So we left the asylums in a state of disrepair and abandonment. Social pressures that were going to emerge in the twentieth century would be the impetus for change. This was a time when psychiatry would begin it's bid to be seen like other medical specialties. This contributed in part to the shift of naming institutions as hospitals, rather then asylums. But also contributed to a desire to engage the public in understanding that mental disorder was something that could be managed by the appropriate medical specialty. Engaging the public in this was given a tremendous boost by the publication of a very influential book called A Mind That Found Itself that was written by Clifford Beers. Clifford Beers was a former patient in an asylum, and in his autobiography he detailed the abuses he had suffered during his time there. The public attention that this brought to the horrible conditions in the asylums led to the establishment of the mental hygiene movement in which medical professionals sought to educate the public about the biological and genetic basis of mental illness and developmental disorders and the importance of early detection, prevention, research and treatment. We're going to be looking at this period in mental health care history, by taking a look at the Canadian National Committee for Mental Hygiene. The Canadian National Committee for Mental Hygiene's origins were announced in the June 1918 edition of the Canadian Medical Association Journal, which described it, as poised to deal with, "Vexed problems of crime, prostitution, papalism and unemployment. Problems in which mental factors are of primary importance. It is also hoped, that the organization will be able through its influence, to be of assistance to the country in solving. Some the difficult problems connected with the return to civil life of the mentally abnormal soldiers as well as those raised by immigration. The images you're going to see in this section are from a training exhibition of posters and artifacts that they did to launch the organization across Canada in the early 1920's. The Canadian National Committee on Mental Hygiene was one of many mental hygiene organizations around the world similarly concerned with the prevention of mental illness, and to some extent, eugenics and the restriction of immigration. Most of these organizations would later abandoned these latter pursuits. Focusing on the promotion of mental health. And they would change their name accordingly. For example, this committee eventually became the Canadian Mental Health association. And these materials are held in the Canadian mental health association archives. That are now housed at the CAMH archives. If you ever have the opportunity, if you're around Toronto or are visiting Toronto. The archives of the Center For Addiction and Mental Health hold a lot of really interesting things that detail the history psychiatry. Particularly over the last 100 years or so. And I really recommend giving it a visit. And I want to thank the CAMH Archives for generously sharing these images for use in the course. So try to imagine that you are walking down the street, shopping in 1924, and you see a store window that is full of these placards. they were really taking this directly to the public, because they really needed to engage a public that had been disengaged around these issues. And some of the placards listed the names of influential people that just at the time that were behind this effort to, to To, put mental health and mental hygiene on the agenda. In their attempt to establish a sense of urgency in the public. They, pointed to issues like. The cost associated with hospitalization. The cost associated with policing. Because it was understood. Or they were presenting mental abnormality as related to rising crime in the cities. An then also, the costs associated. With clinics that treat disease. And, you have to consider. That we're talking about sort of an industrial area. Era of time. So, the cities were growing tremendously. there were. There were a lot of problems with crowding, disease, poverty. but what was happening here is that psychiatry decided to. Define these as problems that were associated with mental abnormality. And, really position themselves as able to manage them. I'm making this message that needed to be communicated to the public, that this was a new era of mental health treatment that changed from calling these places lunatic asylums to insane asylums had signaled less investment in spiritual or supernatural explanations for madness. But, the switch from asylums to hospitals really signaled the confidence that psychiatrists had that madness was like any disorder of the body and could be treated scientifically and effectively. So, when I look at these images, I try to imagine what message they wanted to get across to the public. On the left, there's clearly a message about the need for more hospitals, but I can't help thinking that there's also a message about how these hospitals will be kept far, far away from civilized society. As you will see, that the absence of these hospitals is going to be linked to threats in the communities, is going to be linked to threats to the community in the slides that come next. On the right, the sophisticated atmosphere of the mental hospital is presented as a counter-narrative to what was known then about the deplorable conditions of the asylum. Before the establishment of the Canadian National Committee on mental hygiene, members of the committee head toward the country and discovered horrible conditions. Together with the compelling testimony of Clifford Beers' book, it was clearly important to establish that the modern psychiatric hospital was not a place of abuse, neglect, or the kind of filth that had been described by Joseph Workman or by Clifford Beers. An image like this was meant to restore the confidence of the public. And perhaps to some extent to address some of the fear and stigma that prevented people who needed help from seeking it at that mental hospitals. In the next slide we get a glimpse of the kind of social problems that are mentioned in the announcement from the Canadican, Canadian Medical Association Journal. On the left, a mother identified as insane is the source of tragedy for her young family. And desperately needs treatment. On the right, a woman described as mendably, mentally abnormal is producing illegitimate children who are likely to be mentally abnormal as well. These and other images in the exhibit reinforce a connection between mental health problems and social disorder. You've hopefully also noticed by now that at the time intellectual and developmental disabilities were still being gripped together with mental disorders unto the spectrum of mental disease and abnormality. As we move on these images of slavin leek conditions do to feeble mindedness and on the left alcoholism as well so you'll see that there is a. Bottle there. This person is asleep, and if you look very carefully there is a baby on the floor. they're presented in a way that doesn't allow you to remain neutral. Remember that the asylums kept these problems far away from the public. What the mental hygiene movement wanted people to understand was that the public was no longer protected from this. The assertion on the right, that these people need to be under supervision, hints at the suggestion that the public needs to support initiatives to remove these problems from their neighborhoods. All of the previous images focused on adults and the consequences they created for their families, but you will see there's also an interest in the mental health of children. In fact, as you'll see in the next few slides, examination and screening of children was a large thrust of mental hygiene activity. This young man is described as people-minded, and anti-social, and big trouble because he likes to steal cars. It's nothing that as they say a firm colony won't fix though I can't imagine putting this little cutie into a firm colony. Psychiatry was positioning itself as useful beyond the walls. Mental hospitals. So situations like these could be helped by appropriate consultation to child welfare services and social services. As a side note, the growing importance of psychiatry was important for other fields like social work as well. Their growing conviction that there were scientific solutions to social problems would have a great influence on the practice of case work by social workers at the same and that would would be a great boom to the development of that profession too. So having identified the problems, what solutions were proposed by early twentieth century psychiatrists? Certainly early identification was key. There was a lot of optimism about the possibility of preventing mental disorder, so the idea that psychiatrists should be let into classrooms to identify future problems seemed promising. Although the psychiatric armamentarium was still pretty small there was a belief that the methods available at the time some of which were very similar to moral treatment of the previous entry could make a difference. So the possibility that there were children with mental abnormalities in every classroom was alarming as suggested here, but manageable. Insanity could be prevented. Feeble mindedness could be controlled and mental health could be promoted for all of these children. Part of presenting psychiatry as a scientifically based specialization. Required the field to look more like other medical sciences. Although the anti psychiatry movement wasn't really going to arrive for another 30 years or so, there was already. There were already those that were highly skeptical of the knowledge base of psychiatry. Hence this classification of, four types of mental deficiency. And four types of insanity. Is used to suggest that the field has advanced to a point where it can classify disorder. With reliability and validity. You will see that the terms used to describe, these sub types of disorder reflect. Noseology of the time and of course reflects some of the work by European psychiatrists who were much further ahead with this scientific approach to mental illness largely due to the work of phillipeanel who I mentioned in the last segment. In the late 1800s. You will see that they imply that there are specific treatments available for each type of disorder. Bear in mind that although the asylums are now called hospitals, they, they still need to deal with the public that believes them to be. Places that are ineffective in treating the mental ill, mentally ill. So this is, kind of assertion is very important. The type of science that could be offered at the time was still fairly limit, limited. But much of what the mental hygiene movement was hoping to stimulate was interest in investing in research to develop better screening and treatment. Some of what we see here should be familiar from the sick documentary that you saw earlier in the lecture. Here we're just looking at a research. Facility. But over on the right, we see the slides depicting settings for hydrotherapy, over here. Which had patients sitting in lukewarm water to keep calm. light therapy, I think these are actually both hydrotherapy but, they had light therapy to treat depression, and electrotherapy which, was not the same as electro-convulsive therapy that would come later. These are electrotherapy machines down here. and, they are actually used for the restoration of muscle tissue, and may have been used for treating wounded soldiers. The next slide is depicting farm work and drill exercises, treatments for mental abnormalities. Should remind you of the moral treatments that was done in the asylums. I'm particularly struck by how the work of the so called feeble minded, to reclaim farmland, is presented as useful to them, and also useful to the community. This is, of course, more unpaid labor by patients. The drill on the right. Continues the tradition of using exercise as treatment of men, mental illness, calisthenic exercises may seem particularly appropriate given that there were a significant number of patients at the time that were ex soldiers and of course, they would have been familiar with drill. Now, here we have what is being promised as the outcome of this new enlightened scientifically derived treatment. On the left. We are presented with a home for the feeble minded. And the cost savings that were realized by having them build it themselves. Of course nothing new about having patients build the place that their going to be kept. On the right, the emergence of occupational therapy. With the claim that it will prevent mental deterioration and cure mental illness part of the exhibit was a display of materials that had actually been produced by patients as part of their occupational therapy. although the picture on the left is talking about the need for places to house patients who are unable to live outside of institutions, the promotion of occupational therapy was linked to treatment in the immediate moment and the future livelihood of patients who they hoped would be cured and able to leave the hospital. In this sense it was actually a very optimistic time. So, things were going to get her. It seemed, at least for a little while. If you want to get a sense of how mental health was being dealt with then, and how it was being portrayed to the public. I recommend you go to the resource section, and check out the, the public service film. I think it's called Mental Health Treatment in the 1950s, or the Mental Hospital in the 1950s. Because there, you get a real picture of the kind of problems that they were sort of saying they could deal with, and how they dealt with them. And it's sort of pre-, it's a bit sanitized, in the sense that, of course, they. They were other places that you could go and see betrayals of the hospital that were much less flattering. So for example, I saw a movie just a couple nights ago called Autumn Leaf, starring [LAUGH] Joan Crawford and Cliff Robinson. And I know it sounds funny that I'm bringing in this film, but they, the, the, the thing is that somebody in that film ends up going to a psychiatric hospital. And, they, they certainly portray it as a positive outcome, but the portrayal of the treatment itself is quite harsh. So this is where a lot of people got their ideas about what ECT is like and all that sort of thing, but. And after those harsh treatments, we also see him engaging in psychotherapy, and engaging in occupational therapy. And getting much better. And able to return to the arms of Joan Crawford later. So that's a 1956 film. Which is interesting, because things really started to change around then. They changed quite dramatically. So where we're going next is to the middle of the twentieth century to take a look at how the changes in the surrounding social environment began to have a real effect on what was happening inside mental hospitals.
