Chapter Seventeen
I started my psychiatric training at St. Michael’s Hospital July 1st 1960. I was enrolled in the two year diploma course at the University of Toronto with four six-month rotations in various settings and regular lectures at the old Toronto Psychiatric Hospital at the end of the day. Our title was ‘externe’. At that time the terms interne and resident referred to people who actually lived in the hospital. Our professor Aldwyn Stokes was from the old school in the UK where the term ‘house officer’ was used. Since we did not live in and were only there during the day, we were clearly not any of the above so we were externs.
The two year diploma course at Toronto was divided into four 6 month periods. The first two were on hospital in-patient services and the next two were on out-patient services. I had experience in general hospital psychiatry, then mental hospitals. My third rotation was in Forensic Psychiatry and my fourth was in Child Psychiatry.
First Rotation: General Hospital Psychiatry
On the first day at St. Mike’s I met the chief, Dr. Arthur Doyle and Dr. David Lewis, our staff man. My compatriot was Dr. Leo Levinskas also in the diploma course on his first rotation. It was a busy ward of some 30 beds. The main treatment seemed to be ECT (Electro-convulsive Therapy.) Dr. Doyle specialized in depression and that was the best treatment for depression at the time. The treatments were given at lunch time on Mondays, Wednesdays and Fridays and most patients received 6, 8, or even 12 treatments.
The whole ward staff seemed to be involved and we could put 15 to 20 patients through the treatments in the space of an hour or so. Three rooms were used, one for prep, one for the treatment and one for recovery.1 The treatment room was the busiest with Leo or I giving the muscle relaxant and sedative, David Lewis giving the treatment and the other one of us giving oxygen until the patient began breathing on their own again. Then the nurses would take them into the recovery room. It was a real production line that generated many jokes and snide remarks from the staff. One day my colleague Leo Levinskas brought back a sticker from the Ontario Hydro Exhibit at the Canadian National Exhibition which said “Live Better Electrically”. When he stuck it on the ECT machine, Art Doyle was not amused.
It was no joke from the patients’ point of view; they woke up with terrible headaches and significant memory loss that sometimes did not completely go away. But in those days there was no other effective treatment for severe depression with its accompanying high suicide rate. Even the new tricyclic antidepressants such as Tofranil worked too slowly for the treatment of an acutely suicidal patient. But a whole new range of anti-depressant drugs were on the way so over the next decade, the use of ECT decreased to the point that many hospitals no longer offered it.
Besides our ward work, we were asked to do consultations throughout the hospital for our staff man. We also had a day a week in the out-patient clinic. St. Mikes was in the inner city so we got to see some pretty sorry examples of humanity from time to time and some terrible social and living situations. My colleagues had a lot of trouble with this at first but somehow my experience with my Indian classmates in the one-room country school had prepared me for this and more. Despite their outward appearance I realized that they were people with problems just like everyone else. And their mental illness only made it harder to cope with their lot in life.
Fatherhood
As the summer wore on, Fran became more and more pregnant. By this time we had moved to a 4-plex in Leaside. Dr. Porter, our family doctor was managing the pregnancy but over the summer he was in Muskoka and did medical work there. He assured us that he would be back well before Fran was expecting at the beginning of October. We also had taken out a hospital insurance plan with Physicians Services Incorporated (the days before Medicare) but there was an 8 month delay on obstetrics. But we still thought we were alright because it would become effective on September 1st. It was not to be.
August was hot. Fran had always hated the heat but this was worse. She complained of not having a comfortable night’s sleep. She gave up her job at the law firm in early August and we spent the time getting ready for our new arrival. We had bought a crib and highchair and a lot of that other stuff you need at such times. I had raided the barn over at Two Acres and found some furniture for the larger apartment and the baby’s room. I found an old dresser from my childhood that would do just fine. I also found a rather dilapidated sideboard. We managed to get it over to Toronto and I set to work scraping years of accumulated chicken manure off it, fixing the broken door on the front and then refinishing it. I did all this work in the baby’s room which became quite a mess.
On August 31st before dawn Fran woke up with cramps. We were both pretty inexperienced with this so I timed the contractions and they stopped after a while. Then they started again and I decided we should go to the hospital. We arrived at about 7:30 and Fran was taken up to the delivery area at the Wellesley Hospital. I remember phoning Dr. Doyle at St. Mikes to explain that I would not be in that morning. He was most upset because it was an ECT day and I was needed. David Lewis got on the phone then and he was more understanding.
As it turned out Dr. Porter was still in Muskoka so Fran was delivered by the intern with some supervision from the resident. Peter was born at about 12:30 so the labour was not too long for a primipara.2 Today, I would have been allowed into the delivery room. In those days babies were carefully protected by the nurses from all alien forces – like mothers and especially fathers. I reflected that the intern who delivered Peter probably had no more experience than I did. But in this case I was only a father. I had to sit out in the waiting room with all the other expectant fathers. Oh well, c’est la vie.
Finally I was ushered in to Fran’s room. The baby looked awfully small and fragile. And it made a lot of noise for its size. Fran was very tired so presently the baby went back to the nursery and she went to sleep. I went home for a bit and then went over to the parents’ place for supper. I must have lost track of the time because I suddenly realized I would have to get a move on to get back to the hospital before visiting hours were over. I rushed in to Fran’s room to find her crying and very upset. I seem to blow those prime moments in my life.
There was another reason she was crying and I was not there to help her with it. Peter had a large lipoma in his hand between the index finger and the next one. It made his hand look as if it had two thumbs and three fingers. We talked to the doctor who was a bit too offhand about it, especially for anxious parents. However we were referred to the surgeon who explained that this was not uncommon and could be repaired when the baby was about a year old. At that time he had the surgery at the Hospital for Sick Children by Dr. Bob Salter, probably the leading paediatric surgeon in Toronto at that time.
Fran and Peter were in the hospital for 5 days. I was frantically trying to finish Peter’s nursery and get the place cleaned up and presentable before they came home. Also, since Peter was born in August, before our health coverage clicked in, I had to come up with the money for the hospitalization. The doctor’s bill was OK because of professional courtesy. In those days before universal health care, doctors did not bill other doctors or their families. But it was a frantic 5 days.
I made it – barely. Fran may not have been too impressed with my housekeeping but everything was ready for the new baby. Over the next few months we dealt with one problem after another. But by Christmas time, we had parents and friends in for holiday celebrations. I have pictures of Peter with his grandparents and crawling around the floor with various Christmas wrappings and toys.
My last few months at St. Mikes proceeded apace. I remember some fascinating clinical experiences, such as the patient who was convinced that Dr. Wilder Penfield was directly controlling her brain by mental telepathy from Montreal. She was so convinced and convincing that I almost began believing it myself. Another was David Lewis’s preoccupation with Lilliputian hallucinations. He had several schizophrenic patients who saw little men. I mean little people about six inches tall. He had written papers about it.
When one of his patients was admitted to the ward, he came under my care. I remember one morning when I asked my patient how he was, he replied “terrible!” Apparently his father and several of his friends had appeared to him in miniature form and taunted him from across the room. He became angry and shouted at them. They then came and beat him up as he lay in his bed. He said “They really beat the shit out of me. My chest is still sore.”
I examined him but could find no signs of injury. I then was aware that hallucinations can seem very real to patients but there is no substance to them but I thought I should examine him anyway. However since he had not improved after a few days, we decided to use ECT. I sent him down for an electrocardiogram as part of the workup for ECT. The report came back “recent myocardial infarction”. I phoned the cardiologist and asked him “How long ago is recent?” He replied “about four or five days”. I observed that that was when he had hallucinated that his father and friends had beaten him and he had a sore chest. It was really a heart attack. So hallucinations are not always completely off the wall.
Second Rotation: Mental Hospital Psychiatry
This rotation was at the Ontario Hospital, Toronto – the famous ‘999 Queen St. West’. It was the original Provincial Asylum opened in 1850. The new wings were added on the back in 1878. An admitting hospital was added along Queen Street in 1954. It at least partially concealed the old asylum behind, but the famous dome was clearly visible as you came down Ossington Avenue. It was fashioned on the dome of the Hôpital Salpétrière in Paris, the hospital where Phillipe Pinel struck the chains off the lunatics in the 1790s.
Officially all interns and residents started rotations on the first of July and January. I duly reported for duty on New Year’s Day, 1961. Everything was closed. The supervisor on duty suggested politely that I should come back tomorrow. I humbly returned home to apologize for getting everyone up so early on New Year’s and Fran remarked: “I told you it was a holiday.
The next day I was issued a white lab coat and assigned to one of the Male Units under Dr. Josep Grodzinsky. Dr. Howie Trupp was the senior and there was one other first year externe assigned. We had about 250 patients in total on about four wards. The hospital was divided exactly down the middle with male patients on the west side and female patients on the east side. Overcrowding was terrible. They even had a ward in the base of the dome which had to be accessed by a precarious curving staircase.
The admitting ward for our unit was in the new building on Queen Street. There were about 50 patients in a ward that today would hold about 30. Back in the old building there were two wards so tightly packed that the dormitory had 27” beds down both sides, two beds together separated by a small bedside table, and an additional row of beds down the centre of the room so that you almost had to walk sideways between the beds. The day room was a long room?? about 12’ wide with a 10’ ceiling with two rows of chairs facing each other along the walls. This arrangement discouraged conversation or social interaction. It was too far to talk to people across the room and you had to twist around to talk to the person next to you. The nursing station was almost like a guard tower at the far end. The movie One Flew Over the Cuckoo’s Nest was filmed at the Washington State Hospital and when I saw it I felt like I was back on that ward at 999 yet again.
Another ward for very chronic debilitated patients was behind the main ward in the so-called new wings from 1878. It was even worse. The smell of urine, feces, unwashed bodies and paraldehyde was nauseating. Patients wandered aimlessly around in various states of dress or undress. Some hung around the locked doors, hoping to get out when a staff person opened a door. Sometimes they succeeded and ran down the hall but soon seemed to be unsure what to do next and were corralled and herded back to their ward.
Externs were on duty about once a week. It was a harrowing experience. You had to make rounds about every hour or so and you could be called to a ward by a paging system of flashing numbers on panels in most hallways. Entering the ward was a challenge. You had to open the door slowly with a large skeleton key on a huge heavy ring watching closely for patients hanging around the door who might jump out at you. By comparison, the cockroaches at the Banting were downright friendly.
I remember I was quite discouraged and was again asking if I had made a mistake to go into psychiatry. In retrospect I was probably clinically depressed. I remember talking to Dr. Grodzinski about it and he reassured me that things would get better. He also told me that the World Congress of Psychiatry was having its second international meeting in Montreal in the early spring and many staff people from the OH Toronto were going. When these people returned from the meeting they were very enthused and this helped all of us to feel better.
Cars
While I was at OH Toronto, one of the guys (Roy Hallett) approached me about trading cars over an upcoming holiday weekend. He had a 2 seater Triumph TR3 sports car that he had fitted with roll bars and could not accommodate the 4 people that were going. My old Vauxhall that had barely got us through a Montreal winter was not in good shape. Among other things the synchromesh on high gear had gone so shifting gears was a noisy business. Roy knew how to double-clutch it to make it easier so he said he could manage. So Fran and I had a real sports car for the weekend. We drove around to show our friends.
Later in May my Vauxhall was broadsided by another car that had gone through a stop sign. It was clearly their fault so my insurance declared that my car should be written off and they offered me $500. When I saw what I could get for $500 I decided to have the car repaired and I would pay anything over that amount. So Sally limped on for another while.
As summer approached, I had taken the family out for a Sunday drive. We had gone through the hills and dales and then as we headed home, a rear wheel came off. It did not detach completely but I had no brakes and was only able to stop by letting it coast into a shallow ditch. That was it. I was horrified to think what would have happened if the wheel had come off on one of the hills we had just come from. We could easily have been killed or seriously injured. So Sally was gone to the boneyard. After that I was able to borrow my father’s second car sometimes but could not use it all the time.
Links to the CIA? Brainwashing?
In the 1950s the Department of Psychiatry at McGill was in its heyday. The Chairman, Dr. Ewen Cameron was unquestionably the most prominent psychiatrist in Canada. He was well known internationally and attracted some of the finest minds in the world to McGill. They produced cutting edge research. Everyone was talking about the amazing things that were happening there. It was all linked to the American veterans returning from the Korean War. When I told them that I had recently spent a year at McGill with four months on psychiatry, my stature rose with my colleagues. It seemed that anything was possible.
The American military were still in a state of shock from the effects of “brain-washing” on their troops in the Korean War. Research money became freely available. There is no question that Cameron worked closely and was used by the U.S. military. They channeled millions of dollars (1950’s dollars at that) through reputable foundations into research and they wanted the best. Cameron was determined to give it to them. He hired some of the best researchers such as the psychologist Donald Hebb and Dr. Heinz Lehmann who pioneered research into new drugs that were just coming out. Everyone wanted to train there. Over the next few years we also watched as much of the research that Cameron was doing turned sour and his involvement with the U.S. military became his downfall.
This was later described as a CIA plot. I did not know anything about that. But even as a very junior resident in 1959 I was aware of the origin of the money flowing into the department, and, to us, there did not seem to be anything secret or unethical about it. Other Departments of Psychiatry across Canada were very envious of Cameron because he had managed to capture so much of this money. And this money built the psychiatric program at McGill.
But Ewen Cameron was a better administrator than a researcher. His subsequent fall from grace and the harsh posthumous criticism arose because of two factors. The first was that psychiatry had had so much success so quickly I think it went to our heads. We sometimes deluded ourselves that in a few years we would have all this “mental illness stuff” licked. Many felt they could do no wrong. The second was that Cameron did not consult and often undertook things that were far beyond his (or for that matter anybody’s) capacity to do and when they went wrong, they really went wrong. It was said of him that he did not suffer fools gladly – and everyone who disagreed with him was a fool.
As Cameron’s career unravelled, people began to desert the sinking ship. At one point in the late ’70’s all but two of the Chairmen of Departments of Psychiatry across Canada had trained under Cameron at McGill. They were sardonically referred to as the McGill Mafia.
Psychiatrists were (and are) rather naive. My uncle often insulted someone by saying: “He believes what he reads in the newspapers.” In the ’50’s, I’m sure he would have said that of psychiatry. For many centuries, the care of the mentally ill had been such a low status occupation that there was very little interest in it, not only within medicine but among people generally. Suddenly, it had become an area of considerable scientific interest and everyone wanted to get into the act. Psychiatrists were not familiar with being in the political limelight and some of their responses under stress were – shall we say – less than helpful. When the criticism began to mount, they couldn’t understand what had gone wrong. “After all we are such nice guys and we only want to help people!”
Third Rotation: Forensic Psychiatry
In July I started my rotation at the newly created Forensic Psychiatry Clinic of the Toronto Psychiatric Hospital. TPH had an in-patient service with a few beds under the direction of Dr. Kenneth Gray who was both a physician and a lawyer. In 1956 the sexual assault and murder of three young children in Toronto by a 17 year old man, Peter Woodcock raised the issue of sexual violence and murder by persons with presumed mental illness. The clinic was set up in 1956 as a result of this.3
Dr. R. Edward Turner was the director with Johan (Hans) Mohr as research director. It was a very interesting place to work and all the externes wanted to go there. I went to the clinic on Queens Park Circle on my first day and was introduced to the whole group. I was particularly interested in the research program led by Johan (Hans) Mohr. They were studying sexual deviations, now known as paraphilias. When their book came out in 1964 I purchased a copy which I still have.
Most of the cases came in from the courts and each of us was assigned them as they came in. Homosexuality was illegal at that time and members of the ‘gay’ community were persecuted and prosecuted by the police. There was a bathhouse in Toronto that was raided and found-ins were harshly treated. There was much reaction but it had little effect on what was seen as a perversion. We had many referrals to the clinic, mostly from the police. I remember one in particular.
Another popular spot was a secluded men’s washroom in High Park. It had cubicles that were open at the top under the pitched roof. The police found a way to sit above the cubicles so they could look down on what was happening below. When they spotted a homosexual encounter, they radioed to the cop who was outside so that the two men would be arrested as they were leaving. My patient was so disgusted by this that he asked, “Tell me doc who is more perverted, me or the voyeuristic cop who spies on us? I had no answer for him.
We had regular meetings with Hans Mohr and Ed Turner. Ed discovered that I did not have a functioning car and was coming down on the bus from Leaside. He said that he lived just north of me and would give me a ride whenever he could. This worked on many days. Also we had friendly lunches in the staff room. I remember that the chief psychologist had a 1936 Dodge sedan that he was restoring. More than once I saw it parked on the side of the Don Valley Parkway – presumably while he went for help.
By June 1961, the University Subway Line was under construction. Unlike the Yonge Street Line that used the cut-and-cover method with Yonge Street closed or covered with planks for varying periods, The University Line was bored underground so that it would not disturb the Legislature buildings just above. But we sometimes heard noises in the clinic.
Fourth Rotation: Child Psychiatry
On January 2nd, 1962 I started at the Children’s clinic on Grosvenor St. just a few blocks east of the forensic clinic. It was winter and my father had loaned me his big Pontiac to use in bad weather. There was limited parking there but I usually found a spot. It was also a very good rotation. They had a strong psychology group and we received a series of lectures on Learning Theory and related subjects. This started with Pavlov’s dogs, on to operant conditioning and animal studies on how rats learn to run mazes. We learned about Thorndike, Hull, Skinner, Olds and Mowrer.
Joseph Wolpe had pioneered new psychotherapy techniques that he called ‘reciprocal inhibition’. Harry Harlow was famous for his work on surrogate mothers. He used rhesus monkeys that were still nursing and found that they would attach to a terry cloth model of a monkey with a nipple of a nursing bottle exposed. John Bowlby, working with orphans who had no attachment to a consistent care-giver, found that they developed psychological problems and were never able to relate to consistent adults in their lives. Conrad Lorenz and Nicolaas Tinbergen had studied instinctual behaviour and created a new field called ‘Ethology’ Jean Piaget studied and began to explain the cognitive behaviour of young children. The whole field of psychology was opening before us.
Family Life
When my father died in April, we spent more time at the cottage in the summer. The old cedar strip boat with a 5 HP motor was in bad shape. I decided to buy a new one. I got a 14’ aluminum boat with a 15 HP motor that would really move. I remember taking it to the cottage to show the folks and it became very popular. I had to teach the boys the rules of the road and caution them about starting slowly and keeping a lookout. There were a couple of untoward incidents. Richard was driving when we were approaching ‘Elephant Rock’ in Soyers Lake when he approached too fast and rammed the rock. It broke the cleat on the bow but I was able to put on a new one. Another time one of the Richardson boys prevailed on me to let him drive it. He started it and then pointed it out to the lake. He suddenly applied full power; the boat lunged sideways and rammed the raft, damaging both raft and the bow of the boat. I never let him near it again.
In May 1965 the American Psychiatric Association’s Annual Meeting was in Toronto. All of these bigwigs were there. And Ed Turner was being made a Fellow of the APA. We all attended and it was at that time that I became a member of APA, a membership that I still have many years later.
At the Child and Adolescent Service I worked with children too. The parents worked with a social worker. Often we would meet together to discuss a child’s development. I remember one child who played on the floor but paid no attention to me. We called this ‘parallel play’ and Piaget had described this in very young children. I wondered if he was mentally retarded (the term we used then) but when I spoke to the mother, she said that he had taken his (mechanical) alarm clock completely apart and put it together again – and it worked. This was my introduction to Autism. I remember another occasion when I was reassuring a mother that her child would be well treated in the clinic when from the next room came explosive out bursts of swear words, “s–t, f–k”, other offensive words. The mother was not impressed but this was my introduction to coprolalia, part of the Tourette syndrome.
This was a rich and rewarding experience for all of us. I was sorry when it ended in June. But I was then to take on a seniour externe position at the Toronto Psychiatric Hospital. That fall we had the diploma exams and we studied for them. I remember that my examiner was Dr. Griff McKerracher who had made his name in Saskatchewan. I apparently did well and this helped me in my new position.
Seniour Externe at TPH.
The pay was very poor for people in training. I remember that as a junior interne in 1957-8 I received $45 a month. At the Queen Mary Veterans’ Hospital this was increased to $200 a month so we could not have survived without Fran’s earnings at the law firm that were about $265 a month. As an assistant resident in pathology I received $250 a month so when Fran became pregnant and stopped work we had to dig into bonds that my uncle Eric had left me in his will.
When I started on the Diploma Course, there was a plan that paid better if you gave a return of service in the mental hospitals after becoming a certified psychiatrist. I elected not to do this so my stipend was $400 a month for the first two years rising to $500 a month in the third year. We struggled and I had to get some help from my parents. We had bought a house in Don Mills in June 1962 and they offered us a mortgage at nominal interest.
I started the year with high hopes. I was supervising a couple of juniour externes and working with my roster of patients, most of them on the third floor which was a research floor. The Chairman of the Department and director of HPH had a pet project there so he was on the ward frequently. The assistant director was Dr. Mary Jackson and she worked with women. The men’s ward was directed by Dr. Alex Boncalo who gave us a course on phenomenology, a field that seems to be neglected nowadays. The director of the women’s ward was very interested in hysteria, that erstwhile diagnosis that had survived from the 19th century and Dr. Charcot at the Salpetriere Hospital in Paris. I seemed to spend my time there dealing with threatened or attempted suicide and there were some really scary incidents. He died suddenly about halfway through the year. Mary Jackson told me quietly that it was suicide.
There were Grand Rounds in the auditorium every Wednesday and all the externes and others were expected to attend. I got to know just about everybody in psychiatry. I remember a classmate Dr. Alan Davidson gave a great rounds, complete with audio-visual effects on the topic of brainwashing that came out of the Korean War. Also we had Professor William Sargent, whose brother was Malcolm Sargent, the famous conductor. His topic dealt with the revolution in psychiatric thinking around the world and it inspired us to think about all the changes that were happening at that time. I remembered my father’s concerns about psychiatry being unscientific and this reassured me. But this canard is still raised today by physicians and others.
We were so short staffed that I became the interim director of the women’s ward for a while but I found that attending team meetings, covering duties elsewhere and trying to keep up with my studies was exhausting. In the spring they hired Dr. Phillip Melville to take over the research unit and to assist me on the women’s ward. Phil was an experienced clinician who had much experience in community psychiatry that had become a current buzz-word. I got to know him very well over the next few years. He took on some very difficult tasks such as becoming Medical Director of the newly formed psychiatric hospital in Timmins at South Porcupine. I remember visiting him there when I was a consultant with the Ministry.
Junior Staff man, at the Day Care Centre
When I ended my training in the Diploma Course, I was hoping that I could get a teaching appointment with the Department but that was not to be. I first went to the Day Care Centre in the old church on College Street in 1963. It was a good year. I saw lots of patients who were in various groups and learned about group therapy. I also reviewed a book: Strategies of Psychotherapy by Jay Haley. This introduced me to the so-called ‘Palo Alto Group’ at Stanford University. They had developed what they call Communication Theory and were very productive. However they fell into bad odor when Don Jackson and Gregory Bateson came up with the concept of the schizophrenogenic mother. This outraged mothers and those working in schizophrenia, and the Palo Alto group has faded from sight. It is simply not discussed these days.
I also worked closely with my supervisor in psychoanalysis, and learned a lot about psychotherapy. This was not taught at Toronto. The Chairman, Aldwyn Stokes had studied under Aubrey Lewis at the Maudsley Hospital in London and their orientation was very organic. But most other psychiatric centres in North America were oriented to psychoanalysis so this left a gap in our training. I continued my supervision when I went to the Queen Street Clinic the next year.
I was studying for my Certificate in Psychiatry that fall. I had checked with the Royal College because I had a fifth year (in pathology) so I might have written them the year before. But they decided that this year did not count. As I remember, the written exam was at Sunnybrooke Hospital in September. I passed that so I moved on to the orals, held at TPH in November. There was a panel of several eminent psychiatrists, several of which I had met before. I was asked a question about tertiary syphilis that I knew quite well but they were looking for another point and when I drew a blank, they coaxed me until finally I got it.
The results would be announced at 6 o’clock so I looked for a place to wait until then. But I was so worried about my problem that I couldn’t think of anything else. Finally when I returned to TPH, they took us in one at a time to give us the results. The suspense was awful. Finally when it was my turn, I went in to be congratulated with hand-shakes all around. I couldn’t wait to get home to tell Fran about it. All she said was “I knew you would pass”.
I remember that my classmate Ian Hector who was one of the brains in the class had decided after completing the Diploma Course that he and his young family would study in the UK. He had a year at the Maudsley and then another year at Queens Square (neurology) and had returned home, prepared to write the exams at the same time as I was. But he was so confident that he only applied to write the fellowship instead of the certificate exams that I was doing. Amazingly I passed and he didn’t. so I was a qualified psychiatrist for a whole year ahead of the class brain. But Ian and I were on good terms throughout our whole careers.
I remember one other incident that fall. The assassination of President Kennedy took place in November and this was big news for all of us. We viewed the scenes several times on our little black and white television in the basement at home. They played it over and over again until it was burned into our memories. Peter was just old enough to understand but the twins were too young but later they seemed to know about it.
I was back at the Day Hospital and told everyone there of my success in the exams. After another round of congratulations, we all settled down to work again. Dr. Bruce Quarington was the leading psychologist and he was working on the use of computers and data analysis in psychiatry. Since the data in psychiatry is soft, it required big computers to handle and work with the data. They had been doing it by hand with a calculator and it took many hours to solve one problem. on the computer, these things only took a few minutes. I was to work with this more when I went to Whitby a few years later.
During that year, I made friends with Hugh McLeod who was a psychologist at TPH. His father was the recently retired Moderator of the United Church of Canada. We had many discussions over religion and Hugh’s comment was “I’m not sure if I am agnostic or simply a doubter but I think religion is irrelevant anyway”. I remembered my thoughts about religion after leaving TCS. Hugh and I set up a car-pool but because I didn’t have wheels, he did most of the driving. We remained good friends for many years after that.
Towards the end of the year I asked the chairman for another appointment. This was granted but I was told it would be the last one. In July 1964 I started at the Mental Health Clinic in the OH Toronto on Queen Street West.
Junior Staffman, at the Mental Health Clinic
In July, 1964 I started my year at the Queen Street Mental Health Clinic. Donald McCullogh was the director and Farrell Toombs was a teaching therapist. Farrell was very much into Rogerian therapy4 where you simply reflect back to the patient what they have just said. He also had a great library and I remember I borrowed a book and didn’t return it when the year was over. A year or so later while Fran and I were attending a Toronto Symphony concert, Farrell came up to us and reminded me of the missing book. At the next concert I gave it back to him.
I was still getting psychotherapy supervision and my tutor asked me to pick a patient that we could discuss. I worked with that patient the whole year and practiced much of what I had learned with him. He improved considerably and I continued to work with him for a while after the year was over.
We also had regular sessions with Stan Freeman. He encouraged us to explore society around us from various perspectives. We invited people from the CBC and from other places that really gave us a rich experience. Later, when I was at Whitby, Stan was working on a newly developed project that would send pictures over telephone towers around the province so that we could interview patients in remote locations. But telephone towers had a narrow bandwidth so it meant that the screen was only refreshed every 20 to 30 seconds. This made it very difficult to see the patient’s change of expression during the interview.
They also set up a dedicated line between Western University in London and a university clinic in Woodstock. The low towers worked fine all winter but in the spring they deteriorated until finally they did not work at all. Stan and the technicians discovered the problems. The low towers were not above the taller trees and the leaves had come out. But it was a very challenging experience. There were so many changes that I was somewhat prepared for the many changes along the way.
Another thing happened that was much closer to home. I had returned from lunch when the secretary called and said that my wife had called very upset because Stephen had fallen down the stairs and the bottle he was carrying had broken and a ragged shard had driven into his left eye. Fran was a Sunnybrook emergency and I jumped in the car and got there as fast as I could. Fran met me at the door and said that fortunately the shard had gone in beside the eyeball but had not ruptured it. He was going to be alright. But the long scar beside his left eye is still noticeable today.
I decided that I should try the fellowship exams at least once because I could sense that that was the way things were going. The Royal College at that time did not regard psychiatry as a separate specialty – it was part of neurology and medicine. The pass mark was set at 75% and the failure rate was appalling – about three quarters of the candidates failed. I set about studying but several things were working against me. My father died in early April and there was much to do about the funeral and support of my mother who was in mourning for a while but then began to plan the rest of her life. I remember cousin Harry arrived from Regina and many other family and professional friends contacted us. By then it was early May.
My father-in-law had bought a new car and decided to give his 1958 Rover to me as we did not have a car at that time. I remember Hugh McLeod’s cry of relief that now I could share in the driving. I registered to take the fellowship exams in June. Also, I was working full-time and found it hard to study. I did my best but I failed the exam in September.
In the spring things continued on smoothly although I did not get along with Don McCullogh very well. As we agreed, we were not a ‘good fit’ so I knew that I would have to find another job in July. I checked with the Juvenile and Family Court and was invited to become a part time consultant in psychiatry. This offered me an income and half a day to study for the fellowship exams which I was planning to take in the fall. I also applied at the Wellesley Hospital and at the North York General which was just opening and had an out-patient psychiatric clinic that was looking for people.
I also had heard good things about the OH New Toronto and applied there. Dr. Clinton Moorhouse was the Superintendent and Dr. Gary Cormack was the Assistant Superintendent. They had a mental health clinic in the old superintendent’s house on the grounds. I could start immediately whereas the hospital appointments would take some time longer.
To the Ontario Hospital New Toronto
I had spent time at the O.H. Toronto, then at Toronto Psychiatric Hospital, and eventually at O.H. New Toronto. This hospital was more like my Montreal experience and less like this Toronto experience. The Superintendent was Dr. Clinton Moorhouse and he was determined to move the hospital into the second half of the twentieth century in a hurry. While at New Toronto, he had the Department accept a name change to Lakeshore Psychiatric Hospital. Shortly after I arrived, the Medical Staff Bylaws were approved and we were applying for hospital accreditation.
Dr. Moorhouse had also persuaded Dr. Gary Cormack to come as Assistant Superintendent because Clint was approaching retirement age and he wanted a smooth transition. Gary was one year ahead of me at U. of T. and was also in the University Naval Training Division with me. However I took a four year Arts course instead of Premeds so he finished several years ahead of me. After his psychiatric training he worked with Dr. Moorhouse in the newly opened Mental Health Clinic in Cobourg. It was housed in the old Victoria University building, appropriately enough on University Avenue. The university had moved out in the early years of this century to become Victoria College in the University of Toronto. But the Greek revival building was still the “University” to the people in Cobourg. And the Mental Health Clinic was hence given added status.
There were no separate standards for mental hospitals in those days and we clearly could not comply with the general hospital standards. For one thing we had no surgical service or operating rooms. (This was ironic because when I went to Whitby two years later, they had just closed their surgical service and a few hospitals were still doing psychosurgery. However I do not think that this would have met the accreditation standards.)
Clint Moorhouse convinced the Canadian Council on Hospital Accreditation that his hospital was a specialty hospital and therefore only needed those services which the specialty demanded. It was only a few years after that that the CCHA began to develop specific standards for mental hospitals.
In July, 1965 I started half-time in the Mental Health Clinic under Dr. Leonard Bow. We were located in the previous Superintendent’s House (Clint Moorhouse did not believe that staff should live on the grounds). We had an outreach service and a children’s’ therapy service. We did consultations for local agencies. It was a dynamic place to work. I was able to practice all my psychotherapy skills. I worked closely with the psychologist and soon developed a good practice. I also was expected to run the day care centre that was on the same floor. I did some work with children and families and it proved very interesting.
I was also put in charge of educational events for the hospital. On one occasion I heard that Dr. Abraham Hoffer was giving a lecture in Toronto on the adrenochrome theories of schizophrenia. I invited him to give his lecture at LPH when he was in town. It was a very interesting lecture. They had very good results on the Monroe Wing of the Regina General Hospital using adrenalin and derivatives such as nicotinic acid (Niacin) in large doses. But they also had all the amenities on the ward, such as psychotherapy groups, occupational therapy and much more. After much discussion we concluded that if we had all that going for us, we could have had much better results and it wouldn’t have mattered if we had used nicotinic acid or not.
The psychology department had set up a clinic off the grounds where they were using behaviour therapy techniques with patients who had what was then called sexual deviations. I was invited to do psychiatric assessments there. I had several patients who had pedophilic drives and I remembered my days in the Forensic Clinic. They were using aversive conditioning in which they would show the patient pictures of young children in various states of undress. If the patient showed signs of arousal, they administered an electric shock to the hand and gradually the arousal would disappear on seeing the same pictures. One of my patients became very depressed and told me he had considered suicide. I reacted to this but he pointed out that without his sex drives he had nothing to live for.
Steel Fire Escapes and the Civil Service Attitude
While I was there I learned some of the reasons for this attitude. I was brought to a new realization of how the civil service mentality influenced our lives and work.
I was given a small office in the old Clinic building. Outside my window was a relatively new-looking fire escape from the third floor where the children’s play-therapy room was. One day I began musing on the design of this fire escape. It was a fairly standard design of those years, with a steel angle-bar frame and steel slats in the steps. Some designs where security was a consideration had the lower section hoisted up so that people could not climb it from the ground. On this one however, the steps came right to the ground and were anchored to concrete slabs. Around the whole base was a seven foot chain-link fence with three strands of barbed wire sloping outwards at the top. At the foot of the steps was a gate in the fence which opened outwards with a padlock hasp on the outside. The padlock had been removed and the gate was partly open.
I wondered what the point of the fence was if the gate was standing open. I also wondered if it were closed, how one would open it in a fire emergency from the inside. It was not too difficult to find out. Len Bow told me when I asked.
The Public Works Department of the Ontario Government apparently did not allow fire escape designs with a movable lower section because someone may get hurt on it. However in a mental hospital, you did not want patients climbing it and jumping off. Hence the fence. And a fence has to be opened from the outside because that’s the way they have to be. Security guards must be able to check the lock.
Dr. Len Bow had noticed the arrangements and observed: “I could just picture a fire and taking children down this thing and being trapped inside the fence with the hot bricks coming down.” He had had the padlock removed and found that the hasp had a latching feature so that unless the gate was ajar, it could not be opened from the inside. So he had blocked it so it could not be closed.
My introduction to the Civil Service mind? It is perhaps surprising that I decided to stay in the Civil Service after that introduction. None of my patients had thinking which was any more illogical than that. But after seeing the full range of psychiatric syndromes and working with community agencies and professionals at Lakeshore I came to realize that what we all believed in school was dead wrong. Mental hospitals were not dead ends. The staff were not incompetents, but dedicated people who did an excellent job under the most difficult circumstances. The patients also were people just trying to cope with crippling illnesses the best way they could. And the different clinical presentations were amazing to a young psychiatrist who was still pretty wet behind the ears. By contrast, I realized, the other psychiatrists were dealing mainly with the worried well. Truly in psychiatry, this was where the action was.
This would be my second attempt at the Royal College exams. But I was now working full-time and trying to find time to study. Also I was attending a set of lectures on medicine and neurology that was offered at the Toronto General Hospital. It was a very busy schedule and again I had little time to study. Fran decided that she should go to the Sault with the kids for the summer, going up on the July 1st weekend and coming home on the Labour Day weekend after the boys’ birthdays. We drove up in the Rover and I returned a day or so later. Then I buckled down to study. I couldn’t wait until the Civic Holiday weekend when I flew up to the Sault so that I would have the whole time with the family. Then it was back to the grind. I found myself being distracted so easily – at one point I was painting the kitchen.
After the family returned, it was only a week or so in September before the exams. I failed again but checking with my friends, I was in good company. Most of them had failed as well. I decided that that was enough because there were rumours that the Royal College was reconsidering whether psychiatry should be its own specialty with separate criteria for knowledge and exams. However, this did not take place until some years later when I was at Whitby when they decided to allow people with certificates to apply for fellowship.
Raising the Boys
I had always felt that my father did not pay attention to me until I was old enough to have discussions, even arguments with him. So I was determined that I would not let that happen to my family and my boys. I was very busy during the week but on weekends we were always together. We had time at the cottage and I remember that Peter had his first birthday there. I took him out in his stroller around Leaside until the neighbours got to know him. By 1965 we had three boys and I bought a double stroller so that we could take the twins around. Peter would walk beside us. It was a very happy time for all of us.
I was interested in downhill skiing. I started at TCS, but when I was in university I did not go very much. In Montreal I had not taken my skis so I did not ski in the Laurentians. When we were back in Toronto I began going out with Herb Rogers many weekends in the winter. Our favourite spot was the Hockley Valley Ski Club. I remember the great ice storm in 1963 when all the telephone lines sagged to the ground and the driving was terrible. I also remember visiting Beaver Valley ski resort before it became a private club. I had to upgrade my equipment because the old cable bindings were too hard on my ankles and the boots hurt my feet. But it was fun and presaged better things down the road. I took the boys to a local hill in Toronto but there was no tow and they found climbing the hill herringbone style was difficult and boring. I then took them a couple of times to a place that had a rope tow and that was a bit better.
After we moved to the house on Cottonwood Drive in Don Mills We were regular church attenders at the Church of the Ascension in Don Mills. The founding rector retired in the 1970s and a new rector Beverley Brightling was appointed. He was much younger and energetic. I found myself appointed Warden and Fran was the Chair of the Outreach Committee. After my term of Warden, Bev approached me about becoming the delegate to All Saints Church in downtown Toronto.
All Saints Church
After my term of Warden, Bev approached me about becoming the delegate to All Saints Church in downtown Toronto. The church was at the corner of Sherbourne and Dundas not too far from St. James’ Cathedral on Queen St. East. It had been a leading church in the downtown area for many years but many members had moved to the suburbs and the area was increasingly populated by immigrants and other socially deprived people. The diocese decided to deconsecrate the church and it became a social support centre. The Rev. Norman Ellis became the Director and he did many amazing things. Norman Ellis had been rector of a church in Bootle in Liverpool England near Merseyside, the home of the Beetles. He had all the experience for this new challenge.
All Saints was in very poor repair. The congregation had no money; it was directly supported by the diocese but was seeking support from other churches who could take this on as an outreach project. Beverley soon approached me to become a member of the All Saints board. I visited the church and talked to Norman and he inspired me to take this on. The church was in terrible condition. There was a 4 manual Casavants organ that only emitted squeaks and rumbles. The leathers were gone and repairs were out of the question.
Norman had taken all the long pews out of the nave and it was turned into a social centre. Booths were set up by CMHA and an outreach clinic from Queen Street Mental Health Centre. There were two groups for indigenous people and the parish hall had been turned into an all-night drop-in centre for street people. It was especially popular in the colder weather when the shelters were full and park benches were cold. The doors were opened at 5 pm and a hot meal was offered. Norman turned it into an agape supper and celebrated communion for all present.
There were a few couches and chairs but those who came later had to sleep on the floor. Sometimes fights would break out so Norman hired some bouncers from the bars on Jarvis Street to come in and keep order. This worked well because no-one wanted to be banned from the centre. When I was first there, it was a very active place and I soon found myself as chairman of the board and this meant increasing involvement with the diocese. I also visited parishes that supported the work and gave them a spiel about the work we were doing.
We attended the Sunday church services occasionally but the only one of our family who took to it was Richard and he would come with me often. I continued at Lakeshore during most of this time so I had many evenings out. I got to know Norman’s wife quite well and also some of the women who prepared the meals and did all the other work around the church.
The Great Power Failure and Other Memories
On November 9th, 1965 most of eastern Canada and the US were blacked out for almost a day. I was at the Lakeshore PH when suddenly the hydro power went off and after a couple of brief flashes we were blacked out for almost a day. Soon it was decided that only essential services could stay under emergency power and the rest of us were sent home. I phoned home (Bell telephone has a separate power system) to discover that home was blacked out as well. Apparently, the new networks had linked electricity supplies in a circle around the Great Lakes and it suddenly went into an endless loop that triggered an overload shutdown. When I got home, the house was lit with candles and I started a fire in the fireplace to keep us warm. In the early morning we were awakened by all the lights coming on, and off, and on again. But the voltage was low in what was called a ‘brown out’. But I guess it caused a lot of changes in the network because we never had this happen again.
We also were starting to have car problems. The old Rover was in the shop a lot. I was taking it to Jan Weitzes’ garage on Mt. Pleasant Avenue and he had done a lot of work on it. At one point we had to replace several gears in the transmission. I decided we needed a new car. Consumers Reports had recommended the Plymouth Valiant as the ‘best of the compacts’ so I was soon at the local dealership to buy a new car. It was the end of the model year so there were some bargains. We got a yellow one.
1965 was the first year that seat belts were required on all new cars. They were just lap belts in the front seats but I told the salesman that I wanted three belts in the back seat. He argued with me that they were not necessary and then said that I only needed two. But I explained that I had three kids. His eyes bugged out, his mouth fell open and he exclaimed “You’re going to make your kids wear them!!” Soon it was the talk of the dealership, but I got my three seat belts.
Edmonton and the Rockies
Also I was attending conferences of the OPA and the CPA. In June 1987, the conference was in Edmonton. We flew to Edmonton with a stopover in Winnipeg. The conference was in a downtown hotel and we had joint sessions with the CMA meeting. We also had a chance to pan for gold but I was not very good at it. When the meeting was over, I rented a car and we drove to Jasper, staying in a hotel not far from the statue of the Jasper Bear. After visiting the local museum, we took the Jasper Sky Tram up Pyramid Mountain and drove down to Medicine Lake. Moraine Lake was further down but we were planning to drive the Icefields Highway to Banff the next day.
We drove south following the Assiniboine River past Mount Edith Cavell, a WWI nurse who died in the war. We stopped at the Columbia Icefields and took a special bus to the top of the glacier. I noted that at the base of the glacier, they had signposts showing how much the glacier had receded since 1939. This was long before we had environmental concerns. We stopped at Lake Louise and I thought of my trip to the Banff Conference Centre so many years before. From there, we drove into Yoho National Park and into Emerald Lake. We looked at the 1100 foot waterfall that drifts down the rock face, the highest in Canada if not the World.
In Banff, we stayed in a smaller hotel near the downtown. We visited the Buffalo Compound and when I got out of the car to take a picture, I was warned that a Grizzly bear was coming up behind me. I managed to get into the car quickly and we waited for the bear to disappear. The next day we followed the Bow River to Calgary. We were booked into the Western International Hotel and as the weary travellers pulled up, we must have looked pretty bedraggled. However, once we were in our beautiful room and got cleaned up. We felt much better and went down for dinner. Again it was the height of luxury. The next day, we visited the Calgary Zoo and the Dinosaur Park. There were many things to see and we fell into bed that night. Then it was home. We drove to the airport, turned in the car and took the 5 hour flight to Toronto. It was a great holiday.
Juvenile and Family Court
I started a part-time appointment at the Family Court, 311 Jarvis St. on January 20th, 1967. The pay was $40 a session which was better than the $30 I was getting at other places. The psychiatric clinic had been set up a year or so before. In September the clinic was taken over by the Clarke Institute of Psychiatry so I was then on staff at the Clarke. The Chief of Forensic Service was my old friend, Dr. Ed Turner. I was then involved in seminars set up by the Ontario Legal Aid Plan for Legal Aid lawyers in the York Region. In November I proposed that I could set up some teaching sessions for probation officers, social workers and others who were working with families before the court. This proposal was greeted warmly by the Clarke and plans were made to move ahead. Unfortunately when I became Medical Director at Whitby, I felt it necessary to resign my post at the CIP. They were very disappointed.
While I was at New Toronto, Gary Cormack was Assistant Superintendent. Gary had no sooner got settled in at the hospital in the spring of 1966 when he was offered the position of Director, Psychiatric Services Branch. It was in the fall of 1966 that he called me to offer me the position of Director of the Mental Health Clinic at OH Whitby. A classmate of mine had quit in the summer and the clinic was closed down.
I had applied for appointments at two general hospitals but there were delays in processing. Finally after several months when they came through, I turned them down. My wife must have thought that I had become psychotic like my patients. Hence when Dr. Cormack called me I had to consider it seriously. I remember going out to Whitby several times before I decided to accept the appointment effective March 1st, 1967.
Notes:
1 All convulsive therapies depend on inducing a grand mal epileptic seizure. In those days no-one was exactly sure how it worked but it seemed to disorganize brain function and when the brain recovered and reorganized itself, depression was reduced and many other symptoms were reduced. It originated in Italy before the war and the seizures could be induced by drugs like metrazole or by electricity. Metrazole was soon abandoned because of its unpredictable results and in the post-war period, treatments used electricity – hence the name ‘shock treatments’.
2 Primipara: first pregnancy, first live birth.
3 At Woodcock’s trial in 1957 he was found ‘not guilty by reason of insanity’ and confined to the Oak Ridge Division of the O.H. Penetanguishine on a Lieutenant Governor’s Warrant (LGW).
4 Karl Rogers used what he called ‘client-centered therapy. The therapist is a blank slate and remains silent or reflects the patients’ thoughts, encouraging them to say more.