SUNLIGHT THROUGH SHADOW

The Story of a Canadian Mental Hospital, Which Is Second to None on This Continent, at Whitby

NORMAN REILLY RAINE April 15 1923

SUNLIGHT THROUGH SHADOW

The Story of a Canadian Mental Hospital, Which Is Second to None on This Continent, at Whitby

NORMAN REILLY RAINE April 15 1923

SUNLIGHT THROUGH SHADOW

The Story of a Canadian Mental Hospital, Which Is Second to None on This Continent, at Whitby

NORMAN REILLY RAINE

The Concluding Article in This Series

SO FAR, this series has dealt with the treatment of the insane at the Provincial hospital at Mimico and with the training of the feebleminded at Orillia. These two institutions have provided distinct types for study and considerable difference in treatment, the first being curative and the second entirely instructive. Although these succeeding paragraphs deal again with the insane, it is in different surroundings—in a mental hospital which has no superior on the North American ■ continent, as regards equipment, lay-out, and constructive facilities for the treatment and cure of insanity. Such is the Ontario Hospital at Whitby, which I visited this •winter.

It was nearing Christmas when I stepped off the train at the little country station of Whitby. Icicles hung from the dsrab roof of a coal shed, and a station hand clinked a milk can over the platform, the metallic sound ringing merrily in the frosty air. Snow-covered fields swept away to a patch of woods and swamp, while far on the winter skyline arose a group of buildings, bathed in the sun, and outlined against masses of tumbled clouds.

The snow creaked as I followed the railway to the Whitby Hospital grounds. Rabbit tracks were imprinted in the ditch. These little animals skipped across the rails and back again, to bear me company in my walk. As I approached, the mass of buildings opened out and took form and individuality, spreading along both sides of a winding road. It was like a small model town. Pavements were laid, and lamp posts had been erected. The houses were of cream stucco, trimmed with tapestry brick and with redtiled roofs. The whole had the appearance of a graceful and picturesque bungalow colony. Quaint, old-fashioned lanterns decorated the outer walks, and at each individual cottage entry was some distinctive touch, in the way of a flower-bowl or urn.

Passing several buildings under construction, I noticed that there was in extensive use a beautiful tapestry brick such as was in the completed buildings, and as the manufacture of brick forms an interesting chapter in Canadian industrial history,the story is worth relating.

About seven years ago, when it was decided to use this particular type of brick, bids were asked on a quantity. It was noticed, when the bids were opened, that the prices asked did not differ more than twenty cents per thousand. Seeing in this a possible indication that the brick manufacturers might have combined to maintain a price, the provincial government cast aboùt for other means of obtaining the material, but without success. Then it was remembered that the prison farm at Mimico was close to the diggings of a company manufacturing the type of brick wanted. Samples of clay were sent for an opinion to a plant in Ohio which made the brick.

The reply was that the clay was in every way suitable, so an entire factory was erected and the manufacture began.

The brick produced was not only equal, but superior, to the sort which specifications called for, and it was possible to manufacture it for approximately eight dollars per thousand as against the eighteen dollars per thousand asked by Canadian manufacturers.

To-day, that Mimico plant supplies not only sufficient brick to take care of the construction of all the Ontario provincial institutions but sells in large quantities throughout the Dominion, and occasionally to the United States. In addition, á floor and a roofing tile have been made, patterned after a Welsh type which was reputed to be the hardest and best in the world, and the quality, hardness and smoothness of this almost impromptu Canadian product is in every way superior to the older, established article. The fame of this tile has spread over

the continent, and the plant at Mimico is hard pressed to fill orders. Thus the exigency of seven years ago is responsible for what is now a profitable provincial undertaking.

This interchange of institutional products, as remarked in an earlier part of this series, is important in its substantial saving to the government. Furniture, building materials, clothing and many other articles are bartered either for payment in kind or at cost, and the process of manufacture, not alone in its economic value,

but in the healing effect and improvement of morale which it effects among the workers, cannot be over-estimated.

Personality of the “Supe.”

T FOLLOWED the path to a building marked “Administration,” and entered into a lobby floored with that remarkable, smooth red tile. From here, the administrative offices opened out. Upstairs were the apartments of the Headquarters staff, and from the rear of the building someone was declaiming the virtues of her “coal black mammy” in ambitious song. A girl at the switchboard, after ringing the various departments of the hospital in fruitless quest of Dr. J. M. Forster, the superintendent,

finally bade me sit down and wait. After a time, Dr. Forster appeared. He was a short, sturdy, pleasantly rounded figure of a man, with both hands buried deep in the pockets of his jacket. He removed one to greet me, then promptly concealed it again. In conversation his quizzical glance, under lowered brows, dissolved into contagious laughter, as he rolled from side topside, like some jolly old sea-dog of romance. His personality spread faith, good humor and hope where it was most bitterly needed, and it did not require a second glance to see that they were indeed fortunate who were committed to his kindly care. I could not help but remark to myself that the superintendents of the Ontario mental hospitals which I visited had one great attribute in common—that of inspiring th« love of their patients and the loyal and outspoken admiration of their subordinates.

“Let’s have a look about the place,” the doctor suggested, and entertained me on the way with a running commentary on the life and aims of the hospital which was the design of James Govan.

The Ontario hospital at Whitby is, as said, one of the finest on the continent, in beauty, lay-out, exterior detail and equipment. It occupies about 640 acres, including the farm, and the hospital grounds contain four and onehalf miles of winding roadway. The roads and proposed trees are so planned that not more than two cottages or buildings will be visible at once. The stately headland, had a widespread marsh abounding with wild duck on one side, and Whitby Bay and harbor on the other. Seen in the brilliance of a midwinter day, with the snap of frost in the air and the sun on red-tiled roofs and dazzling snow, it presents a pleasant and colorful picture.

There are six occupied cottages for men and eight for women, the Administration building being an unoccupied patients’ cottage, used temporarily until the planned Administration building is erected. In addition, there are infirmaries for men and women, laboratories, a dental surgery, a surgical theatre, an X-ray room, buildings for acute cases, an auditorium (complete with stage and scenery and with a bowling alley beneath) two central dining-rooms which are off the glistening kitchens, staff residences, a power plant, a laundry and a complete canning factory. The bakery is not yet completed and the bread for the hospital is baked and shipped twice a week from the Queen street hospital in Toronto.

No “Cockroach Promenades”

THE kitchen cf Whitby hospital is well worth a visit. The newest and most efficient of electrical appliances have been installed, and even during the busiest dinner hour the place is a marvel of cleanliness. This department has been the subject of admiring remark by every distinguished psychiater who has visited the hospital, and its present enviable state is the result of the garneringof ideasfromsome of the largest and finest hotel kitchens on the continent. All piping is underground, thus doing away with what Provincial Inspector Dunlop has termed “cockroach promenades.”

The heating of the hospital is done from a central plant and is so modern and efficient that the method of

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of heat control is well nigh perfect, with a. resultant economy ef fuel."

A casual visitor to Whitby once remarked that the cottages seemed just planted down “every which way.” It was speedily pointed out fro him that, as the sun is fairly regular in its habits and does, not deviate overmuch from its beaten path, it was necessary to plan, the buildings so that they would receive the maximum of solar heat and warmth at all hours of the day, throughout the year, this point being of utmost importance to those unfortunates for whom the institution was created, even though the attainment of this object defeated continuity of line. To the discerning, however, this'irregularity of orientation forms one of the greatest charms of the place.

An Earned “Bouquet” from U. S.

SO COMPLETE in equipment and layout is this Canadian hospital that, some months ago, Dr. Thos. W. Salmon of New York, chairman of the National Committee for Mental Hygiene of the United States, wrote, asking Dr. Forster for a copy of the construction plans. He stated that the Whitby hospital had been approved by his organization as a model for the United States hospitals for exservice men.

An American periodical, the “Trained Nurse and Hospital Review,” published recently a number of photographs of the hospital—although without stating where they were taken—and said that they were the models upon which the State Hospitals of Iowa were to be built.

When we entered the patients were at dinner in the central dining hall. Every cottage has a sub-division of the building, each being separated by a low tiled partition. The sections radiated from a common centre, thus assuring quick, efficient supervision, as all of the diners are within view from a central spot.

The food was plain, but wholesome and well-cooked, this particular meal consisting of soup, roast beef, boiled potatoes, gravy, turnips, celery, bread and butter, tea and apple pudding.

I asked Dr. Forster if it waswise to have the patients leave the cottages for meals during inclement weather.

“Yes!” he responded emphatically. “The majority of our people are quite fit physically, and as well able to move about in bad weather as you or I. They have proper and sufficient clothing, and by having them in the central dining halls, we are assured that at least three times every day they will get their lungs full of fresh air, no matter what the weather. And they like it. It gives them an opportunity to leave the cottages. Those unable for any reason to leave the cottages have their meals brought to them. Not only that, but by this system they are assured of having the meal served hot, as the kitchens are in the dining buildings.” The following morning was bitter cold, with the sun making a brave attempt to shine through the snow flurries. The superintendent stamped into his office, puffing like a grampus, and ran through his morning mail. Then he swung about and brought his feet to the floor with a bang.

“Now then!” he said, “would you like to see some more of my family?”

And, Above All, Cure!

WE BUNDLED into greatcoats and mufflers and pushed out into the wind. Far over towards the lake, a group of pines rose, showing through the storm like a smudge of charcoal. There were not many of the trees, but they formed an efficient wind-break, as we discovered when we had tacked into the lee of them. There with our backs to the wind, and the doctor’s breath coming in vanishing clouds. I learned something of the dreams of the staff for an even finer Whitby—and through it all ran the same powerful strain—greater comfort and care for the patients, and above all, cure!

Perhaps it was the contrast from the stormy outer air that lent such warmth and cheer to the cottages that we entered that morning, but truly it seemed as though, in the way of homely comfort, nothing more could be desired. The rooms

with their clean, smooth-tiled floors, dainty cretonne window hangings, and serviceable furniture, are most satisfactory to the eye, while the dormitories and infirmary wards, in blue, cream and white enamel, were an aesthetic delight. Each room, where practicable, has been placed so that sunlight poured in during all the day. There are individual rooms for those requiring them, as at other provincial hospitals, and paying patients and state wards receive equal attention. The keynote is comfort and cure. All else is secondary.

Here is an interesting detail: a refractory patient is warned that unless he behaves he will be placed in a room by himself, and not allowed to mingle with other patients. Similarly, one who is agreeable and docile is promised that, for his good conduct, he is to be allowed a room to himself. Each has the desired result—yet the room is identical in each case.

The nurses, attendants and patients were busy in the cottages, tacking up the Christmas decorations. Festoons of colored crepe paper were stretched from

wall to wall, holly adorned the fixtures and mottos were put into place. All of the decorations were made by the patients in the classes of occupational therapy, conducted by Miss Houstan and her coworker, Miss Creelman, in the Occupational building. In the kitchens, the chefs were baking great pans of Christmas cakes, covered with white icing picked out in pink, and each square was decorated with a holly leaf and a cherry. Every patient was to have an individual cake, and none would be forgotten. Just that morning, the mother of one of the patients after visiting her daughter slipped an envelope into the hands of Dr. Webster, and whispered that it was to buy some Christmas comfort for a friendless patient. The envelope contained $25.00.

Occupational Therapy

THE building devoted to occupational therapy was well worth visiting. Piled on tables and the floor were hundreds of yards of colored paper festoons and crepe paper, cut-outs, rosettes and holiday decorations of all sorts. Patients sat, with busy fingers, evidently delighting in the work. Others were weaving, making rag mats and doing raffia work in a variety of artistic patterns. The novelty of the color schemes and originality of designs were remarkable.

A weaving loom was in operation which turned out fabric of surprising quality. It was made in the hospital carpenter shop. The value of the training received in the Occupational building was apparent in the attitude and appearance of the patients engaged. They were producing normal work in a normal way, and the psychological effect was priceless.

One of the moving factors in this department was a voluble gentleman named Gus. Gus was conversant with all the “ologies”: biology, bacteriology, philology, sociology, theology, and all their kin were the pass words to Gus’ circle of discourse. He loved nothing better than to buttonhole a visitor and entertain him with a dissertation in which his favorite expressions were planted, not always with due regard to their continuity or sense.

But he was a useful man about the place, was Gus, being firmly convinced that his commanding presence kept the house in order. He was due to leave soon for a short visit to the city, for he was thoroughly trustworthy and was allowed home at intervals, as he told me with pride.

There is a standardised system of training for nurses in the Provincial hospitals, which embraces not alone psychiatry, but all branches of general practice. The course takes three years to complete and those who go through with it emerge as most efficient nurses. Periodical lectures are given by the staff doctors, and examinations are held at frequent intervals.

The male attendants are instructed in methods of dealing with patients in all stages and classes of mental disease, and, despite the “revelations” of yellow journnals and irresponsible persons, unkindness, lack of tact, or brutality is not tolerated in the mental hospitals of the Dominion. Constant watch is kept by doctors, cottage supervisors and responsible members of the staff for arty infringement

of this hard and fast rule, and when cases do occur., the offender is instantly dismissed.

I make this statement, not through a superficial visit to various institutions, but after careful, unofficial investigation. None is more keen to enforce observance of this regulation than individual members of the nursing and attendant staff. It would be futile to deny that cases have occurred of cruelty and brutality, but it has always been the work of individual and incapable persons. It is a significant fact that ninety per cent, of the charges of inefficiency and brutality brought against mental hospitals are preferred by people who have been discharged through this cause.

Order for the Disordered

THERE are nearly one thousand patients being treated at Whitby— nearly one thousand disordered minds, in the restricted space of the hospital grounds, yet everywhere system, cleanliness and order are apparent. There is not a strait-jacket, padded cell nor barred window in the place, nor are there any enclosing walls. True, the windows of the “acute” buildings are framed in steel, but the metal is enameled white, in the semblanee of woodwork, and gives no suggestion of restraint.

The method of dealing with troublesome patients is to place them under hydro-therapeutic treatment — that is in continuous baths of water, circulating at body heat. They are put in the bath suspended on a canvas sling and secured over the top with sheets so that they cannot do harm to themselves. The sensation experienced is one of soothing and calm, and there is no other method so sure and speedy in its results. It is necessary, sometimes, to keep the patient in the bath for long periods. Then, meals are brought during the treatment and partaken of in the bath, ánd sleep is induced. For quieting the excitement and violence which generally accompany admission to the hospital, the system of hydro-therapeutics is infallible, and allows of scientific study of the case more

easily and promptly than would otherwise be possible.

During the rounds of the cottages that morning, I had a conversation with a patient, Miss K—. During the half hour of our talk, which covered a variety of subjects, this lady did not once by word or action, suggest the slightest mental aberration. Her manner was delightful. She was an entertaining and fluent speaker, had read and traveled extensively, and, to all manifest appearances, was of normal mentality. When we were leaving she asked the doctor for permission to go home for the Christmas holidays, and to take with her another patient, to whom she promised to give the best of care. The doctor said that he would hold a conference with the medical staff and give her request consideration.

In the afternoon, the conference was called. I have told it in detail, because these conferences, which are held periodically on every patient, form an important part of the curative treatment.

There were present in the room, Dr. Forster; Dr. J. Webster, a large, kindly gentleman, deeply versed in psychiatric lore after over thirty years of treating mental cases; Dr. C. M. Crawford, a sometimes dissenting, but always forceful and logical exponent of modern methods; and Dr. C. G. Lynch, a younger man, whose engaging personality and interest in his work were repaid by the manifest affection of his patients.

The case file of Miss K— was produced and her past history read, with notes and comments of physicians under whom she had been treated. There was abundant evidence of delusions, hallucinations, and irrational acts, culminating in her admission to the hospital. The conference was to determine to what degree these manifestations had decreased. After prolonged discussion of the patient she was brought in. The members arose at her entry, and Dr. Forster bowed her to a chair.

At first, Miss K— responded to questions in a perfectly normal fashion.

Dr. Forster leaned forward and asked gently:

“Will you tell us frankly, Miss K—, if you consider that you are in good health, at present?”

“Yes, Doctor, I certainly do. .that is, mentally. I have been troubled with nervousness, at times, and I am not over strong physically, but there has never been the slightest thing wrong with me mentally, and I cannot see.... ” she hesitated for a moment “.... I really cannot see why I should be kept here, Doctor!”

“Well now, Miss K—-, think back a little. Do you not remember that you had certain ideas about people and things, some time ago, upon which we did not exactly agree?”

“Yes, I remember that. I told you who was responsible for my family troubles ■ and you did not believe me. When I mentioned how I had been persecuted, and my poor mother

And with that came a flood of ideas which showed that although the patient was able to repress expression of them before strangers, her delusions were as powerful and numerous as ever. Other patients, she said, were shooting poison at her from snakes which they kept in the barn; doctors and nurses crept to her room at night and administered hypodermic injections; patients and staff were in a conspiracy to kill her; and her parents had met death through the machinations of a near relative, who was also bent on destroying her. All these and more she stated. One of the doctors interrupted her circumstantial and even flow of words.

“Do you really believe all this, Miss K—?” he asked.

“It is my innate conviction, Doctor, that these things are so, and you will never get me to believe otherwise!” she stated emphatically.

Potential Power for Evil

ASKED her opinion of the mental Zx state of the other patients, this lady was unable to see that there was anything amiss with them. She thought that they were nervous, but with proper care, could well be trusted to go home.

After Miss K— had returned to her room, Dr. Crawford said:

“Can you imagine what would happen if this lady, with her power of keeping her ipental disorder under the surface, and her strong delusions of persecution by the

staff, were to get on the outside and relate her plausible story to the editor of a muck-raking periodical? And she is but one of many in similar state. What were your impressions of her, this morning, Mr. Raine?” he asked.

“I thought she was sane.” I replied.

“And now.. . .?”

Answer was unnecessary. The doctor went on:

“Sometimes we find that a patient will reason about his delusions, and if we keep everlastingly hammering at him that they are but delusions, he begins to lose faith in them. Not that he does not believe them real, but he sees that others doubt, so he makes a strong effort to thrust them into the background, and disregard them. In time, through disuse, they grow weaker, and occasionally disappear. But such cases are exceptions, although they are well worth endless effort to find.”

Conversation on psychiatric treatment then became general, during which it was brought out that alcoholic psychoses have greatly decreased since prohibition. A summary of the views expressed is interesting. One point in particular was emphasized, namely, that the public should try to realize that insanity is a disease—not a disgrace; that it is not limited to social underlings and those primarily of inferior intellect; that it often is brought on by circumstances far more creditable to the sufferer than the causes of a great number of physical ailments; and that it is possible to effect permanent cures. Psychiaters regard insanity wholly and simply as an illness—as the disease of a mind once healthy, which possibly might yield to curative effort.

It was stressed, too that the causes of mental illness were harder to dig out, and required more patience to treat—because of the occasional animosity or passivity of the patient—than physical disability.

Later I obtained estimates to show that of the mental patients of Ontario, fortyfive per cent, receive temporary relief, and nearly twenty-five per cent, are cured permanently. The greatest foe of the mental specialist, however, is environment. Much of the original illness is caused by adverse surroundings and wrong home atmosphere with, frequently, a taint of bad heredity. Patients suffering from recurrent insanity run the same risk, in returning to the old atmosphere, as would a person subject to malaria if he went back to tjie steaming tropics. Like conditions produce like results, but, sö far, no practicable solution has been found of this problem.

For Cure, Not Detention

MANY people consider a mental hospital as purely a place of detention, rather than, primarily, a curative, and secondarily, a segregative institution. The insane are kept apart from the world, not so much to protect the public, as to protect the sufferers, for more harm is done by the public, in various thoughtless ways, than is ever committed by the poor unfortunates who are the real victims.

A feature greatly to be deprecated is the publication in periodicals of names which, as mentioned before, are derogatory and misleading. Terms such as “lunatic asylum,” etc., when spread before the public have the effect of instilling an insurmountable dread of mental hospitals in the minds of those suffering from incipient insanity, and who perhaps would, if that implied stigma and sense of false shame were not present, gladly grasp the opportunity of voluntary mental adjustment within the grounds of a proper institution.

Through the thoughtlessness of certain periodicals, a futile terror of cerebral treatment is fostered and spread. Dr. Crawford mentioned the following item which appeared in a Canadian newspaper, as a perfect illustration of this point. The clipping read:

“BEAUTIFUL HEIRESS SANE, BUT IN ASYLUM

Boston, Mass.—Dorothy Gorden, beautiful heiress, who is confined in the McLean Insane Asylum, was happy to-day as a result of a visit from her uncle, John Gardner, who is fighting to free her and to remove W. F. Jardine as her guardian. Jardine, by his own admission on the witness stand, on Gardner’s petition for removal, committed the girl to the terrors of the insane asylum when she was sane.”

When he had finished reading, the doctor’s face was grim.

“Can you not see,” he said, “what a deterrent, such phrasing would be to some poor sufferer whose mind was hovering in the borderland between reason and insanity, and who would, perhaps, otherwise come to us for relief?”

There is a system of voluntary treatment in operation in Ontario whereby those who feel the approach of a mental disorder may enter the hospital of their own volition and receive treatment. Many come again and again, and return to their homes each time showing decided improvement after their temporary sojourn in an atmosphere of hydrotherapeutics, occupational therapy and other constructive psychiatric treatment. This service is open to all and is free to those who cannot afford to pay.

On a brisk and sunny morning a couple of days later, Dr. Forster entered the Administration building. His ruddy face beamed good nature, and he rubbed his hands together as he approached my chair.

“Get out your best bib and tucker, my boy!” he announced triumphantly. “We’re going to have a show to-day!”

It developed that the Ontario Ladies’ College at the town of Whitby had been asked by the doctor to sanction the production for his patients of a Christmas Dance Pantomime, which had been put on in the College hall by the pupils. The piece presented was “The Sleeping Beauty,” and the costumes and dancing were beautiful. The College staff, glad of an opportunity to give a little happiness to the patients, readily agreed, and the hospital auditorium was put in shape to receive the piece.

“You know,” said the good doctor, "our people have a movie show every Tuesday evening, and a dance on each Thursday night, with odd concerts in between, but they have never had previously an opportunity to see a dainty thing of this kind. I am keen to know how it will impress them. I am sure it will be a treat.”

The Pantomime

THE members of the cast and their friends arrived at the hall by motor at two o’clock, and the patients filed into place and took their seats. The doors were closed. A stray beam of winter sunlight rested for a moment on the silvery head of an old patient, then disappeared. The footlights were switched on, and a piano struck up. To the accompaniment of an audible “ah!” from the eager audience, the curtain arose.

It was worth any man’s time to study the expressions of the patients as the play proceeded. Few of them, even outside, had seen anything so dainty and ethereal, and the event entered like a shaft of warming light into their drab lives. Certain emotions are common to all humanity, whether well or ailing, and, providentially, some of the more subtle and worthwhile are nearest the surface in those who have not the blessedness of health. So if was that the lights, and the bright-hued costumes and the fairy-like dancing of those innocent girls carried a message of hope and gladness to hearts long strange to most of the beautiful things of life. No spoken thanks could have meant half so much as the glad light in the patients’ eyes, and their excited chatter when the play was done.

Returning to Toronto by train the following day, I was accosted over the back of my seat by Gus, who was on his way home for a short visit. We fell into conversation.

“D’you know,” said Gus, “them’s fine fellers up at the hospital—but that Doctor Webster! Say now! There’s a wise gentleman for you! All doctors specialize in something, don’t they? Well, Doctor Webster specializes, too. Did you ever notice how he watches you when you are talking through that earphone thing of his?”—the Doctor, unfortunately, is deaf and is compelled to use an appliance— “Well, he is studying you to read what you are thinking. Then, when he thinks you have said enough he lowers it and cuts you off from him like a stone wall, and you can’t get behind it again unless he lets you! I wonder if he is as deaf as he makes out. That thing of his is a great help when you’ve got to get round as many patients as he has in a day! But I’ll bet it tells him more about you than you know yourself!”