SUNLIGHT THROUGH SHADOW

Story of the Development of Mental Hospitals in the Dominion of Canada

NORMAN REILLY RAINE March 15 1923

SUNLIGHT THROUGH SHADOW

Story of the Development of Mental Hospitals in the Dominion of Canada

NORMAN REILLY RAINE March 15 1923

SUNLIGHT THROUGH SHADOW

Story of the Development of Mental Hospitals in the Dominion of Canada

NORMAN REILLY RAINE

The first of three articles : Mimico Mental Hospital

THE radial car bumped its way over the mellow Ontario landscape. Outside, all the country round was golden with crops and sunlight. A late summer breeze whirled the dust in clouds along the highway.

“Mimico Asylum next!” the conductor announced. The fat man leaned forward and his paper slid off his lap to the floor.

“Great Scott!” he said, “—imagine being cooped up in a lunatic asylum!” He subsided into morbid contemplation of his thought.

The car jolted to a stop. I got out and looked about me.

Open gates denoted the way into the grounds, but aside from the swaying trees and other growing things there was no sign of life. No guards —not even a gate attendant to intimate detention. A long sweeping drive led over an artistic stone bridge to where the Administration building stood, behind a floral centrepiece picked out in color spots of russet, scarlet and gold. In easy curves from the flanks of the main building stretched verandahed cottages. Summer fabrics showed prettily in thé shadows.

Two children, a fair-haired boy and girl, were playing at the foot of the steps. They glanced up shyly as I passed, then rippled into laughter at my wink.

“Isn’t he a funny man, Blair?” the l'ttle girl remarked. “New doctor, I dess!” Blair replied.

In the cool, shadowed hall a lady approached, trim, kindly faced, with enquiring eyes.

“Is Dr. Beemer in, please?” I asked.

She went in search of him. Presently—he came, a tall erect figure, his strong, benevolent face lined with years of ministration and responsibility. He ushered me into his office. When I had explained my mission he sat silent for a time, musing. Then he said:

“You wish to tell the public what is being done for the mentally deficient of Canada. . . .well, I could tell you, of course, but may I suggest that a better way will be for you to come and spend some time with us, learn the routine, and see for yourself, through constant contact, the work that we are doing and what we are trying to accomplish.”

I accepted with thanks.

No “Asylums” To-day

THAT night, sitting alone in the room assigned to me, I watched, through the open window, the lights of patients’ cottages a few yards away. They filtered through soft-hued curtains in beams of yellow and warm crimson. A piano was being played by gentle, skilled fingers in one of the cottages. A motor car rolled over the gravel drive, its lamps lighting the trees beyond to seconds of vivid green. Then the deep, soothing silence of a summer night.

Where, then, were the wild, mad cries, the bloodcurdling moans and the creeping terrors of sensational literature? I thought of the words of Dr. MacLennahan, the assistant superintendent, whose quiet voice and rare smile revealed a fine, equable nature.

“Asylums? There are none in Canada. But there are Mental Hospitals—or, if you prefer, Hospitals for the Treatment of Mental Disease.... for they are hospitals, and nothing else. As for the morbid horrors of lunacv you will have to go to the novelist and to the screen for them. They are non-existent here, as I hope to show you to-morrow.”

Thus I discovered that in the vocabulary of the new psychiatry, such terms as “insane asylum,” “lunatic asylum,” and “madhouse” have no place, being ousted by the more truly descriptive and less harsh term, “mental hospital.” The occupants thereof are no longer stigmatized as lunatics, crazy people or inmates, but are known simply as patients, as in hospitals for the treatment of physical frailties. It is a significant thought, and expresses the trend of modern treatment of mental ills. The narrow thoughtlessness of the appellations formerly

in use was a guide to the inefficient regime maintained within most institutions, but during the past few years, psychiatry has made enormous strides, and the present generation is reaping the beneficent harvest.

The change to the gentler terms is not only more agreeable to the friends and relatives of patients, but to the patients themselves, many of whom possess sensibilities and reasoning powers developed to a surprising

degree. This detail is a part of the constructive psychology which forms the keynote of treatment, and is extensive in its application. No longer are mental hospitals constructed as great, gloomy piles of masonry with narrow, barred windows, strait-jackets and padded cells. To-day, hospitals are located in bright, cheery surroundings, where all the beauties of healing nature may exercise their kindliness, and spread the light of reason through poor shadowed minds. Gone are the grim, stone walls with tops of broken glass. Instead, are hedges, fresh and green, yet yielding a certain seclusion. Gone, too, is the old slogan, firm fixed for centuries in the public mind—“All hope abandon, ye who enter here!” In its stead might well be placed—“Have Faith! Believe in Me and ye shall be whole!” for such is written in the springing grass, the tints of spreading buds, the smell of fresh-turned earth on the wide hospital farm lands, the fragrance of rain-sw7eetened meadows, and in the scientific efforts of these in charge.

Bad Days of Old Are Gone

THE warm night breeze stirred my curtains. Making myself comfortable in an easy chair, I dug out of my bag a book review which appeared in an influential English periodical. The book with which it dealt was “The Experiences of an Asylum Doctor,” by Dr. Montagu Lomax. When it first appeared it aroused a wave of public protest in England against the methods of treatment which Dr. Lomax claimed were in vogue. The book read, it was alleged, like a narrative of the Inquisition, or the dark days of old Bedlam, where the mentally afflicted were thrust into dim and pestilent dungeons and left to gibber their lives away, neglected and halfstarved. The author scored the system of dual superintendence, whereby administrative and medical responsibilities and duties were incorporated in one individual, to the resultant neglect of one or the other.

Particular stress was laid, however, upon the prison routine and discipline and the lack of curative effort. It was a powerful indictment!

It w7as after perusal of this review, that I determined to discover to what extent, if any, similar conditions prevailed in the mental hospitals of the Dominion. The Provincial Hospitals of Ontario were selected for study because the large and diverse population of that Province has provided cases of all forms of cerebral illness. Of the larger administrative aspect it is unnecessary to deal except to state that the hospitals along with other public Provincial institutions, come under the capable and sympathetic supervision of the Provincial Secretary, H. C. Nixon. In the balance of this article, facts will be set forth by which Canadians may judge for themselves as to the way in which this problem of prime importance is being treated in the Dominion. It will readily be understood that where necessary, fictitious initials must be used, to avoid pain to relatives. If the conditions foun'd in Ontario are not truly representative of the Dominion as a whole, it is hoped that this article will be the means of drawing forth necessary comment.

Housed in Separate Cottages

MORNING broke, radiant with jewels trembling on the flowers and a light ground mist dissolving amid the trees. Dressing hastily, I went for a brisk walk about the grounds. The cottages for the patients swept back from the Administration building in wide curves, the five women’s cottages facing the lake and an equal number of habitations for men facing North. Each cottage housed about sixty patients. A rolling lawn spread out before the main building, bisected by a stream bed and dotted with flower plots in full bloom.

Tow7ard the lake, which could be seen flashing in the distance was a grove of splendid young trees, planned and planted years ago by Dr. Beemer, and now providing a grateful shade. A large, well-kept meadow in front of

the women’s cottages held the cricket pitch, for patients and staff, following the example of the superintendent, were ardent cricketers. The lake shore was a pebbly beach, strew n with boulders, picturesque enough but unsuited for bathing. A boathouse at the western end of the grounds held canoes for the staff and a gasoline launch in which patients were taken for picnics and excursions. The whole atmosphere of the place denoted freedom, space, health and sun-blessed beauty. The effect of such surroundings upon cases of melancholia and depression w as at once evident.

When I returned to the main building for breakfast, the grounds were astir with patients, gardening, weeding, mowing grass, rolling the lawns, doing odd jobs of carpentry and masonry on one of the cottages or strolling about.

At breakfast. I learned that Dr. Beemer had left for Quebec the previous evening, and the place was in charge of his assistant. Dr. MacLennahan, the father of the two kiddies who had greeted my arrival. He suggested a program for the day.

‘ First,” he said, "we will bring into the office a patient who is nearly ready to go home. You may hear from him how his cure was effected. Then we will make the round of the cottages.”

Dr. Moyle, whose good-natured wit and offhand camaraderie makes him a favorite with the men patients for whom he is responsible, brought in the case, a man of about twenty-five, with quick, brown eyes and an alert manner. He sat on a chair, fumbling his cap, and looked from one to another with an uncertain smile. There was neither fear nor distrust in his manner. Dr. MacLennahan leaned forward and his eyes rested for a moment on the brown face before him.

"Tell us. Tom when did you first realize that you were well?” he asked kindly.

The other hesitated for a moment, then he smiled broadly and his eyes snapped with animation.

"About a month ago, Doctor.” he replied. “I was sitting in the ward when Doctor Moyle came in. He often stopped and chatted, but this morning he was passing right through. I had had a bad night, so I called him, and told him about the batteries. He just laughed.”

Where the Difference Lay

HERE the assistant superintendent interrupted him.

"You see,” he said, turning to me, “Tom used to have the idea that people were putting electric batteries in his bed and his shoes to do him harm.—Go on, Tom!”

“Well, sir.—as I was saying, the doctor laughed. He made me take off my shoe. Then he asked me how a battery in that thin sole could possibly hurt a strong fellow like me, and—well, sir— I—I felt kind of ashamed of myself for a minute and I begun to think. And after he had gone I kept thinking, and thinking, and then I realized that I had never actually felt any electricity—so I ripped my shoe apart and there was nothing there!”

‘‘What next, Tom?” the doctor prompted.

“Every day after that, when the doctor came through the cottage he would just smile at me and say, ‘You’re not sick, Tom! You only think you are! Why don’t you try and think you are well instead?’ Then one day he come in —in the middle of the afternoon it was, and said, ‘Tom, I want a serious word with you!’ Then he did what made me aman again. He got me to compare myself with the men around me. They

were crazy. They

imagined all kinds of things.

The doctor made me see that I was different—that I was like him. There was nothing wrong with him, so I thought I must be alright too. Of course, that did not come to me all at once, but gradual, like.”

He broke off, and after thanking him he was dismissed, to return to his cottage. Dr. MacLennahan swung back in his chair.

“Tom is almost ready to go out on probation,” he said. “He came to us from the North country two years ago, fighting, raving mad. He had been living alone in the bush, and being of Italian parentage and of a sociable temperament, the solitude was too much for him. We noted him carefully for months, always on the lookout, between his spells of violence, for a chink in tbe armor of his madness.

When he became more settled we tried suggestion at every opportunity— then simple logic.

See how it worked? It will not do so in every case, of course, but we must try all means until we hit upon the right one. Today, one could never recognize in that bright, intelligent man, the wild-eyed man of the Woods of two years ago! He is cured— and so long as he stays away from the bush it will be permanent, I believe.

“Now let us go through the cottages. Mind you—” he added with a smile, “I do not want you to think that this be must a personally conducted visit of yours.

You are perfectly at liberty to go, at any time, day or night, through the cottages or other parts of the hospital, and to question patients, nurses, attendants and doctors. There is nothing to

conceal. Everything is open to all who care to see, provided they are genuinely interested in our work. It is only the morbidly curious whom we exclude!”

On the trip, through the cottages, a feature most prominent was the spotlessness of floors, fittings and furniture, the daintiness and good taste displayed in the decorations and the pools of sunlight which'entered through the speckless windows. On each floor was a cosily-furnished sitting-room, with pictures, rugs, magazines and easy chairs. On the men’s side the feminine touch was lacking, of course, but there was no dearth of cleanly comfort. The dormitories were models of neatness, with their rows of white beds, dressing tables, chairs and the polished floors. Individual rooms for the accommodation of patients who needed seclusion were furnished in simple taste.

Nowhere was there the “institution” smell or atmospere. Rather, it was the homeliness of everything that impressed. There was no excitement and but little noise. The occupants of the cottages sat and read, sewed, knitted, wrote letters or otherwise occupied themselves.

Making the Work Worth While

BY THIS I do not mean to suggest that the cottage atmosphere is always so calm. There are moments when patients break into violence—but the effort of those in charge is always towards normality, and when an unfortunate patient gives evidence of a coming attack, or suddenly lashes out, it is met quietly, efficiently, without harm to the patient, and with as little disturbance as possible to the other occupants. In general, there is little beyond the stereotyped movements or cries of catatonic patients to differentiate the cottage from the convalescent wards of any city hospital.

Of the staff, every one seemed busy, from the trim, blue-clad nurses and sturdy attendants to the force at work in the huge, clean kitchen, with its steaming caldrons and rows of polished utensils.

The patients were divided into categories

and classes, so that those suffering from one type of mental disease should not influence others. Separate rooms were provided for pati i e n t s requiring them, and all patients, whether paying for their maintenance or as wards of the state, received exactly the same care and attention.

On the second floor of one of the cottages, Dr. MacLennahan stopped before a door.

“Want to see something else that makes our work w o r th-w hile ?” he asked quizzically, then without awaiting a reply, tapped on the door.

“Come in!” a voice responded.

We entered a small, neatly furnished room. On a small bed by the open window was a woman, rather thin and ill-looking, but with brilliant black eyes that gave welcome at the doctor’s entry. A soft warm breeze blew into the room and ruffled the dainty pink ribbons at the patient’s throat. The sun, streaming through, lay in checkered gold on the snowy coverlet.

“Good morning, Doctor!” she greeted, then added quickly—“May I go home to-day, Doctor? I feel ever so much better!”

Before replying, the doctor introduced me and said:

“Mrs. G— is one of our most promising and obliging patients. She has been very unwell, but is rapidly improving and I really think. . . . ” with a smiling glance at the bed—“that her husband may come for her some time this week.” He patted her shoulder. “Rest as much as you can,” he added, “for we want you to be your old self when he gets here.”

His patient smiled happily and turned to the morning, her face aglow with hope. As we continued our rounds my companion rapidly sketched the history of Mrs. G—.

“Occasionally,” he began, “we get a patient whose mental illness is the direct result of some physical infirmity. This woman, Canadian born, and the mother of four children, was living in a village up on the fringe of the bush. After the birth of her fifth baby she became suddenly violently insane, with delusions and hallucinations in an acute form. She fought with all who came near her, screamed that there were electric batteries in her bed—a common delusion—said she was being burnt to death, that her food was being poisoned, and so forth. She saw imaginary persons who taunted her, and replied to nonexistent voices. From a healthy, rather pretty young woman she became haggard, fearfully untidy in her habits, and gave all manifestations of advanced mental deterioration. It looked, on the surface, like a hopeless case at first.

“Upon arrival here about a month ago she was put in the continuous baths to sooth her, and to permit observation. Doctor Wright, one of the younger members of our staff, took her in hand, and discovered that she had an acute inflammation of the kidneys. She was placed in his charge and an intensive ‘attack’ was made by him on this condition. It was rapidly cleared up. Almost at once her mental state showed improvement. Her memory was clarified, delusions disappeared, and hallucinations became less frequent. To-day, she is normal, mentally and physically, except that her strength needs building up sufficiently to enable her to make the journey home. We will warn the husband, when he comes, against allowing her to fall into the condition which brought about the attack and, if our instructions are carried out, the cure will be permanent.”

On the way to the men’s cottages a large excavation was passed, behind the buildings.

“That,” said the doctor, “will be our bathing pool. The lake shore is neither suitable nor safe for the patients, as I will explain later. This pool is being dug by the men patients and it will be lined with cement and all piping laid, under the direction of our engineers. Whatever manual’ labor is to be done is performed by our people, for occupation of the hands often balances, and compensates in part, for lack of cerebral energy.”

Judicious Application of Work

'T'HE occupants of Provincial hospitals are not per-

A mitted to do nothing but lie about and give expression to their infirmities. Even though a cure is not possible, the^ mental status of a patient may often be raised by judicious application to some sort of simple work, the accomplishment of which encourages the patient to the belief that he is not entirely useless in the world. Most of the hospitals are in large measure self-supporting. The women knit and weave, do the domestic work and manufacture most of the clothing used by both sexes. The men are occupied in gardening, farming, carpentry, plumbing, tinsmithing, shoe-repairing and many other jobs. When á surplus of products accumulates it is disposed of to other Provincial institutions for payment in kind.

A large assembly hall at the Mimico hospital was built entirely by patients, from building material supplied by the workers in the Provincial prison farms. The hall is now used for Divine service on Sundays, and for movies, concerts and dances for the patients during the week. The staff is at present experimenting with a radiophone, with a view to having amplifiers installed in each cottage.

Recognition of former habits, amusements and occupations has a decided bearing on the curative treatment of the patients. In some cases, a return to a semblance of former work has ill effects, but generally a suggestion of the trade followed by the patient in former life assists him to regain or to approximate a normal status, with its resultant benefits, as the following case will show.

A man was admitted to the hospital in September, 1921, whose illness was diagnosed as “maniac depressive of maniac type.” He was a big powerful fellow of about forty-four years, with strongly-marked face and fierce eyes. Soon after being admitted he became extremely violent, ripping the plaster off the walls of his room and fighting with the attendants. He was absolutely irresponsible and had not one coherent idea. The following conversation, which was recorded a month after his arrival will give some idea as to his mental state. The questions were put byja doctor in an effort to trace the thought connection back to primary causes.

Q

A

Q

A Q A Q A Q A

Q

A Q A Q A

At first glance it seemed that little could be done for him. There was nothing in his past history nor heredity to account for his condition. His every move was watched, to trace some cohesion of thought or action.

How the Gleam Came

/1 'HEN, one day, it was observed that he A was displaying interest in the movements of a carpenter who was repairing part of a cottage verandah. At intervals through the next few days he hung about, and once or twice tentatively approached the tools. He was given an opportunity to handle them.

Although there was sad lack of co-ordination between cerebral impulse and muscular execution, it was plain that he was, or had been, familiar with joinery. Before a week was out he showed improvement, and was given to the carpenter as a helper. His progress was slow but unmistakable. His brain was clearing. Old habits, long stemmed, began to traverse their customary channels.

Violent tendencies disappeared as his energy was consumed in normal ways. His discourse, irresponsible at first, gradually responded to a central theme. In December, three months after his admission to the hospital, he was allowed to go on probation to the home of a friend in Toronto, this

How are you?”

'T am dead.”

“When did you die?” “Saturday night.”

“Last Saturday?”

“Saturday coming.”

“Where have you been?”

“All over.”

“When will you come alive?” “To-morrow morning.” “Where will you be to-night?” “In Paradise.”

“Who with?”

“With Tiffany.”

“Who is he?”

“A steamfitter,” etc.

friend securing him a job as a carpenter’s helper. Three months later he was discharged off the hospital books, cured!

Not all of those discharged, or allowed home on probation, are permanently benefited, however. Occasionally one is returned, and infinite patience must be exercised in dealing with a recurrent case. Curative efforts that were successful in the first instance are not always of benefit later. Nor is the cure effected so quickly. Frequently, years of unremitting attention and treatment pass before improvement is shown. Time is the great judge of a psychiater’s qualities. Often, he must see the careful building up of a fairly normal mental state— perhaps the painstaking work of months or years—swept away in a second, through the violent and irresponsible action of another patient.

Nor is a doctor’s judgment always confined to the medical aspects of a case. Set yourself this problem and see how you would decide it.

A woman, suffering from recurrent insanity, was admitted to the hospital for the fifth or sixth time. Each previous time that she had been discharged, she had returned to her home. During the periods of her illness, which extended over a number of years, she had given birth to seven children, every one of whom was mentally defective, and would in time become a charge upon the state. The citizens of the town in which she lived, hearing that she was again “normal” and was coming home, got up a petition, signed by some two hundred persons, requesting the hospital authorities to keep her confined, in order to prevent the birth of more imbeciles. The husband, hearing of this, threatened legal proceedings against the hospital, if his wife was not released immediately upon her recovery. Manifestly, it would be unfair to detain a well woman in the hospital, yet, at large, she was a menace to the social system. This sort of thing crops up constantly in the life of a mental doctor.

On the following day, Sunday, Divine service was held in the assembly hall. From the cottages to the hall was no great distance, but all of the patients were clad in their Sunday best—constructive psychology—and walked over in orderly cottage groups. Throughout the service there was nothing in the conduct of the congregation to differentiate it from that of a modest church in the poorer sections of a city. All were attentive and well-behaved. The responses were correctly sung and the calming influence of the occasion was patent.

In the afternoon I strolled through the ¡grove to the lake. The sun poured its warming beams in paths of yellow light, staining the glade with translucent green shadows, danced on the summer costumes of the patients, and splashed its brightness on the wide verandahs of the cottages. Patients walked about the grounds, lay at ease in the shade, or read and smoked in the summer houses built near the rippling lake. A fresh breeze stirred the shore to flashing spray, and the white sails of yachts drifted like clouds on the horizon.

Dri MacLennahan, in cool white flannels, joined me.

“Yes,” he said, in answer to a question, “we take the patients in small groups, for a day at the Toronto Ex. They look forward to it, are well-behaved and enjoy it thoroughly. They go, generally in groups of from three to eight, in charge of a nurse or attendant. We have never had trouble with any of them. They mingle with the crowd and no one knows who they are or from where they came.”

He interrupted himself, suddenly, to point to an angle of the shore, formed by the beach and a concrete pier which jutted into the water.

“By the way, do you remember the other day, I mentioned, when we were inspecting the bathing pool, that I would explain why this beach is not safe for patients? Not long ago, a woman patient of suicidal tendencies suddenly broke from a group in the grove and dashed into the water. A young nurse, Miss Lake, rushed after her. At first they were in shallow water, where the bottom is covered with boulders. Miss Lake managed to get to the patient, who struggled frantically against rescue. In the struggle the ivurse’s leg was broken. Despite fearful agony, she clung to her patient, who was dragging her into deep water, and managed to keep the desperate woman’s head above water until help arrived. A peculiar feature is that the man patient, a former soldier, who effected the final rescue was himself of suicidal bent. When thanked by Doctor Beemer for his part in the rescue, he replied, simply, that he hoped the deed would mitigate somewhat his useless past. Little epic, isn’t it? Miss Lake was thanked and rewarded by the Provincial government.”

The Value of the Farm

tpARLY the next day we visited the hospital farm. Our A-/ conveyance was a horse and buggy, and the way lay for a mile or so up a road bordered by wide fields of crops.

We drove first to the farm cottage, the home of the men patients who work the huge farm. It held about thirty patients with their attendants, and was built in the style of an old fashioned farm house, with a great stove in the sitting room, that gave promise of ruddy cheer on cold winter nights. The effort here, as in the main hospital, was toward normality in furnishings and environment. A proper farm atmosphere was created through the rag rugs, long cooking range and simple fittings. On the ground floor was the recreation room, with lounge chairs, benches and periodicals. The farm cottage was the permanent home of many of the men who were accustomed to farm work and could be trusted in the fields. The curative idea was always foremost and was most effective on men who, brought up to country life, could perform a normal day’s work under the open sky. In the home life of the farm, too, they could approximate, in all but its undesirable features, the environment from whence they came. Constructive psychology again—or perhaps a phase of occupational therapy.

The farm supported a splendid herd of cows, horses and swine. Agricultural implements were supplied by the government, but were not used more than was necessary to supplement the work of the men. The reason for this is apparent.

Tomatoes, potatoes, beets, carrots, cabbages and other produce were grown in quantity more than sufficient for the hospital needs, even after the extensive canning was completed. The surplus was sold, and the sum yielded helped substantially to the upkeep of the place

The staff at Mimico is one with high ideals, well and practically thought out. On every day of the year these ideals are applied in concrete form, and the result is a model hospital, run efficiently, economically and with one big idea as a nucleus—the cure, alleviation and comfort of those who labor under the fearful handicap of a diseased mind.

In Dr. Beemer’s office is a black, bound book. The pages within are neatly typewritten from letters, the originals of which show, in their varied chirography, something of

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Continued from page 17

pathos, somewhat of humor and a vast amount of heart-felt gratitude. It is called the “Book of Appreciation,” and consists of copies of letters sent to the

staff by the relatives of patients and by those who, once under the care of the hospital, now know the blessing of restored sanity—and they, of all the world, are most qualified to judge. Here is a note

from an Italian whose wife was still a patient:

“Dr. Beemer.

“Dear Sir:

“Please let me know if my wife has improved since my visit. And I want to make a present of two pigs to all the people of the hospital.

I sent one and please to let me know if you would take the other dead or

This other message needs no comment. “Dear Dr. Beemer:

“Perhaps you thought that I should have shown my appreciation for the kindness shown me in your hospital long before now. But my silence is not the fruit of ingratitude, for never a day passes that does not find me thankful for what was done for me, a stranger, by yourself and staff. I feel at present as well as ever, and could you see my progress you would feel more than repaid for the services given the unfortunates entering your hospital. Once more thanking you, I am...”

The writer of the above was a girl who, after being cured, was able to return to her home in England.

• (The second article will appear in the April 1st issue, and will discuss Orillia.)