Research Essay: Demise of Asylums in the Nineteenth Century
Controversy and differing opinions have always surrounded the topic of mental illness. The asylums in the 1850s to the early1900s were a means to house the mentally ill. Different views on where people who suffer from mental illness should be placed and to what sort of treatment should be administered was a common thread in the articles and books researched. Mental illness is a complex disease that has multiple spectrums from mild depression to schizophrenia, and countless others that is encompassed under the umbrella of “mental illness.” The difficulty in defining mental illness is explored in the chapter, “What is Mental Health” in the book, Concise Introduction to Mental Health in Canada by Elliot M. Goldner, Emily Jenkins, and Dan Bilsker. It provides insight on the many factors that revealed the complexity in not only defining but also treating this disease. It explored the fact there is no test that is able to diagnose the severity of one’s mental state which creates even more problems.[1] Unfortunately, even more factors play into the problems and controversies that surround this complex disease. The research and treatments by scholars and physicians are constantly changing which impacts societies ideologies on how to deal with mental illness. These influential factors not only affect societal norms but the government involvement as well. Presently, confinement and asylums are no longer a measure of treatment for mental illness and instead we see many that suffer on the streets, homeless or in jail. This leads to the question, would people who suffered from the more acute mental illness not be better treated or cared in a facility? For this reason, researching the shift of how mentally ill people were treated in the 1850’s to early 1900’s during the Asylum Era was of interest. Prior to this era, the mentally ill were either kept at home and out of the public eye or incarcerated in jails as we see now. Unfortunately, the research revealed an overwhelming amount of evidence that these asylums were wrought with countless problems and left a negative impact so great that they were shut down. Sadly, asylums did not solve the care and treatment for people with mental illness, as examined in the chapter by James Moran, “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” in Committed to the State Asylum states, “The promise of these developments for the more efficient practice of moral therapy was, however, compromised by the growing backlog of requests for committal to the asylums and the inevitable over-crowding of the psychiatric institutions”[2] revealed a similar outcome as did the many reports, articles and papers sourced. The focus of this paper will be on lunatic asylums in Ontario from the 1850s to the early 1900s, since it was the first province to have one built with a few comparisons to other provinces. It is important to outline the history leading to these facilities being built to then understand the myriad amount of problems that resulted such as how they were constructed, how they were operated, the gender inequalities and disparities that existed, the exploitation of the mentally ill that occurred and lastly the difficulties in segregating the spectrum of illness from the curable versus incurable.
The history of asylums show much disbelief as to what occurred within them, “The rise of the asylum is the story of good intentions gone bad.”[3] This statement sums up much of the research on this topic that reflects the many obstacles and problems that are constantly scrutinized of the “Asylum Era.” It would seem an appropriate measure to place people with mental illness in a safe environment, with the ideology in the late 1800’s that asylums would, “separate them from urban society; to provide a therapeutic and productive work environment; and to allow them to be self-sufficient through on-site industry.”[4] This new ideology caused the public to put pressure on the government to provide such places for family members who suffered from mental illness instead of incarcerating them. To meet the growing demands from the public, and to alleviate the overcrowded jails, many asylums were built in a very short time span. With a pendulum shift of this magnitude, to meet the demand for placement of people suffering from varying mental illnesses created a host of errors in implementation. The lunatic asylums in Ontario were tailored according to what was done in the United States and the United Kingdom where they utilized programs such as “moral treatment” and the model of segregating and removing the mentally ill from society.[5] Using these models as examined by a leader in the field, Edward Jarvis in Christopher A Smith et al addresses in the Article “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada (1876-1902)” was the primary problem. The geographical location and the distance is what caused the lack of accessibility and this was one of the main factor that lead to the demise and closures.[6] This point is reiterated in “’Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906” by Danielle Terbenche reveals that asylums failed due to the location and poor planning from the demand.[7] The demand from misuse was examined by many and as one scholar, Scrull, revealed that families sometimes used asylums as “’a convenient way of getting rid of the inconvenient.’”[8] This sentiment of family misusing the asylums was reiterated in the Moran article where they found that people admitted a family member into the community jail until the asylum was completed, even for small acts of wrong behaviour as “quick and convenient relief to families.”[9] This demand placed further pressure on the government to implement more facilities that were not up to standard as John Conolly’s book The Construction and Government of Lunatic Asylums and Hospitals for the Insane revealed, “Although the first thing demanded by society, when we undertake to relieve it of the presence of those who cannot be at large consistently with the safety of themselves or others, is their perfect security, it must be remembers that this security does not require gloom, or a frightful apparatus. We require that the building should be on a healthy site, freely admitting light and air, and drainage.”[10] It reiterates that the needs of patients were overlooked in order to appease societal pressures during the asylum era. Although, “Institutions were strongly intended to promote health, safety, training and other aspects of growth and well-being”[11] these goals were not achieved.
The belief that asylums would be the solution to treat the mentally ill in the late 1800-1900’s was brought on so quickly that scholars believe it was one of the many problems that led to the failure of these facilities. The social demand caused the expansion and development of these asylums to be built swiftly which led to the poor construction and design. What led to such an increase in demand was explained in the article, “Growth and Decline of Institutions for People with Developmental Disabilities in Ontario, 1876-2009” by Ivan Brown and John Radford who shed light on the overuse with this opinion; “Social Darwinism suggested that too many of the “unfit” were surviving beyond infancy, resulting in large numbers of disabled people requiring care.”[12] Other articles point out that the overcrowding was a result of the influx of admissions of those suffering from minor issues to financial problems. Kirk-Montgomery provides insight on such demands when he states, “Long waiting periods could greatly increase the hardship of families and communities whose decision to commit had been motivated by extreme economic and social stress.”[13] The lack of planning of the asylums to accommodate for growth, was yet another factor as they did not foresee the overcrowding that would occur. There is so much evidence in the articles that substantiate this as well as the primary source, “Horrible Calamity” in The Atchison Champion newspaper, but was best stated by Moran, “The Toronto permanent asylum’s first superintendent, not only did the architecture of the Toronto Asylum fail in many ways to enhance the condition of the insane but until about 1856 the institution actually constituted a major health hazard for its patients.”[14] This article targets the problems within the building regulations and due to lack of proper fire exits, it led to the death of many patients who could not escape when a fire broke out. The poor layout of the Toronto Asylum led to various other problems such as, poor circulation throughout the asylum which caused many deaths from diseases such as tuberculosis. This was the primary focus of the book “Institutional Care of the Insane in the United States and Canada” by Henry M. Hurd et al, which revealed, “overcrowding, combined as it was with many defects in structure and in the various services, such as water, heating, lighting was becoming unbearable.”[15] In contrast, Conolly provides an example of a desirable layout for asylums which is known as the “H shape” as, “it is evident that a building of this shape, long and narrow, consisting of a succession of galleries or corridors, with bedrooms on one side only” with “The want of proper ventilation is chiefly incidental to the angles of the building, and to the centre, and should be carefully provided against”[16] The shape that Conolly describes would limit many of the ventilation issues as well as the problematic exits constructed in Toronto and other regions’ asylums. This reiterates how the rapid building of the asylums led to the poor construction. Another notable flaw was that Ontario and surrounding provinces adopted the plans from the United States and United Kingdom because they were “”well ordered” lunatic asylums where patients were divided into at least nine classes for each sex.”[17] However, Moran states, “Given the architectural limitations of the Toronto Asylum, he was only able to classify his patients into three large divisions.”[18] The superintendent, Workman complained that his inability to separate “the noisy, the violent, the obscene, the epileptic, the filthy, the helpless, the timid and the sick” in their proper wards rendered the asylum “almost useless for curative purposes.””[19] This is an example of how emulating other models and practices do not always translate to other areas. There may be differing opinions on what caused the high demand for the asylums, as stated, “overcrowding, underfunding, lack of demonstrated success, and philosophical, economic and social changes resulted in long decline of institutions”[20] it is collectively agreed that the rapid construction was a large part of the problem.
Another resonating factor that contributed to the failure of the asylums was the manner in which they operated. After all the 1900’s was about maintaining “Victorian Respectability”[21] and was explained best in the article, “Society, Place, Work: The BC Public Hospital for the Insane, 1872-1902” by Ken Scott where the author reiterates that “both the medical community and the local public believed strongly in the importance of separating patients by gender.”[22] It was also expected that each gender was looked after by the same sex which created obstacles to the care given to the patients. All authoritative positions were held by men and this did cause problems in allowing designated areas for female admissions, and allowing females to work and be in charge of the women’s unit. It is reiterated that all powerful positions were held by men, “male politicians made all decisions about financing of the asylums, and the discourse of professional medicine was acutely patriarchal.”[23] Moments of Unreason by Cheryl Krasnick Warsh provided cases where one “matron” and the male superintendent did have opposing views which provided insights on the fact women had very little input or control with implementing policies in a male dominated society.[24] The obstacles to enable provisions to allow for segregated areas while meeting the demands of admissions only taxed this system further.[25] This is substantiated by Moran who exposes the challenges faced and the issues that resulted “patients were divided by gender with male patients occupying the west wing and female patients the east wing. Each group was in turn divided into four principal classifications: the “idiotic” and “intractable or filthy”; patients whose habits were “more orderly”; the quiet; and the convalescent. Within wards there was room for the further subdivision of the patients in each class.”[26] Terbenche’s stated how this system was a fundamental flaw to providing care when asylums were, “an initiative forcing the poor, the feeble, and the insane into a social code controlled by middle class through institutional care.”[27] A patriarchal system attempting to implement care for both genders, different socioeconomic class and as well different methods of treatment as examined by Moran “since local physicians came from a wide range of medical traditions and educational backgrounds, they used a range of medical strategies to deal with insanity, many of which has predated the introduction of the lunatic asylum and its therapeutic ideal.”[28] All the differing views and ideas of treatments which this statement reiterates the scope of problems that occurred in the asylums. Add the external demands, “individual families and community members further shaped the character of asylum development in Ontario and Quebec as they made their decisions to commit those they considered insane to the new institutions.”[29] All of these problems were summed up best when Warsh states, “A succession of increasingly sophisticated and adept medical superintendents and a decline in the use of mechanical restraints, but also overcrowding, deteriorating facilities, and a growing chronic population.”[30] These contributing factors are clearly agreed among many scholars. The high expectations placed on how these asylums were the answer to solving mental health problems did not deliver.[31]
It is important to point out the types of treatments that scholars and physicians were intent on implementing during this time period to understand the gender inequalities that resulted in the asylums. The asylums were run as a patriarchal system that emulated societal norms at this time.[32] It was a focal point of criticism among the scholars and some female historians who felt that women were, “were disproportionately confined in madhouses and mental hospitals due to the stereotypes held by male medical practitioners and society’s desire to ‘shut up’ women who challenged the Victorian ethos of separate spheres”[33] Conversely to the above opinion to females being overly committed, Scott revealed that British Columbia had a very imbalanced male to female ratio in asylums compared to eastern Canada where it was a fairly equal ratio. Little explanation is provided for this disparity, other than British Columbia had a larger population of young men who had “roving dispositions”[34] What many scholars did agree was that “the gendered division of labour in asylums was a standard feature of patients labour”[35] The asylum followed the same structure that existed in the government, and household during this time period, it followed the patriarchal pattern. Since moral therapy was the most commonly used method and was meant to include different activities to encourage productivity it created biases. The work was designated based on gender and severity of illness. For this reason, women were only allowed to work indoors doing domestic duties where the men worked outdoors; farming and building.[36] The book by Moran, and the article, by Scott both examine the work in which patients did as apart of moral therapy and the gender disparity that resulted because of these programs. It reiterates other finding of how women were confined to working indoors but also reveals that due to overcrowding, tuberculosis was a common cause of death among women patients due to the lack of fresh air they received.[37] The over population was a common thread and studies showed “patients separated according to gender and diagnosis, some of which contained several wings and corridors. These became so overcrowded that bed were lined up in rows, and many patients spent most of their time living in their beds.”[38] This is more thoroughly examined in the article, “Dying to Get Out of the Asylum: Mortality and Madness in Four Mental Hospitals in Victorian Canada, 1841-1891” by David Wright et al, that showed the death rates due to the abundance of patients confined in these small spaces, “increased the likelihood of the transmission of endemic diseases (such as tuberculosis) and epidemic diseases (such as cholera and typhus).[39] Similarly, the Victoria British Colonist Newspaper states, “neglecting to provide for the comfort of sick patients; of refusing them proper food;—the significant remark being appended that “in every case the patient died.””[40] This research provides more insight on the harsh living situations and lack of care that was provided to those suffering. It would be a miss to not disclose that there were some benefits of moral treatment where field trips were incorporated which allowed some patients to escape the overcrowded institutions. However, the inequality among genders was noted as only the men were allowed to partake.[41] On the other hand some facilities were in the women’s favor as they had the nicest and most attractive ward that was the least “prison-like.”[42] However, this was not the norm as examined in the “Diary Written in the Provincial Lunatic Asylum” by Mary Huestis Pengilly exposes a first-hand account of a patient who suffered as a result of the inner workings of the asylum.[43] Pengilly states, “If I were committed to the penitentiary for a crime, I would not be used any worse than I am here.”[44] This gives insight on the way the mentally ill were treated within the asylums.
The exploitation of the work done by the mentally ill significantly increased over the duration of asylums’ lifetime, not to mention many cases of physical, mental, and emotional abuse that occurred throughout asylums. Initially, patients were to work short days as a part of their treatment program. However, the government saw the benefit and the income that was generated as a result of the free labour which led them to initiate longer work days. What was once a part of a treatment program, essentially became slave labour. This is explored in many articles researched, such as in Moran’s book which examines patients work initiatives and the benefits to the asylum. Despite one patient’s recovery and “his desire to go back home to his family and friends, he was being kept at the asylum in a state of ‘slavery’ because he was a good worker whose labour was of great value to the institution.”[45] This magnifies how patients were exploited and then used to benefit the asylum versus what was seen to benefit the patient’s mental state. This is also explored throughout Conolly’s article when he states, “a wish, laudable in itself, to make the labour of the patients profitable, leads, no doubt, to the general employment of patients in their own trades; but this, for a tailor, or for a shoemaker, or a weaver, or a dressmaker, is often the worst thing that can be done, and takes away the chance of recovery.”[46] This shows how workers benefited if it was in their field of expertise, however, it negates the treatment of patients. Brown et al article explores the overwork of patients, for example, “Residents provided much of the labour required for the agricultural and domestic aspects of running the asylum, a factor that later worked against rehabilitating people to community settings and contributed to over-crowding.”[47] This collective documentation of the exploitation of the patients was as another large flaw within system. It wasn’t just the work that was expected, it was the hours worked. One article revealed that patients worked 15 to 16 hour work days at some institutions.[48] The labour increase and impacts it had on the asylums is reiterated when an inspector, Langmuir, “was laying the groundwork for the intensification of patient labour, which would see an increase in the rate of patient labour at Ontario’s mental institutions from one-third in the late 1870s to 75 percent of the entire inmate population by 1900.”[49] Later, Moran provided a chart of inmate labour in Ontario between 1880 to 1900 which shows that labour days worked doubled and tripled within a decade. This quantitative data shows in 1880 that there was an average hours worked of about 1,000, versus the 1900’s where the average was 3,800.[50] This clearly reiterates the fact that patients were taken advantage of and the initial purpose of giving them work was a part of their treatment which then became an industry. The abundance of labour patients did was one form of abuse, however, physical, mental, and emotional abuse also occurred throughout the institutions. The article, “Accounts of Abuse of Patients at the Toronto Hospital for the Insane, 1883-1937” by Geoffrey Reaume primarily focused on abuse within asylums which gives grave detail of what patients endured. A patient shared his experience as stated, “Maude’s fear raises the important point of how physical ability was closely related to abuse, something which is made explicit when considering the experiences of a contemporary of hers.”[51] This gives insight on a patient’s experience of abuse and how prominent it was with more vulnerable patients, such as individuals who were blind or paralyzed.[52] The vulnerability of patients clearly indicates that they had no control over situations and the authoritative figures were able to spin situations to benefit themselves. This is further reiterated when another patient’s statement is interpreted through historical data, “It is clear from his clinical record, that Jim had no doubt about who had caused this particular injury – hospital attendants, and not other patients as stated by ward staff.”[53] This further challenges the patients to openly express themselves and the problems that occurred as, “She chose to wait until she was away from the institution before writing this letter to avoid punishment. This raises the point about the fear that patients had when it came to speaking out.”[54] However, this article also shows how nurses would act which gives no indicator of abuse toward the management of these facilities, as stated, “Nurses changed their behaviour when they expected doctors or the matron to appear. This observation highlights how abuse could be hidden or obscured from the official recorders, who were primarily hospital physicians.”[55] These experiences patients shared shines light on how authority controlled the asylum in order to make it look like the patients wrongdoing. Not to mention, the asylum, “was greatly dependent upon the quality of attendant care.”[56] This clearly states that asylums needed the care of nurses however, the abuse that occurred clearly indicates the strong power authoritative figures held above patients in every aspect of the asylum.
The challenges faced when dealing with mental illness is not just discerning who is and who is not curable which is a whole other topic. Instead, exploring the challenges faced by both men and women suffering from the disease when placed in an asylum and how gender affects treatment. In the novel, Outside the Walls of the Asylum?: The History of Care in the Community 1750-2000 by Peter Bartlett and David Wright gives insight on these challenges as stated, “women were seen as the majority of the worried whilst men made up the majority of the threateningly mad.”[57] It circles back to defining mental illness and the difficulties associated with the severity of the illness. The article by Smith et al explores that there is not a perfect solution to meet such a broad spectrum of people who suffer from mental illness and who determines whether they are detrimental to society and themselves which is still relevant today.[58] The construction of asylums became paramount during this time with the model of segregating and treating the mentally ill. The argument against the asylum was that they were “an initiative forcing the poor, the feeble, and the insane into a social code controlled by middle class through institutional care.”[59] Asylums strived to provide a safe place to treat mentally ill people as stated here, “Through the practice of the doctrine of moral therapy, the insane would be cured and released from the asylum as productive members of society.”[60] Unfortunately, as examined here, too many faults and problems resulted due to the haste of the buildings, societal demands on the system, gender inequalities, overcrowding and exploitation. Due to the overwhelming abundance of people admitted into these facilities, the authoritative figures lost sight of the importance that curable and incurable both need care, as Conolly points out, “the commissioners in lunacy seem to have forgotten that a large proportion of the incurable along the insane are even more sensible to all surroundings and circumstances than the curable who are labouring under recent attack.”[61] The author gives insight to another aspect which was lacking within the asylums; as superintendents and other workers within the asylum tended to hold incurable patients in small cramped spaces as they did not want to spend money on patients who were deemed incurable due to the minimal results that would be seen in their efforts.[62] This is further reiterated when Conolly states that the incurable “Require more means of occupation, more space for exercise, greater opportunities of recreation that curable, and a greater variety of comfortable arrangements to reconcile them to their situation and maintain that habitual content and tranquility which distinguished a well-regulated asylum from a miserable madhouse.”[63] However, this is controversial to how the superintendents actually treated the incurable. It may seem that the incurable do not need the amount of care as the curable, however, Conolly argues that they need just as much, if not more due to their unstable mental state. Similarly, Brown discussed the incurable and the minimal treatment they received because if they would not see improvements, why are the workers putting in their resources into the incurable versus curable?[64]
The fundamental flaws of the asylums that were built in the late 1800 to early 1900 were vast. It stemmed from the varying degrees of mental health which is always a challenge to discern what treatment is appropriate for each level of disease. Brown states, “It was a physical representation of the view that people with a developmental disability, variously labelled and stigmatized, habitually treated as different and marginalized, “belonged in an asylum.””[65] This subsequent demand from the public on the government to provide a place for anyone with any degree of mental illness caused such pressure on a system not ready to implement or plan it properly. Also, the patriarchal system at this time did not lend to an unbiased and equal system which only created more problems to administering proper care. Not to mention the scholars and physicians contradicted and opposed certain ideologies and was stated best, “such a combination of emotion and philosophy made it very hard for people in the mental hospital movement to develop agreed-upon definitions and to carry our systematic observations according to standard procedures, in short, to conduct scientific investigations.”[66] Combine these factors with poorly planned, built and overcrowded asylums created an environment of neglect, abuse and exploitation of the patients in order to operate these facilities. Unfortunately, there is an overwhelming amount of evidence that showed the negative impact these facilities had on patients and even the workers with the best intentions, “everyone began to realize this was not the best way to live, so the institutions were all closed and people were moved to communities.”[67] The knowledge gleaned from all the books, articles and papers is that mental illness is a complex disease that requires multiple levels of treatment and that just by building asylums and removing people from society does solve the problem.
Endnotes:
[1] Elliot M. Goldner, Emily Jenkins, and Dan Bilsker. “What is Mental Health” Concise Introduction to Mental Health in Canada, (Ontario: Canadian Scholars’ Press, 2016), 2.
[2] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 89.
[3] Edward Shorter, “The Asylum Era,” In A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. (New York: John Wiley & Sons, Inc, 1997), 33.
[4] Christopher A. Smith, David Wright, and Shawn Day, “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902.” Social Science and Medicine, 64 (2007): 2365.
[5] John Conolly. The Construction and Government of Lunatic Asylums and Hospitals for the Insane, (London: John Churchill, 1847).
https://archive.org/details/constructiongove00cono.
[6] Christopher A. Smith, David Wright, and Shawn Day, “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902.” Social Science and Medicine, 64 (2007): 2365.
[7] Danielle Terbenche. “’Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906.” University of Toronto Press, 86, no. 1 (2005): 29.
[8] Christopher A. Smith, David Wright, and Shawn Day. “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902.” Social Science and Medicine, 64 (2007): 2363.
[9] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 98.
[10] John Conolly. The Construction and Government of Lunatic Asylums and Hospitals for the Insane, (London: John Churchill, 1847), 8.
https://archive.org/details/constructiongove00cono.
[11] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 8.
[12] Ibid, 15.
[13] Allison Kirk-Montgomery. “Loaded Revolvers”: Ontario’s First Forensic Psychiatrists” in James E. Moran and David Wright (Eds), Mental Health and Canadian Society, (Montreal: McGill University Press, 2006), 129.
[14] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 84.
[15] Henry M. Hurd, William, F. Drewry, Richard Dewey, Charles W. Pilgrim, G. Alder Blumer, and T.J. W. Burgess. Institutional Care of the Insane in the United States and Canada, (Baltimore: The Johns Hopkin Press, 1917), 13.
https://archive.org/details/institutionalcar04hurd.
[16] John Conolly. The Construction and Government of Lunatic Asylums and Hospitals for the Insane, (London: John Churchill, 1847).
https://archive.org/details/constructiongove00cono.
[17] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 88.
[18] Ibid.
[19] Ibid.
[20] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 7.
[21] Ken Scott. “Society, Place, Work: The BC Public Hospital for the Insane, 1872-1902” BC Studies, 171 (2011): 97.
[22] Ibid.
[23] Ibid, 98.
[24] Cheryl Krasnick Warsh. Moments of Unreason, (Montreal: McGill University Press, 1989).
[25] Henry M. Hurd, William, F. Drewry, Richard Dewey, Charles W. Pilgrim, G. Alder Blumer, and T.J. W. Burgess. Institutional Care of the Insane in the United States and Canada, (Baltimore: The Johns Hopkin Press, 1917).
https://archive.org/details/institutionalcar04hurd.
[26] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 90.
[27] Danielle Terbenche. “’Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906.” University of Toronto Press, 86, no. 1 (2005): 29.
[28] James Moran. “Criminal Insanity: The Creation and Dissolution of a Psychiatric Disorder” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 108.
[29] Ibid, 170.
[30] Cheryl Krasnick Warsh. Moments of Unreason, (Montreal: McGill University Press, 1989),
4.
[31] Alexander H. Leighton. Caring for the Mentally Ill People, (Ontario: Cambridge Univeristy Press, 1982), 14.
[32] Danielle Terbenche. “’Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906.” University of Toronto Press, 86, no. 1 (2005): 29.
[33] Christopher A. Smith, David Wright, and Shawn Day. “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902.” Social Science and Medicine, 64 (2007): 1973.
[34] Ken Scott. “Society, Place, Work: The BC Public Hospital for the Insane, 1872-1902” BC Studies, 171 (2011): 100.
[35] Geoffrey Reaume. “Patients at Work: Insane Asylum Inmates’ Labour in Ontario, 1841-1900,” in Moran, James E., and David Wright (Eds), Mental Health and Canadian Society, (Montreal: McGill University Press, 2006), 84.
[36] Ken Scott. “Society, Place, Work: The BC Public Hospital for the Insane, 1872-1902” BC Studies, 171 (2011): 102.
[37] David Wright, Laurie Jacklin, and Tom Themeles. “Dying to Get Out of the Asylum: Mortality and Madness in Four Mental Hospitals in Victorian Canada, 1841-1891,” Bulletin of the History of Medicine, 87, no. 4, (2013): 606.
https://muse-jhu-edu.ezproxy.tru.ca/article/532462/pdf.
[38] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 14.
[39] David Wright, Laurie Jacklin, and Tom Themeles. “Dying to Get Out of the Asylum: Mortality and Madness in Four Mental Hospitals in Victorian Canada, 1841-1891,” Bulletin of the History of Medicine, 87, no. 4, (2013): 598.
https://muse-jhu-edu.ezproxy.tru.ca/article/532462/pdf.
[40] Victoria British Colonist Newspaper,(1876): 2.
https://newspaperarchive.com/victoria-daily-british-colonist-apr-28-1876-p-2/.
[41] Ken Scott. “Society, Place, Work: The BC Public Hospital for the Insane, 1872-1902” BC Studies, 171 (2011).
[42] Ibid, 101.
[43] Mary Huestis Pengilly, “Diary Written in the Provincial Lunatic Asylum” Bulletin of the Ontario Hospitals for the Insane, 1, no, 1 (1885): 2.
http://eco.canadiana.ca.ezproxy.tru.ca/view/oocihm.11978/5?r=0&s=1.
[44] Ibid, 5.
[45] James Moran. “Medicine, Moral Therapy, and Madness in Nineteenth-Century Quebec and Ontario” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 93.
[46] John Conolly. The Construction and Government of Lunatic Asylums and Hospitals for the Insane, (London: John Churchill, 1847), 79.
https://archive.org/details/constructiongove00cono.
[47] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 14.
[48] Geoffrey Reaume. “Patients at Work: Insane Asylum Inmates’ Labour in Ontario, 1841-1900,” in Moran, James E., and David Wright (Eds), Mental Health and Canadian Society, (Montreal: McGill University Press, 2006), 80.
[49] Ibid, 69.
[50] Ibid, 81.
[51] Geoffrey Reaume. “Accounts of Abuse of Patients at the Toronto Hospital for the Insane, 1883-1937” Canadian Bulletin of Medical History, 14, vo. 1, (1997): 69.
https://utpjournals.press/doi/pdf/10.3138/cbmh.14.1.65.
[52] Ibid.
[53] Ibid.
[54] Ibid, 72.
[55] Ibid.
[56] James, E. Moran. “Keepers of the Insane: The Role Attendants at the Toronto Provincial Asylum, 1875-1905,” Social History, 28, no. 55 (1995): 52.
https://hssh.journals.yorku.ca/index.php/hssh/article/viewFile/36799/33449.
[57] Peter Bartlett and David Wright. Outside the Walls of the Asylum?: The History of Care in the Community 1750-2000, (London: The Athlone Press, 1999), 246.
[58] Christopher A. Smith, David Wright, and Shawn Day. “Distancing the Mad: Jarvis’s Law and the Spatial Distribution of Admissions to the Hamilton Lunatic Asylum in Canada, 1876-1902,” Social Science and Medicine, 64 (2007).
[59] Danielle Terbenche. “’Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906.” University of Toronto Press, 86, no. 1 (2005): 31.
[60] James E. Moran. “Criminal Insanity: The Creation and Dissolution of a Psychiatric Disorder,” In Committed to the State Asylum, (Montreal: McGill University Press, 2000), 168.
[61] John Conolly. The Construction and Government of Lunatic Asylums and Hospitals for the Insane, (London: John Churchill, 1847), 4.
https://archive.org/details/constructiongove00cono.
[62] Ibid.
[63] Ibid, 5.
[64] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 11.
[65] Ibid, 25.
[66] Alexander H. Leighton. Caring for the Mentally Ill People, (Ontario: Cambridge Univeristy Press, 1982), 27.
[67] Ivan Brown, and John P. Radford. “The Growth and Decline of Institutions for People with Developmental Disabilities in Ontario: 1876-2009” Journal on Developmental Disabilities, 21, no. 2 (2015): 25.
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