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

by Geoffrey Reaume

'Oh that I had wings I would fly like
a dove and be at rest I would fly out
of this asylum ....'

So wrote Ralph M., a patient at the Toronto Hospital for the Insane from 1889 until his death in 1911. Winston O., another inmate at the Toronto asylum, actually sought to build wings like Ralph so longed for. After crafting violins that he played and building from scratch an automobile he was
allowed to drive on the hospital grounds, Winston was reported to be working on the construction of an 'aeroplane'.

In Remembrance of Patients Past , historian Geoffrey Reaume chronicles seventy years of daily life at the institution known as 999, the Toronto Hospital for the Insane at 999 Queen Street West. His narrative stretches from 1870 to 1940 and examines such aspects as diagnosis and admission, daily
routine and relationships, leisure, patients' labor, family and community responses, and discharge and death. Mental patients were at times abused, and they led lives of tedious monotony that could tend to 'flatten' personality, yet many of these women and men worked hard at institutional jobs for
years and decades on end, created their own entertainment, and formed meaningful relationships with other patients and staff. A moving chronicle, the book is also an important argument for flexibility in treatment for mental illnesses and a challenge to the view that traditional mental institutions
were of little help to their patients.

Genres: History

380 pages, Paperback

First published June 8, 2000

Reviews

[Robin Blackburn McBride]

This work is an important piece of scholarship, and one I'm most grateful for. I continue to refer to it for my own research purposes.

[Adam Dunn · Rating 3 out of 5]

There's a saying from the TV show Designing Women that people in the North try and hide their crazy people away, while people in the South sit them on the porch and put them on display. The majority of this book concerns the northern philosophy.

I met the author during Doors Open Toronto and attended his tour of the Queen St Mental Health Centre grounds. It was a very interesting tour, the author was well spoken and obviously very well read on the subject and so I picked up this book.

One of the problems with non-fiction, in particular history, is making it readable and digestible to a modern audience. There's also in parcel with this the issue of limited resources. Telling the story of people who never wrote their story 100 years or more after the fact is difficult. I remember talking with author Paul Russell about his book The Unreal Life of Sergey Nabokov and he said he had chosen to write historical fiction as if he were limited to the information available the work could be no more than a pamphlet. With a wide variety of patients to profile this author has more freedom, but understandably not much.

Writing history is a lengthy process, involving research, collecting data, writing and finally re-writing to make it appeal to a reader. While I do believe here the first three steps were done very well, the final re-writing process seemed lacking to me. The book started off as a thesis and a lot of that dryness is still here. The book does not read like fiction, far from it.

The times the author does share an opinion I found difficult too. In some cases I disagreed and in others I found his opinions contradicting.

Page 159:
“Considering the fact that Toronto was primarily a chronic-care facility where employed patients worked for years, even decades, the therapeutic achievement appears negligible in contrast to the financial gain.”

I question here the use of the term financial gain. Who was gaining? The facility was run by the province and it is never suggested it turned a profit. Also the argument that the patients working a long time minimizes the value of work and routine is specious reasoning.

Contrast this with the later statement:
Page 168:
“For lonely inmates, work and the sense of purpose it gave could help to pass the time and give a feeling of self-worth.”

I have relatives who have mental health issues and some have been held in institutions for periods of time. I get that the author dislikes this patient work scheme, and it seems the institution environment, but when contrasted with the methods we're using today, I don't know that things are much better. The author mentions someone saying you can't really criticize the past in a negative view, but this book is very much written in the vein of what we know now, not how it was then. In an era like the 1930's, before the welfare state and during the Great Depression when people were starving to death, the idea of having patients work for their keep is not unreasonable. Not all patients worked, in some years only around 50% worked. I don't think it was unreasonable. My relative for example now is on disability for mental health issues and does not work. He says he can't work or they would cut his disability. He has his own rent-subsidized apartment in downtown Toronto and spends extra time begging for change on the streets. Compare this to a system where he has friends and fellow patients and staff around to talk to and some work he can get a sense of accomplishment from. I don't necessarily agree that financial "gain" was the prime motivation.

Another passage:
Page 238:
“The final entry in her clinical record poignantly illustrates the utter loneliness of life and death for some asylum inmates:
We have made every effort to locate friends but up to the present have been quite unable to do so. […] she seems quite without friends or relatives.”

I don't necessarily agree that having no outside friends or relatives does illustrate the "utter loneliness of life and death". She could have made friends and had purpose in her life and work in the asylum. I know being gay many times people would be in new situations with new people and would build a new "family" that they could rely on. It's not exactly the same thing but the concept is there.
Also it can be difficult for family and friends, and still is. My relative is imposing physically and recently had an incident with a knife where he threatened to stab someone. Sitting with him listening to how his girlfriend dumped Wayne Gretzky for him and how he received special dispensation from the Pope to marry her is trying, to say the least. Everyone is doing the best they can in this life.

The most controversial statement in the book comes later:
Page 256, amid references to then Conservative premier Mike Harris:
“Forced treatment… continues to harm when it reaches out into the community for someone who does not take prescribed medication, as this only serves to reinforce the dehumanization of the person who suffers such an experience, devoid of any therapeutic benefits to the person on the receiving end.”

I don't really know where this is coming from.

I liked that the book showed clearly how far we've come and how far we have to go. I feel that the book though, the few times it looked at this older vs newer perspective, had more complaints than solutions. For example my relative has cable TV. I don't have cable TV as I can't afford it and I work. I'm not suggesting we should be making people sing for their supper anymore but I think the answer can lie in the middle. If the new system were working fine and giving them money for luxuries was the answer I would say to continue, but I don't know that this is working either. While presenting an interesting portrait of past patients, I felt the book frustrating overall.

[Barb Nobel · Rating 5 out of 5]

An amazing book. The writing is excellent. Stories are told dispassionately, but with great sympathy. This book inspired me to write a short story based on a patients life.

[J. Pearce · Rating 4 out of 5]

Please be aware that I hope to work with this professor in the future.

The goal of this book is to create a picture of lives inside a Victorian Insane Asylum from the point or view of patients rather than from administrators. This can be a very daunting task: many inmates were not literate. Those that were had limited opportunities to record their thoughts. Those that left the asylum may not have been willing to ever record their thoughts at all. I feel Reaume does a good job of pulling together what he has found in the files to create a very strong image of the lives of inmates, while acknowledging throughout that he is working with limited resources.

Reaume describes his technique as going through all the existing files of the asylum, searching for whatever is recorded by the patients themselves. These include letters to the administration and doctors, letters to the outside that were censored and not sent, letters from family members to the patients that were not received, letters to the asylum administration from family, and letters sent by patients who were released. Reaume also takes note of writings that are said to record the thoughts of patients, such as reports from nurses and doctors about what the patients said at certain times.

I like the layout of the book from admission through either discharge or death, with stops between for patient relationships, patient work experiences, and reactions from the general community. Reaume uses his resources to create a very vivid picture of a life that varied drastically from those in the high paying wards to those in the public wards. He also discusses gender, race, and gender-expectation conformity, as well as age.

My only problem with this book is I feel that some of the paragraphs needed to be broken down a bit more than they were. They would start in one place, meander someplace else, and then end up in a third.

I intend to purchase a copy of this book.

[Ravi · Rating 5 out of 5]

This is a masterpiece and essential reading for disability theory scholars in any discipline. A treasure filled with insights.