Ep. 48: History of the Provincial Lunatic Asylum, Part 2 (1857-1907)

This week's episode covers the history of the Provincial Lunatic Asylum over the course of 50 years (1857-1907). Find out what treatments were used during the superintendentship of Drs. Workman and Clark. Learn why one group was disproportionately represented in the asylum and in Toronto jails.

All sources will be listed at the end of the episode transcript.

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Transcript

Hello, hello, hello, and welcome back to another episode of Behind the Walls of the World’s Psychiatric Hospitals! I’m your host, Dr. Sarah Gallup, and today we will be jumping back in to the story of the infamous asylum at 999 Queen Street West in Toronto. 

Like last week, this week’s episode will provide a pretty condensed look at the history of the asylum over the course of a couple decades. After this week’s episode, we’ll speed up the storytelling a bit to cover the rest of hospital’s history. For the time being, I wanted to take advantage of one of my main sources, which is a dissertation by Maximilian Smith that focuses on the history of the Provincial Lunatic Asylum from 1830-1882. It’s an in-depth study of the asylum over the course of 50 years, and it is dense with information. So once we get past 1882, the story will pick up a bit faster.

Primary sources for this episode include the dissertation I just mentioned, as well as a short documentary film called “If these walls could talk: Stories behind Toronto’s psychiatric patient built wall.” These and all other sources will be listed at the end of the episode transcript.

Trigger warnings for this episode include several different types of racism – prejudice and stereotypes, racism in medical terminology, and institutional racism.

For now, come on in and get comfortable as we go behind the walls of the Provincial Lunatic Asylum…

We left off last week in 1857, after Dr. Workman sued George Brown and the Globe for libel. In that episode, I wanted to focus on Dr. Workman and the changes that he had hoped to bring to the asylum. 

But today I’m going to backtrack just a bit to show some of the consistent patterns that had been happening in the background because it affects not only the reasons for the asylum becoming dangerously overpopulated but the necessity of institutional oversight.

What’s hard to imagine (or, actually, maybe not) is how few regulations there were on who could be admitted to the asylum during the 1840s and 1850s and for what reasons. Essentially, it was left up to what people thoughtinsanity looked like. And, unfortunately, that leaves a lot of room for prejudice.

According to Maximilian Smith, who wrote the dissertation on the asylum, about 45.6% of admissions to the Provincial Lunatic Asylum came from local jails and about 49% were admitted by families, friends, and other social relations (231). As we’ve mentioned before, anyone who didn’t really fit the societal mold was at risk of being hospitalized. Folks with physical disabilities or developmental disabilities were also subject to institutionalization because they were often seen as difficult for families to care for. And it’s easy for me to pass judgment on these families. I find myself thinking, “Who could abandon their child or send them away to live in some place with strangers where they would be mistreated?” And then I think that, at least for some families, the decision had to be a difficult one. These were the days when couples had many children to help with work or farming or to beat the mortality statistics. Perhaps it would have been too overwhelming to take care of a child with special needs, or perhaps they were talked into sending their child away by well-meaning family or friends. Whatever the situation, I sincerely hope that it wasn’t done callously.

The group most at risk of being institutionalized unjustly was the poor. And again, this was mid-19th century. There were no social services available for people struggling with poverty. If they had nowhere else to go, often poor folks ended up in jails or asylums. Without going on too much of a rant, we struggle with this same problem today. I’ve worked with many people over the years who got themselves arrested just to get out of the cold or just to get much-needed medical care. We still tend to criminalize poverty.

There was one specific group, however, that had a disproportionate number of people in jails and asylums. I briefly mentioned in the last episode that there was an influx of Irish immigrants coming to Canada in the 1840s. You may remember that the Irish potato famine was rampant from 1845 to 1852. Many people emigrated during these years in search of a better future. For those who came to Canada, many were seen as different. They were often poor laborers, with different religious and cultural practices. As a result, their differences became accentuated, and their behavior was pathologized. For instance, if someone born in Canada got drunk and was stopped by law enforcement, the default assumption was that the person had had a rough night, and he was sent on his way. If an Irish immigrant got drunk and was stopped by law enforcement, the assumption was that this is how all Irish people were. They would be more likely to be arrested for their inebriation.

Maximilian Smith notes that while Irish immigrants accounted for only 18% of the total population in Canada at this time (248), between 1858 and 1863, Irish folks accounted for 60% of arrests in Toronto and 61% of all prison sentences (251). Many of those who were arrested ended up being sent to the asylum following their jail sentence. Dr. Workman pointed out that at one point, over 40% of asylum admissions were people born in Ireland (Smith 246). This was clearly a disproportionate number of folks being institutionalized. We know now that that trauma stemming from poverty and displacement from their home country could contribute to their psychiatric presentation but instead it sounds like good old-fashioned prejudice.

In the 1850s, Dr. Workman noted that the primary cause of admission to the asylum was idiocy (Smith 245), or what we would call Intellectual Disability or another learning disorder today. The second cause was intemperance, usually accompanied by alcohol abuse, and this is what the majority of Irish folks admitted to the asylum would be diagnosed with. Dr. Workman believed that this was because many of the Irish immigrants were impoverished and didn’t have many (if any) relatives who could take them in (Smith 246). Dr. Workman also believed that heredity was a primary cause of insanity, so he believed that Irish immigrants who struggled with alcoholism and mental illness were, by their very nature, incurable (256).

Again, I find myself reflecting on my own reactions to these stories. How did so many people with alcohol abuse end up in the asylum? But then I remember the year of training I did a rehab facility. We had an in-house detox center where new patients would arrive and stay in medical detox for several days or a week. I would sometimes do admission intakes when patients were alert enough to be able to interview. If you’ve never seen someone in active alcohol withdrawal, it is painful to watch. Alcohol and benzodiazepines (like Xanax and Ativan) are the only substances that can kill someone from withdrawal. That’s why medical detox is essential, and it isn’t recommended that alcoholics quit cold turkey. 

Someone in active alcohol withdrawal may notice flu-like symptoms within six hours of not drinking: shaking, anxiety, sweating, nausea, vomiting (DiLonardo). As soon as 12 hours after their last drink, people can begin having auditory, visual, or tactile hallucinations or having seizures (DiLonardo). Only two to three days after they stop drinking, the person can experience life-threatening symptoms: increased blood pressure, fever, heavy sweating, and confusion (DiLonardo).

So, for family members in the mid-1800s, if they started noticing that John or Mary is having visual hallucinations and shaking profusely, they would likely make the assumption that they’ve gone insane. They had no other medical frame of reference. So it makes sense that they would want to see psychiatric care.

I should also add that alcohol is the only substance that studies have consistently shown increases the risk of violence – yes, even more than meth. So it’s also possible that, while John or Mary is seeing hallucinations and shaking profusely, they also become aggressive. That might lead the family to seek law enforcement, and their family member would be arrested. The point is that I gotta believe the families were making what they believed to be the best decision given the knowledge they had at the time and the options available to them at the time.

Apparently, during this time period, a universal sign of insanity was someone tearing their clothing (Smith 262). It was also a symptom of monomania or what we might call an obsession with something today. Smith notes that telltale signs of insanity included “breaking of glass and crockery, tearing clothes and bedding, and sudden excitement of passion” (263). I don’t know about insanity, but that sounds like a really bad day to me.

But what really infuriated Dr. Workman throughout the 1850s and 60s were false diagnoses of insanity. And this blew my mind: physicians who evaluated for insanity were paid two pounds (or the equivalent of about US $350 today) just to give a positive insanity diagnosis (Smith 289). And Dr. Workman started noticing that several of the same doctors were diagnosing people as insane who showed no symptoms of insanity. He suspected that some of those doctors weren’t even meeting with the so-called lunatics. They simply wrote a diagnosis of insanity and collected their cash. It’s entirely possible.

And it became such a debacle because, as I mentioned in the last episode, the asylum was getting more and more crowded. The original design was intended to accommodate 200 patients comfortably – 250 at the most – and the numbers were already surpassing that. And we have to remember: the original design for the asylum was never completed, so it wasn’t even fully constructed and couldn’t house 200-plus patients.

Dr. Workman pushed to get more oversight on the asylum as a whole and on these admissions by experts who understood insanity. He wanted fewer admissions of people who were feigning insanity for whatever reason – whether that was to have a roof over their head or to bypass a prison sentence. He saw the asylum as a place where people with mental illness could be cured. And you can’t cure someone who isn’t mentally ill. So he wanted those folks out. He also didn’t want to admit patients he saw as chronically ill or incurable. And again, this was because he wanted the asylum to be viewed as a place where people got better – not where they were merely warehoused. But that would exclude folks with physical or developmental disabilities and truly chronic cases of psychosis from the asylum.

He got part of his wish in 1857, after his libel trial, with the passage of the Prisons and Asylum Inspection Act (Smith 311). This created a Board of Inspectors to oversee the institutions in Canada. Five members would be appointed to the Board, and the Chair of the board would be expected to be an expert in the treatment of insanity.

As laws tend to do, it would take a while for this one to go into effect. Although the act passed in 1857, it wouldn’t actually be implemented until December 1859 (Smith 312). During that time, more and more patients continued to be admitted. Between August 1858 and February 1859 alone, over 70 new patients were admitted from police court (327). And again, remember, there is nowhere to house these people. They were already over capacity, and no extra funding was coming their way. So Dr. Workman was forced to close the asylum doors to pauper patients (327).

Dr. Workman wanted a complete restructuring of the asylum population. He believed the incurable lunatics were congesting the asylum and that the government refused to accommodate their care by not constructing a designated facility for them (Smith 328). In 1863, when several patients labeled “idiots” – what we would call folks with developmental disorders – were referred by a nearby jail, Dr. Workman adamantly refused to accept them, citing overcrowding. This time, the Board of Inspectors overruled his decision, and admitted the patients. The Chair of the Board agreed with Dr. Workman that it was a place for treatment and correction but stated, “we are…obliged to crowd these institutions as much as they can be without incurring an immediate danger for the general health of their inmates” (qtd. in Smith 328-9). And to that I say…wait, what? You have to crowd the asylum until it becomes too dangerous? That seems like a problem waiting to happen.

I really feel for the asylum administration during this time – and for the patients who had to live in increasingly poor conditions. Remember how I said in the last episode that Dr. Workman had worked at his family hardware shop for 10 years? And he had been able, at least for a while, to keep up with maintenance of the asylum himself. But with too many patients, not enough funding, and not enough staffing, the building itself began to deteriorate.

Dr. Workman certainly wasn’t perfect -- I find his views on people with developmental disorders highly problematic – and he did seem to understand better than others how different types of patients had different needs. He didn’t want the criminally insane to be housed at the asylum – he wanted them to have their own facility. I can appreciate that. We’ve discussed that in previous episodes. I can definitely appreciate wanting to weed out folks who should not be there in the first place. And I can appreciate wanting to separate folks who need long-term, more intensive care from folks who are more likely to be treated and returned to the community. But regardless, the government wasn’t budging. Funding for other facilities was not happening, so they’d have to make do with the facility they had.

In 1864, former jail inspector Edmund Allen Meredith was appointed Chair of the Board of Inspectors (Smith 317). Like Dr. Workman, Meredith also advocated for the expansion of the asylum system and restructuring of the admissions process. The Board didn’t, however, support Dr. Workman’s efforts to separate the criminally insane from the general asylum (331).

By 1865, Chairman Meredith stated that he was “looking round in vain for room to lodge the unhappy claimants for admission” (qtd. in Smith 333). The solution? He said. “Raise the maximum capacity of the asylum to 400 patients” (Berlyne and Likely). If I were Dr. Workman, I’d probably slam my head on a table in frustration. Just poof, raise the max capacity and there will be more space? Just say the words and walls will start growing?

And before long, they did. Starting in 1866, architect Kivas Tully was appointed to take on the addition of residential wings to the asylum (Bissett). Historian of architecture Tara Bissett writes: 

Tully transformed the complex in a U-shape by adding two four-storey wings flanking Howard’s original building.

Tully added architectural details that introduced a domestic atmosphere to the institution. He broke up the facades of the new wings to resemble rows of townhouses and added bay windows, which were common in late-19th century homes. These domestic additions reflected the ethos of the interior, which cultivated the atmosphere of a Victorian home. The asylum’s corridors were long, well-lit, and unusually broad, acting as indoor pathways and inviting safe social interactions: the long sightlines would avoid startling patients with surprise encounters. (Bissett) 

The attempt, at least, of the new construction was to return to the idea of the asylum being a comfortable and home-like environment where patients could relax and return to wellness. The construction of the new wings took four years and were completed in 1870.

While the wings were being constructed, Canada was again going through major changes itself on a structural and governmental level. On July 1, 1867, the British North America Act was passed, effectively combining the territories of Canada, New Brunswick, and Nova Scotia into one large territory (“British North America Act 1867”). I don’t entirely understand how this worked, but the territory of Canada was also split into Ontario and Quebec. They also were apparently eyeballing Newfoundland, Prince Edward Island, British Columbia, Rupert’s Land, and the North Western Territory, beckoning them to join the Confederation (“British North America Acts”). Spoiler alert: they would later join the Confederation.

The restructured government meant that the Prisons and Asylums Inspection Act of 1857 got revamped, as well. One of the changes that occurred was the passage of the (takes a breath) 1868 Act to Provide for the Inspection of Asylums, Hospitals, Common Gaols, and Reformatories in this Province (whew). This effectively relaced the Board of Inspectors with a single inspector who would conduct inspections of each facility at least three times per year (Smith 337).

There was also a distinction made in the types of facilities throughout the province. A distinction was made between Primary Asylums, like the Provincial Lunatic Asylum, which became known as Curative Hospitals for the Insane, and Secondary Asylums, like the facilities in Orillia and Malden, which would operate as Asylums for Chronic and Incurable Patients (Smith 333). Finally, finally, the admissions process to asylums was being regulated and shaped. Lunatics coming from jail were still getting priority admission over voluntary admits by family (Smith 293), but at least some progress was being made.

Treatment for lunatics during the early 1870s consisted primarily of moral therapy, which required patients to work as part of their treatment; it also included a positive environment and staff to treat patients with kindness. To this end, the Provincial Lunatic Asylum added outbuildings that would be used for patient labor – a slaughterhouse, industrial kitchen, workshops (Bissett). This would provide additional revenue for the asylum in the name of patient treatment.

Moral therapy was used around the world at this time, but neurologist Edward Charles Spitzka of New York denounced the entire profession of asylum medicine, saying that asylum superintendents weren’t even medically qualified to treat the insane (Smith 321). Throughout the US and Canada, Dr. Spitzka’s vitriol against asylum medicine actually succeeded in changing public perception of asylums for the worse. This guy sounds like the ultimate Debbie Downer. Regarding moral therapy, Spitzka said:

Certain superintendents are experts in gardening and farming (although the farm account frequently comes out on the wrong side of the ledger), tin roofing (although the roof and cupola is usually leaky), drain-pipe laying (although the grounds are often moist and unhealthy), engineering (though the wards are either too hot or too cold), history (though their facts are incorrect and their inferences beyond all measure so); in short, experts at everything except the diagnosis, pathology, and treatment of insanity. (Qtd. in Smith 322).

Now, to be fair, moral therapy was really lovely in theory, but I don’t think it could work today. Treatment for mental illness needs to be multimodal and individualized for each person. But as far as treatments go from the 19th and early 20th century, moral therapy was just fine. I don’t think it deserved as much hate as it got from Dr. Spitzka. He seemed to have his own issues with asylums (or power in general) that he needed to work on.

Other types of treatment that were prevalent in the 1860s and 1870s were craniometry and phrenology. If you’re unfamiliar with them, they aren’t cute. They were heavily based in medical racism. I could go off on a rant about this, but I’ll try to contain myself.

Craniometry involved measuring the skull in order to find differences or distinguishing features between different races. People who practiced craniometry used these measurements to make unfounded statements about one race’s superiority or inferiority in different domains. Larger skulls meant larger brains and therefore more intelligence. We now know that’s not the case, but they definitely believed it back then. Craniometry was also used to classify criminal traits.

Phrenology was slightly different but just as icky. It put forth the belief that the structure of the skull contained information about the personality of the person. So phrenology was less about classifying differences among races and more about differentiating individuals with certain undesirable traits. Franz Joseph Gall developed the theory and guess who he tested his theory out on? Folks in lunatic asylums, yes. Now, Dr. Gall never came to the Provincial Lunatic Asylum because he had died long before the asylum was constructed, but that didn’t stop people in Canada from using Gall’s theories to make unfounded assumptions about the patients at their asylum. And, if you remember from the start of the episode, there was a disproportionate number of Irish immigrants at the asylum. And so, published in different newspapers in Ontario were “court sketches” of people with exaggerated skull and facial features who would be considered at highest risk of crime. Did you see a guy with a big nose or a protruding eyebrow bone? They were probably committing a crime, weren’t they? Best to arrest them, just in case. It was essentially the beginning of documented racial profiling (Smith 251).

Pretty soon, new asylums began popping up around Ontario. The London Asylum for the Insane was built in 1870 and started accepting new patients (Smith 370). The term “lunatic” lost its favor in the medical community and so, in an effort to destigmatize mental illness, the asylum changed its name from the Provincial Lunatic Asylum to the Asylum for the Insane in 1871 (“History of Queen Street Site”). In 1875, Dr. Workman resigned as superintendent of the asylum “for reasons understood by myself” (qtd. in Raible). Honestly, whatever those reasons were, I can’t blame him. When he started, there were 200-something patients. By the time he left, there were 956 (“Clark, Daniel”). He held that position for 22 years through some of the worst conditions the asylum would ever see. He didn’t simply put his feet up and call it a day, though. Dr. Workman continued to advocate for improvements in asylums for the next decade.

In November 1875, Dr. Daniel Clark took over as medical superintendent. Dr. Clark had a very eclectic background, to say the least. He was born in Scotland, but his family moved all over the US – panning for gold in California to traveling to New York and the Isthmus of Panama. He went back to Scotland for medical school and then served in the American Civil War as a volunteer surgeon. He then moved to Ontario and began studying insanity, making it his specialty, which helped him land his appointment as superintendent. Like Dr. Workman, Dr. Clark was a no-nonsense kind of guy who was critical of policies that diminished his ability to adequately care for patients. He disliked the overcrowding imposed on the asylum, as well as the admission of “incurables.” Unlike Dr. Workman, Dr. Clark was seen as a loner and somewhat odd. His medical opinions were said to go against every other physician of his day (“Clark, Daniel”). I’m not sure if that’s a good thing or a bad thing.

Dr. Clark was rigid about his expectations for certificates of insanity. He turned away ambiguous and sloppy entries on certificates in his search for evidence of insanity. He clearly felt the tension between his role as an administrator and as a physician (“Clark, Daniel”). 

Treatment of mental illness began to be less therapeutic during his tenure. Dr. Clark was a proponent of the curative effects of restraints (Berlyne and Likely). I have mixed feelings about this because, on the one hand, we still use restraints today in situations that pose imminent risk of danger. On the other hand, the types of restraints they used back then were questionable at best. The YouTube video “If these walls could talk” points out that the asylum used locked room seclusion, chair restraints, leather muffs, handcuffs, straitjackets, and this awful contraption called a “crib bed” (Berlyne and Likely) or “Utica crib.” It was basically an adult-sized crib with shorter sides and a slatted lid on top. The patient would have to lie down in the crib, have the lid locked on top of them (and generally there was at most 12 inches between their chest and the lid), and they would have to remain there until they calmed down (“1880 The Utica Crib”). I’m not claustrophobic, but I feel like that thing would make me claustrophobic.

Other treatments included the cold/wet pack, in which a patient was wrapped in a cold-wet sheet and more cold water was added so the patient remained immobile and cool. The intent was to keep so-called maniacal patients wrapped up until they calmed down (Berlyne and Likely). That just sounds like torture to me. Today there’s a concept called “ice diving” that some patients use. The premise is the same: that the cool feeling of the ice will counteract the heat caused by anger or dysregulation, but it’s done very differently. Either the person will hold a cold, wet wash cloth to their face or dunk their face into a small bowl of ice water. But they’re doing this for a very short period of time, maybe 30 seconds or so, and they choose when to remove their face from the cold. If it’s too much after a few seconds, they stop after a few seconds. But having their whole body wrapped in wet, cold sheets? No, thank you.

In previous episodes, we’ve talked about hydrotherapy and how patients remained in tubs for hours with a covering over them, preventing them from getting out. The asylum in Toronto had this, as well as a shower with about eight different showerheads. Now, some people pay extra to have all those nozzles in their shower, but they probably weren’t being forced to stand there for a few hours being pelted by ice cold water (Berlyne and Likely). Just think of the wasted water…

Patient work was still expected during this time. Pauper patients were expected to work regularly in order to “pay their way” at the asylum. They often were crammed into a room with 18 other patients. About 1/3 of the patient population were paying patients. They had some privileges, such as extra outings and fewer work assignments, if any. Although they had private rooms, the conditions of those rooms had deteriorated drastically by the end of the 19th century (Berlyne and Likely). 

By 1885, even Dr. Clark said that the asylum was “cheerless and barn-life, with a jail-like appearance” (Berlyne and Likely). There were stories of violence against patients by staff, regular deaths by suicide, and at least five escapes per year (Berlyne and Likely). By 1886, Dr. Clark said the asylum was nothing more than a “home for incurables.” Therapy had mostly been lost, and staff were simply trying to maintain order (Berlyne and Likely). 

Even the environment surrounding the asylum had changed by this point. When it was originally built, the asylum was intentionally situated in the country, so that patients could recover in a quiet and beautiful natural environment. By the 1880s, the city had surrounded the asylum, taking away its intended healing aesthetic value (Berlyne and Likely).

After the turn of the century, the term “asylum” was no longer viewed by its original definition as a place of refuge. It seemed to signify all the things that were wrong with asylums – not only the one in Toronto but around the world. Instead, administrators wanted it to be seen once again as a place where people came to be cured of their ailments – a true hospital in the medical sense. And so, in 1907, the Toronto Asylum for the Insane was renamed as the Toronto Hospital for the Insane, showing a step forward in progress.

And that’s where I’m going to pause the story this week. I’m going to speed up the timeline a bit next time and hopefully wrap up the history of the Provincial Lunatic Asylum in one or two more episodes. Then I have some patient stories I can’t wait to tell you, so stick around for those.

As always, thank you so much for listening! If you haven’t done so already, please rate and review wherever you’re listening but especially if that’s on Apple Podcasts. No new reviews this week, so it’s a great time for you to leave yours! Be sure to also check out the Patreon page and Beacons page for other ways to interact with the show.

But, as always, “Do the best you can until you know better. Then when you know better, do better.” Until next time…

“1880 The Utica Crib.” Inmates of Willard, 8 September 2012. https://inmatesofwillard.com/2012/09/08/1880-the-utica-crib/

Berlyne, Naomi, and Sibyl Likely. “If these walls could talk: Stories behind Toronto’s psychiatric patient built wall.” YouTube, 10 May 2013. 

Bissett, Tara. “The Provincial Lunatic Asylum (Centre for Addiction and Mental Health), Toronto (1850).” CanadARThistories. https://ecampusontario.pressbooks.pub/canadarthistories/chapter/the-provincial-lunatic-asylum-centre-for-addiction-and-mental-health/

“British North America Act 1867.” UK Parliament. https://www.parliament.uk/about/living-heritage/evolutionofparliament/legislativescrutiny/parliament-and-empire/collections1/parliament-and-canada/british-north-america-act-1867/#:~:text=The%20British%20North%20America%20Act,a%20single%20dominion%20called%20Canada.

“British North America Acts.” Wikipedia. https://en.m.wikipedia.org/wiki/British_North_America_Acts

Craig, Barbara L. “Clark, Daniel.” Dictionary of Canadian Biography, vol. 14. University of Toronto/Université Laval, 1998. http://www.biographi.ca/en/bio/clark_daniel_14E.html

DiLonardo, Mary Jo. “What is Alcohol Withdrawal?” WebMD, 8 Oct. 2023. https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments

“History of Queen Street Site.” Centre for Addiction and Mental Health. https://www.camh.ca/en/driving-change/building-the-mental-health-facility-of-the-future/history-of-queen-street-site

Raible, Chris. “999 Queen Street West: The Toronto Asylum Scandal.” Canada’s History, 24 Jan. 2016. https://www.canadashistory.ca/explore/science-technology/999-queen-street-west-the-toronto-asylum-scandal

Smith, Maximilian. “The world outside these walls”: Toronto’s Provincial Lunatic Asylum in Context, 1830-1882. Dissertation. September 2019. https://yorkspace.library.yorku.ca/server/api/core/bitstreams/8517fb3d-b50b-44cf-849a-25171ccfcbd4/content