during months when cold weather restricted outdoor recreation. A patients’ dance was also held on Friday evenings, usually from 7:30 to 9:30 p.m. for inmates who were allowed off the ward.6 Staff members and patients were also involved in these formal activities, such as by giving a ‘magic lantern exhibition’ and by presenting their own concerts and readings.7 Clark wrote that not only were a number of patients good musicians (piano players, cornet players, violinists), but others were talented actors, reciters, readers, and caricaturists.8 According to Clark, patients looked upon these occasions as ‘the event of the week’, with 20–30 concerts listed each year in the annual reports up to 1905.9 Concerts and dances were continued well into the 1930s and 1940s and were supervised by the occupational therapy department, continuing the therapeutic approach begun more than a half-century earlier.10 However, these activities were reported far less frequently in later years. It was noted in 1936 that during the preceding year there had been six concerts with an average attendance of 185 patients, nearly evenly divided by gender, and 20 dances with an average attendance of 150 patients, including slightly more women than men.11 The decline in the number of concerts is notable. Perhaps as a substitute for fewer concerts, a new form of entertainment had begun by the 1920s, with the showing of ‘moving picture shows’, though Superintendent Herriman noted in 1932 that movies were shown from an ancient ‘pathescope lantern’ and most films were of little interest to patients. This may account for the fact that only two showings are recorded several years later, although the attendance of 200 patients was not insignificant out of a population of 1,100.12 During the late nineteenth and early twentieth centuries winter leisure activities included sleigh rides and, for men, bowling. Yearround ward activities included billiards, bagatelle, cards, checkers, chess, and book and newspaper reading.13 During the summer throughout the entire period studied here, there were occasional picnics with music and dancing on the grass. In 1895 over 400 patients, more than half of the average asylum patient population of nearly 700, attended a picnic. By the 1930s this activity, like other administratively sponsored leisure, was planned by occupational therapy staff.14 Gender differences in outdoor warm-weather activities were noted, with croquet being played by women and cricket by men in the late 1800s.15 Cricket was eventually replaced by baseball, an exclusively male preserve first

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mentioned in 1900 and again in 1934.16 It becomes increasingly clear from annual reports that male patients had many more outlets for official leisure activities during most of the period studied here. Bowling, baseball, and cricket were exclusively for men patients at 999 in the early twentieth century, and in 1937 only males were recorded as having been involved on the softball team.17 When physical training classes were instituted for otherwise unoccupied patients in 1933, this activity was also restricted to men. While the number of patients who took part in these classes was small, an average of 15, they were given the opportunity at regular intervals—70 times in 1936. The one activity where women clearly outnumbered men—card parties—was also the one entertainment that took up the least time for staff, being a sedentary pursuit that could take place on the ward. Statistics indicate females participated in this category of ‘other forms’ of leisure more than three times as much as men did in 1936.18 These officially organized entertainments were not examples of patronizing a few patients or of presenting a pleasing image to outsiders, as there are a number of references to how much some inmates enjoyed themselves. One inmate, Jane F., referred approvingly to ‘a grand picnic’ held in June 1911.19 There are also numerous references in the clinical records of other patients attending and enjoying entertainments held indoors during the cold months. For many people whose social life was severely limited, large-scale social functions were something to look forward to with great anticipation. Confined for 36 years until his death at the age of 58 in 1914, Geoffrey T. was noted during his last years to be very fond of attending officially organized entertainments, so much so that ‘if going to a dance or concert [he] will wash several times during the day.’20 Religious services conducted for the patient population were considered by officials to be among the most uplifting activities. During the early decades of the asylum’s existence two Protestant services were held on Sundays. However, this was changed with a schedule that remained in place from 1880 to 1906. An Anglican service was held at 9:30 a.m. on Sunday, other Protestant denominations took alternate turns beginning between 2:30 and 3:00 p.m., and a Catholic service was held beginning between 4:00 and 4:30 p.m.21 Prior to 1880, Catholic religious visited when they were requested by individual patients, a practice that continued in the years that followed.22 Clark noted that ministers’ sermons were well received by patients, as they tended to be cheerful, while they also avoided talking down to inmates with ‘ “baby talk” as some of our patient hearers call it’.23 Though Daniel Clark claimed that 300–400 patients usually attended

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Sunday services, C.K. Clarke changed this routine, claiming it was an inefficient way to spend staff time and that attendance was low and half-hearted.24 From 1906, ‘there will be but one Protestant service each Sunday’, with the Anglican Church being asked to end its 9:30  a.m. service after 50 years, which Clarke’s wording suggests caused some consternation.25 Though this form of leisure is less frequently commented upon in later reports, both Catholic and Protestant services were held well into the 1940s at provincial institutions, and indeed continue to this day at the Queen Street facility.26 Whether the spiritual needs of non-Christians, such as Jewish patients, were attended to during this period at 999 is not indicated in the records.

Leisure, Personal Space, and Support Networks Whether or not a patient had external support helped to determine the extent of leisure one could enjoy. Access to outside financial aid was crucial to purchasing amenities, such as fruit and chocolates, as well as providing some patients the chance to go on outings and receive such items as reading and sewing material. Access to monetary assistance could also help secure private quarters, which could become a haven from an often noisy and stressful ward environment. An annual effort to provide a source of enjoyment for asylum inmates of all classes, including those with no money, occurred during the Christmas season, albeit in a rather haphazard fashion. Beginning in 1893 and continuing into the 1920s superintendents requested relatives or friends of paying patients to send a gift to place under the Christmas tree set up in every ward. These circulars also mention how important it was to send something extra for those lonely patients who had no one to support them. In 1895, over 700 Christmas gifts were sent for both classes of inmates.27 In one case a Christmas circular was sent to the Department of Indian Affairs in regard to Charles M., a Native Canadian who received financial support under the Indian Act. Noting that this was the first such request that the department had ever received for any patient, even though Charles had by this time been confined for 27 years, the official asked for a list of all Native people in the asylum, after the receipt of which the department ‘will then give consideration to the request.’28 The response to this letter does not exist, nor is there any evidence of a gift being sent for Charles. But this communication does reveal that these Christmas gift requests were by no means applied on a systematic basis to every patient who had access to external financial support. Thus, it is not difficult to surmise that many patients who marked Christmas as a

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special holiday in their lives went without gifts either because of the irregularity of circulars soliciting donations or, more simply, due to their complete isolation from any outside support networks. Regardless of their level of outside support many patients spent a good deal of leisure time going for walks around the asylum, particularly in the warmer weather. The hospital grounds included gravel and plank walks, a garden, trees, and one large and two small fountains.29 This most common type of leisure took two distinct forms outside of the ward. One form was a walking party organized by asylum staff, who accompanied groups of patients not allowed off the ward on their own. This included about 75–80 per cent of the inmate population during the late nineteenth and early twentieth centuries, for whom going out was considered an essential way to get exercise, as with patients like 48-year-old Cyril M., who walked ‘up and down the lawn talking and laughing’.30 How many patients on locked wards were able to get out for exercise with walking parties is very difficult to determine. However, Inspector O’Reilly provided a glimpse during a visit in July 1883. Forty-two out of 64 inmates on the male refractory ward were outside with a walking party, though he also noted during this same visit that all of the occupants on the female refractory ward were inside. A few years earlier he noted that while many male patients could be seen walking about the grounds, only a few female inmates were doing so.31 Over a half-century later, this gender bias continued, though less severely. Statistics clearly show more males on locked wards were taken out on walking parties, the most frequently reported leisure activity—150 times in one year, with an average of 120 males to 75 females, even though men and women were nearly equal in terms of the overall patient population.32 Inmates included in these groups were considered threats either to themselves or to others and so were not trusted to wander about freely, while some patients also had a reputation for escaping when they were unsupervised, though this type of scrutiny did not always prevent people from bolting and getting away from their overseers.33 What two patients thought of these supervised walks suggests that these were not the sort of pleasant strolls most people imagine. Connie D. spent her last nine years in the asylum, beginning in 1905. In August 1910, this 41-year-old woman wrote to her parents, ‘after walking round the flower bed so many [times] I was afraid of getting dizzy for you must know we are not allowed to go off of that square, it gets very tiresome.’34 Another long-term patient, 57-year-old Timothy F., wrote that same year to Dr Clarke that ‘when Mr. W. McCreary

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Jim P. walking dogs around the hospital grounds, 25 March 1927 (above) and a close-up photo from 1935 when he was 64 (next page). He was confined from 1898 until his death in 1941 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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[chief attendant, Ward 4] was putting me out with the “Walking Party,” to sit in the cold, being lame, when the others were walking in line around the fields, you arranged for me stay within doors.’35 Both of these patients give an indication of the discipline on a walking party, which was organized and confined to specific physical spaces on the grounds. The second form of access to the space beyond the ward was for non-resistant patients the staff trusted.36 This group had complete freedom to wander about as they pleased during the daytime. In 1882, among 701 patients, 200 were allowed parole of the grounds on the open-door system reserved for patients in the three cottages and four basement wards (which housed working patients), in contrast to the locked wards on upper floors. By 1895 this figure had declined to 154 paroled patients out of a population of 695 and by 1900 the number had fallen further, to 140 patients out of 710.37 As the above figures indicate, this privileged group comprised between 20 and 25 per cent of the inmates housed at a given period and was closely tied to being trusted as an inmate labourer, as will be discussed in Chapter 5. One

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May F. in 1938 at the age of 67. A patient from 1898 until her death in 1952, she worked as a housemaid for the superintendent and nurses (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

patient, Jim P., who was an inmate for over 42 years until his death in 1941, was trusted so much that a picture pasted into his clinical record from 1927 shows him walking three dogs on the grounds, though nothing in the record explains who owned the dogs, or if this form of exercise for man and animals was a regular occurrence.38 Some patients took their strolls very seriously and did not look too kindly on interference. May F. spent the last 54 years of her life at 999 Queen Street West, dying on Christmas Day 1952 at the age of 81. She worked as a housemaid for the medical superintendent and nurses during the 1920s and was therefore able to enjoy complete freedom to wander at will. As May lived in one of the cottages, access to the grounds was easier for her than for patients in the more restrictive main buildings. Not content to stay indoors at night, as was the rule, she was observed to have ‘rambled about’ the grounds as early as four in the morning. On one occasion May ‘engaged in wordy combat’ with the night-watchman, whom she struck in the face, presumably after he admonished her for walking outside at such an early

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hour. Though the guard was not hurt, May temporarily lost her privileges and was confined to a ward for a month, after which she was returned to the cottage to resume her position as before.39 Enjoying leisure also had clearly defined boundaries that applied to even the most favoured inmates. The majority of patients, who were not so favoured, were expected to make do with spaces created for their daily leisure on the ward. Enclosed verandahs, quadrangular in shape, were attached to each ward. After windows and screens replaced the iron bars in 1890, verandahs were used year-round and eventually were refitted by the 1920s as sun-rooms for 12 patients confined to their beds.40 These airing courts were particularly important for invalid patients, though Inspector Langmuir cautioned in 1879 that such places were no replacement for outdoor exercise.41 However, Daniel Clark noted that ‘maniacal’ patients were, as a rule, kept inside and so were the ones who benefited the most from using verandahs. Reconstructing these airing courts to allow for more privacy and year-round comfort also had the added benefit of giving exuberant patients a place to release their ‘pent-up emotions’, where they would no longer attract public curiosity ‘by their fervid eloquence and melodious oratorios’.42 Thus, patients who enjoyed singing and making speeches could do so without hindrance, at least as far as public interference was concerned. Patients confined to the ward were reported in clinical records to frequent the verandah on a regular basis.43 This change of venue from their regular living quarters would have provided some relief for patients since it offered greater natural light as well as a panoramic view of different parts of the grounds that was not obtainable in the more constricted space on the rest of the ward. Patient files from the late nineteenth and early twentieth centuries also provide numerous examples of one particular type of annual entertainment encouraged by the administration. Passes were given by the directors of the Canadian National Exhibition for patients to attend free of charge, with the participation rate climbing from over 100 inmates in 1879 to over 200 by 1897. It was noted that patients never eloped during these day trips and that they enjoyed criticizing how judges classified and awarded paintings and agricultural, floral, and industrial displays at the fair.44 However, this free admission policy was eliminated by the early 1900s so hospital officials solicited financial support from families to send relatives to the Canadian National Exhibition.45 Thus, these eagerly anticipated outings were more frequently available to those who were fortunate enough to have access to financial aid beyond the asylum. Inmates who lived in the

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most comfortable wards not only had a greater amount of personal space than those who resided as public charges on overcrowded wards, but they also had greater variety in entertainment because such privileges could be purchased by some and not others. Whether this created any resentment among different classes of inmates is not revealed by the sources, but it does help to show how the internal class structure of the asylum permeated all aspects of patients’ lives, including access to leisure activities. Being confined all the time would obviously have been quite boring and conducive to instilling lethargy in people who had nowhere to go. Thus, it is not surprising that laziness developed as a form of everyday leisure for some patients, such as Sophia S., who ‘[l]ounges all day on the couch and when asked to move becomes violent.’ Shortly thereafter she took to her bed for months, where ‘she seems to like it.’ A year later Sophia died of tuberculosis at the age of 50 after 26 years of confinement, during the latter part of which she expressed no interest in anything other than resting.46 Such an example of someone whose life was extremely constricted by being locked on a ward illustrates the obvious limits of leisure in an insane asylum. Some patients had so little chance to pursue any form of external entertainment that their condition deteriorated into one of virtual hopelessness. Mavis M., confined at the age of 19 in 1878, died 38 years later, in a similarly lethargic condition, being variously described as ‘filthy’, ‘impossible to understand’, and sitting on the floor with her skirt over her head. However, she, too, was able to find some solace for her hours of leisure on the ward and was reported to be fond of music and enjoyed drinking large amounts of tea.47 That such amenities were available raises the point that some forms of relaxation were provided within the especially depressed world of a locked ward, to these most isolated patients. Indeed, in 1896, a musical attendant was employed to help with religious services as well as to visit the wards to encourage patients to engage in musical activities as a form of therapy, something at which several women on private wards were reported to be especially talented.48 While lack of resources did prevent some inmates from having much choice, beneath this poverty was an ability to use whatever was available to create personal comforts. The leisure pursuits of two women asylum inmates illustrate how gender differences in social and economic roles could be used to their advantage. Mabel I. died at the age of 72 in 1918 after 48 years of institutionalization. A worker in the laundry, she was recorded as carrying around a bag full of clothes ‘altered by herself, her own style and design . . . most elaborate, fit for

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a museum’.49 Ellen G., who died in 1918 at the age of 80, after 40 years in the asylum, was also reported to have been what is now referred to as a ‘bag lady’ during the last few years of her life. She was seen going about the grounds in a straw hat and apron, at times carrying a tin wash-basin in which she would put rags and other things that she had picked up and would later remake into her own clothes.50 During one of these outings Ellen fell and injured herself, which brought about her death two days later.51 The resourcefulness of both of these women in creating their own clothing was directly related to their having parole of the grounds and being able to find ‘raw material’ for their sewing projects. Thus, a combination of leisure, labour, and gender-biased roles in which females were taught to sew illustrates how these two women were able to sustain a small degree of self-reliance, if only in the clothing they created and wore. Since appearances are a significant part of self-esteem, it is important to consider these fashion-conscious efforts as part of the wider picture of creating a personal space within the context of leisure. Considering the amount of work required to make such personal items, it is also important to note the linkages between labour and leisure, as such time-consuming efforts would most likely have been a source of enjoyment for their creators, who otherwise had so few pleasurable pursuits to occupy their time. Reading was another source of recreation. By the end of the nineteenth century the patients’ library, located in the general administrative office, had over 1,400 volumes. The chief attendant of each ward was responsible for keeping track of loaned books among her or his charges.52 Clark reported that light literature was most widely read, though history, travel, and biography were also frequently checked out among the 3,800 times that books were borrowed in 1879. Though this number had climbed slightly to 4,000 borrowings by 1897, it also oscillated up and down for, as Clark remarked, the number of library patrons among the overall patient population was not large.53 And patients were not free to read any available book, which may have discouraged library use. ‘[A]s far as possible’, staff sought to keep particular books from particular patients: ‘erotic literature from the prurient; religious books from those afflicted with religious melancholy; murders and suicides from those of homicidal impulses, lest these accounts be suggestive.’ Clark made it clear that this activity was not just for ‘killing time’ but was encouraged so that ‘select reading’ could aid patients in their recovery by giving readers a chance to escape from their troubles, a goal, he wrote, that ‘cannot be overestimated’.54

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Men were said to read more than women; women patients were occupied with domestic chores and so had less free time.55 There are no references to this gender division for later periods, so no clear picture of male and female reading patterns emerges beyond the late nineteenth century. However, the therapeutic influence of reading was stressed well into the 1930s and 1940s, as hundreds of new books were purchased, circulating ‘branch’ libraries were established on each ward, presumably for patients who could not get out, and in 1938 a reading room was opened in the library itself for patients who, prior to this, had to take books back to the ward to peruse. This was done at a time when ‘bibliotherapy’ was advocated as a form of treatment within the provincial hospitals to try to interest inmates in reading and thus remove themselves from mental distress.56 Even though asylum inmates were removed from the larger society, some of them clearly showed an interest in, and an awareness of, the changing world beyond the asylum walls. One way of doing this was keeping up with the daily news from outside. Weekly newspapers from throughout southwestern Ontario were sent free to the asylum throughout the late nineteenth century, some having been donated since the early 1850s. Beginning in 1879, the Toronto Evening Telegram sent copies of its daily to the asylum and later the Toronto Globe sent its paper twice weekly. All of these papers were distributed to the wards. According to Clark, newspapers were avidly read since patients, ‘like sane people, hunger for news’. Inmates were often observed reading to one another and checking wall maps on their ward to locate a newsworthy place.57 By the 1930s newspapers and periodicals were donated by public libraries after they had finished with them, either at the end of a week or end of a month. It was also possible for people to get books and newspapers from family and friends.58 But this most common of leisurely pursuits could be ended by a patient’s lack of resources. It was reported in 1916 that 65-year-old Elaine M. was ‘a great reader, but since breaking her spectacles cannot read’. Subsequently, she carried with her a ‘bundle’ of papers that she was no longer able to see clearly.59 Elaine died 12 years later without any reference to her being able to read again. Yet not being able to read did not diminish an interest in contemporary events for at least one inmate who tried to keep abreast of news with a bit of help from the people around him. Jim W. had been blind since he was 56, two years before he was confined in 1903. He remained at 999 until he was released in the care of his sister in 1914. In 1911 it was recorded that Jim ‘will beg of us’ to read the newspaper to him, and three years later his clinical record states:

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Two drawings dated 1910 by Walter T., a patient from 1902 until his death in 1914 at the age of 57 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Re-­ admissions).

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He becomes very much interested and engages in conversation readily when you talk politics to him. He knows the names of the members for all the constituencies in the province and also the past members of parliament that won any fame. He is a staunch liberal and has very little use for and gives very little praise to the best conservative that ever lived.60 Reading material was not the only source for someone seeking an imaginative escape from everyday hospital routine. Storytelling was another source of leisure for some patients. Seventy-four-year-old Wallace M., for example, enjoyed spinning tales ranging from ‘catching whales with hook & line to travelling in far off countries gathering gold chains from trees’.61 Whether he had much of an audience is not stated, but that he engaged in recounting such fanciful tales as a source of fun illustrates how oral traditions could be used as a way to pass the time and cope with boredom. Patients also wrote letters and poems and drew artwork. Walter T., considered a reclusive man by physicians, left seven small drawings, some of which show a manor house, others densely crowded with human and animal figures. Two sketches refer to a ‘Cockatoo’ in the drawing as ‘The sport of kings’.62 There is even a photograph of an old cider mill torn out of a contemporary magazine, on which Walter, in 1910, has drawn faces peering out of the water and roof of the mill. As noted in Chapter 3, writing letters was not always intended as a relaxing activity and could be curtailed by administrators. Another form of leisure activity was also curtailed, in this case for both in­mates and staff. In 1887, smoking and chewing tobacco were banned from the asylum for hygienic and safety reasons, lessening the possibility of an accidental fire and eliminating much expectorating. How long this ban was in effect is not clear, though by the late 1920s male patients were observed to be smoking without censure in the hospital.63 Visits by outsiders could be occasions of great anticipation for patients eager for familiar contact from beyond the asylum walls, though these meetings could also be a source of distress, igniting painful feelings of resentment and hurt. Because of such upset, medical superintendents would sometimes discourage visits.64 Thus, the seemingly benign process of an outsider spending leisurely time with a patient encountered various responses, from mutual enjoyment to intense hostility. Those patients who did not have the good fortune of helpful outside support could nevertheless find ways of enjoying themselves

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with a sort of self-directed ‘internal outing’ while still on the grounds of the hospital. Cindy R., confined at the age of 40 in 1897, spent the last 33 years of her life at the asylum, during which time she apparently had no visitors. On a summer day in 1918, she was reported to have appeared at one of the front gates all ‘dressed up’ with her friend and fellow inmate, Rochelle W. When asked what they were doing Cindy said ‘they were just going to have a look around’, after which they returned quietly to their living quarters at one of the cottages.65 It is easy to imagine these two women, one of whom at least had no outside support, deciding to treat themselves to a leisurely stroll around the grounds, dressed in their best clothes, as if going for a walk in a park. That they went to one of the gates on the edge of the grounds is especially intriguing, and it is worth speculating that the prospect of peering into the forbidden world beyond 999 Queen Street West was considered by these two patients as an added attraction to their outing. Such seemingly mundane pursuits would have made life more enjoyable for anyone while institutionalized, let alone for an isolated inmate for whom getting dressed up and walking with a friend was something to look forward to. Having sketched this general outline of the various types of amusements available to a cross-section of inmates, we can consider more in-depth examples to show just how rich patient culture was when it came to creating a world of leisure and personal space. These case studies also reveal a great deal about relationships and the inner workings of the asylum.

Building a Patient’s Life of Recreation from Scratch One of the most innovative and creative inmates at the Toronto Hospital for the Insane must have been Winston O., who was incarcerated as a public charge for almost 58 years by the time he died in December 1934 at the age of 89. The close relationship between labour and entertainment is made obvious in this man’s energetic outpouring of physical activities during the last two decades of his life, the period for which there is the most evidence in his clinical file. The skills Winston learned as a cooper prior to his confinement were put to good use in his extraordinary carpentry endeavours. Well into his seventies and eighties, he was busy creating homemade inventions for his enjoyment and that of others around the institution. Over the years the recreational pursuit he was reported to enjoy most often was his ability to make and play the violin, which in one case he had fashioned out of a box. Whether sitting in an alcove in the

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basement or on the ward, which he made ‘brighter with his music’, Winston’s talents were appreciated by his fellow inmates, for whom he performed ‘nearly every day’.66 One can only imagine the refreshing spirit such sounds brought to the lives of those patients who heard these performances on otherwise dour and depressing wards where fiddle music was seldom heard. The violin was not the only item of leisure that Winston created. Because of his non-resistant nature, he was allowed complete freedom to walk around the grounds all year, a privilege he took full advantage of when engaging in his many recreational pursuits. Winston was reported to have built an automobile in 1912 at the age of 67, ‘as a joke’. It worked so well that he drove his car around the asylum grounds and had a picture taken of it that was sent to his sister, who wrote regularly inquiring about his welfare.67 He was still building automobiles in 1916. Dr Forster noted that though it was not ‘speedy’ it was ‘a formidable affair’ with ‘a horn, bells and other late contrivances to warn erring pedestrians’. At the same time, this patient also built a snow shovel that he put to good use around the asylum after winter storms. Winston’s attentiveness to what was happening in the world beyond the asylum was made clear when the Medical Superintendent wrote: ‘He seems to watch closely all the latest ideas about these machines and attempts to incorporate these in his own way.’ In his early seventies, Winston kept busy building an ‘airship’, which Dr Forster did not think would run, though he was still reported to be working away on an ‘aeroplane’ 18 months later. Wheelbarrows and ‘many other articles’ were also part of his productive output during this same period.68 At the age of 77 he was reported to be able to ‘swing an axe with most of his juniors’, something he was able to put to use for his benefit and that of the asylum on any number of occasions. Whenever landscaping was undertaken at the hospital, such as cutting down trees or moving buildings, Superintendent Harvey Clare reported in 1924 that Winston ‘is always consulted and takes an active part in directing the operation.’ During the warm weather, he would build himself couches in ‘shady nooks’ as a place to rest and was also keen on growing things, while in the winter he liked to skate and sail an ice-boat on the asylum rink.69 One of the most notable features of this creativity by an elderly inmate was his enthusiasm for bringing into the asylum the very latest technological developments. His fascination with the world around him was remarked upon by hospital staff, who noted he was always ‘watching’ what was taking place inside and outside the

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a­ sylum, including on a trip to the Canadian National Exhibition, where he enjoyed observing ‘all the improvements of the modern age’.70 Interestingly, even though he was a public charge, Winston was allowed to go to the cne, unlike most other such inmates who did not have someone to pay the cost—further evidence of the special favours granted to him. That Winston had the skill to make and play a violin is notable enough. That he was skilful enough to re-create, or attempt to re-­ create, so many modern inventions, regardless of his age, is a testament to his enormous talent. When his many creations are considered, what emerges is a picture of an asylum where there existed an active patient culture, in this case tolerated, even admired, by medical authorities who clearly had a great deal of affection for this colourful inmate. The Medical Superintendent wrote how this man, who seemed ‘happy and contented’ smoking his pipe, was on the best of terms with everyone, both patients and staff, all of whom he considered his old friends. He had individual names for everyone, referring to an asylum doctor as ‘Jimmy’, and once asked him ‘what I am doing down here, says he thought I was over at the corner grocery.’ In the one instance where he was reported to have had a fight with another patient, 83-year-old Winston insisted after being hit in the side of the head with a brick that ‘ “Billy the Cooper” wanted to fight but that he is not hurt’, though a one-inch cut to his ear was noted. His conversation was reported as ‘somewhat silly’ and included a number of references to his earlier life, as well as his thinking that Abraham Lincoln, ‘great praise on him!’, was still President of the United States and believing that the Superintendent was the same man for whom he worked on the Rideau Canal more than 50 years before.71 Yet, he was not unaware of changes that occurred over the course of time, as his inventions make clear. He was also very interested in World War I, having had a long conversation about this and ‘other public matters’ with Dr Forster in the latter’s office, and even talked about enlisting after watching military parades, another source of pleasure for this old man.72 Perhaps most remarkable about Winston was his vitality at such an advanced age, after having spent so many decades in an institutional environment where being worn down as the years went by was a common occurrence. Even his medical observers remarked on his energy.73 Indeed, a few weeks before his eighty-ninth birthday and less than a year before his death due to broncho-pneumonia, Winston was reported busy constructing ‘tubs and buckets in the carpenter’s shop’.74 However, his years in the asylum did affect him in other

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ways. His devoted sister Anna wrote of how ‘strange’ it was that he could write no better than a child when she remembered what a good writer he had been. It is also clear that his abilities made him something of a celebrity, a development that asylum officials apparently did not discourage. So that her brother would not be viewed as some sort of exhibit, Anna wrote to the Medical Superintendent in 1916 and requested a stop to visits by those people who ‘call to see my brother only thru curiosity’.75 That such an elderly inmate engaged in so many pursuits, which the staff allowed because ‘no one has the heart to restrict his activities’, obviously indicates his ability to create a world of recreational entertainment that reinforced his freedom within the institution.76 Clearly, Winston could not have built so many things without the compliance of the staff. The tools he needed to make his automobiles, airship, wheelbarrows, snow shovel, violins, and other creations would likely have come from the carpenter’s shop, where he was often reported working. Given his ingenuity, and the reference about his transforming a box into a violin, it is not hard to imagine Winston spending a good deal of his time hunting around the asylum for material for his latest project. Having assembled such things as were needed, he would have required a dependable spot in which to do his work, while being sure it would not be thrown out, as projects like cars would have taken quite a while to build and somewhere to be housed when not in use. All of this would have had to be done with the knowledge of asylum officials, who the records clearly show were willing to let Winston do as he pleased. Besides the non-threatening nature of this inmate, there are other reasons for this official compliance. Winston’s activities benefited the internal economy of the asylum, as he helped to do some of the physical labour around the grounds and devices such as his snow shovel saved others from doing such work, while the wheelbarrows, tubs, and buckets he made could be used by any number of people. Within the institutional context, his less practical creations, such as automobiles and violins, would have livened the place up and made life more enjoyable for those who watched him try out his latest devices and heard him play his music. Thus, to allow him to pursue these manifold activities was beneficial to the overall social and economic climate of the institution. Not only was Winston causing ‘no trouble whatever’, as the clinical record states, he was, most importantly, contributing to the community of which he was a part by working and entertaining fellow inmates as well as himself. As such, the degree of agency he displayed is manifested in these various activities. Having

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accepted his status as an asylum inmate, he used his carpentry and coopering skills and powers of observation to create his own distinct personal space within a massive institution where such independence was difficult to secure, especially for a patient with no external financial support.77 This, of course, suggests the close relationship between work and leisure. What for many people would have been activities requiring an excessive degree of physical exertion, particularly at an old age, such as cutting down a tree, were for Winston sources of enjoyment. Indeed, that the staff was reluctant to curtail Winston’s activities shows how much his physical labour was for him a form of leisure and entertainment. His references to his earlier life prior to confinement are intriguing and raise the possibility that this world of creativity may have been a way of keeping in touch with the world of Winston’s youth, which­ ­prevented him from deteriorating into a lethargic condition, as so often happened to someone confined for such an extremely long time. Above all, the world Winston created for himself, virtually from scratch, full of new inventions while also recalling a distant past, shows he made sure the links with the community beyond the asylum were maintained and replicated for his enjoyment and those around him.

Subsidizing Patient Culture with External Financial Support Another thoroughly documented example of a patient creating leisure and entertainment can be found in the file of Felicity A.T. or, as she styled herself, ‘Angel Queen XIII’. Admitted in 1894 after months of domestic tension between herself and her husband and children, who she said treated her badly, Felicity remained in the Toronto facility until her death at the age of 79 in 1924. During this 30-year period she became ‘probably our best known and most prominent patient, and in the social sphere in which circumstances placed her she at no time lost her ascendency or any of her force of character.’78 This ‘force of character’, combined with a regular supply of financial assistance from supportive family members, enabled Felicity to pursue a variety of free-time pursuits in a world she believed was hers by divine right. Angel Queen’s most obvious form of recreation was the prodigious output of clothing she made with an enormous quantity of supplies provided over the years, first by her husband and then, after his death in 1918, by their daughter, Veronica. The following items from a typical list, which she received in October 1910, give an idea of the variety of material she was provided with since at least 1895, the date of the earliest receipt in her file.

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8 yds. dark green Sateen 5 yds. dark blue cloth 5 yds. blue Silesia 12 yds. white cotton 2 yds. white linen 2 boxes blue silcotton (dark) 1 box light silcotton (5) 1 box green silcotton (3) 1 box bronze green silcotton79

The clinical record notes that she spent most of her time in her private room making clothes as well as banners, not only for herself but for ‘Angel King’, for whom she had prepared ‘a robe beautifully embroidered’, though she would not tell anyone where this man lived or when she expected him to arrive. Felicity, who answered to no name other than ‘Angel Queen’, by which she was well known throughout the institution, always dressed herself with bracelets, chains, crosses, and crowns, kept her royal robes tucked away in her room, and marked all of her belongings with ‘Angel’.80 She was very demanding when placing her fabric orders and made her displeasure known if the material she received was not to her specifications. Dr Clarke wrote to her husband, Gene, that Felicity had complained that the material he sent was not the right colour and so another order was placed. As for the items already received: ‘I wanted Mrs T__ to return the cotton on hand but she says “Oh no Angel Queen never returns anything.” ’81 Another time, frustrated that her orders were not being followed, she took matters into her own hands by writing up a long list of sewing material she needed, demanding the ‘Best Quality’ and concluding: ‘When I Stipulate The Knitting Silk Those Embroidery Crochet Silk Wont Do[.] There Is Not Enough On The Spool[.] Angel Queen XIII’.82 Her critical eye for style extended beyond her personal wardrobe. Like other inmates, she enjoyed watching nearby parades as a form of entertainment, and one march in particular received her official disapproval. In 1918, Angel Queen was reported to be ‘very much put out at the Orangemen’s parade’, declaring it the worst she had ever seen because they ‘had no banners and no regalia at all’. The world she created for herself was one in which she held court and issued ‘devastating prophecies’ to those she felt had offended her.83 Some of these ‘prophecies’ are preserved in a large document resembling a scroll, with ‘+ The Angel Queen XIII +’ written in big letters across the top, in which she predicts the end of the world. In an undated, 11-page letter, much of which is written in the third person, she threatened to kill

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An undated scroll (left) written by Angel Queen XIII, or Felicity T., a patient from 1894 until her death in 1924 at the age of 79, and an undated fabric order (right) written by her (Archives of Ontario RG 10, Series 20B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

those she believed wanted to starve her and to ‘Strike Down’ anyone who tried to remove her from Ward 7. She also asked that Dr Clarke be informed that the skim milk being sent to the wards was being taken by a staff member to make butter. Upset that other ‘Poor Creatures’ were getting nothing but porridge, Angel Queen insisted that unless this state of affairs ‘Is Immediately Stopped And The Milk New Sent Through The Wards I’ll Put The Cows In A Dairy Outside’.84 This effort to render assistance to other patients on the ward, while impractical on the one hand, also displays her ability to cross over from a self-created world into the everyday problems of hospital routine, in which she ‘always took a great interest’.85 There is no ­evidence that anything ever came of this or any other complaint that Angel Queen issued. Like Winston and his carpentry work, Felicity was able to use her sewing talents and celebrity status within the institution to garner

PAT I ENTS’  LEI SURE AND  PERSO N A L  S PA C E    1 2 3

124   REM EM BRANCE OF PATI ENTS PAST

s­ pecial attention and admiration from the staff, who allowed her a great deal of leeway in how she lived her constricted life. Unlike Winston, however, Felicity had access to external financial support, which she used not only to purchase her sewing fabric but also her food. Relatives bought and sent food to the asylum, and also left enough money for officials to buy her what she asked for. She maintained her own set of dishes, which she washed and kept in her room, and refused to eat the regular meals cooked at the institution, probably because of a fear of being ‘poisoned’, which was mentioned in regard to some tea she was served in the infirmary. While she may have considered herself a monarch sent by God, her appetite was anything but grand—she ‘only eats boiled eggs, hot milk, soup or perhaps a cake, but her chief diet is milk.’86 No doubt this would have made her all the more concerned about the supply of milk sent to the wards. Having established her abilities as a superb dressmaker she was given free rein to order as much material as desired, so long as it was paid for by her family. Her sense of style, along with her dramatic pronouncements and insistence on being called Angel Queen, served to enhance this relative freedom, which she pushed to the limit. From her private room on Ward 7, Felicity believed she ruled the asylum, that all discharges, staff appointments, local improvements, and ordering of supplies were done at her whim, while at the same time she dispensed patronage by issuing ‘large checkes’ for people to be drawn from a bank named after her and telling the nurses that since she owned Eaton’s and Simpsons they had Angel Queen’s permission to order whatever they wished as ‘it will be allright.’87 During the last years of her life Felicity was physically disabled after falling and fracturing a limb at the end of 1915, so much so that she could only get around her bedroom by ‘dragging her affected leg after her’.88 Unlike other disabled patients in the asylum, Felicity was able to secure special help to relieve problems dealing with access and mobility. Her reputation was such that Angel Queen in her last years had another patient, Jean V., act as her ‘body servant’ who would wait on her and would frequently bring hot water for Felicity’s toilet. That she was able to secure so many privileges, most notably in regard to a personal maid who received no pay for her kindness, is a testament to the ‘force of character’ mentioned upon her death. Indeed, as she lay dying of pneumonia, Angel Queen insisted that her illness was due to ‘the poison gas which is put in her room’.89 That she was admired by other patients is obvious by the fact that Jean V. would serve her in such a way, while the affection of the staff is also clear in the clinical record and in letters to her daughter.90

PAT I ENTS’  LEI SURE AND  PERSO N A L  S PA C E    1 2 5

Despite her highly regarded status, Felicity was not so content as may seem to have been the case. Even in her relatively private room, she would get upset at the noise emanating from down the hall and exclaim from her bed: ‘If I could only get around the other patients would not carry on the way they do, breaking up my furniture all the time. I soon won’t have any.’ Perhaps the most poignant reference is to Felicity believing she would be leaving soon and was ‘just waiting the call’ to vacate the premises.91 Thus, her world of royal edicts and dire predictions created for herself a self-contained, ‘safe’ world where she felt under control, thinking that she would only be incarcerated for a little while more. And to a remarkable degree she did exert some influence over her world by creating so many gowns and robes and so much jewellery. She was described as being ‘busy with her fancy work all the time’.92 While any number of patients expressed ideas about being a monarch or a person of great wealth, none were able to realize such thoughts to the extent that Angel Queen did, complete with class deference. She not only had an impressive wardrobe, but also went so far as to have what amounted to her own lady-in-waiting. How this arrangement came about is not revealed by the sources, but that such a relationship existed at all says a great deal about the importance and closeness of patient relationships. Jean was reported to have waited on Angel Queen ‘almost constantly’ during her final years with a ‘great deal of care and attention’.93 Thus, this was more than a master-servant relationship, as the affection of these two women for one another must have been strong to sustain such a friendship, especially given Angel Queen’s demanding personality and the physical and emotional strains Jean would have encountered while caring for an ailing person. How much her reputation within the asylum influenced this friendship will have to remain unknown, but it is conceivable that Jean may have felt a degree of privilege and self-worth by being so close to such a well-known figure as was Angel Queen in the world of 999  Queen Street West. Their relationship also illustrates the high degree of classism that permeated the lives of asylum inmates, with élitist practices of deference reinforcing such attitudes on asylum wards. Above all, the story of Angel Queen’s ability to realize so much relative independence while incarcerated says a great deal about the importance of agency and external support in pursuing a lifestyle that was far less encumbered by institutional rules than was the case for those inmates who had fewer resources to tap into. Henrietta B. expressed herself in her free time in a way that can also reveal an undercurrent of traumatic memories and attempts by a

126   REM EM BRANCE OF PATI ENTS PAST

An undated letter from Henrietta B. with painted flags on it. She was a patient from 1894 until her release in 1918 at the age of 55 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

PAT I ENTS’  LEI SURE AND  PERSO N A L  S PA C E    1 2 7

patient to engage in a form of self-help to cope with such images. Confined in 1894 at the age of 31, Henrietta would remain in the Toronto facility until she was released in the care of her mother in 1918. Reported to be cheerful, ‘artistically inclined in every detail’, and ‘never happier’ than when giving painting lessons in which she ‘excels’, Henrietta was originally locked up after escaping from her mother’s house, where the doors had been bolted, and stating that ‘it was her duty to destroy any books of light literature.’94 Though she was reported to enjoy practising the piano and sewing while institutionalized, just as she did before being incarcerated, her primary form of leisure was painting. During the nearly quarter-­ century of her confinement, Henrietta, like the redoubtable Angel Queen, was supported by her relatives, in this case her mother, and was able to enjoy the privacy of her own room. This support allowed her to create a secure place that became, in effect, an artist’s studio. Henrietta’s enthusiasm for painting was noted a number of times during her last decade at the hospital; at one point she declared ‘art to be the grandest thing on earth’.95 She expressed her feelings by creating pictures on canvas, on her furniture, and even on the letterhead of her correspondence, as one of her two surviving letters attests. Both of these very long letters are written in clear, nearly flawless handwriting, with a prose style rich in detail and imagery, often of a harrowing nature describing nightmare-like episodes of physical and sexual abuse from her home communities of Hamilton and Burlington. At the end of one letter she pleads to ‘Superintendent Clark of the Toronto Jail’ for ‘Legal Help’.96 These letters demonstrate Henrietta’s exhaustive ability to spend time working through her thoughts on paper, though recounting so many upsetting memories could hardly be considered a form of entertainment. Her letters also illustrate less distressing views, in particular the importance of her art in providing a sense of solace. In a letter thanking a correspondent for sending her a lily, Henrietta wrote about her loneliness and how ‘all my valuable hand-work so much prized by me’ made the ‘place that I am in now . . . very much improved to what it was’, even though it was not the home for which she longed. She went on to write about her latest creations: A fancy folding lawn chair, I have gilded and painted seven large maple-leaves on, and also made a flag cushion to go with it, which is very particularly attractive. Then another large flag cushion I have made for my bed-room (viz) bou-doir.97 She wore ‘loud colors’ on her dress and was said to have a penchant for ‘keep[ing] herself decorated’. Although Henrietta was

128   REM EM BRANCE OF PATI ENTS PAST

jovial in nature, her behaviour, in spite of outward appearances, was much more introverted than that of Angel Queen or Winston.98 While she was reported to have regularly attended the various hospital entertainments, for the most part in her daily life she appears to have remained aloof from other inmates, talking to herself and carrying her own little chair when out with the walking party so she could sit alone. If anyone intruded ‘unawares’ into her private room or frightened her in any way, Henrietta was said to become ‘hysterical’, screaming for up to an hour, but she was otherwise quiet.99 This observation and the ideas expressed in her letters indicate that beneath the pleasant and bright personality was a deeply disturbed person with memories of danger, humiliation, and violence who was terrified of the unexpected and unwelcome. When put in the context of these debilitating insecurities, Henrietta’s private world of artistic creation can be viewed as a release not only from the confining world of the asylum in which she found herself, but also from haunting images of abuse and suffering. These traumatic images may help to explain why she kept most people at a distance in the asylum. While there is no indication of what happened to her after she was released at the age of 55, the existing evidence suggests that for Henrietta B. recreational pursuits were not only a way of relaxing but were also a form of self-therapy in an effort to try to heal an immense amount of emotional pain. Some patients who could pay not only were able to secure more material privileges, but could also go out with staff to do their own shopping at local department stores. Ellen K. spent the last 36 years of her life in the asylum, dying at the age of 77 in 1923, while her daughter Coreen K. spent 12 of these years as a fellow patient from 1905 to 1917. They were from a wealthy family—the husband and father was a successful businessman and politician who provided regular financial support to both, which continued after his death in 1910.100 This money allowed them to have private quarters and also ensured they were provided with various luxuries, from food to clothing and trips outside the asylum, estimated in 1911 to cost $150 a year.101 They were also able to purchase reading material and, most interestingly, both mother and daughter were taken out by nurses to go shopping on a regular basis.102 The degree of this privilege is revealed in voluminous writings left by Coreen, in particular. Noting that she had an annual allowance of $1,000 provided by her father’s estate, she wrote to the hospital’s bursar requesting money because ‘the heat is so great I need cooling fruit ice cream.’103 In another instance, Coreen asked for $10 not only for

PAT I ENTS’  LEI SURE AND  PERSO N A L  S PA C E    1 2 9

her enjoyment but for some staff she wished to reward for their friendship: ‘I intend taking a couple of the nurses whom I have found fairly faithful in the discharge of their duty for a trip to Niagara on the Lake tomorrow.’104 Yet these privileges were not an unfettered source of entertainment for such well-positioned patients. The same freedom to exert one’s independence in the pursuit of personal leisure activities within the asylum could also produce serious disputes, as occurred with Coreen and hospital authorities. During the final year of her incarceration in 1917, Coreen contacted a correspondence agency in the United States that specialized in romantic matches. Her name was put on a list as seeking a partner in marriage, and she apparently informed the men who contacted her that she was a nurse at the asylum. Coreen’s bulging file contains a number of letters from men who proclaim their devotion for her, with one man in Chicago being particularly insistent, pledging to visit her in Toronto. Alarmed at the amount of mail she was receiving, which the hospital authorities claimed was more than all the other patients combined, they began confiscating letters addressed to her. Not to be outdone, Coreen contacted a lawyer and private detective agency to investigate what was happening to her mail and duly notified Medical Superintendent Forster: As to the reading and opening of my letters in the office here, I wrote to the Detective Agency in Toronto and asked them to attend to it. My letters were all from honorable friends and I resent any criticism of them. This intrusion into her personal space led Coreen to withdraw her services in playing the piano at the ‘Moving Picture Show’, as well as to no longer appear at classes for student nurses, which she resented on the basis of her class position in the asylum. In effect, she went on strike. Coreen went on to write that her lawyer had secured statements from six nurses attesting that ‘I am perfectly sane, and have never shown any Insanity at all.’105 By violating their ‘social contract’ to respect her freedom to pursue leisurely activities while confined, in this case trying to prevent Coreen from developing romantic liaisons with male pen pals, hospital officials compelled a privileged patient to use her financial resources to a most powerful effect in her own favour. The money that she and her mother had available to enjoy so many comforts and to reward favourite nurses was now used to turn on the administration in an assault on the very legitimacy of her confinement. That she was able to get some asylum nurses to side with her makes this ‘leisure-

130   REM EM BRANCE OF PATI ENTS PAST

based’ revolt all the more remarkable. Undoubtedly, staff support was helped by the friendships Coreen developed through her privileged position of going shopping and driving around the countryside on various occasions. Two days after writing the above letter, she was sent out on probation to the much more prestigious Trinity Hospital, then to a private residence, and six months later she was discharged from the asylum, clearly demonstrating the influence she was able to wield with a combination of her contacts, money, and personality.106 On the day of her release, Coreen wrote an angry letter to Dr Forster threatening a court case and wishing to ‘forever sever all connections’ with 999 Queen Street West: I am so glad to leave also, for I don’t like to remain in any place where the manager is dishonorable enough to read the patients letters, when he is really only a physician after all, not a postmaster, as he evidently imagines himself. Also, on your assertion that ‘men must be kept away,’ not one ‘Gentleman,’ I would rather term my friends, has been allowed to call upon me here, there-fore the assertion was rather flat. The idea of writing as you did to my ­sister about my correspondence I took only as an impertinence. A Doctor after all has his limitations, and one of these is opening a patient’s letters, as the Toronto Detective office agreed with me on this point.107 While issues besides leisure were involved in this dispute, her enjoyment of special privileges and her efforts to create a world of personal entertainment free from institutional restrictions led Coreen to feel angry at the obvious violation of her privacy. Having lost the security of being allowed to do as she pleased within the asylum, she forced her way out, resentful at this intrusion into her personal space.108 When Coreen left the asylum she left behind her mother, something she noted with regret.109 Ellen, who was ‘a great favorite with us all’, continued to receive preferential treatment because of her social class within the asylum, which a steady stream of money maintained. It was noted in 1920 that when it came to meals, Ellen received a ‘special tray’ arranged by the head nurse and ‘sent directly from the kitchen to her’. Thus, she was able to enjoy a significant degree of personal space with specially catered meals as well as respect from staff members, though there is no record that Coreen, after she left, contacted her mother during the last five years of Ellen’s life.110 Whatever unpleasant feelings existed over the dispute between Coreen and hospital officials, there is nothing to indicate that Ellen received any fewer privileges than prior to this conflict. There is also

PAT I ENTS’  LEI SURE AND  PERSO N A L  S PA C E    1 3 1

no reference to the emotional impact on this elderly woman of the departure of her daughter after being confined in the same building with her for 12 years. The state of their relationship is difficult to determine, though one letter from 1911 noted that they should not be on the same ward since they have an ‘injurioys [sic] effect on each other’.111 Though they both benefited from outings and treats, their respective files also indicate that Coreen was able to get out more than her mother, probably because her moods were less volatile than Ellen’s moods, which are mentioned much more frequently.112 Nor is there any specific mention of them engaging in any activity together. Thus, it appears that mother and daughter did not share their leisure activities while confined, with the elder Mrs K. more frequently ­presenting an image of an introverted, depressed, and lonely figure compared to her ebullient and extroverted daughter.

Conclusion The contrast between people with and without external financial support clearly reveals an institution where access to leisure privileges was influenced by social class and money, as well as by behaviour. While relatively wealthy patients like Ellen K. often found themselves locked up on wards because of emotional distress, or a perception of unreliability, just as did the poorest of inmates, this latter group were not able to experience the wide variety of treats and creature comforts that their social ‘betters’ in the asylum were able to purchase. Indeed, a patient like Cindy R., for whom nary an ill reference is contained during her lengthy period of confinement, could never possibly dream of such luxuries as painting supplies, expensive sewing materials, catered food, or the chance to go on an outing. The reason was simple—she had no friends outside the asylum and thus no money to purchase what was beyond her reach. Yet there is also no doubt that financially underprivileged patients like Ellen G., Mabel I., and especially Winston O. were able to develop a range of imaginative alternatives to ‘subsidized’ entertainment by making use of whatever was at hand. Themes around labour are also important to keep in mind since it was their survival skills as workers that enabled some people, like these three inmates, to turn sewing and carpentry into closely allied leisure pursuits. Evidence also shows that for some inmates, regardless of their social status, the functions organized by the administration were a major source of entertainment and relaxation. Perhaps what is most poignant in regard to leisure are the exceptional opportunities and freedom available to those covered by the

132   REM EM BRANCE OF PATI ENTS PAST

brief case studies. Money and parole of the grounds were crucial in determining the extent to which inmates could create a culture of leisure and personal space. It is also clear that the majority of patients were not so fortunate in having economic resources and personal freedom. Trustworthiness and mental state were often mentioned in patient records as a concern, but favouritism also played a role, with well-liked, less resistant patients being allowed more freedom than inmates who presented disagreeable personalities to the staff. Thus, the pursuit of leisure in the asylum served to reinforce class distinctions on one level, while also making it possible for some inmates to develop and sustain their own creative coping mechanisms in an institution that could more easily produce stress and mind-numbing lethargy than an enjoyable and relaxing environment in which to live.

5

Patients’ Labour

The Therapeutic and Economic Context of Patients’ Labour Moral treatment in which coercion was officially downgraded, while suasion through work and leisure was emphasized as the best way to treat a troubled mind, came to be the primary medical justification for patient labour at 999 Queen Street West. As Charlotte MacKenzie has outlined, versions of this theoretically more gentle approach to dealing with insanity existed in Britain by the late eighteenth century, especially when contrasted with the commonplace brutality that had made madhouses notorious among the public. However, it was from 1813 onward, with the publication of Samuel Tuke’s Description of the Retreat, that moral reform began to make gradual inroads among officials responsible for people regarded as mentally disturbed.1 Administrators were not the only people who promoted this policy. An anonymous former inmate of the Glasgow Royal Asylum in the midnineteenth century described how a stable mind was most likely to be achieved by ‘keeping the fingers employed at some light and useful labour’. But this former patient also warned that if inmate-labourers were ‘placed under the charge of some harsh, unfeeling clown who would give them work above their strength or allow them to overwork themselves, as some nervous excitable patients would be very apt to do, the result would be the reverse of desirable.’ 2 Cheryl Krasnick Warsh writes that a contemporary term for this treatment is ‘behaviour modification’, though the term ‘industrial therapy’ has also been used in the second half of the twentieth century.3 During the long tenure of Joseph Workman as Superintendent of 999 Queen Street West, from 1853 to 1875, moral treatment was 133

134   REM EM BRANCE OF PATI ENTS PAST

advocated by promoting ‘kindness in the treatment of the insane’ and by a preference not to use restraints.4 Daniel Clark intensified this policy of moral reform during his tenure, 1875–1905, so that by the time of his retirement the Toronto Hospital for the Insane had a firmly rooted practice of promoting work as therapy, something the records show was carried forward well into the mid-twentieth century. One of Clark’s successors, Superintendent J.M. Forster, echoed this policy in 1918 when he wrote, referring to patient Alice M., that labour was important ‘for the taking of patients out of themselves’.5 Patients worked at 999 from its earliest days. Only a few years after the Provincial Asylum opened on Queen Street West in 1850, Susanna Moodie wrote after a visit that a group of male patients were to be seen working outside in the garden, while inside, women sewed on the ward.6 This policy of mental hospital administrators in Ontario, including both superintendents and provincial inspectors, reveals the widespread adoption of Anglo-American therapeutic aims in the promotion of work as therapy. Inspector Langmuir noted in 1879 that one-third of all asylum inmates in Ontario were employed in labour, though some worked less regularly than others. He argued that labour, along with recreation and amusement, was most effective in treating mental disorders, and he stated that more emphasis needed to be given to inmate work.7 The hours of work were never clearly stated, but would have varied according to jobs and the ability of workers, who were always supervised by staff employed at specific work stations. These hospital employees in effect became ‘occasional attendants’, as James Moran has described.8 Evidence from files indicates that patients’ labour supplemented the daily duties of paid staff, for example, in caring for less able patients, such as those in the infirmary. This occurred when Alice M. helped prepare for the birth of an unnamed patient’s baby in 1918, and when Angel Queen was helped by Jean V. in her final years, as described in Chapters 3 and 4. Patient loyalty and friendship would have played a role in some of these caring relationships, though how often inmates were directed by staff to work as caregivers is not known. Superintendent Isaac Ray of Butler Hospital in Rhode Island wrote in 1866 that the working day for patients ‘never exceeds eight hours’.9 In France during this period, the work day could be longer, lasting from eight to 12 hours depending on the season.10 As Table 4 indicates, the cumulative rise in the percentage of days worked to collective stay at provincial hospitals clearly shows that Langmuir’s goal of increasing the number of patients involved in labour was implemented from the early 1880s onward. This did not

PATI ENT S ’ L A B O U R    1 3 5

Table 4 Percentage of Patient Days Worked to Collective Stay* in Provincial Institutions, 1882–1907

1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907

Toronto

London

Kingston

Hamilton

32.15 30.44 53.90 38.40 41.10 56.37 52.09 51.39 62.01 67.04 75.05 73.44 77.13 91.64 72.04 64.99 66.70 77.63 67.05 59.73 60.68 58.76 58.07 49 49 48

54.00 69.89 86.56 79.58 77.84 77.84 77.54 77.30 75.43 74.40 77.20 78.71 77.41 76.11 75.69 78.01 71.16 74.08 72.67 79.31 69.38 68.02 68.44 67 60 63

45.11 50.33 76.59 61.13 68.26 68.26 65.71 70.56 70.27 87.24 65.89 73.22 74.47 68.60 70.00 69.39 60.00 69.46 67.58 67.60 65.21 63.72 62.00 60 59 59

37.61 62.38 56.40 48.82 62.32 61.49 73.95 57.32 68.43 77.27 76.90 77.20 76.43 76.74 73.64 78.24 76.14 67.62 76.38 77.16 76.16 46.76 74.84 71 72 67

*‘Percentage of days worked to collective stay’ is the terminology used by officials in the Annual Report and is different from the actual number and percentage of patients who worked, as set out in Table 5, which is not based on days worked by everyone but on total number of actual patient labourers. source: Annual Report, 1907, xlviii. Only the four oldest institutions are included in this sample, though figures are also available for Mimico (1892–1907), Brockville and Orillia (1895–1907), Cobourg (1902–7) and Penetanguishene (1905–7).

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occur without questions being raised about the effectiveness of this plan. In 1885, as asylum labour was intensifying in every locale, Daniel Clark commented that classifying who was to work was a problem. He stated that it was good for a physically healthy patient with chronic mania to work when it proved to be a sedative. But for someone with acute mania who was made to work to exhaustion this would be ‘positively injurious’: This new-fangled idea of endeavouring to extract as much work out of the insane as possible is mischievous, useless, subject to certain conditions and limitations. . . . it is evident that discrimination should be used in urging patients to perform manual labour. Many will work to whom it is a manifest injury. Such can be urged to it by coaxing, or by bribing with something of a trifling nature, such as an extra cup of tea or coffee, or a piece of tobacco to any old smoker. . . . Some of them would work night and day . . . were they permitted to do so. . . . The question is not how much work can be got out of patients, but how much work can be done by those to whom it is a healthy exercise and will be conducive to recovery? . . . indiscriminate labour has not the therapeutic effect its ardent advocates claim for it.11 Ironically, the decade after these words were written experienced the most intensified inmate labour during the entire 1870–1940 period. It is not possible to trace the extent of work among groups with specific diagnoses, since statistics on labour do not provide this information. Tables 4, 5, and 6 show the extent of inmate labour from the early 1880s to early 1900s. Figures in Table 5 indicate that work among the overall Toronto asylum population reached a peak of 88.83 per cent in 1895, but this percentage was thereafter gradually reduced to two-thirds and then just over half by 1905. Until 1892, Toronto’s percentage of days worked never rose above those of the other provincial facilities, but for the remainder of the 1890s the Toronto institution was about on a par with others when it was not in advance of other hospitals, as it was in 1895. After 1900, and especially after Daniel Clark left in 1905, when rates for days worked declined to their lowest since 1886, Toronto was consistently lower than its three oldest neighbours, with the exception of 1903 when Hamilton was the lowest. Part of the reason for these generally lower figures at Toronto can be found in Clark’s complaint that the relatives of paying patients often refused to let them engage in any employment. Yannick Ripa has found similar family resistance in nineteenth-century France.12

PATI ENT S ’ L A B O U R    1 3 7

Table 5 Types of Employment and Number of Working Patients, by Occupation, Toronto Hospital for the Insane, 1880–1905

1880

1885

1890

1895

1900

Carpentry shop 2 4 4 4 4 Tailor shop 4 4 2 3 4 Engineer shop 2 9 4 7 8 Blacksmith shop 1 1 1 1 1 Mason work 2 2 2 2 2 Roads repaired 2 2 6 — — Wood yard and 6 12 15 10 8    coal shed Bakery 3 3 3 2 3 Laundry 8 13 17 23 32 Dairy 2 7 7 6 6 Painting 3 3 3 5 5 Farm 26 24 22 4 — Garden 5 34 8 6 9 Grounds 4 — 12 10 8 Stable 5 4 6 7 7 Kitchen 8 17 16 10 8 Dining-rooms 32 54 40 67 70 Officers’ quarters 3 4 6 3 4 Sewing rooms 15 36 22 3 1 Knitting 16 20 20 30 37 Spinning 2 1 — — — Mending 20 58 38 69 74 Wards and halls 48 130 204 362 192 Storeroom 1 3 8 1 1 Shoe shop — 2 1 5 4 Butcher shop — 2 4 1 1 Piggery — 2 3 — —

1905

5 5 6 — 1 — 10 3 34 6 3 — 18 12 6 12 68 4 6 12 — 52 117 1 4 1 —

138   REM EM BRANCE OF PATI ENTS PAST

Table 5  (continued)

1880

1885

1890

1895

1900

1905

Tinshop Book-binding Sewing in wards Upholstering General

— — — — 5

— — — — 18

— — — — 30

1 — — — 130

1 1 61 — 28

1 — 21 6 89

Total

225

469

504

772

580

503

% of patient    population

29.76

57.26

52.44

88.83

68.39

55.33

Note: ‘Garden’ and ‘Grounds’ were separate categories in the 1880 report but were combined in 1885, so the total figure has been placed under ‘Garden’ for that year; these categories are separated again in reports thereafter. ‘Wards and halls’ was an original category; it was divided in two in the 1885 and 1890 reports but has been combined in this table. In the 1895, 1900, and 1905 reports ‘halls’ is no longer listed but ‘Wards’ is, so the total reflects this category for these latter three years. Categories were dropped and added over the years, which is reflected where no work is recorded. source: Annual

Reports, 1880–1905.

Efforts were made to get paying patients to work at 999 with the argument that it would be physically and mentally therapeutic. In 1894 Clark noted that out of 225 paying inmates at least 50 per cent were capable of some type of work. Relatives objected to this goal because they viewed it ‘as derogatory to the social status of the patients’.13 Yet it is clear from the statistics that some success was registered in getting paying patients to work. During the record year of 1895, paying patients made up 37 per cent of Toronto’s hospital population, a higher rate than any other provincial facility, the next closest being London where paying patients comprised only 20 per cent of the overall inmate population. It had been noted by both Clark and Inspector Langmuir as early as 1883 that Toronto’s non-working private patients were an impediment to increasing the work-rate there, in contrast to other facilities in Ontario where there were far fewer in this category.14 Yet in spite of this family opposition, it is clear from the annual statistics that for most of the 1890s up to 1900, some paying patients were included among the inmate working population.

Table 6 Types of Employment and Cumulative Days Worked by Patients, by Occupation and Gender, Toronto Hospital for the Insane, 1880–1905

F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M.

1885

1890

1895

1900

— 626 — 1,252 — 626 — 313 — 626 — 626 — 1,878 — 1,000 1,300 939

— 534 — 927 — 2,170 — 168 — 574 — 152 — 2,650 — 750 1,649 1,248

— 1,210 — 612 — 1,460 — 310 — 620 — 540 — 4,000 — 930 3,130 2,555

— 1,248 — 936 — 2,184 — 312 — 624 — — — 3,120 — 624 5,928 1,296

— 1,248 — 1,012 — 2,184 — 312 — 624 — — — 1,872 — 936 7,614 936

1905

— 1,340 — 1,197 — 1,460 — — — 290 — — — 3,119 — 936 8,700 1,220

PATI ENT S ’ L A B O U R    1 3 9

Carpentry shop Tailor shop Engineer shop Blacksmith shop Mason work Road repairs Wood yard and coal shed Bakery Laundry

1880



Dairy Painting Farm Garden Grounds Stable Kitchen Dining-rooms Officers’ quarters Sewing rooms

F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M.

1880

1885

1890

1895

1900

365 365 — 939 — 8,138 — 1,600 — 1,350 — 1,820 2,190 730 5,840 5,840 730 365 3,900 —

500 940 — 939 — 7,512 — 4,136 — — — 1,460 1,800 1,540 5,678 5,840 730 730 6,000 —

— 2,550 — 700 — 7,756 — 2,504 — 3,756 — 2,190 — 5,840 7,300 7,300 1,095 739 3,286 3,600

— 2,160 — 1,560 — 1,128 — 1,872 — 3,120 — 2,520 — 3,600 10,944 13,764 108 — 936 —

— 2,468 — 1,560 — — — 2,808 — 2,184 — 2,100 — 2,184 10,390 13,280 1,407 — 246 —

1905

— 1,872 — 900 — — — 3,700 — 2,640 — 1,410 — 2,510 13,910 8,110 1,890 — 1,640 —

140   REM EM BRANCE OF PATI ENTS PAST

Table 6  (continued)

Table 6  (continued)

F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M.

1885

1890

1895

1900

4,992 — 364 — 5,200 — 9,855 7,665 — 313 — — — — — — — — — —

6,360 — 261 — 7,580 2,000 12,976 13,134 312 684 — 140 — 730 — 730 — — — —

6,000 — — — 9,000 2,400 28,700 46,220 1,460 1,460 — 64 — 1,050 — 1,095 — — — —

9,360 — — — 7,200 120 80,600 27,636 — 312 — 1,620 — 365 — — — 166 — —

11,410 — — — 12,110 2,910 42,100 18,700 — 312 — 1,248 — 312 — — — 312 — 312

1905

2,140 — — — 14,110 — 16,036 12,036 — 312 — 914 — 312 — — — 300 — —

PATI ENT S ’ L A B O U R    1 4 1

Knitting Spinning Mending Wards and halls Storeroom Shoe shop Butcher shop Piggery Tinshop Book-binding

1880



1880

1885

1890

1895

1900

1905

Sewing in wards Upholstering General

F. M. F. M. F. M.

— — — — — 1,565

— — — — 2,608 2,000

— — — — 5,475 5,475

— — — — 39,960 6,156

14,210 4,360 — — 4,010 6,099

8,410 — — 1,204 10,180 12,110

Total by gender

F. M.

34,736 38,576

46,453 51,688

65,760 106,613

157,856 73,623

103,527 72,183

77,016 57,892

73,312

98,141

172,373

231,479

175,710

134,908

Overall total Work % by gender

F. M.

47.4 52.6

47.3 52.7

38.14 61.86

68.2 31.8

58.9 41.1

57.08 42.92

Patient population % by gender

F.

48.28

48.96

50.88

51.09

51.42

50.61



M.

51.72

51.04

49.12

48.91

48.58

49.39

sources: Annual

Reports, 1880–1905. The final total figures for both female and male workdays for 1895 were incorrectly added in that year’s report but have been corrected above. See Table 5 for additional explanation.

142   REM EM BRANCE OF PATI ENTS PAST

Table 6  (continued)

PATI ENT S ’ L A B O U R    1 4 3

How this affected their class status within the asylum is unclear. However, it is obvious that much of this resistance by families of paying patients was based on a fear of relatives doing work that was ‘below their station’—they quite literally did not want them dirtying their hands if they could at all avoid it. Since Clark directed his criticism in particular at relatives of inmates who paid full rates, the highest class of inmates, this suggests that these individuals were exempted from work more generally than were the majority of their less wealthy peers. Patients who were not among the wealthiest $6-per-week inmates were expected to work as a way of contributing to their board and earning their keep. Patients whose relatives paid lower maintenance fees were not exempt from work, nor, of course, were men and women on the ‘free wards’ who had no outside financial support. Wealthy non-working patients included Jerold M., a well-established lawyer, Ellen and Coreen K., the wife and daughter of a rich businessman, and Reginald F., a stockbroker with friends on Wall Street.15 They were not singled out for their non-working status in clinical files, a point frequently mentioned in regard to less fortunate inmates who either refused to work or were seen as incapable of work. Working-class or poor rural patients who did no work had this point specifically mentioned in their clinical records, as with William G., a farmer who was described as ‘useless’ as a worker in the asylum. Irene B., a dressmaker, was also noted to have refused to do work, while Erin P. was referred to as the ‘laziest’ patient on her ward.16 On the other hand, patients who were regular workers were complimented for their efforts. This theme of patients who contributed to the internal economy of the asylum by working on a regular basis as being more worthy than inmates who did not work regularly, or who did no work at all, is repeated over and over in case files for those who were not rich, and has also been found by Cheryl Krasnick in late nineteenth-century records of the London, Ontario Insane Asylum.17 Wendy Mitchinson has observed that while staff did not force patients to work at Toronto, pressure was exerted and included the sort of bribes that Clark referred to in his 1885 report. Favouritism towards working patients was also practised at the nearby asylum in London, according to S.E.D. Shortt.18 Thus, there was a general devaluing of non-working inmates who were expected to engage in some form of labour, though the outright intolerance mentioned by Yannick Ripa towards ‘idleness’ in French institutions was more implicit than explicit at the Toronto facility.19 Generally, it can be said that those patients with the most money did the least institutional work, while those with the least money or

144   REM EM BRANCE OF PATI ENTS PAST

none at all did or were expected to do most of the work among inmate-labourers. Part of this was simple demographics, as the Toronto Hospital for the Insane was made up primarily of non-paying patients. Those patients whose stay was well financed could literally buy more leisure time than people who had little or no financial resources. Furthermore, the prevalent middle-class attitude of this period was intrinsic to moral therapy, part of which was based on judging a person’s character on his or her self-control and hence reliability for work, as Andrew Scull has discussed.20 When a well-to-do patient was noted to be engaged in work, such as Angel Queen with her numerous sewing projects, this task was chosen by the inmate, whose efforts were subsidized by family and were usually, though not always, for oneself rather than for the wider hospital community. As such, this type of work was far different from the toil of those patients whose hospital-directed jobs had a direct impact on the internal economy of the asylum by reducing expenditures for more paid staff and by producing outputs, such as clothing or helping with building and grounds maintenance. While not in any way diminishing the labours of a more privileged patient like Angel Queen, we must nevertheless recognize that she had a choice many other inmates did not have. The large number of private patients at Toronto contributed to the workload of their less fortunate peers. Clark complained that the ironing of paying patients’ clothes was a ‘heavy weekly task’ that would not be so if the hospital had only free patients, which suggests these privileged patients had more clothes that were given greater attention than would have otherwise been the case.21 This raises the question as to how therapeutic patient labour was and how much it was, in fact, exploitive. In 1900 Inspector Christie noted that 76 per cent of provincial patients were employed at their place of residence and that during the previous 10 years 75 per cent were so occupied, up from the 45 per cent provincial average recorded in 1881.22 Clearly, inmate labour had become a central part of institutional life throughout Ontario and was essential to the internal economy of the provincial mental hospital system. In this respect, Canadian administrators borrowed from the example of European and some American physicians. Nancy Tomes has observed that by the 1860s a regular work regimen for patients was advocated as a way to reduce the need for restraints, and it also ensured that inmate labour kept down maintenance costs.23 While farming and gardening were considered among the best kinds of work for inmates, Inspector Langmuir also noted that outdoor work and ‘products derived therefrom very materially reduce the cost of maintaining Asylums.’24 Inspector Christie wrote in 1896

PATI ENT S ’ L A B O U R    1 4 5

Randall P. in 1935 at the age of 71. A tailor and general labourer in the asylum, he was confined from 1898 until his death in 1944 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

that the quantitative increase in the average number of working patients benefited asylums and their inhabitants: [T]he present condition of the institutions . . . indicate[s] their advanced and improved state. . . . These [projects] have been done largely by institution labor, and the employment of patients. . . . The benefit patients derive from this cannot be overestimated, and if outside labor were employed, it is obvious that the expenditure would be largely increased.25 Even before the province-wide intensification of employing patients began in the late 1870s, local administrators had already begun this process. Joseph Workman reported in 1872 that ‘all clothing’ for Queen Street inmates was made in the institution by patients,

146   REM EM BRANCE OF PATI ENTS PAST

with help from a tailor on the male side and a seamstress on the female side.26 As Tables 5–8 show, the vast amount of unpaid work done by inmates directly cut down on costs. All boots, shoes, and slippers for patients were made at 999 work stations occupied by inmates by the turn of the century. During just one year, 1898, 175 tin vessels were made, 803 tin vessels were repaired, 69 chairs and 7 sofas were upholstered, and 83 mattresses were remade. The total value of this work was estimated by Clark to have been $1,343.96.27 In 1906, it was estimated that three million pieces of laundry went through this department in all provincial mental hospitals combined, most of which would have been work done by female inmates. This material was then sent on to the sewing room for mending when necessary after being washed.28 As Tables 7 and 8 make clear, the amount of inside and outside work done by female and male patients was enormous. In her study of women asylum inmates in nineteenth-­ century France, Ripa has written that physicians were aware of, but remained silent about, the material benefit to institutions of inmate labour, preferring to emphasize work as therapy.29 Yet the documentation clearly shows that Ontario physicians during this period did not hide their enthusiasm for the reputed mental and material benefit of inmate work. Within the labour regime at the Toronto Hospital for the Insane, gender divisions are apparent in a number of areas. The most obvious bias in this regard is the choice of jobs available to male patients in contrast to female patients, as set out in Tables 5 and 6. Out of 32 job categories between 1880 and 1905 only two, or 6 per cent, were allocated exclusively to women, whereas 19, or 60 per cent, were reserved solely for men. Of the remaining 11, or 34 per cent of jobs, both men and women were involved. Evidence shows that women were never allowed to work outside, an exclusively male preserve, though both groups were employed inside. However, women worked inside far more than men, with their highest rate recorded as work on wards and halls, where females did 60 per cent of the total labour under this category. Women’s work was focused primarily on traditional areas, notably sewing and repairing clothes, working as domestic servants for medical officials, basket-making, scrubbing floors, and dusting. Clinical records indicate that both genders swept and polished floors on the wards in which they resided and helped to care for other ill inmates in sex-segregated infirmaries. While there was gender crossover in the laundry, women did the vast amount of work there—86 per cent by 1905. The area of closest parity was in the dining room, where both women and men worked

PATI ENT S ’ L A B O U R    1 4 7

Table 7 Structural Work Completed with Male Patient Labour at the Toronto Hospital for the Insane, 1871–1904 Date

Project

Estimated Outlay Saved

1871 Ditch and drain digging ‘trifling expense’ 1871 Painting, wood grained (ar, 1871, 71) 1871 Front fence bronzed        '' 1877 Ditch digging, gathered stones — 1889 Boundary walls, 1,600–3,000 feet, ‘tens of thousands average 16 feet in height of dollars saved’ (ar, 1890, 42–3) 1889 Two-storey brick workshop,        '' 100 feet x 30 feet 1889 Brick coal shed, 140 feet x 40 feet        '' 1890 New central kitchen        '' 1890 Brick connections between east        '' wards and adjoining building, 45 feet of space, three storeys in height 1890 New stone and brick entrance        '' 1892–3 New brick chapel and recreation hall, 45 feet x 85 feet, two storeys tall — 1893 Brick male infirmary, three storeys $800 1893 Brick addition to cow stable for seven more cows — 1893 New brick feed house for cows — 1894 Brick female infirmary, ‘reduced the three storeys cost very much’ 1894 Reconstruction of Steward’s house (ar, 1894, 5) 1894 New brick woodshed      '' 1895 Unspecified number of bedroom — floors relaid 1895 Floor and sitting-room in Ward 5 — redone 1895 Repainting done in five wards, — halls in central building, and amusement room

148   REM EM BRANCE OF PATI ENTS PAST

Table 7  (continued) Date

Project

Estimated Outlay Saved

1895 1895 1895 1895 1895 1895 1895 1896 1896 1902–4

Addition to conservatory built Concrete floors laid in cow stables Addition and repairs to mortuary Replacement of dumb waiters Laundry room reconstructed New heating boilers in laundry and Cottage C Tramway built to outhouses and stables New brick coal shed Small addition to east lodge Brick bowling alley for men patients, 90 feet x 30 feet

— — — — — — — — — —

Note: Does not include work at Mimico Branch, 1888–94. source: All references can be found in Annual Reports for relevant years, though references to boundary walls provide different lengths in the 1889 and 1895 (p. 5) reports, which is why ‘1,600–3,000 feet’ is cited. Quotes from Superintendents Workman and Clark in right-hand column refer specifically to savings as a direct result of inmate labour.

50 per cent of the total of six sample years. This figure is not surprising since patients were assigned work at their own eating facilities, which were strictly segregated by gender. What is surprising is that men were recorded as working much more than women in the kitchen, which became an exclusively male preserve by 1890 when a new central kitchen building was opened up, replacing the old system of six kitchens scattered about the basement. Nor are women patients ever recorded as working in the bakery, on the farm, or in the garden, all areas of female work in traditional household economies of this period, and only briefly were any women employed in the dairy. This occupational segregation into a few areas for female patients was similar to that documented for French asylums.30 Wendy Mitchinson has argued that gender divisions in patient labour and leisure at Toronto were based on the favouritism Clark showed male patients. In particular, she notes how ‘even in the asylum, women’s work was never done’, as men had more time off

PATI ENT S ’ L A B O U R    1 4 9

Table 8 Patients’ Industrial Operations, Toronto Hospital for the Insane, 1905 Female Wards No. articles of clothing and furnishings made No. articles of clothing and furnishings repaired

5,233 8,011

Sewing Room (Female) No. articles of clothing and furnishings cut No. articles of clothing and furnishings made No. articles of clothing and furnishings repaired

6,685 1,227 638

Tailor Shop (Male) No. garments made No. garments repaired

561 915

Shoe Shop (Male) No. pairs boots and shoes made No. other articles No. pairs boots and shoes repaired No. other articles

331 54 549 13

No. pieces made No. pieces repaired

Tinware (Male)

31 779

Book-Binding (Male) No. new books bound No. books re-bound

20 125

Upholstering (Male) No. mattresses remade No. sofas recovered No. settees recovered No. cushions for bowling alley No. chairs re-upholstered

275 8 4 3 12

Knitting (Female) No. pairs men’s socks made No. pairs women’s stockings made

282 120

Laundry (86% Female) No. pieces passing through laundry source: Annual

Report, 1905, 15.

409,868

150   REM EM BRANCE OF PATI ENTS PAST

Workshop, Toronto Hospital for the Insane, early twentieth century (RG 10-20-B-7-6, Archives of Ontario 4610, Queen Street Mental Health Centre).

d­ uring periods of inclement weather and at night, when outdoor work was not practical.31 Statistics in Table 6 support this argument for the period 1895–1905, when women, who made up just over half of the inmate population, did an average of 61 per cent of the work. From 1880 to 1890 men did 55 per cent of the work at a time when they were in a slight majority of the patient population. Men also worked inside at year-round jobs in the carpenter’s shop, tailor’s shop, and storeroom. Male patients were also employed in at least one outside occupation year-round, the woodyard and coalshed, essential not only for cooking but also for heating during winter months. In ­addition, they were put to work on building projects around the ­institution, as Table 7 shows, and Clark wrote in 1893 that ‘most of the rough and heavy [construction] work’ was done by these men patients.32 Outdoor work could be extremely tedious, such as when male inmates were put to work in the late 1870s to pick by hand thousands of potato bugs by the ‘bushel and barrelful’ and to apply Paris green on the crop.33 This reference to the use of a highly poisonous insecticide also indicates the hazards all patients, male and female, could face on the job. As early as 1853 patients were put to work in unsafe places, clearing up a three-year-old cesspool created by unconnected pipes from water-closets underneath the asylum’s basement. Laundry

PATI ENT S ’ L A B O U R    1 5 1

work, done by hand until 1876 when it was mechanized, sewing, mending, and making clothing and the construction of stone walls and buildings could be physically demanding, with hands and limbs getting strained under difficult conditions with no financial compensation. In 1903 Harriet T. asked that her brother, Daniel T., be paid for his work, so as to offset the $3 weekly charge his family paid for his confinement. Superintendent Clark responded, ‘We cannot possibly have a patient work here and give him credit for his work, although it is always a great benefit to a patient to be employed in one way or another.’34 Clark made similar observations about other inmates, noting Jim P.’s reliability as a worker who ‘earns more than his keep in this way’; virtually identical comments made about Wilfred S. Clark explained the rationale for Wilfred’s work with the gardener and, by extension, that of other similarly situated patients. Noting that he ‘encouraged’ such tasks, Clark wrote, ‘it is good for insane people to be employed.’ 35 This non-payment for inmate labour was in contrast to some inmates in France who were paid, albeit very unevenly, during the 1830s and 1840s.36 Not only were patients at Toronto never paid, as a matter of policy, but some of them were clearly forced to work or were ‘induced’ to do so. Esther H. resisted when asked to polish the floor in 1909, and her record shows that she would ‘not assist with any kind of work and if forced to do so will become violent.’37 The clinical record of this 25year-old woman makes it plain that coercion was used in getting patients to work, thus undermining medical claims that this was supposed to be a ‘therapeutic’ program. Even when some patients proved reluctant to go to their place of work, the work still made its way to them. Women’s work—sewing and knitting—was done in a cramped attic atop the main building, which was also used as a chapel and amusement hall, a place Clark described in 1878 as ‘gloomy and forbidding’. Some women apparently refused to go to this room so by 1884 administrators had women sew on wards, with the result that ‘many of those who could not be induced to work before’ were thereafter employed.38 This change in work venue, as buildings and work practices evolved over the decades, was most noticeable on the farm. By 1888, 999 Queen Street West had been reduced to 26 acres, whereas several years before, in 1880, it had been 105 acres. Clark noted that this land curtailment would cost $6,000 annually in lost crops. The subsequent reduction of outdoor labour left 80 male workers, most of whom had been farm labourers back in their communities, without their usual employment. A new building with industrial workshops opened in

152   REM EM BRANCE OF PATI ENTS PAST

1892 and was intended to remedy this unemployment.39 Mimico, from 1888 to 1894 and later on Whitby, from 1912 to 1917, served briefly as replacement farms with inmate labourers sent from 999 Queen Street West. But after these facilities were separated from Toronto they no longer served as branch farms. While the reduction of land was not so dramatic during the twentieth century, it was slowly whittled down to 20 acres, most of which were taken up by buildings, as only three acres are listed as being set aside for the cultivation of fruit and vegetables by 1940.40 For the first time, women patients were recorded as being allowed to do outdoor labour at Toronto when an acre of ground around the female infirmary was used as a vegetable garden in 1918.41 These women would have been a tiny minority of the overall female patient population, and were quite privileged in this regard. Males allowed to work outside were among the most privileged in the asylum, as they had fresh air on a regular basis and a better diet, which was provincial policy for outside labourers by 1907. By this time, 40 per cent of all patient workers across Ontario toiled outside.42 A decade later, Ontario hospital dietary guidelines stipulated that employed patients were to get one extra egg for breakfast, though it is not clear if this included both men and women. Perhaps the most unorthodox reward given to working patients during the entire 1870–1940 period was that some inmate labourers, most likely males, were given beer at Toronto in the late 1870s, though Inspector Langmuir had advised against this for financial reasons.43 Working inmates who were being prepared to return to the community were also granted certain privileges. Female patients employed as domestic servants at the residence of the Superintendent were allowed to receive dinner at his table rather than with other patients. They were eventually to be released back to their families and so were given domestic duties in this setting to make them more ‘tractable and contented’, according to Commissioner Noxon.44 After 1911 some male patients were allowed to return to work outside the asylum, though they continued to reside inside the hospital until it was decided that they could leave.45 Besides gender distinctions, class status prior to confinement was reflected in the types of jobs patients had in the institution. It was not uncommon to link inmates to jobs with which they had had previous experience on the outside, a practice that improved efficiency and reduced the need to train inmates.46 Mabel I., considered a ‘good reliable patient’ who was regular at her laundry job, had also been a domestic worker prior to confinement. Edward D., a cabinet-maker,

PATI ENT S ’ L A B O U R    1 5 3

worked at the paint shop well into his seventies. Stanley L., a shoemaker before admission, was employed on a daily basis in the shoe shop. Wallace S. was listed as a general labourer at the time of his admission in 1888. In 1926 it was noted that this 66-year-old man carried coal to various fireplaces and had been doing his ‘routine work’ in the same manner for nearly 40 years at 999.47 This internal class system also manifested itself in another significant manner: the transferral between institutions of inmate-labourers. In 1909, following a request from Inspector Armstrong for two inmate-labourers, Dr C.K. Clarke transferred two brothers, Daniel R. and Egbert R., to the recently opened facility in Penetanguishene; both of them, he said, were ‘good workers’.48 Later that same year Clarke sent ‘four good working patients’ to this same facility, two men and two women. In the case of one of these inmates, Aline P., Dr Clarke thought that since she spoke only French she would be better employed in Penetanguishene, where she would ‘be likely to get more companionship in that district than here as we have very few patients of this nationality.’49 A few years later Wilfred S. was presented at a medical conference to determine whether he was suitable to be sent as a worker to a ‘bush farm’ at the Orillia Hospital for the Feeble Minded. He was transferred there in 1911 after 14 years at 999. Another patient was sent to Orillia a few weeks later. The reasons given to the brother of Geoffrey P. indicate that this transfer was seen as therapeutic for the inmate. Dr Clarke stated that farm labour at this facility would do Geoffrey good because it would ‘show that he is capable of concentrating his mind on some work.’50 Patients considered to be reliable workers were clearly valued by administrators. Dr Wilson of the Cobourg institution for women asked Dr Clarke to send him such an inmate, as ‘we are over run with noisy non workers.’51 Clarke complied a few days later. In one case there was a dispute between two institutions about who should get a particular inmate. Francis F. was a 31-year-old patient when he escaped from the asylum in 1908. Several months later he was locked up for vagrancy in the Central Prison, ironically, just several hundred yards south of the asylum. When his former status as an asylum inmate was learned, a series of letters went back and forth between Dr Clarke, Warden Gilmour, and Inspector Christie about whether prison was the proper place for Francis. In the midst of this dispute, Warden Gilmour provided a rare glimpse of how asylum work contrasted with that of labour in a prison. The warden claimed this man was very industrious, a point that Clarke supported. To bolster his argument to keep this man, Warden Gilmour used what he

154   REM EM BRANCE OF PATI ENTS PAST

said were Francis’s own words comparing work at both institutions: ‘The regular work with the machines in the [prison] factory was much more interesting than making up beds and choring around the asylum.’52 Francis remained in prison. Whether or not Francis did in fact say this can never be confirmed, but it does illustrate the importance attached to retaining valued workers during this period. In another, related episode, lack of skilled labour outside the institution caused a former employer to ask for one of its workers back. James W., 43, had been confined for less than seven months when in 1900 the Booth Copper Company of Toronto wrote to the hospital for the second time asking if he was ‘sufficiently recovered’ to be released and returned to his old job as ‘we are anxious to obtain his services, coppersmiths being very scarce.’ Daniel Clark responded that he was not well enough, so James remained confined until his death in 1928, long since forgotten by his former employers, as he was friendless at the end. James spent his institutional work life with the tinsmith and informed staff ‘he would much rather work than lie idle.’53 Some patients tried to create their own internal economy for selfsupport. Evelyn M., a former domestic servant and patient on a public ward, worked regularly in the laundry. She would steal other people’s clothing and remake them into her own style, thus hoping to improve the drab institutional garb with which she was provided.54 This sort of patient-initiated effort regarding clothing was not unusual. In 1916, Superintendent Forster noted that some patients, such as Andrew H., took matters into their own hands. It was sometimes difficult to get inmates to wear the clothes they were given ‘as many of our patients will trade and exchange clothing without consulting us.’55 An even more direct example of this is Laura L., who was confined at the age of 40 in 1902 until her death in 1919. Described on admission as a ‘spinster’, this woman spent her time ‘at fancy work, can make very pretty collars and cuffs, table centres, handkerchiefs, etc. with honiton braid . . . shows it to the best advantage by placing colored paper at the back of it.’ There was a reason for this careful display besides pride in one’s ability. Laura had earlier tried to make some money by asking people in the hospital to buy her work.56 The self-sufficiency of these patients shows how some inmates tried to provide for themselves rather than feel obligated to wait for others to provide for them through the expected process of working for one’s board. The therapeutic component of institutional work continued to be promoted by officials throughout the first half of the twentieth century, and so, too, did the economic benefits to the provincial hospital

PATI ENT S ’ L A B O U R    1 5 5

system. In 1928 labour was touted as being of ‘real healing value’ and patients did much of the work in ‘various trades’. In 1934, inmate labour contributed ‘in a very practicable way to the upkeep and maintenance of hospital grounds, industries, wards, etc.’ and also contributed to the physical and mental health of patients. Building projects were mentioned during the 1920s and 1930s, such as the reconstruction of the laundry in 1928 to allow for more light and air, though there is no reference to the involvement of patient labour. Superintendent S.R. Montgomery reported in 1941 that patients worked in many of the same areas that had been established during the late nineteenth century. This included wards, kitchens, dining rooms, the laundry, shoe repair shop, carpentry shop, paint shop, and garden, all of which he claimed were supposed to be therapeutic.57 Provincial statistics on labour are absent for the two decades preceding 1927, and when these figures reappear it is only for a decade and with much less detail than for the earlier period for which evidence exists. Nevertheless, these statistics, as reproduced in Table 9, reveal that the decline in employed inmates at Toronto, which began in the early 1900s, continued during the intervening years. With the exception of 1928, never more than half of the hospital patient population was at work during the 1927–37 period, a figure that dropped below one third by 1931 before picking up during the following six years. The 11-year average was 41 per cent of patients employed, a notable decline from the 55.33 per cent employed in 1905 (Table 5). The most glaring feature of these later figures is their consistency with the earlier set in regard to a gender bias favouring men patients. The earlier figures do not afford a precise breakdown of how many men and women worked at every specific job, except where there was gender exclusivity, though they do show how many workdays were done by both in comparison to the general population. The statistics from the 1920s and 1930s, while less detailed in types of work and offering no workday breakdown, show exactly how many women and men worked overall. Without exception, women patients were consistently underemployed in hospital labour between 1927 and 1937 in comparison to men and to their percentage within the overall patient population. The closest was an 8.5 per cent difference in 1930, but this disparity had been 52.8 per cent two years earlier. For the 11-year period, 41 per cent of the entire inmate population were employed; 54.66 per cent of all male inmates worked at one time or another, while only 29.5 per cent of the total female population were occupied with hospital labour ­during this same period. As with previous decades, women were concentrated in inside work, with the industrial occupation category being



Industrial work Farm and garden External work Internal work Total patients employed

F. M. F. M. F. M. F. M. F. M.

Total

1927

1928

1929

1930

30 40 — 30 — 60 75 70 105 200

30 16 — 30 — 150 100 100 130 296

45 10 — 25 — 50 95 90 140 175

96 24 — 30 — 30 124 140 220 224

305

426

315

444

% employed of all patients

F.

23.38

28.07

28.68

45.17



M.

48.78

80.87

44.19

54.76

35.50

51.38

35.63

49.55

Total No. of patients

859

829

884

896

156   REM EM BRANCE OF PATI ENTS PAST

Table 9 Types of Employment by Occupation and Gender, Toronto Hospital for the Insane, 1927–1937

Table 9  (continued)

F. M. F. M. F. M. F. M. F. M. F. M.

Total % employed of all patients F. M. Total No. of patients

1932

1933

1934

1935

1936

10 40 — 30 25 20 12 30 60 60 107 180

— — — 45 — 25 10 39 139 100 149 209

43 10 — 45 — 25 10 35 129 183 182 298

45 30 — 35 — 60 7 35 118 118 170 278

42 40 — 30 — 45 7 35 102 123 151 273

40 45 — 36 — 35 6 40 105 200 151 356

45 25 — 40 — 30 5 45 105 100 155 240

287

358

480

448

424

507

395

22.33 43.79 32.24 890

29.21 49.29 38.32 934

35.27 64.92 49.23 975

31.42 57.31 43.66 1,026

27.60 51.90 39.51 1,073

27.06 62.23 44.86 1,130

1937

26.31 43.32 34.55 1,143

source: Annual Reports, 1927–37. Categories listed as cited. Does not include occupational and vocational classes or ­‘special occupation’.

PATI ENT S ’ L A B O U R    1 5 7

Industrial work Farm and garden Utility staff House-keeping, kitchen Ward work Total patients employed

1931



1931

1932

1933

1934

1935

1936

1937

Total

Vocational

F. M.

— —

33 10

— 10

— —

— —

— —

— —

33 20

Occupational

F. M.

110 11

57 30

73 25

55 10

76 10

94 15

80 12

545 113

Special Occupation

F.

—

—

—

—

—

—

—

Occupation

M.

—

2

2

3

2

6

3

18

Total

121

132

110

68

88

115

95

729

Total

578 151

source: Annual

F. M.

79.29% 20.71%

Reports, 1931–7. These statistical categories are not listed in earlier or later reports.

158   REM EM BRANCE OF PATI ENTS PAST

Table 10 Vocational and Occupational Classes and Special Occupation, Toronto Hospital for the Insane, 1931–1937

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laundry jobs, while men still had sole preserve of farm and garden labour, even though this was far reduced from the earlier period. In spite of the 1918 report of women working outside the infirmary it does not appear this practice continued for long. The overall decline of inmate labour may have been partially due to the general increase in patient population by the 1920s and 1930s, with fewer jobs available and most choice of work going to men. However, a clearer explanation is offered in Table 10, which lists attendance at vocational and occupational classes between 1931 and 1937 and an unspecified ‘special occupation’ category, again an area reserved for men only. Women comprised over 79 per cent of patients engaged in these classes, so that a significant number of women who would have been previously employed within the internal labour system were shifted to non-labour classroom work by the 1930s. Thus, institutional labour practices were supplanted in part by occupational therapy programs primarily involving women during the last years of the 1870–1940 period for which statistics are available. Andrew Scull has written that the actual employment of patients in nineteenth-century British institutions was far removed from the therapeutic aims of the architects of moral therapy. In reality, work allowed institutions ‘to run more smoothly and more cheaply’.58 Considering the fact that Toronto was primarily a chronic-care facility where employed patients worked for years, even decades, the therapeutic achievement appears negligible in contrast to the financial gain, a dual goal that was proclaimed from the earliest days by hospital officials in Ontario. The lack of official optimism in the belief that work was in fact therapeutic is palpable in the much more muted references to this point in annual reports during the period after the early 1900s. Peter McCandless has noted that by this time in the United States greater pessimism had developed towards work and leisure therapy, as moral treatment gradually declined while asylum populations grew.59 A greater emphasis was placed on the physical basis of insanity by physicians who looked to Emil Kraepelin rather than William Tuke for their ideas, which explains in large degree why work therapy, though still proclaimed, was no longer emphasized as strongly by Toronto’s superintendents after 1905, when Daniel Clark retired. Yet when the subject was broached, the claim that this work was therapeutic was trotted out like dogma, as with Superintendent Montgomery in 1941, cited above. This perpetual claim that patient work was therapy can be seen as the sort of self-serving rhetoric that doctors used to offset criticism of mental hospitals as a dumping ground where patients were left to ‘rot’ year in and year out, warehoused in abysmal conditions.

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In effect, putting patients to work for years could be seen as a way of claiming that inmates of the institution were contributing to their upkeep and were not a drain on the public purse, as had been argued since the days of Daniel Clark in the late nineteenth century. ‘Therapeutic’ could therefore just as well mean ‘therapeutic’ for the hospital’s public relations and finances as for the people work was supposed to help, at least in theory, and who received no pay for their toil. However, as will be seen, some family members and some patients themselves could see through this thin veneer of medical selfjustification and questioned the intensive drive to make patients work for nothing. In so doing, they exposed unpaid patients’ labour for what it was: exploitation. With an ever-increasing inmate population, work as therapy seemed less a promise to cure insanity than an effort to keep in place a decades-old patient-labour system that reduced internal costs. What patients felt about this ‘therapeutic’ work forms the remainder of this chapter.

Labour and Compensation Ellen Dwyer’s study of patient life during the nineteenth century at two asylums in New York state highlights the need for more patients’ perspectives on this subject. After describing the contemptuous views of one assistant physician towards employed inmates, Dwyer wrote that ‘no one knows’ what patients thought of work as therapy.60 To the contrary, inmates thought a great deal about the place of institutional work in their lives. While mental patients were not paid for their labour, it is important to recognize that some patients raised the issue of compensation with staff and family members. This happened during and after confinement and reveals how unpaid labour was not something that all patients accepted without question. And money was not the only way in which some inmates tried to have their labour rewarded, though the most clear-cut examples of patients asking for some form of compensation are of women and men who asked for a wage. The manner in which the comments of one such inmate were recorded also helps to reveal something about official attitudes on this subject. Josie B. had been confined for just over seven years, during which time she had been employed in the laundry. In 1913 the file for this 33-year-old woman records an observation that speaks volumes about how some inmates advocated on their own behalf: ‘She is constantly demanding her wages and by her conduct and conversation shows that she does not realize her position as an Asylum patient. She

PATI ENT S ’ L A B O U R    1 6 1

seems to think she is employed here and is not receiving her pay.’61 These comments are aimed at driving home the point that Josie’s desire for compensation was a sign of her insanity, of Josie being mentally unstable because she is making supposedly irrational demands that are completely out of place with her status as a patient. Yet, this observation can also be read as the unintended record of an inmate putting forward claims that many contemporary union organizers and advocates of women’s rights would have seen as entirely justified had Josie been working outside the asylum. The fact that her ‘position as an Asylum patient’ prevented her arguments from being taken seriously by medical officials illustrates how inmate labour was exploited and discriminated against, and some labourer-inmates recognized and protested this exploitation. For Josie there would be no compensation—she died two years after these comments were recorded. While she was still alive, her ability to stick up for her rights made quite an impression on at least one other inmate. In 1910, after her own release, Elaine O. had written a plaintive inquiry about this laundry worker: ‘What about Poor [Josie] B__ . . . to think you cant give any one like her what her mind and ability requires her to have with out fighting’.62 A male inmate made similar requests and eventually convinced himself that his demands were met. Jonathan T. was confined from 1890 to 1930, when he was discharged at the age of 78. During most of the last 20 years of his residence, he was reported to have worked faithfully in the kitchen, but it was also noted on several occasions that Jonathan had definite ideas about getting something for this work. In 1927, he told physicians that he deserved ‘a large sum of money for his services’. A few months later, Jonathan was recorded as having a delusion that he had been given a total of $7,000 for work at 999, which of course did not occur.63 By deluding himself in this way, this elderly man was ‘rewarding’ himself for work that no one had paid him to do. One inmate turned this question upside down by believing she had to work to earn her keep, just as the administrators stated. Enid W., a schoolteacher, was said to have a ‘mania to scrub floors’, which she believed was required of her to pay for the institutional clothing she received.64 Even a patient who did not work on a regular basis was known to ask for payment after taking on an occasional task. Constance B. spent the last 20 years of her life at 999 until she died in 1926. On one of the few occasions when she is recorded as having done institutional work, this 76-year-old woman had dried the dishes for several days after which ‘she asked the nurse how much she would get for it.’

162   REM EM BRANCE OF PATI ENTS PAST

It was also noted that she was ‘too deaf’ to understand what was said to her, so while she was able to communicate her feelings to staff, she was unable to hear any response to her compensation request.65 There is no record of Constance doing any other work during her last years. Another inmate understood there would be no monetary gain prior to doing any hospital labour and decided on a course of action beforehand that settled matters quite definitively. Fifty-seven-year-old ­Marianne B. refused to work at 999 since she ‘is not paid for working in an Asylum’.66 This German-speaking woman, who was first locked up in 1902, remained confined until her death in 1920. Marianne’s insistence on getting paid raises the issue of the decline in class status among patients who did work. Patients from a middle-class background, like Marianne, would have seen their class position decline within the asylum if they did work that they saw as ‘below’ them and with which they were unfamiliar. Yet, there can be little doubt that not getting paid translated into a decline in class status for people of all backgrounds in the hospital, as a seamstress or a carpenter did not work for free in the community. Asylum inmates would have known that the lowest-paid unskilled worker outside the mental hospital received more pay than did the most skilled professional patientlabourer inside the asylum. Regardless of the type of work they did before admission, one common feature that all patient-labourers would have experienced was to have had the value of their work diminished as being not worthy of getting any financial compensation, a sort of universal process of further grinding down the class status of everyone in the patient workforce. The compensation requests made by patients can therefore be linked to a desire to maintain some sort of dignity as workers who deserved to get paid a wage, just like out in the community. The most thoroughly documented case of a person seeking financial compensation was of a patient who had left 999 Queen Street West only to write back to advance her cause. Mary A. was 60 years old upon her release in 1911. After leaving under the care of her husband, she wrote letters sporadically to asylum officials, notably in the first few months after returning home in 1911 and again 11 years later. Among other things, these letters reveal her memories of working in the laundry during her confinement, which began in 1894. In one of her first letters a few weeks into her probation, she wrote that she had been ‘hoping it will be alright and that after being a hard worker in the building for 17 years I could have an extended leaf of absence. . . . I have had no holiday.’ A few days later she wrote, ‘if I could do the work I used to I should not feel so bad because I know full well that every body has to do a certain amount of work for their living.’67

PATI ENT S ’ L A B O U R    1 6 3

At this early stage of her post-asylum life, Mary was still unsure about whether she would be allowed to stay out permanently, and was initially trying to justify her release, which the doctors had reluctantly consented to as a reward for her labours. Her second letter also shows how this work was something she felt obliged to do as part of a wider community. Yet, as the years went on and it became clear that she and her husband, Henry, would be able to live out their final years together as they had wanted, Mary became bolder when addressing this issue. Why she decided to take up the cause after so many years of apparent silence is unclear, though it could have been due to her husband’s retirement and the need to obtain more money. The following excerpts say something about how important obtaining a just settlement was for a former patient-labourer at 999. In 1922, over a decade after being discharged, Mary again wrote to her former doctor, who was by this time Medical Superintendent Harvey Clare. In these letters she requested compensation for her years of work at the institution. [W]ord was sent to me while I was in No. 7 ward that I was to earn my own living[.] now why should a married woman earn her own living. . . . every body that earned money received theirs but [I] received none but was kept a prisoner not aloud to go out any where[.] now in 1910 a Mrs. M__ an insane woman pushed me over after I came from my work + I received a compound fracture of the leg + hip that was when I had to quit my work which I always did. . . . now don’t you think that the money I earned should have been sent to me when I came to live at 16 __ Street. I want it. Please will you send me word why I did not receive it.68 The references to the year in which an attack by a specific inmate took place are corroborated in the clinical record.69 Mary was released a year after this assault thanks to her husband’s persistent support. In response to this letter, Dr Clare wrote that she should not worry about a job: ‘I think you have done your share of work in this world.’ Undaunted, Mary again wrote to Dr Clare about compensation a few days later. When I asked for information from you I knew how much I had earned while working in the asylum[.] I earned a pretty good amount at 3 dollars a week that is for the 17 years imprisonment it was 1248 dollars[.] I really think a little should have been sent to me by the paying clerk when I left the asylum every month say about 25 dollars. Now Mr. A__ has . . . retired . . . so we require every cent we can get[.] you will not work for nothing you want yours and know where to apply for it which I don’t .70

164   REM EM BRANCE OF PATI ENTS PAST

After no response was received she wrote again to Dr Clare asking him to acknowledge her inquiry and requesting her letters be shown to the ‘new Mayor Mr. Maquire and the new Magistrate to see what they can do for me’. Clare apologized for not responding sooner, noting that he had been ill, acknowledged her concerns, and concluded, ‘You must not worry about anything, just leave it in my hands, trust in me and I will do all I can to make the matter right.’ In her final surviving letter, Mary wrote that she wanted this issue settled before her death: ‘if not done quickly I shall not need anything it will be too late.’71 There is no further correspondence in her file on this matter, and just over a year later, in May 1923, Mary A. died, never having received the compensation she had requested. Besides wages, patients asked to receive some official reward for their work in other ways. A contemporary of Mary’s in the laundry had similar feelings about the practical worth of her labours. Jane F. had been a domestic servant prior to confinement in 1895. In 1909, it was noted that Jane believed she did ‘more work than any twelve people’ at 999. Two years later, she wrote to her sister: ‘I have worked in the Laundry for 13 years so I think I ought to be able to come home. . . . I hope we will meet in heaven.’72 In effect, Jane was asking to be ‘retired’ from her job by having her sister take her away from her workplace. Her wish was never granted, for just over a month after she wrote these words, this 67-year-old woman was dead from epileptic exhaustion. Another inmate who made a similar request was more fortunate, at least over the long term. Elsa W. was admitted to the asylum in 1898 at the age of 44. She was reported to have worked about the ward doing house-cleaning tasks. Like Jane, she felt that her work entitled her to be let out, which she made clear in a letter to Dr Clarke in 1909: If it is required of me to give you a written resignation I wish to do so now. It seems to be the general impression that I have taken up a permanent position here, which I never intended to do. . . . While here I have tried to do my true duty to God + my neighbor to the best of my ability. I wish you to understand that I wish, from this time, my release from this institution and my self-imposed duties, which I tried to do in the true spirit, hopefully awaiting my release.73 Elsa would have to wait over five more years to get the freedom she felt she deserved. Significantly, her reference to ‘self-imposed’ duties suggests a degree of choice in her work that other inmates did not record. It is also clear that she believed her work should improve her chances for discharge.

PATI ENT S ’ L A B O U R    1 6 5

Her views in this regard underline how much the labour system at 999 relied on very little real choice for most patients. When they were not being forced to do jobs, patients were subjected to other pressure tactics to get work out of them. This was no benign work-as-therapy program that inmates freely chose, as most patients were expected to work whether they ‘applied for a position’ or not. As Elsa’s letter indicates, this was a labour system aimed at a literally ‘captive audience’ in which there was a none-too-subtle point that if a patient worked his or her chances of getting released were better. The psychological influence that this hoped-for liberty had on people like Elsa was used by medical officials to exploit inmate labourers by dangling the carrot of release, all the while using the stick of unpaid work as therapy to get more work done around the building at the cheapest cost possible. For most inmates for whom evidence on this subject exists, compensation requests meant what they do for most people: wages. But for a minority of others, years of work could also be used as a way to barter their way out of the asylum. None of the people mentioned above received what they had been asking for in the way of compensation for their work, other than Elsa, and in her case her barter suggestion made no apparent impact as she was released long after writing to Clarke, by his successor as Medical Superintendent, Dr Forster. However, these requests show that patients tried to explain to themselves and to others the need for some form of tangible gain from their hospital work. In so doing, they were telling their contemporaries that their labour should not be taken for granted. Perhaps the most poignant example of an inmate using her labour to extract some form of compensation is Violet N., who was 68 years old at the time of her death in 1922. Abandoned by her husband, she had been confined since 1889. Dr Vrooman, one of the more thoughtful physicians at Queen Street, wrote the following testimonial to her years of labour after she died: This poor old lady has been here 33 years, and to my certain knowledge for 12 years, and I do not know how much longer, she has worked willingly and faithfully and has done all the drudgery and unpleasant tasks about the admission ward. She was very jealous of her duties and was very displeased if anyone else was allowed to do any of her work; I may here state that as far as I know there was practically no rivalry for the position. The only thing that she ever asked was to have a little fruit, which she seemed to enjoy. . . . She finally died from diabetes after a short illness. . . .

166   REM EM BRANCE OF PATI ENTS PAST

She was a strong, deep chested, thick woman, weighing about 200 lbs. She had always been robust and it was rather pathetic to hear her say that she couldn’t understand it, that when she wanted to get out of bed her legs would not hold her up. She was buried by the hospital. Although it is not likely that anyone will ever read this account, as she was friendless, I thought I would like to write a record of her faithful services.74 For someone as isolated as Violet, her work was compensated for by what would seem like a small pleasure to most people on the outside: ‘a little fruit’.

Labour and Self-Esteem For many patients at 999, labour not only kept them occupied but was also closely tied in with their feelings of self-worth as contributing members of the community of which they were a part. As the following accounts indicate, certain designated tasks were taken very seriously by men and women whose lives often centred on their jobs. Theodore F. was confined at the age of 19 in 1898 and remained at 999 until his discharge in 1940. For years this man worked in the laundry and basement, but he was particularly proud of one task—his daily trip to a store across from the Queen Street facility to collect newspapers for the staff, as well as mail and to accomplish other errands. It was noted that ‘He looks upon this as a very important part of his day’s work.’ In the fall of 1926, Theodore became ill and was replaced by another patient in the daily newspaper trip. After recuperating, another man with whom he worked at the laundry forbade Theodore to resume his old paper route, which, according to his sister, he missed very much because it was a ‘pleasure and a little diversion’ for him. His clinical record notes that by early 1927 he was given back this particular job, following requests, as it was ‘about the only interest’ he had. Theodore kept this job until December 1933, after which date no further references to it are made, most likely due to pneumonia and bronchitis that incapacitated him for 10 months beginning in January 1934. After recuperating from this severe illness, he was transferred out of the laundry department, due to a lung abscess, and was instead employed, from 1936 to 1939, taking care of the rats and guinea pigs that the hospital kept for medical tests. He did this until just before his release.75 Walter G. was confined from 1898 to 1950, when he was transferred at the age of 75 to a retirement home. From 1926 to 1950 officials wrote that he was employed in the bake shop. At one point it was

PATI ENT S ’ L A B O U R    1 6 7

Mathilda K. a few months before she died. A patient for 40 years until her death at the age of 76 in 1938, she worked in the dining-room and laundry (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

observed that he took a great interest in his work, but in little else.76 Mathilda K. spent her last 40 years in the asylum until her death at the age of 76 in 1938. Like Walter, she was without financial support throughout her residence and so was a prime candidate for working to earn her board, which she did by daily toil in the dining-room and laundry. Her self-esteem in regard to this work is evident in a number of observations about her conduct and views towards institutional labour. This diminutive woman, whose weight was listed only as high as 90 pounds, stated she considered herself a paid employee at 999 and was very protective of her duties, chasing any other patientlabourers out of the dining-room where she worked to keep them from assisting her. During the last year of her life, Mathilda’s job was cut back due to her age, ‘to which she objects and she has become more disagreeable’.77 Sandra T., confined in 1903 at the age of 38, spent the last 29 years of her life at the Toronto institution as a free patient. Six years after admission, this black woman made references to white people being

168   REM EM BRANCE OF PATI ENTS PAST

her enemies and how she needed to protect herself from them by keeping a weapon under her mattress on the ward. From 1909 until 1922, Sandra is recorded as having been a regular worker in the asylum laundry. Yet, while she was known to ‘curse’ staff when they made their rounds during this period, when employed at her daily occupation she ‘seems to be happier there than when she is in the ward’. Similar positive feelings that she clearly had towards her laundry job are mentioned when Sandra was forced to stop work due to cataracts over each eye, which eventually led to blindness during the last decade of her life. When this happened in 1922, Dr Vrooman recorded that Sandra ‘feels rather depressed about having to stay on the ward, but understands why she cannot go to the laundry.’78 Feelings of self-esteem were expressed in concepts of ownership towards certain positions an inmate had been holding for years. A waitress before admission at the age of 30, Edna B. had been confined for 13 years when it was recorded that she claimed to be a housekeeper at 999 Queen Street West. Considering the tasks she was recorded as having done, this is an accurate self-description. Her ‘rough work’ included scrubbing, washing dishes, making beds, assisting with the bathing of patients, and working at the nurses’ residence. Edna was especially interested in this latter job. Her clinical chart shows that when she was sick in the infirmary for a week in 1921, she asked ‘if everyone is well at nurses home and says she would like to be back to work.’79 For lonely inmates, work and the sense of purpose it gave could help to pass the time and give a feeling of self-worth. Mary M., an elderly free patient, was not known to have any visitors except when her daughters came at Christmas. Isolated from any regular outside support, she was said to be ‘not of much use’ as a labourer, even though she liked to do ‘odd jobs’. Considered a ‘quiet old lady, quite stupid and rather frail’, she worked with a staff member and helped by dusting on the ward until her health began to decline.80 The impression is of an elderly woman who wanted to do some household work as a way of feeling better. Perhaps such duties allowed a friendless patient like Mary to cope with her loneliness. An older working-class patient like Mary brings to light the emotional meaning of work. Work was linked to experiences outside the hospital, where there was nothing uncommon about working-class men and women toiling into their most senior years as a way of surviving in a world with very few retirement pensions. This would have been so even during the 1930s, let alone in the late nineteenth century, when patients like Mary were younger and would have seen elderly people toiling for their livelihood in the ­community. Thus, for

PATI ENT S ’ L A B O U R    1 6 9

some of these older patients, to work was to survive, emotionally as well as physically. Another patient believed his labour, while not essential, was nevertheless too onerous for others, so he needed to stay at his post. Fifty-six-year-old Warren S. stated that while the laundry could get along without him, ‘it would be a trial on the hospital staff if he left’, as he claimed it took three men to do his job.81 Audrey B. represents perhaps the most vivid personification, among the people discussed here, of how an inmate’s self-esteem became so thoroughly wrapped up in institutional work that there seemed nothing more important than getting back on the job. Confined at the age of 39 in 1905, this former domestic servant remained at 999 Queen Street West until her death in 1946. During this fourdecade period documents show that, with the exception of several years in the mid-1920s when she was working in the men’s diningroom, Audrey worked almost constantly in the asylum sewing room—from at least 1910 until early 1943. Her views towards labour and self-worth are brought to light in a number of comments, particularly during the latter years of her institutional work life. The earliest comments, in 1910, state that she was ‘very dissatisfied’, and five years later Audrey was said to be ‘negativistic’ to those around her. By 1927, when it was noted that she ‘never misses a day’ in the sewing room, she had changed from her previous mood to become quiet, except for repeating comments about ‘my wonderful self’, as well as about how much people wanted to be with ‘such a lovely lady’. Unlike her previous demeanour, 67-year-old Audrey was not reported to be resistant and was even known for her wit, as when a physician asked her age: ‘ “I guess I’m 300 or 400 years old.[”] When asked if she wasn’t 600 years old, she said “Gracious what do you think I am, people just don’t live that long.” ’82 Throughout this alteration in character, she worked daily in the sewing room. As she grew older, there are references to how this job seemed to affect her, ‘where she is more content than when left on the ward’. After a brief illness, Audrey became upset at missing sewingroom work, where she felt she belonged ‘to see how things are getting along there’. At the age of 72, she still went every day to her old job, at which Dr Howitt said she was extremely skilled. The following year, in 1939, a clinical entry noted that Audrey literally worked to exhaustion, wearily leaning over her sewing machine, and so was put to bed, but she was back on the job within two weeks ‘because she insists on going’. As her health became more fragile, Audrey was frequently kept on the ward, about which she was very unhappy, standing by the door asking to go to work:

170   REM EM BRANCE OF PATI ENTS PAST

Audrey B. in 1937 at the age of 71. Confined from 1905 until her death in 1946, she worked for more than 30 years in the asylum sewing room (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

She works regularly in the sewing room making underwear. She is under some pressure of activity and if she is not allowed to go to the sewing room to work at what she has done for the last thirty years, she will pace up and down and will ask why Miss Bowden does not come for her.83 Audrey’s persistent campaign to be reinstated at her old job was successful—she was allowed back for half-days in the sewing room in the spring of 1941. At this time she also worked in the kitchen after meals. The last references to her sewing-room work are from early 1943, when Audrey would have been 77. It is apparent from the evidence that the last few years of this labour were more sporadic than in

PATI ENT S ’ L A B O U R    1 7 1

the period up to 1940. It is also evident how much the work meant to this isolated woman who had no visitors. Fifteen separate entries in clinical records and charts during these last few years note that Audrey repeatedly asked to be allowed to go back to the sewing room: ‘asks frequently—who is working in the sewing room + why can’t I go.’ As she became increasingly confused about her surroundings and her health deteriorated, Audrey spent her last three years up to her death in 1946 away from the job to which she had become so devoted after a lifetime of institutional work.84

A Tale of Two Accounts: Mabel M.’s Institutional Labour Obtaining a clear idea about what asylum work was like for an inmate is made more difficult by the lack of firsthand accounts or of perspectives from people outside the asylum walls. While documentary ­evidence, such as for Audrey B., indicates overwhelming eagerness to work, just one letter from a non-medical observer can throw this whole picture into question. Perhaps this is best illustrated by the contradictory accounts provided in medical documents and in a letter from the daughter of Mabel M. This material also shows the vast amount of labour an individual inmate could do while confined as a long-term patient. Mabel M. lived for over four decades at 999 Queen Street West, beginning in 1904, until her release at the age of 83 in 1947.85 For over 30 of these years, from the first reference to her labour in 1912 until the last such work-related observation in 1943, it is possible to follow this abandoned wife and mother of two daughters as she kept constantly occupied in the daily tasks of the hospital. For this patient, her work was something in which she seemed to take great pride. It is also evident that this work was not moderate or light. Eight years after her admission, it was noted that Mabel worked every day ‘galloping over to the laundry like a child of eight’, though a few weeks later it was also recorded that she dusted and swept around the ward. Her laundry work was observed repeatedly over the years; in 1922 Mabel was noted to be ‘one of our good machine workers’, indicating her duties were to operate the washing machine, while others sorted and pressed material at this place of employment. She continued in this job until 1925, when she was 61. Then this ‘garrulous old woman’ was reported to keep busy by working on the ward. By late 1927 she was toiling in the dining-room, and two years later she was ‘always busily engaged’ in the ward’s diet kitchen. By 1932, then 68-year-old Mabel was again complimented on her hard

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work, this time in the kitchen, where she had taken ‘complete charge’ and kept everything ‘spick and span’.86 Time and again, her colourful personality was remarked upon. This ranged from her ‘remarkable’ knowledge of local gossip, which she was ‘only too ready to repeat’, to her reputation as the ‘greatest talker’ at 999, sounding ‘like a phonograph’. Another time she ordered the staff to Kingston Penitentiary, giving the impression that she saw herself as ‘the most important member of our community’. At the age of 71 she still kept the kitchen in good shape and four years later she was again said to be ‘an excellent worker’. Mabel put her ward cleaning work to personal use where she slept, with characteristic flair. In 1941 she placed three mouse traps under her bed, which she said ‘were for the three blind mice’.87 But her age was telling on Mabel’s energetic lifestyle. By late 1941, at the age of 77, her forgetfulness caused her to mix up the laundry, where she continued to do some work, and she was also said to be ‘too old’ to work in the kitchen, though only the year before she was said to have been ‘domineering’ with both patient and staff coworkers. Mabel still ‘insist[ed] on helping about’ in the ward kitchen in early 1942. By the end of that year, ‘each morning’ Mabel went about scrubbing the floor of her dormitory where she slept, though three months later she was said to be ‘sloppy’. In June 1943 she was observed to be very feeble, but still ‘insists’ on working about the ward. This is the last recorded observation of Mabel’s hectic work life at 999. She gradually became disabled, until she could no longer walk by 1945, though she maintained a lively interest in what was happening around her. In 1947, after 43 years in the asylum, Mabel was taken by her daughter, Ivey L., to be cared for her at home during her final days.88 If we look at these decades-long medical reports of Mabel’s work life, it appears that this woman was a willing participant in the labour regime at 999 Queen Street West. This seems so much so that towards the end of her working life, from 1941 to 1943, the references about Mabel seem to hint at a certain reticence among the staff in allowing her to continue working into her late seventies. Yet the only non-­ medical report about her working conditions gives a somewhat different picture, at least in regard to her earlier years of working in the laundry. Ivey L. undertook some rather lengthy and difficult negotiations with hospital officials to secure her mother’s release in 1947. At one point, she wrote a heart-rending letter about her personal life, noting how, as a 10-year-old girl, she and her sister were placed in an orphanage after their mother was confined and their father abandoned

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them. Ivey wrote that her mother refused to accept any items she had left for her at the Queen Street facility, as Mabel said ‘she was working for the hospital and that they should supply her needs.’ Ivey also wrote a particularly revealing passage about why it was so painful not to take her mother out of 999 sooner: It was not easy to have to leave her there, knowing how extremely hard she was working. I have no doubt but that in the resident doctors’ opinion, my mother was better kept occupied, but it was not easy knowing the long hours she spent in the hospital laundry. I have been told by former nurses from the Ontario Hospital, that my mother had to work extremely hard as long as she was able. Thus, what comes across as a somewhat benign labour system in the official medical records appears much more demanding and exploitive when seen through the eyes of Mabel’s daughter and in the comments of this patient’s nurses, to whom Ivey paid ‘sincere tribute’ for their ‘very human interest and understanding’ of her mother.89 This contradictory evidence suggests that while it is possible to follow patients throughout much of their career as unpaid hospital labourers, it is much more difficult to reveal what individuals felt and experienced during years of toil while confined in a large institution.

Conditions of Work Evidence of the specific conditions under which inmates worked, from the point of view of patients or outside observers, is scant. But what does exist reveals the often stressful environment of institutional labour, as well as the mundane nature of such tasks. In the early 1900s, Timothy P., a man in his fifties, wrote about both his work duties and on-the-job injuries: . . . while in that ward [12] I did with alacrity any work I was told to do and this while waiting for the breakfast bell to ring such as sweeping floors, making beds and cleaning the woodwork. More than ten years back I had my spine hurt, helping Johnny D__, who died a few weeks ago, to carry one four seated and another three seated form out of the chapel.90 Records show that in the two years leading up to his death in 1912, Timothy no longer worked because of poor health.91 Whether he stopped working permanently as a direct result of this injury is unclear, though the letter in which this reference is made suggests that he no longer did heavy jobs. In this particular case, the patient’s

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own writing shows he maintained a willing attitude towards his work. However, his comments about on-the-job injuries bring to light the physical strains caused by institutional labour. These strains would have been most obvious among the elderly and those in declining health. Age and frail physical condition, however, did not prevent hospital officials from continuing to employ some patients for as long as possible. Janet C. was 58 at the time of her death. Dr Vrooman paid tribute to her years of work, noting that ‘she was most faithful and efficient in the discharge of her duties in the officials’ dining-room, where she made toast, did any cooking there was to do and generally managed the place.’ Since she had suffered for the last two years from heart problems, Vrooman added that ‘it is a wonder she has been able to carry on as well as she has’ until just a few weeks before her death in 1923.92 The issue of workplace health standards is raised by the following example of an elderly patient who worked for years around paint fumes. Well into his early seventies, Edward D. was reported to have worked every day mixing paints at the paint shop, even after 50 years at 999. It was noted that this old man preferred to lie in bed during the last years of his life, suggesting he was too tired for work at his age. However, the record shows that he continued to work in the paint shop for over four more years. Whether Edward’s health was adversely affected by so many years in the paint shop is not stated in the file. However, in 1925, seven years before he died, clinical reports describe how this man complained of abdominal problems and sickness, which were put down as being due to old age. He worked in the paint shop until September 1931, when he was 72. At this time Edward’s skin erupted over his chest, shoulder, and arm with herpes zoster, or shingles, an inflammatory skin disease that may lie dormant for years. His condition deteriorated and he died in January 1932 of pneumonia and heart problems.93 At the very least, this elderly man’s place of work would not have helped his physical condition, particularly as he began to decline in the mid-1920s, when his file indicates he wanted to rest much more than before. Patients considered seriously mentally impaired but in good physical shape worked so long as they could be directed in their daily tasks. Each of the following people was considered ‘feeble-minded’ and incurable. Theodore R., a farmer, was said to be one of those ‘harmless dements who make useful patients’ by working around the facility. Another such patient, an elderly man named Jimmy M., who had been a tailor and tinsmith, lived in the asylum for over 50 years, where he worked in the basement until his death in 1927. Some of the

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official references to patient labour contain interesting editorial comments on the writer’s view of this work in the wider scheme of things. Farmer Carl M. was 68 when it was noted that his work around the basement allowed him to ‘eke out an existence which, while devoid of most of the excitement and distractions of modern social life, on the other hand presents none of the difficulties of the present strenuous struggle for existence.’94 Yet it is apparent that the emotional toll work could take on mentally distraught patients shows inmate labour could be quite strenuous and was not a refuge from the outside world for some people. As is discussed in Chapter 3, Elaine O., a 40-year-old woman at the time of her discharge in 1910, wrote dozens of angry letters to the asylum authorities about her treatment. One of these letters includes a labourrelated reference: ‘the idea of working a person to death why dont you treat a person according to age and accountability’.95 While there is no indication in Elaine’s letter about what type of job she was referring to, her comment, along with the following example, suggests work was not therapeutic for some patients. Advocacy efforts by May K., the sister of inmate Anne D., are discussed in Chapter 6 in regard to her efforts to get Walter D. of Calgary to pay support for the wife he had abandoned in 1906. May also left behind accounts of her experience with the asylum’s labour regime while visiting her distraught sister. In the summer of 1915 she wrote two letters to Dr Forster on this subject: I saw a little also of the loving care she gets while I was there. the nurse in charge of her came into the room while I was talking with her and told her she ought to be scrubbing the floor. She is not in the asylum to scrub floors but to be taken care of. I insist upon my sister having a comfortable room and proper care in the asylum and given simple tasks that are congenial to her. she used to be fond of sewing and it is perfectly all right for her to do things of that kind, but I will not have her scrubbing and doing all kinds of menial work and I will have Mr. Coatsworth take the matter up with the asylum authorities if it is not stopped and she given a chance for her life and sanity. it is inhuman brutal the way she has been treated there.96 Anne’s institutional work life was very unstable. She was reported at different times to have worked, though her tasks are not specified, and was also said to be ‘not fond’ of asylum employment; at other times she was said to be too distressed to work. Whether May’s letters

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had any effect on this issue is not documented, though in 1925 Anne was said to have washed dishes and polished the floor when she was not upset.97 Jack P., who was confined for four months in 1907, provided about the only picturesque glimpse of labour conditions uncovered for this book, in this case the daily walk of inmate-labourers from their residence to place of work. While his observations begin in a cheerful vein, this writer hints at the deeper sorrow beneath the surface. The female patients who assist in the laundry have just gone over (a procession of many colored gowns, blue, red, even green and white aprons) some with their arms around the female attendants waist, so this is elegance of art where least expected, the slow easy walk—no rush, excitement or competition. But of course all is not as it seems, and I daresay there are many poor broken spirits among them who have such memories of past happiness, and some who cannot quickly catch the passing sunlight, brief tho’ it may be.98 Third-party observations about the physical appearance and clothing of female inmate-labourers provide additional information on conditions inside the laundry, which are less florid than that provided by Jack P. In 1904 a lawyer wrote on behalf of Mary S., the sister of Hazel G., a 52-year-old woman who had been confined since 1892. W.J. Clark wrote to Inspector Robert Christie that the deceased mother of this patient had left enough money for Hazel to be clothed. In spite of this, Mary S. was ‘astonished to find that absolutely nothing had been expended for clothing for her sister, and that she was so destitute of clothing, she had not sufficient to allow her to come out of the wash room where she is kept working.’ Medical Superintendent Daniel Clark responded to an inquiry from Christie that requests for clothing from friends of the patient had previously gone unanswered, but future supplies would be purchased and billed to the estate. He then offered the following glimpse of working conditions for women in the laundry: The patient works in the laundry + when at work we furnish half worn clothing. Her work is to do ironing + it is dry and easy work + is good for her. Over twenty of our women patients are thus employed. None of them work where it [sic] is not new to that kind of work.99 The physically demanding nature of laundry work, especially when lifting heavy irons, raises questions about whether this was

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Alice G. in a 1937 photo, six months before she died. A patient from 1893 until her death at the age of 84 in 1938, she worked with other women patients in the laundry (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

really as ‘easy’ as Dr Clark suggested. What these women workers felt is impossible to say, since they left no firsthand accounts. However, third-party observations about the conditions in which laundry workers toiled, from Ivey L.’s letter about her mother, Mabel M., having to work so long and hard to the above reference from Dr Clark about ‘half worn clothing’ provided for women employees suggest that this was not ‘soft’ work by any means. An observation by the sister of a male laundry worker provides further evidence that working conditions could wear one down. Wesley P. had been confined since 1895 when his sister, Laurie D., wrote in 1912 that her 41-year-old brother ‘looked so pale + thin the last time I saw him. I suppose doing laundry work, he does not get much fresh air.’ Dr Forster responded that Wesley was in good health and that he would see to it that he was well taken care of.100 Two years later this man was discharged after returning to his farming community.

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Medical observations support the contention of outsiders that patients worked very long hours. In 1910 it was noted of 45-year-old Rhonda D. that from ‘morning till night she goes through all sorts of work’, including washing, ironing, cooking, sewing, teaching music, and singing.101 By William Tuke’s definition, moral therapy was to be light in nature for it to have a redeeming effect on an individual’s mind.102 However, it is apparent that this therapeutic approach was less emphasized among able-bodied workers at 999, where a demanding regimen turned tasks into a job like any other outside the asylum. The significant difference, of course, was that there was no pay. Some lower-class patients could be ‘rewarded’ after years of steady work. Usually, this was possible among the most privileged inmates, whose reliability at their jobs was credited by giving them greater freedom to roam. This was most obvious for those patients who could go to and from places of work with relatively light supervision. Jake M., whose pre-admission occupation was listed as ‘huckster’, wrote an undated letter about his various duties while still a patient at the hospital, around 1915, though he was working outside 999: I did not get back on Tuesday night but I did good work on the lawn so Jm. Forester said[.] I trimmed the undergrowth around the trees and I cut all the lawn filled in some of hallow spots in preparation for the seed[.] I raked all the dead chips[.] the other man quit and I have not filled in the gate ways yet as there is no cart there and it would be rather slow work for one man . . . loading the wagon[.] I am going to trim the bushes tomorrow and I am to stay with the contractor at night Jm. Blacklock so please don’t worry. . . . Every day I see a change on the inside of the House. The clinical record mentions that this patient was so trusted and reliable as a labourer that, besides working around the asylum grounds, he was also sent out into the community to work at various homes, including places owned by Superintendent Forster and another physician. He became a source of free labour to work on property owned by medical officials. As a result of these efforts, this 56-year-old man was discharged in 1915 as recovered after 18 years’ confinement.103 Thus, for Jake M. there was a considerable degree of ‘freedom’ related to the type of work he did and the relatively unsupervised conditions under which he was allowed to operate. But this ‘freedom’ still meant being exploited as an inmate-labourer who received no financial compensation. The records also show that this sort of privilege was unusual— most patients remained confined behind the walls of 999 Queen Street

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West for the duration of their institutional work life. More common was what happened to Daniel K., a teacher, who was known as a ‘good milker’ with the dairy cows.104 Ellen Dwyer has mentioned that inmates at the Utica and Willard State Asylums in late nineteenth-century New York only had ground privileges to go to and from work.105 As was mentioned in Chapter 4, a minority of inmates, about one-fifth, or 160 people out of the overall asylum population of 700 to 800, were accorded wide-ranging probation of the grounds in Toronto.106 This would mean that in the late nineteenth century, similar to Utica and Willard, most of the 420 to 480 inmates who worked—260 to 320 people—did not have unrestricted freedom. This is a conservative figure, as records also show that some of those who had ground parole were elderly inmates who no longer worked. So there were probably even more patient-workers than suggested above who had no general parole outside of work. They were escorted to and from work, as Jack P. described women walking over to the laundry. Even those who did have relative freedom to wander to and from the job were subject to loss of privileges should they transgress the rules. This is what happened to Daniel K. who ran away at the age of 63 while doing his job of carrying milk cans around the buildings, only to be returned a few days later. Thereafter, he was put to work in more closely supervised jobs, as a polisher and tinsmith, never getting back the job he had previously held for years and to which he wished to return. Daniel was released to a nursing home three years later to live out the last days of his life.107

Conclusion Inmate labour played an essential role in the lives of patients and in the internal economy of the Toronto Hospital for the Insane. Unpaid labour, and the immense amount of work patients did, saved administrators a very significant, though generally untabulated, amount of money. It is also clear that while patients were housed and fed, some inmates, like Mary A., did not feel that this was adequate compensation for years of work. The devotion to their jobs that people like Audrey B. exhibited also showed how labour could provide a significant degree of self-esteem, especially for the most isolated of inmates. Audrey’s years of toil, like those of so many of her peers, reveal how the asylum environment of social isolation and the emotional vulnerability of a need on the part of the patients to feel they were doing something worthwhile were used by officials to exploit patient labour. At the same time, of course, they did not pay their

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inmate workforce a cent. An emotionally vulnerable, socially isolated workforce was easy to exploit. They were also vulnerable to being coerced into working, as certainly did happen in both direct and subtle ways, as is indicated by what happened to Esther H. and Elsa W. Administrators cited the therapeutic goals of labour into the 1940s. Yet, the constant demands of these labour-intensive jobs, with men and women working as long as possible, meant that patient work was much more intense than any light duties that the architects of moral reform had envisioned. Thus, as the hospital’s labour regime became more entrenched over the decades, the stated therapeutic aims of superintendents became less important than maintaining a system that put the economic well-being of the institution ahead of any idea of work acting as a curative agent for unpaid inmate labourers.

6

Family and Community Responses to Mental Hospital Patients Public Perceptions of Mental Hospital Patients People who were confined in mental institutions were frequently the object of contempt, ridicule, and scorn from those members of the public who had little or no contact with the individuals they judged. Janet Oppenheim has written that men who had a nervous breakdown were looked upon as weak and passive, something that brought them ‘perilously close to the feminine condition’.1 During the late nineteenth and early twentieth centuries, masculine perceptions were based on notions of self-reliance and self-control among the middle class, upper class, and higher stations of the working class. A man who had a mental collapse was judged to be a moral failure and a disgrace, for he was no longer considered a productive member of society, an ironic attitude considering the amount of work men did while confined as asylum inmates. While ideas about manliness evolved during the period covered by this study, the notion that ‘manhood was powerful’ was ever-present, so that those men who ended up in the asylum were further isolated by not being able to take life’s problems ‘like a man’.2 Women were seen as highly unstable because of their reproductive systems and were therefore believed to be prone to nervous disorders more than men.3 As Wendy Mitchinson has noted, associating madness and a female’s body was widely accepted not only among medical practitioners, but also among women themselves, who internalized these views.4 Though popular beliefs held that women were more likely to have an emotional collapse than men, this did not lessen the stigma of confinement, which could be devastating for an individual’s personal relationships regardless of gender or class. However, working-class 181

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patients were especially vulnerable to additional biases. Angus McLaren has shown that during this period in Canada, hereditarian concerns about ‘mental defectives’ were rooted in class prejudices. Proponents of such a view argued that this group represented a potential ‘criminal’ element in society that had to be confined and, ultimately, prevented from reproducing through sterilization.5 The target of the eugenicists was primarily people labelled ‘feeble-minded’, but they also held in contempt those labelled ‘insane’. The belief that people with mental afflictions inherited an illness, passed on from generation to generation, encompassed all variations of diagnostic pathologies. In 1879 Daniel Clark stated that at least 45 per cent of all patients admitted to asylums were there due to hereditary cause, which ‘in the community [means] that it is incurable’, though he cautioned this perception was not always true.6 Nearly 30 years later, C.K. Clarke wrote that the linking of blood relations with insanity was much more difficult to determine than was often assumed by physicians. He also noted that arriving at scientific conclusions about this point was made more of a challenge by families who were reluctant to divulge ‘family secrets’.7 As will be seen, some families went to great lengths to ensure that other members of the community were unaware that their relative was confined in an insane asylum. In their annual reports, medical superintendents expressed their anger at what Joseph Workman called ‘empty-headed’ visitors who came to the wards only to ‘stare and laugh’ at patients.8 To curtail this, Daniel Clark began to restrict ward visits in 1876 to family members and people who could prove a scientific rather than voyeuristic ­purpose. None were more grateful for this check upon sight-seers than a majority of patients themselves. It is often pitiful to see them hiding in corners, closets, bed-rooms, or any other available place when strangers are approaching, in order to avoid their gaze and questioning.9 Up to 1770 public display of people considered insane at places like Bedlam (Bethlehem Royal Hospital in London, England) was common, and the historical memory of such cruelties likely encouraged superintendents at Toronto to protect their charges from similar intrusiveness.10 Robert Bogdan has shown that this sort of ‘entertainment’ was still publicly accepted from the mid-nineteenth to the midtwentieth centuries when a variety of so-called ‘human oddities’ were put on display in commercial ventures.11 This association with asylum inmates as objects to stare at was made clear by Clark in 1878, and

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again in 1892, when he wrote that during the week of the Canadian National Exhibition a large number of people ‘raided’ the institution after visiting the fair. They had hoped to see patients as an extension of their sight-seeing but were refused entrance, a rule that was unpopular with those people who ‘have no friends on exhibition’.12 Yet, while the wards were off limits to all but those who had genuine cause to be there, the grounds of the facility were open for all to wander. Thus, the intrusive gaze of outsiders could still be felt by patients on the grounds and by those who were getting some fresh air on any of the 12 verandahs attached to the wards. By 1890, the verandahs, originally built with iron bars on them, ‘like cages for wild animals’, had been refitted with windows and screens. Besides allowing for the year-round use of verandahs, this architectural improvement had the added benefit of providing more privacy for patients, who had formerly been leered at by visitors wandering about the grounds in expectation that inmates would perform ‘fantastic tricks’, according to Clark.13 As well as these physical changes, semantic changes were advocated as a way of fighting stereotypes. In 1906, Inspector S.A. Armstrong noted that the name ‘asylum’ was being replaced with ‘hospital’ since the former had such negative connotations, in contrast to the latter.14 In 1907 the name of the Toronto facility was changed in accordance with this view. However, C.K. Clarke noted a year after this new name was adopted that public prejudice continued, as before, to look down on such a facility as an ‘asylum’, a name he said was considered ‘repulsive’ to family and friends.15 Letters written by patients well after this date continued to use the word ‘asylum’. Inspectors wrote optimistically in both 1901 and 1921 about how public attitudes were changing for the better in regard to admitting people to mental hospitals and the erosion of stigma attached to confinement.16 These comments accord with similar promotional efforts on the part of nineteenth-century American superintendents, which, as Nancy Tomes has written, were crucial to encouraging a more positive reputation for the profession.17 However, administrators at Toronto, along with families and patients, expressed a different reality when it came to interaction with outsiders. Prejudice continued from people who did not know or care about people housed in these facilities. C.K. Clarke wrote in 1910 that the public was ‘not only indifferent, but terror-stricken and very often heartless’ in relating to mental patients.18 The ‘terror-stricken’ aspect of this view suggested what Daniel Clark had a few years earlier referred to as ‘Popular Delusions About The Insane’, in which one of the most pervasive prejudices was the belief that to be an asylum inmate one must therefore be a

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‘maniac’. This view was common in spite of the fact that in 1895 it was estimated that less than 5 per cent of Toronto’s patients were ‘suicidal or maniacal’.19 Among the few consistent positive interactions between the wider community and asylum inmates reported by authorities were the concerts and donations of reading material to the institution discussed in Chapter 4. Certain visitations were also intended to brighten up the atmosphere and spread an uplifting moral message, as with the 98 visits between 1889 and 1891 of one devoted member of the Bible Flower Mission, who distributed 5,323 bouquets with scriptural readings attached.20 Merchants and druggists who had contracts with the asylum donated prizes and other items for a picnic and games that over 400 patients participated in during the summer of 1895.21 Yet these instances of community support for asylum inmates are striking by their contrast with the frequently cited everyday obstacles patients and their families encountered among people who showed little or no understanding of the experience of what it was like to be a patient in a mental hospital. The personal stories uncovered for this chapter from clinical records reveal the human face of family members and friends of patients at the Toronto Hospital for the Insane.

Births after Confinement: Family and Community Responses Prejudice in the wider community towards anyone connected to an insane asylum could exacerbate a private tragedy. Such attitudes also reveal how the hereditarian taint that was associated with people confined in mental institutions could negatively affect even the youngest and most vulnerable members of society. The most obvious agony that some family members had to face when confronting mental health problems has to do with the separation intrinsic to confinement. Where there was a caring relationship, this could be especially traumatic. The stories of three families and the vastly different options available to them after the birth of a baby following the incarceration of one parent illustrate the difficulty of separation. Mathilda M. was confined at Toronto for 21 years until her transferral to Penetanguishene in 1912. Several months after her admission in January 1891 it was observed that she ‘has been gradually growing larger in the abdomen’ and was believed to be seven or eight months pregnant, though she claimed her swelling was due to ‘poisoned food’. Since this condition was not noticed at the time of her admission, hospital officials made it plain in May 1891 that Mathil-

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da’s ­husband, Harold, should take her home to their farm in L’Amaroux when she was about to give birth. As there was no response to this request, Dr Clark wrote Harold a month later asking him to provide ‘the necessary articles’ for mother and child and to remove the baby after birth. Evidently, there was a meeting between Clark and Harold in early July at which the prospective father informed the Superintendent that he could not take care of this baby and so wanted it to be placed in a local institution. This is referred to in a letter from a doctor who supported the contention that Harold was in an ‘impossible’ financial and personal situation with ‘a large family of small children the oldest too young to be entrusted with the care of an infant’, all of whom subsisted on their father’s earnings as a farm labourer.22 After a baby boy was born to Mathilda on 8 August 1891, Clark wrote to Harold that institutional rules stipulated it was his responsibility to remove their newborn child. Since Harold ‘paid no attention to this request’ Clark stated that the rules forced him to have the child removed 10 days after birth. Clark claimed that at their July meeting Harold had promised to send clothing and remove the infant. When this did not transpire, the Medical Superintendent personally applied to have the baby accepted into the Infant’s Home, a foundling centre that received annual funding from the province. However, they ‘will have nothing to do with it’ unless maintenance was paid in advance. Clark next telephoned a local Catholic charity, the House of Providence, to accept the baby. He had originally looked elsewhere as the unnamed child was the son of Protestant parents. Clark wrote to Inspector Christie, ‘to their credit . . . the nuns at once took the child in charge, without any enquiry as to payment or parentage.’ This poor ‘helpless and homeless child’, as Clark wrote in his letter of thanks to the nuns, died by the beginning of September 1891, less than a month after he was born, having been described only a few weeks earlier as a ‘very fine healthy boy and like its father in feature’.23 How the separation of mother and child affected Mathilda is not recorded, other than in a brief reference in a letter to her brother four months later that while officials had hoped her mental health would improve after childbirth, they were ‘disappointed in this expectation’.24 During the 10 days in the asylum after his birth, the baby was cared for by a nurse on the ward ‘in addition to her daily work’. Clark angrily wrote that the Board of Management, which was responsible for the Infant’s Home, ‘has not come up to its duty’ in regard to the plight of Mathilda’s son, as they had never before been approached by the asylum with such a request, ‘especially on behalf of an infant of an insane Protestant mother’. This episode of who would care for

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the nameless baby of Mathilda M., highlights a number of crucial themes that arise time and again in relation to community and family response to asylum inmates. In this case it has the added dimension of response to an inmate’s offspring. The Infant’s Home, in spite of its receiving public finances, claimed money was the reason for turning down the asylum request, as well as the obligations this unique situation would have entailed. Municipal officials, all the way up to the Toronto mayor, were asked to intervene on behalf of the baby ‘with no better results’, according to Clark. Prejudice towards the mentally disturbed mother of this baby and the place of his birth is strongly hinted at by Clark.25 Clark charged that Harold had abandoned his child and the evidence bears this out, though it is also clear that he was overloaded with family duties on the farm. The care and removal of his son were left entirely in the hands of asylum staff, in spite of entreaties that the father take an interest in the child before and after his birth. Yet the predicament of the parents illustrates the horrible dilemma that families could face. A mentally disturbed mother, destined to have her child taken from her since there was no possibility of raising a baby in the asylum, is contrasted with her husband, who had a large family to raise on his own in a financially strapped situation out in the country far away from his wife. In such a situation the stress and despair for both parents would have been enormous. For a few years afterwards, letters exchanged between Harold and asylum officials make clear that Mathilda loved her children, whom ‘She likes to hear from.’ In fact, she believed they and her husband were somewhere in the institution. For his part, Harold expressed his and their children’s affection for Mathilda and concern for her wellbeing.26 However, from the mid-1890s onward there are no further letters from Harold, and so it is not possible to trace the extent of his support or that of their children during most of the two decades that she spent at 999 before she was transferred in 1912 and disappeared from the Queen Street records. A similar episode took place four years later, in 1895, when a single 22-year-old woman, Cindy W., gave birth to a child two months after her admission. Fearing a repetition of the events of 1891, Clark asked Inspector Chamberlain to request admission of the baby to the Infant’s Home. When Chamberlain received no response from the agency after waiting five days, the baby, whose gender is not mentioned, was sent to the home, at which time it was accepted.27 There followed complaints back and forth that the women in charge of the Infant’s Home were treated in a brusque manner by the Inspector. This dispute was primarily over the issue of maintenance costs,

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which the Infant’s Home insisted upon and the Inspector adamantly declined to pay, as well as about the appropriateness of transferring a child from the asylum to the Infant’s Home prior to a response being received. The Provincial Secretary responded that there should be no charge as the Infant’s Home received public funding.28 In a crucial departure from the earlier episode, documents reveal that this episode concluded on much better terms, at least in the short-term period for which evidence exists. Cindy W. was discharged as recovered four months after childbirth and went directly to the Infant’s Home, where she took up residence with her baby.29 Yet, this episode also reveals the lingering resentment that the management of this charity continued to have at being asked to accept a baby from a mother who was an inmate of an insane asylum. In another instance, the roles were reversed when a confined man’s wife gave birth to their daughter a month after his admission in 1882. Elaine Y. wrote to Dr Clark asking him to inform her 49-year-old husband, farmer John Y., that ‘he has another little girl who will be three weeks old on Saturday[.] I would like to have him send her a name.’ Clark responded to Elaine how ‘very glad’ John was to hear from her and that he would write to his wife, presumably recommending a name as had been requested.30 Unlike the story of Mathilda and Harold and their family, there was never any doubt about who would raise Elaine and John’s newborn baby. Furthermore, it is also possible to trace the long-term support of members of this family from both the wife’s and a daughter’s perspectives, as well as glimpse the immense stress Elaine Y. endured raising their children on her own. During the nearly 30-year period of his confinement, family members regularly corresponded with hospital officials about the welfare of John Y. and made clear their support for him. One particularly poignant letter from his daughter, Rochelle S., written in May 1911, was addressed to Dr Clarke with lines at the bottom of the page, which she asked to be read to her sick father. Addressed to ‘Dear papa’, she wrote: Mama told me or wrote that you had been ill. I am married I suppose she told you and we have a big boy fifteen months old. I may come up soon to see you with my husband[.] I wont come alone[.] goodbye[.] your loving daughter [Rochelle] 31 A few weeks later John Y. died in the asylum at the age of 78. During the last days of his life, the clinical record noted that this dying man ‘talks a good deal to himself about his daughter’.32 These three families reflect vastly different options available for people who experienced the birth of a baby after confinement. Harold

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chose to leave his son behind for hospital officials to deal with, unlike Elaine, who had no such choice, having given birth under altogether ‘normal’ circumstances, that is, at home and not in an asylum like Mathilda. Cindy, on the other hand was able to leave the asylum after a relatively short period and continued her life with her child, unlike the other two parents whose mental state was considered too severely impaired to allow such an option. Thus, a husband who had to take care of children while his spouse was confined had a way to alleviate the economic pressure on a family in a manner that was available to a father and not to a mother when a new baby arrived. It is also clear that child abandonment, which Harold chose, temporarily cast the Superintendent in the role of adult guardian of a baby without a home. Finally, it is important to note that both parents who were longterm inmates expressed concern for their children after admission, suggesting the pain they must have experienced by this permanent separation. As will be seen in the next section, this pain was often shared by family members about the condition of their kin and matters that were beyond their influence.

Impact of Visits and Physicians’ Letters on Families The extent to which people visited their relatives and friends is not tabulated in hospital records, though in 1923 Superintendent Harvey Clare claimed that 999 Queen Street West had more visitors than all other psychiatric facilities in the province combined. An indication of how little privacy existed for outside visitors up until the early 1930s can be found in Superintendent W.C. Herriman’s comment that partitions had recently been installed to allow quiet conversations between medical officials and families. Previous to this, one room would be congested on visiting days ‘with the entire Medical Staff carrying on interviews with the friends of patients amidst a babel of voices’.33 ­Visits between patients and family members or friends took place on the ward, although in cases where patients had parole of the grounds these meetings could also take place outdoors during warm weather. For people who lived outside Toronto, communication was more often through letters. The way in which family members and friends of patients responded to visits and received news about particular inmates can reveal a great deal about people outside the asylum and how they coped with the confinement of someone they knew. Some family members were so upset by the sight of a loved one that their reaction was not only emotional but also physical. Daniel M. had been in the

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asylum for 27 years when his mother, Loretta, wrote to the hospital in 1929 about how Daniel’s pregnant daughter Mavis felt after seeing him one day. Mavis was so upset about her father’s ‘tattered + torn’ appearance that this visit ‘made her sick on the street car’, so she no longer went to the hospital. Daniel died at Queen Street nine years later. Reginald F. was confined for eight years before being discharged in 1914. Four years later he committed suicide. During most of the period of his residence at 999, Reginald’s wife lived in the United States and occasionally visited. She also wrote voluminously about him and provided financial support. After one visit a few months after her husband’s admission, Alicia F. wrote to Dr Clarke that she felt ‘great shock’ at his appearance and stated that ‘I would not want to go to see him very often, it made me feel so dreadful.’ Not all such trips were so traumatic for relatives. Walter S. was confined in 1900 and was regularly visited by family members who lived in Toronto. Though he was known to be depressed after his relatives went home, Walter’s sister informed Dr Forster that they had seen so much improvement over the years that they wondered if he could be let out on probation.34 Eventually these visits led to his complete discharge in 1916. Years of marital separation were also ended when a spouse found that visits helped to heal old wounds. Henry A. and his confined wife, Mary A., were brought together again by his visits after 16 years, following an attack by another patient that left Mary unable to walk. She was eventually discharged a year later, in 1911, thanks to Henry’s constant support for Mary and his respect for her decision as to when she was ready to leave. This elderly couple lived together in Toronto until Mary died in 1923. A letter Henry wrote in June 1911 after his final visit to 999 suggests how much their recently re-established relationship meant: ‘I got Mrs. A__ home safely on Saturday in her new Invalid Chair, she enjoyed the journey very much more than I did as I have two bad blisters on my hand.’35 Considering the fact that their house was over five kilometres from the hospital and that this man was at least in his late fifties, it was no small effort for Henry to push his wife all that way in her wheelchair. Letters from hospital officials to family members could cause distress, since frequently the news was not good. Eve L. was 25 when she tried to commit suicide a month after her admission in 1884, the details of which Daniel Clark conveyed to her husband. When Gregory L. wrote back in ‘sorrow’ he mentioned how this news had ‘taken all of the pleasure out of my life’, so much so that he cancelled a business trip to Europe. After 1884, there were no further letters from Eve’s husband. He wrote from New York City at one point that

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he had not expected her to be there ‘half as long as she has been’ and so was worried about the continued expense.36 Gregory eventually abandoned Eve, as she remained confined for the rest of her life. She died in 1914. Administrative letters informing relatives of the mental state of a patient were usually quite routine, with the majority of recipients not responding distraughtly about the wording used by officials. However, in a couple of instances the recipients noted their distress over the choice of words. In one case, the brother of an inmate was so concerned about the impact on his mother of a letter from the hospital that he requested and received a more positive second letter. James L. was a professor at a university in Missouri in 1908 when he received a letter from C.K. Clarke about his sister, Caroline L., who had been confined since 1906. Clarke had written in his initial letter that Caroline was in a very severe depression and was regarded as ‘incurable’, with further deterioration likely. James responded that he had originally inquired about Caroline at the request of his mother, who was staying with him for the winter, but that ‘I dare not show your reply’ as she was ill and ‘living in hope of the ultimate recovery of her child’. James asked Clarke for another letter that could offer ‘a little hope + which I could show to my dear old mother’. Clarke obliged with another letter, this time noting Caroline’s ‘excellent bodily health’, her alternately cheerful and depressed state, and her enjoyment of reading, concluding that ‘I trust [Caroline] will improve’ in better weather when she could get outside more often.37 The following year this patient was discharged in the care of her mother. In another instance, the outcome was not resolved so satisfactorily. In 1891, Daniel Clark wrote to the father of inmate Etta C. that she was ‘childish and silly’ though easy to get along with. Etta’s mother, Henrietta, responded that the letter ‘distressed me terribly and makes me tremble with fear of a total collapse’, so perhaps ‘my poor girl’ would do better at home. Clark wrote back his ‘regret’ that the outlook for Etta was so poor that a return home may not do much good. This advice was accepted by the family. Sixteen years later another administrative letter caused upset when it was announced that Etta had been sent to Penetanguishene. Writing from Durham, Ontario, her mother noted how ‘deeply painful’ this news was to the family as they had been hoping to take her out for a visit soon. Moreover, Etta’s brothers and sisters lived in Toronto, were able to visit her, and supplied clothing. Her parents also found it convenient to see their confined daughter when in town to visit their other children. Henrietta C. concluded how ‘exceedingly sorry’ Etta’s family was that they were

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not informed of this move until after the fact.38 There is no response to this letter in the file. The distress of this latter communication from Henrietta C. illustrates how some families were completely left out of administrative decisions that drastically affected their ability to provide personal support for an inmate. Another woman had both her son and husband confined at Toronto. Margaret D. regularly wrote letters inquiring about her husband Gilbert and their son Allen, who were confined together from 1903 to 1909, though the elder man had been confined since 1861. This elderly woman, who lived in Blackstock, Ontario, had not yet received Clarke’s official letter informing her that Allen had been transferred to the House of Refuge in Cobourg. Instead, a neighbour told Margaret this news after seeing Allen D. while on a visit to Cobourg. Most of her letters are very gentle in tone, begging pardon for her handwriting style made difficult by ill health and rheumatism. But upon hearing this latest news, the usually quiet ­Margaret made her distress very plain to Dr C.K. Clarke, whom she always addressed as ‘Dear Kind Frend’: it Almost ciled me[.] it [w]ont be as Well for me for I see my husband and [Allen] I have to go sixteen miles to (illegible) to take the separ gran to Coburg at Toronto[.] I trust friends Would meet me at the Station and go up to the hospitile With me and see me on the Seepar to go home[.] So then I got your leter With ters I was ner ded my hart ner give out[.] it is terable hard on me . . . I am over Seventy yers of age[.] Well doctor I dont Want yous to send [Allen] a away it wold kill me . . . do plese write to me[.] Clarke wrote to Margaret D., telling her of his ‘regret’ about causing her to worry about Allen’s transfer, but went on to state that he believed it was for the best that her son was sent to Cobourg. Within six months, Allen D., who was considered harmless, was back with his mother, who reported him ‘hapy and contented’.39 While this episode turned out better than originally feared, Margaret D.’s letter shows again how routine administrative decisions were anything but routine for people directly affected, especially when they had not even been asked for their opinion on what turned out to be shocking news.

The Experience of Community Stigma towards Mental Hospital Patients and Their Families Patients and their families, even when reunited, could face insurmountable obstacles within the community. Stigma towards people

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with a history of being in a mental institution is a widely recognized problem in contemporary literature, just as it was noted by superintendents at the Toronto Hospital for the Insane.40 Psychiatric patients, families, and friends of patients, as well as mental health professionals, frequently have to deal with the prejudice of people who have no firsthand experience of what it is like to be diagnosed with a mental disorder and to be confined in a mental health facility. The level of antipathy towards a current or former patient could be traumatic for both the person with a diagnosis and those who were related to him or her. Irene B. had been in the Hamilton asylum for four years when she was released in 1890. A 38-year-old single woman employed as a dressmaker, Irene’s only support was her sister Agatha. In financial difficulties of her own as a servant, Agatha was unable to support her sister when Irene was readmitted to an asylum, this time to the institution in Toronto in 1896. Her extreme depression was observed by the committing physicians, a point supported by another lodger at the boarding house who noted how little Irene ate, sometimes nothing more on a given day than a few crumbs from a loaf of bread. The reasons for her withdrawn, isolated condition are made clear in the medical observations: ‘She says that even [sic] since she came out of the Asylum persons have been taunting her with having been there.’ It was noted that she remarked in a ‘sarcastic, hurt manner’ that ‘of course a person who has been in the asylum is not fit to associate with some sane people . . . that persons for whom she was working had this feeling about her.’41 No observations in her admission papers dispute these statements. The support of Irene’s sister was not enough to overcome the immense obstacles placed in this former patient’s path by the verbal harassment and prejudice she experienced from other members of the community, which in turn reinforced her despondency and regression back into a state of emotional misery. The circumstances leading to Irene’s distraught state highlight the importance of community response to released inmates, and how this response was expressed could have a direct bearing on an individual’s mental health and options for reintegration. Irene remained confined until she died in 1921. Officials reported this hostility towards mental hospital patients by outsiders when trying to get non-violent inmates released into community boarding homes. Daniel Clark wrote in 1897 that even though recovered patients were considered ‘industrious and harmless’ by medical officials, the public was less than receptive, especially when they were poor and without family. Instead, these friendless ex-

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inmates were ‘watched and gazed at . . . are often not trusted’, and were believed to be ready to break out in a violent attack at any moment. This could lead to another breakdown, like Irene B. experienced, that could have been prevented had they been ‘treated kindly and as rational human beings’.42 Community resistance to accepting socially isolated patients back in the community was also noted by Inspector S.A. Armstrong. He wrote in 1908 that a census had been taken of the eight public provincial mental institutions to see how many people were considered to be recovered enough to be released into houses of refuge. Out of nearly 5,500 inmates, almost evenly divided between males and females, it was ascertained that 400 friendless patients could be allowed back into the community. But though efforts had been made to transfer them, ‘with few exceptions’ the local authorities would not co-­operate, so most of these patients remained confined.43 Josiah M., a 57-year-old man in 1899, was said by Daniel Clark to be ‘quite harmless’ and not in need of any further confinement after three years in the asylum. In spite of efforts by Clark and Inspector Armstrong to secure lodging for Josiah, Clark wrote, ‘we have failed on account of the diffidence people have in taking anybody who has been insane.’44 This man would remain at 999 until his death 12 years later in 1911. Persistent efforts to get an inmate released into the community could take years due to community bigotry. Like Josiah M., 73-yearold Ettie F. was described as harmless and someone who should be released. But like Josiah, she also had to face social intolerance. After 15 years’ confinement, an application was made on her behalf in late 1905 to the Home for Aged Women in Toronto. The Board wrote that they ‘cannot accept’ her as a resident even though an acquaintance of Ettie’s had offered to pay maintenance and the hospital provided a probationary option of her return to 999 within six months should things not work out. Over two years later, Dr C.K. Clarke wrote in a vein similar to that of his predecessor when he noted that various city boarding homes ‘refuse to take her since she has been in the asylum’.45 Clarke wrote in an earlier letter to Inspector Armstrong that while the Catholic-run House of Providence usually accepted released asylum inmates, ‘some exception was taken on ground of religion’ in previous instances. Thus, even the Toronto charitable institution that was reported as being the least prejudiced towards mental patients as a group, indeed, the one that accepted Mathilda’s baby, nevertheless discriminated at times by turning away non-Catholics such as Ettie. While Catholic-run institutions were primarily for Catholics, who

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funded these charities, the fact that the nuns took in the baby of a Protestant mother and chose to exclude an elderly Protestant woman suggests that they saw Ettie through the lens of the historical tensions between Catholics and Protestants—an older non-Catholic was less amenable to influence than a newborn child.46 In effect, this Catholic charity appears to have decided that Ettie was not worth spending any money or time on, since she was not a Catholic and was unlikely to become one, so she was left back in the asylum. Noting the overcrowding of the asylum and the fact that Ettie ‘shows not the slightest evidence of insanity’, Clarke increased the pressure to have her accepted at a new Home for Aged Women, particularly if they received government funding. This time administrative efforts were successful in securing her release to the Belmont Home, where Ettie F. was sent in September 1908 some three years after the initial efforts failed.47 In instances like this, hospital authorities played an advocacy role in securing a patient’s discharge, while the institution itself served as a shelter for those who were rejected by other social service agencies. What Josiah and Ettie thought of all this is unknown. Considering the obstacles they faced, one wonders what sort of reception awaited inmates like Ettie F. once they were released into a less than welcoming community. One former asylum inmate, while inquiring about her brother Reginald C., who was confined at Toronto from 1891 until his death in 1918, wrote a number of letters about her fears of being considered insane after her own release from institutional care. Katerina G. had been in the Hamilton asylum in 1894 after a miscarriage, where she recalled in 1917 she was ‘kindly treated by doctors, nurses and patients’.48 After Katerina was refused admittance to see her brother because she was said to have been ill, which she claimed was ‘news to me’, she wrote a series of letters to try to prove that there was not ‘anything wrong mentally’. Though she was granted permission to visit her brother once a month, Katerina felt that she was being unfairly restricted on account of her past medical history, asking Dr Forster, ‘Who started the story that I was not in my right senses I cannot prove. All our side are Conservatives, a nephew is in partnership with R.B. Bennett of Calgary.’ In two letters written eight months apart in 1917 Katerina sets out in great detail her personal abilities ‘to prove my sanity’. For his part, Dr Forster advised Katerina not to worry so much, lest she make herself sick.49 While Katerina’s circumstances were more advantageous than what far less privileged patients (or former patients) faced, her concern with dispelling the notion that she was mentally ill suggests how important it was for a former patient to be accepted in the community.

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Relatives of inmates who had never been confined also shared this distress. A woman who lived in the eastern United States visited her mother, Stella S., in 1915. After returning home, Edna S. was upset at what she perceived to be comments ‘of an infamous character’ from people in Toronto about herself and her family. She cited a number of incidents, including one that occurred after leaving the asylum on the Queen Street trolley car of whispering bystanders, with one man telling another that ‘she came over to see her mother.’ Superintendent Forster wrote back that they had been ‘charmed’ by Edna’s visit and that no staff were upset with her, but he hoped that she had ‘gotten a good grip on your nerves’ and would not let daily slights cause upset in the future.50 Edna’s sensitivity suggests how even the perception of public comments about mental illness and one’s family could be upsetting to a visiting relative. This fear of the stigma of insanity extending to family members was deeply rooted among parents, children, and siblings of many inmates. Since much insanity was seen as hereditary there was a great deal of guilt and shame in the nineteenth and early twentieth centuries about confined relatives, as Charlotte MacKenzie observes in regard to families of patients at Ticehurst private asylum.51 Nancy Tomes has also noted a concern in some families that patients could ‘deceive’ neighbours about their condition, which would raise suspicions among acquaintances about motives for confinement.52 This community inquisitiveness happened to a man who neighbours were convinced kept his wife confined when she should have been released. They even had a church elder demand her release in 1886. Clark told Stanley G. to ignore their ‘meddlesome interference’, as Clark insisted his wife was insane.53 Ellen G. remained confined from 1878 until her death in 1918. Records frequently show relatives trying to prevent this type of external interest in the welfare of an inmate. How, and even if, the public should learn about or come into contact with an afflicted relative was an area for great concern among some families. The mother of Martha B., who was confined at the age of 25 from 1891 until her death 22 years later, wrote Daniel Clark with a special request. Minnie B. was upset that an individual from Brantford saw her daughter and then came back to town and had ‘generally given’ an opinion about her appearance and mental state. To stop this from recurring, Minnie asked Clark to ‘deny any except relatives’ when visitors came to call. A similar request came from Edward S., the brother of patient Grace B., who wrote from Port Hope in 1906: ‘I would like you to keep visitors from seeing her or knowing anything about her[.] This is a small Town and some people are after news to tell.’54

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The mother of Rhonda B. sent a special note with a visitor, addressed to Assistant Superintendent Ross, which gave permission for a non-family member to visit her daughter on the basis that this person was a friend. Ruth B. also mentioned in this letter, the only one from a family member in a file spanning 13 years, that she had heard of ‘quite a few’ being refused visitation rights with Rhonda, for which her mother was ‘thankful that you did not grant their request’.55 Cheryl Krasnick Warsh has written about the ‘uninvolved’ family, who effectively abandoned their relatives, the ‘overinvolved’ family, who were constantly active in the patient’s life at the asylum, and the ‘pseudo-involved’ family, apparently concerned about their relative but in fact desiring a degree of distance.56 Yet, members of the same family could have different responses to a confined relative, so in fact such categories were fluid within families—some family members were very concerned about relatives while other members of the same family could not care less. Similarly, some people showed concern in the early stages of confinement and then nothing more is heard as the years go by, whereupon it becomes evident that the patient has been abandoned by what seemed to be interested relatives. These categories need also to take into account the sort of community ostracism the letters reveal, as external prejudices could be crucial to determining the closeness or distance of relatives and how they tried to influence a patient’s life behind asylum walls. Some family members, for example, internalized this prejudice, feeling ashamed that they had a relative in an asylum because of the prejudice shown by people in the wider community towards individuals in mental institutions. Family intervention in preventing unrestricted visitors could extend to patients going on trips outside the asylum where they may be seen among the general public. Andrew H. came from a prosperous family in Cobourg, where he had been a law clerk. In 1903, five years after his confinement began, his mother, Ellen H., wrote an angry letter to the hospital in response to the yearly circular requesting money to send certain patients to the Canadian National Exhibition. Offended that the envelope was received open and with the official hospital stamp on it, Ellen insisted on being sent mail in a plain and closed envelope in the future. In regard to the proposed trip: I wish to adamantly forbid the taking of my invalid son on any such excursion and to insist for the privacy that we are entitled to in this matter. . . . Will you be kind enough to notify Dr Clarke [sic] or all whom it may concern on no account have my son taken from out [of] the Institution.

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In response, Dr Mitchell, the assistant physician, wrote that the unglued envelope had likely occurred after mailing and so was an accident, and that ‘it was only out of kindness to our unfortunate people that we write these letters at all . . . to make their lives less monotonous.’57 He went on to assure Ellen H. that her 35-year-old son Andrew would not go to the cne or anywhere else, just as she had requested. Andrew would remain confined until his death in 1918. This fear of public knowledge about any connection to the asylum, which extended to official envelopes received in the mail, was mentioned by several others. Magdelaine C., the daughter of 65-year-old Sandra C., asked Superintendent Daniel Clark to ‘Please omitt the official stamp.’ John C., the father of Adam C., also asked that a ‘plain envelope’ be used when hospital officials wrote to him about his son. One family member, a wealthy father who lived in Bradford, England, not only wanted to hide the origin of asylum mail from people outside the house but also from some of the people who lived inside. Harold C. wrote to Superintendent Clark in 1884 in reference to his 27-year-old son, Francis: I must be supplied with an address which has no reference to the Asylum, and all letters sent here, must be in plain envelopes, and securely gummed, so that my servants may see nothing that might cause remark, as I wish to spare the feelings of my family as much as possible . . . take care of my poor son.58 Like other family members who made similar requests, Harold C. was trying to minimize the personal impact of public prejudice against asylum inmates and their relatives back in the community. While such moves were understandable, these actions could also limit the number of social contacts and even chances to get out of the institution for some inmates. As a result, relatives like Edward S. and Ellen H. ended up isolating their siblings and children further from the community to lessen their own personal discomfort. In an era when serious public education about overcoming stereotypes regarding people diagnosed with mental health problems was all but unknown, it remained the patients who suffered most from community intolerance, even when they did not always receive it firsthand but instead had to endure the distressing response from prejudice experienced or anticipated by their families.

Community Responses to Escaped Patients The image of an escaped asylum inmate on the loose carried—and still carries—some of the most negative stereotypes of a ‘lunatic at

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large’, someone who was dangerous and needed to be caught as soon as possible.59 While a small minority of people fit this description, most people who escaped from mental institutions had (or have) no desire to cause ‘murder and mayhem’ but instead wanted to get on with life, usually with as low a profile as possible. At Toronto, a person could be returned within 30 days after escape. Most of the reports of escaped inmates from 999 contain very little information about how staff or police responded to individuals referred to as ‘elopers’. However, a number of relatives, friends, and even a stranger wrote to asylum officials about how a runaway patient was received back in the community. After 17 years in the asylum, 57-year-old farmer Jeremiah T. ran away from the institution, only to show up on the doorstep of another farmer he had never met before. Royal Grafton wrote about his surprise visitor in July 1907: I beg to inform the Toronto Assylum [sic] authorities that we have lodged a traveler last night and found on close questioning that he had been one of your inmates for some years. . . . he seems innocent and harmless. I tried hard this morning to retain him in this locality till I would go to Malton or Brampton and telephone you but he seemed anxious to be on the road. . . . He seemed anxious to keep in the rural districts and shun the towns. Yours in haste . . . . Dr C.K. Clarke responded several days later with the news that Jeremiah had voluntarily returned, ‘tired of wandering about the country’.60 He would remain in the asylum until his discharge to the House of Industry in 1930. In this instance, farmer Grafton did not exhibit cruelty towards his visitor but a degree of consideration. He offered Jeremiah shelter and did not throw him out upon hearing where he came from. Grafton also gave Jeremiah road directions, though his reporting of these directions to the hospital indicates that, while he was not personally hostile to his visitor, he thought Jeremiah should be returned to the asylum. Another farmer, 66-year-old John Y., ran away in 1899 after 17 years’ confinement and made his way back to his home town of Dartford, Ontario. His wife, Elaine, had given birth to one of their daughters shortly after he had been sent to 999 in 1882, as was discussed earlier in this chapter. Elaine wrote a frantic letter to the asylum that John ‘is at present here came an hour ago’, though she also stated how unbearable it was to think that he had to go back. Prior to showing up at the house of his wife and their three children, John had wandered about trying to visit people he thought were his friends, and also went to see relatives, including a brother and sisters. In each case

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‘he was not allowed to remain a moment.’ Worn out, John was recaptured by an attendant who ‘surprised him in his own home’.61 In this instance, most of the community shunned an escaped patient while an obviously tormented and sympathetic wife tried to figure out what to do in this predicament, regretfully agreeing with hospital officials that her husband had to be returned to the asylum after more than three weeks on the run. Other relatives could welcome the return of an escaped relative, while also expressing some concern about a person’s condition. In October 1906 one escaped inmate from Toronto literally walked all the way from the asylum to his parents’ homestead in Bloomington, Ontario, near Stouffville after only several weeks’ confinement.62 ­Letters during the next six months from the parents of 23-year-old Egbert G. provide a picture of the supportive home to which he returned. In the first of these letters, Egbert’s father Frank wrote on behalf of himself and his wife to Dr Clarke whom he addressed as ‘dear frind’: I was rely suprised to see [egbert] come home he got home 4 clock in the after noon and his mind seems to be so much better but he is not felling very well as soon as he is able I will trie to fech him back and if he wont come with me I will fone to you at wonce to come and get him. . . . from [egbert] g__ father and mother Egbert’s mother, whose first name is not recorded, wrote at the same time: I gease the worry of getting out and walk home mad him sick he has not mad me a bit of truble yet from his mother he slap till half past 7 this morning63 Any desire to return their son soon took second place to addressing his physical needs. Concern over Egbert’s stomach ailment is mentioned a number of times during the next month, with the father writing that ‘we want to doctor him’, but a few weeks later he worried that ‘we . . . cant find out what is in his stomick.’ Frank came to believe that there was a mind-body connection to their son’s problems, writing that perhaps something is ‘alive in his stomick maby that is what is rong with his mind’.64 If Egbert’s body could be fixed there would be no need to return him to 999 Queen Street West, a hopeful thought to this caring couple. Egbert went back to Toronto where he was hospitalized under the care of Dr Campbell Meyers, the man who, a few months earlier, had set up Canada’s first psychiatric ward in a general hospital.65 While the facility is not specifically

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named by Frank, it was likely to have been the Toronto General Hospital Nervous Ward that his son went to for five weeks, after which his father reported that ‘he has forgoten nearly all about his stomick’ and was sent back home again, where he was eventually reported to be ‘all rite’ working on the farm.66 Egbert’s parents lived in poverty. His father, Frank, was disabled and he could not use either of his arms in physical labour due to paralysis and rheumatism that left him ‘helpless’, according to local officials.67 The emotional as well as economic importance of their son’s return from the hospital is indicated in a brief passage from a letter Frank wrote a few months after Egbert surprised them by walking home: ‘he has ben a good boy to me as I am not able to work my self.’68 With such positive reports, Egbert was fully discharged in March 1907. Though there was an initial desire to send their son back to the asylum, this soon gave way to wanting him to stay at home where he could help them and they could look after him. The thoughtfulness and concern of this former patient’s mother and father would have helped to ease their son’s transition back into life on the farm. Of course, not all patients who ran away and remained at liberty were so fortunate as Egbert G. to have a friendly home to which they could return. Erin W. was a 57-year-old single woman with one known relative in New York state, while the rest of her family lived in Ireland. When she ran away and was not recaptured within 30 days she was ‘written off’ the books in 1907 after having been confined for seven years.69 In November 1921, 14 years after her successful escape, a letter from a Prince Albert, Ontario, doctor was sent to Superintendent Harvey Clare. This man had received a letter from Erin in which she recounted her deteriorating physical condition, long-term unemployment, mental distress, and the ‘cold room’ she occupied in the working-class area of Toronto known as Cabbagetown. By this time Erin would have been 71. The correspondent, Dr Ault, asked if it would be possible to allow Erin to return to the asylum for the winter. He underlined very explicitly that his communication was to be kept a secret from her, as she did not want to go back there. Dr Clare expressed sympathy but indicated that there was not much he could do to help.70 No further letters exist to document what happened to her. These accounts show that most escaped inmates were not violent upon their return to the community. If anything, they wished to get on with their lives and could make a good transition from asylum to home if they had the proper supports, as did Egbert G. Even Royal Grafton, who first came to know Jeremiah T. in conversation before

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finding out he was an escaped asylum inmate, showed a degree of tolerance that was often absent among those who had preconceived ideas about what a mental patient was supposed to be like. In this respect, the shunning by neighbours that greeted the unexpected arrival of John Y. back in his home community shows how even a tired non-threatening patient could be ostracized by most of his relatives and those people who had formerly been his friends. However, in a minority of instances fear about the return of an inmate was firmly rooted in a history of domestic violence.

Fear of a Patient’s Release by Abused Wives and Families While medical officials did not consider most patients violent offenders, there were some whose prospective release was feared for good reason by relatives. This is most obvious with victims of domestic abuse. Several wives wrote letters imploring physicians to keep certain men locked up, lest they return home. Joseph S. had been confined in the Hamilton and London asylums, was released from both, and was eventually sent to the Toronto facility in 1891 at the age of 56. Two years later his wife, Sally, wrote to Daniel Clark after hearing from one of their six children that her husband was improving. She wrote that he had acted ‘cute’ before and was able to secure discharge from the other asylums, but when he returned home ‘he has such a spite to me . . . I would be in terror of my life.’ His wife recounted that Joseph S. once told her that he had to ‘pray to the Lord to keep from killing me in bed at night.’ Sally asked the Medical Superintendent to ‘keep him there for I cannot live with him again. You will have my everlasting gratitude.’71 Three months later a local man wrote on behalf of Sally S., supporting her earlier request. Joseph S. remained in the asylum until his death in 1913. During the first nine months after Jack H. was confined in 1902, his wife Alice wrote several letters making her fears very clear. Upset that Daniel Clark had spoken of releasing her husband, she wrote that she and her six children had their lives threatened by him. In another letter she said Jack H. had told her during a visit to the asylum that even if his release ‘was ten years from now he would have revenge’. The constant dread that Alice and her family had lived under is made poignantly clear in a third letter: i dont want him out any more for i have had the gun pointed at me to meny times[.] the children dont want him home eather for they say they have been knocked around long a enough by him[.] now for i can get enough to eat now and i could not wen i had him with

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me[.] so i am better without him and if he dos come out i wount live with him so keep him their and then we will all be safe.72 Jack H. was never released and died in the asylum in 1908. There is no response in the files from hospital officials to any of these letters pertaining to these two men and their wives and children. In another case, hospital officials were warned by a public trustee, who handled the property of people in state-run institutions, that William D., a man in his late thirties, had told friends in 1908 that he was going to escape. If this was ever to occur ‘his first direct act will be to murder his wife and family’, with whom the letter writer happened to be related by marriage. Clarke gave reassurances that there was not the ‘slightest possibility’ of this man’s release, given his violent reputation.73 A year later similar fears were expressed and assuaged.74 In May 1910, four years after his original admission and two years after the first escape warnings were issued from outside the asylum, William D. eloped. Since he was a warrant inmate who could only be released by permission of the Ontario government, the trustee was especially upset, telling C.K. Clarke that ‘the responsibility rests with you’ should any harm come to William’s wife Laura and their four children. After William D.’s early morning escape he went directly to the east-end home of his wife, arriving at four a.m., and left two hours later with cash. Clarke noted that Laura was most likely too frightened to call the asylum when her husband showed up so unexpectedly in the middle of the night.75 A letter written by Laura soon after his escape gives an indication of her predicament. Noting that William D. had fled to Oshawa where his mother sent his carpentry tools, she wrote: I am the only one who knows where he is, so could you let the matter rest for a few days so that suspicion does not fall on me. . . . Please don’t let him suspect I have let you know as if he comes home again, there is no telling what might happen.76 While Laura mentioned in this same letter that her husband seemed better, the immense strain and fear she had to live with is obvious, especially considering the responsibility she had in raising four children, aged 5 to 14, on her own. There is no response in the file to Laura’s letter. How this situation evolved is unknown, as William D. was not recaptured and so was written off after a month.77 Taken together these documents illustrate how for some women and children the confinement of their husband and father was a relief to the point of being potentially life-saving, and certainly helped to prevent further

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domestic abuse. At the same time, the fear that each of these women expressed about the release, or escape, of a brutal spouse was obviously a nightmare that could come true.

Support and Neglect of Patients by Family Members Some of the most compelling evidence about how family members were affected by the confinement of a relative can be found in the three case studies that conclude this chapter. In each we can see how efforts to support a loved one were undertaken under the most trying personal circumstances, with families torn apart and separated. Long-distance support for an asylum inmate was not in itself that unusual. However, the source of support for one patient was quite unlike that for almost any other inmate. Alan L. was in his early thirties when he was admitted to the Queen Street facility, where he would remain from 1887 until his death in 1918. During part of the last 20 years of Alan’s life a unique phenomenon occurred, so far as patients studied for this book are concerned: he received support from a sibling who was an inmate in another insane asylum. Alan’s sister, Sandra L., was confined in the Kingston, Ontario Hospital for the Insane about a decade after her brother was sent to 999. The date of Sandra’s admission to Rockwood is not clear, though her brother’s file has four letters from the Rockwood asylum written by her between 1898 and 1911. There is not much information on their background, but Alan’s admission papers mention he was a labourer. It is also important to note that Alan had been convicted of assaulting his sister in 1886 and had threatened to rape her at the time of his admission in 1887.78 This information makes Sandra’s years of support for Alan all the more remarkable. Her first letter from Rockwood suggests a degree of hesitancy, for while she wants to know about her brother, she also asked that he not be informed about her inquiry.79 In 1900 she was upset that a previous letter to Dr Clark had not been answered so she wrote to Dr Robinson. Sandra refers to a visit by Dr Ezra Stafford from Toronto, whom she considered asking about her brother, but declined to do so as she did not want people in Rockwood to wonder, ‘as I have never told them anything about our family afares of course you know what a set they are here’. Her fondness for Alan is plain, as she refers to the ‘poor boy must be very lonely . . . when he was well he was a good boy and allways did what was right. . . . I have so longed to hear from him.’80 Less than a year later another letter was written, this time to Daniel Clark, inquiring about money sent to Alan from their late

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brother’s estate in 1890.81 References in administrative correspondence about the volume of her writing, along with comments by Dr Forster about another letter from Sandra in 1918 (which has not survived), suggest that this woman at the Kingston mental hospital wrote letters on a fairly regular basis to Toronto where her brother was confined. It is also evident that she remained concerned about Alan until his death, as the tone of Dr Forster’s letter makes clear: Sandra I have some bad news for you. Your brother Alan . . . suddenly passed away. . . . Now Sandra I do not want you to worry about this for he was most kindly treated, and had what pleasures in life here that he could obtain in the Hospital. Mrs. Forster joins with me in remembrances, and sympathy.82 Abused wives could also be inmates of the hospital, forced to live with the emotional devastation caused by a violent mate who remained at liberty. This is what happened in the following story, which brings to light how advocacy for better treatment and conditions for asylum inmates could be most persistently promoted by devoted siblings. One of the best-documented examples of this form of support is found in the patient file of Anne D., a 42-year-old mother of seven who had been abandoned by her husband prior to admission in 1906.83 Anne’s severe mental deterioration over the next four decades was regularly recorded in her case file until her death in the asylum in 1944. Well into the early 1940s a steady stream of letters from family members inquired about Anne. The bulk of efforts to provide support revolved around Anne’s siblings, especially her sister, May K., who lived most of this time in the eastern United States, principally in Boston, Washington, and New York, before moving to Los Angeles, where she worked as a nurse. It is not clear what happened to the seven children, other than that most of them were initially abandoned by their father, Walter D., though at least two of their daughters eventually moved to Calgary by the late 1910s. At least one daughter, Edith, was able to offer some form of support to her mother on the spot, taking Anne out on probation for a month in 1909 to her home in Toronto.84 Several years later, May noted that Edith was the only family member who was ‘at all kind’ to Anne, but this daughter had died by 1913, so that May, and her brother Paul, who lived in Toronto, were ‘both trying to alleviate at least a little of her sorrow and loneliness.’85 It is clear from the years of long-distance correspondence by May that she regularly exerted pressure on asylum authorities to take better care of her sister, even citing her own experiences with mental patients as a nurse, while also

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Anne D. in a photo from around 1937 when she was 73. Abused and ­abandoned by her husband in 1906, Anne spent the rest of her life in the asylum until her death in 1944, during which time her sister May and brother Paul advocated on her behalf (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

threatening the severest action against her brother-in-law if he did not own up to his responsibilities. Over the years most attention was focused on clothing provisions for this inmate, whom hospital staff said was always tearing up material. In order to make sure regular supplies were issued, May wrote that she had taken her brother-in-law to court through a lawyer in Calgary, where Walter D. had remarried, in an effort to force him to pay

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s­ upport. She was doing this while living in Boston, as ‘I cannot bear the thought of her being left in the way she has been.’ Forster wrote back that ‘we know nothing’ about Walter D. since he never visited or wrote about his wife, though ‘two or three years’ earlier this man had agreed to send $75 a year for his wife’s support, through his father in Guelph, ‘but something seems to have stopped’ this annual payment. Immediately after May wrote two strongly worded letters in July 1915, Forster wrote to Walter D. in Calgary and to Walter’s father in Guelph asking for payment, which the elderly man tried to collect from his son, all of which apparently elicited some money. May then wrote a letter expressing her rage: If money is not forthcoming at once to care for my sister, I insist on knowing it and Mr. W.J. D__ will have the matter and a few others brought to his attention with a horse whip or a bullet pretty soon. One of our brothers lives at Handly, Sask. not very far from him and it will give [Gerald] much pleasure to handle it in that way. it should have been done long ago for the contemptable scoundrel is not fit to live and I insist upon my sister having a comfortable room and proper care in the asylum.86 This sibling advocacy and painful family feud continued for some time. Even the Attorney-General of Alberta became involved, which hospital administrators in Ontario supported, as Inspector Dunlop informed Superintendent Harvey Clare in 1920 that Mr D. was ‘legally liable’ for Anne’s support.87 By 1921, May’s legal efforts and cross-continent advocacy paid off for her sister: Walter D. ‘at last’ had been providing financial support.88 She noted in a letter a few years earlier that the only reason he agreed even to consider this form of support was because Anne’s siblings ‘refrained from taking the matter up in court against him of Desertion and cruelty on his agreement that he would see that her every need was supplyed’.89 How long this very reluctant support from Walter D. lasted is unclear. However, from the 1910s, after May began her strenuous efforts on her sister’s behalf, until the early 1930s Anne’s file contains dozens of receipts for clothing and food from her sister, brother, and children. By the mid-1930s this material support had ceased, and indeed the only letter from Anne’s husband contained in the file is from 1933, in which he asked for and received an update on her condition. Walter D. wrote that there had not been any contact with the institution for ‘some years’, which suggests he had not kept up his obligations.90 That same year May wrote another angry letter about clothing supplies, which she could not afford to pay because she had no income.

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She went on to note that Anne’s husband was employed in Calgary and should be contacted along with other better-situated family members.91 Her brother Paul’s conflict with staff was mentioned, as it had been in 1915 and in 1921. Over a decade earlier, May had noted how she was able to visit her sister only once in 14 years, but her brother Paul, who lived in Toronto, was ‘treated so rudely’ by staff that he was not sure whether to return. At that time, Dr Clare had apologized for any rudeness by employees and hoped that this would not happen again.92 In 1933, May mentioned this problem again with a reference that Anne had been ‘always very fond’ of Paul and how much he had supported her over the years.93 This is corroborated by his letters of concern for her and receipts for items with his name on them in Anne’s file. May continued to send letters to the hospital asking about her sister until shortly before Anne’s death. It is apparent that when this patient died at the age of 80 in 1944, her remains were released to her brother Paul.94 The legal threats and prodding that her siblings, especially her sister May, had engaged in over the years to get her properly clothed and cared for illustrate how essential family members could be in advocating on behalf of inmates. The cruelty of some relatives and integrity of others in the face of an excruciating conflict is revealed in another family feud that erupted over the bequest left to a chronic patient, known for her quiet, withdrawn disposition. Admitted at the age of 31 in 1880, Frances C. spent 51 years in the hospital until her death in 1931. She had originally been committed shortly after the birth of her fourth child with the diagnosis of puerperal mania. In 1927–8 a dispute erupted when the daughter and son-in-law of Frances claimed that they had followed the provisions of a will, left by Frances’s mother, that $1,000 was to be used for clothing and goods for this patient. This will was supposed to have been in effect for over a decade when it was discovered that Frances’s sister, Edwina O., had been sending provisions to her sister four times a year out of her own pocket. Edwina could prove her support with receipts, and hospital officials confirmed that they had only been dealing with her. The dishonesty of the daughter and son-in-law was compounded when this man wrote that he had personally helped his wife send out material to the hospital, though he offered no documentation to prove it, which was in direct contrast to Edwina O.95 Ironically, this man was a lawyer. Deputy Provincial Secretary Robbins wrote to Superintendent F.S. Vrooman that there was ‘no evidence’ the daughter had carried out the terms of the will left by her deceased grandmother on behalf of the younger woman’s mother. Though the Public Trustee was involved to try to force the daughter to

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live up to her legal and moral obligations, Dr Vrooman recommended to Robbins that the ‘matter might as well be dropped’ as nothing would come out of ‘any further controversy’. Evidence in the file indicates that Edwina continued to provide clothing after this.96 The cruelty of this daughter and son-in-law even extended to the grave. They did not tell their aunt that her sister had died—Edwina was left to find out on her own, more than two months after Frances C. succumbed to heart failure, when she made one of her regular calls to inquire about her sibling.97 The appalling nature of this family tragedy is perhaps best summed up in the words of Edwina O. In the midst of the dispute over the bequest several years before Frances died, she wrote the following: This unpleasantness has been most painful to me but the institution which has done so much should benefit from my dear mother’s bequest. Not one who has neglected her own mother who sacrificed her reason in giving birth to a heartless daughter. . . . Mrs. C__ was so clever, so beautiful, so admired and loved by all. It has indeed been a living death. Pardon my tiresome rambling, but other days come back when we were children together.98

Conclusion Family and community response was closely intertwined with prejudice and misunderstanding about people confined in mental institutions, which hospital officials recorded both in public documents and in clinical records. The idea of a hereditary taint associated with madness was so overwhelming among the general public that it was nearly impossible to reverse the negative and usually false stereotypes associated with hospitalization. Thus, some families expressed shame and fear of being ‘found out’ that their relative was a mental hospital patient, lest they be derided and ostracized. Some patients were even less fortunate, being abandoned by relatives after confinement so that they became friendless and without any external support. As the response of charitable agencies illustrates, hostility to both young and old who came from the asylum makes plain the type of obstacles that community prejudices forced upon some of the most vulnerable people in society. Yet documents also reveal that stigma did not prevent concerned relatives from expressing support over many years, often decades, for their confined family members.

7

Discharge and Death

Discharge Rates This chapter examines the final part of an inmate’s life at 999 and what happened after a person departed the institution, either to return to the community or after death. Before we consider the actual experiences of the men and women who were discharged or who died at the Toronto Hospital for the Insane, some statistical figures are necessary, beginning with discharges. As Table 11 shows, during the first century of the existence of the Toronto facility, the discharge rate for males, at 50.26 per cent, was slightly higher than that for females, although because more men than Table 11 Admissions, Discharges, and Deaths, Toronto Hospital for the Insane, 1846–1940

Females

Males

10,849 (48.27%)

11,626 (51.73%)

22,475

Discharges**   7,612   7,692 (49.74%) (50.26%)

15,304

Admissions*

Total

Deaths   2,559   3,159   5,718 (44.75%) (55.25%) *Includes readmissions and transfers. **Includes deportations. source: Annual

Reports, 1937, 28; 1938, 26–7; 1939, 46–7; 1940, 44–5. 209

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women were admitted, the percentage of discharges to admissions was somewhat higher for females (70 per cent, as opposed to 66 per cent for males). Discharge rates varied over the period studied here, from 5.25 per cent of the entire asylum population in 1881 to 6.61 per cent in 1910 (compared to the provincial mental hospital average of 5.69 per cent), and then to 14.16 per cent in 1940 (compared to the Ontario average of 12.25 per cent).1 From the 1870s to the 1920s administrators also tabulated recovery rates based on admissions. S.E.D. Shortt has noted that physicians considered an annual ‘cure’ rate, or people discharged as ‘recovered’, of 40 per cent as being low and 45 per cent as being high when based on annual admissions.2 This inflation of figures was borrowed from the United States in an effort to present a more optimistic picture of the ‘curative’ nature of asylums.3 Annual reports indicate how unreliable these figures are during the 1890s and early 1900s when superintendents provided one set of figures for recovery rates based on admissions at Toronto, and inspectors offered another, usually lower, set of statistics in the very same report. The most glaring example of this discrepancy is in the 1906 report, where there is a 30 per cent divide between their two statements.4 Recovery rates based on admissions include patients with disorders classified as acute as well as patients who eventually became chronic patients. Therefore, the general discharge rate was lowered by the regular admission into the hospital of people who became long-term patients.5 Nevertheless, there are consistent data on this topic in earlier and later reports. In 1870, Joseph Workman reported a recovery rate of 53 per cent based on admissions, a statistic that oscillated wildly over the decades.6 This figure was reported as 42.74 per cent in 1889 (compared to the provincial average of 35.40 per cent), but had receded to 19.74 per cent in 1910 (compared to the provincial average of 27.63 per cent) and had fallen still further by 1925 to 15.85 per cent at 999 (compared to 17.44 per cent for all Ontario mental institutions).7 Thus, by the early twentieth century, the recovery rate for both Toronto and the rest of the province was far below optimistic standards. The volatility of these figures was not unique to Ontario. Charlotte MacKenzie has found that recoveries were 15 per cent of admissions at Ticehurst Private Asylum between 1895 and 1905 and rose to 25 per cent over the following decade.8 The fact that the overall asylum population discharge rate at Toronto had risen by almost 9 per cent between 1870 and 1940 was influenced by the rise of therapeutic optimism during the later period when so-called ‘heroic’ treatments were introduced on a much larger scale than before. Not all patients were discharged as improved or recovered. Most unimproved patients were sent out only when families insisted on

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taking them out, usually over medical objections, and only when they were not certified under a lieutenant-governor’s warrant, in which case only the provincial authorities could authorize a release. Individuals who were deported were also let out as unimproved. All patients who escaped were formally discharged if they were not returned within 30 days. The question of just what it meant to be recovered or ‘cured’ related to a change in symptoms, such as someone who was no longer reported to be hearing voices and who was no longer considered a threat to oneself or others. By the late nineteenth century, physicians believed that such self-control and remission of previous symptoms, such as suicidal tendencies, were crucial to securing discharge.9 However, as Ellen Dwyer has noted, mental hospital doctors were unable to develop ‘a valid, reliable definition of mental health, any more than they could agree on one of mental illness’.10 As we will see, this vague understanding of what it meant to be ‘recovered’ could be greatly influenced by supportive relatives. Perhaps because of this imprecision, there was a degree of flexibility in allowing for release of some non-violent patients. Superintendent Workman reported in 1871 that he chose to send a short-term male patient home after seven weeks as ‘unimproved’ because he believed that to keep him confined longer would have ‘sunk’ him. This man recovered ‘with amazing rapidity’ once he was back home.11 On the other hand, two male patients who were believed to have recovered and were capable of looking out for themselves back in the community were discharged even though they had requested to remain in the institution ‘until they could get some work’.12 This report raises the point about how, in a pre-welfare state, mental institutions could serve as a shelter for those without anywhere to go, as Gerald Grob has noted, which in turn influenced lower discharge rates.13 In 1883 Inspector Christie mentioned why so many people stayed in longer than was deemed necessary—no one wanted them ‘and if put outside of the Asylum gates they would be left to die in the streets.’ He estimated that up to one-third of mental hospital patients in Ontario could have been discharged had there been the proper community supports available.14 For most of the period covered by this study, mental patients had to have family, friends, or a community refuge to go to prior to securing discharge, with this last option being especially difficult for friendless patients, as was discussed in the preceding chapter. In an effort to provide an alternative to traditional options for a small minority of inmates to reintegrate into the community, provincial administrators set up their own approved and monitored boarding houses beginning in 1933.15 Patients sent to these houses were still on the books as part

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of the hospital population and continued to receive out-patient care by occupational therapy staff who organized social gatherings one afternoon a week, as well as by social workers who visited patients every week. By the mid-1930s, 40–50 Queen Street patients were living at approved boarding homes in Toronto.16 Throughout Ontario, the figures for this group of mental hospital out-patients rose from 1.9 per cent in 1934 to 3.6 per cent in 1940.17 As has been evident throughout this book, however, statistics provide only a bare glimpse of the people who made up these numbers. To move beyond nameless statistics it is essential to look at specific examples of the conditions that allowed patients to leave the institution and to learn of their experiences after release.

The Process and Aftermath of Discharge Discharged asylum inmates are among the most difficult to trace since limited documentation exists in the best cases, while the files for most released individuals contain nothing at all after release. In some cases it is possible to infer that an individual had an extremely difficult time back home. For example, Joseph Workman wrote about a woman who was readmitted 11 times. He noted that the first time was after the birth of her tenth child, and she continued to be readmitted after her fourteenth baby was born. Workman clearly placed the responsibility for her problems on the husband of this unnamed patient.18 The discharge of mental hospital patients has to be understood in the context of external support networks and in light of their prospects for survival outside of the asylum. Doctors, friends, family members, and the patients themselves were confronted with various issues when this subject was raised. Wesley P. was released in 1913 on six months’ probation after 18 years of confinement. This happened only after protracted negotiations between family members and hospital officials to secure his release over an eight-year period. These efforts were initiated by Wesley, who wrote to his sister in 1905: ‘Please send me back home when you can. I am just as well now as when I first came in cant Improve me any[.] just as well at Home at work[.] Its only nonsense putting me in here’.19 His family returned this letter to the asylum when they made inquiries about releasing him. The main obstacle was finding someone to care for him back in the community, though farm labour was mentioned as a possibility by Wesley’s brother, who wrote in 1909 that ‘the poor boy seems heartily sick of being confined so long.’ Dr Clarke, however, expressed concern that potential employers would

DI SCHARGE A N D   D E AT H    2 1 3

not understand his mental health problems.20 Nevertheless, pressure from the patient on his family to get him released and their subsequent requests to the administration were kept up. In December 1912, more than seven years after the family first requested his discharge, and then only after their confined brother initiated the process, the administration agreed. While allowing his departure was a significant change from before, Superintendent Forster was cautious about Wesley’s condition and the energy needed to help him back in the community. Curiously, the family did not offer to take him out for another year.21 Nothing in the file indicates why there is such a gap between the hospital granting the request and the relatives acting on it. Finding a responsible party among the brothers and sisters, which had been an issue earlier, may have been a delaying factor. Yet all was by no means resolved by this apparently satisfactory outcome. During the first few months after his probationary release in December 1913, Wesley seemed to be working well at farms outside of Owen Sound. Eventually, he was fully discharged six months after his release. However, even before his final discharge, problems began to surface. Wesley’s brother reported in April 1914 that one of the two farmers who had employed the former asylum inmate was having difficulty hiring him out to other farmers in the area because ‘they all seemed afraid to take any chances.’ Several months after his final discharge Wesley’s brother wrote that six employers had let him go: ‘they all seem to be tired of him in a short time.’ 22 He then asked that Wesley be readmitted into the hospital, as no one would employ him. There is no response to this letter in the file. Legally, the hospital had relinquished all obligations upon final discharge. Wesley does not appear again in the patient records examined for this study. It is clear that his efforts to get released would not have succeeded had there not been a supportive family network helping his cause. His sedentary character was also crucial to securing his freedom, as a patient who exhibited violent or physically aggressive behaviour was considered too dangerous to be at large.23 However, the reservations expressed by asylum officials over several years about the unlikelihood of his getting along in the outside world were proven accurate at least for the period during which we have evidence. This same evidence also records the sort of challenges discharged patients faced from prospective employers, as in the case of the farmers who were reluctant to hire him, which suggests the sort of community prejudice discussed in the preceding chapter. At the same time, the fact that he was hired at six jobs in less than a year after release also shows that some work was found for him, albeit of a temporary nature. How

214   REM EM BRANCE OF PATI ENTS PAST

Wesley P. and his family coped over the long term, however, remains unknown. Ellen Dwyer has noted those patients ‘who kept in closest touch with their families had the best chance of being released.’24 Wesley’s case certainly confirms this, but so, too, was it essential for family members to maintain contact with their confined relatives. When this did not occur, the potential for release could be delayed by years, if not completely evaporate. Patients and family members were not the only ones to ask for the discharge of an inmate. Hospital officials also made this request of families. Randall F., a single labourer from Peterborough, had been confined for 11 years when the assistant physician, J.A. Mitchell, wrote to his mother in 1904: Your son asked me this morning to write you a letter for him. He wants to tell you that he is in very good health and feeling well and would like to have you write to him. He says he wants to send you his best respects and would like to know what day you would care to have him go home. My own opinion is that your son is so quiet and well behaved here that I think possibly you could get along with him very well and if you would like to take him out on probation for a month we will give you permission to do so and if you found him troublesome he could be returned to us.25 This letter was returned over a month later with several forwarding addresses on the envelope crossed out. There are no further documents of any sort in Randall’s file until a probation bond was issued seven years later. Signed by one of his sisters with an ‘X’, this form allowed him to be released into her custody to return to Peterborough for a month. He was fully discharged in October 1911, after which there is no further information.26 This raises questions about the problem of finding support for a patient the administration wanted to see released but were constrained from doing so because of lack of outside support. It is clear that Randall and his sister from Peterborough who signed the probation were both illiterate, which would have made communication with relatives extremely difficult for hospital officials. In such instances the hospital administration could do only a limited amount, particularly since there were obvious problems locating family members. Locating support could pose obstacles for another group of discharged patients: women and men who were deported. The deportation of people who were immigrants to Canada and who ended up in mental hospitals was an area of great interest among medical professionals and non-medical social activists who were motivated by a

DI SCHARGE A N D   D E AT H    2 1 5

belief that deportation would reduce the number of so-called ‘unfit’ citizens coming into Canada from overseas. By the early 1900s there was considerable debate about the federal government’s responsibility in preventing the immigration of people considered mentally ‘degenerate’, a debate that was decidedly racist and prejudiced against people from the lower classes, as well as against people with mental disabilities.27 One of the foremost campaigners for ‘keeping this young country sane’ was C.K. Clarke, who in 1907 denounced what he called ‘the evil results of the addition of defective and mentally diseased immigrants to our population’.28 Medical officials like Clarke enforced a restrictive, racist, and class-based policy by arranging with federal officials the return of mentally disturbed immigrants who came under their jurisdiction. This was not always easy to do, since hospital employees were reluctant to accompany deported inmates on long trips. Deported patients were often sent to a mental hospital in their home country or returned to their relatives. Attendants were offered bonuses to accompany inmates from their provincial point of departure to their country of destination, whereupon the deportee was to be handed over to family or local authorities.29 While the general outline of this immigration policy is well known, it is very difficult to document what happened to people who were sent back to their land of birth. However, evidence from one such episode reveals things did not always work out according to plan. In December 1906 two male patients were deported to Britain accompanied by an attendant, John Dyson, employed at nearby Mimico asylum. Upon arrival in Liverpool, one former inmate was sent directly to a mental hospital. However, the other one from 999, ­Terence J., about whom Dyson wrote that he ‘never showed anything to make me believe he was insane’, had no one there to meet him. Since Terence was believed to be sane, the local Dominion agent suggested that the only option was to ‘send him to the poorhouse or turn him adrift in the streets of Liverpool.’ Attendant Dyson refused to do this. Instead, he bought Terence J. a 14-shilling ticket out of his own pocket so this former patient could take the boat back to his home community of Cork, Ireland. Dyson wrote, ‘if that is the system of handling deports, dumping them in the streets of Liverpool without a cent in their pockets, it wants looking into.’30 Terence J. wrote to Dr Clarke through an intermediary that he had arrived safely back in Cork. He wanted to reimburse the attendant for paying his passage on the final leg of his journey and requested that money be sent to him that he was owed from military service in Canada.31 This shows how conscientious both the asylum employee and former patient were

216   REM EM BRANCE OF PATI ENTS PAST

about helping one another. For most deported inmates, however, it is impossible to know, even over the short term, if they fared any better upon arrival. This is especially true for people like Lee F., who was sent back to China in 1907, 16 months after his admission to 999.32 A victim of state-supported racism, as well as having had to endure poverty and mental health problems, Lee F.’s well-being was of no concern to immigration or medical officials in Canada, including Medical Superintendent C.K. Clarke, who sent this obviously disturbed and isolated man thousands of miles from the institution he was confined in, hardly the sign of a doctor who cared about the fate of his most vulnerable and poorest patients. Some files provide enough evidence to illustrate what happened to discharged inmates to the end of their life. Not all patients wanted to be discharged right away, even when given the opportunity, and when they were released it was only after careful preparations had taken place. Mary A., whom we have met in earlier chapters, had been confined for 17 years when she was released in June 1911 into the care of her husband, Henry. While her distress at confinement is clearly stated in a number of her letters, there are no records of Mary making a specific request to be discharged. Instead, her husband initiated and kept up efforts to bring his wife home in spite of the strenuous objections of some members of their family. Mary was, if anything, quite hesitant about leaving the hospital because of her inability to walk after being attacked by another patient, plus her concern for the financial strain on her husband, a Toronto letter carrier. A letter from Henry to hospital officials mentioned that Mary was initially ‘pleased’ at the prospect of leaving the hospital for a month, but then she expressed second thoughts, as ‘she has got into a certain routine which she is afraid she will forfeit by her absence.’33 The fear of no longer having one’s daily life situated in a structured environment after release was an impediment to discharge for a patient who depended on institutional care for her needs. Mary’s concerns in this regard would have been intensified following her injury, when medical attention was crucial to maintaining a sense of wellbeing. It is also clear that her husband was careful to reassure his wife that her wishes would be respected as to whether or not she wished to be released. Protracted negotiations followed, not least complicated by the resistance of Mary’s son and daughter-in-law to having her released. When she eventually left the asylum her release was granted because of Mary’s ‘harmless’ disposition and her husband’s assurances he could care for her. Mary ‘insisted on signing the probation bond herself’, said she would make weekly reports to the hospital,

DI SCHARGE A N D   D E AT H    2 1 7

and ‘also made her will leaving her trunk and stuff which she had to other patients.’ After arriving home she wrote to Dr Clare: ‘I got to my destination all right. I went out on Monday not very far[.] it does seem so funny not to have so much noise around me now[.] it is quite a change[.] I do miss you all so very much.’ 34 The most important influence in securing Mary A.’s release was the persistent effort of her husband. By waiting until his wife felt comfortable enough to leave and by meeting the hospital’s condition of ensuring home support for Mary, he persuaded both the patient and asylum administration that it was time for her to depart. Mary’s initial reluctance to leave a place she would refer to negatively in later writings also raises the importance of the varied perspectives a given patient could have about the asylum experience. Being confined was traumatic, yet her fear of losing contact with a familiar place and friends among both patients and staff led to insecurity about what would happen to her afterwards. Though some relationships with patients were unpleasant, as is obvious by the attack, her bequest upon departure also shows that she did have affection for others. It is likely that the thought of leaving friends behind was difficult, especially since the ability to form new friendships on the outside would in itself have been a daunting prospect due to the stigma of incarceration and her lack of mobility. When she did leave the difference was immediately apparent. The peacefulness of her new surroundings, which Mary remarked upon after arriving home, gives a strong impression of the stressful world she left behind. The fact that she started doing domestic work around the house a day or two after her release indicates how this discharge was also seen as a practical benefit by Henry in the context of traditional gender roles. Three days after Mary’s arrival her husband wrote that she had made him ‘the best square meals I have had for years’, a comment that supports the observation of Cheryl Warsh that a woman who did domestic chores was a prime ‘candidate’ for family-initiated release.35 Thus, her new-found liberty from the asylum was limited to the domestic world of the house she shared with her husband. Like other woman of her generation, Mary was not truly ‘free’, had she wanted to take this path, to do whatever she wanted outside of the family that had originally confined her. Mary was finally discharged in December 1911, six months after being released on probation with a diagnosis of ‘Dementia Praecox, Hebephraenic variety, improved’.36 What is notable about this is that her diagnosis was so positive for a condition that Dr Clarke had several years earlier described as ‘evidently one of the most incurable of all mental diseases’.37 The husband’s persuasiveness with the doctors

218   REM EM BRANCE OF PATI ENTS PAST

was helped in large degree by his wife’s quiet, dependable nature, which was an important factor in ensuring her liberty. For the next 12 years, until her death in 1923, Mary and Henry lived together in Toronto. During her first three months of probation in 1911, and again during the year before she died, Mary wrote a series of letters to asylum doctors that shed light on what she thought about her new life and about the place she left behind. References to her physical pain and the feeling of being a burden to others are mentioned during the first months of freedom. Though her son who lived downstairs did visit her, this was not the case with other family members, including Mary’s daughter and grandchildren, of whom she wrote that it ‘does seem so hard to me having brought her up’.38 Henry took her out in the wheelchair, including to church on Sundays, where she ‘joined in the service very heartily’. Yet things did not go as smoothly as was first reported. Mary became increasingly upset during her second month of probation, at which point Henry reported the only way to soothe her was to play music on the gramophone. Having had to take an additional leave of absence without pay at the post office, Henry asked Dr Clare if she could be sent back to the hospital for a while as he feared it was not possible to look after her. On the same day as this request was written, Mary also wrote to Clare asking for her own extended leave of absence, pointing out that she had been a ‘hard worker in the building for 17 years . . . but I don’t want to be forced back[.] I will come quietly.’39 She was saying, in effect, her past work should entitle her to more time off. This back and forth, to return or not to return, continued from late July to early September 1911 and makes for curious reading, not least because of the administration’s response. On the same day as the Assistant Superintendent extended Mrs A.’s probation for a month and wished her enjoyment during this period, the Superintendent wrote to Mr A. asking him to return her as soon as possible. Knowing that she had requested to visit the asylum, he suggested to Henry that he bring her there and then tell her to stay.40 The aim was obviously to return her with the least amount of resistance. Mary’s stated position of returning, if and when she wanted, was softened a few weeks later with her own admission that she needed to get along with others at home by not quarrelling and by trying ‘to hold my tongue’. This was at the same time that asylum doctors were trying to convince her to return to the asylum, first by promising Mary ‘the best place we have in the house’. When this did not work, a punitive solution to problems with Mary’s relatives was alluded to: ‘we will always be glad to see you back here and possibly it would teach them a lesson if you just left them and came right back.’41

DI SCHARGE A N D   D E AT H    2 1 9

A week later Henry informed the asylum that Mary was getting into a routine of dressmaking, was becoming more used to her surroundings, and was troubled at the prospect of returning to confinement. His employment problems were worked out to their satisfaction and the earlier request to return her was withdrawn. Mary’s determination to stay at her new residence is made clear a few days later in a letter to Forster and Clare: you ask me very kindly to come back to the instutition[.] really I have been in that building for 17 years and never been any were until I came here[.] that the change is what I wanted so when I get tired I will take your advice.42 There are no further letters in this file from the probationary period, which ended in December 1911. The difficulty of settling in to completely new living arrangements for both a released patient and relative is an important aspect of the discharge process that these letters highlight. The inevitable distress was intensified for a patient who had to experience bigotry from people who wanted nothing to do with her because of her status as a former asylum inmate. The efforts of both parties to try to consider the needs of the other person—Mary by curtailing her arguing, Henry by ensuring that she was kept occupied—were crucial to keeping this former patient at her new home. At the same time, Mary’s insistence that she wanted to stay out of the hospital, in spite of the initial efforts of her husband and the doctors to persuade her otherwise, demonstrates an ability to influence her status decisively, independent of the people around her. Whereas Henry was the most crucial agent in securing his wife’s release from hospital, it was Mary’s steadfastness that kept things moving along in a hopeful direction. Asylum officials, meanwhile, were in a state of legal limbo during a probationary period such as this and could only offer advice from the sidelines. It was up to relatives or friends to return a released patient during a specific time period.43 The final part of the discharge process after leaving the hospital was based very much on decisions made by laypersons rather than by medical officials. This allowed a released inmate a much larger degree of influence about what would be his or her fate than was the case during confinement, when the doctors were in complete control. Mary and Henry return to the files in early 1922, more than a decade after this tumultuous summer. Her friendly relations with the hospital staff, which come through in much of their correspondence, even extended to writing a rather mischievous poem to her former doctor:

220   REM EM BRANCE OF PATI ENTS PAST

Oh my Dr Clare why do you stare At the people whom you meet It is so rude for you to glare at them in the Street and when you have done your staring I am sure you must be tired To have to do so much Glaring at every little child44 After Mary’s death in May 1923, her husband informed Dr Clare and noted: ‘She always thought very highly of you.’ As a fitting postscript, Henry also wrote that their son and daughter lived only a few minutes away, ‘so that [at] the last you see we are all united again.’45 The evidence clearly shows that this discharge was beneficial to the patient. Even though she did not explicitly request to be discharged, Mary was successful in maintaining her liberty because of her own willingness and that of her husband to work at forging a supportive relationship after her injury, in spite of the obstacles they both encountered along the way. Their struggle for a life together again, beyond the barriers of the asylum walls, is a positive antidote to the often bleak assumptions about prospects for patients who were diagnosed with what was considered to be an ‘incurable’ mental disorder. The release of a long-term patient to a neighbourhood boardinghouse provides evidence about the importance of community reintegration. Alex C. had pleaded through personal letters for release for years after his confinement in 1897, though by the early 1910s this had stopped. In 1925 Alex and his wife, Louisa, ended decades of estrangement. She began to visit him on a regular basis after he refused to see her for almost 30 years.46 Her support for the man who had abused her prior to incarceration and who then rebuffed her for so long is at least as impressive as that of Henry for Mary A., about whose relationship there is much more documentation. The evidence that does exist shows that during the last years of his life, Louisa made dozens of visits to Alex and sent him regular supplies of clothing and food. The importance of these visits to this elderly couple is obvious, and they may have helped to give Alex enough peace of mind to encourage his release. By December 1933, entries in the clinical record note that 71-year-old Alex C. was ‘able to carry on a good conversation [and] expresses no delusions or hallucinations’. Thus, this once withdrawn figure, fearing persecution and shunning contact with many of those around him, had changed into a ‘quite pleasant

DI SCHARGE A N D   D E AT H    2 2 1

Alex C. was a patient from 1897 until his release to a boarding house in 1935, a few months after this photo was taken when he was 73 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

and agreeable’ patient by the time he was sent to a boarding-house on 4 May 1935.47 Yet, as with Mary A. over 20 years earlier, Alex had to be persuaded to leave the hospital. The similarity is striking in another respect: Louisa, like Henry, was extremely cautious about not wanting to offend her spouse or do anything that Alex did not wish for fear of upsetting their re-established friendship. So while she was ‘more than willing’ to take him home, Louisa wanted to make sure this proposal came from the doctors and not herself. When the offer was made in the late summer of 1934 and again in March 1935, Alex decided to stay in the hospital. The only reason given for his stance was his wanting to ‘stay where he was for the winter’.48 For an elderly man used to nearly four decades of institutional life such a decision would have made particular sense. The prospect of coping with snow and ice was less intimidating in an environment with which he was familiar than in a neighbourhood about which he knew very little. Getting used to a new home in the spring was therefore physically safer.

222   REM EM BRANCE OF PATI ENTS PAST

For the first 10 months after his release, Alex was placed in a boarding-house with other men, where he was visited regularly by a social worker and his wife, who went out walking with him. Since Louisa was experiencing financial problems, the hospital agreed that ‘we had to look after our patients’ and ordered new clothing for her husband. During this probationary period he was reported to be very quiet, ‘almost pathetic in his desire not to make trouble’.49 His withdrawn nature was believed due in part to deafness, as well as a result of years of confinement in the asylum.50 Thus the hospital report was making a link between the development of passivity and decades in an asylum environment. Certainly, this laconic disposition was in contrast to the years when he was writing letters demanding liberty. Yet, Alex was not without plans for the future. He ‘surprised’ his wife by announcing he wanted to apply for an Old Age Pension so they could move into their own home. His earlier attempt to secure a pension had been turned down in 1932 because he was a mental hospital patient.51 In late March 1936, 74-year-old Alex C. was granted a pension and was given his final discharge from the hospital, less than a year after leaving the asylum and almost 39 years to the day after his admission. He was placed in another Toronto home, though there is no mention of his moving in with his wife. A month later, Alex was admitted to St Michael’s Hospital, where he died of carcinoma on 4 May 1936, barely six weeks after he had been discharged as ‘dementia praecox, improved’, and one year to the day after he walked away from confinement.52 As with other people, his prognosis and the extent of external support were important in influencing the prospects for release. Yet, what is most striking is that a person who had spent so much energy trying to win his freedom would give up this quest, so that only years later did hospital officials raise the suggestion at the instigation of his wife. Ironically, his mellowing with age was a major factor both in ending his campaign for discharge and in helping to secure his release. With the steady support of his wife, Louisa, Alex eventually developed into a less troubled figure during the last years of his life, which more than anything else led to a favourable prognosis. The change brought about by personal contact with Louisa, with whom Alex shared an obvious emotional bond, made a great difference in his personality and in his stability. The emotional levelling effect of confinement, remarked upon after his release, also played a role in altering his temperament and led to his release. Though the case files of most discharged patients do not provide a great deal of information on their post-hospital experiences, even those files with a ‘snapshot’ provide a glimpse of how a former

DI SCHARGE A N D   D E AT H    2 2 3

inmate was doing outside. Several months after her release in 1928, Minnie B. wrote a letter to Dr Fletcher, who had treated her: I am writing this to thank you for the interest you took in me + for all you did for me while I was in your hospital. Am also sorry for the way I spoke to you the day I was cross because I was not let go home. . . . I am always ‘Doing those things I ought not to have done and leaving undone those things I ought to have done.’53 Though social relationships in the community are not discussed in this letter, Minnie’s tone indicates that she was able to cope with life away from 999. In other instances, information in files on discharged patients points to the end of their journey. If a patient was fortunate to have relatives who were willing and supportive enough, death could be eased by being released to go home to die. Nina B., 82 years old, gradually became weaker due to anemia in the autumn of 1929. After almost a quarter-century of confinement, her daughter took Nina home, where this ‘elderly woman with white hair’ passed away three weeks later.54 However, even when such release occurred, it was not necessarily final. One 82-year-old woman was taken home to die by relatives in 1875, but the change had such a ‘salutary effect’ on her that she was returned ‘hale and hearty’ though unimproved mentally.55 What happened to this unnamed patient after readmission is not recorded. As the final weeks of Nina B. indicate, relations after confinement could help to bring a family back together again, including when it was time to say goodbye.

Death of Mental Hospital Patients Yannick Ripa has written, ‘We have no idea of what madwomen thought about death. . . . there is simply no evidence at all.’56 While this may be true about the nineteenth-century asylums in France that Ripa studied, such is not the case for the Toronto Hospital for the Insane. Evidence provides a small glimmer of light about women and men patients’ perspectives on, and experiences of, death and dying. Table 11 shows that more men (55.25 per cent) than women (44.75 per cent) died at the Queen Street facility between 1846 and 1940. These figures are similar to those for male and female inmates in France, though over a much shorter period, 1842–53.57 During the 70year period covered by this study, death rates did not fluctuate as wildly as they did for admissions. In the early 1870s the death rate for patients in the Toronto asylum was 6 per cent and in 1940 it was 6.53

224   REM EM BRANCE OF PATI ENTS PAST

Female Infirmary, Toronto Hospital for the Insane, early twentieth century. Clipboards hanging on walls held the clinical charts of patients. Quotes from these charts can be found in this book (RG 10-20-B-7-6, Archives of Ontario 4611, Queen Street Mental Health Centre).

per cent. In between these years, figures dipped as low as 2 per cent in 1884 to a provincial and institutional high of 16 per cent in 1920 (compared with an Ontario mental hospital average of 8.50 per cent).58 The average provincial asylum death rate between 1884 and 1904 was 5–7 per cent, a rate reflected at Toronto.59 However, the death rate at 999 was higher than the provincial average in later years, with figures being separated by over 8 per cent in 1920, 7 per cent in 1925 (13.53 per cent compared to 6.29 per cent), and thereafter declining to a difference of 3 per cent in 1930 (8.65 per cent compared to 5.79 per cent) and of 2 per cent in 1940 (6.53 per cent compared to 4.74 per cent).60 These statistics show that mortality rates at Toronto were on a close par with the overall asylum discharge rate. However, the situation at Toronto in this respect was better than mid-nineteenth-century statistics indicate for the asylum in Lancaster, England, where J.K. Walton has found that ‘the death rate was almost always higher than the cures.’61 Why Toronto had more deaths among patients than the provincial mental hospital average is not clear, though it may have been due to the declining state of the facility as it became more dilapidated

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Table 12 Causes of Death, by Gender, Toronto Hospital for the Insane, 1846–1920 Cause of Death

Female

Male

Total

Infectious diseases* Constitutional diseases Diseases of digestive system Diseases of intestines Respiratory diseases Circulatory diseases** Blood and gland diseases Genito-urinary diseases Nervous system diseases Organic brain diseases Functional nerve diseases*** Mental diseases**** Debility of old age Accident Suicide Surgical diseases Gynecological diseases Malignant growths or cancer

133 3 1 27 69 101 5 19 2 20 35 95 159 3 8 — — 17

108 1 3 19 62 115 9 24 5 28 40 346 139 1 14 1 — 8

241 4 4 46 131 216 14 43 7 48 75 441 298 4 22 1 — 25

Subtotals

697

923

1,620

Unascertained (56.64%)

958

1,159

2,117

1,655

2,082

3,737

Total

    *73% of infectious diseases were tuberculosis, with females comprising 54% of cases.    **67% of circulatory diseases were heart disease, almost evenly divided between females and males.   ***94.6% of functional nervous diseases were due to epilepsy, almost evenly divided between females and males. ****73% of mental diseases were due to general paresis, with males comprising 90% of the cases. source: Annual Report, 1920, 111–12. It should be noted that there is an error of five extra people in the original report, though this has been ­corrected above.

226   REM EM BRANCE OF PATI ENTS PAST

d­ uring the early part of the century, when there were plans to close down the building. These plans, however, evaporated by 1920, after which the institution was refurbished.62 Table 12 shows that a majority of the causes of death (56.64 per cent) were not recorded for the period 1846–1920. Why there were so many unrecorded deaths probably related to a combination of unsystematic record-keeping, and what S.E.D. Shortt referred to as ‘vague and imprecise’ diagnoses during this period.63 Deaths recorded up to 1920 show that of the causes listed, mental diseases killed the largest number of patients, 27 per cent of the total, out of which paresis made up 73 per cent of this particular group, 90 per cent of whom were men. Old age was second, at 18.4 per cent, a figure that is not surprising for a large chronic-care institution. Infectious diseases were the third largest cause of death, at 15 per cent, with tuberculosis being the leading killer here, comprising 73 per cent of this category, a little more than half being women. Circulatory diseases were another prime cause of death (13.3 per cent), out of which twothirds were due to heart disease, nearly evenly split between women and men. In mortality figures for the last two years of this study, 1939–40, for all mental hospitals and for the population of Ontario, heart ­disease is the only cause of death closely approximated in the general population (Table 13). Respiratory diseases, pneumonia, and bronchitis were major causes of death among provincial mental patients, 29.8 per cent, in contrast to only 6 per cent for the province. This figure is striking in one other respect—the statistics for Queen Street up to 1920 show that this category was responsible for only 8 per cent of all known causes of death in earlier decades. Tuberculosis continued as a notable health threat in mental hospitals, in contrast to the general population. However, it had declined from two decades earlier, likely due to the large-scale intervention program undertaken beginning in 1933–4 at all provincial mental hospitals when regular tb check-ups every four months were instituted.64 Diseases of the arteries and cancer were the only two out of six causes of death listed in 1939–40 that were more common outside provincial mental hospitals than inside. During the entire period covered by this study, there were no major catastrophes, such as a fire, that impacted on asylum patients’ mortality. However, there were reports of epidemics, or fear of an outbreak, such as in 1874 when four female patients contracted small­pox. For tunately, this disease was contained and the patients recovered, but not before three-quarters of the staff fled in terror of being infected.65 The most serious episode threatening the survival of a large number of patients at once was that which spread around much of the world, and

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Table 13 Principal Recorded Causes of Death, Ontario Mental Hospitals, 1939–1940, and Ontario, 1939 Cause of Death

Mental Hospitals No. Rate* %

Ontario No. Rate** %

Pneumonia and    bronchitis

260 1,490 29.8   2,259   60   6.0

Heart disease

197 1,129 22.6   7,705 205

20.5

Tuberculosis    (all forms)   61   350   7.0   1,085   29   2.9 Cerebral hemorrhage   56   321   6.4    814   22   2.2 Circulatory    diseases   60   344   6.9   4,447 119 11.8 Cancer (all forms)   39   224   4.5   4,567 128 12.2 Subtotals

673

38.6   77.1

20,877   5.6   55.6

Other causes

200

11.5   22.9

16,653   4.4   44.4

Total

873

50.1 100.0

37,530 10.0 100.0

  *Per 100,000 under treatment (17,444), except totals, which are per 1,000. **Per 100,000 population, except totals, which are per 1,000. source: Annual

Report, 1940, 40.

the Toronto Hospital for the Insane was no exception: the 1918 influenza epidemic. It struck at the beginning of October 1918, with nurses affected first, followed by 20 to 30 patients a day, and lasted for a couple of weeks. Three hundred patients, or 25 per cent of the entire inmate population at that time, became ill, out of which 13 patients died. All patients 20 to 40 years of age were vaccinated and by the end of the month the epidemic was over. The hospital, which was closed to visitors during this episode, was then reopened to them.66 All of these figures bring us back to the individuals themselves. Philippe Aries has written how, in the early twentieth century, death in the Western world was a very public affair, often with the whole community participating by observing an individual’s passing and burial.67 For inmates of an insane asylum, how were death and the

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rites of mourning and burial experienced? What happened to an inmate’s belongings after he or she died? Were deaths of people considered insane ‘public’ among those who knew them inside and outside the asylum? And how, if at all, did this most final of all human experiences affect those who remained behind in the asylum? Death was an integral and final part of the patient’s experience. The manner in which inmates died can help to explain a great deal about hospital conditions at the end of a patient’s life and about the rituals and procedures that followed death. Tracing the last months and days of an inmate is possible through clinical records and clinical charts, which provide details on the cause(s) of death and emotional state of an inmate during this final period. These often consist of references to a person’s gradual decline after many years at 999 Queen Street West. Andrew J. had leg infections on and off for several years before being sent to the infirmary at the age of 83 to live out his last year in 1922–3. It was reported that he was ‘becoming quite settled in the infirmary’, where his condition was considered ‘rather good’ for such an elderly person. Affectionately known as ‘The Captain’, Andrew stated that the news was always bad and ‘will read away at his paper’ while in the infirmary, right up until two days before his death, which was attributed to old age after 41 years of confinement.68 The gradual decline of a patient could be reported on with no reference to any treatment being delivered. Erin L. was 54 at the time of her death in 1914 after 30 years’ confinement. Reputed to be violent and ‘extremely cruel’ towards other inmates, she was obviously disliked. During the last two weeks of her life, three entries record how she was ‘in a comatose condition’, was so restless that she was kept on a mattress, ‘breathing very heavily’, and finally died of apoplexy. While the cause of death is usually stated, some files provide only brief, rather vague references to the demise of an inmate, as is the case with 59-year-old Jed M.: Oct. 29, 1918. This man has gradually been becoming weaker for some time and now has to be spoon-fed. I do not think he will live very long. Oct. 30, 1918. Patient died today.69 Considering that he died at the time of the flu epidemic, it is probable that this was the cause. Other files clearly show that the impact of oppressive weather conditions or a sudden injury could help to bring about the death of a frail, elderly patient. Seventy-eight-yearold John Y. spent the last four months of his life bed-ridden in the

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infirmary. As he grew steadily weaker, it was noted in June 1911 that he ‘was much prostrated by the extreme heat yesterday and passed away quietly about six o’clock last night.’ Eighty-year-old Ellen G. was known to enjoy wandering about the asylum grounds, and on one such occasion she fell and cut her head, requiring four stitches. Ellen went into shock and died two days later.70 There were also lingering deaths, in which patients painfully deteriorated over an extended period as an ailment worsened. During her last two years at 999 Queen Street, Irene B. suffered from cancer of the right breast, which gradually spread to the lymph glands, from which she died in 1933. When patients such as Irene were on their deathbeds, hospital staff tried to make their deaths less physically painful. Sixty-year-old Anna P. became steadily weaker during her final month and was given strychnine and whisky. She slipped into incoherence and her body became discoloured as she slowly died of ‘General Exhaustion’. At the same time, if a patient was unwilling to stay in bed or receive medical assistance, the deathbed scene could be chaotic and even more painful for the inmate. Though she was dying of pneumonia, Nelly H., 58, was unwilling to stay in bed, which ‘made it very hard to help her . . . and to keep her warm.’ Evelyn T. was 63 when it was observed that her legs were ‘greatly swollen’ with blisters, due to edema, or dropsy, of the ‘hard variety’. Her refusal of medical assistance and subsequent death were recorded by Dr Vrooman: She would permit of no examination, and aimed two or three vigorous kicks at me when I approached her; these, however, did not reach their destination. She would not accept any attention from the nurses, but persisted in getting out of bed. Her condition was rapidly progressive, the edema spreading all over her body and swelling up her neck and face to a most extraordinary degree. She finally died from organic disease of the heart at 5.50 a.m. Feb. 8/23.71 The connection between physical and mental health was written about by one patient and provides a rare glimpse of a distraught patient’s perspective about her final collapse. Fifty-year-old Annie E. had been confined for 19 years in 1910 when she wrote to asylum doctors pleading with them to blow her up with dynamite because ‘Mine is the sadest case on earth.’ A few weeks later, in July 1910, she wrote that her body felt: . . . unatural . . . it unwound in the top of my head lick a clock + seemed to take all my nerve + natural life all down the back of my neck + head + a way down my back. . . . if I lay down to sleep I

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cannot stay in bead I am up and down the Hole night[.] I feel very sorrow to half to explain all this to you but I have been like this longe enough and you Doctors don’t pay the slightest ationen to me were you should put the exrase on me and see what is wrong.72 Three months after she wrote this letter Annie died, only a few hours following the discovery that she had a strangulated hernia. Her immediate cause of death was recorded as ‘Exhaustion of Melancholia’ lasting one week, while the primary cause was listed as ‘Manic Depressive Insanity’ lasting 20 years. During the last year and a half of her life, entries in her clinical record contain repeated references to her deeply distressed emotional state, which is reflected in the letter noted above. Her last months were spent without any expression of hope for herself, and she asked other patients and staff to kill her and predicted her imminent death on several occasions. What these letters and observations indicate is the connection between an inmate’s feeling of hopelessness and her physical condition. Annie’s comments about the twisted state she felt her body to be in at the time of writing her last letter should be understood in the context of her deteriorating physical condition leading up to her death several months later. That she was asking for help is obvious in the desperation of her comments, inviting death on the one hand and begging for more attention from asylum doctors on the other. Yet, the impact of her severe physical problems on Annie’s overall health could only have exacerbated the emotional turmoil she was experiencing during her final traumatic months. In the course of witnessing the deaths of inmates, nurses sometimes made entries in their charts that allow us to glimpse the last comments of psychiatric patients as they were about to die. Comments by two patients in particular expressed a haunting prediction about their pending demise. Forty-year-old Nancy K. spent her last weeks in the infirmary suffering from bladder problems and paralysis. When a urine sample was taken by catheter she wept and said, ‘I can’t lie on my back or on my side, I don’t know what to do, they’re trying to murder me here.’ A month later, writhing in pain, Nancy cried out, ‘Oh if I only had a mother I could stand it better. I can see the minister standing there reading over me.’73 She died the next day, only 16 hours after this comment was made. Joseph S., an 84-yearold man suffering from pneumonia, expressed impatience with his treatment. He not only refused food and liquids at times but was upset that, after having defecated in bed, he was not being attended to quickly enough: ‘Come on! Come on et change me!’ A few days later he said, ‘I’m going soon’ and died within a half-hour.74

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Other patients, while their last words were not recorded, nevertheless exhibited behaviour indicating their state of mind as death approached. Only 15 minutes before she died of complications arising from a coronary thrombosis, Milicent M. was reported as ‘Talkative—seems to be scolding some one—very noisy.’ Nelly H. was anything but calm during her last hours, which she spent ‘greatly frightened and afraid of something’. Thoughts of one’s earlier, preconfinement life could also recur during an inmate’s last days. Albert C., 47, had been confined for 22 years at the time of his death in 1911. It was noted that shortly before his death ‘we heard him say something about Belleville and he also asked for his keys as he said he had to lock up.’ Sixty-seven-year-old Elizabeth H. spent her last days in a state of complete despair after her leg was fractured in an accident, crying and screaming that the plaster cast on her leg was hurting her, before she succumbed to ‘Exhaustion from dementia’.75 While the deaths of some patients were recorded as sudden, it is apparent that in some cases their deteriorating condition had not been caught before it was too late. In 1917, 63-year-old William G. ‘suddenly took sick’ only a few hours before his death. He complained of stomach pains, lost his pulse, turned blue, and died of what was discovered to be duodenal cancer. Some deaths occurred so quickly that medical help was impossible, as inmates died where they fell, among other patients. Cyril M. ate his breakfast, smoked his pipe, and ‘was lying quietly on the sofa’ talking to another patient when he suddenly rolled onto the floor, ‘gave two short gasps’, and died of heart failure. Similarly, in 1947 Michael F. ate his dinner, walked down the hall, and ‘slumped to the floor’ dead from a coronary thrombosis after 44 years’ confinement.76 The most shocking forms of death within the asylum were violent—murder and suicide. There is no record of a staff member being found responsible for killing a patient, though it was reported in 1878 that an inmate died due to severe fracture of the ribs. Daniel Clark concluded after investigating the incident that none of the attendants was at fault, with death instead recorded as due to the patient being ‘exceedingly violent and unmanageable’.77 How this led to death is not explained. Three patients were recorded as being murdered by other patients between 1884 and 1890. These deaths, one male and two females, all took place in isolation cells on the refractory ward, which were shared by two inmates.78 Clark ordered closer monitoring and an open-door policy for these cramped rooms as a preventive measure after the last murder. Some two decades later, the death of a woman patient suggests how these cramped

232   REM EM BRANCE OF PATI ENTS PAST

Michael F., a patient for the last 44 years of his life until his death in 1947, in a picture from 1935 when he was 57 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

c­ onditions brought about another inmate’s violent death. Maude M. was confined at the nearby King Street branch of the Toronto facility in 1911 when she was attacked by an inmate who knocked her over and jumped on her with both feet in the room they shared. Two nurses who were present did not initially stop this assault as they feared that they would be injured as well. After she was rescued, Maude’s pulse was noted to be weak and her limbs were immobile. Dr Clare suspected she might have had a fracture of the femur. He decided to ‘leave her alone until she might rally a little’. The next day Maude died, at which time Dr Clare found that she did have a fracture of the left femur. He concluded his observation: It was found that the patient died of a pneumonia of the right lung which had been caused by placing the patient in bed on her back. . . . As we have no address of friends and as no one has visited patient for a long time and no correspondence she will be buried by the institution.79

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As Table 12 shows, up to 1920, suicide accounted for 1.3 per cent of all known causes of death, with males making up the majority, 63.6 per cent. For some inmates, despair, memories of the past, and isolation were too much to handle. In one case, the motivations of a potential suicide were recorded in detail, as medical intervention postponed her death for a short period. A suicide attempt could be well planned, and the seeds of despondency prompting it could have been sown by traumatic memories from the distant past, before confinement began. This occurred with Mabel I., a 72-year-old woman who had been at the Toronto Hospital for the Insane for 48 years when she drank cleaning disinfectant in 1918. She had hidden this poison for over a year in preparation for her attempt to kill herself, which was triggered, at least in part, by memories of her own father’s suicide half a century before, when he could not go through with selling the family farm. Her feelings were recorded: ‘She said the pain was so bad that she had to pass into the other world. She had been here a long time and they were calling her to the other world.’ Her description of the day her father ended his life and the power this memory exerted on Mabel were recounted in detail in her clinical record, with the conclusion: ‘It was a rather remarkable story from one who has been a patient here for almost 50 years and also shows that she had contemplated ending her own life, as it seems so imprinted on her mind.’ When the hospital staff pumped out her stomach, Mabel became ‘quite excited’ and begged the doctor to allow her to die. Upset that medical treatment saved her life, she said her suicide attempt was ‘a poor way as it is not acting quickly enough’ so she should have ‘tried some other way’.80 Mabel died two months later of pneumonia. For other patients, a sense of hopelessness in their present situation could influence their decision to die. Francis B. was 64 years old when he took his life in 1919 after more than 40 years of confinement. More than two decades earlier he had asked to be discharged in a letter to the Inspector of Asylums and in another communication to his brother-in-law.81 Very little personal detail has survived about this man, but what does exist gives later generations a vivid picture of his last, despondent moments. At 6:50 a.m. this morning Mr. Clark, supervisor of Cottage C was notified by patient W__ that Frank B__ was lying outside on the bench covered with blood. . . . I found the patient on the grass with a jagged wound in the right side of his neck about 3/4˝ long. The ground was covered with blood althoug [sic] the patient was not

234   REM EM BRANCE OF PATI ENTS PAST

Part of Francis B.’s 1896 letter to the Inspector of Asylums asking for ‘my discharge for I have ben so long hear’. He remained confined until his suicide in 1919 at the age of 64, 23 years after this letter was written and 41 years after he was admitted in 1878 (Archives of Ontario RG 10, Series 20B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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bleeding at the time. He was removed to ward 12 and appeared to be very weak from loss of blood. . . . His pulse was very weak and rapid and he breathed with difficulty. He died at 8.15 a.m. Patient had inflicted this injury with a large jack knife which he owned. Before his death he talked in a very depressed manner. He said he wanted to die, that he was only dust and it was no use living any longer.82 When a suicide occurred, the coroner was called in and an official report was filed by the Superintendent with the provincial government. In one instance the Inspector was not satisfied with the information provided. Arlene S., 45, had been confined for 15 years by 1918, during which time she constantly tried to escape but was either unsuccessful or was recaptured (as was discussed in Chapter 3). After breaking windows, she was placed in a pack, which was used to restrain patients, and was then confined in an isolation room, with tragic results. Yesterday the nurse visited her about 2 o’clock when she was alright. About 4.30 o’clock they reported that she had made a noose and attached it to the grating of the door and strangled herself. When Dr. Clare saw her she was dead. After receiving a letter from Superintendent Forster about Arlene’s death, Inspector Dunlop wrote back inquiring about the responsibility of the staff to prevent ‘such an accident’. Forster wrote back that, due to problems finding more personnel, there were only two nurses on duty. They were responsible for all 82 patients on the ward, so that ‘while regretting the outcome in this patient’s case, I cannot see how it could have been avoided.’83 There were no further inquiries about Arlene’s death. This exchange between Dunlop and Forster highlights the impersonal nature that death could take in such a large public facility. On a large ward such as this, with one member of staff for every 41 patients, it would not have been possible for the staff to give much personal attention to an inmate in extreme emotional distress other than restraining measures, which would only have intensified the distress. The common bond in the suicides of both Francis and Arlene is that both patients were recorded, at different times, as having unsuccessfully tried to secure their release, though by very different methods. This point provides an important clue about what may have motivated their last desperate acts—despair at never being released. However, one suicide provides another angle on motivation—distress at the thought of leaving 999 Queen Street West. An 80-year-old

236   REM EM BRANCE OF PATI ENTS PAST

man, John H., had been in the asylum for over 30 years when it was decided to transfer him to Hamilton with other patients in 1884. He cut his throat and died two days later from an act that Daniel Clark seemed to believe had been brought about by ‘the idea of leaving this asylum, where he had resided so long’.84 This episode raises the point about how the prospect of removal or actual removal from the institution could have such a devastating impact on a patient, something that was revealed nearly 50 years later in the following account of a non-violent death. Jonathan D. was 78 years old when he was sent to the House of Industry after 25 years at the Queen Street facility. It was noted that he was ‘very quiet’ so he was sent on probation to see if he could ‘adapt himself satisfactorily’ to this new location. Instead, this man, who was originally from the United States and had no known family, was devastated at being removed from an environment he knew so well. The details of the events leading up to his death were reported in a newspaper: It was about 4.15 [p.m.] . . . that D__was brought to the House of Industry, stated Mrs. F Laughlen, superintendent of the establishment. ‘About 20 minutes later, according to my report, the old man approached the clerk and said that he was going home. This isn’t a prison and we cannot exactly keep our inmates in by force. That was the last we saw of him. . . .’ Three hours later after having covered four weary miles of tramping, the aged man collapsed in front of R.H. Burrell, on Sunnyside Avenue. ‘I’m tired,’ is all he could say to Burrell. He was taken to St. Joseph’s Hospital a few blocks from the home he had known for a quarter of a century and there he died four weeks later, while futile efforts were made to find his friends. Another report noted how Jonathan spent his last days at St Joseph: ‘During his month at this institution the old man never uttered a connected sentence, the sisters said. He was never heard to say a word that even gave a clue about his former life.’85 No cause of death is specifically stated anywhere in his file. He was in good physical health at the time of his release from the Queen Street facility a month earlier, so it would appear that the trauma and disorientation of being sent away from the place he literally called home may have been significant in Jonathan’s death. The tragic irony of this destitute old man’s demise is that we have such a detailed account of what happened to him only because, at the time of his death, press reports alleged that Jonathan D., ‘the amnesia victim’, was in fact Ambrose J. Small, a millionaire Toronto theatre owner who disappeared in 1919. Many of Small’s ­former acquaintances and

DI SCHARGE A N D   D E AT H    2 3 7

a male relative came to look at Jonathan as he lay in the morgue, and the Chief Coroner, Chief Constable of Police, and Assistant Chief of Detectives all became involved in the investigation. It was not until asylum Superintendent W.K. Ross recognized the newspaper description of Jonathan’s clothes as belonging to his old ward 8 that a positive identification was made.86 Jonathan D. spent his final days in what must have been for him a bewildering world where he was unable to communicate with those who were trying to find out his identity. That he ‘fell through the cracks’ is evident since he left the House of Industry and ‘disappeared’. The employees there claimed to have told 999 Queen Street of his departure, while the asylum claimed the call must have gone out to the wrong institution, and no one at either facility bothered to follow up on how he was getting along.87 Forgotten by those who were supposed to watch out for him while on probation, Jonathan was no more than ‘the amnesia victim’ in his last days. His death exemplifies how taking someone out of an institution was not automatically good for the patient involved, as clearly this had not been the desire of this poor old man. It also illustrates the class-based nature of his death, where he became a person of widespread interest only after he had died, and only then because of the mistaken belief that Jonathan was a missing millionaire. The publicity surrounding his death was certainly unusual for an asylum inmate. Most people who were wards of the state, like Jonathan, died in the obscurity of the institution in which they resided, mourned in some cases by no one or, if they had been fortunate, by family members and some employees and patients who had come to know them over the years. Considerable respect was shown to dying inmates, both in the physical care they received and in attention to their spiritual needs. A few days before his death, due to chronic heart problems and senility at the age of 74 in 1926, Paul M. requested and was granted a visit from a priest who administered the last rites. Similarly, Carl M., Winston O., and Mavis M. were visited by a priest from St Michael’s ­College who administered this religious sacrament in the days before they died.88 How deaths such as these affected others is not usually stated. In a few cases, however, documentation clearly shows the impact on others of an inmate’s passing, as in the following observation about the reaction of May F., a long-term patient: May works about the doctors’ flat usually, but at times she has spells, commencing with depression, for a week or ten days, usually brought on by being upset over somebody dying, whom she may just know.89

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In the case of this patient, an orphan, and others like her, deaths of acquaintances among the patient population could have been especially upsetting. May belonged to that category of patients who were termed ‘friendless’, individuals who had no known relatives or friends outside of the institution. Thus, the death of another patient with whom an inmate had had a friendship, possibly lasting many years, would have caused a great deal of grief for people without external support networks, as well as for anyone else who liked a particular resident. Staff were also affected by the deaths of those they had come to like or of the especially unfortunate for whom they felt sympathy. Testimonials, such as Dr Vrooman’s eulogy to Violet N., discussed in Chapter 5, were occasionally recorded in case files. One man who died of phthisis in 1871 had been a resident for 23 years. Joseph Workman noted, ‘He was the well known blind man, who rejoiced in the possession of all the highest titles of the British peerage; and he would have stood in the Hierarchy many degrees above St. Patrick, had he not declared himself that very personage. His absence has been felt not a little. Take him for all in all, this asylum will never hold his equal.’90 Fifty years later, another patient, Ellen K., had a lengthy tribute paid to her by Dr Vrooman, two days after her death at the age of 77: Sept. 10/23 (F.S.V.) Mrs. [Ellen] K__ has been a patient in this institution continuously for a period of thirty six years. During twelve years of that time I have had her under my observation for considerable periods and, although very insane at times, her instincts have always guided her sufficiently that I have never known her to either do or say anything that was unseemly. In her lucid intervals she remained bright and companionable. She always read the daily papers and magazines and kept fairly well in touch with current events. . . . She is in age, as in length of residence, one of our oldest patients, and I wish to put it on our records that throughout her residence here she has commanded the respect of the other patients as well as those who have cared for her.91 Finally, there is the tragic story of Lizzie C. Her short life ended in 1912 at the age of only 27, the last eight years of which she spent confined at 999 with epilepsy. Lizzie, who spent her final years consoling herself by nursing and singing to a doll, had ‘severe frequent convulsions’ that increased her weakened state. After she died, Lizzie’s autopsy noted that she weighed 80 pounds and had ‘numerous adhesions’ on her scalp, likely due to injuries sustained while having seizures. The final entry in her clinical record poignantly illustrates the utter loneliness of life and death for some asylum inmates:

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We have made every effort to locate friends but up to the present have been quite unable to do so. No one about the institution has ever known her to have a visitor. The name of the correspondent on our cards knows nothing about her, and she seems quite without friends or relatives.92

Disposal of the Remains of Patients In 1887 Daniel Clark referred approvingly to American alienists’ views that more autopsies were needed as too much ‘material’ was allowed to ‘go to waste’ without contributing to medical knowledge.93 From the late nineteenth century, autopsies were performed at the asylum mortuary, referred to by the first assistant physician, Ezra Stafford, as an ‘excellent’ facility that was used for this purpose frequently.94 The mortuary was located at the northwest corner of the grounds, attached to the complex of farm buildings.95 Post-mortem exams were undertaken with the consent of families, according to Superintendent Forster, though for isolated inmates like Lizzie C. there is no evidence that consent was required by anyone. However, after 1933, it was necessary at all provincial mental hospitals to have the permission of both the next of kin and the district crown attorney.96 Though autopsies were not conducted on all deceased inmates, a standard report was filed on the physical condition of a patient at the time of death (or discharge). These reports began appearing in most patient files after 1909. This document, issued by the province, records the external physical appearance of a dead person as well as the items and disposal of a departed person’s belongings. Most of the comments are very brief and are what one would expect to find on a form about someone who has just died. For example, ‘Very thin in a wasted condition’ is noted about Henry K. after his death of pulmonary tuberculosis, while others are much less descriptive, such as that for Mathilda C., which contains one-word comments of ‘Good’ and ‘None’ in reference to her physical condition and indication of bruises. On the other hand, a description can provide gruesome details of the unhygienic conditions in which a patient died. The following entry was written about the corpse of Evelyn F., who died of tuberculosis on 2 May 1909 at the age of 23: ‘Body very thin: left hand and right elbow had been bitten by the rats the preceding night: slight discoloration there and above left eye.’97 This form was signed the day after her death but records the examination as having taken place less than two hours after Evelyn died, after six years’ confinement. The reference to rats biting her ‘the preceding night’ thus raises

240   REM EM BRANCE OF PATI ENTS PAST

the spectre of this young, poverty-stricken woman spending her last night under especially horrifying conditions. The disposal of a dead patient’s personal belongings, in cases where they had any, was taken care of quite simply, either by sending the material to relatives or, should they not want them, by disposing of them within the institution. If clothing was sent to the morgue with the body, as occurred with Mary D. in 1932, then these items were most likely not fit to be recirculated among other patients and so were burned.98 On the other hand, an individual’s personal effects could be distributed among those inmates who had nothing. It is worth noting that ‘friendless’ patients had no belongings other than institutional clothing. The sister of Anna P. specifically requested that some of her items be given to this deceased patient’s close friend: . . . among the Patients, was a Mrs. W__, with whom my sister was very friendly, and who was kind to her, if she would like any little things, as a keepsake, would the supervisor be good enough to let her have them, there was a workbag, sent last Christmas. Any books or cards, in fact anything she would choose, and we would like you to thank her from us, for all her care + kindness. Dr C.K. Clarke responded by noting this request and an earlier reference to give ‘my poor sister’s clothes’ to other needy patients: ‘we will dispose of the clothing, etc. belonging to Miss P___ as requested as we always have some patients who have no friends and who are very glad to get other than institution clothing.’99 Other families, such as the relatives of Ellen K., were not so generous. A very wealthy private patient, her belongings included a furlined coat, two hats, three pairs of gloves, six handkerchiefs, bedroom slippers, books, pictures, and a clock, among other luxuries, all of which were packed up and sent back to the family estate following her death in 1923.100 In one case, a family member exhibited appalling cruelty by taking away a gold ring that belonged to her sister, Eunice M., as she lay dying of breast cancer, to which she succumbed two weeks later.101 More common, however, was the respect shown to inmates like Sandra C., who was confined for the last 20 years of her life. After her death at the age of 64, it was noted that Sandra’s only personal belonging was her wedding ring, which, the nurse wrote, was ‘left on finger’.102 The disposal of an inmate’s body was sometimes inquired about years in advance to ensure that the wishes of a patient or relatives were taken into account. Mary A. wrote on a small, undated card the following instructions to the Superintendent:

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If I die it is my wish that my body shall be delivered over to Mr. Stone of Yonge St. to be forwarded to Mr. H. A__, Miss A__ + Master A__[.] it must not be wash or dressed in here nothing done to it what ever but giving over just as death takes it[.] what ever are found on it giving up to Master E.F. A__ all of Toronto[.] Please if it happens pay attention to my wish[.] They know. Mrs. H.A. A__103 As it turned out Mary died at home in 1923, as is discussed earlier in this chapter. However, this gives some idea of how a patient could make preparations for death with considerable self-worth and dignity, and also indicates the kind of trust she placed in her family to look after her remains. One particularly devoted sister wrote to Superintendent Daniel Clark more than 30 years in advance of her brother’s death to make sure he was buried in the family plot in Merrickville, Ontario. Anna O. wrote in 1897 and then again in 1903 about ‘proper burial arrangements’ for her brother, Winston O., a patient since 1877. Winston died in 1934, two months short of his ninetieth birthday. Anna predeceased him by 14 years. A niece of this brother and sister saw to it that Anna’s wish was respected—Winston’s body was returned to his home community, after nearly 58 years of confinement, to rest in peace with his family.104 Many other patients were not so fortunate as to have private burials with family members taking care of the arrangements. In some cases, families simply could not afford the expense, particularly during hard times as in the Great Depression. This was the case with Irene B., whose funeral in 1933 was attended by eight relatives and friends. The costs were carried by the asylum where she had lived during the last 42 years of her life.105 Inspector Christie made an observation in 1883 that was consistent for the entire period studied here: unless family or friends came to take them away, ‘indigent-chronics once in the Asylum remain there for life and are buried at the expense of the province.’106 Some of these indigent patients had no one on the outside who mourned their passing. When 62-year-old Warren S. died in 1933 after 28 years of confinement, no relatives attended. Instead, a brief service was held, officiated by a Methodist Minister at Bates and Dodds Undertaking Parlour, a couple of blocks east of 999 Queen Street West. It was witnessed by a hospital supervisor. Warren was then interred at Prospect Cemetery. By 1952, ‘friendless’ patients like May F., an inmate since 1898, were buried at a larger and newer location, Park Lawn Cemetery. A service was conducted for May by Reverend Davies of Dovercourt Road Baptist Church, with one hospital employee being the only other recorded witness.107

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Hospital employees were under strict instructions to treat the ­bodies of the dead respectfully and were responsible for washing the bodies of deceased inmates as well as dressing them in clean bedgowns or shirts. Undertakers who were in any way disrespectful to ‘even a pauper patient’s body’ were to be dismissed at once. Until at least the mid-1890s the asylum mortuary doubled as a funeral parlour where family and friends could visit the deceased, and funeral services were also known to have been held there.108 However, by the early 1900s, the neighbourhood firm of Bates and Dodds became the official undertaking service and remained under contract with the asylum well into the 1950s to provide the final journey for indigent asylum inmates. Formal reports were filed about some institutional burials, with comments stating that the proceedings were ‘reverently’ carried out or were ‘satisfactory’.109 While the vast majority of people who died were Christians, people of other faiths also died in the asylum. But no indication is given of what happened to the remains of individuals such as Belinda R., a 44-year-old Russian Jewish immigrant who died of meningitis in 1908, other than a report of her autopsy.110 She had been confined for the last four years of her life. Patients who had no known relatives were apparently buried in unmarked graves. This is evident in a reference to the burial of one particular person. Hospital administrators specifically requested that the remains of Marcia B., who died of tuberculosis in 1914, be buried by Bates and Dodds in a marked grave, implying that had this request not been made her burial plot would have been anonymous.111 Though she had relatives out of town, telegrams notifying them of her death had been returned. It would seem that officials wanted to ensure that should relatives ever inquire about where she was buried, they would be able to locate her grave. Under such circumstances, these institutional burials underline how, at the end of their troubled lives, some ‘friendless’ patients were given a degree of respect by hospital officials that the outside world had denied them in life.

Conclusion The discharge and death of asylum inmates represent two diverging strands at the end of an inmate’s life as a mental hospital patient. On the one hand, an inmate’s life within the walls was over, either to try to pursue a new life back in the community or to go to a final resting spot after death. Evidence shows that even where there was care within the community, the challenges a released patient faced were considerable under the best conditions. At the same time, patients

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such as Mary A. demonstrate how some individuals were able to live in the community with reliable support, even though her prospects were initially considered very poor. Her story and that of other former inmates is also a reminder that being discharged did not mean the end of emotional distress; readmission always remained a possibility should things not go well. Death provides a picture of the asylum as a place where the most disadvantaged inmates were cared for and then interred at the end of their life. The mental hospital could be for them a last refuge, the only community that looked out for their final needs. It is also evident that for some isolated inmates like Jonathan D., sent out into a unknown world beyond 999 Queen Street West, life as a mental hospital patient was especially precarious. He was shunted about without being asked whether being released was what he wanted, which may have precipitated his demise. For many of the women and men we have met here, whether they were discharged or died within the asylum, their lives had been irrevocably altered by their experiences as patients at the Toronto Hospital for the Insane.

8

Conclusion

The history of the average citizen of Ontario will never be written,—not because it is lacking in interest, but because its record of achievement is the general average and is therefore of such common knowledge that we all know it. But there are two classes of society whose lives are of sufficient interest to form part of a library. They represent the two extremes. The one is the few outstanding intellectual giants who have accomplished something. These have done work of benefit to mankind. The other class belong to the subnormal population, many of whom have done little work of permanent value, but becoming insane, they were placed in public institutions and their statistical records are found in Parliamentary Reports on the Insane, Feebleminded and Epileptic. H.M. Robbins, Ontario Deputy Provincial Secretary, 1926 1 This book is one response to H.M. Robbins and people like him who have expressed similar views, past and present. It goes without saying that there are today history books aplenty that reveal the richness, detail, and complexity of the lives of ‘the average citizen’, both of Ontario and of countless other places, all of which stand as an eloquent refutation of Robbins’s view of the world. The lives of some of these people are retold in this book—individuals who were labelled ‘subnormal’. These men and women were capable of an enormous amount of work of ‘permanent value’—in their relations with other people they knew and cared for, in their physical labour, in their ­writings, in their numerous uncatalogued creations and activities on 244

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and off the ward, and in the examples they provide as worthwhile human beings who suffered through immense adversity, often alone, but who tried to make a life for themselves as best they could under the circumstances. Among those who have been inspired by the lives of these asylum inmates is the author of this book, who looks to their experiences to understand how and where we have arrived as current or former psychiatric patients and what it was like for those individuals who have gone before us. These were people with names and feelings, not just anonymous statistics. Although they were confined in mental institutions, they were human beings, and they had purpose beyond the ‘statistical records’ dismissively cited by Ontario’s Deputy Provincial Secretary three-quarters of a century ago. The psychiatric patients whose experiences and voices make up this study have much to teach later generations about the world they inhabited at the Toronto Hospital for the Insane. Evidence presented here clearly demonstrates that being confined in a mental institution did not prevent patients from being active agents in their own lives and in the lives of those around them. These individuals were much more than a collection of diagnostic categories and symptoms whose entire existence can only be understood through the medical interpretations of their day. This medical context is, and remains, part of the picture, but it is only a limited part of the picture of any given patient’s life. Confinement in a mental health facility did not prevent the men and women discussed here from thinking about and influencing what was happening to them in ways that went beyond their diagnosis. Just as monolithic views about patients being perpetually controlled by administrators are proven inaccurate as more studies uncover the intricacies of asylum life, so, too, would it be inaccurate to assume that people who were diagnosed as mentally disturbed have little worth revealing to us because of their status as being certified as ‘insane’. In this sense, it is essential for researchers to acknowledge that the lives of psychiatric patients had a context that deserves to be respected. It does not advance understanding of history from the point of view of people who were marginalized simply to dismiss these interpretations as ‘politically correct’ or ‘revisionist’, as Ian Dowbiggin has done in regard to those Canadian citizens who were victimized by eugenics policies when he asks, ‘isn’t it inconsistent for us to condemn earlier generations?’2 Medical doctors and policy-makers were not the only individuals who existed in a historical context. ‘Earlier generations’ also included the very people who were ignored, silenced, and abused in their own lifetimes by officials in positions of power—as did happen to people

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in mental institutions. Whatever their disputes with other members of the élite, psychiatrists were immensely powerful in their relations with patients and there is no doubt that this power was abused on more than just a few occasions. This deserves to be dealt with from the point of view of those who were on the receiving end as a legitimate way of understanding history. In bringing to light the stories of people such as psychiatric patients, historians have to deal with why things happened to them and who was responsible for implementing the decisions that determined the course of their lives. Most importantly, we need to understand, as much as possible, the impact of these decisions on those who lived at that time and who were the focus of policies that drastically affected their existence. Psychiatric patients also had a historical context that is every bit as important to understand and appreciate as is the historical context of any physician, hospital employee, or policy-maker. Explaining away attempts to appreciate the historical context of individuals who were confined in mental institutions as being ‘politically correct’ or ‘presentistic’ (a frequently heard remark) is just another way to ‘condemn earlier generations’ to the marginalization that so many people had to endure in their own lifetime. As the preceding pages indicate, we still have much to understand, but it is clear that patient life was much more diverse and rich than has often been assumed. It is time to bring their lives, their historical context, into the centre of discussion in the history of psychiatry. The themes that make up this book illustrate how patient life at 999 Queen Street West during the 1870–1940 period was part of a vibrant world where inmates sought to shape their environment in ways that made their existence more tolerable. In this sense, mental patients were not very different from people who have never been in an institution such as this. Individuals from a variety of backgrounds who have faced adversity have tried to find ways of living that reduced personal hardships and made life more bearable, such as working-class men and women who socialized to connect with their peers and build personal and political networks of support.3 Yet, this side of life in mental institutions has not been revealed to the extent it deserves, partly because so few studies have been done on psychiatric history from the patients’ perspectives. Where these studies have been done, accounts about inmates are usually presented separately from one another, more as personal memoirs or case studies, with a broader picture of interpersonal relationships being left undeveloped. This book has been one attempt to redress this situation by integrating the individual with the institutional, all the while keeping patients’ voices and experiences front and centre.

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The portrayal of the dreary and monotonous world of patient experience devoid of much variety is revealed here as being seriously lacking in development.4 While such tediousness and misery were part of inmate life, as has been noted particularly in regard to inmates on locked wards, there was much more to their lives than sullenly following ward routine and listening to staff directives. For some patients, especially those with no outside support, this meant creating friendships with both patients and staff to sustain them through their years at 999 Queen Street West. It also meant partaking, to an extent that at times went beyond the staff’s expectations, of both work and recreational activities, such as was shown by Audrey B. and Winston O. In this sense, the therapeutic claims of administrators were overtaken by patients whose daily lives were consumed by the need to keep active in ways that they found most beneficial, regardless of official policy. Even for far less active patients, being able to interest themselves in daily life could be as ordinary as reading a newspaper or telling stories on the ward, which indicates that there was more involvement with the world than is often assumed to be the case among people in mental institutions. Some patients, to be sure, withdrew; many others did not. For those patients who were withdrawn from the world, like Alex C., who wrote in a poetic fashion about his troubles, understanding them also requires distinguishing withdrawal from inactivity. Even some of the most disturbed patients, like Lizzie C., who nursed a doll during her final, lonely years, engaged in activities which indicate that while they had no social relationships with other patients or staff, they tried to cope on their own with their mental anguish in a way that they found therapeutic. The degree of emotional relief these activities provided to such tormented souls is, of course, impossible to estimate. Their activities reveal them as being engaged in some activity while coping with a dull, monotonous ward routine that could numb and debilitate just about anyone after years of confinement. In a place of total physical and mental isolation for someone like Lizzie, this was an environment of virtually no options, of being shut off from the world on a back ward, forgotten and alone. However varied were patients’ experiences, the reports of abuse inflicted on patients by staff indicate a potentially threatening and more contentious environment. Ward dynamics reveal that patients were at a distinct disadvantage when these episodes occurred because of the considerable power imbalance between inmates and staff. There were real issues of conflict on the ward, and patients had ­limited agency because their accounts of abuse were secondary to

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staff views. Thus, for some patients, life in the asylum could be ­traumatic and devastating as they became victims of violence and were controlled by those in positions of power. Class also reflected the limited choice available to patients both on and off the ward, as access to money allowed for greater luxuries and less hospitaldirected labour for a minority of inmates. However, lack of money did not prevent those patients without financial resources from creating their own diversions. The chronic-care background of patients at 999, in which anywhere from 80 per cent to 95 per cent of all inmates were in the longterm category, was the most consistent feature of this institution. This was true regardless of the changes in treatments and diagnostics that occurred during the 70-year period studied here. Thus, while medical practices changed over the decades, this change did not significantly relieve the chronic-care nature of the hospital. The chronic-care function of the Toronto Hospital for the Insane also resulted in a relatively static population within which inmates could forge long-lasting and close relationships. Yet, while caring relationships did exist behind the walls of this asylum, the oppressive nature of being locked away, often for years on end, indicates a society where to be mentally distraught or socially isolated could be turned into a virtual prison sentence with no chance of appeal, especially for those with neither money nor status. The power of the state in enforcing this confinement was central to the lives of the people discussed here and clearly limited the options that patients had, or did not have, options that were also influenced by a person’s class, gender, disability, race, or ethnic background. So while some patients, such as Angel Queen XIII, were able to use their class position to achieve a relative degree of privilege within the asylum, her life, and even more so the lives of most other patients, was one where the ‘choices’ consisted of how best to survive within the walls of a place from which one was unable to leave unless doctors, legal authorities, and in some cases family members decided it was all right. Medical authorities’ rule of the mental institution was backed up in every respect by existing legal and political structures that gave them the power to censor a patient’s letters or confine a person for years on end. Even the efforts of a supportive family member could take time. Henry A. spent a full year persuading doctors to agree to release his wife, Mary A., while Mary herself struggled to decide whether to try life outside the walls of the institution, which eventually she did with enthusiasm. Seldom were inmates as fortunate as Coreen K., who used her class, contacts, and wealth to force her way out of the

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institution in 1917, precipitated as it was by the censorship of her mail. For most other inmates, the censorship of their mail, like the authoritarian control of all facets of their lives, continued unchanged. Simply because doctors did not see most patients every day, especially long-term chronic patients, does not diminish their very real presence in patients’ lives behind the scenes as the ultimate decisionmakers over what would happen to these institutional residents. As Linda Gordon has shown in her study of domestic violence, women who are victims of abuse have contradictory responses about how to deal with their situation, responses that are very much part of the lack of choices they have—especially for mothers who rely on abusive husbands for economic support.5 People confined in a mental institution also live in a situation where they must cope within a system that gives them limited room to manoeuvre, and this is especially true for people of a social class or group that already has plenty of barriers to deal with. While patients at 999 Queen Street West were not simply imposed upon, with no influence over what was happening around them, they were at all times subject to the overriding influence of medical and legal authorities. These officials—doctors, lawyers, police, provincial inspectors—had the power to take a person away from home, to take children away from their mother, to keep an individual confined against his or her will, to confiscate mail, to assist in the recapture of escaped inmates, and to transfer an individual to another facility. All of this was done without any consultation with the person whose life was drastically affected by these actions and who, in most instances, had no legal recourse to appeal what was happening. These things happened to people like Elsa W., Madge M., Anne D., and Jonathan D. For them, and for other people discussed here, the coercive power of the state was very real in their daily lives as psychiatric patients. There can be no doubt where the ultimate power lay in their lives, and it was not with themselves. Along with this power went an arrogance, encapsulated in the remarks of H.M. Robbins at the beginning of this chapter, an arrogance that devalued and denigrated the lives of those who lived in mental institutions as being ‘inferior’ to the officials who ran these places.6 No matter how much control they tried to assert in their own lives, the immense power wielded by authorities who ran mental institutions was the deciding factor in what happened to asylum inmates. So, while an isolated patient like Violet N. was able to eke out an existence by working on the admission ward, she did so in a world where she had virtually no choices beyond living in this constricted space. The emotional vulnerability this isolation fostered among people who

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were shut away from the wider society made for a workforce that was mentally worn down by exploitation—and exploited they were. No amount of rhetoric by doctors about work as therapy can obscure the fact that psychiatric patients were employed to keep costs down, an agenda that had more to do with economics than therapeutics. The influence of structural barriers relating to class, gender, sexuality, race, and disability was felt in the Toronto Hospital for the Insane, just as these barriers existed outside the hospital. Familiarity with these structural barriers depended on a person’s background prior to admission. The general decline in class status was experienced by all patient-labourers, who were not paid anything for their work, a clear sign of the diminished value of their labour inside a mental institution. For some inmates, decline in class status also occurred as outside financial support ran out and they were removed to lower-class public wards, where most of the patient population was located. The widespread prejudice towards people in mental institutions, as expressed by people who have never been in such places, indicates how structural barriers in the wider society towards people with mental disabilities were often felt for the first time by people who had been confined in mental institutions and who then returned to the community. This is what happened to well-to-do lawyer Jerold M. and low-paid dressmaker Irene B., both of whose lives were devastated by community prejudice after their initial release from the asylum, which led to further mental breakdown and readmission to the hospital, never to be released. For them, the reality of stigma towards people who have been confined in mental institutions was a ‘new’ and miserable experience, regardless of class background. Add ‘new’, unfamiliar experiences like this to the lives of those patients for whom barriers were already in place—because a person was female, from the lowest classes, of a racial, ethnic, or religious minority, homosexual or bisexual, or physically disabled—and the picture that emerges of the Toronto Hospital for the Insane is one where the larger structures of inequity and discrimination outside the walls were found inside the world of the institution as well. This intersection of the world outside with the world inside indicates that though hospital patients were removed from society, disparities from outside the walls were very much a part of asylum life behind the walls. Mental hospital patients were not sheltered from the daily struggles that burdened them before confinement, as structural barriers around class, gender, race, sexuality, and disability were a part of everyday life in the hospital as well. The form this took could be ­different—women and men patients were kept in separate living and

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working quarters, for example, so there would have been less sexual harassment of women simply because there were fewer men in their presence to bother them. However, this separation also reproduced the same types of inequities that non-segregated men and women experienced outside the hospital. This is evident in the types of work available to male and female patients, and in the class system that allowed some well-to-do people to get away with doing little or no work while others from the lower classes worked much more than their social ‘superiors’. A world where there were few men in their daily life would have been an unfamiliar and welcome experience for some women patients, but the familiarity of being under the control of men still existed for all of them in the form of male asylum doctors and the Superintendent, not to mention male relatives outside the institution in many instances. Thus, the patients’ world of the asylum had its unfamiliar social practices, in the form of new experiences that could be distressing, such as losing class status and being subjected to community stigma. Some experiences could also have been positive on occasion, most notably in regard to some females who escaped male harassers in the community, though even here this was by no means a sure thing, as sexual harassment and abuse of patients clearly took place in the asylum, as Elaine O.’s letters testify. Generally, most patients, especially those who were among the majority of public inmates from the lowest classes, would have experienced the familiar structural barriers that they had to struggle with all of their lives. Being confined in a mental hospital did not change this fact, as there were more than enough discriminatory barriers for psychiatric patients to deal with at 999 Queen Street West. Of course, many of these disparities are still with us, decades after the people discussed here have died. To take just one example, the historical exploitation of work done by people who are patients in mental hospitals, or people with mental disabilities in general, is not a thing of the past but has continued well into the 1990s.7 This connection between the past and the present, between the lives of the people discussed here and their legacy, indicates how important it is to listen not only to those who were ignored long ago, but to people who have too often been silenced in our own time. The complexity of this topic and the varied experiences and perspectives of the people who were patients at 999 Queen Street West indicate that there is no one easy, clear-cut solution to caring for people with mental health problems. As horrific as 999 was in many ways, the total absence of any institutional support for people who needed care would have

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been even worse. The street or a jail was no alternative for many of the people who, in fact, were sent from precisely these places a century ago and who today are often dumped back on these very same streets, or in jail, without any supports.8 Closing down mental institutions and reducing beds in existing facilities without widespread social supports for people outside the hospital, as has happened in Canada and elsewhere in the Western world, only makes a bad situation worse. A century ago, people like Josiah M. were kept in the asylum until there was a place for them outside—in his case, no place was ever found due to community stigma and so he remained confined until his death. Today, people like him are too often dumped out of mental health facilities, even when social supports are minimal at best, non-existent at worst, with ex-patients ending up homeless or living in squalid boarding-houses. Neither of these ‘options’—staying locked up for years on end or being discharged into poverty and continued social isolation—is, in reality, an option at all, for they offer no real hope or opportunity. If the story of Jonathan D. can tell us anything, it is that the devastating impact of sudden discharge with no social supports beyond a meagre boarding-house, at which Jonathan refused to stay, is not something that has just happened with deinstitutionalization. It also happened decades before the large-scale emptying of mental institutions began. What was absent then was any choice for such a person, who was released without any prior consultation as to what he thought about leaving the hospital, something that this isolated, elderly man did not want to have happen. Thus, Jonathan was left literally to wander off into a disorienting world where no one knew his name—that is, until after he was dead. The bewildering world that Jonathan encountered in his last days can stand as a metaphor for the confusion and complexity that has developed around the history and future direction of mental health care. On the one hand, discharging a patient into the community without social supports, and without even bothering to ask the person who was being sent away from the hospital what he or she thought of this move, was no answer then or now. Then again, a system that kept people locked inside a dark, cold, prison-like mental institution, where many of them became, like Jonathan, totally dependent on the only world they were allowed to know, was hardly a sign of great progress either, then or now. In order to move away from this stark contrast of ‘either/or’—for or against keeping people in mental hospitals—it would be better to offer alternatives that move beyond such polarized positions. Since the nineteenth century, and especially since the 1970s, people who

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have been in mental institutions, and who have struggled both with mental health problems and against many of the systemic barriers experienced by the people described here, have offered criticisms of and alternatives to mental hospitals. These activists and writers range from those who promote separatist, anti-psychiatry views, to others who advocate working for change within the mental health system, to those who express both critical and supportive views of psychiatric treatments.9 Some identify themselves as consumers of psychiatric services, others as psychiatric survivors, others as ex-inmates, still others as psychiatric patients, while some combine one or more of these terms or reject them all in favour of another term, such as ‘users’, ‘clients’, or even ‘crazies’, this last term being a way of reclaiming the age-old insult as a form of defiance. Or as a person. If one thing brings together all of these diverse views, whatever the differences in interpretations and experiences, it is that all people who have been in mental health facilities want to be known by their own names and want to be understood as unique and individual personalities. Jonathan D. or Lizzie C., and even Angel Queen. By listening to and learning from their stories from the past, and by understanding the views of people who have been in mental institutions in our own time, we create the greater possibility of making mental health treatment more humane, less imposing, less impersonal, and more responsive to what the people on the receiving end want or do not want. It is also true that, at times, involuntary committal to a mental health facility was and is today still necessary for those who are a physical threat to themselves or to those around them. The confinement of mentally disturbed men who abused their wives and children, for example, was a relief to their families. Such situations must be considered in historical and contemporary discussions of patients’ rights and responsibilities to people in the community. Those who were and are psychiatric patients also have to respect the rights of others with whom they live by not committing acts of violence, and it can be said that most psychiatric patients have lived up to this code of conduct that should apply to every citizen, today as in the past. As this book has made clear, the vast majority of psychiatric patients were not, and are not, violent. It is important, when researchers write about the minority of people with mental disorders who were and are abusive, that they deal with this issue by avoiding the stereotypes that only perpetuate the myth of the ‘violent mental patient’. This stereotype has been used too often throughout history, and in oral tradition, to tar unfairly all patients with the same brush. It is a caricature and an insult to a very diverse group of people.

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While this book does not presume to offer any grand solutions to the ongoing crisis in the contemporary mental health system, it is essential that any attempt to arrive at improved care in hospitals or out in the community must include the views of the people who know first-hand what it is like to experience debilitating mental health problems. Consideration of complex issues needs to include a wider circle of views, well beyond the medical community, which, during the period covered by this study, dominated the language and interpretation about what it meant to be a psychiatric patient with an arrogance that was overwhelming. This has been changing over the last 30 years, in large part because many current and former psychiatric patients have refused to be silenced, as happened to so many of those from an earlier period when patients had to endure the power and dismissiveness of a medical profession that was unaccountable to the people they confined. Fortunately, that medical power is no longer as

A poem written by Graeme L. in 1907 (Archives of Ontario RG 10, Series 20-B-2, Queen Street Mental Health Centre Records Casefiles, Admissions and Readmissions).

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unaccountable to psychiatric patients as it once was, largely because people campaigned to limit the reach of psychiatrists, much to the chagrin of mental health professionals.10 But there is still a long way to go in protecting patients’ rights and in recognizing that including the perspectives of people who have been or who are today psychiatric patients needs to be at the centre of mental health policies. Resorting to coercive psychiatry in the form of community treatment orders, as the Ontario provincial government of Mike Harris has decided to do in the late 1990s, is a backward step that is as ‘new’ as forcing people to do what the doctor says, an old and justifiably bad memory in the history of psychiatry.11 Forced treatment after admission was degrading and abusive in the past, as the writing of Angela B. indicates. It continues to cause harm when it reaches out into the community for someone who does not take prescribed medication, as this only serves to reinforce the dehumanization of the person who suffers such an experience, devoid of any therapeutic benefits to the person on the receiving end. More imagination is needed in mental health care than this, and if people who have been in mental institutions have one thing in abundance it is imagination, as the stories in this book make clear. The first step is to begin by listening to the people who have been there as psychiatric patients, whether the listener is a doctor, a policy-maker, a historian, or anyone else, and to take these views seriously, free of any judgement about a person’s medical history. As complex as this topic is, it is a simple place to start. Rather than deciding whether or not a person was ‘sick’ and ­slotting him or her into a diagnostic category that was not of the ­individual’s choosing in the first place, this book has instead chosen to look at just what kind of life people at the Toronto Hospital for the Insane experienced between 1870 and 1940—to listen to their stories, as imperfect as this process has been. The patient culture that these ­people created to cope with their confinement deserves closer attention. Patients were not, and are not, separated from one another, automatons going about a self-constructed world with little or no interaction with others. ­Weaving together the qualitative stories that make up this study under specific themes is one way of getting beyond an approach to patients’ history in which accounts of people’s lives are presented on their own, rather than in conjunction with one another to illustrate a wider picture.12 An aspect of this topic that remained essentially unchanged throughout the period of this study was the degree of public misunderstanding and prejudice towards people who were confined in

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mental institutions. Evidence shows that while there was a degree of support by social service agencies and religious groups that sponsored events at the asylum, this support was outweighed by the antipathy shown to patients and relatives of patients who were at 999 Queen Street West. Efforts to combat negative stereotypes were not enough to wipe out the age-old image of people with mental disorders as being either ‘violent maniacs’ or ‘stupid’, ‘incompetent’ people incapable of contributing anything useful to the community in which they lived. This book has attempted to make a small contribution to challenging these prejudices and misperceptions by showing that the men and women who lived at the Toronto Hospital for the Insane during the 1870–1940 period were much less of a monolithic group and much more diverse than has otherwise been described in historical discussions about people in mental institutions. Above all, the people whose voices and experiences make up this study show later generations that psychiatric patients have a great deal to teach us about what it was like to be confined in a mental institution and to live with the psychological troubles that brought them to 999 Queen Street West.

Notes

All Toronto Hospital for the Insane patient file numbers for this book have been recoded, and patients admitted after 1899, and their relatives, have had their names anonymized using actual first and last initials, in accordance with the Freedom of Information and Protection of Privacy Act of the province of Ontario. Some patients admitted before 1899, and their relatives, have also been made anonymous. Patient files, unless otherwise indicated, are located at the Archives of Ontario, Toronto, rg 10, Series 20-B-2, Queen Street Mental Health Centre Records. Throughout the notes ao refers to the Archives of Ontario, and ar with the year refers to Annual Reports of Inspectors of Insane Asylums (or Mental Hospitals, as they were called in Ontario after 1907).

Chapter 1    1. Graeme L., Patient File #12001, typed poem, ‘On Toronto Asylum for Insane’, 8 May 1907, 1.    2. Tom M., Patient File #10001, Clinical Record, June 1941. Tom M. died five months later.    3. This figure was arrived at by adding all admissions between 1870 and 1940 noted in the Annual Reports. This can be done by subtracting 3,656 who were admitted up to 1 October 1870 from the 22,475 admitted up to 1940, to come up with 18,819.    4. ar, 1869–70, 78.    5. Dale Peterson, ed., A Mad People’s History of Madness (Pittsburgh, 1982). Work in this area by Roy Porter includes A Social History of Madness: Stories of the Insane (London, 1987); Mind Forg’d Manacles: A History of Madness from the Restoration to the Regency (London,1987); ‘Bedlam and Parnassus: mad people’s writing in Georgian 258

N O T E S    2 5 9

England’, in George Levine, ed., One Culture: Essays in Science and Literature (Madison, Wis., 1987), 258–84; ‘The Diary of a Madman, 17th Century Style: Goodwin Wharton, mp, and communer with the fairy world’, in R.M. Murray and T.H. Turner, eds, Lectures in the History of Psychiatry: The Squibb Series (London, 1990), 128–43; The Faber Book of Madness (London, 1991). See also Anne Collins, In the Sleep Room: The Story of the CIA Brainwashing Experiments in Canada (Toronto, 1988); Barbara Sapinsley, The Private War of Mrs. Packard (New York, 1991); Denise Jodelet, Madness and Social Representations: Living with the Mad in One French Community, trans. Tim Pownall, ed. Gerard Duveen (Berkeley, 1991); John S. Hughes, ed., The Letters of a Victorian Madwoman (Columbia, SC, 1993); Iain D. Smith and Allan Swann, ‘In Praise of the Asylum—The Writings of Two Nineteenth Century Glasgow Patients’, in L. de Goei and J. Vijselaar, eds, Proceedings of the 1st European Congress on the History of Psychiatry and Mental Health Care (Rotterdam, 1993), 83–9; Michael Barfoot and Allan W. Beveridge, ‘ “Our most notable inmate”: John Willis Mason at the Royal Edinburgh Asylum, 1864–1901’, History of Psychiatry 4, 2 (June 1993): 159–208; Steven Noll, ‘Patient Records as Historical Stories: The Case of Caswell Training School’, Bulletin of the History of Medicine 68, 3 (Fall 1994): 411–28; Jeffrey L. Geller and Maxine ­Harris, eds, Women of the Asylum: Voices From Behind the Walls, 1840–1945 (New York, 1994); Geoffrey Reaume, ‘Keep Your Labels Off My Mind! or “Now I am Going to Pretend I Am Craze But Dont Be a Bit Alarmed”: Psychiatric History from the Patients’ Perspectives’, Canadian Bulletin of Medical History 11, 2 (1994): 397–424; Peter Keefe, ‘Recollections of a Patient at tph: Snakepit’, in Edward Shorter, ed., TPH: History and Memories of the Toronto Psychiatric Hospital, 1925–1966 (Toronto, 1996), 171–82; Jonathan Sadowsky, ‘The Confinement of Isaac O.: A Case of “Acute Mania” in Colonial Nigeria’, History of Psychiatry 7, 1 (Mar. 1996): 91–112; Geoffrey Reaume, ‘Accounts of Abuse of Patients at the Toronto Hospital for the Insane, 1883–1937’, Canadian Bulletin of Medical History 14, 1 (1997): 65–106; Lykke de la Cour, ‘ “She thinks this is the Queen’s Castle”: Women Patients’ Perceptions of an Ontario Psychiatric Hospital’, Health & Place 3, 2 (June 1997): 131–41; Lykke de la Cour and Geoffrey Reaume, ‘Patient Perspectives in Psychiatric Case Files’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto, 1998), 242–65; Diana Gittins, Madness in Its Place: Narratives of Severalls Hospital, 1913–1997 (London: 1998); Allan Beveridge, ‘Life in the Asylum: Patients’ Letters from Morningside, 1873–1908’, History of Psychiatry 9, 4 (Dec. 1998): 431–69.

260   NOTES

   6. See, e.g., Thomas Brown, ‘ “Living with God’s Afflicted”: A History of the Provincial Lunatic Asylum at Toronto, 1830–1911’, Ph.D. thesis (Queen’s University, 1980); Wendy Mitchinson, ‘Gender and Insanity as Characteristics of the Insane: A Nineteenth-Century Case’, Canadian Bulletin of Medical History 4 (1987): 99–117; Mitchinson, ‘Reasons for Committal to a Mid-Nineteenth-Century Ontario Insane Asylum: The Case of Toronto’ in Mitchinson and Janice Dickin McGinnis, eds, Essays in the History of Canadian Medicine (Toronto, 1988), 88–109; Mitchinson, ‘The Toronto and Gladesville Asylums: Humane Alternatives for the Insane in Canada and Australia?’, Bulletin of the History of Medicine 63, 1 (Spring 1989): 52–72; Mitchinson, The Nature of Their Bodies: Women and Their Doctors in Victorian Canada (Toronto, 1991), chs 10 and 11.    7. ar, 1878, 259–60, 263. For a discussion of the debates about establishing the Provincial Lunatic Asylum, see Thomas Brown, ‘The Origins of the Asylum in Upper Canada, 1830–1839: Towards an Interpretation’, Canadian Bulletin of Medical History 1 (1984): 27–58.    8. ar, 1885, 47; 1888, 4; 1940, 104.    9. Andrew Scull, ‘Moral Architecture: The Victorian Lunatic Asylum’, in A. King, ed., Buildings and Society: Essays on the Social Development of the Built Environment (London, 1980), 37–60; Thomas Brown, ‘Architecture as Therapy’, Archivaria 10 (Summer, 1980): 99–123; Barry Edginton, ‘Moral Treatment to Monolith: The Institutional Treatment of the Insane in Manitoba, 1871–1919’, Canadian Bulletin of Medical History 5, 2 (1988): 167–88.   10. J.M.S. Careless, ‘Toronto’, The Canadian Encyclopedia, vol. 4 (Edmonton, 1988), 2170–1.   11. For references to closing down the Toronto Hospital for the Insane, see: ar, 1908, 3; 1910, ix.   12. From 1966 to 1998 this facility was called the Queen Street Mental Health Centre, and since amalgamation in 1998 with three other health care facilities in Toronto it is called the Centre for Addiction and Mental Health, Queen Street Division. The address has also been changed since 1979, when the modern building was opened, from 999 Queen Street West to 1001 Queen Street West. This information, and the historical dates and names of the institution, 1841–1966, can be found at ao, rg 10-20-B, ‘Scope and Content’, 1.   13. ar, 1876, 207; 1898, xv; 1940, 39.   14. ar, 1878, 263; Cyril Greenland, The City and the Asylum (Toronto, 1993), 20–1.   15. ar, 1879, 26–7.   16. ar, 1883, 26–7.

N O T E S    2 6 1

  17.

  18.

  19.   20.   21.   22.   23.   24.   25.   26.   27.

  28.   29.

  30.   31.

ar, 1906, vi; 1917, 85–6; ao, rg 63, Subseries A-8, Vol. 746, File 407, Inspector’s Numbered Subject Files: Public Works at Ontario’s Mental Institutions, 1917–20, Memo re Mercer Reformatory (undated), Memo re Toronto Hospital for the Insane (undated). ar, 1909, 3. ar, 1923, 11, reports that 15 nurses lived on wards, 15 in one of the women’s cottages. A year later over 30 nurses were reported living in the main building: ar, 1924, 8. Reference to nurses using the upper floor of the main building as a dormitory can be found in ar, 1931, 21. ar, 1904, 6. ar, 1879, 26–8; 1883, 48–9; 1882, 17; 1879, 26–7. ar, 1928, 6–7. Daniel Clark complained that nearby trains ‘keep up a constant concert day and night’, which upset patients, especially new arrivals. ar, 1876, 213. William Dendy, ‘The Provincial Lunatic Asylum’, in Dendy, Lost Toronto (Toronto, 1993), 164–7. Anita B., Patient File #9006, Clinical Record, 31 Dec. 1909; Connie D., Patient File #9008, Clinical Record, 3 Aug. 1909; ar, 1923, 11. ar, 1906, 5. Grace B., Patient #3002, Letter to Daniel Clark from W.S., Port Hope, Ont., 10 June 1882; Letter to W.S., Port Hope, Ont., from Daniel Clark, 13 June 1882. Maude B., Patient File #4016, Letter to Mrs N., Brantford, Ont., from Medical Superintendent C.K. Clarke, 14 Nov. 1906. For reference to flies buzzing about the ward and the efforts of one patient to catch them, see Walter R., Patient File #9046, Clinical Record, 6 Dec. 1909. Maude B., Patient File #4016, Letter to Mr Tracy (Asylum Bursar) from Mary B., Brantford, Ont., 9 May 1895. Beatrice M., Patient File #4037, Letter from Dr Daniel Clark to Inspector R. Christie, Toronto, 16 Aug. 1898. Ann P., Patient File #2014, Letter to Inspector S.A. Armstrong from Medical Superintendent C.K. Clarke, 26 Sept. 1907; Mathilda P., Patient File #7001, Letter to E.J.T., Whitby, Ont., from Medical Superintendent Daniel Clark, 15 Oct. 1901. Reginald C., Patient File #4018, Letter to Medical Superintendent Forester [sic] from Katerina G., Whitby, Ont., 28 Dec. 1917; Letter to Dr Forster from Katerina G., Whitby, Ont., 28 Feb. 1918. John Y., Patient File #3004, Clinical Record, 3 June 1911; Hanna M., Patient File #5015, Letter to Mrs S.R. from Medical Superintendent, 9 July 1921; Reginald F., Patient File #10015, Letter to Dr Clark [sic] from A.F., Buffalo, NY, 18 Nov. 1910.

262   NOTES

  32. Ralph M., Patient File # 6010, Undated, unsigned letter, not addressed to anyone, in Ralph’s handwriting, found among other letters he wrote that are dated from 1910 and 1911.   33. Margery A., Patient File #8037, Clinical Record, 7 Sept. 1918; Albert A., Patient File #6030, Clinical Record, 30 Sept. 1939. Medical Superintendent Harvey Clare reported: ‘Verandahs at the end of each ward are used as dormitories for sick patients.’ ar, 1923, 11.   34. Mary D., Patient File #9015, Clinical Record, 22 Jan. 1931; Elaine O., Patient File #8016, Letter to Dr Hernman (probably Dr Herimann, Assistant Superintendent at Toronto, 1908–11) from Elaine O., 28 Mar. 1910.   35. Anne D., Patient File #10009, Letter to Dr Forrester [sic] from M.L.K., Boston, 14 July 1915.   36. This figure is taken from the total number of paying patients, 260 in 1895, contrasted with the overall average daily patient population at 999 Queen Street West that same year, 698 people. For both figures, see ar, 1895, 35.   37. S.E.D. Shortt, Victorian Lunacy: Richard M. Bucke and the Practice of Late Nineteenth-Century Psychiatry (Cambridge, 1986), 128–9; Cheryl L. Krasnick, ‘ “In Charge of the Loons”: A Portrait of the London, Ontario Asylum for the Insane in the Nineteenth Century’, Ontario History 74, 3 (Sept. 1982): 166–70.   38. Nancy Tomes, The Art of Asylum-Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry (Philadelphia, 1994), 21–2.   39. Andrew Scull, ‘From Madness to Mental Illness: Medical Men as Moral Entrepreneurs’, in Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective (Berkeley, 1989), 128–33. For brief biographical information about Workman and Clark, see C.G. Stodgill, ‘Joseph Workman, m.d., 1805–1894: Alienist and Medical Teacher’, Canadian Medical Association Journal 95 (29 Oct. 1966): 917–23; ‘Obituary: Death of Dr. Daniel Clark’, Canadian Journal of Medicine and Surgery 32, 1 (July 1912): 63–4.   40. Nancy Tomes, ‘The Great Restraint Controversy: A Comparative Perspective on Anglo-American Psychiatry in the Nineteenth Century’, in W.F. Bynum, R. Porter, and M. Shepherd, eds, The Anatomy of Madness, vol. 3 (London, 1988), 190–225. For Canadian reference to this development, see Shortt, Victorian Lunacy, 130–1.   41. ar, 1883, 62.   42. John Starett Hughes, ‘The Madness of Separate Spheres: Insanity and Masculinity in Victorian Alabama’, in Mark Carnes and Clyde Griffin, eds, Meanings for Manhood: Constructions of Masculinity in Victorian America (Chicago, 1990), 64.

N O T E S    2 6 3

  43.   44.   45.

  46.   47.   48.   49.

  50.

  51.   52.

ar, 1870–1, 131; 1877, 245; 1878, 288–91; 1879, 24; 1877, 238. References to Clark’s stated medical conservatism can be found in ar, 1896, 39; 1898, 39. ar, 1898, 40; 1900, 6; 1931, 73. See, e.g., Erin L., Patient File #3019, Receipt, 28 Aug. 1901: 653 Spadina Avenue, phone 3422, re: Erin L. in Account with Dr Josephine Wells, Dentist, extracting and filling $2.00. Dental accounts were also arranged and settled by letter with family or friends of patients, or with the Public Trustee. ar, 1898, 40. Shortt, Victorian Lunacy, 124. Elliot S. Valenstein, Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (New York, 1986), 11–22. For a survey of the historical evolution of schizophrenia, see Irving I. Gottesman, Schizophrenia Genesis: The Origins of Madness (New York, 1991), 6–7; U.H. Peters, ‘The German Classical Concept of Schizophrenia’, in John G. Howells, ed., The Concept of Schizophrenia: Historical Perspectives (Washington, 1991), 59–74; Manfred Bleuler, ‘The Concept of Schizophrenia in Europe During the Past One Hundred Years’, in William Flack Jr et al., eds, What Is Schizophrenia? (New York, 1991), 1–15; Joseph Zubin, Stuart R. Steinhauer and Ruth Condray, ‘Schizophrenia from an American Perspective’, in Flack et al, eds, What Is Schizophrenia?, 17–31. Superintendents at 999 Queen Street West during the period covered by this study were as follows: Joseph Workman, 1853–75; Dr Gowan, 1875; William Metcalfe, 1875; Daniel Clark, 1875–1905; C.K. Clarke, 1905–11; J.M. Forster, 1911–20; Harvey Clare, 1920–5; F.S. Vrooman, 1925–8; H.A. McKay, 1928–30; W.K. Ross, 1930–2; W.C. Herriman, 1932–3; J.S. Stewart, 1933–5; R.C. Montgomery, 1935–7; J.R. Howitt, 1937–41. Of these figures, Dr Workman and Dr C.K. Clarke, after whom Toronto’s Clarke Institute of Psychiatry is named, have aroused the most historical interest. See, e.g., Stodgill, ‘Joseph Workman, m.d.’; Cyril Greenland, Charles Kirk Clarke: A Pioneer of Canadian Psychiatry (Toronto, 1966); Ian Dowbiggin, ‘Keeping This Young Country Sane: C.K. Clarke, Immigration Restriction, and Canadian Psychiatry, 1890–1925’, Canadian Historical Review 76, 4 (Dec. 1995): 589–627. Thomas E. Brown, ‘Dr. Ernest Jones, Psychoanalysis, and the Canadian Medical Profession, 1908–1913’, in S.E.D. Shortt, ed., Medicine in Canadian Society: Historical Perspectives (Montreal, 1981), 350. Ezra H. Stafford, ‘Some Clinical Aspects of Mental Disease’, Canadian Journal of Medicine and Surgery 1, 4 (Apr. 1897): 159–60.

264   NOTES

  53. C.K. Clarke, ‘Dementia Praecox’, Canadian Journal of Medicine and Surgery 21, 4 (Apr. 1907): 220, 223.   54. C.K. Clarke, ‘The Psychiatric Clinics of Germany’, Bulletin of the Toronto Hospital for the Insane (later renamed Bulletin of the Ontario Hospitals for the Insane) 1, 4 (Jan. 1908): 18–20 re visit to Zurich Clinic and Bleuler, 25–35 re visit to Munich; quote re ‘true standards’ is on p. 30. See also ar, 1907, 10.   55. ar, 1908, 4; 1906, 8–9; 1911, 109.   56. Barbara L. Craig, ‘Hospital Records and Record-Keeping, c. 1850–c. 1950, Part I: The Development of Records in Hospitals’, Archivaria 29 (Winter 1989–90):. 63–4; Craig, ‘Hospital Records and Record-Keeping, c. 1850–c. 1950, Part II: The Development of Record-Keeping in Hospitals’, Archivaria 30 (Summer 1990): 24–5.   57. C.K. Clarke, ‘The Detection of Mental Defect in School Children’, Canadian Journal of Medicine and Surgery 21, 6 (June, 1907): 344.   58. Of these 180 patients diagnosed with hebephraenic, catatonic, or paranoid dementia praecox in November 1911, 87 women and 93 men had been confined for between five to 50 years at the Queen Street facility. For an early reference to dementia praecox being referred to as schizophrenia in Ontario, see ar, 1933, 75.   59. Dr Harvey Clare, ‘The Treatment of Insanity’, Bulletin of the Ontario Hospitals for the Insane 9, 3 (Apr. 1916): 76.   60. J.P. Harrison, ‘Dementia Praecox’, Bulletin of the Ontario Hospitals for the Insane 3, 5 (Apr. 1910): 7.   61. ar, 1906, 7; 1932, 97.   62. Valenstein, Great and Desperate Cures, 26–7.   63. ar, 1909, 3; 1910, 101–2. For more detail on Ernest Jones during his years in Toronto, 1908–13, see R. Andrew Paskauskas, ‘Ernest Jones: A Critical Study of His Scientific Development (1896–1913)’, Ph.D. thesis (University of Toronto, 1985), 165–224; Brown, ‘Dr. Ernest Jones’, 315–60.   64. ar, 1925, 8; 1926, 14; 1931, 21; 1933, 30–1.   65. I would like to thank Professor Pauline Mazumdar for her comments on this point. See Valenstein, Great and Desperate Cures, 29–31.   66. Ibid., 32, 34.   67. ar, 1938, 5; 1939, 5–6; Valenstein, Great and Desperate Cures, 47, 53.   68. ar, 1940, 21.   69. Harvey G. Simmons, Unbalanced: Mental Health Policy in Ontario, 1930–1989 (Toronto, 1990), 209–24; Simmons, ‘Psychosurgery and the Abuse of Psychiatric Authority in Ontario’, Journal of Health Politics, Policy and Law 12, 3 (Fall 1987): 537–50; Geoffrey Reaume, ‘The Rise and Decline of Psychosurgery in Ontario’ (unpublished paper, 1989), 6.

N O T E S    2 6 5

  70. Simmons, Unbalanced, 216–18.   71. See, e.g., Robert F. Morgan, ed., Electroshock: The Case Against (Toronto, 1991); Douglas G. Cameron, ‘ect: Sham Statistics, the Myth of Convulsive Therapy, and the Case for Consumer Misinformation’, Journal of Mind and Behavior 15, 1–2 (Winter-Spring 1994): 177–98.   72. Chlorpromazine, a behaviour-modifying drug, was introduced in Toronto in December 1953. See ao, rg 10, Series 20-A-1, Box 1, File 5, Ministry of Health, Psychiatric Hospitals Branch, Minutes of Superintendents Conference, 1930–57, 23 Apr. 1954.   73. For a discussion of what health care was like for patients in general medical practice prior to medicare, see Helen Heeney, comp. Life Before Medicare: Canadian Experiences (Toronto, 1995).   74. Valenstein, Great and Desperate Cures, 174–7; Gerald N. Grob, The Mad Among Us: A History of the Care of America’s Mentally Ill (New York, 1994), 103–28.   75. For bibliographical lists of accounts by patients prior to the mid-­ twentieth century, see Geller and Harris, eds, Women of the Asylum, 345–50; K. Portland Frank, The Anti-Psychiatry Bibliography and Resource Guide (Vancouver, 1979), which also lists accounts published from the 1950s to the 1970s. Also see Norman Dain, Clifford W. Beers, Advocate for the Insane (Pittsburgh, 1981). For an example of an early organization that promoted the rights of people in mental institutions, see Nicholas Hervey, ‘Advocacy or Folly: The Alleged Lunatics’ Friends Society, 1845–63’, Medical History 30, 3 (July 1986): 245–75. The output of literature from former patients since the 1960s is far more numerous than can be listed here, so a brief listing will have to suffice: Anne Sexton, To Bedlam and Partway Back (Boston, 1960); Janet Frame, Faces in the Water (New York, 1961); Jack Hirschman, ed., Artaud Anthology (San Francisco, 1965); Frances Farmer, Will There Really Be a Morning? (New York, 1972); Vancouver Mental Patients Association, Madness Unmasked (Vancouver, 1974); Janet and Paul Gotkin, Too Much Anger, Too Many Tears: A Personal Triumph Over Psychiatry (New York, 1975; reissued 1992); Kenneth Donaldson, Insanity Inside Out (New York, 1976); Margaret Gibson Gilboord, The Butterfly Ward (Montreal, 1976); Judi Chamberlin, On Our Own: Patient-Controlled Alternatives to the Mental Health System (New York, 1978); Persimmon Blackbridge and Sheila Gilhooly, Still Sane (Vancouver, 1985); Carol North, Welcome Silence: My Triumph Over Schizophrenia (New York, 1987); Bonnie Burstow and Don Weitz, eds, Shrink Resistant: The Struggle Against Psychiatry in Canada (Vancouver, 1988); Shelagh L. Supeene, As For the Sky, Falling: A Critical Look at Psychiatry and Suffering (Toronto, 1990); Michael Susko, ed.,

266   NOTES

Cry of the Invisible: Writings from the Homeless and Survivors of Psychiatric Hospitals (Baltimore, 1991); parc, Kiss Me You Mad Fool: A Collection of Writing from Parkdale Activity and Recreation Centre (Toronto, 1991); Kate Millet, The Loony-Bin Trip (New York, 1991); Pat Capponi, Upstairs in the Crazy House: The Life of a Psychiatric Survivor (Toronto, 1992); Nere St-Amand and Huguette Clavette, SelfHelp and Mental Health: Beyond Psychiatry (Ottawa, 1992); Susanna Kaysen, Girl, Interrupted (New York, 1993); Seth Farber, Madness, Heresy, and the Rumor of Angels: The Revolt Against the Mental Health System (Chicago, 1993); John Bentley Mays, In the Jaws of the Black Dogs: A Memoir of Depression (New York, 1995); Kathryn Church, Forbidden Narratives: Critical Autobiography as Social Science (Amsterdam, 1995); Jeanine Grobe, ed., Beyond Bedlam: Contemporary Women Psychiatric Survivors Speak Out (Chicago, 1995); Birger Sellin, I Don’t Want To Be Inside Me Anymore: Messages from an Autistic Mind, trans. Anthea Bell (New York, 1995); David A. Karp, Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness (Oxford, 1996); Pat Capponi, Dispatches from the Poverty Line (Toronto, 1997); Elizabeth Ann Anderson, Colour All My Wings: A Poetry Journal (Norval, Ont., 1998); Ann Starr and Susan Squier, ‘Speaking Women’s Bodies: A Conversation’, Literature and Medicine 17, 2 (Fall 1998): 231–54; Wendy Funk, ‘What DiffErenCe Does IT Make?’ (The Journey of a Soul Survivor) (Cranbrook, BC, 1998). Some of the better-known North American periodicals published by current and former psychiatric patients are listed in the Bibliography. Since 1994, first-person accounts on mental health and personal experiences, written by current and former psychiatric patients, have appeared in a regular column, three to four times a year, in the monthly publication Psychiatric Services (formerly Hospital and Community Psychiatry), published by the American Psychiatric Association. For more references to perspectives of people who have been in mental health facilities, see Chapter 8, note 9.

Chapter 2    1. Archives on the History of Canadian Psychiatry and Mental Health Services, Centre for Addiction and Mental Health, Queen Street Division, Toronto: Madeleine B., Patient File #3570, June 1907, Toronto General Hospital Medical Records, ‘Nervous Ward’, Vol. 20.    2. Andrew Scull, ‘The Social History of Psychiatry in the Victorian Era’, in Scull, ed., Madhouses, Mad-Doctors and Madmen: The Social ­History of Psychiatry in the Victorian Era (London, 1981), 5–32.

N O T E S    2 6 7

   3. ar, 1890, 42.    4. Meta Parker, ‘The Admitting of a Patient to the Mental Hospital’, Bulletin of the Ontario Hospitals for the Insane 2, 8 (Jan. 1915): 94–6.    5. Elizabeth W., Patient File #4035, Form of History of a Patient, 21 July 1893, signed F. Oakley, Toronto.    6. Henry N., Patient File #9025, Form A, Certificate of Insanity, 10 July 1906, signed Charles J. Clopp, Toronto.    7. Dr Edward Ryan et al., ‘Rockwood Hospital Number’, The Bulletin of the Toronto Hospital for the Insane 1, 3 (Oct. 1907): 3.    8. ‘Admission of Patients to Hospitals for the Insane’, Bulletin of the Toronto Hospital for the Insane 1, 3 (Oct. 1907): 13–14.    9. Samantha C., Patient File #5017, Letter to Dr S. Secord, Kincardine, Ont., from Dr Clark, 6 Nov. 1895.   10. Gene B., Patient File #9022, Letter to S.A. Armstrong, Inspector of Asylums, Toronto, from Dr C.K. Clarke, 28 April 1906.   11. Jed R., Patient File #3016, Letter to J.H. Widdifield, Newmarket, Ont., from Dr Clark, 21 Jan. 1884.   12. Ibid., Letter to Dr Clark from J.H. Widdifield, Newmarket, Ont., 22 Jan. 1884.   13. James D., Patient File #12008, Clinical Record, Apr. 1907.   14. Esther B., Patient File #9030, Schedule No. 2, signed ‘X’ for Margaret B., G. Denison, Toronto, 23 Oct. 1905.   15. Ibid., Medical Certificate in the Case of Esther B., signed William Oldright, Toronto, 31 Oct. 1905.   16. Mitchinson, The Nature of Their Bodies, 77–98, 301.   17. Shortt, Victorian Lunacy, 142.   18. Frances C., Patient File #2031, Form of History of a Patient, 6 Mar. 1880, signed Walter B(illegible), Toronto; Form K, 4 Mar. 1880, signed Walter B(illegible), Toronto; Form K, 6 Mar. 1880, signed J.F., Toronto; Form K, 6 Mar. 1880, signed David O., Toronto.   19. Jane Ussher, Women’s Madness: Misogyny or Mental Illness? (Amherst, Mass., 1991), 74.   20. During the period 1850–1918 ‘Women continued to be seen in terms of their destinies as wives and mothers.’ Alison Prentice et al., Canadian Women: A History (Toronto, 1988), 162.   21. Sarah S., Patient File #5001, Form A, Certificate of Insanity, 18 Jan. 1894, signed Dr T. McKenzie, Toronto.   22. Ellen M., Patient File #7044, Form of History of a Patient, 16 June 1903, signed W.J.O. Malloch, R.H. Mullin, Toronto.   23. Cynthia H., Patient File #8010, Form A, Certificate of Insanity, 28 May 1904, signed A.T. Hobbs, Guelph, Ontario; Letter to Daniel Clark from C. Lane, Montreal, 19 Aug. 1904; Letter to Dr D. Clark from Dr A.T.

268   NOTES

  24.   25.   26.   27.

  28.   29.   30.   31.

  32.

  33.

  34.   35.

Hobbs, Guelph, Ont., 20 June 1904; Letter to Dr A.T. Hobbs, Guelph, Ont., from Medical Superintendent Daniel Clark, 21 June 1904. Shortt, Victorian Lunacy, 143–55. Lizzie C., Patient File #5017, Letter to W.D. Clement, Woodstock, Ont., from Daniel Clark, 27 Nov. 1897. This correspondence took place two years after Lizzie C. was sent to the asylum. Shortt, Victorian Lunacy, 152. Harvey G. Simmons, From Asylum to Welfare (Downsview, Ont., 1982), 65–109; Angus McLaren, Our Own Master Race: Eugenics in Canada, 1885–1945 (Toronto, 1990), 37–45; P.M.H. Mazumdar, Eugenics, Human Genetics and Human Failings (London, 1992); James W. Trent Jr, Inventing the Feeble-Minded: A History of Mental Retardation in the United States (Berkeley, 1994); Ian Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940. (Ithaca, NY, 1997). Trent, Inventing the Feeble-Minded, 91. McLaren, Our Own Master Race, 37. Ibid., 40–1; Trent, Inventing the Feeble-Minded, 141. Madge M., Patient File #8027, Copy of Medical Certificates in the Case of Madge M., signed Wm Oldright, Toronto, 23 Sept. 1903; Schedule No. 2, signed B. Sanderson, G. Denison, Toronto, 21 Sept. 1903; Copy of Medical Certificates in the Case of Madge M__, signed James H. Richardson, Toronto, 23 Sept. 1903. Opened in 1876, the Orillia Asylum had chronic problems with overcrowding, which also may have influenced decisions about sending people there. Simmons, From Asylum to Welfare, 29–32. See also the discussion of this institution in John P. Radford and Deborah Carter Park, ‘ “A Convenient Means of Riddance”: Institutionalization of ­People Diagnosed as “Mentally Deficient” in Ontario, 1876–1934’, Health and Canadian Society 1, 2 (1993): 369–92. Eve S., Patient File #9045, Schedule No. 2, signed G.A. Chapman, G. Denison, Toronto, 15 Apr. 1904. Admission and transferral dates are on file folder, certificates, and transfer warrant from Hamilton asylum, 30 Aug. 1906. Copy of Medical Certificates in the Case of Eve S__, signed Wm Oldright, Toronto, 16 Apr. 1904; Copy of Medical Certificates in the Case of Eve S__, signed James H. Richardson, Toronto, 15 Apr. 1904. The sexual harassment that domestic servants experienced at their places of work is discussed in Karen Dubinsky, Improper Advances: Rape and Heterosexual Conflict in Ontario, 1880–1929 (Chicago, 1993), 52–3. Patient File #9045, Schedule No. 2, signed G.A. Chapman, G. Denison, Toronto, 15 Apr. 1904; Copy of Medical Certificates in the Case of Lizzie S__, signed James H. Richardson, Toronto, 15 Apr. 1904.

N O T E S    2 6 9

  36. Marcia F., Patient File #10005, Information to be Elicited Upon Inquiry, signed H.F. Holland, Police Magistrate for Cobourg, 25 July 1906; Letter to K.W. Wright, Public Trustee, Osgoode Hall, from Medical Superintendent Harvey Clare, 1 Mar. 1924; Form A, Certificate of Insanity, signed Dr Thos Clark Lapp(?), Cobourg, Ont., 25 July 1906; Form A, Certificate of Insanity, signed Dr James Henderson, Cobourg, Ont., 25 July 1906; Letter to Bursar, 999 Queen Street, from K.W. Wright, Public Trustee, Osgoode Hall, Toronto, 26 Feb. 1924.   37. Mathilda M., Patient File #7053, Schedule No. 2 (signatures illegible), 21 Aug. 1903. Her discharge status is recorded on the front of the case folder. Copy of Medical Certificates in the Case of Mathilda M__, signed Wm Oldright, Toronto, 4 Sept. 1903; Copy of Medical Certificates in the Case of Mathilda M__, signed James H. Richardson, Toronto, 5 Sept. 1903. The official discrimination against gays, lesbians, and bisexuals by psychiatric professionals continued until the 1970s when activists in the United States forced the removal of homosexuality from the diagnostic manual as a ‘mental illness’. Barry Adam, The Rise of a Gay and Lesbian Movement (Boston, 1987), 81–2. However, this advance did not stop the pathologizing of people on the basis of sexual orientation, as is discussed in Bonnie Burstow, ‘A History of Psychiatric Homophobia’, Phoenix Rising: The Voice of the Psychiatrized 8, 3–4 (July 1990): S38–9. See also Ellen Herman, Psychiatry, Psychology, and Homosexuality (New York, 1995); Steven Maynard, ‘On the Case of the Case: The Emergence of the Homosexual as a Case History in Early-Twentieth-Century Ontario,’ in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto, 1998), 65–87.   38. Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender and Power in Modern America (Princeton, 1994), 208.   39. Cheryl Krasnick Warsh, Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923 (Montreal, 1989), 68.   40. Janet Oppenheim, ‘Shattered Nerves’: Doctors, Patients, and Depression in Victorian England (Oxford, 1991), 160.   41. Warsh, Moments of Unreason, 65.   42. E.H. Hare, ‘Masturbatory Insanity: The History of an Idea’, The Journal of Mental Science 108, 452 (Jan. 1962): 2–25; Michael Bliss, ‘ “Pure Books on Avoided Subjects”: Pre-Freudian Sexual Ideas in Canada’, in S.E.D. Shortt, ed., Medicine in Canadian Society: Historical Perspectives (Montreal, 1981), 257–9, 266.   43. The following patient histories record masturbation as a predisposing cause of insanity: Marion H., 27, Patient File #2032; William P., 30, Patient File #4004; Stewart B., 44, Patient File #5007; Lizzie C., 26,

270   NOTES

  44.

  45.

  46.   47.   48.   49.   50.   51.   52.   53.   54.   55.   56.   57.   58.

Patient File #5017; Donald C., 16, Patient File #6005; Theodore F., 19, Patient File #6008; Walter G., 23, Patient File #6013; Randall P., 34, Patient File #6014; Erin P., 35, Patient File #6029; Ansel E., 23, Patient File #6030; Wendell S., 21, Patient File #6031; Edward M., 24, Patient File #6036; Daniel T., 28, Patient File #6038. William P., Patient File #4004, Letter to Dr Daniel Clark from D.P., St Paul, Minn., 16 Apr. 1890. It should be noted that the Form of History states William was 30 at the time of admission while his brother David states he thought he was 36 in 1890. Masturbatory practices and references to temperance and alcohol were usually recorded in the ‘Habits of life’ section of the Form of History, which indicate how ingrained were social attitudes of the time in the diagnosis and admission process. Patient File #4004, Letter to Dr Daniel Clark from D.P., St Paul, Minn., 16 Apr. 1890. Ibid., Letter to D.P., St Paul, Minn., from Dr Clark, 28 Apr. 1890. Ibid., Form A, Certificate of Insanity, 17 Apr. 1890, signed Dr Wesley Robinson, Markham, Ont. Edward M., Patient File #6036, Form A, Certificate of Insanity, 30 Apr. 1900, signed Dr John Stenhouse, Toronto. Ibid., Form A, Certificate of Insanity, 1 May 1900, signed Dr Charles Rea Dickson, Toronto; Form A, Certificate of Insanity, 30 Apr. 1900, signed Dr John Stenhouse, Toronto. Ellen G., Patient File #2017, Form of History of a Patient (unsigned), 6 July 1878. Marion H., Patient File #2032, Form K, Certificate of Insanity, signed Dr E. White, Toronto, 30 June 1880. Ibid., Form K, Certificate of Insanity, signed Dr David J. Oliphant, Toronto, 30 June 1880; Form of History of a Patient, signed Dr D.J. Oliphant, 30 June 1880. Anita C., Patient File #5019, Schedule No. 2, signed Hugh Miller, Ellen Balfour, 9 Nov. 1895. Ibid., Copy of Certification statements by Dr James H. Richardson and William Oldright, Toronto, 14 Nov. 1895. Anne D., Patient File #10009, Schedule No. 2, signed (R?) Chapman, Police Headquarters, Toronto. Ibid., Information and Complaint of: David Archibald, 27 Aug. 1906, attached to Form D (Section 21) Certificate of Justice, signed G.W. Denison attesting to Anne’s insanity. Ibid., Form A, Certificate of Insanity, signed Dr W.J. Harris, Toronto, 17 Aug. 1906; Form A, Certificate of Insanity, signed Dr James H. Richardson, Toronto, 13 Aug. 1906.

N O T E S    2 7 1

  59. Ibid., Letter to ‘The Superintendent’, from May K., Washington, DC (undated). No response to this specific letter is in the file, though based on contents and sequence in relation to other letters, it is probably from the summer of 1913.   60. John H., Patient File #3012, Form of History of a Patient, signed C. Brereton (no location), (9?) May 1883; Form A (‘K’ crossed out), Certificate of Insanity, signed Dr C.H. Brereton, Bethany, Ont., 10 May 1883; Form A (‘K’ crossed out), Certificate of Insanity, signed Dr Thomas Brereton, Bethany, Ont., 9 May 1883.   61. Jed R., Patient File #3016, Form of History of a Patient, signed J.H. Widdifield, Newmarket, Ont., 18 Jan. 1884; Form A, Certificate of Insanity, signed (J.)H. Widdifield, Newmarket, Ont., 29 Jan. 1884; Form A, Certificate of Insanity, signed David L. Rogers, 28 Jan. 1884.   62. Walter G., Patient File #6013, Schedule No. 2, signed Alice G., G. Denison, Toronto, 10 June 1898.   63. Ibid., Certification statements of James H. Richardson, Toronto, 18 June 1898 and Wm Oldright, Toronto, 17 June 1898. Information about William’s discharge can be found in the Clinical Record entry of 10 Feb. 1950.   64. Wilfred S., Patient File #5036, History Form, Ontario Hospital for the Feeble Minded, Orillia, signed Wm Armstrong, 24 Dec. 1897; Copy of Physician’s Certificate of Insanity, signed Dr Wm Armstrong, Toronto, 24 Dec. 1897.   65. Christopher B., Patient File #7005, Schedule No. 2, signed John Richardson, jp, East Toronto, 26 Jan. 1901; Copy of certification statements by Dr Thos Wylie, Toronto, 31 Jan. 1901, Dr James H. Richardson, Toronto, 31 Jan. 1901.   66. Harold T., Patient File #9040. Admission dates can be found on front of folder and committal forms.   67. Ibid., Form of History of a Patient, signed Sandra T. by her solicitors Biggs & Petrie, Confederation Life Building, Toronto, 14 Oct. 1903.   68. Ibid., Affidavit of Agatha T., signed A.E.T. and C.B. Nasmith, Toronto, 29 Oct. 1902, 2–3.   69. Ibid., Form of History of a Patient, signed Sandra T. by her solicitors, 14 Oct. 1903; Form A, Certificate of Insanity, signed W.P. Chamberlain, Toronto, 23 Oct. 1903; Form A, Certificate of Insanity, signed T.J. Page, Toronto, 23 Oct. 1903; Affidavit of Henry Leverney T., signed H.L.J.T. and A.G. Russel Snow, Toronto, 24 Oct. 1902, 2–4.   70. Ibid., Affidavit of Edwin H., unsigned though sworn and filed on behalf of the petitioner, Toronto, Oct. 1903, 3.   71. Ibid., Affidavit of Dr William Giles, signed W. Giles, W. Priest, Haliburton, Ont., 5 Feb. 1903; Affidavit of Dr Earnest Argyle White, Haliburton,

272   NOTES

  72.

  73.   74.   75.   76.   77.   78.   79.   80.

  81.

  82.

  83.

  84.

Ont., (signature page missing); Affidavit of Agatha T., signed A.E.T. and C.B. Nasmith, Toronto, 29 Oct. 1902, 3. Stephen E., Patient File #5008, Form of History of a Patient, signed H.A. McCall, Milton, Ont., 12 May 1894; Form A, Certificate of Insanity, signed Dr Joseph (Baseim?), Toronto, 20 July 1894; Form A, Certificate of Insanity, signed Dr H.A. McCall, Milton, Ont., 20 July 1894. Frank I., Patient File #6002,Typed history, undated, 2; Certification statement of James H. Richardson, Toronto, 31 Dec. 1897. Ibid., Letter to Governor-General Aberdeen, Ottawa, from Daniel Clark, Medical Superintendent, 31 Jan. 1898. Ibid., Letter to Dr Clark from Governor-General Aberdeen, Ottawa, 20 Jan. 1898. Ibid., Letter to His Excellency The Rt Hon. The Earl of Aberdeen, Ottawa, from Frank I., undated. Ibid., Letter to Dr Clark from Governor-General Aberdeen, 20 Jan. 1898. Ibid., Letter to Governor-General Aberdeen from Daniel Clark, 31 Jan. 1898. Millie O., Patient File #6037, Letter to Dr Daniel Clark from Dr. Joachim Guinane, Toronto, 15 May 1900. ‘Is Mental Illness a Crime?—Surely Not’, Canadian Journal of Medicine and Surgery 13, 3 (Mar. 1903): 205–6. It is signed ‘W.A.Y.’ See also the response by Ernest A. Hall, ‘Re the Mental Invalid—A Plea’, Canadian Journal of Medicine and Surgery 13, 5 (May 1903): 363. Jim C., Patient File #7025. The description of his physical condition upon arrival is dated 12 Aug. 1902, signed John J. Ryan, Provincial Bailiff, Toronto. The two copies of statements certifying his insanity while a prisoner are dated 3 Nov. 1898, signed James H. Richardson, Toronto, and 20 Nov. 1898, Toronto, unsigned. Evelyn F., Patient File #7039, Letter to Frederick Mowat, Sheriff, City of Toronto, from G. (illegible) Gov. Gaol, Toronto Gaol, 11 Feb. 1903. Reference to the intervention of Mrs Troman is in Letter to Dr Clark from Inspector of Asylums, R. Christie, Toronto, 4 Feb. 1903. Mary A., Patient File #5002, Letter to Daniel Clark from Henry A.A., Toronto, 1 Feb. 1894. She was transferred from prison to the asylum on 21 Feb. 1894. A more extensive discussion of Mary A. appears in Reaume, ‘Keep Your Labels Off My Mind!’, 397–424. She was imprisoned in late January 1894, where she remained for almost a month before being transferred to the asylum, so she was not in prison in 1893 as was mistakenly mentioned in this article. Edgar-André Montigny, ‘The Decline in Family Care for the Aged in Nineteenth-Century Ontario: Fact or Fiction’, Canadian Bulletin of Medical History 11, 2 (1994): 357–73; Montigny, Foisted Upon the

N O T E S    2 7 3

  85.

  86.   87.

  88.

  89.   90.   91.

  92.

Government? State Responsibilities, Family Obligations, and the Care of the Dependent Aged in Late Nineteenth Century Ontario (Montreal and Kingston, 1997), 82–129. Gloria D., Patient File #6027, Form of History of a Patient, signed H.J. Machell, Toronto, 23 Aug. 1899; Form A, Certificate of Insanity, signed Dr (Edward W. Spragge?), no address, 28 Oct. 1899; Form A, Certificate of Insanity, signed Dr Henry J. Machell, Toronto, 28 Oct. 1899. Ibid., Letter to R. Christie, Inspector of Asylums, Toronto, from Medical Superintendent Daniel Clark, 19 Oct. 1899. James D., Patient File #5024, Schedule No. 2, signed G. Denison, Toronto, 9 Sept. 1896; Statement of Thomas Hassard Wilson, Bookkeeper, Toronto Jail, signed T.H. Wilson, G.P. Denison, Toronto, 19 Sept. 1896; Schedule No. 2, signed Thomas H. Wilson, G. Denison, Toronto, 19 Sept. 1896; Certification statement of Dr James H. Richardson, Toronto, 21 Sept. 1896; Certification statement of Wm Oldright, Toronto, 21 Sept. 1896. Carl G., Patient File #5031, Schedule No. 2, signed ‘X’ by Mabel G., G. Denison, Toronto, 20 Apr. 1897; Certification statement of James H. Richardson, Toronto, 24 Apr. 1897; Certification statement of Wm Oldright, Toronto, 23 Apr. 1897. Audrey B., Patient File #8042, Schedule No. 2, signed Mary B., Elizabeth C. (one other signature illegible), Toronto, 19 May 1905. Ibid., Copy of Medical Certificates in the Case of Audrey B__, signed Chas Sneath, Toronto, 25 May 1905; Copy of Medical Certificates in the Case of Audrey B__, signed Wm Oldright, Toronto, 26 May 1905. Carl G., Patient File #5031. Mabel G. swore two statements about her son. The one quoted in this chapter is the first statement, recorded on a foolscap sheet along with other statements. Statement of Mabel G., signed with an ‘X’ and with ‘her mark’ noted above and below, 20 Apr. 1897. For a discussion of the role played by the asylum in the lives of lowerclass inmates, see Grob, The Mad Among Us, 79–102; Gerald N. Grob, ‘Mental Illness, Indigency, and Welfare: The Mental Hospital in Nineteenth Century America’, in Tamara K. Hareven, ed., Anonymous Americans: Explorations in Nineteenth-Century Social History (Engelwood Cliffs, NJ, 1971), 260–71; J.K. Walton, ‘Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840–1870’, in W.F. Bynum, R. Porter, and M. Shepherd, eds, The Anatomy of Madness: Essays in the History of Psychiatry, vol. 2 (London, 1985), 132–46; Yannick Ripa, Women and Madness: The Incarceration of Women in Nineteenth-­Century France, trans. Catherine du Peloux Menage (Cambridge, 1990), 13–18.

274   NOTES

  93. Jerold M., Patient File #8009. There is no Form of History in this case, but instead there is a detailed personal history in the file from the McLean Hospital in Waverly, Massachusetts, sent in 1907. It notes Jerold was 44 at the time of his hospitalization in 1900–1, and so his age in 1904 has been calculated accordingly, though no specific age is listed in the admission documents for the Toronto facility. See McLean Hospital Report, Form A, Certificate of Insanity, signed Dr John M., Barrie, Ont., 26 Apr. 1904; Form A, Certificate of Insanity, signed Dr H.T. Small, Barrie, Ont., 27 Apr. 1904.   94. Ibid., Clinical Record, entry for Monday, 4 Feb. (no year), 7, 8–9.   95. Ibid., McLean Hospital Report, 1–2; Form A, Certificate of Insanity, signed Dr H.T. Small, Barrie, Ont., 27 Apr. 1904.   96. Ibid., Form A, Certificate of Insanity, signed Dr H.T. Small, Barrie, Ont., 27 Apr. 1904.   97. Ibid., McLean Hospital Report, 3.   98. Ibid., Clinical Record, entry for Monday, 4 Feb. (no year), 8.   99. Ibid., Clinical Record, 23 May 1909. 100. Ibid., Letter to Dr Clark from Isabel M., Barrie, Ont., 29 May 1904, 3–4. 101. Lee F., Patient File #9014, Schedule No. 2, sworn by Constable David McKinney, signed G. Denison, Toronto, 27 Nov. 1905. This consists of a statement by the constable of not being able to find out practically any information about Lee, so none of the questions on the form are answered. Copy of Medical Certificates in the Case of Lee F., statements of Dr Wm Oldright, Toronto, 28 Nov. 1905, and Dr James Richardson, Toronto, 28 Nov. 1905. The deportation of Lee to China is noted as 4 May 1907 on the front of his case file, and in a brief typewritten form dated 27 Apr. 1907. 102. Edgar Wickberg et al., From China to Canada: A History of the Chinese Communities in Canada (Toronto, 1982); Constance Backhouse, ‘The White Women’s Labour Laws: Anti-Chinese Racism in Early Twentieth-Century Canada’, Law and History Review 14 (1996): 315–68; James W. St G. Walker, ‘A Case for Morality: The Quong Wing Files’, in Iacovetta and Mitchinson, eds, On the Case, 204–23. 103. Richard W., Patient File #6021, Schedule No. 2, signed Kate C., R.E. Kingsford, Toronto, 5 Apr. 1899. 104. Ibid., Copy of certification statements of Dr James H. Richardson, Toronto, 12 Apr. 1899, Wm Oldright, Toronto, 11 Apr. 1899; Schedule No. 2, signed Kate C., R.E. Kingsford, Toronto, 5 Apr. 1899. 105. Ibid., Letter to Mrs. Richard W., Ingersoll, Ont., from Medical Superintendent Daniel Clark, 28 Sept. 1904. 106. Vincent J., Patient File #8021, Schedule No. 2, signed G. Chapman, G. Denison, Toronto, 11 Apr. 1904; Copy of statement made by Vincent J., Toronto Jail, undated.

N O T E S    2 7 5

107. Ibid., Letter to Mrs N.J., Kensal Rise W., England, from Medical Superintendent, 3 Jan. 1905; Copy of Medical Certificates in the Case of Vincent J__, signed James H. Richardson, Toronto, 12 Apr. 1904. 108. Ibid., Copy of statement made by Vincent J., Toronto Jail, undated.

Chapter 3    1. ar, 1878, 269.    2. Nancy Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883 (Cambridge, 1984), 199–201; M.E. Kelm, ‘A Life Apart: The Experience of Women and the Asylum Practice of Charles Doherty at British Columbia’s Provincial Hospital for the Insane, 1905–15’, Canadian Bulletin of Medical History 11, 2 (1994), 344. For an indication of what daily life was like on a psychogeriatric ward at Toronto’s Queen Street facility in 1977–8, see Evelyn Parm, ‘ “Good Old 999” ’, in Bonnie Burstow and Don Weitz, eds, Shrink Resistant: The Struggle Against Psychiatry in Canada (Vancouver, 1988), 111–15.    3. ar, 1878, 269.    4. ar, 1880, 292.    5. Ibid. For reference to male patients being shaved twice a week, see Andrew H., Patient File #6003, letter to Miss H.M., Cobourg, Ont., from Medical Superintendent Clark, 16 Nov. 1898.    6. ar, 1878, 267; Charles Cromhall Easterbrook, Notes on a Visit in 1913 to some Mental Hospitals and Clinics in the United States of America and Canada (London, 1914), 181. See also Superintendent Forster’s report: ar, 1912, 110–11.    7. ar, 1877, 20; 1883, 48.    8. ar, 1887, 45.    9. ar, 1892, 38.   10. ar, 1903, 3.   11. ar, 1881, 26. A table printed in 1888 shows very little difference in food served on public wards over a 10-year period from 1878. ar, 1888, 36–40.   12. ar, 1892, 41–2.   13. ar, 1906, xi. See also C.S. McVicar, ‘A Consideration of Diets’, Bulletin of the Ontario Hospitals for the Insane 6, 3 (Apr. 1913): 167–73.   14. Willard C., Patient File #2015, Clinical Record, 5 Mar. 1911.   15. Gene P., Patient File #3034, Clinical Record, 24 Apr., 24 Sept. 1912.   16. Ralph M., Patient File #6010, Letter to ‘My Dear Wife’ from Ralph M., unaddressed, 4 Dec. (no year).   17. Ibid., Clinical Record, 18 July 1911.

276   NOTES

  18. Reginald F., Patient File # 10015, Letter to Dr C.K. Clark [sic] from A.E.F., East Orange, NJ, 18 Nov. 1910.   19. Elaine K., Patient File #3037, Receipt: rec’d for Mrs J.G. K__: 1 roast chicken from Mrs M__, Port Arthur, Ont., 22 Dec. 1921. Much more common receipts for food received by patients with outside support can be found in the slips from the late 1920s and early 1930s, from Laura C., the wife of Alex C., Patient File #5030.   20. Peter Nolan, ‘Reflections of a Mental Nurse in the 1950s’, History of Nursing Society Journal 5, 3 (1994–5): 150–6.   21. May F., Patient File #6007, Clinical Record, 22 Aug. 1938.   22. Mary A., Patient File #5002, Letter to Dr Clare from Mrs Henry A.A., 6 June 1911.   23. Anna N., Patient File #6012, Letter to Dr. Clark [sic] from Anna N., 999 Queen Street West, Toronto, 1 Mar. 1911.   24. Albert L., Patient File #3033, Clinical Record, 1 Feb. 1915.   25. Ellen Dwyer, Homes for the Mad: Life Inside Two Nineteenth-Century Asylums (New Brunswick, NJ, 1987), 163–6, 177–83; Hughes, ed., ­Letters of a Victorian Madwoman, 27; James E. Moran, ‘Keepers of the Insane: The Role of Attendants at the Toronto Provincial Asylum, 1875–1905’, Histoire Sociale/Social History 28, 55 (May 1995): 56–8.   26. Minnie B., Patient File #5032, Clinical Chart, 23, 31 Jan. 1928.   27. Ibid., 24, 25 Jan. 1928.   28. Ettie M., Patient File #6033, Clinical Record, 18 Sept. 1912.   29. Audrey B., Patient File #8042, Clinical Record, 20 Dec. 1922, 20 Apr. 1933, 2 May 1936, 11 Nov. 1941.   30. Ibid., 25 Nov. 1938, 28 Sept. 1943, 10 Oct. 1940.   31. Annette F., Patient File #2023, Letter to Mrs B. Stone from Medical Superintendent Forster, 7 Jan. 1918.   32. Winslow H., Patient File #8003, Clinical Record, 16 Aug. 1922, 26 July 1920, 23 Aug. 1921, 29 June 1927, 8 Sept. 1923, 20 June 1924, 9 Aug. 1927, 24 Jan. 1910, 15 May 1928.   33. Warren S., Patient File #8039, Clinical Record, 28 Mar. 1924, 26 July 1926, 27 July 1927, 26 Nov. 1928.   34. Jerold M., Patient File #8009. Letter to Mrs J.M., Barrie, Ont., from Medical Superintendent Daniel Clark, 27 May 1904; Clinical Record, 10, 21 Jan. 1909.   35. Reginald F., Patient File #10015, Letter to Dr C.K. Clarke from Mrs A.E.F., Buffalo, NY, 25 July 1909; Letter to Mrs A.E.F., Buffalo, NY, from Medical Superintendent, 27 July 1909.   36. Reports of theft are usually mentioned in the context of inmate delusions, though third-party observers also made such references, as did William S., the father of Gina B., though he later retracted this after

N O T E S    2 7 7

  37.

  38.   39.   40.   41.   42.   43.   44.   45.

  46.   47.   48.   49.   50.   51.   52.   53.   54.   55.

meeting his daughter, Gina, and Dr Clark. Gina B., Patient File #3002, Letter to Dr Daniel Clark from William S., 14 Oct. 1883; Letter to William S. from Dr Daniel Clark, 16 Oct. 1883; Letter to Dr Daniel Clark from William S., 26 Oct. 1883. Avis S., Patient File #8019. Avis’s background information can be found on her admission papers, which include the comment that she is ‘Strictly temperate’: Form of History of a Patient, signed Dr Gibson, Hillsburg, Ont., 26 Aug. 1904. Ibid., Clinical Record, 2, 20 Mar. 1909. Ibid., Clinical Record, 16 July 1909 (quote), 4 May 1910. Ibid., Clinical Record, 20 Jan. 1915. Ibid., Clinical Record, 7 Oct. 1918. Alex C., Patient File #5030. Four undated pages, not addressed to anyone, c. 1907–8, when most of the letters that remain in his file were written. Abbie G., Patient File #7020, Clinical Record, 2 May 1909, 15 Oct. 1920. Warsh, Moments of Unreason, 120. References to staff departures include: Daniel Clark reported that there had been 44 changes to staff in 1902 and 39 changes in 1903 (out of 116 employees): ar, 1903, 4; C.K. Clarke reported many attendants had left due to poor pay: ar, 1908, 9; J.M. Forster reported ‘staff greatly reduced in numbers in practically every branch of the service’: ar, 1916, 84. ar, 1900, 3. Arlene S., Patient File #7050, Clinical Record, 20, 23, 25, 26, Jan., 1 Feb., 19 Aug., 24 Sept. 1909. Ibid., $2.00 Receipt for a nearby resident on Manning Ave. ‘for recapture of escaped patient’, 29 Dec. 1906. ‘Received with thanks’ has been written on slip. Ibid., Clinical Record, date deleted to protect Arlene’s confidentiality due to newspaper account pasted into Clinical Record. Ibid., Clinical Record, 31 Aug. 1914, 22 Apr. 1916, 19 Apr. 1917, 20, 22 Jan. 1909, 25 Oct. 1911. Leonard G., Patient File #8011, Report of Elopement, unsigned, date of elopement: 28 June 1909. Henry S., Patient File #8022, Clinical Record, 3 Mar. 1910. Walter B., Patient File #8030, Report of Elopement, unsigned, date of elopement: 28 Mar. 1909; Clinical Record, 28 Mar. 1909. Joseph G., Patient File #8029, Report of Elopement, unsigned, date of elopement: 8 Sept. 1908. Nancy D., Patient File #2040, Letter to Inspector R. Christie from Medical Superintendent Daniel Clark, 15 June 1883. The reference in this

278   NOTES

letter is to Nancy getting ‘on an immigrant at the sheds and was carried to Guelph’. See also telegram from F.W. Randall, Chief of Police, Guelph, to ‘Doctor at Asylum’, 15 June 1883, in which he states: ‘I have the Insane Woman that Escaped from your Asylum on [sic] yesterday in custody here. Send for her today answer.’   56. Wendy Mitchinson also makes these points in regard to gender differences on the issue of escapes from asylums. She also notes that since females were socialized in the acceptance of authority more than males, women were less likely to rebel. Mitchinson, The Nature of Their Bodies, 332–3.   57. Daniel K., Patient File #2022, Clinical Record, 11, 12, 19 Feb. 1924, 29 Oct. 1927.   58. ar, 1900, 4.   59. Elaine M., Patient File #7044, Clinical Record, 7 Sept. 1921, 7 Nov. 1928.   60. Arnold S., Patient File #4011. Clinical Record entries from 29 Nov. 1909 until his death, 6 Dec. 1910, mention Arnold’s violent behaviour.   61. Ibid., Letter to W.M. English, Medical Superintendent, Hamilton Asylum, from Assistant Physician, Toronto, unsigned (probably Dr Clare or Dr Ross), 28 Apr. 1909. This letter was prompted by an inquiry from Superintendent English, who asked about Arnold S. because his nephew was confined at the Hamilton Asylum. This younger man had committed murders and was considered insane. In the file of Arnold S. is an article from a newspaper (date deleted for reasons of privacy) in which the murders of two people and wounding of several others are detailed. Written below this article in Arnold’s file is ‘Patient . . . is an uncle of this man.’   62. Peterson, ed., A Mad People’s History of Madness; Geller and Harris, eds, Women of the Asylum.   63. Grob, ‘Mental Illness, Indigency, and Welfare’, 250–79; Gerald N. Grob, ‘Abuse in American Mental Hospitals in Historical Perspective: Myth and Reality’, International Journal of Law and Psychiatry 3, 3 (1980): 295–310.   64. Dwyer, Homes for the Mad, 22–3.   65. For contemporary studies of abuse of people at institutions in Ontario, see Temi Firsten, ‘Violence in the Lives of Women on Psych Wards’, Canadian Woman Studies/Les Cahiers de la Femme 11, 4 (Summer 1991): 45–8; Liz Stimpson, Colleen Weir, Georgia Maxwell, and Margaret C. Best, Unlocking the Doors: Abuse Against Vulnerable People within Ontario’s Institutions (Toronto, 1996). I would like to thank Marianne Ueberschar for bringing this publication to my attention. The expansion of a medical bureaucracy in Ontario after 1890 and especially the use of typewriters by the early twentieth century had a

N O T E S    2 7 9

significant impact on the scope and extent of records kept on individual patients. In 1907, the first typed clinical records appeared at the Toronto Hospital for the Insane, though the typewriter had been in use for several years already for administrative correspondence. For a general discussion about provincial developments, see Craig, ‘Hospital Records and Record-Keeping . . . Parts I and II.’   66. Patrick J. Connor, ‘ “Neither Courage nor Perseverance Enough”: Attendants at the Asylum for the Insane, Kingston, 1877–1905’, Ontario History 88, 4 (Dec. 1996): 260. The quotation in the title of this paper lends itself to the stereotypical idea that working with people in an insane asylum requires ‘courage’, with the implication that a staff member will naturally be in some kind of danger from inmates. Considering the sort of abuse endured by patients at the hands of staff, a more accurate conclusion would be that the patients required courage to be in an asylum much more than staff.   67. Dwyer states: ‘[P]atient abuse was rooted in social phenomena appreciated by few asylum outsiders. Elitist critics often attributed attendants’ brutality to their class and ethnic origins, but asylum records tell a different story. No matter what the class or ethnicity of attendants, they found working with violent, abusive patients difficult. Not infrequently, delusional patients saw attendants as demons and attacked them. Less threatening but more exasperating were those patients so demented that they could not converse coherently nor control their bodily functions. . . . Unlike parents, or even tutors and nannies, asylum attendants too seldom saw their “children” mature and grow up. Instead many found themselves trapped in situations similar to those which produced abusive mothers, seldom relieved from care of their difficult “children.” As a result, with a frequency impossible to estimate, overworked, harassed attendants responded impatiently, roughly, sometimes even brutally to difficult patients, even when their only offense was an unwillingness to eat or to sleep at night.’ Dwyer, Homes for the Mad, 176–7. Grob states: ‘The work was long and the pay below that of such occupations as shoemakers and woodworkers. Above all, ten or more hours daily work on the wards with the omnipresent threat of violence and social disorganization would have probably tried the patience of anyone. That attendants often responded to disruptive and incontinent patients not as loving parents but as despotic patriarchs was hardly surprising.’ Grob, The Mad Among Us, 93–4. These are clear examples of the condescension and caricaturing that asylum inmates have been subjected to by some academic historians. Patients as a group are viewed as either violent threats or as immature children—polar extremes that put all patients into two simple categories.

280   NOTES

Both categories inaccurately depict a very diverse group of people who found themselves confined in asylums. As is discussed in this book, people confined in mental institutions were and are capable of mature, healthy relationships with one another and with non-patients in a way that was neither violent nor childish. The fact that a minority of patients were abusers is no excuse for tarring all inmates with the same brush. Both Dwyer and Grob imply that problems on the ward were the fault of the inmates, the very group who had absolutely no choice whatsoever in finding themselves there. Staff get tired, having to deal with so many ‘disruptive’ patients, even though there is no similar mention that inmates also became tired after being on locked wards for much longer than staff. Nor does either address the fact that patients were only able to get off the ward with the consent of those same employees who, in some cases, were abusing them. Thus, attendants and nurses are let off the hook for brutality because of difficult working conditions, a consideration not extended to the much more difficult living conditions of patients who were in a far more vulnerable situation than were staff on locked wards. Dwyer’s remark that asylum records tell ‘a different story’ about abuse is remarkably uncritical of the nature of these sources, written up by staff, not by patients, and where a researcher would be least likely to find accounts of abuse that give the patients’ side of the story, unless an inmate’s letter on this topic found its way into the files. If patients’ letters are uncovered in files, it is then up to the historian to decide whether to take such evidence seriously or to maintain a dismissive approach towards inmates’ accounts of abuse.   68. Dwyer, Homes for the Mad, 176. A recent article that claims that psychiatric patients have a higher risk of violence than non-patients nonetheless avoids the sort of stereotypes that Grob and Dwyer use. Noting that ‘Most patients with severe mental illness do not pose a danger to themselves or the community’, Jeremy W. Coid suggests that ‘one in 10 patients is estimated to commit violent assaults against staff.’ In other words, 90 per cent of psychiatric patients, according to British studies, do not assault staff. Coid, ‘Dangerous patients with mental illness: increased risks warrant new policies, adequate resources, and appropriate legislation’, British Medical Journal 312, 7036 (13 Apr. 1996): 965–6. For studies arguing that psychiatric patients are no more violent than the general population, see note 69 below.   69. Otto F. Wahl, Media Madness: Public Images of Mental Illness (New Brunswick, NJ, 1995); John Monahan and Jean Arnold, ‘Violence by People with Mental Illness: A Consensus Statement By Advocates and Researchers’, Psychiatric Rehabilitation Journal 19, 4 (Spring, 1996); Pamela J. Taylor and John Monahan, ‘Commentary: Dangerous Patients

N O T E S    2 8 1

  70.

  71.   72.

  73.   74.

  75.   76.

  77.   78.

or Dangerous Diseases?’, British Medical Journal 312, 7036 (13 Apr. 1996): 967–9; Grant T. Harris and Marnie Rice, ‘Risk Appraisal and Management of Violent Behavior’, Psychiatric Services 48, 9 (Sept. 1997): 1168–76; Henry J. Steadman et al. ‘Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighbourhoods’, Archives of General Psychiatry 55, 5 (May 1998): 393–401; Scott Simmie, Out of Mind: An Investigation Into ­Mental Health (Toronto, 1998), 49–58. I would like to thank Don Weitz and the No Force Coalition, Toronto, for several of the above sources. For a discussion of the contentious nature of patients’ accounts of abuse, see Grob, ‘Abuse in American Mental Hospitals’, 298–301; Reaume, ‘Accounts of Abuse of Patients at the Toronto Hospital for the Insane, 1883–1937’, 65–106. Nancy D., Patient File #2040, Letter to Dr Clark from Kate Cecilia D., Toronto, 11 May 1883; Letter to K.C.D., Toronto, from Dr Clark, 13 May 1883. Jim W., Patient File #7051, Clinical Record, 11 Nov. 1911. Abuse of people with disabilities is still rationalized by some people in Canada, as is most recently evident in the response to the 1993 murder of 12year-old Tracy Latimer by her father. See Dick Sobsey, ‘The Media and Robert Latimer,’ arch type 13, 3 (Aug. 1995): 8–22 (newsletter of the Advocacy Resource Centre for the Handicapped, Toronto). Ralph M., Patient File #6010, Letter to ‘My Dear Wife’, 4 Dec. (no year). Elsa P., Patient File #7047, Letter to the Superintendent of the Toronto Asylum from Elsa P., Centre Island, 7 Sept. (no year, though letter was found at back of her file with other documents from her last years in the asylum). ao, rg 10, Subseries C-3, Vol. 767a, Investigation, Toronto Hospital for the Insane, 1917. Sobsey describes how administrative structures work against complainants in institutions. This includes lack of enforcement of anti-abuse policies, and the way in which resentful ward employees, lacking power with their superiors, take out their frustration on residents in the facility. Dick Sobsey, Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance? (Baltimore: 1994), 90–1, 104–5. Thomas E. Brown, ‘Dance of the Dialectic? Some Reflections (Polemic and Otherwise) on the Present State of Nineteenth-Century Asylum Studies’, Canadian Bulletin of Medical History 11, 2 (1994): 277. The abuse of children and adolescents at Mount Cashel orphanage in Newfoundland and at St John’s and St Joseph’s training schools in Ontario, as well as years of cover-up by authorities, are documented in

282   NOTES

  79.   80.   81.

  82.   83.   84.   85.   86.

  87.

  88.

Michael Harris, Unholy Orders: Tragedy at Mount Cashel (Toronto, 1991); Darcy Henton with David McCann, Boys Don’t Cry: The Struggle for Justice and Healing in Canada’s Biggest Sex Abuse Scandal (Toronto, 1995). Abuse at Canadian Native residential schools is discussed in: J.R. Miller, Shingwauk’s Vision: A History of Native Residential Schools (Toronto, 1996), 317–42. Various types of abuse at the Shanghai Children’s Welfare Institute between 1988–1993, starvation and neglect of orphans, especially disabled children throughout China, and official cover-up attempts are detailed in: Human Rights Watch/Asia, Death By Default: A Policy of Fatal Neglect in China’s State Orphanages (New York: Human Rights Watch/Asia, 1996). Brown, ‘Living with God’s Afflicted’, 275, cited in Mitchinson, ‘The Toronto and Gladesville Asylums’, 69. Agatha H., Patient File #7046, Clinical Record, 29 May 1933, 31 Dec. 1937. Elaine O., Patient File #8016. Background information on Elaine can be found on Schedule No. 2, 4 June 1904, signed A.W. Roffe, Toronto. She was confined at the Toronto Asylum until 1910, when she was discharged in June of that year after six months’ probation. There is a discrepancy about how long she was there prior to 1905, with one document claiming this to have been 10 years, since 1894, while other forms make this less clear. Ibid., Letter to Mr (—men?, illegible) from Miss O., Toronto, 29 June 1910. Ibid., Letter to Mr Hernman [sic, Herriman] from Elaine O., undated, though found among early 1910 letters. Ibid., Letter to Dr Clark [sic] from E.O., Toronto, 14 Sept. 1910. Ibid., Note written on two-sided scrap of paper, unaddressed, undated, unsigned, in Elaine O.’s handwriting. Ibid., Letter to Supt. of Hospital for the Insane, Toronto, from Lennox & Lennox, Barristers, Toronto, 11 June 1913; Letter to Lennox & Lennox, Barristers, Toronto, from Medical Superintendent Forster, 16 June 1913. Mary Elene Wood, The Writing on the Wall: Women’s Autobiography and the Asylum (Urbana, 1994), 8. For a related discussion of the experiences of mentally ill street women in contemporary America, see Stephanie Golden, The Women Outside: Meanings and Myths of Homelessness (Berkeley, 1992), 188–98. Carolyn Strange, Toronto’s Girl Problem: The Perils and Pleasures of the City, 1880–1930 (Toronto, 1995), 65–9. The sexual harassment that domestic servants experienced at their places of work is discussed in Dubinsky, Improper Advances, 52–3. Alison Prentice et al. note in

N O T E S    2 8 3

  89.   90.   91.

  92.   93.

  94.

regard to the period 1850–1914: ‘It was still rare for rapists to be prosecuted, and even more rare for them to be convicted.’ Prentice, et al., Canadian Women: A History, 148. Tomes, A Generous Confidence, 243. Elaine M., Patient File #7044, Clinical Record, 10 July 1918. For examples of people who were tagged as ‘bench patients’ in clinical reports, see Millie L., Patient File #8020, Clinical Record, 12 Mar. 1921; Daniel M., Patient File # 7032, Clinical Record, 2 Dec. 1929; Mary M., Patient File #7026, Clinical Record, 15 Jan. 1924 (reference to her being a ‘bench type’). Angela B., Patient File #8005, Letter to F.R.B., Houghton, Mich. from Dr Clark, 11 Oct. 1904; Letter to Mr(?) B., Port Arthur, Ont., from Dr Clark, 20 July 1905. Patient File #8005, Letter to ‘My Dear [Norman]’ from Angela B., unsigned, undated, found among letters from 1906 and 1907 in her file. For another patient’s point of view about what it was like to endure forced sitting, see ‘Inmate Ward 8’, a.k.a. Marle Woodson, Behind the Door of Delusion, eds William W. Savage Jr and James H. Lazalier (originally published 1932; reissued Niwot, Colo., 1994), 18. Daniel Clark stated that an employee ‘should never behave with harshness towards a patient’, though he also cautioned that an employee was to be considered innocent of misconduct unless there was ‘absolute proof of wrong-doing’. ar, 1880, 289, 286. In 1907 C.K. Clarke responded to Angela H., the wife of Jacob H., a patient who complained of abuse as follows:

I should like to know the source of your information because statements of this kind are heartlessly cruel and do a great injustice to the very much tried and conscientious Staff. It is my business to see that no cruelties are perpetrated here, and while it is true that there have been occasional mistakes made by attendants, such persons have been discharged instantly and will be discharged instantly as long as any reason for complaint is found. A month after this letter was written, the patient whom it concerned, Jacob H., made a successful escape and went home. Jacob H., Patient File #10011, Letter to Mrs J.H. from Medical Superintendent, 27 Feb. 1907.   95. Moran, ‘Keepers of the Insane’, 68. Moran mentions a case of an employee who was fired after a physician witnessed unacceptable behaviour. How the guilt of two other employees was arrived at, and who were discharged, is not explained. In still another incident, when a patient said abusive behaviour was witnessed by another employee, this

284   NOTES

  96.   97.   98.   99.

100.

101. 102.

103. 104.

workmate of the accused dismissed the charges as not serious, something Clark only partially accepted, as he cautioned the alleged offender, believing ‘there was something’ to this complaint. Ibid., 69. Mary M., Patient File #7026, Letter to Dr Clark from Inspector Christie, 20 Mar. 1903; Letter to R. Christie from Dr Clark, 25 Mar. 1903; Clinical Record entries, 1909–16. ao, rg 10, Subseries C-3, Vol. 767a, Investigation, Toronto Hospital for the Insane, 1917, 14. Peter McCandless, Moonlight, Magnolias, & Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era (Chapel Hill, NC, 1996), 291. In 1919 Superintendent Forster wrote about the ‘scarcity of nurses. Our expectation during the past year of having many applicants after the close of the war has not been realized.’ ar, 1919, 91. See also citations re staff departures in 45 above. E. Gil and K. Baxter, ‘Abuse of Children in Institutions’, Child Abuse and Neglect 3 (1979): 693–8; S.S. Cole, ‘Facing the Challenges of Sexual Abuse in Persons with Disabilities’, Sexuality and Disability 7, 3, 4 (1984): 71–88; J.L. Musick, ‘Patterns of Institutional Sexual Abuse’, Response to Violence in the Family and Sexual Assault 7, 3 (1984): 1–11; C.J. Sundram, ‘Obstacles to Reducing Patient Abuse in Public Institutions’, Hospital and Community Psychiatry 35, 3 (1984): 238–43; C.J. Sundram, ‘Strategies to Prevent Patient Abuse in Public Institutions’, New England Journal of Human Services 6 (1986): 20–5; A.G. Marchetti and J.R. McCartney, ‘Abuse of Persons with Mental Retardation: Characteristics of the Abused, the Abusers, and the Informers’, Mental Retardation 6 (1990): 367–71. Dwyer notes that doctors at Utica Asylum did not believe abuse allegations as readily as did their colleagues at Willard. Dwyer, Homes for the Mad, 177–8; Lunbeck, The Psychiatric Persuasion, 171–2. This rule stipulated that male workers were not to attempt ‘to notice, “flirt” with, or talk to girl patients’, or else they would be immediately fired. Steven Noll, Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900–1940 (Chapel Hill, NC, 1995), 142. Warsh, Moments of Unreason, 109. The 16:1 patient to attendant ratio is cited twice by Superintendent Clark: ar, 1885, 42; ar, 1892, 6. Prior to this he had once cited a slightly higher ratio of 18:1 in ar, 1883, 62. At the London, Ontario Asylum, the ratio during this period was 13 patients for every attendant. Shortt, Victorian Lunacy, 43. The average around 1900 in mental institutions in the United States was 12 patients for every attendant, though in the southern states it was 15:1, and on wards with black patients

N O T E S    2 8 5

105.

106.

107. 108.

109. 110. 111.

there were 36 inmates for every attendant, with one ward having 111 black patients and only two staff, indicating the wild fluidity of such figures. McCandless, Moonlight, Magnolias, & Madness, 288. Arlene S., Patient File #7050, Letter to Inspector W.W. Dunlop from Medical Superintendent Forster, 29 Apr. 1918. This letter notes there were two nurses on a ward of 82 female inmates when Arlene S. committed suicide. As noted above (note 99), this was at a time of severe staff shortages. However difficult it was to corroborate staff-initiated abuse, there was much less difficulty in reporting patient-initiated abuse. Hospital officials reported in depth the case of an extremely abusive male patient who was observed sexually assaulting patients and killing animals over many years. C.K. Clarke and J. Webster, ‘Notes of a Clinical Case: The Case of Wm. B.—Moral Imbecility’, Bulletin of the Ontario Hospitals for the Insane 7, 4 (July 1914): 207–31. Admitted to Kingston Asylum in 1870, William B. was sent to the Penitentiary Criminal Asylum in 1877, then was released briefly in 1878. He was reincarcerated after attacking a 13-year-old girl. He remained confined in Kingston Asylum until 1886, when he was transferred to the insane asylum in Hamilton. He was still there in 1914 at the age of 76, in poor health. Sapinsley, The Private War of Mrs. Packard, 180–2, 190–2, 212. Propositions and Resolutions of the Association of Medical Superintendents of American Institutions for the Insane, comp. by Dr Kirkbride of Pennsylvania, Dr Callender of Tennessee, and Dr Nichols of D.C. (Philadelphia, 1876), 31. Resolutions were passed at the amsaii meeting held at Auburn, May 1875. ar, 1880, 287. Enid W., Patient File #6034, Letter to Rev. Wm McCaughan, Chicago, from Dr Clark, 26 Sept. 1902. Alex C., Patient File #5030. He was confined from 1897 to 1935. In an undated letter addressed to Mr William McGuire, which he also asks Dr Clarke to read, Alex writes:

Do you send my letters, my correspondence, through the Toronto Post-office? If you post my letters in the post-office letter boxes, the post office ­letters-carriers would surely deliver them at the proper addresses. I wrote two letters to Mr. E.S. Caswell, Richmond St. West, prior to ­Christmas-time, and, when visiting me here, Mr. Caswell told me he did not get any of my letters. My letters would have prepared his mind to instant friendship.

In a letter to another correspondent noting he had received no answer to three letters to this person, Alex wrote: ‘I was very Expectant of your

286   NOTES

112. 113.

114. 115.

116. 117. 118. 119. 120. 121. 122. 123. 124.

125. 126.

responses to my requests; but there has been prolonged silence, not having received an answer. I concluded that you had not received my letters, and probably my conclusions are correct.’ Letter to Mr Arthur Macoomb, from A.B.C., 6 Apr. 1908. Elsa W., Patient File #6015, Letter to the Hon. W.J. Hanna, Provincial Secretary, Queens Park, Toronto, from Mrs E.F.W., Provincial Institution, Toronto, 19 Nov. 1909. Reginald F., Patient File #10015, Letter to Dr J.M. Forester [sic] from Mrs A.E.F., East Orange, NJ, 28 Dec. 1911; Letter to Mrs A.E.F. from Medical Superintendent Forster, 29 Jan. 1912; Letter to Dr Forster from A.E.F., East Orange, NJ, 26 Dec. 1913. Wendell C., Patient File #7004, Letter to Dr Clark from E.A.C., Port Huron, Mich., 5 Jan. 1904. Anne D., Patient File #10009, Letter ‘To the Superintendent’, from May L.K., Washington, DC, undated though found among letters from 1912–13. Since the subject matter of censored letters is referred to in Forster’s letter, cited below, to Paul K., it is very likely that this particular letter is from the Spring of 1913. Letter to P.J.K., Toronto, from Medical Superintendent Forster, 25 June 1913. John Webster, ‘Litigious or Querulous Paranoia’, Bulletin of the Ontario Hospitals for the Insane 9, 3 (Apr. 1916): 62–3. Tomes, A Generous Confidence, 223–6. Rhonda D., Patient File #8033, Clinical Records, 1 June 1911. Jack P., Patient File #11001. This letter to ‘Dear Bell’ has been typed up in his clinical record, undated, during Jack’s four-month confinement in 1907. Moran, ‘Keepers of the Insane’, 73. Mitchinson, ‘The Toronto and Gladesville Asylums’, 69. Alice M., Patient File #1002, Letter to Mrs J.S., Birkley [sic], Ont., from Superintendent Forster, 25 Jan. 1918. Mildred O., Patient File #8004. Quote is from an unsigned statement certifying Mildred’s mental state, 14 Oct. 1908. Ibid., Letter to Dr H.S. Griffin, Hamilton, Ont., from Medical Superintendent Clarke, 26 Nov. 1907; Letter to ‘Dear Dr. Griffin’ from Mildred O., 11 Nov. (no year, but based on Griffin’s letter to Clarke, in which he encloses Mildred’s letter, her writing is definitely from 1907); Letter to Dr Clarke from Dr H.S. Griffin, Hamilton, Ont., 25 Nov. 1907. He states that ‘her husband and friends do not seem to want her. . . . I suppose if her husband cared to be bothered with her, she might be looked after outside.’ Evelyn T., Patient File #8028, Clinical Record, 20 Mar. 1911, 16 May 1916, 29 Oct. 1910. Gregory F., Patient File #4008, Clinical Record, 6 Mar. 1910.

N O T E S    2 8 7

127. Sandra S., Patient File #8012; Ellen S., Patient File #9018. Regarding Ellen’s desire to be transferred back to the Toronto facility from Cobourg, see Patient File #8012, Letter to Dr Forster from D.R., Denver, Colo., 20 Jan. 1915. See also Patient File #9018, Telex to Dr Forster from D.R., Montclair, NJ, 27 Jan. 1917; cpr Telex to D.R., New Jersey, from J.M. Forster, 29 Jan. 1917. 128. Patient File #8012, Letter to Mrs Stephen B., Woodhaven, Long Island, NY, 23 Feb. 1906. 129. Ibid., Letter to Inspector R. Christie, Toronto, from Medical Superintendent Daniel Clark, 15 July 1905. 130. Ibid., Letter to Dr W.K. Ross from Margaret B., Woodhaven, Long Island, NY, 6 Feb. 1906. 131. Ibid., Letter to Mrs Stephen B., Long Island, NY, from Assistant Superintendent Ross, 14 Sept. 1906. This letter was prompted by an inquiry from Ellen’s daughter, who wanted to send money for her mother to go to the cne: Letter to Dr W.K. Ross from Margaret B., Woodhaven, Long Island, 5 Sept. 1906. 132. Patient File #9018, Letter to Dr Clark [sic] from Margaret B., Woodhaven, Long Island, NY, 19 Nov. 1907. 133. Patient File #8012, Letter to Inspector R. Christie, Toronto, from Assistant Medical Superintendent Ross, 15 Aug. 1905. 134. There are a number of letters from 1904–5, in Sandra’s file, to Dr Clark from Ellen S. about her daughter prior to her own confinement. These letters were written from New York, where she was living. Margaret wrote to Dr Clark, as early as February 1905, informing him of Ellen’s departure and plan to liberate Sandra. Quote is from Patient File #8012, Letter to ‘My Dear Mother’, signed B__ (short-hand for Sandra’s second name), Toronto, 19 Mar. 1905. 135. Ibid. 136. Diana Gittins, Madness In Its Place, 127. 137. Patient File #8012, Letter to Inspector R. Christie, Toronto, from Medical Superintendent Daniel Clark, 15 July 1905. 138. Ibid., Letter to Mrs E.A.S., Brooklyn, NY, from Assistant Superintendent Ross, 9 May 1905. 139. Ibid., Letter to Chief Inspector Archibald, Police Department, City Hall, from Mrs E.A.S., 999 Queen St. West, Toronto, 22 Mar. 1912. 140. Patient File #9018, Letter to Assist. Dept. Chief Archibald, Police Department, City Hall, from Mrs E.A.S., co-signed (Miss) S.B.S., 16 Sept. 1913. This letter, which was written by Ellen S., reverts back and forth between ‘We’ and ‘I’. 141. Sandra S., Patient File #51001, Letter to Deputy Chief Archibald, City Hall, Toronto, from Mrs. E.A. S__ and Miss S.B. S__, 999 Queen St. West, Toronto, 4 July 1917.

288   NOTES

142. Ibid., Letter to D.R., Denver Colo., from Medical Superintendent Forster, 24 Dec. 1917; Letter to D.R., Denver, Colo., from Medical Superintendent Forster, 4 July 1918. 143. Gilbert D., Patient File #1010; Allen D., Patient File #7052. 144. Patient File #7052, Letter to Inspector C. Postlethwaite, Toronto, from Medical Superintendent C.K. Clarke, 19 Nov. 1909.

Chapter 4    1. These references are usually mentioned in the context of moral therapy treatments, rather than as forms of leisure in their own right. See, e.g., Krasnick, ‘ “In Charge of the Loons” ’, 166–7; Shortt, Victorian Lunacy, 133–4; Charlotte Mackenzie, Psychiatry for the Rich: A History of ­Ticehurst Private Asylum, 1792–1917 (London, 1992), 71, 74, 147–8.    2. Dwyer, Homes for the Mad, 124, 141–3, 167–8. Dwyer studied patient and staff life at both Willard Asylum and Utica Asylum, though most of her material specifically relating to patient entertainments deals with inmates of Willard Asylum.    3. McCandless, Moonlight, Magnolias, & Madness, 272.    4. ar, 1895, 6.    5. ar, 1898, 43.    6. ar, 1876, 209; 1886, 5; 1890, 40.    7. ar, 1880, 284; 1897, 11.    8. ar, 1898, 43.    9. ar, 1878, 292–3.   10. ar, 1934, 16.   11. ar, 1936, 34–5.   12. ar, 1924, 13; 1932, 28; 1936, 34–5.   13. ar, 1884, 100; 1890, 40; 1897, 11; 1898, 42–3; 1903, 3; 1904, 6.   14. ar, 1890, 40; 1895, 6; 1934, 16.   15. ar, 1879, 312.   16. ar, 1900, 3; 1934, 16. See also Mitchinson, The Nature of Their­ Bodies, 328.   17. ar, 1937, 16. It should be noted that in 1936 under ‘Other Forms of Organized Recreation’ is listed ‘Bowling, Softball, etc.’ in which women are cited as having been involved, an average of 40 females compared to 25 males 80 times during the year. However, given the specific references in the written reports in which only males are ever recorded as having played these two sports, it is likely women were not involved, though they may have played similar games like lawn tennis, though this is not specified. See ar, 1936, 34–5.   18. ar, 1932, 28; 1933, 31; 1934, 16; 1936, 34–5.

N O T E S    2 8 9

  19. Jane F., Patient File #5010, Letter to Mrs David S. from Jane F., 20 July 1911. Confined in 1895, Jane died from ‘epileptic exhaustion’ at the age of 67 on 31 Aug. 1911, only six weeks after this letter was written. For examples of people who are reported to have enjoyed various administratively organized entertainments, see Violet N., Patient File #3052, Clinical Record, 28 Jan. 1914; Sally C., Patient File #4020, Letter to Mary C., Los Angeles, Calif., from Medical Superintendent, 15 Dec. 1906 (confined at the age of 55 in 1891, Sally was discharged in 1908 as ‘Dementia Improved’); May F., Patient File #6007, Clinical Record, 30 Sept. 1938; Jim P., Patient File #6017, Clinical Record, 23 Feb. 1927, 20 Nov. 1928.   20. Geoffrey T., Patient File #2016, Clinical Record, 13 Dec. 1909. Geoffrey was confined at the age of 22 in 1878 and died in the asylum in 1914.   21. ar, 1880, 284; 1894, 6.   22. ar, 1876, 215–16.   23. ar, 1877, 260; 1895, 7 (Clark’s emphasis).   24. ar, 1899, 38; 1906, 12.   25. ar, 1906,. 12.   26. ar, 1924, 13; 1932, 43; 1941, 47.   27. ar, 1895, 6.   28. Charles M., Patient File #4034, Letter to Medical Superintendent from J.D. McLean, Assistant Deputy and Secretary, Department of Indian Affairs, Ottawa, 21 Dec. 1920. Charles was confined at the age of 27 in 1893 and remained at the hospital until his death in 1923. There are numerous letters in his file noting cheques sent by the Department of Indian Affairs for his maintenance and some for clothing, with his admission papers stating this support began upon Charles’s confinement.   29. For a detailed drawing of a fountain and their locations, see ao, rg 15, 13–2–41, Department of Public Works Drawings, P.L. Asylum, Design for Fountain to be Erected (1859); ao rg 15, 13–2–73, Department of Public Works Drawings, Lunatic Asylum Toronto, Block Plan of Buildings Shewing Proposed Removal of Woodsheds (1869). The 1859 drawing is for a fountain to be placed at the north front end of the asylum grounds, running along Queen Street West, while the 1869 drawing shows the location of two fountains facing south in the direction of King Street West. See also ar, 1879, 27; 1904, 5.   30. E.H.S. (Ezra H. Stafford), ‘Toronto Insane Asylum’, Canadian Journal of Medicine and Surgery 3, 3 (Mar. 1898): 166. This article refers to 160 patients who were not locked up out of 700 to 800 people. Thus the figure of 75–80 per cent was calculated on the basis of the 540 to 640 who remained confined. See also references below in note 37. The

290   NOTES

  31.   32.   33.

  34.   35.   36.

  37.   38.   39.

  40.   41.   42.   43.   44.   45.

quote is from Cyril M., Patient File #4001, Clinical Record, 14 Sept. 1911. Cyril was confined at the age of 26 in 1889 and remained in the asylum until his death in 1912. ar, 1883, 47; 1880, 38. ar, 1936, 20–1, 34–5. For an example of an inmate who successfully, though only temporarily, escaped while out with the walking party see Nancy D., Patient File #2040, Letter to R. Christie, Inspector of Prisons & Public Charities, Toronto, from Daniel Clark, 15 June 1883. She was recaptured within one day. Nancy was confined at the age of 30 in 1881 and remained an inmate until her death 52 years later in 1933. Connie D., Patient File #9008, Letter to ‘Dear Mother, Father’ typed into her clinical record, Toronto, 7 Aug. 1910. Timothy F., Patient File #6023, Letter to Supt. C.K. Clarke, from T.P., Ward 4, Asylum, West Toronto, 4 July 1910. Timothy was confined in 1899 and died in the asylum in 1912. For examples of patients who had free access to the grounds because they were trusted, see Edward D., Patient File #2021, Clinical Record, 6 Mar. 1928. Edward was locked away at the age of 19 and remained in the asylum until he died 54 years later in 1932. Violet N., Patient File #3052, Clinical Record, 28 Jan. 1914, 12 Aug. 1916. Violet was confined in 1889 at the age of 35 and died in the institution in 1922. ar, 1882, 49; 1895, 5; 1900, 4. Jim P., Patient File #6017, Clinical Record, 25 Mar. 1927. Jim was confined at the age of 31 in 1898 and died in 1941 at 999 Queen Street West. May F., Patient File #6007. May was confined from 1898 to 1952. Several times she was sent to boarding-houses in the 1930s and 1940s, but she was returned each time to the asylum where she eventually died. Clinical Record, 2 Sept. 1921. ar, 1923, 11; 1932, 27. ar, 1879, 31. ar, 1887, 43. For example, Arturo C., Patient File #3013, Clinical Record, 19 Dec. 1911. Arturo was confined in 1883 at the age of 45 and died in the asylum in 1917. ar, 1897, 11; 1879, 312; 1880, 284; 1890, 40; 1891, 5. For an example of a patient’s family being asked to send two dollars to ‘defray expenses’ for a trip to the cne, which they complied with, see Sylvie B., Patient File #3003, Letter to Mrs B., Barrie, Ont., from Assistant Superintendent, 29 July 1904. Sylvie was confined at the age of 57 in 1882 and died at the hospital in 1911.

N O T E S    2 9 1

  46. Sophia S., Patient File #3022, Clinical Record, 28 Mar., 31 May 1909. Sophia was confined at the age of 24 in 1884 and remained in the asylum until her death in 1910. Letters in Sophia’s file dating from her early years of incarceration show her to have been generally quiet and withdrawn, with a lack of interest becoming more pronounced as the years wore on.   47. Mavis M., Patient File #2019, Clinical Record, 18 Apr. 1909, 24 May 1909, 7 June 1909, 25 Feb. 1911.   48. ar, 1874, 154; 1894, 5; 1896, 41.   49. Mabel I., Patient File #2001, Clinical Record, 21 July 1909. Mabel was confined at the age of 24 in 1870 and died in the asylum in 1918.   50. Ellen G., Patient File #2017. Clinical Record, 26 Sept. (no year, though it is between entries from 1911 and 1913). Ellen was confined from 1878 until her death in 1918.   51. Ibid., Clinical Record, 2, 4 Nov. 1918.   52. ar, 1876, 209; 1882, 16; 1898, 43.   53. ar, 1879, 312; 1897, 11; 1899, 38.   54. ar, 1883, 62.   55. ar, 1880, 284. Wendy Mitchinson discusses this in The Nature of Their Bodies, 329.   56. ar, 1933, 31; 1934, 16; 1938, 16; 1937, 82–3.   57. ar, 1876, 216–17; 1891, 4; 1897, 11; 1899, 38; 1879, 312.   58. ar, 1936, 81. E.H.S., ‘Toronto Insane Asylum’, 165. For an example of reading material being provided by relatives, see Enid C., Patient File #4002, Letter to Dr Daniel Clark from John C., Durham, Ont., 2 July 1890. Enid was confined in 1890 and was transferred to the institution in Pene­ tanguishene in 1907.   59. Elaine M., Patient File #7044, Clinical Record, 19 Sept. 1916.   60. Jim W., Patient File #7051, Clinical Record, 5 Mar. 1911, 4 Mar. 1914.   61. Wallace M., Patient File #4009. Clinical Record, 4 Sept. 1920. Wallace was confined from 1890 until his death at the age of 75 in 1921.   62. Walter T., Patient File #7021. Most of these sketches are drawn in pencil; the largest is letter size while the others are a quarter or half the size of standard letter paper. Walter was admitted in 1902 and died in 1914.   63. ar, 1887, 45. For smoking reference in the late 1920s, see note 71 below re Winston O., Patient File #2013.   64. For examples of patients who were upset by the visits of relatives, see Ellen G., Patient File #2017, Letter to Dr Clark from S.G., Oakville, Ont., 3 July 1883. This correspondent, her husband, wrote: ‘I have not visited Mrs. G. for some time past as she always became much excited during my visits which of course was rather injurious than otherwise: and also because of the abusive language she would use toward me

292   NOTES

  65.   66.

  67.

  68.

  69.

  70.

which would not run off me as easy as water off a duck’s back. Some of her sisters have also refrained from visiting her for the very same reasons.’ See also letter to S.G., Oakville, Ont., from Dr Daniel Clark, 5  July 1883. This letter is in very bad shape, with much of the print faded away on the carbon paper. However, among the legible lines are: ‘I think it would excite her for you to return. . . . The same is [illegible] in regards to her sisters.’ Sylvie B., Patient File #3003, Letter to Dr Daniel Clark from Judge B., Barrie, Ont., 19 Dec. 1896. This correspondent wrote: ‘On the last two occasions that I saw her as I left she became greatly excited and desired me never to come again.’ Cindy R., Patient File #5029, Clinical Record, 17 July 1918. Cindy was confined from 1897 until her death at the age of 73 in 1930. Winston O., Patient File #2013, Clinical Record, 8 Feb. 1921, 23 Feb., 25 July 1927; Letter to Mrs W.D., Westboro, Ont., 23 Feb. 1921. Winston was confined at the age of 32 on 9 Jan. 1877 and remained at 999 Queen Street West until his death on 8 Dec. 1934. Ibid., Letter to Annie O., Ottawa, from Medical Superintendent, 3 Sept. 1912; Letter to Anna O., Ottawa, from Medical Superintendent, 6 Jan. 1914; Letter to Anna O., Ottawa, from Medical Superintendent, 8 July 1913. Unfortunately, there is no photograph of Winston or his car in his case file. Ibid., Letter to Anna O., Ottawa, from Medical Superintendent, 16 Feb. 1916; Letter to Anna O., Ottawa, from Medical Superintendent, 4 July 1917; Letter to Miss Annie O., Ottawa, from Medical Superintendent, 16 Jan. 1919. Ibid., Clinical Record, 8 May 1922; Letter to Mrs M.D., Westboro, Ont., from Medical Superintendent, 14 July 1924. Three other references note his tree-removing abilities: Letter to Mrs M.D., Westboro, Ont., from Medical Superintendent, 25 Jan. 1922, which states: ‘The high wind of a few weeks ago, blew down a tree in our park, and [Winston] superintended that it be removed.’ Letter to Mrs M.D., Westboro, Ont., from Medical Superintendent, 2 Nov. 1922, which states: ‘only the day before yesterday he cut down a tree, which had died in the park.’ The clinical record, 26 July 1926, notes that 81-year-old Winston ‘can show any of the young men how to cut down a tree’. Also see Letter to Anna O., Ottawa, from Medical Superintendent, 5 Mar. 1914; Letter to Mrs M.D., Westboro, Ont., from Superintendent, 31 May 1928. This letter also refers to Winston having an ‘iron constitution’, which was beginning to ‘bend under the burden of years’. Ibid., Letter to Annie O., Ottawa, from Medical Superintendent, 3 July 1912; Letter to Annie O., Ottawa, from Medical Superintendent, 27 Aug. 1913.

N O T E S    2 9 3

  71. Ibid., Letter to Mrs M.D., Westboro, Ont., from Medical Superintendent, 5 May 1927; Letter to Mrs M.D., Westboro, Ont., from Superintendent, 31 May 1928. Clinical Record, 26 July 1926, 23 Feb. 1927, 12 June 1928, 10 Dec. 1931, 23 Sept. 1927.   72. Ibid., Letter to Anna O., Ottawa, from Medical Superintendent, 26 Sept. 1916. This letter also notes: ‘He is one of our most highly esteemed patients.’ Letter to Anna O., Ottawa, from Medical Superintendent, 19 Mar. 1917.   73. Ibid., Clinical Record, 10 Dec. 1931: Winston was referred to as ‘some what demented, but considering his long stay at this Institution he is in fairly good shape.’   74. Ibid., Clinical Record, 2 Jan. 1934.   75. Ibid., Letter to J.M. Forester [sic] from Anna O., Ottawa, 26 Aug. 1913; Letter to J.M. Forster from Anna O., Ottawa, 2 Feb. 1916.   76. Ibid., Clinical Record, 23 Feb. 1927.   77. Ibid., Clinical Record, 14 Nov. 1928. Two references, 20 years apart, refer to Winston’s perception of confinement. It appears that, like other long-term inmates, he came to accept his life there because of a lack of any alternative being offered. See letter to Medical Superintendent Forester [sic] from Anna O., Ottawa, 4 July 1914, in which his sister writes: ‘[Winston] realizes he cannot leave there But he does not understand the reason.’ The clinical record entry for 2 Jan. 1934 observes: ‘Is content to remain in hospital for the balance of his life.’   78. Felicity T., Patient File #5005, Clinical Record, 31 May 1924. Felicity was confined at the age of 49 on 21 Apr. 1894 and died in the institution on 29 May 1924.   79. Ibid., Receipt dated 21 Oct. 1910 addressed as: Clothing list: To G. T__, signed M. Cooke. There are dozens of receipts in Felicity’s file listing an astonishing variety of sewing material, as well as food.   80. Ibid., Clinical Record, 24 Apr. 1909, 25 Oct. 1911, 5 Jan. 1914, 21 Mar. 1922, 1 Oct. 1923.   81. Ibid., Letter to Mr Gene T., Toronto, from Medical Superintendent, 19 June 1910.   82. Ibid., Undated receipt signed Angel Queen XIII. She also sent along an undated note stating: ‘Give The List To The Clerk At Either Simpsons Or Eatons[.] They Will Fill It Out And Go To The Bank Called Montreal And Get Their Pay For The Items And Trouble Of Collecting It[.] Angel Queen XIII’   83. Ibid., Clinical Record, 17 July 1918, 1 Dec. 1923.   84. Ibid., The scroll is undated but is signed: ‘Written By Command Of Almighty God / Warning / By Angel Queen XIII.’; undated letter, pp. 2, 6, 1.

294   NOTES

  85. Ibid., Letter to Miss Veronica T., Toronto, 2 June 1924. Unsigned letter but it was almost certainly from the Medical Superintendent.   86. Ibid., Clinical Record, 1 Oct. 1923, states: ‘She also washes her own dishes and keeps them in her room.’ Angel Queen’s clinical chart from the infirmary, where she was recovering from a fracture, reads in part: ‘January 24, 1916–8 A.M. Pt says there is morphia in her tea. . . . 6 P.M. Pt taking nourishment well, but refuses to take any more tea. . . . January 30, 1916—7 A.M. . . . Pt refuses to take tea as it is poison in it.’ Staff were known to prepare special trays and meals for wealthy patients, who could afford such luxuries. In Angel Queen’s case, it would not have required much trouble, as her tastes were so simple. Her food was not what was cooked for the other patients.   87. Ibid., Clinical Record, 24 Apr. 1909, 23 Feb. 1915, 1 Oct. 1923. It was noted that during her last years, Angel Queen ‘used to write numerous checks, but recently it is rather an event for her to get out a check.’ ­Clinical Record, 21 Mar. 1922.   88. Ibid., Clinical Record, 21 Mar. 1922. Reference to the accident and subsequent physical disabilities are in Clinical Record, 30 Dec. 1915, 15 Jan. 1916, 1 July 1916.   89. Ibid., Clinical Record, 1 Oct. 1923, 1 Dec. 1923, 29 May 1924.   90. Ibid., Clinical Record, 31 May 1924; Letter to Miss Veronica T., Toronto, 2 June 1924, which states: ‘Your mother was always a great favorite with the staff. In spite of her affliction she retained qualities of mind and heart which endeared her to us. . . . we all join with you in mourning her loss.’ This letter is not signed but it is almost certainly from the Medical Superintendent. See also letter to Miss Veronica T., Toronto, from ‘FSV/LC’ [Dr F.S. Vrooman], 5 June 1924: ‘nearly every morning I visited and conversed with her, and always felt a personal interest in her, as indeed did nearly every one who came in contact with her.’   91. Ibid., Clinical Record, 1 Oct. 1923, 17 July 1918.   92. Ibid., Clinical Record, 25 Oct. 1911.   93. Ibid., Letter to Miss Veronica T., Toronto, from ‘FSV/LC’ [Dr F.S. Vrooman], 5 June 1924.   94. Henrietta B., Patient File #5003. These comments and observations are recorded in Henrietta’s admission papers: Form of History of a Patient, 15 May 1894, signed Dr Wm Richardson, Burlington, Ont.; Form A— Certificate of Insanity, 30 Apr. 1894, signed Dr Austin H. Speers, Burlington, Ont.; Form A—Certificate of Insanity, 30 Apr. 1894, signed Dr Wm Richardson, Burlington, Ont. Henrietta was admitted on 1 May 1894 and discharged on 30 July 1919, though she had been released on probation from the hospital on 23 July 1918.

N O T E S    2 9 5

  95. Ibid., Clinical Record, 10 Aug. (no year, but entry is between observations from 1909 and 1913).   96. Ibid. This 13-page letter by Henrietta to ‘Superintendent Clark of the Toronto Jail’ has written on the top of the first page: ‘No Date’. The word ‘Murder’ is written seven times sideways across the top of the first page. This letter is extremely detailed and imaginative, giving descriptions of dream-like images, often of a nightmarish quality, and includes sexual and racist overtones with references to ‘Savages’. In handwriting that is definitely not Henrietta’s someone has written ‘July 1, 1916’, though both doctors with the name to whom it is addressed (frequently misspelled in the case of C.K. Clarke) had long since departed 999 Queen Street West by 1916. C.K. Clarke left in 1911 and Daniel Clark left in 1905 and died in 1912.   97. Ibid., Letter to Mrs N. (no address), from Henrietta Emily B., no date, though patriotic references to Canada and the maple leaf suggest it may have been written during World War I. This letter is seven pages long and contains a highly stylized description of a horse carriage road accident in Hamilton in which Henrietta and her mother were involved, with the latter being seriously injured. The quotes are on pages 5–7.   98. Ibid., Clinical Record, 9 Jan. (no year, between entries for 1913 and 1916).   99. Ibid., Clinical Record, 20 Nov. 1913, 10 Apr., 18 July 1909. 100. Ellen K., Patient File #3037. Ellen was admitted for the third time at the age of 41 on 21 Oct. 1887 and died in the hospital on 8 Sept. 1923. Coreen K., Patient File #9001. Coreen was admitted for the fourth time on 13 Aug. 1905 and discharged on 27 May 1918, though she was allowed out on probation on 26 Nov. 1917. For a biography of John K., the husband and father of Ellen and Coreen see newspaper obituary attached to page 1 of Clinical Record, entries for period between 4 Mar. 1909 and 1 Dec. 1910 in Patient File #3037. There are dozens of receipts and letters from throughout the period of incarceration for both women concerning the supply of money for maintenance, clothing, sewing, reading materials and food. After John’s death, funds were disbursed by the Toronto General Trusts Corporation. 101. Patient File #3037, Letter to Medical Superintendent from A. Jones for the Inspector of Prisons and Public Charities, Toronto, 20 Mar. 1911. 102. Ibid., Letter to Miss Corley from Hollie M., ‘Sunday’ (no address or date but found among letters from 1903, two years prior to the confinement of Coreen). The correspondent is Ellen’s daughter and she refers to Miss Corley, an asylum nurse, shopping with and purchasing amenities for ‘Mama’. Regarding books purchased by Coreen, see Ibid., ­Letter to J.M. Forster, Medical Superintendent, from W.D. Langmuir,

296   NOTES

103.

104. 105. 106.

107.

108.

109.

110.

General Manager, Toronto General Trusts Corporation, 27 Aug. 1917. This letter concerns Coreen but was misfiled in Ellen’s file. Other references to excursions and purchases are noted below. Ibid., Letter to Mr Edgar, Bursar, T.I.A. from Coreen K., Ward 13, 999 Queen Street West, Toronto, 27 July 191? (the last number is obscured by a hole punch but it appears to be either 1911 or 1917). Though this letter is from Coreen it was misfiled in Ellen’s file. Patient File #9001. Letter to Mr Edgar from Coreen K., 2 Aug. 1917. Ibid., Clinical Record, summer and fall 1917; Letter to Dr Forster from C.K., Asylum, 24 Nov. 1917, 2, 3. Details surrounding her release can be found in her mother’s file: Patient File #3037, Letter to Toronto General Trusts Corporation from Bursar, 6 Dec. 1917; Letter to Dr Forester [sic] from J.H. Drinkwater, Toronto, 5 Mar. 1918. This letter notes that Coreen was enjoying herself, playing the piano, as well as going to church and on outings. Her date of final discharge is noted in the Clinical Record in Coreen’s file: Patient File #9001. Patient File #9001, Letter to Dr Forster from Coreen K., Asylum, (no month or date) 1917. Coreen began this letter with the lines: ‘As you have promised to allow me to leave here Today I do not wish to remain one moment longer than possible.’ This reference, as well as the location of this letter in her file with other letters concerning this dispute, clearly indicates that she wrote the letter on the day she was allowed out on probation, 26 Nov. 1917. Over 20 years after her release from 999 Queen Street West, Coreen was admitted to another psychiatric hospital, though the outcome is not recorded in her file. This information is recorded in her mother’s file: Ellen K., Patient File #3037. Letter to C.B. Farrar, Director of Toronto Psychiatric Hospital, from J.R. Howitt, Superintendent, Ontario Hospital, Toronto, 29 Apr. 1939. This letter is in response to a letter dated 25 Apr. 1939 from Mr Jackson writing for C.B. Farrar to Dr Howitt requesting information on Ellen and Coreen K., which was provided in the form of admission histories with it being noted that Coreen was probated on 26 Nov. 1917 and discharged as ‘Improved’ on 27 May 1918. The initiating letter of 25 Apr. 1939 notes that Coreen K. was admitted to the Toronto Psychiatric Hospital on 17 Apr. 1939. There is no information about Coreen beyond this date. Patient File #9001, Letter to Dr Forster from C.K., Asylum, 24 Nov. 1917, 2–3. Coreen wrote: ‘I only wish I could have all Mother’s money withdrawn from here and her also, for I see no advantage in this Hospital with the modern Hospitals of the day.’ Ellen K., Patient File #3037, Letter to Assistant General Manager, Toronto General Trusts Corp., from Medical Superintendent Dr Harvey

N O T E S    2 9 7

Clare, 8 May 1920. It is important to observe that this letter mentions that Mrs K. was worried about being taken away from her daughter, if she was ever transferred to Whitby Hospital from 999 Queen Street West, something that did not happen. Her admission papers state Ellen had five children, and as there is no reference to any sons during her long incarceration, it is assumed that all of her children were daughters, though this is not specified anywhere. The closest reference to the gender of her children is in a letter from Ellen’s sister, which mentions a parcel from ‘one of her daughters’. Ibid., Letter to Dr Harvey Clare from Miss E.H., Port Hope, Ont., 2 Jan. (no year, though based on Clare’s response it is from 1923). Since Coreen had been released two and one-half years before Ellen’s comments in May 1920, it is not clear which daughter is being referred to, though it does show at least one of her children lived close enough to the institution to have visited her regularly. In any case, this and other letters are clear evidence that Ellen received visitors during her final years, including a sister, so she was by no means forgotten by outsiders. 111. Ibid., Letter to W.D. Langmuir, Toronto General Trust Company, from Medical Superintendent C.K. Clarke, 31 Jan. 1911. 112. Ellen’s Clinical Record notes her feelings which culminated in severe depression on a number of occasions, as is indicated in the following entry from 12 Mar. 1912: Is as a rule a quiet, agreeable and pleasant woman, quite vivacious, and with very gradual deterioration. She has, however, frequent periods of varying lengths, during the early part of which she is more or less fault-finding and unpleasant. She finally lapses into a condition where she sits in her chair without speaking for days or weeks at a time. During the last 14 years of her life there are two references to Ellen going on day-trips outside of the asylum, neither of which occurred during her final decade of incarceration, indicating she did not get outside of the hospital after 1912, unlike her daughter during this period, as is mentioned above. Re Ellen going out during the latter part of her confinement, see: Patient File #3037, Clinical Record, 8 July 1909, 17 Aug. 1912. This latter reference notes Ellen ‘went for a little trip to Niagara which she enjoyed very much.’

Chapter 5    1. MacKenzie, Psychiatry for the Rich, 26–7; Shortt, Victorian Lunacy, 128–9.

298   NOTES

   2. By a Late Inmate of the Glasgow Royal Asylum for Lunatics at Gartnavel, The Philosophy of Insanity, intro. Frieda Fromm-Reichmann (London, 1947), 70.    3. Warsh, Moments of Unreason, 197 n. 2. For an account of occupational therapy in the early 1900s, see C. Floyd Haviland, ‘Occupation for the Insane’, American Journal of Insanity 69; 3 (Jan. 1913): 483–95. During the 1970s and 1980s, occupational therapy was craft-oriented (pottery, drawing, woodwork), whereas industrial therapy was paid employment for specific tasks, either within a mental institution or at a sheltered workshop in the community, such as at Goodwill Industries. Well into the 1980s, Section 24 of the Ontario Employment Standards Act legalized compensation below the minimum wage for those (other than management) who worked at sheltered workshops. This discriminatory practice, which was also in place in other provinces, was challenged in various locales across Canada during the late 1980s and early 1990s by people who worked in these facilities, with the result that regular wages have only recently begun to be paid to some people with ­psychiatric disabilities. See ‘Will the Charter Change Sheltered Workshops?’, Phoenix Rising: The Voice of the Psychiatrized 5, 2–3 (Aug. 1985): 31A–32A. An example of social service and employment agencies run for and by current and former psychiatric patients is the Consumer/Survivor Development Initiative in Ontario. Funded by the Ministry of Health since 1991, there were 36 csdi-sponsored projects across the province in 1996. See csdi, Consumer/Survivor Development Initiative Project Descriptions (Toronto, Mar. 1996). By 1998, seven of these projects were alternative consumer/survivor-run businesses from which ‘400 people gain direct economic benefit.’ Scott Simmie, ‘Investing in pride’, Toronto Star, 10 Oct. 1998, C4. See also the new documentary film on these businesses: Working Like Crazy (SkyWorks, National Film Board of Canada, TVOntario, 1999, 60 minutes).    4. Stodgill, ‘Joseph Workman, m.d.’, 919.    5. Alice M., Patient File #1002, Letter to David M., Owen Sound, Ont. from Superintendent Forster, 22 Jan. 1918.    6. Susanna Moodie, Life in the Clearings versus Life in the Bush (New York, 1853), quoted in Greenland, The City and the Asylum, 10.    7. ar, 1879, 19.    8. Moran, ‘Keepers of the Insane’, 56–7.    9. I. Ray, ‘The Labor Question, and Hospitals for Incurables’, American Journal of Insanity 22, 4 (Apr. 1866): 441.   10. Ripa, Women and Madness, 108.   11. ar, 1885, 45.   12. Ripa, Women and Madness, 106.

N O T E S    2 9 9

  13. ar, 1894, 6.   14. ar, 1895, 35; 1883, 13–14, 66.   15. Jerold M., Patient File #8009; Ellen K., Patient File #3037; Coreen K., Patient File #9001; Reginald F., Patient File #10015.   16. William G., Patient File #3005, Clinical Record, 30 Apr. 1911; Irene B., Patient File #5022, Clinical Record, 18 Dec. 1909; Erin P., Patient File #7031, Clinical Record, 13 Mar. 1909.   17. Krasnick, ‘ “In Charge of the Loons” ’, 168–9.   18. Mitchinson, ‘The Toronto and Gladesville Asylums’, 69; Shortt, Victorian Lunacy, 132.   19. Ripa, Women and Madness, 106.   20. Andrew Scull, ‘Moral Treatment Reconsidered’, in Scull, ed., Social Order/Mental Disorder, 89–94.   21. ar, 1896, 41.   22. ar, 1881, 20; 1900, xiv.   23. Tomes, A Generous Confidence, 285.   24. ar, 1879, 21.   25. ar, 1896, xxiv–xxv.   26. ar, 1871–2, 20.   27. ar, 1898, 41.   28. ar, 1906, xi.   29. Ripa, Women and Madness, 106.   30. Ibid., 109.   31. Mitchinson, The Nature of Their Bodies, 327–9.   32. ar, 1893, 3–4.   33. ar, 1876, 215; 1878, 259, 264; 1879, 311. Clark refers to Paris green in each of these reports, though he ruled out using it in 1876 because it was poisonous. In 1878 he reported his ‘great timidity’ in having it applied to the potato crop as he feared patients may eat it. In 1879 he wrote that it was used ‘with good effect’, though he also noted that the ‘utmost care was taken to put it only in the hands of those who were careful in using it.’ Paris green was used as an insecticide and pigment. It consisted of acetate and arsenite of copper, a ‘highly poisonous bright-green powder’, which was also known as ‘French green, emerald green, Schweinfurt green, Vienna green, and mitis green’. Webster’s New Universal Unabridged Dictionary, Deluxe Second Edition (New York, 1983), 799, col. 2.   34. Daniel T., Patient File #6038, Letter to Dr Clark from Harriet T., Newmarket, Ont., 10 June 1903; Letter to Harriet T., Newmarket, Ont., from Medical Superintendent Clark, 26 June 1903.   35. Jim P., Patient File #6017, Letter to Inspector R. Christie from Medical Superintendent Clark, 31 March 1903; Wilfred S., Patient File #5036,

300   NOTES

  36.   37.   38.   39.   40.   41.   42.   43.   44.   45.   46.   47.

  48.   49.   50.   51.   52.

  53.

  54.

Letter to Inspector R. Christie from Medical Superintendent Clark, 27  Nov. 1902; Letter to William S., Uxbridge, Ont., from Medical Superintendent Clark, 19 Sept. 1900. Ripa, Women and Madness, 110. Esther H., Patient File #11030, Clinical Record, 9 Feb. 1909, 17 May 1909. ar, 1878, 258; 1884, 45. ar, 1885, 47; 1888, 4; 1886, 6; 1887, 44; 1891, 5. ar, 1888, 4–5; 1904, 4; 1912, 110; 1917, 85; 1940, 104. ar, 1918, 86. ar, 1907, xx; 1906, xii. ar, 1878, 25; 1879, 24; ao, rg 63, Subseries A–8, Inspector of Asylums, Vol. 746, File #451: ‘Standard Basic Dietary Ration Table for Use in Provincial Hospitals, 1917.’ See Table 3. ar, 1892, 39. ar, 1911, 109. Superintendent Ray of Butler Hospital, Rhode Island, also suggested the proper selection of inmates for specific tasks would enhance the ‘financial result’: Ray, ‘The Labor Question’, 450–1. Mabel I., Patient File #2001, Clinical Record, 25 Oct. 1911; Edward D., Patient File #2021, Clinical Record, 12 Jan. 1927; Stanley L., Patient File #3017, Clinical Record, 11 Apr. 1910; Wallace S., Patient File #3050, Clinical Record, 28 July 1926. Daniel R., Patient File #4005, Letter to Dr Clarke from Inspector Armstrong, 27 Mar. 1907; Letter to Inspector S.A. Armstrong from Dr. Clarke, 29 Mar. 1909. Alan B., Patient File #7043, Letter to Inspector C. Postlethwaite from Medical Superintendent Clarke, 2 Dec. 1909. Wilfred S., Patient File #5036, Conference Report, 29 May 1911 (J.H.S.). Geoffrey P., Patient File #7028, Letter to F. Nichols, Chicago, from Medical Superintendent Clarke, 18 July 1911. Jill D., Patient File #10002, Letter to Dr Clarke from Dr W.T. Wilson, Hospital for the Insane, Cobourg, Ont., 2 Oct. 1909. Francis F., Patient File #8038, Letter to Dr Clarke from Warden J.T. Gilmour, 29 Dec. 1908; Letter to Inspector Armstrong from Dr Clarke, 31 Dec. 1908; Letter to Inspector Armstrong from Warden J.T. Gilmour, 7 Jan. 1909. James W., Patient File #6028, Letter to Dr Daniel Clarke [sic] from Secretary A.G. Booth, The Booth Copper Co. of Toronto Limited, Coppersmiths, 11 June 1900; Letter to A.G. Booth from Dr Clark, (18?) June 1900; Clinical Record, 10 May 1928, 16 Mar. 1927. Evelyn M., Patient File #7012, Clinical Record, 25 Mar. 1909.

N O T E S    3 0 1

  55. Andrew H., Patient File #6003, Letter to Messrs Bissett & Peine, Toronto, from Dr Forster, 21 Dec. 1916.   56. Laura L., Patient File #7018, Clinical Record, 5 June 1910, 29 Mar. 1909.   57. ar, 1928, 27; 1934, 32–3; 1928, 7; 1932, 96; 1933, 31, 111; 1941, 18.   58. Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (New Haven, 1993), 289.   59. McCandless, Moonlight, Magnolias, & Madness, 271.   60. Dwyer, Homes for the Mad, 148.   61. Josie B., Patient File #9009, Clinical Record, 17 Jan. 1913.   62. Elaine O., Patient File #8016, Letter to Dr Clarke, unsigned, undated. The letter clearly was written by Elaine O. and is among other letters she sent and signed in the summer of 1910.   63. Jonathan T., Patient File #4003, Clinical Record, 9 Mar., 27 Sept. 1927.   64. Enid W., Patient File #2012, Clinical Record, 29 Mar. 1909.   65. Constance B., Patient File #9029, Clinical Record, 9 Dec. 1923.   66. Marianne B., Patient File #7017, Clinical Record, 12 Apr. 1910.   67. Mary A., Patient File #5002, Letter to Dr Clare from Mary A., 29 July 1911; Letter to Dr Clare from Mary A., August 4, 1911.   68. Ibid., Letter to Dr Clare from Mary A., 28 Feb. 1922.   69. Ibid., Clinical Record, 11 June 1910.   70. Ibid., Letter to Mrs H.A. from Medical Superintendent Clare, 3 Mar. 1922; Letter to Dr Clair [sic] from Mrs Mary A., 28 Mar. 1922.   71. Ibid., Letter to Dr Clare from Mrs Mary A., undated, though based on Clare’s response it was likely written in early April 1922. Letter to Mrs H.A. from Medical Superintendent Clare, 12 April 1922; Letter to Dr Clare from Mrs Henry A., 22 Apr. 1922.   72. Jane F., Patient File #5010, Clinical Record, 30 Aug. 1909; Letter to Mrs David S., Stouffville, Ont., from Jane F., 20 July 1911.   73. Elsa W., Patient File #6015, Clinical Record, 17 May 1909; Letter to Dr C. Clarke, Suptd., from (Mrs) E.F.W., 31 Aug. 1909.   74. Violet N., Patient File #3052, Clinical Record, 23 Feb. 1922.   75. Theodore F., Patient File #6008, Clinical Record, 12 May 1925, 19 July 1926, 15 Aug. 1927; Letter to Dr Fletcher from Mrs L.O., Toronto, 14  Nov. 1926; Clinical Record, 12 Jan. 1927, Clinical Record, Jan.–Oct. 1934; Letter to Dr B.T. McGhie, Deputy Minister of Hospitals, Toronto, from Superintendent R.C. Montgomery, 15 May 1935; Clinical Record, 1936–9.   76. Walter G., Patient File #6013, Clinical Record, 18 June 1932. The first reference to Walter working in the bakery is in the Clinical Record, 22 July 1926, while the last reference is in a letter to Lambert Lodge, Toronto, from Superintendent C.A. Cleland, 9 Feb. 1950. In this letter,

302   NOTES

  77.   78.   79.   80.   81.   82.   83.   84.   85.   86.   87.   88.   89.   90.

  91.   92.   93.   94.

Cleland inaccurately states that Walter had been working in the bakery for 15 years, when the records show it was longer by nearly a decade. Mathilda K., Patient File #6018, Clinical Record, 20 Apr. 1933, 17 Mar. 1936, 31 May 1937. Sandra T., Patient File #7041, Clinical Record, 19 Apr. 1909, 15 Jan. 1913, 23 Feb. 1915, 21 Mar. 1922. Edna B., Patient File #7049, Clinical Record, 10 May, 12 Sept. 1916, 12 Mar. 1912, 24 Dec. 1923; Clinical Chart, 11 Sept. 1921. Mary M., Patient File #8018, Clinical Record, 18 Nov. 1929, 23 July 1914, 9 Sept. 1918, 11 Nov. 1920. Warren S., Patient File #8039, Clinical Record, 18 Aug. 1927. Audrey B., Patient File #8042, Clinical Record, 12 April 1910, 30 Jan. 1915, 4 July 1927, 20 Apr. 1933. Ibid., Clinical Record, 15 June, 10 Sept., 30 Nov. 1938, 7, 16 June 1939, 10 Oct. 1940. Ibid., Clinical Record, 16, 19 June 1941, 4 Feb. 1992; Clinical Chart, Feb. (no date) 1943, 2 Nov. 1946. Mabel M., Patient File #8015. Mabel was sent out on probation under the care of her daughter, Ivey L., in July 1947, and was formally discharged on 1 Jan. 1948. Ibid., Clinical Record, 9, 20 Sept. 1912, 9 Mar. 1922, 16 Nov. 1925, 28 Oct. 1927, 17 Sept. 1929, 17 Mar. 1932. Ibid., Clinical Record, 1 Dec. 1923, 8 Jan., 16 Nov. 1925, 12 July 1934, 18 Mar. 1935, 16 Oct. 1939, 19 Mar. 1941. Ibid., Clinical Record, 24 Nov. 1941, May (no date) 1940, Jan. (no date) 1942, 14 Dec. 1942, 12 Mar. 1943, June 1943, 27 Feb. 1945, 28 July 1947. Ibid., Letter to Dr S.R. Montgomery, Superintendent, from Ivey L., 3 Mar. 1947. Timothy P., Patient File #6023. Letter, written in the style of an affidavit, not addressed to anyone, signed T.P., undated. This man’s last name is incorrectly spelled throughout his file with an ‘F’ instead of a ‘P’, which is clearly distinct in his own handwriting. Letter to Dr C.K. Clarke from T.P., Asylum, Toronto, 4 Dec. 1909. Ibid., Clinical Record, 1910–12. Janet C., Patient File #9032, Clinical Record, 12 Feb. 1923. Edward D., Patient File #2021, Clinical Record, 12 Jan. 1927, 11 Oct. 1928, 29 July 1930, 4, 17 Sept. 1931, 10 Jan. 1932; Clinical Chart, 1 Sept. 1931. Theodore R., Patient File #2004, Letter to Inspector S.A. Armstrong from Medical Superintendent Clarke, 13 Aug. 1908; Jimmy M., Patient File #2006, Clinical Record, 5 Feb. 192–[sic]; Carl M., Patient File #2011, Clinical Record, 7 Feb. 1921.

N O T E S    3 0 3

  95. Elaine O., Patient File #8016, Letter to Dr Clark [sic] from Elaine O., Toronto, 4 Nov. 1910.   96. Anne D., Patient File #10009, Letter to Dr Forrester [sic] from May K., Boston, Mass., 14 July 1914; Letter to Supt Forrester [sic] from May K., Boston, Mass., undated but clearly from July 1915, based on Forster’s letter to her of that same month to which May is responding.   97. Ibid., Clinical Record, 15 Mar. 1909, 23 Aug. 1909, 6 Dec. 1909, 7 Mar. 1925.   98. Jack P., Patient File #11001, Clinical Record, typed copy of a letter addressed to Mr E.H.P., ‘Winstanley’ Kings Langley, England, from Jack P., Toronto Asylum, Good Friday–07 (i.e., 1907).   99. Hazel G., Patient File #4030, Letter to Inspector Robert Christie from W.J. Clark, Toronto, 16 Aug. 1904; Letter to Inspector Christie from Daniel Clark, 19 Aug. 1904. 100. Wesley P., Patient File #5011, Letter to Dr Clarke from Laurie D., 4 Jan. (no year but based on Dr Forster’s response, it is from 1912); Letter to Laurie D. from Medical Superintendent Forster, 9 Jan. 1912. 101. Rhonda D., Patient File #8033, Clinical Record, 12 Sept. 1910. 102. Anne Digby, ‘Moral Treatment at the Retreat, 1796–1846’, in W.F. Bynum, Roy Porter, and Michael Shepherd, eds, The Anatomy of Madness, vol. 2 (London, 1985), 52–72. 103. Jake M., Patient File #5033, Letter addressed ‘To Friend’, from Jake M., undated but based on content and information in the Clinical Record, the letter is likely from around 1915; Clinical Record, 8 Sept. (no year), 1 Nov. 1915. 104. Daniel K., Patient File #2022, Clinical Record, 1 July 1912. 105. Dwyer, Homes for the Mad, 16. 106. Stafford, ‘Editorial: Toronto Insane Asylum’, 166. 107. Patient File #2022, Clinical Record, 11, 19 Feb. 1924, 23 July 1926, 10 Aug. 1927.

Chapter 6    1. Oppenheim, ‘Shattered Nerves’, 141.    2. Gail Bederman, Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880–1917 (Chicago, 1995), 15; Oppenheim, ‘Shattered Nerves’, 146, 149, 151, 158.    3. Ibid., 187.    4. Mitchinson, The Nature of Their Bodies, 301.    5. McLaren, Our Own Master Race, 28–45.    6. ar, 1879, 299, repeated in ar, 1899, 40.    7. ar, 1908, 6.    8. ar, 1872–3, 160.

304   NOTES

   9. ar, 1876, 209; see also 1877, 258.   10. Patricia Allderidge, ‘Bedlam: Fact or Fantasy?’, in Bynum, Porter, and Shepherd, eds, The Anatomy of Madness, vol. 2, 21–4.   11. Robert Bogdan, Freak Show: Presenting Human Oddities for Amusement and Profit (Chicago, 1988). See especially the chapter entitled ‘The Exhibition of People We Now Call Mentally Retarded’, 119–46.   12. ar, 1878, 292, repeated in ar, 1892, 4–5.   13. ar, 1890, 42.   14. ar, 1906, x.   15. ar, 1908, 5.   16. ar, 1901, xi; 1921, ix.   17. Tomes, A Generous Confidence, 91.   18. ar, 1910, 99.   19. ar, 1900, 6; 1895, 5.   20. ar, 1891, 3.   21. ar, 1895, 6.   22. Mathilda M., Patient File #4012, Letter to Harold M., L’Amaroux, Ont., from Daniel Clark, 11 May 1891; Letter to Harold M., L’Amaroux, Ont., from Daniel Clark, 18 June 1891; Letter to Dr D. Clark from J.C. Clark, Agincourt, Ont., 18 Aug. 1891.   23. Ibid., Letter to Harold M., L’Amaroux, Ont., from Dr Clark, 8 Aug. 1891: Letter to Harold M., L’Amaroux, Ont., from Dr Clark, 18 Aug. 1891; Letter to R. Christie, Inspector, from Daniel Clark, 4 Sept. 1891; Letter to Mother Superior, House of Providence, Toronto, from Daniel Clark, 18 Aug. 1891.   24. Ibid., Letter to W.E.S., Somerset Co. Main [sic], US, from Daniel Clark, 4 Dec. 1891.   25. Ibid., Letter to R. Christie, Inspector, from Daniel Clark, 4 Sept. 1891.   26. Ibid., Letter to Harold M., L’Amaroux, Ont., from Daniel Clark, 21 Mar. 1891; Letter to Harold M., L’Amaroux, Ont., from Daniel Clark, 25 Oct. 18?? (illegible); Letter to Daniel Clark from Harold M., L’Amaroux, Ont., 30 Jan. 1893; Letter to Dr Clark from Harold M., L’Amaroux, Ont., 28 May 1893; Letter to Dr D. Clark from Harold M., 31 July 1893.   27. ao, rg 63, Subseries A-1, Inspector of Asylums, File #2092, Child Born in Asylum, Letter to Inspector Christie from Supt Clark (handwritten across top of letter: ‘Referred to Dr. Chamberlain’), 28 May 1895; Letter to Mrs Ina Ridout, President, Infant’s Home, Toronto, from Inspector T.F. Chamberlain, 1 June 1895. See also Schedule B, signed Danl Clark, 19 Sept. 1895, re date when child was transferred to Infant’s Home from asylum.   28. Ibid., Letter to Dr Chamberlain from Mrs G.M. Williamson, Secretary, Infant’s Home, 11 June 1895; Letter to Mrs G.M. Williamson, Secty

N O T E S    3 0 5

  29.   30.   31.   32.   33.   34.

  35.

  36.

  37.

  38.

Infant’s Home from Inspector T.F. Chamberlain, 12 June 1895; Letter to Inspector Chamberlain from C.B. Ridout, President, Infant’s Home, 5 Sept. 1895; Letter to C.B. Ridout, President, Infant’s Home, from Inspector Chamberlain, 6 Sept. 1895; Letter to Mrs Boultbee, Toronto, from Secretary of Ontario, 20 Sept. 1895. Ibid., Schedule B, signed Danl Clark, 19 Sept. 1895, re discharge of Cindy W. and her going to the Infant’s Home from asylum. John Y., Patient File #3004, Letter to Superintendent of Asylum from Mrs Elaine Y., Dartford, Ont., 4 Oct. 1882; Letter to Mrs E.L.Y., Dartford, Ont., from Dr Clark, 6 Oct. 1882. Ibid., Letter to Dr C.K. Clarke from Mrs T.S., Lasswade, Ont., undated, though based on Clarke’s response this letter is from May 1911; Letter to Mrs T.S., Lasswade, Ont., from C.K. Clarke, 22 May 1911. Ibid., Clinical Record, 15 May 1911. ar, 1923, 10–11; 1932, 27. Daniel M., Patient File #7032, Letter to Mr Boag from Loretta M., Toronto, 7 Dec. 1929: Reginald F., Patient File #10015, Letter to Dr C.K. Clarke from Alicia F., Buffalo, NY, 20 Dec. 1906; Walter S., Patient File #6031. Six letters, from 11 July 1914 to 25 Jan. 1916, were exchanged between Agatha L.S., Toronto, and Medical Superintendent J.M. Forster regarding Walter’s discharge. Mary A., Patient File #5002, Letter to Dr Clare from Henry A.A., Toronto, 6 June 1911. There are a large number of letters about Mary’s possible move from the asylum between the summer of 1910 and June 1911. This is largely due to a severe family conflict in which her son and daughter-in-law were opposed to her discharge, whereas Henry was very supportive of this move. Mary gradually became more comfortable with the idea, although she was not sure at first. Eve L., Patient File #3019, Letter to G.A.L., New York, from D. Clark, 30 May 1884; Letter to Dr Clark from G.A.L., New York, 7 June 1884; Letter to Dr D. Clark, from G.A.L., New York, 28 Aug. 1884. In 1902 an exchange of letters inquiring about Gregory L.’s address elicited a response from Daniel Clark that he did not know where Eve’s husband lived: Letter to Superintendent of Insane Asylum from Mary E.B., Highbridge, NY, 17 Jan. 1902; Letter to M.E.B., Highbridge, NY, from Daniel Clark, 30 Jan. 1902. Caroline L., Patient File #10007, Letter to J.D.L., Columbia, Mo., from C.K. Clarke, 2 Apr. 1908; Letter to Dr Clarke from J.W.L., Columbia, Mo., 9 Apr. 1908; Letter to J.W.L., Columbia, Mo., from Medical Superintendent Clarke, 13 Apr. 1908. Etta C., Patient File #4002, Letter to Joseph C., Durham, Ont., from D.  Clark, 8 Jan. 1891; Letter to Dr Clark, from H.C., Durham, Ont.,

306   NOTES

  39.

  40.

  41.   42.   43.   44.   45.

12 Jan. 1891; Letter to Mrs H.C., Durham, Ont., from Dr Clark, 16 Jan. 1891; Letter to Dr W.K. Ross, from Mrs J.C., Durham, Ont., 22 Aug. 1907. Gilbert D., Patient File #1010; Allen D., Patient File #7052, Letter to Dr Clark [sic], from Mrs M.D., Blackstock, Ont., 22 Mar. 1909. Clarke had written to notify Margaret D. about her son’s move two weeks earlier, though it obviously reached her after a neighbour had already informed her. Correspondence in the file clearly shows the decision to move Allen was made on or around 3 Mar. 1909, more than a week before his mother was sent notice. See the following letters: Letter to S.A. Armstrong, Inspector, from Medical Superintendent Clarke, 3 Mar. 1909; Letter to Doctor Clarke from Abel D., Blackstock, Ont., 11  Mar. 1909; Letter to Mrs G.D., Blackstock, Ont., from Medical Superintendent Clarke, 11 Mar. 1909; Letter to Mrs G.D., Blackstock, Ont., from Medical Superintendent Clarke, 23 Mar. 1909; Patient File #1010, Letter to Dr C.K. Clark [sic], Toronto, from Mrs M.D., Blackstock, Ont., 6 July 1910. In this letter Margaret reported Allen had been home for nine months, which would date his return home to October 1909, seven months after arriving in Cobourg. Agnes Miles, The Mentally Ill in Contemporary Society (New York, 1981); Paul Jay Fink and Allan Tasman, Stigma and Mental Illness (Washington, 1992); Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (Harmondsworth, UK, 1992); Martha Brinton Mermier, Coping With Severe Mental Illness: Families Speak Out (Lewiston, NY, 1993); Anne Rogers, David Pilgrim, and Ron Lacey, Experiencing Psychiatry: Users’ Views of Services (London, 1993); David Pilgrim and Anne Rogers, A Sociology of Mental Health and Illness (Buckingham, UK, 1993); Philip Bean and Patricia Mounser, Discharged from Mental Hospitals (London, 1993). Irene B., Patient File #5022, Statement of Agatha B., 14 Apr. 1896; Statement of Dr Wm Oldright, 20 Apr. 1896; Statement of Dr James H. Richardson, 18 Apr. 1896. ar, 1897, 6. ar, 1908, vii–viii. Josiah M., Patient File #5020, Letter to Inspector Christie, unsigned, most certainly by Daniel Clark, 4 Jan. 1899. Ettie F., Patient File #4006, Letter to S.A. Armstrong, Inspector, from Medical Superintendent Clarke, 30 Jan. 1908; Letter to Superintendent, Home for Aged Women, Toronto, from Medical Superintendent Clarke, 27 Nov. 1905; Letter to Dr Clark [sic] from E.L. Burns, Aged Women’s Home, Toronto, 30 Nov. 1905; Letter to Dr C.K. Clarke from T.W.W.E., Bradford, Ont., 15 Dec. 1905; Letter to S.A. Armstrong, Inspector, from Medical Superintendent Clarke, 6 Mar. 1908.

N O T E S    3 0 7

  46. Ibid., Letter to S.A. Armstrong, Inspector, from Medical Superintendent Clarke, 30 Jan. 1908. Ettie F. was a Methodist, and a widow, according to her admission papers: Schedule No. 2, signed Geo. ­Graham, Brampton, undated, though from 1890. For a discussion about the work of church-run charities during this period, see Bettina Bradbury, ‘Elderly Inmates and Caregiving Sisters: Catholic Institutions for the Elderly in ­Nineteenth-Century Montreal’ in Iacovetta and Mitchinson, eds, On the Case, 129-55.   47. Patient File #4006, Letter to S.A. Armstrong, Inspector, from Medical Superintendent Clarke, 6 Mar. 1908; Letter to Superintendent, Belmonte [sic] Home for Aged, Toronto, from Medical Superintendent Clarke, 23 Sept. 1908; Probation Certificate, signed by President of Belmont Home, Mary Gunther, 24 Sept. 1908.   48. Reginald C., Patient File #4018, Letter to Dr Forster from Katerina G., Whitby, Ont., 9 Mar. 1917; Letter to Dr Forster from Katerina G., Whitby, Ont., 20 Mar. 1917.   49. Ibid., Letter to Dr Forster from Katerina G., Whitby, Ont., 9 Mar. 1917; Letter to Dr Forster from Katerina G., Whitby, Ont., 24 Mar. 1917; Letter to Dr Forster from Katerina G., Whitby, Ont., 14 Apr. 1917; Letter to Dr Forster from Katerina G., Whitby, Ont., 28 Dec. 1917; Letter to Mrs Katerina G., Whitby, Ont., from Medical Superintendent Forster, 18 Apr. 1917.   50. Stella S., Patient File #5001, Letter to Dr Forster from Mrs E.S., Cambridge, Mass., 18 Apr. 1915: Letter to Mrs E.S., Cambridge, Mass., 23 Apr. 1915.   51. MacKenzie, Psychiatry for the Rich, 115.   52. Tomes, A Generous Confidence, 119.   53. Ellen G., Patient File #2017, Letter to Dr Clark from S.B.G., Oakville, Ont., 28 Dec. 1886; Letter to S.B.G., Oakville, from Daniel Clark, 29 Dec. 1886.   54. Martha B., Patient File #4016, Letter to Dr Clark from Minnie B., Brantford, Ont., undated; Grace B., Patient File #3002, Letter to Dr Clark from Edward S., Port Hope, Ont., 29 Nov. 1906.   55. Rhonda B., Patient File #8033, Letter to Dr Ross from R.L.D., Queensville, Ont., 31 Aug. 1905. This is the only letter from a family member in Rhonda B.’s file, which was open from 1905 until her death at 999 in 1918.   56. Warsh, Moments of Unreason, 93–4.   57. Andrew H., Patient File #6003, Form of History of a Patient, signed Dr J.A. Ivey, Cobourg, Ont., Jan. (no date) 1898; Letter to Dr Mitchell from Mrs Ellen P.H., Cobourg, Ont., 7 Aug. 1903: Letter to Mrs Ellen P.H., Cobourg, Ont., from Assistant Physician Mitchell, 8 Aug. 1903.

308   NOTES

  58. Sandra C., Patient File #4020, Letter to Dr Clark from Magdelaine C., Los Angeles, Calif., 9 Apr. 1905; Adam C., Patient File #7003, Letter to Dr Clark from John C., Streetsville, Ont., 27 Sept. 1900; Francis C., Patient File #2037, Letter to Dr Clarke [sic] from H.W.C., Bradford, England, 30 Sept. 1884.   59. The term ‘lunatic at large’ is taken from a novel of the same name: J. Storer Clouston, The Lunatic At Large (Edinburgh and London, 1909). For a discussion of more recent examples of this prejudice, see Otto F. Wahl, Media Madness: Public Images of Mental Illness (New Brunswick, NJ, 1995).   60. Jeremiah T., Patient File #4003, Letter from Royal Grafton, Farmer, Mount Charles, Ont., 20 July 1907; Letter to Royal Grafton, Esq., Mount Charles, Ont., from Medical Superintendent Clarke, 23 July 1907.   61. John Y., Patient File #3004, Letter to Dr Clark from E.L.Y., Dartford, Ont., undated, though based on related correspondence in the file it is from May 1899; Letter to Dr Clark from Elaine Y., Dartford, Ont., 20  May 1899; Letter to Dr Clark from Mrs. E.L.Y., Dartford, Ont., 20 June 1899. Details of John Y.’s recapture are written on carbon form, signed Clark and (Lett?), 29 May 1899.   62. Egbert G., Patient File #10014, Form of History of a Patient, signed J.A. Todd, j.p., R.R. Carlson, j.p., Stouffville, Ont., 12 Sept. 1906. Egbert was probated to the custody of his father on 12 Oct. 1906, eight days after he was reported back home. This probation was renewed until his complete discharge on 20 Mar. 1907. Thus, hospital authorities must have seen him as not being a threat to have let him go so easily without waiting for the standard 30 days to elapse before writing someone off the books if they had not returned to the asylum.   63. Ibid., Letter to ‘dear frind’, presumably Dr Clarke, from Frank G., Bloomington, Ont., 4 Oct. (no year, but from other correspondence in the file it is clearly from 1906). The latter quotation is from a separate page with ‘from his mother’ written on it, though it is written on the same type of paper with the same handwriting as that of Frank G. He may have written down his wife’s comments for her, as she may have been illiterate.   64. Ibid., Letter to Dr C.H. Clark [sic], from Frank G., Bloomington, Ont., 4 Nov. (no year, though clearly from 1906); Letter to ‘Dr. C.H.’ [sic] from Frank G., Bloomington, Ont., 21 Nov. 1906.   65. Robert Pos, J. Alan Walters, and Frank Sommers, ‘The History of Psychiatry at the Toronto General Hospital’, unpublished manuscript (1972), 15–19; Robert Pos, J. Alan Walters, and Frank Sommers, ‘D. Campbell Meyers, m.d., 1863–1927: Pioneer of Canadian General

N O T E S    3 0 9

  66.

  67.   68.   69.

  70.

  71.

  72.

  73.

  74.   75.

­ ospital Psychiatry’, Canadian Psychiatric Association Journal 20, 5 H (Aug. 1975): 393-403. Patient File #10014, Letter to ‘dr ch clark’ [sic] from Frank G., Bloomington, Ont., 7 Feb. (no year, though clearly from 1907 based on related correspondence in file); Letter to ‘dr ch clark’ [sic], from Frank G., Bloomington, Ont., 6 Mar. 1907. Ibid., Form of History of a Patient, signed J.A. Todd, j.p., R.R. Carlson, j.p., Stouffville, Ont., 12 Sept. 1906. Ibid., Letter to ‘dr ch clark’ [sic] from Frank G., Bloomington, Ont., undated though based on Clarke’s response it is from Dec. 1906. Erin W., Patient File #6034. Evidence of Erin’s relatives dates from five and six years before her escape: Letter to ‘Mr. Doctor Clark of Toronto asylum’ from J.W., Wayne County, NY, undated, though based on Daniel Clark’s response it is from June 1901; Letter to Medical Superintendent from Reverend T.M., The Manse, Bellaghy, Co. Derry, Ireland, 4 Oct. 1902. Ibid. Letter to Superintendent, Insane Asylum, from Dr E.D. Ault, Prince Albert, Ont., 14 Nov. 1921: Letter to Dr E.D. Ault, Prince Albert, Ont., from Medical Superintendent Harvey Clare, 15 Nov. 1921. Joseph S., Patient File #4023. References to Joseph’s previous confinements at Hamilton and London asylums can be found in Schedule No. 2, signed David Jackson Jr, Committing Justice, Durham, Ont., 18 Oct. 1891; Letter to Dr Clark from Mrs J.S., Durham, Ont., 30 Apr. 1893. Letter to Dr Clark from James (Gunn?), Durham, Ont., 18 July 1893. Jack H., Patient File #7030, Letter to ‘Mr Clark’ from Alice H., Langstaff, Ont., Oct. 1902. This letter was written at the time of his admission on 18 Oct. 1902. Letter to ‘Mr Clark’ from Mrs A.H., Langstaff, Ont., 26 Feb. 1903; Letter to ‘DC’ from Mrs H., 2(?) July 1903. William D., Patient File #9024, Letter to Medical Superintendent, Queen Street Asylum, from F.R.D., Toronto General Trusts Corporation, 7 Feb. 1908; Letter to F.R.D., Toronto General Trust Corporation, from Medical Superintendent Clarke, 8 Feb. 1908. Ibid., Letter to Dr Clark [sic], from F.R.D., Toronto General Trusts Corporation, 10 May 1909; Letter to F.R.D., Toronto General Trusts Cor­por­ation, from Medical Superintendent Clarke, 11 May 1909. Ibid., Letter to Dr C.K. Clark [sic] from F.R.D., Toronto General Trusts Corporation, 23 May 1910; Letter to Dr Clarke from F.R.D., Toronto General Trusts Corporation, 19 May 1910; Letter to F.R.D., Toronto General Trusts Corporation, from Medical Superintendent Clarke, 21 May 1910.

310   NOTES

  76. Ibid., letter not addressed to anyone other than a reference to ‘Doctor’, most certainly Clarke, from L.D., undated, though considering its contents and other correspondence in the file on William D.’s escape it was most certainly written in May 1910 by his wife Laura.   77. The only other reference to what happened after the 30-day period had elapsed is a letter noting that some of William D.’s clothes needed to be picked up by Laura’s son. Ibid., Letter to Mrs W.D., Toronto, from Medical Superintendent Clarke, 11 Aug. 1910.   78. Alan L., Patient File #3033, Schedule No. 2, signed Platt Hinman, j.p., Grafton, Ont., undated, though obviously from 1887 when Alan was admitted. Handwritten statements of two physicians on paper: by Dr J.R. Clark, dated 6/4/87, and second statement, illegible, dated 6/4/87. There are two mystery letters in this file, the precise origin of which will have to remain unknown: Letter to ‘Sir’, presumably Clark from A.J.L., East Hamlin, NY, 5 Apr. 1897; Letter to Miss A.J.L., East Hamlin, NY, from Medical Superintendent, 7 Apr. 1897. The initials of the letter writer do not correspond with Sarah’s first initial, but the handwriting style and that of Sarah in Kingston, or Rockwood Asylum as it was also known during the late nineteenth and early twentieth centuries, is almost precisely the same. There is also only a reference to one sister in Alan’s admission papers. In any case, this correspondence occurred before Sarah was known to be in Rockwood, so it does not change the chronology of this story.   79. Ibid., Letter to Dr Robeson [sic: Robinson] from Miss L., Rockwood Hospital, Kingston, 11 June 1898.   80. Ibid., Letter to Dr Robertsone [sic: Robinson] from Miss L., Rockwood Hospital, Kingston, 7 Mar. 1900.   81. Ibid., Letter to Dr Clarck [sic] from Miss L., Rockwood Hospital, Kingston, 24 Jan. 1901.   82. Ibid., Letter to ‘Dear Miss L.’ from Dr Forster, Toronto, 2 Nov. 1918. This letter, like an earlier one to Sandra from October 1911, has no address or official signature as Medical Superintendent, suggesting both personal familiarity and the probability that she was still confined at Rockwood at the time of Alan L.’s death. Dr Forster’s familiarity with Sandra was due to his having been her doctor at Kingston prior to moving to Toronto.   83. Anne D., Patient File #10009, Schedule No. 2, signed (R.?) Chapman, Police Headquarters, Toronto, 3 July 1906.   84. Ibid., Letter to Dr Clarke from E.D., Guelph, Ont., 2 July 1908; Probation Bond for Anne B.D., released into custody of her daughter, Mrs E.S., Toronto, 24 July 1909, for one month.   85. Ibid., Letter to ‘The Superintendent’ from May L.K., Washington, D.C., undated though found among letters from 1912–13.

N O T E S    3 11

  86. Ibid., Letter to Dr Forrester [sic] from M.L.K., Boston, 8 July 1915; Letter to Mrs [sic] M.L.K., Boston, from Medical Superintendent Forster, 13 July 1915; Letter to W.J.D., Calgary, from Medical Superintendent Forster, 19 July 1915; Letter to Mr W.D., Guelph, Ont., from Medical Superintendent, 19 July 1915; Letter to Superintendent Forrester [sic] from M.L.K., undated but clearly from July 1915 based on Forster’s letter to her of that same month to which Walter D.’s father is alluded, a point briefly commented upon by May.   87. Ibid., Letter to Superintendent Harvey Clare from Inspector W.W. Dunlop, Toronto, 15 June 1920.   88. Ibid., Letter to Dr Claire [sic] from Miss M.L.K., New York, undated though based on Clare’s response it is from Oct./early Nov. 1921.   89. Ibid., Letter to Dr Forrester [sic] from M.L.K., Brookline, Mass., 19 Mar., no year, though since it is addressed to Forster, who remained as Superintendent until 1920, this letter is likely from 1918–20, as it was found among letters from this period.   90. Ibid., Letter to Superintendent from W.J.D., Calgary, 15 Sept. 1933; Letter to W.J.D., Calgary, from Superintendent J.S. Stewart, 21 Sept. 1933.   91. Ibid., Letter to Dr J.S. Stewart, Toronto Asylum, from M.L.K., Los Angeles, 4 June 1933. May was very angry at the hospital for asking her for clothing funds, and across the top of this letter is boldly written: ‘No reply’.   92. Ibid., Letter to Dr Harvey Claire [sic] from Miss M.L.K., New York City, undated though based on Clare’s response, it is from Oct. 1921; Letter to Miss M.L.K., New York City, from Medical Superintendent Harvey Clare, 18 Oct. 1921.   93. Ibid., Letter to Dr J.S. Stewart, Toronto Asylum, from M.L.K., Los Angeles, 4 June 1933.   94. Ibid., funeral home permission slip to remove Anne D.’s remains, on the authority of Paul K., 18 Feb. 1944.   95. Frances C., Patient File #2031, Letter to Superintendent F.S. Vrooman from Deputy Provincial Secretary Robbins, 12 Dec. 1927; Letter to Deputy Provincial Secretary Robbins from Superintendent Vrooman, 16 Dec. 1927; Letter to H.M. Robbins, Deputy Provincial Secretary, from E.O., 11 Jan. 1928; Letter to K.W. Wright, Public Trustee from J.W., 6 Feb. 1928.   96. Ibid., Letter to Superintendent Vrooman from Deputy Provincial Secretary Robbins, 6 Feb. 1928; Letter to Deputy Provincial Secretary Robbins from Superintendent Vrooman, 15 Feb. 1928; Letter to E.O. from Superintendent Vrooman, 14 Sept. 1929.   97. Hospital officials said they had tried to contact Edwina about Frances’s death but did not have her correct telephone number. She mentioned in response that it would not have been difficult to locate her, ‘no excuse

312   NOTES

for my not being notified’. Ibid., Letter to E.O. from Superintendent Ross, 21 Oct. 1931; Letter to Superintendent W.K. Ross from E.O., Toronto, 22 Oct. 1931; Letter to E.O. from Superintendent Ross, 23 Oct. 1931.   98. Ibid., Letter to H.M. Robbins, Deputy Provincial Secretary, from E.O., 11 Jan. 1928.

Chapter 7    1. ar, 1881, 16; 1910, xxiv; 1940, 39.    2. Shortt, Victorian Lunacy, 60–1.    3. Dwyer, Homes for the Mad, 150.    4. ar, 1906, xl, 3.    5. I would like to thank Professor Pauline Mazumdar for her comments on this point.    6. ar, 1869–70, 81.    7. ar, 1889, 28; 1910, xxiv; 1925, xviii.    8. MacKenzie, Psychiatry for the Rich, 189.    9. H.F.H. Newington, ‘What are the tests of fitness for discharge from asylums?’, Journal of Mental Science 32 (1887): 497.   10. Dwyer, Homes for the Mad, 149.   11. ar, 1870–1, 133.   12. ar, 1877, 22.   13. Grob, ‘Abuse in American Mental Hospitals’, 305–6, 309–10.   14. ar, 1883, 15.   15. ar, 1939, 26.   16. ar, 1936, 15.   17. ar, 1939, 26; 1940, 30.   18. ar, 1870–1, 133.   19. Wesley P., Patient File #5011, Letter to Mary L. from Wesley P., Toronto, 26 Oct. 1905.   20. Ibid., Letter to Dr Clark from J.E.P., Owen Sound, Ont., 12 Nov. 1909; Letter to J.E.P. from Dr Clark, 15 Nov. 1909.   21. Ibid., Letter to Mrs L.B.D. from Medical Superintendent, 17 December 1912. Letters dealing with Wesley’s release are: to Dr Forester [sic] from J.E.P., 10 Dec. 1913; to J.E.P. from Medical Superintendent, 15 Dec. 1913.   22. Ibid., Letter to Dr Forester [sic] from J.E.P., 9 Apr. 1914; Letter to Dr Forester [sic] from J.E.P., 8 Oct. 1914. References to Wesley’s farm jobs are in: Letter to Dr Forester [sic] from J.E.P. 11 Jan. 1913 [sic]: this should have been dated 1914, according to the contents of the letter referring to release discussed in the two previous communications of Dec. 1913; Letter to Dr Forester [sic] from J.E.P., 16 Feb. 1914.

N O T E S    3 1 3

  23. Stafford, ‘Toronto Insane Asylum’, 165; Warsh, Moments of Unreason, 127.   24. Dwyer, Homes for the Mad, 114–15.   25. Randall F., Patient File #4039, Letter to Mrs Timothy F., Peterborough, Ont., from Dr J.A. Mitchell, 28 Sept. 1904.   26. Ibid., Probation Bond, 2 Sept. 1911. Discharge Certificate, 9 Oct. 1911, though Randall’s discharge is also recorded as 17 Oct. 1911 on his case file folder.   27. McLaren, Our Own Master Race, 48–50.   28. C.K. Clarke’s quote is from his remarks on ‘Defective and Insane Immigration’ while he was Superintendent at 999 Queen Street West, ar, 1907, 9. See also Ian Dowbiggin, ‘ “Keeping this Young Country Sane”: C.K. Clarke, Immigration Restriction, and Canadian Psychiatry, 1890–1925’, Canadian Historical Review 76, 4 (Dec. 1995): 598–627; Ian Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940 (Ithaca, NY, 1997). Dowbiggin makes far too many excuses for Clarke’s prejudices and does not deal seriously with the devastating personal impact that this doctor’s racism and classism had on people whose lives were drastically affected by social policies Clarke helped to influence and most certainly helped to implement, at least in terms of expelling immigrants like Lee F., as is mentioned in this chapter. Dowbiggin also does not critique what is meant by Clarke’s notion of the ‘public interest’. In the social circles that Clarke moved, the ‘public’ did not include people locked in mental institutions or who were otherwise cast aside with the ‘feeble-minded’ or ‘insane’ label.   29. ao, rg 63, Subseries A-1, Inspector of Asylums, Asylum Correspondence, File 2697: Disposition of Undesirable Immigrant, 1905–7 (hereafter Undesirable Immigrant File), Letter to W.D. Scott, Supt of Immigration, Ottawa, from Inspector S.A. Armstrong, 3 Dec. 1906.   30. Undesirable Immigrant File, Letter to ‘Dear Sir’ from [J.] Dyson, Hall Farm, Yorkshire, 24 Dec. 1906.   31. Undesirable Immigrant File, Letter to Dr Clarke from Terence J., per Daniel Driscoll, Cork, Ireland, 8 Jan. 1907.   32. Lee F., Patient File #9014, 27 Apr. 1907 immigration form.   33. Mary A., Patient File #5002, Letter to Dr Clark [sic] from Henry A., 4  Nov. 1910 (the date appears to be a month off, based on Clarke’s response of 8 Dec. 1910); Letter to Dr Herriman from Henry A., 7 Aug. 1910.   34. Ibid., Clinical Record, 11 June to 8 July 1910, re Mary’s pain due to leg injury. Quotes are taken from Clinical Record, 3 June 1911. Letter to Dr Clare from Mrs Henry A.A., 6 June 1911. It is interesting to note that Mary and Henry often wrote to the hospital on the same day, though

314   NOTES

  35.   36.   37.

  38.

  39.   40.   41.

  42.   43.

they preferred to keep their communications private. Mary noted: ‘Mr. H. A__ as informed me he as written to you on what subject I do not know as he writes to you without telling me.’ Letter to Drs Foster [sic] and Clare from Mrs Henry A.A., 4 Sept. 1911. Years later Henry would write about their arrangement in this regard: ‘I make it a point not to cross her more than I can help & so let her send the letter knowing your knowledge of her peculiar temperament would not cause you to take offence.’ Letter to Dr Clare from Henry A.A., 4 Mar. 1922. Ibid., Letter to Dr Clare from Henry A., Toronto, 6 June 1911; Warsh, Moments of Unreason, 97. Mary’s diagnosis is contained in a conference report made five months after she was released, and her improved status is noted on the front of her case file: Patient File #5002, Conference Report, Nov. 1911. Dr Clarke made these comments in a speech to a meeting of the British Medical Association in Toronto in August 1906. He argued it was ‘going too far’ to ‘categorically assert’ dementia praecox was incurable, though he said ‘most of the so-called recoveries should be classed as cases of remission, or put under the heading “improved” ’, as was the case with Mary A. These quotes, and the one in the essay, are from C.K. Clarke, ‘Dementia Praecox’, Canadian Journal of Medicine and Surgery 21, 4 (Apr. 1907): 223. Patient File #5002, Letter to Dr Clare from Mrs Henry A.A., 4 Aug. 1911. For references to Mary’s physical pain and emotional distress, see Letter to Dr Clare from Mrs Henry Archibald A., 12 June 1911; Letter to Dr Clare from Mrs H.A.A., 20 June 1911. For reference to her being shunned by other family members, except her son, see Letter to Dr Clare from Mr H.A.A., 3 July 1911. Ibid., Letter to Dr Clare from H.A.A., 18 July 1911; Letter to Dr Clare from Mr. H.A.A., 29 July 1911; Letter to Dr Clare from Mrs Henry A.A., 29 July 1911. Ibid., Letter to Mrs H.A. from Assistant Medical Superintendent, 31  July 1911; Letter to Henry A.A. from Medical Superintendent, 31 July 1911. Ibid., Letter to Drs Forster and Clare from Mrs Henry A., 22 Aug. 1911. After introducing this letter ‘To the Superintendents Dear Sirs’, Mary wrote: ‘I don’t know whether to say Ladies as well, because I am not their to see’. Letter to Mrs Henry A. from Acting Superintendent, 8 Aug. 1911; Letter to Mrs Henry A.A., from Medical Superintendent, 25 Aug. 1911. Ibid., Letter to Dr Clare from Henry A.A., 31 Aug. 1911; Letter to Drs Foster [sic] and Clare from Mrs Henry A.A., 4 Sept. 1911. Ibid., Probation Bond, signed by Henry A.A. and Mrs Henry A.A., 5 June 1911, witnessed by Dr H. Clare. The probation bond makes it

N O T E S    3 1 5

  44.

  45.

  46.

  47.

  48.

clear that during the specified probationary period, the person responsible for the released patient has to send monthly reports to the Medical Superintendent. Failure to do so within the required period would ‘forfeit the right for (her) re-admission to the said Hospital for the Insane’. Thus, the onus was on a friend or relative to decide whether or not to return a released inmate while on probation. It was not the responsibility of the hospital to make such a decision after a patient had left its jurisdiction. Ibid. At the bottom of this undated poem, which is among Mary’s letters from 1922, she wrote: ‘do you know when I wrote this to you[?]’ Her last letter contained in the file, addressed to Dr Clare asking him to visit her, is dated 22 Apr. 1922. Ibid., Letter to Dr Clare from Henry A.A., 30 May 1923. Though Henry does not mention the cause of death he does provide the following account of her last days: ‘I was in hopes this year she would be able to get out & sit in the Garden but six weeks ago she took a bad spell although able to get out of bed occasionally & two days before she died she could only keep on murmuring to herself. I was sitting by her bedside when she ceased talking & turned her face on the pillow as if dropping off to sleep so I left her for a few minutes to talk to my Son & Daughter who with the Grandchildren were in the front room. When I went back she looked very peaceful but I could not feel her heart beat so I sent for the Doctor who came at once & said her troubles were all over. I can see now it was all for the best, what would have become of her had I gone first.’ Alex C., Patient File #5030, Clinical Record, 30 Oct., 11 Nov. 1925, 14 July 1926. It should be noted that each of these entries gives a different length of time for their separation: The first reference says it was ‘for over 20 years’, the second notes ‘a period of 18 years’, and the third recording states: ‘Lately Mr. C__ has been reconciled to his wife from whom he has been estranged ever since he was admitted here 30 years ago.’ This latter time frame has been chosen as the most accurate because it is the only one recorded in two separate reports. Mrs C. is recorded as telling a social worker that she and her husband had experienced ‘trouble . . . which separated them for thirty years’. Ibid. Ontario Mental Health Clinic, Social Services Record, 29 Aug. 1934. Ibid., 1 Dec. 1933, 4 May 1935. Alex’s case file contains numerous notes acknowledging receipt of clothes, fruit, Christmas gifts, and other goods, primarily from Louisa C., especially during the 1930s. There is also a visiting sheet recording dozens of visits by her between June 1933 and April 1935. Ibid., Ontario Mental Health Clinic, Social Service Record, 29, 31 Aug., 5 Sept. 1934; Clinical Record, 16 Mar. 1935.

316   NOTES

  49. Ibid., Ontario Mental Health Clinic, Social Service Record, 17 Aug. 1935.   50. Ibid., Ontario Mental Health Clinic, Social Service Record, 15 Jan. 1936. This entry observes: ‘Mrs. Skene reports that he is no trouble whatever, in fact he is a little too quiet but this may be due to his deafness and of course to his long period of confinement in the hospital.’   51. Ibid., Ontario Mental Health Clinic, Social Services Record, 30 Nov. 1935. See letter to Alex C. from D. Jamieson, Chairman, Commission, Ontario Old Age Pensions Act, 13 Apr. 1932.   52. Ibid., Ontario Mental Health Clinic, Social Services Record, 24 Mar. 1936. For information about his diagnosis upon final discharge, see Clinical Record, 24 Mar. 1936. For information regarding the circumstances of Alex’s death, see Letter to Dr Margaret McAlpine, Toronto, from Dr Gordon S. Foulds, St Michael’s Hospital, Toronto, 20 May 1936.   53. Minnie B., Patient File #5032, Letter to Dr Fletcher from Minnie B., Mair, Sask., 6 July 1928.   54. Nina B., Patient File #8032, Clinical Record, 27 Aug., 28 Oct., 19 Nov. 1929.   55. ar, 1875, 209.   56. Ripa, Women and Madness, 156.   57. Ibid., 158.   58. ar, 1869–70, 83; 1940, 39; 1884, 43; 1920, xxx.   59. ar, 1904, xi.   60. ar, 1920, xxx; 1925, xviii; 1930, 16–19; 1940, 39.   61. J.K. Walton, ‘Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840–70’, in Bynum, Porter, and Shepherd, eds, The Anatomy of Madness, 5.   62. For a discussion of whether to ‘Remodel or Remove’, see ar, 1906, 5–6.   63. Shortt, Victorian Lunacy, 61.   64. ar, 1933, 101; 1934, 76; 1937, 92; 1938, 5.   65. ar, 1874, 159.   66. ar, 1918, 86.   67. Philippe Aries, The Hour of Our Death (New York, 1981), 559–60.   68. Andrew J., Patient File #3001, Clinical Record, 8 May 1922, 20 Apr. 1923.   69. Erin L., Patient File #3019, Clinical Record, 16, 18, 27 Feb. 1914; Jed M., Patient File #3031, Clinical Record, 29, 30 Oct. 1918.   70. John Y., Patient File #3004, Clinical Record, 3 June 1911; Ellen G., Patient File #2017, Clinical Record, 2, 4 Nov. 1918.   71. Irene B., Patient File #3047, Clinical Record, 5 Sept. 1931, 28 June 1933, 12, 28 Sept. 1933; Anna P., Patient File #2014, Undated handwritten Observation Note that records Anna’s death on 10 Mar. (no

N O T E S    3 1 7

  72.

  73.   74.   75.

  76.   77.   78.

  79.   80.   81.

  82.   83.

year, though 1911); Copy of Death Certificate, signed W. Frederick, F. Dey, 10 Mar. 1911; Nelly H., Patient File #4029, Letter to Mrs Frank R., Sault Ste Marie, Ont., from Medical Superintendent Harvey Clare, 5 Mar. 1920; Evelyn T., Patient File #8028, Clinical Record, 12 Feb. 1923. Annie E., Patient File #4014, Undated letter from Annie S.E. to Dr Clarke, though written on top of page is notation: ‘Mrs. E___ 17 June, 1910’; Undated letter from Annie S.E. to ‘Sir’, written overleaf ‘Fyle Mrs. E__ 177 July 20/10’; Clinical Record, 24 Oct. 1910; Medical Certificate of Death, 24 Oct. 1910, signed Dr W.C. Herriman. And see entries in Clinical Record from 14 Jan. 1909 to 24 Oct. 1910. Nancy K., Patient File #7040, Clinical Chart, 6 Jan., 10 Feb. 1930. Joseph S., Patient File #1013, Clinical Chart, 14, 20 Oct. 1934. Milicent M., Patient File #7026, Clinical Chart, 27 Nov. 1934; Nelly H., Patient File #4029, Letter to Mrs Frank R., Sault Ste Marie, Ont. from Medical Superintendent Harvey Clare, 5 Mar. 1920; Albert C., Patient File #3051, Letter to Mrs A.C., Belleville, Ont., from Medical Superintendent Forster, 6 Oct. 1911; Elizabeth H., Patient File #3029, Clinical Record entries, 5 Apr. to 10 May 1910; Copy of Death Certificate, signed J.A. MacEwan, 10 May 1910. William G., Patient File #3005, Clinical Record, 5 Feb. 1917; Cyril M., Patient File #4001, Clinical Record, 16 Feb. 1912; Michael F., Patient File #7036, Clinical Record, 14 Sept. 1947. ar, 1878, 28. ar, 1884, 97–8; 1889, 3; 1890, 39–40. Clark had repeatedly complained throughout the 1880s about the dangerous situation in the refractory ward for males and females. (One murder was committed on the male side; two murders occurred on the female side. One woman who committed a murder in 1884 died one day later, due to ‘congestion of the brain’.) When no money was forthcoming to relieve overcrowding, beginning in 1890 Clark had the doors of previously locked rooms kept open all night with frequent rounds made by staff to check on inmates. Maude M., Patient File #8006, Clinical Record, 12, 13 Apr. 1911. Mabel I., Patient File #2001, Clinical Record, 4, 6 Oct. 1918. Francis B., Patient File #2020. Francis’s 18 Sept. 1896 letter to the Inspector is addressed to ‘your honor’ and is marked with the Inspector’s stamp, dated 19 Sept. 1896. The request for release to his brotherin-law is noted in Letter to Dr Clark from W.B., Grandvalley, Ont., 28 Sept. 1898. Ibid., Clinical Record, 31 July 1919. Arlene S., Patient File #7050, Clinical Record, 24 Apr. 1918; Letter to Superintendent J.M. Forster from Inspector W.W. Dunlop, Toronto,

318   NOTES

  84.   85.   86.   87.   88.

  89.   90.   91.   92.   93.   94.   95.   96.   97.

  98.   99.

100.

101.

26 Apr. 1918; Letter to Inspector W.W. Dunlop from Medical Superintendent Forster, 29 Apr. 1918. ar, 1884, 4. Jonathan D., Patient File #8035, Clinical Record, date deleted for reasons of privacy due to newspaper accounts pasted into the record. Ibid. Ibid. Paul M., Patient File #3018, Clinical Record, 30 Aug. 1926; Carl M., Patient File #2011, Clinical Record, 27 Apr. 1926; Winston O., Patient File #2013, Letter to Gertrude D., Westboro, Ont., from Medical Superintendent Stewart, 10 Dec. 1934; Mavis M., Patient File #2019, Letter to Mrs W.H., Chicago, from Medical Superintendent Forster, 8 Jan. 1916. May F., Patient File #6007, Clinical Record, 19 Jan. 1924. ar, 1871–2, 151. Ellen K., Patient File #3037, Clinical Record, 10 Sept. 1923. Lizzie C., Patient File #8025, Clinical Record, 12 Mar., 5 Nov. 1910, 18 Mar. 1911, 1 Oct. 1912; Post-Mortem Record, undated. ar, 1887, 46–7. Stafford, ‘Toronto Insane Asylum’, 166. ao, rg 15–13–2–42, Provincial Lunatic Asylum, Plan of Drawing, Farm Buildings, 1867, Architectural Collection, Department of Public Works. ar, 1914, 106: 1933, 90. Henry K., Patient File #7038, Report on Physical Condition on Discharge or Death, 13 Feb. 1913, signed Thomas Brooke, Nurse; Mathilda C., Patient File #7013, Report on Physical Condition on Discharge or Death, 24 Dec. 1919, signed E. Currie; Evelyn F., Patient File #7039, Report on Physical Condition on Discharge or Death, 3 May 1909, signed M. Cooke, Nurse. Mary D., Patient File #9015, Report on Physical Condition on Discharge or Death, 16 Jan. 1932, signed A. Macmillan. Anna P., Patient File #2014, Letter to Dr C.K. Clarke from M.E.P., Guelph, Ont., 14 Mar. 1911; Letter to Dr C.K. Clarke from M.E.P., Guelph, Ont., 13 Mar. 1911; Letter to M.E.P. from Medical Superintendent C.K. Clarke, 16 Mar. 1911. Ellen K., Patient File #3037, Letter to Dr Brooman [sic] from Mrs H.M., Port Arthur, Ont., undated; Receipt for items packed signed ‘Received G.B.’, 8 Nov. 1923; Letter to Superintendent Harvey Clare from Estates Officer, Toronto General Trusts Corporation, 10 Nov. 1923. Eunice M., Patient File #7035, Clinical Record, 4 Apr. 1911. The date of Eunice’s death, 18 Apr. 1911, is not listed in her clinical record, but it is written on the front of her file folder.

N O T E S    3 1 9

102. Sandra C., Patient File #7023, Report on Physical Condition on Discharge or Death, 27 Feb. 1923, signed N. Franklin, K. Turney, Nurse(s). 103. Mary A., Patient File #5002, Undated card addressed ‘To ever is Superdent’ [sic]. 104. Winston O., Patient File #2013, Letters to Dr Daniel Clark from Anna O., 15 Apr. 1897, and 16 Mar. 1903; Letter to Gertrude D., Westboro, Ont., from Medical Superintendent Stewart, 10 Dec. 1934. 105. Irene B., Patient File #3047, Report of Institutional Burial, 29 Sept. 1933, signature illegible. 106. ar, 1883, 15. 107. Warren S., Patient File #8039, Notice of Death, 13 Mar. 1933, unsigned. Typed statement on report of institutional burial, on ‘The Ontario Hospital’ stationery, Toronto, 16 Mar. 1933, signed W. Morrow, Chief Supervisor. May F., Patient File #6007, Notice of Death, 19 Dec. 1952, unsigned. Report of Institutional Burial, 27 Dec. 1952, signed James Armstrong, Supervisor. 108. ar, 1880, 294; 1894, 5. 109. These comments can be found in the reports on burials cited in notes 105 and 107. 110. Belinda R., Patient File #8026. Her post-mortem is typed in the Clinical Record, 23 Apr. 1908, the same day that she died. 111. Marcia B., Patient File #3015, Clinical Record, 10 Jan. 1914.

Chapter 8    1. ar, 1926, v.    2. Ian Dowbiggin, ‘Alberta is paying for eugenics revisionism’, Globe and Mail, 3 July 1998. See also the related debate about interpretations of Canadian history: J.L. Granatstein, Who Killed Canadian History? (Toronto, 1998); A.B. McKillop, ‘Who Killed Canadian History? A View From The Trenches’, Canadian Historical Review 80, 2 (June 1999): 269–99.    3. For a Canadian example of this point, see: Peter Delottinville, ‘Joe Beef of Montreal: Working-Class Culture and the Tavern, 1860–1889’, in Laurel Sefton MacDowell and Ian Radforth, eds, Canadian Working Class History: Selected Readings (Toronto, 1992), 245–68.    4. For an example of a portrayal of these types of conditions, see Mark Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981), 185–9.    5. Linda Gordon, Heroes of Their Own Lives: The Politics and History of Family Violence (New York, 1989), 272–3.

320   NOTES

   6. Of the superintendents at Toronto during the 1870–1940 period perhaps none comes across as more arrogant than C.K. Clarke (1857–1924), Medical Superintendent at 999 Queen Street West from 1905 to 1911. His scorn for people who were diagnosed with mental health problems is made clear by his own writing. In 1907 he referred to people diagnosed with dementia praecox in the following terms: ‘These wrecks are the most striking evidences and proofs of what a bad heredity will do for those who are cursed with it, and who try to endure the strain imposed upon the organism by civilization. If it were the truth that as nature weeded out the weaklings, gradually, dementia precox [sic] was disappearing, there would be little reason for calling attention to the present state of affairs. Unfortunately, civilization and culture are not always under the control of the best of nature’s laws, and certain conditions of society are decidedly artificial.’ In this article, Clarke advocated working with ‘intelligent teachers’ to diagnose and treat children he described as ‘abnormal’ or ‘diseased’. C.K. Clarke, ‘The Detection of Mental Defect in School Children’, Canadian Journal of Medicine and Surgery 21, 6 (June 1907): 343, 344, 347.    7. Pat Worth, who has been active in the organization People First, an organization for people with developmental disabilities, has pointed out the continuation of this exploitation in late twentieth century Canada: ‘We helped our local groups develop regional meetings for the purpose of having one-day workshops on real jobs. That took a whole lot of education because a lot of our members are people that did not understand that workshops were not real jobs. They did not understand the idea of minimum wage and how they were deprived of earning a salary like anyone else. A lot of us were conned into believing that a disability pension was actually a salary. . . . Most of us were put into workshops doing the same thing every day for 20 years, for very little money, for nothing because people thought we were too disabled.’ Quoted in Bruce Kappel, ‘A History of People First in Canada’, in G. Dybwad and H. Bersani Jr, eds, New Voices: Self-Advocacy by People with Disabilities (Cambridge, Mass., 1996), 117. In 1990, the Salvation Army was paying 50 cents an hour to people who worked in sheltered workshops in Toronto, primarily psychiatric out-patients, on top of their meagre disability income. This was justified as being for rehabilitation—i.e., work as therapy. Glenn Cooly, ‘Workshop Wage Wrangle’, Now, 15–21 Mar. 1990.    8. David Cohen, Forgotten Millions: The Treatment of the Mentally Ill—A Global Perspective (London, 1988); Dylan Tomlinson, Utopia, Community Care and the Retreat from the Asylums (Buckingham, 1991); David Brandon, Innovation Without Change? Consumer Power in Psychiatric Services (London, 1991); Peter Barham, Closing the Asylum:

N O T E S    3 2 1

The Mental Patient in Modern Society (Harmondsworth, UK, 1992, 1997); Philip Bean and Patricia Mounser, Discharged from Mental Hospitals (London, 1993); Michael McCubbin, ‘Deinstitutionalization: The Illusion of Disillusion’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 35–54; Joan Busfield, Men, Women and Madness: Understanding Gender and Mental Disorder (London, 1996); Scott Simmie, Out of Mind: An Investigation into Mental Health (Toronto, 1998); Pat Capponi, The War At Home: An Intimate Portrait of Canada’s Poor (Toronto, 1999); Sarah Payne, ‘Outside the Walls of the Asylum? Psychiatric Treatment in the 1980s and 1990s’, in Peter Bartlett and David Wright, eds, Outside the Walls of the Asylum: The History of Care in the Community, 1750–2000 (London, 1999): 244–65.    9. For various interpretations on the history of psychiatric patients’ groups in North America, see Lenny Lapon, Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany and the United States (Springfield, Mass., 1986), ch. 6; Barbara Everett, ‘Something is Happening: The Contemporary Consumer and Psychiatric Survivor Movement in Historical Context’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 55–70; Norman Dain, ‘Psychiatry and Anti-­ Psychiatry in the United States’, in M.S. Micale and R. Porter, eds, Discovering the History of Psychiatry (Oxford, 1994), 415–44; Paul J. Carling, Return to Community: Building Support Systems for People with Psychiatric Disabilities (New York, 1995), ch. 3; Irit Shimrat, Call Me Crazy: Stories from the Mad Movement (Vancouver, 1997). For ongoing developments about self-definition by, and work among, current and former psychiatric patients, see Anne Rogers, David Pilgrim, and Ron Lacey, Experiencing Psychiatry: Users’ Views of Services (London, 1993); David Pilgrim and Anne Rogers, A Sociology of Mental Health and Illness (Buckingham, UK, 1993), 161–76; Lilith Finkler, ‘Notes for Feminist Theorists on the Lives of Psychiatrized Women’, Canadian Woman Studies/Les Cahiers de la Femme 13, 4 (Summer, 1993): 72–4; Lisa Dixon, Nancy Krauss, and Anthony Lehman, ‘Consumers as Service Providers: The Promise and Challenge’, Community Mental Health Journal 30, 6 (Dec. 1994): 615–25 (see also the responses to this article in the same journal by Lindy Fox and David Hilton, 627–9, and Phyllis Solomon, 631–4); Michael A. Susko, ‘Caseness and Narrative: Contrasting Approaches to People Who Are Psychiatrically Labelled’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 87–112; Laurie Howton Ford, Providing Employment Support for People with Long-term Mental Illness (Baltimore, 1995); Kim T. Mueser et al., ‘A Survey of Preferred Terms for

322   NOTES

Users of Mental Health Services’, Psychiatric Services 47, 7 (July 1996): 760–1; Lilith Finkler, Psychiatric Survivor Pride Day: Community Organizing With Psychiatric Survivors’, Osgoode Hall Law Journal 35, 3–4 (Fall/Winter 1997): 763–72. For related discussions on contemporary mental health and views of people with developmental disabilities and psychiatric patients, see Marie Putman, Mentely Handicapped Love (Madeira Park, BC, 1981); D. Ross, P. Campbell, and A. Neeter, ‘Community Care: Users’ Perspectives’, in M.P.I. Weller and M. Muijen, eds, Dimensions of Community Mental Health Care (London, 1993), 316–30; Angela Novak Amado, ed., Friendships and Community Connections between People with and without Developmental Disabilities (Baltimore, 1993); Tammy L. Morrell-Bellai and Katherine M. Boydell, ‘The Experience of Mental Health Consumers as Researchers’, Canadian Journal of Community Mental Health 13, 1 (Spring 1994): 97–110; Baukje Miedema, ‘Control or Treatment? Experiences of People Who Have Been Psychiatrically Hospitalized in New Brunswick’, Canadian Journal of Community Mental Health 13, 1 (Spring 1994): 111–22; Elaine C. Castles, ‘We’re People First’: The Social and Emotional Lives of Individuals with Mental Retardation (Westport, Conn., 1996); Gunnar Dybwad and Hank Bersani Jr, eds, New Voices: Self-Advocacy by People with Disabilities (Cambridge, Mass., 1996); Joan Morris and Virginia Hartley, Idiot, Patient, Client, Citizen: The Changing Lives of People with Developmental Disabilities (Toronto, 1996); Lynda Jacko, My Life Has Been a Gift from God (Guelph, Ont., 1997); Craig Newnes, Guy Holmes, and Cailzie Dunn, eds, This Is Madness: A Critical Look at Psychiatry and the Future of Mental Health Services (London, 1999). See also Chapter 1, note 75 for more references to perspectives by people who have been in mental health facilities.   10. Simmons, Unbalanced, 125–269.   11. Anita Szigeti, ‘Legal and Ethical Objections to Coerced Psychiatric Treatment in the Community’, unpublished paper presented to the 24th International Congress on Law and Mental Health, University of Toronto, 18 June 1999.   12. For examples of psychiatric history from the patients’ perspectives through individual accounts, rather than thematically, see Peterson, A Mad People’s History of Madness; Porter, A Social History of Madness; Reaume, ‘Psychiatric History from the Patients’ Perspectives’, 397–424.

Bibliography

Primary Sources, Unpublished Archives of Ontario, Toronto (AO) ao, rg

10, Series 20-B-2. Queen Street Mental Health Centre Casefiles, Admissions and Readmissions, Box Q1–Q12, Q51. ao, rg 10, Series 20-A-1. Box 1, File 5. Ministry of Health, Psychiatric Hospitals Branch, Minutes of Superintendents Conference, 1930–57, 23 Apr. 1954. ao, rg 15, 13-2-41. Department of Public Works Drawings. P.L. Asylum, Design for Fountain to be Erected, 1859. ao, rg 15-13-2-42. Architectural Collection, Department of Public Works. Provincial Lunatic Asylum, Plan of Drawing, Farm Buildings, 1867. ao, rg 15 13-2-73. Department of Public Works Drawings. Lunatic Asylum Toronto, Block Plan of Buildings Shewing Proposed Removal of Woodsheds, 1869. ao, rg 63, Subseries A-1. Inspector of Asylums, Asylum Correspondence, 1870–1935: File #2092, Child Born in Asylum, 1891–5. ao, rg 63, Subseries A-1, Inspector of Asylums, Asylum Correspondence, 1870–1935: File #2697: Disposition of Undesirable Immigrant, 1905–7. ao, rg 63, Subseries A-8, Inspector of Asylums, Inspector’s Numbered Subject Files: Vol. 746, File #451: ‘Standard Basic Dietary Ration Table for Use in Provincial Hospitals, 1917’. ao, rg 63 Subseries C-3, Vol. 767a, Inspector of Asylums: Investigation, Toronto Hospital for the Insane, 1917.

323

324   BIBLIOGRAP HY

Archives on the History of Canadian Psychiatry and Mental Health Services, Centre for Addiction and Mental Health, Queen Street Division, Toronto Toronto General Hospital Medical Records, ‘Nervous Ward’, Vol. 20, #3501–3601 (June 1907–April 1908).

Primary Sources, Published Government Reports, Ontario Annual Report of the Inspector of Asylums, Prisons and Public Charities, 1868–1906. Annual Report of the Inspector of Hospitals for the Insane, 1907–30. Annual Report of Ontario Hospitals for the Mentally Ill, 1931–50. (The remainder of this bibliography includes both cited material and material not cited in the notes.)

Books (Anonymous) By a Late Inmate of the Glasgow Royal Asylum for Lunatics at Gartnavel. The Philosophy of Insanity. Intro. Frieda Fromm-Reichmann. London: Fireside Press, 1947. Bastedo, Walter A. Materia Medica Pharmacology: Therapeutics Prescription Writing for Students and Practitioners, 2nd edn. Philadelphia: W.B. Saunders, 1918. Burgess, T.J.W. A Historical Sketch of Our Canadian Institutions for the Insane. Toronto: Copp-Clark, 1898. Clark, Daniel. Heredity, Worry and Intemperance as Causes of Insanity. Toronto: C.B. Robinson, 1880. ———. Mental Diseases: A Synopsis of Twelve Lectures Delivered at the Hospital for the Insane, Toronto, to the Graduating Medical Classes. Toronto: W. Briggs, 1895. Dock, Lavinia L. Text-Book of Materia Medica for Nurses, 3rd edn. New York: G.P. Putnam’s Sons, 1901. Easterbrook, Charles Cromhall. Notes on a Visit in 1913 to some Mental Hospitals and Clinics in the United States of America and Canada. London: Dumfries, 1914. Hurd, Henry M., ed. The Institutional Care of the Insane in the United States and Canada, vol. 4. Baltimore: Johns Hopkins Press, 1917. London, Louis S. Mental Therapy: Studies in Fifty Cases, 2 vols. New York: Covici Friede Publishers, 1937.

BI BL I O G R A P H Y   3 2 5

Moodie, Susanna. Life in the Clearings Versus Life in the Bush. New York: DeWitts Davenport, 1853. Paul, George P. A Text-Book of Materia Medica for Nurses, Including Therapeutics and Toxicology. Philadelphia: W.B. Saunders, 1907. Propositions and Resolutions of the Association of Medical Superintendents of American Institutions for the Insane. Comp. Dr Kirkbride of Pennsylvania, Dr Callender of Tennessee, and Dr Nichols of D.C. Philadelphia: Collins Printer, 1876. Stevens, A.A. A Text-Book of Therapeutics Including the Essentials of Pharmacology and Materia Medica, 6th edn. Philadelphia: W.B. Saunders, 1923. Tuke, Daniel Hack. The Insane in the United States and Canada. London: H.K. Lewis, 1885. ———, ed. A Dictionary of Psychological Medicine, 2 vols. Philadelphia: P. Blakiston, Son & Co., 1892.

Newspapers and Journals American Journal of Insanity Bulletin of the Ontario Hospitals for the Insane (formerly Bulletin of the Toronto Hospital for the Insane) Canadian Journal of Medicine and Surgery Canadian Medical Association Journal Canadian Methodist Magazine Canadian Practitioner Globe and Mail Journal of Mental Science Toronto Daily Star Toronto Telegram Toronto World

Articles Clare, Harvey. ‘The Treatment of Insanity’, Bulletin of the Ontario Hospitals for the Insane 9, 3 (Apr. 1916): 76–80. Clark, Daniel. ‘An Animated Molecule and Its Nearest Relatives’, American Journal of Insanity 35, 2 (Oct. 1878): 189–228. ———. ‘Heredity’, Canadian Methodist Magazine 19 (1884): 257–67. ———. ‘Neurasthenia’, Canadian Practitioner 13, 7 (July 1888): 109–15. ———. ‘The Relationship of Mind and Body’, American Journal of Insanity 49, 1 (July 1892): 1–25. ———. ‘Reflexes in Psychiatry’, Canadian Journal of Medicine and Surgery 5, 1 (Jan. 1899): 86–93.

326   BIBLIOGRAP HY

Clarke, C.K. ‘The Care of the Insane in Canada’, American Journal of ­Insanity 50, 3 (Jan. 1894): 381–5. ———. ‘Dementia Praecox’, Canadian Journal of Medicine and Surgery 21, 4 (Apr. 1907): 219–23. ———. ‘The Detection of Mental Defect in School Children’, Canadian Journal of Medicine and Surgery 21, 6 (June 1907): 343–8. ———. ‘The Psychiatric Clinics of Germany’, Bulletin of the Toronto Hospital for the Insane 1, 4 (Jan. 1908): 3–37. ———. ‘The Defective and Insane Immigrant’, Bulletin of the Ontario Hospitals for the Insane 1, 2 (July 1908): 3–22. ——— and J. Webster. ‘Notes of a Clinical Case: The Case of Wm. B. Moral Imbecility’, Bulletin of the Ontario Hospitals for the Insane 7, 4 (July 1914): 207–31. ‘Committee which Visited European Asylums Returns Home’, Canadian Journal of Medicine and Surgery 22, 4 (Oct. 1907): 272. ‘Complaint Unwarranted’, Toronto World, 27 Mar. 1917. Cumberland, Thomas D. ‘A Review of the Sympathetic Nervous System and Its Clinical Importance’, Bulletin of the Ontario Hospitals for the Insane 7, 3 (Apr. 1914): 168–79. Davis, Lena A. ‘Nursing in the Hospitals for Insane’, Bulletin of the Ontario Hospitals for the Insane 7, 3 (Apr. 1914): 197–203. ‘Dr. Daniel Clark’s Resignation’, Canadian Journal of Medicine and Surgery 18, 4 (Oct. 1905): 267–8. ‘Dr. Harvey Clare—Guelph Doctor Was Outstanding as Psychiatrist’, Globe and Mail, 6 Aug. 1949. (Editorial) ‘A Psychiatric Clinic for Toronto’, Canadian Journal of Medicine and Surgery 21, 6 (June 1907): 377–9. (Editorial) ‘Admission of Patients to Hospitals for the Insane’, Bulletin of the Toronto Hospital for the Insane 1, 3 (Oct. 1907): 13–14. (Editorial) ‘Is Mental Illness a Crime?—Surely Not’, Canadian Journal of Medicine and Surgery 13, 3 (Mar. 1903): 205–6. (Editorial) ‘Immigration of Defectives’, Bulletin of the Ontario Hospitals for the Insane 3, 2 (Mar. 1909): 47–50. (Editorial): ‘Notification of Insanity, and Voluntary Patients in Hospitals for the Insane’, Canadian Journal of Medicine and Surgery 26, 3 (Sept. 1909): 197–9. (Editorial) ‘The Unfavourable Prognosis of Insanity in Ontario’, Canadian Journal of Medicine and Surgery 19, 5 (May 1906): 323–6. ‘Female Nurses in Male Wards of Mental Hospitals’, Bulletin of the Ontario Hospitals for the Insane 9, 3 (Apr. 1916): 81–6. Forster, J.M. ‘Reception Hospitals for Cases of Mental Diseases’, Bulletin of the Ontario Hospitals for the Insane 7, 3 (Apr. 1914): 168–79.

BI BL I O G R A P H Y   3 2 7

———. ‘The Reception Hospital—Hospital for the Acutely Insane’, Bulletin of the Ontario Hospitals for the Insane 8, 3 (Apr. 1915): 109–13. G., L.C. (Patient at Hospital for the Insane, Brockville, Ontario). ‘Eastertide’, Bulletin of the Ontario Hospitals for the Insane 6, 3 (Apr. 1913): 177–8. Hall, Ernest A. ‘Re the Mental Invalid—A Plea’, Canadian Journal of Medicine and Surgery 13, 5 (May 1903): 363. Harrison, J.P. ‘Dementia Praecox’, Bulletin of the Ontario Hospitals for the Insane 3, 5 (Apr. 1910): 6–18. Hattie, W.H. ‘The Prevention of Insanity’, Canadian Medical Association Journal 1, 11 (Nov. 1911): 1019–26. Haviland, C. Floyd. ‘Occupation for the Insane’, American Journal of Insanity 69, 3 (Jan. 1913): 483–95. Hummer, H.R. ‘Insanity among the Indians’, American Journal of Insanity 69, 3 (Jan. 1913): 615–23. Kidd, G.C. ‘Notes on the Treatment of Mental Excitement with Report of Three Cases’, Bulletin of the Ontario Hospitals for the Insane 6, 3 (Apr. 1913): 150–5. McVicar, C.S. ‘A Consideration of Diets’, Bulletin of the Ontario Hospitals for the Insane 6, 3 (Apr. 1913): 167–73. ———. ‘Some Psychiatric Problems from the General Practitioner’s Standpoint’, Bulletin of the Ontario Hospitals for the Insane 7, 1 (Oct. 1913): 34–41. Mills, Elizabeth. ‘The Prevention of Noise in Hospitals for the Insane’, Bulletin of the Ontario Hospitals for the Insane 7, 4 (July 1914): 250–5. Newington, H.F.H. ‘What Are the Tests of Fitness for Discharge from Asylums?’, Journal of Mental Science 32 (1887): 491–500. ‘Obituary: Death of Dr. Daniel Clark’, Canadian Journal of Medicine and Surgery 32, 1 (July 1912): 63–4. ‘Obituaries: Dr. Harvey Clare’, Canadian Medical Association Journal 61, 4 (Oct. 1949): 430. Parker, Meta. ‘The Admitting of a Patient to the Mental Hospital’, Bulletin of the Ontario Hospitals for the Insane 8, 2 (Jan. 1915): 94–5. ‘Post-Mortems on Bodies of the Insane’, Canadian Journal of Medicine and Surgery 14, 5 (Nov. 1903): 382–3. Ray, I. ‘The Labor Question, and Hospitals for Incurables’, American Journal of Insanity 22, 4 (Apr. 1866): 439–62. Riddell, William Renwick. ‘Insanity in its Legal Aspects’, Canadian Journal of Medicine and Surgery 33, 5 (May 1913): 355–60. Ross, George W. ‘A Test for the Diagnosis of General Paralysis of the Insane’, Canadian Journal of Medicine and Surgery 27, 4 (May 1910): 297–303. Ryan, Edward, et al. ‘Rockwood Hospital Number’, Bulletin of the Toronto Hospital for the Insane 1, 3 (Oct. 1907): 3–12.

328   BIBLIOGRAP HY

Smith, R.W. Bruce. ‘Preludes to Insanity’, Canadian Journal of Medicine and Surgery 19, 5 (May 1906): 277–83. Stafford, Ezra H. ‘Some Clinical Aspects of Mental Disease’, Canadian Journal of Medicine and Surgery 1, 4 (Apr. 1897): 157–62. ——— (‘E.H.S.’). ‘Toronto Insane Asylum’, Canadian Journal of Medicine and Surgery 3, 3 (Mar. 1898): 164–6. ———. ‘The Correlation of Insanity and Crime’, Canadian Journal of Medicine and Surgery 5, 5 (May 1899): 311–18. ‘The Death of Dr. James H. Richardson’, Canadian Journal of Medicine and Surgery 27, 2 (Feb. 1910): 111–13. Webster, John. ‘Litigious or Querulous Paranoia’, Bulletin of the Ontario Hospitals for the Insane 9, 3 (Apr. 1916): 57–63. Workman, Joseph. ‘Asylum Management’, American Journal of Insanity 38, 1 (July 1881): 1–15. ———. ‘Moral Insanity: What is it?’, American Journal of Insanity 39, 43 (Jan. 1883): 334–48. ‘World Famous Toronto Doctor Mended Broken Minds: Canada Owes Immeasurable Debt to Dr. C.K. Clarke, Who Helped to Lift the Shadow of Misery and Hopelessness from Insane Asylums’, Toronto Sunday World, 23 Mar. 1924.

Contemporary Periodicals by Current and Former Psychiatric Patients Madness Network News. Published in San Francisco, 1972–86. Phoenix Rising: The Voice of the Psychiatrized. Published in Toronto, 1980–90. Counterpoint. Published in Groton, Vt, 1985– . Dendron. Published in Eugene, Oreg., 1987– . The Consumer/Survivor Information Resource Centre Bulletin. Published in Toronto, 1992– . Schizophrenia Digest. Published in Fort Erie, Ont., 1994– .

Secondary Sources Books, Reports, Pamphlets Adam, Barry. The Rise of a Gay and Lesbian Movement. Boston: Twayne Publishers, 1987. Alexander, F.G., and S.T. Selesnick. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York: Harper and Row, 1966. Alty, Ann, and Tom Mason. Seclusion and Mental Health: A Break with the Past. London: Chapman & Hall, 1994.

BI BL I O G R A P H Y   3 2 9

Amado, Angela Novak, ed. Friendships and Community Connections between People with and without Developmental Disabilities. Baltimore: Paul H. Brookes, 1993. Anderson, Elizabeth Ann. Colour All My Wings: A Poetry Journey. Norval, Ont.: Moulin Publishing, 1998. Arieno, Marlene A. Victorian Lunatics: A Social Epidemiology of Mental Illness in Mid-Nineteenth-Century England. Selinsgrove, Penn.: Susquehanna University Press, 1989. Aries, Philippe. The Hour of Our Death. New York: Alfred A. Knopf, 1981. Atwood, Margaret. Alias Grace. Toronto: McClelland & Stewart, 1996. Barham, Peter. Closing the Asylum: The Mental Patient in Modern Society. Harmondsworth: Penguin Books, 1992, 1997. Bean, Philip, and Patricia Mounser. Discharged from Mental Hospitals. London: Macmillan in association with Mind Publications, 1993. Bederman, Gail. Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880–1917. Chicago: University of Chicago Press, 1995. Bentall, Richard P., ed. Reconstructing Schizophrenia. London: Routledge, 1990. Berrios, German, and Roy Porter, eds. A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone Press, 1995. Blackbridge, Persimmon, and Sheila Gilhooly. Still Sane. Vancouver: Press Gang, 1985. Bogdan, Robert. Freak Show: Presenting Human Oddities for Amusement and Profit. Chicago: University of Chicago Press, 1988. Boyle, Mary. Schizophrenia: A Scientific Delusion? London: Routledge, 1990. Brandon, David. Innovation Without Change? Consumer Power in Psychiatric Services. London: Macmillan, 1991. Breggin, Peter R., and David Cohen. Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medication. New York: Perseus Books, 1999. Brody, Howard. Stories of Sickness. New Haven: Yale University Press, 1987. Brown, Phil. Transfer of Care. London: Routledge, 1988. Brugha, T.S., ed. Social Support and Psychiatric Disorder: Research Findings and Guidelines for Clinical Practice. Cambridge: Cambridge University Press, 1995. Burleigh, Michael. Death and Deliverance: ‘Euthanasia’ in Germany, c. 1900–1945. Cambridge: Cambridge University Press, 1994. Burstow, Bonnie, and Don Weitz, eds. Shrink Resistant: The Struggle Against Psychiatry in Canada. Vancouver: New Star Books, 1988. Busfield, Joan. Managing Madness: Changing Ideas and Practice. London: Unwin Hyman, 1986.

330   BIBLIOGRAP HY

———. Men, Women and Madness: Understanding Gender and Mental ­Disorder. London: Macmillan, 1996. Cameron, Jim. Good For What Ails You: Self-Help Remedies from 19th Century Canada. Burnstown, Ont.: General Store Publishing House, 1995. Capponi, Pat. Upstairs in the Crazy House: The Life of a Psychiatric Survivor. Toronto: Viking Press, 1992. ———. Dispatches from the Poverty Line. Toronto: Penguin Books Canada, 1997. ———. The War at Home: An Intimate Portrait of Canada’s Poor. Toronto: Viking Press, 1999. Carling, Paul J. Return to Community: Building Support Systems for People with Psychiatric Disabilities. New York: Guilford Press, 1995. Castel, Robert. The Regulation of Madness: The Origins of Incarceration in France. Trans. W.D. Halls. Cambridge: Polity Press, 1988. Castles, Elaine E. ‘We’re People First’: The Social and Emotional Lives of People with Mental Retardation. Westport, Conn.: Praeger, 1996. Chamberlin, Judi. On Our Own: Patient Controlled Alternatives to the Mental Health System. New York: Hawthorn, 1978. Chesler, Phyllis. Women and Madness. New York: Harcourt Brace Jovanovich, 1972, 1989. Church, Kathryn. Forbidden Narratives: Critical Autobiography as Social Science. Amsterdam: Gordon and Breach, 1995. Clouston, J. Storer. The Lunatic at Large. Edinburgh and London: William Blackwood and Sons, 1909. Cohen, David. Forgotten Millions: The Treatment of the Mentally Ill—A Global Perspective. London: Paladin Grafton Books, 1988. Coleman, Lee. The Reign of Error: Psychiatry, Authority, and the Law. Boston: Beacon Press, 1984. Collins, Anne. In the Sleep Room: The Story of the CIA Brainwashing Experiments in Canada. Toronto: Lester & Orpen Dennys, 1988. Copp, Terry, and Bill McAndrew. Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939–1945. Montreal and Kingston: McGillQueen’s University Press, 1990. Cosbie, W.G. The Toronto General Hospital, 1918–1965: A Chronicle. Toronto: Macmillan, 1975. csdi. Consumer/Survivor Development Initiative Project Descriptions. Toronto: Consumer/Survivor Development Initiative, Mar. 1996. Cutting, John, and Michael Shepherd. The Clinical Roots of the Schizophrenia Concept: Translations of Seminal European Contributions on Schizophrenia. Cambridge: Cambridge University Press, 1987. Dain, Norman. Clifford W. Beers, Advocate for the Insane. Pittsburgh: University of Pittsburgh Press, 1981.

BI BL I O G R A P H Y   3 3 1

Digby, Anne. Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914. Cambridge: Cambridge University Press, 1985. Dinham, Paul S. You Never Know What They Might Do: Mental Illness in Outport Newfoundland. St John’s: Memorial University of Newfoundland, 1977. Doerner, Klaus. Madmen and the Bourgeoisie: A Social History of Insanity and Psychiatry. Trans. J. Neugroschel and J. Steinberg. Oxford: Basil Blackwell, 1981. Dols, Michael. Majnun: The Madman in the Medieval Islamic World. Oxford: Clarendon Press, 1992. Dowbiggin, Ian Robert. Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940. Ithaca, NY: Cornell University Press, 1997. Donaldson, Kenneth. Insanity Inside Out. New York: Crown Publishing, 1976. Driedger, Diane. The Last Civil Rights Movement: Disabled Peoples’ International. London: Hurst & Company, 1989. Dubinsky, Karen. Improper Advances: Rape and Heterosexual Conflict in Ontario, 1880–1929. Chicago: University of Chicago Press, 1993. Dunham, H. Warren, and S. Kirson Weinberg. The Culture of the State Mental Hospital. Detroit: Wayne State University Press, 1960. Dwyer, Ellen. Homes for the Mad: Life Inside Two Nineteenth Century ­Asylums. New Brunswick, NJ: Rutgers University Press, 1987. Dybwad, Gunnar, and Hank Bersani Jr, eds. New Voices: Self-Advocacy by People with Disabilities. Cambridge, Mass.: Brookline Books, 1996. Ehrenreich, Barbara, and Deirdre English. Complaints and Disorders: The Sexual Politics of Sickness. Old Westbury, NY: Feminist Press, 1973. Elliot, David W. Listen to the Silence. New York: Holt, Rinehart and Winston, 1971. Epstein, Julia. Altered Conditions: Disease, Medicine, and Storytelling. New York: Routledge, 1995. Ernst, Waltraud. Mad Tales from the Raj: The European Insane in British India, 1800–1858. London: Routledge, 1991. Farber, Seth. Madness, Heresy, and the Rumor of Angels: The Revolt Against the Mental Health System. Chicago: Open Court, 1993. Farmer, Frances. Will There Really Be a Morning? New York: Dell, 1972. Fernando, Suman. Mental Health, Race and Culture. Houndmills, UK: Macmillan, 1991. Findley, Timothy. Headhunter: A Novel. Toronto: HarperCollins, 1993. Fink, Paul Jay, and Allan Tasman. Stigma and Mental Illness. Washington: American Psychiatric Press, 1992. Finnane, Mark. Insanity and the Insane in Post-Famine Ireland. London: Croom Helm, 1981.

332   BIBLIOGRAP HY

FitzGerald, James. Old Boys: The Powerful Legacy of Upper Canada College. Toronto: Macfarlane Walter & Ross, 1994. Fleming, Michael, and R. Manvell. Images of Madness: The Portrayal of Insanity in the Feature Film. Rutherford, NJ: Fairleigh Dickinson University, 1985. Ford, Laurie Howton. Providing Employment Support for People with Longterm Mental Illness. Baltimore: Paul H. Brookes, 1995. Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Vintage Books, 1965, 1988. Fox, Richard W. So Far Disordered Mind: Insanity in California, 1870–1930. Berkeley: University of California Press, 1978. Frame, Janet. Faces in the Water. New York: G. Braziller, 1961. Frank, K. Portland. The Anti-Psychiatry Bibliography and Resource Guide. Vancouver: Press Gang, 1979. Funk, Wendy. ‘What DiffErenCe Does IT Make?’ (The Journey of a Soul ­Survivor). Cranbrook, BC: Wild Flower Publishing, 1998. Gabbard, Krin and Glenn O. Psychiatry and the Cinema. Chicago: University of Chicago Press, 1987. Gallagher, Hugh Gregory. By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich. New York: Henry Holt and Company, 1990. Garton, Stephen. Medicine and Madness: A Social History of Insanity in New South Wales, 1880–1940. Kensington: New South Wales University Press, 1988. Geller, J.L. and M. Harris, eds. Women of the Asylum: Voices from Behind the Walls, 1840–1945. New York: Anchor Books, 1994. Gibson, Margaret. Sweet Poison. Toronto: HarperCollins, 1993. Gilboord, Margaret Gibson. The Butterfly Ward. Montreal: Oberon Press, 1976. Gilman, Charlotte Perkins. The Yellow Wallpaper. Old Westbury, NY: Feminist Press, 1973. (First published in 1892.) Gilman, Sander L. Seeing the Insane. New York: Brunner-Mazzel, 1982; ­Lincoln: University of Nebraska Press, 1996. ———. Disease and Representation: Images of Illness from Madness to AIDS. Ithaca, NY: Cornell University Press, 1988. Gittins, Diana. Madness in Its Place: Narratives of Severalls Hospital, 1913–1997. London: Routledge, 1998. Glenn, Michael, ed. Voices from the Asylum. New York: Harper & Row, 1974. Goddard, Jocelyn. Mixed Feelings: Littlemore Hospital—An Oral History Project. Westgate, UK: Oxfordshire County Council, 1996. Goffman, Erving. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, NY: Doubleday, 1961. Golden, Stephanie. The Women Outside: Meanings and Myths of Homelessness. Berkeley: University of California Press, 1992.

BI BL I O G R A P H Y   3 3 3

Gordon, Barbara. I’m Dancing As Fast As I Can. New York: Harper & Row, 1979, 1989. Gordon, Linda. Heroes of Their Own Lives: The Politics and History of Family Violence, Boston, 1880–1960. New York: Penguin Books, 1989. Gotkin, Janet and Paul. Too Much Anger, Too Many Tears: A Personal ­Triumph Over Psychiatry. New York: New York Times, 1975; reissued New York: Harper Perennial, 1992. Gottesman, Irving I. Schizophrenia Genesis: The Origins of Madness. New York: W.H. Freeman and Company, 1991. Granatstein, J.L. Who Killed Canadian History? Toronto: HarperCollins, 1998. Greenland, Cyril. Charles Kirk Clarke: A Pioneer of Canadian Psychiatry. Toronto: Clarke Institute of Psychiatry, 1966. ———. The City and the Asylum: Celebrating the Bi-Centennial of the City of Toronto, 1793–1993. Toronto: Museum of Mental Health Services, 1993. Grob, Gerald N. Mental Illness and American Society, 1875–1940. Princeton, NJ: Princeton University Press, 1983. ———. From Asylum to Community. Princeton, NJ: Princeton University Press, 1991. ———. The Mad Among Us: A History of the Care of America’s Mentally Ill. New York: Free Press, 1994. Grobe, Jeanine, ed. Beyond Bedlam: Contemporary Women Psychiatric Survivors Speak Out. Chicago: Third Side Press, 1995. Hacking, Ian. Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton, NJ: Princeton University Press, 1995. ———. Mad Travellers: Reflections on the Reality of Transient Mental Illness. Charlottesville: University Press of Virginia, 1998. ———. The Social Construction of What? Cambridge, Mass.: Harvard University Press, 1999. Harris, Michael. Unholy Orders: Tragedy at Mount Cashel. Toronto: Penguin Books, 1991. Heaman, Elsbeth. The Inglorious Arts of Peace: Exhibitions in Canadian Society During the Nineteenth Century. Toronto: University of Toronto Press, 1999. Heeney, Helen, comp. Life Before Medicare: Canadian Experiences. Toronto: Ontario Coalition of Senior Citizens Organizations, 1995. Henton, Darcy, with David McCann. Boys Don’t Cry: The Struggle for Justice and Healing in Canada’s Biggest Sex Abuse Scandal. Toronto: McClelland & Stewart, 1995. Herman, Ellen. Psychiatry, Psychology, and Homosexuality. New York: Chelsea House, 1995. Hirsch, Shelley, et al. Madness Network News Reader. San Francisco: Glide Publications, 1974. Hirschman, Jack, ed. Artaud Anthology. San Francisco: City Light Books, 1965.

334   BIBLIOGRAP HY

Howells, John G., ed. The Concept of Schizophrenia: Historical Perspectives. Washington: American Psychiatric Press, 1991. Hughes, John S., ed. The Letters of a Victorian Madwoman. Columbia: ­University of South Carolina Press, 1993. Human Rights Watch/Asia. Death By Default: A Policy of Fatal Neglect in China’s State Orphanages. New York: Human Rights Watch/Asia, 1996. Hunt, Lynn, ed. The New Cultural History. Berkeley: University of California Press, 1989. Hyde, Christopher. Abuse of Trust: The Career of Dr. James Tyhurst. Vancouver: Douglas & McIntyre, 1991. Jacko, Lynda. My Life Has Been a Gift from God. Guelph, Ont.: Sharing to Learn, 1997. Jodelet, Denise. Madness and Social Representations: Living with the Mad in One French Community. Trans. T. Pownall, ed. G. Duveen. Berkeley: University of California Press, 1991. Jones, Colin, and Roy Porter, eds. Reassessing Foucault: Power, Medicine and the Body. London: Routledge, 1994. Kakar, Sudhir. Shamans, Mystics and Doctors: A Psychological Inquiry into India and Its Healing Traditions. New York: Alfred A. Knopf, 1982. Karp, David A. Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness. Oxford: Oxford University Press, 1996. Kaysen, Susanna. Girl, Interrupted. New York: Turtle Bay Books, 1993. Kealey, Gregory S. Toronto Workers Respond to Industrial Capitalism, 1867–1892. Toronto: University of Toronto Press, 1980. Kelm, Mary-Ellen. Colonizing Bodies: Aboriginal Health and Healing in Bri­tish Columbia, 1900–50. Vancouver: University of British Columbia Press, 1998. Kingston Literacy. Merry-Go-Rides. Kingston, Ont.: The Read-Write Centre, Kingston Literacy, 1991. ———. I Live My Own Life Now. Kingston, Ont.: The Read-Write Centre, Kingston Literacy, no date. ———. If We Had Only Known. Kingston, Ont.: The Read-Write Centre, Kingston Literacy, 1992. Laing, R.D. The Politics of Experience. New York: Pantheon, 1967. Landrine, Hope. The Politics of Madness. New York: Peter Lang, 1992. Lane, Harlan. When the Mind Hears: A History of the Deaf. New York: ­Vintage Books, 1984. Lapon, Lenny. Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany and the United States. Springfield, Mass.: Psychiatric Genocide Research Institute, 1986. Lessing, Doris. The Four-Gated City. New York: Bantam, 1976.

BI BL I O G R A P H Y   3 3 5

Lightner, David L. Asylum, Prison, and Poorhouse: The Writings and Reform Work of Dorothea Dix in Illinois. Carbondale and Edwardsville: Southern Illinois University Press, 1999. Littlewood, Roland, and Maurice Lipsedge. Aliens and Alienists: Ethnic Minorities and Psychiatry. London: Unwin Hyman, 1989. Lunbeck, Elizabeth. The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton, NJ: Princeton University Press, 1994. McCandless, Peter. Moonlight, Magnolias, & Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era. Chapel Hill: University of North Carolina Press, 1996. McCulloch, Jock. Colonial Psychiatry and ‘The African Mind’. Cambridge: Cambridge University Press, 1995. McFarland-Icke, Bronwyn Rebekah. Nurses in Nazi Germany: Moral Choice in History. Princeton, NJ: Princeton University Press, 1999. MacGregor, John M. The Discovery of the Art of the Insane. Princeton, NJ: Princeton University Press, 1989. MacKenzie, Charlotte. Psychiatry for the Rich: A History of Ticehurst Private Asylum, 1792–1917. London: Routledge, 1992. McLaren, Angus. Our Own Master Race: Eugenics in Canada, 1885–1945. Toronto: McClelland & Stewart, 1990. Marshall, John. Madness: An Indictment of the Mental Health Care System in Ontario. Toronto: Ontario Public Service Employees Union, 1982. Masson, Jeffrey Moussaieff. A Dark Science: Women, Sexuality, and Psychiatry in the Nineteenth Century. Trans. J.M. Masson and M. Loring. New York: Farrar, Strauss and Giroux, 1986 ———. The Assault on Truth: Freud’s Suppression of the Seduction Theory. New York: Atheneum, 1988. Massumi, Brian. A User’s Guide to Capitalism and Schizophrenia: Deviations from Delueze and Guattari. Cambridge, Mass.: mit Press, 1992. Mays, John Bentley. In the Jaws of the Black Dogs: A Memoir of Depression. New York: Viking, 1995. Mazumdar, P.M.H. Eugenics, Human Genetics and Human Failings. ­London: Routledge, 1992. Mermier, Martha Brinton. Coping with Severe Mental Illness: Families Speak Out. Lewiston, NY: Edwin Mellen Press, 1993. Miles, Agnes. The Mentally Ill in Contemporary Society. New York: St Martin’s Press, 1981. Miller, J.R. Shingwauk’s Vision: A History of Native Residential Schools. Toronto: University of Toronto Press, 1996. Millet, Kate. The Loony-Bin Trip. New York: Touchstone, 1991.

336   BIBLIOGRAP HY

Mitchinson, Wendy. The Nature of Their Bodies: Women and Their Doctors in Victorian Canada. Toronto: University of Toronto Press, 1991. Modrow, John. How To Become a Schizophrenic: The Case Against Biological Psychiatry. Everett, Wash.: Apollyn Press, 1992. Monroe, Russell R. Creative Brainstorms: The Relationship Between Madness and Genius. New York: Irvington Publishers, 1992. Montigny, Edgar-André. Foisted Upon the Government? State Responsibilities, Family Obligations and the Care of the Dependent Aged in Late Nineteenth-Century Ontario. Montreal and Kingston: McGill-Queen’s University Press, 1997. Morgan, H. Wayne. Drugs in America: A Social History, 1800–1980. Syracuse, NY: Syracuse University Press, 1981. Morgan, Robert F., ed. Electroshock: The Case Against. Toronto: ipi Publishing, 1991. Morris, Jenny. Pride Against Prejudice: Transforming Attitudes Towards ­Disability. London: Women’s Press, 1991. Morris, Joan, and Virginia Hartley. Idiot, Patient, Client, Citizen: The Changing Lives of People with Developmental Disabilities. Toronto: Dundurn Press, 1996. Newnes, Craig, Guy Holmes, and Cailzie Dunn, eds. This Is Madness: A Critical Look at Psychiatry and the Future of Mental Health Services. London: pccs Books, 1999. Ng, Vivien W. Madness in Late Imperial China: From Illness to Deviance. Norman: University of Oklahoma Press, 1990. Noll, Steven. Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900–1940. Chapel Hill: University of North Carolina Press, 1995. North, Carol. Welcome Silence: My Triumph Over Schizophrenia. New York: Simon and Schuster, 1987. Oppenheim, Janet. ‘Shattered Nerves’: Doctors, Patients and Depression in Victorian England. New York: Oxford University Press, 1991. Palmer, Bryan. Working-Class Experience: The Rise and Reconstitution of Canadian Labour, 1800–1980. Toronto: Butterworths, 1983. parc. Kiss Me You Mad Fool: A Collection of Writing from Parkdale Activity and Recreation Centre. Toronto: Positive Print, 1991. Penfold, P. Susan, and Gillian A. Walker. Women and the Psychiatric Paradox. Montreal: Eden Press, 1983. Peterson, Dale, ed. A Mad People’s History of Madness. Pittsburgh: University of Pittsburgh Press, 1982. Pilgrim, David, and Anne Rogers. A Sociology of Mental Health and Illness. Buckingham, UK: Open University Press, 1993. Piva, Michael J. The Condition of the Working Class in Toronto—1900–1921. Ottawa: University of Ottawa Press, 1979.

BI BL I O G R A P H Y   3 3 7

Porter, Roy. A Social History of Madness: Stories of the Insane. London: Weidenfeld and Nicholson, 1987. ———. Mind-Forg’d Manacles: A History of Madness in England from the Restoration to the Regency. London: Athlone Press, 1987. ———. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton, 1997. ———, ed. The Faber Book of Madness. London: Faber and Faber, 1991. Portnov, Anatoly, and Dmitry Fedotov. Psychiatry. Trans. Yuri Shirokov. Moscow: Mir Publishers, 1965, 1969. Poster, Mark. Foucault, Marxism and History: Mode of Production versus Mode of Information. Cambridge: Cambridge University Press, 1985. Prentice, Alison, et al. Canadian Women: A History. Toronto: Harcourt Brace Jovanovich, 1988. Prinzhorn, Hans. Artistry of the Mentally Ill. Trans. E. von Brockdorff. New York, Heidelberg: Springer-Verlag, 1972. (First published in Germany in 1922.) Proctor, Robert N. Racial Hygiene: Medicine Under the Nazis. Cambridge, Mass.: Harvard University Press, 1988. Putman, Marie. Mentely Handicapped Love. Madeira Park, BC: Harbour Publishing, 1981. Rack, P. Race, Culture and Mental Disorder. London: Tavistock, 1982. Ralph, Diana. Work and Madness: The Rise of Community Psychiatry. ­Montreal: Black Rose Books, 1983. Reaume, Geoffrey. A Classified Bibliography on the History of Psychiatry and Mental Health Services in Canada. Toronto: Museum of Mental Health Services, 1998. Rechnitzer, Peter A. R.M. Bucke: Journey to Cosmic Consciousness. Markham, Ont.: ams/Fitzhenry & Whiteside, 1994. Ripa, Yannick. Women and Madness: The Incarceration of Women in Nineteenth Century France. Trans. C. Menage. Cambridge: Polity Press, 1990. Roazen, Paul. Canada’s King: An Essay in Political Psychology. Oakville, Ont.: Mosaic Press, 1998. Roccatagliata, Guiseppe. A History of Ancient Psychiatry. New York: Greenwood Press, 1986. Rogers, Anne, David Pilgrim, and Ron Lacey. Experiencing Psychiatry: Users’ Views of Services. London: Macmillan in association with Mind Publications, 1993. Rosenberg, Charles E. The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age. Chicago: University of Chicago Press, 1968. Rosenberg, Morris. The Unread Mind: Unravelling the Mystery of Madness. New York: Lexington Books, 1992. Rothman, David J. The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little, Brown, 1971.

338   BIBLIOGRAP HY

Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in America. New York: Basic Books, 1994. Rutty, Christopher J. A Circle of Care: 75 Years of Caring, St. Mary’s General Hospital. Kitchener, Ont.: St Mary’s General Hospital, 1999. Sadowsky, Jonathan. Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria. Berkeley: University of California Press, 1999. St-Amand, Nere. The Politics of Madness. Trans. E. Garmaise and R.­ Chodos. Halifax: Formac Publishing, 1988. ——— and Huguette Clavette. Self-Help and Mental Health: Beyond Psychiatry. Ottawa: Canadian Council on Social Development, 1992. Sapinsley, Barbara. The Private War of Mrs. Packard. New York: Paragon House, 1991. Sass, Louis A. Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. New York: Basic Books, 1992. Scull, Andrew. Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England. London: Penguin Books, 1979. ———. The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900. New Haven: Yale University Press, 1993. Sellin, Herman. I Don’t Want To Be Inside Me Anymore: Messages from an Autistic Mind. Trans. by Anthea Bell. New York: Basic Books, 1995. Sexton, Anne. To Bedlam and Partway Back. Boston: Houghton Mifflin, 1960. Shimrat, Irit. Call Me Crazy: Stories from the Mad Movement. Vancouver: Press Gang, 1997. Shorter, Edward. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press, 1992. ———. From the Mind Into the Body: The Cultural Origins of Psychosomatic Symptoms. New York: Free Press, 1994. ———. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, 1997. ———, ed. TPH: History and Memories of the Toronto Psychiatric Hospital, 1925–1966. Toronto: Wall & Emerson, 1996. Shortt, S.E.D. Victorian Lunacy: Richard M. Bucke and the Practice of Late Nineteenth Century Psychiatry. Cambridge: Cambridge University Press, 1986. Showalter, Elaine. The Female Malady: Women, Madness and English Culture, 1830–1980. New York: Pantheon Books, 1985. Shutts, David. Lobotomy: Resort to the Knife. New York: Van Nostrand Reinhold, 1982. Siebert, Al. Peaking Out: How My Mind Broke Free from the Delusions in Psychiatry. Portland, Oreg.: Practical Psychology Press, 1995. Simmie, Scott. Out of Mind: An Investigation Into Mental Health. Toronto: Atkinson Foundation, 1998.

BI BL I O G R A P H Y   3 3 9

Simmons, Harvey G. From Asylum to Welfare. Downsview, Ont.: National Institute on Mental Retardation, 1982. ———. Unbalanced: Mental Health Policy in Ontario, 1930–1989. Toronto: Wall and Thompson, 1990. Simon, Bennett. Mind and Madness in Ancient Greece: The Classical Roots of Modern Psychiatry. Ithaca, NY: Cornell University Press, 1978. Singer, Charles. A Short History of Medicine. Oxford: Oxford University Press, 1928. Smith, Theresa C., in collaboration with Thomas A. Oleszczuk. No Asylum: State Psychiatric Repression in the Former USSR. New York: New York University Press, 1996. Sobsey, Dick. Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance? Baltimore: Paul H. Brookes, 1994. Stanford, Gene and Barbara. Strangers to Themselves: Readings on Mental Illness. New York: Bantam Books, 1973. Still, Arthur, and Irving Velody, eds. Rewriting the History of Madness: Studies in Foucault’s ‘Histoire de la folie’. London: Routledge, 1992. Stimpson, Liz, Colleen Weir, Georgia Maxwell, and Margaret C. Best. ­Unlock­ing the Doors: Abuse Against Vulnerable People within Ontario’s Institutions. Toronto: Advocacy Resource Centre for the Handi­capped/ Ontario Ministry of Citizenship, Recreation and Tourism—Office for Disability Issues, 1996. Strange, Carolyn. Toronto’s Girl Problem: The Perils and Pleasures of the City, 1880–1930. Toronto: University of Toronto Press, 1995. Supeene, Shelagh L. As For The Sky, Falling: A Critical Look at Psychiatry and Suffering. Toronto: Second Story Press, 1990. Susko, Michael, ed. Cry of the Invisible: Writings from the Homeless and Survivors of Psychiatric Hospitals. Baltimore: Conservatory Press, 1991. Szasz, Thomas. The Manufacture of Madness. New York: Harper, 1970. ———. The Myth of Mental Illness. New York: Harper and Row, 1974. ———. A Lexicon of Lunacy: Metaphoric Malady, Moral Responsibility, and Psychiatry. New Brunswick, NJ: Transaction, 1993. ———. Cruel Compassion: Psychiatric Control of Society’s Unwanted. New York: John Wiley & Sons, 1994. Tomes, Nancy. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883. Cambridge: Cambridge University Press, 1984. Republished, with a new introduction, as The Art of Asylum-­ Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry (Philadelphia: University of Pennsylvania Press, 1994). Tomlinson, Dylan. Utopia, Community Care and the Retreat from the Asylums. Buckingham, UK: Open University Press, 1991. Trent, James W. Inventing the Feeble-Minded: A History of Mental Retardation in the United States. Berkeley: University of California Press, 1994.

340   BIBLIOGRAP HY

Ussher, Jane. Women’s Madness: Misogyny or Mental Illness? Amherst: University of Massachusetts Press, 1991. Valenstein, Elliot S. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York: Basic Books, 1986. ———. Blaming the Brain: The Truth about Drugs and Mental Health. New York: Free Press, 1998. Vancouver Mental Patients Association. Madness Unmasked. Vancouver: Mental Patients Publishing Project, 1974. Vice, Janet. From Patients to Persons: The Psychiatric Critiques of Thomas Szasz, Peter Sedgewick and R.D. Laing. New York: Peter Lang, 1992. Wahl, Otto F. Media Madness: Public Images of Mental Illness. New Brunswick, NJ: Rutgers University Press, 1995. Ward, Mary Jane. The Snake Pit. New York: New Avenue Library, 1973. (Originally published in 1946.) Warsh, Cheryl Krasnick. Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923. Montreal and Kingston: McGill-Queen’s University Press, 1989. Weisskopf-Joelson, Edith. Father, Have I Kept My Promise? Madness as Seen from Within. West Lafayette, Ind.: Purdue University Press, 1988. Wickberg, Edgar, et al. From China to Canada: A History of the Chinese Communities in Canada. Toronto: McClelland & Stewart, 1982. Wilson, Robert, and Donovan Wylie. The Dispossessed. London: Picador, 1992. Winchester, Simon. The Professor and the Madman: A Tale of Murder, ­Insanity and the Making of the Oxford English Dictionary. New York: ­HarperCollins, 1998. Wood, Mary Elene. The Writing on the Wall: Women’s Autobiography and the Asylum. Urbana: University of Illinois Press, 1994. Woodson, Marle. Behind the Door of Delusion By ‘Inmate Ward 8’. Ed. W.W. Savage, J.H. Lazalier. Niwot, Colo.: University Press of Colorado, 1994. (Originally printed in 1932 by Macmillan.)

Articles Allderidge, Patricia. ‘Bedlam: Fact or Fantasy?’, in W.F. Bynum, R. Porter, and M. Shepherd, eds, The Anatomy of Madness: Essays in the History of Psychiatry, vol. 2 (London: Tavistock, 1985), 17–33. Allodi, Federico. ‘The Evolution of the Mental Hospital in Canada’, Canadian Journal of Public Health 68 (May/June 1977): 219–24. Aly, Götz. ‘Medicine Against the Useless’, in Götz Aly, Peter Chroust, and Christian Pross, Cleansing the Fatherland: Nazi Medicine and Racial

BI BL I O G R A P H Y   3 4 1

Hygiene, trans. Belinda Cooper (Baltimore: Johns Hopkins University Press, 1994), 22–98. Backhouse, Constance. ‘The White Women’s Labour Laws: Anti-Chinese Racism in Early Twentieth Century Canada’, Law and History Review 14 (1996): 315–68. Baehre, Rainer. ‘Victorian Psychiatry and Canadian Motherhood’, Canadian Women’s Studies 2 (1980): 44–6. Barfoot, Michael, and Allan W. Beveridge. ‘ “Our most notable inmate”: John Willis Mason at the Royal Edinburgh Asylum, 1864–1901’, History of Psychiatry 4, 2 (June 1993): 159–208. Beveridge, Allan. ‘John Home: “If You Want to Demoralise a Man in Every Way, Put Him in a Madhouse” ’, In L. de Goei and J. Vijselaar, eds, Proceedings of the 1st European Congress on the History of Psychiatry and Mental Health Care (Rotterdam: Erasmus Publishing, 1993), 90–5. ———. ‘Life in the Asylum: Patients’ Letters from Morningside, 1873–1908’, History of Psychiatry 9, 4 (Dec. 1998): 431–69. Bleuler, Manfred. ‘The Concept of Schizophrenia in Europe During the Past One Hundred Years’, in William Flack Jr et al., eds, What Is Schizophrenia? (New York: Springer-Verlag, 1991), 1–15. Bliss, Michael. ‘ “Pure Books on Avoided Subjects”: Pre-Freudian Sexual Ideas in Canada’, in S.E.D. Shortt, ed., Medicine in Canadian Society: Historical Perspectives (Montreal and Kingston: McGill-Queen’s University Press, 1981), 255–83. Bradbury, Bettina. ‘Elderly Inmates and Caregiving Sisters: Catholic Institutions for the Elderly in Nineteenth-Century Montreal’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto: University of Toronto Press, 1998), 129–55. Brown, Thomas. ‘Architecture as Therapy’, Archivaria 10, 3 (Summer 1980): 99–123. ———. ‘Dr. Ernest Jones, Psychoanalysis, and the Canadian Medical Profession, 1908–1913’, in S.E.D. Shortt, ed., Medicine in Canadian Society: Historical Perspectives (Montreal and Kingston: McGill-Queen’s University Press, 1981), 315–60. ———. ‘The Origins of the Asylum in Upper Canada, 1830–1839: Towards an Interpretation’, Canadian Bulletin of Medical History 1 (1984): 27–58. ———. ‘Shell Shock in the Canadian Expeditionary Force, 1914–1918: Canadian Psychiatry in the Great War’, in Charles G. Roland, ed., Health, Disease and Medicine: Essays in Canadian History (Toronto: Hannah Institute for the History of Medicine, 1984), 308–32. ———. ‘Dance of the Dialectic? Some Reflections (Polemic and Otherwise) on the Present State of Nineteenth-Century Asylum Studies’, Canadian Bulletin of Medical History 11, 2 (1994): 267–95.

342   BIBLIOGRAP HY

Brumberg, Joan Jacobs. ‘From Psychiatric Syndrome to “Communicable” Disease: The Case of Anorexia Nervosa’, in C.E. Rosenberg and J.  Golden, eds, Framing Disease: Studies in Cultural History (New Bruns­wick, NJ: Rutgers University Press, 1992), 134–54. Burleigh, Michael. ‘Psychiatry, German Society, and the Nazi “Euthanasia” Programme’, Social History of Medicine 7, 2 (Aug. 1994): 213–28. Burnet, J.R. ‘The Urban Community and Changing Moral Standards’, in M.  Horn and R. Sabourin, eds, Studies in Canadian Social History (Toronto: McClelland & Stewart, 1974), 298–325. Burstow, Bonnie. ‘A History of Psychiatric Homophobia’, Phoenix Rising: The Voice of the Psychiatrized 8, 3–4 (July 1990): S38–S39. Cairney, Richard. ‘ “Democracy Was Never Intended for Degenerates”: Alberta’s Flirtation with Eugenics Comes Back to Haunt It’, Canadian Medical Association Journal 155, 6 (15 Sept. 1996): 789–92. Cameron, Douglas G. ‘ect: Sham Statistics, the Myth of Convulsive Therapy, and the Case for Consumer Misinformation’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 177–98. Careless, J.M.S. ‘Toronto’, The Canadian Encyclopedia, vol. 4 (Edmonton: Hurtig, 1988), 2170–1. Chamberlin, Judi. ‘The Ex-Patients’ Movement: Where We’ve Been and Where We’re Going’, Journal of Mind and Behavior (Summer/Autumn 1990): 323–36. Coid, Jeremy W. ‘Dangerous Patients with Mental Illness: Increased Risks Warrant New Policies, Adequate Resources, and Appropriate Resources’, British Medical Journal (13 Apr. 1996): 965–6. Cole, S.S. ‘Facing the Challenges of Sexual Abuse in Persons with Disabilities’, Sexuality and Disability 7, 3–4 (1984): 71–88. Connor, Patrick J. ‘ “Neither Courage nor Perseverance Enough”: Attendants at the Asylum for the Insane, Kingston, 1877–1905’, Ontario History 88, 4 (Dec. 1996): 251–72. Cooly, Glenn.’Workshop Wage Wrangle’, Now, 15–21 Mar. 1990. Craig, Barbara L. ‘Hospital Records and Record-Keeping, c.1850–c.1950, Part I: The Development of Records in Hospitals’, Archivaria 29 (Winter 1989–90): 57–87. ———. ‘Hospital Records and Record-Keeping, c.1850–c.1950, Part II: The Development of Record-Keeping in Hospitals’, Archivaria 30 (Summer 1990): 21–38. ———. ‘The Role of Records and of Record-keeping in the Development of the Modern Hospital in London, England, and Ontario, Canada, c.1890–c.1940’, Bulletin of the History of Medicine 65 (1991): 376–97. ———. ‘A Guide to Historical Records in Hospitals in London, England and Ontario, Canada, c.1800–c.1950, Part 1: An Overview of the Continuities

BI BL I O G R A P H Y   3 4 3

and Changes in the Content and Forms of Records’, Canadian Bulletin of Medical History 8, 2 (1991): 263–87. ———. ‘A Guide to Historical Records in Hospitals in London, England and Ontario Canada, c.1800–c.1950, Part 2: A Consolidated List of Records’, Canadian Bulletin of Medical History 9, 1 (1992): 71–141. Dain, Norman. ‘Psychiatry and Anti-Psychiatry in the United States’, in M.S. Micale and R. Porter, eds, Discovering the History of Psychiatry (Oxford: Oxford University Press, 1994), 415–44. de la Cour, Lykke. ‘Workers’ Health and Safety Groups, Women’s Health Groups, and the Addiction Research Foundation’, in Marianne Fedunkiw, comp., Enhancing Communication and Community: A Proactive Healthcare Archives Assistance Policy (Toronto: Hannah Institute for the History of Medicine, 1994), 11–15. ———. ‘ “She thinks this is the Queen’s castle”: Women Patients’ Perceptions of an Ontario Psychiatric Hospital’, Health & Place 3, 2 (June 1997): 131–41. ——— and Geoffrey Reaume. ‘Patient Perspectives in Psychiatric Case Files’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto: University of Toronto Press, 1998), 242–65. Delottinville, Peter. ‘Joe Beef of Montreal: Working-Class Culture and the Tavern, 1860–1889’, in Laurel Sefton MacDowell and Ian Radforth, eds, Canadian Working Class History: Selected Readings (Toronto: Canadian Scholar’s Press, 1992), 245–68. Dendy, William. ‘The Provincial Lunatic Asylum’, in Dendy, Lost Toronto (Toronto: McClelland & Stewart, 1993), 164–7. Digby, Anne. ‘Moral Treatment at the Retreat, 1796–1846’, in W.F. Bynum, Roy Porter, and Michael Shepherd, eds, The Anatomy of Madness, vol. 2, (London: Tavistock, 1985), 52–72. Dixon, Lisa, Nancy Krauss, and Anthony Lehman. ‘Consumers as Service Providers: The Promise and Challenge’, Community Mental Health Journal 30, 6 (Dec. 1994): 615–25. Dowbiggin, Ian. ‘Keeping This Young Country Sane: C.K. Clarke, Immigration Restriction, and Canadian Psychiatry, 1890–1925’, Canadian Historical Review 76, 4 (Dec. 1995): 589–627. ———. ‘Alberta is paying for eugenics revisionism.’ Globe and Mail, 3 July 1998. Edginton, Barry. ‘Moral Treatment to Monolith: The Institutional Treatment of the Insane in Manitoba, 1871–1919’, Canadian Bulletin of Medical History 5, 2 (1988): 167–88. Engston, Eric J. ‘Emil Kraepelin: Psychiatry and Public Affairs in­ Wilhelmine Germany’, History of Psychiatry 2 (1991): 111–32.

344   BIBLIOGRAP HY

Everett, Barbara. ‘Something is Happening: The Contemporary Consumer and Psychiatric Survivor Movement in Historical Context’, Journal of Mind and Behavior 15, 1–2 (Winter-Spring, 1994): 55–70. Finkler, Lilith. ‘Notes for Feminist Theorists on the Lives of Psychiatrized Women’, Canadian Woman Studies/Les Cahiers de la Femme 13, 4 (Summer 1993): 72–4. ———. ‘Psychiatric Survivor Pride Day: Community Organizing With Psychiatric Survivors’, Osgoode Hall Law Journal 35: 3–4 (Fall/Winter, 1997): 763–72. Firsten, Temi. ‘Violence in the Lives of Women on Psych Wards’, Canadian Woman Studies/Les Cahiers de la Femme 11, 4 (Summer 1991): 45–8. Fissell, Mary E. ‘The Disappearance of the Patient’s Narrative and the ­Invention of Hospital Medicine’, in Roger French and Andrew Wear, eds, British Medicine in an Age of Reform (London: Routledge, 1991), 92–109. Fox, Lindy, and David Hilton. ‘Response to “Consumers as Service Providers: The Promise and Challenge” ’, Community Mental Health Journal 30, 6 (Dec. 1994): 627–9. Gil, E., and K. Baxter. ‘Abuse of Children in Institutions’, Child Abuse and Neglect 3 (1979): 693–8. Greenland, Cyril. ‘Services for the Mentally Retarded in Ontario, 1870–1930’, Ontario History 54, 4 (Dec. 1962): 267–74. Grob, Gerald N. ‘Mental Illness, Indigency, and Welfare: The Mental Hospital in Nineteenth Century America’, in Tamara K. Hareven, ed., Anonymous Americans: Explorations in Nineteenth Century Social History (Englewoods Cliffs, NJ: Prentice-Hall, 1971), 250–79. ———. ‘Abuse in American Mental Hospitals in Historical Perspective: Myth and Reality’, International Journal of Law and Psychiatry 3, 3 (1980): 295–310. ———. ‘Marxian Analysis and Mental Illness’, History of Psychiatry 1, 2 (June 1990): 223–32. Hare, E.H. ‘Masturbatory Insanity: The History of an Idea’, Journal of Mental Science 108, 452 (Jan. 1962): 2–25. Harris, Grant T., and Marnie Rice. ‘Risk Appraisal and Management of Violent Behavior’, Psychiatric Services 48, 9 (Sept. 1997): 1168–76. Hervey, Nicholas. ‘Advocacy or Folly: The Alleged Lunatics’ Friends Society, 1845–63’, Medical History 30, 3 (July 1986): 245–75. Hughes, John Starett. ‘The Madness of Separate Spheres: Insanity and Masculinity in Victorian Alabama’, in Mark Carnes and Clyde Griffin, eds, Meanings for Manhood: Constructions of Masculinity in Victorian America (Chicago: University of Chicago Press, 1990), 53–66.

BI BL I O G R A P H Y   3 4 5

Kappel, Bruce. ‘A History of People First in Canada’, in G. Dybwad and H. Bersani Jr, eds. New Voices: Self-Advocacy by People with Disabilities (Cambridge, Mass.: Brookline Books, 1996), 93–129. Keefe, Peter. ‘Recollections of a Patient at tph: Snakepit’, in Edward Shorter, ed., TPH: History and Memories of the Toronto Psychiatric Hospital, 1925–1966 (Toronto: Wall & Emerson, 1996), 171–82. Kelm, Mary-Ellen. ‘ “The only place likely to do her any good”: The Admission of Women to British Columbia’s Provincial Hospital for the Insane’, BC Studies 96 (Winter 1992–3): 66–89. ———. ‘A Life Apart: The Experience of Women and the Asylum Practice of Charles Doherty at British Columbia’s Provincial Hospital for the Insane, 1905–15’, Canadian Bulletin of Medical History 11, 2 (1994): 335–55. Krasnick, Cheryl L. ‘ “In Charge of the Loons”: A Portrait of the London, Ontario Asylum for the Insane in the Nineteenth Century’, Ontario History 74, 3 (Sept. 1982): 138–84. Laqueur, Thomas W. ‘Bodies, Details, and the Humanitarian Narrative’, in Lynn Hunt, ed., The New Cultural History (Berkeley: University of California Press, 1989), 176–204. Lasch, Christopher. ‘Origins of the Asylum’, in Lasch, ed., The World of Nations: Reflections on American History, Politics and Culture (New York: Alfred Knopf, 1974), 3–17. Lothane, Zvi. ‘Schreber’s Soul Murder: A Case of Psychiatric Persecution’, in L. de Goei and J. Vijselaar, eds, Proceedings of the 1st European Congress on the History of Psychiatry and Mental Health Care (Rotterdam: Erasmus Publishing, 1993), 96–103. McCubbin, Michael. ‘Deinstitutionalization: The Illusion of Disillusion’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 35–54. MacDonald, Michael. ‘Madness, Suicide and the Computer’, in Roy Porter and Andrew Wear, eds, Problems and Methods in the History of Medicine (London: Croom Helm, 1987), 207–29. McKillop, A.B. ‘Who Killed Canadian History? A View from the Trenches’, Canadian Historical Review 80, 2 (June 1999): 269–99. McPherson, Cathy. ‘Violence Against Women with Disabilities’, Canadian Woman Studies/Les Cahiers de la Femme 11, 4 (Summer 1991): 49–50. Marchetti, A.G., and J.R. McCartney. ‘Abuse of Persons with Mental Retardation: Characteristics of the Abused, the Abusers, and the Informers’, Mental Retardation 6 (1990): 367–71. Maynard, Steven. ‘On the Case of the Case: The Emergence of the Homosexual as a Case History in Early Twentieth-Century Ontario’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto: University of Toronto Press, 1998), 65–87.

346   BIBLIOGRAP HY

Midelfort, H.C. Eric. ‘Madness and Civilization in Early Modern Europe: A Reappraisal of Michel Foucault’, in B. Malament, ed., After the Reformation (Manchester, UK, 1980), 247–65. Miedema, Baukje. ‘Control or Treatment? Experiences of People Who Have Been Psychiatrically Hospitalized in New Brunswick’, Canadian Journal of Community Mental Health 13, 1 (Spring 1994): 111–22. Mitchinson, Wendy. ‘Causes of Disease in Women: The Case of Late Nineteenth-Century English Canada’, in Charles G. Roland, ed., Health, Disease and Medicine: Essays in Canadian History (Toronto: Hannah Institute for the History of Medicine, 1984), 381–95. ———. ‘Hysteria and Insanity: A Nineteenth Century Canadian Perspective’, Journal of Canadian Studies 21 (1986): 87–105. ———. ‘Gender and Insanity as Characteristics of the Insane: A NineteenthCentury Case’, Canadian Bulletin of Medical History 4 (1987): 99–117. ———. ‘Reasons for Committal to a Mid-Nineteenth-Century Ontario Insane Asylum: The Case of Toronto’, in Mitchinson and Janice Dickin McGinnis, eds, Essays in the History of Canadian Medicine (Toronto: McClelland & Stewart, 1988), 88–109. ———. ‘The Toronto and Gladesville Asylums: Humane Alternatives for the Insane in Canada and Australia?’, Bulletin of the History of Medicine 63, 1 (Spring 1989): 52–72. ———. ‘Problematic Bodies and Agency: Women Patients in Canada, 1900–1950’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto: University of Toronto Press, 1998), 266–86. Monahan, John, and Jean Arnold. ‘Violence by People with Mental Illness: A Consensus Statement by Advocates and Researchers’, Psychiatric Rehabilitation Journal 19, 4 (Spring 1996). Montigny, Edgar-André. ‘The Decline in Family Care for the Aged in ­Nineteenth-Century Ontario: Fact or Fiction’, Canadian Bulletin of Medical History 11, 2 (1994): 357–73. Moran, James E. ‘Keepers of the Insane: The Role of Attendants at the Toronto Provincial Asylum, 1875–1905’, Histoire Sociale/Social History 28, 55 (May 1995): 51–75. Morrell-Bellai, Tammy L., and Katherine M. Boydell. ‘The Experience of Mental Health Consumers as Researchers’, Canadian Journal of Community Mental Health 13, 1 (Spring 1994): 97–110. Mueser, Kim T., et al. ‘A Survey of Preferred Terms for Users of Mental Health Services’, Psychiatric Services 47, 7 (July 1996): 760–1. Musick, J.L. ‘Patterns of Institutional Sexual Abuse’, Response to Violence in the Family and Sexual Assault 7, 3 (1984): 1–11. Nolan, Peter. ‘Reflections of a Mental Nurse in the 1950s’, History of Nursing Society Journal 5, 3 (1994–5): 150–6.

BI BL I O G R A P H Y   3 4 7

Noll, Steven. ‘Patient Records as Historical Stories: The Case of Caswell Training School’, Bulletin of the History of Medicine 68, 3 (Fall 1994): 411–28. Normandin, Sebastian. ‘Eugenics, McGill, and the Catholic Church in Montreal and Quebec: 1890–1942’, Canadian Bulletin of Medical History 15, 1 (1998): 59–86. Odell, Tracy. ‘Disability and Relationships’, Canadian Woman Studies/Les Cahiers de la Femme 13, 4 (Summer 1993): 56–8. Paradis, André M. ‘L’asile québécois et les obstacles a la médicalisation de la folie (1845–1890)’, Bulletin canadien d’histoire de la médecine 11, 2 (1994): 297–334. Parm, Evelyn. ‘Good Old “999” ’, in Bonnie Burstow and Don Weitz, eds, Shrink Resistant: The Struggle Against Psychiatry in Canada (Vancouver: New Star Books, 1988), 111–15. Payne, Sarah. ‘Outside the Walls of the Asylum? Psychiatric Treatment in the 1980s and 1990s’, in Peter Bartlett and David Wright, eds, Outside the Walls of the Asylum: The History of Care in the Community, 1750–2000 (London: Athlone Press, 1999), 244–65. Peters, U.H. ‘The German Classical Concept of Schizophrenia’, in John G. Howells, ed., The Concept of Schizophrenia: Historical Perspectives (Washington: American Psychiatric Press, 1991), 59–74. Porter, Roy. ‘Bedlam and Parnassus: mad people’s writing in Georgian England’, in George Levine, ed., One Culture: Essays in Science and Literature (Madison: University of Wisconsin Press, 1987), 258–84. ———. ‘The Diary of a Madman, 17th Century Style: Goodwin Wharton, mp, and communer with the fairy world’, in R.M. Murray and T.H. Turner, eds, Lectures in the History of Psychiatry: The Squibb Series (London: Royal College of Psychiatrists, 1990), 128–43. Pos, Robert, J. Allan Walters, and Frank Sommers. ‘D. Campbell Meyers, m.d., 1863–1927: Pioneer of Canadian General Hospital Psychiatry’, Canadian Psychiatric Association Journal 20, 5 (Aug. 1975): 393–403. Postel, Jacques, and David F. Allen. ‘History and Anti-Psychiatry in France’, in M.S. Micale and R. Porter, eds, Discovering the History of Psychiatry (Oxford: Oxford University Press, 1994), 384–414. ‘Queen Street Mental Health Centre: Historical Development’, Queen Street Mental Health Centre, 1990. (Three-page flyer.) Radford, John P., and Deborah Carter Park. ‘ “A Convenient Means of Riddance”: Institutionalization of People Diagnosed as “Mentally Deficient” in Ontario, 1876–1934’, Health and Canadian Society 1, 2 (1993): 369–92. Raible, Chris. ‘999 Queen Street West: The Toronto Asylum Scandal’, The Beaver 74, 1 (Feb.-Mar. 1994): 37–43. Reaume, Geoffrey. ‘Psychiatric Patient Advocacy Groups, Institutions and a Medical Archives Bibliography’, in Marianne Fedunkiw, comp., Enhancing

348   BIBLIOGRAP HY

Communication and Community: A Proactive Healthcare Archives Assistance Policy (Toronto: Hannah Institute for the History of Medicine, 1994), 16–20. ———. ‘Keep Your Labels Off My Mind! or “Now I am Going to Pretend I Am Craze But Dont Be a Bit Alarmed”: Psychiatric History from the Patients’ Perspectives’, Canadian Bulletin of Medical History 11, 2 (1994): 397–424. ———. ‘Accounts of Abuse of Patients at the Toronto Hospital for the Insane, 1883–1937’, Canadian Bulletin of Medical History 14, 1 (1997): 65–106. ———. ‘Mental Hospital Patients and Family Relations in Southern Ontario, 1880–1930’, in Lori Chambers and Edgar-André Montigny, eds, Family Matters: Papers in Post-Confederation Canadian Family History (Toronto: Canadian Scholars’ Press, 1998), 271–87. ——— and Barbara L. Craig. ‘Medical Archives: An Update of the Spadoni Bibliography, 1986–1995’, Archivaria 41 (Spring 1996): 121–57. Risse, Guenter B., and John Harley Warner. ‘Reconstructing Clinical Activities: Patient Records in Medical History’, Social History of Medicine 5, 2 (Aug. 1992): 183–205. Rosenberg, Charles E. ‘Disease in History: Frames and Framers’, The Milbank Quarterly 67, 1 (1989): 1–15. Ross, D., P. Campbell, and A. Neeter. ‘Community Care: Users’ Perspectives’, in M.P.I. Weller and M. Muijen, eds, Dimensions of Community Mental Health Care (London: W.B. Saunders, 1993), 316–30. Sadowsky, Jonathan. ‘The Confinement of Isaac O.: A Case of “Acute Mania” in Colonial Nigeria’, History of Psychiatry 7, 1 (Mar. 1996): 91–112. Scull, Andrew. ‘Moral Architecture: The Victorian Lunatic Asylum’, in A. King, ed., Buildings and Society: Essays on the Social Development of the Built Environment (London: Routledge & Kegan Paul, 1980), 37–60. ———. ‘The Social History of Psychiatry in the Victorian Era’, in Scull, ed., Madhouses, Mad-Doctors and Madmen: The Social History of Psychiatry in the Victorian Era (London: Athlone Press, 1981), 5–32. ———. ‘The Domestication of Madness’, Medical History 27 (1983): 233–48. ———. ‘From Madness to Mental Illness: Medical Men as Moral Entre­ preneurs’, in Scull, ed., Social Order/Mental Disorder: Anglo-American Psy­chiatry in Historical Perspective (Berkeley: University of California Press, 1989), 120–61. ———. ‘Moral Treatment Reconsidered’, in Scull, ed., Social Order/Mental Disorder, 82–94. Shortland, M. ‘Screen Memories: Towards a History of Psychiatry and Psychoanalysis in the Movies’, British Journal for the History of Science 20 (1987): 421–53. Simmons, Harvey G. ‘Psychosurgery and the Abuse of Psychiatric Authority in Ontario’, Journal of Health Politics, Policy and Law 12, 3 (Fall 1987): 537–50.

BI BL I O G R A P H Y   3 4 9

Smith, Iain D., and Allan Swann. ‘In Praise of the Asylum—The Writings of Two Nineteenth Century Glasgow Patients’, in L. de Goei and J. Vijselaar, eds, Proceedings of the 1st European Congress on the History of Psychiatry and Mental Health Care (Rotterdam: Erasmus Publishing, 1993), 83–9. Sobsey, Dick. ‘The Media and Robert Latimer’, arch type (newsletter of the Advocacy Resource Centre for the Handicapped, Toronto) 13, 3 (Aug. 1995): 8–22. Solomon, Phyllis. ‘Response to “Consumers as Service Providers: The Promise and Challenge” ’, Community Mental Health Journal 30, 6 (Dec. 1994): 631–4. Spadoni, Carl. ‘Medical Archives: An Annotated Bibliography’, Archivaria 28 (Summer 1989): 74–119. Spiegel, David. ‘Mothering, Fathering and Mental Illness’, in Barrie Thorne and Marilyn Yalom, eds, Rethinking the Family: Some Feminist Questions (London: Longman, 1982), 95–110. Starkman, Mel. ‘The Movement’, Phoenix Rising: The Voice of the Psychiatrized 2–3 (Dec. 1981): S2–S9. Starr, Ann, and Susan Squier. ‘Speaking Women’s Bodies: A Conversation’, Literature and Medicine 17, 2 (Fall 1998): 231–54. Steadman, Henry J., et al. ‘Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighbourhoods’, Archives of General Psychiatry 55, 5 (May 1998): 393–401. Stephen, Jennifer. ‘The “Incorrigible,” the “Bad,” and the “Immoral”: Toronto’s “Factory Girls” and the Work of the Toronto Psychiatric Clinic’, in Louis A. Knafla and Susan W.S. Binnie, eds, Law, Society and the State: Essays in Modern Legal History (Toronto: University of Toronto Press, 1995), 405–39. Stodgill, C.G. ‘Joseph Workman, m.d., 1805–1894: Alienist and Medical Teacher’, Canadian Medical Association Journal 95 (29 Oct. 1966): 917–23. Sundram, C.J. ‘Obstacles to Reducing Patient Abuse in Public Institutions’, Hospital and Community Psychiatry 35, 3 (1984): 238–43. ———. ‘Strategies to Prevent Patient Abuse in Public Institutions’, New England Journal of Human Services 6 (1986): 20–5. Susko, Michael A. ‘Caseness and Narrative: Contrasting Approaches to ­People Who Are Psychiatrically Labeled’, Journal of Mind and Behavior 15, 1–2 (Winter/Spring 1994): 87–112. Taylor, Pamela J., and John Monahan. ‘Commentary: Dangerous Patients or Dangerous Diseases?’, British Medical Journal 312, 7036 (13 Apr. 1996): 967–9. Tomes, Nancy. ‘The Great Restraint Controversy: A Comparative Perspective on Anglo-American Psychiatry in the Nineteenth Century’, in W.F. Bynum, R. Porter, and M. Shepherd, eds, The Anatomy of Madness, vol. 3 (London: Routledge, 1988), 190–225.

350   BIBLIOGRAP HY

———. ‘Feminist Histories of Psychiatry’, in M.S. Micale and R. Porter, eds, Discovering the History of Psychiatry (Oxford: Oxford University Press, 1994), 348–83. Tylor, Peter L. ‘ “Denied the Power to Choose the Good”: Sexuality and Mental Defect in American Medical Practice, 1850–1920’, Journal of Social History 10, 4 (Summer 1977): 472–82. Walker, James W. St G. ‘A Case for Morality: The Quong Wing Files’, in Franca Iacovetta and Wendy Mitchinson, eds, On the Case: Explorations in Social History (Toronto: University of Toronto Press, 1998), 204–23. Walton, J.K. ‘Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840–1870’, in W.F. Bynum, R. Porter, and M. Shepherd, eds, The Anatomy of Madness: Essays in the History of Psychiatry, vol. 2 (London: Tavistock, 1985), 132–46. Weaver, Bill L. ‘Survival at the Alabama Hospital for the Insane, 1861–1892’, Journal of the History of Medicine and Allied Sciences 51, 1 (Jan. 1996): 5–28. ‘Will the Charter Change Sheltered Workshops?’, Phoenix Rising: The Voice of the Psychiatrized 5, 2–3 (Aug. 1985): 31A–32A. Willer, Barry, and Gary Miller. ‘Classification, Cause and Symptoms of Mental Illness: 1890–1900 in Ontario’, Canadian Psychiatric Association Journal 22, 5 (Aug. 1977): 231–5. Woiak, Joanne. ‘ “A Medical Cromwell to Depose King Alcohol”: Medical Scientists, Temperance Reformers, and the Alcohol Problem in Britain’, Histoire Sociale/Social History 27 (1994): 337–65. Wolff, Eberhard. ‘Perspectives on Patients’ History: Methodological Considerations on the Example of Recent German-Speaking Literature’, Canadian Bulletin of Medical History 15, 1 (1998): 207–28. Zubin, Joseph, Stuart R. Steinhauer and Ruth Condray. ‘Schizophrenia from an American Perspective’, in William Flack Jr et al., eds, What Is Schizo­ phrenia? (New York: Springer-Verlag, 1991), 17–31.

Unpublished Secondary Sources Brown, Thomas. ‘ “Living with God’s Afflicted”: A History of the Provincial Lunatic Asylum at Toronto, 1830–1911’. Ph.D thesis, Queen’s University, 1980. Edginton, Barry. ‘The Formation of the Asylum in Upper Canada’. Ph.D. thesis, University of Toronto, 1981. Kelm, Mary-Ellen. ‘Women and Families in the Asylum Practice of Charles Edward Doherty at the Provincial Hospital for the Insane, 1905–1915’. ma thesis, Simon Fraser University, 1990. Moran, James E. ‘Insanity, the Asylum and Society in Nineteenth Century Quebec and Ontario’. Ph.D. thesis: York University, 1998.

BI BL I O G R A P H Y   3 5 1

Paskauskas, R. Andrew. ‘Ernest Jones: A Critical Study of His Scientific Development (1896–1913)’. Ph.D. thesis, University of Toronto, 1985. Pos, Robert, Alan Walters, and Frank Sommers. ‘The History of Psychiatry at the Toronto General Hospital’, 1972. (A copy of this manuscript is available at the Archives on the History of Canadian Psychiatry and Mental Health Services, Centre for Addiction and Mental Health, Queen Street Division, Toronto.) Reaume, Geoffrey. ‘999 Queen Street West: Patient Life at the Toronto ­Hospital for the Insane, 1870–1940’. Ph.D. thesis, University of Toronto, 1997. Reaume, Geoffrey, Ruth Ruth, Ken Innes, and the Puzzle Factory, Friendly Spike Acting Troupe. ‘Angels of 999’. Toronto, playscript, 1999. Szigeti, Anita. ‘Legal and Ethical Objections to Coerced Psychiatric Treatment in the Community’. Paper presented to the 24th International Congress on Law and Mental Health, University of Toronto, 18 June 1999.

Index

Abbie G., 67 Aberdeen, Governor-General, 43–4 Abuse and violence, 38–44, 247, 276n.65, 279n.67 Abused wives, 204 Abuse reports, contentious nature of, 80 Abusive men, incarceration of, 43 Adam C., 197 Ada T., 63 Admission process, 23–8 Admissions, 1846–1940 (table 11), 209 Agatha B., 192 Agatha H., 81 Agatha L.S., 305n.34 Agatha T., 42 Airing courts, 110 Alan L., 203, 310n.78, 310n.82 Albert A., 10 Albert C., 231 Albert L., 62 Alcohol, 14–15, 55, 170n.45 Alcoholism, 17 Alexandria Industrial School, 39 Alex C., 67, 89–90, 220–2, 247, 285n.111, 315n.46 Alice G., 177 Alice H., 201 Alice M., 92, 134 Alicia F., 10, 58, 65, 89, 189 Aline P., 153 Allen D., 99, 191, 306n.39 Amnesia, 236–7

Andrew H., 154, 196–7 Andrew J., 228 Angela B., 84–6, 256 Angela H., 283n.94 Angel Queen XIII (Felicity A.T.), 120–5, 127–8, 134, 144, 248, 253, 293n.78, 293n.82, 294n.86 Anita B., 9 Anita C., 39 Anna C., 89 Anna N., 62 Anna O., 119, 241, 293n.77 Anna P., 229, 240 Anne D., 11, 39–40, 89, 175–6, 204–6, 249 Annette F., 64 Annie E., 229–30 Ann P., 10 Apoplexy, 228 Archibald, Deputy Police Chief, 97–8 Aries, Philippe, 227 Arlene S., 68–70, 235, 285n.105 Armstrong, S.A., 153, 183, 193 Arnold S., 72, 278n.61 Arturo C., 290n.43 Association of Medical Superintendents of American Institutions for the Insane, 88 ‘Asylum’, negative connotations of, 183 Asylum architecture, 23 Audrey B., 48–9, 63–4, 169–71, 179, 247

352

I N D E X    353

Ault, Dr, 200 Autopsies, 239 Avis S., 66, 277n37 Bates and Dodds Undertaking Parlour, 241–2 Beatrice M., 10 Bedlam hospital, London, England, 182 Belinda R., 242 Bellamy home, 40 ‘Bench patients’, 84 Bennett, R.B., 194 Bethlehem Royal Hospital, London, England, 182 Bible Flower Mission, 184 ‘Bibliotherapy’, 113 Bigotry, 80, 193, 219. See also Racism Births, after confinement, 181–8 Bleuler, Eugene, 15–16 Bogdan, Robert, 182 Booth Copper Company, 154 Boston Psychopathic Hospital, 87 Bowden, Miss, 170 British Columbia Provincial Hospital for the Insane, 54 British Medical Association, 16, 314n.37 Brockville, Ont. mental hospital, 19 Bromides, 14 Brown, Thomas E., 16, 81 Bucke, Richard, 30 Bulletin of the Ontario Hospitals for the Insane, 91 Burrell, R.H., 236 Butler Hospital, Rhode Island, 134 Canadian National Exhibition (cne), 94, 110, 118, 183, 196–7 Card parties, 104 Carl G., 48–9 Carl M., 175, 237 Caroline L., 190 Caswell, E.S., 285n.111 Censorship, of patients letters, 21, 73, 88, 91, 129, 286n.115

Certification process, biases in, 27 Chamberlain, Inspector, 186 Charles M., 105, 289n.28 Chewing tobacco, 115 Chloral hydrate, 14 Chlorpromazine, 20 Christie, Robert, 144, 153, 176, 185, 211, 241 Christmas celebrations, 105 Christopher B., 42 Chronic-care patients, 4, 7, 21, 210, 248 Chronic disorders, 19 Church-run charities, 307n.46 Cindy R., 116, 292n.65 Cindy W., 186–8 Circulatory diseases, 226 Clare, Harvey, 9, 12, 16–17, 62, 117, 163–4, 188, 200, 206–7, 217–19, 232 Clark, Daniel, 8–10, 12–15, 23, 26, 30, 35–6, 44, 46–7, 51, 71, 76, 86, 88–9, 92, 94, 96, 102–4, 110, 112–13, 127, 134, 136, 138, 143–4, 147, 150, 154, 159–60, 176, 182, 185–7, 190, 192–3, 195, 197, 201, 203, 231, 236, 239, 241, 283n.94 Clark, W.J., 176 Clark, Wilfred S., 151 Clarke, C.K., 7, 9, 15–17, 26, 65, 82, 86, 92, 99, 105–6, 122, 153, 164, 182–3, 187, 189, 191, 193, 196, 198–9, 201, 212, 215–17, 240, 283n.94, 285n.111; racism and classism of, 313n.28; arrogance of, 320n.6 Classification, 18 Classism, 125, 313n.28; See also Class prejudice Class location, of patients, 10 Class prejudice, 74, 87, 182, 248; See also Classism Cleland, C.A., 301n.76 Clothing, making of, 120–1 cn Tower, 7 Coatsworth, Mr, 175 Cobourg House of Refuge, 34, 93, 97–8, 153, 191

354   INDEX Cod-liver oil, 15 Coercive psychiatry, 256 Coid, Jeremy S., 280n.68 Cold conditions, 10 Committal process, protocol of, 25 Community ostracism, 196, 250; See also Stigma, towards patients and families Community treatment orders, 256 Concerts, 103 Confinement circumstances, variety of, 24 Connie D., 9, 106 Constance B., 161–2 Consumer/Survivor Development Initiative, 298n.3 ‘Continuous bath’, 63 Coreen K., 98–9, 128–31, 143, 248, 295n.100, 296n.106–8 Corley, Miss, 295n.102 Craig, Barbara, 17 Cross-border migration, to United States, 49 ‘Cure’ rate, 210 Custodial confinement, of psychiatric patients, 22 Cynthia H., 30–1 Cyril M., 106, 231, 289n.30 Dances, 103 Daniel K., 70–1, 179 Daniel M., 188 Daniel R., 153 Daniel T., 151 Davies, Reverend, 241 Days worked, by occupation and gender (table 6), 139–42 Deaths, 64, 223–39; causes, 1846–1920 (table 12), 225; causes, 1939–1940 (table 13), 227 Delusions, 38, 43, 53, 65–6, 276n.36 Dementia praecox, 16–17, 217, 222, 264n.58, 314n.37, 320n.6. See also Schizophrenia Dental treatment, 12, 15 Dentists, on staff, 13

Denty, Miss, 70–1 Department of Indian Affairs, 105 Depression, 13, 40, 53, 190, 192. See also Manic depression Description of the Retreat (Tuke), 133 Diagnosis documents, 24–5 Diagnostic updating, 13 Dickson, Charles Rea, 37 Diet, patients and employees, 1917 (table 3), 59–60 Dietary guidelines, 58 Diet roll, patients and attendants, 1878 (table 2), 56–7 Disabilities, patients with: abuse of, 281n.72; confinement of 51–2, 75; exploitation of, 320n.7 Discharge, process and aftermath of, 212–23 Discharge rates, 209–12 Discharges, 1846–1940 (table 11), 209 Domestic violence, 38, 201; medicalizing of, 40, 249 Dovercourt Road Baptist Church, 241 Dowbiggin, Ian, 31, 245, 313n.28 Drug and toxic problems, 17 Drugs, 14. See also specific drugs Dunlop, Inspector, 206, 235 Duodenal cancer, 231 Dwyer, Ellen, 62, 73–4, 101, 160, 179, 211, 214, 179n.67, 280n.68 Dyson, John, 215 Eaton’s, 124 Edema, 229 Edith D., 204 Edna B., 168 Edna S., 195 Edward D., 152, 174, 290n.36 Edward M., 37–8 Edward S., 195, 197 Edwina O., 207–8 Egbert G., 199–200, 308n.62 Egbert R., 153 Elaine K., 61 Elaine M., 71, 84, 113

I N D E X    355

Elaine O., 11, 82–3, 87–8, 161, 175, 251, 282n.81, 282n.85 Elaine Y., 187–8, 198 Elderly, confinement of, 46–7 Electro-convulsive therapy, 20 Elizabeth H., 231 Ellen G., 38, 112, 131, 195, 229, 291n.50, 291n.64 Ellen H., 196–7 Ellen K., 98–9, l28, 130–1, 143, 238, 240, 295n.100, 297n.112 Ellen M., 30, 143 Ellen S., 93–9 ‘Elopers’, 198 Elsa P., 77, 80–1, 87–8, 165 Elsa W., 89, 180, 249 Employment types and number of working patients (table 5), 137–8 Employment types, by occupation and gender (table 9), 156–8 Enid C., 291n.58 Enid W., 88–9, 161 Epilepsy, 32–3, 164, 238 Erin L., 228 Erin P., 143 Erin W., 200 ‘Erotomania’, 81 Escapes, 68–9, 71, 106, 211, 278n.56, 280n.33; community responses to, 197–201; motives for, 70 Esther B., 27–8 Esther H., 151, 180 Ethnic prejudice, 74; See also Racism; Bigotry Etta C., 190 Ettie F., 193–4 Ettie M., 63 Eugenics movement, 31, 35, 182, 245 Eve L., 189–90, 305n.36 Evelyn F., 46, 239 Evelyn T., 93, 229 Eve S., 33 Exhaustion, 17, 229–31 Family relations, 91–9, 93, 99 ‘Feeble-mindedness’, 31–3, 182

Felicity A.T. (Angel Queen XIII), 120–5, 127–8, 134, 144, 248, 253, 293n.78, 293n.82 Female Infirmary, 224 Female-only wards, 96 Female sexuality, and admission, 29 Feminine physiological experiences, 29 Fever cabinets, 13, 19 Flies, 261n.27 Florida Farm Colony, 87 Forced treatment, 256 Force-fed liquids, 15 Form A (diagnosis document), 24 Form of History, patient, 25 Form K (diagnosis) document), 24 Forster, J.M., 12, 16, 64, 86–7, 89, 97–8, 117–18, 129–30, 134, 154, 165, 175, 177, 189, 194–5, 204, 206, 213, 219, 235, 239 Frances C., 29, 207–8 Francis B., 233–5 Francis C., 197 Francis F., 153–4 Frank G., 199–200, 308n.63 Frank I., 43–4 Freedom of Information and Protection of Privacy Act, 4, 258 Free wards, 8; diet for (table 2), 56–57 Gardner, Dr, 30 Geller, Jeffrey, 73 Gender and sexuality, 29–38 Gender and segregation rules, 63 Gene A.T., 121 Gene B., 26 Gene P., 58 General paresis, 17 Geoffrey P., 153 Geoffrey T., 104 Georgette D., 27 Gilbert D., 98–9, 191 Gilmour, Warden, 153 Gina B., 276n.36 Gittins, Diana, 96 Gladesville Asylum, Australia, 92 Glasgow Royal Asylum, 133

356   INDEX Gloria D., 47 Goodwill Industries, 298n.3 Gordon, Linda, 249 Grace B., 9, 195 Graeme L., 1–2, 253 Grafton, Royal, 198, 200 Great Depression, 241 Gregory F., 93 Gregory L., 189–90 Grob, Gerald N., 49, 73–4, 76, 211, 279n.67, 280n.68 Gynecological surgery, 30–1. See also Sexual surgery Hamilton, Ont. mental hospital, 19, 33–4, 42, 55, 89, 136, 192, 194, 201, 236, 278n.61, 285n.106 Hanna, Provincial Secretary, 89 Hanna M., 10 Harold C., 197 Harold M., 185–7 Harold T., 42–4 Harriet T., 151 Harris, Maxine, 73 Harris, Mike, 256 Harrison, J.P., 17 Haven, The (shelter), 32–3, 39 Hazel G., 176 Hazel W., 81 Heart disease, 226, 231 Heat prostration, 10 Henrietta B., 125–8, 294n.94, 295n.96–7 Henrietta C., 190–1 Henry A., 46, 163, 189, 216, 218–20, 248 Henry A.A., 315n.45 Henry A.A., Mrs, 313n.34 Henry K., 239 Henry S., 70 Heredity, and mental illness, 17, 182, 195, 208 ‘Heroic’ treatment, 13, 19–19, 21, 210 Herpes zoster, 174 Herriman, W.C., 16, 103, 188 Hobbs, Dr, 30

Hodgson, Miss, 97 Hollie M., 295n.102 Home for Aged Women, 193–4 Homeless patients, 49 Homes for the Mind (Dwyer), 101 Homewood Sanitarium, Guelph, 30, 35, 49, 68, 87 Homosexual behaviour, 34; discrimination against, 269n.37 Hospital bureaucracy, modernization of, 17 House of Industry, 198, 236–7 House of Providence, 32, 185, 193 Howitt, J.R., 19, 169 Hughes, John S., 14, 62 Hydrotherapy, 12, 18, 63 Hygiene, daily, 55 Hysterectomy, 30 ‘Hysteria’, 29 ‘Imbeciles’, 17 Immigration policy, 215 Incontinence, 75 Indian Act, 105 Industrial operations, of patient labour (table 8), 149 Infant’s Home, 185–7, 304n.27 Infectious diseases, 226 Influenza epidemic (1918), 227–8 Inmate/ward staff ratio, 87–8 Insects, 9 Inspector of Asylums, 26, 47, 86 Inspector of Public Charities, 25 Insulin, shock treatment, 13, 19 Internal economy, for self-support, 154 Interventionist treatments, 18, 21. See also ‘Heroic’ treatments Involutional melancholia, 17, 19 Irene B., 143, 192–3, 229, 241, 250 Isabel M., 50 Ivey L., 172–3, 177 Jack H., 201–2 Jack P., 91, 176, 179 Jacob H., 283n.95 Jake M., 178

I N D E X    357

James D., 47–8 James L., 190 James W., 154 Jane F., 104, 164 Janet C., 174 Jason O., 45 Jauregg, Julius Wagner von, 19 Jean V., 124–5, 134 Jed M., 228 Jed R., 26–7, 41 Jeremiah T., 198, 200 Jerold M., 49–50, 65, 143, 250, 274n.93 Jim C., 45 Jimmy M., 174 Jim P., 107–9, 151, 290n.38 Jim W., 76–7, 113 John C., 197 John H., 40–1, 236 John K., 295n.100 John Y., 10, 187, 198–9, 201, 228 Jonathan D., 236–7, 243, 249, 252–3 Jonathan T., 161 Jones, Ernest, 18, 264n.63 Joseph G., 70 Joseph S., 201 Josiah M., 193–4, 252 Josie B., 160–1 Katerina D., 76 Katerina G., 10, 194 Kingston, Ont. mental hospital, 19, 55, 74, 172, 203–4, 285n.106, 310n.78. See also Rockwood Asylum Kirkbride, Superintendent, 91 Kraepelin, Emil, 12, 16–17, 159 Labour, of patients: coercion and, 151; compensation and, 160–6; con­di­tions of, 173–9; days worked, by occu­pa­ tion and gender (table 6), 139–42; days worked, percentage of (table 4), 135; decline of, 159; emotional meaning of, 168; employ­­ment types and number of workers (table 5),

137–8; employ­ment types, by occupation and gender (table 9), 156–8; gender bias and, 155; gender divisions of, 146; industrial opera­ tions (table 8), 149; internal class system and, 153; outdoor, 150, 152; self-esteem and, 166–71, 179; structural projects (table 7), 147–8; as therapy, 134, 146, 159–60, 165, 250; workplace health standards, 174 Lancaster, England asylum, 224 Langmuir, Jospeh, 14, 55, 110, l34, 138, 144, 152 Language barriers, 50–1 Latimer, Robert, 281n.72 Latimer, Tracy, 281n.72 Laughlen, F., 236 Laura D., 202 Laura L., 154 Laurie D., 177 Laziness, 111 Lee F., 50, 216, 274n.101 Leisure, 101–16; class structure and, 111; culture of, 102, 132; outside financial aid and, 105, 124; scope of, 102; support networks and, 105–6 Leisure privileges, social class and, 131 Leonard G., 69 Letter writing, 115 Library, 112 Lieutenant Governor of Ontario, 25 Lincoln, Abraham, 118 Living environment, quality of, 9–11 Lizzie C., 31, 138–9, 247, 253 Lobotomies, 13, 20 London, Ont. mental hospital, 1, 19, 30, 55, 138, 143, 201 Loretta M., 189 Louisa C., 220, 222 Lower-class inmates, 273n.92 ‘Lunatic at large’, 197–8, 308n.59 Lunbeck, Elizabeth, 35, 87 Mabel G., 273n.91 Mabel I., 111, 131, 152, 233, 291n.49 Mabel M., 171–3, 177

358   INDEX McCandles, Peter, 87, 101, 159 McClenahan, Dr, 84 McCreary, W., 106 McGuire, William, 285n.111 Machell, Dr, 47 MacKenzie, Charlotte, 133, 195, 210 McLaren, Angus, 31–2, 182 Mclean, F.W.F., 98 McLean Hospital, Waverly, Mass., 49–50, 274n.93 MacMurchy, Helen, 32 Madeline B., 23 Madge C., 46 Madge M., 32, 249 Magdelaine C., 197 Maguire, Mayor, 164 Mail censorship, 21, 73, 88, 91, 129; See also Censorship, of patients’ letters Malarial treatments, 13, 18 Manganese chloride, 13, 18 Manic depression, 17, 19; See also Depression Marcia B., 242 Marcia F., 34–5 Margaret B., 93–4 Margaret D., 191, 306n.39 Margery A., 10 Marianne B., 162 Marion H., 38–9, 41 Martha B., 195 Mary A., 46, 61, 162–4, 179, 189, 216–21, 240, 243, 248, 272n.83, 305n.35, 313n.34, 314n.36, 315n.44 Mary D., 10, 240 Mary M., 86, 168 Mary S., 176 Masonic Hall, 48 Masturbation, 35–7, 270n.45; pathol­o­ gizing of, 38 Mathilda C., 239 Mathilda K., 167 Mathilda M., 34–5, 184–8, 193 Maude B., 9 Maude M., 232 Mavis M., 111, 189, 237

May F., 61, 109–10, 237–8, 241, 290n.39 May K., 11, 89, 175, 204–5, 207 Mazumdar, Pauline, 31, 312n.5 Mealtime routines, 55 Medical conferences, 12 Medical therapeutics, course of (table 1), 12–13 Medical treatments: classification period, 12, 18; interventionist period, 13, 18, 21; noninterventionist period, 12, 14 Medication, administration of, 55 Meningitis, 242 Menopause, 29–30 Mental hospital patients, public perceptions of, 181–4; female body, madness and, 181; manliness, ideas about, 181 Mercer Reformatory, 7 Metrazol shock treatment, 13 Meyers, Campbell, 199 Michael F., 231–2 Mildred O., 92–3 Milicent M., 231 Millie O., 45 Mimico mental hospital. See New Toronto mental hospital Minnie B., 62–3, 195, 223 Mitchell, J.A., 197, 214 Mitchinson, Wendy, 29, 92, 143, 148, 181, 278n.56 Montgomery, S.R., 155, 159 Montigny, Edgar-André, 46 Moodie, Susanna, 134 Moral therapy, 11, 14, 101, 133, 144, 178, 288n.1 Moran, James, 62, 86, 91, 134, 283n.95 Morphy, Dr, 62 Mortality rates, 224 Mount Cashel orphanage, Newfoundland, 281n.78 ‘Moving picture shows’, 103, 129 Murder, 231, 317n.78 Musical activities, as therapy, 111 Mutiny, against attendants, 72

I N D E X    359

Nancy D., 70, 76–7, 290n.33 Nancy K., 230 National Council of Women, 32 Nelly H., 229, 231 Neuroleptic drugs, 20 Newspapers, 113, 166 New Toronto (Mimico) mental hospital, 13, 152 Nina B., 223 Nolan, Peter, 61 Noll, Steven, 87 Novarsam, 13 Noxon, James, 58, 152 Nurses, scarcity of, 284n.99 Nurses’ training school, 12, 17 Occupational therapy programs, 159, 298n.3 Old age, as cause of death, 226, 228 Oldright, William, 32, 41 Oliphant, David J., 38–9 Ontario Employment Standards Act, 298n.3 Opium, 14 Oppenheim, Janet, 35, 181 Orangemen’s parade, 121 O’Reilly, Inspector, 106 Organized recreation, gender and, 288n.17 Orillia, Ont. asylum, 26, 33, 42, 153, 268n.32 Outdoor work, 150, 152 Out-patient service, 13 Outsider visits, 115, 188–91 Overcrowding, 7–8; at Orillia asylum, 268n.32 Packard, Elizabeth, 88 Paresis, 226 Paris green (insecticide), 150, 299n.33 Park Lawn Cemetery, 241 Patient culture, richness of, 116, 118, 246 Patient days worked, percentage of (table 4), 135 Patient names, anonymity of, 4, 258

Patient population, diversity of, 20 Patients’ complaints, pathologizing of, 81 Patients’ experiences, 5 Patient’s release, fear of, 201–3 Patients’ rights: advocates, lack of, 80; promotion of, 265n.75 Patient support and neglect, by family members, 203–8 Paul K., 89, 204–5 Paul M., 237 Paying patients, 8, 262 Paying wards, 11; diet for (table 2), 56–7 Penetanguishene, Ont. mental hospital, 153, 184, 190 Pennsylvania Hospital for the Insane, 54, 91 People First, 320n.7 Periodicals, of former psychiatric patients, 266n.75 Personal biases, of recording physicians, 28 ‘Personal space’, 102, 105–16 Peterson, Dale, 73 Phthisis, 238 Physical affection, among inmates, 91–9 Physical and verbal abuse, of inmates, 73–90; acceptance of, 84; apologies for, 75, 84; See also Abuse and violence Physical appearances, as stigma, 65 Physical restraints, 14; abolition of, 86 Physical training classes, 104 Pinel, Philippe, 11, 14 Pneumonia, 124, 166, 174, 226, 229–30, 232–3 Political beliefs, and certification process, 27 Poor hygiene, 9 ‘Popular Delusions About the Insane’ (Clark), 183 Post-mortem exams, 239 Post-partum depression, 29 Poverty, and asylum admission, 47, 51

360   INDEX Power imbalances, between patients and staff, 81, 247 Pregnancy, 92; See also Births, after confinement Prison transfers, 25; class ‘shame’ and, 46 Promiscuity, as mental deficiency, 31 Prospect Cemetery, 241 Psychiatric diagnoses, chaos of, 17 Psychiatric history, patient perspectives on, 322n.12 Psychiatric patient groups, 321n.9 Psychiatrists, power of, 246 Psychosurgery, 20; See also Lobotomies Public wards, 11 ‘Puerperal insanity’, 23, 29, 207 Queen Street Mental Health Centre Records, Archives of Ontario, 3 Queen Victoria, 43 Racism, 51, 216, 313n.28; See also Bigotry Ralph M., 10, 58, 77–8, 88 Randall F., 214 Randall P., 145 Rats, 9 Ray, Isaac, 134 Reading, 112–13, 184, 291n.58; thera­ peutic influence of, 113 Recovery rates, 210 Recreational pursuits, as self-therapy, 128 Reginald C., 10, 194 Reginald F., 10, 58, 65, 89, 143, 189 Relationships, among patients and staff, 61–8 Religious bigotry, 32 Religious services, 104–5 Remains of patients, disposal of, 239–42 Repressive attitudes, and committal process, 53 Research methodology, 5

Residential homes, 21 Respiratory diseases, 226 Rhonda B., 196 Rhonda D., 91 Richardson, James, 34 Richard W., 51 Ridout, Ina, 304n.27 Ripa, Yannick, 136, 143, 146, 223 Robbins, H.M., 207–8, 244, 249 Rochelle W., 116 Rockwood asylum, 203. See also Kingston, Ont. mental hospital Rogers, Inspector, 58 Ross, W.K., 94–7, 196, 237 Russell, James, 30 Ruth B., 196 St John’s training school, 281n.78 St Joseph’s Hospital, 236 St Joseph’s training school, 281n.78 St Michael’s College, 237 St Michael’s Hospital, 222 Sally S., 201 Salvation Army, 320n.7 Salvation Army home, 40 Salversan, 13, 18 Samantha C., 26 Sandra C., 197, 240 Sandra L., 203–4 Sandra S., 29, 93–7, 99 Sandra T., 42, 167–8 Schedule 2 (prison transfer document), 25 Schizophrenia, 13, 16–17, 19, 263n.49, 264n.58 Scull, Andrew, 23, 144, 159 Segregated wards, 55 Self-inflicted violence, 67 Senility, 17, 237 Severalls Hospital, Britain, 96 Sewing projects, 112; See also Felicity A.T. Sexual abuse, 81–2; pathologizing of, 39 Sexual harassment, 39, 41, 251, 268n.34, 282n.88

I N D E X    361

Sexual orientation, pathologizing of, 269n.37 Sexual promiscuity, 34, 53 Sexual relationships, among inmates, 91 Sexual surgery, 12, 15; See also Gynecological surgery Shaving, by male patients, 275n.5 Shingles, 174 Shock treatment. See Insulin shock treatment; Metrazol shock treatment Electro-convulsive therapy Shortt, S.E.D., 143, 210, 226 Simmons, Harvey, 31 Simpson’s, 124 Small, Ambrose J., 236 Smallpox, 226 Smoking, 15, 291n.63 Sobsey, Dick, 281n.76 Social control, and confinement, 53, 73 Social life, 63 Social support networks, 45–52 Sophia S.,111, 291n.46 South Carolina State Hospital, 87, 101 Spinal drainages, 13 Staff departures, 277n.45 Stafford, Ezra H., 16, 203, 239, 289n.30 Stanley G., 195 Stanley L., 153 State power, and psychiatric patients, 21, 249 Statistics, 5 Stella S., 195 Stenhouse, John, 37 Stephen E., 43 Stereotyping, of asylum inmates, 279n.67, 280n.68 Sterilization, 182 Stigma, towards patients and families, 191–7, 250–2 Storytelling, 115 Strachan, Miss, 96 Strange, Carolyn, 83 Structural work with patient labour (table 7), 147–8

Strychnine, 239 ‘Subnormal population’, 244 Suicide, 231, 233, 235, 285n.105 Sulfoxyl salvarsan, 18 Superintendents, terms of, 263n.50 Sylvie B., 290n.45, 291n.64 Syphilis, 13, 19–19, 81 Teeth and gum care, 15; See also Dental treatment Terence J., 215 Theft, 66 Theodore F., 166 Theodore R., 174 Threats, uttering of, 43–4 Ticehurst Private Asylum, 195 Timothy F., 106 Timothy M., 86 Timothy P., 173, 302n.90 Tomes, Nancy, 83, 144, 183, 195 Tom M., 22 Toronto, growth of, 6 Toronto Evening Telegram, 113 Toronto Gaol, 34 Toronto General Hospital, 23, 26, 200 Toronto General Trusts Corporation, 295n.100, 295n.102 Toronto Globe, 113 Toronto Hospital for the Insane: admission process, 23–8; coercive structure at, 21; cottages at, 7; daily routine at 54–6; dismal entrance to, 23; dome tower at, 7; fear of build­ ing, 23; female infirmary at, 224; medical setting at, 11–12; name evolution of, 6–7, 260n.12, number of patients at, 1870–1940, 2; number of patients at, 1841–1870, 3; overcrowding at, 7; physical setting of, 6–11; resistance at, 68–73; as a shelter, 20, 211; staff residences at, 8; superintendents at, terms of, 263n.50; ward verandahs at, 10–11, 110, 183, 262n.33 Toronto Psychiatric Hospital, 20 Transfer warrant, from prison, 25

362   INDEX Trent, James W., 31 Trinity Hospital, 130 Troman, Mrs, 46 Tryparsamide, 13 Tuberculosis, 226, 239, 25–42 Tuke, Samuel, 133 Tuke, William, 6, 11, 14, 159, 178 Typewriters, and record-keeping, 17, 278n.65 Ueberschar, Marianne, 278n.65 ‘Unfit’ immigrants, 215 Unrecorded deaths, 226 Ussher, Jane, 29 Utica, N.Y. asylum, 93, 179, 284n.101 Valenstein, Elliot S., 19 Verandahs, 10–11, 110, 183, 262n.32 Verbal violence, 43 Veronica T., 294n.90 Vincent J., 52 ‘Violent mental patient’, myth of, 75, 253 Violet N., 165, 238, 249, 290n.36 Visits, by relatives and friends, 188–91 Vrooman, F.S., 16, 61, 165, 168, 174, 207–8, 229, 238 Walking parties, 106, 290n.33 Wallace M., 115, 291n.61 Wallace S., 153 Walter B., 70 Walter D., 175, 204–6 Walter G., 41, 166–7, 301n.76 Walter S., 189, 305n.34 Walter T., 114–15, 291n.62 Walton, J.K., 224 ‘Wandering womb’, 29 Ward verandahs, 20–11, 110 Warehousing, of psychiatric patients, 22

Warren S., 65, 169, 241 Warsh, Cheryl Krasnick, 35, 68, 87, 133, 143, 196, 217 Water therapy, 18; See also Hydrotherapy ‘Wayward females’, 32 Webster, John, 89 Weir, Miss, 96 Wells, Josephine, 15, 263n.45 Wendell C., 89 Wesley P., 177, 212–14 Wesley W., 81 Whisky, 15, 229 Whitby, Ont. mental hospital, 19, 93, 97–8, 152 Widdifield, Dr, 26 Wilfred S., 41, 153 Willard C., 58 Willard, N.Y. asylum, 73, 87, 101, 179, 284n.101 William B., 285n.106 William D., 202, 310n.76–7 William G., 143 William P., 36, 38 William S., 276n.36 Wilson, Dr, 153 Winslow H., 64–5 Winston, Dr, 63 Winston O., 116–19, 122, 128, 131, 237, 241, 247, 292n.66, 293n.77 Winter leisure activities, 103 ‘Woman as hypersexual’, 35 Women’s private behaviour, pathologizing of, 33 Wood, Mary Elene, 83 Working conditions, of employees, 74 Workman, Joseph, 12, 14, 133, 145, 148, 182, 210, 212, 238 Workplace health standards, 174 World War I, 118 Worth, Pat, 320n.7 York County Gaol, 32–3, 47

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