Friday, June 27, 2014

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

Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940 by Geoffrey Reaume
My rating: 3 of 5 stars

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.

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