HomeWriting the history of psychiatric deinstitutionalisation in Canada

Writing the history of psychiatric deinstitutionalisation in Canada

Écrire l’histoire de la désinstitutionnalisation psychiatrique au Canada

Joint Panel CSHM-CHA

Panel conjoint SCHM-SHC

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Published on Wednesday, May 23, 2018 by Céline Guilleux

Summary

This bilingual panel revisits recent historical research on psychiatric deinstitutionalisation in Quebec, Ontario, and Saskatchewan in order to examine how new findings have instigated transformations in historical work.

Announcement

Argument

The deinstitutionalisation movement that took place in Canada in the 1960’s aimed to get patients out of asylums and to establish social and community care for mental illness. It was a legal, scientific, and ideological process that became recently a dominant theme in the history of mental healthcare and a serious focus for historians. Historical studies, however, identified an absence of a real deinstitutionalisation. Using a variety of methods to examine dissimilar developments in each Canadian province, historians showed instead a dehospitalization movement. In other words, there was a massive discharge of Canadian patients from mental hospitals, but it did not result in the end of all institutionalisation. On the contrary, discharged psychiatric patients left asylums only to find themselves continually roaming between multiple healthcare institutions. Most institutions offered little in terms of social rehabilitation or community reintegration, and relied more on process that medicalized the problems and lives of former asylum patients.

This bilingual panel revisits recent historical research on psychiatric deinstitutionalisation in Quebec, Ontario, and Saskatchewan in order to examine how new findings have instigated transformations in historical work. To understand the complex and contradictory histories of the so-called deinstitutionalisation movement, historians must distance themselves from conventional scientific texts and institutional archives in order to build bridges between hospitals and communities, and among all stakeholders in mental healthcare (physicians, nurses, social workers, managers, psychologists, etc.). The benefits of interdisciplinary collaborations, including the use of cross-disciplinary concepts, methods, and perspectives, enable historians to illuminate and clarify both dehospitalization and transinstitutionalisation phenomena that have been obscured by the flag of deinstitutionalisation waved by activists, politicians, or legislators. Scholars on the panel employ reflexive stories about their methodologies to approach and understand their object of study. In so doing, we contribute to broader discussions about re-evaluating contemporary practices of writing of history—especially the history of psychiatry—and about contributions from other disciplines that are renewing historiography.

Organization

Organized by Alexandre Klein (Université Laval)

Chair : Susan Lamb

Programme

13:30:15:00 University of Regina

  • Following psychiatric deinstitutionalisation in Quebec in the long term. An historian and a sociologist at the Hôpital des Laurentides. Alexandre Klein (Université Laval)

We don’t know much about how psychiatric deinstitutionalisation took place in Quebec after it was inaugurated by the Bedard Commission in 1961. In histories of this famous public policy on mental health, it is often reduced to its legislative aspects alone. Recognizing that the implications of the Bedard Commission are far broader, I have teamed with sociologist Laurie Kirouac to investigate historical developments at l’Hôpital des Laurentides. This research is part of a bigger book project on psychiatric deinstitutionalisation in francophone contexts. In this examination, we retrace in specific terms how the new public policy was applied at this particular hospital, which was chosen as an experimental model for psychiatric sectorization by Jean Lesage’s government beginning in 1962. Focusing closely on l’Hôpital des Laurentides, we are able to re-examine how the policy was developed and implemented.

Our disciplinary association, between history and sociology, was initially aimed at cultivating a long-term study l’Hôpital des Laurentides between 1960 and 2012.We quickly noticed, however, that it provided us an opportunity to write a different history of psychiatric deinstitutionalisation in this hospital. Popular historical accounts tend to perpetuate the same story about an avant-gardist and pampered psychiatric hospital. Re-examination of verbatim transcripts from interviews with care givers working there between 1970 and 2000 (conducted between 2010 and 2013) provided another gaze on these events. Beyond the hopes and official ambitions advertised by the Bedard Commission during the 1960’s, our historical inquiry sheds light on the many concrete difficulties of implementing deinstitutionalisation. It also reveals the shortcomings of an under-funded and occasionally incoherent public policy with regard to local issues. We show how bringing together historical and sociological approaches allowed us to build up a more complete and complex portrait of the inauguration of psychiatric deinstitutionalisation policy in Quebec. Our paper re-interrogates our original collaboration in order to demonstrate how interdisciplinarity can be useful for historians in general, and how it could be employed to re-evaluate the historiography of Quebecoise psychiatry.

  • Diversity and Deinstitutionalisation: Doing History in Healthcare teams, Erika Dyck (University of Saskatchewan)

Mental health care shifted significantly in the second half of the 20th century.  It transformed from a system of custodial care to outpatient and community-based services.  The process that came to be known as deinstitutionalization, or the closing down of large psychiatric hospitals, occurred differently across the country.  It also transferred the focus of care away from hospitals and into diverse settings relying more on primary care teams and community services to fill gaps in care needs. Transferring people into a system of care in the community also revealed many non-medical factors required in mental health care. Tracing this historical shift in defining and designing mental health care in Canada engages historians in a study of diverse networks of care. In this presentation I explain how we created a team-based approach to researching and writing about deinstitutionalization in Canada.  Our co-produced book emulates some of the tensions, challenges, as well as the benefits of working together with diverse perspectives to solve complex problems. Our team congealed around the central idea that mental illness and poverty are intrinsically linked, and then we drew from our differences in experience, skill, and training to articulate a historical narrative that wove together input from ex-patients, psychiatrists, administrators, trainees, psychologists, and historians, sharing authorship.

  • "Imaginary and sensibilities". Narratives of psychiatric dehospitalization in Ontario, Marie-Claude Thifault (Université d’Ottawa)

Life course perspective, often presented as a theory by health professionals, is one of several approaches used as part of the collection, The End of Asylum? (PUR 2018) to account for atypical life trajectories in mental health patients whose psychiatric care is precipitated by family crises, social disruptions, suicide attempts or depressive episodes – which required admittance to institutional psychiatric care.

To illustrate the trans-institutional pathways of psychiatric patients in Canada’s national capital, we have compiled several decades of psychiatric follow-up interviews into a narrative. Rather than restricting our analysis to diagnostic-related behaviours or deconstructing a particular psychiatric episode, we documented the recurrence of psychiatric disorders and their many social consequences. The resulting narrative, centred around the lived experience of chronic mental illness of psychiatric patients and their loved ones, is original and rarely documented. This approach, influenced by the works of Corbin, is concerned with piercing "the secret of the behavior[s] of those who preceded us, at the crossroads of emotions and representations, of the imaginary and the sensibilities" (Demartini and Kalifa: 2005).

Hundreds of pages of records, including nursing observation notes and psychiatric evaluations, were consulted to craft the narrative of the psychiatric journey presented in The End of Asylum? These sources reveal the trajectory and turning points in the life of one woman, a patient of the Montfort Hôpital mental health program, over the course of twenty years. We relied on the observations and printed word of “experts” (nurses, psychiatrists, social workers) but also read between the lines of these reports to identify, and interpret, the silences (Bourgault: 2015). While our narrative is systematically researched, we also ask, is the historian free or not in shaping the story? What scientific value is accorded to texts that move away from the usual interpretative frameworks, traditional forms, and what place does historiography give to narrative frames or creative writing?

Places

  • Université de Regina - 3737 Wascana Parkway
    Regina, Canada

Date(s)

  • Monday, May 28, 2018

Keywords

  • psychiatrie, désinstitutionnalisation

Contact(s)

  • Alexandre Klein
    courriel : alexandre [dot] klein [dot] 1 [at] ulaval [dot] ca

Information source

  • Alexandre Klein
    courriel : alexandre [dot] klein [dot] 1 [at] ulaval [dot] ca

To cite this announcement

« Writing the history of psychiatric deinstitutionalisation in Canada », Study days, Calenda, Published on Wednesday, May 23, 2018, https://calenda.org/441366

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