Moments of Unreason

Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood Retreat, 1883-1923

CHERYL KRASNICK WARSH
Copyright Date: 1989
Pages: 304
https://www.jstor.org/stable/j.ctt80ps8
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  • Book Info
    Moments of Unreason
    Book Description:

    Moments of Unreason is the first detailed study of a private asylum in North America: the Homewood Retreat in Guelph, Ontario, established in 1883 as an early Canadian venture into corporate health care. Cheryl Krasnick Warsh studies the careers of its first two medical superintendents, Stephen Lett and Alfred Hobbs, which spanned the evolution of mental health theory from moral management to mental therapeutics and, later, neuro-psychiatry.

    eISBN: 978-0-7735-6203-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. Tables and Figures
    (pp. xi-xii)
  4. Acknowledgments
    (pp. xiii-xiv)
  5. Illustrations
    (pp. xv-2)
  6. CHAPTER ONE Introduction
    (pp. 3-5)

    The Homewood Retreat of Guelph, Ontario, established in 1883, was an early Canadian venture in corporate health care. The founders of the first large private asylum for nervous and mental disorders in the Dominion intended to address a growing need in late Victorian society - the mental health care of the middle class. The 1880s were a period of pervasive mistrust of public mental institutions. Private asylums, that is, institutions that appeared to profit from madness, also came under public suspicion because they were popularly associated with an older European tradition of madhouses and keepers. However, by the late nineteenth...

  7. CHAPTER TWO Retreat From the Madhouse: Ontario’s First Experiment in Corporate Health Care
    (pp. 6-20)

    The madhouse, the retreat, or the proprietary asylum did not enjoy a favourable reputation in the eighteenth century, nor did it fare much better for most of the nineteenth. Yet in 1883, a group of prominent, affluent Canadian gentlemen, some of whom had long years of experience in public service, formed the Homewood Retreat Association, a commercial, social and medical venture which in the year of its centenary was praised as one of the country’s “super hospitals.”⁴ Homewood is notable from a historical perspective not simply for its success and longevity but for the similarities in purpose and experiences it shared with the madhouses of an earier period. The Homewood...

  8. CHAPTER THREE Asylum Superintendents and the Medical Community, 1883–1923
    (pp. 21-36)

    The success of the proprietary asylum was largely dependent upon the ability and reputation of the medical superintendent. While he had the opportunity to try increasingly varied therapeutic alternatives, he also faced competition from other institutions and practitioners taking advantage of the same opportunity. In the 1880s many young physicians were no longer satisfied with relying on the traditions of moral management that had dominated psychiatric thinking in the 1860s and 1870s. They emphasized physical causation, although there were still traditionalists who remained convinced that neurological investigation alone did not provide the answers for mental disease.

    The shifting contours of...

  9. CHAPTER FOUR The Medical World of the Asylum: Diagnostics and Therapeutics
    (pp. 37-62)

    When Stephen Lett and Alfred Hobbs advanced to the position of medical superintendent of the Homewood Retreat, no doubt they hoped to leave their mark upon Canadian psychiatry. Indeed, in both diagnostics and therapeutics, the men would be able to exploit advances in the medical community and, through the use of increasingly sophisticated techniques, steer their institution into the scientific, research-oriented medical mainstream. But, as will be demonstrated in this and succeeding chapters, their contribution to psychiatry would be continually compromised by patients’ intrusive families, by independently minded and unskilled employees, and by the recalcitrant patients themselves, as well as...

  10. CHAPTER FIVE The First Mrs Rochester: Family Motivations for Commitment and the Dynamics of Social Redundancy
    (pp. 63-81)

    The history of asylums traditionally has been based upon annual reports and intra-professional medical publications. Accordingly, there has been much emphasis upon types of treatment and their failure to cure, the latter demonstrated by the steady accumulation of a chronic patient population. Yet, as Gerald Grob has argued, the institutionalization of large numbers of incurables and the construction of more asylums to meet further demands were not anticipated nor desired by the founders and the physicians.¹ The increase in the custodial populations was not a manifestation of the failure of the institution, but of its functional success in meeting the...

  11. CHAPTER SIX Hearth to Homewood: Domestic Life, Mental Breakdown, and Responses to the Institution
    (pp. 82-100)

    As I have outlined in the previous chapter, families had many motivations, based on personal and social realities, prompting them to institutionalize their relatives. This should not, however, cloud the very real evidence of patients with mental illness whom the asylum attempted to cure. Many of these illnesses found their roots in or were exacerbated by conditions in the household. This was recognized by Victorian alienists, who used the term heredity to include the range of inherited, congenital, and environmental causes of insanity. The household continued to influence the asylum’s patients, and the asylum itself, beyond the point of the...

  12. CHAPTER SEVEN Daily Life at Homewood: The Sub-Culture of Work
    (pp. 101-119)

    Whatever the therapeutics favoured by Lett and Hobbs, sanctioned by the board, or approved of by patients and their families, it was the poorly paid, overworked nurses and attendants who carried out the physicians’ directives with, often enough, it is likely, scant regard for the rationale behind the treatments or the motivations of the families. While the patients of the Home wood Retreat were drawn primarily from the same class as the directors and physicians, the nurses and attendants were “drawn almost exclusively from a social class - and often from ethnic and religious groups — widely different from those of...

  13. CHAPTER EIGHT Resistant Patients and the Reactive Institution
    (pp. 120-143)

    The patient’s life at a psychiatric hospital like Homewood included every aspect of social interaction: authority figures, friendship, language, uniforms, regulations, and routine, all of which could have overwhelmed past identities and experiences. Up to a point, the Homewood Retreat resembled a total institution.¹ Yet for the majority of patients, a number of circumstances worked against their alienation from the external world. Frequent contact with family and friends provided a window on the outside. A high rate of staff turnover, particularly at the supervisory level, detracted from the establishment of ‘big nurse’ territories. Administration was sometimes so inefficient that a...

  14. CHAPTER NINE Because There is Pain: Medical Treatment of Alcoholism
    (pp. 144-154)

    The use and abuse of alcohol were matters of continuing debate for the medical profession in Victorian Canada, as they were for the country at large. Practitioners had been active in the early temperance movements of the 1830s and 1840s but their roles had become eclipsed by laymen, and many physicians became disaffected as moderate temperance gave way to radical prohibition. This disaffection was also the consequence of the concurrent vogue for alcohol as a therapeutic agent, which divided the profession, exposed it to public censure, and undermined the promotion of the exclusive medical management of alcoholism.

    The failure to...

  15. CHAPTER TEN The Aristocratic Vice: Medical Treatment of Drug Addiction in the Nineteenth Century
    (pp. 155-170)

    The Homewood Retreat’s experiences with drug addicts were somewhat different from its dealings with alcoholics, at least in terms of professional recognition. The relatively recent discovery of the process of addiction and its treatment enabled Stephen Lett to enter the field early on. He subsequently was able to create a sound reputation for himself and the Retreat in addiction therapy. The nascent disease of addiction, not yet as value laden as alcoholism, allowed practitioners more professional freedom and less therapeutic interference in treating their patients, most of whom were the socially respectable.

    Although by 1928, the “dope fiend” was portrayed...

  16. CHAPTER ELEVEN Conclusion
    (pp. 171-174)

    When the Homewood Retreat opened its doors in 1883, its founders believed that they had embarked upon a profitable enterprise. Because there was a demonstrated need in the nation for mental health care for the middle class, the founders predicted their venture would find quick success. But the business of asylum keeping, as they were soon to learn, was a speculative one at best. The weighty bureaucratic structure under which the institution laboured rendered the retreat as tied to governmental direction as the public asylums, but without the cushion of taxpayers’ funds. An unforeseen consequence of managing a proprietary asylum...

  17. APPENDIX ONE Prospectus of 1883
    (pp. 177-179)
    STEPHEN LETT
  18. APPENDIX TWO Prospectus of 1915
    (pp. 180-184)
  19. APPENDIX THREE The Life Chart of Emily C. (#94, 1915)
    (pp. 185-185)
  20. APPENDIX FOUR Sample Patient History and Admitting Interview, Clara B. (#27, 1916)
    (pp. 186-189)
  21. APPENDIX FIVE Prospectus of 1934
    (pp. 190-191)
  22. APPENDIX SIX Schedule of Prices for Inebriates
    (pp. 192-192)
  23. APPENDIX SEVEN Instructions for the Use of the Continuous Baths at the Homewood Sanitarium
    (pp. 193-194)
  24. Abbreviations
    (pp. 195-196)
  25. Notes
    (pp. 197-218)
  26. Bibliography
    (pp. 219-268)
  27. Index
    (pp. 269-279)