Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum forthe Insane,...

1 Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason(New York: Pantheon, 1965; New York: Vintage Books, 1988).

2 David Rothman, The Discovery of the Asylum: Social Order and Disorder in the NewRepublic (Boston: Little, Brown and Company, 1971); Andrew T. Scull, Museums ofMadness: The Social Organization of Insanity in Nineteenth-Century England (New York:St Martin’s Press, 1979).

3 Christopher Lasch, ‘Origins of the Asylum,’ in The World of Nations: Reflections onAmerican History, Politics, and Culture (New York: Alfred A. Knopf, 1973), 3–17.

The Canadian Historical Review 86, 1, March 2005

© University of Toronto Press Incorporated

DANIELLE TERBENCHE

‘Curative’ and ‘Custodial’: Benefits ofPatient Treatment at the Asylum for

the Insane, Kingston, 1878–1906

�

Over the course of the last three decades, the role and function of thenineteenth-century asylum has been widely scrutinized by scholars inte-rested in the history of psychiatry and social welfare. Interest in Victorianasylums initially swelled during the 1970s, largely in response to thesocial control theories proposed by Michel Foucault in Madness andCivilization.1 Foucault’s successors focused on the theoretical origins ofasylums as institutions for regulating insanity, thus opposing liberalnotions of the asylum as representative of human progress. Revisionistssuch as David Rothman and Andrew Scull viewed asylums as repressiveinstitutions that regulated human behaviour to suit the changing socialand economic environment during the early nineteenth century.2 Chris-topher Lasch believed that humanitarian efforts of nineteenth-centuryreformers created an environment where a preponderance of custodialcases was inevitable; the nature of social relations between staff andpatients and the strict regulation of daily activities meant patients learnedto function only within an institutional structure.3 To this extent thenineteenth-century asylum was understood as an initiative forcing thepoor, the feeble, and the insane into a social code controlled by themiddle class through institutional care.

By the early 1980s, historians working under the influences of theevolving social history movement began to question the legitimacy of therevisionists’ theoretically driven claims, advocating the need for studies

30 The Canadian Historical Review

4 Thomas E. Brown, ‘Dance of the Dialectic? Some Reflections (Polemic and Other-wise) on the Present State of Nineteenth-Century Asylum Studies,’ Canadian Bulletinof Medical History 11 (1994): 267–95.

5 Important contributors of this period include Anne Digby, Madness, Morality andMedicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge UniversityPress, 1985); Ellen Dwyer, Homes for the Mad: Life Inside Two Nineteenth-CenturyAsylums (New Brunswick, NJ: Rutgers University Press, 1987); Nancy Tomes, AGenerous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1850–1883(Cambridge: Cambridge University Press, 1984). Canadian studies include Mary-Ellen Kelm, ‘“The only place likely to do her anygood”: The Admission of Women to British Columbia’s Provincial Hospital for theInsane,’ BC Studies 96 (Winter 1992–3): 66–89, and ‘Women, Families and theProvincial Hospital for the Insane, British Columbia, 1905–1915,’ Journal of FamilyHistory 19 (1994): 177–93; Wendy Mitchinson, ‘Gender and Insanity as Characteris-tics of the Insane: A Nineteenth-Century Case,’ Canadian Bulletin of Medical History 4(1987): 99–117; id., The Nature of Their Bodies: Women and Their Doctors in VictorianCanada (Toronto: University of Toronto Press, 1991), chap. 10, 11; id., ‘Reasons forCommittal to a Mid-Nineteenth-Century Ontario Insane Asylum: The Case ofToronto,’ in Essays in the History of Canadian Medicine, ed. Wendy Mitchinson andJanice Dickin McGinnis (Toronto: McClelland & Stewart, 1988), 88–109; S.E.D.Shortt, Victorian Lunacy: Richard M. Bucke and the Practice of Late Nineteenth-CenturyPsychiatry (Cambridge: Cambridge University Press, 1986); Cheryl L. Krasnick, ‘“InCharge of the Loons”: A Portrait of the London, Ontario Asylum for the Insane in theNineteenth Century,’ Ontario History 74 (September 1982): 138–84; id., Moments ofUnreason: The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923(Montreal and Kingston: McGill-Queen’s University Press, 1989).

6 Charlotte MacKenzie, ‘Social Factors in the Admission, Discharge, and ContinuingStay of Patients at Ticehurst Asylum, 1845–1917,’ The Anatomy of Madness: Essays inthe History of Psychiatry, vol. 2, ed. W.F. Bynum, Roy Porter, and Michael Shepherd(London and New York: Routledge, 1988), 147–74; Laurence J. Ray, ‘Models of Mad-ness in Victorian Asylum Practice,’ Archives européens de sociologie 22 (1981): 229–64.

with a stronger basis in empirical research.4 Their criticisms resulted innew approaches to asylum study with scholars conducting detailedinvestigations of individual asylums. Avoiding revisionist images ofhelpless populations of custodial patients, these historians identified thepowers of families and patients to initiate committal, influence treatmentand act as agents in the implementation of asylum policies.5 To thisextent they re-examined patient treatment and stressed the importantsocial function that asylums provided to communities. Efforts to moveaway from social control perspectives also led these scholars to questionthe prevalence of chronic care as suggested by revisionists, arguinginstead for an image of the nineteenth-century asylum as an institutionthat served both short-term and long-term patients. Laurence J. Ray andCharlotte MacKenzie went so far as to subvert the custodial image of theasylum by demonstrating high rates of discharge in both public andprivate asylums.6

Benefits of Patient Treatment at the Asylum for the Insane 31

7 Geoffrey Reaume, Remembrance of Patients Past: Patient Life at the Toronto Hospital forthe Insane, 1870–1940 (Toronto: Oxford University Press, 2000), 248.

8 The years studied were chosen for reasons of administrative consistency. The year1878 was the first that the Kingston asylum operated fully under provincial jurisdic-tion; patients admitted between 1878 and 1884 entered under the same medicalsuperintendent, Dr William Metcalf.

While this dualistic model of the asylum has demonstrated diversityamong patient populations, the perception of ‘curative’ outcomes asinherently positive and ‘custodial’ outcomes as inherently negative hasnot changed significantly within the counter-revisionist framework. Thecause of this discomfort can be attributed to the linguistic and conceptualframework carried over from the revisionist studies of the 1970s. Despiteefforts to avoid the social control perspective over the last two decades,historians continue to interpret and evaluate patient treatment accordingto a dualistic ‘curative/custodial’ model, identifying asylums as successesor failures according to the rate at which they discharged patients. Aswith all binary language terms, this either/or logic is problematicbecause it does not present the complexities of mental illness and thesocial systems influencing the outcome of asylum treatment. Moreimportant, it creates a hierarchy whereby the ‘curative’ asylum is ideal-ized for its suggestion of the medical profession’s ability to triumph overthe biological realm; ‘custodial’ institutions, then, are viewed negatively,for they become representative of a point at which empirical knowledgehas failed. Conceptualizing asylum confinement in this manner hasmeant that asylums are not understood to serve a dual function, provid-ing both long-term and short-term treatment, nor are patients perceivedas agents with active participation in forming their asylum experiences.Geoffrey Reaume’s recent monograph, Remembrance of Patients Past:Patient Life at the Toronto Hospital for the Insane, 1870–1940, is one of theonly studies that identifies this gap. While Reaume argues that ‘chroniccare’ was the ‘most consistent feature’ of the Toronto asylum, he empha-sizes the variance in patient experiences and the strategies they devel-oped to cope with their confinement.7

To build on our understanding of the role of asylum care and itsbenefit to patients, this paper studies a selected group of 240 womenadmitted to the Asylum for the Insane in Kingston, ON, between 1878and 1884, examining the asylum’s treatment program during the latenineteenth century and its influence on the outcomes of committal.8 Anexamination of the moral treatment program will illustrate the forms ofhealth care and social assistance provided in the institution. A subse-quent discussion of the outcome of asylum treatment and the rates of


9 Patients’ records are contained in the female casebooks of the Kingston PsychiatricHospital Records in vol. 1, RG 10-292, Archives of Ontario (hereafter cited as AO). Allreferences to them throughout the paper can be found within this series. Althoughthe women used in this study were those admitted to the Kingston asylum between1878 and 1884, my analysis of their experiences in the asylum extends to 1906, whenthe records end.

10 This paper draws on research conducted for my MA major research paper. SeeDanielle Terbenche, ‘Rehabilitation at Rockwood: Women, Mental Illness and Asy-lums, Kingston, Ontario, 1878–1906’ (master’s thesis, University of Ottawa, 2002).

11 Between 1841 and 1850 the Toronto asylum was temporarily operated in a former jail.

discharge will demonstrate that Kingston’s moral treatment programfacilitated a ‘curative’ experience for many women patients; several wereconfined for short periods to convalesce from emotional breakdowns,puerperal depression, and poor physical health.9 Yet the therapy programprovided at Kingston also benefited the long-term care sector of theasylum’s patient population. By also accounting for this too-often for-gotten group, the paper offers a complex analysis of the asylum’s func-tion, questioning the role of moral treatment in the long-term care of thementally ill. While asylums may have failed to fulfill the overly optimisticexpectations of nineteenth-century physicians and social reformers,Kingston’s treatment program offered patients an alternative livingarrangement with care when all other options had been exhausted.10

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Rockwood, the Asylum for the Insane, was established in 1858 when theCrown purchased a thirty-five-acre estate in Portsmouth Village, justwest of the city of Kingston, ON. Built to relieve overcrowding at theKingston Penitentiary by creating a separate institution for the criminallyinsane, the asylum initially housed only twenty-four female patients inthe refurbished stables of the estate. In 1859, however, a new buildingopened spaces for up to three hundred patients. While Rockwood wasoriginally designated for the criminally insane, the province’s need formental hospitals meant that throughout the 1860s the Kingston asylumincreasingly accepted ‘lunatics’ from regional jails and the overcrowdedToronto asylum, eventually leading to its conversion to a general asylum.In 1877 the Province of Ontario purchased the Kingston asylum from theDominion government, marking its entry into the network of asylumsthat were forming part of Ontario’s social welfare system. The province’sfirst permanent asylum structure specifically designed for treating thementally ill had opened in Toronto in 1850.11 During the late 1850s andearly 1860s two smaller branches were added in Amherstberg (insouthwestern Ontario) and Orillia to alleviate overcrowding. Because the


12 Richard Splane, Social Welfare in Ontario, 1791–1893: A Study of Public Welfare Admin-istration (Toronto: University of Toronto Press, 1965), 205–6.

13 Ibid., 206. 14 Anne Digby, ‘Moral Treatment at the Retreat, 1796–1846,’ in The Anatomy of Mad-

ness: Essays in the History of Psychiatry, vol. 2, eds. W.F. Bynum, Roy Porter, andMichael Shepherd (London and New York: Routledge, 1988), 52–3.

15 The operations included a treatment for pleurisy, removal of an ovarian cyst, and anexperimental surgery to decrease seizures in a severely epileptic patient (Bridget T.

demand for treatment facilities continued to grow during the decade, thegovernment established a second asylum in London in 1870. Yet by themid-1870s, a critical shortage had again developed, leading AsylumInspector John Woodburn Langmuir to suggest a broad plan for futureasylum expansion in the province.12 The plan sought to provide extensiveaccommodation for chronic patients with a view to achieving the maxi-mum number of cures through early admission and treatment.13 Theresult of this plan was the establishment of an asylum in Hamilton andthe purchase of Rockwood in 1877. Although it was officially renamedthe Asylum for the Insane, Kingston, it continued to be generallyreferred to as ‘Rockwood.’

As was the case in the majority of Victorian asylums, the treatmentprogram implemented at the Kingston asylum during the late nineteenthcentury emerged from the theories of what became known as ‘moraltreatment.’ Developed in the early century from the ideas of PhilippePinel of the Salpêtrière in France and Samuel Tuke of the York Retreatin England, moral treatment was designed to provide a calm and struc-tured environment for the mentally ill. A combination of good nutrition,rest, work, exercise, and recreational activities promoted self-healing byenhancing self-esteem and building moral values.14 Reformers hoped to‘cure’ the insane by submerging them in a middle-class model of healthyliving. Equally important to moral treatment was the elimination ofinterventionist forms of therapy including physical and chemical re-straint, drug therapy, and surgery. Though Rockwood’s doctors contin-ued to use a variety of interventionist operations and medications, theydid so only when moral treatment alone proved insufficient to improve apatient’s health. Medications were generally administered to treatcommon physical illnesses developed in the institution, though the seda-tive hyoscyamine continued to be frequently used to calm extremelyviolent patients. Surgery was infrequently used because the Kingstonasylum’s administrators regarded it as a radical form of treatment thatshould not be considered until all avenues were exhausted; indeed, onlythree of the 240 women admitted between 1878 and 1884 underwentsurgical operations.15


#36, Mary Ann W. #181, and Sarah G. #171). These were not radical gynecologicalprocedures like those performed by Dr Richard Bucke at the London asylum. Fordiscussions of Bucke’s practices see Mitchinson, The Nature of Their Bodies, 334–55;Shortt, Victorian Lunacy, 141–56.

16 The province added 170 acres to the initial thirty-five acres by purchasing the neigh-bouring Jackson estate to the east (1878) and Ordnance land to the west (1880). SeeAnnual Reports of the Inspector of Asylums, Prisons and Public Charities (hereaftercited as AR), Ontario Sessional Papers, 1880 (no. 8), 38.

17 Rothman, Discovery of the Asylum, 138. 18 Patients housed in the exterior cottages were generally non-violent, requiring less

supervision.19 By the 1880s, the Toronto asylum’s property had been reduced from its original 100

acres to only twenty-six acres. This reduction made implementing work, exercise, andrecreational programs difficult and caused severe overcrowding. See Reaume,Remembrance of Patients Past, 6–8.

20 1880 (no. 8), 38–40, AR, Ontario Sessional Papers

The successful implementation of moral treatment partially dependedon the suitability of the asylum’s physical setting and structure. Follow-ing guidelines by proponents of moral treatment who believed asylumsshould be located in the countryside close to an urban centre, the Rock-wood estate was chosen for its proximity to Kingston, its lakefrontsetting, and its potential for expansion.16 This location allowed theinstitution to receive employees, services, and supplies from the city,while avoiding noise and crowding that was counterproductive to theaims of the therapy.17 A large property permitted the construction ofamenities such as exercise yards, a farm, a dairy, and vegetable gardens,as well as large cottages for patient accommodation.18 Respectively, thesefacilities provided resources for food and patient work therapy, andhelped the asylum avoid the overcrowding that became problematic inlarger institutions such as the Toronto asylum.19 The tri-annual evalua-tions conducted by the provincial inspectors, along with suggestionsmade by Rockwood’s administrators, resulted in continued expansionduring the last quarter of the nineteenth century. The various improve-ments ensured that Kingston’s physical setting incorporated all facets ofmoral treatment and the available living environment could contribute topatients’ potential for recovery.

According to standard regulations, Rockwood’s main building con-sisted of a central block and two four-storey wings: one for male patientsand one for female patients. The centre block contained the offices of themedical superintendent and bursar, the reception room, attendants’apartments, and patient dining rooms. Nearly all rooms were dividedinto separate ‘apartments’ of 1150 cubic feet, giving patients privateaccommodation, regardless of their financial position.20 As at the London


21 Cheryl L. Krasnick, ‘“In Charge of the Loons,”’ 147. 22 19 May 1878–28 Oct. 1884, Patient’s General Register, Kingston Psychiatric Hospital

Records, vol. 2, RG 294, AO. 23 Ontario Sessional Papers, 1880 (no. 8), 38–40, AR. 24 Since 1877, Metcalf had acted as a temporary replacement for Rockwood’s ailing

former superintendent; he was hired permanently in 1879. 25 Cyril Greenland, Charles Kirk Clarke: A Pioneer of Canadian Psychiatry (Toronto: Clarke

Institute of Psychiatry, 1966), 9–10.

asylum, which Cheryl Warsh describes as being free from a class-basedtreatment program, the Kingston asylum’s patients received the samequality of care, irrespective of whether they paid fees or were supportedby the province.21 Nevertheless, monetary contributions were made to theasylum in approximately 10 per cent of the cases in this study, either bythe patients or their relations; these payments generally ranged from$1.00 to $2.75 per week, depending on an individual’s ability to contrib-ute.22 The menus at Kingston also reflect this absence of a class system,with all patients receiving the same simple but nutritious meals. Dinnerwas the main meal of the day, typically consisting of boiled meat, avegetable, pudding, and bread.23 The inspector’s annual reports suggestthat Langmuir and his successor, W.T. O’Reilly, found the quality ofmeals and dining facilities generally good, though they periodically madesuggestions about the quantity and variation of food offered.

The physical setting and absence of a class system strengthened thequality of treatment available at Rockwood. Yet these aspects would havebenefited patients less if Rockwood had not maintained a competentstaff. At the top of the administrative hierarchy was the medical superin-tendent who, as both head administrator and physician, was responsiblefor managing staff, making crucial decisions on patient treatment, andreporting concerns and suggestions to the provincial inspector. A formerstudent of Dr Joseph Workman at the Toronto asylum, and involved inasylum administration since 1871, Dr William Metcalf was recognized byprovincial officials as having the required background to oversee theprovince’s newest asylum acquisition.24 In 1882 Metcalf’s friend andbrother-in-law, Dr Charles K. Clarke, joined him at Rockwood as assis-tant superintendent. Since Clarke was also educated under Workman, heshared Metcalf’s views of patient treatment and asylum operation. Theircommon perspectives allowed the two men to establish a strong founda-tion for moral treatment and a consistent approach to medicinal andsurgical therapies. After a patient murdered Metcalf in 1885, Clarkebecame head medical superintendent and continued developing thereform ideas the two men initiated during their partnership.25


26 Patrick J. Connor, ‘Neither Courage nor Perseverance Enough: Attendants at theAsylum for the Insane, Kingston, 1877–1905,’ Ontario History 88, no. 4 (1996): 257.

27 Metcalf to Langmuir, 1 Oct. 1878, Inspector’s Correspondence, RG 63 sub-series A-1,correspondence 6712, vol. 235, AO.

28 Connor, ‘Neither Courage nor Perseverance Enough,’ 257.29 In May 1880 an attendant received a warning after she abandoned her duties to visit

her sister, while in Jan. 1881 another was dismissed after previous warnings for fallingasleep on duty. See 1 Jan. 1880–22 Oct. 1889, superintendent’s journal, KingstonPsychiatric Hospital, RG 10-295, vol. 1, AO.

30 Instances of patient abuse are discussed only in relation to female patients. Thesuperintendent’s journals suggest that physical and verbal violence was more com-mon between male staff and patients.

31 General nursing programs were first established in Ontario during the 1870s. SeeGreenland, Charles Kirk Clarke, 10–11.

Management of the asylum’s attendants was an important aspect ofthe superintendent’s duties. At the bottom of the employee hierarchy,attendants were responsible for all aspects of patients’ daily care andwelfare. When Metcalf arrived in 1877 he was appalled at the condition ofthe attendant staff; many were harsh and unsympathetic towards patients,or too old to perform their duties properly.26 He quickly set aboutreplacing them with ‘young active men’ who would ‘best serve theinterest of the Asylum.’27 Government regulations further supportedimprovements to patient care by ordering superintendents to discontinueusing ‘non-attendant’ staff to perform additional duties supervisingpatients.28 Yet this policy meant that the supervisory duties previouslyperformed by these other staff were transferred to the attendants,increasing their already heavy workload. Rarely given holidays, someworkers resorted to abandoning their duties without permission in orderhave leisure time.29 Thus, while women attendants infrequently abusedpatients by physical or verbal assault, they periodically put patients at riskby leaving them unsupervised.30 Working conditions for attendants wereimproved somewhat in 1887 when Clarke implemented a two-year train-ing program for female attendants that provided certification in elemen-tary physiology, anatomy, general nursing of the sick, and nursing theinsane. Called the Rockwood Training School for Nurses, it marked theearliest attempt in Canada to provide formal training in the care of thementally ill.31 The program benefited patients by providing them withmore knowledgeable attendants whose job dissatisfaction was somewhatdecreased by professional recognition of their duties.

One means of reducing the number of staff required at the asylumwas to engage patients in daily labour as part of their treatment program.Since the nineteenth-century social purity movement valued industrious-ness as an attribute indicating a sound moral constitution, work was a


32 Mariana Valverde, The Age of Light, Soap, and Water: Moral Reform in English Canada,1885–1925 (Toronto: McClelland & Stewart, 1991), 18–20.

33 Ontario Sessional Papers, 1882 (no. 8), 35, AR, and 1885 (no. 11), 118, 122, AR.34 Ibid., 1885 (no. 11), 122. 35 Ibid., 1886 (no. 2), 94.36 Lloyd Francis, ‘Outdoor Work as a Remedial Agent in Insanity,’ Journal of Mental

Science 33, no. 143 (October 1887): 366. 37 Margaret C., #119. To preserve anonymity, all patients included in this study are

identified only by first name and last initial. File numbers are recoded according toorder of appearance in the casebooks. This coding system is adapted from that usedby Reaume in Remembrance of Patients Past, 4.

vital component of moral treatment.32 Though never forced, patients whowere physically able were encouraged to work in the morning and after-noon hours between meals. In 1881, seventy women worked at the asylum,representing 33 per cent of Rockwood’s female population; by 1884 thisnumber had increased to 210 women or approximately 70 per cent.33 Thislabour served a dual purpose for administrators and patients by reducingnumbers of paid staff and helping to control patients’ violent behaviour,and decreasing the use of physical restraint; Metcalf addressed its valuein his 1885 report, stating, ‘It is better for patients to work off super-fluous muscular energy by some useful employment than by wrestlingwith a muff.’34 Though Clarke acknowledged that it ‘taxes an ingenuity tosupply work that is at the same time useful and profitable,’ the provincialinspectors praised the Kingston asylum for its sound work program.35

The sexual division of labour meant that most women did not workoutdoors, although proponents of moral treatment believed the fresh airand exercise made outdoor labour the most ideal for procuring overallgood health.36 Working outdoors remained largely the sphere of men,and women patients were instead engaged in the asylum’s laundry,dining rooms, and kitchens. Women patients thus provided essentialdaily services to the institution by providing meals, tidy wards, and cleanclothing and linens. Because these chores were unending and alternativestaffing arrangements did not exist, female patients were given feweropportunities to participate in other activities during the day. To thisextent, the moral treatment program offered at Rockwood was a gender-ed one, designed for men and adapted to women. Despite their specificdisadvantaged position and the risk of injury that came with engagementin any type of labour, some women did not object to working at whatevertasks they were given or were able to perform. For example, Margaret C.worked in the laundry from the time of her admission in December 1881until she injured her hand and wrist in an accident with the clothesmangle.37 Ann M. was an exceptional worker in that she was elderly


38 Ann M., #9.39 W.A.F. Browne, ‘The Moral Treatment of the Insane: A Lecture,’ Journal of Mental

Science 10, no. 51 (October 1864): 317–18, 332–4.40 Ontario Sessional Papers, 1879 (no. 8), 40, AR. 41 Ibid., 1892 (no. 7), 76.42 Ibid., 1891 (no. 6), 98. 43 Adelaide W., #196.44 Dora Q., #170.

(aged sixty at her 1878 admission) and worked outdoors; asylum physi-cians identified her as ‘the most useful woman in the asylum’ for herinitiative in taking full charge of the dairy each day from ‘early till late,’ ajob at which she continued for several years.38 Such labour would havekept Margaret and Ann occupied, while they gained approval fromasylum physicians who saw industriousness as a sign of improvingmental health.

Engagement in work, however, was to be balanced with participationin recreational activities.39 At Rockwood, many ‘amusements’ were madeavailable for patients to improve their physical and mental health. Exer-cise programs were among the most important activities for femalepatients because they compensated for the decreased physical activitywomen experienced working indoors. Langmuir’s expressed concern in1878 that the absence of exercise for women was ‘the most serious defectapparent in the administration’ resulted in the construction of a boardfence around the rear yard so that female patients could spend severalhours a day walking outside.40 Specific programs were not implementeduntil 1890, when Clarke introduced daily ‘physical culture classes’ wherewomen participated in callisthenics put to music performed on theasylum piano.41 As with the issue of patient labour, Clarke was of theopinion that the classes had value ‘not only as a curative agent, but alsoin establishing a healthful discipline in the wards.’42 Some violent anddelusional women were therefore placed in the asylum’s exercise classesas a means of warding off their violent outbursts. Prior to beginning‘callisthenics, walking exercises and cold sponge baths’ in September1895, Adelaide W. was frequently excited and violent.43 Four monthslater, asylum doctors hoped to stop Dora Q.’s attacks on other patients byhaving her begin the ‘physical drill.’44 While Adelaide’s outbursts wereslightly reduced, the exercise had little effect on Dora, and she continuedto instigate physical altercations with other patients. To this extentexercise could be read as a harmless mechanism of control. While it maynot have always succeeded in improving mental health and troublesomebehaviour, at the very least the exercise programs provided additionalstimulation, reduced stress, and provided opportunities for socializing.


45 Both patients and staff participated in these groups. 46 The medical superintendent’s journal indicates that a boat was rented in the early

1880s and later purchased under the permission of the government.47 Clarke to O’Reilly, 10 Aug. 1886, file 6742, vol. 238, Inspector’s Correspondence, AO. 48 Warsh states that prospective attendants at London stood little chance of being hired

if they did not have musical skills. See ‘“In Charge of the Loons,”’ 166. 49 Greenland, Charles Kirk Clark, 11.50 Connor, ‘Neither Courage nor Perseverance Enough,’ 262; Greenland, Charles Kirk

Clark, 11.

Large-scale social events for patients were first organized in the early1880s. During the winter they included weekly dances, theatrical perfor-mances, and music concerts given by community groups or the asylum’sdrama and minstrel clubs.45 When snow-levels permitted, patients weretaken on sleigh rides around the city. Summer months were particularlypleasant for patients, because the good weather increased the variety ofavailable activities and provided opportunities to escape the confines ofthe wards. The availability of a steamship from the early 1880s meantthat most patients were taken for weekly trips around the lake.46 Patientsdemonstrating high levels of industriousness and good behaviour weretaken on annual excursions to local circuses and fairs off the asylumproperty; however, the importance of women’s labour likely madeadministrators more reluctant to allow large numbers of women to go onthese trips. A letter Clarke wrote to Inspector O’Reilly requesting moneyfor an 1886 circus trip states, ‘We would like to send male patientsworking on the farm and a few of the women.’47 Whatever the reason,the letter again suggests a gender bias and a second area in which femalepatients were less able to participate in outdoor activities.

The aspect of entertainment at Kingston that drew province-wideattention to the asylum, however, was its music program. Because musicwas a valued facet of moral treatment, the Ontario government andasylum administrators strongly favoured staff with musical training.48 Asuccessful amateur musician himself, Charles Clarke had an interest inmusic as a method of treatment that made him particularly attractive asan asylum superintendent; under his leadership, music became a centralelement of patient therapy at the Rockwood.49 Clarke encouragedpatients and staff to play the asylum’s various pianos and organs, and hisyearly expenditures for sheet music often reached $100.50 Expanding thetradition of inviting local church choirs to perform at the asylum, Clarkeinitiated the organization of an asylum orchestra and brass band whosemembers were a mix of patients and staff. In 1888 Rockwood hired Wil-liam Madill, a former army bandsman to conduct the band, making theasylum the first to hire a full-time music instructor. By the late 1880s


51 Ibid. 52 O’Reilly to Clarke, Jan. 1888, Inspector’s Correspondence, RG 63, sub-series A1,

correspondence 6742, vol. 238, AO. 53 O’Reilly to Clarke, 26 Mar. 1890, ibid.

Rockwood’s musical groups were well known throughout Kingston, andtheir performances became popular community events.51 Their renownalso gained the approval of provincial inspectors who brought adminis-trators from other asylums to Rockwood to showcase its performers. Forexample, in January 1888, Inspector O’Reilly brought the London asy-lum’s bursar to the ‘At Home’ because the bursar was a ‘swell’ musicianwho took an interest in asylum amusements.52 When O’Reilly later tookDr. Ross of the Hamilton Asylum to the March 1890 ‘At Home,’ he toldClarke that he wished ‘to have the Asylum trotted out a little,’ allowingRoss to ‘see all that there is as I think it will open his eyes.’53 This interestin the asylum’s programs suggest that Kingston may have had anexemplary role in the improvement of entertainment programs at otherinstitutions.

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Since the quality of the asylum’s moral treatment program placed itamong the best offered at contemporary institutions, an examination ofRockwood’s patients provides important insight into moral treatment’ssuccess in the rehabilitation of the mentally ill. To assess the suitabilityof the therapy for women, the remainder of the paper studies the out-comes of the 240 female patients, determining the asylum’s ability torehabilitate women and provide a solution to various social problems andforms of mental illness. To differentiate between the outcomes of thewomen and the effectiveness of moral treatment in helping them, thispaper divides their cases into three categories according to length ofcommittal. Making the observation that patients with minor breakdownsand illnesses generally spent less than two years in the asylum, short-termwill refer to those patients committed two years or less. Similarly, thecasebooks show that if patients were still confined after five years, theytypically remained there for long periods as a result of serious mental orphysical illness, or an absence of persons willing to assume responsibilityfor their care after discharge; for this reason long-term refers to patientswho remained in the asylum five years or more after their admission. Todifferentiate between the previous categories, medium-term will refer topatients with varying degrees of illness who were confined in the asylumfor between two and five years. Table 1 illustrates outcomes among thewomen admitted to Rockwood between 1878 and 1884, according to thelength of asylum committal.


54 David Wright, James Moran, and Sean Gouglas, ‘The Confinement of the Insane inVictorian Canada: The Hamilton and Toronto Asylums, c. 1861–1891,’ in The Confine-ment of the Insane, 1800–1965: International Perspectives, ed. Roy Porter and DavidWright (Cambridge: Cambridge University Press, 2003), 124, table 4.7. BecauseWright et al. measure length of time by number of months spent in the institution,comparisons between the Kingston and Hamilton asylums incorporate their monthlydivisions into the timeframes used here (for example, short-term = 2 years = 24months).

TABLE 1Length of Committal and Means of Leaving the Kingston Asylum

for the Insane, Women Patients Admitted 1878–1884

Length of Stay Number of Files* % of Total Files

Short-term 113 45.6

Discharged 82 33.1

Died 29 11.7

Transferred 2 0.8

Medium-term 27 10.8

Discharged 13 5.2

Died 13 5.2

Transferred 1 0.4

Long-term 108 43.6

Discharged 9 3.6

Died 40 16.1

Transferred 38 15.4

Remain in 1906 21 8.5

Total files 248 100

* Tabulations in table 1 are based on 248 patient files because 8 of the 240individual women were admitted to the asylum twice between 1878 and1884.

Source: 28 January 1878–28 October 1884, Casebooks – Female, KingstonPsychiatric Hospital, vol. 1, RG 10–292, AO.

The statistics at Rockwood reflect similar findings by David Wright,James Moran, and Sean Gouglas on lengths of committal at the Hamil-ton asylum during the same period. As evidenced in their work, Hamil-ton’s statistics show an almost identical number of short-term patients,with only a 5 per cent differentiation in number of medium- and long-term patients.54 Since both institutions evolved as general asylums within


55 Ibid. 56 Patient Mary Ann S. (file #152) drowned after jumping from the asylum’s wharf into

the rough, frigid waters of Lake Ontario in Nov. 1884.57 Reaume notes that cause of death is absent in 57 per cent of the cases at Toronto. See

Reaume, Remembrance of Patients Past, 226.

a decade of one another (Rockwood began accepting non-criminalpatients in the mid-1860s, while Hamilton was constructed as a generalasylum in 1875), both likely suffered from the transfer of chronic patientsfrom the Toronto asylum suggested by Wright et al.55 As mentionedpreviously, Kingston did not suffer the problems of overcrowding, so itcould house chronic patients for longer periods of time. The almostequal number of short- and long-term cases at both asylums meant theywere serving a dual function as short- and long-term care facilities.Administrators and physicians were thus in the difficult position oftrying to run a moral treatment program that procured improvement andrecovery for patients with minor illnesses, while also ensuring that thetherapy provided healthful living and enrichment to long-term patients.

The ability to achieve these goals, however, partly depended on thephysical health of individual patients and the extent to which illnessescould be eliminated. Deaths represented one third of asylum departuresat Kingston, with eighty of the 240 women eventually dying in the insti-tution. With the exception of one woman who committed suicide, thesedeaths were all caused by a decline in physical health, whether throughsickness or general debility.56 Because deaths occurred for a variety ofreasons, the records of these women do not suggest any specific patternsrelating to the length of time spent in the asylum prior to death. Theshort-term patients who died typically did so as a result of a specific phy-sical illness acquired before or shortly after entering the asylum, whilelong-term patients generally died after a chronic illness that caused theirhealth to gradually decline over time. Post-mortem examinations wereroutine following the death of a patient, with detailed findings recordedin the asylum’s post-mortem book and a ‘cause of death’ statementincluded at the end of the patient’s casebook file. As a result, causes ofdeath are available for most of the women in this study, although thestated cause frequently becomes ambiguous when read in context of thefull illness, which was often multi-faceted. It supports Reaume’s explana-tion for the number of unrecorded deaths at Toronto, which he attributesto unsystematic record-keeping and imprecise diagnoses.57

One quarter of deaths among the women occurred as a result oftuberculosis. Phthisis, as it was called, was one of the most commonterminal diseases during the late nineteenth century. The airborne


58 Mitchinson, The Nature of Their Bodies, 333. 59 Bridget C., #122. 60 Mary D., #23. 61 Eliza R., #3.

bacterial infection was particularly prevalent in hospitals and other insti-tutional facilities where high populations, combined with poor ventila-tion, facilitated its transmission. Because women spent more timeindoors without the benefit of fresh air, they faced a greater risk thanmen of contracting tuberculosis, offering another possible explanationfor Inspector Langmuir’s enthusiasm to establish better outdoor recre-ation facilities for women.58 Patients who contracted the disease followeda similar pattern of declining health. Though Bridget C. had good ‘bodilyhealth’ when she entered the asylum in February 1883, by the followingNovember she had ‘failed very much,’ was thin, and ‘confined to her bedpart of the time.’ An examination two weeks later revealed limitedexpansion of both lungs. By January 1884 she had ‘continued to fail,’ andwas ‘thin and weak’ with a poor appetite. Since she appeared ‘not likelyto live many hours,’ a priest was brought to offer the last rites, and shedied shortly after.59

Old age and general frailty were the next most prevalent causes ofdeath, together claiming approximately the same number of deaths astuberculosis. As the case of Mary D. exemplifies, these causes wereclosely related, because the frail and feeble were often elderly patients.When she entered the asylum in November 1878, Mary was seventy-eightyears old and suffered from senile dementia, constantly wanting ‘to roamthe ward and ... expose her person.’ Over the course of her sixteen-monthcommittal, her physical health gradually declined, until she died inMarch 1880.60 Similarly, Eliza R., a medium-term patient, had had fre-quent illnesses since her 1879 admission and died after four years of frailhealth and listlessness at age seventy-two.61

Epilepsy could lead to death at any age, though a patient seldom diedof the disorder directly, but rather as a result of physical injuries orstrokes occurring after several years of ongoing, severe seizures. Many ofRockwood’s epileptics were long-term patients whose families likely haddifficulty providing constant watch over relatives with the disorder,whose characteristic seizures often involved loss of consciousness andconvulsions. As there were few treatments for epilepsy during this periodand the few that existed were usually unsuccessful, patients sufferingwith this condition faced the constant prospect of injury from falling orbanging into objects, and risked exhaustion and stroke from the physicalexertion experienced during the attacks. Of the 240 patients studied, nine


62 Jane M., #28. 63 Mary Ann W., #162 and #181. Between 1894 and 1896 Mary Ann had between 204

and 324 seizures each year. The operation removed a portion of her skull to relievepressure on the brain. See note 15.

women died from complications associated with epilepsy. Patient JaneM. was partially paralytic when she was admitted to Rockwood in January1879, diagnosed with epileptic mania. In April 1882 a severe seizurerendered her temporarily comatose, and over the next two years heroverall health gradually declined until her death in early 1884.62 PatientMary Ann W. had also experienced seizures for three or four years whenshe was admitted to Rockwood in January 1883, and they continuedthroughout her long-term stay at Rockwood, despite physicians’ efforts totreat them with bromides and amyl nitrite. By 1894 they were so severethe doctors began charting their frequency, and in 1895 a surgicalprocedure was performed to try to alleviate the problem, but their effortswere in vain, and Mary Ann died of exhaustion in January 1900.63

Though death claimed a significant proportion of patients, it wasmore common for patients to be discharged. Generally, patients werepermitted to leave the asylum only after they demonstrated signs ofimprovement or full recovery. Since the patients most likely to recoverwere those suffering from less severe forms of mental illness, whichwere easier to treat with the available resources, the majority of dis-charges occurred among short-term patients. Yet discharge depended onnot only a patient’s improved health, but also the presence of family orfriends willing to accept responsibility for the patient’s continued care.The fact that over 40 per cent of the women in this study were eventuallydischarged from Kingston demonstrates the presence of social supportfor the majority of these female patients.

While the timing of discharge was sometimes determined exclusivelyby a patient’s family, more often the asylum superintendent contactedfamilies once there was evidence that the relative was recovering.Improved temperament, general cooperativeness, and good personalhygiene were all examples of behavioural changes that could lead todischarge. While the presence of these attributes did not guarantee fullrecovery, they suggested that a patient could begin re-integration into a‘normal’ life outside the asylum. Provincial regulations for asylumdischarges required an initial period of probationary discharge of at leastthree months, providing the option of removing patients from the King-ston asylum on a trial basis before deciding on a permanent discharge.Asylum superintendents did not apply for final discharge certificatesfrom the lieutenant-governor until reports from family or friends assuredthat the patient was able to function outside the institution.


64 Sarah L., #126.65 Warsh, Moments of Unreason, 97; Kelm, ‘Women, Families and the Provincial

Hospital for the Insane,’ 187. 66 Kelm, ‘“The only place likely to do her any good,”’ 73. 67 Catherine’s file suggests she was incontinent. See Catherine C., #102.

Family motivations for prematurely removing relatives from theasylum varied. In some cases, such as fifty-eight-year-old Sarah L., therequest for discharge was clearly an act of compassion. Admitted toRockwood in March 1882, Sarah developed erysipelas of the face threeweeks after her admission, which quickly led to further skin infections.By May her health was failing rapidly as a result of the development ofseveral abscesses on her back, legs, and hips. When Metcalf informedSarah’s family of the situation, they decided to remove her to their ownhome, where she died a few days later.64 The reasons behind other casesof early discharge are less clear; however, many families continued toinfluence terms of committal from outside the asylum. Cheryl Warshand Mary-Ellen Kelm have both noted that the importance of women’shousehold roles made them candidates for early discharge becauserelatives sometimes appealed for their release on the basis of familyneed.65 Families may also have requested early discharge in order to gaingreater control over their relative’s treatment.66 Catherine C.’s daughterrequested her mother’s discharge in October 1881 after only six weeks ofcommittal, though there had been no improvement in her violenttendencies or ‘unclean’ habits.67 It is possible that Catherine’s familyviewed the asylum as a temporary care facility during a time when theywere unable to assume the responsibility themselves. Whatever therelatives’ reasons for wanting her discharged, cases such as Catherine’sindicate ambivalent attitudes towards institutionalization. Indeed, thenegative societal perception of asylums made families continually wary ofdecisions surrounding committal and discharge.

Yet discharging patients with continued ill health was not commonpractice, and families typically waited until they were informed ofimprovements before removing relatives. Of the patients in this studywho returned home, over 90 per cent left Rockwood only when doctorsidentified them as recovered or improving. These women were typicallythose whose illnesses had an identifiable or suspected cause, and themajority of them (80.4 per cent) left Rockwood after a committal of lessthan two years. This pattern of short-term committal before dischargesuggests not only the presence of familial support, but also that themoral treatment program offered at the Kingston asylum served itspurpose for a large number of women by helping to relieve their symp-


68 Emiline T., #39. 69 Melina B., #245. 70 28 Jan. 1878–28 Oct. 1884, Casebooks – Female, Kingston Psychiatric Hospital

Records, vol. 1, RG 10–292, AO. 71 Mitchinson, The Nature of Their Bodies, 153, 297.

toms of mental illness. Such recovery was particularly common amongwomen suffering from emotional traumas and nervous breakdowns.When Emiline T. arrived at Rockwood in May 1879, she was melancholicand suicidal; however, by November of that year she was ‘industrious ...cleanly in her person ... cheerful and trustworthy,’ having improvedenough to be sent home with her husband on three months’ probation.In his letters sent to the superintendent, Emiline’s husband reported, ‘Iam happy to inform you that my wife Emiline is getting along very well.Her mind is alright and her bodily health improving. She sends her bestrespects to all.’ Her progress continued, and Emiline’s final dischargecertificate was granted on 23 February 1880.68

Like Emiline, Melina B. also suffered from melancholia, though inher case it was attributed to the demands of childbearing. Melina wasforty-seven years old with ten children when she entered the asylum inSeptember 1884. The jail doctor identified her as anaemic with a ‘pro-found change in nutrition,’ caused by ‘some mental anxiety of prolongedworry acting upon an insufficiently nourished brain.’ Though Melina’sfile indicates she never completely recovered her former self, after onemonth in the institution she was reported as ‘improving steadily underthe influence of tonics,’ being cheerful and working steadily. After eightmonths she was taken home on probation.69

The speed at which Melina improved was not unusual, given thecircumstances surrounding her committal. Puerperal mania (insanityattributed to childbirth) was a common diagnosis among female patients;of the women admitted to Rockwood between 1878 and 1884, puerperalcauses were identified as causing the insanity of fifteen patients (6 percent).70 Reading the records of these patients reveals that most had whatwould now be regarded as postpartum depression or psychosis. Thefrequency of puerperal fever and other childbirth complications causednineteenth-century physicians to attribute puerperal insanity to thephysical aspects of pregnancy and birth; the idealization of motherhoodas women’s primary social role meant that they often failed to recognizethe emotional and physical strain of caring for young children.71 Inreality, many women’s health problems dated back to the start of marriedlife and childbearing; lack of sufficient food and money often forcedmothers to go without in order to adequately feed and clothe their


72 Ibid., 61. 73 Delmia R., #139.

children, making nutritional deficiencies common.72 Even when awoman had a happy relationship with her husband, the daily toil ofdomestic labour could lead to mental breakdown, depending on theamount of work and the availability of food, money, and household help.Examination of the patient files suggests that these problems factored inthe illnesses of several women patients beyond those specifically identi-fied as puerperal cases. By offering proper rest, nutrition, and someopportunities for fresh air and exercise, Rockwood’s moral treatmentprogram gave many women suffering from breakdowns or mild depres-sion a much-needed break to renew their physical and emotional health.Most women with puerperal insanity were initially treated with irontonics to raise their energy levels, a practice that in some cases wassufficient to elicit recovery within a few months. Though several womenworked at the asylum doing domestic chores that were similar to thosethey performed at home, the work was undoubtedly less taxing: no childcare was involved, hours of work were limited by the asylum’s schedule,and chores were shared among patients and staff. For some, the routinecreated by regular work may have provided a sense of normalcy in anotherwise unfamiliar existence. Thus, the asylum’s program enabledwomen with minor illnesses to recuperate in a way that was impossiblewhen surrounded with the stresses of everyday life at home.

Unfortunately, when illnesses were severe, the treatment was not assuccessful in improving patients’ conditions. One puerperal case that fellinto this category was that of twenty-nine-year-old Delmia R., committedto the asylum 22 June 1882. Married with nine children, Delmia hadlikely given birth to a child every year since her marriage. Doctorsidentified her as a case of puerperal mania with mental affliction causedby ‘hard work and poor food together with family troubles’ after child-birth. Although Delmia had been insane six years and had threatened totake her husband’s life on several occasions, the final decision to commitcame after she became ‘cruel and heartless to her children,’ abusingthem and making several attempts to ‘destroy her infant.’ Throughouther thirteen-year stay at Rockwood, Delmia’s mental state remainedunchanged, and she continually vacillated between periods of quietcomplacency and noisy, violent behaviour. She was eventually trans-ferred to the Brockville asylum in February 1895.73

Like the majority of women transferred to other asylums, Delmia wasa long-term Rockwood patient at the time of her departure to Brockville.Of the thirty-eight women in this sample who were eventually trans-


74 This transfer included nineteen of the women in this study. 75 Records are not available for women transferred to Brockville and Mimico; Cobourg’s

records are currently restricted under Ontario’s Freedom of Information Act. 76 Four of the women transferred a second time were transferred in Feb. 1891 from

Toronto’s main branch to Mimico, as part of the readjustments at the time of theKingston Regiopolis closing. Population changes in one asylum evidently affectedpopulations in all provincial asylums.

77 Edgar-André Montigny, ‘“Foisted Upon the Government”: Institutions and theImpact of Public Policy upon the Aged; The Elderly Patients of Rockwood Asylum,1866–1906,’ Journal of Social History 28, no. 4 (summer 1995): 824. Montignydefines elderly as those over sixty.

ferred, thirty-five were not relocated until they had been in Rockwood forat least five years. Since these women probably had little chance of futuredischarge, administrators were probably less concerned with the poten-tial effects of disrupting treatment. Non-violent patients were preferredin order to minimize disruption in the new asylum. Transfers most ofteninvolved a mass relocation of patients to one asylum because of changesin Rockwood’s patient capacity or following the opening of a newinstitution. When the Regiopolis Branch of the Kingston asylum closedin February 1891, a large group of patients were transferred to theToronto asylum.74 Patients were also transferred after the opening of theBrockville (1894) and Cobourg (1902) asylums. Little can be said aboutthe final outcome for these women because it is difficult to trace theirrecords after transfer.75 Of the nine women whose files appear in theavailable records of the Toronto and Hamilton asylums, two wereeventually discharged, two died, and the other five were transferredagain.76 The situation of transfer patients, therefore, was similar to thatof Rockwood’s other long-term patients, because these moves implied acontinued stay within the Ontario asylum system.

What was the reality of asylum life for long-term patients? As theintroduction to this paper identifies, traditional discussions of ‘custodialcare’ have rarely considered long-term care as a form of treatment in itsown right. Since approximately one quarter of the women in this studyremained in the Kingston asylum for many years, to fully appreciate therole of asylum treatment in these patients’ lives it is essential to gain anunderstanding of long-term care. A number of women became long-term patients because they were homeless or there was no one able orwilling to care for them. In his studies of Rockwood’s elderly population,Edgar-André Montigny discovered that people with no immediate familywere over-represented among the aged population, a point similarlyreflected among the patients studied here.77 Minnie C., aged sixty, was ‘astranger picked up on the streets of Kingston’ in July 1881, having run


78 Minnie C., #99.79 Lavinia C., #24.80 Mary E., #32. 81 Mary M., #232.

away from her career with a theatre troupe in Seneca Falls, NY. Full of‘ludicrous’ delusions, ‘unable to take care of herself,’ and withoutrelatives or a home, likely she found that the asylum was the only optionavailable to her. Using her professional talent, Minnie quickly settled atRockwood, happily participating in the asylum’s music concerts.78

Similarly, sixty-five-year-old Lavinia C. entered the asylum in November1878 suffering from delusions determined to be the result of abuse froma drunken husband. Though she was not able to perform heavy labour,she nevertheless was ‘inclined to do all she [could] helping round theward,’ working diligently into her seventies. There can be little doubt thatregular work in the asylum gave her a sense of security she had not hadat home.79 For both these women, the activities provided by the moraltreatment program brought security and contentment to their lives thathad previously been fraught with stress, anxiety, and physical danger.

Instances of abuse and neglect like that suffered by Lavinia werecommon reasons behind the committal of younger women who enteredthe asylum without family support. Mary E. was given to wandering thestreets when she arrived at Kingston in March 1879, ‘believing she was aman.’ Suicidal and emotionally unstable, the twenty-year-old was foundto have been sexually assaulted ‘at the hands of a ruffian.’ With both herparents dead and no other relatives to assume care for her, Mary E.became a permanent resident of the asylum’s South Cottage.80 PatientMary M. also experienced abuse; however, in her case it was perpetratedby her own family in the form of neglect. Mary M.’s family committedher to the Kingston asylum in July 1884 after doctors declared herdelusional and ‘very much inclined to do her family injury.’ Mary M.claimed to hear voices threatening to poison her and believed someonewas trying to rob her and kill her husband. Although in September 1884Mary M. returned home with her brother on six months’ probation, shewas returned in December after being found ‘roaming the streets withinsufficient clothing upon her.’ Inspector O’Reilly received reports fromneighbours expressing concern for her safety because her brothersneglected her care. With no other person available to assume responsibil-ity for her, O’Reilly wrote to Metcalf, ‘There seems to be no other courseopen than to keep her in the asylum until she is thoroughly cured shouldthat event ever take place.’ Since Mary M.’s delusions and threats ofviolence continued, she continued to live at Kingston until her transfer toToronto in 1891.81


82 Owsei Temkin, The Falling Sickness: A History of Epilepsy from the Greeks to the Begin-nings of Modern Neurology, 2nd ed. (Baltimore and London: Johns Hopkins Press,1971), 364–66.

83 Adelaide W., #196, see note 43. 84 Mary Jane J., #51 and #223.

It was continuing illnesses like Mary M.’s that often resulted in long-term asylum committal, though it was not usually due to family neglect.More typically, committal came at the request of the family and stood asa formal acknowledgement of their inability to cope with the illness athome. Epilepsy was particularly problematic because, in addition to thephysical difficulties discussed previously, social interpretations of thedisease also influenced decisions to commit; epileptics were stigmatizedas morally degenerate, intellectually weak, and (at the extreme) demoni-cally possessed.82 Such inferences could result in the social isolation ofindividuals and their families. Thus, the extent to which family andfriends were able to tolerate the combined pressures of physical care andsocial stigma undoubtedly played a large role in their initial decision tocommit and later reluctance to have the relative discharged.

Yet epilepsy was a unique condition in that the seizures usuallyharmed only those afflicted with it. The majority of custodial patientsexperienced delusions and fits of physical violence that also threatenedthe welfare of others, meaning that their families faced physical dangeras well as social stigma. The files of many of these women suggest thatfamilies were often willing to cope with troublesome behaviour, so longas it remained an annoyance, rather than a serious threat. Committalusually came only after delusions escalated to acts of violence. AdelaideW., discussed earlier in the paper, was insane four years before relativesbegan the process of committing her to an asylum. Since she had avolatile temper that was accompanied by a ‘desire to burn things and ...have matches in her possession,’ doctors determined that Adelaide was‘not a safe person to be at large.’ She entered Rockwood in January 1884,where she remained until 1906.83 Similarly, Mary Jane J. was known fordisruptive and erratic behaviour that caused her to be admitted to theKingston asylum twice, first in November 1879 and again in May 1884.Mary Jane also had a ‘violent temper’ and was verbally and physicallyabusive towards others. She first left the asylum in May 1882 when herfather took her home on three months’ probation against the recommen-dations of asylum physicians. Though the father’s reports back to theasylum indicated that Mary Jane’s behaviour had not improved, he urgeddoctors to allow her to remain at home since she ‘[couldn’t] help it’ and‘[felt] sorry when ... quiet again.’ Eventually, however, her behaviourwould again prove too difficult for her family to handle, and within twoyears she was back at Rockwood, this time as a permanent resident.84


85 Ibid.

As might be expected, the problems of such patients did not stopupon entering the asylum; it is among these cases that aspects of moraltreatment also operated as mechanisms of institutional control. WhenMary Jane re-entered the asylum in 1884, her temper was ‘worse thanever,’ a fact made evident when she threw a bowl of soup at an attendantand developed a ‘fondness for throwing chairs about the ward.’ From thistime forward the asylum staff tried to channel her energies into usefulwork activities where possible, and in later years she spent time sewingon the ward. In Mary Jane’s case, however, the illness placed limits onher ability to participate in other forms of work and recreation.85 Never-theless, the ability to curb violent behaviour offered benefits to all sidesby preventing injury to staff, eliminating opportunities for antagonizingor harming other patients, and reducing the chances of the patientharming herself. So while patient files do not present a clear picture ofthe patients’ feelings about such mechanisms of control, these activitiesat least provided a means of avoiding chaos and ensuring physical safetythat could only be beneficial.

� � �

A conflation of events and influential people placed the Asylum for theInsane, Kingston, in an ideal position for implementing all the require-ments of a modern program of moral treatment during the last quarterof the nineteenth century. Much of the institution’s success can beattributed to its physical setting on the shores of Lake Ontario, the strongadministration provided by Drs William Metcalf and Charles Clarke, andthe extensive financial support provided by the Ontario government. Asone of the better-equipped institutions within the province’s asylumnetwork, Rockwood’s therapy program enabled many of its femalepatients to find relief from symptoms of mental illness. Though certainmechanisms of control were used, they were seemingly less oppressivethan former practices involving restraint and isolation. While not allpatients may have been willing participants, some were, and the methodsmost frequently used were designed to provide physical and emotionalhealth benefits. Without a means of maintaining security in the institu-tion, it would not have been possible to offer such an extensive range ofwork and leisure programs to patients.

Women who benefited most from their committal to Rockwood werethose suffering from emotional breakdowns precipitated by a distinctiveevent or brought on by an identifiable cause that asylum committal couldeliminate. For women who suffered from the stresses of child-bearingand child-rearing, asylum treatment provided a much-needed break to


get adequate sleep, sufficient food, and opportunities for recreation. Asthe paper demonstrates, however, it is important not to limit interpreta-tions of successful treatment to patients who were quickly discharged.Even when an institution offered the most modern facilities and therapyavailable, its ability to successfully treat patients was limited by theseverity of their illnesses and the social circumstances influencing theirexperience inside and outside the asylum. Since one quarter of thewomen in this study were long-term patients who received the samequality of care as those discharged, it is important to consider the role ofRockwood’s moral treatment program beyond the achievement of ‘cures.’As the cases of the custodial patients demonstrate, long-term care at theKingston asylum was an option when other alternatives were unavailable.Minimally, it provided security, food, and shelter to persons who had losttheir social support network through homelessness or the severity oftheir mental illness. While many long-term patients may not haveexperienced ‘curative’ benefits from treatment at the asylum, the abilityof the leisure and work programs to relieve their symptoms and reducethe frequency of violent outbursts suggests that it provided some benefit.The fact that several women willingly participated in labour and recre-ational activities suggests an acceptance of institutional life and theirdesire to develop a social role where they were able to do so.

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