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UBC Theses and Dissertations

Care of the mentally ill in British Columbia Clark, Richard James 1947

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Cop. I CARE OF THE MENTALLY Ric h a r d ILL IN BRITISH COLUMBIA James C l a r k A t h e s i s submitted i n p a r t i a l f u l f i l m e n t o f the requirements f o r the degree o f MASTER OF SOCIAL WORK i n the Department of SOCIAL WORK FOREWORD The wise observation, "Nature says what may happen, hut nurture says what w i l l happen", i s s t i l l v a l i d . The.opportunities that are afforded an i n d i v i d u a l to "blossom out and fl o w e r " are of muoh greater s i g n i f i c a n c e than many of the genes that may be tucked away i n some of h i s chromosomes. A beneficent s o c i a l environment w i l l p r o t e c t many an i n d i v i d u a l from the development of a mental d i s o r d e r that may be p o t e n t i a l l y present because of " t a i n t e d " h e r e d i t y ; w h i l e , on the other hand, > a social-environment that induces constant t e n s i o n , a n x i e t y , and f r u s t r a t i o n w i l l not only evoke the p a t h o l o g i c a l c o n t r i b u t i o n s of h e r e d i t y , i f they are present, but w i l l even create mental i l l h e a l t h i n those i n -d i v i d u a l s i n whom h e r e d i t y f a c t o r s are out of the question. Schreiber, J u l i u s . "The Interdependence of Democracy and Mental-Health", Mental Hygiene, v o l . 29, p. 615, A p r i l , 1945. i i TABLE OP CONTENTS Page LIST OP TABLES ' i v INTRODUCTION 1 Chapter I. THE EARLY YEARS 6 The Pioneer Days. The Royal H o s p i t a l i n V i c t o r i a . The New Westminster Asylum. I I . DEVELOPMENT FROM 1894-1905 . . . 19 The Royal Commission of 1894. I t s Recommendations. Improve-ments a f t e r I n v e s t i g a t i o n . I I I . 1905-1919: NEW INSTITUTIONS . . . .39 Colony Farm. Essondale founded. A new branch at Vernon. Establishment of u n i t at C o l q u i t z . IV. 1919-1932: MODERN INFLUENCES . . . 58 Mental Hygiene Survey, 1919. Appointment of Royal Commission, 1925. Use of New Westminster U n i t f o r Mental D e f e c t i v e s , 1930. V. RECENT DEVELOPMENTS 87 C h i l d Guidance C l i n i c . Alexandra Cottage. New V i s t a S o c i e t y . . Psych-i a t r i c Wards i n General H o s p i t a l s . VI. THE SITUATION TODAY 106 A d m i n i s t r a t i o n . The P a t i e n t i n the H o s p i t a l S e t t i n g . . Modern Therapies. Plans f o r the Future. VI I . CONCLUSIONS 117 B IBL i o GRAPHY : 123 LIST OF TABLES Table Page 1. Cost of S a l a r i e s and Maitenance i n ten year Periods from. 1875 18 2. Comparison of the Years 1933 and 1945 as to S t a f f , Number o f Inmates, and Budget of the Various I n s t i t u t i o n s . • « . . . 114 i v CARE OF THE MENTALLY ILL IN BRITISH COLUMBIA Thesis A b s t r a c t This t h e s i s i s ' a study of the care of the mentally i l l i n B r i t i s h Columbia from the e a r l y days of the pioneers to the present time. I t i s hoped that t h i s study w i l l be of value to those charged w i t h the care of the unfortunate persons among us who s u f f e r from some form of mental i l l n e s s . I t i s a l s o hoped that t h i s work" w i l l help to c l e a r up some of the misconceptions surrounding the whole t o p i c o f mental hygiene. The study begins i n the e a r l y years of the nin e -teenth century. The s o - c a l l e d insane were at f i r s t sent to an asylum i n C a l i f o r n i a but l a t e r were placed i n the gaol i n V i c t o r i a . L a t er the Royal H o s p i t a l i n that c i t y was used to house them up u n t i l the f i r s t asylum was b u i l t i n New Westminster. A f t e r the turn of the century many new ideas regarding the care of the mentally i l l began to spread throughout the c i v i l i z e d world, and had a profound a f f e c t on the a d m i n i s t r a t i o n of the mental h o s p i t a l s i n B r i t i s h Columbia. A f t e r World War I p s y c h i a t r y developed very r a p i d l y and s c i e n t i f i c treatment began to replace simple c u s t o d i a l care i n the mental h o s p i t a l s . The f i n d i n g s of a survey made by the Canadian N a t i o n a l committee f o r Mental Hygiene i n 1919 and the recommendations of a Royal Commission i n 1927 g r e a t l y i n f l u e n c e d the government i n p r o v i d i n g b e t t e r f a c i l i t i e s throughout the province. The f i r s t s o c i a l worker came to h o s p i t a l at Essondale i n 1932, and l a t e r that year the O h i l d Guidance C l i n i c was opened. I t has done e x c e l l e n t work hut i t has been s u c c e s s f u l i n h e l p i n g only the c h i l d r e n who need urgent a t t e n t i o n . -Shock therapy i s used e x t e n s i v e l y at Essondale and the r e s u l t s have been very encouraging. Other modern forms of therapy are used i n c l u d i n g organized r e c r e a t i o n , h a n d i c r a f t s , and cosmetherapy. N e i t h e r psychoanalysis nor 1 group psychotherapy i s p r a c t i s e d at the h o s p i t a l . There has been a gradual development i n B r i t i s h Columbia from simple c u s t o d i a l care to modern treatment procedures. In s p i t e of present day knowledge, however, the mentally i l l i n t h i s province are not g e t t i n g the f u l l b e n e f i t of a l l the techniques f o r c u r i n g them. Overctfowding has always been, and s t i l l i s , a major problem. Lack of t r a i n e d personnel, of adequate methods of a f t e r - c a r e , o f s a t i s f a c t o r y preventive s e r v i c e s are a l l problems which need more a t t e n t i o n . - 1 -INTRODUCTION Sinee e a r l y times mental i l l n e s s has been s u r - " rounded w i t h s u p e r s t i t i o n s and misconceptions which have per-s i s t e d to t h i s day. The great m a j o r i t y of the general p u b l i c has l i t t l e opportunity to obtain r e l i a b l e i n f o r m a t i o n on t h i s v i t a l subject. Through the medium of the r a d i o and motion p i c t u r e , however, they often o b t a i n a garbled and very much exaggerated idea of mental disease. The nineteenth century saw great s t r i d e s made i n l o o k i n g a f t e r those who were mentally a f f l i c t e d . During the l a t t e r h a l f of the century, the great reformer Dorothea lynde Dix made i t her mission i n l i f e to have the mentally i l l t r a n s f e r r e d from gaols and poorhouses to s p e c i a l i n s t i t -u t i o n s f o r them alone. Her orusade beginning i n 1841, l a s t e d f o r f o r t y years, and was devoted to b u i l d i n g enough "insane-asylums'* to look a f t e r a l l the mentally s i c k confined i n penal and pauper i n s t i t u t i o n s . In 1872, the New York N e u r o l o g i c a l A s s o c i a t i o n was founded and 'almost immediately found i t t s e l f at c r o s s purposes w i t h the organized medical superintendents o f mental h o s p i t a l s . The new a s s o c i a t i o n became a l l i e d w i t h s o c i a l workers who f o r many years had seen the s o c i a l and economic consequences of mental disease i n the homes of the a f f l i c t e d . The s o c i a l work approach to the subject was t h e r e f o r e , much broader than the medical, and workers were thoroughly i n favor o f Dorothea - 2 -Dix's campaign to get the insane out of almhouses and i n t o s p e c i a l h o s p i t a l s where they might receive humane treatment. They were a l s o among the f i r s t to recognize the great s o c i a l and economic "benefits that would accrue from a program of prevention o f mental i l l n e s s . v The beginning o f the twentieth century saw the i n c e p t i o n of.great h e a l t h and humanitarian movements. The p e r i o d i s known as the golden age of s o c i a l reform. Led by a whole group of enlightened young men and women i n the United S t a t e s , campaigns were launched f o r a b o l i s h i n g slums, improving wages, b e t t e r p r o t e c t i o n of i n f a n t and maternal h e a l t h , and f u l l e r r e a l i z a t i o n o f known p u b l i c h e a l t h p r i n c i p l e s . Mas; t s i g n i f i c a n t o f a l l was the f a c t that these trends found organized expression. The time was r i p e - f o r the s t a r t of a mental hygiene movement, and the man who s t a r t e d i t was C l i f f o r d Beers. In 1900, he s u f f e r e d a "nervous breakdown" and a f t e r attempting s u i c i d e , was put i n a mental h o s p i t a l i n Massachusetts. During the next three years he was i n three d i f f e r e n t i n s t -i t u t i o n s both p r i v a t e and p u b l i c . He was b r u t a l l y t r e a t e d i n a l l three of them, s u f f e r i n g at the hands of inhuman a t t e n -dants and i n d i f f e r e n t doctors. In order to expose the con-d i t i o n s under which the mentally i l l were made to s u f f e r , he wrote a book c a l l e d "The Mind That Found I t s e l f " 1 , which not only brought out the shortcomings of these mental h o s p i t a l s , - 3 -but put forward w e l l thought out ideas f o r improving c o n d i t i o n s . Beers proposed to found an o r g a n i z a t i o n which would wage an-ed u c a t i o n a l campaign against the p r e v a i l i n g ignorance regard-ing mental i l l n e s s . In sho r t , h i s goal was to cure the d i s -ease by preventing i t . His book became an American c l a s s i c and founded the mental hygiene.movement. I t began at an aus-p i c i o u s moment because/ of the growing awareness of the need f o r mental hygiene. The widely accepted view that mental i l l n e s s was hopeless, had r a i s e d a great b a r r i e r against pro-gr e s s i v e measures on b e h a l f of the mentally i l l . The force of the mental hygiene movement was f e l t very s t r o n g l y i n s o c i a l work. Workers i n t h i s f i e l d had l o n g been i n touch w i t h the problems of mental disease, and the f a c t o r s operating during and a f t e r World War I brought to a focus the trend toward the converging of mental hygiene and s o c i a l work. A f t e r the s t a r t o f the twentieth century, psych-i a t r i s t s became p a r t i c u l a r l y aware of the great value of know-in g the s o c i a l h i s t o r i e s of t h e i r p a t i e n t s . Mental h o s p i t a l s began to use t r a i n e d s o c i a l workers i n 1905 to get s o c i a l h i s -t o r i e s and to do follow-up work w i t h discharged p a t i e n t s i n t h e i r own homes. L a t e r , the a f t e r - c a r e movement which had s t a r t e d i n Eurdpe was introduced i n North America. I t s pur- ' pose was to a s s i s t paroled or discharged p a t i e n t s to re a d j u s t to community l i f e . Thus, p s y c h i a t r i s t s began to recognize ths r o l e of environmental f a c t o r s i n the causes, prevention, treatment, and ul t i m a t e cure of mental i l l n e s s , and more and more c a l l e d i n s o c i a l workers to c o l l a b o r a t e w i t h them. The years a f t e r the f i r s t world war saw the a p p l i c -a t i o n of mental hygiene p r i n c i p l e s to the c h i l d welfare f i e l d . The c h i l d guidance movement f o r m a l l y began i n 1922, and c l i n i c s were e s t a b l i s h e d i n connection w i t h j u v e n i l e courts and i n d -u s t r i a l schools. Mental hygiene c l i n i c s f o r a d u l t s a l s o were s t a r t e d i n communities, many of them being connected w i t h the mental h o s p i t a l ; others were part of the o u t - p a t i e n t s T dep-artments of general h o s p i t a l s , s o c i a l agencies, c o u r t s , or c o r r e c t i o n a l i n s t i t u t i o n s . Some were independently created. The care of the mentally i l l i n B r i t i s h Columbia during the l a s t hundred years was n a t u r a l l y i n f l u e n c e d by developments i n other p a r t s of the world. At f i r s t m e n t ally i l l persons were put i n the gaol i n V i c t o r i a , and l a t e r t r a n s -f e r r e d to a h o s p i t a l on the o u t s k i r t s of the c i t y f o r m e r l y used as a pest-house. By 1878, a new h o s p i t a l had been com-p l e t e d i n Hew Westminster, and a l l the inmates were removed to t h i s i n s t i t u t i o n . Before the end of the century conditions had become so bad that a Royal Commission was appointed to i n v e s t i g a t e . Many of the recommendations made by t h i s Com-mission were l a t e r c a r r i e d out. A f t e r C l i f f o r d Beers s t a r t e d the mental hygiene movement i n the United S t a t e s , a N a t i o n a l Committee f o r Mental Hygiene was e s t a b l i s h e d i n Canada i n 1918, and i n the f o l l o w i n g year at the request of the p r o v i n c i a l s e c r e t a r y , a survey was made i n B r i t i s h Columbia i n order to f i n d out the needs r e -garding the care of the mentally i l l and the mentally d e f e c t i v e She report of the Committee was f u l l of suggestions f o r improve ment, some of which were put i n t o e f f e c t . The C h i l d Guidance C l i n i c s t a r t e d i n Vancouver i n 1932, r e f l e c t i n g the growth of s i m i l a r c l i n i c s under the aegis of the mental hygiene movement. The f i r s t s o c i a l worker came i n 193^ to the mental h o s p i t a l , and her s a l a r y was p a i d f o r one year by the Canadian N a t i o n a l Committee f o r Mental Hygiene. In B r i t i s h Columbia, there has been a gradual development from simple c u s t o d i a l care of the mentally i l l to r e a l treatment procedures. With the exception of c o n v i c t s who happen to be mentally i l l , p a t i e n t s i n the p r o v i n c i a l mental h o s p i t a l s r e c e i v e the b e n e f i t of modern treatment. The C h i l d Guidance C l i n i c r e f l e c t s the need f o r some preven-t i v e service' and i s attempting to expand i t s program. Against the background of t h i s h i s t o r i c a l survey i t w i l l perhaps be c l e a r that there are s t i l l c e r t a i n inad-equacies i n the p u b l i c care of the mentally i l l i n B r i t i s h Columbia, and i t may a l s o be that there are c l e a r e r i n d i c a t -ions of how these shortcomings might be overcome. 6 CHAPTER I THE EARLY YEARS Pioneer Bays The e a r l y s e t t l e r s i n B r i t i s h Columbia were com-p r i s e d of b u s i n e s s - l i k e t r a d e r s , hardy c o l o n i a l s , s p e c u l a t i n g gold-seekers, Imperial o f f i c i a l s , and Royal Engineers. Pioneers were f i r s t a t t r a c t e d to t h i s part of the continent by the i n s a t i a b l e d e s i r e to obtain f u r s . Alexander Mackenzie crossed overland to B e l l a Coola i n 1793 to e s t a b l i s h a t r a d i n g post f o r the North West Company, and i n 1805 Simon Fraser i n the i n t e r e s t s of the same company came down the muddy r i v e r which was l a t e r c a l l e d a f t e r him. The Hudson's Bay Company was not to be outdone and i n 1846, a f t e r the famous Boundary Dispute w i t h the United S t a t e s had been s e t t l e d , b u i l t a f o r t at the southern t i p of Vancouver I s l a n d to p r o t e c t i t s f u r t r a d i n g i n t e r e s t s i n B r i t i s h T e r r i t o r y . C o l o n i z a t i o n f o l l o w e d and i n 1850 the Colony of Vancouver I s l a n d was created, and V i c t o r i a on the s i t e of the Hudson's Bay f o r t became the c a p i t a l , tyueen V i c t o r i a appointed governor, Ric h a r d Blanshard, but he was succeeded the next year by James Douglas who had been the Hudson Bay f a c t o r and was a v i t a l and dominant p e r s o n a l i t y . He had great f a i t h i n the f u t u r e of the young colony and was l a r g e l y r e s p o n s i b l e f o r the success of i t s e a r l y years. Trade was begun wi t h Russian ports i n Alaska and by the time gold was discovered - 7 -i n 1858, the colony was f i r m l y e s t a b l i s h e d . The i n f l u x o f some 20,000 gold-seeking adventurers i n 1858 changed V i c t o r i a from a small t r a d i n g post to a f a i r -s i z e d c i t y . One of the e a r l y s e t t l e r s was very c r i t i c a l o f the hordes that were pouring i n and describes the i n f l u x i n v i v i d terms: V i c t o r i a was a s s a i l e d by an i n d e s c r i b a b l e array of . P o l i s h Jews, I t a l i a n fishermen, French oobks, spec-u l a t o r s of every k i n d , land agents, a u c t i o n e e r s , hangers on at au c t i o n s , bummers, bankrupts, and brokers of every d e s c r i p t i o n . . • To the above l i s t may be added a f a i r seasoning of gamblers, swind-l e r s , t h i e v e s , drunkards 4, and j a i l b i r d s l e t loose by the Governors of C a l i f o r n i a f o r the b e n e f i t 6 f mankind, besides the h a l t , lame, b l i n d , and mad. In s h o r t , the outscourings of a p o p u l a t i o n c o n t a i n -i n g l i k e that of C a l i f o r n i a , the outscourings of the world . . . When the older i n h a b i t a n t s beheld these v a r i e d specimens of humanity steaming down i n ' motley crowds from the steamers and s a i l i n g v e s s e l s , and covering the wharves as i f they had come to take possession of the s o i l , they looked on i n amazement, as i f contemplating a second i r r u p t i o n of the barbarians. 1 The gold-seekers o u t f i t t e d at V i c t o r i a , which at the time was the only port of en t r y f o r the t e r r i t o r y and proceeded to seek the precious metal on the lower bars of the Fraser R i v e r . Soon towns grew up on the mainland, Hew West-minster, Hope, and Yale being the f i r s t of these. Many who f a i l e d to f i n d gold s e t t l e d on the r i c h l a n d along the v a l l e y and by 1859 the po p u l a t i o n had grown to such an extent that 1. Waddirigton, A l f r e d , The ^ i s t o r y of Four Months, or The Fraser Mines VindicatedT''"vTotoria. P. DeGarro, 185U7 . pp7. 17-187 the new Colony of B r i t i s h Columbia oame i n t o being. The Queen sent the Royal Engineers that year to help b u i l d the c a p i t a l c i t y o f New Westminster, survey the la n d , b u i l d roads, and take over the Royal Navy's job of p o l i c i n g the t e r r i t o r y . More gold was discovered i n the Upper Fraser i n 1861/and more adventurers came, t h i s time c h i e f l y from E a s t e r n Canada and the United Kingdom. P a r a l l e l i n g these events was the s w i f t develop-ment of responsible government. The two c o l o n i e s u n i t e d i n 1866, a year before Confederation. When t h i s was accomplished i n 1867, there was v a r i e d opinion i n the western colony. Some wished to r e t a i n c o l o n i a l s t a t u s , others wanted annex-a t i o n w i t h the United S t a t e s , and those from E a s t e r n Canada pressed f o r union w i t h the new Dominion. These diverse opin-ions d i d not prevent the new governor, Anthony Musgrave, from drawing up terms on which the colony would enter i n t o confed-e r a t i o n and e v e n t u a l l y i n 1871 B r i t i s h Columbia became part of the Dominion of Canada. In 1873 the L e g i s l a t u r e of B r i t i s h Columbia passed the f i r s t <&ct which set f o r t h the r e g u l a t i o n s f o r e s t a b l i s h i n g Asylums f o r the Insane i n the province. The Act c a l l e d f o r a Medical Superintendent to d i r e c t and c o n t r o l "the medical and moral treatment" of the p a t i e n t s , a Superintendent to i conduct the f i n a n c i a l business and a f f a i r s of the Asylum, and such other o f f i c e r s and servants as may be r e q u i r e d . The Act provided that a l u n a t i c should be committed to the Asylum - 9 -upon the c e r t i f i c a t e of two medical p r a c t i o n e r s , who were to examine the p a t i e n t i n the presence of each other. One dan-gerous p r o v i s i o n was set f o r t h i n s e c t i o n twenty-two which gave the superintendent the r i g h t to provide e x t r a comforts f o r p a t i e n t s w i t h money. This p r o v i s i o n was an i n v i t a t i o n f o r g r a f t i n g and i t was not lon g before a dishonest s u p e r i n -tendent took advantage of the opportunity. U n t i l the gold rush of 1858 there had been only one instance recorded of an insane person i n B r i t i s h Columbia. In 1850 a young immigrant from Scotland "proved h i m s e l f to be a genuine maniac by making a most unprovoked a t t a c k upon Br. Helmcken during a v i s i t " . 1 He was sent home and l a t e r recovered. Dr. J.S. Helmcken who h e l d the p o s i t i o n of Gaol Surgeon i n V i c t o r i a f o r f i f t y years, thus was the f i r s t phys-i c i a n to come i n oontact o f f i c i a l l y w i t h a mentally i l l person i n B r i t i s h Columbia. When the gold rush s t a r t e d i n 1858, many newcomers broke down under the s t r a i n and hardships endured and had to be taken care of. The nearest asylum at t h i s time was i n C a l i f o r n i a , and the only p]a ce i n the province f o r l o o k i n g a f t e r v i o l e n t cases was the gaol i n V i c t o r i a . The a u t h o r i t i e s began to send the insane back to C a l i f o r n i a where they were committed to the Uapa Asylum i n that s t a t e . T h i s procedure "'"British Columbia Sessional'Papers, Annual Report on the P u b l i c H o s p i t a l f o r the Insane, 1901, gp. 463-468. - 10 -continued u n t i l C a l i f o r n i a n o t i f i e d the B r i t i s h Columbia Government that i t must pay towards the upkeep of those per-sons sent from that colony. This suggestion was not accepted, instead the mentally i l l were kept i n the gaol i n V i c t o r i a u n t i l i t became too f u l l to h o l d any more, and the m i l d e r cases were t r a n s f e r r e d to the Eoyal H o s p i t a l . The gaol of those e a r l y days contained only ten or twelve c e l l s and was b u i l t on hewn l o g s at f i r s t , but l a t e r a two s t o r y b r i c k a d m i n i s t r a t i o n b u i l d i n g was added to the f r o n t of i t . The s i t e was the same as the one l a t e r occupied by the Law Courts on B a s t i o n S t r e e t . The gaol continued to be used u n t i l women p a t i e n t s began to appear and the govern-ment was f o r c e d to provide a more adequate place. The Royal H o s p i t a l was a h o s p i t a l f o r men only and was s i t u a t e d on the 3onghees Indian Reserve, on the other side of the harbor opposite the c i t y . I t was o r i g i n a l l y b u i l t as a pest-house, so f o r that reason was l o c a t e d outside the c i t y l i m i t s . Women p a t i e n t s were housed at f i r s t i n a h o s p i t a l on Pandora S t r e e t opened by V i c t o r i a women, but because of f i n a n c i a l d i f f i c u l t i e s i t was amalgamated w i t h the Royal H o s p i t a l which s u p p l i e d a woman's ward. When two mentally i l l women came under the n o t i c e of Dr. I.W. Powell, he made the suggestion to the government of remodelling the Royal H o s p i t a l f o r an asylum. This was done and on October 12, 1872 i t became the f i r s t p r o v i n c i a l - 11 mental h o s p i t a l i n B r i t i s h Columbia and f u l f i l l l a e d that fun-c t i o n f o r f i v e and one h a l f years. The new i n s t i t u t i o n came under the o f f i c e of the' P r o v i n c i a l Secretary, which depart-ment has been responsible f o r i t s management ever s i n c e . The f i r s t asylum was a whitewashed wooden b u i l d i n g of two s t o r i e s , i n s i z e about f i f t y f e e t by f o r t y f e e t . A door from the upper s t o r y l e d onto a balcony which commanded an e x c e l l e n t view of the harbor, and a l l i n a l l the s i t u a t i o n was a pleasant one. The i n t e r i o r had been remodelled and c o n s i s t e d of c e l l s or very small s i n g l e rooms. F i v e men and two women made up the f i r s t p a t i e n t s , two days a f t e r the opening a t h i r d woman being admitted. Dr. I.W» Powell became the f i r s t Medical Superintendent (non-resident), Mr. E.A. Sharpe was appointed Superintendent of the Asylum, w i t h Mrs. F l o r a Ross as Matron. The r e s t of the s t a f f c o n s i s t e d of three "keepers" or male attendents, a cook, and an Indian washwoman. .Thus at f i r s t there were as many employees as p a t i e n t s , a s i t u a t i o n which d i d not l a s t very long, however. "Crude as things must have been i n t h i s embryo asylum, there were mal i n g e r i n g a p p l i c a n t s f o r admission. Dr. Helmcken t e l l s of one who pretended to be not only insane bat paralyzed, but as h i s deception was suspected by a phys-i c i a n , the l a t t e r took a p a i l of water up to the balcony while the man was i n f r o n t of the b u i l d i n g and suddenly dashed the - 12 -the contents upon the would-be l u n a t i c , who suddenly made a complete recovery and dis p l a y e d good a c t i o n i n h i s l e g s while h u r r y i n g away. I n t e r n a l l y the-asylum was i l l adapted f o r i t s work and a carpenter was kept busy r e p a i r i n g the damage done by di s t u r b e d p a t i e n t s . To keep order, i t was necessary at times to use some form of mechanical r e s t r a i n t , and t h i s o b j e o t i o n -able feature developed and stayed w i t h i t f o r many years. The f i r s t superintendent of the i n s t i t u t i o n proved u n s a t i s f a c t o r y i n every way. He tre a t e d the pauper p a t i e n t s i n a p a t r o n i z i n g manner and gave them the poorest of food. Those w i t h money were b e t t e r o f f as he was au t h o r i z e d to see that they r e c e i v e d "greater comfort 1* and i n p r o v i d i n g t h i s he had ample opportunity for g r a f t i n g . He t r i e d to repla c e . the matron by h i s own w i f e , but i n a s e r i e s of l e t t e r s to the P r o v i n c i a l Secretary the matron expoeed the whole s o r d i d t . . . . . . . a f f a i r and the Superintendent was removed from o f f i c e f o r " t h e f t , i n t o x i c a t i o n , q u a r r e l l i n g , and i n t e r f e r i n g " . I t was n e a r l y four years, however, before the change was made. At the end of 1873, when there were fourteen pat-i e n t s , Dr. Powell resigned and was succeeded by Dr. J.B. Mathews. By the close of 1875 there were t h i r t y - t w o p a t i e n t s , and i n the s p r i n g of 1876 a small shed-like a d d i t i o n was b u i l t r ^ • B r i t i s h Columbia. S e s s i o n a l Papers, Annual Report of the P u b l i c H o s p i t a l f o r the Insane. 1901, p. 46F~ ™ - 13 -to make more room. On December 1, 1877, Dr. Mathews having resigned, Dr. Maclaughton-Jones became the f i r s t r e s i d e n t Medical Superintendent, ^ t the end of that year there were t h i r t y - s e v e n p a t i e n t s and the b u i l d i n g could accommodate no more. A Se]e ct Committee appointed to i n q u i r e i n t o the P r o v i n c i a l L u natic Asylum i n 1875 agreed that the o r i g i n a l b u i l d i n g was u n f i t i n every respect f o r the treatment of the insane, and urged the t r a n s f e r of the establishment." 1" At the time, there was a c a p a c i t y f o r twenty p a t i e n t s ( t h i r t y -two were i n r e s i d e n c e ) , there was no f u r n i t u r e and wooden beds were the only "comfort" f o r the inmates. The government, decided to b u i l d a new asylum and chose a s i t e near Hew Westminster apparently as some compensation to that c i t y f o r b e i n g passed over as the p r o v i n c i a l c a p i t a l . The land'used f o r the purpose was a government r e s e r v a t i o n of about 180 acres. ' The f i r s t b u i l d i n g at New Westminster was completed by the end of 1877 at a cost of about ^4,000. I t was a two s t o r y b r i c k s t r u c t u r e , 125 f e e t l o n g by d5 f e e t wide. There were four wards each w i t h seven s i n g l e rooms f o r p a t i e n t s , a day room, and a l a v a t o r y . Dr. Jones, the new medical super-intendent inspected the b u i l d i n g before t a k i n g occupancy and "was not at a l l pleased with i t . In a l e t t e r to the government 1 B r i t i s h Columbia, S e s s i o n a l Papers, 1875, p. 690. - 14 -dated November 19, 1877 he said:" 1 The window bars i n the c e l l s and p a t i e n t s ' general rooms i n v i t e and preclude the p o s s i b i l i t y of prevent-i n g s u i c i d e , while the unaccouritable precautions taken to prevent the p a t i e n t s from even o b t a i n i n g a glimpse of the outside world w i l l have'a very d e l -e t e r i o u s e f f e c t on the inmates;"indeed, would be enought to d r i v e a sane man mad. An ornamental hole i n the upper lobby i n v i t e s s u i c i d e or suggests murder. There are v e n t i l a t i n g apertures f o r the e x i t of f o u l a i r i n the c e l l s and p a t i e n t s ' rooms, b u t ' I could not discover whence pure a i r was to come. The t r a n s i t windows are placed at the wrong end of the b u i l d i n g . The o f f i c e r s ' rooms are a l l constructed on the b e l i e f that these people do not r e q u i r e a i r ; s e v e r a l of them are only boxes p l a s t e r e d inside...There are no b e l l s i n the b u i l d i n g nor any means of communication except by word of mouth...There are no padded rooms. In case f i r e o r i g i n a t e d i n the body of the b u i l d i n g , the"inmates c o u l d not p o s s i b l e escape. There are only three modes of e x i t i n the b u i l d i n g , the f r o n t door and'two small ones i n the d i r e c t ' r e a r of the b u i l d i n g , at the end of the main h a l l . The i n t e r i o r i s so badly l i g h t e d that one can h a r d l y see to read. On the whole, the b u i l d i n g , i n i t s present s t a t e , seems' to me a madhouse of former times, and not a' modern hospittal f o r p a t i e n t s a f f e c t e d with disease of the brain.1 The Report of the Commissioners on the s t a t e of 2 the L u n a t i c A s y l u m of Decemba r 15, 1877, made a number of recommendations none of whioh were c a r r i e d out f o r s e v e r a l years. I t recommended i n c r e a s i n g dormitory accommodation to a f f o r d room f o r f o r t y p a t i e n t s , lowering the windows, i n s t a l -l a t i o n of o e n t r a l h e a t i n g , permanent water supply, e x i t s at the end of each c o r r i d o r on both f l o o r s , two padded rooms, e l i m -•'•British-Columbia, S e s s i o n a l Papers, 1878, p. 517. 2 i b i d , p. 520. - 15 -i n a t i o n o f barred windows, e r e c t i o n of wings and r e c r e a t i o n room, a detached cottage f o r the medical superintendent,,and the s e t t i n g aside of f i f t y acres f o r an asylum farm. P a t i e n t s were t r a n s f e r r e d from V i c t o r i a to the new h o s p i t a l i n May, 1878 and the t h i r t y - e i g h t of them overtaxed the accommodation which was not increased f o r seven years. As soon as the p a t i e n t s were s e t t l e d Dr. Jones r e s i g n e d And Dr. T*R. Molnnes ( l a t e r Lieutenant-Governor of B.C.) became the non-resident Medical Superintendent, the o l d system being r e v e r t e d to. At t h i s time the Superintendent, Mr. James P h i l l i p s r e c e i v e d a s a l a r y of $1200 a year, while the Medical Superintendent r e c e i v e d only #400, l e s s than e i t h e r of the f i v e keepers, matron cook or n i g h t watchman. The f i r s t Annual Report f o r the year 1882 makes i n t e r e s t i n g reading. B r i t i s h Columbia had a p o p u l a t i o n of about 30,000 at that time, and i t s wealth of resources was a t t r a c t i n g newcomers from the B r i t i s h I s l e s and E a s t e r n Canada. There was t a l k of b u i l d i n g a t r a n s c o n t i n e n t a l r a i l w a y which would provide a d i r e c t l i n k w i t h the more s e t t l e d p a r t s of North America. The Superintendent, Mr. P h i l l i p s , was appalUe d by the f a c t that there was one insane person f o r every s i x hundred i n the p o p u l a t i o n , and he recommended the c o n s t r u c t i o n of a d d i t i o n a l space i n order to accommodate se v e n t y - f i v e persons. He suggested that the four acres i n f r o n t of the b u i l d i n g should be c u l t i v a t e d and convalescent p a t i e n t s allowed - 16 to do the. work, thereby saving the government a considerable sum of money. In h i s p l e a f o r more room he t r i e d to be as dramatic as p o s s i b l e and wrote: "To have two i r r a t i o n a l beings occupying the same room, no matter how q u i e t and i n -o f f e n s i v e they may have been f o r even months, they are l i a b l e at any moment to become v i o l e n t , r a v i n g maniacs, and l i k e an enraged animal, pounce upon the unfortunate roommate and i n f l i c t s erious i n j u r y , or even take l i f e . T his i s no i d l e dream , , ,"V*" Judging from the 1882 Annual Report only three k i n d s of i n s a n i t y , mania, monomania, and melanoholia, e x i s t e d . The personnel at that time i n a d d i t i o n to the superintendent, medical o f f i c e r , and matron c o n s i s t e d of f i v e keepers, as w e l l as a night watchman, cook, and washerwoman. S a l a r i e s t o t a l l e d $5,815. In theory, p a t i e n t s were charged w i t h a l l expenses except house r e p a i r s and the transport of l u n a t i c s and keepers. In p r a c t i c e , however, they p a i d l e s s than h a l f o f . t h e i r upkeep as tne t o t a l cost of upkeep f o r 1883 was $11,196, the p a t i e n t s c o n t r i b u t i n g $507.18. The Asylum continued to be overcrowded. In 1884 a $26,000 wing was added, the window s i l l s were lowered, and a balcony was b u i l t on esch ward. The new a d d i t i o n r a i s e d the c a p a c i t y to seventy beds, while about s i x t y p a t i e n t s B r i t i s h Columbia, S e s s i o n a l Papers, Annual Report  on the Asylum f o r the Insane, 1882, p. 3£5Y - 17 -were i n residence. On January 1, 1885, Dr. R.I. 'Bentley who had p r e v i o u s l y been v i s i t i n g p h y s i c i a n , was put i n complete charge of the i n s t i t u t i o n w i t h an increased s a l a r y , and the former Superintendent, Mr. P h i l l i p s , became steward. This change was long overdue and was a r e c o g n i t i o n of the f a c t that f u l l time medical s u p e r v i s i o n was necessary i n caririg .y f o r the mentally i l l , although c u s t o d i a l care was a c t u a l l y s t i l l the only treatment. Dr. Bentley introduced an imp-ortant i n n o v a t i o n when he allowed the p a t i e n t s to work on the grounds, and henceforth e x e r c i s e i n the f r e s h a i r became part of the treatment afforded. Greater e f f o r t was put f o r t h at t h i s time to amuse p a t i e n t s by games and dancing. However*, since the men and women were segregated, the women had to dance wi t h each other, and i n the absence of a piano, without any music. By 1889 the h o s p i t a l was so crowded that new pat-i e n t s had to wait i n the Hew Westminster P e n i t e n t i a r y u n t i l there was room f o r them i n the I n s t i t u t i o n . In that year, a d d i t i o n a l wings were added and a l s o a c e n t r a l b u i l d i n g w i t h k i t c h e n f a c i l i t i e s and o f f i c e space. - 18 -* TABLE 1 S a l a r i e s , Maintenance, T o t a l Expenditure of' the P r o v i n c i a l Mental H o s p i t a l s i n decades 1875-1945. FISCAL YEAR SALARIES . MAINTENANCE TOTAL 1875 1 3,783.96' 3,126.10 7,410.06 1885 2 9,399.96 .6,433.76 15,833.72 1895 15,542.07 20,006.86 35,548.93 1905 3 38,088.88 84,560.68 122,648.56 1915 4 119,521.43 280,207.24 399,728.67 1925 5 305,992.41 393,476.55 699,468.96 1935 622,018.70 475,357.83 1,097,375.53 1945 6 1,290,416.66 1,244,715.36 2,535,132.02 1 Royal V i c t o r i a H o s p i t a l 2 New Westminster Asylum 3 Includes Colony Farm 4 Includes Essondale 5 Includes O o l q u i t z 6' Vancouver C l i n i o , Headquarters,, Essondale, New Westminster, Colony Farm, C o l q u i t z . CHAPTER I I "DEVELOPMENT FROM 1894-1905 The Royal Commission of 1894 The year 1894 was a momentous one i n the h i s t o r y of the P r o v i n c i a l Asylum f o r the Insane. Ugly r e p o r t s ahout i l l treatment of the inmates had "been reaching the Government, and i n order to f i n d out i f there were any j u s t i f i c a t i o n f o r these rumours, a Royal Commission was appointed made up of two medical doctors, Edward H a s e l l and Charles Newcombe, the l a t t e r of whom had worked i n mental i n s t i t u t i o n s i n Great B r i t a i n . They were given a u t h o r i t y to i n q u i r e i n t o "the s a n i t a r y and p r o f e s s i o n a l treatment of p a t i e n t s , the s a n i t a r y arrangements, the number and d u t i e s of the o f f i c e r s and employees of the Asylum and t h e i r conduct, the cost of maintenance, and g e n e r a l l y a l l matters concerning the manage-ment of the Asylum, or r e l a t i n g to the welfare of the inmates or the p u b l i c i n t e r e s t s . " The Commission v i s i t e d the Asylum f o r the f i r s t time oh October 31st and the f o l l o w i n g ten days. They found i t necessary to come back l a t e r i n November to reexamine c e r t a i n witnesses because the o f f i c i a l stenographer had d i s -appeared together w i t h a l l h i s notes. Both p a t i e n t s and o f f i c i a l s were interviewed i n f o r m a l l y at f i r s t , but l a t e r the "'"British Columbia, S e s s i o n a l Papers, 1894-95, Royal  Commission Report on the P r o v i n c i a l Asylum f o r the Insane , November W. 1894, p7~5"03. ~ ~ - 19 -- 20 attendants were pat under oath i n order that the Commission could get as complete and honest a st o r y as p o s s i b l e . Of the s t o r i e s t o l d by the inmates, the o f f i o i a l r e p o r t says: I t was w i t h i n f i n i t e d i f f i c u l t y , however, i n m o s t cases that we could induce these poor people to b e l i e v e that they would not be seve r e l y punished i f they reported what they had seen and s u f f e r e d . . • Taken at random, from every ward, without' any p o s s i b i l i t y of c o l l u s i o n , they, one and a l l , t o l d the same s t o r y of c r u e l t y and oppression. They a l l gave us the impression of being t e r r o r i z e d , not only . by the punishments they had themselves experienced, but a l s o by the r e p o r t s which had reached them, i n .some cases hp doubt exaggerated, of punishments i n -f l i c t e d upon others. Thus, they were a l l aware of the man Schubert's death i n a dark c l o s e t while confined i n a s t r a i t - j a c k e t , and they a l l knew of the' cage i n the basement c e l l a r . . . Having on the f i r s t day of our v i s i t been informed that no pun-ishments whatever were now imposed upon p a t i e n t s , and that mechanical r e s t r a i n t was only used by s p e c i a l order, and a f t e r proper enquiry, we were astounded at hearing p a t i e n t a f t e r p a t i e n t t e l l i n g the same s t o r i e s of inmates being thrashed w i t h s t r a p s , of t h e i r being k i c k e d , handcuffed f o r t r i f -l i n g offences, struck w i t h the f i s t , ducked i n c o l d water u n t i l n e a r l y s u f f o c a t e d , of t h e i r b eing t o r -tured by semi-s t r a n g u l a t i o n by means of the s t r a i t -j a c k e t , and o f one man having a hand c r i p p l e d f o r l i f e by the prolonged use of a l e a t h e r ' m i t 1 , f o l -lowed by inflammation and abscess i . . We f e l t compelled to s i f t t h i s matter to the bottom and hour a f t e r hour, f o r two days, we l i s t e n e d to most dep-r e s s i n g t a l e s of c r u e l t y and h u m i l i a t i n g usage." 1 The evidence obtained from the attendants under oath proved that c r u e l t i e s had been i n f l i c t e d upon the pat-i e n t s contrary to the r u l e s of the Asylum, and that the Med-i c a l Su]£ rintendent had not properly supervised h i s keepers nor enforced h i s own r u l e s . At the time of the Commission's i b i d , p. 504. - 21 -v i s i t , the Asylum was d i v i d e d i n t o s i x wards: Ward "A" - f o r quiet p a t i e n t s and convalescents; 9 of these employed; & e p i l e p t i c s . Ward "B" - contained most of the p a t i e n t s who helped w i t h the work of the asylum; of the 25 p a t i e n t s , dl were employed about the b u i l d i n g . Ward mD" - used f o r r e c e p t i o n of new p a t i e n t s and con-tained the i n f i r m a r y ; 30 p a t i e n t s of whom three were e p i l e p t i c s . Ward "E" - reserved f o r v i o l e n t , n o i s y , and r e f r a c t o r y p a t i e n t s ; 29 p a t i e n t s , three of whom were e p i l e p t i c s ; two p e n i t e n t i a r y p a t i e n t s . Ward "F" - f o r Chinese; 20 p a t i e n t s , four employed, no e p i l e p t i c s . In oontrast to the others was: Ward UC" - women's ward; the b r i g h t e s t and l e a s t p r i s o n - l i k e i n the Asylum; but a l l three p a t i e n t s were employed i n scrubbing; washing c l o t h e s , or sewing; contained books, news-papers, and potted p l a n t s which gave i t a home-like atmosphere q u i t e i n co n t r a s t to the other wards. Meals were served i n a room set aside i n each ward, the men us i n g enamel-wear dishes w i t h worn o i l - c l o t h on the tabl e s . In the women's ward, the d i n i n g t a b l e s were covered w i t h c l e a n white table c l o t h s and the cups and saucers were made of crockery. The only e a t i n g u t e n s i l s used by a l l p a t i e n t s were spoons. F u r n i t u r e throughout the i n s t i t u t i o n c o n s i s t e d of wooden benches and ta b l e s w i t h no comfortable c h a i r s what-soever. The only amusements provided were a few checker boards and one b i l l i a r d table made by the p a t i e n t s . The few - 22. -books and newspapers present were o l d . The Chinese Ward had both p l a n t s and canaries which belonged to the head attendant there and were brought by him f o r the pleasure of h i s p a t i e n t s . The Commission was favorable impressed w i t h the care given to the female p a t i e n t s under the d i r e c t i o n of the Matron, Mrs. Ross. She was so i n t e r e s t e d i n the work, that at her own expense and time, had v i s i t e d s i m i l a r i n s t i t u t i o n s i n Oregon and Washington and i n the care of the women under her charge incorporated some of the best features of these h o s p i t a l s . At r e g u l a r i n t e r v a l s the women went to the r e c -r e a t i o n h a l l s i t u a t e d u p s t a i r s which was fu r n i s h e d w i t h a piano and had been decorated with f l a g s r e p r e s e n t i n g the nations of the world. These had teen made by the women them-selves under the Matron's d i r e c t i o n . When the weather was wet, instead of going outside, the women played f o o t b a l l i n the r e c r e a t i o n h s l l and took much pleasure i n t h i s sport. On the whole, the Commission found the s a n i t a r y arrangements of the h o s p i t a l were s a t i s f a c t o r y . The v e n t i l -at i o n of the wasrda was good. They found, though, that the d r a i n pipes i n some oases emptied i n t o an o l d b r i c k d r a i n causing a f o u l odor. The k i t c h e n was very b i d and needed rep l a c ing. The report noted that very l i t t l e o f the la n d be-lon g i n g to the Asylum was a v a i l a b l e f o r the use of the p a t i e n t s . The men used an a i r i n g yard or c o r r a l which was 314 f e e t by 172 f e e t and was surrounded by a clo s e d board fence about - 23 -f i f t e e n feet high, which completely blocked out the view. The women's c o r r a l was 164 fee t by 133 f e e t and was used e x t e n s i v e l y i n dry weather. The Medical Superintendent had refused permission to the p a t i e n t s to e x e r c i s e outside the asylum p r e c i n c t s . The Commission recommended that the present ground at the f r o n t and sides of the b u i l d i n g be made i n t o a r e c r e a t i o n and a i r i n g ground, that paths be made, and seats placed f o r the p a t i e n t s ' use. They b e l i e v e d that ex-e r c i s e i n the open a i r was a b s o l u t e l y necessary as a c u r a t i v e agent, and thought that with troublesome p a t i e n t s the e x t r a space provided was a r e a l feature i n t h e i r s u c c e s s f u l t r e a t -ment as i t allowed them room and opportunity to "blow o f f steam . . . and get thoroughly t i r e d " . 1 They were very concerned over the f a c t that during the autumn and winter months most of the p a t i e n t s were eooped i n t h e i r wards f o r l o n g periods because of the absence of dry paths which would have allowed e x e r c i s e exoept i n the wettest weather. The confinement and l a c k of e x e r c i s e and f r e s h a i r they suggested, w i t h good reason, were the cause of increased i r r i t a b i l i t y and e x t r a t r o u b l e to the attendants r e s u l t i n g i n the use o f mechanical r e s t r a i n t . In t h e i r o p i n i o n , too much labor had been spent -«an improving, the Medical Superintendent's grounds, l a b o r --•Ibid, p. 508. - 24 -which should have been used to improve the land around the Asylum i t s e l f f o r the b e n e f i t of the p a t i e n t s . They noted that only twenty acres now belonged to the i n s t i t u t i o n , which was not n e a r l y enough. The attempts at r a i s i n g vegetables were desultory and inadequate. The s t a f f i n 1894 was ma.de up of ten attendants, two nurses f o r the women p a t i e n t s , a night watchman, cook, and laundress as w e l l as the medie. a l superintendent, steward, c l e r k , and matron. The working day f o r attendants and nurses was from 6 A.M. to 7 P.M. They were allowed only one f r e e afternoon pe.r week and a f t e r one year were given a meagre ten days' annual leave. Ho notes of any k i n d were kept by the male attendants, but the Matron i e p t a j o u r n a l i n which was r e c -orded n o t i c e s of r e s t r a i n t , s e c l u s i o n , and punishment. This j o u r n a l was open to i n s p e c t i o n by the Medical Superintendent. A l l orders to attendants were given v e r b a l l y and re p o r t s to the Medical Superintendent were also by word of mouth. He never v i s i t e d the b u i l d i n g at nigh t unless sent f o r , and so the Hight Watchman was i n charge of the whole i n s t i t u t i o n from 7 P.M. to 6.A.M. The l a t t e r was supposed to attend to p a t i e n t s who were wet or d i r t y , to change t h e i r c l o t h i n g or bedding, and to bathe or wash them i f necessary. He was given no w r i t t e n l i s t of e p i l e p t i c and s u i c i d a l p a t i e n t s . - 25 -Mechanical r e s t r a i n t s found to he i n use inc l u d e d handcuffs, l e a t h e r m i t s , l e a t h e r muffs, s t e e l a n k l e t s , l e a t h e r a n k l e t s f o r women, p i n i o n s t r a p s , camisoles and s t r a i t - j a c k e t s . The Commission was a p p a l l e d at the extensive use o f t h i s kirfl. of r e s t r a i n t and s a i d : Of the n e c e s s i t y of t h i s formidable array of imp-lements, the l i k e of which we have never seen "before exoept in'museums, we are unable to obta i n s a t i s -f a c t o r y evidenoe, at a l l events as remedial agents. The keepers do not record t h e i r use i n a proper book, and, notwithstanding t h e i r p r i n t e d r u l e s , ' they seem to apply the r e s t r a i n t s f i r s t and then, only sometimes, to re p o r t the f a c t to the steward or medical superintendent."! Handcuffs were considered the m i l d e s t form of r e s -t r a i n t and were used c h i e f l y f o r general r e s t l e s s n e s s , v i o -l e n c e , d e s t r u c t i v e n e s s , and to prevent masturbation. Leather muffs took t h e i r place on the women's ward. Sometimes men had t h e i r arms handcuffed behind t h e i r backs f o r s e v e r a l n i g h t s i n a row, even f o r a matter of weeks. The l e a t h e r m i ts often i n j u r e d the p a t i e n t s ' hands, and i n one case permanent "contraction of the f i n g e r s r e s u l t e d . The oamis:ole used f o r the women was made of a man's s h i r t w i t h e x t r a l o n g sleeves which allowed the arms to be held to the si d e s . The matron experimented w i t h sev-e r a l types u n t i l she found one that was l e a s t i n j u r i o u s to the women under her charge. Before a l l o w i n g the use of ariy mechanical r e s t r a i n t she t r i e d i t on h e r s e l f and i f she 1 I b i d , p. 510. found i t to be at a l l harmful, refused to sanction i t s use on any of the women p a t i e n t s . U n f o r t u n a t e l y no such humane impulse p r e v a i l e d on the male attendants. Beating w i t h straps ( o f t e n w i t h buckle end f i r s t ) was a common occurrence, while k i c k s and blows w i t h the f i s t were frequent i n c i d e n t s of "treatment". She two worst punishments were the s t r a i t - j a c k e t and the " c o l d d i p " . These t o r t u r e s were so odious and the use of them such an indictment of the c a l l o u s a t t i t u d e of the medical superintendent and attendants that i t i s necessary t o give a r a t h e r f u l l d e s c r i p t i o n of them. The s t r a i t - j a c k e t was a p p l i e d by f i r s t throwing the p a t i e n t down and p u t t i n g h i s hands i n t o l e a t h e r m i t s , which were f i r m l y held to the waist by a b e l t . A coarse, canvas jacket was then thrown over the p a t i e n t ' s head, l a c e d t i g h t l y to the body, and kept down by a cord known as the . "martingale" which passed through the legs ( t h i s cord was used as an instrument of t o r t u r e as i t was ofte n i n t e n t i o n -a l l y drawn t i g h t and caused sores on the c r o t c h of the body). The upper cord passed around the neck and through e y e l e t s down the back and then "cinched™, l i k e a saddle to a horse, w i t h the keeper's foot or knee pressed against the body to obtain a good purchase. The pressure thus created could be ^graduated and was sometimes so great that i t caused s w e l l i n g of the face. P a t i e n t s t e s t i f i e d that t h e i r s u f f e r i n g was - 27 -acute, b r e a t h i n g was impeded, p a l p i t a t i o n of the heart was sometimes produced, and the c i r c u l a t i o n of the hands was so impeded that cramps and numbness r e s u l t e d * Along w i t h the p h y s i c a l t o r t u r e , a p a t i e n t became "an object o f r i d -i c u l e and rough horseplay f o r thos'e who. are unable by t h e i r i n f i r m i t y to p i t y him « . . On the minds of those p a t i e n t s who r e t a i n any s e n s i b i l i t y f o r the misfortunes of others, we b e l i e v e the e f f e c t of this, punishment to be most depress-ing and i n j u r i o u s . 1 , 1 The other method of t o r t u r e was known as the '"ducking" or " c o l d d i p " . The p a t i e n t was handcuffed w i t h hands behind him, the f e e t h e l d together w i t h s t e e l a n k l e t s , and i n t h i s h e l p l e s s c o n d i t i o n he was plunged i n t o a tub almost f u l l of c o l d water, the head being h e l d under almost u n t i l s u f f o c a t i o n , '^ he head was immersed s e v e r a l times u n t i l the p a t i e n t ' s s p i r i t was broken. "Gold Dip" was i n f l i c t e d f o r such causes as: "Being troublesome at n i g h t " , " i n the case of one man f o r drumming on chest", " f o r running away", " f o r throwing f i l t h at a keeper", "on e p i l e p t i c p a t i e n t s ' f o r f i g h t i n g ' " , " f o r r e f u s i n g food", " f o r d i r t y i n g the ward". In no case on record was i t ever used as a remedial agent. S t r a i t - j a c k e t was used f o r many reasons i n c l u d i n g f i g h t i n g , d e s t r u c t i v e n e s s , abusing Medical Superintendent or 1 I b i d , p. 510. keepers, d i s t u r b i n g others by constant k n e e l i n g and praying, r e f u s i n g to work, s t r i k i n g Medical Superintendent or keepers. In the matter of s e c l u s i o n , the ev i l e n e e showed that the broom c l o s e t s measuring approximately s i x f e e t by four f e e t were o f t e n used to confine troublesome p a t i e n t s . The Commission a l s o found i n the basement "a dark c e l l , made of s c a n t l i n g , l i n e d and f l o o r e d w i t h boards. In t h i s was l y i n g a small piece of matting. I t i s a very c o l d place . . . , f l Dr. B e n t l e y , the Medical Superintendent, admitted that i t s c o n s t r u c t i o n had not been sanctioned by the P r o v i n c i a l Sec-r e t a r y and s t a t e d i t had been used only once f o r a Chinese p a t i e n t . The evidence of the steward and keepers, however, showed that i t had been used f o r at l e a s t four men and one woman. The Matron h e r s e l f s a i d that she had used i t one ni g h t when a p a t i e n t o f hers became so n o i s y that she was d i s t u r b i n g a l l the women i n the ward. She had taken the woman to the basement and confined her to the "cage", but at no time had l e f t the p a t i e n t alone, and had rel e a s e d her a f t e r one hour. The Commission was q u i t e s a t i s f i e d w i t h the by-laws, r u l e s , and r e g u l a t i o n s of the Asylum drawn up i n 1885 .by Dr. B e n t l y and copied from the Uapa Asylum i n C a l i f o r n i a . They b e l i e v e d that most of the r u l e s were w e l l c a r r i e d out and found no f a u l t w i t h the c l e a n l i n e s s of the i n s t i t u t i o n I b i d , p. 511. - £9 -and the patients.- Rule 14, however, they found had been c o n s t a n t l y broken, and no r e a l attempt made to c a r r y i t out. t h i s r u l e s t a t e d : The use of r e s t r a i n i n g apparatus i s p r o h i b i t e d , except by express permission of the Medical Superintendent. S e c l u s i o n to a p r i v a t e room, or the personal care of the keepers must be employed u n t i l f u r t h e r d i r e c t i o n s can be obtained. V/henever a p a t i e n t becomes so n o i s y or v i o l e n t as" to demand s e c l u s i o n , ample a i d should be procured, and i f force be r e q u i r e d i t should be used i n a f i r m and decided, but m i l d and gentle manner without any anger or appearance or anger. The reasons should be p l e a s a n t l y and k i n d l y e x p l a i n e d . 1 They noted that Dr. Bentley's memory seemed to be a complete blank regarding the use of mechanical r e s t r a i n t , seemingly having ordered i t s disuse r a t h e r than use. He had never used h i s power to discharge an attendant f o r breaking any of the r u l e s , and had i n no instance informed the P r o v i n c i a l Secretary when Rule 14 had been broken. The only conclusion was that lie could not have considered mech-a n i c a l r e s t r a i n t a ser i o u s matter, because he could e a s i l y have c o n t r o l l e d i t by keeping a l l instruments i n h i s own care. In t h e i r f i n a l r e p o r t the Commission made a number of suggestions and recommendations the most important of which were: ' 1. Proper s e c l u s i o n and padded rooms. E l i m i n a t i o n of "cage" i n the basement. Bentley, R.I., By-laws, Rules and Regulations of the P r o v i n c i a l L u n atic Asylum. B7c. Ste.am"~Pr int,~1885,"~p.~14. - 30 -2. The Asylum to he enlarged to provide l i v i n g space f o r the Superintendent. Mis present house to he used f o r p a t i e n t s working outdoors and a l s o f o r the r e c r e a t i o n and amusement of the p a t i e n t s . 3. P r o v i s i o n of easy c h a i r s , p i c t u r e s , newspapers, and hooks f o r each ward. 4. Record hooks to he kept, e s p e c i a l l y a punish-ment and r e s t r a i n t took. 5. P r o p o r t i o n of attendants to p a t i e n t s one to ei g h t as i n England, r a t h e r than one to t h i r t e e n as at present; t h i s would n e c e s s i t a t e a d d i t i o n s to the s t a f f . 6. Obtain attendants w i t h some trade who are qua l -i f i e d to i n s t r u c t p a t i e n t s i n u s e f u l occupations, r a t h e r than ones who are b i g and strong. 7. S u b s t i t u t e an open p i c k e t fence f o r the present one i n the a i r i n g yards. 8. P r o v i s i o n f o r a number of dry paths throughout the grounds so that p a t i e n t s may get e x e r c i s e . 9. H e d i c a l Superintendent to see every p a t i e n t twice a day, to have Night Watchman repo r t to him every n i g h t at 10 P.M., and to v i s i t wards unexpectedly at n i g h t at l e a s t once a week. 10. A b o l i t i o n o f nechanical r e s t r a i n t . The Com-mission b e l i e v e d that "Chains, handcuffs, s t r a i t - j a c k e t s , and the l i t e , have been done away i n Great B r i t a i n f o r about f o r t y years and t h e i r place has been taken by humaner and more s c i e n t i f i c methods of treatment. These in v o l v e higher q u a l i f i c a t i o n s , both mental and moral, on the patience of attendants than be f o r e , and i n some cases a l a r g e r s t a f f , but whereever what i s c a l l e d the n o n - r e s t r a i n t system has been t r i e d , success has i n v a r i a b l y followed, and we do not know of a s i n g l e instance where a r e t u r n has been made to the older and more p r i m i t i v e methods • . • R e s t r a i n t was formerly r e s o r t e d to i n a l l oases to save t r o u b l e , and so i t became wholesale, n e g l e c t " . 1 B r i t i s h Columbia, S e s s i o n a l Papers, 1894-95, Royal Commission Report on the P r o v i n c i a l Asylum f o r the Insane, November 27, 1894, p.~513. ~ ™ - 31 -Four days a f t e r the Royal Commission submitted i t s r e p o r t , the P r o v i n c i a l Secretary sent a l e t t e r to Dr. Bentley suspending him from a l l d u t i e s connected w i t h the Asylum. He was s e v e r e l y censured f o r the c r u e l t i e s which had been i n f l i c t e d upon the inmates, and the l e t t e r con-cluded with these words: " I f the l u n a t i c s had been crim-i n a l s of the worst type, the treatment administered would have been inexcusable; but c o n s i d e r i n g that the poor c r e a t -ures are i r r e s p o n s i b l e f o r t h e i r a c t i o n s , the manner i n whioh they have been governed i s nothing short o f barbarous. Dr. Bentley resigned at the end of 1894 and Dr. Hewoorabe who had served on the Commission became tem-porary Superintendent u n t i l a permanent appointment c o u l d be made, -^number of doctors a p p l i e d f o r the vacant p o s i t i o n , one of whom, Dr. G.F. Bodington, enclosed no l e s s than eighteen references from eminent medical men i n E n g i a n a W h 0 t e s t i f i e d to h i s a b i l i t y and moral character. He promised, i f appointed,, to r e v o l u t i o n i z e the system and reorganize the h o s p i t a l on a new and sound b a s i s along the l i n e s of the asylum i n England where he had been superintendent f o r seventeen years. The government was impressed w i t h h i s reccr d, and on January 9, 1895 appointed him at a s a l a r y of $2,500 a year. B r i t i s h Columbia, S e s s i o n a l Papers. L e t t e r to Dr. Bentley dated December"!, 1894, p. 574. - 32 Improvements r e s u l t i n g from the I n v e s t i g a t i o n Dr. Bodington served the i n s t i t u t i o n f o r s i x years and during that time implemented most of the changes recom-mended by the Boyal Commission. U n f o r t u n a t e l y , mechanical r e s t r a i n t was. not done away wi t h because of the great i n f l u x of new p a t i e n t s , the number more than doubling from 164 to 349. R e s t r a i n t , however, was r i g i d l y c o n t r o l l e d and used not as a punishment but as p r o t e c t i o n of the p a t i e n t or other inmates. The two worst male attendants were discharged, and one of the others resigned. They were replaced by f i v e new men, and a shoemaker and t a i l o r were engaged a l s o to act as trade i n s t r u c t o r s and attendants. For a number of appoint-ments, the men secured had had previous experience i n asylum* i n England or the United States. Obtaining t r a i n e d s t a f f was an important step i n the gradual development from cus-t o d i a l care to treatment. A new residence f o r the sups rintendent was added to the f r o n t part of the i n s t i t u t i o n and h i s former d w e l l i n g was taken over f o r convalescent women p a t i e n t s . Renamed Lawn House, i t s t a r t e d a new l i f e . A t r a i n e d nurse, Mrs. Janet Crawford, w i t h s e v e r a l years experience i n U n i t e d States asylums was appointed as A s s i s t a n t Matron i n charge o f Lawn House and a Miss Gamble who had had e i g h t years s e r v i c e i n a Toronto A g y i u m became a member of s t a f f . T h i s change i s the - 33 -f i r s t recorded instance of classifying patients according to their condition. The padded room recommended by the Commission was compile ted in 1897, and this anachronism s t i l l exists today although i t has not been used for many years. Socials held onoe a month became an entertainment feature and were thoroughly enjoyed by the patients. The Matron, Mrs. Boss, was responsible for organizing them and their success was largely due to her efforts.. One of the attendants was an accomplished v i o l i n i s t and he encouraged the patients to learn music and formed a choir for the Sunday services. The inmates were given more opportunity to get away temporarily from the hospital and attended the Hew Westminster Exhibition and lacrosse games in that city. Others, accompanied by attendants, went on fishing trips and long hikes. Mrs. Ross died in 1897 having served the hospital fai t h f u l l y for over a quarter of a century. She had been i l l for several months before her death but asked to stay on u n t i l the very end. "Or. Bodington paid tribute to her faithf u l service and stated that the one bright spot in the whole institution when he took over was the management of the women patients. Me praised her energy and enthusiasm and hoped that the same treatment might be afforded the male patients as had been rendered the women inmates. - 3 4 -The year 1897 saw a forward step made In l e g i s l a t -i o n r e g arding the mentally i l l . The Insane Asylum Act was changed to become the H o s p i t a l s f o r Insane A c t , a r e c o g n i t i o n of the f a c t that c u s t o d i a l cazre alone was not enough, hut that medical treatment was r e q u i r e d f o r the mentally s i c k . The new Act a l s o made p r o v i s i o n f o r s p e c i f i c forms f o r the commitment of persons to the h o s p i t a l . In a d d i t i o n , the a d m i n i s t r a t i v e and f i n a n c i a l aspects o f the h o s p i t a l were put i n t o the hands of a steward and c l e r k who were respons-i b l e to the superintendent. In 1899, Sr. G.H. Manchester was appointed A s s i s t -ant Superintendent and i n 1901 succeeded the e l d e r l y Dr. Bodington, who r e t i r e d because o f i l l h e a l t h . The new Sup-erintendent was an able and f o r t h r i g h t i n d i v i d u a l w i t h admir-able ideas on the care of the mentally i l l , who made a r e a l attempt to put them i n t o p r a c t i c e . H i s conception of the treatment o f mental i l l n e s s came c l o s e r to modern thought on the matter. He b e l i e v e d that "the cure of the insane i s not to be compassed by the use of medicines alone, nor of any other s i n g l e measure, but rat h e r by every means that w i l l tend to put the body i n good c o n d i t i o n and d i v e r t the mind from i t s morbid a c t i o n . " Dr. Manchester b e l i e v e d i n g i v i n g the best of food to the p a t i e n t s and thought i t should be p r o p e r l y prepared •"•British Columbia, S e s s i o n a l Papers, Annual Report of the H o s p i t a l f o r the Insane. 1901, p. 473. - 35 and served. During h i s a d m i n i s t r a t i o n , benches i n the d i n i r g rooms were r e p l a c e d by c h a i r s , and knives and forks were placed upon the t a b l e s , as w e l l as spoons. H e g u l a r i t y of l i v i n g h a b i t a and l o n g hours of r e s t he a l s o considered important, but f e l t that the l a t t e r was somewhat overdone i n the h o s p i t a l as many p a t i e n t s were kept i n t h e i r rooms too long at n i g h t . He r e a l i z e d that employ-ment was an absolute n e c e s s i t y to r e l i e v e the monotony and boredoms of i n s t i t u t i o n a l l i f e . To provide occupation f o r the p a t i e n t s was one of h i s foremost d u t i e s , he b e l i e v e d , and he encouraged the b u i l d i n g of workshops to teach the i n -mates a v a r i e t y of trades. In h i s e s t i m a t i o n amusement and r e c r e a t i o n were e s s e n t i a l and fundamental requirements of treatment', He a deplored the fact that they r e c e i v e d such l i t t l e a t t e n t i o n at the h o s p i t a l and remarked, "I know- o f no s i m i l a r i n s t i t -u t i o n where there are so few p r o v i s i o n s under t h i s head as here, where not even a campus i s a v a i l a b l e . 1 , 1 Entertainments and dances became a f o r t n i g h t l y feature. -Vr. Manchester managed to obtain a piano for the women p a t i e n t s and remarked: "Music i s something that poss-esses a place of i t s own i n the l i v e s of most persons, and nothing can take i t s place . . . I would place a piano i n - 36 -i n every ward and hope some day i t may even come to p a s s . 1 , 1 Two more b i l l i a r d t a b l e s were added to the male wards, and a v a r i e t y of reading matter made a v a i l a b l e to the p a t i e n t s . S p e c i a l Problems During Dr. Manchester's regime two s p e c i a l pro-blems began to develop. P r e v i o u s l y very few mental d e f e c t -i v e s had been admitted, but i n 1903, f i v e boys and two g i r l s of t h i s type became p a t i e n t s . She Sup r i n t e n d e n t belle.ved that more and more of these unfortunates would a r r i v e and thought i t necessary to provide a d i f f e r e n t k i n d of i n s t i t -u t i o n where they could r e c e i v e proper education, xhe other problem was the increase i n p a t i e n t s of a c r i m i n a l tendency. The doctor hoped that the government would soon provide s p e c i a l quarters f o r these people whom he considered were a danger to the other inmates. The probation idea which allowed convalescent pat-i e n t s to r e t u r n to the community, was developed r a t h e r f u l l y by Dr. Manchester. I t worked s a t i s f a c t o r i l y i n two ways, g i v i n g the p a t i e n t the opportunity to adjust to h i s o l d sur-roundings and former work while s t i l l under s u p e r v i s i o n , and a l l o w i n g many e c c e n t r i c people who d i d not r e a l l y need hosp-i t a l care to earn t h e i r own l i v i n g . During 1902, f i f t y - s e v e n p a t i e n t s were allowed to leave on pro b a t i o n , and of these l o o . c i t . - 37 -twenty-seven were f u l l y discharged, s i x t e e n were s t i l l out at the end of the year, and twelve returned to the h o s p i t a l . Treatment f a c i l i t i e s were completely inadequate at t h i s time and the Superintendent remarked that the i n s t i t u t -i o n narrowly escaped ranking as a mere house of detention. He l i s t e d as v i t a l needs i n t h i s respect examining rooms, l a b o r a t o r i e s to examine blood, u r i n e , and sputum, hydro-therapy, e l e c t r o t h e r a p y , a gymnasium, a campus f o r outdoor r e c r e a t i o n i n summer, and walks which would all o w an a i r i n g f o r p a t i e n t s . In 1905 Dr. C.l» Doherty became Superintendent when Dr. Manchester resigned. The l a t t e r had found the r e s -p o n s i b i l i t y of running the h o s p i t a l very t r y i n g . There were fo u r d i f f e r e n t governments while he was superintendent and many of the attendants taken on the s t a f f were p o l i t i c a l l y appointed. Dr. Manchester's only recourse was to discharge them i f they proved u n s a t i s f a c t o r y . The attendants s t r u c k f o r higher wages and the superintendent discharged nine o f them which made him very unpopular. Another problem he was faced w i t h was the l e a s i n g of part o f the h o s p i t a l grounds to a brickmaking company, x h i s move meant that the p a t i e n t s had l i t t l e space f o r walks. s i d e l i g h t on the i n s t a b i l i t y of the government of the day was the f a c t that p r o v i n c i a l revenues were so low the p r o v i n c i a l s e c r e t a r y used to phone the superintendent at frequent i n t e r v a l s and ask f o r the - 38 -m o n e y w h i c h h a d b e e n c o l l e c t e d f r o m t h e p a t i e n t s f o r t h e i r h o a r d a n d l o d g i n g . CHAPTER I I I 1905-1919: Hew I n s t i t u t i o n s A very important treatment procedure was s t a r t e d during the f i r s t deoade of the twentieth century* P r e v i o u s to t h i s time the value of work i n the open a i r had been r e c -ognized, but because of the l i m i t e d l a nd a v a i l a b l e f o r c u l t " i v a t i o n of the s o i l , attempts i n t h i s d i r e c t i o n had been only on a small scale* At t h i s time p a t i e n t s began to c l e a r l a n d at Coquitlam f o r what was to become Colony Farm and Essondale Mental H o s p i t a l . The growth of t h i s feature i s i n t e r e s t i n g and warrants a s e c t i o n by i t s e l f i n any h i s t o r y of the care of the mentally i l l i n B r i t i s h Columbia. In 1904, the P r o v i n c i a l Government acquired one thousand acres of v i r g i n l a n d at the j u n c t i o n of the Cof-u i t l a m and Eraser R i v e r s , a distance of s i x m i l e s from the Hew Westminster I n s t i t u t i o n . Sr. Manchester had been l o o k i n g f o r a new s i t e f o r the h o s p i t a l and one day wh i l e enroute by boat to a churoh p i c n i c he saw a s u i t a b l e t r a c t of lan d , tie suggested that the government e r e c t a complete modern hos-p i t a l f o r the insane upon the property and use the present i n s t i t u t i o n as an asylum f o r i d i o t and chronic cases. Colony Farm In J u l y , 1905, a s t a r t was made i n the work of c l e a r i n g land and e r e c t i n g temporary b u i l d i n g s on the new s i t e . From August 1st on, an average of eighteen p a t i e n t s - 39 -40 accompanied by two attendants, helped to c l e a r l a n d . . 'i'hey worked a l l summer and w i n t e r and i n the f o l l o w i n g s p r i n g , t h e i r number was increased to t h i r t y . &t f i r s t they l i v e d i n t e n t s , but l a t e r moved i n t o b u i l d i n g s which c o n s i s t e d of four bedrooms, three rooms f o r attendants, a b i l l i a r d room, d i n i n g room, k i t c h e n , and l a v a t o r y . In the management and l a y i n g out of t h i s l a r g e area, the a u t h o r i t i e s had i n mind the accomplishment o f three general r e s u l t s : 1. The pleasure and h e a l t h of the p a t i e n t s . 2. P r o v i d i n g employment f o r those who would b e n e f i t by r e g u l a r work i n the open a i r . 3. Economy by u s i n g t h i s h elp to provide f r u i t , f l o w e r s , vegetables, and farm and d a i r y products f o r the h o s p i t a l . The work continued f o r s i x years. I n 1911 Colony Farm was completed, and the value of the produce i n that year was $24,065. More important was the f a c t that the advantage to p a t i e n t s was shown by the increase i n r e c o v e r i e s . Work done by p a t i e n t s i n that year i s impressive: Work on farm 13,071 days C u t t i n g wood and c l e a r i n g l a n d 1,919 Work i n k i t c h e n 1,007 Work i n dining-room 2,145 Work i n s t a b l e s 1,007 Ward or housework 5,423 Work w i t h engineer 424 Work w i t h carpenter 266 Work w i t h surveyor 359 Work w i t h p l a s t e r e r 906 n n it n it II n it n Work w i t h teamster 482 ? TOTAL 27,009 days - 41 -The p u b l i c a t i o n i n 1909 of a hook on mental d i s -eases by an I t a l i a n doctor had a profound e f f e c t on the oare of the mentally i l l i n B r i t i s h Columbia. The ideas expressed i n the book were s i m i l a r to those of Dr. Doherty who was very e n t h u s i a s t i c about farming. He was p a r t i c u l a r l y impressed w i t h one s e c t i o n d e a l i n g w i t h outside work: Work and e s p e c i a l l y work i n the open a i r and i n open and healthy surroundings i s of the utmost value f o r mental p a t i e n t s . I t renders them more composed and p a t i e n t , and b e t t e r S a t i s f i e d w i t h themselves. Being a f a c t o r i n the production of h e a l t h and happiness, i t a l s o becomes a means of cure. In those asylums i n which work f o r p a t i e n t s i s c a r e f u l l y organized the m o r t a l i t y r a t e i s dec-reased, me ch'anieal r e s t r a i n t i s reduced to a min-imum, and r e c o v e r i e s are more frequent; the s p i r i t s of the p a t i e n t s are brightened, the labour of those who attend them i s ameliorated, and the mission o f the S t a t e , provinces, and communes, which thus provide not only f o r the custody but a l s o f o r the recovery of t h e i r p a t i e n t s i s ennobled, aenoe every good asylum possesses an a g r i c u l t u r a l colony. The author b e l i e v e d that such a farm c o u l d a l s o be used as a plaice of probation, p a r t i c u l a r l y since an open door p o l i c y could be f r e e l y adopted. He was not concerned w i t h the o c c a s i o n a l escape which might occur, as " i t does not c o n s t i t u t e a danger or a f a u l t , but w i l l serve to im-press upon the p a t i e n t s and the p u b l i c the l i b e r a l s p i r i t of the i n s t i t u t i o n . " 2 By 1913, a f t e r s e v e r a l years experience at Colony Farm the a d m i n i s t r a t i o n was thoroughly convinced of the value •^Tanzi, Eugenio, A Textbook of Mental Diseases, London, itehman L i m i t e d , 1909, p. 788.™ 2 l o c . c i t . - 42 -of occupation as a remedial agent i n the treatment o f mental i l l n e s s , s u i t a b l e employment as the .best remedy f o r many i l l s of the mind and body had l o n g been recognized, but i t was thought that only a very few types of i n s a n i t y would b e n e f i t from a c t u a l work. I t was evident, however, that at l e a s t two-thirds of a l l the male p a t i e n t s were capable of - employment and needed i t as much as sane people. With the new resources, as a man's symptoms improved he was sent to Colony Farm, where much greater freedom p r e v a i l e d , and from there to h i s own home. By adopting these me'thods i t was found "that only a very small residuum i s r e l e g a t e d to that 1 eyesore, the r e f r a c t o r y ward." The work i n the open a i r amid healt h y surroundings was found to be f a r s u p e r i o r v t h a n any other form of occup-a t i o n , and i n 1913 n e a r l y two hundred male p a t i e n t s r e c e i v e d the b e n e f i t of t h i s v a l u a b l e therapy. I t s very success l e d to some misunderstanding, however. Colony Farm re c e i v e d considerable c r i t i c i s m when i t began to e x h i b i t l i v e s t o c k i n va r i o u s f a i r s i n Canada and the United States. I t was a l l e g e d that the property was approaching the st a t u r e of an experimental farm and that the p a t i e n t was being l o s t s i g h t of i n order to breed p r i z e -winning l i v e s t o c k . Nevertheless, the many blue ribbons won - r ^ B r i t i s h Columbia, S e s s i o n a l Papers, Annual Report of the Mental H o s p i t a l . 1913. p. JE9. - 43 -by Colony Farm stock focused a t t e n t i o n on the experiment being c a r r i e d out i n B r i t i s h Columbia f o r the mentally i l l . Other s i m i l a r i n s t i t u t i o n s i n Canada were impressed by the b e n e f i t that p a t i e n t s r e c e i v e d from f i e l d l a b o r and were encouraged to make s i m i l a r arrangements f o r t h e i r own inmates. I n t e r n a t i o n a l r e c o g n i t i o n came f o r the new t r e a t -ment i n 19&3 when a Chicago newspaper published a p a n e g y r i c a l account of t h i s method of treatment: when the judges pinned the blue r i b b o n on H e r i s s a at the I n t e r n a t i o n a l L i v e s t o c k Show, they not only put the o f f i c i a l s e a l of approval on. the handsome mare, but they recorded a v i c t o r y f o r the new method of t r e a t i n g i n s a n i t y which i s being worked out i n the Province of B r i t i s h Columbia. U e r i s s a and her companions . . . are the product of the care and la b o r of insane p a t i e n t s at the Mental H o s p i t a l at Coquitlam, where a g r i c u l t u r e and stock-breeding have proved a s e l f - s u s t a i n i n g means f o r c u r i n g i n s a n i t y • • . She r e s u l t of t h i s H o s p i t a l ' s r e v o l u t i o n a r y methods may mean world-wide changes i n the a d m i n i s t r a t i o n of State i n s t i t u t i o n s f o r the care of those who are i n the t w i l i g h t s t a t e of mental derangement.^ According to the superintendent, £>r. Doherty, Bayard Holmes, a w e l l known p s y c h i a t r i s t at that time was very favorable impressed w i t h the. methods of treatment f o r the mentally i l l i n this, province and was p a r t i c u l a r l y en-t h u s i a s t i c about Colony Farm of which he s a i d : "The out-of-door labour and work w i t h animals . . . are a l l e x c e l l e n t , and when combined with c a r e f u l medical treatment should produce noteworthy r e s u l t s . " 2 I b i d , p. H 10. 2 l o c . c i t - 44 -In 1912 the per c a p i t a cost of c a r i n g f o r p a t i e n t s was reduced to $177.71 or a per diem r a t e of 48.6 cents, lowest i n the h i s t o r y of the i n s t i t u t i o n to that year. The Superintendent, Dr. Doherty, i n h i s Annual Report f o r the year wrote: f o r t h i s r e d u c t i o n of cost we have n o t h i n g to thank but Colony Farm and i t s abundant crops, and the f a c t that.we are now l i v i n g i n an age which permits Of a more enlightened perception of i n s a n i t y . *ou y o u r s e l f , s i r , by the modern methods which you have always i n s i s t e d upon, have at l a s t robbed the f r e e -man of much of h i s s e l f - c o n c e i t and made him l o o k upon h i s brother's greater i n f i r m i t y w i t h a l a r g e r c h a r i t y . Through your Government t h i s Province has at l a s t learned that a l l the mental weaklings i n our midst need not be locked up, and that many of them isay l e a d the extramural l i f e of u s e f u l n e s s , w i t h p r o f i t not only to themselves, but a l s o to B r i t i s h Columbia.2 Essondale 1906 was an important date i n the development of the care of the mentally i l l i n B r i t i s h Columbia, f o r i n * that year Henry Bsson Young, a medical doctor, beoame pro-v i n c i a l s e c r e t a r y and served i n that c a p a c i t y f o r many years. This able and s o o i a l l y minded M i n i s t e r made the mental h o s p i t a l one of h i s most v i t a l concerns and was l a r g e l y r e s p o n s i b l e f o r b u i l d i n g the new i n s t i t u t i o n at Coquitlam which was named a f t e r him. In 1908 a competition was opened to the a r c h i t e c t s of the province who were asked to draw up plan's f o r a mod-ern hospital f o r the mentally i l l . I t was very s i g n i f i c a n t *BrTt i s h Columbia, S e s s i o n a l Papers, Annual Report of ^ e _ H ^ S 2 i t a l _ f o r _ t h e _ I n 1912, p. GT3. - 45 -that among the c o n d i t i o n s l a i d down f o r the competitors were that " a l l p r i s o n and c u s t o d i a l features were to give way, as f a r as p o s s i b l e , to wholesome and c u r a t i v e f e a t u r e s , while every e s s e n t i a l f o r the s c i e n t i f i c study, c l a s s i f i c -a t i o n , and treatment o f cases was to he a f f o r d e d . " 1 Several l e a d i n g a r c h i t e c t s i n B.C. spent considerable time and money v i s i t i n g modern h o s p i t a l s i n Canada and the United S t a t e s , and the plans f i n a l l y accepted by the government re c e i v e d great commendation from p s y c h i a t r i s t s i n general and from the Lunacy Commission of flew York State. F r a n k l i n B. Ware, State A r c h i t e c t of New York was the a d j u d i c a t o r and he awarded f i r s t p r i z e to a design of an i n s t i t u t i o n arranged i n the c o r r i d o r - p a v i l i o n s t y l e , c o n s i s t i n g of a c e n t r a l a d m i n i s t r a t i o n u n i t , w i t h s e r v i c e quarters on the second f l o o r , and a k i t c h e n and bakery on the t h i r d s t o r y . The other b u i l d i n g s i n the design were an i n f i r m a r y , and b u i l d i n g s f o r the acute and chronic cases r e s p e c t i v e l y , on e i t h e r side of the a d m i n i s t r a t i o n b u i l d i n g i n a horseshoe arrangement. Convalescent homes, were to be b u i l t i n f r o n t and on e i t h e r side of the a d m i n i s t r a t i o n b u i l d i n g , and behind them the i s o l a t i o n h o s p i t a l , mortuary, and l a b o r a t o r y were to be placed on one s i d e , w i t h workshops and amusement h a l l on the other. "-'British Columbia, S e s s i o n a l Papers, Annual Report of the H o s p i t a l f o r the Insane. 1908, p. D HT, - 46 -A l l the b u i l d i n g s were to be completely f i r e p r o o f end faced w i t h red b r i c k . They were designed to accommodate 1800 p a t i e n t s and the cost was estimated at between $1,600,000 to #2,000,000. Br. Doherty, the Medical Superintendent, i n s i s t e d on three features i n the p r o v i s i o n s f o r c o n s t r u c t i o n : 1. The i s o l a t i o n of a l l oases o f acute i n s a n i t y or acute mania, and p r o v i s i o n f o r them to have f r e s h - a i r treatment. 2. The p r o v i s i o n f o r accommodation of at l e a s t n i n e t y percent of the chronic insane i n congregate d o r m i t o r i e s . 3. The p r o v i s i o n o f proper b u i l d i n g s f o r manual a r t s and c r a f t s as w e l l as f o r amusement. In h i s v i s i t s to s i m i l a r i n s t i t u t i o n s he had noted the inadequate p r o v i s i o n of b u i l d i n g s f o r manual a r t s and c r a f t s t r a i n i n g and f e l t that a modern h o s p i t a l should have well-equipped departments f o r t h i s type of a c t i v i t y . He therefore urged that " s u r e l y i t i s a matter of economy.for us to supply t h i s c l a s s of the best producing p a t i e n t s w i t h every means of proper hygiene j u s t as w e l l d u r i n g waking hours as i t i s at any other t i m e . " 1 The superintendent had great hopes f o r the new h o s p i t a l . The plans as drawn up were never f u l l y c a r r i e d out but t h i s was not f o r l a c k of v i s i o n on the. part of the B r i t i s h Columbia, S e s s i o n a l Papers, Annual Heport o f the H o s p i t a l f o r the Insane. 1912, p. G ST - 47 -d i r e c t o r . H i s views r e f l e c t the change which was t a k i n g place i n the. care of those a f f l i c t e d w i t h mental i l l n e s s . Dr. Doherty was completely c a r r i e d away hy h i s enthusiasm f o r the future h o s p i t a l , hut h i s a t t i t u d e i s t y p i c a l of the l i b e r a l i s m which was making i t s e l f known throughout North America. " I am i n c l i n e d to t h i n k " , he s a i d , "that B r i t i s h Columbia's new Mental H o s p i t a l , now r a p i d l y nearing complet-i o n , w i l l approach more n e a r l y the i d e a l standard than any other Canadian h o s p i t a l yet constructed. Here we w i l l have b u i l d i n g s of the very best p o s s i b l e c o n s t r u c t i o n , a b s o l u t e l y f i r e p r o o f throughout, w i t h separate b u i l d i n g s f o r the chronic cases comprised of l a r g e a i r y d o r m i t o r i e s and s i n g l e rooms; w i t h day rooms, a l l of which have n a t u r a l l i g h t from three s i d e s , are a r t i f i c i a l l y v e n t i l a t e d , and each of which opens out upon a comfortable solarium, she Acute b u i l d i n g s are s p l e n d i d l y adapted f o r the r e c e p t i o n , examination, and proper treatment of those a c t u a l l y insane; while the H o s p i t a l p a v i l i o n f o r the treatment, medical and s u r g i c a l , of those p h y s i c a l l y i l l , I t h i n k w i l l compare w i t h the most up-to-date general h o s p i t a l s i n t h i s Dominion. Another feature worthy of mention i s the i s o l a t i o n H o s p i t a l f o r the t u b e r c u l a r and other cases, which i s s p l e n d i d l y l a i d out f o r the purpoee f o r which i t i s intended, as a l s o are the b u i l d i n g s f o r manual a r t s and c r a f t s t r a i n i n g , w i t h a l l the needs which - 48 -experience has d i c t a t e d . " "Given such an equipment", Dr. Doherty w r o t e , " i t c e r t a i n l y behooves a l l to form the highest i d e a l s of the p a r t i c u l a r part which each i s to pl a y i n the c a r r y i n g to success of h i s or her s p e c i a l d u t i e s i n t h i s new h o s p i t a l . J S O W, by i d e a l s , I do not a s s o c i a t e my views w i t h any s l o v -enly or weak sentimentalism or c o r r u p t i n g c o u n t e r f e i t s ; I mean the r e a l sentiment, the r a t i o n a l i n s t i n c t f o r s e r v i c e ; no s t a r - g a z i n g or c r y s t a l - r e a d i n g s , but work. In our new H o s p i t a l , l e t our i d e a l be a p p l i c a t i o n of imagination to r e a l i t i e s , the greatest of which w i l l be the p a t i e n t h i m s e l f . 1 , 1 . The cornerstone f o r the new h o s p i t a l was l a i d by the Lieutenant-Governor on February 25th 1911, and two years l a t e r the new i n s t i t u t i o n opened i t s doors to male p a t i e n t s . At the end of 1913 there were 453 men under i t s r o o f . Progressive Developments By. the turn of the century a new s p i r i t r e g a r d i n g the treatment of mental i l l n e s s was beginning to permeate the mental i n s t i t u t i o n s , xhe many v o i c e s which had been r a i s e d i n the past i n regard .to s o c i a l reform at l a s t found organized expression and a more enlightened view of mental i l l n e s s began to pervade the h o s p i t a l s devoted to the care •''British Columbia, S e s s i o n a l Papers, Annual Report of the H o s p i t a l f o r the insane. 1911, p. D 6, ~ ~" - 49 -of the mentally i l l . In B r i t i s h Columbia i t was becoming c l e a r that a l l mental p a t i e n t s should be t r e a t e d as s i c k persons, and treatment on an i n d i v i d u a l b a s i s was being attempted. The Annual Report f o r 1907 declared that " k i n d and humane t r e a t -ment i s enforced i n every department; mechanical r e s t r a i n t of a l l kinds has been abolished; the p h y s i c a l l y s i c k r e c e i v e s p e c i a l d i e t according to t h e i r needs; a l l engage i n jud-i c i o u s open-air e x e r o i s e , both winter and summer, while e v e r y t h i n g i s done, duri n g l e i s u r e hours, to d i v e r t the p a t i e n t from h i s t r o u b l e . " 1 The new Superintendent, Dr. Doherty, e f f e o t e d a number of changes. i ;he accommodation at Hew Westminster was enlarged and the chronic and curable cases were segregated. The f e e b l e and i n f i r m were given separate quarters i n a new ward. In 1907, a Department of Pathology was set up to a i d d i a g n o s i s , and i n the l a b o r a t o r y r e p o r t f o r that year was an account of blood counts and s e v e r a l s c i e n t i f i c terms r e f -e r r i n g to mental d i s o r d e r s . Hydrotherapy and E l e c t r o t h e r a p y were added i n the same year and the r e s u l t s from the former of these treatments were very encouraging. The superintendent proceeded along l i n e s of prac-t i c e e s t a b l i s h e d i n the more modern h o s p i t a l s . A l l p a t i e n t s were c l a s s i f i e d according to the seriousness of t h e i r i l l n e s s . "'•British Columbia, S e s s i o n a l Papers, A n n u a i r e p o r t of the P u b l i c H o s p i t a l f o r the Insane. 19077 p. tf 7, *" - 50 -A f t e r a sojourn i n the r e c e i v i n g ward, those considered cur-able were segregated from the s o - o a l l e d i n c u r a b l e , the feeble and i n f i r m were sent to s p e c i a l q u a r t e r s , while the conval-escents were, assigned to quiet quarters w i t h ample l i b r a r i e s , r e a d i n g and amusement rooms. Absolute r e s t i n bed was en-fo r c e d f o r the acute cases and the p r i n c i p l e was to see that "they r e c e i v e every care, treatment, and a t t e n t i o n that the s i c k should r e c e i v e . " The modern hydrotherapeutic apparatus r e c e n t l y i n s t a l l e d f o r the treatment of these cases was found to be "very b e n e f i c i a l . " A l l p a t i e n t s not p h y s i c a l l y i n c a p a c i t a t e d were encouraged to take e x e r c i s e i n the open a i r both summer and winter. Regular concerts and dances were h e l d and i t appears were much appreciated by the inmates. In 1907, Dr. J.G. McKay became A s s i s t a n t Medical Superintendent. During the years of the f i r s t World War he was a c t i n g superintendent i n the absence of Dr. Doherty who served overseas as. an army medical o f f i c e r . Upon Dr. Doherty 1s r e t u r n . Dr. McKay resigned and l a t e r opened the Hollywood Sanatarium i n Hew Westminster, a p r i v a t e i n s t i t -u t i o n f o r mentally i l l persons which he s t i l l heads. The value of pr o p e r l y t r a i n e d nurses, both male and female, was commented on more than once. The s u p e r i n t -endent made every e f f o r t "to r e t a i n as attendants w e l l -p r i n c i p l e d persons, i n t e l l i g e n t enoughc to understand the - 51 -reason of t h e i r r u l e s and the unreason of t h e i r p a t i e n t s ; . • • w i t h kindness of heart enought to put themselves i n the p o s i t i o n o f t h e i r p a t i e n t s at times; w i t h s e l f - c o n t r o l enough never to abuse the poor unfortunates e n t r u s t e d to them, and w i t h observation enough to recognize changes i n the mental c o n d i t i o n of t h e i r p a t i e n t s so that they may a n t i c i p a t e outbreaks, e i t h e r s u i c i d a l or h o m i c i d a l U n t i l t h i s time the h o s p i t a l had not been provided w i t h n i g h t nurses. The n i g h t watchman used to make ho u r l y rounds c a r r y i n g a kerosene l a n t e r n . In the past a l l pat-i e n t s were locked i n t h e i r rooms at night and stayed there u n t i l they were allowed out i n the morning. This archaio system .was e l i m i n a t e d through the improvement of adding a number of n i g h t nurses to the s t a f f , and henceforth p a t i e n t s had the use of t o i l e t rooms f o r the f u l l twenty-four hours of the day. In r e t r o s p e c t t h i s innovation seems m i l d enough, and l i t t l e more than l o g i c a l , but to many su p e r i n -tendents of that tirae i t c o n s t i t u t e d a very r a d i c a l change. Many previous d i s c u s s i o n s among heads of mental h o s p i t a l s had centred on the chamber pot as an o f f e n s i v e or defensive weapon and the p o s s i b i l i t y of u s i n g some l i g h t e r m a t e r i a l i n i t s c o n s t r u c t i o n ' •^•British Columbia, Sessional Papers, Annual Report  of the P u b l i c Hospital f o r the Insane. 1906, p. «P7. - 52 -J u s t i f y i n g the use of ni g h t nurses,, the s u p e r i n t -endent wrote "having someone wit h the insane p a t i e n t s day and n i g h t , d e a l i n g f i r m l y , yet k i n d l y and g e n t l y , has a sub-duing e f f e c t ; a warm bath, a c o l d bath, a warm pack, a c o l d pack, or a gl a s s of warm m i l k , are much b e t t e r than r e s -t r a i n t , hypnotics and loc k e d doors." 1 The schism between the surgeon and the p s y c h i a t r i s t was apparent even i n those days, and i n h i s Annual Seport f o r 1911 Dr. Doherty undertook to prove that the i n s t i t u t i o n which he headed was a modern h o s p i t a l i n every respect, "Let the house surgeon from any general h o s p i t a l go i n t o the o f f i c e s of a modern mental h o s p i t a l , and he w i l l f i n d the a l i e n i s t w i t h h i s b a c t e r i o l o g i s t and c l i n i c a l c l e r k s d i v i n g i n t o h i s t o r i e s and making'examinations so thoroughly that,he i s astounded."' 2 He proceeded to e x p l a i n how accurate c h a r t s were kept o f the progress of each p a t i e n t , and that complete f a m i l y and personal h i s t o r i e s were obtained showing that the h i s t o r y of the present i l l n e s s proceeded step by step u n t i l mental unbalance ensued. Charts were kept show-in g a l l v a r i a t i o n s of temperature, the st a t e of the blood, and v a r i a t i o n s from normal of a l l s e c r e t i o n s and excretions* He continued: "Take him i n t o the acute wards and — l e t him see f o r hi m s e l f the precautions taken i n f e e d i n g '''British Columbia, s e s s i o n a l Papers, Annual Report of  H o s p i t a l f o r the Insane, 1909, p. C 8. ^ B r i t i s h Columbia, S e s s i o n a l Papers, Annual Report of H o s p i t a l f o r the Insane. 1911, p. D 6. ~ "" "* - 53 -maniacal cases i n order to support s t r e n g t h against exhaust-i o n ; l e t him see the u p b u i l d i n g of n u t r i t i o n by for c e d feeding and s u i t a b l e t o n i c s ; and, i f not yet s a t i s f i e d , take him i n t o the shops, or, b e t t e r s t i l l , out to the farm, and l e t him witness the arousing of the s l u g g i s h and the d i v e r s i o n of the depressed mind by occupation, and he s u r e l y w i l l by t h i s time be d i s i l l u s i o n e d and w i l l recognize that our treatment i s p u r e l y medical and s u r g i c a l treatment, j u s t as much as that adopted i n h i s h o s p i t a l i n c a r r y i n g a pat-i e n t over the c r i s i s of pneumonia,, or that, adopted by him i n the a p p l i c a t i o n of s p l i n t s i n the treatment of a f r a c -tured l e g . In f a c t i f he has been p r o p e r l y shown through the mental h o s p i t a l I think he w i l l admit, that here i t req-u i r e s , to a much greater extent, an i n s i g h t and knowledge of the i n d i v i d u a l and of human nature seldom c a l l e d f o r i n the conduct of a case o f b o d i l y i l l n e s s . 1 , 1 Dr. Doherty was very concerned about the l a c k o f knowledge regarding mental i l l n e s s on the part of the general p r a c t i t i o n e r . At a meeting of the B r i t i s h uolumbia Medical A s s o c i a t i o n i n 1906 he presented a paper e n t i t l e d "Diagnosfe of I n s a n i t y by the General P r a c t i t i o n e r and the Consequent Duties Which Must N e c e s s a r i l y Devolve Upon Him". In the l i g h t of present day knowledge, h i s opening paragraph i s most i l l u m i n a t i n g . "A proper r e c o g n i t i o n of the e a r l y and l o c . c i t . - 54 -premonitory symptoms of i n s a n i t y i s u r g e n t l y r e q u i r e d , as prompt and j u d i c i o u s treatment w i l l o f t e n save the p a t i e n t from an impending attack. I t i s usual among the p u b l i c to p i c t u r e an a t t a c k of i n s a n i t y as coming on suddenly, whereas, i n n e a r l y a l l cases, the onset i s gradual, isven i n acute mania there i s often a short foregoing p e r i o d of depression."' Foreshadowing the use of s o c i a l workers he s t r e s s e d the need of o b t a i n i n g a f u l l case h i s t o r y from a re3£ t i v e or f r i e n d , because of the i n v a l u a b l e h e l p " t h i s gave the doctor i n the subsequent treatment of the p a t i e n t . Much to h i s disgust many persons were being brought to the h o s p i t a l shackled and handcuffed, and he noted the s u r p r i s e of the nurses or policemen when the h o s p i t a l o f f i c i a l s imne d i a t e l y removed this, r e s t r a i n i n g .apparatus. Dr. Doherty was very much opposed to the establishment of p s y c h i a t r i c wards i n , general hospittals, and i n t h i s regard pleaded • . • " i f any e f f o r t i s to be made i n the i n t e r e s t s of the insane, l e t i t be i n the shape of i n c r e a s i n g the general comforts, amusements, and the s c i e n t i f i c treatment i n our p u b l i c i n s t i t u t i o n s " . 2 S c i e n t i f i c C l a s s i f i c a t i o n Q?he 1905 Annual Heport i n i t s l i s t of d i s o r d e r s shows the r e s u l t of the more s c i e n t i f i c c l a s s i f i c a t i o n o f B r i t i s h uolumbia, S e s s i o n a l Papers, Annual Heport of H o s p i t a l f o r the Insane. 1908, p. D 36. " ^ I b i d , D~387 - 55 -mental i l l n e s s devised "by X r a e p l i n some years e a r l i e r . In co n t r a s t to the f i r s t r e p o r t s which showed only three types of i n s a n i t y , the one f o r that year broke down the k i n d s to no l e s s than seventeen. Dementia , praecox 25 S e n i l e melancholia 2 " s e n i l e 8 R e s i s t i v e " 4 "? terminal 12 D e l u s i o n a l 7 2 General P a r e s i s 21 Toxic i n s a n i t y 3 E p i l e p t i c i n s a n i t y 2 I d i o c y 2 Melancholia 12 I m b e c i l i t y 1 Acute mania 10 Dementia p a r a l y t i c 1 Recurrent mania 4 Not c l a s s i f i e d 1 Paranoia 13 The a l l e g e d cause of the a t t a c k s of i n s a n i t y f o r 1905 were l i s t e d , the greatest number of p a t i e n t s supposedly breaking down f o r these reasons: h e r e d i t y , onanism, s y p h i l i s , a l c o h o l i c intemperance, mental worry, s e n i l i t y , l a c t a t i o n , and c h i l d b i r t h . • In 1912, the l e g i s l a t i v e assembly passed an amend-ment to the 1897 Act which e l i m i n a t e d the word "insane" i n the t i t l e , the new name becoming the Mental H o s p i t a l s Act. The previous year the Act had been r e v i s e d but no great change was e f f e c t e d . The r e v i s i o n s t a k i n g p l a c e , however, were but a r e f l e c t i o n of the changing a t t i t u d e r e g a r d i n g the mentally i l l . Branch at Yernon In s p i t e of the many progressive features i n the care, of the mentally i l l which thus made themselves manifest - 56 -a f t e r the turn o f the century, a backward*step had been taken i n 1904. 'i'he h o s p i t a l at Hew Westminster had become so crowded that some d r a s t i c move was necessary i n order to r e l i e v e the s i t u a t i o n . The superintendent was given the choice of u s i n g the gaol e i t h e r i n Kamloops or Vernon. A f t e r v i s i t i n g bo'th of them, he chose the l a t t e r , because i t was new and would at l e a s t give the p a t i e n t s reasonable s a t i s -f a c t o r y p h y s i c a l comfort. In September, f o r t y - e i g h t male p a t i e n t s and f i v e attendants were t r a n s f e r r e d to Vernon, and of the move the suje r i n t e n d e n t wrote w t h e r e l i e f i s welcome, but a gaol i s a gaol and bears no s i m i l i t u d e to a h o s p i t a l f o r the i n s a n e . " 1 This s o - c a l l e d Branch H o s p i t a l operated u n t i l the opening o f Essondale a'nd housed at times as many as sev e n t y - f i v e to e i g h t y men. There are no records of how the p a t i e n t s f a r e d i n t h i s i n s t i t u t i o n ; but i t i s doubtful i f they could ever have escaped the impression of bei n g under f o r c i b l e detention. In the Annual Report f o r 1914 the idea was ex-pressed f o r the f i r s t time that the excessive use of a l c o h o l might be a symptom of mental disorder r a t h e r than the cause of i t . In that year Dr. A.L. Crease, the present General Sup r i n t e n d e n t and P r o v i n c i a l P s y c h i a t r i s t j o i n e d the s t a f f of the Hew Westminster H o s p i t a l as t h i r d p h y s i c i a n . He cane •'•British Columbia, S e s s i o n a l Papers, Annual Report of H o s p i t a l f o r the Insane, 1904, p. I 13. ~ ~ - 57 -to B r i t i s h Columbia from Bhode IsHend where he had done f o i r years of research work and i t was thought that he would be a valuable a d d i t i o n to the medical s t a f f , which c e r t a i n l y proved to be the case. In 1915 the Binet-Simon I n t e l l i g e n c e Test-'was-first used to form a t a b l e of mental development, and to determine the amount of d e t e r i o r a t i o n that takes place a f t e r prolonged e x c i t e d or depressed periods. The year 1916 saw the appoint-raent of a d e n t i s t f o r one day a week. In the same year, tte superintendent recommended that a h o s p i t a l be b u i l t f o r the feeble-minded where they c o u l d attend e d u c a t i o n a l c l a s s e s . C o l q u i t z A modern b u i l d i n g at Saanich on Vancouver I s l a n d was taken over i n 1918 f o r the s o - c a l l e d c r i m i n a l l y insane. I t was opened i n tthe f i r s t part of 1919 and by March of the f o l l o w i n g year there were nin e t y - n i n e inmates. A l s o i n 19i9 the f i r s t attempt at segregation of the feeble-minded was made when excavations were made f o r a subnormal boys' school. An o l d carpenter's shop standing on the grounds of the h o s p i t a l was renovated and r e f i t t e d to make a reasonably comfortable home f o r some s i x t y c h i l d r e n . CHAPTER IV 1919-1932: MODERN INFLUENCES In 1919, the Canadian N a t i o n a l Committee f o r Mental Hygiene, founded the previous year, conducted a ' survey of B r i t i s h Columbia at the request o f the P r o v i n -c i a l Secretary. The study was c a r e f u l l y and thoroughly conducted and inc l u d e d an examination of c o n d i t i o n s i n connection w i t h the insane end mental d e f e c t i v e s . Mental Hygiene Survey, 1919 In the foreword to the repo r t the committee st a t e d that i t r e c e i v e d the utmost co-operation from those i n charge of the var i o u s i n s t i t u t i o n s . I t f e l t that the people of B r i t i s h Columbia were f u l l y a l i v e to the impor-tance of making s o c i a l reforms and that the province gen-e r a l l y was to be congratulated on the progress made i n the care and treatment of the insane. Although the war had impeded advance, the outlook f o r the fu t u r e was hopeful i n t h e i r opinion. The Committee b e l i e v e d the west had the ad-vantage o f not being hampered by many t r a d i t i o n s which often impede progress, and the western provinces d i d not think they were above c r i t i c i s m , which made them more prepared to accept modern die turns regarding the mentally i l l . They thought the management o f the New Westmin-s t e r I n s t i t u t i o n was admirable, but deplored the f a c t that - 58 -1 -59-the a u t h o r i t i e s were f o r c e d to accept a l l mental types, from i d o i c y and acute i n s a n i t y to s e n i l e dementia. Owing to c o n d i t i o n s of overcrowding and want of space, the s t a f f was asked to do the impossible i n making a proper c l a s s i f i c a t i o n . In the words of the r e p o r t : "the demands of the modern h o s p i t a l f o r the insane are q u i t e as exact-i n g as those of the general h o s p i t a l , and u n t i l t h i s f a c t i s recognized no r e a l progress can he made."1 The committee acknowledged, however, that B r i t i s h Columbia had not been penurious i n making expenditures f o r the mentally i l l , but noted that Essondale might be c l a s s e d as having adopted too elaborate a type o f c o n s t r u c t i o n . I f a mistake was made, though,. they h e l d that i t was on the r i g h t side o f the account. The t r a i n i n g school f o r p s y c h i a t r i c nurses e s t -a b l i s h e d at New Westminster j u s t before the war began was now doing e x c e l l e n t work, although i t had been somewhat disor g a n i z e d d u r i n g the war years because of the absence of so many of the s t a f f . The course was two years l o n g and i n -s t r u c t o r s i n c l u d e d Drs. Doherty, Steeves, Crease, M c A l l i s t -e r , and Ryan. The report s t a t e d that no i n s t i t u t i o n w i t h -out a t r a i n i n g school should be c a l l e d a h o s p i t a l . I t put forward the suggestion that the male wards should be placed under the c o n t r o l of women nurses beoause "they do the work w i t h i n t e l l i g e n c e and have a humanizing i n f l u e n c e that i s ^•Canadian N a t i o n a l Committee f o r Mental Hygiene, i^e£ar^_i2f_^rv^_ijl_BrJ.JJ.B}i_C£ilujiibia^iL-iaia_ V o l . 2 p. 5 A p r i l 1920. ' * * - 60 -of e s p e c i a l value i n the care of the i n s a n e . " 1 Whenever nurses are placed i n mental h o s p i t a l s the r e s u l t i s to e s t a b l i s h even i n s t i t u t i o n s f o r chronic p a t i e n t s on a new b a s i s . Trained nurses on the v a r i o u s wards help to convince the p u b l i c that i n t e l l i g e n t and s k i l l e d treatment i s t a k i n g the place of mere c u s t o d i a l care. The report a f f i r m e d that i t had become the h a b i t i n some quarters to regard a l l mental maladies as i n c u r a b l e and to re l e g a t e the p a t i e n t s s u f f e r i n g from such diseases to the scrap heap. The committee considered the medical s t a f f at Hew Westminster f a r too sm a l l , although the s c i e n t i f i c p art of the treatment o f p a t i e n t s had not been neglected and the p h y s i c i a n s were e n t h u s i a s t i c about t h e i r work. The n e c e s s i t y of having one doctor f o r every hundred p a t i e n t s was pointed out, as u n d e r s t a f f i n g l e f t l i t t l e time f o r i n -v e s t i g a t i o n , and a s s i s t a n t s hampered by a mass of r o u t i n e and c l e r i c a l work were apt to l o s e t h e i r z e a l f o r research and e v e n t u a l l y become f o s s i l i z e d and u s e l e s s . In h o s p i t a l s that accumulate many chronic oases t h i s tendency must be combatted f o r "the moment the i n d i v i d u a l i s f o r g o t t e n i n a p herd, h i s chance of improvement has p r a c t i c a l l y gone. The r e p o r t proposed a change i n the form o f a d -m i s s i o n as t h e o r e t i c a l l y at l e a s t , the m a j o r i t y of the insane tLoc7~ C i t r ' 8Ibid .TP< 6-. - 61 had to s u f f e r the i n d i g n i t y of having to appear before a magistrate upon somewhat the same p l a i n as a c r i m i n a l . -Many p a t i e n t s were kept i n gaol before being admitted to the H o s p i t a l . The gaol system, except i n extreme cases, should be abolished, and p r o v i s i o n made f o r v o l u n t a r y ad-mission. Why should acute mental i l l n e s s be put on a d i f -f e r e n t l e v e l than i s the care of p h y s i c a l d i s a b i l i t y i n general h o s p i t a l s ? To quote from the survey made i n Mani-toba'previously: "The i n t e l l i g e n t method of admissions seeks to remove the s u s p i c i o n s of the p u b l i c i n regard to i n s t i t u t i o n s and to recognize that i n s a n i t y i s a disease, not a c r i m e . n l F a c i l i t i e s f o r p r o v i d i n g s u i t a b l e occupation f o r mental p a t i e n t s were found to be inadequate. The number of inmates who were employed was f a r too small to meet modern requirements, but i f occupational therapy were adopted as a p o l i c y to be f o l l o w e d , the r e s u l t s would be g r a t i f y i n g , thought the committee. The h o s p i t a l management r e a l i z e d the importance o f t h i s f e a t u r e , but lacked the money to i n s t i t u t e t h i s much needed reform. The r e p o r t s t r e s s e d the need of p r o v i d i n g q u a l i f i e d teachers and w e l l equipped, shops because "occupation i s not only a s u b s t i t u t e f o r r e -s t r a i n t , but i s a l s o a therapeutic measure of v a l u e . " 2 I b i d . , p.8 2 I b i d . . n.10 - 62 -A w e l l organized s o c i a l s e r v i c e department was considered to be a primary need, as the absolute n e c e s s i t y o f such a s e r v i c e i n general h o s p i t a l s had already been proved. I t was almost impossible to prevent p a t i e n t s from developing the h o s p i t a l h a b i t without the a s s i s t a n c e o f w e l l t r a i n e d s o c i a l workers who could e x e r c i s e i n t e l l i g e n t s u p e r v i s i o n over the p a t i e n t s who might win t h e i r way to improved h e a l t h and freedom. B r i t i s h Columbia because o f i t s s c a t t e r e d p o p u l a t i o n was p a r t i c u l a r l y i n need of so-c i a l workers. The employment of t r a i n e d workers would e f f e c t a r e a l economy to the government, as i t would r e -l i e v e i t of the burden of maintenance wh i l e the p a t i e n t was on probation. The committee was pleased with the r e l a t i v e l a c k o f mechanical r e s t r a i n t at Hew Westminster and iissondale, and maintained that the. development of occ u p a t i o n a l ther-apy on an extensive scale would tend towards the complete disappearance of t h i s o b j e c t i o n a b l e feature of h o s p i t a l management. The most g l a r i n g need i n B r i t i s h Columbia i n the opinion of the committee was p r o v i s i o n f o r the immediate care of mentally i l l persons without the hamperings o f r e d tape and r o u t i n e . They looked over the u n i v e r s i t y b u i l d -ings connected w i t h the Vancouver General H o s p i t a l and found two of them which would lend themselves admirably « - 63 -to the purpose of p r o v i d i n g a psyehopathio h o s p i t a l con-t a i n i n g t h i r t y or more beds w i t h the best types of e q u i p - t ment f o r s u i t a b l e treatment. They s t r e s s e d e m p h a t i c a l l y the need f o r psychopathic wards i n connection with general h o s p i t a l s and could see no reason f o r any delay i n pro-v i d i n g them f o r Vancouver. The committee was pleased to note that the im-portance o f p s y c h i a t r y had been brought to the f o r e by the developments of the war. P r e v i o u s l y i n s a n i t y had been misunderstood by general medioal p r a c t i t i o n e r s , l a r g e l y because c l i n i c a l s t u d i e s were neglected due to the l a c k o f m a t e r i a l f o r the student and i n t e r n e i n h o s p i t a l s , and because the subject of p s y c h i a t r y was f o r g o t t e n f o r the great part i n medical schools. The oommittee contended that the r i g h t s of the insane to e a r l y s c i e n t i f i c t r e a t -ment be recognized and p r o v i s i o n made f o r t h i s i n general h o s p i t a l s , where p h y s i c i a n s and students could be put i n the p o s i t i o n of seeing more of the disease and i t s t r e a t -ment. Psychopathic wards at the Vancouver General H o s p i t a l would not only prove a boon to the community, but would form a c l e a r i n g house f o r many cases before being sent to the H o s p i t a l f o r the Insane. Those who made the survey advocated the e r e c t i o n o f a psychopathic u n i t e i t h e r at New Westminster or' Esson-dale to supplement the psychopathic wards i n Vancouver. \ - 64 -This b u i l d i n g should c o n t a i n e v e r y t h i n g necessary i n the way o f equipment and should have p r o v i s i o n f o r extensive research work. In t h e i r o p i n i o n , no branch of medicine was more i n need of research than p s y c h i a t r y . The r e p o r t a s s e r t e d that Essondale which housed men only was a s o r t o f g l o r i f i e d farm colony f o r chronic oases of i n s a n i t y and had much to commend i t , i f c u s t o d i a l care alone was aimed a t . The p a t i e n t s were housed i n la r g e d o r m i t o r i e s w i t h f i f t y p a t i e n t s each. The young men on t h e . s t a f f were doing e x c e l l e n t work and from a 'purely p h y s i c a l standpoint the inmates were w e l l cared f o r . The c h i e f l a c k , however, outside of s c i e n t i f i c equipment was the humanizing i n f l u e n c e o f women nurses. The committee's recommendations regarding the i n -sane were: 1. Establishment of a psychopathic h o s p i t a l . The advan-tages of such a u n i t were formulated by the Mental Hygiene Committee o f the Hew York State C h a r i t i e s A i d A s s o c i a t i o n , which i n summary declared that such a h o s p i t a l i s an i n t e g r a l part of a complete p r o v i n c i a l h o s p i t a l system, and without i t the system goes lame; i t would check the present r a p i d increase i n the num-ber of the insane by heading o f f the stream at i t s source; such a h o s p i t a l by preventing and c u r i n g cases of mental disease i n i n c i p i e n t and e a r l y stages, would prevent t h e i r becoming chronic insane p a t i e n t s and would save the s t a t e the expense o f continuous care of chronic cases f o r a l o n g term o f years: f i n a l l y , the h o s p i t a l would prevent overcrowding i n other prov-i n c i a l h o s p i t a l s by d i m i n i s h i n g the number annually committed. In a d d i t i o n to other d u t i e s , the s t a f f c o u l d be used f o r survey work i n Vancouver p u b l i c schools, and f o r the mental examination of j u v e n i l e and a d u l t court oases. - 65 -2. A b u i l d i n g f o r aeute oases at Essondale. j r a o i l i t i e s should be provided f o r occupational therapy and hydro-therapy. 3. C o n s t r u c t i o n of a nurses' home at New Westminster. 4. P r o v i s i o n f o r volu n t a r y admission to mental h o s p i t a l s placed on the st a t u t e books. 5. A convalescent home at e i t h e r New Westminster or Esson-dale to f a c i l i t a t e the more r a p i d recovery o f p a t i e n t s . 6. S o c i a l s e r v i c e i n connection w i t h New Westminster and Essondale. 7. T r a v e l l i n g p s y c h i a t r i c c l i n i c f o r mental examination of paroled p a t i e n t s , p u b l i c school cases, and others r e s i d e n t outside o f Vancouver. The e f f e c t of suoh a c l i n i c on the h o s p i t a l , the h o s p i t a l p h y s i c i a n , and on the community would be i n v a l u a b l e . 8. Appointment o f a p a t h o l o g i s t at New Westminster. t 9. Increased medical s t a f f at both mental h o s p i t a l s . The s t a f f of three p h y s i o i a n s f o r some 600 p a t i e n t s at New Westminster i s not s u f f i c i e n t to conduct e f f i c i e n t -l y the work r e q u i r e d . The proper r a t i o should be one doctor f o r every 100 p a t i e n t s . 10. Occupational therapy to curb mental d e t e r i o r a t i o n and increase the number o f r e c o v e r i e s . 11. Annual v i s i t s o f s t a f f members to other i n s t i t u t i o n s . In regard to the feeble-minded o f the province, the committee were convinced that from the data presented mental d e f i c i e n c y l a y at the very root of suoh c o n d i t i o n s as crime, j u v e n i l e delinquency, p r o s t i t u t i o n , and pauperism and that i t was a s i g n i f i c a n t p u b l i c school problem. They made three recommendations f o r mental d e f e c t i v e s , advoca-t i n g f a c i l i t i e s f o r d i a g n o s i s , f o r t r a i n i n g , and the exten-s i o n of s p e c i a l c l a s s e s . - 66 -Two f a r t h e r general recommendations were made* .Abandonment of the b u i l d i n g which housed the Boys I n d u s t r i a l School was one and the other was a strong recommendation f o r the appointment o f a Mental Hygiene Commission i n B r i t -i s h Columbia to make a study o f the problem o f mental ab-nor m a l i t y i n the province, and then to develop a s u i t a b l e p l a n f o r i t s s o l u t i o n . I t would c o n s i s t of a w e l l t r a i n e d and competent man i n whom the people had confidence as i t s head, a w e l l t r a i n e d p s y c h i a t r i s t , p o s s i b l y the general superintendent of the p r o v i n c i a l mental h o s p i t a l s , and a lawyer to he l p w i t h the many p o i n t s o f law i n connection w i t h a l l i n s t i t u t i o n s . In a d d i t i o n , there should be a seoretary. This commission should be an independent body, fr e e from p o l i t i c a l c o n t r o l * but i n the confidence of the government a i d r e s p o n s i b l e to i t . I t should be empowered to i n s p e c t the a c t i v i t i e s of a l l i n s t i t u t i o n s supported by governmental a i d . xhe h i s t o r y o f the State Commission i n Hew York founded i n 1889 was c i t e d as an example; i t was very unpopular at f i r s t because i t i n t e r f e r e d w i t h p o l i t i c a l patronage, but had more than j u s t i f i e d i t s ex-is t e n c e from the standpoint of economy, humanity, and gen-e r a l progress. A l l appointments made were from those who. reached the high standard demanded by competitive c i v i l s e r -v i c e examinations. - 67 -In concluding the r e p o r t , the medical d i r e c t o r , C.K. C l a r k e , and the a s s i s t a n t medical d i r e o t o r and sec-r e t a r y , CM. Hinoks, on b e h a l f of the Canadian N a t i o n a l Committee f o r Mental Hygiene, announced that they d i d not expect that a l l the recommendations would be put i n t o e f -f e c t immediately, but f e l t that the d e s i r e f o r progress i n B r i t i s h Columbia was so great that many o f t h e i r sug-gestions would be adopted i n the comparatively near f u t u r e . The r e p o r t of the survey was presented to the p r o v i n c i a l s e c r e t a r y i n October, 1919, and some of the recommendations were immediately put i n t o e f f e c t . By the time the r e p o r t was published in. the Canadian J o u r n a l o f Mental Hygiene i n A p r i l , 1920 p r o v i s i o n had been made f o r the establishment of a t r a i n i n g school f o r mental defec-t i v e s on the Essondale property, arrangement f o r a new b u i l d i n g f o r acute cases at Essondale and f o r the e r e c t i o n of a nurses' residence at Hew Westminster. Amendments to Mental H o s p i t a l s Act The recommendation of the mental hygiene com-mittee regarding v o l u n t a r y admission to the mental hosp-i t a l s was placed on the s t a t u t e books i n 1920. The amend-ment to the Act i n that year a l s o made p r o v i s i o n f o r r e -moving mentally i l l c o n v i c t s from p r i s o n and p l a c i n g them i n the new i n s t i t u t i o n at Colqn.itz. They were t r a n s f e r r e d by means of an u r d e r - i n - C o u n c l l from the Lieutenan^.Gover-nor. A form was f i l l e d out by the keeper of the gaol or - 68 - „ lock-up, or by the superintendent of the. I n d u s t r i a l School and forwarded to the medical superintendent. M e n t a l l y i l l c o n v i c t s considered to be recovered were returned to the i n s t i t u t i o n from which they came, to f i n i s h t h e i r sentence. The Mental h o s p i t a l s Act of 1924 contained the forms of admission used to-day. Ordinary admission r e -qu i r e d one form signed by anyone having knowledge o f the p a t i e n t ( p r e f e r a b l y a r e l a t i v e ) , two forms signed by q u a l -i f i e d p h y s i c i a n s , and one form signed by a judge. Volun-ta r y admission n e c e s s i t a t e d v o l u n t a r i l y w r i t t e n a p p l i c a -t i o n by the p a t i e n t accompanied by a form signed by a med-i c a l p r a c t i t i o n e r . Urgent admission could be obtained without the forms signed by doctors, but these had to be obtained w i t h i n fourteen days of admission. Death of Sr. Doherty Dr. Doherty died i n 1920 a f t e r a short i l l n e s s and was succeeded by Dr. H. c. Steeves. The new superi n -tendent acknowledged the great debt the people of t h i s province owed to h i s predeoessor, p r a i s i n g h i s energy and or g a n i z i n g a b i l i t y and g e n i a l p e r s o n a l i t y . During h i s lo n g and s u c c e s s f u l a d m i n i s t r a t i o n the mental h o s p i t a l s had been brought to a very high standard of e f f i c i e n c y . In the words o f Dr. Steeyes: "Hi's name w i l l be ever assoc-i a t e d w i t h the h i s t o r y of progress i n the care of oxr in s a n e . 1 , 1 ^ - B r i t i s h Columbia S e s s i o n a l Papers, Annual Report of the P r o v i n c i a l Mental H o s p i t a l s , 1921, p.w 9. - 69 -Need f o r a B u i l d i n g Program Recommendations f o r the e r e c t i o n of a b u i l d i n g f o r acute cases at Essondale were h e l d i n abeyance. By t h i s time the b u i l d i n g s were overcrowded by a t l e a s t one t h i r d and the management of the h o s p i t a l f e l t that some d i s t i n c t p o l i c y should be made to provide a b u i l d i n g every f i v e years to take care of the increase i n p o p u l a t i o n . In the 1923 r e -p o r t , Dr. Steeves c a l l e d a t t e n t i o n to the p r e s s i n g need f o r a b u i l d i n g program and a l s o s t r e s s e d the need of separate i n s t i t u t i o n a l care f o r the feeble-minded. The h o s p i t a l pop-u l a t i o n when the l a s t b u i l d i n g was completed i n 1912 was 752, but ten years l a t e r i t had r i s e n to 1649. In other words, the h o s p i t a l was g r e a t l y overcrowded. During t h i s p e r i o d modern cottages were erected at Essondale f o r mar-r i e d employees. New B u i l d i n g By the end o f 1924 the new acute b u i l d i n g at Essondale was completed and opened. Occupation o f t h i s b u i l d i n g made i t p o s s i b l e to r e c l a s s i f y p a t i e n t s , and en-abled the s t a f f to modernize methods o f r e c e p t i o n and treatment. The top f l o o r was set aside as a psychopathic admission u n i t e n t i r e l y separate i n i t s s t a f f o r g a n i z a t i o n and i n i t s care of p a t i e n t s from other p a r t s of the i n s t i -t u t i o n . Two years l a t e r a new complete c e n t r a l h e a t i n g p l a n t was b u i l t , to take care o f the increase i n b u i l d i n g s . - 70 -Dr. Crease Becomes Superintendent Dr. Steeves died i n 1926 while on a v i s i t to V i c t o r i a to d i s c u s s h o s p i t a l matters w i t h the p r o v i n c i a l s e c r e t a r y . He had been w i t h the h o s p i t a l since 1914. Dr. A. 1. Crease succeeded him and has been i n charge ever since. Royal Commission on Mental Hygiene, appointed 1925 The year 1925 was an important one i n the h i s t o r y o f the care o f the mentally i l l i n B r i t i s h Columbia, f o r i n November of that year a s e l e c t committee of the l e g i s l a t i v e assembly was appointed. The o r i g i n a l motion s a i d that "whereas the number o f p a t i e n t s t r e a t e d i n the Mental Hos-p i t a l and i t s branches i s i n c r e a s i n g to an alarming extent, whereas 66 per cent of the inmates are not Canadian born and 90 per cent are not n a t i v e s of the province, and where-as i t i s necessary to erect f u r t h e r b u i l d i n g s , and whereas the cost to the people of the province f o r the maintenance of the mentally a f f l i c t e d i s now over $750,000.00 an n u a l l y , e x c l u s i v e of c a p i t a l charges, and whereas the treatment and care of subnormal and mentally d e f i c i e n t c h i l d r e n has a l s o become an urgent and very s e r i o u s q u e s t i o n , " that a s e l e c t committee be appointed to i n v e s t i g a t e and r e p o r t upon the f o l l o w i n g matters: 1. The reasons f o r the increase i n the number of p a t i e n t s maintained i n the P r o v i n c i a l Mental H o s p i t a l s and branches thereof. - 71 -2. The causes and prevention of lunacy i n the province g e n e r a l l y . 3. The en t r y i n t o the province of insane, mentally d e f i c -i e n t , and subnormal persons. 4. The cure and treatment of subnormal c h i l d r e n . 5. A l l such matters and things r e l a t i n g to the subject of i n s a n i t y , e s p e c i a l l y as they e f f e c t the province o f B r i t i s h Columbia, as the s a i d Committee may deem p e r t i n -ent to the enquiry. The Committee composed of Messrs. R o t h w e l l , Odium, W. A. McKenzie, Hayward, and H a r r i s o n proceeded w i t h t h e i r enquiry f o r a month and then asked permission to continue the i n v e s t i g a t i o n . On December 30, 1925 they were appoint-ed Commissioners under the p r o v i s i o n s of the " P u b l i c I n q u i r -i e s A c t . " During the next year the Royal Commission h e l d p u b l i c hearings i n Vancouver and V i c t o r i a where evidence was given and recommendations made by members of the medi-c a l p r o f e s s i o n , p u b l i c o f f i c i a l s , r e p r e s e n t a t i v e s of var-ious welfare o r g a n i z a t i o n s , and other i n t e r e s t e d persons. The members inspected the P r o v i n c i a l Mental H o s p i t a l and i t s branches and made a survey of the records of a l l pa-t i e n t s admitted during the previous ten years. U n l i k e the Royal commission appointed some t h i r t y years e a r l i e r , no i n q u i r y was made i n t o i n d i v i d u a l cases and complaints as the members considered i t outside the scope of the i n q u i r y to enter i n t o any questions a f f e c t i n g i n d i v i d u a l cases i n the mental i n s t i t u t i o n s . The commission i n the time at - 72 -t h e i r d i s p o s a l secured and st u d i e d a l l a v a i l a b l e informa-t i o n from other p a r t s o f the world, p a r t i c u l a r l y i n the other provinces of Canada, the United S t a t e s , Great B r i t a i n , and the other dominions. Their f i r s t r e p o r t dated February 28, 1927, was f i f t y - f o u r pages i n l e n g t h i n c l u d i n g seven appendices. In t h e i r general observations, the commissionery contended that mental d i s o r d e r should be recognized as a disease l i k e other diseases, and mental d e f i c i e n c y as an abnormality l i k e any b o d i l y abnormality. They s t a t e d that a mind diseased may be t r e a t e d no l e s s e f f e c t i v e l y than a body diseased; the duty of s o c i e t y and the st a t e to the mentally a f f l i c t e d i n no way d i f f e r s from i t s recognized duty towards the a f f l i c t -ed i n body. Treatment o f the mentally a f f l i c t e d , the science of p s y c h i a t r y , was making great advances as the r e s u l t o f an awakened i n t e r e s t and a growing sense of the Importance of the problem.. That a c l e a r d i s t i n c t i o n be recognized between men-t a l d i s o r d e r (commonly known as i n s a n i t y ) , which i n many cases may be prevented or cured, and mental d e f i c i e n c y (com-monly known as feeble-mindedness), which cannot be cured, but whose e f f e c t s might be m i t i g a t e d i n many cases by s u i t -able t r a i n i n g , was put forward i n the re p o r t . The two groups c o n s t i t u t e d separate problems r e q u i r i n g d i f f e r e n t care and treatment. - 73 -The members of the Commission s t a t e d that the problems o f prevention a i d care were g r e a t l y complicated i n . B r i t i s h Columbia because of i t s great area and the s c a t t e r e d nature of settlement outside a few l a r g e centres. In regard to the causes and prevention of mental d i s o r d e r , they found that a search o f the recorded opinions of men prominent i n the medical p r o f e s s i o n i n v a r i o u s c o u n t r i e s f o r c e d the c o n c l u s i o n that not enough was known as to the causation of mental d i s o r d e r to j u s t i f y any def-i n i t e general pronouncement. Apart from t h a t , records of what was known were too complicated to f i n d a place i n t h e i r r e p o r t . The members studi e d the 1926 r e p o r t o f the B r i t i s h Royal Commission on Lunacy and Mental Disorder, which observed at the outset: I t has become I n c r e a s i n g l y evident to us that there i s no c l e a r l i n e of demarcation between mental i l l n e s s and p h y s i c a l i l l n e s s . The d i s -t i n c t i o n as commonly drawn i s based, on a d i f -ference o f symptoms. In ordinary parlance, a disease i s mental i f i t s symptoms manifest them-selves predominantly i n d i s o r d e r s of conduct and as p h y s i c a l i f i t s symptoms manifest them-selves i n derangement of b o d i l y f u n c t i o n . This c l a s s i f i c a t i o n i s m a n i f e s t l y imperfect. A men-t a l i l l n e s s may have p h y s i o a l concomitants; probably i t always has, although they may be d i f -f i c u l t of d e t e c t i o n . A p h y s i c a l i l l n e s s on the other hand may have, and probably always has, mental concomitants. And there are many cases i n which i t i s a question whether the p h y s i o a l or the mental symptoms predominate. i B r i t i s h Columbia, S e s s i o n a l Papers, Regort of the g^gai_Qo"gmiasion on Mental Hygiene (1927), 1926-27"7"~p. CC11. - 74 -These words w r i t t e n over twenty years ago, are as good a d e s c r i p t i o n of psychosomatic medicine as one could f i n d to-day, except that at the present time we have more s p e c i f i c knowledge of the psychogenic f a c t o r s which cause h o d i l y malfunction. The Committee noted that complete abstinence from aloohol would not wipe out a l l i n s a n i t y a t t r i b u t e d to that cause because many people drink e x c e s s i v e l y because o f t h e i r mental c o n d i t i o n . The mental h o s p i t a l s were g e t t i n g fewer gen e r a l p a r e s i s cases, which according to the superintend-ent, Dr. Steeves, was the r e s u l t of the venereal disease preventive campaign of the P r o v i n c i a l Board o f Health. The idea was advanced that g r e a t e r a t t e n t i o n be paid, to general b o d i l y hygiene i n e a r l i e r years i n order to pre-vent s e n i l e i n s a n i t y . I t was f e l t that the diseases of o l d age were u s u a l l y i n s i d i o u s i n o r i g i n and gradual i n development and that t h e i r seeds had been sown i n middle l i f e or even e a r l i e r . When o l d age comes, prevention i s then too l a t e . The report quoted a general statement by the s t a t i s t i c i a n of the Un i t e d States N a t i o n a l Committee f o r Mental Hygiene which summed up the f i n d i n g s o f the organs i z a t i o n . I t read: The r e d u c t i o n i n the use of a l c o h o l , the gradual e l i m i n a t i o n of veneral diseases, and t h e . d i s -semination of more complete knowledge of the - 75 -p r i n c i p a l s of mental hygiene tend to lower the rate o f mental disease. On the other hand, the crowding of population i n t o c i t i e s , the i n c r e a s i n g economic s t r e s s , and the re d u c t i o n of the b i r t h -r a t e among the more stable elements o f the pop-u l a t i o n are c o n d i t i o n s unfavourable to mental h e a l t h . 1 l e e d f o r e a r l y treatment A study of current opinion among a u t h o r i t i e s g e n e r a l l y and of records i n d i c a t i n g the trend of new methods being adopted, showed a s t e a d i l y i n c r e a s i n g b e l i e f i n the preventive value of e a r l y treatment. The reforms of a few years e a r l i e r had changed i n s t i t u t i o n s from asylums where detention and safeguarding of the p a t i e n t was the only c o n s i d e r a t i o n , i n t o mental h o s p i t a l s , where c u r a t i v e methods took f i r s t p l a c e ; t h i s development marked a notable advance i n the whole a t t i t u d e o f the p u b l i c and the s t a t e towards the mentally i l l . While t h i s change had undoubtedly r e s u l t e d i n a much l a r g e r percentage of cures and had thus shortened the term of i l l n e s s i n many cases, •. and had added g r e a t l y to the comfort and general w e l l -being of the p a t i e n t , i t had had no preventive e f f e c t what-ever. The mental h o s p i t a l had no concern w i t h any case u n t i l i t reached the stage where the i n d i v i d u a l c o u l d be c e r t i f i e d f o r admission. B r i t i s h Columbia, as i n other p l a c e s , had done p r a c t i c a l l y n othing towards o a r i n g f o r the i n c i p i e n t cases that might be prevented from developing, or i n a f f o r d i n g treatment f o r young persons whose general I b i d , p.CCl2. - 76 -make-up i n d i c a t e d a d i s p o s i t i o n to l a t e r mental breakdown. The B r i t i s h Royal Commission recognized t h i s f a c t when i t observed that "the keynote of the past has been detention; the keynote of the future should be prevention and' t r e a t -ment." 1 Dr. C. M. Hincks, Medical D i r e c t o r of the Canad-ia n N a t i o n a l Committee f o r Mental Hygiene, who had spent, s i x months of 1926 i n Europe, s t a t e d i n a communication to the Commission that he had consulted medical s p e c i a l -i s t s i n s i x c o u n t r i e s , a l l of whom advocated p s y c h i a t r i c or c h i l d guidance c l i n i c s . They had discovered that many cases of mental i l l n e s s that e v e n t u a l l y became i n -s t i t u t i o n a l wards of the state could have been s u c c e s s f u l l y t r e a t e d during childhood. P s y c h i a t r i c c l i n i c s c o u l d f u r n -i i s h advice and treatment that would ward o f f mental d i s a s -t e r . The c l i n i c at Oxford, England had been so s u c c e s s f u l that the mental h o s p i t a l p o p u l a t i o n had decreased n o t i c e a b l y since i t s i n a u g u r a t i o n . In d i r e c t oontrast to t h i s , the num-ber of inmates i n other i n s t i t u t i o n s which had no c l i n i c s was i n c r e a s i n g . The p s y c h i a t r i c c l i n i c s i n Montreal, Toronto, Hamilton, London, and Winnipeg had convinced Dr. Hincks that such c l i n i c s c o n s t i t u t e d the best method of prevention of mental i l l n e s s . An other important f u n c t i o n of such a pro-gram was the s u p e r v i s i o n of i n s t i t u t i o n a l cases on probation i n the community. - 77 -The Board o f C o n t r o l f o r England and Wales,one of the foremost a u t h o r i t i e s i n the world on a l l matters p e r t a i n i n g to state p r o v i s i o n f o r the mentally a f f l i c t e d , s t r e s s e d the value and n e c e s s i t y o f e a r l y treatment i n se v e r a l r e p o r t s . In 1925, i t made a s p e c i a l p l e a f o r out - p a t i e n t c l i n i c s , d e c l a r i n g that "there i s a wide f i e l d of usefulness f o r out-patient treatment i n regard to e a r l y cases of mental d i s o r d e r and the case of psychoneurotics f o r whom no e f f e c t i v e treatment i s o r g a n i z e d . " 1 Dr. C. P a r r a r , "Director o f the Toronto Psycho-p a t h i c H o s p i t a l , g i v i n g evidence before the Commission, maintained: Mental disease, l i k e any other d i s a b i l i t y , and probably more so, s u f f e r s from l a c k of pro-p h y l a x i s . I do not think that any man who has r e a l l y s t u d i e d mental d i s a b i l i t i e s and t h e i r causes has f a i l e d to r e a l i z e t h at, when we get a case i n middle l i f e , we f i n d we are d e a l i n g w i t h the main produot of a process that has been going on f o r years and, i n many i n s t a n c e s , r i g h t from e a r l y l i f e . . . * He also contended that a prevalent idea was the hopelessness of mental d i s o r d e r s , and that a p a t i e n t ' s doom was sealed onoe he i s sent to a mental h o s p i t a l . I t c e r t a i n l y was not commonly known that the improvement and recovery r a t e s among mental p a t i e n t s compared f a v o r a b l y w i t h those i n other k i n d s o f i l l n e s s . I t was true that . ~!lbid7~p7~CC13 " ' 2Loc. C i t . - 78 -there were those i n whom disease had made such inroads when they came under treatment that l i t t l e hope c o u l d he hel d out f o r them. But the same was true of other types o f diseases whioh a f f e c t e d the organic systems of the body. He concluded that " n e i t h e r the i n t e r n i s t nor the surgeon oan cure a l l h i s p a t i e n t s ; and the n e u r o l o g i s t and the p s y c h i a t r i s t are p r e c i s e l y i n the same c a s e . " 1 A f t e r studying the evidence given before them and the inf o r m a t i o n obtained from other p a r t s o f the world, the Commissioners were thoroughly convinced that the most immediate need i n B r i t i s h Columbia was f o r f a c i l i t i e s f o r e a r l y diagnosis and treatment o f mental d i s o r d e r , and that such f a c i l i t i e s should be as r e a d i l y a c c e s s i b l e and as f r e e from l e g a l f o r m a l i t y as treatment f o r any b o d i l y ailment under the general h o s p i t a l system. The p r o v i s i o n of such f a c i l i t i e s should be the u l t i m a t e aim o f a well-balanced program of mental hygiene, the f i r s t step of which was a psychopathic h o s p i t a l . In concluding t h e i r observations on the p o s s i b i l -i t i e s of p r a c t i c a l preventive measures, the Commission found i t s e l f e n t i r e l y i n accord w i t h the B r i t i s h Royal Commission that "the problem of i n s a n i t y i s e s s e n t i a l l y a p u b l i c - h e a l t h problem to be d e a l t w i t h on modem p u b l i c h e a l t h l i n e s . " 2 • ^ e ^ i i - 2 I b i d , p UC18 - 79 - . v * The Psychopathic H o s p i t a l A f t e r . l i s t e n i n g to medical men and representat-i v e s o f various welfare o r g a n i z a t i o n s both i n Vancouver and V i c t o r i a the memebers of the Commission were convinced of the need of c l i n i c s e r v i c e . Dr. A. T. Mathers, p r o v i n -c i a l P s y c h i a t r i s t f o r Manitoba and D i r e c t o r of the Winni- . peg Psychopathic H o s p i t a l , placed a p a r t i c u l a r h i g h value on the o u t - p a t i e n t and s o c i a l s e r v i c e branches of the work of h i s h o s p i t a l . He had found that the value o f the soc-i a l s e r v i c e department was not confined to the i n d i v i d u a l a f f e c t e d . The c o n d i t i o n of the p a t i e n t was o f t e n the r e -s u l t of f a m i l y c o n d i t i o n s which the trained-worker soon r e -cognized and was o f t e n able to a d j u s t , so that the whole f a m i l y benefited. S o c i a l workers were a l s o able to a i d recovered p a t i e n t s to adjust themselves both at home and i n employment. . Many of the p a t i e n t s of the Winnipeg Psychopathic H o s p i t a l were r e f e r r e d there by various s o e i a l agencies which formerly had no place to send t h e i r problem oases. In summing up the need f o r e a r l y treatment the Commission found that there had been a s t e a d i l y mounting demand f o r places to which the mentally i l l c i t i z e n could go f o r examination and advice, j u s t as he could go"to a general h o s p i t a l with h i s b o d i l y t r o u b l e s , i n the B r i t i s h I s l e s and Jfiurope such places were known as 'mental, wards, - 80 -f mental c l i n i c s , or p s y c h i a t r i c h o s p i t a l s . In Canada and the U n i t e d States they were g e n e r a l l y known as psycho-pat h i c h o s p i t a l s . She s e r v i c e such an i n s t i t u t i o n a f f o r d -ed was a very r e a l need i n B r i t i s h Columbia i n the o p i n i o n of the Hoyal Commission. A s i x t y bed h o s p i t a l w i t h ade-quate f a c i l i t i e s f o r occupational therapy, o u t - p a t i e n t and s o c i a l s e r v i c e , and the neeessary a d m i n i s t r a t i o n o f f i c e s would cost approximately f250,000. The Commissioners pro-posed that i t be e s t a b l i s h e d i n c l o s e co-operation w i t h a l e a d i n g general h o s p i t a l . Report of A n a l y s i s o f Case Records Appendix "0" c o n s i s t e d of an expert a n a l y s i s o f the case records of the mental h o s p i t a l s of B r i t i s h C o l -umbia f o r the previous ten years. I t was prepared by Miss Helen Davidson, a former teacher o f subnormal c h i l -dren i n Hew Westminster, the main p o i n t s covered by the rep o r t being h e r e d i t y , country of b i r t h , l e n g t h of r e s i -dence i n B r i t i s h Columbia, and l e n g t h o f residence i n Canada. A f t e r doing a thorough piece of research, Miss Davidson found that by p u t t i n g the worst complexion on her f i g u r e s , that 30 per cent was the l a r g e s t amount of i n s a n i t y that c o u l d be considered due to h e r e d i t a r y t a i n t of v a r y i n g degrees. The importance of these f i n d i n g s was recognized by Miss Davidson and i n her report she quoted the warning o f a too p l a c i d acceptance o f the theory of - 81 -h e r e d i t y voiced by H. A. Cotton, Medical D i r e c t o r of the New Jersey State H o s p i t a l : " The d o c t r i n e o f h e r e d i t y as a p p l i e d i n the f i e l d of mental d i s o r d e r s has been detr i m e n t a l and d e s t r u c t i v e . . . I t has exerted a p e r n i c i o u s i n -fluence on both the study and treatment o f mental di s o r d e r s . For i f we f i r m l y b e l i e v e i n these d o c t r i n e s o f h e r e d i t y and the ' i n h e r i t e d c o n s t i -t u t i o n 1 which means i n a broader sense that i n c e r t a i n cases mental disease i s i n e v i t a b l e and that nothing can be done to prevent or to cure i t , then e v i d e n t l y i t would be f u t i l e to t r y to a r r e s t the disease or search f o r methods of r e l i e f except along eugenic l i n e s . I t cannot be denied that such has been the a t t i t u d e o f p s y c h i a t r i s t s i n general, and when ev e r y t h i n g i s blamed on h e r e d i t y , t h i s f a t a l i s m assumes the r o l e of a cloak to hide our ignorance and s t i f l e i n i t i a t i v e i n the i n v e s -t i g a t i o n of causation l o o k i n g to prevention and r e l i e f . 9 f o r t u n a t e l y we are to-day i n a p o s i t i o n to show that the d o c t r i n e of h e r e d i t y as a p p l i e d to mental d i s o r d e r s i s not i n harmony with modern b i o l o g i c a l knowledge and " i s , t h e r e f o r e , obsoles-cent. The i n h e r i t e d c o n s t i t u t i o n i n the newer sense would r e f e r s p e c i f i c a l l y to the i n d i v i d -u a l ' s c o n s t i t u t i o n a l r e s i s t a n c e to v a r i o u s t o x i n s , r a t h e r than to merely mental i n s t a b i l i t y . 1 Miss Davidson made t h i r t e e n recommendations i n her report which were given c o n s i d e r a t i o n by the Koyal Com-mission, and some were incorporated i n t o t h e i r recommenda-t i o n s * F i n d i n g s of the Commission 1. With regard to the l a r g e increase i n the number of p a t i e n t s i n the p r o v i n c i a l mental h o s p i t a l s i n recent years, the Commission found: 1 I b i d , p CC36 - 82 -(a) There i s no reason to b e l i e v e that the increase i s d i s p r o p o r t i o n a t e to the increase i n the general p o p u l a t i o n during the same p e r i o d . (b) I t i s not due to, or to be regarded as proof of, any great increase i n the proportionate amount of mental abnormality i n the p o p u l a t i o n , but i s l a r g e l y accounted f o r by a growing tendency of the p u b l i c to seek h o s p i t a l accommodation when the occasion a r i s e s . (c) In p r o p o r t i o n to p o p u l a t i o n , the. increase i n h o s p i t a l p a t i e n t s i s not greater i n B r i t i s h Columbia than i n the other provinces or other p a r t s o f the c i v i l i z e d world. 2. The present mental h o s p i t a l s are s e r i o u s l y overcrowd-ed and at the l i m i t of t h e i r c a p a c i t y . This f a c t i s accounted f o r because they have been r e q u i r e d to ., accommodate mental d e f i c i e n t s f o r whom no other pro-v i s i o n has ever been made. 3. The mental h o s p i t a l s , i n respect to equipment, meth-ods of care, and c u r a t i v e treatment, compare fa v o r -ably w i t h any on t h i s continent and are h e l d gener-a l l y i n high regard. 4. According to the records o f the p r o v i n c i a l mental h o s p i t a l s , the foreign-born i n the population appear to have c o n t r i b u t e d a c o n s i d e r a b l y l a r g e r p r o p o r t i o n of mental cases than should be expected from t h e i r numbers i n the general population o f the province. Hecommendations of the Commission 1. The c r e a t i o n o f a P r o v i n c i a l Board of C o n t r o l , to be composed o f o f f i c i a l s already i n the p u b l i c s e r v i c e who s h a l l serve on the Board without added remuneration, to act i n an a d v i s o r y c a p a c i t y i n c o - o r d i n a t i n g and s u p e r v i s i n g the work of the p r o v i n c i a l mental h o s p i t a l s and to perform such other d u t i e s as may be e n t r u s t e d to i t . 2. The establishment of a psychopathic h o s p i t a l . . 3. Removal from the mental h o s p i t a l s , as soon as other accomodation can be provided, for mental d e f i c i e n t s ( i n c l u d i n g i d i o t s and i m b e c i l e s ) and - 83 -t h e i r establishment i n other appropriate quarters. 4. S t e r i l i z a t i o n i n c e r t a i n cases by consent a f t e r recommendation of the superintendent of the hosp-i t a l and the approval of the Board of C o n t r o l . 5. Conferences w i t h other provinces l o o k i n g to an agreement whereby the c o s t of maintenance o f p a t i e n t s from other provinces w i l l be borne by the province to which t h e i r support p r o p e r l y belongs. 6. Representations to the Dominion Government r e -questing greater care i n the examination of im-migrants to ensure the t o t a l e x c l u s i o n of the mentally u n f i t and those l i a b l e to i n s a n i t y ; that t h i s province be given n o t i f i c a t i o n and f u l l p a r t i c u l a r s o f a l l immigrants admitted to Canada under s p e c i a l permit. In concluding t h e i r r e p o r t the Commissioners s t a t -ed that they had found the problem had wider r a m i f i c a -t i o n s and presented more d i f f i c u l t i e s than they had sus-pected at the outset. They professed the b e l i e f that the growth of p u b l i c enlightenment on the subject had forced r a d i c a l changes i n the a t t i t u d e and sense of r e s p o n s i -b i l i t y of the state towards the mentally a f f l i c t e d . The r e s u l t had been something of a r e v o l u t i o n i n methods of care and treatment. Only w i t h i n the l a s t decade had seri o u s a t t e n t i o n been d i r e c t e d to the p o s s i b i l i t i e s o f preventive measures which might w e l l prove as f r u i t f u l as successes i n the f i e l d of t u b e r c u l o s i s , typhoid, and venereal disease. The new methods and new types of i n -s t i t u t i o n s were of such recent and v a r i e d development that there had not been time f o r a standard to be evolved. - 84 -Consequently the geatest care should he e x e r c i s e d i n s e l -e c t i n g those which appeared to he best s u i t e d to condi-t i o n s i n B r i t i s h Columbia. In the exact words of the r e -port: "The problem i s l a r g e l y economic;" to decide what methods o f f e r the g f e a t e s t p r a c t i c a l promise, and then to decide to what extent they can be adapted to our p a r t i c u -l a r geographical problems and how f a r the p u b l i c purse can or should go. " 1 The f i n a l report of the Royal Commission d e a l t l a r g e l y w i t h the problem of mental d e f e c t i v e s , a problem outside the scope of t h i s essay. In the past the mentally d e f e c t i v e and the mentally i l l had been mixed up together, although some attempt had been made at segregation. The Commission came to the co n c l u s i o n that the problem was educational r a t h e r than medical, and b e l i e v e d that nine-tenths of d e f i c i e n t c h i l d r e n c o u l d be t r a i n e d with great-es t advantage i n the p u b l i c school system. They recom-mended c u s t o d i a l treatment of low-grade i d i o t s and imbe-c i l e s and v o c a t i o n a l t r a i n i n g of higher-grade mentally de-f i c i e n t s . An important general recommendation was the appointment of a p r o v i n c i a l p s y c h i a t r i s t to act as medical and a d m i n i s t r a t i v e head of the proposed psychopathic hos-p i t a l and as adviser to the p r o v i n c i a l government i n mat-t e r s connected w i t h mental hygiene. 1 Ifcia.' P CC7 - 85 -In h i s f i r s t annual report f o r the year ending March 31, 1927 the new superintendent, Dr. A. L. Crease recommended a new wing f o r chronic p a t i e n t s , a nurses* home, a psychopathic h o s p i t a l , s o c i a l s e r v i c e , segrega-t i o n of the feeble-minded, and increased f a c i l i t i e s f o r treatment of the s i c k and i n f i r m . He was pleased to note that many of these recommendations were being d e f i n i t e l y acted upon and had been thoroughly studied by the p r o v i n -c i a l s e c r e t a r y , w i t h the valuable a i d o f members of the Canadian n a t i o n a l Committee f o r Mental Hygiene and the P r o v i n c i a l Hygiene Commission. New B u i l d i n g s In 1929 a nurses* residence was opened at Esson-dale and the f o l l o w i n g year the new Female Chronic b u i l d -. i n g opened i t s doors to women p a t i e n t s from the New west-minster H o s p i t a l . The p a t i e n t s were transported i n l a r g e vans, and t h i s mass movement of s e v e r a l hundred mentally i l l women with l i t t l e f uss or commotion was s a i d to be an unf o r g e t t a b l e s i g h t . P r o v i s i o n was made i n the new b u i l d -i n g f o r occupational therapy and p h y s i c a l t r a i n i n g . Dr. Crease was endeavoring.to give a l l p a t i e n t s employment and supervised r e c r e a t i o n because of the great c u r a t i v e value "attached to such occupation. The cottage at Colony Farm was enlarged at t h i s time to help r e l i e v e the overcrowding . - 86 -there. A f t e r the women p a t i e n t s moved to Essondale, the Hew Westminster H o s p i t a l was remodelled to be used as a home f o r the aged, but was used i n s t e a d f o r mental defec-t i v e s . Appointment of Occupational Therapist In the year 1931, the f i r s t occupational t h e r a p i s t was appointed to work wi t h the women, p a t i e n t s . Many a r t i c l e s were made i n t h i s department, some of which were s o l d and the proceeds used to buy more m a t e r i a l . The superintendent was very pleased w i t h the therapeutic a f f e c t of the new de-partment and found i t to be more e s s e n t i a l than was a n t i c i -pated. Occupations such as weaving and basketry absorbed the p a t i e n t ' s a t t e n t i o n and r e d i r e c t e d her thoughts from h e r s e l f . I t a l s o provided the opportunity f o r a p a t i e n t to attempt c o n s t r u c t i v e work which gave a greater sense of s e c u r i t y and adequacy as the time approached to leave the h o s p i t a l . CHAPTER V RECENT DEVELOPMENTS In 1932 the Canadian N a t i o n a l Committee f o r Mental Hygiene sent a s o c i a l worker, Miss K i l b u r n , to Essondale f o r one year at t h e i r expense. Thus a new period i n the development of our mental i n s t i t u t i o n s began, and the changes which began about t h i s time are s i g n i f i c a n t of a more enlightened outlook i n regard to the care and preven-t i o n of the mentally i l l . The importance o f preventive meas-ures was at l a s t beginning to be recognized by the govern-ment. The C h i l d Guidance C l i n i c As a r e s u l t of her s t i m u l a t i n g e f f o r t s , a C h i l d Guidance C l i n i c was opened i n Vancouver under the P r o v i n -c i a l Government i n J u l y of 1932. The c l i n i c was l o c a t e d i n the downtown area on Hornby St r e e t and at f i r s t was open only one day a week, the s t a f f t r a v e l l i n g from Essondale. E a r l y i n 1933 i t was opened two days each week, but the demand f o r i t s s e r v i c e s was so great that before the end of the year appointments were being made two months ahead. The opening of the c l i n i c marked the f i r s t p o s i -t i v e step i n acknowledging the p o s s i b i l i t y and d e s i r a b i l -i t y of prevention of mental d i s o r d e r s . The c l i n i c was diag-n o s t i c of f u n c t i o n , and attempted to keep c h i l d r e n from - 88 -becoming p s y c h o t i c , that i s , developing a s e r i o u s mental i l l n e s s . The s t a f f s t u d i e d the p e r s o n a l i t y of the c h i l d and o f f e r e d v o c a t i o n a l c o r r e c t i o n or change i n the en-vironment, i n order to r e d i r e c t the already e x i s t i n g f o r -mation of poor and unde s i r a b l e h a b i t s . In 1934 an e x t r a s o c i a l worker was added to the s t a f f and the f i r s t t r a v e l l i n g c l i n i c made a t r i p to V i c t o r i a , By t h i s time the c l i n i c was examining boys and g i r l s from the I n d u s t r i a l Schools. In the next year c l i n -i c s were h e l d i n Hanaimo, Courtenay, and C h i l l i w a c k . In 1937 a p s y c h o l o g i s t was added to the s t a f f and by the next year the c l i n i c i n Vancouver was open f i v e days a week. During the war, a large, p r i v a t e home near the C i t y H a l l was, acquired and remodelled to serve as the new c l i n i c , but the work i t s e l f was very much c u r t a i l e d because o f sh o r t -age of s t a f f . Since the end o f h i s t i l i t i e s the c l i n i c has expanded i t s program and t r a v e l l i n g c l i n i c s have v i s i t e d P e n t i c t o n , Vernon, l e l s o n , Prince Rupert, P r i n c e George, Cranbrook, and Kamloops. I t accepts welfare r e f e r r a l s , gives c o n s u l t a t i v e s e r v i c e and v o c a t i o n a l c o u n s e l l i n g , as w e l l as attempting to educate the p u b l i c about mental i l l -ness. A c t u a l l y the c l i n i c has been able to take acute cases only, to give adequate s e r v i c e would r e q u i r e a much l a r g e r s t a f f . P r o v i g i o n _ f o r _ S o c i a l Workers A f t e r Miss K i l b u r n had been on the s t a f f o f - 89 Essondale f o r one year, the government was convinced of the value of her s e r v i c e s and put her on t h e i r own pay-r o l l . With the i n t r o d u c t i o n of s o c i a l s e r v i c e a new as-pect of treatment was opened up, not only to the p a t i e n t s themselves, hut al s o to t h e i r f a m i l i e s . This new s e r v i c e was used i n two ways. By means of close contact w i t h the fa m i l y , the s o c i a l worker was able to o b t a i n p e r t i n e n t i n f o r m a t i o n i n regard to the p a t i e n t ' s background; t h i s h i s t o r y enabled the p s y c h i a t r i s t i n charge to make a more accurate d i a g n o s i s of the p a t i e n t ' s i l l n e s s and to pre-s c r i b e s u i t a b l e treatment. I t was a l s o the job of the s o c i a l worker to i n t e r p r e t the h o s p i t a l to the f a m i l y , i n order to prepare them f o r the p a t i e n t ' s r e t u r n . The worker acted as a l i n k between the p a t i e n t and h i s f a m i l y and by h e l p i n g to s t r a i g h t e n out.various problems, eased the p a t i e n t ' s w o r r i e s so that the medical treatment was more b e n e f i c i a l . Further Developments In June o.f 1932 the f i r s t graduation of the three year t r a i n i n g course f o r nurses was held. Since that time many nurses have t r a i n e d at the h o s p i t a l , and have o f f e r e d t h e i r much needed s e r v i c e s i n c a r i n g f o r an i n -c r e a s i n g number of p a t i e n t s . Several years l a t e r a system of a f f i l i a t i o n w i t h the Vancouver General H o s p i t a l was be-gun by which i t s n u r s e s - i n - t r a i n i n g r e c e i v e d a three - 90 -months course i n p s y c h i a t r i c n u r s i n g at Essondale. Sexual S t e r i l i z a t i o n Act As a r e s u l t of the recommendation made by the Royal Commission i n 1927, the p r o v i n c i a l l e g i s l a t u r e passed The Sexual S t e r i l i z a t i o n Act i n 1933. This Act provided that the Lieutenant-Governor i n C o u n c i l might from time to time appoint three persons; a Judge of a Court of Record i n the -Province, a p s y c h i a t r i s t , and a person experienced i n s o c i a l welfare work who should con-s t i t u t e a board to be known as the Board of Eugenics. S e c t i o n 4 s t a t e s : Where i t appears to the Superintendent of any i n s t i t u t i o n w i t h i n the scope of t h i s Act (any p u b l i c h o s p i t a l f o r the insane, I n d u s t r i a l School f o r G i r l s , I n d u s t r i a l School) that any inmate of that i n s t i t u t i o n i f discharged there-from without being subjected to any operation f o r sexual s t e r i l i z a t i o n , would be l i k e l y to beget or bear c h i l d r e n who by reason of inher-i t a n c e would have a tendency to s e r i o u s mental disease or mental d e f i c i e n c y , the Superintend-ent may submit to the Board of Eugenics a r e c -ommendation that a s u r g i c a l operation be per-formed upon that inmate f o r sexual s t e r i l i z a ^ t i o n . l I f the.Board unanimously agreed they were em-powered to appoint some l e g a l l y q u a l i f i e d medical p r a c t i -t i o n e r to perform the operation. Such operation could not be c a r r i e d out, however, unless the inmate consented i n w r i t i n g or i f incapable of such an a c t , the husband or w i f e , ,J3£iliS^ Columbia S t a t u t e s , 1953. King's P r i n t e r , Victoria"!" Chapter~5*97 P« 199 - 91 -parent or guardian, or the p r o v i n c i a l s e c r e t a r y when the above p a r t i e s d i d not e x i s t . Veterans' Building-In 1935 a new b u i l d i n g was opened at Essondale f o r veterans. A c t u a l segregation of t h i s group had been a moot p o i n t , but i t was f i n a l l y decided that they should have a u n i t to themselves. The s t r u c t u r e c o n s i s t e d of -three s t o r i e s f o r l i v i n g q u a r t e r s ; the bottom f l o o r was set aside f o r amusement and occupation. A separate d i n i n g room i n c a f e t e r i a s t y l e .was b u i l t , and f u l l k i t c h e n s were connected to the main b u i l d i n g by an underground passage. The modern accommodation provided f o r the veterans was e n t h u s i a s t i c a l l y endorsed by returned s o l d i e r s ' organiza-t i o n s . Problems Created By Overcrowding a By t h i s time the number of p a t i e n t s amounted to about 3500 and there was more than f i f t y per cent over-crowding. The h o s p i t a l budget had been sev e r e l y c u r t a i l e d d uring the great depression and an ever i n c r e a s i n g l o a d was put on the shoulders of too few t r a i n e d personnel. Because of the overcrowding i t wag.almost impossible to separate the acute or newly admitted cases from the chronic or l o n g term cases. Dr. Crease advocated the establishment of an i n s t i -t u t i o n a l school f o r mental d e f e c t i v e s which would f r e e the u n i t at lew Westminster f o r i n t e n s i v e treatment, and would - 92 -a l s o serve as an edu c a t i o n a l centre f o r the treatment and preventive program f o r the whole province. In h i s annual report f o r 1937 the superintendent noted that the population of the h o s p i t a l was d e f i n i t e l y on an upward trend; i t had r i s e n from approximately 250 at the beginning of the century to more than 3500. He a t t r i b u t e d t h i s l a r g e l y to the f a c t that people g e n e r a l l y were begin-ning to know that mental i l l n e s s could be t r e a t e d , and were t a k i n g advantage of the treatment f a c i l i t i e s provided by the mental h o s p i t a l s . Hot making p r o v i s i o n f o r an average y e a r l y increase of 117 had been the cause of the overcrowd-i n g . He suggested the e r e o t i o n of a new mental i n s t i t u t i o n i n the next l a r g e s t centre of po p u l a t i o n , and r e i t e r a t e d the d e s i r a b i l i t y of a new s i t e f o r a school f o r mental def-e c t i v e s . Again he s t r e s s e d that "the I n s t i t u t i o n at New Westminster can be f u r t h e r remodelled to form an a c t i v e -treatment centre, where not only treatment can be c a r r i e d out, but i t should be a centre f o r teaching the s t a f f o f a l l our h o s p i t a l b r a n c h e s . w l Home f o r the Aged • In 1936 the former Boys' I n d u s t r i a l School a d j a -cent to Essondale was handed over to them to be used as a home f o r the aged. Dr. Crease wrote: " I t i s a very s a t i s - <> f a c t o r y u n i t , both from p o i n t of view of the p a t i e n t s as B r i t i s h Columbian s e s s i o n a l Papers, Annual Report of the P r o v i n c i a l Mental H o s p i t a l s , 1937, p. V l l - 93 -w e l l as t h e i r r e l a t i v e s . " 1 A number of s e n i l e p a t i e n t s from various b u i l d i n g s were t r a n s f e r r e d to the new i n s t i t u -t i o n . An important and much needed ordnance was made i n 1939 when two wards were remodelled and used f o r men and women p a t i e n t s s u f f e r i n g from t u b e r c u l o s i s , Treatment „By the end of the 1920's m a l a r i a , tryparsamide, and bismuth treatments were being given to s y p h l i t i c p a t i e n t s s u f f e r i n g from general p a r e s i s . The r e s u l t s were s a t i s f a c t o r y : one t h i r d apparent cures, one t h i r d improved, one t h i r d unimproved. I n s u l i n Shook The year 1937 saw the i n t r o d u c t i o n of the specta-c u l a r new treatment discovered by a Viennese doctor named Sakel some years e a r l i e r . Dr. Sakel had found that by a d m i n i s t e r i n g l a r g e doses of i n s u l i n to s c h i z o p h r e n i c s , the p a t i e n t s went into, a coma and afterwards many of t h e i r symptoms disappeared. P s y c h i a t r i s t s do not know to t h i s day why the treatment i s e f f e c t i v e , but that i t i s has been proved beyond question. Eighty-nine schizophrenic pa-t i e n t s were given i n s u l i n shock therapy at Es-sondale i n 1937 and good remissions (temporary abatement of symptoms) were obtained i n almost h a l f of these cases. -Metrazol 1 l o o . c i t . - 94 -shock therapy was a l s o s t a r t e d i n that year and 212 schizophrenic p a t i e n t s r e c e i v e d the treatment. Of these, 12 per cent showed marked improvement, and 28 per cent were improved. These r e s u l t s were considered to be encour-aging when i t was considered that the average l e n g t h of i l l n e s s was 4.3 years. E l e c t r i c Shock In 1942 e l e c t r i c shock .therapy was f i r s t used at Essondale f o r manic-depressive p a t i e n t s . This treatment put the p a t i e n t i n t o a b r i e f coma, but u s u a l l y w i t h i n an hour he was wa l k i n g about the ward. I t was easy to ad-m i n i s t e r , and by 1944 when t h i s method was used i n f u l l on one-hundred and twenty p a t i e n t s , the r e s u l t s were very g r a t i f y i n g . Twenty-four p a t i e n t s recovered, and f i f t y -f o u r were improved. P a r a l l e l i n g the developments i n the s t a t e care of the mentally i l l were two experiments under p r i v a t e a u s p i -ces. One of these was the Alexandra Cottage f o r c h i l d r e n and the other was the New V i s t a Home f o r convalescent women p a t i e n t s from Essondale. Alexandra Cottage f o r C h i l d r e n In 1937, owing, to the decreased demand f o r i n -s t i t u t i o n a l care f o r c h i l d r e n , the Board o f the Alexandra C h i l d r e n ' s Home decided to use t h e i r b u i l d i n g as a - 95 neighborhood centre, and to transfer the ten remain-• ing children to a smaller building to be known as the Alexandra Children's Cottage, where the best type of in-stitutional care could be given to a small number of children. After several conferences with the Provincial ' Child Guidance Clinic i t was suggested that a small unit of this type might be used as a treatment centre for children with behavior problems that required adjustment, and that such a program would require the services of a psychiatric social worker. In the course of the year this proposal received careful consideration, and i t was f i n -a l l y decided that the home would accept as part of i t s work, responsibility for the provision of one or more cottage homes, to be used for children requiring simple shelter care or those requiring treatment for special behavior problems. Where possible and on the advice of the Child Guidance Clinic, children in the second group were to be cared for i n the same institution as those in the f i r s t group. "The Board of the Alexandra Children's Home considered that the primary purpose of the Cottage was to provide simple shelter care of a high standard, for a limited number of children, and at the same time to offer specialized treatment under a trained psych-i a t r i c social worker, for normally developed children exhibiting behavior problems re-sulting from deep seated causes. These - 96 -problems included: p e t t y s t e a l i n g , e n u r e s i s , temper tantrums, b u l l y i n g , and va r i o u s forms of a n t i s o c i a l behavior, such as might r e s u l t i n the development of a d i f f i c u l t p e r s o n a l i t y , or d e f i n i t e mental i l l n e s s , i f not checked wh i l e the c h i l d i s s t i l l young. Such problems may not be of se r i o u s o r i g i n , and only s k i l l e d d i agnosis can d i s t i n g u i s h normal v a r i a t i o n s , and those v a r i a t i o n s which are due to some deep-seated cause." 1 A p r i v a t e home i n Marpole was purchased and i n the summer of 1938 the Cottage Home opened. In October, the se r v i c e s of Miss E l i z a b e t h Grubb, s o c i a l worker, were se-cured, w i t h the understanding that she would spend part of her time at the C h i l d Guidance C l i n i c which was to pay part of her s a l a r y . The re s i d e n t s t a f f c o n s i s t e d of a house mother and one j u n i o r s t a f f member. The p o l i c y of the Cottage was purposely l e f t . e l a s t i c to al l o w f o r such adjustment as experience might i n d i c a t e . During 1939 the monthly average population rose from 5 .2 to 9.6. Of the twenty-one c h i l d r e n r e s i d e n t during 1939, f i v e were l e f t over from the o l d C h i l d r e n ' s Home, s i x were r e f e r r e d by the C h i l d Guidance C l i n i c be-cause o f behavior problems, and ten were admitted f o r temporary care. Although the C h i l d Guidance C l i n i c r e -f e r r e d only s i x c h i l d r e n , a c t u a l l y 15 (or 71 per cent) attended or were preparing to attend the C l i n i c on account of t h e i r behavior. U n f o r t u n a t e l y f o r the future of the Cottage Home ^Vancouver C o u n c i l o f S o c i a l Agencies, Report o f the Work and Function of the Alexandra C h i l d r e n ' s Cottage, S a r c h T 19*40, p7~27 there was confusion among an o v e r l y l a r g e Board as to j u s t what the home was t r y i n g to accomplish. There was no c l e a r - c u t o b j e c t i v e from the beginning, and haying three d i f f e r e n t groups o f c h i l d r e n was unwise. Those with behavior problems f e l t i n f e r i o r to the others, and the f e e l i n g among the groups was always somewhat s t r a i n e d . The p s y c h i a t r i c s o c i a l worker had no d i r e c t access to the Board, finances were inadequte, and the s e r v i c e s of a v i s i t i n g p s y c h i a t r i s t were needed. Two p s y c h i a t r i s t s were i n t e r e s t e d i n an observation home f o r c h i l d r e n . Dr. Gee, of the P r o v i n c i a l Mental H o s p i t a l s s t a f f , was i n favor of. some k i n d of a day home f o r younger c h i l d r e n which would be a treatment centre, but the c h i l d would not stay overnight. Dr. Sundry of the Vancouver Metro-p o l i t a n Health Committee, who worked l a r g e l y w i t h c h i l d r e n i n the schools, favored a home which would-t r e a t adolescents. Alexandra Cottage d e a l t c h i e f l y w i t h young c h i l d r e n who stayed there f o r v a r y i n g periods o f time. Miss Grubb resigned a f t e r s i x t e e n months w i t h the home and a f t e r she had l e f t the so c a l l e d problem c h i l d r e n were removed. The home was used then f o r tem-porary placement of c h i l d r e n going to f o s t e r homes and f o r c h i l d r e n evacuated from Europe. I t was f i n a l l y c l o s e d in. 1942 because the Community Chest d i d not want to spend more money on i t , "but i s used to-day as a r e -c e i v i n g home f o r the Ch i l d r e n ' s A i d Society. The im-portance of the Alexandra Cottage l i e s i n the f a c t that i t was the f i r s t attempt i n B r i t i s h Columbia to provide f a c i l i t i e s f o r observation and treatment of c h i l d r e n w i t h behavior d i f f i c u l t i e s . In other words i t attempted to prevent mental i l l n e s s which might l e a d to''eventual commitment to the mental h o s p i t a l or to p r i s o n . Hew V i s t a S o c i e t y In d i r e c t c o n t r a s t to the f a i l u r e of the Ale x -andra Cottage, a s u c c e s s f u l experiment i n another sphere of mental i l l n e s s was begun i n 1943 under p r i v a t e a u s p i -ces. The establishment of the New V i s t a S o c i e t y was the f i r s t progressive step, on an organized b a s i s , made i n B r i t i s h Columbia toward the r e h a b i l i t a t i o n o f p a t i e n t s from the P r o v i n c i a l Mental H o s p i t a l s . Mr. E. E. Winch had f o r a number o f years taken a keen i n t e r e s t i n the care o f the mentally i l l i n B r i t -i s h Columbia. He b e l i e v e d that one of the greatest needs was the p r o v i s i o n of a home where convalescent p a t i e n t s could go f o r a time before being discharged from Esson-dale. He used h i s own home.--at f i r s t , f o r a l i m i t e d number of p a t i e n t s , but f i n a l l y w i t h the help o f Miss Lowdon who h e r s e l f had been i n the mental h o s p i t a l as a p a t i e n t , conceived the idea of forming a s o c i e t y which would concern - 99 -i t s e l f w i t h the r e h a b i l i t a t i o n of people who were ready-to leave the h o s p i t a l . The i n i t i a l campaign f o r funds i n the autumn o f 1943 r a i s e d more than fl l . O P O . from a wide c r o s s - s e c t i o n of I n d i v i d u a l s and business f i r m s . At f i r s t the s o c i e t y planned to purchase a l a r g e residence on the o u t s k i r t s of the c i t y , hut.on the advice of a p s y c h i a t r i s t , Dr. l i n d e n f e l d , who b e l i e v e d t h i s s i t e was too i s o l a t e d , a p r i v a t e home was bought i n the K i t s i l a n o d i s t r i c t i n Nov-ember 1943, and has been i n operation ever s i n c e . The home was not acquired without o p p o s i t i o n . One of the property owners near the proposed home c i r c u -l a t e d a p e t i t i o n i n the d i s t r i c t which sought to prevent i t s opening because i t might d e f l a t e property values and the p a t i e n t s would be a menace to the c h i l d r e n i n the d i s t r i c t . That the p u b l i c i s w o e f u l l y ignorant about mental i l l n e s s was evidenced by the f a c t that the p e t i -t i o n r e c e i v e d a l a r g e number o f sign a t u r e s . In the pamphlet issued by the New V i s t a S o c i e t y the a r t i c l e s o f i n c o r p o r a t i o n s t a t e that the purpose of the o r g a n i z a t i o n i s to "provide f a c i l i t i e s f o r the care and r e h a b i l i t a t i o n o f convalescent women from the B r i t i s h Columbia P r o v i n c i a l Mental H o s p i t a l s and al s o to provide f a c i l i t i e s f o r the care and treatment of any person and upon such terms and c o n d i t i o n s as the D i r e c t o r s deem the - 100 -circumstances warrant."1 The organizers of the s o c i e t y f e l t that c o n d i t i o n s were desperate because of the over-crowding i n the mental h o s p i t a l s and a l s o because of the negative a t t i t u d e of the p u b l i c and i n t h e i r o pinion: More encouraging c o n d i t i o n s w i l l not be evidenced u n t i l the nature and i m p l i c a t i o n s of mental i l l n e s s are more g e n e r a l l y un-derstood and d e f i n i t e a g i t a t i o n organized f o r the p r o v i s i o n o f psychopathic u n i t s ; a more comprehensive program of f a m i l y care; and more adequate p r o v i s i o n f o r o l d e r people who are now being forced i n t o our mental h o s p i t a l s as an only r e c o u r s e . 2 The Society'to-day has a membership of about 200 people. The home i t s e l f has looked a f t e r some s i x t y -f i v e women p a t i e n t s , f i f t y of whom have taken t h e i r p l a c e s again i n the community. Psychopathic Wards i n General H o s p i t a l s - Vancouver General""Hqspi t a l ~~ Records of the h i s t o r y of a ward f o r p s y c h i a t r i c cases at Vancouver General H o s p i t a l are very incomplete. In 1906 a h o s p i t a l committee s a i d there was a need f o r segregation of. p a t i e n t s s u f f e r i n g from delerium tremens, and two years l a t e r i t was recommended that the h o s p i t a l should add two padded c e l l s . About 1915, the carpenter's shop i n the basement was remodelled f o r a l a r g e open ward which was known as Ward "X" and housed p a t i e n t s w i t h l o n g -term i l l n e s s . In 1918 the ward was c u b i c l e d and ^"pltmphlet7"The"~New~Visia~SooietyT"^roadway P r i n t e r l t d . 2 I h i d , p. 4-5." ~™ ~ P* 1 ; - 101 -i n f e c t i o u s persons were sent there and l a t e r removed to separate cottages. Ahout t h i s time, a l c o h o l i c cases and so c a l l e d "tough guys" were sent to Ward "2". Many of them were h e a v i l y drugged and sent to Essondale. Two years e a r l i e r , i n h i s annual r e p o r t , the superintendent i n p o i n t i n g out the needs of the h o s p i t a l wrote that "many mental cases have to he brought to the h o s p i t a l f o r a few days, or f o r observation, or with a s s o c i a t e d condi-t i o n s needing h o s p i t a l treatment, and f o r these i t i s necessary to have s p e c i a l l y l o c a t e d rooms." 1 In 1918 a committee o f three doctors i n c l u d i n g the superintendent, pointed out the need of a s p e c i a l b u i l d i n g f o r p s y c h i a t r i c cases. In 1933 the superintendent of the school o f nurs-i n g s a i d that much thought had been given to the l a c k of mental hygiene t r a i n i n g i n the course. She continued: "...the experience gained on Ward "X" i s not only l i m i t e d and i s given under most undesirable c o n d i t i o n s (owing to l o c a t i o n and environment) to p a t i e n t s who because o f t h e i r malady should be r e c e i v i n g treatment i n the b r i g h t e s t and' most a t t r a c t i v e ward a h o s p i t a l has to o f f e r . " L i t t l e was done to improve c o n d i t i o n s i n the ensuing years, but i n the report f o r 1944, the superintendent of nurses ex-pressed her approval of the proposed removal of p a t i e n t s •'•Vancouver General H o s p i t a l , Annual Report, 1916, p.29 2Vancouver General H o s p i t a l , Annual Report. 1944, p.21 e - 102 -from Ward W Z W to Ward "R". Although to have i d e a l con-d i t i o n s , medical and n u r s i n g treatment of mentally i l l p a t i e n t s should he given i n a separate b u i l d i n g designed f o r the purpose, she s t a t e d that the contemplated change was a step i n the r i g h t d i r e c t i o n , and concluded her r e -marks about Ward "Z": "The e f f e c t of the present surround-in g s , however, on the care and treatment of the p a t i e n t s and on the morale and p h y s i c a l w e l l - b e i n g of the nurses can only be d e t r i m e n t a l , and a l s o , such c o n d i t i o n s can only lower the standards of s e r v i c e of the h o s p i t a l . " 1 Ward "R" which was formerly the gynaecological department, was reconstructed, and i n 1945 became the p s y c h i a t r i c ward of the h o s p i t a l . Ward "X" i s no longer used f o r housing p a t i e n t s . The present ward contains twenty-eight beds and i s d i v i d e d i n t o two s e c t i o n s , one part c o n t a i n i n g l o c k e d s i n g l e rooms and the other, two bed wards f o r convalescing p a t i e n t s . There i s a sun porch at the end of the ward. A l c o h o l i c and drug cases are not acoepted unless t h e i r c o n d i t i o n i s acute, and no p a t i e n t s over seventy are allowed. Medical treatment i n c l u d e s e l e c t r i c shock and i n s u l i n i n sub-coma doses. One very good feature of the present set-up i s p r o v i s i o n f o r persons to come to the h o s p i t a l , r e c e i v e e l e c t r i c shook therapy i n the morning, and leave l a t e r i n the day. •'•Vancouver General H o s p i t a l , Annual Report. 1944, p,21 - 103 -There i s l i t t l e physiotherapy or occupational therapy given because of shortage of s t a f f . Two beds on the ward are reserved f o r r e f e r r a l s by Dr. Papton, p o l i c e surgeon. At the present time there i s a lo n g w a i t i n g l i s t of those who need treatment on Ward "R1*. Royal J u b i l e e H o s p i t a l . V i c t o r i a . B.C. P s y c h i a t r i c rooms have been a v a i l a b l e i n t h i s h o s p i t a l since i t s i n c e p t i o n i n 1858. A p s y c h i a t r i c ward was e s t a b l i s h e d i n 1937 which was l a t e r converted i n t o an i s o l a t i o n ward ( u s u a l l y t h i s sequence has been r e -versed i n p r o v i d i n g care f o r the mentally i l l . j The present b u i l d i n g known as the Observation Ward was b u i l t i n 1936 and was opened i n the summer of that year. I t was not p o s s i b l e to s t a f f the b u i l d i n g at once, however, so that i t has been f u l l y s t a f f e d only since February, 1947. The Observation ward i s a separate b u i l d i n g on one f l o o r which contains e i g h t p r i v a t e rooms. The s t a f f normally i n c l u d e s four graduate nurses, f o u r o r d e r l i e s , a ward maid, a s o c i a l worker, an occupational t h e r a p i s t , and a p s y c h i a t r i s t - the l a s t f o u r being on a part time b a s i s . With the establishment of f a c i l i t i e s the ward has been f i l l e d to c a p a c i t y at a l l times. Treatment i n c l u d e s psychotherapy, group therapy, occupational therapy, e l e c t r i c shock, subshoek i n s u l i n , - 104 -and n a r c o a n a l y s i s (the g i v i n g of a b a r b i t u r a t e drug, sodium pentothai or sodium amytal i n t r a v e n o u s l y at a slow rate u n t i l a seminarcosed s t a t e i s induced, d u r i n g which many p a t i e n t s are able to r e l i v e a traumatic ex-perience w i t h r e l e a s e of powerful and intense emotions). Cases are a l s o admitted f o r observation pending t r a n s f e r to the p r o v i n c i a l mental h o s p i t a l ; a l s o f o r purposes o f the Courts and f o r s o c i a l agencies. Both sexes are ad-mitted. By arrangement, a bed i s a v a i l a b l e at a l l times f o r member of A l c o h o l i c s Anonymous - a bed- being kept empty i n another part of the h o s p i t a l so that a p a t i e n t may be t r a n s f e r r e d to t h i s bed i n the event of a member of A l c o h o l i c s Anonymous r e q u i r i n g admission to h o s p i t a l . As a matter of p o l i c y no p a t i e n t over the age of s i x t y -f i v e w i l l be admitted. Mental H o s p i t a l s Act Rev i s i o n s • In 1940, the word " l u n a t i c 9 8 was completely r e -moved from the Mental H o s p i t a l s Act. P s y c h i a t r i s t s had f o r years discarded the use of the term and the l e g i s -l a t i v e a c t i o n r e f l e c t e d the progress which had been made i n the a t t i t u d e of the w e l l informed towards those who were mentally i l l . A new feature o f the Act was a s e c t i o n a l l o w i n g a p a t i e n t to ask f o r re-examination by two q u a l i -f i e d p h y s i c i a n s a f t e r he had been i n h o s p i t a l f o r at l e a s t three months. Bo person, however, accused of a crime who, - 105 -at the time of h i s t r i a l , was adjudged to he insane and committed to a mental h o s p i t a l , was permitted to make an appeal. The Act a l s o provided f o r payments to other provinces when a- p a t i e n t having Residence i n B r i t i s h Columbia was t r e a t e d i n a public-mental h o s p i t a l i n an-other province. An amendment to the Act i n 1942 s t a t e d that the committal form signed by the judge was v a l i d f o r t h i r t y days a f t e r 'the order. In 1945, an amendment was made p l a c -i n g the business management and f i n a n c i a l a f f a i r s of the p r o v i n c i a l mental h o s p i t a l s under a business manager. In regard to the maintenance of p a t i e n t s , the amount charged i s accord i n g to. a b i l i t y to pay. Many, how-ever, are unable to pay anything, yet they get the same treatment and care as the others. This system i s evidence of an enlightened a t t i t u d e i n regard to the mentally i l l and i s a r e c o g n i t i o n that help must be given to those i n need re g a r d l e s s of t h e i r economic s t a t u s . CHAPTER VI THE SITUATION TODAY Ad m i n i s t r a t i o n of the h o s p i t a l treatment of the mentally i l l and mentally d e f e c t i v e , and preventive c l i n -i c a l treatment i s under the d i r e c t i o n of the P r o v i n c i a l P s y c h i a t r i s t (Dr. Crease, who i s a l s o General Superintendent of Mental H o s p i t a l s ) , and comes under the Department of tbs P r o v i n c i a l Secretary.* 1" P r o v i n c i a l mental h o s p i t a l s are l o c a t e d at Esson-dale, Hew Westminster, and at C o l q u i t z , Vancouver I s l a n d . The Essondale u n i t i s comprised of u n i t s f o r the treatment and care of men and women p a t i e n t s , war veterans, and s e n i l e persons. Over 4000 beds are occupied. The New Westminster i n s t i t u t i o n i s known as the "Home f o r the Feeble Minded" and houses mentally d e f e c t i v e p a t i e n t s who are unable to be cared f o r p r i v a t e l y , The b u i l d i n g at C o l q u i t z gives c u s t o d i a l care to those diagnosed as c r i m i n a l l y mentally i l l . C h i l d guidance and p s y c h i a t r i c c l i n i c s are e s t a b l i s h e d i n Vancouver and V i c t o r i a , and t r a v e l l i n g c l i n i c s serve other p a r t s of the province. The object of t h i s s e r v i c e i s the prevention of mental i l l n e s s through diagnosis of e a r l y symptoms and pre-s c r i b e d s o c i a l treatment. P r o v i n c i a l s o c i a l workers a s s i s t 1 Resources Manual, S e c t i o n I I , prepared by the S o c i a l Assistance"Branch"7""5epartment of the P r o v i n c i a l Secretary, King's P r i n t e r , V i c t o r i a , 1945, p.76-77. - 106--107-i n t h i s p s y c h i a t r i c s e r v i c e by o b t a i n i n g s o c i a l h i s t o r i e s from the f a m i l i e s of p a t i e n t s admitted to h o s p i t a l and ' s u p e r v i s i n g the p a t i e n t s during t h e i r probation p e r i o d . The c l i n i c s are a l s o used i n a c o n s u l t a t i v e c a p a c i t y i n the course of work w i t h i n d i v i d u a l s and f a m i l i e s known to the s o c i a l workers. The P a t i e n t i n the H o s p i t a l S e t t i n g A l l p a t i e n t s are admitted through Essondale. From there the so c a l l e d c r i m i n a l l y insane.are sent to C o l q u i t z , the mentals d e f e c t i v e s to New Westminster and the s e n i l e s to the Home f o r the Aged. On admission, the p a t i e n t i s seen by the a d m i t t i n g s t a f f p s y c h i a t r i s t and rece i v e s a complete p h y s i c a l examination. He a l s o r e c e i v e s a p s y c h i a t r i c examination when a h i s t o r y i s taken by the p s y c h i a t r i s t from the p a t i e n t ' s p o i n t of view. The p h y s i c a l examination e n t a i l s a l l the l a b o r a t o r y examinations i n -oludingthe d i f f e r e n t types of blood t e s t , u r i n a l y s i s , com-p l e t e dental checkup, and treatment i f necessary. O p t i c a l examinations are given i f needed, and treatment provided. There are two a d m i t t i n g wards, one f o r men and the other f o r women. A c t i v e treatment i s s t a r t e d as soon as p o s s i b l e a f t e r admission and includes, e l e c t r i c shock therapy, and lobotomy. The l a t t e r i s performed i n the Vancouver General H o s p i t a l on c e r t a i n longterm cases and -108-the technique c o n s i s t s of making i n c i s i o n s through the white matter of the f r o n t a l lobes. The superintendent r e -ported that nine cases who were most d i f f i c u l t to t r e a t and - d i d not respond to any other known methods had been operated upon "with much b e n e f i t tq the p a t i e n t s and the h o s p i t a l " . ^ Hydrotherapy and physiotherapy, i n c l u d i n g sedative baths, foam baths and needle spray, c o l d wet pack, massage, and u l t r a - v i o l e t ray are an important p a r t of the treatment. N e i t h e r psychoanalysis nor group psychotherapy are used as treatment procedures. A beauty p a r l o r serves the h o s p i t a l p o p u l a t i o n , but l a c k s enough personnel to give a r e a l l y adequate s e r v i c e . A f t e r observation i n the a d m i t t i n g ward, the p a t i e n t i s t r a n s f e r r e d at the medical superintendent's d i s c r e t i o n to the ward best s u i t e d f o r the continuance o f h i s treatment. About 400 p a t i e n t s have ground p a t r o l . Women p a t i e n t s are allowed out i n p a i r s from 9 A.M. to 4 P.M. and men from 9 A.M. to 9 P.M. B r i t i s h Columbia, S e s s i o n a l Papers, Annual Beport of the P r o v i n c i a l Mental H o s p i t a l s , 1945, p. HH~TST -109-R e o r e a t i o n a l Therapy In 1945 a r e c r e a t i o n a l d i r e c t o r was appointed "to r e l i e v e the monotony of i n s t i t u t i o n a l l i f e and enhance the treatment of p a t i e n t s " . 1 The p a t i e n t s are encouraged as part o f t h e i r treatment to p a r t i c i p a t e i n a l l forms of r e c r e a t i o n as p r e s c r i b e d by the p s y c h i a t r i s t s . This t r e a t -ment may be indoor or outdoor, a c t i v e or passive. Indoor a c t i v i t i e s include bingo games w i t h e x c e l l e n t p r i z e s , c r i b and checker tornaments, r i n g t o s s , a modified form of bad-minton played r i g h t on the wards, r e g u l a r concerts f e a t u r i n g the p a t i e n t s themselves. On Wednesday afternoons a dance i s h e l d on the i n s u l i n ward f o r the p a t i e n t s that have r e c e i v e d i n s u l i n shock therapy the-same morning, and on F r i d a y s there i s a dance i n the l a r g e s t ward f o r other p a t i e n t s . Some of the outdoor sports are t e n n i s , g o l f , horseshoes, archery, and swimming. Those who p a r t i c i p a t e i n the l a t t e r a c t i v i t y are allowed to choose t h e i r own bathing s u i t s which are new and i n the l a t e s t s t y l e . I t has been found that cata-t o n i c , h o m i c i d a l , and s u i c i d a l p a t i e n t s respond w e l l to swimming and diving.. The d i r e c t o r , Mr. Brown, b e l i e v e s that organized recreation, b r i n g s forward the p l a y impulses of childhood which many persons have completely l o s t . He i s most e n t h u s i a t i o about h i s work and says that never i n h i s B r i t i s h Columbia, S e s s i o n a l Papers, Annual Report of the P r o v i n c i a l Mental H o s p i t a l s . 1945, p. HH TT. - 1 1 0 -t h i r t y years o f r e c r e a t i o n a l work has he worked w i t h a more cooperative or a p p r e c i a t i v e group of people. Because at present there i s no r e c r e a t i o n h a l l , he i s handicapped i n h i s e f f o r t s to help the inmates and has to do a great d e a l of i m p r o v i s i n g to keep the program going forward. Occupational Therapy A part of the womenns b u i l d i n g i s set aside f o r t h i s important therapy and a number of women are a c t i v e i n such p u r s u i t s as sewing, k n i t t i n g , weaving, and p a i n t i n g . U n f o r t u n a t e l y , because of the overcrowding, space that should be used f o r t h i s v i t a l s e r v i c e i s taken up wit h beds. Occupational therapy f o r the men i s housed i n a l a r g e b u i l d i n g by i t s e l f to which an a d d i t i o n has r e c e n t l y been made. In operation at present i s a cabinet and woodworking shop, a mattress and u p h o l s t e r i n g shop, and a s e c t i o n where rugs are made from o l d socks (the most d e t e r i o r a t e d p a t i e n t s unwind the wool). To be opened'shortly i s a t a y l o r shop, and when equipment becomes a v a i l a b l e a metal shop and a modern shoe shop. According to Mr. H a l l who i s i n charge, the i d e a of occupational therapy i s to r e h a b i l i t a t e the p a t i e n t s and teach them a trade at the same time. He has waited f i f t e e n years f o r the present f a c i l i t i e s . At present there are eigh t teachers on s t a f f besides Mr. H a l l , but more are re q u i r e d . . ' Records "~ Records' of the p a t i e n t s are kept i n a u n i t f i l e o -111-system. A l l inform a t i o n i s kept i n one f i l e and inc l u d e s l a b o r a t o r y reports^. medical c h a r t s , i n s u l i n or e l e c t r i c shock c h a r t s , c l i n i c a l r e c o r d , ward notes, s o c i a l s e r v i c e h i s t o r y , p r o b a t i o n reeords, and correspondence. G o l q u i t z Mental Home To t h i s branch at Saanich a hydrotherapy u n i t was added i n 1940. About the same time a s u i t a b l e b u i l d i n g was erected to be used f o r occupational therapy. W r i t i n g of the l a t t e r , Dr. Grease noted " t h i s enables s t i l l more p a t i e n t s to be occupied, and i s not only b e n e f i c i a l to the p a t i e n t s * p h y s i c a l h e a l t h but a l s o helps to occupy the mind at a higher stat e of e f f i c i e n c y . In a d d i t i o n , i t o f f e r s encouragement and serves to give them a b e t t e r out-look, and a l t o g e t h e r makes f o r more contentment", 1 This i n s t i t u t i o n has no r e s i d e n t medical s t a f f . Although i t was founded p r i m a r i l y to house c r i m i n a l types, about two t h i r d s of the inmates are harmless cases r e c e i v i n g c u s t o d i a l care. I t was formerly a gaol and i s an anachronism i n an age that s t r e s s e s h o s p i t a l treatment f o r the mentally i l l . Home f o r the Feeble Minded This u n i t at present has about 650 cases and i s 65 percent overcrowded. Another 200 mental d e f e c t i v e s are mixed w i t h mentally i l l p a t i e n t s at Essondale because there B r i t i s h Columbia, S e s s i o n a l Papers, Annual Report of the P r o v i n c i a l Mental H o s p i t a l s , 1940, p. K 11, -112-i s no room f o r them at Hew Westminster* T r a i n i n g c l a s s e s under competent teachers are provided, hut there are not enough of these. A c t u a l l y the i n s t i t u t i o n can accommodate only a small number of those who need a t t e n t i o n , which means that the mental h o s p i t a l i s hampered i n i t s work because complete segregation of the two groups i s impossible. Apparently the government plans to b u i l d a s p e c i a l i n s t i -t u t i o n f o r mentally d e f e c t i v e c h i l d r e n and expects to con-v e r t the present b u i l d i n g s i n t o a home f o r s e n i l e cases. Home f o r the Aged Cottages belonging to the Boys' I n d u s t r i a l School have been used to house s e n i l e p a t i e n t s . Two new cottages have r e c e n t l y heen completed, one f o r women and the other f o r men. The b u i l d i n g s are w e l l planned, and although not n e a r l y as elaborate as the other b u i l d i n g s at Essondale, they are comfortable and w e l l equipped. The women's b u i l d i n g was i n operation i n March, 1947, and the w r i t e r was very impressed w i t h the p h y s i c a l care the o l d people were g e t t i n g . There are s i n g l e rooms provided and al s o l a r g e b r i g h t wards which are c u b i c l e d so that each p a t i e n t may have a sense of p r i v a c y . Adequate s i t t i n g rooms w i t h comfortable c h a i r s are i n evidence on both f l o o r s . A ramp on a very s l i g h t i n c l i n e l e a ds from one f l o o r to another. Throughout the b u i l d i n g there are many windows w i t h b r i g h t drapes hanging which r a d i a t e a pleasant aura -113-about the whole s e t t i n g . When the men's "building i s opened, i t w i l l help to r e l i e v e the over crowding to some extent. Colony Farm Over 200 p a t i e n t s are housed at Colony Farm, adjacent to Essondale. A s p e c t a c u l a r f i r e i n December of 1946 destroyed one o f the la r g e b u i l d i n g s on the property n e c e s s i t a t i n g the crowding of p a t i e n t s and s t a f f i n t o The Cottage and i t s Annex. Most of the work i s done by pa i d l a b o r , but about one f i f t h of the p a t i e n t s there help out with the more menial tasks. Plans f o r the Future The M i n i s t e r of P u b l i c Works hopes to s t a r t con-s t r u c t i o n t h i s year of a nurses' home, r e c r e a t i o n b u i l d i n g , and a new u n i t at Colony Farm a l l i n connection w i t h Essondale. At New Westminster, a nurses' home, a one hundred bed u n i t , a laundry, and a shops b u i l d i n g are planned f o r 1947. T o t a l cost w i l l be about a m i l l i o n and a h a l f d o l l a r s . 1 An a d d i t i o n to the Veteran's B u i l d i n g i s now under c o n s t r u c t i o n and when completed w i l l house the new psycho-pathic u n i t where a l l p a t i e n t s w i l l be admitted. I t i s hoped that The Mental H o s p i t a l s Act w i l l be r e v i s e d so that p a t i e n t s may come to t h i s u n i t f o r a p e r i o d of three months without being l e g a l l y committed. The X-ray department w i l l move to the new u n i t and a l l i n t e n s i v e medical treatment w i l l be administered there. The psychopathic u n i t i s l ^ ^ ~ ^ - c ^ - j - - j e - ^ g T r - - vaEcouver"" Hu^n^n^ou^erTlaroTiT 1947,p.l - 114 -TABLE 2 S t a f f , inmates, and "budget of the P r o v i n c i a l Mental H o s p i t a l s f o r the years 1932 & 1945. Dec. 31, 1932 Dec. 31, 1945 STAFF: Superintendents P h y s i c i a n s , F u l l n Part D e n t i s t s , f u l l - t i m e lf part-time Stewards Matrons Nurses, graduate w other Attendants Occupational Therapists Teachers & S o c i a l Workers T o t a l Personnel 3 10 2 1 0 4 3 25 113 186 0 1 526 4 11 3 1 2 1 3 25 277 320 7 7 956 INMATES.:. Male Female T o t a l 1,913 998 2,911 2,407 1,705 4,112 BUDGET: Sellarie s & Wages. Food F u e l , power, water Other # 452,808.08 f 1229,323.86 . 260,809.20 350,331.87 104,746.78 151,013.21 213,243.22 435,383.33 T o t a l #1,031,607.28 #2,166,052.27 -115-c o n f i d e n t l y expected to be a r e a l c l i n i c , w i t h adequate teaching f a c i l i t i e s f o r s t a f f . The management hopes to increase the r a t i o of doctors to p a t i e n t s so that a con-c e n t r a t e d e f f o r t may be made to t r e a t and discharge.the newly admitted p a t i e n t s w i t h i n the three months p e r i o d . I t i s f e l t that an o u t - p a t i e n t s department away from Essondale where p a t i e n t s may come i n , r e c e i v e shock therapy, and leave the same day i s needed. The management i s very much i n favor of a r e h a b i l i t a t i o n department which w i l l h e l p discharged p a t i e n t s to secure and h o l d v a r i o u s kinds of jobs. They are i n favor of p s y c h i a t r i c wards i n general h o s p i t a l s , but do not favor psychopathic h o s p i t a l s because supplying these "puts a fence around the mental h o s p i t a l " and i s o l a t e s i t more than ever. Such a c t i o n w i l l make i t an asylum again instead of a h o s p i t a l , and treatment w i l l degenerate once more i n t o c u s t o d i a l care. When one views i n r e t r o s p e c t the h i s t o r y of the care of the mentally i l l i n B r i t i s h Columbia, one cannot help but f e e l that we have moved forward at a great pace, p a r t i c u l a r l y since the beginning of t h i s century. This progress leads one to hope that the many d i f f i c u l t i e s that confront our mental h o s p i t a l s today may e v e n t u a l l y be surmounted. In flae realm of prevention, there are many c o n f l i c t s between the d i f f e r e n t schools of p s y c h i a t r i c -116-theory. As soon as these v a r i o u s groups can agree on some general p r i n c i p l e s of approach and p u b l i c education, the road ahead w i l l be c l e a r e d of obstacles that hamper progress. The f i r s t world war gave a tremendous impetus to p s y c h i a t r i c knowledge. World War I I has shown us the h i t h e r t o unrevealed prevalence of i n c i p i e n t mental i l l n e s s i n the form of psycho-ne u r o s i s among the young men of Canada. Let us hope that i n the care and prevention of a l l forms of mental i l l n e s s , great forward s t r i d e s may be made i n the f u t u r e . CHAPTER V I I CONCLUSIONS Mental i l l n e s s as a p u b l i c h e a l t h issue i s a d i f -f i c u l t idea f o r many people. Nearly everyone i s f a m i l i a r with the conquest of such diseases as smallpox and ye l l o w fever by the powerful combination of medical science and enlightened p u b l i c i n t e r e s t , yet few have as yet heard the b a t t l e c r y of these same f o r c e s d i r e c t e d against mental i l l n e s s . That the mental h e a l t h of a community i s of utmost importance should be obvious, f o r without i t , even the most vigorous person cannot maintain a s a t i s f a c t o r y s o c i a l or economic adjustment i n the competitive, s o c i e t y i n which we l i v e . In regard to mental i l l n e s s we have not progressed f a r from medieval ' s u p e r s t i t i o n , f o r there i s s t i l l a stigma attached to the mentally s i c k , and we are prone to d i s r e g a r d that which i s e i t h e r unpleasant or l i t t l e understood. Real progress has been made i n the province of B r i t i s h Columbia i n the care of the mentally i l l , yet there are s t i l l many inadequacies and shortcomings. In p o i n t i n g these out the w r i t e r r e a l i z e s there are many d i f f i c u l t i e s i n p r o v i d i n g t e t t e r f a c i l i t i e s f o r those i n need, but the problem w i l l never be solved, unless the government makes a courageous e f f o r t to do what i s necessary to provide the best treatment f o r the mare than 4,000 p a t i e n t s a l ready i n the mental h o s p i t a l s , and at the same time s u b s t a n t i a l l y - 117 -- 118 -increases the preventive f a c i l i t i e s already i n ex i s t e n c e . Overcrowding I t i s impossible to t r e a t adequately the p a t i e n t s i n the p r o v i n c i a l mental h o s p i t a l s as long as the present overcrowding e x i s t s . True, the government i s at present b u i l d i n g a lar g e a d d i t i o n at Essondale, but how lo n g w i l l i t be before the treatment f a c i l i t i e s provided t'here w i l l be handicapped by the gradual use of valuable space w i t h h o s p i t a l beds? Successive superintendents have s t r o n g l y urged a r e g u l a r b u i l d i n g program to take care of the average annual increase of p a t i e n t s . Instead, c o n s t r u c t i o n has been de s u l t o r y and haphazard. New accommodation f o r mental def-e c t i v e s i s u r g e n t l y needed today i n order to segregate them completely from the mentally i l l . Polony Farm Colony Farm was p r i m a r i l y s t a r t e d to provide mean-i n g f u l work i n the open a i r f o r the p a t i e n t s . Becaus e of the general overcrowding at the present time, many p a t i e n t s are sent there who aire not able to b e n e f i t from working i n the f i e l d s and i n s t e a d spend much of t h e i r time i n idleness.. Only inmates who are i n need of the b e n e f i c i a l treatment of outside occupation should be sent to the farm. I f the p a t i e n t s were c a r e f u l l y s e l e c t e d , some of the work nan done by paid labor might be taken over by them, not as a matter - 119 -of economy, t u t as a treatment procedure. Need f o r more t r a i n e d personnel There i s u n r e m i t t i n g need f o r more t r a i n e d personnel. Unfortunately, Canada has given l i t t l e weight to p s y c h i a t r i c t r a i n i n g i n her medical schools, and there i s a great short-age of p s y c h i a t r i s t s i n the dominion. Since the end of the war, B r i t i s h Columtia has teen a t l e to increase the numher of such men i n her mental h o s p i t a l s , hut there are s t i l l not n e a r l y enough to maintain the highest standard. The quota of s o c i a l workers f o r the h o s p i t a l s i s h i g h , t u t only h a l f the es t a t l i s h t a e n t i s f i l l e d . There are not enough graduate nurses and occupational t h e r a p i s t s . The adoption of a new s a l a r y schedule should help somewhat to a t t r a c t more p r o f e s s i o n a l personnel. Convalescent homes Convalescent homes f o r t o t h men and wo:nen should fee provided as soon as p o s s i b l e . There are many p a t i e n t s i n h o s p i t a l who are there f o r only one reason, that they have no other place to go. In a semi-sheltered environ-ment, where the s t a f f i s t r a i n e d i n the principles of mental hygiene, the recovery of these persons would t e hastened. The p r o v i s i o n of . moire i n d u s t r i a l workshops w i l l help p a t i e n t s on the way to mental h e a l t h . - 120 -Prevention There are many p r e s s i n g needs i n the preventive f i e l d . About h a l f of the cases going to the mental hos-p i t a l s are r e c e i v e d too l a t e f o r remedial treatnent. The need f o r e a r l i e r diagnosis i s , t h e r e f o r e , obvious. The * ft C h i l d Guidance C l i n i c and the t r a v e l l i n g c l i n i c s attempt to serve both c h i l d r e n and a d u l t s , but because of the great demand'for t h e i r s e r v i c e s they are able to take the meet urgent cases only. I f money is not a v a i l a b l e from the pro-v i n c i a l t r e a s u r y to g r e a t l y expand t h i s work, g r a n t s - i n - a i d from the f e d e r a l government should be provided. In order to supplement the d i a g n o s t i c f a c i l i t i e s of the C h i l d Guidance C l i n i c , an observation home should be acquired and s t a f f e d w i t h w e l l q u a l i f i e d personnel. The c l i n i c should a l s o operate as an educational centre where the general p u b l i c may be kept w e l l informed of the p r i n c i p l e s of mental hygiene. The s e r v i c e at present i s inadequate. The mental hygiene program should be i n t e g r a t e d with both the educat-i o n a l and welfare programs. To encompass such a goal would require s o c i a l workers, p u b l i c h e a l t h nurses, and other wel-fare personnel w e l l t r a i n e d i n c e n t a l hygiene p r i n c i p l e s and s p e c i a l i z e d techniques. R e v i s i o n of Committal Procedure Some changes are r e q u i r e d i n l e g i s l a t i o n r e g a r d i n g the mentally i l l and mentally d e f e c t i v e . The committal - 121 -prooedure f o r admission under the Mental H o s p i t a l s Act i s not i n l i n e with the t e s t modern thought on the suhj; c t . The present law does not d i f f e r e n t i a t e between psychosis, e p i l e p s y , and mental d e f i c i e n c y , and mentally d e f e c t i v e c h i l d r e n have to be c e r t i f i e d as mentally i l l . A s i m p l i f i e d admission would a l l o w a p a t i e n t to go to the mental h o s p i t a l i n e x a c t l y the same way as he goes to a general h o s p i t a l . Legal commitment, i n the m a j o r i t y of cases, i s an anachron-ism i n the middle of the twentieth century. Sexual S t e r i l i z a t i o n Act The Sexual S t e r i l i z a t i o n Act has been used very l i t t l e i n B r i t i s h Columbia because of the many r e s t r i c t i o n s surrounding i t . The whole sub js ct of s t e r i l i z a t i o n i s h i g h l y c o n t r o v e r s i a l , t u t since c e r t a i n mental d e f e c t i v e s could only do harm to s o c i e t y t y reproducing t h e i r k i n d , and sines i n many cases s t e r i l i z a t i o n would a l l o w them to l i v e i n the community instead of an i n s i t u t i o n , the r e v i s i n g of the Act to make i t more e f f e c t i v e , could t e of r e a l t e n e f i t to them. To inaugurate a comprehensive prop-ram of- treatment and prevention, c l e a r l y , would require more t r a i n e d person-n e l , greater i n s t i t u t i o n a l accommodation, convalescent homes, expansion of the C h i l d Guidance C l i n i c w i t h more t r a v e l l i n g c l i n i c s end p r o v i s i o n f o r d e a l i n g w i t h a d u l t s , and greater i n t e g r a t i o n of the prqp ram w i t h education and welfare. L e g i s l a t i v e r e v i s i o n should t e made regarding - *122 - . admission and s t e r i l i z a t i o n . These changes cannot be wrought overnight, but i n a p r o v i i x e as progressive i n welfare matters as B r i t i s h Columbia, they could be brought about i n the not too distant f u t u r e . Such a program would r e q u i r e the i n i t i a l spending of considerable money, but i n the f i n a l a n a l y s i s , the d i r e c t and i n d i r e c t cost of mental i l l n e s s would be diminished and mean a r e a l saving to the ps ople of B r i t i s h Columbia, 0 BIBLIOGRAPHY Books American P s y c h i a t r i c A s s o c i a t i o n , One Hundred Years of American P s y c h i a t r y , Columbia UniversTTy"~P*ress, lew York, 1944." Beers, C l i f f o r d . ?hej£ind_TJmt_Pound^^elf, Longmans, Green and"*Company, New~York, 1908. Deutsch, A l b e r t . The M e n t a l l y 111 i n America, Doubleday, So ran and Company, NeV"YorS7 19377"" E n g l i s h , O.S. and Pearson, H.J. Emotional Problems of L i v i n g , W.W. Norton and"~Company,""lew York,"1945. Henderson, U.K. and G i l l e s p i e , R.D. A Textbook of P s y c h i a t r y f o r Students and~Practioners, ^xford^OniversTry^Press, Eondon, T9133. Noyes, Arthur. Modern C l i n i c a l P s y c h i a t r y , W.B. Saunders Company, Philadelphia7~193*9T~ Ray, Marie. Doctors of the Mind, L i t t l e , Brown and Company, Boston,"19427 Stern, E d i t h . Mental I l l n e s s - A Guide f o r the Pamilg;, CommonwealfE Fund!, New~York, 1942. Sadler, 7 / i l l i a m . Modern P s y c h i a t r y , C.V. Mosby Company, St. Louis,""1945*. Tiffany,. F r a n c i s . L i f e of Dorothea Lynde Dix, Houghton, M i f f l i n and Company, Boston, lB"9T7~" Government Documents B r i t i s h Columbia, Annual Reports of the P r o v i n c i a l Mental g.qgg.1.t a i s , " l B g a T I g ^ B r i t i s h Columbia, F i n a l Report of the Royal Commission on Mental Hygiene. K i n g T s P r i n H r , ~ v T c T o r I a 7 ~ T 9 ^ 8 T B r i t i s h Columbia, Resources Manual, S e c t i o n II, Department of the P r o v i n c i a l Secretary, S o c i a l " A s s i s t a n c e Branch,. Zing's P r i n t e r , V i c t o r i a , 1945. -123--124-B r i t i s h Colambia.Journals of the L e g i s l a t i v e Assembly, 187221946, K i n g ^ ~ P r i n t e r , " V i c t o r i a . B r i t i s h Columbia, P u b l i c Accounts, 1875-1945, King's P r i n t e r , V i c t o r i a . ~" "• B r i t i s h Columbia, S e s s i o n a l Papers. 1872-1946,King's P r i n t e r , " " V i c t o r i a . B r i t i s h Columbia, St a t u t e s . 1873-1946.King's P r i n t e r , V i c t o r i a . Canada, Dominion Bureau of S t a t i s t i c s , I n s t i t u t i o n a l S t a t i s t i c s Branch, Annual Reports of Mental I n s t i t u t i o n s . 1932-1945. King's Printer.""oTtawa. Canada, Report of Rowell S i r o i s Commission, P u b l i c ^ I I l I I 2 2 S £ S£ l E 5 7 ^ I n ^ ^ " ^ I n l*e r , "Ottawa, 193 9. Reports Canadian Medical A s s o c i a t i o n , Report of a Survey of the Canadian N a t i o n a l Committee f o r MenTal Hygiene Tl932T7~The"MeIropolitan L i f e Insurance Company, Ot tawa. Canadian N a t i o n a l Committee f o r Mental Hygiene, Confident-i a l Report of a Survey of the Province oF*Man-I"5o*ba"( 1918). Vancouver General H o s p i t a l , Annual Reports. 1916-1946. Vancouver. P e r i o d i c a l s Canadian N a t i o n a l Committee f o r Mental Hygiene. "Report of a Survey of B r i t i s h Columbia i n 1919," Canadian J o u r n a l of Mental Hygiene, v o l . - 2 , pp. 1-39, A p r i l , 19"2*07 G r i f f i n , J.D.M. "Mental Hygiene i n Canada," Canadian P u b l i c H e a l t h J o u r n a l , v o l . 31, pp. "l6*3-l"?4, I p r i l " 3 T , 1940. -125-G r i f f i n , J.D.M. "Mind i s your Business," Health. p. 14, M a r c h - A p r i l , 1947. . ~" Report of a Committee of the B r i t i s h Medical A s s o c i a t i o n , "Planning f o r Mental H e a l t h , " B r i t i s h Medical J o u r n a l , pp. 276-278, August.23, 1941. Sohreiher, J u l i u s . "The Interdependence of Democracy Mental Health". . Mental Hygiene*, v o l . 29, pp. 606-621, A p r i l , 1945. Numerous a r t i c l e s i n Mental Hygiene and The American J o u r n a l of Orthopsychiatry served to document the background of the e v o l u t i o n of modern methods of c a r i n g f o r the mentally i l l . Unpublished M a t e r i a l Hood, M a r j o r i e H. H i s t o r y of B r i t i s h Columbia's Mental Hospitals7"Sssay~submitted to' the DepartmenlT" o F l S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia, December 12, 1945. Webber, Erminie. The P r o v i n c i a l Mental H o s p i t a l s of B r i t i s h Columbia, Essay sumitted to the Depart-ment of S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia, December, 1945. 

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