Chapter Eighteen
A Job Offer
In October 1966 I got a telephone call from Gary Cormack, who had just become the Director of the Psychiatric Services Branch, in the Department of Health. I knew Gary from the UNTD and met him again as Assistant Superintendent at Lakeshore under Dr. Clinton Moorhouse while I was there. After a brief exchange of pleasantries, he urged me to accept the position of Director of the Mental Health Clinic at the Ontario Hospital, Whitby. My first reaction was positive. I had only been a certified psychiatrist for 3 years, and this would be a positive career move. It was followed by some very mixed feelings. I was happy in my job as Psychiatrist in the Mental Health Clinic at Lakeshore and hoped to stay there for a while. And what I had heard about Whitby was not encouraging. It was commonly regarded as a fossil from the past, the graveyard of any young ambitious psychiatrist’s career. But Gary was insistent. He said that a very progressive psychiatrist, Dr. Patrick Lynes had been appointed Superintendent, and he needed someone with progressive ideas to support him in the reform of the hospital’s programs.
I knew very little about the Hospital. There were some fourteen Ontario Hospitals in the system at that time. Three of them, the O. H. London, Toronto and Kingston were teaching hospitals. Hamilton was about to become a teaching hospital as the fledgling Medical School at McMaster was coming to life. New Toronto was an old hospital with a progressive reputation. It had just been approved to change its name to “Lakeshore Psychiatric Hospital”. Penetanguishine was different because of the Hospital for the Criminally Insane, which was also getting a name change to the Oak Ridge Division and a new Community Division had just opened. North Bay and Port Arthur had both been built in the early 1950’s (interestingly enough, to exactly the same architectural plan) and because of their remote location in Northern Ontario, they had chronic problems of professional staffing but were still seen as good hospitals. Three new “Community Hospitals” had been built in the 1960’s in Godrich, Owen Sound and South Porcupine near Timmins although it took 3 years to get a Medical Director for the South Porcupine Hospital. Then there were the three hospitals at Brockville, St. Thomas and Whitby!! They were seen as very chronic, non-progressive and everything that gave the old asylums a bad name.
For these reasons I might have refused the offer if Gary had not been a friend of mine, (and incidentally as the Director of the Psychiatric Services Branch he was also my boss). I remember telling a colleague that I was going to Whitby and having him say in a shocked voice “To Whitby? Why? I thought you were a pretty good psychiatrist!”
First Impressions of Whitby
At that time, Mental Health Clinics were usually located in hospitals but were under a separate Branch. Dr. Bill Henderson, a M.H. Clinic director in Ottawa had just been appointed Director. There were big changes in mental health and the Department was in the process of making the old Mental Health Branch into a Division. Gary informed me that that was about to change. Dr. Henderson was to become the Executive Director of the new Mental Health Division. By the time I started, I would be reporting to Dr. Patrick Lynes, Superintendent of the Ontario Hospital, Whitby not to the soon-to-be-phased-out Mental Health Clinic Branch.
I was invited out to the Hospital to see the clinic and meet Dr. Lynes. Pat had worked at Whitby after completing his training in psychiatry about 1960. He had then spent three years at the Peterborough Mental Health Clinic ending up as director. It would soon become the psychiatric unit at the Peterborough Civic Hospital. He had worked there with John Pratten, who was Superintendent at Kingston, and Ray Berry who was a psychologist, a planner and later, Director of the Program Development Branch, Ministry of Health.
The Whitby Clinic had functioned for several years under Dr. Tom Enright, a psychiatrist who had trained with m at Whitbye in Toronto. Tom had left in the summer of 1966, and although efforts were made to keep the clinic open, no new patients were being accepted and activities had pretty well wound down. Because it was the only service in that area which treated children, Pat Lynes was under tremendous pressure to get it going again.
On that visit, I met Jim Carson, a Social Worker, who, like me, was just being recruited for the Mental Health Clinic. Jim was about fifteen years older than I, had been in the Canadian Army in both the Second World War and the Korean War, and was a garrulous raconteur. He had tremendous energy. I had the feeling he could get things going just by determination. Sometime later, I discovered that his wife, Victoria was related to Victor Mueller who was married to a second cousin of mine. It was another of those complicated family circles. In my mother’s family, the ‘black-sheep’ uncle Harry had left his first wife Jessie who then went to Toronto to be with her family the Muellers and had died there. We kept in touch for many years but it faded when after his wife died, Jim moved to Hamilton, hoping to be closed to us. This was discussed in Chapter Two. Jim died some years ago.
Cars
Jim also shared my love of automobiles, especially classic or unusual ones. He would have a new or different car about every year or so. He had a Mercedes coupe when I met him, about a 1955 model as I recall. He then got a Ford Mustang – one of the original ones – which he loved until one day a transport ran over it on the 401. Somehow Jim wasn’t killed. He only got a few scratches, but the car was flattened. We all shared his grief. One time he almost persuaded me to buy a 1956 Bentley which he said was in excellent shape. I had at that time a 1958 Rover touring car and was having trouble keeping it in repair. When I found out that the parts for a Bentley were even more expensive than the Rover, I demurred. Jim died some years ago.
I had been driving the Valiant to Whitby from our home in Don Mills. Within Toronto the handling was acceptable but on longer runs on the highway I found that it did not track as well as the English cars that I had driven so much. I took it to the Plymouth Chrysler dealer in Oshawa and had it completely checked over. They found no problems so I had to accept that it just was that way. Meanwhile, my friend Jim had found me a 1966 Rover 2000, the updated model that was considered quite advanced for the day. Jim had even negotiated the price with the seller and when I phoned him to confirm the deal he asked me if Jim was my agent or dealer, he was such a hard bargainer.
We closed the deal and I went to pick up the car. It didn’t take long for me to conclude that this was the best handling car I had ever driven. It had a single overhead camshaft four cylinder engine and four wheel disc brakes that were fitted inboard on the de Dion rear end.1 This structure placed the differential on the frame, not on the axle thereby reducing the unsprung weight ratio so that it was well controlled over bumps.
Tracking was excellent with a front suspension that was pivoted on the firewall with steering rods coming back to the steering box also mounted on the firewall. It was fitted with radial ply tires at a time when they were new in Europe but unheard of in North America. It really outclassed the BMW 2002 that was its German contemporary.
I found a mechanic in Whitby who could work on English cars and he became my friend. He loved the Rover and did many things to help maintain it. Unfortunately over time I required increasing maintenance and I recalled saying that it was a beautiful car to drive but my garage mechanic got to drive it more than I did.
I also took the Valiant in to him to check the highway handling. He discovered that the caster and camber settings were off and he reset them. Because of the location of the dust and rust marks, he concluded that they had been set wrong at the factory. The car handled a bit better on the highway but not much.
The Mental Health Clinic Team
I accepted the job and planned to start on 1 March 1967. That was almost four months away but I had several commitments at Lakeshore P.H. which I had to wind down. During February, I spent every Wednesday in Whitby and met with the team which was being assembled. By the time I came full time, referrals were flowing in; we already had appointments booked, and were under way.
We hired a psychologist, Dr. Barry Jackson who was very interested in children. He later became Director of Psychological Services with the Durham Region Board of Education. Barry was also a clinical supervisor in Psychology for York University and we frequently had psychology students with us as well. I enjoyed working with students and frequently took them out with me to talk to Home and School groups or make presentations to the Children’s Aid Society. Everybody on the team was encouraged to do this kind of community service as much as possible. A public health nurse, Carol Servent had been hired to work both in and out-patients. Her office was in the clinic space and she often worked with the team.
All members of the clinic team were very active in community groups. We were active in the Oshawa CMHA, the Family Counselling Services, the Family and Children’s Services (Children’s Aid) and other groups. I gave talks to many groups around the area. I even offered a series of lectures on understanding mental illness. A few years later, we offered a 10 week course at Durham College that was well received.
I remember one such talk that didn’t go so well. It was to a Home and School group in Blackstock as I recall. I asked our current psychology student to present something on raising preschool children which was to be the topic of our presentation. She was not married, a very inexperienced child-raiser talking to an audience of battle hardened veterans. I sat in some discomfort as she tried to explain current psychological theories on corporal punishment and why it should not be used. The audience was growing more and more restless and finally I stood up and commented that the important thing was to show love and acceptance in everything you did with your child. From the back of the room came a sharp question: “Doctor do you ever spank your children?” As if in some sort of dissociative state, I vaguely remember answering: “I never spank them… …unless I’m so damned mad I don’t know what else to do.” That brought the house down. We somehow got out of there with our skins but not much else. But we were never invited back.
Carol had started a car pool with Mike Naughton, an engineer who worked at Dunlop in Whitby. They invited me to join. We would meet at a parking lot in Scarborough and take turns driving to Whitby. Mike was as Irish as Paddy’s pig and regaled us with stories. One story was the attempt to build a road in Ireland that involved removing a fairy tree. All attempts had failed; equipment broke down and finally they were giving up. The fairy tree had shown its power. I said: ‘Mike, do you believe in that stuff?” He turned to me and replied: “What do you mean ‘believe in’?”
He once described his work at Dunlop. He was testing tires to destruction, looking for weaknesses. At high speeds he said the tires could develop standing waves that were so hard on the fabric that the tire would often explode. He said: “Have you ever seen a square tire?” We tried to imagine it. I finally had to give up the car pool because I was busier and often late whereas Carol and Mike wanted to leave right on time. I lost track of Mike, but Carol and I remained close friends for many years after that.
The Mental Retardation Branch
Bill Henderson created a Mental Retardation Branch in the Mental Health Division. Prior to that, there had been two large facilities, the Ontario Hospital School at Orillia and at Smiths Falls that were part of the Psychiatric Hospitals Branch. A new director had been appointed, Don Zarfas who had reorganized the Ontario Hospital School in London into the Children’s Psychiatric Research Institute, known as CPRI. He went on a buying spree of any sites he could find that could be converted. Many of them were sites from the old Pine Tree Line – radar stations that were now obsolete with the development of the Distant Early Warning (DEW) Line, much further north. He turned an old military base in Picton into a retardation centre. Other facilities were being developed at the old Hospital for Epileptics at Woodstock. There were many meetings and great expansion of the system.
One day Carol came into a team meeting to say that she had wangled an invitation to one of Don’s acquisitions, an old radar base at Edgar, just west of Orillia. She persuaded the whole team to go along. The radar base had been built in the early 1950’s but it didn’t take long for the locals to realize that while it could give several hours warning to cities in the industrial heartland in the USA but less than half an hour to Canada, and with ICBMs that became only a few minutes. We met the staff and some of the residents. Don’s staff had found good uses for all the buildings but one. The Radar dome itself. The equipment had all been removed. Because the empty cavity did not even have a flat floor, it couldn’t even be used for storage. We never did find out what they used it for.
Simultaneously there was rapid development in services for these people. The name was changed from ‘mentally retarded’ to ‘intellectually handicapped’ and then ‘exceptional children’. Community centres developed all over Ontario with sheltered workshops and rehabilitation services. It was exciting to see what Don Zarfas had stimulated in a short time. It was only a couple of years later that we were approached at Whitby to develop a centre there.
‘Woodstock’ North
It was the ’60’s. Hippies and flower children were into drugs in a big way. And drugs were just entering the consciousness of the older generation. We got numerous requests to make presentations about drugs. After a while I had a stock presentation down pat. I always included alcohol in the list which did not sit too well with some of the parents. They would say “Why is my kid smoking marijuana and taking LSD? Why doesn’t he just drink beer like me?” A few months after I started at the Clinic, we learned that a big rock festival was planned in a farmers field near Pontypool. It was modeled on “Woodstock” in the US which was still very fresh in people’s memories. They called it “Strawberry Fields” which we presumed had been the original use of the site. After the festival, the road racing track at “MoSport” was built near the same site. We were asked to send some staff for the medical and support services. A couple of staff were eagerly recruited, but if they were expecting a lot of drug reactions and “bad trips” they were disappointed. Most of the problems were sunburn or food poisoning or insect bites. But I understand the music was pretty good.
I had vaguely thought of going myself. But when I mentioned it to Fran, my wife, she pointed out that we were taking the children to my mother’s cottage and family came first. I didn’t ask her if there were any other concerns. Oh well, during this busy time in my career, I did try to spend some time with my three boys. Peter was coming up seven, and Stephen and Richard (twins) were almost five. So I reluctantly informed them that I had a prior commitment.
Great Days for Community Psychiatry
It was a time of great expansion for mental Health. The report of a U.S. Congressional committee called “Action for Mental Health” stated that community mental health spending should be doubled. President Kennedy proclaimed mental health as a priority and funding was allocated, Ironically the first Community Mental Health Center only came on stream after his Assassination. By 1967 there were Centers all across the country.
In Canada, the Tyhurst Committee sponsored by the C.M.H.A. published its report “More for the Mind” in 1963. The expansion in community mental health and smaller hospital units was also increasing in Canada. Our clinic was only three years old. At the same time the Ontario County Health Unit was attempting to establish a mental health clinic in Oshawa.
Psychiatrists were in short supply. At that time Oshawa was a city of 80,000 and one of the largest cities in Ontario without any psychiatric services. There was one private psychiatrist in Oshawa, Dr. Norman Raskin, who was so busy that his waiting list was almost two years long, He mentioned to me a couple of times that he would take off for about a month each winter to some place down south where he couldn’t be reached. Often in the summer too he would be unavailable. He referred to this as his “mental health time”.
The catchment area of Whitby Psychiatric Hospital was Scarborough, East York, Leaside, half of North York, half of York County, Ontario County and Durham County (Ontario and Durham later became the Regional Municipality of Durham), and Victoria County. The population at that time was almost one million people, four hundred thousand of them outside of Metropolitan Toronto. And there were only four community psychiatrists, two in Newmarket, one in Oshawa and myself to serve them. Late in 1967, the Oshawa Mental Health Clinic hired a psychiatrist from down east, bringing the total to five.
I would venture that our clinic was quite successful in the two and a half years that I was there. In fact, acknowledging that there is a tremendous difference between an outpatient admission and an inpatient admission, with a staff of five (including secretarial services) we had 600 admissions to the clinic in 1968 when the whole hospital admitted just over 1200. We worked hard.
“An Army Marches on its Stomach”
There were two dining rooms at the north end of the main corridor in the Administration building. The one on the left was the Officer’s dining room where doctors, psychologists, social workers, and the chaplains had lunch. Senior nurses ate in the one on the right referred to as the Matron’s dining room. They always complained that they were segregated from the other professionals. Other staff either brought their own lunches or ate in one of the dining rooms in the two buildings in the center of the two rings of eight cottages where the patient dining rooms and kitchens were. A few years later one of these buildings was used by the new “Industrial Therapy” programme.
The Officers’ dining room had white table cloths and waitress service. Meal tickets were 50 cents but you could also buy a monthly card for $7 that gave you 21 meals. In 1961 there had been a similar arrangement at O.H. Toronto but new staff cafeterias had opened during the spring of 1961 so I was used to sitting wherever I saw a space. In the first month I had committed what must have seemed like all the cardinal sins.
Seating arrangements in the dining room were supposed to be flexible but in practice were rigidly adhered to. Once I unwittingly sat in the chair “reserved” for the senior chaplain. I was quietly informed of this by someone trying to be helpful, but not before the chaplain came in, and with a frown, sat somewhere else. I wondered if this would affect my future access to heaven. On another occasion I sat down at a table always used by a team from one of the in-patient units. Since I was the new boy in town, they took me on and I, still being young, innocent and believing in the basic friendliness of everyone, tried to answer their questions in a disingenuous way. It turned out to be a very uncomfortable lunch and I never sat there again.
There was a large patch of tall grass growing near a clump of trees on the edge of the cliff, near the lake shore. I loved to go for walks along the cliff at lunch time and I noticed in the tall grass patches where the grass was flattened down. These were quite unnoticeable from the road or the hospital and could only be seen when you waded right into the grass.
One morning as I drove into the hospital, I noticed that the tall grass was gone. There was one lawn mower still at work finishing the job. I was curious enough that I asked Pat Lynes about it. He told me that the Matron (now known as the Director of Nursing) Miss Vanessa Pickens, who lived on the grounds, had been out for her evening constitutional when she tripped over a copulating couple in the tall grass. Orders were issued. It always took me at least a month to get the Maintenance Department to do anything for me. Vanessa Pickens had the grass cutters out by 7 the next morning. It taught me that it is important to understand where the power in a hospital lies.
Daily Routines
We administered Electro-convulsive Therapy (ECT) on Tuesdays and Fridays in the east admitting wards (Female Admission unit). Sometimes we had an out-patient come in for ECT. The whole north end of the ward would be thronged with patients lying in beds, waiting their turn for ECT. Between 8 and 9 in the morning we would have treated 20 or 25 patients.
I remember a woman I saw in the clinic who was diagnosed as Manic-Depressive. She was so depressed she could hardly talk. She had also recently made a serious suicide attempt and her family was quite worried. I booked her for ECT two days later. When I arrived on the ward area to assist with the ECT, I could not find my patient in the collection of beds. Suddenly a voice shouted from the other side of the room, “Hi, Dr. Deadman, I’m over here!” This was my first experience with what we now call rapid cyclers. She looked so different in a manic mood that I did not recognize her.
ECT was quite a production. But because of the rather crude and debilitating procedures of the early days, it had acquired a bad reputation. Also the introduction of anti-depressant drugs had made it less necessary. I can remember five years later when I was Medical Director, debating whether we needed an ECT service because we only had 1 or 2 patients at a time and some weeks, none at all. Our anaesthetists came from the pool in Oshawa and soon they refused to come because there were not enough patients to justify the trip.
We then sent patients who needed ECT over to the Oshawa General Hospital and closed our service down. But our next Accreditation survey criticized us because as a Psychiatric Hospital we should have an ECT service. Finally one of our own physicians became qualified as a GP anaesthetist and we were able to start the service again. But the number of treatments remained low.
A Brief History of the Whitby Hospital
It almost seemed that there was an unwritten formula in the location of asylums. They were usually a few miles outside the town, but on a main road and with a quiet sylvan atmosphere on a body of water. The O.H. Hamilton was an exception, located on the edge of the escarpment, with a commanding view of the city. By 1911, the Hospital for the Insane, Toronto, was so outdated, overcrowded and dilapidated that a decision was taken to replace it. Besides, by this time, the growing city of Toronto had incorporated Parkdale and there were political concerns about locating a mental hospital within a large urban area. Its replacement was planned in the same way as most of the others, this time a little farther east of Toronto, in a pastoral setting near a small village (Port Whitby) fronting on Lake Ontario. Some 650 acres of prime farmland were assembled extending up almost to the town of Whitby itself.
Dr. J.M. Forster, the newly appointed Superintendent of the Toronto Hospital for the Insane was invited to participate in the planning for its long overdue replacement. The concepts of moral therapy2 were still important in the early years of this century, even though most people had not heard of it. The design followed a new concept “The Cottage Plan”. It tried to create a humane therapeutic milieu in the form of small villages for the mentally ill which would “normalize” their environment. Every service which any person, alienated or not, would require was to be provided in these new villages-cum-hospitals.
The plan for Whitby was ambitious. It was to be a complete town, with all the amenities that the inmates could need. It had admitting wards at the lake front, acute hospitals behind them for the very disturbed patients, a medical service in two large infirmaries towards the back, as well as an isolation hospital some distance away. The “residential units” were set up in two rings of eight cottages each, and there was a large farm – the “industrial therapy” of the time. As well, a School of Nursing was provided, and residences for the staff on the grounds. Because salaries in those days were abysmally low, one of the perks of the job was a house on the grounds at ridiculously low rents.
Construction started in 1912. Prisoners from Guelph Reformatory were brought in to build it. They camped out in tents in the farmers’ fields which formed the campus. The Chronic cottages and infirmaries were built first, completed about 1914. When the First World War broke out, there was much concern whether work should continue but it did, albeit at a slower pace. The acute hospitals (pavilions) were started next, as well as some of the smaller buildings.
In 1916, the Army appropriated the hospital for wounded soldiers returning from the trenches in France, many of whom suffered from post-traumatic stress disorder, then known as “shell shock”. The military built the new auditorium and gymnasium. The railway spur line constructed in 1912 for moving construction materials was now used for goods and returning troops. By 1919 all soldiers had been demobilized and a more permanent military hospital was established in the former Lieutenant-Governor’s residence, Chorley Park in Toronto.
In the fall of 1919 as the troops were moving out, the first official transfers of patients began from the Hospital for the Insane, Toronto. (It should be noted that Dr. Forster had brought some patients out in 1914 to help with the construction, but these were not considered transfers as the hospital did not yet exist.) When the official opening took place on 1 January, 1920, the hospital had already been in full operation for almost three months.
After the army left, construction ground to a halt. The political will seemed to be lacking. Dr. Forster used all his diplomatic skills to persuade the Office of the Provincial Secretary (there was no Department of Health in 1920, although one was created shortly after this) to provide funds to finish the admitting hospitals and administration building. When the funds finally came, they were inadequate to complete the original plan so a much smaller building, housing both the administration and the admitting wards was built. It was not completed until 1926. Complaints about the inadequacy of the structure began even before it opened, but it was not until 1959 that extensions to the admitting wards were completed. But that is another story. Despite these problems, the hospital was considered to be the latest thing in therapy for the mentally ill, and when the Annual Meeting of the American Psychiatric Association was held in Toronto in 1933, special tours were arranged so that delegates could visit it.
The overcrowded hospital at 999 Queen Street West in Toronto never was closed. The overcrowding was reduced somewhat, but it carried on. A new administration building with admitting wards was built along Queen Street in 1954, but the old original structure of 1850 (with the “New wings” of 1876) were not finally replaced until the mid-1970’s. Whitby got a new administration building and enlargements of the admitting wards in 1959 but otherwise remained the same. The (then) Minister of Health, Dennis Timbrell proposed a new hospital in 1977. After many studies, delays and bureaucratic muddles, construction actually began in 1993. At the time of the 75th anniversary celebrations, the name was changed to Whitby Mental Health Centre and more recently, the new complex was divested from the government and renamed Ontario Shores Mental Health Services. This is now a prominent and progressive treatment centre.
The Structure of an Old Mental Hospital
The Ontario Hospitals system had reached a peak by 1959. At that time there were about 420 patients per 100,000 population in Ontario. Staffing in all the hospitals was extremely short so that at Whitby there would be about 500 staff of all ranks for about 2000 patients. In the 1960s these ratios would change dramatically. By 1967 when I arrived there were about 1400 patients with a staff of over 900. By the time I became medical director in December 1969, there were about 1150 patients and the official complement of staff was 987. I remember the day when the morning report indicated that we had a 1:1 patient-staff ratio; the administrator and I went out for lunch to celebrate.
The hospital was organized in a rigid hierarchical pattern. I always imagined a dotted line up the centre of the main corridor of the administration building right to the north end of the campus, with the women to the right and the men to the left. It went between the two pavilions, between the two circles of cottages and the two infirmaries up into the lower fields of the farm somewhere near the pig barn (now long gone). Fraternization was actively discouraged. Men were to stay to the west, women to the east. It seems to me that the cows and pigs were probably also segregated.
20th Century Reforms
The Whitby hospital reflected the reforms after the First World War. After the Second World War the atrocities committed by the Nazis were so egregious that many minority groups began demanding change in their own countries. The mentally ill in Canada took on a civil rights agenda and demanded the closing of the old asylums. When the reformers got going, they convinced governments to adopt a policy of deinstitutionalization with proceeds of the closings going to community programs. It was assumed that a few general hospital units could care for those who needed institutional care.
There were other revolutions afoot. The old mental health legislation dated from the 1930s. In it two medical practitioners had to make out certificates stating that the person was suffering from a mental illness and was not able to look after him/herself. The hospital could not refuse admission and over the years there was massive overcrowding to the point that Whitby, designed for about 500 patients in 1920 had over 2000 in 1960. When I was there it had decreased to about 1400 in 1967 and with the help of all the staff we got it down to below 500 by the time I left in 1977. In some of the cottages, designed for about 30 patients there were as many as 120 in 1967. And staffing was so short that on the night shift, there might only be one attendant for two cottages. They spent the night doing rounds on one cottage, locking the door and going to the next cottage, repeating this all night. Conditions were terrible and by 1970 there were increasing demands to close all the mental hospitals.
There was a new Mental Health Act (1967) based on the legislation in the UK. It completely changed the old legislation to say that the persons presented a safety risk to themselves or others. Only one form was required and it specified that the persons must be examined at the hospital and admission refused if it was deemed that they did not meet the criteria. There were other revisions in 1976, 1977 and 1983 that tightened the criteria so much that many physicians were reluctant to make out certificates even when there was strong need for them.
In 1984, the American Psychiatric Association published a study entitled: “The Homeless Mentally Ill” that showed that most of the discharged patients were in jail or living on the street. The nice units in general hospitals didn’t want them and the community programs could not handle them. By 1990 this policy was shown to be a failure but many reformers would not admit that.
When things are taken too far, sooner or later there is a backlash. In 1990 Brian Smith, a reporter for TV station CJOT in Ottawa was shot in the parking lot by a man with a long history of mental illness who had been examined by a psychiatrist not long before and no certificate was issued. This created such a reaction that in 1995 amendments to the Mental Health Act called: “Brian’s Law” reversed most of the civil rights changes and imposed much stricter controls on discharged patients. There was an outcry from the civil rights groups but it did not change things.
I have gone into this in considerable detail because it is necessary for you to understand how bad things were in the mental health service when I first joined it. I worked at New Toronto from 1965 to 1967. I was at Whitby from 1967 to 1977 when much of this was taking place. The hospital seemed to stagger from one crisis to the next for all those years. I was usually late for supper at home and I am sure I complained a lot about all these problems. One day Fran told me that Peter had remarked: “Why does dad do that job if he doesn’t like it? The only answer I could give was that it had become a mission and that my father had told me that I was not a quitter. He also told me not to be a hack and that stuck with me all my days.
The Adolescent Program
It was 1968 and I was Director of the Mental Health Clinic. When I got in one morning, Dr. Lynes called me in to his office and showed me an article in the Globe and Mail. The minister of health had announced that adolescent programs would be set up in several hospitals and OH Whitby was one. We scurried to find staff and looked for adolescent patients on the wards. I was appointed as interim director and a senior psychologist with some adolescent training and experience was appointed to the unit. We had several nursing staff as well. We found a location on the grounds to meet and began setting up a program.
We set up a busy activities program. I remember that summer we took all the kids to Sibbald Point Provincial Park on Lake Simcoe. It was quite an experience because the funny little hospital bus would not accommodate all of the kids and staff so I wound up taking several kids in my car. At the park we swam and walked and explored the area. We organized many other outings that year. In the Fall, we were able to hire a psychiatrist for the unit and it took on a much more formal shape. But the psychiatrist and the psychologist had very different views on how things should be done and soon we had to intervene. Pat Lynes favoured the psychiatrist and the psychologist moved out. Later he was to take over the mental retardation program but that was a few years later.
I was much involved in the program and soon the psychiatrist and I were disagreeing. In the reorganization of 1972 we were assigned Cottage 6 and it was possible to move all the kids in together. Then the psychiatrist took another position and I was in charge again. I was medical director by this time so we hired a trained child care worker to work under my supervision. We went to the Thistletown Hospital that had been going through some crises of its own. It led to our decision to move from nurses to child care workers and this was done gradually over a year. At that point we hired Jim Ricks, a psychologist who had specialized in adolescent program design, and the program really took off.
A Significant Promotion
In November, 1969, when I had completely reorganized the clinic and done a few other tasks for the hospital such as chairing the Metrification Committee which introduced SI (the metric system) to the hospital, Pat Lynes called me into his office. He told me that he had just been appointed as Director of the Professional Services Branch of the Mental Health Division in Queen’s Park and would be going on final leave from the Medical Director’s job on 15th of December. Also in 1969 the old hospital superintendents were replaced by an administrator and medical director. Our new administrator was Mr. Ken Temple.
Pat was recommending me for appointment as the new Medical Director of the hospital. I was only five years in practice, had worked mainly with out-patients and felt quite unready to take on a large hospital with, at that time, about 1200 patients. I demurred and said that I was quite happy in the clinic, but Pat quickly pointed out that the only other possible candidates in the existing medical staff were within a few years of retirement. Further, he emphasized that the new winds of change blowing through the department would probably not accept a doctor from the old school and would look outside the hospital, if I did not accept the position. When I applied for the position I was invited in to meet the Director of the Mental Health Branch, Dr. Anthony Ives. Tony had been very instrumental in the dramatic changes in Saskatchewan’s mental health service in 1967 through 1970. I remember Tony’s words to me: “John, I want you to bring Whitby into the 20th century before the century ends”. That was my mandate.
At that time there were four in-patient units, two male and two female. The two male unit directors were Dr. Godfreid Kaszanowski and Dr. Edgar Citry. Dr. Bob Just and Dr. Ron Kay were in the two female units. As director of out-patients, in this discussion I was always ignored. It had always been my impression that the female units were more progressive than the male units but I was never sure if this reflected the nature of the patients or of the unit directors.
The Medical Advisory Committee was a study in psycho-politics. I became aware of a constant struggle between Pat Lynes and the old unit directors. Pat wanted to bring the hospital into the twentieth century which was already two thirds gone. Some of the unit directors considered that changing the position of ashtrays on the ward constituted a fairly major change.
Geographic units were being introduced in many hospitals. The so-called “Clarinda Plan” had been pioneered in upstate New York in the late ’50’s. The idea was that if each patient was treated on a unit with direct connections to the area in which they lived, return home was facilitated. There were few other psychiatric services in those days, so the unit’s outreach teams could provide continuity of care. The big problem in the old mental hospitals was that when a patient was admitted, contact with friends and family was lost and it became extremely difficult to reintegrate them into their communities. This meant unnecessarily long admissions and justified the motto over the door of one old chronic care facility: “Abandon Hope All Ye who Enter Here.”
The new hospital at Fort Logan near Denver Colorado was purpose-built for this plan and had become famous. I remember Pat talking about Fort Logan and introducing the plan at an MAC meeting. A real sticking point was that if each unit accepted patients from a particular area, they would have to take both men and women. According to the directors of the male units this would result in a dramatic increase in immoral and aggressive behaviour on the wards. The clincher was “We know what these patients are really like”.
Finally after a year of debate, the wards were “integrated”. The units of Drs. Kay and Citry were first. It also meant integrating the staff. In the old organization there were only male attendants on the male wards and female nurses on the female wards. Now they must work side-by-side on integrated wards. Many tribal practices would be abandoned. I really think it was harder on the staff than the patients. This was Pat Lynes’ major accomplishment.
Another of Pat’s accomplishments was the building of a new School of Nursing, a beautiful multi-storey building with classrooms on the main floor and accommodation for nursing students on the floors above. The old nursing school buildings that were in the middle of the grounds became accommodation for clinical staff who were not assigned to units.
Notes:
1Most cars in those days had a solid rear axle with the differential mounted on it. This increased the unsprung weight ratio so that bumps would cause the wheels to hop off the paved surface for a moment. This dould cause the driver to loose control. The de Dion rear end had the differential mounted on the frame above with two half-axles to the back wheels. This reduced the unsprung weight ratio considerably and the car handled beautifully over ridges and bumps. I remember that there was a hump backed bridge over the railway tracks near the hospital and in the Rover I could take it at a good speed without throwing the rear seat passengers against the ceiling.
2 Moral therapy (traitment morale) was introduced into the Bicetre and Salpetriere asylums in 1793 by Dr. Philippe Pinel, the newly appointed chief of hospitals in Paris. He is famous for striking off the chains of the inmates in the men’s asylum (Bicetre). The attendants opposed this, being afraid that they would be attacked but the inmates were so arthritic they could hardly stand. Pinel is a famous name in psychiatric history, particularly in French-speaking parts of the world. L’Institute national de psychiatrie legale Philippe Pinel, the large forensic hospital in Montreal is named after him.