Insanity
So-called quiet lunatics made up the vast majority of the mentally ill. They were traditionally cared for by their families and the community. People suffering from dementia were institutionalized to prevent them from harming themselves or others. Often kept in chains, they were held in jail or in tiny squalid cells at the Hôpital-Général in Quebec City, Trois-Rivières, and Montreal.
In the early nineteenth century, the government began subsidizing the care of destitute mental patients at these institutions. However, this financial support was far too modest to have a meaningful impact on living conditions.
Amid this deplorable situation, many argued that insanity should be treated in specialized institutions. They drew inspiration from the writings of popular French physician Philippe Pinel, who saw insanity as a disease of the mind that could be treated at specially deigned hospitals called asylums.
A Network of Asylums
The Montreal Lunatic Asylum, the first such institution in Quebec, opened in 1839. It occupied a floor of the city’s jail. The provincial government later began subsidizing the cost of housing destitute mental patients in private asylums, including the Beauport Asylum (1845), the Saint-Ferdinand d’Halifax Asylum (1872), the Saint-Jean-de-Dieu Asylum in Longue-Pointe (1873), and the Protestant Hospital in Verdun (1890).
Having Someone Committed to an Asylum
Asylums were primarily charitable institutions that cared for patients who had been recognized as destitute by public authorities. In these cases, both the province and the destitute patient’s home municipality subsidized the care provided. For someone to be committed to an asylum, a “relative, friend, or protector” had to submit forms completed by a doctor, a priest, and a mayor (or the latter’s representative).
These documents confirmed that the person had a mental illness, was a danger to those around them, and could not be cared for by their family. However, refusal to comply with social norms was often seen as scandalous and a symptom of insanity. This meant that women could be institutionalized for failing to do housework, and men for failing to secure paid employment.
The Beauport Asylum—Saint-Michel-Archange Hospital
The efforts of physicians James Douglas, Charles-Jacques Frémont, and Joseph Morrin saw the Beauport Asylum, the first such permanent institution in Quebec, open its doors in 1845. Morrin sold his shares in the asylum in 1860 to finance the establishment of Morrin College, located in Quebec City’s former jail. Today, the building houses the Morrin Centre. The asylum, which became the property of the Sisters of Charity in 1893, has been known by a variety of names: the Quebec Lunatic Asylum, Saint-Michel-Archange Hospital, the Robert-Giffard Hospital and, finally, the Institut universitaire en santé mentale de Québec.
At the turn of the twentieth century, the asylum mainly housed people the medical community of the time referred to as idiots, imbeciles, maniacs, and melancholics. Seen as favourable to mental health care, the rural setting was intended to support the implementation of moral treatment principles based on Dr. Pinel’s research. But as in other asylums, underfunding and overcrowding compromised this mission. Between 1909 and 1945, the number of patients rose from 1,500 to 3,700.
Sometimes transferred from jail, asylum patients included a high proportion of complex cases deemed chronic and incurable. Medical monitoring was virtually non-existent and recovery rates were low. At the turn of the twentieth century, very few patients were considered cured upon their release. Family members usually played a more crucial role than medical professionals in improving a patient’s health.
Saint-Jean-de-Dieu, Canada’s Largest Asylum
At the turn of the twentieth century, Saint-Jean-de-Dieu was Canada’s largest psychiatric hospital. The property of the Sisters of Providence, the institution had been founded in Longue-Pointe in 1873, when it consisted of a handful of modest buildings. Like its counterpart in the Quebec City area, it was built in a rural setting. By 1922, the facility boasted 24 separate pavilions for treating more than 3,000 patients variously diagnosed as “idiots,” “imbeciles,” or epileptics. In fact, the site was so extensive that it had its own rail network and fire department.
Like other mental asylums, Saint-Jean-de-Dieu suffered from overcrowding and struggled to meet the needs of the many poor families from Montreal and elsewhere whose loved ones required treatment. Patients were rarely seen by a doctor, who tended to only conduct consultations when under pressure from a particularly insistent family. Like the Beauport Asylum, Saint-Jean-de-Dieu had a low recovery rate. Barely 30% of patients who left the facility were considered cured, improved, or even stable.
Verdun’s Protestant Hospital for the Insane
The Protestant Hospital for the Insane was incorporated in 1881. Until that time Protestants had entered the Catholic Saint-Jean-de-Dieu. A group of leading citizens led by Alfred Perry, the city’s fire chief, had raised the need for a English Protestant institution. Land was purchased in Verdun along the shores of the St. Lawrence and construction begun. The first patients were admitted in July 1890. By the end of the year 140 patients had entered, many of them removed from Catholic asylums. By 1908, with 585 patients as well as medical staff resident in the building, the hospital was overpopulated; slowly other pavilions were added.
With the construction of this new hospital, the Protestant community hoped to provide treatment for their own population. The institution was managed by a Board of prominent citizens and doctors and received funding support from the community. The Medical Superintendent, Thomas J.W. Burgess, and doctors including James Douglas hoped to implement a humanistic approach to patient care. This approach advocated the need for a healthy environment and the importance of a schedule of work and recreational activities rather than confinement to both treat and cure mental health problems. Patients worked on the farm, and in activities such as painting and mending clothes. Nonetheless, to a large extent the institution served as a means to isolate people thought by many to be abnormal, often against their wishes.
The hospital was renamed the Verdun Protestant Hospital in 1924, and, in 1965, it became the Douglas Hospital in honour of the contributions made by psychiatrist James Douglas to its foundation, financing, and work in the early years. McGill students trained in psychiatry at the hospital from 1900 but the institution was not officially affiliated with McGill University until 1946. The Douglas Mental Health University Institute is still active today.
Life and Death at the Asylum
Cut off from the outside world, patients in an asylum lived an austere existence governed by a strict and repetitive schedule. Rising at 5 a.m. and going to bed at 9 p.m., they spent their days praying together and taking part in supervised recreational activities, as well as working. Indeed, the principles of moral treatment called for regular periods of work to keep the mind occupied and boredom at bay. Men worked in the gardens and on the farm, while also helping in the kitchen. In addition to kitchen work, women were assigned household chores, sewing, weaving, and spinning.
Few patients could count on a visit from a family member to break the monotony of institutional life. Many were simply “forgotten”, and the bodies of deceased patients often went unclaimed. The law required the Sisters of Providence to transfer such unclaimed bodies to the provincial Inspector of Anatomy within twenty-four hours. In fact, at the turn of the twentieth century, Quebec asylums were the main source of cadavers for dissection at the province’s medical schools. In short, being destitute and mentally ill meant being marked for social exclusion—even after death.
